Background Systemic-to-pulmonary shunt(SPS) is an effective surgery for newborns diagnosed with atresia or severe pulmonary stenosis leading to insufficient pulmonary blood flow. However, there is no consistent conclu...Background Systemic-to-pulmonary shunt(SPS) is an effective surgery for newborns diagnosed with atresia or severe pulmonary stenosis leading to insufficient pulmonary blood flow. However, there is no consistent conclusion on surgical plan chosen for the particular patient. Methods Shunt configurations including central shunt(CS) and MBTS(Right mb T innominate;Left m BT subclavian) were virtually reconstructed for newborn based on preoperative CT data. Candidate shunt configurations were evaluated based on the parameters that were computed from the flow simulations. Results Vortex occurred at the anastomosis of the shunt and the aorta for all three shunt configurations. For CS, it produced the highest pulmonary artery(PA) flow, with the shunt ratio of44.6%. Blood flow in LPA was 8.5% higher than blood flow in RPA. For MBTS, the indexed power loss(i PL)of Right m BT innominate configuration was lower than that of Left m BT subclavian, which was 28.4% and 36.1%respectively. Conclusions The anastomosis of the shunt and the aorta is prone to cause thrombosis. CS configuration is prone to cause hyperemia due to excessive pulmonary blood flow. So, it could be considered for patients without a risk of overflow. It also causes non-symmetric PA flow in favor of LPA. For Right m BT innominate,which has the lowest i PL, tends to produce smaller vortex regions compared to CS and Left m BT subclavian. As for Left m BT subclavian, vortex currents formed when blood flows into the LPA could prevent the formation of thrombosis.[S Chin J Cardiol 2019;20(4):217-227]展开更多
Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CP...Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CPB）at different levels of temperature with cardioplegic arrest on the developing fetus. Methods Twelve pregnant goats were randomly divided into hypothermic CPB group（H group）： cardiopulmonary bypass with perfusion at 30-32℃（n=6） and normothermic CPB group（N group）： cardiopulmonary bypass with perfusion at 36℃-38℃（n=6）. Fetal cardiopulmonary bypass was maintained including 30 minutes of cardiac arrest. Fetal mean arterial blood pressure（MAP） and heart rate（HR） were monitored. Fetal arterial blood samples were analyzed. The pulse index（PI） and resistance index（RI） of the fetal umbilical artery were recorded. Results The maternal weight,fetal weight and pump flow had no significant difference between the 2 groups. After clamp removal, two fetal hearts did not auto-beat in H group. The fetal HR and MAP b were significantly different（P〈0.05） etween the 2 groups. There was remarkable decreasing in post-CPB fetal HR and MAP in H group. A stable decrease in partial pressure of oxygen with a concomitant stable increase of carbon dioxide partial pressure in H group was noted.The lactic acid in H group was significantly higher than that in the N group（P〈0.05）. The PI and RI in H group were significantly elevated 1 hour after off CPB and further markedly increased 2 hours after off bypass. Conclusions Fetal CPB could be performed under both hypothermic and normothermic conditions. However, normothermic bypass may provide better delivery of oxygen to fetal tissue.展开更多
Background Objective:The aorta root dilation remains one of the major concerns in surgical management for patients with unrepaired or repaired tetralogy of Fallot.The present study was sought to characterize the evolu...Background Objective:The aorta root dilation remains one of the major concerns in surgical management for patients with unrepaired or repaired tetralogy of Fallot.The present study was sought to characterize the evolution of aorta root dilation after tetralogy of Fallot repair in a long-term follow-up and determine the necessity of simultaneous intervention or reoperation on the dilated aortic root.Methods:We retrospectively reviewed a total of 100consecutive patients undergoing intra-cardiac tetralogy of Fallot repair in Guangdong Provincial People’s Hospital from Jan 2010 to Jan 2015.Operation records and transthoracic echocardiography data including initial preoperative assessment and a series of postoperative visits were all collected and compared.Results:Of the 100 consecutive patients(24.9±13.3 years,51 male),40%and 55%underwent ventricular septal defect repair with an operational approach on the right atrium incision and right ventricle outflow tract incision,respectively.The aorta root dimension decreased shortly after tetralogy of Fallot repair(P=0.01)but significantly augmented in the second postoperative follow-up(P=0.02),with no distinct change in the next several postoperative follow-ups.Conclusion:The aorta root dilation in patients after late tetralogy of Fallot repair is common but seems stable in a long-term follow-up,suggesting that it might not necessitate surgical correction during or after repairing the tetralogy of Fallot,especially for those without preoperative aortic root dilation.展开更多
基金funded by the key Program of Union of National Natural Science Foundation of China-Guangdong Province(No.U1401255)the Natural Science Foundation of Guangdong Province(No.2018A030313785)+2 种基金the National key Research and Development Program(No.2018YFC1002600)the Science and Technology Planning Project of Guangdong Province(No.2019B020230003/No.2018B090944002/No.2017A070701013/No.2017B090904034/No.2017B030314109)Guangdong Medical Science and Technology Research Fund(No.A2018038)
文摘Background Systemic-to-pulmonary shunt(SPS) is an effective surgery for newborns diagnosed with atresia or severe pulmonary stenosis leading to insufficient pulmonary blood flow. However, there is no consistent conclusion on surgical plan chosen for the particular patient. Methods Shunt configurations including central shunt(CS) and MBTS(Right mb T innominate;Left m BT subclavian) were virtually reconstructed for newborn based on preoperative CT data. Candidate shunt configurations were evaluated based on the parameters that were computed from the flow simulations. Results Vortex occurred at the anastomosis of the shunt and the aorta for all three shunt configurations. For CS, it produced the highest pulmonary artery(PA) flow, with the shunt ratio of44.6%. Blood flow in LPA was 8.5% higher than blood flow in RPA. For MBTS, the indexed power loss(i PL)of Right m BT innominate configuration was lower than that of Left m BT subclavian, which was 28.4% and 36.1%respectively. Conclusions The anastomosis of the shunt and the aorta is prone to cause thrombosis. CS configuration is prone to cause hyperemia due to excessive pulmonary blood flow. So, it could be considered for patients without a risk of overflow. It also causes non-symmetric PA flow in favor of LPA. For Right m BT innominate,which has the lowest i PL, tends to produce smaller vortex regions compared to CS and Left m BT subclavian. As for Left m BT subclavian, vortex currents formed when blood flows into the LPA could prevent the formation of thrombosis.[S Chin J Cardiol 2019;20(4):217-227]
基金supported by the National Natural Science Foundation of China(No.81370274)Guangdong Provincial Natural Science Foundation(No.2016A030310313)
文摘Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CPB）at different levels of temperature with cardioplegic arrest on the developing fetus. Methods Twelve pregnant goats were randomly divided into hypothermic CPB group（H group）： cardiopulmonary bypass with perfusion at 30-32℃（n=6） and normothermic CPB group（N group）： cardiopulmonary bypass with perfusion at 36℃-38℃（n=6）. Fetal cardiopulmonary bypass was maintained including 30 minutes of cardiac arrest. Fetal mean arterial blood pressure（MAP） and heart rate（HR） were monitored. Fetal arterial blood samples were analyzed. The pulse index（PI） and resistance index（RI） of the fetal umbilical artery were recorded. Results The maternal weight,fetal weight and pump flow had no significant difference between the 2 groups. After clamp removal, two fetal hearts did not auto-beat in H group. The fetal HR and MAP b were significantly different（P〈0.05） etween the 2 groups. There was remarkable decreasing in post-CPB fetal HR and MAP in H group. A stable decrease in partial pressure of oxygen with a concomitant stable increase of carbon dioxide partial pressure in H group was noted.The lactic acid in H group was significantly higher than that in the N group（P〈0.05）. The PI and RI in H group were significantly elevated 1 hour after off CPB and further markedly increased 2 hours after off bypass. Conclusions Fetal CPB could be performed under both hypothermic and normothermic conditions. However, normothermic bypass may provide better delivery of oxygen to fetal tissue.
基金supported by the Project of Guangdong Provincial Clinical Research Center for Cardiovascular disease(No.2020B1111170011)Guangdong Special Funds for Science and Technology Innovation Strategy,China(Stability Support for Scientific Research Institutions Affiliated to Guangdong Province-GDCI 2021)Guangdong Peak Project(No.DFJH201802)。
文摘Background Objective:The aorta root dilation remains one of the major concerns in surgical management for patients with unrepaired or repaired tetralogy of Fallot.The present study was sought to characterize the evolution of aorta root dilation after tetralogy of Fallot repair in a long-term follow-up and determine the necessity of simultaneous intervention or reoperation on the dilated aortic root.Methods:We retrospectively reviewed a total of 100consecutive patients undergoing intra-cardiac tetralogy of Fallot repair in Guangdong Provincial People’s Hospital from Jan 2010 to Jan 2015.Operation records and transthoracic echocardiography data including initial preoperative assessment and a series of postoperative visits were all collected and compared.Results:Of the 100 consecutive patients(24.9±13.3 years,51 male),40%and 55%underwent ventricular septal defect repair with an operational approach on the right atrium incision and right ventricle outflow tract incision,respectively.The aorta root dimension decreased shortly after tetralogy of Fallot repair(P=0.01)but significantly augmented in the second postoperative follow-up(P=0.02),with no distinct change in the next several postoperative follow-ups.Conclusion:The aorta root dilation in patients after late tetralogy of Fallot repair is common but seems stable in a long-term follow-up,suggesting that it might not necessitate surgical correction during or after repairing the tetralogy of Fallot,especially for those without preoperative aortic root dilation.
