Understanding the Choice of Sleep Arrangements and Soothing Methods and Their Associations with Sleep Problems among Children Under 3 Years Old: A Chinese Population-Based Study / 生物医学与环境科学（英文）

Objective@#This study aimed to examine the sleep arrangements and soothing methods and to assess their associations with sleep problems among children aged < 3 years in China.@*Methods@#A cross-sectional survey was conducted in 2019 from six provinces in China. A total of 1,195 caregivers of children aged 0-35 months were included in the study. Data on sleep arrangements, soothing methods, and sleep problems (i.e., frequent night awakenings and difficulty falling asleep) were assessed using the Brief Infant Sleep Questionnaire. The reasons for bed-sharing in sleep arrangements were recorded using a self-designed questionnaire.@*Results@#The bed-sharing practice was very prevalent at any age, which ranged from 69.9% to 78.3%. Most infants fell asleep while feeding or being rocked/held before age 12 months. By age 35 months, 62.4% of the children fell asleep in bed near parents. The most common reasons for bed-sharing were breastfeeding/feeding and convenience. Parental involvement when falling asleep was significantly related with frequent night awakenings and difficulty falling asleep. No association was found between bed-sharing and sleep.@*Conclusion@#Bed-sharing and parental involvement were very common among Chinese children aged < 3 years. Children who fall asleep with parental involvement were more likely to have sleep problems.

Quality Measurement and Improvement Study of Surgical Coronary Revascularization: Medication Adherence (MISSION-2) / 中华医学杂志(英文版)

Background@#Secondary preventive therapies play a key role in the prevention of adverse outcomes after coronary artery bypass grafting (CABG). However, medication adherence after CABG is often poor, and conventional interventions for improving adherence have limited success. With increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve adherence. Carefully designed trials are needed to provide reliable evidence for the use of these applications in patients after CABG.@*Methods@#The Measurement and Improvement Studies of Surgical Coronary Revascularization: Medication Adherence (MISSION-2) study is a multicenter randomized controlled trial, aiming to randomize 1000 CABG patients to the intervention or control groups in a 1:1 ratio. We developed the multifaceted, patient-centered, smartphone-based Heart Health Application to encourage medication adherence in the intervention group through a health self-management program initiated during hospital admission for CABG. The application integrated daily scheduled reminders to take the discharge medications, cardiac educational materials, a dynamic dashboard to review cardiovascular risk factors and secondary prevention targets, and weekly questionnaires with interactive feedback. The primary outcome was secondary preventive medication adherence measured by the Chinese version of the 8-item Morisky Medication Adherence Scale at 6 months after randomization. Secondary outcomes included all-cause death, cardiovascular rehospitalization, and a composite of death, myocardial infarction, stroke, and repeat revascularization.@*Discussion@#Findings will not only provide evidence regarding the feasibility and effectiveness of the described intervention for improving adherence to CABG secondary preventive therapies but also explore a model for outpatient health self-management that could be translated to various chronic diseases and widely disseminated across resource-limited settings.@*Trial Registration@#https://clinicaltrials.gov (NCT02432469).

Development of the National Norms of Negligence on children aged 0 to 35 months in rural areas of China / 中华流行病学杂志

Objective To develop the National Norms of Negligence (NNN) for rural children aged 0 to 35 months.Methods According to multi-stage stratified cluster sampling principle,10 provinces or municipalities (Jilin,Shaanxi,Shanxi,Beijing,Anhui,Jiangsu,Hunan,Hubei,Yunnan,Chongqing) in China were selected.A national research group was formed collaboratively.A questionnaire was designed by ourselves.According to several statistical analysis methods,such as item,factor and reliability analysis etc.we determined the norm.The evaluation criteria of the scale were determined by percentile method.Finally,the reliability and validity of the norm were evaluated.Results In total,2310 children were surveyed,in which the effective sample were 2227,with an effective rate as 96.4％.The scale consisted of 6 neglected dimensions and 65 items in total.The total Cronbach's α coefficient of the scale was 0.903,with the split-half reliability coefficient as 0.829,the parallel reliability as 0.720 and the re-test reliability as 0.678,respectively.The total neglect cut-off score of this scale was 139.Conclusion The scale seemed to have perfect stability and reliability and all the statistical indicators met the psychometric demands.

Development of national neglect norms for children aged 3 to 6 years in rural areas of China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To develop the national neglect norms for rural children aged 3 to 6 years, which are suitable for Chinese situations.</p><p><b>METHODS</b>According to the multi-stage stratified cluster sampling principle, 84 towns of 10 provinces or municipalities were selected in China. Children aged 3 to 6 years were surveyed in November 2010, the sample of analysis were 3240 (of whom males were 49.6% (1608/3240) and the Han nationality were 93.3% (3023/3240)). Questionnaire was designed by authors and deleted items that did not meet the requirements through several statistical analysis methods, such as item analysis method, factor analysis method, reliability analysis method. The reliability analysis and validity analysis were used to test the stability and reliability of the norm. The evaluation criteria of the scale was determined by the percentile method, then the initial development of the norm completed.</p><p><b>RESULTS</b>After deleting inappropriate items by statistical processing, finally, the scale consisted of 57 items, and included 6 neglected dimensions (physical neglect, emotional neglect, educational neglect, safe neglect, medical neglect and social neglect). Its item loadings ranged from 0.359 to 0.789, which met the statistical requirements. The scale's total Cronbach α coefficients 0.904, the total split-half reliability coefficients were 0.820, the 6 neglect dimensions' Cronbach α coefficients ranged from 0.620 to 0.815, the 6 neglect dimensions' split-half reliability coefficients ranged from -0.034 to 0.789, the scale's parallel reliability were 0.785 and it's re-test reliability were 0.613. After construct validity, external validity and content validity testing, the result showed that this scale could effectively reflect the real neglected status of children investigated. The total neglect cut-off score of this scale were 121.</p><p><b>CONCLUSION</b>The scale has good stability and reliability. And it adapts Chinese conditions and it's convenient to operate.</p>

The status of child neglect among rural areas children aged 0 - 6 years in China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the status of child neglect among rural areas children aged 0 - 6 years in China.</p><p><b>METHODS</b>A total of 7411 rural children aged 0 - 6 years old who were composed of two age groups (3315 children aged 0 - 2 years old and 4096 children aged 3 - 6 years old) were multistage stratified randomly sampled from 84 villages which were representative of 10 provinces of China, in accordance with sex and age in November 2010. To identify the child neglect based on the Neglect Norms for Children Aged 0 to 2 and 3 to 6 Years Old in Rural Areas of China, SPSS 13.0 was employed for analyzing neglect frequency and degree for every group of different age, sex and neglect type (including physical, emotional, educational, medical, safety and social neglects). χ(2) test and analysis of variance were also used.</p><p><b>RESULTS</b>The degree of child neglect for the children aged 0 - 2 years old was 45.01 ± 7.56, the neglect frequency was 54.9% (1819/3315); the degree of child neglect for the children aged 3 - 6 years old was 44.42 ± 7.57, the neglect frequency was 53.8% (2203/4096). The neglect frequency of children aged 0, 1, 2 years old were 58.5% (654/1117), 52.2% (597/1144), 53.9% (568/1054) (P < 0.05). For children aged 3 - 6 years old, the degrees of emotional and safety neglect for males (44.60 ± 7.86, 36.82 ± 9.03) were higher than females (44.03 ± 7.72, 36.25 ± 9.05) (P < 0.05); and the frequencies of emotional and social neglect for males (16.8% (349/2072), 28.3% (586/2072)) were also higher than females (14.1% (286/2024), 24.8% (503/2024)) (P < 0.05). All children of two age groups suffered neglect mainly on one of the six neglect types (incidences were 20.6% (683/3315) and 22.7% (931/4096)). For 0-2 age groups, the higher neglect frequencies happened in the single-parent family and the remarried family (62.5% (15/24) and 63.2% (12/19)), but for children aged 3 - 6 years old groups, it happened in the single-parent family (60.0%, 27/45).</p><p><b>CONCLUSION</b>Degree and frequency of child neglect among children aged 0 to 6 years old in the rural areas of China are high, and we should find out risk factors and provide efficient prevention measures.</p>

Impact of a nationwide training program for neonatal resuscitation in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Seventeen million births occur in China each year. Neonatal mortality is the leading cause of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth. The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program (NRP) on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants.</p><p><b>METHODS</b>The Chinese NRP incorporated policy change, professional education, and creation of a sustainable health system infrastructure for resuscitation. Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade. The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality. Program evaluation data came from 322 representative hospitals in those provinces.</p><p><b>RESULTS</b>Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure. From 2004 through 2009 more than 110,659 professionals received NRP training in the 20 target provinces, with 94% of delivery facilities and 99% of counties reached. Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4 per 10,000 from 2003 to 2008, and the incidence of Apgar ≤ 7 at 1 minute decreased from 6.3% to 2.9%.</p><p><b>CONCLUSIONS</b>The Chinese NRP achieved policy changes promoting resuscitation, trained large numbers of professionals, and contributed to reduction in delivery room mortality. Improved adherence to the resuscitation algorithm, extension of training to the township level, and coverage of births now occurring outside health facilities can further increase the number of lives saved.</p>

The anatomy features and surgical significance of the pulmonary circuits of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the anatomy features of the pulmonary circuits in the patients with pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCA), and discuss the clinical significance.</p><p><b>METHODS</b>From April 2002 to June 2010, the anatomy features of pulmonary circuits in 33 patients with PA/VSD/MAPCA were examined and analyzed. There were 21 male and 12 female patients. The age ranged from 11 months to 29 years. The anatomic types of PA/VSD included group B for 22 cases, group C for 11 cases. Thirty-one patients of them underwent 33 operative procedures. The operations included aorta-pulmonary shunt in 8 cases, one stage unifocalization with VSD open in 2 cases, complete repair in 23 cases.</p><p><b>RESULTS</b>Twenty-nine (87.9%) patients had native pulmonary arteries, 6 of them were normal size and 23 were hypoplastic size. Four patients (12.1%) had no native pulmonary arteries. The postoperative oxygen saturation of the patients undergone shunt and one stage unifocalization was increased to 83% to 90%. There was one early death after complete repair because of multiorgan function failure. There were 4 cases of severe low cardiac output and 3 cases of respiratory function failure. Sixteen patients after complete repair were followed up more than one year. The postoperative right ventricular pressure was 41 to 99 mmHg (1 mmHg = 0.133 kPa). The ejection fraction value was more than 50% in 14 patients and less than 50% in 2 patients. Two patients had medium pulmonary insufficiency.</p><p><b>CONCLUSIONS</b>An individualized approach based on the anatomy of the pulmonary circuits permits achievement in the patients with PA/VSD/MAPCA. The surgical strategy for PA/VSD/MAPCA mainly depends on the anatomy features of native pulmonary arteries, confluent pulmonary arteries and MAPCA.</p>

Development of sleep/wake patterns in infants during the first 12 months of life / 中华儿科杂志

<p><b>OBJECTIVE</b>This was a nationwide study of sleep circadian in term infants. The aim was to understand the development characteristics of infants' sleep/wake patterns longitudinally in their own home environments over the first 12 months of life.</p><p><b>METHOD</b>Totally 524 healthy term infants from 9 urban districts took part in this project Their sleep/wake patterns over 24 h were recorded using parental sleep diaries, from the 2nd day to 12 months old.</p><p><b>RESULT</b>The results showed that infant daytime sleep changed significantly at 0-2, 3-4, 5-6, and 8-9 months after birth, and the change was the fastest in the first month, the mean percentage of daytime sleep decreased from 82.4% at Day 2 to 62.8% at 1 month old. Also, the average number of naps reduced from 3.7 to 2 across the infancy. The ability of continuous sleep throughout the night gradually enhanced from 1 month old, and the nocturnal longest sleep time extended to 6.8 h at 4 months of age as well as the nighttime awakening frequency less than 0.5 over 6 months old. Additionally, the nighttime sleep increased significantly at 4 and 9 months after birth, where the proportion of nighttime sleep increased from 55.8% at Day 2 to 64.3% of 4 months and 71.2% of 9 months respectively. In general, the total sleep time over a 24 h period presented a downward trend as the infant aged.</p><p><b>CONCLUSION</b>The periods 0-6 and 8-9 months after birth were the key periods for the development of infant sleep.</p>

Family risk factors of overweight and obesity in preschool children / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore family risk factors of overweight and obesity focusing on parental characteristics, feeding practice and lifestyle.</p><p><b>METHODS</b>Five kindergartens were selected randomly from two of all the six urban districts in Beijing. The body height and weight of all the children in the 5 kindergartens were measured in light clothing and without shoes. Information on parental characteristics, dietary habits, lifestyle, and feeding practice was collected from 1173 families by parental self-report questionnaires in the 5 kindergartens. Overweight and obesity were defined according to sex- and age-specific body mass index (BMI) cut-points proposed by the International Obesity Task Force. Correlations and multivariate regression analysis was used to explore risk factors of child overweight and obesity.</p><p><b>RESULTS</b>The prevalence of overweight and obesity was 6.9% and 4.1%, respectively, among the sample children. Significantly more overweight and obese children were from obese families (15.2%) than they were from non-obese families (7.5%). Significant associations could be observed between children and parents' characteristics for BMI, frequency of eating in restaurant, television-watching hours, and physical activity hours. Parental obesity, low maternal education level and television watching for > 2 h/d were risk factors of child overweight and obesity after adjusting for sex, age, family income, and kindergarten.</p><p><b>CONCLUSIONS</b>Child overweight and obesity were influenced by family environment. Strategies for prevention should include identified family risk factors.</p>

Study on prevalence and risk factors of sleep disorder among Chinese children aged 0 to 23 months in city / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the prevalence and main influences on sleep disorder among Chinese children aged 0 to 23 months, as to providing scientific interventions for infant sleep disorder.</p><p><b>METHODS</b>All 7601 children under two years old were selected by stratifying samples from twelve cities in China. The objects' parents were surveyed with questionnaire. All data were analyzed with SPSS statistical software.</p><p><b>RESULTS</b>The total incidence of sleep disorders at 0 to 23 months was 21.94%. The main problems were difficulty falling asleep, nighttime waking and snoring. Feeding manner, sleep environment, sleep-associated habits and medical conditions were all influences on infant's sleep disorder.</p><p><b>CONCLUSIONS</b>Enhancing sleep health education to change parents' nurturing modes should be an important role in preventing infant sleep disorders.</p>

Clinical analysis on surgical treatment of single atrium / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of surgical treatment of single atrium.</p><p><b>METHODS</b>From August 1984 to August 2004, there were 33 patients with single atrium in our study. Plastic surgery for mitral valves were performed for 30 cases with mitral insufficiency. Plastic surgery for tricuspid valves were performed for 18 cases with tricuspid valve insufficiency. There were 3 cases only with complete absence of atrial septum. There were 14 cases with left superior vena cava. All new atrial septums were made with patches including 24 autologous pericardial patches and 9 terylene patches. Complicate abnormalities were corrected in the same time. Tow suture techniques were used in operations to prevent conductive system block, and plastic surgery for mitral valves were performed until the mitral valves were sufficiency.</p><p><b>RESULTS</b>There weren't death and conductive system block after operation in the group. One case was low-grade mitral insufficiency and the others weren't mitral insufficiency. Twenty-five cases were followed up from 3 months to 11 years, and they could work and study normally.</p><p><b>CONCLUSIONS</b>Single atrium should be operated as early as possible. The key of surgery is to prevent conductive system block, to properly correct mitral insufficiency and to drastically correct complicated abnormality. The new atrial septum should be made by patch and an autologous pericardial patch is the first selection.</p>

Surgical treatments and results of pulmonary atresia with ventricular septal defect / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the indication and operative program of ventricular septal defect with pulmonary atresia (VSD-PA).</p><p><b>METHODS</b>From June 1984 to March 2005, there were 32 patients with VSD-PA, which underwent 33 operations. Among them, 15 were males and 17 were females. The ages ranged from 6 months to 9 years. There were 9 patients with aortopulmonary collateral arteries. The operations included central aorta-pulmonary shunts 3 cases, one stage complete repair 27 cases and one stage unifocalization with VSD open 2 cases.</p><p><b>RESULTS</b>There were early 5 death including one death after aorta-pulmonary shunt and 4 deaths after one stage complete repair. The causes of death were severe low cardiac output (2 patients), respiratory function failure (1 patient), multiorgan function failure (1 patient) and severe infect (1 patient). Twenty-one patients were followed up from 3 months to 15.5 years. Heart function (NYHA) was class I or II in 19 cases and class III or IV in 2 cases.</p><p><b>CONCLUSIONS</b>The operative indication and methods mainly depend on the developing of pulmonary arteries and aortopulmonary collateral arteries. Completely surgical repair of patients with VSD-PA can be achieved with acceptable mortality.</p>

The treatments and results of tetralogy of Fallot with major aortopulmonary collateral arteries / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the indication and operative program of complete repair of tetralogy of Fallot with major aortopulmonary collateral arteries (TOF-MAPCA).</p><p><b>METHODS</b>From January 2000 to May 2004, 9 patients with TOF-MAPCA including 5 patients with pulmonary atresia underwent complete surgical repair, 6 of them were male and 3 were female. The ages ranged from 3 to 9 years. All patients underwent corrected operations with moderate hypothermia and cardiopulmonary bypass. Transcatheter occlusion of MAPCA was performed in 5 patients just before corrected operation. Ligation of MAPCA was performed in 1 patient in the same time of cardiac corrected operation. Midline one-stage complete unifocalization and repair were performed in 3 patients with pulmonary atresia.</p><p><b>RESULTS</b>There was one early death. The cause of death was spinal cord hemorrhage. There was no death then. Eight patients were followed up from 3 month to 4 years. Heart function (NYHA) was class I or II in 7 patients and III in 1 patient.</p><p><b>CONCLUSIONS</b>Completely surgical repair of patients with TOF-MAPCA should be performed as early as possible, which can achieve with satisfactory results by transcatheter occlusion of MAPCA or one-stage unifocalization.</p>

Study on the current situation and influential factors of child neglect among aged 3-6 year-olds in the urban areas of China / 中华流行病学杂志

<p><b>OBJECTIVE</b>Children aged 3 - 6 years in the urban areas of China were surveyed for the first time to find out the state of child neglect (CN) as well as the major relevant risk factors so as to provide evidence for developing intervention measures.</p><p><b>METHODS</b>1163 children (of whom 49.6% were males and 4.5% were minority nationality) were randomly sampled under multistage stratification, from 25 cities which representing 15 provinces of China. Based on the Child Neglect Norms used by China, prevalence of CN was identified and SPSS-Windows 11.0 was employed for statistical analysis. Scores, frequency/degrees, age, sex and 5 types (physical, emotional, educational, medical and safety) of CN on every group of the regions, were calculated. Multifactorial analysis was conducted through Binary Logistic Regression and multiple linear regression to determine the relevant risk factors.</p><p><b>RESULTS</b>(1) The average degree of CN for the 3 - 6 year-olds was 42.2, with its prevalence as 28.0%. Degrees of CN for the groups of 3, 4, 5, 6-year-olds were 41.7, 42.2, 42.1 and 43.1 (F = 0.988, P > 0.05), with frequencies of 25.0%, 25.3%, 27.9% and 35.4% (chi(2) = 4.798, P > 0.05), respectively. Degrees for CN in males and females were 42.7 and 41.8 (F = 2.502, P > 0.05) with the frequencies as 32.6% and 23.7% (chi(2) = 6.585, P < 0.05), respectively. Degrees of CN for the five types were 39.4-43.4 with the frequencies as 5.1%-12.9%, respectively. No significant difference was found in the frequency of the types (with an exception on 'physical neglect') between males and females (P > 0.05). The highest frequency (42.9%) of CN was seen in the single-parent families and the lowest in large family with three generations (25.5%). (2) According to monofactorial chi(2) test, the possible risk factors of CN would include: educational background, occupation and decrease of income of the parents during last year, etc. (3) Binary Logistic regression analysis showed that the influential factors to the occurrence of CN would include: father's educational background, sex of the child and mother's occupation, etc. (4) Multiple linear regression showed that the influential factors to the degree of CN were: family structure, number of supporting family members, relationship between parents and children, etc.</p><p><b>CONCLUSION</b>The degree and frequency of CN among children aged 3 to 6 in the urban areas of China were high but similar among the four age groups. Male children had a higher frequency of neglect than females, but with similar degree. Children in single-parent families had the highest frequency. The major influential factors of CN would include: educational background, occupation, family structure, family income of the parents which were similar to the results reported from foreign literature.</p>

Surgical treatment of secundum atrial septal defects in adults over 30 years old / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of surgical treatment of secundum atrial septal defects in adults over 30 years old.</p><p><b>METHODS</b>There were 469 patients with secundum atrial septal defects in our study (male 144, female 325; ages 30-68, mean 38.6 years old). There were 105 cases with pulmonary hypertension and 458 cases with arrhythmia in the group. Surgical closure of defects were performed in all patients. Surgical closure of 358 cases were done by patches including 305 autologous pericardial patches. The low dose (6 x 10(-6)) nitric oxide inhalation was used in 25 postoperative patients with pulmonary hypertension. Right sided maze procedures were done in 5 cases with atrial fibrillation.</p><p><b>RESULTS</b>Surgical mortality was 0.6% (3 cases), the others were healed. In the group, there were 180 cases with arrhythmia, 27 cases with left ventricular function amyoplasia, 28 cases with low cardiac output syndrome, 12 cases in secondary operation for bleeding and 1 case with air-embolism. The level of mean pulmonary artery pressure of 25 postoperative patients with pulmonary hypertension inhaled nitric oxide was down 28.5%. After right sided maze procedures were done in 5 cases with atrial fibrillation, atrial fibrillation disappeared. 352 cases were followed up from 3 months to 20 years (mean 5.6 years). Twenty-nine cases were in class I-II of cardiac function, and the others were better than class I of cardiac function.</p><p><b>CONCLUSIONS</b>Atrial septal defects in adult should be operated as early as possible. When patch is needed, an autologous pericardial patch is the first selection. Inhaled nitric oxide is an effective method to postoperative pulmonary hypertension. The maze operation should be performed for atrial septal defect with atrial fibrillation while the surgical closure of defect was done. During and after operation, much attention should be paid to preventing and curing arrhythmia and protecting and supporting left heart function.</p>

Surgical treatment on residual shunt after repair of ventricular septal defect / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in surgical treatment of residual shunt after repair of ventricular septal defect and investigate the position of the residual shunts.</p><p><b>METHODS</b>Between January 1979 and May 2003, re-operations on residual shunt after repair of ventricular septal defect were performed in 37 patients with congenital heart disease including ventricular septal defect, tetralogy of Fallot, double outlet right ventricle in 19, 17 and 1 patients, respectively. It accounted for 0.21% (37/18000) of open heart operations performed during these years. The patients included 26 males and 11 females with age from 3 months to 53 years (mean 16 +/- 12 years). The residual shunt was diagnosed by postoperative murmur and echocardiography. Twenty-six cases were repaired with patch and 11 cases were closed directly with mattresses sutures.</p><p><b>RESULTS</b>Two patients (2/37, 5%) died within 48 hrs postoperatively. The results in other 35 patients followed up after surgery from 3 months to 15 years were satisfactory.</p><p><b>CONCLUSIONS</b>Most of the residual shunts occurred in base of septal leaflet of tricuspid valve, the second and the first transfer suture respectively. Effects of reoperations on residual shunts were satisfactory.</p>