ObjectiveTo evaluate the possibility of monitoring regional tissue oxygen saturation by near-infrared spectroscopy (NIRS) for early predicting adverse events in patients with pulmonary atresia.MethodsTwenty-six patients aged under 3 months who were diagnosed with pulmonary atresia and admitted to cardiovascular intensive care unit in our hospital between January 2016 and May 2017, accepted regional tissue oxygenation (cerebral and splanchnic) by near-infrared spectroscopy. There were 19 males and 7 females at age of 2–89 days. A total of 625 times of heart rate, blood pressure, pulse saturation, regional tissue oxygenation, and 98 serum lactate were retrospectively analyzed. The relationship of the tissue oxygen saturation and clinical adverse events was explored.ResultsThe adverse event by routine monitoring was 69 (11.04%) person-time: isolated hypoxia in 27, hypoxia combined increased lactate in 16, hypotension in 6, hypotension combined increased lactate in 17, isolated increased lactate in 3. A reduction of 12.80% in cranial oxygen predicted the high probability of adverse events, with a sensitivity of 85.30% and a specificity of 87.00%. A reduction of 20.60% in splanchnic oxygen predicted the high probability of adverse event, with a sensitivity of 73.50% and a specificity of 91.2%. On average, the splanchnic oxygenation had fell 3 minutes before a reduction of blood pressure, or 45 minutes before an increase in lactate.ConclusionFor preoperative patients with pulmonary atresia, a fall of 12.80% in cranial oxygen saturations, or of 20.60% in splanchnic oxygen saturation, should attract clinician’s awareness.
Objective To explore the feasibility and option of different surgeries for neonates with pulmonary atresia and ventricular septal defect (PA/VSD) through assessing the effect of common surgeries. Methods Fourteen neonates who underwent their first surgery in our center from July 2004 to October 2014 were included. Their basic characteristics, operation and pre- and postoperative clinical information were extracted. Follow up was conducted and the last visit was on October 10, 2016. Short- and midterm survival and total correction rate were compared among different surgeries. Results Among the 14 patients, there were 4 (28.6%) patients, 6 (42.9%) and 4 (28.6%) who underwent one-stage repair, right ventricular outflow tract (RVOT) reconstruction, and systemic to PA shunt operation respectively. The overall in-hospital mortality after the first operation was 28.6% (4/14). At last visit, no death occurred resulting the 5-year survival rate of 71.4% (10/14). The overall total correction rate for all neonates was 64.3% (9/14). Although no statistical difference was found in the mortality among the one-stage repair , RVOT reconstruction and systemic to PA shunt group(50.0% vs. 33.3% vs. 0.0%, P=0.280), the survival and hazard analysis implied better outcomes of the systemic to PA shunt palliation operation. There was no statistical difference in the total correction rate and months from the first palliative operation to correction between those who underwent RVOT reconstruction and systemic to PA shunt (75.0% vs. 50.0%, P=0.470; 32.0 months vs. 18.0 months, P=0.400). Conclusion Performing surgeries for neonates with PA/VSD is still a great challenge. However, the midterm survival rate was optimistic for the early survivors. Systematic to PA shunt seemed to be a better choice with lower mortality for the neonates with PA/VSD who need the surgery to survive.
ObjectiveTo analyze the outcomes of complicated congenital heart diseases (CCHD) patients accepting multiple (>2) re-sternotomy operations.MethodsWe retrospectively analyzed the clinical data of 146 patients undergoing multiple cardiac re-sternotomy operations between 2015 and 2019 in our center. There were 95 males and 51 females with an age of 4.3 (3.1-6.8) years and a weight of 15.3 (13.4-19.0) kg at last operation.ResultsThe top three cardiac malformations were pulmonary atresia (n=51, 34.9%), double outflow of right ventricle (n=36, 24.7%) and functional single ventricle (n=36, 24.7%). A total of 457 sternotomy procedures were performed, with 129 (88.3%) patients undergoing three times of operations and 17 (11.7%) patients undergoing more than three times. Fifty-two (35.6%) patients received bi-ventricular repair, 63 (43.1%) patients received Fontan-type procedures, and 31 (21.2%) patients underwent palliative procedures. Ten (6.8%) patients experienced major accidents during sternotomy, including 7 (4.8%) patients of urgent femoral artery and venous bypass. Eleven (7.5%) patients died with 10 (6.8%) deaths before discharge. The follow-up time was 20.0 (5.8-40.1) months, and 1 patient died during the follow-up. The number of operations was an independent risk factor for the death after operation.ConclusionSeries operations of Fontan in functional single ventricle, repeated stenosis of pulmonary artery or conduit of right ventricular outflow tract post bi-ventricular repair are the major causes for the reoperation. Multiple operations are a huge challenge for CCHD treatment, which should be avoided.