Objective: To describe the superior approach for correction of supracardiac (type I) total anomalous pulmonary venous return. Methods: From June 1998 to August 2001, total 11 of the supracardiac type of TAPVC were corrected by the superior approach. There were 7 males and 4 females with mean age of (5。33?4。98) years(5 months to 15 years) and mean weight of (15。09? 8。78)kg (6。4 to 33 kg). The total correction was performed under CPB. The top of the left atrium and the common pulmonary venous trunk were exposed through the transverse sinus and a direct anastomosis between those was done. Results: There was no operative mortality. No late death and arrhythmia occurred during follow-up period (4 months to 3 years). Conclusion: This superior approach for correction supracardiac type of TAPVC can afford a better exposure and a bigger orifice between the left atrium and the common pulmonary venous trunk and less injury. Therefore, the postoperative morbidity of arrhythmia is low.

ObjectiveTo summarize the experience of right mini-thoracotomy in the treatment of congenital cardiac defects.MethodsA total o f 1258 patients with congenital cardiac defects received right thoracotomy approach correction u nder cardiopulmonary bypass between October 1994 and March 2003. The cardiac def ects included 293 cases of atrial septal defect, 604 cases of ventricular septal defect, 98 cases of atrial septal defects associated with ventricular septal de fects, 177 cases of Fallot's Tetralogy, 29 cases of partial endocardial cushion defects, and 57 cases of other defects. Complicating anomalies were as follows: patent ductus arteriosus, left superior vena cava, mitral insufficiency, anomalo us pulmonary venous connection, right ventricular outflow tract obstruction, etc .ResultsAmong the 9 fatal cases (0.7%) in the study, 5 succu mbed to low card iac output, 2 to severe pulmonary infection, 1 to perfusive lung injury, and 1 t o pulmonary hypertension crisis. Postoperative complications occurred in 36 case s (2 9%). The cardiopulmonary bypass time was (60 3?32 1) min (range, 15 min ～359 min), the aortic crossclamping time was (37 7?24 6) min (range, 3 min～ 205 min ), the duration of postoperative mechanical ventilation was (19 7?34 4) hours ( range, 1 5 hours～401 hours), and the postoperative hospital stay was (8 0?12 1) days (range, 5 days～300 days).ConclusionsRight mini-thorac otomy is minimall y invasive, without impairing the integrity of the bony thorax. It gives excelle nt cosmetic results and prevents patients from postoperative pigeon chest.

60 minutes. There were no significant differences in the three groups in age, sex ratio, C/T ratio, or left ventricular function. Blood samples for analysis were collected before skin incision and at time intervals up to 6 days postoperatively. Analysis of creatine kinase MB, LDH and cardiac-specific troponin I was used for the detection of myocardial damage. Meantime, the ECG was checked for myocardial infarction. After the reperfusion, myocardial tissue was obtained from the free wall of right ventricle myocardial structure studies. Results: The level of cTnI was increased significantly when the time of myocardial ischemia was prolonged. The changes of CK-MB and LDH were not significant in these three groups. Electron microscopy demonstrated the mitochondria of myocardial cell swelled, the myofilament shortened and the sarcoplasmic reticulum vacuolated in group III. The ECG was almost normal in all groups. Conclusion: The cTnI was an early and highly sensitive biochemical marker of ischemic and reperfusion injury during correction of cardiac defects in children. The concentration of cTnI was correlated ischemia with the degree of so evaluation of the release of cTnI could be used to assess myocardial protection during cardiac operation.

Objective: The aim of this study is to review the experience of using bidirectional Glenn shunt without cardiopulmonary bypass(CPB). Methods: Fifty-eight patients underwent bidirectional Glenn shunt without CPB between May, 2000 and September, 2001. The age was (3.65?1.59) years and the weight was (13.6?4.0) kg. The procedure consists of establishing temporary bypass with cannulae placed in the SVC and right auricular appendage for venous drainage and transection of right SVC. The cardiac end of the SVC is overseen. The cranial end is anastomosed to a longitudinal incision in the superior margin of the right pulmonary artery with absorbable running suture. The anterior wall of the anastomosis is widened with pericardium patch. Results: There was no operative mortality. Five cases had postoperative complications including coma in 1 and chylothorax in 4. The mean SVC crossclamp time was (48?15) mins. The preoperative oxygen saturation and CVP were 0.75?0.09 and (12.8?2.3) mmHg, respectively. While the postoperative oxygen saturation and CVP were 0.93?0.05 and (16.5?2.9) mmHg, respectively. The drainage was (145?103)ml. The average mechanical ventilation time was (13?7) hrs. The mean postoperative hospital stay was (10?5) days. Conclusion: Bidirectional Glenn shunt without CPB is a safe and reliable method, for complicated congenital heart diseases children with inadequate pulmonary blood flow when anatomic and primary physiological correction are not suitable.

Objective: We assessed whether inhalation of low dose of nitric oxide comparing with administering 100% oxygen during cardiac catheterization would be as a method to screen patients with congenital heart disease and pulmonary hypertension for operation. Methods: We chose 67 cases of congenital heart disease with pulmonary hypertension undergoing cardiac catheterization. While spontaneously breathing room air (FiO 2, 0 21), the pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) were recorded as baseline. Patients continued to breathing 40 ppm nitric oxide with FiO 2 0.30 and 100% oxygen, for 30 minutes. Effects of inhalation of nitric oxide on pulmonary vasculature were studied. Results: Comparing with breathing room air, after inhalation of 100% oxygen or 40 ppm nitric oxide, PAP, PVR and PRV/SVR were decreased significantly. Conclusion: Comparing with administer 100% oxygen, inhalation of nitric oxide is more sensible and reliable predictor in selecting patients with congenital heart disease and pulmonary hypertension for operation.

Objective: To study the correlation between radionuclide pulmonary perfusion imaging (PPI) data and quantitative analyzed data of lung biopsy specimens in congenital heart defects with left to right shunt associate with severe pulmonary hypertension in young children. Methods: 52 data of PPI were collected from 43 young children with severe pulmonary hypertension caused by congenital heart defects. Lung biopsies were performed in 26 cases and the specimens were quantitative analyzed. The correlation between PPI and lung biopsy was studied. Results: The percentage of wall thickness (%MT) and percentage of wall area (%MS) were significantly increased in cases with right upper to lower count ratio (RULR)≥0.70 (P

Objective: The expression of eNOS and iNOS in lung tissues plays an important role in lung injury after cardiopulmonary bypass. The aim of this study is to evaluate the effect of pulmonary artery perfusion with hypothermic solution on eNOS and iNOS expression in lung tissue during CPB. Methods: 34 young children with congenital heart disease and pulmonary hypertension were divided into the control group (n=23) and protective group (n=11). The basic parameters (age, weight, data of catheterization and other assistant examination) were similar. In the control group, operation were performed using routine techniques, and in the protective group, pulmonary artery was infused with 4℃ protective solution during CPB. Immunohistochemical analysis was performed on 4-?m paraffin sections of lung tissue at end of CPB. The distribution and expression of eNOS and iNOS in pulmonary endothelium, bronchi epithelium and macrophages were studied using the immunohistochemical technique. Results: The strong iNOS-expression was showed in pulmonary endothelium (2.24?0.60) and lower iNOS-expression in bronchia epithelium (0.88?0.60) and alveolar macrophages (10.6?4.0) in protective group and lower eNOS-expression in endothelia and over iNOS-expression in alveolar macrophages and bronchia epithelia in the control group (P

Objective: To review the experience of valvuloplasty in children aged 4 months to 6 years. Methods: 199 children aged 4 months to 6 years (mean age, 2.94 years) and weight 3.1 kg to 22.0 kg (mean, 11.7 kg) underwent valvuloplasty under CPB from January 1990 to December 2001. 21 patients with isolated valvular lesions mitral incompetence(MI) in 7, tricuspid incompetence(TI) in 6, aortic incompetence(AI) in 1, aortic stenosis(AS) in 1, MI and TI in 2, MI and AI in 2, MI and AS in 1,MI and mitral stenosis in 1, the remain 178 patients had valvular disease with other pathologies (MI=122, TI=26, AI=9, MI+TI=13, tricuspid stenosis=2, AS=2, MI and AI=2, MI+AS=2). The procedures of valvuloplasty included leaflet resection and repair, annulus remodeling, choral shortening, transferal etc. depended on the anatomical variation of the lesions. Associated cardiac anomalies were corrected simultaneous. Results: There were 4 early deaths (2.0%) including 2 heart failure, 1 severe infection and 1 pulmonary hypertension. No late death was encountered during the period of 4.7 years (range 2 months-8 years) follow-up. Conclusion: Good result may be expected in valvuloplasty in children aged 4 months to 6 years.

Objective: To evaluate the effect of perfusion of pulmonary artery using hypothermic protective solution on the inflammatory response of lung during cardiopulmonary bypass. Methods: 40 children with TOF were divided into control group (n=20) and protective group (n=20). The basic parameters (age, weight, C/T ratio, oxygen saturate) were not different between both groups. In control group, the operation was performed using routine approaches. While in protective group pulmonary artery were infused with 4℃ protective solution during CPB. Plasma TNF-?, IL-6 and IL-8 of tracheal suction was measured. Lung biopsy specimens were obtained after operations for study on histological changes. At same time, patients' pulmonary functions and clinic index were monitored. Results: TNF-? was lower in protective group when compared with control group immediately and at 24h after operations (P

Objective To review the experience of one stage surgical repair of pulmonary atresia with homologous monocuspid valve patch. Methods From October 1996 to May 2002,twenty-eight patients,4 months to 20 years of age (mean 35.3 months),received surgical repair wih homologous monocuspid valve patch in right ventricular outflow tract reconstruction. 17 patients had ventricular septal defect,others had intact ventricular septum. ResultsTwo patients died of low cardiac output syndrome with a hospital mortality of 7.14%. The leading complications were atelectasis,infection,anoxic encephalopathy,capillary leakage syndrome,residual shunt. Conclusion The repair with homologous monocuspid valve patch for right ventricular outflow tract reconstruction in pulmonary atresia provided good early results and minimizes pulmonary insufficiency. Surgical technique emphasized.