Abstract: Objective To discuss whether priming solution with blood can reach a physiologic state after ultrafiltration and investigate the influence of this method on electrolytes, acidbase balance and cardiopulmonary function in patients in perioperative period. Methods Forty patients with congenital heart diseases treated in our hospital from February to June 2009 were enrolled in this study. The weight of these patients was less than 8 kg. They were randomly divided into two groups: the experimental group (n=20, 12 males and 8 females; age: 131.00±103.00 d; weight: 4.14±0.96 kg） and the control group (n=20, 11 males and 9 females; age: 127.00±88.00 d; weight: 4.38±1.05 kg). For patients in the experimental group, the priming solution was filtered with a blood ultrafilter in the cardiopulmonary bypass(CPB) circuit for twenty minutes, while the priming solution circulated in the CPB circuit without filtration for patients in the control group before operation. Data were obtained from the priming solution before and after ultrafiltration. Blood gas analysis was done and indexes like the electrolytes were detected during the operation. Fractional shorting (FS), ejection fraction (EF) and cardiac output (CO) were measured by echocardiography. Pulmonary function change was also observed. Results No death occurred in both groups. Mechanical ventilation time for the experimental group was significantly shorter than that of the control group (2.7±0.3 d vs. 4.1±0.4 d，Plt;0.05). After ultrafiltration for the experimental group, all indexes of the priming solution reached normal values: pH increased (from 6.89±0.22 to 7.40±0.57, P=0.001); base excess increased (from -16.12±0.98 mmol/L to +0.31±2.40 mmol/L, P=0.000); potassium concentration decreased (from 10.33±2.13 mmol/L to 4.27±0.93 mmol/L, P=0.000); interleukin8 (IL-8) decreased (from 78.40±6.10 pg/ml to 64.30±48.10 pg/ml, P=0.036); and bradykinin decreased (from 5 982±1 353 pg/ml to 531.00±35.00 pg/ml, P=0.031). The decrease of FS, EF and CO in the experimental group was smaller than that of the control group. Four hours after surgery, CO in the experimental group was significantly higher than that in the control group (2.77±0.95 L/min vs. 1.66±0.75 L/min, P=0.001). Twentyfour hours after surgery, EF in the experimental group was significantly higher than that in the control group (67.44%±6.89% vs. 61.17%±9.02%, P=0.003). Six hours after surgery, alveolararterial oxygen difference (A-aDO2) and respiratory index (RI) increased significantly (Plt;0.05) in both groups, and then started to drop to normal. Patients in the experimental group recovered gas exchange earlier than patients in the control group. Fortyeight hours after operation, A-aDO2 and RI in the experimental group were significantly lower than those in the control group (Plt;0.05). Conclusion Ultrafiltration of priming solution may confer an advantage in maintaining more physiological conditions, reducing inflammatory mediators, and improving cardiopulmonary function after operation, which is very important in performing cardiac surgery on the newborn and infants with complex congenital heart diseases.
Abstract: Objective To summarize onestage repair of coarctation of the aorta(CoA) with intracardiac malformation in infants. Methods From January 2001 to January 2006, 28 patients with CoA and associated intracardiac malformation underwent onestage repair. There were 18 patients with preductal and another 10 patients with juxtaductal CoA. Six patients were accompanied by diffuse hypoplasia of aortic arch and 22 patients were associated with patent ductus arteriosus (PDA). Associated cardiac malformation included ventricular septal defect in 16 patients, ventricular septal defect and atrial septal defect in 5 patients, atrioventricular canal defect in 3 patients, transposition of great artery and ventricular septal defect in 2 patients and double outlet right ventricle in 2 patients. Left posterolateral thoracotomy combined with median sternotomy were used in 12 patients and single median sternotomy was used in 16 patients. End to end anastomosis of aorta with removal of the coarctated segment were performed in 20 patients, Gore-Tex patch graft aortoplasty were performed in 4 patients and aortoplasty with left subclavain flap were performed in 4 patients. Results There was no death.The lasting time of intubation was 7h to 13d, and intensive care unit (ICU) staying time was 3 to 18d. Four patients received delayed sternal closure in 48 to 72h after surgery because of cardiac dilatation. Three patients received peritoneal dialysis for acute renal failure following cardiac surgery. Three patients received inhalation of nitric oxide for treatment of postoperative pulmonary hypertension. The systolic pressure difference between lower limb and upper limb measured after operation was 10 to 20mmHg in 18 patients.There were no obvious systolic pressure difference between arm and leg in 8 patients.The systolic pressure of upper limb was higher than that of lower limb in 2 patients, and the pressure difference was 15mmHg and 20mmHg. All patients were followed up from 3 to 50 months. They were all survival except one died of severe tricuspid regurgitation, pulmonary infection and respiratory failure 3 months after surgery which diagnosis was transposition of great artery and ventricular septal defect. The results of other 27 patients were satisfactory. Recoarctation occurred in 1 patient with end to end anastomosis and 1 patient with Gore-Texpatch graft aortoplasty. The pressure difference through the measurement of echocardiography was 25mmHg and 28mmHg. No reoperation were undergone. Conclusion CoA with intracardiac malformation can be repaired by single median sternotomy or left posterolateral thoracotomy combined with median sternotomy in onestage. This operative approach is beneficial, not only with shorten period of therapy and less operative cost, but also advantageous for the recovery of cardiac and pulmonary function.