At present, the operative results of complex congenital heart disease are suboptimal which is closely correlated to the understanding of the anatomy and function of complex congenital heart disease, and operative techniques. With the further understanding to pathology and physiology of congenital heart disease, strategies and techniques in well-known operations and complex procedures have developed in recent years. Currently, designing and applying individual operative method in terms of patient’s characteristics of anatomy and physiology is very important trend. This article reviewed the advances of knowledgement and techniques in some representive complex congenital heart disease including complete atrioventricular septal defect, unifocalization for major aortopulmonary collateral arteries, transopsition of the great artery and Fontan type operation.
Bidirectional superior cavopulmonary anastomosis(BCPA)is a palliative method used in the single ventricular repair. It mainly includes bidirectional Glenn shunt and hemi-Fontan operation. The indications of BCPA are those as an intermediate option of total cavopulmonary anastomosis, partial biventricular or 1 1/2 ventricle repair and a practical approach to complex congenital heart surgery. The choise of age,influence on pulmonary artery maturation,remain of additional pulmonary flow,formation of collaters and time to Fontan are demand of study.
Abstract:The use of pulmonary autograft was first reported in 1967 by Ross for the treatment of aortic valve disease in adults. Since that time, Ross procedure has been applied to a variety of forms of aortic stenosis and left ventricular outflow tract obstruction and mitral valve disease, Ross procedure has undergone several modifications, such as the root replacement method, inclusion cylinder technique, annular reduction, Konno root enlargement procedures and replacement of the mitral valve with a pulmonary autograft （Ross-Kabbani procedure or Ross Ⅱ procedure）. Advantages of Ross procedure in women of childbearing age, children and young adults include freedom from anticoagulation, appropriate sizing, cellular viability with growth potential proportional to somatic growth, acceptable long-term durability, excellent hemodynamic performance and decreased susceptibility to endocarditis. Surgical technical aspects, indications, selection criteria for the Ross procedure and its modifications, their applicability in the surgical management of aortic stenosis, left ventricular outflow tract obstruction and mitral valve disease and clinical outcome of Ross procedure are reviewed in this article.
Objective To compare the difference of effect while using homograft pericardium patch and Gore- tex patch in staged repair of tetralogy of Fallot（TOF） to enlarge the right ventricular outflow tract （RVOT）. Methods Twenty-eight patients with TOF who underwent the staged complete repair were divided into 2 groups according to the date of surgery. Gore-rex group, 13 cases, their RVOT were enlarged with Gore-tex patches. Cryopreserved homograft pericardium patch group, 15 cases, their RVOT were enlarged with cryopreserved homograft pericardium patches. Clinical results and follow-up results were compared. Results There were 1 operative death in Gore-tex patch group （7. 7%）, and 1 early postoperative death in cryopreserved homograft pericardium patch group （6. 7%）. Hemostasia time, the pericardial cavity drainage volume in cryopreserved homograft pericardium patch group were less than those in Gore-tex patch group （P〈0. 01）. All patients were followed-up for 0.8-4.5years. The residual obstruction rate at RVOT level in Gore-tex patch group was higher than that in cryopreserved homograft pericardium patch group by echocardiography （P〈0.01）. No calcification shadow was found on the chest X-ray. Conclusion Homograft pericardium is the tissue with high density and intensity, its elasticity and compliance are good. Using homograft pericardium patch may be helpful to decrease the residual obstruction of RVOT after operation. It can be adapted as a repairing material in heart surgery.
Abstract： Objective To investigate the outcome of continuous shallow stitching repairing perimembranous ventricular septal defect(pVSD). Methods From January 2002 to October 2004,50 patients less than 10kg of body weight with simple pVSD were chosen in our hospital. VSD was repaired by continuous shallow stitching with autograft pericardium. Results The aortic clamping time was 32±21min（14-52min）, cardiopulmonary bypass time 56±35min（29-69min）.No Ⅲ° atrioventricular conduction block happened, 9 patients developed right bundle branch block, and 2 patients showed junctional rhythm. Two patients with perimembranous extending outlet were repaired because of residual shunt(0.4cm,0.3cm) on the anterosuperior rim of defect. One patient with trivial residual shunt(0.15cm) on the posteroinferior rim of defect was found closed spontaneously six months later. Tricuspid valve was incised in 10 patients of VSD sextending outlet,8 patients vertical to the valve ring,2 patients parallel to the valve ring. Moderate tricuspid valve regurgitation was found in 1 patient, mild in 5 patients, trivial in 4 patients. No one aggravated. One patient complicated with pericardial effusion.One patient was reoperated because of bleeding. Conclusion Continuous shallow stitching repairing pVSD is effective.