Objective To investigate the early and mid-term clinical outcomes of the modified cone reconstruction in the treatment of Ebstein’s anomaly (EA). Methods Clinical data of 18 consecutive patients with EA in our hospital between May 2008 and August 2015 were retrospectively analyzed. All patients were diagnosed by echocardiography. There were 8 males and 10 females with an average age of 20.3 years ranging from 5 to 41 years. According to New York Heart Association classification, 12 patients were classified into grade Ⅱ and 6 grade Ⅲ. One patient had acute arterial embolism and amputation of left lower extremity caused by paradoxical embolism of combined secundum atrial septal defect, and another one was combined with double-orifice technique due to postoperative poor closure of tricuspid valve. The modified cone reconstruction was used to correct the EA, to make leaflets coapted well and form central blood flow. For those patients whose anterior leaflet developed poor and smaller, valve leaflet was widened by using autologous pericardial. For all patients, tricuspid annulus was reinforced by autologous pericardial. Results Two patients suffered arrhythmia, and returned to normal after medication. The rest patients recovered well without death. Echocardiography found 1 patient with moderate regurgitation and the rest of patients’ leaflets coapted well and had no tricuspid stenosis. They were followed up 9 to 38 months postoperatively, and cardiac function of gradeⅠin 14 patients and gradeⅡin 4 patients. Conclusion The early and mid-term clinical outcomes of the modified cone reconstruction in the treatment of EA are affirmative which can make leaflets coapt completely and have a strong anti-regurgitation ability, reducing the incidence of re-operation, valve replacement and postoperative mortality.
ObjectiveTo investigate the clinical application of fresh autologous pericardial patch transplantation in cardiovascular surgery. MethodFrom January 2008 to December 2014, we used fresh autologous pericardial patch as a repair material in surgical treatment of congenital heart disease, valvular and vascular malformation. A total of 239 patients were included (130 males, 109 females), with a mean age of 0.40±13.80 years ranging from 0.25-69.00 years, including 180 infants. ResultThe time of intensive care unit (ICU) stay was 3-15 days and the time of ventilator-assisted breathing was 4-100 hours. Postoperative atelectasis and pleural effusion occured in 8 patients and was cured successfully by closed thoracic drainage and anti-infection therapy. Nine patients died within 30 days after surgery, including 3 deaths caused by low cardiac output syndrome and acute renal failure, 5 deaths caused by multiple organ failure, and 1 death caused by malignant arrhythmia. All patients had no infective endocarditis, thrombosis, hemolysis, blood vessel stenosis, or calcification of pericardial patch. The cause of death was associated with the primary lesion, but not with transplanted pericardium. We followed up 198 patients for 3-64 months. During follow-up, echocardiography showed no patch graft vegetation, thrombosis, perforation or calcification. ConclusionThe fresh autologous pericardium is a good material for repairing cardiac defects.
Objective To explore the effect of aortic valve neo-cuspidization (AVNeo) for patients with severe aortic valve lesions simultaneously. Methods Patients who underwent AVNeo combined valve repair surgery for multiple valve diseases were included in Beijing Anzhen Hospital from May 2016 to September 2023. Results We included 11 patients with 7 males and 4 females at a median age of 38 (36, 49) years. Rheumatic heart disease was found in 5 (45.5%) patients and non-rheumatic heart disease in 6 (54.5%) patients. The median EuroSCORE Ⅱ score was 1.62 (1.18, 1.75) points. Eight patients underwent AVNeo plus mitral and tricuspid valve repair, and 3 patients underwent AVNeo plus mitral valve repair. The median operative time was 356 (315, 415) min, and the median cardiopulmonary bypass time and aortic clamping time were 203 (174, 231) min and 168 (131, 188) min, respectively. In the early stage, 2 patients underwent combined valve repair surgery, and 1 patient underwent in-hospital reoperation for aortic valve replacement because of severe aortic regurgitation. There were 9 patients in the mature stage of AVNeo, and no perioperative adverse events or moderate or above residual valvular disease occurred. All patients recovered and were discharged from the hospital. The follow-up period was 3-99 months, and no reoperation, severe valve disease, bleeding, cerebral infarction, or other adverse events occurred in all patients. Conclusion For non-elderly patients whose mitral and tricuspid valves can be repaired successfully with severe aortic valve lesions, AVNeo can be attempted after proficiency. But the operation time and cardiopulmonary bypass time will inevitably be prolonged, and the patient's basic situation should be carefully evaluated before surgery.
We reported a case of a six-year-old boy diagnosed of single ventricle, pulmonary atresia and interrupted inferior vena cava. After modified Blalock-Taussig shunt and bidirectional Glenn procedure, he received the Fontan procedure. The Fontan procedure was done through a unilateral thoracotomy, using an autologous pericardial conduit to connect hepatic vein and azygos vein. The result of short-term follow-up was satisfactory.
Objective To summarize the clinical experiences of using selfpericardial patch heightening to treat aortic valve prolapse. Methods From May 2000 to July 2007, seventeen patients with aortic valve prolapse were treated by selfpericardial patch heightening. Fifteen cases had right coronary cusp prolapse, one had left coronary cusp prolapse, and one had no coronary cusp proplapse. There were 10 cases with moderate aortic regurgitation and 7 with severe regurgitation. Autologous pericardium was continuously sutured on the proplapsed cusp by 5-0 or 6-0 Prolene suture. The transesophageal echocardiography(TEE) showed that there was few or mild aortic regurgitation during operation. Preoperative and postoperative echocardiography results were compared. Results The comparison between preoperative and postoperative echocardiography results showed that postoperative left ventricular enddiastolic diameter reduced obviously(38.3±9.6 mm vs. 47.2±10.3 mm，P=0.013)；postoperative aortic valve systolic pressure difference reduced（9.8±5.6 mm Hg vs. 10.3±5.3 mm Hg，P=0.792）; postoperative aortic valve diastolic pressure difference reduced obviously(45.7±13.6 mm Hg vs. 78.4±19.9 mm Hg，P= 0.000). Echocardiographic examination before discharge showed that 4 cases had no obvious aortic regurgitation, 9 had mild aortic regurgitation and 4 had moderate aortic regurgitation. The average followup time was 32 months(4.74 months). One case underwent aortic valve replacement because of severe aortic regurgitation 4 months later after the operation, and the rest needed no second operation. Conclusion Using selfpericardial patch heightening to treat aortic valve prolapse is a simple operative method, and it is good for young patients or small aortic annulus.