A historical comparison of long-term behavioral and emotional outcomes in children and adolescents after invasive treatment for congenital heart disease

Background/Purpose

Children with congenital heart disease (ConHD) are known to be vulnerable to behavioral and emotional problems. In this study, a historical comparison is made between the level of behavioral and emotional problems in a sample of children and adolescents with ConHD treated recently vs a comparable historical sample operated upon before 1980 in the same institute. The hypothesis was that improvements in medical care would result in more favorable behavioral and emotional outcomes for children and adolescents with ConHD treated recently, that is, between 1990 and 1995, compared with same-aged patients operated on before 1980.

Methods

To assess behavioral and emotional problems, the Child Behavior Checklist (parent report) and Youth Self-Report were used. The historical samples (n = 98 and n = 123, respectively) and recent samples (n = 90 and n = 84, respectively) consisted of 4 diagnostic groups.

Results

Parents and patients from the recent sample with ConHD reported fairly similar levels of behavioral and emotional problems compared with parents and patients in the historical sample with ConHD.

Conclusion

Despite evident improvements in diagnostic and surgical techniques and medical treatment of ConHD over the past decades, virtually no changes were found in levels of problem behavior of the recent patient sample compared with the historical patient sample, who both underwent invasive treatment for ConHD.     

The long-term quality of life outcomes in adolescents with Hirschsprung disease

Background

Postoperative outcomes for Hirschsprung disease (HD) remain variable, with many patients affected by constipation and/or fecal incontinence. The long-term impact upon quality of life (QoL) for HD patients is unclear. We measured long-term QoL outcomes in adolescents with HD using validated questionnaires.

先天性心脏病术后病儿的腹膜透析治疗

目的　评估腹膜透析治疗在儿童心脏手术后维持体液平衡方面的有效性。方法　 2 0 0 0年 7月至 12月间 ,12例 (2 0 8% ,12 / 5 76例 )先天性心脏病手术后病儿因急性肾功能不全接受了腹膜透析治疗。年龄 5月龄～ 7岁 ,平均 (2 9± 2 0 )岁 ;体重 7 4～ 18 5kg ,平均 (12± 3)kg。结果　术后 4 4～ 4 2h ,平均(2 1 2± 11 4 )h开始腹膜透析 ;持续 0 5～ 15 0d ,平均 (6 3± 4 8)d。死亡 3例。腹膜透析排出液量每天(34 7± 17 8)ml/kg。透析期间血动力学及呼吸功能指标均有改善。血小板减少及高血糖为主要并发症 ,但均易于治疗。结论　腹膜透析是治疗儿童先天性心脏病手术后急性肾功能不全的一种安全、有效的手段。     

先心病术后危重患儿的早期腹膜透析治疗

目的 探讨先天性心脏病术后早期腹膜透析(peritoneal dialysis,PD)对患儿早期预后的影响.方法 回顾性分析2008年1月至2009年12月先天性心脏病手术患儿4561例中需要PD治疗患儿62例.收集PD患儿术前、术后相关变量,建立数据库.手术室或术后3h内PD治疗患儿为早期PD组,其余患儿为传统PD治疗组.结果 PD治疗发生率1.36％(62/4561例).死亡15例,早期PD组10.71％(3/28例)和传统PD组35.29％(12/34例),差异有统计学意义(P=0.036)；RIFLE标准Ⅲ期早期PD组2例(7.1％)和传统治疗组10例(29.4％),差异有统计学意义(P=0.001).PD治疗24 h后血管活性药评分和血清肌酐值早期PD组明显降低[(19.00±2.39)对(37.00±5.22),P=0.002; (50.51±21.84) μmol/L对(130.13±76.09) μmol/L,P=0.001)].结论 积极早期PD能够降低先天性心脏病术后患儿急性肾功能损伤发生率,减轻疾病严重程度,降低死亡率.     

Parent reported long-term quality of life outcomes in children after congenital diaphragmatic hernia repair

Purpose

The aim of this study was to determine long-term outcomes for congenital diaphragmatic hernia (CDH) patients including quality of life (QoL), symptom burden, reoperation rates, and health status.

Scoliosis after thoracotomy/sternotomy in children with congenital heart disease

Context:

Congenital heart disease (CHD) patients bear a higher risk of scoliosis during their lifetime compared to their normal counterparts. On the other hand, operation on chest wall has been shown to increase the risk of scoliosis. However, the data are inconclusive. The present retrospective analysis is undertaken to determine the frequency of post-thoracotomy/sternotomy scoliosis in children with CHD.

Materials and Methods:

One hundred and eighty children with CHD who underwent thoracotomy/sternotomy and had a minimum followup of 3 years in a teaching center from 1997 to 2010 were recruited. After operation, all the patients were regularly examined for the development of scoliosis. 102 patients underwent thoracotomy and 78 sternotomy. Student''s t test, Chi-square test, Fisher''s exact test were used for statistical analyses.

Results:

Eighty-eight males and 92 females with a mean age of 9.95 ± 2.31 (range: 5–15) years were enrolled. The mean age at operation was 2.59 ± 1.66 (range: 0–9) years and the mean follow-up period was 7.36 ± 2.12 (range: 5–13) years. Scoliosis was confirmed in two patients (1.1%): 1 (1%) in the thoracotomy group (a 12-year-old female operated 2 years earlier with a spinal 22° convexity to the right and 78° kyphosis) and another (1.1%) in the sternotomy group (an 8-year-old female operated during her neonatal period with a spinal 23° convexity to the left).

Conclusion:

Scoliosis is not a common finding among the operated children with CHD in our center.     

先心病患儿介入治疗后中期生存质量研究

目的了解先心病患儿介入治疗后中期生存质量状况,为临床制订针对性的护理策略提供依据。方法选择2008年3月至2009年1月在哈尔滨市某三级甲等医院心内科住院行介入治疗的先心病患儿100例(先心组)为研究对象。应用儿童生存质量量表系列普适性核心量表第4版为研究工具,分别于介入治疗前24h和治疗后6个月进行问卷调查。同期采取目的抽样的方法选择黑龙江省同龄健康儿童520例(健康组)进行调查。结果先心组介入治疗后6个月生存质量总分为80.47±9.69,除社会功能外,生理领域、心理社会领域、情感功能、角色功能与健康组比较,差异无统计学意义(均P0.05)。结论先心病介入治疗能显著改善患儿的生存质量,使大多数患儿都达到较好的中期生存质量水平。但社会功能仍较差,应引起医护人员的高度重视,并采取有效措施重点干预。     

微创技术同期治疗漏斗胸合并先天性心脏病

目的 探讨应用微创技术同期治疗漏斗胸合并先天性心脏病(先心)的方法及可行性.方法 2006年7月至2011年6月应用双微创技术6例,其中男4例,女2例;年龄4～6岁5月,平均5岁4月;体重16 ～ 20 kg,平均(18.00±1.79) kg.CT Haller指数3.9 ～5.0,平均(4.35±0.43).其中4例行室间隔缺损微创伞封术(3例膜部和1例主动脉瓣下室间隔缺损,缺损直径4 ～5 mm);2例行中央型继发孔房间隔缺损微创伞封术,直径12～16mm.先心微创术后行Nuss手术,术后常规放置心包纵隔引流管.结果 手术顺利,术后5～11h拔除气管插管,平均(8.17±2.04)h.48h拔除心包纵隔引流管.无手术死亡、大出血及胸腔脏器损伤等危险并发症.术后检查先心封堵效果良好,肺复张良好.术后出现1例切口延期愈合,经治疗后,均顺利出院.3例行钢板取出术,效果满意.结论 微创技术同期治疗合并先心的漏斗胸安全、满意,避免了二次手术所带来的困难和风险.     

Surgical treatment of infective valve endocarditis in children with congenital heart disease

Abstract Objective: This study assesses surgical procedures, operative outcome, and early and intermediate‐term results of infective valve endocarditis in children with congenital heart disease. Methods: Seven consecutive children (five females, two males; mean age, 10.8 years) who underwent surgery for infective valve endocarditis between 2006 and 2010 were included in the study. The aortic and mitral valves were affected in two and tricuspid in five patients. Indications for operation included cardiac failure due to atrioventricular septal rupture, severe tricuspid valve insufficiency, and septic embolization in one, moderate valvular dysfunction with vegetations in three (two tricuspid, one mitral), and severe valvular dysfunction with vegetations in the other three patients (two tricuspid, one mitral). The pathological microorganism was identified in five patients. Tricuspid valve repair was performed with ventricular septal defect (VSD) closure in five patients. Two patients required mitral valve repair including one with additional aortic valve replacement. Results: There were no operative deaths. Actuarial freedom from recurrent infection at one and three years was 100%. Early echocardiographic follow‐up showed four patients to have mild atrioventricular valve regurgitation (three tricuspid and one mitral) and three had no valvular regurgitation. No leakage from the VSD closure or any valvular stenosis was detected postoperatively. Conclusions: Mitral and tricuspid valve repairs can be performed with low morbidity/mortality rates and satisfactory intermediate‐term results in children with infective valve endocarditis . (J Card Surg 2012;27:93‐98)     

Short-term outcomes after surgical treatment of traumatic posterior sternoclavicular fracture-dislocations in children and adolescents

Posterior sternoclavicular joint (SCJ) dislocations and posteriorly displaced physeal fractures of the medial clavicle require prompt diagnosis and treatment to prevent persistent symptoms, recurrent instability, and potential complications. The purpose of this investigation was to review one institution's experience with these injuries. A retrospective review of 13 patients with posterior SCJ fracture-dislocations was performed. Average patient age was 14.6 years, and 85% of injuries were sustained during sporting activities. Patients with posterior dislocations underwent ligament repair and those with posteriorly displaced medial clavicular physeal fractures had open reduction and suture stabilization. At an average of 22.2 months follow-up, all patients had excellent functional outcomes. There were no respiratory or neurovascular complications. Skeletally immature patients may expect excellent functional outcomes following surgery for posterior SCJ dislocations or posteriorly displaced physeal fractures of the medial clavicle.     

Surgical outcomes in congenital heart disease: expectations and realities

The past 50 years of congenital heart surgery has produced enormous progress. Current results surpass expectations. Yet there are important residual problems in patients growing up after heart surgery for congenital heart disease. Our system of care must evolve to care for these people throughout their lives. The evolution of congenital heart surgery has reached a point in time when we should extend care to patients in under serviced emerging countries. Development of local expertise will be required within those countries that are willing to commit resources to an organized program of caring for people with congenital heart disease. Database technology is an essential tool for ensuring and improving quality of care in every congenital heart centre. Both Registry and Academic databases have much to offer in improving care for future patients. Yet overzealous privacy laws threaten the knowledge base provided by computerized databases. We need to guide our legislators in ensuring that the valuable resource provided by database technology is not lost.     

先天姓心脏病及其治疗方式对病儿心理行为的影响

目的 探讨外科修补术与介入治疗对先天性心脏病(CHD)病儿心理行为影响,并进一步评价不同年龄段病儿治疗前、后心理行为的差异.方法 采用中国标准化的Achenbach儿童行为量表对CHD病儿分别在术前和术后1年进行心理行为测试,探讨不同的治疗方式对病儿心理行为的影响,并分别对两治疗组中高、低年龄段病儿进行治疗前、后比较.选取健康儿童作为对照组.结果 治疗前各组CHD病儿心理行为异常检出率、心理行为总粗分均显著高于健康对照组(P＜0.01),男、女各组均表现有抑郁、体诉、社会退缩、违纪行为.治疗后1年测试,男、女两治疗组心理行为总粗分分别显著低于治疗前(P＜0.01),外科组男孩术后总粗分及攻击行为粗分分别高于介入组(P＜0.05),外科组女孩术后心理行为总粗分及抑郁、社会退缩和违纪行为粗分分别高于介入组(P＜0.05).术前高年龄组病儿心理行为总粗分均分别高于低年龄组(P＜0.05),外科治疗后高年龄组心理行为总粗分高于低年龄组(P＜0.05).结论 先天性心脏病影响病儿心理行为的健康发展,早期治疗可明显改善病儿的心理行为状况.与介入治疗相比,外科修补术后较长时间内应给予病儿更多的心理帮助,以利身心健康早日恢复.