ABSTRACT
@#Objective To compare and analyze the effect of myocardial protection between HTK and del Nido cardioplegia solutions in neonates with surgeries for transposition of the great arteries. Methods The clinical data of 208 neonates with complete transposition of the great arteries in our institution from 2014 to 2020 were retrospectively analyzed. According to the cardioplegia solutions utilized in the operations, the patients were divided into two groups: a HTK group and a del Nido group. Propensity score matching was conducted to eliminate the biases. The cardiopulmonary bypass time, aortic cross-clamping time, total amount of cardioplegia solutions, transfusion frequency of cardioplegia, ICU stay time, mechanical support time, inotropic score, hospital stay, left ventricular ejection fraction, N-terminal proBNP and troponin I were compared and analyzed between the two groups after matching. Results After 1:1 propensity score matching, a total of 54 patients were analyzed with 27 patients in each group. In the HTK group, there were 22 males and 5 females with a median age of 7.0 (2.0, 11.0) d. In the del Nido group, there were 23 males and 4 females with a median age of 8.0 (3.0, 11.0) d. A total of 3 children died after the surgery: 2 (7.4%) patients in the HTK group and 1 (3.7%) patient in the del Nido group. There was no significant difference in hospital mortality between the two groups (P=1.000). The total amount of cardioplegia solutions in the HTK group was significantly higher than that of del Nido group (P<0.001). Transfusion frequency of cardioplegia in del Nido group was significantly higher than that of the HTK group (P=0.043). There was no significant difference in the postoperative ICU time, mechanical support time, length of hospital stay, inotropic score, left ventricular ejection fraction, N-terminal B-type natriuretic peptide precursor or troponin I between the two groups (P>0.05). Conclusion For neonates with surgeries for complete transposition of the great arteries, HTK cardioplegia solutions can provide effective and safe myocardial protection, which is similar to del Nido cardioplegia solutions.
ABSTRACT
Objective To assess the value of tomographic ultrasound imaging (TUI) for prenatal analysis of the relative orientation of fetal heart and great arteries. Methods Volume datasets acquired from 12 patients of transposition of the great arteries (TGA) and 13 normal fetal heart were evaluated offline with TUI. The aortic valves (AV) and pulmonary valves (PV) were respectively showed on the two parallel slices. According to the pivot point in the middle of the PV in one slice, the relative orientation of the AV on another slices were analyzed. Results In the 12 patients of TGA confirmed postnatally, 7 were concomitant with single ventricle anomaly, AV was on the anterior-right orientation of the PV in 5, and was relatively on the anterior and anterior-left orientation in other 2 of them.In the remained 5 with seeming normal 4 chamber view, AV was found on the anterior-right of the PV in 3, and was relatively on the anterior and upright orientation.in other 2 patients. In 13 normal fetuses, TUI showed that all AV located on the posterior-right orientation to the PV. Conclusion TUI can provide detailed spatial information of the great arteries both in normal and abnormal fetal heart. It may be a convenient and veracious tool for prenatal exploring the morphology of the great arteries.