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Open heart operation on neonates with critical congenital heart disease 推荐 CAJ下载 PDF

Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.

Congenital Heart Disease: Evaluation with Three Dimensional 64Multidetector Computed Tomography

目的:评价先天性心脏病（CHD）不同病变类型在64层螺旋CT（64-MDCT）三维重建图像上的表现及显示效果。方法:回顾性分析36例CHD患者的64-MDCT资料,分别在轴位、冠状、矢状位及容积再现（VR）重组图像上观察病变,统计分析不同重组图像显示总体病变及房、室间隔缺损效果有无差异。结果:36例患者共有病变59处,轴位、冠状及矢状位图像在发现病变（59处,100.0%；57处,96.6%；53处,89.8%）及室间隔缺损显示（显示效果评分:41、38及39分）方面无明显差异（P＞0.05）,但轴位图像显示房间隔缺损明显优于冠、矢状位图像（显示效果评分:19、13及12分）（P＜0.05）。VR图像与轴位及冠、矢状位图像显示心外大血管病变效果无差异P＞0.05）。不同类型病变在轴位,冠、矢状位及VR图像上表现特征不尽相同,而不同重组图像有各自优势显示的病变类型。结论:64-DCT三维重建图像能够很好地显示先心病各种类型病变,了解不同重建图像上病变表现特征及显示效果有利于做出准确、全面的诊断。

经胸微创膜部室间隔缺损封堵术围术期炎症因子的变化

上腔静脉右肺动脉分流术治疗三尖瓣闭锁

目的 总结上腔静脉右肺动脉分流术治疗三尖瓣闭锁(TA)的临床经验。 方法 2004年10月至2008年4月，采用上腔静脉右肺动脉分流术治疗TA 10例，男8例，女2例 ；年龄2～13岁，平均年龄5.6岁；体重10.0～33.5 kg，平均体重16.4 kg。TA合并大动脉错位(右位心)2例，房室间隔缺损3例，永存左上腔静脉1例。均在常温非体外循环下手术，切断上腔静脉，近端缝合，远端与右肺动脉做端侧吻合；1例合并永存左上腔静脉患者行双侧上腔静脉肺动脉吻合术。 结果 全组无死亡患者，术后末梢血氧饱和度由74%±9%上升至92%±5%。所有患者紫绀明显减轻，顺利出院。随访10例，分别随访6~36个月，血氧饱和度86%±3%，活动能力明显改善。 结论 上腔静脉右肺动脉分流术治疗TA效果满意，是比较理想的术式。

十字交叉心的外科治疗

目的 总结4例十字交叉心外科治疗的临床经验，以提高对该病的认识。 方法 2004年3月~2008年1月手术治疗4例十字交叉心患者（平均年龄3.2岁；平均体重10.9 kg）。1例采用心内隧道修补术（intravetricular tunnel rapair IVR），1例采用双向Glenn手术，1例采用双侧双向Glenn术，1例采用IVR+大动脉转位术（arterial switch operation， ASO）。 结果 住院死亡1例，为采用IVR者，死于低心排血量综合征。2例行双向Glenn手术患者术后随访6~12个月，生长发育良好，SpO2 88%左右；1例行IVR+ ASO者，随访6个月，心脏较术前略缩小，生长发育良好。结论 十字交叉心病理解剖复杂，必须根据不同的解剖特点选择不同的手术方法，明确的术前诊断是优化手术方式的先决条件。

先天性心脏病心脏不停跳心内直视手术

摘要 目的　介绍体外循环心脏不停跳下心内直视手术治疗先天性心脏病心内畸形的应用体会。　方法　327例先天性心脏病心内畸形行浅低温体外循环心脏不停跳心内直视手术。常规建立体外循环，置左心房引流管，降温至32±1℃并维持，仅阻断上、下腔静脉，不阻断升主动脉，维持灌注压在60mmHg左右，在心脏不停跳下施行心脏畸形矫正术，方法同心脏停搏手术。　结果　死亡7例，死亡率2.1%，其余均痊愈出院，随访1～13个月，恢复良好。　结论　心脏不停跳下心内直视手术有较好的心肌保护作用，能减少并发症的发生，并简化操作，缩短体外循环时间。

同种带瓣大动脉重建右心室流出道

摘要目的 应用自行采集和冷冻保存的同种带瓣大动脉(VHC)完成先天性心脏病右心室流出道的重建，并观察其疗效及存在的问题。方法 用VHC材料治疗先天性心脏病95例，90例手术根治，5例行VHC右心室流出道与肺动脉连接姑息手术。结果 院内死亡13例；术后随访68例，死亡2例，均为感染。66例长期生存者中25例胸部X线片示VHC有钙化，多为主动脉材料，仅5例有轻中度压力阶差(35～60mmHg)。结论 VHC可广泛用于治疗复杂先天性心脏病。程序降温、超低温保存和两步化冻是VHC使用质量的保证。VHC的长期通畅比合成管道好，随植入时间延长钙化率增加，肺动脉VHC优于主动脉。有肺动脉高压者宜尽早手术。为了预防VHC植入后感染，应重视、改进其收集和保存的方法。

Minimally invasive techniques for treatment of special cardiac malformations

ObjectiveTo share the experience of treating special cardiac malformations by applying minimally invasive techniques.MethodsEight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge.ResultsEight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory.ConclusionThe application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.

Application of Systemic-Normothermic/Cardiac-hypothermic Cardiopulmonary Bypass on Surgery of Congenital Heart Disease

Objective To investigate the value of systemic-normothermic/cardiac-hypothermic cardiopulmonary bypass（CPB）on operation of congenital heart disease. Methods Thirty patients of congenital heart disease were randomly divided into two groups, the normothermia group（n=15）and hypothermia group（n=15）. The changes of CPB time, aortic cross-clamp time,operation time and postoperative drainage and the value of blood cell were observed. Results The duration of CPB （37. 5 ±11. 6rain vs. 51. 6± 12. 0 min, P〈0. 05） and operation time （2.2± 0.6h vs. 2. 7±0. 5h, P〈0. 01） in normothermia group were shorter than those of hypothermia group statistically, the differences of postoperative drainage and the value of blood cells between two groups were not statistically significant. Conclusion The use of systemic-normothermic/cardiac-hypothermic CPB on operation of congenital heart disease shows that the time of operation is shorter remarkly , and it could be clinically used safely.

Minimally Invasive Direct Cardiac Surgery for Elderly Patients with Heart Disease

ObjectiveTo summary the safety and efficiency of the minimally invasive direct cardiac surgery (MIDCS) approach in elderly patients with heart disease. MethodsWe retrospectively analyzed the clinical data of 60 patients underwent MIDCS in Beijng Anzhen Hospital between April 2010 and January 2013. There were 34 males and 26 females with mean age of 66.4±4.8 years and mean weight of 66.1±10.6 kg. ResultsMean cardiopulmonary bypass time and aortic cross-clamp time was 141.2±57.2 minutes and 99.8±37.6 minutes respectively. A total of 37 patients (90.2%) recovered to beat automatically after heart ceased operation. Median mechanical ventilation time was 17.1±9.1 hours. Mean intensive care unit stay was 22.1±12.2 hours. Mean post operative hospital stay was 7.0±2.5 days. Mean incision length was 5.3±0.9 cm. Mean pericardial draining volume was 466.6±412.1 ml in the first day after operation. No transfusion occurred in 27 (45.0%) patients. Early postoperative mortality was 3.3% (2/60). There were 2 patients of reexplorations for bleeding, 1 patient of the twice tracheal intubation, 1 patient of cardiac arrest after operation, 2 patients of poor healing of skin incision, and 1 patient of injury of right phrenic nerve. When leaving hospital, 47 patients were in heart functional class Ⅰ, 8 patients in class Ⅱ, and 3 patients in class Ⅲ. ConclusionMIDCS is associated with good operative effect in the near future with superior safety and broad application range in elderly patients with heart disease.