To investigate an association between surface electrocardiographic (ECG) parameters and sustained ventricular tachycardia (VT) in children after repair of congenital heart disease (CHD), data were obtained and analyzed in three groups (group I, 7 postoperative patients with episode of sustained VT (4 tetralogy of Fallot (TOF), 2 double outlet right ventricle (DORV), 1 truncus arteriosus); group II, 14 children with postoperative TOF not associated with VT; group III, 14 normal children). Mean age at the onset of sustained VT was 129+/-77 months (range 60-232); mean age at corrective surgery, 44+/-33 months (range 10-102); mean follow-up period after surgery, 84+/-74 months (range 20-185); the duration from repair to the onset of sustained VT, range 1-185 months. Compared to group II and III, group I showed longer QRS duration (group I, 137+/-10 msec; group II, 114+/-22 msec; group III, 65+/-12 msec) and shorter corrected J to Tmax interval (group I, 209+/-24 msec; group II, 272+/-44 msec; group III, 249+/-18 msec). QT and corrected QT, J to Tmax interval, and their dispersions in group I and II are significantly different from those of group III. In conclusion, QRS duration and corrected J to Tmax interval could be helpful to predict ventricular tachycardia in postoperative CHD.
Adolescence ; Child ; Child, Preschool ; Electrocardiography ; Female ; Heart Defects, Congenital/surgery* ; Heart Defects, Congenital/physiopathology ; Human ; Infant ; Male ; Tachycardia, Ventricular/etiology*

BACKGROUND: To study the effect of chloral hydrate oral premedication on sedation and arterial oxygen saturation in noncyanotic and cyanotic congenital heart disease children. METHODS: 18 noncyanotic congenital heart disease patients and 18 cyanotic congenital heart disease patients scheduled for cardiac surgery were premedicated orally with chloral hydrate 50 mg/kg. Arterial oxygen saturations were measured with pulse oximeter before and after oral premedication and sedation effects evaluated. RESULTS: In noncyanotic group oxygen saturation decreased from 98.7+/-0.95% (mean+/-?SD) before premedication to 97.8+/-1.15% after premedication with statistical significance but without meaning. 16 of the 18 patients (89%) were adequately sedated without airway obstructions. In cyanotic group oxygen saturation increased with statistical insignificance from 73.5+/-10.9% before premedication to 74.0+/-13.9% after premedication. 15 of the 18 patients(83%) were adequately sedated. Effects on oxygen saturation in cyanotic group patients were quite variable with 3 of the patients revealing more than 10% decrease in oxygen saturation. CONCLUSIONS: Chloral hydrate has a good sedative effects on congenital heart disease children but its effects on oxygen saturation were variable and close monitoring followed by oxygen administration is recommended in cyanotic heart patients.
Airway Obstruction ; Child* ; Chloral Hydrate* ; Heart ; Heart Defects, Congenital* ; Humans ; Hypnotics and Sedatives ; Oxygen* ; Premedication ; Thoracic Surgery

OBJECTIVETo summarize the experience of mitral valve (MV) repair in infants and young children with congenital mitral malformation.

METHODSThirty-eight consecutive infants and young children with this disease, aged (2.3 +/- 1.2) years, weighted (12.6 +/- 3.9) kg, underwent mitral repair from January 1996 to March 2002. The procedure included partial annuloplasty, repair of the cleft of the mitral leaflet, chordal shortening, chordal transfer, artificial chordae and reconstruction of the posterior leaflet. The modified annuloplasty allows natural growth of the annulus. The associated cardiac anomalies were totally corrected.

RESULTSIn these patients, no early and late deaths were observed, nor reoperation and severe complications. No or trivial regurgitation occurred in 11 patients, mild regurgitation in 22, and moderate and greater regurgitation in 5. Thirty-seven patients were asymptomatic.

CONCLUSIONSMitral repair procedure may be effective in infants and children with early or intermediate mitral regurgitation.

Cardiac Surgical Procedures ; Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Infant ; Male ; Mitral Valve Insufficiency ; congenital ; surgery

Objective: To explore the application value of percutaneous peripheral interventional therapy in pulmonary atresia with intact ventricular septal (PA-IVS). Methods: Retrospective case summary. The data was collected from 25 children who were hospitalized at the Children's Hospital,Zhejiang University School of Medicine from August 2019 to August 2022, had been diagnosed with PA-IVS by echocardiography, and underwent interventional treatment. The sex, age, weight, operation time, radiation exposure time, and radiation dose of the patients were collected. The patients were divided into the arterial duct stenting group and the non-stenting group. Preoperative tricuspid annular diameters and Z scores, right ventricular length diameters, and right ventricular/left ventricular length-diameter ratios were compared by paired t-tests. Right ventricular systolic pressure difference, oxygen saturation, lactic acid before and after the surgery were compared for 24 children who received percutaneous balloon pulmonary valvuloplasty. Right ventricular improvement in 25 children after operation was analyzed. The correlation between postoperative oxygen saturation and postoperative right ventricular systolic blood pressure difference, the degree of pulmonary valve opening and the Z value of tricuspid valve ring in the non-stenting group were analyzed. Results: A total of 25 patients with PA-IVS were enrolled in the study, of whom 19 were males and 6 females, with an age at surgery of 12 (6, 28) days and a weight of (3.7±0.5) kg. One of them underwent only stenting of the arterial duct; 20 children underwent only percutaneous pulmonary valve perforation and balloon angioplasty; 4 children underwent both procedures. The Z-value of the tricuspid ring was -1.5±1.2 in the group with arterial duct stenting, and -0.1±0.4 in the group without stenting (t=2.77, P=0.010). The tricuspid regurgitant flow rate 1 month after surgery was significantly lower than the preoperative ((3.4±0.6) vs. (4.8±0.9) m/s, t=6.62,P<0.001). In the 24 children with percutaneous pulmonary valve perforation and balloon angioplasty, the preoperative right ventricular systolic blood pressure was (110±32) mmHg, and the postoperative systolic blood pressure was (52±19) mmHg (1 mmHg=0.133 kPa) (F=59.55, P<0.001). The factors that may affect postoperative oxygen saturation in 20 cases of non-stenting group were analyzed. The results suggested that the pre and post-operative right ventricular systolic blood pressure differences (r=-0.11, P=0.649), and the pulmonary valve orifice opening (r=-0.31, P=0.201) and tricuspid annulus Z value (r=-0.18, P=0.452) at 1 month after the operation were not significantly correlated with the postoperative oxygen saturation. Conclusions: Interventional therapy can be used as the first choice for one-stage operation of PA-IVS. Percutaneous pulmonary valve perforation and balloon angioplasty are more suitable for children with well-developed right ventricles, tricuspid annulus, and pulmonary arteries. While the smaller the tricuspid annulus, the more dependent it is on the ductus arteriosus and thus patients are more suitable for arterial duct stenting.
Child ; Female ; Male ; Humans ; Pulmonary Atresia/surgery* ; Follow-Up Studies ; Retrospective Studies ; Heart Defects, Congenital/surgery*

This study was performed to assess the accuracy of pulsed Doppler echocardiographic(PDE) diagnosis of ventricular septal defect(VSD). 119 children with congenital heart disease, aged 9 months to 17 years, admitted to our hospital for cardiac surgery, were studied. These children had VSD(56), ASD(18), PDA(43), PS(1) and Cortriatrium(1). A specific PDE diagnosis of VSD can be made by following the turbulent VSD jet(TVJ) through the septum, and a PDE diagnosis of VSD was made in 53 out of 56 patients(95%) proven by catheterization and operation. There were two false positive PDE diagnosis of VSD by PDE, were proven to be perimembranous VSD at operation, and 3 children who were classified into subarterial infundibular VSD by PDE, were proven to be perimembranous VSD at operation. PDE seems to be a very useful tool in preoperative evaluation of VSD.
Catheterization ; Catheters ; Child ; Diagnosis* ; Echocardiography, Doppler, Pulsed* ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Humans ; Thoracic Surgery

Adolescent ; Adult ; Child ; Child, Preschool ; Heart Defects, Congenital ; surgery ; Humans ; Young Adult

BACKGROUNDPulmonary atresia with ventricular septal defect (PA-VSD) and major aortopulmonary collateral arteries (MAPCAs) remains a challenging complex congenital heart disease nowadays. In the present study, we aimed to develop a two-stage surgical method and to evaluate outcomes of this method in managing PA-VSD and MAPCAs.

METHODSBetween December 2003 and December 2008, 7 female and 4 male patients between the age of 5 and 10 years who were suffering from PA-VSD and MAPCAs were selected and recruited. The native pulmonary artery trunks were absent in all patients; the lungs were solely supplied by major aortopulmonary collaterals, and the numbers of supplied lung segments ranged from 15 to 20 (17.9 +/- 1.6). There were a total of 43 MAPCAs in all the patients (3 - 5 (3.9 +/- 0.7) MAPCAs per patient). The accumulated Nakata index was (222.9 +/- 29.9) mm(2)/m(2) (ranged from 182 to 272). All the patients underwent two sequential operations. Stage one included left major aortopulmonary collateral unifocalization and modified Blalock-Taussig shunt from left posterior lateral thoracotomy; stage two comprised right unifocalization, ligation of the shunt, followed by ventricular septal defect closure and right ventricular outflow tract reconstruction assisted with cardiopulmonary bypass from midline sternotomy.

RESULTSAll the patients survived the initial surgery, but one of them died of low cardiac output syndrome on the third day after the second operation. Postoperative complications included pneumonia in one case and capillary leak syndrome in another. Postoperative oxygen saturation maintained about 95% - 100%, which was significantly higher than pre-operation (P < 0.01). During the follow-up period of 3 - 51 (25.4 +/- 15.2) months, there were no late death and no need for re-intervention. All the patients enjoyed their lives with good conditions.

CONCLUSIONSThis two-stage complete repair strategy was well-tolerated and effective with good outcome, thus offering an alternative surgical approach in the treatment of PA-VSD and MAPCAs.

Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; surgery ; Heart Septal Defects, Ventricular ; surgery ; Humans ; Male ; Pulmonary Artery ; abnormalities ; Pulmonary Atresia ; surgery ; Thoracotomy ; Treatment Outcome

OBJECTIVETo investigate the methods of interventional catheterization for combined congenital heart disease and to evaluate its efficacy in children.

METHODSFrom March 1994 to December 2003, 15 cases (6 boys, 9 girls) underwent transcatheter intervention for combined congenital heart diseases. The procedure of transcatheter intervention was as follows: for pulmonary stenosis (PS) and atrial septal defect (ASD) or patent ductus arteriosus (PDA), PBPV first, occlusion of ASD or PDA later; for coarctation of aorta (COA) and PDA, dilation of COA first, occlusion of PDA 4-15 months later; for aortic stenosis (AS) and PDA, PBAV first, occlusion of PDA later; for ventricular septal defect (VSD) and PDA, all occlusions with detachable coils.

RESULTTranscatheter intervention for combined congenital heart diseases was successful in all patients. There was no residual shunt after occlusion immediately apart from 2 cases of PDA which were little residual after occlusion immediately. Follow-up for (3.57 +/-2.61) years, the systolic pressure gradients across pulmonary valve and coarctation were normal by ultrasonic or transcatheter, except AS. There was 3 cases presented postoperative complications: 1 with mechanical haemolysis, 1 with fall off of coil and 1 with arterial embolism, respectively.

CONCLUSIONTranscatheter intervention for combined congenital heart diseases could obtain satisfactory results with appropriate indications and procedure manipulations.

Abnormalities, Multiple ; surgery ; Cardiac Catheterization ; Catheterization ; Child ; Child, Preschool ; Ductus Arteriosus, Patent ; surgery ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; surgery ; Heart Septal Defects, Atrial ; surgery ; Heart Septal Defects, Ventricular ; surgery ; Humans ; Infant ; Male ; Pulmonary Valve Stenosis ; surgery

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze natural history and clinical features of scoliosis developed after surgery for congenital heart disease and to investigate the influence of cardiac surgery on the onset and progression of scoliosis. MATERIALS AND METHODS: Three hundred and five patients who had been operated for congenital heart disease from Jan.1988 to Dec.1990 and followed up for more than 5 years were analyzed. The curve which was more than 10 degrees on radiography was defined as significant scoliosis and the patients with congenital spinal anomalies were excluded. We compared age at surgery, cardiac disease and effect of cyanosis between scoliosis and non-scoliosis group. Furthermore, in scoliosis group, prevalence, onset of significant scoliosis, and manifestation of curve according to side of thoracotomy were assessed. RESULTS: Fifty-six patients(18.4%) had scoliosis of more than 10 degrees. As for location, high thoracic in 19, thoracic in 23, double thoracic in 8, thoraco-lumbar in 5 and double major in 1. Of the 42 patients with thoracic or high thoracic curves, 17(40%) showed convexity to the left. The magnitudes of curves were less than 40 degrees except 1. There was no significant difference in prevalence(p=0.513) and Cobb angle(p=0.634) between cyanosis and acyanosis group. Scoliosis developed between 3 and 6 years after cardiac operation in 26 patients(46%). In high thoracic curve, 6 of 7 patients with left thoracotomy demonstrated convexity to the left and 5 of 6 patients with right thoracotomy demonstrated convexity to the right(p=0.026). CONCLUSIONS: The prevalence of scoliosis after surgery for congenital heart disease was 18.4%. High thoracic and left thoracic curves were more frequent compared to idiopathic curves and a half of them developed 3 to 6 years after cardiac surgery. Most patients did not have severe curve to need surgical intervention and there was no correlation between severity of scoliosis and age at cardiac operation and cyanosis. In high thoracic curve, the tendency for the curve to be convex to the side of cardiac approach was demonstrated.
Child* ; Cyanosis ; Heart Defects, Congenital* ; Humans ; Natural History ; Prevalence ; Radiography ; Retrospective Studies ; Scoliosis* ; Thoracic Surgery ; Thoracotomy

PURPOSE: The purpose of this study was to explore the relationships of family strain, perceived social support, family hardiness, and family adaptation and identify the family resiliency factors for the adaptation of families who have a child with congenital heart disease. METHOD: The sample consisted of 90 families who had a child diagnosed with congenital heart disease and completed surgical treatment. Data was collected from parents using a questionnaire. RESULTS: Results from path analyses revealed that family strain had a direct effect on both perceived social support and family hardiness, and an indirect effect on family adaptation. Also, the findings revealed that perceived social support had a direct effect on both family hardiness and family adaptation, and family hardiness had a direct effect on family adaptation. Thus, these results indicated that perceived social support and family hardiness had a mediating effect on family strain. CONCLUSION: Findings provide the evidence for the theoretical and empirical significance of perceived social support and family hardiness as family resiliency factors for family adaptation. Clinical implications of these findings might be discussed in terms of family-centered nursing interventions for the families who have a child with congenital heart disease based on an understanding of family resiliency for adaptation.
*Adaptation, Psychological ; Child ; Family/*psychology ; Female ; Heart Defects, Congenital/*psychology/surgery ; Humans ; Male ; Questionnaires ; Social Support