A preliminary investigation of relationship between serum apelin level and pulmonary artery pressure in children with congenital heart disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To preliminarily investigate the relationship between serum apelin level and pulmonary artery pressure in children with congenital heart disease.</p><p><b>METHODS</b>One hundred and twenty-six children with congenital heart disease undergoing surgical treatment were enrolled as subjects. The serum level of apelin was determined before surgery and at 7 days after surgery. The ratio of pulmonary artery systolic pressure to aortic systolic pressure (Pp/Ps) was calculated before extracorporeal circulation. According to the Pp/Ps value, patients were classified into non-pulmonary arterial hypertension (PAH) group, mild PAH group, moderate PAH group, and severe PAH group. Pulmonary artery mean pressure was estimated by echocardiography at 7 days after surgery.</p><p><b>RESULTS</b>The non-PAH group had the highest serum level of apelin before and after surgery, followed by the mild PAH group, moderate PAH group, and severe PAH group (P<0.05). All groups had significantly increased serum levels of apelin at 7 days after surgery (P<0.05). The serum level of apelin was negatively correlated with pulmonary artery pressure before surgery (r=-0.51, P<0.05) and at 7 days after surgery (r=-0.54, P<0.05).</p><p><b>CONCLUSIONS</b>The decrease in serum apelin level is associated with the development of pulmonary hypertension in children with congenital heart disease. The significance of serum apelin in predicting the development and degree of pulmonary hypertension in children with congenital heart disease deserves further studies.</p>

Protective effect of cold autologous blood cardioplegic solution on the heart of infants with cyanotic congenital heart disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the protective effect of cold autologous blood cardioplegic solution on the heart of infants with cyanotic congenital heart disease (CCHD).</p><p><b>METHODS</b>Ninety-six infants with CCHD who underwent cardiopulmonary bypass (CPB) were randomly and equally divided into three groups: histidine-tryptophan-ketoglutarate (HTK) solution, cold non-autologous blood cardioplegic solution, and cold autologous blood cardioplegic solution. The right auricular tissues were taken before aortic cross-clamping and at 30 minutes after aortic declamping, and ATP level and energy charge (EC) in the myocardium were measured. Venous blood was collected before and immediately after CPB, and the serum levels of creatine kinase (CK)-MB and cardiac troponin I (cTnI) were measured. The clinical parameters, such as the re-beat time and re-beat rate during CPB, cardiac index, dependence on positive inotropic agents, and left ventricular ejection fraction (LVEF) at 2 hours after CPB, the incidence rate of arrhythmia within 24 hours after CPB, and postoperative complications and mortality, were recorded.</p><p><b>RESULTS</b>At 30 minutes after aortic declamping, the three groups showed significantly decreased ATP and EC levels (P<0.05), and the cold autologous blood group had significantly higher ATP and EC levels than the other two groups (P<0.05). Immediately after CPB, the three groups showed significantly increased serum levels of CK-MB and cTnI (P<0.05), and the cold autologous blood group had significantly lower serum levels of CK-MB and cTnI than the other two groups (P<0.05). The cold autologous blood group had significantly better outcomes than the other two groups in terms of the re-beat time during CPB and the dependence on positive inotropic agents and LVEF at 2 hours after CPB (P<0.05).</p><p><b>CONCLUSIONS</b>Cold autologous blood cardioplegic solution is superior to HTK and cold non-autologous blood cardioplegic solutions in preserving myocardial energy and reducing myocardial injury in infants with CCHD who undergo CPB, thus providing a better protective effect on the heart.</p>

One-stage complete correction of 52 cases infantile aortic coarctation or interrupted aortic arch associated with intracardiac anomalies / 中华外科杂志

<p><b>OBJECTIVE</b>To sum up one-stage complete correction of infantile aortic coarctation (CoA) or interrupted aortic arch (IAA) associated with intracardiac anomalies through median sternotomy.</p><p><b>METHODS</b>The clinical data of 52 infants with CoA or IAA associated with intracardiac anomalies from May 2004 to March 2010 was analyzed. There were 32 male and 20 female, aged from 25 d to 7 months with a mean of (2.03 ± 0.15) months, weighted from 2.5 to 8.0 kg with a mean of (3.9 ± 0.5) kg. All of intracardiac defect were corrected by self-arcula cordisand. Forty cases with CoA were underwent by operative techniques, including resection with end to side anastomosis, extended end to side anastomosis (n = 34), and vertical incision and cross joint (n = 3). Three cases of pseudo-CoA were cut and ductus arteriosus or ligamentum arteriosus and dissected arch. Twelve cases of IAA were underwent by extended end to side anastomosis.</p><p><b>RESULTS</b>The time of cardiopulmonary bypass was (98 ± 41) min, and all patients hemorrhaged (78 ± 13) ml during operation. One case of IAA associated with double outlet right ventricle died after 43 d post-operation because of left bronchial stenosis. The other patients were in good condition. The rate of aneurysm formation was 11% in 1 to 6 years' follow-up.</p><p><b>CONCLUSIONS</b>One-stage complete correction of infantile CoA or IAA associated with intracardiac anomalies through median sternotomy yields excellent intermediate surgical results. This operative approach is beneficial, not only with shorten period of therapy and loss operative cost.</p>

A series of observation on the expression of TGF-beta1 in the lung of nitrofen-induced congenital diaphragmatic hernia rat model / 中华外科杂志

<p><b>OBJECTIVE</b>To access the expression of transforming growth factor beta1 (TGF-beta1) in the lung of Nitrofen-induced congenital diaphragmatic hernia rat model.</p><p><b>METHODS</b>Twelve timed-pregnant Sprague-Dawley rats were randomly divided into two groups, namely control group and CDH group on day 9.5 of gestation. Each rat in the CDH group was given 125 mg of Nitrofen (dissolved in seed fat) by gavage. Each rat in the control group was given the same dose of single oil. On day 16 of gestation, the two groups mentioned above were divided into three subgroups, and fetuses were delivered by cesarean section respectively on day 16, 18 and 21 of gestation. After the fetuses were checked for diaphragmatic hernia, lung tissue weight (LW) and body weight (BW) of each fetus on gestational day 21 were recorded. Lung histologic evaluations were made with microscope and TGF-beta1 immunohistochemistry staining were performed with image analyzing.</p><p><b>RESULTS</b>At day 16 of gestation, no visible diaphragm closure was observed in all fetuses. Diaphragmatic hernia was observed in 32 of the 44 rat fetuses of the CDH groups on day 18 and day 21 of gestation (72.7%). Lw/Bw of the 21d subgroups of CDH group were lower than those of corresponding control group (P < 0.01). Observed under the microscope, the lungs of fetuses in CDH groups showed marked hypoplasia. The expression of TGF-beta1 was detected in cytoplasmic, without definite expression in nuclear. It was significantly stronger that the expression of TGF-beta1 was in the lungs of the CDH group than that of the control group (P < 0.01).</p><p><b>CONCLUSIONS</b>Nitrofen interferes with lung development in early stage of the fetal before the diaphragm developed. TGF-beta1 would be one of the important factors which lead to pulmonary hypoplasia.</p>

Non-thoracoscopic Nuss procedure for correction operation of pectus excavatum / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experience in correction operation of pectus excavatum with non-thoracoscopic Nuss procedure.</p><p><b>METHODS</b>From September 2005 to August 2007, 108 patients with pectus excavatum were surgically corrected by non-thoracoscopic Nuss procedure. There were 91 male patients and 17 female patients. The age was from 2 years and 10 months old to 25 years old with an average of 7 years and 9 months old. The Haller indexes were from 3.6 to 10.1 before the operation.</p><p><b>RESULTS</b>The operation in all patients had been performed successfully without any severe complications. The average time of operation was 40 minutes. The average bleeding volume during procedure was 10 ml. Uneventful recovery was achieved in all the cases. Excellent outcome was obtained in the follow-up of 2 months to 21 months in 92 patients.</p><p><b>CONCLUSIONS</b>Non-thoracoscopic Nuss procedure for correction of pectus excavatum is safe and effective. It is unnecessary to perform the procedure into thoracic cavity so that there is less trauma and shorter time for the operation.</p>