Myocardial and cerebral protection are always the major concerns in neonatal aortic arch surgery. From the application of deep hypothermic circulatory arrest technology to continuous cardio-cerebral perfusion strategy adopted in many cardiac centers recently, each perfusion method has its own pros and cons, so there is no consensus on which one is the most suitable. This review aims to summarize the development and research progress of various perfusion methods, so that to provide a foundation for further development.
Abstract:Objective To evaluate the effects of modified uhrafihration （MUF）on blood rheology in infants after open cardiac surgery. Methods According to admission number, 22 infants of body weight less than 10 kilograms with ventricular septal defect （VSD） and pulmonary hypertension （PH） were divided into control group （10 infants, the mantissa of their admission number was odd number） and experimental group （12 infants, the mantissa of their admission number was even number）. Cases in control group didn＇t undergo MUF at the end of cardiopulmonary bypass （CPB）, while cases in experimental group underwent MUF; the flow rate of MUF ranged from 10 ml/min · kg to 15 ml/min · kg. MUF lasting for 10-15 minutes. Blood samples were repeatedly collected as following time： before operation, at the end of CPB, 15 minutes after CPB or the end of MUF, 2, 24 h after operation. Blood sample of 2. 5 ml was collected from the radial artery with hepathrom test-tube. The changes of relative indexes of the blood rheology were observed by MDK-3200 completely automatic dual pathways blood rheology testing analysator at 37±1 C. Results Hemoglobin, hematocrit, red cell count, blood yielding stress, plasma viscosity, the whole blood viscosity at high shear rate, the whole blood viscosity at middle shear rate and low shear rate, the whole blood reduction viscosity at high shear rate and middle shear rate, the whole blood reduction viscosity at low shear rate and Casson viscosity in experimental group at the end of MUF were significantly higher than those in control group at 15 minutes after CPB （P〈0. 05）. There was no significant difference in red cell aggregation index and red cell deformity between two groups at each moment （P 〉 0.05 ）. Conclusion Hemoglobin, hematocrit and red cell count are significantly elevated through MUF after CPB. Whole blood viscosity in infants undergone open cardiac surgery after CPB with MUF is higher than those who didn＇t undergo MUF.
Zero-balanced uhrafihration; Stored blood; Priming solution; Infant; Heart surgery
ObjectiveTo evaluate the effectiveness of elbow arthrography through lateral approach in the treatment of elbow fractures in infants.MethodsThe clinical data of 24 infants with elbow fractures admitted between May 2016 and May 2018 were retrospectively analyzed. There were 14 boys and 10 girls with an average age of 1.8 years (range, 2 months to 3 years). The time from injury to admission ranged from 1 hour to 7 days, with an average of 6.7 hours. The preoperative carrying angle was (30.8±4.5)° (range, 24°-41°), and the elbow range of motion was (128.5±4.5)° (range, 125°-134°). Elbow arthrography through lateral approach was used in all cases, including 10 cases of humeral lateral condylar fracture, 6 cases of distal humeral epiphysis fracture, 3 cases of fresh Monteggia fracture, and 5 cases of radial neck fracture. According to fracture types, open reduction with Kirschner wire fixation, closed reduction with plaster cast fixation, or closed reduction with percutaneous Kirschner wire fixation were used.ResultsNone of the children had adverse reactions such as drug allergy. All patients were follow-up 14-38 months, with an average of 19.6 months. The skin irritation around the needle tail occurred in 2 cases after operation, and the symptoms disappeared after the Kirschner wire was pulled out. The anteroposterior and lateral X-ray films of elbow joint showed that the fractures healed well and no mulunion at the fracture site or premature epiphysis closure was observed. At last follow-up, the carrying angle was (5.2±1.9)° (range, 2°-8°) and the elbow range of motion was (137.1±4.7)° (range, 133°-141°), which were significantly improved when compared with those before operation (t=22.670, P=0.000; t=11.910, P=0.000). According to Flynn clinical function evaluation standard of elbow joint, 22 cases were excellent, 1 case was good, and 1 case was fair. The excellent and good rate was 95.8%.ConclusionElbow arthrography through lateral approach can clearly judge the cartilage damage of the elbow joint surface in infants, and minimize the occurrence of misdiagnosis and missed diagnosis, and can guide the choice of treatment.
ObjectiveTo summarize clinical experience of staged left ventricular retraining for infants with transposition of the great arteries (TGA). MethodsFrom January 2001 to December 2011, 38 TGA infants with intact ventricular septum or a small ventricular septal defect underwent left ventricular retraining in Fu Wai Hospital. There were 26 male and 12 female patients with their age of 19.1±7.7 months and body weight of 7.6±4.7 kg. Preoperative arterial oxygen saturation (SaO2)was 72.6%±9.1%. Left ventricular retraining included aortopulmonary shunt and pulmonary artery banding. Three patients received concomitant excision of the atrial septum. All survival patients were followed up after discharge. ResultsPostoperatively, SaO2 increased to 83.9%±8.1% from preoperative 72.6%±9.1%, and left ventricle-to-right ventricle pressure ratio increased to 0.75±0.09 from preoperative 0.36±0.04. Three patients (7.89%)died postoperatively. Thirty-five patients were followed up for 2 to 11 years. During follow-up, 23 patients successfully received second stage arterial switch operation (ASO). ConclusionFor TGA infants with decreased left ventricular mass who have missed the neonate period, left ventricular retraining is a safe and efficacious procedure to provide necessary preparation for second stage ASO.
Objective To summarize the clinical characteristics, diagnosis and treatment of Bochdalek hernia in neonates and infants. Methods The data of 15 neonates and 10 infants with Bochdalek hernia，undergoing the normal diagnosis and surgical repair from August 1983 to June 2004, were retrospectively reviewed. Location was left in 22 cases and right in 3 cases. Twenty-four cases were treated by operation and 1 case died of respiratory failurebefore operation.Results Before April 1998，7 of 8 (5 neonates，3 infants) cases of Bochdalek hernia stayed healthy and respiratory symptomfree 1 year after operation; they were followed up 1 year and 3 months to 11 years. One premature neonate with Bochdalek hernia died of respiratory failure before operation, and his lung volume was found to be dysplasia. From April 1998 to June 2004, 15（8 neonates，7 infants） of 17 （10 neonates，7 infants）cases of Bochdalek hernia survived postoperatively, while 2 neonates died of respiratory failure. Conclusion The earlier dyspnoea of neonates ofBochdalek hernia occur，the worse their healthy status appear. The standard andtimely surgical repairs could improve the curative ratio. Whether the operationwas suspended depended on the healthy states of babies.