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@#Objective To explore the effect of LeCompte maneuver on in-hospital mortality and mid-to-long term reintervention after single-stage arterial switch operation in children with side-by-side Taussig-Bing anomaly. Methods Clinical data of patients diagnosed with side-by-side Taussig-Bing anomaly and undergoing single-stage arterial switch operation in Shanghai Children’s Medical Center from 2006 to 2017 were retrospectively analyzed. Patients were divided into two groups based on whether LeCompte maneuver was performed: a LeCompte maneuver group and a non LeCompte maneuver group. The clinical data of two groups were compared. Results Finally 92 patients were collected. LeCompte maneuver was performed in 32 out of 92 patients with a median age of 65.0 days and an average weight of 4.3 kg, among whom 24 (75.0%) were male. Fifteen (46.9%) patients received concomitant aortic arch repair while 12 (37.5%) patients were associated with coronary artery malformation. LeCompte maneuver was not performed in 60 patients with a median age of 81.0 days and an average weight of 4.8 kg, among whom 45 (75.0%) were male. Twenty-two (36.7%) patients received concomitant aortic arch repair while 35 (58.3%) patients were associated with coronary artery malformation. The average cardiopulmonary bypass duration of the LeCompte maneuver group showed no statistical difference from the non LeCompte maneuver group (179.0±60.0 min vs. 203.0±74.0 min, P=0.093). The in-hospital mortality of the two groups were 6 (18.8%) and 7 (11.7%), respectively, which also showed no statistical difference (P=0.364). The median follow-up period was 4.1 (1.6, 7.5) years for 79 patients with 8 lost to follow-up, and no death was observed. Kaplan-Meier curve and log-rank test showed no statistical difference in overall mid-to-long term reintervention rate (P=0.850) as well as right ventricular outflow tract and pulmonary artery reintervention rate (P=0.240) with or without LeCompte maneuver. Conclusion Whether or not to perform LeCompte maneuver shows no statistical impact on in-hospital mortality and mid-to-long term reintervention rate of single-stage arterial switch operation for side-by-side Taussig-Bing anomaly.
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@#Objective To discuss outcomes of arch reintervention for post-repair recoarctation in children. Methods From 2009 to 2019, 48 patients underwent reintervention for post-repair recoarctation in Shanghai Children’s Medical Center. Of the 48 patients, 22 patients had surgical repair, 25 patients had balloon angioplasty (BA), and 1 patient had a stent implantation. The clinical data were analyzed, and the difference in time-to-event distribution between the surgical group and the BA group was determined by a log-rank test. Results The median age at reintervention was 15.0 months (range, 3.0 months-15.1 years). The median weight at reintervention was 9.8 kg (range, 3.0-58.0 kg). The time to reintervention after initial repair was 12.5 months (range, 2.0 months-7.8 years). One patient (2.1%) died in hospital and 1 patient (2.1%) experienced arrhythmia after surgical repair. One late mortality (2.1%) occurred after surgical reintervention. One patient (2.1%) experienced aortic dissection after BA. No patient died after BA. Freedom from residual coarctation or new recurrences was 66.7%, 61.3%, and 56.9%, respectively, at 1, 2, and 5 years after reintervention. Freedom from residual coarctation or new recurrences was 90.0%, 81.8%, and 70.1%, respectively, at 1, 2, and 5 years after surgical repair. Freedom from residual coarctation or new recurrences was 52.0%, 48.0%, and 48.0%, respectively, at 1, 2, and 5 years after BA. Compared with BA, surgery-based reintervention had a lower incidence of residual coarctation or recurrences (χ2=4.400, P=0.036). Conclusion Reintervention for recoarctation has favorable early outcomes. Compared with balloon angioplasty, surgical repair has a more lasting effect in relieving the recoarctation.
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Objective@#To assess the effects of acute exposure to electronic cigarette ( e-cigarette ) on leukocyte and total protein levels in bronchoalveolar lavage fluid ( BALF ) and pulmonary surfactant protein expression in a mouse model, so as to provide insights into the elucidation of the mechanism underlying the damages to the respiratory system caused by e-cigarette.@*Methods@#Twenty-one C57BL/6N female mice were randomly divided into the blank control group, the solvent control group and the nicotine group. Mice in the solvent control group and the nicotine group were exposed to the solvent aerosol or e-cigarette aerosol containing 25 mg/mL nicotine for 3 hours daily, while mice in the blank control group were bred in clean air. Following 3-day exposure, mouse BALF and lung specimens were collected. The cell morphology was observed using microscopy following Wright-Giemsa staining and the leukocyte count was estimated in BALF, while the total protein expression was quantified using bicinchoninic acid ( BCA ) assay. In addition, the mRNA expression of pulmonary surfactant protein genes was detected in mouse lung specimens using quantitative real-time PCR ( qPCR ) assay.@*Results@#All mice in three groups grew well without obvious abnormality or death seen. Wright-Giemsa staining showed a higher number of mononuclear macrophages in mouse BALF in the nicotine group than in the blank control group and the solvent control group. The leukocyte counts were ( 2.00±0.77 )×107, ( 1.79±0.99 )×107 and ( 4.00±1.35 )×107 cells/L ( F=9.199, P=0.002 ), and the total protein levels were ( 0.16±0.03 ), ( 0.12±0.02 ) and ( 0.16±0.04 ) mg/mL in mouse BALF in the blank control group, solvent control group and nicotine group ( F=3.610, P=0.048 ), and the relative mRNA expression of pulmonary surfactant protein B (SP-B) and SP-D was 1.00±0.14, 0.82±0.12 and 0.74±0.07 ( F=5.491, P=0.028 ), and 1.00±0.06, 0.90±0.02 and 0.71±0.15 in mouse lung specimens, respectively ( F=10.460, P=0.005 ). The leukocyte count was significantly higher in the nicotine group than in the blank control group and solvent control group (P=0.007, 0.003), and the total protein content was higher in the nicotine group than in the solvent control group ( P=0.060 ), while the relative SP-B mRNA expression was lower in the nicotine group than in the blank control group ( P=0.025 ), and the relative SP-D mRNA expression was lower in the nicotine group than in the blank control group and solvent control group ( P=0.004, 0.041 ).@*Conclusion@#Acute exposure to e-cigarette results in elevated intrapulmonary inflammatory responses, pulmonary capillary barrier impairment and reduced pulmonary surfactant protein expression.
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Objective:To summarize single-center experience and short-term outcomes of surgical treatment of pediatric cardiac fibromas.Methods:There was a retrospective study of 10 patients who underwent surgical treatment of cardiac fibromas between January 2018 and October 2021. Fibromas were located in the left ventricle in 7 cases, and in the right ventricle in 3 cases. Mean tumor diameter was(5.6±2.0) cm.Results:Median age at surgery was 3.1 years old(5 months-9 years old). Nine patients received complete resection, and the other one received partial resection. One patient with giant left ventricular fibroma required extracorporeal membrane oxygenation support for ventricular fibrillation after weaning from cardiopulmonary bypass, and was successfully weaned on the third postoperative day. There was no early mortality. Median follow-up time was 6 months(1 month-3 years). No tumor recurrence nor ventricular arrhythmia was documented during the follow-up period.Conclusion:Pediatric cardiac fibromas can be usually treated by complete resection, with relief of cardiac dysfunction and ventricular arrythmia after surgery, and with satisfactory results.
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Objective:To summarize the experience and effect of mitral valvuloplasty in the treatment of mitral valve disease in infants.Methods:The clinical data of 140 infants with mitral valve disease from June 2010 to June 2020 were retrospectively analyzed. There were 62 males and 78 females, with body weight of(6.4±1.4)kg and age of(196.6±80.1)days. Among them, 131 cases were moderately or above mitral insufficiency, and 9 cases were mitral stenosis. The perioperative and follow-up clinical data were recorded, and the therapeutic effect and prognostic factors of mitral valve plastic surgery were analyzed.Results:All 140 children were received surgery of mitral valve repair under cardiopulmonary bypass. Cardiopulmonary bypass time was(79.1±41.9)min, aortic cross clamp time was(46.8±20.0)min, 7(5%)early death. Mechanical ventilation time was(74.2±149.8)h. After surgery, mild mitral regurgitation was found in 48 cases, mild-moderate regurgitation in 53 cases, moderate regurgitation in 32 cases, moderate-severe regurgitation in 6 cases, severe regurgitation in 1 case, with no mitral stenosis. During the follow-up period of 6-126 months, 3 cases died in the long term, and 11 cases were reoperated. Freedom from >moderate mitral regurgitation at 5 years after surgery was 81.2%. Longer cardiopulmonary bypass time and postoperative mitral regurgitation were risk factors for death and moderate or above regurgitation at the follow-up.Conclusion:Mitral valvuloplasty can effectively treat the mitral regurgitation and stenosis in infants. The prognosis of children with short cardiopulmonary bypass time and good valve plastic effect is better. For infants with Carpentier type I, good shaping effect can be achieved by mitral annuloplasty alone, while for type Ⅱ and type Ⅲ, treatment should be tailored to deal with the problems at all levels of the valve, and additional annuloplasty should be performed.
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Objective:To compare the results of surgical valvuloplasty and balloon dilation in patients with aortic stenosis (AS) at our center.Methods:We retrospectively reviewed the clinical data of children diagnosed with AS, underwent aortic repair or balloon dilation from January 2008 to December 2019. Seeking to analyze the early and long-term valvular function, evaluate mortality and freedom from reoperation by Kaplan- Meier method and figure out the risk factors by logistic regression. Results:There were 116 patients having received surgical valvuloplasty (SAV) and 64 having received balloon dilation (BD). There were no significant differences between two groups respect to median age, weight, preoperative peek gradient, aortic insufficient degree, left ventricular ejection fraction left ventricular end-diastolic dimension Z-score and aortic anulus diameter Z-score ( P>0.05). SAV achieved better gradient reduction and freedom from reoperation than did BD. The mean follow-up time was (5.2±3.1) years in SAV and (4.5±2.1) years in BD. Survival at 10 year was comparable between 2 groups ( P=0.51). Freedom from reoperation at 10 years was 59.6% in SAV and 49.7% in BD respectively ( P=0.01). Multivariate analysis revealed that BD contributed to subsequent reoperation ( P=0.05). Conclusion:SAV and BD both significantly relieved aortic stenosis and obtained good survival benefit. SAV yielded better gradient reduction and lower reoperation risk. BD might increase the hazard of reoperation.
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Objective:To summarize the surgical outcomes of interrupted aortic arch with ventricular septal defect (IAA/VSD) in neonates and infants.Methods:This was a retrospective review of clinical data of 123 neonates and infants who received surgery for IAA/VSD from Jan 2009 to Jan 2019. Median age at repair was 48 days. Forty-four patients (36%) were neonates. One-hundred-and-twenty-two patients (99%) underwent standard aortic arch reconstruction with VSD closure, and one neonate (1%) underwent staged Yasui operation. Risk factors for early mortality was analyzed by decision tree model.Results:Early mortality after surgery was 13%. Duration of cardiopulmonary bypass longer than 135 min, surgery received during neonatal period and before 2016 was identified as higher risk group for mortality. Median follow-up time was 3.5 years (range, 1-10 years). Freedom from aortic arch obstruction at 6 months, 1 year, 5 years after surgery was 75%, 72% and 72% respectively. Freedom from left ventricular outflow tract (LVOT) obstruction at 6 months, 1 year, 5 years after surgery was 91%, 83% and 73% respectively. A total of 17 patients received 21 reoperations. The patient who received Yasui operation experienced no residual obstruction during the follow-up.Conclusion:Early outcomes after surgery for IAA/VSD in neonates and infants are satisfactory. However, patients with standard aortic arch reconstruction have a higher risk for aortic and LVOT obstruction, and require multiple reoperations.
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@#Objective To explore the experience of surgical repair for congenital aortic stenosis (AS) in our center. Methods We retrospectively reviewed the clinical data of 145 children diagnosed with AS, who underwent aortic repair from 2008 to 2019, with or without aortic insufficiency (AI), including 104 males and 41 females with a median age of 2.9 (0.6, 7.8) years. The preoperative and intraoperative data, early and long-term valvular function, long-term survival rate and freedom from reoperation and aortic valve replacment (AVR) were analyzed. Results There were 120 patients receiving commissurotomy, 15 valvuloplasty with extra pericardium patch, and 25 AVR. The mean follow-up time was 0.25-11.20 (4.2±2.8) years. Survival rate at 10 years was 92.3%. Freedom from reoperation and AVR was 63.2% and 60.4%respectively. Multivariate analysis revealed that using a patch during surgery (P=0.036) was an independent risk factor for reoperation. A history of preoperative balloon dilation (P=0.029) and significant preoperative AI (P=0.001) contributed to AVR. Conclusion Surgical treatment of congenital aortic valve stenosis in children is a safe and effective method that provides enough time to achieve a more definitive solution. Using a patch during surgery increases reoperation hazard. A history of previous balloon dilation and significant preoperative AI may result in AVR during the follow-up.
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@#Objective To explore the early results of Ozaki operation in children with aortic regurgitation. Methods We retrospectively analyzed the clinical data of 15 patients with aortic regurgitation who received the Ozaki operation in our hospital from April 2017 to July 2019. There were 11 males and 4 females with an average operation age of 10.7±3.7 years. Besides preoperative evaluation, aortic regurgitation and cardiac function were evaluated on 1 day, 1 week, 1 month, 3 months, and 6-12 months after surgery. Results In 14 (93.3%) patients , the aortic valve leaflets functioned well on 1 day, 1 month, 3 months, and 6-12 months, and the regurgitation grade was Ⅰ-Ⅱ, which was improved than before (P=0.001). The cardiac function of children recovered quickly after operation. There was no statistical difference in ejection fraction on 1 day, 1 month, 3 months, and 6-12 months after operation (P>0.05). No children died, and no other clinical event was found. Conclusion The Ozaki technique of reconstructing a tricuspid aortic valve leaflet for the treatment of severe aortic regurgitation in children is effective in short term, and the persistence of its valve function remains to be determined in the long-term follow-up.
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Objective:The purpose of this article was to assess the outcomes of different surgical methods of persistent truncus arteriosus(PTA)and to figure out the risk factors of mortality and reoperation.Methods:A retrospective review of pediatric patients(n=84) who underwent PTA repair between 2008 and 2018 at Shanghai Children’s Medical Center. There were 45 males and 39 females. Among them, five were neonates and 67 were infants(<1 year old). The PTA morphology, regarding to Van Praagh, type A1 in 36 patients, type A2 in 34 patients, type A3 in 7 and type A4 in 7. Right ventricular outflow tract reconstruction by autologous tissue was performed in 34 patients. Extracardiac conduits were used in 50 patients.Results:The mean cardiopulmonary bypass(CPB) and aortic cross-clamp time was(148.0±46.9) minutes and(91.0±25.9) minutes respectively. There were 13 early deaths and 3 late deaths. Time-related survival was 79.5% at 10 years. Multivariate analysis did not find any independent risk factor for early or late death. Sixteen patients received 19 reoperations, freedom from reoperation at 10 years was 10.8%. Infants younger than 3 months( P=0.014) and reconstructing a new pulmonary valve( P=0.021)were risk factors for reoperation. Conclusion:Patients achieved excellent results following repair of PTA, despite high reoperation rate. Lower weight, younger age, significant truncal valve regurgitation, repair of truncal valve and suffering from interrupted aortic arch or coronary artery anomalies were not risk factors for mortality. Younger age at repair and reconstructing a new pulmonary valve significantly increased the hazard of reoperation.
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To analyze the outcomes of early Fontan failure after Fontan takedown. Methods A retrospective study of early Fontan Failure(EFF) children undergoing Fontan takedown from November 2013 to December 2017 was performed. Fontan takedown was defined as takedown back to an intermediate circulation, superior cavopulmonary connection. Fontan takedown was performed in 14 patients. There were 9 boys and 5 girls. Children were on average aged(4. 3 ± 1. 4) years when they had Fontan procedure. The mean weight was(14. 3 ±2. 7)kg. Operative procedure was extra-cardiac Fontan in 5 children, 9 had intra-cardiac Fontan. Fenestration was used in 11/14 patients. The outcomes were summarized with statistics, and risk factors for mortality after Fontan takedown were identified. Results The mortality after Fontan takedown was 4/ 14(28. 6％). In two patients(14. 3％), ECMO was followed after takedown, one of them died after two days. The time of ICU stay and hospital stay was relatively long(17. 0 ±11. 2)days and(33. 8 ±19. 4)days. The interval time between the Fontan procedure and the takedown operation is the risk fact after Fontan takedown. Conclusion Fontan takedown can be used as an effective management for the early Fontan failure, still with a high risk of mortality. Early diagnosis and takedown is recommended for EFF.
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Objective Mitral valve regurgitation often leads to cardiac insufficiency or even heart failure .Methods We tried a mitral valve annuloplasty with a ring to improve the effect of mitral valvuloplasty , 5 males and 6 females; aged(8.0 ± 4.5)years;weight(26.1 ±13.9)kg.From February 2015 to December 2017, 11 children underwent mitral valve annuloplasty with an mitral valve ring in our hospital.Immediately after surgery, the degree of mitral valve regurgitation was significant im-proved from moderate-severe to mild-moderate(P<0.05).Results 1 case of early death, 1 case had a mitral valve replace-ment because of early hemolysis.The rest of the children were discharged smoothly.The follow-up of 3 months of mitral valve regurgitation was not aggravated comparing with that immediately after surgery(P>0.05).There was no worsening of cardiac function at follow-up(P>0.05), and no other adverse events.Therefore, artificial mitral annuloplasty with a ring is effective in treating mitral regurgitation in children .The annulus had potential growth characteristics and did not require lifelong oral an-ticoagulant.Conclusion For some patients with difficulty, this method of mitral valvuloplasty can enlarge the surgical indica-tion and improve the quality of life of children.The treatment effect is good.
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Objective To investigate the therapeutic effect of the transcatheter closure of antegrade pulmonary blood flow with high-risk Fontan operations.Methods Retrospective analysis of 6 Fontan surgical patients, 4 males and 2 females, who received surgical treatment in the cardiothoracic surgery of Shanghai Children's Medical Center from May 2016 to August 2018;Age(5.7 ±2.9) years;(19.8 ±5.5) kg weight.All 6 patients were treated with primary pulmonary artery banding operation and secondary bilateral Glenn operation(BDG) and re-PAB.Before Fontan surgery, cardiac catheterization was performed in the department of cardiology to close the antegrade pulmonary blood flow .Results These six patients received interventional therapy in the department of cardiology.The mean pulmonary artery pressure(Pp) before occlusion was(17.0 ±0.8) mmHg (1 mmHg=0.133 kPa), the ventricular diastolic pressure(VEDP) was (11.2 ±0.9) mmHg, and the mean pulmonary artery pressure after occlusion was effectively decreased to(14.2 ±0.7) mmHg and VEDP to(9.7 ±0.7) mmHg.Fontan surgery was performed 6 to 12 months after the occlusion.No death was found after the operation, and all the clinical indicators were normal after the operation.Follow-up was conducted for 2-24 months, and the cardiac function and the function of each organ recov-ered well.Conclusion For some patients with high risk Fontan before operation , this method can safely and effectively reduce the average pulmonary artery pressure and reduce the ventricular and pulmonary vascular load , which is of positive help for the successful Fontan operation.
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Objective The purpose of this manuscript was to compare the outcomes of different surgical methods of Berry syndrome and to figure out the occurrence of postoperative morbidity.Methods From January 2003 through December 2017,nineteen infants with Berry syndrome underwent one-stage repair at Shanghai Children's Medical Center.There were 12 male and 7 female.Among them,six patients were neonates.The IAA morphology was type A in 17 patients and type B in 2 patients.The APW morphology was type Ⅰ a in 6 patients,type Ⅱ b in 11 patients,and type Ⅲ in 2 patients.Preoperative mechanical ventilation was required in 4 patients.Three different surgical correction techniques were employed to repair the APW and AORPA,including intra-aortic baffle in 8 patients,right pulmonary artery (RPA) detachment in 6 patients,and RPA angioplasty with aortic cuff in 5 patients.The descending aorta was then anastomosed to the aortic arch by an end-to-side anastomosis with a patch augmentation in the anterior wall.Results The mean CPB and aortic cross-clamp time was (146.7 ± 63.5)minutes (range,79 to 260 minutes) and (74.3 ± 27.4)minutes(range,46 to 147 minutes),respectively.There were 3 deaths.One patient died of severe pneumonia and multiorgan dysfunction on postoperative day 26.One patient suffered severe low cardiac output syndrome after surgery and died on postoperative day 1.One patient died of congestive heart failure at 2 months after discharge.Reoperations were required in 3 patients during the follow-up period.RPA arterioplasty with bovine pericardial patch augmentation was performed in 2 patients for RPA restenosis.Lecompte maneuverer was performed in 1 patient to release the compression of the RPA from the ascending aorta.Conclusion The mortality of one-stage repair of Berry syndrome was high.Surgical correction should be performed as soon as diagnosed.An intra-aortic baffle patch is suitable for type Ⅱ a APW defect patients beyond the neonatal period.Pulmonary hypertension crisis is important after surgery.RPA restenosis is the main reason for reoperation.
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Objective To summarize and evaluate our surgical approach of tetralogy of Fallot with complete atrioventricular septal defect.Methods 11 patients underwent surgical correction at our institute between June 2007 and April 2012.All of the 11 patients received biventricular or partial biventricular repair through a combined right atrial and right ventricular outflow tract approach.Two-patch technique was used in all 11 children.To minimize the incision in the right ventricular outflow tract(ROVT),8 patients underwent a transatrial approach to close ventricular septal defect.A transannular patch was needed in 7 patients,and a monocuspid valve was inserted in 1 of these patients.Results One hospital death occurred during intensive care stay due to severe low cardiac output syndrome and one late death took place six months after operation because of pneumonia and heart failure.The mean follow-up time was (21.20 ± 19.08) months (range,3-60 months).The KaplanMeier curve for the survival rate was 79.5％ at 5 years.Several postoperative complications occurred during the first 3 months,including 1 mild RVOT obstruction and 1 pulmonary artery stenosis,2 tiny residual atrial septal defects and 1 slight residual ventricular septal defect.Moderate pulmonary valve regurgitation was present in all patients,whether transannular patch was used or not.All survivors remained in good condition in NYHA class Ⅰ or Ⅱ.Conclusion Outcomes of complete correction of tetralogy of Fallot with complete atrioventricular septal defect are favorable during follow-up time.It is feasible to close a ventricular septal defect with a 2-patch technique through a transatrial approach alone.Accurate suturing is the key to the success of the surgery.