OBJECTIVES:In paediatric cardiac surgery, reoperations remain challenging since the injury and the formation of dense adhesions before reoperations can be life-threatening to the heart, bypass conduits or great vessels. To prevent the formation of dense adhesions, a variety of different types of pericardial membrane substitute have been employed. However, due to peel formation, calcification and infection, the routine application of these pericardial membrane substitute has not been achieved clinically. A novel bioabsorbable membrane has been developed from polylactic acid (PLA) to overcome these drawbacks. The purpose of this study was to assess the biosafety and the effectiveness of PLA membrane as a new bioabsorbable pericardial membrane substitute after pericardium replacement in a rabbit model.METHODS:A total of 33 rabbits underwent abrasion on the surface of the heart through right thoracotomy and were divided into a PLA membrane group (n = 17) and a control group (n = 16). Biosafety was assessed by comparing pre- and postoperative liver/kidney function and C-reactive protein levels. Subsequently, at 4 and 12 weeks postoperatively, the degree of reabsorption of the membrane and the intensity of adhesions were macroscopically assessed, followed by a microscopic evaluation for histological changes. Samples of the regenerated fibrous membranes that were harvested 12 weeks after implantation were used to perform immunostaining for cytokeratin and human bone marrow endothelial cell-1 (HBME-1).RESULTS:The PLA membrane group exhibited a little inflammatory response (P > 0.05) and liver/kidney dysfunction (P > 0.05). The PLA membrane was mostly absorbed by 12 weeks with the replacement of loosely adherent tissue. Moderate adhesions were found between the pericardial membrane substitute and the epicardium at the 4-week postoperative inspection. After 12 weeks postoperatively, the adhesions were found to have resolved completely. The composite score, which combined the histological findings of inflammation and the tightness of adhesions, was graded on a scale of 0 to 3. Significant differences between the PLA and control groups were detected at 4 weeks (1.2 ± 0.4, 2.1 ± 0.6; P = 0.007, respectively) and 12 weeks (0.5 ± 0.5, 2.5 ± 0.7; P = 0.001, respectively). Twelve weeks after the replacement of the pericardium with the PLA membrane, as shown by the cells positively immunostained for cytokeratin and HBME-1, the regenerated membrane consisted of a bilayer structure mimicking the native pericardium.CONCLUSIONS:To prevent the formation of adhesions after cardiac surgery, the bioabsorbable PLA membrane might serve as a promising substitute for the pericardium, which proved to be safe and efficacious in our study.

Objective To analysis the effects of early prognosis, safety and medical costs in congenital heart diseases (CHD) children transferred through the newly-built National Transfer Network System for Congenital Heart Disease Children (NTNS) to get emergency transferring. Methods NTNS was founded by the National Center for Cardiovascular Disease (NCCD), combined with the major medical centre, which is based on the on-line network and covers most areas of China. NTNS has formed a CHD transferring and collaborative network. This system is based on the most experienced medical resources in Beijing and regional hospitals. In the meanwhile, the CHD database was established to exchange the medical files, records and photos among the collaborative health care facilities, making medical suggestions and decisions of transferring for further urgent surgical procedures decided by on-line medical councils for the severely sick CHD children even in the most undeveloped provinces. After the major operations, the CHD children who need the continuous recovery are discussed by the multi-disciplinary team on-line and the children will be transferred the proper health care centres for further treatment. All of these form a comprehensive CHD therapy system combined with early diagnosis, fast cooperative medical councils, emergent transferring, early intervention and postoperative rehabilitation among the medical centres. Results NTNS has transferred 121 severely sick CHD children and run 143 distanced medical councils. These children’s median age was 10 months (5.6, 21.0) with youngest age at 4 days, the mean hospital stays of them was 12.9 ± 4.8 days, which is much shorter than the children with same diagnosis in the same period of time transferred traditional ways. However, the post-operative PICU stays (p = 0.58) and hospital cost (p = 0.17) were no statistical differences. The out-patient treatment cycles and out-patient cost of the children in NTNS-transferred group were 2.7 days and 78234.43RMB, which were less than those in the children in the traditional group. Conclusions The National Transfer Network System for Congenital Heart Disease Children has been founded as a safe and effective working platform, which provided the prenatal diagnosis, emergent transferring, early surgical intervention and post-operative rehabilitation. This system shortened the hospital stays, treatment cycles, medical cost with sharing the capital’s experienced medical resources. NTNS will continue to provide the experiences in health policies and emergent transferring, which will bring more good results to the CHD children.

Objective: To evaluate the efficacy and safety for remote consulting and rescuing the children with critical congenital heart disease(CHD) by the first network transfer system(NTS) in China. Methods:We performed regional transferring in 244 children with complicated and critical CHD by both NTS and traditional system(TS). NTS group, n=96 and TS group, n=148. We documented and compared the patients' basic information, clinical condition, out-hospital time and peri-operative outcomes between 2 groups. Results:The median age in NTS group and TS group were 12(10-19) months and 12(9.3-19) months, P=0.321. NTG group had more complicated CHD patients, the ventilation time and PICU stay were longer than TS group, P=0.002 and P<0.001, the total in-hospital stay was shorter than TS group, P=0.023. There was no in-hospital death in either group and the total complication incidence was similar between 2 groups P=0.447. NTS group had less pre-hospital waiting time than TS group,(1.5±0.5) vs.(5.5±2.5) days, P<0.001 and the cost was lower, RMB(464.3±97.4) vs.(1023.6±231.4), P<0.001. Conclusion: Compared with TS, the NTS contained more complicated CHD patients, had shorter in-hospital stay, less pre- hospital waiting and lower cost. The total complication was similar between 2 groups.

Objective The intensive insulin therapy (IIT) has shown great results in the therapy of acquired cardiac lesions’ surgeries during intensive care unit (ICU) while it’s unknown in the palliative operations for complex congenital heart disease (CHD). This trial was to estimate the results for controlling the hyperglycemic in the palliative heart surgeries in CHD children during the paediatric intensive care unit (PICU) stays. Methods We enrolled 79 children diagnosed with congenital complex cardiac lesions who are going through the palliative operations. They were assigned into two groups randomly by computer, the IIT (n = 39) and conventional insulin therapy (CIT) group, which blood glucose concentrations ranges were 70–130 mg/dL and 70–220 mg/dL, respectively. The insulin infusion is pumped continuously to the children once glycemic level exceeds the upper limit of their own group after the surgeries back to PICU. In this prospective clinical trial we consider the hypoglycemic as the blood glucose falls below 70mg/dL and the 50% dextrose solution will be given to deal with the hypoglycemia till the glycemic is back into the settled range of their own group with the double check of blood glucose concentration. The PICU stays, chest effusion, transfusion, blood tests and major complications were documented to analysis. Results There was no hospital death and two infants in CIT group received the secondary surgeries for post-operation bleeding. One neonate and an infant in IIT group were excluded from this study due to the cardiopulmonary resuscitation for pulmonary hypertension crisis and the use of extracorporeal membrane oxygenation (ECMO) for low cardiac output syndrome. The incidence of hypoglycemia in IIT group was 19% while the one in CIT group was 11% (p = 0.047). The mean peak blood glycemic in IIT and CIT was 161 mg/dL and 221 mg/dL, respectively, which showed significant statistical differences (p = 0.013). The mean PICU stays and ventilation hours in both groups were no significant difference. The mean chest effusion in CIT group was 312 mL in the children of Fontan circulation, which was much less than that of IIT group (p = 0.031). The total hospital days in two groups were no statistical differences (p = 0.057). Conclusions The children in IIT group got better short outcomes than that of CIT group. It’s important to enlarge the population in this trial and other complex CHD would be included to analysis to acquire more information on the controlling of hyperglycemia in the perioperative care for complex CHD children.

粘连是结缔组织纤维带与相邻的组织或器官粘附在一起而形成的异常结构,其形成打破了组织正常愈合的生理过程.在心脏外科中,由于损伤心脏、大血管及旁路血管的存在,手术时间延长、失血及感染等危险因素的影响,心脏术后心包粘连会使再次手术的风险增高[1],再次开胸大血管损伤发生率为2％～6％[2]。

OBJECTIVE:To observe the efficacy of hybrid balloon valvuloplasty for the treatment of low-body weight infants with severe congenital valvular aortic stenosis (AS).METHODS:Five infants with severe congenital valvular aortic stenosis underwent the hybrid balloon aortic valvuloplasty through median sternotomy in the hybrid operating room. The mean age was (40.2 ± 7.0) days, weight was (4.48 ± 0.75) kg. The patients were followed up by echocardiography for 9 - 13 months post procedure.RESULTS:Operation was successful in all 5 patients and they were discharged from hospital uneventfully. The gradient pressure decreased significantly from (98.8 ± 9.0) mm Hg (1 mm Hg = 0.133 kPa) to (13.8 ± 3.3) mm Hg (P < 0.05) post operation. There was no moderate or severe aortic insufficiency. All patients were alive, the gradient pressures was (18.8 ± 2.5) mm Hg and there was no moderate or severe aortic insufficiency during follow-up [9 - 13 (11.0 ± 1.4) months].CONCLUSION:The hybrid balloon aortic valvuloplasty is an effective option for the low-body weight infants with severe congenital valvular aortic stenosis.

Objective To evaluate the effectiveness of autologous pericardium applied to pulmonary artery banding in a swine model.Methods In a swine model,pulmonary artery stenosis was created by autologous pericardium which made the left pulmonary artery banded to 30％-40％ of its original diameter.Animals underwent right heart catheterization and angiography 4 weeks postoperatively,and balloon-expandable'stents were implanted through right ventricular outflow tract.The animals were sacrificed at 12th week following stenting and microscopic evaluation for histologic changes was made.Results Pulmonary artery banding was performed on 8 swines.The lumen diameter was decreased from (16.0 ± 0.4) mm to (6.4 ± 0.2 )mm ( P ＜ 0.01 ),while the gradient inereased from median (range) 0 mm Hg to 35 ( 18-52 )mm Hg (1 mm Hg =0.133 kPa,P ＜0.01 ) following banding.One month later,the models were all survived.Compared to the instant result after banding,there was no significant difference in the lumen diameter ( P ＞ 0.05) or the gradient (P ＞ 0.05),and there was no banding dislodged and also no animal with severe left pulmonary artery hypoplasia or atresia.Conclusion Autologous pericardium as a banding to create an experimental pulmonary artery stenosis model appears safe and effective.

Objectives To evaluate the effectiveness of implanting a balloon-expandable stent into a stenotic pulmonary artery in a swine model.Methods In eight swine,a pulmonary artery stenosis model was created by banding the left pulmonary artery to 30%-40% of its original diameter.The animals underwent right heart catheterization and angiography four weeks postoperatively,and Cobalt-Chromium alloy stents were implanted through the right ventricular outflow tract.Four animals were sacrificed at 1 month,and the other four at 3 months after stenting.They were then microscopically evaluated for histologic changes.Results The lumen diameter increased from 6.4±0.2 mm to 15.6±0.4 mm(P<0.01),while the gradient decreased from median(range) 34.5(23-52) mm Hg to 6.0(1-20) mm Hg(P=0.012) following stenting.No stents dislodged,and there were no significant vessel tears or ruptures.Stents with neointimal proliferation were observed by scanning electron microscope in 2 animals sacrificed at 3 months;however,there was no significant hemodynamic difference between the two animals.Conclusions The novel balloon-expandable stent implanted in an experimental pulmonary artery stenosis model appears safe and effective.