RESUMO
Objective:This study defined mid-term results of a policy of single-stage repair of interrupted aortic arch associated cardiac anomalies.Methods:Between October 2012 and June 2019, 38 patients with interrupted aortic arch were evaluated for short- and mid-term results after surgical treatment, the average age of patients was(12±7) days and the mean body weight was(3.3±0.5)kg.29 patients belonged to IAA type A, and 7 patients to type B, and 2 patients belonged to IAA type C, 30 patients were complicated with ventricular septal defect, atrial septal defect, and patent ductus arteriosus, two complicated with bicuspid aortic valve, four complicated with Taussig-Bing malformation and two with double outlet right ventricle, one with truncus arteriosus(A4), one with aortopulmonary window, one with left ventricle outflow tract obstruction. Single-stage repair was performed in all patients with cardiac anomalies.Results:Early mortality was 5.2%(2 cases), one was die for low cardiac output syndrome, the other die of septic shock. Median CPB time was 138 min(90-305 min), and median aortic cross clamping time was 68 min(47-163 min). Hospital day was 25d( 13-52 days).32 patients were followed-up, median time 34 months(9-85months). 2 patients(6.0%) were mild pulmonary stenosis pressure(20-25 mmHg), 3 patients(9.3%) suffer aortic anastomosis mild stnosis(21-44)mmHg.1 patient(3.1%) LVOTO was repaired ten months after the repair of interrupted aortic arch. The left broncus of of one patient was mild stenosis but without dyspnea.Conclusion:Single-stage end -to-side anastomosis repair of interrupted aortic arches in neonatal and repair of associated cardiac anomalies is safe and have low effective with low motality.
RESUMO
Objective:To investigate the efficacy of descending aortic translocation in relieving the compression of trachea or bronchus caused by aortic deformity.Methods:From January 2017 to July 2019, a total of 11 patients with distal trachea or proximal bronchial stenosis caused by aortic deformity were treated with descending aortic translocation. Cardiac CT and fiberoptic bronchoscopy were performed before surgery. The median age was 55(23-540) days, and the body weight was 4(2.1-9.0)kg. Five patients had a special type of vascular ring(left aortic arch with right descending aorta, small aortic window with funnel chest; left aortic arch with right descending aorta and right artery ligament, vagus right subclavian artery, combined with trachea, carina and left and right bronchial stenosis in 1 case; Right aortic arch with left descending aorta, combined with tracheomalacia stenosis in 1 case; Right aortic arch with left descending aorta combined with broad tracheal stenosis and left pulmonary dysplasia in 1 case) compressed tracheal or bronchial tube in 5 cases. Three patients with left main bronchus constriction after traditional arch disconnection surgery. 3 patients with left main bronchus stenosis before coarctation or interrupted aortic arch.Surgical methods: Descending aortic translocation was performed through a midline sternotomy with cardiopulmonary bypass and deep hypothermia.The proximal descending aorta was transected distal to the left subclavian artery, proximal sutures were performed, and the distal brought up though the transverse sinus caudad to the right pulmonary artery and tracheal carina, and anastomosed in end-to-end fashion to the ascending aorta, and simultaneous correction was performed with intracardiac malformations, such as airway plasty was performed at the same time without improvement after compression of tracheal stenosis.Results:There was no death in the whole group. Median cardiopulmonary bypass was 180(136-337)min with an median aortic cross-clamp time of 51(30-84)min; Median absence of perfusion to the descending thoracic aorta 34(21-50)min .Tracheal compression was effectively relieved in 5 patients, and airway plasty was performed simultaneously in 6 patients due to persistent tracheal softening and stenosis. All patients had resolution of symptoms.There was only one case anastomotic stenosis after descending aortic translocation.The mean follow-up was(18.0±9.4)months.Conclusion:Descending aortic translocation can effectively relieve this kind of pressure due to aortic deformity.
RESUMO
Objective To explore the value of echocardiography in evaluation of pulmonary venous in total anomalous pulmonary venous connection (TAPVC).Methods Fifty-five children with TAPVC were enrolled in the study.The data of echocardiography and CT angiography were retrospectively analyzed and compared with intraoperative findings.Results Totally 55 patients with TAPVC were classified into supra-cardiac type (n=24),cardiac type (n=20),infra-cardiac type (n=7) and mixed type (n=4) according to the sites of drainage of pulmonary venous in echocardiography.In 15 patients with obstruction of pulmonary vertical vein,the sites of obstruction in the supra-cardiac type mostly presented between vertical vein and superior vena cava or innominate vein,and the sites of obstruction in the infra-cardiac presented all between vertical vein and hepatic or portal vein.In 4 patients with pulmonary vein stenosis,3 cases with local pulmonary vein stenosis were all cardiac type,which presented between individual pulmonary vein and common confluence or right atrium;1 patient with diffuse pulmonary vein stenosis was infra-cardiac type.In 9 patients of abnormal individual pulmonary vein,8 cases were not detected by echocardiography,but all were detected by CT angiography.Conclusion Echocardiography is able to make more comprehensive evaluation for the pulmonary venous drainage,obstruction,and proximal stenosis of individual pulmonary vein in TAPVC.CT angiography is superior in evaluation of abnormalities of connection and amount of individual pulmonary vein,and imaging of distal pulmonary vein.
