Objective To explore the security of using a new artery sheath in the transthoracic aortic balloon valvuloplasty.Methods Healthy male piglets began to take food orally,which was rich in cholesterin(0.5％) and in Vitamin D2 (100000 IU daily).Sixteen of them were selected based on the aortic pressure gradient (＞30 mmHg,1 mmHg=0.133 kPa) through transthoracic echocardiography and were randomly divided into 2 groups with 8 cases in each group.The piglets in group A adopted new artery sheath during operations,while the piglets in group B did the old one.Both groups underwent transthoracic aortic balloon valvuloplasty through the ascending aorta via stemotomy.Results The transthoracic aortic ballon valvuloplasty were carried out on all piglets successfully.There were no significant differences in the aortic valve pressure gradient before operation between group A and group B [(41.3± 3.9)mmHg vs (40.6±3.5) mmHg,t=0.30,P=0.74].The aortic valve pressure gradient decreased distinctly to (12.5±1.6) mmHg and(12.8±1.9) mmHg,respectively after operation,and the differences were significant in statistics(t =23.83,23.79,all P＜0.001).And the passage duration of the guide wire through aortic valve was significantly shorter in group A than that in group B [(16.4±2.6) min vs (27.4±4.6) min,t=5.88,P＜0.001].The frequencies (1 to 10) of the guide wire strayed into coronary artery and the cases(0 to 5) of the aortic valve and ascending aorta injured by the guide wire in group A were significantly lower than those in group B,which had statistical significance (Z=-2.183,-2.219,P=0.029,0.027).Conclusions Transthoracic aortic balloon valvuloplasty is an effective treatment for aortic stenosis.It's much safer to apply the new artery sheath than the old one in the operation.

OBJECTIVE:To avoid the radiation injuries and use of contrast agent, we assessed the safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance.METHODS:From June 2013 to June 2014, thirty patients (mean age: (6.3 ± 2.5) years, mean body weight:(22.5 ± 7.3) kg) with pure patent ductus arteriosus were continuously included in this study. The mean diameter of patent ductus arteriosus was (3.8 ± 0.9) mm. Patients were all treated by percutaneous patent ductus arteriosus closure via right femoral artery solely under thoracic echocardiography guidance. The efficacy of the procedure was evaluated by thoracic echocardiography. Follow-up was performed at one month after procedure.RESULTS:All 30 cases were successfully treated with percutaneous patent ductus arteriosus closure solely under thracic echocardiography guidance. The procedural time was (32.8 ± 5.7) minutes. The mean diameter of Amplatzer ADO II was (4.9 ± 1.0) mm. Postoperative trivial residual shunt occurred in six patients immediately after the procedure. All patients survived without peripheral vascular injury or complications such as cardiac perforation. Hospitalization time was (3.4 ± 0.7) days. At one-month follow-up, no complications such as residual shunt or pericardial effusion were observed.CONCLUSION:Echocardiography guided percutaneous patent ductus arteriosus closure by femoral artery approach is safe and effective, and can avoid X-ray and the use of contrast agents.

Introduction: Infants and children after cardiac surgery may develop hyper- or hypoglycemia, associating with higher nosocomial infection or neurological morbidities. Hypothesis: The hypothesis of this perspective randomized control study is moderate glucose control may improve clinical outcomes. Methods: We randomly assigned children(≤3 years of age) who were admitted to the pediatric cardiac intensive care unit (PICU) after cardiopulmonary bypass surgery into either moderate glucose control group (target blood glucose: 110-143mg per deciliter) or conventional glucose control group (target level below 200mg per deciliter). The primary outcome was the rate of nosocomial infection in PICU. Second outcomes include hospital mortality, duration of mechanical ventilation and PICU stay, and a composite morbidity variable included events of requiring extracorporeal membrane oxygenation, delayed sternal closure, dialysis-dependent renal failure and hypoglycemia. Results: A total of 593 patients underwent randomization: 293 to moderate glucose control group and 300 to conventional glucose control group. The baseline data were balanced between these two groups. Mean 72 hours time-weighted blood glucose average was lower in the moderate control group than in the conventional group (129.9±22.1 mg per deciliter vs. 138.8±28.6 mg per deciliter, p<0.001). Although no statistically significance reached, there is a trend that nosocomial infection occurred less in moderate glucose group (17 (5.80%) vs. 29 (9.67%), P=0.054). Duration of mechanical ventilation was shorter in the moderate control group (18 (range, 4-300) hours vs 22 (range 3-771) hours, p=0.046). Hypoglycaemia (blood glucose ≤65mg per deciliter) which occurred in 7(2.39%) patients in the moderate group versus 8 (2.67%) in the conventional group, was statistically similar between groups. Other secondary outcomes did not differ significantly between groups. Conclusions: With moderate glucose control, although the major clinical outcomes did not change, this randomized control study showed shorter ventilation time after pediatric cardiac surgery, substantially benefit for patients with complex congenital cardiac anomalies.

Objective The surgical management of anomalies of ventriculoarterial with ventricular septal defect (VSD) and left ventricular outflow tract obstruction(LVOTO) continues to present a surgical challenge because of the wide variability in anatomy and the disappointing late results with current approaches.For this reason,several techniques for surgical repair have been proposed.The optimal surgical strategy remains controversial.Here we present a mid term result of an alternative solution for these anomalies by a new technique named double-root translocation.Methods Between December 2007 and September 2013,a total of 78 consecutive patients underwent a double-root translocation procedure,at a median age of 3.0 (range,0.3-22.0) years.The VSD was repaired with a dacron patch,and the aortic root translocation was done with coronary reimplantation.The neopulmonary artery was reconstructed with a monocusp bovine jugular vein patch or a homograft patch.The mean follow-up interval was 56 months (range,2 to 98 months).Biventricular outflow tract function was assessed by echocardiography.Results In-hospital mortality was 4.4％ (3 patients).The causes of death are as follows,renal failure,low cardiac output,septicemia.During the follow-up period,no patient requiring reintervention,and 2 follow-up deaths caused by heart failure and sudden death.Postoperative echocardiography showed satisfactory hemodynamic effect of the reconstructed biventricular outflow tract and ventricular function.LVOT gradient was very low,indicating that root translocation procedures offer satisfying relief of LVOT obstruction.Mean RVOT gradient was only 10.4 mmHg (1.38 kPa),and in most of cases,the pulmonary valves only present mild or moderate regurgitation.Conclusion Our strategy for RVOT reconstruction is to reconstruct a free neo-pulmonary root with a monovalve patch plus native pulmonary artery.Therefore,the competence and the growth potential of the neo-pulmonary root can be expected.The double root transloction procedure is a true-meaning anatomic repair for transposition of the great arteries or double outlet of right ventricle,with ventricular septal defect and pulmonary stenosis in terms of physiologic cardiac hemodynamics.

Objective To investigate the application and surgical results of the modified perfusion strategy,that means,mild/moderate hypothermia,regional cerebral perfusion combined with cardiac perfusion,in the surgical correction of coarctation of the aorta(CoA) in infants and young children of CoA with intracardiac malformations.Methods From September 2010 to December 2012,59 patients of CoA combined with intracardiac malformation were enrolled in the study,37 males and 22 females..Among them,modifed purfusion strategy were performed in 29 patients,whereas "Traditional surgical strategy" were applied in 30 randomly selected cases as control.The age of the whole group ranged from 2 to 46 (8.2 ± 6.3) months and the body weight was from 4.0-18 (6.58 ± 2.15) kg.The key points of the " Modified purfusion strategy" include:Cooling to a nasopharyngeal temperature of 26℃-35℃,rectal temperature of 29℃-35℃,Occlusion clamp was placed between the innominate arterv-the left common carotid artery and the distal end of CoA.By keeping the position of asending arotic catheterization unchanged and keeping the heart beating,regional cerebral perfusion combined with heart perfusion were realised at 40-60 ml · kg-1 · min-1 flow rate.With lower body circulatory arrest,CoA were corrected by the approach of end-to-end or extentive end-to-end anastomosis.After the CoA correction is completed,clamping the asending aortic,cardiac arrest,correction of cardiac anomalies.Traditional perfusion strategy group using conventional cardiac arrest,deep hypothermia,regional cerebral perfusion approch to correct COA,the rest of the operation is the same as described above.Results There was no operative death,postoperative pulmonary infection occurred in 12 cases,3 cases occured pneumothorax,1 case suffered wound in fection and underwent secondary debridement,3 cases encountered postoperative oliguria and were treated with peritoneal dialysis.All patients received echocardiography examination before discharge and showed aortic arch coarctation has released,anastomotic stoma is patent,flow rate is normal or slightly fast.All patients were followed up for 3-26 months,no late death or complications occours.Modified perfusion strategy group was significantly superiors to the traditional persufion strategy group in the aspects of cardiac arrest time[(35.3 ± 10.2) min vs.(58.4 ± 19.8) min],auxiliary CPB time [(16.8 ± 4.0) min vs.(31.6 ± 12.1) min] and the vasoactive drug dosage[dopamine:(4.5 ±0.8) μg · kg-1 · min-1 vs.(6.3 ± 1.3) μg · kg-1 · min-1] after surgery.Conclusion Modified perfusion strategy can reduce myocardial injury,significantly reduce cardiac arrset 、circulatory support and temperature adjusting time and shorten the total duration of surgery compared with conventional perfusion strategy,the early result is satisfactory and has broad application prospects.

OBJECTIVE:To explore the feasibility of transcatheter closure of atrial septal defect (ASD) under transthoracic echocardiography (TTE) guidance.METHODS:Retrospective analysis was performed in 65 patients with simple ASD who underwent transcatheter closure under echocardiography guidance in Fuwai hospital from February to August 2013. They were divided into TTE group (n = 30) and transesophageal echocardiography (TEE) group (n = 35). The TTE group patients who underwent localized anesthesia or basal anesthesia received transcatheter closure of ASD under the guidance of TTE. The TEE group patients who underwent tracheal intubation and general anesthesia received transcatheter closure of ASD under the guidance of TEE. The patients were followed up with TTE and electrocardiogram at one month after procedure at outpatient department.RESULTS:In the TTE group, 28 occluders were implanted successfully and 2 patients were subsequently switched to TEE guidance because of unclear TTE images, and the occluder implantation in these 2 patients was successful. There were no obvious differences in age, sex, body weight, ASD size, and time of hospital stay between the two groups (all P > 0.05) . Compared with TEE group, the TTE group had a significantly shorter operation time ((52.77 ± 9.00 ) min vs. (60.11 ± 9.15) min, P < 0.05), respirator ventilation duration ((0.25 ± 0.95) h vs. (3.17 ± 0.69) h, P < 0.05), and stay time in ICU ((1.50 ± 1.96) h vs. (16.43 ± 6.99) h, P < 0.05). The dose of propofol required was significantly lower in the TTE group compared to TEE group ((2.41 ± 2.97) mg/kg vs. (9.43 ± 3.70) mg/kg, P < 0.05). The patients in both groups had no complications such as residual shunt, peripheral vascular injury or cardiac perforation at the time of hospitalization.No complications, such as occluder dislocation, residual shunt, or pericardial effusion were seen during follow-up at one month post procedure in both groups.CONCLUSION:Transcatheter closure of ASD under TTE guidance is feasible and has a broad application prospects.

Objective To summarize therapeutic experience of superior vena cava obstruction (SVCO) following corrective surgery for congenital heart disease in infants. Methods From January 1999 to May 2010, 3 infants were complicated with SVCO after congenital heart disease corrective surgery at this center. The diagnosis was made based on clinical manifestations, chest X-ray radiography and ultrasonography. Once the diagnosis was made, conservative therapy or surgery was performed to relief the obstruction of superior vena cava. Results Two patients underwent surgery, and the other one with incomplete SVCO received conservative management. After treatment, their blood circulation was stabilized, pleural effusion was also reduced. Conclusions SVCO is a rare complication following pediatric cardiac surgery. The infants with low birth weight have higher risks for developing postoperative SVCO. To prevent SVCO, blood clots and hemostatic agents should be carefully removed during surgery. Intimal injury of superior vena cava should be avoided during cannulation or placing purse string on the superior vena cava. Deep vein thrombosis should also be prevented.