Objective To investigate the hemodynamic performance of valved bovine jugular vein conduits (BJVC) for right ventricular outflow tract reconstruction in canine model. Methods The BJVC that were treated with the glutaraldehyde were implanted between the pulmonary artery and right ventricle in seven young canines. Right ventricular and pulmonary artery pressures were measured directly before and after the implantation. Hemodynamic evaluations were carried out by echocardiography and cardiac catheterization after the implantation. Results Seven canines were survival one year after the implantation. The pulmonary artery pressures (including systolic pressure, diastolic pressure and mean pressure) had not significantly changed after reconstruction with the conduits. The right ventricular diastolic pressures had not increased after the reconstruction, but the right ventricular systolic pressure and mean pressure had increased. One year later, the echocardiography showed valve motion with no obvious thickening of the leaflets. No graft kinking or obvious regurgitation of the valve was observed. Cardiac catheterization and angiography showed that the pressure gradients between the right ventricle and the conduits varied from 3 to 19mmHg, the diastolic pressures in the conduits were higher than that of right ventricle((Plt;)0.01), and the conduits and pulmonary arteries had no obvious obstruction. Conclusion The glutaraldehyde-fixed bovine jugular vein conduit has good hemodynamic performance in the pulmonary circulation.
Objective Comparing postoperative change of blood gas and hemodynamic status in patients underwent a right ventricletopulmonary artery (RVPA) conduit or a modified BlalockTaussig (mBT) shunt for pulmonary atresia with ventricular septal defect and without major arterial pulmonary collaterals (MAPCAs), to affirm the effect on oxygen supply /demand with different procedure. Methods From July 2006 to October 2007, 38 patients with pulmonary atresia and ventricular septal defect without MAPCAs were divided into two groups according to different procedures: RVPA group (n=25) and mBT group (n=13).Perioperative mortality, blood gas and hemodynamic data during postoperative 48 hours, including heart rate, blood pressure, systemic oxygen saturation, mixed venous oxygen saturation, oxygen excess factor, inotropic score were compared in both groups. Results The difference in the mortality between RVPA group (4.0％，1/25) and mBT group （7.7％，1/13) showed no statistical significance（Pgt;0.05）. The total of 33 patients were followed up, the followup time was from 6 to 18 months.11 patients (4 patients in mBT group, 7 patients in RVPA group) underwent corrected procedures during 9 to 18 months after palliative procedures, one case died of elevated pulmonary vascular resistance and right ventricle failure. The mixed venous oxygen saturation at 24h and 48h after surgery were higher than that at 6h after surgery (Plt;0.01) both in RVPA group and mBT group. The systolic blood pressures at 6h, 24h, 48h after surgery in RVPA group were lower than those in mBT group (P=0.048，0.043， 0.045)，the mean systemic blood pressures in RVPA group were higher than those in mBT group (P=0.048, 0.046, 0.049),the diastolic blood pressures in RVPA group were higher than those in mBT group (P=0.038, 0.034, 0.040)， the inotropic scores in RVPA group were lower than those in mBT group (P=0.035， 0.032，0.047). Conclusion The blood pressures and inotropic scores are found significantly different in RVPA conduit and mBT procedures, while postoperative systemic oxygen delivery areequivalent. Both RVPA and mBT patients decline to nadir in hemodynamic status at 6 h after surgery.
Objective To optimize the surgical strategies and managements of doubleoutlet right ventricle(DORV)with atrioventricular discordance, the anatomic features, the surgical managements and results were reviewed. Methods From September 1990 to August 2004, 7 cases of DORV with atrioventricular discordance received surgical therapy. The age ranged from 3 years to 7 years. Surgical managements included: ventricular septal defect (VSD )repair and homograft connected the morphologic left ventricle with pulmonary artery in 3 cases, double-switch in 2 cases, modified Fontan in 2 cases. Results The early mortality rate was 14.3% (1/7). The death was because by Homograft infection 2 months after repair. Complete atrioventricular block occurred in one case who received permanent pacemaker later. Obstruction of superior vena cava return and pericardial effusion occurred in one Fontan case who was recovered at the time of discharge. The time of ICU stay was shortest in double-switch patients in 6 days postoperation. Conclusion Double-switch operation is the first choice in correction of DORV with atrioventricular discordance, especially in patients with right ventricular disfunction or tricuspidal regurgitation. If the heart can not be corrected because of combined complicated malformations, the strategy of one ventricular repair can be chosen.
ObjectiveTo investigate effect of cardiac function and tricuspid regurgitation (TR) degree of concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent mitral valve replacement (MVR), and provide an objective basis for clinical decision about concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR. MethodsA total of 36 patients who underwent MVR from April to October 2013 in Department of Cardiovascular Surgery, West China Hospital, Sichuan University were enrolled in this study. Preoperative echocardiography showed mild TR and tricuspid valve annular end-diastolic dimension (TVAEDD)/body surface area (BSA)>21 mm/m2. All the 36 patients were randomly divided into a tricuspid annuloplasty group (TAPG group, n=18, including 7 males and 11 females) and a no tricuspid annuloplasty group (NTAPG group, n=18, including 6 males and 12 females). One week and 6 months postoperative echocardiography were recorded. ResultsThere were no statistical differences in age, gender, heart rate, body surface area, preoperative cardiac function (NYHA), left atrium dimension (LAD), left ventricular dimension (LVD), maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension (RVD2), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) between the two groups (P>0.05). Six-months postoperative left atrial-ventricular diameter significantly reduced than that before surgery in the two groups (P<0.05). In the TAPG group, six-months postoperative right ventricle dimension (RVD1), right ventricular wall thickness (RVWT), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) significantly decreased, while percent shorting of tricuspid valve annulus (PSTVA) did not change significantly (P>0.05), TR degree improved significantly (P<0.05), right ventricular fractional area change (RVFAC) and right ventricular ejection fraction (RVEF) significantly increased (P<0.05). In the NTAPG group, compared with preoperative data, six-months postoperative RVD1, RVWT significantly increased, TVAEDD, TVAESD, PSTVA did not change significantly (P>0.05), RVEF reduced significantly (P<0.05), RVFAC increased significantly but less than that in the TAPG group at the same period, constituent ratio of TR changed significantly (P<0.05), but postoperative moderate or more TR were recorded in 6 patients. ConclusionConcomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent mitral valve replacement (MVR) can help to decrease RVD1, RVWT, TVAEDD and TVAESD, improve the constituent ratio of TR, and increase RVFAC and RVEF.
Follow the advance of surgical treatment in complex congenital heart disease, the application of right ventricular(RV)-bypass procedures in RV-hypoplasia/dysfunction was gradually recognized; the pathological pattern of RV-hypoplasia/dysfunction, the histological change of RV-bypass operation and the option on different operative procedure, emphasis on the indication of bidirectional superior cavopulmonary anastomosis(BCPA),the form and method of procedure,and peri-operative management were reviewed in this paper,the optimal age for BCPA, the optimal timing for conversion to Fontan procedure, on pump or off pump, section of the pulmonary trunk, and its difference from hemi-Fontan and 1 1/2 ventricular operation were discussed.
ObjectiveTo investigate pulmonary artery growth, valvular regurgitation and right heart function after right ventricle-pulmonary artery (RV-PA) anastomosis for right ventricle outflow (RVOT) reconstruction in patients with different types of pulmonary atresia and ventricle septal defect (PA/VSD). MethodsClinical data of 31 PA/VSD patients who underwent right ventricle-pulmonary anastomosis for RVOT reconstruction from November 2002 to September 2012 in Guangdong General Hospital were retrospectively analyzed. There were 20 male and 11 female patients with their age ranging from 14 days to 14.50 years (47.90±53.84 months). Patients were followed up after discharge to evaluate the anastomasis, pulmonary artery growth, pulmonary artery and tricuspid regurgitation and their relationship with follow-up duration. Right ventricular strain and other echocardiography indexes were used to evaluate right heart function. ResultsThree patients died postoperatively. Twenty-seven patients (27/31, 87.1%)were followed up for 4-129 (35.97±28.24)months. There was no late death during follow-up. There was no anastomotic restenosis in patients who received radical surgery. Four patients who received palliative surgery had comparative anastomotic restenosis. The diameters of RV-PA anastomasis, left and right branches of the pulmonary artery during follow-up were significantly larger than early postoperative diameters (P < 0.05). Echocardiography showed that pulmonary artery and tricuspid regurgitation were aggravated, which was not correlated to follow-up duration. Overall right heart function was good during follow-up. ConclusionsClinical outcomes of RV-PA anastomosis for RVOT reconstruction in patients with PA/VSD are satisfactory. RV-PA anastomasis, left and right branches of the pulmonary artery can keep their growth and development. Mid-term and long-term right heart function is good.