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.

Objective To investigate the expression and effect of elastin in full-term rats with hyperoxia induced by chronic lung diseases. Methods One hundred and forty-four full-term rats are randomly exposed to hyperoxia (hyperoxia group)and room air(room air group).Chronic lung disease(CLD)is induced by hyperoxia exposure. Gomori's stain for elastic fibers and in situ hybridization methods were used to detect the expressions of secondary crest and tropoelastin mRNA on the 1st,3 rd, 7th, 10th,14th and 21st days after exposure. Results The expressions of secondary crest decreased significantly in hyperoxia group, compared with room air group on the 3rd to 14th days(P＜0.05).The expressions of tropoelastin mRNA decreased significantly in hypemxia group, compared with room air group on the 3rd to 10th days (P＜0.05),otherwise increased significantly from the 14th to 21 st days(P＜0.05). Hyperoxia exposure can delay the peak of tropoelastin mRNA. Conclusion Elastin is involved in the inhibition of alveolarization and lung fibrosis in the development of CLD.

Objective To study the therapeutic effects of inhaled iloprost on pediatric pulmonary hypertension after congenital heart disease operation and to investigate the mechanisms of iloprost.Methods Thirteen 10 min every time,every 4 hours for 48 h after the surgery.We used the 24 h cardiac monitoring and ultrasonic cardiography for hemodynamical monitoring.We examined the blood cAMP and cGMP by ELISA assay.Results The patients were(17.88±12.56) months old with average weight of(9.29±3.59) kg.The right atrial pressure,systolic pulmonary arterial pressure,systolic pulmonary arterial pressure/systolic blood pressure were(11.5±1.41)mm Hg,(61.64±13.6) mm Hg and 0.66±0.16 before the treatment and they were(9.88±1.88) mm Hg,(47.67±12.18) mm Hg and 0.52±0.15 at the time point of 20 min after the treatment.For all the three parameters,there were significant differences before and after treatment.The effect of iloprost continues to 120 min later.The cAMP level was(335.75±127.31) μg/L before iloprost inhalation and increased to(519.68±148.54)μg/L at the time point of 20 min after inhaling iloprost,showing a significant difference(P＜0.01).Blood pressure,cGMP level and ventilator parameters showed no notable difference before and after the treatment.Conclusion Inhaled iloprost significantly improves pulmonary hemodynamics in children with pulmonary hypertension after congenital heart disease operation,which might be achieved by increasing the blood cAMP.However,systemic blood pressure and respiratory function keep unaffected after iloprost inhalation.

Objective To investigate the hemodynamic effects and mechanisms of aerosolized iloprost in children with pulmonary hypertension(PAH)after congenital heart surgery,in the setting of early ventilation and continuous nitric oxide(NO)inhalation were administered.To observe the outcomes of the patients after iloprnst therapy.Methods From April 2008 to April 2009,all postoperative children with PAH in ICU,Fuwai hospital had regularly been given ventilation and NO inhalation at a dose of 10 ppm for 2 hours since they were leaving the operation room,and then ultrasonic cardiography was used to evaluate the systolic pulmonary arterial pressure(sPAP=4×TIVmax+RAP).Thirty children were diagnosed as having postoperative PAH for sPAP/sBP≥0.5.They were divided into two groups(group T and group C)randomly,with ventilation and NO inhalation administered continuously,and were given inhaled iloprost at a dose of 100 ng·kg-1·min-1*10 min and inhaled 0.9% NaCl 4ml respectively,once every 4 hours for 48 hours.We used the 24-hour cardiac monitors and ultrasonic cardiography for hemodynamic monitoring in the patients of two groups at the six time points:baseline(t1),20 min later after the first inhalation(t2),120 min later after the first inhalation(t3),24 hours later after the treatment(t4),48 hours later after the treatment(t5) and 24 hours after ceasing the last inhalation(t6).We examine the blood cAMP and cGMP by ELISA assay before and after the first inhalation.We observed the blood coagulation,the liver and kidney function of these patients.The outcomes of these patients were also investigated.Results At t1,the sPAP and sPAP/sBP had no differences between the two groups.At t2,the sPAP(43.23±11.72)mmHg and sPAP/sBP(0.48±0.13)in group T were both lower than the sPAP(53.13±13.60)mmHg and sPAP/sBP(0.60±O.15)in group C(P<0.05).At t3,the sPAP/sBP of group T was also lower than that of group C(0.48±0.09 vs 0.59±0.14,P<0.05).At t4 and t5,the sPAP in group T were (39.84±12.87)and(34.99±12.98)mm Hg,with sPAP/sBP(0.42±0.15)and(0.36±0.14),were much lower than those in group C(P<0.01).From t1 to t2,the cAMP level increased sharply from(406.64±179.18)to(578.68±193.05)pg/dl in group T(P<0.01),and was also obviously higher than that in group C at t2(392.26±94.46)pg/dl(P<0.01).HR,BP and RAP showed no notable difference between two groups at every time point.So did the PIP.There were no differences in coagulation,liver and kidney function at t6.2 patients died from pulmonary hypertension crisis(PAH)in group C and no one in group T.One patient showed flush during the treatment in group T and recovered spontaneously after the inhalation.Nevertheless,none in group C.Conclusiou Inhaled iloprost significantly improved pulmonary hemodynamics in children with PAH after congenital heart operation even thongh they were ventilated and inhaling NO.Increased blood cAMP level was considered to be a contributing factor.Howeve,systemic BP remain unaffected after iloprost inhalation.Aerosolized iloprost may be associated with improvement in the survival and deczeased PHC.

Objective: To evaluate the clinical results of cryopreserved homografts for the treatment of complex congenital heart defects. Methods: In 420 patients with complex congenital heart diseases received surgical correction with right ventricular outflow tract (RVOT) reconstruction was done using cryopreserved homografts. Of the 420 homografts, 234 were aortic homografts and 186 were pulmonary homografts. The mean age of patients was 4.6 years (range, 5 months to 21 years). The mean body weight was 17.5 kg (range, 5.5～52 kg). The mean follow-up time was 27.8 months (range, 3 months to 12.9 years). Results: There were 19 operative deaths with a mortality rate of 4.5%. The postoperative complications occurred in 25 patients and they all recovered uneventfully. The postoperative mechanical ventilation time was 48.7±42.5 hours (range, 8～192 hours). The mean hospital stay was (12.2±9.0) days (range, 7～46 days). There were no late death and complication. Conclusion: The results of this study suggest that ROVT reconstruction with cryopreserved homografts as transannular patch can be achieved with excellent the clinical outcome.

Lung injury was one of the most complications after extracorporeal circulation. As a result of blood exposure to the surface of the extracorporeal circulation circuit, the complements and leukocytes were activated. The activated neutrophil adhered to endothelial cells and released many inflammatory mediators, as protease, oxygen free radicals, arachidonic acid metabolites. All of these inflammatory mediators caused lung injury. In vivo and in vitro, many studies demonstrated that leukocyte depletion in extracorporeal circulation of heart operation could reduce lung injury and improve lung function. Leukocyte depletion could reduce pulmonary resistance, particularly effective in patients with a low preoperative oxygenation capacity and in those for whom an extended period of extracorporeal circulation was required.

0.05).Right Group had lower incidence of pigeon chest compared with that of Median Group [0 vs.1.6%,?2=413.041,P=0.000].The scores of TACQOL questionnaire of Right Group were higher than that of Median Group in the domains "Physical Complaints" [(29.6?2.8) vs.(28.1?3.0),t=4.843,P=0.000],"Motor Functioning" [(31.2?1.1) vs.(30.5?1.6),t=5.139,P=0.000] and "Cognitive Functioning" [(29.9?3.2) vs.(26.9?4.2),t=7.902,P=0.000].Conclusions The repair surgery of ventricular septal defects through a shorter right lateral thoracotomy can provide superior early and late outcomes and better health-related quality of life for pediatric patients.

Objective Pulmonary artery atresia (PAA) with intact ventricular septum (IVS) is an anatomically heterogeneous entity. A variety of surgical strategies is possible. We sought to evaluate the clinical results of various surgical corrections of PAA with IVS. Methods A retrospective review of our surgical database revealed 17 patients with PAA and IVS operation between January 1992 to August 2004. There were 9 males and 8 females. The age ranged from 15 days to 12 years [(25.5?7.9) months]. The body weight was 3.5 to 28.0 kg [(7.8?5.4) kg]. Radical operation was performed in 10 cases with the Z score -2.3～1.2 (-0.78?0.34), the pulmonary artery index (PAI) 149.53～297.89 mm~2/m~2 (206.35?82.15 mm~2/m~2). Two infants received BT shunt operation for the severe hypoxia at first postoperative day. Palliative operation was performed in 6 cases with the Z score -6.1～0.2 (-2.7?0.92), the PAI 39.88～218.29 mm~2/m~2 (131.85?72.93 mm~2/m~2), including bi-directional Glenn bypass (2 cases), systemic-to-pulmonary arterial (BT) shunt (1 case), right ventricular outflow tract (RVOT) reconstruction and BT shunt (3 cases). One patient accepted one and a half ventricular repair, first underwent bi-directional Glenn bypass operation, two years later ,underwent ASD occulsion、PDA occlusion and RVOT reconstruction. Results 3 patients(16.7%) died at perioperative time [two patients who had the radical operation, but next day, had the BT shunt operation, one patient had the right ventricular outflow tract (RVOT) reconstruction and BT shunt]. The rest recovered smoothly. The main complications included low cardiac output in 3 patients, hypoxemia in 3 patients, hydrothorax in 1 patients and right heart failure in 3 patients. Conclusion Surgical outcome for patients with the PAA with IVS maybe satisfactory, strategries are to be chosen according to the anatomic subtypes such as the tricuspid valve diameter, right ventricular size, pulmonary artery index and coronary anatomy.

0.05). The mechanical strength of dacron and thread were not significantly changed. Rb/Rc was approximately 1.2, H/Rc was approximately 1.4 and ?was approximately 10. These parameters accord with standard of prosthetic valve design. Conclusion The stented homograft valve can be cyropreserved by liquid nitrogen and accord with standard of prosthetic valve design.

Objective: To evaluate hemodynamic function of the cryopreserved stented homograft bioprosthetic valve , compared to Perfect bovine pericardial bioprosthetic heart valve. Methods: Three sorts of stented homograft aortic and pulmonary valve (21 #, 23 #, 25 #) preserved by liquid nitrogen were prepared. In vitro pulsatile flow tests were performed on the valve in accordance with ISO/FDA guideline. Effective orifice area (EOA), transvalve pressure gradient and regurgitation ratio were recorded at various flow volume, compared with Perfect bioprosthetic valve. Results: There was no difference between the transvalve pressure gradient of the stented homograft aortic and pulmonary valve, but they were higher than Perfect bioprosthetic valve. The stented homograft aortic and pulmonary valve showed the larger regurgitation ratio than perfect valve, but there was no difference between two types of valve. EOA of the stented homograft aortic and pulmonary valve were smaller than Perfect valve's, there was no discrepancy between them. Though actual orifice area (AOA) of the stented homograft valve was smaller than Perfect's, but EOA/AOA ratio was no difference between two types of valve.Conclusion: The stented homograft valve has satisfactory hemodynamic performance. There is no significant discrepancy between homograft aortic and pulmonary valve's hemodynamic function.