ObjectiveTo summarize clinical outcomes of atrial septal defect (ASD)occlusion for patients with ASD and tricuspid regurgitation (TR). MethodsBetween July 2006 and January 2012, 98 patients with ASD and TR under-went ASD occlusion in Xinhua Hospital, Shanghai Jiaotong University School of Medicine. There were 36 male and 62 female patients with their age aging from 2 months to 80 years. All ASD were secundum ASD with their diameter of 3-23 mm. There were 60 patients with mild TR, 28 patients with moderate TR, and 10 patients with severe TR. All the patients received ASD closure without specific management for TR, including 51 patients under digital subtraction angiography (DSA), 46 patients via a minithoracotomy approach, and 1 patient guided by transthoracic echocardiography. All the patients were followed up with echocardiography to evaluate changes of TR after ASD closure. ResultsThere was no in-hospital death. ASD occlusion was not successful in 1 patient who was found to have residual ASD shunt on the third postoperative day. Another patient underwent reexploration for abnormal bleeding on the third postoperative day. All the other patients had uneventful postoperative recovery. Eighty-four patients were followed up for 1-64 (26.56±21.35)months. During follow-up, the patient who have residual ASD shunt on the third postoperative day received open chest repair 6 months after discharge. TR of 73 patients (86.90%)improved in different degrees. Preoperative severe TR in 10 patients changed into mild TR in 8 patients, moderate TR in 1 patients and still severe TR in 1 patient. Preoperative moderate TR in 26 patients changed into none TR in 6 patients, mild TR in 18 patients and still moderate TR in 2 patients. Preoperative mild TR in 48 patients changed into none TR in 40 patients and still mild TR in 8 patients. ConclusionFor patients with ASD and TR, conservative treatment strategy is recommended. Simple ASD closure can provide satisfactory clinical outcomes, and also avoid adverse complications of cardiopulmonary bypass including myocardial injury and lung injury.
ObjectiveTo investigate the therapeutic effect of modified tricuspid valvuloplasty using anterior leaflet in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia. MethodsNinety-five patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia underwent surgical treatment in our hospital from June 2002 to March 2014. There were 39 males and 56 females with an average age of 3.2±6.6 years (range 3 months to 46 years). Preoperative echocardiography prompted all patients had varying degrees of tricuspid valve dysplasia and tricuspid regurgitation (mild in 14 cases, moderate in 49 cases, and severe in 32 cases). According to the different development of anterior and septal leaflet, we used different techniques to repair the tricuspid problems. If the residual septal leaflet was larger than one third of the normal septal leaflet, we continuously stitched the half of the septal side of anterior leaflet to the two third of the left side of residual septal leaflet. If the residual septal leaflet was less than one third of the normal septal leaflet, we reserved part of pericardial patch at right side of septal crest at repairing the atrial septal defect, and continuously stitched the left two third of the patch edge to the half of septal side of anterior leaflet. All patients received transesophageal echocardiography (TEE) to evaluate the intraoperative effect of valvuloplasty. The patients were followed up with echocardiography after 3 to 6 months to evaluate the condition of tricuspid. ResultsThere was no perioperative death or Ⅲ degree atrioventricular block. Intraoperative TEE showed that the effect of tricuspid valvuloplasty was good with 3 cases of mild regurgitation and 2 cases of moderate regurgitation. Other 90 cases had no significant regurgitation. The aortic cross-clamping time was 35.2±11.2 min and cardiopulmonary bypass time was 64.9±16.6 min. In the followed-up between 3 to 6 months, tricuspid regurgitation situation improved significantly than that in preoperative period with mild regurgitation or no reflux in 89 cases and moderate regurgitation in 6 cases. There was no severe regurgitation occurred. ConclusionThe therapeutic effect is satisfactory by using anterior leaflet to repair the regurgitation of tricuspid in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia.
ObjectiveTo explore the midterm therapeutic effect of modified Blalock-Taussing shunts (MBTs) in the treatment of tetralogy of Fallot. MethodsWe retrospectively analyzed the clinical data of 69 children with tetralogy of Fallot undergoing MBTs in Shanghai Xinhua Hospital between July 2006 and January 2013. There were 44 males and 25 females with mean age of 17.97±24.73 months (ranged from 2 months to 10 years). The patients weighted from 4 to 24 (9.00±4.03) kg. All the MBTs between subclavian artery and pulmonary artery were performed through right or left posterior lateral incision. ResultsThe patients were followed up for 6-36 months including 57 patients with 6 months following-up, 33 patients with 6 months and 12 months following-up, 16 patients with 12 months and 24 months following-up, and 11 patients with 24 months and 36 months following-up. There was significant growth in McGoon ratio during the first 12 months follow-up (preoperative vs. 6 months:1.09 ±0.33 vs. 1.40 ±0.40, P=0.00; 6 months vs. 12 months:1.29±0.31 vs. 1.36±0.33, P=0.00). There was no obvious growth in McGoon ratio after 12 months (12 months vs. 24 month:1.22±0.31 vs. 1.19±0.32, P=0.14; 24 months vs. 36 months:1.22±0.23 vs. 1.23±0.20, P=0.45). The left ventricular end diastolic volume index (LVEDVI) increased significantly in 6 months after MBTs (preoperative vs. 6 months:29.60±10.12 ml/m2 vs. 49.18±11.57 ml/m2, P=0.00), but there was no significant growth after 6 months. There was no significant decline in left ventricular ejection fraction (LVEF) after MBTs. ConclusionThe MBTs can significantly promote the growth of McGoon ratio in 12 months of patients with tetralogy of Fallot, but there is no obvious growth of McGoon ratio after 12 months. MBTs can significantly improve left ventricular development within 6 months, and it won't lead to excessive expansion of the left ventricle when we extend follow-up time. The MBTs affects little on cardiac function of patients with tetralogy of Fallot.
ObjectiveTo compare the outcomes of repeated tricuspid valve surgery for patients with late severe tricuspid regurgitation (TR) after cardiac surgery through right anterior minithoracotomy and conventional median sternotomy approaches. MethodsBetween June 2002 and June 2013, 89 patients with late severe tricuspid regurgitation after cardiac surgery underwent repeated tricuspid valve surgery through right anterior minithoracotomy in our hospital. The patients were divided into two groups. Fifty one patients were in a minimally invasive group with 28 males and 23 females at age of 46.59±11.53 years. Thirty eight patients were in a conventional median sternotomy (conventional group) with 15 males and 23 females at age of 50.42±9.30 years. The outcomes of the two groups were compared. ResultsThere was no statisitcal difference in preoperative clinical data between two groups. All patients successfully underwent repeated tricuspid valve surgery. Tricuspid valve replacement (TVR) was performed in 68 patients (38 patients vs. 30 patients), and tricuspid valvuloplasty (TVP) was performed in 21 patients (13 patients vs. 8 patients). Compared with the conventional group, operation time, time of establishing cardiopulmonary bypass and postoperative in-hospital time were significantly shorter in the minimally invasive group (P<0.001). The postoperative drainage was significantly reduced in the minimally invasive group compared with the value of the conventional group (P<0.001). Three patients died in the early postoperative period (1 patient vs. 2 patients). In the conventional group, one patient needed re-exploration for bleeding and 2 patients had wound infection. At discharge, transthoracic echocardiography showed that all patients had no or mild TR and no paravalvular leakage occurred. During the follow-up (12-144 months), 4 patients died (2 patients vs. 2 patients). In the minimally invasive group, one patient underwent repeated TVR due to severe TR associated with infective endocarditis, and another patient had moderate TR. In the conventional group, one patient underwent repeated TVR due to mechanical valve thrombosis. ConclusionRight anterior minithoracotomy is safe, effective and reliable for patients with late severe TR after cardiac surgery. It has the similar effect of the correction of valvular lesions with conventional median sternotomy, but right anterior minithoracotomy has more benefits, including more, minimally invasive, less blood loss, shorter operation time and faster recover.