OBJECTIVES Coronary artery atresia is a rare coronary artery anomaly in children and has a high rate of misdiagnosis. We aimed to summarize the profile and early outcomes after the surgical reconstruction of coronary artery atresia in children. METHODS A retrospective analysis was performed in 12 consecutive patients with coronary artery atresia who were admitted to the Department of Paediatric Cardiac Surgery of Fuwai Hospital between October 2016 and September 2020. Ten patients underwent surgical reconstruction of the coronary artery with the pulmonary artery anterior wall, and 8 patients underwent concomitant mitral valvuloplasty. RESULTS There were 6 females and 6 males, with an age of 1.75 years [interquartile range (IQR), 1.0-3.5] and weight of 10.0 kg (IQR, 8.9-14.75). There were 10 cases of left coronary artery atresia and 2 cases of right coronary artery atresia. All the patients were initially misdiagnosed in the outpatient clinic, but further nonselective coronary angiography confirmed the diagnosis of coronary artery atresia. In all 10 patients with mitral regurgitation, echocardiogram of the mitral valve chordae and papillary muscle revealed ischaemic changes. The clamp time was 89.0 min (IQR, 75.0-101.0), the pump time was 126.0 min (IQR, 119.0-132.0) and the intensive care unit stay time was 1.5 days (IQR, 1.0-3.0). No perioperative deaths were noted. After 9.5 months (IQR, 5.5-13.5) of follow-up, 2 patients with fractional shortening that significantly decreased to 14.1% and 14.8% died and 1 patient had moderate pericardial effusion that improved after treatment with oral diuretics. Coronary artery ultrasound and enhanced computed tomography showed a patent main coronary artery in all the patients. CONCLUSIONS Coronary artery atresia in children is often associated with mitral regurgitation, and mitral valve chordae and papillary muscle exhibit ischaemic changes. Coronary artery reconstruction is safe and effective in children with coronary artery atresia.

Background: Free wall rupture is a fatal and emergency complication of acute myocardial infarction. The factors associated with in-hospital mortality from free wall rupture remain unclear. Objectives: To investigate the factors associated with in-hospital mortality from free wall rupture. Methods: We performed a single-center, retrospective study. We enrolled 111 consecutive patients with free wall rupture following acute myocardial infarction who were admitted to Fuwai Hospital from January 2005 to May 2021. The primary endpoint was in-hospital death. Clinical characteristics, laboratory data, and treatment modalities associated with in-hospital mortality were analyzed. Results: Eighty-seven of the 111 study participants died in hospital. Multivariate Cox regression analysis showed that pericardiocentesis (hazard ratio [HR] 0.296, 95% confidence interval [CI] 0.094-0.929, p = 0.037), pericardial effusion at admission (HR 0.083, 95% CI 0.025-0.269, p<0.001), time interval between acute myocardial infarction and free wall rupture (HR 0.670, 95% CI 0.598-0.753, p<0.001), and previous myocardial infarction (HR 0.046, 95% CI 0.010-0.208, p<0.001) were independently associated with in-hospital mortality. Conclusions: Pericardiocentesis, pericardial effusion at admission, the acute myocardial infarction to free wall rupture time, and previous myocardial infarction are associated with a lower rate of in-hospital mortality from free wall rupture after acute myocardial infarction. (C) 2022 Elsevier Inc. All rights reserved.

目的 探索合并异位心及左室流出道狭窄的矫正型大动脉转位患者姑息性分流术后的二次手术治疗策略.方法 回顾性分析2011年6月至2019年5月连续性收治的姑息性分流术后合并异位心及左室流出道狭窄的矫正型大动脉转位54例患者的临床资料.所有患者均双心室发育均衡,按手术方式分为两组:一个半心室组,行一个半心室矫治术者24例,男16例、女8例,平均年龄(5.4±2.2)岁;单心室组,行单心室矫治术者30例,男19例、女11例,平均年龄(8.6±6.2)岁.通过电话随访并预约复查获取随访资料.结果 术前两组间体循环系统瓣膜反流率和体循环系统心室射血分数差异无统计学意义.单心室组的体外循环时间、主动脉阻断时间和机械通气时间均显著短于一个半心室组,但迁延性胸腔积液发生率明显高于一个半心室组.无院内死亡.一个半心室组中位随访时间49(17～83)个月,随访率93.9％,随访死亡1例.单心室组中位随访时间47(12～85)个月,随访率90.9％,随访死亡1例.随访终点时一个半心室组体循环系统心室射血分数显著性高于单心室组,而且心功能分级(NYHA)Ⅲ级和Ⅳ级比例低于单心室组,差异有统计学意义(P＜0.05).两组术后生存率及免除再干预率差异无统计学意义(P＞0.05).结论 对于姑息性分流术后的合并异位心及左室流出道狭窄的矫正型大动脉转位患者,一个半心室矫治术是理想的二次手术治疗策略选择.

目的 分析低龄重度主动脉瓣狭窄婴儿的病变特征及手术治疗结果.方法 选择2012年8月至2019年12月于我院行主动脉瓣交界切开术低龄婴儿(年龄≤90d)28例,其中男22例、女6例,年龄62.00(47.00,82.50)d.分析患者病变特征、手术及随访结果.结果 20例(71.43％)患者瓣叶病理为二叶瓣.术前5例(17.86％)患者心力衰竭,2例(7.14％)使用前列腺素.术后呼吸机使用时间25.00(17.00,62.75)h,住ICU时间3.50(2.00,8.50)d,术后住院时间10.00(7.00,16.50)d.延迟恢复(住ICU时间＞14 d)4例(14.29％),死亡1例(3.57％).术后随访55.00(43.25,82.25)个月,随访期间无死亡,4例(14.81％)患者再次入院行手术治疗,其中3例(11.11％)为主动脉瓣重度狭窄、1例(3.70％)为主动脉瓣重度关闭不全.结论 低龄重度主动脉瓣狭窄婴儿病情重,术后恢复时间长,需尽早手术,术后随访结果满意.

Objective:To summarize the surgical treatments of deep sternal wound infection (DSWI) in children aged under 7 years after pediatric cardiac surgery.Methods:From January 2010 to December 2019, a total of 31 866 children underwent cardiac surgery through a median sternal incision.There were 387 neonates.Among them, 0.15%(47/31 866) developed deep incision infection involving sternum.The incidence of DSWI in children of different ages was 2.33%(9/387) for neonates, 0.15%(6/4 018) for children aged 2-6 months, 0.09% for children aged 6-12 months (6/7 010), 0.13% (15/11 511) for children aged 1-3 and 0.12%(11/8 940) for children aged 3-7.Among 47 children, there are 30 boys and 17 girls; their age was (1.98±2.03) years; their weight (10.55±6.24) kg.Complex congenital heart disease accounted for 75% of all cases.There were 9 neonates (19.1%), 21 infants (44.7%) aged under 1 year, 14 infants (29.8%) with wound infection and debridement within 15 days after an initial operation, 11 infants (23.4%) with wound infection and debridement 15 to 30 days after an initial operation and 22 infants (46.8%) over 30 days.Results:The incidence rate of postoperative deep incision infection in newborns was significantly higher than that in children of other ages, and the difference had statistical significance ( P=0). All 47 children had a median sternotomy, and the original surgical incision was opened for drainage and dressing change immediately after the diagnosis of infection. After the wound was clean and granulation was fresh, they were sent to the operating room for debridement surgery. The time from debridement surgery to the last cardiac surgery was (126.89±310.53) d, ranging from 4 to 1997 days. Among them, the children with infection time >30 days who underwent debridement surgery had a high recurrence rate of infection, 50.0% (11/22) required multiple debridement, and only 59.1% (13/22) of the children were able to preserve the sternum. In this study, 29.8% (14/47) of the children required more than two debridement procedures in the hospital; 25.5% (12/47) of the children underwent pectoralis major muscle flap transfer surgery due to severe infection that could not preserve the sternum; and 14.9% (7/47) of the children used closed continuous vacuum aspiration therapy before debridement surgery due to severe exudation of the infection or inability to cooperate with bedside dressing change. Bacteriological culture was performed on the wound secretions of 31 children, of which 18 cultured Gram-positive cocci, mainly Staphylococcus epidermidis and Staphylococcus aureus, 9 did not detect pathogenic bacteria, and the remaining 4 cultured Gram-negative bacilli. There were no hospital deaths among the children in this study. One child required continuous dressing change after discharge due to sinus formation; one child had cardiac rupture and bleeding during debridement, and the chest was successfully closed after intraoperative compression hemostasis, and the child was recovered and discharged; no serious complications occurred in other children. Conclusions:Higher attention should be paid to treatment, early detection and diagnosis, thorough drainage, early debridement and avoiding other serious complications caused by the expansion of infection range are vital for a successful treatment.

目的:总结分析室间隔缺损介入封堵术后并发症的发生情况及外科治疗的效果.方法:选择2016年5月至2019年12月因室间隔缺损介入封堵术后并发症就诊于我院并行外科手术治疗的患者14例,分析室间隔缺损介入封堵术后并发症的发生情况、手术方法的选择、手术结果及随访结果.结果:患者室间隔缺损介入封堵术后并发症的发生包括:瓣膜损伤9例(三尖瓣、主动脉瓣损伤分别有5例和6例,其中三尖瓣和主动脉瓣同时损伤2例),左心室流出道梗阻1例,心律失常6例(三度房室阻滞2例、完全性左束支阻滞4例),溶血1例.所有患者均于体外循环下行室间隔缺损封堵器取出术和室间隔缺损修补术;另外,5例患者行主动脉瓣成形术,1例行主动脉瓣置换术,9例行三尖瓣成形术,2例植入永久起搏器.术后重症监护室住院时间为19.00(13.00,46.75)h,呼吸机使用时间为6.00(3.00,9.25)h,总住院时间为7.00(6.00,9.50)d.术后中位随访18.00(7.75,38.00)个月,所有患者室间隔缺损无残余分流,无瓣膜功能不良,植入起搏器的患者起搏器功能良好.结论:室间隔缺损封堵术后需外科手术治疗的并发症较多样,应以预防为主,一旦出现需早期外科干预;外科干预效果良好.

目的:总结应用可吸收聚左旋乳酸(PLLA)微骨板外固定术治疗先天性心脏病(先心病)合并支气管软化患儿的经验.方法:回顾性分析2017年12月至2019年1月,在我中心接受可吸收PLLA微骨板外固定术治疗先心病合并支气管软化的患儿8例,其中男性2例,女性6例.平均年龄(8.4±4.1)个月,平均体重(6.5±1.2)kg.观察术后机械通气时间、重症监护病房(ICU)时间、呼吸系统并发症等评估治疗效果.并于术后1、3、6、12个月复查超声心动图和胸部CT.结果:8例患儿中7例成功接受同期心脏畸形矫治和支气管可吸收PLLA微骨板外固定术,1例成功接受单纯支气管可吸收PLLA微骨板外固定手术.全组无围术期死亡,术后呼吸机辅助时间(24.4±23.7)小时,ICU时间(3.8±3.8)天.平均随访时间(6.5±6.2)个月,超声心动图显示所有患者心脏畸形矫治满意,CT显示支气管通畅.结论:采用可吸收PLLA微骨板外固定术治疗先心病合并支气管软化简便易行,治疗效果明显,可显著缩短机械通气时间及ICU时间,降低费用.近期效果满意.

To evaluate the feasibility and efficacy of external suspension with absorbable poly-l-lactic acid material shaping microplates for infants with severe bronchomalacia and congenital heart disease. From November 2017 to January 2019, 11 continual patients with severe bronchomalacia and congenital heart disease underwent bronchial membrane external suspension together with cardiovascular surgery. An absorbable plate made with poly-l-lactic acid material was used as the shaping fixation material in all patients. Data included the details of the operation, and clinical results were collected. The mean age was 1.2 ± 1.0 years, and the mean weight was 7.7 ± 2.9 kg. The patients with cardiac malformations were operated on under low-temperature cardiopulmonary bypass (CPB) through median sternotomy. There were no in-hospital deaths. The CPB time, mechanical ventilation time, and length of intensive care unit stay were 123.9 ± 36.9 min, 20.7 ± 19.4 h, and 71.6 ± 54.9 h, respectively. Two patients underwent surgery through a left posterolateral incision without CPB. One was a double aortic arch repair, and the other was only bronchial membrane external suspension with prior IAA repair. No patients needed ECMO support. The mean follow-up time was 12.1 ± 5.6 months, and no patients were lost to follow-up. No cases of late death were noted, and no patients needed reoperation. According to the CT scans, no patients had bronchial restenosis. External bronchial membrane suspension with an absorbable poly-l-lactic acid material shaping plate, which had better histocompatibility, for infants with severe bronchomalacia and congenital heart disease was a safe and feasible procedure.

目的 探索室间隔穿孔外科治疗的策略及远期预后.方法 回顾性分析2002年1月至2017年12月在阜外医院行室间隔穿孔修补术105例患者的临床资料,并对术后生存患者进行随访.其中男63例、女42例,平均年龄63岁.结果 患者根据循环状态行血管活性药物、主动脉内球囊反搏或左室辅助装置等联合治疗,手术时机采取个体化策略.患者诊断为室间隔穿孔后即被分为循环稳定组(25例,2例急诊手术,23例择期手术)和循环不稳定组(80例,34例行血管活性药物支持及择期手术,4例行血管活性药物及急诊手术,20例行血管活性药物与主动脉内球囊反搏支持及择期手术,16例行血管活性药物与主动脉内球囊反搏支持及急诊手术,2例行血管活性药物、主动脉内球囊反搏、呼吸机支持及择期手术,2例行血管活性药物、主动脉内球囊反搏、呼吸机支持及急诊手术,2例行血管活性药物、呼吸机支持及择期手术).3例患者住院死亡,生存102例,其中99例完成了随访,随访率为97.1％,平均随访时间(76.56±47.78)个月.2例远期死亡.结论 室间隔穿孔修补术手术时机应个体化选择,外科治疗术后远期结果满意.

目的 本研究旨在报道本院缩窄性心包炎患者行心包剥脱术后的远期随访结果,并分析影响预后的危险因素.方法 回顾性分析自1997年1月至2016年12月在阜外医院因慢性缩窄性心包炎行心包剥脱术共297例患者的临床资料,对所有患者进行术后随访及统计分析.结果 患者年龄在3.7～83(41.8±16.1)岁,女性患者81例(27.3％),NYHA心功能Ⅳ级41例(13.8％),术前合并房颤140例(47.1％),既往接受过心包剥脱术70例(23.6％),结核性心包炎有182例(61.3％),特发性心包炎有99例(33.3％).本次手术剥脱完全者281例(94.6％),体外循环下手术48例(16.2％),21例患者同期接受了二尖瓣或三尖瓣手术.手术死亡13例,手术死亡率4.4％(其中非体外循环下手术249例,死亡7例,死亡率2.8％;体外循环下手术48例,死亡6例,死亡率12.5％).平均随访55.7月,失随访38例(12.8％),随访中死亡13例.手术时年龄、术前房颤及再次心包剥脱术是影响患者主要不良心脑血管事件的危险因素,而再次心包剥脱术是影响患者远期生存率的唯一独立危险因素OR=4.03(1.5-10.5).结论 缩窄性心包炎行心包剥脱术治疗安全有效,再次心包剥脱术是影响预后的独立危险因素.

Objective:To explore the clinical features,surgical treatment and prognosis in acute myocardial infarction (AMI) patients with ventricular septal rupture (VSR) complicating cardiogenic shock (CS).Methods:A total of 77 AMI-VSR patients received surgical repair in our hospital from 2005-01 to 2015-05 were retrospectively studied.The patients were divided into 2 groups:CS group n=52 and Without CS group,n=25.Clinical features were compared between 2 groups and the outcomes in CS group were analyzed.Results:Both groups showed multiple aneurysm (73.0％ vs 68.0％);CS was more occurred in patients with posterior VSR (48.0％ vs 24.0％),P=0.044.Compared to Without CS group,CS group had the larger diameter of VSR (16.16±6.73) mm vs (11.86±4.62) mm,P=0.003;lower LVEF (45.0±8.8) ％ vs (47.9±12.3) ％,higher pre-operative application rates of IABP (34.6％ vs 0％) and vasoactive drugs (96.2％ vs 28.0％),more patients received emergent surgery (42.3％ vs 8.0％) and less patients received elective surgery (57.7％ vs 92.0％),all P＜0.05.In CS group,there were 3 in-hospital death,49 patients survived with the mean follow-up time at (4.5±3.1) years and 2 patients died during that period.Conclusion:Larger or posterior VSR were more likely to develop CS,the patients survived after surgical treatment may have good mid-term outcomes.

目的:未经干预的缩窄性心包炎自然病程预后差,本研究旨在报道我院缩窄性心包炎患者行心包剥脱术后的结果,并分析影响患者预后的危险因素. 方法:回顾性分析自 2005-01 至 2014-01 在阜外医院因缩窄性心包炎行心包剥脱术共 297 例患者的临床资料,对所有患者进行术后随访及统计分析.

Objective To analyze the effect of postoperative residual interventional treatment of cardiovascu‐lar disease after complex congenital heart surgery ,and to explore the feasibility of congenital heart lesions with interventional therapy .Methods Totally 75 cases of patients with residual cardiovascular disease after complex congenital heart surgery were selected as the subjects who were treated by intervention theropy in author's hospital from January 2000 to January 2014 ,in which a total of 29 cases of patients were treated by a large pulmonary collateral vessels embolization (MAPCAS) ,26 patients with occlusion therapy and 20 patients with balloon angioplasty or stent implantation treatment ,outcomes of the patients were retrospec‐tively analyzed .Results In this study ,40 collateral vessels were thrombosis in 29 patients with MAPCAS embolization ,and no residual shunt were found after treatment by echocardiography ,including two cases of patients dead of multiple organ failure and the remaining 27 patients were recovery and discharge .26 pa‐tients treated by occlusion were one -time successful closure ,no severe postoperative atrioventricular block and other serious complications except two cases with a small amount of residual ventricular shunt .The pressure gradient in 20 patients taken balloon angioplasty or stenting was significantly lower in stenosis . The pressure gradient before intervention was (60 .2 ± 14 .9)mmHg ,significantly reduced after the inter‐vention stenosis pressure gradient ,as (17 .3 ± 11 .4)mmHg ,the difference before and after interventional treatment was statistical significance (P<0 .01);stenting in the treatment of patients with blood flow ,no <br> thrombus formation ,and no sandwich in dilatation of the aortic coarctation hintted by spiral CT examina‐tions .Conclusion The intervention may be effective in the treatment of complex congenital heart surgery residual cardiovascular disease ,but the indications should be strictly controlled and appropriate intervention programs are developed according to the disease .

Objective Analyze the results of distal aortic reoperation in Marfan syndrome patients after proximal aortic surgery.Methods Between January 2000 and January 2010, 28 Marfan patients underwent surgical repair of distal aortic disease after aortic root surgery at our institution.There were 20 males and 8 females.Age ranged from 23 to 52 years [ mean (38.5 ± 8.7) years ].First time operations were Bentall procedure in 24, David procedure in 4.There were 8 cases of Stanford A dissection and 20 cases of aortic root aneurysm.The second time operations included 1 partial aortic arch replacement, 2 total arch replacements, 7 total arch replacements combined with stent elephant trunk, 6 descending thoracic aorta replacements,10 thoracoabdominal aorta replacements and 2 total aorta replacements.The interval between the lst and 2nd operation was 1 to 12 years [mean (6.43 ±3.07) years].The surgical technique used for distal procedures was dependent on the pathology of the aorta.Median repeat sternotomy was used for surgical exposure in 10 patients, who required an arch/proximal descending aortic procedure.Cardiopulmonary bypass (CPB) was established through the right axillary perfusion and right femoral venous drainage in all of these patients.16 patients were operated on through a left-sided incision, namely, a posterolateral thoracotomy, or a thoracoabdominal incision, depending on the distal extent of aortic replacement.For such patients, the left femoral vessels were cannulated for CPB in 14 patients and the rest 2 patients were operated on without CPB.Two patients with total aorta replacement were operated on through a median sternotomy combined with thoracoabdominal incision.22 patients underwent deep hypothermic circulatory arrest because of the replacement of anrtic arch or the extensive aneurismal arch.Reconstruction of intercostal arteries (T8-L1) was performed in 16 patients for the protection of spinal cord.Results Two patients (7.1％) died postoperatively.Neurological morbidity included 1 patient with stroke, 1 paraplegia and 2 temporary paraparesis Three patients required temporary tracheotomy for prolonged weaning form the respirator.All patients were followed up for 10-118 months [mean (40.8 ±29.5) months].Two patients died during follow-up.The survival rate was (94.5 ± 1.3)％,(90.6 ± 1.4) ％ at 1-and 5-year, respectively.Conclusion Distal aortic reoperation in Marfan patients can be performed with good short-and long-term results.Complete aortic arch replacement with elephant trunk technique, if safely performed,should be considered for Marfan patients presenting with type A dissection.

室间隔穿孔是急性心肌梗死后严重并发症之一,约占急性心肌梗死患者的1%～2%。内科保守治疗效果差,一旦穿孔发生后往往迅速发生心力衰竭、心源性休克而致死亡。手术治疗是公认有效的治疗方法,但手术风险仍尚高,早期死亡率高,近期出现介入治疗的探索。