Infective endocarditis with congenital heart disease

From 1988 to 2005, seven patients were operated at our hospital because of infectious endocarditis (IE) with congenital heart disease (CHD). Underlying CHD included ventricular septal defect (VSD) in 4 (2 previous operations with residual region), atrial septal defect (ASD) in 2 and bicuspid aortic stenosis (AS) in 1. No cases had preventive antibiotic prophylaxis for dental procedures. We could confirm bacteria origin from blood culture in all cases, but two patients had operations without gaining control of the infection. VSD or ASD closure and valve surgery were performed in four patients. One patient had a VSD closure, two patients had valve surgery. There were no operative or hospital deaths and there were no recurrences of IE during the study period. We successfully treated IE with CHD by enough debridement of the infective focus of IE, and valve surgery. It is important for patients with CHD to have preventive antibiotic prophylaxis for dental procedures.     

微创技术同期治疗漏斗胸合并先天性心脏病

目的 探讨应用微创技术同期治疗漏斗胸合并先天性心脏病(先心)的方法及可行性.方法 2006年7月至2011年6月应用双微创技术6例,其中男4例,女2例;年龄4～6岁5月,平均5岁4月;体重16 ～ 20 kg,平均(18.00±1.79) kg.CT Haller指数3.9 ～5.0,平均(4.35±0.43).其中4例行室间隔缺损微创伞封术(3例膜部和1例主动脉瓣下室间隔缺损,缺损直径4 ～5 mm);2例行中央型继发孔房间隔缺损微创伞封术,直径12～16mm.先心微创术后行Nuss手术,术后常规放置心包纵隔引流管.结果 手术顺利,术后5～11h拔除气管插管,平均(8.17±2.04)h.48h拔除心包纵隔引流管.无手术死亡、大出血及胸腔脏器损伤等危险并发症.术后检查先心封堵效果良好,肺复张良好.术后出现1例切口延期愈合,经治疗后,均顺利出院.3例行钢板取出术,效果满意.结论 微创技术同期治疗合并先心的漏斗胸安全、满意,避免了二次手术所带来的困难和风险.     

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。     

Sternal closure with resorbable synthetic loop suture material in children

PURPOSE: The reliability of poly-p-dioxanone (PDS) suture for sternal closure was tested on 264 consecutive sternotomies in the authors' department from April 1987 to May 1998. METHODS: The reason for sternotomy was tetralogy of Fallot in 65 cases (24.6%), ventricular septal defect (VSD) in 38 cases (14.4%), atrial septal defect (ASD) in 77 cases (29.2%), ASD + VSD in 23 (8.7%), mitral valve replacement in 22 cases (8.3%), aortic valve replacement in 10 cases (3.8%), and other cardiac disorders in 29 cases (11.0%). RESULTS: Sternal wound infection, sternal dehiscence, and mediastinitis occurred in 1.5% of patients (4 of 264). The overall hospital mortality rate related to the mediastinitis was 1.1% (3 of 264) in the early postoperative period. CONCLUSION: This absorbable suture and our different technique are a safe alternative to standard sternotomy closure after pediatric open cardiac surgery.     

静脉注射吸毒者感染性心内膜炎的外科治疗

目的 探讨静脉注射毒品所致感染性心内膜炎的外科治疗经验.方法 17例患者静脉注射毒品史2～10年,均有心脏瓣膜赘生物;其中三尖瓣赘生物并关闭不全16例,二尖瓣赘生物并关闭不全合并室间隔缺损1例,术前血培养阳性8例.三尖瓣置换术8例,三尖瓣成形术8例,二尖瓣置换同期室间隔缺损修补术1例.术后平均随访(44.7 ±19.1)月.结果 全部患者治愈出院,心功能明显改善,随访期间抗凝不当致大咯血1例,三尖瓣重度返流1例.结论 外科手术修复受累瓣膜或置换瓣膜是治疗静脉吸毒性感染性心内膜炎的有效手段.     

先天性心脏病介入治疗57例

目的分析常见先天性心脏病(先心病)介入治疗的疗效。方法回顾性分析2009年3月至2012年1月德阳市人民医院经导管介入治疗57例先心病患者的临床资料,男31例,女26例;年龄1.5～75.0(29.4±3.5)岁。单纯动脉导管未闭(PDA)21例,室间隔缺损(VSD)12例,房间隔缺损(ASD)20例;VSD合并ASD 2例,VSD合并PDA 1例,ASD合并PDA 1例。均采用国产封堵器及输送系统。ASD合并PDA患者先封堵动脉导管,再封堵ASD;VSD合并PDA患者先堵动脉导管,再封堵VSD;VSD合并ASD患者先封堵VSD,再封堵ASD。结果介入治疗手术时间30～90 min。全组手术成功56例,成功率98.3%(56/57),1例老年女性ASD患者合并慢性肺源性心脏病,因肺动脉压高放弃封堵而终止手术。住院时间3～7 d。全组门诊以心脏彩色超声心动图、胸部X线片、心电图随访1个月～2年,无并发症发生。结论只要严格掌握手术适应证,规范操作,经导管介入治疗先心病安全、微创、疗效确切。     

Surgical treatment for infectious tricuspid valve endocarditis with ventricular septal defect; report of a case

We report a case of tricuspid valve endocarditis with a ventricular septal defect (VSD). A 54-year-old female who had a history of dental therapy admitted to our hospital with a fever of unknown origin. Echocardiography showed vegetation attached to the tricuspid valve and small VSD. The direct closure of VSD and tricuspid valve replacement was performed. The patient's postoperative course was uneventful.     

Clinical outcome of aortic valve replacement in the elderly

Since elderly patients are being referred for surgery in increasing numbers, we reviewed the clinical outcome of 459 consecutive patients aged 70 to 89 years, who had aortic valve replacement between 1993 and 2000. We subdivided the study population into three groups: in Group 1 we included patients aged 70-74 years old; in Group 2 patients aged 75-79 years old; and in Group 3 patients aged 80 years old or older. An isolated AVR was performed in 289 patients (63%), concomitant coronary artery bypass graft (CABG) in 168 patients (36.6%), an isolated ventricular septal defect (VSD) closure in one patient (0.2%) and an isolated atrial septal defect (ASD) closure in one patient (0.2%). The overall perioperative mortality rate was 7% (32 patients), without significant differences among the three groups (P=0.88). Our study confirms the good outcome of aortic valve replacement in elderly patients even in octagenarians and only concomitant CABG procedures increase the operative risk, reducing long-term survival (P<0.05).     

TEE引导下经胸微创封堵治疗先天性心脏病

目的探讨TEE引导下经胸介入封堵治疗先天性心脏病(CHD)的临床应用价值。方法回顾50例接受TEE引导下经胸介入封堵治疗的CHD患者的资料,包括29例室间隔缺损(VSD)、12例房间隔缺损(ASD)、1例ASD合并VSD及8例动脉导管未闭(PDA),封堵前均经TEE再次明确诊断并观察心脏缺损情况,术中超声实时监测并引导导丝、鞘管等到达指定位置及封堵伞放置,术后超声观察有无残余分流、瓣膜功能障碍评以价封堵效果,并通过心电图监测患者有无心律失常、传导阻滞。结果 49例介入封堵成功,其中11例术后即刻TEE可见残余分流;术后1、3、6个月复查TEE,49例均显示封堵器位置良好,无残余分流及封堵术导致的瓣膜反流,复查心电图未见心律失常及传导阻滞。1例VSD介入封堵失败。结论 TEE用于引导经胸介入封堵治疗CHD安全、有效且创伤小、无辐射、无需对比剂,操作简便,值得临床推广应用。     

全胸腔镜下手术治疗先天性心脏病

目的探讨胸壁打孔全胸腔镜下先天性心脏病手术的可行性。方法2004年10月-2008年8月,完成胸壁打孔全胸腔镜下先天性心脏病手术156例,其中单纯房间隔缺损79例、单纯室间隔缺损65例、主动脉窦瘤破裂合并室间隔缺损1例、右室双腔心合并室间隔缺损3例、房间隔缺损合并部分性肺静脉异位引流8例。右侧胸壁3孔,股动脉、静脉插管建立体外循环,特制的长阻闭钳阻闭升主动脉,冷晶体心脏停跳液顺行灌注保护心肌。结果手术均获成功,体外循环时间（74±28）m in,升主动脉阻闭时间（29±13）m in,术后呼吸机辅助时间（3.2±1.1）h,术后住院时间（6.1±1.2）d。术后并发症13例：7例右侧气胸,胸腔穿刺一次治愈;6例右腋下切口液化,伤口延期愈合。无严重并发症发生。全组术后5-7天超声心动图示房间隔、室间隔无残余分流,1例主动脉窦瘤破裂合并室间隔缺损修补术后主动脉瓣轻度返流,3例室间隔缺损合并右室双腔心术后右室流出道疏通满意;心电图示窦性心律,无房室传导阻滞。132例术后随访3个月-3年,其中95例〉12个月,无不适,心功能Ⅰ级。结论胸壁打孔全胸腔镜下手术治疗房、室间隔缺损安全可靠,创伤小,恢复快,美容效果好。     

Successful surgical treatment of a case of corrected transposition in situs inversus with associated anomalies

A 33-year-old female with corrected transposition (situs inversus) with ventricular septal defect (VSD), atrial septal defect (ASD), and pulmonary stenosis (valvular and subvalvular) was operated successfully. Closure of ASD and infracristal VSD was performed through right atrial approach. In order to get complete exposure of VSD, a part of anterior leaflet of mitral valve was detached temporally. An external conduit was interposed between the morphologic left ventricle and the main pulmonary artery to relieve pulmonary stenosis. Postoperative course was uneventful except a transient complete heart block for a day. Several technical aspects of the radical operation were discussed including VSD closure method to avoid damaging the atrioventricular conducting tissues and reconstructive procedure of morphological left ventricular outflow.     

Absent pulmonary valve syndrome: operation in infants with airway obstruction.

From 1979 through 1991, 19 infants with absent pulmonary valve syndrome and airway obstruction were seen for surgical treatment. All patients underwent extensive pulmonary artery aneurysmorrhaphy using cardiopulmonary bypass. Fourteen patients had simultaneous transatrial ventricular septal defect (VSD) closure, infundibular resection, and placement of a short transannular patch; 2 had transventricular VSD closure and infundibular resection without a transannular patch; 1 underwent transventricular VSD closure and transannular patching; and 2 underwent pulmonary artery aneurysmorrhaphy alone with the VSD left open. All 19 infants had good hemodynamics when taken from the operating theater, but 3 died postoperatively of severe airway obstruction, despite further tracheobronchopexy procedures in 2 (hospital mortality rate, 16%; confidence limits, 7% to 29%). Among the 16 patients discharged from the hospital, there was one late death. Five other patients have required reoperation for branch pulmonary artery stenosis (n = 2), residual airway obstruction resulting from persistent pulmonary artery dilatation (n = 1), closure of VSD (n = 1), and homograft valve insertion for pulmonary incompetence and right ventricular dysfunction (n = 1). There are 15 long-term survivors. Eight of them have episodic bronchospasm of mild to moderate severity, and all are responsive to sympathomimetic bronchodilator aerosols. The remaining 7 are asymptomatic.     

Coronary artery bypass grafting in adults with congenital heart disease

Abstract Background: Adults with congenital heart disease (CHD) and coronary artery disease (CAD) have unique clinical manifestation due to the coexistence of intracardiac anomalies and CAD. Case reports are rare in surgical management of CHD combined with CAD. Our goal is to study the outcome of surgical intervention of CHD and CAD concomitantly. Methods: From February 2002 to August 2009, 29 adult patients underwent coronary artery bypass grafting (CABG) and surgical correction of CHD concomitantly. Congenital cardiac anomalies include atrial septal defect (ASD) in 21 cases, ventricular septal defect in four cases, atrioventricular septal defect in three cases, and cor triatriatum in one case. Coronary angiography demonstrated: one‐vessel disease in 10 cases, two‐vessel disease in 11 cases, and three‐vessel disease in eight cases. Coronary revascularization and intracardiac anomalies were corrected with cardiopulmonary bypass in 23 cases. There were six patients who had off‐pump coronary artery pass grafting (OPCAB) and intraoperative device closure of ASD. Results: One patient died of pulmonary infection and multiorgan failure. Follow‐up time was from 2 to 89 months (mean, 42 ± 25 months). One patient with recurrent angina did not need intervention of the revascularization. Six patients who acquired OPCAB and intraoperative device closure of ASD had no complications after surgery. Conclusions: Surgery for adult patients who had CHD with CAD was a safe and effective management. OPCAB with intraoperative device closure of ASD was a reasonable approach for some selective patients. (J Card Surg 2010;25:629‐632)     

Off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on simple congenital heart diseases (ASD,VSD and PDA) attached consecutive 210 cases report: A single institute experience

Objective  

This paper intends to report our experiences by using an operation of off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on the treatment of consecutive 210 patients with simple congenital heart diseases (CHD) including atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA).     

Methods for Repair of Simple Isolated Ventricular Septal Defect

One hundred fifteen consecutive patients underwent repair of a variety of "isolated" simple ventricular septal defects (VSD), from February 1985 through December 1989. In no patient was a ventriculotomy required to accomplish the ventricular septal defect closure. There were no instances of permanent complete atrioventricular dissociation, and there have been no reoperations for residual or recurrent VSD. Postoperative echocardiographic and Doppler studies were performed in each patient and revealed good surgical results. There was one hospital death. The technical strategies used to accomplish the repair are described. These include methods for transatrial, transaortic, and transpulmonary approach to VSD closure. Enabling methodologies described include detaching the septal leaflet of the tricuspid valve to enhance VSD exposure in patients wherein the defect is obstructed by the tricuspid valve with "aneurysm of the membranous septum." Also, splitting of the VSD patch in order to manage tricuspid valve chordal straddling is outlined.     

成人先天性心脏病合并冠心病的外科治疗

目的探讨年龄>40岁的先天性心脏病合并冠心病手术治疗的安全性和有效性。方法 2002年2月～2009年5月,26例先天性心脏病(房间隔缺损18例,室间隔缺损4例,房室管畸形3例,三心房1例)合并冠心病(冠状动脉造影显示:单支病变10例,双支病变9例,三支病变7例)接受心脏畸形矫治联合冠状动脉搭桥手术,22例体外循环下行心脏畸形矫治和冠状动脉搭桥术,4例食管超声引导下行房间隔缺损术中伞堵(intraoperative device closure,IODC)及非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)。冠状动脉旁路移植共完成46处远端吻合,同期行二尖瓣置换术2例,二尖瓣成形术3例,三尖瓣成形术5例,房颤射频消融术2例。结果 1例房室管畸形因肺部感染和多器官衰竭死亡,其余25例康复出院,无手术并发症。术后随访17～105个月,(57.6±24.7)月:1例术后18个月再发心绞痛,未接受再次医疗干预;术后患者心功能和肺动脉高压情况改善;4例杂交手术随访中未发现残余分流、血栓和封堵装置移位等并发症。结论外科治疗成人先天性心脏病合并冠心病效果良好。IODC联合OPCAB治疗房间隔缺损安全、有效。     

儿童感染性心内膜炎的外科治疗

目的：总结儿童感染性心内膜炎的外科治疗经验，以期掌握好手术时机及指征，提高手术成功率。方法：28例儿童心内膜炎病人，7例因急性心力衰竭、栓塞或严重败血症急诊手术；21例经抗生素治疗体温正常后择期手术。彻底清除赘生物后，同时行主动脉瓣瓣膜置换5例，主动脉根部拓宽、主动脉瓣瓣膜置换2例，室间隔缺损（室缺）修补5例，室缺修补、右室流出道疏通2例，室缺和佛氏窦瘤修补2例，室缺修补、主动脉瓣瓣膜置换2例，动脉导管缝扎3例，动脉导管缝扎、主动脉瓣瓣膜置换1例，二尖瓣瓣膜置换3例，二尖瓣瓣膜置换、左冠前降支取栓并搭桥1例，法洛四联症矫正、Rastelli手术和1例。同期行三尖瓣成形6例、肺动脉瓣成形7例。结果：手术死亡1例（3．6％），死亡原因为术后霉菌性感染不能控制、多器官功能衰竭。术后平均随访2．6年，心内膜炎复发2例，无远期死亡。结论：儿童感染性心内膜炎手术治疗的远期效果满意，其手术时机及指征的掌握对治疗效果至关重要。     

杂交(hybrid)手术在复杂性先天性心脏病治疗中的初步应用

目的探讨结合介入器械和实时影像学的术中"杂交"(hybrid)手术对复杂性先天性心脏病的治疗价值.方法2005年3月～10月,我院行hybrid手术治疗7例复杂性先天性心脏病.球囊扩张组3例均为室间隔完整型肺动脉闭锁(PAIVS)的新生儿.缺损封堵组4例,其中1例右冠状动脉异常起源于肺动脉合并房间隔缺损,1例右侧肺静脉异位引流合并房间隔缺损(ASD),2例多发室间隔缺损(VSD).正中进胸,在超声引导下经右室流出道置入球囊扩张管扩张肺动脉瓣或经右心房植入封堵器.多发室间隔缺损于体外循环下经三尖瓣植入封堵器.合并的其他心脏病变同期常规外科矫正.术后心脏超声随访.结果7例均顺利出院,无一例手术死亡.3例PAIVS术后中位住院时间10 d,余4例均在术后7 d出院.随访1～6个月,7例生长发育良好,人工体肺分流管通畅,未发现中度以上的肺动脉瓣再狭窄,ASD和多发VSD术后均未发现明显残余分流及封堵器移位,均无影响瓣膜功能等并发症发生.结论hybrid手术可以不采用体外循环,减少手术创伤,对于提高复杂性先天性心脏病的疗效具有重要的意义.     

50例先天性主动脉窦瘤的外科治疗

总结先天性主动脉窦瘤外科治疗经验。方法：先天性主动脉窦瘤５０例,合并室间隔缺损３１例,主动脉瓣脱垂１４例。行窦瘤切除修补术１７例,窦瘤切除加定夺缺修补１９例,窦瘤切除加主动脉瓣成形１２例,主动脉瓣替换２例。结果：全组无手术死亡,无残余分流。结论：心脏超声对ＣＡＳＶ诊断准确率高。     

流出道室间隔缺损合并主动脉瓣关闭不全的外科处理

目的总结流出道室间隔缺损（VSD）合并主动脉瓣关闭不全（AI）的外科处理经验。方法回顾分析94例VSD合并AI的临床资料、VSD补片修补和主动脉瓣处理方法。结果无手术死亡，术后低心排6例（6．4％）。在主动脉瓣脱垂伴轻度AI60例中，出院时超声检查（UCG）14例仍有轻度AI，随访中2例加重需再次手术。在主动脉瓣成形术25例中，UCG提示23例主动脉瓣轻度返流，2例轻微返流，2～5年后3例返流加重。9例主动脉瓣置换术中1例术后1年死于感染性心内膜炎。结论流出道VSD伴有AI，应根据主动脉瓣病理改变而选择恰当的方法。