Objective To evaluate possibility and reliability of the technique of artificial pulmonary valve reconstruction in right ventricular outflow tract reconstruction. Methods We retrospectively analyzed the clinical data of 35 patients with artificial pulmonary valve reconstruction of right ventricular outflow tract reconstruction surgery in our hospital between February 2012 and December 2016. There were 35 patients with 19 males and 16 females at age of 10 years ranged 5 months to 42 years and body weight of 26 (8–62) kg. There were 21 patients with artificial moncusp valve, 6 patients with bicuspid technology, 8 patients with comprehensive forming method. Results Average extracorporeal circulation time was 75–251 (120±37) min. Aorta blocking time was 32–185 (72±28) min. ICU stay time was 14–225 (59±51) hours. Breathing machine auxiliary time was 6–68 (24±18) hours. There were 3 early postoperative deaths. There was no death during the long term following-up time. Thirty-two patients survived with heart function of class Ⅰ in 20 patients, class Ⅱ in 10 patients, class Ⅲ in 2 patients. Conclusion In right ventricular outflow tract reconstruction using the technique of artificial pulmonary valve reconstruction in the operation, it can reduce early postoperative right ventricular volume load. To smooth out perioperative patients, the surgical technique is simple, cheap, safe, but long-term follow-up still needs further observation.
Objective To assess the mid- and long-term outcomes of right ventricular outflow tract reconstruction for children with congenital heart disease. Methods We retrospectively analyzed the clinical data of 3 138 children with complex congenital heart disease in right heart system admitted to our hospital from January 2007 to January 2017. There were 1 660 males and 1 478 females. The age at surgery was 9 days to 84 months, and the body weight was 2.2 to 28.6 kg. Pulmonary patch enlargement was performed in 2 335 patients (1 477 patients of valve-sparing repair and 858 patients of transannular repair); autologous tissue (direct anastomosis, left auricle or pericardial conduit) was used to connect with right ventricle in 289 patients; extracardiac conduits were used for reconstruction in 514 patients. Results There were 181 in-hospital deaths with a mortality of 5.8%. The early postoperative causes of death were low cardiac output syndrome (LCOS), severe pulmonary hypertension and right heart failure. Fifteen patients died of cardiac insufficiency or sudden death during follow-up (6–27 months postoperatively). The echocardiography showed 408 patients with right ventricular outflow tract obsturction (RVOTO), 340 patients with pulmonary trunk or branches stenosis, 609 with pulmonary regurgitation (morderate or severe). 12.6% (394/3 138) of patients underwent reintervention or reoperation with 39 deaths. About 92.4% of patients exhibited an improvement of New York Heart Association (NYHA) functional class from Ⅲ or Ⅳ preoperatively to Ⅰ or Ⅱ at follow-up. Conclusion The anatomical structure of right ventricular outflow tract is complicated and various, and each operation method has different strengths and favorable outcomes. The operation should be individually designed according to pathological types, anatomical features, clinical symptoms and operation conditions.
ObjectiveTo evaluate the early- and mid-term outcomes of surgical repair of persistent truncus arteriosus in children in a single institution of China.MethodsThe clinical data of 27 consecutive patients with persistent truncus arteriosus undergoing surgical repair in Guangzhou Women and Children’s Medical Center from November 2009 to May 2018 were retrospectively reviewed. There were 14 males and 13 females. Median age was 3.0 months (range: 13 days -11 years), of whom 10 (37.0%) were older than 6 months. ResultsThere were three early deaths with a mortality of 11.1%. The main complications included VSD partial repair in 2 patients, complete atrioventricular block in one patient. The mean follow-up time was 24.5±19.3 months (range: 1–76 months). There were three late deaths, and two patients lost follow. Echocardiology showed seven patients of right heart outflow tract obstruction, including three in pulmonary artery trunk, and four of pulmonary artery branches. One patient showed moderate aortic valve regurgitation. None required re-intervention during the follow-up. Survival estimates for the entire cohort following surgery were both 76.1% (95%CI 59.2% to 92.9%) at 1 year and 5 years.ConclusionThe surgical repair of persistent truncus arteriosus (PTA) remains challenges. The early- and mid-term outcomes of surgical repair of persistent truncus arteriosus are acceptable. For older children with severe pulmonary artery hypertension and/or trunk valve regurgitation, the risk of death is still higher. Some children have the higher risk of late right heart obstructive lesions.