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《Journal of Applied Clinical Pediatrics》 2012-23
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Surgical Treatment of Pediatric Congenital Heart Disease Complicated with Infective Endocarditis

WANG Li,GONG Li,PI Ming-an(Department of Cardiothoracic Surgery,Wuhan Children′s Hospital,Huazhong University of Science and Technology,Wuhan 430016,Hubei Province,China)  
Objective To summarize the clinical experience of surgical treatment of pediatric congenital heart disease(CHD) complica-ted with infective endocarditis(IE). Methods Cardopulmonary bypass(CPB)was performed on 15 cases with pediatric CHD complicated with IE in Wuhan Children′s Hospital from Jan.2002 to Apr.2011,male 7 cases,female 8 cases,age 3-12 years,weight 10-27 kg.Blood culture was positive in 15 cases(100%).Streptococcus was found in 7 cases,staphylococcus in 6 cases and other bacteria in 2 cases.Endocardial vegetations were found in 15 cases by ultrasonic cardiography(UCG) including patch vegetation 2 cases,and vegetation in bicuspid valve or tricuspid valve 13 cases.Valve perforation was found in 3 cases.Operations were performed to eliminate infective focus thoroughly and reconstruct impaired intra cardiac construction,and rescue the cardiac anomalies.The methods of operation included eliminated vegetations in 15 cases,VSD repair in 4 cases,ASD repair in 2 cases,ASD/VSD repair with tricuspid valvuloplasty(TVP) in 5 cases,ASD repair with mitral valve replacement and TVP in 2 cases,VSD repair with removal of polyester patch in 1 case,and right ventricular outflow reconstructed in 1 case.CPB was performed with mid-low temperature(26-30 ℃) and moderate or high flow rate(80-120 mL·kg-1·min-1).Cardioplegia with St.Thomas Ⅱ cold crystalloid or 4 ℃ 41(bloodcrystalloid) was performed by antegrade coronary sinus perfusion for myocardial protection. Results The duration of CPB ranged from 85 to 180 min,and aorta cross-clamp time from 40 to 120 min.Fifteen cases were weaned from CPB successfully,no complications associated with CPB in all cases,and infection was controlled after operation.Intensive care unit stay lasted 1-6 d,and hospitalization was 40-60 d.One case developed right upper lung embolism;3 cases had wound infection;1 case had acute renal failure(ARF).One case died 2 years later because of heart failure.Others were followed up for 3 months to 9 years without recurrence. Conclusion Aggressive surgical intervention,suitable surgical treatment and individualized CPB are the key factors for recovery.
【CateGory Index】: R726.5
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