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Objective To evaluate retained fetal cardiovascular function after radio frequency ablation in complicated monochorionic diamnionic twins.Methods A total of 19 complicated monochorionic diamnionic twins [10 twin-twin transfusion syndrome (TTTS) and 9 selective intrauterine growth restricted (sIUGR)] who were diagnosed at Fetal Medicine Center of the First Affiliated Hospital of Sun Yat-Sen University from December 2013 to July 2015 were enrolled,and the cardiovascular profile score (CVPS) and Tei index of retained fetus were measured preoperatively and postoperatively at 24 h,3 days,1 week,1 month,2 months respectively.Each case was matched by normal fetuses with same gestational age as control group and the same parameters were measured.Results (1) TTTS:CVPS [(8.71 ± 1.11) scores] was increased significantly at 3 days postoperatively compared with preoperation [(6.86 ± 2.12) scores],and there was a statistical significance (t =2.571,P ＜ 0.05);CVPS [(9.29-± 0.95) scores] had no statistical significance 1 month postoperatively (P ＞ 0.05) as compared with controls [(10.00 ± 0.00) scores].Tei indexes of the left ventricle (LV-Tei) (0.41-± 0.06) and Tei indexes of the right ventricle (RV-Tei) (0.42 ± 0.06) decreased as compared with those before operation (LV-Tei:0.66 ± 0.19,RV-Tei:0.63 ± 0.12) with significant difference (LV:t =-3.193,P ＜ 0.05;RV:t =-3.565,P ＜ 0.05),but there was no statistical significance 1 month after operation(all P ＞ 0.05) as compared with the controls (LV-Tei:0.35-± 0.03,RV-Tei:0.35-± 0.03).(2) sIUGR:CVPS [(9.71 ± 0.45) scores] showed no statistical significance 1 week after operation (P ＞ 0.05) as compared with controls [(10.00 ± 0.00) scores].Tei indexes of the right and left ventricle 1 week after operation were lower than after operation with significant difference (LV-Tei:0.39 ± 0.04 vs.0.47 ± 0.06,t =-6.687,P ＜ 0.01;RV-Tei:0.38 ± 0.04 vs.0.47 ± 0.05,t =-6.000,P ＜ 0.01).Compared with the controls,RV-Tei (0.38 ± 0.04)had no statistical significance 1 week after operation (P ＞ 0.05),LV-Tei (0.36-± 0.02) showed no statistical significance 1 month after operation (P ＞ 0.05).Conclusions Retained fetal cardiovascular function of TTTS and sIUGR can be restored obviously after operation.In TTTS,its cardiovascular function is recovered completely 1 month postoperatively.In sIUGR,its cardiovascular function is recovered completely 1 week postoperatively.
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Objective To analyze the preoperative related factors of early weaning of infants with congenital heart disease after operation. Methods From January ,2014 to January ,2017 in Pediatric Cardiology CICU , infants with congenital heart disease were selected as research objects. The clinical data were retrospectively collect ed and the relationship between preoperative influencing factors and postoperative early weaning were analyzed. Early weaning meant mechanical ventilation time was shorter than 24 h and late weaning meant longer than 24 h. Results Single factor analysis showed that early weaning success rate was related to preoperative cardiac function grade 1,NNIS grade 0~1,ASA grade 1,no lung infection and no or mild pulmonary hypertension(average P<0.05). Non conditional logistic regression analysis showed that preoperative heart function grade 1 was an indepen-dent influencing factor,with OR value(95%CI)of 3.9(1.9~7.7). Conclusions In infants with congenital heart disease,preoperative heart function grade 1,NNIS grade 0 ~ 1 ,ASA grade 1,no lung infection and no or mild pulmonary hypertension benefit early withdrawing of ventilator and preoperative cardiac function grade 1 is an inde-pendent factor for early weaning.
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Objective To evaluate Doppler spectrum of ductus venosus(DV) in selective intrauterine growth restricted(sIUGR) pregnancies.Methods Thirty-five sIUGR pregnancies and 35 normal single pregnancies with same gestational week were enrolled,there were 10 sIUGR Ⅰ,13 sIUGR Ⅱ and 12 sIUGR Ⅲ in sIUGR.Spectrum of ductus venosus,such as DV S wave,DV D wave,DV A wave,DV PI,DV PLI and S/A were assessed.Results ① There was no significantly difference in spectrum of ductus venosus between bigger of sIUGR,smaller of sIUGR Ⅰ with normal fetus (all P ＞0.05).② Compared with normal fetus,DV-PI,DV-PLI and S/A were significant higher in smaller of sIUGR Ⅱ and sIUGR Ⅲ (P ＜0.05);DV-S wave,and DV-D wave showed no significantly difference in smaller of sIUGR Ⅱ and sIUGRⅢ (P ＞0.05).Conclusions Spectrum of ductus venosus in bigger of sIUGR and smaller of sIUGR Ⅰ are mainly normal,and nearly in good condition in utero,inversely,abnormal spectrum of ductus venosus commonly exists in smaller of sIUGR Ⅱ and sIUGR Ⅲ,and supervision should be done carefully in these group.
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Objective To investigate the risk factors of extubation failure following surgical repair of congenital heart defects (CHD) in infants.Methods Infantile patients who underwent surgical repair of CHD under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to October 2016 were included.According to results of extubation,the patients were divided into the extubation failure group and extubation success group.Clinical and laboratory data were collected and analyzed,including age,gender,body mass,the types of congenital heart disease,extracorporeal circulation time and the use of vasoactive drug,et al.Results Sixty cases were enrolled in this study.Among them 12 cases (7 males,5 females with the boy to girl ratio of 1.4 ∶ 1.0,and average age was 0.56 years old) were in the extubation failure group,in which 3 cases (25.0％)aged ＜3 months,5 cases(41.6％) aged 3-6 months.Eight cases(66.7％) weighed ≤5 kg and 4 cases(33.3％)weighed ＞ 5-10 kg.Forty-eight cases (27 males,21 females;the boy to girl ratio was 1.2 ∶ 1.0 and average age was 1.15 years old) were in the extubation success group.The distribution of age and body weight were significantly lower in the extubation failure group than those in the extubation success group [0.42 (0.37) years old vs.1.00 (1.08)years old,Z=-3.22,P＜0.01;5.00 (1.25) kgvs.8.40 (3.95) kg,Z=-3.57,P＜0.01].The durations of CPB and mechanical ventilation until the initial extubation were significantly longer in the extubation failure group than those in the extubation group [114.0 (110.O) minutes vs.80.0 (45.0) minutes,Z =1.59,P ＜ 0.05;142.5 (229.5)hours vs.14.0 (48.9) hours,Z =2.00,P ＜ 0.05].The incidences of airway spasm and pulmonary infection had no difference between the 2 groups (x2 =4.00,5.54,all P ＞ 0.05).Multiple Logistic regression showed thatthe duration of CPB was an independent risk factor of extubation failure [odds ratio (OR) =0.967,95％ CI:0.956-0.997,P =0.024].Conclusions The risk factors of extubation failure include young age,low body weight,and prolonged CPB and mechanical ventilation.CPB time is an independent risk factor of extubation failure following cardiac surgery in infants.
ABSTRACT
Objective To investigate the risk factors of extubation failure following surgical repair of congenital heart defects (CHD) in infants.Methods Infantile patients who underwent surgical repair of CHD under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to October 2016 were included.According to results of extubation,the patients were divided into the extubation failure group and extubation success group.Clinical and laboratory data were collected and analyzed,including age,gender,body mass,the types of congenital heart disease,extracorporeal circulation time and the use of vasoactive drug,et al.Results Sixty cases were enrolled in this study.Among them 12 cases (7 males,5 females with the boy to girl ratio of 1.4 ∶ 1.0,and average age was 0.56 years old) were in the extubation failure group,in which 3 cases (25.0％)aged ＜3 months,5 cases(41.6％) aged 3-6 months.Eight cases(66.7％) weighed ≤5 kg and 4 cases(33.3％)weighed ＞ 5-10 kg.Forty-eight cases (27 males,21 females;the boy to girl ratio was 1.2 ∶ 1.0 and average age was 1.15 years old) were in the extubation success group.The distribution of age and body weight were significantly lower in the extubation failure group than those in the extubation success group [0.42 (0.37) years old vs.1.00 (1.08)years old,Z=-3.22,P＜0.01;5.00 (1.25) kgvs.8.40 (3.95) kg,Z=-3.57,P＜0.01].The durations of CPB and mechanical ventilation until the initial extubation were significantly longer in the extubation failure group than those in the extubation group [114.0 (110.O) minutes vs.80.0 (45.0) minutes,Z =1.59,P ＜ 0.05;142.5 (229.5)hours vs.14.0 (48.9) hours,Z =2.00,P ＜ 0.05].The incidences of airway spasm and pulmonary infection had no difference between the 2 groups (x2 =4.00,5.54,all P ＞ 0.05).Multiple Logistic regression showed thatthe duration of CPB was an independent risk factor of extubation failure [odds ratio (OR) =0.967,95％ CI:0.956-0.997,P =0.024].Conclusions The risk factors of extubation failure include young age,low body weight,and prolonged CPB and mechanical ventilation.CPB time is an independent risk factor of extubation failure following cardiac surgery in infants.