Observation of neuropsychological development status in children after surgical treatment of congenital heart diseases / 中华胸心血管外科杂志

Objective To observe neuropsychological development status in children after surgical treatment of congenital heart diseases(CHDs)and analyze the risk factors. Methods 89 children who received outpatient review in Fuwai Hospital from September 2015 to March 2016 after surgical treatment of CHDs were recruited in this study and 90 normal children were recruited as the control group. The children with CHDs were divided into simple CHDs group(RACHS- 1 score≤2)and com-plex CHDs group(RACHS- 1 score≥3)according to RACHS- 1 classification. Neuropsychological development status was meas-ured according to pediatric-psychological mental test scale developed by Capital institute of pediatrics,Beijing and statistical a-nalysis was compared. Results The measurements of neuropsychological development showed the normal children behaved better than the children with CHDs(P < 0. 05). The simple CHDs group achieved better distribution of development quotient than complex CHDs group(P = 0. 032)and there was no difference between the normal control group and simple CHDs group (P = 0. 420). Multivariate regression analysis indicated that younger age at cardiac surgery,lower preoperative blood urea ni-trogen(BUN),higher preoperative creatinine(Cr)and prolonged duration of cardiopulmonary bypass(CPB)accounted for low-er scores in the test scale(P < 0. 05). Conclusion Distinct neuropsychological difficulties could be present especially in chil-dren with complex CHDs. Younger age at cardiac surgery,preoperative BUN,Cr and CPB duration were perioperative factors that were associated with long-time neuropsychological development.

The Early- and Med-term Outcomes of Modified Fontan Operation in Patients With Functional Single Ventricle and Separate Hepatic Venous Drainage / 中国循环杂志

Objective: To summarize the early- and med-term outcomes of modified Fontan operation in patients with functional single ventricle and separate hepatic venous (SHV) drainage. Methods: A total of 39 patients with functional single ventricle and SHV drainage received modified Fontan operation in our hospital from 2009-01 to 2015-12 were retrospectively analyzed. There were 26 (66.7%) male, the average age was (6.98±3.62) years, body weight was (20.79±9.66) kg and pre-operative mean pulmonary artery pressure was (9.77±2.51) mmHg. Based on if SHV combining Apicocaval Juxtaposition (ACJ), the patients were divided into 2 groups: SHV group,n=29 and SHV+CAJ group,n=10. The early (3 months) - and med (5 years)-term post-operative outcomes were analyzed. Results: General clinical data was similar between 2 groups,P>0.05. There were 20/39 patients with one-stage operation, 19 with two-stage operation (18 after Glenn operation and 1 after B-T operation). Modified Fontan operation method was mainly used extracardiac conduit-common open technique (30 patients, 76.9%). 19 patients had CPB with aorta clamping, CPB time was 72-446 (189.74±84.96) min and aorta clamping time was 26-171 (89.05±43.96) min; the other 19 patients had CPB without aorta clamping, CPB time was 60-209 (109.99±98.86) min. 10 patients received re-surgery due to early post-operative complications. 3 patients died at early post-operation with the mortality at 7.7%. The average follow-up time was 3.9 (0.83-7.17) years, 1 patient had cardiac function at NYHA II and the others at NYHA I; the 5-year survival rate was 100%. Conclusion: The early- and med-term outcomes of modified Fontan operation were good in patients with functional single ventricle and SHV drainage. Selection of modified Fontan operation method should be based on the distance form inferior vena cava to SHV and presence of ACJ.

Risk Factor Analysis for Peri-operative Mortality in Patients With Total Anomalous Pulmonary Venous Connection / 中国循环杂志

To analyze the risk factors for peri-operative mortality in patients with total anomalous pulmonary venous connection (TAPVC). Methods: A total of 563 TAPVD patients including atrial septal defect, ventricular septal defect and patent ductus arteriosus treated in our hospital from 1996-10 to 2012-12 were retrospectively investigated. There were 219 (38.9%) male, the mean age of patients was (4.6±9.0) years and the mean body weight was (13.2±14.6) kg. The patients were divided into 2 groups: Death group, n=34 and Survival group, n=529. Risk factors for peri-operative mortality were studied by single and multi Logistic regression analysis. Results: The overall peri-operative mortality was 6.0% (34/563). Compared with Survival group, Death group had more patients≤1 year of age (P=0.008), the higher ratio of elective surgery (P=0.002), the longer cardiopulmonary bypass time (P=0.000) and longer aorta clamping time (P=0.001). Multi Logistic regression analysis presented that the age≤1 year was the independent risk factor for TAPVC peri-operative death (OR=3.802, P=0.013) and elective surgery was the protective factor for TAPVC peri-operative death (OR=0.234, P=0.027). Conclusion: The patient's age≤1 year was the independent risk factor for TAPVC peri-operative death, while elective surgery was the protective factor for TAPVC peri-operative death.

Clinical characters and surgical treatment of unroofed coronary sinus syndrome / 中华胸心血管外科杂志

Objective To analyze clinical characters,associated anomalies,diagnostic approach,and surgical procedures in patients with unroofed coronary sinus syndrome.Methods The clinical,echocardiographic,operative and follow-up data of 109 patients with unroofed coronary sinus syndrome from May 1999 to July 2016 were reviewed retrospectively(type Ⅰ51cases,type Ⅱ 17 cases,type Ⅲ 17 case and type Ⅳ 24 cases).The initial diagnosis of unroofed coronary sinus syndrome was made by echocardiography in 56 cases,while the remains were confirmed by the surgeon at repair of other congenital cardiac anomalies.69 of the 109 cases associated with left superior vena cava(LSVC),and 53 of the 69 directed drained into the left atrium(LA).Among the 109 cases,2 cases associated with complex anomalies underwent palliative operations,and other cardiac malformations were corrected simultaneously by surgical correction in the other cases.LSVC was ligated in 8 cases,and the intracardiac tunnel to drain LSVC to right atrium(RA) was reconstructed in 38 cases,intracardiac baffle in 9 cases,extracardiac repair in 2 cases.The associated cardiac lesions were corrected concomitantly.Results There were 5 hospital deaths.3 patients died of low cardiac output syndrome and 2 patients died of pulmonary infection.We followed up 87 early survivors,and there was no death and severe complications.Conclusion Unroofed coronary sinus syndrome is often missed in the preoperative evaluation of congenitally malformed hearts.Preoperative TTE is still the most important method in the diagnosis of UCSS.Strengthening the understanding of the pathological anatomy and physiological characteristics of the heart malformation may help us to improve the preoperative diagnosis of UCSS.When associated with LSVC,UCSS should be considered as a possible additional finding.We performed different surgical approaches to deal with the different kinds of LSVC with a good result.

Comparative Study of Autologous Pericardium Patch and Pulmonary Patch for Treating the Infants With Aortic Coarctation Combining Hypoplastic Aortic Arch / 中国循环杂志

Objective: To compare the effects of pericardium patch aortoplasty and pulmonary patch aortoplasty for treating the infants with aorticcoarctation (AC) combining hypoplastic aortic arch in order to provide a better surgical choice in clinical practice. Methods: A total of 57 patients with AC combining hypoplastic aortic arch treated in our hospital from 2009-01 to 2014-12 were retrospectively studied. The patients were divided into 2 groups: Pericardium patch aortoplasty group,n=26 and Pulmonary patch aortoplasty group,n=31. The changes of the pressure gradient at post-operation and follow-up period were compared. Results: There were 2/57 (3.5%) patients died, 1 in Pericardium patch aortoplasty group by pulmonary hypertension crisis, the other 1 in Pulmonary patch aortoplasty group by respiratory distress syndrome. No renal failure or neurological complication occurred in neither groups. The cardiopulmonary bypass time, aortic clamping time, ventilator time and ICU stay time were similar between 2 groups,P>0.05. Selective cerebral perfusion time in Pericardium patch aortoplasty group was shorter than Pulmonary patch aortoplasty group (30.5 ± 8.6) s vs (35.6 ± 10.3) s,P0.05. Follow-up study was conducted in 51 patients for (17.6 ± 16.6) months, Pericardium patch aortoplasty group had 6 patients with re-stenosis, 3 of them would receive balloon angioplasty and 3 would be continuously followed-up; Pulmonary patch aortoplasty group had 6 patients with re-stenosis, 2 of them ifnished balloon angioplasty and their pressure gradients were obviously decreased, 4 would be continuously followed-up. Kaplan-Meier curves presented that Pulmonary patch aortoplasty group was superior to Pericardium patch aortoplasty group in re-stenosis occurrence during follow-up period. Conclusion: Both pericardium patch aortoplasty and pulmonary patch aortoplasty were effective for treating the patients with AC combining hypoplastic aortic arch, the early post-operative efifcacy was similar, while the mid-term follow-up result was better in pulmonary patch aortoplasty.

Analysis of the mid and long term results of mitral valve replacement in 48 cases / 中华胸心血管外科杂志

Objective To study the mid-and long-term outcomes and prognostic risk factors of mitral valve replacement (MVR) in children.Methods Retrospectively studied the cases(＜ 14 years) receiving MVR between July 2003 and March 2014 in our hospital,and recorded the gender,age,operation related data and the results of echocardiography,electrocardiogram and chest X-ray in the out-patient department.Results A total of 48 patients were followed up.Age was 8 months 15 days-13 years 9 months and 22 days,the average was (9.5 ± 3.9) years.24 cases were original operations,others were second operations.43 mechanical valves were used,as well as 5 tissue valves.The mortality was 8.3 ％ and the incidence of complications was 25.0％ during the hospitalization or within 30 days after the operations.Follow-up time was 4.7-150.7 months,the average was(62.0 ± 42.3) months.The long-term mortality was 9.1％,and the incidence of complications was 9.4％.Follow-up of left ventricular ejection fraction was 0.30-0.77,the average was 0.61 ±0.08.There was no redo-MVR or implantation of pace maker.The survival rates of 1 year,5 years and 10 years were (89.5 ± 4.5) ％、(83.0 ± 6.1) ％、(77.8 ±7.6)％,respectively.Children younger than 5 years was the risk factor for perioperative mortality or complications (OR =8.47,95％ CI:1.36-52.61).Children with perioperative complications was the risk factor for long-term mortality or complications(OR =9.97,95％ CI:1.39-71.76).Conclusion The results of children with MVR were satisfactory.To perform MVR in children older than 5 years if possible and to reduce the incidence of perioperative complications could improve the prognosis.

Surgical treatment of failure interventional cases in congenial heart disease / 中华胸心血管外科杂志

Objective To summarize the cases of surgical treatment of patients with patent ductus arteriosus (PDA),atrial septal defect(ASD),or ventricular septal defect(VSD) after failure of congenital cardiac catheterization(CCC).Methods From January 2000 to December 2013 in our hospital 26 patients were retrospectively studied,follow-up results recorded for each patient by telephone and outpatient follow-up review.Results There were no deaths.The average age of the patients was (18.8 ± 17.9) (3.0-67.0) years old.The median time of the intervals between interventions and surgeries were 14 days(2 hours to 5 years),the median length of hospital stay were 10 days(7-21 days),median cardiopulmonary bypass time was 67minutes (0-206 minutes),the median blocking time 40 minutes (0-90 minutes),the median time of mechanical ventilation 8.5 hours (2.0-88.0 hours),median ICU stay one day (1-6 days).The average follow-up were (93.0 ± 49.3) months (7.0-182.4 months).Surgical results were satisfactory.Conclusion Interventional treatment of congenital heart disease (CHD) is safe after all,but should strictly the indications controlled,the operations completed by skilled doctors.If there are complex complications,surgical intervention should be concerned,and the results are satisfactory.Patients after CCC should be followed up regularly.

Use of laryngeal mask airway ProSeal for airway management during open heart surgery performed under CPB in children / 中华麻醉学杂志

Objective To investigate the use of laryngeal mask airway (LMA) ProSeal for airway management during open heart surgery performed under CPB in children. Methods Seventy-six ASA Ⅱ and NYHA class Ⅰ or Ⅱ patients aged 3 months-8 yr, weighing 3.3-34.5 kg undergoing open heart surgery under CPB were randomly divided into 2 groups ( n = 38 each): tracheal intubation group (group T) and ProSeal LMA group (group P1). Tracheal tube and LMA were inserted after induction of anesthesia with 8% sevoflurane. The rate of successfultracheal intubation and LMA placement, placement time, peak airway pressure and side effects during and after surgery including hypoxemia, tachycardia, bradycardia, hypotension and hypertension, laryngesl edema, dysphagia, bucking, dyspnea and hoarseness were recorded. Results There were no significant differences in the rate of successftl tracheal intubation and LMA placement, peak airway pressure, bucking, dyspnea and hoarse voice between the two groups (P＞ 0.05). The LMA placement time was significantly shorter than tracheal intubation time and the incidence of laryngeal edema and dysphagia lower in group P than in group T ( P ＜ 0.05). Conclusion The LMA ProSeal can provide adequate ventilation during operation with less complications and can be used effectively for cardiac surgery performed under CPB in children.

Ecbocardiographyic diagnosis of aortico-left ventricular tunnel / 中华超声影像学杂志

Objective To explore the value of echocardiography on diagnosis and differential diagnosis of aortico-left ventricular tunnel(AOLVT).Methods Echocardiographic features of 9 patients with AOLVT were reviewed and analyzed.The diagnosis methodology was summarized;the reasons for missed diagnosis and misdiagnosis by echocardiography were analyzed.Results Among 9 patients with AOLVT,one was diagnosed through CT examination prior to the operation and died from the cardiac arrest.The others all received the surgical operation and were diagnosed as AOLVT.Five patients were accurately diagnosed by echocardiography prior to the operation,4 patients were misdiagnosed,in which 3 patients were diagnosed as aortic valve regurgitation,one patient was diagnosed as aortic dissecting aneurysm.The diameter of left ventricle(LV)decreased and LV ejection fraction increased distinctively for 7 operated patients(P＜0.001)in six months after operation.Only one operated patient failed to recover from the LV dysfunction and died of aortic valve perivalvular leak in two monthes.Conclusions The diagnosis of the AOLVT mainly depends on the echocardiography.By enhancing the understanding on such disease and investigating on the structure and hemodynamics will be contributive to the accurate diagnosis of echocardiography.

Surgical treatment of coronary artery aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To describe the diagnosis and surgical management of coronary artery aneurysm.</p><p><b>METHODS</b>Between October 1996 and May 2000, 6 patients with coronary artery aneurysm underwent surgical treatment. Of these patients, 3 had Kawasaki disease and 3 coronary artery fistula. All patients underwent coronary artery bypass grafting. Three patients had aneurysms resected and fistulous ostium closed. One patient received aortic valve replacement.</p><p><b>RESULTS</b>There were no deaths and later death, nor major complications during the hospital stay. The results of follow-up were satisfactory.</p><p><b>CONCLUSIONS</b>Coronary artery aneurysm is rare and its prognosis is poor. Early diagnosis and operation are necessary. The aneurysm should be resected, the coronary artery should be bypassed, and other associated diseases should be treated properly.</p>