BackgroundSurgical treatment of functional single ventricle combined with atrioventricular valve regurgitation remains a clinical challenge. The outcomes of atrioventricular valve repair in patients with single ventricle are limited.MethodsA retrospective study was conducted of all 28 patients with functional single ventricle treated with single-ventricle palliation who underwent atrioventricular valve operation at the First Hospital of Tsinghua University between April 2007 and October 2022.ResultsIn our cohort, the female/male ratio was 7:21, with an average age of 8.7 ± 6.0 (0.75–26) years. Half of patients (50%) were right-ventricle type for single-ventricle morphology. 18 patients (64.3%) were with a common atrioventricular valve. Twenty-three patients (82.1%) were combined with heterotaxy syndrome. Pre-operatively, twenty-four patients (85.7%) were diagnosed with severe atrioventricular valve regurgitation. AVV was repaired at the Glenn (n = 16, 57.1%), Glenn-Fontan (n = 2, 7.1%) and Fontan (n = 10, 35.7%) stage, respectively. Valve plastic techniques included valve annulus/commissure constriction (n = 24), clefts repair (9 cases), edge-to-edge suturing (13 cases) and common atrioventricular valve separation (4 cases). The early mortality was 3.6% (1/28). All survival patients were observed with improved regurgitation situations. Twenty-two patients (78.5%) were observed with no more than mild regurgitation postoperatively. The mean follow-up time was 5.4 ± 2.9 years (range, 3.08–11.83 years), with late mortality of 11.1% (3/27). All these three cases were observed with a severe regurgitation by echocardiogram in the last follow-up. Besides, reoperation rate of this cohort was 3.6% (1/28).ConclusionsAVV repair could significantly improve AVV function in SV patients combined with severe AVVR, with satisfactory mid-term results. Part of the cohort showed poor prognosis due to repeated AVVR. Regular follow-up by echocardiogram is critically important for these patients.

BACKGROUND:Ebstein's anomaly (EA) is a rare and complex congenital heart anomaly, and the effect of surgical treatment is not ideal. This study aims to introduce our experience in management strategies, surgical techniques, and operative indications for patients with Ebstein's anomaly.METHODS:A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020. 32 patients had previously received cardiac surgery in other hospitals. The clinical data including diagnosis, operative indications, techniques, pathological changes, and survival rates were collected and analyzed.RESULTS:Anatomical correction was performed in 203 (78.7%) operations, 1½ ventricle repair in 38 (14.7%) operations, tricuspid valve repair only in four operations (1.6%), tricuspid valve replacement in ten (3.9%), total cavopulmonary connection (TCPC) in two (0.8%), and Glenn operation in one operation (0.4%). Reoperation was performed in five patients (2.0%) during hospitalization. Among them, tricuspid valve replacement was performed in one patient, 1½ ventricle repair in two patients, and tricuspid valve annulus reinforcement in two patients. Five patients died with an early mortality rate of 2.0%. Complete atrioventricular conduction block was complicated in one patient (0.4%). A total of 244 patients was followed up (four in the 253 patients lost) with a duration of 3.0-168.0 (87.6 ± 38.4) months. Cardiac function of 244 patients improved significantly with mean New York Heart Association (NYHA) functional class recovery from 3.5 to 1.1. The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5. Three late deaths (1.2%) occurred. The survival rates at five and ten years after surgery were 98.6% and 98.2%, respectively. Reoperation was performed in five patients (2.0%) during the follow-up period.CONCLUSION:Based on our management strategies and operative principles and techniques, anatomical correction of EA is capable of achieving excellent long-term results, and low rates of TCPC, 1½ ventricle repair and valvular replacement.

Abstract Background The treatment of coronary artery disease combined with severe atherosclerotic stenosis proximal to a left anterior descending artery myocardial bridge (LAD-MB) is still controversial. This study aimed to analyze the outcomes of surgical intervention in patients with severe atherosclerotic stenosis proximal to a LAD-MB. Methods We retrospectively reviewed all patients with coronary artery disease combined with severe atherosclerotic stenosis proximal to the LAD-MB. The enrolled criteria were systolic compression of LAD more than or equal to 50% and atherosclerotic stenosis proximal to the LAD-MB more than or equal to 70%. All patients suffered from anginal symptoms refractory to medical therapy. All patients received supra-arterial myotomy and coronary artery bypass grafting (CABG) procedures. Clinical characteristics, intraoperative findings, and postoperative outcomes were evaluated. Results Between 2004 and 2021, sixteen patients underwent supra-arterial myotomy and CABG procedure. The compression and length of LAD-MB were 63 ± 17.9% and 25.9 ± 16.3 mm, respectively. Of the 16 patients, one patient had a LAD-MB and proximal coronary stenosis, and 15 patients had LAD-MBs and multivessel lesions. All patients survived and recovered uneventfully without in-hospital mortality or severe complications. The median transfusion amount of red blood cells in the operation was 2 units, and no patients required unplanned reoperation for bleeding. The average length of intensive care unit stay was 2.74 days. Fifteen patients were followed up for 6–146.1 months (mean 45.3 ± 42.9 months). One patient had a recurrence of angina pectoris one year after surgery, and 14 patients had no symptoms of myocardial ischemia during the follow-up period. Significant improvement in symptoms and quality of life using the Seattle Angina Questionnaire assessment was observed in all five categories after surgery (p < 0.01). Conclusions Based on the results, supra-arterial myotomy and concomitant bypass surgery may be a better option for the treatment of LAD-MB combined with severe proximal stenosis.

The advection–diffusion–Langmuir adsorption processes of a liquid solution, colloid, or suspension occur in many biomedical and chemical engineering fields. The dynamics of the system can be described by the so-called advection–diffusion–reaction (ADR) equations and are greatly influenced by five nondimensional numbers. Up to now, cases over a wider range of parameters have not been thoroughly studied, and the quantitative dependence of the system dynamics on the parameters remains unclear. In this study, we systematically solve the ADR equations in two-dimensional plane Poiseuille flows for cases with selected values of parameters by the finite difference method. We identify two different regimes in terms of the distribution of the maximum adsorption flux and discuss the dominant mechanism of mass transfer and the influences of the nondimensional parameters in each regime. We then propose analytical models to describe the influences of specific parameters on the adsorption equilibrium time. The results of this research may provide a convenient method to identify the dominant processes in the advection–diffusion–Langmuir adsorption system in future studies.

Background Myocardial bridges are congenital coronary artery anomalies. There are still many controversies surrounding surgical treatment strategies for myocardial bridges combined with other heart disorders. The purpose of this study was to evaluate the surgical treatment strategies and outcomes in patients with these conditions. Methods Between March 2004 and October 2021, our institution witnessed 77 patients diagnosed with myocardial bridging who underwent surgical intervention. According to the myocardial bridge and combined heart disorder, four groups were identified: 1. isolated LAD supra-arterial myotomy group, 2. LAD CABG and(or not) myotomy group, 3. LAD supra-arterial myotomy and grafting of other branches group, and 4. LAD supra-arterial myotomy and other cardiac surgery group. The perioperative outcomes, symptoms, life quality, mortality, and major adverse cardiac events (MACEs) were analyzed. Results There were no deaths during hospitalization and no rethoractomy for postoperative bleeding or major adverse cardiac events (MACEs). The follow-up period ranged from 2 months to 199.2 months (55.61 ± 10.21) months, the 10-year cumulative survival rates for the four groups of patients were 95.0%, 100%, 100% and 74.1%, and the 10-year freedom rates from the MACEs were 83.9%, 92.0%, 87.5% and 76.2%, respectively. Conclusions Supra-arterial myotomy is preferred in patients with isolated myocardial bridge, and acceptable results can be achieved by choosing supra-arterial myotomy in combination with CABG or other cardiac surgery simultaneously for patients with myocardial bridges and other heart disorders.

A centrifugal rotary blood pump was treated to investigate the effects of blade thickness by numerical simulation, where Reynolds averaged Navier-Stokes method coupling with k-ω SST turbulence model is applied. For comparison, five pumps were designed with different blade thickness distribution from the leading edge to trailing edge. The numerical methods were validated by the comparison of hydraulic performance between the simulation and the experiment for a test pump. Results showed that the thicker blade near leading edge suppresses the separation flow in blade-to-blade passage of pump impeller, and can improve hydraulic efficiency at low flow rate. On the other hand, the blade shape modification by trimming suction side near trailing edge is helpful to reduce the hydraulic loss by suppressing the flow mixing downstream impeller exit. Power loss analysis based on the simulated internal flow indicated that viscous dissipation of mean kinetic energy (VDKE) and turbulence kinetic energy production (TKEP) are main source terms contributing to power loss for the blood pump. The blade thickness near trailing edge changes the interaction between volute tongue and impeller blade, and the trimmed blade is helpful for decreasing the large values of VDKE and TKEP in pump volute compared with the conventional blade. The analysis further indicates that the blade modifications with thickness increment seem to slightly increase the degree of RBCs damage, and the effect of blade thickness on the hemolysis index of the blood pump should be carefully considered. The results are expected to be beneficial to the wide application of centrifugal rotary blood pumps.

The surgical strategy among patients with malignancy and coronary artery disease (CAD) remains controversial. In this study, we present the experiences of coronary artery bypass grafting (CABG) in patients with malignancy and analyzed the treatment outcomes. From January 2011 to October 2021, eight patients combined with coronary artery disease and malignancy, six of them with three-vessel disease and two with anterior descending branch lesions on coronary angiography. The age ranged from 54 to 73 years (61.8 ± 7.7years). Four patients underwent CABG and staging for surgical oncology, and 2 patients underwent CABG and surgical oncology simultaneously. Four patients underwent CABG procedure with cardiopulmonary bypass (on-pump CABG), and the other patients underwent the procedure without cardiopulmonary bypass (off-pump CABG). All patients were followed up for 3 to 96 months (40.4 ± 31.5 months) postoperatively. The mean number of grafts was 2.6 ± 1.1, there was no in-hospital death, postoperative myocardial infarction, and stroke. Among the eight patients, one patient received chemotherapy and radiation before bypass surgery, which occurred postoperatively pulmonary infection, and the rest of 7 patients had no major adverse cardiovascular events during follow-up periods. Based on the results of the present study, simultaneous or staged CABG and oncologic surgery according to the TNM stage of the tumor and cardiac assessment is an effective treatment for patients with severe CAD combined with malignancy.

Background Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) with a severe dilated left ventricle and dysfunction leads to left ventricle remodeling. But there are rarely reports on the left ventricle reverse remodeling (LVRR) after AVR. This study aimed to investigate the LVRR and outcomes in chronic AR patients with severe dilated left ventricle and dysfunction after AVR. Methods We retrospectively analyzed the clinical datum of chronic aortic regurgitation patients who underwent isolated AVR. The LVRR was defined as an increase in left ventricular ejection fraction (LVEF) at least 10 points or a follow-up LVEF ≥ 50%, and a decrease in the indexed left ventricular end-diastolic diameter of at least 10%, or an indexed left ventricular end-diastolic diameter ≤ 33 mm/m 2 . The changes in echocardiographic parameters after AVR, survival analysis, the predictors of major adverse cardiac events (MACE), the association between LVRR and MACE were analyzed. Results Sixty-nine patients with severe dilated left ventricle and dysfunction underwent isolated AVR. LV remodeling in 54 patients and no LV remodeling in 15 patients at 6–12 months follow-up. The preoperative left ventricular dimensions and volumes were larger, and the EF was lower in the LV no remodeling group than those in the LV remodeling group (all p < 0.05). The adverse LVRR was the predictor for MACE at follow-up. The mean follow-up period was 47.29 months (range 6 to 173 months). The rate of freedom from MACE was 94.44% at 5 years and 92.59% at 10 years in the remodeling group, 60% at 5 years, and 46.67% at 10 years in the no remodeling group. Conclusions The left ventricle remodeling after AVR was the important predictor for MACE. LV no remodeling may not be associated with benefits from AVR for chronic aortic regurgitation patients with severe dilated LV and dysfunction.

INTRODUCTION:Myocardial bridging (MB) is a common and usually benign inborn coronary abnormality that may lead to anginal symptoms, acute coronary syndrome, arrhythmias, and rarely sudden cardiac death. MB are most commonly localized in the middle segment of the left anterior descending coronary artery (LAD). The treatment of LAD-MB is still challenging. Our objective was to assess the short- and long-term results of surgical procedures in patients with LAD-MB who had chest pain refractory to medical therapy.METHODS:Between March 2005 and January 2020, 26 patients (19 males and 7 females; mean 55.8 ± 12.4 years) with MB underwent surgery. All MB was located in the mid-segment of the LAD with a mean length of 4.2 ± 1.7 cm. Coronary angiography before surgery demonstrated LAD-MB with systolic compression more than or equal to 70% in all patients.RESULTS:Twenty-five patients underwent myotomy and one patient underwent coronary artery bypass grafting (CABG). All patients survived and recovered uneventfully. Neither hospital or late death nor major complications occurred. Follow-up time was 3-173 months (mean 55.7 months). Follow-up of coronary angiography or computed tomography scan performed in 16 patients demonstrated restoration of coronary blood flow and myocardial perfusion without significant residual compression of the artery. All patients were symptom-free and are currently in NYHA Class I.CONCLUSION:The symptomatic LAD-MB patients who are refractory to medication should actively undergo the surgical intervention such as myotomy and CABG to eliminate the clinical symptoms and achieve satisfactory results by follow-up findings. Myotomy is a preferred procedure because of its safety and satisfactory results.

Centrifugal blood pumps have provided a powerful artificial support system for patients with vascular diseases. In the design process, geometrical optimization is usually needed to acquire a more biocompatible model for clinical uses. In the current paper, we propose a method for multi-objective optimization concerning both the hydraulic and the hemolytic performances of the pump based on the near-orthogonal array in which the traditional hemolysis index (HI) is replaced with the maximum scalar shear stress criteria to reduce the computation load. The method is demonstrated with the optimization of an extracorporeal centrifugal blood pump with an unshrouded impeller. CFD studies on the original and nine modified pump models are carried out. The calculated hydraulic performances of the optimized model are also compared against the experiments for validation of the numeric method, with an error of 3.6% at the original design point. The resulting blood pump with low maximum scalar shear stress (132.2 Pa) shows a low degree of calculated HI (1.69 × 10−3).

Objective: To analyze the long-term outcome of unoperated Ebstein's anomaly (EA) patients aged over 18 years, and to evaluate the related factor of outcomes. Methods: The data of 48 unoperated EA patients from March 2004 to December 2008 in the First Hospital of Tsinghua University, were analyzed. The clinical data of the patients were collected, and patients received regular echocardiography, ECG and chest X-ray examinations. Septal leaflet attachment ratio (SLAr) was calculated based on transthoracic echocardiography imagines. The patients were divided into 3 groups according to SLAr: SLAr<0.45 (n=18), 0.45≤SLAr≤0.60 (n=21) and SLAr>0.60 (n=9). Chest X-ray was used for measurement of cardiothoracic ratio (CTR). Kaplan Meier survival curve was used to calculate the long-term survival rate. Cox proportional hazards regression model was used to analyze the influencing factors of death. Results: There were 19 males, and the mean age at diagnosis was (21.3±11.1) years. Forty-two patients (87.5%) were complicated with arrhythmia, including W-P-W syndrome (n=4), supraventricular tachycardia (n=16), right bundle branch block (n=37), and atrial fibrillation (n=2). The mean duration of follow-up was (148.8±16.8) months, the follow-up rate was 100% with no loss-to-follow up. Nine cases (18.8%) died during follow-up: 6 cases (12.5%) died of cardiac origin, including 3 cases of heart failure, 1 case of arrhythmia, and 2 cases of sudden death; 1 case died of accident; 2 cases died from unknown causes. During the follow-up period, the survival rates were 17/18, 19/21 (90.5%) and 3/9 in the SLAr<0.45, 0.45≤SLAr≤0.60 and SLAr>0.60 group, respectively. According to Kaplan-Meier survival curve, the 5-year survival rates among the three groups were 100%, 100% and 78%, respectively. The 10-year survival rates among the three groups were 94%, 95% and 44%, respectively. Decreased activity tolerance and heart failure were found in 7 patients (6 patients in SLAr>0.60 group and 1 patient in 0.45≤SLAr≤0.60 group). Two patients had cerebrovascular embolism. There were 3 cases with tachyarrhythmia lasting more than 24 hours. Cox regression analysis showed that the risk of death was higher in patients with SLAr>0.60 than in patients with SLAr<0.45 (HR=12.375, 95%CI 1.692-22.146, P=0.015); the risk of death in patients with CTR≥0.65 was 1.306 times higher than that in patients with CTR<0.65 (HR=1.306, 95%CI 0.417-12.754, P=0.038). Conclusions: EA patients often combines with arrhythmia. For unoperated EA patients, SLAr>0.60 and CTR≥0.65 are risk factors of death. EA patients with arrhythmia should be actively treated with drugs or radiofrequency ablation.

Objective: Pediatric primary cardiac tumor is an extremely rare disease. The tumor can extend into the conduction system and cause malignant arrhythmias. We retrospectively reviewed 6 consecutive cases of children with primary cardiac tumor that manifested as rhythm disturbance. Methods: In our center, 6 children were enrolled from October 2009 to August 2016. Detailed operative data and follow-up information were comprehensively collected and statistically analyzed. Results: The patients were ages 1 to 16 years and weighed 7.9 to 44.5 kg. Preoperative ventricular tachycardia was present in 3 patients, frequent ventricular ectopic beats in 1 patient, supraventricular tachycardia in 1 patient, and atrial flutter in 1 patient. All 6 patients underwent a complete tumor resection. The tumors were localized in the left ventricular free wall (3 patients), left ventricular outflow tract (1 patient), left atrium (1 patient), and right atrium (1 patient). One patient received 2 radiofrequency ablation procedures before tumor resection. Postoperative sick sinus syndrome occurred in 1 patient because the tumor infiltrated the sinoatrial node. Tumors from 2 patients were pathologically diagnosed as fibroma and 4 as rhabdomyoma. Reoperation of mitral valve repair was performed in 1 patient 1 year after tumor resection. The mean (± SD) follow-up time was 63.7 ± 31.4 months, and all children were well, with Ross functional classification I and no signs of recurrence or metastasis. Conclusions: In conclusion, cardiac tumor is a rare but nonneglectable reason for arrhythmia, and surgical resection is the optimal procedure, with satisfactory results.

The non-physiologic turbulent flows in centrifugal rotary blood pumps (RBPs) may result in complications such as the hemolysis and the platelet activation. Recent researches suggest that the turbulent viscous dissipation in the smallest eddies is the main factor of the blood trauma caused by the turbulent flow. The turbulent viscous shear stress (TVSS) was taken as the realistic physical force acting on the cells. However, limited by the temporal and spatial resolutions of the instrumentation currently available, very limited studies are available for the TVSS in the RBPs. In this paper, the large eddy particle image velocimetry (PIV) method is used to estimate the turbulent dissipation rate in the sub-grid scale, to investigate the effect of the TVSS on the blood trauma. Detailed flow characteristics, such as the relative velocity vectors, the estimated TVSS levels and the Kolmogorov length scales, are analyzed in three impeller phases at three constant flow rates (3 L/min, 5 L/min and 7 L/min). Over the measures range in this study, the maximum TVSS in the investigated RBP is lower than the reported critical value of stress. This study demonstrates that the large eddy PIV method is effective to evaluate the flow-dependent force on the cells. On the other hand, it is found that the TVSS is highly dependent on the flow behavior. Under severe off-design conditions, the complex flow characteristics, such as the flow separation and the vortical structures, will increase the TVSS. Thus, in order to reduce the hemolysis in the RBPs, the flow disturbance, induced by the departure of the incidence angle, should be avoided during the design of the RBPs.

BACKGROUND:Postoperative pericardial adhesion formation is a prominent cause of morbidity and death in cardiovascular surgery, but there is still no ideal prevention method, especially in redo cases. This study investigated a novel antiadhesion trilaminar polymeric film compared with the Gore PRECLUDE Pericardial Membrane (W. L. Gore & Associates, Flagstaff, AZ) and a negative control. METHODS:Our novel trilaminar membrane is composed of polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC). An established pericardial adhesion rabbit model was used to test the property of the membrane. After sternotomy, a portion of pericardium was resected and the epicardium was abraded. Rabbits (n = 24) were randomly assigned to 3 groups: control group, no trilaminar membrane or expanded polytetrafluoroethylene (ePTFE); ePTFE group, or trilaminar membrane group (PVA-CMC group). Evaluation of adhesion formation was performed by resternotomy 4 weeks after the operation. RESULTS:The degree of tissue adhesion surrounding the heart in the PVA-CMC group was significantly less than in the control (P < .01) and ePTFE (P < .05) groups. The inflammation score in group PVA-CMC was significantly lower than that in the ePTFE (P < .01) and control (P < .01) groups. The fibrosis score was significantly lower in group PVA-CMC than that in the ePTFE (P < .05) and control (P < .01) groups. CONCLUSIONS:The novel trilaminar membrane effectively reduced postoperative pericardial adhesions. The placement of the trilaminar membrane at the time of sternal closure provides a novel combination to minimize the extent and severity of pericardial adhesions while providing a physical barrier between the sternum and the cardiac structures.

Background and Aims: Bicuspid aortic valve (BAV) related aortopathy has been a controversial issue in the past few years. Most of the researches focused on BAV with dilated ascending aorta after aortic valve replacement (AVR), but there were limited documents of patients with the normal-sized proximal aorta. We retrospectively analyzed the clinical data of patients undergoing AVR in our institution and evaluated the progression of the unreplaced ascending aorta in a relatively long term follow-up. Methods: In our institution, 165 patients were consecutively recruited from July 2004 to December 2017. Detailed perioperative information and follow-up data were comprehensively collected and quantitatively analyzed. Results: 48 patients (29.1%) had BAV, while TAV was found in 117 patients. A significant difference was observed in diameters of ascending aorta at baseline between BAV and TAV group (37.5 ±4.2mm vs 35.1 ±4.4mm; p=0.001). The overall survival rates were 89% and 95.8% at 10 years postoperatively in BAV versus TAV group (Plog rank=0.138). Only 1 patient suffered an aortic dissection and underwent proximal aortic surgery. No difference in the progression of ascending aorta (0.8±4.7mm vs 0.6±3.5mm, p=0.821) was observed. The diameter of ascending aorta at baseline was a significant predictor of progression in ascending aorta. Conclusions: BAV patients with a normal-sized ascending aorta have a considerable low incidence of late adverse aortic events after AVR. Meanwhile, the progression of the unreplaced ascending aorta in BAV patients is not different from that in TAV patients.

Ventricular assist device (VAD) implantation is an effective treatment for patients with end-stage heart failure. However, patients who undergo long-term application of VADs experience a series of VAD-related adverse effects including pump thrombosis, which is induced by rotate impeller-caused blood cell injury and hemolysis. Blood cell trauma-related flow patterns are the key mechanism for understanding thrombus formation. In this study, we established a new method to evaluate the blood cell damage and investigate the real-time characteristics of blood flow patterns in vitro using rheometer and bionic microfluidic devices. The variation of plasma free hemoglobin (PFH) and lactic dehydrogenase (LDH) in the rheometer test showed that high shear stress was the main factor causing erythrocyte membrane injury, while the long-term exposure of high shear stress further aggravated this trauma. Following this rheometer test, the damaged erythrocytes were collected and injected into a bionic microfluidic device. The captured images of bionic microfluidic device tests showed that with the increase of shear stress suffered by the erythrocyte, the migration rate of damaged erythrocyte in bionic microchannel significantly decreased and, meanwhile, aggregation of erythrocyte was clearly observed. Our results indicate that mechanical shear stress caused by erythrocyte injury leads to thrombus formulation and adhesion in arterioles.

BACKGROUND Acute kidney injury (AKI) is one of the common complications in infants and children after complex congenital heart surgery. Peritoneal dialysis (PD) is usually applied for renal replacement therapy (RRT), especially in infants. We investigated the efficacy and safety of modified PD for the treatment of acute renal failure and congestive heart failure after cardiac surgery for congenital heart disease in infants. METHODS We retrospectively analyzed five consecutive patients from October 2015 to February 2017. The patients were aged from four days to five years old, and all had acute renal failure and congestive heart failure after cardiac surgery. In the five patients treated with modified PD (five males; average weight: 11.2 ± 5.5 kg), we used the Seldinger technique percutaneous abdominal puncture 16 G single lumen central venous catheter instead of the Tenckhoff peritoneal dialysis catheter as a PD catheter. Modified PD was intermittent. We recorded and monitored circulation and metabolism index. RESULTS Five cases (100%) with modified PD were restored to normal renal function. Congestive heart failure was gradually alleviated, and pulmonary and cardiovascular function were improved. Urine volume increased. Neither peritonitis nor catheter leakage occured in any of our cases. Urine volume increased due to PD, from 0.16 + 0.18 mL/kg*h before PD to 2.63 + 1.05 ml/kg*h at the end of PD (P < .05). Serum creatinine, serum urea nitrogen, and serum K+ changed from 85.0 ± 36.5 μmol/L, 17.1 ± 7.5 mmol/L, and 4.57 ± 0.30 mmol/L before PD, to 76.0 ± 36.7 μmol/L, 20.1 ± 11.0 mmol/L, and 4.42 ± 0.42 mmol/L at the end of PD, respectively (P > .05). Acidosis, hyperkalemia, hypoxemia and low cardiac output syndrome were improved. All patients were cured and discharged with normal renal function. CONCLUSION We conclude that modified single lumen central venous catheter for PD is a safe, feasible, and less invasive therapeutic strategy for AKI in infants undergoing cardiac surgery, and is worthy of being widely applied in clinical practice.

Surgical Ebstein Objective: To evaluate the outcomes of patients who underwent the different techniques according to the pathology of Ebstein Anomaly (EA). Method: From March 2004 to February 2017, 228 patients (mean age, 19.8±15.4 years; range, 7 months-64 years) with EA underwent 232 cardiac operations at our hospital. 29 patients had a prior cardiac procedure before. Among the patients in first procedures, 92 patients (46.2%) were categorized to Carpentier type C and 63 patients (31.7%) were type D, 7 patients (3.5%) had isolated anterior leaflet downward displacement. Anatomical repair were performed in 179 patients (Type B, n=35; type C, n=92; Type D, n=29; unclassifiable, n=7; reoperation, n=16), 1½ ventricle repair in 37 (Type D, n=33; reoperation, n=4), tricuspid valve repair in 3 (Type A, n=2;Type B, n=1), tricuspid valve replacement in 10 (7 reoperations), and Fontan procedure in 3 (TCPC, n=2; Glenn, n=1). Atrialized right ventricle presented in 194 cases (168 excised, 6 incorporated). The pathology of 199 patients who underwent first procedures at our center described in Table 1. Result: The mortality was 1.7% (n=4: anatomical repair, n=3; 1½ ventricle repair, n=1). Among these, 1 pathology type was Carpentier type C and 3 were type D. 1 A-V block (0.4%) newly occurred. 214 patients were available to follow up. The range of follow-up duration was 10 months to 13 years (mean, 7.3±3.2 years). Late survival was 99% (2 late deaths) at 10 years. 3 patients received reoperation (reoperation rate,

Due to the tireless efforts of medical staff, we have made great progress in the surgical treatment of congenital heart disease in recent years. A lot of new experiences has been accumulated and many new methods have been created in the diagnosis and treatment of congenital heart disease in neonates, minimal invasive surgical technique, hybrid procedure and the surgical treatment of complicated congenital heart disease. It is proved that innovation and practice are the basis of the surgical treatment of congenital heart disease.