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Objective To evaluate the effects of inhaled nitric oxide in the early period after extracardiac total cavopulmonary connection (ETCPC). Methods 32 patients after ETCPC were evaluated,of them 16 patients (experimental group) were administered with inhaled nitric oxide in the early postoperative period. Another 16 patients were as control. The cardiac index (CI), pulmonary vascular resistance(PVR), respiratory index(RI), pulmonary-left atrium pressure gradient(PLG), duration of ventilation, intensive care time, hydrothorax drainage and hospital stay were recorded. Results In experimental group, after inhaled NO, RI decreased from 2.61?0.32 to 1.41?0.21 (t=2.35,P
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Objective To evaluate the surgical results of central aorto-pulmonary shunts in the tetralogy of Fallot. Methods Between January 1998 and December 2003, 24 patients with tetralogy of Fallot, 16 males and 8 females, with age from 7 months to 19 years [mean (5.3?4.6) years] and weight from 6.5 kg to 45.0 kg [mean (16.9?9.7)kg], were studied. Central aorto-pulmonary shunts were performed with Teflon artificial blood vessels in 10 cases and varicosity Teflon artificial blood vessels (Gore-Tex) in 14 cases. The diameter of these vessels was 3 mm to 6 mm. Results Ideal pulmonary flow in each patient was obtained. The mean SaO 2 stepped up from 0.67?0.09 to 0.93?0.04 after operation (P
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Ovbective To summarize the clinic data of pathological morphology,diagnosis,surgical treatment and associated anomalies of cor triatriatum from 37 patients enlisted in this study. Methods Thirty-seven patients,21 males and 16 females with a mean age of (9.8?8.6) years were studied. Clinical pathologic anatomy of cor triatriatum was type I in 2 cases,type IIa in 9,type IIb in 24,and type III in 2. Complete cor triatriatum in 31 cases and incomplete cor triatriatum in 6. Thirty-two cases (86%) accompanied with other cardiovascular anomalies. Diagnosis was made in 16(43%) cases preoperatively. All patients had excision of the fibromuscular membrane through the right atrial transseptal approach. Results The mortality rate in this group was 8.11% (3 of 37 cases). Thirty-four cases were followed up after surgery from 3 months to 15 years was satisfactory. Conclusion Cor triatriatum is a rare congenital cardiac anomaly. Treatment of associated deformities was a committed step in cor triatriatum surgical correction. Result of surgical treatment was satisfactory.
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Objective: To summarize the experience of clinical application of extracardiac valved tubes in complex congenital heart disease. Methods: From September 1979 to December 2001, 131 patients with complex congenital heart disease underwent surgical treatment by using extracardiac valved tubes, including 22 cases of aortic valved homografts, 73 cases of swine pulmonary valved tubes and 36 cases of extracardiac tubes with anti-calcified swine pericardium valve. Results: The overall mortality rate was 17.5%. The mortality rate has decreased to 10.7% in the late 10 years, and 4.5% in recent 5 years, respectively. Conclusion: It was suggested that aortic and pulmonary valved homograft preserved by liquid nitrogen is the first choice for extracardiac valved tubes. Extracardiac tubes with anti-calcified swine pericardium valve can also be used and they easily available. A better postoperative haemodynamic effect can be achieved by proper placement of the tubes, choice of suitable size and positioning in good geometrical figure.
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Objective: To study blood distribution in extracardiac total cavopulmonary connection (ETCPC). Methods: To combine a bidirectional cavopulmonary anastomosis with a Gore-Tex extracardiac conduit interposition between the inferior vena cava and the main pulmonary artery, and to evaluate the changes of pulmonary blood distribution with SPECT in all surviving patients. Results: The cournts of pulmonary radionuclide was (313.7?40.1)?10 3 increased significantly after surgery (t=2.23, P
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Objective: To summarize the experience of corrective surgery for Ebstein's anomaly. Methods: 139 patients with Ebstein's anomaly were operated on from June, 1980 to January, 2000. Among them, 111 cases received atrialized ventricle plication, tricuspid valve plasty and Devega tricuspid annuloplasty, 27 cases undergoing tricuspid valve replacement. One case of right ventricular hypoplasia received extra total cavopulmonary connection (ETCPC). Results: In the whole group, there were 12 operative deaths, with mortality rate of 8.6%. While in the later 10 years, operative mortality rate was reduced to 3.3%. In the group of plastive operation, 10 cases were re-operated with valve replacement and all were survived. Conclusion: Operative method of Ebstein's anomaly should be decided according to the pathologicoanatomic feature. For mild type, tricuspid valve plasty should be chosen. For medium A type, plastic operation should be performed. For medium B type, plasty or valve replacement should be cautiously selected. For severe type, valve replacement should be considered.
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<p><b>OBJECTIVES</b>To assess the changes of the levels of plasma endothelin (ET-1), nitric oxide (NO) and atrial natriuretic peptide (ANP) after cardiopulmonary bypass (CPB) and the influence of inhaled nitric oxide in patients with ventricular septal defect (VSD) and pulmonary hypertension (PH).</p><p><b>METHODS</b>Sixty patients with VSD were enrolled in this study. They were divided into 2 groups: group A [no-PH group, mean pulmonary artery pressure (mPAP) < 20 mm Hg (1 mm Hg = 0.133 kPa) n = 20] and group B (PH group, mPAP > 20 mm Hg, n = 40). Group B was subdivided into two groups by randomized block, group B(1) (inhaled NO group, n = 20) and group B(2) (contrast group, n = 20). The plasma ET-1, NO, ANP concentrations were assayed at 24 h pre-operation and 0 h, 1 h, 5 h, 12 h, 24 h, 48 h after CPB.</p><p><b>RESULTS</b>The preoperative plasma ET-1, NO and ANP concentrations in group B were significantly higher than those in group A. In three groups, the plasma ET-1 concentration at 0 h after CPB was significantly higher than that at 24 h pre-operation, and the plasma NO concentration at 0 h after CPB was significantly lower than that at 24 h pre-operation. In group B, the plasma ANP concentration at 0 h after CPB was significantly higher than that at 24 h pre-operation. After CPB, the plasma ET-1 concentration in group B(1) decreased faster than that in group B(2), and the plasma NO concentration in group B(1) increased faster than that in group B(2). In group B, the preoperative plasma ET-1 concentration negatively correlated with the preoperative plasma NO concentration and positively correlated with the preoperative ANP concentration.</p><p><b>CONCLUSIONS</b>The broken dynamic balance of ET-1/NO may take part in generation and development of pulmonary hypertension. ANP acts as a favorable physiological regulating factor in the pathogenesis of pulmonary hypertension. CPB can regulate the level of ET-1 up and NO and ANP down while inhaled NO can cause the level of ET-1 down and the level of NO up.</p>
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Child, Preschool , Female , Humans , Male , Administration, Inhalation , Atrial Natriuretic Factor , Blood , Cardiopulmonary Bypass , Endothelin-1 , Blood , Heart Septal Defects , Blood , General Surgery , Hypertension, Pulmonary , Blood , General Surgery , Nitric Oxide , Blood , PharmacologyABSTRACT
<p><b>OBJECTIVE</b>To study the changes of calcitonin gene-related peptide (CGRP) in patients who underwent total cavopulmonary connection (TCPC) and to assess the effects of non-pulsatile blood flow on the secretion function of the lung.</p><p><b>METHODS</b>Twenty-six patients were divided into 2 groups: study group, 13 patients who underwent extracardiac TCPC, and control group, 13 patients who underwent definitive repair for ventricular septal or atrial septal defect. Blood samples for measurement of CGRP were obtained preoperatively, postoperatively or in the follow-up period. Cardiac index (CI) and pulmonary vascular resistance (PVR) were measured by cardiac catheter.</p><p><b>RESULTS</b>The plasma level of CGRP was significantly higher in the study group than in the control group. CGRP was negatively correlated with PVR (r = -0.99, t = 9.82, P < 0.05), and positively correlation with CI (r = 0.98, t = 6.95, P < 0.05).</p><p><b>CONCLUSIONS</b>After total right heart bypass, the non-pulsatile blood flow in pulmonary circulation may stimulate the lung to secrete CGRP, leading to the decrease of PVR and improve early postoperative recovery.</p>
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Humans , Calcitonin Gene-Related Peptide , Bodily Secretions , Fontan Procedure , Heart Defects, Congenital , General Surgery , Pulmonary Circulation , Vascular ResistanceABSTRACT
2 67kPa) after MVR were enrolled in the study Parameters in hemodynamics and oxygenation were measured with Swan Ganz technique , 5min before NO inhalation (T 1), 5,15 and 30min following NO 20ppm inhalation (T 2,T 3,T 4), 15min after stopping NO 20ppm inhalation (T 5), 15min and 5h following NO 6ppm inhalation (T 6,T 7) and 15min before and after weaning from mechanical ventilator (T 8,T 9) respectively Results Compared with those at T 1, at T 2 pulmonary artery pressure, pulmonary vascular resistance, alveolar arterial oxygen difference and intrapulmonary shunting significantly decreased, but arterial oxygen partial pressure, oxygen content and oxygen availability index increased significantly (P0 05) Conclusions The persistently inhaled low dose NO is effective and safe for the pulmonary hypertension induced with heart surgery
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Objective: To summarize the experience of surgical treatment of subaortic stenosis. Methods: 70 patients with subaortic stenosis were treated surgically. The diagnosis was made by echocardiography, left ventricular catheterization and angiography. There were 46 males and 24 females. The mean age at operation was 11.8 years (range 3 to 46 years). 64 patients had discrete stenosis and 6 had tunnel stenosis. For the discrete stenosis cases, simply resection of stenosis membrane was done in 58 cases and plus myoctomy in 6 cases. For the tunnel stenosis cases, left ventricular muscle was resected to relieve obstruction. In 59 patients combined cardiovascular malformation were corrected at the same time. Results: There were two postoperative deaths. Mitral valve injury occurred in 1 patient. The mean systolic gradient of left ventricle to aorta was 7.5 mmHg with a range of 0-30 mmHg in 38 cases after operation. The 1-, 3-, 5-, 10-, 20-year follow-up rate was 83%, 77%, 68%, 45%, and 9%,respectively. All patients were asymptomatic postoperatively. No reoperation was required. Conclusion: Once subaortic stenosis was diagnosed, operation should be done. Preoperative echocardiography and routine exploration of the root of aorta should be done during operation are in diagnosing. The key point of the operation that left ventricular outflow tract should be thoroughly dredged, no injury should be made to the mitral valve, aortic valve and conduction bundle.
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Two cases of the aortopulmonary scptal defect were operated on our hospital. Among them, one was associated with patent ductus arterious and primary thrombocytopenia and the other with chronic heart failure. The defects were repaired successfully with a patch through a transaortic approach by means of four-point fixation. The diagnosis and surgical technique were discussed.
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To establish a new model of total cavopulmonary connection (TCPC) by improving the vascular anastomosis between vena cava and pulmonary artery and to study the postoperative hemodynamic changes, a Y shaped prosthetic blood vessel was used, one limb of the prosthesic was anastomosed with vena cava, and the other to pulmonary artery in an end to side way. Then the proximal vena cava was ligated. The mean pulmonary artery pressure was kept at about 20mmHg, the hemodynamic parameters were measured. All dogs tolerated the operative procedure. It was found that pulmonary vascular resistance (PVR) showed a significantly negative correlation with cardiac output (CO), mean aortic pressure (mAoP), and the ratio of right/left pulmonary artery flow (RPF). The model was successfully developed without cardiopulmonary bypass, and the tricuspid valve and pulmonary artery valve were left untouched. Hemodynamic parameters remained stable. It will be useful in study of the circulation after TCPC operation.