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Open heart operation on neonates with critical congenital heart disease 推荐 CAJ下载 PDF

Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.

Changes of the Level of G Protein in Newborn Guinea-pig Myocardium Undergoing Global Ischemic Reperfusion

ObjectiveTo study the changes of levels of α subunits of stimulatory (Gsα) and inhibitory guanine nucleotide binding protein (Giα) in newborn guinea pig (0 2 days old) myocardium undergoing global ischemic reperfusion, and influences on the changes by St.Thomas Ⅱ and cold blood cardioplegic solution.MethodsThirty newborn guinea pigs were randomly assigned to three groups. GroupⅠ ( n = 10): the newborn hearts suffered by hypothermic global ischemia; group Ⅱ( n =10): the newborn hearts arrested by St. Thomas Ⅱ , and group Ⅲ ( n = 10): the newborn hearts arrested by cold blood cardioplegic solution. Levels of Gsα and Giα were investigated with Western blot analysis.ResultsNo differences of levels of Gsα and Giα were found in three groups before ischemia ( P gt;0.05). The level of Gsα after ischemia was significantly decreased than before ischemia in groupⅠand group Ⅱ ( P lt; 0 01), whereas no pronounced changes in group Ⅲ ( P gt;0.05) were noted after ischemia. The level of Gsα in group Ⅲ was not significantly changed after reperfusion compared with before ischemia( P gt;0 05), and it was much higher than those in groupⅠand group Ⅱ ( P lt; 0 01). Level of Giα was found not markedly changed in group Ⅲ after reperfusion compared with that before ischemia, but was notable higher in groupⅠand group Ⅱ( P lt;0.01). ConclusionsSignificant decrease of level of Gsα, whereas marked increase of level of Giα are found in myocardium of newborn guinea pig undergoing hypothermic (20℃) ischemic reperfusion. No impact of St. Thomas Ⅱ on these changes is verified, but recovery to the level of Gsα and Giα before ischemia is achieved by cold blood cardioplegic solution after ischemia and reperfusion. Unbalance between Gsα and Giα is the one of the mechanisms of ischemic reperfusion injury for immature myocardium.

In vitro experience with tissue engineered heart valve leaflets

Objective To investigate the possibility of creation of tissue engineered heart valve leaflets in vitro . Methods Aorta were obtained from 9 hybrid young pigs. The endothelial cell, fibroblast and smooth muscle cells were isolated and cultured to get enough cell. The expanded fibroblast, smooth muscle cell,and endothelial cells were seeded on the polymers sequentially. The cell polymer constructs were sent for scanning electron microscopy(SEM) examination after cultured for 7, 14, and 28 days. Histological examination were performed after the cell polymer constructs cultured for 28 days. Results SEM showed that the number of cells on the polymers increased as the culture time prolonged, with the formation of matrix. After 28 days, there were a great number of cells and large amount of matrix on the scaffolds. The confluent cell had covered a large area of the polymers. Hematoxylin and eosin(HE) stain showed large amount of cells attached to the polymers. Conclusion With the viability of the cultured cellular scaffolds,it is possible to create tissue engineered heart valve leaflets in vitro.

Application of BiLevel Positive Airway Pressure Mechanical Ventilation on Cardiac Surgery Patients in Intensive Care Unit

【摘要】 目的 探讨双水平无创正压通气(BiPAP)对心脏外科术后需要二次机械辅助通气患者的治疗效果。方法 2008年9月—2009年9月，收集心脏外科手术后成功脱离呼吸机辅助通气后心功能衰竭或呼吸功能衰竭需要二次机械通气的患者,符合纳入及排除标准者共53例，进行回顾性分析,根据治疗方案分为无创通气组(32例)和有创通气组(21例),在需要机械通气时(T1),机械通气后30 min(T2),机械通气后2 h(T3)及预计脱离机械通气时(T4),分别统计患者心率、血气分析等情况,比较氧分压、ICU停留时间及术后至出院时间。结果 给予辅助通气前,两组患者的心率及PO2无统计学差异(Pgt;0.05)。给予辅助通气后,无创通气组患者的心率由T1(130.8±21.10)次/min,下降到T2(125.60±21.36)次/min,T3(101.70±13.73)次/min,T4(87.40±9.35)次/min；PO2由T1(64.70±14.12) mm Hg,上升到T2 (121.40±30.19) mm Hg，T3 (140.40±25.29) mm Hg，T4 (132.90±16.33) mm Hg。有创通气组患者的心率由T1 (138.27±21. 39)次/min,下降到T2(118.18±18.03)次/min，T3(100.00±11.73)次/min，T4(87.00±10.70)次/min；PO2由T1 (61.45±13.56) mm Hg上升到T2(122.55±29.50) mm Hg，T3(138.91±24.77) mm Hg，T4(133.55±18.00) mm Hg。两组患者心率及PO2均较辅助通气前降低(Plt;0.05)。两组患者之间各时间点心率及PO2比较无差异(Pgt;0.05)。无创通气组的ICU停留时间及术后至出院时间分别为(1.75±2.97) d及(9.14±4.11) d，均低于有创通气组的(4.38±5.13) d及(14.00±0.82) d,有统计学意义(Plt;005)。结论 双水平无创正压通气可用于心脏外科术后需要二次机械通气的患者。

风湿性心脏病二尖瓣和主动脉瓣胶原变化的研究

摘要 目的 研究风湿性心脏病二尖瓣和主动脉瓣瓣膜胶原含量及其类型对瓣膜成形术病例选择的影响。方法 采用羟脯氨酸法测定瓣膜胶原含量的变化，并用十二烷基磺酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)分离法测定心瓣膜胶原的类型。结果 正常二尖瓣腱索的胶原含量较瓣叶高（Plt;0.01），主动脉瓣胶原含量较二尖瓣低（P＜0.01）。风湿性心脏病患者二尖瓣和主动脉瓣的胶原含量较正常瓣膜有显著升高（P＜0.01）。正常瓣膜以Ⅰ型胶原为主，Ⅲ型胶原含量较少，而病变二尖瓣和主动脉瓣其Ⅰ型、Ⅲ型胶原均明显增加，且以Ⅰ型胶原为主。有钙化的二尖瓣腱索胶原含量高于无钙化瓣膜（P＜0.05）。二尖瓣病变以狭窄为主的病例其二尖瓣腱索的胶原含量较以关闭不全为主的病例高（P＜0.01），且二尖瓣瓣叶及腱索的胶原含量与二尖瓣口面积呈负相关（r=-0.5431和r=-0.8819，P＜0.01）。结论 风湿性心脏病心瓣膜胶原含量和类型的变化与心瓣膜功能的改变密切相关，瓣膜有无钙化以及二尖瓣病变的性质，可作为施行心瓣膜成形术的选择条件。

Cryopreserved Homograft Pericardium Patch in Staged Repair of Tetralogy of Fallot

Objective To compare the difference of effect while using homograft pericardium patch and Gore- tex patch in staged repair of tetralogy of Fallot（TOF） to enlarge the right ventricular outflow tract （RVOT）. Methods Twenty-eight patients with TOF who underwent the staged complete repair were divided into 2 groups according to the date of surgery. Gore-rex group, 13 cases, their RVOT were enlarged with Gore-tex patches. Cryopreserved homograft pericardium patch group, 15 cases, their RVOT were enlarged with cryopreserved homograft pericardium patches. Clinical results and follow-up results were compared. Results There were 1 operative death in Gore-tex patch group （7. 7%）, and 1 early postoperative death in cryopreserved homograft pericardium patch group （6. 7%）. Hemostasia time, the pericardial cavity drainage volume in cryopreserved homograft pericardium patch group were less than those in Gore-tex patch group （P〈0. 01）. All patients were followed-up for 0.8-4.5years. The residual obstruction rate at RVOT level in Gore-tex patch group was higher than that in cryopreserved homograft pericardium patch group by echocardiography （P〈0.01）. No calcification shadow was found on the chest X-ray. Conclusion Homograft pericardium is the tissue with high density and intensity, its elasticity and compliance are good. Using homograft pericardium patch may be helpful to decrease the residual obstruction of RVOT after operation. It can be adapted as a repairing material in heart surgery.

Pulmonary artery reconstruction to repair infant isolated unilateral absence of pulmonary artery: A retrospective cohort study in a single center

Objective To confirm the changes of pulmonary artery pressure, neo pulmonary artery stenosis and reoperation in children with unilateral absence of pulmonary artery (UAPA) undergoing pulmonary artery reconstruction. Methods The clinical data of the infants with UAPA undergoing pulmonary artery reconstruction in our hospital from February 19, 2019 to April 15, 2021 were analyzed. Changes in pulmonary artery pressure, neo pulmonary artery stenosis and reoperation were followed up. Results Finally 5 patients were collected, including 4 males and 1 female. The operation age ranged from 13 days to 2.7 years. Cardiac contrast-enhanced CT scans were performed in all children, and 2 patients underwent pulmonary vein wedge angiography to confirm the diagnosis and preoperative evaluation. Preoperative transthoracic echocardiography and intraoperative direct pulmonary arterial pressure measurement indicated that all 5 children had pulmonary hypertension, with a mean pulmonary arterial pressure of 31.3±16.0 mm Hg. Pulmonary arterial pressure decreased immediately after pulmonary artery reconstruction to 16.8±4.2 mm Hg. The mean follow-up time was 18.9±4.7 months. All 5 patients survived during the follow-up period, and 1 patient had neo pulmonary artery stenosis or even occlusion and was re-operated. Conclusion Pulmonary artery reconstruction can effectively alleviate the pulmonary hypertension in children with UAPA. The patency of the neo pulmonary artery should be closely followed up after surgery, and re-pulmonary angioplasty should be performed if necessary.

套管法与缝合法行大鼠异位心脏移植术的比较

目的分别采用缝合法和套管法制作大鼠异位心脏移植模型,以便为器官移植的研究提供理想的手术方式. 方法 SD大鼠为受者,Wistar大鼠为供者.套管法是将供者的无名动脉和肺动脉分别与受者的颈总动脉和颈外静脉行套管连接.缝合法是将供者的升主动脉和肺动脉分别与受者的腹主动脉和下腔静脉吻合. 结果套管法手术180次,手术成功率高于96%;缝合法手术20次,手术成功率小于40%. 结论套管法心脏移植术操作简单,热缺血时间短,并发症少,手术成功率明显提高.

原发性心脏淋巴瘤一例

高容量血液滤过治疗心脏手术后急性肾功能衰竭