Objective To explore the application effect of 3D printed heart models in the training of young cardiac surgeons, and evaluate their application value in surgical simulation and skill improvement. MethodsEight young cardiac surgeons were selected form West China Hospital as the trainees. Before training, the Hands-On Surgical Training-Congenital Heart Surgery (HOST-CHS) operation scores of the 8 cardiac surgeons were obtained after operating on 2 pig heart models of ventricular septal defect (VSD). Subsequently, simulation training was conducted on a 3D printed peri-membrane VSD heart model for 6 weeks, once a week. After the training, all trainees completed 2 pig heart VSD repair surgeries. The improvement of doctors’ skills was evaluated through survey questionnaires, HOST-CHS scores, and operation time after training. ResultsBefore the training, the average HOST-CHS score of the 8 trainees was 52.2±6.3 points, and the average time for VSD repair was 54.7±7.1 min. During the 6-week simulation training using 3D printed models, the total score of HOST-CHS for the 8 trainees gradually increased (P<0.001), and the time required to complete VSD repair was shortened (P<0.001). The trainees had the most significant improvement in scores of surgical cognition and protective awareness. The survey results showed that trainees were generally very satisfied with the effectiveness of 3D model simulation training. Conclusion The 3D printed VSD model demonstrates significant application advantages in the training of young cardiac surgeons. By providing highly realistic anatomical structures, 3D models can effectively enhance surgeons’ surgical skills. It is suggested to further promote the application of 3D printing technology in medical education, providing strong support for cultivating high-quality cardiac surgeons.
ObjectiveTo investigate the therapeutic effect of modified tricuspid valvuloplasty using anterior leaflet in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia.
MethodsNinety-five patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia underwent surgical treatment in our hospital from June 2002 to March 2014. There were 39 males and 56 females with an average age of 3.2±6.6 years (range 3 months to 46 years). Preoperative echocardiography prompted all patients had varying degrees of tricuspid valve dysplasia and tricuspid regurgitation (mild in 14 cases, moderate in 49 cases, and severe in 32 cases). According to the different development of anterior and septal leaflet, we used different techniques to repair the tricuspid problems. If the residual septal leaflet was larger than one third of the normal septal leaflet, we continuously stitched the half of the septal side of anterior leaflet to the two third of the left side of residual septal leaflet. If the residual septal leaflet was less than one third of the normal septal leaflet, we reserved part of pericardial patch at right side of septal crest at repairing the atrial septal defect, and continuously stitched the left two third of the patch edge to the half of septal side of anterior leaflet. All patients received transesophageal echocardiography (TEE) to evaluate the intraoperative effect of valvuloplasty. The patients were followed up with echocardiography after 3 to 6 months to evaluate the condition of tricuspid.
ResultsThere was no perioperative death or Ⅲ degree atrioventricular block. Intraoperative TEE showed that the effect of tricuspid valvuloplasty was good with 3 cases of mild regurgitation and 2 cases of moderate regurgitation. Other 90 cases had no significant regurgitation. The aortic cross-clamping time was 35.2±11.2 min and cardiopulmonary bypass time was 64.9±16.6 min. In the followed-up between 3 to 6 months, tricuspid regurgitation situation improved significantly than that in preoperative period with mild regurgitation or no reflux in 89 cases and moderate regurgitation in 6 cases. There was no severe regurgitation occurred.
ConclusionThe therapeutic effect is satisfactory by using anterior leaflet to repair the regurgitation of tricuspid in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia.
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.
ObjectiveTo summarize the relationship between preoperative duration of mechanical ventilation and prognosis in patients with ventricular septal defect. MethodsThe clinical data of patients with ventricular septal defect requiring ventilator support preoperatively and undergoing surgical treatment in our hospital from May 2009 to May 2020 were retrospectively reviewed. Based on the duration of preoperative ventilation, the patients were divided into three groups: a group A (0-47 hours), a group B (48-96 hours), and a group C (＞96 hours). Each group's postoperative recovery, complications, and medical costs were analyzed. Results Finally 272 patients were enrolled, including 154 males and 118 females, with a median surgical age of 2 (1, 4) months. There were 43 patients in the group A, 75 patients in the group B, and 154 patients in the group C. Early death occured in 3 (1.3%) patients, all in the group C. No statistical difference in mortality was found among the three groups (P=0.734). The mean postoperative duration of mechanical ventilation in the three groups was 158.6±133.5 hours, 101.2±56.1 hours, and 133.1±97.9 hours, respectively. The group B had significantly shorter duration than the other two groups (P＜0.05). The mean postoperative hospital stay in the three groups was 17.5±9.9 days, 13.5±5.8 days, and 16.5±10.8 days, respectively. Postoperative hospital stay in the group B was significantly shorter than that in the other two groups (P＜0.05). The mean total in-hospital cost in the three groups were 89 000±34 000 yuan, 87 000±21 000 yuan, and 109 000±41 000 yuan, respectively. The costs in the group C were significantly higher than those in the other two groups (P≤0.001). ConclusionPrompt surgical repair is necessary for patients with ventricular septal defects requiring ventilator support preoperatively. However, attention should be paid to surgical timing. Preoperative duration of mechanical ventilation is associated with better surgical outcomes within 48-96 hours than 0-47 hours or ＞96 hours.
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.
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 analyze the clinical efficacy of right midaxillary straight incision surgery in the treatment of doubly committed subarterial ventricular septal defect. MethodsThe clinical data of children with doubly committed subarterial ventricular septal defect who received surgeries in our hospital from August 2020 to July 2023 were analyzed retrospectively. All the children underwent surgical repair and were divided into two groups according to the incision position, including a right midaxillary straight incision group and a median incision group. The outcomes were compared between the two groups. ResultsA total of 187 patients were enrolled. There were 102 patients in the right midaxillary straight incision group, including 55 males and 47 females with a median age of 26.0 (5.0, 127.0) months and a median weight of 12.5 (5.1, 32.8) kg at surgery. There were 85 patients in the median incision group, including 37 males and 48 females with a median age of 4.0 (2.0, 168.0) months and a median weight of 6.7 (4.8, 53.9) kg at surgery. No mortality occurred in the study. There was no statistical difference between the two groups in the cardiopulmonary bypass time [(50.0±18.4) min vs. (46.1±15.7) min] or aortic cross-clamping time [(31.3±18.6) min vs. (26.3±17.5) min] (P>0.05). Compared to the median incision group, the time from the end of cardiopulmonary bypass to the closure of chest [(22.3±15.6) min vs. (37.1±13.4) min, P<0.001], postoperative hospital stay [(6.9±3.9) d vs. (8.6±3.6) d, P=0.002], the length of incision [(4.3±2.7) cm vs. (8.5±3.2) cm, P<0.001], drainage volume [(79.0±32.2) mL vs. (100.2±43.1) mL, P<0.001], and the pain score on the 2nd and the 3rd day after the operation were statistically better in the right midaxillary straight incision group (P<0.05). The medical experience and incision satisfaction scores at discharge of the right midaxillary straight incision group were higher (P<0.05). During the follow-up of 21.0 (1.0, 35.0) months, no residual shunt was detected and all patients in both groups had a normal cardiac function and mild or less valve regurgitation. ConclusionCompared to the median incision, minimally invasive right midaxillary straight incision for the repair of doubly committed subarterial ventricular septal defect offers comparable efficacy and reliability, with the added advantages of being minimally invasive, cosmetically superior, and promoting faster postoperative recovery.
Objective To evaluate the efficacy of 3-dimensional printing model (3DPM) aiding decision making and surgery rehearsal for the treatment of double outlet right ventricle (DORV) with non-committed ventricular septal defect (NC-VSD).
Methods From January 1st, 2012 through December 30th, 2014, 12 patients with DORV and NC-VSD were operated with the aid of “3DPM guidance” to do decision making and surgical technique rehearsal preoperatively. There were 9 males and 3 females at age of 2.9±2.2 years. The “3DPM guidance” consisted of step by step procedures: computerized tomography (CT) scan for the patients, CT based 3DPM rendering, 3DPM exploration, decision making, and surgery rehearsal. During surgery rehearsal, surgeons did patch designing, VSD enlargement planning, muscle bundle resection etc. Eight out of the twelve patients underwent biventricular repair, 4 patients underwent single ventricle repair. Six of the eight biventricular repair patients had intra-ventricular baffle repair, 1 patient had intra-ventricular baffle repair and arterial switch procedure, 1 had modified Nikaidoh procedure. VSD enlargement was performed in all the patients in biventricular repair group. The reasons not to do a biventricular repair included very restrictive VSD, tricuspid attachments across the sub-aortic passway.
Results The operation findings correlated well with the 3DPM in all the cases. There was no hospital death, no major complication. One patient had a mild sub-aortic stenosis and he was under close follow-up. There was no late death and reoperation. Surgeons involved were satisfied with the “3DPM guidance”.
Conclusions 3-D printing model is an excellent way to help decision making for DORV with NC-VSD and can provide surgery simulation which decrease complication rate and help achieve good outcomes.
Abstract: Objective To introduce a new technique: transthoracic closure of perimembranous ventricular septal defect (VSD) without cardiopulmonary bypass (CPB) under transesophageal echocardiography (TEE）guidance, and summarize the clinical experiences and midterm followup results. Methods A total of 136 patients with perimembranous VSD, 3 months to 15 years averaging 1.8 years, underwent transthoracic device closure. The weight of these patients ranged from 4.0 to 26.0 kg with an average weight of 12.7 kg. The diameter of their VSD ranged from 3 to 12 mm averaging 5.1 mm. A small transthoracic incision (34 cm incision by inferior sternotomy or 23 cm transverse incision in the third intercostal space) was made and the best location for right ventricular puncture was chosen and the delivery pathway was established under TEE guidance. Proper devices were delivered and then deployed to close the defect. Patients were followed up closely with a standard protocol, arranged for echocardiography, electrocardiogram and chest Xray film. Results In all the cases, 131 cases of VSD (96.3%) were successfully closed. The procedure time was less than 90 minutes and the implanting time was 5.42 minutes (16.3±5.7 min). Symmetrical devices were implanted into 89(67.9%) of the 131 patients and the other 42 patients (32.1%) were closed with asymmetrical ones. The result of TEE soon after operation showed that 3 patients had tiny residual shunt, 4 had new trivial and mild tricuspid regurgitation (TR). However, no TR worsening, aortic regurgitation (AR), complete atrioventricular heart block, or left or right outflow tract obstruction was detected in all patients. One patient 〖CM(159mm〗with transient atrioventricular block restored to sinus rhythm after 3 days of medical treatment. Five cases (3.7%) were converted to conventional open heart repair during the operation. Followup was done to all the patients for a period ranged from 6 months to 30 months (18.3±6.6 months). Tiny residual shunt in the 3 cases mentioned above vanished during the followup period. No new TR, AR, hemolysis, thrombosis, dislocation of the devices, or outflow stenosis was detected postoperatively. The tiny incision caused less psychologic depression. Conclusion Minimally invasive transthoracic device closure of VSD without CPB is a simple, effective and safe intervention under guidance of TEE for most of perimembranous VSD patients. The short and midterm clinical outcomes are promising. Longterm followup is indispensable.
Objective To explore the clinical effect of ventricular septal defect repair and lung allograft (simply as "heart repair and lung transplant") in the treatment of ventricular septal defect complicated with severe pulmonary hypertension. Methods A 21-year-old female patient with ventricular septal defect and severe pulmonary hypertension was treated with cardiopulmonary bypass (CPB) under general anesthesia, and then right lung transplantation was performed, and then left lung transplantation was performed after changing body position. Results The operation was conducted successively. The intraoperative CPB support time was 90 minutes, and the blood loss was 2000 mL. Extracorporeal membrane oxygenation was removed on the second day after operation, the ventilator was evacuated on the third day, and the patient recovered and discharged on the 38th day. Postoperative echocardiography showed significant improvement in pulmonary artery pressure. Conclusion For patients with simple congenital heart disease complicated with severe pulmonary hypertension, "heart repair and lung transplant" can improve their quality of life.
