Patent foramen ovale (PFO) is a common cardiac structural abnormality in children, which has garnered significant clinical attention due to its epidemiological characteristics and natural course. Although PFO is asymptomatic in many cases, its potential complications and impact on children’s health should not be underestimated. In recent years, there has been an increase in research on the epidemiological data of PFO in children under 16 years old. However, controversy remains regarding its natural course and clinical intervention strategies. This paper reviews the latest research progress on PFO in terms of epidemiological characteristics, natural course, current interventions, indications, timing of percutaneous PFO closure, risks, and complications, aiming to provide evidence-based guidance for clinical decision-making and improved management strategies for children with patent foramen ovale.

ObjectivesThe aims of the present study were to explore the causes of minimally invasive surgical ventricular septal defect (VSD) closure failure under transesophageal echocardiography guidance and thus to improve the success rate of surgical VSD closure.MethodsFrom January 2015 to December 2019, 522 children with VSD underwent minimally invasive surgical closure. Nineteen procedures (3.64%) were unsuccessful. The failure causes, VSD locations and surgical incision approaches were retrospectively analyzed.ResultsAmong the 19 patients (3.64%) with unsuccessful outcomes, 18 were switched to cardiopulmonary bypass (CPB) surgery, and 1 was closed successfully using an occlusion device a year later. The causes of failure included occlusion device shedding or shifting (n=6), failure of the guidewire (or the sheath) to pass through a small defect (n=5), device-related valve regurgitation (n=4), significant residual shunt (n=2), ventricular fibrillation (n=1), and continuous sharp blood pressure decreases (n=1). Patients with high VSD had a slightly higher failure rate than those with perimembranous VSD (p=0.049), and its key reason is the high proportion of occlusion device shedding or shifting (p=0.001). No significant difference in the failure rate was found between patients with different surgical incision approaches.ConclusionsMinimally invasive surgery has a high success rate for perimembranous VSDs. Occlusion device shedding or shifting is the most common cause of failure. The shedding or shifting risk of eccentric occlusion devices being used only for high VSDs is much greater than that of concentric occlusion devices being used for perimembranous VSDs, which increases the risk of conversion to CPB surgery for high VSDs.

Aims To investigate the value of transesophageal echocardiography (TEE) in perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children. Methods From January 2015 to December 2020, 212 children with PmVSDs underwent device occlusion via an ultra-minimal trans intercostal incision. TEE was used throughout the perioperative period, including TEE assessment, TEE-guided localization of the puncture site, and TEE guidance. All patients were followed up using transthoracic echocardiography for more than 6 months. Results A total of 207 cases were successfully occluded, and the success rate was 97.64%. One hundred forty-five patients had a single orifice, and 62 patients had multiple orifices in the aneurysm of the membranous septum (AMS). During the operation, the surgeon readjusted the device or replaced it with a larger device in 17 cases. After the operation, 19 cases of a slight residual shunt, 13 cases of pericardial effusion, and 4 cases of pleural effusion were noted. All patients returned to normal during the 4-month follow-up period. Mild mitral regurgitation was present in one patient and remained the same during the follow-up period. No other complications were found. Conclusions Under TEE guidance, PmVSDs were closed successfully using a concentric occluder via an ultra-minimal trans intercostal incision. TEE, which was used to assess defects and postoperative effect, effectively guide PmVSDs closure, is of great value.

Objective:Combined with the actual clinical situation, to introduce the application of invasive trans super minimal intercostal device closure in doubly committed ventricular septal defect(DCVSD).Methods:Between January 2017 and July 2020, 82 DCVSD children were recruited. Relevant data such as operation time, length of hospital stay, postoperative complications, etc. were analyzed, and the follow-up of the postoperative period was used to evaluate the effect of the operation.Results:Among them, 2 children’s puncture points were bleeding. Chest closure time was obviously extended. The total operation time of the remaining children was 24-72(47.54±12.06)min, among which the umbrella release time was 5-37(16.16±8.01)min, and the chest opening and closing time was 14-59(31.56±9.58) min. Pericardial effusion occurred in 2 patients after operation, and the discharge time was more than 2 weeks. The remaining children were hospitalized for 3-9(5.79±1.45)days after surgery.Conclusion:Closing DCVSDs through a super minimal intercostal incision under TEE guidance was safe, effective and less trauma.

Object: To compare the clinical data of sternotomy and left intercostals incision, combined with the literature, to provide the best surgical incision for committed subarterial ventricular septal defect（DCS-VSD）. Methods: From July 2016 to July 2020, a total of 117 cases of occlusion surgeries for DCSVSD, which guided by transoesophagel echocardiography(TEE) were completed, including 34 cases with sternotomy incision and 83 cases with left intercostal incision. Statistics and analysis of the operation and follow-up. Results: 115 cases successfully occluded, the successful rate was 98.29%, and 1 case failed in each group. Pericardial effusion occurred in 5 children after the drainage device was removed, and the pericardial effusion disappeared after diuretic treatment. There was no statistical difference between the two groups in operation time, occlusion time, thoracotomy time and postoperative hospital stay. All the children recovered and were discharged from the hospital, and were followed up for 2-30 months after operation. Conclusion: TEE-guided intercostal DCS-VSD occlusion is safe and effective. There is no statistical difference between two approach with the operation time, chest opening and closing time, occluder placing time, and postoperative hospital staying. At the same time, the surgical incision by intercostal incisionis smaller and the operation invasion is less, it is a surgical approach which worth to develop.

Objective To explore the value of transesophageal echocardiography ( T EE ) in high ventricular septal defect ( VSD) occlusion via a left parasternal ultra‐minimal intercostal incision ( ≤1 cm ) with eccentric occluder in children . Methods Forty‐eight children with high VSD underwent device occlusion via ultraminimal intercostal incision with eccentric occluder . T he w hole operation , including preoperative evaluation ,intraoperative localization and guidance and postoperation evaluation were performed under the guidance of T EE . Results Forty‐six children with high VSD underwent successfully device closure in all 48 cases and the operation success rate was 95 .8% . T he average size of high VSD was 2 .2－6 .0 ( 3 .70 ± 0 .90) mm and the average size of eccentric occluder was 4－8 ( 5 .48 ± 1 .12) mm . T he average operation duration was 18－98 ( 49 .80 ± 16 .71) min . T here were 2 cases of peri‐membranous high VSD and 44 cases of outlet‐typle VSD ,of w hich 10 cases of mild aortic valve prolapses ( AVOP) ,including 5 cases of aortic valve regurgitation ( AR ) . In addition ,there was 1 case of replacement of device ,1 case of having septum below the margin of the defect and 1 case of using a dilator for a small defect . T he 46 cases were followed up for 6 to 42 months ,and the pericardial effusion occured in 3 cases and disappeared during follow‐up . No other abnormal conditions were found . Conclusions During the surgery of high VSD device occlusion via ultraminimal intercostal incision with eccentric occluder ,T EE has an important value in defect assessment ,intraoperative localization and guidance ,and immediate evaluation of efficacy ,and can effectively guide the device occlusion of high VSD .

Objective To explore the value of doubly committed ventricular septal defect (DCVSD) closure through a left parasternal intercostal minimal incision under transesophageal echocardiography (TEE) guidance in children.Methods Between August 2014 and December 2016,40 DCVSD children were recruited.The lesions were closed through a left parasternal intercostal minimal incision (≤ 1 cm) and pericardium hanging technique under TEE guidance.TEE was employed for guiding and monitoring the whole procedure.The effectiveness of device closure was assessed by postoperative regular follow-up.Results Among them,39 children underwent complete closure with an operative success rate of 97.5％.The average size of DCVSDs was 3.59 ± 0.92 (2.2-6.0) mm,the average device size 5.33 ± 1.40 (4-9) mm and the average operative duration 45.04 ± 12.81 (18-70) min.Postoperative follow-up period lasted from 6 to 24 months.Seven cases with mild aortic valve prolapse (AoVP) and/or mild aortic regurgitation (AR) were detected preoperatively and pre-existing AR disappeared postoperatively in one patient and remained unchanged in another.There were no cases of perioperative mortality,device deformation or displacement,residual shunt,complete atrioventricular block or valve involvement.Mild pericardial effusion in two patients disappeared during a follow-up period of 3 months.One patient was converted into repairing under direct visualization with a cardiopulmonary bypass because of obvious residual shunt around the occluder.Conclusions Closing DCVSDs through a left parasternal intercostal minimal incsion under TEE guidance in children has the following advantages:avoidance of radiation and sternum incision,procedural reliability and safety,definite efficacy,lower complication rate,minimal incision and simple handling.Wider application of this procedure is recommended.

Objective To summarize the surgical experience of hypoplastic left heart syndrome (HLHS).Methods Based on clinical profiles and databases,current domestic status was discussed for surgical treatment of HLHS.Results One child with HLHS was successfully operated at our hospital.Clinical experiences and literature searches shown that only few domestic hospitals had successfully implemented Norwood surgery.Postoperative maintenance of body-pulmonary vascular balance is essential for survival.Conclusions Surgical treatment of HLHS is still elementary in China.Norwood surgery is an effective treatment for HLHS and maintaining a dynamic balance of bodypulmonary circulation is vital.

Through researching the relevant published articles in both English and Chinese,this review summarizes current domestic and foreign therapeutic status of long-gap esophageal atresia.Also its definition,multicenter study tendency,common surgical approaches,emerging techniques and future perspectives are discussed.

患儿女,41 d,因"咳嗽半月"入院.查体:心率178次/min,呼吸40次/min,血压88/59 mmHg (1 mmHg=0.133 kPa),体重2.9 kg,口唇发绀,呼吸音粗,心前区2~3级收缩期杂音,血氧饱和度54%~90%.超声心动图检查结果:左心发育不良 (图1);二尖瓣重度狭窄;主动脉瓣闭锁;升主动脉及主动脉弓发育不良;动脉导管未闭4.0 mm;房间隔缺损6.4 mm;肺动脉高压.CTA 检查结果同超声诊断.

OBJECTIVES This study aimed to investigate the safety, feasibility and availability of doubly committed ventricular septal defect (DCVSD) closure via an ultraminimal intercostal incision under the guidance of transoesophageal echocardiography in children. METHODS From August 2014 to August 2016, 35 children with DCVSDs (≤5 mm in diameter) were enrolled in this study. A left parasternal ultraminimal intercostal incision (≤1 cm) and a pericardium hanging technique were employed without sternal incision. DCVSDs were closed through a short delivery sheath assembled with an eccentric occluder device. Transoesophageal echocardiography was used to guide and monitor the entire procedure. All patients were followed up. RESULTS All 35 children had complete closures with an operation success rate of 100%. The average size of DCVSDs was 3.50 ± 0.79 (range 2.2‐5.0) mm, and the average device size was 5 ± 2 (range 4‐9) mm. The average operation duration was 45.42 ± 11.77 (range 25‐70) min, and the average hospital stay was 8 ± 2 (range 7‐16) days. The median follow‐up period was 17 months (range 6 months‐2.5 years). Pre‐existing aortic regurgitation disappeared after surgery in 1 patient and remained the same in 4 patients. No other complications were found during the operation or during follow‐up. CONCLUSIONS Under transoesophageal echocardiography guidance, DCVSD closure using an eccentric occluder via an ultraminimal intercostal incision is feasible, safe and effective in children. The use of this approach is recommended.

Objective This study was aimed to discuss the safety, feasibility and availability of perimembranous ventricular septal defects(PmVSD) closure via super minimal intercostal incision under transesophageal echocardiography(TEE) guidance in children.Methods There were 81 cases of PmVSD via super minimally invasive transintercostal device closure operation(length of incision ≤ 1cm) from August 2014 to August 2016.TEE was used to guide and monitor the entire procedure.Assessed the effectiveness of device closure by postoperative regular follow-up.Results 80 patients were successfully operated by super minimally invasive transintercostal device closure in all 81 cases.Operation success rate reached 98.77%.The average diameter of ventricular septal defects was(3.72±0.96)mm.The average diameter of amplatzer occluder was(4.88±0.95)mm.Postoperative follow-up time was from 6 months to 24 months.One of 16 cases that with aneurysm of membranous septum had more than two shunts, remained a mild residual shunt beside of the amplatzer occluder but self cured during follow-up.Mild pericardial effusion was found in one patients after the operation and disappeared during follow-up.There were no cases of perioperative death, device deformation or displacement, residual shunt, complete atrioventricular block and valve involvement in the patients whom were successfully operated.One patient transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass, because ventricular fibrillation happened when guide wire passed the ventricular septal.Conclusion Super minimally invasive transintercostal device closure of PmVSD in children guided by TEE was safety and availability, that could avoid x-ray radiation and sternotomy, and operate simply, with small incision and low complication.

先天性食管闭锁是新生儿外科常见的致死性疾病，非外科手术不能治愈。手术径路有经胸或者胸腔镜辅助手术[1-2]。经胸为右侧胸后外侧切口或腋下切口。对于右位主动脉弓患儿，右胸径路可以顺利的完成手术[2-3]。但是对于右位心患儿目前尚未见报道。我们总结2例食管闭锁合并右位心的手术治疗经验，报告如下。

永存左上腔静脉(persistent left superior vena cava,PLSVC)是先心病患儿的常见血管畸形[1,3],但是永存左上腔合并右上腔静脉(right superior vena cava,RSVC)缺如非常罕见,约占先天性心血管畸形的0.07％～0.34％[2,4].右侧上腔静脉缺如一般没有临床症状,常在检查或手术巾被发现[2,5,7]. 我们介绍1例患有先天性房间隔缺损,合并右侧上腔静脉缺如、永存左上腔静脉、右上肺静脉异位引流的手术治疗.

Objective To summarize our experience of surgical treatment for double-outlet right ventricle (DORV) in children. Methods From August 1984 to June 2010, 118 patients with DORV underwent surgical repair at this center. Among the 118 patients, 62 were males and 56 were females.Their ages ranged from 10 days to 12 years old (mean age, 3. 2 ± 2. 6). Their weight ranged from 3. 0to 22. 5 kg (mean weight, 9. 6 ± 3. 7 kg). According to the STS-EACTS international nomenclature,86 patients were DORV associated with ventricular septal defect (VSD), 22 were DORV with tetralogy of Fallot (TOF), 3 were DORV with transposition of the greater arteries (TGA), and 7 were DORV with remote VSD. Corrective surgeries included 22 interventricular repairs, 84 interventricular repairs plus right ventricular outflow tract reconstruction (pericardium was used for the reconstruction in 82 cases, and valved extracardiac conduits was used in 2 cases), 4 switch procedures, 6 bidirectional Glenn procedures, 1 Fontan procedure, 1 Pulmonary artery banding procedure, and 1 Blalock-Taussig Shunt procedure. The surgical safety and efficacy were studied by retrospectively analyzing the clinical data of the 118 cases. Results Nine patients died after surgery (7. 6%). The leading cause of death was low cardiac output syndrome. Of the 51 patients underwent corrective surgery before 2004,7 died after surgery (13. 7%). However, only 2 died in the 67 patients who had surgery after 2005(2. 9%). The patients were followed up for 2 months to 10 years. Cardiac ultrasonography didn't show any obstruction of left ventricular outflow tract, but 1 patient developed left ventricular outflow tract obstruction 2 years after surgery and received corrective surgery. No long-term death and other complications were noted. Conclusions Surgical strategy for the children with double-outlet right ventricle should be made based on patients individual anatomic anomalies.

<正>原发性心脏肿瘤发病率低,体检发生率不超过3‰,临床表现没有特异性,12%没有症状[1],但有猝死可能[2,3]。2000年1月至2008年12月,我院收治原发性心脏肿瘤患儿14例,其中接受手术治疗10例,现将护理体会总结如下。

Objective To study the surgical treatment for Ebstein's anomaly in children.Methods From August 1992 to August 2010,there were 31 cases of Ebstein's anomaly in children underwent surgical repair,including thirteen males and eighteen females,aged from 6 months to fifteen years[mean(6.9±1.6) years] and the weight was from 5.5 to 53.5 kg[mean(19.6±4.7)kg].Eight patients underwent Danielson repair of tricuspid valve,among these 2 patients were added bidirectional Glenn operation;23 patients underwent Carpentier repair of tricuspid valve,among these 5 patients were added bidirectional Glenn operation.The results of 31 cases of Ebstein's anomaly in children were retrospectively analyzed.Results There was no postoperative death with Carpentier repair of tricuspid valve.All survivals were in New York Heart Association class Ⅰ.Postoperative tricuspid regurgitation was markedly improved,echocardiography showed disappearance of tricuspid incompetence in 9 patients,mild incompetence in 13 and moderate incompetence in 1.There was one postoperative death with Danielson repair of tricuspid valve,and main causes of death were tachyarrhythmia and continuance hypoxia.All survivals were in New York Heart Association class Ⅰ.Postoperative echocardiaography showed disappearance of tricuspid incompetence in 3 patients,mild competence in 3 and moderate mild competence in 2. No reoperation for residual or recurrent tricuspid incompetence was required in all survivals. Conclusions In spite of the variable degree of Ebstein's anomaly present,the majority of patients can undergo a surgical repair.Tricuspid reconstruction should be the first choice of surgical procedures whenever possible in children.Carpentier repair of tricuspid valve is the best procedure at present.The bidirectional Glenn could be adopted according to the function of tricuspid valve and right ventricle.

OBJECTIVE:To describe the anatomic variations of total anomalous pulmonary venous connection (TAPVC) and its corresponding surgical techniques.METHODS:A total of 143 TAPVC subjects were hospitalized from April 1981 to July 2010. Those patients with other complex congenital heart diseases, such as transposition of great artery and single ventricle, were excluded. A pathological diagnosis was made by echocardiography, magnetic resonance imaging, computed tomography, catheterization and intra-operative findings. The specific types of TAPVC were as follows:supra-cardiac (49.7%, 71/143), cardiac (40.6%, 58/143), infra-cardiac (4.2%, 6/143) and mixed (5.6%, 8/143). The subtypes were classified by the pathway of common confluence, distribution of pulmonary vein and their orifice site. The techniques of surgical repairs included modified Warden procedure and pulmonary vein transplantation.RESULTS:The patients with supra-cardiac type were further divided into 4 subtypes according to the course of vertical veins and their orifice site: right and left veins forming a common confluence, then draining into vertical and innominate veins (n = 65); common confluence of pulmonary vein drainage into superior vena cava through a short vertical vein at the right pulmonary hilus (n = 3); right and left pulmonary veins separately draining into superior vena cava (n = 2); common confluence draining into innominate vein through a right path beside trachea (n = 1). Cardiac types were further divided into 3 subtypes: coronary sinus (n = 20), right atrium (n = 37) and right atrium & sinus (n = 1). Infra-cardiac type had no subtype. Mixed type was more complex and it was further divided into 3 subtypes: bilateral & symmetrical connection (right 2 + left 2, n = 5); bilateral & asymmetrical connection (3 + 1, n = 3). Surgical repairs were performed on 135 patients. The surgical mortality of TAPVC was 5.9% (8/135). And there was no late death. The major causes of death were pulmonary infection and low cardiac output syndrome.CONCLUSION:A detailed classification of TAPVC is of great importance for surgical approaches and methodological designs. And an individualized surgical plan yields excellent patient outcomes.