ABSTRACT
OBJECTIVE: Ischemic postconditioning effectively minimizes the ischemic/reperfusion injury, and the large series of case reports on its protective effects in cardiac surgery are limited. A randomized trial was conducted to investigate the effect of ischemic postconditioning on cardiopulmonary protection in children undergoing cardiac surgery for tetralogy of Fallot. METHODS: One hundred and five-children with tetralogy of Fallot undergoing surgery were randomly assigned to control (n=58) and ischemic postconditioning groups (n=47). Ischemic postconditioning was performed by intermittent aortic clamping after reperfusion. After surgery, the duration of intensive care unit (ICU) stay, capacity of blood transfusion, hemodynamics, inotropic scores, respiratory function, and release of blood lactate were assayed. RESULTS: There was a significant decrease in the ICU stay in the postconditioned group compared with the control group (37+/-21 hrs vs 54+/-26 hrs; P<0.05 ). The capacity of blood transfusion (308+/-230 mL vs 526+/-515 mL; P<0.05) and the inotropic scores (5.9+/-5.0 vs 10.3+/-7.7; P<0.05) in the postconditioned group were significantly reduced compared with those in the control group. Blood lactate contents in the postconditioned group was significantly lower that those in the control group 1, 3, 6, 9, 12 and 20 hrs after surgery. The postconditioned group showed more improved hemodynamics and respiratory function than the control group. CONCLUSIONS: Ischemic postconditioning may provide clinical benefits with respects to myocardial and pulmonary protections in children undergoing repair for tetralogy of Fallot.
Subject(s)
Cardiac Surgical Procedures/methods , Myocardial Reperfusion Injury/prevention & control , Tetralogy of Fallot/surgery , Adolescent , Cardiopulmonary Bypass , Child , Child, Preschool , Female , Hemodynamics , Humans , Infant , Lactic Acid/metabolism , Male , Postoperative Complications/prevention & control , Respiration , Tetralogy of Fallot/physiopathologyABSTRACT
We describe a simple and cost-effective technique to repair anomalous origin of the right coronary artery from the left coronary artery in tetralogy of Fallot. The proximal right coronary artery is re-implanted into the aorta after it is mobilized and transected. This technique avoids the use of conduits in infants or adults with tetralogy of Fallot and anomalous right coronary arteries, and maintains the growth potential of the translocated native coronary artery.
Subject(s)
Cardiac Surgical Procedures , Coronary Vessel Anomalies/surgery , Coronary Vessels/surgery , Tetralogy of Fallot/surgery , Adult , Anastomosis, Surgical , Aorta/surgery , Cardiopulmonary Bypass , Child, Preschool , Coronary Vessel Anomalies/complications , Coronary Vessels/pathology , Female , Humans , Male , Patient Selection , Replantation , Tetralogy of Fallot/complications , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the surgical point and technique of artificial mechanical valve replacement in children with heart valve diseases. METHODS: From Jan. 1989 to Oct. 2005, 63 children under 15 years received mechanical cardiac valve replacement with cardiopulmonary bypass (CPB). RESULTS: The valve replacement included aortic valve replacement in 20 children, mitral valve replacement in 37 children and combined aortic valve and mitral valve replacement in 6 children. CONCLUSION: The operation mortality was 7.94%(5/63). The follow-up periods were from 4 months to 204 months. The late mortality was 10.34%(6/58). All the other children were in NYHA class I - II. The operation mortality of children with heart valve replacement is higher than that of adults, but it was very effective.
Subject(s)
Aortic Valve/surgery , Cardiopulmonary Bypass , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Mitral Valve/surgery , Adolescent , Child , Female , Follow-Up Studies , Humans , Male , Treatment OutcomeABSTRACT
OBJECTIVE: This study is to evaluate the effects of aminophylline on systemic inflammatory response after cardiopulmonary bypass in patients undergoing valve replacement. METHODS: Thirty patients undergoing elective valve replacement were randomized to receive either aminophylline treatment (aminophylline, n = 15) or no aminophylline (control, n = 15). Administration of aminophylline (5 mg/kg) was injected intravenously after induction of anesthesia and maintained with 0.5 mg/kg per h until the end of cardiopulmonary bypass. Perioperative cytokines (interleukin-8 and interleukin-10, tumor necrosis factor-alpha) and respiratory function, blood neutrophil count ratio of right atrium to that of left atrium, plasma malondialdehyde were measured during the experiment. RESULTS: Interleukin-8 and tumor necrosis factor-alpha levels after cardiopulmonary bypass were significantly lower in the aminophylline group than that in the control group (P < 0.05, for each group), and interleukin-10 level in aminophylline group was significantly higher than in control (P = 0.001). The respiratory index was greater in the control than in aminophylline group (P < 0.05). Neutrophil count ratio of right atrium blood to left atrium blood and plasma malondialdehyde level in aminophylline group were much lower (P = 0.02 and 0.001, respectively) than in the control 30 min after aortic declamping. Compared with control group, the duration of ventilation and intensive care unit stays were shorter in aminophylline group (P = 0.032 and 0.013, respectively). CONCLUSIONS: Intraoperative administration of aminophylline had anti-inflammatory effect and improved pulmonary oxygenation in patients undergoing valve replacement.
