刘文超
中国医学科学院阜外医院 普外科
Partial anomalous pulmonary venous drainage (PAPVD) is a common congenital heart disease. If the insertion of an anomalous pulmonary vein (PV) is high into the superior vena cava (SVC), the traditional 1-patch or 2-patch surgical repair might be challenging. Unlike patch procedures, the cavoatrial anastomosis technique (Warden procedure) theoretically reduces complications such as sinus node dysfunction and venous obstruction. We investigate outcomes of the Warden procedure (WP) at a single institution. A total of 67 patients (42 males and 25 females) with PAPVD who underwent the WP between January 2011 and December 2018 were consecutively enrolled. The median age was 2.8 years (3-61 years old). 52 cases were younger than 18 years old. perioperative and follow-up clinical data were collected. In addition, we selected possible risk factors (a total of 18 risk factors) of SVC stenosis or obstruction. Univariate and multivariate analyses were conducted to confirm the independent risk factors. The average Cardiopulmonary bypass (CPB) time was 132.3 ± 46.3 min, and the aortic cross-clamp time was 85.2 ± 35.7 min. One patient died postoperatively in hospital. The mean follow-up time of the remaining patients (n = 66) was 15.8 ± 14.5 months (3-64 months). No abnormal cardiac function or sinus node dysfunction cases were identified during the follow-up. Of the survival patients, no venous obstruction was presented before the discharge. Numbers of patients identified with mild PV and SVC stenosis were 1 (1.5%) and 7 (10.6%, 4 of them turned negative eventually) at discharge. At the last follow-up, no PV obstruction was identified, whereas, 4 cases (6%) had SVC obstruction. Numbers of PV and SVC stenosis cases were 3 (4.5%) and 8 (12%). Univariate and multivariate analyses showed that only the diameter of SVC less than 10 mm was an independent risk factor for SVC stenosis or obstruction at the last follow-up. Warden procedure can effectively treat PAPVD (anomalous drainages into SVC), with satisfactory early and mid-term postoperative results. Different modifications of the Warden procedure may be selected according to the anatomic characteristics. The diameter of SVC less than 10 mm predicts SVC stenosis or obstruction after Warden procedure.
Pediatric cardiology 2020
The objective of this study was to assess the mid-term results of mitral valve (MV) repair in infancy and childhood with isolated mitral regurgitation (MR). From January 2005 to January 2016, 40 consecutive patients with isolated MR underwent MV repair in Fuwai Hospital, Beijing, China. Patients' clinical data were analyzed retrospectively. Mean age at operation was 13 ± 5 (6-24) months and 22 patients (55%) were younger than 1 year. Mean weight at operation was 8.5 ± 1.9 (4.2-13) kg and 34 patients (85%) were lighter than 10 kg. All patients presented moderate or greater MR. After MV repair, all patients had mild MR or none, while two patients underwent re-repair immediately when TEE showed moderate MR. Mean left atrial diameter decreased from 28.0 ± 6.5 to 20.7 ± 4.8 mm and mean left ventricular end-diastolic diameter decreased from 38.6 ± 7.0 to 30.2 ± 4.9 mm (p < 0.001 for both). There was no early death. Clinical follow-up was conducted in 37 patients over an average period of 49 ± 31 (20-134) months. Follow-up echocardiography showed that one patient had severe MR who underwent redo repair 14 months after operation, one patient had moderate to severe MR, and three patients had moderate MR. Overall freedom from moderate or greater MR was 96.3 ± 3.6%, 91.9 ± 5.5%, and 83.6 ± 9.4% at 2, 5, and 10 years, respectively. The early and mid-term results of MV repair in pediatric patients with isolated MR were satisfactory. In majority of patients, less complex surgical repair techniques were utilized, namely annuloplasty or commissuroplasty. The combination of various repair methods in complex patients could achieve excellent outcome.
Pediatric cardiology 2017
