Objective:To summarize the surgical experiences and follow-up results of different surgical approaches for interrupted aortic arch (IAA) and to optimize surgical planning.Methods:From October 2012 to September 2020, 53 IAA children aged under 1 year were selected as study subjects.The concurrent conditions included ventricular septal defect (VSD, n=41), subaortic membrane and severe stenosis, parachute mitral valve & intramitral annulus (n=1), main aorta-pulmonary window (APW, n=6), common arterial trunk (n=1), complete atrial ventricular septal defect (n=1), double outlet of right ventricle & abnormal origin of coronary artery (n=1) and bicuspid aortic valve (n=1). Primary anatomical correction (n=52) and staged surgery (n=1) were performed.The procedures included end-to-end anastomosis of descending aorta & proximal aortic arch (n=8), extended end-to-side anastomosis of descending aorta & proximal aortic arch (n=28), extended end-to-side anastomosis of descending aorta and proximal aortic arch + bovine pericardial patch widened anterior wall of aortic arch (n=12), left subclavian artery inversion and direct anastomosis of descending aorta (n=2) and extended end-to-side anastomosis of descending aorta and proximal aortic arch and widening of anterior aortic wall with pulmonary vascular patch (n=3). The parameters of delayed sternal closure time, postoperative mortality and restenoticc rate were statistically analyzed with SPSS 22.0.Results:The outcomes were survival (n=48), death (n=5) and delayed thoracic closure (n=26). Two postoperative children underwent extracorporeal membrane oxygenation (ECMO) assisted circulation due to low cardiac output syndrome.One case of postoperative cardiac tamponade underwent emergency thoracotomy for hemostasis; Staphylococcus aureus was detected in blood culture of 1 child and cure obtained after antibiotic dosing of imipenem and vancomycin.In another case, chylothorax disappeared after a combination of fasting and with parenteral nutrition.One child developed postoperative convulsions and cranial MRI hinted at hypoxic-ischemic encephalopathy.After intensive nutrition and rehabilitation, he was discharged after improvements.One child underwent percutaneous balloon dilation of aortic arch with a pressure difference of 86 mmHg(1 mmHg=0.133 kPa) at 1 year postoperatively.And others were followed up with a pressure difference of <30 mmHg for 1 year.Conclusions:Upon a definite diagnosis of IAA, early surgical intervention is mandatory.Proper surgical approaches should be based upon the location, extent and associated intracardiac abnormalities.Surgical intervention is indicated for such chronic conditions as subaortic membrane formation and left ventricular outflow obstruction.

目的:回顾总结新生儿主动脉弓中断一期手术治疗经验,探讨新生儿主动脉弓中断的最佳手术时机及手术方式.方法:自2012年10月至2017年10月,我中心共收治新生儿主动脉弓中断26例.男性19例,女性7例;手术年龄3～28 d,平均(17.3±1.6)d;体质量2.6～4.4 kg,平均(3.3±0.1)kg.解剖学分型:A型20例,B型6例.全部病例合并动脉导管未闭,合并主肺动脉间隔缺损1例,合并室间隔缺损25例,其中17例同时合并房间隔缺损.手术均采用正中切口,体外循环采用升主动脉及肺动脉干双插管灌注,先矫治心内畸形,体温降至20～25℃后选择性脑灌注.重建主动脉弓采用扩大端侧吻合17例,扩大端侧吻合+牛心包补片加宽前壁9例.结果:全组术中体外循环转流102～150 min,平均(127.5±15.8)min,主动脉阻断47～75 min,平均(62.3±9.5)min,选择性脑灌注时间20～46 min,平均(32.54±9.4)min.术后死亡2例,病死率7.7％.1例死于术后严重低心排综合征、脑出血,1例死于毛细血管渗漏综合征、肾衰竭.余患儿手术成功,痊愈出院.术后失访2例,随访22例,中位随访时间28个月(9～ 60个月).无远期死亡,主动脉弓再狭窄1例,予以行经皮介入球囊扩张.结论:主动脉弓中断一旦诊断明确,应于新生儿期内施行手术.选择性脑灌注下一期矫治主动脉弓中断及其合并畸形手术效果满意.

目的:探讨自体心包补片延长二尖瓣后瓣技术治疗婴幼儿二尖瓣关闭不全的效果.方法:自2016年1月至2017年12月,我中心采用自体心包补片延长二尖瓣后瓣技术行二尖瓣成形术7例,其中男性4例,女性3例;年龄2～12个月,平均5.9个月;体质量4.7～9kg,平均(6.7±1.6)kg.术前心脏彩超评估二尖瓣重度关闭不全4例,中重度关闭不全3例.单纯二尖瓣关闭不全2例,合并室间隔缺损3例,合并Williams综合征伴左心室室壁瘤1例,合并动脉导管未闭1例.7例患儿术中均采用自体心包补片延长后瓣叶,其他修复技术包括交界环缩、瓣叶楔形切除.术中同时矫治合并畸形.结果:术中经食道超声检查5例无明显反流,2例轻度反流.7例患儿均顺利康复出院.术后随访6个月～2年,7例患儿二尖瓣反流程度无明显变化.结论:采用自体心包补片延长后瓣叶技术治疗以后瓣叶发育不良为主的婴幼儿先天性二尖瓣关闭不全近期效果满意,中远期效果尚需观察.

Objective To discuss the comprehensive measures during perioperative period for sternal wound infections in children undergoing cardiac surgery.MethodsPatients from January 2013 to December 2014 who underwent cardiac surgery in our center were selected and randomly divided into the study group (n=337) and the control group (n=309). Study group received comprehensive measures to prevent wound infection; while control group received the routine measures.ResultsThe weight of study group and control group was (5.3±1.2) and (5.0±1.3) kg; the age was (6.2±3.3) and (7.2±1.4) months;extracorporeal circulation ratio was 47.5% (160/337) and 46.9% (145/309); and delay closed chest ratio was 14.8% (50/337) and 19.4% (60/309). There was no significant difference about the above indicators between two groups (P>0.05). The infection incidence ofⅠ、Ⅱ、Ⅲ type of study group and control group was 0.3% (1/337) and 0.6% (1/337), 0.0% (0/337) and 8.4% (26/309), 0.0% (0/337) and 1.0% (3/309);the average hospitalization days were (20.1±17.5) and (21.1± 15.5) d; the mean costs of hospitalization were (73 141±53 853) and (101 654±174 699) yuan. The above three indicators in study group were lower than control group (P<0.05).Conclusions Taking comprehensive preventive measures during perioperative period can greatly decrease the incidence of incision infection in pediatric patients undergoing cardiac surgery.

Objective To analyze the surgical timing and outcome of artery switch operation (ASO) for neonates with transposition of the great arteries with intact ventricular septum (TGA/IVS) .Methods 25 patients underwent ASO from February 2012 to February 2015 were analyzed retrospectively. There were 13 cases in group of emergency operation (group A), and 12 cases in group of selective operation (group B). The surgical outcomes of two groups were compared.ResultsThere were 19 male cases and 6 female cases among the 25 patients. The indexes of sex ratio, proportion of premature infants, birth weight, age at hospitalization, weight at operation, age at operation and artery location of the two groups were no statistically different (P>0.05). The duration of admission to operation of group A was shorter than that of group B[1.0 (1.0~1.5) vs 1.0 (8.3~14.8) d,T=91.000,P<0.05)]. The ratio of pre-operation mechanical ventilation of group A was higher (13/13 vs 3/12,χ2=15.234,P < 0.05), while pre-operative oxygen partial pressure was lower than that of group B[23 (17~27) vs 30 (23~45) mmHg,T=127.000,P<0.05)]. There were no statistically difference (P>0.05) in extracorporeal circulation time, aorta blocking time and the ratio of delayed sternal closure. Meanwhile, the proportion of early low cardiac output syndrome (2/13 vs 1/12,χ2=0.294), the proportion of early post-operative death (1/13 vs 1/12,χ2 = 0.003), and the duration of hospital stay[26.0 (18.5~27.5) vs 18.5 (21.5~40.8) d,T=150.500] of the two groups were no statistically different (P>0.05) .Conclusion Reasonable perioperative management in neonates with TGA/IVS can obtain better short-and long-term efifcacy.