Efficacy Ananlysis Of Different Surgical Methods For Pulmonary Atresia With Ventricular Septal Defect

Objective To compare and analyze the surgical outcomes of different surgical methods in the treatment of different types of pulmonary atresia with ventricular septal defect(PA/VSD),to investigate the effects of various surgical treatments for pulmonary atresia with ventricular septal defect(PA/VSD),summarize clinical experience and provide basis for clinical decision.Methods Collected and analyzed restrospectively the clinical data of 29 patients with PA/VSD who Underwent surgical procedures in the Department of Cardiovascular Surgery,Tianjin Chest Hospital from September 2006 to September 2017.In the International Naming System for Congenital Heart Disease,these diseases are classified into three types according to the source of pulmonary circulation blood supply,whether there are intrinsic pulmonary artery and major arota pulmonary collaterals arteries(MAPCAs):Type A: The intrinsic pulmonary artery is present,pulmonary circulation is supplied by patent ductus arteriosus(PDA),no large collateral pulmonary artery(MAPCAs);Type B: The intrinsic pulmonary artery and MAPCAs coexist.,the intrinsic pulmonary artery and its branches may have different degrees of hypoplastic.The pulmonary blood supply mainly comes from MAPCAs;Type C: The intrinsic pulmonary artery is absent,and pulmonary blood flow is completely supplied by MAPCAs.According to this classification method,29 patients selected in this study were divided into two types,A(n=4)and B(n=25),and the relevant data and indicators of preoperative,intraoperative and postoperative of patients were collected for analysis.Including 18 males and 11 females:2 days ~ 26.4years old;Body weight: 3.5 ~ 46.0kg.Type A children have patent ductus arteriosus,Pulmonary blood supply is mainly provided by the patent ductus arteriosus.Pulmonary valve was considered as membranous atresia.Percutaneous interventional pulmonary valvuloplasty and RVOT/PDA stent implantation were performed.Type B patients were divided into palliative surgery group(n=18)and radical surgery group(n=7)according to whether radical operation was performed in the first stage.Palliative procedures included central shunt(n=5),modified Blalock-Taussig shunt(n=5),pericardial patch enlargement(n=8).Radical procedures included autologous pericardial patch enlargement(n=4),pericardial tube(n=3)and Gore-Tex conduit(n=1).Fenestrated ventricular septal defect patch was used in 2 cases in radical surgery group.The clinical parameters between palliative group and radical group were tested by independent sample t test.The mortality ratio of the two groups was compared by λ2 test,P < 0.05 was considered statistically significant.Results No death occurred during the operation.17 cases underwent cardiopulmonary bypass(CPB),the extracorporeal circulation time was mean(128.7±58.2)min.7patients underwent radical surgery,the time of aortic occlusion was mean(85.5 ±34.7)minutes.Early postoperative mortality was 2(6.9%),both in the radical group.There was no significant difference between the two groups in mortality(P=0.07).The cause of death was respiratory failure in one case and low cardiac output syndrome in the other.Postoperative complicants included pulmonary infection(n=3),re-exploration for anastomotic bleeding(n=1),bad healing of surgical incision(n=1),left pulmonary artery stenosis compared with preoperative(n=1).Follow-up ranged from 10 months to 8 years with 1 cases missing.During the follow-up,total pulmonary artery index increased by different degrees.7 patients underwent reoperation.Among children with type A,radical operation was performed in 3 cases.In the palliative group,4 cases underwent two-stage operation and 5underwent radical operation,among children with type B.Conclusion Different surgical methods are safe and effective for different types of pulmonary atresia with ventricular septal defect.Early establishment of pulmonary artery anterior blood flow plays an important role in promoting pulmonary artery development.It is necessary to preoperative evaluate the morphological development of the pulmonary artery and the anatomy of the MAPCAs comprehensively,and select the individualized surgical method.Follow-up should be strengthened for the patients undergoing palliative surgery,and the second-stage radical surgery should be performed for the patients with surgical indications.