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find Keyword "双向Glenn手术" 4 results
  • Perioperative Thromboembolic Complications after Cavo-pulmonary Connections

    Abstract: Objective To analyze the manifestation, treatment,outcome and potentially predisposing risk factors of perioperative thromboembolism after cavo-pulmonary connection, and to assess the effects of our prophylactic antithrombotic strategy. Methods Clinical data of 264 cases of bidirectional Glenn and 224 cases of total cavopulmonary connection (TCPC) operations undertaken from September 2005 to December 2010 in Fu wai hospital were retrospectively analyzed. Perioperative thromboembolic complications occurred in 9 patients. 5 of them were after bidirectional Glenn, 4 were after TCPC. Most of the 9 patients had at least one thrombi-related risk factor. The routine prophylactic antithrombotic therapy after these operations were intravenous infusion of heparin 10 U/(kg·h) initially, followed with oral aspirin 1-3 mg/(kg·d). Results Thromboembolic events occurred within 7 days after the operation in 6 cases, appeared 2 to 4 weeks after the surgery in 3 cases. All 9 patients received anticoagulation with heparin. One patient also undertook take-down operation. 3 (33%) patients died, accounting for 33% (1/3), and 18% (2/11) of the early deaths after bidirectional Glenn and TCPC operations. Clinical symptoms improved or disappeared in the remaining 6 patients. Conclusion The mortality of perioperative thromboembolic complications after cavo-pulmonary connection is high, consisting of the important cause of early deaths after these procedures. Our prophylactic anticoagulation strategy proved to be effective, though some thrombi-relatedrisk factors still need to be avoided.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 非体外循环双向Glenn手术治疗小儿复杂先天性心脏病

    目的 总结非体外循环双向Glenn手术在小儿复杂先天性心脏病中的应用经验。 方法 2005年4月至2008年8月,青岛市儿童医院收治22例先天性心脏病患者,男14例,女8例;年龄10个月~7岁,平均年龄3.0岁;体重6~18 kg。功能性单心室合并肺动脉狭窄9例,室间隔完整的肺动脉闭锁4例,重度三尖瓣下移畸形3例,三尖瓣闭锁3例,矫正型大动脉转位合并右心室流出道狭窄2例,室间隔缺损合并重度三尖瓣狭窄1例。所有患者均在非体外循环下行双向Glenn手术,其中7例行双侧双向Glenn手术。 结果 无手术死亡。术后发生胸腔积液2例,经胸腔穿刺抽液后治愈。术后患者肺动脉平均压13.0±2.3 mm Hg,呼吸机辅助呼吸时间3.0±1.7 h,住院时间9.0±23 d,出院时脉搏血氧饱和度85%±8%,活动耐量明显改善。所有患者均获得随访,随访时间8个月~4年;超声心动图提示:所有患者吻合口通畅,均无扭曲及血栓形成;心功能Ⅰ级18例,Ⅱ级4例。 结论 非体外循环双向Glenn手术治疗小儿复杂先天性心脏病安全,可适当扩大手术适应证。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • 非体外循环双向Glenn分流术治疗

    目的 总结非体外循环下行双向Glenn分流术治疗紫绀型复杂先天性心脏病的临床经验,以提高手术疗效。 方法 2001年5月至2007年5月,56例患者在非体外循环下行双向Glenn分流术,术后采用电话和信件问卷方式对患者进行随访。 结果 术后早期死亡3例,死于低心排血量综合征。术后肺动脉压较术前增高(16.3±3.2 mm Hg vs. 12.4±2.1 mm Hg,Plt;0.05);术后动脉血氧饱和度较术前提高(91%±5% vs. 74%±10%,Plt;0.05)。随访39例,随访时间3个月~6年,失访14例。随访期间死亡2例,其中1例出院后即死于心力衰竭,1例于3年后死于肺气肿。37例生存患者的5年生存率为95% (37/39),32例紫绀有所减轻,21例患者于术后3~6个月行心电图、彩色超声心动图检查,腔静脉肺动脉吻合口均通畅,肺动脉压为17.3±1.8 mm Hg。 2例患者于术后2年行全腔静脉肺动脉连接术,二期手术后效果满意。 结论 非体外循环下双向Glenn手术安全、可靠,是一种治疗难以解剖根治或一期生理矫治的紫绀型复杂先天性心脏病患者的较好术式。

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • Bidirectional Glenn Procedure for the Treatment of Complex Cyanotic Congenital Heart Diseases

    ObjectiveTo summarize our clinical experience of bidirectional Glenn procedure (BGP) for the treatment of complex cyanotic congenital heart disease (CHD). MethodsClinical data of 68 patients with complex cyanotic CHD who underwent BGP in People's General Hospital of Xinjiang Uygur Autonomous Region from January 2007 to December 2012 were retrospectively analyzed. There were 40 male and 28 female patients with their average age of 3.9 years (range, 3 months to 22 years) and body weight of 6.2-53.0 (13.6±8.5)kg. Preoperative diagnosis included tricuspid atresia in 20 patients, single ventricle (SV) in 11 patients, double outlet right ventricle in 10 patients, complete transposition of great arteries in 7 patients, tricuspid stenosis in 5 patients, pulmonary atresia in 5 patients, corrected transposition of great arteries in 4 patients, tetralogy of Fallot in 4 patients and Ebstein's anomaly in 2 patients. Among them, there were 14 patients with dextrocardia or dextroversion of the heart, 2 patients with SV and pulmonary hypertension after pulmonary artery banding, and 1 complete transposition of great arteries patient after aortopulmonary shunt. Twenty-three patients received BGP under cardiopulmonary bypass (CPB) and 45 patients received BGP without CPB. ResultsTwo patients died postoperatively, including 1 patient with severe low cardiac output syndrome (LCOS) and another patient with pulmonary infection. Postoperative pulse oximetry oxyhemoglobin saturation (SpO2, 89.3%±7.4%) was significantly higher than preoperative SpO2 (66.8%±11.8%, P < 0.05). In 53 patients, postoperative SpO2 was more than 10% higher than preopera-tive SpO2. Postoperative hematocrit (0.40±0.07) was significantly lower than preoperative hematocrit (0.49±0.11, P < 0.05). Postoperative complications included pleural effusion in 16 patients (23.5%), chylothorax in 7 patients (10.3%), LCOS in 5 patients (7.4%), arrhythmias in 4 patients (5.9%), and pneumothorax in 1 patient (1.5%), who were all cured after appropriate treatment. Fifty-five patients were followed up for 9 months to 6 years after discharge with satisfactory clinical results. All anastomoses remained patent without stenosis or thrombosis. Four patients successfully received total cavopulmonary connection 2 to 5 years after discharge. ConclusionBGP is safe and reliable for patients with complex cyanotic CHD who cannot undergo anatomic correlation or one-stage repair.

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