Analysis of coronary angiographic findings in 117 children with Kawasaki disease and coronary artery lesion / 中华实用儿科临床杂志

Objective:To analyze the coronary angiographic (CAG) characteristics of coronary artery lesion (CAL) in children with Kawasaki disease (KD), and to clarify the necessity of CAG in the diagnosis and treatment of KD combined with CAL in children.Methods:It was a retrospective study to analyze the clinical data, electrocardiogram, echocardiography, time and findings of CAG in children with KD and CAL who underwent CAG in Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from January 2013 to August 2022.The distribution, type, severity, and prognosis of CAL were analyzed.Results:A total of 117 children with KD and CAL were included in the analysis.The onset age of KD was from 2 months to 12.8 years old, and the age of performing CAG was from 8 months to 18.1 years old.A total of 234 coronary artery lesions were detected in 117 cases.Among them, CAL in the right coronary artery (RCA), left anterior descending branch (LAD), left main coronary artery and left circumflex artery were detected in 96 branches(41.1%), 78 branches(33.3%), 44 branches(18.8%), and 16 branches(6.8%), respectively.Unilateral coronary artery involvement was detected in 43 cases (36.8%), of which LAD was the dominant; while bilateral involvement was detected in 74 cases (63.2%), among which, LAD and RCA were the most involved arteries.Stratified by the degree of coronary involvement, large coronary aneurysms and severe coronary stenosis were most frequently occurred in the RCA and LAD.In contrast, 10 cases (13.6%), 20 cases (24.3%), 55 cases (45.8%) and 37 cases (67.3%) of intraluminal lesions were found in small, medium and large coronary aneurysms, and stenosis or occlusion, respectively.The incidence of intraluminal lesions tended to be higher in the site of severe lesions.CAG showed stenosis or occlusion in a total of 55 cases, and collateral circulation at varying degrees was found in cases of severe stenosis or occlusion.Conclusions:CAL in children with KD are complex and varied.Although clinical symptoms, routine electrocardiogram and cardiac ultrasound may indicate severe CAL.Their applications are limited by the diagnosis of the type (especially stenosis), degree, and extent of CAL, as well as the detection of extracoronary lesions.CAG is of great significance to identify vascular lesions and guide clinical management of KD combined with CAL in children.

Clinical analysis of congenital coronary artery fistula in 71 children / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics, therapeutic efficacy and prognosis of congenital coronary artery fistula (CAF) in children.Methods:Clinical data of 71 pediatric patients diagnosed with congenital CAF at Department of Cardiology and Department of Cardiac Surgery, Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine from January 2013 to June 2019 were retrospectively analyzed.The median age was 2.2 years (0.1-14.0 years), and the median body weight was 18.3 kg (3.2-55.8 kg), including 37 males (52.1%) and 34 females (47.9%). They were divided into the transcatheter closure group (30 cases) and surgical repair group (41 cases). The therapeutic effect and follow-up data of the 2 groups were compared by the Fisher′ s exact test. Results:Among the 71 congenital CAF children, 70 had heart murmurs, 2 had chest tightness after activity, and 5 were prone to recurrent respiratory tract infection.Transcatheter closure and surgical repair were successfully performed in 22/30 (73.3%) and 41/41 (100.0%) cases with a statistically significant difference ( P=0.001). However, in the surgical repair group, 1 (2.4%) case died after operation and 2(4.9%) needed further transcatheter closure due to large residual shunt during the follow-up period.At the last follow-up, there were 2 cases with minimal or small residual shunt in both groups ( P=0.567). There were 2/71(2.8%) cases suffering from postoperative thrombosis. Conclusions:Cardiac murmur is the main sign of congenital CAF in children, and some of them may have frequent respiratory tract infection due to increased lung blood caused by a large amount of shunt.A few children have chest tightness and chest pain due to myocardial ischemia caused by coronary steal.Both percutaneous closure and surgical repair are safe and effective with few complications.

Hybrid treatment and prognosis of Scimitar syndrome / 中华胸心血管外科杂志

Objective:To evaluated the clinical optimization of treatment strategies for the disease and risk factors for prognosis.Methods:The records of 34 patients with scimitar syndrome evaluated at our medical center between Jan 2013 and Dec 2018 were reviewed, including clinical data, treatment outcome and follow-up.Results:Scimitar syndrome was identified in 34 patients, 16 males and 18 females, aged (21.16±33.19) months. The mean length of follow-up after diagnosis was (50.30±26.99) months. Compared with adult form patients, patients presenting less than 1 year of age had a higher incidence of pulmonary hypertension and pulmonary veins stenosis. 8 patients didn’t require surgical treatment after interventional coil embolization of aortopulmonary collaterals or other interventional maneuvers in associated congenital heart diseases. 15 patients had scimitar vein surgery, 4 patients had postoperative pulmonary vein obstruction that occurred with similar frequency after baffle or reimplantation procedures( P=0.569), and tended to be more common in patients had preoperative obstruction of scimitar vein( P=0.009). Overall, 7(20.5%) of 34 died. High risk factors for death included age at diagnosis( P=0.000), obvious pulmonary hypertension( P=0.007) and pulmonary vein stenosis( P=0.014). Conclusion:Patients with pulmonary artery systolic pressure near normal and absence of congenital heart disease excluding atrial septal defect do not require surgery. Postoperative pulmonary vein obstruction is related with scimitar vein stenosis before surgery regardless of redirection technique. Age at diagnosis, obvious pulmonary hypertension and pulmonary vein stenosis are risk factors for death in patients with scimitar syndrome.

A novel decision tree-based algorithm for differentiation of incompleted Kawasaki disease from infectious diseases / 中国小儿急救医学

Objective:To establish a novel decision tree-based algorithm in complete Kawasaki disease(cKD)and evaluate its diagnostic value in incomplete Kawasaki disease(iKD)and pediatric infectious disease(IF)with common clinical characteristics, which facilitates early and accurate diagnosis of iKD.Methods:Based on inclusion criteria of KD and IF, clinical and laboratory data of patients with cKD, iKD and IF from Shanghai Children′s Medical Center between December 2018 and December 2019 were collected.The training data set included cKD and random half number of IF patients, and validation data was constituted with iKD and the rest of IF patients.The decision tree algorithm analysis was performed in training data set to generate a clinical diagnostic panel for cKD.Finally, the decision tree-based algorithm was verified and evaluated among the iKD patients.Results:A single statistical analysis was performed on 26 examination indexes of constructing decision tree-based algorithm.It was found that 16 examination indexes were obviously different between cKD and IF patients, and 17 examination indexes were significantly different between iKD and IF patients.According to date set of cKD and IF patients, the decision tree-based algorithm was established.The erythrocyte sedimentation rate>35mm/h, N-terminal atrial brain natriuretic peptide precursor≥315 pg/ml, CD3 -/CD19 + %≥21%, and the amount of neutrophil≥8.5×10 9/L were constructed as key elements.The algorithm had a sensitivity of 0.947 and a specificity of 0.963, and correctly classified subjects with iKD who were difficult to be distinguished from patients with IF. Conclusion:A decision tree-based algorithm based on the examination indexes of cKD is one of the effective methods to identify iKD and IF, which provides strong support for the early clinical diagnosis of iKD.

Clinical analysis of Staphylococcus aureus infective endocarditis in children / 中华实用儿科临床杂志

Objective@#To describe the clinical characteristics, treatment and outcomes of Staphylococcus aureus infective endocarditis (SAIE) in children.@*Methods@#One hundred and fifty-one children with infective endocarditis (IE) and treated in Shanghai Children′s Medical Center of Shanghai Jiaotong University School of Medicine were retrospectively analyzed, from January 2007 to December 2017.There were 88 boys and 63 girls, the age of IE onset ranged from 1 month to 17 years [(6.27±4.80) years]. There were 23 cases (15.2%) with infection of staphyloco-ccus aureus, 128 cases with non-Staphylococcus aureus infective endocarditis (NSAIE). The clinical characteristics, treatment and prognosis of patients between the SAIE group and the NSAIE group were analyzed and compared.@*Results@#Among the SAIE group, there were 15 boys and 8 girls, the age of IE onset ranged from 3 months to 16 years [(6.2±5.6) years]; 10 cases of them had no underlying heart disease.There was no significant difference in gender, age and previous cardiac surgery between the SAIE group and the NSAIE group (all P>0.05). The number of patients without underlying heart disease in the SAIE group was more than that in the NSAIE group, and the difference was statistically significant[43.5%(10/23 cases) vs.20.3%(26/128 cases), χ2=5.762, P=0.016]. Compared with the NSAIE group, the SAIE group was associated with significantly higher levels of C-reactive protein [60.0(128.0) mg/L vs.25.0(58.0) mg/L, Z=-2.033, P=0.042], higher erythrocyte sedimentation rate [(59.3±43.2) mm/h vs.(39.4±31.5) mm/h, t=-2.283, P=0.024], and lower levels of serum albumin [30.1(12.7) g/L vs.34.3(8.4) g/L, Z=-2.282, P=0.022]. The proportion of severe sepsis in the SAIE group was also significantly higher than that in the NSAIE group [21.7%(5/23 cases) vs.7.0%(9/128 cases), Z=5.014, P=0.045]. Twelve cases (52.2%) of the SAIE group had systemic embolic events, including cerebral events (6 cases), pulmonary (2 cases), limbs (1 case), splenic (1 case), limbs and mesenteric (1 case), limbs and cerebral events (1 case). Eighteen cases in the SAIE group were treated with antibiotics combined with surgery and 1 case died, while 5 cases were treated with antibiotics alone, 4 cases died and 1 case abandoned.The SAIE patients had a significantly higher systemic embolic rate [52.2%(12/23 cases) vs.20.3%(26/128 cases), χ2=7.978, P=0.016], neurological events rate [30.4%(7/23 cases) vs.10.9%(14/128 cases), χ2=4.669, P=0.031] and in-hospital mortality [21.7%(5/23 cases) vs.6.3%(8/128 cases), χ2=4.139, P=0.042] than those in the NSAIE group.@*Conclusions@#SAIE was most common in those without heart disease.Compared with NSAIE, SAIE is characterized by a higher prevalence of severe sepsis, major neurological events, and inpatient mortality.Timely surgery is recommended in these cases, when possible, before the occurrence of complications.

Clinical characteristics of anomalous origin of the left coronary artery from the pulmonary artery in 91 children / 中华儿科杂志

Objective@#To explore the clinical manifestations, diagnosis, treatment and prognosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) .@*Methods@#A retrospective study identified 91 patients diagnosed with ALCAPA at Shanghai Children′s Medical Center from March 2010 to August 2017. According to the left ventricular ejection fraction (LVEF) at the time of consultation, patients were divided into the cardiac insufficiency group (n=54) and the normal cardiac function group (n=37). Clinical features (age of onset, clinical performance, etc) and auxiliary examinations (electrocardiogram, echocardiography, etc) between the two groups were compared using a t-test and a Chi-square test. Prognostic factors were analyzed by an ordered logistic regression and a Pearson correlation coefficient.@*Results@#(1) The age of diagnosis of patients in the cardiac insufficiency group who were usually misdiagnosed as cardiomyopathy was (10.0±2.6) months (20/54) , whereas the age of diagnosis of patients in the normal cardiac function group who were usually misdiagnosed as valvular diseases was (40.0±7.8) months (4/37). According to the pathophysiological mechanism, forty of the 54 (74%) patients in the cardiac insufficiency group were infantile type, and 78% patients (29/37) in the normal cardiac function group were adult type. (2) Preoperative electrocardiogram showed the deep Q wave in lead I occurred more frequently in the cardiac insufficiency group than in the normal cardiac function group (28/54 vs. 11/37, χ2=4.388, P=0.036). (3) Twenty patients died in the cardiac insufficiency group including 12 patients who died from postoperative cardiac pump failure and 8 children who did not undergo surgery due to poor prognosis and died from other reasons. There was no death in the normal cardiac function group. (4) Preoperative LVEF was the unique risk factor affecting prognosis (F=16.872, P=0.005). The preoperative LVEF was significantly lower than the postoperative LVEF ((37±11)% vs. (45±14)%, t=3.614, P=0.001) in the cardiac insufficiency group. During the follow-up period, 6 patients in the cardiac insufficiency group still presented with postoperative cardiac dysfunction, and the patients in the normal cardiac function group still had normal cardiac function.@*Conclusions@#Preoperative LVEF was the unique risk factor affecting prognosis of ALCAPA. Patients with infantile type ALCAPA and preoperative cardiac insufficiency should receive long-term follow-up treatment.

Clinical analysis of Staphylococcus aureus infective endocarditis in children / 中华实用儿科临床杂志

Objective To describe the clinical characteristics,treatment and outcomes of Staphylococcus aureus infective endocarditis (SAIE) in children.Methods One hundred and fifty-one children with infective endocarditis (IE) and treated in Shanghai Children's Medical Center of Shanghai Jiaotong University School of Medicine were retrospectively analyzed,from January 2007 to December 2017.There were 88 boys and 63 girls,the age of IE onset ranged from 1 month to 17 years [(6.27 ±4.80) years].There were 23 cases (15.2％) with infection of staphylococcus aureus,128 cases with non-Staphylococcus aureus infective endocarditis (NSAIE).The clinical characteristics,treatment and prognosis of patients between the SAIE group and the NSAIE group were analyzed and compared.Results Among the SAIE group,there were 15 boys and 8 girls,the age of IE onset ranged from 3 months to 16 years [(6.2 ±5.6) years];10 cases of them had no underlying heart disease.There was no significant difference in gender,age and previous cardiac surgery between the SAIE group and the NSAIE group (all P ＞ 0.05).The number of patients without underlying heart disease in the SAIE group was more than that in the NSAIE group,and the difference was statistically significant [43.5 ％ (10/23 cases) vs.20.3 ％ (26/128 cases),x2 =5.762,P =0.016].Compared with the NSAIE group,the SAIE group was associated with significantly higher levels of C-reactive protein [60.0 (128.0) mg/L vs.25.0(58.0) mg/L,Z =-2.033,P =0.042],higher erythrocyte sedimentation rate [(59.3 ±43.2) mm/h vs.(39.4 ±31.5) mm/h,t =-2.283,P =0.024],and lower levels of serum albumin [30.1 (12.7) g/L vs.34.3 (8.4) g/L,Z =-2.282,P =0.022].The proportion of severe sepsis in the SAIE group was also significantly higher than that in the NSAIE group [21.7％ (5/23 cases) vs.7.0％ (9/128 cases),Z =5.014,P =0.045].Twelve cases (52.2％) of the SAIE group had systemic embolic events,including cerebral events (6 cases),pulmonary (2 cases),limbs (1 case),splenic (1 case),limbs and mesenteric (1 case),limbs and cerebral events (1 case).Eighteen cases in the SAIE group were treated with antibiotics combined with surgery and l case died,while 5 cases were treated with antibiotics alone,4 cases died and 1 case abandoned.The SAIE patients had a significantly higher systemic embolic rate [52.2％ (12/23 cases) vs.20.3％ (26/128 cases),x2 =7.978,P =0.016],neurological events rate [30.4％ (7/23 cases) vs.10.9％ (14/128 cases),x2 =4.669,P =0.031] and in-hospital mortality [21.7％ (5/23 cases) vs.6.3％ (8/128 cases),x2 =4.139,P =0.042] than those in the NSAIE group.Conclusions SAIE was most common in those without heart disease.Compared with NSAIE,SAIE is characterized by a higher prevalence of severe sepsis,major neurological events,and inpatient mortality.Timely surgery is recommended in these cases,when possible,before the occurrence of complications.

Clinical study of 62 cases of anomalous left coronary artery from the pulmonary artery / 临床儿科杂志

Objective To explore the clinical manifestation, treatment and prognosis of anomalous left coronary artery from the pulmonary artery (ALCAPA). Method The clinical data of patients with ALCAPA from January 2011 to September 2016 were retrospectively analyzed. All the patients were divided into infant group (<12 months) and child group (≥12 months). Results In the 62 patients (38 infants and 24 children) with ALCAPA, the median ΔLVDD (actually measured LVDD – the normal upper limit of LVDD in this age group) of infant group and child group was 13.6 (8.4～17.5) mm and 8.5 (3.3～13.7) mm respectively. The mean LVEF of the infant group was 40.6±2.4 ％, lower than that of the children group (59.0±2.9) ％, and the difference was statistically significant (P<0.01). Sixty children were treated with surgery. The mean cardiopulmonary bypass duration of infant group (137.1±8.4 min) was longer than that of the children group (105.9±6.6 min), and the difference was statistically significant (P=0.010). The median mechanical ventilation time after operation in infant group (6 d, 3～7 d), was longer than that in the children group (2 d, 1～4 d), and the difference was statistically significant (P<0.01). The median follow-up time of 60 patients was 38 months. Six patients died within 1 month after surgery (5 cases in the infant group and 1 in the children group), and there were no deaths more than 1 month after surgery. In 22 cases, the flow rate of pulmonary valve increased rapidly within 1 week after operation (>1.8 m/s). Conclusion ALCAPA is easily misdiagnosed as dilated cardiomyopathy. The clinical manifestations of infants were more severe than those of children. The mortality was high within 1 month after surgery, and the long-term prognosis was better.

New conception of interventional therapy for congenital heart disease in neonates / 中华实用儿科临床杂志

The main clinical manifestations of neonatal critical and complex congenital heart disease (CHD) are cardiac insufficiency and severe hypoxemia.Because of the rapid development of the CHD,most children will die early.Through the analysis of the successful interventional treatment of some severe CHDs in the neonatal,the indivi-dualized interventional treatment can be used according to different congenital malformations,and the interventional ma-terials,which are different from the pediatric cardiology,are used reasonably.So many interventional therapies before or after surgery were used,and even,replace traditional surgical treatment to cure or palliate the CHD in neonates.

Head-up tilt test induced shortened QT interval:a case report and literature review / 临床儿科杂志

Objective To explore the cause of secondary QT interval shortening. Method The data of a child with vasovagal syncope and cardiac depression in whom shortened QT interval was induced in head-up tilt test (HUTT) was analyzed retrospectively, and the related literatures were reviewed. Result A 12-year-old boy visited for fainting when brushing his teeth in the morning. ECG showed sinus bradycardia, heart rate at 55 times /min and normal QT and QTc interval. Dynamic electrocardiogram showed sinus rhythm, mean heart rate at 70 times/min, atrial anterior contraction 3 times, normal mean QT and mean QTc. UCG showed approximately normal heart structure and the left ventricular systolic function. There was no abnormality in EEG and cranial CT. His fasting blood glucose was 5.2 mmol/L. The basal tilt test was positive with vasovagal syncope and cardiac depression. During the tilt table test, Holter monitoring showed that sinus arrest occurred in the child when upright tilt for16 min, and then fainted. Time of sinus arrest was 2.9 s and 11.4 s, respectively, and artificial chest compressions were performed. The QT interval was shortened (QT=330 ms), and so was QTc interval (QTc=320 ms). The ratio of QT/QTp was 78% (the lower limit of normal QT interval was 88% of QTp) before sinus arrest occurred. Conclusion Increased vagal tone may induce QT interval shortening.

Treatment of infective endocarditis in 29 children with Linezolid / 中华实用儿科临床杂志

Objective To explore the effectiveness and safety of Linezolid (LIZ) in treating children with infective endocarditis (IE).Methods The clinical data of 112 children with IE and treated in the Shanghai Children's Medical Center of Shanghai Jiao Tong University School of Medicine from August 2008 to September 2015 were retrospectively analyzed.There were 64 boys and 48 girls,and the age of IE onset ranged from 1 month to 17 years [(6.0 ± 4.8) years].Twenty-nine patients received LIZ treatment ＞ 7 days (LIZ treatment group),including 21 males and 8 females,and the age ranged from 5 months to 15 years [(6.9 ±5.2) years].The remaining 83 patients were identified without LIZ treatment(non-LIZ treatment group),including 43 boys and 40 girls,and the age ranged from 1 month to 17 years [(5.7 ±4.7) years].The etiological results,curative effect and adverse reactions of the LIZ treatment group were observed.Results Among the LIZ treatment group,22 cases had congenital heart disease and 1 case had intravenous catheter.There were 10 cases with infection of staphylococcus aureus,6 cases with coagulase negative staphylococcus,5 cases with oral streptococci and Streptococcus bovis group,3 cases with streptococcus pneumonia,2 cases with enterococcus faecium and 3 cases with negative blood culture results.All cases of the LIZ treatment group received Vancomycin therapy at first,LIZ was given when the Vancomycin therapy failed(16 cases with temperature reiteration,1 case inadequate microbiological response),Vancomycin intolerance (6 neutropenia,2 renal toxicity,2 allergy),and oral maintenance therapy (2 cases).The duration of LIZ treatment ranged from 9 to 135 days [(39.2 ±27.2) days].Three patients (10.3％) had adverse effects during LIZ treatment,1 case with severe digestive symptoms after treatment,1 case with teeth discoloration,1 case with the indicators decreasing by 2 routine blood test.Meanwhile,16 cases of 85 patients (18.8％) had side effects during Vancomycin treatment,in which 7 cases with neutropenia,6 cases with rash and 3 cases with renal insufficiency.But there were no significant differences in adverse effects between LIZ and Vancomycin treatment (x2 =1.l19,P ＞0.05).Twenty-five cases were cured (86.2％) and 2 cases dead (6.9％) in the LIZ treatment group.And no significant difference was found in cure rate,or mortality between LIZ treatment group and non-LIZ treatment group (86.2％ vs.77.1％,x2 =1.090;6.9％ vs.8.4％,x2 =0.069,all P ＞ 0.05) at 6 to 84 (23.9 ± 19.1) months follow-ups.Conclusions LIZ can be used to deal with Vancomycin failure and IE caused by gram positive coccus.LIZ was generally well tolerated in patients with IE.It may be useful in cases of IE complicated by brain abscesses for the good distribution.It is 100％ orally bioavailable,allowing oral administration for outpatients.

Diagnostic value of invasive cardiac catheterization for constrictive pericarditis and restrictive cardiomyopathy / 中华实用儿科临床杂志

Objective To evaluate the diagnostic value of invasive cardiac catheterization for restrictive cardiomyopathy (RCM) and constrictive pericarditis (CP).Methods Twenty-seven children with CP or RCM hospitalized in Department of Cardiology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiaotong University from February 2002 to December 2015,were selected,including 10 patients who had been surgically documented CP and 17 patients with RCM who underwent cardiac catheterization.Intracardiac pressure waveforms were recorded and all the measurement indexes of pressure of all the patients were analyzed.The changes of cardiac pressure under deep breathing in 9 patients with local anesthesia was recorded.Results There were significant differences in pulmonary artery pressure,difference between left ventricular end-diastolic pressure (LVEDP) and right ventricular end-diastolic pressure (RVEDP),and the ratio of RVEDP/right ventricular systolic pressure between group RCM and group CP [(50.2 ± 12.0) mmHg(1 mmHg =0.133 kPa) vs.(38.1 ±6.8) mmHg,(7.8±5.5) mmHgvs.(1.8 ±4.7) mmHg,0.27 ±0.10vs.0.45 ± 0.20,respectively;t =2.912,2.787,2.418,all P ＜ 0.05].However,there was overlapping for these criteria,and the predictive sensitivity of any of the criteria was less than 66.7％.In patients with CP,reciprocal changes in the filling between right ventricle and left ventricle occurred during respiration.In patients with RCM,the right ventricle and left ventricle pressures moved concordantly with respiration.The systolic area index was greater in group CP than that in group RCM (1.20 ± 0.03 vs.0.70 ± 0.14),and the difference was significant (t =6.152,P ＜ 0.01).The systolic area index had a sensitivity of 100.0％ and a predictive accuracy of 100.0％ for the identification of patients with surgically proven CP.Conclusions Measurements in catheterization,especially the ratio of right ventricular to left ventricular systolic area during inspiration and expiration is a reliable catheterization criterion for differentiating CP from RCM.

Stent implantation for treatment of branch pulmonary artery and anastomosis stenosis in children with univentricular hearts / 中华胸心血管外科杂志

Objective Patients with single-ventricle physiology pose a wide variety of therapeutic challenges.Pulmonary artery or anastomosis stenosis in single-ventricle physiology will have only subtle hemodynamic derangements due to the lack of the pumping chamber to force blood across the stenosis.This study aimed to evaluate the feasibility and usefulness of the stent implantation for treatment of branch pulmonary artery and anastomosis stenosis in children with univentricular hearts.Methods Retrospective analysis of 8 implanted stents between March 2014 and January 2015 in Shanghai Children's Medical Center.Transthoracic echocardiography,chest roentgenography and electrocardiography were carried out as follow-up studies at the second day after operation and 1,3,6,12 months after the procedure.Results In all of eight patients (6 males and 2 females),5 cases were post-Glenn operation and 3 cases were post-Fontan operation.The median age was 6.6 years (range 4.0-8.5 years).The median weight was 19.5 kg(range 13.8-25.6 kg).9 stents were implanted successfully in all patient,6 in left pulmonary arteries,2 in right pulmonary arteries and 1 in anastomosis.All stents were placed in the target lesion without any complication.The diameter of the narrowed segment improved from (3.63 ± 2.06) mm to (7.89 ± 1.62) mm (P ＜ 0.01).During follow-up no other complication occurred except thrombus in one patient because of discontinuation anticoagulation.Conclusion Branch pulmonary arterial stenosis in single-ventricle patients may often be underestimated due to the low pressure venous system and/or the development of venovenous collaterals bypassing and decompressing the pulmonary circuit.In these patients,even mild stenosis should be treated aggressively,especially in the presence of pleural effusions,pericardial effusions,protein-losing enteropathy and low-output states.Stent implantation is an effective method of treating branch pulmonary artery stenosis.

Initial experience with the new Pul-Stent in treating postoperative branch pulmonary artery stenosis / 中华儿科杂志

<p><b>OBJECTIVE</b>The Pul-stent is a new cobalt alloys stent, specially licensed for pulmonary artery stenosis. The aim of this study was to investigate the value of the stent implantation as the treatment of postoperative pulmonary artery stenosis.</p><p><b>METHOD</b>Clinical practice was carried out to evaluate effectiveness, safety and maneuverability of Pul-stent in the defined clinical setting. Transthoracic echocardiography, chest roentgenography and electrocardiography were carried out as follow-up studies at 1 and 3 months after procedures.</p><p><b>RESULT</b>Ten patients (7 males and 3 females) received Pul-stent implantation in left or right pulmonary arteries (9 stents in left and 1 stent in right). For 9 cases transcatheter stent implantation was performed and in I case hybrid procedure. The median age was 7. 9 years (range 3. 4 - 13. 7 years). The median weight was 22. 3 kg (range 13 - 32 kg). Among them 6 cases were post surgical repair of tetralogy of Fallot, 2 cases were after Fontan procedures, 1 patient was post surgical repair of pulmonary atresia with ventricular septal defect, and 1 patient had stenosis at Glenn pathway. The pressure gradient at the stenosis decreased from (31. 6 ± 10. 2) mmHg(1 mmHg =0. 133 kPa) to (7. 3 ± 10. 3) mmHg, and the diameter of the narrowest segment increased from (4. 0 ± 2. 3) mm to (9. 6 ± 2. 7) mm, the right ventricle to aortic pressure ratio decreased from 0. 54 to 0. 36, all of these improvements were statistically significant (t = 3. 9, -9. 7, 4. 5; P =0. 008, 0. 000, 0. 004). The total procedure time ranged from 55 to 220 min (median 117 min) , and the fluoroscopy time ranged from 9 to 67 min (median 26 min). There were 2 cases of post-stenting pneumorrhagia. No stent fracture, stent malposition and other severe complications were observed. Initial follow-up of 1 and 3-months showed good results with maintenance of improved caliber of the stented vessel, and the gradient across the stenosis area measured by echocardiography was (32. 0 ± 14. 6) mmHg after 3 months. Compared with before stentifng ((40.6 ± 15. 2) mmHg) and 1 month later ((30. 6 ± 13. 6) mmHg), the difference was not statistically significant (t =2. 2,1. 76; P =0. 07, 0. 10).</p><p><b>CONCLUSION</b>Pul-Stent tracking and delivery was excellent, the initial experience has shown that Pul-stent implantation was effective and safe in treating post-operative branch pulmonary artery stenosis. Further follow-up study should be conducted to make sure whether those good results would be kept constant.</p>

Transcatheter treatment of postoperative pulmonary stenosis:current status and future perspectives / 中华实用儿科临床杂志

Postoperative pulmonary artery stenosis is one of the popular complications.The disappointing results of surgical treatment for such lesions led to the introduction of interventional procedures (balloon angioplasty and stent implantation).Balloon angioplasty is applicable for branch pulmonary artery stenosis,however,balloon dilation alone rarely been effective in the long-term for these lesions.Since pulrmonary artery stenting was introduced in 1991,indications and use of stents for dealing with pulmonary artery stenosis have played a leading role in recent times.Intravascular stents are effective for stenotic artery dilation,can reduce right ventricle pressure and improve heart function.Excellent mid-and long-term results after stenting of postoperative pulmonary artery stenosis are demonstrated by numerous researches,with the new developments in stent design,indications for pulmonary artery stent implantation are likely to widen in the future.

Stent implantation for relief of pulmonary artery branch stenosis / 中华儿科杂志

<p><b>OBJECTIVE</b>Branch pulmonary artery stenosis is one of the common congenital heart disease. Stent implantation to relieve branch pulmonary artery stenosis (BPAS) is an alternative to failed surgical or balloon angioplasty. The aim of this study was to explore the indication, methods and complications of using balloon expandable stent placement to treat branch pulmonary artery stenosis, and evaluate the results of stent implantation in the treatment of branch pulmonary artery stenosis.</p><p><b>METHOD</b>From August 2005 to December 2012, 19 patients underwent an attempt at stent implantation. The median age of those patients was 9.1 years (range 4.0-15.0 years). The median weight was 31.7 kg (range 17.0-60.5 kg); 14/19 patients underwent post surgical repair of tetralogy of Fallot, one patient received post surgical repair of pulmonary atresia with ventricular septal defect, one patient underwent post surgical repair of pulmonary atresia with intact septum, one with native left BPAS, and one was after surgical repair of aortopulmonary window and the other truncus arteriosus. CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the inner balloon and outer balloon was inflated successively to expand the stent to desired diameter. Statistical analysis was performed with the unpaired Student t test.</p><p><b>RESULT</b>A total of 26 stents were implanted successfully in 19 patients. The systolic gradient across the stenosis fell from a median of (36.0 ± 18.3) to (3.8 ± 3.4) mmHg (P < 0.01, 1 mmHg = 0.133 kPa) and the diameter of the narrowest segment improved from (6.0 ± 1.9) to (11.6 ± 3.1) mm (P < 0.01). The right ventricle to aortic pressure ratio fell from 0.68 to 0.49 (P < 0.01). Complications included the following: two stents were malpositioned in the right ventricular outflow tract and one balloon ruptured when dilated the hole of the stent. No other complications occurred. All patients were followed up for 6 months to 6.0 (2.5 ± 1.8) years. One patient underwent stent re-dilation in order to accommodate somatic growth two years later.</p><p><b>CONCLUSION</b>Balloon expandable stents are safe and effective in relieving BPAS. Stent implantation should be considered the treatment of choice for most patients with BPAS. Stents placed into growing children will require further dilation to keep up with normal somatic growth. Intermediate and long-term follow up studies have shown excellent results after further dilation over time.</p>

Clinical characteristics and therapeutic effect of tachycardia-induced cardiomyopathy in 22 children / 临床儿科杂志

Objectives To explore the clinical symptoms, therapy and prognosis of tachycardia-induced cardiomyopathy (TIC) in children. Methods Clinical data of 22 children with TIC from July 2007 to July 2012 were retrospectively analyzed. Results TIC was mostly seen in male infants and 81.82%of TIC was caused by atrial arrhythmias. The clinical symptom relieved after arrhythmia and ventricular rates were under control with average effective treatment time of (14.00 ± 8.20) days. Ten patients had tachycardia recurrence, 7 of them had atrial arrhythmia and their clinical symptoms were improved after treatment;while 3 of them showed longer time of therapy with average treatment time of (19.50±8.40) days (P<0.05). Five children underwent radiofrequency ablation before school age and got good therapeutic effect. The post-treatment echocardiographic parameters showed cardiac function of TIC children was significantly improved after treatment, including left ventricular end-diastolic diameter index, left ventricular end-systolic diameter index, left ventricular ejection fraction and shortening score (all P<0.05). Conclusions Childhood TIC is a reversible myocardial dysfunction and its prognosis is good. TIC can be induced by various types of tachyarrhythmias and normally by atrial arrhythmia. The preferred treatment of TIC is administration of antiarrhythmic drugs but radiofrequency ablation is needed to ventricular arrhythmias induced TIC.