TREATMENT OF CONGENITAL HEART DISEASE WITH PULMONARY HYPERTENSION DURING PERI-OPERATION / 解放军医学杂志

Forty-seven patients with congenital heart disease and pulmonary hypertension were treated surgically. Among them, 31 were male and 16 female. The age ranged from 2 to 47(13. 7? 11. 2) years. Gongenital heart abnormalities included ventricular septal defect (VSD) in 20, huge atrial septal defect (ASD) in 1, VSD+ASI) in 12, VSD with patent ductus arteriosus (PDA) in 6, endocardial cushion in 2, VSD with aortopulmonary septal defect (APSD) in 1, double outlet right ventricle with PDA in 1 and total anomalous pulmonary venous connection in 1. Right heart catheterization was performed in 15 cases. The mean pulmonary artery pressure was (73 ? 24)mmHg, total pulmonary resistance was (78. 0 ?61. 2)kPa/(L/s). There were 7 cases examined in operation. Their mean pulmonary artery pressure was (55?13)mmHg. The others were examined by echocardiography. The mean pulmonary artery pressure was (49?15)mmHg. All patients were treated pre-op-eratively with oxygen inhalation therapy, hyperbaric oxygenation, prostaglandin E1 , respectively according to the degree of pulmonary hypertension. During cardiopulmonary bypass, pulmonary artery perfusion was performed with protective solution containing aprotinin for lung protection. Vasoactive drugs were routinely administrated postoperatively. There were 2 operative deaths with hospital mortality rate of 4. 3%. The cause of deaths was severe low cardiac output syndrome. The postoperative morbidity rate was 4. 3%. Our conclusion is proper peri-operative management could reduce post-operative mortality and morbidity for congenital heart disease with pulmonary hypertension.

Study on Predisposing Factors of Low Cardiac Output Syndrome after Corrective Surgery for Tetralogy of Fallot / 第三军医大学学报

One hundred and seven cases of tetralogy of Fallot (TOF) were surgically corrected in this institute in the period from Jan 1983 to Dec 1989. Adequate corrective procedures were performed in 106 cases and aorto-pulmo-nary shunt with 1.2 Dacron tube in one. The corrective procedures employed included simple intracardiac repair in 18, subpulmonary RV outflow patch in 50, transannular RV outflow patch in 37, and RV-PA coronary conduit in 1 because of anomalous right coronary artery. The operative mortality rate was 13% , and the main complication was low cardiac output syndrome (LCOS) , which occurred in 26 cases (24%) .It was found that the predisposing factors of LOS after corrective surgery for TOF were serious clinical manifestations of the patient before operation, and residual right ventricular outflow tract obstruction due to improper repair of the right ventricular outflow tract, which were fatal in some cases.