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.