Recent progress of pediatric cardiac surgery in China.
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Cardiac Surgical Procedures↗
Biomedical subjects
Ying-long Liu
Publications and source records attributed to Ying-long Liu.
[Experiences in surgical treatment of cardiac tumors].
OBJECTIVE: To summarize the experiences in surgical treatment of cardiac tumors. METHODS: The results of surgical treatment of 494 patients with cardiac tumors hospitalized from 1975 to 2004, aged 43 +/- 16 (4 months to 78 years), 432 with myxoma, 27 with benign nonmyxoma, and 35 with malignant tumors, were analyzed. RESULTS: Complete resection of malignant tumor was achieved in 10 cases (28.6%), and subtotal resection was achieved in 15 cases (42.9%). or partial resection was performed based on the intra-operative condition. Only biopsy was performed in 10 patients (28.6%) because of extensive metastasis of tumor. Hospital death occurred in 11 myxoma patients (2.5%), and 3 malignant tumor patients (8.6%), and none of the benign non-myxoma tumor patients. The patients were followed up for 70 +/- 36 months with a follow-up rate of 92.9%. Late follow-up was performed for the 241 patients with myxoma who had underwent resection after 1990. Seventeen patients were lost to follow-up. There were 10 late deaths, 5 resulting from recurrence and 5 from unknown causes. Follow-up for malignant tumors showed 18 (51.4%) late deaths because of recurrence or metastasis, occurring 2 months to 2 years after operation. CONCLUSION: Excellent immediate and long-term operative results can be obtained for benign cardiac tumors. However, for the patients with malignant tumors the survival chances are dismal.
Adolescent↗
[An integral approach for cyanotic congenital heart disease with major aortopulmonary collateral arteries].
OBJECTIVE: To demonstrate the feasibility of combined collateral embolization with surgical repair for tetralogy of Fallot or pulmonary atresia with major aorta pulmonary collateral arteries. METHODS: The clinical, catheterization and surgical data of 15 such patients from November 1992 to September 2003 were analyzed retrospectively. RESULTS: All 15 patients underwent combined therapy of major-aorto pulmonary collateral arteries (MAPCAs) occlusion and complete repair with a mortality of 26.7%. Of the 46 collateral arteries, 35 were occluded with a successful rate of 90.6%. Embolization was performed before corrective surgery in 12 patients. The causes of early death in three patients were low cardiac output syndrome, pulmonary hemorrhage, and pulmonary infarction respectively. Complications included extensive pulmonary infiltration in 1 patient and right ventricular dysfunction in another patient. The other 7 patients recovered smoothly with the arterial oxygen saturation greater than 97% at discharge. Embolization was performed after corrective surgery in 3 patients with postoperative congestive heart failure. One patient died of congestive heart failure. The symptoms and signs of heart failure was significently relieved in the other two cases. CONCLUSIONS: In selective group of patients with dual pulmonary blood supply by both MAPCA and native pulmonary arteries, this combined therapy of collateral embolization and surgical repair simplifies complete surgical operation and enhances surgical results. It is necessary to minimize the error in distinguish sole pulmonary blood supply from dual pulmonary blood supply to avoid postoperative pulmonary infarction. Embolization after surgical correction is an important rescue measurement to congestive heart failure.
Adolescent↗
[Indications of arterial switch operation for complex congenital heart defect with severe pulmonary hypertension and ventriculoarterial discordant connection].
OBJECTIVE: To summarize the experience in arterial switch operation (ASO) for complex congenital heart defect (CHD) with severe pulmonary hypertension (PH) and ventriculoarterial discordant connection in children older than 6 months. METHODS: Twenty-three consecutive pediatric patients suffering from severe CHD, such as transposition of great arteries (TGA), Taussing-Bing anomaly, etc, with moderate to severe PH, 15 male and 8 female, aged 7-84 months, with the body weight of 4.5-20.0 kg, pulmonary pressure of 24.0-80.0 mm Hg, and pulmonary resistance of 49.2-1261.9 dyn.s.cm(-5), and with different complication such as left ventricular outflow tract obstruction (3 cases), subpulmonary membrane (1 case), and subaortic membrane (1 case), underwent ASO under general anesthesia and extracorporeal circulation with low temperature (18 degrees C-22 degrees C) and low volume blood flow (50 ml.kg(-1).min(-1)). The complicated anomalies were corrected simultaneously. Nitric oxide and alpha-blocker were used to the children with PH during the peri-operational period. RESULTS: Twenty children survived, and were cured and discharged with an obvious improvement of heart function, only one of which had sequel of coma due to cerebral anoxia. After operation the pulmonary pressure decreased to 23 mm Hg +/- 9 mm Hg, significantly lower than that before operation (P = 0.000). Physical activities increased obviously. Three children died post-operatively of the reasons un-related to the pre-operative PH and pulmonary arterial resistance, with a mortality of 13.04%. Follow-up of 14 +/- 8 months showed no death and complication. CONCLUSION: ASO can still realize satisfactory early results for the children older than 6 months suffering from complex CHD with moderate to severe PH and ventriculoarterial discordant connection provided they are in a rather good condition without severe cyanosis (SaO(2) > 60%) and with the pulmonary arterial resistance being acceptable (pressure of right atrium < 1000 dyn.s.cm(-5)).
Cardiac Surgical Procedures↗
[Diagnostic value of echocardiography for cardiac tumors in infancy and childhood].
OBJECTIVE: The present study was designed to evaluate the clinical manifestations, surgical findings, pathologic types and treatment of cardiac tumor and to analyze the echocardiographic characteristics of the cases. METHODS: Records of 19 patients with cardiac tumors confirmed by operations and pathology at Fuwai Cardiovascular Hospital in Beijing, China between Jan, 1983 and Dec, 2003 were reviewed. Clinical and echocardiographic data of all patients were analyzed. RESULTS: The median age of patients was 7 +/- 5 years, ranging from 5 months to 14 years. There were 8 male and 11 female cases. The surgical findings revealed that 57.9% (11 cases) of cardiac tumors were found in left heart, 36.8% (7 cases) in right heart, 5.3% (1 case) in two ventricles. The pathological study revealed that 17 cases (89.5%) were diagnosed as primary cardiac benign tumors including myxoma in 10 cases (52.6%), rhabdomyoma in 4 cases (21.1%), fibroma in 2 cases (10.5%) and lipoma in 1 case (5.3%). Two cases were diagnosed (10.5%) as cardiac malignant tumors including a primary cardiac rhabdomyosarcoma and a metastatic epithelioid sarcoma. By using echocardiography 11 cases were diagnosed as myxomas and rhabdomyoma (11/19, 57.9%), 8 cases were diagnosed as space occupying lesions of the heart or myxoma (8/19, 42.1%). CONCLUSIONS: Myxomas are the most common heart tumors seen in infancy and childhood, followed in frequency by rhabdomyomas, fibromas and lipomas. Surgery is recommended for patients with refractory and severe clinical symptoms.
Adolescent↗
[Decellularized human tissue engineering aortic valves conduit].
OBJECTIVE: To explore the suitable method to create a decellularized human tissue engineering homograft aortic valves conduit and to study its biologic, immol/Lunological, and biomechanical properties. METHODS: Human homograft aortic valves conduits donated by healthy adult males undergoing brain death preserved in liquid nitrogen were treated with pH 8.0 hypotonic Tris buffer for 12 hours; then pH 8.0 isotonic buffer with 0.5% DOA, 1% DOA or 1% Triton for 12 hours-24 h; l and then pH 7.6 isotonic buffer with DNAase 200 micro g/ml, RNAase 20 micro g/ml for 2 hours. the histology, HLA-DR antigen, water content, thinkness, denaturation temperature, DNA content, Collagen Contents, stress-strain, destroying stress were examined. RESULTS: In comparison with the standard cryopreserved human homograft aortic valves conduit, the valves, wall and muscle of the homograft aorta treated by 1% DOA for 24 hours were decellularized completely, and the 3-dimensional network structure of elastic fibers and collagenous fibers remained intact. Immol/Lunohistochemistry showed a remarkable decrease of expression of tissue genome DNA contents, a decrease by 91.14% in the valves, and by 91.53% in the wall, and a remarkable decrease of the expression of HLA-DR antigens. However, the water content in the decellular aortic wall was increased significantly (75.4 +/- 1.8 vs 82.0 +/- 0.7, P < 0.05). No significant differences were found in the denaturation temperature, stress-strain, destroying stress parameter, and tissue extension ratio in the decellular human homograft aortic valves conduits. CONCLUSION: The decellularization method by isotonic buffer with 1% DOA-DNAase is effective. The decellularized human homograft aortic valves conduits are unaltered in biologic, biomechanical, and physical properties with lowered immol/Lunogenicity, It can be used as an ideal valve for patients or as a homograft stent for developing tissue engineering valve by host recellularization.
Adult↗
[The advancement and challenges of management of infant and young children's congenital heart defect in China].
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Cardiac Surgical Procedures↗
[Pulmonary artery perfusion with hypothermic solution inhibits the apoptosis of lung parenchymal cells during cardiopulmonary bypass].
OBJECTIVE: To study effects of pulmonary artery perfusion with hypothermic solution on the apoptosis of lung parenchymal cells during cardiopulmonary bypass. METHODS: Forty children with tetralogy of Fallot were divided into control group (n = 20) and protective group (n = 20). The patients in control group were performed using routine approaches. Patients' pulmonary artery were infused with 4 degrees C protective solution during cardiopulmonary bypass in protective group. Lung biopsy specimens were obtained after operations in order to study the apoptosis of lung parenchymal cells using tunnel techniques. At same time, patients' pulmonary functions and clinic index were monitored. RESULTS: The rate of apoptosis cells of lung parenchymal cells was (18 +/- 7)% in control group, whereas (10 +/- 2)% in protective group. There was significant difference between both groups (t = -2.95, P < 0.05). Index O(2) in protective group was higher than that in control group at 0, 6 and 12 hours after operations [(492 +/- 172), (444 +/- 104), (489 +/- 58) mm Hg versus (369 +/- 126), (347 +/- 107), (340 +/- 119) mm Hg, t = 2.59, P < 0.05; t = 2.88, P < 0.01; t = 5.06, P < 0.01, respectively)]. The time of mechanical ventilation was significantly shorter in protective group than in control group [(15 +/- 11) hours versus (26 +/- 15) hours, t = -2.76, P < 0.01]. CONCLUSION: Pulmonary artery perfusion with hypothermic solution can inhibit the apoptosis of lung parenchymal cells and relieve cardiopulmonary bypass-induced lung injury.
Apoptosis↗
[Surgical management of coarctation of the aorta and associated intracardiac defect].
OBJECTIVE: To study the efficiency of surgical treatment on coarctation of the aorta and associated with heart defect. METHODS: From 1994 to 2001, 45 patients with aortic coarctation and associated with heart defect underwent surgical repair. They were divided into two groups: single-stage repair group (26 cases) and two-stage repair group (19 cases). There was mild or severe pulmonary hypertension in 23 cases (with mean pulmonary artery pressure being 56 mm Hg). There were two incisions used in first-stage group (single midline incision in 21 cases and left-side combined midline incision in 5 cases). The mean course for the second operation was 105 days in second-stage group. RESULTS: Two patients died in each group. Twenty-four patients had not blood pressure difference between arm and leg after operation. The mean systolic blood pressure difference was less than 10 mmHg in 10 patients. Mean period of follow-up was 28.6 months. No patients died and had re-coarctation. CONCLUSION: The operative results showed no difference between single-stage and two-stage repair in surgical correction of aortic coarctation associated intracardiac defect. The left-side combined midline incision in single-stage operation was an effective and safe technique.
Adolescent↗
[Quantitative structural study of pulmonary artery in patients with pulmonary atresia with ventricular septal defect ].
OBJECTIVE: In order to provide pathologic reference for therapeutic rationale, the pathological changes of the pulmonary vasculature in patients with pulmonary atresia with ventricular defect and patent ductus arteriosus were observed by contrast with normal control group. METHODS: Lung biopsies were taken in the operation in 10 children suffered from pulmonary atresia with ventricular septal defect associated with patent ductus arteriosus (PA group). Autopsy specimens were obtained from 10 children died of non-cardiovascular diseases as normal control group. The tissue was fixed with buffered formalin, routinely prepared by impregnated in wax. Sections were stained by hematoxylin-eosin, Weigert's elastic stain counter-stained by van Gieoson's method. Seven parameters were obtained including percentage of media thickness (MT%), percentage of media section area (MS%), numbers of vascular per square centimeter (VPSC), mean alveolar number (MAN), mean linear intercept (MLI), proportion of parenchyma area in total area (PPA), and alveolar/vascular ratio per unit area (AVR) by a computer image processor by quantitative analysis. RESULTS: There were significant difference between the two groups in MAN, VPSC, and AVR (P < 0.05). VPSC was significantly lower in PA group than in control group (P < 0.01). Other parameters had no significant difference. The mean alveolar diameter had an increased trend in PA group, although there was no significant difference. MS% of nearly 50% patients was closed to the normal value in PA group. The shape of pulmonary arteriole was irregular. There were few muscular arteries in a field of vision. CONCLUSIONS: The density of muscular arteries decreases in patients with pulmonary atresia with ventricular septal defect and patent ductus arteriosus, but percentage of media thickness and percentage of media section area of pulmonary arterioles are close to the normal value. Diminished flow in pulmonary circulation has a significant effect on numbers of pulmonary arterioles per square centimeter that impact the selection of surgical method and the effect of operation because of the reduction pulmonary arterioles. The decrease of mean alveolar number results in compensatory enlargement of alveolar diameter. The impaired lung development is a major cause of abnormal lung function. Feasible and earlier operation, which can increase pulmonary flow and promote development of pulmonary vasculature will be helpful to restore lung function.
Abnormalities, Multiple↗