Clinical Case Analysis Of Down Syndrome With Congenital Heart Disease

Objective With the comparisons of the complications before andafter surgical treatment, the postoperative mortality and the decrease ofpulmonary artery pressure between the DS with CHD patients and theCHD patients, this paper aims to explore the safety of surgical treatmentfor DS with CHD patients and the effectiveness of decreasing pulmonaryartery pressure.Methods1. This study has collected clinical data of DS children admitted toChildren’s Hospital of Chongqing Medical University from2008.01.01to2012.12.31, and analyzes the morbidity of DS with CHD, the types ofCHD, the complications before and after surgeries, the postoperative deathrate and the follow-ups of pulmonary artery pressure;2. This study has collected postoperative clinical data of CHDchildren admitted to Children’s Hospital of Chongqing Medical Universityfrom2008.01.01to2012.12.31, and analyzes the postoperative death rate; 3. This study has collected the clinical data of CHD patients from2012.01.01to2012.12.31, and analyzes the complications before and aftersurgeries and the postoperative decrease of pulmonary artery pressure;4. This study adopts the retrospective studying method, and comparesthe postoperative death rate of the DS with CHD patients and the CHDpatients having surgeries meanwhile from2008.01.01to2012.12.31;5. This study adopts the retrospective studying method, and comparesthe complications before and after surgeries and the postoperativedecrease of pulmonary artery pressure between the DS with CHD patients(from2008.01.01to2012.12.31) and the CHD patients (from2012.01.01to2012.12.31).Results1. This paper has collected435clinical cases of DS patients admittedto Children’s Hospital of Chongqing Medical University from2008.01.01to2012.12.31, among whom239patients with CHD (54.9%),100casesare male,139cases are female, ranging in age from10days to13years3months old; the types of DS with CHD include ASD/PDA in63cases(26.4%), CAVC in42cases (17.6%), ASD in28cases (11.7%),ASD/VSD/PDA in25cases (10.5%), VSD in24cases (10.0%), PDA in22cases (9.2%); the complications include pneumonia in201cases(84.0%), PH in110case (46.0%), HF in72cases (30.1%);72cases(30.1%) have had surgeries, the main postoperative complications include pneumonia in52cases (72.2%), LCOS in6cases (8.3%), complete rightbundle branch block in10cases (13.9%), III°-AVB in9cases (12.5%),I°-AVB in6cases (8.3%);5cases (6.9%) have postoperative death; DSwith CHD have preoperative PH in65cases, in which the postoperativepulmonary artery pressure decreases in59cases (90.8%); thepostoperative PH decreases below moderate level in45cases (69.2%)(45/65)；2. This study has collected2459cases of CHD patients havingsurgeries from2008.01.01to2012.12.31, among whom1294cases aremale,1165cases are female, ranging in age from23days to17years9months old; there are118cases of death, the death rate is4.8%；3. This study has collected5611cases of clinical data of CHDpatients from2012.01.01to2012.12.31, among which2792cases aremale,2819cases are female, ranging in age from two days to15years4months old; the main complications are pneumonia in3591cases (64.0%),PH in645cases (11.5%), HF in477cases (8.5%);551cases (9.8%)having had surgeries, the main postoperative complications are pneumoniain128cases (23.2%), LCOS in17cases (3.1%), complete right bundlebranch block in74cases (13.4%), I°-AVB in20cases (3.6%), II°-AVB in7cases (1.3%), III°-AVB in15cases (2.7%), intraventricular block in10cases (1.8%), left anterior fascicular block in10cases (1.8%); a total of187cases of follow-ups of pulmonary artery pressure of CHD patients with PH before surgeries, among which postoperative pulmonary arterypressure decreases in179cases (95.7%), PH decreases below moderatelevel of CHD patients in167cases (89.3%)(167/187);4. The morbidity of pneumonia, PH and HF of DS with CHD patients(84.0%,46.0%and30.1%) is higher than that of CHD patients (64.0%,11.5%and8.5%), the difference is statistically significant (P<0.05); thepostoperative morbidity of pneumonia and LCOS (72.2%and8.3%) ishigher than that of CHD patients (23.2%and3.1%), the difference isstatistically significant (P<0.05); the morbidity comparison ofpostoperative conduction block (34.7%) of DS with CHD patientscompared to that (24.8%) of CHD patients, the difference is statisticallyinsignificant (P＞0.05);5. The postoperative morbidity of DS with CHD patients (6.9%)compared to that (4.8%) of CHD patients, the difference is statisticallyinsignificant (P＞0.05); the total postoperative decrease rate of pulmonaryartery pressure of DS with CHD patients (90.8%) compared to that (95.7%)of CHD patients, the difference is statistically insignificant (P＞0.05); thepostoperative PH decreases below moderate level of DS with CHDpatients (69.2%) compared to that (89.3%) of CHD patients, the differenceis statistically significant (P<0.05). Conclusion1. DS with CHD patients have a higher incidence rate to havecomplications of pneumonia, PH and HF than CHD patients;2. After surgeries, DS with CHD patients have a higher incidence rateto have complications of pneumonia and LCOS than CHD patients; thepostoperative complication morbidity of cardiacarrhythmia of DS withCHD patients has no obvious difference to that of CHD patients;3. After surgeries, DS with CHD patients have insignificant differentdeath rate than CHD patients, it means that surgeries are safe for DS withCHD patients;4. The total decrease rate of postoperative pulmonary artery pressureof DS with CHD patients has insignificant difference to that of CHDpatients, it means that surgeries are safe to decrease the pulmonary arterypressure of DS with CHD patients; however, the decrease degree ofpostoperative pulmonary artery pressure of DS with CHD patients issmaller than that of CHD patients, it is possible that DS patients havecomplications of other dysphasia restricts the postoperative decrease ofpulmonary artery pressure.