Background The surgical outcomes have been greatly improved over the past four decades for functional single ventricle(FSV). However,the repair for coexistence of FSV and total anomalous pulmonary venous connection(TA...Background The surgical outcomes have been greatly improved over the past four decades for functional single ventricle(FSV). However,the repair for coexistence of FSV and total anomalous pulmonary venous connection(TAPVC),especially obstructed TAPVC,has remained a clinical challenge. Little is known about the results of surgical treatment for patients with FSV-TAPVC in China. Methods Forty consecutive patients with FSV-TAPVC undergoing initial surgical palliation(median age:16.8 months;body weight:8.25 kg)were retrospectively enrolled from 2006 to 2016 in a specialized cardiovascular institute. TAPVC was repaired in 30 patients. The mean follow-up period was 49 months. Results All of the 7 patients with preoperative pulmonary vein obstruction(PVO)underwent repair of TAPVC at the first operation and survived. When a systemic to pulmonary(S-P)shunt or pulmonary artery banding(PAB)was necessary,patients with concomitant TAPVC repair had lower mortality(30.0%)and higher total cavopulmonary connection completion rate(20.0%)than those without TAPVC repair[75.0% and 0%,respectively],although with no statistical significance(Fisher test,P=0.505 and P=0.245). The overall survival rates for the cohort at 1,3 and 5 years after the initial surgical intervention were 80.0%,77.1% and 77.1%,respectively. Multivariate COX regression analysis detected that SP shunt(adjusted odds ratio:6.51;95%CI:1.26-33.71,P=0.030)is the only risk factor for survival. The reintervention rate for postoperative PVO was higher in patients with preoperative PVO than those without(57.1%vs. 4.3%,Log Rank:P=0.006). Conclusion The mid-term results of surgical repair of FSV-TAPVC are still challenging. When PVO exists,surgical repair for TAPVC is suggested as soon as possible. Repair for TAPVC should also be considered when S-P shunt or PAB is necessary. Further study with larger population are warranted to support our finding.展开更多
Background Although acute rheumatic fever and rheumatic heart disease are now rare in affluent populations,they remain major health issues in developing countries such as China. Rheumatic mitral stenosis is the most c...Background Although acute rheumatic fever and rheumatic heart disease are now rare in affluent populations,they remain major health issues in developing countries such as China. Rheumatic mitral stenosis is the most common valvular disease during pregnancy. Some patients can receive percutaneous balloon mitral valvuloplastyduring pregnancy and obtain good outcomes. Methods A retrospective study of 14 women undergoing percutaneous balloon mitral valvuloplasty with rheumatic mitral valve stenosis during pregnancy in our hospital from Jan 2014 to Oct 2019 was conducted. The maternal and fetal outcomes were analyzed. Results Percutaneous balloon mitral valvuloplasty was successful in all patients with significant improvement in their mitral valve area(pre-operation:0.83±0.21 cm^2 and post-operation:1.64±0.27 cm^2,P<0.05). Pulmonary artery systolic pressure(pre-operation:69.62±28.27 mmHg and post-operation:37.23±12.65 mmHg,P<0.05)was significantly decreased. All 14 patients had an uneventful course afterthe operation. The total number of newborns was 14,none of whom required intensive care monitoring,and no malformations were found. Conclusions Percutaneous balloon mitral valvuloplasty performed during pregnancy with necessary precautions is feasible and effectivefor the mother and mightbe safe forthe fetus. There is marked symptomatic relief,along with good maternal and fetal outcomes.展开更多
基金the National Key R&D Program of China(No.2018YFC1002600)National Natural Science Foundation of China(No.81903287)+4 种基金Natural Science Foundation of Guangdong Province(No.2018A030313329)the Science and Technology Planning Project of Guangdong Province(No.2017A070701013)the Science and Technological Program of Guangzhou,China(No.201704020126)Guangdong Medical Research Foundation(No.A2017328)Guangdong Provincial Administration of Traditional Chinese Medicine(No.20181004).
文摘Background The surgical outcomes have been greatly improved over the past four decades for functional single ventricle(FSV). However,the repair for coexistence of FSV and total anomalous pulmonary venous connection(TAPVC),especially obstructed TAPVC,has remained a clinical challenge. Little is known about the results of surgical treatment for patients with FSV-TAPVC in China. Methods Forty consecutive patients with FSV-TAPVC undergoing initial surgical palliation(median age:16.8 months;body weight:8.25 kg)were retrospectively enrolled from 2006 to 2016 in a specialized cardiovascular institute. TAPVC was repaired in 30 patients. The mean follow-up period was 49 months. Results All of the 7 patients with preoperative pulmonary vein obstruction(PVO)underwent repair of TAPVC at the first operation and survived. When a systemic to pulmonary(S-P)shunt or pulmonary artery banding(PAB)was necessary,patients with concomitant TAPVC repair had lower mortality(30.0%)and higher total cavopulmonary connection completion rate(20.0%)than those without TAPVC repair[75.0% and 0%,respectively],although with no statistical significance(Fisher test,P=0.505 and P=0.245). The overall survival rates for the cohort at 1,3 and 5 years after the initial surgical intervention were 80.0%,77.1% and 77.1%,respectively. Multivariate COX regression analysis detected that SP shunt(adjusted odds ratio:6.51;95%CI:1.26-33.71,P=0.030)is the only risk factor for survival. The reintervention rate for postoperative PVO was higher in patients with preoperative PVO than those without(57.1%vs. 4.3%,Log Rank:P=0.006). Conclusion The mid-term results of surgical repair of FSV-TAPVC are still challenging. When PVO exists,surgical repair for TAPVC is suggested as soon as possible. Repair for TAPVC should also be considered when S-P shunt or PAB is necessary. Further study with larger population are warranted to support our finding.
基金Guangdong Medical Research Foundation(No.A2017328)。
文摘Background Although acute rheumatic fever and rheumatic heart disease are now rare in affluent populations,they remain major health issues in developing countries such as China. Rheumatic mitral stenosis is the most common valvular disease during pregnancy. Some patients can receive percutaneous balloon mitral valvuloplastyduring pregnancy and obtain good outcomes. Methods A retrospective study of 14 women undergoing percutaneous balloon mitral valvuloplasty with rheumatic mitral valve stenosis during pregnancy in our hospital from Jan 2014 to Oct 2019 was conducted. The maternal and fetal outcomes were analyzed. Results Percutaneous balloon mitral valvuloplasty was successful in all patients with significant improvement in their mitral valve area(pre-operation:0.83±0.21 cm^2 and post-operation:1.64±0.27 cm^2,P<0.05). Pulmonary artery systolic pressure(pre-operation:69.62±28.27 mmHg and post-operation:37.23±12.65 mmHg,P<0.05)was significantly decreased. All 14 patients had an uneventful course afterthe operation. The total number of newborns was 14,none of whom required intensive care monitoring,and no malformations were found. Conclusions Percutaneous balloon mitral valvuloplasty performed during pregnancy with necessary precautions is feasible and effectivefor the mother and mightbe safe forthe fetus. There is marked symptomatic relief,along with good maternal and fetal outcomes.
