Kidney injury after cardiopulmonary bypass in infants with congenital heart disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study kidney injury in infants with congenital heart disease (CHD) who underwent cardiac surgery with cardiopulmonary bypass (CPB).</p><p><b>METHODS</b>Forty CHD infants undergoing cardiac surgery with CPB from October 2009 to July 2010 were enrolled. The concentrations of serum tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), cystatin C (CysC) and urinary N-acetyl-beta-D-glucosaminidase (NAG) were detected using ELISA before bypass, at the end of surgery, and 2 hrs, 6 hrs and 24 hrs after surgery. Serum concentrations of creatinine (Cr) and urea nitrogen (BUN) were measured with conventional biochemistry technique before and after surgery.</p><p><b>RESULTS</b>The concentrations of serum Cr and BUN were normal before and after surgery. After CPB, the concentrations of serum TNF-α and IL-6 and urinary NAG increased significantly (P<0.05). Serum TNF-α was positively correlated with urinary NAG and serum CysC (r=0.195, 0.190, respectively; both P<0.05). Serum IL-6 was positively correlated with urinary NAG (r=0.278, P<0.01). The positive rate in kidney injury was detected by serum CysC and urinary NAG were significantly higher than by serum Cr or BUN (both P<0.01).</p><p><b>CONCLUSIONS</b>CPB can cause acute kidney injury in infants, which may be correlated with the increase in the concentrations of serum TNF-α and IL-6. Serum CysC and urinary NAG may be used as sensitive markers for reflecting the changes of renal function.</p>

Intervention of astragalus injection on the kidney injury after cardiopulmonary bypass of infants with congenital heart disease / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the intervention of astragalus injection in the kidney injury of infants with congenital heart disease after cardiopulmonary bypass, thus providing a new method for protection of the kidney injury in them.</p><p><b>METHODS</b>Forty infants undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to the test group and the control group, twenty in each group. Astragalus Injection (at the dose of 2 mL/kg) was added in the perfusion fluid before giving to infants in the test group before bypass, while the normal saline of the same volume was added in the perfusion fluid before giving to infants in the control group (P < 0.01). The concentrations of serum tumor necrosis factor-alpha (TNF)-alpha, interleukin-6 (IL-6), cystatin C (CysC), and N-acetyl-beta-D-glucosaminidase (NAG) were detected with ELISA at the following time points, i.e., before bypass (T1), by the end of the surgery (T2), 2 h after surgery (T3), 6 h after surgery (T4), and 24 h after surgery (T5).</p><p><b>RESULTS</b>The serum CysC concentrations were not significantly higher after CPB (P > 0.05). The urinary NAG level increased significantly in the control group after surgery (P < 0.05), but no obvious increase of the urinary NAG level was found in the test group after surgery (P > 0.05). It was obviously lower than that of the control group (P < 0.05). After CPB serum TNF-alpha and IL-6 levels increased significantly in the control group (P < 0.05), while they were lower in the test group than in the control group (P < 0.01).</p><p><b>CONCLUSIONS</b>CPB may result in the renal tubular injury in infants with congenital heart disease. The application of Astragalus Injection before the CPB plays a role in protecting renal tubular functions.</p>

The surgical treatment of pectus excavatum in children by modified sternal elevation / 中华胸心血管外科杂志

Objective To review the experience of modified sternal elevation in management of pectus excavatum deformities. Methods A retrospective study was carried out on 268 children with pectus excavatum deformities from January 2002 to December 2005.Of these patients,213 were boys and 55 were girls.Their age ranged from 2 to 16 years and 2 months[mean,(4.48?2.74) years)].Among then,69 cases were aged from 2 to 3 years,130 cases from 3 to 6 years and 69 cases over 6 years.268 patients with PE underwent modified sternal elevation and fixation with the home made stainless steel strut.The lung cysts,esophageal hatal hernia and congenital heart diseases were surgical treated simultaneously.Results There was no death postoperative.Postoperative compli- cations included pneumonia in 1 case,subcutaneous fluid in 2.the foUow-up period was 1-5 years.One patient was found having light notch in sternum.All patients had satisfactory results.In 165 cases stainless steel strut have been taken off postoperatively and no recurrence occurred.Conclusion The modified sternal elevation procedure for pectus excavatum results in an excellent cosmetic outcome.