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1.
Eur J Cardiothorac Surg ; 65(5)2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38588563

RESUMO

OBJECTIVES: The Haller index (HI) is widely utilized as a quantitative indicator to assess the extent of the pectus excavatum (PE) deformity, which is the most common chest wall abnormality in children. Both preoperative correction planning and postoperative follow-up need to be based on the standard of normal thoracic growth and development. However, there is currently no established reference range for the HI in children. Consequently, the goal of this study was to conduct a preliminary investigation of normal HI values among children to understand thoracic developmental characteristics. METHODS: Chest computed tomography images obtained from January 2012 to March 2022 were randomly selected from the imaging system of the Children's Hospital of Chongqing Medical University. We divided the images of children into a total of 19 groups: aged 0-3 months (1 group), 4-12 months (1 group) and 1 year to 17 years (17 groups), with 50 males and 50 females, totaling 100 children in each group. HI was measured in the plane where the lowest point of the anterior thoracic wall was located and statistically analysed using SPSS 26.0 software. RESULTS: A total of 1900 patients were included in the study. Our results showed that HI, transverse diameter and anterior-posterior diameter were positively correlated with age (P < 0.05). Using age as the independent variable and HI as the dependent variable, the best-fit regression equations were HI-male = 2.047 * Age0.054(R2 = 0.276, P<0.0001) and HI-female = 2.045 * Age0.067(R2 = 0.398, P<0.0001). Males had significantly larger thoracic diameters than females, and there was little difference in the HI between the 2 sexes. CONCLUSIONS: The HI rapidly increases during the neonatal period, slowly increases during infancy and stops increasing during puberty, with no significant differences between the sexes.


Assuntos
Tórax em Funil , Tomografia Computadorizada por Raios X , Humanos , Feminino , Masculino , Criança , Lactente , Tórax em Funil/cirurgia , Tórax em Funil/diagnóstico por imagem , Pré-Escolar , Adolescente , Valores de Referência , Recém-Nascido , Parede Torácica/diagnóstico por imagem , Parede Torácica/anatomia & histologia , Estudos Retrospectivos
2.
Pediatr Neurol ; 141: 109-117, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36812697

RESUMO

BACKGROUND: To investigate clinical manifestations and factors of perioperative brain injury (PBI) after surgical repair of coarctation of the aorta (CoA) combined with other heart malformations under cardiopulmonary bypass (CPB) in children under two years. METHODS: The clinical data of 100 children undergoing CoA repair were retrospectively reviewed between January 2010 and September 2021. Univariate and multivariate analyses were performed to identify factors of PBI development. Hierarchical and K-means cluster analyses were conducted to evaluate the association between hemodynamic instability and PBI. RESULTS: Eight children developed postoperative complications, and all of them had a favorable neurological outcome one year after surgery. Univariate analysis revealed eight risk factors associated with PBI. Multivariate analysis indicated operation duration (P = 0.04, odds ratio [OR], 2.93; 95% confidence interval [CI], 1.04 to 8.28) and pulse pressure (PP) minimum (P = 0.01; OR, 0.22; 95% CI, 0.06 to 0.76) were independently associated with PBI. The following three parameters emerged for cluster analysis: PP minimum, mean arterial pressure (MAP) dispersion, and systemic vascular resistance (SVR) average. Using cluster analysis, PBI mainly occurred in subgroups 1 (12%, three of 26) and 2 (10%, five of 48). The mean value of PP and MAP in subgroup 1 was significantly higher than in subgroup 2. The mean SVR in subgroup 1 was the highest. The lowest PP minimum, MAP, and SVR were observed in subgroup 2. CONCLUSION: Lower PP minimum and longer operation duration were independent risk factors for developing PBI in children under two years during CoA repair. Unstable hemodynamics should be avoided during CPB.


Assuntos
Coartação Aórtica , Lesões Encefálicas , Humanos , Criança , Lactente , Estudos Retrospectivos , Fatores de Risco , Ponte Cardiopulmonar/efeitos adversos , Análise por Conglomerados , Lesões Encefálicas/etiologia , Coartação Aórtica/cirurgia
3.
Zhongguo Zhong Xi Yi Jie He Za Zhi ; 31(5): 631-4, 2011 May.
Artigo em Chinês | MEDLINE | ID: mdl-21812263

RESUMO

OBJECTIVE: To study the intervention of astragalus injection in the kidney injury of infants with congenital heart disease after cardiopulmonary bypass, thus providing a new method for protection of the kidney injury in them. METHODS: Forty infants undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to the test group and the control group, twenty in each group. Astragalus Injection (at the dose of 2 mL/kg) was added in the perfusion fluid before giving to infants in the test group before bypass, while the normal saline of the same volume was added in the perfusion fluid before giving to infants in the control group (P < 0.01). The concentrations of serum tumor necrosis factor-alpha (TNF)-alpha, interleukin-6 (IL-6), cystatin C (CysC), and N-acetyl-beta-D-glucosaminidase (NAG) were detected with ELISA at the following time points, i.e., before bypass (T1), by the end of the surgery (T2), 2 h after surgery (T3), 6 h after surgery (T4), and 24 h after surgery (T5). RESULTS: The serum CysC concentrations were not significantly higher after CPB (P > 0.05). The urinary NAG level increased significantly in the control group after surgery (P < 0.05), but no obvious increase of the urinary NAG level was found in the test group after surgery (P > 0.05). It was obviously lower than that of the control group (P < 0.05). After CPB serum TNF-alpha and IL-6 levels increased significantly in the control group (P < 0.05), while they were lower in the test group than in the control group (P < 0.01). CONCLUSIONS: CPB may result in the renal tubular injury in infants with congenital heart disease. The application of Astragalus Injection before the CPB plays a role in protecting renal tubular functions.


Assuntos
Astrágalo , Ponte Cardiopulmonar/efeitos adversos , Medicamentos de Ervas Chinesas/uso terapêutico , Cardiopatias Congênitas/tratamento farmacológico , Fitoterapia , Acetilglucosaminidase/urina , Feminino , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/urina , Humanos , Lactente , Interleucina-10/sangue , Testes de Função Renal , Masculino , Período Pós-Operatório , Fator de Necrose Tumoral alfa/sangue
4.
Zhongguo Dang Dai Er Ke Za Zhi ; 13(5): 385-7, 2011 May.
Artigo em Chinês | MEDLINE | ID: mdl-21575343

RESUMO

OBJECTIVE: To study kidney injury in infants with congenital heart disease (CHD) who underwent cardiac surgery with cardiopulmonary bypass (CPB). METHODS: Forty CHD infants undergoing cardiac surgery with CPB from October 2009 to July 2010 were enrolled. The concentrations of serum tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), cystatin C (CysC) and urinary N-acetyl-beta-D-glucosaminidase (NAG) were detected using ELISA before bypass, at the end of surgery, and 2 hrs, 6 hrs and 24 hrs after surgery. Serum concentrations of creatinine (Cr) and urea nitrogen (BUN) were measured with conventional biochemistry technique before and after surgery. RESULTS: The concentrations of serum Cr and BUN were normal before and after surgery. After CPB, the concentrations of serum TNF-α and IL-6 and urinary NAG increased significantly (P<0.05). Serum TNF-α was positively correlated with urinary NAG and serum CysC (r=0.195, 0.190, respectively; both P<0.05). Serum IL-6 was positively correlated with urinary NAG (r=0.278, P<0.01). The positive rate in kidney injury was detected by serum CysC and urinary NAG were significantly higher than by serum Cr or BUN (both P<0.01). CONCLUSIONS: CPB can cause acute kidney injury in infants, which may be correlated with the increase in the concentrations of serum TNF-α and IL-6. Serum CysC and urinary NAG may be used as sensitive markers for reflecting the changes of renal function.


Assuntos
Injúria Renal Aguda/etiologia , Ponte Cardiopulmonar/efeitos adversos , Cardiopatias Congênitas/cirurgia , Acetilglucosaminidase/urina , Criança , Pré-Escolar , Cistatina C/sangue , Feminino , Humanos , Interleucina-6/sangue , Masculino , Fator de Necrose Tumoral alfa/sangue
5.
Eur J Cardiothorac Surg ; 40(3): 764-6, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21367612

RESUMO

The natural history of total pulmonary venous connection (TAPVC) is unfavorable per se. We describe a modified technique of intra-atrial repair in infants with supra- and infracardiac TAPVC. Twenty patients were treated. The median age at repair was 16 (range 3-62) days. Echocardiography and multi-detector row computed tomography were used to confirm the diagnosis. Our policy was to perform surgery on an urgent basis whenever there was a sign of severe pulmonary congestion or hypoxia. The procedures performed in cardiopulmonary bypass (CPB) were established in a standard fashion using bi-caval cannulation and moderate hypothermia. A novel modification of our surgical technique is the H-shaped instead of simple straight incision of pulmonary venous confluence and intra-atrial sewing. H-shaped incision of pulmonary venous confluence can increase the anastomotic area than simply straight-line incision and create a large anastomosis with maximal use of the venous confluence and atrial tissue. Intra-atrial repair can avoid torsion and rotation of the pulmonary veins. There were no operative deaths and no recurrent pulmonary venous obstruction was noted after a mean period of 2 ± 0.8 years (range: 12-20 months). Intra-atrial repair provides excellent results for primary repair of supra- and infracardiac TAPVC in infants.


Assuntos
Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Anastomose Cirúrgica/métodos , Ponte Cardiopulmonar , Átrios do Coração/cirurgia , Humanos , Lactente , Recém-Nascido , Complicações Pós-Operatórias/prevenção & controle , Veias Pulmonares/diagnóstico por imagem , Pneumopatia Veno-Oclusiva/prevenção & controle , Tomografia Computadorizada por Raios X
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