Objective:The objective of this study was to compare cardiac transplant operative and postoperative courses of patients with failed Fontan physiology who were initially palliated with a Norwood(FFN)to those without a ...Objective:The objective of this study was to compare cardiac transplant operative and postoperative courses of patients with failed Fontan physiology who were initially palliated with a Norwood(FFN)to those without a prior Norwood(FF).Methods:A single-institution retrospective review of all patients with Fontan failure who under-went cardiac transplantation from 2003–2021 was completed-22 underwent prior Norwood(FFN)and 11 did not(FF).Descriptive and inferential statistics were calculated for operative course and patient outcomes.Results:The operative course of the FFN cohort appeared to be more complex(not statistically significant,but clinically relevant)-this group exclusively experienced sternal re-entry events(3 of 22 patients)and concomitant neo-aor-tic reconstruction(6 patients),had a longer duration of surgery(median of 682 min vs.575.5 min),more time on circulatory arrest(median of 25.5 min vs.12.5 min),and more frequent use of open sternal management[50%of patients(11/22)vs.27.3%of patients(3/11)].Postoperatively,these patients underwent more mediastinal explora-tions[other than sternal closure;40.9%of patients(9/22)vs.18.2%of patients(2/11)],spent more time on mechanical ventilation(median of 5 days vs.2 days),had a longer length of stay(median of 30 days vs.19 days),and required more catheter-based re-interventions[22.7%of patients(5/22)vs.9.1%of patients(1/11)].Conclu-sion:Although underpowered,our results suggest that the operative course of FFN patients is more challenging,based mostly on neo-aortic arch issues.In turn,this likely leads to a more complex postoperative course.We are currently collaborating with other institutions to increase the cohort size and power of the study.展开更多
Background:Shunt repair for the Norwood procedure with either the right ventricle to pulmonary artery shunt(RVPAS)or the modified Blalock-Taussig-Thomas Shunt(BTTS)varies by institution and surgeon preference.Shunt ch...Background:Shunt repair for the Norwood procedure with either the right ventricle to pulmonary artery shunt(RVPAS)or the modified Blalock-Taussig-Thomas Shunt(BTTS)varies by institution and surgeon preference.Shunt choice has been informed by landmark trials including the Single Ventricle Reconstruction trial and modern outcomes data may engender future complementary studies.Methods:We conducted a retrospective analysis of all patients who underwent the Norwood procedure from 2014–2022 at a single center to compare outcomes by shunt type.The primary outcome measure was freedom from death or transplant.Secondary outcome measures included hospital length of stay,complications,and unplanned interventions.Results:93 patients underwent the Norwood procedure at a median age of 7 days(IQR 5,9)and 39 weeks gestation(IQR 38,39).67.7%had hypoplastic left heart syndrome.39 patients received a BTTS compared to 54 RVPAS.There was no difference in operative mortality(BTTS 12.8%,RVPAS 9.3%,p=0.58),death or transplant at 1 year(BTTS 15.4%,RVPAS 7.4%,p=0.31),or between 1 and 3 years(BTTS 0%,RVPAS 5.6%,p=0.26).There was a significantly higher rate of pulmonary arterial stenting in the RVPAS group(BTTS 1.21/100 patient-years,RVPAS 15.68/100 patient-years,p=0.01).Conclusions:Similar short-and medium-term survival were seen in BTTS and RVPAS groups with fewer pulmonary artery interventions for BTTS,though our study is underpowered to suggest superior freedom from interventions.These results may serve as a hypothesis-generating study to revisit the SVR trial with a modern cohort in the setting of improved surgical technique and perioperative management.展开更多
Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients,who had undergone Norwood procedure (prior to Glenn procedure) received cardiac cathet...Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients,who had undergone Norwood procedure (prior to Glenn procedure) received cardiac catheterization and angiography. Interventional therapy展开更多
Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a crit...Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.展开更多
目的:分析影响男性雄激素性脱发(AGA)严重程度的相关因素及不同严重程度的男性AGA患者的皮肤镜特征。方法:收集2021年8月—2022年4月就诊于武汉大学中南医院皮肤科门诊的男性AGA患者253例,年龄18~50岁,根据Norwood⁃Hamilton分级方法,将...目的:分析影响男性雄激素性脱发(AGA)严重程度的相关因素及不同严重程度的男性AGA患者的皮肤镜特征。方法:收集2021年8月—2022年4月就诊于武汉大学中南医院皮肤科门诊的男性AGA患者253例,年龄18~50岁,根据Norwood⁃Hamilton分级方法,将患者分为Ⅰ~Ⅶ级,其中轻中度患者142例,重度患者111例,收集研究对象的基本信息,包括身高、体重、家族史、吸烟、饮酒、运动、睡眠、熬夜的情况,并对每位患者进行皮肤镜检测,分别统计其单一毛发毛囊单位比例、黄点征、针尖样白点、毛周褐色环、分枝状血管、蜂窝状色素网、白色鳞屑的情况。采用SPSS 23.0统计软件进行Logistic回归分析,其中单毛囊的毛囊单位比例用t检验进行统计分析。结果:体质量指数(BMI)、家族史、吸烟、饮酒、熬夜、睡眠均与脱发严重程度呈正相关,OR值分别为1.192、2.051、1.001、0.99、1.344、0.553,P<0.05;运动与脱发严重程度不相关,P>0.05;皮肤镜表现:针尖样白点、蜂窝状色素网与脱发严重程度呈正相关,OR值分别为2.3、3.113,P<0.05;分枝状血管、白色鳞屑与脱发严重程度呈负相关,OR值分别为0.405、0.436,P<0.05;黄点征、毛周褐色环与脱发严重程度不相关,P>0.05;与轻中度组相比,重度组单一毛发毛囊单位比例显著升高(0.30 vs 0.17),P<0.05。结论:(1)BMI、家族史、吸烟、饮酒、熬夜、睡眠是AGA的加重因素;而运动不影响男性AGA的严重程度。(2)针尖样白点、蜂窝状色素网、分枝状血管、白色鳞屑可作为脱发严重程度的指标,单一毛发毛囊单位比例、针尖样白点、蜂窝状色素网是AGA的重度指标,分枝状血管、白色鳞屑是轻中度脱发的指标;黄点征、毛周褐色环不能作评价男性AGA严重程度的指标。展开更多
文摘Objective:The objective of this study was to compare cardiac transplant operative and postoperative courses of patients with failed Fontan physiology who were initially palliated with a Norwood(FFN)to those without a prior Norwood(FF).Methods:A single-institution retrospective review of all patients with Fontan failure who under-went cardiac transplantation from 2003–2021 was completed-22 underwent prior Norwood(FFN)and 11 did not(FF).Descriptive and inferential statistics were calculated for operative course and patient outcomes.Results:The operative course of the FFN cohort appeared to be more complex(not statistically significant,but clinically relevant)-this group exclusively experienced sternal re-entry events(3 of 22 patients)and concomitant neo-aor-tic reconstruction(6 patients),had a longer duration of surgery(median of 682 min vs.575.5 min),more time on circulatory arrest(median of 25.5 min vs.12.5 min),and more frequent use of open sternal management[50%of patients(11/22)vs.27.3%of patients(3/11)].Postoperatively,these patients underwent more mediastinal explora-tions[other than sternal closure;40.9%of patients(9/22)vs.18.2%of patients(2/11)],spent more time on mechanical ventilation(median of 5 days vs.2 days),had a longer length of stay(median of 30 days vs.19 days),and required more catheter-based re-interventions[22.7%of patients(5/22)vs.9.1%of patients(1/11)].Conclu-sion:Although underpowered,our results suggest that the operative course of FFN patients is more challenging,based mostly on neo-aortic arch issues.In turn,this likely leads to a more complex postoperative course.We are currently collaborating with other institutions to increase the cohort size and power of the study.
文摘Background:Shunt repair for the Norwood procedure with either the right ventricle to pulmonary artery shunt(RVPAS)or the modified Blalock-Taussig-Thomas Shunt(BTTS)varies by institution and surgeon preference.Shunt choice has been informed by landmark trials including the Single Ventricle Reconstruction trial and modern outcomes data may engender future complementary studies.Methods:We conducted a retrospective analysis of all patients who underwent the Norwood procedure from 2014–2022 at a single center to compare outcomes by shunt type.The primary outcome measure was freedom from death or transplant.Secondary outcome measures included hospital length of stay,complications,and unplanned interventions.Results:93 patients underwent the Norwood procedure at a median age of 7 days(IQR 5,9)and 39 weeks gestation(IQR 38,39).67.7%had hypoplastic left heart syndrome.39 patients received a BTTS compared to 54 RVPAS.There was no difference in operative mortality(BTTS 12.8%,RVPAS 9.3%,p=0.58),death or transplant at 1 year(BTTS 15.4%,RVPAS 7.4%,p=0.31),or between 1 and 3 years(BTTS 0%,RVPAS 5.6%,p=0.26).There was a significantly higher rate of pulmonary arterial stenting in the RVPAS group(BTTS 1.21/100 patient-years,RVPAS 15.68/100 patient-years,p=0.01).Conclusions:Similar short-and medium-term survival were seen in BTTS and RVPAS groups with fewer pulmonary artery interventions for BTTS,though our study is underpowered to suggest superior freedom from interventions.These results may serve as a hypothesis-generating study to revisit the SVR trial with a modern cohort in the setting of improved surgical technique and perioperative management.
文摘Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients,who had undergone Norwood procedure (prior to Glenn procedure) received cardiac catheterization and angiography. Interventional therapy
文摘Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.
文摘目的:分析影响男性雄激素性脱发(AGA)严重程度的相关因素及不同严重程度的男性AGA患者的皮肤镜特征。方法:收集2021年8月—2022年4月就诊于武汉大学中南医院皮肤科门诊的男性AGA患者253例,年龄18~50岁,根据Norwood⁃Hamilton分级方法,将患者分为Ⅰ~Ⅶ级,其中轻中度患者142例,重度患者111例,收集研究对象的基本信息,包括身高、体重、家族史、吸烟、饮酒、运动、睡眠、熬夜的情况,并对每位患者进行皮肤镜检测,分别统计其单一毛发毛囊单位比例、黄点征、针尖样白点、毛周褐色环、分枝状血管、蜂窝状色素网、白色鳞屑的情况。采用SPSS 23.0统计软件进行Logistic回归分析,其中单毛囊的毛囊单位比例用t检验进行统计分析。结果:体质量指数(BMI)、家族史、吸烟、饮酒、熬夜、睡眠均与脱发严重程度呈正相关,OR值分别为1.192、2.051、1.001、0.99、1.344、0.553,P<0.05;运动与脱发严重程度不相关,P>0.05;皮肤镜表现:针尖样白点、蜂窝状色素网与脱发严重程度呈正相关,OR值分别为2.3、3.113,P<0.05;分枝状血管、白色鳞屑与脱发严重程度呈负相关,OR值分别为0.405、0.436,P<0.05;黄点征、毛周褐色环与脱发严重程度不相关,P>0.05;与轻中度组相比,重度组单一毛发毛囊单位比例显著升高(0.30 vs 0.17),P<0.05。结论:(1)BMI、家族史、吸烟、饮酒、熬夜、睡眠是AGA的加重因素;而运动不影响男性AGA的严重程度。(2)针尖样白点、蜂窝状色素网、分枝状血管、白色鳞屑可作为脱发严重程度的指标,单一毛发毛囊单位比例、针尖样白点、蜂窝状色素网是AGA的重度指标,分枝状血管、白色鳞屑是轻中度脱发的指标;黄点征、毛周褐色环不能作评价男性AGA严重程度的指标。
