Double-root translocation for double-outlet right ventricle with noncommitted ventricular septal defect or double-outlet right ventricle with subpulmonary ventricular septal defect associated with pulmonary stenosis: an optimized solution.

BACKGROUND:Biventricular repair of double-outlet right ventricle (DORV) with noncommitted ventricular septal defect (VSD) or subpulmonary VSD, associated with pulmonary stenosis, remains controversial. The usual technique, Rastelli or réparation à l'étage ventriculaire (REV) procedure, may not meet a perfect biventricular outflow tract reconstruction in terms of hemodynamic performance and long-term outcome. Here we present an early result of an alternative solution for these anomalies by double-root translocation technique.METHODS:Between August 2006 and August 2009, a total of 10 consecutive patients underwent a double-root translocation procedure, at a median age of 48 +/- 55 months (range, 1 to 16 years). The VSD was repaired with a Dacron patch, and VSD enlargement was done in 3 patients. The aortic translocation was done with (n = 4) or without (n = 6) coronary reimplantation. The neopulmonary artery was reconstructed with a monocusp bovine jugular vein patch (n = 8) or a homograft patch (n = 2). The mean follow-up interval was 21.9 +/- 11 months (range, 2 to 36). Biventricular outflow tract function was assessed by echocardiography.RESULTS:There were no early or late deaths, and no required reoperations. Two patients required early support by extracorporeal membrane oxygenation. Postoperative echocardiography showed satisfactory hemodynamic effect of the reconstructed biventricular outflow tract and ventricular function. One patient had trivial aortic regurgitation and 4 patients had trivial or mild pulmonary insufficiency in follow-up.CONCLUSIONS:The early results showed an optimized solution for DORV with noncommitted VSD or DORV with subpulmonary VSD, associated with pulmonary stenosis. Long-term benefits need to be evaluated with a larger number of patients and longer follow-up.

[Value of balloon atrial septostomy in hybrid procedure for patients with complex congenital heart disease].

OBJECTIVE:To access the value of balloon atrial septostomy (BAS) in hybrid procedure for patients with complex congenital heart disease.METHODS:From September 2000 to February 2008, ten patients with complex congenital heart disease underwent BAS before surgical radical therapy with the guidance of X-ray or transthoracic echocardiography. Eight patients (ages from 2 days to 50 days) were complete transposition of great arteries (TGA), and two patients (age was 60 days, 39 years respectively) were total anomalous of pulmonary venous connexion (TAPVC) with restrictive atrial septal defect.RESULTS:All procedure achieved successfully, no severe complications occurred. The average oxygen saturation of femoral arteries of patients increased from 68.3% (pre-procedure) to 81.8% (post-procedure) significantly. the status in short of oxygen of all patients improved immediately. All patients survived until a surgical radical therapy. After successful operations, nine patients discharged, only one patient died of disorder of electrolyte.CONCLUSION:BAS was a ideal palliate therapy for some cyanotic complex congenital heart disease, and can play a important role in hybrid procedure for patients with complex congenital heart disease.

[One-stop hybrid cardiac surgery for neonates and young children with congenital heart disease].

OBJECTIVE:To summarize our 5 years experiences of one-stop hybrid procedure (OHP) for the management of congenital heart disease (CHD) in neonates and young children (< 2 years old).METHODS:Clinical data derived from consecutive 152 young children and neonates with CHD underwent OHP between March 2004 to March 2009 were analyzed. Patients were divided into 3 groups: Balloon plasty group (n = 72), device closure group (n = 43) and collateral arteries occlusion group (n = 37). All procedures were image-guided and performed in a specially designed hybrid operation room. Incidence of major adverse cardiovascular events was obtained.RESULTS:Patients received successful per-ventricular valvuloplasty or per-aortic balloon angioplasty in balloon plasty group. Two patients in this group with severe right ventricle outflow obstruction received regular open-heart outflow tract reconstruction immediately (n = 1) or selective conventional open-heart operation after discharge (n = 1). One neonate with pulmonary atresia with intact ventricular septum died from liver failure 6 month after OHP. In device closure group, device closure was failed in 3 cases (2 with atrial and 1 with ventricular septum defects), 1 young child with ventricular septum defects died from pneumonia after successful device closure. No device malposition was observed in device closure group during the follow-up. All patients received major collateral arteries occlusion and open-heart correction were discharged without complication.CONCLUSION:OHP could avoid or shorten the application of cardiopulmonary bypass and reduce the surgical trauma in selected young children with CHD. Although OHP was feasible and safe, the image outfits, image-guided technology and OHP-related device should be further developed and improved for better procedure outcome.

Strategy for biventricular outflow tract reconstruction: Rastelli, REV, or Nikaidoh procedure?

OBJECTIVE:Three techniques have been developed as the surgical management for patients with anomalies of ventriculoarterial connection, ventricular septal defect, and pulmonary outflow tract obstruction (stenosis): the Rastelli, Lecompte, (REV), and Nikaidoh procedures. This study was designed to compare these procedures in terms of hemodynamics of the reconstructed biventricular outflow tract, early clinical consequences, and follow-up.METHODS:Between March 2004 and September 2006, a total of 30 consecutive patients underwent double root translocation procedures (modified Nikaidoh n = 11, REV n = 7, Rastelli n = 12). In the Nikaidoh procedure, both aortic and pulmonary roots were translocated. A single-valved bovine jugular vein patch was used to repair the stenotic pulmonary artery in both Nikaidoh and REV procedures. The Senning procedure was added for those with atrioventricular discordance.RESULTS:The Nikaidoh procedure was the most time-consuming in terms of mean cardiopulmonary bypass and aortic crossclamp times. The average mechanical ventilation time was significantly shorter in the Rastelli group (63.3 +/- 89 hours) than that in the Nikaidoh group (188.7 +/- 159 hours, P = .016), but not different from that in the REV group (76.4 +/- 112.5 hours, P = .395). Two patients in the REV group and 1 in the Rastelli group died. There were no in-hospital or late deaths in the Nikaidoh group. Postoperative echocardiography demonstrated physiologic hemodynamics in the left ventricular outflow tract and normal heart function in the Nikaidoh group. Abnormal flow pattern in the left ventricular outflow tract was noted in both REV and Rastelli groups. There were no late deaths or reoperations in any group during follow-up.CONCLUSION:The modified Nikaidoh procedure is a better surgical option for transposition of the great arteries, ventricular septal defect, and pulmonary stenosis in terms of physiologic cardiac hemodynamics. Its long-term benefits need to be evaluated with a larger number of patients and longer follow-up.

Open-chest device closure for the minimally invasive management of atrial septal defect in young children.

BACKGROUND:We integrated a catheter-based device and minimally invasive surgical techniques for the treatment of atrial septal defect for children younger than 2 years old.METHODS:Forty-three patients were divided into 3 groups: group A underwent open-chest device closure with a right lateral thoracotomy (n = 12), group B underwent open-heart repair with a right lateral thoracotomy and cardiopulmonary bypass (n = 11), and group C underwent open-heart repair with a median thoracotomy and cardiopulmonary bypass (n = 20).RESULTS:Group A had the lowest weight (9.25 +/- 1.3 kg) and smallest defect size (10.25 +/- 3.9 mm). In group A, 2 patients had to be transitioned to open-heart repair after unsuccessful occlusion. Compared with the open-heart groups, the device group had a shorter total operation time (111 +/- 39 minutes), required the minimum amount of blood products (39 +/- 38 mL), and had a smaller amount of pleural drainage in the first 12 hours after the procedure (29 +/- 12 mL). All patients were discharged. The right ventricular end-diastolic diameter reduced significantly after the repair; furthermore, there was no difference in the size of reduction. However, the device group had the highest medical costs (30,639 +/- 3831 Chinese yuan). During the follow-up, there were no occluder-related complications observed in Group A, and there were no residual shunts or arrhythmia observed in the groups.CONCLUSIONS:The open-chest device closure was safely performed as a supplement for percutaneous treatment for young children.

Hybrid procedure for the neonatal management of pulmonary atresia with intact ventricular septum.

Double-root translocation for double-outlet right ventricle with noncommitted ventricular septal defect or double-outlet right ventricle with subpulmonary ventricular septal defect associated with pulmonary stenosis: an optimized solution.

BACKGROUND:Biventricular repair of double-outlet right ventricle (DORV) with noncommitted ventricular septal defect (VSD) or subpulmonary VSD, associated with pulmonary stenosis, remains controversial. The usual technique, Rastelli or réparation à l'étage ventriculaire (REV) procedure, may not meet a perfect biventricular outflow tract reconstruction in terms of hemodynamic performance and long-term outcome. Here we present an early result of an alternative solution for these anomalies by double-root translocation technique.METHODS:Between August 2006 and August 2009, a total of 10 consecutive patients underwent a double-root translocation procedure, at a median age of 48 +/- 55 months (range, 1 to 16 years). The VSD was repaired with a Dacron patch, and VSD enlargement was done in 3 patients. The aortic translocation was done with (n = 4) or without (n = 6) coronary reimplantation. The neopulmonary artery was reconstructed with a monocusp bovine jugular vein patch (n = 8) or a homograft patch (n = 2). The mean follow-up interval was 21.9 +/- 11 months (range, 2 to 36). Biventricular outflow tract function was assessed by echocardiography.RESULTS:There were no early or late deaths, and no required reoperations. Two patients required early support by extracorporeal membrane oxygenation. Postoperative echocardiography showed satisfactory hemodynamic effect of the reconstructed biventricular outflow tract and ventricular function. One patient had trivial aortic regurgitation and 4 patients had trivial or mild pulmonary insufficiency in follow-up.CONCLUSIONS:The early results showed an optimized solution for DORV with noncommitted VSD or DORV with subpulmonary VSD, associated with pulmonary stenosis. Long-term benefits need to be evaluated with a larger number of patients and longer follow-up.

[Value of balloon atrial septostomy in hybrid procedure for patients with complex congenital heart disease].

OBJECTIVE:To access the value of balloon atrial septostomy (BAS) in hybrid procedure for patients with complex congenital heart disease.METHODS:From September 2000 to February 2008, ten patients with complex congenital heart disease underwent BAS before surgical radical therapy with the guidance of X-ray or transthoracic echocardiography. Eight patients (ages from 2 days to 50 days) were complete transposition of great arteries (TGA), and two patients (age was 60 days, 39 years respectively) were total anomalous of pulmonary venous connexion (TAPVC) with restrictive atrial septal defect.RESULTS:All procedure achieved successfully, no severe complications occurred. The average oxygen saturation of femoral arteries of patients increased from 68.3% (pre-procedure) to 81.8% (post-procedure) significantly. the status in short of oxygen of all patients improved immediately. All patients survived until a surgical radical therapy. After successful operations, nine patients discharged, only one patient died of disorder of electrolyte.CONCLUSION:BAS was a ideal palliate therapy for some cyanotic complex congenital heart disease, and can play a important role in hybrid procedure for patients with complex congenital heart disease.

[One-stop hybrid cardiac surgery for neonates and young children with congenital heart disease].

OBJECTIVE:To summarize our 5 years experiences of one-stop hybrid procedure (OHP) for the management of congenital heart disease (CHD) in neonates and young children (< 2 years old).METHODS:Clinical data derived from consecutive 152 young children and neonates with CHD underwent OHP between March 2004 to March 2009 were analyzed. Patients were divided into 3 groups: Balloon plasty group (n = 72), device closure group (n = 43) and collateral arteries occlusion group (n = 37). All procedures were image-guided and performed in a specially designed hybrid operation room. Incidence of major adverse cardiovascular events was obtained.RESULTS:Patients received successful per-ventricular valvuloplasty or per-aortic balloon angioplasty in balloon plasty group. Two patients in this group with severe right ventricle outflow obstruction received regular open-heart outflow tract reconstruction immediately (n = 1) or selective conventional open-heart operation after discharge (n = 1). One neonate with pulmonary atresia with intact ventricular septum died from liver failure 6 month after OHP. In device closure group, device closure was failed in 3 cases (2 with atrial and 1 with ventricular septum defects), 1 young child with ventricular septum defects died from pneumonia after successful device closure. No device malposition was observed in device closure group during the follow-up. All patients received major collateral arteries occlusion and open-heart correction were discharged without complication.CONCLUSION:OHP could avoid or shorten the application of cardiopulmonary bypass and reduce the surgical trauma in selected young children with CHD. Although OHP was feasible and safe, the image outfits, image-guided technology and OHP-related device should be further developed and improved for better procedure outcome.

Strategy for biventricular outflow tract reconstruction: Rastelli, REV, or Nikaidoh procedure?

OBJECTIVE:Three techniques have been developed as the surgical management for patients with anomalies of ventriculoarterial connection, ventricular septal defect, and pulmonary outflow tract obstruction (stenosis): the Rastelli, Lecompte, (REV), and Nikaidoh procedures. This study was designed to compare these procedures in terms of hemodynamics of the reconstructed biventricular outflow tract, early clinical consequences, and follow-up.METHODS:Between March 2004 and September 2006, a total of 30 consecutive patients underwent double root translocation procedures (modified Nikaidoh n = 11, REV n = 7, Rastelli n = 12). In the Nikaidoh procedure, both aortic and pulmonary roots were translocated. A single-valved bovine jugular vein patch was used to repair the stenotic pulmonary artery in both Nikaidoh and REV procedures. The Senning procedure was added for those with atrioventricular discordance.RESULTS:The Nikaidoh procedure was the most time-consuming in terms of mean cardiopulmonary bypass and aortic crossclamp times. The average mechanical ventilation time was significantly shorter in the Rastelli group (63.3 +/- 89 hours) than that in the Nikaidoh group (188.7 +/- 159 hours, P = .016), but not different from that in the REV group (76.4 +/- 112.5 hours, P = .395). Two patients in the REV group and 1 in the Rastelli group died. There were no in-hospital or late deaths in the Nikaidoh group. Postoperative echocardiography demonstrated physiologic hemodynamics in the left ventricular outflow tract and normal heart function in the Nikaidoh group. Abnormal flow pattern in the left ventricular outflow tract was noted in both REV and Rastelli groups. There were no late deaths or reoperations in any group during follow-up.CONCLUSION:The modified Nikaidoh procedure is a better surgical option for transposition of the great arteries, ventricular septal defect, and pulmonary stenosis in terms of physiologic cardiac hemodynamics. Its long-term benefits need to be evaluated with a larger number of patients and longer follow-up.

Open-chest device closure for the minimally invasive management of atrial septal defect in young children.

BACKGROUND:We integrated a catheter-based device and minimally invasive surgical techniques for the treatment of atrial septal defect for children younger than 2 years old.METHODS:Forty-three patients were divided into 3 groups: group A underwent open-chest device closure with a right lateral thoracotomy (n = 12), group B underwent open-heart repair with a right lateral thoracotomy and cardiopulmonary bypass (n = 11), and group C underwent open-heart repair with a median thoracotomy and cardiopulmonary bypass (n = 20).RESULTS:Group A had the lowest weight (9.25 +/- 1.3 kg) and smallest defect size (10.25 +/- 3.9 mm). In group A, 2 patients had to be transitioned to open-heart repair after unsuccessful occlusion. Compared with the open-heart groups, the device group had a shorter total operation time (111 +/- 39 minutes), required the minimum amount of blood products (39 +/- 38 mL), and had a smaller amount of pleural drainage in the first 12 hours after the procedure (29 +/- 12 mL). All patients were discharged. The right ventricular end-diastolic diameter reduced significantly after the repair; furthermore, there was no difference in the size of reduction. However, the device group had the highest medical costs (30,639 +/- 3831 Chinese yuan). During the follow-up, there were no occluder-related complications observed in Group A, and there were no residual shunts or arrhythmia observed in the groups.CONCLUSIONS:The open-chest device closure was safely performed as a supplement for percutaneous treatment for young children.

Hybrid procedure for the neonatal management of pulmonary atresia with intact ventricular septum.