Evaluation Of The Clinical Effect Of Different Methods In The Treatment Of Congenital Heart Diseases With Diminutive Pulmonary Blood Accompany Aortopulmonary Collateral Arteries In The Perioperative Period

Objective: To summarize the clinical effects of different methods of treatment of major aortopulmonary collateral arteries(MAPCAs)in the perioperative period of Congenital Heart Diseases with diminutive pulmonary blood,and to provide a strong basis for the selection of reasonable treatment for this kind of disease.Methods: The clinical data of children with Congenital Heart Diseases with diminutive pulmonary blood who were hospitalized in the children's Hospital of Medical University of Chongqing between January2014 to August 2019 were analyzed retrospectively,and the clinical characteristics,the distribution and morphological characteristics of MAPCAs were summarized.At the same time,the children with MAPCAs blocked before operation and those with MAPCAs ligated during operation were selected as treatment group.There were 50 cases in the treatment group,67 cases in untreated group who did not deal with MAPCAs beforeand during the operation.The perioperative conditions of the two groups were compared,such as the time of using invasive ventilator,the time of staying in ICU after the operation,the time of hospitalization after the operation,the time of total hospitalization,the occurrence of postoperative complications and early death.Results: 117 cases were included finally.Tetralogy of Fallot accounted for the largest proportion,with 64 cases(54.7%).91 cases(77.8%)underwent radical operation,26 cases(22.2%)received palliative operation.115 out of 117 cases were examined by CTA before operation.A total of 139 MAPCAs were found.110 of them(79.1%)originated from descending aorta(thoracic aorta).67 cases were examined by DSA.92 MAPCAs were found,80 of them(86.9%)originated from descending aorta(thoracic aorta),44(47.8%)supplying double lungs,83(90.2%)branches.The time of using invasive ventilator,staying in ICU,hospital stay and total hospital stay in the treatment group were shorter than those in the untreated group,and the difference was statistically significant(P <0.05).The early mortality rate of the treatment group was lower than that of the untreated group(P < 0.05).In the treatment group,14 cases(28.6%)of low cardiac output syndrome,1 case(2.0%)of "perfusion lung",4 cases(8.2%)of serious lung infection,9 cases(18.4%)of liver,kidney and brain damage.In the untreated group,20 cases(36.4%)of low cardiac output syndrome,4 cases(7.3%)of "perfusion lung",11 cases(20%)of seriouslung infection and 20 cases(36.4%)of liver damage,kidney damage or brain damage were found.In the untreated group,2 children had missed the collateral vessels before operation.After operation,there were recurrent pulmonary exudation,pink phlegm sputum and hypoxemia.They were separated from invasive ventilator difficultly.After completing the DSA examination,1-2 MAPCAs were found.After sealing,the clinical symptoms of the two children were improved significantly,and they soon got out of the invasive ventilator and recovered.Conclusion: The anatomical structure of MAPCAs is complex and changeable,and it is a key factor affecting the curative effect of cardiac deformity correction for Congenital Heart Diseases with diminutive pulmonary blood.Correct choice of surgical strategy and timing is essential for the early recovery of this kind of disease.Interventional closure of MAPCAs before operation and collateral vessel ligation during operation can effectively reduce operative complications,shorten postoperative recovery time,reduce early operative mortality,and improve the effectiveness and safety of operation;Ligation of collateral vessels during the operation is a "one-stop" treatment plan for patients with a small number of collateral vessels and located around the incision,but there is a possibility of omission.Postoperative remedial occlusion of collaterals is not recommended as a routine treatment for this type of disease,only as a remedial method after missing the treatment of collateral vessels to avoidsecondary thoracotomy.Preoperative interventional occlusion of collateral vessels can effectively identify all abnormal collateral vessels,which is the best treatment plan and choice for Congenital Heart Diseases with diminutive pulmonary blood with MAPCAs.