34例婴儿先天性心脏病外科治疗

目的总结婴儿先天性心脏病(先心病)手术治疗经验。方法 34例不满1周岁先天性心脏病患儿,经明确诊断、充分术前治疗及手术评估后,28例行体外循环下根治术,余6例于全麻下行动脉导管结扎术。结果术后死亡1例,余33例均痊愈出院。结论婴儿先心病应充分评估治疗方法并择期实施合理术式治疗,可有效提高手术成功率,效果肯定。     

从广东资料看我国先天性心脏病外科的现状与进展

我国在先天性心脏病(先心病)的外科治疗方面取得了长足的进步,但新时期先心病的外科治疗也呈现一些新的特点和趋势。广东省先天性心脏病防治网(先心网)是获得国际认可的高质量数据库。我们分析了先心网近年广东省先心病的发生率、手术治疗率、手术死亡率以及先心病的外科治疗质量的数据,准确把握了本地区先心病外科的发展特征,明确地区先心病外科治疗的现状,便于制定更合理的先心病外科发展策略,最终促进我国先心病外科的进一步发展。     

新生儿心内直视手术的麻醉体会

随着小儿先天性心脏病(简称先心病)诊治技术的进步,手术年龄日趋低龄化。新生儿期施行先心病手术治疗风险大,难度高。除手术技巧外,新生儿先心病麻醉亦具有其特殊性。现总结我院72例新生儿心内直视手术的麻醉管理体会,以探讨适宜新生儿心内直视手术的麻醉管理和操作技巧,提高新生儿心内直视手术的成功率。     

小儿先天性心脏病心内直视手术43例治疗体会

目的探讨小儿常见先天性心脏病外科治疗的方法,为治疗提供经验与建议。方法总结和分析2008年8月至2010年7月对43例小儿先心病行心内直视手术矫治的围术期资料,对各类型病种先心病的不同治疗进行归纳。结果本组无1例死亡,残余分流2次手术纠正2例,胸管嵌顿2次手术2例,肺部感染1例,均经治疗而愈。结论心内直视手术治疗先心病要严格掌握手术适应证,术前明确诊断,仔细术中探查,彻底矫治心内畸形,加强术后治疗,才可取得良好的手术效果。     

主动脉-左心室通道的外科治疗

1996年7月至2006年4月,我院心内直视手术治疗39 481例心脏病病人,同期先天性心脏病(先心病)手术21 242例,其中发现5例主动脉-左心室通道病人.现报道诊断、手术特点和随访结果.     

经食管超声心动图在小儿先天性心脏病手术中的应用

术中经心外膜超声心动图对小儿先天性心脏病 (先心病 )手术方案的选择具有重要意义 ,但对手术视野有干扰 ,临床应用受到限制〔1〕。随着小儿经食管超声心动图 (ＴＥＥ)探头的研制成功 ,婴幼儿先心病术中超声心动图监测成为可能。现总结我们 1996年 10月至 1997年 5月在 2 3例小儿先天性心脏病术中应用ＴＥＥ的情况 ,探讨该技术的安全性、实用性及临床价值。临床资料和方法　 2 3例病儿中男 12例 ,女 11例 ;年龄 6个月～ 11岁。体重 5 5～ 2 3.0ｋｇ ,其中 <10ｋｇ者 8例 ,10～ 2 0ｋｇ 11例 ,>2 0ｋｇ 4例。术前均经体表超声心动图和心导管…     

婴儿先天性心脏病术后处理

由于先天性心脏病(先心病)诊治技术的进步，1岁以内婴儿手术逐渐增多。保证手术治疗的成功，在手术技巧、体外循环(CPB)技术水平的提高下，术后监护处理非常重要。先心病术后危重病情处理水平的提高，对婴儿先心病术后渡过危险期尤为关键。现介绍86例婴儿先心病处理经验如下。     

危重婴幼儿先天性心脏病的急诊外科治疗

先天性心脏病患儿约1/3在1岁内处于危重状态,但此类患儿并非等同于复杂先天性心脏病(先心病)~([1-3]).危重小婴儿的急诊、亚急诊手术治疗在国内还没有广泛开展,对于"危重状态"的判定和手术时机的把握也没有统一意见.本文回顾性分析我院2008年1月至2009年8月共实施的48例急诊或亚急诊手术(同期手术907例)的治疗时机和效果,为进一步规范对此类患儿的治疗方案以提高疗效提供依据.     

《中国心血管健康与疾病报告2019》先天性心脏病部分解读

先天性心脏病(先心病)是我国发病率最高的出生缺陷。2020年9月国家心血管病中心发布了《中国心血管健康与疾病报告2019》,文中对先心病的防治现状做了简要概述。本文从《中国心血管健康与疾病报告2019》先心病部分出发,补充了部分先心病流行病学、外科手术治疗、介入治疗等相关数据,对该报告进行展开及解读。     

110例小儿先天性心脏病的外科治疗

目的:总结小儿先天性心脏病外科治疗的经验教训。方法:回顾性分析110例小儿先天性心脏病的术前诊断、手术治疗方法、治疗结果、并发症和死亡情况。结果:小儿先天性心脏病的手术治疗带来了全身重要脏器的功能变化,强调围手术期处理重要性,特别是重视心肌保护,重视呼吸道护理,防治心律失常,防治低心排出量是保证满意疗效的关键。     

Comparative study on cerebral injury after open heart surgery in patients with congenital and rheumatic heart disease

Alongwiththedevelopmentofscienceandtechnology,intracardiacoperationsbecomemuchsaferthanever.Althoughthemortalityrateofthepatientsreceivingintracardiacoperationwith helpofcardiopulmonarybypass(CPB)hasdecreased butneurologicalcomplicationsoccurfrequently.Neurologicalcomplicationshavebeenidentifiedsince theearlydayswhenemployingcardiacsurgery.1And neurologicalcomplicationsaftertheemploymentofCPB areimportantfatalcomplicationsofnon cardiovascular originatpresent.2Theincidenceofneuropsychologica…     

自体肺动脉瓣移植术治疗先天性主动脉瓣病变

目的　总结自体肺动脉瓣移植手术 (Ross手术 )治疗先天性主动脉瓣病变的疗效。方法　自 1994年 10月至 2 0 0 3年 11月 ,共收治 2 0例先天性主动脉瓣病变患者行Ross手术治疗 ,其中男 15例 ,女 5例 ,平均年龄 2 5岁 ;术前诊断 :主动脉瓣二瓣畸形 12例 ,主动脉瓣叶脱垂 5例 ,瓣叶发育不良 3例 ,合并亚急性细菌性心内膜炎 4例 ,合并室间隔缺损 2例。术前超声心动图检查 (UCG)示所有患者均存在主动脉瓣狭窄或 /并关闭不全 (中重度 )。左心室舒张末内径 (LVDD) (6 0 5 1±11 87)mm ,主动脉瓣跨瓣压差 (2 7 0 4± 6 80 )mmHg。心功能 (NYHA分级 )Ⅱ级 17例 ,Ⅲ级 3例。所有病例均在全麻体外循环中度低温下进行 ,手术分三步进行 :(1)采取自体肺动脉瓣 ;(2 )切除病变的主动脉瓣并移植自体肺动脉瓣于主动脉位 ;(3)利用同种动脉瓣重建右心室流出道。结果　全组患者无手术死亡 ;左心室舒张末内径明显缩小 ,为 (46 38± 9 17)mm (t=3 4 0 0 7,P =0 0 0 0 8) ,术后主动脉跨瓣压差降至正常范围 (6 80± 0 19)mmHg。术后随访 3个月至 9年 ,所有患者的主动脉瓣、肺动脉瓣结构及功能正常。结论　自体肺动脉瓣移植手术是一种临床疗效好的治疗先天性主动脉瓣病变的手术方法 ,近中期效果良好。     

Different Nuss procedures and risk management for pectus excavatum after surgery for congenital heart disease

Purpose

In Nuss procedure for pectus excavatum (PE) after surgery for congenital heart disease (CHD), retrosternal adhesion may increase the risk of cardiac injury. This study aimed to explore different Nuss procedures and their implications for reducing the incidence of serious complications and improving surgical safety.

瓣膜病变病人围术期神经体液因子和血流动力学改变

目的 观察瓣膜病变病人围术期神经体液因子和血流动力学变化规律，为临床治疗提供参考。方法 检测24例瓣膜病变病人和7例先天性心脏病病人围术期儿茶酚胺(CA)、血管紧张素Ⅱ(AGⅡ)、醛固酮(ALD)、心钠素(ANP)水平及血流动力学指标。结果 瓣膜病变病人血浆CA、AGⅡ、ALD及ANP水平在术前不同程度升高的基础上，体外循环((2PB)中显著升高。结论 二尖瓣病变病人表现为围术期高醛固酮血症，血浆去钾肾上腺素(NE)、AGⅡ水平的显著升高是术中及术后早期循环高阻力的重要原因；二尖瓣病变合并肺动脉高压病人术后早期大多数肺动脉压力和阻力明显下降。     

非先天性心脏病患儿气道环状软骨平面横径预测模型能否适用于先天性心脏病患儿

目的 评价基于非先天性心脏病患儿(children without congenital heart disease,NCHD)气管环状软骨平面横径值(transverse diameter of cricoid cartilage,CD)与年龄或体型所建立的直线回归方程,比较回归方程预测先天性心脏病患儿(children with congenital heart disease,CHD)环状软骨平面的气管横径值(cricoid diameter predicted by formula,CDfomula)和超声实测值(cricoid diameter measured by ultrasound,CDultra)的一致性.方法 纳入64名NCHD,镇静后测量CDultra,记录患儿年龄、身高、体重、BMI、体表面积等数据,采用逐步向前法与CD建立线性回归模型.纳入CHD 30例和NCHD 25例,比较两组患儿CD超声测量值与线性回归模型预测值的一致性.结果 NCHD的CD值与年龄呈正相关(r=0.90,P＜0.05),回归方程为CD(cm)=0.048×年龄(岁)+0.525.两组人群CDfomulaCDultra之间存在相关性(P＜0.05),NCHD组患儿CDfomula和CDultra的相关性为0.94,而CHD组患儿CDfomula和CDultra的相关性为0.71.NCHD组和CHD组CDultm和CDfomula的偏移值分别为-0.00 cm、-0.01 cm,95％一致性界限分别为(-0.06 cm,0.05 cm)和(-0.17 cm,0.15 cm),虽然两组患儿CDultra和CDfomula的偏移相近,但是CHD组患儿的界限值宽于NCHD组患儿.结论 在建立NCHD超声测量的CD值与年龄间线性回归方程的基础上,认为CHD模型预测和超声实测的一致性不如NCHD.因此在CHD气管插管时,测量CDultra可能会使气管导管的选择更加准确和便捷.     

Natural history of scoliosis in congenital heart disease

We defined the natural history of scoliosis in congenital heart disease (CHD) with respect to the risk of progression and indications for treatment. We reviewed radiographs of 48 children with CHD and scoliosis. Thirty-seven had developmental scoliosis (77%), and 11 (23%) had congenital scoliosis. Children with congenital scoliosis can be managed in the same way as children without CHD. Developmental curves less than 30 degrees in children aged greater than 10 years showed no progression. Developmental curves greater than 30 degrees with onset in children aged less than 10 years and progression greater than 9 degrees per year require treatment.     

Living donor liver transplantation in children with congenital heart disease

BACKGROUND: The occurrence of congenital heart disease (CHD) with congenital biliary disease is uncommon. Our aim is to present our experience in living donor liver transplantation (LDLT) as treatment for end-stage liver disease (ESLD) in children with CHD. METHODS: A review of transplant records from June 1994 to December 2004 was performed. Twenty-three LDLT (13 males, 10 females) recipients were diagnosed to have both CHD and ESLD. RESULTS: CHD diagnoses were made preoperatively using transthoracic two-dimensional color flow Doppler echocardiography. The mean age was 22.3 months. There were 20 (87%) biliary atresia, two (9%) neonatal hepatitis, and one (4%) glycogen storage disease patients. Isolated CHD associated with ESLD included atrial septal defect (11, 48%), pulmonary stenosis (including 2 Alagille syndrome; 4, 17%), patent foramen ovale (4, 17%), ventricular septal defect (1, 4%), and mitral valve prolapse (1, 4%). Complex CHD included atrial septal defect + patent ductus arteriosus + patent foramen ovale (1, 4%), and atrial septal defect + pulmonary stenosis (1, 4%). The median Child's and Pediatric End-stage Liver Disease scores were 9, and 17, respectively. In all, 70% presented with varying degrees of pulmonary congestion pretransplant. There were no perioperative cardiac complications. Posttransplant, the patent foramen ovale in four recipients and atrial septal defect in four recipients closed spontaneously; and two recipients with pulmonary stenosis had their stenoses resolved spontaneously. The overall rejection rate was 17%. There was no mortality. The overall recipient and graft survivals at 1 and 5 years were both 100%. CONCLUSION: LDLT is a safe procedure in a select group of ESLD patients with CHD.     

Cardiopulmonary transplantation for congenital heart disease in the adult.

BACKGROUND: Patients surviving into adulthood with congenital heart disease (CHD) often succumb to progressive cardiopulmonary dysfunction. For these patients transplantation is often considered. METHODS: We performed a retrospective review of 69 adults (age >18 years) with CHD transplanted between 1984 and 1999. RESULTS: We evaluated 31 heart-lung (HLTxp), 30 lung (LTxp), and 8 heart (HTxp) transplants performed in 22 men and 47 women with CHD. Mean age was 37 +/- 10 years with a mean follow-up of 3.1 +/- 3.5 years. A concomitant cardiovascular procedure was performed in 1 HLTxp, 23 LTxp, and 2 HTxp. Early mortality (>30 days) was 26% (8/31) for HLTxp, mostly due to bleeding. Early LTxp mortality was 23% (7/30), largely due to graft failure. One and 3-year survival was similar in adults transplanted for CHD and adults transplanted for other disease. Early mortality among HTxp recipients was 50% (4/8) from rejection or technical complications. Survival for patients undergoing HLTxp versus LTxp with cardiac repair was similar. When examined by era, the survival of patients transplanted for CHD between 1992 and 1999 was greater than that of patients transplanted between 1984 and 1991. CONCLUSIONS: Adults undergoing HLTxp and LTxp for CHD can expect survival comparable to that of non-CHD adults. In the presence of a reparable cardiac lesion, LTxp with cardiovascular repair for CHD is an attractive option, optimizing organ allocation. Specific technical concerns are discussed. Survival of adults undergoing cardiopulmonary transplantation for CHD has improved over time.     

经食管超声心动描记术在先天性心脏病镶嵌治疗中的应用

目的观察TEE在非体外循环下先天性心脏病镶嵌治疗中的临床应用价值。方法回顾性分析167例TTE初筛拟行先天性心脏病镶嵌治疗的患者,术前TEE检查进一步筛选患者,指导选择适当封堵器,术中TEE监测引导置入封堵器并评价其疗效。结果本组167例中,24例房间隔缺损(ASD)和121例室间隔缺损(VSD)成功完成镶嵌治疗,1例ASD和5例VSD术后即刻TEE可见一丝残余分流,术后3个月复查1例ASD和4例VSD残余分流消失,1例VSD右心室流出道血流速度稍加快,1例VSD术前无主动脉瓣反流,术后出现轻-中度反流。3例ASD和9例VSD镶嵌治疗不顺利,转体外循环。对1例ASD和2例VSD由于缺口过小而放弃治疗。7例VSD合并主动脉瓣脱垂直接放弃镶嵌治疗,转修补术。结论在非体外循环下先天性心脏病的镶嵌治疗中,TEE能为选择适应证和封堵器提供技术支持,实时监测指导及评价手术,降低手术风险,提高手术成功率。