The effects of coronary abnormalities on reconstruction of right ventricular outflow tract in patients with complex congenital heart disease / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the effects of coronary abnormalities on reconstruction of right ventricular outflow tract in patients with complex congenital heart disease.</p><p><b>METHODS</b>Eighty patients, including tetralogy of Fallot 14 cases and double outlet right ventricle (DORV) 4 cases with anomalous coronary artery, underwent surgical treatment from April 1989 to May 2004. The coronary diseases included single left or right coronary artery in 11 cases, left anterior descending coronary artery originating from right coronary artery in 6 cases, vascular plexus on right outflow tract in 1 case. One-stage correction was undergone in 17 cases, palliative procedure in 1 case. The reconstruction methods were as follows: mobilizing coronary artery and expanding incision under coronary artery with pericardial patches in 4 cases; repairing ventricular septal defect (VSD) via the incision beneath the coronary artery and expanding right ventricular outlet tract (RVOT) and pulmonary via longitudinal incision over the coronary artery in 3 cases. VSD were repaired via right atrium and minimal incision on RVOT plus incision on pulmonary were made to expand RVOT. Trunk of pulmonary were anastomosis with RVOT in 3 cases. Homograft valved aorta were used in 3 cases.</p><p><b>RESULTS</b>One case died of serious low cardiac output syndrome postoperatively. There was no critical complication of hemorrhage and respiratory tract. Oxygen saturation rose from 68.0% to 82.0% after treated by palliative procedure. Seventeen cases were followed from 10 months to 8 years, 1 case suddenly died with no clear cause. Three cases were with residual leak, 3 with residual obstruction.</p><p><b>CONCLUSIONS</b>Surgical procedure should be selected according to the characteristics of coronary disease with complex congenital heart disease.</p>

Clinical analysis for 70 sinus of valsalva aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To review retrospectively the experience of surgical repair of sinus of valsalva aneurysm (SVA) in 70 patients.</p><p><b>METHODS</b>Between September, 1988 and October, 2003, Seventy patients with SVA underwent surgical repair by the aid of general anesthesia and cardiopulmonary bypass, comprised 1.4% (70/4960) of all open-heart operation. Forty-five were male and 25 female. Age ranged from 3 to 69 years old [mean (29 +/- 15) years]. The aneurysms ruptured into the right ventricle in 46 patients, right atrium in 23 and left ventricle in 1 respectively. The aneurysms originated from right and noncoronary sinus in 61 patients (87%) and 9 patients (13%) respectively. The most common associated cardiovascular lesions were ventricular septal defect (VSD, n = 34) and aortic valve incompetence (n = 21). Repairs were achieved through an incision in right atriotomy, right ventriculotomy or aortotomy only or both aortotomy and right atriotomy (or right ventriculotomy). The defects in the sinus of valsalva was repaired with either direct sutures (n = 43) or a patch (n = 27). The aortic valve was replaced in 6 patients.</p><p><b>RESULTS</b>There were no deaths in early time after repair. Postoperative hospital stay was 8 approximately 33 days [mean +/- standard deviation, (14.3 +/- 6.4) days] before 1997 and 6 approximately 15 days [mean +/- standard deviation, (9.1 +/- 2.6) days] after 1997 respectively. Complications included infection (n = 4), hemorrhage (n = 4), pneumothorax (n = 1), arrhythmia (n = 4) and residual shunt (n = 1) of VSD. Fifty-three (76%) patients (2 months approximately 13 years) were followed-up [mean +/- standard deviation, (6.6 +/- 3.8) years]. All patients survived except that one died of rupture of dissecting aortic aneurysm 7 years after operation.</p><p><b>CONCLUSIONS</b>The ruptured sinus of valsalva aneurysm and unruptured sinus of valsalva aneurysm with ventricle septal defect or(and) aortic valve regurgitation should be repaired surgically as soon as the diagnosis was confirmed. Long-term results are associated with preoperative aortic valve regurgitation.</p>