ABSTRACT
Objective To summarize the clinical experience of comprehensive management of critical newborns with transposition of great arteries (TGA) by neonatologists and cardiac surgeons.Methods Seventeen critical newborns with TGA rescued by combined efforts of neonatologists and pediatric cardiac surgeons from Oct.2010 to Oct.2012were retrospectively analyzed.Results Of the 17 newborns(14 cases were male,3 cases were female),9 cases were TGA with ventricular septal defect(TGA/VSD),8 cases TGA with intact ventricular septal defect (TGA/IVS).The babies aged from 1-45 days,weighed from 2.7-4.6 kg at operation.Of the 9 cases TGA/VSD babies,3 cases were treated with prostaglandins E (PGE) for hypoxemia correction and selective operation opportunity ;2 cases underwent emergency arterial switch operation (ASO) for severe cardiac shock.All of the 8 cases TGA/IVS babies received PGE treatment preoperatively for life threatening hypoxemia,and 4 cases of them underwent emergency ASO.There were 12 cases delayed sternal closure and 5 cases of them were emergency babies.Peritoneal dialysis was employed for 6 cases and extracorporeal membrane oxygenation (ECMO) for l case.There were 6 cases with postoperative incision infection,including 5 emergencies.Thirteen newborns survived and 4 cases died at hospital:one case complicated with postoperative septicemia and severe mediastinitis which leaded to pericardium patch rupture and fatal pulmonary arterial hemorrhage;one case with abnormal inferior vena cava connection and severe low cardiac output syndrome;one case with disseminated intravascular coagulation (DIC) due to septicemia and severe mediastinitis postoperatively,one case with abnormal coronary artery during surgery and difficult coronary artery transplantation and insufficient blood supply after aorta was open.Conclusions Correcting hypoxemia and stabilizing the severe babies are critical in NICU to avoid emergency surgery.Emergent ASO is the optimized medical therapy for those with persistent severe hypoxemia and heart failure.
ABSTRACT
Objective To investigate the outcomes of hybrid treatment of pulmonary valve's balloon valvuloplasty via right ventricle without cardiopulmonary bypass for pulmonary atresia with intact ventricular septum(PA/IVS) and critical pulmonary stenosis(PS) in neonates.Methods The clinical features and data of 3 children(1 case of PA/ IVS and 2 cases of critical PS),who underwent hybrid treatment of balloon valvuloplasty,were recorded and retrospectively analyzed.All patients' right ventricle grow well,tricuspid valve Z score ＞-2,and underwent pulmonary valve balloon valvuloplasty via fight ventricle without cardiopulmonary bypass.Results All the 3 children underwent pulmonary valve balloon valvuloplasty via fight ventricle without cardiopulmonary bypass,and there was no death.The mean arterial blood oxygen saturation after operation went up,and there was no complication related to balloon valvuloplasty.The children were followed up for 3 to 6 months,and all the patients had mild pulmonary stenosis,but they did not need any treatment.Conclusions Pulmonary valvuloplasty with hybrid technique is effective in treatment of selective PA/IVS children(fused leaflets of pulmonary valve) and critical PS in neonates.Hybrid therapy may provide adequate pulmonary blood flow and promote further growth of tricuspid valve and right ventricular cavity with less trauma and more safety.
ABSTRACT
Objective To evaluate the feasibility and safety on closing ventricular septal defects (VSDs) under cardiopulmonary bypass(CPB) in neonatal patients with VSD and congestive heart failure.Methods From Oct.2010 to Sep.2012,16 newborn infants with VSD and congestive heart failure in Neonatal Intensive Care Unit(NICU),the Bayi Children's Hospital Affiliated to Beijing Military General Hospital,were selected as the observed group,VSD repair operation was done under CPB.As the control group,18 patients in Pediatrical Cardiac Surgical Department were randomly selected in the same period in hospital,and selective VSD repair operations were done under CPB.Between the 2 groups,demographics(body weight,gender,VSD diameter),clinical characteristics (CPB time,aortic crossclamp time) and early outcomes were compared.Results For the diameter of VSD and gender,there were no significant difference between the 2 groups (P ＞ 0.05).For the body weight,the patients in control group [(8.27 ± 3.39) kg] were more heavier than those in observed group [(3.69 ± 0.72) kg] (P ＜ 0.01).In the operation period,there were no significant differences in CPB time and aortic crossclamp time between 2 groups(all P ＞ 0.05).The lactate value of the patients in observed group [(2.76 ± 1.12) mmol/L] was significantly higher than that in control group [(1.65 ±0.34) mmol/L] (P ＜ 0.01).At the same time,the ventilation time [(3.69 ± 1.66) days] and PICU stay [(9.75 ± 3.44) days] were significantly longer than those in control group[(2.00 ±0.89) days and (6.17 ± 1.98) days] (all P ＜ 0.01).All the patients in the 2 groups discharge out of the hospital,there was no significant difference in outcome.Conclusions The newborns with VSD and congestive heart failure in NICU,can be not improved after the medical management,then closing the VSD is feasible and safe under CPB.
ABSTRACT
<p><b>OBJECTIVE</b>Acute lung injury is a severe complication after cardiac surgery performed with cardiopulmonary bypass in infant patients. Pulmonary surfactant has been successfully used in treating neonatal respiratory distress syndrome for many years. This study focused on exploring the clinical efficacy of exogenous pulmonary surfactant in treating infant patients with acute lung injury after cardiac surgery with the use of extracorporeal circulation.</p><p><b>METHOD</b>Twenty-three infants with ventricular septal defect (VSD) were enrolled in the study. None of the patients needed oxygen treatment nor ventilation before heart surgery. VSD repair operation was done under cardiopulmonary bypass, and acute lung injury was found postoperatively. Ten infant patients in the treatment group were given pulmonary surfactant by tracheal instillation during mechanical ventilating postoperatively. Thirteen patients in control group were randomly selected in the same period in hospital, and acute lung injury was diagnosed without pulmonary surfactant treatment after cardiopulmonary bypass. Blood samples were obtained from all the patients, and blood gas analysis was performed every 6 hours. Demographics (body weigh, age, gender, VSD diameter) and clinical characteristics (CPB time, oxygenation index, mean airway pressure, pH and PCO2) of all the patients were collected, and statistical analysis was done to compare the data between treatment and control group.</p><p><b>RESULT</b>In the first 24 hours after heart surgery, compared with the control group, a more increased oxygenation index (from 89.36 ± 12.69 to 285 ± 16.51) was observed in treatment group, and it was from 93.71 ± 11.82 to 133 ± 19.62 in the control group. There was a significant difference in oxygenation index between the two groups (P < 0.05). At the same time, the MAP (from 17.5 ± 3.18 to 10.4 ± 3.37) of the patients in comparison with the control group (from 18.2 ± 2.63 to 13.8 ± 2.55), a more significantly decreased MAP was observed in the treatment group (P < 0.05). There was no significant difference in pH and PCO2 between the two groups. The ventilation time in cardiac care unit was shorter in treatment group (17.43 ± 9.12) h compared with the control group [(30.97 ± 14.85) h, P < 0.05]. ICU stay time of treatment group (3.90 ± 1.34) d was shorter than that of control group [(6.18 ± 1.90) d, P < 0.05].Two infants of the control group died, but none in treatment group died.</p><p><b>CONCLUSION</b>In this study, a satisfactory curative effect was observed for the treatment of acute lung injury with PS intratracheal instillation after heart surgery under cardiopulmonary bypass in infant patients. It can reduce the duration of mechanical ventilation and cardiac care unit stay and improve prognosis. In addition, this study was a pilot study and the limited sample size was probably the cause of insufficient statistical power. Further study of larger scale is needed.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Acute Lung Injury , Therapeutics , Cardiopulmonary Bypass , Pilot Projects , Postoperative Complications , Therapeutics , Pulmonary Surfactants , Therapeutic UsesABSTRACT
<p><b>OBJECTIVE</b>To report clinical application of Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia.</p><p><b>METHOD</b>A seven-year old male patient with severe pneumonia complicated with heart and lung function failure was admitted to PICU in 28th of December, 2008.Veno-artery access was set up via euthyphoria cannulation in operative incision. Blood was drained from the right atrium through a cannula introduced via femoral veins, and returned via femoral artery. The inter-surface of the ECMO equipment system was completely coated with heparin-coating technique. Anticoagulation was maintained with heparin to keep the activated clotting time (ACT) between 150 and 200 seconds and heparin usage dose was 10 U/(kg.h), mean blood flow was 1/2-2/3 of 80-120 ml/(kg.min) during ECMO assistant period. During ECMO, ventilator settings were gradually reduced to allow lung rest, i.e. peak inspiratory pressure less than 25 cm H2O (1 cm H2O=0.098 kPa), end expiratory pressure 8-10 cm H2O, rate 10-15 breaths per minute and FiO2 30%-40%.</p><p><b>RESULTS</b>In management of ECMO, the incipient blood flow was set at 0.8 L/min, the radio of oxygen and blood flow was 1:1, FiO2 60%. After ten minutes of ECMO working, the blood oxygen saturation of radial artery increased from 40 mm Hg (1 mm Hg=0.133 kPa) to 177 mm Hg, Lac decreased from 3.5 mmol/L to 2.8 mmol/L. Four hours later, blood gas analysis of radial artery showed PaO2 202 mm Hg, PCO2 44 mm Hg, Lac 1.5 mmol/L, blood flow was set at 0.6 L/min, FiO2 60%, PaO2 kept above 150 mm Hg. 96 hours after ECMO supporting, the blood flow was set at 0.4 L/min [20 ml/(kg.min)], the results of blood gas analysis of radial artery was PaO2 190 mm Hg, PaCO2 36 mm Hg, SaO2 100%, Lac 0.9 mmol/L, then the child weaned off successfully from ECMO. Two days later, the child was successfully extubated. After two weeks treatment, the patient was discharged. The main complication associated with extracorporeal membrane oxygenation were bleeding.</p><p><b>CONCLUSION</b>ECMO is an effective mechanical assistant therapy method for severe pulmonary and cardiac failure in a child.</p>