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@#Objective To 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). Methods A 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. Results There 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). Conclusion All 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.
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Objective:To analyze the coronary angiographic (CAG) characteristics of coronary artery lesion (CAL) in children with Kawasaki disease (KD), and to clarify the necessity of CAG in the diagnosis and treatment of KD combined with CAL in children.Methods:It was a retrospective study to analyze the clinical data, electrocardiogram, echocardiography, time and findings of CAG in children with KD and CAL who underwent CAG in Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from January 2013 to August 2022.The distribution, type, severity, and prognosis of CAL were analyzed.Results:A total of 117 children with KD and CAL were included in the analysis.The onset age of KD was from 2 months to 12.8 years old, and the age of performing CAG was from 8 months to 18.1 years old.A total of 234 coronary artery lesions were detected in 117 cases.Among them, CAL in the right coronary artery (RCA), left anterior descending branch (LAD), left main coronary artery and left circumflex artery were detected in 96 branches(41.1%), 78 branches(33.3%), 44 branches(18.8%), and 16 branches(6.8%), respectively.Unilateral coronary artery involvement was detected in 43 cases (36.8%), of which LAD was the dominant; while bilateral involvement was detected in 74 cases (63.2%), among which, LAD and RCA were the most involved arteries.Stratified by the degree of coronary involvement, large coronary aneurysms and severe coronary stenosis were most frequently occurred in the RCA and LAD.In contrast, 10 cases (13.6%), 20 cases (24.3%), 55 cases (45.8%) and 37 cases (67.3%) of intraluminal lesions were found in small, medium and large coronary aneurysms, and stenosis or occlusion, respectively.The incidence of intraluminal lesions tended to be higher in the site of severe lesions.CAG showed stenosis or occlusion in a total of 55 cases, and collateral circulation at varying degrees was found in cases of severe stenosis or occlusion.Conclusions:CAL in children with KD are complex and varied.Although clinical symptoms, routine electrocardiogram and cardiac ultrasound may indicate severe CAL.Their applications are limited by the diagnosis of the type (especially stenosis), degree, and extent of CAL, as well as the detection of extracoronary lesions.CAG is of great significance to identify vascular lesions and guide clinical management of KD combined with CAL in children.
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With the research and summary of the cases, the surgical indications, surgical procedures, and reference values for material selection for the surgical treatment of neonatal complex congenital heart disease are further refined, and the diagnosis and treatment system is further standardized and completed. In order to increase the success rate of surgery, reduce postoperative mortality and postoperative complications, many researchers have proposed improved surgical procedures, some of which have become mature technologies. In addition, in recent years, the surgical age of newborns has gradually advanced and the surgical weight has gradually decreased. In particular, the increasing application of Hybrid therapy has enabled some critically ill, premature, and low birth weight children to survive smoothly to accept surgical correction. This article will review the recent advances in the surgical treatment of neonatal complicated congenital heart disease.
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Objective:To explore and summarize the surgical strategies of biventricular conversion from single-ventricle palliation for the complex congenital heart defects in this study.Methods:From April 2017 to December 2019, a total of 14 cases with complex complex congenital heart defects who had planned to undergo single-ventricle palliation were finally accepted biventricular conversion. According to the development and anatomical characteristics of the ventricles, they were divided into two groups: ventricular well development group(9 cases), all of which showed complex intracardiac defects, and the ventricles well developed, including 4 cases of double outlet right ventricle with remote ventricular septal defect, 2 cases of transposition of great arteries combined with ventricular septal defect and left ventricular outflow tract obstruction, one case of congenitally corrected transposition of the great arteries combined with double outlet right ventricle and interrupted aortic arch, one case of double outlet right ventricle with subpulmonary ventricular septal defect and atrioventricular connection inconsistency, one case of pulmonary atresia with ventricular septal defect. Ventricular unbalanced development group(5 cases), all of which were functional single ventricle, including 3 cases of heterotaxy and 2 cases of unbalanced complete atrioventricular septal defect. The operation time, postoperative complications, death, cardiac function and reoperation of the two groups were compared.Results:There was one early death, with a mortality rate of 7.1%. In the ventricular well development group, the average waiting time for biventricular conversion was(56.4 ± 38.9) months. One case died after the operation. The early complications included 2 case of arrhythmias, 3 cases of pleural effusions and 2 cases of pulmonary infections. In the ventricular unbalanced development group, the average waiting time for biventricular conversion was(20.4 ± 15.8) months, and the average of left ventricular end-diastolic volume was(33.6 ± 2.1) ml/m 2. The early complications included 2 cases of low cardiac outputs, one case of arrhythmia and one case of renal failure. There was no significant difference in operation time, intubation time and ICU time between the two groups. The patients were followed up for 4 months to 3 years, and there was no death. In the ventricular well development group, one case was reoperated due to the obstruction of the anastomosis between the superior vena cava and the right atrial appendage. In the ventricular unbalanced development group, one case was implanted with a permanent pacemaker due to the degree Ⅲ atrioventricular block. The NYHA grade of the whole group was Ⅰ-Ⅱ. Conclusion:Whether the complex congenital heart defects with the ventricles well developed or unbalanced, the comprehensive evaluation before the planned single-ventricle palliation will be helpful to find the appropriate cases for biventricular conversion. According to its anatomical characteristics performed the corresponding biventricular conversion can obtain a satisfied clinical outcomes, although the long-term results still need further follow-up.
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Objective:To study the surgical results of Yasui procedure for interruption of aortic arch and ventricular septal defect(IAA/VSD) associated with aortic stenosis(AS) or aortic atresia(AA).Methods:A retrospective study was performed on all 4 children with IAA/VSD/AS(AA) that underwent a Yasui procedure from Dec 2014 to Dec 2019. Three patients had AS, and 1 patient had AA. The age was from 10 days to 25 months and the weight was from 2.7 kg to 10 kg. The type of IAA was type A in 1 and type B in 3. The diameter and Z value of the aortic annulus were 1.9-4.3 mm and -6.7--3.6. The diameter and Z value of the ascending aorta were 2.6-5.8 mm and -5.4--2.6. The mean Z value of LVEDD and LVEDS was 3.6±2.6 and 3.6±2.9 resparately.Results:All 4 patients survived after the Yasui procedure. Three patients underwent primary repair and 1 patient underwent staged repair. CPB time was 128-283 min and aortic cross-clamping time was 98-171 min. Ventilation time was 93-296 h, and ICU and hospital length of stay was 7-25 days and 18-39 days. Follow-up was complete in all patients from 8 to 92 months, and there was no late death. All the patients were in good biventricular function with NYHA grade Ⅰ in 3 and NYHA grade Ⅱ in 2 patients. No residual left ventricular outflow tract obstruction was detected.Conclusion:The Yasui procedure can be an option for patients with IAA/VSD/AS(AA) and good developed left ventricle and can achieve good early surgical results.
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Tetralogy of Fallot (TOF) is one the most common cyanotic congenital heart diseases. With the advancement of surgical techniques, most patients can achieve long term survival. However, they often encounter right ventricular dysfunction in the late course. Echocardiogram, one of the major techniques used in the postoperative follow-up, is assuming a growing role in the assessment of right ventricular function. Hereby, we reviewed the echocardiographic indices for right ventricular systolic function commonly used in the follow-up of TOF patients, so as to provide new insights into their treatment.
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Objective:To summarized the experience of 149 cases of critical pediatric cardiac surgery in a single-center during the epidemic period, for providing a safe and feasible management strategy.Methods:Based on the epidemiological characteristics of COVID-19, a strategy consisting of 14 days of isolation was established for the arrangement of cardiac surgery in children during the epidemic period. Retrospective analysis of clinical data of 149 cases of critical cardiac surgery performed from January 23, 2020 to March 20, 2020 under the guidance of this strategy. The primary composite endpoint was death and suspected or confirmed COVID-19.Results:The median age of the children undergoing surgery was 136 days; 73(49.0%) cases were male. Twenty-one cases (14.1%) came from Shanghai, one case (0.7%) came from Hubei Province, and 127 cases (85.2%) came from areas other than Hubei and Shanghai. One patient (0.7%) outside Shanghai who had been isolated for less than 14 days carried emergency surgery under special protection; other 148 patients (99.3%) underwent elective early repair procedure. One patient (0.7%) died, and no COVID-19 was confirmed or suspected.Conclusion:During the COVID-19 epidemic, pediatric cardiac surgery can be safely performed using a specific management strategy, which can be used as a reference when major public health events occur.
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Objective:To summarize cardiac function feature and its support method after ALCAPA(anomalous origin of left coronary arteries from pulmonary artery) operation. Analysis its early outcome and risk factors of its mortality.Methods:Review the clinical data of 108 ALCAPA cases treated in Shanghai Children Center between January 2005 and December 2017. All the cases were divided into two groups according to their ages when they received the surgery: group 1<1 yr; group 2>1yr. Adopted LVEF(left ventricle ejection fraction) and LVEDD(left ventricle end-diastolic diameter) Z-score as a parameter to describe the cardiac function change after operation. Summarize the selection and application of vasoactive agents and its score(VIS) after operation, indirectly reflect the post-operative cardiac function. Analysis the opportunityofinitiation and termination of mechanical circulation support and the timefor mechanical ventilationevacuation. Adopt the logistic analysis to find the risk factors of early death risk factors after ALCAPA operation. Results:Cardiac function had little improve in early period after ALCAPAoperation, did not attained normal range in fifth day post-operative, LVEF was 0.42 in group 1 and 0.45 in group 2, respectively. The application of vasoactive agents tended to choose α, β receptor-agonist, which epinephrine and norepinephrine is the preferred and VIS score was high in early period. Mechanical circulation support was used in 18 cases. 12 cases died in our group, mortality was 11%. Logistic regression analysis implied that low age and low level of LVEF before operation is the risk factor for mortality. Conclusion:Cardiac function was still in low level in early period after ALCAPA operation, depended on higher dosage of vasoactive agents and mechanical circulation support if necessary. We recommend the LVEF index for evacuated from mechanical circulation support and mechanical ventilation is over 0.40 and 0.35 respectively, and other clinical sign should be considered simultaneously. Low age and low LVEF level before operation is the risk factors for early death after ALCAPA operation.
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@#Objective To analyze the outcomes of complicated congenital heart diseases (CCHD) patients accepting multiple (>2) re-sternotomy operations. Methods We retrospectively analyzed the clinical data of 146 patients undergoing multiple cardiac re-sternotomy operations between 2015 and 2019 in our center. There were 95 males and 51 females with an age of 4.3 (3.1-6.8) years and a weight of 15.3 (13.4-19.0) kg at last operation. Results The top three cardiac malformations were pulmonary atresia (n=51, 34.9%), double outflow of right ventricle (n=36, 24.7%) and functional single ventricle (n=36, 24.7%). A total of 457 sternotomy procedures were performed, with 129 (88.3%) patients undergoing three times of operations and 17 (11.7%) patients undergoing more than three times. Fifty-two (35.6%) patients received bi-ventricular repair, 63 (43.1%) patients received Fontan-type procedures, and 31 (21.2%) patients underwent palliative procedures. Ten (6.8%) patients experienced major accidents during sternotomy, including 7 (4.8%) patients of urgent femoral artery and venous bypass. Eleven (7.5%) patients died with 10 (6.8%) deaths before discharge. The follow-up time was 20.0 (5.8-40.1) months, and 1 patient died during the follow-up. The number of operations was an independent risk factor for the death after operation. Conclusion Series operations of Fontan in functional single ventricle, repeated stenosis of pulmonary artery or conduit of right ventricular outflow tract post bi-ventricular repair are the major causes for the reoperation. Multiple operations are a huge challenge for CCHD treatment, which should be avoided.
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@#To evaluate the surgical strategy and follow-up for pulmonary atresia with intact ventricular septum (PA/IVS) in our heart center. Methods From January 2008 to December 2018, 151 patients with PA/IVS were divided into two groups: a one-stage surgery group (26 patients), including 17 males and 9 females at an average age of 14.7±13.2 months, and a staged surgery group (125 patients) including 72 males and 53 females at an average age of 6.4±6.3 months. The clinical effectiveness of the two groups were analyzed. Results All patients were followed up for 1-11 years. Eighteen patients died and 19 patients were lost to follow-up. The 1-year, 5-year and 10-year survival rate was 90.2%, 87.0%, and 85.2%, respectively. Two patients died in the one-stage surgery group. Twelve patients died after initial surgery, and 4 patients died after final operation in the staged surgery group. The Z value of tricuspid valve (P=0.013) and severe right ventricular dysplasia (P=0.025) were the risk factors of postoperative death in the patients with PA/IVS. Furthermore, 58 patients completed final operation, and the total number of the final operation (including one-stage radical surgery) accounted for 55.6% (84/151). Five patients accepted the re-operation intervention in the medium-term follow-up. The rest of the patients recovered well. Only 2 patients were classified as grade Ⅲ in cardiac function, and the rest patients were classified as gradeⅠ-Ⅱ. Conclusion According to the degree of right ventricular hypoplasia, the age at operation and the presence or absence of coronary artery malformation, the individualized surgical strategy could significantly improve the success rate of PA/IVS, and early completion of right ventricular decompression operation is conducive to improve the chance for biventricular repair.
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@#Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare congenital heart disease with high mortality. Due to the complexity and diversity of pathological anatomy, there is no uniform standard for the optimal surgical scheme of PA/IVS. In order to further standardize the surgical treatment strategy of PA/IVS, this expert consensus will focus on the evaluation of right ventricular anatomy and function, operation timing, operation mode and prognosis of PA/IVS. Through the synthesis of many domestic treatment experience, the Chinese expert consensus on PA/IVS surgical treatment has been finally formed.
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Objective To discuss the surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA) and the risk factors of postoperative recovery in infants and children.Methods A retrospective review of all patients who underwent surgical treatment of ALCAPA in Shanghai Children Medical Center(2003.1-2018.1) was conducted.Patients were divided into early surgery group (2003.1-2012.12) and late surgery group (2013.1-2018.1) according to the operation time,a preoperative left ventricular ejection fraction(LVEF) ＜0.35 was defined as severe group and LVEF≥0.35 as the control group in both surgery group.Meantime,and the clinical data among the groups were analyzed and compared.Results 102 patients were included in our study.According to the operation time and preoperative LVEF grouping:10 cases in the early severe group,early death in 4 cases(40％);28 cases in the early control group,and 3 cases died(10.7％)in hospital.Preoperative LVEF(0.29 ± 0.06 vs.0.53 ± 0.12),surgical age [(8.0 ± 7.9) months vs.(23.3 ± 27.7)months],and cardiopulmonary bypass time [(131.1 ± 39.6) min vs.(103.8 ± 29.8) min] were statistically different between the early two groups.The results of the late surgery had been improved:24 cases in the late severe group,4 cases died in hospital(16.7％);40 cases in the late control group,and early death in 2 cases (5％).In the late surgery groups,there was a statistically significant difference in preoperative LVEF(0.28 ±0.05 vs.0.59 ±0.12),left ventricular end-diastolic diameter(LVDD) Z-score(3.09 ±1.16 vs.2.11 ±0.95),and surgical age [(5.3 ±3.0) months vs.(24.8 ±30.5)months],clamping time [(67.1 ± 15.5) min vs.(82.7 ± 28.4) min].In the severe group,there was no significant difference in preoperative clinical data between early and late patients,and the early mortality decreased from 40％ in the early period to 16.7％ in the late period.In this study,13 cases(38.2％) of children with severe ALCAPA underwent mechanical circulation support(MCS).One patient died during MCS support and 2 died after weaning.Conclusion The early mortality severe ALCAPA remains high,which may be related to severe cardiac ischemia,left ventricular enlargement and age at surgical time.The modify of surgery technology and the use of MCS in the early clinical stage can improve the early survival rate.
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Objective@#The purpose of this report was to discuss and evaluate the timing and outcome of reintervention for children with postoperative valve disease.@*Methods@#The clinical data of 139 patients with postoperative valve disease who received reintervention at SCMC from Sep. 2004 to Mar. 2019 were retrospectively analysed, including 85 males and 54 females. The age ranged from 8-175 months, and the weight ranged from 6.2-75.9 kg. With a mid-long term follow-up (2-133 months), the echocardiography result showed: 40 cases of aortic valve disease, 49 cases of mitral valve disease, 32 cases of tricuspid valve disease and 18 cases of pulmonary valve disease. All patients underwent reintervetion treatment, the distribution of reintervention methods were shown as follow: 47 cases of valve replacement, 40 cases of valvuloplasty, 23 cases of annuloplasty and 29 case of valve reconstruction.@*Results@#There were 6 in-hospital deaths with a mortality of 4.3%. The death cases included 2 cases of aortic disease, 2 cases of mitral disease, 1 case of tricuspid disease and 1 case of pulmonary disease. The early postoperative causes of death were acute myocardial failure, multiple organ failure and severe hyoxemia. Three delayed deaths occurred 8-26 months after operation because of cardiac insufficiency and cardiac shock. All survivors were under a follow-up of 4-148 months. The echocardiography showed the velocity of 92.3% valve stenosis patients had decreased significantly (P<0.05); the insufficient grades of 84.9% patients had reduced and maintained under morderate degree. 6 cases occurred aggravated insufficiency or stenosis and received reoperation in mid-term follow-up included 3 cases of aortic valve, 2 cases of pulmonary valve and 1 case of mitral valve. The cardiac function of survival patients has been improved after reintervtion, 83.1% patients maintained cardiac function at NYHA Ⅰ/Ⅱ at follow-up. The long-term survival rates of 4 valve disease were all over 90%.@*Conclusion@#The anatomical structure of chilidren’s valve is complicated and various, valve insufficiency and stenosis often occured after operation. The timing of reintervetion should focus on clinic symptom and cardiac function.The operation should be individually designed according to valve anatomy, which could effectly correct abnormal valve structure, promote cardiac function and improve living quality.
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Objective The purpose of this report was to discuss and evaluate the timing and outcome of reintervention for children with postoperative valve disease.Methods The clinical data of 139 patients with postoperative valve disease who received reintervention at SCMC from Sep.2004 to Mar.2019 were retrospectively analysed,including 85 males and 54 females.The age ranged from 8-175 months,and the weight ranged from 6.2-75.9 kg.With a mid-long term follow-up (2-133 months),the echocardiography result showed:40 cases of aortic valve disease,49 cases of mitral valve disease,32 cases of tricuspid valve disease and 18 cases of pulmonary valve disease.All patients underwent reintervetion treatment,the distribution of reintervention methods were shown as follow:47 cases of valve replacement,40 cases of valvuloplasty,23 cases of annuloplasty and 29 case of valve reconstuction.Results There were 6 in-hospital deaths with a mortality of 4.3％.The death cases included 2 cases of aortic disease,2 cases of mitral disease,1 case of tricuspid disease and 1 case of pulmonary disease.The early postoperative causes of death were acute myocardial failure,multiple organ failure and severe hyoxemia.Three delayed deaths occurred 8-26 months after operation because of cardiac insufficiency and cardiac shock.All survivors were under a follow-up of 4-148 months.The echocardiography showed the velocity of 92.3％ valve stenosis patients had decreased significantly (P ＜0.05);the insufficient grades of 84.9％ patients had reduced and maintained under morderate degree.6 cases occurred aggravated insufficiency or stenosis and received reoperation in mid-term follow-up included 3 cases of aortic valve,2 cases of pulmonary valve and 1 case of mitral valve.The cardiac function of survival patients has been improved after reintervtion,83.1％ patients maintained cardiac function at NYHA Ⅰ / Ⅱ at follow-up.The long-term survival rates of 4 valve disease were all over 90％.Conclusion The anatomical structure of chilidren's valve is complicated and various,valve insufficiency and stenosis often occured after operation.The timing of reintervetion should focus on clinic symptom and cardiac function.The operation should be individually designed according to valve anatomy,which could effectly correct abnormal valve structure,promote cardiac function and improve living quality.
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Objective The purpose of this report is to summarize and evaluate the clinical effect and experience of re-intervention for children with pulmonary venous restenosis.Methods The clinical data of 53 patients with pulmonary venous restenosis who received reintervention at SCMC from September 2009 to January 2018 were retrospectively analysed, including 34 males and 19 females with mean age of(15.1 ±13.2)months(2-77 months) and mean weight of(7.9 ±3.3)kg(3.7 -17.3 kg).The mean preoperative pulmonary venous velocity was(2.28 ±0.40)m/s(1.89 -3.07 m/s).Primary disease in-cluded 43 cases of total anomalous of pulmonary venous drainage(14 supracardiac type, 20 infracardiac type, 2 intracardiac type and 7 mix type), 8 cases of partial anomalous of pulmonary venous drainage and 2 cases of primary pulmonary venous ste-nosis.The distribution of reintervention methods were shown as follow:34 cases of sutureless technique(21 cases with pedicle pericardium and 13 cases with left auricle tissue), 10 cases of bovine pericardium enlargement, 5 cases of blunt enlargement, 3 cases of balloon dilatation and 1 case of stent implantation.Results The early postoperative pulmonary venous velocity was (1.12 ±0.23) m/s.There were 4 in-hospital deaths with a mortality of 7.5％.49 survivors were under a follow-up of 3-98 months.The echocardiography showed pulmonary venous anastomosis and diameter have grown after reintervetion with a mean growth speed of(0.022 ±0.014)cm/month(P<0.05) and a mean velocity of(1.25 ±0.28)m/s;4 patients occured varying degrees of pulmonary venous obstruction( >1.6 m/s) but no one need reoperation at present.More than 90％ patients exhibi-ted an improvement of NYHA functional class from Ⅲ or Ⅳ preoperatively to Ⅰ or Ⅱ at follow-up.Conclusion Pulmonary venous restenosis is a common complication after primary pulmonary malformations operation .The reintervetion should be per-formed in early period of pulmonary venous obstruction .Pulmonary venous anastomoses after sutureless technique , bovine peri-cardium enlargement and blunt enlargement have grown obviously; although balloon dilatation has a good effect at early period of postoperation, it also has a high restenosis rate and needs a strict mid-and long-term follow-up.
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Objective To investigate the early curative effect of Blalock-Taussig(B-T) shunt and summarize the key point in its post-operative intensive care,analyze the related risk factor of its mortality.Methods We collected 71 patients who received B-T shunt in Shanghai Children's Medical Center from June 2015 to June 2017. All of 71 cases were divided into neonates group (25 cases) and non-neonate group (46 cases). All patients were operated through median sternotomy,19 were emergency cases,in which 15 cases were neonates. Eight cases used cardio-pulmonary bypass in our study,in which 4 cases were neonates. Twenty-nine cases received ductus ligation in total 34 patients with patent ductus arterious. Percutaneous heparin was immediately administered after operation as an anticoagulation therapy. Relative large dosage inotropic agents was used after sufficient volume infusion in order to guarantee diastolic pressure higher than 35 mmHg(in neo-nates >30 mmHg,1 mmHg =0. 133 kPa). Ventilator parameter was adjusted to obtain appropriate flow distribu-tion between pulmonary and systemic circulation. In order to avoid excessive pulmonary flow,the target PO2 was set between 40 ～ 45 mmHg. Results Oxygen saturation elevated by 15％ after operation in all 71 cases. Average mechanical ventilation time was 92 hours,mean inotropic agents score was 17. There were 6 dead cases,mortality was 8. 5％ . In neonates,4 cases dead,mortality was 16. 0％ . There was no significant difference in ventilation time,ICU retention day and mortality between neonates group and non-neonates group. The logis-tic regression analysis showed that the body weight and ratio between the shunt conduit diameter and body weight (mm/ kg) were the risk factors for early post-operative mortality[body weight:2500 ～ 3500 g:OR =6. 729,95％ CI =1. 373 ～17. 131;≤2500 g:OR = 7. 832,95％ CI = 2. 563 ～ 28. 325. the ratio between the shunt conduit diameter and body weight (mm/ kg):1. 10 ～1. 15:OR = 4. 204,95％ CI = 1. 195 ～ 23. 926;≥1. 15:OR= 3. 981,95％ CI =1. 195 ～12. 926]. Conclusion B-T shunt is still a high risk operation although it is a palli-ative method. Low body weight and bigger diameter conduit are the significant factors related to its mortality. Strict control of the systemic and pulmonary flow ratio is the key point in the post-operation intensive care.
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Objective To analyze the influencing factors of surgical management for Blalock-Taussig shunt during neonatal period,and to summarize the clinical experience,therefore,to improve the surgical outcome.Methods The clinical data between Jan 2011 and Dec 2016 were reviewed,42 neonates(26 males,16 females)with the mean age from 1 to 29 days,and weight from 2.3 to 4.1 kg,underwent a Blalock-Taussig shunt.The additional operation included PDA retention in 3 patients,right ventricular outflow tract retention in 12 patients,B-T conduit banding in 2 patients and PDA banding in 1 patient.Results The early mortality was 28.6％ (12/42).Univariate analysis revealed low birth weight,waiting time for surgery,preoperative acidosis or cardiac shock,dual pulmonary blood supply,conduit/weight,high IS (inotropic drugs score),unplanned intervention as risk factors for early death.In the multivariate analysis,preoperative acidosis or cardiac shock,conduit/weight,high IS were independent risk factors of early death.Conclusion The mortality rate after the neonatal modified Blalock-Taussig shunt remains high.It can be improved by proper perioperative treatment,immediate surgical treatment and choose suitable conduit size,maintain the stable circulation.
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Objective To discuss the methods and experience of using short term left ventricular assist devices (LVADs) in patients after congenital heart disease(CHD) corrective surgery.Methods This study included 17 postoperative cases using short term LVAD support.The device used was a Maquet Rotaflow system, and the clinical patient data was collected and eval-uated retrospectively.Results The 17 patients were divided into two groups by the clinical outcome as follows: 6 cases in the early death group(Group D) and 11 cases in the survival group(Group S).The pre-support time[(9.00 ±9.95)h vs. (23.83 ±13.23)h, P＝0.042]and the lactate level values[(4.01 ±2.15)mmol/L vs.(9.30 ±4.90)mmol/L, P＝0.045] were significantly lower and more favorable in Group S.Patients in Group S also received a longer support time than patients in Group D.Conclusion Using the Maquet Rotaflow system is generally safe and efficient, when used as a short term LVAD in postoperative pediatric patients.The selection of patients, the timing of support, and reasonable management were the keys to patient survival.
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Objective To summarize 566 consecutive cases of Fontan operation in the treatments of complex congenital heart diseases and to analyze the risk factors of early surgical outcome.Methods We reviewed all 566 consecutive patients who underwent a Fontan procedure in Shanghai Children's Medical Center from January 2006 to May 2014.Preoperative records of staged surgeries,perioperative data and imaging results were obtained from medical records.Results A total of 566 patients(M/F =345/221) underwent a Fontan operation,with 166 cases of single stage Fontan operation and 400 cases of multi-staged operation.The median age at the time of the Fontan procedure was 5 years,and the median weight was 15.4 kg.In our series,there were 278 extracardiac conduits,110 intracardiac conduits,114 lateral tunnels,36 intracardiac/extracardiac conduits,and 27 direct cavopulmonary conduits.There were 36 cases of early Fontan failure,with overall early postoperative survival rate being 93.6％.The median ventilation duration was 8 h,with the median postoperative intensive care unit stay being four days,the average oxygen saturation being 0.90 at the end of ICU stay,the median chest drainage time being 10 days,and the median postoperative hospital stay being 19 days.Besides the CICU oxygen saturation,the rest postoperative results had no obvious differences in five surgical groups.Heterotaxy syndrome,earlier age at the time of the Fontan procedure,bilateral Glenn shunt,moderate AV valve regurgitation and severe and right ventricular-type morphology were risk factors of early Fontan failure,P ＜ 0.05.Conclusion In order to improve the early outcome of Fontan operation,closely follow-up should be taken directly after Glenn operation in high-risk patients.Doctors should also have an in-depth understanding of the of postFontan physiological and pathological features,and select the operation time and Fontan type most suited to the of the individualized characteristics.
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Objective To explore risk factors of cardiac surgery in neonates with low body weight.Methods Retrospective analysis was made in neonates weighing less than 3 kg at surgery(n =192;group 1) and 3 to 6 kg(n =517;group 2),who had undergone open cardiac repairs from January 2006 to December 2015 at our institution.Patients were grouped according to the primary procedure performed and analyzed according to their weight at the time of surgical intervention.Patients were also analyzed according to preoperative risk scores.Univariate versus multivariate risk analysis was performed.Results Hospital early mortality in group 1 was 25.0％ (n =48) versus 14.5 ％ (n =75) in group 2 (P =0.001).Compared with group 2,neonates in group 1 had a significantly higher mortality for simple arterial switch procedure.Lower body weight remained strongly associated with mortality risk after stratifying the population by preoperative risk scores category levels 2.Within group 1,age,weight at surgery,preoperative risk score and type of procedure were not associated with significant differences in early mortality.Cardio-pulmonary bypass time,aortic cross-clamp time and the presence of a surgical complication were independent risk factors for early mortality in group 1.Conclusion Among neonates weighing less than 3.0kg who underwent open cardiac surgery,perioperative hemodynamic status,reflected by bypass time,cross-clamp time,and surgical complications,strongly influenced early mortality.In contrast,low body weight itself was not associated with early mortality.