Application of neurally adjusted ventilatory assist in infants who underwent cardiac surgery for congenital heart disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to neural effort. This study aimed to compare the hemodynamic safety, oxygenation and gas exchange effects ventilated with NAVA and with pressure support ventilation (PSV) in infants who underwent open-heart surgery.</p><p><b>METHODS</b>Twenty-one infants who underwent open-heart surgery for congenital heart disease (mean age 2.9+/- 2.1 months and mean weight 4.2+/- 1.4 kg) were enrolled. They were ventilated with PSV and NAVA for 60 minutes respectively in a randomized order. The hemodynamic, oxygenation and gas exchange effects produced by the two ventilation modes were compared.</p><p><b>RESULTS</b>Three cases failed to shift to NAVA because of the bilateral diaphragmatic paralysis after operation. In the other 18 cases, there were no significant differences in the heart rate (HR), systolic blood pressure (BPs) and central venous pressure (CVP) in the two ventilation modes. The PaO2/FiO2 (P/F) ratio in NAVA was slightly higher than in PSV, but there was no statistical difference. PaCO2 did not show significant differences in the two modes. The peak inspiratory pressure (PIP) and electrical activity of the diaphragm (EAdi) in NAVA were significantly lower than in PSV. The EAdi signal after extubation was higher in infants who needed reintubation or intervention of noninvasive mechanical ventilation than in those who were extubated successfully (30.0+/- 8.4 microV vs 11.1+/- 3.6 microV; P<0.01).</p><p><b>CONCLUSIONS</b>As the first study of application of NAVA in infants in China, this study shows that NAVA has the same homodynamic effects as PSV. However the PIP for maintaining the same level of PaCO2 in NAVA is significantly lower than that in the traditional PSV. Monitoring the EAdi signal after extubation may show the risks of reintubation or intervention of noninvasive mechanical ventilation.</p>

Arterial switch operation for transposition of the great arteries and double outlet of right ventricle with subpulmonary ventricular septum defect / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical experience on the arterial switch operation for complex congenital heart disease in recent 3 years in our hospital.</p><p><b>METHODS</b>Sixty-one patients with complex congenital heart disease received by arterial switch operation from Jan 2000 to May 2003. There were 26 patients with transposition of the great arteries and intact ventricular septum (TGA-IVS), 19 patients with transposition of the great arteries and ventricular septal defect (TGA-VSD) and 16 patients with double outlet of right ventricle with subpulmonary ventricular septum defect (Taussig-Bing).</p><p><b>RESULTS</b>There were 2 death among TGA-IVS cases, 4 deaths among TGA-VSD cases and 4 deaths among Taussig-Bing cases. The total operative mortality was 16%. All patients were followed up 3 months to 3 years. In all patients, the cyanosis disappeared and the physical activities increased obviously. One patients with Taussig-Bing keep moderate mitral valve reflux unchanged, 2 patients with TGA had pulmonary and aortic supra-valve stenosis with 40 mmHg pressure gradient. One patient with subpulmonary stenosis and residual VSD was re-operated 3 months later. All survivor had good heart function.</p><p><b>CONCLUSIONS</b>The effect of arterial switch operation on the treatment of TGA was well accepted in this study. The procedure used in treatment on Taussig-Bing can prevent pulmonary obstruction and avoid the complication of left ventricular outflow tract obstruction caused by intraventricular repair.</p>

Application of peritoneal dialysis for the treatment of acute renal failure in children underwent cardiac surgery / 中华胸心血管外科杂志

5.5mmol/L),persistent metabolic acidosis,or low cardiac output syndrome.Following data were collected in all patients:time to ni- tiation and duration of PD;time point of the recovery of urine output;baseline serum creatinine level(Cr0),rise of Cr(Crl),peak Cr (Cr2),descending Cr(Cr3),recovery of Cr(Cr4);and their corresponding postoperative time points.Results Of the 63 patients,58 (92.1%)required PD.Overall mortality rate was 33.3%(21/63).Patients undergone more complex surgery requiring longer aortic damping time;have higher Cr0,Cr2,Cr3 and longer period of the recovery of Cr and urine output(P6d)was associated with more complicated surgical procedure,higher Cr1 and Cr2,delayed recovery of Cr and urine output after surgery,longer period of low cardiac output syndrome,more dysfunctional organs,longer mechanical ventilation and ICU stay postoperatively(P