Abstract: Objective To analyze the early outcomes of open heart surgery for congenital heart diseases in sixty low birth weight infants and premature infants. Methods Sixty low birth weight infants (body weight<2 500 g) and premature infants with congenital heart diseases undergoing surgical repair from May 2003 to October 2011 were studied retrospectively in Guangdong Cardiovascular Institute. There were 43 male patients and 17 female patients with their mean gestational age of 33.5±4.1 weeks (ranging from 26 to 42 weeks) and mean age at operation of 24.9±12.5 d(ranging from 4 to 55 d). Among them there were 47 premature infants with their mean birth weight of 1 729.3±522.5 g(ranging from 640 to 2 500 g)and mean weight at operation of 1 953.2±463.6 g (ranging from 650 to 2 712 g). All the patients received preoperative treatment in newborn intensive care unit(NICU) and underwent surgical repair under general anesthesia, including 29 patients without cardiopulmonary bypass (CPB)and 31 patients with CPB . All surviving patients received postoperative monitoring and treatment in NICU, and their postoperative complications and in-hospital death were reported. Results A total of 13 patients died during hospitalization with a total in-hospital mortality of 21.7%(13/60), including 4 intra-operative deaths, 6 early deaths (within 72 h postoperatively) and 3 patients giving up postoperative treatment. CPB time was 121.0±74.7 min, aortic clamp time was 74.8±44.7 min, and postoperative mechanicalventilation time was (136.9±138.1)h. Thirteen patients underwent delayed sternal closure. Eight patients underwentreexploation for postoperative bleeding. Ten patients had severe pneumonia, 2 patients had pulmonary hypertensive crisis, and 8 patients had low cardiac output syndrome. All the postoperative complications were resolved or improved after proper treatment. Follow-up was complete in 47 patients from 2 to 12 monthes, and all the patients were alive during follow-up. Conclusion Early surgical repair for low birth weight infants and premature infants with congenital heart diseases is safe and effective.
Citation:
ZENG Rong,ZHUANG Jian,CHEN Jimei,et al .. Early Outcome of Open Heart Surgery for Congenital Heart Diseases in Low Birth Weight Infants and Premature Infants. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 227-231. doi:
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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Mossad EB, Machado S, Apostolakis J. Bleeding following deep hypothermia and circulatory arrest in children. Semin Cardiothorac Vasc Anesth, 2007,11 (1):34-46.
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宓亚平, 贾兵, 李炘, 等. 低体重儿危重先天性心脏病的早期体外循环手术治疗. 中华急诊医学杂志, 2008, 17 (8):817-820.
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周成斌, 陈萍, 彭东, 等. 体重2500克以下危重先天性心脏病患者的体外循环管理. 中国胸心血管外科临床杂志, 2007, 14 (4):319.
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宋兴荣, 梁洁贤, 王晟. 新生儿心脏手术132例麻醉处理. 岭南心血管病杂志, 2007,13 (3):186-188.
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凌庆, 汪涛, 赵萍, 等. 新生儿复杂先天性心脏病的外科治疗. 中国胸心血管外科临床杂志, 2005, 12 (3):155-157.
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陈林, 肖颖彬, 钟前进, 等. 心内直视手术后多脏器功能衰竭的危险因素与防治措施. 中国急救医学, 2004, 24 (2) :81 - 83.
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聂磊,杨劲松,刘一骐. 盐酸氨溴索预防体外循环术后急性肺损伤的作用与机制. 广东医学,2010,3l (l8):2367-2369.
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Refai M, Brunelli A, Xiumé F, et al. Short-term perioperative treatment with ambroxol reduces pulmonary complications and.
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管咏梅, 周艳萍, 徐卓明, 等. 先天性心脏病低出生体重儿的术后护理. 护理学杂志, 2008, 23 (2):29-30.
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- 1. hospital costs after pulmonary lobectomy: a randomized trial. Eur J Cardiothorac Surg, 2009,35 (3):469-473.
- 2. 郝芳之, 杨兴季, 主编. 临床儿科心脏病学. 天津:天津科学技术出版社, 1997. 203.
- 3. 奚政君, 王燕, 梁书锋. 新生儿先天性心脏病1393例病理分类统计分析. 临床与实验病理学杂志, 1998, 14 (6):546-566.
- 4. Seo DM, Park JJ, Yun TJ, et al. The outcome of open heart surgery for congenital heart disease in infants with low body weight less than 2500 g. Pediatr Cardiol, 2011,32 (5):578-584.
- 5. Ades A, Johnson BA, Berger S. Management of low birth weight infants with congenital heart disease. Clin Perinatol, 2005, 32 (4): 999-1015.
- 6. Bové T, François K, De Groote K, et al. Outcome analysis of major cardiac operations in low weight neonates. Ann Thorac Surg, 2004,78 (1):181-187.
- 7. 李菁, 孙建华, 黄萍. 新生儿先天性心脏病的术前机械通气21例. 小儿急救医学, 2004, 6 (Suppl 1):32-34.
- 8. Hartyánszky I, Lozsádi K, Király L, et al. Surgical management of preterm infants and low birth weight neonates with congenital heart disease. Orv Hetil, 2005, 146 (2):69-73.
- 9. 史嘉玮, 肖雅琼, 董念国, 等. 新生儿小婴儿先天性心脏病围术期肺炎的临床特征. 中华小儿外科杂志, 2010,31 (5):365-368.
- 10. 苏肇伉, 史珍英, 孙爱敏, 等. 小婴儿危重先天性心脏病的急症手术. 中华小儿外科杂志, 1998, 5:260-262.
- 11. 柯俊, 王晟, 张燕, 等. 低出生体重儿心内直视术的体外循环管理. 中国体外循环杂志, 2010, 8 (4):229-231.
- 12. DeLeon SY, Idriss FS, Ilbawi MN, et al. Comparison of single versus multidose blood cardioplegia in arterial switch procedures. Ann Thorac Surg, 1988,45 (5):548-553.
- 13. Mossad EB, Machado S, Apostolakis J. Bleeding following deep hypothermia and circulatory arrest in children. Semin Cardiothorac Vasc Anesth, 2007,11 (1):34-46.
- 14. 宓亚平, 贾兵, 李炘, 等. 低体重儿危重先天性心脏病的早期体外循环手术治疗. 中华急诊医学杂志, 2008, 17 (8):817-820.
- 15. 周成斌, 陈萍, 彭东, 等. 体重2500克以下危重先天性心脏病患者的体外循环管理. 中国胸心血管外科临床杂志, 2007, 14 (4):319.
- 16. 宋兴荣, 梁洁贤, 王晟. 新生儿心脏手术132例麻醉处理. 岭南心血管病杂志, 2007,13 (3):186-188.
- 17. 凌庆, 汪涛, 赵萍, 等. 新生儿复杂先天性心脏病的外科治疗. 中国胸心血管外科临床杂志, 2005, 12 (3):155-157.
- 18. 陈林, 肖颖彬, 钟前进, 等. 心内直视手术后多脏器功能衰竭的危险因素与防治措施. 中国急救医学, 2004, 24 (2) :81 - 83.
- 19. 聂磊,杨劲松,刘一骐. 盐酸氨溴索预防体外循环术后急性肺损伤的作用与机制. 广东医学,2010,3l (l8):2367-2369.
- 20. Refai M, Brunelli A, Xiumé F, et al. Short-term perioperative treatment with ambroxol reduces pulmonary complications and.
- 21. 管咏梅, 周艳萍, 徐卓明, 等. 先天性心脏病低出生体重儿的术后护理. 护理学杂志, 2008, 23 (2):29-30.