Objective To summarize the clinical characteristics and surgical treatment experience of 1 106 patients with cardiac myxoma. Methods Clinical data of 1 106 patients with cardiac myxoma who underwent surgical treatment in Beijing Anzhen Hospital from 2002 to 2018 were retrospectively analyzed. There were 749 (67.7%) females and 357 (32.3%) males. Results The highest incidence rate was at the age of 51-70 years. The location of the disease was: left atrium in 987 (89.2%) patients, right atrium in 99 (9.0%) patients, left ventricle in 10 (0.9%) patients, right ventricle in 8 (0.7%) patients. There were 1 013 patients of heart classification (NYHA) Ⅰ-Ⅱ and 93 patients of Ⅲ-Ⅳ. There were 301 patients with cerebral infarction and 57 patients with peripheral arterial embolism. Tumor size was closely related to hemodynamic symptoms (P≤0.05), but not to peripheral vascular embolism (P>0.05). Two (0.2%) patients died in hospital and 306 patients were followed up, with a follow-up rate of 27.7%. The median follow-up time was 7 years (range, 1-18 years). One patient died of all causes, and 23 patients recurred, with a recurrence rate of 2.1%. Among 23 recurrent patients, 15 (65.2%) patients were atypical myxoma and 8 (34.8%) patients were typical myxoma. There was no statistical difference in aortic clamping time, ICU stay time, ventilator-assisted breathing time, postoperative hospital stay time, postoperative mortality, or cardiac ejection fraction at discharge between the reoperation in 23 recurrent patients and the first operation in 1 083 non-recurrentpatients. Conclusion Cardiac myxoma is more common in middle-aged and elderly women, and it often occurs in the left atrium. The size of cardiac myxoma can affect the hemodynamic changes. Surgical treatment is effective. Atypical myxoma is more common in recurrent patients, and the effect is still satisfactory through surgical treatment.
Objective To evaluate the efficacy of Radiofrequency （RF） modified maze procedure combined with open-heart surgery for atrial fibrillation （AF）. Methods From January 2003 to October 2004, 66 patients underwent the RF modified maze Ⅲ procedure for AF combined with open-heart surgery. The preoperative and postoperative indexes of electrocardiogram and echoeardiogram were compared through retrospective analysis and follow-up. Postoperative cardiac function and thromboembolie events were evaluated through telephone and mail. Results The time needed for RF modified maze Ⅲ was 18.61±3.56 min. There were no hospital deaths and the complications was 15.15%（10/66）. Follow-up duration was 14.25±6.47 months with 95.45%（63/66） completion. At the lastest follow-up, the rate of freedom from AF was 80.95% （51/63）and the rate of restoration to sinus rhythm was 74.60%（47/63）. No thromboembolic events was seen. 77.78%（49/63） of patients were in NYHA class Ⅰ. Significant decrease was seen in both left atrial dimension （LAD） and left ventricular dimension （LVD）（P〈0.01） more than 6 months after operation. Conclusion RF modified maze Ⅲ procedure as an adjunctive procedure is safe, time-sparing and effective in eliminating AF.
ObjectiveTo summarize our experience of right axillary straight mini-thoracotomy for surgical treatment of common congenital heart diseases in infants. MethodsWe conducted a retrospective analysis of 369 infants undergoing open heart surgery through right axillary straight mini-thoracotomy in the 153th Central Hospital of People's Liberation Army from April 2009 to April 2013. There were 191 males and 178 females with their mean age of 8.2±3.1 months (range, 3-12 months)and body weight of 7.8±4.5 kg (rang, 4.5-11.2 kg). Surgical procedures included ventricular septal defect (VSD)repair in 290 patients, atrial septal defect (ASD)repair in 16 patients, VSD and ASD repair in 34 patients, VSD repair and mitral valvuloplasty in 4 patients, valvotomy for pulmonary valve stenosis (PVS)in 9 patients, ASD repair and valvotomy for PVS in 6 patients, correction of partial anomalous pulmonary venous connection in 4 patients, and correction of partial atrioventricular canal defect in 6 patients. ResultsSix patients (1.6%)died postoperatively. Postoperative complications included right atelectasis in 3 patients, right pneumothorax in 2 patients, pneumonia in 16 patients, incision fat liquefaction in 12 patients, third-degree atrioventricular block in 1 patient, cerebral air embolism in 1 patient, and reexploration for bleeding in 3 patients. A total of 295 patients were followed up for 6 to 12 months after discharge. Residual VSD shunt was found in 4 patients, and mild mitral regurgitation was found in 2 patients. ConclusionClinical outcomes of right axillary straight mini-thoracotomy during open heart surgery are satisfactory for infants with common congenital heart diseases, but strict indications and skillful surgical techniques are needed.
ObjectiveTo assess the predictive abilities of postoperative regional oxygen saturation (rSO2) measured by near-infrared spectroscopy (NIRS) and lactate level for early postoperative outcome in children undergoing congenital heart disease surgery.MethodsA total of 73 children (43 males, 30 females, mean age of 91±18 days) undergoing cardiovascular surgery were enrolled from December 2016 to September 2017. The 73 children were divided into an early poor outcome group and a without poor outcome group. Binary logistic regression method was used to determine the independent factors of predicting early poor outcome. Receiver operating characteristic curve was used to identify the optimal cutoff values.ResultsThe early poor outcome rate was 47%. By regression analyses, nadir splanchnic rSO2 values, peak lactate level were 2 independent factors of predicting poor outcome. For nadir splanchnic rSO2 alone, the area under the ROC curve for poor outcome were 0.897. For peak lactate alone, the area under the ROC curve for poor outcome was 0.867. After combination of nadir splanchnic rSO2 and peak lactate, the area under the ROC curve for poor outcome increased to 0.944 (P<0.05).ConclusionCombining the parameter of nadir splanchnic rSO2 and peak lactate during the first postoperatively 24 hours yielded to a more accurate predictive ability for early outcome in children undergoing congenital cardiac surgery.
Objective Tho evaluate the outcomes of early percutaneous occlusion of these residual major aortopulmonary collateral arteries after heart surgery. Methods This was a retrospective review of children undergoing early percutaneous embolization of major aortopulmonary collateral arteries after cardiac surgery. From January 2013 to February 2017, 52 consecutive patients with postoperative residual major aortopulmonary collateral arteries were treated with percutaneous embolization (38 males, 14 females; median age of 10.0 months, interquartile range 14.0 months; median weight 8.6 kg, interquartile range 4.4 kg). Fifty-one patients were cyanotic and 1 patient was acyanotic. Forty-nine patients underwent corrective surgery and 3 patients underwent B-T shunt. Results Typical symptoms and signs of major aortopulmonary collateral arteries included: elevated left atrial pressure; focal lung infiltration, pink or blood-stained frothy sputum. The median time interval from cardiac surgery to percutaneous occlusion of major aortopulmonary collateral arteries was 5 (9) d, median duration of mechanic ventilation support since occlusion was 72 (159) h, mechanic ventilation support was 239 (480) h and median duration of intensive care unit was 19 (29) d. There was no death in this group. Conclusion Angiocardiography could be able to demonstrate the existence of postoperative major aortopulmonary collateral arteries. The early percutaneous occlusion appears to be simple, safe and effective.
Objective To summarize the experience of the surgical treatment of complex congenital heart diseases in 29 newborns. Methods Twenty-nine newborns were operated on for various congenital heart diseases, ages were from 3 to 28 d. There were ventricular septal defect 3 cases, D-transposition of the great arteries (D-TGA) 10 cases, pulmonary atresia (PA) 1 case,tricuspid atresia 3 cases, single ventricle 1 case, tetralogy of Fallot 6 cases, endocardial cushion defect 4 cases and truncus arteriosus 1 case. All patients were combined with atrial septal defect and patent ductus arteriosus. All operations were performed under hypothermic cardiopulmonary bypass. Results The operative mortality was 13.8%(4/29). One case with D-TGA and 1 case with PA succumbed due to low cardiac output syndrome, and 2 cases due to acute respiratory distress syndrome and low blood oxygen saturation. Twenty-five cases were discharged. Follow-up was completed in 19 patients,with a duration of 1-31 months, all patients have been normal. Conclusion Anesthesia and cardiopulmonary bypass should be performed smoothly and satisfactorily in newborn babies for cardiac surgery. Surgical manipulation should be accurate with less trauma and well protection of myocardium and lung is important.
ObjectiveTo analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization.MethodsFrom June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed.ResultsTotally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis.ConclusionOverall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.
Objective Summarize and review on surgical repair of congenital heart disease in infants. Methods Between January 1988 and June 2003, seven hundred and eighty seven less than 6 months of age patients were operated. There were 109 cases of complete transposition of the great arteries(D-TGA), 51 total abnormal pulmonary venous connection(TAPVC), 16 pulmonary atresia with ventricular septal defect(VSD), 33 coarctation of aorta, 299 VSD with pulmonary hypertention, 44 tetralogy of Fallot, 23 double outlet right ventricle, 9 pulmonary atresia with intact ventricle septum, et al. The operative procedure was dependent on different disease. Results There were 77 patients died, the total mortality was 9.78%(77/787). Following improvement of surgical procedure, the mortality was decreased from 25% in 1988-1995 to 4.11% in 2003. In the D-TGA patients, there was one residual VSD who was repaired 3 months late, and two had mild pulmonary and aortic supravalve obstruction. They were still be followed up. Two patients with intracardiac type of TAPVC had venous return obstruction, one was died and another was re-operated 4 days later. In the VSD patients, there were 5 patients with residural VSD, but all of them did not need to repair. Conclusion The time of surgical repair is very important, especially for complex congenital heart disease. The best operative procedure will be lost, if the infants is repaired too late, the postoperative events and mortality will be increased.
ObjectiveTo evaluate the efficacy and safety of cardiac surgery concomitant with bipolar radiofrequency ablation(BRFA) for the patients with heart disease and atrial fibrillation(AF). MethodsFrom April 2008 to September 2014, clinical data of 167 patients(43 males, 124 females) of organic-heart-disease patients combined with atrial fibrillation were analyzed retrospectively in our hospital. Within 167 patients, 102 patients underwent bipolar radiofrequency ablation without aortic cross-clamping were as a trial group and the other 65 patients underwent cardiac surgery and bipolar radiofrequency ablation with aortic cross-clamping were as a control group. And there were no significant difference in the age and gender between the two groups. ResultsThe time of radiofrequency ablation was 23.1±5.0 minutes in all the patients and there was no significant difference between the two groups(P=0.279). The extracorporeal circulation time was 156.6±56.4 minutes and the aortic cross-clamping time was 82.1±42.6 minutes. There was a significant difference between two groups in extracorporeal circulation time and aortic cross-clamping time. One patient underwent bipolar radiofrequency ablation with aortic cross-clamping died of severe pulmonary infection and multiple organ dysfunction syndrome(MODS) in one month after the surgery. The duration of follow-up was 1-77(35.3±3.5) months. The sinus rhyme conversion rate was estimated by electrocardiogram(ECG) in 1 month, 3 months, 6 months, 12 months, 36 months, 60 months after operation. The sinus rhyme conversion rates were 85.3%(133/156), 83.4%(126/151), 82.7%(115/139), 77.0%(94/122), 75.9%(41/54), and 72.0%(18/25). There was no significant difference during the follow-up in all of the sinus rhyme conversion rate. During the fellow-up, 2 patients died. One died after 1 month and another died after 6 months after their hospital-discharges. ConclusionThe efficacy and safety of cardiac surgery concomitant with bipolar radiofrequency ablation is satisfied. It can reduce the time of myocardial ischemia in bipolar radiofrequency ablation without aortic cross-clamping. It is beneficial to critical patients.
ObjectiveTo investigate clinical outcomes of isolated atrial septal defect (ASD)repair on the beating or non-beating heart through minimally invasive right axillary approach. MethodsForty-five patients underwent isolated ASD repair through minimally invasive right axillary approach in Research Institute of Surgery, Daping Hospital of the Third Military Medical University from September 2009 to August 2011. According to different surgical techniques, all the patients were divided into a beating-heart group and a non-beating heart group. In the beating-heart group, there were 22 patients including 13 males and 9 females with their mean age of 3.2±2.1 years and body weight of 13.1±4.0 kg. There were 20 patients with ostium secundum ASD and 2 patients with ostium primum ASD. Mean ASD diameter in the beating-heart group was 12.2±5.1 mm. In the non-beating heart group, there were 23 patients including 14 males and 9 females with their mean age of 3.5±2.5 years and body weight of 12.9±3.3 kg. There were 18 patients with ostium secundum ASD, 3 patients with sinus venosus ASD, and 2 patients with ostium primum ASD. Mean ASD diameter in the non-beating heart group was 11.6±4.7 mm. Serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST)and highly sensitive cardiac troponin I (cTnI)were examined preoperatively, after weaning from cardiopulmonary bypass (CPB), 6 hours and 24 hours postoperatively. ResultsThere was no in-hospital death. Postoperatively, 1 patient had right atelectasis and another patient had right pneumothorax. CPB time and operation time of the beating-heart group were significantly shorter than those of the non-beating heart group (P < 0.05). There was no statistical difference in intraoperative blood transfusion, mechanical ventilation time, length of postoperative ICU stay or hospital stay, chest drainage within 24 hours postoperatively, or postoperative cardiac function between the 2 groups (P > 0.05). Preoperative levels of CK, CK-MB, AST and cTnI were all within the normal limit, and there was no statistical difference between the 2 groups (P > 0.05). After CPB, CK, CK-MB, AST and cTnI levels increased in both groups, but increased significantly greater in the non-beating heart group (P < 0.05). Postoperative levels of CK, CK-MB, AST and cTnI of the beating-heart group were significantly lower than those of the non-beating heart group (P < 0.05). ConclusionIsolated ASD repair on the beating heart via minimally invasive right axillary approach is a safe and cosmetic procedure with shorter operation time and less myocardial injury.