Liu Yinglong

ASSA14-14-01 The application of minimally invasive open heart surgery through right subaxillary shorter incision for ventricular septal defects in infants weighted less than 5 Kg

Objective To explore the safety and outcome of minimally invasive open heart surgery for ventricular septal defects (VSD) in infants with low body weight. Method Eighty five infants weighted less than 5 Kg who had undergone repair of VSD through a right subaxillary short incision were surveyed (right group) and 113 patients of the same weight were surveyed who had undergone the repair of VSD through a median sternotomy (median group). Preoperative data, perioperative parameters, mortality and morbility were investigated for retrospective analysis. Results Most of the preoperative data in right group and median group were similar (p > 0.05) except that the body weight, (4.61 ± 0.41 Kg vs 4.95 ± 1.18 Kg, p < 0.05), body surface area (0.27 ± 0.02 m2 vs 0.28 ± 0.01 m2, p < 0.05), the incidence of preoperative pneumonia history (44.2% vs 64.7%, p < 0.05) in median group were lower than that of right group (p < 0.05). Compared with median group, right group was with shorter incision (6.01 ± 0.85 cm vs 9.13 ± 1.04 cm, p < 0.05), length of operative time (143.64 ± 22.41 min vs 152.12 ± 22.80 min, p < 0.05) and postoperative stay (7.13 ± 2.60 vs 8.86 ± 3.67, p < 0.05), and less drainage (14.47 ± 4.99 ml/Kg vs 17.21 ± 10.98 ml/Kg, p < 0.05) and transfusion of red blood cell (10.34 ± 9.70 ml/Kg vs 14.60 ± 1.59 ml/Kg, p < 0.05). There were no deaths and low incidence of complications in both groups, and without significant difference between them (p > 0.05). Conclusion The minimally invasive open heart surgery through right subaxillary short incision for VSD in infants with low body weight was safe and effective.

ASSA14-14-02 The application of Bidirectional Cavopulmonary Shunt in Patients With Anomalies of Systemic and/or Pulmonary Venous Drainage

Objective To explore the effect of the bidirectional Glenn procedure on complex cardiac malformations with anomalies of systemic venous drainage (ASVD), pulmonary venous drainage (APVD), or both. Methods Between March 2010 and December 2013, 29 patients with anomalous systemic or pulmonary venous drainage underwent bidirectional cavopulmonary shunt. The man age of these patients was (60.8 ± 49.6) months and the mean weight was weight (17.6 ± 10.4) kg. A combination of anomalous systemic and pulmonary venous drainage was present in 3 patients, whereas 20 patients had anomalous drainage only from the systemic circulation and 6 patients had isolated anomalies of pulmonary venous return. Results All the patients underwent unilateral or bilateral bidirectional Glenn operation, and the associated procedures included ligation of small left superior vena cava in 3 patients, modified BT shunt to left pulmonary artery in 1 patient, correction of anomalous pulmonary venous drainage in 3 patients, atrioventricular valvuloplasty in 4 patients, pulmonary banding in 3 patients. There were 1 (3.4%) early death due to malignant arrhythmias. Two patients required for reoperation for bleeding, 2 patients developed pericardial effusion, 1 patient developed cerebral embolism and 1 patient developed wound dehiscence. At a mean follow-up of (17.4 ± 10.9) months, no death occurred, the mean blood oxygen saturation was (84 ± 6)%, and 2 patients have undergone total cavopulmonary connexion. One patient received radiofrequency ablation for WPW syndrome, and two patients need medication for decreasing pulmonary artery pressure. Conclusion Bidirectional cavopulmonary shunt can be performed in patients with anomalous systemic or/and pulmonary venous drainage with satisfactory early and mid-term outcomes. The combination of multiple surgical procedures may be an important way to improve outcomes.

Single-stage surgical repair of a complex pathology in Williams syndrome

Williams syndrome is caused by a gene deletion of chromosome 7. A majority of the cases are sporadic with typical facial appearance, cardiac anomalies, and mental retardation. We report a rare case of Williams syndrome associated with supravalvular aortic stenosis, subvalvular aortic membrane, mitral regurgitation, aortic coarctation, and patent ductus arteriosus. The patient had undergone a single-stage surgical repair with satisfactory results at 5 months of follow-up.

SURGICAL TREATMENT OF FIVE PATIENTS WITH INTERRUPTED AORTIC ARCH AND AORTOPULMONARY WINDOW

Objectives To summarised review the surgical experience of single stage repair of interrupted aortic arch (IAA) associated with aortopulmonary window (APW) in five patients. Methods Between December 1997 and December 2009, five patients (male 4, female 1) diagnosed IAA with APW were surgically repaired. The operative age was 1.7 months-13 years (median age, 1.6 years) old and body weight was 4.7–26 kg. Three patients were IAA type A and 1 type B as well as 1 type C. Two patients were APW type I and 3 type III. The associated anomalies included aortic origin of the right pulmonary artery, subvalvular aortic stenosis, mitral regurgitation and atrial septal defect. Extracorporeal circulation was intubed through patent ductus arteriosus in three cases and femoral artery associated with ascending aorta in two cases. Aortic arch was rebuilded by profound hypothermia circulation arrest and end-to-side anastomosis directly or broadly with pericardium. Ascending aorta was blocked highly and APW was patched after cardioplegia. Results One case died of pulmonary hypertension crisis. There were one case of tracheotomy and one case recurred severe pulmonary hypertension at average 22 months follow-up. Conclusions IAA associated APW is a rare congenital cardiac anomaly that accounts for high mortality in infant because of progressive pulmonary hypertension. Once definite diagnosis, primary single stage repair should be used as the first choice, and will achieve high successful rate and good long-term prognosis. Ultrasound cardiogram, cardiovascular CT and angiocardiography can reduce misdiagnosis. A median sternotomy incision was made, and the entire arch vessels were mobilised. Cardiopulmonary bypass was instituted between a single venous cannula in the right atrial appendage and a single arterial cannula in the distal portion of the ascending aorta. Such as complex aortic arch abnormalities, pulmonary thick expansion can also be used to establish cardiopulmonary bypass through the femoral artery. The APW was closed through aortic way in order to reveal the edge of the defect, the aortic valve and coronary artery. Accurate preoperative prediction of pulmonary artery pressure, conscious sedation, hyperventilation slightly, vasodilating agent and vasoactive drugs are of great important in preventing pulmonary hypertension crisis.