Judgement of the left ventricle retraining in the rapid two stage-switch operation / 中华外科杂志

<p><b>OBJECTIVES</b>To Summarize the results of left ventricle retraining in rapid two-stage switch operation and to determine the estimating index of left ventricle retraining and the best time of the second stage operation.</p><p><b>METHODS</b>From September 2002 to September 2007, 21 patients underwent rapid two stage switch operation. There were 13 male and 8 female patients, ageing from 29 to 250 d [mean (103 ± 69) d, median 75 d], weighting from 3.5 to 7.0 kg [mean (5.0 ± 1.2) kg, median 5.0 kg]. After pulmonary band, bedside echocardiography was regularly done every other day. Paired t-test was used to analyze the changes of left ventricular end-diastolic dimension (LVDd), left ventricular posterior wall dimensions (LVPWd), diastolic intra-ventricular septal dimensions (IVSd), left ventricular (LV) mass and LV mass indexed for body surface area.</p><p><b>RESULTS</b>The mean interval was (9 ± 5) d. After the left ventricle preparative operation, the left ventricular to right ventricular pressure ratio (pLV/RV) raised from 0.47 ± 0.15 to 0.91 ± 0.20 (P < 0.01). LV mass indexed for body surface area raised from (30 ± 11) g/m(2) to (60 ± 20) g/m(2) (P < 0.01). Extremely significant difference of LV mass existed between pre-arterial switch operation and pre-left ventricle preparative operation, and significant difference existed in LVDd, LVDd(3), LVPWd and IVSd between the two operative timing points.</p><p><b>CONCLUSIONS</b>The left ventricular function of the transposition of the great arteries can be retraining by the left ventricle preparative operation. The interval of left ventricle retraining should be controlled in 7 to 10 d, and the pLV/RV reach 0.65 and the LV mass index over 50 g/m(2) are two important indicators of the second stage operation of arterial switch operation.</p>

Novel GATA4 mutations identified in patients with congenital atrial septal defects / 中华心血管病杂志

<p><b>OBJECTIVE</b>To identify the genetic defects in patients with congenital atrial septal defects (ASD).</p><p><b>METHODS</b>The clinical data and blood samples from 180 unrelated subjects with congenital ASD were collected and evaluated. Two hundred healthy individuals served as controls. The coding exons and the flanking introns of GATA4 gene were amplified by polymerase chain reaction and sequenced using the di-deoxynucleotide chain termination approach. The acquired sequences were aligned with the sequences publicized in GenBank by the aid of programme BLAST to identify the sequence variations. Clustal W software was applied for analysis of the conservation of altered amino acids.</p><p><b>RESULTS</b>Two novel heterozygous missense GATA4 mutations were identified in 2 out of 180 ASD patients. Namely, the triplet substitutions of GTC for GGC at codon 21 and TCG for CCG at codon 87 were detected, predicting the conversions of glycine into valine at amino acid residue 21 (G21V) and proline into serine at amino acid residue 87 (P87S). None of the two mutations were detected in 200 healthy controls. Across-species alignment of GATA4 encoded protein sequences displayed that the mutated amino acids were highly conserved evolutionarily. Additionally, a single nucleotide polymorphism c.99G>T was observed. However, the polymorphic frequency distribution in ASD cases was similar with that in healthy controls (for genotype GT, χ(2) = 0.7556, P = 0.3847; for allele T, χ(2) = 0.7235, P = 0.3950).</p><p><b>CONCLUSIONS</b>Two novel mutations of GATA4 gene are identified in two unrelated ASD patients. This finding provides new insight into the molecular etiology responsible for ASD.</p>

Numerical analysis on the mechanism causing the left pulmonary artery stenosis after repair by tetralogy of fallot / 医用生物力学

Objective To investigate the influence from the left pulmonary artery (LPA) with different stenosises (50%,20%,0%) after complete repair of tetralogy of fallot (TOF) on the hemodynamic features using computational fluid dynamics(CFD). Method The 3D models were reconstructed by the computer tomography (CT) images. CFD simulations were performed on these three models to describe the flow characteristics of the main pulmonary artery and the bifurcations such as average speed in LPA and right pulmonary artery(RPA), flow patterns, static pressure and wall shear stress. Results In the unsteady state simulation, different regurgitation and flow velocity distribution can be easily found in the start of LPA due to the stenosis rate of LPA, while the flow velocity distribution is uniform in the RPA. The flow velocity distribution, static pressure, pressure drop and wall shear stress are also different in these three models. Conclusions It is important to expand the branch pulmonary arteries during the TOF operation. LPA stenosis may be an early and important cause of pulmonary artery regurgitation. The use of CFD simulation can provide the early reference information for the effect after TOF operation.

Use of the lecompte procedure for ventriculoarterial connection abnormalities in infants and children with congenital heart diseases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The Lecompte (REV) procedure is used to correct abnormal ventriculoarterial connections in patients with congenital heart diseases; it avoids the need for an extracardiac conduit for pulmonary outflow tract reconstruction. The present study aimed to investigate effectiveness and criteria of the REV procedure in children with abnormal ventriculoarterial connections.</p><p><b>METHODS</b>Thirty-eight children (mean age, (2.2 +/- 1.7) years; mean weight, (11.5 +/- 3.8) kg) with abnormal ventriculoarterial connections who had an REV procedure in our hospital from January 1998 to May 2006 were studied. Only 10 patients had the usual anteroposterior relationship of the two great arteries. The infundibular septum between the two semilunar valves was aggressively resected to enlarge it and construct a straighter left ventricular outflow tract and a wide tunnel between the ventricular septal defect (VSD) and the aorta. Eighteen cases had the original REV procedure; 20 had a modified REV procedure.</p><p><b>RESULTS</b>All patients are alive; none developed severe complications. The postoperative right ventricular (RV) to left ventricular (LV) pressure ratio was 0.20-0.45. Five patients had RV dysfunction; 2 patients had a pressure gradient in the RV ventricular outlet of 30.0-34.5 mmHg; 3 cases had a 37.5-47.3 mmHg pressure difference in the RPA. All patients had an RV pressure less than half the systemic pressure. These gradients' magnitudes in all patients were consistent with the post-operative RV to LV pressure ratio (P < 0.05). During the follow-up (mean, (4.2 +/- 0.6) years), 2 patients had an RPA pressure gradient of 24.0-29.3 mmHg which abated to less than 10 mmHg after two years.</p><p><b>CONCLUSIONS</b>The REV procedure provides satisfactory short- to medium-term results. It may be superior to the Rastelli procedure for treating ventriculoarterial connection abnormalities; it allows early, complete anatomic repair and reduces the need for late re-operation, since no extracardiac conduit is needed. Longer follow-up is needed to determine long-term outcomes.</p>

Analysis surgical results of 113 patients with complete transposition of the great arteries / 中华外科杂志

<p><b>OBJECTIVE</b>To review and analysis the surgical results of 113 arteries Switch operations.</p><p><b>METHODS</b>One hundred and thirteen patients had been repaired by arterial Switch operation from January 2001 to December 2005. There were 60 patients with transposition of the great arteries and intact ventricular septum (TGA/IVS), 53 patients with transposition of great arteries and ventricular septal defect (TGA/VSD). The lowest body weight was 2.3 kg, and the youngest operative age was 6 h. The arteries Switch operation was performed underwent deep hypothermic circulation arrest and low-flow perfusion.</p><p><b>RESULTS</b>The total mortality was 9.7%. There were 5 deaths among TGA/IVS (8.3%), 6 deaths among TGA/VSD (11.3%). Following improvement of surgical technique, post-operative management and cardiopulmonary bypass, the operative mortality was decreased from 16.6% to 5.5%.</p><p><b>CONCLUSIONS</b>The main reason for operative mortality was abnormal coronary arteries. The incidence of abnormal coronary arteries was high at TGA/VSD. The surgical results was not infected by the position of great arteries. The low cardiac output was appeared if the ratio of left ventricular pressure and right ventricular pressure less than 0.6.</p>

Single-stage arterial switch operation for transposition of the great arteries and Taussig-Bing with aortic arch obstruction / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate one-stage arterial Switch operation for transposition of the great arteries (TGA) and Taussig-Bing with aortic arch obstruction.</p><p><b>METHODS</b>From January 2001 to June 2004, 8 patients had aortic arch obstruction, 3 with TGA and 5 with Taussig-Bing. Except one patient was 8 months old, all of others were 5 days to 3 months old, the mean operation age was (40 +/- 36) d and the mean weight was (4.3 +/- 0.5) kg. All patients were repaired by one-stage operation. The aortic arch obstruction was repaired in deep hypothermia circulatory arrest, and arterial switch procedure was performed in deep hypothermia and low flow perfusion.</p><p><b>RESULTS</b>There had 1 death who was 8 months old and had low cardiac output, complete artrioventricular block (AVB) and severe pulmonary hypertension postoperation. One patient was 3 months old who had asphyxia at 5 days postoperatively. Six patients followed up from 5 months to 2 years. One Taussig-Bing with interrupted aortic arch had residual obstruction at the anastomosis of aorta. Two had trivial aortic valve regurgitation, and one had mild pulmonary valve regurgitation.</p><p><b>CONCLUSIONS</b>One-stage repair for TGA and Taussig-Bing with aortic obstruction achieves excellent results. The reasons for the death were pulmonary hypertension and abnormal coronary artery. The operative procedure should be performed as early as possible for the better result.</p>