Surgical Treatment Of Congenital Heart Disease Under1Year Old

Objective: Confenital heart disease(CHD) in children is one of the mostcommon cardiovacular disease.Currently,China each year about10to15million babies are born suffering from CHD.Some serious,complexcardiovascular malformations babies such as after,lack of timely and correctdiagnosis and treatment will soon die.With the development of CardioSurgery,surgical treatment of CHD are involving more and more younger andlow weight patients.Statistical our hospital nearly seven years to1year oldsurgical treatment of CHD.Explore CHD diagnosis, surgical treatment,perioperative cardiopulmonary bypass(CPB) processing experience.Methods:This study collects109children who had CHD and wereunderwent the cardiac surgery in the Cardiac Surgery Department in theSecond Hospital of Hebei Medical University from Mar2005to Nov2012,which includes55male cases and54female cases. The patient’s age isbetween one month and twelve months. The patient’s weight is between3.5kgand12kg. Of17cases were simple Patent Ductus Arteriosus(PDA),1caseswith Atrial Septal Defect(ASD) and2cases with high Pulmonary arterialhypertension(PAH).1case was Pulmonary Stenosis(PS) and2casescombined PS with Patent foramen ovale(PFO).10cases were Tetralogy ofFallot(TOF), which include1cases with PDA and5cases with PFO.1casewas TOF.1case combined ASD with PFO. Of31cases combined VentricularSeptal Defect(VSD) with PFO,11cases with moderate and high PAH.2casescombined VSD and PDA.4cases combined VSD with ASD.1case was VSD,PFO, and PDA combined.3cases combined VSD with Right VentricularOutflow Tract Obstruction(RVOTO), which include1case with PFO.1casecombined VSD, PFO and Double Chamber Right Ventricle(DCRV). Of31cases were VSD,7cases with moderate and high PAH.1case was PartialEndocardial Cushion Defect(PECD) along with Total Anomalous Pulmonary Venous Drainage(TAPVD) and high PAH combined.1case was PECD alongwith PDA.1case was intracardiac form of TAPVD along with ASD, PFO,PDA and hight PAH.1case was Mirror Image Dextrocardia along withDCRV and VSD and hight PAH combined.6cases were switched to CardiacSurgery Department and progressed the operation after the treatment byChildren’s Internal Medicine Department.21cases were underwent theoperations directly with perfect preoperative examination after the stabletreatment by Children’s Internal Medicine Department.16cases underwentthe operation subject to no cardiopulmonary bypass（CPB）. Of93casesunderwent the operations and treatment subject to CPB with ConventionalUltrafiltration（CUF）,10cases were combined with Modified Ultrafiltration（MUF） and practiced one-stage radical operation, then transferred toIntensive Care Unit（ICU） for intensive care with antibiotics, nutritionalsupport, cardiotonic, diuretics, and comprehensive treatment of blood pressureand heart rate controlled.Results: All109CHD children were undergone the open-heart surgery.16patients with PDA were practiced small incision surgery, which account for14.7%;2.7%of patients were undergone the surgery without aortic crossclamp and holding heart in stopping, which included1PS patient and2patients under the PS along with PFO; other90cases were practiced thesurgery subject to profound hypothermia CPB, which account for82.6%underaortic cross clamp time (10~140) min, CPB time (26~406) min. Of the90cases, there was1case to report severe low cardiac output during the surgeryand to die at the end;6cases died due to severe low cardiac output and MODS,which account for6.4%. All CHD children were practiced the one-stageradical operation and entered in ICU. After the surgery, in the ICU first CPAPusing time (1h15min~220h37min), treatment in the ICU time(1h25min~220h37min).2cases of postoperative delayed sternal closureaccount for1.8%,5cases of second hemostatic thoracotomy account for4.6%,6cases of using CPAP again account for4.6%subject to using time(4h32min~48h40min),4patients who presented postoperative pneumonia account for3.7%,3patients appeared kidney failure and then were treated byperitoneal dialysis (PD);3patients occurred arrhythmia after the surgery;3patients were implanted with temporary pacemaker (TPM).24.8%of patientsall were cured and discharged, which included6patients practiced the surgeryand21patients practiced the surgery via green channel, and cure rate up to100%without follow-up after the surgery.Conclusion:Definite diagnosis is of great importance to prepare theoperation scheme. The establishment of surgical green channel and combinedtherapy in medicine and surgery both can reduce the mortality. Postoperativecare and the promotion of nursing level lead to significantly reduce theincidence of postoperative complication.