Objective To summarize the experiences of the surgical management for adult patients with aortic coarctation. Methods Clinical data of 40 adult patients diagnosed with aortic coarctation undergoing surgical repair in our center between July 2004 and March 2015 were retrospectively analyzed. There were 28 males and 15 females with a mean age of 26.3±11.0 years (ranging 16-57 years). We evaluated the effect of surgery by the change of pressure gradient between upper limb and lower limb, mechanical ventilation time, and length of ICU stay and hospital stay. Results Forty surgeries were finished successfully. One patient died after surgery. The follow-up ranged from 12 to 36 months. The mean pressure gradient reduced significantly after surgery. There were 6 patients suffering blood hypertension at their discharge, and all of them still need antihypertensive drugs. Conclusion Surgical repair is an effective treatment for adult with aortic coarctation. Extra-anatomic ascending-to-descending aortic bypass and concomitant repair of intracardiac anomalies is safe and effective.
ObjectiveTo compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH).MethodsClinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group).ResultsFinally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P＞0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P＜0.001).ConclusionThe mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.
Objective To analyze the feasibility of bidirectional Glenn procedure (BDG) in treatment of adult congenital heart disease (ACHD). Methods From December 2004 to December 2015, 42 ACHD patients received BDG in our hospital. There were 23 males and 19 females with a mean age of 24.6±8.5 years (range: 18 to 49 years). There were functional single ventricle (FSV) in 14 patients, Ebstein’s anomaly in 11, corrected transposition of great arteries in 7, transposition of great arteries in 5, double outlet of right ventricle in 3 and tricuspid atresia in 2. Twenty patients suffered moderate or severe atrioventricular valve regurgitation (AVVR). Half of the patients were operated upon with cardiopulmonary bypass (CPB) and the others with off-pump coronary artery bypass grafting (OPCABG). Thirty-four patients underwent unilateral BDG shunt and eight bilateral BDG shunts. Concomitant procedures included correction of Ebstein’s anomaly (7 patients), atrioventricular valve replacement (7), atrial septostomy (3), ligation of patent ductus arteriosus (3), ligation of major aortopulmonary collateral arteries (2), correction of total anomalous pulmonary venous connection (1) and mitral valve repair (1). Results The early operative mortality was 9.5% (4/42). FSV and moderate or severe AVVR were risk factors for BDG in ACHD. Early postoperative oxygen saturation increased from 78.8%±11.2% to 89.3%±6.6% (P<0.05). The follow-up time was 6-132 (41.4±33.1) months. There was no death. The heart function improved (2.7±0.5 vs. 1.9±0.4, P<0.05). Conclusion The BDG shunt can be applied to ACHD. Although the early mortality is relatively high, the middle- and long-term results are satisfactory. The oxygen saturation increases and the heart function improves. The life quality of patients will also improve. FSV and moderate or severe AVVR are risk factors for BDG in ACHD.
ObjectiveTo analyze the causes and preventions of stent graft induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection, particularly from the standpoint of biomechanical behavior of stent graft. MethodsSINE was defined as the new tear caused by the stent graft itself, excluding those arising from natural disease progression or any iatrogenic injury from the endovascular manipulation. Twentytwo patients with SINE were retrospectively collected and analyzed out of 650 cases undergoing TEVAR for type B dissection from August 2000 to June 2008 in our center. An additional case included was referred to our center in 14 months after TEVAR performed in another hospital. ResultsTotally, there were 24 SINEs found in 23 cases, including SINE at the proximal end in 15 cases, at the distal end in 7, and at both in 1, and 6 patients died. The incidence was 3.4% ( 22/650) in our hospital, and the mortality was 26.1% (6/23). All 16 proximal SINEs was located at the greater curve of the arch and caused retrograde type A dissection. All 8 distal SINEs occurred at the dissected flap, and 5 of them caused enlarging aneurysm while 3 remained stable. All 23 cases had the endograft placed across the distal aortic arch during the primary TEVAR. ConclusionsSINE is not rare following TEVAR for type B dissection, and associates with a high substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is of significance to take the stressinduced injury into account during both design and placement of the endograft.