Background
Hybrid technology has become a hot topic in cardiovascular surgery,has been widely used in the minimally invasive closure of simple coronary heart diseases (CHDs). For some children with special CHDs, it is still impossible to avoid the huge trauma caused by cardiopulmonary bypass. This study aimed to investigate the feasibility、safety and efficacy of hybrid technology in the treatment of several specific CHDs.
Methods
A total of 29 children with specific CHDs hospitalised in the Cardiac Surgery Department of Dalian Children’s Hospital from July 2014 to June 2019 were enrolled. There were 2 cases of right coronary artery-right ventricular fistula, 17 cases of neonatal critical pulmonary stenosis (CPS), 9 cases of neonatal pulmonary atresia-intact ventricular septum (PA/IVS), and 1 case of giant aortopulmonary window (APW). All of them underwent surgical treatment with hybrid technology guided by transoesophageal echocardiography (TEE). The TEE enabled immediate evaluation of the surgical curative effect. Further chest X-ray, electrocardiogram (ECG) and echocardiogram were performed in the outpatient department after discharge.
Results
The surgical treatment with hybrid technology was smooth except that 1 CPS patient was converted to open-heart surgery with cardiopulmonary bypass (CPB) due to a torn right ventricular outflow tract after balloon dilatation. No complication, such as wound or intracardiac infection, arrhythmia or pericardial effusion occurred. No children have been lost to follow-up and the investigation results and prognosis remain satisfactory.
Conclusions
the use of hybrid technology is a safe and effective alternative therapy for specific paediatric CHD cases. It has significant advantages in alleviating trauma and reducing medical costs and, therefore, has good prospects for broad application in the future.
Background
Surgery is the fundamental method for the treatment of primary cardiac tumours. However, due to the inaccessibility of anatomy and the proximity of important structures, it is very difficult to completely resect tumours of the left atrium or left ventricle without damaging the normal tissues. Cardiac autotransplantation for the resection of cardiac tumours is carried out by taking out the heart from the body, resecting cardiac tumours, and then transplanting the heart back into the body.
Case summary
This article presents a successful case of cardiac autotransplantation for the complete resection of primary cardiac tumour in a 2-month-old infant and shares the noteworthy experience.
Discussion
Tumours located in the left atrium and left ventricle are difficult to be exposed because of their deep posterior location and proximity to important anatomical structures such as mitral valve and chordae tendineae. How to resect the tumours completely without damaging the normal tissues is a great challenge. This case proves that cardiac autotransplantation is a good solution for tumours that are difficult to be resected completely by orthotopic cardiac transplantation.
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