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find Author "苏肇伉" 36 results
  • 开展术后随访的困境和策略

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • 先天性心脏病微创手术的发展趋势

    Release date:2016-08-30 06:26 Export PDF Favorites Scan
  • 亟待提高我国复杂先天性心脏病外科治疗的质量

    Release date:2016-08-30 06:27 Export PDF Favorites Scan
  • Current Clinical Application of Ross Procedure

    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.

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • Advances of operative technique for several complex congenital heart disease

    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.

    Release date:2016-08-30 06:27 Export PDF Favorites Scan
  • Bidirectional superior cavopulmonary anastomosis

    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.

    Release date:2016-08-30 06:28 Export PDF Favorites Scan
  • 双向上腔静脉肺动脉吻合术后并发肺动静脉异常的发病机制

    综述肺动静脉异常发生的病理机制.双向上腔静脉肺动脉吻合术后并发肺动静脉异常是患者术后紫绀进行性加重的主要原因之一,其发病机制一般认为与肺循环血流动力学、肝因子或肝静脉缺乏和低氧等因素有关.双向上腔静脉肺动脉吻合术后低于正常值的动脉血氧饱和度可刺激一些血管生成因子,如血管内皮生长因子和成纤维细胞生长因子的表达增加;肝静脉血被排除在肺循环以外,其内在的抑血管形成因子缺乏使血管重塑,最终导致肺动静脉异常的形成.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • Surgical Intervention for Tetralogy of Fallot in Early Infancy

    Objective To summarize the experiences of surgical intervention for tetralogy of Fallot(TOF) in early infancy and to discuss the relevant issues about primary treatment procedures in the period. Methods We retrospectively analyzed the clinical operative information of 21 patients in their early infancy (less than 6 months) with TOF treated in Children’s Hospital of Shanghai from June 2008 to August 2010. There were 14 males and 7 females with a mean age of 4.86±1.15 months and a mean body weight of 6.84±1.33 kg. All patients were diagnosed by heart color Doppler ultrasound. Four patients underwent CT or magnetic resonance imaging(MRI) or right heart catheter arteriography examination. The McGoon ratio was 1.86±0.41 and the pulmonary artery index(PAI) was 142.54±59.46 mm2/m2. The ventricular septal defect (VSD) was closed with autologous pericardium using continuous sutures through right atrium (19 cases) or right ventricle (2 cases). Transannular repair was performed when pulmonary valve annulus was one standard deviation less than the normal Z value (18 cases). If the annulus diameter approached or reached the normal Z value, the valve annulus was preserved and pericardium was used to enlarge the right ventricular outflow tract(RVOT) and the main pulmonary artery (3 cases). Results There was one death due to heart failure on the 15th day after operation, one patient had acute laryngeal edema after removal of endotracheal intubation on the second day after operation, and received reintubation and assisted ventilation for three days. All the other patients recovered well. Eighteen patients were followed up for 9.89±6.47 months. Their heart functions were in modified Ross class I or II. Echocardiography during the followup showed that RVOT pressure was 21.20±12.27 mm Hg (8.10-45.14 mm Hg); pulmonary incompetence (PI) was mild in 10 cases, moderate in 5 cases, and no severe PI occurred. Two cases of residual VSD were spontaneously closed. Compared with the early postoperative period, RVOT pressure and PI levels were not significantly different (Pgt;0.05). Right heart function was good.onclusion Early complete repair of TOF yields good surgical results. Transatrial repair of intracardiac pathology and retaining pulmonary valve annulus can be safely applied to yield good postoperative right ventricular function.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • Change of Blood Gas and Hemodynamic Status after Palliative Procedurein the Patients with Pulmonary Atresia and Ventricular Septal Defect

    Objective Comparing postoperative change of blood gas and hemodynamic status in patients underwent a right ventricletopulmonary artery (RVPA) conduit or a modified BlalockTaussig (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: RVPA group (n=25) and mBT group (n=13).Perioperative mortality, blood gas and hemodynamic data during postoperative 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 RVPA 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 followup time was from 6 to 18 months.11 patients (4 patients in mBT group, 7 patients in RVPA 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 RVPA group and mBT group. The systolic blood pressures at 6h, 24h, 48h after surgery in RVPA group were lower than those in mBT group (P=0.048,0.043, 0.045),the mean systemic blood pressures in RVPA group were higher than those in mBT group (P=0.048, 0.046, 0.049),the diastolic blood pressures in RVPA group were higher than those in mBT group (P=0.038, 0.034, 0.040), the inotropic scores in RVPA 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 RVPA conduit and mBT procedures, while postoperative systemic oxygen delivery areequivalent. Both RVPA and mBT patients decline to nadir in hemodynamic status at 6 h after surgery.

    Release date:2016-08-30 06:04 Export PDF Favorites Scan
  • 先天性心脏病矫治术后膈肌麻痹的诊断与治疗

    目的 总结先天性心脏病矫治手术后膈肌麻痹的原因、临床表现和外科治疗经验,以提高对该类患者的诊治水平。 方法 2000年1月至2007年6月,36例患者在先天性心脏病矫治手术后出现膈肌麻痹,其中13例因手术后撤呼吸机困难,无法脱离呼吸机;6例术后出现呼吸矛盾运动,二氧化碳潴留(动脉血二氧化碳分压>50 mm Hg)和低氧血症(动脉血氧饱和度<90% );4例反复发生肺部感染无法治愈,均施行了膈肌折叠术,平均年龄为13个月;另外13例膈肌麻痹患者能顺利撤离呼吸机,未行手术治疗。 结果 术后因败血症和弥漫性血管内凝血死亡1例。膈肌折叠手术后胸部X线片示:所有患者膈肌位置正常或抬高小于1个肋间,肺部体征明显改善,呼吸矛盾运动消失,能正常撤离呼吸机。随访13例,失访22例,随访时间1~6年,其中行膈肌折叠的10例患者膈肌位置保持正常;未行膈肌折叠的3例患者膈肌仍然抬高1~2个肋间,但呼吸运动正常,未发生反复呼吸道感染。 结论 先天性心脏病手术后并发膈肌麻痹的原因大多与术中损伤膈神经有关;对低龄儿童和婴儿,早期施行膈肌折叠术可获得较好的临床治疗效果。

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
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