ObjectiveTo summarize clinical results and experience of subarterial ventricular septal defect (sVSD) closure through a minimal right vertical infra-axillary incision in children, and evaluate the feasibility of this technique. MethodsClinical data of 27 sVSD patients who underwent surgical repair through a minimal right vertical infra-axillary incision from March 2009 to January of 2013 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 20 male and 7 female patients with their age of 1.1-11.0 (4.4±2.8) years and body weight of 7.6-28.0 (14.6±5.3) kg. After induction of anesthesia, the patients were placed in a 90 degree left lateral position. The incision was performed along right midaxillary line vertically between the superior border of the third rib and inferior border of the fifth rib. The thoracic cavity was entered through the fourth intercostal space. The pericardium was opened 2 cm anterior to the phrenic nerve and suspended to elevate the heart and great vessels by the pericardial traction sutures. Cardiopulmonary bypass (CPB) was established after cannulation of the ascending aorta, superior vena cava and inferior vena cava. Closure of sVSD was performed through longitudinal pulmonary incision. After procedures under CPB finished, the aortic cannula was removed and the pericardium was closed with interrupted sutures. The thoracic drainage tube was placed through the sixth intercostal space. All the patients were followed up 3, 6 and/or 12 months after surgery. Satisfactory degree of the patients and their relatives were evaluated. Chest X-ray, electrocardiography and echocardiography were examined. ResultsSurgical repair of sVSD was performed in all the patients through this incision without any difficulty, incision prolongation or conversion to another incision. There was no in-hospital death, reexploration for bleeding, postoperative atelectasis, pulmonary infection, pleural effusion, impairment of central nervous system, phrenic nerve damage, poor wound healing, wound infection or pericardial effusion. Incision length was 4.4-7.0 (5.07±0.66) cm. Echocardiography before discharge showed no residual shunt in all the patients. All the patients were followed up 3, 6 and/or 12 months at the outpatient department or via the phone. During follow-up, there was no late death, residual shunt or chest asymmetry. The short incision under the armpit was obscured and provided favorable cosmetic results. All the patients and their relatives were satisfied with the cosmetic results. ConclusionRepair of sVSD through a minimal right vertical infra-axillary incision is feasible and safe for children. The advantages of this technique are favorable for children with sVSD.
ObjectiveTo systematically review the efficacy and safety of ibuprofen for premature infants with patent ductus arteriosus. MethodsDatabases including PubMed, Ovid-EMbase, The Cochrane Library (Issue 11, 2014), CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) and quasi-RCTs about ibuprofen for premature infants with patent ductus arteriosus from inception to December 2014. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. ResultsA total of 37 RCTs, involving 2 370 patients were included. The results of meta-analysis showed that, compared with the placebo/blank group, ibuprofen could increase the closure rate of PDA (LBWI:RR=1.93, 95%CI 1.25 to 2.99，P=0.003; VLBW:RR=1.23, 95%CI 1.02 to 1.48, P=0.03; ELBWI:RR=2.86, 95%CI 1.51 to 5.41, P=0.001) and decrease the incidence of sepsis (VLBW:RR=0.21, 95%CI 0.07 to 0.64，P=0.006); Compared with the indometacin groups, ibuprofen could decrease the incidence of the increase of serum creatinine (LBWI:RR=0.11, 95%CI 0.04 to 0.37, P=0.000 2), NEC (LBWI, RR=0.52, 95%CI 0.29 to 0.95, P=0.03) and oliguria (LBWI: RR=0.30, 95%CI 0.16 to 0.56, P=0.000 2; VLBW:RR=1.40, 95%CI 1.03 to 1.92, P=0.03); Compared with the intravenous ibuprofen, Oral ibuprofen could increase the closure rate of PDA (VLBW: RR=1.35, 95%CI 1.12 to 1.62, P=0.002; ELBWI, RR=1.42, 95%CI 1.07 to 1.87, P=0.01). ConclusionCurrent evidence shows that there is not indeterminate between ibuprofen and paracetamol groups. Compared with other general drugs, ibuprofen has an advantage over curing PDA and obviously reduces side effects. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo evaluate the early and mid-term outcomes of GK bileaflet mechanical valve applied in mitral valve replacement. MethodsTwenty patients with rheumatic mitral stenosis underwent mitral valve replacement in our hospital from March 2008 to June 2011. Ten patients of them chose GK bileaflet mechanical valve for surgery (a GK group, 5 males and 5 females, aged 56.4±8.9 years), while the other 10 patients chose Medtronic Open Pivot mechanical valve (a Medtronic group, 4 males and 6 females, aged 50.2±8.0 years). The preoperative, perioperative and postoperative data were analyzed and compared between the two groups. Cardiac CT angiography (CTA) and transesophageal echocardiography (TEE) were performed to evaluate leaflets opening angle, the morphological features of the mechanical valve and the hemodynamic features in the third year after surgery during the follow-up. ResultsNo mortality, defect, low cardiac output syndrome or bleeding after surgery occurred in either group. The result of 3-year follow-up showed that the function of the mechanical valve showed no difference between the two groups. Cardiac CTA and TEE showed good morphological features in all patients. ConclusionThe GK bileaflet mechanical valve has equivalent effect as Medtronic Open Pivot mechanical valve for mitral valve replacement during the 3-year follow-up.