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Objective@#To analyze the clinical features and surgical treatment of unroofed coronary sinus syndrome(UCSS) in children, and to provide evidence for the diagnosis and treatment of such diseases during the perio-perative period.@*Methods@#A retrospective analysis was conducted based on the clinical data of 13 patients with UCSS, who underwent surgical treatment at Beijing Children′s Hospital Affiliated to Capital Medical University from January 2011 to December 2017.All 13 patients were complicated with persistent left superior vena cava(PLSVC) and other cardiac malformations; 7 patients were diagnosed preoperatively and 6 patients were diagnosed intraoperatively.Eleven cases were diagnosed type Ⅰ and 2 cases were type Ⅳ according to Kirklin′s classification.In all of 13 cases, atrial septal reconstruction was performed to drain the left superior vena cava(LSVC) to the right atrium, and other cardiac malformations were corrected at the same time.@*Results@#One patient died in this group, and the other 12 patients had early recovery after operation.Postoperative-ventilator-assisted time was 5-246 h(median 29 h) and hospital stay time was 8-40 d(median 16 d). The remaining 12 cases were followed up from 6 months to 7 years and 2 months.No death or complications occurred.No residual shunt or residual obstruction was found.@*Conclusions@#In the case of congenital heart disease with PLSVC, UCSS should be alerted.Atrial septal reconstruction and drainage of LSVC into right atrium in children with UCSS can achieve satisfactory surgical results.
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Objective To study the clinical effect of endotracheal stent implantation for treatment of congenital tracheal obstruction due to preoperative airway stenosis and postoperative dislocation difficulty .Methods 23 children with congenital heart disease complicated with severe tracheal stenosis were treated in our hospital from March 2015 to December 2017.The op-eration of congenital heart disease and airway stenting were performed .The preoperative diagnosis of the children was based on the bronchoscopy and CT airway reconstruction, and the patients were followed up for 1 to 24 months after the hospital was dis-charged.And every 1 to 3 month, the hospital was assessed by FFB.Results 20 children had good growth and development, and 21 of the 23 cases were removed by tracheal intubation to NCPAP within 1 weeks after the stent implantation , and they were transferred to the general ward within 2 weeks after the operation, and the hospital was discharged within 4 weeks after the oper-ation.1 children were discharged from hospital in 4 month after the operation ,because of severe lung infection.In 1 cases, the airway was blocked by recurrent granulation tissue and necrotic epithelium, the treatment was abandoned.22 cases of children were followed up by FFB.The stent was well epithelialization.13 out of 23 cases were successfully removed.Conclusion Tracheal intubation can not be performed in children with congenital heart disease due to airway stenosis before operation .After operation,with uncontrolled pulmonary infection and atelectasis, the children often failed to removing intubation.By FFB, the airway stent of implantation and removal are one of the effective treatment methods .However, there are still many complications and need to be strictly controlled .
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Objective To analyze the clinical features and surgical treatment of unroofed coronary sinus syn-drome(UCSS)in children,and to provide evidence for the diagnosis and treatment of such diseases during the perio-perative period. Methods A retrospective analysis was conducted based on the clinical data of 13 patients with UCSS, who underwent surgical treatment at Beijing Children＇s Hospital Affiliated to Capital Medical University from January 2011 to December 2017. All 13 patients were complicated with persistent left superior vena cava( PLSVC)and other cardiac malformations;7 patients were diagnosed preoperatively and 6 patients were diagnosed intraoperatively. Eleven cases were diagnosed typeⅠand 2 cases were typeⅣaccording to Kirklin＇s classification. In all of 13 cases,atrial sep-tal reconstruction was performed to drain the left superior vena cava(LSVC)to the right atrium,and other cardiac mal-formations were corrected at the same time. Results One patient died in this group,and the other 12 patients had early recovery after operation. Postoperative-ventilator-assisted time was 5-246 h( median 29 h)and hospital stay time was 8-40 d(median 16 d). The remaining 12 cases were followed up from 6 months to 7 years and 2 months. No death or complications occurred. No residual shunt or residual obstruction was found. Conclusions In the case of congenital heart disease with PLSVC,UCSS should be alerted. Atrial septal reconstruction and drainage of LSVC into right atrium in children with UCSS can achieve satisfactory surgical results.
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Objective: To explore the effects of peritoneal dialysis on acute renal insufifciency and on relevant blood indicators in children with congenital heart disease (CHD) after the operation. Methods: A total of 48 CHD patients received direct open heart surgery by cardiopulmonary bypass and suffered from post-operative acute renal insufifciency in our hospital from 2011-12 to 2014-12 were retrospectively analyzed. The patients were divided into 2 groups: Peritoneal dialysis group and Routine medication group,n=24 in each group. The differences of renal function indexes, the blood levels of electrolyte and inlfammatory factors were compared between 2 groups. Results: Compared with Routine medication group, the patients in Peritoneal dialysis group presented decreased serum critinine, BUN and urine β2-micro globulin, 24-hour protein level,P Conclusion: Peritoneal dialysis may improve the renal function in CHD patients with post-operative acute renal insufifciency and optimize the blood levels of electrolyte and inlfammatory factors.
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Objective To approach the efficacy of magnesium sulfate(MgSO4 )supplemantation to prevent junctional ectopic tachycardia(JET)during the early postoperative period in infant patients after sur-gery for congenital heart disease.Methods A total of 325 infant patients undergoing cardiac surgery with cardiopulmonary bypass were randomly divided into two groups:the trial group (n =162,50 mg /kg 25%MgSO4 )and the placebo group(n =163,normal saline).The serum magnesium concentrations were meas-ured at five time points.Continuous electrocardiographic documentation by Holter monitor was performed for 24 hours after cardiac sugery.Results At T3 time point(1 hour after 50 mg /kg 25% magnesium sulfate and equivalent saline applied in intravenous infusion),the concentration of serum magnesium in trial group was higher than that of the placebo group[(1.79 ±0.33)mmol /L vs.(0.92 ±0.18)mmol /L],and the differ-ence between two groups was significant(P =0.001 ).At T4 and T5 time points(after magnesium sulfate and equivalent saline applied 12 and 24 hours respectively),the concentrations of serum magnesium in trial group were throughout higher than those of the placebo group [T4:(1.24 ±0.2)mmol /L vs.(0.83 ±0.17 ) mmol /L;T5:(1.20 ±0.16)vs.(0.80 ±0.19)mmol /L,P =0.024,P =0.035,respectively].The overall incidence of JET was 5.2%(17 /325),the placebo group had a significantly greater occurrence of JET than that of the trial group,the difference was significant between two groups [9.2%(15 /163 )vs.1.2%(2 /162),P =0.013 ].The onset time of JET in placebo group was earlier than that of the trial group (P =0.019).A total of 14 of 17 cases(82.4%)with JET had hypomagnesaemia,the cases with JET had a signif-icant longer period of mechanical ventilation and CICU stay.Conclusion Positively supplementation with magnesium sulfate during the early postoperative period in infant patients after surgery for congenital heart diseaae could reduce the incidence of JET.Hypomagnesaemia is related to JET.