Objective To evaluate the terminal segment of the intracranial vertebral artery (tICVA) fine and atherosclerotic lesions using high-resolution MRI (HRMRI) in order to guide endovascular interventional therapy.Methods From October 2015 to October 2016,4 patients with bilateral tICVA diagnosed with digital subtraction angiography (DSA) and admitted to Xuanwu Hospital,Capital Medical University were analyzed retrospectively.At the same time,time of flight (TOF) and black blood imaging were used.The bilateral tICVA imaging features in 4 patients were analyzed.Congenital dysplasia of vertebral artery and atherosclerotic lesions were identified.Results DSA revealed that bilateral tICVA fine or occlusion.HRMRI evaluation of the vascular wall structure showed that vascular dysplasia in 4 cases were all located on the right sides,showing no obvious thickening of the wall thickness,and the diameter was less than 1/2 of the contralateral side.One patient had atherosclerotic stenosis on the left and 3 had occlusion,showing local wall thickening,plaque formation,and resulting in the narrowing of the corresponding lumen and even occlusion.Three of the patients were treated with endovascular intervention.Conclusion HRMRI is helpful to differentiate hypoplasia in terminal intracranial vertebral artery and atherosclerotic stenosis or occlusion,identifying the dominant side of the vertebral artery and providing image basis for endovascular treatment of vertebral artery.

Objective: To summarize the early- and med-term outcomes of modified Fontan operation in patients with functional single ventricle and separate hepatic venous (SHV) drainage. Methods: A total of 39 patients with functional single ventricle and SHV drainage received modified Fontan operation in our hospital from 2009-01 to 2015-12 were retrospectively analyzed. There were 26 (66.7%) male, the average age was (6.98±3.62) years, body weight was (20.79±9.66) kg and pre-operative mean pulmonary artery pressure was (9.77±2.51) mmHg. Based on if SHV combining Apicocaval Juxtaposition (ACJ), the patients were divided into 2 groups: SHV group,n=29 and SHV+CAJ group,n=10. The early (3 months) - and med (5 years)-term post-operative outcomes were analyzed. Results: General clinical data was similar between 2 groups,P>0.05. There were 20/39 patients with one-stage operation, 19 with two-stage operation (18 after Glenn operation and 1 after B-T operation). Modified Fontan operation method was mainly used extracardiac conduit-common open technique (30 patients, 76.9%). 19 patients had CPB with aorta clamping, CPB time was 72-446 (189.74±84.96) min and aorta clamping time was 26-171 (89.05±43.96) min; the other 19 patients had CPB without aorta clamping, CPB time was 60-209 (109.99±98.86) min. 10 patients received re-surgery due to early post-operative complications. 3 patients died at early post-operation with the mortality at 7.7%. The average follow-up time was 3.9 (0.83-7.17) years, 1 patient had cardiac function at NYHA II and the others at NYHA I; the 5-year survival rate was 100%. Conclusion: The early- and med-term outcomes of modified Fontan operation were good in patients with functional single ventricle and SHV drainage. Selection of modified Fontan operation method should be based on the distance form inferior vena cava to SHV and presence of ACJ.

Objective: To compare the effects of pericardium patch aortoplasty and pulmonary patch aortoplasty for treating the infants with aorticcoarctation (AC) combining hypoplastic aortic arch in order to provide a better surgical choice in clinical practice.
Methods: A total of 57 patients with AC combining hypoplastic aortic arch treated in our hospital from 2009-01 to 2014-12 were retrospectively studied. The patients were divided into 2 groups: Pericardium patch aortoplasty group,n=26 and Pulmonary patch aortoplasty group,n=31. The changes of the pressure gradient at post-operation and follow-up period were compared.
Results: There were 2/57 (3.5%) patients died, 1 in Pericardium patch aortoplasty group by pulmonary hypertension crisis, the other 1 in Pulmonary patch aortoplasty group by respiratory distress syndrome. No renal failure or neurological complication occurred in neither groups. The cardiopulmonary bypass time, aortic clamping time, ventilator time and ICU stay time were similar between 2 groups,P>0.05. Selective cerebral perfusion time in Pericardium patch aortoplasty group was shorter than Pulmonary patch aortoplasty group (30.5 ± 8.6) s vs (35.6 ± 10.3) s,P<0.05. By ultrasound estimation, the post-operative AC pressure gradients were decreased than they were before, as in Pericardium patch aortoplasty group (9.5 ± 7.5) mmHg vs (39.9 ± 15.5) mmHg and in Pulmonary patch aortoplasty group (11.8 ± 11.3) mmHgvs (39.2 ± 14.5) mmHg, bothP<0.05; while post-operative pressure gradients were similar between 2 groups,P>0.05. Follow-up study was conducted in 51 patients for (17.6 ± 16.6) months, Pericardium patch aortoplasty group had 6 patients with re-stenosis, 3 of them would receive balloon angioplasty and 3 would be continuously followed-up; Pulmonary patch aortoplasty group had 6 patients with re-stenosis, 2 of them ifnished balloon angioplasty and their pressure gradients were obviously decreased, 4 would be continuously followed-up. Kaplan-Meier curves presented that Pulmonary patch aortoplasty group was superior to Pericardium patch aortoplasty group in re-stenosis occurrence during follow-up period.
Conclusion: Both pericardium patch aortoplasty and pulmonary patch aortoplasty were effective for treating the patients with AC combining hypoplastic aortic arch, the early post-operative efifcacy was similar, while the mid-term follow-up result was better in pulmonary patch aortoplasty.

Objective To compare the effects of rhBNP on the discharge time and pleural effusion in children with total cavo-pulmonary connection, and to provide a more reasonable method for the clinical treatment of postoperative children. Meth-ods Retrospective analysis of Jan 2016 to Jan 2017 during the hospital 40 cases of complex congenital heart disease in children with total cavo-pulmonary connection clinical data, of which 5 cases due to postoperative thrombosis or postoperative venous pressure was too high and had a second Fontan surgery, the patients excluded from the inclusion criteria. 9 cases of children re-turned to the ward after surgery, such as cardiac, diuretic and other conventional treatment based on the application of unequal dose of rhBNP(3-11 days) for the rhBNP group, 26 cases of conventional treatment of children with conventional treatment group. By comparing the early postoperative survival rate, the number of days of hospital stay and the retention time of the tho-racic drainage between the two groups. Results There were no significant differences in the time of cardiopulmonary bypass, postoperative ventilator use time, ICU time and positive inotropic drug scores in all the two groups. All the patients underwent preoperative examination with total cavo-pulmonary connection were alive and healthy discharge. The median hospital stay was 18 days in the rhBNP group(11-33 days, mean 19. 2 days), and the median length of hospital stay was 28 days in the routine treatment group(9 to 95 days, mean 34. 4 days). The difference of hospitalization days between the two groups was statistically significant(P=0. 038). In the retention time of the thoracic drainage tube, the median thoracic drainage tube retention time was 14 days(9-27 days, mean 15. 6 days) in the rhBNP group and 23 days in the conventional treatment group(7-91 days, mean 30. 9(P=0. 046). All the patients had no adverse effects such as excessive fluid load, intractable hypotension and liver or kidney function injury. Conclusion RhBNP can be used safely in pediatric cardiac surgery. Compared with the convention-al treatment group, rhBNP has advantages in the early discharge time and the time of thoracic drainage tube removal in children with total cavo-pulmonary connection.

The research on brain functional mechanism and cognitive status based on brain network has the vital significance. According to a time-frequency method, partial directed coherence (PDC), for measuring directional interactions over time and frequency from scalp-recorded electroencephalogram (EEG) signals, this paper proposed dynamic PDC (dPDC) method to model the brain network for motor imagery. The parameters attributes (out-degree, in-degree, clustering coefficient and eccentricity) of effective network for 9 subjects were calculated based on dataset from BCI competitions IV in 2008, and then the interaction between different locations for the network character and significance of motor imagery was analyzed. The clustering coefficients for both groups were higher than those of the random network and the path length was close to that of random network. These experimental results show that the effective network has a small world property. The analysis of the network parameter attributes for the left and right hands verified that there was a significant difference on ROI2 ( = 0.007) and ROI3 ( = 0.002) regions for out-degree. The information flows of effective network based dPDC algorithm among different brain regions illustrated the active regions for motor imagery mainly located in fronto-central regions (ROI2 and ROI3) and parieto-occipital regions (ROI5 and ROI6). Therefore, the effective network based dPDC algorithm can be effective to reflect the change of imagery motor, and can be used as a practical index to research neural mechanisms.

Objective    To summarize the experience of surgical treatment of transposition of the great arteries with intact ventricular septal (TGA-IVS) after left ventricular regression by comparing the characteristics of rapid and long-term two-stage arterial switch operation (ASO). Methods    Forty-one patients who were mainly diagnosed with TGA-IVS from January 2007 to January 2019 and underwent two-stage ASO were included. They were divided into a rapid two-stage ASO group (19 patients) and a long-term two-stage ASO group (22 patients) according to the interval of left ventricular training surgery and ASO. The clinical effectiveness of the two groups was compared. Results    There was a statistical difference in age, body weight, blood oxygen saturation before ASO, end diastolic diameter of left ventricle before training, and thickness of posterior left ventricular wall before ASO (P<0.05). Children older than 1 year was an independent risk factor for long-term two-stage ASO. Conclusion    Long-term two-stage ASO is suitable for children who are older than 1 year and who have severe left ventricular regression.

A 12-year-old girl with double outlet of right ventricle, complete atrioventricular septal defect, pulmonary valve stenosis, single atrium, inferior vena cava-hemiazygos vein drainage and left isomerism, who had undergone surgical left superior vena cava-pulmonary artery connection was referred to our hospital. Echocardiography revealed thickening, crimping and malalignment of common atrioventricular valve, moderate-to-severe regurgitation mainly from the left side and the main pulmonary artery was poorly developed. We preserved the autologous valve and used the 31# mechanical mitral valve which was sutured to mitral annulus. After the main pulmonary artery was transected, proximal end was sutured and a 20# Gore-tex artificial vessel was anastomosed to the distal end of the main pulmonary artery. We excised hepatic vein from the right atrium which was then anastomosed to another artificial vessel. Postoperative oxygen saturation was 95%-100%. Echocardiography and CT showed that the function of mechanical valve and heart was good before discharge. Common atrioventricular valvuloplasty is the preferred choice of the management of impaired valve. However, when dysfunction of valve is too severe and valvuloplasty is more likely to fail, the risk of barely performing a valvuloplasty will increase dramatically. On this condition, the mechanical valve replacement should be performed.

Objective    To investigate the effect of simvastatin and mechanical pretreatment on intimal hyperplasia of venous graft and its mechanism. Methods    Twelve New Zealand rabbits were selected and randomly divided into 4 groups: a blank control group, a simvastatin topical treatment group, a mechanical precondition group and a combined group (n=3 in each group). Ultrasound was used to evaluate the changes of graft wall and blood flow velocity in the graft, and pathological section was used to evaluate the intimal hyperplasia. Human umbilical cord endodermal cells were cultured in vitro. A simvastatin group and a solvent control group were set to detect YAP phosphorylation, downstream target gene expression and cell proliferation. Results    Vascular ultrasound showed that except the simvastatin topical treatment group, the flow velocity in vein grafts in the other three groups significantly increased 21 days after surgery compared with 7 days after surgery (P<0.01). Pathological sections showed that the thickness of new intima in the simvastatin topical treatment group, mechanical precondition group, combined group and blank control group were 45.56±4.11 μm, 201.28±16.71 μm, 143.57±7.82 μm, 249.45±13.33 μm, respectively, and there were statistical differences compared with the blank control group (P<0.05). In vitro results showed that compared with the solvent control group, cell death was observed in high concentration simvastatin (5 mmol/L) group, cell proliferation was inhibited in low concentration simvastatin (2.5 mmol/L) group (P<0.05), the expression of YAP protein in the simvastatin group was unchanged, but the expression of phosphorylated YAP protein significantly increased (P<0.05), and the expression of downstream target gene ccn1 was down-regulated (P<0.001). Conclusion    Intravascular local application of simvastatin and mechanical preconditioning alone or in combination can inhibit intimal hyperplasia of venous graft. High concentration of simvastatin has cytotoxicity, while low concentration of simvastatin has inhibitory effect on cell proliferation. Simvastatin can inhibit the formation of new intima by inhibiting the entry of YAP into the nucleus and reducing the transcription of cell proliferation-related target gene ccn1.

Objective     To summarize the characteristics of children diagnosed with secondary subaortic stenosis after the surgical closure for ventricular septal defect and explore its potential mechanism. Methods     We retrospectively collected patients aged from 0 to 18 years, who underwent ventricular septal defect closure and developed secondary subaortic stenosis, and subsequently received surgical repair from 2008 to 2019 in Fuwai Hospital. Their surgical details, morphological features of the subaortic stenosis, and the follow-up information were analyzed. Results     Six patients, including 2 females and 4 males, underwent the primary ventricular septal defect closure at the median age of 9 months (ranging from 1 month to 3 years). After the first surgery, patients were diagnosed with secondary subaortic stenosis after 2.9 years (ranging from 1 to 137 months). Among them, 2 patients underwent the second surgery immediately after diagnosis, and the other 4 patients waited 1.2 years (ranging from 6 to 45 months) for the second surgery. The most common type of the secondary subaortic stenosis after ventricular septal defect closure was discrete membrane, which located underneath the aortic valve and circles as a ring. In some patients, subaortic membrane grew along with the ventricular septal defect closure patch. During the median follow-up of 8.1 years (ranging from 7.3 to 8.9 years) after the sencond surgery, all patients recovered well without any recurrence of left ventricular outflow tract obstruction. Conclusion     Regular and persistent follow-up after ventricular septal defect closure combining with or without other cardiac malformation is the best way to diagnose left ventricular outflow tract obstruction in an early stage and stop the progression of aortic valve regurgitation.

Objective    To investigate the best anatomical classification, surgical timing, procedure and clinical outcomes of congenital vascular ring. Methods    The clinical data of 58 patients who underwent congenital vascular ring surgery in Pediatric Surgery Center, Fuwai Hospital between 2014 and 2019 were retrospectively analyzed. There were 32 (55.2%) males and 26 (44.8%) females with a median age of 16.5 (2-73) months. Preoperative symptoms, imaging examinations, anatomical classifications, surgical procedures and postoperative recovery were assessed. Results    There were 20 (34.5%) patients of double aortic arch, 22 (37.9%) patients of right aortic arch with left arterial duct or ligament, 15 (25.9%) patients of left aortic arch with aberrant right subclavian artery, and 1 (1.7%) patient of circumflex aorta with cervical aorta arch. The median ventilator supporting time was 6.0 (0-648) h, and the median hospital stay time was 14.5 (7-104) d. One patient with coarctation of aorta died of severe pulmonary infection during perioperative period, and the others survived without symptoms and reoperation after discharge. The median follow-up time was 7.0 (1-62) months. Conclusion    For children with unexplained dyspnea and dysphagia, or with right aortic arch, preoperative imaging examinations such as computed tomography or magnetic resonance imaging are required to confirm the diagnosis of vascular ring. Surgical correction of congenital vascular ring is safe and reliable, and can effectively relieve symptoms. The mortality rate and reoperation rate are low, and the follow-up results are satisfactory.