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Objective To investigate the incidence and prognosis of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects in pediatric patients as well as the risk factors of regurgitation occurrence or aggravation.Methods Clinical data of 1 108 patients who underwent percutaneous closure in Shanghai Children's Medical Center,School of Medicine,Shanghai Jiaotong University from January 2011 to January 2017 was analyzed retrospectively,and the prognosis and risk factors of postoperative tricuspid regurgitation and aggravation were also analyzed.Results Mild tricuspid regurgitation occurred in 24 cases after surgery with the incidence of 2.1％.Among 5 cases with mild or above preoperative tricuspid regurgitation,the regurgitation was alleviated after surgery in 4 cases.No severe tricuspid regurgitation requiring surgical intervention occurred in any patient during follow-up.Univariate analysis showed that intervention time (P ＜ 0.05) and residual shunt (P ＜ 0.05) were risk factors for mild or above tricuspid regurgitation after intervention.Binary regression analysis indicated that the size of the occluder (mm) (OR =1.48,95％ CI:1.13-1.90) and residual shunt (OR =6.53,95％ CI:1.69-25.30) were risk factors for tricuspid regurgitation after intervention (all P ＜ 0.05).Conclusions There is a certain incidence of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects,but most tricuspid regurgitation do not need surgical intervention.The intervention time,size of occluder and residual shunt are risk factors of intraoperatively or postoperatively tricuspid regurgitation.
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Objective@#To investigate the incidence and prognosis of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects in pediatric patients as well as the risk factors of regurgitation occurrence or aggravation.@*Methods@#Clinical data of 1 108 patients who underwent percutaneous closure in Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiaotong University from January 2011 to January 2017 was analyzed retrospectively, and the prognosis and risk factors of postoperative tricuspid regurgitation and aggravation were also analyzed.@*Results@#Mild tricuspid regurgitation occurred in 24 cases after surgery with the incidence of 2.1%.Among 5 cases with mild or above preoperative tricuspid regurgitation, the regurgitation was alleviated after surgery in 4 cases.No severe tricuspid regurgitation requiring surgical intervention occurred in any patient during follow-up.Univariate analysis showed that intervention time (P<0.05) and residual shunt (P<0.05) were risk factors for mild or above tricuspid regurgitation after intervention.Binary regression analysis indicated that the size of the occluder (mm) (OR=1.48, 95%CI: 1.13-1.90) and residual shunt (OR=6.53, 95%CI: 1.69-25.30) were risk factors for tricuspid regurgitation after intervention (all P<0.05).@*Conclusions@#There is a certain incidence of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects, but most tricuspid regurgitation do not need surgical intervention.The intervention time, size of occluder and residual shunt are risk factors of intraoperatively or postoperatively tricuspid regurgitation.
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Background: We reviewed our experience with ruptured sinus of Valsalva aneurysms (RSOV) to determine a correlation with preexisting heart failure (HF) and coexisting cardiac lesions (aortic regurgitation [AR] and ventricular septal defect [VSD]) to postoperative left ventricular (LV) dysfunction and postoperative outcomes. Materials and Methods: Retrospective review of RSOV cases over 15 years showed that RSOV repair was done in 87 patients. We looked for patients who presented with HF and patients having AR and/or VSDs. Statistical analysis was done to see if the coexisting lesions and preoperative HF were associated with postoperative LV dysfunction. Chi-square test was used on contingency table for statistical analysis. Complications in the postoperative period and prolonged Intensive Care Unit stay were noted. Results: 17% (15/87) presented with HF. Fifty-two patients had moderate to severe AR and 50 patients had VSD. Seventeen patients had postoperative LV dysfunction. The correlation of preoperative HF and coexisting lesions with postoperative LV dysfunction was not statistically significant. Two patients underwent redo surgery for residual RSOV and AR. Two patients had arrhythmias. One patient had cerebrovascular accident. No mortality was seen in the study. Conclusion: Preoperative HF and the presence of VSD and/or AR have no statistical significant correlation with postoperative LV dysfunction. As the outcome of RSOV repair is good, all patients need to undergo early repair to avoid complications.
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OBJECTIVE: To evaluate the the effect and prognosis of transcatheter device closure for perimembranous ventricular septal defects(PmVSDs)with aortic valve prolapse(AVP). METHODS: The clinical data of 1108 patients who underwent percutaneous closure from January 2011 to January 2017 were collected to conduct this retrospective study,mainly including transthoracic echocardiography,digital subtraction angiography data,occluder type and sociodemographic information(age,weight and gender). T-test and Mann-Whitney U test were used to compare group measurement data. Wilcoxon signed rank test was used for the nonnormal distribution of paired design data. Fisher exact test was used for the four fold table. Monte Carlo approximation exact probability method was used for the R×C table.Multiple Logistic-regression analysis was used to estimate the risk factors of AR. RESULTS: Compared with 10(0.9%)of1053 patients without AVP,8(14.5%)of the 55 children with preoperative AVP presented aggravated postoperative aortic regulation(AR)and AR usually occurred in the long-term follow-up(>1 year). None of the AR progressed to moderate or severe. There were no significant changes in left ventricular ejection fraction,left ventricular shortening rate or AR before and after interventional operation in PmVSDs with AVP. CONCLUSION: Percutaneous closure for ventricular septal defect combined with AVP is an effective alternative to surgery when using appropriate occluders,meeting related standards and operated in an experienced cardiovascular center.
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Objective@#To reviewe our clinical experience on biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch and right ventricle apex excluding technique in 9 infants.@*Methods@#From March 2014 to March 2019, a series of 9 patients(M/F=2/7) with Swiss-cheese ventricular septal defects were admitted in our center to receive surgical treatment, with a median age of 4.8(2-12) months and a median body weight of 4.5(3.7-6.8) kg. All the 9 cases were symptomatic with shortness of breath and sweating. All the patients received echocardiography, ECG and chest X-ray. 3 patients with other intracardiac anomalies received CT angiography and 1 with severe pulmonary hypertension had transcatheter angiography. 4 cases of 9 had antenatal echocardiography but with no positive findings. The median cardiothoracic ratio was 0.63(0.58-0.72). 8 cases underwent one-stage surgical repair with the two-patch and right ventricle apex excluding technique and 1 case received a second-stage surgical repair with the same technique following a previous pulmonary artery banding procedure. The surgical repair was carried out with cardiopulmonary bypass under moderate hypothermia and using HTK cardioplagia to stop the heart in all the 9 cases. 2 fresh autologous pericardium patchs were used to closure defects of the outflow tract area and the apex trabecular defects respectively by excluding the apex of the right ventricle from the right ventricular inflow. Other intracardiac anomalies were corrected simultaneously. Patients were strictly followed up with a stanard protocol.@*Results@#All the operations were successful. Median cardiopulmonary bypass time and aortic clamping time were 96(68-167)min and 68(43-122)min respectively. Delayed chest closure were done in 2 cases within 48-72 hours postoperatively. The time of mechincal ventilation and ICU stay were 131.3(32-328)hours and 8.7(5-31)days respectively. All the patients were discarged in 11.5(9-42)days after operation. There was no mortality and major complication except for 1 case of low cardiac output syndrome, 2 cases of ventilator associated pnumonia and 2 cases of residual shunt(less than 2 mm). All the patients were followed up for 3.2 years(1 month-9 years). There was no death and major complication. The latest echocardiography results showed that the left and right heart function was normal in all the cases.@*Conclusion@#Biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants can be relatively easy with favorable early and mid-term results. Long term results need to be evaluated with more cases.
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Ventricular septal defects are the most common congenital heart disease and there are three therapies to close them including surgical closure,hybrid closure as well as transcatheter closure.In 1988,Lock first reported on a series of patients who underwent transcatheter closure of muscular ventricular septal defects using the Rashkind device.With the renovation of the device,the improvement of operational procedure and the accumulation of clinical experience,transcatheter closure of ventricular septal defects has been widely carried out in the clinic.It has the advantages of small trauma,good curative effect,rapid postoperative recovery,no scar,less main complications and good long-term prognosis,which are getting more and more attention.This article reviews the current status and major complications of transcatheter closure of ventricular septal defects and the therapeutic efficacy is also under discussion.
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Ventricular Septal Defects (VSD) with severe pulmonary hypertension (PHT) patients are the difficult ones to intervene as they carry increased risk of postoperative morbidity and mortality especially when pulmonary pressures are near to systemic pressures.We share our experience of 31 such cases managed by double flap technique and use of pulmonary vasodilators.
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Objective:To investigate the feasibility and safety of perimembranous ventricular septal defects (PmVSD) closure solely by femoral vein approach under transesophageal echocardiography (TEE) guidance.Methods:From January 1,2014 to May 31,2016,26 patients with PmVSD in Second Xiangya Hospital were selected,with age at 3.2-6.0 (4.3±0.7) years old and body weight at 15.0-19.5 (16.7±1.4) kg.The diameter of VSD was 3.5-4.8 (4.1±0.3) mm.All patients were treated by percutaneous PmVSD closure solely by femoral vein approach under TEE guidance.The effect of the procedure was evaluated by TEE and transthoracic echocardiography (TTE).The clinical follow-up study was conducted by TTE at 1,3,6 and 12 month (s) after the procedure.Results:Twenty cases were successfully treated with percutaneous PmVSD closure solely by femoral vein approach under TEE guidance,and the success rate was 76.9％.Six patients were converted to perventricular closure under TEE guidance because the guide wire in two cases or catheter in other cases could not pass through PmVSD.The diameter of symmetrical VSD occluder was 6.0-7.0 (6.2±0.4) mm.The procedural time was 12.0-64.0 (26.8±6.3) min.The residence time at ICU was 1.8-2.4 (26.8±6.3) h.The in-hospital time was 4.0-5.0 (4.4±0.5) d.There were 3 patients with immediate post-operative trivial residual shunt and incomplete right bundle branch block (IRBBB).All patients survived with no peripheral vascular injury or complications such as tricuspid regurgitation,pericardial tamponade and pulmonary infection.The residual shunt disappeared in 3 patients and IRBBB became normal rhythm in 3 patients at 1 month follow-up time point.No patients suffered from occluder malposition,residual shunt,pericardial effusion,arrhythmia (atrio-ventricular block),aortic valve regurgitation and tricuspid regurgitation.Conclusion:TEE-guided percutaneous PmVSD closureby femoral vein approach is safe and effective.
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Objective To explore if any rules in electrocardiogram changes after transcatheter closure of perimembranous ventricular septal defects ( PMVSD ) . Methods We included all the 358 patients who have accepted transcatheter closure of PMVSD in our hospital between July 2006 to October 2014 and the electrocardiogram (ECG) done in hospital and during follow up in 1,3, 6 and 12 months after operation were all reviewed. Results No changes were found in heart rates and electrical axis during follow-up as compared to preclosure ECG. PR interval was shorter, the QRS duration and QT interval were longer than preclosure. Incidence rate of arrhythmia was 38. 0% ( 136/358 ) and incidence rate of serious arrhythmias ( including Ⅱ° or Ⅲ° atrioventricular block and complete left bundle branch block) was 5. 0%(18/358). Among the 180 patients who had ECG done in all follow up between the first 12 months post closure, the rates of new developed arrhythmias was 12. 8% ( 23/180 ) and severe arrhythmia was 0. 6%(1/180) during follow-up. Conclusions Incidence rate of serious arrhythmias after transcatheter closure of PMVSD is low and most patients have good clinical outcome.
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Objective To analyze the causes of failed transcatheter closure for ventricular septal defects (VSD)in children. Methods One thousand two hundred and eighty children aged 13 to 141 months who underwent transcatheter closure from June 2009 to September 2013 in Guangdong General Hospital were selected. There were 43 failures(3. 36% ). The clinical data including transthoracic echocardiograph( TTE),radiography,interventional ap-proach and surgical findings were analyzed. Results Forty - three patients included 25 male and 18 female. The pa-tients' ages ranged from 13 to 141(43. 0 ± 31. 9)months and their weight ranged from 10 to 35(16. 3 ± 5. 59)kg. The causes of failure including doubly committed subarterial VSD misdiagnosed as perimembranous VSD(PMVSD)or intracristal VSD were in 6 patients. The size of occluder was too small in 13 cases,and there were statistical differences between three measurements of size of VSD(F = 19. 134,P = 0. 001). The size of VSD measured by left ventricular an-giography was significantly smaller than that measured by TTE,and there was statistical difference[(4. 78 ± 1. 11) mm vs(6. 48 ± 1. 43)mm,t = 4. 50,P = 0. 001]. The dimension of VSD measured by left ventricular angiography was significantly smaller than that measured by surgical findings,and there was statistical difference[(4. 78 ± 1. 11) mm vs(7. 02 ± 1. 08)mm,t = 5. 92,P = 0. 001]. But,the size of VSD measured by TTE had no significant difference compared with that measured by surgical findings(t = 1. 42,P = 0. 168). Aortic regurgitation occurred in 14 cases;atrioventricular block or left bundle branch block in 3 patients;tricuspid stenosis in 2 cases and residual shunt in 5 pa-tients. Conclusions Doubly committed subarterial VSD may be misdiagnosed as PMVSD or intracristal VSD. In the ca-ses of VSD concomitant with aortic valve prolapse,size of the occluders should be referred to VSD dimensions measured by TTE. In the cases of VSD adjacent to aortic valve,suitable occluders should be selected and operation technique should be improved to avoid aortic regurgitation.
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Objective: Traditional percutaneous ventricular septal defect (VSD) closure had disadvantages of radiation and contrast media reaction in relevant patients. We want to investigate the efifcacy and safety of percutaneous VSD closure under solely guidance of echocardiography. Methods: A total of 28 VSD patients treated by percutaneous VSD closure under solely guidance of trans-thoracic echocardiography in our hospital from 2014-02 to 2014-10 were summarized. The patients mean age was (9.5 ± 3.1) years with the body weight at (31.3 ± 7.7) kg. The average diameter of VSD was (4.6 ± 0.9) mm, and the clinical follow-up study was conducted by echocardiography at 1, 3, 6 and 12 months after the procedure. Results: There were 26 patients with successful treatment by percutaneous VSD closure under solely guidance of echocardiography. 1 patient was converted to perventricular closure with trans-esophageal echocardiography guidance because the catheter could not pass through the defect; another patient was converted to surgical repair because of the residual shunt > 2 mm. The average procedural time was (63.3 ± 11.7) min and the mean diameter of symmetrical occluder was (6.6 ± 1.0) mm. There were 2 patients with immediate post-operative residual shunt, and the average in-hospital time was (3.7 ± 1.3) days. All patients discharged without the complications as peripheral vascular injury or cardiac perforation. The average follow-up time was (6.2 ± 3.4) months. The residual shunt disappeared in 2 patients at 1 month follow-up time point. No patients suffered from pericardial effusion, occluder malposition, atrio-ventricular block and aortic valve regurgitation. Conclusion: Echocardiography guided percutaneous VSD closure is safe and effective, it may avoid the radiation and contrast media reaction in relevant patients.
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Objective To explore the operative indication operation time and post-operative care for infants with large ventricular septal defects (VSD).Methods Eighty-eight infants who suffered from large VSD were selected,male 53 cases,female 35 cases,aged from 3 to 18 months[average (7.5-±2.9) months],weight from 5 to 13 kg [average (7.9 ± 1.9) kg].All patients underwent VSD repair and other accompanied anomaly corrections under cardiopulmonary bypass.Fifty-eight cases were operated through right atrium,14 cases through pulmonary artery and 16 cases through right ventricle.Patch repairs were done in all patients,78 cases given bovine pericardium patches,10 cases given self pericardium patches treated by Glutaral.Patients were sent to the intensive care unit after surgery,vasoactive drugs were used as a routine method.Antibotics were selected based on their sputum cultures postoperatively.Nutritional support was given in the earlier stage.Results There were no hospital death,average hospitalization days were (15.2 ± 5.9) days (from 11 to 32 days).The main complication were pneumonia (5 cases),bad coalesce of incision (4 cases),atelectasis (3 cases),minimal residual shunt of VSD (3 cases).All patients were discharged from hospital,76 cases were followed up from 1 to 12 months,2 cases had residual shunt of VSD,the residual shunt of the other case disappeared;76 patients had no clinical symptom,28 patients body weight returned to normal after 6 months of operation.There was no other complication and death.Conclusion Early surgical treatment for infants with large VSD is a safe and effective way with a better prognosis.
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Objective To study the feasibility and long-term effects in 173 infants with congenital ventricular septal defect who underwent transcatheter therapy by double-disk ventricular septal defect occluder. Methods We analyzed the clinical data of 173 infants with ventricular septal defect who were performed interventional therapy followed by a follow up study from December 2002 to October 2013. Results The procedure was performed in 173 infants (male = 81 cases and female = 92 cases) aged 11 month-3 years[(2.1±0.7)years]. The weight were 6-15 kg[(10.2±3.6)kg]. The diameter of the defects ranged from 2.5-9.0 mm[(5.1±1.7) mm]. The characteristics of septal were classiifed into four types:the simply perimembranous ventricular septal defects (88 patient,50.8%), the perimembranous ventricular septal defects with pseudoaneurysm (52 patients, 30.0%), the perimembranous ventricular septal defects complicated with aortic valve prolapse (13 patients, 7.5%), and the intracristal ventricular septal defect (20 patients, 11.7%). The diameter of the occluders were between 4-12 mm[(6.3±2.2)mm]. The period of follow-up ranged from 1 month-10 years[(6.2±1.3)years]. The 168 defects were completely occluded in 173 patients(97.1%closure rate) except 5 infants, which 3 patients because the occluder hinder the function of aortic valves and the other occurred complete atrioventricular block(CAVB) when the catheter through defect. One patient occurred CAVB on the third day after the procedure, was reversed by dexamethasone after 4 days. 3 patients with complete left bundle branch block(CLBBB) after the procedure and one went to sustained, but did not observed heart failure in this case during 5 years follow-up. One patient observed sustained CLBBB on the fourth year after the procedure, also did not observed heart failure in this case during 3 years follow-up. 8 patients with trivial residual shun and 4 patients with newly appearance of trivial aortic regurgitation after the procedure, the shun all disappear at one year and the regurgitation did not progress during longest follow-up period at 8.5 years. No other complications, including late-onset CAVB, hematolysis, the occluder displacement and detachment, occurred during 1 month-10 years of follow-up. Conclusions Transcatheter closure of congenital ventricular septal defects is an efifcient method that can be safely used in the majority of infants with ventricular septal defects and have signiifcant long-term effects.
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Objective To design and prepare a ventricular septal defect (VSD) occluder with bioabsorbable materials and to evaluate its in vitro degradation and mechanical force. Methods A bioresorbable VSD occluder was made of polymeric materials polydioxanone (PDA) monofilament, poly-L-lactic acid (PLA) fabrics and polyglycolic acid(PGA) sutures. Tantalum particleswere sewn on the symmetrical parts of the occluder disc as tracers for X-ray, and the end of the right side of the disc was designedwith a circular loop for the matched delivery system to clamp and deliver. Mechanical property and the degradation of the occluder were tested in vitro, and the effect of degradation on the mechanical properties and weights of the samples was examined. Results The mechanical properties of the bioresorbable VSD occluder, including the compression/elastic recovery properties, ultimate intensity of circular loop in the right disc, and left disc support force, met the requirements for transcathetering closure of VSD. In vitro degradation experiment demonstrated that the structure and shape of the occluder remained unchanged within eight weeks; PDO wire fracture, disintegration, and incomplete disc structure were observed on the 12th week. The support force of the left disc increased to 121. 7% and 107. 8 % of the original ones at the 2nd week and the 3rd week, respectively; while the force decreased to 88. 6% and 85. 3% of the original ones at the 4th and the 6th week, respectively. The weight of the occluder decreased by less than 1% within the first 4 weeks, and significantly decreased 6 weeks later. Conclusion The VSDoccludermade of biodegradable materials has qualified mechanical force for transcatheter implantation, and it can be used for future animal study.
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Objective To investigate the proper anesthetic administration schemes in pediatric patients undergoing surgery of transcatheter ventricular septal defect closure .Methods A total of 120 pediatric patients with congenital heart diseases of ventricu-lar septal defect ,aged 3-9 years old with ASA physiological status Ⅰ or Ⅱ ,undergoing surgery of transcatheter ventricular septal defect closure were randomly divided into 4 groups with 30 each :ketamine group( K group) ,propofol group( P group) ,ketamine associate with propofol ( KP group) ,sevoflurane group( S group) .Spontaneous respiration were maintained in K ,P ,PK groups ,but mechanical ventilation was adopted after endotracheal tube intubation in S group .The values of MAP ,HR ,SpO2 ,RR were recorded at the following time points :before anesthesia ,incision immediate ,procedure in heart ,completion of operation ,and 30min after oper-ation .awaking time and adverse reactions were recorded .Results Anesthesia and operation were carried out successfully in all pa-tients .Awaking time in P group and KP group markedly shorter than K group (P<0 .01) .The incidence rate of adverse reactions such as cough ,asphyxia and body motion in pediatric patients by mechanical ventilation and sevoflurane inhaled markedly less than other groups(P<0 .01) .Conclusion It is safe that pediatric patients received mechanical ventilation and sevoflurane inhaled after endotracheal intubation undergoing surgery of transcatheter ventricular septal defect closure .
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Objective To design and prepare a polyester-coated nitinol ventricular septal defect (VSD) occluder. Methods The shape wax model was made by slightly stretching the shape of the commercially available nitinol VSD occluder. The wax model was fixed on the weaving machine and a wax model-polyester coat compomer was made using the medical 4-0 sutures by warp knitting method. Then dewaxing and defatting were done and the polyester coat was produced. The commercially available nitinol VSD occluder was placed into the coat by sheath, with the ends of the polyester coat sutured at the VSD stainless steel rivets, and the surplus parts of both ends were cut by hightemperature knife. Results The polyester coat of VSD occluder was successfully made by weaving machine and warp knitting method. Polyester coat had a waist diameter of 8 mm and a disc diameter of 12 mm, and it completely fit with the conventional nitinol VSD occluder with diameter being 8 mm. The polyester coat was sutured tightly with the VSD occluder, and the surplus parts of two ends of the VSD occluder were cut smooth by high-temperature knife, with no loosening of the wire. Conclusion The polyester coat of nitinol VSD occluder can be woven by the weaving machine and warp knitting method, and then the polyester-coated nitinol VSD occluder can be successfully made by suture and high-temperature cutting.
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Objective To evaluate the early clinical efficaoy of hybrid procedure for infants less than six months old with ventricular septal defect and coarctation of aorta.Methods From January 2010 to July 2011,20 patients with ventricular septal defect and coarctation of aorta received hybrid procedure in our center.The body weight was (4.5 ± 1.6) kg ( ranged from 1.9 kg to 6.5 kg) and the age was ( 56 ± 45 ) days ( ranged from 18 days to 6 months).The pressure gradient of the coarctation of the aorta ranged from 30 mm Hg to 56 mm Hg,5 patients of them were diagnosed as hypoplasty of aortic arch.The size of the ventricular septal defect ranged from 8 mm to 16 mm.Results The mortality was zero in all the 20 cases during the surgery,and the mobidity was 20％ (4/20).The complications were pneumonia in 2 cases,infective endocarditis in 1 case and pneumothorax in 1 case.The diameter of coarctation of the aorta ranged from 1.5 mm to 3.4 mm,and the size of the balloon ranged from 4 mm to 12 mm.The pressure gradient of the coarctation of the aorta decreased to 0 to 27 mm Hg.The bypass time ranged from 40 minutes to 87 minutes,and the crossclamp time of the aorta ranged from 20 minutes to 41minutes.The atrial septal defects were repaired and the patent ductuses were ligated during the surgery without leaving the sternum open.The total operation time was (4.0 ± 0.7 ) hours ( ranging from 3.0 hours to 5.2 hours).The mean ventilation time was (2.2 ± 1.4) days and mean ICU stay time was (5 ± 3 ) days.All the patients were followed up for ( 10.0 ± 3.6) months without aneurysm in arch and obstruction in airway.The residual obstructive pressurc gradicnt in the aortic arch ranged from 12 mm Hg to 35 mm Hg and 2 patients received reintervention.One patient received re-balloon dilation and the other received surgery.The cardiac function reached NYHA Ⅰ - Ⅱ in all eases.Conclusion The early outcome of the hybrid procedure (balloon dilation of the coartation of the aorta and surgical repair of ventricular septal defect) for infants with ventricular septal defect and coarctation of aorta was satisfying,which could avoid from circulatory arrest.It is a relatively safe procedure which could be the optional method for one-stage surgical repair.
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ObjectiveTo investigate the learning curve of total thoracoscopicy cardiac surgery.MethodsClinical data of a succession of 125 patients undering total thoracoscopicy ASD and VSD repair between October 2004 to January 2010 were collected and reviewed.The procedure was perfomed by the same surgeon.The patients were divided equally into 5 groups (groupA,B,C,D and E,n =25 in each group ) according to the sequence of the operation.The operative time,extracorporeal circulation time,aortic cross-clamped time,the rate of conversion rate to thoracotomy and postoperative complications were compared between the 5 groups.ResultsThere were no statistically significant differences between the 5 groups with respect to age,gender,weight,dieases and surgical approach(P ＞ 0.05).The operative time,extracorporeal circulation time and aortic clump time in group A and group B significant longer then that in group C,group D and group E(P ＜0.05).Group A and group B was no statistically significant difference each other( P ＞ 0.05 ).Group C,D and E have no statistically significant differences between(P ＞0.05 ).The rate of conversion rate to thoracotomy and postoperative complications in 5 groups have no statistically significant differences comparative( P ＞ 0.05 ).ConclusionThe learning curve of total thoracoscopicy surgery is approximalely 50 cases.
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AIM: To investigate the downstream genes of the transcriptional factor Pax-8 related to cardiopathy. METHODS: The total RNA derived from the heart of Pax-8 KO~(-/-) and Pax-8 KO~(+/-) mice was extracted. Mouse genome DNA microarray containing 31 802 mouse oligonucleotides probes was used to investigate the differential expression between the Pax-8 KO~(-/-) and the Pax-8 KO~(+/-) mice hearts. The candidate genes were confirmed by RT-PCR and real time RT-PCR assay. RESULTS: Microarray results showed that, compared to the Pax-8 KO~(+/-) mice, 25 genes were down-regulated and 17 were up-regulated in the Pax-8 KO~(-/-) mice, concerning metabolize enzymes, cell signal conducting and nuclear transcript factors and so on. Bcl2-like 14 (Bcl2l14) was proved to be up-regulated by RT-PCR. Real time RT-PCR results revealed that Bcl2l14 in the Pax-8 KO~(-/-) mice was 2.07 and 2.23 fold as much as that in the Pax-8 KO~(+/-) and the Pax-8KO~(+/+) mice (P<0.01). CONCLUSION: The Bcl2l14 gene is one of the downstream genes of Pax-8 and probably plays an important role in the mechanism of ventricular septum defect.
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Objective Explore the reversibility and potential molecular mechanisms of pulmonary hypertension in pa-tients with complete transposition of the great arteries (cTGA) combined with ventricular septal defect (VSD) in comparison with those with simple VSD. Methods Twenty-four patients with pulmonary hypertension (mean pulmonary arterial pressure was greater than 30 mmHg) were enrolled in our study, in which 10 patients suffered from cTGA with VSD, and the rest 14 pa-tients suffered from simple VSD. Lung specimens were taken from the right middle lobe of lung before cardiopulmonary bypass. The extent of pulmonary hypertension was then graded according to the Heath-Edwards classification. ELISA was used to exam-ine the expression of eNOS, iNOS, ET-1, ET-AR, ET-BR, MMP-2, MMP-9 and TIMP in all the specimens. Results No statistically significant differences in age, height, weight, the size of VSD, and the pulmonary artery pressure before operation were found between the groups. The level of hemoglobin, aortic and pulmonary arterial oxygen saturation, and the reduction value of pulmonary arterial pressure after surgery were significantly higher in the cTGA patients than that in the simple VSD pa-tients (P < 0.05). All patients had grade 0 - Ⅱ Heath-Edwards changes in their lung biopsy samples. The expression of eNOS and MMP-2 was significantly lower in the TGA group than that in the simple VSD group [eNOS: (280.13 ± 101.92) ng/mg vs. (488.41±249.6) ng/mg, P<0.05; MMP-2:(31.68±15.36)ng/mg vs. (69.28±49.12)ng/mg, P<0.05]. There were no statistically significant differences between the two groups regarding the expression of iNOS, ET-1, ET-AR, ET-BR,MMP-9 or TIMP. Conclusion The imbalance of the NOS/ET system and the MMP/TIMP system involves in the development of pulmonary hypertension in patients with TGA combined with VCD. In patients with cTGA, the high oxygenation state in pul-monary circulation may decrease the expression of MMP2 and eNOS, and may affect the progress of pulmonary hypertension to a certain extent.