Abstract: Objective To review the shortterm outcome of modified Nikaidoh operation, aortic translocation and biventricular outflow tract reconstruction as an alternative surgical procedure for the treatment of transposition of the great arteries with ventricular septal defect and pulmonary stenosis (TGA/VSD/PS). Methods Between January 2004 and December 2005, 8 consecutive patients had undergone Nikaidoh procedure for the treatment of TGA/VSD/PS at Shanghai Children’s Medical Center. All patients had ventriculoarterial discordance and atrioventricular concordance. Associated lesions included a straddling atrioventricular valve in one patient and hypoplastic left pulmonary artery. The median age at operation was 11.4±7.6months (4 to 29months). Weight of body was 8.0±1.9kg (5.2 to 11.0kg). No patient had previous palliative procedure. The surgical technique used was a modification of the Nikaidoh procedure. Results The median total cardiopulmonary bypass time was 176±50 minutes (range,112 to 250 minutes), and the median aortic crossclamp time was 101±27 minutes (range, 73 to 139minutes). The median length of stay in the intensive care unit was 12±9 days, with a median hospital stay of 19±12 days. There was 1 hospital death as a esult of severe left ventricle failure. There was no residual left ventricular outflow tract obstruction (LVOTO) and right ventricular outflow tract obstruction (RVOTO), but 3 patients with mild to moderate pulmonary regurgitation and 4 patients with moderate. At a median follow-up of 8.8 months (range, 3 to 18months), all patients were alive. All have the normal ventricular function. There were ejection fraction (EF) 0.64±0.02 and fractional shortening (FS) 0.33±0.02. None of the patients developed aortic insufficiency and progressed LVOTO or RVOTO. Conclusions Nikaidoh procedure is a valuable surgical option for TGA/VSD/PS in infant, especially in the presence of “inadequate anatomy” for a Rastelli repair. Big evidence and longer follow-up are required to fully assess the potential longterm benefits of this procedure compared with the Rastelli repair.
Objective To evaluate the effect of cardiopulmonary bypass （CPB） on pulmonary function in infants with variable pulmonary arterial pressure resulting from congenital ventricular septal defect （VSD）. Methods Twenty infants with VSD underwent corrective surgery were divided into pulmonary hypertension group （n= 10） and non-pulmonary hypertension group （n= 10） according to with pulmonary hypertension or not. Pulmonary function was measured before CPB , 3h,6h,9h,12h,15h,18h,21h, and 24h after CPB and duration for mechanical ventilation and cardiac intensive care unit stay were recorded. Results Pulmonary function parameters before CPB in nonpulmonary hypertension group were superior to those in pulmonary hypertension group （P〈0.01）, and pulmonary function parameters after CPB deteriorated than those before CPB （P〈0.05）, especially 9h,12h and 15h after CPB （P〈0.01）. Compared to pulmonary function parameters before CPB, pulmonary function parameters of pulmonary hypertension group at 3h after CPB were improved （P〉0.05）, but they deteriorated at 9h,12h and 15h after CPB （P〈0. 05）. Pulmonary function parameters at 21h and 24h after CPB was recoverd to those before CPB in two groups. Conclusions Although exposure to CPB affects pulmonary function after VSD repair in infants, the benefits of the surgical correction to patients with pulmonary hypertension outweigh the negative effects of CPB on pulmonary function. Improvement of cardiac function can avoid the nadir of pulmonary function decreasing. The infants with pulmonary hypertension will be weaned off from mechanical ventilator as soon as possible, if hemodynamics is stable, without the responsive pulmonary hypertension or pulmonary hypertension crisis after operation.
Objective To investigate the hospital outcomes and therapeutic strategy for multiple organ dysfunction syndrome （MODS） in children after cardiac surgery. Methods Seventy-seven consecutive pediatric patients （57 male/20 female, age 3.47±3.67 years, weight 13.08±7.52 kg） with MODS after cardiac surgery were enrolled in the study from 1999.7 to 2005.10. Corrective and palliative operation were performed in sixty-six patients and eleven patients, respectively. We evaluated the clinical score for all study patients according to the extent of organ injury. Results The overall mortality rate was 28. 6%（22/77）. （1） Cardiovascular, renal, hepatic, hematologic, neurologic and respiratory dysfunction was present in 100% （77/77）, 97.4% （75/77）, 84.4% （65/77）, 48.1%（37/77）, 45. 5%（35/77） and 44. 2%（34/77） of the patients, respectively. Cardiac injury appeared much earlier than other organs （P〈0. 05）. （2） Mortality rate with two, three, four, five and six dysfunctional organ systems was 0%, 12.5 %, 31.8 %, 42. 9 % and 87.5 %, respectively （r=0.487, P〈0. 001 in trend）. Furthermore, there was a positive correlation between the clinic score and mortality rate （r=0.603, P〈0. 001）. （3） Compared with survivors, non-survivors had longer cardiopulmonary bypass time, clamping time, higher incidence of accidental events and cardiopulmonary resuscitation during and after surgery （P〈0. 05）. Conclusion Mortality associated with MODS was highly correlated with the number of organ failing and clinical score. Cardiac dysfunction was the primary disease in MODS after cardiac surgery. Therefore, therapeutic strategy for MODS should be focused on management of primary disease, as well as providing consecutive evaluation and improvement for organ function.
Objective To evaluate the effect of exogenous pulmonary surfactant(PS) replacement therapy for infants who suffered pulmonary injury after cardiopulmonary bypass. Methods Seven infants (age 0.49±0 82 year, weight 4.87±2.18kg) who depended on respiratory mechanical support with clinical and radiological evidence of pulmonary surfactant sufficiency were enrolled in the study. Oxygen index(OI), artery oxygen saturation(SaO 2) and artery bicarbonate pressure(PaCO 2) were measured at 4, 6, 12, 24, 48, and 72 h after the first application of PS(100mg/kg). At the meantime, maximum spontaneous respiratory tidal volume, chest X ray changes and ventilator time were recorded. Results Compared to the baseline values, OI and SaO 2 increased significantly 4 h after PS therapy, with a maximal increase slope (34.7%, 6.6%) after 24 h. While PaCO 2 decreased significantly 4 h after PS therapy, with a lowest decrease slope (22.8%) after 6 h ( P lt;0.05, 0.01). Spontaneous tidal volume and chest X ray si...更多gn were improved in all infants. The success rate of extubation was 85 7%. Conclusion Exogenous PS replacement therapy could improve pulmonary function for postoperative infants, and highly decrease the ventilator time.
Abstract: Objective To evaluate the protective effects of Ulinastatin on the peri-operative liver and renal function in patients undergoing cardiac surgery for tetralogy of Fallot (TO F). Methods Thirty-eight patients with TOF were divided into Ulinastatin group and control group according to admission sequence, 19 cases in each group.For Ulinastatin group, intravenous Ulinastatin was given with a dosage of 10 000U /kg at 1h before operation, 1h and 24 h after operation. For control group, no Ulinastatin was given. 10 ml fresh urine and 2 ml blood samples were collected before operation, and postoperative 1h, 10h, 24h, 48h and 72h, respect ively. The liver and renal functions were measured. Fluid intake, urine output, chest drainage, dosage of furosemide, durations of mechanical ventilation and intensive care unit ( ICU ) stay were recorded. Results Neither arrhythmia nor low cardiac output syndrome occurred for both groups. No peri-operative death. Compared with control group, dose of furosemide, period of mechanical ventilation were lower, while urine output was higher in Ulinastat in group; the aberrant climax value of urine pro tein and N-acetylglucosam inidase (NAG) were lower in Ulinastatin group (10h post-operat ively, urinem icroalbum in: 65. 2 ± 58. 3mg/L vs. 71. 8 ±58. 9mg/L ; urine transferrin: 5. 8 ± 3. 6mg/L vs. 7. 4 ± 5. 4mg/L ; urine immunoglobulin G: 26. 9±20. 3mg/L vs. 31. 3±23. 3mg/L ; 1h post-operat ively; urine NAG: 61. 4±81. 6U /L vs. 76.1±48. 5 U /L ; P lt; 0. 05) and maintained in shorter period (P lt; 0. 05) , it returned to baseline value at 48h and 72 h post-operatively. The value of alanine aminotransferase (ALT) significantly increased post-operatively at every time points in control group (P lt; 0. 01) , w hile no obvious change in Ulinastat in group (P gt; 0. 05). The increased value of aspartate aminotransferase (AST ) in Ulinastatin group was significantly lower than that in control group (10h post-operat ively: 144. 4±20. 8U /L vs. 202. 7±74. 1U /L ; P lt; 0. 01). The value of AST returned to baseline value at 48h and 72h post-operat ively. Conclusion U linastatin is an effect ive strategy for protecting peri-operat ive liver and renal function of the patients with tetralogy of Fallot and the clinical application of Ulinastatin is safe and effective.