主动脉与人工血管侧侧吻合技术在体肺动脉分流术中的应用

目的 探讨主动脉与人工血管侧侧吻合技术在体肺动脉分流术中的应用.方法 2010年4月至2011年6月,44例紫绀型先天性心脏病患儿行主动脉与人工血管侧侧吻合的体肺动脉分流术,其中升主动脉-主肺动脉38例,升主动脉-左肺动脉4例,升主动脉-右肺动脉2例.男、女各22例;＜1岁23例,1～3岁14例,＞3岁7例;体质量(9.2±3.6) kg.肺动脉闭锁32例(3例室间隔完整,29例伴室间隔缺损),法洛四联症10例,右室双出口合并肺动脉狭窄和矫正性大动脉转位并肺动脉狭窄各1例.术后定期随访.结果 全组无手术死亡.2例出现早期狭窄,1例因早期分流堵塞再次行中心分流术,1例分流过多.术后经皮血氧饱和度由0.67±0.10增加至0.81±0.07.术后动脉压增加0～ 25mm Hg(1 mm Hg =0.133 kPa),中位值6.5 mm Hg.所有患儿随访12 ～ 23个月.2例出院后第1、3个月因误吸死亡;2例人工血管狭窄;2例人工血管闭塞,其中1例术后14个月再次行体肺动脉分流术;7例肺动脉发育良好者行进一步手术治疗,其中4例行根治手术,3例行Glenn手术.余患儿经皮血氧饱和度0.82±0.05,超声心动图示分流血管通畅,血流束与人工血管口径一致.结论 主动脉与人工血管侧侧吻合技术的体肺动脉分流术操作简单,安全性高,人工血管堵塞率低,可以推广应用.     

改良B-T分流手术治疗106例紫绀型先天性心脏病效果及随访

目的 评估改良B-T分流手术的手术方法、围术期处理及其在紫绀型先天性心脏病治疗中的重要性.方法 2000年10月至2012年8月,106例紫绀型先天性心脏病患儿接受改良B-T分流手术.男64例,女42例;年龄生后1天～37.2个月,平均(3.8±1.1)个月;体质量2.3 ～ 12.0 kg,平均(5.0±2.1) kg.室间隔完整型肺动脉闭锁25例,室间隔缺损型肺动脉闭锁45例,三尖瓣闭锁11例,重度法洛四联症(TOF)7例,单心室18例.术前患儿均严重发绀,78例应用前列腺素E1维持动脉导管开放;经皮血氧饱和度0.69±0.23.应用不同口径的PTFE人工血管,3mm8例,3.5mm 11例,4mm65例,5 mm26例.结果 患儿术后住院1 ～18天;住监护室1～12天;机械通气4h ～7天.术后住院期间死亡3例(2.6％),人工血管急性栓塞、严重低氧和循环衰竭各1例.术后患儿经皮血氧饱和度上升到0.79±0.12.4例出现人工血管栓塞再次行对侧改良B-T分流手术.94例随访患儿中,血氧饱和度0.63～0.92,平均(0.81±0.10);2例远期(术后17和25个月)死亡.截至现在,86例次患儿行进一步手术治疗,其中TOF根治手术6例,Rastelli手术31例,Glenn手术25例,Fontan手术18例.结论 改良B-T分流手术可提高紫绀型先天性心脏病患儿的经皮血氧饱和度,明确增加肺血流,提高血氧含量,挽救患儿生命,为进一步手术争取机会并创造更好的条件.     

非体外循环下改良全腔静脉-肺动脉连接术

目的：探讨非体外循环下行改良全腔静脉－肺动脉连接手术治疗功能性单心室技术。方法：3例功能性单心室病儿在非体外循环下施行了改良全腔静脉－肺动脉连接手术。术中先作上、下腔静脉插管并与右房插管连接，静脉血分流入右房，然后置右肺动脉侧壁钳，上腔静脉远心端与右肺动脉上缘行端侧吻合，吻合口尽量偏左；下腔静脉通过心外管道与右肺动脉下缘连接，吻合口尽量偏右。最后缝扎肺动脉口。结果：术后无早、晚期死亡，仅1例发生低心输出量综合征及胸腔渗出。动脉血氧饱和度0．94－0．97。术后随访1－3个月，心功能I级2例，Ⅱ级1例。结论：非体外循环下行改良全腔静脉－肺动脉连接术，是治疗功能性单心室的有效技术，可取得良好的手术效果。     

双向Glenn手术治疗儿童功能性单心室68例分析

目的总结1998年4月至2005年12月行双向Glenn手术治疗68例儿童功能性单心室的经验。方法本组男47例,女21例;年龄5个月～14岁（中位年龄3．7岁）;体重6．7～30．0kg（中位体重12．5kg）。右侧双向Glenn手术39例,左侧双向Glenn手术13例,双侧者16例。同期行肺动脉环束3例、肺动脉结扎1例、主动脉-肺动脉分流管道切断缝合术1例、动脉导管结扎6例、大侧支循环切断4例、全肺静脉异位引流矫治1例、部分肺静脉异位引流矫治2例、房室瓣整形4例。结果68例患者死亡3例,病死率4．4％。术后上腔静脉压力（15．9±2．4）mmHg（1mmHg=0．133kPa）,较术前的（8．3±1．8）mmHg显著上升（P〈0．01）。术后安静时经皮血氧饱和度（89．3±4．2）％,较术前的（78．4±6．0）％显著上升（P〈0．01）。结论双向Glenn手术治疗功能性单心室效果满意;双向Glenn手术宜保留肺动脉的搏动性血流。     

小儿室间隔缺损伴动脉高压78例

目的 为了提高小儿室间隔缺损合并肺动脉高压外科治疗效果，分析总结78例患者的手术经验。方法 1986年10月－1998年2月我科连续行体外循环心内直视术纠治小儿室间缺损伴肺动脉高压78例，其中66例为重度肺动脉高压。年龄1－12岁，平均年龄5岁；全部患者的肺／体动脉压≥0．75，肺／体血流量1．1－8．4，平均2．2；肺血管阻力96－1280dyn.s/cm^2，平均624dyn.s/cm^5；动脉血氧饱和度0．85－0．98，平均0．92；心导管检查示双向分流17例，16例合并其它心脏病变。结果 78例全部手术存活，12例术后发生心脏压塞、传导阻滞、出血等并发症，经治疗均痊愈出院。结论 提高危重病例手术存活的关键在于重视术前研究，明确诊断病变和估价病情，综合分析临床资料，确定手术指征，改进手术技术和良好的围术期处理。     

小儿室间隔缺损伴肺动脉高压78例

目的　为了提高小儿室间隔缺损合并肺动脉高压外科治疗效果 ,分析总结 78例患者的手术经验。　方法1986年 10月～ 1998年 2月我科连续行体外循环心内直视术纠治小儿室间隔缺损伴肺动脉高压 78例 ,其中 6 6例为重度肺动脉高压。年龄 1～ 12岁 ,平均年龄 5岁 ;全部患者的肺 /体动脉压≥ 0 .75 ,肺 /体血流量 1.1～ 8.4,平均 2 .2 ;肺血管阻力 96～ 12 80 dyn· s/cm5,平均 6 2 4dyn· s/cm5;动脉血氧饱和度 0 .85～ 0 .98,平均 0 .92 ;心导管检查示双向分流 17例 ,16例合并其它心脏病变。　结果　 78例全部手术存活 ,12例术后发生心脏压塞、传导阻滞、出血等并发症 ,经治疗均痊愈出院。　结论　提高危重病例手术存活的关键在于重视术前研究 ,明确诊断病变和估价病情 ,综合分析临床资料 ,确定手术指征 ,改进手术技术和良好的围术期处理     

非体外循环下全腔静脉肺动脉连接术的临床应用

目的　评价非体外循环下全腔静脉肺动脉连接术的临床应用价值。方法　 2 0 0 0年 5月至2 0 0 2年 12月 ,9例病人接受了非体外循环下的全腔静脉肺动脉连接术。其中男 5例 ,女 4例。年龄 4～2 4岁 ,平均 (10 3± 6 4 )岁。体表面积 0 6 5～ 1 6 6m2 ,平均 (0 95± 0 35 )m2 。术前经皮血氧饱和度 0 6 0～0 80 ,平均 0 73± 0 0 6。术中测肺动脉压 10～ 16mmHg(1mmHg =0 133kPa) ,平均 (12 7± 2 4 )mmHg。结果　 1例死亡。 1例出现乳糜胸 ,2例术后早期循环不稳定又行外管道与右心房开窗术。所有生存病人出院时无明显发绀 ,呼吸空气时经皮血氧饱和度 0 89～ 0 97,平均 0 94± 0 0 3。结论　非体外循环下的全腔静脉肺动脉连接术操作较为简便 ,术后早期效果良好。     

改良全腔静脉-肺动脉连接术治疗功能性单心室

目的 为了进一步改善全腔静脉－肺动脉连接手术的效果,探讨其经典手术方式的改良方法。方法 对１３例功能性单心室施行了改良全腔静脉－肺动脉妆手术 上腔静脉远心民右肺动脉上缘作端侧吻合,吻合口尽量偏左,近心端与右肺动脉下缘吻合,吻合口尽量偏右。其中５便在心脏不停跳下用Ｇｏｒｅ－Ｔｅｘ心外管道连接下腔静脉与右肺动脉下缘,８例采用心房内隧道。结果 术后早期死亡１例（７．７％）,１２例（９２．３％）存活者术后     

心外管道全腔静脉-肺动脉连接术在复杂先天性心脏病外科治疗中的应用

目的总结心外管道全腔静脉-肺动脉连接术治疗复杂先天性心脏病的应用经验及其治疗效果。方法回顾性分析2006年9月至2012年12月间广州军区广州总医院心脏外科中心52例行心外管道全腔静脉-肺动脉连接术患者的临床资料。12例行一期心外管道全腔静脉-肺动脉连接术,40例为双向Glenn手术后行二期心外管道全腔静脉-肺动脉连接术。分析所有患者的临床资料,并比较两种手术方式患者的死亡率、并发症发生率、住院时间、住重症监护室（ICU）时间、机械辅助通气时间、动脉血氧饱和度的改善情况等。结果围术期死亡2例,死亡率3．8％。其中1例术后因严重低心排血量综合征死亡,1例术后因多器官功能衰竭死亡;50例治愈出院。二期心外管道全腔静脉．肺动脉连接术患者（40例肌械辅助通气时间、住ICU时间、住院时间明显短于一期心外管道全腔静脉-肺动脉连接术患者（12例）,但两种手术方式患者术后并发症发生率及术后动脉血氧饱和度（二期手术与一期手术比较：93％±3％vs．94％±3％）、死亡率（二期手术与一期手术比较：2．5％vs．8．3％）差异均无统计学意义（P〉0．05）。随访45例（90％）,随访时间6～52个月,随访期间无死亡。术后3个月,存活患者心功能均为Ⅰ～Ⅱ级,心脏彩色超声心动图显示：腔静脉肺动脉吻合口血流通畅。结论心外管道全腔静脉．肺动脉连接术血流动力学更符合生理血流动力学特点,手术操作简捷,是不能进行双心室治疗时的有效手术术式;分期心外管道全腔静脉-肺动脉连接术较一期心外管道全腔静脉-肺动脉连接术手术适应证广泛,术后恢复较好,更易推广。     

永存动脉干纠治术中右心室流出道重建方式的选择

目的比较采用自体肺动脉和外管道连接右心室的两种不同手术方法，以选择更佳的手术方案。方法2000年2月至2006年9月，我院共收治23例永存动脉干患者，手术年龄为1．5～63．3月龄。根据右心室切口与肺动脉连接的方法不同分为两组，组Ⅰ：18例，采用自体肺动脉连接右心室；组Ⅱ：5例，采用外管道连接右心室至肺动脉。3例合并主动脉弓中断。采用Kaplan—Meier法分析两组患者的早期生存情况、术后生存时间、再手术情况，采用配对t检验或团体t检验分析患者远期肺动脉生长情况以及心功能的变化。结果术后早期死亡2例。术后随访17例，随访时间2．14±1．97年（32．00d～6．95年），随访中无死亡。总生存率为91．30％（21／Z3），生存时间的95％可信区间为5．55～7．15年。1例因术后右室流出道梗阻（RVOTO）再次手术。组Ⅰ生存率为94．44％（17／18），组Ⅱ为80．00％（4／5）。术后组Ⅰ主肺动脉与右心室吻合口直径早期为1．01±0．26cm，远期为1．32±0．45cm（P=0．019）；组Ⅱ术后主肺动脉与右心室吻合口直径早期为1．46±0．77cm，远期1．26±0．21cm（P=0．581）；两组吻合口、左右肺动脉开口处血流速度变化差异无统计学意义（P〉0．05）。组Ⅱ近远期左、右肺动脉开口直径均大于组Ⅰ。组Ⅰ早期左心室射血分数（LVEF）为62.82％，远期为69．87％（P=0．026）；组Ⅱ早期LVEF为58．17％，远期为64．00％（P=0．029），两组患者术后远期心功能均较术后近期明显改善。无因动脉干瓣膜反流而再手术者。结论永存动脉干手术成功率高，术后生存率及随访结果满意。采用自体肺动脉重建右心室流出道，使吻合口具有生长性，术后肺动脉及分叉处梗阻率低，术后心功能良好。术后早期死亡与合并主动脉弓中断及动脉干瓣膜反流有关。     

Surgical treatment of hypoplastic left heart syndrome: a successful case report

A successful case of Norwood operation for a 5-day-old infant with hypoplastic left heart syndrome is reported. Norwood procedure and central shunting with a 4 mm PTFE tube was performed. Cerebral and coronary artery were perfused independently during reconstruction of aorta in order to shorten the time of circulatory arrest. Post operative UCG documented un-obstructive systemic output from the right ventricle, well regulated pulmonary arterial blood flow and widely patent interatrial communication. This baby was discharged the hospital 66 days after surgery. He has been clinically well for six month after the operation.     

Experience with the Norwood procedure without circulatory arrest.

OBJECTIVE: We evaluated a new cardiopulmonary bypass technique that allowed complete avoidance of circulatory arrest and deep hypothermia in the Norwood procedure for hypoplastic left heart syndrome. METHODS: A total of 10 patients were included in this study. The arterial line of the cardiopulmonary bypass circuit was divided in two in a Y shape; one branch was used for cerebral perfusion through the innominate artery and the other for lower body perfusion through the cannula inserted into the descending thoracic aorta. Moderate hypothermia (29 degrees C-31 degrees C rectal temperature) and high pump flow (150-180 mL. kg(-1). min(-1)) were used. A valveless conduit between the right ventricle and the pulmonary artery was used in 6 patients as an alternative pulmonary blood source to a conventional Blalock-Taussig shunt (n = 4). RESULTS: Circulatory arrest was completely avoided throughout the operation in all cases, and no complications from the new cardiopulmonary bypass technique were seen. Early deaths occurred in 3 cases. Neurologic deficits were not seen among the survivors, and the postoperative course was stable and uneventful, including satisfactory renal function. CONCLUSIONS: The Norwood procedure for hypoplastic left heart syndrome was successfully accomplished with complete avoidance of circulatory arrest by means of cerebral perfusion through the innominate artery combined with cannulation of the descending aorta. A conduit between the right ventricle and the pulmonary artery seems an excellent alternative pulmonary blood source, although right ventricular function needs to be carefully monitored.     

Neonatal aortic arch reconstruction avoiding circulatory arrest and direct arch vessel cannulation.

BACKGROUND: Aortic arch reconstruction in neonates routinely requires deep hypothermic circulatory arrest. We reviewed our experience with techniques of continuous low-flow cerebral perfusion (LFCP) avoiding direct arch vessel cannulation. METHODS: Eighteen patients, with a median age of 11 days (range 1 to 85 days) and a mean weight of 3.2 +/- 0.8 kg, underwent aortic arch reconstruction with LFCP. Seven had biventricular repairs with arch reconstruction, 9 underwent the Norwood operation and 2 had isolated arch repairs. In 1 Norwood and 7 biventricular repair patients, LFCP was maintained by advancing the cannula from the distal ascending aorta into the innominate artery. In 8 of 9 Norwood patients, LFCP was maintained by directing the arterial cannula into the pulmonary artery confluence and perfusing the innominate artery through the right modified Blalock-Taussig shunt fully constructed before cannulation for cardiopulmonary bypass. In 2 patients requiring isolated arch reconstruction, the ascending aorta was cannulated and the cross-clamp was applied just distal to the innominate artery. RESULTS: LFCP was maintained at 0.6 +/- 0.2 L x min(-1) x m(-2) for 41.0 +/- 13.9 minutes at 18.5 degrees C +/- 1.1 degrees C. In 10 of the 18 patients, blood pressure during LFCP was 15 +/- 8 mm Hg remote from the innominate artery (left radial, umbilical or femoral arteries). In 8 of the 18 patients, right radial pressure during LFCP was 24 +/- 10 mm Hg. The mean mixed-venous saturation was 79.8% +/- 10% during LFCP. Two patients had preoperative seizures, whereas none had seizures postoperatively. One patient died. CONCLUSIONS: Neonatal aortic arch reconstruction is possible without circulatory arrest or direct arch vessel cannulation. These techniques maintained adequate mixed-venous oxygen saturations with no associated adverse neurologic outcomes.     

Comparison of hemodynamics between Norwood procedure and systemic-to-pulmonary artery shunt for single right ventricle patients

Objective: Despite that surgical outcomes of patients with hypoplastic left heart syndrome have improved, one of the problems remaining is the high interstage mortality after a stage I Norwood procedure. The purpose of this study was to determine the hemodynamic characteristics of hypoplastic left heart syndrome after a Norwood procedure. We examined the perioperative hemodynamic differences of the staged operation between the first stage of the Norwood procedure and systemic pulmonary shunt for single right ventricle patients. Methods: Data from 39 patients who underwent a Norwood procedure (right ventricle to pulmonary artery conduit: 19, Blalock–Taussig shunt, 20) were analyzed. There were nine early and seven interstage deaths. Bidirectional cavopulmonary shunt was performed in 15 patients and the Fontan procedure in 9 (group H). We defined the control group as 26 patients who underwent the first stage of a systemic pulmonary shunt for a single ventricle. Bidirectional cavopulmonary shunt was performed in 14 patients and the Fontan procedure in 8 (group C). We compared the perioperative hemodynamics of the staged operation between the two groups. Results: Cardiothoracic ratio and single ventricular diastolic dimension before bidirectional cavopulmonary shunt were acutely increased in group H (P=0.02, <0.001). There was no significant difference between the two different types of Norwood procedures. The pulmonary artery index for the right heart bypass operation was lower in group H than in group C (P<0.001). Oxygen saturation before bidirectional cavopulmonary shunt in group H decreased (P<0.001) and thus was lower than that in group C (P=0.003). Mortality and the postoperative clinical parameters of the right heart bypass operation were not different between the two groups. Conclusions: Patients with hypoplastic left heart syndrome showed hemodynamic instability of acutely increased cardiothoracic ratio, and single ventricular diastolic dimension despite decreased oxygen saturation interstage after stage I of a Norwood procedure. This suggests that this hemodynamic characteristics in hypoplastic left heart syndrome correlates with the higher mortality before second stage palliation than in found with single right ventricle patients.     

Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome

OBJECTIVE: Pulmonary overcirculation through a systemic-pulmonary shunt has been one of the major causes of early death after the Norwood procedure. To avoid this lethal complication, we constructed a right ventricle-pulmonary shunt in first-stage palliation of hypoplastic left heart syndrome. METHODS: Between February 1998 and February 2002, 19 consecutive infants, aged 6 to 57 days (median, 9 days) and weighing 1.6 to 3.9 kg (median, 3.0 kg), underwent a modified Norwood operation with the right ventricle-pulmonary artery shunt. The procedure included aortic reconstruction by direct anastomosis of the proximal main pulmonary artery and a nonvalved polytetrafluoroethylene shunt between a small right ventriculotomy and a distal stump of the main pulmonary artery. The size of the shunt used was 4 mm in 5 patients and 5 mm in 14. RESULTS: All patients were managed without any particular manipulation to control pulmonary vascular resistance. There were 17 survivors (89%), including 3 patients weighing less than 2 kg. Two late deaths occurred due to obstruction of the right ventricle-pulmonary artery shunt. Thirteen patients underwent a stage II Glenn procedure after a mean interval of 6 months, with 2 hospital deaths. To date, a stage III Fontan procedure has been completed in 4 patients. Overall survival was 62% (13/19). Right ventricular fractional shortening at the last follow-up (3-48 months after stage I) ranged from 26% to 43% (n = 13, mean, 33%). CONCLUSION: Without delicate postoperative management to control pulmonary vascular resistance, the modified Norwood procedure using the right ventricle-pulmonary shunt provides a stable systemic circulation as well as adequate pulmonary blood flow. This novel operation may be particularly beneficial to low-birth-weight infants with hypoplastic left heart syndrome.     

Modified extended septoplasty for left ventricular outflow tract obstruction after repair of double-outlet right ventricle report of a case

A three-year-old boy with residual VSD and LVOTO after repair of double outlet right ventricle underwent modified extended septoplasty successfully. Preoperative left ventriculography showed a residual VSD and LVOTO. The peak systolic pressure gradient between the left ventricle and aorta was 38 mmHg. Operation aimd not only at relief of the obstruction, but also at streamlining of the LVOT by removal of protrusions. We modified the extended septoplasty reported by Belli et al in 1996. The postoperative course was uneventful and patient was discharged at 15 postoperative day. The most recent echocargiogram revealed no residual LVOTO.     

The transluminal balloon angioplasty of a stenosed Blalock-Taussig systemic-pulmonary anastomosis in congenital heart defects of the blue type]

Dilatation of a stenosed Blalock-Taussig anastomosis was performed in 15 patients with blue-type congenital heart diseases at the Bakulev Institute of Cardiovascular Surgery, AMS USSR, from March, 1989 to May, 1991. Seven of these patients had a severe form of Fallot's tetralogy, 4--double origin of the great vessels from the right ventricle with stenosis of the pulmonary artery, 2--atresia of the right atrioventricular orifice with stenosis of the pulmonary artery, 1--atresia of the right atrioventricular orifice with atresia of the pulmonary artery, and 1 patient had corrected transposition of the great vessels with stenosis of the pulmonary artery. The patients' ages ranged from 4 to 13 years (9.45 +/- 8.1 years on the average). Saturation of arterial blood with oxygen varied from 38 to 77% (64.2 +/- 2.9% on the average). A low-amplitude to-and-fro sound of the anastomosis was either recorded or absent on the phonocardiogram. The diameter of the balloons used ranged from 4 to 13 mm. Inflation of the balloon lasted from 5 to 60 sec. Dilatation was conducted 3 to 9 times. After dilatation saturation of arterial blood with oxygen increased to 81 +/- 2.7% on the average. A clearly defined to-and-fro murmur of the anastomosis was recorded on the phonocardiogram. Angiometry of the anastomosis performed before and after dilatation showed it to be widened considerably from 3.5 +/- 0.2 mm to 5.7 +/- 0.4 mm on the average. One patient underwent a radical operation 8 months after balloon dilatation.     

Anomalous systemic arterial supply to normal basal segment of the left lower lobe; report of a case

A 28-year-old male was referred to our hospital because of hemoptysis. A chest X-ray revealed an increase of vascular marking in the left lower field and a partial defect in the lateral line of the descending thoracic aorta. An aortogram and pulmonary arteriogram showed a large artery arising from the descending thoracic aorta and supplying the left basal segment, which had no normal pulmonary arteries. A bronchoscopy showed no abnormal findings in the bronchial tree. A clinical diagnosis of systemic arterial supply to the basal segment of the left lower lung was made, and a left lower lobectomy and closure of the anomalous systemic artery by video-assisted thoracic surgery (VATS) were successfully performed. Vascular marking of the visceral pleura of left lower basal segment was observed and the anomalous arterial pressure was 84 mmHg, as high as systemic arterial pressure, during the procedure. The histopathological examination revealed normal alveolar structure, and sclerosis and hypertrophy of pulmonary arteries of the lesion (Heath-Edwards V, which means irreversible vascular changes due to pulmonary hypertension). The patient had an uneventful postoperative course and was discharged on postoperative day 8. The VATS procedure is a more useful and less invasive method for cases of systemic arterial supply to the basal segment of the left lower lung than an open thoracotomy.     

Ventricular function determination during extracorporeal membrane oxygenation (ECMO) following Norwood operation: a case report

Extracorporeal membrane oxygenation has been used successfully to support both cardiac and pulmonary function following Stage I Norwood operation. Determination of the return of native cardiac function and pulmonary function can be easily accomplished because of the single ventricle physiology. The pulmonary function can be assessed while on full flow ECMO by isolating the membrane oxygenator gas compartment, allowing evaluation of native pulmonary gas exchange through the modified Blalock-Taussig shunt. Cardiac output can be calculated by using the following oxygen delivery equation: Total O2 delivery = ECMO oxygen delivery + ventricular oxygen delivery. The ventricular O2 saturation used in the formula for oxygen delivery is same as the mixed venous O2 saturation returning to the ECMO pump because of the large atrial communication following the Norwood operation. A 3.2 kilogram patient was placed on a pediatric ECMO circuit utilizing a heparin-coated centrifugal pump and a microporous membrane oxygenate after failure to wean from bypass because of a low oxygen saturation and poor ventricular function. On day 1 of support, the systemic arterial oxygen saturation was 100% and matched the ECMO arterial saturation. On day 2 of the support, the patient's arterial saturation decreased to 96%, and the ECMO mixed venous saturation was 87%. Using the oxygen delivery formula, the ventricular cardiac output was calculated to be 175 mL/min, with an ECMO flow of 400 mL/min for a total cardiac output of 575 mL/min. The native ventricular contribution was, therefore, 30% of total cardiac output. Calculation of cardiac output would normally require a left ventricular sample in a patient with biventricular physiology. The single ventricle physiology in the post-operative Norwood patient makes this calculation a useful tool for assessing return of ventricular function in these patients.     

The case report of minimal access CABG for triple-vessel disease]

A 55-year-old male patient underwent CABG for triple-vessel disease using the minimal access approach. The procedure was performed through a limited (10 cm) left para-sternal thoracotomy using extracorporeal circulation established with a usual aortic cannula, and pulmonary arterial and right atrial drainage. The myocardium was protected by antegrade administration of cold cardioplegic solution while the aorta was being cross-clampled. The saphenous vein graft was connected sequentially to the 4 PD and OM branches, and the left internal thoracic artery was grafted to the LAD. The postoperative course was uneventful and coronary angiography showed that all three grafts were patent. The patient was discharged one week postoperatively.