ABSTRACT
OBJECTIVE@#To evaluate the safety of surgical repair for neonatal aortic coarctation combined with ventricular septal defect. @*METHODS@#Twenty-three aortic coarctation neonates received surgical treatment and their clinical data between April, 2013 and May, 2015 were analyzed retrospectively. All patients underwent coarctation repair + ventricular septal defect repair and mild hyperthermia cardiopulmonary bypass under the condition of general anesthesia. All patients were subjected to delayed sternal closure. @*RESULTS@#One patient died at early post-operation, and no one died during 2-27 months' follow-up. Operation time, cardiopulmonary bypass time, aortic cross-clamp time, ICU stay time, mechanical ventilation time, delayed sternal closure time, and post-operative hospital stay time were (192.7±43.4) min, (132.4±26.4) min, (65.3±18.4) min, (185.3±56.4) h, (42.4±24.5) h, (36.3±18.6) h, and (15.3±4.6) d, respectively. Post-operative complications presented in 12 patients, including post-operative hemorrhage in 6 patients, acute renal insufficiency in 4 patients, wound infection in 1 patient, and post-operative coarctation of the aorta in 1 patient. @*CONCLUSION@#One-stage complete repair for severe aortic coarctation combined with ventricular septal defect in neonates is safe, and the outcomes are satisfied. Fully free of the aortic arch and individual aorta reconstruction are the keies to successful operation.
Subject(s)
Humans , Infant, Newborn , Aorta , Aortic Coarctation , Heart Septal Defects, Ventricular , Postoperative Complications , Postoperative Period , Retrospective Studies , SafetyABSTRACT
Objective 22q11 microdeletion is featured with hemotological dysfunction,among others:hypocalcemia,thrombocytopenia and megathrombocyte.This study was trying to work out the platelet characteristics of 22q1 1 microdeletion patients and its potential clinical application.Methods A total of 80 cases who had undergone open-heart surgery were selected and confirmed with fluorescence in situ hybridization (FISH) to have 22q1 1 microdeletion among 40 cases while the others were negative.The relevant data in full blood routine of all the 80 cases in hospital information system (HIS) then were collected and analyzed with suitable statistical methods.Results The mean platelet volume in microdeletion group was statistically higher than that in the control group [(11.20 ± 1.94)fL vs (8.95 ± 1.58) fL,P ＜0.01].The area under the receiver operating characteristic (ROC) curve was 0.82,meaning significant predictive values.The corresponding sensitivity and specificity for mean platelet volume (MPV) =10 fL were 70.0 ％ and 80.0 ％,respectively.Conclusions MPV in congenital heart defect patients with 22q11 is significantly higher than those without 22q11.It is an effective method for preliminary screening 22q11.Being obtained from full blood routine data,it is economic and quick.MPV =10 fL can be used as a cutoff for guidance for irradiated blood transfusion postoperatively.
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Based on the first hand cardiothoracic surgical training experiences in Australia, the author introduced the Australian surgical training system's objective, structure, outline and specific training methods as well as its contents in detail. Its overall characters can be summarized as high standard, strict requirement and equal stress on both theory and practice. Hopefully, this introduction and reflection may shed some light on the improvement and evolvement of the resident training system in China.
ABSTRACT
Objective To study the feasibility and safety of limb remote ischemic preconditioning (RIPC) in infants and explore the protective effect on myecardium ischemia reperfusion injury for infants undergoing cardiac operation under cardiopulmonary bypass. Methods 60 infants weight less than 7 kilograms with ventricular septal defect were enrolled into the study. 30 of them (RIPC group) were ischemic preconditioned two times (24 hours and 1 hour preoperatively) by three cycles of iscbemia (5 minutes for each) and reperfusion on the left upper arm using a blood pressure cuff. Serum lactate dehydrogenase (LDH), creatine kinase (CK) and its isoenzyme (CK-MB), and tro-ponin I (TnI) ; malondialdehyde (MDA) and superoxide dismutase (SOD) was preoperatively detected. The expression of heat shock pro-tein 70 (HSP 70) in cardiomyocytes was determined by western blot analysis. The surgical outcome including limb movement and sensory function was also recorded. Results No limb disability or sensory disturbance or no other surgical complications was found in all infants. LDH, CK, TnI at the beginning of operation in RIPC group was higher than those in control group. After operation, leakage of heart enzymes were attenuated in RIPC group, and the serum concentration of enzymes were lower than those in the control group. The RIPC group had low coronary sinus venous concentration of MDA but high SOD. The expression of HSP70 was upregulated in cardiomyocytes of RIPC group. Conclusion The limb RIPC can be done easily and safety in infants, and BIPC can reduce the leakage of myocardial enzymes and upregu-late the expression of HSP, which possess protective effect on myocardial IRI.