ObjectiveTo investigate the clinical effectiveness of early repair in infants with large ventricular septal defect complicated with pneumonia. MethodsWe retrospectively analyzed the clinical data of 30 infants who underwent emergency operation in our hospital between January 2014 and April 2015. There were 16 males and 14 females at age of 0.9-12.0 (4.6±2.9) months and with weight of 3.0-8.8 (5.6±1.4) kg. They were diagnosed as ventricular septal defect combined with pneumonia as a trial group. There were other 30 patients without pneumonia, 10 males and 20 females, aged of 0.7-19.0 (4.9±4.8) months, weighing 2.6-12 (5.8±2.1) kg, as a control group. All the patients were followed up for 6 months. ResultsOne patient died in the trial group. None died in the control group. There were statistical differences in length of hospital stay (15.73±6.44 d vs. 10.16±2.16 d, P=0.002) and mechanical ventilation time (28.00±15.72 h vs.12.17±9.10 h, P=0.000) between the trial group and the control group. There was no statistical difference in aortic cross-clamping time, cardiopulmonary bypass time, or CICU residence time (P > 0.05). All the patients were followed up for 6 months. Incidence of pneumonia reduced, growth status and exercise tolerance significantly improved. ConclusionEmergency operation for the infants who suffered from ventricular septal defect with severe pneumonia is efficient and effective. Early mechanical ventilation may be beneficial to the procedure.
Objective To analyze the clinical outcome of one-stage repair of aortic coarctation combined with cardiac anomalies and pneumonia. Methods We retrospectively reviewed the clinical data of 26 patients with severe pneumonia undergoing repair of aortic coartation between January 2014 and August 2015, among whom 7 patients (26.9%) received tracheal intubation, 5 patients double incision, and 21 patients single incision. Long-term follow-up results were obtained from outpatient department. Results Two patients died from operations. The mean hospital stay was 18.5±4.5 d, bypass time 93.5±36.4 min, and mechanical ventilation time 89.5±41.3 min. Postoperative complication mainly was pneumonia. During 6-month follow-up at outpatient department, incidence of pneumonia decreased, and children’s growth and development remarkably improved. Conclusion In the case of uncontrollable pneumonia, one-stage repair of aortic coarctation associated with cardiac anomalies still can receive a good outcome.
ObjectiveTo investigate clinical outcomes and safety of transesophageal echocardiography (TEE)-guided occlusion of infundibular ventricular septal defect (VSD) via minithoracotomy. MethodsClinical data of 21 pediatric patients with infundibular VSD who underwent TEE-guided occlusion via minithoracotomy in Children's Hospital of Hebei Province from January to June 2013 were retrospectively analyzed. There were 10 male and 11 female patients with their age of 8-24 (16±8) months and body weight of 9±3 kg. The size of VSD was 4.5±2.5 mm. TEE was used to evaluate the position of the occluder, its influence on the atrioventricular valves and aortic valve, and the presence of residual shunt. ResultsThere was no perioperative death or complication. VSD occlusion was successfully performed in 20 out of 21 patients (95.2%). One patient received conversion to open VSD repair under extracorporeal circulation because VSD size was too big. Mean time of delivery of occluders was 32±16 minutes, the size of the occluders was 5±3 mm, and length of hospital stay was 6-8 days. All the patients were followed up for 3-6 months after discharge. During follow-up, echocardiography showed clear echo and normal position of the occluders, and there was no mild or more severe residual shunt or valvular regurgitation. ConclusionTEE-guided occlusion of infundibular VSD via minithoracotomy is easy to perform and safe with satisfactory clinical outcomes.
ObjectiveTo investigate the influence of immunoglobulin (Ig)on celluar immune function of postoperative infants with cyanotic congenital heart disease (CCHD). MethodsForty infants who underwent surgical repair of CCHD in Department of Cardiac Surgery, Children's Hospital of Hebei Province from March to December 2012 were enrolled in this study. All the patients were randomly divided into 2 groups. Patients in Ig group received intravenous Ig treatment at the dosage of 1g/ (kg·day)for 2 days postoperatively in addition to routine therapy. Patients in the control group only received routine therapy without Ig treatment. Five ml venous blood samples of all the patients were taken preoperatively, 0.5 hour and 2 days postoperatively to examine serum levels of interferon gamma (IFN-γ)and interleukin-4 (IL-4)with double-antibody sandwich enzyme-linked immunosorbent assay (ELISA), which were compared between the 2 groups. ResultsThere was no statistical difference in serum levels of IL-4 or IFN-γ preoperatively and at 0.5 hour postoperatively between the 2 groups (P > 0.05). Serum levels of IL-4 and IFN-γ at 0.5 hour postoperatively were significantly higher than preoperative levels in the 2 groups respectively (P=0.000). Serum IL-4 level of Ig group 2 days postoperatively was not statistically different from preoperative level (P=0.362), while serum IL-4 level of the control group 2 days postoperatively was significantly higher than preoperative level (P=0.006). Two days after the operation, serum levels of IL-4 and IFN-γ of Ig group were significantly lower than those of the control group respectively (P=0.039 and 0.007 respectively). Compared with serum levels at 0.5 hour postoperatively in the control group, serum IL-4 level at 2 days postoperatively decreased by 20.08% (P=0.001), and serum IFN-γ increased by 17.80% (P=0.001). Compared with serum levels at 0.5 hour postoperatively in Ig group, serum IL-4 level at 2 days postoperatively decreased by 35.38% (P=0.000), and serum IFN-γ only increased by 7.60% (P=0.143). ConclusionCellular immune function disorder caused by the operation and cardiopulmonary bypass can be effectively improved by postoperative intravenous Ig administration, which may help to reduce postoperative complications.
ObjectiveTo summarize the experiences of minimally invasive occlusion of ventricular septal defect (VSD) via small chest incision. MethodsWe retrospectively analyzed the clinical data of 131 infants with VSD in Hebei children's Hospital between March 2013 and September 2014, including 83 patients with perimembranous VSD, 24 patients with membranous aneurysm and 24 patients with intracristal VSD. There were 63 males and 68 females with a mean age of 35.28±29.22 months and a mean body weight of 14.56±7.47 kg. Before surgery, a multiple-section transthoracic echocardiography (TTE) was employed to evaluate various parameters of the VSD. Under general anesthesia, a small incision was made to expose the right ventricle. Under TEE guidance, proper device was delivered and deployed to close the defect. Patients also received postoperative following-up by transesophageal echocardiogram (TEE) at regular intervals. ResultsOne hundred twenty-nine patients were successfully performed operation. Two patients were converted to perform traditional surgical closure with cardiopulmonary bypass (cPB). concentric devices were used in 52 patients and eccentric devices were used in 77 patients. During the following-up (1-12 months) period, complications occurred in three patients. Massive pericardial effusion appeared and disappeared after pericardicentesis in one patient. The occlusion device was dislocated in the next day after operation and took out by cPB operation in one patient. There was an asymptomatic residual shunt at 1 mm in one patient. ConclusionThe minimally invasive occlusion of VSD via small chest incision is a safe and effective treatment. It should be encouraged to use in the clinical practice.
目的 探索手术对低出生体重先天性心脏病患儿的临床疗效以及围术期的处理办法。 方法 回顾性分析 2012 年 1 月至 2015 年 6 月我院行心内直视根治性手术的 788 例低出生体重先天性心脏病患儿的临床资料，其中男 379 例，女 409 例，平均年龄 4.5（1～6）个月，出生时平均体重 1 780～2 500（1 844.6±44.5）g。对患儿手术时间、围术期处理以及手术成功率等情况进行观察分析。 结果 心内直视根治术平均手术时间 110～240（132±18）min，平均体外循环时间 32～120（80±20）min，平均主动脉阻断时间 15～45（35±11）min，平均呼吸机辅助治疗时间 5～96（15±5）h。患儿术后治愈总有效率达到 96.8%，死亡率 3.2%，患儿的治愈效果较显著。 结论 加强围术期处理可以有效地提高患儿的存活率，改善患儿的生活质量，因此低出生体重先天性心脏病患儿早期治疗方式值得在临床工作中推广应用。
Objective To analyze the curative effect of nitric oxide (NO) and bosentan on treatment of the interruption of aortic arch (IAA) with ventricular septal defect (VSD) and serious pulmonary hypertension (SPH). Methods Thirty-two children with IAA and VSD combined SPH from January 2015 to May 2017 confirmed by cardiac CT and ultrasound in Children’s Hospital of Hebei Province were enrolled including 17 males and 15 females, aged 1.10-4.30 months (mean, 2.71±0.98 months) and weighing 3.33-6.10 kg (mean, 4.57±0.88 kg). The 32 children were randomly divided into two groups (n=16 in each), a NO group and a bosentan group. All the patients underwent interruption of aortic arch and ventricular septal defect repair. When patients returned to cardiosurgery intensive care unit (CSICU) half an hour later, patients in the NO group inhaled NO 20 ppm for 36 h and those in the bosentan group were given bosentan by nasogastric feeding 15 mg, twice a day. The cardic index, pulmonary/systemic pressure ratio, oxygenation index at 3 h, 6 h, 12 h, 24 h, 36 h after surgery were evaluated, and the differences between the two groups were compared. Results The pulmonary/systemic pressure ratio in the two groups increased at first and then decreased, while oxygenation index in the two groups decreased at first and then increased, and the differences in the same groups at the adjacent time points were statistically significant (P<0.05). The cardiac index in the two groups decreased at first and then increased, the differences in the same groups at the adjacent time points were statistically significant, except for 6 h and 12 h after surgery in the bosentan group (P>0.05). At postoperative 6 h, 12 h, the oxygenation index in the NO group was significantly higher than that in the bosentan group, and the pulmonary/systemic pressure ratio in the NO group was less than that in the bosentan group (P<0.01). The cardiac index in the NO group was higher than that of the bosentan group after 6 h, 12 h, 24 h of operation, which were statistically significant (P<0.05), and the cardic index of children in the NO group was greatly higher than that in the bosentan group after 12 h of surgery (P<0.01); at the same time point, the corresponding indexes were not statistically significant between the two groups (P>0.05). Conclusion NO inhalation in the treatment of IAA with VSD and SPH in children with early postoperative SPH is better than the bosentan, but in the late postoperative period, the effect is similar.
Objective To explore the hemodynamic assessment after radical surgery in children with tetralogy of Fallot (TOF) by both echocardiography and Mostcare monitor. Methods Clinical data of 63 children with TOF who underwent radical surgery in our hospital from February 2016 to June 2018 were retrospectively analyzed, including 34 males and 29 females, aged 6-24 (9.82±5.77) months. There were 19 patients undergoing transannular patch reconstruction of the right ventricular outflow tract (a transannular patch group) while 44 patients retained the pulmonary valve annulus (a non-transannular patch group) . The echocardiography and Mostcare monitor parameters were recorded and brain natriuretic peptide was tested at the time points of 0, 8, 12, 24 and 48 hours after operation (T 0, T 1, T 2, T 4) to analyze their correlations and the change trend at different time points after radical surgery. Results The left ventricular ejection fraction at T 1 (43.49%±3.82%) was lower than that at T 0 (48.29%±4.55%), T 2 (45.83%±3.69%), T 3 (53.76%±4.43%) and T 4 (60.54%±3.23%, P<0.05). The cardiac index at T 1 (1.85±0.35 L·min−1·m−2) was lower than that at T 0 (2.11±0.38 L·min−1·m−2), T 2 (2.07±0.36 L·min−1·m−2), T 3 (2.42±0.37 L·min−1·m−2) and T 4 (2.82±0.42 L·min−1·m−2, P<0.05). The cardiac circulation efficiency at T1 (0.19±0.05) was lower than that at T 0 (0.22±0.06), T 2 (0.22±0.05), T 3 (0.28±0.06) and T 4 (0.34±0.06, P<0.05). The right ventricular two-chambers view fraction area change at T 1 (23.17%±3.11%) was lower than that at T 0 (25.81%±3.74%), T 2 (25.38%±3.43%), T 3 (30.60%±4.50%) and T 4 (36.94%±5.85%, P<0.05). The pulse pressure variability was the highest at T 0 (18.76%±3.58%), followed by T 1 (14.81%±3.32%), T 2 (12.44%±2.94%), T 3 (10.39%±2.96%) and T 4 (9.18%±1.92%, P<0.05). The blood brain natriuretic peptide was higher at T 1 (846.67±362.95 pg/ml) than that at T 0 (42.60±18.06 pg/ml), T 2 (730.95±351.09 pg/ml), T 3 (510.98±290.39 pg/ml) and T 4 (364.41±243.56 pg/ml, P<0.05). There was no significant difference in left ventricular ejection fraction, cardiac circulation efficiency and heart index between the two groups (P>0.05). The right ventricular two-chambers view fraction area change of the transannular patch group was significantly lower than that of the non-transannular patch group at each time point (P<0.05). The blood brain natriuretic peptide and pulse pressure variability of the transannular patch group were significantly higher than those of the non-transannular patch group (P<0.05). Left ventricular ejection fraction was positively correlated with cardiac index (r=0.637, P=0.001) and cardiac circulation efficiency (r=0.462, P=0.001) while was significantly negatively correlated with blood brain natriuretic peptide (r=–0.419, P=0.001). Conclusion Both methods can accurately reflect the state of cardiac function. Mostcare monitor has a good consistency with echocardiography. Using transannular patch to recontribute right ventricular outflow tract in operation has more influence on right ventricular systolic function. The Mostcare monitor can guide the hemodynamic management after surgery in real time, continuously and accurately.
ObjectiveTo establish and preliminarily validate a nomogram model for predicting the risk of retinal vein occlusion (RVO). MethodsA retrospective clinical study. A total of 162 patients with RVO (RVO group) diagnosed by ophthalmology examination in The Second Affiliated Hospital of Xi'an Jiaotong University from January 2017 to April 2022 and 162 patients with age-related cataract (nRVO group) were selected as the modeling set. A total of 45 patients with branch RVO, 45 patients with central RVO and 45 patients with age-related cataract admitted to Xi 'an Fourth Hospital from January 2022 to February 2023 were used as the validation set. There was no significant difference in gender composition ratio (χ2=2.433) and age (Z=1.006) between RVO group and nRVO group (P=0.120, 0.320). Age, gender, blood routine (white blood cell count, hemoglobin concentration, platelet count, neutrophil count, monocyte count, lymphocyte count, erythrocyte volume, mean platelet volume, platelet volume distribution width), and four items of thrombin (prothrombin time, activated partial thrombin time, fibrinogen, and thrombin time) were collected in detail ), uric acid, blood lipids (total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, lipoprotein a), hypertension, diabetes mellitus, coronary heart disease, and cerebral infarction. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were calculated. The single logistic regression was used to analyze the clinical parameters of the two groups of patients in the modeling set, and the stepwise regression method was used to screen the variables, and the column graph for predicting the risk of RVO was constructed. The Bootstrap method was used to repeated sample 1 000 times for internal and external verification. The H-L goodness-of-fit test and receiver operating characteristic (ROC) curve were used to evaluate the calibration and discrimination of the nomogram model. ResultsAfter univariate logistic regression and stepwise regression analysis, high density lipoprotein, neutrophil count and hypertension were included in the final prediction model to construct the nomogram. The χ2 values of the H-L goodness-of-fit test of the modeling set and the validation set were 0.711 and 4.230, respectively, and the P values were 0.701 and 0.121, respectively, indicating that the nomogram model had good prediction accuracy. The area under the ROC curve of the nomogram model for predicting the occurrence of post-stroke depression in the modeling set and the verification set was 0.741 [95% confidence interval (CI) 0.688-0.795] and 0.741 (95%CI 0.646-0.836), suggesting that the nomogram model had a good discrimination. ConclusionsLow high density lipoprotein level, high neutrophil count and hypertension are independent risk factors for RVO. The nomogram model established based on the above risk factors can effectively assess and quantify the risk of post-stroke depression in patients with cerebral infarction.