Abstract： Objective To summarize our experience of surgical treatment for anomalous origin of one pulmonary artery in infants and children. Methods From March 2005 to May 2010，11 patients with anomalous origin of one pulmonary artery and other concomitant congenital cardiovascular malformations underwent surgical repair in Xijing Hospital of Fourth Military Medical University．The mean age of the patients was 11.5 months with a range from 2 months to 36 months．Their mean body weight was 7.1 kg with a range from 4 to 13 kg. Seven patients had anomalous origin of the right pulmonary artery from the ascending aorta, and four patients had anomalous origin of the left pulmonary artery from the ascending aorta. All the eleven patients had other concomitant intracardiac anomalies or vascular malformations as well as pulmonary hypertension, and underwent one stage surgical repair via median sternotomy under hypothermia and cardiopulmonary bypass. Results Their operation time was 169 - 293 （231±55） min, cardiopulmonary bypass time was 87-210 （138±47） min, and aortic-clamping time was 45-133 （86±28） min. There was one postoperative death who had low cardiac output syndrome after repair for tetralogy of Fallot and anomalous origin of the right pulmonary artery. The overall postoperative mortality was 9.1％. Postoperative echocardiography of all the surviving patients showed their left and right pulmonary artery origined from the right ventricle and pulmonary artery with satisfactory malformation correction but no residual shunt and pulmonary stenosis . All the surviving ten patients were followed up with a follow-up rate of 100% and mean follow-up time of 13.5 months with a range from 3 to 32 months. Their echocardiography during follow-up showed that there was no pulmonary stenosis in all the patients, and pulmonary blood pressure significantly decreased in 9 patients. Conclusion Patients with anomalous origin of one pulmonary artery should undergo surgical repair as early as possible with satisfactory short-term outcomes in infants and children. For elder patients with irreversible pulmonary hypertension, the choice of surgical treatment should be more cautious. During the surgery, the anomalous pulmonary artery and ascending aorta should be dissociated fully, and transection of the ascending aorta is helpful to get a satisfactory operating field view for the surgeon. Repairing aortic defect with autologous pulmonary arterial patch can effectively avoid the occurrence of postoperative aortic aneurysm.
Objective To summarize clinical characteristics and treatment results of adult patients with coronary heart disease and ventricular aneurysm，and evaluate surgical outcomes. Methods Clinical data of 86 adult patients with coronary heart disease and ventricular aneurysm who underwent surgical treatment in Fu Wai Hospital from January 2011 to November 2012 were retrospectively analyzed. There were 70 male and 16 female patients with their average age of 57.7±10.6 years and average body weight of 71.7±10.5 kg. Preoperative echocardiography or left ventriculography showed left ventricular thrombus in 22 patients. Coronary angiography showed 47 patients with 3 vessel disease，29 patientswith 2 vessel disease，and 10 patients with single vessel disease. Sixteen patients underwent direct linear suturing of theaneurysm off pump，39 patients underwent simple linear suturing under cardiopulmonary bypass，15 patients received endoventricular purse-string reconstruction，and 16 patients received endoventricular purse-string reconstruction and patch plasty. Three patients underwent reexploration for bleeding. Sixty-four patients received concomitant coronary artery bypass grafting（CABG）. Results Postoperatively 2 patients（2.3%） died of refractory ventricular fibrillation and multiple organ dysfunction syndrome respectively. Patients undergoing concomitant CABG received 2.3±1.2 grafts on the average. Seventy-eightpatients （92.9%） were followed up for 2-24 months after discharge. During follow-up，patients’ angina symptoms significantlyresolved，heart function improved in varying degrees，and no new sign of myocardial ischemia was found on electrocardiogram.Left ventricular ejection fraction （LVEF） was significantly higher than preoperative LVEF（51%±7% vs. 41%±9% ，t=6.20，P=0.00），and left ventricular end-diastolic diameter （LVEDD） was significantly smaller than preoperative LVEDD （54.2±6.2 mm vs. 56.0±6.8 mm，t=4.60，P=0.00） . Conclusion Ventricular aneurysm repair and concomitant CABG （or ventricular septal perforation repair，mitral valvuloplasty et al） are positive and effective treatment strategies for postinfarction ventricular aneurysm. Satisfactory clinical outcomes can be achieved by individualized treatment based on appropriate surgical strategies according to the size of ventricular aneurysm.
Abstract： Objective To optimize surgical treatment for children with patent ductus arteriosus （PDA） and mitral regurgitation （MR） and evaluate its midterm to longterm outcome in terms of MR. Methods Between Jan. 2008 and Jan. 2011， 25 children with PDA and MR underwent surgical treatment in Shanghai Children’s Medical Center. There were 14 male patients and 11 female patients with average age of 26.36±40.75 （1.72-142.83）months and average weight of 8.98±6.85 （3.80-36.00） kg. The average diameter of PDA was 7.84±3.10 （3-15）mm. There were 22 children with duct-type PDA and 3 children with window-type PDA. There were 5 children with severe MR， 18 children with moderate MR， and 2 children with mild MR. Except one child with mitral stenosis who underwent PDA ligation plus mitral valvuloplasty supported with cardiopulmonary bypass， all other 24 children only underwent PDA ligation through left posterolateral thoracotomy without any management for the mitral valve. Results There was no in-hospital death. The average ventilation time in ICU was 6.70±4.39 （3-24） hours. Except one child was reintubated because of asthma， all other children recovered uneventfully without any postoperative complication. All the 25 children were followed up for 329.23±288.39 （29-967） days. During follow-up， 23 children （92.00%） had their MR level ameliorated in different degree. Preoperative severe MR in 5 children changed into moderate MR in 2 children and mild MR in 3 children. Preoperative moderate MR in 16 children changed into none MR in 5 children, trivial MR in 5 children and mild MR in 6 children. Preoperative mild MR in 2 children changed into none MR in 1 child and trivial MR in another child. Two children with preoperative moderate MR had no improvement during follow-up. Conclusion For infants and children with PDA and MR， conservative treatment strategy should be carried out. Simple PDA ligation can provide satisfactory clinical outcome， which may also avoid negative complications including myocardial injury caused by cardiopulmonary bypass.
Objective To introduce a modified Sakakibara classification system for a ruptured sinus of Valsalva aneurysm （RSVA），and suggest different surgical approaches for corresponding types of RSVA. Methods Clinical data of 159 patients undergoing surgical repair for RSVA in Fu Wai Hospital between February 2006 and January 2012 were retrospectively analyzed. There were 105 male and 54 female patients with their age of 2-71 （33.4±10.7） years. All these patients were divided into 5 types as a modified Sakakibara classification system. Type I: rupture into the right ventricle just beneath the pulmonary valve （n=66），including 84.8% patients with ventricular septal defect （VSD） and 53.8% patients with aortic valve insufficiency （AI）. TypeⅡ：rupture into or just beneath the crista supraventricularis of the right ventricle （n=17），including 88.2% patients with VSD and 23.5% patients with AI. Type Ⅲ：rupture into the right atrium （typeⅢ a，n=21） or the right ventricle （typeⅢv，n=6） near or at the tricuspid annulus，including 18.5% patients with VSD and 25.9% patients with AI. TypeⅣ：rupture into the right atrium （n=46），including 23.9% patients with AI but no patient with VSD. TypeⅤ：other rare conditions，such as rupture into the left atrium，left ventricle or pulmonary artery （n=3），including 100% patients with AI and 33.3% patients with VSD. Most RSVA originated in the right coronary sinus （n=122），and others originated in the noncoronary sinus （n=35） or left coronary sinus （n=2）. Results All the type V patients （100%） and 50% patients with typeⅢv received RSVA repair through aortotomy. In most patients of typeⅠ，II andⅣ，repair was achieved through the cardiac chamber of the fistula exit （71.2%，64.7% and 69.6% respectively）. Both routes of repair were used in 76.2% patients with typeⅢ a. The cardiopulmonary bypass time （92.4±37.8 minutes） and aortic cross-clamp time （61.2±30.7 minutes） was the shortest to repair typeⅣRSVA. There was no in-hospital death in this group. Two patients （type I andⅡrespectively） underwent reoperation during the early postoperative period because of restenosis of the right ventricular outflow tract. Most patients received reinforcement patch for RSVA repair （n=149），and only 10 patients received simple suture repair （including 5 patients with typeⅣ，4 patients with typeⅢ a and 1 patient with typeⅡ）. Aortic valve replacement was performed for 33 patients （66.7% of those with typeⅠ）. A total of 147 patients （92.5%） were followed up after discharge. Two patients （type I andⅢ a respectively） developed atrial fibrillation and received radiofrequency ablation treatment，1 patient （typeⅣ） underwent reoperation for residual shunt，and there was no late death during follow-up. Conclusion Modified Sakakibara classification system for RVSA provides a guidance to choose an appropriate surgical approach，and satisfactory clinical outcomes can be achieved for all types of RSVA.
Abstract: Objective To summarize the surgical outcomes and clinical experience of surgical disease for patients having undergone orthotopic heart transplantation. Methods Five cardiac transplant recipients requiring surgical management due to other surgical diseases including acute cholecystitis in 2 patients, acute appendicitis, bilateral mammary hypertrophy and lung tumor in 1 patients, respectively. The mean age of the entire group at the time of reoperation was 44. 6 years (14-60 years) and the average time of operative procedures after transplant was 16. 4 months (4-37 months). Four patients were treated with t riple immunosuppression, including cyclosporine A (CsA ) or tacroimus, mycophenolate mofetil and corticosteroids, respect ively. One patient received double-therapy of CsA and mycophenolate mofetil withearly withdrawal of corticosteroids. All the acute cholecystitis and appendicitis patients underwent open cholecystectomy and appendectomy emergently. Reduction mammaplasty was performed on the bilateral mammary hypert rophy patients. For the lung tumor patient, right upper lobectomy and nodes excision were undertaken radically after the sample proved to be malignancy by the thoracoscopy. Closely surveillance at concentration of CsA or FK506 was performed continueously in o rder to adjust the effect ive blood concentration in a steady way by which acute rejection can be avoided. The pathways which pathogen organisms invading the human body were controlled strictly as well as intension on ant i-infection treatment during perioperative period. Results Four patients discharged to home within 2 weeks. Only one patient needed further treatment in Digestive Department after emergent cholecystectomy due to gastric retention. And shewas discharged after 66 days. No acute reject ions or operative complications such as severe infection or bleeding were found during the perioperative period. The average length of stay was 21. 3 days (8-66 days). During the fo llow -up from 1month to 13months, there was no relapse or allograft disfunction performed on any patients. All of them enjoy quality lives. Conclusions More attention should be paid to regular follow -up after transplantation, by which the emergent surgical diseases can be diagnosed and treated earlier and more effectively. Cardiac transplant recipients who subsequently require surgical intervention do quite well overall. Most of them can obtain excellent surgical outcomes.
Abstract: Objective To investigate the role of video-assisted thoracoscopic surgery (VATS) in treatment of benign pulmonary disease, in order to promo te the mini-invasive way of operation. Methods From May 2001 to M ay 2006, 128 patients with benign pulmonary diseases were treated by VATS. The diseases included 17 kinds of different lesions, such as tuberculosis, bronchiectasis, inflammatory pseudotumor, giant bullae of lung, hamartoma,lymphangiomyomatosis, etc. 53 cases had definite diagnosis before operation, the others had final diagnosis by pathology. Limited resection were performed in 66 cases, single lobectomy in 56 cases, bilobectomy in 2 cases, and concomitant bilateral lobectomy in 4 cases. Limited resections were carried out by pure thoracoscopic procedure with three ports, lobectomies were carried out by video-assisted minithoracotomy with 7-10cm incision. Results For lim ited resect ion, the average operat ive durat ion w as 110m in (30-180m in) , blood loss was 60m l (10-300m l) , none had intraoperative blood transfusion needed. Conversion to minithoracotomy occurred in 2 patients. Postoperative bleeding happened in one case, which was controlled by medicine. Average length of stay was 6. 5 days. For lobectomy, the average operation time was 145 min (80-260min) , blood loss was 190ml (50-500m l) , no intraoperative blood tansfusion needed. Conversion to tranditional thoracotomy occurred in 3 patients, pneumonia occurred in 2 patients, delayed healing of mini-incision occurred in 2 patients. One diaphragmat ic hernia and one active bleeding after operat ion underwent second thoracotomy. Average length of postoperative stay was 7. 4 days (4-13d). For bilateral lobectomies, the average operative duration was 330min (270-415m in) , postoperative length of hospital stay was 10.7days (8-16d). No perioperative death occurred. Conclusion VATS for benign pulmonary disease is miniinvasive and safe, the pat ients recover quickly. It could be the choice of operation for selected patients in equipped center.
Abstract： Objective To investigate clinical characteristics， surgical strategy and prognosis of pulmonary pleomorphic carcinoma， and improve the diagnostic and therapeutic level of pulmonary pleomorphic carcinoma. Methods We retrospectively analyzed clinical data of 7 patients with pulmonary pleomorphic carcinoma who underwent surgical resection from January 2006 to August 2011 in West China Hospital of Sichuan University. There were 5 male patients and 2 female patients with the male/female ratio of 2.5︰1.0 and the mean age of 58.85 （43-69） years old. We also conducted a literature review through PubMed using pulmonary pleomorphic carcinoma and surgery as the key words， and 8 patients with integral clinical data from 2005 to 2011 were identified. There were 7 male patients and 1 female patient with the male/female ratio of 7︰1 and mean age of 70.25 （51-79） years old. All the patients underwent surgical resection and systemic lymph node dissection. Results The mean age of this group was 64.93 （43-79） years old. Among the 15 patients， there were 12 males and 3 females with the male/female ratio of 4︰1. The main symptoms were cough， blood in phlegm， hemoptysis and chest pain. Pathology diagnosis confirmed pleomorphic carcinoma in all the patients. Among the 7 patients of our hospital， there were 3 patients with spindle cell with squamous cell carcinoma， 2 patients with spindle cell with adenocarcinoma， and 2 patients with spindle cell with large cell carcinoma and adenocarcinoma. During follow-up， 3 patients died with the longest survival time of 49 months， and the other 4 patients were still alive. Among the 8 patients in the literature review， there were 4 patients with spindle cell with squamous cell carcinoma， 1 patient with spindle cell with adenocarcinoma， 1 patient with spindle cell with large cell carcinoma and squamous cell carcinoma, and 2 patients with spindle cell with adenocarcinoma and squamous cell carcinoma. During follow-up， 5 patients died with the longest survival time of 22 months， and the other 3 patients were still alive. Conclusion Pulmonary pleomorphic carcinoma is extremely rare and surgical resection is an effective treatment strategy for it.
Abstracts： Objective To summarize clinical experience and surgical outcomes of congenital coronary arterial fistula （CAF）. Methods We retrospectively analyzed clinical records of 12 patients （6 males, 6 females）, aged from 4 to 77 （50.90±23.8） years, who underwent surgical repair of CAF in Nanjing First Hospital between February 2005 and June 2011. There were 3 CAF patients associated with coronary artery aneurysms, one with patent foramen ovale and 2 with coronary artery disease （CAD）. One CAD patient had concomitant severe aortic valve stenosis. One patient underwent surgical repair without cardiopulmonary bypass （CPB） and 11 patients underwent surgery under CPB, among whom 3 patients underwent surgery with beating heart. One patient underwent concomitant aortic valve replacement and coronary artery bypass grafting.?Results?All the patients recovered uneventfully. Operation time was 151.25±42.65 min （ranging from 90 to 245 min）, cardiopulmonary bypass time was 65.06±29.16 min （ranging from 31 to 116 min）, mean aortic cross-clamping time was 43.00±33.41 min （ranging from 18 to 97 min） and postoperative hospital stay was 12.50±1.45 d （ranging from 10 to 15 d）. There was no early or late death. All the patients were followed up from 4 months to 6 years and no patient had symptom recurrence, myocardial ischemia or residual fistula during the follow-up. Conclusions All CAF patients should be surgically treated once diagnosis are made with satisfactory surgical outcome.
Abstract： Objective To summarize our surgical experience of tetralogy of Fallot（TOF） with anomalous coronary artery（ACA）， explore diagnostic method of ACA， and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract（RVOT） reconstruction. Methods From January 2004 to January 2010， 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years （5 months to 33 years）and median body weight of 18 （5 to 51） kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement， repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation （REV） technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above， below or beside coronary arteries （single patch or two patch technique）. Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results The median cardiopulmonary bypass time was 78 （65-102） min， median aortic crossclamp time was 50（40-82） min， and median operation time was 150 （126-178） min. There was no early death or severe coronary artery injury. Two patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 （21-83）months and there was no late death during follow-up. All the patients were in New York Heart Association （NYHA） classⅠduring follow-up， their left ventricular ejection fraction was normal， there was no sign of myocardial ischemia in electrocardiogram， and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient （△P） was 19 （8-38） mm Hg， and the RVOT gradient （△P） did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography （64-MSCT）. Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.
Objective To investigate clinical outcomes of one-stage repair for patients with persistent truncus arter-iosus who missed optimal timing of surgery. Methods We retrospectively analyzed clinical data of 12 patients with persistent truncus arteriosus who had missed optimal timing of surgery and were admitted to Wuhan Asia Heart Hospital between June 2003 and August 2011. There were 7 male patients and 5 female patients with their median age of 4.5 （0.6-14.0）years and median body weight of 23 （6-36）kg. All the patients underwent one-stage surgical repair. There were 9 patients with Van Praagh type A1，2 patients with type A2，and 1 patient with type A4 persistent truncus arteriosus. There were 2 patients with anomalous origin of coronary artery，2 patients with moderate truncal valve insufficiency，and 3 patients with moderate tricuspid valve insufficiency which required concomitant surgical repair. All the patients received preoperative right heart catheterization which showed severe pulmonary hypertension. The median pulmonary-systemic blood flow ratio （Qp/Qs ratio） was 2.42 （1.50-5.26），and median pulmonary vascular resistance was 8.1 （4-12） Wood units. All the patients showed a positive pulmonary vasodilator response to oxygen. Right ventricular outflow tract （RVOT） reconstruction was achieved using a valved conduit in 7 patients and a valved patch in 5 patients. Results There was no in-hospital death in this group. Three patients had transient pulmonary hypertensive crisis during postoperative intensive care and were healed after proper treatment. Early postoperative pulmonary artery pressure monitoring in all the patients showed that main pulm-onary artery systolic pressure/radial artery systolic pressure was 0.48±0.12. All the 12 patients were followed up for 48（12-91）months. There were 10 patients with New York Heart Association （NYHA） classⅠand 2 patients with NYHA classⅡ during follow-up. One patient received reoperation for residual ventricular septal defect and right ventricular failure.Two patients required long-term medication treatment for high pulmonary vascular resistance and right ventricular failure. The latest echocardiography during follow-up showed that average pressure gradient across RVOT was 21 （16-42） mm Hg in patients with valved conduit for RVOT reconstruction and 18 （10-28） mm Hg in patients with valved patch for RVOT reconstruction. None of the patients required reoperation for RVOT obstruction. Pulmonary regurgitation was less than moderate degree in all the patients. Two patients with anomalous origin of coronary artery didn’t have symptoms or electrocardiogram changes of myocardial ischemia during follow-up. Conclusion For patients with persistent truncus arteriosus who missed optimal timing of surgery， one-stage repair can achieve good early and intermediate clinical outcomes，but long-term follow-up is needed to observe truncal valve regurgitation and right ventricular function.