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.

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>