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Objective:To investigate the diagnosis, surgical methods, perioperative treatment and surgical results of Kommerell's diverticulum with double aortic arch in infants.Methods:From December 2014 to December 2019, 22 cases of double aortic arch combined with Kommerell diverticulum were operated in our hospital, 14 males and 8 females, with an average age of (13.7±11.6) months (1-36 months) and mean body mass of (9.8±3.4)kg (5-20 kg). The children had respiratory symptoms such as asthmatic suffocation, shortness of breath, repeated respiratory tract infection and chronic cough before operation. All patients underwent cardiac CT examination. The average diverticulum was 8 mm×9 mm, in the trachea The average compression degree of the lower segment was 56%±16% (30%-80%). The distal part of the left arch was atresia and Kommerell's diverticulum was found in all patients. The operation methods were left aortic arch separation, ligament separation and diverticulectomy. In one case, tracheal stent was placed simultaneously during the operation because of severe tracheal malacia.Results:The average time in the ward was(1.4±0.8)days (1-4)days, and the average time in hospital was (6.7±2.8)days (4-13 days). The average follow-up period was (25.5±16.9) months (2-60 months). During the follow-up period, 18 children had no persistent respiratory symptoms, and 4 children had only slight respiratory symptoms.Conclusion:Kommerell's diverticulum can also be combined with double aortic arch. The operation method is to separate the aortic arch and ligament at the atresia end and resect the diverticulum at the same time. It has a good early prognosis and may eliminate the residual symptoms and late complications.
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Objective:To investigate the morphological characteristics and operative methods of mixed total anomalous pulmonary venous connection (TAPVC), and to analyze the risk factors of postoperative death.Methods:From January 2011 to January 2019, 17 cases of mixed TAPVC were operated in Department of Cardiovascular Surgery, Beijing Children′s Hospital, Capital Medical University, with 10 males and 7 females.The average age was (4.4±3.8) months (1-15 months) and the average body mass was (5.6±1.7) kg (3.5-10.0 kg), including 1 case of ventricular septal defect, 17 cases of atrial septal defect and 15 cases of ductus arteriosus.Preoperative pulmonary vein stenosis was discovered in 4 cases and severe pulmonary hypertension was in 10 cases.A total of 5 cases needed ventilator support before operation, and 2 cases needed emergency operation.The diagnosis was confirmed by color Doppler ultrasound and CT before operation.There were 2 cases of type Ⅰ (type 2+ 2), 13 cases of type Ⅱ (type 3+ 1), and 2 cases of type Ⅲ (anatomic variant).Results:All the patients were treated through operation.The principle of operation was to correct all pulmonary veins to the left atrium.The cardiopulmonary bypass time was (182.3±122.8) min, the aortic occlusion time was (84.3±15.9) min, the postoperative ventilator support time was (92.9±70.0) h, and the monitoring room time was (6.9±4.9) d. In this group, 3 cases died in hospital (17.6%) and 1 case died out of hospital (5.9%).Conclusions:The mortality of mixed TAPVC type Ⅲ was high, while preoperative pulmonary vein stenosis, severe pulmonary hypertension and the combination of sub-cardiac type were the important risk factors of death.The operation mode depends on the anatomic drainage mode, so individualized operation is recommended.
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<p><b>OBJECTIVE</b>To observe the feasibility of establishing a porcine model of microvascular coronary artery spasm by intracoronary neuropeptide Y (NPY) infusion, and to analyze the characterization of this model.</p><p><b>METHODS</b>Minipigs were divided into four groups (n = 4 each): normal saline (NS) group, 1 nmol NPY group, 3 nmol NPY group, and 6 nmol NPY group. Arterial sheaths were planted into bilateral femoral arteries of minipigs. A pigtail catheter was placed at the left sheath to determine the hemodynamic parameters. NS and different doses of NPY were injected into the left anterior descending branch through the right sheath. Intravenous myocardial contrast echocardiography (MCE) was applied to measure the microvessel volume (α), filling velocity (β), and microcirculation blood flow (MBF) before and at 10 and 30 minutes after NS and NPY injection.</p><p><b>RESULTS</b>Before and after injection, there were no difference in α, β and MBF between NS and 1 nmol NPY group (all P > 0.05). In 3 nmol NPY group, α and MBF decreased at 10 min (P < 0.01 and 0.05, respectively), which were recovered at 30 min except α. Reductions of β (P < 0.05) and MBF (P < 0.01) were observed at 10 min in 6 nmol NPY group, which were recovered at 30 min, but MBF still remained lower than at baseline (P < 0.01) and compared to 3 nmol NPY group (P < 0.05).</p><p><b>CONCLUSION</b>Intracoronary injection of NPY into the anterior descending coronary artery can establish the porcine model of microvascular coronary artery spasm, which might serve as a useful animal model for coronary microvascular studies.</p>
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Animals , Coronary Circulation , Coronary Vasospasm , Coronary Vessels , Disease Models, Animal , Echocardiography , Spasm , Swine , Swine, MiniatureABSTRACT
Objective This study was designed to investigate the relationship of the coronary anatomy pattern in 56 arterial switch operation (ASO) with the early outcome.Methods From May 2010 to September 2013,a total of 56 patients with transposition of the great arteries complicated with other defomities(39 males and 17 females,with age of 5 days to 126 months),who were undertook ASO in Capital Medical University affiliated Beijing Anzhen Hospital.There were 19 patients with complete transposition of the great arteries and intact ventricular septum,35 patients with complete transposition of the great arteries and ventricular septal defect.and 1 patient with double outlet right ventricle with subpulmonary ventricular septal defect (Taussing-Bing).33 were complicated with atrial septal defect and 26 with patent ductus arteriosus,20 had severe pulmonary hypertension,2 had pumonic valve stenosis and 1 had coarctatioin of aorta.All patients undertook ASO,coronay distribution were detected during the procedure and coronary artery were grafed.Results Coronary artery:Yacoub type A were 46 cases:4 patients died during the 30 days after the operation,Yacoub type B were 5 cases:2 patients died.Yacoub type C were 2 cases:1 died of low cardiac output on the operating day.Yacoub type D were 1 case and Yacoub type E were 2 cases:none of them died.Conclusion Patients with common coronary variants have undergone ASO without added mortality rate.Those with intramural or single coronary arteries have significant added mortality rate.
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Objective To investigate the feasibility and clinical application of real-time threedimensional transesophageal echocardiography(RT3D-TEE). Methods Fifty-nine patients with various heart diseases were examined or monitored by RT3D-TEE.Among them,20 patients with different kinds of arrhythmias,24 patients with valvular heart diseases, 12 patients with congenital heart diseases,2 patients with aortic dissection, 1 with unexplained pulmonary hypertension. Results RT3D-TEE was performed successfully in all the patients with good image quality and the normal tissues as well as diseased cardiac structures were distinctly displayed.Conclusions RT3D-TEE is a safe and reliable new technique which can be applied in the patients with poor acoustic window and may be a powerful tool in the intraoperative monitoring.RT3D-TEE is also an important supplement to real time three dimensional transthoracic echocardiography and makes it possible for the first time to monitor the cardiac operation with RT3D-TEE without interrupting the operation procedure.