Abstract: The cyanotic congenital heart defect remains a focal point to study in congenital heart diseases. A successfully developed model of cyanotic congenital heart defect can contribute to a profound advancement of clinical diagnosis and treatment. Various kinds of animal models simulating cyanotic heart diseases have been created and improved step by step , such as experimental pulmonary arteriovenous fistulas, inferior vena cava-left atrium shunt, pulmonary artery-left atrium shunt and breeding animals in mionect ic environment. As an important means, they are used to investigate the animal’s pathophysilolgocal characteristics in cyanotic and hypoxic state. However, it need a further exploration since these models are not fully perfect yet.
ObjectiveTo explore the hemodynamic effects of inhaled nitric oxide (iNO) on postoperative hemodynamic in patients with cyanotic congenital heart disease (CHD) combined with decreased pulmonary blood flow.MethodsFrom 2014 to 2018, there were 1 764 patients who received corrective repair of cyanotic CHD with decreased pulmonary blood flow in the Department of Pediatric Cardiac Surgery of Fuwai Hospital. We included 61 patients with the ratio of right ventricular systolic pressure to systolic blood pressure (SBP) ≥75% after weaning from cardiopulmonary bypass. There were 41 males and 20 females, with the age of 20.5 (9.0, 39.0) months and weight of 12.5±7.8 kg. The patients were divided into two groups: a conventional group (33 patients, conventional therapy only) and a combined therapy group (28 patients, iNO combined with conventional therapy). The hemodynamics during the first 24 hours after iNO therapy and the in-hospital outcomes of the two groups were investigated and compared.ResultsThere was no statistical difference between the two groups in demographic characteristics and surgical parameters (P>0.05). The hemodynamic effects of iNO within 24 hours included the decrease in the vasoactive inotropic score (VIS, 21.6±6.6 vs. 17.3±7.2, P=0.020) along with the increase in blood pressure (SBP: 73.7±9.7 mm Hg vs. 90.8±9.1 mm Hg, P<0.001) , the decrease in central venous pressure (10.0±3.1 mm Hg vs. 7.9±2.1 mm Hg, P=0.020), the decrease in lactate (2.2±1.7 mmol/L vs. 1.2±0.5 mmol/L, P<0.001) and increase in urine output [2.8±1.7 mL/(kg·h) vs. 4.9±2.2 mL/(kg·h), P<0.001]. The decrease of VIS at 24 h after the surgery in the conventional therapy group was not statistically significant (22.1±7.9 vs. 20.0±8.5, P=0.232). Besides, we discovered that the need for renal replacement therapy (RRT) was less in the combined therapy group than that in the conventional therapy group, especially in the moderate complicated surgery [risk adjustment in congenital heart surgery (RACHS-1) ≤3] subgroup (9.5% vs. 40.7%, P=0.016).ConclusionIn pediatric patients after corrective repair of cyanotic and pulmonary blood follow decreased CHD with increased pulmonary vascular resistance, iNO combined with conventional therapy can improve the hemodynamics effectively. Compared with the conventional therapy, the combined therapy with iNO can decrease the VIS and the need for RRT, which is beneficial to the postoperative recovery of patients.
ObjectiveTo identify the risk factors of postoperative blood loss among pediatric patients following corrective operation of tetralogy of Fallot (TOF) and to develop nomogram predicting the risk of postoperative blood loss.MethodsA retrospective case-control study was conducted in pediatric TOF patients who underwent corrective operation in our hospital from November 2018 to June 2019. And the clinical data from each enrolled patient were gathered and analyzed. Clinically significant postoperative blood loss was defined as drainage volume from chest tube ≥16 mL/kg during the first 24 h after surgery, which corresponded to the 75th percentile of the blood loss in our population. The primary outcome was to determine the independent predictors of postoperative blood loss by the least absolute shrinkage and selection operator (LASSO) regression, univariate and multivariate logistic regression analysis. On the basis of the independent predictors of postoperative bleeding, nomogram was developed and its discrimination and calibration were estimated.ResultsA total of 105 children were selected (67 males and 38 females aged 3-72 months). The drainage volume from chest tube in the bleeding group was significantly higher than that in the non-bleeding group during the first 24 h (P<0.0001). Multivariate logistic regression analysis showed that low body weight (OR=0.538, 95%CI 0.369-0.787, P=0.001), high preoperative hemoglobin concentration (OR=1.036, 95%CI 1.008-1.066, P=0.013) and prolonged intraoperative aortic cross clamp time (OR=1.022, 95%CI 1.000-1.044, P=0.048) were independent risk factors for postoperative blood loss. In the internal validation, the model displayed good discrimination with a C-index of 0.835 (95%CI 0.745-0.926) and high quality of calibration plots in nomogram models was noticed.ConclusionThe nomogram demonstrated good discrimination and calibration in estimating the risk of postoperative blood loss among pediatric patients following corrective operation of TOF.
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 our clinical experience of bidirectional Glenn procedure (BGP) for the treatment of complex cyanotic congenital heart disease (CHD). MethodsClinical data of 68 patients with complex cyanotic CHD who underwent BGP in People's General Hospital of Xinjiang Uygur Autonomous Region from January 2007 to December 2012 were retrospectively analyzed. There were 40 male and 28 female patients with their average age of 3.9 years (range, 3 months to 22 years) and body weight of 6.2-53.0 (13.6±8.5)kg. Preoperative diagnosis included tricuspid atresia in 20 patients, single ventricle (SV) in 11 patients, double outlet right ventricle in 10 patients, complete transposition of great arteries in 7 patients, tricuspid stenosis in 5 patients, pulmonary atresia in 5 patients, corrected transposition of great arteries in 4 patients, tetralogy of Fallot in 4 patients and Ebstein's anomaly in 2 patients. Among them, there were 14 patients with dextrocardia or dextroversion of the heart, 2 patients with SV and pulmonary hypertension after pulmonary artery banding, and 1 complete transposition of great arteries patient after aortopulmonary shunt. Twenty-three patients received BGP under cardiopulmonary bypass (CPB) and 45 patients received BGP without CPB. ResultsTwo patients died postoperatively, including 1 patient with severe low cardiac output syndrome (LCOS) and another patient with pulmonary infection. Postoperative pulse oximetry oxyhemoglobin saturation (SpO2, 89.3%±7.4%) was significantly higher than preoperative SpO2 (66.8%±11.8%, P < 0.05). In 53 patients, postoperative SpO2 was more than 10% higher than preopera-tive SpO2. Postoperative hematocrit (0.40±0.07) was significantly lower than preoperative hematocrit (0.49±0.11, P < 0.05). Postoperative complications included pleural effusion in 16 patients (23.5%), chylothorax in 7 patients (10.3%), LCOS in 5 patients (7.4%), arrhythmias in 4 patients (5.9%), and pneumothorax in 1 patient (1.5%), who were all cured after appropriate treatment. Fifty-five patients were followed up for 9 months to 6 years after discharge with satisfactory clinical results. All anastomoses remained patent without stenosis or thrombosis. Four patients successfully received total cavopulmonary connection 2 to 5 years after discharge. ConclusionBGP is safe and reliable for patients with complex cyanotic CHD who cannot undergo anatomic correlation or one-stage repair.
ObjectiveTo compare the anti-apoptotic potency of human mesenchymal stem cells (hMSCs) derived from patients with cyanotic congenital heart diseases (C-CHD) or acyanotic congenital heart diseases (A-CHD) in vitro and explore the possible mechanism. MethodshMSCs were isolated from patients with cyanotic (Group C) or acyanotic (Group A) congenital heart diseases and cultured in a hypoxic incubator (1% O2, 5% CO2, 94% N2) in vitro. The anti-apoptotic potency of the hMSCs was assayed by the Annexin V-FITC/PI double labeled flow cytometry. The content of B-cell lymphoma-2 (Bcl-2), Bax and caspase-3 in both groups was determined by Western blot. ResultsFlow cytometry results revealed that hMSCs from C-CHD patients presented higher level of resistance to ischemia-and anoxia-induced apoptosis with lower overall (P<0.05) and early apoptosis ratio (P<0.01). Further Western blot examination identified that C-CHD-derived hMSCs produced more Bcl-2 (P<0.05) but less Bax (P<0.05) and caspase-3 (P<0.05) in comparison to their A-CHD-derived ones. ConclusionC-CHD-derived hMSCs presented the superiority for the anti-apoptotic potential, and the possible mechanism is the favorable change of Bcl-2, Bax and caspase-3 induced by the natural hypoxic and anoxic precondition.