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.

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 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.

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 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.

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

ObjectiveTo summarize the experience of right mini-thoracotomy in the treatment of congenital cardiac defects.MethodsA total o f 1258 patients with congenital cardiac defects received right thoracotomy approach correction u nder cardiopulmonary bypass between October 1994 and March 2003. The cardiac def ects included 293 cases of atrial septal defect, 604 cases of ventricular septal defect, 98 cases of atrial septal defects associated with ventricular septal de fects, 177 cases of Fallot's Tetralogy, 29 cases of partial endocardial cushion defects, and 57 cases of other defects. Complicating anomalies were as follows: patent ductus arteriosus, left superior vena cava, mitral insufficiency, anomalo us pulmonary venous connection, right ventricular outflow tract obstruction, etc .ResultsAmong the 9 fatal cases (0.7%) in the study, 5 succu mbed to low card iac output, 2 to severe pulmonary infection, 1 to perfusive lung injury, and 1 t o pulmonary hypertension crisis. Postoperative complications occurred in 36 case s (2 9%). The cardiopulmonary bypass time was (60 3?32 1) min (range, 15 min ～359 min), the aortic crossclamping time was (37 7?24 6) min (range, 3 min～ 205 min ), the duration of postoperative mechanical ventilation was (19 7?34 4) hours ( range, 1 5 hours～401 hours), and the postoperative hospital stay was (8 0?12 1) days (range, 5 days～300 days).ConclusionsRight mini-thorac otomy is minimall y invasive, without impairing the integrity of the bony thorax. It gives excelle nt cosmetic results and prevents patients from postoperative pigeon chest.

60 minutes. There were no significant differences in the three groups in age, sex ratio, C/T ratio, or left ventricular function. Blood samples for analysis were collected before skin incision and at time intervals up to 6 days postoperatively. Analysis of creatine kinase MB, LDH and cardiac-specific troponin I was used for the detection of myocardial damage. Meantime, the ECG was checked for myocardial infarction. After the reperfusion, myocardial tissue was obtained from the free wall of right ventricle myocardial structure studies. Results: The level of cTnI was increased significantly when the time of myocardial ischemia was prolonged. The changes of CK-MB and LDH were not significant in these three groups. Electron microscopy demonstrated the mitochondria of myocardial cell swelled, the myofilament shortened and the sarcoplasmic reticulum vacuolated in group III. The ECG was almost normal in all groups. Conclusion: The cTnI was an early and highly sensitive biochemical marker of ischemic and reperfusion injury during correction of cardiac defects in children. The concentration of cTnI was correlated ischemia with the degree of so evaluation of the release of cTnI could be used to assess myocardial protection during cardiac operation.

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.