Abstract： Objective To investigate the outcome of continuous shallow stitching repairing perimembranous ventricular septal defect(pVSD). Methods From January 2002 to October 2004,50 patients less than 10kg of body weight with simple pVSD were chosen in our hospital. VSD was repaired by continuous shallow stitching with autograft pericardium. Results The aortic clamping time was 32±21min（14-52min）, cardiopulmonary bypass time 56±35min（29-69min）.No Ⅲ° atrioventricular conduction block happened, 9 patients developed right bundle branch block, and 2 patients showed junctional rhythm. Two patients with perimembranous extending outlet were repaired because of residual shunt(0.4cm,0.3cm) on the anterosuperior rim of defect. One patient with trivial residual shunt(0.15cm) on the posteroinferior rim of defect was found closed spontaneously six months later. Tricuspid valve was incised in 10 patients of VSD sextending outlet,8 patients vertical to the valve ring,2 patients parallel to the valve ring. Moderate tricuspid valve regurgitation was found in 1 patient, mild in 5 patients, trivial in 4 patients. No one aggravated. One patient complicated with pericardial effusion.One patient was reoperated because of bleeding. Conclusion Continuous shallow stitching repairing pVSD is effective.
ObjectiveTo evaluate the mid-term outcomes between tricuspid valve detachment (TVD) and non-detachment (NTVD) for ventricular septal defect (VSD).Methods The patients who underwent perimembranous VSD repair in the Department of Cardiovascular Surgery, West China Hospital from 2015 to 2020 were included. According to the surgical method, the patients were divided into a TVD group and a NTVD group. The clinical data of the two groups were compared.Results Totally 538 patients were included in the study. There were 240 patients in the TVD group, including 121 males and 119 females, with an average age of 3.85±8.42 years and an average weight of 14.12±12.97 kg. There were 298 patients in the NTVD group, including 149 males and 149 females, with an average age of 4.42±9.36 years and an average weight of 14.87±12.51 kg. There was no statistical difference in the age, weight, sex, preoperative New York Heart Association (NYHA) classification or tricuspid regurgitation (TR) degree between the two groups (P＞0.05). Median follow-up was 30 (23, 40) months in the TVD group, and 29 (23, 41) months in the NTVD group (P=0.600). After operation, one patient in each group developed third-degree atrioventricular block and recovered to sinus rhythm before discharge (P=0.848). No pacemaker was needed. There was no statistical difference in the length of stay (P=0.054), mortality (P=1.000), in-hospital reoperation (P=0.199), or follow-up reoperation (P=0.505). More than 98% of patients in both groups had postoperative TR less than moderate (P=0.926). At the last follow-up, only 7 (2.9%) patients in the TVD group were detected trivial residual shunting, and 14 (4.7%) in the NTVD group (P=0.289). No one needed to have reoperation because of residual VSD. The TVD group showed less TR during the follow-up (P=0.019).Conclusion TVD is an alternative technique which can be safely used in the closure of VSD, especially in technologically mature medical center. Appropriate tricuspid valve detachment for those hard-to-expose VSDs does not result in poorer tricuspid valve function or higher risk of atrioventricular block, and might reduce the incidence of residual shunting.
Objective To discuss the methods and results of the surgical treatment of apical muscular ventricular septal defects （VSD） , in order to improve the surgical outcome of this disease. Methods The clinical data of 29 patients with apical muscular VSD of Fuwai hospital through Jan. 1999 to July 2004 were analyzed retrospectively. The apical VSDwere repaired via 4 different approaches： right atrium, apical right ventriculotomy, apical left ventriculotomy and the incision of the outflow tract of right ventricle combined with apical left ventriculotomy. The operative outcomes between different approaches were analyzed and compared. Results There were 2 perioperative deaths （6. 9%）. One patient repaired via apical left ventriculotomy died of low cardiac output syndrome, the other died intraoperatively from endocardial fibroelastosis, which was confirmed by myocardial biopsy. There were residual VSD in 4 （13. 8%） patients, who were repaired via the right atrium, which did not necessitate reoperation. Other patients were discharged uneventfully. Follow up was completed {n 11 patients and extended 2 to 34 months, none of the 6 survivors had apical ventricular aneurysms. Conclusions The operative outcome of patients with apical VSD is satisfactory although the incidence of residual VSD is higher. The intraoperative transesophageal echocardiography （TEE） should be performed routinely. Surgical approach should be chosen on the actual site of the VSD at operation. Try to repair the VSD via the right atrium as possible, via the apical right ventrieulotomy if needed and try to avoid left ventriculotomy.
ObjectiveTo analyze the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis.MethodsWe retrospectively analyzed the clinical data of 40 patients with ventricular septal defect complicated with infective endocarditis in our hospital from 2001 to 2016. There were 25 males and 15 females, aged 20-62 (39.92±11.16) years. They were divided into two groups according to the duration from admission to surgery: a group A (an early operation group whose surgery was performed within 7 days after admission) and a group B (a conventional treatment group with the duration from admission to surgery>7 days). Among them, there were 27 patients in the group A including 15 males and 12 females with an average age of 39.56±11.80 years, and 13 patients in the group B including 10 males and 3 females with an average age of 40.69±10.13 years. All patients were examined by echocardiogram and blood bacterial culture to investigate their etiology, echocardiogram results and treatment status. And the clinical data of the two groups were compared.ResultsTwo patients died before operation in the group B, one died of heart failure, and one cerebral infarction. No reoperation during hospitalization, cerebral infarction, thromboembolism or other complications occurred. The ventilation time in the group A was significantly shorter than that in the group B (18.00±14.85 h vs. 31.00±29.57 h, P=0.015). There was no statistical difference in the extracorporeal circulation time, myocardial block time, or postoperative hospital stay between the two groups (P>0.05). After discharge, the patients continued antibiotic therapy for 3-6 weeks. Patients were followed up for 12-127 (75.74±6.01) months, 1 died of malignant tumors in the group A, 1 developed atrial fibrillation and 1 developed cardiac insufficiency in the group B, and the rest of patients did not complain of obvious discomfort. There was no residual shunt, recurrence of infective endocarditis, reoperation, postoperative stroke or thromboembolism.ConclusionPreoperative echocardiography and blood bacteriological culture are helpful for the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis. Early surgery is safe and effective for these patients, and can improve the long-term survival rate.
Objective To explore the application effect of 3D printed heart models in the training of young cardiac surgeons, and evaluate their application value in surgical simulation and skill improvement. MethodsEight young cardiac surgeons were selected form West China Hospital as the trainees. Before training, the Hands-On Surgical Training-Congenital Heart Surgery (HOST-CHS) operation scores of the 8 cardiac surgeons were obtained after operating on 2 pig heart models of ventricular septal defect (VSD). Subsequently, simulation training was conducted on a 3D printed peri-membrane VSD heart model for 6 weeks, once a week. After the training, all trainees completed 2 pig heart VSD repair surgeries. The improvement of doctors’ skills was evaluated through survey questionnaires, HOST-CHS scores, and operation time after training. ResultsBefore the training, the average HOST-CHS score of the 8 trainees was 52.2±6.3 points, and the average time for VSD repair was 54.7±7.1 min. During the 6-week simulation training using 3D printed models, the total score of HOST-CHS for the 8 trainees gradually increased (P<0.001), and the time required to complete VSD repair was shortened (P<0.001). The trainees had the most significant improvement in scores of surgical cognition and protective awareness. The survey results showed that trainees were generally very satisfied with the effectiveness of 3D model simulation training. Conclusion The 3D printed VSD model demonstrates significant application advantages in the training of young cardiac surgeons. By providing highly realistic anatomical structures, 3D models can effectively enhance surgeons’ surgical skills. It is suggested to further promote the application of 3D printing technology in medical education, providing strong support for cultivating high-quality cardiac surgeons.
目的评价单穿刺点经胸微创封堵治疗房间隔缺损（ASD）合并室间隔缺损（VSD）的安全性及有效性。 方法纳入2014年6月至2015年8月于我院成功完成单穿刺点经胸微创封堵术治疗ASD合并VSD的8例患儿，分析患儿在术后第l个月、3个月、6个月的门诊随访资料。观察围术期及随访期间患者残余分流、瓣膜反流、心律失常等并发症发生情况。 结果8例患儿中，术后早期均无残余分流、心律失常，微量三尖瓣反流（TR）患者1例（12.5%）。平均随访时间5～9（6±2）个月，各瓣膜均未发现中度及以上反流，未发现存在血栓、严重心律失常、死亡的患者。 结论单穿刺点经胸微创封堵治疗ASD合并VSD安全、有效，且更为微创。