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Coarctation of the Aorta with Aortic Arch Hypoplasia：Midterm Outcomes of Aortic Arch Reconstruction with Autologous Pulmonary Artery Patch

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Chinese Medical Journal 2017年第23期130卷 2802-2807页

作者： Zhi-Ling Ma Jun Yan Shou-Jun Li Zhong-Dong Hua Fu-Xia Yan Xu Wang Qiang Wang Pediatric cardiac surgical Center Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background： Coarctation of the aorta （CoA） with aortic arch hypoplasia （AAH） is a relatively common congenital heart disease in clinical practice. Nonetheless, the corrective surgical technique for infants and children is a clinical problem that remains controversial. In this study, we sought to evaluate the surgical effects of aortic arch （AA） reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch for infants and young children with CoA and AAH. Methods： Between January 2009 and December 2015, a total of 22 infants and young children with CoA and AAH who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch were enrolled in this study. The median age of patients was 4.5 （Q1, Q3： 2.0, 14.0） months and the median body weight was 5.75 （Q1, Q3： 4.10, 9.38） kg. All patients were diagnosed with CoA and AAH, and concomitant cardiac anomalies were corrected in one stage. Perioperative and postoperative data were collected and analyzed using the paired sample t-test. Results： No perioperative deaths occurred. No residual obstruction was detected by echocardiography. The postoperative pressure difference across the repaired segment of CoA was 14.05 ± 4.26 mmHg （1 mmHg = 0.133 kPa）, which was smaller than the preoperative pressure difference （48.30 ± 15.73 mmHg; t = -10.119, P 〈 0.001）. The median follow-up time was 29.0 （Q1, Q3： 15.5, 57.3） months. There was no death during the follow-up period, and all patients experienced obvious clinical improvement. Only one child underwent subsequent aortic balloon angioplasty due to restenosis. Computed tomography angiography showed that the AA morphology was smooth, with no aortic aneurysm or angulation deformity. Conclusion： AA reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch could effectively correct CoA with AAH, and the rate of reintervention for restenosis is low.

关键词： Aortic Arch Hypoplasia: Aortic Arch Reconstruction: Aortic Coarctation cardiac surgical procedures Congenital HcartDisease

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Clinical features and long-term prognosis of patients with anomalous origin of the left coronary artery from the pulmonary artery

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Chinese Medical Journal 2010年第20期123卷 2888-2894页

作者： ZHENG Jian-yong HAN Ling DING Wen-hong JIN Mei ZHANG Gui-zhen XIAO Yan-yan LUO Yi CHENG Pei MENG Xu ZHAO Qu-ming Department of Pediatric Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China Department of cardiac Surgery Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China

Background Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare congenital heart anomaly. We aimed to illustrate the clinical features and long-term prognosis of patients with *** Twenty three patients （13 males and 10 females, ages ranging from 2.5 months to 65 years） identified as ALCAPA in Beijing Anzhen Hospital from April 1984 to June 2009 were divided into two groups, based on the age of onset： group 1 （≤12 months, n=16） and group 2 （〉12 months, n=7）.Results Fifty six point three percent of patients in group 1 had been misdiagnosed as endocardial fibroelastosis （9/16）,18.8% as dilated cardiomyopathy （3/16） and 6.3% as myocardial infarction （1/16）. Patients in group 2 were usually diagnosed as coronary heart disease, myocarditis, or patent ductus arteriosus. Electrocardiography in group 1 revealed abnormal Q waves with T wave inversion in leads I, avL, V4-V6, especially in lead avL （deep and wide Q wave）; but no specific manifestations in group 2. A higher percentage of patients in group 1 had cardiomegaly on chest radiograph （86.7% vs. 33.3%, P=0.031）, while pulmonary artery protrusion was more common in group 2 （26.7% vs. 83.3%,P=0.046）. Lower left ventricular ejection fraction （LVEF） was present in group 1 than in group 2 （（48.5±11.5）% vs.（65.0±6.1）%, P 〈0.001）. Apical ventricular aneurysm （62.5% vs. 0%, P=0.007）, enhanced echogenicity of papillary muscles （87.5% vs. 28.6%, P=0.011） and endocardial thickening （93.8% vs. 14.3%, P 〈0.001） were more frequent in group 1 than in group 2. The ratio of the proximal right coronary artery （RCA） diameter to the aortic root diameter exceeded 0.14 in all cases, more prominent in group 2 （0.26±0.05 vs. 0.33±0.03, P=0.009）. Increased coronary artery collaterals within the interventricular septum were detected in 18 patients （78.3%） by Doppler imaging. Twenty one patients underwent cardiac surgery, including left coronary artery （LCA） ligation （1/21）, LCA ligation plus corona

关键词： coronary artery disease pulmonary artery electrocardiography echocardiography cardiac surgical procedures

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surgical treatment of anterior mitral valve prolapse using artificial chordae loop

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Chinese Medical Journal 2010年第22期123卷 3351-3353页

作者： LI Ji-yong ZHOU Qi-wen ZHANG Jian-qun ZHANG Fu-en HE Yi-hua Department of cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Ultrasonic Diagnosis Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Artificial chordae replacement with expanded polytetrafluoroethylene （ePTFE; Gore-Tex, *** and Associates Inc., Flagstaff, AZ, USA） is an established technique for mitral valve repair with excellent long-term results. There is growing interest in the application of artificial chordae to correct mitral valve regurgitation caused by anterior leaflet prolapse. Application of pre-measured artificial chordae facilitates creation of chordae with appropriate length. The aim of this study was to illustrate the technique for creation of pre-measured artificial chordae.

关键词： anterior leaflet prolapse artificial chordae loop cardiac surgical procedures

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Surgery for sinus of Valsalva aneurysm： 33-year of a single center experience

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Chinese Medical Journal 2014年第23期127卷 4066-4070页

作者： Yan Fei Murat Abudureheman Huo Qiang Askaer Shabiti Zhu Tao Liu Zhen Department of cardiac Surgery First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang 830011 China

Background Sinus of Valsalva aneurysm （SVA） is a rare anomaly and few large or long-term series are well *** study was designed to review 33-year surgical experience of SVA in one *** From August 1980 to December 2013,patients with SVA underwent surgical repair were retrospectively *** A total of 160 patients were identified with mean age of （30±12） years and 112 （70％） of them were *** right coronary sinus origin of SVA was found in 108 patients （67.5％）,the non-coronary sinus in 51 patients （31.9％）,and the left coronary sinus in one patient （0.6％）.The rupture of 3VA into the right ventricle was identified in 89 （55.6％） cases,the right atrium in 61 （38.1％）,the left ventricle in 2 （1.3％） and no rupture in 8 （5.0％）.Ventricular septal defect （VSD） and aortic regurgitation （AR） were found in 59 （37％） and 45 （28％） patients *** approach via the involved chamber was used in 86 patients （54％）,aortotomy in 8 （5％）,and a combined approach in 66 （41％）.Either direct suture （56,35％） or patch （104,65％） closure were used to repair the *** VSD was closed with a patch （44/59,75％） or direct suture （15/59,25％）.aortic valve replacement （AVR） was performed in 23/45 （51％） and aortic valvuloplasty （AVP） in 9/45 （20％） patients combined with *** were 3 hospital deaths （1.9％） and 2 late deaths and 84％ of the patients were followed up for （17.6±4.2） *** York Heart Association functional class improved significantly after surgery （P＜0.01）.Actuarial survival was 94％ at 10 years,and 88％ at 20 *** surgical treatment of SVA is safe and effective,ruptured SVA or unruptured SVA with VSD and/or AR should be repaired surgically as early as ***,late progressive AR is still a risk during long-term follow-up,and early aggressive measures are *** include more use of a combined approach to achieve optimal evaluation of lesions,more patch repairs to reduce the chance of recurrence,and more AVR in pati

关键词： sinus of Valsalva aortic regurgitation ventricular septal defect cardiac surgical procedures

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The Use of the Ratio between the Veno-arterial Carbon Dioxide Difference and the Arterial-venous Oxygen Difference to Guide Resuscitation in cardiac Surgery Patients with Hyperlactatemia and Normal Central Venous Oxygen Saturation

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Chinese Medical Journal 2015年第10期128卷 1306-1313页

作者： WeiDu YunLong Xiao-TingWang Da-WeiLiu Department of Critical Care Medicine Peking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China

Background：After cardiac surgery,central venous oxygen saturation （ScvO2） and serum lactate concentration are often used to guide resuscitation;however,neither are completely reliable indicators of global tissue *** observational study aimed to establish whether the ratio between the veno-arterial carbon dioxide and the arterial-venous oxygen differences （P（v-a）CO2/C（a-v）O2） could predict whether patients would respond to resuscitation by increasing oxygen delivery （DO2）.Methods：We selected 72 patients from a cohort of 290 who had undergone cardiac surgery in our institution between January 2012 and August *** selected patients were managed postoperatively on the Intensive Care Unit,had a normal ScvO2,elevated serum lactate concentration,and responded to resuscitation by increasing DO2 by 〉10%.As a consequence,48 patients responded with an increase in oxygen consumption （VO2） while VO2 was static or fell in ***：At baseline and before resuscitative intervention in postoperative cardiac surgery patients,a P（v-a）CO2/C（a-v）O2 ratio ≥1.6 mmHg/ml predicted a positive VO2 response to an increase in DO2 of〉1 0% with a sensitivity of 68.8% and a specificity of 87.5%.Conclusions：P（v-a）CO2/C（a-v）O2 ratio appears to be a reliable marker of global anaerobic metabolism and predicts response to DO2 ***,patients likely to benefit from resuscitation can be identified promptly,the P（v-a）CO2/C（a-v）O2 ratio may,therefore,be a useful resuscitation target.

关键词： cardiac surgical procedures Lactic Acid Physiologic Monitoring Resuscitation

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Aortic implantation for anomalous origin of the left coronary artery from the pulmonary artery:A ten-year single center experience

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South China Journal of Cardiology 2017年第4期18卷 272-277,286页

作者：郭海江庄建陈寄梅许刚岑坚正温树生滕云 Department of cardiac Surgery Guangdong General Hospital Guangdong Academic of Medical ScienceGuangdong Cardiovascular Institute Guangdong Provincial Key Laboratory of South China Structural Heart Disease

Background At present, creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery （ALCAPA）. However, controversy still exists over the initial management of mitral regurgitation （MR） at the time of ALCAPA repair. Methods Between March 2005 and March 2015, 52 consecutive patients （20 males and 32 females） underwent direct aortic implantation of ALCAPA. Median age at surgery was 10 months （range, 2 to 193）. Mean weight was 9.7_＋7.8 kg. In order to facilitate the analysis, description of MR was given a numeric grade： 0 = none, 1 = trivial, 2 = mild, 2.5 = mild-moderate, 3 = moderate, 3.5 = moderate-severe, and 4 = severe. Results The LV shortening fraction （LVFS） demonstrated significant improvement between presentation and discharge （32.1±10.1% vs. 28.6±9.6%, P = 0.023）, and there was also significant improvement in the mean MR grade between presentation and discharge （2.40＋1.16 vs. 2.91＋ 1.19, P = 0.001）. There were 4 hospital deaths （7.7%）. The median follow-up was 21 months （range 1.5 to 111）, 3 patients （5.8%） were lost to follow-up, 1 patient required reoperation for mitral valve replacement. Significant improvement was seen in LVFS between discharge and late follow-up （38.0±6.0% vs. 32.1±10.1%, P = 0.001）, however, the degree of MR did not dem- onstrate further change （2.29_＋1.20 vs. 2.40＋1.16, P = 0.541）. Conclusion Creation of a dual coronary system with direct aortic implantation of the left coronary artery results in complete recovery of left ventricular function. Concomitant mitral valve （MV） repair for ALCAPA patients with moderate-severe and severe MR is helpful to early MV function recovery.

关键词： heart defects, congenital cardiac surgical procedures left coronary artery anomalous origin pulmonary artery mitral regurgitation

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Diagnosis and treatment of traumatic tricuspid valve insufficiency

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Chinese Journal of Traumatology 2003年第6期6卷 379-381页

作者：姜春力谷天祥章志伟修宗谊 Department of cardiac Surgery First Affiliated Hospital of China Medical University

Traumatic tricuspid valve insufficiency (TTVI) is a relatively uncommon disease. To summarize the experience in the diagnosis and treatment of TTVI, we have analyzed the clinical data of 3 patients with TTVI who were admitted to the department of cardiac surgery of our hospital between April 1997 to April 2002. Relevant literatures have also been reviewed.

关键词： Heart Valve Prosthesis Accidents, Traffic Adult cardiac surgical procedures Electrocardiography Follow-Up Studies Heart Injuries Humans Injury Severity Score Male Middle Aged Multiple Trauma Risk Assessment Sampling Studies Treatment Outcome Tricuspid Valve Insufficiency

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