OBJECTIVEThis research reported the experience of early surgical treatment for infants with large atrial septal defects (ASD) or ventricular septal defects (VSD) complicated by pneumonia.

METHODSBetween January 2003 and January 2008, 39 infants with large ASD or VSD complicated by pneumonia were admitted to the Second Xiangya Hospital. Thirty-six patients underwent surgical repair within 7-10 days after pneumonia had been controlled. Mean age was 5.4+/-3.4 months and mean weight was 4.7+/-1.6 kg in the 36 patients. Three patients received conservative treatment due to uncontrolled lung infections.

RESULTSOf the 36 patients, 33 had successful surgery and 3 (8.3%) died of serious low cardiac output (n=1) or respiratory failure due to congenital tracheostenosis (n=2). The 33 survivors showed normal growth and development in a 6 month-5 year follow-up. Of the 3 patients receiving conservative treatment, 1 died of cardiopulmonary failure and 2 were discharged after the symptoms had been improved.

CONCLUSIONSWith increasing medical experience and technique, early surgical operation may be performed with good outcomes in infants with large ASD or VSD complicated by pneumonia.

Adolescent ; Child ; Child, Preschool ; Female ; Heart Septal Defects, Atrial ; complications ; surgery ; Heart Septal Defects, Ventricular ; complications ; surgery ; Humans ; Infant ; Male ; Pneumonia ; etiology ; Postoperative Complications ; etiology

Adult ; Cardiac Catheterization ; Female ; Heart Septal Defects, Ventricular ; surgery ; Humans ; Postoperative Complications

Adult ; Cardiac Catheterization ; adverse effects ; Female ; Heart Septal Defects, Ventricular ; surgery ; Hemolysis ; Humans ; Postoperative Complications ; etiology

High degree atrioventricular block (HDAVB) is a serious complication of transcatheter closure of a perimembranous ventricular septal defect (PMVSD). We report one patient who developed transient HDAVB seven days after transcathter closure of PMVSD and had recurrent HDAVB 42 months after the procedure.
Atrioventricular Block ; etiology ; Heart Septal Defects, Ventricular ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Recurrence ; Septal Occluder Device

50 days old, 4.5kg male patient was admitted at department of pediatrics due to congenital heart disease with congestive heart failure. The echocardiographic finding was perimembranous type ventricular septal defect. The patient underwent open heart surgery for patch closure of VSD. Immediately postoperatively, junctional ectopic tachycardia developed and the patient was in hemodynamically unstable state with decreased urine output. We used inotropics, digitalis and diuretics, however these treatments were not effective in recovering the unstable state. Therefore, we tried a mild hypothermic treatment (34degree C). During the POD #2, mild hypothermia method was repeated four times. The junctional ectopic tachycardia was converted to normal sinus rhythm, hemodynamic state was stable, and urine output was increased. The patient was discharged at POD #8.
Digitalis ; Diuretics ; Echocardiography ; Heart Defects, Congenital ; Heart Failure ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypothermia* ; Male ; Pediatrics ; Postoperative Complications ; Tachycardia, Ectopic Junctional* ; Thoracic Surgery

Heart-lung transplantation is an effective treatment for patients with various forms of congenital heart disease or pulmonary hypertension. Since the first heart-lung transplantation in 1997, five transplants have been performed in Korea. Three cases were performed in 1997, one in 1998, and the latest one in 2002. The preoperative diagnoses were complex congenital heart disease (CHD) in 2, and CHD with Eisenmenger's syndrome in 3. In this paper, we report five cases of heart-lung transplantation performed in Korea, and include a review of the relevant literature.
Adult ; Child ; Ductus Arteriosus, Patent/complications ; Eisenmenger Complex/etiology/*surgery ; Female ; Heart Defects, Congenital/complications/*surgery ; Heart Septal Defects, Ventricular/complications/surgery ; *Heart-Lung Transplantation ; Humans ; Korea ; Male ; Pulmonary Atresia/complications/surgery

OBJECTIVETo evaluate the safety and efficacy of staged hybrid approach in treating ventricular septal defect (VSD) patients combined with patent ductus arteriosus (PDA) and pulmonary artery hypertension (PAH).

METHODSFrom July 2004 to July 2009, 22 VSD patients with PDA and PAH were enrolled and received staged hybrid approach treatment (transcatheter PDA occlusion and elective open surgery for VSD several days after PDA occlusion). All patients were followed up to examine rhythm change, residual shunt, shape of occlude, possible valve regurgitation, and aortic stenosis by echocardiography.

RESULTSAfter transcatheter PDA occlusion, pulmonary arterial systolic pressure decreased from (76.2 ± 25.8) mm Hg (1 mm Hg = 0.133 kPa) to (55.4 ± 20.6) mm Hg (P = 0.005), mean pulmonary artery pressure decreased from (53.5 ± 23.5) mm Hg to (36.2 ± 17.8) mm Hg (P = 0.049), total pulmonary resistance decreased from (8.2 ± 4.9) wood units to (6.9 ± 4.3) wood units (P = 0.037), and pulmonary-to-systemic flow ratio (Qp/Qs) increased from 2.8 ± 2.3 to 3.4 ± 1.7 (P = 0.045) post transcatheter interventional PDA occlusion. After VSD repair, pulmonary arterial systolic pressure decreased from (64.5 ± 22.3) mm Hg to (43.1 ± 18.9) mm Hg (P = 0.001) and mean pulmonary artery pressure decreased from (40.2 ± 18.7) mm Hg to (29.5 ± 15.8) mm Hg (P = 0.040). There was no death or right heart failure during the follow-up.

CONCLUSIONStaged hybrid approach is an effective and safe strategy for treating VSD patients with PDA and PAH.

Adolescent ; Adult ; Cardiac Catheterization ; Cardiac Surgical Procedures ; Child ; Ductus Arteriosus, Patent ; complications ; surgery ; Female ; Heart Septal Defects, Ventricular ; complications ; surgery ; Humans ; Hypertension, Pulmonary ; complications ; surgery ; Male ; Young Adult

The changes of adrenomedullin (ADM), endothelin-1 (ET-1) and nitric oxide (NO) levels before and after operation in congenital heart disease (CHD) associated with pulmonary hypertension (PH) were observed in order to investigate their role in CHD with PH and their clinical significance. The CHD patients were divided into 3 groups according to pulmonary artery systolic pressure (PASP): Non-PH group: PASP < or = 30 mmHg (n = 11); mild-PH group: PASP 31-49 mmHg (n = 10); moderate or severe-PH group: PASP > or = 50 mmHg (n = 12). The control group consisted of 15 health children. Plasma ADM, ET-1 and NO levels were determined by radioimmunoassay and colorimetry methods. The correlation between ADM and ET-1, NO, PASP was analyzed. The changes in plasma ADM, ET-1 and plasma NO on the 7th day after operation among the groups were compared. The results showed that plasma ADM levels in non-PH group were significantly higher than that in control group (P < 0.05), but there was no significant difference in ET-1 and NO levels between the two groups (P > 0.05). ADM and ET-1 levels in mild-PH group were significantly elevated as compared with those in non-PH group (both P < 0.05), but NO levels were decreased (P < 0.05). ADM and ET-1 levels in moderate or severe-PH groups were increased as compared with those in mild-PH group (both P < 0.01), but NO level significantly declined (P < 0.05). On the 7th day after operation, plasma ADM and ET-1 levels in PH group were significantly decreased (P < 0.05, P < 0.01) as compared with those before operation, but there was no significant difference in NO levels (P > 0.05). But NO levels in non-PH group were significantly increased (P < 0.05). Plasma ADM levels in CHD were positively correlated with PASP and ET-1 (r = 0.77, P < 0.01; r = 0.82, P < 0.01), negatively correlated with NO (r = -0.56, P < 0.05). It was concluded that during the progression of PH in the cases of CHD, plasma ADM, ET-1 and NO might play an important role in the development of PH. The increased ADM may represent a compensatory mechanism. It can interact with NO and ET-1 to regulate pulmonary circulation in the pathophysiology of PH with CHD. ADM may be involved in the defence mechanism against further increase of pulmonary arterial pressure. ADM could be used as a reliable indicator of the severity of CHD associated PH.
Adolescent ; Adrenomedullin ; Child ; Child, Preschool ; Endothelin-1 ; metabolism ; Female ; Heart Septal Defects, Atrial ; complications ; metabolism ; surgery ; Heart Septal Defects, Ventricular ; complications ; metabolism ; surgery ; Humans ; Hypertension, Pulmonary ; etiology ; metabolism ; Infant ; Male ; Nitric Oxide ; metabolism ; Peptides ; metabolism ; Postoperative Period

OBJECTIVE: To investigate the characters and surgical treatment methods of anomalous drainage of left superior vena cava to left atrium. METHODS: Clinical data of 8 cases were analyzed retrospectively.The patients aged from 6 months to 168 months with weight between 6 and 29 kg. RESULTS: The associated cardic lesions existed in all patients: 4 had partial atrioventricular septal defect (PAVSD),including 1 coronary sinus orifice atresia (CSOA), 1 ventricle septal defect (VSD), 1 ventricle septal defect associated with right ventricular outlet tract stenosis (VSD/RVOTS), and 1 atrial septal defect (ASD) and complete atrioventricular septal defect (CAVSD), respectively.No patient died. Preoperation diagnosis was in 1 case, intraoperation diagnosis in 5 cases,and postoperation diagnosis in 2 cases due to reoperation for hypoxemia.Three patients were repaired by intratrium tunnel, and the other 5 were managed by extracardic shunt. CONCLUSION This lesion is easily missed in preoperation diagnosis,which can be avoided by awareness and careful inspection.The methods for management of anomalous drainage of left superior vena cava to left atrium depend on time of diagnosis and experience of surgeons.
Adolescent ; Cardiac Surgical Procedures ; methods ; Cardiopulmonary Bypass ; Child ; Child, Preschool ; Female ; Heart Atria ; abnormalities ; Heart Defects, Congenital ; complications ; surgery ; Heart Septal Defects, Ventricular ; complications ; surgery ; Humans ; Infant ; Male ; Retrospective Studies ; Vena Cava, Superior ; abnormalities ; surgery

OBJECTIVE: To evaluate the impact of Down syndrome (DS) on surgical management in patients with congenital heart defects (CHD). METHODS: We retrospectively analyzed the clinical data from 35 children with DS and CHD, who underwent cardiac surgery between 2004 and 2009. The data on surgical mortality, complications and follow-up results are emphasized. RESULTS: All of the patients underwent primary repair. One child (2.9%) with DS and complete atrioventricular septal defect (CAVSD) died early postoperatively because of pulmonary hypertension. Two patients (5.7%) had low cardiac output syndrome, and 15 (42.9%) suffered pulmonary complications. III degree atrioventricular block (AVB) occurred in 4 patients (11.5%). Thirty children who were followed up 10 months to 6 years [(3.8±1.1) years] are in NYHA class I or II. There were no reoperations or later death. CONCLUSION CHD in DS children can be repaired with a low risk of mortality, although a high incidence of severe infections and III degree AVB can result in a complicated postoperative course. The results of mid-term follow up are satisfactory.
Child ; Child, Preschool ; Down Syndrome ; complications ; Female ; Heart Defects, Congenital ; complications ; mortality ; surgery ; Heart Septal Defects, Ventricular ; complications ; mortality ; surgery ; Humans ; Infant ; Male ; Postoperative Complications ; etiology ; Retrospective Studies ; Survival Analysis ; Treatment Outcome