Results for repair of 28 cases of endocardial cushion defects combined with double-orifice mitral valve / 中华胸心血管外科杂志

Objective To review the surgical results of 28 cases of endecardial cushion defect combined with double-ori-rice mitral valve. Methods Of 860 consecutive patients with endocardial cushion defect, double-orifice mitral valve was iden-tiffed in 28 patients (3.26% ) form October 1996 to November 2007. Intracardiac deformities were corrected simultaneously during the operation. Preoperative mitral valve function, surgical procedures and incidence of pestoperative mitral valve dys-function were reviewed and compared between patients with total endecardial cushion defect ( group Ⅰ, n = 11 ) and partial en-docardial cushion defect ( group Ⅱ, n = 17). Results There were 4 operative deaths in group Ⅰ caused by severe pulmonary inflammation in 3 cases and low cardiac output in 1 case. Two cases were identified as severe mitral valve dysfunction or steao-sis in reoperaticu or autopsy. There was no later death. Mitral valve function is not eatisfactory in group Ⅱ as compared with group Ⅰ in 3 to 89 months of follow-up( averaging 33 months). Conclusion Double-orifice mitral valve is a high risk factor for operative death in total endocardial cushion defect and the longer term results of partial endocardial cushion defect combined with double-orifice mitral valve is not satisfactory.

Early and mid-term outcome of the arterial switch operation for transposition of great arteries: predictors and functional evaluation / 中华胸心血管外科杂志

Objective The aim of this report was to study the early and mid-term outcome in hospital and follow-up mortality, predictors for late pulmonary stenosis (PAS) and insufficiency of neo-aortic valve (neo-AVI) in patients with transposition of great arteries (TGA) and Taussig-Bing malformation undergoing arterial switch operation ( ASO ). Methods Between January 2004 and December 2007, 169 patients (129 male, 40 female; mean age of [(11.71 ± 26.3 ) months] with TGA or Taussig-Bing malformation underwent ASO. The patients were divided into Group Ⅰ (n = 56 ): TGA with intact ventricular septum and Group Ⅱ ( n = 113 ): TGA with ventricular septal defect (VSD). All patients were followed up in out-patient department by ultrasonic cardiogram. The mean follow-up periods was (27.66 ± 14.6 ) months. Multiple logistic regression analysis was performed to find out the risk factors. Results The overall hospital mortality was 11.24% (19/169)and there was no significant difference between the two Groups. With the improving of perioperative management, the hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The overall actuarial survival at 1-, 3- and 5-year follow-up was 94.00%,91.33%, and 91.33%, respectively. The multivariate analysis revealed that age above 6 months was a strong predictor for poor postoperative survival. Predictors for neo-AVI were: combined with VSD, age > 6 months and postoperative neo-AVI Z-score > 1. Predictors for moderate to severe PAS were age ＜ 1 months and pulmonary artery plasty with an unstretchable patch. Conclusion ASO remains the optimal choice for treating various forms of TGA with an acceptable early and mid-term outcome regarding overall survival rate. Patients with TGA should be treated as early as possible. Age >6 months is a predictor for poor postoperative survival and neo-AVI. Mismatch between the neo-aortic root and distal aorta may induce neo-AVI. Unstretchable patch in pulmonary artery plasty may induce PAS.

Complete transposition of the great arteries with severe pulmonary hypertension increses late mortality after artery switch operation / 中华胸心血管外科杂志

Objective The postoperative outcomes of transposition of the great arteries with severe pulmonary hypertension (PH) are still controversial. Based on relative large data, we evaluated the relationship between preoperative pulmonary hypertension and postoperative early and midterm clinical outcomes. Methods In this retrospective study, a cohort of consecutive patients with TGA was studied. One hundred and one patients underwent artery switch operation between February 2004 and October 2007. Preoperative medical records were reviewed. The mean follow-up period was 22.6 months. All artery switch operations were performed through a median sternotomy utilizing extracorporeal circulation. Deep hypothermia and circulatory arrest were used in 6 patients. After sternotomy, pulmonary arterial pressure was measured directly. According preoperative mean pulmonary pressure ( mPAP), patients were divided into three groups: normal group ( mPAP ＜25mmHg, n =43), moderate PH group ( mPAP between 25 to 50mmHg, n = 47) and severe PH group ( mPAP ≥50mmHg, n = 11 ). The methods of coronary anastomosis were "open trap door" ( 39 cases), "bay window" (61 cases) and "pulmonary artery tunnel" ( 1 case)techniques. Besides repairing of atrial septal defect and ventricular septal defect, ligation of patent ductus arteriosus, concomitsnt operations also involved mitral valvuloplasty (5 patients), tricuspid valvuloplasty (2 patients), pulmonary valvuloplasty (5 patients), pulmonary artery transplantation ( 1 patient ), subvalvular membrane resection ( 2 patients), widening of the right ventricular outflow tract ( 1 patient ) and collateral circulation occlusion ( 1 patient). The early and late postoperative results were compared among different groups. Results After operation, mPAP in severe PH group decreased from (61.2 ± 8.6 ) mmHg to ( 34.6 ± 13.6 ) mmHg( P ＜ 0.01 ). In moderate PH group it decreased from ( 34.5 ± 6.7 ) mmHg to ( 21.3 ± 5.6) mmHg( P ＜ 0.0l ). mPAP was not significantly changed in the control group. Operative mortality was 7.9% ( 8 patients ).The causes of early death were low output syndrome in 3 patients, septicemia in 4, central nervous system complications in 1.There was no difference in the postoperative complication rates among three groups. Also, no significant differences were found between groups regarding the early operative mortality (control group: 7.0%, moderate PH group: 8.5%, severe PH group:9.1%, P = 0.953 ). Combined abnormity contributed to postoperative death. Patients with ventricular septal defect and patent ductus arteriosus had a higher mortality rate. During follow-up 8 patients died: 5 in control group ( 11.6% ), 5 in moderate PH group ( 10.6% ) and 6 in severe PH group (54.5% ), P ＜ 0.01. Causes of midterm death were sudden death in 10, progressive heart failure in 4, pneumonia in 2. The rates of midterm mortality of the three groups were significantly different ( 11.6%,10.6% and 54.5% for control, moderate PH and severe PH group, respectively, P = 0.001 ). Kaplan-Meier survival analysis for patients with different age groups showed that survival rate in group with age older than 1 year was lower ( P = 0.029 ).Conclusion In TGA/PH patients, mPAP lower than 50 mmHg is suitable for artery switch operation and can get satisfying postoperative outcomes. If mPAP higher than 50 mmHg, even though the operation may decrease the pulmonary pressure, radical artery switch operation should not be recommended because of higher late mortality.

Operative and Mid-Term Results of 107 Corrected Congenital Transposion of Great Arteries / 中国循环杂志

Objective:To retrospectively analyze the results and mid-term outcomes of 107 patients with corrected congenital transposition of great arteries(CCTGA)who underwent surgical treatment.Methods:A total of 107 CCTGA patients with surgical treatment from January 1996 to October 2005 in our hospital were studied.There were 72 male and 35 female,with the mean age of 11.5±8.4years and mean body weight of 31.6±4.7kg. Among the cohort,81 were levocardia,23 dextrocardia,and 3 medocardia.Initial surgical procedure included single ventricle repair in 14 cases,conventional biventricular repair in 75 and biventricular anatomical repair in 18 cases. 99(93%)patients were followed up with the mean time of 47.8 months.Results:The early operative mortality rate was 4.76% in different procedures.The death rate with single ventricle repair was 0%,conventional biventricular repair 4%,atrial-arterial double switch 0%,atrial-ventricular double switch 40%. The risk factors for operative mortality were lesions with double outlet left ventricle combined with pulmonary stenosis(P<0.01)and Rastelli procedure(P<0.05). 12 patients(12.6%)died during the follow up period,among them,10(83.3%)were in conventional repair group,2(16.7%)in single ventricle repair group,and no death in double switch group. The risk of death during the follow up period of time were conventional biventricular repair,Rastelli procedure and tricuspid regurgitation.Conclusion:Conventional biventricular repair had a disappointing outcome in both operation and in long-term of follow up time. Patients suitable for single ventricular repair had fair short-and mid-term outcomes. Atrial-arterial double switch procedure had good operation and long-term results.

Intermedial to Long Term Surgical Management in Aortic Valve Insufficiency After Ventricular Septal Defect Repair / 中国循环杂志

Objective:To explore the intermedial to long term surgical management in aortic valve insufficiency(AI)after ventricular septal defect(VSD)repair.Methods:A total of 22 consecutive patients with AI after VSD repair in our hospital from January 1996 to December 2007 underwent surgical treatment were enrolled in this study. Valve perforation was mainly pathological changes. Aortic valve replacement was performed in 13 patients and aortic valvuloplasty was done in 9 patients.Results:One patient died after the operation.Post operative X-ray and echocardiogram revealed that both cardio-thoracic ratio(0.57±0.07 vs. 0.52±0.04 P<0.05)and left ventricular end diastolic diameter(54.5±10.2 mm vs. 46.7±5.8mm P<0.05)decreased markedly. 3 patients suffered from mild aortic regurgitation after valvuloplasty.Conclusion:The iatrogenic injury of aortic valve during VSD repair could be corrected satisfactorily by valve replacement or valvuloplasty.

Arterial switch operation:coronary artery pattern and surgical treatment(Report of 102 cases) / 中华胸心血管外科杂志

Objective To summarize the coronary artery pattem of arterial switch operation(ASO),operative skill and surgical results.Methods Between October 1999 to October 2005,102 patients underwent arterial switch operation.The mean age was(8? 16)months ranged from 3 days to 7 years.The mean body weight was(5.9?3.2)kg,ranged from 2.5 kg to 20.0 kg.Most com- monly(74/102),the aorta was more or less to the right of the pulmonary artery.In 10 patients,the aorta was directly anterior to the pulmonary artery,and in 11 patients,the aorta was to the left of the pulmonary artery.The great arteries were side by side in 7 pa- tients.We used Leiden classification for coronary artery pattern by operative descriptions.The most prevalent coronary pattern [1LCx2R]was found in 69(67.6%),abnormal coronary artery pattern in 33(32.3%).Intramural course of coronary artery was fotmd In three patients.The Leeampte maneuver was used in all cases.In most patients,the "open trap door" or "bay window" tech- nique for coronary osfia transfer.Results Total mortality rate was 14.7 %(15 eases),6 cases(8.7 %)with normal coronary pattem and 9(27.3%)deaths 33 patients with abnormal coronary pattern.3 cases with coronary event occurred in 5 deaths of simple rIGA, 4 cases with coronary event in 6 deaths of complex TGA and 3 eases with coronary event in 4 deaths of Taussing-Bing anomaly.Con- clusion Complex coronary artery anatomy increases the operative risk.With experience or improving surgical technique,we may get better results.

Homologous monocuspid valve patch in one stage repair of pulmonary atresia / 中华胸心血管外科杂志

Objective To review the experience of one stage surgical repair of pulmonary atresia with homologous monocuspid valve patch. Methods From October 1996 to May 2002,twenty-eight patients,4 months to 20 years of age (mean 35.3 months),received surgical repair wih homologous monocuspid valve patch in right ventricular outflow tract reconstruction. 17 patients had ventricular septal defect,others had intact ventricular septum. ResultsTwo patients died of low cardiac output syndrome with a hospital mortality of 7.14%. The leading complications were atelectasis,infection,anoxic encephalopathy,capillary leakage syndrome,residual shunt. Conclusion The repair with homologous monocuspid valve patch for right ventricular outflow tract reconstruction in pulmonary atresia provided good early results and minimizes pulmonary insufficiency. Surgical technique emphasized.

Clinical use of arterial switch operation for the complex congenital heart defects with ventriculoarterial connection anomaly / 中华胸心血管外科杂志

Objective To summarizes the clinical experience of the arterial switch operation (ASO) for the complex congenital heart defects with ventriculoarterial connection anomaly. Methods Between January 2000 and August 2004, 60 consecutive neonatal and infants, aged 2 days to 11 years with mean body weight (6.5?4.3)kg (2.6～22 kg), underwent the arterial switch operation at Fu Wai hospital, including 42 patients in early years (2000.1～2003.5), and eighteen patients in recent years (2003.6～2004.8). Primary cardiac diagnoses included transposition of the great arteries (TGA, n=49) and Taussing-Bing anomaly (TBA, n=7), and the congenitally corrected transposition of the great arteries (ccTGA, n=4). The operation was performed under general anesthesia and extracorporeal circulation with the low temperature and low volume blood flow. The great arteries were transected above the valvular commissures; the coronary ostia with all the adjacent sinus of valsalva were excised and reimplanted to the proximal neo-aorta. The proximal neo-pulmonary trunk was reconstructed with a large autologous native pericardium as a pantatoon patch. The pulmonary anastomosis was completed after the aortic cross-clamp was released. The VSDs were repaired through the atrium or proximal aorta with dacron patches. For the patients with ccTGA, double switch operation included Senning procedure and ASO were performed. Results The total operative mortality rate was 16.7% (10 cases), 9 cases in early years (21.4%, 9/42) and 1 case in recent year (5.6%, 1/18), two groups had significant difference (P

Clinical experience of left ventricle retraining before arterial switch / 中华胸心血管外科杂志

Objective To investigate the clinical results of left ventricle retraining procedure. Methods From Apr. 2001 to May 2004, 7 consecutive cases of simple TGA underwent left ventricle retraining procedure, which was composed of aorto-pulmonary shunt and pulmonary artery banding. At the operation, the ratio of systolic pulmonary/systemic pressure increased from 0.34 to 0.76. Contemporary atrial septum excision was performed in 2 cases and pulmonary artery banding revision in one. Results There was no hospital death in this series. 4 cases underwent second stage arteries switch operation (ASO) successfully 2 weeks after primary retraining procedure and discharged uneventfully. 1 case was readmitted 3 months later for ASO and died of postoperative hepatic failure. 2 cases were discharged without second staged operation because of postoperative complications. Conclusion Left ventricle retraining is necessary preparation for ASO in cases of simple TGA beyond the neonatal period. Atrial communication plays an important role in left ventricle retraining procedure. The surgical results of rapid two-stage ASO are quite satisfactory.

Arterial Switch Operation in Older Infants With Severe Pulmonary Hypertension / 中国医师杂志

Objective To introduce experience of switch operation applied to treat the transposition of the great arteries(TGA) and Taussing-Bing deformity.Methods Between June,2000 and Aug,2002, 27 consecutive patients underwent an arterial switch operation at our institution. The patients including TGA with intact ventricular septum in 5, TGA with ventricular septal defect in 18, Taussing-Bing deformity in 3, and corrected TGA in 1.Age ranged from 3 days to 6 years at operation (mean, 10 1?5 7 months), and the mean body weight was 6 3?2 81kg. Twenty patients were older than age 1 month. Ninteen patients had pre-operative catheterization. Seventy-four percents had severe pulmonary hypertention. Two patients had left ventricular outlet stenosis. Coronary type A distribution was recognized in 23 cases,type D in 4, and one of them had the origin of the left descending artery tunneled in the aortic wall. The great arteries were side by side in 3 cases. One patient underwent balloon atrial septostomy and another one underwent pulmonary banding and systemic to pulmonary shunt preoperatively. The great arteries were transected above the valvular commisures,the coronary ostia with all the adjacent sinus of Valsalva were excised and re-implanted to the proximal neo-aorta,then aortic anastomosis was carried out.The proximal neo-pulmonary trunk was reconstructed with a large autologous native pericardium as a posterior patch.The pulmonary anastomosis was completed,after the aortic cross clamp was released.The VSDs were repaired through the atrium or proximal aorta with Dacron patches.Results The hospital mortality was 7 4% (2 cases), and no death cases were directly related to any coronary artery problem. One perioperative death was a 5 day-old neonate with TGA and an intact septum who had refractory hypotension, hypoxemia, and acidosis preoperatively who underwent an emergency operation. The patient had a refractory low cardiac output syndrome postoperatively, and died after 20 hours. Another patient had a chylothorax and died of allergy from iodophor 22 days postoperation. The pulmonary pressure had gone down significantly in 20 patients who had severe pulmonary hypertension preoperatively (the mean pressure 46.7mmHg preoperation, and 31.3mmHg postoperation). Follow-up of 1 to 26 months was achieved in all survivors, with no late complications and death. Conclusions The arterial switch procedure for age over 1 month infants with severe pulmonary hypertention still has satisfactory efficacy.