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经胸微创膜部室间隔缺损封堵术围术期炎症因子的变化

Perventricular Closure of Atrial Septal Defect and Ventricular Septal Defect Through a Single Port: The Initial Experience

目的评价单穿刺点经胸微创封堵治疗房间隔缺损（ASD）合并室间隔缺损（VSD）的安全性及有效性。 方法纳入2014年6月至2015年8月于我院成功完成单穿刺点经胸微创封堵术治疗ASD合并VSD的8例患儿，分析患儿在术后第l个月、3个月、6个月的门诊随访资料。观察围术期及随访期间患者残余分流、瓣膜反流、心律失常等并发症发生情况。 结果8例患儿中，术后早期均无残余分流、心律失常，微量三尖瓣反流（TR）患者1例（12.5%）。平均随访时间5～9（6±2）个月，各瓣膜均未发现中度及以上反流，未发现存在血栓、严重心律失常、死亡的患者。 结论单穿刺点经胸微创封堵治疗ASD合并VSD安全、有效，且更为微创。

主动脉窦瘤破裂继发感染性心内膜炎合并肺动脉瓣损毁一例

The application of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect in children

ObjectiveTo summarize the application and clinical effect of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect (VSD) in children.MethodsFrom October 2015 to April 2019, 21 children with subarterial VSD underwent surgical repair via left anterior minimally invasive thoracotomy. There were 13 males and 8 females, aged 5-13 (9.1±2.2) years, and weighing 22-55 (35.6±9.5) kg. The diameter of subarterial VSD was 4-15 (9.1±3.3) mm. Eight patients had right coronary valve prolapse, and 4 aortic valve regurgitation (3 mild and 1 mild-to-moderate). The minimally invasive surgery was performed via left parasternal thoracotomy through the second or third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. After aortic cross-clamp (ACC), subarterial VSD was performed with direct suture of patch closure through an incision on the root of pulmonary artery.ResultsAll patients successfully underwent surgical repair (patch closure, n=15; direct suture, n=6) of subarterial VSD through left anterior minimally invasive thoracotomy. The cardiopulmonary bypass time was 45-68 (57.1±6.3) min. The ACC time was 23-40 (32.6±4.7) min. The postoperative ventilation time was 5-9 (6.3±1.3) h, postoperative in-hospital time was 5-8 (5.7±1.0) d and drainage volume was 33-105 (57.5±17.7) mL in postoperative 24 h. No death, residual VSD shunt, atrioventricular block, wound infection or thoracic deformity occurred during the perioperation or follow-up. Only one patient still had trivial aortic valve regurgitation.ConclusionLeft anterior minimally invasive thoracotomy could be safely and effectively applied to surgical repair of subarterial VSD in children, with satisfactory early- and mid-term outcomes.

镜面右位心并右室双出口病变一例

双腔右心室的外科治疗

目的总结64例双腔右心室(DCRV)的诊断和手术治疗经验。方法术前经超声心动图和/或右心导管及右心室造影确诊为DCRV53例,测右心室高、低压腔间压力阶差为40～100mmHg(1kPa=7.5mmHg);11例于术中确诊。所有患者均经右心室切口疏通右心室腔梗阻,其中51例合并室间隔缺损(VSD)、3例房间隔缺损(ASD)的患者均于术中一并修补。经VSD疏通主动脉瓣下狭窄2例,行改良Fontan手术1例。结果无手术死亡患者,随访15例,随访时间1～13年,除1例因残余VSD仍有明显的临床症状外,其余患者均无临床症状,生活质量明显改善。结论术前明确诊断和识别此类心脏畸形的病理解剖特点是正确纠治DCRV、并获得满意效果的关键。

Minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects in 783 children: A retrospective analysis in a single center

ObjectiveTo summarize the minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects (VSD) under transesophageal echocardiography (TEE) guidance.MethodsWe retrospectively analyzed the clinical data and medium-long-term follow-up results of 783 patients who undertook perventricular device closure under TEE guidance in Dalian Children’s Hospital from July 2011 to January 2020, in which perimembrane VSD were found in 598 patients, VSD with aortic valve prolapse in 135 patients and muscular VSD in 2 patients. There were 463 males and 320 females at age of 5 months to 13 years with average age of 3.3±1.2 years, and body weight of 5.9-51.0 (15.9±8.3) kg. The left ventricular defect diameter of the VSD ranged from 5.0 to 11.0 mm, with an average of 6.3±1.2 mm. The right ventricular defect diameter of the VSD ranged from 2.3 to 8.0 mm, with an average of 4.3±0.9 mm.ResultsThe procedures were completed successfully in 753 patients. The device of 1 patient (0.1%) fell off and embedded in the right pulmonary artery after the operation, and the occluder was taken out and the VSD was closed with cardiopulmonary bypass (CPB) in the secondary operation. One patient (0.1%) appeared Ⅲ degree atrioventricular block in 2 years after operation. The device was taken out and VSD was closed with CPB in the secondary operation, and the patient gradually reached to sinus rhythm in post-operation. Eight patients (1.1%) presented delayed pericardial effusion in 1 week after operation, and were cured by pericardiocentesis with ultrasound-guided. Symmetric occluders were used in 580 patients, eccentric occleders were used in 171 patients and muscular occluders were used in 2 patients. The follow-up time was 9 months to 9 years. The rate of loss to follow-up was 96.7% (704/728). No residual shunt, occlude-loss or arrhythmia was found during follow-up. Conclusion The minimally invasive penventricular device closure of VSD guided by TEE is safe and availabe. Medium-long-term follow-up results are satisfactory, it is worthy of clinical promotion, and longer term follow-up is still needed.

“一鞘两伞” Hybrid 技术封堵室间隔缺损残余漏及左心室右心房通道一例

Two Nutrition Support Methods in Infants after Ventricular Septal Defect Repair Operation: A Case Control Study

ObjectiveTo compare the outcome between two nutrition support methods, total enteral nutrition (TEN) and enteral nutrition combined with parenteral nutrition, in infants after ventricular septal defect (VSD) repair operation. MethodsWe retrospectively analyzed the clinical data of 76 infants who underwent VSD repair operation in Xinhua Hospital in 2012 year. There were 46 males and 35 females aged 1.6-11.9 (5.5±2.5) months. Nutrition support was started from the first day after operation. There were 35 patients in the group A with TEN 60 kcal/(kg·d), and 41 patients in the group B with both enteral nutrition at 30 kcal/(kg·d) and parenteral nutrition at 30 kcal/(kg·d). ResultsThere was no statistical difference between two groups in demography data and preoperative clinical indicators. The number of patients suffered abdominal distension and gastric retention was more in the group A (22.9% vs. 4.9%, 68.6% vs. 2.4%, P<0.05). There was no difference in diarrhea. The completion of nutrition support in the group A was worse than that in the group B. In the group A, only 40% of the goal calorie was finished on the first and the second day after operation. It was improved until the third day, and the goal calorie could be finished on the seventh day. In the group B, the nutrition support method could be finished on the first day. The prealbumin level in the group B was significantly higher on the third, fifth and seventh day (P<0.05). The blood urea nitrogen (BUN) level in the two groups on the first day after operation was higher than that before operation (P<0.05), and persisted in the group A, while decreased to the normal level gradually in the group B. Following up to discharge, the weight was higher and the length of stay was shorter in the group B (P<0.05). There was no statistical difference in the cost of hospitalization between the two groups (P>0.05). ConclusionThe nutrition support method, enteral nutrition combined with parenteral nutrition, is better than TEN for infants after VSD repair operation.

经胸微创室间隔缺损封堵术38例临床分析

目的 探讨食管超声心动图（ TEE）引导下应用国产封堵器经胸微创封堵室间隔缺损（VSD）的临床价值。方法 回顾性分析自2011年5月至2012年5月内蒙古医学院第一附属医院38例VSD患者的临床资料，，男20例，女18例；年龄2.6～13.0岁；体重10～35 kg。其中膜部VSD 30例，干下型VSD 6例，肌部VSD 2例。术前经胸超声心动图检查符合封堵条件者在全身麻醉下经口插入食管超声探头，手术开始前重新评估VSD是否符合封堵治疗，如符合，根据VSD最大直径选择合适的封堵伞。于手术开始后，监测整个封堵过程，引导封堵伞的位置，评价即刻封堵效果，确认是否有残余分流及并发症。 结果 38例患者均一次封堵成功，置入封堵器直径4～10 mm，TEE显示封堵器与VSD边缘吻合紧密无残余分流。术后4～7 d复查心脏彩色超声心动图提示封堵器位置正常、牢固，无残余分流，主动脉瓣无反流。随访31例，随访时间10～24个月，未出现新的瓣膜和主动脉瓣反流，无溶血和血栓形成，无封堵器位置移动现象，未发现左、右心室流出道狭窄，手术切口隐蔽，基本不影响美观。 结论经胸微创VSD封堵术安全、有效，无需体外循环、创伤小，无需X线辅助，住院时间短，使该手术成为更简便、可行、成功率更高的封堵方法，值得临床广泛推广应用。