Abstract： Objective To assess the effects of three different palliative procedures including modified BlalockTaussig (B-T) shunt, Waterston shunt, and reconstruction of right ventricularpulmonary artery (RV-PA) continuity for pulmonary atresia with ventricular septal defect (PAVSD). Methods We retrospectively analyzed the clinical data of 93 patients with PAVSD who had undergone palliative surgical procedures including modifie BT shunt, Waterston shunt, and RVPA econstruction in Fu Wai Hospital from September 1998 to September 2008. There were 53 males and 40 females, aged from 14.0 days to 14.4 years, with the body weight ranged from 3.6 to 33.0 kg (9.9±6.3 kg). According to International Congenital Heart Surgery Nomenclature and Database Project, these patients were categorized into 2 groups: 64 of type Ⅰ and 29 of type Ⅱ. The most common associated anomaly is rightsided aortic arch (except for ventricular septal defect). The application of the three kinds of palliative surgical procedures in staged management of PAVSD and the followup results were statistically analyzed. Results The corrective rate of the three palliative procedures were 28.12% (18/64) for modified BT shunt, 7.14%(1/14) for Waterston shunt, and 66.67% (10/15) for RV-PA reconstruction, respectively. RV-PA reconstruction had a significantly higher corrective 〖CM(1585mm〗rate than the other two surgical procedures (P=0.016). The percutaneous oxygen saturation (SpO2) increased by 4%59% and Nakata index by 31-104 mm2/m2. No tortuous pulmonary artery was found under echocardiogram or angiocardiography after palliative operation. The perioperative mortality of both surgical stages was 10 patients. Twostage radical surgery was successfully performed for 25 patients, among whom 20 were followed up till May 2009. During the followup, one died suddenly, 15 were classified as New York Heart Association (NYHA) Ⅰ, and 4 as NYHA Ⅱ. Conclusion The surgical management of PAVSD needs to be improved continuously. Compared with shunting procedures, the RVPA reconstruction is a better palliative operation method, and the modified B-T shunt is preferred in younger patients.
Objective To summarize the immediate and intermediate outcomes of surgical correction on patients with tetralogy of Fallot and absent pulmonary valve (TOF/PVAB). Methods From January 1996 to August 2009, 14 patients，including 5 males and 9 females, aged 3.4±3.4 years (0.2-11.0 years) with an average weight of 12.0±6.3 kg (4-26 kg), underwent complete surgical correction in Beijing Fu Wai Cardiovascular Hospital. The right ventricular outflow tract was reconstructed with valved conduit in 4 patients, and monocusp with transannular patch was used in 10 patients. Six patients underwent pulmonary artery wall reduction, and 2 patients underwent both pulmonary artery plication and wall reduction. Results There were 2 (14.3%) perioperative deaths. Both were low bodyweight infants. One died of low cardiac output and respiratory failure, and the other died of central nervous system complications. Ten patients were followed up for an average time of 8.3±4.3 years (0.6-13.0 years). All patients followed up survived. The echocardiogram found pulmonary valvular dysfunction in 4 patients. The patients’ cardiac function were classified as New York Heart Association(NYHA) Ⅰ to Ⅱ. There was no late death or reoperation. Conclusion The immediate and intermediate outcomes of surgical correction of TOF/PVAB are good, but the function of pulmonary valves and conduit should be followed-up closely.
Abstract: Objective To summarize the clinical experience for complex congenital heart disease treated with modified Fontan operation. Methods From November 1996 to May 2005,124 patients (male 83,female 41; including tricuspid atresia, single ventricle, double outlet of right ventricle, malposition of great arteries, pulmonary atresia, corrected transposition of great arteries, hypoplastic rightheart syndrome, etc.) underwent modified Fontan operation at age 7.6±5.5 years. Noncardiopulmonary bypass was used in 19 patients, 105 patients with cardiopulmonary bypass. Right atria-pulmonary artery connection were performed in 17 patients, right atria-ventricular connection were performed in 19 patients, and total cavopulmonary connection (TCPC) were performed in 88 patients. Staged operation were performed in 23 patients. Results The hospital mortality (30 days postoperative) was 13.7% (17/124). The hospital mortality of patients undergone right atria-pulmonary artery connection was 23.5%(4/17), patients undergone right atria-ventricular connection was 15.8%(3/19), patients undergone TCPC was 11.4%(10/88), patients undergone operation with fenestration was 14.6%(6/41), and the patients undergone staged operation was 8.7%(2/23). Low cardiac output syndrome, multiple organ failure, and ventricular fibrillation were the cause of death. Morbidity of complications was 16.9％(21/124) in early period. Complications consisted of pleural effusion, arrhythmia, pericardial effusion and low cardiac output syndrome, etc. Eightynine patients were followed up, followup time was from postoperative 6 months to 65 months. Re-hospitalization rate was 6.5%, and re-operation rate was 0.9%. There were pleural effusion in 3 patients, pericardial effusion in 3 patients, and obstruction of inferior vena cava in 1 patient. All patients recovered. Conclusion Modified Fontan operation is an optimal procedure for functional single ventricle, fenestration seems to decrease postoperative pleural effusions.
ObjectiveTo assess mid− and long−term outcomes of ascending aortic wrapping (AAW) in adult patients undergoing aortic valve replacement (AVR). MethodsWe retrospecctively analyzed clinical data of adult patients who underwent AVR and AAW in Fuwai Hospital from January 2010 to August 2019. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. ResultsA total of 33 patients were enrolled, including 23 males and 10 females aged 22−73 (51.06±12.61) years. There was no perioperative death. The mean preoperative, postoperative and follow−up AAD of the patients were 46.06±3.54 mm, 34.55±5.17 mm, and 37.12±5.64 mm, respectively. The median follow−up time was 38.20 (18.80−140.30) months. The median increase rate of diameter was 0.63 (−0.11, 1.36) mm per year after the surgery. The increase rate was>5 mm per year in 1 patient, and>3 mm in another one. ConclusionMid−term outcomes of AAW in adult patients undergoing AVR are satisfied and encouraging.