ABSTRACT
To study the methods and principles for simultaneous treatment in the children with pectus excavatum (PE) combined with congenital cardiothoracic diseases. Methods: The medical records of all children, who underwent simultaneous repair of PE combined with congenital cardiothoracic diseases, were retrospectively reviewed in Hunan Children's Hospital from January 2007 to September 2018. The patients were divided into a PE combined with congenital heart disease (CHD) group (n=17) and a PE combined with thoracic disease group (n=10). The repair with a custom-made sternal lifting device, a Nuss repair, were performed in the treatment of PE, and the correction of the CHD was performed by heart open surgery using cardiopulmonary bypass (through sternotomy or right infra-axillary thoracotomy) or by transcatheter closure under echocardiography or X-ray-guided percutaneous intervention in the PE combined with CHD group. The children in the PE combined with thoracic disease group underwent thoracic surgery plus Nuss procedure concurrently. Results: All 27 pediatric patients underwent simultaneous repair of the PE combined with congenital cardiothoracic diseases. In the PE combined with CHD group, the duration of hospital stay ranged from 8.0 to 25.0 (13.2±4.8) days. Two patients had delayed healing of the surgical wound and 1 patient developed a small left pleural effusion postoperatively. In the PE combined with thoracic disease group, the duration of hospital stay ranged from 10.0 to 34.0 (19.9±7.5) days. One patient was complicated with chylothorax and 2 patients were complicated with pleural effusionin. The treatment for the patients in the 2 groups was satisfactory. No severe complications like surgical death, severe bleeding, chest organ injuries, and implant rejections were observed. Conclusion: According to the characteristics of patients, individualized programs should be selected in order to correct children's PE combined with congenital cardiothoracic diseases in the same period, which are safe, effective and can avoid the risk of multiple operations and anesthesia, and can reduce the financial burden of family.
Subject(s)
Child , Humans , Cardiac Surgical Procedures , Funnel Chest , General Surgery , Heart Defects, Congenital , Minimally Invasive Surgical Procedures , Retrospective Studies , Sternotomy , Treatment OutcomeABSTRACT
Based on the first hand cardiothoracic surgical training experiences in Australia, the author introduced the Australian surgical training system's objective, structure, outline and specific training methods as well as its contents in detail. Its overall characters can be summarized as high standard, strict requirement and equal stress on both theory and practice. Hopefully, this introduction and reflection may shed some light on the improvement and evolvement of the resident training system in China.
ABSTRACT
Objective 22q11 microdeletion is featured with hemotological dysfunction,among others:hypocalcemia,thrombocytopenia and megathrombocyte.This study was trying to work out the platelet characteristics of 22q1 1 microdeletion patients and its potential clinical application.Methods A total of 80 cases who had undergone open-heart surgery were selected and confirmed with fluorescence in situ hybridization (FISH) to have 22q1 1 microdeletion among 40 cases while the others were negative.The relevant data in full blood routine of all the 80 cases in hospital information system (HIS) then were collected and analyzed with suitable statistical methods.Results The mean platelet volume in microdeletion group was statistically higher than that in the control group [(11.20 ± 1.94)fL vs (8.95 ± 1.58) fL,P ＜0.01].The area under the receiver operating characteristic (ROC) curve was 0.82,meaning significant predictive values.The corresponding sensitivity and specificity for mean platelet volume (MPV) =10 fL were 70.0 ％ and 80.0 ％,respectively.Conclusions MPV in congenital heart defect patients with 22q11 is significantly higher than those without 22q11.It is an effective method for preliminary screening 22q11.Being obtained from full blood routine data,it is economic and quick.MPV =10 fL can be used as a cutoff for guidance for irradiated blood transfusion postoperatively.
ABSTRACT
Objective To demonstrate clinical value of surgical repair combined with collateral embolization for tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs).Methods The clinical catheterization and surgical data of 8 such patients from October 2004 to May 2008 were analyzed retrospectively.All 8 patients underwent completely surgical repair combined with MAPCAs occlusion.Of 25 collateral arteries,20 were occluded before surgical procedure and 5 small ones were left.Corrective repairs were accomplished under moderate hypothermic cardiopulmonary bypass.Ventricular septal defect was closed with Dacron patch,and all patients underwent non-valved autologous right ventricular outflow tract reconstruction.Results No complications were observed,only 1 patient got hypoxemia.Blood returned to left atrium from lung was decreased.During 6 months follow-up,7 cases were in NYHA class Ⅰ,another was in NYHA class Ⅱ.Conclusions In selective patients with dual pulmonary blood supply by both MAPCAs and native pulmonary arteries,this combined therapy of collateral embolization and surgical repair simplifies copmpleling surgical procedure,improves surgical results and achieves higher rate of one-stage repair.