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@#Objective To share the experience of treating special cardiac malformations by applying minimally invasive techniques. Methods Eight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge. Results Eight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory. Conclusion The application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.
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@#Objective To explore the safety and efficacy of transesophageal echocardiography (TEE)-guided percutaneous intervention for patent ductus arteriosus (PDA) in obese teenagers. Methods From January 2018 to June 2019, 21 obese teenagers with PDA treated with femoral artery occlusion guided by TEE in the Department of Cardiac Surgery, Dalian Children's Hospital of Dalian Medical University were included in this study, including 13 males and 8 females aged 12.8-17.3 (15.1±1.7) years, with an average weight of 51.0-89.0 (73.4±10.1) kg. The operative effect was evaluated. Results All patients successfully received the surgery, and none was changed to radiation-guided or thoracotomy ligation. The average operating time was 23.9±6.8 min, the average postoperative hospitalization time was 3.8±0.6 d. No peripheral vascular injury, intracardiac infection or pericardial effusion occurred. The mean follow-up time was 19.5±4.9 months, and the results of all reexaminations were good. Conclusion For some PDA children with obesity, emphysema or thoracic malformation, it is difficult to block PDA by transthoracic ultrasound-guided percutaneous intervention, and TEE can avoid the interference of chest wall and lung qi, or other factors. It is an effective supplementary guidance method worthy of promotion.
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Objective To explore the safety and therapeutic effect of transesophageal echocardiography(TEE)-guided transthoracic minimally invasive intervention for congenital heart disease complicated with compound heart ab-normalities in children.Methods From September 2013 to January 2018,32 children with congenital heart disease complicated with compound heart abnormalities were collected,who undergoing TEE-guided transthoracic minimally invasive intervention at the Department of Cardiothoracic Surgery,Dalian Children's Hospital were collected.There were 6 cases of ventricular septal defect (VSD)combined with atrial septal defect (ASD),11 cases of VSD combined with patent ductus arteriosus (PDA),9 cases of ASD combined with PDA,3 cases of VSD combined with pulmonary stenosis (PS),and 3 cases of ASD combined with PS.TEE-guided transcatheter closure was performed within a minimally in-vasive transthoracic minimal incision (1 -2 cm)under non-cardiopulmonary bypass.The efficacy of the procedure was evaluated by TEE.The transthoracic echocardiography,chest film and cardiogram after post-procedure examina-tions were followed.Results TEE-guided transthoracic minimally invasive perventricular intervention was successfully performed in all the sick children.The mean duration of operation,intensive care unit monitoring and ventilation were (54.2 ± 21.8)min,(14.3 ± 8.7)h and (3.7 ± 2.9)h,respectively.No patient received diuretic drugs,sedation drugs,blood transfusion or conventional surgical repair. The follow - up period for all the patients lasted 12 -48 months.No arrhythmias,residual shunts or occluder detachments,or thrombosis,hemorrhage,or new valve regurgitation occurred.Conclusions TEE -guided transthoracic minimally invasive intervention is feasible and has a promising prognosis for young children with congenital heart disease combined with compound heart abnormalities.
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Objective To evaluate the effect of percutaneous device closure guided by transesophageal echo-cardiography (TEE)on atrial septal defect(ASD)via right internal jugular vein(RIJV)in children.Methods A total of 8 cases with secundum ASD were recruited as candidates to receive percutaneous device closure via RIJV between July 22 and November 5,201 5 in Heart Center,Dalian Children′s Hospital.In this group,5 boys and 3 girls who were 5 months to 1 0 years old were included.The youngest patient was a 30 weeks premature infant of 5 months old,with 3 -month correction gestational age.All patients were clearly diagnosed as ASD by transthoracic echocardiography(TTE) before operation.Five patients had single central type ASD which were 5 -8 mm in diameter,and 3 patients had multi-ple(1 biforate and 2 cribriform)ASD which were 1 0 -1 2 mm in shunt range.New type Fustar curve adjustable sheath was delivered after RIJV accessed.By passing through the ASD by adjusting the depth and bending of the tips of sheath,then the device was delivered and released to close the ASD.The procedures were always guided and monitored by TEE.After the devices were released,the position of device,residual shunt,and the effect of valves were assessed by TEE or TTE.Results All patients were tested with TEE and TTE after procedure,devices were stable and well shaped,and the defects were closured well without any residual shunt.All the patients were followed up more than 6 months.No hydropericardium,thrombogenesis,tachyarrhythmia,complete atrioventricular block or other complications were found.Conclusions To close ASD with new type curve adjustable sheaths via RIJV may have wide indications, short operation path,well curative effect,minimal invasion and fast recovery in pediatrics,especially fit for the small age children with a big ASD who are difficult to treat via femoral vein.
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The use of bronchoscope in pediatrics is more common that following the development and perfection of bronchoscope technology.Because of the particularity of children,the safety about using bronchoscope in pediatric had been paid close attention all the time.The study and observation,which are related to the safety of diagnosis and treatment with bronchoscope in children has been became hot spot.In order to reduce the incidence of adverse reactions and complications,in operation we should choose appropriate anesthesia,continue to offer oxygen and complete the operating expertly and quickly;we also must closely monitor the patient's vital signs,especially for small age groups.Improving and strictly enforcing the disinfection and isolation system in order to avoid unnecessary iatrogenic infection.The safety of the medical staffshould be protected at the same time.
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<p><b>OBJECTIVE</b>To observe the effect of bronchoalveolar lavage on the heart rhythm and conduction of children with severe pneumonia through monitoring the electrocardiogram change of different step of the bronchoalveolar lavage, for proving the safety of the operation of bronchoalveolar lavage from the perspective of cardiac electrophysiology.</p><p><b>METHOD</b>From July 2011 to March 2012, 30 patients who were hospitalized in pneumology department of Dalian Children's Hospital and met the inclusion criteria and therapeutic indications of bronchoalveolar lavage were chosen. They were 3 to 12 years old, the average age was 5.3 years, including 17 boys and 13 girls, the ratio of boys and girls is 1.3: 1. Continuous sampling the electrocardiogram before and during the process including anesthesia, entering into glottis, lavage, aspiration, and revive, and recording the heart rate, rhythm amplitude and width of P wave, the PR interval, the form and width of QRS complex were also measured. The recorded data were analyzed and statistical analysis to reflect the change of the cardiac electrophysiology.</p><p><b>RESULT</b>The incidence of heart rate increase was 100.0%, 26 (86.7%) patients began to emerge after anesthesia, the rest of the patients also developed heart rate increase after the start of bronchoscopic operation. All patients had sinus tachycardia, and were most obvious in the progress of lavage and revive. In the process of entering into glottis, lavage, aspiration, 13 (43.3%) patients had arrhythmia episodes. Types of arrhythmia included sinus bradycardia, atrioventricular block and premature beat. Incidences of intraoperative arrhythmia compared with the pre- and post-operation were all statistically significantly different (P = 0.00). The most common arrhythmia were premature beat, in 17 of the 30 cases there were premature beat including 9 cases with atrial premature beats and 8 cases ventricular premature contraction. Two patients had III° atrioventricular block accompanied by serious sinus bradycardia. All kinds of arrhythmias except sinus tachycardia disappeared after the operation was ended. Five patients (16.7%) had PR interval prolongation. Five patients (16.7%) had incomplete right bundle branch block (IRBBB) . Incidences of IRBBB compared with the pre-operation and post-operation were all not significantly different [13.3% (n = 4) vs. 0(n = 0) and 3.3% (n = 1), all P > 0.05]. Different operating progress made no significant difference in the measurement value of electrocardiogram[13.3% (n = 4) vs. 0(n = 0) and 3.3% (n = 1), all P > 0.05], but showed the most notable effect on heart rate.</p><p><b>CONCLUSION</b>Bronchoalveolar lavage can influence the heart rhythm and conduction, but most of the influence with pathological significance are transient. Cardiac electrophysiological changes were the most obvious in endotracheal operation with the risk of malignant arrhythmia but the risk is low, the bronchoalveolar lavage technique is safe. The contingency plans for dealing with all kinds of adverse reactions must be ready before the operations of bronchoalveolar lavage. During the procedure, the patient's ECG changes should be closely monitored to reduce the incidence of adverse reactions.</p>