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Objective:To investigate the diagnosis, surgical methods, perioperative treatment and surgical results of Kommerell's diverticulum with double aortic arch in infants.Methods:From December 2014 to December 2019, 22 cases of double aortic arch combined with Kommerell diverticulum were operated in our hospital, 14 males and 8 females, with an average age of (13.7±11.6) months (1-36 months) and mean body mass of (9.8±3.4)kg (5-20 kg). The children had respiratory symptoms such as asthmatic suffocation, shortness of breath, repeated respiratory tract infection and chronic cough before operation. All patients underwent cardiac CT examination. The average diverticulum was 8 mm×9 mm, in the trachea The average compression degree of the lower segment was 56%±16% (30%-80%). The distal part of the left arch was atresia and Kommerell's diverticulum was found in all patients. The operation methods were left aortic arch separation, ligament separation and diverticulectomy. In one case, tracheal stent was placed simultaneously during the operation because of severe tracheal malacia.Results:The average time in the ward was(1.4±0.8)days (1-4)days, and the average time in hospital was (6.7±2.8)days (4-13 days). The average follow-up period was (25.5±16.9) months (2-60 months). During the follow-up period, 18 children had no persistent respiratory symptoms, and 4 children had only slight respiratory symptoms.Conclusion:Kommerell's diverticulum can also be combined with double aortic arch. The operation method is to separate the aortic arch and ligament at the atresia end and resect the diverticulum at the same time. It has a good early prognosis and may eliminate the residual symptoms and late complications.
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Objective:To investigate the morphological characteristics and operative methods of mixed total anomalous pulmonary venous connection (TAPVC), and to analyze the risk factors of postoperative death.Methods:From January 2011 to January 2019, 17 cases of mixed TAPVC were operated in Department of Cardiovascular Surgery, Beijing Children′s Hospital, Capital Medical University, with 10 males and 7 females.The average age was (4.4±3.8) months (1-15 months) and the average body mass was (5.6±1.7) kg (3.5-10.0 kg), including 1 case of ventricular septal defect, 17 cases of atrial septal defect and 15 cases of ductus arteriosus.Preoperative pulmonary vein stenosis was discovered in 4 cases and severe pulmonary hypertension was in 10 cases.A total of 5 cases needed ventilator support before operation, and 2 cases needed emergency operation.The diagnosis was confirmed by color Doppler ultrasound and CT before operation.There were 2 cases of type Ⅰ (type 2+ 2), 13 cases of type Ⅱ (type 3+ 1), and 2 cases of type Ⅲ (anatomic variant).Results:All the patients were treated through operation.The principle of operation was to correct all pulmonary veins to the left atrium.The cardiopulmonary bypass time was (182.3±122.8) min, the aortic occlusion time was (84.3±15.9) min, the postoperative ventilator support time was (92.9±70.0) h, and the monitoring room time was (6.9±4.9) d. In this group, 3 cases died in hospital (17.6%) and 1 case died out of hospital (5.9%).Conclusions:The mortality of mixed TAPVC type Ⅲ was high, while preoperative pulmonary vein stenosis, severe pulmonary hypertension and the combination of sub-cardiac type were the important risk factors of death.The operation mode depends on the anatomic drainage mode, so individualized operation is recommended.
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Objective To investigate the diagnosis, surgical treatment and surgical results of infantile left subclavian ar-tery combined with Kommerell diverticulum.Methods In our hospital from 2014 to 2017, there were 15 cases of left subclavi-an artery combined with Kommerell diverticulum, 10 males and 5 females, average age 11.8 months(2 to 48 months), average weight of 9.2kg(4 -24 kg), including 3 cases with ventricular septal defect ( VSD), and 1 cases of coarctation of aorta (COA).Children with postoperative respiratory difficulty, recurrent respiratory infection, chronic cough and other respiratory symptoms, preoperative detection of airway and or esophagus compression performance after cardiac computed tomography ex-amination confirmed, general anesthesia, thoracotomy or left chest lateral thoracotomy, cut off arterial ligaments and Kommerell diverticulum Resection and vagal left subclavian artery transplantation were performed in the left common carotid artery com-bined with cardiac malformation.Results All the children were cured and discharged from hospital.The follow-up and mid-term recovery were good.Conclusion Infants with airway and esophageal compression may have aberrant left subclavian artery combined with Kommerell diverticulum , cardiac CT is an effective means to diagnose this disease .Removal of the associated Kommerell diverticulum and transferring the left subclavian artery to the left common carotid artery , as the main operative meth-od has good early prognosis,and may eliminate residual symptoms and late complications .
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Objective: To explore the effects of peritoneal dialysis on acute renal insufifciency and on relevant blood indicators in children with congenital heart disease (CHD) after the operation. Methods: A total of 48 CHD patients received direct open heart surgery by cardiopulmonary bypass and suffered from post-operative acute renal insufifciency in our hospital from 2011-12 to 2014-12 were retrospectively analyzed. The patients were divided into 2 groups: Peritoneal dialysis group and Routine medication group,n=24 in each group. The differences of renal function indexes, the blood levels of electrolyte and inlfammatory factors were compared between 2 groups. Results: Compared with Routine medication group, the patients in Peritoneal dialysis group presented decreased serum critinine, BUN and urine β2-micro globulin, 24-hour protein level,P Conclusion: Peritoneal dialysis may improve the renal function in CHD patients with post-operative acute renal insufifciency and optimize the blood levels of electrolyte and inlfammatory factors.
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Objective To approach the efficacy of magnesium sulfate(MgSO4 )supplemantation to prevent junctional ectopic tachycardia(JET)during the early postoperative period in infant patients after sur-gery for congenital heart disease.Methods A total of 325 infant patients undergoing cardiac surgery with cardiopulmonary bypass were randomly divided into two groups:the trial group (n =162,50 mg /kg 25%MgSO4 )and the placebo group(n =163,normal saline).The serum magnesium concentrations were meas-ured at five time points.Continuous electrocardiographic documentation by Holter monitor was performed for 24 hours after cardiac sugery.Results At T3 time point(1 hour after 50 mg /kg 25% magnesium sulfate and equivalent saline applied in intravenous infusion),the concentration of serum magnesium in trial group was higher than that of the placebo group[(1.79 ±0.33)mmol /L vs.(0.92 ±0.18)mmol /L],and the differ-ence between two groups was significant(P =0.001 ).At T4 and T5 time points(after magnesium sulfate and equivalent saline applied 12 and 24 hours respectively),the concentrations of serum magnesium in trial group were throughout higher than those of the placebo group [T4:(1.24 ±0.2)mmol /L vs.(0.83 ±0.17 ) mmol /L;T5:(1.20 ±0.16)vs.(0.80 ±0.19)mmol /L,P =0.024,P =0.035,respectively].The overall incidence of JET was 5.2%(17 /325),the placebo group had a significantly greater occurrence of JET than that of the trial group,the difference was significant between two groups [9.2%(15 /163 )vs.1.2%(2 /162),P =0.013 ].The onset time of JET in placebo group was earlier than that of the trial group (P =0.019).A total of 14 of 17 cases(82.4%)with JET had hypomagnesaemia,the cases with JET had a signif-icant longer period of mechanical ventilation and CICU stay.Conclusion Positively supplementation with magnesium sulfate during the early postoperative period in infant patients after surgery for congenital heart diseaae could reduce the incidence of JET.Hypomagnesaemia is related to JET.