ABSTRACT
Objective To evaluate the myocardial protective effects of Histidine-TryptophanKetoglutarate (HTK) solution on infants with tetralogy of fallot in cardiac operation through comparison with St.Thomas Ⅱ cardioplegia(STH) and HTK cardioplegia in the operation of tetralogy of fallot.Methods Forty infants with tetralogy of fallot(TOF) were enrolled in this study.Their age ranged from 7 to 35 months,and body mass from 5.3 to 9.5 kg.The infants were randomly divided into HTK (n =20) group and STH (n =20) group who received HTK or STH solution respectively.Then 3 ml blood sample were got at 1,2,4,8,24 and 48 h after the opening of ascending aorta.The serum levels of cardiac troponin Ⅰ(cTnI),creatine kinase(CK) and creatine kinase MB(CK-MB) were measured.Results There was significant difference between two groups in terms of the level of cTnI at different time (F(inner group)=49.94,P＜0.001;F(between group) =10.23,P＜0.001;F (across group) =28.49,P＜0.001),and the level of cTnI in HTK group was lower than that of STH group at 1,2,4,8,24 and 48 h after the opening of ascending aorta (P＜0.05).There was significant difference between two groups in terms of the level of CK at different time (F(inner group) =58.85,P＜0.001;F(between group) =16.43,P＜0.001;F(across group)=18.32,P＜0.001),and the level of CK in HTK group was lower than that of STH group at 1,2,4,8,24 and 48 h after the opening of ascending aorta (P＜0.05).There was significant difference between two groups in terms of the level of CK-MB at different time (F(inner group)=34.51,P ＜0.001;F(between group)=11.03,P＜0.001;F(across group)=10.28,P＜0.001),and the level of CK-MB in HTK group was lower than that of STH group at 1,2,4,8,24 and 48 h after the opening of ascending aorta (P ＜0.05).Conclusion HTK is more valid than STK for improving the ability of anti ischemia of myocardium and cardiac function,reducing arrhythmia and ischemia reperfusion injury on infants with TOF in cardiopulmonary bypass.
ABSTRACT
Objective To share the clinical experience of tetralogy of stage Ⅰ Fallot children with little left ventricle.Methods Thirty-eight cases with stage Ⅰ Fallot with little left ventricle from March 2008 to Jun 2012 were selected as our subjects.Of them,18 were boys and 20 were girls.The age of the cases ranged from 5 to 18 months and average was (9.37 ±2.45) months.The weight ranged from 6.6 to 10.4 kg,and average was (8.33 ± 1.72) kg.All cases showed cyanosis of oral lip.They all were performed tetralogy by the breast bone median incision and then expanding interventricular septal defect.Results All cases survived.Following-up 6 -18 months showed that all cases got good recovery.Left arterial diameter at before the operation,discharge,3 months after surgery were (14.07 ± 0.79) mm,(14.37 ± 0.68) mm,(16.01 ± 0.72) mm respectively and transverse diameter of right atrium were (18.23 ± 1.07) mm,(18.74 ± 0.96) mm,(19.28 ± 0.71) mm respectively.The differences were significant (F =99.474,69.760,P =0.000).Main pulmonary artery diameter at before the operation,discharge,3 months after surgery were (7.98 ±0.92) mm,(8.16 ±0.54) mm and (9.92 ± 0.81) mm,and left ventricular end diastolic diameter were (19.27 ± 1.15) mm,(21.06 ± 1.75) mm,(23.41 ± 1.18) mm.Meanwhile,left ventricular fractional shortening rate were (35.57 ± 1.45)％,(32.61 ± 2.15) ％,(34.29 ± 2.12) ％,and main pulmonary artery systolic flow velocity were (450 ± 98.36) cm/s,(150.0 ± 9.22) cm/s,(148.0 ± 7.92) cm/s.All differences were statistically significant (F =108.620,96.410,99.485,102.914;P =0.000).Conclusion Tetralogy on Fallot children with little left ventricle can lead to cardiac remodeling,which reduce the load of right ventricle and improve left ventricular function.