Effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia

Objective:To study the effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia.Methods:A total of 70 children with congenital heart disease and pneumonia in our hospital from June 2014 to Octomber 2016 were enrolled in this study. The subjects were divided into the control group (n=35) and the treatment group (n=35) randomly. The control group was treated with dobutamine, the treatment group were treated with dobutamine combined with meropenem. The two groups were treated for 10 days. The serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before and after treatment were compared.Results: There were no significantly differences of the serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before treatment. The serum BNP, TNF-a, IL-6 and hs-CRP levels of the two groups after treatment were significantly lower than before treatment, the serum IGF-1 and IGFBP-3 levels of the two groups after treatment were significantly higher than before treatment, and that of the treatment group were significantly better than the control group.Conclusion:Dobutamine combined with meropenem can significantly reduce the serum BNP, TNF-a, IL-6 and hs-CRP levels, improve serum IGF-1 and IGFBP-3 levels of children with congenital heart disease and pneumonia, and it was worthy clinical application.

Having a Partner and Having Children:Comparisons of Adults with Congenital Heart Disease and the General Population:A 15-Year Case-Control Study

Objectives:To examine whether patients with congenital heart disease(CHD)are less likely to have a partner or children than individuals from the general population.Methods:Longitudinal study with two assessments of the same patients(n=244)from a hospital population and controls(n=238)from the German Socio-Economic Panel(GSOEP)using parental education,patients age,and sex as matching criteria.The first patient study was conducted between 5/2003 and 6/2004,the second one between 5/2017 and 4/2019.Controls were drawn from GSOEP-surveys 2004 and 2018.CHD-severity was classified according to type of surgery:curative,reparative,or palliative.Living single was used as outcome measure,for offspring the outcome was having children or not.Results:Among women with CHD the rate of those living single was higher than among controls with the differences depending on disease complexity(curative:OR=5.5;reparative:OR=1.9;palliative:OR=2.7).No statistically significant differences between patients and controls emerged in the male study population.With respect to children a marked difference emerged between women with CHD and controls.Among patients the odds of having children were lower than among controls(curative:OR=0.3;reparative:OR=0.3;palliative:OR=0.2).The rate of patients with children with CHD(women:5.6%;men:4.9%)was higher than expected(1%)if compared with the general population.Conclusions:Using partnership and children as outcome criteria,patients with CHD are disadvantaged if compared to subjects from the general population.In female patients the social consequences of the disease turned out as more pervasive than in women.

Effect of Hemodilution on Fluctuation of Cerebral Oxygen Saturation during Cardiopulmonary Bypass in Children with Cyanotic Congenital Heart Disease

Background:In patients with cyanotic congenital heart disease(CHD),cerebral oxygenation may be maintained by elevations in hematocrit(Hct).Hemodilution accompanying cardiopulmonary bypass(CPB),however,can disrupt cerebral oxygen balance,leading to fluctuations in cerebral oxygen saturation(ScO_(2)).The present study investigated the effects of Hct changes on the fluctuation of ScO_(2)during CPB in cyanotic CHD using performance measurement(PM).Methods:Children with CHD(51 acyanotic and 46 cyanotic)who had undergone cardiac surgery using CPB were enrolled.Median performance error(MDPE),median absolute performance error(MDAPE),and wobble parameters of ScO_(2)were calculated before(reference value),during,and after CPB.Correlations of PM parameters with Hct and reductions in Hct(ΔHct)were also evaluated.Results:Before CPB,patients with cyanotic CHD had lower MDPE and larger wobble than those with acyanotic CHD,although mean ScO_(2)did not differ significantly between the two groups.During CPB,ScO_(2)of acyanotic CHD increased asΔHct increased,but PM variables were not associated withΔHct.In cyanotic CHD,MDPE(r=−0.324,p=0.032)and MDAPE(r=0.339,p=0.024)correlated significantly withΔHct during CPB.After CPB,MDPE(r=0.574,p=0.025)and MDAPE(r=−0.543,p=0.036)were significantly correlated with Hct in children with cyanotic CHD who underwent palliative surgery.Conclusion:Therefore,ScO_(2)fluctuation during CPB in children with cyanotic CHD may be affected by the decrease in Hct,suggesting that excessive hemodilution can negatively influence the maintenance of cerebral oxygenation in these patients.

Application of voxel-based morphometric method to detect brain changes in children with non-cyanotic congenital heart disease

BACKGROUND Congenital heart disease(CHD)is a cardiovascular malformation caused by abnormal heart and/or vascular development in the fetus.In children with CHD,abnormalities in the development and function of the nervous system are common.At present,there is a lack of research on the preoperative neurological development and injury in young children with non-cyanotic CHD.AIM To determine the changes in white matter,gray matter,and cerebrospinal fluid(CSF)by magnetic resonance imaging(MRI)in children with non-cyanotic CHD as compared with healthy controls.METHODS Children diagnosed with non-cyanotic CHD on ultrasonography(n=54)and healthy control subjects(n=35)were included in the study.All the subjects were aged 1-3 years.Brain MRI was performed prior to surgery for CHD.The SPM v12 software was used to calculate the volumes of the gray matter,white matter,CSF,and the whole brain(sum of the gray matter,white matter,and CSF volumes).Volume differences between the two groups were analyzed.Voxel-based morphometry was used to compare specific brain regions with statistically significant atrophy.RESULTS Compared with the control group,the study group had significantly reduced whole-brain white matter volume(P<0.05),but similar whole-brain gray matter,CSF,and whole-brain volumes(P>0.05).As compared with the healthy controls,children with non-cyanotic CHD had mild underdevelopment in the white matter of the anterior central gyrus,the posterior central gyrus,and the pulvinar.CONCLUSION Children with non-cyanotic CHD show decreased white matter volume before surgery,and this volume reduction is mainly concentrated in the somatosensory and somatic motor nerve regions.

Clinical Effect of an Improved Post-Operative Feeding Protocol“in Transition”Infants of Congenital Heart Disease with Pulmonary Hypertension

Background:To achieve successful management of infants with congenital heart disease(CHD)together with pulmonary hypertension(PH),postoperative care,especially feeding care is vital in addition to surgery.Postoperative feeding is comprised of three stages:feeding in the intensive care unit,feeding in the general ward and family feeding,in which the general ward is considered as the“transitional stage”.At present,there is little research on the optimal mode of feeding care for the transitional stage,and there is no universally recognized and accepted protocol.Methods:We retrospectively analyzed 114 CHD infants with PH who underwent family-centered(FC)feeding care from July 2017 to December 2018,and prospectively studied 122 CHD infants with the same baseline level who adopted the improved mode,nurse-parent-driven(NPD)feeding mode from January 2019 to June 2020.The feasibility and efficacy of NPD as a“transitional”feeding nursing mode in CHD infants with PH were compared with the FC cohort by observing and analyzing the stress of family caregivers,feedingrelated complications,the proportion of breastfeeding,improvement of nutritional status,acquisition of knowledge and skills of feeding care,inpatient’s satisfaction rating and prognosis.Results:When compared with the FC feeding care,the NPD mode significantly reduced the burden of family caregivers,improved the rate of feeding care knowledge and skills and inpatient’s satisfaction rating,reduced the incidence of improper feeding-related complications,and enhanced the proportion of breastfeeding and nutritional status of infants at the“transitional stage”(all P<0.05).The self-assessment score of care ability of family caregivers and weight gain of children in the NPD group were significantly higher than those in the FC group(all P<0.05)during the follow-up.Conclusions:As a transitional mode of feeding in CHD infants with PH,NPD feeding care is superior to the conventional FC mode,which therefore can be adopted as a standard protocol in clinical practice.

Early Cardiac Catheterizations within 30 Days Post Congenital Heart Surgery in Children

Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.

The Prevalence of Congenital Heart Disease among School-Age Children in China:A Meta-Analysis and Systematic Review

Objectives:To estimate the prevalence of Congenital Heart Disease(CHD)in school-age children,to identify the extent to which altitude affects the prevalence of the disease,and to examine trends in prevalence over time in China.Methods:Seven databases were systematically searched and last retrieved on September 10,2021 for all studies reporting the prevalence of CHD in children after 1970 in China,which were then divided into high and low altitude regions based on 2500 meters above sea level.The random-effected model was used to combine prevalence data and subgroups analysis.The baseline data of all cases and individuals were used for comparison to calculate the odds ratio(OR)for overall and different altitude prevalence.Results:A total of 12,926,083 individuals(aged 3-18 years),with 31,835 cases from 86 studies,were included in the analysis.The pooled CHD prevalence of total children was 4.69[95%confidence interval(CI):4.10 to 5.29]per 1000 children.Overall,temporal trends analysis indicated that the prevalence of CHD in children continuously decreased with time,from 6.19(95%CI:4.50 to 7.88)per 1000 children in 1976-1985 to 3.30(95%CI:2.49;4.38)per 1000 children in 2016-2021.The OR for the prevalence of CHD in children from high and low altitudes with baseline data was 2.84(95%CI:2.48 to 3.27)and 1.31(95%CI:1.13 to 1.53)(χ^(2)=53.89,p<0.01),respectively.The OR of the prevalence of CHD in male children compared to females was 0.60(95%CI:0.53 to 0.68)at high altitudes and 0.79(95%CI:0.71 to 0.89)at low altitudes.Among the seven most common subtypes,patent ductus arteriosus was the most common at high altitudes,while atrial septal defects were the most common at low altitudes.Conclusion:This study provides valuable insights for further disease prevention and etiological exploration.The overall decreasing trend in the prevalence of CHD in children over time may indicate a positive effect of perinatal management and treatment during infancy.

Effects of Palivizumab Guideline Changes on RSV Admissions in Patients with Congenital Heart Disease and Prematurity

Background: Respiratory syncytial virus (RSV) causes significant morbidity and mortality in patients with a history of prematurity and congenital heart disease (CHD). In 2014, the guidelines for Palivizumab became more restrictive for this population. We hypothesized the percentage of RSV+ admissions would increase overall and in this target group (TG) specifically. Methods: We conducted a retrospective review of patients under age 2 years admitted with bronchiolitis two seasons prior to the change (Pre) and two seasons after (Post). Our TG included patients who were eligible prior to the 2014 changes but currently no longer eligible. We used chi-square analysis to answer the two main hypotheses: 1) Percent RSV+/total bronchiolitis Pre vs Post and 2) Percent of TG/RSV+ Pre vs Post. Results: 1283 patients (546 pre, 737 post) were admitted with the diagnosis of RSV between 2012-2016, 866 actually tested positive for RSV (367 Pre, 499 Post). There was no significant difference in the number of total patients admitted with RSV (Pre = 67.2%, Post = 67.7%) or in our TG (Pre 7.1% vs Post 8.2%). TG overall had a more complicated course: longer length of stay, median 5 days, IQR 2 - 12 vs 3 days, IQR 1 - 5, (p < 0.001), intensive care unit admissions (36% vs 22.8%, p = 0.02), positive pressure ventilation (25.4% vs 15.4%, p = 0.03) and intubation (16.4% vs 6.8%, p = 0.004), but there was no difference Pre vs Post. Conclusion: The TG had an overall higher acuity, but there was no increase in the number of patients hospitalized with RSV or severity as a result of the Palivizumab guideline changes.

Specific Injuries Management in the Postoperative of Congenital Heart Diseases(Ⅱ):Univentricular Hearts

It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart disease. The fundamental philosophy of treatment of every univentricular heart is to ensure the flow system and/or restrict the lung flow. Thus, initially a patient with univentricular heart who is undergoing surgery may need to ensure systemic flow (reconstruction of the aortic?arch type Norwood), to restrict the lung flow (pulmonary banding) or to provide enough?pulmonary flow (pulmonary-systemic fistulae). However, some heart diseases with univentricular physiology remain “balanced” autonomously, until the “second” stage of palliation is performed (cavo-pulmonary anastomosis type Glenn), but others require performance of pulmonary banding, if there’s no native lung protection and/or repair of the systemic circuit in a first stage, to reach next palliation steps in the best possible conditions.

Congenital Heart Disease in Rural Senegal: A Retrospective Study of 79 Patients

Introduction: Congenital heart disease (CHD) is a malformation of the heart present at birth and resulting from a developmental defect during embryonic life. The aim was to assess CHD in rural areas. Methodology: This is a retrospective study conducted over a period of 2 years in rural Senegal. Results: During the study period, we collected 79 patients with CHD, representing a hospital prevalence of 2.6%. The mean age at diagnosis was 17.05 months and the sex ratio was 1.19. The mean birth weight was 2826 g. The main comorbidities were anaemia (54.43%) and respiratory infections 38 cases (48.10%). Respiratory distress was the most common sign with 98.73%. Radiological cardiomegaly was noted in 86.7%. The most frequent CHD were interventricular septal defect (IVD) 21.51% and atrial septal defect (ASD) 8.86%. No patient was able to receive surgical treatment. Seven children died (8.86%) and 21 children were lost to follow-up (26.58%). On Doppler echocardiography, 16.45% of the patients had pulmonary arterial hypertension (PAH). Conclusion: In light of this work, emphasis should be placed on the quality of antenatal consultations, the quality of management and the regular availability of echocardiography and a cardio-paediatrician in order to reduce morbidity and mortality.

Epidemiology of Cardiovascular Diseases in Children at the Teaching Hospital of Brazzaville, Congo

Context: Several studies were conducted throughout the world on heart diseases in children;no data is available in Congolese child. Objective: To evaluate epidemiological profile of Congolese children and teenager carrying cardiovascular diseases. Methods: A descriptive and prospective study was carried out during 4 years in the pediatric department of teaching hospital of Brazzaville, near the children received in consultation of pediatric cardiology. Results: On 41,472 patients admitted in pediatric service, 526 patients were received in consultation for suspicion of heart diseases. Among them, 444 had cardiopathy (incidence of 10.7‰). It was about a congenital heart disease to 316 (60%) incidence of 7.6‰;Acquired heart disease to 128 (24.4%) incidence of 3.1‰. Among congenital heart defects observed frequency of patients with ASD was 20.3%, isolated in 10.1% of cases, and associated with ECD (11.8%). The VSD was observed in 30.1% of cases, and the Tetralogy of Fallot in 10.1% of cases. Among the acquired heart diseases, severe hypo kinetic dilated cardiomyopathy (DCM) was noted in 24.4% of cases. The rheumatic heart diseases accounted for 41.4% of cases. It was mitral regurgitation (33.6%), a mitral stenosis (1.6%). Pericarditis was objectified at 10.1% of the patients. The evolution was favorable for 43.3% of patients. An aggravation of symptoms was observed to 2.7% of patients. Mortality was 11.9% and 71.9% of deaths were observed to not operate carriers of congenital heart disease. 69.9% of dead patients were carrying a cyanogen heart disease. Left to right shunt represented 21.7% of the deaths. Conclusion: Heart diseases are real problem of public health for Congolese children.

EXTRAVASCULAR LUNG WATER AND VENTILATORY MANAGEMENT IN CHILDREN AFTER OPEN HEART SURGERY

The accumulation of extravascular lung water （EVLW） after cardiac surgery of congenital heart disease may predicted from the preoperative level of pulmonary blood flow. This accumulation of EVLW may adversely affect ventilatory parameters. Lung compliance （LC）, cardiac index （CI）, blood arterial oxygen tension （PaO2）, left atrial pressure （LAP）and EVLW were measured serially immediately postoperative in two groups of children after complete repair of congenital heart disease contrasted by their level of pulmonary blood flow: Tetralogy of Fallot （TOF, n=10, 4.6±1.9 years） and ventrvcular septal defect with pulmonary arterial hypertension （VSD+PAH, n=10, 5.4±2.0 years）.Using a double indicator-dilution technique （DIDT） the EVLW peaked at the 16th hour postoperation in TOF group and at the 8 th hour postoperation inthe VSD with PAH group. During the first 24 hours after surgery the EVLW was consistently higher in the VSD with PAH group （P【0.01）. There was a negative correlation between the EVLW and LC, CI and PaO2 and no correlation between the EVLW and LAP. In three hypoxemic patients of the VSD with PAH group the LC deteriorated while the EVLW was elevated. After treatment with positive end expiratory pressure （PEEP） the hypoxemia corrected as the LC increased and the EVLW decreased, with no change in the CI. Thus, measurement of EVLW provides a sensitive method for explaining changes in LC, that may lead to a more rational adjustment of mechanical ventilator parameters.

Heart Failure in Children: Epidemiological, Etiological and Diagnostic Aspects in Diamniadio Children’s Hospital (Senegal)

Introduction: Heart failure is a major cause of morbidity and mortality in children. The authors aimed to report the epidemiological and etiological characteristics of heart failure (HF) in children in Senegal. Patients and Methods: This was a retrospective study conducted at the Children’s Hospital of Diamniadio (CHD) from 01-01-2016 to 31-12-2017. Children aged 0 to 15 years with heart failure confirmed by echocardiography were included. Results: Sixty-six children were admitted for heart failure. The prevalence of HF was 5.3‰. The mean age of the children was 41.59 months ± 53.35 months (range: 0 to 168 months). The 0 - 5 age group was the most represented (n = 48;72.72%). The HF concerned 38 boys and 28 girls, a sex ratio (M/F) of 1.36. The majority of our patients came from the semi-urban area (42.4%). The etiology of HF was represented in order of frequency by congenital heart disease, rheumatic heart disease and cardiomyopathy with 59.09% of cases, 22.73% of cases and 7.58% of cases respectively. It was unknown in 4.54% of the cases. At echocardiography, the left ventricular ejection fraction (LVEF) was impaired (less than 50%) in 19 patients, in 29.2% of cases with an average of 64% +/- 15.16% (extremes: 24% and 86%). Anemia was the comorbidity most commonly associated with their condition (n = 33%;50%). Conclusion: Heart failure in children is uncommon. The main etiology is represented by congenital heart disease.

Management of Specific Complications after Congenital Heart Surgery(I)

In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care specialist to fully understand the preoperative anatomy and the intraoperative details of these patients. This allows a timely and appropriate treatment of general and lesion-specific complications. In this article we provide a list of commonly-performed surgical procedures and possible associated problems to be anticipated in the early postoperative period. Then it follows a discussion about the diagnosis and management of these complications, based on their pathophysiological features.

Optical coherence tomography of the pulmonary arteries in children with congenital heart diseases:A systematic review

Importance:Optical coherence tomography(OCT)is a high-resolution intravascular imaging tool and has shown promise for providing real-time quantitative and qualitative descriptions of pulmonary vascular structures in vivo in adult pulmonary hypertension(PH),while not popular in pediatric patients with congenital heart diseases(CHD).Objective:The aim of this review is to summarize all the available evidence on the use of OCT for imaging pulmonary vascular remodeling in pediatric patients.Methods:We conducted the systematic literature resources(Cochran Library database,Medline via PubMed,EMBASE,and Web of Knowledge)from January 2010 to December 2021 and the search terms were“PH”,“child”,“children”,“pediatric”,“OCT”,“CHD”,“pulmonary vessels”,“pulmonary artery wall”.Studies in which OCT was used to image the pulmonary vessels in pediatric patients with CHD were considered for inclusion.Results:Five studies met the inclusion criteria.These five papers discussed the study of OCT in the pulmonary vasculature of different types of CHD,including common simple CHD,complex cyanotic CHD,and Williams-Beuren syndrome.In biventricular anatomy,pulmonary vascular remodeling was primarily reflected by pulmonary intima thickening from two-dimensional OCT.In single-ventricle anatomy,due to the state of hypoxia,the morphology of pulmonary vessels was indirectly reflected by the number and shape of nourishing vessels from three-dimensional OCT.Interpretation:OCT may be an adequate imaging procedure for the demonstration of pulmonary vascular structures and provide additional information in pediatric patients.

Clinical cardiac regenerative studies in children

Although the incidence of pediatric heart failure is low, the mortality is relatively high, with severe clinical symptoms requiring repeated hospitalization or intensive care treatment in the surviving patients. Cardiac biopsy specimens have revealed a higher number of resident human cardiac progenitor cells, with greater proliferation and differentiation capacity, in the neonatal period as compared with adults, demonstrating the regeneration potential of the young heart, with rising interest in cardiac regeneration therapy in critically ill pediatric patients. We review here the available literature data, searching the MEDLINE, Google Scholar and EMBASE database for completed, and www.clinicaltrials.gov homepage for ongoing studies involving pediatric cardiac regeneration reports. Because of difficulties conducting randomized blinded clinical trials in pediatric patients, mostly case reports or cohort studies with a limited number of individuals have been published in the field of pediatric regenerative cardiology. The majority of pediatric autologous cell transplantations into the cardiac tissue have been performed in critically ill children with severe or terminal heart failure. Congenital heart disease, myocarditis, and idiopathic hypertrophic or dilated cardiomyopathy leading to congestive heart failure are some possible areas of interest for pediatric cardiac regeneration therapy. Autologous bone marrow mononuclear cells, progenitor cells, or cardiospheres have been applied either intracoronary or percutaneously intramyocardially in severely ill children, leading to a reported clinical benefit of cell-based cardiac therapies. In conclusion, compassionate use of autologous stem cell administration has led to at least short-term improvement in heart function and clinical stability in the majority of the critically ill pediatric patients.

中国儿童先天性心脏病流行病学特征研究进展

从2004年开始先天性心脏病发病率上升至我国出生缺陷第一位,虽然随着医疗技术在不断发展,先天性心脏病的检出率越来越高,但先天性心脏病仍然是新生儿死亡的重要原因,会给社会及家庭带来极大的经济负担。本文对目前中国儿童先天性心脏病流行病学特征进行总结,提升群众对先天性心脏的认知率,为预防和降低先天性心脏病发病率提供参考依据。

超声心动图对婴幼儿先天性冠状动脉瘘的应用价值

目的探讨超声心动图对先天性冠状动脉瘘(CAF)的应用价值。方法选择2015年3月至2022年7月在深圳市儿童医院收治的19例先天性CAF患儿,其中男性7例,女性12例;年龄1天~3岁1个月,平均年龄10.56个月;病程0.5~37.3个月,平均病程3.89个月;就诊原因,1例因体检发现,1例因生长缓慢就诊,1例因胸痛就诊,9例因发现心脏杂音而就诊,3例因气促而就诊,2例因胎儿期超声检出CAF而就诊,2例因既往检查发现先天性心脏病(CHD)而就诊。全部患儿行超声心动图检查,观察左右心房室大小、各瓣膜启闭情况和冠状动脉起源、内径及走行、瘘口位置、瘘口大小及术后残余瘘,比较手术前后冠状动脉和心腔的变化。观察手术前后的超声心动图结果,并与手术结果进行对比分析。结果19例先天性CAF患儿手术前后均行超声心动图检查。术前17例患儿超声心动图及手术均发现位置及数目相同的病变,1例术前超声心动图漏诊CAF,1例术前超声心动图显示1个瘘口术中发现2个瘘口。术前超声诊断准确率达89.4%。19例中右CAF 14例(73.7%),左CAF 5例(26.3%)。19例中合并房间隔缺损6例,室间隔缺损3例,法洛四联症1例。冠状动脉不同程度增宽迂曲,内径为2.4~16.0 mm,瘘口直径为1.8~5.0 mm。术后3例超声心动图显示瘘口有残余瘘,8例受累心腔大小恢复正常,8例受累扩张的冠状动脉内径变小。结论超声心动图在先天性CAF的术前诊断、术后随访中具有重要的临床应用价值。

儿童肌部室间隔缺损的介入治疗研究

目的探讨应用Cardi-O-Fix Plug封堵器治疗儿童肌部室间隔缺损(muscular ventricle septal defect,mVSD)的有效性和安全性。方法将昆明医科大学第一附属医院从2015年7月至2021年6月心内科收治的14例mVSD患儿作为研究对象。分为实验组(14例)和对照组(10例),实验组采用Cardi-O-Fix Plug封堵器进行封堵,对照组采用Cardi-O-Fix mVSD封堵器进行封堵。术后1d以及随访1个月、3个月、6个月采用经胸超声心动图和心电图评价封堵疗效及并发症的发生情况。结果24例患儿中22例成功封堵,2例封堵失败(实验组和对照组各1例),实验组成功率92.8%(13/14),对照组成功率90.0%(9/10)。实验组的平均手术时长(71.93±14.85)min,对照组的平均手术时间时长(90.70±19.78)min,二者比较差异有统计学意义(P<0.05)。实验组和对照组在术中及随访期间均未出现严重并发症。比较不同时间点2组的心脏超声指标(包括左室射血分数、左室舒张末期内径以及肺动脉压),差异均无统计学意义(P>0.05)。结论采用Cardi-O-Fix Plug封堵器在经皮导管封堵心尖部及小梁部的儿童mVSD手术安全有效,短期及中长期发生心律失常的概率低。

中国儿童肺动脉高压诊治现状

肺动脉高压是一类具有不同的病因和发病特点、多因素致病的疾病。中国儿童肺动脉高压最常见的类型是先天性心脏病相关肺动脉高压和特发性肺动脉高压。现重点介绍这两类疾病的诊治现状,同时介绍与儿童肺动脉高压相关的其他疾病,以及分析当前存在的问题和挑战,并对未来进行展望。