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.

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.

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.

Objective To summarizes the clinical experience of the arterial switch operation (ASO) for the complex congenital heart defects with ventriculoarterial connection anomaly. Methods Between January 2000 and August 2004, 60 consecutive neonatal and infants, aged 2 days to 11 years with mean body weight (6.5?4.3)kg (2.6～22 kg), underwent the arterial switch operation at Fu Wai hospital, including 42 patients in early years (2000.1～2003.5), and eighteen patients in recent years (2003.6～2004.8). Primary cardiac diagnoses included transposition of the great arteries (TGA, n=49) and Taussing-Bing anomaly (TBA, n=7), and the congenitally corrected transposition of the great arteries (ccTGA, n=4). The operation was performed under general anesthesia and extracorporeal circulation with the low temperature and low volume blood flow. The great arteries were transected above the valvular commissures; the coronary ostia with all the adjacent sinus of valsalva were excised and reimplanted to the proximal neo-aorta. The proximal neo-pulmonary trunk was reconstructed with a large autologous native pericardium as a pantatoon patch. The pulmonary anastomosis was completed after the aortic cross-clamp was released. The VSDs were repaired through the atrium or proximal aorta with dacron patches. For the patients with ccTGA, double switch operation included Senning procedure and ASO were performed. Results The total operative mortality rate was 16.7% (10 cases), 9 cases in early years (21.4%, 9/42) and 1 case in recent year (5.6%, 1/18), two groups had significant difference (P

Objective To observe the protective effect of acceleration neutruphils apoptosis on lung injury after cardiopulmonary bypass(CPB) . Methods The neutrophils were separated using discontinuous Percoll gradients in vitro and cultured for 48 hours with or without clarithromycin. Neutrophil survival was determined by typan blue dye exclusion method. Apoptotic neutrophils were detected with flow cytometry. Immune histochemistry was used to examine the expression of protein of Fas and bcl-2 which interrelated with neutrophil apoptosis. In vivo study twelve adult sheeps were randomly divided into two groups. Pulmonary artery was clamped after CPB was established and the lungs were perfused with 4℃ low molecular weight dextran solution in control group (n = 6) and 4℃ low molecular weight dextran solution with clarithromycin in protective group (n - 6), The bypass was withdrawn after 90 minutes. Respiratory function were recorded during CPB and cytokines in the lung were measured. Lung biopsies and the apoptosis of the neutrophil were also performed after operation. Results Clarithromycin significantly shortened neutrophil survival in a dose-dependent fashion. The result of flow cytometry showed that the apoptosis rates at 24h of clarithromycin group were (33.7?4.9)%, (48.0?4.9)%, (52.0?5.4)% and (53.0?7.1)% at 1, 5, 10 and 20 ?g/ml of clarithromycin respectively while the rate in control group was (31.5?3.5)% (P

Objective Using a bioreactor to culture reendothelializing homograft bioprosthetic valve (HBV) in order to ultimately form viable tissue in vitro, so as to provide basic material for animal experiment and clinical application. Methods The reendothelializign HBV was placed in a pulse duplicator system (“bioreactor”), designed and fabricated by us. These grown under gradually increasing nutrient media flow and pressure for additional 14 days: 125 ml/min at 30 mm Hg (days 1-4), 250 ml/min at 40 mm?Hg (days 5-7), 500 ml/min at 50 mm Hg (days 8-10), 750 ml/min at 75 mm Hg (days 11 to 14). Throughout the studies, the flow device was placed in an incubator with 95% humidity and 5% carbon dioxide. The morphologic structure was observed and photographed by stereomicroscope with 0.5% silver nitrate (AgNO_3)staining and SEM on the 7th, 10th and 14th day. The retention rate of the ECs overlaid onto the HBV was evaluated with the percentage (%). Results The reendothelization level on the surface of the leaflets was 92% before pulsatile-flow-cultivation. But the rate of ECs retention on the scaffold exposured to pulsatile flow was only 36%, 23% and 11% on the 7th, 10th and 14th day, respectively. Conclusion The retention rate of ECs on the scaffold was low for pulsatile-flow-cultivation in vitro. Problems, including deficiency of mature stress fibers in the endothelial cells from MSCs deficiency of the adherence and growth factors still need improvement.

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 investigate the effect of total liquid ventilation on pulmonary inflammatory reaction in piglets after cardiopulmonary bypass. Methods After receiving cardiopulmonary bypass operation, 12 piglets were randomly treated with conventional gas ventilation or total liquid ventilation for 240 minutes. Samples for blood gas analysis were collected before and at 30-minute interval after cardiopulmonary bypass. The degree of lung injury was analyzed histologically. The inflammatory cells and the levels of interleukin-6, interleukin-8, and myeloperoxidase in bronchoalveolar lavage were analyzed. Results Normal gas exchange was maintained during total liquid ventilation. Nuetrophil and macrophage count in bronchoalveolar lavage and histological lung injury were significantly reduced in the study group. The concentrations of interleukin-6, myeloperoxidase in bronchoalveolar lavage were reduced in the study group [(53.55?15.48) vs. (81.32?15.23) pg/ml, (50.00?7.37) vs. (75.00?9.19) U/L], P

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.