Abstract： Objective To optimize surgical treatment for children with patent ductus arteriosus （PDA） and mitral regurgitation （MR） and evaluate its midterm to longterm outcome in terms of MR. Methods Between Jan. 2008 and Jan. 2011， 25 children with PDA and MR underwent surgical treatment in Shanghai Children’s Medical Center. There were 14 male patients and 11 female patients with average age of 26.36±40.75 （1.72-142.83）months and average weight of 8.98±6.85 （3.80-36.00） kg. The average diameter of PDA was 7.84±3.10 （3-15）mm. There were 22 children with duct-type PDA and 3 children with window-type PDA. There were 5 children with severe MR， 18 children with moderate MR， and 2 children with mild MR. Except one child with mitral stenosis who underwent PDA ligation plus mitral valvuloplasty supported with cardiopulmonary bypass， all other 24 children only underwent PDA ligation through left posterolateral thoracotomy without any management for the mitral valve. Results There was no in-hospital death. The average ventilation time in ICU was 6.70±4.39 （3-24） hours. Except one child was reintubated because of asthma， all other children recovered uneventfully without any postoperative complication. All the 25 children were followed up for 329.23±288.39 （29-967） days. During follow-up， 23 children （92.00%） had their MR level ameliorated in different degree. Preoperative severe MR in 5 children changed into moderate MR in 2 children and mild MR in 3 children. Preoperative moderate MR in 16 children changed into none MR in 5 children, trivial MR in 5 children and mild MR in 6 children. Preoperative mild MR in 2 children changed into none MR in 1 child and trivial MR in another child. Two children with preoperative moderate MR had no improvement during follow-up. Conclusion For infants and children with PDA and MR， conservative treatment strategy should be carried out. Simple PDA ligation can provide satisfactory clinical outcome， which may also avoid negative complications including myocardial injury caused by cardiopulmonary bypass.
Objective To assess the application value of 3-dimensional(3D) printing technology in surgical treatment for congenital tracheal stenosis. Methods We retrospectively analyzed the clinical data of preoperative diagnosis, intra-operative decision-making and postoperative follow-up of four children with congenital tracheal stenosis under the guidance of 3D printing in our hospital between February 2013 and May 2014. There were 3 males and 1 female aged 23.0±7.1 months. Among them, two children were with pulmonary artery sling, one with ventricular septal defect, and the other one with tetralogy of Fallot. The airway stenosis was diagnosed preoperatively by chest CT scan and 3D printing tracheal models, and was confirmed by the help of bronchoscopy under anesthesia. During operation the associated cardiac malformation was corrected firstly under extracorporeal circulation followed by tracheal malformation remedy. The design and implementation of tracheal operation plans were guided by the shape and data from 3D printing trachea models. There were two patients with long segment of tracheal stenosis who received slide anastomosis. And the other two patients were characterized with tracheal bronchus, one of which combined ostial stenosis of right bronchial performed extensive slide anastomosis, and the other one performed end to end anastomosis. Results All the children’s preoperative 3D printing trachea models were in accord with bronchoscopy and intra-operative exploration results. Intra-operative bronchoscopy confirmed that all tracheal stenosis cured completely. All anastomotic stomas were of integrity, and all the luminals were fluent. There was no operative death or no serious complication. During 1-2 years follow-up, all patients breathed smoothly and their airways were of patency by postoperative 3D printing trachea model. Conclusion 3D printing can provide a good help to congenital tracheal stenosis in preoperative diagnosis, the design of operation plan, intra-operative decision-making and manipulation, which can improve the operation successful rate of tracheal stenosis.