Background： Double outlet right ventricle （DORV） is a group of complex congenital heart abnormalities. Preoperative pulmonary hypertension （PH） is considered an important risk factor for early death during the su...Background： Double outlet right ventricle （DORV） is a group of complex congenital heart abnormalities. Preoperative pulmonary hypertension （PH） is considered an important risk factor for early death during the surgical treatment of DORV. The aim of this study was to report our experience on surgical treatment of DORV complicated by PH. Methods： From June 2004 to November 2016, 61 patients （36 males and 25 females） aged 2 weeks to 26 years （median： 0.67 years and interquartile range： 0.42-1.67 years） with DORV （two great arteries overriding at least 50%） complicated by PH underwent surgical treatment in our center. All patients were categorized according to surgical age and lesion type, respectively. Pulmonary artery systolic pressure （PASP）, pulmonary artery diastolic pressure （PADP）, and mean pulmonary artery pressure （mPAP） were measured directly before cardiopulmonary bypass （CPB） was established and after CPB was removed. An intracardiac channel procedure was performed in 37 patients, arterial switch procedure in 19 patients, Rastelli procedure in three patient, Senning procedure in one patients, and Mustard procedure in one patient. The Student＇s t-test and Chi-squared test were performed to evaluate clinical outcomes of the surgical timing and operation choice. Results： Fifty-five patients had uneventful recovery. PASP fell from 55.3 ± 11.2 mmHg to 34.7±11.6 mmHg （t = 14.05, P 〈 0.001）, PADP fell from 29.7 ± 12.5 mmHgto 18.6± 7.9 mmHg （t = 7.39,P〈 0.001）, and mPAP fell from 40.3 ± 10.6 mmHgto25.7 ± 8.3 mmHg （t= 11.85, P 〈 0.001）. Six （9.8%） patients died owing to complications including low cardiac output syndrome in two patients, respiratory failure in two, pulmonary hemorrhage in one, and sudden death in one patient. Pulmonary artery pressure （PAP） dropped significantly in infant and child patients. Mortality of both infants （13.9%） and adults （33.3%） was high. Conclusions： PAP of patients with DORV complicated by PH can be expected to fall significantly after surgery. An arterial switch procedure can achieve excellent results in patients with transposition of the great arteries type. Higher incidence of complications may occur in patients with ventricular septal defect （VSD） type before 1 year of age. For those with remote VSD type, VSD enlargement and right ventricle outflow tract reconstruction are usually required with acceptable results. The degree of aortic overriding does not influence surgical outcome.展开更多
INTRODUCTION Complete transposition of the great arteries （TGAs）is a common cyanotic congenital heart defect,with an incidence rate of 0.02%,accounting for 5-7% of congenital heart diseases.[1] After birth,infants w...INTRODUCTION Complete transposition of the great arteries （TGAs）is a common cyanotic congenital heart defect,with an incidence rate of 0.02%,accounting for 5-7% of congenital heart diseases.[1] After birth,infants with TGA largely rely on ventricular septal defect （VSD）,atrial septal defect （ASD）,and patent ductus arteriosus （PDA）to sustain life.Without systemic-pulmonary shunt and surgical correction,these infants will probably die on the day after birth.展开更多
The non-physiologic turbulent flows in centrifugal rotary blood pumps (RBPs) may result in complications such as the hemolysis and the platelet activation. Recent researches suggest that the turbulent viscous dissipat...The non-physiologic turbulent flows in centrifugal rotary blood pumps (RBPs) may result in complications such as the hemolysis and the platelet activation. Recent researches suggest that the turbulent viscous dissipation in the smallest eddies is the main factor of the blood trauma caused by the turbulent flow. The turbulent viscous shear stress (TVSS) was taken as the realistic physical force acting on the cells. However, limited by the temporal and spatial resolutions of the instrumentation currently available, very limited studies are available for the TVSS in the RBPs. In this paper, the large eddy particle image velocimetry (PIV) method is used to estimate the turbulent dissipation rate in the sub-grid scale, to investigate the effect of the TVSS on the blood trauma. Detailed flow characteristics, such as the relative velocity vectors, the estimated TVSS levels and the Kolmogorov length scales, are analyzed in three impeller phases at three constant flow rates (3 L/min, 5 L/min and 7 L/min). Over the measures range in this study, the maximum TVSS in the investigated RBP is lower than the reported critical value of stress. This study demonstrates that the large eddy PIV method is effective to evaluate the flow-dependent force on the cells. On the other hand, it is found that the TVSS is highly dependent on the flow behavior. Under severe off-design conditions, the complex flow characteristics, such as the flow separation and the vortical structures, will increase the TVSS. Thus, in order to reduce the hemolysis in the RBPs, the flow disturbance, induced by the departure of the incidence angle, should be avoided during the design of the RBPs.展开更多
Primary cardiac tumors are rare in children,with the prevalence of 0.0017-0.28% in autopsy series.[1] Benign tumors account for over 90% of the total.Cardiac fibromas （CFs） represent the second most common benign ca...Primary cardiac tumors are rare in children,with the prevalence of 0.0017-0.28% in autopsy series.[1] Benign tumors account for over 90% of the total.Cardiac fibromas （CFs） represent the second most common benign cardiac tumor in the pediatric population following rhabdomyomas.Patients can be asymptomatic or present with palpitations,cardiac murmur,arrhythmias,congestive heart failure,and even sudden death according to the size and location of the tumor.Surgical resection should be considered as the best option in symptomatic patients.[2,3] This study reported four surgical cases of large left ventricular fibroma in children.展开更多
Background： Ebstein＇s anomaly （EA） has various spectrums in clinical and anatomic features. This study aimed to report the experience of two-dimensional intraoperative transesophageal echocardiography （2D-ITEE） ...Background： Ebstein＇s anomaly （EA） has various spectrums in clinical and anatomic features. This study aimed to report the experience of two-dimensional intraoperative transesophageal echocardiography （2D-ITEE） during the EA surgery and to analyze the characteristics of the tricuspid valve （TV） by comparing the data from 2D-ITEE with the results from the surgery. Methods： 2D-ITEE data of 164 patients with EA who were operated in the First Hospital of Tsinghua University between July 2004 and April 2014 were retrospectively analyzed in this study. 2D-ITEE was applied in all patients. Downward displacement distances were measured, and the numbers of downward displacement or absent leaflets were compared with that of the surgery and with that of the two-dimensional-transthoracic echocardiogram （2D-TTE）. Data comparison was peribrmed using the Chi-square test. Results： The anterior leaflet partial or total downward displacement was 37.76 ±17.50 mm in 54 cases, absent in one patient; septal leaflet downward displacement was 29.07 ± 12.34 mm in 134 cases, absent in 17 cases; and posterior leaflet downward displacement was 43.18 ± 19.16 mm in 115 cases, absent in 34 cases. Statistically, there was no significant difference between the results from 2D-ITEE and that of 2D-TTE. The consistency rates of 2D-ITEE with operation for septal and posterior leaflets were 93.2% and 96.1%, respectively, while the rate for anterior was only 40.1%o, which was significantly different. Color Doppler flow image showed severe regurgitation in 150 cases and moderate in 14 cases. After surgical correction, moderate regurgitation of TV was found in 58 cases with 2D-ITEE, repair was performed again until the effect was satisfied. No complication occurred relating to the use of 2D-ITEE. Conclusions： 2D-ITEE could help diagnose anterior leaflet, evaluate the effect of TV repair, increase operational success rate, and reduce complication.展开更多
文摘Background： Double outlet right ventricle （DORV） is a group of complex congenital heart abnormalities. Preoperative pulmonary hypertension （PH） is considered an important risk factor for early death during the surgical treatment of DORV. The aim of this study was to report our experience on surgical treatment of DORV complicated by PH. Methods： From June 2004 to November 2016, 61 patients （36 males and 25 females） aged 2 weeks to 26 years （median： 0.67 years and interquartile range： 0.42-1.67 years） with DORV （two great arteries overriding at least 50%） complicated by PH underwent surgical treatment in our center. All patients were categorized according to surgical age and lesion type, respectively. Pulmonary artery systolic pressure （PASP）, pulmonary artery diastolic pressure （PADP）, and mean pulmonary artery pressure （mPAP） were measured directly before cardiopulmonary bypass （CPB） was established and after CPB was removed. An intracardiac channel procedure was performed in 37 patients, arterial switch procedure in 19 patients, Rastelli procedure in three patient, Senning procedure in one patients, and Mustard procedure in one patient. The Student＇s t-test and Chi-squared test were performed to evaluate clinical outcomes of the surgical timing and operation choice. Results： Fifty-five patients had uneventful recovery. PASP fell from 55.3 ± 11.2 mmHg to 34.7±11.6 mmHg （t = 14.05, P 〈 0.001）, PADP fell from 29.7 ± 12.5 mmHgto 18.6± 7.9 mmHg （t = 7.39,P〈 0.001）, and mPAP fell from 40.3 ± 10.6 mmHgto25.7 ± 8.3 mmHg （t= 11.85, P 〈 0.001）. Six （9.8%） patients died owing to complications including low cardiac output syndrome in two patients, respiratory failure in two, pulmonary hemorrhage in one, and sudden death in one patient. Pulmonary artery pressure （PAP） dropped significantly in infant and child patients. Mortality of both infants （13.9%） and adults （33.3%） was high. Conclusions： PAP of patients with DORV complicated by PH can be expected to fall significantly after surgery. An arterial switch procedure can achieve excellent results in patients with transposition of the great arteries type. Higher incidence of complications may occur in patients with ventricular septal defect （VSD） type before 1 year of age. For those with remote VSD type, VSD enlargement and right ventricle outflow tract reconstruction are usually required with acceptable results. The degree of aortic overriding does not influence surgical outcome.
文摘INTRODUCTION Complete transposition of the great arteries （TGAs）is a common cyanotic congenital heart defect,with an incidence rate of 0.02%,accounting for 5-7% of congenital heart diseases.[1] After birth,infants with TGA largely rely on ventricular septal defect （VSD）,atrial septal defect （ASD）,and patent ductus arteriosus （PDA）to sustain life.Without systemic-pulmonary shunt and surgical correction,these infants will probably die on the day after birth.
基金Project supported by the National Natural Science Foundation of China(Grant No.51536008)the National Key R&D Program of China(Grant No.2018 YFB0606101).
文摘The non-physiologic turbulent flows in centrifugal rotary blood pumps (RBPs) may result in complications such as the hemolysis and the platelet activation. Recent researches suggest that the turbulent viscous dissipation in the smallest eddies is the main factor of the blood trauma caused by the turbulent flow. The turbulent viscous shear stress (TVSS) was taken as the realistic physical force acting on the cells. However, limited by the temporal and spatial resolutions of the instrumentation currently available, very limited studies are available for the TVSS in the RBPs. In this paper, the large eddy particle image velocimetry (PIV) method is used to estimate the turbulent dissipation rate in the sub-grid scale, to investigate the effect of the TVSS on the blood trauma. Detailed flow characteristics, such as the relative velocity vectors, the estimated TVSS levels and the Kolmogorov length scales, are analyzed in three impeller phases at three constant flow rates (3 L/min, 5 L/min and 7 L/min). Over the measures range in this study, the maximum TVSS in the investigated RBP is lower than the reported critical value of stress. This study demonstrates that the large eddy PIV method is effective to evaluate the flow-dependent force on the cells. On the other hand, it is found that the TVSS is highly dependent on the flow behavior. Under severe off-design conditions, the complex flow characteristics, such as the flow separation and the vortical structures, will increase the TVSS. Thus, in order to reduce the hemolysis in the RBPs, the flow disturbance, induced by the departure of the incidence angle, should be avoided during the design of the RBPs.
文摘Primary cardiac tumors are rare in children,with the prevalence of 0.0017-0.28% in autopsy series.[1] Benign tumors account for over 90% of the total.Cardiac fibromas （CFs） represent the second most common benign cardiac tumor in the pediatric population following rhabdomyomas.Patients can be asymptomatic or present with palpitations,cardiac murmur,arrhythmias,congestive heart failure,and even sudden death according to the size and location of the tumor.Surgical resection should be considered as the best option in symptomatic patients.[2,3] This study reported four surgical cases of large left ventricular fibroma in children.
文摘Background： Ebstein＇s anomaly （EA） has various spectrums in clinical and anatomic features. This study aimed to report the experience of two-dimensional intraoperative transesophageal echocardiography （2D-ITEE） during the EA surgery and to analyze the characteristics of the tricuspid valve （TV） by comparing the data from 2D-ITEE with the results from the surgery. Methods： 2D-ITEE data of 164 patients with EA who were operated in the First Hospital of Tsinghua University between July 2004 and April 2014 were retrospectively analyzed in this study. 2D-ITEE was applied in all patients. Downward displacement distances were measured, and the numbers of downward displacement or absent leaflets were compared with that of the surgery and with that of the two-dimensional-transthoracic echocardiogram （2D-TTE）. Data comparison was peribrmed using the Chi-square test. Results： The anterior leaflet partial or total downward displacement was 37.76 ±17.50 mm in 54 cases, absent in one patient; septal leaflet downward displacement was 29.07 ± 12.34 mm in 134 cases, absent in 17 cases; and posterior leaflet downward displacement was 43.18 ± 19.16 mm in 115 cases, absent in 34 cases. Statistically, there was no significant difference between the results from 2D-ITEE and that of 2D-TTE. The consistency rates of 2D-ITEE with operation for septal and posterior leaflets were 93.2% and 96.1%, respectively, while the rate for anterior was only 40.1%o, which was significantly different. Color Doppler flow image showed severe regurgitation in 150 cases and moderate in 14 cases. After surgical correction, moderate regurgitation of TV was found in 58 cases with 2D-ITEE, repair was performed again until the effect was satisfied. No complication occurred relating to the use of 2D-ITEE. Conclusions： 2D-ITEE could help diagnose anterior leaflet, evaluate the effect of TV repair, increase operational success rate, and reduce complication.
