At present, the operative results of complex congenital heart disease are suboptimal which is closely correlated to the understanding of the anatomy and function of complex congenital heart disease, and operative techniques. With the further understanding to pathology and physiology of congenital heart disease, strategies and techniques in well-known operations and complex procedures have developed in recent years. Currently, designing and applying individual operative method in terms of patient’s characteristics of anatomy and physiology is very important trend. This article reviewed the advances of knowledgement and techniques in some representive complex congenital heart disease including complete atrioventricular septal defect, unifocalization for major aortopulmonary collateral arteries, transopsition of the great artery and Fontan type operation.
Bidirectional superior cavopulmonary anastomosis(BCPA)is a palliative method used in the single ventricular repair. It mainly includes bidirectional Glenn shunt and hemi-Fontan operation. The indications of BCPA are those as an intermediate option of total cavopulmonary anastomosis, partial biventricular or 1 1/2 ventricle repair and a practical approach to complex congenital heart surgery. The choise of age,influence on pulmonary artery maturation,remain of additional pulmonary flow,formation of collaters and time to Fontan are demand of study.
Abstract:The use of pulmonary autograft was first reported in 1967 by Ross for the treatment of aortic valve disease in adults. Since that time, Ross procedure has been applied to a variety of forms of aortic stenosis and left ventricular outflow tract obstruction and mitral valve disease, Ross procedure has undergone several modifications, such as the root replacement method, inclusion cylinder technique, annular reduction, Konno root enlargement procedures and replacement of the mitral valve with a pulmonary autograft （Ross-Kabbani procedure or Ross Ⅱ procedure）. Advantages of Ross procedure in women of childbearing age, children and young adults include freedom from anticoagulation, appropriate sizing, cellular viability with growth potential proportional to somatic growth, acceptable long-term durability, excellent hemodynamic performance and decreased susceptibility to endocarditis. Surgical technical aspects, indications, selection criteria for the Ross procedure and its modifications, their applicability in the surgical management of aortic stenosis, left ventricular outflow tract obstruction and mitral valve disease and clinical outcome of Ross procedure are reviewed in this article.