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Right vertical infra-axillary thoracotomy in surgical repair for intra-cardiac congenital heart defects combined with patent ductus arteriosus

ObjectiveTo investigate effectiveness and safety of right vertical infra-axillary thoracotomy (RVIAT) in surgical repair for intra-cardiac anomalies combined with patent ductus arteriosus (PDA).MethodsWe retrospectively analyzed the clinical data of 34 patients who underwent intra-cardiac correction of congenital heart defects and PDA ligation simultaneously via RVIAT in our hospital from August 2014 to August 2019. There were 25 males and 9 females with an age range of 0.5-6.1 years.ResultsThe length of incision was 3.0 (3.0, 3.5) cm. The operation time lasted 110.0 (90.0, 121.0) min. The cardiopulmonary bypass time was 45.5 (38.8, 63.5) min and the aortic cross-clamp time was 22.5 (14.8, 34.8) min. The bleeding volume was 20.0 (13.8, 20.0) mL. ICU stay time was 17.0 (5.5, 22.3) h, post-operative mechanical ventilation time was 4.0 (2.0, 6.0) h, total in-hospital cost was 46 (39, 51) thousand yuan. There was no mortality or reoperation during perioperative and follow-up period. Within the median follow-up of 636.0 days, 1 patient had minimal residual ventricular septal defect shunt while no new-onset scoliosis, funnel chest or pectus carinatum was detected. No bilateral mammary developmental asymmetry was observed in the female patients during the follow-up period. All the patients’ parents or guardians were satisfied with the right vertical infra-axillary aesthetic skin incision.ConclusionThe minimally invasive repair for intra-cardiac heart defects combined with PDA via RVIAT is a safe and effective method with minimal invasiveness and excellent cosmesis.

Ligation of Ductus Arteriosus Assisted by Minithoracoscope

目的:报告电视胸腔镜辅助小切口(VATM)动脉导管(PDA)结扎手术的体会。方法:2004年元月至2008年12月,共施行VATM下PDA结扎术36例。手术采用传统右侧卧位,胸壁6cm长左右小切口,胸腔镜插入与操作切口为同一个切口。分离结扎PDA不需特殊器械,用10号慕丝线4根交叉作垫结扎。术毕不安置胸腔引流管。结果:手术平均时间为(71.3±12.5)min,术中出血量lt;20mL,术后4~7日出院。术后随访心脏杂音消失,无残余分流体征,全部恢复健康。结论:VATM结扎PDA具有创伤小,术后患者疼痛轻,恢复快,显著减少镇痛药和其它用药剂量及用药时间,缩短住院日,降低医药费,胸壁不留大的瘢痕,有较好美容效果等优点。

动脉导管未闭合并重度肺动脉高压患者的介入与外科治疗

目的 探讨动脉导管未闭(PDA)合并重度肺动脉高压(PH)患者外科手术治疗与介入封堵治疗的适应证和治疗效果。 方法 回顾分析1998年5月至2008年5月我科收治的30例PDA患者的临床资料，其中男14例，女16例；年龄14～41岁，平均年龄25.8岁。18例行外科手术治疗，12例行介入封堵治疗。 结果 经外科手术和介入封堵治疗患者术后即刻的肺动脉收缩压(608±120 mm Hg vs. 100.2±14.2 mm Hg; 60.3±11.6 mm Hg vs. 108.4±17.6 mm Hg)和平均肺动脉压(401±98 mm Hg vs. 76.1±11.3 mm Hg; 40.2±10.5 mm Hg vs. 79.5±13.6 mm Hg)均较术前明显降低（Plt;0.05）。术后4例手术患者中有2例出现声音嘶哑，2例残余分流；介入封堵治疗患者术后未出现明显并发症。随访29例，随访时间3个月~2年；1例失访。随访期间患者无明显胸闷、气促等，超声心动图检查大动脉水平未探及残余分流，1例术前伴有心房颤动的患者在封堵术后2个月时猝死，死亡原因不明。28例患者术后90 d复查超声心动图提示：肺动脉收缩压均较术前明显降低（Plt;0.05），两种治疗方法的疗效差异无统计学意义（Pgt;0.05）。 结论 介入封堵治疗PDA合并重度PH的患者与外科手术治疗相比较具有创伤小、风险小、并发症少和恢复快等优点，尤其是介入封堵治疗可行试验性封堵，对鉴别动力性和阻力性PH具有不可替代的优越性。但一些特殊类型的PDA患者仍需外科手术治疗。

Clinical investigation of percutaneous closure of patent ductus arteriosus under echocardiography guidance

Objective To assess the efficacy and safety of percutaneous closure of patent ductus arteriosus (PDA) solely under echocardiography guidance. Methods We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups: a femoral artery approach group (n=143) and a femoral vein approach group (n=57). In the femoral artery approach group, there were 42 males and 101 females aged 3.20±5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30±11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram. Results All 200 patients were successfully treated with percutaneous closure of PDA. The patients’ gender, in-hospital stay, rates of occluder detachment were similar between the two groups (P>0.05). Compared with the femoral vein approach group, the femoral artery approach group had a younger age (3.20±5.63 yearsvs. 7.30±11.36 years, P<0.001), less body weight (14.25±11.54 kgvs. 24.25±19.14 kg, P<0.001) and shorter diameter of PDA (3.06±0.79 mmvs. 5.93±0.68 mm, P<0.001) and PDA occluders (5.43±1.00 mmvs. 12.14±0.54 mm, P<0.001), but had higher hospitalization expenses (32 108.2±3 100.2 yuanvs.25 120.7±3 534.1 yuan, P<0.001). In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up. Conclusion Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.

电视胸腔镜手术治疗动脉导管未闭16例

目的探讨电视胸腔镜手术(VATS)治疗动脉导管未闭(PDA)的手术方法与效果。方法在电视胸腔镜下游离动脉导管,10例采用丝线结扎,然后用钛夹钳闭动脉导管;6例单纯采用钛夹钳闭动脉导管。结果全组16例术后无喉返神经损伤,无导管残余分流等并发症,平均住院时间7d。随访15例,超声心动图检查无导管再通。结论VATS治疗PDA操作简便、安全可靠、容易掌握和推广,具有创伤小、术后疼痛轻、出血少、恢复快及美观等优点。

动脉导管未闭合并其他心脏畸形的外科治疗

摘要: 　目的　总结动脉导管未闭合并其他心脏畸形的外科治疗经验, 以提高手术效果。　方法　2004 年11 月～2006 年12 月手术治疗动脉导管未闭合并其他心脏畸形44 例, 40 例采用正中切口, 上、下腔静脉插管, 转流前游离动脉导管, 双10 号线结扎; 对导管粗大者可在并行转流下分离导管并结扎, 4 例患者实行分期手术。　结果　本组无手术死亡。术后发生低心排血量综合征3 例, 经积极治疗治愈; 2 例发生血红蛋白尿, 均在2d 内恢复。44 例术后超声心动图复查均无再通, 无灌注肺发生。术后随访36 例, 均在3 个月～ 2 年顺利恢复, 活动正常。　结论　经胸部正中切口手术是一种简单、有效的方法, 可同时修补其他心内畸形。分离、结扎动脉导管时应熟练掌握导管及其邻近解剖关系, 根据生命体征及导管直径的大小决定是否应用并行心肺转流。

重症极低出生体质量早产儿动脉导管结扎治疗

Minimally Invasive Transthoracic Closure of Patent Ductus Arteriosus Through Left Parasternal Approach：A Report of 21 Cases

目的 总结经左胸骨旁途径封堵动脉导管未闭的经验和技术方法。 方法 回顾性分析2013年11月至2014年8月广州医科大学附属第一医院21例动脉导管未闭封堵手术患者的临床资料。其中，男8例、女13例，年龄2～20 （6.7±4.9）岁，体重9～40 （19.3±9.4） kg。取左胸骨旁第2肋间1.5～3 cm切口，在肺动脉主干前上壁缝荷包，在经食管超声心动图（TEE）实时监测引导下利用自制弯形中空探条引导钢丝通过动脉导管建立输送轨道，或将装有封堵伞的输送鞘直接通过动脉导管后释放封堵器。 结果 21例手术均成功完成，无中转开胸及输血，手术时间35～130 （65.2±28.4） min，出血量10～200 （47.8±60.8） ml，术后住院时间2～6 （3.4±1.3） d，术后无封堵器脱落、溶血、肺炎、心律失常、二次开胸、切口感染等并发症，出院前复查未见封堵伞移位、脱落，无明显胸腔积液及心包积液。 结论 经左胸骨旁途径封堵动脉导管未闭安全、切口小、恢复快，为动脉导管未闭患者提供了一种治疗方案。

Early outcomes of surgical treatment for patent ductus arteriosus combined with intracardiac abnormity via right vertical infra-axillary thoracotomy

ObjectiveTo explore the early outcomes of the surgical treatment for patent ductus arteriosus (PDA) combined with intracardiac abnormities via right vertical infra-axillary thoracotomy (RVIAT).MethodsA total of 7 children with PDA combined with intracardiac defects underwent surgery through RVIAT at the Second Affiliated Hospital of Nanjing Medical University from 2016 to 2018. There were 4 males and 3 females, with an average age of 5.3±4.5 years and weight of 18.0±11.2 kg.ResultsIn all patients, PDA was ligated before the repair of intracardiac abnormities. No patient died in hospital. All patients were followed up, with a mean follow-up time of 18.0±8.0 months. No other complications such as residual shunts, arrhythmias, hemorrhaging or wound infection occurred after operations or during the follow-up period.ConclusionRVIAT is an emerging technique used for the surgical repair of PDA combined with intracardiac defects. It yields satisfying cosmetic results, without increasing postoperative complications or mortality.

Establishment of patent ductus arteriosus model in Bama miniature pigs using autogenous jugular vein

ObjectiveTo explore the method and feasibility of establishing patent ductus arteriosus (PDA) model in Bama miniature pig by using autologous jugular vein, and to provide a large animal model for the development of PDA occluder and the study of pulmonary hypertension associated with congenital heart disease. MethodsFive male Bama miniature pigs weighing about 45 kg were selected to gain the PDA model of the autogenous jugular vein, which was fixed by glutaraldehyde and anastomosed between the ascending aorta and the main pulmonary artery. The patency of PDA was confirmed by echocardiography and angiocardiography immediately and one week after the operation. Two animals were selected to undergo transcatheter closure of PDA via femoral vein 1 week after the operation, and the rest were euthanized to obtain PDA and lung tissue for pathological examination. ResultsThe PDA model was successfully established in all five animals with a success rate of 100.0%. Immediately and 1 week after the operation, echocardiography and angiography showed that PDA blood flow was unobstructed, and hematoxylin-eosin staining showed that PDA endothelialization was good. One week after the operation, two animals were successfully treated with transcatheter femoral vein occlusion. The pathological examination of lung tissue showed thickening of the intima and muscular layer of pulmonary arterioles, thickening of pulmonary interstitium and infiltration of neutrophils. ConclusionIt is safe and feasible to establish a large animal model of PDA by using autogenous jugular vein anastomosis between the ascending aorta and the main pulmonary artery. The model can be used for the development of PDA interventional occlusive devices and the pathophysiological study of congenital heart disease-related pulmonary hypertension.