Objective To observe the effect of glutamine （Gln） on intestinal permeability after surgery of children, also its influence on the plama level of interleukin-2（IL-2）, endotoxin and synthesize of protein through a random nutrition trial. Methods Twenty children suffered from congenital heart disease were divided into Gln group and control group with random number table, 10 cases in each group. They were all given isonitrogenous and isocaloric total paraenteral nutrition after 24 h postoperatively. In Gln group the Dipeptiven [-N （2）-L-alanyl-Lglutamine] was used with 2 ml/kg · 24h additionly. Before operation, 24h and 96 h after operation, intestinal permeability, serum level of endotoxin, IL-2, C-reaction protein, prealbumine were measured. Results Intestinal permeability increased in 24 h after cardiac surgery in two groups, while the concentration of endotoxin also increased, 96 h after surgery the intestinal permeability recovered, but the endotoxin level did not decrease in control group （P〈0. 01）. Conclusion Utilization of Gln can improve immune suppression, elevate the IL-2 level, decrease the endotoxin concentration, alleviate the infection, but has no effect on the protein synthesis after congenital cardiac operation of children.
Objective
To summarize the clinical characteristics of coarctation of the aorta (CoA) associated with intracardiac anomalies in infants.
Methods
The data from August 2009 to August 2017 of 86 infants who were diagnosed with CoA associated with intracardiac anomalies were analyzed. Preoperative diagnosis, surgical findings and post-operation follow-up were analyzed retrospectively. There were 56 males and 30 females at age of 1–346 (95.1±78.0)d. All the included patients underwent single-stage repair of CoA associated with intracardiac anomalies.
Results
Mean operative time was 279.0±56.4 min, mean cardiopulmonary bypass time was 162.3±51.0 min, and mean aorta cross-clamp time was 74.7±25.2 min. Mean length of ICU stay and ventilation time was 7.4±4.7 days and 101.1±75.4 hours, respectively. The residual transcoarctation gradient before discharge was lower than pre-operative transcoarctation gradient significantly (42.3±17.7 mm Hg vs. 22.1±9.4 mm Hg, P<0.001), and 7 early deaths were observed after surgery. The mean follow-up time of 79 hospital survivors was 31.0±27.4 months. And no late death was found. Transcoarctation gradient of hospital survivors in the last time follow-up was 21.2±11.0 mm Hg. Transcoarctation gradient of 29 patients was higher than 20 mm Hg. However, only 4 patients with significant clinical symptom of lower limbs retardation were recommended for ballon angioplasty consultant. The cumulative recoarctation-free survival in 2-year follow-up was 69.2%.
Conclusions
To avoid early second-stage operations, single-stage repair of CoA associated with intracardiac anomalies is effective and safe, and the outcomes of early to mid term follow-up are satisfactory.
The multi-window time-frequency reassignment helps to improve the time-frequency resolution of bark-frequency spectral coefficient (BFSC) analysis of heart sounds. For this purpose, a new heart sound classification algorithm combining feature extraction based on multi-window time-frequency reassignment BFSC with deep learning was proposed in this paper. Firstly, the randomly intercepted heart sound segments are preprocessed with amplitude normalization, the heart sounds were framed and time-frequency rearrangement based on short-time Fourier transforms were computed using multiple orthogonal windows. A smooth spectrum estimate is calculated by arithmetic averaging each of the obtained independent spectra. Finally, the BFSC of reassignment spectrum is extracted as a feature by the Bark filter bank. In this paper, convolutional network and recurrent neural network are used as classifiers for model comparison and performance evaluation of the extracted features. Eventually, the multi-window time-frequency rearrangement improved BFSC method extracts more discriminative features, with a binary classification accuracy of 0.936, a sensitivity of 0.946, and a specificity of 0.922. These results present that the algorithm proposed in this paper does not need to segment the heart sounds and randomly intercepts the heart sound segments, which greatly simplifies the computational process and is expected to be used for screening of congenital heart disease.
Total anomalous pulmonary venous connection (TAPVC) is a relatively rare but complex congenital heart disease characterized by the anomalous drainage of the pulmonary veins. Rather than connecting to the left atrium, the pulmonary veins drain either directly or indirectly into the systemic venous circulation or the right atrium via abnormal pathways. While there is broad consensus on the diagnostic criteria for TAPVC, significant debate persists regarding the optimal timing of surgical intervention, preferred surgical techniques, and postoperative management including re-intervention strategies. This article formulates a Chinese consensus based on evidence-based data from the literature and opinions from domestic experts, with the goal of further standardizing the surgical treatment of TAPVC in China.
Objective To investigate the effect of new type ultrafiltration technique in preventing and relieving the main organ injury that may follow open heart surgery with cardiopulmonary bypass (CPB),and improve the operative effects and decrease the postoperative complications. Methods Thirty patients with congenital heart diseases were randomly divided into two groups. Modified ultrafiltration group: modified ultrafiltration was used after CPB; new type ultrafiltration group: new type ultrafiltration technique was used throughout CPB. The serum concentrations of nflammatory mediators,hematocrit,serum albumin concentrations, pulmonary function, operative duration time and main organ function parameters were measured in both groups. Results Ultrafiltration time after CPB in new type ultrafiltration group was significantly shorted as compared with modified ultrafiltration group（6.35±1.28 min vs. 12.45±4.52 min，P=0.000）; serum concentrations of interleukin6(IL-6)and tumor necrosis factor α(TNF-α) after CPB were significantly decreased as compared with modified ultrafiltration group（292.84±58.23 μg/L vs. 383.79±66.24 μg/L,P=0.000; 13.32±2.31 μg/L vs. 16.41±2.65 μg/L,P=0.000）; the hematocrit and serum albumin concentrations at the ten minutes after CPB were increased as compared with modified ultrafiltration group (0.39±0.04 vs. 0.35±0.03,P=0.003; 38.32±4.26 g/L vs. 34.04±2.83 g/L, P=0.003); the mechanical ventilation support time and ICU time after operation was shorted as compared with modified ultrafiltration group (Plt;0.05); main organ function was improved as compared with the modified ultrafiltration group. Conclusion The clinical application of new type ultrafiltration throughout CPB can effectively exclude some harmful inflammatory mediators, concentrate blood,short operation time,attenuate the main organ edema and injury.
Objective To compare the clinical effect between high flow rate modified ultrafiltration （HMUF） and conventional modified ultrafiltration（CMUF）, and the effect on hemodynamic data and inflammatory mediators. Methods Forty children were divided into two groups with random number table, HMUF group and CMUF group, 20 cases each group. Hematocrit （HCT） and hemodynamic changes were recorded and the concentration of tumor necrosis factor （TNF） and interleukin 6 （IL-6） were measured. Results The operations were done uneventfully with moderate hypothermia cardiopulmonary bypass in 40 patients. Duration of ultrafiltration of HMUF group （7.83±0. 75 min） was less than that of CMUF group （13.86±1.95 min, P〈0.01）. The volumes ultrafiltrated of HMUF group （440.00±91.86ml） was more than that of CMUF group （372.22±56.52ml, P〈0.01）. There are no significant differences about the hemodynamic data, HCT, TNF and IL-6 between two groups. Conclusion The HMUF is safe and efficient,when it was used after pediatric cardiopulmonary bypass, the duration of ultrafiltration can be shortened significantly.
Objective
To explore the feasibility of ultrasound diagnosis of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery.
Methods
There were 542 patients with congenital heart disease after surgery, difficult to be weaned off the ventilator or suspected diaphragmatic paralysis of the patients, respectively, in the ventilator continous positive pressure breathing (CPAP) mode and completely independent breathing state, whose ultrasound examination of diaphragm function was conducted to determine the presence of diaphragmatic paralysis in our hospital between January 1, 2013 and April 30, 2016. There were 327 males and 215 females at age of 14±32 months. The results of ultrasound diagnosis between ventilator CPAP mode and completely spontaneous breathing mode were compared.
Results
Five hundred and forty-two patients underwent ultrasound diaphragmatic examination. The results of bedside ultrasound were completely diagnosed: in completely spontaneous breathing, 82 patients who were diagnosed as diaphragmatic paralysis, including 39 on the right, 25 on the left, 18 on both sides; in CPAP mode, 82 patients who were diagnosed as diaphragmatic paralysis, 38 on the right, left 25, bilateral 19. Using ultrasound in CPAP mode to diagnose diaphragmatic paralysis after congenital heart disease surgery, compared with the completely spontaneous breathing state, the sensitivity was 100.0% and the specificity was 99.9%.
Conclusion
It is accurate and feasible to diagnose the presence of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery.
ObjectiveTo summarize the results of surgical treatment for 79 patients with coarctation of the aorta (CoA) combined with complex anomalies (CA) in recent years.MethodsThe data from 79 patients with CoA combined with CA admitted to Guangzhou Women and Children's Medical Center between January 19, 2010 and September 7, 2017 were collected and analyzed. There were 52 males and 27 females. The median age was 71 days, and the median weight was 4.3 kg. There were 26 patients combined with tracheostenosis and 7 patients with preoperative tracheal intubation. Extended end-to-side anastomosis was used to correct the CoA, and the associated cardiac abnormalities were treated simultaneously by an incision through median sternotomy. All operations were performed by the same group of surgeons.ResultsThe median deep hypothermic circulatory arrest was 18 (13-28) minutes, the median aorta cross-clamp time was 62 (15-199) minutes, the median cardiopulmonary bypass time was 145 (71-674) minutes, the median ventilation time was 72 (9-960) hours, the median length of ICU stay was 144 (12-1 944) hours, and the median length of hospital stay was 24 (2-93) days. Early death occurred in 9 patients and late death occurred in 5 patients. Reoperation occurred in 28 patients and recoarctation developed in 10 patients. After operation, transcoarctation gradient was reduced, and the transcutaneous oxygen saturation, C-reactive protein (CRP), lactate and creatinine were increased. Compared to the survival group, both preoperative and postoperative transcutaneous oxygen saturation were worse and the postoperative levels of plasma brain natriuretic peptide (BNP) and CRP were higher in the death group.ConclusionCorrecting the CoA and the associated CA simultaneously with extended end-to-side anastomosis by an incision through median sternotomy is effective and safe, and the outcomes of immediate and medial-term are satisfactory. Improving oxygenation and limiting elevation of BNP and CRP levels may reduce the death rate.
ObjectiveTo explore the prognostic value of serum cystatin C (Cys C) in patients with congenital heart disease-associated pulmonary arterial hypertension (PAH-CHD).MethodsA retrospective cohort study was conducted on adult PAH-CHD patients who were hospitalized for the first time in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2020. The serum Cys C and other related data of patients were collected. The median follow-up time was 57 months. The main end event was all-cause death. According to the prognosis, the patients were divided into a survival group and a death group. Cox regression was used to analyze the risk factors for all-cause death in patients with PAH-CHD.ResultsA total of 456 patients were enrolled, including 160 males and 296 females, aged 38.99±14.72 years. The baseline data showed that there were statistical differences in resting heart rate, serum Cys C, creatinine, NT-proB-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), high-sensitivity C reactive protein (hs-CRP), New York Heart Association (NYHA) cardiac function classification and serum potassium between the survival group and the death group. Univariate Cox regression analysis showed that serum Cys C, NT-proBNP, hs-cTnT, creatinine and NYHA cardiac function classification were related risk factors for all-cause death in patients with PAH-CHD. Multivariate Cox regression analysis showed that serum Cys C (HR=3.820, 95%CI 2.053-7.108, P<0.001), NYHA grade Ⅲ (HR=2.234, 95%CI 1.316-3.521, P=0.010), NYHA grade Ⅳ (HR=4.037, 95%CI 1.899-7.810, P=0.002) and NT-proBNP (HR=1.026, 95%CI 1.013-1.039, P<0.001) were independent risk factors for all-cause death in patients with PAH-CHD and had a good predictive value.ConclusionAs a new cardiac marker, serum Cys C can predict all-cause death in patients with PAH-CHD and is an independent risk factor.
Objective To identify clinical risk factors for early major adverse cardiovascular events (MACEs) following surgical correction of supravalvar aortic stenosis (SVAS). Methods Patients who underwent SVAS surgical correction between 2002 and 2019 in Beijing and Yunnan Fuwai Cardiovascular Hospitals were included. The patients were divided into a MACEs group and a non-MACEs group based on whether MACEs concurring during postoperative hospitalization or within 30 days following surgical correction for SVAS. Their preoperative, intraoperative, and postoperative clinical data were collected for multivariate logistic regression. Results This study included 302 patients. There were 199 males and 103 females, with a median age of 63.0 (29.2, 131.2) months. The incidence of early postoperative MACEs was 7.0% (21/302). The multivariate logistic regression model identified independent risk factors for early postoperative MACEs, including ICU duration (OR=1.01, 95%CI 1.00-1.01, P=0.032), intraoperative cardiopulmonary bypass (CPB) time (OR=1.02, 95%CI 1.01-1.04, P=0.014), aortic annulus diameter (OR=0.65, 95%CI 0.43-0.97, P=0.035), aortic sinus inner diameter (OR=0.75, 95%CI 0.57-0.98, P=0.037), and diameter of the stenosis (OR=0.56, 95%CI 0.35-0.90, P=0.016). Conclusion The independent risk factors for early postoperative MACEs include ICU duration, intraoperative CPB time, aortic annulus diameter, aortic sinus inner diameter, and diameter of the stenosis. Early identification of high-risk populations for MACEs is beneficial for the development of clinical treatment strategies.
