Clinical Value of Pulmonary Artery Parameters and Pulmonary Valve Annulus Z Scores for Choosing the Type of Operation in Complete Repaire of Pediatric Tetralogy of Fallot / 中国循环杂志

Objective: To investigate the clinical value of transthoracic echocardiography (TTE) measured pulmonary artery parameters and pulmonary valve annulus Z scores for choosing the type of operation in complete repair of pediatric tetralogy of Fallot (TOF) Methods: A total of 143 patients received complete repair of pediatric TOF in our hospital were retrospectively studied. The patient's median age was 8 (1-171) months. Based on the type of operation, patients were divided into 2 groups: Trans-annular patch group, n=100 and Valve sparing repair group, n=43. Conventional TTE parameters, right ventricular outflow parameters and pulmonary valve annulus Z scores were compared between 2 groups; pulmonary valve annulus diameters measured by TTE and surgery were studied by correlation analysis. Results: Compared with Valve sparing repair group, Trans-annular patch group had decreased left ventricular end diastolic diameter (23.14±3.82) mm vs (25.23±4.56) mm, pulmonary valve annulus diameter (8.52±2.18) mm vs (10.01±2.61) mm and main pulmonary artery diameter (67.31 vs 82.91) all P<0.05. With reduced value of pulmonary valve annulus Z scores, the constituent ratio in Trans-annular patch group was gradually increasing and in Valve sparing repair group was gradually decreasing, all P<0.05. Correlation analysis indicated that pulmonary valve diameters measured by TTE and surgery had moderate agreement (r=0.581, P<0.001). Conclusion: TTE measured pulmonary valve annulus diameter, main pulmonary artery diameter and pulmonary valve annulus Z scores were the objective parameters provided to surgeon at pre-operation, which had clear clinical value.

Effects of home visiting on care burden and positive experience in caregivers of cerebral apoplexy patients / 中华护理杂志

Objective To evaluate the effects of home visiting on care burden and positive experience in caregivers of cerebral apoplexy patients.Methods The recruited 80 caregivers of cerebral apoplexy patients were randomly divided into the experimental group and the control group,with 40 cases in each group;the experimental group received nursing intervention of home visiting,while the control group received routine nursing guidance.Zarit Caregiver Burden Interview (ZBI) and Positive Aspects of Caregiver (PAC) were used to evaluate the care burden and positive experience in caregivers of cerebral apoplexy patients after 24 weeks.Results After the intervention,the burden of care of caregivers in the experimental group was significantly lower and the positive experience in the experimental group was significantly higher than those in the control group,and the differences were both statistically significant (P＜0.01).Conclusion Nursing intervention of home visiting can decrease caregiver burden and increase positive experience of caregivers of cerebral apoplexy patients.

Evaluation of coronary artery diameter in normal children by echocardiography and its clinical significance / 中华儿科杂志

<p><b>OBJECTIVE</b>To obtain normal range of coronary artery diameter with body surface area (BSA) dynamic changes in normal children at different age.</p><p><b>METHOD</b>The left main coronary artery (LCA), left anterior descending artery (LAD), left circumflex artery (LCX) and the right coronary artery (RCA) diameter were measured in 400 normal subjects from Chinese population aged 0 d to 18 years [(6.43 ± 4.45) years], using HP Sonos 5500 color Doppler ultrasonic system, according to the standard method of measuring the coronary artery diameter.</p><p><b>RESULT</b>(1) The diameters of LCA, LAD, LCX and RCA in different age groups (0 d-12 months, -3 years, -6 years, -9 years, -12 years, -18 years) had significant differences (F = 61.688, 51.343, 46.375, 50.192, P < 0.01,all groups mean differences had significant differences, there was significant difference between every two groups, P < 0.05), there were no significant differences between male and female subjects (P > 0.05). (2) The correlation analyses showed that the diameter of LCA, LAD, LCX and RCA had significant linear correlations with age, height, weight and BSA (r ranged from 0.71 to 0.85, P < 0.01 ). (3) The regression analyses were respectively performed on the diameters of LCA, LAD, LCX and RCA with BSA to establish seven regression models. The coefficients were compared for each model, the best model was chosen to create a Z score calculator, tracing out the Z value curve, through clinical practice,we chose Z score within ± 2 as the coronary artery diameter's normal range for Chinese children.</p><p><b>CONCLUSION</b>Coronary artery diameter's Z score curve is effective and reliable, it provide objective basis for clinicians and sonographers to accurately and quickly diagnose the anomalies in diameter of coronary artery.</p>

Congenital vascular rings: a rare cause of respiratory distress in infants and children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Congenital vascular rings may often cause unexplained respiratory symptoms in infants and young children. Their diagnosis and treatment are often delayed. Few studies of vascular rings have been reported in China. The aim of this study was to describe the clinical presentation, diagnosis and surgical management of infants and children with congenital vascular rings.</p><p><b>METHODS</b>Clinical histories, physical examinations, investigations, image studies and surgical interventions were retrospectively evaluated in 7 children (age range: 2 months-4 years, mean 7 months) with congenital vascular rings. Chest radiography was performed in all patients. Echocardiography and computed tomography (CT) with 3-dimensional (3D) reconstructions were performed in 6 patients. Esophagography, cardiac catheterization and angiography, and bronchoscopy were performed in 1, 1 and 4 children, respectively.</p><p><b>RESULTS</b>Six of the 7 patients had respiratory symptoms, including recurrent cough, stridor and wheeze. Age at onset of symptoms ranged from 1 month to 11 months. Chest X-ray showed nothing important on the vascular rings, besides bronchitis and pneumonia. Contrast-enhanced CT diagnosed vascular rings in 6 patients. Four patients had double aortic arches, two had balanced arches and two were right arch dominant. One patient had a right aortic arch with left ligament and 1 patient had a pulmonary artery sling. Echocardiography failed to diagnose vascular rings in 2 patients. The esophagogram of 1 patient showed esophageal compression. Bronchoscopy of 4 patients showed compression of the distal trachea. Five of the 7 patients underwent surgical division of the vascular rings. Surgical observation confirmed the CT findings in each patient.</p><p><b>CONCLUSIONS</b>Patients, especially infants or young children, with recurrent respiratory symptoms such as chronic cough, stridor and wheeze, should be examined for the possible presence of congenital vascular rings. Contrast-enhanced CT can clearly show the anatomy of vascular rings. As a noninvasive technique, echocardiography is helpful for diagnosis. Early surgical management in symptomatic patients is effective.</p>

Diagnosis and Treatment of 6 Children with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery / 实用儿科临床杂志

Objective To analyze diagnostic experience of children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and assess its surgical results.Methods Six children with ALCAPA had been diagnosed in our hospital from Mar. 2006 to Oct.2007 aged from 6 months to 10 years old(median 43.5 months).The medical data included common clinical presentations,the findings of electrocardiogram(ECG),the echocardiogram,ECG-gated 64-slice computed tomography,the digital subtraction angiogram (DSA),surgical records and the outcome.Results Diaphoresis,fantod,breathlessness and difficult feeding were commonly presented in 5 cases ALCAPA and the 5 children presented with left ventricular failure in infancy.The predominant ECG findings were Q waves and ST segment changes in the anterolateral chest leads in 4 cases,ST changes in 1 case,and normal ECG in 1 case.Cross-sectional echocardiography showed dilated left ventricles with poor contractility in 4 cases,medium mitral regurgitation in 2 cases and severe mitral regurgitation in 2 cases,aneurysmal dilatation of the right coronary artery(RCA) in 2 cases.CT and DSA examinations showed characteristic changes in these children.The surgical reestablishment of a two-coronary system was performed in 5 cases,direct reimplantation in 2 cases and creation of an autologous extrapulmonary tunnel in 3 cases.Simultaneous mitral annuloplasty was performed in 2 cases.After operation,the symptoms of 5 cases were all improved and none died.Conclusions Understanding the clinical manifestations and lab findings of ALCAPA is helpful to making an early diagnosis of ALCAPA.Early surgical treatment can improve the patients′ outcome.