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Objective:To investigate the clinical outcomes of selective major aortopulmonary collaterals(MAPCAs) unifocalization and report histopathological findings in patients with pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals(PA/VSD/ MAPCAs).Methods:The study enrolled 6 MAPCAs/VSD/PA patients with age ranged from 6 to 96 months and body weight ranged from 5.0 to 23.0 kg. These patients underwent selective MAPCAs unifocalization and primary repairs. Preoperative cardiac catheter, selective arteriography, cardiac CTA and intraoperative pathology were performed to identify different function, anatomic distribution and histopathology of MAPCAs.Results:6 MAPCAs/VSD/PA patients underwent selective MAPCAs unifocalization and primary repair. No death occurred after operation and at follow-up which lasted for 1 to 20 months. Preoperative cardiac catheter, selective arteriography and intraoperative histopathology demonstrated distribution of functional MAPCAs similar to native pulmonary artery arborization and participating in arterial gas exchange. Functional MAPCAs were classified into elastic arteries according to histopathology.Conclusion:There are two histological type of MAPCAs which play different roles. Selective unifocalization to functional MAPCAs which are classified into elastic arteries like native pulmonary artery is a safe and effective treatment approach for PA/VSD/MAPCAs.
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Objective:To evaluate the relationship between preoperative long-term sleep disorder and postoperative hyperalgesia in the patients undergoing cardiac surgery.Methods:One hundred and eighty-one adult patients of both sexes, aged 18 yr, undergoing elective cardiac valve surgery under cardiopulmonary bypass with general anesthesia, were enrolled in this study.On 1st day before surgery, the Pittsburgh Sleep Quality Index questionnaire was used to assess the patient′s sleep quality in the last month.When Pittsburgh Sleep Quality Index score was more than 5, the patient was considered to have long-term sleep disorder.Postoperative analgesia was performed with sufentanil.Patients were divided into 2 groups according to the numeric rating scale (NRS) score: non-hyperalgesia group (NHA group, NRS score <4) and hyperalgesia group (HA group, NRS score ≥4). A multivariate logistic regression was used to identify the risk factors associated with postoperative hyperalgesia.Results:The results of logistic regression analysis found that smoking and preoperative long-term sleep disorder were independent risk factors for postoperative hyperalgesia.Conclusion:Preoperative long-term sleep disorder may induce hyperalgesia after cardiac surgery in patients.
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Objective:To evaluate the accuracy of pRIFLE criterion and KDIGO criterion for the diagnosis of acute kidney injury (AKI) after radical operations for tetralogy of Fallot in children from the perspective of postoperative outcomes.Methods:A total of 375 children, aged<8 yr, undergoing radical operations for tetralogy of Fallot, were selected continuously and retrospectively. According to the pRIFLE and KDIGO diagnostic criteria, postoperative AKI was diagnosed, and the children were classified into different AKI grades. The prognostic parameters (postoperative mechanical ventilation time, duration of intensive care unit (ICU) stay, postoperative length of hospital stay, total costs of hospitalization, and in-hospital mortality, etc.) were collected, and the differences among different AKI grades were compared. Logistic regression method was used to analyze the risk factors for prolonged postoperative length of hospital stay (≥14 days) when two different criteria were used to diagnose AKI. The children diagnosed as non-AKI by KDIGO criterion were further confirmed using pRIFLE criterion, and the prognostic parameters in the children who were diagnosed as AKI and non-AKI were compared.Results:When two different criteria were used to diagnose AKI after radical resection for tetralogy of Fallot, the incidence was 56.8% (pRIFLE criterion) and 40.0% (KDIGO criterion). AKI diagnosed according to the two criteria was the independent risk factor for prolonged postoperative length of hospital stay, and the levels of all the prognostic parameters (postoperative mechanical ventilation time, duration of ICU stay, postoperative length of hospital stay, total costs of hospitalization, and in-hospital mortality) were significantly higher in AKI children than in non-AKI (AKI grade 0) children ( P<0.01). Among the 225 children diagnosed as non-AKI according to the KDIGO criterion, 63 cases were diagnosed as AKI and 162 cases as non-AKI according to the pRIFLE criterion, however, there was no significant difference in each prognostic parameter between children with AKI and non-AKI ( P>0.05). Conclusion:The pRIFLE criterion has a higher sensitivity, while the KDIGO criterion produces better accuracy when used to evaluate the diagnosis of AKI after radical operation for tetralogy of Fallot in children from the perspective of postoperative outcomes.
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Objective@#To investigate the clinical outcomes of selective major aortopulmonary collaterals(MAPCAs) unifocalization and report histopathological findings in patients with pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals(PA/VSD/ MAPCAs).@*Methods@#The study enrolled 6 MAPCAs/VSD/PA patients with age ranged from 6 to 96 months and body weight ranged from 5.0 to 23.0 kg. These patients underwent selective MAPCAs unifocalization and primary repairs. Preoperative cardiac catheter, selective arteriography, cardiac CTA and intraoperative pathology were performed to identify different function, anatomic distribution and histopathology of MAPCAs.@*Results@#6 MAPCAs/VSD/PA patients underwent selective MAPCAs unifocalization and primary repair. No death occurred after operation and at follow-up which lasted for 1 to 20 months. Preoperative cardiac catheter, selective arteriography and intraoperative histopathology demonstrated distribution of functional MAPCAs similar to native pulmonary artery arborization and participating in arterial gas exchange. Functional MAPCAs were classified into elastic arteries according to histopathology.@*Conclusion@#There are two histological type of MAPCAs which play different roles. Selective unifocalization to functional MAPCAs which are classified into elastic arteries like native pulmonary artery is a safe and effective treatment approach for PA/VSD/MAPCAs.
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Objective To identify the risk factors for early fluid overload (FO) following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) complicated with moderate or severe left ventricular dysfunction (left ventricular ejection fraction [LVEF] ＜50％) and evaluate the effect on clinical outcomes.Methods Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction,aged 2-128 months,weighing 4.5-34.5 kg,with New York Heart Association Ⅲ or Ⅳ,undergoing ALCAPA repair,were enrolled in this study.The pediatric patients were divided into FO ≥ 5％ group (n =14) and FO＜5％ group (n =29)according to the FO developed within 24 h after operation.The pediatric Risk,Injury,Failure,Loss,and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation.Factors including age,height,weight,preoperative LVEF,preoperative biomarkers,operative data,postoperative ventilation time,duration of intensive care unit (ICU) stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO ≥ 5％ developed within 24 h after operation.The effect of FO≥5％ on postoperative severe acute kidney injury (Injury and Failure),ventilation time,duration of ICU stay and etc.was assessed.Results Fourteen cases developed early postoperative FO≥5％,and the incidence was 33％.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO ≥ 5％ (P＜0.05).Compared with FO＜5％ group,the postoperative ventilation time and duration of ICU stay were significantly prolonged,the number of pediatric patients who developed pulmonary infection and required reintubation was increased,the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased (P＜0.05),and no significant change was found in the other parameters of clinical outcomes in FO ≥ 5％ group (P＞0.05).Conclusion Lower preoperative LVEF is a risk factor for early postoperative FO in pediatric patients with ALCAPA complicated with a moderate or severe left ventricular dysfunction undergoing repair,and it is not helpful for clinical outcomes in pediatric patients when postoperative early FO≥5％ occurs.
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Objective@#To identify the risk factors for early fluid overload(FO)following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) complicated with moderate or severe left ventricular dysfunction (left ventricular ejection fraction [LVEF]<50%) and evaluate the effect on clinical outcomes.@*Methods@#Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction, aged 2-128 months, weighing 4.5-34.5 kg, with New York Heart Association Ⅲ or Ⅳ, undergoing ALCAPA repair, were enrolled in this study.The pediatric patients were divided into FO≥5% group (n=14) and FO<5% group (n=29) according to the FO developed within 24 h after operation. The pediatric Risk, Injury, Failure, Loss, and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation. Factors including age, height, weight, preoperative LVEF, preoperative biomarkers, operative data, postoperative ventilation time, duration of intensive care unit(ICU)stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO≥5% developed within 24 h after operation.The effect of FO≥5% on postoperative severe acute kidney injury (Injury and Failure), ventilation time, duration of ICU stay and etc. was assessed.@*Results@#Fourteen cases developed early postoperative FO≥5%, and the incidence was 33%.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO≥5% (P<0.05). Compared with FO<5% group, the postoperative ventilation time and duration of ICU stay were significantly prolonged, the number of pediatric patients who developed pulmonary infection and required reintubation was increased, the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased (P<0.05), and no significant change was found in the other parameters of clinical outcomes in FO≥5% group (P>0.05).@*Conclusion@#Lower preoperative LVEF is a risk factor for early postoperative FO in pediatric patients with ALCAPA complicated with a moderate or severe left ventricular dysfunction undergoing repair, and it is not helpful for clinical outcomes in pediatric patients when postoperative early FO≥5% occurs.
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Objective To evaluate the effect of aminophylline on the efficacy of extubation under ultra-fast track anesthesia ( UFTA) in pediatric patients with congenital heart disease ( CHD) undergoing surgical correction of anomaly. Methods Ninety American Society of Anesthesiologists physical status Ⅰor Ⅱ pediatric patients, aged<6 yr, undergoing surgical correction of anomaly, were randomized into 3 groups ( n=30 each) using a random number table method: group Ⅰ, group Ⅱ and group Ⅲ. After the end of surgery, normal saline was given in groupⅠ, 1 mg∕kg aminophylline was given in groupⅡ, and 2 mg∕kg aminophylline was given in groupⅢ. The condition of extubation in the operating room and respirato-ry rate at extubation were recorded. Mean arterial pressure, heart rate and bispectral index value were re-corded at the end of surgery, and at 9 and 15 min after administration. Results Compared with groupⅠ, the rate of successful extubation in the operating room, BIS value at 9 min after administration and respira-tory rate at extubation were significantly increased inⅡand Ⅲ groups ( P<0. 05) . There was no significant difference in the parameters mentioned above between group Ⅱand group Ⅲ ( P>0. 05 ) . Conclusion Aminophylline can increase the efficacy of extubation under UFTA in pediatric patients with CHD undergoing surgical correction of anomaly, and 1 mg is the recommended dose.
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Objective@#To investigate the outcomes of coarctation resection and aortoplasty with autologous pulmonary artery patch for treating coarctation of the aorta combined with hypoplastic aortic arch in infants.@*Methods@#Clinical data of 21 infants with coarctation of the aorta and hypoplastic aortic arch, who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch in Fuwai hospital from January 2009 to June 2016 were retrospectively analyzed. The age of the patients was 4 (2, 5) months,and the body weight of the patients was (5.3±1.6) kg. The patients were followed up to observe the surgery effect.@*Results@#No perioperative death and serious complications occurred. When the patients were discharged,the systolic blood pressure of the right upper limb was lower than the preoperative systolic blood pressure ((85.7±5.9) mmHg(1 mmHg=0.133 kPa) vs. (100.7±16.6) mmHg, P<0.001),and the systolic blood pressure of the right lower limb was higher than the preoperative systolic blood pressure ((98.7±13.3) mmHg vs. (85.6±20.8) mmHg, P<0.001). The pressure gradient of aortic coarctation detected by echocardiography was lower than the preoperative pressure gradient ((13.1±3.8) mmHg vs. (46.2±17.1) mmHg, P<0.001). No restenosis was detected by echocardiography at discharge. Follow-up data were obtained in 19 patients, and the follow-up time was 18 (8, 45) months.The patients grew well, and no death occurred. Restenosis occurred in 3 cases, 1 patient underwent aortic balloon dilatation and the remaining 2 patients were under follow up observation. Computed tomography angiography showed that the morphology of aortic arch was normal without signs of aortic aneurysm.@*Conclusion@#Coarctation resection with autologous pulmonary artery patch aortoplastystrategy is considered as a safe and effective surgical method for management of infant coarctation with hypoplastic aortic arch, and this surgery method is related with satisfactory early and mid-term outcomes in this patient cohort.
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Objective: To compare the effects of ultra-fast track anesthesia and traditional anesthesia on blood levels of high sensitivity C-reactive protein (Hs-CRP), C-reactive protein (CRP) and procalcitonin (PCT) in patients after pediatric cardiac surgery. Methods: A total of 101 patients received pediatric cardiovascular surgery by a same anesthesiologist in our hospital from 2013-09 to 2014-05 were retrospectively reviewed. The patients were studied in 2 anesthesia groups:Ultra-fast track group, in which the extubation was conducted in operating room, n=40 and Traditional group, n=44. Blood levels of Hs-CRP, CRP and PCT at pre-operation (T0), 1st day post-operation (T1) and 2nd day post-operation (T2) were compared. Results: ①Hs-CRP levels were higher at T1 and T2 than T0 in both groups, all P Conclusion: Compared With traditional anesthesia, ultra-fast track anesthesia could decrease the post-operative elevations of Hs-CRP, CRP and PCT in patients after pediatric cardiac surgery.
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<p><b>OBJECTIVE</b>To compare the impact of fenestration on early outcome in patients undergoing modified Fontan operation.</p><p><b>METHODS</b>Data from 90 consecutive patients underwent modified Fontan operation from November 2008 to June 2013 were retrospectively analyzed. Patients were divided into fenestrated group (49 patients) and non-fenestrated group (41 patients) and early outcome post operation was compared between the two groups.</p><p><b>RESULTS</b>Anatomy, age, gender, body weight and disease classifications were similar between the two groups (all P > 0.05). Postoperative central venous pressure was (11.4 ± 4.1) mmHg (1 mmHg = 0.133 kPa) in fenestrated group and (12.1 ± 3.8) mmHg in non-fenestrated group (P = 0.894). The duration of chest tube drainage was (11.1 ± 9.2) day in fenestrated group and (15.0 ± 10.7) day in non-fenestrated group (P = 0.160). Volume of pleural drainage was 772.0 (411.5-1 971.5) ml in fenestrated group and 1 259.0 (571.0-2 647.5) ml in non-fenestrated group (P = 0.214). Duration of ICU stay was 24.0 (18.0-40.0) day in fenestrated group and 24.0 (19.0-36.0) day in non-fenestrated group (P = 0.751). The time of respirator use was 9.0 (6.0-15.0) hours in fenestrated group and 8.0 (6.0-16.0) hours in non-fenestrated group (P = 0.951). Duration of hospital stay was significantly longer in fenestrated group than in non-fenestrated group ((32.7 ± 23.0) day vs. (27.8 ± 12.6) day, P = 0.025). One patient (2.0%) died of low cardiac output syndrome in fenestrated group and 1 patient (2.4%) experienced hydropericardium in non-fenestrated group. The incidence rate of complications (P = 0.898) and mortality (P = 1.000) were similar between the two groups.</p><p><b>CONCLUSION</b>Early outcome is similar for patients undergoing the modified Fontan operation with or without fenestration.</p>
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Aged , Humans , Fontan Procedure , Methods , Length of Stay , Postoperative Period , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To investigate the impacts of the left ventricular size for infants with total anomalous pulmonary venous connection(TAPVC) on the early results of anatomical correction.Methods From Jan 2010 to Jun 2013,103 cases of TAPVC children under 1 year of age received biventricular correction in our hospital,including 65 males and 38 females with the mean body weight of(5.3 ± 1.3) kg.Taking left ventricular end-diastolic volume index(LVEDVI) of 20 ml/m2 as a boundary,all the children were divided into two groups:Small LV group and the Near normal LVgroup.Various factors including age,body weight,pathological type,pulmonary venous obstruction and restricted atrial septal defect were compared between the two groups.The Z value were introduced to demonstrate the small extent of the left atrium and left ventricle of TAPVC patients in comparison with the normal children.TAPVC correction surgery were performed with conventional median sternotomy,moderate hypothermic cardiopulmonary bypass and combined malformations were treated simultaneously.Results 45 patients were classified to Small LV group and 58 patients were classified toNear normal LV group.71.1％ of all Small LV patients was diagnosed as the obstruction type of TAPVC,the ratio was significantly higher than that of theNear normal LV group.The Z value of left ventricular end-diastolic diameter in theSmall LV group was significantly lower than that of the Near normal LV group.The mean CPB and aortic clamping time of all patients were (96.6 ± 34.4) min and (58.0 ±21.1) min respectively.There were 4 early postoperative death and the overall mortality was 3.9％.No patient was dead of low cardiac output.The duration of postoperative mechanical ventilation,ICU stay and vasoactive drugs application in Small LV group was significantly longer than that of Near normal LV group.Conclusion TheSmall LV,which should be viewed as relative dysplasia of left ventricle ,is more common in obstructive type of TAPVC.As long as the sizes of mitral valve and aortic valve were not significantly reduced,anatomic correction can be implemented and need not to concern the reducing degree of left ventricle.Nevertheless,the prevention and treatment of low cardiac output in the operation and early postoperative period were still key points for small LV patients to achieve good surgical results.
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Objective: Compared with ketamine anesthesia, to investigate sevoflurane inhalation combining laryngeal mask airway for anesthesia induction in pediatric cardiac surgery. Methods:A total of 40 pediatric patients with congenital heart diseases received elective cardiac surgery in our hospital from 2013-08 to 2014-01 were studied. The children were from 6 months to 2 years of age and randomly divided into 2 groups, n=20 in each group. Sevolfurane group, the children inhaled the mixture of 8%sevolfurane and 100%O2, laryngeal mask airway was used upon losing consciousness for mechanical ventilation, the anesthesia was maintained by (3-4)% sevolfurane inhalation to facilitate central venous catheter placement. Ketamine group, the children received intramuscular injection of ketamine (7 mg/kg)+atropine (0.01 mg/kg). The peripheral venous line was established upon losing consciousness, the intravenous midazolam (0.1 mg/kg), pipecuronium (0.10 mg/kg), fentanyl (5 μg/kg) were applied, then tracheal intubation was performed for mechanical ventilation and the anesthesia was maintained by (0.5-1)%sevolfurane to facilitate central venous catheter placement. Results: Sevoflurane group had the shorter time for losing the consciousness than that in Ketamine group (48.90 ± 3.93) s vs (577.85 ± 116.41) s, P0.05. The arterial PH value, PaCO2, BE and lactatein were similar between 2 groups, P>0.05. Conclusion: Sevoflurane inhalation combining laryngeal mask airway could shortening anesthesia preparation time with simple management. It provided an important anesthesia option in pediatric cardiac surgery.
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Two hundred and thirty-five patients of both sexes (123 male,112 female) aged 18-54 yr,weighing 35-62 kg underwent repair of tetralogy of Fallot from January 1996 to July 2009 in Fuwai hospital.Direct BP, ECG,CVP,SpO2,naso-pharyngeal temperature and TEE were continuously monitored during operation.Anesthesia was induced with midazolam and/or etomidate, fentanyl and pipecuronium and maintained with isoflurane/sevoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium. The total amount of fentanyl administered ranged from 30-50 μg/kg. Cardiac function was supported and hemodynamic stability was maintained with vasoactive and inotropic drugs. Measures were taken to strengthen blood conservation and respiratory function support.Seven patients(2.9%) needed urgent CPB during operation because of serious cyanotic spells. Perfusion-induced lung injury occurred in 18 patients (7.6%). Circulation was assisted by ECMO in 2 patients (0.9%). Three patients (1.3%) died of serious low cardiac output and perfusion-induced lung injury.
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Objective To investigate the use of laryngeal mask airway (LMA) ProSeal for airway management during open heart surgery performed under CPB in children. Methods Seventy-six ASA Ⅱ and NYHA class Ⅰ or Ⅱ patients aged 3 months-8 yr, weighing 3.3-34.5 kg undergoing open heart surgery under CPB were randomly divided into 2 groups ( n = 38 each): tracheal intubation group (group T) and ProSeal LMA group (group P1). Tracheal tube and LMA were inserted after induction of anesthesia with 8% sevoflurane. The rate of successfultracheal intubation and LMA placement, placement time, peak airway pressure and side effects during and after surgery including hypoxemia, tachycardia, bradycardia, hypotension and hypertension, laryngesl edema, dysphagia, bucking, dyspnea and hoarseness were recorded. Results There were no significant differences in the rate of successftl tracheal intubation and LMA placement, peak airway pressure, bucking, dyspnea and hoarse voice between the two groups (P＞ 0.05). The LMA placement time was significantly shorter than tracheal intubation time and the incidence of laryngeal edema and dysphagia lower in group P than in group T ( P ＜ 0.05). Conclusion The LMA ProSeal can provide adequate ventilation during operation with less complications and can be used effectively for cardiac surgery performed under CPB in children.
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Objective:To investigate the effects of deep hypothermia on MAC,cardiac anesthetic index and myocardial stability of valotile anesthetics. Method: Forty New Zealand white rabbits were randomly divided into 4 groups:halothane, enflurane,isoflurane and sevoflurane. MAC of valotile agents were determined with the test of clamping tail at normal(38 C?0.5 C )and deep hypothermic(23 C?0.5 C )temperatures. The end-tidal valotile agent concentration at which ventricular arrhythmia appeared by increasing valotile agent concentration and stimulating the heart with extrathoracic electric shock(25V 50Hz)were recorded. Result:MAC of halothane, enflurane,isoflurane and sevoflurane were decreased by average percentage of 5.1,3.6,4.4 and 4.3 per degree from 38 C to 23 C respectively. Cardiac anesthetic indexes during deep hypothermia were 4.4,3.18.6.25 and 4.6. There was significantly higher incidence of ventricular fibrilation in halothane and enflurane groups (100％) than that in isoflurane and sevoflurane groups(40％)under 8 MAC anesthetics. Conclusion:Isoflurane is the most suitable valotile agent for deep hypothermic anesthesia, while enflurane is the least.