Abstract： Objective To summarize surgical results of secondary subaortic stenosis （SSS） after congenital heart disease （CHD） operations，and analyze the pathogenesis of SSS. Methods We retrospectively analyzed clinical data of 19 patients who underwent surgical repair for SSS in Guangdong General Hospital from 1st June 2008 to 31st December 2012. There were 10 males and 9 females. CHD types included double outlet right ventricle，ventricular septal defect and partial atrioventricular septal defect，et al. The median age of the patients when they received their first CHD operations was 4 months （15 days to 5 year and 11 months）. The median age of the patients when they received SSS repair was 5 years and 3 months （1 year to 15 years and 3 months）. The median time interval from CHD operation to SSS repair was 4 years and 10 months （8 months to 13 years and 11 months）. Results All the patients successfully received their SSS repair. There was no surgical death in this study. Median cardiopulmonary bypass time was 79 （39 to 172） minutes，and median aortic cross-clamp time was 42 （22 to 124） minutes. Median postoperative hospital stay was 7 （5 to 9） days. Postoperatively， 1 patient required permanent pacemaker implantation. All the patients were followed up after discharge for a median durationof 1 year and 10 months （5 months to 4 years and 4 months） . During follow-up， none of the patients had any clinical symptom，their heart function was normal，and there was no late death. One patient received another subaortic stenosis repair for gradually aggravating left ventricular outflow tract stenosis. Conclusions SSS is very rare after CHD operations. The pathogenesis of SSS is perhaps related to abnormal blood flows in the left ventricular outflow tract after CHD operations. The pathogenesis time of SSS and types of CHD leading to SSS cannot be predicted. Subaortic stenosis repair is a simple and safe procedure for SSS，but postoperatively left ventricular outflow tract stenosis may appear and aggravate again.
ObjectiveTo explore the clinical effect of delayed sternal closure (DSC) after neonatal cardiac operations. MethodsWe retrospectively analyzed the clinical data of 347 neonates who underwent cardiac operations through midterm sternotomy in Shanghai Children's Medical Center between January 2008 and December 2012. There were 273 male and 74 female patients with mean age of 14.8±8.4 days and mean weight at 3.4±0.5 kg. We analyzed the influencing factors of delayed sternal closure and the relationship between delayed sternal closure and mortality. A total of 127 patients had DSC (36.6%). Ninety-two patients were of primary DSC because of hemodynamic instability in the operation room, and 35 were of the secondary DSC because that the sternum was reopened in intensive care unit during the early postoperative period. The diagnosis of complex congenital heart defects had a high risk of DSC. The incidence of DSC for great artery (TGA), corctation of aorta (CoA), interruption of aortic arch (IAA), total anormalous pulmonary vein drainage (TAPVD), Taussig-Bing malformation, hypoplastic left heart syndrome (HLHS) was 43.2%, 83.3%, 62.5%, 15.6%, 71.4%, and 66.7% respectively. The DSC patients had longer duration of CPB time (141.4±51.7 min versus 108.5±51.9 min) and clamping time (79.3±29.2 min versus 65.4±25.5 min). In 113 patients the sternums were closed 1-11 days after the initial operation. Sixteen patients died ultimately including 2 deaths after the closure of sternum with a mortality of 12.6%. Surgical site infection occurred in 5 patients including 2 severe patients with surgical intervention. ConclusionDSC has been an essential part of neonatal heart surgery. It provides an opportunity for the recovery of cardiac function.
Objective To summarize the method and outcomes of surgical treatment for 21 patients with congenital anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods We retrospectively analyzed the clinical data of 21 patients with ALCAPA underwent surgical treatment in our center from January 2010 to January 2015. There were 11 males and 10 females with a mean age of 4.3 years (ranging from 0.5 to 16.0 years) and a mean weight of 19.3 kg (ranging from 5.0 to 97.0 kg). All of 21 patients underwent surgery under cardiopulmonary bypass and corrected malformations. Results There were 2 perioperative deaths and the mortality rate was 9.5%. The mean cardiopulmonary bypass time was 116.6 minutes ranging from 109.0 to 388.0 minutes and the mean aortic cross clamping time was 82.9 minutes ranging from 62.0 to 129.0 minutes. The mean time of hospital stay was 11.1 days ranging from 1.0 to 25.0 days. After surgery, cardiac function improved significantly in all patients. The mean left ventricular ejection fraction (EF), left ventricular fractional shortening (FS), and left ventricular end-diastolic diameter (LVEDD) have significantly improved after surgery (P < 0.05). Conclusions Once patients with ALPACA are diagnosed, they should be treated with surgery and most of them will achieve a satisfactory long term clinical result.
Objective To summarize the experience of the superior vena cava and pulmonary connection surgery for functional single ventricle (SV) with total anomalous pulmonary venous (TAPVC). Methods We retrospectively analyzed the clinical data of 10 patients with SV and TAPVC in our hospital from January 2012 through June 2014. There were 7 males and 3 females at average age of 90.33±86.53 months. The 10 patients were with right atrial isomerism, 9 with heterotary and asplenia syndrome. Five patients were anatomic single ventricle and others were with functional uni-ventricle. Nine patients were with supracardiac pattern TAPVC and one was with intracardiac TAPVC. All patients were operated unilateral or bilateral bidirectional Glenn procedure with TAPVC correction. Results The arterial oxygen saturation (SaO2) increased prominently after operation (86%±6% vs. 79%±6%, P<0.01). There were 3 patients with low cardiac output syndrome, one patient with severe arrhythmia, 4 patients with serious pleural effusion, 4 patients with hospital-acquired infection, and 3 patients with central nervous system complications (epilepsy or hemiplegia). One died because of hemorrhage and pulmonary thrombosis, and the other died of hypoxemia and mutiple organ dysfunction syndrome (MODS). Conclusion Glenn is one of palliated procedure choice for SV/TAPVC patients. The indication for surgery and perioperative management individually is crucial.
While the Fontan operation has improved the survival of a generation of children born with a functional single ventricle, it does not recreate a normal circulation. However, significant challenges remain. Early stage mortality risk seems stubbornly high. The risk of late cowplications seriously affect the longterm survival of children. As new techniques and therapies exist, more single ventricle patients survive till adulthood. Therefore, the limits of Fontan procedures is more and more evident. In recent years, the study of mechanical cavopulmonary assisting device, which addresses the limitations of Fontan circulation, has been developed and provided a more stable and effective biventricular of blood flow in the total cavopulmonary connection in existence. This would benefit not only the treatment of late Fontan complications, but also facilitating early surgical repair, which is promising.
Objective Tho evaluate the outcomes of early percutaneous occlusion of these residual major aortopulmonary collateral arteries after heart surgery. Methods This was a retrospective review of children undergoing early percutaneous embolization of major aortopulmonary collateral arteries after cardiac surgery. From January 2013 to February 2017, 52 consecutive patients with postoperative residual major aortopulmonary collateral arteries were treated with percutaneous embolization (38 males, 14 females; median age of 10.0 months, interquartile range 14.0 months; median weight 8.6 kg, interquartile range 4.4 kg). Fifty-one patients were cyanotic and 1 patient was acyanotic. Forty-nine patients underwent corrective surgery and 3 patients underwent B-T shunt. Results Typical symptoms and signs of major aortopulmonary collateral arteries included: elevated left atrial pressure; focal lung infiltration, pink or blood-stained frothy sputum. The median time interval from cardiac surgery to percutaneous occlusion of major aortopulmonary collateral arteries was 5 (9) d, median duration of mechanic ventilation support since occlusion was 72 (159) h, mechanic ventilation support was 239 (480) h and median duration of intensive care unit was 19 (29) d. There was no death in this group. Conclusion Angiocardiography could be able to demonstrate the existence of postoperative major aortopulmonary collateral arteries. The early percutaneous occlusion appears to be simple, safe and effective.