Outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting / 中华儿科杂志

Objective: To summarize the outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting. Methods: This study was a retrospective cohort study. A total of 19 neonates who had pulmonary atresia treated by ductus arteriosus stenting in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from April 2014 to June 2021 were included. They were divided into the intact ventricular septum (PA-IVS) group and the ventricular septal defect (PA-VSD) group. Ductus arteriosus stents were implanted by different approaches. These children were followed up regularly at the 1, 3, 6, and 12 months after the surgery and annually since then to evaluate the outcome. Independent sample t-test was used for the statistical analysis. Results: There were 12 children in PA-IVS group and 7 in PA-VSD group. All of them were full term in fants. The gestational age of the PA-IVS group and the PA-VSD group was (38.8±1.1) and (37.7±1.8) weeks, the birth weights were (3.2±0.4) and (3.4±1.1) kg, and the age at operation was (10±9) and (12±7) days, respectively, without significant difference (all P>0.05). Among the 12 children with PA-IVS, 9 had stents successfully implanted through the femoral artery and 3 through the femoral vein. Of the 7 children with PA-VSD, 2 had the stents successfully implanted via the femoral artery and 2 failed, and the remaining 3 had stents successfully implanted via the left carotid artery. There was no postoperative thromboembolism, arteriovenous fistula, pseudoaneurysm or other vascular complications. Five children with PA-VSD who had successful operations were followed up at 6 months of age. They all had the operation for pulmonary atresia, repair of the ventricular septal defect, removal of arterial duct stents, and ligation of the arterial duct. All children survived without any stent displacement or stenosis and biventricular circulation was achieved during the follow-up. Conclusions: Ductus arteriosous stenting can be the first-stage treatment for children with PA-IVS and PA-VSD. In addition to the traditional femoral vein and femoral artery approach, the carotid artery can be used as a route for stent placement.

Comparative study on heart function assessment of left single ventricle in children by echocardiography the doppler myocardial performance index and tissue doppler imaging / 中华实用儿科临床杂志

Objective To explore the accuracy of heart function assessment of the left single ventricle problems in children by three-dimensionalechocardiography (3 DE),the doppler myocardial performance index (MPI) and tissue doppler imaging(TDI).Methods Twenty-nine healthy children (the healthy control group) and 29 children with problems in the single left ventricles (the case study group) were enrolled in this study.End-diastolic volume (EDV),end-systolic volume(ESV) and ejection fraction(EF) were acquired by using IE 33 system and Q-lab software between 2 groups.MPI was calculated from doppler tracings on the ventricular inflow and outflow,and the velocity profile of atrioventricular annular was obtained by TDI.Max(dp/dt) of the left single ventricle was estimated by atrioventricular regurgitation using simplified Bernoulli equation.Results EDV,ESV and MPI in the case study group were higher than those of the healthy control group(t =2.821,5.287,2.085,all P ＜0.05),and EF of the case study group was lower than that of the healthy control group(t =-13.840,P ＜ 0.05).Em,Am and Em/Am on the side of the left ventricular lateral wall of mitral annulus in the control group were higher than those of the case study group at the nonresidual cardiac cavity side(t =-3.059,2.219,-4.762,P ＜ 0.05) ;Sm and Em/Am in the healthy control group at mitral annular lateral ventricular septal side were higher than those in the case study group at the residual cardiac cavity side(t =-2.200,-2.962,P ＜0.05).Q-Sm interval in healthy control group was lower than that in the case study group(t =2.345,P ＜ 0.05).There was a negative correlation between Max (dp/dt) and MPI in the case study group (r =-0.57,P ＜0.05),there was a positive correlation between Max(dp/dt) and EF and Q-Sm interval in the case study group(r =-0.74,0.62,P ＜ 0.05).Conclusions Impaired ventricular functions can be found in patients with left single ventricle problems,which can be assessed accurately by 3DE.

Diagnostic value and misdiagnosis analysis of tetralogy of Fallot by prenatal echocardiography / 中华实用儿科临床杂志

Objective To evaluate the diagnostic value of prenatal echocardiography in fetus with tetralogy of Fallot(TOF),and to analyze the reason of misdiagnosed in order to improve the echocardiographic diagnosis.Methods A retrospective echocardiographic review of 36 fetuses with TOF confirmed by prenatal magnetic resonance imaging (MRI) or postnatal echocardiography.Results Among 36 cases of TOF fetuses,31 cases (86.1 ％) were diagnosed correctly by echocardiography,and in the remaining 5 cases,4 cases(11.1％) were misdiagnosed [2 cases misdiagnosed as ventricular septal defects (VSD),2 cases misdiagnosed as double outlet of right ventricles],and 1 case (2.8％) was missed diagnoses at 20 weeks gestation and confirmed as TOF at 36 weeks gestation based on the echocardiographic findings of malalignment type VSD,overriding aorta,pulmonary stenosis,and right ventricular hypertrophy.Malalignment type VSD,overriding aorta,and pulmonary stenosis were observed in 31 cases with TOF diagnosed by prenatal echocardiography,right ventricular hypertrophy was observed only in 6 cases.The most common associated anomalies were tricuspid regurgitation in 13 cases(36.1％),aortic insufficient in 6 cases(16.7％),absent pulmonary valve in 4 cases(11.1％),right-side aortic arch in 4 cases(11.1％),persistent left superior vena cava in 3 cases(8.3％),and complete atrioventricular septal defect in 1 case (2.8％).Conclusions Combining visualization of TOF in four-chamber view,outflow tract view,and three vessels view,TOF can be accurately diagnosed by prenatal echocardiography.

Evaluation of early monitoring of cardiotoxicity induced by anthracyclines / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Anthracyclines (ANT) are effective for leukemia and solid tumors. However the long-term life quality of patients is seriously affected by ANT-related cardiotoxicity. The aim of this study was to evaluate the value of two dimension echocardiography (2DE) and serum biochemical indicators in monitoring ANT-related cardiotoxicity.</p><p><b>METHODS</b>Seventy children who received ANT chemotherapy (ANT dose: 124 ± 73 mg/m2) and were followed up for 22 ± 13 months were enrolled. 2DE with aspects of conventional indexes (left ventricular diameter and wall thickness, ejection fraction, E/A), myocardial performance index (MPI) and tissue Doppler imaging (TDI) were performed. Serum levels of troponin (CTnI) and brain natriuretic peptide (BNP) were measured. Thirty-seven healthy children served as the control group.</p><p><b>RESULTS</b>There were no significant differences in conventional indexes of 2DE between the ANT and the control groups. The MPI of left and right ventricular in the ANT group increased significantly compared with that in the control group (0.237 ± 0.06 vs 0.203 ± 0.06, 0.171 ± 0.05 vs 0.140 ± 0.04 respectively; P<0.01). TDI showed the late diastolic peak velocity in the basal and middle sections of left ventricular, interventricular septum and right ventricular in the ANT group were significantly higher than the controls. There were significant differences in the ratio of early to late diastolic peak velocity of the middle section of left ventricular and the basal and middle sections of the interventricular septum between the two groups (P<0.05). The changes of MPI and TDI became more obvious with the increased dose of ANT. There were no significant differences in serum CtnI and BNP levels between the two groups.</p><p><b>CONCLUSIONS</b>The heart function of patients who received ANT chemotherapy needs to be monitored for a long term. MPI and TDI can be used as early indexes for monitoring the heart function.</p>

Diagnostic value of the currently used criteria and brain natriuretic peptide for diagnosing congestive heart failure in children with congenital heart disease / 中华儿科杂志

<p><b>OBJECTIVE</b>To improve the accuracy of diagnosis of heart failure (HF) has been the focus of research for a long time. The diagnosis for HF with congenital heart disease, however, is more difficult. The aim of the study was to evaluate the diagnostic criteria for HF in children and examine the value of plasma brain natriuretic peptide (BNP) and NT-proBNP for diagnosing HF in pediatric patients with congenital heart disease, and to look for the most valuable index for the diagnosis according to the multifactor analysis.</p><p><b>METHODS</b>Totally 118 children with congenital heart disease were enrolled. They were diagnosed using modified Ross score, Qingdao criteria, NYU PHFI, and plasma BNP and NT-proBNP. According to modified Ross score as the referent criteria, other diagnostic criteria and plasma BNP and NT-proBNP were studied. The sensitivity, specificity and area of the ROC curve were examined. Logistic regression analysis was used to select the valuable index for diagnosing HF.</p><p><b>RESULTS</b>(1) The value of each clinical criteria: 1 The sensitivity of Qingdao criteria for diagnosing HF was 47.9%. The specificity was 100% and the accuracy was 57.6%. 2 There were 52 patients younger than six months in whom 27 (51.9%) were breast fed. Only 25 children were measured with Ross score. The Ross score was positively correlated with the modified Ross score (r = 0.948). The area under the ROC curve of Ross score diagnosing HF was 0.985, and the sensitivity was 88%, while the specificity was 100%. 3 NYU PHFI score was positively correlated with the modified Ross score. The area under the ROC curve of the NYU PHFI diagnosing HF was 0.964, and the sum of sensitivity and specificity was favorite when > or = 8 was set as the cut-off point. If > 2 was set as cut-off point, it had a high sensitivity but a low specificity. The sensitivity of NYU PHFI was 100% > was set 2 as cut-point for diagnosing HF, but the specificity was 4.5%. (2) Plasma BNP and NT-proBNP were positively correlated with the modified Ross score, and increased with the severity of congestive HF. The area under the ROC curve of BNP was 0.880, and the cut-off line was > or = 349 pg/ml. The area under the ROC curve of NT-proBNP was 0.981, and the cut-off line was > or = 499 fmol/ml. (3) Logistic regression analysis showed that in multifactor analysis, only plasma concentration of NT-proBNP, dyspnea, tachycardia, tachypnea, failure to thrive were the independent predictors for diagnosing HF. (4) Plasma concentration of NT-proBNP incorporated with clinical criteria would improve its accuracy.</p><p><b>CONCLUSION</b>All the clinical criteria commonly used were valuable for diagnosing HF in children with congenital heart disease, but each has its own limits, such as the low sensitivity of Qingdao, the low adaptation of Ross score because of the high breast-feeding rate in our country and the low specificity of NYU PHFI when > 2 was set as the cut-off point. Plasma concentrations of BNP and NT-proBNP were valuable for diagnosing HF in children with congenital heart disease, and NT-proBNP was the independent predictor for HF.</p>

Diagnostic value of plasma concentration of pro-brain natriuretic peptide in congestive heart failure in pediatric patients with ventricular septal defects / 中华儿科杂志

<p><b>OBJECTIVE</b>The value of plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) can reflect cardiac function and therefore can be used for diagnosing congestive heart failure (CHF) and evaluating cardiac function. There are few reports, however, on the value of BNP and NT-proBNP in pediatric cases of congenital heart defect. The aim of this study was to assess the value of plasma NT-proBNP in the diagnosis of CHF and evaluation of cardiac function in pediatric patients with ventricular septal defect (VSD).</p><p><b>METHODS</b>Fifty-one patients with VSD aged from 2 months to 2 years old (mean 7.9 months) were enrolled. According to the modified Ross Score, the patients were divided into three groups, no CHF group (20 patients), mild CHF group (18 patients) and moderate to severe CHF group (13 patients). Fifteen age-matched normal children were used as controls. Plasma NT-proBNP was measured using enzyme immunoassay. All patients had complete echocardiographic study, including measurement of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic wall stress (LVSEWS), heart rate corrected mean velocity of circumferential fiber shortening (mVcFc), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and contractility index (Con). The correlation between plasma NT-proBNP level and modified Ross Score and echocardiographic cardiac functional indexes was determined. The sensitivity, specificity and ROC curve of plasma NT-proBNP for diagnosing CHF was studied.</p><p><b>RESULTS</b>Plasma NT-proBNP was positively correlated with modified Ross Score (r = 0.75, P < 0.01). Plasma NT-proBNP concentration in moderate to severe CHF group (2061 +/- 908) fmol/ml was significantly higher than that of mild CHF group (810 +/- 335) fmol/ml, and Plasma NT-proBNP concentration in mild CHF group was higher than that in no CHF group (309 +/- 68) fmol/ml. 97.14% of normal controls and subjects in no CHF group had their plasma NT-proBNP below 400 fmol/ml. 83.3% of children in mild CHF group had their plasma NT-proBNP between (400-1400) fmol/ml while in moderate and severe CHF group 84.6% of children had their plasma NT-proBNP beyond 1400 fmol/ml. Plasma NT-proBNP was also positively correlated with LVEDVI and LVSEWS. There was no correlation among mVcFc, LVEF, LVFS, Con and plasma NT-proBNP concentration. Using plasma NT-proBNP concentration > or = 400 fmol/ml as cut-point for diagnosing CHF, the sensitivity was 89.3%, the specificity was 91.2%, and the area under the ROC curve was 0.944.</p><p><b>CONCLUSIONS</b>Plasma NT-proBNP level could be used to assess cardiac function and diagnose CHF in pediatric patients with VSD.</p>