ABSTRACT
Objective To summarize the experiences of surgical treatment for aortic coarctation and/or aortic hypoplasty associated with intracardiac anomalies in infants.Methods The clinical data of 51 cases with aortic coarctation and/or aortic hypoplasty hospitalized in Wuhan Children's Hospital between Jan.2010 and Jun.2013 were analyzed retrospectively.Thirty-two patients had received a expanded end-to-end anastomosis and 19 patients had got a end-to-side anastomosis.Autologous pericardial patch,bovine pericardial patch or autologous pulmonary patch was taken according to the circumstances during surgery.Results There were 2 intraoperative deaths because of serious low cardiac output syndrome,and 2 postoperative deaths,which could not take off long-term respiratory assistance after surgery in aortic one child and low cardiac output syndrome in the other.Three patients appeared trachyphonia but recovered basically after 3 months follow-up.Forty-seven patients were followed up for 2 months-3 years,among them,3 patients had significant upper to lower extremity systolic blood pressure gradient[＞20 mmHg(1 mmHg =0.133 kPa)],and a second operation was proposed recently for 1 of them,while the other 2 children were in follow-up.The other 44 patients did not appear obvious restenosis.The 47 cases of children had no neurologic symptoms.Conclusions There have to be positive diagnoses and strictly surgery indications for aortic coarctation and/or hypoplasty associated with intracardiac anomalies in infants.Selective antegrade cerebral perfusion or deep hypothemic circulatory arrest depends on the surgon's discretion.Both expanded end-to-end anastomosis and end-to-side anastomosis can achieve good operation effects.
ABSTRACT
Objective To investigate the operation method for congenital tracheal stenosis(CTS) with vascular ring(VR),in order to minimize surgical risk.Methods The data of 53 VR patients diagnosed by CT imaging,fiber bronchoscope and color doppler echocardiography were analyzed retrospectively.The age ranged from 5.0 days to 2.5 yeas old,median age was 12.5 months,including pulmonary artery sling,double aortic arch,right arch combined with abnormal left subclavian artery and innominate artery oppression,et al,in which 12 patients (8 male,4 female) associated with CTS symptoms.All patients were treated by operations,8 patients were dead,others were followed up for 3 to 5 years at 6-month interval.Results Fifty-three patients with VR were categorized into 2 treatment groups.There were 41 patients(25 male,16 female) without CTS symptoms treated by VR repair(3 cases died),mortality was 7.3％.Of the 12 patients(8 male,4 female) with VR + CTS symptoms,7 cases were treated by selective VR repair with 2 cases deaths,5 cases underwent combined V R and CTS repairs with 3 cases died,for an overall mortality of 41.7 ％.Of the 41 patients with VR but no CTS,7 cases had intracardiac anomalies with 2 cases died.In contrast,3 of 12 patients with VR + CTS and intracardiac anomalies with 2 cases died;5 patients received cardiac and CTS repairs(3 cases died) and 7 cases in selective VR repairs(2 cases died).Conclusions Not all cases of TN associated with VR require combined correction.CTS and the combined cardiac abnormalities increased the risk of VR surgery in children.The individualized treatment program should be developed for such children.