Objective To investigate and compare the different surgical strategies for typeⅠpulmonary atresia with ventricular septum defect (PA/VSD) and the outcomes of postoperative prognosis in early stage. Methods We retrospectively analyzed the clinical data of 61 typeⅠPA/VSD patients (40 males, 21 females) with a median age of 249 days (range, 13 days-19 years) in Guangdong Cardiovascular Institute from January 2005 to December 2014 . Among them, 42 patients (27 males, 15 females) with a median age of 11.11 months, ranging from 0.80–211.70 months received radical surgery as a radical surgery group. And 19 patients (13 males, 6 females) with a median age of 2.96 months, ranging from 0.47–161.83 months underwent palliative surgery as a palliative surgery group. We compared the two surgeries and their early outcomes. Results The mean postoperative oxygen saturation was 88.08%±9.64%, which showed significant improvement compared with preoperative oxygen saturation of 74.08%±12.99% (P＜0.05). Patients in the palliative surgery group had a lower body temperature during cardiopulmonary bypass and more respiratory complications than those in the radical surgery group (24.69 °C±3.11 °C vs. 27.18 °C±2.10 °C). Conclusion Both radical and palliative surgeries are good for the increase of pulmonary blood volume and the development of pulmonary vessels. Surgeons must pay more attention to choosing radical surgery for the babies, which is only considerd for those with well developed pulmonary arteries.
ObjectiveTo compare the efficacy of additional tricuspid valve annuloplasty (TVP) and isolated closure for atrial septal defect (ASD) with moderate to severe tricuspid regurgitation (TR). MethodsClinical data of the patients diagnosed with ASD combined with secondary moderate to severe TR and treated in our hospital from January 2009 to June 2020 were retrospectively analyzed. Patients were divided into a TVP group and a non-TVP group based on whether TVP was performed simultaneously. The baseline data of two groups were matched with a ratio of 1∶1 propensity score. ResultsA total of 32 pairs from 257 patients were successfully matched. In the TVP group, there were 24 females and 8 males with an average age of 44.0±13.1 years. In the non-TVP group, there were 28 females and 4 males with an average age of 44.5±11.6 years. The TR area and estimated pulmonary artery pressure in the two groups were significantly decreased compared with preoperation (all P<0.001). The TR area (P=0.001) and the estimated pulmonary artery pressure (P=0.002) were decreased more significantly in the TVP group than those in the non-TVP group. Linear regression analysis showed that age and preoperative TR area had a positive correlation with TR area at follow-up (β=0.045 and 0.259, respectively, both P<0.05), while additional TVP had a negative correlation (β=–1.542, P=0.001). ConclusionAdditional TVP can significantly reduce the TR area and pulmonary artery pressure, and elderly patients with severe TR before surgery should actively receive TVP.
Objective To review the clinical experience of one-stage repair of interrupted aortic arch(IAA) in neonate with cardiac anomalies. Methods We retrospectively analyzed the clinical data of 21 patients (18 males, 3 females) with IAA total repair in our hospital between May 2003 and September 2014. The average age of patients was 6–26 (15.9±5.8) days and the mean body weight was 3.3±0.4 kg. Fourteen patients belonged to IAA type A, and 7 patients to type B. All patients were complicated with ventricular septal defect, atrial septal defect, and patent ductus artefious. All patients with cardiac anomalies underwent one-stage repair through median sternotomy. The aortic continuity was reestablished by anastomosis between the descending aortic segment and aortic arch. Results CPB time was 92–174 (132.6±27.1) min, and aortic cross clamping time was 48-118 (70.9±18.8) min. Hospital day was 4-52 (28.0±12.1) d. There were 3 postoperative deaths. Causes of death included a cardiac arrest in one patient, hematosepsis in one patient, and a pulmonary hypertension crisis in one patient. Eighteen patients were followed up for 3 months to 11 years and the results were excellent. Conclusion One-stage repair of IAA in neonate with cardiac anomalies can improve life quality of patients and achieve good results.
Unilateral absence of a pulmonary artery (UAPA) is a rare congenital malformation resulting from the failed development or premature involution of the sixth aortic arch during embryogenesis, leading to a failure to establish a connection with the main pulmonary artery. Currently, there is a notable lack of consensus regarding the surgical management of UAPA in China. Drawing upon the latest clinical research, this consensus aims to summarize surgical approaches and techniques to improve the clinical management of UAPA patients and serve as a scientific reference for physicians specializing in pediatric cardiology and structural heart disease. This consensus aims to promote the standardization of UAPA diagnosis and treatment, thereby facilitating improved patient outcomes and long-term management, and stimulating the continuous development and innovation of surgical treatment for this condition in China.
ObjectiveTo summarize and analyze the experience of subarterial ventricular septal defect (VSD) repaired with simple pulmonary artery approach.MethodsWe retrospectively anlyzed the clinical data of 102 patients with subarterial VSD repaired with simple pulmonary artery approach in our hospital from August 2015 to October 2018. There were 67 males and 35 females at median age of 3 years (ranging 4 months to 49 years).ResultsThe median operation time was 82 (54-136) min. Median cardiopulmonary bypass time was 36 (21-62) min. The median aortic cross-clamping time was 13 (7-32) min. Thirty two patients of tracheal intubation were removed from the fast-track operating room immediately after surgery. Of the 102 patients, 67 patients underwent a small incision in the lower sternum. The median postoperative ICU stay time was 26 (13-36) h. There was no planned reoperations and no early death.ConclusionSimple pulmonary artery approach for subarterial ventricular septal defect repair with less intracardiac procedures, short operation time, less trauma, quick postoperative recovery has certain advantages in the application of specific groups.
Objective To analyze the clinical efficacy and mid-term outcomes of reimplantation of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA), and to evaluate whether concomitant management of mitral regurgitation (MR) during ALCAPA repair is needed. Methods Between March 2005 and March 2015, 52 consecutive patients (20 males and 32 females with a median age of 10 months ranging 2-193 months) underwent reimplantation of ALCAPA at Department of Cardiac Surgery, Guangdong Cardiovascular Institute. There were 14 males and 21 females with a mean age of 35.4±42.8 months not receiving mitral valvuloplasty (a Non-MVP group), and 6 males and 11 females with a mean age of 13.5±11.0 months receiving mitral valvuloplasty (a MVP group). In order to facilitate the analysis, degree of MR was graded by number: 0.0=none, 1.0=trivial, 2.0=mild, 2.5=mild-moderate, 3.0=moderate, 3.5=moderate-severe and 4.0=severe. Results The left ventricular fractional shortening (LVFS) and left ventricular end diastolic diameter (LVEDD) demonstrated significant improvement between preoperation and discharge (28.6%±9.6% vs. 32.1%±10.1%, P=0.023; 38.4±5.6 mm vs. 30.5±5.7 mm, P<0.001), and there was also significant improvement in the mean MR grade between preoperation and discharge (2.9±1.2,vs. 2.4±1.2, P=0.001). There were 4 in-hospital deaths (7.7%). The median follow-up was 21.0 months (ranging 1.5-111.0 months). Three patients (5.8%) were lost to follow-up, 1 patient required reoperation for mitral valve replacement and there was no death during follow-up. Significant improvement was seen in LVFS between discharge and final follow-up (32.1%±10.1% vs. 38.0%±6.0%, P=0.001); however, there was no significant difference in the degree of MR between discharge and final follow-up (2.4±1.2 vs. 2.3±1.2, P=0.541). There was no significant difference in cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time or hospital stay between the two groups. Conclusion Creation of a dual coronary system with reimplantation of the left coronary artery results in complete recovery of left ventricular function. However, concomitant management of MR during ALCAPA repair remains controversial. Concomitant mitral valve repair for ALCAPA patients with moderate-severe and severe MR is helpful to early function recovery of mitral valve.
ObjectiveTo analyze the effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates.MethodsThe clinical data of 33 neonates undergoing modified Blalock-Taussig shunt between January 1, 2013 and December 31, 2017 were reviewed, including 28 males and 5 females with the age of 3.0-28.0 (18.0±6.1) d and weight of 1.9-3.7 (2.9±0.5) kg.ResultsThere were 3 (9.1%) in-hospital deaths. Ten (30.3%) patients required early unplanned reoperations after surgery. Five (15.2%) patients were lost to follow-up. In the multivariate analysis, preoperative acidosis, emergency operation and postoperative bedside thoracotomy were independent risk factors of early death. During the follow-up of 18.0-93.0 (40.2±22.5) months, there was no death and 9 (36.0%) survival patients underwent corrective surgery and stage-two palliative surgery. In the multivariate analysis, preoperative hyperhemoglobinemia was an independent risk factor of nonadministration of the corrective surgery and stage-two palliative surgery. Receiver operating characteristic curve showed that preoperative hyperhemoglobinemia was significant in determining whether secondary surgery was possible.ConclusionThe modified Blalock-Taussig shunt is effective in promoting development of pulmonary arteries and preparing for the secondary surgery. The rate of mortality and postoperative complications after the neonatal modified Blalock-Taussig shunt remains high. The rate of secondary surgery is still low during follow-up.
ObjectiveTo investigate the management of hepatic vein (HV) in patients with functional single ventricle (FSV) and separate hepatic venous drainage (SHVD) undergoing total cavopulmonary connection (TCPC) and evaluate this kind of surgery.MethodsThe clinical data of 32 consecutive patients with SHVD who underwent modified TCPC operation from August 2005 to January 2017 in our center were retrospectively analyzed. There were 25 males and 7 females with an average age of 2-19 (8.0±5.0) years and body weight of 11-66 (25.4±15.8) kg.ResultsThere were 20 patients with heterotaxy syndrome and 12 patients with other types of FSV. SHVD was diagnosed preoperatively in 27 patients, among whom 20 patients were connected by intra-extracardiac Gore-Tex conduit, and the other 7 patients were connected by extracardiac Gore-Tex conduit. Because of the missed diagnosis of SHVD, the other 5 patients showed severe decrease of blood oxygen saturation in the early postoperative period and underwent re-operation soon. The postoperative blood oxygen saturation was 92.0% (90.0%, 96.0%), central venous pressure was 10-23 (15.5±3.5) mm Hg, mechanical ventilation assisted time was 16.0 (7.5, 24.0) h, and ICU stay time was 3.0 (2.0, 5.5) d. There were 3 early and 1 late deaths.ConclusionIntra-extracardiac conduit is an effective and feasible modified TCPC operation for patients with FSV and SHVD, while the surgical details need to be formulated in combination with individual anatomical structure. Preoperative missed diagnosis of SHVD must be avoided. Otherwise, after TCPC, a large amount of stealing blood from HV with low circulation pressure into atrium would lead to unacceptable hypoxemia.
Objective To summarize the experience and prognosis of Cone reconstruction used in Ebstein's anomaly. Methods We retrospectively analyzed the clinical data of 10 consecutive patients with Ebstein's anomaly, who underwent Cone reconstruction in our hospital from January 1, 2012 through February 1, 2015. According to Carpentier's classification, there were 2 patients of type A, 4 of type B, 2 of type B-C and 2 of type C. Results There was no death. One patient had arrhythmia after operation. The mean regurgitation area was 1.4±1.8 cm2 after operation, 6.4±6.9 cm2 at the time of discharge, respectively. Both of them were lower than preoperative regurgitation area (18.7±11.4 cm2) with statistical differences (95%CI –25.154 to –9.573,P=0.001; 95%CI 6.567 to 18.113,P=0.001). Three months after operation, the regurgitation was improved significantly compared to the preoperative regurgitation (95%CI 4.523 to 12.052,P=0.004). While it was higher in the regurgitation area when the patients were discharged. However, there was no statistical difference (95%CI –5.783 to 1.039,P=0.126). The incidence of severe regurgitation was about 85.7% at end of 3 months after operation, while decreased to 32.1%, 13 months later. The size of right atrium was much smaller than preoperative size (95%CI 1.033 to 31.480,P=0.039) when the patients were discharged. Conclusion Cone technique with ringed annuoplasty permits a good leaflet-to-leaflet coaptation. Tricuspid competence after operation could be sustained for a long time. However, postoperative short term is the crisis period to severe regurgitation. Further investigation for more appropriate surgical strategy should be carried on.
ObjectiveTo investigate if the ratio of pulmonary valve annulus, which is the proportion of pulmonary valvular annulus size to total size of aortic valvular annulus and pulmonary valvular annulus, can better guide the choice of surgical approach than the value of z.MethodsA retrospective analysis was made for 254 patients who underwent total correction of tetralogy of Fallot in Guangdong General Hospital between January 2016 and January 2018. There were 154 males and 100 females with an average age of 14.60±18.76 years. The patients were categorized into two groups, a transannular patch group (TAP, n=164) and a non-TAP group (n=90). The sizes of pulmonary and aortic valvular annulus were evaluated in each group, and the cutoff value of proportion of pulmonary valvular annulus for TAP was calculated.ResultsBoth proportion of pulmonary valvular annulus and z-scores were smaller in the TAP group than those in the non-TAP group (0.29±0.06 vs. 0.36±0.06, P<0.001; –4.04±2.13 vs. –2.06±1.84, P<0.001, respectively). In receiver operating characteristics analyses, proportion of pulmonary valvular annulus and the z-score cutoff values were 0.353 (area under the curve 0.781, 95%CI 0.725–0.831) and –2.13 (area under the curve 0.766, 95%CI 0.709–0.817), respectively, demonstrating that the proportion of pulmonary valvular annulus was a more powerful diagnostic tool as a predictor of TAP.ConclusionOur results suggest that the proportion of pulmonary valvular annulus is an effective predictor for TAP and can be easily applied to clinical practice.