Objective To evaluate the accuracy and clinical practicality of DNA chip in comparison with serology in typing of human leukocyte antigen A (HLA-A) in Han's individuals of donor-recipients of transplantation. Methods 120 peripheral blood samples were obtained from donor-recipients of transplantation. Each sample was divided into two parts and HLA-A antigens were identified by DNA chip in one part and by serology in another. Samples in which the HLA-A typing results by these 2 methods were discordant were verified by polymerase chain reaction with sequence specific primers (PCR-SSP). Accuracy and clinical practicability of both methods were compared according to the typing results. Results Serological typing for HLA-A took 3 h, while DNA chip typing 4. 5-5 h. 112 samples have been typed successfully. Typing results were same in 91 samples and discordant in 21 cases. The verified results showed that DNA chip made 2 incorrect typing and the error rate was 2%. Meanwhile, serology made 19 mistakes, consisting of 5 antigens being incorrectly interpreted and 14 "blanks" turning out to be definable alleles. The discrepancy rate was 17 %. Conclusions DNA chip typing for HLA-A is suitable for clinical application in Chinese Han's population with a greater precision than serology. It may replace the serology in future after being improved and perfected.

Objective To evaluate the experiences of complete repair of tetralogy of Fallot with pulmonary atresia (TOF-PA). Methods From June1984 to December 2003, 24 patients with TOF-PA underwent complete surgical repair. There were ten males and fourteen females. The age ranged from 6 months to 9 years. 14 patients were in type I TOF-PA, type II 8, type III and type IV 1 each. Through a standard median sternotomy incision, all patients were operated on under moderate hypothermia and cardiopulmonary bypass. An artificial vessel patch with a monocuspid valve was applied to enlarged the outlet of right ventricle in typeIpatients and a conduit with valves from right ventricle to pulmonary artery was applied in typeII patients. Midline one-stage complete unifocalization and repair of ventricular septal defect and major aortopulmonary collaterals were used in patients with type III and IV. Results Early mortality was 13.3% (4 patients). The causes of death were severe low cardiac output (2 patients), respiratory function failure (1 patient) and multiorgan function failure (1 patient). There was no late death. 18 patients were followed up from one month to 15.5 years. Postoperative heart function (NYHA) was class I or II in 16 patients and class III or IV in 2. Conclusion Surgical repair of patients with TOF-PA can be achieved with acceptable mortality and good results. In selected patients one stage surgical correction can be done through a midline sternotomy approach.

Objective To discuss the surgical technique in correction of tetralogy of Fallot with complete atrioventricular septal defect (TOF-AVSD). Methods 16 patients aged 2-16 years underwent correction of TOF-AVSD. The atrioventricular septal defect was closed through a right atriotomy and longitudinal right ventriculotomy in each case. The three-patch technique was used for the first 7 cases and two-patch technique for the later 9 cases. The commissure between the superior and inferior bridging leaflets of the left portion of the common atrioventricular valve was closed in each patient. RVOT obstruction was relieved by a transannular patch. Results Results There were 4 deaths in the early postoperative period, 3 deaths in the first 7 cases compared to 1 death in the later 9 cases (P

Objective To report the outcomes of double switch operation as the primary approach for congenital corrected transposition of great arteries (cTGA) with heart anomaly. Methods From April 2002 to June 2004, seven patients ranged 4 to 15 years with cTGA underwent double switch operation. Six patients were situs solitus (SLL segmental anatomy) while one patient was situs inversus (IDD segmental anatomy). The heart defects included ventricular septal defect in 6 cases, secondary atrial septal defect in, double outlet of right ventricle in 1, pulmonary stenosis in 6, dextrocardia in 3 and levocardia in 1. The operative procedures comprised of 4 modified Senning+Rastelli, Mustard +Rastelli +bidirectional Glenn, 1 Senning +Rastelli, 1 modified Senning+switch. Results There was one early operative death after modified Senning+switch operation. The cause of death was left ventricular failure. The postoperative complications included severe low cardiac output syndrome in 1, temporary atrioventricular block in 1, pleurisy and low plasma protein in 2. The survivors were followed up from 2 to 24 months, all of them were in sinus cardiac rhythm except one case with junction cardiac rhythm. All were in NYHA I class. Conclusion Anatomic correction of cGTA by double switch operation can be performed with lower operative mortality and good medial-term outcome. In the SLL cases, modified Senning operation may yield better outcomes than Mustard operation.

ObjectiveTo study the pulmonary arterial development over five years in patients underwent extracardiac total cavopulmonary connection (ETCPC).Methods43 survived patients,who had undergone ETCPC were examined with pulmonary perfusion at one month and five year following the operation.Central venous pressure (CVP) and arterial oxygenation saturation (SatO2 ％ ) were measured by right cardiac catheter,pulmonary arterial index (PAI) and pulmonary vascular resistance (PVR) were calculated.Pulmonary blood distribution were measured and calculated by 99m Tc-MAA perfusion imaging.ResultsThe PAI and PVR of the follow-up group reduced significantly ( t =2.41,P ＜ 0.05 ; t =2.08,P ＜ 0.05 ),CVP also reduced significantly ( t =2.69,P ＜ 0.05 ),but SatO2 ％ did not changed significantly.Total radionuclide counts and the ratio of rightorleft pulmonary perfusion did not change significantly.( t =0.38,P ＞ 0.05 ;t =1.12,P ＞ 0.05 ),but the ratio of the superior and inferior lobe decreased significantly( t =2.54,P ＜ 0.05 ).ConclusionThe weak pulsation and low dynamic of Fontan circulation also can promote pulmonary vascular development.However,the improvement of hemodynamic in pulmonary circulation at mid-term follow will not lead to an increased amount of pulmonary perfusion or oxygen supply,which is probably due to the massive opening of the arteriovenous shunt and increased futile circulation.

Objective To study the long-term effect of total right heart bypass on pulmonary perfusion after extracardiac total cavopulmonary connection (ETCPC).Methods Fifty-three patients (29males,24 females; average age (10.8±6.1) years) undergoing ETCPC from March 1990 to December 2005were retrospectively analyzed.Forty-three patients had full set of pulmonary perfusion data at 1 month and 5years postoperation.The perfusion ratios of each lung segment were calculated based on 99Tcm-MAA radionuclide imaging.The PVR and pulmonary artery index were calculated from angiocardiography measurements.All data were compared with paired t test.Results Compared with the early postoperative data,the perfusion ratio of superior/inferior segment(0.72±0.20 vs 0.75±0.01; t =2.54,P＜0.05),the PVR ((142.98±2.61) vs (146.95±2.54) dyn · s · cm-5; t=2.08,P＜0.05; 1 dyn · s · cm-5 =0.1 kPa · s · L-1) and vena cava pressure ((9.35±0.24) vs (9.95±0.23) mmHg; t=2.69,P＜0.05; 1 mmHg=0.133 kPa) decreased significantly in follow-up data; while the ratio of posterior basal segment perfusion increased significantly (0.12±0.00 vs 0.10±0.03; t=2.16,P＜0.05).The arterial oxygen saturation ((92.70±0.30)％ vs (92.86±0.29) ％ ; t =1.12,P＞0.05),the total pulmonary nuclear counts ((701.91 ± 8.26) × 103 vs (698.93 ± 12.0) ×103 ; t=0.38,P＞0.05) and the perfusion ratio of inferior vena cava to the right lung (0.61±0.06 vs 0.60±0.06 ; t =0.74,P ＞ 0.05) were similar between the two terms of follow-up.The early angiographic and radionuclide perfusion studies did not match in 5 patients.Conclusions Hypostatic redistribution of pulmonary blood flow is the characteristics in long-term follow-up of ETCPC patients.The radionuclide imaging is superior to angiocardiography in revealing functional pulmonary blood perfusion.

Objective The study aimed to evaluate the short and middle term results in the patients with tetralogy of Fallot(TOF) after one-stage repair and staged repair.Methods A total of 459 TOF younger children less than five-year-old between January 2009 and December 2013 had received surgical repair,including 416 patients by one-stage repair(group Ⅰ)and 43 patients by staged repair(group Ⅱ).Among them,245 were male and 214 were female.The average repair surgical age was 27.8 ranged from 4 to 60 months,average palliation age was 15.4 ranged from 3 to 40 months.23 perioperative and follow-up parameters were assessed including sex,age,weight,preoperative clinic symptom,ratio of McGoon,pulmonary artery index,Z score of pulmonary annulus,cardiopulmonary bypass time,aortic cross-clamping time,type of VSD repair,type of RVOT procedure,Peak RV/LV pressure radio,RV-PA pressure grade,mortality,severely low cardiac output syndrome,hypoxemia,extubation time,ICU time,fellow-up time,left ventricular eject faction,RV index of myocardial performance (MPI),tricuspid annular plane systolic excursion(TAPSE) and pulmonary regurgitation.Results Compared with group Ⅰ,age and weight were significantly lower in patients in group Ⅱ[(19.1 ± 16.4) months vs.(21.1 ± 11.2) months,P ＜ 0.05) and(19.1 ±16.4) kgvs.(21.1 ±11.2) kg,P ＜0.01].The Z score of pulmonary annulus of patients in group Ⅱ were significantly less than those in group Ⅰ (-3.69 ± 2.36 vs.-2.50 ± 1.95,P ＜ 0.01).The ratio of repairing VSD by RV incision and using TAP in patient of group Ⅱ were significantly more than those in group(27/43 vs.71/413,P ＜0.01),(41/43 vs.221/413,P ＜0.01).There was no difference of mortality,complication,extubation time and ICU time bewteen two groups.All patients followed up 12-52 months,there was no difference of LVEF,MPI and TAPSE between two groups.However,the severity of pulmonary regurgitation in patients of group Ⅱ was significant more than those of group Ⅰ (47.6％ vs.32.1％,P ＜ 0.01).Conclusion The early and mid-term results in the the young children patients with TOF after one-stage repair or staged repair were good.Although the prior palliative shunt could promote the development of the hypoplasia pulmonary arteries in the young children patient,it may related to the technique of repairing operations and the postoperative pulmonary regurgitation.

Objective To evaluate the indication and surgical technique for treating tetralogy of F allot with pulmonary atresia (TOF-PA).Methods From June 1984 to June 2009,66 patients with TOF-PA underwent 69 operations.Among them,34 were males and 32 females.Their age ranged from 6 months to 29 years.The anatomic characteristics of TOF-PA included 31 cases of Type Ⅰ,14 Type Ⅱ,12 Type Ⅲ and 9 Type Ⅳ.The operations included palliative aorto-pulmonary shunts in 11 cases,one-stage unifocalization with unpatched VSD in 2 cases,one stage complete repair in 40 cases,one-stage unifocalization with VSD repair in 13 cases,and delayed intracardiac repair after shunt procedures in 3 cases.Results There were 6 early deaths,including 1 death happened after aorta-pulmonary shunt and 5 after complete repair.The causes of death were severe low cardiac output in 3 cases,respiratory failure in 1,multiorgan function failure in 1 and severe wound infection with endocarditis in 1 after aorta-pulmonary shunt.The postoperative oxygen saturation of the patients undergone shunt and one stage unifocalization with unpatched VSD increased to 82％ ～ 91％.The postoperative ratio of right ventricular pressure/left ventricular pressure after complete repair was ＜ 0.5 in 31 cases,18 cases were between 0.5 and 7 cases ＞ 0.75.47 patients were followed up from 3 months to 15.5 years.The heart function(NYHA) of 44 patients were in class Ⅰ or Ⅱ and 3 in class Ⅲ or Ⅳafter operation.Conclusion The surgical strategy for TOF-PA mainly depends on the anatomic characteristics of the pulmonary and aortopulmonary collateral arteries.An individualized approach based on the anatomy of the pulmonary circuits permits a better result in the patients with TOF-PA.Patients with well developed pulmonary arteries should undergo one stage complete repair as early as possible.

Objective To assess the results of the Fontan procedure in patients with visceroatrial heterotaxy syndrome and complex cardiac anomalies.Methods From April 2002 through December 2010,25 patients (male 10,female 15) had undergone the Fontan procedure for heterotaxy syndrome or atrial isomerism and complex congenital heart disease 28 times.Median age at operation was (9.1 ± 5.5) years (2 to 18 years).Heterotaxy syndrome were associated with right atrial isomerism (n =18) or left atrial isomerism (n =7),asplenia (n =13) or polysplenia (n =7),double inlet of left ventricle (n =15),double inlet and outlet of left ventricle (n =5),double outlet right ventricle with pulmonary atresia (n =2) and with pulmonary stenosis (n =1),tricuspid or mitral atresia (n =2).A bidirectional cavopulmonary shunt was performed in 8 patients (bilateral in 3 patients).A cavopulmonary shunt placement,so-called Kawashima operation,was performed in 4 patients.An extracardiac conduit Fontan connection was pefformed in 15 patients and intracardiac lateral tunnel Fontan connection in one patient.Results 2 patients died in hospital caused by ventricular failure.Five patients developed early postoperative atrial arrhythmias and 2 patients had sinus node dysfunction.Mean arterial oxygen saturation at discharge was 0.86 ± 0.07 (range,0.78 to 1.00).Follow-up (range,0.5 to 7 years) was available on 15 patients.Mean arterial oxygen saturation was 0.82 ±0.08 (range,0.68 to 0.97).Ventricular function was normal in 13 patients (EF range,0.50 to 0.66) and depressed in 2 patients.Four patients had a junctional rhythm.Conclusion The Fontan procedure was still the main procedure for patients with visceroatrial heterotaxy syndrome and complex cardiac anomalies,which can reach satisfactory early and medium-term results.The choice of Fontan procedure,extracardiac conduit Fontan connection,aggressive treatment of concomitant malformations were essential to improve the outcomes.

BACKGROUND:The treatment of pulmonary hypertension secondary to congenital heart disease has been a hot topic in the clinical research on cardiac surgery. Although traditional drugs for reducing pulmonary hypertension have excelent effects, there are some defaults, such as difficult monitoring and rebounding phenomenon after drug withdrawal. The traditional heart dacron graft is prone to cause complications, such as deformation, thrombosis, embolism, hemolysis and infection. OBJECTIVE:To investigate the effect of glutaraldehyde-fixed bovine pericardium patch and aerosolized iloprost in patients with pulmonary hypertension secondary to congenital heart disease. METHODS:Ninety patients with pulmonary hypertension due to congenital heart disease underwent a surgery. Glutaraldehyde-treated bovine pericardium patch were used to repair cardiac septal defect, and then aerosolized iloprost was applied after operation, administered for 3 days according to 30 ng/min/kg, every 4 hours in the first 12 hours of a day, and every 6 hours in the resting 12 hours. Mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance index, pulmonary vascular resistance index were recorded before inhalation, immediately after inhalation, and 30 minutes after inhalation. The pericardium-associated complications, and cardiac function were also observed at folow-ups. RESULTS AND CONCLUSION: The involved 90 cases were detected by echocardiography. The results showed that, al the flaps were closed, there was no shunting or echo discontinuation of atrial septum. The heart contraction function was normal. No pericardium-associated complications were found. There was no significant difference in the mean arterial pressure and systemic vascular resistance index in al patients at different time points. The mean pulmonary arterial pressure and pulmonary vascular resistance index immediately after inhalation were significantly lower than that before inhalation (P < 0.01). The decrease was also significant 30 minutes after inhalation (P < 0.05). The intervention of glutaraldehyde-fixed bovine pericardium patch and aerosolized iloprost is safe and effective to treat patients with pulmonary hypertension secondary to congenital heart disease.