ObjectiveTo investigate the risk factors for prolonged postoperative mechanical ventilation patients with total anomalous pulmonary venous connection (TAPVC). MethodsWe retrospectively analyzed the clinical data of 97 survived TAPVC patients in our hospital between June 2011 and December 2013. There were 55 males and 42 females with age of 4.4 (2, 12) months. The patients ventilated longer than mean time were as a prolonged ventilated group (n=50) and the others as a normal group (n=47). Perioperative variables between the two groups were compared and selected, then put into logistic regression analysis. ResultsFor the 97 survived patients, the mean ventilation time is 49 (25, 90) hours. Age, weight, pre-operative left ventricular end-diastolic dimension, atrial septal defect (ASD) caliber, inotropic drug dosage, postoperative left ventricular end-diastolic dimension, maximum pulmonary venous velocity (P < 0.01), and cardio-pulmonary bypass (CPB) time (P < 0.05) were statistically different between the two groups. In logistic regress analysis, age (OR=0.804 with 95%CI 0.71 to 0.91) and maximum pulmonary venous velocity (OR=1.016 with 95%CI 1.00 to 1.03) were risk factors for prolonged postoperative mechanical ventilation. ConclusionAge and maximum pulmonary venous velocity are the risk factors associated with prolonged postoperative mechanical ventilation in patients with TAPVC.
ObjectiveTo evaluate the advantages and disadvantages of patch aortoplasty and extended side-to-end anastomosis for the treatment of coarctation of the aorta (CoA) and hypoplastic aortic arch, and provide a more reasonable surgical choice. MethodsClinical data of 45 patients who underwent surgical correction for CoA and hypoplastic aortic arch in Beijing Anzhen Hospital from June 2008 to June 2013 were retrospectively analyzed. According to different surgical strategies for aortic arch hypoplasia, all the 45 patients were divided into 2 groups. In group I, there were 26 patients including 15 males and 11 females with their age of 0.5-6.8 (0.9±2.5) years and body weight of 5.0-20.3 (9.5±7.3) kg, who received patch aortoplasty and whose preoperative pressure gradient between right upper and lower limbs was 38.3±15.6 mm Hg. In groupⅡ, there were 19 patients including 14 males and 5 females with their age of 0.6-7.5 (1.0±2.7) years and body weight of 5.5-21.5 (10.2±6.6) kg, who received extended side-to-end anastomosis and whose preoperative pressure gradient between right upper and lower limbs was 40.7±16.1 mm Hg. Postoperative changes of pressure gradient between right upper and lower limbs of the 2 groups were examined and compared with preoperative values. ResultsTwo patients died postoperatively (4.4%) including 1 patient with low cardiac output syndrome and the other patient with severe lung infection. None of the patients in either group had renal failure or neurological complications. Postoperatively, there were 28 patients whose systolic blood pressure (SBP) of lower extremities was 10-20 mm Hg higher than that of upper extremities, 13 patients whose SBP gradient between upper and limbs was less than 10 mm Hg, and 4 patients whose upper limb SBP was 20 mm Hg higher than lower limb SBP. Postoperative average pressure gradient of right upper and lower extremities was 3.2±13.5 mm Hg and significantly lower than preoperative value (P < 0.05). Postoperative pressure gradient of upper and lower extremities was significantly lower than preoperative value in both groups (P < 0.05). There was no statistical difference in preoperative and postoperative changes of pressure gradient of upper and lower extremities between the 2 groups (P > 0.05). Thirty-eighty patients (88.4%) were followed up from 3 months to 5 years. During follow-up, there was 1 patient whose blood flow velocity of the descending aorta was increasingly accelerated. Pressure gradient across the aortic arch was larger than 40 mm Hg. Computer tomography showed aortic arch restenosis. This patient received reoperation 8 months after the first discharge. Three patients whose aortic pressure gradient was larger than 20 mm Hg were still followed up. Aortic arch pressure gradient was less than 20 mm Hg in all the other patients. ConclusionBoth patch aortoplasty and extended sideto-end anastomosis are ideal surgical methods for the treatment of CoA and hypoplastic aortic arch. Appropriate surgical method should be chosen according to individual conditions of pediatric patients.
ObjectiveTo explore surgical methods and risk factors of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). MethodsClinical data of 28 ALCAPA patients who underwent surgical repair from October 1993 to September 2013 in Beijing Anzhen Hospital were retrospectively reviewed. There were 8 male and 20 female patients with their age of 0.6-l6.8 (4.3±0.7)years including 10 patients less than 1 years old. Surgical procedures included simple ligation of left coronary artery, intrapulmonary tunnel procedure (Takeuchi)and direct coronary reimplantation of the anomalous artery. Postoperative death, complication and cardiac function were observed. ResultsAmong the 28 patients, 1 patient received simple ligation of left coronary artery, and 7 patients received intrapulmonary tunnel procedure (Takeuchi), among whom 2 patients died postoperatively. Twenty patients received direct implantation of the anomalous artery into the ascending aorta, and 3 patients died postoperatively. Five patients who died postoperatively were 10.20±3.27 months old, including 3 patients with moderate mitral regurgitation (MR)and 2 patients with mild MR preoperatively. Preoperative heart function of the patients who died postoperatively was significantly reduced. Preoperative left ventricular ejection fraction of the patients who died postoperatively was significantly lower than that of the patients who survived (36.6%±8.5% vs. 60.9%±10.7%, P=0.000). Low cardiac output syndrome was the reason for all postoperative death. All survival patients were followed up from 1 month to 18 years. One patient who underwent intra-pulmonary tunnel procedure (Takeuchi)received pulmonary artery balloon dilatation for pulmonary supravalvular stenosis 15 years after discharge. None of the other patients received a secondary operation. During follow-up, left ventricular function was improved. Growth and development of all the patients was normal. MR did not significantly aggravate in all the patients. ConclusionPatients with younger age and worse left ventricular function have greater surgical risks of ALCAPA.
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.
ObjectiveTo summarize clinical experience and results of surgical treatment of subaortic membrane (SM). MethodsClinical data of 32 SM patients who underwent surgical resection of SM between March 2009 and September 2013 in Beijing Anzhen Hospital were retrospectively analyzed. There were 22 male and 10 female patients with their age of 0.5-14.0 (3.6±3.2)years and body weight of 5.5-43.0 (17.2±9.5)kg. Among the 32 patients, 7 patients had isolated SM, and 25 patients had other intracardiac lesions including ventricular septal defect in 21 patients, mitral regurgi-tation in 1 patient, patent ductus arteriosus (PDA)in 1 patient, SM occurrence after PDA occlusion in 1 patient and surgical correction for coarctation of the aorta in another patient. Eighteen patients had aortic insufficiency (AI)in different degree. ResultsSM diagnosis was missed by preoperative echocardiography in 1 patient. Mean cardiopulmonary bypass time was 71.7±21.7 minutes, aortic cross-clamping time was 48.7±15.1 minutes, ICU stay was 2.2±1.7 days, and postoperative hospital stay was 7.9±2.5 days. There was no in-hospital death in this group. Postoperatively, 1 patient had second-degree atrioventricular block which returned to sinus rhythm 6 days after the operation. All the patients were followed up for 2-54 months after discharge. During follow-up, AI of 6 patients with isolated SM was relieved, and AI of 5 SM patients with other intracardiac lesions was relieved (P=0.003). Among the 7 patients with isolated SM, preoperative moderate AI in 4 patients changed to mild AI in 3 patients and trivial AI in 1 patient, and preoperative mild AI in 3 patients changed to trivial AI in 2 patients. Among the 25 patients with other intracardiac lesions, preoperative mild AI in 8 patients changed to trivial AI in 3 patients, and preoperative moderate AI in 3 patients changed to mild AI in 1 patients and trivial AI in another patient. There was no SM recurrence during follow-up in this group. ConclusionSM diagnosis may be missed by preo-perative echocardiography, and early surgical correction is needed once the diagnosis is established. Meticulous surgical techniques are necessary during the operation. Postoperative SM recurrence may happen, so regular follow-up is required after discharge.