Objective To evaluate early results of valved bovine jugular vein patch for reconstruction of the right ventricular outflow tract （RVOT）.?Methods From May 2009 to March 2010， a total of 60 patients with complex congenital heart diseases underwent reconstruction of RVOT with valved bovine jugular vein patch in Wuhan Asia Heart Hospital. There were 42 males and 18 females with their mean age of 6.2±8.9 years （ranging from 5 months to 33 years） and mean body weight of 27.5±24.0 kg， and 34 patients were less than 1 year. Preoperative clinical diagnosis included tetralogy of Fallot （n=38） and double outlet of right ventricle with pulmonary stenosis （n=22）. All the patients underwent one-stage surgical repair. Before operation， 4 patients underwent catheter intervention for their major aortopulmonary collaterals. The diameters of pulmonary arterial ring of all the patients were 2 standard deviation less than normal range， and trans-annular patch was chosen for RVOT reconstruction. All the patients were postoperatively followed up for 18 to 26 months （mean 21.2±4.6 months）.?Results There was no in-hospital death. And no second surgical intervention was needed for conspicuous RVOT stenosis or pulmonary regurgitation. Three patients needed reintubation for lung edema after extubation as a result of major aortopulmonary collaterals. Four patients underwent reexploration for postoperative bleeding. And all the other patients were discharged uneventfully. Mean cardiopulmonary bypass time was 84.0±22.0 min， and mean aortic cross-clamping time was 42.0±12.0 min. Mean RVOT gradient right after surgery was 18.0±4.5 mm Hg， which was not statistically different from mean RVOT gradient of 19.2±5.4 mm Hg measured by transthoracic echocardiography at their last postoperative follow-up（P＞0.05）. The degree of pulmonary regurgitation right after surgery was trivial in 32 patients（1＋）， mild in 28 patients（2＋）， which were not statistically different from the degree of pulmonary regurgitation at their last postoperative follow-up: trivial in 28 patients （1＋）， mild in 27 patients（2＋）， and moderate in 5 patients（3＋）. Calcification was not observed on the valved bovine jugular vein patch and valve cusp， and the valve cusp motioned well. No thrombosis or endocarditis was observed on the valved bovine jugular vein.?Conclusions For patients with tetralogy of Fallot or double outlet of right ventricle （DORV） and pulmonary stenosis， valved bovine jugular vein patch is a good choice for trans-annular reconstruction of RVOT. There is no severe postoperative complication related to bovine jugular vein， the RVOT pressure gradient does not increase significantly， and anti-regurgitation result is satisfactory in short-term follow-up. Further follow-up is required to evaluate its long-term outcome.
ObjectiveTo summarize the experience and lessons of right ventricular decompression in children with pulmonary atresia and intact ventricular septum (PA/IVS) and to reflect on the strategies of right ventricular decompression.MethodsThe clinical data of 12 children with PA/IVS who underwent right ventricular decompression in our hospital from March 2015 to December 2019 were reviewed retrospectively. There were 10 males and 2 females with a median age at the time of surgery was 5 d (range, 1-627 d). Correlation analysis between the pulmonary valve transvalvular pressure gradient and changes in Z score of tricuspid valves after decompression was performed.ResultsOne patient died of refractory hypoxemia due to circulatory shunt postoperatively and family members gave up treatment. There were 2 (16.67%) patients received postoperative intervention. The pulmonary transvalvular gradient after decompression was 31.95±21.75 mm Hg. Mild pulmonary regurgitation was found in 7 patients, moderate in 2 patients, and massive in 1 patient. The median time of mechanical ventilation was 30.50 h (range, 6.00-270.50 h), and the average duration of ICU stay was 164.06±87.74 h. The average postoperative follow-up time was 354.82±331.37 d. At the last follow-up, the average Z score of tricuspid valves was 1.32±0.71, the median pressure gradient between right ventricle and main pulmonary artery was 41.75 mm Hg (range, 21-146 mm Hg) and the average percutaneous oxygen saturation was 92.78%±3.73%. Two children underwent percutaneous balloon pulmonary valvoplasty at 6 and 10 months after surgery, respectively, with the rate of reintervention-free of 81.8%. There was no significant correlation between pulmonary transvalvular gradients after decompression and changes in Z score of tricuspid valves (r=–0.506, P=0.201).ConclusionFor children with PA/IVS, the simple pursuit of adequate decompression during right ventricular decompression may lead to severe pulmonary dysfunction, increase the risk of ineffective circular shunt, and induce refractory hypoxemia. The staged decompression can ensure the safety and effectiveness for initial surgery and reduce the risk of postoperative death.
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.
Heart diseases seriously threaten people's health. More and more functional evaluation of cardiac right ventricle has been considered in the clinical diagnosis in addition to the classical functional evaluation of cardiac left ventricle. It is very important to evaluate the functional parameters of right ventricle in clinical heart disease diagnosis, especially when the ejection fraction of left ventricle is very low. Right ventricular segmentation is needed for the functional evaluation. However, right ventricular segmentation has been difficult due to its thin myocardium, complex structure and significant individual variability. Cine cardiac magnetic resonance image is a golden standard in clinical functional evaluation of cardiac ventricle. In the present paper, we summarize the classic segmentation approaches, evaluation methods and their development, which can help the researchers in the related field have a quick and basic understanding to the right ventricle segmentation.
ObjectiveTo evaluate the clinical value of three-dimensional (3D) printing model in accurate and minimally invasive treatment of double outlet right ventricle (DORV).MethodsFrom August 2018 to August 2019, 35 patients (22 males and 13 females) with DORV aged from 5 months to 17 years were included in the study. Their mean weight was 21.35±8.48 kg. Ten patients who received operations guided by 3D printing model were allocated to a 3D printing model group, and the other 25 patients who received operations without guidance by 3D printing model were allocated to a non-3D printing model group. Preoperative transthoracic echocardiography and CT angiography were performed to observe the location and diameter of ventricular septal defect (VSD), and to confirm the relationship between VSD and double arteries.ResultsThe McGoon index of patients in the 3D printing model group was 1.91±0.70. There was no statistical difference in the size of VSD (13.20±4.57 mm vs. 13.40±5.04 mm, t=−0.612, P=0.555), diameter of the ascending aorta (17.10±2.92 mm vs. 16.90±3.51 mm, t=0.514, P=0.619) or diameter of pulmonary trunk (12.50±5.23 mm vs. 12.90±4.63 mm, t=−1.246, P=0.244) between CT and 3D printing model measurements. The Pearson correlation coefficients were 0.982, 0.943 and 0.975, respectively. The operation time, endotracheal intubation time, ICU stay time and hospital stay time in the 3D printing model group were all shorter than those in the non-3D printing model group (P<0.05).ConclusionThe relationship between VSD and aorta and pulmonary artery can be observed from a 3D perspective by 3D printing technology, which can guide the preoperative surgical plans, assist physicians to make reasonable and effective decisions, shorten intraoperative exploration time and operation time, and decrease the surgery-related risks.
Objective To investigate the surgical indications and the mid and long term results of morphologic tricuspid valve replacement for corrected transposition of the great arteries（cTGA）. Methods From September 1997 to September 2007, 18 cases with cTGA were treated in Fu Wai Hospital. There were 15 male and 3 female, aged from 16 to 51 years（33.3±12.8 years）, and weighed from 47 to 90 kg(60.9±14.7 kg). There were 10 cases with isolated morphologic tricuspid valve insufficiency, 3 complicated with ventricular septal defect, 2 complicated with ventricular septal defect and pulmonary valve stenosis, 2 with morphologic tricuspid valve insufficiency after septal defect repair, and 1 with mechanical valve dysfunction after morphologic tricuspid valve replacement. The preoperative mean morphologic right ventricle ejection fraction was 562%±11.6%. Of the 18 cases, 12 were in grade Ⅱ and 6 were in grade Ⅲ according to New York Heart classification（NYHA）.All the cases had undergone morphologic tricuspid valve replacement. Postoperative indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results One patient died of postoperative low cardiac output syndrome. Two had pervavlvular leak, which were cured by pervavlvular leak repair at 7th and 30th day after operation, respectively. Sixteen were followed up with a followup time of 57.0±407 months. There was no statistical significance between preoperative and postoperative mean morphologic right ventricle ejection fraction（52.8%±9.2% vs.56.2%±11.6%; t=2.062, Pgt;0.05）. The followup showed that 12 were in NYHA grade Ⅰ or Ⅱ, and 4 were in NYHA grade Ⅲ. There was no statistical significance between preoperative and postoperative percentage of cases in NYHA grade Ⅲ（χ2=1.532，Pgt;0.05）. Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function caused by morphologic tricuspid valve insufficiency. The mid and long term results were satisfying. During the followup, the morphologic right ventricle can function appropriately.