Sensory function of the neurovascular island flap in thumb reconstruction: comparison of original and modified procedures

A study was conducted to examine the sensory function of thumbs that were reconstructed using 2 procedures: the original Littler neurovascular island flap (NVIF) procedure and a modification of the NVIF procedure in which the divided nerve of the transferred island flap is sutured to the original nerve of the thumb. Twenty-one patients with a mean follow-up period of 4.6 years were examined. Nine patients were treated with the NVIF procedure and 12 with the modified NVIF procedure. Paresthesia was observed more frequently in the patients treated with the original NVIF procedure. The Semmes-Weinstein test and the static and moving 2-point discrimination examinations showed no significant difference between the 2 groups. The pulp writing test showed significantly better results for the patients treated with the modified NVIF procedure. The transferred pedicle flap was fully recognized as representing the thumb in the modified procedure. In the original procedure, however, the sensibility of the transferred pedicle flap was recognized as coming from the thumb in only 61% of the cases; furthermore, the original procedure carried an additional disadvantage in that sensibility of the transferred pedicle flap was recognized as coming from both the donor and recipient sites.     

A new era in the surgical treatment of atrial fibrillation: the impact of ablation technology and lesion set on procedural efficacy

BACKGROUND/OBJECTIVE: While the Cox-Maze procedure remains the gold standard for the surgical treatment of atrial fibrillation (AF), the use of ablation technology has revolutionized the field. To simplify the procedure, our group has replaced most of the incisions with bipolar radiofrequency ablation lines. The purpose of this study was to examine results using bipolar radiofrequency in 130 patients undergoing a full Cox-Maze procedure, a limited Cox-Maze procedure, or pulmonary vein isolation alone. METHODS: A retrospective review was performed of patients who underwent a Cox-Maze procedure (n = 100), utilizing bipolar radiofrequency ablation, a limited Cox-Maze procedure (n = 7), or pulmonary vein isolation alone (n = 23). Follow-up was available on 129 of 130 patients (99%). RESULTS: Pulmonary vein isolation was confirmed by intraoperative pacing in all patients. Cross-clamp time in the lone Cox-Maze procedure patients was 44 +/- 21 minutes, and 104 +/- 42 minutes for the Cox-Maze procedure with a concomitant procedure, which was shortened considerably from our traditional cut-and-sew Cox-Maze procedure times (P < 0.05). There were 4 postoperative deaths in the Cox-Maze procedure group and 1 in the pulmonary vein isolation group. The mean follow-up was 13 +/- 10, 23 +/- 15, and 9 +/- 10 months for the Cox-Maze IV, the pulmonary vein isolation, and the limited Cox-Maze procedure groups, respectively. At last follow-up, freedom from AF was 90% (85 of 94), 86% (6 of 7), and 59% (10 of 17) in the in the Cox-Maze procedure group, limited Cox-Maze procedure group, and pulmonary vein isolation alone group, respectively. CONCLUSIONS: The use of bipolar radiofrequency ablation to replace Cox-Maze incisions was safe and effective at controlling AF. Pulmonary vein isolation alone was much less effective, and should be used cautiously in this population.     

A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged?

In a series of 1304 patients (1867 knees), the results of simultaneous and staged bilateral total knee arthroplasty were compared with each other and with unilateral total knee arthroplasty. The bilateral procedures had a significantly higher rate of complications than unilateral procedures, almost entirely because of thromboembolic problems. However, this did not correspond to an increase in mortality. If a bilateral procedure was indicated, then a simultaneous procedure had no increased risk over a staged procedure. There was no increase in cardiovascular complications, the rate of deep-vein thrombosis or pulmonary embolism or mortality. The rate of infection was lower with a bilateral procedure and the overall revision rate was less than 1% in all groups. The prosthesis functioned as well in all groups in the medium and longer term periods.We feel that simultaneous bilateral total knee arthroplasty is a safe and successful procedure when compared with a staged bilateral procedure. It also has the added benefit of single anaesthetic, reduced costs and decreased total recovery time when compared to a staged bilateral procedure. For these reasons it should be considered as an option in the presence of bilateral knee joint disease.     

中医针刺操作评价指标研究

目的编制适用于护理专业学生针刺操作考核的标准化评分表。方法采用系统分析法,以教学和临床经验为基础,初步拟订针刺操作评分表,通过4轮专家咨询筛选;依据层次分析法,计算权重系数,最终确定评分条目。结果专家权威系数为0.890,最终确立的评分表有操作前评估、操作准备、针刺操作、操作后评价4个一级指标,归一化权重分别为0.046、0.204、0.654、0.096;共15个条目,各条目归一化权重0.049~0.701,以此建立针刺操作评分表。结论该评分表可靠性高,达到教学和临床实践的要求,可作为考核护理专业学生针刺操作的工具。     

Twenty-Year Experience of a Double-Bundle Anterior Cruciate Ligament Reconstruction

Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a four-strand semitendinosus tendon was started in our department in July 1994. The motivation for starting the procedure was that the EndoButton with an inside-out procedure instrument became available in Japan. A review article of our DB ACL reconstruction procedure was summarized for the twentieth anniversary of the surgical procedure. Initial tension setting of the two grafts was changed in the first 8 years to achieve better stability during DB ACL reconstruction. A randomized clinical trial (RCT) was started in July 2002 to clarify superiority of the DB procedure to single-bundle (SB) reconstruction under the concept of anatomic reconstruction. Several anatomic studies were performed to describe normal ACL anatomy, which is essential for realizing anatomic reconstruction. A remnant-preserving technique would be an additional option for our DB procedure to improve reconstruction outcomes. Thus, a new remnant-preserving DB procedure was started in 2012. The reproducibility of the new procedure was investigated using three-dimensional computed tomography images. More complex procedures were performed using a transtibial technique and EndoButtons. Initial tension balancing between the two grafts was important for a better outcome. Superiority of knee stability after the DB compared to that after the SB procedure was clarified by the RCT. However, no patient consensus has been reached on any subjective advantage to the DB procedure. Studies of normal ACL anatomy have left questions unresolved regarding where the two tunnels should be created for direct and indirect insertions based on normal anatomy. A new remnant-preserving DB ACL procedure has been practiced. The procedure was more reproducible with respect to creating the femoral tunnel. DB ACL reconstruction using a semitendinosus tendon is an attractive option when pursuing a better outcome for patients.     

Sugiura procedure outside Japan. The Mexican experience

In the last 10 years, we operated on 231 patients with hemorrhagic portal hypertension. Most of these patients had some form of liver disease. We performed various surgical procedures: 47 conventional shunts with H grafts and terminolateral portacaval shunts with arterialization of the portal stump, 139 selective Warren shunts, and in those patients in whom a selective portasystemic shunt could not be performed for technical reasons, esophagogastric devascularization in the form of the Sugiura procedure. Forty-five patients were treated with the Sugiura procedure as a one stage or two stage procedure. A total of 68 emergency and elective operations were performed. The operative mortality rate for the emergency thoracic operation was 41 percent and for the abdominal operation, 42 percent. The overall operative mortality rate in the emergency group was 41 percent. The incidence of recurrent variceal bleeding and encephalopathy was 0 in the surviving patients. The survival rate at 3 year follow-up was 40 percent. The elective group was made up of 24 patients. Eighteen patients had a two stage procedure and 6 patients had a one stage procedure. The operative mortality rate for the abdominal operation was 11 percent, whereas that for the thoracic operation was 7 percent. The operative mortality rate for the one stage procedure was 16 percent. The overall operative mortality rate in the elective group was 10.8 percent. None of these patients had recurrent variceal bleeding and encephalopathy developed in only one (5 percent). The encephalopathy was easily controlled with medical treatment. The 3 year survival rate was 83 percent. We conclude that the Sugiura procedure is an effective procedure to treat hemorrhagic portal hypertension when a selective shunt cannot be performed.     

Modified Thiersch operation for rectal prolapse. Technique and results

Rectal prolapse is best treated by intra-abdominal or perineal procedures that either resect the redundant rectosigmoid colon or fix the rectum within the pelvis. We have found the Thiersch procedure to be adequate treatment in patients who are high risk or who have only mild to moderate prolapse of the rectum. Over the past 20 years, we have treated 15 patients with a modified Thiersch procedure, using a knitted Dacron vascular graft to encircle the anus. One patient required a second Thiersch procedure after failure of a Ripstein procedure that followed failure of a Thiersch procedure done with wire. A second Thiersch procedure was required in two patients after suture breakage, and in one patient after removal of an infected graft. Two other patients had graft infections necessitating removal of the Dacron graft; one patient had a perianal infection that was treated without removing the graft. Continence was achieved in six of nine patients previously incontinent, and maintained in the six patients who had been continent before operation. Prolapse was corrected in 13 of the 15 patients. Although the Thiersch procedure is not applicable to all patients with rectal prolapse, it can be used successfully when performed properly.     

Endoscopic management of post-traumatic prostatic and supraprostatic strictures using Neodymium-YAG laser.

We assessed the feasibility, efficacy and long-term results of endoscopic management using Neodymium-YAG (Nd-YAG) laser as a day care procedure in patients with post-traumatic supraprostatic and prostatic strictures. Three patients with post-traumatic prostatic and supraprostatic obliterative strictures underwent Nd-YAG laser core through urethrotomy as a day care procedure. Patient age ranged between 12 and 14 years. Mean duration of injury was 16 months. The length of stricture was assessed by bi-directional endoscopy prior to the procedure in all cases. Core through procedure was carried out using Nd-YAG laser under the guidance of a cystoscope placed antegradely. Patients were discharged on the same day with urethral catheter. Foley catheters were removed at 6 weeks. Nd-YAG laser core through procedure was carried out successfully in all cases with negligible blood loss in a mean time of 48 min. There were no intraoperative or postoperative complications. Patients were discharged on the same day. Follow-up cystogram was conducted at 6 weeks and urethroscopy at months. At a mean follow-up of 23 months, patients were asymptomatic and voiding well. Nd-YAG laser core through urethrotomy is a safe and effective procedure. It is a less invasive alternative to more complex urethroplasty procedures for patients with post-traumatic prostatic and supraprostatic strictures. It can be carried out as a day care procedure in carefully selected patients and has no complications.     

LAPAROSCOPY-ASSISTED RADICAL NEPHRECTOMY IN COMBINATION WITH MINILAPAROTOMY: REPORT OF INITIAL 7 CASES

We recently developed a new procedure for laparoscopy-assisted radical nephrectomy in combination with minilaparotomy to remove kidneys with renal cell carcinoma. A pararectal incision approximately 7 cm in length was performed from the subcostal region. A 12-mm trocar was placed at the mid-clavicular line at the level of the umbilicus. An 11 -mm trocar was placed at the tip of the rib. Under laparoscopic and trans-minilaparotomic observation, intra-abdominal manipulation was begun. The contents of Gerota's fascia were freed from the surrounding tissues and removed through the abdominal incision. Seven patients have been successfully treated with this procedure. The operating time for this procedure was shorter than the time of laparoscopic nephrectomy. There were none of the adverse hemodynamic or ventilatory effects associated with pneumoperitoneum in this procedure. This procedure also resulted in less postoperative pain and a shorter convalescence period when compared with open nephrectomy.     

Surgical treatment of atrial fibrillation with bipolar radiofrequency ablation: mid-term results in one hundred consecutive patients

AIM: The Cox-Maze procedure was introduced nearly two decades ago for the surgical treatment of atrial fibrillation (AF). Recently, our group has replaced most of the incisions of the Cox-Maze procedure with bipolar radiofrequency (RF) ablations (Cox-Maze IV procedure). The purpose of this study was to examine our midterm results with the Cox-Maze procedure using bipolar RF ablation. METHODS: From January 2002 to October 2005, 100 consecutive patients underwent a modified Cox-Maze procedure with bipolar RF ablation for AF; 32 were lone operations, and 68 were concomitant procedures. Follow-up was performed at 1, 3, 6, and 12 months, and then annually thereafter. Heart rhythm was confirmed by electrocardiography. RESULTS: The mean age of patients was 62+/-13 years; 57% were male. Duration of AF was 6.3+/-7.6 years (0.1 to 40 years), 59% had paroxysmal AF, and 34% had permanent AF. Follow-up was complete for all patients with a mean follow-up of 13+/-10 months. At 12-month follow-up, 91% (49/54) of patients were free of AF. Cross-clamp time in the lone Cox-Maze IV procedure patients was 42+/-15 minutes, while it was 101+/-29 minutes for the Cox-Maze IV with a concomitant procedure (compared to 93+/-34 minutes and 122+/-37 minutes for the traditional procedure, P<0.05). There were four operative deaths. CONCLUSIONS: The Cox-Maze IV procedure had good mid-term efficacy. The use of bipolar RF energy significantly decreased operative time and simplified the procedure compared to the traditional Cox-Maze procedure, potentially increasing utilization of the procedure among cardiac surgeons.     

Comparison of an immunohistochemical and immunofluorescence procedure to detect antibody to pancreatic islet cells

Antibody to the islet cells of the pancreas is detected in the serum of many patients with recent onset, insulin-dependent diabetes. Islet cell antibodies have been detected using the procedure of indirect immunofluorescence. We have adopted an immunohistochemical procedure using glucose oxidase to the histochemical identification of islet cell antibody. This procedure was found to be more sensitive than the immunofluorescence procedure, and, in addition, it was much easier to determine when a positive reaction was present. Thus, the glucose-oxidase immunohistochemical procedure for detecting antibodies to islet cells is preferable in comparison with indirect immunofluorescence.     

The optimal management of malrotation diagnosed after infancy: a decision analysis

BACKGROUND: The benefit of a prophylactic Ladd's procedure in older children and adults with malrotation is controversial. The purpose of this study was to determine the role of the Ladd's procedure in patients with asymptomatic malrotation diagnosed after infancy. METHODS: A Markov decision analysis was used to compare the quality adjusted life expectancy with and without a Ladd's procedure among patients with asymptomatic malrotation. Data obtained from the Nationwide Inpatient Sample were used to estimate the age-related probability of emergency surgery or volvulus among patients with malrotation. Estimates of the mortality of elective and emergency surgery, mortality of volvulus, and utilities of each health state were obtained from the literature. RESULTS: After infancy, the gain in quality adjusted life expectancy associated with a prophylactic Ladd's procedure was highest when asymptomatic malrotation was treated at 1 year old and steadily declined until asymptomatic malrotation was treated at 20 years old. An increasing advantage of observation over prophylactic surgery on life expectancy was observed after the second decade of life. A 2-fold increase in mortality risk for an elective Ladd's procedure decreased the age threshold to 14 years, whereas a 4-fold increase decreased the threshold to 7 years. These results were found to be robust by sensitivity analyses and Monte Carlo simulation. CONCLUSION: A Ladd's procedure should be considered for children diagnosed with asymptomatic malrotation, particularly those who are younger and with a low risk of postoperative mortality. The rare occurrence of midgut volvulus does not justify performing a prophylactic Ladd's procedure on most adults with malrotation.     

Surgical treatment of atrial fibrillation: predictors of late recurrence

OBJECTIVE: The Cox maze procedure was introduced in 1987 for the treatment of atrial fibrillation. This study evaluated the predictors of late atrial fibrillation recurrence in 276 consecutive patients who underwent this procedure at our institution. METHODS: From 1987 through June 2003, 276 patients (79 female and 197 male patients; mean age, 55 +/- 11 years) underwent the Cox maze procedure. Thirty-three patients had Cox maze procedure I, 16 patients had Cox maze procedure II, and 197 patients had Cox maze procedure III. The last 30 patients underwent a modified procedure (Cox maze procedure IV) with bipolar radiofrequency ablation. There were 113 (41%) patients who had a concomitant operation, most commonly either a mitral valve procedure (19%) or coronary artery bypass grafting (20%). Data were analyzed by means of univariate analysis, with preoperative and perioperative variables used as covariates. Patient follow-up was conducted by means of questionnaire, physician examination, and electrocardiographic documentation. All patients had a minimum of 6 months of follow-up. RESULTS: Patient follow-up was achieved in 92.8% of cases, with a mean follow-up time of 5.8 +/- 3.6 years. Risk factors for late atrial fibrillation recurrence were duration of preoperative atrial fibrillation (P = .01) and Cox maze procedure version (P = .001). There was no difference in actuarial 10-year survival between the Cox maze procedure versions. CONCLUSION: The Cox maze procedure remains the gold standard for the treatment of atrial fibrillation and has excellent long-term efficacy. The most significant predictor of late recurrence was duration of preoperative atrial fibrillation, suggesting that earlier surgical intervention would further increase efficacy.     

Ultrasound and bronchoscopic controlled percutaneous tracheostomy on trauma ICU

Tracheostomy is a common surgical procedure performed in long-term ventilated patients in intensive care. Since the role of percutaneous dilatational tracheostomy (PDT) on Intensive Care Unit (ICU) has become steadily more important in the last few years, a prospective study was started to evaluate the economic efficiency and to show the minimization of the complication rate of this procedure. In 72 patients we performed PDT as a bedside procedure. Initially the thyroid gland and the subcutaneous vessels were studied by ultrasound in every patient. The puncture of the trachea, the dilatational procedure and the insertion of the tracheal cannula were executed under bronchoscopic monitoring. Finally, a bronchoscopic control view followed via the new cannula to detect intratracheal complications. Mechanical ventilation was maintained during the procedure and controlled by continuous pulse oximetry. According to prior ultrasound findings the place to puncture the trachea was changed in 24% of the patients, in one case tracheostomy was performed as an open conventional procedure. The following complications could be observed: one case involving perforation of a cartilaginous ring, one case with venous bleeding of a small subcutaneous vein and two cases with punctures of the bronchoscope. There were no cases of miscannulation, penetration of the posterior tracheal wall or major bleeding requiring intervention or conversion. The followup study revealed that there was no sign of further complications in any patient. In addition, cost analysis demonstrated that there was a significant economical advantage of PDT in comparison with open standard tracheostomy. Standardized ultrasonographically and bronchoscopically controlled PDT turns out to be a safe, simple and cost effective bedside procedure on ICU. Because of ultrasound examination performed before the procedure, and bronchoscopic surveillance during the procedure, safety of this procedure can be enhanced, thus minimizing the rate of complications.     

The Cox-Maze procedure: the Cleveland Clinic experience

The Cox-Maze procedure was designed to address the consequences of atrial fibrillation, tachycardia, hemodynamic impairment, and thromboembolism. From 1991 until June 1999, 100 patients underwent the Maze operation at the Cleveland Clinic Foundation. The group included 72 men with a mean age of 58 +/- 11 years (range, 23 to 78 years). Initially, the Maze-I procedure was performed primarily for patients with lone atrial fibrillation. However, since 1995, the Maze-III procedure has been performed exclusively, and it is typically combined with mitral valve repair. Twenty-three patients had only a Maze procedure, 60 patients had the Maze procedure/mitral valve repair, 10 patients had Maze procedure/coronary artery bypass, 6 had Maze procedure/mitral valve replacement, and 1 had Maze procedure/atrial septal defect repair. Chronic atrial fibrillation was present in 78% of patients for a mean of 8 +/- 9 years. There was a 1% perioperative mortality and 5% late mortality rate. Median hospital stay was 9 +/- 5 days. Six patients required new early permanent pacemaker insertion. With a mean follow-up of 3 years, 90.4% of patients are in sinus rhythm (or atrial pacing). Preoperative symptoms were reduced: 24% had preoperative syncope; none had syncope in follow-up; 14% of patients preoperatively had cerebral or systemic emboli; and there were no perioperative or late embolic events. The Maze procedure effectively addressed the major complications of atrial fibrillation and was associated with low perioperative and late morbidity rates.     

Selective distal splenorenal shunt versus side-to-side portacaval shunt. Clinical results of a prospective, controlled study

A prospective, controlled study comparing the clinical results of the selective distal splenorenal shunt procedure and the side-to-side portacaval shunt procedure was undertaken in 1980. Ninety-three cirrhotic patients with previous episodes of bleeding from esophageal varices underwent a distal splenorenal shunt procedure (47 patients). The operative mortality rate was 2 percent in both groups. The intraoperative decrease of portal hypertension after the portacaval shunt procedure was higher than after the distal splenorenal shunt procedure (p less than 0.05), and in those with patent shunts, there was a 0 percent incidence of early variceal rebleeding after the portacaval shunt procedure compared with a 9 percent incidence after the distal splenorenal shunt procedure (p less than 0.05). Both shunts, however, had similarly satisfactory results in preventing long-term variceal rebleeding (portacaval shunt 2 percent and distal splenorenal shunt 0 percent). Postoperative ascites was more common after the distal splenorenal shunt procedure (58 percent versus 24 percent; p less than 0.01). Analysis of actuarial survival curves showed no difference between the two procedures. The incidences of long-term episodes of chronic encephalopathy were not statistically different after both procedures. The only three instances of severe encephalopathy occurred in patients with the portacaval shunt (p less than 0.05). The distal splenorenal shunt also seemed to have a less negative effect on postoperative liver function than the portacaval shunt. These data suggest that the selective shunt should be viewed as a first choice strategy in the treatment of portal hypertension.     

The advantages of pylorus-preserving pancreatoduodenectomy in malignant disease of the pancreas and periampullary region.

The aim of this study was to establish whether the pylorus-preserving pancreatoduodenectomy (PPPD) is a safe and radical procedure in malignant disease of the head of the pancreas and periampullary region, without increased morbidity and mortality rates compared with the standard Whipple's procedure. During the period 1984 to 1990, a Whipple's procedure (n = 44) or PPPD (n = 47) was performed in 91 patient. In-hospital mortality rates were 2% after PPPD and 5% after Whipple's procedure. Median duration of the resection procedure and median blood loss in the PPPD group were 210 minutes and 1800 mL, respectively. After Whipple's procedure, these figures were 255 minutes and 2500 mL, both significantly different (p less than 0.01) as compared with PPPD. No difference was found during follow-up with respect to days of gastric suctioning, start of liquid diet, normal diet, complaints of ulcer disease, postoperative complications, recurrence of disease, and survival. In all patients, curative resection was performed with comparable TNM (tumor, nodes, metastases) staging. The number of tumor-containing duodenal or gastric resection margins did not differ in both groups of patients (two patients after PPPD, two patients after Whipple's procedure). Hospital stay was significantly (p = 0.02) shorter after PPPD; median 14 days, compared with median 18 days after Whipple's procedure. The advantage of the PPPD is that it is an easier and less time-consuming operation, with less blood loss, a shorter hospital stay, and better weight gain (p = 0.02) during follow-up. In conclusion, PPPD is a safe and radical procedure for cancer in the head of the pancreas or periampullary region, with the same survival and appearance of locoregional recurrence and distant metastases as after standard Whipple's resection.     

A prospective, single-center clinical trial of a modified Cox maze procedure with bipolar radiofrequency ablation

OBJECTIVE: The Cox maze III procedure has excellent long-term efficacy in curing atrial fibrillation. It has not been widely practiced because it is technically challenging and requires prolonged cardiopulmonary bypass. The aim of this study was to examine a simplified Cox maze III procedure that uses bipolar radiofrequency energy as an ablative source. METHODS: Beginning January 2002, a total of 40 consecutive patients underwent a modified Cox maze III procedure with bipolar radiofrequency energy. Nineteen had a lone maze procedure and 21 had a maze procedure plus a concomitant operation. One month after the operation, the first 8 patients were investigated with high-resolution magnetic resonance imaging. Patients were followed up monthly with clinical examination and electrocardiography. RESULTS: There was no operative deaths. The crossclamp times were 47 +/- 26 minutes for the modified lone Cox maze III procedure and 92 +/- 37 minutes for the Cox maze III procedure plus concomitant procedures. These were significantly shorter than our previous times for the traditional Cox maze III procedure (93 +/- 34 minutes and 122 +/- 37 minutes, respectively, P <.05). Follow-up magnetic resonance imaging showed no evidence of pulmonary vein stenosis, and atrial contractility was preserved in all patients. There were no late strokes. At 6-month follow-up, 91% of patients (21/23) were in sinus rhythm. CONCLUSIONS: Bipolar radiofrequency ablation can be used to replace the surgical incisions of the Cox maze procedure. This energy source did not result in pulmonary vein stenosis. The modification of the Cox maze III procedure to use bipolar radiofrequency ablation simplified and shortened this procedure without sacrificing short-term efficacy.     

Temporary tracheotomy for post-intubation laryngeal edema after lung cancer surgery: a case report

We compare the early and late outcomes of a modified aortic root remodelling (ARR) technique for aortic root replacement without mobilisation or reimplantation of the coronary ostia, with those of the modified Bentall-de Bono procedure. A retrospective observational study was performed comprising 181 consecutive patients who underwent aortic root replacement with a modified Bentall-de Bono procedure (104 patients) or ARR (77 patients) between January 2013 and December 2019. Primary endpoints included hospital mortality and late survival. Secondary endpoints included incidence of post-operative complications and freedom from late re-operation. ARR procedures were performed with shorter cross-clamp times and comparable cardiopulmonary bypass times to modified Bentall-de Bono procedures. The incidence of early post-complications was comparable between groups. 30-day mortality was numerically lower with ARR than the modified Bentall-de Bono procedure. Over 7-year follow-up, 4 patients (3.8%) required repeat aortic surgery after a modified Bentall-de Bono procedure, and none after ARR. Long-term mortality after ARR and after modified Bentall-de Bono procedures was 17.1% and 22.7%, respectively. The cumulative incidence of reintervention on the aortic root/valve was 3.2% after a modified Bentall-de Bono procedure and 0% after ARR. When adjusted for other independent risk factors, late mortality was not influenced by the procedure performed, although competing risk adjusted for age showed that the modified Bentall-de Bono procedure was associated with an increased risk of aortic root/aortic valve re-operation. The modified ARR technique is associated with reduced myocardial ischaemia time, lower post-operative mortality and aortic re-intervention rates compared to a modified Bentall-de Bono procedure. It may be considered a safe and feasible procedure for aortic root/ascending aortic replacement offering good long-term outcomes.     

Norwood术后心导管造影检查的应用及介入治疗

目的 探讨Norwood术后心导管造影检查结果以及介入治疗方法和疗效.方法 13例病婴均为Norwood术后而尚未行Glenn手术者,其中12例接受了介入治疗.结果 13例中6例出现新主动脉弓再狭窄,行主动脉成形术.1例左肺动脉狭窄,行左肺动脉球囊扩张术,3个月后左肺动脉置入支架.2例Sano-Shunt狭窄和1例BT-Shunt狭窄,均置入支架治疗,改善肺血流.4例合并体肺动脉侧支,其中3例采用Coil行侧支血管堵塞术,另1例于次日Glenn手术术中结扎.结论 Norwood术后血流动力学异常的发生率很高,术后造影和血流动力学的评估以及对新主动脉弓或肺动脉狭窄的介入治疗是必要的.

Abstract：

Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients, who had undergone Norwood procedure (prior to Glenn procedure)received cardiac catheterization and angiography. lnterventional therapy was performed in 12 patients as indicated. Results Angioplasty was carried out for re-coarctation in 6 of the13 patients. 1 patient with left pulmonary artery stenosis received balloon dilation and 3 months later a stent implantation. A stent was implanted to improve the pulmonary blood flow in 2 patients with Sano-Shunt stenosis and 1 patient with BT-Shunt stenosis. Transcatheter coil embolization was performed in 3 of the 4 patients with systemic to pulmonary collateral vessels. The other one was scheduled for Glenn procedure the next day. Conclusion The incidence of hemodynamic restrictions after Norwood procedure is high (12 of 13 patients). Postoperative angiography and hemodynamic assessment for diagnosis and interventional treatment for new pulmonary artery or aortic arch stenosis is necessary after Norwood procedure.