Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.
目的:评价先天性心脏病（CHD）不同病变类型在64层螺旋CT（64-MDCT）三维重建图像上的表现及显示效果。方法:回顾性分析36例CHD患者的64-MDCT资料,分别在轴位、冠状、矢状位及容积再现（VR）重组图像上观察病变,统计分析不同重组图像显示总体病变及房、室间隔缺损效果有无差异。结果:36例患者共有病变59处,轴位、冠状及矢状位图像在发现病变（59处,100.0%；57处,96.6%；53处,89.8%）及室间隔缺损显示（显示效果评分:41、38及39分）方面无明显差异（P＞0.05）,但轴位图像显示房间隔缺损明显优于冠、矢状位图像（显示效果评分:19、13及12分）（P＜0.05）。VR图像与轴位及冠、矢状位图像显示心外大血管病变效果无差异P＞0.05）。不同类型病变在轴位,冠、矢状位及VR图像上表现特征不尽相同,而不同重组图像有各自优势显示的病变类型。结论:64-DCT三维重建图像能够很好地显示先心病各种类型病变,了解不同重建图像上病变表现特征及显示效果有利于做出准确、全面的诊断。
Fontan operation is still a main procedure for treatment of complex congenital heart disease, such as univentricular heart. Fontan procedure has undergone many revisions since its introduction in 1968. The earlyapplied atriumpulmonary connection has been replaced by total cavopulmonary connection. The midterm and late results of both the intraatrial lateral tunnel and extracardiac total cavopulmonary connections were compared and analyzed in this article. Extracardiac conduit is better. The Fontan circulation failure would appear at last because of nopump function of the right ventricle. Once Fontan circulation failure occurred and could not recover by medicine, heart transplantation is mandatory, but the source of donor heart is lacking. The study of mechanical cavopulmonary assist device, to “biventricularize” the univentricular Fontan circulation, has been developed, which is quite promising. Following the development of diagnostic and treatment techniques for fetal heart disease, the treatment procedure of complex congenital heart disease has been broadened in recent years, such as to prevent the severe aortic stenosis from developing into hypoplastic left heart syndrome with fetal cardiac intervention so as to increase the chance of biventricular repair, and to terminate gestation to decrease its birth rate of complex heart abnormalities, which could not be completely repaired to date.
Objective To investigate the effect of surgical treatment on ventricular septal defect （VSD） in infants under 6kg weight, including the operative indication, surgical techniques and perioperative therapy. Methods All clinical data of 148 consecutive infants under 6kg weight with VSD were collected and studied retrospectively. The infants, age was 1-13（mean 5.3） months with the body weight of 3.5-6.0 （mean 5.3） kg. VSD was perimembranous in 105 cases, subpulmonary in 25, muscular inlet tract in 8, muscular outlet tract 9, and muscular trabecular in 1 case. Other associated cardiac abnormalities included atrial septal defect in 39, patent ducts arteriosus in 17, insufficiency of mitral valve in 9 and moderate to severe pulmonary hypertension in 52. The operations were performed under cardiopulmonary bypass at moderate to low flow, moderate hypothermia and cold crystalloid cardioplegia. Patch repair was used in 85, direct sutures in 63 and 23 cases repaired with partial sternal incision and beating heart. Results The hospital mortality was 4. 1% （6/148）, the causes of death were severe pulmonary hypertention in 2, aortic arch interruption in 2, severe malnutrition in 1 and poor result of mitral valvuloplasty in 1. Other major operative complications included residual shunts （1- 2mm） in 2, and Ⅲ° A-V block in 2, who recoveried 5 days after the operation. The hospital stay was 6 15 （mean 8） days. Follow-up was complete in all 142 survived cases for 4 months-6 years. Two residual shunts healed in first year after the cardiac operation, others recovery smoothly, and are developing well. Conclusion With the improvement of the surgical techniques, the surgical treatment for VSD in infants with low weight is safe and effective, and it is also essential to further improve the effects of surgical treatment in VSD associated with complex abnormalities.
ObjectiveTo compare the outcome between two nutrition support methods, total enteral nutrition (TEN) and enteral nutrition combined with parenteral nutrition, in infants after ventricular septal defect (VSD) repair operation. MethodsWe retrospectively analyzed the clinical data of 76 infants who underwent VSD repair operation in Xinhua Hospital in 2012 year. There were 46 males and 35 females aged 1.6-11.9 (5.5±2.5) months. Nutrition support was started from the first day after operation. There were 35 patients in the group A with TEN 60 kcal/(kg·d), and 41 patients in the group B with both enteral nutrition at 30 kcal/(kg·d) and parenteral nutrition at 30 kcal/(kg·d). ResultsThere was no statistical difference between two groups in demography data and preoperative clinical indicators. The number of patients suffered abdominal distension and gastric retention was more in the group A (22.9% vs. 4.9%, 68.6% vs. 2.4%, P<0.05). There was no difference in diarrhea. The completion of nutrition support in the group A was worse than that in the group B. In the group A, only 40% of the goal calorie was finished on the first and the second day after operation. It was improved until the third day, and the goal calorie could be finished on the seventh day. In the group B, the nutrition support method could be finished on the first day. The prealbumin level in the group B was significantly higher on the third, fifth and seventh day (P<0.05). The blood urea nitrogen (BUN) level in the two groups on the first day after operation was higher than that before operation (P<0.05), and persisted in the group A, while decreased to the normal level gradually in the group B. Following up to discharge, the weight was higher and the length of stay was shorter in the group B (P<0.05). There was no statistical difference in the cost of hospitalization between the two groups (P>0.05). ConclusionThe nutrition support method, enteral nutrition combined with parenteral nutrition, is better than TEN for infants after VSD repair operation.
Objective To therapy the atrial septal defect(ASD) much more better, comparative study of clinical outcomes in surgical treatment of ASD to other three minimally invasive procedures was performed. Methods From June 2007 to March2008, 652 ASD patients had undergone surgery（n=301）, transcatheter closure (n=274), openchest Hybrid closure(n=50) and without tracheal intubation Hybrid closure (n=27) of ASD. Patients were and divided into four groups according to the different procedures. Retrospectively we compared the data of patient’s age, hospital stay, trauma, cost of hospitalization, blood transfusion, anesthesia, tracheal intubation and postoperative fellowup. Results Median age and weight of openchest Hybrid and without tracheal intubation Hybrid groups were significantly less than those of the other two groups (Plt;0.01). The achievement ratio of four groups were 100.0％,97.2％,92.6％,100.0％. There was statistically difference in the achievement ratio of four groups (Plt;0.01). [CM(158.5mm]Median hospital stay and cost of blood transfusion of transcatheter closure and without tracheal intubation Hybrid groups were significantly less than other two groups (Plt;0.01). The mean cost of hospitalization in four groups were 24 802.90±360.96￥，25 095.07±437.13￥，24 856.77±445.87￥，24 853.56±673.99￥ respectively. There was no statistically difference in the cost of hospitalization(Pgt;0.05). All patients were recovered and discharged without eventuality. The mean followup time were 4.64±0.32 month，4.57±0.31 month，4.49±0.28 month，4.62±0.31 month. There was no statistically difference in the followup time (Pgt;0.05). The complication rate of postoperative incision were 3.32％，0.47％，6.00％，0.00％. The transcatheter closure and without tracheal intubation Hybrid groups were significantly less than other two groups (Plt;0.01). Conclusions The mean cost of hospitalization in four procedure were almost the same. The ability to close any ASD regardless of its size, location or patient’s age remains an important advantage of surgery. Transcatheter closure of ASD has the advantage of less complications. But there are limitationsto lowerweight and infant patients. OpenChest Hybrid closure offers a valuable and complementary operative approach for any age patients. Without extracorporeal circulation, it reduces trauma significantly but it always has few surgery injury. Without tracheal intubation Hybrid closure without tracheal intubation can be used for patients of any age. The cost of hospitalization is not higher than surgical treatment and transcatheter closure. The success of procedure is high and the incidence of postoperative complications is lower. It is an ideal treatment to infant ASD patients especially to lowerweight and younger infant patients.
ObjectiveTo analyze the outcomes of surgical repair for mixed total anomalous pulmonary venous connection (TAPVC).MethodsBetween 2006 and 2018, a total of 51 patients with mixed TAPVC underwent surgery in our hospital. Patients with such associated anomalies as single ventricle and tetralogy of Fallot were excluded. There were 35 males and 16 females with a median age of 102.0 (59.0, 181.0) days and a median weight of 5.0 (4.1, 6.4) kg. Patients were divided into three categories based on the anatomy: "3+1" pattern (n=38, three pulmonary veins drained at one site, and the other drained at the opposite site); "2+2" pattern (n=9, the pulmonary veins from each lung joined to form a confluence and drained at separate sites); bizarre pattern (n=4, the anatomy could not be classified into the above two patterns).ResultsThere was no in-hospital death. The median follow-up was 41.0 (18.0, 86.5) months. Postoperative pulmonary venous obstruction occurred in 10 patients. Kaplan-Meier survival curves showed no statistically significant difference in postoperative pulmonary venous obstruction among the three groups (P=0.239). Cox risk regression showed that preoperative pulmonary venous obstruction was significantly associated with postoperative pulmonary venous obstruction (P=0.024).ConclusionMixed TAPVC has various anatomic morphologies and requires individualized surgery.
ObjectiveTo summarize the minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects (VSD) under transesophageal echocardiography (TEE) guidance.MethodsWe retrospectively analyzed the clinical data and medium-long-term follow-up results of 783 patients who undertook perventricular device closure under TEE guidance in Dalian Children’s Hospital from July 2011 to January 2020, in which perimembrane VSD were found in 598 patients, VSD with aortic valve prolapse in 135 patients and muscular VSD in 2 patients. There were 463 males and 320 females at age of 5 months to 13 years with average age of 3.3±1.2 years, and body weight of 5.9-51.0 (15.9±8.3) kg. The left ventricular defect diameter of the VSD ranged from 5.0 to 11.0 mm, with an average of 6.3±1.2 mm. The right ventricular defect diameter of the VSD ranged from 2.3 to 8.0 mm, with an average of 4.3±0.9 mm.ResultsThe procedures were completed successfully in 753 patients. The device of 1 patient (0.1%) fell off and embedded in the right pulmonary artery after the operation, and the occluder was taken out and the VSD was closed with cardiopulmonary bypass (CPB) in the secondary operation. One patient (0.1%) appeared Ⅲ degree atrioventricular block in 2 years after operation. The device was taken out and VSD was closed with CPB in the secondary operation, and the patient gradually reached to sinus rhythm in post-operation. Eight patients (1.1%) presented delayed pericardial effusion in 1 week after operation, and were cured by pericardiocentesis with ultrasound-guided. Symmetric occluders were used in 580 patients, eccentric occleders were used in 171 patients and muscular occluders were used in 2 patients. The follow-up time was 9 months to 9 years. The rate of loss to follow-up was 96.7% (704/728). No residual shunt, occlude-loss or arrhythmia was found during follow-up. Conclusion The minimally invasive penventricular device closure of VSD guided by TEE is safe and availabe. Medium-long-term follow-up results are satisfactory, it is worthy of clinical promotion, and longer term follow-up is still needed.