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find Author "严勤" 5 results
  • Surgical Treatment of Persistent Fifth Aortic Arch Associated with Stenosis and Interrupted Aortic Arch

    Objective To summarize the experiences of single stage repair of persistent fifth aortic arch associated with stenosis and interrupted aortic arch and other cardiac anomalies,and to improve surgical effect of the diseases. Methods From Jan.2000 to May 2008,five patients with persistent fifth aortic arch were operated in this hospita1,the age at operation was 1.8-108.0 months and body weight 3.7-31.0 kg.Three patients had chronic heart failure and respiratory infection repeatedly.All patients received single stage repair. Results There were two early hospital deaths,one patient’s parents gave up all the therapy because of cardiac insufficiency, pulmonary hypertension crisis and severe pulmonary infection; another one died of severe pulmonary hypertension crisis,the low cardiac outflow and left heart failure. Three patients were followed up, followup time was 55.67±48.64 months. The results were excellent,and one patient had been followed up for 8 years,the latest magnetic resonance imaging showed that diameter of the enlarged fifth aortic arch was 9.3 mm. Conclusion Persistent fifth aortic arch operation can achieve good exposure,less incisional wound and excellent recovery through midline sternotomy.Because of systemic hypertension and the affection of associated anomalies the operation should be performed as early as possible.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • Application of Nikaidoh Operation to the Treatment of Transposition of Great Arteries with Ventricular Septal Defect and Pulmonary Stenosis

    Abstract: Objective To review the shortterm outcome of modified Nikaidoh operation, aortic translocation and biventricular outflow tract reconstruction as an alternative surgical procedure for the treatment of transposition of the great arteries with ventricular septal defect and pulmonary stenosis (TGA/VSD/PS). Methods Between January 2004 and December 2005, 8 consecutive patients had undergone Nikaidoh procedure for the treatment of TGA/VSD/PS at Shanghai Children’s Medical Center. All patients had ventriculoarterial discordance and atrioventricular concordance. Associated lesions included a straddling atrioventricular valve in one patient and hypoplastic left pulmonary artery. The median age at operation was 11.4±7.6months (4 to 29months). Weight of body was 8.0±1.9kg (5.2 to 11.0kg). No patient had previous palliative procedure. The surgical technique used was a modification of the Nikaidoh procedure. Results The median total cardiopulmonary bypass time was 176±50 minutes (range,112 to 250 minutes), and the median aortic crossclamp time was 101±27 minutes (range, 73 to 139minutes). The median length of stay in the intensive care unit was 12±9 days, with a median hospital stay of 19±12 days. There was 1 hospital death as a esult of severe left ventricle failure. There was no residual left ventricular outflow tract obstruction (LVOTO) and right ventricular outflow tract obstruction (RVOTO), but 3 patients with mild to moderate pulmonary regurgitation and 4 patients with moderate. At a median follow-up of 8.8 months (range, 3 to 18months), all patients were alive. All have the normal ventricular function. There were ejection fraction (EF) 0.64±0.02 and fractional shortening (FS) 0.33±0.02. None of the patients developed aortic insufficiency and progressed LVOTO or RVOTO. Conclusions Nikaidoh procedure is a valuable surgical option for TGA/VSD/PS in infant, especially in the presence of “inadequate anatomy” for a Rastelli repair. Big evidence and longer follow-up are required to fully assess the potential longterm benefits of this procedure compared with the Rastelli repair.

    Release date:2016-08-30 06:15 Export PDF Favorites Scan
  • 一期手术矫治先天性主动脉弓中断

    目的 探讨先天性主动脉弓中断(IAA)一期手术矫治的手术方法、疗效,总结其临床经验. 方法 对10例少见的先天性IAA进行一期手术矫治,平均手术年龄2.7±2.4岁,其中5例为A型IAA,3例为B型,另2例IAA合并残存第5弓狭窄;8例患者均合并其它心血管畸形和重度肺动脉高压.一期矫治术中有7例进行了主动脉弓直接端侧或端端吻合连接术,2例行Gore-Tex管道连接重建主动脉弓,1例IAA合并残存第5弓狭窄用自身心包补片作狭窄处扩大成形术;8例患者于矫治IAA的同时矫治心血管其他畸形. 结果 术后早期发生心功能不全、心律失常、肺动脉高压危象等并发症5例,其中近10年仅发生1例.住院死亡3例,近10年连续6例无住院死亡.术后早期5例肺动脉收缩压/体循环动脉收缩压(Pp/Ps)由术前的0.84±0.04显著下降至正常范围(0.28±0.03),1例主动脉弓部压力阶差为30mmHg(1kPa=7.5mmHg).随访7例,平均随访2.6±4.0年,均存活,其中有3例主动脉弓部压力阶差≥30mmHg.心功能均正常. 结论 先天性IAA一旦诊断明确,应尽早进行一期矫治术; 主动脉弓直接吻合连接术效果较佳.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • Pulmonary Artery Banding for Morphologic Left Ventricular Training in Corrected Transposition of the Great Arteries

    Abstract: Objective To evaluate clinical outcomes of pulmonary artery banding for morphologic left ventricular training in corrected transposition of the great arteries.?Methods?A total of 89 patients with corrected transposition of the great arteries underwent surgical repair in Shanghai Children’s Medical Center from January 2007 to December 2011 year. Among them, 11 patients underwent pulmonary artery banding, whose clinical records were retrospectively analyzed. Except that one patient was 12 years, all other patients were 3 to 42 (16.40±11.67) months old and had a body weight of 6 to 32 (11.70±7.20)kg. All the patients were diagnosed by echocardiogram and angiocardiogram.?Results?There was no postoperative death after pulmonary artery banding in 11 patients. The pulmonary arterial pressure/systemic blood pressure ratio (Pp/Ps) was 0.3 to 0.6 (0.44±0.09) preoperatively and 0.6 to 0.8 (0.70±0.04) postoperatively with statistical difference (P<0.01). Tricuspid regurgitation was mild in 2 (18.2%) patients, moderate in 5 (45.4%), severe in 4 (36.4%)preoperatively,and none in 2(18.2%)patients, mild in 7 (63.6%),and mild to moderate in 2 (18.2%)postoperatively. Five patients underwent staged double-switch operation after pulmonary artery banding at 15.20±8.31 months, and 1 patient died. The other 6 patients were followed up for 18.83±3.43 months, and echocardiogram showed tricuspid regurgitation as trivial in 2 (33.3%), mild in 3 (50.0%), and moderate in 1 (16.7%)patient.?Conclusions?In patients with corrected transposition of the great arteries, pulmonary artery banding is helpful to reduce tricuspid regurgitation, and morphologic left ventricle can be trained for staged double-switch operation with good clinical outcomes. It is important to follow up these patients regularly to evaluate their morphologic left ventricular function and tricuspid regurgitation after pulmonary artery banding.

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • Medical Results of One-stage Fontan Procedure in 116 Patients at A Single Institute

    ObjectiveTo analyze the outcomes of patients with one-stage Fontan procedure and short-term prognosis at a single institute. Method We retrospectively analyzed clinical records of 116 patients with one-stage Fontan procedure in our hospital from January 2008 through September 2013. There were 77 males and 39 females (36%), with median age 6.27 years (ranged 3.15 to 17.47 years) at the time of surgery and the median weight at 17.5 kg (ranged 10.0 to 80.0 kg). There were 55 patients with standard extracardiac conduit, 13 patients with direct extracardiac connection, 17 patients with intra-atrial or intra/extracardiac conduit, and 31 patients with lateral tunnel. ResultsMedian cardiopulmonary bypass time was 124 (61-256) minutes. Median cross-clamp time was 60 (19-152) minutes. There were six early deaths (5.1%). The overall median time of the cardiac intensive care unit stay was 4 (1-17) days, with a median ventilator support of 7.3 (1.0-181.0) hours. The mean room air saturation was 90.00%±4.68% before discharge. Median length of chest tube drainage was 10 (4-45) days. Multiple logistic analysis confirmed that heterotaxy syndrome was the only independent predictor for postoperative renal insufficiency. Operations with aortic cross-clamping (OR=26.184, 95% CI 1.712-400.451), preoperative sinus mode dysfunction (OR=6.777, 95% CI 1.495-30.721) and cross-clamp time over 60 minutes (OR=1.036, 95% CI 1.002-1.076) were predictors for prolonged chest tube drainage. A total of 110 patients were followed up for 17 (8-47) months with 2 deaths and 1 with thrombosis. No reoperation occurred. ConclusionThe one-stage Fontan procedure can be performed with satisfactory outcomes. Staged strategies for operations may be appropriately loosen for selected elder children.

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