Advances in the application of near-infrared spectroscopy in the perioperative period of congenital heart disease / 中华实用儿科临床杂志

Near-infrared spectroscopy (NIRS) can be employed to monitor regional oxygen saturation (rSO 2), to reflect the oxygen metabolism and local effective blood perfusion of the measured site in a real-time and noninvasive manner.NIRS has been extensively used in monitoring blood perfusion of brain, kidney, gastrointestinal tract and organ function evaluation in different conditions.During the perioperative period of congenital heart disease, hemodynamic fluctuation may easily cause organ hypoperfusion, which would lead to the development of ischemia, hypoxia and internal environment disorder, thus resulting in harmful changes in tissue oxygenation status.However, there is no change in the arterial oxygen saturation (SaO 2) and mixed venous saturation (SvO 2). NIRS can be employed to sensitively monitor the changes of tissue rSO 2, so as to prevent further injury caused by tissue ischemia and hypoxia.This paper briefly describes the basic principle, limitations and new progress of NIRS in the perioperative application of CHD, in order to provide new ideas and directions for its clinical application in the perioperative period of CHD, early evaluate the patient′s condition and guide clinical work.

Surgical treatment of tracheal stenosis in children / 中华胸心血管外科杂志

Objective:To investigate the common types, surgical treatment and effects of tracheal stenosis in children.Methods:A total of 23 children with tracheal stenosis in our hospital from December 2017 to August 2020 were retrospectively reviewed, including 14 males and 9 females. The mean age at operation was(8.9±5.8)months(range: 2-3 months) and the mean weight was(6.4±2.3)kg(range: 4.2-10.5 kg). The common types of tracheal stenosis were complete tracheal ring in 9 children, tracheomalacia in 10 and subglottic membranous annular hyperplasia in 4. The type of congenital heart diseases included 10 patients of pulmonary artery sling, 1 of tetralogy of Fallot, 5 of ventricular septal defect, 1 of pulmonary atresia, and 1 of right aortic arch with aberrant left subclavian artery. Slide tracheoplasty was performed in 9 patients, external splint in 8, endotracheal stent in 2 and tracheal dilation in 4. All children were followed up after 1, 3, 6, and 12 months of operation with CT and bronchoscopy.Results:There was 1 death in all 23 patients and the mortality was 4.3%, which died of granulation tissue hyperplasia after slide tracheoplasty. Reoperation was performed in 1 patient with endotracheal stent. All patients were followed for 1 to 24 months. Clinical symptoms of tracheal stenosis disappeared and the results of CT and bronchoscopy were satisfied.Conclusion:Slide tracheoplasty is the effective surgical method for complete trachea ring. 3D printing bioresorbable external splint is a promising method for the treatment of tracheomalacia.

The follow-up study of mitral insufficiency valvuloplasty in children / 中华胸心血管外科杂志

Objective:To analyze the early and middle term clinical effects of mitral valve repair in children with mitral insufficiency.Methods:From January 2012 to January 2019, a total of 202 cases of children with mitral insufficiency treated by mitral valve repair were selected from the department of cardiothoracic surgery of Nanjing Children's Hospital, patients with atrioventricular septal defect, single ventricle and ischemic mitral regurgitation were excluded. Echocardiography was used to compare the preoperative and postoperative left ventricular function and degree of regurgitation in children to evaluate the early and middle term efficacy of mitral valvuloplasty.Results:There were 5 cases of early death(5/202, 2.5%) and 3 cases of late death(3/202, 1.5%). The mean follow-up time was(19.49±17.48) months(1-68 months). Postoperative echocardiography showed that the left heart function and mitral regurgitation were significantly improved.Conclusion:Mitral valvuloplasty can significantly correct mitral insufficiency in children, and it has satisfactory mid-term efficacy and good clinical value.

Energy balance and prognosis of children with mechanical ventilation in pediatric intensive care unit / 中华临床营养杂志

Objective To investigate the influencing factors for energy balance and the relationship be-tween energy balance and clinical outcome in PICU mechanical ventilation children. Methods Children with mechanical ventilation who were hospitalized in PICU for more than 3 days from June 2015 to May 2016 were collected, resting energy expenditure was measured by resting energy metabolic detector, and the nutrition bal-ance was calculated, the influencing factors on energy balance was analyzed by regression analysis. Results A total of 104 mechanical ventilation children were included with the average energy consumption of ( 265. 4 ± 63. 2) kJ/kg in the first 3 days and the average energy supply of (219. 8±82. 9) kJ/kg, and failed to reach the target value ( P<0. 05) . As the time of hospitalization was prolonged, the supply of energy increased gradu-ally, the SAPS Ⅱ ( r=-0. 609, P=0. 000) , mechanical ventilation time ( r=-0. 456, P=0. 000) , ICU stay time ( r=-0. 646, P=0. 000) , the number of organ failure ( r=-0. 568, P=0. 000) , infection complications ( r=-0. 859, P=0. 000) were negatively correlated to energy supply balance; regression analysis showed that complications of nosocomial infection ( P = 0. 000 ) , number of organ failure ( P = 0. 000 ) , mechanical ventilation time ( P=0. 000) , ICU retention time ( P=0. 001) were predictors of energy supply balance. Con-clusion Insufficient supply of energy for the first three days of mechanical ventilation is high in the critically ill children. Factors affecting energy supply balance include patient's organ failure, infection complications, me-chanical ventilation time, and ICU retention time, which suggest that the strengthening of the nutritional man-agement of the critically ill children with mechanical ventilation will benefit to the clinical outcome.

Application of thoracoscopic surgery in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula in neonates / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To compare the efficacy of thoracoscopic surgery versus thoracotomy in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula (EA/TEF) in neonates.</p><p><b>METHODS</b>A retrospective analysis was conducted in 97 neonates who underwent EA/TEF repair between January 2012 and December 2017 in the Affiliated Children's Hospital of Nanjing Medical University, including 75 patients receiving thoracotomy and 22 patients receiving thoracoscopic surgery. The perioperative data and the incidence of early postoperative complications were compared between two groups.</p><p><b>RESULTS</b>The operations were completed in all patients. One child (4.5%) in thoracoscopic surgery group was converted to thoracotomy with modified Livaditis procedure due to the long distance of two blind ends (>4 cm) and thinner distal end. The operation time was longer in thoracoscopic surgery group[(143±48) min vs. (120±40) min, <0.05], but the postoperative ventilation time was shorter[(55±22) h vs. (65±19) h, <0.05] and the first oral feeding was earlier in thoracoscopic surgery group[(3.2±1.1) d vs (3.9±1.3) d, <0.05]. No statistical difference was observed in the ratio of red blood cell transfusion, length of hospital stay and drainage tube indwelling time between two groups (all >0.05). The incidence of lung complications in thoracotomy group was higher than that in thoracoscopic surgery group (20.0% vs. 9.1%, <0.01), while there were no significant differences in the incidence of other postoperative complications between two groups. There was no death in thoracoscopic surgery group, while 2 patients died in thoracotomy group.</p><p><b>CONCLUSIONS</b>Thoracoscopic repair is a preferred surgical procedure for EA/TEF in neonates.</p>

Percutaneous punctured transcatheter device closure of ventricular septal defect / 中华胸心血管外科杂志

Objective To explore the feasibility of percutaneous puncture for ventricular septal defect(VSD).Methods From March 2015,we did percutaneous punctured transcatheter device closure of VSD for 22 patients.The patients included 15 males and 7 females with age from 2 years 6 months to 11 years 7 months, weight from 13.5 kg to 44.0 kg.Among 22 pa-tients,6 were diagnosed with residual shunt after VSD repair, with size of residual shunt from 4.8 mm to 7.0 mm.Residual shunts are perimembranous, conoventricular and intracristal.The other 16 patients were diagnosed with isolated VSD,with de-fect size from 3.5 to 5.1 mm.For all patients,we punctured directly through the right ventricular surface into the right ventri-cle in the 3th or 4th intercostal space of the left sternal border.Next, we succeeded to extract the guide wire after inserting a conveyor tube for 21 patients.Subsequently,7-10 mm VSD closure device were delivered via the conveyor tube.Only one patient was changed to perform occlusion of VSD through chest small incision due to improper selection of punctured position. Results A total of 21 closure devices were placed for 21 patients.18 of them are equilateral device,and 3 are decentered de-vice,with size from 5 mm to 10 mm.There were small amount of pericardial effusion in 4 patients using TEE examination,and no future treat was performed after observation.For one-year follow-up, all patients have recovered very well.Conclusion Percutaneous punctured transcatheter device closure fits for treatment for children with residual shunt after VSD repair and isola-ted VSD.It has a good recent result.

Early enteral nutritional support on nutrition assessments and clinical outcomes of congenital heart disease postoperation / 中华胸心血管外科杂志

Objective To investigate the effect and feasibility of early enteral nutrition support on postoperative nutrition assessments and clinical outcomes in children patients with congenital heart disease. Methods From October 2013 to October 2014, a number of 100 cases congenital heart disease aged six months to two years old were treated with early enteral nutrition support after operation. According to gender, fifty patients were randomly divided into the intervened group, who were treated with the early enteral nutrition support program. The other fifty patients were divided into control group with no nutrition sup-port. The detailed early enteral nutrition support project were( a) withdraw breathing machine at the same day, giving enteral nutrition 6 hours later after postoperation;( b) patients assist with long-term breathing machine, giving enteral nutrition 12-24 hours later after postoperation. The age, heigth, weight, serum C- reactive protein(CRP), serum retinoic binding protein ( RBP) , serum prealbumin( Pre-ALB) were recorded before operation. Seven days after operation, above indicators were ob-served again. In addition, the first time of excrete, the number of feeding interruption, the time of feeding, the time of ventila-tor, and the related complications were also recorded at hospitalization period. Results No difference of basic information and accompanying complications were observed between control and nutritional intervention group. As to nutritional status, weight-for-age z-score(WAZ) were significant higher in the nutritional intervention group than the control group( -0. 22 ± 1. 16 vs. 0.73 ±1.29, P=0.019) after operation. However length/height-for-age z-score(LAZ/HAZ) and weight-for-length/height z-score( WLZ/WHZ) were similar between control and nutritional intervention group whatever pre-operation and postoperation. Preoperative CRP, RBP, and Pre-ALB were no significant difference between early enteral nutrition and control group. After operation CRP levels in the early enteral nutrition group were significantly lower than that of control group[(45.2 ±16.2)mg/L vs.(67.3±35.5)mg/L,P<0.001],whileRBP[(0.3±0.1)mg/Lvs.(0.2±0.1)mg/L]andPre-ALB[(35.2±12.2)g/Lvs.(25.2±14.2)g/L] weresignificantlyhigherthanthoseofcontrolgroup(Pvaluewere0.031and0.029,respective-ly) . In the early nutritional intervention group and control group, the first time of excrete were remarkable in advance in nutri-tionalinterventiongroupcompredtocontrolgroup[(36±12)hvs.(65±15)h,P=0.008],whilethedifferenceoffeeding interruption times, intensive care unit( ICU) time and mechanical ventilation time in the two groups were not statistically signif-icant(P>0. 05). Conclusion Early nutritional intervention can help gastrointestinal function, enhance nutritional status, lower serum CRP levels and increased serum RBP and Pre-ALB concentrations. It did not add ICU time and ventilation time.

The follow-up study of edge to edge mitral repair in children / 中华胸心血管外科杂志

Objective To analyze the operation of long-term effect of edge to edge mitral repair for mitral vavle moderateto-severe insufficiency in children retrospectively.Methods Clinical dates of 102 patients who underwent edge to edge mitrel valve repair in Nanjing Children's Hospital from March 2003 to March 2015 were collected.Postoperative thoracic echocardiography was adopted to observe the effect of mitral valve forming and evaluate the follow-up results.Results The whole group of 2 patients died in hospital,Followed up for 1 months to 12 years,during the follow-up of 10 patients were lost.The early fol low-up,medium-term follow-up and long-term follow-up were completed 93,55 and 26 cases,respectively.In the early followup,6 patients had recurrent moderate mitral regurgitation(MR),and 5 patients had recurrent moderate-to-severe MR and reoperated during the follow-up period,a total of 2 cases died.In the medium-term follow up,moderate and severe MR were found in 6 and 4 cases,respectively.Three patients accepted reoperation,two patients died.In the long-term follow-up,1 case had recurrent severe MR,2 cases had re-operation and had no death.Early survival rate was 97.8 ％ (91/93),avoid reoperation rate was 94.6％ (88/93).The incidence of moderate or severe mitral regurgitation was 11.8％ (11/93).Midtcrm survival rate was 96.4％ (53/55),avoid reoperation rate was 94.6％ (52/55),moderate or severe mitral regurgitation rate was 18.2％ (10/55).Long-term follow-up have no death,avoid reoperation rate was 92.3 ％ (24/26),mitral valve moderate and above reflux rate was 7.7 ％ (2/26).The actuarial survival and freedom from MV reoperation rate was (92.4 ± 2.4) ％ and (77.7 ± 6.4) ％ at 10 years,respectively.Conclusion Edge to edge mitral repair in the treatment of children with moderate to severe mitral insufficiency had relatively stable curative effect,relatively fewer complications,and high long-term clinical effect.

The feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect repair / 中华胸心血管外科杂志

Objective To explore the feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect(VSD) repair.Methods From March 2015,we did percutaneous punctured transcatheter device closure of residual shunt after VSD repair for four patients.The patients included 2 males and 2 females with age from 4 years 9 months to 11 years 7 months and weight from 18 kg to44 kg.Four patients are diagnosed for4 years after VSD repair,3 years after tetralogy of Fallot (TOF),3 years after coarctation of aorta(CoA) combined with VSD,and 1 year after VSD repair,respectively.The withsize of residual shunt from 4.8 mm to 6.8 mm.Residual shunt are perimembranous,conoventricular and intracristal.Punctured directly through the right ventricular surface into the right ventricle in the 4-th or 5th intercostal space of the left sternal border.Next,extracted the guide wire after inserting a conveyor tube.Subsequently,7-10 mm VSD closure device were delivered via the conveyor tube.Results All the four operations were succeeded.A total of four closure devices were placed.Two of them are equilateral devices,and two are decentered devices,with size from 7mm to 9mm.Echocardiographyexamination revealed no significant pericardial effusion.Post-operative ultrasonic cardiogram showed the VSD closure device on site,with no pericardia1 effusion and no obvious morphological abnormalities of the valve.For one-year follow-up,the cardiac functionsof all patients were well.Conclusion Percutaneous punctured transcatheter device closure is a new,efficient and reliable method of treatment for children withresidual shunt after VSD repair.This method also can extend and offer a new avenue for valvular prosthesis and Perimembranous VSD.

The follow-up study of edge to edge mitral repair in children / 中华胸心血管外科杂志

Objective To analyze the operation of long-term effect of edge to edge mitral repair for mitral vavle moderateto-severe insufficiency in children retrospectively.Methods Clinical dates of 102 patients who underwent edge to edge mitrel valve repair in Nanjing Children's Hospital from March 2003 to March 2015 were collected.Postoperative thoracic echocardiography was adopted to observe the effect of mitral valve forming and evaluate the follow-up results.Results The whole group of 2 patients died in hospital,Followed up for 1 months to 12 years,during the follow-up of 10 patients were lost.The early fol low-up,medium-term follow-up and long-term follow-up were completed 93,55 and 26 cases,respectively.In the early followup,6 patients had recurrent moderate mitral regurgitation(MR),and 5 patients had recurrent moderate-to-severe MR and reoperated during the follow-up period,a total of 2 cases died.In the medium-term follow up,moderate and severe MR were found in 6 and 4 cases,respectively.Three patients accepted reoperation,two patients died.In the long-term follow-up,1 case had recurrent severe MR,2 cases had re-operation and had no death.Early survival rate was 97.8 ％ (91/93),avoid reoperation rate was 94.6％ (88/93).The incidence of moderate or severe mitral regurgitation was 11.8％ (11/93).Midtcrm survival rate was 96.4％ (53/55),avoid reoperation rate was 94.6％ (52/55),moderate or severe mitral regurgitation rate was 18.2％ (10/55).Long-term follow-up have no death,avoid reoperation rate was 92.3 ％ (24/26),mitral valve moderate and above reflux rate was 7.7 ％ (2/26).The actuarial survival and freedom from MV reoperation rate was (92.4 ± 2.4) ％ and (77.7 ± 6.4) ％ at 10 years,respectively.Conclusion Edge to edge mitral repair in the treatment of children with moderate to severe mitral insufficiency had relatively stable curative effect,relatively fewer complications,and high long-term clinical effect.

The feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect repair / 中华胸心血管外科杂志

Objective To explore the feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect(VSD) repair.Methods From March 2015,we did percutaneous punctured transcatheter device closure of residual shunt after VSD repair for four patients.The patients included 2 males and 2 females with age from 4 years 9 months to 11 years 7 months and weight from 18 kg to44 kg.Four patients are diagnosed for4 years after VSD repair,3 years after tetralogy of Fallot (TOF),3 years after coarctation of aorta(CoA) combined with VSD,and 1 year after VSD repair,respectively.The withsize of residual shunt from 4.8 mm to 6.8 mm.Residual shunt are perimembranous,conoventricular and intracristal.Punctured directly through the right ventricular surface into the right ventricle in the 4-th or 5th intercostal space of the left sternal border.Next,extracted the guide wire after inserting a conveyor tube.Subsequently,7-10 mm VSD closure device were delivered via the conveyor tube.Results All the four operations were succeeded.A total of four closure devices were placed.Two of them are equilateral devices,and two are decentered devices,with size from 7mm to 9mm.Echocardiographyexamination revealed no significant pericardial effusion.Post-operative ultrasonic cardiogram showed the VSD closure device on site,with no pericardia1 effusion and no obvious morphological abnormalities of the valve.For one-year follow-up,the cardiac functionsof all patients were well.Conclusion Percutaneous punctured transcatheter device closure is a new,efficient and reliable method of treatment for children withresidual shunt after VSD repair.This method also can extend and offer a new avenue for valvular prosthesis and Perimembranous VSD.

Research progress of perioperative energy metabolism in infants with congenital heart disease / 中华临床营养杂志

Nutritional risk is present in a large proportion of infants with congenital heart disease,which is associated with various factors including malnutrition,pulmonary hypertension,and hemodynamic instability.Standard perioperative nutrition support may effectively decrease nutritional risk and has become an essential part in clinical treatment of congenital heart disease.Understanding the rules of perioperative energy metabolism is key to nutrition support.This article reviews the progress of research on the energy metabolism in infants with congenital heart disease in perioperative period,aiming to provide evidence for clinical nutrition support in this group of patients.

STRONGkids for congenital heart disease perioperative nutritional risk screening / 中华临床营养杂志

Objective To identify the nutritional risks of the hospitalized children with congenital heart disease (CHD) during perioperative period and the relationship between nutrition risks and the clinical outcomes.Methods Totally 780 CHD children (522 cases of ventricular septal defect,133 cases of atrial septal defect,70 cases of tetralogy of fallot,and 55 of patent ductus arteriosus) were recruited.The STRONGkids (Screening Tool for Risk on Nutritional Status and Growth) was used to analyze the nutritional risks of CHD children and to identify the nutritional risks of these children at different ages.Also,the potential effect of pulmonary hypertension on malnutrition and effects of the possible nutritional risks on the clinical outcomes were analyzed.Results Of these 780 CHD children,260 (33.3％) were found to be with high and moderate nutritional risks.The incidences of these risks were 49.2％ (187/380) in the 0-1-year-old group,which was significantly higher than that in the 1-3-year-old group (26.2％,60/229) (x2 =25.174,P ＜0.001) and the ＞ 3-year-old group (7.6％,13/171) (x2 =36.029,P ＜ 0.001).Both pulmonary hypertension and malnutrition showed synergic effects on the clinical nutritional risk,and higher nutrition risks were associated with poorer clinical outcomes.Conclusions STRONGkids can effective evaluate the nutritional risks of CHD children during the perioperative period and thus can inform the standardized nutrition support.

Perioperative care of total anomalous pulmonary venous connection in newborns and babies within 6 months / 中华胸心血管外科杂志

Objective To summarize perioperative care and effect of surgical treatment of total anomalous pulmonary venous connection (TAPVC) in newborns and babies within 6 months.Methods From September 2001 to May 2013,ninetytwo consecutive patients with TAPVC received surgical correction under cardiopulmonary bypass (CPB) with moderate or deep hypothermia.The anatomic subtype included supracardiac type 48,intracardiac type 36,infracardiac type 6 and mixed type 2.There were 36 newboms.Pathological diagnosis was made by echocardiogram,computerized tomography and operative findings during operation.The option of procedure was determined by findings.Respirator assisted breathing after operation and cardiac function was maintained by a variety of positive inotropic drugs,to prevent the happening of the pulmonary hypertension crisis.Results Severely low cardiac output syndrome occurred in 8 patients and they died within 24 hours after operation.The remaining cases postoperative recover smoothly and receive postoperative follow-up about 1 month to 12 years,3 cases of postoperative pulmonary vein stenosis (PPVS) occurred.Conclusion Total anomalous pulmonary venous connection should be surgical treatment as soon as possible with satisfied effect.The key of perioperative care is maintenance of left heart function,negative balance of liquid,prevention and treatment of pulmonary hypertension.

One-stage surgical repairs for interrupted aortic arch associated with cardiac defects in infants / 中华胸心血管外科杂志

Objective To sum up the clinical information and outcomes of one-stage surgical repairs for interrupted aortic arch (IAA) associated with cardiac defects through median stemotomy in infant.Methods From August 2005 to January 2012,23 IAA patients,aged 18 days to 3 years [mean age (8.61 ± 11.81) months],body weight 3.3-13.0 kg [mean (6.61 ± 3.26) kg] were reviewed underwent one-stage repair.There were 12 male and 11 female.The anatomic subtype ineluded type A 20 (87.0％),type B 3 (13.0％),and no type C in the records.All cases included ventricular septal defect and patent ductus artefious,some also with artirical-pulmonary window,aterical septal defect,bicuspid or unicuspid aortic valve,and subvalvular aortic stenosis.Diagnosis was determined in of the patients and suspected in by echocardiography.Also,64 layers helico-CT was employed to make a definite diagnosis for 18 patients and cardiac catheterization was used for 4 patients.All patients with cardiac anomalies underwent one-stage repair through median sternotomy.The aortic continuity was reestablished by anastomosis between the descending aortic segment and aortic arch.Results In all 23 cases,21 were successful.There was 2 (8.69％) postoperative death:one was due to surgical hemorrhage and severe low cardiac output during perioperative stage and the other was 2-month old due to crisis of pulmonary hypertension.CPB time was ranged from 53-215 min [(129.76 ± 38.98) min],and aortic crossclamp time was 34-125 min[(74.47 ± 24.30) min].The length of stay in ICU postoperatively was 96h averagely.The postoperative complications included severe low cardiac output syndrome in 3 patients,hypoxemia in 13,pneumonia in 7,and supraventricular tachycardia in 12.21 patients were followed up from 2 months to 6 years and were in good condition without recoactation.Conclusion The outcomes of early and medium term for one-stage repair of IAA and associated cardiac anomalies through median stemotomy is excellent.Technique of extended anastomosis between the descending aortic segment and aortic arch may reduce the incidence of recoarctation.It is simplified the procedure and improved life quality of patients.

Hybrid procedure with cardiopulmonary bypass for muscular ventricular septal defects in children / 中华胸心血管外科杂志

Objective To summarize the technique and clinical experience of hybrid procedure under cardiopulmonary bypass (CPB) in children with muscular ventricular septal defect (mVSD). Methods From January 2006 to June 2010, 45 cases of mVSD underwent hybrid procedure with CPB. mVSDs were closed with devices under direct vision in 45 cases. Of them, there were 20 males and 25 females. They ranged from 52 days to 12 years [mean (2.05 ±2.48) year] in age and from 3 to 30 kg [(11.93 ±7.70)kg] in body weight. Preoperatively, most of children were highly susceptible to respiratory tract infections. The hybrid approach was used in all patients with CPB under the guidance of transesophageal echocardiography (TEE). The diameter of mVSDs ranged from 2 to 7 mm under TEE. Of 45 cases, 40 patients had increased rates of pulmonary blood flow. 29 patients had left axis deviation and 12 cases had sinus arrhythmia on electrocardiography (ECG). 19 had other congenital heart lesions, including transposition of great arteries in 1 case, tetralogy of Fallot in 2, pulmonary artery stenosis in 3, patent ductus arteriosus in 6, atrial septal defects in 6) and aorta coactation in 1. The quantity of VSDs were from 1 to 7 (single, in 7; two, in 24 case; three, in 8 case; four, in 5 case and seven, in lease. 37 patients were combined with pulmonary hypertension in our cohort. 38 patients with another large VSD and 19 with other congenital heart lesions were required surgical repair at sometime. Results The hybrid procedures were undertaken in all 45 cases of this cohort. All cases were successful and no deaths occurred during operation. A total of 48 devices were implanted in 45 patients, including single devices in 42 cases (device size ranged from 4 to 10 mm) and two devices in 3 cases (device size ranged from 4 -7 mm). The average time on CPB was (58.28 ±20.70) min , while aortic crossclamp time was(34. 94 ± 14.75) min. In addition, the time on mechanical ventilation postoperatively ranged from 2 hours to 6 days. Compared to the older children, 20 infante aged less than 8 monhad a significant difference in cardiac function in the early postoperative period. One infant was given up treatment because of serious infection. Anather cases recovered with the use of supportive treatment, such as using vasoactive agents, digoxin, inhaling nitric oxide, diuresis, and so on. The enteric-coated aspirin was given at dose of 5 mg ? kg -1. day -1 for a period of 3 to 6 months as usual postoperatively. All patients attended follow-up at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post-procedure. No major complications were encountered during this period. All cases were no instance of migration of any of the devices, residual shunt, aortic regurgitation, atrioventricular valve dysfunction, Ⅲo atrial-ventricular conduction block, new arrhythmia, and so on. There are no death in long-term follow-up. Conclusion Hybrid procedure is safe and effective for the closure of congenital heart defects in children.

Establishment and evaluation of the model of deep hypothermic low flow in young rats / 中华创伤杂志

Objective To investigate the changes of cerebral blood flow and the level of brain injury in a rat model of deep hypothermia low flow(DHLF).Methods Twelve SD rats aged 3 weeks were randomly divided into sham group and model group.Regional cerebral blood flow(rCBF)of all rats was measured continuously during the operation by laser Doppler flowmetry,and the changes of rCBF were measured before temperature decreased,when the temperature decreased to(21.0±0.5)℃,0-5 minutes,25-30 minutes,55-60 minutes,115-120 minutes during DHLF and 0-5 minutes after DHLF operation.Another 60 SD rats aged 3 weeks were randomly divided into sham group and model group.Six rats of each group were sacrificed at 1,6,24,72 hours and 7 days after DHLF operation to detect the pathological changes of the brain and the neuronal apoptosis by HE staining and TUNEL assay.The neurological deficit score(NDS)was recorded at 24,72 hours and 7 days after operation for evaluating the neurologic functional outcome.ResultsWhen the temperature was decreased to(21.0±0.5)℃,the levels of rCBF of sham group and model group were significantly decreased to(41.1±4.2)% and(40.7±3.4)% of the baseline value,and the rCBF level of model group was further decreased to(15.7±3.5)% of the baseline value 0-15 minutes during DHLF(P ＜ 0.01),with no obvious changes in all the time intervals during DHLF.Compared with the sham group,the scores of NDS of model group were significant lower at 24 and 72 hours after operation(P ＜ 0.05 or 0.01).Besides,a significant pathological change of the brain tissue and a increased percentage of TUNEL-positive staining cells were observed in model group at 6,24,72 hours and 7 days after operation(P ＜ 0.01).Conclusions Rat model of DHLF is an ideal and reliable model of brain injury,for it is similar to DHLF procedure of clinical cardiac operation.

Modified Nuss procedure for complicated pectus excavatum / 中华胸心血管外科杂志

Objective To review the clinical experiences of modified Nuss procedure and technique for complicated pectus excavatum. Methods From September 2006 to October 2009,45 children (27 boys and18 girls), aged 3 - 16 years [mean (6.4 ± 3.5 )years] with complicated pectus excavatum underwent modified Nuss procedure. VATS was used in 6 cases. 3 patients associated with lung cyst were treated by open surgery and 1 case with ASD was treated by Hybrid procedure.Results The surgery was successfully performed in all patients. The mean operative time was 54 minutes and the average hospital stay was 7 days. Postoperative evaluation was"excellent"in 30 cases , "good"in 13, and"moderate"in 2. Conclusion Modified Nuss procedure is a safe and effective method for correction of complicated pectus excavatum.