Follow the advance of surgical treatment in complex congenital heart disease, the application of right ventricular(RV)-bypass procedures in RV-hypoplasia/dysfunction was gradually recognized; the pathological pattern of RV-hypoplasia/dysfunction, the histological change of RV-bypass operation and the option on different operative procedure, emphasis on the indication of bidirectional superior cavopulmonary anastomosis(BCPA),the form and method of procedure,and peri-operative management were reviewed in this paper,the optimal age for BCPA, the optimal timing for conversion to Fontan procedure, on pump or off pump, section of the pulmonary trunk, and its difference from hemi-Fontan and 1 1/2 ventricular operation were discussed.
ObjectiveTo analyze the outcomes of complicated congenital heart diseases (CCHD) patients accepting multiple (>2) re-sternotomy operations.MethodsWe retrospectively analyzed the clinical data of 146 patients undergoing multiple cardiac re-sternotomy operations between 2015 and 2019 in our center. There were 95 males and 51 females with an age of 4.3 (3.1-6.8) years and a weight of 15.3 (13.4-19.0) kg at last operation.ResultsThe top three cardiac malformations were pulmonary atresia (n=51, 34.9%), double outflow of right ventricle (n=36, 24.7%) and functional single ventricle (n=36, 24.7%). A total of 457 sternotomy procedures were performed, with 129 (88.3%) patients undergoing three times of operations and 17 (11.7%) patients undergoing more than three times. Fifty-two (35.6%) patients received bi-ventricular repair, 63 (43.1%) patients received Fontan-type procedures, and 31 (21.2%) patients underwent palliative procedures. Ten (6.8%) patients experienced major accidents during sternotomy, including 7 (4.8%) patients of urgent femoral artery and venous bypass. Eleven (7.5%) patients died with 10 (6.8%) deaths before discharge. The follow-up time was 20.0 (5.8-40.1) months, and 1 patient died during the follow-up. The number of operations was an independent risk factor for the death after operation.ConclusionSeries operations of Fontan in functional single ventricle, repeated stenosis of pulmonary artery or conduit of right ventricular outflow tract post bi-ventricular repair are the major causes for the reoperation. Multiple operations are a huge challenge for CCHD treatment, which should be avoided.
ObjectivesTo systematically review the efficacy of His-bundle pacing (HBP) and right ventricular pacing (RVP).MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on efficacy of HBP and RVP from inception to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 8 studies involving 1 130 patients were included. The results of meta-analysis showed that: HBP group was superior to RVP group in QRS duration (MD=–43.88, 95%CI –52.53 to –35.22, P<0.000 01), LVEF (MD=4.53, 95%CI 2.67 to 6.38, P<0.000 01), and NYHA (MD=–0.85, 95%CI –1.14 to –0.56, P<0.000 01). However, the operation time (MD=15.21, 95%CI 11.44 to 18.98, P<0.000 01) and fluoroscopy duration (MD=2.98, 95%CI 2.10 to 3.85, P<0.000 01) of HBP group were longer than that of RVP group.ConclusionsCurrent evidence shows that, compared with RVP, HBP is superior in maintaining of QRS duration, LVEF and NYHA; however, the operation time is longer. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
Objective To evaluate the changes of right ventricular function in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after continuous positive airway pressure (CPAP) treatment by two-dimensional speckle tracking imaging (2D-STI). Methods Fifty patients with moderate and severe OSAHS were selected for CPAP treatment, and another 40 healthy volunteers were selected as a control group. 2D-STI and traditional echocardiography were conducted in the study group before treatment, after 3 months of continuous treatment and after 6 months of continuous treatment and in the control group. Results The differences between the control subjects and the OSAHS patients were statistically significant in right ventricular global longitudinal strain (RVGLS), right ventricular free lateral wall longitudinal strain (RVLLS), apical segment of the right ventricular free wall longitudinal strain (Apical RV-SL), basal segment of the right ventricular free wall longitudinal strain (Basal RV-SL), and media segment of the right ventricular free wall longitudinal strain (Media RV-SL) (all P<0.05). RVGLS, RVLLS and Apical RV-SL were significantly improved after 3 months of CPAP treatment (all P<0.05). Basal RV-SL was significantly improved after 6 months of CPAP treatment (P<0.05). Conclusions The right ventricular function of patients with OSAHS is abnormal. CPAP treatment can improve the right ventricular function of OSAHS patients. 2D-STI can accurately assess the changes of right ventricular function.
Objective Comparing postoperative change of blood gas and hemodynamic status in patients underwent a right ventricletopulmonary artery (RVPA) conduit or a modified BlalockTaussig (mBT) shunt for pulmonary atresia with ventricular septal defect and without major arterial pulmonary collaterals (MAPCAs), to affirm the effect on oxygen supply /demand with different procedure. Methods From July 2006 to October 2007, 38 patients with pulmonary atresia and ventricular septal defect without MAPCAs were divided into two groups according to different procedures: RVPA group (n=25) and mBT group (n=13).Perioperative mortality, blood gas and hemodynamic data during postoperative 48 hours, including heart rate, blood pressure, systemic oxygen saturation, mixed venous oxygen saturation, oxygen excess factor, inotropic score were compared in both groups. Results The difference in the mortality between RVPA group (4.0％，1/25) and mBT group （7.7％，1/13) showed no statistical significance（Pgt;0.05）. The total of 33 patients were followed up, the followup time was from 6 to 18 months.11 patients (4 patients in mBT group, 7 patients in RVPA group) underwent corrected procedures during 9 to 18 months after palliative procedures, one case died of elevated pulmonary vascular resistance and right ventricle failure. The mixed venous oxygen saturation at 24h and 48h after surgery were higher than that at 6h after surgery (Plt;0.01) both in RVPA group and mBT group. The systolic blood pressures at 6h, 24h, 48h after surgery in RVPA group were lower than those in mBT group (P=0.048，0.043， 0.045)，the mean systemic blood pressures in RVPA group were higher than those in mBT group (P=0.048, 0.046, 0.049),the diastolic blood pressures in RVPA group were higher than those in mBT group (P=0.038, 0.034, 0.040)， the inotropic scores in RVPA group were lower than those in mBT group (P=0.035， 0.032，0.047). Conclusion The blood pressures and inotropic scores are found significantly different in RVPA conduit and mBT procedures, while postoperative systemic oxygen delivery areequivalent. Both RVPA and mBT patients decline to nadir in hemodynamic status at 6 h after surgery.
Objective To investigate the hemodynamic performance of valved bovine jugular vein conduits (BJVC) for right ventricular outflow tract reconstruction in canine model. Methods The BJVC that were treated with the glutaraldehyde were implanted between the pulmonary artery and right ventricle in seven young canines. Right ventricular and pulmonary artery pressures were measured directly before and after the implantation. Hemodynamic evaluations were carried out by echocardiography and cardiac catheterization after the implantation. Results Seven canines were survival one year after the implantation. The pulmonary artery pressures (including systolic pressure, diastolic pressure and mean pressure) had not significantly changed after reconstruction with the conduits. The right ventricular diastolic pressures had not increased after the reconstruction, but the right ventricular systolic pressure and mean pressure had increased. One year later, the echocardiography showed valve motion with no obvious thickening of the leaflets. No graft kinking or obvious regurgitation of the valve was observed. Cardiac catheterization and angiography showed that the pressure gradients between the right ventricle and the conduits varied from 3 to 19mmHg, the diastolic pressures in the conduits were higher than that of right ventricle((Plt;)0.01), and the conduits and pulmonary arteries had no obvious obstruction. Conclusion The glutaraldehyde-fixed bovine jugular vein conduit has good hemodynamic performance in the pulmonary circulation.
Objective To summarize clinical outcomes of right ventricle-to-pulmonary artery shunt （Sano shunt）as the first stage palliative operation for patients with pulmonary atresia with ventricular septal defect （PA/VSD）. Methods Between September 2009 and May 2011，17 PA/VSD patients underwent Sano shunt in Fu Wai Hospital. There were 10 male patients and 7 female patients with their median age of 9.7 （2.5-73.8） months and average weight of （8.3±3.4）kg. Preoperative McGoon ratio was 1.04±0.29 and Nakata index was （102.0±56.9） mm2/m2. Five children had severe intrapericardial left pulmonary aretery stenosis，11 patients had patent ductus arteriosus （PDA），and 1 patient had major aorto-pulmonary collateral arteries. Preoperative transcutaneous oxygen saturation （SpO2） was 72.6%±11.6%. Results All the patients received Sano shunt placement successfully. Eleven patients underwent concomitant PDA ligation，and 7 patients underwent concomitant left pulmonary artery plasty. The Sano shunts were constructed with glutaraldehyde-fixed autologous pericardium in 10 patients，fresh autologous pericardium in 1 patient and Gore-Tex graft in 6 patients. All the patients underwent reconstruction of the right ventricular outflow tract via the right ventricular incision. The average cardiopulmonary bypass time was （75.0±30.0） min. Postoperative SpO2 was 89.8%±5.3% and significantly higher than preoperative SpO2 （P＜0.05）. All the patients were discharged alive and followed up for （12.1±6.7） months. During follow-up，8 patients underwent angiography study whose McGoon ratio and Nakata index improved to 2.05±0.37 and （304.8±51.3） mm2/m2 respectively，both of which were significantly higher than preoperative values（P＜0.05）. Four patients successful underwent second stage total correction. Conclusion Sano shunt is a comparatively safe procedure as the first stage palliative operation for PA/VSD patients，and can significant improve their pulmonary artery growth.
Double outlet right ventricle (DORV) is a complex cardiac malformation with many anatomic variations and various approaches for surgical repair. DORV is mainly defined as the congenital heart disease with ventriculoarterial connection in which both pulmonary artery and aorta arising primarily (>50%) from the right ventricle, associated with continuity or discontinuity between the aorta and mitral valve. DORV can be subclassified by various ways. Now subclassification is usually performed according to the relationship between the ventricular septal defect (VSD) and the great arteries. Various approaches for surgical repair of DORV ranging from single ventricle palliation to biventricular repair are reported from many centers. However, the high-grade guideline of surgical management of DORV is still absent. Hence, we developed the Chinese expert consensus on DORV as the evidence for surgical strategies.