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Objective To evaluate the clinical characteristics,diagnosis and surgical repair methods of double aortic arch (DAA) associated with complex cardiac anomalies.Methods Retrospectively analyzed the clinical data of the 5 DAA associated with complex cardiac anomalies patients,4 males and 1 female,age from 41 days to 19 years old,weight 4.3-56.0 kg.Accompanied cardiac malformites including 2 cases with TOF,2 cases with DORV,and 1 case with d-TGA.4 cases were diagnosed DAA via MSCT and were surgical treated combined with cardiac malformations at same stage.1 case of DAA associated with d-TGA experienced stubborn pulmonary infection with increased airway resistance and could not tolerate ventilator weaning after aterial switch operation.Then he was diagnosed DAA with left arch atresia through MSCT.So,the patient underwent another surgery to excise the left aortic arch.Results One case worsened postoperatively by the cause of vomiting and aspiration and then died.The other four were survival and discharged with no DAA repair relating complication.Conclusion Double aortic arch can be cured by surgical repair and DAA with cardiac defects can be operated in one stage via median sternotomy.Congenital vascular ring should be considered in patients with stubborn and unexplained respiratory symptoms,who should receive timely imaging examinations for accurate diagnosis and surgical treatment at the early stage.
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Objective To compare the effect of repairing large perimembranous ventricular septal defect (VSD) with a new continuous stitching and two classical methods. Methods From January 2005 to January 2008,321 cases with VSD were operated. All the cases were divided into 3 groups according to operational way, with discontinuous stitching in group A (70 cases), continuous stitching in group B(116 cases),new continuous stitching in group C (135 cases). All the patients were total corrected with hypothermic cardiopulmonary bypass. Results Group C had the shortest cardiopulmonary bypass and aortic cross-clamp times [(48 ± 36) min and (26 ± 18) min]among the three groups (P < 0.05). Group C had not residual shunt and incidence rate was lowest among the three groups (P < 0.05). Temporary second degree auriculo-ventricular bolck (AVB) was found in the early stage and no third degree AVB among the three groups. Tricuspid regurgitation was higher in group A,but there was no significant difference between group B and group C. Follow-up was completed in a duration of 1-3 years and all the cases had a good health after discharged. Conclusions The new continuous stitching method has short eardiopulmonary bypass and aortic cross-clamp times. It has fewer residual shunt than other two classical methods and has no evidence of higher AVB occurrence.
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55 mm or course of AF over 2 years [54.5%(24/44) and 68.7%(46/67),?2=29.265,P=0.000 and ?2=13.814,P=0.000].Conclusion RFA Maze Ⅲ procedure during open-heart surgery is safe and effective for patients with AF.
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Objective To analyze the feasibility and superiority of off-pump coronary artery bypass grafting(OPCAB) in patients with left main coronary lesions.Methods A retrospective study was carried out to review our experience on 392 cases with left main coronary lesions,who underwent CABG in our hospital.Among the cases,279 patients(71.2%) underwent OPCAB and 113 cases received CCABG.The early postoperative mortality and complications of the two groups were compared.Results The number of bypass grafts was(4.17?0.86) in Group OPCAB and(4.24?0.94) in Group CCABG,showing no significant difference between them(t=-0.710,P=0.478).No significant difference was detected in peri-and post-operative morbidity between the two groups [atrial fibrillation: 31(11.1%) vs 8(7.1%),?2=1.459,P=0.227;perioperative myocardial infarction: 7(2.5%) vs 3(2.7%),?2=0.000,P=1.000;renal inefficiency: 9(3.2%) vs 4(3.5%),?2=0.000,P=1.000;pulmonary complications: 15(5.4%) vs 6(5.3%),?2=0.000,P=1.000].The early postoperative mortality of Group OPCAB was significantly lower than that in Group CCABG[2(0.7%) vs 5(4.4%),?2=4.368,P=0.037].The time of intubation[20(8-48) h vs 51(14-130) h,Z=-2.823,P= 0.005],ICU-stay [51(38-141) h vs 92(42-352) h,Z=-2.618,P=0.009],volume of transfusion [500(200-1200) ml vs 800(400-2100) ml,Z=-2.411,P= 0.016],re-open [5(1.8%) vs 10(8.8%),?2=9.052,P=0.003] and complication of CNS [3(1.1%) vs 9(8.0%),?2=10.647,P=0.001] of Group OPCAB were significantly less than that of Group CCABG.Conclusions It is feasible,safe and effective to perform OPCAB in patients with left main coronary lesions.
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Objective The preservation of all subvalvular apparatus for chronic mitral regurgitation has been reported in many studies. In this paper we analyzed the effects of complete chordal preservation for mitral stenosis versus mitral regurgitation on postoperative recovery.Methods Thirty-nine patients undergoing mitral valve replacement(MVR) with preservation of all subvalvular apparatus were divided into two groups, mitral stenosis (MS) group(n=23) and mitral incompetence (MI) group(n=16), according to the preoperative diagnosis. Echocardiography was performed preoperatively and at the time of discharge to determined left ventricular end diastole dimension (LVEDD),ejection fraction(EF) and the hemodynamics of the prosthesis.Results The LVEDD and EF did not change in MS group, declined in MI group postoperatively. No hemodynamic disorder of the prosthesis was detected in either group.Conclusions The valve replacement with preservation of all subvalvular apparatus could be used in both the mitral stenosis and mitral regurgitation.The early-term effects of two groups are similar,and the long-term effects are still to be observed.