ObjectiveTo summarize clinical experience of staged left ventricular retraining for infants with transposition of the great arteries (TGA).
MethodsFrom January 2001 to December 2011, 38 TGA infants with intact ventricular septum or a small ventricular septal defect underwent left ventricular retraining in Fu Wai Hospital. There were 26 male and 12 female patients with their age of 19.1±7.7 months and body weight of 7.6±4.7 kg. Preoperative arterial oxygen saturation (SaO2)was 72.6%±9.1%. Left ventricular retraining included aortopulmonary shunt and pulmonary artery banding. Three patients received concomitant excision of the atrial septum. All survival patients were followed up after discharge.
ResultsPostoperatively, SaO2 increased to 83.9%±8.1% from preoperative 72.6%±9.1%, and left ventricle-to-right ventricle pressure ratio increased to 0.75±0.09 from preoperative 0.36±0.04. Three patients (7.89%)died postoperatively. Thirty-five patients were followed up for 2 to 11 years. During follow-up, 23 patients successfully received second stage arterial switch operation (ASO).
ConclusionFor TGA infants with decreased left ventricular mass who have missed the neonate period, left ventricular retraining is a safe and efficacious procedure to provide necessary preparation for second stage ASO.
ObjectiveTo investigate the effect and safety of the pulmonary vasodilators in pediatric patients after Fontan operation.
MethodsThis retrospective study evaluated the clinical utility of pulmonary vasodilators in pediatric patients with Fontan surgery. Between January and December 2013, 42 consecutive patients with single ventricle physiology who underwent a modified Fontan procedure of total cavapulmonary collection (TCPC) were enrolled. After extubated oral intake started, 24 patients (the treated group) received the pulmonary vasodilator treatment, while 18 patients (the untreated group) didn't not receive the treatment.
ResultsNo inpatient death occurred after surgery. The primary endpoints were time of stay in hospital and time of chest tube drainage. There was no statistical difference between the two groups. Instead, patients in the treatment group seemed to have longer time of hospital stay (22 to 21 days) and chest tube drainage (14.0 to 8.5 days) than those in the untreated group. Compared with the untreated group, patients in the treatment group were younger (P=0.082) with no statistical difference, and had higher postoperative Lac with statistic difference (P=0.031), longer ventilation time with no statistical difference (P=0.050), and lower postoperative oxygen saturation with statistic difference (P=0.065). No clinically significant adverse events relating to pulmonary vasodilator therapy occurred during this study and, in particular, no significant abnormalities in hepatic, renal function tests were observed in pediatric Fontan patients.
ConclusionsPulmonary vasodilator agents were found to be particularly used in the patients with serious conditions in our study. Our study results failed to show significant improvement of pulmonary vasodilator drugs after Fontan surgery in decreasing time of pleural drainage and time of stay in hospital.
ObjectiveTo analyze risk factors contributing to prolonged postoperative recovery after Fontan operation.
MethodsClinical data of 60 patients undergoing Fontan operation between January 2012 and June 2013 in Beijing Fu Wai Hospital were retrospectively analyzed, including their demographic data, preoperative angiography and echocardiogram, and preoperative, intraoperative and postoperative hemodynamic data and blood test results. According to different length of hospital stay (LOS), all the 60 patients were divided into 2 groups. In the normal recovery group, there were 45 patients including 33 males and 12 females with their age of 5.7±1.7 years, whose LOS was shorter than 32.5 days. In the prolonged recovery group, there were 15 patients including 10 males and 5 females with their age of 4.9±1.6 years, whose LOS was longer than 32.5 days (over 75th percentile of LOS). LOS of the 60 patients ranged from 12 to 53 days, and 75th percentile of LOS was 32.5 days. Clinical results were compared between the 2 groups, and risk factors for prolonged postoperative recovery were analyzed.
ResultsPreoperatively, their oxygen saturation by pulse oximetry was 80.5%±7.4%, ejection fraction (EF)was 64.1%±6.6%, Nakata index was 370.6±234.2 mm2/m2, Mcgoon ratio was 2.2±0.7, and pulmonary arterial pressure (PAP)was 12.4±4.0 mm Hg. Twenty-seven patients (45.0%)received Glenn procedure before Fontan operation at the age of 0.9-4.0 years, and the duration from Glenn procedure to Fontan operation was 1.0-5.1 years. Two patients (3.3%)died after Fontan operation. Cardiopulmonary bypass time of 55 patients who received Fontan operation under parallel circulation was 112.0±52.4 minutes. Aortic cross-clamping time of 5 patients who received concomitant repair of intracardiac anomalies under circulatory arrest was 44.8±9.2 minutes. The duration of mechanical ventilation was 18.8±6.4 hours, and ICU stay was 5.1±2.1 days. Univariate analysis showed that risk factors for prolonged postoperative recovery included higher preoperative PAP (P < 0.05), lower preoperative EF (P < 0.05), right ventricle as functional single ventricle (P < 0.05), previous Glenn procedure history (P < 0.05), concomitant total anomalous venous connection (P < 0.05), higher postoperative lactate level (P < 0.05), higher postoperative central venous pressure (P < 0.05), the need for greater volume of fluid resuscitation during the first 24 hours postoperatively (P < 0.05), long duration of chest drainage (P < 0.05)and postoperative infection (P < 0.05).
ConclusionShort-term clinical results of Fontan operation for the treatment of functional single ventricle are satisfactory. Careful assessment and appropriate management of risk factors are helpful to improve postoperative recovery after Fontan operation.
