ABSTRACT
Objective To evaluate the feasibility and safety on closing ventricular septal defects (VSDs) under cardiopulmonary bypass(CPB) in neonatal patients with VSD and congestive heart failure.Methods From Oct.2010 to Sep.2012,16 newborn infants with VSD and congestive heart failure in Neonatal Intensive Care Unit(NICU),the Bayi Children's Hospital Affiliated to Beijing Military General Hospital,were selected as the observed group,VSD repair operation was done under CPB.As the control group,18 patients in Pediatrical Cardiac Surgical Department were randomly selected in the same period in hospital,and selective VSD repair operations were done under CPB.Between the 2 groups,demographics(body weight,gender,VSD diameter),clinical characteristics (CPB time,aortic crossclamp time) and early outcomes were compared.Results For the diameter of VSD and gender,there were no significant difference between the 2 groups (P ＞ 0.05).For the body weight,the patients in control group [(8.27 ± 3.39) kg] were more heavier than those in observed group [(3.69 ± 0.72) kg] (P ＜ 0.01).In the operation period,there were no significant differences in CPB time and aortic crossclamp time between 2 groups(all P ＞ 0.05).The lactate value of the patients in observed group [(2.76 ± 1.12) mmol/L] was significantly higher than that in control group [(1.65 ±0.34) mmol/L] (P ＜ 0.01).At the same time,the ventilation time [(3.69 ± 1.66) days] and PICU stay [(9.75 ± 3.44) days] were significantly longer than those in control group[(2.00 ±0.89) days and (6.17 ± 1.98) days] (all P ＜ 0.01).All the patients in the 2 groups discharge out of the hospital,there was no significant difference in outcome.Conclusions The newborns with VSD and congestive heart failure in NICU,can be not improved after the medical management,then closing the VSD is feasible and safe under CPB.
ABSTRACT
Objective To summarize the clinical experience of comprehensive management of critical newborns with transposition of great arteries (TGA) by neonatologists and cardiac surgeons.Methods Seventeen critical newborns with TGA rescued by combined efforts of neonatologists and pediatric cardiac surgeons from Oct.2010 to Oct.2012were retrospectively analyzed.Results Of the 17 newborns(14 cases were male,3 cases were female),9 cases were TGA with ventricular septal defect(TGA/VSD),8 cases TGA with intact ventricular septal defect (TGA/IVS).The babies aged from 1-45 days,weighed from 2.7-4.6 kg at operation.Of the 9 cases TGA/VSD babies,3 cases were treated with prostaglandins E (PGE) for hypoxemia correction and selective operation opportunity ;2 cases underwent emergency arterial switch operation (ASO) for severe cardiac shock.All of the 8 cases TGA/IVS babies received PGE treatment preoperatively for life threatening hypoxemia,and 4 cases of them underwent emergency ASO.There were 12 cases delayed sternal closure and 5 cases of them were emergency babies.Peritoneal dialysis was employed for 6 cases and extracorporeal membrane oxygenation (ECMO) for l case.There were 6 cases with postoperative incision infection,including 5 emergencies.Thirteen newborns survived and 4 cases died at hospital:one case complicated with postoperative septicemia and severe mediastinitis which leaded to pericardium patch rupture and fatal pulmonary arterial hemorrhage;one case with abnormal inferior vena cava connection and severe low cardiac output syndrome;one case with disseminated intravascular coagulation (DIC) due to septicemia and severe mediastinitis postoperatively,one case with abnormal coronary artery during surgery and difficult coronary artery transplantation and insufficient blood supply after aorta was open.Conclusions Correcting hypoxemia and stabilizing the severe babies are critical in NICU to avoid emergency surgery.Emergent ASO is the optimized medical therapy for those with persistent severe hypoxemia and heart failure.