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Objective To investigate the impact of one-step hybrid procedure(HP) which combined surgical and interventional approaches simultaneously on kidney function in tetralogy of Fallot(TOF) with major aortopulmonary collateral arteries (MAPCAs).Methods The children with TOF who underwent corrective procedures,whether underwent one-step HP,aged less than 3-years during the period of January 2014 to June 2015,were reviewed in this retrospective cohort study.Univariate analyse was performed to compare with traditional operation(control group) and one-step HP(HP group).Multivariable analyses was carried out to identify significant determinants of one-step HP.Results In univariate analyses,the age,preoperative oxygen saturation,Nakata indext、McGoon index、LVEDIV、CPB time、ACC time and transannular patch had no significant difference between HP group and control group.The morbidity of acute kidney injury(AKI) was 59.38％ in one-step HP group as well as 23.76％ in traditional operation group.The one-step HP could significantly increased AKI compared with control group.Multivariable logistic regression showed that younger children who had less mechanical ventilation time(OR:0.971,95 ％ CI:0.949-0.994,P =0.003),less time to negative fluid balance (OR:0.984,95 ％ CI:0.967-0.998,P =0.015) and higher morbidity of AKI(OR:4.817,95％ CI:2.597-8.937,P =0.001) in HP group.Conclusion The one-step HP could significantly decrease the mechanical ventilation time and time to negative fluid balance while it increased the morbidity of mild AKI.Moreover,the mild AKI was not associated with poor outcomes when children was prophylactically implemented renal protection.
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@#Objective Tho evaluate the outcomes of early percutaneous occlusion of these residual major aortopulmonary collateral arteries after heart surgery. Methods This was a retrospective review of children undergoing early percutaneous embolization of major aortopulmonary collateral arteries after cardiac surgery. From January 2013 to February 2017, 52 consecutive patients with postoperative residual major aortopulmonary collateral arteries were treated with percutaneous embolization (38 males, 14 females; median age of 10.0 months, interquartile range 14.0 months; median weight 8.6 kg, interquartile range 4.4 kg). Fifty-one patients were cyanotic and 1 patient was acyanotic. Forty-nine patients underwent corrective surgery and 3 patients underwent B-T shunt. Results Typical symptoms and signs of major aortopulmonary collateral arteries included: elevated left atrial pressure; focal lung infiltration, pink or blood-stained frothy sputum. The median time interval from cardiac surgery to percutaneous occlusion of major aortopulmonary collateral arteries was 5 (9) d, median duration of mechanic ventilation support since occlusion was 72 (159) h, mechanic ventilation support was 239 (480) h and median duration of intensive care unit was 19 (29) d. There was no death in this group. Conclusion Angiocardiography could be able to demonstrate the existence of postoperative major aortopulmonary collateral arteries. The early percutaneous occlusion appears to be simple, safe and effective.
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A multistage plan and multidisciplinary approach are the keys to successful repair in patients with pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs). In this article, we present a multidisciplinary approach adopted to treat a patient with PA with VSD and MAPCAs associated with left pulmonary artery interruption.
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Humanos , Arterias , Defectos del Tabique Interventricular , Arteria Pulmonar , Atresia PulmonarRESUMEN
Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries is a rare kind of congenital heart disease. Nowadays, staged surgical treatment has been recognized by more and more surgeons with the surgical treatment of the disease continuing to progress and a deeper understanding of surgical treatment.