ObjectiveTo study the clinical characteristics of patients with partial and transitional atrioventricular septal defects (P/TAVSDs) in our hospital, and to evaluate the early follow-up outcomes from a real-world research perspective.MethodsThe clinical data of all patients diagnosed with P/TAVSDs from January 1, 2018 to July 12, 2020, in our hospital were collected, and all patients' examination results were used as the real-world follow-up data, univariable Cox risk proportional model was used to analyze the outcomes. A total of 93 patients were finally included in the analysis, 72 with partial and 21 with transitional AVSD. There were 38 males and 55 females at age of 182.0 months (20.0 d to 779.5 months).ResultsUnivariable Cox proportional risk model suggested that at least one cardiac malformation (HR=15.00, 95%CI 3.00 to 75.00, P=0.001), preoperative moderate or greater mitral regurgitation (HR=6.60, 95%CI 1.70 to 26.00, P=0.007), and preoperative moderate or greater tricuspid regurgitation (HR=13.00, 95%CI 3.10 to 51.00, P<0.0001) were risk factors for moderate or greater postoperative atrioventricular valve regurgitation.ConclusionChildren with coarctation of the aorta or partial pulmonary vein connection, moderate or greater preoperative mitral regurgitation, and moderate or greater preoperative tricuspid regurgitation need to be alerted to the risk of moderate or greater postoperative atrioventricular valve regurgitation. Real-world data, with relaxed statistical P values and combined expertise, can suggest clinical conclusions that are close to those of high-quality retrospective studies.
ObjectiveTo investigate the efficacy and safety of hybrid perventricular device closure (PVDC) for the treatment of muscular ventricular septal defect (MVSD) in pediatric patients.
MethodsWe retrospectively analyzed clinical data of 35 pediatric patients with MVSD who received hybrid PVDC in West China Hospital between 2009 and 2012. There were 16 males and 19 females with their median age of 3.9 years (range, 1 month to 7 years). There were 10 patients with single MVSD, 12 patients with multiple MVSD, 6 patients with other congenital heart defects, and 7 patients with post-surgical residual MVSD.
ResultsAmong the 35 patients, immediate complete closure was achieved in 28 (80.0%) patients. Residual shunt was noted in 7 (20.0%) patients. Median device size was 5 mm. Cardiopulmonary bypass was avoided in 19 patients. Two (5.7%) patients died postoperatively due to postoperative heart failure resulted from complex congenital heart defect. All survival patients were followed up for a mean duration of 6 months, and there was no late death. Thirty-one (93.9%) patients had good positioning of the closure devices but no residual shunt. Small residual shunt at the apex was noted in 2 (6.1%) patients.
ConclusionHybrid PVDC is an effective treatment for MVSD with relatively high successful rate but low mortality and morbidity, and its short-term results are satisfactory.
Objective To investigate the risk factors of prolonged postoperative mechanical ventilation for adult patients with atrioventricular septal defect (AVSD). Methods We retrospectively analyzed the clinical data of 76 patients with AVSD aged more than 18 years in our hospital from January 1, 2011 to December 31, 2017. The patients ventilated longer than 24 hours were described as a prolonged ventilation group (n=27) and the others as a normal group (n=49). There were 9 males and 18 females aged 32.22±9.64 years in the prolonged ventilation group, and 16 males and 33 females aged 35.98±11.34 years in the normal group. Perioperative variables between the two groups were compared and selected, and then analyzed by logistic regression analysis. Results The result of univariate analysis showed that there was a statistical difference in weight, preoperative pulmonary artery systolic pressure, duration of cardiopulmonary bypass, the level of postoperative platelet, hemoglobin, blood glucose, lactic acid and serum creatinine, postoperative maximum heart rate and postoperative infection rate between the prolonged ventilated group and the normal group. Multivarable logistic regression showed that preoperative pulmonary artery hypertension (OR=1.056, 95%CI 1.005 to 1.110, P=0.030), prolonged duration of cardiopulmonary bypass (OR=1.036, 95%CI 1.007 to 1.066, P=0.016) and the low postoperative hemoglobin level (OR=0.874, 95%CI 0.786 to 0.973, P=0.014) were the risk factors of prolonged postoperative mechanical ventilation. Conclusion Preoperative pulmonary artery hypertension, long duration of cardiopulmonary bypass and postoperative anaemia are the risk factors associated with prolonged postoperative mechanical ventilation.
ObjectiveTo compare and investigate the efficacy and differences of modified B-T shunt, central shunt and right ventricle-pulmonary artery (RV-PA) connection in the treatment of pulmonary atresia with ventricular septal defect (PA/VSD).MethodsA total of 124 children with PA/VSD underwent initial palliative repair in Shanghai Children's Medical Center from September 2014 to August 2019, including 63 males and 61 females, aged 7 days to 15 years. They were divided into in a modified B-T shunt group (55 patients), a central shunt group (22 patients) and a RV-PA connection group (47 patients). The clinical data of these children were retrospectively analyzed.ResultsThere were 9 early deaths after palliation, with an early mortality rate of 7.3%. The mean follow-up time was 26.5±20.3 months, with 5 patients lost to follow-up, 5 deaths during the follow-up period, and 105 survivors. The 1-year and 5-year survival rates were both 89.7%. The monthly increased Nakata index was 5.2 (–0.2, 12.3) mm2/m2, 9.2 (0.1, 23.6) mm2/m2, 6.3 (1.8, 23.3) mm2/m2 in the modified B-T shunt group, the central shunt group, and the RV-PA connection group, respectively, with no statistical difference among the three groups. The 1-year survival rate was 85.3%, 78.4%, 95.2%, and the 5-year (4-year in the central shunt group) survival rate was 85.3%, 58.8%, 95.2% in the three groups, respectively, with a statistical difference among them (P<0.05). The complete repair rate was 36.5%, 19.0% and 67.4% in the three groups, respectively, with a statistical difference among the three groups (P<0.001).ConclusionAll these three palliative surgical approaches can effectively promote pulmonary vascular development. But compared with systemic-pulmonary shunt, RV-PA connection has a lower perioperative mortality rate and can achieve a higher complete repair rate at a later stage, which is beneficial for long-term prognosis.
摘要: 目的: 探討小兒先天性心臟病（CHD）部分性房室間隔缺損（PAVSD）的外科治療方法，以期提高療效。方法: 對1999年6月至2009年8月收治27例PAVSD臨床資料進行分析，男16例，女11例，年齡1.3~14歲,平均6.08歲。術前均經彩色多普勒超聲心動圖（Echo）和部分心導管檢查確診。手術全部在中低溫體外循環（CPB）下行根治術。結果: 無手術死亡。22例獲1個月~10年隨訪，1例術后3個月因重度二尖瓣返流（MR）,心力衰竭死亡，1例Ⅱ°房室傳導阻滯（AVB）6個月后自行恢復，2例仍有輕度二尖瓣關閉不全; 余生活、學習正常，心功能Ⅰ級。結論: 一旦確診應盡早手術治療。修補原發孔缺損，注意避免損傷傳導束，二尖瓣裂修復完善是手術成功和減少并發癥的關鍵。Abstract: Objective: To discuss the surgical treatment of congenital heart disease as partial atrioventricular septal defect（PAVSD）to improve the therapeutic effect. Methods: From June1999 to December2008, the clinical data of 27 children suffering from PAVSD were analyzd. Male：16,female: 11. The ages ranged from 1.3 to 14 years, the average age is 6.08±3.73 years.All the children were final diagnosised by color Doppler echocardiogram and right catheterization.All underwent the radical correction under moderate hypothermic cardiopulmonary bypass. Results: There was no operative mortality. 25 cases were followed up for 6 months to 10 years, 1 case died of heart failure secondary to severe mitral regurgitation 3 months after the operation, 1 case had Ⅱdegree atrioventricular block , recovered 6 months later. 2 cases still had mild mitral regurgitation. Other cases lived and studied normally, their heart function is first class. Conclusion: Surgical treatment should be taken as soon as the diagnosis is confirmed. Shallow suturing repairing primum atrial defect and complete repairing mitral valve cleft are the key points of success and avoiding complications.
Objective To analyze the risk factors for death in children with interruption of aortic arch (IAA) and ventricular septal defect (VSD) after one-stage radical surgery. Methods A retrospective analysis was performed on patients with IAA and VSD who underwent one-stage radical treatment in the First Hospital of Hebei Medical University from January 2006 to January 2017. Cox proportional hazards regression model was used to analyze the risk factors for death after the surgery. Results A total of 152 children were enrolled, including 70 males and 82 females. Twenty-two patients died with a mean age of 30.73±9.21 d, and the other 130 patients survived with a mean age of 37.62±11.06 d. The Cox analysis showed that younger age (OR=0.551, 95%CI 0.320-0.984, P=0.004), low body weight (OR=0.632, 95%CI 0.313-0.966, P=0.003), large ratio of VSD diameter/aortic root diameter (VSD/AO, OR=2.547, 95%CI 1.095-7.517, P=0.044), long cardiopulmonary bypass time (OR=1.374, 95%CI 1.000-3.227, P=0.038), left ventricular outflow tract obstruction (LVOTO, OR=3.959, 95%CI 1.123-9.268, P=0.015) were independent risk factors for postoperative death. Conclusion For children with IAA and VSD, younger age, low body weight, large ratio of VSD/AO, long cardiopulmonary bypass time and LVOTO are risk factors for death after one-stage radical surgery.
ObjectiveTo explore the mechanism of volume-related mitral regurgitation (MR) from the anatomy of mitral valve.MethodsA total of 32 patients with ventricular septal defect (VSD) combined MR meeting inclusion criteria in West China Hospital from September 2018 to November 2019 were enrolled in this study. The direction relative to the cardiac axis: the deviation of the MR bundle along the left atrial wall was eccentric, otherwises it was central. There were 23 patients of VSD and eccentric MR (EMR, a VSD-EMR group), including 10 males and 13 females aged 21 (10, 56) months, and 9 patients of VSD and central MR (CMR, a VSD-CMR group), including 4 males and 5 females aged 26 (12, 87) months. Besides, 9 healthy children were enrolled in a control group, including 4 males and 5 females aged 49 (15, 72) months. All patients underwent transthoracic echocardiography (TTE) examination at 2 weeks before surgery and 6 months after surgery, respectively, The MR degree, end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), antero-posterior diameter (AP), annulus circumference (AC), commissural diameter (CD) were assessed.ResultsBefore operation, EDV, ESV, SV, AP, AC and CD in the VSD-EMR and VSD-CMR groups were significantly larger or longer than those in the control group (P<0.05); after operation, EDV, ESV, SV, AP and CD decreased compared with those before operation (P<0.05), but there was no significant difference compared with the control group (P>0.05). Compared with the control group, AC was slightly decreased (P<0.05). There was no significant difference in EF between and within groups before and after operation (P>0.05). The improvement rate of MR was 78.9% (15/19) in the VSD-EMR group and 100.0% (9/9) in the VSD-CMR group.ConclusionAfter unloading of volume, the valve structure is back to normal except AC. The improvement rate of MR in the VSD-EMR group is lower than that in the VSD-CMR group, which may indicate that the mechanism of VSD-EMR is more complicated.
ObjectiveTo explore the anatomical characteristics and surgical strategies of atrioventricular septal defect (AVSD) with left ventricular outflow tract (LVOT) stenosis.MethodsThe clinical data of 11 AVSD patients with LVOT stenosis who underwent surgeries in our hospital from 2008 to 2019 were retrospectively analyzed, including 6 males and 5 females with a median age of 15.0 (7.6-22.0) years.ResultsThere were 3 patients of complete AVSD and 8 patients of partial AVSD. Subaortic stenosis resulted from discrete subaortic membrane in 3 patients, diffused subaortic membrane in 4 patients, hypertrophied muscle bundles in 3 patients and distorted valve frame in 1 patient. Among these patients, 5 patients underwent LVOT stenosis and AVSD repairs simultaneously for the first time, 5 patients underwent LVOT stenosis repair for the second time and 1 patient for the third time. No postoperative death occurred. The postoperative LVOT flow velocity decreased dramatically after LVOT stenosis repair compared with preoperative one [449.0 (393.0, 507.5) cm/s vs. 212.0 (183.0, 253.5) cm/s, P<0.05].ConclusionSurgical results of AVSD combined with LVOT stenosis are satisfactory, but the restenosis should be paid attention to via long-term follow-up.
Abstract: Objective To investigate the safety and feasibility of fast track (FT) treatment in young children with atrioventricular septal defect (CAVSD) and pulmonary artery hypertension (PAH) following surgical repair. Methods A total of 51 young children patients including 24 boys and 27 girls with age at 12.5±8.9 months from 4 to 36 months, underwent CAVSD repair in the pediatric surgery department of Fu Wai Hospital from January 2006 to March 2009. Among them, 21 patients were administered FT management. PICU length of stay and the rate of reintubation were analyzed retrospectively and the decrease of pulmonary artery pressure (PAP) after operation was also measured. Results Twentyone patients under FT treatment were extubated within 8 hours after operation. The mean pulmonary artery pressure(MPAP) decreased significantly after surgery (39.59 mm Hg vs.24.50 mm Hg,t=5514,Plt;0.05). PICU length of stay was 2.05±0.87 d (18 h-3 d). One patient was reintubated due to lung infection, which had nothing to do with the FT treatment. During the followup which lasted for 3 to 6 months, 21 patients had good heart function with no reoperation or death. Conclusion FT treatment is safe and feasible to some CAVSD patients associated with PAH, and shorter PICU length of stay can be achieved. The validation of FT model for the CAVSD patients with severe PAH needs research with large sample.
Objective
To evaluate the efficacy and safety of transthoracic minimally invasive occlusion operation for the treatment of congenital atrial and ventricular septal defects.
Methods
The clinical data of 88 patients who underwent surgical occlusion operation from December 2015 to February 2017 were summarized. There were 52 males and 36 females, aged 6.8±7.5 years ranging from 1.6 to 24.0 years. All the patients were followed up by ultrasound and electrocardiogram at postoperative 3, 6 and 12 months. The efficacy of minimally invasive thoracotomy was analyzed by statistical methods.
Results
The patients were followed up for 3-15 (6.8±2.3) months, and the follow-up rate was 92.0%. Ultrasound showed occluder fixed well and no residual shunt, valve regurgitation, thrombosis or other complications occurred. The heart was reduced, the ejection fraction was greater than 55%, and heart function rating for all patients was grade Ⅰ.
Conclusion
Transthoracic mini-invasive surgical occlusion of atrial and ventricular septal defects is safe and effective. The short and middle-term effect is satisfying. It can be widely used in clinical, but multi-center and long-term follow-up and assessment still need to be carried out.
