Extracorporeal membrane oxygenation (ECMO) provides cardiorespiratory support during cardiopulmonary resuscitation unresponsive to conventional methods. Here, we analyzed the extracorporeal cardiopulmonary resuscitation (ECPR) results of children in a cardiac arrest setting after cardiac surgery. Of 3119 cases of pediatric open‐heart surgery, 31 required postoperative ECMO. Among the 31 patients, 11 experienced cardiac arrest and ECPR in the early postoperative period. These 11 patients’ median age is 1.5 [range, 0.1‐19] months and median weight is 3.9 [range, 2.9‐10.3] kg. The medical records of ECPR cases were analyzed. The median ECMO‐assisted time was 68 (range, 13‐456) hours and 4 cases (36.4%) survived. The ECMO‐assisted times were ≤2 days in 4 patients (all eventually died), ≥6 days in 3 patients (all also died), and all 4 cases supported for 2‐6 days were discharged successfully (P = 0.006). In the survivors and nonsurvivors, peak lactate levels were 10.8 ± 7.04 and 22.8 ± 6.98 mmol/L (P = 0.023) and peak creatinine levels were 47.50 ± 25.9 and 153.7 ± 73.9 mg/dL (P = 0.035), respectively. In these 11 ECPR cases, the most common complications were bleeding requiring re‐exploration (n = 6, 54.5%) and renal failure (n = 6, 54.5%). The incidence of renal failure was significantly correlated with hypoperfusion time (P = 0.015). ECPR is valuable in children with postoperative cardiac arrest. The higher peak lactate level, higher peak creatinine level, and prolonged ECMO duration were associated with higher mortality. Early diagnosis and intervention of residual anatomical problems could improve survival. Bleeding and renal failure were the most common complications and the incidence of renal failure may be correlated with longer hypoperfusion duration.

Abstract. The value of the right bundle branch block (RBBB) in the treatment of acute myocardial infarction remains unclear. Studies on the RBBB may significantly influence the treatment of acute myocardial infarction. A total of 845 patients with acute myocardial infarction who underwent primary coronary angiography at Henan Provincial People's Hospital were analyzed. Higher peak enzyme levels, a higher ratio of Killip ≥II and closer proximal occlusion of infarct-related artery (IRA) were observed in patients with RBBB compared with those without. The ratio of TIMI flow 0/1 of IRA and ratio of received primary percutaneous coronary intervention (PCI) to IRA in the RBBB group were significantly higher compared with those in the left (L) BBB or no BBB groups. The in-hospital major adverse cardiac events (MACE) incidence in the RBBB group was higher compared with that in the no BBB group, but there was no significant difference between the RBBB and LBBB groups. Logistic regression revealed that proximal occlusion and TIMI flow 0/1 of IRA were predictive factors of RBBB. Cox regression analysis identified RBBB [risk ratio (RR), 4.682; P<0.001] and LBBB (RR, 3.687; P<0.001) as independent predictors of in-hospital MACE. The cumulative one-year survival rate in the RBBB group was significantly lower than those in the no BBB group (P<0.05) and the LBBB group (P<0.05). Similar to the guidelines regarding new onset of LBBB, new onset RBBB should be considered as a standard indicator for reperfusion therapy; as RBBB is associated with more severe symptoms, and higher incidents of complete occlusion of IRA and primary PCI treatment compared with LBBB.

No abstract

It is difficult to manage tributary varicose veins with endovenous laser ablation. Using the intravenous catheter-guided laser fiber to ablate the tributary varicose veins has been proposed. From April 2004 to December 2009, we randomly assigned 134 patients with 170 limbs for laser therapy, of which, 89 limbs in 74 patients were treated with laser ablation. The residual tortuous veins were abolished with the intravenous catheter-guided laser ablation (ICLA group), whereas residual varicose veins in 81 limbs in 60 patients were treated by stab avulsion (SA group). Patients were followed up with the median of 44.5 months after surgery. The outcomes and durability of treatment in both groups were evaluated. The primary end point was recurrence of varicose veins. In comparison with the SA group, patients in the ICLA group had fewer surgical incisions and morbidity, a shorter hospital stay, and returned to normal activity earlier. The overall 5-year recurrence of varicose veins was infrequent in the ICLA group but was much higher in the SA group (5.4% versus 20%, P = 0.022). ICLA provided better outcomes than conventional SA in managing the branched varicose veins and may be an alternative for the treatment of branch varicose veins.

Given the similar patency rate between UBAVF and RCAVF, the UBAVF could be considered as a reliable alternative when an RCAVF is not possible.