Our country has made great progress in the surgical treatment of congenital heart disease, but after entering the new era, congenital cardiac surgery also presents some new features and trends. The quality of data of Guangdong congenital heart defects monitoring network was recognized by international organizations. We analyzed the data of the incidence of congenital heart disease, the rate of surgical treatment, the mortality of surgical procedures and the quality of surgical treatment in Guangdong province from Guangdong congenital heart defects monitoring network, and then accurately understood the development characteristics of congenital cardiac surgery. It is very helpful to clarify the regional status of congenital cardiac surgery, which is conducive to the development of a more reasonable surgical strategy for congenital heart disease, and finally promote the further development of congenital cardiac surgery in China.
In recent years, three-dimensional (3D) technology has been more and more widely used in the auxiliary diagnosis and treatment of structural heart disease (SHD), and is also an important basis for the application of other technologies such as artificial intelligence. However, there are still some problems to be solved in the clinical application of 3D technology. In this paper, the application of 3D technology in SHD field is reviewed, and the future development of 3D technology is prospected.
This review provides an overview of prenatal interventional treatments for fetal congenital heart disease (CHD), with a particular focus on the latest advancements in fetal aortic valvuloplasty (FAV) and fetal pulmonary valvuloplasty (FPV). FAV aims to improve left heart hemodynamics, prevent hypoplastic left heart syndrome (HLHS), and promote biventricular circulation. FPV seeks to improve the natural history of pulmonary atresia with intact ventricular septum (PA/IVS) and critical pulmonary stenosis with intact ventricular septum (CPS/IVS), alleviate right ventricular outflow tract obstruction, and promote biventricular circulation. This article discusses patient selection, technical details, risk assessment, and clinical outcomes for these procedures, highlighting the challenges in current research, including the lack of standardized patient selection criteria and long-term prognostic studies. Additionally, it emphasizes the opportunities and challenges of fetal cardiac intervention (FCI) development in China and proposes recommendations for future improvements and research directions.
Objective To examine the influence of hormonal fluctuations on the perioperative outcomes of patients undergoing congenital heart surgery. Methods We conducted a retrospective analysis of clinical data from fertile women diagnosed with congenital heart disease at the Guangdong Provincial People's Hospital, between January 1, 2015, and July 30, 2019. Initially, patients were categorized into groups based on serum progesterone levels: a low progesterone group (n=31) and a high progesterone group (n=153). Furthermore, based on serum estrogen levels, they were divided into a low estrogen group (n=10), a medium estrogen group (n=32), and a high estrogen group (n=118) for comparative analysis. A control group (n=24) consisted of patients who received progesterone injections before their menstrual period. Results We finally included 184 patients. The patients’ average age was 27.6±5.7 years, with 142 (77.17%) presenting with complex congenital heart conditions. There were statistically significant differences in total postoperative standard thoracic drainage volume and postoperative albumin level between the high and low progesterone groups (P<0.05), while other perioperative outcome indicators showed no statistical differences (P>0.05). Among the different serum estrogen level groups, there were statistically significant differences in postoperative blood urea nitrogen levels, total postoperative standard thoracic drainage volume, and hospital stay (P<0.05), while other perioperative outcome indicators showed no statistical differences (P>0.05). ConclusionConsidering the overall clinical significance, the physiological changes in sex hormone levels appear to have a negligible effect on the perioperative outcomes of fertile women with congenital heart disease.
Objective To evaluate the impact of an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease (CHD) on perioperative and long-term outcomes of the arterial switch operation (ASO), and to analyze the efficacy of ASO in a single center. Methods This retrospective study analyzed the clinical data of 183 children who underwent ASO at Guangdong Provincial People’s Hospital from 2018 to 2024. The cohort included 106 (57.9%) patients of transposition of the great arteries with intact ventricular septum (TGA/IVS), 61 (33.3%) patients of transposition of the great arteries with ventricular septal defect (TGA/VSD), and 16 (8.7%) patients of Taussig-bing anomaly (TBA). Perioperative indicators were compared between 91 patients in the prenatal-postnatal integrated management group (an integrated group) and 92 patients in the traditional management group (a non-integrated group). Long-term survival and reoperation rates were analyzed using Kaplan-Meier curves. Results The overall perioperative mortality rate was 4.9% (9/183), showing a downward trend year by year. The primary cause of perioperative mortality was low cardiac output syndrome (LCOS), which occurred in 12 patients (6.6% incidence) with a mortality rate of 75.0%. The integrated group had a higher proportion of males (89.0% vs. 72.8%, P<0.05) and lower body weight [3.1 (2.7, 3.3) kg vs. 3.3 (3.0, 3.7) kg, P<0.05] compared to the non-integrated group. The age at surgery was significantly earlier in the integrated group [7 (3, 10) d vs. 14 (9, 48) d, P<0.05], and all children in the integrated group underwent ASO within the optimal surgical window (100.0% vs. 82.6%, P<0.05). Intraoperatively, cardiopulmonary bypass time [173 (150, 207) min vs. 186 (159, 237) min, P<0.05] and aortic cross-clamp time [100 (90, 117) min vs. 116 (97, 142) min, P<0.05] were significantly shorter in the integrated group. Although the integrated group had longer postoperative mechanical ventilation time [145 (98, 214) h vs. 116 (77, 147) h, P<0.05] and higher 48-hour maximum vasoactive inotropic score [15 (10, 21) points vs. 12 (8, 16) points, P<0.05], there was no statistically significant difference in the incidence of severe complications (LCOS, necrotizing enterocolitis, extracorporeal membrane oxygenation) or mortality rate (3.3% vs. 6.5%, P=0.51) between the two groups, despite earlier surgical intervention and a higher proportion of critically ill cases in the integrated group. The length of hospital stay in the emergency surgery group was significantly shorter than that in the elective surgery group [20 (15, 28) d vs. 25 (21, 30) d, P<0.05], suggesting that early surgery may be of potential benefit. A total of 163 patients were successfully followed up for a median of 4.7 years, with a 5-year survival rate of 95.1% and a freedom from reintervention survival rate of 95.1%. There were no late deaths, and the most common postoperative complication was pulmonary artery stenosis. Conclusion The integrated management model allowed critically ill children with lower body weights to safely undergo surgery, significantly optimizing the timing of surgery and shortening intraoperative times. The long-term risk of reoperation after ASO is primarily concentrated on pulmonary artery stenosis, necessitating long-term follow-up and monitoring.
ObjectiveTo investigate the influencing factors of umbilical cord blood collection volume in newborns with congenital heart disease (CHD), so as to provide a scientific basis for promoting the development of umbilical cord blood reinfusion technology. MethodsA retrospective study was conducted on CHD newborns who were delivered in the Department of Obstetrics, Guangdong Provincial People's Hospital and underwent umbilical cord blood collection from August 2024 to January 2026. Clinical data related to pregnant women, newborns, placentas and umbilical cords were collected. ResultsA total of 144 CHD newborns were enrolled, including 50 in the simple CHD group and 94 in the complex CHD group. The mean maternal age was (31.0±5.0) years. Among the CHD newborns, 96 (66.7%) were male and 48 (33.3%) were female. Umbilical cord blood collection volume was significantly positively correlated with maternal weight, placental weight, umbilical cord length, neonatal body length, neonatal head circumference and birth weight, among which neonatal head circumference (r=0.315, P<0.001) and birth weight (r=0.327, P<0.001) showed the strongest correlations. Multiple linear regression analysis revealed that after adjusting for neonatal birth weight, placental weight, umbilical cord length and maternal weight, only umbilical cord length was an independent influencing factor for umbilical cord blood collection volume (B=0.488, β=0.262, P=0.007). ConclusionThe volume of umbilical cord blood collected from CHD newborns is affected by multiple factors, among which umbilical cord length is the most dominant one.
ObjectiveTo summarize the early and mid-term surgical outcomes of cone reconstruction for Ebstein’s anomaly. MethodsPatients with Ebstein’s anomaly who underwent cone reconstruction at Guangdong Provincial People’s Hospital from 2015 to 2024 were retrospectively enrolled. Baseline characteristics, echocardiographic parameters before and after surgery, and follow-up results were collected and analyzed. ResultsA total of 115 patients were included, comprising 28 males and 87 females, with a mean age of (33.29±15.72) years. There were 94 patients in the adult group (>14 years old), and 21 patients in the pediatric group (≤14 years old). Severe or greater tricuspid regurgitation was present in 98.3% of patients preoperatively, and 89.6% were in New York Heart Association (NYHA) functional class Ⅱ. All patients successfully underwent cone reconstruction. The in-hospital reoperation rate for tricuspid valve disease was 1.7%, and no in-hospital death occurred. In the pediatric group, tricuspid regurgitation area and right atrial longitudinal dimension were significantly smaller at 5 days, 6 months, and 1 year postoperatively than preoperative values (P<0.05). In the adult group (n=92, excluding 2 patients who underwent in-hospital reoperation for tricuspid valve disease), tricuspid regurgitation area, pulmonary artery systolic pressure, right atrial longitudinal dimension and anteroposterior diameter of the right ventricular outflow tract were significantly decreased at 5 days, 6 months, and 1 year after surgery (P<0.05), while the right ventricular longitudinal dimension was significantly increased (P<0.001) compared to preoperative levels. The left ventricular end-diastolic and end-systolic diameters were significantly increased at 6 months and 1 year postoperatively (P<0.001). Right heart functional parameters (right ventricular fractional area change, tricuspid annular plane systolic excursion, and tricuspid annular myocardial systolic velocity) demonstrated a trend of gradual recovery after an initial decline in the early postoperative period. The median follow-up duration was 1.8 years, with a follow-up rate of 95.7%. During the follow-up, 3 patients underwent repeated tricuspid valve surgery and 1 patient died. ConclusionCone reconstruction is safe and effective for Ebstein’s anomaly, and can significantly alleviate tricuspid regurgitation and reverse right heart structural remodeling. Both pediatric and adult patients achieve marked improvements in tricuspid regurgitation and right heart morphology, additionally, adult patients also gain obvious benefits in left heart function. Postoperative right heart function shows a gradual recovery trend, with favorable mid-term follow-up outcomes.
Objective To comprehensively analyze the clinical outcomes of total cavopulmonary connection (TCPC) in the treatment of functional single ventricle combined with heterotaxy syndrome (HS). MethodsA retrospective analysis was conducted on the patients with functional single ventricle and HS who underwent TCPC (a HS group) in Guangdong Provincial People's Hospital between 2004 and 2021. The analysis focused on postoperative complications, long-term survival rates, and identifying factors associated with patient survival. Early and late postoperative outcomes were compared with matched non-HS patients (a non-HS group). Results Before propensity score matching, 55 patients were collected in the HS group, including 42 males and 13 females, with a median age of 6.0 (4.2, 11.8) years and a median weight of 17.0 (14.2, 28.8) kg. Among the patients, there were 53 patients of right atrial isomerism and 2 patients of left atrial isomerism. Eight patients underwent TCPC in one stage. TCPC procedures included extracardiac conduit (n=39), intracardiac-extracardiac conduit (n=14), and direct cavopulmonary connection (n=2). Postoperative complications included infections in 27 patients, liver function damage in 19 patients, and acute kidney injury in 11 patients. There were 5 early deaths. The median follow-up time was 94.7 (64.3, 129.8) months. The 1-year, 5-year, and 10-year survival rates were 87.2%, 85.3%, and 74.3%, respectively. After propensity score matching, there were 45 patients in the HS group and 81 patients in the non-HS group. Compared to the non-HS group, those with HS had longer surgical and mechanical ventilation time, higher infection rates (P<0.05), and a 12.9% lower 10-year survival rate. Multivariate Cox regression analysis identified asplenia was a risk factor for mortality (HR=8.98, 95%CI 1.86-43.34, P=0.006). ConclusionCompared to non-HS patients, patients with HS have lower survival rates after TCPC, and asplenia is an independent risk factor for the survival of these patients.
Objective To analyze and summarize the early and medium-term outcomes of self-expanding interventional pulmonary valve stent (SalusTM) for right ventricular outflow tract dysfunction with severe pulmonary valve regurgitation. Methods We established strict enrollment and follow-up criteria. Patients who received interventional pulmonary valve in transthoracic implantation in Guangdong Provincial People’s Hospital from September 2, 2021 to July 18, 2023 were prospectively included, and all clinical data of patients were collected and analyzed. ResultsA total of 38 patients with severe pulmonary regurgitation were included, with 23 (60.5%) males and 15 (39.5%) females. The mean age was 24.08±8.12 years, and the mean weight was 57.66±13.54 kg. The preoperative mean right ventricular end-diastolic volume index (RVEDVI) and right ventricular end-systolic volume index (RVESVI) were 151.83±42.84 mL/m2 and 83.34±33.05 mL/m2, respectively. All patients successfully underwent transcatheter self-expandable pulmonary valve implantation, with 3 (7.9%) patients experiencing valve stent displacement during the procedure. Perioperative complications included 1 (2.6%) patient of postoperative inferior wall myocardial infarction and 1 (2.6%) patient of poor wound healing. The median follow-up time was 12.00 (6.00, 17.50) months. During the follow-up period, there were no deaths or reinterventions, and no patients had recurrent severe pulmonary regurgitation. Three (7.9%) patients experienced chest tightness and chest pain, and 1 (2.6%) patient developed frequent ventricular premature beats. Compared with preoperative values, the right atrial diameter, right ventricular diameter, and tricuspid annular plane systolic excursion were significantly reduced at 6 months and 1 year postoperatively, with improvement in the degree of pulmonary regurgitation (P<0.01). Compared with preoperative values, RVEDVI and RVESVI decreased to 109.51±17.13 mL/m2 and 55.88±15.66 mL/m2, respectively, at 1 year postoperatively (P<0.01). Conclusion Self-expanding interventional pulmonary valve in transthoracic implantation is safe and effective for severe pulmonary valve regurgitation and shows good clinical and hemodynamic results in one-year outcome.
Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.