Study of cardiopulmonary adaptation during exercise in patients after extracardiac conduit total cavopulmonary connection / 中华外科杂志

<p><b>OBJECTIVE</b>To study cardiopulmonary physiology during exercise in patients after extracardiac total cavopulmonary connection (ECTCPC).</p><p><b>METHODS</b>Twenty-six patients were studied after ECTCPC by exercise testing with bicycle treadmill protocol. Heart rate (HR), blood pressure (BP), respiratory frequency (RF) and pulse oxygen saturation (SpO(2)) were measured continuously; twenty-six patients suffered from Fallot 4 underwent biventricular repair were also studied as control group.</p><p><b>RESULTS</b>In ECTCPC group, HR, BP, SpO(2) and RF all increased with exercise below 3 grade; when exceed 4 grade, BP, SpO(2) decreased and RF kept increasing. Compared with control group, HR, RF were higher (t = 2.13, P < 0.05; t = 2.31, P < 0.05), SpO(2) was lower (t = 2.46, P < 0.05) under the quiescent condition; When exceed 3 grade, HR, BP, SpO(2) decreased more significantly, but RF increased continuously. In fenestration group after ECTCPC, HR reached the top at 5 grades, but in group without fenestration it reached the top at 3 grades; In the whole process of exercising, RF kept higher and SpO(2) kept lower in fenestration group.</p><p><b>CONCLUSIONS</b>The ECTCPC patients showed obviously exercise limitation. Totally bypass of sinoatrial node in this operation may have some adverse effects on the integer regulation of HR.</p>

Clinical analysis on surgical treatment of single atrium / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of surgical treatment of single atrium.</p><p><b>METHODS</b>From August 1984 to August 2004, there were 33 patients with single atrium in our study. Plastic surgery for mitral valves were performed for 30 cases with mitral insufficiency. Plastic surgery for tricuspid valves were performed for 18 cases with tricuspid valve insufficiency. There were 3 cases only with complete absence of atrial septum. There were 14 cases with left superior vena cava. All new atrial septums were made with patches including 24 autologous pericardial patches and 9 terylene patches. Complicate abnormalities were corrected in the same time. Tow suture techniques were used in operations to prevent conductive system block, and plastic surgery for mitral valves were performed until the mitral valves were sufficiency.</p><p><b>RESULTS</b>There weren't death and conductive system block after operation in the group. One case was low-grade mitral insufficiency and the others weren't mitral insufficiency. Twenty-five cases were followed up from 3 months to 11 years, and they could work and study normally.</p><p><b>CONCLUSIONS</b>Single atrium should be operated as early as possible. The key of surgery is to prevent conductive system block, to properly correct mitral insufficiency and to drastically correct complicated abnormality. The new atrial septum should be made by patch and an autologous pericardial patch is the first selection.</p>

Surgical treatments and results of pulmonary atresia with ventricular septal defect / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the indication and operative program of ventricular septal defect with pulmonary atresia (VSD-PA).</p><p><b>METHODS</b>From June 1984 to March 2005, there were 32 patients with VSD-PA, which underwent 33 operations. Among them, 15 were males and 17 were females. The ages ranged from 6 months to 9 years. There were 9 patients with aortopulmonary collateral arteries. The operations included central aorta-pulmonary shunts 3 cases, one stage complete repair 27 cases and one stage unifocalization with VSD open 2 cases.</p><p><b>RESULTS</b>There were early 5 death including one death after aorta-pulmonary shunt and 4 deaths after one stage complete repair. The causes of death were severe low cardiac output (2 patients), respiratory function failure (1 patient), multiorgan function failure (1 patient) and severe infect (1 patient). Twenty-one patients were followed up from 3 months to 15.5 years. Heart function (NYHA) was class I or II in 19 cases and class III or IV in 2 cases.</p><p><b>CONCLUSIONS</b>The operative indication and methods mainly depend on the developing of pulmonary arteries and aortopulmonary collateral arteries. Completely surgical repair of patients with VSD-PA can be achieved with acceptable mortality.</p>

The effects of inhaled nitric oxide on pulmonary vascular resistance in patients after total cavopulmonary connection / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effects of inhaled nitric oxide (NO) on pulmonary vascular resistance in patients after total cavopulmonary connection (TCPC).</p><p><b>METHODS</b>Fifty-two patients after TCPC were evaluated, of them 24 patients were administered with inhaled nitric oxide in the early postoperative period. The cardiac index (CI) and pulmonary vascular resistance (PVR) were compared before and after inhaled NO.</p><p><b>RESULTS</b>In experimental group, after inhaled NO, partial pressure of oxygen in artery/fraction of inspired oxygen increased from 161 +/- 17 to 193 +/- 23 (t = 2.75, P < 0.01); CI from (2.86 +/- 0.24) L.min(-1).m(-2) to (3.13 +/- 0.22) L.min(-1).m(-2) (t = 2.25, P < 0.05); PVR decreased from (4.2 +/- 0.5) U/m(2) to (3.8 +/- 1.4) U/m(2) (t = 2.29, P < 0.05); central venous pressure (CVP) from (17.0 +/- 1.8) mm Hg to (15.0 +/- 1.1) mm Hg, decreased 11.7%. Compared with the control group, respirator time decreased from (86 +/- 27) h to (54 +/- 18) h (t = 2.29, P < 0.05); ICU time from (6 +/- 2) d to (4 +/- 2) d (t = 2.32, P < 0.05); But hydrothorax drainage and length of stay had no significant difference.</p><p><b>CONCLUSIONS</b>Though inhaled NO, there is no significant long-term effects in patients after TCPC, but it may play an important role in the management of low cardiac output syndrome and high cava pressure caused by reactive elevated pulmonary vascular resistance in the early postoperative period of TCPC.</p>

The treatments and results of tetralogy of Fallot with major aortopulmonary collateral arteries / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the indication and operative program of complete repair of tetralogy of Fallot with major aortopulmonary collateral arteries (TOF-MAPCA).</p><p><b>METHODS</b>From January 2000 to May 2004, 9 patients with TOF-MAPCA including 5 patients with pulmonary atresia underwent complete surgical repair, 6 of them were male and 3 were female. The ages ranged from 3 to 9 years. All patients underwent corrected operations with moderate hypothermia and cardiopulmonary bypass. Transcatheter occlusion of MAPCA was performed in 5 patients just before corrected operation. Ligation of MAPCA was performed in 1 patient in the same time of cardiac corrected operation. Midline one-stage complete unifocalization and repair were performed in 3 patients with pulmonary atresia.</p><p><b>RESULTS</b>There was one early death. The cause of death was spinal cord hemorrhage. There was no death then. Eight patients were followed up from 3 month to 4 years. Heart function (NYHA) was class I or II in 7 patients and III in 1 patient.</p><p><b>CONCLUSIONS</b>Completely surgical repair of patients with TOF-MAPCA should be performed as early as possible, which can achieve with satisfactory results by transcatheter occlusion of MAPCA or one-stage unifocalization.</p>

Surgical treatment of secundum atrial septal defects in adults over 30 years old / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of surgical treatment of secundum atrial septal defects in adults over 30 years old.</p><p><b>METHODS</b>There were 469 patients with secundum atrial septal defects in our study (male 144, female 325; ages 30-68, mean 38.6 years old). There were 105 cases with pulmonary hypertension and 458 cases with arrhythmia in the group. Surgical closure of defects were performed in all patients. Surgical closure of 358 cases were done by patches including 305 autologous pericardial patches. The low dose (6 x 10(-6)) nitric oxide inhalation was used in 25 postoperative patients with pulmonary hypertension. Right sided maze procedures were done in 5 cases with atrial fibrillation.</p><p><b>RESULTS</b>Surgical mortality was 0.6% (3 cases), the others were healed. In the group, there were 180 cases with arrhythmia, 27 cases with left ventricular function amyoplasia, 28 cases with low cardiac output syndrome, 12 cases in secondary operation for bleeding and 1 case with air-embolism. The level of mean pulmonary artery pressure of 25 postoperative patients with pulmonary hypertension inhaled nitric oxide was down 28.5%. After right sided maze procedures were done in 5 cases with atrial fibrillation, atrial fibrillation disappeared. 352 cases were followed up from 3 months to 20 years (mean 5.6 years). Twenty-nine cases were in class I-II of cardiac function, and the others were better than class I of cardiac function.</p><p><b>CONCLUSIONS</b>Atrial septal defects in adult should be operated as early as possible. When patch is needed, an autologous pericardial patch is the first selection. Inhaled nitric oxide is an effective method to postoperative pulmonary hypertension. The maze operation should be performed for atrial septal defect with atrial fibrillation while the surgical closure of defect was done. During and after operation, much attention should be paid to preventing and curing arrhythmia and protecting and supporting left heart function.</p>

Surgical treatment on residual shunt after repair of ventricular septal defect / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in surgical treatment of residual shunt after repair of ventricular septal defect and investigate the position of the residual shunts.</p><p><b>METHODS</b>Between January 1979 and May 2003, re-operations on residual shunt after repair of ventricular septal defect were performed in 37 patients with congenital heart disease including ventricular septal defect, tetralogy of Fallot, double outlet right ventricle in 19, 17 and 1 patients, respectively. It accounted for 0.21% (37/18000) of open heart operations performed during these years. The patients included 26 males and 11 females with age from 3 months to 53 years (mean 16 +/- 12 years). The residual shunt was diagnosed by postoperative murmur and echocardiography. Twenty-six cases were repaired with patch and 11 cases were closed directly with mattresses sutures.</p><p><b>RESULTS</b>Two patients (2/37, 5%) died within 48 hrs postoperatively. The results in other 35 patients followed up after surgery from 3 months to 15 years were satisfactory.</p><p><b>CONCLUSIONS</b>Most of the residual shunts occurred in base of septal leaflet of tricuspid valve, the second and the first transfer suture respectively. Effects of reoperations on residual shunts were satisfactory.</p>