RESUMEN
Objective To summarize the experience of surgical treatment of severe ventricular septal defect (VSD) accompanied by pulmonary hypertension (PH) in little infants. Methods The clinical data of 11 patients with VSD accompanied by PH admitted to the Department of Cardiac Surgery of Tianjin Children's Hospital of the Pediatric Clinical College in Tianjin Medical University from January 2016 to January 2017 were retrospectively analyzed. There were 6 males and 5 females, with the ages of 3 - 6 months, mean (5.36±1.03) months and body weights 4.2 - 7.5 kg, mean (5.9±1.0) kg. Preoperatively, all patients had recurrent pneumonia and heart failure history. After 2 - 3 times of medical treatment in hospitals, the patients underwent sub-acute radical operation under cardiopulmonary bypass. All patients were followed-up with echocardiography, chest X-ray and electrocardiogram examinations at 3, 6 and 12 months after heart surgery. Results After operation, all the children spontaneously recovered the heart beats, the stay times in surgical intensive care unit (SICU) were 2 - 7 days, and total hospitalization times were 12 - 17 days. All patients were followed up for 12 months, no death occurred in the whole group, and the heart and lung functions recovered satisfactorily. Conclusions Little infants with large VSD and PH should undertake operation as early as possible. The patients with recurrent pneumonia, heart failure in a short term should receive medical and surgical doctors' cooperative treatment, and the disease situation ought to be adjusted with one's best ability to a stable status when the sub-acute surgery can be carried out safely.
RESUMEN
Objective To investigate the diagnostic value of urinary neutrophil gelatin enzyme-related lipid delivery protein (NGAL) and kidney injury molecule-1 (KIM-1) in the acute kidney injury (AKI) after cardiopulmonary bypass (CPB) operation in children with non-cyanotic congenital heart disease (CHD). Methods A retrospective analysis was conducted. 200 CPB undergoing cardiac surgery in children with non-cyanotic CHD admitted to Tianjin Children's Hospital from June 2015 to May 2017 were enrolled. All patients were divided into AKI group and non-AKI group within 48 hours after operation, and the two groups matched with age, sex, weight, basic complications, operation time and other factors. The differences in serum creatinine (SCr), urinary NGAL and KIM-1 [corrected for urinary creatinine (UCr)] between the two groups before and after operation were compared. The early diagnosis value of urinary NGAL and KIM-1 on AKI was analyzed by the receiver operating characteristic curve (ROC). Results There were 32 patients with different degrees of AKI 48 hours post operation, and the incidence was 16.0%; 60 cases were enrolled in non-AKI group. Compared with non-AKI group, urinary NGAL at 2 hours after operation, urine KIM-1 at 4 hours after operation, and SCr at 10 hours after operation in AKI group were significantly increased, which decreased gradually after reaching peak at 6, 8, 24 hours respectively. It was shown by ROC curve analysis that the area under ROC curve (AUC) and 95% confidence interval (95%CI) of postoperative 2-hour urine NGAL, 4-hour urine KIM-1 and 10-hour SCr for diagnosis of AKI were 0.940 (95%CI = 0.890-0.990), 0.939 (95%CI = 0.891-0.986) and 0.959 (95%CI = 0.916-1.000) respectively. When the cut-off value of postoperative 2-hour urine NGAL was 588.0 μg/g, the sensitivity was 87.5%, the specificity was 95.0%, the accuracy was 93.5%; when the cut-off value of postoperative 4-hour urine KIM-1 was 9.55 ng/mg, the sensitivity was 87.5%, the specificity was 91.7%, the accuracy was 90.2%; and when the cut-off value of postoperative 10-hour SCr was 61.90 μmol/L, the sensitivity was 90.6%, the specificity was 95.0%, and the accuracy was 95.7%. Conclusion Urine NGAL and KIM-1 can be used as biomarkers for early diagnosis of AKI after CPB for the non-cyanotic CHD in children.