The prediction and verification of outcome of extracardiac conduits fontan based on computational fluid dynamics simulation.

Objective: This study applied preoperative computed tomography angiography (CTA) and computational fluid dynamics (CFD) simulation to predicte and verify the outcome of Y-shaped extracardiac conduits Fontan for functional single ventricle. Methods: Based on the preoperative CTA data of functional single ventricle (FSV), 4 types of spatial structures of extracardiac conduits were designed for 4 experimental groups: Group A, a traditional TCPC group (20 mm); Group B, a diameter-preserving Y-shaped TCPC (YCPC) group (branch 10 mm); Group C, YCPC group (branch 12 mm); and Group D, an area-preserving YCPC group (branch14 mm). Four indicators including flow velocity, pressure gradient (PG), energy efficiency and inferior vena cava (IVC) blood flow distribution were compared. The optimal procedure was applied. The radionuclide lung perfusion, CTA, echocardiography, cardiovascular angiography and catheterization were performed postoperatively. Results: There were the lowest PG, the lowest flow velocity of branches, the highest energy efficiency, and a relatively balanced and stable distribution of IVC flow for group D. Subsequently, the group D, a handcrafted Y-shaped conduit (14 mm) was used for the YCPC procedure. There was no postoperative PG between the conduit and pulmonary artery with normal pressure and resistance. IVC flow was distributed uniformly. Conclusion: CTA-based CFD provided more guidance for the clinical application of TCPC. A comprehensive surgical design could bring good postoperative outcome. Area-preserving YCPC has more advantages than TCPC and the diameter-preserving YCPC. The study effectively improved the feasibility of clinical applications of YCPC.

Surgical treatment for Behcet's disease with acute superior vena cava syndrome.

BACKGROUND AND AIM OF THE STUDY: Behcet's disease (BD) is a multisystem vasculitis with unknown etiology. The involvement of superior vena cava (SVC) is reported in less than 2% of patients with BD. METHODS: We report a patient with acute edema of neck and face associated with dyspnea as the primary manifestation. So a diagnosis of superior Vena Cava syndrome (SVCS) was made and the thickening wall of SVC was resected. An Operation was performed under cardiopulmonary bypass to remove the mass and thrombus for avoiding for pulmonary embolism. RESULTS: The diagnosis of Behcet's disease (BD) didn't not be made until the recurrent oral and genital ulceration occurred 2 weeks later. The patient taked aspirin and prednisolone orally as prescribed and no recurrence were observed during the 30 months follow-up. CONCLUSIONS: BD should be suspected in patients presenting with SVCS, when there is thickening of SVC, whether thrombosis or not. Early diagnosis and treatment are essential for management of BD.

Traditional Atriopulmonary Connection Fontan with Excellent Outcome for 32 Years.

Although the traditional right atrial-pulmonary artery (RA-PA) Fontan has been replaced by the total cavopulmonary connection, some RA-PA Fontan patients still have good outcome. We report a 37-year-old male who underwent traditional Fontan 32 years ago with the diagnosis of L-transposition of great arteries, subvalvular pulmonary stenosis and cardiac dextroversion. Among the recent CTA, electroconvulsive therapy, catheterization and angiography, pulsatile PA, uniform pulmonary blood, normal PA pressure and resistance were observed in this patient. The traditional RA-PA Fontan may be an alternative surgical procedure.

Coexisting ventricular septal defect affects the features of ruptured sinus of Valsalva aneurysms.

OBJECTIVES: To determine the correlation exists between ventricular septal defect (VSD) and ruptured sinus of Valsalva aneurysm (RSVA). Methods: Between September 2003 and April 2014, 80 RSVA patients underwent surgical repair. These patients were retrospectively divided into two groups: the VSD group (38 cases) and the non-VSD group (42 cases).  Results: Rupture points of SVA originated more frequently in the right coronary sinus (RCS) of patients in the VSD group than those in the non-VSD group (p=0.002). In the VSD group, more than 92.1% tended to rupture into the right ventricular outflow tract. The rupture points are diverse in the non-VSD group. A significant difference was found in rupture points of RSVA between the two groups (p less than 0.001). Patients in the VSD group presented with aortic valve disease more often than those in the non-VSD group (p less than 0.001). A total of 67 patients were repaired with a patch at the opening of RSVA; of those, all patients in VSD group and 29 patients in non-VSD group were repaired with a patch. Nine patients in non-VSD group received transcatheter closure of RSVA. Conclusion: The presence or absence of VSD affects the rupture points of SVA, aortic valve disease involved, and therapeutic schedule. Ruptured sinus of Valsalva aneurysm type should be clinically modified on the basis of presence or absence of VSD.

Aortic Implantation for Anomalous Connection of the Coronary Artery to the Pulmonary Artery in Older Children and Adults.

Background Anomalous connection of the coronary artery to the pulmonary artery (ACAPA) has a low incidence rate in older children and adults. The aim of this article was to evaluate the outcome of treating ACAPA with aortic implantation in older children and adults. Methods We included 21 patients (9 children and 12 adults) with ACAPA in our hospital between January 1991 and January 2015. Among these patients, 19 had anomalous connection of the left coronary artery to the pulmonary artery, 2 had anomalous connection of the right coronary artery to the pulmonary artery (ARCAPA). All of the patients underwent aortic implantation, aged 4 to 62 years (median, 18). The mean left ventricular ejection fraction (LVEF) was 55.9 ± 7.6% (<50% in 4). Eleven patients underwent direct aortic implantation (including two ARCAPAs), while 10 patients underwent tubular implantation. Eleven patients had varying degrees of mitral regurgitation, while mitral valve plasty or replacement was performed in six patients (severe mitral regurgitation) concurrently. Results There was no early mortality. Follow-up observation was performed in all 21 patients, with a mean follow-up time of 6.4 ± 5.6 years (ranging from 0.5 to 23 years). Two patients died due to noncardiac reasons 1 and 10 years after operation, respectively. Seven patients had mild mitral regurgitation, while no patients had moderate or severe mitral regurgitation after operations. The postoperative mean LVEF was not improved at 54.7 ± 7.0%, p > 0.05. Conclusion Among the multiple surgical strategies for the treatment of ACAPA, aortic implantation was used commonly in older children and adults, while mitral valve repair can be performed concurrently.

Early- and intermediate-term results of surgical correction in 122 patients with total anomalous pulmonary venous connection and biventricular physiology.

BACKGROUND: We retrospectively reported our 26-year experience with operative repair of total anomalous pulmonary venous connection (TAPVC) with biventricular physiology. METHODS: Between December 1982 and December 2008, 122 TAPVC patients with biventricular heart underwent surgical repair in our department. Moderate or deep hypothermia was induced at the time of cardiopulmonary bypass (CPB). Follow-up was conducted for 5 postoperative years. Surgical outcomes of early and intermediate deaths after TAPVC repair were retrospectively analyzed. RESULTS: Six deaths occurred operatively; and three deaths, during follow-up. The 5-year survival rates after TAPVC repair was 92.6 %, without gradient across the anastomosis. The survival rate of the patients who were younger was 78.8 %, significantly lower than those older than 1 year. It was also lower in those who were less than 6 kg in weight. Three patients died during follow-up. Three patients died of ventricular arrhythmia, right heart failure, and pneumonia, respectively, during follow-up. If the left atrium pressure was higher than 15 mm Hg, the snare of the vertical vein was loosened after CPB ceased in the patients with supracardiac connection. It decreased from 21 ± 5 to 13 ± 3 mm Hg. The vertical vein was ligated in 57 cases and left open in 20 cases. A patient with an intact vertical vein had a large shunt and was cured by intervention afterward. Supraventricular arrhythmia occurred in 19 patients with the supercardiac type repaired through a biatrial incision. One patient died of ventricular arrhythmia, and none of the remaining patients had arrhythmias. CONCLUSION: Surgical treatment of TAPVC carried a low operative risk and had satisfactory immediate and intermediate results. Age younger than 1 year and weight less than 6 kg were risk factors. It was a good choice to leave the vertical vein open in the patients with a left atrial pressure higher than 15 mm Hg.

Meta-analysis of short-term high versus low doses of atorvastatin preventing contrast-induced acute kidney injury in patients undergoing coronary angiography/percutaneous coronary intervention.

This study aimed to investigate the impact of different doses of atorvastatin on contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) requiring contrast media by performing a meta-analysis. We searched the PubMed, EMBASE, Cochrane Library, Wanfang database, China National Knowledge Infrastructure, and VIP database through April 2014. Only randomized controlled trials (RCTs) comparing short-term high-dose atorvastatin with low-dose atorvastatin on CI-AKI were selected. The main outcomes were the change of acute kidney injury markers and the incidence of contrast-induced nephropathy (CIN). We combined 14 RCTs consisting of 1,689 patients. Compared with the low-dose atorvastatin, high-dose atorvastatin treatment was associated with a reduction in serum creatinine levels (weighted mean differences [WMD]-0.1 mg/dL; 95%CI -0.14 to -0.05). In addition, high-dose atorvastatin treatment was also associated with a lower incidence of CIN (risk ratios 0.41; 95%CI 0.29-0.56). This meta-analysis suggests that short-term high-dose atorvastatin therapy appears to be superior to the low-dose atorvastatin in preventing CI-AKI among patients undergoing CAG/PCI requiring contrast media.

Development of pulmonary arteries after a central end-to-side shunt in patients with pulmonary atresia, ventricular septal defect, and diminutive pulmonary arteries.

AIM: To evaluate the development of pulmonary arteries (PAs) in patients with pulmonary atresia, ventricular septal defect, and diminutive PAs by using a central end-to-side shunt. METHODS: A total of 103 consecutive patients (71 male and 32 female) with pulmonary atresia, ventricular septal defect, and diminutive PAs received a central end-to-side shunt between PA and aorta from May 2004 to December 2010. The age and weight ranged between 2 to 86 months and 2.5 to 21.5 kg, respectively. Overall 79 patients with main PA diameters less than 4 mm received a central end-to-side shunt between PA and aorta, and 24 patients with main PAs absence received a modified central shunt between PA branches and aorta. RESULTS: There were no deaths during operation and follow-up. Compared with preoperative measures, total PA index increased from mean value 68.8 ± 11.4 mm2/m2 to 129.1 ± 24.9 mm2/m2 (p < 0.001). The increased PA index change at the time of 6 months or final repair after shunt completion was 87.7 ± 27.4% (27-150%). By multivariate regression analysis, age at shunt, shunt procedure, and number of major aortopulmonary collateral arteries were correlated with increasing PA index change. CONCLUSION: The central end-to-side shunt promoted sufficient growth of the diminutive central PAs, especially in infant patients. Due to the risk of a distortion of pulmonary branches, the authors interposed a modified procedure for patients with main PAs absence by anastomosis of left PA and right PA directly in an end-to-side fashion to the both lateral wall of ascending aorta. It is technically easy to perform, warrants low risk of shunt thrombosis, and flow restriction in the early postoperative period.

Association of genetic polymorphisms in ADH and ALDH2 with risk of coronary artery disease and myocardial infarction: a meta-analysis.

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) are the major enzymes responsible for alcohol metabolism in humans. Emerging evidences have shown that functional polymorphisms in ADH and ALDH genes might play a critical role in increasing coronary artery disease (CAD) and myocardial infarction (MI) risks; however, individually published studies showed inconclusive results. The aim of this meta-analysis is to evaluate the associations between the genetic polymorphisms of ADH and ALDH genes with susceptibility to CAD and MI. A literature search was conducted on PubMed, Embase, Web of Science and Chinese BioMedical databases from inception through December 1st, 2012. Crude relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Twelve case-control studies were included with a total of 9616 subjects, including 2053 CAD patients, 1436 MI patients, and 6127 healthy controls. Meta-analysis showed that mutant genotypes (GA+AA) of the rs671 polymorphism in the ALDH2 gene were associated with increased risk of both CAD and MI (CAD: RR=1.20, 95%CI: 1.03-1.40, P=0.021; MI: RR=1.32, 95%CI: 1.11-1.57, P=0.002). However, there were no significant associations of ADH genetic polymorphisms to CAD and MI risks (CAD: RR=0.92, 95%CI: 0.73-1.15, P=0.445; MI: RR=0.93, 95%CI: 0.84-1.03, P=0.148). In conclusion, this meta-analysis provides strong evidence that ALDH2 rs671 polymorphism may be associated with increased risks of CAD and MI. However, further studies are still needed to accurately determine whether ADH genetic polymorphisms are associated with susceptibility to CAD and MI.

Staged procedures versus primary repair for tetralogy of Fallot and small left ventricle.

INTRODUCTION: This study was conducted to address whether staged surgical intervention or primary repair would be preferred for treating patients with tetralogy of Fallot and small left ventricle. METHODS: We retrospectively assessed 28 patients with tetralogy of Fallot and small left ventricle at the Chinese PLA 208th Hospital, Changchun, between January 2005 and December 2008. Of this cohort, 11 patients had undergone a systemic-to-pulmonary arterial shunt with a polytetrafluoroethylene interposition graft (off pump), followed by ancillary repair procedures as a surgically staged group; the remaining 17 patients underwent primary intracardiac repair via cardiopulmonary bypass. The oxygen level as measured by pulse oximetry (SpO2), the McGoon ratio, and the left ventricular end-diastolic volume index (LVEDVI) were measured before shunt procedures and at 6 to 18 months afterwards. All data were analyzed statistically with the paired Student t test. The 2 groups were compared with respect to LVEDVI values and McGoon indices at baseline by the independent t test. RESULTS: None of the patients died as a direct result of the surgery, but 1 fatality due to pneumonia occurred 4 months after shunting. Mean postshunt values for SpO2, the McGoon ratio, and the LVEDVI increased significantly from 76.8% ± 9.0% to 87.5% ± 2.4% (P < .01), from 1.42 ± 0.27 to 1.62 ± 0.32 (P < .05), and from 20.1 ± 7.0 mL/m2 to 34.3 ± 7.4 mL/m2 (P < .01), respectively. Nine patients were fully repaired within the 6- to 18-month time frame after shunting, while 1 patient awaited definitive surgery for pulmonary hypoplasia. In the primary-repair group, in which the increases the LVEDVI and McGoon ratio were comparatively higher, 1 patient died of hypoxemia. CONCLUSION: A LVEDVI 20 mL/m2 may be an indication for primary repair in patients with tetralogy of Fallot. With values <20 mL/m2, staged procedures (i.e., shunt with a polytetrafluoroethylene interposition graft) can promote left ventricle development and allow safe transition to the final repair.

Radionuclide and angiographic assessment of pulmonary perfusion after Fontan procedure: comparative interim outcomes.

BACKGROUND: Right-side heart function is essentially externalized during extracardiac total cavopulmonary connection. The Fontan procedure has a certain impact on pulmonary hemoperfusion and may explain various postsurgical complications. In this study, alterations of pulmonary perfusion in patients undergoing the Fontan procedure were analyzed at the 5-year postoperative mark by radionuclide imaging and angiocardiography, and results of both methods were compared. METHODS: For 43 post-Fontan patients, perfusion ratios of each lung segment were calculated based on radionuclide imaging data. The pulmonary vascular resistance and pulmonary artery index of each patient were also calculated from right angiocardiographic measurements. RESULTS: The radionuclide count and advantage perfusion ratio of right lung at follow-up did not differ significantly from early postoperative values (t=0.38, p>0.05; t=1.12, p>0.05), and superior/inferior vena cava perfusion ratios were stable (t=0.88, p>0.05; t=0.74, p>0.05). The superior/inferior segment perfusion ratio of the whole lung declined significantly (t=2.54, p<0.05), while that of the dorsal lung segment rose significantly (t=2.16, p<0.05). Compared with early postoperative status, the pulmonary arterial index of patients at follow-up were significantly increased (t=2.41, p<0.05), while small pulmonary vascular resistances declined significantly (t=2.08, p<0.05; t=2.69, p<0.05), and arterial oxygen saturation levels were unaltered (t=1.12, p>0.05). The early angiographic and radionuclide perfusion studies of 5 patients did not match. CONCLUSIONS: After the Fontan procedure, hypostatic redistribution of pulmonary blood flow is characteristic. The weak pulse of blood, in the absence of ventricular ejection, can promote pulmonary vascular changes, but at later (intermediate) follow-up, the decline in vascular resistance that results carries no benefit in terms of blood perfusion or oxygenation. Microcirculatory arteriovenous shunting is the likely cause. In this study of functional pulmonary hemoperfusion, radionuclide imaging was deemed superior to angiocardiography.

The mid-term follow-up of pulmonary perfusion in patients after extracardiac total cavopulmonary connection.

OBJECTIVE: To explore the changes of pulmonary perfusion over 5 years in patients who underwent extracardiac total cavopulmonary connection. METHODS: Forty-three patients who had undergone extracardiac total cavopulmonary connection were examined with pulmonary perfusion 1 month and 5 years following the operation. 99mTc-MAA was used for perfusion imaging; pulmonary perfusion value and blood distribution were measured and calculated. Vena cava pressure and arterial oxygenation were measured using the right cardiac catheter, and the pulmonary arteriole resistance was calculated. The status of the conduit connection was assessed by computed tomography three-dimensional reconstruction. RESULTS: Radionuclide counts of the follow-up group were similar to those of the early postoperative group, and the ratios of right to left pulmonary perfusion and inferior vena cava perfusion were not changed. However, the ratio of the whole pulmonary superior to inferior segment was remarkably reduced (t=2.54, P<0.05), with a significantly higher perfusion rate in the posterior segment of the lower lobe (t=2.16, P<0.05). The pulmonary arteriole resistance of the follow-up group was reduced significantly (t=2.08, P<0.05). The vena cava pressure was also reduced (t=2.69, P<0.05), but oxygenation was not significantly changed. Five patients showed a mismatch between pulmonary angiography and radionuclide scintigraphy soon after the operation. The pulmonary angiography showed that the anastomosis was patent, and both lungs were demonstrated. However, the radionuclide scintigraphy only demonstrated the unilateral lung soon after the operation, and both lungs were demonstrated during follow-up. CONCLUSION: Radionuclide scintigraphy is superior to the pulmonary angiography in the study of functional pulmonary perfusion. Fontan circulation may lead to gravity-dependent blood redistribution, and its weak pulsation can promote pulmonary vascular development. However, the reduced pulmonary arterial resistance at mid-term follow-up may not lead to an increased amount of pulmonary perfusion or oxygen supply, which is probably because of the massive opening of the arteriovenous shunt and increased futile circulation.

[The anatomy features and surgical significance of the pulmonary circuits of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries].

OBJECTIVES: To analyze the anatomy features of the pulmonary circuits in the patients with pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCA), and discuss the clinical significance. METHODS: From April 2002 to June 2010, the anatomy features of pulmonary circuits in 33 patients with PA/VSD/MAPCA were examined and analyzed. There were 21 male and 12 female patients. The age ranged from 11 months to 29 years. The anatomic types of PA/VSD included group B for 22 cases, group C for 11 cases. Thirty-one patients of them underwent 33 operative procedures. The operations included aorta-pulmonary shunt in 8 cases, one stage unifocalization with VSD open in 2 cases, complete repair in 23 cases. RESULTS: Twenty-nine (87.9%) patients had native pulmonary arteries, 6 of them were normal size and 23 were hypoplastic size. Four patients (12.1%) had no native pulmonary arteries. The postoperative oxygen saturation of the patients undergone shunt and one stage unifocalization was increased to 83% to 90%. There was one early death after complete repair because of multiorgan function failure. There were 4 cases of severe low cardiac output and 3 cases of respiratory function failure. Sixteen patients after complete repair were followed up more than one year. The postoperative right ventricular pressure was 41 to 99 mmHg (1 mmHg = 0.133 kPa). The ejection fraction value was more than 50% in 14 patients and less than 50% in 2 patients. Two patients had medium pulmonary insufficiency. CONCLUSIONS: An individualized approach based on the anatomy of the pulmonary circuits permits achievement in the patients with PA/VSD/MAPCA. The surgical strategy for PA/VSD/MAPCA mainly depends on the anatomy features of native pulmonary arteries, confluent pulmonary arteries and MAPCA.

Effective pulmonary artery perfusion mode during cardiopulmonary bypass.

AIM: Reducing lung injury during cardiopulmonary bypass (CPB) is important for patients' recovery. The present study was designed to research convenient and effective pulmonary artery perfusion mode during CPB in an animal model. METHODS: Twelve healthy mongrel dogs were randomly divided into 2 groups: a control group and a perfusion group designed to simulate clinical CPB-induced lung injury. During CPB, pulmonary artery perfusion with modified low-potassium dextran (LPD) solution was performed immediately after the initiation of ischemia and before reperfusion for 3 to 4 minutes each time, with pressure maintained at 15 to 20 mmHg; animals in the control group were not perfused. After pulmonary reperfusion, the changes in pulmonary function and tissue biochemical data were determined. RESULTS: Compared with the control group, lung compliance, oxygenation, and vascular resistance after reperfusion were significantly improved in the perfusion group. The malonaldehyde concentration, neutrophil sequestration ratio, and tissue water content also decreased significantly in the perfusion group. CONCLUSION: The pulmonary artery perfusion mode used in this experiment could relieve CPB-induced lung injury effectively. Improving cellular tolerance to hypoxia and decreasing inflammatory reaction may be the important mechanisms. Moreover, this mode is convenient and does not interfere with the intended operations, which is promising for clinical use.

Half rotation of the truncus arteriosus plus arterial switch for transposition of the great arteries with ventricular septal defect and pulmonary outflow tract obstruction.

OBJECTIVE: The goal of our study was to report our experience of using half rotation of the truncus arteriosus plus arterial switch, as a modification of the Nikaidoh procedure, for anatomic repair of transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary outflow tract obstruction (pulmonary stenosis (PS)). METHODS: From December 2006 to December 2009, 11 patients (six male, five female) underwent half rotation of the truncus arteriosus plus arterial switch for repair of TGA, VSD, and PS or double-outlet right ventricle (DORV) at our heart center. RESULTS: There was no operative death. All patients had relief of left ventricular outflow tract obstruction (LVOTO) as determined by direct pressure measurements intraoperatively. Echocardiography was performed for all patients intraoperatively and before discharge. Two patients had mild aortic regurgitation and two patients had mild pulmonary regurgitation. For a median follow-up of 15 months (range 6-42 months), all patients were alive. Echocardiography was performed at 3, 6, 12, 24 and 36 postoperative months. All patients have normal ventricular function. No evidence of LVOTO was founded in all patients. Two patients had mild aortic regurgitation and three patients had mild to medium pulmonary regurgitation. CONCLUSIONS: Half rotation of the truncus arteriosus plus arterial switch, as a modification of the Nikaidoh procedure, is a good alternative treatment for complete anatomic repair for TGA, VSD, and PS or DORV with malposition of great arteries and PS. The technique might allow to reconstruct biventricular outflow tract, preserve competence and growth potential of the pulmonary root with valves and decrease the probability of reoperation. Its long-term benefits need to be evaluated with a large number of patients and longer follow-up.

[Clinical analysis of surgical procedures and outcomes for corrected transposition of great arteries with heart anomaly].

OBJECTIVE: To determine the outcome of anatomically corrective repair and traditional repair of corrected transposition of great arteries (c-TGA) with heart anomaly. METHODS: From April 2002 to December 2006, nineteen patients including fourteen male and five female with c-TGA, underwent operations, age ranged from 2 to 22 years old and weight ranged from 10 to 48 kg. Fifteen of them received anatomically corrective repair and the other four received traditional repair. Eighteen patients were referred to SLL (segmental anatomy) in situs solitus while fifteen of them with levocardia and three with dextrocardia. One patient was referred to IDD (segmental anatomy) in situs inversus with levocardia. Associated cardiac lesions included ventricular defect in eighteen patients, double outlet of right ventricle in one patient, pulmonary stenosis in seventeen patients and pulmonary hypertension in two patients. The operative procedures to anatomically correct atrioventricular discordance included an atrial switch plus a ventricle-arterial switch. The atrial switch was performed using the modified Senning procedure (n=13), Senning procedure (n=1) and Mustard procedure (n=1). The ventricle-arterial switch was performed using a Rastelli procedure (n=13) or an arterial switch (n=2). The patients underwent Mustard and Rastelli procedure had received bi-direct Gleen shunt due to postoperative high pressure of superior vena cava. Three patients underwent traditional cardiac repair because of small ventricular septal defect and one patient was reoperated to undergo traditional cardiac repair because of left ventricular failure after received anatomically corrective repair. RESULTS: In the patients received anatomically corrective repair, there was one early operative death received a modified Senning atrial switch and an arterial switch. The cause of death was acute myocardial failure due to imperfect coronary transfer. The postoperative complications included severe low cardiac output syndrome (n=1), temporary atrioventricular block (n=1) and thorax cavity fluidify (n=1). The survivors were followed up for 6 months to 4 years. All were sinus cardiac rhythm and in NYHA class I or II. There was no death in the patients received traditional repair. Four patients were followed up for 1 year. Three patients were in NYHA I or II class and one patient in class II. CONCLUSIONS: Anatomically corrective repair of c-TGA can be performed with good operative survival and intermediate-term outcome. The patients with good right ventricular function and well developed tricuspid valve who were difficult to undergo anatomically corrective repair might be fit to receive traditional repair.

[Study of cardiopulmonary adaptation during exercise in patients after extracardiac conduit total cavopulmonary connection].

OBJECTIVE: To study cardiopulmonary physiology during exercise in patients after extracardiac total cavopulmonary connection (ECTCPC). METHODS: Twenty-six patients were studied after ECTCPC by exercise testing with bicycle treadmill protocol. Heart rate (HR), blood pressure (BP), respiratory frequency (RF) and pulse oxygen saturation (SpO(2)) were measured continuously; twenty-six patients suffered from Fallot 4 underwent biventricular repair were also studied as control group. RESULTS: In ECTCPC group, HR, BP, SpO(2) and RF all increased with exercise below 3 grade; when exceed 4 grade, BP, SpO(2) decreased and RF kept increasing. Compared with control group, HR, RF were higher (t = 2.13, P < 0.05; t = 2.31, P < 0.05), SpO(2) was lower (t = 2.46, P < 0.05) under the quiescent condition; When exceed 3 grade, HR, BP, SpO(2) decreased more significantly, but RF increased continuously. In fenestration group after ECTCPC, HR reached the top at 5 grades, but in group without fenestration it reached the top at 3 grades; In the whole process of exercising, RF kept higher and SpO(2) kept lower in fenestration group. CONCLUSIONS: The ECTCPC patients showed obviously exercise limitation. Totally bypass of sinoatrial node in this operation may have some adverse effects on the integer regulation of HR.

[Surgical treatments and results of pulmonary atresia with ventricular septal defect].

OBJECTIVE: To evaluate the indication and operative program of ventricular septal defect with pulmonary atresia (VSD-PA). METHODS: From June 1984 to March 2005, there were 32 patients with VSD-PA, which underwent 33 operations. Among them, 15 were males and 17 were females. The ages ranged from 6 months to 9 years. There were 9 patients with aortopulmonary collateral arteries. The operations included central aorta-pulmonary shunts 3 cases, one stage complete repair 27 cases and one stage unifocalization with VSD open 2 cases. RESULTS: There were early 5 death including one death after aorta-pulmonary shunt and 4 deaths after one stage complete repair. The causes of death were severe low cardiac output (2 patients), respiratory function failure (1 patient), multiorgan function failure (1 patient) and severe infect (1 patient). Twenty-one patients were followed up from 3 months to 15.5 years. Heart function (NYHA) was class I or II in 19 cases and class III or IV in 2 cases. CONCLUSIONS: The operative indication and methods mainly depend on the developing of pulmonary arteries and aortopulmonary collateral arteries. Completely surgical repair of patients with VSD-PA can be achieved with acceptable mortality.

[The treatments and results of tetralogy of Fallot with major aortopulmonary collateral arteries].

OBJECTIVE: To evaluate the indication and operative program of complete repair of tetralogy of Fallot with major aortopulmonary collateral arteries (TOF-MAPCA). METHODS: From January 2000 to May 2004, 9 patients with TOF-MAPCA including 5 patients with pulmonary atresia underwent complete surgical repair, 6 of them were male and 3 were female. The ages ranged from 3 to 9 years. All patients underwent corrected operations with moderate hypothermia and cardiopulmonary bypass. Transcatheter occlusion of MAPCA was performed in 5 patients just before corrected operation. Ligation of MAPCA was performed in 1 patient in the same time of cardiac corrected operation. Midline one-stage complete unifocalization and repair were performed in 3 patients with pulmonary atresia. RESULTS: There was one early death. The cause of death was spinal cord hemorrhage. There was no death then. Eight patients were followed up from 3 month to 4 years. Heart function (NYHA) was class I or II in 7 patients and III in 1 patient. CONCLUSIONS: Completely surgical repair of patients with TOF-MAPCA should be performed as early as possible, which can achieve with satisfactory results by transcatheter occlusion of MAPCA or one-stage unifocalization.