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.

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

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.

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 Evaluate the outcome of total anomalous pulmonary venous connection (TAPVC) repair in newborn,controlling for anatomic subtypes and surgical technique.Methods Between 1999 and 2011,68 patients (median age 16 days) underwent repair for supracardiac (21),cardiac ( 8 ),infracardiac ( 36 ) or mixed ( 3 ) TAPVC.All patients were emergencies,due to obstructed drainage.Supracardiac and infracardiac TAPVC repair included the side-to-side anastomosis between the pulmonary venous (PV) confluence and the left atrium.Coronary sinus unroofing was preferred for cardiac TAPVC repair.Results Early mortality was 2.9％ (2/68).The echo showed no obstruction in the pulmonary vein anastomosis and flow rate was 1.1 m/s ～ 1.42 m/s in the follow-up of 3 years.Side-to-side anastomosis provides excellent results for TAPVC repair while left atrial enlargement procedures appear to be associated with higher risk of late arrhythmias.Although early and aggressive reintervention for recurrent PV obstruction is mandatory,intrinsic PV stenosis remains a predictor of adverse outcome.The incidence of pulmonary vena is gradually reduced to 6％ ～ 11％.This often occurred in the infracardiac or mixed TAPVC.Conclusion The nicety of preoperative diagnose,the improvement of protection of heart function,using of pulmonary vena tissue for anastomose and avoiding of distortion of pulmonary venues and delayed closure of stemum can reduce the mortality.The preoperative degree of pulmonary veno obstruction and the time of emergency operation and the infracardiac or mixed TAPVC can affect prognosis.Along with the surgical technique,the mortality of TAPVC is gradually reduced and the result is amazing,but it is important to attach importance to the patient with re-stenosis of pulmonary veno,the time and method for reoperation.

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.

Objective Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare complicated congenital heart disease.The intracardiac structure is also complicated.We sum up the corporal surgical procedure of PA/IVS.Methods Between May 2004 and May 2010,we performed emergency or sub-emergency operation in 72 newborns,infants and children [age,1 day to 5.2 years; mean age,(1.3 ±0.6) years] with favorable anatomy.The surgical procedures were divided into three kinds:1.16 cases were performed with Blalock-Tassuing (B-T) shunt operation for A group; 2.33 cases were performed with transannular patch from RVOT-MPA with or without B-T shunt operation for B group.3.22 cases were performed a hybrid procedure with or without B-T shunt operation for C group.From all the patients,15 cases had been finished the two staged operation.Results 10 patients has been died in which 6 patients were in B group with B-T shunt.Only 2 patients were for the hybrid procedure.The ECHO showed the gradient across the pulmonary annular was 15-39 mm Hg [(23 ± 5) mm Hg (1 mm Hg =0.133 kPa)] after operation.The tricuspid insufficient had been siginificantly improved.There were 58 cases were preoperatively serious tricuspid insufficient.There were 11 cases and 13 cases were respectively for middle and mild to middle tricuspid insufficient postoperatively.Follow-up with 2-5 years,there were radical operation for 8 cases,one and half ventrical operation for 5 cases and BDG and Fontan operation for 2 cases.Conclusions.Conclusion BT shunt in common procedure and using a hybrid approach is more safe and feasible than traditional procedure for the patients with PA/IVS.Z vale and right ventricular growth were importment for procedure in the future including radical 、one and half ventrical and Fon tan operation.

ObjectiveTo review and summarize the experiences of the modified mitral valve annuloplasty for mitral valve regurgitation (MR) in children.MethodsOne hundred and six patients with moderate to severe MR were retrospectively studied from March 1999 to December 2009.They aged from 0.4 to 8.5 years [ mean (3.7 ± 1.8) years ]and weighted from 6.6 to 52.0 kg [ mean(10.0 ± 3.5) kg].There were 69 males and 37 females.The heart function was evaluated by echocardiography.Patients were divided into three groups according to the age: group 1, ＜6 months , 16 cases; group 2, from 6months to 2 years, 51 cases; and group 3, from 2 years to 8.5 years, 39 cases.Seven cases were MR combined with mitral valve stenosis. Different operations were performed according to preoperative homodynamic, heart function and anatomical structure.ResultsThe operative mortality rate was 2.8％.In 3 died patients, 2 were due to MR and 1 due to severe pulmonary hypertension.104 cases were recovered.All patients were followed up 3 months to 3 years.ConclusionModified mitral valve reconstruction is necessary for children with moderate to severe MR.It should be the first choice for MR patients associated with other cardiac malfomation.This technique could prolong the time for mitral valve replacement when needed.Moreover,this technique not only reduces the valve injury but also decreases the reoperation rate.

Objective To summarize the experiences with minimally invasive pectus repair (Nuss procedure) for recurrent and acquired pectus excavatum after open thoracic surgery.Methods From Jun 2004 to Sep 2011,eighteen patients with recurrent or acquired pectus excavatum underwent Nuss procedure,including 12 males and 6 females The age ranged from 3.1to 14.8 years with mean age of (8.8 ±4.0) years.The body weight was 11 to 55kg with mean weight of (30.2 ±14.8 ) kg.Ten cases were recurrent pectus excavatum with previously failed open surgery repair,eight were acquired pectus excavatum after other open thoracic surgery.Sixteen cases had symmetrical and 2 had asymmetrical pectus excavatum.Haller' s index was 5.4 ± 3.4.The operation was performed with thoracoscopic assistance.Results All patients had successful operation with one bar insertion in each patient,one stabilizer was put on right side in seventeen and double stabilizers were put in one case.Therapeutic results evaluation was excellent in 16 cases and good in 2.Percentage of excellent and good was the same with that in our primary Nuss procedure ( P ＞ 0.05 ).Chest drainage duration was 1 to 4 days.One case had bar displacement revision 5 months later.Heart perforation occurred in one on whom a sternotomy and perforation repair were immediately performed.The echocardiography exam shows normal cardiac function after operation,and no nerve system complications were detected.One developed pneumothorax on operative day and one had pleural effusion three days later,both were treated by chest tube drainage.Twelve patients' bars were removed after 24 - 45 months of stagnation period.Anatomic results at bar removal were 10 excellent and 2 good,there were no recurrent cases.Conclusion Nuss procedure is an effective method and has good results on recurrent and acquired pectus excavatum.Safety of patients and complications minimization is always the first to be considered.