Delivery Outcomes in Non-Tertiary Referral Centers for Women with Congenital Heart Disease

Background:Women with congenital heart disease(CHD)have increased risk for adverse events during pregnancy and delivery.Prior studies have assessed pregnancy and delivery outcomes at tertiary referral centers(TRC).The aim of our study was to assess pregnancy outcomes in women with CHD who deliver in a non-tertiary referral center(non-TRC).Methods:Clinical demographics were collected,including anatomic complexity,physiologic state and pre-pregnancy risk assessment.Patients were stratified by delivery location,either TRC or non-TRC.Maternal and neonatal complications of pregnancy were reported.Results:Women with CHD who delivered in a TRC had a higher pre-pregnancy risk when assessed by the Zahar and CARPREG-II scores,and had more patients fall into a higher WHO classification.There was no difference in rates of maternal cardiac complications between delivery locations(11%)and neonatal complications(20%)between deliveries at TRC and non-TRC.Conclusions:There were not increased maternal cardiac or neonatal complications when delivery occurred at a non-TRC.Neonatal complications remained high regardless of delivery location.This study suggests that proper risk assessment may help identify women who are candidates for safe delivery at non-TRC in women with CHD,and that neonatal resources should be considered when planning delivery location.

The Outcomes of Pregnancy with Congenital Heart Disease: An Integrative Literature Review

Purpose: The purpose of this review was to identify the short-term and long-term outcomes of pregnancy in women suffering from congenital heart disease (CHD). Methods: An integrative review is used to identify the pregnancy outcomes in women with CHD. Data search was between 2010 and 2020 using Google Scholar, Scopus, Web of Science, Science Direct, Pub Med, Medline, CINAHL, EBSCO, Cochrane, and EBSCO host. Sixteen articles met the eligibility criteria. Results: The sixteen reviewed articles utilized descriptive retrospective and prospective design. Themes were short-term outcomes that include;cardiac maternal and obstetric outcomes, and long-term outcomes. Conclusion: Previous uncertainty about the ability of CHD patients to successfully become pregnant and deliver safely has replaced by the recognition that a large number can have excellent outcomes. However, these patients do continue to have higher cardiac, obstetric, and fetal risks than the general population. This illuminates the importance of preconception counseling and risk assessment for women suffering from CHD regarding the expected maternal and fetal outcomes. Moreover, there is a need for providing accurate and appropriate education about pregnancy and delivery options.

Mortality and Long-Term Outcome of Neonates with Congenital Heart Disease and Acute Perinatal Stroke:A Population-Based Case-Control Study

Objective:Neonates with congenital heart disease(CHD)and perinatal stroke have high mortality and survivors are at risk for poor long-term neurodevelopmental outcome.The aim of this study was to assess the risk factors and outcome of neonates with both CHD and MRI-confirmed perinatal stroke(Study Group)and compare those to the risk factors and outcome of infants matched for CHD without stroke(Control-1)and of infants matched for MRI-confirmed stroke without CHD(Control-2).Methods:We conducted a population-based case-control study enrolling 28 term neonates with CHD and MRI-confirmed acute perinatal stroke born between 2007–2017 in the Central-Hungarian Region.Each of the control groups included 56 infants.The Bayley Scales of Infant Development-II,the Brunet-Lézine test and the Binet Intelligence scales-V were used for neurodevelopmental follow-up at a median age of 61 months.Results:Mortality was highest in the Study Group(25%compared to 5%and 2%,respectively,p=0.001).Adverse neurodevelopmental outcome was prevalent in the Study(53%)and Control-2 Groups(52%,p=0.03).Significantly different parameters among the three groups included Apgar scores,mode of delivery,gestational age at birth,cardiac interventions and twin pregnancy.In a multivariable regression analysis adjusted for clinically relevant parameters,patients in the Study Group had significantly higher odds for mortality compared to patients in the Control-1 Group(OR:6.595%CI:1.1–39.4).Conclusions:Neonates with perinatal stroke and CHD are at a higher risk for dying compared to neonates with CHD without stroke.In addition,the stroke-associated direct insult to the brain likely plays an important role in the development of neurodevelopmental morbidity in these patients.

Depression in adults with congenital heart disease-public health challenge in a rapidly expanding new patient population

There is a growing population of adults with congenital heart disease(CHD) due to improved survival beyond childhood.It has been suggested that adults with CHD may be at increased risk for mental health problems,particularly depression.The reported incidence of depression in CHD varies from 9% to 30%.This review examines the evidence for a higher depression rate in CHD vs general population.Possible explanations are offered from a variety of disease models,ranging from brain injury to the psychoanalytical approach.Risk factors for an abnormal emotional adjustment and depression include early exposure to stress from illness and medical interventions in infancy,separation from the parents during hospitalizations and brain organic syndromes.Later in life,patients often have to cope with physical limitations.Recent improvements in care may be protective.Current patients may benefit from an earlier age at first surgical intervention,fewer reoperations and inclusion to the mainstream schooling,among other factors.At this point,there is little systematic knowledge about evidence-based therapeutic interventions for depression in adults with CHD.Health care providers of patients with CHD should be aware of mental health challenges and may take a more proactive approach to identifying patients at risk for depression.

Kabuki-Syndrome and Congenital Heart Disease-A Twenty-Year Institutional Experience

Background:Patients with genetic syndromes who undergo surgery to correct congenital heart defects can be at risk for increased morbidity or mortality.Surgical outcomes and postoperative courses following congenital heart surgery in patients with Kabuki-Syndrome(KS)have not been well studied.Objectives:The purpose of this study was to describe the postoperative courses and associated outcomes in the largest set of KS patients undergoing congenital heart surgery to date.Methods:Patients with a confirmed molecular diagnosis of KS and a diagnosis of a CHD admitted to Texas Children’s Hospital between January 1,2000 and January 1,2020 were included(n=20).Demographics and medical histories were collected from the hospitals’electronic health records.Results:Of 20 patients identified with KS and a CHD,15 required surgical correction of their congenital cardiac malformation.Median age and weight at the time of surgery was 2 months and 4.1 kg,respectively.Median duration of hospital stay was 49 days for all surgeries and 151 days for the Norwood procedure.Postoperative infections and pleural effusions were detected and treated in 45.8%and 50%of patients,respectively.There was no in-hospital mortality for any surgery.Median follow up time was 5.6 years;survival at 6 years was 94%.Conclusions:Although KS patients seem to be at increased risk for a more complicated,prolonged postoperative course than that of patients without a genetic syndrome,patients with a diagnosis of a CHD and KS do not appear to be at increased risk of mortality following congenital heart surgery.

Entirely subcutaneous defibrillator and complex congenital heart disease: Data on long-term clinical follow-up

AIM To describe the long-term follow-up of patients with complex congenital heart disease who underwent subcutaneous implantable cardiac defibrillator(S-ICD), focusing on local complications, appropriate and inappropriate shocks.METHODS Patients with complex congenital heart disease underwent S-ICD implant in two centers with the conventional technique. Data at follow-up were retrieved from clinical notes and institutional database. RESULTS Eight patients were implanted in two centres between 2010 and 2016. Median age at implant was 37.5 years(range 13-57). All patients who were deemed suitable for S-ICD implant passed the pre-procedural screening. Three patients were previously implanted with a antibradycardia device, one of whom with CRT. In one patient the device was explanted due to local infection. Duringthe total median follow-up of 874 d, one patient had an appropriate and one inappropriate shock triggered by fast atrial tachycardia. None of the patients had inappropriate shocks secondary to T wave oversensing or electrical interference with anti-bradycardia devices.CONCLUSION S-ICD appears to be effective and safe in patients with complex congenital heart disease.

Cardiac biomarkers in pediatric heart disease:A state of art review

Every year there are more than 11000 hospitalizations related to heart failure in children resulting in significant morbidity and mortality.Over the last two decades,our understanding,diagnosis and management of pediatric heart failure is evolving but our ability to prognosticate outcomes in pediatric heart acute heart failure is extremely limited due to lack of data.In adult heart failure patients,the role of cardiac biomarkers has exponentially increased over the last two decades.Current guidelines for management of heart failure emphasize the role of cardiac biomarkers in diagnosis,management and prognostication of heart failure.It is also noteworthy that these biomarkers reflect important biological processes that also open up the possibility of therapeutic targets.There is however,a significant gap present in the pediatric population with regards to biomarkers in pediatric heart failure.Here,we seek to review available data regarding cardiac biomarkers in the pediatric population and also explore some of the emerging biomarkers from adult literature that may be pertinent to pediatric heart failure.

Contemporary treatments and outcomes of preterm infants with critical congenital heart disease in a tertiary cardiovascular institute in China

Background The survival rate of preterm infants with critical congenital heart disease （P-CCHD） has been improved by medicine advances. The aims of this study were to investigate the contemporary treatments for short-term outcomes of P-CCHD and to evaluate risk factors associated with the outcomes. Methods Sixty-four P-CCHD patients admitted to Guangdong General Hospital between 2011 and 2015 were included in this study. De-mographic characteristics and patient records were reviewed. Logistic regression was used to analyze the risk fac-tors of P-CCHD outcome. Results Thirty-six patients underwent surgical treatments for cardiac anomalies. Moreover, 31.25% of the P-CCHD infants did not receive surgery because these parents refused further treat-ment. The in-hospital mortality rate was 8.3% for the patients who underwent surgeries. During a median follow-up of 1.2 years, the survivors were basically healthy. However, mental and physical growth retardation remained. Conclusions Compared to infants in developed Western countries, the treatments and short-term outcomes of P-CCHD infants were satisfactory. However, the long-term outcomes remain to be determined.

Current profile and outcome of 100 esophageal atresia patients in the Kyushu area of Japan

Objectives: Since Spitz et al. reported the prognostic classification of esophageal atresia (EA) patients in 1994, decades have been past and there have been many advances in surgery and neonatology. Nevertheless, there have been very few reports according to the recent outcome of the neonates with EA, and otherwise, time has come to re-evaluate the credibility of this classification. The aim of this study was to validate the recent prognosis of the EA. Methods: Patient data were collected from 22 cooperative facilities during the 5 year period from 2005 to 2009 in Kyushu area, Japan. Total of 100 EA patients were retrospectively reviewed according to their characteristics and the outcome. Patient who missed the characteristics and outcome was excluded from the respective data. Results: Only 29.8% (28/94) was prenatally diagnosed and 52.0 (52/100) had associated anomalies including major congenital heart disease (CHD), abnormal chromosome, and others. According to the operation, primary anastomosis was performed 57.0% (57/100) and the staged operation was performed 34.0% (34/100). Survival rate in the neonatal period was 89.0% (89/ 100), and overall survival rate was 78.0% (78/100). According to the Spitz classification, if patients with associated anomalies were excluded, survival rate of Group 1 (>1500 g and no CHD) was 93.8% (61/65), Group 2 (<1500 g or CHD) was 68.4% (13/19), and Group 3 (<1500 g and CHD) was 50% (1/2). Conclusion: EA was proved to be rarely diagnosed prenatally. Primary outcome of the Group 1 and Group 3 in Spitz classification were fairly good, but Group 2 was worse as ever. The comprehensive treatment strategy for EA patients with birth weight under 1500 g or CHD should be reconsidered to improve the overall outcome.

Cardiovascular surgery in Turner syndrome-early outcome and long-term follow-up

BACKGROUND Cardiovascular disease is the leading cause of death in patients with Turner syndrome(TS),and cardiovascular surgery is frequently required for management of these patients.TS is associated with medical comorbidities than can complicate the care of this patient population.AIM To describe the cardiovascular surgical outcomes of patients with TS.METHODS A retrospective case series was compiled of 51 consecutive TS patients who had at least one cardiovascular surgery at Mayo Clinic Rochester from 1977-2017.The baseline clinical data of these patients were reviewed including demographics,medical comorbidities,congenital heart disease history,and medications.Echocardiographic reports were analyzed in detail.Operative reports and surgical hospital courses were reviewed.Long-term mortality was determined using medical records and the Social Security Death Index.Survival analysis was performed with the Kaplan Meier method.RESULTS The cohort comprised 51 TS patients,average age at the time of surgery at Mayo Clinic was 28(8-41)years,and 23(45%)patients were under the age of 18.At the time of first Mayo Clinic surgery,18(35%)patients had previously undergone cardiac surgery at another institution.The most common procedures were repair of aortic coarctation in 14(28%)patients,aortic valve replacement in 6(12%)patients,and composite aortic root/ascending aorta replacement in 7(14%)patients,with 7 patients undergoing repair of more than one lesion.Aortic dissection required operative intervention in 5 patients.After initial Mayo Clinic surgery,subsequent operations were required in 6(13%)patients.Average hospital length of stay was 6±2 d.There were 4(8%)early surgical deaths.Freedom from death was 97%and 89%at 10 and 20 years,and the freedom from reoperation was 93%and 81%at 10 and 20 years.CONCLUSION Cardiovascular surgery is associated with 8%early mortality given the medical complexity of TS patients.Those who survive to dismissal have good survival.Later cardiovascular reoperations are not rare.

Current outcomes and treatment of tetralogy of Fallot

One of the most common types of cyanotic congenital heart disease is Tetralogy of Fallot(ToF).Treatment has constantly increased since the first surgical repair in 1954.Excellent treatment having long-term survival(30 years survival ranges from 68.5%to 90.5%)is available for the ToF.However conventional and frequently required re-interventions include residual issues like right ventricular outflow tract obstruction,pulmonary regurgitation and(ventricular)arrhythmia.Right ventricular dysfunction might lead to longstanding pulmonary regurgitation and/or stenosis.It is important to perform pulmonary valve replacement or relief of pulmonary stenosis prior to irreversible right ventricular dysfunction,though determining optimal timing of pulmonary valve replacement is a problematic task due to various reasons.As seen in longstanding pulmonary regurgitation,the biological mechanisms underlying dysfunction of the right ventricle is often unclear.Various techniques of assessing the right ventricle are used to predict imminent dysfunction.The interventricular,ventriculo-arterial and atrioventricular interactions of right ventricle are not completely explained but play significant role in right ventricle performance.This review focuses on providing a brief overview of the history of ToF,describing the current strategies for treatment and describing the long-term survival,residual lesions and re-interventions following repair.Remaining related challenges and present condition of the art regarding these challenges are also illustrated.

Senning operation for correction of the transposition of the great arteries, results, long-term outcome and quality of life

Objective: Long-term results after the Senning operation for transposition of the great arteries are little known. Sinus node dysfunction and systemic ventricular dysfunction are crucial in patient survival. We evaluated the results, long term outcome and quality of life in a group of 39 patients. Methods: The study was a retrospective analysis, of 39 (39/40 = 97.5%) surgical surviving patients, submitted to Senning operation, with a mean follow-up time of 14.7 +/– 3.1 years. Electrocardiogram, echocardiogram, and chest radiograph series were performed every 6 months. Thirty six patients of this series underwent Holter study and ergometric test, to evaluate the physical capacity. Three patients living overseas were excluded. Results: There was only one late death (1/39) (late mortality = 2.5%): a 16 year-old patient had a no cardiac death. The actuarial survival was 95.0% (38/40) (simple or with little VSD, TGA). The probability of staying in sinus rhythm, in 39 surviving patients was 77.1% (30) or normal right ventricular function was 76.5% (29), 10 to 20 years after operation. The incidence of sinus node and right ventricular dysfunction increased gradually over time. No re-operations and pacemaker implantation, was performed. Functional class: I = 30 (85.7%) cases and functional class II = 5 (14.3%) cases. Conclusions: Patients with simple TGA submitted to Senning procedure in our experience, presented during late follow-up: 1—Low incidence of right ventricular dysfunction and active arrhythmias;2—Low mortality and no sudden death recorded;3—Good quality of life and 4—Satisfactory surgical results (free of re-operation or definitive pacemaker implantation).

婴儿经右腋下小切口治疗先天性心脏病的疗效分析

目的探讨经右腋下小切口建立体外循环在婴儿心内直视手术中应用的效果。方法回顾性分析2018年6月—2022年2月在新疆医科大学第一附属医院小儿心胸外科接受心脏手术的185例先天性心脏病(CHD)患儿(3~12个月),其中房间隔缺损98例,室间隔缺损87例。将两组患儿按照手术方法不同分为胸骨正中切口组(A组)与右侧腋下小切口组(B组)。比较A、B组房间隔缺损与室间隔缺损患儿手术时间、体外循环时间、主动脉阻断时间、术后住院时间、ICU滞留时间、呼吸机插管时间、术后24 h胸腔引流量、FLACC评分、患儿家属切口满意度及并发症发生情况。结果房间隔缺损患儿A、B组手术时间、体外循环时间、主动脉阻断时间比较,差异均无统计学意义(P>0.05)。房间隔缺损患儿B组住院时间、ICU滞留时间、呼吸机插管时间短于A组(P<0.05),术后24 h胸腔引流量少于A组(P<0.05)。房间隔缺损患儿不同时间点的FLACC评分有差异(P<0.05);两组的FLACC评分有差异(P<0.05),B组低于A组;两组FLACC评分的变化趋势有差异(P<0.05)。房间隔缺损患儿家属满意度评分B组高于A组(P<0.05)。房间隔缺损患儿术后均未出现相关并发症。室间隔缺损患儿A、B两组手术时间、体外循环时间、主动脉阻断时间比较,差异均无统计学意义(P>0.05)。室间隔缺损患儿B组住院时间、ICU滞留时间、呼吸机插管时间均短于A组(P<0.05),术后24 h胸腔引流量少于A组(P<0.05)。室间隔缺损患儿不同时间点的FLACC评分有差异(P<0.05);两组的FLACC评分有差异(P<0.05),B组低于A组;两组FLACC评分的变化趋势无差异(P>0.05)。室间隔缺损患儿家属B组切口满意度评分高于A组(P<0.05)。室间隔缺损患儿A组有2例出现胸廓畸形,1例切口感染;B组出现1例术后肺不张。结论在婴儿群体中经右腋下小切口治疗CHD,切口隐蔽、美观,对患儿的身体及心理创伤小,住院时间缩短,术后呼吸机插管时间缩短、胸腔引流量减少,能有效减轻疼痛,更容易被患儿及其家属接受,临床疗效优于正中开胸。

体外循环预充糖皮质激素对小儿简单先天性心脏病手术的临床作用

目的观察心肺转流(CPB)预充液中使用糖皮质激素对小儿心脏手术乳酸及临床结果的影响,为临床实践提供相应的依据。方法2023年2月至2024年1月,选取择期行室间隔缺损修补术和(或)房间隔缺损修补术的简单先天性心脏病患儿54例,随机分为两组,每组27例。对照组不使用地塞米松;地塞米松组预充液中加入5 mg/kg地塞米松。分别于麻醉诱导后CPB前、CPB15 min、主动脉开放前5 min、CPB结束时、术毕、入ICU后2 h取血样行动脉血气、乳酸和血糖水平测试,记录临床主要结果。结果两组患者血糖、手术室气管插管拔管率、ICU时间、机械通气时间、发热天数、最高体温、室上速发生率、死亡率、住院时间、住院费用对比均无统计学意义(P<0.05)。地塞米松组乳酸在T1、T4显著高于对照组(P<0.05)。结论简单先心手术CPB预充液中加入地塞米松对控制术中及术后乳酸水平无积极作用,对术中及术后血糖水平无明显影响,也不能改善小儿心脏手术后的临床结果。

西藏地区单中心妊娠合并先天性心脏病50例分析

目的探讨西藏高原地区单中心妊娠合并先天性心脏病对孕产妇及围产儿的影响。方法回顾性分析2018年3月至2023年3月在西藏自治区人民医院产科住院分娩的50例妊娠合并先天性心脏病产妇临床资料,将孕前行心脏矫治手术的10例产妇为观察组,孕前未行心脏矫治手术的40例产妇为对照组,分析比较两组产妇心功能级别、新生儿Apgar评分及围产儿结局。结果50例病例中,先心病类型以房间隔缺损(52%)和动脉导管未闭(28%)为主;孕前行心脏病手术患者的心功能以I~II级为主,孕前未行心脏病手术患者的心功能以III~IV级为主,两组间对比P<0.05,有统计学意义;观察组早产1例(10%),对照组早产21例(52.5%),两组间对比P<0.05,有统计学意义;观察组出现新生儿窒息1例(10%),对照组出现新生儿窒息24例(60%),两组间对比P<0.05,有统计学意义;观察组新生儿5分钟Apgar评分为(9.8±0.1),对照组新生儿5分钟Apgar评分为(8.2±0.2),两组间对比P<0.05,有统计学意义;观察组新生儿体质量为(3003.5±166.1),对照组新生儿体质量为(2500.5±92.5),两组间对比P<0.05,有统计学意义。结论孕前行心脏矫治手术能显著降低早产率及新生儿并发症的发生率,改善孕妇心脏情况,无手术禁忌证的孕产妇在孕前应积极治疗先天性心脏病。

Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study

Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS.? Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database;11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less than 20 days and VVR score at 48 hours greater than 23 identified three CCU LOS groups with mean CCU LOS of 77.6, 55.1, and 9.5 days. Conclusions: Recursive partition analysis identified ventilator days greater than 20 days and the sub-population VVR at 48 hours as predictive of CCU LOS in patients undergoing re-entry sternotomy for CHD.

安抚奶嘴联合音乐疗法干预对先天性心脏病患儿临床指标及情绪状况的影响

目的:探讨安抚奶嘴联合音乐疗法干预对先天性心脏病患儿的应用效果。方法:选取2018年3月—2021年3月河南省人民医院收治的60先天性心脏病患儿作为研究对象,以随机数表法分为对照组和研究组,每组各30例。对照组采取常规护理,研究组在常规护理基础上加用安抚奶嘴联合音乐疗法干预。对比两组患儿各项临床指标、护理后情绪状态、术后疼痛程度[儿童疼痛行为量表(FLACC)评分]、术后监护治疗时间、并发症发生率、护理满意度。结果:护理后,研究组心率、呼吸频率明显低于对照组,血氧饱和度明显高于对照组,差异有统计学意义(t=6.991、9.608、8.502,P<0.05)。护理后,研究组安静率为90.00%,明显高于对照组的66.67%,差异有统计学意义(χ^(2)=12.134,P<0.05)。研究组术后12 h、24 h、48 h、72 h FLACC疼痛评分均明显低于对照组,术后监护治疗时间明显短于对照组,差异有统计学意义(t=12.026、10.771、18.962、7.440、21.592,P<0.05)。研究组心功能衰竭发生率明显低于对照组,差异有统计学意义(χ^(2)=4.043,P<0.05)。研究组家长护理满意度为96.67%,明显高于对照组的76.67%,差异有统计学意义(χ^(2)=5.192,P<0.05)。结论:对先天性心脏病患儿应用安抚奶嘴联合音乐疗法干预,可有效改善其生命体征,稳定其情绪状态,降低疼痛评分,缩短术后监护治疗时间,减少并发症发生,提升家长护理满意度。

先天性心脏病病儿术前营养状况与住院时间相关性研究

目的:本研究旨在评估术前营养状况对小儿心脏手术后住院时间的影响。方法:回顾性调查2016年7月-2016年12月在浙江大学医学院附属儿童医院心胸外科病房178例接受心脏手术的0至10岁的病儿。主要观察并比较术前的体质量、身高对术后住院时间的影响,同时观察并比较术前紫绀、肺动脉高压、先天性心脏病手术风险分级、机械通气时长等对住院时间的影响。结果:方差分析结果显示术WAZ,HAZ和WHZ与LOS有关(P<0.05)。多元线性回归结果显示WAZ每增加1个单位,LOS下降1.367(P=0.044),HAZ、WHZ与LOS无关(P=0.219,P=0.193)。结论:接受先天性心脏病根治性手术的病儿,术前WAZ与住院时间相关,HAZ和WHZ与住院时间无关,应该更多关注此类病儿术前WAZ。

先天性心脏病相关肺动脉高压患者剖宫产术后死亡及胎儿不良事件危险因素分析

目的:探究先天性心脏病相关肺动脉高压患者剖宫产术后42d内死亡及妊娠期胎儿不良事件影响因素,并构建相关风险模型。方法:纳入自2013年3月至2020年1月来自山东省多中心的先天性心脏病相关肺动脉高压患者144例。以孕妇死亡、胎儿发生妊娠不良结局为结局变量,收集患者一般资料及肺动脉收缩压、心功能、总胆红素等相关临床资料,采用二元logistics回归分析探究结局变量的独立影响因素,并制作列线图。结果:10例患者死亡,出现胎儿不良结局77例。孕妇死亡事件发生的独立促进因素为肺动脉收缩压(PASP)(OR=2.634)、总胆红素(OR=5.242)、心功能(OR=4.07),孕妇死亡风险预测模型:P孕妇=1/{1+e-[-10.796+(0.969*PASP)+(1.657*总胆红素)+(1.404*心功能]},截断值(灵敏度,特异度)为-2.24(0.8,0.866),最大约登指数0.666,对应风险预测值均约为0.16,相应风险预测总分为119分,即得分≥119分为高危患者。NT-proBNP(OR=1.403)、总胆红素(OR=15.718)是胎儿不良结局发生的独立促进因素,白蛋白(OR=0.246)是胎儿不良结局事件发生的独立阻碍因素,胎儿不良结局风险预测模型:P胎儿=1/{1+e-[(0.3391*NT-proBNP)+(2.755*总胆红素)+(-1.404*白蛋白)]},截断值(灵敏度,特异度)为0.256(0.508,0.852),最大约登指数0.357,对应风险预测值均约为0.29,相应风险预测总分为140分,即得分≥140分为高危患者。结论:多因素综合风险预测模型能够较好的识别合并先心病相关肺动脉高压产妇中的高危人群。

术后红细胞分布宽度峰值和达峰时间与先天性心脏病患儿术后结局的关系

目的探讨先天性心脏病(CHD)儿童接受心脏手术治疗后红细胞分布宽度(RDW)峰值及达峰时间与CHD患儿手术后结局的关系。方法纳入2006年1月1日至2017年12月31日在上海儿童医学中心因先天性心脏病接受心脏手术治疗的12857名患者,收集患者基本信息及实验室检查指标。以logistic回归模型分析术后RDW峰值及达峰时间与术后结局(死亡、急性肾损伤、ICU住院时间>72 h、呼吸机使用时间>72 h、术后住院时间>10 d)的关系。结果术后RDW峰值及达峰时间均与死亡无关;术后RDW达峰时间与呼吸机使用时间>72 h也无关;术后RDW峰值升高和达峰时间缩短是患儿发生急性肾损伤、ICU住院时间>72 h、术后住院时间>10 d的危险因素。结论CHD患儿术后RDW峰值及达峰时间与其术后结局显著相关,可通过检测这两个参数预测患儿预后。