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《Journal of Applied Clinical Pediatrics》 2012-23
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Surgical Treatment for Congenital Heart Disease with Preoperative Ventilation in Children

GONG Li1,2,YAO Wen-yan1,WANG Tao1,WANG Li1,XIE Yan-li1,PI Ming-an1,DONG Nian-guo2(1.Department of Cardiothoracic Surgery,Wuhan Children′s Hospital,Huazhong University of Science and Technology,Wuhan 430016,Hubei Province,China;2.Department of Cardiovascular Surgery,Union Hospital,Huazhong University of Science and Technology,Wuhan 430022,Hubei Province,China)  
Objective To summarize the surgical treatment approach for young children with congenital heart disease who required mechanical ventilation before cardiac surgery. Methods A retrospective review of a cohort of patients in our department from Sep.2011 to Apr.2012 was performed.The subjects study included 16(10 male and 6 female) cases of congenital heart diseases supported with mechanical ventilation before cardiac surgery.Their ages ranged from 21 days to 7 months post-delivery.Among them 10 cases were less than 2 months old.Before the operations,all patients required tracheal intubation for mechanical ventilation(6 cases due to hypoxic seizures,10 cases due to respiratory failure).The duration of preoperative mechanical ventilation was from 1 to 20 days.Different types of surgical procedures and cardiopulmonary by passes(CPB) were performed according to the types of diseases.Anatomy correction was performed in 14 cases,while sta-geing operations were needed in 2 cases. Results The mean aortic cross clamp time was(34.34±30.24) min(ranging 24-93 min),the mean CPB time was(54.28±60.43) min(ranging 34-196 min),the mean duration of postoperative ventilation was(98.21±100.36) hours(ranging 40-391 hours),and the mean ICU was(7.25±12.94) days(ranging 4-19 days).One case died during the operation,and 2 cases died post-surgery,they all died of pneumorrhagia.The other 13 survivors were discharged with recovery.Two cases of them required delayed sternal closure because of unfavorable postbypass hemodynamics.Other morbidities in the immediate postoperative period included low cardiac output state(n=3),peritoneal dialysis(n=3),chylothorax(n=1),which were cured with thoracic duct ligation 1 week later.Eight patients had positive postoperative sputum bacterial cultures with the same organisms that were cultured preoperatively in 5 cases of them.There were no instances of wound infection or mediastinitis. Conclusions High risks existed in congenital heart surgeries with preoperative mechanical ventilation.More complications and longer postoperative recovery time were noted.Corrective cardiac surgery should be consi-dered before the emergence of critical symptoms.
【CateGory Index】: R726.5
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