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1.
Article in Chinese | WPRIM | ID: wpr-929807

ABSTRACT

Congenital heart disease(CHD)is one of the most common genetic diseases, mainly refers to the abnormal cardiovascular development caused by various abnormal factors during fetal development.Studies have found that the normal development of cardiovascular functional structure requires accurate positioning of the left-right asymmetry.As an essential link in body material metabolism and signal-transducing mechanism, cilia may participate in the pathogenesis of CHD by affecting the distribution of the left-right asymmetry of human organs and tissues during embryonic development.Therefore, a thorough understanding of the role, molecular mechanism, and related regulatory genes of cilia in CHD can provide accurate diagnosis and treatment for clinical work to obtain a better prognosis.Here we review the effects of cilia on the positioning of the left-right asymmetry during embryo development and its role in the pathogenesis of CHD.

2.
Article in Chinese | WPRIM | ID: wpr-943092

ABSTRACT

ObjectiveTo obtain content characteristics of inorganic elements in Scutellariae Radix (aged 1-4 years), and to explore the feasibility of identifying the growth years of Scutellariae Radix based on characteristic spectrum of inorganic elements combined with chemometric models. MethodAfter microwave digestion, the contents of Mn, Zn, Ca, Fe, Mg, Na, K, Cr, Cu, Se, As, Cd, Hg, Pb and Ni in 21 batches of Scutellariae Radix were determined by inductively coupled plasma atomic emission spectrometry (ICP-OES) and inductively coupled plasma mass spectrometry (ICP-MS). Meanwhile, characteristic spectrum of inorganic elements in samples was drawn. The identification model was constructed to discriminate the growth years of Scutellariae Radix based on the combination of principal component analysis (PCA), Fisher discriminant function and support vector machine (SVM). ResultThe contents of Mn (7.79-36.48 μg·g-1), Zn (10.12-31.43 μg·g-1), Cu (6.38-17.20 μg·g-1), K (2.98-13.89 μg·g-1), Mg (3.45-7.78 μg·g-1) and Ca (2.32-7.09 μg·g-1) in Scutellariae Radix were detected by ICP-OES and ICP-MS, and their contents increased with the prolongation of growth years. PCA results showed that Cu, Ni, Cd, Na, Mg, Fe, Ca, Zn, Mn and Hg were characteristic elements of Scutellariae Radix. Samples with different years could be divided into four categories in the spatial characteristic diagram of Fisher discriminant analysis. The correct rate of SVM model for identifying the growth years of samples was 95.2%. ConclusionThis established method is accurate and rapid for discriminating the growth years of Scutellariae Radix, which can provide reference for the identification of other Chinese medicinal materials. It is suggested that some elements should be considered as indexes in subsequent construction of the quality evaluation system of Scutellariae Radix.

3.
Article in Chinese | WPRIM | ID: wpr-882308

ABSTRACT

Congenital heart disease is one of the most common birth defects, which is the main cause of death in children.Cardiovascular development is a complex process involving multiple genes, signaling pathways and regulatory factors.According to the sequencing of human genome and encode project, more than 80% of the genes in the genome are transcribed, but only 3% of these transcripts correspond to protein-encoding RNA.It is pointed out that non-coding RNA is as important or even more important as encoding RNA.More and more evidences show that not only encoding genes are involved in the regulation of cardiovascular development, but also protein non-coding genes play an important role in the development of heart.This review will summarize the biological characteristic and function of long noncoding RNAs, and introduce the role of some representative lncRNA in heart development and congenital heart disease.

4.
Frontiers of Medicine ; (4): 91-100, 2021.
Article in English | WPRIM | ID: wpr-880951

ABSTRACT

Congenital heart disease (CHD) is the most common birth defect worldwide. Long non-coding RNAs (lncRNAs) have been implicated in many diseases. However, their involvement in CHD is not well understood. This study aimed to investigate the role of dysregulated lncRNAs in CHD. We used Gene Expression Omnibus data mining, bioinformatics analysis, and analysis of clinical tissue samples and observed that the novel lncRNA SAP30-2:1 with unknown function was significantly downregulated in damaged cardiac tissues from patients with CHD. Knockdown of lncRNA SAP30-2:1 inhibited the proliferation of human embryonic kidney and AC16 cells and decreased the expression of heart and neural crest derivatives expressed 2 (HAND2). Moreover, lncRNA SAP30-2:1 was associated with HAND2 by RNA immunoprecipitation. Overall, these results suggest that lncRNA SAP30-2:1 may be involved in heart development through affecting cell proliferation via targeting HAND2 and may thus represent a novel therapeutic target for CHD.


Subject(s)
Basic Helix-Loop-Helix Transcription Factors , Cell Proliferation , Heart Defects, Congenital/genetics , Histone Deacetylases , Humans , RNA, Long Noncoding/genetics , Transcription Factors
5.
Article in Chinese | WPRIM | ID: wpr-802562

ABSTRACT

Echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI), as the non-invasive cardiovascular imaging techniques, play an increasingly important role in the preoperative diagnosis, intrao-perative monitoring and follow-up of congenital heart disease (CHD). At present, these techniques are widely used in the clinical diagnosis and assessment of CHD, providing comprehensive and reliable information about the cardiovascular structure and function for clinical decision-making.However, these techniques have their own advantages and limitations.The research progress of echocardiography, CT and MRI used in the diagnosis of CHD were reviewed in this paper.

6.
Article in Chinese | WPRIM | ID: wpr-797163

ABSTRACT

Fulminant myocarditis is characterized by acute hemodynamic disorder, with rapid progress and high mortality.This article reviewed the current diagnostic criteria, the development of diagnostic techniques, as well as the development of current immunological, antiviral, and mechanical circulation adjuvant therapy for fulminant myocarditis in children.

7.
Article in Chinese | WPRIM | ID: wpr-790069

ABSTRACT

Fulminant myocarditis is characterized by acute hemodynamic disorder,with rapid pro﹣gress and high mortality. This article reviewed the current diagnostic criteria,the development of diagnostic techniques,as well as the development of current immunological,antiviral,and mechanical circulation adju﹣vant therapy for fulminant myocarditis in children.

8.
Chinese Journal of Pediatrics ; (12): 108-112, 2019.
Article in Chinese | WPRIM | ID: wpr-810419

ABSTRACT

Objective@#To investigate the application of coronary angiography (CAG) in children with Kawasaki disease complicated with coronary artery lesion (CAL).@*Methods@#A total of 139 patients (115 boys and 24 girls, age (48±42) months) with Kawasaki disease complicated with CAL underwent CAG between June 2006 and June 2018 in Children′s Hospital of Fudan University. CAL in all children were at grade Ⅲ and above assessed by echocardiography and underwent CAG under general anesthesia with parental consent. A retrospective analysis was performed to identify the safety and complication of CAG, degree of satisfaction of image, distribution of CAL, and the treatment and follow-up management according to the result of CAG.@*Results@#All the 139 patients underwent CAG, and 17 patients received CAG twice. In these cases, there was a total of 309 CAL with an average of 2.22 CAL per patient. After CAG, children were re-graded as grade Ⅲ in 33 cases, grade Ⅳ in 56 cases, grade Ⅴa in 33 cases and grade Ⅴb in 17 cases according to the clinical severity. Ten patients (7.2%) had only aortic root angiography and 129 (92.8%) patients had selective left or right CAG. Among these, 27 cases (19.4%) showed thrombosis in coronary aneurysm, 23 cases (16.5%) showed coronary artery stenosis, 4 cases (2.9%) showed recanalization after occlusion in right coronary artery. All the patients obtained satisfied images, and no complication was found. Eight of the grade Ⅴb patients underwent coronary artery bypass grafting (CABG). One patient died during the surgery due to severe heart failure, and the other seven patients received CABG successfully and recovered well during a long-term follow up (18 to 108 months).@*Conclusions@#CAG is safe for children with Kawasaki disease with CAL, and the images of CAG are satisfied. Patients who were graded according to CAG and received the corresponding surgical treatment could get satisfied effect in the medium and long-term follow-up.

9.
Article in Chinese | WPRIM | ID: wpr-752337

ABSTRACT

Echocardiography,computed tomography( CT)and magnetic resonance imaging( MRI),as the non-invasive cardiovascular imaging techniques,play an increasingly important role in the preoperative diagnosis,intrao-perative monitoring and follow-up of congenital heart disease(CHD). At present,these techniques are widely used in the clinical diagnosis and assessment of CHD,providing comprehensive and reliable information about the cardiovascular structure and function for clinical decision - making. However,these techniques have their own advantages and limitations. The research progress of echocardiography,CT and MRI used in the diagnosis of CHD were reviewed in this paper.

10.
Journal of Practical Radiology ; (12): 1584-1587,1604, 2017.
Article in Chinese | WPRIM | ID: wpr-657833

ABSTRACT

Objective To evaluate aorta's compliance after repair of coarctation of the aorta (CoA)using the pulse wave velocity (PWV)of MRI.Methods A retrospective analysis of cardiac MR images in 22 patients after repair of CoA was performed.PWV was measured and calculated with phase contrast MRI,and echocardiography was performed to measure both ventricular function and myocardial thickness during the same period.Age and sex-matched 22 normal subjects were served as a control group and their aortic PWVs were measured.Results The averaged PWV in study group was significantly higher than that in control group [(4 .42 ± 3 .02 )m/s vs (2 .73 ± 0 .76 )m/s,P =0.02].In study group,the PWV value of children with moderate anastomotic stenosis was the highest. ROC curve analysis showed the highest sensitivity and specificity could be achieved to distinguish the mild or moderate anastomotic stenosis when the threshold for PWV was 3.37 m/s.No significant correlations were found between left ventricular end-diastolic volume,left ventricular end-systolic volume,ejection fraction,left ventricular thickness and PWV.Conclusion PWV is increased in children after repair of CoA.Significant aortic remodelling can be observed in patients with moderate anastomotic stenosis.

11.
Chinese Journal of Pediatrics ; (12): 360-363, 2017.
Article in Chinese | WPRIM | ID: wpr-808596

ABSTRACT

Objective@#To improve the diagnostic accuracy of transthoracic echocardiography (TTE) by analyzing its limitations in diagnosing partial anomalous pulmonary venous drainage (PAPVD).@*Method@#This was a retrospective analysis of PAPVD patients seen at the Children′s Hospital of Fudan University from October 1 2006 to October 1 2016. The echocardiographic data were compared to findings on multi-slice spiral CT (MSCT), cardiac catheterization or surgery. The echocardiography machines used were Philip IE33, GE Vivid 7 and Vivid i with frequency ranging from 5.0 MHz to 7.5 MHz. The cardiac structure was analyzed according to Van Praagh segments.@*Result@#A total of 43 cases of PAPVD were enrolled, male∶ female ratio 20∶23 with average age (27.9±21.4) months. Among them, 3 cases were simple PAPVD and 40 cases had other associated congenital heart diseases. TTE was successful in diagnosing 29 cases (67%) while 14 cases were missed. The diagnostic rate for right pulmonary vein drainage into superior vena cava, right atrium, inferior vena cava were 5/10, 17/20, and 3/5 respectively while left pulmonary vein drainage into left innominate vein was only 1/4. Added TTE images to re-exam the 9 of the 14 missed cases, 5 cases of abnormal drainage from right superior pulmonary vein were diagnosed, while 4 cases of drainage from right lower or left pulmonary vein were only picked up by indirect signs.@*Conclusion@#The distance of the pulmonary veins from the routine ultrasound view and the possibility of branch number variation may limit the accuracy of TTE in diagnosing PAPVD, especially for drainage from right lower and left pulmonary vein. But TTE is still the preferred diagnostic method. The diagnostic rate could be increased by paying special attention to non-routine views including the suprasternal fossa, the right parasternal and subcostal area.

12.
Chinese Journal of Pediatrics ; (12): 260-266, 2017.
Article in Chinese | WPRIM | ID: wpr-808420

ABSTRACT

Objective@#Undiagnosed critical congenital heart disease (CCHD) was assessed before discharge from maternity hospital.Basic information was provided for screening CCHD in the early neonatal stage.Chi-squared test was used for comparison of categorical variables(detection rate of different types of CCHD).@*Method@#A retrospective cohort study was conducted in neonates with CCHD who were admitted to Children′s Hospital of Fudan University between 1 January 2012 and 31 December 2015. For comparing with the previously reported undiagnosed rate of CCHD at discharge, CCHD was defined as all duct dependent congenital heart disease (DDCHD) and any cyanotic CHD that required early surgery.@*Result@#A total of 1 036 infants with CCHD were included. The prenatal detection rate of CCHD was 14.04%(122/869). As a whole, 52.51% (544/1 036) of CCHD cases were undiagnosed at discharge, and 14.09%(146/1 036)were still missed after 6-week examination. The diagnoses most likely to be unrecognized at discharge included critical coarctation of the aorta (COA) (75.00%), total anomalous pulmonary venous connection (61.54%), pulmonary atresia (PA) with ventricle septal defect (VSD) (61.45%), single ventricle (SV) (60.10%) and critical aortic stenosis (52.94%). Among newborns diagnosed prior to discharge, 54.88% (270/492) due to symptom or prenatal ultrasonographic diagnosis, 45.12% (222/492) due to abnormal findings in routine examination. Among asymptomatic CCHD cases without prenatal diagnosis, 71.02% (544/766) were undiagnosed and the most common delayed diagnosis was SV (82.78%), interrupted aortic arch (81.82%), transposition of the great arteries with intact ventricular septum (79.63%), PA/VSD (79.07%), and critical COA (78.57%). Newborns with DDC were more likely to develop symptoms within the first few days after birth, in comparison with non-DDC cases. However, their detection rates were close to each other.@*Conclusion@#The rate of misdiagnosis of CCHD before discharge from maternity hospitals is high in China, indicates the importance of implementation of CCHD screening in Chinese maternity hospitals, so as to give timely diagnosis and proper treatment.

13.
Journal of Practical Radiology ; (12): 1584-1587,1604, 2017.
Article in Chinese | WPRIM | ID: wpr-660291

ABSTRACT

Objective To evaluate aorta's compliance after repair of coarctation of the aorta (CoA)using the pulse wave velocity (PWV)of MRI.Methods A retrospective analysis of cardiac MR images in 22 patients after repair of CoA was performed.PWV was measured and calculated with phase contrast MRI,and echocardiography was performed to measure both ventricular function and myocardial thickness during the same period.Age and sex-matched 22 normal subjects were served as a control group and their aortic PWVs were measured.Results The averaged PWV in study group was significantly higher than that in control group [(4 .42 ± 3 .02 )m/s vs (2 .73 ± 0 .76 )m/s,P =0.02].In study group,the PWV value of children with moderate anastomotic stenosis was the highest. ROC curve analysis showed the highest sensitivity and specificity could be achieved to distinguish the mild or moderate anastomotic stenosis when the threshold for PWV was 3.37 m/s.No significant correlations were found between left ventricular end-diastolic volume,left ventricular end-systolic volume,ejection fraction,left ventricular thickness and PWV.Conclusion PWV is increased in children after repair of CoA.Significant aortic remodelling can be observed in patients with moderate anastomotic stenosis.

14.
Article in Chinese | WPRIM | ID: wpr-497938

ABSTRACT

Objective To explore the clinical efficacy of secondary unreamed intramedullary nailing following primary external fixation for open tibial shaft fractures.Methods From March 2011 to June 2014,we treated 28 open tibial shaft fractures.They were 17 men and 11 women,aged from 21 to 62 years (average,38.2 years).After thorough debridement,the tibia was stabilized temporarily with external fixation.The wounds were handled with primary closure or secondary repair with skin grafts or tissue flaps.After the wounds healed,the external fixation was replaced by unreamed intramedullary nailing.Fracture union and complications were documented.The clinical efficacy was evaluated at the final follow-ups according to the Johner-Wruhs scoring system.Results All the 28 patients were followed up for 12 to 18 months (average,13.5 months).Bony union was achieved in all after 4 to 15 months (average,4.9 months).Delayed union was observed in 4 cases which were healed after dynamic fixation.There was no deep infection,nail breakage,malunion or limb shortening in any one.Mild knee pain was reported by 5 cases after surgery.According to the Johner-Wruhs criteria,18 cases were excellent,7 good,and 3 moderate,giving an excellent to good rate of 89.3%.Conclusion Primary external fixation and secondary unreamed intramedullary nailing can result in good fracture union with satisfactory biomechanical stability and favorable early rehabilitation in the treatmeut of open tibial shaft fractures.

15.
Article in Chinese | WPRIM | ID: wpr-485319

ABSTRACT

Duchenne muscular dystrophy(DMD)is a fatal muscular wasting disease in children.Because of various factors such as DMDˊs low incidence,quick progression,limited knowledge of this disease,and treat-ment outcomes of respiratory failure,heart failure has become the leading cause of death in these patients.Early diagnosis and treatment is essential for prolonging the survival time and improving the quality of life.This review describes recent progress in the study of epidemiology,pathogenesis,early diagnosis,prevention and treatment of cardiac injury in patients with DMD.

16.
Chinese Journal of Pediatrics ; (12): 690-695, 2015.
Article in Chinese | WPRIM | ID: wpr-351497

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of evaluation,treatment and follow-up of Kawasaki coronary artery disease based on the clinical severity classification.</p><p><b>METHOD</b>This study evaluated 52 patients admitted to the Children's Hospital of Fudan University between July 2005 and December 2013 who were diagnosed with Kawasaki Disease with coronary artery disease.Inclusion criteria were a disease course of more than two months, initial echocardiography showing severity of grade IV and above, and confirmation of disease severity by angiography. Of those studies, 44 were male and eight were female, aged 6 to 142 (average 41) months. Treatment was planned according to protocols in "Suggestions for Management of Kawasaki Coronary Artery Disease" with follow-up. Those patients with grade IV and above confirmed by angiogram were given oral low-dose asprin and warfarin, and those with grade Vb were given coronary artery bypass grafting (CABG) after comprehensive evaluation. Analysis was carried out for diagnosis, treatment, complications, and results of follow-up.</p><p><b>RESULT</b>(1) Satisfied images were shown by the angiography of all 52 cases. Forty five patients (86%) had giant aneurysm or multiple aneurysms, with thrombosis found in 10 of 45 patients (22%). Coronary artery lesions occurred in 138 coronary branches, and more common in left anterior descending branch (47 branches, with incidence 34%) and right coronary artery (48 branches, with incidence 35%). There were no complications during or after angiography. (2) After angiography, 49 patients remained at grade IV or above, and three improved to grade III. Ultimately, clinical severities of coronary artery disease included three patients at grade III, 31 patients at grade IV, nine patients at grade Va, and nine patients at grade Vb. (3) Thirty-eight patients were properly using aspirin and warfarin, and two patients with severely elevated international normalized ratio (INR) levels presented with knee joint and gastric hemorrhage, both of which were treated successfully.Patients with INR levels between 1.5 and 2.5 did not show signs of hemorrhage. (4) In follow-up visits between 6 months and 8 years, one patient had representation of thrombosis on angiography, but did not lead to coronary stenosis; four patients were improved from grade IV to either grade III or II. The remaining showed no new thrombotic formation or stenosis. (5) Of the nine grade Vb patients, five underwent coronary artery bypass grafting. The youngest of these patients, a 22 months old girl, died intraoperatively. The remaining four recovered postoperatively and were followed up for 8 to 90 months. One patient had a preoperative left ventricular ejection fraction (LVEF) of only 32.8%, with LVEF remaining abnormal post-CABG, between 35% and 44%. The remaining three patients had normal heart size, cardiac function, and electrocardiogram.Of the other four grade Vb patients, two were contraindicated for surgery due to severe heart failure and loss of myocardial activity. Two other cases are being followed up closely due to their young age of 9 months.</p><p><b>CONCLUSION</b>Coronary angiography is safe and efficacious in children, and even in infants.It is the current gold standard tool for grading Kawasaki coronary artery disease. Proper anticoagulation therapy can markedly decrease the incidence of coronary artery occlusion in patients with Kawasaki coronary artery disease. Safe ranges of corrected INR should be between 1.5 and 2.5 after taking warfarin. CABG is an effective treatment for severe coronary artery disease with myocardial ischemia.</p>


Subject(s)
Aspirin , Therapeutic Uses , Child , Child, Preschool , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease , Therapeutics , Disease Management , Echocardiography , Electrocardiography , Female , Humans , Infant , Male , Mucocutaneous Lymph Node Syndrome , Therapeutics , Treatment Outcome , Ventricular Function, Left , Warfarin , Therapeutic Uses
17.
Chinese Journal of Pediatrics ; (12): 460-463, 2014.
Article in Chinese | WPRIM | ID: wpr-345766

ABSTRACT

<p><b>OBJECTIVE</b>To screen for genomic copy number variations (CNVs) in two unrelated neonates with multiple congenital abnormalities using Affymetrix SNP chip and try to find the critical region associated with congenital heart disease.</p><p><b>METHOD</b>Two neonates were tested for genomic copy number variations by using Cytogenetic SNP chip.Rare CNVs with potential clinical significance were selected of which deletion segments' size was larger than 50 kb and duplication segments' size was larger than 150 kb based on the analysis of ChAs software, without false positive CNVs and segments of normal population. The identified CNVs were compared with those of the cases in DECIPHER and ISCA databases.</p><p><b>RESULT</b>Eleven rare CNVs with size from 546.6-27 892 kb were identified in the 2 neonates. The deletion region and size of case 1 were 8p23.3-p23.1 (387 912-11 506 771 bp) and 11.1 Mb respectively, the duplication region and size of case 1 were 8p23.1-p11.1 (11 508 387-43 321 279 bp) and 31.8 Mb respectively. The deletion region and size of case 2 were 8p23.3-p23.1 (46 385-7 809 878 bp) and 7.8 Mb respectively, the duplication region and size of case 2 were 8p23.1-p11.21 (12 260 914-40 917 092 bp) and 28.7 Mb respectively. The comparison with Decipher and ISCA databases supported previous viewpoint that 8p23.1 had been associated with congenital heart disease and the region between 7 809 878-11 506 771 bp may play a role in the severe cardiac defects associated with 8p23.1 deletions. Case 1 had serious cardiac abnormalities whose GATA4 was located in the duplication segment and the copy number increased while SOX7 was located in the deletion segment and the copy number decreased.</p><p><b>CONCLUSION</b>The region between 7 809 878-11 506 771 bp in 8p23.1 is associated with heart defects and copy number variants of SOX7 and GATA4 may result in congenital heart disease.</p>


Subject(s)
Abnormalities, Multiple , Diagnostic Imaging , Genetics , Chromosome Deletion , Chromosome Duplication , Genetics , Chromosome Inversion , Chromosomes, Human, Pair 8 , Comparative Genomic Hybridization , DNA Copy Number Variations , Female , Heart Defects, Congenital , Diagnostic Imaging , Genetics , Humans , Infant, Newborn , Oligonucleotide Array Sequence Analysis , Polymorphism, Single Nucleotide , Ultrasonography
18.
Chinese Journal of Pediatrics ; (12): 535-539, 2014.
Article in Chinese | WPRIM | ID: wpr-345748

ABSTRACT

<p><b>OBJECTIVE</b>Balloon angioplasty is an alternative to surgical repair for coarctation of the aorta in children. However, its role in the treatment of neonates and infants younger than 3 months old remains controversial. The purpose of this study was to evaluate the efficacy and safety of balloon angioplasty for native coarctation by comparing children in different age groups.</p><p><b>METHOD</b>This is a retrospective clinical study including 37 children treated with balloon angioplasty for native coarctation from January 2006 to December 2012. A total of 37 patients consisting of 26 boys and 11 girls underwent the procedure, with median age 10 months (range from 7 days to 6 years) and the mean body weight was 6.3 (2.5-17.0) kg. The indication of the procedure includes discrete native coarctation without aortic arch hypoplasia and a peak-to-peak systolic pressure gradient > 20 mmHg (1 mmHg = 0.133 kPa) across aortic coarctation. During one year follow-up, the approach artery injury, recoarctation and aneurysm formation were particularly assessed.</p><p><b>RESULT</b>We classified these patients into two groups according to their age. Group A consisted of 25 patients younger than 3 months and Group B of 12 patients older than 3 months. There was no significant difference between the two groups in systolic pressure gradient before balloon angioplasty (P > 0.05). The mean peak systolic gradient decreased from (38 ± 18) mmHg to (12 ± 11) mmHg immediately after angioplasty in group A and from (47 ± 18) to (17 ± 12) mmHg in group B (P = 0.000 for both). Meanwhile, the mean diameter of the coarctation segment increased from (1.8 ± 0.7) to (3.7 ± 1.1) mm after angioplasty in group A and from (2.6 ± 1.5) to (5.5 ± 1.8) mm in group B (both P = 0). The initial successful balloon angioplasty (immediate postangioplasty peak pressure gradient < 20 mmHg) was achieved in all the 37 patients; 32 patients (86.5%) have been followed up for one year. Approach arterial complications occurred in 3 patients (9.4%), all of whom were in Group A (P = 0.537). Two patients had decreased femoral artery pulse and one required surgical repair for a postoperative pseudoaneurysm at left carotid artery. At follow-up, 8 patients (25.0%) developed recoarctation, with 6 cases in Group A and 2 in Group B. There was no significant difference between groups A and B in the recoarctation rate (P = 1.000). Among them, 7 patients underwent repeat balloon angioplasty, and all showed successful relief of coarctation, and one patient required surgical repair. Two patients (2/37, 5.4%) had small aneurysms of the descending aorta immediately after balloon angioplasty, with one patient in each group (12/25 vs.1/12, P = 0.755).Late aneurysm development has not been observed in the 17 patients who have had a follow-up CTA or MRA study.</p><p><b>CONCLUSION</b>Balloon angioplasty of discrete native coarctation is effective and safe in children both younger and older than 3 months with similar incidence of approach arterial complication, recoarctation and aneurysm formation.</p>


Subject(s)
Angioplasty, Balloon , Aortic Aneurysm , Epidemiology , Aortic Coarctation , Therapeutics , Child , Child, Preschool , Female , Follow-Up Studies , Heart Septal Defects , General Surgery , Humans , Infant , Infant, Newborn , Male , Postoperative Complications , Epidemiology , Recurrence , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome
19.
Chinese Journal of Pediatrics ; (12): 699-702, 2014.
Article in Chinese | WPRIM | ID: wpr-345714

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of percutaneous balloon aortic valvuloplasty (PBAV) for congenital aortic valve stenosis in children.</p><p><b>METHOD</b>This is a retrospective clinical study including 14 children treated with PBAV for congenital aortic valve stenosis from October 2006 to December 2012 in our institute. During clinical follow-up, aortic residual stenosis and restenosis, left ventricular function and the procedure-related complications, including the approach artery injury, and aortic regurgitation were particularly assessed.</p><p><b>RESULT</b>A total of 14 patients consisting of 12 boys and 2 girls underwent the procedure, with mean age (17.1 ± 10.5) months (range from 8 days to 6 years) and the mean body weight (8.9 ± 5.5) kg (range from 1.9 kg to 23.0 kg). The indication for PBAV was a Doppler-derived peak instaneous gradient of ≥ 75 mmHg(1 mmHg = 0.133 kPa) or a smaller gradient with signs of severe left ventricular dysfunction or left ventricular strain on the ECG. The mean ratio of balloon-annulus was 0.92 ± 0.09 (range from 0.75 to 1.09). The catheter-measured peak systolic valve gradient was successfully relieved in all the patients, decreasing from (69 ± 26) mmHg to (29 ± 13) mmHg immediately after balloon valvuloplasty (t = 7.628, P = 0.000). The Doppler-derived peak and mean gradient decreased from (95 ± 21) mmHg and (50 ± 7) mmHg to (49 ± 16) mmHg and (24 ± 11) mmHg, respectively (t = 7.630, 10.401; P = 0.000, 0.000) . The mean follow-up period was 1 day to 61 months. At follow-up, 2 patients (2/14, 14%) underwent the second balloon valvuloplasty for the significant restenosis, and both showed successful relief of restenosis, however 1 patient required surgical Ross procedure due to significant recurrent systolic pressure gradient and moderate aortic regurgitation 4 years after the second balloon valvuloplasty. Among the 3 young infants who presented with congestive heart failure before intervention, 1 died 1 day after the procedure, the other 2 patients had improved left ventricular systolic function significantly during post-procedural follow-up. Only 1 patient (1/14, 7%) developed moderate aortic regurgitation. There was no other procedure-related complication.</p><p><b>CONCLUSION</b>PBAV for congenital aortic valve stenosis is effective and safe in children. It is a very feasible palliative intervention for children with severe aortic valve stenosis to postpone the aortic valve surgery.</p>


Subject(s)
Aorta , Aortic Valve , Aortic Valve Insufficiency , Aortic Valve Stenosis , Therapeutics , Balloon Valvuloplasty , Blood Pressure , Child , Child, Preschool , Echocardiography, Doppler , Female , Heart Failure , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , Systole , Treatment Outcome , Ventricular Dysfunction, Left , Ventricular Function, Left
20.
Article in Chinese | WPRIM | ID: wpr-453712

ABSTRACT

Kawasaki disease can affect the coronary arteries,including coronary artery dilation,aneurysm,stenosis and thrombus.Conventional coronary angiography is the gold standard for coronary artery evaluation,but there are risks associated with its invasive nature and with the exposure to contrast agents and radiation.With the rapid development,computed tomography angiography and magnetic resonance angiography become the noninvasive imaging modalities to evaluate the coronary artery.

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