Objective A meta-analysis was performed for a comparison of outcomes between transcatheter closure and transthoracic closure for simple congenital heart diseases (CHD). Methods Electronic databases, including PubMed, EMbase, Scopus, CNKI, Wanfang Data and Weipu Data were searched systematically for the literature aimed mainly at comparing the therapeutic effects for CHD administrated by transcatheter closure and transthoracic closure. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. The meta-analysis was conducted with Revman 5.3. Results Twelve studies meeting the inclusion criteria were included, involving 8 studies regarding to atrial septal defect (ASD), 2 studies regarding to ventricular septal defect (VSD) and 2 studies with regard to patent ductus arteriosus (PDA). A total of 1 423 patients were included. It was observed that compared with transthoracic closure, transcatheter closure entailed a lower complication rate (OR=5.62, 95%CI 2.78 to 11.36, P<0.001). However, meta-analysis of operative success rate(OR=1.65, 95%CI 0.92 to 2.98, P=0.09), instantly (OR=0.75, 95%CI 0.40 to 1.41, P=0.37) and long-term (OR=0.72, 95%CI 0.25 to 2.05, P=0.54) persistent shunt after surgery showed no significant differences between two approaches. No publication bias was found according to the funnel plot of complication rate and operative success rate. Conclusion In the treatment of simple CHD such as ASD, VSD and PDA, compared with transthoracic closure, a lower complication rate were associated with transcatheter closure. Meanwhile, operative success rate, instantly and long-term persistent shunt after surgery were not statistically different between the two surgical approaches. However, this study was based on retrospective studies, the level of evidence remained low. More large sample size randomized controlled trials should be designed to explore the safety and effectiveness of these two approaches in the treatment of CHD.
Objective To introduce a modified technique of right ventricular outflow tract (RVOT) reconstruction using a handmade bicuspid pulmonary valve crafted from expanded polytetrafluoroethylene (ePTFE) and to summarize the early single-center experience. Methods Patients with complex congenital heart diseases (CHD) who underwent RVOT reconstruction with a handmade ePTFE bicuspid pulmonary valve due to pulmonary regurgitation at Guangdong Provincial People’s Hospital from April 2021 to February 2022 were selected. Postoperative artificial valve function and right heart function indicators were evaluated. Results A total of 17 patients were included, comprising 10 males and 7 females, with a mean age of (18.18±12.14) years and a mean body weight of (40.94±19.45) kg. Sixteen patients underwent reconstruction with a handmade valved conduit, with conduit sizes ranging from 18 to 24 mm. No patients required mechanical circulatory support, and no in-hospital deaths occurred. During a mean follow-up period of 12.89 months, only one patient developed valve dysfunction, and no related complications or adverse events were observed. The degree of pulmonary regurgitation was significantly improved post-RVOT reconstruction and during follow-up compared to preoperative levels (P<0.001). Postoperative right atrial diameter, right ventricular diameter, and tricuspid regurgitation area were all significantly reduced compared to preoperative values (P<0.05). Conclusion The use of a 0.1 mm ePTFE handmade bicuspid pulmonary valve for RVOT reconstruction in complex CHD is a feasible, effective, and safe technique.
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.
ObjectiveTo investigate whether metformin has protective effect on myocardial injury in patients with coronavirus disease 2019 (COVID-19) combined with coronary heart diseases and diabetes.MethodsCOVID-19 patients with coronary heart disease and diabetes who were admitted to Tongji Hospital from January 18 to April 25 in 2020 were enrolled. They were divided into a metformin group and a none-metformin group according to whether the metformin was used. The demographic characteristics, clinical symptoms, laboratory parameters, treatment and clinical outcomes of the two groups were analyzed retrospectively.ResultsThere were 29 patients in the metformin group, 3 patients (12.0%, 3/25) suffered myocardial injury and 1 (3.4%) died of acute respiratory failure complicated by septic shock; 67 patients were in the non-metformin group and 24 (37.5%, 24/64) had myocardial injury but 15 died in hospital among whom 1 died of septic shock complicated by disseminated intravascular coagulation, 1 acute respiratory failure complicated by possible cerebral hemorrhage, 2 acute respiratory failure, 1 fulminant myocarditis, 3 acute myocardial infarction and 7 cardiac arrest. The incidence of myocardial injury (12.0% vs. 37.5%, P=0.019), hospital mortality (3.4% vs. 22.4%, P=0.034) and mortality of cardiovascular events (0.0% vs. 16.4%, P=0.049) in the metformin group were significantly lower than those in the non-metformin group. Multivariate analysis showed that the use of insulins (OR=11.235, P=0.003) was an influencing factor for in-hospital mortality of patients. The use of metformin (OR=0.154, P=0.013) was positively correlated with the myocardial injury.ConclusionWhen patients with coronary heart disease and diabetes are infected with COVID-19, metformin can effectively reduce myocardial damage and has a certain effect on reducing hospital mortality. Combined with clinical considerations, it is worthy of popularization.
ObjectiveTo reveal the risk factors for delayed recovery and complications in infants with weight≤5.0 kg after surgical ventricular septal defect (VSD) closure.MethodsWe retrospectively reviewed a consecutive series of 86 patients with weight≤5.0 kg who were admitted to our institution for surgical VSD closure between January 2016 and July 2019, including 31 males and 55 females with an age of 17-266 (80.3±40.4) d and a weight of 2.5-5.0 (4.4±0.6) kg. The VSDs were divided into perimembranous (n=65, 75.6%), subaortic (n=17, 19.8%) and subaortic combined muscular types (n=4, 4.7%). Mechanical ventilation (MV) time≥24 h or ICU stay≥72 h were defined as delayed recovery. Death, sudden circulatory arrest, complete heart block requiring a permanent or temporary pacemaker implantation, neurological complications, reoperation (for residue shunt or valvular regurgitation), reintubation and diaphragmatic paralysis were considered as significant major adverse events.ResultsThere was no death, reoperation due to residual VSD or neurological complication. Totally 51 (59.3%) patients had MV timec≥24 h and 51 (59.3%) patients stayed in the ICU≥72 h. Two (2.3%) patients required temporary pacemaker and six (7.0%) patients required reintubation. During the follow-up of 3-36 (15.8±8.8) months, 1 patient died of pneumonia after discharge, 5 patients suffered mild tricuspid valve regurgitation and 1 patient suffered decreased left ventricular systolic function in the follow-up. No aortic valve injuries occurred.ConclusionFor patients whose weight≤5.0 kg, short-term results of surgical VSD closure are excellent. Low weight and age may prolong MV time; low birth weight and pulmonary hypertension may prolong ICU stay, but are not independent risk factors.
ObjectiveTo investigate the efficacy of intravenous infusion of recombinant human brain natriuretic peptide in rheumatic heart valves patients with cardiorenal syndrome preoperatively, the function and operational results before and after treatment were compared. MethodsA randomized, single-blind, and controlled study was conducted in 60 patients characterized of rheumatic heart valves patients in our hospital from March 2012 through March 2015. There were 24 males and 36 females at average age of 52.1±8.9 years (ranged from 35-73 years). Their left ventricular ejection fraction was less than 40% and plasma creatinine was mildly or moderately raised. They were recruited into an experiment group and a control group by random digital table. The control group received continuous intravenous Dopamine and Nitroglycerin based anti-heart failure treatment (n=30). The experimental group received additional recombinant human brain natriuretic peptide for 48 hours without bolus (at a dose of 0.006 μg·kg-1·min-1, n=30). The levels of the biomarkers for cardiac and renal function between before and after treatment were compared. ResultsIn the experiment group, treatment with recombinant human brain natriuretic peptide for 48 hours had lower level of plasma NT-proBNP than the baseline level with a statistical difference (88.6±55.1 pg/ml vs. 55.0±47.6 pg/ml, P=0.014), lower level of high sensitivity creative reaction protein than the baseline level with a statistical difference (2.79±1.27 mg/l vs. 1.39±0.79 mg/l, P=0.000), more 24 hours urine output than the baseline level with a statistical difference (1 464.0±348.3 ml vs. 1 223.0±279.9 ml, P=0.005), lower level of serum cystatin-C than the baseline level with a statistical difference (0.25±0.14 mg/l vs. 0.08±0.07 mg/l, P=0.000), higher inotrope requirement within three days after operation (2.52±1.30 mg·kg-1·min-1 vs.3.36±1.15 mg·kg-1·min-1, P=0.011), less ICU stay days (4.5±1.2 days vs. 5.3±1.6 days, P=0.03). There were no statistical differences between the experiment group and the control group after treatment in cardiac function class, left ventricular ejection fraction, left ventricular end-diastolic diameter, creatinine, chest tube drainage volume, and intra-aortic balloon pumping use. ConclusionIntravenous injection of recombinant human brain natriuretic peptide in the patients with rheumatic valve disease combined with cardiorenal syndrome before operation can decrease systemic inflammation reaction and cardiac and renal function injury, and enhance operational recovery.
Surgical Therapy for Valve Diseases Combined with Coronary Heart Diseases in Patients Over or Below 70 Years Old YU Lei, GU Tianxiang, SHI Enyi, XIU Zongyi, FANG Qin, ZHANG Yuhai. (Department of Cardiac Surgery, The No. 1 Hospital of China Medical University, Shenyang 110001, P.R. China)Corresponding author: GU Tianxiang, Email: cmugtx@sina.comAbstract： Objective To summarize the experiences of valve replacement combined with coronary artery bypass grafting (CABG) in senile patients by comparing clinical outcomes of valve diseases combined with coronary heart diseases in patients over or below 70 years old. Methods We retrospectively analyzed the clinical data of 49 patients who received valve replacement combined with CABG in our department from May 1999 to December 2007. Based on the age, the patients were divided into ≥70 years group (17 cases) with its patients at or above 70 years old and lt;70 years group (32 cases) with its patients younger than 70. The percentage of chronic obstructive pulmonary diseases (COPD) before surgery in ≥70 years group was higher than that in lt;70 years group(Plt;0.05). No significant difference was found in the other relevant factors between the two groups. The clinical index of patients in the two groups were compared and analyzed. Results There were significant differences between the two groups in such factors as the percentage of biovalve use (82.4% vs. 12.5%, χ2=23.311, P=0.000), the time of mechanic ventilation (34.5±29.3 h vs. 18.0±16.1 h, t=-2.542,P=0.014), the time of ICU stay (4.4±1.5 d vs. 3.3±0.7 d, t=-3.522, P=0.001), the time of hospital stay (21.4±7.7 d vs. 18.1±1.8 d, t=-2.319, P=0.025), the percentage of IABP use (29.4% vs. 6.3%, χ2=4.862, P=0.037), the percentage of pulmonary function failure (35.3% vs. 6.3%, χ2=6.859, P=0.009), the percentage of acute renal failure (23.5% vs. 3.1%, χ2=5.051, P=0.025), and the percentage of cerebrovascular accident (11.8% vs. 0.0%, χ2=3.933, P=0.048). There was no significant difference between the two groups in factors like the anastomosis of distal graft (2.5±3.1 vs. 2.4±14, t=0.301, P=0.758), the time of aortic occlusion (89.3±25.4 min vs. 88.5±31.0 min, t=0.108,P=0.913), the time of cardiopulmonary bypass (144.6±44.8 min vs. 138.3±52.9 min, t=0.164, P=0.871) and the mortality (5.9% vs. 6.3%, χ2=0.002,P=0.959). The perioperative myocardial infarction rate was zero in both groups. ≥70 years group patients were followed up for 2 months to 9 years with only 1 case missing. One patient who had undergone mechanic valve replacement died of cerebral hemorrhage 1.5 years after operation. Two died of heart failure and lung cancer 3 months and 6 years after operation respectively. For all the others, the cardiac function was at class Ⅰ to Ⅱ and their life quality was significantly improved. The follow up time of lt;70 years group was 1 month to 6 years and 5 cases were missing. Four patients who had undergone mechanic valve replacement died of complications in relation to anticoagulation treatment. One died of severe low cardiac output. Another died of traffic accident. Conclusion Surgery operation and effective perioperative treatment are key elements in improving surgery successful rate and decreasing mortality in patients with valve and coronary artery diseases. Valve replacement combined with CABG is safe for patients older than 70 years old.
The consensus was authored by National Society of Congenital Heart Diseases. After employing the Delphi process and incorporating literature reviews and expert discussions, seven recommendations were ultimately formulated. The consensus provides a detailed elaboration on the pathoanatomy, pathophysiology, clinical manifestations, diagnostic methods, and surgical treatment approaches for aortic valve diseases in children. It emphasizes that the treatment of aortic valve diseases in children should take into account the needs of growth and development, and recommends surgical strategies for different age groups and types of lesions, including valve plasty, Ross procedure, valve replacement, and balloon dilation. Specifically, aortic valve plasty is recommended for neonates and infants, while surgical options for older children are more diversified. The consensus only discusses isolated aortic valve disease and does not cover cases complicated with other heart malformations.
ObjectiveTo evaluate the surgical outcomes of modified Blalock-Taussig shunts in the patients with congenital heart diseases of diminutive pulmonary blood. MethodsWe retrospectively analyzed the clinical data of 39 patients with congenital heart diseases of diminutive pulmonary blood, who underwent modified Blalock-Taussig shunts with Gore-Tex vessels in the First Affiliated Hospital, Hunan University of Chinese Medicine between June 2007 and June 2013. There were 23 male and 16 female patients at age of 6 months to 16 years (4.64±3.85) years, body weigh at 4.5-43.0 (14.81±8.69) kg. ResultsThere were 4 postoperative deaths. The early mortality was 7.69% (3/39). The arterial oxygen saturation increased from 64.28%±8.05% to 81.07%±5.76% (P < 0.01). Ideal pulmonary flow in each patient was obtained. Pulmonary arteries were significantly improved compared with those before operation. McGoon ratio (1.11±0.16 versus 1.58±0.22, P < 0.01) and Nakata index (113.98±14.84 mm2/m2 versus 160.98±26.65 mm2/m2, P < 0.01) increased with a statistical difference. Two-stage radical operations were performed in 8 patients. ConclusionsModified Blalock-Taussig shunt is effective in promoting development of the pulmonary arteries and improving cyanosis significantly. Modified Blalock-Taussig shunt can correct hypoxia to prepare for the radical operation．
Objective To evaluate the application of three-dimensional printing technique in surgical treatments on complex congenital heart diseases. Methods Two patients were enrolled with complex congenital heart diseases. The computerized tomography data were used to build the 3D architecture of cardiac anomalies. The White-Jet-Process technique was used to print the models with 1∶1 ratio in size. The models were used to make the treatment strategy making, young surgeon training and operation simulation. Results The full color and hollowed-out cardiac models with 1∶1 ration in size were printed successfully. They were transected at the middle point of vertical axis, which was conveniently to explore the intracardiac anomalies. However, for patient 1, the model lost the atrial septal defect. Taking the two models as references, operation group held preoperative consultation, operation simulation, and finally, the operation plans were determined for the two patients. Both the two operation were carried out smoothly. Conclusion Although the limitations of 3D printing still exist in the application for congenital heart diseases, making the preoperative plan and operation simulation via 3D cardiac model could enhance the understanding of following operation and procedure details, which could improve the tacit cooperation among operation group members. Furthermore, operation results also could be improved potentially. Therefore, the cardiac 3D printing should be popularized in clinic in the future.