ObjectiveTo explore the safety and efficacy of transesophageal echocardiography (TEE)-guided percutaneous intervention for patent ductus arteriosus (PDA) in obese teenagers.MethodsFrom January 2018 to June 2019, 21 obese teenagers with PDA treated with femoral artery occlusion guided by TEE in the Department of Cardiac Surgery, Dalian Children's Hospital of Dalian Medical University were included in this study, including 13 males and 8 females aged 12.8-17.3 (15.1±1.7) years, with an average weight of 51.0-89.0 (73.4±10.1) kg. The operative effect was evaluated. ResultsAll patients successfully received the surgery, and none was changed to radiation-guided or thoracotomy ligation. The average operating time was 23.9±6.8 min, the average postoperative hospitalization time was 3.8±0.6 d. No peripheral vascular injury, intracardiac infection or pericardial effusion occurred. The mean follow-up time was 19.5±4.9 months, and the results of all reexaminations were good.ConclusionFor some PDA children with obesity, emphysema or thoracic malformation, it is difficult to block PDA by transthoracic ultrasound-guided percutaneous intervention, and TEE can avoid the interference of chest wall and lung qi, or other factors. It is an effective supplementary guidance method worthy of promotion.
ObjectiveTo discuss the diagnosis and treatment of culture-negative aortic infective endocarditis.MethodsThe clinical data of 73 patients with infective endocarditis of the aortic valve whose results of bacteria culture were negative from January 2013 to January 2018 were retrospectively analyzed, including 59 males and 14 females aged 14-71 (39.2±14.8) years.ResultsSixty seven (91.8%) patients received aortic valve replacement, 2 (2.7%) patients received the second operation in hospital, and 12 (16.4%) patients had concomitant mitral valvuloplasty. In-hospital death occurred in 8 (11.0%) patients. Postoperatively, 11 (20.7%) patients had a low cardiac output and 4 (11.0%) patients had heart block, and 1 patient required implantation of a permanent pacemaker. The 1- and 5- year survival rates were 92.3%±2.3% and 84.5%±4.5%, respectively.ConclusionThere are difficulties in the diagnosis and treatment of culture-negative infective endocarditis. Most of the affected patients are in a healed status, which could be a cause of negative culture results. In-hospital mortality in the patients is associated with a history of previous cardiac surgery, whereas the long-term survival rate is good for the patients after surgery.
A case of a 4-month-old child with an aortopulmonary fenestration weighing 6.6 kg who underwent successful transthoracic minimally invasive occlusion in our hospital was reported in this article. The child was transferred from the intensive care unit (ICU) to the general ward 1 day after surgery and discharged 5 days later. Compared with conventional ligation or repair of extracorporeal circulation for the aortopulmonary fenestration, the transthoracic minimally invasive occlusion is characterized by less trauma and faster recovery. However, it requires strict surgical indications and is not suitable for all patients with aortopulmonary fenestration.
ObjectiveTo share the experience of treating special cardiac malformations by applying minimally invasive techniques.MethodsEight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge.ResultsEight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory.ConclusionThe application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.