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@#Objective To explore the operative strategy after palliative shunt for correcting congenitally corrected transposition of great artery (cTGA) patients with left ventricular outflow tract obstruction (LVOTO) and cardiac malpostion. Methods We retrospectively analyzed the clinical data of 54 patients with onsecutive cTGA with LVOTO and cardiac malpositon from June 2011 to May 2019. The patients were devided into two groups. There were 24 patients (16 males and 8 females at mean age of 5.4±2.2 years) who underwent one and a half ventricle repair as a one and half ventricle group. And there were 30 patients (19 males and 11 females at age of 8.6±6.2 years) who underwent one ventricle repair operation as a one ventricle group. Follow-up data were collected by telephone interviews. Results There was no statistical difference in systemic atrioventricular valve regurgitation and systemic ventricular ejection fraction between the two groups (P>0.05). Compared with one and a half ventricle group, the cardiopulmonary bypass time (CPB) time, mechanical ventilation time and intensive care unit stay were significant shorter than those in the one ventricle group (P<0.05), but prolonged pleural effusions developed more frequently in the one ventricle repair group (P<0.05). There was no in-hospital death but 1 follow-up death in each group. The follow-up time was 49 (17-38) months in the one and half ventricle group at follow-up rate of 93.9%, and 47 (12-85) months at follow-up rate at 90.9% in the one ventricle group. One and a half ventricle group had better systemic ventricular ejection fraction (EF) than that in the one ventricle repair group. And the rate of heart function (NYHA) class Ⅲ and class Ⅳ in one and a half ventricle group was lower than that in the ventricle group. No significant difference of survival and freedom from re-intervention probability between the two groups was found. Conclusion For patients of correction of cTGA with LVOTO and cardiac malposition after palliative shunt, the one-and-a-half ventricular repair procedure is ideal operative strategy.
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@#Objective To analyze the results of surgical treatment of severe aortic stenosis in infants. Methods From August 2012 to December 2019, 28 infants undergoing aortic valvuloplasty in our hospital were selected, including 22 males and 6 females, aged 62.00 (47.00, 82.50) d. The baseline characteristics of the patients, postoperative complications and follow-up results were analyzed. Results Twenty (71.43%) patients had bicuspid aortic valves. Five (17.86%) patients had heart failure and two (7.14%) patients used prostaglandin before surgeries. Postoperative mechanical ventilation time was 25.00 (17.00, 62.75) h, ICU stay was 3.50 (2.00, 8.50) d and postoperative hospital stay was 10.00 (7.00, 16.50) d. Four (14.29%) patients got delayed recovery (ICU stay>14 d). One (3.57%) perioperative death was observed. The follow-up time was 55.00 (43.25, 82.25) months. No death was found during follow-up. Four (14.81%) patients underwent a second operation, including three (11.11%) patients with severe aortic stenosis, and one (3.70%) patient with severe regurgitation. Conclusion Infants with severe aortic stenosis are seriously ill and have a long postoperative recovery time, requiring early surgery. The postoperative follow-up results are satisfactory.
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Objective: To explore the correlation between genetic polymorphism of matrix metalloproteinase-9 [MMP- 9] in patients with coronary artery disease [CAD] and cardiac remodeling. Methods: A total of 272 subjects who received coronary angiography in our hospital from July 2008 to September 2013 were selected, including 172 CAD patients [CAD group] and another 100 ones [control group]. Both groups were subjected to MMP-9 and ultrasonic detections to determine vascular remodeling and atherosclerotic plaques. C1562G polymorphism of MMP-9 gene was detected, and correlation with vascular remodeling and atherosclerotic plaque was analyzed. Results: Serum MMP-9 level of CAD group [330.87+/-50.39 ng/ml] was significantly higher than that of control group [134.87+/-34.02 ng/ml] [P<0.05]. Compared with control group, CAD group had significantly higher intima-media thickness, and significantly lower systolic peak velocity, mean systolic velocity and end-diastolic velocity [P<0.05]. Total area of stenotic blood vessels was 67.34+/-22.98 mm2, while that of control blood vessels was 64.00+/-20.83 mm2. G/G, G/C and C/C genotype frequencies of MMP-9 differed significantly in the two groups [P<0.05]. G and C allele frequencies of CAD group [70.9% and 29.1%] were significantly different from those of control group [50.0% and 50.0%] [P<0.05]. G/G, G/C and C/C genotypes were manifested as lipid-rich, fibrous and calcified or ulcerated plaques respectively. Total area of stenotic blood vessels of G/G genotype significantly exceeded those of G/C and C/C genotypes [P<0.05], whereas the latter two had no significant differences. Conclusion: CAD promoted 1562C-G transformation of MMP-9 gene into genetic polymorphism, thus facilitating arterial remodeling and increasing unstable atherosclerotic plaques
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ObjectiveAnalyze the results of distal aortic reoperation in Marfan syndrome patients after proximal aortic surgery.MethodsBetween January 2000 and January 2010, 28 Marfan patients underwent surgical repair of distal aortic disease after aortic root surgery at our institution.There were 20 males and 8 females.Age ranged from 23 to 52 years [ mean (38.5 ± 8.7) years ].First time operations were Bentall procedure in 24, David procedure in 4.There were 8 cases of Stanford A dissection and 20 cases of aortic root aneurysm.The second time operations included 1 partial aortic arch replacement, 2 total arch replacements, 7 total arch replacements combined with stent elephant trunk, 6 descending thoracic aorta replacements,10 thoracoabdominal aorta replacements and 2 total aorta replacements.The interval between the lst and 2nd operation was 1 to 12 years [mean (6.43 ±3.07) years].The surgical technique used for distal procedures was dependent on the pathology of the aorta.Median repeat sternotomy was used for surgical exposure in 10 patients, who required an arch/proximal descending aortic procedure.Cardiopulmonary bypass (CPB) was established through the right axillary perfusion and right femoral venous drainage in all of these patients.16 patients were operated on through a left-sided incision, namely, a posterolateral thoracotomy, or a thoracoabdominal incision, depending on the distal extent of aortic replacement.For such patients, the left femoral vessels were cannulated for CPB in 14 patients and the rest 2 patients were operated on without CPB.Two patients with total aorta replacement were operated on through a median sternotomy combined with thoracoabdominal incision.22 patients underwent deep hypothermic circulatory arrest because of the replacement of anrtic arch or the extensive aneurismal arch.Reconstruction of intercostal arteries (T8-L1) was performed in 16 patients for the protection of spinal cord.ResultsTwo patients (7.1％) died postoperatively.Neurological morbidity included 1 patient with stroke, 1 paraplegia and 2 temporary paraparesisThree patients required temporary tracheotomy for prolonged weaning form the respirator.All patients were followed up for 10-118 months [mean (40.8 ±29.5) months].Two patients died during follow-up.The survival rate was (94.5 ± 1.3)％,(90.6 ± 1.4) ％ at 1-and 5-year, respectively.ConclusionDistal aortic reoperation in Marfan patients can be performed with good short-and long-term results.Complete aortic arch replacement with elephant trunk technique, if safely performed,should be considered for Marfan patients presenting with type A dissection.