Objective:Advanced heart failure in children sometimes requires mechanical circulatory support as a bridge to transplantation, with extracorporeal membrane oxygenation (ECMO) remaining a critical option despite its associated risks. The pediatric Sequential Organ Failure Assessment (pSOFA) may have potential in evaluating prognosis in ECMO-bridged candidates. Methods:188 Children underwent orthotopic heart transplantation in Union hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2018 and April 2025 were studied retrospectively, with 24 received ECMO assistance as a bridge to transplant. Patients were divided into two groups according to outcomes while discharged. Serial pediatric Sequential Organ Failure Assessment and other medical data during bridging were collected for comparison. Results:66.7% of the 24 patients survived to discharge, with mortality linked to younger age (p = 0.034), higher pre-ECMO pSOFA scores (p = 0.019), and congenital heart disease. ECMO cannulation was mostly peripheral (66.7%), with left heart decompression in 87.5%. External cardiopulmonary resuscitation (50% of cases) increased mortality risk (p = 0.027). The death group had higher peak/trough/average pSOFA scores, reinforcing its predictive value. Non-survivors had more complications (ECMO reuse, septic shock, neurological issues) after heart transplant. pSOFA trends distinguished outcomes: survivors showed declining scores (p = 0.006), and average pSOFA ≤8 predicted better survival (p = 0.003). ECPR patients had worse baselines but might recover with optimized management. Findings support pSOFA-guided risk stratification in ECMO-bridged HTx. Conclusion:Continuous pSOFA monitoring effectively risk-stratifies ECMO-bridged pediatric transplant candidates, identifying high-risk patients after transplant. Planned ECMO initiation yields better outcomes than ECPR. These findings warrant prospective validation to optimize bridging strategies.

Introduction Mechanical circulatory support (MCS) can help to maintain hemodynamic stability, improve cardiac function, reduce cardiac load, and is an important method for the treatment of advanced heart failure. However, traditional MCS systems [IABP, Impella, TandemHerat, veno-arterial extracorporeal membrane oxygenation (VA-ECMO)] are associated with limitations including trauma, a high rate of complications (hemolysis, bleeding) and require complex care from nurses. Case summary We report a case of left heart failure resulting from dilated cardiomyopathy in a 24 years-old man. A catheter was placed through the right jugular vein and a drainage tube was positioned under ultrasound guidance through the superior vena cava, right atrium, atrial septum, to the left atrium, and returned to the axillary artery using an extracorporeal magnetic levitation ventricular assist device (VAD). The patient was successfully supported for 10 days and bridged to heart transplant. Discussion To the best of our knowledge, this is the first report of the use of an extracorporeal magnetic levitation VAD for MCS via a percutaneous approach. Our findings support the wider use of this strategy for patients awaiting myocardial recovery or who require heart bridging or transplantation.

Objective To sequence the antigen-encoding genes pepA and PPE18 from clinical isolates of Mycobacterium tuberculosis (MTB) and analyze their polymorphisms. Methods A total of 168 clinical isolates of MTB collected from the Department of Infection of the Children's Hospital of Chongqing Medical University from December 2006 to December 2013 were selected, corresponding to 168 cases with tuberculosis in children aged 7.8±5.7 years, with 87 males and 81 females.The target genes, pepA and PPE18, were amplified by PCR and sequenced respectively.The results of sequences were compared with the gene sequences of H37Rv, the standard strain of MTB, and the sequences of the epitopes searched from the immune epitope database (IEDB) to analyze the mutation characteristics of the gene sequences of pepA and PPE18. Results Among the 168 strains, mutations in PPE18 were found in 117(69.64%) strains and 10 of the 17 T cell antigenic epitopes of the PPE18 were altered.Six (9.84%) TB strains out of 168 clinical TB isolates showed polymorphisms in pepA gene and did not result in alteration of T cell antigenic epitopes. Conclusion PepA gene sequence is conservative, and PPE18 is highly polymorphic, which is predicted to affect the immune function of the M72 vaccine composed of pepA and PPE18 proteins, thus affecting the immunization effectiveness of the M72 vaccine.

Objective:To explore the value of delayed sternal closure in pediatric heart transplantation.Methods:The clinical data of 73 children with heart transplantation in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 1, 2018 to August 31, 2021 were analyzed retrospectively. According to the primary sternal closure after operation, they were divided into delayed sternal closure group (n=10) and non-delayed sternal closure group (n=63). The effects of delayed sternal closure on the recovery of graft function, surgical incision infection, pulmonary infection, 30 days mortality after operation and mortality during hospitalization were analyzed.Results:The protopathy of recipients in the delayed sternal closure group consisted largely of complex congenital heart disease heart failure, and the non-delayed sternal closure group was mainly cardiomyopathy heart failure. The median delayed sternal closure time in the delayed sternal closure group was 4 d, all recipients used the sternal closure technique once or several times, and the sternum were all successfully closed. The mean age and weight of recipients in the delayed sternal closure group were (6.4±5.3) years and (16.3±11.4) kg, both lower than those in the non-delayed sternal closure group [(9.7±4.7) years and (29.5±15.6) kg]; the donor recipient weight ratio of the delayed sternal closure group was (3.1±1.4), which was higher than that in the non-delayed sternal closure group (1.9±0.7). The differences were statistically significant (t=2.0, 3.2 and -4.5, all P<0.05). The preoperative and postoperative usage rate of VA-ECMO assistance, postoperative renal replacement treatment usage rate, pulmonary infection rate and mortality during hospitalization in the delayed sternal closure group were all higher than those in the non-delayed sternal closure group, and the differences were statistically significant (all P<0.05). The right ventricular volume change fraction in the delayed sternal closure group (37.0±5.8)% at 2 weeks after operation was lower than those (43.1±7.8)% in the non-delayed sternal closure group, and the difference was statistically significant (t=2.4, P<0.05). There was no significant difference in sex, preoperative serum total bilirubin and creatinine, left ventricular ejection fraction 2 weeks after operation, incision infection rate and mortality within 30 days after operation between the two groups (all P>0.05).Conclusion:Delayed sternal closure is a safe and effective treatment strategy in pediatric heart transplantation when the donor recipient weight is mismatched.

Objective:To study the application value of stepwise lung recruitment technique in postoperative hypoxemia in patients with obese aortic dissection.Methods:Retrospective analysis was performed on 78 cases of postoperative hypoxemia of obese patients with aortic dissection in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from December 2016 to January 2019. According to the treatment mode, 40 cases treated with conventional mechanical ventilation were divided into control group, and 38 cases treated with progressive pulmonary retraction were divided into experimental group. The heart rate (HR), respiration (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), arterial partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2), lung dynamic compliance (Cdyn), SpO 2, ventilator use time, ICU stay time and complications were compared between the two groups before and after lung recruitment. Results:There was no significant difference in HR between the two groups after 1 hour of pulmonary recruitment ( P>0.05). The RR at 1 hour after lung recruitment in the control group was significantly lower than that in the study group. SBP and DBP were significantly higher than the study group, and the differences were statistically significant ( P<0.01). PaO 2, PaO 2/FiO 2 and Cdyn at 1 hour after lung recruitment in the control group were significantly lower than those in the study group, and the differences were statistically significant ( P<0.05). There was no significant difference in SpO 2 between the two groups at 1 hour after lung recruitment ( P>0.05). The ventilator use time and ICU stay time in the control group were significantly higher than those in the study group, and the differences were statistically significant ( P<0.05). There was no statistically significant difference in the incidence of complications between the control group and the experimental group ( P>0.05). Conclusions:Gradual lung recruitment technique can significantly improve postoperative hypoxemia in patients with obese aortic dissection, improve lung ventilation situation and promote early recovery of patient.

目的 探讨体外受精-胚胎移植(IVF-ET)后先兆流产患者不良情绪与社会支持的相关性.方法 选择本院2016年7月至2019年6月进行IVF-ET患者142例,根据其是否发生先兆流产,分为先兆流产组60例和非先兆流产组82例.比较两组的基本情况、焦虑自评量表(SAS)、抑郁自评量表(SDS)、赫氏希望量表(HHS)、社会支持评定量表(SSRS)评分.结果 两组的婚龄、不孕年限、不孕因素、文化程度、是否初次行IVF-ET比较差异均无统计学意义(P>0.05);先兆流产组的年龄显著高于非先兆流产组,孕周显著低于非先兆流产组,差异有统计学意义(P<0.05).先兆流产组的SAS,SDS评分显著高于非先兆流产组(P<0.05);HHS,SSRS各项评分显著低于非先兆流产组(P<0.05).经Pearson直线相关法分析,IVF-ET后先兆流产患者的SAS,SDS评分与社会支持呈正相关(P<0.05),HHS与社会支持呈负相关(P<0.05).结论 IVF-ET后先兆流产者的不良情绪易受社会支持的影响,临床可根据患者焦虑、抑郁严重程度及希望水平的高低采取针对性干预措施.

目的 通过观察脂多糖(lipopolysaccharide,LPS)对主动脉瓣膜间质细胞(aortic valve interstitial cells,AVICs)炎症细胞因子表达的影响,以及利用小干扰RNA(small interfering RNA,siRNA)靶向沉默长正五聚蛋白3(pentraxin 3,PTX3)后AVICs炎症细胞因子白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、单核细胞趋化因子-1(MCP-1)表达的变化,探讨PTX3在钙化性主动脉瓣膜病(calcific aortic valve disease,CAVD)发病机制中的作用.方法 收集诊断为CAVD的瓣膜标本12例为实验组,并以心脏移植术中无病变的主动脉瓣膜标本12例为对照组,行免疫组织化学染色;体外培养AVICs,以不同浓度LPS(0、50、100、200 ng/mL)干预AVICs 24 h,利用Real-time PCR检测炎症细胞因子IL-6、IL-8、MCP-1的表达水平;利用PTX3靶向小干扰RNA(PTX3 siRNA)转染AVICs 48 h后,Western blot检测PTX3的沉默效果;转染PTX3 siRNA后的AVICs再以LPS(100 ng/mL)干预24 h,Real-time PCR检测其炎症细胞因子IL-6、IL-8、MCP-1的表达水平;结果 ①与对照组比较,实验组瓣膜PTX3表达水平明显增加;②不同浓度LPS干预后,AVICs表达IL-6、IL-8、MCP-1的水平均呈浓度依赖性增加,LPS浓度达100 ng/mL时,IL-6、IL-8、MCP-1的表达较对照组均显著增加(P<0.05,P<0.01);③PTX3 siRNA可有效沉默PTX3的表达(P<0.01);④ 与对照组(Scramble siRNA组)比较,在100 ng/mL LPS干预后,LPS+PTX3 siRNA组AVICs表达IL-6、IL-8、MCP-1均明显减少(均P<0.05).结论CAVD患者瓣膜表达PTX3较对照组明显增加;LPS促进AVICs表达炎症细胞因子IL-6、IL-8、MCP-1,但靶向沉默PTX3可明显抑制AVICs在LPS刺激下IL-6、IL-8、MCP-1的表达水平.PTX3对炎症细胞因子表达的调节可能在CAVD的发生机制中起重要作用.

Primary cardiac tumors are very rare and generally benign. The most common type, cardiac rhabdomyoma, comprises 45% to 75% of primary cardiac tumors. Cardiac rhabdomyoma is a rare benign tumor that commonly presents with tuberous sclerosis. We present a case of an infant with multifocal cardiac rhabdomyomas with an atrial septal defect and tricuspid insufficiency and no sign of tuberous sclerosis. She was successfully treated with an operation, the treatment plan included mass resection, tricuspid annuloplasty, and closure of the patent foramen ovale. The right atrial lesion was resected entirely, while the lobulated lesion in the right ventricle was resected as two pieces. There was no evidence of recurrence 1 year after the surgery.

Background: The arterial switch operation (ASO) has become the preferred method for surgical correction of transposition of the great arteries (TGA) and Taussig-Bing anomaly.This study was aimed to analysis the early and mid-term results of patients receiving ASO for TGA and Taussig-Bing anomaly in our institute.Methods: A single-institution retrospective study was conducted to assess cardiovascular outcomes after ASO between January 2007 and December 2013.A total of 119 consecutive patients were included in this study.The median age at operation was 30 days (range, 1 day-8 years), the median weight was 3.8 kg (range, 2.0-23.0kg).The ventricular septum was intact in 59 (49.6%) patients, 43 (36.1%) had ventricular septal defect, and 17 (14.3%)had a Taussig-Bing anomaly.We followed up patients with echocardiography.Special attention had been paid to the neo-aortic regurgitation and pulmonary stenosis.Results: In hospital deaths occurred in 10 (8.4%) patients.The most cause of death was low cardiac output due to deconditioning of the left ventricle and myocardial infarction.Echocardiographic data after ASO were collected in 93 (85.3%) patients at a mean duration of 60.7±20.2months.Among them, 4 (4.3%)patients had moderate to severe neo-aortic regurgitation, 1 (1.1%) patient had moderate tricuspid regurgitation, 4 (4.3%)patients had moderate pulmonary regurgitation; 1 (1.1%) patients had moderate pulmonary stenosis and no patients had severe stenosis.Only two patients required a surgical reintervention.Conclusions: The early mortality rate has decreased and the most cause of death was low cardiac output.The outcomes of the ASO using our reconstruction and reimplantation techniques were excellent and the reoperation rate was very low in the early and mid-term follow-up.

目的:婴幼儿瓣膜关闭不全,由于其瓣膜菲薄、面积有限,成人中常用的腱索转移、部分瓣叶切除等技术实施困难,而腱索包埋缩短技术也被证明复发率高.本中心在 15 例婴幼儿患者二尖瓣关闭不全中采用了人工腱索技术,取得满意效果.

目的:心下型完全型肺静脉异位引流(TAPVC),由于全身肺静脉血流经肝静脉或门静脉回流,梗阻难以避免,绝大多数需要在新生儿期手术治疗,由于其解剖及病理特点,术后死亡率及并发症发生率明显高于其它类型.我们对其术式进行了改良以获得更好的手术效果.

目 的:Williams 综 合 征 是 由 于 7 号 染 色 体 长 臂 近 端(7q11.23)区域的缺失所导致的一种少见常染色体显性遗传性疾病,临床表现多样,包括神经发育障碍,特异性面部特征("小精灵"面容),但多数合并主动脉瓣上狭窄等心脏疾病,本研究探讨 Williams 综合征合并主动脉瓣上狭窄和 / 或肺动脉狭窄的外科治疗方法和效果.

1 临床资料 患者 男,25岁.因"复杂先天性心脏病(先心病)双向Glenn术后8年,乏力并下肢水肿6年,加重1年"入住华中科技大学同济医学院附属协和医院.患者8年前外院诊断为先心病,右心室双出口(室间隔缺损远离两大动脉),右心室流出道狭窄,行双向Glenn手术治疗,术后患者口唇发绀及体力均有所好转.

目的:对本心中大动脉调转术后再次手术资料进行回顾性分析,研究其原因及治疗策略. 方法:2006-06 至 2017-05 期间,本中心共实施大动脉调转术 223 例.7 位患者行再手术 8 次,根据其手术原因分为3 类.第一类为左心系统瓣膜反流,1 例患者大动脉调转室缺修补术后 4 年因主动脉瓣重度关闭不全而行主动脉机械瓣置换.1 例患者行大动脉调转及主动脉缩窄矫治术后 3 年因出现二尖瓣重度反流和缩窄复发而行二尖瓣整形+缩窄段加宽术.第二类为肺动脉病变:3 例患者因术后肺动脉进行性瘤样扩张,导致心、肺功能不全,而行肺动脉重建术,切除动脉瘤,采用牛心包卷重建右室 - 肺动脉连接.第三类为介入手术 3 例,对于首次手术年龄偏大,重度肺动脉高压患者,我们采用大动脉调转 + 室间隔补片留孔的手术方式,分别于术后 24 个月、16 个月、11 个月对 3 位患者行二期室缺封堵.

Objective To compare early and mid-term outcomes between end-to-side anastomosis and synthetic interposition graft in repairing infant interrupted aortic arch(IAA).Methods 26 infants underwent a one-stage IAA repair.According to the operation points,26 infants were divided into two groups.10 of them had a synthetic interposition graft while the other 16 patients(two of them used bovine pericardium to broaden the antetheca of aortic arch) had end-to-side anastomosis to reconstruct the aortic arch.Follow-up time range from 6 to 84 months.Then compared early and mid-term outcomes.Results Comparison the early outcomes(group of a synthetic interposition graft vs group of end-to-side anastomosis):cardiopulmonary bypass time(119.3±21.5)min vs(148.4±56.6)min,aortic clamping time(65.0±30.1)min vs(79.4±29.1)min,circulatory arrest time(24.3±6.4)min vs(23.3±13.4)min,ventilating time(113.1±36.9)h vs(124.3±48.1)h,intensive care unit (ICU)stay time(12.9±6.3)d vs(13.0±3.6)d,mortality(0 case vs 2 cases),postoperative complications(2 cases vs 6 cases).Postoperative mid-term results:mortality(0 case vs 1 cases),left ventricular outflow track obstruction(LVOTO)(3 cases vs 2 cases),The aortic arch restenosis(3 cases vs 1 cases),New York Heart Association (NYHA) Ⅰ~Ⅱ(10 cases vs 9 cases).There were no significant differences in all early and mid-term outcomes between a synthetic interposition graft and end-to-side anastomosis to repair IAA(P>0.05).Using a synthetic interposition graft and end-to-side anastomosis are both effective methods to repair IAA,there were no significant differences in all early and mid-term outcomes between these two methods.Conclusion It's a feasible alternative to use a synthetic interposition graft to repair IAA,especially for the cases when IAA merged with the long isthmus,and further intervention were needed for the long-term curative effect.

A neonate developed severe dyspnea following an arterial switch operation due to compression of the trachea and left main bronchus by a dilated pulmonary artery. This was relieved by a second procedure in which the dilated pulmonary artery was excised and reconstructed with bovine pericardium.

Objective Although heart transplantation (HTx) has become a standard therapy for end-stage heart diseases,experience with pediatric HTx is limited in China.In this article,we will try to provide the experience with indications,complications,perioperative management,immunosuppressive therapy,and survival for pediatric HTx based on our clinical work.Method This is a retrospective chart review of the pediatric patients undergoing HTx at Department of Cardiovascular Surgery of Union Hospital from September 2008 to December 2015.We summarized the indications,surgical variables,postoperative complications,and survival for these patients.Result Twenty-three pediatric patients presented for HTx at Union Hospital of Tongji Medical College,of whom 12 were male.The age at the time of transplantation ranged from 3 months to 18years (median 14 years).Patient weight ranged from 5.2 kg to 57.0 kg (median 36.0 kg).Pretransplant diagnosis included cardiomyopathy (16 cases),complex congenital heart disease (5cases) and tumors (2 cases).All recipients received ABO compatible donor hearts.Postoperative complications occurred in 14 patients,including cardiac dysfunction,arrhythmia,pulmonary infection,renal dysfunction,and rejection.Two of them experienced cardiac failure and required extracorporeal membrane oxygenation.The immunosuppression regimen was comprised of prednisone,a calcineurin inhibitor,and mycophenolate.All patients recovered with New York Heart Association (NYHA) Class Ⅰ Ⅱ cardiac function and were discharged.Only one patient suffered sudden death 19 months after transplantation.Conclusion Orthotopic HTx is a promising therapeutic option with satisfactory survival for the pediatric population in China with end-stage heart disease.

目的 探讨脂多糖(LPS)上调主动脉瓣膜间质细胞(AVICs)表达长正五聚蛋白3(PTX3),在钙化性主动脉瓣膜病(CAVD)发生发展过程中的作用.方法 体外培养AVICs,用不同浓度LPS(0、50、100、200 ng/mL)干预AVICs 48h,蛋白免疫印迹法检测PTX3、骨形态发生蛋白2(BMP2)、骨桥蛋白(OPN)的表达;采用PTX3靶向小干扰RNA(PTX3siRNA)转染AVICs沉默PTX3 72 h,蛋白免疫印迹法检测PTX3的表达;PTX3 siRNA转染AVICs 48 h后再给予LPS(200 ng/mL)干预AVICs,蛋白免疫印迹法检测BMP2、OPN的表达.结果 ①不同浓度LPS干预AVICs表达PTX3、BMP2、OPN均呈浓度依赖性增加,LPS浓度达200 ng/mL时,PTX3、BMP2、OPN的表达与对照组比较均显著增加(均P＜0.01);②PTX3 siRNA组与对照组比较可有效沉默PTX3的表达(P＜0.01);③与对照组比较,LPS+ PTX3 siRNA组AVICs成骨因子的表达明显减少(P＜0.05).结论 LPS可刺激AVICs表达PTX3,从而促进AVICs表达BMP2、OPN,PTX3参与了CAVD的发生发展过程.