ABSTRACT
Objective:To summarize the surgical treatment result in patients with anomalous left coronary artery from pulmonary artery (ALCAPA) combining severe left ventricular dysfunction.Methods:A total of 24 ALCAPA patients combining severe left ventricular dysfunction received coronary reimplantation in our hospital from 2009-02 to 2016-04 were retrospectively studied.The patients' mean age was 7.0 (5.0,17.8)months including 13 male;mean left ventricular ejection fraction (LVEF)＜30％ and the median pre-operative LVEF was 21.0％ (17.3％,26.5％).Results:There were 2/24 (8.3％) in-hospital death,The median cardiopulmonary bypass time was 109 (95,128) min,aorta cross-clamp time 65 (48,87) min,mechanical ventilation time 94.5 (48.3,165.5) h and ICU stay time 176.5 (101.0,305.3) h;2 patients received ECMO support and weaned off successfully and 2 patients received re-intubation.In 22 survival patients,the median discharge LVEF was 26.0％ (20％,35％) which was similar to pre-operative condition,P＞0.05.The mean follow-up time was (15.3±14.9) months at the longest of 63 months,no re-admission,reoperation and death occurred.The patients had NYHA I and the last follow-up LVEF was 60％ (50％,69％) which was increased than discharge level,P＜0.05,4 patients had LVEF＜50％.Conclusion:Surgical treatment had satisfactory short-and mid-term outcomes in ALCAPA patients combining severe left ventricular dysfunction;comprehensive effort should be emphasized in surgery,anesthesia,cardiopulmonary bypass and ICU management at peri-operative period.
ABSTRACT
Objective: To retrospectively summarize the clinical experience of one-stage repair and surgical management in patients with interrupted aortic arch (IAA) combining aortopulmonary window (APW). Methods: A total of 8 patients with IAA combining APW received surgical repair in our hospital from 2009-01 to 2016-08 were enrolled including 4 male, the age at operation was between 3 months to 4.5 years. There were 6 patients<1 year at the mean age of (5.2±2.7) months with the mean body weight at (5.7±1.6) kg; 2 patients>1 year at the mean age of (4.1±0.6) years with the mean body weight at (14.6±0.9) kg. All patients had the history of repeated respiratory infection before the operation. The IAA morphology included type A in 6 patients and type B in 2; APW morphology included type II in 6 patients and type III in 2. All patients received median sternotomy with deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. The malformation of IAA combining APW was corrected by one-stage operation. Results: The mean pre-operative pulmonary artery systolic pressure (PASP) was (83.1±8.3) mmHg, mean cardiopulmonary bypass time was (127.0±18.5) min, aortic cross-clamp time was (78.0±14.1) min; the mean post-operative PASP was (43.6±8.5) mmHg, no operative death occurred. The patients were followed-up for (19.8±13.9) months and the mean aortic arch pressure gradient was (11.2±4.7) mmHg, all patients were well recovered. Conclusion: Primary anatomical IAA combining APW can be thoroughly corrected by one-stage operation; median sternotomy was simple method with good effect.
ABSTRACT
Objective:To summarize the surgical treatment result in patients with anomalous left coronary artery from pulmonary artery (ALCAPA) combining severe left ventricular dysfunction.Methods:A total of 24 ALCAPA patients combining severe left ventricular dysfunction received coronary reimplantation in our hospital from 2009-02 to 2016-04 were retrospectively studied.The patients' mean age was 7.0 (5.0,17.8)months including 13 male;mean left ventricular ejection fraction (LVEF)＜30％ and the median pre-operative LVEF was 21.0％ (17.3％,26.5％).Results:There were 2/24 (8.3％) in-hospital death,The median cardiopulmonary bypass time was 109 (95,128) min,aorta cross-clamp time 65 (48,87) min,mechanical ventilation time 94.5 (48.3,165.5) h and ICU stay time 176.5 (101.0,305.3) h;2 patients received ECMO support and weaned off successfully and 2 patients received re-intubation.In 22 survival patients,the median discharge LVEF was 26.0％ (20％,35％) which was similar to pre-operative condition,P＞0.05.The mean follow-up time was (15.3±14.9) months at the longest of 63 months,no re-admission,reoperation and death occurred.The patients had NYHA I and the last follow-up LVEF was 60％ (50％,69％) which was increased than discharge level,P＜0.05,4 patients had LVEF＜50％.Conclusion:Surgical treatment had satisfactory short-and mid-term outcomes in ALCAPA patients combining severe left ventricular dysfunction;comprehensive effort should be emphasized in surgery,anesthesia,cardiopulmonary bypass and ICU management at peri-operative period.