Research progress on origin of abnormal aorta in coronary artery / 中华胸心血管外科杂志

Anomalous aortic origin of the coronary artery(AAOCA) refers to the abnormal initiation, route, or distribution of coronary arteries, which is generally believed to be caused by abnormal or incomplete development of embryonic coronary arteries, and is a rare congenital cardiovascular malformation. It can exist independently without other congenital heart disease. With the development of medical science and people's understanding of AAOCA, more and more AAOCA has been detected, and its clinical significance has attracted more and more attention. Based on abnormal coronary artery opening, malignant or potential contorts can cause long-term blood flow dynamic change, appear abnormal blood vessel hardening of the arteries, at the same time due to walk in the pulmonary artery and the ascending aorta between two vessels, vulnerable to the extrusion of large blood vessels, which caused a temporary blood flow in coronary artery interruption, can cause acute angina pectoris, myocardial infarction, arrhythmia, exercise-induced cardiac syncope. This review focuses on the anatomy, diagnosis and treatment of coronary artery abnormalities arising from aorta.

Reduction in the duration of postoperative fever following NUSS surgery during the COVID-19 pandemic.

BACKGROUND: Our study aimed to compare the prevalence of postoperative fever during the COVID-19 pandemic period with that of the preceding non-pandemic period. METHODS: A retrospective analysis was conducted on patients with pectus excavatum (PE) undergoing minimally invasive repair (also called NUSS procedure) at Nanjing Children's Hospital from January 1, 2017 to March 1, 2019 (Group 2019), and from January 1, 2020 to March 1, 2021 (Group 2021). Data from a total of 284 patients, consisting of 200 (70.4%) males and 84 (29.6%) females with an average age of 9.73 ± 3.41 (range, 4 to 17) years, were collected. The presence of post-operative fever (defined as a forehead temperature of 37.5℃ or above within 72 h post-surgery), as well as the time of operation, duration of postoperative mechanical ventilator and urinary catheter use, and length of hospitalization were all assessed in admitted patients from Group 2019 (n = 144) and Group 2021 (n = 140). Postoperative white blood cell (WBC), C-reactive protein (CRP) levels, and prevalence of postoperative complications (i.e., pneumothorax, pulmonary atelectasis, pneumonia, wound infection, and dehiscence) were also determined. RESULT: Our results showed a statistically significant decrease in the incidence of postoperative fever within 24 to 72 h of surgery in patients admitted from Group 2019 as compared to Group 2021 (p < 0.001), as well as a decrease in peak body temperature within 72 h (p < 0.05). Meanwhile, no significant differences were observed in age and body mass index (BMI), time of operation, or duration of postoperative mechanical ventilator and urinary catheter use between the two groups (p > 0.05). The average hospitalization length of Group 2021 was significantly shorter than Group 2019 (12.49 ± 2.57 vs. 11.85 ± 2.19 days, p < 0.05). Furthermore, while the WBC count between the two groups 24 h after surgery showed a statistical difference (p < 0.05), no differences in CRP levels or the incidence of postoperative complications were observed (p > 0.05). CONCLUSION: The prevalence of postoperative fever within 72 h of surgery and the length of hospital stay for patients with PE undergoing NUSS surgery were both decreased in Group 2021. We propose that the above phenomenon may be related to increased used of personal protection equipment (such as surgical masks and filtering facepiece respirators (FFRs)) by physicians, nurses, and the patients themselves.

Bioinformatic analysis identifies GPR91 as a potential key gene in brain injury after deep hypothermic low flow.

Purpose: Explore the transcription change of brain ischemia and reperfusion injury after deep hypothermic low flow. Method: The data from PRJNA739516 and GSE104036 were obtained for the differentially expressed genes identification, functional enrichment analysis, gene set enrichment analysis, protein-protein interaction construction and hub gene identification. Oxygen and glucose deprivation model was set to validate the hub gene and explore the detailed brain injury mechanism. Result: Interleukin, immunological response, NF-κB signaling pathway, G protein-coupled receptor signaling pathway and NLRP inflammatory are functional pathway were enriched in differentially expressed genes analysis. Sucnr1, Casr, Cxcr4, C5ar1, Tas2r41, Tas2r60 and Hcar2 were identified and verified in the OGD model. Knocking down GPR91 reduces the inflammatory response after OGD and GPR91 may be involved in the inflammatory pre-reaction through the synergistic activation of NF-κB, NLRP3, and IL-1ß respectively. Conclusion: Our study found that Interleukin, immunological response, NF-κB signaling pathway, G protein-coupled receptor signaling pathway and NLRP inflammatory are all associated with brain ischemia and reperfusion injury after deep hypothermic low flow and GPR91 can activate NF-κB/NLRP3 pathway and trigger the release of IL-1ß in this progress.

The potential value of cuprotosis in myocardial immune infiltration that occurs in pediatric congenital heart disease in response to surgery with cardiopulmonary bypass.

BACKGROUND: Cardiopulmonary bypass may cause malfunction in the myocardium. Cuproptosis is a novel cell death aggregating mitochondrial proteins. However, the research on cardiopulmonary bypass-caused heart tissue injury in immune infiltration and cuproptosis is limited. METHOD: Immune infiltration, enrichment analysis, protein-protein interaction network, and medication prediction are applied to reanalysis differentially expressed genes and cuproptosis-related genes in gene expression omnibus data set GSE132176. RESULTS: Seven cuproptosis related genes (PDHA1, LIPT1, LIAS, DLST, DLD, DLAT, and DBT) and dendritic cells and Th1 cells are involved in heart tissue injury in response to surgery with cardiopulmonary bypass. CONCLUSIONS: Immune infiltration and cuproptosis are potential mechanisms by which cardiopulmonary bypass surgery may cause damage to heart tissue, which may be a new therapeutic target.

Feasibility of measuring pulmonary venous blood flow spectrum by transesophageal ultrasound in evaluating intraoperative left atrial pressure in pediatric patients with complex congenital heart disease / 中华麻醉学杂志

Objective:To evaluate the feasibility of measuring pulmonary venous blood flow spectrum by transesophageal ultrasound in assessing intraoperative left atrial pressure (LAP) in pediatric patients with complex congenital heart disease.Methods:Twenty-five pediatric patients with complex congenital heart disease of either sex, aged < 3 yr, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ, with New York Heart Association class Ⅲ or Ⅳ, undergoing surgery with general anesthesia and requiring LAP monitoring during surgery, were selected.Transesophageal echocardiography was used to record the left pulmonary venous blood flow spectrum during surgery.S wave velocity (PV S), D wave velocity (PV D), AR wave velocity (PV AR), and deceleration time of pulmonary venous diastolic flow (DT D) were measured at 15 min after termination of CPB.The ratio of S wave peak velocity to D wave peak velocity (S/D ratio) was calculated.Measurement was carried out for 3 consecutive cardiac cycles, and the average value was calculated.The LAP was simultaneously measured through the left atrial piezometer.Pearson correlation analysis was performed between PV S, PV D, PV AR, DT D, S/D ratio and LAP. Results:PV S, PV D, PV AR and S/D ratio had no correlation with LAP ( r=-0.06, 0.21, 0.19, -0.38, respectively, P>0.05), while DT D was negatively correlated with LAP ( r=-0.84, P<0.05). Conclusions:DT D measured by transesophageal ultrasound can be used to evaluate intraoperative LAP in pediatric patients with complex congenital heart disease.

Sex differences in the link between blood cobalt concentrations and insulin resistance in adults without diabetes

BACKGROUND@#Little is known about the effects of environmental cobalt exposure on insulin resistance (IR) in the general adult population. We investigated the association between cobalt concentration and IR.@*METHODS@#A total of 1281 subjects aged more than 20 years with complete blood cobalt data were identified from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 cycle. Blood cobalt levels were analyzed for their association with IR among all populations and subgroups by sex. Regression coefficients and 95% confidence intervals (CIs) of blood cobalt concentrations in association with fasting glucose, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) were estimated using multivariate linear regression after adjusting for age, sex, ethnicity, alcohol consumption, body mass index, education level, and household income. A multivariate generalized linear regression analysis was further carried out to explore the association between cobalt exposure and IR.@*RESULTS@#A negative association between blood cobalt concentration (coefficient = - 0.125, 95% CI - 0.234, - 0.015; P = 0.026) and HOMA-IR in female adults in the age- and sex-adjusted model was observed. However, no associations with HOMA-IR, fasting glucose, or insulin were found in the overall population. In the generalized linear models, participants with the lowest cobalt levels had a 2.74% (95% CI 0.04%, 5.50%) increase in HOMA-IR (P for trend = 0.031) compared with subjects with the highest cobalt levels. Restricted cubic spline regression suggested that a non-linear relationship may exist between blood cobalt and HOMA-IR.@*CONCLUSIONS@#These results provide epidemiological evidence that low levels of blood cobalt are negatively associated with HOMA-IR in female adults.

The follow-up study of mitral insufficiency valvuloplasty in children / 中华胸心血管外科杂志

Objective:To analyze the early and middle term clinical effects of mitral valve repair in children with mitral insufficiency.Methods:From January 2012 to January 2019, a total of 202 cases of children with mitral insufficiency treated by mitral valve repair were selected from the department of cardiothoracic surgery of Nanjing Children's Hospital, patients with atrioventricular septal defect, single ventricle and ischemic mitral regurgitation were excluded. Echocardiography was used to compare the preoperative and postoperative left ventricular function and degree of regurgitation in children to evaluate the early and middle term efficacy of mitral valvuloplasty.Results:There were 5 cases of early death(5/202, 2.5%) and 3 cases of late death(3/202, 1.5%). The mean follow-up time was(19.49±17.48) months(1-68 months). Postoperative echocardiography showed that the left heart function and mitral regurgitation were significantly improved.Conclusion:Mitral valvuloplasty can significantly correct mitral insufficiency in children, and it has satisfactory mid-term efficacy and good clinical value.

Surgical treatment of tracheal stenosis in children / 中华胸心血管外科杂志

Objective:To investigate the common types, surgical treatment and effects of tracheal stenosis in children.Methods:A total of 23 children with tracheal stenosis in our hospital from December 2017 to August 2020 were retrospectively reviewed, including 14 males and 9 females. The mean age at operation was(8.9±5.8)months(range: 2-3 months) and the mean weight was(6.4±2.3)kg(range: 4.2-10.5 kg). The common types of tracheal stenosis were complete tracheal ring in 9 children, tracheomalacia in 10 and subglottic membranous annular hyperplasia in 4. The type of congenital heart diseases included 10 patients of pulmonary artery sling, 1 of tetralogy of Fallot, 5 of ventricular septal defect, 1 of pulmonary atresia, and 1 of right aortic arch with aberrant left subclavian artery. Slide tracheoplasty was performed in 9 patients, external splint in 8, endotracheal stent in 2 and tracheal dilation in 4. All children were followed up after 1, 3, 6, and 12 months of operation with CT and bronchoscopy.Results:There was 1 death in all 23 patients and the mortality was 4.3%, which died of granulation tissue hyperplasia after slide tracheoplasty. Reoperation was performed in 1 patient with endotracheal stent. All patients were followed for 1 to 24 months. Clinical symptoms of tracheal stenosis disappeared and the results of CT and bronchoscopy were satisfied.Conclusion:Slide tracheoplasty is the effective surgical method for complete trachea ring. 3D printing bioresorbable external splint is a promising method for the treatment of tracheomalacia.

Chinese expert consensus on surgical treatment of congenital heart disease (13): Congenital mitral valve malformation / 中国胸心血管外科临床杂志

@#To investigate the anatomical classification, diagnosis, indications, surgical methods, surgical techniques, intraoperative management, postoperative management and surgical efficacy of mitral valve malformation. Using the internationally used Delphi procedure, PubMed, Medline, The Cochrane Library, Wanfang and other databases were searched to review domestic and foreign literatures on congenital mitral valve deformity from January 1940 to February 2020, and select the ones of higher quality as evidence. In addition, with regard to the multiple disputes in the diagnosis and treatment of congenital mitral valve, experts from pediatric cardiac surgery and related disciplines have been convened for discussion for many times, and finally the following consensus has been formed to guide the clinical treatment and provide theoretical and technical guidance for the surgical treatment of congenital mitral valve malformation in China.

Application of thoracoscopic surgery in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula in neonates / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To compare the efficacy of thoracoscopic surgery versus thoracotomy in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula (EA/TEF) in neonates.</p><p><b>METHODS</b>A retrospective analysis was conducted in 97 neonates who underwent EA/TEF repair between January 2012 and December 2017 in the Affiliated Children's Hospital of Nanjing Medical University, including 75 patients receiving thoracotomy and 22 patients receiving thoracoscopic surgery. The perioperative data and the incidence of early postoperative complications were compared between two groups.</p><p><b>RESULTS</b>The operations were completed in all patients. One child (4.5%) in thoracoscopic surgery group was converted to thoracotomy with modified Livaditis procedure due to the long distance of two blind ends (>4 cm) and thinner distal end. The operation time was longer in thoracoscopic surgery group[(143±48) min vs. (120±40) min, <0.05], but the postoperative ventilation time was shorter[(55±22) h vs. (65±19) h, <0.05] and the first oral feeding was earlier in thoracoscopic surgery group[(3.2±1.1) d vs (3.9±1.3) d, <0.05]. No statistical difference was observed in the ratio of red blood cell transfusion, length of hospital stay and drainage tube indwelling time between two groups (all >0.05). The incidence of lung complications in thoracotomy group was higher than that in thoracoscopic surgery group (20.0% vs. 9.1%, <0.01), while there were no significant differences in the incidence of other postoperative complications between two groups. There was no death in thoracoscopic surgery group, while 2 patients died in thoracotomy group.</p><p><b>CONCLUSIONS</b>Thoracoscopic repair is a preferred surgical procedure for EA/TEF in neonates.</p>

Research progress on transcription factors and signal pathways involved in congenital esophageal atresia / 浙江大学学报·医学版

Congenital esophageal atresia is one of the serious birth defects. Identifying the etiology and mechanism of esophageal development can provide clues for the effective prevention and treatment of congenital esophageal atresia. Recent studies have shown that a variety of transcription factors and signaling pathways (including Wnt signaling pathway, bone morphogenetic protein signaling pathway, SHH signaling pathway, vascular endothelial growth factor signaling pathway) are involved in esophageal proliferation, differentiation and other processes, promoting the normal development of esophagus. Understanding the regulatory mechanisms during the normal development of esophagus can give reference for the prevention and treatment of congenital esophageal atresia. This article reviews the research progress on related transcription factors and signaling pathways in esophageal development.

Advances in surgical diagnosis and treatment of mitral valve prolapse in children / 中华实用儿科临床杂志

Mitral valve prolapse is a disease which causes mitral regurgitation,which is one of the common causes of mitral insufficiency.With the aggravation of blood reflux,mitral valve prolapse will eventually lead to pulmo-nary hypertension,heart failure and even death in children.The main diagnostic methods include chest X－ray,echocar-diography,spiral CT and magnetic resonance imaging.Mitral valvuloplasty is the main surgical method for mitral valve prolapse in children.It includes valvuloplasty,annuloplasty,tendon chordoplasty,edge－to－edge mitral valve repair, and so on.Now,the progress in surgical diagnosis and treatment of mitral valve prolapse in children were reviewed in or-der to provide a meaningful reference for its individual treatment.

Progress in surgical treatment of parachute mitral valve / 中华实用儿科临床杂志

The parachute mitral valve is a rare group of heart valve diseases that are typically characterized by only one papillary muscle.All the chordae tendineaes are connected to the papillary muscle and shaped like a para-chute.It mainly causes mitral stenosis and occasionally leads to mitral regurgitation. Due to the early appearance of clinical symptoms and rapid development of the disease,early accurate diagnosis and surgical treatment are needed. Common surgical treatments are mitral valve repair and mitral valve replacement.Now,the progress of surgical treatment of ＂parachute－like＂ mitral valve malformation was reviewed in order to provide a meaningful reference for its surgical treatment.

Surgical treatment and follow up for pediatric patients with primary cardiac tumors / 中华胸心血管外科杂志

Objective To summarize the experience in surgical treatment of primary cardiac tumors in children .Meth-ods Retrospective analysis of 13 children with primary cardiac tumors which were surgically treated in our department from June 1994 to March 2016.Among the 13 patients, 8 were boys and 5 were girls.The mean and standard deviation(range) of age was(4.85 ±4.61) years(5 days -13 years).The diagnosis was identified by echocardiography and computed tomography before operation and by pathological diagnosis after operation .All patients were followed up after discharge .Results A num-ber of 13 patients underwent surgical treatment.One patient died from cardiac failure after surgery.Histologic examination re-vealed rhabdomyoma in 8 patients, myxoma in 2 patients, fibroma in 2 patients, and rhabdomyosarcoma in 1 patient.All the remaining 12 patients followed up for(85.71 ±17.04) months(3-247 months), one patient with benign tumor was relapsed without tumor-related symptoms, the other patient with malignant tumor was relapsed and died from abandoning treatment .Oth-ers had good cardiac function and symptom improvement .Conclusion Primary cardiac tumors in children are mostly primarily benign.Tumors with different characteristics get different clinical symptoms and prognosis .Personalized therapy strategies need to be performed to achieve better outcomes .

Percutaneous punctured transcatheter device closure of ventricular septal defect / 中华胸心血管外科杂志

Objective To explore the feasibility of percutaneous puncture for ventricular septal defect(VSD).Methods From March 2015,we did percutaneous punctured transcatheter device closure of VSD for 22 patients.The patients included 15 males and 7 females with age from 2 years 6 months to 11 years 7 months, weight from 13.5 kg to 44.0 kg.Among 22 pa-tients,6 were diagnosed with residual shunt after VSD repair, with size of residual shunt from 4.8 mm to 7.0 mm.Residual shunts are perimembranous, conoventricular and intracristal.The other 16 patients were diagnosed with isolated VSD,with de-fect size from 3.5 to 5.1 mm.For all patients,we punctured directly through the right ventricular surface into the right ventri-cle in the 3th or 4th intercostal space of the left sternal border.Next, we succeeded to extract the guide wire after inserting a conveyor tube for 21 patients.Subsequently,7-10 mm VSD closure device were delivered via the conveyor tube.Only one patient was changed to perform occlusion of VSD through chest small incision due to improper selection of punctured position. Results A total of 21 closure devices were placed for 21 patients.18 of them are equilateral device,and 3 are decentered de-vice,with size from 5 mm to 10 mm.There were small amount of pericardial effusion in 4 patients using TEE examination,and no future treat was performed after observation.For one-year follow-up, all patients have recovered very well.Conclusion Percutaneous punctured transcatheter device closure fits for treatment for children with residual shunt after VSD repair and isola-ted VSD.It has a good recent result.

The feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect repair / 中华胸心血管外科杂志

Objective To explore the feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect(VSD) repair.Methods From March 2015,we did percutaneous punctured transcatheter device closure of residual shunt after VSD repair for four patients.The patients included 2 males and 2 females with age from 4 years 9 months to 11 years 7 months and weight from 18 kg to44 kg.Four patients are diagnosed for4 years after VSD repair,3 years after tetralogy of Fallot (TOF),3 years after coarctation of aorta(CoA) combined with VSD,and 1 year after VSD repair,respectively.The withsize of residual shunt from 4.8 mm to 6.8 mm.Residual shunt are perimembranous,conoventricular and intracristal.Punctured directly through the right ventricular surface into the right ventricle in the 4-th or 5th intercostal space of the left sternal border.Next,extracted the guide wire after inserting a conveyor tube.Subsequently,7-10 mm VSD closure device were delivered via the conveyor tube.Results All the four operations were succeeded.A total of four closure devices were placed.Two of them are equilateral devices,and two are decentered devices,with size from 7mm to 9mm.Echocardiographyexamination revealed no significant pericardial effusion.Post-operative ultrasonic cardiogram showed the VSD closure device on site,with no pericardia1 effusion and no obvious morphological abnormalities of the valve.For one-year follow-up,the cardiac functionsof all patients were well.Conclusion Percutaneous punctured transcatheter device closure is a new,efficient and reliable method of treatment for children withresidual shunt after VSD repair.This method also can extend and offer a new avenue for valvular prosthesis and Perimembranous VSD.

The follow-up study of edge to edge mitral repair in children / 中华胸心血管外科杂志

Objective To analyze the operation of long-term effect of edge to edge mitral repair for mitral vavle moderateto-severe insufficiency in children retrospectively.Methods Clinical dates of 102 patients who underwent edge to edge mitrel valve repair in Nanjing Children's Hospital from March 2003 to March 2015 were collected.Postoperative thoracic echocardiography was adopted to observe the effect of mitral valve forming and evaluate the follow-up results.Results The whole group of 2 patients died in hospital,Followed up for 1 months to 12 years,during the follow-up of 10 patients were lost.The early fol low-up,medium-term follow-up and long-term follow-up were completed 93,55 and 26 cases,respectively.In the early followup,6 patients had recurrent moderate mitral regurgitation(MR),and 5 patients had recurrent moderate-to-severe MR and reoperated during the follow-up period,a total of 2 cases died.In the medium-term follow up,moderate and severe MR were found in 6 and 4 cases,respectively.Three patients accepted reoperation,two patients died.In the long-term follow-up,1 case had recurrent severe MR,2 cases had re-operation and had no death.Early survival rate was 97.8 ％ (91/93),avoid reoperation rate was 94.6％ (88/93).The incidence of moderate or severe mitral regurgitation was 11.8％ (11/93).Midtcrm survival rate was 96.4％ (53/55),avoid reoperation rate was 94.6％ (52/55),moderate or severe mitral regurgitation rate was 18.2％ (10/55).Long-term follow-up have no death,avoid reoperation rate was 92.3 ％ (24/26),mitral valve moderate and above reflux rate was 7.7 ％ (2/26).The actuarial survival and freedom from MV reoperation rate was (92.4 ± 2.4) ％ and (77.7 ± 6.4) ％ at 10 years,respectively.Conclusion Edge to edge mitral repair in the treatment of children with moderate to severe mitral insufficiency had relatively stable curative effect,relatively fewer complications,and high long-term clinical effect.

The feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect repair / 中华胸心血管外科杂志

Objective To explore the feasibility of hybrid procedure of percutaneous puncture for residual shunt after ventricular septal defect(VSD) repair.Methods From March 2015,we did percutaneous punctured transcatheter device closure of residual shunt after VSD repair for four patients.The patients included 2 males and 2 females with age from 4 years 9 months to 11 years 7 months and weight from 18 kg to44 kg.Four patients are diagnosed for4 years after VSD repair,3 years after tetralogy of Fallot (TOF),3 years after coarctation of aorta(CoA) combined with VSD,and 1 year after VSD repair,respectively.The withsize of residual shunt from 4.8 mm to 6.8 mm.Residual shunt are perimembranous,conoventricular and intracristal.Punctured directly through the right ventricular surface into the right ventricle in the 4-th or 5th intercostal space of the left sternal border.Next,extracted the guide wire after inserting a conveyor tube.Subsequently,7-10 mm VSD closure device were delivered via the conveyor tube.Results All the four operations were succeeded.A total of four closure devices were placed.Two of them are equilateral devices,and two are decentered devices,with size from 7mm to 9mm.Echocardiographyexamination revealed no significant pericardial effusion.Post-operative ultrasonic cardiogram showed the VSD closure device on site,with no pericardia1 effusion and no obvious morphological abnormalities of the valve.For one-year follow-up,the cardiac functionsof all patients were well.Conclusion Percutaneous punctured transcatheter device closure is a new,efficient and reliable method of treatment for children withresidual shunt after VSD repair.This method also can extend and offer a new avenue for valvular prosthesis and Perimembranous VSD.

The follow-up study of edge to edge mitral repair in children / 中华胸心血管外科杂志

Objective To analyze the operation of long-term effect of edge to edge mitral repair for mitral vavle moderateto-severe insufficiency in children retrospectively.Methods Clinical dates of 102 patients who underwent edge to edge mitrel valve repair in Nanjing Children's Hospital from March 2003 to March 2015 were collected.Postoperative thoracic echocardiography was adopted to observe the effect of mitral valve forming and evaluate the follow-up results.Results The whole group of 2 patients died in hospital,Followed up for 1 months to 12 years,during the follow-up of 10 patients were lost.The early fol low-up,medium-term follow-up and long-term follow-up were completed 93,55 and 26 cases,respectively.In the early followup,6 patients had recurrent moderate mitral regurgitation(MR),and 5 patients had recurrent moderate-to-severe MR and reoperated during the follow-up period,a total of 2 cases died.In the medium-term follow up,moderate and severe MR were found in 6 and 4 cases,respectively.Three patients accepted reoperation,two patients died.In the long-term follow-up,1 case had recurrent severe MR,2 cases had re-operation and had no death.Early survival rate was 97.8 ％ (91/93),avoid reoperation rate was 94.6％ (88/93).The incidence of moderate or severe mitral regurgitation was 11.8％ (11/93).Midtcrm survival rate was 96.4％ (53/55),avoid reoperation rate was 94.6％ (52/55),moderate or severe mitral regurgitation rate was 18.2％ (10/55).Long-term follow-up have no death,avoid reoperation rate was 92.3 ％ (24/26),mitral valve moderate and above reflux rate was 7.7 ％ (2/26).The actuarial survival and freedom from MV reoperation rate was (92.4 ± 2.4) ％ and (77.7 ± 6.4) ％ at 10 years,respectively.Conclusion Edge to edge mitral repair in the treatment of children with moderate to severe mitral insufficiency had relatively stable curative effect,relatively fewer complications,and high long-term clinical effect.

Early enteral nutritional support on nutrition assessments and clinical outcomes of congenital heart disease postoperation / 中华胸心血管外科杂志

Objective To investigate the effect and feasibility of early enteral nutrition support on postoperative nutrition assessments and clinical outcomes in children patients with congenital heart disease. Methods From October 2013 to October 2014, a number of 100 cases congenital heart disease aged six months to two years old were treated with early enteral nutrition support after operation. According to gender, fifty patients were randomly divided into the intervened group, who were treated with the early enteral nutrition support program. The other fifty patients were divided into control group with no nutrition sup-port. The detailed early enteral nutrition support project were( a) withdraw breathing machine at the same day, giving enteral nutrition 6 hours later after postoperation;( b) patients assist with long-term breathing machine, giving enteral nutrition 12-24 hours later after postoperation. The age, heigth, weight, serum C- reactive protein(CRP), serum retinoic binding protein ( RBP) , serum prealbumin( Pre-ALB) were recorded before operation. Seven days after operation, above indicators were ob-served again. In addition, the first time of excrete, the number of feeding interruption, the time of feeding, the time of ventila-tor, and the related complications were also recorded at hospitalization period. Results No difference of basic information and accompanying complications were observed between control and nutritional intervention group. As to nutritional status, weight-for-age z-score(WAZ) were significant higher in the nutritional intervention group than the control group( -0. 22 ± 1. 16 vs. 0.73 ±1.29, P=0.019) after operation. However length/height-for-age z-score(LAZ/HAZ) and weight-for-length/height z-score( WLZ/WHZ) were similar between control and nutritional intervention group whatever pre-operation and postoperation. Preoperative CRP, RBP, and Pre-ALB were no significant difference between early enteral nutrition and control group. After operation CRP levels in the early enteral nutrition group were significantly lower than that of control group[(45.2 ±16.2)mg/L vs.(67.3±35.5)mg/L,P<0.001],whileRBP[(0.3±0.1)mg/Lvs.(0.2±0.1)mg/L]andPre-ALB[(35.2±12.2)g/Lvs.(25.2±14.2)g/L] weresignificantlyhigherthanthoseofcontrolgroup(Pvaluewere0.031and0.029,respective-ly) . In the early nutritional intervention group and control group, the first time of excrete were remarkable in advance in nutri-tionalinterventiongroupcompredtocontrolgroup[(36±12)hvs.(65±15)h,P=0.008],whilethedifferenceoffeeding interruption times, intensive care unit( ICU) time and mechanical ventilation time in the two groups were not statistically signif-icant(P>0. 05). Conclusion Early nutritional intervention can help gastrointestinal function, enhance nutritional status, lower serum CRP levels and increased serum RBP and Pre-ALB concentrations. It did not add ICU time and ventilation time.