Objective:To observe the influence of sevoflurane pretreatment in the lung function of the infants during heart operation by cardiopulmonary bypass (CPB), and to explore its lung protection and possible mechanism.Methods:Sixty infants with ventricular septal defect were enrolled at age less than 1 year old and randomly assigned to pretreatment group and control group (n=30).After the induction of general anesthesia and tracheal intubation,the patients in pretreatment group received continuous inhalation of 1.0 MAC sevoflurane until the beginning of CPB.Inhale sevoflurane was absent in control group.The duration of ventilator support of the infants in two groups was recorded.The Pplate,CL,OI,A-aDO2 ,RI,the number of leukocytes and neutrophils segregated in lung of the patients were compared between two groups at the four time points T0 (before aorta clamping),T1 (30 min after aorta declamping),T2,and T3 (2 h and 6 h after CPB).Results:Compared with control group,the duration of ventilator support of the infants in pretreatment group was obviously shortened (P <0.05).In each group,the CL and OI were significantly decreased (P < 0.05 or P < 0.01),while the Pplate, A-aDO2 ,RI,the number of leukocyte and neutrophils segregated in lung were significantly increased (P <0.05 or P <0.01)at T1,T2,T3 time points compared with T0 time point.The CL and OI in pretreatment group were significantly increased (P <0.05 or P <0.01);the Pplate,A-aDO2,RI,the number of leukocytes and neutrophils segregated in lung in pretreatment group were significantly decreased at T1,T2,and T3 (P <0.05 or P <0.01) compared with control group.Conclusion:Sevoflurane pretreatment might play a role in decreasing the leukocyte adhesion and protecting the lung function in the infants during opening heart operation by CPB.

Objective To study the protective effect of intraaortic protamine injection on lung in infants undergwent opening heart operation by cardiopulmonary bypass surgery. Methods Sixty infants (age ≤ 1 year,weight ≤ 10 kg)who accepted opening heart operation by cardiopulmonary bypass surgery were randomly assigned into 2 groups ( n = 30 in each group) reciving intra-aortic and intra-venous protamine injection respectively. P-peak, P-plate, CL, Oxygenation Index, the number of WBC and neutrophil segregated in lungs were compared between two groups before injecting protamine and 10 minutes, 1 hour, 3 hours after injecting protamine. The time of mechanical ventilation were compared as well. Results P-peak, P-plate, the number of WBC and neutrophil segregated in lungs of intra-aortic injection group significantly decreased than intra-venous injection group at 1 hour, 3 hours after injecting protamine (t =2.743, 3.512; 3.218, 3.469; 3.716, 5.243; 3.853,4. 783 respectively, Ps ＜ 0. 05 ), while the CL and Oxygenation Index increased significantly ( t = 3. 976,4. 267; 4. 557,4. 265 respectively, P ＜ 0. 05 ). The duration of mechanical ventilation follow operation in intraaortic injection group ( [8. 03 ± 5. 14] h ) was shorter compared with intra-venous injection group ( [10. 56 ±6.95]h) (t =2.599,P＜0.05). Conclusion By intra-aortic protamine injection the lung injury decreased significantly. It shows good protective effect on lung in infants underwent opening heart operation by cardiopulmonary bypass surgery.

Objective: To investigate the effect of cold self-blood cardioplegia with ulinastatin on immature myocardial cell apoptosis and protein expressions of Bcl-2, Bax in ventricular septal defect (VSD) infants.
Methods: A total of 60 infants received VSD repairing operation with cardiopulmonary bypass (CPB) in our hospital were summarized. The patients were randomly divided into 2 groups:Test group, the infants received cold self-blood cardioplegia with ulinastatin when aortic cross-clamp was closed. Control group, the infants received cold self-blood cardioplegia when aortic cross-clamp was closed. n=30 in each group. The right atrium tissue was collected before CPB and 10 min after releasing aortic cross-clamp. The index of myocardial cell apoptosis was observed by TUNEL method, and the protein expressions of Bcl-2, Bax were examined by immunohistological method.
Results: Both groups showed the higher index of myocardial cell apoptosis at 10 min after releasing aortic cross-clamp than 5 min before CPB, and the apoptosis index in Test group was lower than that in Control group, all P<0.05. The protein expressions of Bcl-2 and Bax were obviously increased at 10 min after releasing aortic cross-clamp than 5 min before CPB in both groups. Compared with Control group, Test group presented the higher Bcl-2 protein expression and lower Bax protein expression, all P<0.05.
Conclusion: Cold self-blood cardioplegia with ulinastatin could protect immature myocardum from ischemia-reperfusion injury in VSD infants during CPB operation in clinical practice.

Objective To investigate the effects of ulinastatin-containing autologous cold blood cardioplegic solution on the cardiac function of infants after cardiopulmonary bypass surgery.Methods Sixty infants younger than 10 months old,who underwent ventricular septal defect repair under cardiopulmonary bypass,were randomized into autologous cold blood cardioplegia group (30 patients,Group A)and ulinastatincontaining cold blood cardioplegia group (30 patients,Group B).CI,SI and LCWI were monitored 1 and 6 hours after opening the aorta.The time and rate of cardiac resuscitation,as well as the dependence on the inotropic drugs,were intraoperatively monitored.Results The automatic resuscitation rate in two groups was not siynificantly ( P ＞ 0.05).The time for automatic resuscitation were (34.2 ± 4.7) s and (52.1 ± 6.5 ) s for Group B and Group A,respectively ( P ＜ 0.05 ).The rate of dependence on inotropic drug were 40.0％ (12/30) and 66.7％ (20/30)for Group B and Gro~p A,respectively (P ＜ 0.05).Mter the operation,the CI,SI and LCWI of group B were higher than that of group A ( P ＜0.05 ).Conclusion Ulinastatin-containing autologous cold blood cardioplegic solution is beneficial to the functional cardiac recovery of the infants after heart bypass surgery by protecting the immature myocardium.

Objective To study the influence of autoblood cardioplegia on ATPase in neonatus myocardium with congenital heart disease and approach the mechanism of self-blood cardioplegia in protecting the myocardium in neonatus.Methods There were 30 cases of neonatus with congenital heart disease with body weight less than 8 kg,including 2 cases of ventricular septal defect(VSD),11 of VSD with severe pulmonary hypertension(PH),9 cases of USD with ASD,2 cases of atrial septal defect (ASD),6 of VSD and FPO.30 neonatus were divided into autoblood cardioplegic solution group(group A,n=10),allograft blood cardioplegic solution group (group B,n=10)and crystalloid cardioplegic solution group(group C,n=10).The biopsies were taken from right atrium just before arrested and after heart self-recovery to measure ATPase.Results Comparing with preoperative one,Na+-K+-ATPase creased obviously after operation in group A,B ,C (P＜0.05 ).There had no significant difference among the three groups before operation (P＞0.05).After operation,myocardial cell's Na+-K+-ATPase,Ca2+-ATPase and Ca2+Mg2+-ATPase in group A were decreased obviously as compared with that in group B and C (P＜0.05).Conclusion There is slight influence of autobloed cardioplegia on ATPase in neonatus with congenital heart disease,which can give a good protection to the myocardium in neonatus.

Objective To study the effect of the Periopeiative manngement on successful surgical treatment of congenital esophageal atresia with severe pneumonia.Method To review the Periopeiative manngement in congenital esophageal atresia with severe pneumonia.Result 33 cases were healed and one csse had anastomotic stoma leak and 2 cases died.Conclusion The key of one stage successful surgical treatment of congenital esophageal atresia with severe pneumonia is the good Pefiopeiative manngement.

Objective To observe and evaluate the changes in plasma C3a and C5a concentration after injecting protamine via two different pathways:ascending aorta and superior vena cava.Methods Sixty children with age under 1-year-old who underwent cardiopulmonary bypass were randomly divided into two groups:experimental group(injecting protamine via ascending aorta,n =30)and control group(injecting protamine viasuperior vena cava,n =30;).The plasma concentration of C3a and C5a were measured by ELISA at prior to protamine injected(Time 1)and 1 hour after the protamine injected(Time 2).Results In experimental group,there was no statistical difference on C3a and C5a concentration before and after injection of protamine[C3a:(18.762±3.792) μg/L vs(19.554±3.453) μg/L,t =-0.846,P =0.20; C5a:(0.843±0.159) μg/L vs (0.825±0.119) μg/L,t =0.496,P =0.31].In control group,C3 a concentration increased from(18.780±3.864) μg/L to(22.961±3.501) g/L,C5a concentration increased from(0.839±0.157) μg/L to(0.979±0.116)μg/L after injection of protamine,and the differences were significant(t =-4.392,-3.928,respectively,P ＜0.01).The level of C3a concentration in experimental group was significantly higher than that in control group[(19.554±3.453) μg/L vs.(22.961±3.501) μμg/L,ι =3.795,P < 0.01]after injection of protamine for 1 h and the level of C5a concentration exhibited the same change[(0.825±0.119) μg/L vs.(0.979±0.116)μg/L,t =-5.075,P ＜0.01].Conclusion The levels of C3a and C5a concentration of infants underwent cardiopulmonary bypass are decreased significantly after protamine injected via ascending aorta compated with via superior vena cava.

Objective:To discuss the effect of modified ultrafiltration combined with sequential infusion of blood products, such as platelets and cryoprecipitation, on perioperative coagulation function in neonates undergoing cardiovascular surgery under extracorporeal circulation.Methods:A retrospective analysis was performed on 83 neonates who underwent cardiovascular surgery from January 2017 to December 2019. They were divided into the control group (conventional ultrafiltration, 51 cases) and the treatment group (modified ultrafiltration + sequential infusion of blood products, 32 cases).Results:The age of treatment group was significantly younger than that of the control group ( P<0.05). The extracorporeal circulation time of the treatment group was significantly longer than that of the control group. Compared with the preoperative data, post-APTT, post-PT and post-INR were increased significantly in the control group, platelet count and FIB were decreased significantly ( P<0.01), while there was no significant difference in the treatment group. Compared with the treatment groups, post-APTT, post-PT and post-INR were significantly increased in the control group, and postoperative platelet count and FIB were significantly decreased ( P<0.05). The drainage of control group was significantly higher than that of the treatment group at 12 h and 24 h after surgery ( P<0.01). Conclusion:The application of modified ultrafiltration combined with sequential infusion of blood products can significantly improve perioperative coagulation and reduce mediastinal bleeding in neonatal after cardiovascular surgery.

Objective To review the clinical experience with the Norwood stage Ⅰprocedure.Methods Between June 2016 to October 2018, totally 5 neonates underwent Norwood stage Ⅰ procedure.There were 3 boys and 2 girls, weighing(2. 98 ±0.60)kg with median of 2.95 kg.Age at surgeries ranged from 1 to 8 days.All 5 cases underwent the Norwood stage Ⅰprocedure under deep hypothermic circulatory arrest, including 3 cases of modified Blalock-Taussig shunts (MBTS) and 2 ca-ses of RV-PA shunt.Results The third case was successfully closed the chest on postoperative day 2 and extubated, but died from DIC due to severe infection on the postoperative day 6.The fifth case died from pericardiol tamponade at 10 hours after the operation.The first,second and fourth cases were followed up 1 month after discharge with NYHA Ⅰ, but the first and second cases dropped out of follow-up due to some personal resaons.The fourth case underwent the bidirectional Glenn procedure 9 monthes after the stage Ⅰ procedure and recovered smoothly.Conclusion The application of these modified methods and te-chiques based on the classical Norwood procedure help to accumulate experience in sugical treatment of HLHS in China .

Objective Norwood Stage Ⅰ is the standard procedure to cope with hypoplastic left heart syndrome (HLHS),which continues to be the most challenging congenital heart disease.The aim of this study is to retrospectively compare the classical perioperative management of Norwood Stage] with the modified strategy.Methods Between June 2010 and November 2017,totally 10 patients with HLHS underwent the standard Norwood Stage Ⅰ procedure.They are stratified to two tiers:Group A,from June 2010 to August 2014,there were 5 boys.Age at surgeries ranged from 29 to 75 days,and weight 2.57-3.50 kg with median of 3.13 kg.Group B,from August 2014 to November 2017,there were 4 boys and 1 girl.Age at surgeries ranged from 6 to 22 days,and weight from 2.0-3.1 kg.In Group A,all 5 cases underwent the standard Norwood Stage.procedure under deep hypothermic circulatory arrest,including 4 cases of modified Blalock-Taussig shunt (MBTS) and 1 case of RV-PA shunt.In Group B,all 5 cases adopted side graft technique and RV-PA shunt,aortic arch and ascending aorta were reconstructed with treated bovine pericardial patch.Group B used incubators to adjust systemic vascular resistance instead of vasodilators.Results Group A's early mortality is 40％;Group B's early mortality is 20％,1 case died of tamponade.Conclusion The standard Norwood Stage Ⅰ procedure is a complex procedure,which demands multidisplinary cooperation,to palliatively correct HLHS.To adjust and find a suitable perioperative managements can improve the results.Sharing experiences on perioperative managements of Norwood Stage Ⅰ between heart centers in China will be helpful to decrease the mortality and morbidity in relatively short period.