ABSTRACT
Objective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.
ABSTRACT
Objective:To investigate the efficacy and safety of Treprostinil in the treatment of children with early decompensation after the Fontan procedure.Methods:A retrospectively analysis was performed on the clinical data of 16 children with early decompensation after the Fontan procedure treated with Treprostinil injection from December 2017 to June 2020 at Fuwai Central China Cardiovascular Hospital.A total of 16 patients were included, including 5 boys (31.2%) and 11 girls (68.8%). The age was (4.6 ±1.2) years, the weight was (16.0±2.1) kg.The changes of central venous pressure (CVP), heart rate (HR), systolic blood pressure (SBP), central venous oxygen saturation (ScvO 2), lactic acid (Lac), oxygenation index and B-type natriuretic peptide (BNP) were recorded at the infusion of Treprostinil and 3 hours, 24 hours, 48 hours and 72 hours after the infusion.The short-term efficacy of Treprostinil was observed[mortality, mechanical ventilation time, and length of intensive care unit (ICU) stay]; paired t-test was used to analyze the above indexes at different time points.The adverse reactions during the administration were also recorded. Results:Of the 16 children, the median mechanical ventilation time was 9 (5, 22) h, and the median ICU stay time was 2 (1, 12)days.After 72 hours of drug administration, CVP, Lac, BNP and HR decreased: CVP decreased from(16±5) mmHg (1 mmHg=0.133 kPa) to (11±2) mmHg ( P<0.001), Lac decreased from(6.8±3.2) mmol/L to (3.2±1.2) mmol/L ( P=0.002), BNP decreased from(980±223) ng/L to (250±120) ng/L( P<0.001), HR decreased from(150±20) times/min to (125±16) times/min( P=0.002); SBP, ScvO 2 and oxygenation index increased: SBP increased from(83±10) mmHg to (98±12) mmHg( P<0.001), ScvO 2 increased from 0.53±0.13 to 0.65±0.11 ( P=0.003), oxygenation index increased from (200±72) mmHg to (298±13) mmHg ( P<0.001), and the differences were statistically significant(all P< 0.05). One case died (6.3%), 2 cases (12.5%) had transient blood pressure drop and 1 case (6.3%) had nausea and vomiting.Besides, no other treatment-related complications were observed. Conclusions:As for children with early decompensation after the Fontan procedure, the intravenous application of Treprostinil can reduce pulmonary artery pressure rapidly, effectively improve circulatory status and oxygenation and ultimately improve the prognosis.
ABSTRACT
Objective@#To investigate the efficacy of Levosimendan in the treatment of postoperative low cadiac output syndrome (LCOS) in infants with congenital heart disease (CHD).@*Methods@#Clinical data of patients with CHD developed postoperative LCOS in the Children Heart Center of Fuwai Central China Cardiovascular Hospital from January to December 2018 was collected.In patients that traditional vasoactive drugs failed to alleviate LCOS, the efficacy of continuous infusion of 0.1 μg/(kg·min) Levosimendan was observed.Besides, the mechanical ventilation time, ICU stay time, mortality, the changes of ejection fraction (EF) and central venous oxygen saturation (ScvO2) at the infusion of Levosimendan and 48 h after infusion, as well as the changes of heart rate (HR), systolic blood pressure (SBP), vasoactive drugs score (VIS) and lactic acid at the infusion of Levosimendan and 3 h, 6 h, 12 h, 24 h and 48 h after infusion were recorded.@*Results@#There were 29 cases, including 17 males (58.6%) and 12 females (41.4%), with median age of 2 (0.5, 40.0) months, median body mass of 4.7 (2.6, 13.5) kg, median mechanical ventilation time of 109.5 (42.5, 367.0) h, ICU stay time of 187.5 (83, 446) h, and 1 case died (3.4%). EF (48% vs.52%) and ScvO2 (53% vs.58%) increased 48 h after infusion, and the differences were statistically significant (all P<0.01). HR level (173 times/min, 176 times/min, 175 times/min, 173 times/min, 170 times/min, 170 times/min) and lactic acid level (4.72 mmol/L, 4.65 mmol/L, 4.34 mmol/L, 3.79 mmol/L, 3.28 mmol/L, 2.74 mmol/L) gradually decreased after infusion, and the differences of both between the beginning of infusion and 48 h after infusion were statistically significant (P=0.029); SBP decreased and then increased (74 mmHg, 70 mmHg, 71 mmHg, 73 mmHg, 74 mmHg, 75 mmHg, 1 mmHg=0.133 kPa), and VIS increased and then decreased (26 scores, 27 scores, 27 scores, 26 scores, 25 scores, 25 scores) at different time points after infusion, however, the data of both between the beginning of infusion and 48 h after infusion had no significant differences (P=0.294, 0.151).@*Conclusions@#Levosimendan can increase EF, enhance myocardial contractility and systemic tissue perfusion, thus improving the prognosis, when Levosimendan was applied for the treatment of postoperative LCOS of infants with CHD.
ABSTRACT
Objective To investigate the efficacy of Levosimendan in the treatment of postoperative low cadiac output syndrome (LCOS) in infants with congenital heart disease (CHD).Methods Clinical data of patients with CHD developed postoperative LCOS in the Children Heart Center of Fuwai Central China Cardiovascular Hospital from January to December 2018 was collected.In patients that traditional vasoactive drugs failed to alleviate LCOS,the efficacy of continuous infusion of O.1 μg/(kg · min) Levosimendan was observed.Besides,the mechanical ventilation time,ICU stay time,mortality,the changes of ejection fraction (EF) and central venous oxygen saturation (ScvO2) at the infusion of Levosimendan and 48 h after infusion,as well as the changes of heart rate (HR),systolic blood pressure (SBP),vasoactive drugs score (VIS) and lactic acid at the infusion of Levosimendan and 3 h,6 h,12 h,24 h and 48 h after infusion were recorded.Results There were 29 cases,including 17 males (58.6％) and 12 females (41.4％),with median age of 2 (0.5,40.0) months,median body mass of 4.7 (2.6,13.5) kg,median mechanical ventilation time of 109.5 (42.5,367.0) h,ICU stay time of 187.5 (83,446) h,and 1 case died (3.4％).EF (48％ vs.52％)and ScvO2 (53％ vs.58％) increased 48 h after infusion,and the differences were statistically significant (all P ＜0.01).HR level (173 times/min,176 times/min,175 times/min,173 times/min,170 times/min,170 times/min) and lactic acid level (4.72 mmol/L,4.65 mmol/L,4.34 mmol/L,3.79 mmol/L,3.28 mmol/L,2.74 mmol/L) gradually decreased after infusion,and the differences of both between the beginning of infusion and 48 h after infusion were statistically significant (P =0.029);SBP decreased and then increased (74 mmHg,70 mmHg,71 mmHg,73 mmHg,74 mmHg,75 mmHg,1 mmHg =0.133 kPa),and VIS increased and then decreased (26 scores,27 scores,27 scores,26 scores,25 scores,25 scores) at different time points after infusion,however,the data of both between the beginning of infusion and 48 h after infusion had no significant differences (P =0.294,0.151).Conclusions Levosimendan can increase EF,enhance myocardial contractility and systemic tissue perfusion,thus improving the prognosis,when Levosimendan was applied for the treatment of postoperative LCOS of infants with CHD.
ABSTRACT
Objective To investigate the feasibility and safety of surgical device closure of doubly committed sub-arterial ventricular septal defect via left sub-axillary.Methods A total of 45 patients diagnosed as doubly committed sub-arterial ventricular septal defect (dcVSD) with transthoracic echocardiography (TTE) and transesophageal echocardiography(TEE) were enrolled from June 2014 to August 2016 in Henan Children Heart Center,Henan Provincial People's Hospital.There were 39 males and 6 females,with the mean age of (2.2 ±2.1) years old(0.5-8.0 years),the body weight (13.8 ± 7.1) kg(7.0-34.1 kg),the defect size (4.5 ± 1.0) mm (3.0-8.0 mm).After general anesthesia,the patients were in supine and evaluated by TEE which indicated whether they were fit to closure.Then,they were turned to the right lateral position while this technique was determined.A vertical incision of 2-3 cm was made between the third and the fifth intercostal space and invasion in thoracic space via fourth intercostal space.Puncture was done at the anterior surface of right ventricular outlet tract to build a delivery tract.The occluder was released and the VSD was occluded under transesophageal echocardiography guidance.Results Forty-one patients had a successful surgical dcVSD closure with asymmetric occluders sized (6.0 ± 1.5) mm(4-10 mm).Among 4 failure cases,2 cases (4.4％) were switched to open-heart surgical repair,1 case (2.2％) due to device related aortic regurgitation,the rest 1 case (2.2％) experienced a dislocation of occluder into pulmonary artery and was converted to surgical repair after retrieve of occluder.Trivial residual shunt was detected in 2 cases (4.4％) postoperatively,a spontaneous closure was observed by 1 month follow-up and 3 months follow-ups,respectively.All the patients were discharged 5 to 8 days after the operation.With a follow-up of (10.4 ±5.0) months [3-24 months],there were no complications such as pericardial effusion,displacement of device,atrioventricular block or new valvular dysfunction.Conclusions Minimally invasive device closure of doubly committed sub-arterial ventricular septal defect via left sub-axillary is a feasible and safe treatment for closure of dcVSD.This technique has advantages of minor wound,less exudation,covert incision,however,long term follow-up is necessary.
ABSTRACT
Objective To explore the clinical diagnosis of tetralogy of Fallot( TOF) children with concurrent DiGeorge syndrome ( DGS ) . Methods Retrospective analyses were conducted for the clinical characteristics of 715 TOF children with concurrent DGS at Henan Provincial People′s Hospital and the Third Affiliated Hospital of Zheng-zhou University from January of 2008 to October of 2014. Among them,there were 78 definite cases of thymic aplasia (DGS group),including 45 boys and 33 girls with an age range of(9. 12±4. 35) months and a body mass range of (7. 28±2. 34) kg. And the remainder was designated as non-DGS group(NDGS group),including 387 boys and 250 girls with an age range of(8. 21±5. 61) months and a body mass range of(8. 19±3. 47) kg. In DGS group,genetic screening uncovered 10 cases of chromosome 22q11. 2 gene deletion. And based upon this result,DGS group was fur-ther divided into genetic and clinical diagnosis subgroups. The genetic diagnosis group had 10 cases,including 6 boys and 4 girls with an age range of(8. 12±4. 15) months and a body mass range of(6. 28±2. 74) kg,the clinical diagnosis group had 68 cases,including 39 boys and 29 girls with an age range of(8. 19±4. 37) months and a body mass range of (7. 05±2. 39) kg. Results No statistical difference existed in age,body mass or preoperative developmental status of pulmonary vasculature between DGS group and NDGS group(P>0. 05). And the preoperative incidence of recurrent pneumonia was obviously higher in DGS group than that in NDGS group(P0. 05). And an inter-group comparison of T lymphocyte immunity defect had no statistical difference(P>0. 05). The duration of on-machine and intensive care unit stay was markedly longer in DGS group than that in NDGS group(P0. 05). And an inter-group comparison of T lymphocyte immunity defect had no statistical difference ( P>0. 05 ) . Conclusions With diverse clinical manifestations,DGS patients may have non-specific findings of cellular immunity defect,hypocalcemia or facial malformation. TOF children with concurrent thymic aplasia should raise an alert so that effective interventions may be adopted to boost their long-term quality of life.
ABSTRACT
Objective:To study the preparation and quality control of loxoprofen sodium patches and develop an HPLC method for the determination of loxoprofen sodium. Methods:Loxoprofen sodium patches were prepared with CMC-Na and PVP as the adjuvants, and an HPLC method was used to determine the content of loxoprofen sodium. Results:The linear range of loxoprofen sodium was 4-24μg·ml-1(r=0. 999 7), the average recovery was 99. 99%(RSD=0. 99%, n=6). Conclusion:The preparation method is reason-able, simple and stable. The developed HPLC method is specific to determine the content of loxoprofen.