ObjectiveTo summarize and analyze the experience of subarterial ventricular septal defect (VSD) repaired with simple pulmonary artery approach.MethodsWe retrospectively anlyzed the clinical data of 102 patients with subarterial VSD repaired with simple pulmonary artery approach in our hospital from August 2015 to October 2018. There were 67 males and 35 females at median age of 3 years (ranging 4 months to 49 years).ResultsThe median operation time was 82 (54-136) min. Median cardiopulmonary bypass time was 36 (21-62) min. The median aortic cross-clamping time was 13 (7-32) min. Thirty two patients of tracheal intubation were removed from the fast-track operating room immediately after surgery. Of the 102 patients, 67 patients underwent a small incision in the lower sternum. The median postoperative ICU stay time was 26 (13-36) h. There was no planned reoperations and no early death.ConclusionSimple pulmonary artery approach for subarterial ventricular septal defect repair with less intracardiac procedures, short operation time, less trauma, quick postoperative recovery has certain advantages in the application of specific groups.
ObjectiveTo explore surgical methods and risk factors of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). MethodsClinical data of 28 ALCAPA patients who underwent surgical repair from October 1993 to September 2013 in Beijing Anzhen Hospital were retrospectively reviewed. There were 8 male and 20 female patients with their age of 0.6-l6.8 (4.3±0.7)years including 10 patients less than 1 years old. Surgical procedures included simple ligation of left coronary artery, intrapulmonary tunnel procedure (Takeuchi)and direct coronary reimplantation of the anomalous artery. Postoperative death, complication and cardiac function were observed. ResultsAmong the 28 patients, 1 patient received simple ligation of left coronary artery, and 7 patients received intrapulmonary tunnel procedure (Takeuchi), among whom 2 patients died postoperatively. Twenty patients received direct implantation of the anomalous artery into the ascending aorta, and 3 patients died postoperatively. Five patients who died postoperatively were 10.20±3.27 months old, including 3 patients with moderate mitral regurgitation (MR)and 2 patients with mild MR preoperatively. Preoperative heart function of the patients who died postoperatively was significantly reduced. Preoperative left ventricular ejection fraction of the patients who died postoperatively was significantly lower than that of the patients who survived (36.6%±8.5% vs. 60.9%±10.7%, P=0.000). Low cardiac output syndrome was the reason for all postoperative death. All survival patients were followed up from 1 month to 18 years. One patient who underwent intra-pulmonary tunnel procedure (Takeuchi)received pulmonary artery balloon dilatation for pulmonary supravalvular stenosis 15 years after discharge. None of the other patients received a secondary operation. During follow-up, left ventricular function was improved. Growth and development of all the patients was normal. MR did not significantly aggravate in all the patients. ConclusionPatients with younger age and worse left ventricular function have greater surgical risks of ALCAPA.
Objective To confirm the changes of pulmonary artery pressure, neo pulmonary artery stenosis and reoperation in children with unilateral absence of pulmonary artery (UAPA) undergoing pulmonary artery reconstruction. Methods The clinical data of the infants with UAPA undergoing pulmonary artery reconstruction in our hospital from February 19, 2019 to April 15, 2021 were analyzed. Changes in pulmonary artery pressure, neo pulmonary artery stenosis and reoperation were followed up. Results Finally 5 patients were collected, including 4 males and 1 female. The operation age ranged from 13 days to 2.7 years. Cardiac contrast-enhanced CT scans were performed in all children, and 2 patients underwent pulmonary vein wedge angiography to confirm the diagnosis and preoperative evaluation. Preoperative transthoracic echocardiography and intraoperative direct pulmonary arterial pressure measurement indicated that all 5 children had pulmonary hypertension, with a mean pulmonary arterial pressure of 31.3±16.0 mm Hg. Pulmonary arterial pressure decreased immediately after pulmonary artery reconstruction to 16.8±4.2 mm Hg. The mean follow-up time was 18.9±4.7 months. All 5 patients survived during the follow-up period, and 1 patient had neo pulmonary artery stenosis or even occlusion and was re-operated. Conclusion Pulmonary artery reconstruction can effectively alleviate the pulmonary hypertension in children with UAPA. The patency of the neo pulmonary artery should be closely followed up after surgery, and re-pulmonary angioplasty should be performed if necessary.
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.
ObjectiveIn order to correct left pulmonary artery (LPA) stenosis in tetralogy of Fallot (TOF), a technique for LPA reconstruction by widening pulmonary arterial posterior wall was devised. To evaluate its surgical technique as well as postoperative outcome. MethodsFrom January 2008 through August 2014 year, 1 142 consecutive patients underwent repair of TOF including 44 patients with TOF and LPA stenosis in our hospital. We used widening pulmonary arterial posterior wall for LPA reconstruction in 21 patients. The median age was 22.8 months (range, 1 month to 11 years), and the median weight was 9.1 kg (range, 3.8-29 kg). ResultsThere was one operative death. No death occurred during the follow-up period in the other 20 patients. There were 4 patients with complicate unbalanced pulmonary perfusion postoperatively. Echocardiography at 3-72 months follow-up demonstrated no obvious stenosis was found at LPA in 14 patients, and mild stenosis (32.8±12.7 mm Hg) in 6 patients. Only 1 patient required further interventions because of restenosis of LPA. ConclusionsLPA reconstruction by widening pulmonary arterial posterior wall is an effective method in the management of stenosis of LPA in the patients with TOF. We emphasize division of the arterial duct or ligamentum completely because it will tether and kink the LPA. This procedure retains the better growth potential by increasing autogenous tissue of native tissue.
Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods A retrospective, single institution review was conducted on thirty-six adult patients with ALCAPA surgical treatment from November 1991 to November 2017 in Fuwai Hospital. Of these patients, nine were males and twenty-seven were females. The mean age was 36.6±13.3 years. The mean weight was 60.0±9.4 kg. The preoperative echocardiography showed the mean left ventricular ejection fraction (LVEF) was 57%±6% and the mean left ventricular end-diastolic dimension (LVEDD) was 52.3±6.3 mm. Severe mitral regurgitation (MR) was seen in one patient, moderate in five patients. The operative procedures included coronary artery re-implantation in seventeen patients, Takeuchi operation in sixteen patients, ligation of left coronary artery plus coronary artery bypass graft in three patients. In addition, six patients underwent mitral valve repair. Results There was no in-hospital mortality. The mean cardiopulmonary bypass time was 152.5±72.9 min and aortic cross clamp time was 101.9±43.6 min, respectively. The mean mechanical ventilation time and ICU time was 17.3±16.3 h and 43.1±30.7 h, respectively. The mean postoperative LVEF was 59%±6%, which did not significantly improve compared with preoperative LVEF. However, the mean postoperative LVEDD of 46.9±5.9 mm had significant reduction compared with the preoperative LVEDD. Of the six patients with mitral valve repair, one was mild and the other five were trivial. Thirty-five patients (97.2%) completed the follow-up with a mean time of 5.5 years. All the patients survived with New York Heart Association class Ⅰor Ⅱ. Two patients needed interventional occlusion or re-operation due to the fistula of internal tunnel within the pulmonary artery. At the latest echocardiography, the mean LVEF of 69%±7% improved significantly compared with the preoperative LVEF. Mild MR was detected in ten patients, moderate in two patients during the follow-up period. Conclusion The surgical treatment of adult patients with ALCAPA has satisfactory short- and long-term results. The patients who underwent Takeuchi procedure may need re-operation due to fistula of internal tunnel within the pulmonary artery during the long-term follow-up.
All four patients were female, with an average age of 28.8 days and an average weight of 3.64 kg. Only case 4 was born prematurely at 34 W+5 and was treated conservatively until 71 days to complete operation. All the others completed primary corrective surgery in the neonatal period, and all survived after operation and were followed up to now. Two different surgical techniques were used to repair the aortic-pulmonary window and the aortic origin of the right pulmonary artery, including 1 case using the aortic internal baffle technique and another 3 cases underwent replantation of the right pulmonary artery (1 case was reconstructed in situ, and the other 2 cases were reconstructed by moving the right pulmonary artery in the anterior of aorta). Case 2 who used aortic internal baffle technique underwent two reoperation because of right pulmonary artery stenosis. While, right pulmonary artery of cases 3 and 4 developed well after being reconstructed the right pulmonary artery anterior translocation. One-stage surgical repair of Berry syndrome is a high-risk and complicated operation, but it is safe in an experienced heart center.
Objective To observe and describe anatomical types of the pulmonary arteries to keep safety of lung resection. Methods Between November 25, 2005 and January 22, 2013, 194 patients who underwent right upper lobectomy/sleeve lobectomy or combined lung resection including right upper lobectomy were included in Peking University Cancer Hospital. There were 128 males with a median age of 59 (37-86) years and 66 females with a median age of 60 (42-77) years. We separated the pulmonary arteries and recorded the number and positions of them. Some patients were recorded photographically. Results There were 10 types of right upper lobe pulmonary artery branches in this study. Type 1: 1 apicoanterior segmental artery, 1 ascending segmental artery, 96 patients (49.5%); Type 2: 1 apicoanterior segmental artery, 2 ascending segmental arteries, 48 patients (24.7%); Type 3: 2 apicoanterior segmental arteries, 1 ascending segmental artery, 28 patients (14.4%); Type 4: 2 apicoanterior segmental arteries, 2 ascending segmental arteries, 9 patients (4.6%); Type 5: 1 apicoanterior segmental artery only, 6 patients (3.1%); Type 6: 1 apicoanterior segmental artery, 3 ascending segmental arteries, 3 patients (1.5%); Type 7: 4 apicoanterior segmental arteries, 1 ascending segmental artery, 1 patient (0.5%); Type 8: 3 apicoanterior segmental arteries, 1 ascending segmental artery, 1 patient (0.5%); Type 9: 2 apicoanterior segmental arteries, 1 patient (0.5%); Type 10: 3 apicoanterior segmental arteries, 2 ascending segmental arteries, 1 patient (0.5%). Conclusion The types of pulmonary artery branches are predictable in some way. It would be helpful to reduce the risk of pulmonary artery injury and improve the operation safety by following the rules. Variations of pulmonary artery should be noticed to avoid the major bleeding due to the pulmonary artery injury.
ObjectiveTo explore the clinical applications of 3D-CT reconstruction combined with 3D printing in the analysis of anatomical types and variations of bilateral pulmonary arteries. MethodsFrom January 2019 to February 2022, the clinical data of 547 patients who underwent anatomical lung lesion resection in our hospital were retrospectively collected. They were divided into a 3D-CT reconstruction plus printing technology group (n=298, 87 males and 211 females aged 53.84±12.94 years), a 3D-CT reconstruction group (n=148, 55 males and 93 females aged 54.21±11.39 years), and a non-3D group (n=101, 28 males and 73 females aged 53.17±10.60 years). ResultsIn the 3D-CT reconstruction plus printing technology group, the operation time of patients (right: 125.61±20.99 min, left: 119.26±28.44 min) was shorter than that in the 3D-CT reconstruction group (right: 130.48±11.28 min, left: 125.51±10.59 min) and non-3D group (right: 134.45±10.20 min, left: 130.44±9.53 min), which was not associated with the site of surgery; intraoperative blood loss (right: 20.92±8.22 mL, left: 16.85±10.43 mL) was not statistically different compared with the 3D-CT reconstruction group (right: 21.13±8.97 mL, left: 19.09±7.01 mL), but was less than that of the non-3D group (right: 24.44±10.72 mL, left: 23.72±11.45 mL). Variation was found in the right pulmonary artery of 7 (3.91%) patients and in the left pulmonary artery of 21 (17.65%) patients. We first found four-branched lingual pulmonary artery in 2 patients.ConclusionPreoperative CT image computer-assisted 3D reconstruction combined with 3D printing technology can help surgeons to formulate accurate surgical plans, shorten operation time and reduce intraoperative blood loss.
Objective To investigate the impact of three kinds of palliative operation on the body and growth of pulmonary artery in patients with congenital heart diseases of diminutive pulmonary blood. Methods Clinical data was reviewed in 28 cases of congenital heart diseases with diminutive pulmonary blood who had been performed cavopulmonary connection （n = 9）, systemic-pulmonary shunt （n = 8 ）, and palliative reconstruction of right ventricular outflow tract （n=11）. The period between re-hospitalized and the first was 5-54 months （19.07±10. 06 months ）. Hematocrit （HCT）, hemoglobin （Hb）, percutaneous oxygen saturation （SpO2）, body surface area （BSA）, and pulmonary artery index （PAI） etc. were observed both before palliation and before the second operation. Results After the second hospitalization, there were 7 cases of death from hemorrhage, failure of circulation and extracorporeal circulation accident etc. The time of respirator, intensive care unit and total amount of dopamine in patients of palliative reconstruction of right ventricular outflow tract were longer and more than those in patients of cavopulmonary connection （P〈0. 05）. HCT, Hb before the second operation were decreased than thoes before palliative operations in all patients, SpO2, BSA and PAI increased significantly （P 〈 0. 01 ）. Before the second operation, BSA of patients with cavopulmonary connection, BSA and PAI of patients with systemic-pulmonary shunt, SpO2, BSA and PAI of patients with palliative reconstruction of right ventricular outflow tract were increased than those before palliative operations（P〈0. 01）. HCT of palliative reconstruction of right ventricular outflow tract was decreased（P〈0. 05）. Conclusion This results suggests that pulmonary blood of patients with congenital heart diseases of diminutive pulmonary blood can be increased, development of pulmonary arteries can be improved efficiently by systemic-pulmonary shunt and palliative reconstruction of right ventricle outflow tract, but it can not be found in cavopulmonary connection patients.