Objective:To compare the growth speed of pulmonary artery and left ventricle after the repair of tetralogy of Fallot(TOF) with valve-sparing and transannular patch.Methods:The clinical data of children with tetralogy of Fallot admitted to our hospital from January 2015 to October 2020 were reviewed. According to the way of relieving right ventricular outflow tract stenosis, they were divided into two groups: valve-sparing and transannular patch. Independent sample t test or non- parametric test was used to compare the pulmonary artery and left ventricular growth indexes before operation and at the last follow-up between the two groups. The paired t test was used to compare preoperative and postoperative indexes. Results:A total of 104 children with tetralogy of Fallot, including 58 males and 46 females, had surgery at a median age and weight of 6.7(4.1, 10.3) months and 7.0(5.8, 8.4) kg, respectively. The preoperative Nakata index, McGoon ratio, pulmonary artery Z-score, left ventricular end diastolic volume(LVEDV) index and Z-score in valve-sparing were higher than those in transannular patch( P=0.001, 0.000, 0.003, 0.000, 0.000). At the last follow-up, the Z-scores of pulmonary arteries in both groups were greater than those before operation( P=0.016, 0.000), the LVEDV Z-score in transannular patch was greater than that before surgery( P=0.000), while the LVEDV Z-score of valve-sparing was not significantly different from that before operation( P=0.581), there was no significant difference in pulmonary artery Z-score and LVEDV Z-score between two groups( P=0.468, 0.884). The difference between the last follow-up and preoperative of pulmonary artery Z-score and LVEDV Z-score in valve-sparing was smaller than that in transannular patch( P=0.000, 0.000). Conclusion:Compared with valve-sparing, the pulmonary artery and left ventricle grow faster in transannular patch during the early stage after TOF repair.

ObjectiveTo explore the guidance value of “treatment of disease in accordance with three conditions” theory in the prevention and treatment of corona virus disease 2019（COVID-19） based on the differences of syndromes and traditional Chinese medicine（TCM） treatments in COVID-19 patients from Xingtai Hospital of Chinese Medicine of Hebei province and Ruili Hospital of Chinese Medicine and Dai Medicine of Yunnan province and discuss its significance in the prevention and treatment of the unexpected acute infectious diseases. MethodDemographics data and clinical characteristics of COVID-19 patients from the two hospitals were collected retrospectively and analyzed by SPSS 18.0. The information on formulas was obtained from the hospital information system （HIS） of the two hospitals and analyzed by the big data intelligent processing and knowledge service system of Guangdong Hospital of Chinese Medicine for frequency statistics and association rules analysis. Heat map-hierarchical clustering analysis was used to explore the correlation between clinical characteristics and formulas. ResultA total of 175 patients with COVID-19 were included in this study. The 70 patients in Xingtai，dominated by young and middle-aged males，had clinical symptoms of fever， abnormal sweating，and fatigue. The main pathogenesis is stagnant cold-dampness in the exterior and impaired yin by depressed heat， with manifest cold， dampness， and deficiency syndromes. The therapeutic methods highlight relieving exterior syndrome and resolving dampness， accompanied by draining depressed heat. The core Chinese medicines used are Poria，Armeniacae Semen Amarum，Gypsum Fibrosum，Citri Reticulatae Pericarpium，and Pogostemonis Herba. By contrast，the 105 patients in Ruili， dominated by young females， had atypical clinical symptoms， and most of them were asymptomatic patients or mild cases. The main pathogenesis is dampness obstructing the lung and the stomach， with obvious dampness and heat syndromes. The therapeutic methods are mainly invigorating the spleen， resolving dampness， and dispersing Qi with light drugs. The core Chinese medicines used are Poria，Atractylodis Macrocephalae Rhizoma，Glycyrrhizae Radix et Rhizoma，Coicis Semen，Platycodonis Radix，Lonicerae Japonicae Flos， and Pogostemonis Herba. ConclusionThe differences in clinical characteristics， TCM syndromes， and medication of COVID-19 patients from the two places may result from different regions，population characteristics， and the time point of the COVID-19 outbreak. The “treatment of disease in accordance with three conditions” theory can help to understand the internal correlation and guide the treatments.

Objective    To summarize the experience and lessons of right ventricular decompression in children with pulmonary atresia and intact ventricular septum (PA/IVS) and to reflect on the strategies of right ventricular decompression. Methods    The clinical data of 12 children with PA/IVS who underwent right ventricular decompression in our hospital from March 2015 to December 2019 were reviewed retrospectively. There were 10 males and 2 females with a median age at the time of surgery was 5 d (range, 1-627 d). Correlation analysis between the pulmonary valve transvalvular pressure gradient and changes in Z score of tricuspid valves after decompression was performed. Results    One patient died of refractory hypoxemia due to circulatory shunt postoperatively and family members gave up treatment. There were 2 (16.67%) patients received postoperative intervention. The pulmonary transvalvular gradient after decompression was 31.95±21.75 mm Hg. Mild pulmonary regurgitation was found in 7 patients, moderate in 2 patients, and massive in 1 patient. The median time of mechanical ventilation was 30.50 h (range, 6.00-270.50 h), and the average duration of ICU stay was 164.06±87.74 h. The average postoperative follow-up time was 354.82±331.37 d. At the last follow-up, the average Z score of tricuspid valves was 1.32±0.71, the median pressure gradient between right ventricle and main pulmonary artery was 41.75 mm Hg (range, 21-146 mm Hg) and the average percutaneous oxygen saturation was 92.78%±3.73%. Two children underwent percutaneous balloon pulmonary valvoplasty at 6 and 10 months after surgery, respectively, with the rate of reintervention-free of 81.8%. There was no significant correlation between pulmonary transvalvular gradients after decompression and changes in Z score of tricuspid valves (r=–0.506, P=0.201). Conclusion    For children with PA/IVS, the simple pursuit of adequate decompression during right ventricular decompression may lead to  severe pulmonary dysfunction, increase the risk of ineffective circular shunt, and induce refractory hypoxemia. The staged decompression can ensure the safety and effectiveness for initial surgery and reduce the risk of postoperative death.

Objective:To investigate the timing of primary repair for tetralogy of Fallot based on pulmonary valve-sparing.Methods:A retrospective analysis of the perioperative data of children undergoing primary repair for tetralogy of Fallot in our hospital between June 2015 and May 2019 was performed. To determinate cutoff value of pulmonary valve-sparing by using receiver operating characteristic curve( ROC curve); the children were divided into two groups according to the age of cutoff value. The duration of postoperative mechanical ventilation, the length of hospital and ICU stay, emergency surgery rate, hospital mortality, 31 day readmission rate, valve-sparing rate and fast-track rate and other indicators were compared between the two groups. Results:A total of 105 children were enrolled according to the inclusion criteria, including 67 males and 38 females, with a body mass of 4.21 kg to 21.5 kg, the median body mass was 7.9 kg, and age 1.3 months to 99.1 months, the median age was 8.8 months. Cutoff value of age for pulmonary valve-sparing was between 5.5 months and 5.6 months(sensitivity 0.90, specificity 0.58, 95% CI: 0.588-0.792). Based on the age of 6 months, the children with tetralogy of Fallot were divided into two groups.There were no significant differences in duration of postoperative mechanical ventilation, length of ICU stay, emergency surgery rate, hospital mortality, 31 day readmission rate and fast-track rate in <6 months group compared with those in ≥6 months group( P>0.05). The rate of valve-sparing in <6 months group was higher than that in ≥6 months group(65.52% vs. 30.26%)( P<0.01), and the length of hospital stay was lower than that in ≥6 months group(11 days vs. 15 days)( P<0.01). The median follow-up was 14.5 months(0.3-54.9 months), and there was no reoperation intervention at the last follow-up. There were no significant difference in the follow-up period, pulmonary regurgitation and residual obstruction between the two groups( P>0.05). Conclusion:Therapeutic effect of elective early primary repair for tetralogy of Fallot in infants is not only satisfactory, but also improve the rate of pulmonary valve-sparing during operation. It is recommended that the age of elective primary repair for tetralogy of Fallot should be advanced to less than 6 months.

OBJECTIVE: To investigate the distribution of Chinese medicine (CM) syndrome in patients with acute myocardial infarction (AMI) on admission and its impact on prognosis. METHODS: A total of 525 AMI patients were prospectively recruited and classifified into 4 groups based on their clinical characteristics: excess-heat, excess-cold, deficiency-heat and deficiency-cold syndromes. Major adverse cardiovascular events (MACEs) were followed up. RESULTS: The excess syndrome was more common than deficiency syndrome (72.95% vs. 27.05%; P<0.05). Totally 495 (94.29%) of 525 AMI patients were followed up (median 277 days). There were 59 (11.92%) MACEs. After adjusted with confounding factors in Cox regression models, the hazard ratio (95% confifidence interval) of excess-heat, excess-cold, defificiency-heat and defificiency-cold syndrome groups were 1, 1.25 (0.63, 2.49; P<0.05), 2.37 (1.14, 4.94; P<0.05), 3.76 (1.71, 8.28; P<0.05), respectively. CONCLUSIONS Excess syndrome was more common in AMI patients and had better prognosis, while defificiency-cold syndrome had the poorest prognosis. CM syndrome was of value in predicting long-term outcomes in AMI patients.

Objective To analysis the the strategy of repairing coarctation of aorta with hypoplastic aortic arch in neo-nate.Methods Collected consecutive 24 neonates suffered coarctation of aorta with hypoplastic aortic arch form January 2015 to March 2017,12 patients were underwent aortic arch reconstruction with extremely extended end-to-end anastomosis under cardiopulmonary bypass(CPB) through the media sternotomy approach(CPB group), while another 12 cases were under coarc-tation repair using end-to-end anastomosis or end-to-side anastomosis through left posterolateral thoracotomy approach ( control group).The postoperative blood pressure,echocardiography and cardiac CT scan were used to evaluate the result of the aortic arch rconstruction.The pressuregradientof the upper limb and lower limb,flow velocity of the anastomoses, aortic arch morphol-ogy,rate of the residual abstruction were compared between the two groups.Results Mechanical ventilation time[ CPB group (17 ±27)h vs.control group(44 ±52)h, P＜0.05], ength of stay in ICU[CPB group(3.75 ±1.36)days vs.control group (6.54 ±5.08)days, P＜0.05], all patients were followed up for 1－12 months,the aortic residual pressure[CPB group(14 ± 10)mmHg (1 mmHg＝0.133 kPa) vs.control group(26 ±17)mmHg,P ＜0.05) ], flow velocity of the anastomoses[CPB group(2.32 ±0.78)m/s, control group(1.55 ±0.99)m/s, P ＜0.05 ], pressuregradientof the upper limb and lower limb [CPB group (6.67 ±3.49)mmHg, control group(7.41 ±4.29)mmHg, P＞0.05].There was no died in two gruops.Con-clusion Anastomosis with end to end techinique under cardiopulmonary bypass may achieve better effect in neonates with co-arctation of aorta with hypoplastic aortic arch,it has better duplcity, operability and early curative effect,but the long-term effect need the multicenter and large sample-volume study to explore.

OBJECTIVETo preliminarily investigate the relationship between serum apelin level and pulmonary artery pressure in children with congenital heart disease.

METHODSOne hundred and twenty-six children with congenital heart disease undergoing surgical treatment were enrolled as subjects. The serum level of apelin was determined before surgery and at 7 days after surgery. The ratio of pulmonary artery systolic pressure to aortic systolic pressure (Pp/Ps) was calculated before extracorporeal circulation. According to the Pp/Ps value, patients were classified into non-pulmonary arterial hypertension (PAH) group, mild PAH group, moderate PAH group, and severe PAH group. Pulmonary artery mean pressure was estimated by echocardiography at 7 days after surgery.

RESULTSThe non-PAH group had the highest serum level of apelin before and after surgery, followed by the mild PAH group, moderate PAH group, and severe PAH group (P<0.05). All groups had significantly increased serum levels of apelin at 7 days after surgery (P<0.05). The serum level of apelin was negatively correlated with pulmonary artery pressure before surgery (r=-0.51, P<0.05) and at 7 days after surgery (r=-0.54, P<0.05).

CONCLUSIONSThe decrease in serum apelin level is associated with the development of pulmonary hypertension in children with congenital heart disease. The significance of serum apelin in predicting the development and degree of pulmonary hypertension in children with congenital heart disease deserves further studies.

Apelin ; Blood Pressure ; Child, Preschool ; Female ; Heart Defects, Congenital ; blood ; physiopathology ; Humans ; Hypertension, Pulmonary ; blood ; Infant ; Intercellular Signaling Peptides and Proteins ; blood ; Male ; Pulmonary Artery ; physiopathology

Objective To understand the influencing factors of hypertension control,and to provide a theoretical basis for developing intervention measures.Methods A two-stage cluster random sampling method was performed and a total of 1 377 cases and 749 controls in Yuhang District were selected.Univariate and multivariate logistic regression analysis were used.Results The control rate of hypertension was 64. 77%.Hypertension control was related to BMI,course of disease and models of follow-up by univariate logistic regression analysis(P<0. 05 ).The multivariate logistic regression analysis showed that older age (OR =0. 983,95%CI=0. 974 -0. 993 ),male (OR =1. 272,95%CI=1. 053 -1. 535 ), overweight (OR=0. 709,95%CI=0. 576-0. 872),obesity (OR=0. 297,95%CI=0. 210-0. 421)and model of group follow-up (OR=0. 495,95%CI=0. 375 -0. 654)were the major influencing factors.Conclusion The older age,male, overweigt,obesity and model of group follow-up were the major influencing factors.Comprehensive intervention measures should be strengthened so as to improve the control rate of hypertension in community.

Objective To detect the expression of Id1 and HBx in HBV-related hepatocellular carcinoma (HCC) tissue samples and analyzed the correlation between Id1 expression levels and clinicopathological features of patients.Methods Tumor tissue samples obtained from a total of 113 HCC patients.The expression of Id1 proteins of these samples were detected by immunohistochemical (IHC) staining and evaluated by two independent pathologists.The corrections between the clinical pathological parameters and the IHC scores for Id1and the prognostic significance were statistical analyzed by SPSS 19.0 software.Results Ninty-six of 113 patients is HBV-related HCC.Over-expression of Id1 were found positively correlated with the HBsAg ＞ 200 s/n,histological grade,portal vein invasion.Patients with Id1 overexpression had both shorter disease-free and overall survival times.Conclusions High expression of Id1 was correlated with serum HBsAg,histological grade,portal vein invasion and poor clinical outcomes in HBV-related HCC.