ObjectiveTo study the safety of right vertical infra-axillary thoracotomy (RVIAT) in the repair of ventricular septal defect (VSD) and the optimal age for RVIAT.MethodsBetween June 2014 and June 2018, 441 children underwent VSD repair via RVIAT in our hospital. According to the age, they were divided into four groups: a 4 months to 1 year old group (R1 group, n=123), a 1-2 years old group (R2 group, n=106), a 2-5 years old group (R3 group, n=166), a >5 years old group (R4 group, n=46). The clinical effects of the patients were compared.ResultsAll the operations were successfully performed and no serious complication was found in all groups. No statistical difference was observed in the operation time, blood loss during operation, thoracic drainage 24 h after operation among groups (P>0.05). The cardiopulmonary bypass time, aortic cross-blocking time and ICU stay time in the R1 and R2 groups were longer than those in the R3 and R4 groups (P<0.05). In the R1 group, the postoperative ventilating time and postoperative hospital stay time were longer, and the blood transfusion volume was more than those in the R3 and R4 groups (P<0.05). The incidence of postoperative complications was higher in the R4 group than that in the R1 and R3 groups (P<0.05).ConclusionVSD repair via RVIAT may be more effective in children >2 years old, and 2-5 years old may be the optimal age.
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 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.
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 compare the benefits and drawbacks of primary patch expansion versus pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). MethodsA retrospective study was conducted on patients diagnosed with PA/VSD who underwent primary right ventricular-pulmonary artery connection surgery at our center between 2010 and 2020. Patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: a pericardial tube group and a patch expansion group. Clinical data and imaging findings were compared between the two groups. ResultsA total of 51 patients were included in the study, comprising 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. The pericardial tube group included 19 patients with a median age of 17.17 (7.33, 49.67) months, while the patch expansion group consisted of 32 patients with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter of pulmonary artery, McGoon index, and Nakata index significantly increased after treatment (P<0.001). However, the pericardial tube group exhibited a longer extracorporeal circulation time (P<0.001). The reoperation rate was notably high, with 74.51% of patients requiring further surgical intervention, including 26 (81.25%) patients in the patch expansion group and 12 (63.16%) patients in the pericardial tube group. No statistical differences were observed in long-term cure rates or mortality between the two groups (P＞0.005). Conclusion In patients with PA/VSD, both patch expansion and pericardial tube right ventricular-pulmonary artery connection serve as effective initial palliative treatment strategies that promote pulmonary vessel development and provide a favorable foundation for subsequent radical operations. However, compared to the pericardial tube approach, the patch expansion technique is simpler to perform and preserves some intrinsic potential for pulmonary artery development, making it the preferred procedure.
ObjectiveTo summarize the reoperation experience for complete atrioventricular septal defect (CAVSD) with severe left atrioventricular valve regurgitation (LAVVR) by standardized mitral repair-oriented strategy.MethodsFrom 2016 to 2019, 11 CAVSD patients underwent reoperation for severe LAVVR by standardized mitral repair-oriented strategy at Fuwai Hospital, including 5 males and 6 females with a median age of 56 (22-152) months. The pathological characteristics of severe LAVVR, key points of repair technique and mid-term follow-up results were analyzed.ResultsThe interval time between the initial surgery and this surgery was 48 (8-149) months. The aortic cross-clamp time was 54.6±21.5 min and the cardiopulmonary bypass time was 107.4±38.1 min, ventilator assistance time was 16.4±16.3 h. All patients recovered smoothly with no early or late death. The patients were followed up for 29.0±12.8 months, and the echocardiograph showed trivial to little mitral regurgitation in 5 patients, little regurgitation in 5 patients and moderate regurgitation in 1 patient. The classification (NYHA) of cardiac function was class Ⅰ in all patients.ConclusionStandardized mitral repair-oriented strategy is safe and effective in the treatment of severe LAVVR after CAVSD surgery, and the mid-term results are satisfied.
ObjectiveTo evaluate the mid-term safety, efficacy and feasibility of perventricular device closure for subarterial ventricular septal defect.MethodsClinical data of 97 patients diagnosed with subarterial ventricular septal defect through echocardiography in West China Hospital from September 2013 to December 2015 were retrospectively analyzed. There were 66 males and 31 females aged 3 (1.8, 5.9) years. All the patients underwent perventricular device closure under the guidance of transesophageal echocardiography using eccentric occlusion device. Possible complications such as residual shunt, valvular regurgitation, atrioventricular conduction block and arrhythmias were recorded during the 1-year, 3-year and 5-year follow-up.ResultsAll the patients received perventricular device closure successfully except that 1 patient underwent open surgical repair under cardiopulmonary bypass 3 months later because of the migration of device. So the rate of complete closure was 99.0%. No residual shunt, moderate or severe valvular regurgitation, atrioventricular conduction block or arrhythmias were observed 5 years later.ConclusionTreating subarterial ventricular septal defect through perventricular device closure exhibits remarkable mid-term efficacy, safety and feasibility with high success rate.
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.
Objective
To analyze the clinical efficacy of totally thoracoscopic surgery and conventional thoracotomy in repair of ventricular septal defect (VSD).
Methods
We retrospectively reviewed the clinical data of 50 VSD patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2017. According to the surgical pattern, they were divided into two groups: a totally thoracoscopic surgery group (21 patients, 13 males, 8 females, aged 38.36±10.02 years), and a thoracotomy group (29 patients, 18 males, 11 females, aged 42.36±13.02 years). The operation time, hospital stay, ventilator-assisted time and thoracic drainage were compared between the two groups.
Results
There was no death in two groups. In the thoracoscopic group the duration of cardiopulmonary bypass (CPB) time and the aortic clamping time were longer than those of the thoracotomy group (P<0.05), but postoperative drainage, patients with postoperative use of blood products and postoperative hospital stay were less (P<0.05). There was no statistically significant difference between the two groups in operation time, postoperative ventilator-assisted time or duration of ICU stay.
Conclusion
Compared with the conventional thoracotomy, totally thoracoscopic VSD repair with less trauma, quicker recovery and less blood use, is safe and reliable and can be used as a preferred surgical intervention.
ObjectiveTo reveal the risk factors for delayed recovery and complications in infants with weight≤5.0 kg after surgical ventricular septal defect (VSD) closure.MethodsWe retrospectively reviewed a consecutive series of 86 patients with weight≤5.0 kg who were admitted to our institution for surgical VSD closure between January 2016 and July 2019, including 31 males and 55 females with an age of 17-266 (80.3±40.4) d and a weight of 2.5-5.0 (4.4±0.6) kg. The VSDs were divided into perimembranous (n=65, 75.6%), subaortic (n=17, 19.8%) and subaortic combined muscular types (n=4, 4.7%). Mechanical ventilation (MV) time≥24 h or ICU stay≥72 h were defined as delayed recovery. Death, sudden circulatory arrest, complete heart block requiring a permanent or temporary pacemaker implantation, neurological complications, reoperation (for residue shunt or valvular regurgitation), reintubation and diaphragmatic paralysis were considered as significant major adverse events.ResultsThere was no death, reoperation due to residual VSD or neurological complication. Totally 51 (59.3%) patients had MV timec≥24 h and 51 (59.3%) patients stayed in the ICU≥72 h. Two (2.3%) patients required temporary pacemaker and six (7.0%) patients required reintubation. During the follow-up of 3-36 (15.8±8.8) months, 1 patient died of pneumonia after discharge, 5 patients suffered mild tricuspid valve regurgitation and 1 patient suffered decreased left ventricular systolic function in the follow-up. No aortic valve injuries occurred.ConclusionFor patients whose weight≤5.0 kg, short-term results of surgical VSD closure are excellent. Low weight and age may prolong MV time; low birth weight and pulmonary hypertension may prolong ICU stay, but are not independent risk factors.
