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.
Abstract： Objective To improve therapeutic outcomes for severe leftsided atrioventricular valve regurgitation (LAVVR) after repair of atrioventricular septal defect (AVSD) through discussing pathological changes of the valve and surgical management for these patients, and summarizing the medical experiences of perioperative managements. Methods We retrospectively analyzed the clinical data of 29 patients including 16 males and 13 females with LAVVR after repair of AVSD treated in Xinhua Hospital, Medical College of Shanghai Jiaotong University between January 1995 and December 2009. The age of these patients ranged from 4 to 62 years, averaging at 26.5. According the classification of New York Heart Association (NYHA), there were 10 patients of class Ⅱ, 17 of class Ⅲ and 2 of class Ⅳ before reoperation. Partial repair of AVSD had been carried out for 18 patients, and complete repair had been performed on 11 patients. At reoperation, valve rerepair was performed on 17 patients and mechanical valve replacement (MVR) was necessary in 12 patients. Results In the early period after operation, one patient died of multiple organ failure, one patient had a permanent pacemaker inserted because of complete atrioventricular block, and 1 patient aged 4 years got recovery after 56 hours of circulatory support for severe cardiac failure after reoperation. A mean follow-up of 8.2 years (6 months to 14 years) was done for 25 patients with 3 missing. During the follow-up for 14 patients undergone heart valve repair, there was no obvious acceleration of the forward blood flow of the leftside atrioventricular valve. Ten patients had mild or less LAVVR, 1 had moderate LAVVR and 3 underwent successful left atrioventricular valve replacement at 10 days, 3 years or 6 years after reoperation because of severe LAVVR. Clinical status, as assessed by the NYHA classification, improved after surgery for LAVVR in 25 patients who were followed up with 17 in NYHA class Ⅰ, 6 in class Ⅱ, and 2 in class Ⅲ. Podoid decreased significantly and cardiothoracic ratio was 0.53-0.67 (0.60±0.11) in chest Xray picture. There was no late death. Conclusion With timely surgical treatment, and appropriate surgical method, LAVVR after complete or partial AVSD repair can be managed with excellent shortterm and longterm outcomes.
ObjectiveTo investigate the effectiveness and safety of esophageal ultrasound-guided percutaneous femoral artery closure of ventricular septal defect (VSD).MethodsThe clinical data of 24 patients with congenital VSD in our hospital from March 2017 to December 2019 were retrospectively analyzed, including 6 males and 18 females, with a median age of 12 (3-42) years, weight of 32 (12-91) kg, and VSD diameter of 4 (3-7) mm. There were 3 patients with VSD combined with atrial septal defect.ResultsTwenty-four patients successfully underwent interventional closure of percutaneous femoral artery under esophageal ultrasound guidance, and the position and shape of the occluders were good. The operation time was 45 (39-54) min, and the waist size of the occluders was 7 (5-12) mm. Among the patients, 14 patients used symmetric ventricular occlusion devices, 8 patients used asymmetric ventricular occlusion devices, and 2 patients used ventricular occlusion muscle occluders. Small amount of residual shunt occurred in 2 patients after the operation and it disappeared 3 months after the operation. One patient with right bundle branch block, which disappeared after 1 week of observation. There were no complications such as occluder closure, pericardial effusion or valve regurgitation during the perioperative period. During the follow-up period [3-18 (9.25±5.04) months], no serious complication occurred.ConclusionTransesophageal ultrasound-guided transfemoral artery occlusion for VSD is simple and safe, and it avoids the damage of radiation and contrast medium. It has advantages over traditional percutaneous interventional occlusion therapy.
ObjectiveTo compare the outcome between two nutrition support methods, total enteral nutrition (TEN) and enteral nutrition combined with parenteral nutrition, in infants after ventricular septal defect (VSD) repair operation. MethodsWe retrospectively analyzed the clinical data of 76 infants who underwent VSD repair operation in Xinhua Hospital in 2012 year. There were 46 males and 35 females aged 1.6-11.9 (5.5±2.5) months. Nutrition support was started from the first day after operation. There were 35 patients in the group A with TEN 60 kcal/(kg·d), and 41 patients in the group B with both enteral nutrition at 30 kcal/(kg·d) and parenteral nutrition at 30 kcal/(kg·d). ResultsThere was no statistical difference between two groups in demography data and preoperative clinical indicators. The number of patients suffered abdominal distension and gastric retention was more in the group A (22.9% vs. 4.9%, 68.6% vs. 2.4%, P<0.05). There was no difference in diarrhea. The completion of nutrition support in the group A was worse than that in the group B. In the group A, only 40% of the goal calorie was finished on the first and the second day after operation. It was improved until the third day, and the goal calorie could be finished on the seventh day. In the group B, the nutrition support method could be finished on the first day. The prealbumin level in the group B was significantly higher on the third, fifth and seventh day (P<0.05). The blood urea nitrogen (BUN) level in the two groups on the first day after operation was higher than that before operation (P<0.05), and persisted in the group A, while decreased to the normal level gradually in the group B. Following up to discharge, the weight was higher and the length of stay was shorter in the group B (P<0.05). There was no statistical difference in the cost of hospitalization between the two groups (P>0.05). ConclusionThe nutrition support method, enteral nutrition combined with parenteral nutrition, is better than TEN for infants after VSD repair operation.
Objective To explore the feasibility and option of different surgeries for neonates with pulmonary atresia and ventricular septal defect (PA/VSD) through assessing the effect of common surgeries. Methods Fourteen neonates who underwent their first surgery in our center from July 2004 to October 2014 were included. Their basic characteristics, operation and pre- and postoperative clinical information were extracted. Follow up was conducted and the last visit was on October 10, 2016. Short- and midterm survival and total correction rate were compared among different surgeries. Results Among the 14 patients, there were 4 (28.6%) patients, 6 (42.9%) and 4 (28.6%) who underwent one-stage repair, right ventricular outflow tract (RVOT) reconstruction, and systemic to PA shunt operation respectively. The overall in-hospital mortality after the first operation was 28.6% (4/14). At last visit, no death occurred resulting the 5-year survival rate of 71.4% (10/14). The overall total correction rate for all neonates was 64.3% (9/14). Although no statistical difference was found in the mortality among the one-stage repair , RVOT reconstruction and systemic to PA shunt group(50.0% vs. 33.3% vs. 0.0%, P=0.280), the survival and hazard analysis implied better outcomes of the systemic to PA shunt palliation operation. There was no statistical difference in the total correction rate and months from the first palliative operation to correction between those who underwent RVOT reconstruction and systemic to PA shunt (75.0% vs. 50.0%, P=0.470; 32.0 months vs. 18.0 months, P=0.400). Conclusion Performing surgeries for neonates with PA/VSD is still a great challenge. However, the midterm survival rate was optimistic for the early survivors. Systematic to PA shunt seemed to be a better choice with lower mortality for the neonates with PA/VSD who need the surgery to survive.