Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a ...Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a result.Currently,less invasive methods such as Arterial Duct(AD)stenting have been performed as alter-natives.This study aims to compare the outcome of AD stenting and MBTS.Method:Systematic research was performed in online databases using the PRISMA protocol.The outcomes measured were 30-day mortality,com-plication,unplanned intervention,oxygen saturation,duration of hospital,and ICU length of stay.Any compara-tive study provided with full text is included.The outcome of each study was analyzed using a trandom effects model with relative risk and mean difference as the effect size.Bias risk assessment was conducted using the New-castle-Ottawa Scale.All analyses were performed using Review Manager 5.4.1.Result:A total of 11 studies with 3154 samples included in this study.There is no significant difference in 30-day mortality between the two groups(p-value=0.10).However,there is significantly less complication(RR 0.53[0.35,0.82];p-value=0.004)and unplanned intervention(RR 0.59[0.38,0.92];p-value=0.02)in the AD stent group.Comparison of the Nakata index showed no significant difference(p-value=0.88).Post-operative oxygen saturation was measured signifi-cantly higher in the AD stenting(MD 1.80[0.85,2.74];p-value=0.0002).However,AD stent group shows sig-nificantly lower long-term oxygen saturation(MD-8.43[-14.38,-2.48];p-value=0.005).Both hospital and ICU length of stay was significantly shorter in the AD stent group(MD-8.30[-11.13,-5.48];p-value<0.00001;MD-5.09[-7.79,-2.38];p-value=0.0002).Conclusion:AD stenting provides comparable outcomes relative to MBTS as it provides less complication and unplanned intervention and higher post-procedural O2 saturation.However,MBTS proved its superiority in maintaining higher long-term oxygen saturation and still became the preferred option to manage complex cases 展开更多
SCLEROSING cholangitis represents progressing jaundice or/and paroxysmal symptom of cholangitis, finally developing to end-stage of liver disease. When compared with primary sclerosing cholangitis （PSC）, there are n...SCLEROSING cholangitis represents progressing jaundice or/and paroxysmal symptom of cholangitis, finally developing to end-stage of liver disease. When compared with primary sclerosing cholangitis （PSC）, there are no apparent differences in pathology and clinical manifestation in secondary sclerosing cholangitis （SSC）.展开更多
Objectives:To determine immediate and long-term follow-up of transcatheter closure of patent ductus arteriosus(PDA)in children.Background:National antibiotic prophylaxis(AP)guideline for infective endocarditis changed...Objectives:To determine immediate and long-term follow-up of transcatheter closure of patent ductus arteriosus(PDA)in children.Background:National antibiotic prophylaxis(AP)guideline for infective endocarditis changed after 2009,the effect on practice of PDA closure is unknown.Methods:Observational single center study analyzing follow-up of PDA closure comparing two time periods before(2002–2009)and after(2010–2019)changes in AP guideline.Results:332 patients(68.1%female),median(interquartile range)age 3.0 years(1.5–5.7)and body weight 14.0 kg(10.0–19.3),were enrolled.PDA morphology was conical type A(50.3%),window type B(1.2%),tubular type C(40.1%),complex type D(2.1%),elongated type E(0.9%)and other(5.4%).Minimal PDA diameter and length were 1.9 mm(1.3–2.5)and 8.0 mm(6.2–10.2).PDA was closed using coils(56.3%),Amplatzer Duct Occluders(41.9%)and others(1.8%).Complete closure rate was 61.1%at catheter intervention,72.3%on day 1,87.7%after 6 months and 98.4%at last follow-up on echocardiography.Moderate complication rate(severity level 3)was 4.2%and major complication rate(severity level 4)0.3%,with no catastrophic complications(severity level 5).Annual PDA closure rate declined in the second time period(22.6/year vs.15.5/year,p=0.018),PDA size increased(1.6 mm vs.2.0 mm,p=0.002)and proportion of coils decreased(72.4%vs.37.1%,p<0.001).Conclusions:Interventional closure of PDA is associated with excellent closure rates during follow-up(>98%)and only a small number of complications leading to reintervention or surgery.Change in AP guidelines changed indication for and practice of PDA closure.展开更多
We present a case of a one-day-old newborn,without prenatal diagnosis,referred to our cardiologic intensive care unit in critical condition presenting sub-cyanosis and peripheral oxygen saturation of 80%.Echocardiogra...We present a case of a one-day-old newborn,without prenatal diagnosis,referred to our cardiologic intensive care unit in critical condition presenting sub-cyanosis and peripheral oxygen saturation of 80%.Echocardiography diagnosis was tricuspid valve dysplasia with severe regurgitation,functional pulmonary valve atresia with intact ventricular septum and reversal flow in the large patent ductus arteriosus(PDA).Chest X-ray showed severe cardiomegaly and wall to wall heart.Prostaglandin E1 infusion was started once after birth.After few days,clinical conditions progressively worsened because of right heart failure;a first pharmacological approach to close PDA failed and surgery ligation of PDA was necessary to restore anterograde pulmonary flow and heart size.展开更多
目的检索、评价和总结小儿外周动脉导管冲洗系统维护的相关证据, 为临床提供参考。方法系统检索Up To Date、BMJ Best Practice、英国国家临床医学研究指南库(NICE)、医脉通、Cochrane Library、Joanna Briggs Institute(JBI)循证卫生...目的检索、评价和总结小儿外周动脉导管冲洗系统维护的相关证据, 为临床提供参考。方法系统检索Up To Date、BMJ Best Practice、英国国家临床医学研究指南库(NICE)、医脉通、Cochrane Library、Joanna Briggs Institute(JBI)循证卫生保健中心数据库、CINAHL、迈特思创、PubMed、万方、中国知网、维普等数据库关于小儿外周动脉导管冲洗系统管理与维护的二次证据资源。对各类型文献进行质量评价后提取并汇总证据。结果共纳入9篇文献。形成小儿外周动脉导管冲洗装置基本要求、动脉冲洗方式、注射泵系统冲洗速率、加压袋泵系统冲洗压力、动脉冲洗液、小儿外周动脉导管冲洗系统更换与维护、动脉导管维护的持续改进7个方面共计22条最佳证据。结论小儿外周动脉导管冲洗系统建立与维护的最佳证据为医护人员的临床决策提供依据, 但仍需要实践检验。展开更多
Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision andsafe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous sa...Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision andsafe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous saphenous vein graft is the preferred method practiced routinely. However the right hepatic artery reconstruction has also been carried out with several other vessels like gastroduodenal artery, right gastroepiploic artery or the splenic artery. We report a case of 63-year-old man presenting with history of progressive jaundice, pruritus and impaired appetite. Following various imaging modalities including computed tomography, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, intraductal ultrasound extrahepatic bile duct cancer was diagnosed; however, none of those detected vessel invasion. Intraoperatively, right hepatic artery invasion was revealed. Right hepatic artery was resected and reconstructed with a graft harvested from the first jejunal artery(JA). Postoperative outcome was satisfactory with a long-term graft patency. First JA can be a reliable graft option for right hepatic artery reconstruction.展开更多
文摘Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a result.Currently,less invasive methods such as Arterial Duct(AD)stenting have been performed as alter-natives.This study aims to compare the outcome of AD stenting and MBTS.Method:Systematic research was performed in online databases using the PRISMA protocol.The outcomes measured were 30-day mortality,com-plication,unplanned intervention,oxygen saturation,duration of hospital,and ICU length of stay.Any compara-tive study provided with full text is included.The outcome of each study was analyzed using a trandom effects model with relative risk and mean difference as the effect size.Bias risk assessment was conducted using the New-castle-Ottawa Scale.All analyses were performed using Review Manager 5.4.1.Result:A total of 11 studies with 3154 samples included in this study.There is no significant difference in 30-day mortality between the two groups(p-value=0.10).However,there is significantly less complication(RR 0.53[0.35,0.82];p-value=0.004)and unplanned intervention(RR 0.59[0.38,0.92];p-value=0.02)in the AD stent group.Comparison of the Nakata index showed no significant difference(p-value=0.88).Post-operative oxygen saturation was measured signifi-cantly higher in the AD stenting(MD 1.80[0.85,2.74];p-value=0.0002).However,AD stent group shows sig-nificantly lower long-term oxygen saturation(MD-8.43[-14.38,-2.48];p-value=0.005).Both hospital and ICU length of stay was significantly shorter in the AD stent group(MD-8.30[-11.13,-5.48];p-value<0.00001;MD-5.09[-7.79,-2.38];p-value=0.0002).Conclusion:AD stenting provides comparable outcomes relative to MBTS as it provides less complication and unplanned intervention and higher post-procedural O2 saturation.However,MBTS proved its superiority in maintaining higher long-term oxygen saturation and still became the preferred option to manage complex cases
文摘SCLEROSING cholangitis represents progressing jaundice or/and paroxysmal symptom of cholangitis, finally developing to end-stage of liver disease. When compared with primary sclerosing cholangitis （PSC）, there are no apparent differences in pathology and clinical manifestation in secondary sclerosing cholangitis （SSC）.
文摘Objectives:To determine immediate and long-term follow-up of transcatheter closure of patent ductus arteriosus(PDA)in children.Background:National antibiotic prophylaxis(AP)guideline for infective endocarditis changed after 2009,the effect on practice of PDA closure is unknown.Methods:Observational single center study analyzing follow-up of PDA closure comparing two time periods before(2002–2009)and after(2010–2019)changes in AP guideline.Results:332 patients(68.1%female),median(interquartile range)age 3.0 years(1.5–5.7)and body weight 14.0 kg(10.0–19.3),were enrolled.PDA morphology was conical type A(50.3%),window type B(1.2%),tubular type C(40.1%),complex type D(2.1%),elongated type E(0.9%)and other(5.4%).Minimal PDA diameter and length were 1.9 mm(1.3–2.5)and 8.0 mm(6.2–10.2).PDA was closed using coils(56.3%),Amplatzer Duct Occluders(41.9%)and others(1.8%).Complete closure rate was 61.1%at catheter intervention,72.3%on day 1,87.7%after 6 months and 98.4%at last follow-up on echocardiography.Moderate complication rate(severity level 3)was 4.2%and major complication rate(severity level 4)0.3%,with no catastrophic complications(severity level 5).Annual PDA closure rate declined in the second time period(22.6/year vs.15.5/year,p=0.018),PDA size increased(1.6 mm vs.2.0 mm,p=0.002)and proportion of coils decreased(72.4%vs.37.1%,p<0.001).Conclusions:Interventional closure of PDA is associated with excellent closure rates during follow-up(>98%)and only a small number of complications leading to reintervention or surgery.Change in AP guidelines changed indication for and practice of PDA closure.
文摘We present a case of a one-day-old newborn,without prenatal diagnosis,referred to our cardiologic intensive care unit in critical condition presenting sub-cyanosis and peripheral oxygen saturation of 80%.Echocardiography diagnosis was tricuspid valve dysplasia with severe regurgitation,functional pulmonary valve atresia with intact ventricular septum and reversal flow in the large patent ductus arteriosus(PDA).Chest X-ray showed severe cardiomegaly and wall to wall heart.Prostaglandin E1 infusion was started once after birth.After few days,clinical conditions progressively worsened because of right heart failure;a first pharmacological approach to close PDA failed and surgery ligation of PDA was necessary to restore anterograde pulmonary flow and heart size.
文摘目的检索、评价和总结小儿外周动脉导管冲洗系统维护的相关证据, 为临床提供参考。方法系统检索Up To Date、BMJ Best Practice、英国国家临床医学研究指南库(NICE)、医脉通、Cochrane Library、Joanna Briggs Institute(JBI)循证卫生保健中心数据库、CINAHL、迈特思创、PubMed、万方、中国知网、维普等数据库关于小儿外周动脉导管冲洗系统管理与维护的二次证据资源。对各类型文献进行质量评价后提取并汇总证据。结果共纳入9篇文献。形成小儿外周动脉导管冲洗装置基本要求、动脉冲洗方式、注射泵系统冲洗速率、加压袋泵系统冲洗压力、动脉冲洗液、小儿外周动脉导管冲洗系统更换与维护、动脉导管维护的持续改进7个方面共计22条最佳证据。结论小儿外周动脉导管冲洗系统建立与维护的最佳证据为医护人员的临床决策提供依据, 但仍需要实践检验。
文摘Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision andsafe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous saphenous vein graft is the preferred method practiced routinely. However the right hepatic artery reconstruction has also been carried out with several other vessels like gastroduodenal artery, right gastroepiploic artery or the splenic artery. We report a case of 63-year-old man presenting with history of progressive jaundice, pruritus and impaired appetite. Following various imaging modalities including computed tomography, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, intraductal ultrasound extrahepatic bile duct cancer was diagnosed; however, none of those detected vessel invasion. Intraoperatively, right hepatic artery invasion was revealed. Right hepatic artery was resected and reconstructed with a graft harvested from the first jejunal artery(JA). Postoperative outcome was satisfactory with a long-term graft patency. First JA can be a reliable graft option for right hepatic artery reconstruction.
