Abstract： Objective To summarize our surgical experience of tetralogy of Fallot（TOF） with anomalous coronary artery（ACA）， explore diagnostic method of ACA， and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract（RVOT） reconstruction. Methods From January 2004 to January 2010， 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years （5 months to 33 years）and median body weight of 18 （5 to 51） kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement， repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation （REV） technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above， below or beside coronary arteries （single patch or two patch technique）. Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results The median cardiopulmonary bypass time was 78 （65-102） min， median aortic crossclamp time was 50（40-82） min， and median operation time was 150 （126-178） min. There was no early death or severe coronary artery injury. Two patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 （21-83）months and there was no late death during follow-up. All the patients were in New York Heart Association （NYHA） classⅠduring follow-up， their left ventricular ejection fraction was normal， there was no sign of myocardial ischemia in electrocardiogram， and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient （△P） was 19 （8-38） mm Hg， and the RVOT gradient （△P） did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography （64-MSCT）. Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.
Objective To investigate clinical outcomes of one-stage repair for patients with persistent truncus arter-iosus who missed optimal timing of surgery. Methods We retrospectively analyzed clinical data of 12 patients with persistent truncus arteriosus who had missed optimal timing of surgery and were admitted to Wuhan Asia Heart Hospital between June 2003 and August 2011. There were 7 male patients and 5 female patients with their median age of 4.5 （0.6-14.0）years and median body weight of 23 （6-36）kg. All the patients underwent one-stage surgical repair. There were 9 patients with Van Praagh type A1，2 patients with type A2，and 1 patient with type A4 persistent truncus arteriosus. There were 2 patients with anomalous origin of coronary artery，2 patients with moderate truncal valve insufficiency，and 3 patients with moderate tricuspid valve insufficiency which required concomitant surgical repair. All the patients received preoperative right heart catheterization which showed severe pulmonary hypertension. The median pulmonary-systemic blood flow ratio （Qp/Qs ratio） was 2.42 （1.50-5.26），and median pulmonary vascular resistance was 8.1 （4-12） Wood units. All the patients showed a positive pulmonary vasodilator response to oxygen. Right ventricular outflow tract （RVOT） reconstruction was achieved using a valved conduit in 7 patients and a valved patch in 5 patients. Results There was no in-hospital death in this group. Three patients had transient pulmonary hypertensive crisis during postoperative intensive care and were healed after proper treatment. Early postoperative pulmonary artery pressure monitoring in all the patients showed that main pulm-onary artery systolic pressure/radial artery systolic pressure was 0.48±0.12. All the 12 patients were followed up for 48（12-91）months. There were 10 patients with New York Heart Association （NYHA） classⅠand 2 patients with NYHA classⅡ during follow-up. One patient received reoperation for residual ventricular septal defect and right ventricular failure.Two patients required long-term medication treatment for high pulmonary vascular resistance and right ventricular failure. The latest echocardiography during follow-up showed that average pressure gradient across RVOT was 21 （16-42） mm Hg in patients with valved conduit for RVOT reconstruction and 18 （10-28） mm Hg in patients with valved patch for RVOT reconstruction. None of the patients required reoperation for RVOT obstruction. Pulmonary regurgitation was less than moderate degree in all the patients. Two patients with anomalous origin of coronary artery didn’t have symptoms or electrocardiogram changes of myocardial ischemia during follow-up. Conclusion For patients with persistent truncus arteriosus who missed optimal timing of surgery， one-stage repair can achieve good early and intermediate clinical outcomes，but long-term follow-up is needed to observe truncal valve regurgitation and right ventricular function.
Objective To evaluate early results of valved bovine jugular vein patch for reconstruction of the right ventricular outflow tract （RVOT）.?Methods From May 2009 to March 2010， a total of 60 patients with complex congenital heart diseases underwent reconstruction of RVOT with valved bovine jugular vein patch in Wuhan Asia Heart Hospital. There were 42 males and 18 females with their mean age of 6.2±8.9 years （ranging from 5 months to 33 years） and mean body weight of 27.5±24.0 kg， and 34 patients were less than 1 year. Preoperative clinical diagnosis included tetralogy of Fallot （n=38） and double outlet of right ventricle with pulmonary stenosis （n=22）. All the patients underwent one-stage surgical repair. Before operation， 4 patients underwent catheter intervention for their major aortopulmonary collaterals. The diameters of pulmonary arterial ring of all the patients were 2 standard deviation less than normal range， and trans-annular patch was chosen for RVOT reconstruction. All the patients were postoperatively followed up for 18 to 26 months （mean 21.2±4.6 months）.?Results There was no in-hospital death. And no second surgical intervention was needed for conspicuous RVOT stenosis or pulmonary regurgitation. Three patients needed reintubation for lung edema after extubation as a result of major aortopulmonary collaterals. Four patients underwent reexploration for postoperative bleeding. And all the other patients were discharged uneventfully. Mean cardiopulmonary bypass time was 84.0±22.0 min， and mean aortic cross-clamping time was 42.0±12.0 min. Mean RVOT gradient right after surgery was 18.0±4.5 mm Hg， which was not statistically different from mean RVOT gradient of 19.2±5.4 mm Hg measured by transthoracic echocardiography at their last postoperative follow-up（P＞0.05）. The degree of pulmonary regurgitation right after surgery was trivial in 32 patients（1＋）， mild in 28 patients（2＋）， which were not statistically different from the degree of pulmonary regurgitation at their last postoperative follow-up: trivial in 28 patients （1＋）， mild in 27 patients（2＋）， and moderate in 5 patients（3＋）. Calcification was not observed on the valved bovine jugular vein patch and valve cusp， and the valve cusp motioned well. No thrombosis or endocarditis was observed on the valved bovine jugular vein.?Conclusions For patients with tetralogy of Fallot or double outlet of right ventricle （DORV） and pulmonary stenosis， valved bovine jugular vein patch is a good choice for trans-annular reconstruction of RVOT. There is no severe postoperative complication related to bovine jugular vein， the RVOT pressure gradient does not increase significantly， and anti-regurgitation result is satisfactory in short-term follow-up. Further follow-up is required to evaluate its long-term outcome.