Medium-term follow-up of percutaneous pulmonary valve implantation using the Venus-P self-expanding valve / 中华实用儿科临床杂志

Objective:To evaluate the medium-term clinical and hemodynamic outcomes of percutaneous pulmonary valve implantation (PPVI) using a domestic Venus-P self-expanding valve in the treatment of severe pulmonary regurgitation after Tetralogy of Fallot (TOF).Methods:Retrospective study.From December 2017 to December 2020, 13 TOF patients with (17.8±4.7) years old and (50.2±12.3) kg underwent PPVI using the Venus-P self-expanding valve in the Department of Children′s Heart Center, Zhengzhou University People′s Hospital were recruited.The mean valve size was (31.9±3.1) mm.All patients received the transannular patch surgery and developed severe pulmonary regurgitation.After PPVI, 13 patients were followed up for at least 12 months.The operation-related complications, improvement of valve and heart function and the durability and reintervention of the Venus-P self-expanding valve were analyzed.The right ventricular end-diastolic volume index (RVEDVi) before and after operation was compared by the paired t-test, and the New York Heart Association (NYHA) class was compared by the paired Wilcoxon signed rank sum test. Results:PPVI was successfully performed in all 13 patients without death.At 6 months post-PPVI, cardiac magnetic resonance imaging findings showed that RVEDVi was significantly reduced[(145.7±9.6) mL/m 2vs.(100.2±12.2) mL/m 2, P<0.05], and the NYHA class was significantly improved ( P<0.05). One patient presented moderate pulmonary valve regurgitation at 12 months postoperatively.No vegetation was found on echocardiography, and blood culture was negative in this case.Six patients did not have postoperative pulmonary valve regurgitation, and the remaining presented mild or less pulmonary regurgitation.One patient had sudden ventricular tachycardia on the 6 th day postoperatively, which was converted to sinus rhythm after synchronous electrocardiography.Only one case underwent appendectomy 7 months after operation due to acute appendicitis, and the remaining did not require valve-related reintervention after implantation.During the follow-up for (22.8±8.0) months, no patients had perivalve leakage, stent migration and rupture.Complications like embolization and coronary artery compression were not reported. Conclusions:PPVI using the Venus-P self-expanding valve is safe and effective in patients with severe pulmonary valve regurgitation after TOF surgery, showing an acceptable medium-term follow-up outcome.Studies with a large sample size and long follow-up period are still needed to validate our findings.

Clinical efficacy and safety of Treprostinil in the treatment of children with early decompensation after the Fontan procedure / 中华实用儿科临床杂志

Objective:To investigate the efficacy and safety of Treprostinil in the treatment of children with early decompensation after the Fontan procedure.Methods:A retrospectively analysis was performed on the clinical data of 16 children with early decompensation after the Fontan procedure treated with Treprostinil injection from December 2017 to June 2020 at Fuwai Central China Cardiovascular Hospital.A total of 16 patients were included, including 5 boys (31.2%) and 11 girls (68.8%). The age was (4.6 ±1.2) years, the weight was (16.0±2.1) kg.The changes of central venous pressure (CVP), heart rate (HR), systolic blood pressure (SBP), central venous oxygen saturation (ScvO 2), lactic acid (Lac), oxygenation index and B-type natriuretic peptide (BNP) were recorded at the infusion of Treprostinil and 3 hours, 24 hours, 48 hours and 72 hours after the infusion.The short-term efficacy of Treprostinil was observed[mortality, mechanical ventilation time, and length of intensive care unit (ICU) stay]; paired t-test was used to analyze the above indexes at different time points.The adverse reactions during the administration were also recorded. Results:Of the 16 children, the median mechanical ventilation time was 9 (5, 22) h, and the median ICU stay time was 2 (1, 12)days.After 72 hours of drug administration, CVP, Lac, BNP and HR decreased: CVP decreased from(16±5) mmHg (1 mmHg=0.133 kPa) to (11±2) mmHg ( P<0.001), Lac decreased from(6.8±3.2) mmol/L to (3.2±1.2) mmol/L ( P=0.002), BNP decreased from(980±223) ng/L to (250±120) ng/L( P<0.001), HR decreased from(150±20) times/min to (125±16) times/min( P=0.002); SBP, ScvO 2 and oxygenation index increased: SBP increased from(83±10) mmHg to (98±12) mmHg( P<0.001), ScvO 2 increased from 0.53±0.13 to 0.65±0.11 ( P=0.003), oxygenation index increased from (200±72) mmHg to (298±13) mmHg ( P<0.001), and the differences were statistically significant(all P< 0.05). One case died (6.3%), 2 cases (12.5%) had transient blood pressure drop and 1 case (6.3%) had nausea and vomiting.Besides, no other treatment-related complications were observed. Conclusions:As for children with early decompensation after the Fontan procedure, the intravenous application of Treprostinil can reduce pulmonary artery pressure rapidly, effectively improve circulatory status and oxygenation and ultimately improve the prognosis.

Analysis of risk factors of lower extremity venous thrombosis in pediatric patients after surgery for congenital heart disease / 中华实用儿科临床杂志

Objective:To explore the risk factors of puncture- or catheter-related lower extremity venous thrombosis after surgery for congenital heart disease(CHD).Methods:A retrospective analysis was performed on 683 children with venipuncture or venous catheterization in the lower extremities who underwent surgery for CHD in Children′s Heart Center Intensive Care Unit, Henan Provincial People′s Hospital from January 2017 to December 2018, and there were 55 children suspected thrombosis, among whom, 26 cases of thrombosis confirmed by ultrasound were included in the thrombosis group, and 29 cases without thrombosis seen by ultrasound were assigned to the control group.A comparative analysis was carried out to see whether there were statistical differences in the possible risk factors between the 2 groups, and the risk factors of puncture- or catheter-related lower extremity venous thrombosis after operation of CHD.Results:The incidence of puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD was 3.81% (26/683 cases). The differences between the thrombosis group and the control group in age (62 d vs.92 d), weight [(3.92±0.66) kg vs.(4.61±0.86) kg], CHD postoperative critical score (Vasoactive-Ventilation-Renal score, VVR)[(29.58±15.50) scores vs.(22.14±11.72) scores], peak blood lactate within 24 hours after surgery [(3.59±0.66) mmol/L vs.(1.71±1.13) mmol/L], postoperative blood transfusion[76.9%(20/26 cases) vs.34.5%(10/29 cases)], co-infection[53.8%(14/26 cases) vs.24.1%(7/29 cases)], cyanotic congenital heart disease [84.6%(22/26 cases) vs.34.5%(10/29 cases)] and puncture difficulty[69.2%(18/26 cases) vs.17.2%(5/29 cases)] were statistically significant(all P<0.05). Logistic regression analysis showed postoperative VVR score ( OR=0.88, 95% CI: 0.77-0.99, P=0.04), blood lactate peak within 24 hours after surgery ( OR=6.62, 95% CI: 1.35-32.46, P=0.02), and cyanotic congenital heart disease ( OR=0.04, 95% CI: 0.00-0.63, P=0.04) were risk factors for venous thrombosis in the lower extremities. Conclusions:High postoperative VVR score, high 24 h blood lactate peak after surgery and cyanotic congenital heart disease are high risk factors for puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD.

Efficacy of Levosimendan on postoperative low cardiac output syndrome of infants with congenital heart disease / 中华实用儿科临床杂志

Objective To investigate the efficacy of Levosimendan in the treatment of postoperative low cadiac output syndrome (LCOS) in infants with congenital heart disease (CHD).Methods Clinical data of patients with CHD developed postoperative LCOS in the Children Heart Center of Fuwai Central China Cardiovascular Hospital from January to December 2018 was collected.In patients that traditional vasoactive drugs failed to alleviate LCOS,the efficacy of continuous infusion of O.1 μg/(kg · min) Levosimendan was observed.Besides,the mechanical ventilation time,ICU stay time,mortality,the changes of ejection fraction (EF) and central venous oxygen saturation (ScvO2) at the infusion of Levosimendan and 48 h after infusion,as well as the changes of heart rate (HR),systolic blood pressure (SBP),vasoactive drugs score (VIS) and lactic acid at the infusion of Levosimendan and 3 h,6 h,12 h,24 h and 48 h after infusion were recorded.Results There were 29 cases,including 17 males (58.6％) and 12 females (41.4％),with median age of 2 (0.5,40.0) months,median body mass of 4.7 (2.6,13.5) kg,median mechanical ventilation time of 109.5 (42.5,367.0) h,ICU stay time of 187.5 (83,446) h,and 1 case died (3.4％).EF (48％ vs.52％)and ScvO2 (53％ vs.58％) increased 48 h after infusion,and the differences were statistically significant (all P ＜0.01).HR level (173 times/min,176 times/min,175 times/min,173 times/min,170 times/min,170 times/min) and lactic acid level (4.72 mmol/L,4.65 mmol/L,4.34 mmol/L,3.79 mmol/L,3.28 mmol/L,2.74 mmol/L) gradually decreased after infusion,and the differences of both between the beginning of infusion and 48 h after infusion were statistically significant (P =0.029);SBP decreased and then increased (74 mmHg,70 mmHg,71 mmHg,73 mmHg,74 mmHg,75 mmHg,1 mmHg =0.133 kPa),and VIS increased and then decreased (26 scores,27 scores,27 scores,26 scores,25 scores,25 scores) at different time points after infusion,however,the data of both between the beginning of infusion and 48 h after infusion had no significant differences (P =0.294,0.151).Conclusions Levosimendan can increase EF,enhance myocardial contractility and systemic tissue perfusion,thus improving the prognosis,when Levosimendan was applied for the treatment of postoperative LCOS of infants with CHD.

Efficacy of Levosimendan on postoperative low cardiac output syndrome of infants with congenital heart disease / 中华实用儿科临床杂志

Objective@#To investigate the efficacy of Levosimendan in the treatment of postoperative low cadiac output syndrome (LCOS) in infants with congenital heart disease (CHD).@*Methods@#Clinical data of patients with CHD developed postoperative LCOS in the Children Heart Center of Fuwai Central China Cardiovascular Hospital from January to December 2018 was collected.In patients that traditional vasoactive drugs failed to alleviate LCOS, the efficacy of continuous infusion of 0.1 μg/(kg·min) Levosimendan was observed.Besides, the mechanical ventilation time, ICU stay time, mortality, the changes of ejection fraction (EF) and central venous oxygen saturation (ScvO2) at the infusion of Levosimendan and 48 h after infusion, as well as the changes of heart rate (HR), systolic blood pressure (SBP), vasoactive drugs score (VIS) and lactic acid at the infusion of Levosimendan and 3 h, 6 h, 12 h, 24 h and 48 h after infusion were recorded.@*Results@#There were 29 cases, including 17 males (58.6%) and 12 females (41.4%), with median age of 2 (0.5, 40.0) months, median body mass of 4.7 (2.6, 13.5) kg, median mechanical ventilation time of 109.5 (42.5, 367.0) h, ICU stay time of 187.5 (83, 446) h, and 1 case died (3.4%). EF (48% vs.52%) and ScvO2 (53% vs.58%) increased 48 h after infusion, and the differences were statistically significant (all P<0.01). HR level (173 times/min, 176 times/min, 175 times/min, 173 times/min, 170 times/min, 170 times/min) and lactic acid level (4.72 mmol/L, 4.65 mmol/L, 4.34 mmol/L, 3.79 mmol/L, 3.28 mmol/L, 2.74 mmol/L) gradually decreased after infusion, and the differences of both between the beginning of infusion and 48 h after infusion were statistically significant (P=0.029); SBP decreased and then increased (74 mmHg, 70 mmHg, 71 mmHg, 73 mmHg, 74 mmHg, 75 mmHg, 1 mmHg=0.133 kPa), and VIS increased and then decreased (26 scores, 27 scores, 27 scores, 26 scores, 25 scores, 25 scores) at different time points after infusion, however, the data of both between the beginning of infusion and 48 h after infusion had no significant differences (P=0.294, 0.151).@*Conclusions@#Levosimendan can increase EF, enhance myocardial contractility and systemic tissue perfusion, thus improving the prognosis, when Levosimendan was applied for the treatment of postoperative LCOS of infants with CHD.

Clinical Experience and Short-term Outcome for Minimally Invasive Occlusion in Patients With Peri-membranous Ventricular Septal Defect via Right Subaxillary Route / 中国循环杂志

Objective: To summarize the clinical experience and short-term outcome of minimally invasive occlusion in patients with peri-membranous ventricular septal defect (PmVSD) via right subaxillary route under trans-esophageal echocardiography (TEE) guidance. Methods: A total of 122 PmVSD patients treated in our hospital from 2014-01 to 2015-07 were summarized. There were 54 male and 68 female with the mean age of (2.7±2.2, 0.5-9.7) years, mean body weight of (13.9±6.0, 6.1-38.0) kg and mean PmVSD diameter of (3.8±0.8, 2.5-7.0) mm. The patients were taken left lateral position, a (2-3) cm incision was performed along right mid-axillary line between the 3rd rib and 4th rib, the thoracic entrance was at 4th inter-costal space. A purse-string suture was conducted on right atrial surface, a special hollow probe was inserted into right atrium and crossed tricuspid into right ventricle under TEE guidance; the probe was adjusted to the point or crossed VSD into left ventricle followed by guide wire insertion to establish a deliver pathway, and ifnally, occlusion device was regularly deployed to close the defect. Post-operative ECG, TEE and chest X-ray were conducted for followed-up study. Results: There were 119/122 (98.4%) patients occluded successfully and 3 failed patients were converted to cardiopulmonary bypass surgery at the original incision. The average size of occluder was (4.9±1.1, 4-10) mm and all devices were concentric. The patients were followed up at the mean of (8.3±5.0, 1.0-19.8) months, during that period, 12/119 (10.1%) had new mild tricuspid regurgitation, 16 (13.4%) suffered from incomplete right bundle branch block, 4 (3.4%) had small residual shunt and 2 of them were self-closed at 1 and 3 months after operation respectively. There were no complete atrio-ventricular block, no new aortic valve regurgitation and no device dislocation. Conclusion: Minimally invasive occlusion of PmVSD via right subaxillary route under TEE guidance was a safe, effective, feasible and better cosmetic method for treating relevant patients; while its long-term outcome should be further observed.

Analysis about strategies on lung protection of ventricular septal defect infants during perioperation / 中华胸心血管外科杂志

Objective Approach to safe and effective lung protection strategies on ventricular septal defect infants during perioperation.Methods There were 4 groups as blank control group,ambroxol group,methylprednisolone group and ulinastatin group.We tried to find a safe and effective stratege on lung protection by comparing each other on the respiratory function indexes and inflammation biomarkers.Results Postoperation of VSD repair,respiratory function indexes such as Ppeak,oxygenation index inspiratory resistance and mechanical ventilation time were significantly different (P ＜ 0.05) among the 4 groups.The inflammation biomarkers such as WBC,CRP and PCT had no differences the first day(P ＞0.05),and were statistically significant the third day (P ＜ 0.05).Conclusions Ambroxol,methylprednisolone and ulinastatin all are effective drugs for lung protection.Considering about the clinical curative effect and side effects,ambroxol is more safe and effective relatively.

Clinical study on standardized scoring system after repair of tetralogy of Fallot / 中华实用儿科临床杂志

Objective To establish a standardized scoring system after tetralogy of Fallot (TOF) correction and explore its clinical application values.Methods During the period of Jan.2006 and Apr.2014 at the Third Affiliated Hospital,Zhengzhou University and Henan Provincial People's Hospital,a total of 624 infants undergoing stage Ⅰ anatomic correction were selected and their common clinical parameters such as liver size,systolic blood pressure,urinary volume,oxygenation index and occurrences of complications were recorded and scored.The cases were divided into low-risk,medium-risk and high-risk groups according to scores.The relevant endpoint parameters,including mortality or survival,on-pump time,intensive care unit(ICU) duration,hospitalization and medical expenses were recorded to analyze their relationship with postoperative scores.Results The data indicated that the short-term mortality after repair of tetralogy of Fallot was 5 ％.Moreover,there was no statistical difference (P =0.309) in the mortality between the lowrisk group (total score ＜ 3 and mortality of 0) and medium-risk group,and the mortality of the medium-risk group was statistically different(P ＜ 0.001) from that of the high-risk group (total score ＞ 7 and mortality of ＞ 80％).The postoperative standby time,ICU stay,total hospital stays and cost increased with the rise of the score(P ＜ 0.001),and there were no statistical differences in hospital stays(P =0.469) and cost(P =0.365) between the medium-risk group and the high-risk group.Conclusions Based upon common clinical parameters,a standardized scoring system has been successfully established for patients after TOF correction,which plays an important role in gauging the disease progression and predicating the immediate postoperative outcomes of TOF.

The effect of entrapment of CpG sequence with cationic PLG nanoparticles on the immune responses of mice to pig paratyphoid vaccine / 生物医学工程学杂志

Cationic PLG nanoparticles and liposome were prepared and used as package molecules to pack up pUC18-CpG. The effects of the packed pUC18-CpG on the cellular and humoral immune responses were detected in the mice that were inoculated with pig paratyphoid vaccine. The results showed that compared with the control, the amount of IgG and the titre of specific antibody were significantly increased in the sera of mice immunized with the CpG plasmid entrapped by cationic PLG nanoparticles; the proliferation and induced IL-2 bioactivity of lymphocytes were significantly enhanced in the spleen of the immunized mice; the stimulatory effect of cationic PLG nanoparticles was similar to or stronger than that of cationic liposome. These indicated that cationic PLG nanoparticle could be employed as an effective package molecule to promote the immunostimulatory effect of pUC18-CpG.

Effects of entrapment of murine interleukin-2 gene with chitosan nanoparticles on expression of mIL-2 gene and on regulation of immune response in mice / 生物医学工程学杂志

The experiment was conducted to prepare chitosan nanoparticles (CNP), to entrap VRMIL-2 with CNP, the eukaryotic VR1020 expression plasmid containing murine IL-2 gene (mlL-2), and to investigate the expression in vivo and the regulatory effect of mIL-2 on immune-response and immuno-protection in mice inoculated muscularly with CNP entrapped VMIL-2 at 21 days old. The results showed that IgG, IgM and IgA contents increased to different degrees in the sera from the inoculated mice, which were remarkably higher than those of the controls inoculated VR1020 packed with CNP (P<0.05); so were the IL-2, IL-4 and IL-6 contents in the sera of the immunized mice. The number of white blood cells and lymphocytes significantly increased respectively in the vaccinated mice, compared with those of controls. These mice were orally challenged with virulent E. coli 35 days post-inoculation, and all the immune responses were significantly higher than those of the control except the number of neutrophils. The mice inoculated with VRMIL-2 survived healthily, while the mice of control group were ill with the evident lesions. Although there are no remarkable differences between the cellular and humoral immune indexes of mice inoculated with CNP-VRMIL-2 and nude VRMIL-2 (P>0.05), the dosage of CNP-VRMIL-2 is only one fifth of the VRMIL-2. These indicated that entrapment of mIL-2 gene with chitosan nanoparticles could remarkably enhance the expression of mIL-2 in vivo, and significantly raise the levels of cellular and humoral immune, and increase the resistance of mice against E. coli infection. The results suggested that chitosan nanoparticles and IL-2 gene could be used as an effective immunoenhancer to increase the immunity of animals against infection.