Diagnosis and treatment of congenital heart disease in children crossing over altitudes and regions through long-distance transportation:observational study of efficacy and complications
Objective:To evaluate the effectiveness and safety of long-distance transportation and diagnosis and treatment of congenital heart disease in children across geographical regions and altitudes.Methods:A professional team was set up and went to Xizang to examine 2 800 children in three counties and districts with transthoracic Doppler echocardiography,and then organized long-distance transportation across 3 000 km to perform surgical treatment for children who meet the surgical indications.Financial support was provided by the local social security and social charity organizations in Xizang for diagnosis and treatment.Cardiologist from Shanghai and Fujian jointly conducted the operation.After the operation,relevant adverse events were observed,and the operation results were evaluated by rechecking electrocardiogram and color Doppler echocardiography.Results:19 children with congenital heart disease were selected,with a median age of 6.There were ten male children,and including 10 cases of atrial septal defect,4 cases of patent ductus arteriosus,4 cases of ventricular septal defect,and 1 case of ventricular septal defect combined with patent ductus arteriosus.There were no adverse events involving the child or family members during the entire long-distance and long-term transportation process.6 cases of atrial septal defect and 4 cases of patent ductus arteriosus underwent interventional closure surgery.4 cases of atrial septal defect,4 cases of ventricular septal defect,and 1 case of ventricular septal defect combined with patent ductus arteriosus underwent cardiac surgery.All patients'postoperative follow-up by echocardiography indicated no residual shunt.The postoperative left ventricular ejection fraction(LVEF)was 64.7%±7.1%,compared to the preoperative LVEF of 68.4%±4.6%,there was no significant difference(P＞0.05).The postoperative pulmonary artery pressure was(28.3±8.3)mmHg,which was significantly lower than the preoperative pulmonary artery pressure of(37.7±13.4)mmHg(P＜0.05).The postoperative PR interval of children undergoing interventional therapy was(130.3±16.3)ms,compared to the preoperative PR of(126.0±15.2)ms,there was no significant difference(P＞0.05).There was no significant difference between the postoperative QRS interval of(77.4±7.7)ms and the preoperative QRS interval of(81.6±10.3)ms(P＞0.05).A child with patent ductus arteriosus experienced brief symptoms of headache,dizziness,and elevated blood pressure 1-2 d after surgery but fully recovered one week later.Other children recovered well after surgery and returned to Xizang safely two weeks later.Conclusion:Due to regional development differences,the medical conditions in some areas are relatively weak and can't meet the diagnosis and treatment needs of local children with congenital heart disease.The expected surgical effectiveness and safety have been achieved by transporting the patients over a long distance to areas with higher levels of economic development for treatment.
congenital heart diseaseXizanghigh altitudediagnosis and treatment modemedical assistance
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