ObjectiveTo evaluate the early- and mid-term outcomes of surgical repair of persistent truncus arteriosus in children in a single institution of China.MethodsThe clinical data of 27 consecutive patients with persistent truncus arteriosus undergoing surgical repair in Guangzhou Women and Children’s Medical Center from November 2009 to May 2018 were retrospectively reviewed. There were 14 males and 13 females. Median age was 3.0 months (range: 13 days -11 years), of whom 10 (37.0%) were older than 6 months. ResultsThere were three early deaths with a mortality of 11.1%. The main complications included VSD partial repair in 2 patients, complete atrioventricular block in one patient. The mean follow-up time was 24.5±19.3 months (range: 1–76 months). There were three late deaths, and two patients lost follow. Echocardiology showed seven patients of right heart outflow tract obstruction, including three in pulmonary artery trunk, and four of pulmonary artery branches. One patient showed moderate aortic valve regurgitation. None required re-intervention during the follow-up. Survival estimates for the entire cohort following surgery were both 76.1% (95%CI 59.2% to 92.9%) at 1 year and 5 years.ConclusionThe surgical repair of persistent truncus arteriosus (PTA) remains challenges. The early- and mid-term outcomes of surgical repair of persistent truncus arteriosus are acceptable. For older children with severe pulmonary artery hypertension and/or trunk valve regurgitation, the risk of death is still higher. Some children have the higher risk of late right heart obstructive lesions.
Objective To explore the efficacy of humidified high flow nasal cannula ( HHFNC) for respiratory failure after ventilator weaning in post-operative newborns and infants with congenital heart disease. Methods FromJanuary 2010 to August 2010, 33 newborns and infants [ ( 7. 8 ±8. 4) months, range 3 days to 36 months; weight ( 6. 6 ±3. 6) kg, range 2. 2 to 19. 6 kg] were treated with HHFNC ( 22 cases) and routine oxygen therapy ( 11 cases) for respiratory failure following ventilator weaning after operation of congenital heart disease. Symptoms, blood oxygen saturation ( SpO2 ) , partial pressure of oxygen( PaO2 ) , partial pressure of carbondioxide ( PaCO2 ) , incidence rate of re-intubation, duration of ICU, and hospital stay were assessed and compared between the HHFNC group and the routine oxygen therapy group.Results There were no statistical significance in the duration of ICU, hospital stay, duration of mechanical ventilation, or infection rate between the HHFNC group and the routine oxygen therapy group ( P gt; 0. 05) . But the incidence rate of re-intubation was lower in the HHFNC group than that in the routine oxygen therapy group. Meanwhile SpO2 and PaO2 increased and PaCO2 decreased significantly in the HHFNC group ( P lt;0. 05) . Conclusion HHFNC shows a clinical improvement rapidly and efficiently in preventing respiratory failure after ventilator weaning in post-operative newborns and infants with congenital heart disease.
ObjectiveTo review our clinical experience of modified Fontan procedure for complex congenital heart disease (CHD) in children. MethodsClinical data of 62 children with complex CHD who underwent modified Fontan procedure in Guangzhou Women and Children's Medical Center from May 2008 to December 2013 were retrospectively analyzed. There were 41 male and 21 female patients with their median age of 4 years(range, 16 months to 14 years) and body weight of 12.5 (8.9-49.5) kg. Diagnosis included functional single ventricle in 45 patients, transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) in 6 patients, corrected TGA with VSD and LVOTO in 6 patients, double outlet right ventricle with severe pulmonary stenosis in 4 patients, and right ventricular dysplasia in 1 patient. Previous procedure included pulmonary artery banding in 10 patients, unilateral bidirectional Glenn shunt in 37 patients, and bilateral bidirectional Glenn shunt in 8 patients. Seventeen patients received single-stage modified Fontan procedure, and 45 patients received two-stage modified Fontan procedure. Extracardiac conduit was used in 56 patients, and lateral tunnel was used in 6 patients. Concomitant procedures included fenestration in 41 patients, atrioventricular valvuloplasty in 6 patients, and pulmonary artery angioplasty in 3 patients. ResultsTwo patients in both single-stage and two-stage groups died postoperatively with mortality of 11.8% and 4.4% respectively (P=0.299). Postoperative mechanical ventilation time, length of ICU stay, chestdrainage duration, postoperative hospital stay and morbidity were not statistically different between single-stage and two-stage group. Mean follow-up was 2.0 ±0.5 years (range, 3 months to 5 years). There were 2 late death in the singlestage group but no late death in the two-stage group. Growth of all survival children was good, and their exercise capacity significantly improved. Percutaneous oxygen saturation was higher than 90%. Echocardiography showed patent superior and inferior vena cava anastomosis without thrombosis, stenosis, atrioventricular valve regurgitation aggravation or pulmonary venous return obstruction. All survival patients were in New York Heart Association class Ⅰ or Ⅱ. None of the patients had arrhythmia, chronic effusion or protein losing enteropathy. ConclusionEarly and mid-term results of modified Fontan procedure were satisfactory for children with complex CHD. For children with high risk factors, staged Fontan procedure can reduce surgical mortality.
ObjectiveTo analyze the risk factors for delayed sternal closure (DSC) in the operation for the neonates with congenital heart defects. MethodsWe retrospectively analyzed the case notes of the 203 neonates with congenital heart defect in our hospital between January 2010 and June 2014. There were 152 males and 51 females at age of 0-28 (17.68±8.62) days. The relative factors were analyzed by univariate and multivariate logistic regression. ResultsThese factors significantly correlated with DSC in univariate analysis:age at operation, premature, low weight (weight≤2.5 kg) at operation/weight at operation, RACHS-1, mechanical ventilation before operation, continuous use of intravenous cardiovascular drugs before operation, CPB time, aortic clamping time, total circulatory arrest with profound hypothermia. The results of logistic regression analysis showed that weight at operation/low weight, pre-operative mechanical ventilation, total circulatory arrest with profound hypothermia were independent risk factors for DSC. ConclusionWeight at operation/low weight, pre-operative mechanical ventilation, and total circulatory arrest with profound hypothermia are the independent risk factors for DSC in the operation for the neonates with congenital heart defects.