ObjectiveTo investigate clinical outcomes and safety of transesophageal echocardiography (TEE)-guided occlusion of infundibular ventricular septal defect (VSD) via minithoracotomy. MethodsClinical data of 21 pediatric patients with infundibular VSD who underwent TEE-guided occlusion via minithoracotomy in Children's Hospital of Hebei Province from January to June 2013 were retrospectively analyzed. There were 10 male and 11 female patients with their age of 8-24 (16±8) months and body weight of 9±3 kg. The size of VSD was 4.5±2.5 mm. TEE was used to evaluate the position of the occluder, its influence on the atrioventricular valves and aortic valve, and the presence of residual shunt. ResultsThere was no perioperative death or complication. VSD occlusion was successfully performed in 20 out of 21 patients (95.2%). One patient received conversion to open VSD repair under extracorporeal circulation because VSD size was too big. Mean time of delivery of occluders was 32±16 minutes, the size of the occluders was 5±3 mm, and length of hospital stay was 6-8 days. All the patients were followed up for 3-6 months after discharge. During follow-up, echocardiography showed clear echo and normal position of the occluders, and there was no mild or more severe residual shunt or valvular regurgitation. ConclusionTEE-guided occlusion of infundibular VSD via minithoracotomy is easy to perform and safe with satisfactory clinical outcomes.
ObjectiveTo summarize the experiences of minimally invasive occlusion of ventricular septal defect (VSD) via small chest incision. MethodsWe retrospectively analyzed the clinical data of 131 infants with VSD in Hebei children's Hospital between March 2013 and September 2014, including 83 patients with perimembranous VSD, 24 patients with membranous aneurysm and 24 patients with intracristal VSD. There were 63 males and 68 females with a mean age of 35.28±29.22 months and a mean body weight of 14.56±7.47 kg. Before surgery, a multiple-section transthoracic echocardiography (TTE) was employed to evaluate various parameters of the VSD. Under general anesthesia, a small incision was made to expose the right ventricle. Under TEE guidance, proper device was delivered and deployed to close the defect. Patients also received postoperative following-up by transesophageal echocardiogram (TEE) at regular intervals. ResultsOne hundred twenty-nine patients were successfully performed operation. Two patients were converted to perform traditional surgical closure with cardiopulmonary bypass (cPB). concentric devices were used in 52 patients and eccentric devices were used in 77 patients. During the following-up (1-12 months) period, complications occurred in three patients. Massive pericardial effusion appeared and disappeared after pericardicentesis in one patient. The occlusion device was dislocated in the next day after operation and took out by cPB operation in one patient. There was an asymptomatic residual shunt at 1 mm in one patient. ConclusionThe minimally invasive occlusion of VSD via small chest incision is a safe and effective treatment. It should be encouraged to use in the clinical practice.
目的 探索手术对低出生体重先天性心脏病患儿的临床疗效以及围术期的处理办法。 方法 回顾性分析 2012 年 1 月至 2015 年 6 月我院行心内直视根治性手术的 788 例低出生体重先天性心脏病患儿的临床资料，其中男 379 例，女 409 例，平均年龄 4.5（1～6）个月，出生时平均体重 1 780～2 500（1 844.6±44.5）g。对患儿手术时间、围术期处理以及手术成功率等情况进行观察分析。 结果 心内直视根治术平均手术时间 110～240（132±18）min，平均体外循环时间 32～120（80±20）min，平均主动脉阻断时间 15～45（35±11）min，平均呼吸机辅助治疗时间 5～96（15±5）h。患儿术后治愈总有效率达到 96.8%，死亡率 3.2%，患儿的治愈效果较显著。 结论 加强围术期处理可以有效地提高患儿的存活率，改善患儿的生活质量，因此低出生体重先天性心脏病患儿早期治疗方式值得在临床工作中推广应用。
Objective To explore the hemodynamic assessment after radical surgery in children with tetralogy of Fallot (TOF) by both echocardiography and Mostcare monitor. Methods Clinical data of 63 children with TOF who underwent radical surgery in our hospital from February 2016 to June 2018 were retrospectively analyzed, including 34 males and 29 females, aged 6-24 (9.82±5.77) months. There were 19 patients undergoing transannular patch reconstruction of the right ventricular outflow tract (a transannular patch group) while 44 patients retained the pulmonary valve annulus (a non-transannular patch group) . The echocardiography and Mostcare monitor parameters were recorded and brain natriuretic peptide was tested at the time points of 0, 8, 12, 24 and 48 hours after operation (T 0, T 1, T 2, T 4) to analyze their correlations and the change trend at different time points after radical surgery. Results The left ventricular ejection fraction at T 1 (43.49%±3.82%) was lower than that at T 0 (48.29%±4.55%), T 2 (45.83%±3.69%), T 3 (53.76%±4.43%) and T 4 (60.54%±3.23%, P<0.05). The cardiac index at T 1 (1.85±0.35 L·min−1·m−2) was lower than that at T 0 (2.11±0.38 L·min−1·m−2), T 2 (2.07±0.36 L·min−1·m−2), T 3 (2.42±0.37 L·min−1·m−2) and T 4 (2.82±0.42 L·min−1·m−2, P<0.05). The cardiac circulation efficiency at T1 (0.19±0.05) was lower than that at T 0 (0.22±0.06), T 2 (0.22±0.05), T 3 (0.28±0.06) and T 4 (0.34±0.06, P<0.05). The right ventricular two-chambers view fraction area change at T 1 (23.17%±3.11%) was lower than that at T 0 (25.81%±3.74%), T 2 (25.38%±3.43%), T 3 (30.60%±4.50%) and T 4 (36.94%±5.85%, P<0.05). The pulse pressure variability was the highest at T 0 (18.76%±3.58%), followed by T 1 (14.81%±3.32%), T 2 (12.44%±2.94%), T 3 (10.39%±2.96%) and T 4 (9.18%±1.92%, P<0.05). The blood brain natriuretic peptide was higher at T 1 (846.67±362.95 pg/ml) than that at T 0 (42.60±18.06 pg/ml), T 2 (730.95±351.09 pg/ml), T 3 (510.98±290.39 pg/ml) and T 4 (364.41±243.56 pg/ml, P<0.05). There was no significant difference in left ventricular ejection fraction, cardiac circulation efficiency and heart index between the two groups (P>0.05). The right ventricular two-chambers view fraction area change of the transannular patch group was significantly lower than that of the non-transannular patch group at each time point (P<0.05). The blood brain natriuretic peptide and pulse pressure variability of the transannular patch group were significantly higher than those of the non-transannular patch group (P<0.05). Left ventricular ejection fraction was positively correlated with cardiac index (r=0.637, P=0.001) and cardiac circulation efficiency (r=0.462, P=0.001) while was significantly negatively correlated with blood brain natriuretic peptide (r=–0.419, P=0.001). Conclusion Both methods can accurately reflect the state of cardiac function. Mostcare monitor has a good consistency with echocardiography. Using transannular patch to recontribute right ventricular outflow tract in operation has more influence on right ventricular systolic function. The Mostcare monitor can guide the hemodynamic management after surgery in real time, continuously and accurately.