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Pediatric heart transplantation is the standard treatment for children complicated with refractory heart failure which is difficult to be treated by conventional surgery or drugs. At present, an increasing quantity of pediatric heart transplantation is being performed worldwide, whereas relevant experience is still lacking in China. In recent 10 years, significant progress has been achieved in pediatric heart transplantation. On one hand, the number of pediatric heart transplantation has been increased year by year. On the other hand, ABO-incompatible heart transplantation, application of ventricular assist device in children, and recipient-donor weight mismatch transplantation have been widely employed to resolve the shortage of donor heart in pediatric heart transplantation. However, relevant experience of pediatric heart transplantation is lacking in China, especially in understanding the indications of pediatric heart transplantation and the application of specific strategies for pediatric heart transplantation, etc. In this article, the development history, advances in therapeutic strategy and clinical prognosis of pediatric heart transplantation were reviewed.
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Objective To observe the clinical effect of Levosimendan for treatment of patients with refractory heart failure in order to provide a reference for doctors treating this disease. Methods One hundred and eighty patients with refractory heart failure were admitted to Tongde Hospital of Zhejiang Province from February 2014 to December 2017, and they were divided into two groups by random number table method: a western medicine routine treatment group (western control group) and a Levosimendan group, each group 90 cases. The patients in western control group were given conventional anti-cardiac failure drugs ; and those in Levosimendan group were treated with the therapies as above group, and additionally Levosimendan continuous intravenous infusion for 24 hours was given. The clinical efficacy of the two groups was evaluated after 3 days of treatment. After treatment, the differences of ejection fraction (EF), stroke volume (SV), end-systolic volume (ESV), end-diastolic volume (EDV) and the levels of N-terminal brain natriuretic peptide precursor (NT-proBNP) and cardiac troponin I (cTnI) were compared between the two groups. Results After treatment, the EF and SV levels were significantly increased, while the ESV, EDV, NT-proBNP and cTnI levels were decreased obviously compared with those before treatment in the two groups (all P <0.05); the changes of the levels of EF, SV and NT-proBNP and cTnI of Levosimendan group were more significant than those of the western control group [EF: 0.49±0.06 vs. 0.44±0.06, SV (mL): 86.54±17.63 vs. 81.48±18.46, NT-proBNP (μg/L): 5.50±1.28 vs. 6.64±1.54, cTnI (μg/L): 0.08±0.01 vs. 0.14±0.13, all P < 0.05], while there were no significant differences of the levels of ESV and EDV between the two groups [ESV (mL): 111.56±32.53 vs. 128.76±32.13, EDV (mL): 187.95±39.28 vs. 185.06±41.23, both P > 0.05]. The total effective rate of the Levosimendan group was obviously higher than that of the western control group [97.78% (88/90) vs. 78.89% (71/90), P < 0.05]. Conclusion Levosimendan can effectively improve the hemodynamics in patients with refractory heart failure, the elevation of patients' heart function, and the short-term therapeutic effect is very remarkable.
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Objective:To observe the clinical efficacy and safety of Sofre injection combined with isosorbide mononitrate in the treatment of refractory heart failure. Methods:Totally 66 cases of patients with refractory heart failure in our hospital were randomly di-vided into the observation group and the control group with 33 cases in each. Each patient received the conventional treatment. On the basis of routine treatment, the control group was treated with isosorbide mononitrate injection (25mg,qd,ivd). On the basis of control group, the observation group was treated with Sofre injection (10ml, qd, ivd). The treatment course was 14 days. Before and after the treatment, the improvement degree clinical symptoms, left ventricular ejection fraction ( LVEF) , left ventricular end diastolic diameter (LVEDD), cardiac index (CI), stroke volume (SV) and 6-min walking distance (6MWD) were observed, and the rate of heart fail-ure hospitalization, heart failure mortality and 6MWT changes were followed up for 6 months in the two groups. The adverse drug reac-tions ( ADR) in both groups during the treatment were recorded as well. Results:After the 2-week treatment, the effective rate and the total effective rate of the observation group were significantly higher than those of the control group (P<0. 05); LVEF, CI, SV and 6MWD of the two groups after the treatment were significantly higher than those before the treatment, and LVEDD significantly de-creased (P<0. 05), and the improvement of the observation group was more obvious than that of the control group (P<0. 05). After the 6-month follow-up, 6MWD was significantly longer in the observation group than that in the control group (P<0. 05), while there were no statistically significant differences in the hospitalization rate and the mortality rate between the groups (P>0. 05). There were no adverse reactions in both groups during the whole treatment. Conclusion:Sofre injection combined with isosorbide mononitrate can significantly improve cardiac function in the patients with refractory heart failure with improved clinical efficacy and good safety.
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Objective To studythe efficacy of levosimendan in treating refractory heart failure complicating severe renal in sufficiency.Methods Sixty-seven cases of refractory heart failure complicating severe renal insufficiency in the internal medicine department of our hospital were randomly divided into the levosimendan treatment group(L group,n=33)and dopamine treatment group(D group,n=34).The changes of N-terminal pro-B-type natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction (LVEF)and glomerular filtration rate(GFR)before treatment and on 1,3,7,30 d after treatment were compared between the two groups and analyzed.Results Before the treatment,there were no statistically significant differences in the baseline indicators between the two groups(P＞0.05).The group L:the NT-pro-BNP level on 1,3,7 d after treatment was decreased significantly(P＜ 0.05),LVEF on 3,7 d was significantly increased compared with th baseline(P＜0.05)and GFR on 1,3,7,30 d was significantly increased compared with the baseline(P＜0.05).The group D:the NT-pro-BNP level on 7 d of treatment was significantly decreased(P＜0.05),LVEF on 7 d of treatment was significantly increased compared with the baseline(P＜0.05),and no statistically significant changes were observed in GFR on 1,3,7,30 d(P＞0.05).After treatment,NT-pro-BNP,LVEF and GFR significant level values in the group L were better than those in the group D.Conclusion Levosimendan is superior to dopamine in improving heart and renal function for the patients with refractory heart failure complicating severe renal insufficiency.
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Objective To analyze and investigate dopamine combined with milrinone treatment effect on elderly patients with intractable heart failure and N-terminal B-type natriuretic peptide level and cardiac function.Methods 80 cases of elderly patients with heart failure according to the number table method randomly divided into two groups: control group and experimental group, and control group was given conventional drugs.The patients in experimental group were received dopamine +Milrinone on the basis of control group.Clinical efficacy, N-terminal pro-B-type natriuretic peptide levels ( NT proBNP ) and heart function condition between two groups are compared and analyzed.Results The total effective rate of experimental group (95.00%) was higher than that of control group (70.00%) (P<0.05).NT-proBNP(2013.31 ±295.84)ng/L、LVEDD(61.48 ± 10.11)mm、LVEF(59.69 ±8.44)% in the experimental group was significantly better than the control group(P <0.05).Conclusion Dopamine combined with milrinone in the treatment of elderly patients with intractable heart failure is remarkable, can relieve the level of NT proBNP, and promote the recovery of cardiac function.
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Objective:To observe the clinical efficacy of rh-BNP combined with continuous renal replacement therapy on the re-fractory heart failure in cardiorenal syndrome. Methods:Totally 48 patients with refractory heart failure in cardiorenal syndrome in our hospital were selected and randomly divided into the observation group and the control group. The control group was received the con-ventional drug therapy combined with continuous renal replacement therapy, and the observation group was received rh-BNP therapy ad-ditionally. After 7 days, NT-ProBNP, heart rate, LVEF, SV, BUN, Scr and GFR of the two groups were compared, and the clinical efficacy of the two groups was evaluated. Results:After the treatment, all the observed indicators in the two groups were significantly improved than those before the treatment, and the improvement in the observation group was better than that in the control group ( P<0. 05). The total effective rate of the observation group was higher than that of the control group(91. 67% vs 79. 17%, P<0. 05). Conclusion:The combination of rh-BNP and continuous renal replacement therapy can improve heart and kidney function of the refrac-tory heart failure in cardiorenal syndrome with better efficacy.
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Objective:To investigate the curative effect and safety of slow continuous ultrafiltration(SCUF) treatment on congestive refractory heart failure with renal failure, and to investigate the correlation between fluid balance and the postoperative complications.Methods:Thirty patients with congestive refractory heart failure with renal failure were chosen to receive slow continuous ultrafiltration treatment after deep vein catheterization, blood flow volume being 100-150 ml/min and therapy time being 24h. PiCCO was used to monitor the hemodynamic parameters, along with the change of blood pressure, blood oxygen saturation, heart beat and electrolyte.Results: After the slow continuous ultrafiltration treatment, the hemodynamic parameters of all patients showed obvious improvements, with better results on cardiac function and electrolyte balance. All the patients patients developed cardiopulmonary complications postoperatively have a larger total fluid balance of the first two days postoperatively than those without complications.Conclusion:SCUF have therapeutic effect and safety for treating congestive refractory heart failure with renal failure, and the status of the fluid balance can be a predictor of the postoperative morbidity and mortality.
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Objective: To observe the clinical effect of sodium nitroprusside and dopamine injected by micro pump for the treatment of refractory heart failure. Methods:One hundred and six cases of patients with refractory heart failure were chosen as the research object, which were cardiac functionⅢ~Ⅳlevel. All patients were treated with sodium nitroprusside and dopamine injected by micro pump. Starting dose of sodium nitroprusside was 6.25 μg/min. At same time pumping dopamine, starting dose of 2 g/kg·min, the dose was increased gradually until blood pressure dropped to 90~100 mm Hg, continuous 7~10 d, the signs and symptoms after treatment and parameters of cardiac function and adverse reactions were observed. Results: 1)In 106 cases of patients with refractory heart failure after treatment, the total effective rate 85.85%(91/106). 2)The heart rate, blood pressure, cardiothoracic ratio, left ventricular short axis reduced rate,cardiac output, each index of cardiac,indexes of left ventricular ejection fraction were improved significantly after treatment. Conclusion:The clinical effect for the treatment of refractory heart failure by using the micro pump injection of small doses of sodium nitroprusside combined dopamine would be obvious, have less adverse reactions, worthy of clinical popularization and application.
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Objective To investigate the efficacy of recombinent human B-type natriuretic peptide (rhBNP) in peripartum cardiomyopathy (PPCM) with refractory heart failure (RHF).Methods From January 2010 to January 2014,a total of 61 patients with PPCM-RHF of the First Hospital of Qinhuangdao were enrolled into this study.All patients were randomly assigned into the rhBNP group (30 cases) and control group (31 cases).rhBNP was given 1.5 μg/kg,2 mim intravenously in rhBNP group and then infused intravenously 0.007 5-0.030 μg/(kg · min) for 24 hours,0.015-0.030 μg/(kg · min) for 24 hours when systolic blood pressure(SBP) ≥ 85 mmHg (1 mmHg =0.133 kPa) and mean brachial arterial pressure (MBP) ≥ 65 mmHg.Routine therapy followed the clinic practice was administrated in control group for 24 hours.Recorded the dyspnea change.Blood samples were collected at different time points to investigate BNP at 6 h,14 d and 30 d.Ultrasonic cardiography (UCG) was performed to evaluate left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension(LVEDD) before the initiation of the infusion,at day 1,14 and 30 after the infusion.All patients were followed up for one month to record the main adverse cardiac events (MACE),including heart failure recurrence,cardiac death and ventricular fibrillation and tachycardia.Results The time of dyspnea resolved in rhBNP group was significantly shorter than control group ((1.69 ± 1.07) h vs (2.69 ±1.39) h,P =0.002).Concentration of plasma BNP(6 h:(296.50±123.25) ng/L,14 d:(141.37±69.54) ng/L,30 d:(107.41±33.69) ng/L) was signifisantly reduced in both groups than basic line (727.07 =± 146.84) ng/L,and it was significantly different between two groups.LVEF raised and LVEDD decreased were observed at 24 hours((52.23±4.54) mm),14 d((49.60±4.20) mm) and 30 d((42.59±3.90) mm) in rhBNP group and were significant better than the control group ((56.33 ± 4.38) mm,(53.03 ± 4.95) mm,(48.85±4.96) mm;P ＜0.05).There was no significant difference in term of LVEF between two groups after treatment.However,24 h(4.12±41.13)％,14 d(4.10±43)％,30 d(44.52±3.43)％ were significantly higher than the baseline(36.73±5.82)％ in rhBNP group.MACEs were lower in rhBNP group at 30 dayscontrast to the control(10％ (3/30) vs.42％ (13/31);P =0.005).Conclusion Compared with conventional treatment,rhBNP can effectively improve the heart function in patients with PPCM-RHF,reduce the occurrence of major adverse cardiac events in 30 d,and improve the prognosis of patients.
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Objective To observe the therapeutic effect of Qili Qiangxin capsule combined with glucocorticoid for treatment of patients with dilated cardiomyopathy accompanied by refractory heart failure. Methods A prospective study was conducted. Forty-eight patients with dilated cardiomyopathy and refractory heart failure in Hebei Cangzhou Central Hospital were enrolled,and they were randomly divided into three groups:control group,treatmentⅠand treatmentⅡgroups(each,16 cases). All groups were treated with conventional anti-heart failure western treatment, meanwhile additionally prednisone was given to treatment groupⅠand groupⅡ,firstly 40 mg/d,then the dosage of 5 mg was decreased in every 5 days until reaching 5 mg per day;in treatment groupⅡ,besides the same treatment of group I,the traditional Chinese medicine therapy Qili Qiangxin capsule 4 granules(one capsule 0.3 g)each time and 3 times a day was added,2 months being the therapeutic course in all the patients. The clinical efficacy and cardiac functional indexes,such as the left ventricular end-diastolic volume(LVEDV),the left ventricular end-systolic volume(LVESV),the left ventricular ejection fraction(LVEF)and the plasma B type brain natriuretic peptide (BNP),etc. were observed in 1 week and 2 months after treatment. Meanwhile the electrocardiogram(ECG),aspartate transaminase(AST),alanine aminotransferase(ALT),urea nitrogen(BUN),serum creatinine(SCr),blood routine, urine routine examination and the adverse effects were investigated. Results The total effective rates in treatment groupⅠand treatment groupⅡwere significantly higher than those in the control group〔after treatment for 1 week:81.2%(13/16),81.2%(13/16)vs. 43.8%(7/16);after 2 months:87.5%(14/16),93.7%(15/16)vs. 50.0%(8/16), all P<0.05〕. After treatment,the LVEDV,LVESV and BNP were lowered and the LVEF was increased in the three groups,and the above indexes in treatment groupⅡwere improved more significantly than those in groupⅠ〔LVEDV (mL):142.4±33.0 vs. 174.8±52.5,LVESV(mL):111.6±23.7 vs. 132.4±29.0,LVEF:0.421±0.037 vs. 0.390±0.045,BNP(μg/L):1.944±0.751 vs. 3.038±1.905,all P<0.05〕. Conclusion Qili Qiangxin capsule combined with glucocorticoid may effectively improve the cardiac function and clinical symptoms in near and forward future in patients with dilated cardiomyopathy accompanied by refractory heart failure,thus it may elevate the patients' life quality.
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Objective To summarize the efficacy and safety of diuretic mixture in the treatment of refractory heart failure.Methods One hundred and twenty patients with refractory heart failure were randomized into treatment group and control group.All the patients were treated with digitalis,diuretics,ACEI,nitrates,and strategies to control infection and correct water and electrolyte disorders.The treatment group was given additional diuretic mixture and was monitored for 7 days.Results In the treatment group and control group,the overall response rates were 91.7 ％ ( 55/60 ) and 71.7％ ( 43/60 ),respectively.The difference was significant (x2 =8.541,P ＜ 0.05).Conclusions The patients with heart failure and gefractory to conventional treatment will benefit from diuretic mixture treatment,with the advantages of safety and economy.
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Objective To observe the therapeutic effect of Qiliqiangxin capsule combined on refractory heart failure.Methods 60 patients with refractory heart failure were randomly recruited into a control group and a therapeutic group. The control group received the conventional treatment, and the therapeutic group took Qiliqiangxin capsule on the base of the conventional treatment (3 times a day, 4 granules/each time) combined with 120 mg cAMP meglumine. Treatment in both group lasted 14 days. Results: After the treatment, the therapeutic group showed improvement in the symptoms of heart failure. Comparing with the control group, the difference was significant (P＜0.05). Conclusion The therapeutic effect of Qiliqiangxin capsule combined on refractory heart failure is satisfied and can improve the quality obviously.