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Effect of Cardioplegia for Myocardial Protection in pediatric cardiac surgery:A Network Meta-Analysis

Congenital Heart Disease 2021年第6期16卷 609-645页

作者： Ke Zhou Dongyu Li Xintong Zhang Wensheng Wang Shusen Li Guang Song Department of cardiac surgery Shengjing Hospital of China Medical UniversityShenyangChina Department of Ultrasound Shengjing Hospital of China Medical UniversityShenyangChina

Cardioplegia has been widely used to reduce myocardial injury during pediatric cardiac surgery;however,which cardioplegia solution has the best protective effect has not been ***,we compared the myocardial protective effects of different cardioplegia solutions used in pediatric cardiac *** databases were searched to identify the relevant randomized controlled trials.A network meta-analysis with a Bayesian framework was *** outcomes included the following biochemical and clinical outcomes:serum concentrations of the creatine kinase-myocardial band at 6 h postoperatively;cardiac troponin I(cTnI)at 4,12,and 24 h postoperatively;spontaneous beating after declamping;postoperative arrhythmias;inotropic support percentage and duration;mechanical ventilation hours;intensive care unit stay in days;hospital stay in days;and *** group treated with cold crystalloid cardioplegia(cCCP)was chosen as the control *** 22 studies involved 1529 *** types of cardioplegia solutions were described in these studies,including cold blood cardioplegia,cCCP,del Nido,histidine-tryptophan-ketoglutarate(HTK),terminal warm blood cardioplegia,and warm blood cardioplegia(wBCP).The serum concentrations of the 24-h cTnI with wBCP(MD=−2.52,95%CI:−4.74 to−0.27)was significantly lower than *** serum concentrations of the 24-h cTnI with HTK(MD=4.91,95%CI:2.84–7.24)was significantly higher than *** was no significant difference in other biochemical and clinical outcomes when compared to *** conclusion,wBCP may have a superior myocardial protective effect with lower 24-h cTnI levels postoperatively and similar clinical outcomes after pediatric cardiac surgery.

关键词： Cardioplegia pediatric cardiac surgery cardiac troponin I meta-analysis

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Prediction of Pulmonary Arterial Pressure Level after Repair of Congenital cardiac Communications and Discharge from the Hospital: Role of Down Syndrome and Early Postoperative Hemodynamics

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Congenital Heart Disease 2022年第3期17卷 351-363页

作者： Eloisa Sassa Carvalho Maria Francilene SSouza Kelly Cristina O.Abud Claudia R.P.Castro Juliano G.Penha Ana Maria Thomaz Vanessa A.Guimaraes Antonio Augusto Lopes Heart Institute(InCor) University of Sao Paulo School of MedicineSão PauloBrazil

Background:Postoperative pulmonary hypertension limits the success of surgical treatment in some patients with unrestrictive congenital cardiac *** patients at risk of developing postoperative pulmonary hypertension is important to individualize follow-up ***:We analyzed a prospective cohort of 52 pediatric patients(age 3 to 35 months)looking for perioperative predictors of mildly elevated pulmonary arterial pressure 6 months after surgery,defined as a systolic pressure greater than 30 mmHg by transthoracic *** corresponds to a mean pulmonary arterial pressure of>20 ***,echocardiographic and hemodynamic parameters were *** hemodynamics was assessed by directly measuring pulmonary and systemic arterial pressures using indwelling *** postoperative pulmonary hemodynamics was defined as the mean pulmonary/systemic mean arterial pressure ratio(PAP/SAP)obtained per patient during the first 6 h of postoperative ***:Among the factors that were investigated as possible predictors,perioperative hemodynamics and the presence of Down syndrome were initially selected using univariate analysis(p0.35 was 76%sensitive and 74%specific at predicting a systolic pulmonary arterial pressure of>30 mmHg 6 months after surgery(hazard ratio with 95%CI 8.972[2.428–33.158],p=0.002).Conclusion:The hypertensive early postoperative behavior of the pulmonary circulation was strongly but not exclusively associated with Down syndrome,and it was char

关键词： Pulmonary hypertension congenital heart disease Down syndrome pediatric cardiac surgery

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Veno-Venous Extra-Corporeal Membrane Oxygenation (ECMO) in a Child with Hemoptysis and Fontan Circulation

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Open Journal of pediatrics 2020年第2期10卷 280-287页

作者： Claudine Kumba Gauthier Loron Anais Mons Claude Marcus Francis Grossenbacher Nathalie Bednarek-Weirauch Vito Giovanni Ruggieri Emre Belli Jean-Marc Malinovsky Pierre Mauran Department of Anesthesia and Critical Care CHU Reims Reims France Department of pediatric Anesthesia and Critical Care HU Necker Enfants Malades University Hospital Assistance Publique Hopitaux de Paris Paris France Department of pediatric and Neonatal Intensive Care CHU Reims Reims France Department of Radiology CHU Reims Reims France Department of Intensive Care and Emergency Medicine CHU Reims Reims France Department of Thoracic and Cardiovascular surgery CHU Reims Reims France Department of pediatric cardiac surgery Marie Lannelongue Hospital Le Plessis Robinson France Department of pediatric Cardiology and Congenital Heart Diseases American Memorial Hospital CHU Reims Reims France

Background: Extracorporeal membrane oxygenation is a rescue life support technique used in life threatening conditions of refractory respiratory and/or cardiac distress. Indication for extracorporeal life support in children depends on age and varies from pulmonary to cardiac pathologies. In some cases, it may be used as a bridge to a therapeutic procedure. We described here the management of respiratory failure due to hemoptysis in a child with a Fontan circulation and veno-venous extracorporeal membrane oxygenation which served as a bridge to angio-embolization. Hemoptysis can be a life threatening condition which can lead to hypovolemic shock and impaired alveolar gas exchange. The latter can result in respiratory failure and consequent asphyxia. When hemoptysis occurs in a patient with a univentricular heart and a Fontan circulation, management of this clinical situation can be challenging due to the particular physiology of the latter. Total cavopulmonary connection is a palliative surgical repair whi

关键词： Extracorporeal Membrane Oxygenation Fontan Circulation Univentricular Heart Tricuspid Atresia Children One Lung Ventilation Mobile ECMO Team pediatric Anesthesia and Critical Care Angio-Embolization Interventional Radiology pediatric Cardiology pediatric cardiac surgery Trans-Thoracic Echocardiography Aortic Velocity Time Integral Fluid Responsiveness Goal Directed Fluid and Hemodynamic Therapy

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Endotracheal Tube Displacement during cardiac surgery in Infants: A Retrospective Cohort Study of Its Incidence and Predictors

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Open Journal of Anesthesiology 2022年第7期12卷 219-228页

作者： Atsuhiro Sekiguchi Akira Kitamura Miki Tsujita Yuki Shiko Hideyuki Nakagawa Department of Anesthesiology Saitama International Medical Center Saitama Medical University Saitama Japan Research Administration Center Saitama Medical University Biostatics Section Clinical Research Center Chiba University Hospital Chiba Japan

Introduction: With the traction on the trachea and intrathoracic manipulation during cardiac surgery, the position of the endotracheal tube (ETT) might be changed as compared to before surgery. Migration of the ETT during pediatric cardiac surgery is particularly problematic in infants. Methods: In this retrospective cohort study, chest X-rays were taken in the operating room just before and after surgery. The position of the ETT among all infants under 1 year of age who underwent cardiac surgery between December 2017 to December 2019 was evaluated. The displacement of the ETT position was examined by measuring the position of the tube tip from the tracheal bifurcation on a chest X-ray, and the relationship between surgery-related factors (age, height, weight, sex, surgery time, cardiopulmonary bypass, tube size, use of tube cuff) was analyzed. Results: Eighty-eight of the 141 patients were enrolled. There was a significant proximal displacement of the ETT tip during cardiac surgery. The distance from the carina to the tube tip after surgery was long, on average 2.5 mm, compared to that before surgery (P = 0.013). Cephalad displacement of the ETT either ≥5 mm or ≥2.5 mm was found in 28 and in 38 out of 88 infants after surgery, respectively. After performing multivariate analysis, the use of un-cuffed ETT was the sole exploratory variable predictive of tube tip displacement (OR 0.34, 95% CI 0.10 - 0.93 if ≥5 mm;and OR 0.24, 95% CI 0.08 - 0.75 if ≥2.5 mm displacement;P = 0.04 and 0.01, respectively). Conclusion: Proximal displacement of the ETT during cardiac surgery occurs more frequently in infants with un-cuffed ETT.

关键词： Endotracheal Tube Disposition pediatric cardiac surgery Neonates Infants Risk Factor

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Palliative Senning Procedure: Management of dTGA with VSD and PVOD in an Adolescent

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World Journal of Cardiovascular surgery 2020年第8期10卷 150-157页

作者： Amitabh Satsangi Biswajit Singh Department of Cardiothoracic and Vascular surgery All India Institute of Medical Sciences New Delhi India Department of Surgical Disciplines All India Institute of Medical Sciences New Delhi India

Patients with D-TGA with atrial level mixing of systemic and pulmonary blood, the morphological left ventricle supports the low pressure pulmonary circulation and regresses in mass and volume as time passes. The LV once regressed is unable to support the high pressure systemic circulation after ASO. These patients are candidates for early ASO, preferably within 3 weeks of life. As age progresses, the scope of these surgical procedures skews and an atrial switch remains the only option to improve quality of life. In Atrial switch, the pulmonary and systemic circulation is returned into an “in series” circulation and cyanosis is obliterated.

关键词： Atrial Switch Palliation pediatric cardiac surgery

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Nursing cooperation related to thoracoscopic surgery in children

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Nursing Communications 2022年第1期6卷 34-37页

作者： Hong-Xu Ren Si-Qin Wang Shuang-Shuang Liu Yong-Chao He Xiao-Yu Liu The Affiliated Yantai Yuhuangding Hospital of Qingdao University Yantai 264000China Xianshuigu Township Health Center Tianjin 300350China The Affiliated Children’s Hospital of Shandong University Jinan 250022China

Objective:To explore the nursing cooperation of pediatric cardiac surgery by ***:30 patients undergoing thoracoscopy in a third-grade hospital in Yantai were observed and their nursing process was recorded and ***:The good cooperation of operating room nurses and equipment nurses can relax the children and increase the success rate of surgery and reduce the occurrence of ***:Full preoperative preparation,close intraoperative cooperation,strict instrument maintenance,and cleaning and disinfection are the guaranteeof pediatric thoracic surgery.

关键词： thoracoscopy pediatric cardiac surgery perioperative nursing

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