Abstract: The cyanotic congenital heart defect remains a focal point to study in congenital heart diseases. A successfully developed model of cyanotic congenital heart defect can contribute to a profound advancement of clinical diagnosis and treatment. Various kinds of animal models simulating cyanotic heart diseases have been created and improved step by step , such as experimental pulmonary arteriovenous fistulas, inferior vena cava-left atrium shunt, pulmonary artery-left atrium shunt and breeding animals in mionect ic environment. As an important means, they are used to investigate the animal’s pathophysilolgocal characteristics in cyanotic and hypoxic state. However, it need a further exploration since these models are not fully perfect yet.
ObjectiveTo summarize our clinical experience of bidirectional Glenn procedure (BGP) for the treatment of complex cyanotic congenital heart disease (CHD). MethodsClinical data of 68 patients with complex cyanotic CHD who underwent BGP in People's General Hospital of Xinjiang Uygur Autonomous Region from January 2007 to December 2012 were retrospectively analyzed. There were 40 male and 28 female patients with their average age of 3.9 years (range, 3 months to 22 years) and body weight of 6.2-53.0 (13.6±8.5)kg. Preoperative diagnosis included tricuspid atresia in 20 patients, single ventricle (SV) in 11 patients, double outlet right ventricle in 10 patients, complete transposition of great arteries in 7 patients, tricuspid stenosis in 5 patients, pulmonary atresia in 5 patients, corrected transposition of great arteries in 4 patients, tetralogy of Fallot in 4 patients and Ebstein's anomaly in 2 patients. Among them, there were 14 patients with dextrocardia or dextroversion of the heart, 2 patients with SV and pulmonary hypertension after pulmonary artery banding, and 1 complete transposition of great arteries patient after aortopulmonary shunt. Twenty-three patients received BGP under cardiopulmonary bypass (CPB) and 45 patients received BGP without CPB. ResultsTwo patients died postoperatively, including 1 patient with severe low cardiac output syndrome (LCOS) and another patient with pulmonary infection. Postoperative pulse oximetry oxyhemoglobin saturation (SpO2, 89.3%±7.4%) was significantly higher than preoperative SpO2 (66.8%±11.8%, P < 0.05). In 53 patients, postoperative SpO2 was more than 10% higher than preopera-tive SpO2. Postoperative hematocrit (0.40±0.07) was significantly lower than preoperative hematocrit (0.49±0.11, P < 0.05). Postoperative complications included pleural effusion in 16 patients (23.5%), chylothorax in 7 patients (10.3%), LCOS in 5 patients (7.4%), arrhythmias in 4 patients (5.9%), and pneumothorax in 1 patient (1.5%), who were all cured after appropriate treatment. Fifty-five patients were followed up for 9 months to 6 years after discharge with satisfactory clinical results. All anastomoses remained patent without stenosis or thrombosis. Four patients successfully received total cavopulmonary connection 2 to 5 years after discharge. ConclusionBGP is safe and reliable for patients with complex cyanotic CHD who cannot undergo anatomic correlation or one-stage repair.
ObjectiveTo investigate the influence of immunoglobulin (Ig)on celluar immune function of postoperative infants with cyanotic congenital heart disease (CCHD). MethodsForty infants who underwent surgical repair of CCHD in Department of Cardiac Surgery, Children's Hospital of Hebei Province from March to December 2012 were enrolled in this study. All the patients were randomly divided into 2 groups. Patients in Ig group received intravenous Ig treatment at the dosage of 1g/ (kg·day)for 2 days postoperatively in addition to routine therapy. Patients in the control group only received routine therapy without Ig treatment. Five ml venous blood samples of all the patients were taken preoperatively, 0.5 hour and 2 days postoperatively to examine serum levels of interferon gamma (IFN-γ)and interleukin-4 (IL-4)with double-antibody sandwich enzyme-linked immunosorbent assay (ELISA), which were compared between the 2 groups. ResultsThere was no statistical difference in serum levels of IL-4 or IFN-γ preoperatively and at 0.5 hour postoperatively between the 2 groups (P > 0.05). Serum levels of IL-4 and IFN-γ at 0.5 hour postoperatively were significantly higher than preoperative levels in the 2 groups respectively (P=0.000). Serum IL-4 level of Ig group 2 days postoperatively was not statistically different from preoperative level (P=0.362), while serum IL-4 level of the control group 2 days postoperatively was significantly higher than preoperative level (P=0.006). Two days after the operation, serum levels of IL-4 and IFN-γ of Ig group were significantly lower than those of the control group respectively (P=0.039 and 0.007 respectively). Compared with serum levels at 0.5 hour postoperatively in the control group, serum IL-4 level at 2 days postoperatively decreased by 20.08% (P=0.001), and serum IFN-γ increased by 17.80% (P=0.001). Compared with serum levels at 0.5 hour postoperatively in Ig group, serum IL-4 level at 2 days postoperatively decreased by 35.38% (P=0.000), and serum IFN-γ only increased by 7.60% (P=0.143). ConclusionCellular immune function disorder caused by the operation and cardiopulmonary bypass can be effectively improved by postoperative intravenous Ig administration, which may help to reduce postoperative complications.
ObjectiveTo compare the anti-apoptotic potency of human mesenchymal stem cells (hMSCs) derived from patients with cyanotic congenital heart diseases (C-CHD) or acyanotic congenital heart diseases (A-CHD) in vitro and explore the possible mechanism. MethodshMSCs were isolated from patients with cyanotic (Group C) or acyanotic (Group A) congenital heart diseases and cultured in a hypoxic incubator (1% O2, 5% CO2, 94% N2) in vitro. The anti-apoptotic potency of the hMSCs was assayed by the Annexin V-FITC/PI double labeled flow cytometry. The content of B-cell lymphoma-2 (Bcl-2), Bax and caspase-3 in both groups was determined by Western blot. ResultsFlow cytometry results revealed that hMSCs from C-CHD patients presented higher level of resistance to ischemia-and anoxia-induced apoptosis with lower overall (P<0.05) and early apoptosis ratio (P<0.01). Further Western blot examination identified that C-CHD-derived hMSCs produced more Bcl-2 (P<0.05) but less Bax (P<0.05) and caspase-3 (P<0.05) in comparison to their A-CHD-derived ones. ConclusionC-CHD-derived hMSCs presented the superiority for the anti-apoptotic potential, and the possible mechanism is the favorable change of Bcl-2, Bax and caspase-3 induced by the natural hypoxic and anoxic precondition.
Objective To investigate the iron deficiency (ID) in children with congenital heart disease (CHD) and find high risk factors of ID. Methods The clinical data of 227 pediatric patients with CHD from February to June 2016 were retrospectively analyzed. The incidence of ID according to the result of iron metabolism examination (serum ferritin <12 μg/L as the diagnostic criteria) was investigated. According to their basic CHD types, patients were divided into a cyanotic group and an acyanotic group. We tried to find the high risk factors of ID in those pediatric CHD patients by comparing their age, gender, growth condition and blood routine test results. Results There were 19.8% pediatric CHD patients complicated by ID. The incidence of ID in the cyanotic patients was higher than that in the acyanotic patients (31.0% vs. 17.3%, P=0.045). In both groups, ID patients presented the characteristics of younger age, higher anemia rate, lower mean corpuscular volume (MCV), lower mean corpuscular hemoglobin (MCH), lower mean corpuscular-hemoglobin concentration (MCHC) and longer red blood cell distribution width (RDW). Conclusion Cyanosis, younger age (infant), anemia, decreased MCV, decreased MCH, decreased MCHC and increased RDW are high risk factors of ID in CHD children.