ObjectivePulmonary vein banding was used to establish a piglet model of pulmonary vein stenosis. We investigated the pathomorphological alterations of pulmonary veins in the model and compared it with the vascular tissue of recurrent stenosis after total anomalous pulmonary venous connection (TAPVC).MethodsTen pigs of 6 weeks old were selected and randomly divided into 2 groups: 5 in a sham operation group and 5 in a pulmonary vein banding group. The operation had two stages, in which thoracotomies through intercostal space were done respectively on both sides. Biocompatible materials were applied around the pulmonary veins in the experimental group. The same method was used in the sham group. But the pulmonary veins were not banded. Six weeks after the operation, the pulmonary veins of the animals were harvested for hematoxylin-eosin staining and immunofluorescence staining to observe the pathological alterations of pulmonary veins. The proliferative tissues of patients with recurrent stenosis after TAPVC repair were collected and observed by hematoxylin-eosin staining and immunofluorescence staining.ResultsBoth the sham operation group and the pulmonary vein banding group survived. But the pulmonary vein banding group had obvious clinical manifestations of pulmonary venous stenosis. Compared with the sham group, the pulmonary vein banding group showed intimal hyperplasia, decreased expression of endothelial marker and increased expression of mesenchymal markers, and co-expression of endothelial and mesenchymal markers in intimal cells. Human pathology also showed intimal hyperplasia and co-expression of endothelial and mesenchymal markers in intimal cells.ConclusionThe surgical pulmonary vein stenosis in piglets shows intimal hyperplasia and myofibroblasts, which was consistent with clinical pathology.
Objective To summarize the experience of the surgical treatment of total anomalous pulmonary venous connection (TAPVC) in 31 cases，so as to elevate the operative effect. Methods The total corrected operation under moderate hypothermic cardiopulmonary bypass were performed in 31 cases with TAPVC. Site of drainage was supracardiac (n=16),cardiac(n=13)and mixed(n=2). Other accompanying congenital cardiac malformations were diagnosed such as atrial septal defect(n=31), patent ductus arteriosus(n=4), pulmonic stenosis(n=1), mitral regurgitation(n=1), tricuspid regurgitation (n=15)，etc. Results No hospital death was observed in the early period of operation (30 d). Complication occurred in 8 cases (25.8%), such as paroxysm of nodal rhythm(n=1), Ⅰ° atrial ventricular block(n=1), frequently atrial premature beats and paroxysm of auricular tachycardia(n=1),pulmonary infection(n=2),atelectasis(n=1), pneumatothorax (n=1), left diaphragmatic paralysis and pulmonary infection with tracheal reintubation (n=1),etc. All of them discharged after active therapy. All of 31 cases was followed up, followup time was 2.8±1.5 years. 30 cases were living (96.7%) and 1 case died of heart failure 8 months after operation. 2 cases had auricular arrhythmia with a bad medical effect. 28 cases(93.3%) had normal heart function and they could work and live normally after discharged. Conclusion Surgical procedure should be based on individual abnormality for TAPVC.Surgeons should take care not only of the stenosis of anastomotic stoma,but also of the arrhythmia after operation.Satisfied correction of the abnormality is important and the curative effect of those cases is approving.
ObjectiveTo analyze the clinical presentations and radiological characteristics of pulmonary vein stenosis after radiofrequency ablation. MethodsClinical and radiological data of 2 patients with pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. ResultsBoth patients had undergone circumferential pulmonary vein isolation. The symptoms appeared approximately 2 months after the operation. The major symptoms were cough, hemoptysis, exacerbation of dyspnea and chest pain. Both patients were misdiagnosed as other diseases such as pneumonia in other hospitals, and the anti-infection therapy was invalid. Both CT scans showed parenchymal exudative consolidation with varying degrees of interstitial septal thickening and small nodules. Both patients were confirmed as pulmonary vein stenosis by CT angiography. Literature review identified 21 cases of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. The main clinical features are hemoptysis, chest pain, shortness of breath and cough. The most common features of thoracic radiological imaging are consolidation, groud-glass attenuation, pleural effusion and interstitial septal thickening. ConclusionsIf a patient presents with hemoptysis, dyspnea, chest pain or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation with interstitial septal thickening and multiple small nodules, the possibility of pulmonary vein stenosis should be considered. Contrast-enhanced CT combined with pulmonary vein imaging technology can clearly show the opening diameter of each pulmonary vein and its branches, so it is an important non-invasive examination method for the evaluation and diagnosis of pulmonary vein stenosis.
ObjectiveTo evaluate the efficacy of the epicardial circumferential left atrial ablation (CLAA) with pulmonary vein isolation (PVI) in curing atrial fibrillation (AF). MethodsThirty experimental pigs, weight from 60-78 kg, were divided into 3 groups with the method of random sampling:a group of AF (AF group, n=10), a group of PVI (PVI group, n=10), and a group of CLAA and PVI (CLAA+PVI group, n=10). AF mode was induced by rapid atrial pacing. After AF was induced, no ablation was performed for pigs in the AF group, PVI was performed for pigs in the PVI group with bipolar radiofrequency ablation clamp, and the CLAA+PVI group underwent CLAA after accepted PVI with bipolar radiofrequency ablation clamp. After ablation, we applied electrovert on AF pigs to recover to sinus rhythm, then we tested the vulnerability and lasting time of AF in all 3 groups. ResultsAll pigs developed a stable and sustained AF by rapid left atrial pacing. The pigs of the PVI group and the CLAA+PVI group successfully underwent ablation with the beating heart. Isolated PVI terminated AF in 3 of 20 pigs, and CLAA with PVI terminated AF in 5 of 8 pigs (15% vs. 62.5%, P=0.022). After all pigs recovered to the sinus rhythm, compared with the AF group (10/10), the incidence of sustained AF by burst pacing was statistically decreased in the PVI group (3/10, P=0.003) and the CLAA+PVI group (0/10, P<0.001). There was no statistical difference between the PVI group and the CLAA+PVI group (P=0.211). There was a statistical decreasing of AF duration in the PVI group (P=0.003) and the CLAA+PVI group (P<0.001) compared with the AF group and there was a statistical decreasing of AF duration in the CLAA+PVI group compared to that of the PVI group (P=0.008). ConclusionCompared with isolated PVI, CLAA+PVI may effectually stop the lasting of AF, restrain the recurrance of AF, and improve the treatment effect of AF.
【摘要】 目的 探讨正常成人肺静脉开口径线（pulmonary vein ostia，PVO）的测量方法，并获得我院PVO径线值的95%参考值范围。 方法 2005年6月-2006年1月收集无明显心肺疾病的正常成人236例，对其进行多层螺旋CT扫描，利用斜冠面重建和三维标定的方法测量PVO径线。 结果 四条PVO径线的95%参考值范围如下：右上肺静脉长径线为男性1.49~2.63 cm，女性1.31~2.37 cm，短径线为男性0.87~2.05 cm，女性0.91~1.81 cm；右下肺静脉长径线为男性1.12~2.06 cm，女性1.05~1.95 cm，短径线为男性0.77~1.83 cm，女性0.79~1.69 cm；左上肺静脉长径线为男性1.18~2.20 cm，女性1.09~2.11 cm，短径线为男性0.82~1.72 cm，女性为0.80~1.62 cm；左下肺静脉长径线为男性0.96~1.98 cm，女性1.03~1.81 cm，短径线为男性0.56~1.26 cm，女性0.51~1.33 cm。除左下肺静脉短径男女差异无统计学意义外，其余径线值男性均大于女性。 结论 采用CT三维重建像改进测量方法测量PVO径线值既简便又准确。【Abstract】 Objective To measure and calculate the diameters of pulmonary vein ostia (PVO) by multi-slice spiral computed tomography (MSCT) in healthy people. Methods From June 2005 to January 2006, 236 healthy people were adopted to undergo MSCT. Their diameters of PVO were measured and calculated by oblique coronal planes reconstruction and 3D position-setting. Results Right superior vein: the 95% reference ranges of the long diameters were 1.49-2.63 cm in the male and 1.31-2.37 cm in the female;the ranges of the short diameters were 0.87-2.05 cm in the male and 0.91-1.81 cm in the female. Right inferior vein: the ranges of the long diameters were 1.12-2.06 cm in the male and 1.05-1.95 cm in the female;the ranges of the short diameters were 0.77-1.83 cm in the male and 0.79-1.69 cm in the female. Left superior vein: the ranges of the long diameters were 1.18-2.20 cm in the male and 1.09-2.11 cm in the female;the ranges of the short diameters were 0.82-1.72 cm in the male and 0.80-1.62 cm in the female. Left inferior vein: the ranges of the long diameters were 0.96-1.98 cm in the male and 1.03-1.81 cm in the female;the ranges of the short diameters were 0.56-1.26 cm in the male and 0.51-1.33 cm in the female. The diameters in the male were all longer than those in the female, except the short diameter of left inferior vein. Conclusions It is a convenient and accurate method to measure the diameters of PVO by blique coronal planes reconstruction and 3D position-setting.
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 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.