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.

Aortic dissection has been remained highly lethal by far,especially for those involving the aortic arch.Many ways have been tried to tackle with aortic arch lesions including open surgery,endovascular therapy and hybrid procedure.Among them,surgical replacement of aortic arch seems to be the most promising on account of its long-term follow-up.However,there is still no uniform surgical procedure for aortic arch replacement.And surgical complications often occur due to its complex anatomical structures.Accordingly,many surgical procedures aiming at simplifying the procedure and lowering the risk of the operation have been raised.This article will introduce these new ways by reviewing related literatures and making brief comments.

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.

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: 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 analyze risk factors for acute kidney injury after aortic arch operation under deep hypothermic circulatory arrest.Methods Between January 2005 and June 2011,549 cases aortic arch replacement under deep hypothermic circulatory arrest were retrospectively analyzed.According to the occurrence of acute kidney injury they were divided into two groups.Univariate and multivariate analysis (multiple logistic regression) were used to identify the risk factors.Results AKI occurred in 102 cases (18.6％) and 27 cases(4.9％) had dialysis.Multiple logistic regression showed that body mess Index(OR =1.072,95％ CI:1.006-1.141,P =0.031),serum creatinin (OR =1.011,95％ CI:1.006-1.017,P =0.000),cardiopulmonary bypass time(OR =1.006,95 ％ CI:1.002-1.009,P =0.005) and the peak intraoperative glucose level (OR =1.007,95 ％ CI:1.002-1.011,P =0.003) were independent risk factors for AKI.Conclusion The higher BMI,serum creatinin level maybe indicate the occurrence of AKI,and AKI maybe can be reduced by controlling CPB time and intraoperative hyperglycemia.

Objective Retrospectively analyze 47 cases received reoperation with aortic disease after aortic valve replacement to deepen the understanding of aortic valve disease.Methods From January 2003 to June 2012,47 patients with previous aortic valve replacement received aortic root or other aortic operation because of new aortic disease.38 male and 9 female,the interval (6.0 ± 3.8) years. All cases with new aortic disease were diagnosed by cardiac ultrasound and aortic computed tomography.Bentall's procedure were operated on 14 patients,total aortic arch replacement with elephant trunk procedure on 14 patients,aortic root and aortic arch with elephant trunk procedure on 7 patients,ascending aortic replacement on 10patients,total thoracic and abdominal aorta replacement on 2 cases.All patients were followed by clinic interview or telephone.Results Aortic dissection and aneurysmal dilatation were occurred on ascending aorta,each account for 50％,in patients with previous aortic valve replacement because of rheumatic valve disease and bicuspid aortic valve; 3 cases with Marfan syndrome occurred ascending aortic dilatation and 4 cases occurred aortic dissection.Diameter in ascending aorta increased (5.2 + 7.1)mm per year and aortic sinus (3.3 ± 3.1)mm per year.The value of ascending aortic dilatation per year in patients with rheumatic disease was higher than patients with Marfan syndrome(P ＜ 0.05).47 patients were re-operated in fuwai hospital,1 patients died in operating room because aortic dissection seriously involved right coronary artery.7 patients have renal insufficiency after operation and all were cured by hemofiltration; neurological complication occurred in 14 patients including that 7 patients stroked and 7 patients had transient brain dysfunciotn.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time were(53.49 +33.79) months.8 cases were died during follow-up and threeyear survival rate was 83％.There were no cases received operation due to aortic disease during follow-up.Conclusion Deepening the understanding of aortic valve disease combine ascending aorta changes,especially pay attention to patients with previous aortic valve replacement because of Marfan syndrome and rheumatic disease during follow-up after first operation,all efforts should decrease the occurrence of aortic adverse events in long term.

ObjectiveTo retrospectively analysis the role of intercostal artery reconstruction in spinal cord protection for patients with extent thoracoabdominal aotic aneurysm (TAAA) repair.MethodsFrom August 2003 to August 2010,extent Crawford Ⅱ TAAA repair were performed in 81 consecutive patients with mean age (39.4 ± 10.3) years and 61 (75.3％)were males.All the procedures were performed under profound hypothermia with interval cardiac arrest.Patientswere opened with a thoracoabdominal incision.Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium.T6 to T12 intercostal arteries and L1,2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8mm branch for keeping spinal cord blood perfusion.Visceral arteries were joined into a patch and anastomosed to the end of the main graft.Left renal artery was anastomosed to an 8mm branch or joined to the patch.The other 10mm branches were anastomosed to iliac arteries.ResultsWith 100％ follow-up,early mortality was 7.4％ (6/81),one patient was dead result from cerebral hemorrhage,three from renal failure,one from heart failure because of myocardial infarction and one from rupture of cliac artery dissection.Postoperative spinal cord deficits was 3.7％ (3/81),temporary paraplegia were observed in 2 patients and paraparesis occurred in 1 patient,but all of them were without bladder or rectum deficits.Neo- intercostal arteries were clogged in 12 patients within follow-up,and two of those patients with Marfan syndrome underwent pseudoaneurysm after intercostal arteries reconstruction.The mean survival time in this group is (54.22 ± 3.03 )months (95％ CI:44.37 months,59.90 months)with survival rate 92.37％ after 1 year,89.02％ after 2 years,85.54％ after 5 years.Three patient were dead with long term follow-up,one were resulted from cerebral hemorrhage at 20th month,one from rupture of ascending aorta at 23rd month and the last from rupture of aorta ulcer.ConclusionIntercostal artery reconstruction is a reliable method in spinal cord protection for patients with TAAA repair.It is a feasible method with acceptable surgical risks and satisfactory results.It can achieve long term result with less risk of spinal cord deficits and good quality of daily life.