Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces mor...Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.展开更多
Most of the congenital heart diseases can be diagnosed in utero using fetal echocardiography. With the development of ultrasonography and intrauterine cardiac intervention technique, fetal cardiac intervention （FC1）...Most of the congenital heart diseases can be diagnosed in utero using fetal echocardiography. With the development of ultrasonography and intrauterine cardiac intervention technique, fetal cardiac intervention （FC1） for critical aortic stenosis, highly restrictive or intact atrial septum, pulmonary atresia with an intact ventricular septum （PA/ IVS）, and critical pulmonary stenosis （CPS） are available in more countries.展开更多
INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a car...INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a cardiac tumor in the womb. It was reported that ex utero intrapartum treatment （EXIT） procedure solved the problems of fetal airway or pulmonary lesion during delivery to avoid hypoxia after birth. The goal of EXIT is to maintain placental circulation while steps are taken to optimize the transition of the baby from fetal to neonatal life. This study introduced the experience of EXIT procedure to solve the problems of fetal circulation induced by a fetal cardiac tumor.展开更多
基金This study was supported by“the Fundamental Research Funds for the Central Universities”(No.226-2022-00060)National Key R&D Program of China(No.2021YFC2701700).
文摘Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.
文摘Most of the congenital heart diseases can be diagnosed in utero using fetal echocardiography. With the development of ultrasonography and intrauterine cardiac intervention technique, fetal cardiac intervention （FC1） for critical aortic stenosis, highly restrictive or intact atrial septum, pulmonary atresia with an intact ventricular septum （PA/ IVS）, and critical pulmonary stenosis （CPS） are available in more countries.
文摘INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a cardiac tumor in the womb. It was reported that ex utero intrapartum treatment （EXIT） procedure solved the problems of fetal airway or pulmonary lesion during delivery to avoid hypoxia after birth. The goal of EXIT is to maintain placental circulation while steps are taken to optimize the transition of the baby from fetal to neonatal life. This study introduced the experience of EXIT procedure to solve the problems of fetal circulation induced by a fetal cardiac tumor.
