OBJECTIVEThe advances in interventional cardiac catheterization have changed the therapeutic strategy for many patients with congenital heart diseases. The aim of this study was to evaluate the role of therapeutic cardiac catheterization in the treatment of complex congenital heart diseases.

METHODSBalloon atrial septostomy (BAS) was performed in 59 children using Rashkind balloon catheter. Static balloon dilatation of the atrial septum was performed in 2 children with hypoplastic right heart syndrome. One child with pulmonary artery stenosis at the suture lines after arterial switch was treated with balloon dilatation. Percutaneous balloon pulmonary valvuloplasty (PBPV) and balloon angioplasty were performed in 15 children with tetralogy of Fallot (TOF). Transcatheter coil embolization was performed in 18 children with systemic to pulmonary collateral vessels and 5 children with B-T shunts before surgical procedures. Transcatheter closure of fenestration with Amplatzer septal occluder device was performed in 1 child who had undergone Fontan procedure.

RESULTSIn 46 children with transposition of great arteries (TGA), the arterial oxygen saturation (SaO(2)) was increased from 0.57 +/- 0.17 to 0.76 +/- 0.13 (t = 14.58, P < 0.01) after BAS. The pressure gradients across left and right atrium were less than 2 mmHg. The created atrial septal defects were 5 - 20 mm in size. In 10 children with pulmonary atresia with intact ventricular septum (PA/IVS), the arterial oxygen saturation did not change after BAS (t = 1.57, P > 0.05), but the pressure gradients across left and right atrium were less than 2 mmHg. In children with TOF, the arterial oxygen saturation was increased by 15 percent after PBPV and pulmonary valvular stenosis was relieved. In 14 of 18 children with systemic to pulmonary collateral vessels and 5 children with B-T shunts, complete occlusion was accomplished and the procedures were successful. In the child who had undergone Fontan procedure, the fenestration was occluded successfully and no complication was observed.

CONCLUSIONIn management of complex congenital heart diseases, combination of surgical procedure and interventional catheterization therapy could be suggested to have better outcome.

Cardiac Catheterization ; methods ; Catheterization ; Child ; Heart Defects, Congenital ; therapy ; Humans ; Prosthesis Implantation ; Pulmonary Atresia ; therapy ; Pulmonary Valve Stenosis ; therapy ; Tetralogy of Fallot ; therapy ; Transposition of Great Vessels ; therapy

An investigation of extrapulmonary oxygenation was made in dogs, rabbits and, finally, in a case of Tetralogy of Fallot using an intestinal perfusion of hydrogen peroxide (H2O2). For a single administration, 0.4 per cent H2O2 can be given safely by enema, in doses of 10ml./Kg. of body weight, this would give maximum oxygenation in both the portal vein and inferior vena cava without the formation of gas emboli. Concentrations higher than this caused gas bubbles in the portal vein. For serial administrations, 0.2 per cent H2O2 can be given by enema exchanging the intestinal contents at 10 to 15 minutes intervals. When given concomitantly with human whole blood, 1.0ml./Kg. of body weight, there is a prolonged higher oxygenation in the portal vein, inferior vena cava and femoral artery. This concentation of H2O2 would not cause gas emboli in the portal vein. Although extrapulmonary oxygenation is possible by giving oxygen by enema, this method would cause too much abdominal distension. In experiments of death by suffocation, the group given H2O2 had doubled the duration of E.K.G. activity when compared with controls. One patient with Tetralogy of Fallot, confirmed by clinical findings, X-ray studies, E.K.G. and cardiac catheterization, who was not suitable for cardiac surgery because of low mentality, was selected for this study. 0.2 per cent H2O2, 10ml. per Kg. of body weight by enema, exchanging intestinal contents at 30 minutes intervals, resulted in a marked elevation of the pO2 in the venous blood and in the inferior vena cava. There was a disappearance of finger tip and toe tip cyanosis and flushing of the soles and palms was noted during the procedure.
Acidosis, Respiratory/diagnosis ; Animals ; Asphyxia/therapy ; Carbon Dioxide/blood ; Child ; Dogs ; Enema ; Female ; Hematocrit ; Human ; Hydrogen Peroxide/administration & dosage/*therapeutic use ; Male ; Oxygen/blood ; Tetralogy of Fallot/*therapy

Protein-losing enteropathy can result from primary or secondary intestinal lymphangiectasia. Sec ondary intestinal lymphangiectasia develops as a result of lymphatic obstruction or elevated lym phatic pressure. Cardiac lesions such as constrictive pericarditis, post-Fontan procedure state, and chronic congestive heart failure increase lymphatic pressure and may cause intestinal lymphan giectasia and protein-losing enteropathy. An 11-year-old girl who underwent corrective surgery for Tetralogy of Fallot at two years of age had been suffering from chronic congestive heart failure, taking digitalis and diuretics. She was afflicted with protein-losing enteropathy nine years after surgery. Diagnosis was made by means of radioisotope scan using technetium-99m-labeled albumin. Symptoms were not improved with diet therapy, so prednisolone was given orally and remission was achieved. Although relapses occurred four times, remission was achieved with pre dnisolone at each time. Thereafter the patient remained in remission state over one year after dis continuation of prednisolone.
Child ; Diagnosis ; Diet Therapy ; Digitalis ; Diuretics ; Estrogens, Conjugated (USP)* ; Female ; Heart Failure* ; Humans ; Pericarditis, Constrictive ; Prednisolone* ; Protein-Losing Enteropathies* ; Recurrence ; Tetralogy of Fallot

OBJECTIVETo evaluate the effect of Milkvetch Injection (MI) on cardiac function and hemodynamics in children with tetralogy of Fallot after radical operation.

METHODSThirty-two children with tetralogy of Fallot were divided into two groups, the 20 patients in the control group treated with conventional treatment and the 12 patients in the treated group treated with 15 ml of MI every 12 hrs for 7 days. The cardiac function and hemodynamic parameters were determined by echocardiography and thermodilution catheter inserted in pulmonary artery.

RESULTSPatients' cardiac function and hemodynamic parameters were improved significantly 1 hr after administering 15 ml of MI Injection, but restored to the level before medication in 2-4 hrs. Administering MI injection for successive 7 days could gradually improve patients' cardiac function and hemodynamic parameters after operation, and the improvement became more evident with the prolonging time of medication. The intubation time, intensive care unit duration and the time of intravenously administration of inotropic drugs in the treated group were significantly shorter than those in the control group (P < 0.01).

CONCLUSIONMI could significantly improve the hemodynamics and cardiac function, and shorten the recovery time in children with tetralogy of Fallot after radical operation.

Astragalus Plant ; Child ; Child, Preschool ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hemodynamics ; Humans ; Male ; Phytotherapy ; Postoperative Period ; Tetralogy of Fallot ; drug therapy ; physiopathology ; surgery ; Ventricular Function

OBJECTIVETo determine risk factors of capillary leak syndrome(CLS) in children with tetralogy after operation.

METHODSClinical data were retrospectively collected and analyzed from 32 tetralogy cases with CLS and 50 cases without CLS(control group), who received operation under cardiopulmonary bypass (CBP) in our hospital from October 2002 to December 2006. Risk factors with statistical significance were screened with univariate logistic regression analysis, independent risk factors of CLS were determined with multivariate logistic regression analysis. Postoperative outcome was compared between CLS group and control group.

RESULTLogistic analysis showed that the risk factors for CLS were age(OR=6.783), duration of CBP(OR=4.756)and MGoon index (OR=3.826). There were statistical differences in injection of colloid, time of inotropic drugs and ventilation between CLS and control groups(P<0.01). Eight CLS cases underwent peritoneal dialysis and 2 CLS cases died.

CONCLUSIONThe risk factors of CLS in children with tetralogy after CBP are age, duration of CBP and MGoon index.

Capillary Leak Syndrome ; etiology ; physiopathology ; therapy ; Cardiopulmonary Bypass ; Child, Preschool ; Female ; Humans ; Infant ; Logistic Models ; Male ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Tetralogy of Fallot ; surgery

BACKGROUND: Reperfusion of ischemic myocardium is clinically encountered during thrombolytic therapy of acute myocardial infarction, percutaneous transluminal coronary angioplasty(PTCA), and coronary artery bypass graft(CABG). Reperfusion results in endothelial dysfunction characterized by a reduced release of endothelium-derived relaxing factor(EDRF) in animal studies. Studies with experimental animals have emphasized the role of oxygen free radicals and lipid peroxidation in pathophysiology of reperfusion injury and myocardial stunning. The object of this study is to determine whether endothelial dysfunction was developed after open heart surgery and to evaluated the role of oxygen free radical and lipid peroxidation in reperfusion injury. METHODS: The study group was comprised 13 patients who underwent open heart surgery(male/female : 2/11, mean age : 43+/-4 year, Atrial septal defect in 4, Ventricular septal defect in 1, Mitral regurgitation in 2, Tetralogy of Fallot in 1, and Aortic stenosis and Regurgitation with Mitral stenosis in 5 patients). The endothelial function was evaluated with the vasomotor response to acetylcholine and nitroglycerin by change of arterial diameter during the continous infusion of acetylcholin, from 10(-9) to 10(-6) molar concentration to the coronary artery and intracoronary injection of 200microg nitroglycerin after acetylcholine infusion. The infusion study was performed before and 10 days after surgery. For analysis of the role of oxygen free radical and lipid peroxidation in reperfusion injury, blood samples for malondialdehyde and neutrophil respiratory burst test(hydrogen peroxide amount of neutrophils) were obtained in pre-declamping of aorta and 5 min, 10 min, and 20 min after declamping of aorta from coronary sinus. RESULTS: 1) The vasoconstrictor response to acetylcholine, 10(-9) to 10(-6)M concentration, at proximal and distal left anterior descending coronary artery, were increased significantly in post-operation infusion study but there was no singnificant difference in vasodilator response to nitroglycerin. 2) The mean absorbance value of malondialdehyde(MDA) in pre-declamping and 5min, 10min, and 20min after reperfusion were 96+/-12, 73+/-12, 89+/-11 and 77+/-12, respectively. There was no significant difference in plasma MDA level and hydrogen peroxide amount of neutrophils after reperfusion(aortic declamping). CONCLUSION: These data suggest that endothelium dependent vascular relaxation is impaired in patients with open heart surgery and post-ischemic reperfusion injury may be responsible for the abnormal response. But we did not determine the role of lipid peroxidation and oxygen free radical in reperfusion injury.
Acetylcholine ; Animals ; Aorta ; Aortic Valve Stenosis ; Coronary Artery Bypass ; Coronary Sinus ; Coronary Vessels ; Endothelium ; Free Radicals ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Hydrogen Peroxide ; Lipid Peroxidation* ; Malondialdehyde ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Molar ; Myocardial Infarction ; Myocardial Stunning ; Myocardium ; Neutrophils ; Nitroglycerin ; Oxygen* ; Plasma ; Relaxation ; Reperfusion Injury* ; Reperfusion* ; Respiratory Burst ; Tetralogy of Fallot ; Thoracic Surgery* ; Thrombolytic Therapy

BACKGROUND: Reperfusion of ischemic myocardium is clinically encountered during thrombolytic therapy of acute myocardial infarction, percutaneous transluminal coronary angioplasty(PTCA), and coronary artery bypass graft(CABG). Reperfusion results in endothelial dysfunction characterized by a reduced release of endothelium-derived relaxing factor(EDRF) in animal studies. Studies with experimental animals have emphasized the role of oxygen free radicals and lipid peroxidation in pathophysiology of reperfusion injury and myocardial stunning. The object of this study is to determine whether endothelial dysfunction was developed after open heart surgery and to evaluated the role of oxygen free radical and lipid peroxidation in reperfusion injury. METHODS: The study group was comprised 13 patients who underwent open heart surgery(male/female : 2/11, mean age : 43+/-4 year, Atrial septal defect in 4, Ventricular septal defect in 1, Mitral regurgitation in 2, Tetralogy of Fallot in 1, and Aortic stenosis and Regurgitation with Mitral stenosis in 5 patients). The endothelial function was evaluated with the vasomotor response to acetylcholine and nitroglycerin by change of arterial diameter during the continous infusion of acetylcholin, from 10(-9) to 10(-6) molar concentration to the coronary artery and intracoronary injection of 200microg nitroglycerin after acetylcholine infusion. The infusion study was performed before and 10 days after surgery. For analysis of the role of oxygen free radical and lipid peroxidation in reperfusion injury, blood samples for malondialdehyde and neutrophil respiratory burst test(hydrogen peroxide amount of neutrophils) were obtained in pre-declamping of aorta and 5 min, 10 min, and 20 min after declamping of aorta from coronary sinus. RESULTS: 1) The vasoconstrictor response to acetylcholine, 10(-9) to 10(-6)M concentration, at proximal and distal left anterior descending coronary artery, were increased significantly in post-operation infusion study but there was no singnificant difference in vasodilator response to nitroglycerin. 2) The mean absorbance value of malondialdehyde(MDA) in pre-declamping and 5min, 10min, and 20min after reperfusion were 96+/-12, 73+/-12, 89+/-11 and 77+/-12, respectively. There was no significant difference in plasma MDA level and hydrogen peroxide amount of neutrophils after reperfusion(aortic declamping). CONCLUSION: These data suggest that endothelium dependent vascular relaxation is impaired in patients with open heart surgery and post-ischemic reperfusion injury may be responsible for the abnormal response. But we did not determine the role of lipid peroxidation and oxygen free radical in reperfusion injury.
Acetylcholine ; Animals ; Aorta ; Aortic Valve Stenosis ; Coronary Artery Bypass ; Coronary Sinus ; Coronary Vessels ; Endothelium ; Free Radicals ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Hydrogen Peroxide ; Lipid Peroxidation* ; Malondialdehyde ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Molar ; Myocardial Infarction ; Myocardial Stunning ; Myocardium ; Neutrophils ; Nitroglycerin ; Oxygen* ; Plasma ; Relaxation ; Reperfusion Injury* ; Reperfusion* ; Respiratory Burst ; Tetralogy of Fallot ; Thoracic Surgery* ; Thrombolytic Therapy

OBJECTIVETo evaluate the effect of milkvetch injection (MI) on immune function of children with tetralogy of Fallot (TOF) after radical operation.

METHODSForty-children with TOF were divided into two groups, the 20 in the control group treated with conventional treatment alone and the 20 in the treated group treated with conventional treatment plus 15 ml of MI every 12 hrs for 14 days. Changes of immunoglobulin, complements, lymphocyte phenotypes and cytokines were observed.

RESULTSIn the treated group, the abnormally increased levels of IgG, IgM, C3, C4, CD8+ and CD19+ began to lower at lst-2nd week after treatment, and basically restored to the levels of normal at 3rd-4th week; while the decreased levels of IgA, CD3+, CD4+, CD4+/CD8+ ratio, CD3+/HLA-DR+ and CD3+/CD16+ -CD56+ raised gradually from the 1st week and restored to normal range at 2nd-3rd week. The IL-6 and tumor necrosis factor-alpha (TNF-alpha) levels in the plasma and supernatant, produced in vitro by peripheral blood mononuclear cells (PBMC) decreased gradually at 1st week and restored to the normal level at 3rd-4th weeks. The different value before and after treatment of the above-mentioned indexes in the treated group were superior to those in the control group (P<0.05 or P<0.01).

CONCLUSIONMI could significantly improve the immune function of children with TOF after radical operation.

Adjuvants, Immunologic ; therapeutic use ; Astragalus Plant ; CD4-CD8 Ratio ; Cardiopulmonary Bypass ; Child ; Child, Preschool ; Complement C4 ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Immunoglobulin G ; blood ; Infusions, Intravenous ; Male ; Phytotherapy ; Postoperative Period ; Tetralogy of Fallot ; drug therapy ; immunology ; surgery ; Tumor Necrosis Factor-alpha ; metabolism