Objective:To summarize and evaluate the temporal trends of the burden of congenital heart disease (CHD) in China and globally from 1990 to 2021, and to predict the burden of the disease up to 2035.Methods:The Joinpoint regression method was used to study the time trend of congenital heart disease, and the Bayesian age-period-cohort method (BAPC) was used to predict the change in disease burden due to congenital heart disease in China and globally between 2022 and 2035. Results:From 1990 to 2021, the disability-adjusted life years and mortality burdens of congenital heart disease have decreased in China and globally. Although the disease burden is higher in men than in women, the difference is gradually decreasing. BAPC estimates that the burden of congenital heart disease is expected to continue to decline in China and globally in 2022-2035, but congenital heart disease remains a major health problem. China has made remarkable progress in reducing the burden of congenital heart disease, which reflects the positive impact of rapid advances in medical technology and improved public health policies.Conclusion:Although congenital heart disease will remain a significant disease burden over the past three decades and into 2035, it is critical to focus on disease-specific differences to develop more targeted interventions to further reduce the disease burden of congenital heart disease and improve the quality of life and living standards of patients.

Objective:To summarize and evaluate the temporal trends of the burden of congenital heart disease (CHD) in China and globally from 1990 to 2021, and to predict the burden of the disease up to 2035.Methods:The Joinpoint regression method was used to study the time trend of congenital heart disease, and the Bayesian age-period-cohort method (BAPC) was used to predict the change in disease burden due to congenital heart disease in China and globally between 2022 and 2035. Results:From 1990 to 2021, the disability-adjusted life years and mortality burdens of congenital heart disease have decreased in China and globally. Although the disease burden is higher in men than in women, the difference is gradually decreasing. BAPC estimates that the burden of congenital heart disease is expected to continue to decline in China and globally in 2022-2035, but congenital heart disease remains a major health problem. China has made remarkable progress in reducing the burden of congenital heart disease, which reflects the positive impact of rapid advances in medical technology and improved public health policies.Conclusion:Although congenital heart disease will remain a significant disease burden over the past three decades and into 2035, it is critical to focus on disease-specific differences to develop more targeted interventions to further reduce the disease burden of congenital heart disease and improve the quality of life and living standards of patients.

Children with congenital heart disease (CHD) experience intestinal dysbiosis, and an effective assessment of changes in their gut microbiota aids in optimizing screening, diagnosis, treatment, and risk monitoring for CHD.This review focuses on the microecological changes in the gut microbiota of CHD children and their impact on the development of CHD, aiming to provide new directions for the development of personalized therapies and interventions for CHD children.

Children with congenital heart disease (CHD) experience intestinal dysbiosis, and an effective assessment of changes in their gut microbiota aids in optimizing screening, diagnosis, treatment, and risk monitoring for CHD.This review focuses on the microecological changes in the gut microbiota of CHD children and their impact on the development of CHD, aiming to provide new directions for the development of personalized therapies and interventions for CHD children.

Anomalous aortic origin of the coronary artery(AAOCA) refers to the abnormal initiation, route, or distribution of coronary arteries, which is generally believed to be caused by abnormal or incomplete development of embryonic coronary arteries, and is a rare congenital cardiovascular malformation. It can exist independently without other congenital heart disease. With the development of medical science and people's understanding of AAOCA, more and more AAOCA has been detected, and its clinical significance has attracted more and more attention. Based on abnormal coronary artery opening, malignant or potential contorts can cause long-term blood flow dynamic change, appear abnormal blood vessel hardening of the arteries, at the same time due to walk in the pulmonary artery and the ascending aorta between two vessels, vulnerable to the extrusion of large blood vessels, which caused a temporary blood flow in coronary artery interruption, can cause acute angina pectoris, myocardial infarction, arrhythmia, exercise-induced cardiac syncope. This review focuses on the anatomy, diagnosis and treatment of coronary artery abnormalities arising from aorta.

Objective:To determine the risk factors of reoperation and mortality after complete atrioventricular septal defect repair, and to evaluate the medium and long-term prognosis.Methods:From March 2008 to March 2022, a total of 266 children were selected from the Department of Thoracic and Cardiovascular Surgery, Nanjing Children's Hospital, who underwent the complete atrioventricular septal defect repair. Exclusion of children with conotrucal anomaly such as tetralogy of Fallot, transposition of the great arteries, and right ventricular double outlet. Demographic characteristics, surgical data, postoperative follow-up and associated risk factors were analyzed.Results:All the children were repaired with modified single-piece method for the first time, and 26 children were reoperated because of severe left atrioventricular valve regurgitation, left ventricular outflow tract obstruction and atrioventricular block. The 1-year, 3-year and 5-year overall survival rate and freedom from reoperation rate of all children were (98.1±0.8)%, (97.3±1.0)%, (96.2±1.2)%, (96.6±1.1)%, (93.9±1.5)% and (92.2±1.7)%, respectively. A total of 11 (42.3%) early reoperations and 15 (57.7%) late reoperations were performed, of which 1-year, 3-year and 5-year survival rates were (92.3±5.2)%, (82.1±8.3)% and (76.6±9.4)% respectively. Multifactorial analysis showed that age <3 months and left atrioventricular regurgitation >grade 2 at 24 hours postoperatively were independent risk factors for reoperation, whereas age <3 months and experience of reoperation were independent risk factors for death of children.Conclusion:Complete atrial septal defects have excellent surgical outcomes, but some children still require reoperation, and age <3 months and postoperative left atrioventricular valve regurgitation(LAVVR)>2 grades remain important predictors of their surgical prognosis.

Congenital heart disease (CHD) is the most common birth defect, and in recent years, its neurodevelopmental disorder (NDD) has been gradually emphasized, among which neurodevelopmental disorder in complex congenital heart disease (CCHD) is more common, and the research on related risk factors is gradually deepening. The risk factors of CCHD neurodevelopmental disorder are complex and diversified, with synergistic and cumulative effects, which can be classified into preoperative, surgical-related and postoperative according to the time period, and involve various aspects such as genetics, hemodynamic disorders, extracorporeal circulation, nursing care, and family and social factors. In this paper, we try to review the risk factors of neurodevelopmental disorders in CCHD by combining the latest domestic and international studies.

Objective:To evaluate the feasibility of measuring pulmonary venous blood flow spectrum by transesophageal ultrasound in assessing intraoperative left atrial pressure (LAP) in pediatric patients with complex congenital heart disease.Methods:Twenty-five pediatric patients with complex congenital heart disease of either sex, aged < 3 yr, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ, with New York Heart Association class Ⅲ or Ⅳ, undergoing surgery with general anesthesia and requiring LAP monitoring during surgery, were selected.Transesophageal echocardiography was used to record the left pulmonary venous blood flow spectrum during surgery.S wave velocity (PV S), D wave velocity (PV D), AR wave velocity (PV AR), and deceleration time of pulmonary venous diastolic flow (DT D) were measured at 15 min after termination of CPB.The ratio of S wave peak velocity to D wave peak velocity (S/D ratio) was calculated.Measurement was carried out for 3 consecutive cardiac cycles, and the average value was calculated.The LAP was simultaneously measured through the left atrial piezometer.Pearson correlation analysis was performed between PV S, PV D, PV AR, DT D, S/D ratio and LAP. Results:PV S, PV D, PV AR and S/D ratio had no correlation with LAP ( r=-0.06, 0.21, 0.19, -0.38, respectively, P>0.05), while DT D was negatively correlated with LAP ( r=-0.84, P<0.05). Conclusions:DT D measured by transesophageal ultrasound can be used to evaluate intraoperative LAP in pediatric patients with complex congenital heart disease.

BACKGROUND: Little is known about the effects of environmental cobalt exposure on insulin resistance (IR) in the general adult population. We investigated the association between cobalt concentration and IR. METHODS: A total of 1281 subjects aged more than 20 years with complete blood cobalt data were identified from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 cycle. Blood cobalt levels were analyzed for their association with IR among all populations and subgroups by sex. Regression coefficients and 95% confidence intervals (CIs) of blood cobalt concentrations in association with fasting glucose, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) were estimated using multivariate linear regression after adjusting for age, sex, ethnicity, alcohol consumption, body mass index, education level, and household income. A multivariate generalized linear regression analysis was further carried out to explore the association between cobalt exposure and IR. RESULTS: A negative association between blood cobalt concentration (coefficient = - 0.125, 95% CI - 0.234, - 0.015; P = 0.026) and HOMA-IR in female adults in the age- and sex-adjusted model was observed. However, no associations with HOMA-IR, fasting glucose, or insulin were found in the overall population. In the generalized linear models, participants with the lowest cobalt levels had a 2.74% (95% CI 0.04%, 5.50%) increase in HOMA-IR (P for trend = 0.031) compared with subjects with the highest cobalt levels. Restricted cubic spline regression suggested that a non-linear relationship may exist between blood cobalt and HOMA-IR. CONCLUSIONS These results provide epidemiological evidence that low levels of blood cobalt are negatively associated with HOMA-IR in female adults.
Adult ; Aged ; Aged, 80 and over ; Cobalt/blood* ; Cross-Sectional Studies ; Environmental Pollutants/blood* ; Female ; Homeostasis ; Humans ; Insulin/blood* ; Insulin Resistance ; Male ; Middle Aged ; Nutrition Surveys ; Sex Factors ; United States ; Young Adult

Objective:To analyze the early and middle term clinical effects of mitral valve repair in children with mitral insufficiency.Methods:From January 2012 to January 2019, a total of 202 cases of children with mitral insufficiency treated by mitral valve repair were selected from the department of cardiothoracic surgery of Nanjing Children's Hospital, patients with atrioventricular septal defect, single ventricle and ischemic mitral regurgitation were excluded. Echocardiography was used to compare the preoperative and postoperative left ventricular function and degree of regurgitation in children to evaluate the early and middle term efficacy of mitral valvuloplasty.Results:There were 5 cases of early death(5/202, 2.5%) and 3 cases of late death(3/202, 1.5%). The mean follow-up time was(19.49±17.48) months(1-68 months). Postoperative echocardiography showed that the left heart function and mitral regurgitation were significantly improved.Conclusion:Mitral valvuloplasty can significantly correct mitral insufficiency in children, and it has satisfactory mid-term efficacy and good clinical value.