Objective To report the experience of surgical treatment of 4 patients with complete transposition of great areteries (TGA). Methods 4 cases received arterial switch operation and senning operation from November 2004 to January 2008, including 1 case of TGA without VSD(TGA - IVS), 3 TGA with VSD (TGA -VSD), 2 TGA with Mild pulmonary valve stenosis. Results There no death during the operation or postoperation. Patients were followed up from 5 months to 3years. All the patients got better ,grew faster and cyanosis relieved apparently. 2 patients had mild to moderate mitral regurgitation preoperatively. I patient had mild mitral regurgitation post-operatively and 1 patient had no mitral regurgitation. There was no aortic stenosis or pulmonary valve stenosis after operation. I patient assis-ted respiration for 62 days after operation because of old age. All the patients recovered smoothly after operation. Conclusion Using arte-rial switch operation and senning operation to correct complete transposition of great artery could get satisfying operative results, and the ar-terial switch operation will also get good effect in older children with better left ventricular development.

Pulmonary arterial hypertension is common in patients with congenital heart disease.An effective reduction in pulmonary vascular resistance could improve the survival rate in the future.Research in the pathophysiology of pulmonary arterial hypertension shows that phosphodiesterase 5 inhibitors result in pulmonary vasodilation,decrease vascular resistance.Sildenafil,a inhibitor of phosphodiesterase 5 has been permitted to treat pulmonary arterial hypertension oversea now.Phosphodiesterase 5 inhibitors are proved to reduce pulmonary vascular resistance significantly,improve the survival rate in the future and be well tolerated.This review contains the changes of hemodynamics,exercise tolerance,side effect and pharmacokinetics of phosphodiesterase 5 inhibitors.

Objectives To investigate the expression of hTERT, p16 and Topo-Ⅱ? in astrocytoma as well as their relationship during histogenesis and development of astrocytoma. Methods The expression of hTERT, p16 and Topo-Ⅱa in 64 astrocytoma specimens with different malignant grades and 10 normal brain tissues were studied using tissue microarray and immunohistochemistory. Results The expression rate of hTERT and Topo-Ⅱa were 50 % and 59.4 % respectively, they increased along with the increase of the malignant grade(P

Objective To investigate the durability of the cryopreserved valved homograft conduit (VHC) used in reconstruction the right ventricular outflow tract (RVOT) and its risk factors. Methods 119 cases undergoing VHC reconstruction the RVOT in our hospital between November 1989 and July 2003. 65 cases were followed-up, including the clinical examination, electroeardiography, chest radiography, echooardiography, or cardiac MRI for detection of development of homograft calcifications, obstruction and conduit valve regurgitation, and we used the morden statistics method to analyze the factors for the VHCs' durability. Results Among 65 cases, the median survival time for the VHCs was 10.9 years. The longest survival lasted for 12.8 years.The homografts failure was 15.4% . Conclusion The younger age(≤4y), smaller weighl(≤10 kg),aortic homograft are the risk factors for the VHC' durability(P

Objective To explore the preoperative assessment of airway morphology affecting the early-phase prognosis by observing congenital tracheal stenosis survival after surgical treatment.Methods Totally 52 cases of CTS surgically treated in the Shanghai children's Medical Center,from April 2007 to June 2013,were retrospectively analyzed to study their clinical characteristics,survival condition and related factors influencing the early-phase prognosis.Using log-rank test and Cox multiple factors analysis for statistical analysis.Results Overall postoperative survival rate of 3 months was 73.1％.There were 14 deaths among 48 patients.Single factor and multiple factors analysis showed that the cross-sectional area(CSA) of stenosis and Anton-Pacheco classification were both associated with early-phase prognosis as independent factors(P ＜0.05).Long CPB duration was a prognostic factor for the outcome of surgical treatment for CTS(P ＜ 0.05).CPB time was significantly longer in death cases than in surviving cases.Conclusion CSA and Anton-Pacheco classification were significant prognostic factors for CTS.The proper utilization of radiologic imaging allow for improved patient care.

Objective To compare the results of surgical repair for congenitally corrected transposition of the great arter-ies(ccTGA) with pulmonary stenosis(PS), and to analyze the risk factors that may affect early results and surgical technique. Methods From Aug. 2001 to Dec. 2008, 21 patients with ccTGA and PS were treated in our hospital. They aged 3.5 months to 6.3 years [(31 ± 18) months], weighted 6.28 kg [(13.1± 6.5) kg]. Fifteen cases had paramembranous ventricular sep-tal defect (VSD), 1 noncommitted VSD and 5 subpulmonary VSD. The repairs comprised of Senning and Rastelli operation. RV-PA reconstruction was done by xenopericardial conduit in 13 patients. RV-PA direct anastomosis plus pericardial patch in 6 patients and homograft patch with autopulmonary valve in 2 patients. Results All the patients were alive. During 2 - 5 years follow-up, blood flow rate in superior vena cava increased to 1.8 - 2.2 m/s in 3 cases. One of them needed reoperation to re-lease the stenosis and the rest 2 were in follow-up. Tow patients had right ventricular outlet obstruction with a pressure gradient of 30 -45 mmHg were in follow-up. There was no other stenosis and valve insufficiency. Conclusion Double-Switch opera-tion is practical and impressive in treating of CCTGA with PS. It is important to evaluate the size of VSD and the reconstruction of RV-PA. But it still need more cases and longer time to evaluate the long-term effects.

Objective To evaluate accurately the cardiac output, an early post-operative indicator for the cardiac function, after cardiac surgery in the neonates with congenital heart diseases and assess the risk factors for surgery, with an aim at exploring the early strategy for decressing the mortality. Methods From January 2007 to November 2007, forty-seven consec-utive neonates with complex congenital heart diseases underwent surgical correction at Shanghai Children's medical center.There were 38 boys and 9 girls with age from 3 days to 29 days [mean age (21.98 +8.15) days] and weight from 2.6 kg to 4.2 kg [ mean (3.49±0.51 ) kg]. 15 patients had delayed sternal clousure. The operations were performed with hypothermia, deep hypothermia low flow, or deep hypothermia circulatory arrest techniques. Cardiac index (CI) was derived from pulse contour analysis and calculated with the PiCCO plus system. Meanwhile, serum cardiac troponin I ( cTnl), mixed venous oxygen saturation ( SvO_2 ) and cardiopulmonary bypass (CPB) time were measured. Finally, the risk factors for surgical treatment in survivors and that associated with an increased mortality were analyzed. The association between post-operative cardiac output and the death after surgery was examined. Results Four neonates died after surgery, with a surgical mortality of 8.5%. CIvalue in the neonates [ (2.0±0.3 ) liters per minute per square meter of body surface was less than normal 2.5±0. 3. CI was associated inversely with CPB time but had a positive correlation with SvO_2. No significant difference association between CI and cTnI was observed. The value of cTnl was associated with the type of surgical procedures. Cases for which DHCA and low flow cerebral pefusion technique were used were free from neurological complications, ischemia in the lower extremities and oli-guria. The duration of cardiopulmonary bypass, urgent state of the operation and the abnormal coronary artery were associated with high mortality in the neonates after cardiac surgery. Conclusion The cardiac output of the neonates in whom cardiac pro-cedures were performed is adequate for the the oxygen supply required by the whole body though it is slightly lower than nomad after cardiac surgery. Higher mortality in the neonates during early postoperative period may be due to the complexity of the primary diseases, prolonged cardiopulmonary bypass time, residual abnormalities and severe acidosis before operation. Various techniques for CPB and that for the myocardial protection are safe and can provide an appropriate operative field.

ObjectiveTo discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant.MethodsBetween May 2007 and Dec 2009,14 cases including 9 males and 5 females with caorctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in our hospital.The age ranged from 23 days to 17 months,with a median of 4.33 months.The mean body weight was (6.14 ±2.36) kg.All patients were diagnosed as aortic coarctation combined with VSD and hypoplastic aortic arch.The surgery was performed under deep hypothermia cardiopulmonary bypass with selective cerebral perfusion in 8 cases and circulation arrest in 6 cases.Fresh pulmonary autograft patch harvested from the main pulmonary artery was used for aortoplasty.The associated VSD was repaired in the same stage.ResultsAll patients survived except one died from circulatory failure during the perioperative period.Low cardiac output syndrome occurred in another case who was cured afterwards by correspondent treatments.No residual obstruction was detected by echocar-diography after the operation.Follow-up was carried out in 13 cases from 4 months to 3 years.Echocardiographic examination showed that the pressure gradient across the aortic arch was less than 16 mm Hg in all cases.The blood velocity at the descending aortic arch was not significantly changed during the follow-up period as compared with that of the immediate after operation.Computed tomography showed that the morphology of aortic arch was normal.The left bronchus compression was relieved obviously or totally disappeared in patients who suffered from left bronchus stenosis before operation,and no aortic aneurysm were detected in these patients.ConclusionConclusion Coarctation resection plus aortoplasty with pulmonary autograft patch is the optimal surgical method for treating coarctation of the aorta combined with hypoplastic aortic arch in infant.

Objective: The purpose of this study was to investigate the relationship among the maternal body composition,gestation weight gain and fetal birth weight.Methods: Pregnant women with a singleton gestation and without medical diseases before pregnancy were enrolled.Anthropometry measurements and bioelectrical impedance measurements were performed during 24-25 weeks(the second trimester) and 37-38 weeks(the third trimester).Results: Gestation weight gain was correlated significantly with gains of intracellular fluid,extracellular fluid,total body water,body fat,fat free mass,body cell mass,mother's basal metabolic rate and arm circumference seperately,which were correlated with the fetal birth weight(P0.05).Conclusion: Maternal weight gains during pregnancy were affected by their body composition.Fat free mass is considered an important predictor of fetal birth weight.

Objective Reviewed and evulated the prognosis of multiple levels of left ventricular outflow tract obstruction (LVOTO) with Konno operation.Methods Between May 2006 and May 2012,we performed Konno operation in 16 children with LVOTO.They aged from 1.9 to 13.6 years,averaged(5.1 ± 0.7)years,and weighted from 12 to 39 kg,averaged (18.3 ±6.3) kg.There are 13 cases of patients who were multiple levels of LVOTO.The pressure gradient of LVOTO was 56-185 mmHg[(96 ± 31) mm Hg].The operations were performed with middle low temperature in cardiopulmonary bypass (CPB).The time for CPB and Aortic clamp arrest was 70-182 min [(98 ± 21) min] and 34-148 min[(51 ± 11) min] respectively.There were 3 cases,4 cases and 9 cases for Konno,Konno ± Ross and Konno-Rastan respectively.Results All the pacients were alive.The time for making use of respirometer and staying in ICU was 3-9 days [(4.0 ± 1.5) days] and 5-16 days [(8.0 ±2.9) days] respectively.Follow-up with 6 months to 3 years,the ECHO showed no residual obstruction.The pressure gradient of LVOTO was 1.10-2.42 m/s.LVEF was 0.58-0.72 (0.66 ± 0.03).There were 2 cases for mild to middle aortic valve regurgitation,1 case for middle to severe aortic valve regurgitation and 1 case for middle pulmonary valve regurgitation and middle tricuspid valve regurgitation.Conclusion Konno procedure is safty and effective operation for LVOTO in children and is beneficial to the recovery of left ventricular function.It is necessary to follow up the complication in the future.