Objective To explore the surgical management method and outcome of functional univentricular heart with total anomalous pulmonary vein drainage (UVH-TAPVD). Methods We reviewed the surgical procedures and results for 44 UVH-TAPVD patients in our hospital between the year 2010 and 2016. There were 34 males and 10 females. The age of the patients was 312 (77-4 220) d when they accepted the first surgical treatment. Results There were 8 deaths in stage Ⅰ palliation, 1 death in stage Ⅱ palliation and 5 deaths during the follow-up. The overall survival rate was 68.2% (30/44). Glenn operation was undertaken in 34 patients with 5 deaths. Fontan operation was undertaken in 9 patients with 2 deaths. Conclusion Surgical strategies for UVH-TAPVD should be planned according to different anatomical and pathophysiological conditions in different patients. Staged palliations can reduce mortality and morbidity. But pulmonary venous obstruction and heterotaxy syndrome are still risk factors for these patients.
ObjectiveTo investigate the effect of Rex surgery (superior mesenteric vein-left portal vein shunt) with internal jugular vein bypass on the anticoagulant factors and portal pressure in children with extrahepatic portal vein obstruction (EHPVO).MethodsFrom January 2014 to December 2018, children with EHPVO in Xi’an Children’s Hospital were retrospectively analyzed. All children underwent Rex surgery. The anticoagulant factors, blood routine indicators, and portal pressure-related indicators of all children were tested before and 1 year after Rex surgery, and the differences were compared. ResultsA total of 32 children were enrolled, and all children were followed up for 1 year after Rex surgery, and no follow-up was lost. Follow-up ultrasound examination 1 year after surgery showed that the portal vein blood flow in all children was unobstructed, and there was no venous thrombosis. The concentration of protein C, protein S and antithrombin Ⅲ activity of the children 1 year after surgery [(5.91±0.67) μg/mL, (2.43±0.34) μg/mL and (59.64±4.54)%, respectively] were all higher than those before surgery [(3.25±0.82) μg/mL, (2.02±0.37) μg/mL and (50.22±3.91)%, respectively], and the differences were statistically significant (P<0.05). There was no statistically significant difference in the concentration of antithrombin Ⅲ 1 year after surgery compared with that before surgery (P>0.05). The red blood cell count, hemoglobin concentration, white blood cell count and platelet count of the children 1 year after surgery [(4.61±0.17)×1012/L, (128.53±6.55) g/L, (6.09±0.72)×109/L and (104.88±5.74)×109/L, respectively] were all higher than those before surgery [(3.78±0.19)×1012/L, (105.53±5.31) g/L, (3.39±0.58)×109/L and (87.42±5.53)×109/L, respectively], and the differences were statistically significant (P<0.05). The diameter of the left portal vein 1 year after surgery was larger than that before surgery [(7.23±0.66) vs. (2.30±0.69) mm], the spleen volume was smaller than that before surgery [(55.74±4.07) vs. (67.21±4.22) cm3], and the portal vein pressure was lower than that before surgery [(23.37±1.27) vs. (35.29±1.36) cm H2O (1 cm H2O=0.098 kPa)], and the differences were statistically significant (P<0.05). ConclusionRex surgery with internal jugular vein bypass is beneficial to improving the level of anticoagulant factors in children with EHPVO, improving portal vein blood flow and pressure, and effectively relieving hypersplenism, which has a certain promotion value.
ObjectiveTo analyze the surgical results of patients with supracardiac total anomalous pulmonary venous connection (TAPVC) in a single pediatric cardiac center.MethodsA retrospective study was conducted on 98 pediatric patients with supracardiac TAPVC receiving surgical repair from 2014 to 2019 in our center. There were 64 males and 34 females with a median surgical age of 3.0 (1.5, 7.0) months and a median weight of 5.0 (4.0, 6.0) kg. Twenty-three (23.5%) patients had preoperative pulmonary vein obstruction. Ninety-two (93.9%) patients received conventional surgical repair, while six (6.1%) patients were treated with the sutureless technique. The Cox regression model was used to analyze the data.ResultsThe median follow-up time was 26.50 (5.75, 44.25) months. There were 9 (9.2%) deaths. Lower weight at the time of repair (P=0.013) and prolonged cardiopulmonary bypass time (P=0.007) were associated with mortality. Postoperative pulmonary vein obstruction was observed in 8 (8.2%) patients. Associated risk factors for postoperative pulmonary vein obstruction included lower weight at the time of repair (P=0.042) and prolonged cardiopulmonary bypass time (P=0.002).ConclusionSurgical repair of supracardiac TAPVC has achieved satisfactory results in our center. Risk factors such as lower weight at the time of repair and prolonged cardiopulmonary bypass time are associated with a poor prognosis.
On January 11, 2022, the European Society of Vascular Surgery (ESVS) completed its first update in the “European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” since 2015. Based on the existing literatures and expert consensus, the guidelines added and revised the treatment strategies, postoperative monitoring, and postoperative anticoagulation of superficial venous insufficiency of the lower extremities and pelvic venous diseases. The new and modified parts will be interpreted.
Objective To analyze risk factors for pulmonary vein obstruction(PVO) after cardiac-type total anomalous pulmonary venous connection (TAPVC) repair. Methods A retrospective analysis of clinical and echocardiography data of 169 patients with cardiac-type TAPVC who underwent surgery at our center from April 2009 to April 2019 was conducted. Kaplan-Meier curves were used to assess the risk of postoperative pulmonary vein obstruction. Logistic regression analysis was used to identify relevant risk factor for postoperative pulmonary vein obstruction. ResultsThe median age at surgery was 89 days, and the median weight at surgery was 4.8 kg. Post-repair pulmonary vein obstruction occurred in 8.9% (15/169) of cases. The subtype of coronary sinus/right atrium did not significantly affect the risk of PPVO (P=0.33). Relevant risk factors included preoperative pulmonary vein obstruction (P<0.001) and the ratio of left ventricular end-diastolic diameter to right ventricular diameter (P=0.025). ConclusionSurgical repair of cardiac-type TAPVC has achieved satisfactory results in our center, but the long-term risk of obstruction should not be underestimated. An increased ratio of left ventricular end-diastolic diameter to right ventricular diameter and preoperative pulmonary vein obstruction were associated with post-repair pulmonary vein obstruction.