1983年 · 第21卷第02期

The incidence of congenital heart disease accounts for about 8-10‰ in the total of newborn babies. The past 30 years saw a tremendous advance in the diagnosis and treatment of this disease throughout the world. Particularly during the last decade, with the application of improved surgical operations, anesthesia, diagnostic and therapeutic equipment, catheterization and angiocardiography in newborns and premature babies, Intensive Care Units have been set up for serious cases. As a result, the pre-and postoperative mortality has been greatly reduced. Most of the congenital heart diseases now can be diagnosed and successfully treated, although the mortality for some complicated cardiovascular deformaties still remain high in infancy.

In China today, many provinces and municipalities have their own contingents for pediatric cardiovascular diseases. Of course, to meet the needs of people, still greater efforts have to be made in this aspect, including giving full play to the superiority of the socialist system, organiz ing and promoting academic exchange, training professional personnel, setting up more preventive and therapeutic centers of congenital heart disease, perfecting related teaching programs in colleges, and develop ing the research on prevention.

This is a report of 120 cases of selective angiocardiography in children. Age ranged from 16 hours to 5 years with 81 males and 39 females. 58.3% were under 3 years old. Of 100 cyanotic patients, 13 were complicated with cardiac failure. Congenital anomalies confirmed by angiocardiography were tetralogy of Fallot, pulmonary steno sis, truncus arteriosus, double outlet of right ventricle, complete transposition of great arteries, total anomalies of pulmo nary venous drainage and malposition of heart in the order of frequency.

Complications encountered were: hypo xic cyanosis aggravated 3 cases, allergic reaction to contrast medium 2 cases, auri cular fibrillation, auricular flutter, tem porary respiratory arrest, convulsion and cerebral embolism one case each. All recovered without death. In authors' opin ion, the following measures are of help in preventing and minimizing the compli cations: Correction of acidosis, hypogly cemia and congestive cardiac failure; main taining of normal body temperature and fluid balance before and after procedure;for cyanotic patients, keeping on O₂ inha lation and dextrin intravenously; before procedure for tetralogy of Fallot, giving morphine for sedation and inderal orally for hypoxic spell. Operation should be carried out precisely and tenderly shortening the duration of examination, monitoring of circulation and respiration during and after operation. It seemed adequate to maintain a quiet state during anesthesia in children and only local anesthesia was applied to newborn infants.

Six cases of severe valvular pulmonic stenosis with intact ventricular septum, aged 1-6 months, are reported. One of the 6 patients was operated on successfully Two patients died of right heart failure before surgery. Clinically, most of these cases had some degree of cyanosis. All the patients showed marked right ventrioular hypertrophy by ECG, and an enlarged heart with decreased pulmonary vascularity on X-ray film. There was no marked post stenotic dilation. Echocardiography showed increased depth of "a" wave. However, con trast echoes showed the presence of right to-left atrial shunting. The diagnosis was confirmed by the cardiac catheterization and selective right ventriculography. It is empha sized that the cases with typical clinical manifestation could be operated on without catheterization and angiocardiography.

This paper reports 35 cases of congeni tal heart disease examined by radionuclide angiocardiography. This is a non-invasive examination. Its strong points are simpli city, rapidity, safety and accuracy. It can be used repeatedly in neonatal and critical patients. Compared with X-ray angiocardio graphy, its weak points are smaller images, less clarity and insufficient accumulated data. It can not replace cardiac cathe terization because it does not provide data on arterial PO₂. For the diagnosis of congenital heart disease, results of radionu clide angiocardiography should be analysed together with other data such as history, clinical findings, chest X-ray, ECG, UCG, etc. to arrive at a correct diagnosis.

91 cases of purulent pericarditis in the Jiangxi Provincial Children's Hospital during the years 1973-1980 were reported. Out of 91 cases 66 were acute purulent pericarditis, 13 subacute constrictive pericarditis with effusion, and 12 acute constrictive pericarditis. The route of infection was transmission through blood circulation or directly through lesions in the adjacent organs. The primary pathogens were sta phylococci aurei. The chief clincal mani festations were symptoms of infection, and signs of hydropericardium and systemid venostasis. Diagnostic problems were dis cussed. It was suggested that the effective treatment depended on an adequate com bined use of antibiotics and a thorough drainage of pericardial effusion. Pericardio lysis should be performed in all constric tive cases as early as possible.

The method, workload and results of "submaximal exercise ECG test" on 116children were studied. The children included three groups. Group I comprised cases of myocarditis. Group II comprised cases of suspected myocarditis, Group III com prised children without myocarditis as con trol. The children were instructed to squat down and stand up alternately or to jump in addition for 50—60 times in order to accelerate heart rate up to 150-160 per minute (70% of maximal exercise test). The result was positive in 32 cases and suspective positive in 21. 23 positive cases (46.9%) were in group I, 9(25,0%) were in group II, but note in group III. This indicated that there was no false positive. The authors believe that this can be used as a diagnostic criterion for the examina tion of cardiac function in cases of sus pected myocarditis or cases of myocarditis during convalescent stage with normal ECO findings. This method is simple, safe and suitable for children. The ECG changes in the test-positive group were ST-T devi ation, low voltage, ventricular bigeminal rhythm, atrial bigeminal rhythm, prolongation of Q-T interval and incomplete right bundle branch block, etc. ECG of some patients revealed significantly increased P voltage and right axis deviation. Its clinical significance remains to be studied.

Cardiac output and the sequential phases of ventricular systole in the cardiac cycle were measured in 191 healthy pre school children by the non-invasive thoracic impedance cardiogram, phonocardiogram and electrocardiogram recorded simul taneously. The results obtained from dif ferent age groups were subjected to statis tical analysis and the means and standard deviations could be used as references for pediatrician in clinical practice. The aver ages of each parameter are: stroke volume 33.51 ml/stroke; cardiac output 3.22 L/min; cardiac index 4.08 L/min/m²; stroke index 43.28 ml/stroke/m²; Q-X interval 334.3 m.sec; Q-B interval 72.7 m.sec; BX interval 261.3 m.sec; Q-Z interval 120.7m.sec; B-Z interval 48.5 m. sec. The techniques described in this paper are con sidered rather precise and reliable.

This is a report of statistical analysis of childhood tumors in the teaching hos pitals, especially in children's hospital of Shanghai First Medical College during the past 30 years. There were 2,897 cases of be nign tumors and 2,777 cases of malignant tumors, altogether 5,674 cases below age of 12. All were pathologically proved. 29. 2 %of tumors occurred in patients 0—3 years of age and more than half of cases occurred below age of 6. The ratio of male to fe male was 1.4:1.

Malignant tumors of nervous tissue, lympho-hemopoietic tissue and malignant embryomas were the main groups in malig nant tumors. These 3 groups together ac counted for 88.6% of the total malignant tumors. While tumors of soft tissue, epi thelial tissue and congenital vestigial tis sues were the benign tumors most com monly encountered, altogether constituting 92.4% of total benign tumors.

In comparison with the tumors reported in foreign literatures, it shows that dif ferences in race, region, heredity and environment factors could influence the frequency of different tumors. The knudson's concept of two "hits" on the genome of a susceptible cell to be a tumor cell in relation to the early formation and development of certain malignant tumors in infants and young children was discussed.

753 normal full-term neonates' cord blood lipids were studied. Blood cholesterol level in 751 (378 males, 373 females) was significantly different between the males and females; the mean value being 71.4mg/dl and 79.3 mg/dl, and the upper limit being 107 mg/dl and 119 mg/dl. No significant difference was observed in tri glyceride level and β-lipoprotein between the males and females. In 742 cases the mean value for cord blood triglyceride was 38.2 mg/dl with an upper limit 78.0mg/dl and in 294 cases the mean value for cord blood β-lipoprotein was 95.1 mg/dl with an upper limit 158 mg/dl. 89 cases had 1 of their 3 cord blood lipids above the upper normal limit. 23 of the 89 cases were reevaluated at age 1, the blood lipids level returned to normal in all. This sug gests that the cord blood lipids do not necessarily reflect the blood lipids in infants and children.

The dermatoglyphic nomogram of 30cases with an impression of Down's syn drome were studied. The result was similar to data in foreign countries. Out of 30cases, 27 had the crossing points within the Down's syndrome area, and the diagnosis of Down's syndrome was supported by karyotyping carried out later. 3 had the crossing points between Down's syndrome area and normal area. The diagnosis was ruled out in 2 cases by karyotyping. There fore, the nomogram offered a quick diagnosis with an diagnostic accuracy of 80—90 percent. Simple and effective, this method can be used widely in clinical practice. Despite its accuracy, dermatogly phic analysis, in the diagnosis of Down's syndrome, can only be used as a supple ment to the more precise methods, such as karyotyping and not to replace them.

Renal artery fibromuscular hyperplasia, also called renal artery fibromuscular dys plasia, is the most frequent cause of hyper tension due to stenosis of renal artery in children. Many of these cases have been previously called congenital renal anomaly. In 1971, this disease was classified inter nationally into 3 types: arterial intimal fibroplasia, periarterial fibroplasia and tu nica media fibromuscular dysplasia, the last type being the most common.

From 1974 to 1979, hypertensive children caused by renal artery stenosis as a result of fibromuscular hyperplasia were admitted to our hospital 3 cases were cured by operation. 1 died of congestive heart failure and another died of hypertensive encephalopathy. All 5 cases were shown to be suffering from this disease patholo gically. With early diagnosis and proper treatment, this is a curable disease. This is also a progressive disease, other arteries may be involved besides the renal artery.