ABSTRACT
Objective To assess the application of echocardiography in mini-invasive surgical device closure of ventricular septal defect (VSD). Methods 73 VSD patients including 35 with aneurysm formation and among them 21 with multi-defects in the aneurysm were treated by mini-invasive device closure. A closure device was positioned to the defect through parastemal mini-incision in all patients. TEE was used to monitor the whole procedure, to guide the device positioning and to evaluate the curative effect instantly after operation. All patients were evaluated by TTE one year postoperatively. Results All patients were successfully positioned closure devices by TEE guiding. 9 cases were found with trace to small amount residual shunt instantly after operation. 7 cases still had small amount residual shunt at the time of 48 hours after the operation. In the one year follow-up, 4 cases had residual shunt, but the size and volume of left ventricle were significantly reduced than those before operation, and the pulmonary artery systolic pressure was also reduced. Conclusion Echocardiography possesses an important role in preoperative indication screening, intraoperation monitoring and evaluating the curative effect postoperatively.
ABSTRACT
[Objective]To explore the apparatus assembly,operative methods,post-operative management procedure and the effect of Ilizarov's technique of distraction histogenesis to correct the severe compound knee joint deformities (more than two deformities of knee joint such as knee flexion contracture with genu varus and limb shortening).[Method]According to Ilizarov technique of distraction histogenesis,three dimensional knee joint distraction apparatus together with limb lengthening accessories for simultaneous lengthening of the lower limb were designed.In accordance with different types of compound knee joint deformities and the positions of skeletal deformities,across knee joint distraction apparatus was applied with simultaneous distal femoral or proximal tibial osteotomy.Soft tissue contracture of knee joint along with co-existing skeletal deformity and shortening were simultaneously corrected by slowly turning the corresponding distraction rods at seven days after the operation.During the period of distraction,patients can walk with partial weight bearing.After healing of the distraction bone regenerate,the distraction apparatus was removed and the knee joint brace applied for the patients to walk for about 3～6 months.From May 1996 to Feb 2004,compound knee joint deformities were corrected in 14 patients aged between 5 and 41 years old with an average age of 27 years and etiologies of 7 kinds,in whom four cases had developmental deformities of the knee joint caused by epiphyseal injury or infection in infancy and ten cases caused by other reasons.[Result]The time of joint distracting and bone healing was 80~390 d,average 154 d.All cases had satisfactory correction of severe compound knee joint deformities such as knee flexion contracture,genu varus,genu valgus,limb shortening and rotational deformity with good walking function.None had complications such as severe pin tract infection,injury to blood vessels and nerves and non-union.But a different extent of knee joint stiffness occurred.[Conclusion]Ilizarov technique of distraction histogenesis can be used to correct severe compound knee joint deformities and limb length inequality.It follows with biological principles,makes achievements unattained by traditional orthopedic surgery and have good prospect of application.