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Objective:To explore and summarize the surgical strategies of biventricular conversion from single-ventricle palliation for the complex congenital heart defects in this study.Methods:From April 2017 to December 2019, a total of 14 cases with complex complex congenital heart defects who had planned to undergo single-ventricle palliation were finally accepted biventricular conversion. According to the development and anatomical characteristics of the ventricles, they were divided into two groups: ventricular well development group(9 cases), all of which showed complex intracardiac defects, and the ventricles well developed, including 4 cases of double outlet right ventricle with remote ventricular septal defect, 2 cases of transposition of great arteries combined with ventricular septal defect and left ventricular outflow tract obstruction, one case of congenitally corrected transposition of the great arteries combined with double outlet right ventricle and interrupted aortic arch, one case of double outlet right ventricle with subpulmonary ventricular septal defect and atrioventricular connection inconsistency, one case of pulmonary atresia with ventricular septal defect. Ventricular unbalanced development group(5 cases), all of which were functional single ventricle, including 3 cases of heterotaxy and 2 cases of unbalanced complete atrioventricular septal defect. The operation time, postoperative complications, death, cardiac function and reoperation of the two groups were compared.Results:There was one early death, with a mortality rate of 7.1%. In the ventricular well development group, the average waiting time for biventricular conversion was(56.4 ± 38.9) months. One case died after the operation. The early complications included 2 case of arrhythmias, 3 cases of pleural effusions and 2 cases of pulmonary infections. In the ventricular unbalanced development group, the average waiting time for biventricular conversion was(20.4 ± 15.8) months, and the average of left ventricular end-diastolic volume was(33.6 ± 2.1) ml/m 2. The early complications included 2 cases of low cardiac outputs, one case of arrhythmia and one case of renal failure. There was no significant difference in operation time, intubation time and ICU time between the two groups. The patients were followed up for 4 months to 3 years, and there was no death. In the ventricular well development group, one case was reoperated due to the obstruction of the anastomosis between the superior vena cava and the right atrial appendage. In the ventricular unbalanced development group, one case was implanted with a permanent pacemaker due to the degree Ⅲ atrioventricular block. The NYHA grade of the whole group was Ⅰ-Ⅱ. Conclusion:Whether the complex congenital heart defects with the ventricles well developed or unbalanced, the comprehensive evaluation before the planned single-ventricle palliation will be helpful to find the appropriate cases for biventricular conversion. According to its anatomical characteristics performed the corresponding biventricular conversion can obtain a satisfied clinical outcomes, although the long-term results still need further follow-up.
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In cardiac surgery such as myocardial infarction, congenital heart disease, and heart transplantation, myocardial ischemia-reperfusion (I/R) damages mitochondria, which in turn causes myocardium energy metabolism disturbance, homeostatic destruction, reactive oxygen species production and DNA damage, and activates myocardium apoptosis and necrosis signals, which eventually lead to myocardial dysfunction or heart failure. Different from the previous I/R treatment targets focusing on a certain pathway or a certain medium, autologous mitochondrial transplantation (AMT) is an emerging method, which transplant viable and respiration-competent mitochondria from healthy organs or tissues to the injured sites which suffer from I/R injury, to replace or repair damaged mitochondria. In recent years, AMT has achieved remarkable results in the prevention and treatment of myocardial I/R. This article reviews the role and mechanism of AMT in I/R myocardial protection.
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Objective:To study the surgical results of Yasui procedure for interruption of aortic arch and ventricular septal defect(IAA/VSD) associated with aortic stenosis(AS) or aortic atresia(AA).Methods:A retrospective study was performed on all 4 children with IAA/VSD/AS(AA) that underwent a Yasui procedure from Dec 2014 to Dec 2019. Three patients had AS, and 1 patient had AA. The age was from 10 days to 25 months and the weight was from 2.7 kg to 10 kg. The type of IAA was type A in 1 and type B in 3. The diameter and Z value of the aortic annulus were 1.9-4.3 mm and -6.7--3.6. The diameter and Z value of the ascending aorta were 2.6-5.8 mm and -5.4--2.6. The mean Z value of LVEDD and LVEDS was 3.6±2.6 and 3.6±2.9 resparately.Results:All 4 patients survived after the Yasui procedure. Three patients underwent primary repair and 1 patient underwent staged repair. CPB time was 128-283 min and aortic cross-clamping time was 98-171 min. Ventilation time was 93-296 h, and ICU and hospital length of stay was 7-25 days and 18-39 days. Follow-up was complete in all patients from 8 to 92 months, and there was no late death. All the patients were in good biventricular function with NYHA grade Ⅰ in 3 and NYHA grade Ⅱ in 2 patients. No residual left ventricular outflow tract obstruction was detected.Conclusion:The Yasui procedure can be an option for patients with IAA/VSD/AS(AA) and good developed left ventricle and can achieve good early surgical results.
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Objective:To study the surgical results of Ross procedure in pediatric patients. We report our early outcomes of the Ross procedure for congenital aortic valve disease.Methods:Retrospective analysis was performed on all 16 children with congenital aortic valve disease that underwent a Ross procedure from May 2018 to December 2019. Three patients had aortic stenosis(AS), 5 had aortic regurgitation(AR), and 8 patients had AS/AR. Two patients had endocarditis. Nine patients had prior aortic valve surgeries or interventions, 7 had percutaneous balloon aortic valvuloplasty, 1 had surgical valvotomy and 1 had aortic valve repair by cusp extension. Six patients had bicuspid and 1 had quadricuspid aortic valves.Results:There was no early death. Mean CPB time was (193.8±66.9) min (range 123~359 min), mean aortic cross-clamping time was (125.9±29.7) (range 82-186 min). Mean ventilation time was (58.0±42.4) h (range 22.7-163.0 h), and mean ICU and hospital length of stay was (5.4±3.4) d (range 2-16 d) and (25.9±18.7) d (range 7-77d). Six patients developed low cardiac output syndrome and 2 patient had hepatic dysfunction, which all improved after treatment. Follow-up was complete in all patients from 3 to 23 months, and there was no late death. Thirteen patients were in NYHA grade Ⅰ, and 3 in grade Ⅱ. The peak gradients through the aortic valve and pulmonary valve were (8.3±5.5)mmHg (3.7-26.6mmHg) and (20.5±16.4) mmHg (6.8-62.1 mmHg), respectively. The aortic regurgitation was negative in 3 patients, trivial in 1 patient and mild in 12 patients. The pulmonary regurgitation was trivial in 4 patients, mild in 9 patients and moderate in 3 patients.Conclusion:Ross procedure is a safe, effective surgical operation for congenital aortic valve disease in children >1-year of age.
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Objective A retrospective study of patients in the past ten years who underwent surgeries because of secondary subaortic stenosis(SSS) after previous repair of congenital heart disease(CHD) was performed.The anatomy,indication,and surgical outcomes were studied.Methods Between January 2004 and October 2013,forty-eight patients underwent surgeries because of SSS.Thirty-five patients were males,and 13 were females.The mean age was(54.0 ± 34.9) months (12-156 months).The mean weight was(16.1 ±6.2)kg(6.0-37.5 kg).And the mean interval between the first and second surgery was(39.6 ±25.0) months(11-115 months).The primary diagnosis of CHD included ventricular septal defect,double outlet of right ventricle,corctation,interruption of aortic arch,patent trucus arteriosus,atrio-ventricular defect,tetralogy of fallot,transposition of great arteries,and univentricle.Results Twenty-five patients were discrete subaortic stenosis,and had the fibromuscular ridge resected.Twenty-three patients were diffuse type of subaortic stenosis.Myectomy,reconstruction of the intraventricular baffle,and modified Konno procedure were done in 8,5,and 10 patients separately.One patient died of cardiac failure postoperatively.One developed complete left bundle branch block,and another one developed complete atrioventricular block.The pressure gradients dropped from(76.8 ±20.4)mmHg to(12.4 ±8.4)mmHg,P ＜0.001.One patient was lost in follow-up and the left 46 patients had been followed up for 27 ～ 144 months [mean (59.6 ± 28.3) months] with no late death.The recent echocardiography results showed that the pressure gradients were(16.3 ± 15.2) mmHg.Five patients required reoperations due to recurrence of stenosis and the freedom from reoperation was 82.8％ at 10 years.Conclusion Earlier diagnosis and intervention is recommended for SSS,and excellent relief can be achieved.
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Objective A retrospective study of patients in the past ten years who underwent surgeries because of secondary subaortic stenosis(SSS) after previous repair of congenital heart disease(CHD) was performed.The anatomy,indication,and surgical outcomes were studied.Methods Between January 2004 and October 2013,forty-eight patients underwent surgeries because of SSS.Thirty-five patients were males,and 13 were females.The mean age was(54.0 ± 34.9) months (12-156 months).The mean weight was(16.1 ±6.2)kg(6.0-37.5 kg).And the mean interval between the first and second surgery was(39.6 ±25.0) months(11-115 months).The primary diagnosis of CHD included ventricular septal defect,double outlet of right ventricle,corctation,interruption of aortic arch,patent trucus arteriosus,atrio-ventricular defect,tetralogy of fallot,transposition of great arteries,and univentricle.Results Twenty-five patients were discrete subaortic stenosis,and had the fibromuscular ridge resected.Twenty-three patients were diffuse type of subaortic stenosis.Myectomy,reconstruction of the intraventricular baffle,and modified Konno procedure were done in 8,5,and 10 patients separately.One patient died of cardiac failure postoperatively.One developed complete left bundle branch block,and another one developed complete atrioventricular block.The pressure gradients dropped from(76.8 ±20.4)mmHg to(12.4 ±8.4)mmHg,P ＜0.001.One patient was lost in follow-up and the left 46 patients had been followed up for 27 ～ 144 months [mean (59.6 ± 28.3) months] with no late death.The recent echocardiography results showed that the pressure gradients were(16.3 ± 15.2) mmHg.Five patients required reoperations due to recurrence of stenosis and the freedom from reoperation was 82.8％ at 10 years.Conclusion Earlier diagnosis and intervention is recommended for SSS,and excellent relief can be achieved.
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Objective A retrospective review of the use of delayed sterna closure (DSC) after pediatric cardiac operations.The purpose of this study is to access the morbidity of DSC and to analyze the risk factors that may predict the need for DSC.Methods Between January 2008 and December 2011,5 546 infants (2 843 males,2 703 females) underwent cardiac operations through midterm sternotomy in Shanghai Children' s Medical Center.Median age was 5 months(1 day to 11 months) and mean weight was 6.1 kg(2.0-12.5 kg).The pathologies included transposition of great artery(TGA),corctation of aorta (CoA),interruption of aortic arch (IAA),pulmonary atresia (PA),truncus arteriosus (Truncus),complete atrioventricular septal defect(CAVSD),total anormalous pulmonary vein connection (TAPVC),double outlet of right ventricle(DORV),tetralogy of Fallot(TOF),and ventricular septal defect(VSD),et al.All hospital records were reviewed and clinical data were studied and analyzed.Results A total of 313 patients had DSC (5.6％).There were 191 males and 122 females.The reasons for DSC are hemodynamic instability in 296,bleeding in 11,and ECMO(or VAD) in 6 patients.Two hundred and fiftyone (80.2％) patients were less than 5 kg,84 (26.8 ％) patients were neonates,and 125 (39.9％) patients aged between one and three months old.The incidences of DSC for these patients were 13.9％,34.4％,and 18.4％ respectively.The diagnosis of complex congenital heart defects had a high risk of DSC.The incidences of DSC for TGA,CoA,IAA,PA,Truncus,CAVSD,TAPVC,and DORV were 28.8％,17.8％,43.1％,9.0％,30.4％,6.5％,and 10.8％ respectively.The DSC patients had longer duration of CPB time(147 min versus 72 min) and clamping time(81 min versus 40 min).In 282 patients the sternums were closed 1-11 days after the initial operation.In 3 cases the trial of closure failed for the first time and succeeded a second time until several days later.Fouty-six patients died ultimately including 15 patients died after the closure of sternum with a total mortality of 14.7 ％.Surgical site infection occurred in 17 patients (5.4％),and surgical intervention were needed in 4 severe cases(1.3％).Conclusion Neonates,an age less than 3 months,weight less than 5 kg,long CPB time and clamping time,and the diagnosis of complex congenital heart defects were risk factors of the need for delayed sterna closure after pediatric cardiac operations.
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Objective To studiy the surgical outcomes of children with congenital aortic stenosis (AS),and summarized the experience of surgical procedures.Methods From February 2006 to November 2011,a total of 49 consecutive children with AS underwent surgical treatments.Twenty-nine patients were male and 20 patients were female.The median age was 17 months (1 month to 14 years),and median weight was 15.6 kg (3.2-47.0 kg).Peak AS gradients was (74.9 ±20.4)mmHg (45-123 mm Hg) before surgery.Fourteen patients had isolated congenital AS,4 had combined moderate-to-severe aortic insufficiency (AI).Thirty-Three patients had associated cardiac anomalies,including ventricular septal defect,atrial septal defect,patent ductus ateriosus,coarctation of aorta,subaortic stenosis,and supravalvular mitral stenosis.Thirty-one patients underwent aortic valvotomy,9 valvuloplasty,2 Aortic valve replacement (AVR),1 Ross procedure,2 Ross-Konno procedure,and 4 Konno/AVR.Median follow-up was 20 months (2-55 months).Clinical and echocardiographic follow-up data were analyzed.Results There was 1 postoperative death who died of heart failure due to severe mitral valve insuffciency.Latest follow-up data showed that the survivals performed in satisfactory cardiac function.Left ventricular ejection fraction (LVEF)was 0.69 ±0.10,and fraction shortening (FS) was 0.38 ±0.09.Peak AS gradients decreased significantly after surgery to (38.6 ± 15.8) mm Hg (20-73 mm Hg),P ＜ 0.001.One patient needed reintervention because of severe recurrence of adhesion in the commissure 3 months after the previous surgery.Totally 31 patients underwent simple valvotomy procedure.Postoperative AI was none or trace in 5,mild in 20,and moderate in 6.Two surgical techniques were used to repair the aortic valve according to the anatomy of the valve and the cause of insufficiency,including commissuroplasty in 6 and pericarial casp extension in 3.Nine patients underwent valvuloplasty procedure,post-operative AI was none or trace in 3,mild in 5,and moderate in 1.We put more attention to the 7 patients who had moderate AI valvotomy or valvuloplasty,and the latest follow-up showed that these patients were in good condition and there was no deterioration the degree of AI.Conclusion Long-term outcomes show that aortic valvotomy and valvuloplasty are reliable and effective approaches for congenital AS in children.When moderate-to-severe AI exists,other procedures such as Ross,Ross-Konno,AVR,or Konno/AVR are preferred.