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Early outcomes of surgical treatment for patent ductus arteriosus combined with intracardiac abnormity via right vertical infra-axillary thoracotomy

ObjectiveTo explore the early outcomes of the surgical treatment for patent ductus arteriosus (PDA) combined with intracardiac abnormities via right vertical infra-axillary thoracotomy (RVIAT).MethodsA total of 7 children with PDA combined with intracardiac defects underwent surgery through RVIAT at the Second Affiliated Hospital of Nanjing Medical University from 2016 to 2018. There were 4 males and 3 females, with an average age of 5.3±4.5 years and weight of 18.0±11.2 kg.ResultsIn all patients, PDA was ligated before the repair of intracardiac abnormities. No patient died in hospital. All patients were followed up, with a mean follow-up time of 18.0±8.0 months. No other complications such as residual shunts, arrhythmias, hemorrhaging or wound infection occurred after operations or during the follow-up period.ConclusionRVIAT is an emerging technique used for the surgical repair of PDA combined with intracardiac defects. It yields satisfying cosmetic results, without increasing postoperative complications or mortality.

The Interruption of Patent Ductus Arteriosus with Video Assisted Thoracic Operation——A Comparison with the Conventional Trans thoracic Approach

Objective\ To investigate the surgical technique and clinical results of interruption of patent ductus arteriosus (PDA) with video assisted thoracic operation (VATO).\ Methods\ Fifty PDA cases were divided into two groups, 25 cases treated with VATO(VATO group) as compared to other 25 cases with conventional surgical interruption(conventional surgical interruption group). In the VATO group, the PDA was interrupted by 2 3 hemoclips under VATO technique, and PDA interrupted by suture ligation with the techni...

Comparative Study between Videoassisted Thoracoscopic Surgery and Percutaneous Catheter Occlusion in Interruption of Patent Ductus Arteriosus

Abstract： Objective To investigate videoassisted thoracoscopic surgery (VATS) and percutaneous catheter occlusion (PCO) in interruption of patent ductus arteriosus (PDA), in order to achieve minimally invasive surgical injuries and better clinical results. Methods From November 1995 to September 2009, 312 cases of PDA were treated in Fujian provincial hospital, among whom 252 patients were interrupted with VATS(VATS group) and 60 patients with PCO technique(PCO group). For the VATS group, there were 78 males and 174 females aged from 7 d to 31 years old (9.16±8.91 years), while there were 17 males and 43 females aged from 4 to 57 years old (25.55±14.10 years) in the PCO group. We used titanium clip to interrupt PDA under videoassisted thoracoscope for patients in the VATS group, and adopted Amplatzer method for patients in the PCO group. The clinical results, complications and hospital cost in the two groups were compared in this study. Results In the VATS group, all the PDA were successfully interrupted with no residual shunt. In the PCO group, 5% (3/60) of the patients had minor residual shunt after the procedure. No mortality occurred in both groups. Time of the procedure and hospital stay in the PCO group were shorter than that in the VATS group (70.20±31.20 min vs. 112.50±16.30 min, t=6.344,P=0.002; and 4.70±2.20 d vs. 6.50±2.80 d, t=3.241, P=0.022, respectively). However, the hospital cost for each patient in the PCO group was much higher than that in the VATS group (23 222.00±4 333.40 yuan RMB vs. 8 904.50±2 634.60 yuan RMB,t=25.360, P=0.000). Conclusion Compared with PCO, VATS in interrupting PDA can achieved not only excellent clinical results, especially in the newborn and baby cases, but also very satisfying cost which is just a little more than one third of the PCO cost.

围产期动脉导管未闭患者并发急性大面积肺栓塞手术治疗及围术期管理一例

应用Amplatzer封堵器治疗动脉导管未闭

目的 评价Amplatzer封堵器在动脉导管未闭(PDA)介入治疗中的安全性和疗效. 方法 自2000年9月开始应用Amplatzer封堵器治疗30例PDA患者,在术后24小时、1个月、3个月行超声心动图检查,观察封堵效果及有无并发症. 结果 PDA最窄处直径为2.5～12.0mm,平均5.3mm;1例伴有重度肺动脉高压的粗大PDA采用Amplatzer房间隔缺损封堵器治疗,余29例用Amplatzer PDA封堵器.29例术后24小时、1例48小时时彩色多普勒超声心动图检查均未见残余分流,1例术后早期发生机械性溶血.随访中,未出现封堵器移位、残余分流和再通. 结论 应用Amplatzer封堵器治疗PDA是一种安全有效的非外科手术方法,适应证广、技术成功率高、近期疗效满意,远期效果尚需进一步观察.

Effectiveness of Pulmonary Artery Patch Repair Treatment of Patent Ductus Arteriosus

目的总结常温体外循环下经肺动脉内补片修补术治疗成人粗大型动脉导管未闭（patent ductusarteriosus，PDA）的临床经验。 方法回顾性分析新疆医科大学第一附属医院收治的62例直径大于15 mm PDA患者的临床资料，其中男45例、女17例，年龄18～35岁；常温体外循环辅助下经肺动脉前壁切开，用Foley气囊导管堵住PDA开口直视下行补片修补术，合并其它心内畸形的同期进行矫正。 结果全组病例无早期死亡，术中体外循环时间（40.78±11.03）min，住院时间（12.55±8.41）d。通过电话及门诊随访56例，失访6例，失访率9.68%，随访时间2～18（11±5）个月，无1例死亡，复查心脏超声未见残余分流。术后出现低心排血量综合征2例、不同程度的高血压8例，经积极治疗后均痊愈出院。 结论经肺动脉内补片修补术治疗成人粗大型动脉导管未闭，手术操作简单、风险小、效果良好。

Surgical Strategy for Children with Patent Ductus Arteriosus and Mitral Regurgitation

Abstract：　Objective　To optimize surgical treatment for children with patent ductus arteriosus （PDA） and mitral regurgitation （MR） and evaluate its midterm to longterm outcome in terms of MR.　Methods　Between Jan. 2008 and Jan. 2011， 25 children with PDA and MR underwent surgical treatment in Shanghai Children’s Medical Center. There were 14 male patients and 11 female patients with average age of 26.36±40.75 （1.72-142.83）months and average weight of 8.98±6.85 （3.80-36.00） kg. The average diameter of PDA was 7.84±3.10 （3-15）mm. There were 22 children with duct-type PDA and 3 children with window-type PDA. There were 5 children with severe MR， 18 children with moderate　MR， and 2 children with mild MR. Except one child with mitral stenosis who underwent PDA ligation plus mitral　valvuloplasty supported with cardiopulmonary bypass， all other 24 children only underwent PDA ligation through left posterolateral thoracotomy without any management for the mitral valve.　Results　There was no in-hospital death. The average ventilation time in ICU was 6.70±4.39 （3-24） hours. Except one child was reintubated because of asthma， all other children recovered uneventfully without any postoperative complication. All the 25 children were followed up for 329.23±288.39 （29-967） days. During follow-up， 23 children （92.00%） had their MR level　ameliorated in different　degree. Preoperative severe MR in 5 children changed into moderate MR in 2 children and mild MR in 3 children. Preoperative moderate MR in 16 children changed into none MR in 5 children, trivial MR in 5 children and mild MR in 6 children.　Preoperative mild MR in 2 children changed into none MR in 1 child and trivial MR in another child. Two children with preoperative moderate MR had no improvement during follow-up.　Conclusion　For infants and children with PDA and MR， conservative treatment strategy should be carried out. Simple PDA ligation can provide satisfactory clinical outcome， which may also avoid negative complications including myocardial injury caused by cardiopulmonary bypass.

外科治疗肺动脉瘤合并动脉导管未闭一例

【摘 要】 目的 报道1例肺动脉瘤合并动脉导管未闭患者临床资料，分析其病因、临床表现及治疗方法。方法 2010年11月收治1例36岁肺动脉瘤合并动脉导管未闭男性患者，心脏彩色超声多普勒检查示肺动脉分叉偏左与降主动脉间有一通道，大小约12.0 mm × 6.7 mm，大血管水平探及左向右双期分流。左心室明显增大，主肺动脉明显扩张，约65 mm，估测肺动脉压力65 mm Hg（1 mm Hg=0.133 kPa）。采用切除肺动脉瘤并取牛心包补片重建主肺动脉治疗。结果 患者手术成功，无严重并发症发生。术后6个月随访恢复正常生活。 结论 肺动脉瘤只要早期诊断、把握手术时机、选择正确手术方法，可以获满意临床疗效。

Establishment of patent ductus arteriosus model in Bama miniature pigs using autogenous jugular vein

ObjectiveTo explore the method and feasibility of establishing patent ductus arteriosus (PDA) model in Bama miniature pig by using autologous jugular vein, and to provide a large animal model for the development of PDA occluder and the study of pulmonary hypertension associated with congenital heart disease. MethodsFive male Bama miniature pigs weighing about 45 kg were selected to gain the PDA model of the autogenous jugular vein, which was fixed by glutaraldehyde and anastomosed between the ascending aorta and the main pulmonary artery. The patency of PDA was confirmed by echocardiography and angiocardiography immediately and one week after the operation. Two animals were selected to undergo transcatheter closure of PDA via femoral vein 1 week after the operation, and the rest were euthanized to obtain PDA and lung tissue for pathological examination. ResultsThe PDA model was successfully established in all five animals with a success rate of 100.0%. Immediately and 1 week after the operation, echocardiography and angiography showed that PDA blood flow was unobstructed, and hematoxylin-eosin staining showed that PDA endothelialization was good. One week after the operation, two animals were successfully treated with transcatheter femoral vein occlusion. The pathological examination of lung tissue showed thickening of the intima and muscular layer of pulmonary arterioles, thickening of pulmonary interstitium and infiltration of neutrophils. ConclusionIt is safe and feasible to establish a large animal model of PDA by using autogenous jugular vein anastomosis between the ascending aorta and the main pulmonary artery. The model can be used for the development of PDA interventional occlusive devices and the pathophysiological study of congenital heart disease-related pulmonary hypertension.

动脉导管未闭合并重度肺动脉高压患者的介入与外科治疗

目的 探讨动脉导管未闭(PDA)合并重度肺动脉高压(PH)患者外科手术治疗与介入封堵治疗的适应证和治疗效果。 方法 回顾分析1998年5月至2008年5月我科收治的30例PDA患者的临床资料，其中男14例，女16例；年龄14～41岁，平均年龄25.8岁。18例行外科手术治疗，12例行介入封堵治疗。 结果 经外科手术和介入封堵治疗患者术后即刻的肺动脉收缩压(608±120 mm Hg vs. 100.2±14.2 mm Hg; 60.3±11.6 mm Hg vs. 108.4±17.6 mm Hg)和平均肺动脉压(401±98 mm Hg vs. 76.1±11.3 mm Hg; 40.2±10.5 mm Hg vs. 79.5±13.6 mm Hg)均较术前明显降低（Plt;0.05）。术后4例手术患者中有2例出现声音嘶哑，2例残余分流；介入封堵治疗患者术后未出现明显并发症。随访29例，随访时间3个月~2年；1例失访。随访期间患者无明显胸闷、气促等，超声心动图检查大动脉水平未探及残余分流，1例术前伴有心房颤动的患者在封堵术后2个月时猝死，死亡原因不明。28例患者术后90 d复查超声心动图提示：肺动脉收缩压均较术前明显降低（Plt;0.05），两种治疗方法的疗效差异无统计学意义（Pgt;0.05）。 结论 介入封堵治疗PDA合并重度PH的患者与外科手术治疗相比较具有创伤小、风险小、并发症少和恢复快等优点，尤其是介入封堵治疗可行试验性封堵，对鉴别动力性和阻力性PH具有不可替代的优越性。但一些特殊类型的PDA患者仍需外科手术治疗。