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Sample records for amplatzer septal occluder

  1. Assessment of the geometric profile of the Amplatzer and Cardioseal septal occluders by three dimensional echocardiography

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    Acar, P; Saliba, Z; Bonhoeffer, P; Sidi, D; Kachaner, J

    2001-01-01

    OBJECTIVE—To apply three dimensional echocardiography to describe the geometric profile of the Amplatzer and Cardioseal occluders after deployment for closure of atrial septal defect.
METHODS—20 patients (mean (SD) age, 14 (5) years) were enrolled for transcatheter closure of a secundum atrial septal defect with the Amplatzer occluder (10) or with the Cardioseal occluder (10). The two populations were matched for the stretched diameter of the defect (mean 18 (6) mm). The profile of the two oc...

  2. Transcatheter closure of secundum atrial septal defect using an Amplatzer septal occluder

    Institute of Scientific and Technical Information of China (English)

    孔祥清; 曹克将; 杨荣; 许迪; 盛燕辉; 黄峻; 马文珠

    2002-01-01

    Objective To evaluate the safety and efficacy of the Amplatzer septal occluder for transcatheter closure in patients with secundum atrial septal defect (ASD Ⅱ). Methods Patients with clinically confirmed ASD Ⅱ were recommended for transcatheter closure of ASD Ⅱ. Results 30 ASD Ⅱ patients (20 females) underwent transcatheter closure at a median age of 18.4 years (5-55 years). Both the stretched diameters of ASDs and the sizes of the devices were from 18 to 34?mm (25±7?mm). The successful placement rate was 100%. The rest shunt documented by color Doppler, was immediately after implantation in 40% of patients, in 9.9% after 24 hours, and in 3.3% trace at 3 months. No serious complications were observed. There was improvement in symptoms and in cardiac size. Septal motion abnormalities normalized in all patients after 3 months follow-up. Conclusion The Amplatzer septal occluder is a safe and effective device for transcatheter closure of ASD Ⅱ. Long-term follow-up is still required before widespread clinical use can be recommended.

  3. Late endocarditis of Amplatzer atrial septal occluder device in a child

    Institute of Scientific and Technical Information of China (English)

    Neerod; K; Jha; Laszlo; Kiraly; John; SK; Murala; Csaba; Tamas; Haitham; Talo; Hazem; El; Badaoui; Magdi; Tofeig; Malaika; Mendonca; Sameer; Sajwani; Mary; A; Thomas; Sura; Ahmed; Al; Doory; Mohammad; D; Khan

    2015-01-01

    Bacterial endocarditis following atrial septal defect closure using Amplatzer device in a child is extremely rare. We report a 10-year-old girl who developed late bacterial endocarditis, 6 years after placement of an Amplatzer atrial septal occluder device. Successful explantation of the device and repair of the resultant septal defect was carried out using a homograft patch. The rare occurrence of this entity prompted us to highlight the importance of a closed long-term follow up, review the management and explore preventive strategies for similar patients who have multiple co-morbidities and a cardiac device. A high index of suspicion is warranted particularly in pediatric patients.

  4. Utilization of 3 amplatzer occluders for closure of post-myocardial infarction ventricular septal defect.

    Science.gov (United States)

    Kar, Saibal; Ibebuogu, Uzoma N; Conte, Antonio Hernandez

    2012-05-01

    This case report describes a patient who sustained a post-myocardial infarction ventricular septal defect (VSD) with an associated left ventricular aneurysm who developed cardiogenic shock and required an intra-aortic balloon pump for hemodynamic stabilization. After deployment of a single Amplatzer occluder (AGA Medical), a residual VSD measuring 0.5 cm was noted. Therefore, a second Amplatzer occluder was deployed and a minimal residual VSD remained. The patient remained hemodynamically stable throughout the procedure and was subsequently extubated with removal of intra-aortic balloon pump. Post-discharge, the patient was readmitted with congestive heart failure. A third Amplatzer device was deployed to ameliorate the recurrent VSD shunt. At 9-week follow-up, transthoracic echocardiogram was performed and findings included: 1) left ventricular ejection fraction of 62%; 2) appearance of 3 Amplatzer devices along the interventrcular septum seated well with no motion and residual shunt; 3) moderate diastolic dysfunction with pseudonormal left ventricular filling pattern; and 4) no valvular abnormalities. The patient had increased exercise tolerance with no shortness of breath at rest or with exertion. This case demonstrates the utility and viability of multiple Amplatzer device deployment as a means of repairing a large post-myocardial infarction VSD and recurrent VSDs.

  5. Endocarditis and Incomplete Endothelialization 12 Years after Amplatzer Septal Occluder Deployment.

    Science.gov (United States)

    Nguyen, Allan K; Palafox, Brian A; Starr, Joanne P; Gates, Richard N; Berdjis, Farbouch

    2016-06-01

    A 4-year-old boy had a 15-mm atrial septal defect repaired percutaneously with use of an Amplatzer Septal Occluder. At age 16 years, he presented with a week's history of fever, chills, dyspnea, fatigue, and malaise. Cultures grew methicillin-sensitive Staphylococcus aureus. A transesophageal echocardiogram showed a 1.25 × 1.5-cm pedunculated mass on the left aspect of the atrial septum just superior to the mitral valve, and a smaller vegetation on the right inferior medial aspect of the septum. At surgery, visual examination of both sides of the septum revealed granulation tissue, the pedunculated mass, the small vegetation, and exposed metal wires that suggested incomplete endothelialization of the occluder. We removed the occluder and patched the septal defect. The patient returned to full activity after 4 months and was asymptomatic 3 years postoperatively. Our report reinforces the need for further investigation into prosthetic device endothelialization, endocarditis prophylaxis, and recommended levels of physical activity in patients whose devices might be incompletely endothelialized. In addition to reporting our patient's case, we review the medical literature on this topic. PMID:27303238

  6. Device closure of secundum atrial septal defect in a 4.5 kilogram infant: Novel use of the Amplatzer DuctOccluder II device.

    Science.gov (United States)

    McCrossan, B A; Walsh, K P

    2016-02-01

    Modest secundum atrial septal defects (2°ASD) may cause significant pulmonary over perfusion during infancy, particularly in conjunction with left heart obstructive lesions. Amplatzer Septal Occluders are not ideal in this setting especially given recent concerns regarding device erosion. We report the first use of the Amplatzer Duct Occluder II device (ADO2) to close a 2°ASD in a 4.5 kg infant.

  7. Home-made fenestrated amplatzer occluder for atrial septal defect and pulmonary arterial hypertension

    Institute of Scientific and Technical Information of China (English)

    Fabio Dell'Avvocata; Gianluca Rigatelli; Paolo Cardaioli; Massimo Giordan

    2011-01-01

    We report the management of a patient with secundum atrial septal defect (ASD)and severe pulmonary hypertension.A 65-year-old male with recently diagnosed atrial serital defect was referred to our centre for decompensated right heart failure with rest and exercise induced dispnea and severe pulmonary hypertension.Right heart catheterization confirmed a mean pulmonary pressure of about 55 mmHg and a Qp/Qs of 2.7.An occlusion test with a compliant large balloon demonstrated partial fall of pulmonary arterial pressure.The implantation of a home-made fenestrated Amplatzer ASD Occluder (ASO) was planned in order to decrease lefttoright shunt and promote further decrease of pulmonary arterial pressure in the long-term.Thus,by means of mechanical intracardiac echocardiography study with a 9F 9 MHz Ultralce catheter(Boston Scientific Corp.),we selected a 34 mm ASO for implantation.Four millimeter fenestration was made inflating a 4 ntm non-compliant coronary balloon throughout the waist of the ASO,which was successfully implanted under intracardiac echocardiography.After six months,a decrease of pulmonary arterial pressure to 24 mmHg and full compensated right heart failure was observed on transthoracic echocardiography and clinical examination.This case suggests that transcatheter closure with home-made fenestrated ASD in elderly patients with severe pulmonary hypertension is feasible.

  8. Reliability of transthoracic echocardiography in estimating the size of Amplatzer septal occluder and guiding percutaneous closure of atrial septal defects

    Institute of Scientific and Technical Information of China (English)

    LI Gui-shuang; KONG Guang-ming; JI Qiu-shang; LI Ji-fu; CHEN Yu-guo; YOU Bei-an; ZHANG Yun

    2008-01-01

    Background In China,transthoracic echocardiography(TTE)is popularly used for pre-intervention examination for atrial septal defect(ASD)and for guiding ASD closure.However,the ability to determine ASD size and the safety and efficacy of TTE for guiding ASD closure still has not been widely accepted This study aimed to evaluate the efficacy and safety of TTE used before,during and after transcatheter ASD closure with Amplatzer septal occluders(ASO).Methods Sixty-eight subjects(15 men and 53 women;mean age(33.7±17.3)years)were enrolled.TTE was used to measure the diameters and guide transcatheter closure of ASD.The ASD was examined by long-axis view,basal short-axis view,apical four-chamber view and the subcostal view to observe position.diameter and reIation with neighbouring structures.The largest diameter was selected as the reference diameter.Patients were divided into 3 groups according to the ASD reference diameter:22 subjects with ASD diameter 4-14 mm(group A):21 subjects with ASD diameter 15-20 mm(group B);and 25 subjects with ASD diameter 21-33 mm(group C).Results ASD was occluded successfully in groups A and B.In group C.occlusion failed in 2 cases;1 case remained with a 3-mm residual shunt sustained untiI 6-month follow-up.However,at 6-month follow-up,no case of thromboembolism,ASO dislocation or death occurred in the three groups.The diameter of ASD measured bv TTE could accurately predict the ASO size that could successfully occlude the ASD.especially in patients with ASD<20 mm.The ASD diameter measured by TTE correlated well with ASO size(r=0.925,P<0.001:r=0.976,P<0.001;r=0.929,P<0.001 respectively).Conclusions ASD diameter measured by TTE can accurately estimate the size of the ASO needed for successful closure of ASD.The larger the ASD,the much larger the ASo needed.TTE is a satisfactory guiding imaging tool for ASD closure.

  9. Transcatheter Closure of Atrial Septal Defect with Amplatzer Septal Occluder in Adults: Immediate, Short, and Intermediate-Term Results

    Directory of Open Access Journals (Sweden)

    Majid Dehghani

    2011-05-01

    Full Text Available Background: The transcatheter closure of the atrial septal defect (ASD has become an alternative technique to surgical procedures. The aim of this study was to assess the immediate, short, and intermediate-term results of the transcatheter closure of the secundum ASD with the Amplatzer Septal Occluder (ASO in adult Iranian patients.Methods: Between December 2004 and July 2008, the transcatheter closure of the ASD using the ASO was attempted in 58consecutive, adult patients. The mean age of the patients was 37.1 ± 12.7 years (range = 19 - 75 years.All the procedures were performed under local anesthesia with transthoracic or transesophageal echocardiography and fluoroscopic guidance. The stretched diameter of the ASD was determined with a balloon sizing catheter, and device selection was based on and matched to the stretched diameter of the septal defect.Transthoracic echocardiography was performed immediately after the release of the device and before discharge.Further follow-up at one month, six months, and yearly thereafter included physical examination, electrocardiography, andtransthoracic echocardiography.Results: The mean ASD diameter, as measured by esophageal echocardiography, was 24.8 ± 5.4 mm (range = 13 - 34 mm.The mean stretched diameter, as measured by the balloon catheter, was 27.1 ± 6.4 mm (range = 12.5 - 39 mm. Deploymentof the ASO was successful in 52 (89.6% patients and failed in 6 (10.4%. Four patients experienced severe complications,1 had tamponade requiring drainage, 2 had device embolization to the left atrium and right ventricular outflow tract, and 1 had late wire fracture (surgical removal and repair of the ASD. The position of two large devices (34 mm and 36 mm was considered unsuitable and unstable after implantation and resulted in the removal of these devices.Minor complications included transient complete atrioventricular block in 1 patient, paroxysmal supra tachycardia in 3 patients, atrial flutter in 1 patient

  10. The role of MRI for the evaluation of atrial septal defects before and after percutaneous occlusion with the Amplatzer Septal Occluder trademark

    International Nuclear Information System (INIS)

    Purpose: Evaluation of morphologic and functional MRI of atrial septal defects (ASD) before and after percutaneous occlusion with the Amplatzer Septal Occluder (AOC). Comparison of MRI with transesophageal echocardiography (TEE), balloon measurement (IVBM) and cardiac catheterization with shunt quantification (CCSQ). Materials and Methods: Twenty patients with ASD were examined before and three months after AOC implantation. ECG-triggered, breath-hold T1-weighted Turbo Spin Echo Segmented FLASH 2D and dynamic turbo-FLASH-GRE sequences after application of 0,2 mmol gadolinium DTPA per kg body weight were obtained in a 1.5 T MRI system. Defect size, and distance to coronal sinus (CS) and right upper pulmonary vein (RUPV) were determined for pre-interventional planning, and the AOC size was measured quantitatively for post-interventional follow-up. The shunts were evaluated qualitatively (occurrence of jets), semiquantitatively (jet length, turbulence square product) and quantitatively (flow measurement in the thoracic aorta and in the left and right pulmonary arteries). Results: The average size of the ASD measured by MRI was 17.6 mm (11-24.8 mm) in the axial view, 15.9 mm (10.8-28.9 mm) in the sagittal view and 16.4 mm (12.1-24.8 mm) in the short axis view. In comparison, the average defect size was 15 mm (8-24 mm) by TEE and 20 mm (13-27 mm) by IVBM. The average distance to the RUPV was 17 mm (9.6-21.9 mm) and to the CS 11.2 mm (5-17 mm). The AOC was visualized with only minimal artifacts. Qualitative analysis of the MRI findings revealed an occurence of jets in 17/20 patients. Semiquantitative analysis documented a high correlation for jet length and square product of the turbulence to defect size r=0.81 resp. r=0.82. Mean QP/QS-ratio measured by MR-volumetry was 1.6±0.29 and by MR-flow 1.6±0.26. The corresponding measurements were 1.7±0.3 for TEE and 1.5±0.5 for CCSQ. In comparison to TEE, the correlation coefficient was r=0.96 for MR-volumetry and r=0.85 for

  11. Atrial septal defects type II: noninvasive evaluation of patients before implantation of an amplatzer septal occluder and on follow-up by magnetic resonance imaging compared with TEE and invasive measurement

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate morphological and functional MRI of atrial septal defects (ASD) before and after interventional occlusion by the Amplatzer Septal Occluder (AOC) in comparison to trans-oesophageal echocardiography (TEE), invasive balloon measurement (IVBM) and cardiac catheterisation (QCC). Sixty patients with an ASD type II were enrolled. They underwent TEE, IVBM, QCC and MRI at 1.5T. Cine gradient echo, steady-state free precession sequences and a gradient echo phase contrast sequence were used. In MRI, pulmonary-to-systemic flow ratio (Qp/Qs) was calculated and compared with the QCC Qp/Qs ratio. Qp/Qs ratio in baseline MRI examination was 1.56 ± 0.29 (range: 1.05-2.2) and in QCC 1.71 ± 0.30 (range: 1.2-2.4) with a significant correlation (R = 0.65, P < 0.01). Defect size on MRI was 15.3 ± 7.4 mm (range: 3-30 mm), in TEE 14.3 ± 4.9 mm (range: 4-24 mm), and the balloon stretched diameter in IVBM was 23.4 ± 4.2 mm (range: 14-32 mm). Correlation between defect size in MRI vs. TEE was R = 0.67 (P < 0.01) and MRI vs. IVBM was R = 0.77 (P < 0.01). Right ventricular volumes decreased after intervention. MRI is an accurate noninvasive test for diagnosis, planning and follow-up after interventional ASD occlusion using an AOC. (orig.)

  12. Atrial septal defects type II: noninvasive evaluation of patients before implantation of an amplatzer septal occluder and on follow-up by magnetic resonance imaging compared with TEE and invasive measurement

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Christoph; Adam, Gerhard [University Medical Center Hamburg-Eppendorf, Diagnostic Center, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Weber, Michael; Ekinci, Okan; Neumann, Thomas; Deetjen, Anja; Rolf, Andreas; Hamm, Christian W.; Dill, Thorsten [Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim (Germany)

    2008-11-15

    The purpose of this study was to evaluate morphological and functional MRI of atrial septal defects (ASD) before and after interventional occlusion by the Amplatzer Septal Occluder (AOC) in comparison to trans-oesophageal echocardiography (TEE), invasive balloon measurement (IVBM) and cardiac catheterisation (QCC). Sixty patients with an ASD type II were enrolled. They underwent TEE, IVBM, QCC and MRI at 1.5T. Cine gradient echo, steady-state free precession sequences and a gradient echo phase contrast sequence were used. In MRI, pulmonary-to-systemic flow ratio (Qp/Qs) was calculated and compared with the QCC Qp/Qs ratio. Qp/Qs ratio in baseline MRI examination was 1.56 {+-} 0.29 (range: 1.05-2.2) and in QCC 1.71 {+-} 0.30 (range: 1.2-2.4) with a significant correlation (R = 0.65, P < 0.01). Defect size on MRI was 15.3 {+-} 7.4 mm (range: 3-30 mm), in TEE 14.3 {+-} 4.9 mm (range: 4-24 mm), and the balloon stretched diameter in IVBM was 23.4 {+-} 4.2 mm (range: 14-32 mm). Correlation between defect size in MRI vs. TEE was R = 0.67 (P < 0.01) and MRI vs. IVBM was R = 0.77 (P < 0.01). Right ventricular volumes decreased after intervention. MRI is an accurate noninvasive test for diagnosis, planning and follow-up after interventional ASD occlusion using an AOC. (orig.)

  13. Percutaneous ventricular septal defect closure with Amplatzer devices resulting in severe tricuspid regurgitation.

    Science.gov (United States)

    Matyal, Robina; Wang, Angela; Mahmood, Feroze

    2013-11-15

    While percutaneous intervention is an alternative for patients who are not surgical candidates, the rate of morbidity and mortality is comparable to open repair. Appending the reported complications associated with percutaneous intervention (device mal-positioning, dislodgement, and entrapment in the sub-valvular apparatus), we report mechanical damage to the tricuspid valve (TV). Percutaneous closure with an Amplatzer septal occluder device was attempted on three patients who developed a ventricular septal defects (VSD) after myocardial infarction. In all three cases, damage to the tricuspid leaflet was noted post-procedure. The accompanying severe tricuspid regurgitation led to right ventricular failure, even in the patients where the VSD was considered successfully occluded. Despite successful deployment of the Amplatzer device, complications with catheter manipulation may still arise. Damage to the TV can occur during percutaneous VSD closure with Amplatzer device. Periprocedure TEE monitoring can detect damage to the tricuspid leaflets. PMID:23553968

  14. Transcatheter closure with double Amplatzer septal occluder device in treatment of multiple atrial septal defects%双封堵器介入治疗多孔性房间隔缺损

    Institute of Scientific and Technical Information of China (English)

    孙鑫; 杨延坤; 郑宏; 徐争鸣; 徐仲英; 蒋世良; 赵世华; 张戈军; 吴文辉

    2013-01-01

    Objective To evaluate the clinical feasibility and effectiveness of transcatheter closure of multiple atrial septal defects (ASD) using double occluders.Methods Seventeen patients underwent transcatheter closure of multiple ASD (2 or 3) with double devices under X-ray fluoroscopy and TTE.Electrocardiogram,X-ray chest radiography as well as echocardigraphy were performed to evaluate the effectiveness after the procedure.Results All patients had multiple ASD (12 with 2 defects and 5 with 3 defects).TTE during the procedures showed that the mean diameters of the larger,medium and smaller defects was (13.94±3.21)mm,(9.65±2.64)mm and (4.80±1.92)mm,respectively.Tanscatheter closure of multiple ASD succeeded in 16 patiets (16/17,94.12 %),1 failed because the second defect was not suitable for intervention,and was cured by surgery,and totally 32 occluder devices were implanted and closed 37 defects.The mean diameters of the larger and the smaller occluders was (20.75 ± 4.07)mm and (16.94 ± 3.75)mm,respectively,larger than the value showed by TTE during procedures by (7.06±2.65)mm (larger defects) and (7.44±3.25)mm (medium defects).Immediately after the procedure,3 patients had trivial shunt (2 patients with 3 defects),which disappeared 2,3 days and 3 month later,respectively.No severe complication occurred,while femoral arteriovenous fistula was observed in 1 patient and disappeared 1 month later.The cardiothoracic ratio of X-ray chest radiography and the right ventricle internal diameter measured by echocardiography dropped during follow-up (all P<0.01).Conclusion Transcatheter closure of multiple ASD with double devices is feasible,safe and effective.%目的 对双封堵器介入治疗多孔性房间隔缺损(ASD)的可行性与有效性进行临床评估.方法 对17例多孔性ASD(12例为2孔,5例为3孔)患者在X线透视和超声心动图监测下植入Amplatzer封堵器,同时闭合2~3个缺损.术后复查ECG、X线平

  15. Treatment of patent ductus arteriosus by the use of an Amplatz canine ductal occluder device.

    Science.gov (United States)

    White, Pam

    2009-04-01

    A 7-month-old female, spayed border collie was referred to the Ontario Veterinary College due to a continuous murmur noted by the referring veterinarian prior to ovariohysterectomy. Auscultation confirmed a grade VI/VI continuous murmur. An echocardiogram confirmed patent ductus arteriosus (PDA). An Amplatz canine ductal occluder device was successfully placed for occlusion of blood flow though the ductus. PMID:19436449

  16. Amplatzer封堵器治疗儿童伴有假性室隔瘤的膜周部室间隔缺损%Transcatheter closure of aneurysm of perimembrane ventricular septal defect with Amplatzer duct occluder in children

    Institute of Scientific and Technical Information of China (English)

    唐礼江; 高伟; 方崇峰; 林仙方; 江建军; 刘志国

    2004-01-01

    我们应用Amplatzer不对称的膜周部室间隔缺损封堵器介入治疗伴有假性室隔瘤的膜周部室间隔缺损(Aneurysm of perimembrane ventricular septal defect)28例,现报告如下。

  17. Percutaneous Catheter Closure of Atrial Septal Defect and an Atrial Septal Aneurysm: One Case Report

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We describe a 56-yr-old female presented with palpitation and shortness of breath on exertion and intracardiac echocardiography showed atrial septal defect and an atrial septal aneurysm. She was underwent successfully percutaneous catheter closure with Amplatzer occluder devices.

  18. Simultaneous stent implantation for coarctation of the aorta and closure of patent ductus arteriosus using the Amplatzer duct occluder.

    Science.gov (United States)

    Hakim, F; Hawelleh, A A; Goussous, Y; Hijazi, Z M

    1999-05-01

    We report on a 13-year-old girl with coarctation of the aorta and patent ductus arteriosus who underwent successful simultaneous stent implantation for the coarctation and catheter closure of the ductus using an Amplatzer duct occluder. PMID:10385155

  19. Transcatheter Closure of Atrial Septal Defect with Amplatzer Device in Children and Adolescents: Short and Midterm Results; an Iranian Experience

    Directory of Open Access Journals (Sweden)

    Saiyed-Habibollah Hosseini

    2011-06-01

    Full Text Available Objective:Transcatheter closure of secundum atrial septal defect (ASD with Amplatzer device is an alternative procedure to surgical repair, with some limitations. The aim of this study was to assess the initial and mid-term results of the treatment of ASD with Amplatzer septal occluder in children and adolescents. Methods:From May 2003 to January 2008 sixty three consecutive children and adolescent patients underwent transcatheter closure of ASD at a mean±SD age of 8.5±4.8 years (range 2.2 to 18 years. All procedures were performed under local anesthesia and moderate sedation or general anesthesia with transthoracic echocardiography and fluoroscopic guidance. Stretch diameter of ASD was determined by balloon sizing catheter. Device selection was based on and matched to the standard diameter of the septal defect. Follow up at 24 hours, 1 month, 6 months, 12 months and yearly thereafter included physical examination, electrocardiography and transthoracic echocardiography. Findings:The mean ASD diameter, measured with transthoracic echocardiography and balloon catheter were 19.5± 5.5 mm and 20.9± 6.2 mm, respectively. The mean follow up period was 32.4±18.8 months. Deployment of the device was successful in 57 (90.5% and failed in 6 (9.5% patients. The major complication included dislodgement of device in 1 patient and device embolization to right ventricular inlet (surgically removed in 1 patient. The minor complication included transient atrial tachycardia in 10 patients, paroxysmal supraventricular tachycardia in 2 patients during procedure, successfully terminated with medication. At 24 hour, 1 month, 6 month and 1 year follow up, total occlusion rates were 73.6 %, 91%, 94.7%, and 94.7%, respectively. Conclusion:Transcatheter occlusion of ASD with Amplatzer device is an effective and safe procedure with minimal complication rate and short hospital stay, as well as excellent short and intermediate outcome in children and adolescents.

  20. Real-time-MR guidance for placement of a self-made fully MR-compatible atrial septal occluder: in vitro test

    International Nuclear Information System (INIS)

    Purpose: This in vitro study investigated the feasibility to visualize the placement of three different atrial septal occluder systems using real-time MR control. Methods: The experiments were performed on an interventional 1.5 T high field whole body system. Real-time MR imaging was achieved by radial or spiral k-space filling in conjunction with the sliding window reconstruction technique yielding an imaging speed of 15 frames per second. The CardioSeal, Ampaltzer Septal Occluder and a specially designed MR-compatible closure device were tested in a water bath. A punctured plastic wall served as model for the atrial septal defect. Results: The delivery systems of the CardioSeal and Amplatzer Occluder were ferromagnetic and caused substantial artifacts, making the device placement impossible, even if the magnetic forces would have been acceptable. The self-made prototype caused only minor susceptibility artifacts allowing its visualization on the MR images. The MR imaging techniques applied enabled real-time control of the occluder including steering through the artificial septal foramen and visualization of the occluder deployment. Conclusion: Real-time MR imaging allows for guidance and placement of an MR-compatible septal occluder in vitro suggesting the feasibility to perform atrial septal occlusion under MR-guidance in vivo as well. (orig.)

  1. Ventricular Septal Perforation after Biventricular Takotsubo Cardiomyopathy Successfully Repaired with an Amplatzer Device: First Report in the Literature

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    Alfredo E. Rodríguez

    2016-01-01

    Full Text Available A 79-year-old female was admitted with sudden onset dyspnea, mild oppressive chest pain, and severe anxiety disorder. Patient had history of hypertension, dyslipidemia, smoking, and chronic obstructive pulmonary disease. On admission blood pressure was 160/90 and heart rate was 130 bpm. Transthoracic echocardiography (TE and contrast tomography showed a thin septum with an abnormal left and right ventricular contraction with an “apical ballooning” pattern and mild increase of cardiac enzymes. At the 4th day of admission, the patient presented symptoms and signs of congestive heart failure and developed cardiogenic shock. EKG showed an inversion of T waves in all precordial leads. In a new TE, a ventricular septal perforation (VSP in the apical portion of the septum was seen. Coronary angiogram showed angiographically “normal” coronary arteries. With a diagnosis of VSP in takotsubo cardiomyopathy, a percutaneous procedure to repair the VSP was performed 11 days after admission. The VSP was closed with an Amplatzer device. TE performed 24 hours after showed significant improvement of ventricular function and good apposition of the Amplatzer device. Three days later she was discharged from the hospital. To our knowledge, this is the first reported case of a VSP in a TCM repaired percutaneously with an occluder device.

  2. The exploration of the closure of patent ductus arteriosus with Amplatzer occluder through single venous approach under ultrasound monitoring

    International Nuclear Information System (INIS)

    Objective: To explore the feasibility and effectiveness of transcatheter closure of patent ductus arteriosus (PDA) with Amplatzer occluder by using single venous approach method under ultrasound monitoring. Methods: During the period from May 2003 to April 2010, transcatheter closure of PDA were performed in 123 cases. Of the 123 patients, the procedure was accomplished by using arteriovenous dual approach method in 46 and by using single venous approach method in 77. All the procedures were monitored by ultrasound. The shape, size of PDA and immediate therapeutic results were checked with angiography in arteriovenous dual approach method or with ultrasonography in single venous approach method. The size of Amplatzer occluder was individually selected according to the smallest diameter of PDA. Echocardiography was performed at 3 days, one, 6 and 12 months after the procedure to evaluate the results. Results: Successful device placement with the initially selected occluder was obtained in 118 cases. In 4 cases the procedure was eventually completed after a bigger occluder was employed to replace the initial one, while in one case a smaller occluder had to use to replace the first one. The technical success rate was 100%. Conclusion: The transcatheter closure of PDA with Amplatzer occluder under ultrasound monitoring by single venous approach method is clinically effective and feasible. Being technically simple and time-saving, this single venous approach method is of great value in clinical practice. (authors)

  3. Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects

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    Pedra Carlos A.C.

    2003-01-01

    Full Text Available OBJECTIVE: To evaluate the initial clinical experience with the Helex septal occluder for percutaneous closure of atrial septal defects. METHODS: Ten patients underwent the procedure, 7 patients with ostium secundum atrial septal defects (ASD with hemodynamic repercussions and 3 patients with pervious foramen ovale (PFO and a history of stroke. Mean age was 33.8 years and mean weight was 55.4 kg. Mean diameter by transesophageal echocardiography and mean stretched ASD diameter were 11.33 ± 3.3mm, and 15.2 ± 3.8mm, respectively. The Qp/Qs ratio was 1.9 ± 0.3 in patients with ASD. RESULTS: Eleven occluders were placed because a patient with 2 holes needed 2 devices. It was necessary to retrieve and replace 4 devices in 3 patients. We observed immediate residual shunt (< 2mm in 4 patients with ASD, and in those with patent foramen ovale total occlusion of the defect occurred. No complications were noted, and all patients were discharged on the following day. After 1 month, 2 patients with ASD experienced trivial residual shunts (1mm. In 1 patient, we observed mild prolapse in the proximal disk in the right atrium, without consequences. CONCLUSION: The Helex septal occluder was safe and effective for occluding small to moderate atrial septal defects. Because the implantation technique is demanding, it requires specific training of the operator. Even so, small technical failures may occur in the beginning of the learning curve, but they do not involve patient safety.

  4. Closure of a short patent ductus arteriosus using an atrial septal occluder

    Institute of Scientific and Technical Information of China (English)

    Keyhan Sayadpour Zanjani

    2010-01-01

    @@ Patent ductus arteriosus (PDA) device closure was first attempted by Porstmann et al1 in 1967. Due to the rapid development in this field, it is the therapy of choice in current era. As most of PDAs have conical shape, Amplatzer PDA occluders were designed to fit into these ducts.

  5. Initial experience of occluding special type patent ductus arterioses using the Amplatzer vascular plug

    Institute of Scientific and Technical Information of China (English)

    ZHANG Po; ZHU Xian-yang; WANG Qi-guang; ZHANG Duan-zhen; HAN Xiu-min

    2013-01-01

    Background Occluders licensed for clinical use are not fit for some special Krichenko E patent ductus arterioses.The Amplatzer vascular plug I (AVP1) has not been licensed for use for closure of patent ductus arteriose.We report our initial experience to occluding special type patent ductus arterioses with the AVP1-a single lobe device of single layer Nitinol mesh for short vessel landing zones.Methods Patients referred with small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter underwent occlusion using AVP1.All cases underwent pre-,intra-and post-procedural echocardiography and chest X-ray at the completion of the procedure,the next day and at a 30-day,3-month and 6-month follow-up visits.Device sizing for device waist diameter and length was based on aortography.Results From April 2008 to June 2012,26 patients with a mean age of (7.6±8.0) years (range 6 months-32 years)and a mean weight of (23.8±14.8) kg (range 7-67 kg) underwent successful patent ductus arteriose closure.The mean ductus diameter was (2.1±0.7) mm (range 1-3 mm).Transpulmonary (22/26) and transaortic approaches (4/26) were used.No persistent patency was observed after 24 hours and after one month.No device displacement,residual flow and iatrogenic coarctation of the aorta were observed after three months and six months.Conclusions The AVP1 makes it easy to close some Krichenko E patent ductus arterioses.Smaller delivery catheter profile and symmetric cylindrical device shape allow for use for small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter and small patients through transaortic approaches.Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.

  6. The first clinical experience with the new GORE® septal occluder (GSO)

    DEFF Research Database (Denmark)

    Søndergaard, Lars; Loh, Poay Huan; Franzen, Olaf;

    2013-01-01

    Aims: A new GORE® septal occluder (GSO) was granted CE mark in Europe in June 2011 for the treatment of patent foramen ovale and atrial septal defect. Major changes have been made to the device and delivery system compared to the HELEX® device. The new delivery system has simplified the implantat......Aims: A new GORE® septal occluder (GSO) was granted CE mark in Europe in June 2011 for the treatment of patent foramen ovale and atrial septal defect. Major changes have been made to the device and delivery system compared to the HELEX® device. The new delivery system has simplified the...... of these patients had patent foramen ovale and one had secundum atrial septal defect. In all the cases, the GSO devices were successfully deployed in the first attempt without any complication. Only one patient had a minor residual shunt detected immediately after the device deployment. All the...

  7. Experiência inicial no fechamento percutâneo da comunicação interatrial com a prótese de Amplatzer Initial experience in percutaneous occlusion of atrial septal defects with the Amplatzer device

    Directory of Open Access Journals (Sweden)

    Valmir F. Fontes

    1998-03-01

    Full Text Available OBJETIVO: Analisar a experiência inicial no fechamento percutâneo da comunicação interatrial ostium secundum (CIA OS com a prótese de Amplatzer. MÉTODOS: Sete pacientes foram submetidos ao procedimento através da via venosa anterógrada, orientados pela ecocardiografia transesofágica (ETE e sob anestesia geral. Uma criança era portadora de 2 CIA e de canal arterial (CA. As CIA medidas pelo ETE variaram de 8,7 a 20mm. Um ecocardiograma transtorácico foi realizado na manhã seguinte do procedimento. RESULTADOS: Oito próteses foram implantadas nos 7 pacientes com sucesso. Em um paciente, o CA foi ocluído na mesma sessão com mola de Gianturco, tendo surgido taquicardia supraventricular durante a oclusão de uma das CIA, controlada com adenosina. Todos receberam alta hospitalar na manhã seguinte, com oclusão total dos defeitos. CONCLUSÃO: O procedimento mostrou-se seguro, eficaz e versátil, podendo ser considerado como uma alternativa terapêutica inicial em pacientes selecionados com CIA OS.PURPOSE: To evaluate our initial experience with percutaneous closure of secundum type atrial septal defects (ASD with the Amplatzer septal occluder. METHODS: Seven patients underwent occlusion by anterograde approach, under general anesthesia and transesophageal echocardiography (TEE guidance. One child had 2 ASD and a patent ductus arteriosus (PDA. The ASD size ranged from 8,7 to 20mm as measured by TEE. A transthoracic echocardiogram was performed in the morning after the procedure. RESULTS: Eight devices were successfully implanted in 7 patients and the PDA was occluded with a Gianturco coil at the same session. In this patient, there was an episode of supraventricular tachycardia during the occlusion of one ASD which was reverted with adenosin. All patients were discharged the day after, with complete occlusion of all defects. CONCLUSION: The procedure is safe, effective and versatile. It can be applied as an initial alternative to the

  8. Interventional Closure of Patent Foramen Ovale (PFO with Amplatzer PFO Occluder in Patients with Paradoxical Cerebral Embolism

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Haji Zeinali

    2006-08-01

    Full Text Available Background: Percutaneous transcatheter closure has been proposed as an alternative to surgical closure or long-term anticoagulation in patients with presumed paradoxical embolism and patent foramen ovale (PFO. Methods: There were two symptomatic patients (29 and 47 years old who underwent percutaneous transcatheter closure of PFO after at least two events of cerebral ischemia; one embolic event had occurred under anti-platelet therapy. For both patients, Amplatzer PFO occluder measuring 25 mm in diameter were used. In both cases, complete occlusion by color Doppler and transesophageal contrast echocardiography investigation was achieved after the procedure and lasted at least up to 3 months after implantation as determined by our follow up. Mean fluoroscopy time was 16.7 minutes. Results: Percutaneous transcatheter closure was technically successful in both patients (100%. No residual shunt was seen at the end of the procedure or in follow-ups. In-hospital follow-up was uneventful. At a mean follow-up of 3 months, no recurrent embolic neurological events were observed. Conclusion: Transcatheter closure of PFO with Amplatzer PFO occluder devices is a safe and effective therapy for patients with previous paradoxical embolism PFO. Percutaneous closure is associated with a high success rate, low incidence of hospital complications, and freedom of cerebral ischemic events.

  9. Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder

    Directory of Open Access Journals (Sweden)

    Er-Ping Xi

    2012-11-01

    Full Text Available OBJECTIVE: Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. METHODS: We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired, patient examinations revealed ventricular septal defects with pulmonary/systemic flow ratios (Qp/Qs of over 1.7. The post-traumatic ventricular septal defects were closed percutaneously with a patent ductus arteriosus occluder (Lifetech Scientific (Shenzhen Co., LTD, Guangdong, China utilizing standard techniques. RESULTS: Post-operative transthoracic echocardiography revealed no residual left-to-right shunt and indicated normal ventricular function. In addition, 320-slice computerized tomography showed that the occluder was well placed and exhibited normal morphology. CONCLUSION: Our experiences indicate that closure of a post-traumatic ventricular septal defect using a patent ductus arteriosus occluder is feasible, safe, and effective.

  10. Percutaneous closure of huge patent ductus arterious associated with anomalous inferior vein cava drainage and dextrocardia with muscular ventricular septal defect occluder

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Transcatheter occlusion of patent ductus arterious (PDA) using various occluders and coils has been a well-established method1-5 since Porstmann and colleagues6 reported the first case in 1967. However, when patients associated with anomalous inferior vein cava drainage or/and huge high pulmonary artery pressure ductus (HPAP-PDA), the method is not suitable. First, it is unfeasible to carry out the procedure via femoral vein. Second, in the presence of high pulmonary artery pressure such devices including the Amplatzer ductu occluder carry the risk of embolising into the aorta.7 The muscular ventricular septal defect occluder (MVSDO), which is a device for transcatheter closure of muscular ventricular septal defect, may be more suitable for using with HPAP-PDA as its double disk tends to anchor the device, preventing embolisation into the aorta. We present a patient, who is suffering from huge PDA associated with anomalous inferior vein cava drainage and dextrocardia, in whom percutaneous closure of PDA using MVSDO was successfully accomplished via transjugular approach.

  11. Low molecular weight heparin microcapsule coated occluder for atrial-septal defects

    Institute of Scientific and Technical Information of China (English)

    SUN Yong; WU Jian; ZHANG Ruo-xi; SHI Xiu-jie; LIU Hai-xia; ZHAO Yang; YU Bo

    2009-01-01

    Background Whether the low molecular weight heparin microcapsule coated occluder is helpful to endothelialization in atrial-septal defect models is uncertain. This study aimed to investigate the best conditions for low molecular weight heparin coated Nil-I alloy occluder and provide the evidence of the efficacy and safety of atrial-septal defect occluders in vivo.Methods Low molecular weight heparin microcapsules were investigated using gelatin as microcapsule material. The prepared low molecular weight heparin gelatin particles were subjected to nickel and titanium alloy occluder coating by sodium hyaluronate. A dog model of atrial septal defects was established after treatment with low molecular weight heparin microcapsule coated occluder (n=4) and uncoated occluder (n=4). Endotheliocytes and fibroblastic cells in occluders were observed. And the rate of endothelialization was detected.Results When the concentration of gelatin was 1%, the diameters of particles were mostly about 100 pm, and the particle size was uniform. The envelope efficiency of low molecular weight heparin microcapsule was about 80%. The endothelialization of occluder in the model was more obvious in the coated group than in the uncoated group (P <0.0001).Conclusions Low molecular weight heparin can be prepared into microcapsules with their particle size in nanometric grade. The antithrombotic properties are kept in the nickel and titanium alloy occluder successfully coated with sodium hyaluronate. The endothelialization after the interventional occlusion in the coated group is obvious, indicating that low molecular weight heparin is helpful to the growth of endothelial cells in the occlude and the healing after the interventional occlusion.

  12. Live/Real Time Three-Dimensional Trans Esophageal Echocardiographic Findings in Amplatzer ASD Closure Devices in Adults

    Directory of Open Access Journals (Sweden)

    Fatemeh Nabavizadeh

    2012-09-01

    Full Text Available Six female patients aged from 19 to 73 years, with ostium secundum atrial septal defect underwent closure procedure with Amplatzer septal occluder device. Three-dimensional Echocardiography (3D-TEE was done during the procedure or one day after the procedure. 3D-TEE provides incremental value over Two- dimensional trans-esophageal echocardiography in measuring Amplatzer septal occluder disc sizes and correlates well with manufacture device size. 3D-TEE will surely prove to increase the technical efficiency and it will become an important tool for the interventionists for periprocedural evaluation of device closures.

  13. Patent ductus arteriosus equipment and technique. Amplatzer duct occluder: intermediate-term follow-up and technical considerations.

    Science.gov (United States)

    Thanopoulos, B D; Hakim, F A; Hiari, A; Tsaousis, G S; Paphitis, C; Hijazi, Z M

    2001-04-01

    Between May 1997 and June 2000, 69 patients, ages 0.1 to 34 years, underwent attempted anterograde transcatheter closure of a patent ductus arteriosus (PDA) using the Amplatzer Duct Occluder (ADO). The ADO is a cone-shaped, self-centering, and repositionable occluder made of nitinol wire mesh. A 5Fr to 7Fr sheath was used for the delivery of the device. The mean PDA diameter (at the pulmonary end) was 4.6 +/- 1.9 mm (range 1 mm-8.5 mm). Sixty-seven of the 69 patients had successful device placement. The mean ADO smallest diameter was 6.9 +/- 1.8 mm (range 4 mm-12 mm). Complete angiographic closure occurred in 62 (92.5%) of 67 patients (95% confidence interval, 88.22%-98.77%). In five patients, there was a trivial residual shunt immediately after the procedure. At 24 hours, color Doppler flow imaging revealed complete closure in all 67 (100%) patients. The unsuccessful attempts occurred in two patients with a small, 1-mm diameter native PDA and residual PDA after surgical occlusion. Fluoroscopy time was 7.6 +/- 1.8 minutes (4 min-18 min). No complications were observed. At a median follow-up of 1.5 years (range 0.25 to 3.2 years), all patients had complete closure without complications. We conclude that transcatheter closure using the ADO is a highly effective and safe treatment for most patients with PDA. PMID:12053313

  14. Occlusion of atrial septal defect utilizing occluder devise via minimally invasive right chest approach

    Institute of Scientific and Technical Information of China (English)

    励峰; 李伟; 康宁; 龚宝生; 吴东进; 徐方杰; 邱兆昆; 吴卫华

    2011-01-01

    Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2 -3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe, less invasive, and has excellent outcomes.

  15. Application of Amplatzer vascular occluder in hepatic artery closure as a method of treatment of high-flow arterioportal fistula before liver transplantation

    International Nuclear Information System (INIS)

    Arterioportal fistula (APF) is an abnormal, direct connection between hepatic artery or its branch and the portal vein. Fistula can be acquired or, rarely, congenital. One of the acquired causes of fistula is a liver biopsy. Patients with liver cirrhosis are particularly vulnerable to its development due to the large number of performed biopsies. APF increases mortality and morbidity of liver transplantation procedure and may be a contraindication to it. The authors present a patient with liver cirrhosis, in whom percutaneous APF closure facilitated liver transplantation. We describe a case of a 50-year-old patient with liver cirrhosis and APF, probably formed as a result of liver biopsy. Due to the presence of a high-flow fistula, which elevated portal hypertension, patient did not qualify for the liver transplantation. Patient was transferred to the interventional radiology department, where the fistula’s vascular supply was endovascularly closed using the Amplatzer occluder. This subsequently enabled the execution of transplantation. Percutaneous closure of APF should be considered a relatively simple and fast-acting tool to facilitate or even enable liver transplant surgery. Currently, there are more and more products available such as e.g. Amplatzer occluder to simplify the procedure and shorten the duration of exposure to ionizing radiation

  16. Aortic iatrogenic perforation during transseptal puncture and successful occlusion with Amplatzer ductal occluder in a case of mitral paravalvular leak closure.

    Science.gov (United States)

    Mijangos-Vázquez, Roberto; García-Montes, José Antonio; Zabal-Cerdeira, Carlos

    2016-08-01

    Complications of transseptal puncture are significant and potentially life threatening. Aortic perforation is one of these complications and it needs to be repaired immediately. We report the case of a 48-year-old female with a history of rheumatic mitral valve disease. She underwent three previous mitral valve replacements. Her last echocardiogram reported an anterolateral leak in the mitral prosthesis. Catheterization was performed. During the procedure, when attempting to perform transseptal puncture, catheterization was complicated by a forcefully puncture of the aortic root by the Brockenbrough needle followed by an immediately advancement of an 8-Fr Mullins sheath. We decided to leave the 8-Fr sheath in the aortic root recognizing the danger of removing the sheath and finally we advanced a 6/4 mm Amplatzer ductal occluder (ADO I) through the Mullins sheath and under fluoroscopy and TEE guidance we achieved a successful deployment of the device and closure of the perforation. Subsequently, the paravalvular leak was closed with an Amplatzer Vascular Plug (AVP III 10/5 mm). There are only three cases of a similar technique for the same injury in which the authors describe successful closing of aortic perforation with percutaneous closure devices. Our case is the first described during a mitral paravalvular leak closure. It is also the first to describe a different technique of leaving the Mullins sheath in the aortic root and advancing the Amplatzer device through it to achieve successful closure of the aortic perforation. We preferred the percutaneous closure over open-heart repair. © 2015 Wiley Periodicals, Inc. PMID:26489701

  17. Safety and efficacy of nano lamellar TiN coatings on nitinol atrial septal defect occluders in vivo

    International Nuclear Information System (INIS)

    Atrial septal defect (ASD) occlusion devices made of nickel–titanium (NiTi) have a major shortcoming in that they release nickel into the body. We modified NiTi occluders using Arc Ion Plating technology. Nano lamellar titanium–nitrogen (TiN) coatings were formed on the surfaces of the occluders. The safety and efficacy of the modified NiTi occluders were evaluated in animal model. The results showed that 38 out of 39 rams (97%) survived at the end of the experiment. Fibrous capsules formed on the surfaces of the devices. Gradual endothelialization took place through the attachment of endothelial progenitor cells from the blood and the migration of endothelial cells from adjacent endocardium. The neo-endocardium formed more quickly in the coated group than in the uncoated group, as indicated by the evaluation of the six month study group. After TiN coating, there was no significant difference in endothelial cell cycle. TiN coating significantly reduced the release of nickel in both in vivo and in vitro indicating an improved biocompatibility of the nitinol ASD occluders. Superior and modified ASD occluders may provide a good choice for people with nickel allergies after sFDA registration, which is expected in one to two years. - Highlights: ► The nano lamella TiN coating did not change the shape-memory behavior and flexibility of the nitinol occluder. ► Nano lamella TiN coating modifications significantly reduced nickel release from nitinol ASD occluder. ► The new ASD occluder was found to be superior to nitinol ASD occluder with respect to both safety and efficacy

  18. Safety and efficacy of nano lamellar TiN coatings on nitinol atrial septal defect occluders in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Zhi xiong, E-mail: Top5460@163.com [Research Institute of Peking University in Shenzhen, Shenzhen 518057 (China); Fu, Bu fang, E-mail: fubnicpbp@163.com [National Institutes for Food and Drug Control, Beijing (China); Zhang, De yuan, E-mail: Deyuanzhangcn@yahoo.com.cn [Lifetech Scientific (Shenzhen) Co., Ltd., Shenzhen (China); Zhang, Zhi wei, E-mail: Zhzhx65@163.com [Guangdong Cardiovascular Institute, Guangzhou (China); Cheng, Yan, E-mail: chengyan@pku.edu.cn [Academy for Advanced Interdisciplinary Studies, Peking University, Beijing (China); Sheng, Li yuan, E-mail: lysheng@yeah.net [Research Institute of Peking University in Shenzhen, Shenzhen 518057 (China); Lai, Chen, E-mail: laichen1110@163.com [Research Institute of Peking University in Shenzhen, Shenzhen 518057 (China); Xi, Ting fei, E-mail: Xitingfie@pku.edu.cn [Research Institute of Peking University in Shenzhen, Shenzhen 518057 (China); Academy for Advanced Interdisciplinary Studies, Peking University, Beijing (China)

    2013-04-01

    Atrial septal defect (ASD) occlusion devices made of nickel–titanium (NiTi) have a major shortcoming in that they release nickel into the body. We modified NiTi occluders using Arc Ion Plating technology. Nano lamellar titanium–nitrogen (TiN) coatings were formed on the surfaces of the occluders. The safety and efficacy of the modified NiTi occluders were evaluated in animal model. The results showed that 38 out of 39 rams (97%) survived at the end of the experiment. Fibrous capsules formed on the surfaces of the devices. Gradual endothelialization took place through the attachment of endothelial progenitor cells from the blood and the migration of endothelial cells from adjacent endocardium. The neo-endocardium formed more quickly in the coated group than in the uncoated group, as indicated by the evaluation of the six month study group. After TiN coating, there was no significant difference in endothelial cell cycle. TiN coating significantly reduced the release of nickel in both in vivo and in vitro indicating an improved biocompatibility of the nitinol ASD occluders. Superior and modified ASD occluders may provide a good choice for people with nickel allergies after sFDA registration, which is expected in one to two years. - Highlights: ► The nano lamella TiN coating did not change the shape-memory behavior and flexibility of the nitinol occluder. ► Nano lamella TiN coating modifications significantly reduced nickel release from nitinol ASD occluder. ► The new ASD occluder was found to be superior to nitinol ASD occluder with respect to both safety and efficacy.

  19. Dexmedetomidine sedation for transesophageal echocardiography during percutaneous atrial septal defect closure in adult

    OpenAIRE

    Jung, Jae Wook; Cheol Go, Gwang; Jeon, Sang Yoon; Bang, Sira; LEE, Ki Hwa; Kim, Yong Han; Kim, Dong-Kie

    2013-01-01

    Atrial septal defect (ASD) is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography (TEE) is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine (DEX), which is a highly selective α2-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation.

  20. Dexmedetomidine sedation for transesophageal echocardiography during percutaneous atrial septal defect closure in adult.

    Science.gov (United States)

    Jung, Jae Wook; Cheol Go, Gwang; Jeon, Sang Yoon; Bang, Sira; Lee, Ki Hwa; Kim, Yong Han; Kim, Dong-Kie

    2013-11-01

    Atrial septal defect (ASD) is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography (TEE) is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine (DEX), which is a highly selective α2-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation. PMID:24550975

  1. Successful retrieval of a Figulla Occlutech septal occluder - embolized device stability and potential solutions

    Directory of Open Access Journals (Sweden)

    Masood Sadiq

    2016-01-01

    We report a case of an atrial septal defect where a Figulla Occlutech device embolized into the right ventricle. As this device has no left atrial hub, we brought the bare device into the inferior vena cava and used a novel two-snare technique to slenderize the device into the sheath. This report highlights additional tips in transcatheter device retrieval.

  2. Oclusão percutânea das comunicações interventriculares: experiência inicial Interventricular septal defects percutaneous occlusion: initial experiment

    Directory of Open Access Journals (Sweden)

    Francisco José Araújo Chamié de Queiróz

    2005-09-01

    Full Text Available OBJETIVO: Avaliar a experiência inicial com o fechamento percutâneo das comunicações interventriculares (CIV, em especial, das CIV perimembranosas (CIVPM com a nova prótese de Amplatzer. MÉTODOS: Foram submetidos ao procedimento onze pacientes, seis com CIV perimembranosas (CIVPM e cinco com CIV musculares (CIVM. Dois apresentavam infecções repetidas do trato respiratório e tinham baixo ganho ponderal. Um apresentou história prévia de endocardite infecciosa. Os demais eram assintomáticos e foram selecionados pela ecocardiografia transtorácica (ETT. RESULTADOS: No grupo das CIVM (n=5, um paciente tinha uma CIV apical, dois tinham defeitos médio-septais e dois pacientes apresentavam defeitos múltiplos. Neste grupo, foi utilizada uma prótese de comunicação interatrial (CIA (Amplatzer Septal Occluder® e cinco próteses para CIVM (Amplatzer VSD-MUSC Occluder®, sendo que uma mesma paciente recebeu dois dispositivos. Todos os implantes foram bem sucedidos e transcorreram sem complicações. No grupo das CIVPM (n=6, dois tinham aneurismas de septo membranoso. Em 5, identificamos dois pertuitos com angiografia seletiva. Utilizamos próteses de Amplatzer para canal arterial (PCA (Amplatzer Duct Occluder® em 1 paciente e próteses específicas para CIVPM nos demais (Amplatzer VSD-MEMB Occluder®. Um oclusor perimembranoso migrou imediatamente depois de liberado, sendo retirado da aorta descendente. Outro paciente apresentou bloqueio atrioventricular total (BAVT, que reverteu após corticoterapia. CONCLUSÃO: O procedimento é tecnicamente complexo e deve ser executado apenas em centros especializados. Apesar disso, mostrou-se seguro e eficaz nos casos selecionados, e pode ser oferecido como alternativa ao tratamento cirúrgico tradicional.OBJECTIVE: To assess the initial experiment with percutaneous closure of interventricular septal defects (IVSD, especially perimembranous IVSD (PMIVSD with the new Amplatzer prosthesis. METHODS

  3. Randomized clinical trial comparing percutaneous closure of patent foramen ovale (PFO using the Amplatzer PFO Occluder with medical treatment in patients with cryptogenic embolism (PC-Trial: rationale and design

    Directory of Open Access Journals (Sweden)

    Schuler Gerhard

    2011-02-01

    Full Text Available Abstract Background Several studies have shown an association of cryptogenic stroke and embolism with patent foramen ovale (PFO, but the question how to prevent further events in such patients is unresolved. Options include antithrombotic treatment with warfarin or antiplatelet agents or surgical or endovascular closure of the PFO. The PC-Trial was set up to compare endovascular closure and best medical treatment for prevention of recurrent events. Methods The PC-Trial is a randomized clinical trial comparing the efficacy of percutaneous closure of the PFO using the Amplatzer PFO occluder with best medical treatment in patients with cryptogenic embolism, i.e. mostly cryptogenic stroke. Warfarin for 6 months followed by antiplatelet agents is recommended as medical treatment. Randomization is stratified according to patients age ( Discussion patients were randomized in 29 centers of Europe, Canada, and Australia. Randomization started February 2000. Enrollment of 414 patients was completed in February 2009. All patients will be followed-up longitudinally. Follow-up is maintained until the last enrolled patient is beyond 2.5 years of follow-up (expected in 2011. Trial Registration Trial listed in ClinicalTrials.gov as NCT00166257 and sponsored by AGA Medical, Plymouth, MN, USA

  4. 经胸超声心动图指导下Amplatzer封堵成人房间隔缺损%Transthoracic echocardiographic guidance for closure of secun dum atrial septal defects with the Amplatzer septal occluder device in adults

    Institute of Scientific and Technical Information of China (English)

    张玉顺; 李寰; 张军; 贾国良; 代政学; 王小燕

    2002-01-01

    目的经胸超声心动图(TTE)指导下置人Amplatzer封堵器评价治疗成人继发孔型房间隔缺损(ASD)的可行性和治疗效果. 方法全组74例,年龄14~65 (33.6 ±14.4)岁. 按照术中超声检测的不同,分为TEE组:36例,在TEE和X线透视下监测封堵ASD;TTE组:38例,在T TE和X线透视下监测封堵ASD. 结果两组患者ASD的TTE测量值、BSD值、封堵器直径和透视时间之间等均无显著性差异(P>0.05). TTE组手术时间(64.4±13.6) min明显短于TEE 组的(76.1±16.8) min (P0.05). 随访1~3 mo,封堵器形态,位置良好,未对毗邻结构产生影响. 结论 TTE指导下经导管置入Amplatzer封堵器治疗ASD是一种安全、有效、简便可行的方法.

  5. 房间隔缺损封堵术后头痛与封堵器形态相关分析%Correlation analysis on headache accompanied by atrial septal defect occlusion and morphometric characteristics of occluder

    Institute of Scientific and Technical Information of China (English)

    王星烨; 成革胜; 杜亚娟; 张玉顺

    2013-01-01

    目的:研究房间隔缺损封堵术后头痛与封堵器形态之间的关系,以此探讨术后头痛的原因和机制.方法:继发孔型房间隔缺损患者183(男66,女117)例,年龄6~72(30.1±18.5)岁.经胸心动超声(transthoracic echocardiography,TTE)测量房间隔缺损最大直径为8~35(19.8±7.5) mm,选用的封堵器大小为10~44(25.9 ±8.9)mm.结果:术后3个月新出现头痛症状患者为16例,发生率为8.7%.头痛组房间隔缺损(atrial septal defect,ASD)缺损大小为(27.3 ±6.2)mm,无头痛组为(17.1±7.2) mm,头痛组缺损明显大于无头痛组(P<0.01).头痛组封堵器直径、超声测量封堵器的厚度均较无头痛组大(均P<0,01).封堵器直径与缺损大小的差值和封堵器直径与术后封堵器直径的差值头痛组亦明显大于无头痛组(P<0.05或P<0.01).多因素相关分析显示,头痛与封堵器厚度显著相关(P<0.01),而与年龄、缺损大小、封堵器直径等不相关.结论:封堵器厚度越厚,头痛症状发生率越高.头痛可能与封堵器表面内皮化不全或内皮化进程延长有关.%AIM:This study investigated the causes and mechanism for headache observed after atrial septal defect (ASD) occlusion by studying the correlation between headache and the geometric characteristics of the occluder.METHODS:One hundred eighty three patients (66 male,117 female) with secundum ASD were included with ages of 6-72 (30.1 ± 18.5) years.The maximum size of the defect was in the range of 8-35 mm (19.8-± 7.5) mm,measured by transthoracic echocardiography (TTE).Sizes of the occluders used were 10-44 mm (25.9 ± 8.9).RESULTS:Sixteen patients (8.7% of all patients) reported a postoperative headache after 3 months.The group with reported headache had significantly greater ASD defect sizes (27.3-± 6.2) mm compared with the defect sizes in the group without headache [(17.1 ±7.2) mm,P <0.01].In the group with headaches,both the diameter and thickness (measured by

  6. 生物可吸收室间隔缺损封堵器的体外降解和力学性能%In vitro degradation property and mechanical force test of a bioresorbable ventricular septal defect occluder

    Institute of Scientific and Technical Information of China (English)

    朱玉峰; 陈文瑶; 黄新苗; 白元; 吴弘; 张瑾; 秦永文; 赵仙先

    2013-01-01

    目的 设计和制作生物可吸收室间隔缺损(ventricular septal defect,VSD)封堵器,观察其体外降解特性并对其机械力学性能进行测试,为下一步经导管闭合VSD的动物实验打下基础.方法 采用可降解高分子聚合材料聚对二氧环己酮(polydioxanone,PDO)单丝、聚左旋乳酸(poly-L-lactic acid,PLA)无纺布和聚乙醇酸(polyglycolic acid,PGA)缝线制作生物可吸收VSD封堵器,在封堵器盘片上对称部位缝上金属钽颗粒为X线下显影标记,右侧盘片尾部设计一环形小襻供配套输送系统钳夹输送.体外测试可吸收VSD封堵器的相关力学性能,行体外降解试验,测定封堵器盘片支撑力和质量衰减情况.结果 可吸收VSD封堵器的机械力学性能包括压缩/弹性恢复性能、尾部环形襻极限拉力、左侧盘片支撑力皆满足经导管输送的封堵力学要求.体外降解实验显示,可吸收封堵器8周内结构和形状仍保持不变,12周时PDO丝出现断裂、崩解,盘片结构不完整.左侧盘片支撑力在体外降解2周和3周时支撑力比初始时增强(分别为初始支撑力的121.7%和107.8%),4周和6周时支撑力比初始时下降(分别降至88.6%和85.3%).封堵器质量最初4周下降不到1%,6周以后质量明显下降.结论 用生物可吸收材料制作的VSD封堵器满足经导管植入体内的生物力学要求,可进行下一步的动物实验研究.%Objective To design and prepare a ventricular septal defect (VSD) occluder with bioabsorbable materials and to evaluate its in vitro degradation and mechanical force.Methods A bioresorbable VSD occluder was made of polymeric materials polydioxanone (PDO) monofilament,poly-L-lactic acid (PLA) fabrics and polyglycolic acid(PGA) sutures.Tantalum particles were sewn on the symmetrical parts of the occluder disc as tracers for X-ray,and the end of the right side of the disc was designed with a circular loop for the matched delivery system to clamp and

  7. Hybrid management of a large atrial septal defect and a patent ductus arteriosus in an infant with chronic lung disease

    International Nuclear Information System (INIS)

    We report a case wherein a dysmorphic four-month-old infant (weighing 4.5 kgs) with an 8 mm atrial septal defect (ASD), a 1.5 mm patent ductus arteriosus (PDA), a 2 mm mid-muscular ventricular septal defect (VSD) associated with chronic lung disease, and severe pulmonary hypertension, was successfully managed using a hybrid approach, without the use of cardiopulmonary bypass (CPB). Through a median sternotomy, the PDA was ligated and the ASD was closed with a 9 mm Amplatzer septal occluder implanted through peratrial access. The VSD was left untouched. Serial echocardiograms showed complete closure of the ASD and PDA, with progressive normalization of the pulmonary artery (PA) pressures within three months. The child rapidly gained weight and was weaned from sildenafil and oxygen administration. After 12 months, the VSD closed spontaneously and the child remained well, with normal PA pressures. A hybrid approach without the use of CPB should be considered in the management of infants with congenital heart disease, associated with chronic lung disease and pulmonary hypertension

  8. Effect of domestic-made occluder device in the treatment of atrial septal defect with edge-insufficiency%国产封堵器治疗边缘不足的房间隔缺损的效果观察

    Institute of Scientific and Technical Information of China (English)

    龚明霞; 徐国林; 孙建辉; 刘亚平; 张晓膺; 成少飞

    2010-01-01

    Objective To evaluate the feasibility and effect of the domestic-made occluder device in blocking secundum atrial septal defect(ASD)with edge-insufficiency(<5 mm).Methods Twenty-seven patients with edge-insufficiency were measured by transthoracic and transesophageal color Doppler echocardiography preoperatively.and the most expanding defect diameter was(22.89±8.08)mm.According to the edge-insufficiency conditions,defects were divided into anterior edge-insufficiency(aortic edge),posterior edge-insufficiency(aortic contralateral edge),inferior edge-insufficiency(inferior vena cava edge)and complex type.Domestic-made occluder device was selected to adapt for corresponding type.The position of occluder device and shunt were observed by echocardiography at 48-72 hours and the 3rd month after operation.Meanwhile the size of right heart was measured.Results The anterior edge-insufficiency type was20 cases(0-4 mm),inferior edge-insufficiency type was 3 cases(1-4 mm),posterior edge-insufficiency type was 1 case(2 mm)and complex type was 3 cases(<5 mm).Devices were successfully deployed in 26patients.1 patient whose device exfohated 1 hour after operation accepted reoperation in euthyphoria.Successful rate was 96.3%(26/27).The size of right atrium and ventricle postoperation reduced significantly compared with peroperation(P< 0.01).There was no complication in all patients.Conclusions Secundum ASD with anterior,inferior and posterior edge-insufficiency(< 5 mm)can be occluded by domestic-made occluder device.It is safe,effective,with fewer complications and lower-cost.%目的 探讨使用国产封堵器治疗边缘不足(<5 mm)的继发孔型房间隔缺损(ASD)的可行性及近期疗效.方法 27例边缘不足的继发孔型ASD患者术前经胸或经食管超声心动图测得缺损最大直径平均为(22.89±8.08)mm,根据ASD边缘不足分为前缘(主动脉缘)不足型、后缘(主动脉对侧缘)不足型、下缘(下腔静脉缘)不足型及复合不足型,分

  9. Single Centre Experience for Percutaneous Closure of Secundum Atrial Septal Defect

    Directory of Open Access Journals (Sweden)

    Ramazan Aydemir

    2011-12-01

    Full Text Available Introduction: Atrial septal defect (ASD is the most common congenital heart disease in adults and constitutes 5-10% of all congenital heart disease. Primary surgical closure has been the standard approach for many years with high success rate. Transcatheter closure of ASD in selected patients has became the contemprorary practice that has the advantages of short hospital stay and relative ease of prosedure. In this article, we reported the results of percutaneous closure of ASD in our center.
Methods: Between 2009-2011, thirty-two patients (mean age 36±18 years and 24 females who had secundum type ASD which detected by transthoracic echocardiography (TTE and transesophageal echocardiography (TEE were included in this study. Twenty-nine (90,6% patients were closed percutaneously. Tree patients were referred for surgery because of failure of percutaneous closure. Amplatzer Septal Occluder was used in 25 (86,2% patients and Occlutech device was used in other patients. All procedures were performed under local anesthesia. All of the patients were examined with TTE before the procedure and, at the 1st, 3rd, 6th and 12th month follow-up visits.
Results: Pre-operative mean pulmonary artery pressure was 33,3±7,5 mmHg and mean pulmonary to systemic flow (Qp/Qs ratio was 2,9±1,1. Mean ASD diameter measured by TEE was 20,1±6,6 mm and mean streched diameter measured by balloon catheter was 22,1±5,9 mm. Mean device size 24±6 mm (range 12-36 mm. In the follow-up period no major complication was observed, but mild to moderate residual shunt flow was detected in two patients (% 6,8.
Conclusion: Percutaneous ASD closure has been performed with high success and low complication rates in patients with secundum atrial septal defect in our center.

  10. [Amplatzer® Vascular Plug III, for closing residual mitral paravalvular leak: three-dimensional transesophageal echocardiography image].

    Science.gov (United States)

    Reyes-Gómez, Carlos Alberto; García-Montes, José Antonio; Arias-Godínez, Antonio; Zabal-Cerdeira, Carlos

    2015-01-01

    Paravalvular leak is a significant complication after surgical valve replacement. Traditionally, redo surgery has been considered the treatment of choice, but is associated with high morbidity and mortality as well as increase risk of developing new leaks. Percutaneous treatment of paravalvular leak appears as an attractive alternative. Such treatment has been made possible by the current ability to integrate multiple imaging modalities that have helped to define the anatomy of the defect and planning and guiding the percutaneous closure procedure, thus resulting in better outcomes. The Amplatzer® Vascular Plug III (St. Jude Medical) is the first device specifically designed for percutaneous closure of paravalvular leak with promising results. We present the three-dimensional transesophageal echocardiographic images of a successful outcome of percutaneous closure of a residual mitral paravalvular leak with an Amplatzer® Vascular Plug III device (St. Jude Medical), after an initial procedure of percutaneous closure with an Amplatzer® duct occluder (St. Jude Medical). PMID:25912709

  11. Percutaneous Interventional Treatment of Atrial Septal Defect Secundum in Macedonia

    Directory of Open Access Journals (Sweden)

    Ivan Milev

    2014-03-01

    Conclusion: In conclusion, the implantation of a septal occluder was found to be a safe procedure that resulted in improved hemodynamic parameters that result from right ventricular volume overload with favorable short- and mid-term results.

  12. Transcatheter Closure of Atrial Septal Defects in a Center With Limited Resources: Outcomes and Short Term Follow-Up

    Directory of Open Access Journals (Sweden)

    Sukman T. Putra

    2015-12-01

    Full Text Available Background: Transcatheter closure of atrial septal defects (ASD has been accepted world-wide as an alternative to surgical closure with excellent results. This interventional, non-surgical technique plays an important role in the treatment of ASD mostly in the developing world where resources are limited. Objectives: To report the outcomes and short term follow-up of transcatheter closure of ASD over a 12-year period at our institution with limited resources. Patients and Methods: This retrospective study included all patients with the diagnosis of secundum ASD and significant shunting (Qp/Qs > 1.5:1 as well as dilated right atrium and right ventricle who had transcatheter closure at Integrated Cardiovascular Center (PJT, Dr. Cipto Mangunkusumo Hospital between October 2002 and October 2014. One hundred fifty-two patients enrolled in this study were candidates for device closure. Right and left heart cardiac catheterization was performed before the procedure. All patients underwent physical examination, ECG, chest X-ray and transthoracal echocardiography (TTE prior to device implantation. Results: A total of 152 patients with significant ASD underwent device implantation. Subjects’ age ranged from 0.63 to 69.6 years, with median 9.36 years and mean 16.30 years. They consisted of 33 (21.7% males and 119 (78.3% females, with mean body weight of 29.9 kg (range 8 to 75; SD 18.2. The device was successfully implanted in 150 patients where the majority of cases received the Amplatzer septal occluder (147/150; 98% and the others received the Heart Lifetech ASD occluder (3/150, 2%, whereas two other cases were not suitable for device closure and we decided for surgical closure. The mean ASD size was 19.75 (range 14 - 25 mm. During the procedure, 5 (4.9% patients had bradycardia and 3 (2.9% patients had supraventricular tachycardia (SVT, all of which resolved. Conclusions: In our center with limited facilities and manpower, transcatheter closure of

  13. Feasibility and safety of transthoracic echocardiography-guided transcatheter closure of atrial septal defects with deficient superior-anterior rims.

    Science.gov (United States)

    Li, Gui-Shuang; Li, Hai-De; Yang, Jie; Zhang, Wen-Quan; Hou, Zong-Shen; Li, Qing-Chen; Zhang, Yun

    2012-01-01

    Although previous studies showed that transthoracic echocardiography (TTE) can be used to guide transcatheter closure of atrial septal defect (ASD), whether TTE can be used to guide transcatheter closure of secundum ASD with a deficient superior-anterior rim is unknown and this critical issue was addressed in the present study. A total of 280 patients with secundum ASD who underwent transcatheter ASD closure were recruited and divided into groups A and B depending on ASD superior-anterior rim>4 mm (n = 118) or ≤4 mm (n = 162). TTE was used to guide Amplatzer-type septal occluder (ASO) positioning and assess residual shunt. Procedure success was defined as no, trivial and small residual shunt immediately after the procedure as assessed by color Doppler flow imaging. Group A and group B did not differ in complication rate (8.55% vs.7.55%), procedure success rate (98.3% vs. 95.0%) or complete closure rate immediately after the procedure (89.7% vs. 89.3%) or at 6-month follow-up (98.3% vs. 96.8%). The mean procedure and fluoroscopy time in group B were much longer than those in group A. In conclusion, the absence of a sufficient superior-anterior rim in patients undergoing percutaneous closure of secundum-type ASDs using fluoroscopic and TTE guidance is associated with slightly greater device malposition and migration as well as increased procedural and fluoroscopic times, but the overall complication rate did not differ with TTE guidance when compared to historical controls that used TEE guidance. PMID:23284660

  14. Feasibility and safety of transthoracic echocardiography-guided transcatheter closure of atrial septal defects with deficient superior-anterior rims.

    Directory of Open Access Journals (Sweden)

    Gui-Shuang Li

    Full Text Available Although previous studies showed that transthoracic echocardiography (TTE can be used to guide transcatheter closure of atrial septal defect (ASD, whether TTE can be used to guide transcatheter closure of secundum ASD with a deficient superior-anterior rim is unknown and this critical issue was addressed in the present study. A total of 280 patients with secundum ASD who underwent transcatheter ASD closure were recruited and divided into groups A and B depending on ASD superior-anterior rim>4 mm (n = 118 or ≤4 mm (n = 162. TTE was used to guide Amplatzer-type septal occluder (ASO positioning and assess residual shunt. Procedure success was defined as no, trivial and small residual shunt immediately after the procedure as assessed by color Doppler flow imaging. Group A and group B did not differ in complication rate (8.55% vs.7.55%, procedure success rate (98.3% vs. 95.0% or complete closure rate immediately after the procedure (89.7% vs. 89.3% or at 6-month follow-up (98.3% vs. 96.8%. The mean procedure and fluoroscopy time in group B were much longer than those in group A. In conclusion, the absence of a sufficient superior-anterior rim in patients undergoing percutaneous closure of secundum-type ASDs using fluoroscopic and TTE guidance is associated with slightly greater device malposition and migration as well as increased procedural and fluoroscopic times, but the overall complication rate did not differ with TTE guidance when compared to historical controls that used TEE guidance.

  15. Transient ST-segment-elevation during transcatheter closure of atrial septal defect(ASD) with ASD occluder made in China: A report of two cases%国产封堵器闭合房间隔缺损过程中的短暂ST段抬高2例

    Institute of Scientific and Technical Information of China (English)

    王显; 胡大一; 孙琪; 谭琛

    2008-01-01

    目的 国产房间隔封堵器闭合房间隔缺损的安全性和有效性已得到证实.我们报告在使用国产封堵器闭合房间隔缺损过程中出现的短暂ST段抬高现象2例.方法 适合进行经皮封堵术的房间隔缺损患者35例,使用北京华医圣杰公司生产的房间隔封堵器进行封堵.术前经胸超声充分评估缺损的大小、位置、与周围结构的距离以及房间隔的软硬边缘等,选择封堵器要与缺损的伸展直径相匹配.手术过程在局部麻醉或者基础麻醉下进行,术中使用经胸超声引导.封堵器释放后有效闭合缺损、位置稳定且不影响周边结构视为手术成功.术后3,6,12月进行随访.结果 在35例患者中有2例在封堵器释放过程中,出现短暂性ST段抬高超过2 mV,伴有心绞痛发作.心电图改变和症状发作平均持续时间(4.2±2.2)min,2例心电图改变均发生于Ⅱ,Ⅲ和aVF导联,此过程伴有心率减慢和血压降低.静脉注射硝酸甘油后心电图和症状没有得到即刻改善,但封堵器沿鞘管被收回后心电图立即改善、症状逐渐消失.换用较小型号的封堵器闭合房间隔缺损后,没有引起任何血流动力学异常和短暂性心电图改变.随访3,6,12月没有发现心肌缺血和心绞痛发作.结论 经导管闭合房间隔缺损过程中出现的短暂ST段抬高现象,可能与所选封堵器直径过大,刺激房间隔有关.%AIM The safety and efficacy of atrial septal defect (ASD) occluder(ASDO) made in China for transeatheter closure of ASD have investigated prospectively. We report the phenomenon of transient ST-segment-elevation(TSTE) during transcatheter closure of ASD with ASDO made in China in this single-centre study. METHODS A total of 35 consecutive patients in whom a septal defect occluder (Huayishengjie Inc. , Beijing, China) was used to close a clinically significant ASD were included in our study. All procedures performed under basic or local anaesthesia

  16. 先天性心脏病封堵器治疗随访过程中彩色多普勒超声的应用%Color Doppler ultrasound in the follow-up of occluder-treated congenital heart disease

    Institute of Scientific and Technical Information of China (English)

    张敏; 谷翔; 许向东; 王冰

    2011-01-01

    BACRGROUND: Currently, occluders, instead of traditional surgeries, are used for treatment of atrial septal defect, ventricular septal defect, patent ductus arteriosus due to congenital heart disease. As a result, color Doppler ultrasound is widely used in the follow-up of occlusion therapy.OBJECTIVE: To assess the value of color Doppler ultrasound in the follow-up of occluder-treated congenital heart disease.METHODS: The first author performed an electronic retrieve of Wanfang database for articles related to the follow-up of occluder-treated congenital heart disease published from January 1999 to December 2009. The keyword were "color ultrasound,congenital heart disease, atrial septal defect, ventricular septal defect, patent ductus arteriosus, occluder". Repetitive articles,reviews and Meta analysis were excluded, and finally 24 articles were included in the result analysis.RESULTS AND CONCLUSION: The appropriate occluder was chosen according to defect size and distance between the defect and the right coronary aortic valve measured based on echocardiography and left ventricular angiography. Selection of cases with appropriate indications by using color Doppler ultrasound was the key to successful occlusion. The Amplatzer occluder made of superelastic nickel-titanium memory alloy had a good biocompatibility and safety. During the follow-up of 35 years,patients receiving the implantation of the Amplatzer occluder showed no adverse effects, and the occluder position was fixed and did not shift. During the treatment of congenital heart disease with occluders, color Doppler ultrasound plays an important role in preoperative examination, intraoperative monitoring and postoperative follow-up.%背景:目前先天性心脏病(先心病)房间隔缺损、室间隔缺损、动脉导管未闭的封堵器治疗替代了传统的外科手术,彩色多普勒超声(彩超)在封堵治疗随访中得到广泛应用.目的:评价彩超在先心病封堵器治疗随访过程中

  17. Ventricular septal defect (image)

    Science.gov (United States)

    Ventricular septal defect is a congenital defect of the heart, that occurs as an abnormal opening in ... wall that separates the right and left ventricles. Ventricular septal defect may also be associated with other ...

  18. Live 3D image overlay for arterial duct closure with Amplatzer Duct Occluder II additional size.

    Science.gov (United States)

    Goreczny, Sebstian; Morgan, Gareth J; Dryzek, Pawel

    2016-03-01

    Despite several reports describing echocardiography for the guidance of ductal closure, two-dimensional angiography remains the mainstay imaging tool; three-dimensional rotational angiography has the potential to overcome some of the drawbacks of standard angiography, and reconstructed image overlay provides reliable guidance for device placement. We describe arterial duct closure solely from venous approach guided by live three-dimensional image overlay.

  19. Coronary anastomoses over intraluminal occluders

    OpenAIRE

    Stanford, William

    1980-01-01

    A simplified technique with the use of intraluminal vessel occluders to prevent collateral flow of blood and cardioplegic solution during saphenous vein distal coronary artery anastomosis is presented here. Additional advantages of this technique are the stenting of vessels to facilitate vessel approximation and the assurance of anastomotic patency.

  20. ANNOTATION SUPPORTED OCCLUDED OBJECT TRACKING

    Directory of Open Access Journals (Sweden)

    Devinder Kumar

    2012-08-01

    Full Text Available Tracking occluded objects at different depths has become as extremely important component of study for any video sequence having wide applications in object tracking, scene recognition, coding, editing the videos and mosaicking. The paper studies the ability of annotation to track the occluded object based on pyramids with variation in depth further establishing a threshold at which the ability of the system to track the occluded object fails. Image annotation is applied on 3 similar video sequences varying in depth. In the experiment, one bike occludes the other at a depth of 60cm, 80cm and 100cm respectively. Another experiment is performed on tracking humans with similar depth to authenticate the results. The paper also computes the frame by frame error incurred by the system, supported by detailed simulations. This system can be effectively used to analyze the error in motion tracking and further correcting the error leading to flawless tracking. This can be of great interest to computer scientists while designing surveillance systems etc.

  1. Successful device closure of a post-infarction ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Choi SW

    2016-07-01

    Full Text Available Si-Wan Choi,* Ji Hye Han,* Seon-Ah Jin, Mijoo Kim, Jae-Hwan Lee, Jin-Ok Jeong Division of Cardiology, Department of Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea *These authors contributed equally to this work Abstract: Ventricular septal defect (VSD is a lethal complication of myocardial infarction. The event occurs 2–8 days after an infarction and patients should undergo emergency surgical treatment. We report on successful device closure of post-infarction VSD. A previously healthy 66-year-old male was admitted with aggravated dyspnea. Echocardiography showed moderate left ventricular (LV systolic dysfunction with akinesia of the left anterior descending (LAD territory and muscular VSD size approximately 2 cm. Coronary angiography showed mid-LAD total occlusion without collaterals. Without percutaneous coronary intervention due to time delay, VSD repair was performed. However, a murmur was heard again and pulmonary edema was not controlled 3 days after the operation. Echocardiography showed remnant VSD, and medical treatment failed. Percutaneous treatment using a septal occluder device was decided on. After the procedure, heart failure was controlled and the patient was discharged without complications. This is the first report on device closure of post-infarction VSD in Korea. Keywords: heart septal defects, myocardial infarction, septal occluder device, ventricular septal defect

  2. Unexpected difficulty during transcatheter device closure of atrial septal defect associated with right aortic arch

    International Nuclear Information System (INIS)

    Right aortic arch (RAA) associated with isolated atrial septal defect (ASD) is very rare. We report successful closure of ASD associated with RAA using a 26-mm atrial septal occluder in a 30-year-old male patient. The impingement of right descending aorta in RAA caused malposition of the device in the left atrium. Deployment of the device through the right upper pulmonary vein successfully closed the defect. Follow-up evaluation by computerized tomography scan and echocardiogram showed no pulmonary venous obstruction

  3. Amplatzer PDA occluder used in adult patent ductus arteriosus with serious pulmonary hypertension after testing balloon occlusio

    Institute of Scientific and Technical Information of China (English)

    卢才义; 魏璇; 黄丛春; 罗惠兰; 谈维洁; 毛树森

    2002-01-01

    @@ A 36-years-old female had heart palpitation and chest press for five years and the symptoms had been worsening for half a year. She was diagnosed with patent ductus arteriosus with moderate pulmonary hypertension in a local hospital 5 years before but was not operated. Physical examination showed: T 37℃, P 87?bpm, R 18?bpm and BP 130/70?mm?Hg. There was no distension of the jugular vein, and the lungs were clear. There was continuous mechanic murmur at the second intercostal space, and grade 2 systolic blowing murmur at the apex. P2 was strengthened. The liver and spleen were not enlarged and there was no edema in either leg. ECG showed a pulmonary P wave and right ventricular hypertrophy. Chest X-ray film showed pulmonary segment projection 3?cm, and the dimension of the right inferior pulmonary artery bed increased to 3?cm in diameter. On echocardiography, both atria, the pulmonary artery and the right ventricle were enlarged.

  4. Transcatheter closure of atrial septal defect associated with arrhythmogenic right ventricular cardiomyopathy: a case report and literature review.

    Science.gov (United States)

    Wang, Haiyan; Ding, Hongyu; Lei, Lei; Zhang, Xiaohong; Gong, Yuling; Hou, Yinglong

    2015-03-01

    Arrhythmogenic right ventricular cardiomyopathy is characterised by progressive, fibrofatty replacement of myocardium, and ventricular arrhythmias, and its prognosis is usually poor. Arrhythmogenic right ventricular cardiomyopathy associated with atrial septal defect is very rare, and this combination may make the diagnosis, treatment, and prognosis difficult. We present a case of a patient with this association who underwent interventional treatment with a septal defect occluder. Transcatheter closure of atrial septal defect in a patient with arrhythmogenic right ventricular cardiomyopathy is hitherto unreported. During a 3-year follow-up he remained relatively stable. We also review the cases reported in the medical literature describing this uncommon association between arrhythmogenic right ventricular cardiomyopathy and atrial septal defect or patent foramen ovale.

  5. Use of Nasal Septal Bone for Septal Extension Graft after Jaw Surgery

    Directory of Open Access Journals (Sweden)

    Gui Rak Kim, MD

    2013-11-01

    Conclusions: Use of septal bone for septal extension graft may serve as a valuable option in septal cartilage–depleted patients. It gives a strong construct for tip surgery with patient satisfaction.

  6. A novel method of creation of a fenestration in nitinol occluder devices used in closure of hypertensive patent arterial ducts

    Directory of Open Access Journals (Sweden)

    Anil Kumar Singhi

    2016-01-01

    Full Text Available Test occlusion with a balloon is done to predict operability of large hypertensive patent ductus arteriosus (PDA. If the fall in the pulmonary artery pressures is inadequate, a complete closure is not desired. To create a predictable premeasured fenestration in a nitinol occluder device used for closing hypertensive PDA. A large nitinol occluder device was punctured with an 18G needle to advance a 0.035½ stiff guide wire through the occluder before loading it into the delivery system. The occluder with the guidewire was then deployed across the PDA. A coronary guide catheter was later threaded through the guidewire into the fabric of the device, which was still held by the delivery cable. A coronary stent was deployed across the fenestration in the occluder to keep it patent. An 8-year-old boy with Down syndrome and hypertensive PDA was hemodynamically assessed. Even though there was a fall in the pulmonary vascular resistance index and pressures on test occlusion, the pulmonary artery pressures were labile with fluctuations. A customized fenestration was made in a 16 mm muscular ventricular septal defect occluder (MVSO with a 4.5 mm bare-metal coronary stent. The pulmonary artery pressures remained at half of the aortic pressures after the procedure. This fenestration model precisely and predictably fenestrated a large occluder device used to close a hypertensive large PDA. Long-term patency of these fenestrations has to be assessed on the follow-up, and may be improved through larger fenestrations, systemic anticoagulation and use of covered stents.

  7. Atrial – Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    T Panagiotopoulos

    2009-05-01

    Full Text Available Atrial and ventricular septal defect constitute the most common congenital heart disease.Aim: Τhe aim of the present retrospective study was to record data and factors that affect atrial and ventricular septal defect.Method and material: The sample study included patients of both sexes who were hospitalized with diagnosis atrial and ventricular septal defect in a Cardiac Surgery hospital of Athens. A specially constructed printed form was used for data collection, where were recorded the demographic and personal variables, the pathological, surgical, cardiology and obstetric history, the habits of adults, as well as the personal characteristics of mothers. Analysis of data was performed by descriptive statistical analysis.Results: The sample study consisted of 101 individuals with diagnosis atrial or ventricular Septal Defect, of which 40% were boys and 60% girls. The 70% of the sample study suffered from atrial Septal Defect and the 30% suffered from ventricular Septal Defect. Regarding age, 12% of the sample study was 0-1 years old, 35% was >1 years old, 8% was >12-18 years old and 45% over than 18 years old. Regarding educational status of the adult participants, 9% was of 0-6 years education, 22%>6 -12 years, 13%>12 years. 14% of the adult paticipants smoked, 4% consumed alcohol and 5% smoked in conjunction with alcohol. In terms of the obstetric history of the sample studied, 32% of the cases had normal birth, 4% had a twin birth and 1% had a triplet one. According to the variables related to mothers, the mean age of the mother was 30 years and 3 months, 10% were smokers at pregnancy and 3% used chemical substance and mainly hair color. Also, the results of the present study showed that individuals of 12-18 and >18 years old did not suffer from ventricular Septal Defect, whereas the infants 0-1 years old did not suffer from Atrial Septal Defect. The mean value of age at the admission in intensive care unit was 7 months (12% for the infants

  8. A Complication following the Transcatheter Closure of a Muscular Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    Mustafa Karaçelik

    2015-12-01

    Full Text Available Today, congenital heart diseases may be treated without surgery through advances in interventional cardiology. However, complications such as infection and thrombus formation may develop due to foreign materials used during these procedures. Surgical intervention may be required for the removal of the device utilized for the procedure. In this case report, we present the surgical treatment of a residual ventricular septal defect (VSD that had developed in a 6-year-old patient with an apical muscular VSD closed with the Amplatzer muscular VSD device. The patient was admitted to the emergency room with complaints of abdominal pain and high fever 5 days after discharge without any cardiac symptoms. When she arrived at our clinic, she had a heart rate of 95 bpm, blood pressure of 110/70 mmHg, and temperature of 38.5ºC. Examinations of the other systems were normal, except for a 3/6 pan-systolic murmur at the mesocardiac focus on cardiac auscultation. Echocardiography showed a residual VSD, and the total pulmonary blood flow to the total systemic blood flow ratio (Qp/Qs of the residual VSD was 1.8. In the operating room, the Amplatzer device was removed easily with a blunt dissection. The VSD was closed with an autologous fresh pericardial patch. Following the pulmonary artery debanding procedure, the postoperative period was uneventful. The condition of the patient at the time of discharge and in the first postoperative month’s follow-up was good. There was no residual VSD or infection. 

  9. Alarm!!! A UFO inside the heart.

    Science.gov (United States)

    Santoro, Giuseppe; Castaldi, Biagio; Iacono, Carola; Giugno, Luca; Gaio, Gianpiero; Russo, Maria G

    2012-10-01

    An 8-year-old asymptomatic child was referred for surgical repair of coronary sinus atrial septal defect resulting in significant left-to-right shunt and right chamber volume overload. The septal fenestration was located near to its drainage site into the right atrium. Due to this seemingly favourable anatomy, transcatheter closure of the septal defect was performed using an Amplatzer Septal Occluder device. The echocardiographic postprocedural evaluation imaged the occluding device almost perpendicular to the atrial septum, seemingly floating above the mitral valve orifice, like an alien spaceship inside the heart. PMID:22955207

  10. Alarm!!! A UFO inside the heart.

    Science.gov (United States)

    Santoro, Giuseppe; Castaldi, Biagio; Iacono, Carola; Giugno, Luca; Gaio, Gianpiero; Russo, Maria G

    2012-10-01

    An 8-year-old asymptomatic child was referred for surgical repair of coronary sinus atrial septal defect resulting in significant left-to-right shunt and right chamber volume overload. The septal fenestration was located near to its drainage site into the right atrium. Due to this seemingly favourable anatomy, transcatheter closure of the septal defect was performed using an Amplatzer Septal Occluder device. The echocardiographic postprocedural evaluation imaged the occluding device almost perpendicular to the atrial septum, seemingly floating above the mitral valve orifice, like an alien spaceship inside the heart.

  11. Transcatheter closure of small ductus arteriosus with amplatzer vascular plug

    Directory of Open Access Journals (Sweden)

    Eunhyun Cho

    2013-09-01

    Full Text Available Purpose: The purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA by using an Amplatzer vascular plug (AVP.&lt;br&gt; Methods: We reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared.&lt;br&gt;Results: The mean age of the patients was 54.9±45.7 months old. The PDAs were of type C (n=5, type D (n=12 and type E (n=3. The mean pulmonary end diameter of the PDA was 1.7±0.6 mm, and the aortic end diameter was 3.6±1.4 mm. The mean length was 7.3±1.8 mm. We used 3 types of AVP devices: AVP I (n=5, AVP II (n=7, and AVP IV (n=8. The ratio of AVP size to the pulmonary end diameter was 3.37±1.64, and AVP size/aortic end ratio was 1.72±0.97. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P =0.002. The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter (1.10±0.31, P =0.032. &lt;br&gt;Conclusion: Transcatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.

  12. Alveolar septal pulmonary amyloidosis: a case report

    International Nuclear Information System (INIS)

    Primary pulmonary amyloidosis is a rare diesase, and is classified as either tracheobronchial or parenchymal; the latter is also divided into nodular and diffuse alveolar septal forms. The alveolar septal form is extremely rare and usually produces reticular and nodular opacities. We describe a case of alveolar septal pulmonary amyloidosis manifested as multiple small nodules on chest radiograph and disseminated micronodules mainly in centrilobular and subpleural location without reticular opacities, on HRCT

  13. Graph-based matching of occluded hand gestures

    OpenAIRE

    Shamaie, Atid; Sutherland, Alistair

    2001-01-01

    Occlusion is an unavoidable subject in most machine vision areas. Recognition of partially-occluded hand gestures is an important problem. In this paper a new algorithm is proposed for the recognition of occluded and non-occluded hand gestures based on matching the Graphs of gestures in an eigenspace

  14. The Twin Amplatz Sheath Method: A Modified Technique of Percutaneous Cystolithotripsy for Large Bladder Stones in Female Patients

    Science.gov (United States)

    Kumar, Amit; Dalela, Deepansh; Dalela, Divakar; Goel, Apul; Paul, Sagorika; Sankhwar, Satya N.

    2013-01-01

    To minimize the operative time and to avoid open cystolithotomy in women with large bladder stone (>5 cm), we present here a modification of percutaneous cystolithotomy, a well-described standard procedure for urinary bladder stones. With this technique, suprapubic percutaneous access was achieved under cystoscopic guidance. The suprapubic tract was dilated and an Amplatz sheath of 30 Fr was placed. Simultaneously, the urethra was sequentially dilated with fascial dilators and a 28 Fr Amplatz sheath was guided into the bladder and the foot end of the table lowered to 20° to facilitate high-speed outflow of irrigant and stone particles. A 26.5 Fr nephroscope was passed through the suprapubic Amplatz sheath and the stone was fragmented by intracorporeal pneumatic device keeping the stone close to the proximal end of the urethral Amplatz. These maneuvers help in washing out stone fragments periurethrally and keeping the endoscopic vision clear while breaking the stone. PMID:24741433

  15. Nasal Septal Deviation and Facial Skeletal Asymmetries.

    Science.gov (United States)

    Hartman, Christopher; Holton, Nathan; Miller, Steven; Yokley, Todd; Marshall, Steven; Srinivasan, Sreedevi; Southard, Thomas

    2016-03-01

    During ontogeny, the nasal septum exerts a morphogenetic influence on the surrounding facial skeleton. While the influence of the septum is well established in long snouted animal models, its role in human facial growth is less clear. If the septum is a facial growth center in humans, we would predict that deviated septal growth would be associated with facial skeletal asymmetries. Using computed tomographic (CT) scans of n = 55 adult subjects, the purpose of this study was to test whether there is a correlation between septal deviation and facial asymmetries using three-dimensional (3D) geometric morphometric techniques. We calculated deviation as a percentage of septal volume relative to the volume of a modeled non-deviated septum. We then recorded skeletal landmarks representing the nasal, palatal, and lateral facial regions. Landmark data were superimposed using Procrustes analysis. First, we examined the correlation between nasal septal deviation and the overall magnitude of asymmetry. Next, we assessed whether there was a relationship between nasal septal deviation and more localized aspects of asymmetry using multivariate regression analysis. Our results indicate that while there was no correlation between septal deviation and the overall magnitude of asymmetry, septal deviation was associated with asymmetry primarily in the nasal floor and the palatal region. Septal deviation was unassociated with asymmetries in the lateral facial skeleton. Though we did not test the causal relationship between nasal septal deviation and facial asymmetry, our results suggest that the nasal septum may have an influence on patterns of adult facial form. PMID:26677010

  16. Photodynamic therapy for occluded biliary metal stents

    Science.gov (United States)

    Roche, Joseph V. E.; Krasner, Neville; Sturgess, R.

    1999-02-01

    In this abstract we describe the use of photodynamic therapy (PDT) to recanalize occluded biliary metal stents. In patients with jaundice secondary to obstructed metal stents PDT was carried out 72 hours after the administration of m THPC. Red laser light at 652 nm was delivered endoscopically at an energy intensity of 50 J/cm. A week later endoscopic retrograde cholangiogram showed complete recanalization of the metal stent.

  17. Amplatzer vascular plug as an embolic agent in different vascular pathologies: A pictorial essay

    Science.gov (United States)

    Tresley, Jonathan; Bhatia, Shivank; Kably, Issam; Poozhikunnath Mohan, Prasoon; Salsamendi, Jason; Narayanan, Govindarajan

    2016-01-01

    The Amplatzer Vascular Plug (AVP) is a cylindrical plug made of self-expanding nitinol wire mesh with precise delivery control, which can be used for a variety of vascular pathologies. An AVP is an ideal vascular occlusion device particularly in high-flow vessels, where there is high risk of migration and systemic embolization with traditional occlusion devices. We performed 28 embolizations using the AVP from 2009 to 2014 and achieved complete occlusion without complications.

  18. Balloon dilation versus Amplatz dilation during ultrasound-guided percutaneous nephrolithotomy for staghorn stones

    Institute of Scientific and Technical Information of China (English)

    Ren Minghua; Zhang Cheng; Fu Weijun; Fu Yiming; Ma Li; Zhao Weiming; Xu Wanhai

    2014-01-01

    Background Amplatz dilation and balloon dilation are different methods in creating the accesses during percutaneous nephrolithotomy (PCNL).The aim of this study was to review the surgical experiences of managing staghorn calculi by Amplatz dilation and balloon dilation for 3 years.Methods We retrospectively analyzed clinical data from 125 patients (129 kidneys)with staghorn kidney stones who underwent PCNL from January 2010 to December 2012,of whom 60 patients underwent Amplatz dilation (AD group) and 65 underwent balloon dilation (BD group) during PCNL.Results The AD and BD groups were similar in age,male-female ratio,stone burden,stone type,hydronephrosis,and proportion of patients who had undergone extracorporeal lithotripsy.However,these two groups showed significant differences in terms of duration of percutaneous access (15.1±3.6) minutes vs.(10.0±3.3) minutes,one-attempt success rate of dilation via a single access 88.9% (72/81) vs.97.8% (91/93),hemoglobin drop after surgery (3.5±0.9) g/dl vs.(1.7±0.9) g/dl,number of cases requiring intraoperative and postoperative blood transfusion 27.9% (n=17) vs.13.2% (n=9),changes of central venous pressure before and after surgery (2.3±1.2) cmH2O vs.(1.2±0.7) cmH2O,number of patients who experienced postoperative fever >37.5℃ 21 (34.4%) vs.13 (19.1%) (all P <0.05).No injury of adjacent organs,including pleura,liver,spleen,or bowel,was noted in patients.Conclusions During ultrasound-guided PCNL for staghorn stones,balloon dilation and Amplatz dilation are all effective and safe.Compared with Amplatz dilation,balloon dilation is a better choice,as it has a higher access creation success rate,shorter access creation time less blood loss,and lower proportions of circulatory overload and postoperative fever.

  19. Application of Amplatzer vascular occluder in hepatic artery closure as a method of treatment of high-flow arterioportal fistula before liver transplantation

    OpenAIRE

    Poncyljusz, Wojciech; Pauli, Wojciech

    2012-01-01

    Summary Background: Arterioportal fistula (APF) is an abnormal, direct connection between hepatic artery or its branch and the portal vein. Fistula can be acquired or, rarely, congenital. One of the acquired causes of fistula is a liver biopsy. Patients with liver cirrhosis are particularly vulnerable to its development due to the large number of performed biopsies. APF increases mortality and morbidity of liver transplantation procedure and may be a contraindication to it. The authors presen...

  20. Combining rhinoplasty with septal perforation repair.

    Science.gov (United States)

    Foda, Hossam M T; Magdy, Emad A

    2006-11-01

    A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair. PMID:17131270

  1. Transposition of the great arteries, atrial septal defect and ventricular septal defect

    OpenAIRE

    Camilleri, Ramona

    2013-01-01

    Three-day-old baby girl, transferred to NPICU because of low saturations and a development of a murmur. Following a number of rigourous test and the appropriate investigations, she was diagnosed with Transposition of the Great Arteries (TGA), a large Atrial Septal Defect, and a malaligned Ventricular Septal Defect. She was then transferred to Great Ormond Street Hospital (GOSH) for corrective surgey.

  2. Amplatzer vascular plug IV for occlusion of pulmonary arteriovenous malformations in a patient with cryptogenic stroke

    Directory of Open Access Journals (Sweden)

    Surendranath R Veeram Reddy

    2014-01-01

    Full Text Available Paradoxical embolism resulting in cryptogenic stroke has received much attention recently, with the primary focus on patent foramen ovale (PFO. However, it is essential to be vigilant in the search for other causes of paradoxical embolic events, such as pulmonary arteriovenous malformations (PAVM. We describe successful closure of pulmonary AVM with a St Jude Medical (Plymouth, MN Amplatzer TM vascular plug IV. The newer AVP-IV devices can be used for successful embolization of tortuous pulmonary AVM in remote locations where use of other traditional devices may be technically challenging.

  3. RE: Endovascular Treatment of Congenital Intrahepatic Portosystemic Shunts with Amplatzer Plugs

    Energy Technology Data Exchange (ETDEWEB)

    Sierre, Sergio; Alonso, Jose; Lipsich, Jose [Hospital Nacional de Pediatria ' JP Garrahan' , Combate de los Pozos, Buenos (Argentina)

    2012-01-15

    In our paper entitled 'Endovascular treatment of congenital portal vein fistulas with the Amplatzer occlusion device' published in the Journal of Vascular and Interventional Radiology in 2004, we already reported the use of the AVP in the treatment of an intrahepatic portosystemic venous shunt. This situation does not undervalue the quality of the reported case, but for didactic purposes, we believe it is important to state that the work of Dr. Lee confirms, as was previously reported, that these devices are useful and safe for these rare situations.

  4. Transhepatic Preoperative Portal Vein Embolization Using the Amplatzer Vascular Plug: Report of Four Cases

    International Nuclear Information System (INIS)

    The Amplatzer Vascular Plug (AVP) is a device originally intended for arterial and venous embolization in peripheral vessels. From December 2004 to March 2007 we implanted a total of 8 AVPs in the portal venous system in our institution for preoperative portal vein embolization in 4 patients (55-71 years) prior to right hemihepatectomy. AVP implantation was successful in all patients. Total occlusion of the embolized portal vein branches was achieved in all patients. There were no major complications associated with the embolization

  5. [Asymptomatic myxoma of the tricuspid valve septal leaflet].

    Science.gov (United States)

    Jedliński, Ireneusz; Jamrozek-Jedlińska, Maria; Bugajski, Paweł; Kalawski, Ryszard; Poprawski, Kajetan; Słomczyński, Marek

    2012-01-01

    We presented a case of asymptomatic myxoma of the tricuspid valve septal leaflet. The tumour was diagnosed accidentally during rutine transthoracic echocardiography and confirmed by transesophageal echocardiography. It was resected and the septal leaflet repaired during surgery.

  6. Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

    DEFF Research Database (Denmark)

    Jensen, Morten K; Prinz, Christian; Horstkotte, Dieter;

    2013-01-01

    The infarction induced by alcohol septal ablation (ASA) may predispose to arrhythmia and sudden cardiac death (SCD).......The infarction induced by alcohol septal ablation (ASA) may predispose to arrhythmia and sudden cardiac death (SCD)....

  7. Amplatzer occlusion of paravalvular leak of mitral mechanical prosthesis following a reoperation for thrombosed mitral mechanical prosthesis

    OpenAIRE

    Nikolic, Aleksandar; Schranz, Ditmaer; HRISTOV, Nikola; Mitrev, Zan

    2008-01-01

    We describe a case of a 46-year-old woman with dehiscence and paravalvular leak of a second-time replaced mitral mechanical prosthesis, successfully treated with Amplatzer occlusion of the paravalvular leak, thus avoiding a second reoperation and improving the patient’s symptoms.

  8. Endovascular treatment of a ruptured pulmonary artery aneurysm in a patient with Behcet's disease using the amplatzer vascular plug 4

    International Nuclear Information System (INIS)

    A pulmonary artery aneurysm is a common manifestation and the leading cause of mortality in Behcet's disease. We describe a case of spontaneous rupture of a pulmonary artery aneurysm that, due to the inadequacy of medical therapy and the disadvantages of surgery, became the ideal candidate for endovascular management and was successfully performed by using the Amplatzer Vascular Plug 4.

  9. QUANTIFICATION OF RIGHT VENTRICULAR FUNCTION IN ATRIAL SEPTAL DEFECT USING ULTRASOUND-BASED STRAIN RATE IMAGING

    Institute of Scientific and Technical Information of China (English)

    MENG Xiang-chun; SUN Kun; ZHANG Yu-qi; HUANG Mei-rong; GAO Wei; ZHANG Zhi-fang; SHEN Rong; CHEN Shu-bao

    2005-01-01

    Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular (RV) function in atrial septal defect (ASD). Methods Tissue Doppler images (TDI) of RV longitudinal and short axes were recorded from the apical 4-chamber view and the subcostal short-axis view in 18 normal controls, 28 children with ASD and 14 children after Amplazter closure of ASD respectively. Peak systolic velocities (V), peak systolic strain rates (SR), peak systolic strains (S) at the basal segment, middle segment of RV lateral wall and the basal septum from the longitudinal axis, the middle segment of RV free wall from the short axis were quantitatively measured using QLAB TM tissue velocity quantification software system respectively. Peak dp/dt from the RV isovolumic contraction determined during the right cardiac catheterization in 28 ASD patients was used as the gold standard of RV contractility. Peak systolic indices were compared against max dp/dt by linear correlation. Results Peak systolic indices at the basal and middle segments of RV lateral wall from the longitudinal axis increased significantly in 28 ASD patients.Peak systolic indices at the basal septum also increased in patient group, but not significantly. Significant decreases in peak systolic indices at the basal and middle segments of RV lateral wall were observed after the Amplatzer closure in 14 ASD patients. There was no significant difference at the middle segment of RV free wall from the short axis between patient group and normal control. A strong correlation was found between max dp/dt and peak systolic indices at the basal and middle segments of RV lateral wall (P<0.05). Conclusion Ultrasound-based strain rate imaging can assess quantitatively RV function in CHD. Peak systolic strains determined at the basal and middle segments of RV lateral wall are strong noninvasive indices of RV contractility.

  10. Endovascular treatment of pulmonary sequestration in adults using Amplatzer® vascular plugs.

    Science.gov (United States)

    Leoncini, Giacomo; Rossi, Umberto G; Ferro, Carlo; Chessa, Leonardo

    2011-01-01

    Two adult patients were diagnosed with extralobar and intralobar pulmonary sequestration. One patient presented with haemoptysis. Both patients suffered from recurrent episodes of severe pulmonary infections. Both patients were treated by means of endovascular embolization using Amplatzer(®) vascular plugs (AVPs). They were discharged from hospital after 48 and 24 h and then followed up for 24 and six months, respectively. No recurrence of symptoms was observed. Computed tomography scans were obtained every six months. Persistent occlusion of vascular supply and moderate regression of the sequestered lung tissue are evident after 24 and six months in both patients. Just one case of an adult patient affected by pulmonary sequestration and treated by endovascular embolization has been reported to date. The present report is the first on the use of the AVPs in adults for this condition. The potential advantages and drawbacks of this treatment modality in adults are discussed, as well the specific benefit represented by the AVPs.

  11. Hemostatic completion of percutaneous nephrolithotomy using electrocauterization and a clear amplatz renal sheath

    Directory of Open Access Journals (Sweden)

    Ho Song Yu

    2016-02-01

    Full Text Available ABSTRACT Background and Purpose A tubeless PCNL can reduce postoperative pain, the need for analgesics, hospital stay, and postoperative urinary leakage. However, perioperative or delayed bleeding remains the primary postoperative concern. We demonstrate a simple and cost-effective method to develop a clear nephrostomy tract after completion of a tubeless PCNL. Materials and Methods Four consecutive patients with renal calculi >3cm underwent a tubeless PCNL. We used a 24 Fr nephroscope and a 24 Fr transurethral resectoscope. Intraoperative urologist-directed percutaneous renal access was performed under fluoroscopy. After calculi removal, active bleeders were identified via a clear Amplatz renal sheath. The sheath provided excellent visualization of the nephrostomy tract for the detection of bleeders and surrounding structures. Bleeders were electrocauterized using a roller barrel electrode. During extraction of the renal sheath, the surgeon can confirm hemostasis in the tract and apply intermittent suction. Results Bleeding primarily originated from the torn calyeceal mucosa and the parenchyma. Tract electrocauterization was successful. All patients had mild hematuria, which resolved within two days. The average hemoglobin decrease was 1.65g/dL (0.8-2.1 and no patients required a transfusion. No perioperative complications occurred. On postoperative day 2, the patients could ambulate without a Foley catheter. During three months of follow-up, delayed bleeding or percutaneous urine leakage did not occur. Conclusions Electrocauterization with a roller barrel electrode and a clear Amplatz renal sheath is an effective method to obtain hemostasis after completion of a PCNL. Our technique is cost-effective and readily adapted without the need for additional instruments.

  12. A Taxonomy of 3D Occluded Objects Recognition Techniques

    Science.gov (United States)

    Soleimanizadeh, Shiva; Mohamad, Dzulkifli; Saba, Tanzila; Al-ghamdi, Jarallah Saleh

    2016-03-01

    The overall performances of object recognition techniques under different condition (e.g., occlusion, viewpoint, and illumination) have been improved significantly in recent years. New applications and hardware are shifted towards digital photography, and digital media. This faces an increase in Internet usage requiring object recognition for certain applications; particularly occulded objects. However occlusion is still an issue unhandled, interlacing the relations between extracted feature points through image, research is going on to develop efficient techniques and easy to use algorithms that would help users to source images; this need to overcome problems and issues regarding occlusion. The aim of this research is to review recognition occluded objects algorithms and figure out their pros and cons to solve the occlusion problem features, which are extracted from occluded object to distinguish objects from other co-existing objects by determining the new techniques, which could differentiate the occluded fragment and sections inside an image.

  13. Could early septal involvement in the remodeling process be related to the advance hypertensive heart disease?

    Directory of Open Access Journals (Sweden)

    Fatih Yalçin

    2015-06-01

    Conclusions: LV diastolic dysfunction becomes more severe in septal wall than lateral wall in hypertensive LVH. Septal myocardial performance is more dominantly affected by hypertension possibly due to earlier septal involvement in disease course. Septal MPI is correlated moderately with septal wall thickness.

  14. Perventricular device closure of residual muscular ventricular septal defects after repair of complex congenital heart defects in pediatric patients.

    Science.gov (United States)

    Zhu, Da; Tao, Kaiyu; An, Qi; Luo, Shuhua; Gan, Changping; Lin, Ke

    2013-01-01

    Residual muscular ventricular septal defects are surgical challenges, especially after the repair of complex congenital heart defects. We investigated perventricular device closure as a salvage technique in pediatric patients who had postoperative residual muscular ventricular septal defects. From February 2009 through June 2011, 14 pediatric patients at our hospital had residual muscular ventricular septal defects after undergoing surgical repair of complex congenital heart defects. Ten patients met our criteria for perventricular device closure of the residual defects: significant left-to-right shunting (Qp/Qs >1.5) or substantial hemodynamic instability (a defect ≥2 mm in size). The patients' mean age was 20.4 ± 13.5 months, and their mean body weight was 10 ± 3.1 kg. The median diameter of the residual defects was 4.2 mm (range, 2.5-5.1 mm). We deployed a total of 11 SQFDQ-II Muscular VSD Occluders (Shanghai Shape Memory Alloy Co., Ltd.; Shanghai, China) in the 10 patients, in accord with conventional techniques of perventricular device closure. The mean procedural duration was 31.1 ±9.1 min. We recorded the closure and complication rates perioperatively and during a 12-month follow-up period. Complete closure was achieved in 8 patients; 2 patients had persistent trivial residual shunts. No deaths, conduction block, device embolism, or other complications occurred throughout the study period. We conclude that perventricular device closure is a safe, effective salvage treatment for postoperative residual muscular ventricular septal defects in pediatric patients. Long-term studies with larger cohorts might further confirm this method's feasibility.

  15. Left Septal Fascicular Block: Myth Or Reality?

    OpenAIRE

    MacAlpin, Rex N.

    2003-01-01

    Anatomic studies have shown that the left bundle branch divides into three fascicles in most humans. Changes in the 12 lead ECG (electrocardiogram) due to conduction abnormalities of the left anterior fascicle and left posterior fascicle are now part of the standard repertoire of electrocardiographic interpretation. There are no standard criteria for detecting conduction defects involving the third left fascicle, the septal or median fascicle, and the very existence of such defects is still a...

  16. Asymmetric septal hypertrophy and hypothyroidism in children.

    OpenAIRE

    Altman, D I; Murray, J.; Milner, S.; Dansky, R; Levin, S. E.

    1985-01-01

    Any echocardiographic study of two children with hypothyroidism demonstrated the presence of asymmetric septal hypertrophy. One child died aged 11 months, and pronounced thickening of the interventricular septum was confirmed at necropsy. There was also hypertrophy of the left ventricular free wall. Histological examination showed only slight muscle fibre disarray, but there was striking vacuolation and hypertrophy of muscle fibres. In the second case, a child aged five years, the asymmetric ...

  17. Prenatal diagnosis of fetal aortopulmonary septal defect with ventricular septal defect by two-dimension echocardiography

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Fetal aortopulmonary septal defect (APSD) is an extremely rare condition, accounting for 0.1%-0.2% of all cardiac defects in live births world wide.1 Hospital mortality is 13% and 33% for simple and complex APSD, respectively.2 This rare cardiac defect refers to a congenital malformation in the development of the arteriosus truncus septum, and is usually associated with a wide variety of other structural cardiac anomalies such as ventricular septal defect (VSD), pulmonary valve stegnosis and so on.3 Prenatal diagnosis of an APSD is possible by echocardiography.

  18. Application of occluders in endovascular repair of aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    SHI Zhen-yu; FU Wei-guo; WANG Yu-qi; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; XU Xin; YANG Jue; ZHU Ting

    2007-01-01

    @@ Since Parodi et al1 reported the first successful case of endovascular treatment for abdominal aortic aneurysm (AAA) in 1991, the endovascular repair has become an important option for the surgical treatment of aortic aneurysms.2-4 The occluder is a newly-developed device introduced intraluminally to block the blood flow in certain arteries.

  19. Oclusão percutânea do apêndice atrial esquerdo com o Amplatzer Cardiac PlugTM na fibrilação atrial Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Márcio José Montenegro

    2012-02-01

    , anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation. Objective: To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation. Methods: We report our initial experience with Amplatzer Cardiac PlugTM (St. Jude Medical Inc., Saint Paul, Estados Unidos in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months. Results: In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up. Conclusion: Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.

  20. Muscular ventricular septal defects: A reappraisal of the anatomy

    NARCIS (Netherlands)

    Wenink, A.C.G.; Oppenheimer-Dekker, A.; Moulaert, A.J.

    1979-01-01

    Among 79 autopsy specimens of hearts with an isolated ventricular septal defect, there were 29 cases of muscular defect. Among 60 hearts with complete transposition of the great arteries and a ventricular septal defect, there were 13 cases with a muscular defect. All muscular defects could be classi

  1. Thrombosis and prevention after transcatheter occlusion of atrial septal defect%房间隔缺损介入封堵术后血栓形成及其防治

    Institute of Scientific and Technical Information of China (English)

    刘倩

    2012-01-01

    目前,介入治疗已逐渐取代外科开胸手术成为房间隔缺损首选的治疗方法.但各种类型封堵器植入均有血栓形成报道,并引起脑栓塞、心肌梗死、肺栓塞等严重并发症.封堵器相关血栓形成主要与心房颤动、房间隔膨胀瘤、封堵器类型、凝血功能激活、封堵器内皮化过程等密切相关.该文总结了封堵器血栓形成的相关因素及目前房间隔缺损介入术后各种血栓预防方案,为介入封堵术后血栓防治提供理论基础及实验依据.%Transcatheter closure as an alternative to medical surgery has become a preferred therapeutic method to atrial septal defect (ASD).However,thrombopoiesis after occluder implantation has been reported comprehensively and causes a series of serious complications such as cerebral embolism、myocardial infarction,pulmonary embolism and so on.Reasons of device thrombopoiesis are closely associated with atrial fibrillation,persistent atrial septal aneurysm,occluder type,activated coagulation system and occluder endothelialization process.This paper summarizes correlation factors of occluder thrombopoiesis and current related prevention proposal after transcatheter closure of ASD,and provides theoretical and experimental foundation for prevenition of device thrombopoiesis after occluder implantation of ASD.

  2. Recognition of 3-D Scene with Partially Occluded Objects

    Science.gov (United States)

    Lu, Siwei; Wong, Andrew K. C...

    1987-03-01

    This paper presents a robot vision system which is capable of recognizing objects in a 3-D scene and interpreting their spatial relation even though some objects in the scene may be partially occluded by other objects. An algorithm is developed to transform the geometric information from the range data into an attributed hypergraph representation (AHR). A hypergraph monomorphism algorithm is then used to compare the AHR of objects in the scene with a set of complete AHR's of prototypes. The capability of identifying connected components and interpreting various types of edges in the 3-D scene enables us to distinguish objects which are partially blocking each other in the scene. Using structural information stored in the primitive area graph, a heuristic hypergraph monomorphism algorithm provides an effective way for recognizing, locating, and interpreting partially occluded objects in the range image.

  3. Tratamiento endovascular de una fuga paraprotésica mitral con dispositivo Amplatzer®

    Directory of Open Access Journals (Sweden)

    Alberto Sciegata

    2012-10-01

    Full Text Available El leak o fuga paraprotésica mitral se presenta entre el 5 y el 17% de los pacientes tratados con cirugía de reemplazo valvular. En general, los defectos son únicos, la mayoría se encuentran localizados en la región postero-medial del anillo valvular y solo la tercera parte produce reflujo de grado grave. El cierre percutáneo por vía endovascular es una alternativa terapéutica válida en pacientes con elevado riesgo para re-operación. La estrategia de abordaje depende de la localización, tamaño, morfología y relaciones adyacentes del o los defectos. El procedimiento debe ser realizado por profesionales con experiencia en el tratamiento de cardiopatías estructurales y en el manejo de estos dispositivos de cierre, y se considera imprescindible la utilización de un ecocardiograma transesofágico tridimensional. Se presenta el caso de un paciente con una fuga paraprotésica valvular mitral que fue cerrada con un dispositivo Amplatzer ® introducido en forma percutánea desde la vena femoral.

  4. Drainage systems, an occluded source of sanitation related outbreaks

    OpenAIRE

    Blom, Kristina

    2015-01-01

    Background Drainage systems and its role in sanitation related outbreaks are evident but still occluded once it has been installed. This current review evaluates if drainage systems can cause infections and thus be of clinical concern. Method A review of the literature was analyzed. Papers, guidelines, and quality management systems have been considered. Results Adequate sanitation is fundamental and a prerequisite for safe life and productivity. In contrast, malfunctioning sanitation has bee...

  5. Transesophageal echocardiographic guidance for percutaneous closure of aortic pseudoaneurysm using a type II Amplatzer vascular plug: a case report

    Science.gov (United States)

    Lee, Sangmin Maria; Sung, Kiick; Kang, I-Seok; Min, Jeong Jin; Kim, Eunhee; Park, Jiyeon; Park, Jin Hyoung

    2016-01-01

    Aortic pseudoaneurysm after cardiac surgery is a rare entity, but it is potentially fatal due to its clinical course along with higher morbidity and mortality rates. Instead of open surgical repair, percutaneous procedures have been introduced as other options for managing an aortic pseudoaneurysm. In this case report, we describe transesophageal echocardiography guidance for successful percutaneous closure of an aortic pseudoaneurysm located in the left ventricular outflow tract by using a type II Amplatzer vascular plug in a patient in whom open surgical repair was not recommended. PMID:27482320

  6. Cierre de fístula coronaria con Amplatzer vascular plug en el paciente pediátrico

    OpenAIRE

    Ricardo Gamboa; Francisco P. Mollón; Ríos Méndez,Raúl E; Gutiérrez,Diego F

    2008-01-01

    La fístula coronaria congénita es una patología poco frecuente y en general asintomática, por lo que muchas veces se diagnostica por un hallazgo incidental. Con dependencia de la repercusión hemodinámica, algunos siguen una conducta conservadora, otros indican tratamiento quirúrgico o, más recientemente, oclusión por cateterismo.Se presenta el caso de una paciente con una gran fístula coronaria-cameral, que se trató mediante embolización percutánea con dispositivo Amplatzer vascular plug. No ...

  7. Atrioventricular septal defects among infants in Europe

    DEFF Research Database (Denmark)

    Christensen, Nikolas; Andersen, Helle; Garne, Ester;

    2013-01-01

    had heterotaxia sequence, and 23 had a monogenic syndrome. The total prevalence of chromosomal cases was 3.1 per 10,000 (95% confidence interval 1.9 to 4.3), with a large variation between registers. Of the 993 cases, 639 cases were live births, 45 were stillbirths, and 309 were terminations...... of pregnancy owing to foetal anomaly. Among the groups, additional associated cardiac anomalies were most frequent in heterotaxia cases (38%) and least frequent in chromosomal cases (8%). Coarctation of the aorta was the most common associated cardiac defect. The 1-week survival rate for live births was 94...... and a chromosomal anomaly. Clinical outcomes for atrioventricular septal defects varied between regions. The proportion of termination of pregnancy for foetal anomaly was higher for cases with multiple anomalies, chromosomal anomalies, and heterotaxia sequence....

  8. Use of the Amplatzer Type 2 Plug for Flow Redirection in Failing Autogenous Hemodialysis Fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Bozkurt, Alper, E-mail: bozkurtalper@yahoo.com; Kırbaş, İsmail, E-mail: drismailk@yahoo.com [Turgut Ozal University Hospital, Radiology Department (Turkey); Kasapoglu, Benan, E-mail: benankasapoglu@hotmail.com [Turgut Ozal University Hospital, Internal Medicine Department (Turkey); Teber, Mehmet Akif, E-mail: drteberma@hotmail.com [Ataturk Education and Training Hospital, Radiology Department (Turkey)

    2015-08-15

    PurposeTo present our experience with redirecting the outflow of mature arteriovenous fistulae (AVFs) in patients with cannulation and/or suboptimal flow problems by percutaneous intervention using the Amplatzer Vascular Plug II (AVP II).MethodsWe retrospectively reviewed patients who presented with difficulty in cannulation and/or suboptimal flow in the puncture zone of the AVF and who underwent intervention using the AVP II to redirect the outflow through a better cannulation zone from March 2009 to November 2012. The mean survival rate of all AVFs was estimated, and the effects of patient age, sex, and AVF age on the AVF survival time were determined.ResultsIn total, 31 patients (17 male and 14 female) with a mean age of 57.8 years (range, 20–79 years) were included. In 2 patients, the AVF failed within the first 15 days because of rapid thrombosis. In 9 patients, the new AVF route was working effectively until unsalvageable thrombosis developed. One of the 31 patients died 9 months before the last radiologic evaluation. The new AVF route was still being used for dialysis in the remaining 19 patients. The mean AVF survival rate was 1,061.4 ± 139.4 days (range, 788–1,334 days). Patient age, sex, and AVF age did not affect the survival time.ConclusionWe suggest that the AVP II is useful for redirecting the outflow of AVFs with cannulation problems and suboptimal flow. Patency of existing AVFs may be extended, thereby extending surgery-free or catheter intervention-free survival period.

  9. Use of the Amplatzer Type 2 Plug for Flow Redirection in Failing Autogenous Hemodialysis Fistulae

    International Nuclear Information System (INIS)

    PurposeTo present our experience with redirecting the outflow of mature arteriovenous fistulae (AVFs) in patients with cannulation and/or suboptimal flow problems by percutaneous intervention using the Amplatzer Vascular Plug II (AVP II).MethodsWe retrospectively reviewed patients who presented with difficulty in cannulation and/or suboptimal flow in the puncture zone of the AVF and who underwent intervention using the AVP II to redirect the outflow through a better cannulation zone from March 2009 to November 2012. The mean survival rate of all AVFs was estimated, and the effects of patient age, sex, and AVF age on the AVF survival time were determined.ResultsIn total, 31 patients (17 male and 14 female) with a mean age of 57.8 years (range, 20–79 years) were included. In 2 patients, the AVF failed within the first 15 days because of rapid thrombosis. In 9 patients, the new AVF route was working effectively until unsalvageable thrombosis developed. One of the 31 patients died 9 months before the last radiologic evaluation. The new AVF route was still being used for dialysis in the remaining 19 patients. The mean AVF survival rate was 1,061.4 ± 139.4 days (range, 788–1,334 days). Patient age, sex, and AVF age did not affect the survival time.ConclusionWe suggest that the AVP II is useful for redirecting the outflow of AVFs with cannulation problems and suboptimal flow. Patency of existing AVFs may be extended, thereby extending surgery-free or catheter intervention-free survival period

  10. Subintimal Recanalization of Occluded Stents: The Substent Technique

    Energy Technology Data Exchange (ETDEWEB)

    Diamantopoulos, Athanasios, E-mail: adiamant@upatras.gr; Katsanos, Konstantinos; Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [School of Medicine, Patras University Hospital, Department of Interventional Radiology (Greece)

    2013-08-01

    PurposeApplication of metal stents is complicated by neointimal hyperplasia leading to vessel restenosis and reocclusion. Treatment options in cases presenting with complete occlusion of the stented segment and recurrent critical limb ischemia (CLI) are limited. We present the option of the subintimal/substent technique in dealing with occluded stents.MethodsThe study included patients presenting with recurrent CLI due to impaired blood flow as a result of complete occlusion of previously inserted metal stents and unsuccessful intraluminal crossing of the lesion via either the antegrade or retrograde approach. In these cases, crossing the occlusion through the subintimal/substent plane was attempted. Primary end points included technical success, safety of the procedure, clinical improvement, and limb salvage, while secondary end points were patient survival, primary patency, and vessel restenosis rates at 1-year follow-up. Study end points were calculated by Kaplan-Meier survival analysis.ResultsBetween July 2006 and October 2011, a total of 14 patients (mean age 69.14 {+-} 12.59 years, 12 men) were treated with the substent technique and included in the analysis. Technical success rate was 85.71 % (12 of 14), with a total lesion length of 193.57 {+-} 90.78 mm. The mean occluded stented segment length was 90.21 {+-} 44.34 mm. In 10 (83.33 %) of 12 cases, a new stent had to be placed by the side of the old occluded one, while the remaining two cases (16.67 %) were treated only with balloon angioplasty. No serious adverse events were noted during the immediate postprocedural period. All successfully treated patients improved clinically. Estimated limb salvage was 90.9 %, and patient survival rate was 90.0 % at 1 year's follow-up. Primary patency was 45.50 % and vessel restenosis 77.30 %.ConclusionSubintimal recanalization of occluded metal stents through the substent plane is a valuable alternative treatment option, especially in patients with recurrent CLI

  11. Septal Myectomy Surgery to Treat Obstructive Hypertrophic Cardiomyopathy (HCM)

    Medline Plus

    Full Text Available Septal Myectomy Surgery to Treat Obstructive Hypertrophic Cardiomyopathy (HCM) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2016 BroadcastMed, Inc. All ...

  12. Intra-cardiac echocardiography in alcohol septal ablation

    DEFF Research Database (Denmark)

    Cooper, Robert M; Shahzad, Adeel; Newton, James;

    2015-01-01

    Alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy reduces left ventricular outflow tract gradients. A third of patients do not respond; inaccurate localisation of the iatrogenic infarct can be responsible. Transthoracic echocardiography (TTE) using myocardial contrast can...

  13. Importance of Nasal Septal Deviation Type on Planning of Surgery

    Directory of Open Access Journals (Sweden)

    Imran Aydogdu

    2015-11-01

    Full Text Available Aim: Aim of study is to evaluate effectiveness of pre operative data and classification of septal deviation in planning of surgical intervention. Material and Method: 60 patients who were operated because of septal deviation were included to study. 30 patients were applied open technique and other 30 were applied closed technique septoplasty. Types of septal deviations in both groups were classified according to Baumann’s classification peri operatively. Data obtained from both groups were compared by Mann Whitney U test. Results: Type 4 and 3 were the most common deformities seen in open technique group, whereas type 1 and 5 were the most common deformities in closed technique group. We detected significant difference between deviation types clustered between 2 techniques. Discussion: Pre operative assesment of septal deviation type helps surgeon to choose surgical technique.

  14. Septal Myectomy Surgery to Treat Obstructive Hypertrophic Cardiomyopathy (HCM)

    Medline Plus

    Full Text Available Septal Myectomy Surgery to Treat Obstructive Hypertrophic Cardiomyopathy (HCM) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2016 BroadcastMed, Inc. All rights reserved.

  15. Septal Myectomy Surgery to Treat Obstructive Hypertrophic Cardiomyopathy (HCM)

    Science.gov (United States)

    Septal Myectomy Surgery to Treat Obstructive Hypertrophic Cardiomyopathy (HCM) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2016 BroadcastMed, Inc. All rights reserved.

  16. Mammoth interatrial septal aneurysm in the ICE age

    OpenAIRE

    Timperley John; Bhindi Ravinay; Ormerod Oliver J

    2007-01-01

    Abstract Background Intracardiac echocardiography (ICE) is a useful imaging modality that is now being used more widely to assist in the percutaneous closure of atrial septal defects (ASD) and patent foramen ovales (PFO). Case presentation A 42 year old lady with a history of transient ischaemic attacks and migraine underwent percutaneous closure of an ASD. Intraprocedural ICE demonstrated a mammoth billowing multiperforated interatrial septal aneurysm in association with a secondum ASD. Conc...

  17. Zero net flux estimates of septal extracellular glucose levels and the effects of glucose on septal extracellular GABA levels

    OpenAIRE

    Krebs-Kraft, Desiree L.; Rauw, Gail; Baker, Glen B.; Parent, Marise B.

    2009-01-01

    Although hippocampal infusions of glucose enhance memory, we have found repeatedly that septal glucose infusions impair memory when γ-aminobutyric acid (GABA) receptors are activated. For instance, hippocampal glucose infusions reverse the memory-impairing effects of co-infusions of the GABA agonist muscimol, whereas septal glucose infusions exacerbate memory deficits produced by muscimol. One potential explanation for these deleterious effects of glucose in the septum is that there are highe...

  18. Transvenous closure of large aortopulmonary collateral

    Directory of Open Access Journals (Sweden)

    Parag W Barwad

    2014-01-01

    Full Text Available Aortopulmonary collaterals (APCs are occluded either preoperatively or at the time of cardiac surgery in patients with pulmonary atresia and ventricular septal defect (PAVSD. If left untreated, APCs are an important cause of deterioration in the early postoperative period. We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period. Usual arterial approach failed due to extensive angulation with ostial narrowing. The large residual APC was successfully closed with an Amplatzer duct occluder (ADO device delivered through the transvenous route.

  19. Early Experience with the Amplatzer Vascular Plug II for Occlusive Purposes in Arteriovenous Hemodialysis Access

    International Nuclear Information System (INIS)

    The Amplatzer Vascular Plug Type II (AVP II) has proven effective in the therapeutic embolization of various vascular lesions. It benefits from very rapid occlusion of the target lesion and can be deployed, retrieved, and redeployed if required. There is no literature available on use of the AVP II in the maintenance, closure, and management of complicated arteriovenous access in hemodialysis patients. In this series, we present our clinical experience with the use of the AVP II for embolization of problematic hemodialysis access. The AVP II is a self-expandable Nitinol wire-mesh device. Mounted on a delivery wire it has the capability to be deployed, recaptured, and redeployed. In total seven patients (four males: one diabetic, all nonsmokers), with ages ranging from 44 to 81 years (mean, 63 years), were treated between July 2008 and January 2009. One patient had not started dialysis. The remaining six patients had varied histories, with the time on hemodialysis ranging from 1 to 21 years. Retrospective review of clinical notes revealed patient demographics, type of access, device size, deployment site, and outcomes. Indications for embolization included steal syndrome (one patient), high-flow tributaries (two patients), and limb swelling (four patients). All patients had clinical and sonographical follow-up to 3 months. Surgical ligation had either failed, was considered a contraindication due to concerns regarding wound healing, or was considered difficult due to complex venous anatomy. Only one device was used in each patient, ranging from 6 to 16 mm in diameter. Immediate technical success was seen in 100%. All these patients were followed up clinically in the vascular access radiology clinic at 4 weeks and 3 months. Occlusion of the treated vessel and resolution of symptoms were reconfirmed in 100% of cases at 3 months. It was also noted whether patients were having successful dialysis, if required. There were no complications. Average procedural time was 19

  20. TWO-STAGE OCCLUDED OBJECT RECOGNITION METHOD FOR MICROASSEMBLY

    Institute of Scientific and Technical Information of China (English)

    WANG Huaming; ZHU Jianying

    2007-01-01

    A two-stage object recognition algorithm with the presence of occlusion is presented for microassembly. Coarse localization determines whether template is in image or not and approximately where it is, and fine localization gives its accurate position. In coarse localization, local feature, which is invariant to translation, rotation and occlusion, is used to form signatures. By comparing signature of template with that of image, approximate transformation parameter from template to image is obtained, which is used as initial parameter value for fine localization. An objective function, which is a function of transformation parameter, is constructed in fine localization and minimized to realize sub-pixel localization accuracy. The occluded pixels are not taken into account in objective function, so the localization accuracy will not be influenced by the occlusion.

  1. Reoperations for occluded arterial bypasses in the lower limbs

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background We reviewed the outcomes of reoperations for 29 patients (30 limbs) who had undergone occluded arterial bypass in the lower limbs from May 1996 to September 2005. Methods The 30 lower limbs of the 29 patients with arteriosclerotic obstruction received 44 reoperations, including thrombectomy alone (group T, 27) and inflow or outflow reconstruction plus thrombectomy (group C, 17). Among the 17 operations in group C, 17.6% (3/17) were inflow reconstructions involving the axillary-femoral (1), aorta-iliac (1) and aorta-femoral (1) arteries, and 76.4% (13/17) outflow reconstructions involving the femoral-popliteal bypass-tibial (8), femoral-tibial (1), femoral-popliteal bypass-popliteal arteries below the knee (2), and the femoral-popliteal bypass-tibial-peroneal trunk (2). One patient (1 limb) underwent both inflow and outflow reconstructions with an iliac arterial stent and a graft-popliteal anastomosis patch. Polytetrafluoroethylene (PTFE) grafts were used in the inflow or outflow reconstructions abve the knee. Autovenous grafts or autovenously combined PTFE grafts were used in the outflow reconstructions below the knee. Results The percentages of Fontaine stage III and IV before primary operation and reoperation were 60% (18/30) and 86.7% (26/30), respectively (P0.05). Among 42 reoperations, 19 failed within 1 month in groups T (16) and C (3) (P0.05). The rate of limb salvage was 64.29% (18/28). Conclusions The percentages of Fontaine stage III and IV before reoperation may be much higher than those before primary operation. Thrombectomy plus inflow/outflow reconstruction creates patency better than thrombectomy alone for re-occluded bypass.

  2. Nasal Septal Deviations: A Systematic Review of Classification Systems

    Science.gov (United States)

    Teixeira, Jeffrey; Certal, Victor; Chang, Edward T.; Camacho, Macario

    2016-01-01

    Objective. To systematically review the international literature for internal nasal septal deviation classification systems and summarize them for clinical and research purposes. Data Sources. Four databases (including PubMed/MEDLINE) were systematically searched through December 16, 2015. Methods. Systematic review, adhering to PRISMA. Results. After removal of duplicates, this study screened 952 articles for relevance. A final comprehensive review of 50 articles identified that 15 of these articles met the eligibility criteria. The classification systems defined in these articles included C-shaped, S-shaped, reverse C-shaped, and reverse S-shaped descriptions of the septal deviation in both the cephalocaudal and anteroposterior dimensions. Additional studies reported use of computed tomography and categorized deviation based on predefined locations. Three studies graded the severity of septal deviations based on the amount of deflection. The systems defined in the literature also included an evaluation of nasal septal spurs and perforations. Conclusion. This systematic review ascertained that the majority of the currently published classification systems for internal nasal septal deviations can be summarized by C-shaped or reverse C-shaped, as well as S-shaped or reverse S-shaped deviations in the anteroposterior and cephalocaudal dimensions. For imaging studies, predefined points have been defined along the septum. Common terminology can facilitate future research. PMID:26933510

  3. Nasal Septal Deviations: A Systematic Review of Classification Systems

    Directory of Open Access Journals (Sweden)

    Jeffrey Teixeira

    2016-01-01

    Full Text Available Objective. To systematically review the international literature for internal nasal septal deviation classification systems and summarize them for clinical and research purposes. Data Sources. Four databases (including PubMed/MEDLINE were systematically searched through December 16, 2015. Methods. Systematic review, adhering to PRISMA. Results. After removal of duplicates, this study screened 952 articles for relevance. A final comprehensive review of 50 articles identified that 15 of these articles met the eligibility criteria. The classification systems defined in these articles included C-shaped, S-shaped, reverse C-shaped, and reverse S-shaped descriptions of the septal deviation in both the cephalocaudal and anteroposterior dimensions. Additional studies reported use of computed tomography and categorized deviation based on predefined locations. Three studies graded the severity of septal deviations based on the amount of deflection. The systems defined in the literature also included an evaluation of nasal septal spurs and perforations. Conclusion. This systematic review ascertained that the majority of the currently published classification systems for internal nasal septal deviations can be summarized by C-shaped or reverse C-shaped, as well as S-shaped or reverse S-shaped deviations in the anteroposterior and cephalocaudal dimensions. For imaging studies, predefined points have been defined along the septum. Common terminology can facilitate future research.

  4. Morphometric analysis of septal aperture of humerus

    Directory of Open Access Journals (Sweden)

    Raghavendra K, Anil kumar Reddy Y, Shirol VS, Daksha Dixit, Desai SP

    2014-04-01

    Full Text Available Introduction: Lower end of humerus shows olecranon and coronoid fossae separated by a thin bony septum, sometimes it may deficient and shows foramen which communicates both the fossae called Septal aperture, which is commonly referred as supratrochlear foramen (STF. Materials & Methods: We have studied 260 humeri (126 right side and 134 left side, measurements were taken by using vernier caliper, translucency septum was observed by keeping the lower end of humerus against the x-ray lobby. Results: A clear cut STF was observed in 19.2% bones, translucency septum was observed in 99 (91.6% humeri on the right side and 95 (93.1% humeri on the left sides respectively (Table – 1. Clinical significance: The presence of STF is always associated with the narrow medullary canal at the lower end of humerus, Supracondylar fracture of humerus is most common in paediatric age group, medullary nailing is done to treat the fractures in those cases the knowledge about the STF is very important for treating the fractures. It has been observed in x-ray of lower end of the humerus the STF is comparatively radiolucent, it is commonly seen as a type of ‘pseudolesions’ in an x-ray of the lower end of humerus and it may mistake for an osteolytic or cystic lesions. Conclusion: The present study can add data into anthropology and anatomy text books regarding STF and it gives knowledge of understanding anatomical variation of distal end of the humerus, which is significant for anthropologists, orthopaedic surgeons and radiologists in habitual clinical practice.

  5. Echocardiographic evaluation of ventricular septal defect haemodynamics

    Directory of Open Access Journals (Sweden)

    Miranović Vesna

    2007-01-01

    Full Text Available Introduction Ventricular septal defect (VSD is an opening in the interventricular septum. 30-50% of patients with congenital heart disease have VSD. Objective The aim of the study was to determine the dependence of the left ventricular diastolic dimension (LVD, left ventricular systolic dimension (LVS, shortening fraction (SF, left atrium (LA, pulmonary artery truncus (TPA on the body surface and compare their values among experimental, control and a group of healthy children. Values of maximal systolic gradient pressure (Pvsd of VSD were compared with children from one experimental and control group. Method Children were divided into three groups: experimental (32 children with VSD that were to go to surgery, control (20 children with VSD who did not require surgery and 40 healthy children. Measurements of LVD, LVS, SF, LA, TPA were performed in accordance to recommendations of the American Echocardiographic Association. The value of Pvsd was calculated from the maximal flow velocity (V in VSD using the following formula: Pvsd=4xVІ (mm Hg. Results For children from the experimental group, the relationship between the body surface and the variability of the LVD was explained with 56.85%, LVS with 66.15%, SF with 4.9%, TPA with 58.92%. For children from the control group, the relationship between the body surface and the variability of LVD was explained with 88.8%, LVS with 72.5%, SF with 0.42%, PA with 58.92%. For healthy children, the relationship between the body surface and the variabilitiy of the LVD was explained with 88.8%, LVS with 88.78%, SF with 5.25% and PA with 84.75%. There was a significant statistical difference between average values of Pvsd in the experimental and control group (p<0.02. Conclusion The presence of the large VSD has an influence on the enlargement of LVD, LVS, SF, TPA. The enlargement of the size of the pulmonary artery depends on the presence of VSD and there is a direct variation in the magnitude of the shunt

  6. Real life identification of partially occluded weapons in video frames

    Science.gov (United States)

    Hempelmann, Christian F.; Arslan, Abdullah N.; Attardo, Salvatore; Blount, Grady P.; Sirakov, Nikolay M.

    2016-05-01

    We empirically test the capacity of an improved system to identify not just images of individual guns, but partially occluded guns and their parts appearing in a videoframe. This approach combines low-level geometrical information gleaned from the visual images and high-level semantic information stored in an ontology enriched with meronymic part-whole relations. The main improvements of the system are handling occlusion, new algorithms, and an emerging meronomy. Well-known and commonly deployed in ontologies, actual meronomies need to be engineered and populated with unique solutions. Here, this includes adjacency of weapon parts and essentiality of parts to the threat of and the diagnosticity for a weapon. In this study video sequences are processed frame by frame. The extraction method separates colors and removes the background. Then image subtraction of the next frame determines moving targets, before morphological closing is applied to the current frame in order to clean up noise and fill gaps. Next, the method calculates for each object the boundary coordinates and uses them to create a finite numerical sequence as a descriptor. Parts identification is done by cyclic sequence alignment and matching against the nodes of the weapons ontology. From the identified parts, the most-likely weapon will be determined by using the weapon ontology.

  7. Familial Atrial Septal Defect and Sudden Cardiac Death

    DEFF Research Database (Denmark)

    Ellesøe, Sabrina Gade; Johansen, Morten Munk; Bjerre, Jesper Vandborg;

    2016-01-01

    OBJECTIVE: Atrial septal defect (ASD) is the second most common congenital heart defect (CHD) and is observed in families as an autosomal dominant trait as well as in nonfamilial CHD. Mutations in the NKX2-5 gene, located on chromosome 5, are associated with ASD, often combined with conduction...

  8. Aspects of surgery for congenital ventricular septal defect

    NARCIS (Netherlands)

    G. Bol Raap (Goris)

    2007-01-01

    textabstractIn chapter 1, an outline of the thesis is given. This thesis focuses on aspects of surgical closure of a congenital ventricular septal defect. In Chapter 2, the accuracy and the potential of 3-D echocardiography in the preoperative assessment of a congenital VSD were evaluated. 3-D ech

  9. Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

    DEFF Research Database (Denmark)

    Axelsson, Anna; Weibring, Kristina; Havndrup, Ole;

    2014-01-01

    AIMS: Lesion of the atrioventricular conduction system is a well known adverse effect of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM). We assessed the atrioventricular conduction at long-term follow-up after ASA. METHODS: In patients with a pacemaker...

  10. Tricuspid valve detachment in closure of congenital ventricular septal defect.

    Science.gov (United States)

    Zhao, Jinping; Li, Jun; Wei, Xiang; Zhao, Bo; Sun, Wei

    2003-01-01

    From January 1991 through December 2001, 600 patients underwent closure of a perimembranous ventricular septal defect through a right atrial approach at our institution. In 122 of these patients, the operation included temporary detachment of a tricuspid valve septal leaflet from the annulus to allow complete visualization of a perimembranous ventricular septal defect The mean age of the patients at surgery was 4.6 years in those who underwent leaflet detachment and 4.7 years in the 478 patients who did not (P > 0.05). Preoperatively, all patients were in sinus rhythm. Echocardiography showed trivial tricuspid regurgitation in 21 of the patients undergoing detachment and in 39 of the non-detachment patients. There was no difference in bypass time or aortic cross-clamp time between the 2 groups. Postoperatively, 3 patients in the non-detachment group had heart block; all other patients were in sinus rhythm. Echocardiograms on the 7th postoperative day showed small residual ventricular septal defects in none of the patients who underwent valve detachment and in 10 of the non-detachment patients; mild tricuspid regurgitation was present in 12 non-detachment patients only; and trivial tricuspid regurgitation was present in 19 patients who underwent valve detachment and in 29 who did not. There was no hospital death in either group. Long-term follow-up showed no progression of tricuspid regurgitation or tricuspid stenosis. All patients remained in sinus rhythm. This study suggests that tricuspid valve detachment is a safe, effective technique that improves exposure for ventricular septal defect repair and does not adversely affect valve competence. PMID:12638669

  11. Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery

    Science.gov (United States)

    Qin, J. X.; Shiota, T.; Lever, H. M.; Kapadia, S. R.; Sitges, M.; Rubin, D. N.; Bauer, F.; Greenberg, N. L.; Agler, D. A.; Drinko, J. K.; Martin, M.; Tuzcu, E. M.; Smedira, N. G.; Lytle, B.; Thomas, J. D.

    2001-01-01

    OBJECTIVES: This study was conducted to evaluate follow-up results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy. BACKGROUND: Controversy exists with regard to these two forms of treatment for patients with HOCM. METHODS: Of 51 patients with HOCM treated, 25 were treated by PTSMA and 26 patients via myectomy. Two-dimensional echocardiograms were performed before both procedures, immediately afterwards and at a three-month follow-up. The New York Heart Association (NYHA) functional class was obtained before the procedures and at follow-up. RESULTS: Interventricular septal thickness was significantly reduced at follow-up in both groups (2.3 +/- 0.4 cm vs. 1.9 +/- 0.4 cm for septal ablation and 2.4 +/- 0.6 cm vs. 1.7 +/- 0.2 cm for myectomy, both p Doppler, the resting pressure gradient (PG) across the left ventricular outflow tract (LVOT) significantly decreased immediately after the procedures in both groups (64 +/- 39 mm Hg vs. 28 +/- 29 mm Hg for PTSMA, 62 +/- 43 mm Hg vs. 7 +/- 7 mm Hg for myectomy, both p treatment for LVOT obstruction.

  12. Treatment of a Common Iliac Aneurysm by Endovascular Exclusion Using the Amplatzer Vascular Plug and Femorofemoral Crossover Graft

    International Nuclear Information System (INIS)

    We report our initial experience using the Amplatzer Vascular Plug II (AVP2) in the treatment of a left common iliac aneurysm. Following investigation by computerized tomographic angiography and catheter angiography, a 79-year-old man was found to have a markedly tortuous iliac system, with a left common iliac artery aneurysm that measured 48 mm in maximal diameter. Due to the patient's age and comorbidities the surgical opinion was that conventional open repair was not suitable. However, due to the tortuous nature of the aneurysm and iliac vessels, standard endovascular repair, using either a bifurcated or an aorto-uni-iliac stent graft, was also not possible. A combined approach was used by embolizing the ipsilateral internal iliac artery using coils and excluding the aneurysm using two AVP2 occlusion devices, followed by femorofemoral crossover grafting. Total aneurysm occlusion was achieved using this method and this allowed the patient to have a much less invasive surgical procedure than with conventional open repair of common iliac aneurysms, thus avoiding potential comorbidity and mortality.

  13. Septo-Hippocampo-Septal Loop and Memory Formation

    Directory of Open Access Journals (Sweden)

    Fatemeh Khakpai

    2013-01-01

    Full Text Available   Cholinergic and GABAergic fibers in the medial septal/diagonal band of Broca (MS/DB area project to the hippocampus and constitute the septo-hippocampal pathway, which has been proven in learning and memory. In addition, the hippocampus has bidirectional connections with the septum, which use this relation for self-regulation of cholinergic input.   The activity of septal and hippocampal neurons is modulated by several neurotransmitters including glutamatergic neurons from the entorhinal cortex, serotonergic fibers from the raphe nucleus, dopaminergic neurons from the ventral tegmental area (VTA, histaminergic cells from the tuberomammillary nucleus and adrenergic fibers from the locus coeruleus (LC. Thus, changes in the glutamatergic, serotonergic and etc. mediated transmission in the MS/DB may influence cholinergic or GABAergic transmission in the hippocampus.

  14. [The crooked nose: correction of dorsal and caudal septal deviations].

    Science.gov (United States)

    Foda, H M T

    2010-09-01

    The deviated nose represents a complex cosmetic and functional problem. Septal surgery plays a central role in the successful management of the externally deviated nose. This study included 800 patients seeking rhinoplasty to correct external nasal deviations; 71% of these suffered from variable degrees of nasal obstruction. Septal surgery was necessary in 736 (92%) patients, not only to improve breathing, but also to achieve a straight, symmetric external nose. A graduated surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the nasal dorsum or nasal tip. The approach depended on full mobilization of deviated cartilage, followed by straightening of the cartilage and its fixation in the corrected position by using bony splinting grafts through an external rhinoplasty approach. PMID:20809379

  15. Three-dimensional echocardiographic assessment of atrial septal defects

    Directory of Open Access Journals (Sweden)

    Charles German

    2015-01-01

    Full Text Available Echocardiography provides a useful tool in the diagnosis of many congenital heart diseases, including atrial septal defects, and aids in further delineating treatment options. Although two-dimensional echocardiography has been the standard of care in this regard, technological advancements have made three-dimensional echocardiography possible, and the images obtained in this new imaging modality are able to accurately portray the morphology, location, dimensions, and dynamic changes of defects and many other heart structures during the cardiac cycle.

  16. An incidentally detected giant membranous interventricular septal aneurysm secondary to previous surgery for subaortic valvular stenosis

    Science.gov (United States)

    Karagöz, Ahmet; Çelik, Abdullah; Vural, Aslı; Başer, Bengi

    2014-01-01

    Ventricular septal aneurysms are rare clinical entities and their certain prevalence and clinical significance are not well known. Most of them are thought to develop during or after the closure process of the accompanying ventricular septal defects. Although a majority of the patients are typically asymptomatic, the potential risks should also be kept in mind. We present a case of a membranous interventricular septal aneurysm that developed after surgery for subaortic valvular stenosis. The points that make our case worth reporting are development of the aneurysm after aortic surgery and lack of a concomitant ventricular septal defect. On the basis of the existence of an aortic valve surgery history and reports that do not mention any ventricular septal defect and ventricular septal aneurysm when she was operated, we suggest that the aneurysmatic formation in the membranous portion of the interventricular septum developed due to valve surgery in the postoperative wound healing period. PMID:25240004

  17. Septal co-infusions of glucose with a GABAB agonist impair memory

    OpenAIRE

    Erickson, Erika J.; Watts, Kelly D; Parent, Marise B.

    2005-01-01

    Septal infusions of glucose exacerbate memory deficits produced by co-infusions of drugs that increase γ-aminobutyric acid (GABA)A receptor activity. To further understand the interaction between glucose and GABA, this experiment tested whether glucose would also potentiate spatial working memory deficits produced by septal infusions of the GABAB receptor agonist baclofen. Fifteen minutes prior to assessing spontaneous alternation (SA), male Sprague–Dawley derived rats were given septal infus...

  18. Evaluation of morphological characteristics of septal rims affecting successful transcatheter atrial septal defect closure in children and adults

    OpenAIRE

    Oflaz, Mehmet Burhan; Pac, Feyza Aysenur; Kibar, Ayse Esin; Balli, Sevket; Ece, Ibrahim

    2013-01-01

    Introduction Determining other echocardiographic predictors along with the measured atrial septal defect (ASD) size and evaluating the closure together with these predictors would increase the chance of success for transcatheter closure of ASD. Aim To evaluate echocardiographic parameters affecting defect closure in children and adult patients with secundum ASD. Material and methods In all patients, size of ASD, total length of atrial septum (TS), superior-posterior, inferior-posterior, super...

  19. Percutaneous closure of a coronary fistula with single Amplatzer Vascular Plug II in a five-month-old female: The youngest case report.

    Science.gov (United States)

    Gulgun, Mustafa; Slack, Michael

    2016-02-01

    Coronary artery fistula (CAF) is a rare clinical abnormality characterized by a connection between one or more coronary arteries and an adjacent cardiac chamber or vascular structure. Although CAF complications are more common in older children over time, there is still no consensus in terms of treatment indications in children with asymptomatic fistula. We describe an asymptomatic infant diagnosed with a severely dilated right coronary artery and a coronary-cameral fistula treated successfully by transcatheter device closure. The Amplatzer Vascular Plug II appears to be safe, effective and relatively easy to use for CAF closure in infants. PMID:26852309

  20. A case of hybrid closure of a muscular ventricular septal defect: anatomical complexity and surgical management.

    Science.gov (United States)

    Karimi, Mohsen; Hulsebus, Elise; Murdison, Kenneth; Wiles, Henry

    2012-06-01

    Complex muscular ventricular septal defect poses difficult surgical management and is associated with high morbidity and mortality despite advancements in surgical therapy. Device closure of muscular ventricular septal defect has been encouraging and has been used in hybrid approach at a few centres. However, device closure has some limitations in patients with complex muscular ventricular septal defect. We report a case of perventricular device closure of a complex muscular ventricular septal defect in a beating heart with entrapped right ventricular disc and its surgical management.

  1. Nasal septal abscess--retrospective analysis of 14 cases from University Hospital, Kuala Lumpur.

    Science.gov (United States)

    Jalaludin, M A

    1993-10-01

    Fourteen patients who presented to the University Hospital of Kuala Lumpur between June 1981 and June 1991 were reviewed retrospectively. Nasal septal abscesses are uncommon and therefore there are limited reports in the medical literature. Early diagnosis and immediate therapy is mandatory to avoid cosmetic nasal deformity or intracranial infection. Two out of the fourteen patients developed saddle nose deformity and septal perforation because of delay in treatment, the cases were misdiagnosed by non-otolaryngologist as turbinates swelling. The leading cause of nasal septal abscess was non-surgical trauma which accounted for about 85.7%. The commonest pathogenic organism isolated from the pus of nasal septal abscess was Staphylococcus aureus.

  2. Improvement of the Technique for Transcatheter Closure of Atrial Septal Defect in Children

    Institute of Scientific and Technical Information of China (English)

    Wang Huishen; Qian Mingyang; Zhang Zhiwei

    2005-01-01

    Objectives To improve experience of procedure and success rate of interventional treatment of atrial septal defect (ASD) in children, applying the technique of controlling release of devices in the pulmonary vein (controlling two disc of device opening for subsequence) in children cases with ASD who can not be occluded by regularly interventional treatment. Methods Since 2000 year 182 child cases (male 70 and 112 female) underwent the procedure of controlling release of devices in the pulmonary vein. The patients' age was from 2 to 14years old (average 3.77±1.55). The body weight was from 9 to 48 Kg (average 21.53±10.63). When the devices were placed on the right position with difficulty and failure in some cases with short and soft rims of the defect and large defect and the angle between the device and the interval atrial septal (IAS), It could be helpful to put the device into the left upper pulmonary vein, and to make right atrium (proximal) disc opened before the left atrium (distal) disc naturally fall down.At the end the double disc of the device clamped and stood up at the right position of the IAS. After closure of ASD, patients were followed up regularly by echocardiography, X-ray and ECG in the 1,3,6,12month and 3,5 years. Results The successful rate of device implantation in the improving group (98.4%)was obviously higher than that in the regularly group (68%). The techniques improved in this group with the smaller age, the lighter weight, the larger defect and the larger device comparing with the regularly group.The velocity of the pulmonary vein before occlusion procedure was (0.54±0.15)m/s; after procedure was (0.56±0.16)m/s, P > 0.05,there were no significant difference. All cases couldn't found pulmonary congestion by follow up. Conclusions The method of controlling release of device in the pulmonary vein has been used more than 5 years in the occlusion of ASD with double disc device. It is feasible and safety. The aim of the improvement is

  3. Catching what we can't see: manual interception of occluded fly-ball trajectories.

    Directory of Open Access Journals (Sweden)

    Gianfranco Bosco

    Full Text Available Control of interceptive actions may involve fine interplay between feedback-based and predictive mechanisms. These processes rely heavily on target motion information available when the target is visible. However, short-term visual memory signals as well as implicit knowledge about the environment may also contribute to elaborate a predictive representation of the target trajectory, especially when visual feedback is partially unavailable because other objects occlude the visual target. To determine how different processes and information sources are integrated in the control of the interceptive action, we manipulated a computer-generated visual environment representing a baseball game. Twenty-four subjects intercepted fly-ball trajectories by moving a mouse cursor and by indicating the interception with a button press. In two separate sessions, fly-ball trajectories were either fully visible or occluded for 750, 1000 or 1250 ms before ball landing. Natural ball motion was perturbed during the descending trajectory with effects of either weightlessness (0 g or increased gravity (2 g at times such that, for occluded trajectories, 500 ms of perturbed motion were visible before ball disappearance. To examine the contribution of previous visual experience with the perturbed trajectories to the interception of invisible targets, the order of visible and occluded sessions was permuted among subjects. Under these experimental conditions, we showed that, with fully visible targets, subjects combined servo-control and predictive strategies. Instead, when intercepting occluded targets, subjects relied mostly on predictive mechanisms based, however, on different type of information depending on previous visual experience. In fact, subjects without prior experience of the perturbed trajectories showed interceptive errors consistent with predictive estimates of the ball trajectory based on a-priori knowledge of gravity. Conversely, the interceptive responses

  4. From the Heart: Interatrial Septal Aneurysm Identified on Bedside Ultrasound

    Directory of Open Access Journals (Sweden)

    Michael Butterfield

    2014-09-01

    Full Text Available A 61 year-old man presented to the Emergency Department for one day of nonspecific chest pain. Bedside echocardiogram performed by the emergency physician revealed normal systolic cardiac function but also showed a large ( > 10mm bicornuate interatrial septal aneurysm (IASA projecting into the right atrium (Figure 1, Video 1. There was no evidence of intraatrial thrombus. A formal echocardiogram performed later that day confirmed the diagnosis and also detected a patent foramen ovale (PFO with a left-to-right shunt that reversed with Valsalva maneuver. [West J Emerg Med. 2014;15(6:719–720

  5. Dysphagia Lusoria with atrial septal defect: Simultaneous repair through midline

    International Nuclear Information System (INIS)

    An aberrant right subclavian artery from the descending aorta is almost always reported as an isolated anomaly. We present the case of a four-year-old child with an anomalous origin of the right subclavian artery from the descending aorta, associated with an ostium secundum atrial septal defect. The patient underwent simultaneous repair of both the anomalies through median sternotomy, with implantation of the subclavian artery into the right common carotid artery. We believe that median sternotomy is the optimal surgical approach for the management of these lesions. Other operative approaches are also discussed

  6. Pulmonary edema following transcatheter closure of atrial septal defect

    Directory of Open Access Journals (Sweden)

    Keerthi Chigurupati

    2015-01-01

    Full Text Available We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.

  7. [Non-puncture treatment of sinusitis in nasal septal defects].

    Science.gov (United States)

    Shilenkova, V V; Markov, G I; Shilenkov, A A

    1994-01-01

    The [symbol: see text] sinus-catheter was used to treat purulent sinusitis with septal perforation or defective septum of the sinuses. The procedure described implies simultaneous introduction of two sinus-catheters the functioning channels of which unite into one output by means of T-joint. The method has been successfully tried in the treatment of exudative and aggravated chronic purulent hemisinusitis (6 cases). The authors hold that communication between nasal sinuses is not a contraindication for sinus-catheter application. This fact widely extends potentialities of its use.

  8. Diffuse interlobular septal thickening in a coal miner

    Energy Technology Data Exchange (ETDEWEB)

    Thrumurthy, S.G.; Kearney, S.; Sissons, M.; Haider, Y. [Lancashire Teaching Hospital for NHS Funding Trust, Chorley (United Kingdom)

    2010-01-15

    Diffuse interlobular septal thickening (DIST) is an abnormality seen on high-resolution CT (HRCT) scanning of the thorax. While DIST may be present to variable extents in a number of lung conditions, it is uncommon as a predominant finding except in a few entities. This report features an ex-coal miner, thought to have coal workers' pneumoconiosis (CWP), in whom the HRCT scan showed no evidence of CWP and instead showed DIST. The patient's condition progressed incessantly towards death from severe secondary pulmonary hypertension. The case links fatal pulmonary hypertension to DIST, a pattern not previously described in coal workers.

  9. Simultaneous transfemoral transcatheter mitral and tricuspid valve edge-to-edge repair (using MitraClip system) completed by atrial septal defect occlusion in a surgically inoperable patient. First-in-human report.

    Science.gov (United States)

    Kowalski, Marek; Franz, Norbert; Ritter, Frank; Hofmann, Steffen; Stabel-Mahassine, Chourok; Warnecke, Henning; Thale, Joachim

    2015-12-01

    Transcatheter transfemoral mitral valve repair using the MitraClip system (Abbott Vascular, USA) is used in high-risk or inoperable patients with severe mitral regurgitation. We report the first-in-human simultaneous transfemoral clipping of the mitral and tricuspid valve completed by occlusion of an atrial septal defect (ASD). The procedure was performed in an 84-year-old patient in October 2015. After effective reduction of mitral and tricuspid regurgitations using the MitraClip system a PFO Occluder (St. Jude Medical, USA) was implanted. Transfemoral simultaneous mitral and tricuspid valve repair using the MitraClip system with ASD occlusion seems to be an effective therapy for high-risk or inoperable patients. PMID:26855642

  10. Percutaneous closure of atrial septal defect with situs solitus and dextrocardia.

    Science.gov (United States)

    Galal, Mohammed Omar; Khan, Muhammad Arif; El-Segaier, Milad

    2015-02-01

    Percutaneous closure of secundum atrial septal defect associated with situs solitus and dextrocardia has not been reported previously. We describe the technical difficulties encountered during transcatheter closure of a secundum atrial septal defect in a 19-month-old girl with situs solitus and dextrocardia.

  11. Descriptive anatomy of the dominant septal perforators using Dual Source Coronary CT Angiography.

    Science.gov (United States)

    Brinjikji, Waleed; Harris, Scott R; Froemming, Adam T; Christensen, Kevin N; Lachman, Nirusha; Araoz, Philip A

    2010-01-01

    Although clinical outcomes for septal ablation in treating left ventricular outflow tract obstructions are generally favorable, a variety of complications have been reported including a high incidence of right bundle branch block. These complications may be attributed to anatomic variability of the dominant septal perforator. We used Dual Source CT Coronary Angiography (DS-CTA) to determine the location of the termination point of the dominant septal perforator as well as the distance of the termination point from the mitral annulus in patients undergoing DS-CTA. One-hundred-fourteen DS-CTA scans were retrospectively reviewed by two observers by consensus. The left ventricle was divided into anterior wall, anterioseptum, and inferioseptum. For each segment, the myocardium was divided into three layers (1) right ventricular side, (2) mid portion, and (3) left ventricular side. The zone of termination of the dominant septal perforator was identified as well as the distance of the termination point from the mitral annulus. The dominant septal perforator terminated in the right ventricular side of the anterioseptum in 86 of the 118 visualized terminations (73%) and in the left ventricular anterior wall in 6 visualized terminations (5%). On average, the dominant septal perforator terminated 26.3 +/- 8.6 mm from the mitral annulus. In the majority of cases, the dominant septal perforator terminates in the right ventricular side of anterioseptum. In addition, there is great variability in the distribution of the termination point of the dominant septal perforator from the mitral annulus. PMID:19918876

  12. INFERIOR-SEPTAL MYOCARDIAL INFARCTION MISDIAGNOSED AS ANTERIOR-SEPTAL MYOCARDIAL INFARCTION: ELECTROCARDIOGRAPHIC, SCINTIGRAPHIC, AND ANGIOGRAPHIC CORRELATIONS

    Institute of Scientific and Technical Information of China (English)

    Ji-lin Chen; Zuo-xiang He; Zai-jia Chen; Jin-qing Yuan; Yue-qin Tian; Shu-bin Qiao; Rong-fang Shi; Yi-da Tang; Zong-lang Lu

    2007-01-01

    To explore the infarct sites in patients with inferior wall acute myocardial infarction (AMI) concomitant with ST segment elevation in leads V1-V3 and leads V3R-V5R.Methods Five patients diagnosed as inferior, right ventricular, and anteroseptal walls AMI at admission were enrolled. Electrocardiographic data and results of isotope 99mTc-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging and coronary angiography (CAG) were analyzed.Results Electrocardiogram showed that ST segment significantly elevated in standard leads Ⅱ, Ⅲ, aVF, and leads V1-V3 , V3R-V5R in all five patients. The magnitude of ST segment elevation was maximal in lead V1 and decreased gradually from lead V1 to V3 and from lead V1 to V3R-V5R. There was isotope 99mTc-MIBI myocardial perfusion imaging defect in inferior and basal inferior-septal walls. CAG showed that right coronary artery was infarct-related artery.Conclusions The diagnostic criteria for basal inferior-septal wall AMI can be formulated as follows: ( 1 ) ST segment elevates ≥2 mm in lead V1 in the clinical setting of inferior wall AMI; (2) the magnitude of ST segment elevation is the tallest in lead V1 and decreases gradually from lead V1 to V3 and from lead V1 to V3R-V5R. With two conditions above, the basal inferior-septal wall AMI should be diagnosed.

  13. Detection of Occluded Face Image using Mean Based Weight Matrix and Support Vector Machine

    Directory of Open Access Journals (Sweden)

    R. S.D. Wahida Banu

    2012-01-01

    Full Text Available Problem statement: Face occlusion is a very challenging problem in face recognition. The performance of face recognition system decreases drastically due to the presence of partial occlusion on the face. Extracting discriminative features to achieve accurate detection versus computational overhead in extracting the features, which affects the classification speed, would be a sustained problem. The objective of this study is to segment the human face into non-occluded and occluded part of the occluded human face image. In General, for face detection special facial features are extracted. In the proposed study a simplified algorithm to extract the features is developed. Approach: An algorithm which enables the automatic detection of the presence of occlusions on the face would be a useful tool to increase the performances of the system. The face image was preprocessed to enhance the input face images in order to reduce the loss of classification performance due to changes in facial appearance. The experiment also balances both illumination and facial expression changes. Results: In this study, a Mean Based Weight Matrix (MBWM algorithm has been proposed to enhance the performance by 4.25% than the LBP method. Conclusion: The proposed model has been tested on occluded face images with a dataset obtained from the MIT face database.

  14. 18 CFR 270.302 - Occluded natural gas produced from coal seams.

    Science.gov (United States)

    2010-04-01

    ... produced from coal seams. 270.302 Section 270.302 Conservation of Power and Water Resources FEDERAL ENERGY... produced from coal seams. A person seeking a determination that natural gas is occluded natural gas produced from coal seams must file an application with the jurisdictional agency which contains...

  15. Balloon-occluded percutaneous transheptic obliteration of isolated vesical varices causing gross hematuria

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Dong Hoon; Kim, Dong Hyun; Kim, Min Seok; Kim, Chul Sung [Department of Urology, College of Medicine, Chosun University, Gwangju (Korea, Republic of)

    2013-01-15

    Gross hematuria secondary to vesical varices is an unusual presentation. We report such a case recurrent gross hematuria in a male patient who had a history of bladder substitution with ileal segments that had been treated by balloon-occluded percutaneous transhepatic obliteration of vesical varices.

  16. Endoscopic management of occluded biliary uncovered metal stents:A multicenter experience

    Institute of Scientific and Technical Information of China (English)

    Panagiotis Katsinelos; Kostas Fasoulas; Stefanos Atmatzidis; Christos Zavos; Jannis Kountouras; Athanasios Beltsis; Grigoris Chatzimavroudis; Dimitris Paikos; George Paroutoglou; Dimitris Kapetanos; Sotiris Terzoudis; Georgia Lazaraki; Ioannis Pilpilidis

    2011-01-01

    AIM:To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents(SEMSs)that had been placed for palliative treatment of unresectable malignant biliary obstruction.METHODS:A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs.The technical success of performed treatment in occluded SEMSs,the patency of the stent,the need for re-intervention and the financial costs of each treatment were analyzed.RESULTS:Fifty four patients were included in the analysis;21 received Hanaro,19 Wallstent and 14 Flexus.For the relief of obstruction,a plastic stent was inserted in 24 patients,a second SEMS in 25 and mechanical cleaning was performed in 5 patients.The overall median second patency rates between second SEMSs and plastic stents did not differ(133 d for SEMSs vs 106 d for plastic stents;P = 0.856).Similarly,no difference was found between the overall survival of SEMS and plastic stent groups,and no procedure-related complications occurred.Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece.CONCLUSION:Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs;insertion of plastic stents appears to be the most cost-effective strategy.

  17. Redefining the Septal L-Strut to Prevent Collapse

    Science.gov (United States)

    Ha, Dong-Heon; Kim, Sung Won; Cho, Dong-Woo

    2016-01-01

    During septorhinoplasty, septal cartilage is frequently resected for various purposes but the L-strut is preserved. Numerous materials are inserted into the nasal dorsum during dorsal augmenation rhinoplasty without considering nasal structural safety. This study used a finite element method (FEM) to redefine the septal L-strut, to prevent collapse as pressure moved from the rhinion to the supratip breakpoint on the nasal dorsum and as the contact percentage between the caudal L-strut and the maxillary crest changed. We designed a 1-cm-wide L-strut model based on computed tomography data. At least 45% of the width of the L-strut in the inferior portion of the caudal strut must be preserved during septoplasty to stabilize the septum. In augmentation rhinoplasty, the caudal L-strut must either be preserved perfectly or reinforced to prevent collapse or distortion of the L-strut. The dorsal augmentation material must be fixed in an augmentation pocket to prevent movement of graft material toward the supratip breakpoint, which can disrupt the L-strut. We conducted a numerical analysis using a FEM to predict tissue/organ behavior and to help clinicians understand the reasons for target tissue/organ collapse and deformation. PMID:27073993

  18. Redefining the Septal L-Strut to Prevent Collapse.

    Science.gov (United States)

    Lee, Jung-Seob; Lee, Dong Chang; Ha, Dong-Heon; Kim, Sung Won; Cho, Dong-Woo

    2016-01-01

    During septorhinoplasty, septal cartilage is frequently resected for various purposes but the L-strut is preserved. Numerous materials are inserted into the nasal dorsum during dorsal augmenation rhinoplasty without considering nasal structural safety. This study used a finite element method (FEM) to redefine the septal L-strut, to prevent collapse as pressure moved from the rhinion to the supratip breakpoint on the nasal dorsum and as the contact percentage between the caudal L-strut and the maxillary crest changed. We designed a 1-cm-wide L-strut model based on computed tomography data. At least 45% of the width of the L-strut in the inferior portion of the caudal strut must be preserved during septoplasty to stabilize the septum. In augmentation rhinoplasty, the caudal L-strut must either be preserved perfectly or reinforced to prevent collapse or distortion of the L-strut. The dorsal augmentation material must be fixed in an augmentation pocket to prevent movement of graft material toward the supratip breakpoint, which can disrupt the L-strut. We conducted a numerical analysis using a FEM to predict tissue/organ behavior and to help clinicians understand the reasons for target tissue/organ collapse and deformation. PMID:27073993

  19. Oclusão do apêndice atrial esquerdo com o Amplatzer Cardiac Plug em pacientes com fibrilação atrial Left atrial appendage closure with the Amplatzer Cardiac Plug in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Ênio Eduardo Guérios

    2012-06-01

    Full Text Available FUNDAMENTO: A oclusão percutânea do apêndice atrial esquerdo (OAAE surgiu como alternativa à anticoagulação oral (AO para prevenção do acidente vascular cerebral (AVC em pacientes com fibrilação atrial não-valvular (FANV. OBJETIVO: Relatar os resultados imediatos e o seguimento clínico de pacientes submetidos a OAAE com o Amplatzer Cardiac Plug (ACP em um único centro de referência. MÉTODOS: Oitenta e seis pacientes consecutivos com FANV, contra-indicação à AO e escore CHADS2= 2,6±1,2 foram submetidos a OAAE com implante de ACP. Realizou-se seguimento clínico e ecocardiográfico no mínimo 4 meses após o implante. RESULTADOS: Todos os implantes foram guiados apenas por angiografia. O sucesso do procedimento foi de 99% (1 insucesso por tamponamento cardíaco e consequente suspensão da OAAE. Houve 4 complicações maiores (o tamponamento já referido, 2 AVCs transitórios e uma embolização com retirada percutânea da prótese e duas menores (um derrame pericárdico sem tamponamento e uma pequena comunicação interatrial evidenciada no seguimento. Houve 1 óbito hospitalar após 6 dias, não relacionado à intervenção. Todos os outros pacientes receberam alta sem AO. Após seguimento de 25,9 pacientes-ano (69 pacientes não houve AVCs nem embolizações tardias de próteses. O AAE estava completamente ocluído em 97% dos casos. Seis pacientes apresentaram evidência de trombo sobre a prótese, que desapareceram após reinstituição de AO por 3 meses. CONCLUSÃO: OAAE se associa a um alto índice de sucesso, um índice aceitável de complicações e resultados promissores a médio prazo, podendo ser considerada uma alternativa válida à OA na prevenção do AVC em pacientes com FANV.BACKGROUND: Percutaneous left atrial appendage closure (LAAC has emerged as an alternative to oral anticoagulation (OA for prevention of thromboembolic stroke in patients with non-valvular atrial fibrillation (NVAF. OBJECTIVE: To describe the

  20. Cardiac Plug I and Amulet Devices: Left Atrial Appendage Closure for Stroke Prophylaxis in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Akhil Parashar MD; E. Murat Tuzcu MD FACC FSCAI; Samir R Kapadia MD FACC FSCAI.

    2015-04-01

    Full Text Available Percutaneous left atrial appendage (LAA occlusion has emerged as an exciting and effective modality for stroke prophylaxis in patients with non-valvular atrial fibrillation who are deemed too high risk for anticoagulation with warfarin or newer anticoagulants. The Amplatzer devices have been used in LAA occlusion for more than a decade, starting with off label use of an atrial septal occluder device for LAA occlusion. This was followed by introduction of a dedicated Amplatzer cardiac plug (ACP 1 for LAA occlusion, and more recently, the second generation Amulet device, with reported better stability enhancing features, has been introduced. Both these devices are widely used outside the United States, where only the WATCHMAN device has been commonly used. Unlike the WATCHMAN device, where the evidence is continuously building as the data from two pivotal randomized controlled trials are emerging, most of the evidence for ACP devices is from pooled multicenter registry data. In this article, we review the device design, implantation techniques and the most recently published evidence for both the Amplatzer cardiac plug 1 and the newer Amulet device. Our goal is to summarize the most recent literature and discuss the current role of the Amplatzer devices in the exciting and rapidly growing field of percutaneous LAA occlusion.

  1. Leiomyosarcoma with coronary fistulae and ventricular septal perforation:A case study

    Institute of Scientific and Technical Information of China (English)

    Dang-Sheng HUANG; Yu-Mei WANG; Yu CHEN

    2014-01-01

    Coronary fistulae and ventricular septal perforation are very rare clinically, and even less caused by cardiac leiomyosarcoma. A case is reported that a 67-year-old female had cardiac leiomyosarcoma with progressive heart failure and coronary fistulae and ventricular septal perforation. This case was special since all ante-mortem examinations and cardiac surgery failed to detect the presence of any abnormal car-diac mass. Therefore, the malignant cardiac tumors could appear in an invasive form without mass and be one of the causes of the coronary fistulae and ventricular septal perforation.

  2. [Axillary approach for surgical closure of atrial septal defect].

    Science.gov (United States)

    Gil-Jaurena, J M; Castillo, R; Zabala, J I; Conejo, L; Cuenca, V; Picazo, B

    2013-08-01

    Mid-line sternotomy is the routine approach for surgical repair of congenital heart diseases. However, its noticeable scar is a constant reminder of having undergone heart surgery. Several alternative approaches have been developed for simple cardiac conditions to hide the scar. Our series, consisting of 26 patients with axillary closure of atrial septal defect, is presented. The median age was 5.45 years (range 3-13), and median weight was 19.84 Kg. (range 13-37). The defect was closed directly in 13 cases, and with an autologous pericardial patch in the other 13. The number of surgical steps and time taken were the same as in median sternotomy. Functional recovery, intensive care unit stay, and hospital discharge were also standard. The cosmetic result, assessed both by patients and relatives, was excellent. PMID:23462094

  3. Percutaneous Treatment of a Jejunovaginal Fistula Using a Combination of the Amplatzer Vascular Plug II and N-Butyl-2-Cyanoacrylate: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Kyung; Kwak, Hyo Sung; Han, Young Min [Dept. of Radiology, Chonbuk National University School of Medicine and Hospital, Chonju (Korea, Republic of); Kim, Young Kon [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2011-04-15

    Treatment for an enterovaginal fistula should consider the location of an intestinal fistula. Most rectovaginal fistulas develop in the lower third of the vagina and can be treated surgically. Jejunovaginal fistulas can spontaneously close during conservative management. We report the first use of the Amplatzer vascular plug II (AVP II; AGA Medical Corp, Golden Valley, MN, USA) and the use of an N-butyl-2-cyanoacrylate (NBCA; Histoacryl, Braun, Melsungen, Germany)- iodized oil (Lipiodol Ultra-Fluid, Guerbet, Aulnay-sous-Bois, France) mixture for treatment of a patient with a jejunovaginal fistula which failed to close after conservative management. The patient did not have any vaginal discharge one day later after deployment of the AVP II.

  4. Percutaneous Treatment of a Jejunovaginal Fistula Using a Combination of the Amplatzer Vascular Plug II and N-Butyl-2-Cyanoacrylate: A Case Report

    International Nuclear Information System (INIS)

    Treatment for an enterovaginal fistula should consider the location of an intestinal fistula. Most rectovaginal fistulas develop in the lower third of the vagina and can be treated surgically. Jejunovaginal fistulas can spontaneously close during conservative management. We report the first use of the Amplatzer vascular plug II (AVP II; AGA Medical Corp, Golden Valley, MN, USA) and the use of an N-butyl-2-cyanoacrylate (NBCA; Histoacryl, Braun, Melsungen, Germany)- iodized oil (Lipiodol Ultra-Fluid, Guerbet, Aulnay-sous-Bois, France) mixture for treatment of a patient with a jejunovaginal fistula which failed to close after conservative management. The patient did not have any vaginal discharge one day later after deployment of the AVP II.

  5. Does asymptomatic septal agenesis exist? A review of 34 cases

    Energy Technology Data Exchange (ETDEWEB)

    Belhocine, Ouardia; Andre, Christine; Kalifa, Gabriel; Adamsbaum, Catherine [St Vincent de Paul Hospital, Radiology Department, Paris (France)

    2005-04-01

    Primary septal agenesis (PSA) is a rare brain malformation that can be isolated or part of developmental brain abnormalities (holoprosencephaly, septo-optic dysplasia or cortical malformation). Such associated malformation can be subtle, leading to difficulties in the prenatal management of PSA. Moreover, the neurological prognosis of isolated PSA remains debatable. The aims of the study were to specify the patterns and frequency of brain malformations associated with septal agenesis (SA), to identify the clinical prognosis, and to discuss the aetiology of PSA with the new insights provided by molecular genetics. The study consisted of a 14-year retrospective review of brain MRI in 34 patients having PSA (mean age, 5 years). Chiasm and optic nerves were not evaluated. Post-hydrocephalus SA or incomplete data were excluded. The clinical data were correlated to the MRI patterns. The study disclosed 82.5% associated lesions with MRI (28/34): 11 neuronal migration disorders, 9 holoprosencephalies (HP), 7 pituitary stalk interruptions, 1 corpus callosum partial agenesis; 17.5% (6/34) of cases were apparently isolated PAS. Clinically, the patients had motor dysfunction in 68% (23/34), mental retardation in 65% (22/34), blindness in 24% (8/34), endocrinological defects in 21% (7/34) and epilepsy in 18% (6/34) of cases. Nine percent of patients (3/34) were neurologically normal (including one with scoliosis and two infants younger than 2 years at the last follow-up). Patients with bilateral cortical anomalies and HP (even if mild) had the worst neurological prognosis. A severe motor impairment was present without evidence of hemispheric anomaly in 12% of patients (4/34). Interestingly, the frontal lobes were involved in 90% of cortical anomalies and HP, supporting the malformative aetiology of PSA. PSA rarely appears isolated and severe psychomotor impairment may occur in apparently isolated forms. These unfavourable results should be highlighted and need to be confirmed

  6. Does Nasal Septal Deviation Affect the Success of Tympanoplasty Surgery?

    Science.gov (United States)

    Tan, M; Kalcioglu, MT; Akarcay, M; Toplu, Y; Karaca, S

    2015-01-01

    ABSTRACT Objective: This paper deals with the investigation of the effects of nasal septal deviation evaluated by acoustic rhinometry (ARM) in the success of tympanoplasty surgery. Subject and Methods: All patients who underwent tympanoplasty surgery by the same surgeon were reviewed. The patients with nasopharyngeal or nasal masses, polyps, symptoms of allergic rhinitis or rhinosinusitis, or concha bullosa were excluded from the study. Forty patients who underwent tympanoplasty at least one year ago were included in the study. The patients were divided into two groups according to the graft success results. Acoustic rhinometry evaluations of the patients were performed. Results: There were 25 and 15 cases in the intact graft (group A) and re-perforated group (group B), respectively. For the same side of the operated ear, ARM values of group A were 0.47 cm 2 at the first narrowest cross-sectional area (MCA 1), 0.43 cm2 at the second narrowest cross-sectional area (MCA 2), 1.51 cm3 volume at the first 2 cm of the nasal cavity (Vol 1) and 3.33 cm3 volume between the second and fifth cm of the nasal cavity (Vol 2). Acoustic rhinometry values of group B were 0.50 cm2, 0.47 cm2, 1.60 cm3 and 3.19 cm3 for MCA 1, MCA 2, Vol 1, and Vol 2, respectively. Conclusion: The results of this study showed that nasal septal deviation may not affect the success of tympanoplasty surgery, and septoplasty may not be necessary before ear surgery. PMID:26624593

  7. Transcatheter closure of a giant coronary artery fistula with patent duct occluder

    Institute of Scientific and Technical Information of China (English)

    ZHOU Tao; SHEN Xiang-qian; FANG Zhen-fei; ZHOU Sheng-hua; QI Shu-shan; L(U) Xiao-ling

    2006-01-01

    @@ Coronary artery fistula (CAF), an uncommon form of congenital heart disease, is characterized by abnormal communication between a coronary artery and a cardiac chamber or vessel.1 This disease is often found incidentally in asymptomatic individuals,and leads to cardiac failure, myocardial ischemia and angina, infective endocarditis, and heart rupture in later life. Both surgical repair and transcatheter closure were effective and safe in the treatment of CAF,2 but percutaneous management of CAF can obviate median sternotomy and cardiopulmonary bypass, and there may be less morbidity with transcatheter embolization techniques,3,4 including the use of occluders or microcoils. We report a successful percutaneous closure of a giant CAF from the left coronary artery to the right ventricle using patent duct occluder.

  8. In Vitro Ability of a Novel Nanohydroxyapatite Oral Rinse to Occlude Dentine Tubules

    OpenAIRE

    Hill, Robert G.; Xiaohui Chen; David G. Gillam

    2015-01-01

    Objectives. The aim of the study was to investigate the ability of a novel nanohydroxyapatite (nHA) desensitizing oral rinse to occlude dentine tubules compared to selected commercially available desensitizing oral rinses. Methods. 25 caries-free extracted molars were sectioned into 1 mm thick dentine discs. The dentine discs (n = 25) were etched with 6% citric acid for 2 minutes and rinsed with distilled water, prior to a 30-second application of test and control oral rinses. Evaluation was ...

  9. Reuse of Occluded Veins During Permanent Pacemaker Lead Extraction: A New Indication for Femoral Lead Extraction

    OpenAIRE

    Staniforth, Andrew D; Schilling, Richard J

    2002-01-01

    Objectives: This study examined the utility of a novel technique for reuse of thrombosed veins when extracting permanent pacemaker leads via a femoral vein approach. Background: Although lead extraction permanent pacemaker using a femoral approach has advantages over the subclavian approach, it cannot be used to provide access for a new lead using currently employed techniques. This is important because up to 23% of patients have occluded veins after permanent pacemaker implantation. M...

  10. Smaller calcite lattice deformation caused by occluded organic material in coccoliths than in mollusk shell

    DEFF Research Database (Denmark)

    Frølich, Simon; Sørensen, Henning Osholm; Hakim, Sepideh Sadat;

    2015-01-01

    and the coccolithophorids. These differences were reflected in lattice deformation (macrostrain), structure (microstrain), and atomic disorder distributions (δorganic). The influence of the biological macromolecules on the inorganic phase was consistently smaller in the P. carterae compared to P. nobilis......The growth and nucleation of biominerals are directed and affected by associated biological molecules. In this paper, we investigate the influence of occluded biomolecules on biogenic calcite from the coccolithophorid Pleurochrysis carterae and from chalk, a rock composed predominantly of fossil...

  11. Percutaneous coronary intervention in the Occluded Artery Trial: Procedural success, hazard, and outcomes over 5 years

    OpenAIRE

    Buller, C; Rankin, J.; Carere, R; P. Buszman; Pfisterer, M.; Dzavik, V; Thomas, B.; Forman, S.; Ruzyllo, W; Mancini, G.; Michalis, L; de Abreu, G.; Lamas, G.; Hochman, J

    2009-01-01

    BACKGROUND: The Occluded Artery Trial (OAT) was a 2,201-patient randomized clinical trial comparing routine stent-based percutaneous coronary intervention (PCI) versus optimal medical therapy alone in stable myocardial infarction (MI) survivors with persistent infarct-related artery occlusion identified day 3 to 28 post MI. Intent-to-treat analysis showed no difference between strategies with respect to the incidence of new class IV congestive heart failure, MI, or death. The influence of PCI...

  12. Total and occluded residual gas content inside the nuclear fuel pellets

    International Nuclear Information System (INIS)

    This work describes three techniques available to measure total and occluded residual gases inside the UO2 nuclear fuel pellets. Hydrogen is the major gas compound inside these pellets, due to sintering fabrication process but Nitrogen is present as well, due to storage atmosphere fuel. The total and occluded residual gas content inside these pellets is a mandatory requirement in a quality control to assure the well function of the pellets inside the nuclear reactor. This work describes the Gas Extractor System coupled with mass spectrometry GES/MS, the Gas Extractor System coupled with gas chromatography GES/GC and the total Hydrogen / Nitrogen H/N analyzer as well. In the GES, occlude gases in the UO2 pellets is determinate using a high temperature vacuum extraction system, in which the minimum limit of detection is in the range 0.002 cc/g. The qualitative and quantitative determination of the amount of gaseous components employs a mass spectrometry or a gas chromatography technique. The total Hydrogen / Nitrogen analyzer employ a thermal conductivity gas detector linked to a gaseous extractor furnace which has a detection limit is in the range 0.005 cc/g. The specification for the residual gas analyses in the nuclear fuel pellets is 0.03 cc/g, all techniques satisfy the requirement but not the nature of the gases due to reaction with the reactor cladding. The present work details the chemical reaction among Hydrogen / Nitrogen and nuclear reactor cladding. (author)

  13. Template occluded SBA-15: An effective dissolution enhancer for poorly water-soluble drug

    International Nuclear Information System (INIS)

    The aim of the present work was to improve the dissolution rate of piroxicam by inclusion into template occluded SBA-15. Our strategy involves directly introducing piroxicam into as-prepared SBA-15 occluded with P123 (EO20PO70EO20) by self assembling method in acetonitrile/methylene chloride mixture solution. Ultraviolet spectrometry experiment and thermogravimetric analysis-differential scanning calorimetry (TG-DSC) profiles show that the piroxicam and P123 contents in the inclusion compound are 12 wt% and 28 wt%, respectively. X-ray powder diffraction and DSC analysis reveal that the included piroxicam is arranged in amorphous form. N2 adsorption-desorption experiment indicates that the piroxicam has been introduced to the mesopores instead of precipitating at the outside of the silica material. The inclusion compound was submitted to in vitro dissolution tests, the results show that the piroxicam dissolve from template occluded inclusion compound more rapidly, than these from the piroxicam crystalline and template removed samples in all tested conditions. Thus a facile method to improve the dissolution rate of poorly water-soluble drug was established, and this discovery opens a new avenue for the utilization of templates used for the synthesis of mesoporous materials.

  14. Ventricular Septal Defect Spontaneous Close Induced by Transcatheter: A Case Report

    Institute of Scientific and Technical Information of China (English)

    Qilian Xie; Jun Wang; Lei Gao; Zhen Wang; Milin Zhang; Kunshen Liu

    2007-01-01

    Congenital ventricular septal defect (VSD) spontaneous close induced by transcatheter treatment is rare and has not yet been reported.We report on one case of VSD spontaneous close induced by transcatheter treatment in a 10 years old girl.

  15. Short-term prognosis and risk factors of ventricular septal rupture following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    胡小莹

    2013-01-01

    Objective To analyze the short-term prognosis and risk factors of ventricular septal rupture(VSR)following acute myocardial infarction(AMI).Methods A total of 70 consecutive VSR patients following AMI hospitalized in

  16. Short-term prognosis and risk factors of ventricular septal rupture following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    胡小莹

    2013-01-01

    Objective To analyze the short-term prognosis and risk factors of ventricular septal rupture(VSR)following acute myocardial infarction(AMI).Methods A total of 70 consecutive VSR patients following AMI

  17. Transconjunctival subperiosteal fat reposition for tear trough deformity: pedicled fat redraping versus septal reset.

    Science.gov (United States)

    Youn, Seungki; Shin, Jong In; Kim, Jeong Tae; Kim, Youn Hwan

    2014-11-01

    Fat-preserving lower blepharoplasty techniques are increasingly common, but to date there has been insufficient data comparing the results of fat repositioning and septal reset. The authors compared the aesthetic results of the 2 methods using statistical analysis. A total of 120 patients, who had undergone transconjunctival subperiosteal fat repositioning from February 2008 to April 2009, were included. Group 1 (71 patients) underwent fat reposition with pedicled infraorbital fat redraping. Group 2 (49 patients) underwent septal reset to reposition the underlying fat. Documentation of the results with grading (grade 0-III) by 2 surgeons was done, and the results were evaluated for clinical improvement.Septal reset showed statistical significance on grade improvement compared to direct fat manipulation methods in the patients with grade II and grade III deformities. Septal reset also showed a trend for a higher degree of improvement compared to the latter. There were no major postoperative complications. PMID:23722575

  18. Delayed Ventricular Septal Rupture after Percutaneous Coronary Intervention in Acute Myocardial Infarction

    OpenAIRE

    Park, Ji Young; Park, Seong Hoon; Oh, Ji Young; Kim, In Je; Lee, Yu Hyun; Park, Si Hoon; Kwon, Ki Hwan

    2005-01-01

    In the era before reperfusion therapy, ventricular septal rupture complicated 1~3% of acute myocardial infarctions (AMI) usually 3-5 days after onset. Studies have reported a positive correlation between the incidence of septal perforation and total occlusion of the coronary arteries. A 70-year old female patient was referred to the emergency room with the diagnosis of acute anterior myocardial infarction (MI) and recent cerebral infarction. The coronary angiogram showed a 90% stenosis at the...

  19. Surgical Outcome and Complications of Nasal Septal Perforation Repair with Temporal Fascia and Periosteal Grafts

    OpenAIRE

    Paula Virkkula; Mäkitie, Antti A.; Seija I. Vento

    2015-01-01

    AIMS Surgical treatment of nasal septal perforation remains a challenging field of rhinology. A large variety of techniques and grafts with promising results have been introduced for perforation repair. However, the use of fascia or fascia with periosteum has not been previously evaluated for a large sample of patients. METHODS During the years 2007–2014, 105 operations were performed and 98 patients were treated for nasal septal perforation at the Department of Otorhinolaryngology—Head and N...

  20. Total endoscopic robotic atrial septal defect repair in a patient with dextrocardia and situs inversus totalis.

    Science.gov (United States)

    Iino, Kenji; Watanabe, Go; Ishikawa, Norihiko; Tomita, Shigeyuki

    2012-04-01

    Situs inversus with mirror-image of the heart is a rare condition. The present report describes a case of a patient with dextrocardia with situs inversus who had atrial septal defect with multiple holes in the fossa ovalis. The patient underwent total endoscopic atrial septal defect repair using the da Vinci surgical system. This procedure was achieved safely with good clinical and excellent cosmetic results.

  1. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

    Directory of Open Access Journals (Sweden)

    Abdul-rahman R. Abdel-karim

    2016-01-01

    Full Text Available Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO percutaneous coronary interventions (PCI with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome.

  2. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

    Science.gov (United States)

    Abdel-karim, Abdul-rahman R.; Main, Michael L.

    2016-01-01

    Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA) CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome. PMID:27668097

  3. Asymmetric septal hypertrophy - a marker of hypertension in aortic stenosis (a SEAS substudy)

    DEFF Research Database (Denmark)

    Tuseth, Nora; Cramariuc, Dana; Rieck, Ashild E;

    2010-01-01

    Some patients with aortic stenosis develop asymmetric septal hypertrophy (ASH) that may influence the surgical approach and is associated with higher perioperative morbidity. The aim of this analysis was to characterize further this subtype of aortic stenosis patients.......Some patients with aortic stenosis develop asymmetric septal hypertrophy (ASH) that may influence the surgical approach and is associated with higher perioperative morbidity. The aim of this analysis was to characterize further this subtype of aortic stenosis patients....

  4. Classification of Atrial Septal Defect and Ventricular Septal Defect with Documented Hemodynamic Parameters via Cardiac Catheterization by Genetic Algorithms and Multi-Layered Artificial Neural Network

    Directory of Open Access Journals (Sweden)

    Mustafa Yıldız

    2012-08-01

    Full Text Available Introduction: We aimed to develop a classification method to discriminate ventricular septal defect and atrial septal defect by using severalhemodynamic parameters.Patients and Methods: Forty three patients (30 atrial septal defect, 13 ventricular septal defect; 26 female, 17 male with documentedhemodynamic parameters via cardiac catheterization are included to study. Such parameters as blood pressure values of different areas,gender, age and Qp/Qs ratios are used for classification. Parameters, we used in classification are determined by divergence analysismethod. Those parameters are; i pulmonary artery diastolic pressure, ii Qp/Qs ratio, iii right atrium pressure, iv age, v pulmonary arterysystolic pressure, vi left ventricular sistolic pressure, vii aorta mean pressure, viii left ventricular diastolic pressure, ix aorta diastolicpressure, x aorta systolic pressure. Those parameters detected from our study population, are uploaded to multi-layered artificial neuralnetwork and the network was trained by genetic algorithm.Results: Trained cluster consists of 14 factors (7 atrial septal defect and 7 ventricular septal defect. Overall success ratio is 79.2%, andwith a proper instruction of artificial neural network this ratio increases up to 89%.Conclusion: Parameters, belonging to artificial neural network, which are needed to be detected by the investigator in classical methods,can easily be detected with the help of genetic algorithms. During the instruction of artificial neural network by genetic algorithms, boththe topology of network and factors of network can be determined. During the test stage, elements, not included in instruction cluster, areassumed as in test cluster, and as a result of this study, we observed that multi-layered artificial neural network can be instructed properly,and neural network is a successful method for aimed classification.

  5. Collagen immunostains can distinguish capsular fibrous tissue from septal fibrosis and may help stage liver fibrosis.

    Science.gov (United States)

    Chen, Wei; Rock, Jonathan B; Yearsley, Martha M; Hanje, A James; Frankel, Wendy L

    2014-01-01

    Core-needle biopsy remains essential for diagnosis of cirrhosis; however, evaluation of fibrosis in such biopsies is often challenging due to the fragmented nature of cirrhotic liver specimens. It is also common to see portions of liver capsules present in the biopsy which adds to the diagnostic challenge. The distinction between capsular/subcapsular fibrous tissue and septal fibrosis is critical to avoid potential overstaging of liver fibrosis. We compared the differential immunostaining in liver capsular and septal areas for collagens III, IV, V, VI, vitronectin, laminin, Orcein, and Trichrome in 15 whole sections of explanted cirrhotic livers and 5 simulated liver biopsies. Collagens III, IV, V, VI, Trichrome, and Orcein show distinct staining patterns in capsular fibrous tissue and septal fibrosis. Collagen IV shows strong diffuse septal staining and consistently weak to negative capsular staining. Collagens III and VI stain similar to IV for septal fibrosis, whereas collagen V, Trichrome, and Orcein show strong staining in both areas. Collagen IV, possibly with III or VI in addition to the routine Trichrome and hematoxylin and eosin stain, is useful in differentiating capsular fibrous tissue from septal fibrosis on challenging and fragmented liver biopsies.

  6. Reward contingency modulates neuronal activity in rat septal nuclei during elemental and configural association tasks

    Directory of Open Access Journals (Sweden)

    Nozomu eMatsuyama

    2011-05-01

    Full Text Available It has been suggested that septal nuclei are important in the control of behavior during various reward and non-reward situations. In the present study, neuronal activity was recorded from rat septal nuclei during discrimination of conditioned sensory stimuli (CSs of the medial forebrain bundle associated with or without a reward (sucrose solution or intracranial self-stimulation, ICSS. Rats were trained to lick a spout protruding close to the mouth just after a CS to obtain a reward stimulus. The CSs included both elemental and configural stimuli. In the configural condition, the reward contingency of the stimuli presented together was opposite to that of each elemental stimulus presented alone, although the same sensory stimuli were involved. Of the 72 responsive septal neurons, 18 responded selectively to the CSs predicting reward (CS+-related, four to the CSs predicting nonreward (CS0-related, nine to some CSs predicting reward or nonreward, and 15 nondifferentially to all CSs. The remaining 26 neurons responded mainly during the ingestion/ICSS phase. A multivariate analysis of the septal neuronal responses to elemental and configural stimuli indicated that septal neurons encoded the CSs based on reward contingency, regardless of the stimulus physical properties and were categorized into three groups; CSs predicting the sucrose solution, CSs predicting a nonreward, and CSs predicting ICSS. The results suggest that septal nuclei are deeply involved in discriminating the reward contingency of environmental stimuli to manifest appropriate behaviors in response to changing stimuli.

  7. [Septal alcohol ablation in patients with hypertrophic cardiomyopathy].

    Science.gov (United States)

    López-Aburto, Gustavo; Palacios-Rodríguez, Juan Manuel; Cantú-Ramírez, Samuel; Galván-García, Eduardo; Tolosa-Dzul, Gonzalo; Morán-Benavente, Armando; Ontiveros-Martínez, Raúl

    2013-01-01

    Objetivo: conocer características demográficas, clínicas y hemodinámicas de los pacientes con ablación con alcohol para tratar la miocardiopatía hipertrófica septal obstructiva (MHSO). Métodos: estudio observacional, longitudinal, descriptivo de 21 pacientes con MHSO resistente a tratamiento o con gradiente = 30 mm Hg en reposo o = 60 mm Hg provocado y con movimiento sistólico anterior o insuficiencia mitral > grado II. Resultados: edad de 50 ± 16 años; hombres 38.1 % y mujeres 61.9 %. Los síntomas fueron angor 42.9 %, disnea 85.7 % y síncope 23.8 %. La clase funcional NYHA preablación fue grados III y IV en 61.9 %; al año todos tenían grados I y II. Preablación y al año, el espesor del septo interventricular fue de 22.7 ± 4.9 y 20.7 ± 3.1 mm. Preablación, después y al año, la fracción de eyección fue de 65.5 ± 7, 62.2 ± 6.5 y 68.7 ± 6.2 %. Preablación, después y al año, el gradiente del tracto de salida del ventrículo izquierdo fue de 106.9 ± 29.9, 44.6 ± 24.3 y 22.0 ± 5.7 mm Hg. Preablación, la insuficiencia mitral fue grados III y IV en 33.3 y 47.6 % y al año fue grados 0 en 52.4 %, I en 28.6 % y II en 19 %. No hubo defunciones intrahospitalarias. Conclusiones: la ablación septal con alcohol en pacientes con MHSO fue exitosa.

  8. Repetitive Delay in Diagnosis of Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    Zahra Nikyar

    2011-12-01

    Full Text Available Objective: Although ventricular septal defect (VSD is the most common congenital heart disease, it is usually diagnosed late. The presentation of the disease is variable; sometimes it is so quiet and silent that might even improve and heal spontaneously, and in some certain cases if the appropriate, on time and early treatment is not done, this would lead to irreparable complications and mortality even in the early life period. This study reviews the diagnostic process, treatment and follow-up of the patients. It is hoped that the results of the present study be used to improve the patients' condition.Methods: This was a cross-sectional study done on 145 patients with VSD during 54 months in Isfahan. The disease was identified through color Doppler echocardiogram, cardiac catheterization and angiography if necessary. The required data were collected at the time of definite diagnosis.Findings: Mean age at initial and definite diagnosis of the disease was 17 months and 44 months, respectively. Heart murmur led to initial diagnosis in 85% of the cases. In 27.5% VSD was associated with other cardiac anomalies. Pulmonary artery hypertension existed in 16.5% of the cases. Fifty nine surgeries were performed on 40 patients.Conclusion: In routine physical examination of the infants, the probability of heart disease should be considered; conducting echocardiogram in suspected cases would lead to early diagnosis and eventually timely treatment. Appropriate follow-up of the patients will provide optimal care and treatment at proper time.

  9. Device Closure of Small Ventricular Septal Defects: When and Why?

    Directory of Open Access Journals (Sweden)

    IB Vijayalakshmi

    2014-10-01

    Full Text Available Ventricular septal defect (VSD accounts for approximately 20-30 % of all forms of congenital heart disease (CHD. They were traditionally closed surgically in the past. The surgery though safe carries the risk of morbidity, complete heart block, wound infection and thoracotomy scar on the chest. On weighing the risk and benefit, the small VSDs were not submitted to surgery in the past. So for many years it has been taught that the small VSDs are to be left alone and surgery is not recommended. Many clinicians believed in spontaneous closure of VSDs. Hence they advised the parents to wait for spontaneous closure till the child is 9 years old. But what if the VSD does not close by 10 years is the question. Are they normal as grown up congenital heart (GUCH. The Jane Somerville GUCH unit showed that spontaneous closure occurred only in 10% between the age of 17 and 45 (mean - 27 years in small VSDs in adults. What is worth noting is about 25% had serious complications: infective endocarditis (11%, progressive aortic regurgitation (5%, age-related symptomatic arrhythmias (8.5% like atrial fibrillation. This means that asymptomatic small VSDs in childhood is not necessarily benign during adult life. This raises the question, when we have a safe non-surgical device closure available to close the small VSDs, should we put the future lives of the young in danger by not giving the benefit of technology to them?

  10. Electrophysiologic abnormalities of children with ostium secundum atrial septal defect.

    Science.gov (United States)

    Ruschhaupt, D G; Khoury, L; Thilenius, O G; Replogle, R L; Arcilla, R A

    1984-06-01

    Sinus node (SN) and atrioventricular node (AVN) function were evaluated in 49 patients with secundum type atrial septal defect (ASD). Automaticity and conduction system function were assessed by intracardiac recording of the AH and HV intervals at rest, corrected SN recovery time, sinoatrial conduction time, AVN refractory period and the ability of the AVN to conduct rapidly paced atrial beats to the ventricles. Electrophysiologic abnormalities were found in 41% of the 34 patients who were studied before surgery. However, no preoperative abnormalities were present in children younger than 2.5 years. If only children older than 2.5 years were analyzed, the incidence of conduction abnormalities was similar for the patients studied before operation (62%) and those studied after operation (71%). The size and ejection fractions of the right and left ventricles, the magnitude of shunt flow and the size of the ASD did not differ between the patients with and those without electrophysiologic abnormalities. AVN dysfunction was present in 40% of the patients who were studied after surgical repair. While this frequency was more than twice the preoperative incidence of AVN dysfunction, it was not statistically significant. The data suggest that patient age is the major factor that influences the presence of conduction system dysfunction in patients with ASD.

  11. MORTAL PULPOTOMY ON CHILDREN WITH VENTRICULAR SEPTAL DEFECT

    Directory of Open Access Journals (Sweden)

    Devi N. R. Devy

    2006-04-01

    Full Text Available Congenital heart disease is a condition of heart anomaly found since birth. The most common is ventricular septal defect whereby an aperture is found in the partition of heart chamber. It is estimated that 40,000 newborn in Indonesia have this defective condition. Dental treatment for patients with such condition must be undertaken in a very cautious way. Tooth with multiple caries can potentially lead to endocarditis bacteria. As such, dentist must be watchful on dental treatment that may worsen the patient’s condition. To prevent endocarditis bacteria, a prophylaxis antibiotic is required as recommended by the American Heart Association (AHA. In this particular case, a dental treatment was undertaken to a child patient with congenital heart disease. Previously, the patient has undergone dental treatment in the form of multiple extractions under general anesthesia before conducting cardiac surgery. In this case the treatment includes mortal pulpotomy, GIC restoration, and fissure sealant – all conducted in one visit under general anesthesia. A year after the treatment, there are no complaints from the patient and no irregularity on x-ray results.

  12. Septum Development in Neurospora crassa: The Septal Actomyosin Tangle

    Science.gov (United States)

    Delgado-Álvarez, Diego Luis; Bartnicki-García, Salomón; Seiler, Stephan; Mouriño-Pérez, Rosa Reyna

    2014-01-01

    Septum formation in Neurospora crassa was studied by fluorescent tagging of actin, myosin, tropomyosin, formin, fimbrin, BUD-4, and CHS-1. In chronological order, we recognized three septum development stages: 1) septal actomyosin tangle (SAT) assembly, 2) contractile actomyosin ring (CAR) formation, 3) CAR constriction together with plasma membrane ingrowth and cell wall construction. Septation began with the assembly of a conspicuous tangle of cortical actin cables (SAT) in the septation site >5 min before plasma membrane ingrowth. Tropomyosin and myosin were detected as components of the SAT from the outset. The SAT gradually condensed to form a proto-CAR that preceded CAR formation. During septum development, the contractile actomyosin ring remained associated with the advancing edge of the septum. Formin and BUD-4 were recruited during the transition from SAT to CAR and CHS-1 appeared two min before CAR constriction. Actin patches containing fimbrin were observed surrounding the ingrowing septum, an indication of endocytic activity. Although the trigger of SAT assembly remains unclear, the regularity of septation both in space and time gives us reason to believe that the initiation of the septation process is integrated with the mechanisms that control both the cell cycle and the overall growth of hyphae, despite the asynchronous nature of mitosis in N. crassa. PMID:24800890

  13. Dealing with Inaccurate Face Detection for Automatic Gender Recognition with Partially Occluded Faces

    Science.gov (United States)

    Andreu, Yasmina; García-Sevilla, Pedro; Mollineda, Ramón A.

    Gender recognition problem has not been extensively studied in situations where the face cannot be accurately detected and it also can be partially occluded. In this contribution, a comparison of several characterisation methods of the face is presented and they are evaluated in four different experiments that simulate the previous scenario. Two of the characterisation techniques are based on histograms, LBP and local contrast values, and the other one is a new kind of features, called Ranking Labels, that provide spatial information. Experiments have proved Ranking Labels description is the most reliable in inaccurate situations.

  14. Endoscopic management of occluded metal biliary stents:Metal versus 10F plastic stents

    Institute of Scientific and Technical Information of China (English)

    Won; Jae; Yoon; Ji; Kon; Ryu; Jung; Won; Lee; Dong-Won; Ahn; Yong-Tae; Kim; Yong; Bum; Yoon; Sang; Myung; Woo; Woo; Jin; Lee

    2010-01-01

    AIM:To compare the efficacy of self-expandable metal stents(SEMSs) with 10F plastic stents(PSs) in the endoscopic management of occluded SEMSs.METHODS:We retrospectively reviewed the medical records of 56 patients who underwent SEMS insertion for palliation of unresectable malignant biliary obstruction between 2000 and 2007 and subsequent endoscopic retrograde biliary drainage(ERBD) with SEMS or PS for initial SEMS occlusion between 2000 and 2008.RESULTS:Subsequent ERBD with SEMS was performed in 29 patient...

  15. Evaluation on occluded hydrocarbon in deep–ultra deep ancient source rocks and its cracked gas resources

    Directory of Open Access Journals (Sweden)

    Jian Li

    2015-12-01

    Full Text Available Oil-cracked gas, as the main type of high-over mature marine natural gas in China, is mainly derived from occluded hydrocarbon. So it is significant to carry out quantitative study on occluded hydrocarbon. In this paper, the occluded hydrocarbon volume of the main basins in China was calculated depending on their types, abundances and evolution stages by means of the forward method (experimental simulation and the inversion method (geologic profile dissection. And then, occluded hydrocarbon evolution models were established for five types of source rocks (sapropelic, sapropelic prone hybrid, humic prone hybrid, humic and coal. It is shown that the hydrocarbon expulsion efficiency of sapropelic and sapropelic prone hybrid excellent source rocks is lower than 30% at the low-maturity stage, 30%–60% at the principal oil generation stage, and 50%–80% at the high-maturity stage, which are all about 10% higher than that of humic prone hybrid and humic source rocks at the corresponding stages. The resource distribution and cracked gas expulsion of occluded hydrocarbon since the high-maturity stage of marine source rocks in the Sichuan Basin were preliminarily calculated on the basis of the evolution models. The cracked gas expulsion is 230.4 × 1012 m3 at the high evolution stage of occluded hydrocarbon of the Lower Cambrian Qiongzhusi Fm in this basin, and 12.3 × 1012 m3 from the source rocks of Sinian Doushantuo Fm, indicating good potential for natural gas resources. It is indicated that the favorable areas of occluded hydrocarbon cracked gas in the Qiongzhusi Fm source rocks in the Sichuan Basin include Gaoshiti–Moxi, Ziyang and Weiyuan, covering a favorable area of 4.3 × 104 km2.

  16. Congenital Heart Disease in an Infant with 49,XXXXY Syndrome

    Directory of Open Access Journals (Sweden)

    Mustafa Argun

    2015-04-01

    Full Text Available 49,XXXXY syndrome which is characterized with the addition of three extra X chromosomes to 46,XY is the rarest sex chromosome aneuploidy syndrome. Its classical findings were defined as a triad of mental retardation, hypogonadism and radioulnar synostosis. In 49,XXXXY syndrome, congenital heart defects like patent ductus arteriosus, atrial septal defect, ventricular septal defect, pulmonary stenosis, Fallot’s tetralogy have been reported. We present a case diagnosed in the newborn stage with low birth weight, short stature, dysmorphic craniofacial findings and hypoplastic male genitalia who was found to have severe pulmonary hypertension and medium patent ductus arteriosus when admitted at 4 months of age with heart failure and who underwent transcathater ductus closure with Amplatzer Duct Occluder I. To our knowledge, our case is the first reported 49,XXXXY syndrome with patent ductus arteriosus closed with the transcathater route.

  17. Enhanced reconstruction of partially occluded objects with occlusion removal in synthetic aperture integral imaging

    Institute of Scientific and Technical Information of China (English)

    Zhiliang Zhou; Yan Yuan; Xiangli Bin; Qian Wang

    2011-01-01

    @@ Synthetic aperture integral imaging provides the ability to reconstruct partially occluded objects from multi-view images.However, the reconstructed images suffer from degraded contrast due to the super-imposition of foreground defocus blur.We propose an algorithm to remove foreground occlusions before reconstructing backgrounds.Occlusions are identified by estimating the color variance on elemental im-ages and then deleting it in the final synthetic image.We demonstrate the superiority of our method by presenting experimental results as well as comparing our method with other approaches.%Synthetic aperture integral imaging provides the ability to reconstruct partially occluded objects from multi-view images. However, the reconstructed images suffer from degraded contrast due to the superimposition of foreground defocus blur. We propose an algorithm to remove foreground occlusions before reconstructing backgrounds. Occlusions are identified by estimating the color variance on elemental images and then deleting it in the final synthetic image. We demonstrate the superiority of our method by presenting experimental results as well as comparing our method with other approaches.

  18. Efficacy and safety of balloon-occluded retrograde transvenous obliteration with sodium tetradecyl sulfate liquid sclerotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Il Soo; Park, Sang Woo; Kwon, So Young; Cheo, Won Hyeok; Cheon, Young Koog; Shim, Chan Sup; Lee, Tae Yoon; Kim, Jeong Han [Digestive Disease Center, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2016-04-15

    To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices. Between February 2012 and August 2014, STS liquid sclerotherapy was performed in 17 consecutive patients (male:female = 8:9; mean age 58.6 years, range 44-86 years) with gastric varices. Retrograde venography was performed after occlusion of the gastrorenal shunt using a balloon catheter and embolization of collateral draining veins using coils or gelfoam pledgets, to evaluate the anatomy of the gastric varices. We prepared 2% liquid STS by mixing 3% STS and contrast media in a ratio of 2:1. A 2% STS solution was injected into the gastric varices until minimal filling of the afferent portal vein branch was observed (mean 19.9 mL, range 6-33 mL). Patients were followed up using computed tomography (CT) or endoscopy. Technical success was achieved in 16 of 17 patients (94.1%). The procedure failed in one patient because the shunt could not be occluded due to the large diameter of gastrorenal shunt. Complete obliteration of gastric varices was observed in 15 of 16 patients (93.8%) with follow-up CT or endoscopy. There was no rebleeding after the procedure. There was no procedure-related mortality. BRTO using STS liquid can be a safe and useful treatment option in patients with gastric varices.

  19. Incidental Discovery of a Membranous Ventricular Septal Aneurysm in Two Dissimilar Patients

    Directory of Open Access Journals (Sweden)

    Abhishek Naidu

    2012-01-01

    Full Text Available A ventricular septal aneurysm (VSA is a rare cardiac anomaly, and an accurate statistic of its prevalence has not been reported in the literature. True incidence is likely underestimated as most patients are thought to be asymptomatic. As a result, most VSAs are discovered incidentally on echocardiography, during angiography, or at autopsy. Potential complications include rupture, bacterial endocarditis, right ventricular outflow tract obstruction, and thromboembolic disease. It has been proposed that VSAs occur in association with ventricular septal defects (VSDs and other congenital cardiac abnormalities. It is uncommon for a VSA to exist in the absence of a known prior ventricular septal defect. We present two cases, each highlighting an incidental intact aneurysm involving the membranous interventricular septum. We discuss the contrast in the two patients with regard to their age, accompanying cardiac anomalies and cardiovascular fitness. Clinical implications of the condition are reviewed.

  20. Percutaneous repair of post-myocardial infarction ventricular septal defect: current approaches and future perspectives.

    Science.gov (United States)

    Baldasare, Maria D; Polyakov, Mark; Laub, Glenn W; Costic, Joseph T; McCormick, Daniel J; Goldberg, Sheldon

    2014-12-01

    Post-myocardial infarction ventricular septal defect is a devastating complication of ST-elevation myocardial infarction. Although surgical intervention is considered the gold standard for treatment, it carries high morbidity and mortality rates. We present 2 cases that illustrate the application of percutaneous closure of a post-myocardial infarction ventricular septal defect: the first in a patient who had undergone prior surgical closure and then developed a new shunt, and the second as a bridge to definitive surgery in a critically ill patient. PMID:25593526

  1. Percutaneous septal ablation for left mid-ventricular obstructive hypertrophic cardiomyopathy: a case report

    Directory of Open Access Journals (Sweden)

    Alioglu Emin

    2006-04-01

    Full Text Available Abstract Background Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHC is a rare type of cardiomyopathy. The diagnosis is based on the hourglass appearance on the left ventriculogram and the presence of pressure gradient between apical and basal chamber of the ventriculum on the hemodynamic assessment. Case presentation The present case represents successful percutaneous treatment with septal ablation to patient with MVOHC associated with systolic anterior motion of the mitral valve and obstruction at both the mid-ventricular and outflow levels. Conclusion Alcohol septal ablation has been proposed as less invasive alternatives to surgery in patients with MVOHC.

  2. [Pulmonary stenosis and atrial septal defect: a rare association in the elderly].

    Science.gov (United States)

    Zampi, Giordano; Pergolini, Amedeo; Celestini, Andrea; Benvissuto, Fabrizio; Tinti, Maria Denitza; Ortenzi, Mariano; Sommariva, Luigi

    2016-01-01

    We report the case of an elderly woman with persistent unrepaired atrial septal defect and moderate pulmonary stenosis. The diagnostic work-up and the echocardiographic findings of such a rare case are reported, along with a brief description of heart failure pathophysiology in this grown-up congenital heart disease.To the best of our knowledge, this is the first case with the greater longevity in an elderly patient with unrepaired atrial septal defect and pulmonary stenosis ever reported in the literature.

  3. Determinants and importance of atrial pressure morphology in atrial septal defect.

    OpenAIRE

    Parikh, D N; J. Fisher; Moses, J W; Goldberg, H.L.; Levin, A. R.; Engle, M. A.; Borer, J S

    1984-01-01

    A prominent "v" wave relative to the "a" wave in the jugular vein and right atrial pressure tracing is considered to be a common haemodynamic sign of atrial septal defect. Since the prevalence, age relation, and haemodynamic determinants of the "v" greater than or equal to "a" wave configuration have not been studied the pressure recordings from 15 adults and 80 children with an isolated secundum atrial septal defect in sinus rhythm and from 40 adults and 55 children in sinus rhythm without s...

  4. Acquisition of nonlinear forward optics in generative models: two-stage "downside-up" learning for occluded vision.

    Science.gov (United States)

    Tajima, Satohiro; Watanabe, Masataka

    2011-03-01

    We propose a two-stage learning method which implements occluded visual scene analysis into a generative model, a type of hierarchical neural network with bi-directional synaptic connections. Here, top-down connections simulate forward optics to generate predictions for sensory driven low-level representation, whereas bottom-up connections function to send the prediction error, the difference between the sensory based and the predicted low-level representation, to higher areas. The prediction error is then used to update the high-level representation to obtain better agreement with the visual scene. Although the actual forward optics is highly nonlinear and the accuracy of simulated forward optics is crucial for these types of models, the majority of previous studies have only investigated linear and simplified cases of forward optics. Here we take occluded vision as an example of nonlinear forward optics, where an object in front completely masks out the object behind. We propose a two-staged learning method inspired by the staged development of infant visual capacity. In the primary learning stage, a minimal set of object basis is acquired within a linear generative model using the conventional unsupervised learning scheme. In the secondary learning stage, an auxiliary multi-layer neural network is trained to acquire nonlinear forward optics by supervised learning. The important point is that the high-level representation of the linear generative model serves as the input and the sensory driven low-level representation provides the desired output. Numerical simulations show that occluded visual scene analysis can indeed be implemented by the proposed method. Furthermore, considering the format of input to the multi-layer network and analysis of hidden-layer units leads to the prediction that whole object representation of partially occluded objects, together with complex intermediate representation as a consequence of nonlinear transformation from non-occluded to

  5. Effect of non-Newtonian characteristics of blood on magnetic particle capture in occluded blood vessel

    Energy Technology Data Exchange (ETDEWEB)

    Bose, Sayan; Banerjee, Moloy, E-mail: moloy_kb@yahoo.com

    2015-01-15

    Magnetic nanoparticles drug carriers continue to attract considerable interest for drug targeting in the treatment of cancer and other pathological conditions. Magnetic carrier particles with surface-bound drug molecules are injected into the vascular system upstream from the desired target site, and are captured at the target site via a local applied magnetic field. Herein, a numerical investigation of steady magnetic drug targeting (MDT) using functionalized magnetic micro-spheres in partly occluded blood vessel having a 90° bent is presented considering the effects of non-Newtonian characteristics of blood. An Eulerian–Lagrangian technique is adopted to resolve the hemodynamic flow and the motion of the magnetic particles in the flow using ANSYS FLUENT. An implantable infinitely long cylindrical current carrying conductor is used to create the requisite magnetic field. Targeted transport of the magnetic particles in a partly occluded vessel differs distinctly from the same in a regular unblocked vessel. Parametric investigation is conducted and the influence of the insert configuration and its position from the central plane of the artery (z{sub offset}), particle size (d{sub p}) and its magnetic property (χ) and the magnitude of current (I) on the “capture efficiency” (CE) is reported. Analysis shows that there exists an optimum regime of operating parameters for which deposition of the drug carrying magnetic particles in a target zone on the partly occluded vessel wall can be maximized. The results provide useful design bases for in vitro set up for the investigation of MDT in stenosed blood vessels. - Highlights: • Two counter rotating vortices forces the fluid flow back through the more viscous region. • The existence of strong recirculation zone just downstream side of the occlusion. • Configuration 4 produces the better efficient MDT system. • Modified Casson model predicts the highest value of CE, whereas the generalized power law gives

  6. Effect of non-Newtonian characteristics of blood on magnetic particle capture in occluded blood vessel

    International Nuclear Information System (INIS)

    Magnetic nanoparticles drug carriers continue to attract considerable interest for drug targeting in the treatment of cancer and other pathological conditions. Magnetic carrier particles with surface-bound drug molecules are injected into the vascular system upstream from the desired target site, and are captured at the target site via a local applied magnetic field. Herein, a numerical investigation of steady magnetic drug targeting (MDT) using functionalized magnetic micro-spheres in partly occluded blood vessel having a 90° bent is presented considering the effects of non-Newtonian characteristics of blood. An Eulerian–Lagrangian technique is adopted to resolve the hemodynamic flow and the motion of the magnetic particles in the flow using ANSYS FLUENT. An implantable infinitely long cylindrical current carrying conductor is used to create the requisite magnetic field. Targeted transport of the magnetic particles in a partly occluded vessel differs distinctly from the same in a regular unblocked vessel. Parametric investigation is conducted and the influence of the insert configuration and its position from the central plane of the artery (zoffset), particle size (dp) and its magnetic property (χ) and the magnitude of current (I) on the “capture efficiency” (CE) is reported. Analysis shows that there exists an optimum regime of operating parameters for which deposition of the drug carrying magnetic particles in a target zone on the partly occluded vessel wall can be maximized. The results provide useful design bases for in vitro set up for the investigation of MDT in stenosed blood vessels. - Highlights: • Two counter rotating vortices forces the fluid flow back through the more viscous region. • The existence of strong recirculation zone just downstream side of the occlusion. • Configuration 4 produces the better efficient MDT system. • Modified Casson model predicts the highest value of CE, whereas the generalized power law gives the least

  7. An External Focus of Attention Enhances Manual Tracking of Occluded and Visible Targets

    Directory of Open Access Journals (Sweden)

    Matthew eSchlesinger

    2013-01-01

    Full Text Available The present study investigated the enhancement effects of an external focus-of-attention (FOA in the context of a manual-tracking task, in which participants tracked both visible and occluded targets. Three conditions were compared, which manipulated the distance of the FOA from the participant as well as the external/internal dimension. As expected, an external FOA resulted in lower tracking errors than an internal FOA. In addition, analyses of participants' movement patterns revealed a systematic shift toward higher-frequency movements in the external FOA condition, consistent with the idea that an external FOA exploits the natural movement dynamics available during skilled action. Finally, target visibility did not influence the effect of focused attention on tracking performance, which provides evidence for the proposal that the mechanisms that underlie FOA do not depend directly on vision.

  8. Cannabinoids Occlude the HIV-1 Tat-Induced Decrease in GABAergic Neurotransmission in Prefrontal Cortex Slices.

    Science.gov (United States)

    Xu, Changqing; Hermes, Douglas J; Mackie, Ken; Lichtman, Aron H; Ignatowska-Jankowska, Bogna M; Fitting, Sylvia

    2016-06-01

    In the era of combined antiretroviral therapy (cART), human immunodeficiency virus type 1 (HIV-1) is now considered a chronic disease that specifically targets the brain and causes HIV-1-associated neurocognitive disorders (HAND). Endocannabinoids exhibit neuroprotective and anti-inflammatory properties in several central nervous system (CNS) disease models, but their effects in HAND are poorly understood. To address this issue, whole-cell recordings were performed on young (14-24 day old) C57BL/6J mice. We investigated the actions of the synthetic cannabinoid WIN55,212-2 (1 μM) and the endocannabinoid N-arachidonoyl ethanolamine (anandamide; AEA, 1 μM) in the presence of HIV-1 Tat on GABAergic neurotransmission in mouse prefrontal cortex (PFC) slices. We found a Tat concentration-dependent (5-50 nM) decrease in the frequency and amplitude of miniature inhibitory postsynaptic currents (mIPSCs). The cannabinoid 1 receptor (CB1R) antagonist rimonabant (1 μM) and zero extracellular calcium prevented the significant Tat-induced decrease in mIPSCs. Further, bath-applied WIN55,212-2 or AEA by itself, significantly decreased the frequency, but not amplitude of mIPSCs and/or spontaneous IPSCs (sIPSCs), and occluded a further downregulation of IPSCs by Tat. Pretreatment with rimonabant but not the CB2R antagonist AM630 (1 μM) prevented the WIN55,212-2- and AEA-induced decrease in IPSCs frequency without any further Tat effect. Results indicated a Tat-induced decrease in GABAergic neurotransmission, which was occluded by cannabinoids via a CB1R-related mechanism. Understanding the relationship between Tat toxicity and endocannabinoid signaling has the potential to identify novel therapeutic interventions to benefit individuals suffering from HAND and other cognitive impairments. PMID:26993829

  9. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding patient

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Seong, Chang Kyu; Kim, Yong Joo; Park, Noh Hyuk [Kyungpook National University School of Medicine, Daegu (Korea, Republic of); Shin, Tae Beom [Dong-A University Medical Center, Pusan (Korea, Republic of); Choi, Jin Soo [Soonchunhyang University College of Medicine, Asan (Korea, Republic of)

    2003-03-01

    To evaluate the technical feasibility and clinical efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in the treatment of gastric variceal bleeding. Between September 2001 and March 2002, ten patients with gastric variceal bleeding and gastrorenal shunt, underwent BRTO. Three of the ten also had hepatic encephalopathy. To evaluated the gastrorenal shunt and exclude portal vein thrombosis, all patients underwent pre-procedural CT scanning. An occlusion balloon catheter was inserted from the right internal jugular vein and on ballooning was wedged into the left adrenal vein. A sclerosing agent (5% ethanolamine oleate-lipiodol mixture) was injected until the varices were completely filled. In four patients, the collateral veins seen at balloon-occluded adrenal venography were embolized with coils prior to sclerotherapy. Post-procedural follow-up CT (n=3) or endoscopy (n=8) was performed 1-4 weeks later, and both before and after the procedure, hepatic function was also monitored. Treatment was successful in nine cases: the failure involed rupture of the occlusion balloon during inflation, and a transjugular intrahepatic portosystemic shunt was performed. The cessation of bleeding was confirmed endoscopically or clinically; in three patients, follow-up CT showed complete obliteration of the varices. Hepatic function improved in eight patients, but three weeks after the procedure, one expired due to progressive infiltrative hepatoma. The clinical symptoms of the three patients with hepatic encephalopathy showed remarkable improvement. Although more extensive studies and long-term follow up are needed to overcome the limitations of our study, we believe that BRTO is a technically feasible and clinically effective treatment for gastric varices and hepatic encephalopathy.

  10. Virtual Cardiac Surgery Using CFD: Application to Septal Myectomy in Obstructive Hypertrophic Cardiomyopathy

    Science.gov (United States)

    Vedula, Vijay; Mittal, Rajat; Abraham, Theodore

    2011-11-01

    Obstructive hypertrophic cardiomyopathy (HOCM) is characterized by ventricular wall thickening, diastolic dysfunction, and dynamic outflow tract obstruction, all of which strongly influence the vortex dynamics and pressure distribution in the left ventricle (LV). Severe cases of HCM are usually managed through septal myectomy where the surgeon resects the hypertrophic mass. Surgeons currently try to remove as much tissue as possible in order to optimize the post surgical result. However, excessive debulking increases the chance of ventricular septal defects, bundle branch block or complete heart block, and aneurysmal septal thinning. On the other hand, insufficient tissue removal also leads to unsatisfactory outcomes in terms of reduction of outflow tract pressure gradient. Knowing how much muscle to remove and where to remove it from could reduce the likelihood of complications and suboptimal outcomes. In the present study, we employ an immersed boundary solver to model the effect of septal myectomy for ventricles with HOCM and demonstrate the potential of such an approach for surgical planning. Computational resources were provided by the National Institute of Computational Science under Tergrid grant number TG-CTS100002.

  11. Videodensitometric time-density curve change after alcohol septal ablation of obstructive hypertrophic cardiomyopathy.

    Science.gov (United States)

    Nemes, A; Kalapos, A; Sasi, V; Ungi, T; Ungi, I; Forster, T; Sepp, R

    2015-02-01

    A recently developed computerized method for estimation of myocardial perfusion, based on the analysis of the time-density curves, is demonstrated to assess myocardial blush over a selected myocardial region of interest in a patient with obstructive hypertrophic cardiomyopathy before and after alcohol septal ablation. PMID:23184598

  12. [Permanent cardiac stimulation in a patient with isolated dextrocardia and ventricular septal defect].

    Science.gov (United States)

    Słowiński, S; Derlaga, B; Kapusta, J

    A case of pacemaker implantation because of acquired atrioventricular block third degree in woman aged 39 years with rare isolated dextrocardia with inversion of cardiac ventricles, compensatory transposition of both aorta and pulmonary artery, and ventricular septal defect. The end of electrode has wedged in the apex of the arterial ventricle. Following pacemaker implantation, patients clinical course of gynaecological operation was uneventful.

  13. Percutaneous closure of congenital aortocaval fistula with a coexisting secundum atrial septal defect

    DEFF Research Database (Denmark)

    Loh, Poay Huan; Jensen, Tim; Søndergaard, Lars

    2012-01-01

    Congenital aortocaval fistula is a very rare anomaly. Clinically, it resembles conditions that cause left-to-right shunt of blood. We report a case of such anomaly in combination with a secundum atrial septal defect in a 13-month-old girl who presented with failure to thrive and exertional respir...

  14. Direct transatrial pericardiocentesis for tamponade caused by left atrial perforation after trans-septal puncture.

    Science.gov (United States)

    Picard, Fabien; Millán, Xavier; de Hemptinne, Quentin; L L'allier, Philippe

    2016-01-01

    Trans-septal puncture is associated with risks of serious complications. We report a case of an obese 52-year-old man with hypertrophic cardiomyopathy who underwent preoperative coronary angiography and cardiac catheterisation complicated by left atrial perforation. We describe a direct transatrial pericardiocentesis approach to treating cardiac tamponade. PMID:27389729

  15. Lateral septal vasopressin in rats : Role in social and object recognition?

    NARCIS (Netherlands)

    Everts, HGJ; Koolhaas, JM

    1997-01-01

    The capacity of male rats to remember familiar conspecifics is called social recognition. It is a form of short-term memory modulated by lateral septal (LS) vasopressin (VP). The specificity of this phenomenon was studied by examining whether recognition of previously investigated objects is also un

  16. Right ventricular collagen and fibronectin levels in patients with pulmonary atresia and ventricular septal defect

    NARCIS (Netherlands)

    Peters, Theodorus H F; de Jong, Peter L; Klompe, Lennart; Berger, Rolf M F; Saxena, Pramod R; Sharma, Hari S; Bogers, Ad J J C; Berger, Rudolphus

    2003-01-01

    Pulmonary atresia (PA) with ventricular septal defect (VSD) is an extreme form of tetralogy of Fallot with characteristic right ventricular hypertrophy. To reduce the right ventricular overload, these children have to undergo staged corrective surgery to restore physiological pulmonary perfusion. We

  17. Difficult case of a trans-septal puncture: Use of a “SafeSept” guidewire

    Institute of Scientific and Technical Information of China (English)

    Martina; Zucchetti; Michela; Casella; Antonio; Dello; Russo; Gaetano; Fassini; Corrado; Carbucicchio; Eleonora; Russo; Vittoria; Marino; Valentina; Catto; Claudio; Tondo

    2015-01-01

    A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped "Safe Sept" trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the "Safe Sept" guidewire, when advanced into the left atrium, becomes atraumatic.

  18. The role of temporalis fascia for free mucosal graft survival in small nasal septal perforation repair.

    Science.gov (United States)

    Jeon, Eun-Ju; Choi, Jin; Lee, Joo-Hyung; Kim, Sung-Won; Nam, In-Chul; Park, Yong-Su; Jin, Sang-Gyun; Cheon, Byung-Jun

    2014-01-01

    Temporalis fascia has been used widely as a interposition graft for mucosal rotation flap in nasal septal perforation repair. However, the exact role of temporalis fascia in healing process has not yet been clarified. For the pedicle of rotation flap has been considered as a major vehicle for nutrition distribution, the role of temporalis fascia has been devaluated. In this study, we experienced small nasal septal perforation repairs using free mucosal graft not having pedicles but covered by temporalis fascia. Three patients with small nasal septal perforations not larger than 1 × 1 cm were included. In 2 patients, the perforations were repaired using free composite grafts from the inferior turbinate mucosa covered by continuous temporalis fascia not divided, and the surgical results were successful with complete healings. In 1 patient, however, the temporalis fascia was divided into 2 parts to better fit the shape of the perforation, and the graft failed to survive. These surgical results suggest that the temporalis fascia might have an important role in healing process of nasal septal defect and could be used as a beneficial options for small mucosal defect repair surgeries using free mucosal grafts.

  19. Sinonasal Headaches and Post-Operative Outcomes after Septoplasty in Patients with Nasal Septal Deviation

    Directory of Open Access Journals (Sweden)

    Ali Ghazipour

    2011-03-01

    Headache is one of the most common symptoms in patients with nasal anatomical abnormalities such as septal deviation and usually responds well to surgical treatment. More studies with long-term follow-ups seems to be inevitable to determine the relationship between headaches and nasal anatomical abnormalities, accurate surgical results in patients’ recovery and the recurrence rate of headaches.

  20. Lupus vulgaris of external nose with septal perforation--a rarity in antibiotic era.

    Science.gov (United States)

    Garg, Ajay; Wadhera, Raman; Gulati, S P; Singh, Jagjit

    2010-07-01

    Lupus vulgaris (LV) is the commonest morphological variant of cutaneous tuberculosis. Case of LV of external nose extending to internal nose causing septal perforation is documented here. Histopathology of biopsy taken confirmed the diagnosis of LV. Patient responded well to Anti-tubercular therapy (ATT).

  1. Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

    DEFF Research Database (Denmark)

    Veselka, Josef; Jensen, Morten Kvistholm; Liebregts, Max;

    2016-01-01

    AIMS: The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still...

  2. Cardiac troponin I degradation in serum of patients with hypertrophic obstructive cardiomyopathy undergoing percutaneous septal ablation

    DEFF Research Database (Denmark)

    Madsen, Lene H; Lund, Terje; Grieg, Zanina;

    2009-01-01

    : percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic obstructive cardiomyopathy (HOCM). Here the iatrogenic induction of myocardial necrosis occurs in vivo, allowing us to investigate degradation of cTnI by the second. METHODS: Blood samples were obtained from 8 patients with HOCM just...

  3. Transcoronary ablation of septal hypertrophy compared with surgery in the treatment of hypertrophic obstructive cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    姜腾勇; 吴学思; 吕强; 孟旭; 贾长琪; 张银

    2004-01-01

    @@ Transcoronary ablation of septal hypertrophy (TASH)can lead to sustained improvement in both hemodynamics and symptoms in patients with hypertrophic obstructive cardiomyopathy ( HOCM ) . 1-4 However, there have been few reports about its efficacy and safety compared with traditional surgical procedures. This study sought to compare TASH with surgery in the treatment of HOCM.

  4. The unnatural history of the ventricular septal defect : outcome up to 40 years after surgical closure

    NARCIS (Netherlands)

    Menting, Myrthe E; Cuypers, Judith A A E; Opić, Petra; Utens, Elisabeth M W J; Witsenburg, Maarten; van den Bosch, Annemien E; van Domburg, Ron T; Meijboom, Folkert J; Boersma, Eric; Bogers, Ad J J C; Roos-Hesselink, Jolien W

    2015-01-01

    BACKGROUND: Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD). OBJECTIVES: The objective of this study was to investigate clinical outcomes>30 years after surgical VSD closure. METHODS: Patients who underwent surgical VSD clos

  5. Balloon occluded retrograde transvenous obliteration of bleeding stomal varices using sodium tetradecyl sulfate foam: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Chang; Yang, Po Sang; Lee, Yeon Soo; Kim, Hyun Jeong; Park, Gun [Dept. of Radiology, The Catholic University of Korea College of Medicine, Daejeon St. Mary' s Hospital, Daejeon (Korea, Republic of)

    2015-05-15

    A small varix is an uncommon complication with a high mortality rate occurring secondary to portal hypertension in patients with a stoma. We describe a case of recurrent stomal varix bleeding successfully managed by balloon occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam.

  6. Balloon occluded retrograde transvenous obliteration of bleeding stomal varices using sodium tetradecyl sulfate foam: A case report

    International Nuclear Information System (INIS)

    A small varix is an uncommon complication with a high mortality rate occurring secondary to portal hypertension in patients with a stoma. We describe a case of recurrent stomal varix bleeding successfully managed by balloon occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam.

  7. THE FIRST EXPERIENCE OF LEFT ATRIAL APPENDAGE OCCLUDING DEVICES IMPLANTATION FOR PREVENTION OF STROKE IN THE STATE RESEARCH CENTRE FOR PREVENTIVE MEDICINE

    Directory of Open Access Journals (Sweden)

    K. V. Davtyan

    2015-09-01

    Full Text Available Some aspects of prevention of thromboembolic events in patients with atrial fibrillation, in particular, the use of implantable left atrial appendage occluding devices are discussed. Along with the literature review on this issue, the results of authors own experience of left atrial appendage occluding devices implantation is presented.

  8. Routine preoperative cardiac catheterization necessary before repair of secundum and sinus venosus atrial septal defects

    International Nuclear Information System (INIS)

    Between January 1976 and July 1983, 217 patients with atrial septal defect underwent surgical repair at Children's Hospital. Thirty with a primum atrial septal defect and 26 who underwent cardiac catheterization elsewhere before being seen were excluded from analysis. Of the 161 remaining patients, 52 (31%) underwent preoperative cardiac catheterization, 38 because the physical examination was considered atypical for a secundum atrial septal defect and 14 because of a preexisting routine indication. One hundred nine (69%) underwent surgery without catheterization, with the attending cardiologist relying on clinical examination alone in 5, additional technetium radionuclide angiocardiography in 5, M-mode echocardiography in 13 and two-dimensional echocardiography in 43; both M-mode echocardiography and radionuclide angiography were performed in 24 and two-dimensional echocardiography and radionuclide angiography in 19. Since 1976, there has been a trend toward a reduction in the use of catheterization and use of one rather than two noninvasive or semiinvasive techniques for the detection of atrial defects. Of the 52 patients who underwent catheterization, the correct anatomic diagnosis was made before catheterization in 47 (90%). Two patients with a sinus venosus defect and one each with a sinus venosus defect plus partial anomalous pulmonary venous connection, partial anomalous pulmonary venous connection without an atrial septal defect and a sinoseptal defect were missed. Of 109 patients without catheterization, a correct morphologic diagnosis was made before surgery in 92 (84%). Nine patients with a sinus venosus defect, three with sinus venous defect and partial anomolous pulmonary venous connection, four with partial anomalous pulmonary venous return without an atrial septal defect and one with a secundum defect were incorrectly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Association of TBX5 gene polymorphism with ventricular septal defect in the Chinese Han population

    Institute of Scientific and Technical Information of China (English)

    LIU Cai-xia; SHEN A-dong; LI Xiao-feng; JIAO Wei-wei; BAI Song; YUAN Feng; GUAN Xiao-lei; ZHANG Xin-gen; ZHANG Gui-rong; LI Zhong-zhi

    2009-01-01

    Background Congenital heart disease is a diverse group of diseases determined by genetic and environmental factors. Considerable research has been done on genes associated with development of the heart. A recent focus is the role of transcription factor TBX5 in the development of atria, left ventricle and conduction system. As part of a larger study, high density, single nucleotide polymorphism (SNP) scanning was used to explore the relationship between TBX5 gene polymorphism and susceptibility to ventricular septal defect not associated with forelimb malformation in the Chinese Han population. Methods One hundred and ninety two paediatric patients with congenital ventricular septal defect and 192 matched healthy control subjects were studied. The haplotype reconstructions were calculated by PHASE2.0 software. Haploview software was used to 15erform linkage disequilibrium assessment and defining of haplotype blocks. The algorithm used for defining of blocks was the confidence interval method. Results The TBX5 gene region can be divided into 3 haplotype blocks of 27, 15 and 2 SNPs. Strong linkage disequilibrium exists within each block. SNP rs11067075 within the TBX5 gene had significant correlation with ventricular septal defect (P=0.0037) by single marker association analysis. In addition, a 20 kb haplotype composed of 27 SNPs correlated with ventricular septal defect (P=0.05, multiple loci regression analyses based on reconstructed haplotype blocks). Conclusions TBX5 is associated with the occurrence of ventricular septal defect and may be a predisposing gene to congenital heart disease in Hart Chinese. This finding has set a direction for further genetic and functional studies.

  10. Characterization of a non-occluded baculovirus-like agent pathogenic to penaeid shrimp.

    Science.gov (United States)

    Nadala, E C; Tapay, L M; Loh, P C

    1998-07-30

    A non-occluded baculovirus-like agent recently isolated by this laboratory from moribund Penaeus japonicus shrimps obtained from China and named Chinese baculovirus (CBV) was purified and some of its properties characterized. Under the electron microscope, negatively stained virus particles were rod-shaped, enveloped, and measured 322 to 378 nm in length and 130 to 159 nm in diameter. The nucleoprotein core exhibited a unique striated structure and measured 316 to 350 nm in length and 65 to 66 nm in diameter. The striations appear to be the result of the stacking of ring-like structures. These rings consisted of 2 rows of 12 to 14 globular subunits. Each globular subunit measured approximately 10 nm in diameter. SDS-PAGE gels of purified virus preparations showed, among several, 4 prominent protein bands with approximate molecular weights of 19, 23.5, 27.5 and 75 kDa. The structural viral proteins were identified by western blot analysis using polyclonal hyperimmune serum made against purified CBV. The 19, 27.5, and 75 kDa structural proteins were determined to be non-glycosylated components associated with the viral envelope. The 23.5 kDa protein, also non-glycosylated, was identified with the capsid structure. Viral genomic DNA digested with Hind III restriction endonuclease revealed at least 29 different fragments with a conservatively estimated total size of at least 183 kb.

  11. Evaluation of the occluded carbon within husk phytoliths of 35 rice cultivars

    Science.gov (United States)

    Sun, Xing; Liu, Qin; Gu, Jie; Chen, Xiang; Zhu, Keya

    2016-01-01

    Rice is a well-known silicon accumulator. During its periods of growth, a great number of phytoliths are formed by taking up silica via the plant roots. Concurrently, carbon in those phytoliths is sequestrated by a mechanism of long-term biogeochemical processes within the plant. Phytolith occluded C (PhytOC) is very stable and can be retained in soil for longer than a millennium. In this study, we evaluated the carbon biosequestration within the phytoliths produced in rice seed husks of 35 rice cultivars, with the goal of finding rice cultivars with relatively higher phytolith carbon sequestration efficiencies. The results showed that the phytolith contents ranged from 71.6 mg•g‒1 to 150.1 mg•g‒1, and the PhytOC contents ranged from 6.4 mg•g‒1 to 38.4 mg•g‒1, suggesting that there was no direct correlation between the PhytOC content and the content of rice seed husk phytoliths (R = 0.092, p>0.05). Of all rice cultivars, six showed a higher carbon sequestration efficiency in phytolith seed husks. Additionally, the carbon biosequestration within the rice seed husk phytoliths was approximately 0.45‒3.46 kg-e-CO2•ha‒1•yr‒1. These rates indicate that rice cultivars are a potential source of carbon biosequestration which could contribute to the global carbon cycle and climate change.

  12. Laser scoop desobliteration: a method for minimally invasive remote recanalization of chronically occluded superficial femoral arteries

    Science.gov (United States)

    Heneweer, Carola; Siggelkow, Markus; Helle, Michael; Petzina, Rainer; Wulff, Asmus; Schaefer, Joost P.; Berndt, Rouven; Rusch, Rene; Wedel, Thilo; Klaws, Guenther; Müller-Gerbl, Magdalena; Röcken, Christoph; Jansen, Olav; Lutter, Georg; Cremer, Joachim; Groß, Justus

    2015-02-01

    Stenosis and occlusion of the superficial femoral artery (SFA) are most common in arterial occlusive disease. There are numerous interventional, surgical, and combined approaches to reconstitute maximum blood supply to the lower limb; however, despite intense clinical research, the long-term success rates are still poor. We present the first results with a catheter prototype for laser-based minimal invasive endarterectomy, called laser scoop desobliteration (LSD). The tip of a glass fiber containing a catheter was modified with a spatula head design and connected to an ultraviolet laser. It was tested in cadavers fixed with the Thiel embalming technique preserving tissue consistency, flexibility, and plasticity. After longitudinal arteriotomy of the SFA, a circular dissection between media and adventitia was performed. Then the LSD catheter was inserted and propagated with a progress of 1 mm/s. Afterward, the atheroma core, which showed a plain surface without substantial attaching tissue debris, was removed. Histological examination of the vessel wall showed that the dissection was performed at the media/adventitia interface. In summary, the constructed LSD catheter allowed a rapid and easy way to perform an endarterectomy, thereby offering an innovative approach in the treatment of chronic occluded SFA.

  13. The Incidence of Hepatocellular Carcinoma after Balloon-Occluded Retrograde Transvenous Obliteration

    Directory of Open Access Journals (Sweden)

    Keiji Yokoyama

    2015-01-01

    Full Text Available Balloon-occluded retrograde transvenous obliteration (BRTO is a highly effective therapy for gastric varices with liver cirrhosis. We have investigated the incidence of hepatocellular carcinoma (HCC after BRTO. We enrolled 71 patients with viral hepatitis in which HCC had not appeared with liver imaging findings at the time of BRTO. The overall survival rate after BRTO was 86.8%, 76.1%, and 50.5% at 1, 3, and 5 years. The occurrence rate of HCC after BRTO was 20.9%, 41.1%, and 60.7% at 1, 3, and 5 years, especially showing a higher occurrence of HCC at one year. Meanwhile, the occurrence rate of HCC after treatment which excluded BRTO for esophagogastric varices in patients was 6.3%, 19.2%, and 42.5% at 1, 3, and 5 years. The log-rank test revealed that the occurrence rate of HCC after treatment was significantly higher in the BRTO group compared with that in the non-BRTO group (P=0.0447. The recurrence rate of HCC after BRTO was 35.8% and 80.0% at 1 and 3 years. The present study demonstrated a high incidence of HCC after BRTO in liver cirrhosis patients with viral hepatitis infection. We have suggested the potential for BRTO to accelerate hepatocarcinogenesis.

  14. Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

    Institute of Scientific and Technical Information of China (English)

    Min Joung Kim; Byoung Kuk Jang; Woo Jin Chung; Jae Seok Hwang; Young Hwan Kim

    2012-01-01

    We report a case of duodenal varix bleeding as a long term complication of balloon occluded retrograde transvenous obliteration (BRTO),which was successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS).A 57-year-old man was admitted to the emergency room suffering from melena.He had undergone BRTO to treat gastric varix bleeding 5 mo before admission.Endoscopy and a computed tomography (cr) scan showed complete obliteration of the gastric varix,but the nodular varices in the second portion of the duodenum expanded after BRTO,and spurting blood was seen.TIPS was performed for treatment of duodenal variceal bleeding,because attempts at endoscopic varix ligation were unsuccessful.The postoperative course was uneventful and the patient was discharged without complications.A follow up CT scan obtained 21 mo after TIPS revealed a patent TIPS tract and complete obliteration of duodenal varices,but multinodular hepatocellular carcinoma had developed.He died of hepatic failure 28 mo after TIPS.

  15. Transjugular Approach to Device Closure of Atrial Septal Defect in a Child with Heterotaxia and Interrupted Inferior Vena Cava

    OpenAIRE

    Ozbarlas, Nazan; Kiziltas, Alev; Kucukosmanoglu, Osman; Erdem, Sevcan

    2012-01-01

    In heterotaxia syndrome with left atrial isomerism, the distinguishing feature is interrupted inferior vena cava with azygos continuation. We report using a transjugular approach to device closure of an atrial septal defect in an 8-year-old boy with heterotaxia syndrome. We found that device closure of the child's atrial septal defect through a jugular venous approach was safe when an inferior vena cava approach was not possible. To our knowledge, ours is the first report of the use of intern...

  16. Value of transthoracic echocardiography on guiding occlusion of soft-rim atrial septal defect%经胸超声心动图指导软缘房间隔缺损封堵的价值

    Institute of Scientific and Technical Information of China (English)

    张军; 李军; 石晶; 张玉顺; 左健; 代政学; 李寰; 朱霆

    2008-01-01

    Objective To evaluate the feasibility and effect of transthoracic echocardiography(TTE)on guiding the occlusion of the soft-rim atrial septal defect(ASD).Methods Sixty two patients with the soft-rim ASD were enrolled.The size of ASD was measured and rim of ASD was observed by TTE on various views by using color Doppler system with tissue harmonic function before occlusion,and filmy rim of ASD with flapping which could not sustain occluder was eliminated.The size of occluder was selected by integratively judging the size of ASD and"sustainable diameter of ASD"The waist size of occluder was measured after releasing occluder and compared with the longest diameter of ASD and"sustainable diameter of ASD"measured by TTE.Results The longest diameter of ASD measured by TTE before occlusion was 11-35 mm[average(21.6±5.2)mm],the "sustainable diameter of ASD"was 15-37 mm[average(25.6±5.(J)mm],the size of selected occluder was 18-44mm[average(30.7±5.5)mini and the waist size of released occluder was 13-35 mm[average(24.2±5.6)mm].Fine correlation was existed between the longest diameter of ASD measured by TTE and the waist size of released occluder(r=0.86,P<0.000I).Morever,improved correlation was found between the"sustainable diameter of ASD"measured by TTE and the waist size of released occluder(r=0.89,P<0.0001).Occluder was firmly fixed without falling in all patients.Conclusions TTE with tissue harmonic function can be used to measure the size of soft-rim ASD and the"sustainable diameter of ASD".It is a feasible,and effective method on guiding occlusion of soft-rim ASD.%目的 评价经胸超声心动图(TTE)指导软缘房间隔缺损(ASD)封堵术的可行性和作用.方法 62例软缘ASD患者,术前用彩色多普勒超声心动图结合组织谐波功能经胸测量各切面ASD大小及观察周缘软硬情况,将菲薄且来回明显摆动、无支撑力的软缘剔除测量"ASD支撑径".再根据ASD大小和"ASD支撑径"大小综合判断选择适当的

  17. Overexpression of SepJ alters septal morphology and heterocyst pattern regulated by diffusible signals in Anabaena.

    Science.gov (United States)

    Mariscal, Vicente; Nürnberg, Dennis J; Herrero, Antonia; Mullineaux, Conrad W; Flores, Enrique

    2016-09-01

    Filamentous, N2 -fixing, heterocyst-forming cyanobacteria grow as chains of cells that are connected by septal junctions. In the model organism Anabaena sp. strain PCC 7120, the septal protein SepJ is required for filament integrity, normal intercellular molecular exchange, heterocyst differentiation, and diazotrophic growth. An Anabaena strain overexpressing SepJ made wider septa between vegetative cells than the wild type, which correlated with a more spread location of SepJ in the septa as observed with a SepJ-GFP fusion, and contained an increased number of nanopores, the septal peptidoglycan perforations that likely accommodate septal junctions. The septa between heterocysts and vegetative cells, which are narrow in wild-type Anabaena, were notably enlarged in the SepJ-overexpressing mutant. Intercellular molecular exchange tested with fluorescent tracers was increased for the SepJ-overexpressing strain specifically in the case of calcein transfer between vegetative cells and heterocysts. These results support an association between calcein transfer, SepJ-related septal junctions, and septal peptidoglycan nanopores. Under nitrogen deprivation, the SepJ-overexpressing strain produced an increased number of contiguous heterocysts but a decreased percentage of total heterocysts. These effects were lost or altered in patS and hetN mutant backgrounds, supporting a role of SepJ in the intercellular transfer of regulatory signals for heterocyst differentiation.

  18. Radionuclide assessment of left ventricular perfusion and function after percutaneous translumial septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

    International Nuclear Information System (INIS)

    Objective: The purpose of this study was to evaluate the clinical value of 99Tcm-MIBI myocardial perfusion imaging (MPI) and equilibrium radionuclide angiography (ERNA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent percutaneous translumial septal myocardial ablation (PTSMA). Methods: Eight patients (5 men, 3 women) with symptomatic HOCM underwent rest 99Tcm-MIBI MPI and ERNA before and after PTSMA. The septal-to-lateral counts ratio and the extent of septal perfusion defect of the left ventricle were calculated from MPI. The left ventricular ejection fraction (EF), peak filling rate (PFR) and septal regional EF were measured from ERNA. Results: 99Tcm-MIBI MPI showed increased septa199Tcm-MIBI uptake before PTSMA in all patients, but septal perfusion defects after PTSMA in 7 patients. The count-activity ratio of the septal-to-lateral wall decreased from 1.15±0.11 to 0.76±0.14 (p0.05 ]. Conclusion: MPI and ERNA are useful for the assessment of myocardial pefusion and change of left ventricular function after PTSMA in patients with HOCM. (authors)

  19. Study Of The Effect Of Nasal- Septal Deviation On The Middle Ear Pressure

    Directory of Open Access Journals (Sweden)

    Motesaddi Zarandi M

    2003-10-01

    Full Text Available Eustachian tube connects middle ear space to the nasopharyngeal space. Upper airway obstruction, with any cause, can derange Eustachian tube function. Nasal septal deviation is one of the prevalent causes of upper airway obstruction which can affects the ventilation function of Eustachian tube."nMaterials and Methods: This study was conducted on the patients who underwent septoplasty due to severe septal deviation leading to unilateral nasal obstruction in Amiraalam hospital from summer of 1378 till the spring of 1379."nResults: There was 140 patients whose data were as: female patients 34 (24.3% male patients 106 (75.7%, mean age (22.7. Median age (20 years and mode of age (18 years of age. they were from 12 to 40 years of age."nConclusion: Comparison between preoperative and postoperative middle ear pressures shows no any significant statistical difference (p=0.798.

  20. Double-chambered right ventricle, ventricular septal defect, patent ductus arteriosus in a dog

    International Nuclear Information System (INIS)

    A 4-month-old female mongrel puppy was presented with an anophthalmos. On physical examination, systolic murmur was heard at the 4th left intercostal space near the sternum. However the dog appeared healthy without cyanosis and had no history of exercise intolerance. The phonocardiogram revealed a pansystolic murmur and a continuous murmur on the mitral area. A systolic ejection murmur was also recorded on the pulmonic area. The electrocardiogram indicated bi-ventricular hypertrophy. Left ventricular enlargement was seen on chest radiographs. Ventricular septal defect (VSD) and patent ductus arteriosus (PDA) were diagnosed from these findings. PDA closure was performed at 2 years of age. After 2 months from the operation, the dog died during an attempted repair of the VSD. At necropsy, it was found that the double-chambered right ventricle (DCRV) was formed by an anomalous septal band. The VSD was localized on the proximal conus and was 8 mm in diameter. (author)

  1. Prolonged postoperative desaturation in a child with Down syndrome and atrial septal defect

    Directory of Open Access Journals (Sweden)

    Renu Sinha

    2011-01-01

    Full Text Available We report prolonged desaturation in a child with Down syndrome (DS and atrial septal defect due to undiagnosed interstitial lung disease. An 18-month-old child with DS was scheduled for bilateral lens aspiration for cataract. The child had atrial septal defect and hypothyroidism. He also had delayed milestones and hypotonia with episodes of recurrent respiratory tract infection necessitating repeated hospitalization. Preoperative evaluation was unremarkable. General anaesthesia and controlled ventilation using proseal laryngeal mask airway was instituted. He had uneventful intraoperative period. In the postoperative period, the child had desaturation 1 hour after surgery on discontinuation of oxygen supplementation by face mask, which improved with oxygen therapy. Supplemental oxygen via face mask was continued and weaned off over several days. On further evaluation, the child was diagnosed as having interstitial lung disease. He improved and discharged from the hospital 15 days after the surgery with room air saturation of 90%.

  2. Comparison of P2X receptors in rat mesenteric, basilar and septal (coronary) arteries.

    Science.gov (United States)

    Lewis, C J; Evans, R J

    2000-07-01

    alpha beta meATP-evoked concentration-dependent, PPADS-sensitive, desensitising, P2X receptor-mediated, constrictions of mesenteric, basilar and septal artery rings with EC(50) values of 1, 1 and 30 microM, respectively. In patch clamp studies on acutely dissociated artery smooth cells alpha beta meATP-evoked transient inward currents (tau approximately 100 ms) with mean current densities of approximately 340, 175 and 120 pA/pF, respectively. P2X(1) receptor immunoreactivity was expressed in mesenteric and basilar arteries and this receptor subunit appears to dominate the P2X receptor phenotype in these vessels. In contrast P2X(1) receptor immunoreactivity was not detected in septal arteries and the alpha beta meATP sensitivity of constriction was not consistent with the involvement of P2X(1) receptors. These results suggest that not all arteries share a common P2X receptor phenotype.

  3. The role of septal surgery in management of the deviated nose.

    Science.gov (United States)

    Foda, Hossam M T

    2005-02-01

    The deviated nose represents a complex cosmetic and functional problem. Septal surgery plays a central role in the successful management of the externally deviated nose. This study included 260 patients seeking rhinoplasty to correct external nasal deviations; 75 percent of them had various degrees of nasal obstruction. Septal surgery was necessary in 232 patients (89 percent), not only to improve breathing but also to achieve a straight, symmetrical, external nose as well. A graduated surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the dorsum or nasal tip. The approach depended on full mobilization of deviated cartilage, followed by straightening of the cartilage and its fixation in the corrected position by using bony splinting grafts through an external rhinoplasty approach. PMID:15692343

  4. Synaptic Targets of Medial Septal Projections in the Hippocampus and Extrahippocampal Cortices of the Mouse.

    Science.gov (United States)

    Unal, Gunes; Joshi, Abhilasha; Viney, Tim J; Kis, Viktor; Somogyi, Peter

    2015-12-01

    Temporal coordination of neuronal assemblies among cortical areas is essential for behavioral performance. GABAergic projections from the medial septum and diagonal band complex exclusively innervate GABAergic interneurons in the rat hippocampus, contributing to the coordination of neuronal activity, including the generation of theta oscillations. Much less is known about the synaptic target neurons outside the hippocampus. To reveal the contribution of synaptic circuits involving the medial septum of mice, we have identified postsynaptic cortical neurons in wild-type and parvalbumin-Cre knock-in mice. Anterograde axonal tracing from the septum revealed extensive innervation of the hippocampus as well as the subiculum, presubiculum, parasubiculum, the medial and lateral entorhinal cortices, and the retrosplenial cortex. In all examined cortical regions, many septal GABAergic boutons were in close apposition to somata or dendrites immunopositive for interneuron cell-type molecular markers, such as parvalbumin, calbindin, calretinin, N-terminal EF-hand calcium-binding protein 1, cholecystokinin, reelin, or a combination of these molecules. Electron microscopic observations revealed septal boutons forming axosomatic or axodendritic type II synapses. In the CA1 region of hippocampus, septal GABAergic projections exclusively targeted interneurons. In the retrosplenial cortex, 93% of identified postsynaptic targets belonged to interneurons and the rest to pyramidal cells. These results suggest that the GABAergic innervation from the medial septum and diagonal band complex contributes to temporal coordination of neuronal activity via several types of cortical GABAergic interneurons in both hippocampal and extrahippocampal cortices. Oscillatory septal neuronal firing at delta, theta, and gamma frequencies may phase interneuron activity. PMID:26631464

  5. Successful device closure of a post-infarction ventricular septal defect

    OpenAIRE

    Jin, Seon Ah

    2016-01-01

    Si-Wan Choi,* Ji Hye Han,* Seon-Ah Jin, Mijoo Kim, Jae-Hwan Lee, Jin-Ok Jeong Division of Cardiology, Department of Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea *These authors contributed equally to this work Abstract: Ventricular septal defect (VSD) is a lethal complication of myocardial infarction. The event occurs 2–8 days after an infarction and patients should undergo emergency surgical ...

  6. Successful device closure of a post-infarction ventricular septal defect

    OpenAIRE

    Choi SW; Han JH; Jin SA; Kim M; Lee JH; Jeong JO

    2016-01-01

    Si-Wan Choi,* Ji Hye Han,* Seon-Ah Jin, Mijoo Kim, Jae-Hwan Lee, Jin-Ok Jeong Division of Cardiology, Department of Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea *These authors contributed equally to this work Abstract: Ventricular septal defect (VSD) is a lethal complication of myocardial infarction. The event occurs 2–8 days after an infarction and patients should undergo emergency surgical treatmen...

  7. A Case Report of Percutaneous Transluminal Septal Myocardial Ablation in Patients with Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    M.H. Namazi

    2004-10-01

    Full Text Available A number of patients with severe obstruction due to hypertrophic cardiomyopathy have derived benefit at least over the short-term from inventional infarction of a portion of the interventricular septum by the infusion of alcohol into a selectively catheterized septal artery , with reduction of the outflow gradient and improvement in symptoms .This paper contains successful TASH on a symptomatic patient with high LVOT gradient and methods and complications.

  8. Hippocampal infusions of pyruvate reverse the memory-impairing effects of septal muscimol infusions

    OpenAIRE

    Krebs, Desiree L.; Parent, Marise B.

    2005-01-01

    Hippocampal infusions of glucose reverse memory deficits in spontaneous alternation and in a continuous multiple trial inhibitory avoidance task. The current experiments tested whether glucose metabolism may participate in these effects of glucose. Specifically, these experiments determined whether the glycolytic metabolite pyruvate would mimic these effects of glucose. Male Sprague–Dawley rats were given septal infusions of vehicle or the gamma-aminobutyric acid (GABA) receptor agonist musci...

  9. Free Wall Rupture and Ventricular Septal Defect Post Acute Anterior Myocardial Infarction

    OpenAIRE

    Mohammad Sahebjam; Ali Mohammad Haji Zeinali; Maryam Semnani; Seyed Hesameddin Abbasi; Shahla Majidi; Mahmood Shirzad; Naghmeh Moshtaghi; Seyed Ebrahim Kassaian; Kyomars Abbasi; Hakimeh Sadeghian

    2007-01-01

    Myocardial free wall rupture is a catastrophic complication of acute myocardial infarction, and prognosis will depend on the prompt diagnosis by echocardiography, extension of infarct size, and prompt surgical treatment. Free wall rupture concomitant with ventricular septal defect (VSD) may be more complicated for management. A case of a 69-year-old man with myocardial free wall rupture and VSD following acute anterior myocardial infarction is presented.

  10. EPIDURAL ANESTHESIA FOR CESAREAN SECTION IN ATRIAL SEPTAL DEFECT WITH PULMONARY HYPERTENSION

    Directory of Open Access Journals (Sweden)

    Rashmi

    2015-07-01

    Full Text Available Pregnant patients with atrial septal defect (ASD with pulmonary hypertension , occasionally present for anaesthesia . These patients are considered high risk for anaesthesia due to increased chances of per i operative cardiovascular complications . Anaesthesia requires intensive cardiovascular mo nitoring and maintenance of stable pulmonary and systemic haemodynamics . Here is a case of second gravida for LSCS which was managed under epidural anaesthesia successfully

  11. Dilatation of the Great Arteries in an Infant with Marfan Syndrome and Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    L. Rozendaal

    2011-01-01

    Full Text Available We describe an infant presenting with contractures of the fingers, a large ventricular septal defect (VSD, and severe pulmonary artery dilatation. He had clinical and echocardiographic features of both neonatal or infantile Marfan syndrome (MFS and congenital contractural arachnodactyly. After surgical VSD closure, the aortic root developed progressive dilatation while the size of pulmonary artery returned to normal limits. Eventually the diagnosis of MFS was confirmed by DNA analysis.

  12. Masking of Pressure Overload in a Patient with Pulmonary Thromboembolism Accompanied by Atrial Septal Aneurysm

    OpenAIRE

    Yu, Tae Kyung; Kim, Woo Shik; Kim, Weon

    2011-01-01

    A pulmonary thromboembolism (PTE) causes a dramatic pressure overload to the right heart. Previous case reports have shown that elevated right atrial pressure secondary to a PTE can cause right-to-left shunting in the presence of an atrial septal aneurysm (ASA). A 57-year-old female with diabetes, hypertension, and an old cerebral infarction was admitted to our hospital with acute PTE. Initial transthoracic echocardiography (TTE) showed an ASA swing from the right side to the left side, and r...

  13. TYMPANOPLASTY WITH SEPTAL CARTILAGE AND CORTICAL MASTOID BONE IN CHOLESTEATOMA PATIENTS

    Directory of Open Access Journals (Sweden)

    Biram Singh

    2015-12-01

    Full Text Available OBJECTIVE This study was conducted to find out the ideal graft between septal cartilage and cortical mastoid bone in Farrior’s type 3 tympanoplasty in cholesteatoma patients in terms of hearing improvement, graft status and recurrence rate of the disease after canal wall down mastoidectomy. METHODS This randomized controlled trial was conducted in a tertiary care centre and the procedure and data collections were carried out for one and a half calendar year with effect from September 2007 and each case was followed up for 6 months. The data were entered and calculated statistically using SPSS16 for windows. RESULTS The study shows significant hearing improvement in both the groups. The tympanoplasty type 3 with cortical mastoid bone had air bone gap less than 20dB in 40% of patients. In septal cartilage, tympanoplasty group air bone gap less than 20dB was observed in 36.4%. Retraction of graft developed in 1(2.4% out of 20 patients among cortical mastoid bone tympanoplasty group. Among 22 patients of septal cartilage tympanoplasty type 3, 2(4.8% patients had cartilage resorption and 3(7.1% had graft displacement. Of the total 42 patients, 2(4.8% developed recurrence of the disease. CONCLUSION Cholesteatoma management is controversial. Canal wall down mastoidectomy can reduce the recurrence of disease. The cortical mastoid bone and septal cartilage grafts can provide hearing improvement after tympanoplasty type 3. There is no significant difference in hearing improvement between the two grafts.

  14. Interventricular septal rupture after myocardial infarction despite early percutaneous coronary intervention

    OpenAIRE

    Davran Cicek; Seher Gokay; Tonguc Saba; Ismail Sapmaz; Haldun Muderrisoglu

    2011-01-01

    Ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) is a serious clinical problem with high mortality rate due to cardiogenic shock or prolonged hemodynamic compromise. Despite multiple improvements in medical, interventional and surgical techniques, early and long-term prognosis after AMI related VSR still remain unpromising. We report a patient in whom an acute VSR was diagnosed 7 days after an anterior myocardial infarction treated with early primary percutaneou...

  15. Acute oral administration of low doses of methylphenidate targets calretinin neurons in the rat septal area.

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    Alvaro eGarcía-Aviles

    2015-03-01

    Full Text Available Methylphenidate (MPD is a commonly administered drug to treat children suffering from attention deficit hyperactivity disorder (ADHD. Alterations in septal driven hippocampal theta rhythm may underlie attention deficits observed in these patients. Amongst others, the septo-hippocampal connections have long been acknowledged to be important in preserving hippocampal function. Thus, we wanted to ascertain if methylphenidate administration, which improves attention in patients, could affect septal areas connecting with hippocampus. We used low and orally administered methylphenidate doses (1.3; 2.7 and 5mg/Kg to rats what mimics the dosage range in humans. In our model, we observed no effect when using 1.3mg/Kg methylphenidate; whereas 2.7 and 5 mg/Kg induced a significant increase in c-fos expression specifically in the medial septum, an area intimately connected to the hippocampus. We analyzed dopaminergic areas such as nucleus accumbens and striatum, and found that only 5mg/Kg induced c-fos levels increase. In these areas tyrosine hydroxylase correlated well with c-fos staining, whereas in the medial septum the sparse tyrosine hydroxylase fibres did not overlap with c-fos positive neurons. Double immunofluorescence of c-fos with neuronal markers in the septal area revealed that co-localization with choline acethyl transferase, parvalbumin, and calbindin with c-fos did not change with MPD treatment; whereas, calretinin and c-fos double labeled neurons increased after MPD administration. Altogether, these results suggest that low and acute doses of methylphenidate primary target specific populations of caltretinin medial septal neurons.

  16. RESIDUAL DEFECTS AFTER SURGICAL REPAIR OF VENTRICULAR SEPTAL DEFECTS IN CHILDREN:

    OpenAIRE

    K Sayadpour-Zanjani; M Y Aarabi-Moghadam

    2008-01-01

    "nResidual ventricular septal defects (VSD) are major complications after cardiac surgery. We studied the incidence of this complication, risk factors for its occurrence and short-term follow-up in 179 pediatric patients that underwent surgical closure of VSD from April 2003 until May 2004. All data were gathered retrospectively except measurements of shunt ratio. Studied risk factors included age, sex, weight, height, ejection fraction, VSD size, presence of pulmonary stenosis (PS), res...

  17. Ventricular septal rupture caused by myocardial bridge, solved by interventional closure device

    OpenAIRE

    Zóka, András; Andréka, Péter; Becker, Dávid; Fontos, Géza; Merkely, Béla; Szabó, György; Szatmári, András; Bárczi, György

    2012-01-01

    Myocardial bridging is a common coronary anomaly, which is generally described as a benign phenomenon. However, a growing number of studies consider this anomaly a relevant pathophysiological phenomenon with serious pathological consequences. Here we report on the case of an 88-year-old woman suffering from myocardial infarction and ventricular septal rupture, lacking any recognizable coronary disease except for a myocardial bridge causing the systolic compression of the left anterior descend...

  18. Vector electrocardiographic alterations after percutaneous septal ablation in obstructive hypertrophic cardiomyopathy: possible anatomic causes

    Directory of Open Access Journals (Sweden)

    Pérez Riera Andrés Ricardo

    2002-01-01

    Full Text Available OBJECTIVE: Analyze the dromotropic disturbances (vector-electrocardiographic, and the possible anatomic causes, provoked by selective alcohol injection in the septal branch, for percutaneous treatment, of obstructive hypertrophic cardiomyopathy. METHODS: Ten patients with a mean age of 52.7 years underwent percutaneous septal ablation (PTSA from october 1998; all in functional class III/IV. Twelve-lead electrocardiogram was performed prior to and during PTSA, and later electrocardiogram and vectorcardiogram according to Frank's method. The patients were followed up for 32 months. RESULTS: On electrocardiogram (ECG prior to PTSA all patients had sinus rhythm and left atrial enlargement, 8 left ventricular hypertrophy of systolic pattern. On ECG immediately after PTSA, 8 had complete right bundle-branch block; 1 transient total atrioventricular block; 1 alternating transient bundle-branch block either right or hemiblock. On late ECG 8 had complete right bundle-branch block confirmed by vectorcardiogram, type 1 or Grishman. CONCLUSION: Septal fibrosis following alcohol injection caused a predominance of complete right bundle-branch block, different from surgery of myotomy/myectomy.

  19. Oclusão do apêndice atrial esquerdo com o Amplatzer Cardiac Plug em pacientes com fibrilação atrial

    Directory of Open Access Journals (Sweden)

    Ênio Eduardo Guérios

    2012-06-01

    Full Text Available FUNDAMENTO: A oclusão percutânea do apêndice atrial esquerdo (OAAE surgiu como alternativa à anticoagulação oral (AO para prevenção do acidente vascular cerebral (AVC em pacientes com fibrilação atrial não-valvular (FANV. OBJETIVO: Relatar os resultados imediatos e o seguimento clínico de pacientes submetidos a OAAE com o Amplatzer Cardiac Plug (ACP em um único centro de referência. MÉTODOS: Oitenta e seis pacientes consecutivos com FANV, contra-indicação à AO e escore CHADS2= 2,6±1,2 foram submetidos a OAAE com implante de ACP. Realizou-se seguimento clínico e ecocardiográfico no mínimo 4 meses após o implante. RESULTADOS: Todos os implantes foram guiados apenas por angiografia. O sucesso do procedimento foi de 99% (1 insucesso por tamponamento cardíaco e consequente suspensão da OAAE. Houve 4 complicações maiores (o tamponamento já referido, 2 AVCs transitórios e uma embolização com retirada percutânea da prótese e duas menores (um derrame pericárdico sem tamponamento e uma pequena comunicação interatrial evidenciada no seguimento. Houve 1 óbito hospitalar após 6 dias, não relacionado à intervenção. Todos os outros pacientes receberam alta sem AO. Após seguimento de 25,9 pacientes-ano (69 pacientes não houve AVCs nem embolizações tardias de próteses. O AAE estava completamente ocluído em 97% dos casos. Seis pacientes apresentaram evidência de trombo sobre a prótese, que desapareceram após reinstituição de AO por 3 meses. CONCLUSÃO: OAAE se associa a um alto índice de sucesso, um índice aceitável de complicações e resultados promissores a médio prazo, podendo ser considerada uma alternativa válida à OA na prevenção do AVC em pacientes com FANV.

  20. Oclusão percutânea do apêndice atrial esquerdo com o Amplatzer Cardiac PlugTM na fibrilação atrial

    Directory of Open Access Journals (Sweden)

    Márcio José Montenegro

    2012-02-01

    Full Text Available Fundamento: A fibrilação atrial está associada a acidentes vasculares embólicos que frequentemente resultam em morte ou invalidez. Eficaz na redução desses eventos, a anticoagulação possui várias limitações e vem sendo amplamente subutilizada. Mais de 90% dos trombos identificados nos portadores de fibrilação atrial sem doença valvar se originam no apêndice atrial esquerdo, cuja oclusão é investigada como uma alternativa à anticoagulação. Objetivo: Determinar a viabilidade da oclusão percutânea do apêndice atrial esquerdo em pacientes com alto risco de eventos embólicos e limitações ao uso de anticoagulação. Métodos: Relatamos a experiência inicial com o Amplatzer Cardiac PlugTM (St. Jude Medical Inc., Saint Paul, Estados Unidos em pacientes com fibrilação atrial não valvar. Foram selecionados pacientes com alto risco de tromboembolia, sangramentos maiores e contraindicações ao uso ou grande labilidade na resposta ao anticoagulante. Os procedimentos foram realizados por via percutânea, sob anestesia geral e com ecocardiografia transesofágica. O desfecho primário foi a presença de complicações periprocedimento e o seguimento programado incluiu reavaliação clínica e ecocardiográfica em 30 dias e por contato telefônico após nove meses. Resultados: Nos cinco pacientes selecionados se conseguiu a oclusão do apêndice atrial esquerdo sem complicações periprocedimento. Não houve eventos clínicos no seguimento. Conclusão: Ensaios clínicos controlados são necessários antes que o fechamento percutâneo do apêndice atrial esquerdo constitua uma alternativa à anticoagulação na fibrilação atrial não associada a doença valvar. Mas o dispositivo se mostrou promissor em pacientes com alto risco de embolia e restrições ao uso de anticoagulantes.

  1. Fechamento de perfuração septal nasal em coelhos com celulose bacteriana Nasal septal perforation closure with bacterial cellulose in rabbits

    Directory of Open Access Journals (Sweden)

    Eulógio Emílio Martinez Neto

    2010-08-01

    Full Text Available Biomateriais podem ser válidos à somação de tecido e estrutura para o fechamento da perfuração do septo nasal. OBJETIVO: Testar celulose produzida pela bactéria Acetobacter xylinum associada à cola biológica no fechamento de perfurações septais em coelhos. Comparar histologicamente fibrose, inflamação, congestão vascular, integridade do enxerto e fechamento da perfuração septal. MATERIAL E MÉTODO: Quinze coelhos foram distribuídos em dois grupos: Controle (5 coelhos e celulose - Bionext® associado à cola de fibrina - Tissucol® (10 coelhos. Foi realizada uma perfuração cirúrgica no septo nasal em todos os coelhos. Nos animais do grupo Bionext® foi realizado o fechamento da perfuração com a colocação de celulose e aplicação de cola de fibrina. RESULTADOS: Dois coelhos foram a óbito. No grupo com celulose ocorreu o fechamento de duas perfurações e em 4 casos a celulose manteve-se impactada entre os bordos das perfurações. No grupo controle não ocorreu fechamento da perfuração septal em nenhum dos coelhos operados. CONCLUSÃO: Não houve diferença estatística significante nos quesitos inflamação aguda, congestão vascular e fibrose, avaliado histologicamente. Nos casos onde o enxerto se manteve posicionado, não houve alteração quanto à sua integridade. Pode ser útil à somação do arsenal terapêutico como base para re-epitelização dos bordos da perfuração.Alloplastic materials can be used together with tissue and structure to close nasal septal perforation. AIM: to test cellulose use in the closure of septal perforation in rabbits and to compare fibrosis, inflammation, vascular congestion and graft integrity. MATERIALS AND METHODS: Fifteen rabbits. The rabbits were divided into two groups: Control: Five rabbits and Bionext® and fibrin glue Tissucol®: Ten rabbits. Septal perforations were done in all of them. In the Bionext® group the closure was performed with the placement of cellulose

  2. Identification of residual ischemia in the occluded coronary artery irrigation area using myocardial perfusion scintigraphy

    Directory of Open Access Journals (Sweden)

    Baškot Branislav

    2007-01-01

    . Conclusion. Determination and identificantion of vivid but ischemic myocard of culprit lesion type in the occluded artery irrigation zone enable making choice of the best therapy for a patient.

  3. 经胸与经食管超声心动图在室间隔缺损外科封堵中的应用价值%APPLICATION VALUE OF TTE AND TEE IN DEVICE CLOSURCE OF VENTRICULAR SEPTAL DEFECTS

    Institute of Scientific and Technical Information of China (English)

    张小杉; 哈斯; 吴晓萍; 王晓磊; 朱宪明; 刘志平

    2012-01-01

    目的:评价经胸与经食管超声心动图在室间隔缺损外科封堵中的价值.方法:2009 - 08~2011 - 06经我院心外科确诊的室间隔缺损病人29例.膜周型缺损21例,嵴内型缺损8例.缺损直径3~9mm,平均5.35±3.12mm.术前用经胸超声心动图观察缺损大小及缺损与主动脉瓣的距离.在经食管超声的引导下,经右室游离壁置入国产室缺封堵器.术后用经食管超声即刻评价封堵效果,出院前及封堵3 mo后用经胸超声心动图随访观察.结果:25例封堵成功,使用等边封堵器18例,7例偏心封堵器,术后即刻超声及术后超声观察均无分流信号,2例病人术后出现少量三尖瓣反流.2例膜周型缺损TEE发现缺损处有多处破口无法进行封堵.2例嵴内型封堵失败,即刻术中行开胸修补术.结论:经胸与经食管超声心动图在室间隔缺损外科封堵术前评估、术中监测及术后随访中发挥重要的价值.%objective: To access the application value of TTE and TEE in device closurce of ventricular septal defects. Methods: From August 2009 to June 2011, A total of 29 patients diagnosised with VSD(17 males and 12 females) underwent TTE preoperative assessment in the cardial surgical department in our hospital. 21 cases with Perimembranous VSD,other 8 cases with intracristal type VSD. The defect diameter ranges from 3mm to 9mm,the average value is 5. 35 ± 3.12mm. Used TTE to access defect size and distance from the aortic valve in preoperative. Introduce domestic ventricular septal defect occluder through right ventricular free wall under the guidance of TEE. Immediate evaluate postoperative effect with TEE, TTE was used to follow - up study in the prior to dischargr and three months after. Results:The procedures were successful in 25 cases. Equilateral occluders were used in 18 cases, eccentric occluders in 7 cases. There was no signal of shunt observed by immediate postoperative TEE in the 25 cases,2 patients had mild

  4. Characterization of opioid receptor types modulating acetylcholine release in septal regions of the rat brain.

    Science.gov (United States)

    Gazyakan, E; Hennegriff, M; Haaf, A; Landwehrmeyer, G B; Feuerstein, T J; Jackisch, R

    2000-07-01

    Presynaptic opioid receptors of the delta- and mu-types have been shown to inhibit the release of acetylcholine (ACh) in the rat striatum and hippocampus, respectively, but it is unknown whether opioid receptors modulate the release of ACh also in the region of origin of the hippocampal cholinergic innervation, the septum. To answer this question, slices (350 microm) of the medial septal area and of the diagonal band of Broca, as well as (for comparison) of the hippocampus, were prepared from adult male Wistar rats. The slices were incubated with [3H]choline, superfused in the presence of hemicholinium-3 (10 microM) and stimulated twice (S1, S2) by electrical fields (360 pulses, 3 Hz, 2 ms, 60 mA); opioid receptor agonists were present during S2. The preferential mu-agonist [D-Ala2,N-Me-Phe4,Gly-ol5]enkephalin (DAMGO) inhibited the evoked ACh release by maximally about 40% in hippocampal slices and acted even more strongly in the medial septal area, or the diagonal band of Broca (about 60% or 75% maximal inhibition, respectively). These effects were reduced or abolished by the preferential mu-antagonist naloxone, which showed no effects when given alone. Using naloxone in the presence of a cocktail of peptidase inhibitors, no evidence for an endogenous tone of opioid peptides was found in the medial septal area, diagonal band of Broca or the hippocampus. Using the preferential delta-agonist [D-Pen2, D-Pen5]enkephalin (DPDPE) and the delta-antagonist naltrindole, a delta-opioid receptor inhibiting evoked ACh release was clearly detectable both in the medial septal area and the diagonal band of Broca, but not in the hippocampus, whereas the preferential kappa-agonist trans-3,4-dichloro-N-methyl-N-[2(1-pyrrolidinyl)cyclo-hexyl] benzeneacetamide (U50,488H) had only weak or no effects. In addition to the functional experiments, double in-situ hybridization studies were performed, in which cells containing mRNA for choline acetyltransferase (ChAT) were labeled by an

  5. Analyzing nasal septal deviations to develop a new classification system: a computed tomography study using MATLAB and OsiriX.

    Science.gov (United States)

    Lin, Jonathan K; Wheatley, Francis C; Handwerker, Jason; Harris, Norman J; Wong, Brian J F

    2014-01-01

    IMPORTANCE Accurately characterizing nasal septal deviations is valuable for surgical planning, classifying nasal septal deviations, providing a means to accurately perform outcomes research, and understanding the causes of chronic conditions. OBJECTIVE To determine and quantify regions of septal deformity that can be used to develop a comprehensive classification system. DESIGN, SETTING, AND PARTICIPANTS A retrospective case series study was conducted at an academic tertiary care hospital. Sixty-four participants were selected based on a convenience sample of computed tomography (CT) scans of the paranasal sinuses and midface available between June 29, 2011, and August 16, 2012. Exclusion criteria consisted of incomplete or inadequate CT series. The most recent CT scans were chosen for analyses regardless of the indication for imaging. Digital Imaging and Communications in Medicine format bitmap file–formatted data were obtained and analyzed using MATLAB and OsiriX. The line to curve ratio, deviation area, and root mean square (RMS) values of the septal contour vs the ideal straight septum fit were calculated. Analysis was performed to detect significant differences (P < .05) using the 3 measures.MAIN OUTCOMES AND MEASURES Quantitative analysis of nasal septal deviation.RESULTS The population consisted of 50 male and 14 female patients aged 3 to 83 years(mean, 42 years). Mean line to curve ratios, areas, and RMS values were highest in contours that intersected the perpendicular plate–vomer junction, with a mean line to curve ratio of1.04 and mean deviated area of 627.16 arbitrary units (P = .02). Maximal deviation areas were also seen midway from the perpendicular plate–vomer junction to the nasal spine with a mean area of 577.31 arbitrary units (P = .01). The RMS values were significantly elevated along the crista galli and perpendicular plate–vomer junction (P < .05).CONCLUSIONS AND RELEVANCE Maximum septal deviation is seen at the perpendicular plate

  6. The Prevalence of Concha Bullosa and Nasal Septal Deviation and Their Relationship to Maxillary Sinusitis by Volumetric Tomography

    Directory of Open Access Journals (Sweden)

    Kyle D. Smith

    2010-01-01

    Full Text Available The objective of this study was to determine the prevalence of concha bullosa and nasal septal deviation and their potential relationships to maxillary sinusitis. 883 CT scans taken at Creighton University School of Dentistry from 2005 to 2008 were retrospectively reviewed for the presence of concha bullosa, nasal septal deviation, and maxillary sinusitis. 67.5% of patients exhibited pneumatization of at least one concha, 19.4% of patients had a deviated septum, and 50.0% had mucosal thickening consistent with maxillary sinusitis. 49.3% of patients who had concha bullosa also had evidence of maxillary sinusitis. Only 19.5% of patients with concha bullosa also had nasal septal deviation, whereas 19.7% of patients with sinusitis also presented with nasal septal deviation. Although concha bullosa is a common occurrence in the nasal cavity, there did not appear to be a statistically significant relationship between the presence of concha bullosa or nasal septal deviation and maxillary sinusitis.

  7. A New Perspective for Spreader Graft Use in Severely Deviated Septum: Is Septal Continuity an Obligation for a Stable and Straight Nasal Septum?

    Science.gov (United States)

    Sirinoglu, Hakan; Yesiloglu, Nebil; Ersoy, Burak

    2016-08-01

    Severe septal deviation is a challenging deformity usually treated using aggressive surgical methods, and extracorporeal septoplasty (ECS) is a commonly used method for this issue. However, this method has severe risks and complications such as the recurrent deformity or nasal saddling. In this article, we present an alternative solution to ECS procedure for the correction of severe septal deviation. Sixteen patients with severe c- or s-shaped septal deviation with a mean age of 26.5 years were included in the study. The entire deviated part of the septal cartilage was resected as a vertical block creating a full-thickness defect between the most cranial and caudal parts of the septal cartilage. After that, two spreader grafts were placed bilaterally facilitating the septal integrity and leaving the full-thickness septal defect unchanged. The surgical results were evaluated using the preoperative and postoperative facial photographs and patient satisfaction was determined using nine relevant questions of DAS-59 scale. The only complication observed in the follow-up period of 19 months was hanging columella deformity which was corrected at the postoperative first year. The mean length of the resected septal segment was 12.4 mm. The mean length of the resultant septal cartilage defect after the vertical resection was 5.9 mm. The mean length of the placed spreader grafts was 25.6 mm. The comparison of the preoperative and postoperative photographs showed significant improvement of the nasal contour and considerable correction of the septal deviation. The statistical evaluation of the answers given to the questions of the DAS-59 scale clearly demonstrates that a significant degree of patient satisfaction was achieved. Severe septal deviation may be successfully corrected by full-thickness resection of the deviated part and reconstruction with bilateral spreader grafts with a low risk of postoperative complications. PMID:27494592

  8. Alcohol septal ablation in obstructive acromegalic hypertrophic cardiomyopathy - a first case report.

    Science.gov (United States)

    Viveiros Monteiro, André; Fiarresga, António; Cacela, Duarte; de Sousa, Lídia; Ramos, Ruben; Galrinho, Ana; Branco, Luísa; Cruz Ferreira, Rui

    2016-09-01

    Acromegaly is a rare disease, mostly caused by a growth hormone (GH)-secreting benign pituitary tumor, with an increased production of GH and insulin-like growth factor 1 (IGF-1). Cardiovascular complications are common and are associated with cardiomyocyte apoptosis and concentric cardiac hypertrophy. Suppression of GH and IGF-1 appears to improve cardiac function only in the short term, with little or no decrease in left ventricular mass or improvement in cardiac function after prolonged treatment. Alcohol septal ablation (ASA) has emerged as a minimally invasive alternative to septal myectomy, with significant improvement in symptoms, gradients and left ventricular remodeling. In this report, we describe the case of a 73-year-old woman with acromegaly due to a pituitary adenoma diagnosed and treated surgically at the age of 38 but with recurrence and reoperation at the age of 50. She was referred to our cardiology department due to a three-month history of progressively worsening exercise-induced dyspnea and orthopnea under optimal medical therapy. Echocardiography and magnetic resonance imaging revealed severe basal hypertrophy of the interventricular septum (19 mm), dynamic left ventricular outflow tract obstruction with a gradient of 70 mmHg at rest and 120 mmHg with Valsalva maneuver, and systolic anterior movement (SAM). Genetic testing excluded the most frequent forms of familial hypertrophic cardiomyopathy. ASA was performed with injection of 2 cc of alcohol in the first septal branch of the left coronary artery, without complications. At one-year reassessment, significant clinical and echocardiographic improvement was noted, with disappearance of SAM. To our knowledge, there have been no previously reported cases of ASA in hypertrophic cardiomyopathy due to acromegaly. We report a case of successful ASA in acromegalic cardiomyopathy. PMID:27503591

  9. Alcohol septal ablation in obstructive acromegalic hypertrophic cardiomyopathy - a first case report.

    Science.gov (United States)

    Viveiros Monteiro, André; Fiarresga, António; Cacela, Duarte; de Sousa, Lídia; Ramos, Ruben; Galrinho, Ana; Branco, Luísa; Cruz Ferreira, Rui

    2016-09-01

    Acromegaly is a rare disease, mostly caused by a growth hormone (GH)-secreting benign pituitary tumor, with an increased production of GH and insulin-like growth factor 1 (IGF-1). Cardiovascular complications are common and are associated with cardiomyocyte apoptosis and concentric cardiac hypertrophy. Suppression of GH and IGF-1 appears to improve cardiac function only in the short term, with little or no decrease in left ventricular mass or improvement in cardiac function after prolonged treatment. Alcohol septal ablation (ASA) has emerged as a minimally invasive alternative to septal myectomy, with significant improvement in symptoms, gradients and left ventricular remodeling. In this report, we describe the case of a 73-year-old woman with acromegaly due to a pituitary adenoma diagnosed and treated surgically at the age of 38 but with recurrence and reoperation at the age of 50. She was referred to our cardiology department due to a three-month history of progressively worsening exercise-induced dyspnea and orthopnea under optimal medical therapy. Echocardiography and magnetic resonance imaging revealed severe basal hypertrophy of the interventricular septum (19 mm), dynamic left ventricular outflow tract obstruction with a gradient of 70 mmHg at rest and 120 mmHg with Valsalva maneuver, and systolic anterior movement (SAM). Genetic testing excluded the most frequent forms of familial hypertrophic cardiomyopathy. ASA was performed with injection of 2 cc of alcohol in the first septal branch of the left coronary artery, without complications. At one-year reassessment, significant clinical and echocardiographic improvement was noted, with disappearance of SAM. To our knowledge, there have been no previously reported cases of ASA in hypertrophic cardiomyopathy due to acromegaly. We report a case of successful ASA in acromegalic cardiomyopathy.

  10. Radiation dosage accepted by children during interventional treatment for congenital ventricular septal defect

    International Nuclear Information System (INIS)

    Objective: To estimate the radiation dose to which children are exposed during cardiac catheterizations for the treatment of ventricular septal defect, to analyze the factors affecting the radiation dose and to find out the measures to decrease the radiation dose. Methods: From December 2008 to October 2009, transcatheter closure was performed in 30 children with perimembranous ventricular septal defect. During the procedure the radiation doses to the children were estimated by using thermoluminescent dosimetry (TLD). The TLD chips were calibrated before use and were attached in four measuring points,representing the radiation dose of the crystalline lens, the thyroid, the exposure field and the gonad. Results: The mean entrance dose of the crystalline lens,the thyroid,the exposure field and the gonad was (65.7 ± 48.8)μGy, (2618.2 ± 862.6)μGy, (3376.5 ± 838.4)μGy and (57.0 ± 59.4)μGy, respectively. The mean fluoroscopic time used for interventional procedure was (7.2 ± 3.0) minutes, and the mean angiographic exposures time was (6.1 ± 1.8) seconds. Conclusion: Transcatheter closure therapy for perimembranous ventricular septal defect is safe and effective. The exposure field is the region receiving the largest radiation dose, in the next place was the thyroid.Some more effective protections, such as smaller exposure field, strengthened protection of thyroid region, etc. should be taken in order to decrease the X-ray radiation dosage accepted by children as they are more sensitive to radiation exposure. (authors)

  11. Will Septal Correction Surgery for Deviated Nasal Septum Improve the Sense of Smell? A Prospective Study

    Directory of Open Access Journals (Sweden)

    Neelima Gupta

    2015-01-01

    Full Text Available Background and Objectives. Nasal obstruction due to deviated nasal septum is a common problem bringing a patient to an otorhinolaryngologist. Occasionally, these patients may also complain of olfactory impairment. We proposed to study the effect of septal deviation on the lateralised olfactory function and the change in olfaction after surgery of the septum (septoplasty. Methods. Forty-one patients with deviated nasal septum were evaluated for nasal airflow, olfactory score, and nasal symptomatology. Septoplasty was done under local anesthesia. Pre- and postoperative olfactory scores, airflow and olfactory scores, and nasal symptomatology and olfactory scores were compared and correlated. Results. The range of preoperative composite olfactory score (COS on the side of septal deviation was 4–14 (mean 7.90±2.234 and on the nonobstructed side was 9–18 (mean 14.49±2.378. Severity of deviated nasal septum and preoperative COS of diseased side were correlated and the correlation was found to be significant (rho = −0.690, p=0.000 (<0.001. The preoperative mean COS (7.90±2.234 was compared with the postoperative mean COS (12.39±3.687 and the improvement was found to be statistically significant (p=0.000 (<0.001. Conclusion. We found improvement in olfactory function in 70.6% patients after surgery, no change in 20.1%, and reduced function in 7.6%. With the limitation of a small sample size and a potential repeat testing bias, we would conclude that correction of nasal septal deviation may lead to improvement in sense of smell.

  12. Three interventional methods in closure of patent ductus arteriosus

    International Nuclear Information System (INIS)

    Objective: To review the clinical results of three different methods in embolization of PDA. Methods: (1) Porstmann's Ivalon plugging method (2) Spring coil (3) Amplatzer ductus occluder. Results: The authors used Porstmann's method in 450 cases, Spring coil 30 cases and Amplatzer occluder 6 cases. All of them were successfully closed. Conclusions: Porstmann's method are relatively complicated, but all the equipment can be made domestically. Spring coil method is only used limitedly in small ductus, Amplatzer occluder is simple with no limitation for age and size of ductus but is expensive

  13. Phase image showing pseudoparadoxical septal motion in case of rupture of the chordae tendineae

    Energy Technology Data Exchange (ETDEWEB)

    Zatta, G.; Boccolari, S.; Mana, O.; Marino, V.; Wu, S.C.; Tarolo, G.L.; Ciro, A.; Civelli, M.

    1987-10-01

    When observing a phase image with an apparent dykinetic behaviour of the intraventricular septum, a differential diagnosis between conditions with true paradoxical septal motion and conditions of apparent paradoxical movement due to other causes is necessary, like in the case reported here. In a patient with a good EF value and a high RI, ventricular wall motion has to be scrutinized by cinedisplay, since it may show a vigorous contraction and rotation of the heart to the left. A recent sudden valvular insufficiency has to be considered likely due to a myxomatous change of the mitral valvular apparatus.

  14. Prenatal Isolated Ventricular Septal Defect May Not Be Associated with Trisomy 21

    OpenAIRE

    Ori Shen; Sari Lieberman; Benjamin Farber; Daniel Terner; Amnon Lahad; Ephrat Levy-Lahad

    2014-01-01

    The aim of this study was to examine if isolated fetal ventricular septal defect (VSD) is associated with trisomy 21. One hundred twenty six cases with prenatal VSD diagnosed by a pediatric cardiologist were reviewed. Cases with known risk factors for congenital heart disease, the presence of other major anomalies, soft signs for trisomy 21 or a positive screen test for trisomy 21 were excluded. Ninety two cases formed the study group. None of the cases in the study group had trisomy 21. The ...

  15. Successful anesthetic management of a child with blepharophimosis syndrome and atrial septal defect for reconstructive ocular surgery

    Directory of Open Access Journals (Sweden)

    Dalim Kumar Baidya

    2011-01-01

    Full Text Available Blepharophimosis syndrome is an autosomal dominant disorder characterized by eyelid malformation, involvement of reproductive system and abnormal facial morphology leading to difficult airway. We report a rare association of blepharophimosis syndrome and atrial septal defect in a 10-year-old girl who came for reconstruction surgery of eyelid. The child had dyspnea on exertion. Atrial septal defect was identified preoperatively by clinical examination and echocardiography. Anesthesia management was complicated by failure in laryngeal mask airway placement and Cobra perilaryngeal airway was subsequently used.

  16. Experimental study on the mechanism of intrapulmonary kinetics of 123I-IMP in balloon occluded bronchus of rabbit

    International Nuclear Information System (INIS)

    To investigate the mechanism of intrapulmonary kinetics of N-isopropyl-p-123I-iodoamphetamine (123I-IMP), we performed lung scanning with 123I-IMP in 13 rabbits in which a unilateral bronchus was occluded by a balloon catheter. In 9 rabbits, on the delayed distribution images, an abnormal accumulation of 123I-IMP was detected in the hypoperfusion area of the peripheral lung field of the occluded bronchus, which was detected on lung perfusion images with 99mTc-MAA. Comparison of early (a summation image during 20 seconds immediately after injection) and delayed (a summation image from 70 to 90 minutes after injection) distribution images confirmed that during this period, 123I-IMP accumulated in the area of reduced distribution of 123I-IMP. Moreover, at the site of abnormal accumulation, washout of 123I-IMP from the lung was delayed compared with that in the normal lung field. We find this experimental study is similar to the results in 63 clinical cases, which we have reported previously, and confirm that pulmonary arterial perfusion, especially hypoperfusion, influences the intrapulmonary kinetics of 123I-IMP. (author)

  17. Off-Pump Repair of a Post Myocardial Infarction Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2014-01-01

    Full Text Available Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated and external sandwich closure of post myocardial ventricular septal defect (VSD appears to be simple and effective after initial myocardial infarction (MI. The three cases presented with a VSD after of acute MI with or without thrombolysed with streptokinase during patient admission. The general condition of the three patients was poor with pulmonary edema, low cardiac output and renal failure. The heart was approached through a median sternotomy. Off-pump coronary artery bypass grafting of the coronary artery lesion was done first using octopus and beating heart surgery method and latero - lateral septal plication was performed using sandwich technique. Low cardiac output managed with intra-aortic balloon pump in these patients accompanied with inotropic drugs. Post-operative transesophageal echocardiography revealed that VSD was closed completely in one patient and in two patients small residual VSD remained. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs.

  18. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential.

    Science.gov (United States)

    Nguyen, Tin; Cao, Long; Movahed, Assad

    2014-10-01

    Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods. PMID:24919944

  19. Pulmonary stenosis development and reduction of pulmonary arterial hypertension in atrioventricular septal defect: a case report

    Directory of Open Access Journals (Sweden)

    Ninet Gérard

    2009-09-01

    Full Text Available Abstract A 24-year-old patient was admitted for dyspnoea and syncope. He had a previous history of complete atrio-ventricular septal defect and trisomy 21. At the age of 6 months, in 1984, cardiac catheterization revealed a quasi-systemic pulmonary arterial hypertension with a bidirectional shunt corresponding to an Eisenmenger syndrome. Corrective cardiac surgery was not performed at this time because surgical risk was considered too high. Until the age of 20 years old, he showed few symptoms while under medical treatment. But since 2006, his functional status became worse with an increased dyspnoea, syncopes, and severe cyanosis. In these conditions, haemodynamic parameters have been re-evaluated in 2006 and 2008. They highlighted a late and progressive development of a valvular and infundibular pulmonary stenosis leading to a normalisation of pulmonary arterial pressures. At the age of 24 , the patient underwent corrective cardiac surgery which was successful. Late development of both infundibular and valvular pulmonary stenosis have not been described before in non operated congenital ventricular septal defects, but development of one or the other abnormality would be found in 8% of patients. The physiopathological mechanism of this obstruction is unclear. Nevertheless, in unoperated congenital cardiac shunt lesions, reversibility of severe pulmonary arterial hypertension should be reconidered and re-assessed during follow up.

  20. Urgent hybrid approach in treatment of the acute myocardial infarction complicated by the ventricular septal rupture

    Directory of Open Access Journals (Sweden)

    Radosavljević-Radovanović Mina

    2014-01-01

    Full Text Available Introduction. Ventricular septal rupture (VSR in the acute myocardial infarction (AMI is a rare but very serious complication, still associated with high mortality, despite significant improvements in pharmacological and surgical treatment. Therefore, hybrid approaches are introduced as new therapeutical options. Case Outline. We present an urgent hybrid approach, consisting of the initial percutaneous coronary intervention (PCI of the infarct-related artery, followed by immediate surgical closure of the ventricular septal rupture, for treatment of high risk, hemodynamically unstable female patient with AMI caused by one-vessel disease and complicated by VSR and cardiogenic shock. Since the operative risk was also very high (EUROSCORE II 37%, this therapeutic decision was based on the assumption that preoperative PCI could promptly establish blood flow and thereby lessen the risks, duration and complexity of urgent cardiosurgical intervention, performed on the same day. This approach proved to be successful and the patient was discharged from the hospital on the fifteenth postoperative day in stable condition. Conclusion. In selected cases, with high operative risk and unstable hemodynamic state due to AMI complicated by VSR, urgent hybrid approach consisting of the initial PCI followed by surgical closure of VSR may represent an acceptable treatment option and contribute to the treatment of this complex group of patients.

  1. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential.

    Science.gov (United States)

    Nguyen, Tin; Cao, Long; Movahed, Assad

    2014-10-01

    Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods.

  2. Maternal alcohol drinking pattern during pregnancy and the risk for an offspring with an isolated congenital heart defect and in particular a ventricular septal defect or an atrial septal defect

    DEFF Research Database (Denmark)

    Strandberg-Larsen, Katrine; Skov-Ettrup, Lise Skrubbeltrang; Grønbaek, Morten;

    2011-01-01

    BACKGROUND: This cohort study examines the possible association between maternal alcohol intake, including binge drinking, during pregnancy, and the subsequent risk of having a child with an isolated congenital heart defect and, more specifically, with the isolated form of ventricular septal defe...

  3. Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Hirohiko Tanihata; Tetsuo Sonomura; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Masaki Terada

    2006-01-01

    A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration (BRTO) was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.

  4. Construction of occluded recombinant baculoviruses containing the full-length cry1Ab and cry1Ac genes from Bacillus thuringiensis

    Directory of Open Access Journals (Sweden)

    B.M. Ribeiro

    1998-06-01

    Full Text Available The administration of baculoviruses to insects for bioassay purposes is carried out, in most cases, by contamination of food surfaces with a known amount of occlusion bodies (OBs. Since per os infection is the natural route of infection, occluded recombinant viruses containing crystal protein genes (cry1Ab and cry1Ac from Bacillus thuringiensis were constructed for comparison with the baculovirus prototype Autographa californica nucleopolyhedrovirus (AcNPV. The transfer vector pAcUW2B was used for construction of occluded recombinant viruses. The transfer vector containing the crystal protein genes was cotransfected with linearized DNA from a non-occluded recombinant virus. The isolation of recombinant viruses was greatly facilitated by the reduction of background "wild type" virus and the increased proportion of recombinant viruses. Since the recombinant viruses containing full-length and truncated forms of the crystal protein genes did not seem to improve the pathogenicity of the recombinant viruses when compared with the wild type AcNPV, and in order to compare expression levels of the full-length crystal proteins produced by non-occluded and occluded recombinant viruses the full-length cry1Ab and cry1Ac genes were chosen for construction of occluded recombinant viruses. The recombinant viruses containing full-length and truncated forms of the crystal protein genes did not seem to improve its pathogenicity but the size of the larvae infected with the recombinant viruses was significantly smaller than that of larvae infected with the wild type virus.

  5. Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect

    NARCIS (Netherlands)

    G. Bol-Raap (Goris); A.H.J. Koning (Anton); T.V. Scohy (Thierry); A.D.J. ten Harkel (Arend); F.J. Meijboom (Folkert); A.P. Kappetein (Arie Pieter); P.J. van der Spek (Peter); A.J.J.C. Bogers (Ad)

    2007-01-01

    textabstractBackground. This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD). Methods. 12 da

  6. Differential modulation of lateral septal vasopressin receptor blockade in spatial learning, social recognition, and anxiety-related behaviors in rats

    NARCIS (Netherlands)

    Everts, HGJ; Koolhaas, JM

    1999-01-01

    The role of lateral septal vasopressin (VP) in the modulation of spatial memory, social memory, and anxiety-related behavior was studied in adult, male Wistar rats. Animals were equipped with osmotic minipumps delivering the VP-antagonist d(CH2)5-D-Tyr(Et)VAVP (1 ng/0.5 mu l per h) bilaterally into

  7. The Memory-Impairing Effects of Septal GABA Receptor Activation Involve GABAergic Septo-Hippocampal Projection Neurons

    Science.gov (United States)

    Krebs-Kraft, Desiree L.; Wheeler, Marina G.; Parent, Marise B.

    2007-01-01

    Septal infusions of the [gamma]-aminobutyric acid (GABA)[subscript A] agonist muscimol impair memory, and the effect likely involves the hippocampus. GABA[subscript A] receptors are present on the perikarya of cholinergic and GABAergic septo-hippocampal (SH) projections. The current experiments determined whether GABAergic SH projections are…

  8. The unnatural history of an atrial septal defect: Longitudinal 35 year follow up after surgical closure at young age

    NARCIS (Netherlands)

    J.A.A.E. Cuypers (Judith); P. Opic (Petra); M.E. Menting (Myrthe); E.M.W.J. Utens (Elisabeth); M. Witsenburg (Maarten); W.A. Helbing (Willem); A.E. van den Bosch (Annemien); M. Ouhlous (Mohamed); R.T. van Domburg (Ron); F.J. Meijboom (Folkert); A.J.J.C. Bogers (Ad); J.W. Roos-Hesselink (Jolien)

    2013-01-01

    markdownabstractABSTRACT Objective: To describe the very long-term outcome after surgical closure of an atrial septal defect (ASD). Design: Longitudinal cohort study of 135 consecutive patients who underwent surgical ASD repair at age <15 years between 1968 and 1980. The study protocol included EC

  9. Transcoronary ablation of septal hypertrophy (TASH): a new treatment option for hypertrophic obstructive cardiomyopathy.

    Science.gov (United States)

    Kuhn, H; Gietzen, F H; Leuner, C; Schäfers, M; Schober, O; Strunk-Müller, C; Obergassel, L; Freick, M; Gockel, B; Lieder, F; Raute-Kreinsen, U

    2000-01-01

    In 1991, our group started to develop a catheter interventional therapy for hypertrophic obstructive cardiomyopathy (HOCM). The new concept was proposed in 1994. It is based on the conventional PTCA technique with the aim of inducing an artificial myocardial infarction by instillation of 96% ethanol into the most proximally situated septal branch of the left anterior descending coronary artery. This leads to a subaortic contraction disorder with subsequent decrease of the intraventricular pressure gradient, shrinkage of the hypertrophied septal bulge and widening of the outflow tract ("therapeutic remodeling"). The subaortic defect is small and well demarcated as assessed by left ventricular angiography, transesophageal echocardiography and 18 F-glucose positron emission tomography. The term transcoronary ablation of septum hypertrophy (TASH) was suggested. Our patient cohort that now comprises 215 therapeutic procedures in 187 patients underwent a large variety of prospective studies (maximum follow-up 4.5 years) including invasive controls at regular intervals, investigation of hemodynamics at rest and at exercise, transesophageal and transthoracic echocardiography, Doppler echocardiography during bicycle exercise, electrophysiologic testing, Holter monitoring and measurement of myocardial metabolism and perfusion, assessment of microembolic events by transcranial Doppler sonography and histological examinations. This article gives an overview and reports our increasing experience in applying TASH. The following post-TASH findings were obtained: significant hemodynamic and clinical improvement at rest and at exercise, decrease of septum thickness, increase of outflow tract area and decrease of induced ventricular tachycardia. There were well-demarcated, histologically atypical subaortic myocardial defects, no microembolic events, abnormal early peak of infarct related enzymes, and no change of baroreflex sensitivity. Pre-/post-TASH evaluations of the patients

  10. Sinonasal Headaches and Post-Operative Outcomes after Septoplasty in Patients with Nasal Septal Deviation

    Directory of Open Access Journals (Sweden)

    Ali Ghazipour

    2011-03-01

    Full Text Available Introduction: Investigators believe that anatomical abnormalities in the sinonasal region can be the cause of some chronic and refractory headaches that may respond well to surgical intervention. This study presents the prevalence of headache in patients with nasal septal deviation and their response to surgical treatment over a 2-year follow-up period. Materials and Methods: This descriptive and prospective study was conducted on 98 patients with nasal septal deviation who underwent septoplasty surgery in the Imam Hospital in Ahwaz. Preoperative information was acquired by asking the patients and by completing SNOT-20 questionnaires by patients. After the surgery, information about changes in the quality of headache in patients with dominant contact points in preoperative nasal endoscopy whose headache responded to topical anaesthesia with lidocaine 2%+naphazoline 0.5% was collected over a 2-year follow-up. Final data were analyzed by SPSS and descriptive statistics. Results: Ninety-eight patients were studied, comprising 58.2% men and 41.8% women. They ranged in age between 18 and 46 years (mean=24. Nasal obstruction (72.4%, snoring (58.1%, headache (46% and epistaxis (17.3% were the most frequent preoperative symptoms. The most common site of the headache was the frontal region (68.8%.  Patients' headache was bilateral in 71.1% of cases. In 82.2% of patients, headache lasted less than four hours a day. The headache was pulsatile in 53.3%, sharp in 31.2% and compressive in 15.5% of cases. In the post-operative assessment, despite gradual decline in the referral patients for follow-up, a notable and gradual recovery in patients’ headache was seen with 82.8% of the patients reporting complete or partial recovery of the headache at the end of the 2-year follow-up. Conclusion: Headache is one of the most common symptoms in patients with nasal anatomical abnormalities such as septal deviation and usually responds well to surgical treatment. More

  11. Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study using Transesophageal Echocardiography

    Science.gov (United States)

    Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.

    1993-01-01

    Background and Purpose: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and,.in some reports, with mitral valve prolapse. These two latter cardiac disorder; have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. Methods: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients aneurysm and patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. Results: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P=.01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P=.003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of >lo-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of aneurysm and patent foramen ovale are both significantly associated with cryptogenic stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of >lo-mm excursion are associated with a higher risk of stroke. (Stroke. 1993;24:1865-1873.) KEY WORDS aneurysm echocardiography foramen ovale, patent mitral valve prolapse o young adults

  12. Transcatheter closure of atrial septal defect in a patient with Noonan syndrome after corrective surgery

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    Mangovski Ljupčo

    2015-01-01

    Full Text Available Introduction. Transcatheter atrial septal defect (ASD closure is considered to be a gold standard for patients with the suitable anatomy as compared to cardiac surgery. Reocurrence of ASD after surgical closure is a very rare late complication which can be successfully managed with transcatheter procedure. Case report. We reported a female patient with Noonan syndrome who presented with hemodinamically significant ASD 37 years after the corrective cardiac surgery. Due to numerous comorbidities which included severe kyphoscoliosis, pectus excavatum and multiple surgeries we decided to perform transcatheter closure of ASD. The procedure itself was very challenging due to the patient’s short stature and heart’s orientation in the chest, but was performed successfully. The subsequent follow-up was uneventful and the patient reported improvement in the symptoms. Conclusion. Transcatheter closure of ASD in a patient with Noonan syndrome with the history of surgically corrected ASD can be performed successfully, despite challenging chest anatomy.

  13. Numerical investigation of the flow field in realistic nasal septal perforation geometry.

    Science.gov (United States)

    Faramarzi, Mohammad; Baradaranfar, Mohammad Hossein; Abouali, Omid; Atighechi, Saeid; Ahmadi, Goodarz; Farhadi, Pejman; Keshavarzian, Erfan; Behniafard, Nasim; Baradaranfar, Amin

    2014-07-01

    The computational fluid dynamics (CFD) are used to evaluate the physiological function of the nose. We evaluated the aerodynamics of the nasal cavity in a patient with septal perforation (SP), pre- and postvirtual repair. Three-dimensional nasal models were reconstructed, and then a wide range of the pressure drops and flow rates were analyzed. The airflow velocity is higher in the central region and is lower around the boundary of the SP. The air velocity in the SP increases as the pressure drop increases. Furthermore, at the anterior part of the SP, the shear stress is higher in the upper part. In addition, the repair of SP does not affect the total nasal airflow rate and the velocity contour patterns. The potential usage of the CFD technique as a predictive technique to explore the details and a preoperative assessment tool to help in clinical decision making in nasal surgery is emphasized. PMID:24988523

  14. Optogenetic activation of septal GABAergic afferents entrains neuronal firing in the medial habenula

    Science.gov (United States)

    Choi, Kyuhyun; Lee, Youngin; Lee, Changwoo; Hong, Seokheon; Lee, Soonje; Kang, Shin Jung; Shin, Ki Soon

    2016-01-01

    The medial habenula (MHb) plays an important role in nicotine-related behaviors such as nicotine aversion and withdrawal. The MHb receives GABAergic input from the medial septum/diagonal band of Broca (MS/DB), yet the synaptic mechanism that regulates MHb activity is unclear. GABA (γ -aminobutyric acid) is a major inhibitory neurotransmitter activating both GABAA receptors and GABAB receptors. Depending on intracellular chloride concentration, however, GABAA receptors also function in an excitatory manner. In the absence of various synaptic inputs, we found that MHb neurons displayed spontaneous tonic firing at a rate of about ~4.4 Hz. Optogenetic stimulation of MS/DB inputs to the MHb evoked GABAA receptor-mediated synaptic currents, which produced stimulus-locked neuronal firing. Subsequent delayed yet lasting activation of GABAB receptors attenuated the intrinsic tonic firing. Consequently, septal GABAergic input alone orchestrates both excitatory GABAA and inhibitory GABAB receptors, thereby entraining the firing of MHb neurons. PMID:27703268

  15. Prenatal Isolated Ventricular Septal Defect May Not Be Associated with Trisomy 21

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    Ori Shen

    2014-04-01

    Full Text Available The aim of this study was to examine if isolated fetal ventricular septal defect (VSD is associated with trisomy 21. One hundred twenty six cases with prenatal VSD diagnosed by a pediatric cardiologist were reviewed. Cases with known risk factors for congenital heart disease, the presence of other major anomalies, soft signs for trisomy 21 or a positive screen test for trisomy 21 were excluded. Ninety two cases formed the study group. None of the cases in the study group had trisomy 21. The upper limit of prevalence for trisomy 21 in isolated VSD is 3%. When prenatal VSD is not associated with other major anomalies, soft markers for trisomy 21 or a positive nuchal translucency or biochemical screen, a decision whether to perform genetic amniocentesis should be individualized. The currently unknown association between isolated VSD and microdeletions and microduplications should be considered when discussing this option.

  16. Echocardiographic diagnosis and necropsy findings of a congenital ventricular septal defect in a stranded harbor porpoise.

    Science.gov (United States)

    Szatmári, Viktor; Bunskoek, Paulien; Kuiken, Thijs; van den Berg, Annemarie; van Elk, Cornelis

    2016-03-30

    A live-stranded harbor porpoise Phocoena phocoena was found on the west coast of the Dutch island Texel (North Sea) and transported to a rehabilitation center for small cetaceans, where it underwent a veterinary health check. Cardiac auscultation revealed a systolic cardiac murmur with the point of maximal intensity in the right hemithorax with an intensity of IV out of VI. Transthoracic echocardiography revealed a congenital ventricular septal defect with left-to-right shunting. Because the left atrium was not dilated according to the reference range of canine left atrium to aortic ratio, the presence of congestive heart failure was considered very unlikely. Therefore, this congenital cardiac anomaly was thought to be a clinically non-relevant incidental finding and would not explain the weakness, coughing, anorexia, vomiting, and diarrhea. Because the animal was still unable to swim or eat by itself after 2 wk of supportive care, it was euthanized. Post-mortem examination confirmed the presence of a ventricular septal defect. The weight of the heart relative to the animal's length was greater than expected, using linear regression analysis on the lengths and cardiac weights of 71 other stranded wild harbor porpoises without macroscopic cardiac pathologic changes. This finding suggests that the left ventricle had an eccentric hypertrophy because of volume overload resulting from the intracardiac shunt. This is the first report of a congenital cardiac anomaly and its ante-mortem diagnosis in this species. Data presented for the other 71 harbor porpoises may provide reference values for this species. PMID:27025305

  17. The influence of septal lesions on sodium and water retention induced by Walker 256 tumor

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    F. Guimarães

    1999-03-01

    Full Text Available In the course of studies on the effects of septal area lesions on neuroimmunomodulation and Walker 256 tumor development, it was observed that tumor-induced sodium and water retention was less marked in lesioned than in non-lesioned rats. In the present study possible mechanisms involved in this phenomenon were investigated. The experiments were performed in septal-lesioned (LW; N = 15 and sham-operated (SW; N = 7 8-week-old male Wistar rats, which received multifocal simultaneous subcutaneous (sc inoculations of Walker 256 tumor cells about 30 days after the stereotaxic surgery. Control groups (no tumor, sham-operated food-restricted (SFR, N = 7 and lesioned food-restricted (LFR, N = 10 were subjected to a feeding pattern similar to that observed in tumor-bearing animals. Multifocal inoculation of Walker 256 tumor rapidly induces anorexia, which is paradoxically accompanied by an increase in body weight, as a result of renal Na+ and fluid retention. These effects of the tumor were also seen in LW rats, although the rise in fractional sodium balance during the early clinical period was significantly smaller than in SW rats (day 4: SW = 47.6 ± 6.4% and LW = 13.8 ± 5.2%; day 5: SW = 57.5 ± 3.5% and LW = 25.7 ± 4.8%; day 6: SW = 54.4 ± 3.8% and LW = 32.1 ± 4.4%; P<0.05, suggesting a temporary reduction in tumor-induced sodium retention. In contrast, urine output was significantly reduced in SW rats and increased in LW rats (LW up to -0.85 and SW up to 4.5 ml/100 g body weight, with no change in osmolar excretion. These temporary changes in the tumor's effects on LW rats may reflect a "reversal" of the secondary central antidiuretic response induced by the tumor (from antidiuretic to diuretic.

  18. Allelic Interaction between CRELD1 and VEGFA in the Pathogenesis of Cardiac Atrioventricular Septal Defects

    Science.gov (United States)

    Redig, Jennifer K.; Fouad, Gameil T.; Babcock, Darcie; Reshey, Benjamin; Feingold, Eleanor; Reeves, Roger H.; Maslen, Cheryl L.

    2014-01-01

    Atrioventricular septal defects (AVSD) are highly heritable, clinically significant congenital heart malformations. Genetic and environmental modifiers of risk are thought to work in unknown combinations to cause AVSD. Approximately 5–10% of simplex AVSD cases carry a missense mutation in CRELD1. However, CRELD1 mutations are not fully penetrant and require interactions with other risk factors to result in AVSD. Vascular endothelial growth factor-A (VEGFA) is a well-characterized modulator of heart valve development. A functional VEGFA polymorphism, VEGFA c.–634C, which causes constitutively increased VEGFA expression, has been associated with cardiac septal defects suggesting it may be a genetic risk factor. To determine if there is an allelic association with AVSD we genotyped the VEGFA c.–634 SNP in a simplex AVSD study cohort. Over-representation of the c.–634C allele in the AVSD group suggested that this genotype may increase risk. Correlation of CRELD1 and VEGFA genotypes revealed that potentially pathogenic missense mutations in CRELD1 were always accompanied by the VEGFA c.–634C allele in individuals with AVSD suggesting a potentially pathogenic allelic interaction. We used a Creld1 knockout mouse model to determine the effect of deficiency of Creld1 combined with increased VEGFA on atrioventricular canal development. Morphogenic response to VEGFA was abnormal in Creld1-deficient embryonic hearts, indicating that interaction between CRELD1 and VEGFA has the potential to alter atrioventricular canal morphogenesis. This supports our hypothesis that an additive effect between missense mutations in CRELD1 and a functional SNP in VEGFA contributes to the pathogenesis of AVSD. PMID:25328912

  19. Allelic Interaction between CRELD1 and VEGFA in the Pathogenesis of Cardiac Atrioventricular Septal Defects

    Directory of Open Access Journals (Sweden)

    Jennifer K. Redig

    2014-03-01

    Full Text Available Atrioventricular septal defects (AVSD are highly heritable, clinically significant congenital heart malformations. Genetic and environmental modifiers of risk are thought to work in unknown combinations to cause AVSD. Approximately 5–10% of simplex AVSD cases carry a missense mutation in CRELD1. However, CRELD1 mutations are not fully penetrant and require interactions with other risk factors to result in AVSD. Vascular endothelial growth factor-A (VEGFA is a well-characterized modulator of heart valve development. A functional VEGFA polymorphism, VEGFA c.-634C, which causes constitutively increased VEGFA expression, has been associated with cardiac septal defects suggesting it may be a genetic risk factor. To determine if there is an allelic association with AVSD we genotyped the VEGFA c.-634 SNP in a simplex AVSD study cohort. Over-representation of the c.-634C allele in the AVSD group suggested that this genotype may increase risk. Correlation of CRELD1 and VEGFA genotypes revealed that potentially pathogenic missense mutations in CRELD1 were always accompanied by the VEGFA c.-634C allele in individuals with AVSD suggesting a potentially pathogenic allelic interaction. We used a Creld1 knockout mouse model to determine the effect of deficiency of Creld1 combined with increased VEGFA on atrioventricular canal development. Morphogenic response to VEGFA was abnormal in Creld1-deficient embryonic hearts, indicating that interaction between CRELD1 and VEGFA has the potential to alter atrioventricular canal morphogenesis. This supports our hypothesis that an additive effect between missense mutations in CRELD1 and a functional SNP in VEGFA contributes to the pathogenesis of AVSD.

  20. Oclusão percutânea das comunicações interventriculares: experiência inicial Interventricular septal defects percutaneous occlusion: initial experiment

    OpenAIRE

    Francisco José Araújo Chamié de Queiróz; Raul Ivo Rossi Filho; Sérgio Ramos; César Esteves; Daniel Silva Chamié de Queiróz; Paulo Renato Machado; João Carlos Tress; Stella Suzana Horowitz; Helder Paupério; Rosaura Victer

    2005-01-01

    OBJETIVO: Avaliar a experiência inicial com o fechamento percutâneo das comunicações interventriculares (CIV), em especial, das CIV perimembranosas (CIVPM) com a nova prótese de Amplatzer. MÉTODOS: Foram submetidos ao procedimento onze pacientes, seis com CIV perimembranosas (CIVPM) e cinco com CIV musculares (CIVM). Dois apresentavam infecções repetidas do trato respiratório e tinham baixo ganho ponderal. Um apresentou história prévia de endocardite infecciosa. Os demais eram assintomáticos ...

  1. SUCCESSFUL ANAESTHETIC MANAGEMENT OF A PATIENT WITH PARADOXICAL VENTRICULAR SEPTAL MOTION (PVSM POSTED FOR MODIFIED RADICAL NECK DISSECTION WITH RADIAL FREE FLAP

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    Amruta

    2015-04-01

    Full Text Available BACKGROUND : Patients with paradoxical ventricular septal motion are a challenge to anaesthesiologist due to risk of perioperative myocardial ischaemia and sudden cardiac arrest. CASE DESCRIPTION : We present anaesthetic management of a 45year old lady with a diagnosed case of carcinoma left buccal mucosa with paradoxical ventricular septal motion posted for modified radical neck disse ction with radial free flap. CONCLUSION : Although clinical manifestations of this cardiac condition may be mild, there is certainly associated pathology of direct relevance, which carries importance in the anaesthetic management in the peri - operative perio d. Patients with paradoxical ventricular septal motion of any etiology are more prone for perioperative myocardial ischaemia and sudden cardiac arrest, because if cardiac conduction is not maintained properly then it may result in further increase in the p aradoxical ventricular septal motion

  2. Effects of septal nucleus lesion on dopamine D2 receptor expression in the prefrontal lobe, striatum, and brainstem in a rat model of schizophrenia

    Institute of Scientific and Technical Information of China (English)

    Xin Li; Shuande Li

    2008-01-01

    BACKGROUND: It has been demonstrated that the septal nucleus is involved in the pathogenesis of schizophrenia. Based on autopsies of schizophrenia patients, studies have shown a reduced number of septal nucleus neurons and gila. In addition, experimental rat models of schizophrenia have shown increased dopamine receptor D2 binding sites in the basal ganglia, septal nuclei, and substantia nigra. Previous studies have demonstrated that the septal nucleus modulates dopamine metabolic disorder and dopamine D2 receptor balance.OBJECTIVE: Dopamine D2 receptor expression in a rat model of schizophrenia, combined with antipsychotic drugs, was analyzed in the prefrontal lobe, striatum, and brainstem. In situ hybridization was used to observe the effects of stereotactic septal nucleus lesions on dopamine D2 receptor expression in the brains of methylamphetamine-treated rats. DESIGN, TIME AND SETTING: A randomized, controlled, animal experiment was performed in the Laboratory of General Institute of Psychosurgery, Third Hospital of Chinese PLA from November 2005 to June 2006. MATERIALS: A total of 120 healthy, adult Sprague Dawley rats, weighing approximately 200 g, were included. Methylamphetamine (Sigma, USA) and an in situ hybridization detection kit for dopamine D2 receptor (Boster, China) were also used for this study. METHODS: All rats were randomly allocated to the following 4 groups, with 30 rats in each group: normal control, simple administration, septal nucleus lesion, and sham-operated groups. In the normal control group, rats were not administered or lesioned. In the remaining 3 groups, rats were intraperitoneally administered 10 mg/kg methylamphetamine, once per day, for 15 successive days to establish a schizophrenia model. Following successful model establishment, rats from the septal nucleus lesion group were subjected to stereotactic septal nucleus lesions. The cranial bone was exposed in rats from the sham-operated group, and the septal nucleus was not

  3. Immunological tolerance to pig-serum partially inhibits the formation of septal fibrosis of the liver in Capillaria hepatica-infected rats

    OpenAIRE

    Rodrigo Guimarães Andrade; Bruna Magalhães Gotardo; Bárbara Cristina A Assis; José Mengel; Zilton A. Andrade

    2004-01-01

    Systhematized septal fibrosis of the liver can be induced in rats either by repeated intraperitoneal injections of pig-serum or by Capillaria hepatica infection. The relationship between these two etiological factors, as far as hepatic fibrosis is concerned, is not known, and present investigation attempts to investigate it. C. hepatica-induced septal fibrosis of the liver was considerably inhibited in rats previously rendered tolerant to pig-serum. Pig-serum-tolerant rats developed antibodie...

  4. LEFT VENTRICULAR INFLOW OBSTRUCTION BY GIANT ATRIAL SEPTAL ANEURYSM IN A NEONATE WITH HYPOPLASTIC RIGHT HEART SYNDROME: CASE REPORT.

    Science.gov (United States)

    Yuko-Jowi, C; Okello, C A

    2013-02-01

    Atrial septal aneurysm remains a rare congenital cardiac malformation. In the neonatal age group it can occur as an isolated cardiac malformation or in association with complex hypoplastic cardiac malformations of the right and left heart. In the adult population most aneurysms have been described in association with stroke. Baby H.N delivered on 10/05/2008 by C/S, was cyanosed at birth with systemic desaturation. Chest X-ray showed oligaemic lung fields while two dimensional echocardiograms showed tricuspid atresia with hypoplastic right ventricle, large secundum atrial septal defect, and highly mobile gigantic aneurysms of the atrial septum obstructing the inflow of the mitral valve and entering the left ventricle in diastole. Surgical intervention was not possible and child died on second day.

  5. Retraction: Selective cerebro-myocardial perfusion under mild hypothermia during primary repair for aortic coarctation with ventricular septal defect.

    Science.gov (United States)

    2013-04-01

    The following article from Artificial Organs, "Selective Cerebro-Myocardial Perfusion Under Mild Hypothermia During Primary Repair for Aortic Coarctation With Ventricular Septal Defect" by Huiwen Chen, Haifa Hong, Zhongqun Zhu and Jinfen Liu, published online on 2 November 2012 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor-in-Chief, Paul S. Malchesky, the International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. The retraction has been agreed due to simultaneous publication of a substantially similar article, "Continuous Cerebral and Myocardial Perfusion During One-Stage Repair for Aortic Coarctation With Ventricular Septal Defect", by Huiwen Chen, Haifa Hong, Zhongqun Zhu and Jinfen Liu, in Pediatric Cardiology 7 November 2012 [Epub ahead of print].

  6. Novel Mutations in the Transcriptional Activator Domain of the Human TBX20 in Patients with Atrial Septal Defect

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    Irma Eloisa Monroy-Muñoz

    2015-01-01

    Full Text Available Background. The relevance of TBX20 gene in heart development has been demonstrated in many animal models, but there are few works that try to elucidate the effect of TBX20 mutations in human congenital heart diseases. In these studies, all missense mutations associated with atrial septal defect (ASD were found in the DNA-binding T-box domain, none in the transcriptional activator domain. Methods. We search for TBX20 mutations in a group of patients with ASD or ventricular septal defect (VSD using the High Resolution Melting (HRM method and DNA sequencing. Results. We report three missense mutations (Y309D, T370O, and M395R within the transcriptional activator domain of human TBX20 that were associated with ASD. Conclusions. This is the first association of TBX20 transcriptional activator domain missense mutations with ASD. These findings could have implications for diagnosis, genetic screening, and patient follow-up.

  7. Guillain - Barre syndrome in a patient with acute myocardial infarction with ventricular septal defect repair treated with plasma exchange

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    Maitrey D Gajjar

    2015-01-01

    Full Text Available Guillain - Barre syndrome (GBS is an acute, frequently severe progressive illness of peripheral nervous system that is autoimmune in nature. GBS after myocardial infarction (MI with ventricular septal defect (VSD is uncommon with high mortality rate if not treated promptly. [1] We report a successful outcome of GBS post MI with VSD in a 60-year-old male patient who was on a ventilator treated successfully with therapeutic plasma exchange.

  8. Pulmonary Root Translocation with the Lecompte Maneuver: For Transposition of the Great Arteries with Ventricular Septal Defect and Pulmonary Stenosis

    OpenAIRE

    Yoon, Dong Woog; Kim, Tae Ho; Shim, Man-shik; Jun, Tae-Gook; Jang, Jae Seok

    2015-01-01

    A five-month-old boy who had undergone previously transcatheter balloon atrioseptostomy at 3 days of age for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis underwent pulmonary root translocation with the Lecompte maneuver. This operation has the advantages of maintaining pulmonary valve function, preserving the capacity for growth, and avoiding problems inherent to the right ventricular to pulmonary artery conduit. This patient progressed we...

  9. Impaired exercise capacity following atrial septal defect closure: an invasive study of the right heart and pulmonary circulation

    OpenAIRE

    Santos, Mário; Systrom, David; Epstein, Stephen E.; John, Anitha; Ruiz, George; Landzberg, Michael J.; Opotowsky, Alexander R.

    2014-01-01

    Patients with early repair of an isolated atrial septal defect (ASD) are expected to have unremarkable right ventricular (RV) and pulmonary circulation physiology. Some studies, however, suggest persistent functional impairment. We aimed to examine the role of abnormal RV and pulmonary vascular response to exercise in patients who had undergone ASD closure. Using a previously published data set, we reviewed invasive exercise cardiopulmonary testing with right-sided hemodynamic data for 12 asy...

  10. Guillain — Barre syndrome in a patient with acute myocardial infarction with ventricular septal defect repair treated with plasma exchange

    OpenAIRE

    Gajjar, Maitrey D.; Nidhi M Bhatnagar; Nirav J Patel; Tarak Patel

    2015-01-01

    Guillain - Barre syndrome (GBS) is an acute, frequently severe progressive illness of peripheral nervous system that is autoimmune in nature. GBS after myocardial infarction (MI) with ventricular septal defect (VSD) is uncommon with high mortality rate if not treated promptly. [1] We report a successful outcome of GBS post MI with VSD in a 60-year-old male patient who was on a ventilator treated successfully with therapeutic plasma exchange.

  11. Feasibility and Safety of Transthoracic Echocardiography-Guided Transcatheter Closure of Atrial Septal Defects with Deficient Superior-Anterior Rims

    OpenAIRE

    Gui-Shuang Li; Hai-De Li; Jie Yang; Wen-Quan Zhang; Zong-Shen Hou; Qing-Chen Li; Yun Zhang

    2012-01-01

    Although previous studies showed that transthoracic echocardiography (TTE) can be used to guide transcatheter closure of atrial septal defect (ASD), whether TTE can be used to guide transcatheter closure of secundum ASD with a deficient superior-anterior rim is unknown and this critical issue was addressed in the present study. A total of 280 patients with secundum ASD who underwent transcatheter ASD closure were recruited and divided into groups A and B depending on ASD superior-anterior rim...

  12. Small Left Atrial Size Complicating Percutaneous Transcatheter Device Closure of Secundum Atrial Septal Defect with Conventional Approach

    OpenAIRE

    Ko, Hong Ki; Kang, So Yeon; Yu, Jeong Jin; Ko, Jae-Kon; Kim, Young-Hwue

    2015-01-01

    Background and Objectives Transcatheter device closure becomes the first option for treating secundum atrial septal defect (ASD), but the conventional method is sometimes unsuccessful even when the defect size indicates the closure to be feasible. To increase the success rate, modified methods have been introduced and used. This study aimed to find predictors for using the modified methods in the device closure of secundum ASDs. Subjects and Methods Between October 2010 and December 2012, 92 ...

  13. The effects of various lesions and knife-cuts on septal and amygdala kindling in the rat.

    Science.gov (United States)

    Racine, R J; Paxinos, G; Mosher, J M; Kairiss, E W

    1988-06-28

    Large bilateral aspiration lesions of the hippocampus had no significant effect on septal kindling, whereas large bilateral DC lesions of the pyriform lobe resulted in a small but significant increase in the number of septal stimulations required to complete kindling. Bilateral aspiration lesions of the dorsal hippocampus or large bilateral DC lesions of the ventral hippocampus had no effect on amygdala kindling. Small DC lesions of the stria terminalis significantly facilitated amygdala kindling. Unilateral or bilateral ventral knife-cuts delivered in a coronal plane anterior to the amygdala, disrupting communication with anterior pyriform structures, produced a small but nearly significant increase in the number of stimulations required for amygdala kindling. Similar cuts placed posterior to the amygdala, disrupting communication with the hippocampus, significantly facilitated kindling. Cuts that were medially placed, to disrupt the ventral amygdala-fugal pathway, had no effect on amygdala kindling. These results show that the hippocampus is not critical for either septal or amygdala kindling. The pyriform lobe structures appear to play a facilitatory role in kindling, but none of the lesions or knife-cuts were capable of blocking or even severely retarding kindling.

  14. Surgical treatment of partial atrioventricular septal defect: functional analysis of the mitral valve in the postoperative period

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    Josué Viana Castro Neto

    2002-11-01

    Full Text Available OBJECTIVE: To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect. METHODS: Fifty patients underwent surgical correction of the partial form of atrioventricular septal defect. Their mean age was 11.8 years and 62% of the patients were males. Preoperative echocardiography showed moderate and severe mitral insufficiency in 44% of the patients. The mitral valve cleft was sutured in 45 (90% patients (group II - GII. Echocardiographies were performed in the early postoperative period, and 6 and 12 months after hospital discharge. RESULTS: The patients who had some type of arrhythmia in the postoperative period had ostium primum atrial septal defect of a larger size (2.74 x 2.08 cm. All 5 patients in group I (GI, who did not undergo closure of the cleft, had a competent mitral valve or mild mitral insufficiency in the preoperative period. One of these patients began to have moderate mitral insufficiency in the postoperative period. On the other hand, in GII, 88.8% and 82.2% of the patients had competent mitral valve or mild mitral insufficiency in the early and late postoperative periods, respectively. CONCLUSION: The mitral valve cleft was repaired in 90% of cases. Echocardiography revealed competent mitral valve or mild mitral insufficiency in 88.8% and 82.2% of GII patients in the early and late postoperative periods, respectively.

  15. Compound heterozygous or homozygous truncating MYBPC3 mutations cause lethal cardiomyopathy with features of noncompaction and septal defects

    Science.gov (United States)

    Wessels, Marja W; Herkert, Johanna C; Frohn-Mulder, Ingrid M; Dalinghaus, Michiel; van den Wijngaard, Arthur; de Krijger, Ronald R; Michels, Michelle; de Coo, Irenaeus FM; Hoedemaekers, Yvonne M; Dooijes, Dennis

    2015-01-01

    Familial hypertrophic cardiomyopathy (HCM) is usually caused by autosomal dominant pathogenic mutations in genes encoding sarcomeric or sarcomere-associated cardiac muscle proteins. The disease mainly affects adults, although young children with severe HCM have also been reported. We describe four unrelated neonates with lethal cardiomyopathy, and performed molecular studies to identify the genetic defect. We also present a literature overview of reported patients with compound heterozygous or homozygous pathogenic MYBPC3 mutations and describe their clinical characteristics. All four children presented with feeding difficulties, failure to thrive, and dyspnea. They died from cardiac failure before age 13 weeks. Features of left ventricular noncompaction were diagnosed in three patients. In the fourth, hypertrabeculation was not a clear feature, but could not be excluded. All of them had septal defects. Two patients were compound heterozygotes for the pathogenic c.2373dup p.(Trp792fs) and c.2827C>T p.(Arg943*) mutations, and two were homozygous for the c.2373dup and c.2827C>T mutations. All patients with biallelic truncating pathogenic mutations in MYBPC3 reported so far (n=21) were diagnosed with severe cardiomyopathy and/or died within the first few months of life. In 62% (13/21), septal defects or a patent ductus arteriosus accompanied cardiomyopathy. In contrast to heterozygous pathogenic mutations, homozygous or compound heterozygous truncating pathogenic MYBPC3 mutations cause severe neonatal cardiomyopathy with features of left ventricular noncompaction and septal defects in approximately 60% of patients. PMID:25335496

  16. Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes.

    Science.gov (United States)

    Battaglia, P; Turri-Zanoni, M; De Bernardi, F; Dehgani Mobaraki, P; Karligkiotis, A; Leone, F; Castelnuovo, P

    2016-06-01

    Over the past decade surgery for sinonasal malignancies encroaching into the anterior skull base (ASB) has evolved from open craniofacial resection to the use of minimally invasive transnasal endoscopic approaches. Using these techniques, ASB reconstruction is most often performed in a multilayer fashion with autologous free grafts (fascia lata or iliotibial tract) which leads to the production of abundant nasal crusting in the postoperative months and discomfort for patients. In carefully selected cases, we propose harvesting a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), which can be rotated to resurface the ASB defect. The exclusion criteria for using the SFF were as follows: cases where the tumour extended to both ethmoid complexes; cases where there was nasal septum or planum spheno-ethmoidalis involvement by the disease; cases of sinonasal malignant tumour with multifocal histology. In our tertiary care referral centre, skull base reconstruction using the SFF was performed in four patients; one was affected by ethmoidal teratocarcinosarcoma, one by persistence of sinonasal undifferentiated carcinoma after radio-chemotherapy, another by olfactory cleft esthesioneuroblastoma and the fourth by ethmoidal squamous cell carcinoma. Successful skull base reconstruction was obtained in all four cases without any intra- or post-operative complications. Post-operatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. No recurrences of disease have been observed after a mean follow-up of 15 months. The SFF can be considered as a safe and effective technique for ASB reconstruction with high success rates similar to those obtained with other pedicled flaps. This flap also ensured a faster healing process with reduction of nasal crusting and improvement in the quality of life of patients in the postoperative period. This technique appears

  17. An in vivo assessment of the effects of using different implant abutment occluding materials on implant microleakage and the peri-implant microbiome

    Science.gov (United States)

    Rubino, Caroline

    Microleakage may be a factor in the progression of peri-implant pathology. Microleakage in implant dentistry refers to the passage of bacteria, fluids, molecules or ions between the abutment-implant interface to and from the surrounding periodontal tissues. This creates a zone of inflammation and reservoir of bacteria at the implant-abutment interface. Bone loss typically occurs within the first year of abutment connection and then stabilizes. It has not yet been definitively proven that the occurrence of microleakage cannot contribute to future bone loss or impede the treatment of peri-implant disease. Therefore, strategies to reduce or eliminate microleakage are sought out. Recent evidence demonstrates that the type of implant abutment channel occluding material can affect the amount of microleakage in an in vitro study environment. Thus, we hypothesize that different abutment screw channel occluding materials will affect the amount of observed microleakage, vis-a-vis the correlation between the microflora found on the abutment screw channel occluding material those found in the peri-implant sulcus. Additional objectives include confirming the presence of microleakage in vivo and assessing any impact that different abutment screw channel occluding materials may have on the peri-implant microbiome. Finally, the present study provides an opportunity to further characterize the peri-implant microbiome. Eight fully edentulous patients restored with at dental implants supporting screw-retained fixed hybrid prostheses were included in the study. At the initial appointment (T1), the prostheses were removed and the implants and prostheses were cleaned. The prostheses were then inserted with polytetrafluoroethylene tape (PTFE, TeflonRTM), cotton, polyvinyl siloxane (PVS), or synthetic foam as the implant abutment channel occluding material and sealed over with composite resin. About six months later (T2), the prostheses were removed and the materials collected. Paper

  18. Initial Experience with Balloon-Occluded Trans-catheter Arterial Chemoembolization (B-TACE) for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Mitsunari, E-mail: mitunari@med-shimane.u.ac.jp; Yoshizako, Takeshi, E-mail: yosizako@med.shimane-u.ac.jp; Nakamura, Tomonori, E-mail: t-naka@med.shimane-u.ac.jp; Nakamura, Megumi, E-mail: megumi@med.shimane-u.ac.jp; Yoshida, Rika, E-mail: yoshidar@med.shimane-u.ac.jp; Kitagaki, Hajime, E-mail: kitagaki@med.shimane-u.ac.jp [Shimane University Faculty of Medicine, Department of Radiology (Japan)

    2016-03-15

    PurposeThis study was performed to evaluate the accumulation of lipiodol emulsion (LE) and adverse events during our initial experience of balloon-occluded trans-catheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) compared with conventional TACE (C-TACE).MethodsB-TACE group (50 cases) was compared with C-TACE group (50 cases). The ratio of the LE concentration in the tumor to that in the surrounding embolized liver parenchyma (LE ratio) was calculated after each treatment. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Effects (CTCAE) version 4.0.ResultsThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). Only elevation of alanine aminotransferase was more frequent in the B-TACE group, showing a statistically significant difference (Mann–Whitney test: P < 0.05). While B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation, there was no statistically significant difference in incidence between the groups. Multivariate logistic regression analysis suggested that the significant risk factor for liver abscess/infarction was bile duct dilatation (P < 0.05).ConclusionThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation.

  19. Chronic immobilization stress occludes in vivo cortical activation in an animal model of panic induced by carbon dioxide inhalation

    Directory of Open Access Journals (Sweden)

    Mohammed Mostafizur eRahman

    2014-09-01

    Full Text Available Breathing high concentrations of carbon dioxide (CO2 can trigger panic and anxiety in humans. CO2 inhalation has been hypothesized to activate neural systems similar to those underlying fear learning, especially those involving the amygdala. Amygdala activity is also upregulated by stress. Recently, however, a separate pathway has been proposed for interoceptive panic and anxiety signals, as patients exhibited CO2-inhalation induced panic responses despite bilateral lesions of the amygdala. This paradoxical observation has raised the possibility that cortical circuits may underlie these responses. We sought to examine these divergent models by comparing in vivo brain activation in unstressed and chronically-stressed rats breathing CO2. Regional cerebral blood flow measurements using functional Magnetic Resonance Imaging (fMRI in lightly-anaesthetized rats showed especially strong activation of the somatosensory cortex by CO2 inhalation in the unstressed group. Strikingly, prior exposure to chronic stress occluded this effect on cortical activity. This lends support to recent clinical observations and highlights the importance of looking beyond the traditional focus on limbic structures, such as the hippocampus and amygdala, to investigate a role for cortical areas in panic and anxiety in humans.

  20. Mapping functional group free energy patterns at protein occluded sites: nuclear receptors and G-protein coupled receptors.

    Science.gov (United States)

    Lakkaraju, Sirish Kaushik; Yu, Wenbo; Raman, E Prabhu; Hershfeld, Alena V; Fang, Lei; Deshpande, Deepak A; MacKerell, Alexander D

    2015-03-23

    Occluded ligand-binding pockets (LBP) such as those found in nuclear receptors (NR) and G-protein coupled receptors (GPCR) represent a significant opportunity and challenge for computer-aided drug design. To determine free energies maps of functional groups of these LBPs, a Grand-Canonical Monte Carlo/Molecular Dynamics (GCMC/MD) strategy is combined with the Site Identification by Ligand Competitive Saturation (SILCS) methodology. SILCS-GCMC/MD is shown to map functional group affinity patterns that recapitulate locations of functional groups across diverse classes of ligands in the LBPs of the androgen (AR) and peroxisome proliferator-activated-γ (PPARγ) NRs and the metabotropic glutamate (mGluR) and β2-adreneric (β2AR) GPCRs. Inclusion of protein flexibility identifies regions of the binding pockets not accessible in crystal conformations and allows for better quantitative estimates of relative ligand binding affinities in all the proteins tested. Differences in functional group requirements of the active and inactive states of the β2AR LBP were used in virtual screening to identify high efficacy agonists targeting β2AR in Airway Smooth Muscle (ASM) cells. Seven of the 15 selected ligands were found to effect ASM relaxation representing a 46% hit rate. Hence, the method will be of use for the rational design of ligands in the context of chemical biology and the development of therapeutic agents.

  1. Thrombocytopenia in Patients with Gastric Varices and the Effect of Balloon-occluded Retrograde Transvenous Obliteration on the Platelet Count

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    W E Saad

    2014-01-01

    Full Text Available Objectives: Gastric varices primarily occur in cirrhotic patients with portal hypertension and splenomegaly and thus are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting. Moreover, one-third of patients after balloon-occluded retrograde transvenous obliteration (BRTO have aggravated splenomegaly, which potentially may cause worsening thrombocytopenia. The aim of the study is to determine the prevalence and degree of thrombocytopenia in patients with gastric varices associated with gastrorenal shunts undergoing BRTO, to determine the prognostic factors of survival after BRTO (platelet count included, and to assess the effect of BRTO on platelet count over a 1-year period. Materials and Methods: This is a retrospective review of 35 patients who underwent BRTO (March 2008-August 2011. Pre- and post-BRTO platelet counts were noted. Potential predictors of bleeding and survival (age, gender, liver disease etiology, platelet count, model for end stage liver disease [MELD]-score, presence of ascites or hepatocellular carcinoma were analyzed (multivariate analysis. A total of 91% (n = 32/35 of patients had thrombocytopenia (90% of patients in patients undergoing BRTO. However, BRTO (with occlusion of the gastrorenal shunt has little effect on the platelet count. Long-term outcomes of BRTO for bleeding gastric varices using sodium tetradecyl sulfate in the USA are impressive with a 4-year variceal rebleed rate and transplant-free survival rate of 9% and 76%, respectively. Platelet count is not a predictor of higher rebleeding or patient survival after BRTO.

  2. A case of liver cirrhosis with bleeding from stomal varices successfully treated using balloon-occluded retrograde transvenous obliteration.

    Science.gov (United States)

    Takano, Masashi; Imai, Yukinori; Nakazawa, Manabu; Chikayama, Taku; Ando, Satsuki; Sugawara, Kayoko; Nakayama, Nobuaki; Mochida, Satoshi

    2016-06-01

    A 66-year-old male patient with liver cirrhosis because of alcohol intake underwent a Hartmann's procedure for rectal cancer. Four months later, bleeding from the sigmoid stoma occurred and persisted for 2 months. A colonoscopic examination revealed bleeding from stomal varices. Three-dimensional computed tomography (CT) imaging demonstrated the inferior mesenteric vein and left superficial epigastric vein as the feeding and drainage vessels, respectively. Balloon-occluded retrograde transvenous obliteration (B-RTO) through the left epigastric vein was performed using a microballoon catheter inserted from the right femoral vein according to the Seldinger method. A CT examination performed 2 days after the B-RTO procedure revealed that the blood flow had disappeared, with thrombosis formation in both the stomal varices and the feeding vein. No recurrent bleeding from the stoma occurred. B-RTO using a microballoon catheter is useful as a therapeutic procedure for stomal varices to prevent bleeding, since the procedure can be performed with minimal invasion using the Seldinger method. PMID:27048279

  3. Avaliação de deformidade septal por videofibroscopia nasal em pacientes adultos com atresia transversal de maxila Septal deformity evaluation by nasofibroscopy in adult patients with transverse maxillary deficiency

    Directory of Open Access Journals (Sweden)

    Ana I.A. Andrade

    2002-10-01

    Full Text Available Introdução: A ocorrência de deformidades da maxila conjuntamente com problemas respiratórios, principalmente obstrução nasal, tem chamado a atenção de diversos pesquisadores para a possibilidade desses eventos guardarem uma relação entre si. São objetivos desse trabalho avaliar a ocorrência de obstrução nasal e de deformidade septal em pacientes adultos portadores de mordida cruzada posterior e discutir a realização de tratamento cirúrgico integrado (cirurgia maxilar/septoplastia nesses pacientes. Forma de estudo: Clínico prospectivo randomizado. Material e Método: Realizou-se avaliação otorrinolaringológica com ênfase no exame da cavidade nasal através da nasofibroscopia de 30 pacientes adultos, portadores de mordida cruzada posterior e com indicação de tratamento ortodôntico-cirúrgico (expansão rápida de maxila assistida cirurgicamente. Resultados: Dos pacientes estudados 56,7% apresentaram relato de obstrução nasal, sendo que 43,3% não apresentavam queixa respiratória. Considerando o estudo nasofibroscópico, verificamos presença de deformidade septal em 100% dos pacientes. Quanto ao diagnóstico topográfico da deformidade septal (de acordo com Cottle, verificamos comprometimento da área I em 13,4%, área II em 83,3%, área III em 90%, área IV em 83,3% e área V em 3,3%. Conclusões: Verificamos que pacientes adultos com mordida cruzada posterior esquelética não apresentam obrigatoriamente quadro de obstrução nasal. Concluímos pela importância do exame nasofibroscópico em pacientes adultos portadores de mordida cruzada posterior esquelética para diagnóstico de deformidade septal. Ressaltamos a importância do trabalho em conjunto do Cirurgião Maxilo-Facial com o Otorrinolaringologista, visto que nos casos em que esteja programada expansão rápida de maxila cirurgicamente assistida, e o paciente apresentar prejuízo da função nasal às custas de deformidades septais, pode-se programar os dois

  4. Polymorphic haplotypes of CRELD1 differentially predispose Down syndrome and euploids individuals to atrioventricular septal defect.

    Science.gov (United States)

    Ghosh, Priyanka; Bhaumik, Pranami; Ghosh, Sujoy; Ozbek, Umut; Feingold, Eleanor; Maslen, Cheryl; Sarkar, Biswanath; Pramanik, Vishmadeb; Biswas, Priyanka; Bandyopadhyay, Biswajit; Dey, Subrata Kumar

    2012-11-01

    To explore the role of CRELD1 variants on congenital heart defects, we sequenced the entire reading frame of CRELD1 in the samples from Kolkata and adjoining areas. Nearly, 400 participants were included in the genetic association study and they were stratified as Down syndrome (DS) with atrioventricular septal defect (AVSD), DS without AVSD, euploid with AVSD, and euploid without AVSD. A significant association was found between AVSD and three polymorphisms, namely rs9878047 (c.1049-129T > C), rs3774207 (c.1119C > T), and rs73118372 (c.1136T > C) among the Down syndrome and euploid individuals. The polymorphism rs73118372, involves a transition (c.1136T > C) that leads to change in amino acid methionine to threonine which alters protein secondary structure as confirmed by the bioinformatics software SOPMA. In addition, two haplotypes, C-T-C and C-T-T, in the order of loci rs9878047-rs3774207-rs73118372 were associated with incidence of AVSD among euploid and Down syndrome, with a slightly higher odds ratio in the later group. We hypothesize that these haplotypes increase the risk of AVSD, and the susceptibility is exacerbated in DS, possibly due to the trisomy 21 genetic background. Moreover, we report for the first time on an interaction between the mutant alleles of rs3774207 and rs73118372 which could disrupt the delicate balance between different CRELD1 isoforms.

  5. Natural and modified history of complete atrioventricular septal defect--a 17 year study.

    Science.gov (United States)

    Frontera-Izquierdo, P; Cabezuelo-Huerta, G

    1990-01-01

    We reviewed 103 cases of isolated complete atrioventricular septal defect. These cases represented 4.4% of the cases of congenital heart disease diagnosed in our hospital by catheterisation and angiography during 1971-88. Most children (n = 76) had Down's syndrome. Banding of the pulmonary artery was performed in seven cases and complete repair in 67 cases. In the period 1971-82 the complete correction was performed at a mean age of 23 months with a surgical mortality of 88.8%. In the period 1983-8 the mean age at complete correction was 13 months, the mortality 43.2%, and the five year actuarial survival was 46.8%. The 22 patients that survived after complete correction were in functional classes I and II of the New York Heart Association classification. After a mean follow up of 10 years only eight (36%) of the 22 who were followed up and treated medically survived; all had developed pulmonary vascular obstructive disease and were in functional classes III or IV. Our findings stress the importance of early complete surgical repair. PMID:2221969

  6. Imaging Techniques in Percutaneous Cardiac Structural Interventions: Atrial Septal Defect Closure and Left Atrial Appendage Occlusion.

    Science.gov (United States)

    Rodríguez Fernández, Antonio; Bethencourt González, Armando

    2016-08-01

    Because of advances in cardiac structural interventional procedures, imaging techniques are playing an increasingly important role. Imaging studies show sufficient anatomic detail of the heart structure to achieve an excellent outcome in interventional procedures. Up to 98% of atrial septal defects at the ostium secundum can be closed successfully with a percutaneous procedure. Candidates for this type of procedure can be identified through a systematic assessment of atrial septum anatomy, locating and measuring the size and shape of all defects, their rims, and the degree and direction of shunting. Three dimensional echocardiography has significantly improved anatomic assessments and the end result itself. In the future, when combined with other imaging techniques such as cardiac computed tomography and fluoroscopy, 3-dimensional echocardiography will be particularly useful for procedure guidance. Percutaneous closure of the left atrial appendage offers an alternative for treating patients with atrial fibrillation and contraindication for oral anticoagulants. In the future, the clinical focus may well turn to stroke prevention in selected patients. Percutaneous closure is effective and safe; device implantation is successful in 94% to 99% of procedures. However, the procedure requires an experienced cardiac structural interventional team. At present, 3-dimensional echocardiography is the most appropriate imaging technique to assess anatomy suitability, select device type and size, guide the procedure alongside fluoroscopy, and to follow-up the patient afterwards. PMID:27354151

  7. Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy: From Experiment to Standard of Care

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    Lothar Faber

    2014-01-01

    Full Text Available Hypertrophic cardiomyopathy (HCM is one of the more common hereditary cardiac conditions. According to presence or absence of outflow obstruction at rest or with provocation, a more common (about 60–70% obstructive type of the disease (HOCM has to be distinguished from the less common (30–40% nonobstructive phenotype (HNCM. Symptoms include exercise limitation due to dyspnea, angina pectoris, palpitations, or dizziness; occasionally syncope or sudden cardiac death occurs. Correct diagnosis and risk stratification with respect to prophylactic ICD implantation are essential in HCM patient management. Drug therapy in symptomatic patients can be characterized as treatment of heart failure with preserved ejection fraction (HFpEF in HNCM, while symptoms and the obstructive gradient in HOCM can be addressed with beta-blockers, disopyramide, or verapamil. After a short overview on etiology, natural history, and diagnostics in hypertrophic cardiomyopathy, this paper reviews the current treatment options for HOCM with a special focus on percutaneous septal ablation. Literature data and the own series of about 600 cases are discussed, suggesting a largely comparable outcome with respect to procedural mortality, clinical efficacy, and long-term outcome.

  8. Novel and functional DNA sequence variants within the GATA5 gene promoter in ventricular septal defects

    Institute of Scientific and Technical Information of China (English)

    Ji-Ping Shan; Xiao-Li Wang; Yuan-Gang Qiao; Hong-Xin Wan Yan; Wen-Hui Huang; Shu-Chao Pang; Bo Yan

    2014-01-01

    Background: Congenital heart disease (CHD) is the most common human birth defect. Genetic causes for CHD remain largely unknown. GATA transcription factor 5 (GATA 5) is an essential regulator for the heart development. Mutations in the GATA5 gene have been reported in patients with a variety of CHD. Since misregulation of gene expression have been associated with human diseases, we speculated that changed levels of cardiac transcription factors, GATA5, may mediate the development of CHD. Methods: In this study, GATA5 gene promoter was genetically and functionally analyzed in large cohorts of patients with ventricular septal defect (VSD) (n=343) and ethnic-matched healthy controls (n=348). Results: Two novel and heterozygous DNA sequence variants (DSVs), g.61051165A>G and g.61051463delC, were identified in three VSD patients, but not in the controls. In cultured cardiomyocytes, GATA5 gene promoter activities were significantly decreased by DSV g.61051165A>G and increased by DSV g.61051463delC. Moreover, fathers of the VSD patients carrying the same DSVs had reduced diastolic function of left ventricles. Three SNPs, g.61051279C>T (rs77067995), g.61051327A>C (rs145936691) and g.61051373G>A (rs80197101), and one novel heterozygous DSV, g.61051227C>T, were found in both VSD patients and controls with similar frequencies. Conclusion: Our data suggested that the DSVs in the GATA5 gene promoter may increase the susceptibility to the development of VSD as a risk factor.

  9. Preoperative cardiac computed tomography for demonstration of congenital cardiac septal defect in adults

    International Nuclear Information System (INIS)

    We aimed to evaluate the role of preoperative cardiac computed tomography (CT) for adults with congenital cardiac septal defect (CSD). Sixty-five consecutive patients who underwent preoperative CT and surgery for CSD were included. The diagnostic accuracy of CT and the concordance rate of the subtype classification of CSD were evaluated using surgical findings as the reference standard. Sixty-five patients without CSD who underwent cardiac valve surgery were used as a control group. An incremental value of CT over echocardiography was described retrospectively. Sensitivity and specificity of CT for diagnosis of CSD were 95 % and 100 %, respectively. The concordance rate of subtype classification was 91 % in CT and 92 % in echocardiography. The maximum size of the defect measured by CT correlated well with surgical measurement (r = 0.82), and the limit of agreement was -0.9 ± 7.42 mm. In comparison with echocardiography, CT was able to detect combined abnormalities in three cases, and exclusively provided correct subtype classification or clarified suspected abnormal findings found on echocardiography in seven cases. Cardiac CT can accurately demonstrates CSD in preoperative adult patients. CT may have an incremental role in preoperative planning, particularly in those with more complex anatomy. (orig.)

  10. Preoperative cardiac computed tomography for demonstration of congenital cardiac septal defect in adults

    Energy Technology Data Exchange (ETDEWEB)

    Eom, Hye-Joung; Yang, Dong Hyun; Kang, Joon-Won; Lim, Tae-Hwan [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, Seoul (Korea, Republic of); Kim, Dae-Hee; Song, Jong-Min; Kang, Duk-Hyun; Song, Jae-Kwan [University of Ulsan College of Medicine, Department of Cardiology and Heart Institute, Cardiac Imaging Center, Asan Medical Center, Seoul (Korea, Republic of); Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won [University of Ulsan College of Medicine, Department of Cardiothoracic surgery, Cardiac Imaging Center, Asan Medical Center, Seoul (Korea, Republic of)

    2015-06-01

    We aimed to evaluate the role of preoperative cardiac computed tomography (CT) for adults with congenital cardiac septal defect (CSD). Sixty-five consecutive patients who underwent preoperative CT and surgery for CSD were included. The diagnostic accuracy of CT and the concordance rate of the subtype classification of CSD were evaluated using surgical findings as the reference standard. Sixty-five patients without CSD who underwent cardiac valve surgery were used as a control group. An incremental value of CT over echocardiography was described retrospectively. Sensitivity and specificity of CT for diagnosis of CSD were 95 % and 100 %, respectively. The concordance rate of subtype classification was 91 % in CT and 92 % in echocardiography. The maximum size of the defect measured by CT correlated well with surgical measurement (r = 0.82), and the limit of agreement was -0.9 ± 7.42 mm. In comparison with echocardiography, CT was able to detect combined abnormalities in three cases, and exclusively provided correct subtype classification or clarified suspected abnormal findings found on echocardiography in seven cases. Cardiac CT can accurately demonstrates CSD in preoperative adult patients. CT may have an incremental role in preoperative planning, particularly in those with more complex anatomy. (orig.)

  11. Peptidomic Analysis of Amniotic Fluid for Identification of Putative Bioactive Peptides in Ventricular Septal Defect

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    Xing Li

    2016-05-01

    Full Text Available Background: Ventricular septal defect (VSD is one of the most common congenital heart diseases and to date the role of peptides in human amniotic fluid in the pathogenesis of VSD have been rarely investigated. Methods: To gain insight into the mechanisms of protein and peptides in cardiovascular development, we constructed a comparative peptidomic profiling of human amniotic fluid between normal and VSD fetuses using a stable isobaric labeling strategy involving tandem mass tag reagents, followed by nano liquid chromatography tandem mass spectrometry. Results: We identified and quantified 692 non-redundant peptides, 183 of which were differentially expressed in the amniotic fluid of healthy and VSD fetuses; 69 peptides were up regulated and 114 peptides were down regulated. These peptides were imported into the Ingenuity Pathway Analysis (IPA and identified putative roles in cardiovascular system morphogenesis and cardiogenesis. Conclusion: We concluded that 35 peptides located within the functional domains of their precursor proteins could be candidate bioactive peptides for VSD. The identified peptide changes in amniotic fluid of VSD fetuses may advance our current understanding of congenital heart disease and these peptides may be involved in the etiology of VSD.

  12. BMP9 protects septal neurons from axotomy-evoked loss of cholinergic phenotype.

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    Ignacio Lopez-Coviella

    Full Text Available BACKGROUND: Cholinergic projection from the septum to the hippocampus is crucial for normal cognitive function and degeneration of cells and nerve fibers within the septohippocampal pathway contributes to the pathophysiology of Alzheimer's disease. Bone morphogenetic protein (BMP 9 is a cholinergic differentiating factor during development both in vivo and in vitro. METHODOLOGY/PRINCIPAL FINDINGS: To determine whether BMP9 could protect the adult cholinergic septohippocampal pathway from axotomy-evoked loss of the cholinergic phenotype, we performed unilateral fimbria-fornix transection in mice and treated them with a continuous intracerebroventricular infusion of BMP9 for six days. The number of choline acetyltransferase (CHAT-positive cells was reduced by 50% in the medial septal nucleus ipsilateral to the lesion as compared to the intact, contralateral side, and BMP9 infusion prevented this loss in a dose-dependent manner. Moreover, BMP9 prevented most of the decline of hippocampal acetylcholine levels ipsilateral to the lesion, and markedly increased CHAT, choline transporter CHT, NGF receptors p75 (NGFR-p75 and TrkA (NTRK1, and NGF protein content in both the lesioned and unlesioned hippocampi. In addition, BMP9 infusion reduced bilaterally hippocampal levels of basic FGF (FGF2 protein. CONCLUSIONS/SIGNIFICANCE: These data indicate that BMP9 administration can prevent lesion-evoked impairment of the cholinergic septohippocampal neurons in adult mice and, by inducing NGF, establishes a trophic environment for these cells.

  13. An evaluation of the left atrial/aortic root ratio in children with ventricular septal defect.

    Science.gov (United States)

    Lester, L A; Vitullo, D; Sodt, P; Hutcheon, N; Arcilla, R

    1979-08-01

    Echocardiograms were performed in 80 infants and children with isolated ventricular septal defect (VSD) who underwent cardiac catheterization. The pulmonary-to-systemic flow ratio (Qp/Qs) was correlated with the echocardiographic left atrial-to-aortic root diameter ratio (LA/Ao), and a relatively poor correlation (r = 0.62) was found. The end-systolic diameters of the left atrium and aorta at the level of the aortic root, obtained from lateral cineangiograms of 55 of the 80 patients, were compared with the corresponding echocardiographic dimensions. To assess the possible effect of transducer beam angulation upon the echocardiographic determinations, the angiographic measurements were made at 0 degrees position (perpendicular to the frontal plane) and at angles of 5 degrees, 10 degrees, 15 degrees and 20 degrees from zero, using the aortic root center as the point of intersection. The echocardiographic and angiographic aortic root measurements were comparable (r = 0.95), and the angiographically derived aortic diameter did not vary with different angle projections. However, the left atrial angiographic dimensions were significantly influenced by the angle of projection. We conclude that the echocardiographic LA/Ao ratio cannot reliably estimate the severity of the shunt flow in VSD.

  14. Coblation nasal septal swell body reduction for treatment of nasal obstruction: a preliminary report.

    Science.gov (United States)

    Kim, So Jeong; Kim, Hee Tae; Park, Yun Hwi; Kim, Ju Yeon; Bae, Jung Ho

    2016-09-01

    In this paper, we present the results of coblation nasal septal swell body (NSB) reduction for the treatment of nasal obstruction in patients with abnormally thickened NSB. The study design was a retrospective clinical series conducted at a single tertiary medical center. Eight patients underwent coblation NSB reduction. Pre-operative and post-operative nasal functions were evaluated by acoustic rhinometry and subjective symptom scales. We also analyzed pre-operative CT scan images and nasal endoscopic findings. The mean maximal NSB width was 16.4 ± 2.2 mm on pre-operative coronal CT scan images. The mean visual analog scale score for nasal obstruction was decreased from preoperative 7.63 ± 0.99 points to 3.88 ± 0.92 points (postoperative 3 months), 4.16 ± 0.78 points (postoperative 6 months), and 4.63 ± 0.69 points (postoperative 1 year). Six out of the eight patients were satisfied with the clinical outcome at 1 year after the procedure. To the best of our knowledge, coblation NSB reduction has not yet been reported in the medical literature. Our results show that it can be an effective treatment modality for nasal valve narrowing in patients with abnormally thickened NSB. PMID:26912145

  15. Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury

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    Yun Mi Kim

    2011-02-01

    Full Text Available Traumatic ventricular septal defect (VSD resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.

  16. Coblation nasal septal swell body reduction for treatment of nasal obstruction: a preliminary report.

    Science.gov (United States)

    Kim, So Jeong; Kim, Hee Tae; Park, Yun Hwi; Kim, Ju Yeon; Bae, Jung Ho

    2016-09-01

    In this paper, we present the results of coblation nasal septal swell body (NSB) reduction for the treatment of nasal obstruction in patients with abnormally thickened NSB. The study design was a retrospective clinical series conducted at a single tertiary medical center. Eight patients underwent coblation NSB reduction. Pre-operative and post-operative nasal functions were evaluated by acoustic rhinometry and subjective symptom scales. We also analyzed pre-operative CT scan images and nasal endoscopic findings. The mean maximal NSB width was 16.4 ± 2.2 mm on pre-operative coronal CT scan images. The mean visual analog scale score for nasal obstruction was decreased from preoperative 7.63 ± 0.99 points to 3.88 ± 0.92 points (postoperative 3 months), 4.16 ± 0.78 points (postoperative 6 months), and 4.63 ± 0.69 points (postoperative 1 year). Six out of the eight patients were satisfied with the clinical outcome at 1 year after the procedure. To the best of our knowledge, coblation NSB reduction has not yet been reported in the medical literature. Our results show that it can be an effective treatment modality for nasal valve narrowing in patients with abnormally thickened NSB.

  17. Medial septal GABAergic projection neurons promote object exploration behavior and type 2 theta rhythm.

    Science.gov (United States)

    Gangadharan, Gireesh; Shin, Jonghan; Kim, Seong-Wook; Kim, Angela; Paydar, Afshin; Kim, Duk-Soo; Miyazaki, Taisuke; Watanabe, Masahiko; Yanagawa, Yuchio; Kim, Jinhyun; Kim, Yeon-Soo; Kim, Daesoo; Shin, Hee-Sup

    2016-06-01

    Exploratory drive is one of the most fundamental emotions, of all organisms, that are evoked by novelty stimulation. Exploratory behavior plays a fundamental role in motivation, learning, and well-being of organisms. Diverse exploratory behaviors have been described, although their heterogeneity is not certain because of the lack of solid experimental evidence for their distinction. Here we present results demonstrating that different neural mechanisms underlie different exploratory behaviors. Localized Cav3.1 knockdown in the medial septum (MS) selectively enhanced object exploration, whereas the null mutant (KO) mice showed enhanced-object exploration as well as open-field exploration. In MS knockdown mice, only type 2 hippocampal theta rhythm was enhanced, whereas both type 1 and type 2 theta rhythm were enhanced in KO mice. This selective effect was accompanied by markedly increased excitability of septo-hippocampal GABAergic projection neurons in the MS lacking T-type Ca(2+) channels. Furthermore, optogenetic activation of the septo-hippocampal GABAergic pathway in WT mice also selectively enhanced object exploration behavior and type 2 theta rhythm, whereas inhibition of the same pathway decreased the behavior and the rhythm. These findings define object exploration distinguished from open-field exploration and reveal a critical role of T-type Ca(2+) channels in the medial septal GABAergic projection neurons in this behavior. PMID:27208094

  18. Contribution of Copy Number Variation to Down Syndrome-associated Atrioventricular Septal Defects

    Science.gov (United States)

    Ramachandran, Dhanya; Mulle, Jennifer G.; Locke, Adam E.; Bean, Lora J.H.; Rosser, Tracie C.; Bose, Promita; Dooley, Kenneth J.; Cua, Clifford L.; Capone, George T.; Reeves, Roger H.; Maslen, Cheryl L.; Cutler, David J.; Sherman, Stephanie L.; Zwick, Michael E.

    2014-01-01

    Purpose The goal of this study was to identify the contribution of large copy number variants (CNV) to Down syndrome (DS) associated atrioventricular septal defects (AVSD), whose risk in the trisomic population is 2000-fold more compared to general disomic population. Methods Genome-wide CNV analysis was performed on 452 individuals with DS (210 cases with complete AVSD; 242 controls with structurally normal hearts) using Affymetrix SNP 6.0 arrays, making this the largest heart study conducted to date on a trisomic background. Results Large common CNVs with substantial effect sizes (OR>2.0) do not account for the increased risk observed in DS-associated AVSD. In contrast, cases had a greater burden of large rare deletions (p<0.01) and intersected more genes (p<0.007) when compared to controls. We also observed a suggestive enrichment of deletions intersecting ciliome genes in cases compared to controls. Conclusion Our data provide strong evidence that large rare deletions increase the risk of DS-associated AVSD, while large common CNVs do not appear to increase the risk of DS-associated AVSD. The genetic architecture of AVSD is complex and multifactorial in nature. PMID:25341113

  19. Medial septal modulation of the ascending brainstem hippocampal synchronizing pathways in the freely moving rat.

    Science.gov (United States)

    Bland, Brian H; Bird, Jen; Jackson, Jesse; Natsume, Kiyohisa

    2006-01-01

    Rats implanted with hippocampal recording electrodes were tested in a wheel-running apparatus under three conditions: (1) independent electrical stimulation of the medial septal nucleus (MS); (2) independent electrical stimulation of the posterior hypothalamic nucleus (PH); and (3) combined electrical stimulation of the MS and PH using pairings of two stimulation conditions, 7 or 10 Hz stimulation of the MS, and a low- or high-intensity PH stimulation. Quantitative measures of running speed were taken, and hippocampal recordings were subjected to fast-Fourier transform analysis. Electrical stimulation of the PH induced wheel-running behavior; running speed and the accompanying hippocampus (HPC) theta frequency increased with increase in stimulation intensity. Electrical stimulation of the MS failed to induce wheel-running behavior despite the fact that HPC theta was induced at the frequency of the applied stimulation (7 and 10 Hz). Electrical stimulation of the MS reset the frequency of HPC theta induced by PH stimulation in both the upward and downward directions and increased theta power, while wheel-running speed was modulated in a downward direction only.

  20. Infective Endocarditis Complicated by Septic Pulmonary Emboli in a Case of a Ventricular Septal Defect

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    Roodpeyma

    2015-11-01

    Full Text Available Introduction Infective endocarditis (IE causes serious complications in patients. Congenital heart disease (CHD is an important underlying condition in children. Septic pulmonary embolism is an uncommon syndrome, and pulmonary valve IE is rare. The current study presented a case of right-sided IE with pulmonary valve involvement and its complications as pulmonary septic emboli in a child with CHD. Case Presentation A 6-year-old girl with a ventricular septal defect (VSD was presented. Echocardiography revealed large vegetation in the right ventricular outflow tract near the pulmonary valve. The patient showed clinical symptoms of lung involvement, and radiologic investigation was compatible with a diagnosis of septic pulmonary emboli. She had good response to antibacterial therapy and underwent a successful surgical closure of the heart defect. Conclusions Children with CHD are at risk of severe complications with the involvement of other organs. long-term febrile illness should be taken seriously in these children. They need hospitalization and careful evaluation.

  1. Influence of Septal Deviation on the Prognosis of Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy.

    Science.gov (United States)

    Raposo, Alberto; Piqueras, Francisco; García-Purriños, Francisco; Martínez-Martinez, María Ll; Lajara, Jerónimo

    2016-01-01

    Purpose. The objective of the present study is to determine whether the success rate in transcanalicular diode laser-assisted dacryocystorhinostomy (TCL DCR) is influenced by the variant septal deviation (SD). Methods. Patients were divided into two groups: one including operated lacrimal pathways (LP) with no anatomical nasosinusal variants and the other group of LP with SD. This study began on January 1, 2008, and ended on December 31, 2010, at Morales Meseguer Hospital. Variables were compared by means of ANOVA and a logistic regression model (LOGIT). Results. Out of the 159 LP operated on, 102 had no nasosinusal anatomic variant, but 39 LP were associated with SD. The first group evidenced a success rate of 67.64%, while the second group evidenced a success rate of 66.7%. Conclusion. We found no significant statistical differences between the success rates in the two groups (with SD and no anatomical variants). So we could avoid previous or concomitant septoplasty in some cases (mild and moderate SD). PMID:27144017

  2. Comparison of Sinonasal Symptoms in Patients with Nasal Septal Deviation and Patients with Chronic Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Mohammad Naeimi

    2013-01-01

    Full Text Available Introduction: Disorders of the nose and paranasal sinuses are among the most common chronic illnesses. Although considerable progress has been made in the medical and surgical control of these diseases, a large number of questions relating to the diagnosis, evaluation, and treatment of these conditions remain unanswered. The aim of the present study was to evaluate differences in the frequency of symptoms and disease severity in patients with nasal septal deviation (NSD compared with chronic rhinosinusitis (CRS.  Materials and Methods: A total of 156 patients, divided into NSD and CRS groups, were studied in relation to symptoms and disease severity. Patients were selected from those referred to the Ear, Nose, and Throat (ENT Wards of the Imam Reza and Ghaem Hospitals, who had not responded to a variety of treatments. Depending on the type of disease, patients were candidates for either septoplasty or endoscopic sinus surgery. The Rhinosinusitis Symptom Inventory was administered to measure the severity of symptoms, with scores assigned based on the answers given by patients (Likert scale.  Scores were compared between the CRS and NSD groups.  Results: A total of 156 patients (78 with NDS and 78 with CRS entered the study in overall sinonasal symptoms were more prevalent in CRS group. Nasal congestion, runny nose, earache, toothache, and smelling disorder were significantly more common in the CRS group (P0.05.  Conclusion:  Patients with CRS manifested statistically significantly greater sinonasal symptom scores than patients with NSD.

  3. Influence of Septal Deviation on the Prognosis of Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy

    Directory of Open Access Journals (Sweden)

    Alberto Raposo

    2016-01-01

    Full Text Available Purpose. The objective of the present study is to determine whether the success rate in transcanalicular diode laser-assisted dacryocystorhinostomy (TCL DCR is influenced by the variant septal deviation (SD. Methods. Patients were divided into two groups: one including operated lacrimal pathways (LP with no anatomical nasosinusal variants and the other group of LP with SD. This study began on January 1, 2008, and ended on December 31, 2010, at Morales Meseguer Hospital. Variables were compared by means of ANOVA and a logistic regression model (LOGIT. Results. Out of the 159 LP operated on, 102 had no nasosinusal anatomic variant, but 39 LP were associated with SD. The first group evidenced a success rate of 67.64%, while the second group evidenced a success rate of 66.7%. Conclusion. We found no significant statistical differences between the success rates in the two groups (with SD and no anatomical variants. So we could avoid previous or concomitant septoplasty in some cases (mild and moderate SD.

  4. RESIDUAL DEFECTS AFTER SURGICAL REPAIR OF VENTRICULAR SEPTAL DEFECTS IN CHILDREN:

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    K Sayadpour-Zanjani

    2008-12-01

    Full Text Available "nResidual ventricular septal defects (VSD are major complications after cardiac surgery. We studied the incidence of this complication, risk factors for its occurrence and short-term follow-up in 179 pediatric patients that underwent surgical closure of VSD from April 2003 until May 2004. All data were gathered retrospectively except measurements of shunt ratio. Studied risk factors included age, sex, weight, height, ejection fraction, VSD size, presence of pulmonary stenosis (PS, responsible surgeon, use of patch material for closing VSD, mean degree of hypothermia, cardiopulmonary bypass and aortic cross-clamp times, hemorrhage, documented infection, and surgical approach for defect closure. The incidence of all residual VSDs was 56% and significant ones (i.e. with Qp/Qs > 1.5 22%. The only statistically significant risk factors were higher age, weigh and height of the patients. There was notable but statistically insignificant differences in residual shunt incidence among the patients of different surgeons and with the use of different patch materials. During the median follow-up period of 9.5 months, 35% of the residual defects were closed spontaneously. Six patients underwent catheterization, three of which were candidates of residual VSD closure. As residual VSD is a hemodynamically and psychologically important complication, we recommend VSD closure at lower age and the use of intraoperative epicardial or transesophageal echocardiography to minimize its occurrence.

  5. Salivary Biomarkers Associated with Myocardial Necrosis: Results from an Alcohol Septal Ablation Model

    Science.gov (United States)

    Foley, Joseph D.; Sneed, J. Darrell; Steinhubl, Steven R.; Kolasa, Justin R.; Ebersole, Jeffrey L.; Lin, Yushun; Kryscio, Richard J.; McDevitt, John T.; Campbell, Charles L.; Miller, Craig S.

    2013-01-01

    Objective To determine if salivary biomarkers demonstrate utility for identifying aspects of myocardial necrosis. Methods Twenty-one patients undergoing alcohol septal ablation (ASA) for treatment of hypertrophic cardiomyopathy provided serum and unstimulated whole saliva at baseline and incremental time points post-ASA. Samples were analyzed for seven biomarkers related to myocardial damage, inflammation and tissue remodeling using immunosorbent assays. Levels were compared to baseline and levels observed in 97 healthy controls. Results Biomarkers of myocardial damage and inflammation (i.e., troponin I, creatine kinase-MB, myoglobin, C-reactive protein) rose in serum 2 to 812-fold after ASA (p<0.01). Significant elevations of 2 to 3.5-fold were observed with C-reactive protein and troponin I in saliva (p<0.02). Significant correlations between levels in serum and saliva were observed for C-reactive protein, matrix metalloproteinase-9, and myeloperoxidase (p < 0.001). Conclusions Select salivary biomarkers reflect changes that occur during, and subsequent to, myocardial necrosis caused by ASA. PMID:23021916

  6. Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Yoshimasa Maeda; Yumiko Ibata; Katsuhiko Higashi

    2006-01-01

    A 66-year-old woman underwent partial splenic embolization (PSE) for hypersplenism with idiopathic portal hypertension (IPH). One week later, contrastenhanced CT revealed extensive portal vein thrombosis (PVT) and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase.The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration (BRTO) technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt.Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

  7. The Changes of Left Ventricular Form and Function After Closure of Moderate-to Large-sized Patent Ductus Arteriosus Using Domestic-made Occluder

    Institute of Scientific and Technical Information of China (English)

    Mo Jianmei; Wu Weifeng; Liu Tangwei; Huang Kai; Guo Shenglan; Zhang Bingdong; Wu Ji

    2005-01-01

    Objectives To evaluate the changes of the left ventricular form and function after closure of moderate- to large-sized patent ductus arteriosus (PDA) using domestic-made occluder.Methods 22 patients with PDA underwent procedure successfuly using the domestic-made occluder. The mean PDA minimal (pulmonary end) diameter by aortography was 8.01±2.47 mm (range 4 to 15.Smm).All patients underwent transthoracic echocardiography (TTE) study before the procedure and the following 48hours, 3 months after procedure. Results All patients had been implanted the domestic-made occluders successfully with no haematolysis, infective endocarditis, recanalization and other complications.At 3 months, mean LVED was decreased to 50.05±6.55mm, compared to the pre-procedure (55.67±8.48mm), P < 0.01. After 48 hours of the procedure, mean LVEDD and LVESD decreased significantly (156.22±51.40 mLvs. 121.28±35.73ml, 57.16±32.07 mL vs.45.88±15.97 mL), P<0.05. At3 months, LVEDDdecreased to 110.93±15.08ml, LVSV reached 73.50±9.19 mL, compared to the pre-procedure, P < 0.01.LVESD decreased to 37.43±10.44 mL at 3 months, P <0.05. Conclusions Closuring of moderate- to largesized PDA using domestic-made occluder is effective and safe. After procedure, left ventricular form and function improved.

  8. Studies on the Construction Parameter of an Artificial Occluded Cell for In-situ Inspection of the Propagation Rate of Localized Corrosion

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    An artificial localized corrosion system is assembled and some parameters related to the localized corrosion in active dissolution state(i.e.,non-passive state)have been studied.The results showed that the developed electrochemical system can satisfactorily imitate a naturally formed localized corrosion and the coupling current can indicate the maximum localized propagating rate.In this artificial system, the anodic dissolution reaction followed the auto-catalytic mechanism.The localized corrosion current density was dependent on the area ratio R of the cathode tothe occluded anode. While R was equal to or more than 6, the coupling current reached at a maximum value and did not alter with the increase in R-value. Therefore, R=7 is chosen as one of these optimum parameters used in constructing the system, with which the biggest galvanic current might be obtained. In contrast, the thickness of the polymer filler separating the occluded anode area from the bulk electrolyte solution and the volume of the occluded anode area did not affect the corrosion current obviously. They might affect the response time to approach a steady state.

  9. Pupil-occluding organized hyphema anterior to the intraocular lens treated by neodymium: yttrium-aluminum-garnet laser: a case report

    Science.gov (United States)

    Kim, Moosang; Lee, Seung-Jun; Han, Sang Beom; Yang, Hee Kyung; Hyon, Joon Young

    2016-01-01

    We report, to our best knowledge, the first case of treatment of pupil-occluding postoperative organized hyphema anterior to the intraocular lens (IOL) using neodymium: yttrium-aluminum-garnet (Nd:YAG) laser. A 78-year-old Asian female underwent uneventful cataract operation. She had been taking aspirin, which she discontinued 1 week before surgery. Iris prolapse occurred at the end of the surgery, which led to intracameral bleeding. Two weeks later, her best-corrected visual acuity was hand motion. Although hyphema had decreased, pupil-occluding organized hematoma had formed anterior to the IOL. The blood clot anterior to the IOL was removed using Nd:YAG laser. One week later, although the hematoma anterior to the IOL resolved, endocapsular hematoma was observed, which was dispersed with Nd:YAG laser posterior capsulotomy. Two weeks later, her best-corrected visual acuity improved to 20/60. There was no complication associated with Nd:YAG laser. In conclusion, pupil-occluding organized hyphema anterior to the IOL can occur as a complication of cataract surgery, in which Nd:YAG laser can be a useful treatment option. PMID:27462181

  10. Intraoperative device closure of secundum atrial septal defect associated with deficient rims with a right anterior minithora-cotomy%右胸小切口封堵缺乏边缘的Ⅱ孔型房间隔缺损

    Institute of Scientific and Technical Information of China (English)

    孙晓宁; 赵强; 陈安清; 夏利民; 周光华; 王哲; 徐德民

    2009-01-01

    Objective To evaluate the feasibility of inrtaoperative device closure of secundum atrial septal defects(ASDs) as-sociated with deficient rime using the china-made septal occluder through a right antierior minithoractomy.Methods 25 patients with deficient rims underwent an attemptes intraoperative device closure.The patients had a deficient anterior rim (n=11),a deficient anterior rim and an inferior rim (n=3),a deficient anterior rim and a posterior rim(n=4),posterior rim(n=1),deficient anterior rim and superior rim(n=1),superior rim(n=4)as assessed by transesophgeal echocardiography(TEE).54 patients with sufficient rims(>5mm)who underwent closure served as controls.For deficient inferior rim,a sticth was sewed at the inferior vena cava near right infrior pulmonary vein to enforce the umbrella.For deficient posterior rim,a sticth was sewed at the right atrium to enfoce the umbrella.Results There were no differences between the 2 grouos in ASD stretched diameter and devioe (P>0.05).Of 25patients with deficient rims,25(100%)had immediate complete closure compared with 52 of 54 patients (96%) with sufficient rims (P5衄)行右胸小切El房间隔缺损封堵治疗者作为对照组,其中女36例.男18例,平均年龄31.9岁(5-72岁).结果 无边缘组房间隔缺损直径10-38衄,平均(23.3±8.5)mm.封堵器大小为(27.9±7.8)mm(14-42衄).对照组房间隔缺损直径9.38衄,平均(23.6±7.0)mm,封堵器大小为(29.4-I-7.3)r唧(12-42m).两组房间隔缺损直径和所用封堵器大小差别无统计学意义(P>O.05).平均手术时间分别为(30±7)min和(15 4-4)rain.差别有统计学意义(P<0.c15).25例缺乏边缘者100%(25,25例)封堵成功,对照组96%(52,54例)封堵成功,2例存在轻度残余分流.随访6个月,两组封堵成功率均为100%,均无严重并发症.结论 右胸小切口可以成功封堵边缘缺乏的房间隔缺损,但需要更长期的随访评估长期的安全性和有效性.

  11. 单纯食管超声引导经皮封堵治疗房间隔缺损%Percutaneous transcatheter closure of atrial septal defect guided by transesophageal echocardiography in children

    Institute of Scientific and Technical Information of China (English)

    欧阳文斌; 潘湘斌; 逄坤静; 胡盛寿; 田鹏声; 张大伟; 张凤文; 郭改丽; 刘垚

    2014-01-01

    Objective To investigate the early clinical effects of using transesophageal echocardiography (TEE) in order to guide percutaneous transcatheter closure of atrial septal defect in children in comparison to fluoroscopy.Methods From Oct.2012 to Jan.2014,50 cases of consecutive children (TEE group) undergoing percutaneous transcatheter closure of atrial septal defect received the procedure completely guided and monitored by TEE.One hundred and sixty-two children who guided by conventional fluoroscopy during the same period served as controls.After 1 month of the operation,patients of 2 groups were followed up by conducting transthoracic echocardiography.Results The mean age,mean body weight,the mean size of atrial septal defect and occlusion,procedure time,and hospital stay time had no statistical differences between 2 groups.In comparison with the TEE group and control group,there were no differences in the rate of successful occlusion (100.0% vs 97.5%,P =0.58) and immediate postoperative residual shunt (0 vs 4.4%,P =0.20).The TEE group required general anesthesia intubation time lasted (2.9 ± 0.5) h and the control group was spontaneously breathing under sedation.During 1 month follow-up,there were no complications such as residual shunt,peripheral vascular injury,cardiac perforation or occluder abscission in all patients.Conclusions Percutaneous transcatheter closure of atrial septal defect completely guided by TEE is safe and minimally invasive in children.The procedure can avoid the injuries of radiation and contrast agent.Its effect can compete with that by using traditional fluoroscopy.%目的 通过与传统放射线引导方法相比较,评价单纯经食道超声(TEE)引导在经皮介入封堵儿童房间隔缺损中的早期临床应用效果.方法 收集2012年10月至2014年1月单纯TEE引导下经皮房间隔缺损封堵患儿50例(TEE组),均采用TEE引导并监测封堵全过程.选取同期传统放射线引导下经

  12. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Ho; Yoon, Chang Jin; Park, Jae Hyung; Chung, Jin Wook; Kwon, Jong Won [Seoul Natioonal University College of Medicine, Seoul (Korea, Republic of); Choi, Guk Myung [Cheju National University College of Medicine, Jeju (Korea, Republic of)

    2003-06-01

    To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test. One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02). BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.

  13. Development of Thrombus in a Systemic Vein after Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

    Energy Technology Data Exchange (ETDEWEB)

    Yoshimatsu, Rika; Yamagami, Takuji; Tanaka, Osamu; Miura, Hiroshi; Nishimura, Tsunehiko [Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto (Japan); Okuda, Kotaro; Hashiba, Mitsuoki [Fukuchiyama City Hospital, Kyoto (Japan)

    2012-06-15

    To retrospectively evaluate the frequency and risk factors for developing thrombus in a systemic vein such as the infrarenal inferior vena cava or the iliac vein, in which a balloon-occluded retrograde transvenous obliteration (B-RTO) catheter was indwelled. Forty-nine patients who underwent B-RTO for gastric varices were included in this study. The B-RTO procedure was performed from the right femoral vein, and the B-RTO catheter was retained overnight in all patients. Pre- and post-procedural CT scans were retrospectively compared in order to evaluate the development of thrombus in the systemic vein in which the catheter was indwelled. Additionally, several variables were analyzed to assess risk factors for thrombus in a systemic vein. In all 49 patients (100%), B-RTO was technically successful, and in 46 patients (94%), complete thrombosis of the gastric varices was achieved. In 6 patients (12%), thrombus developed in the infrarenal inferior vena cava or the right common-external iliac vein. All thrombi lay longitudinally on the right side of the inferior vena cava or the right iliac vein. One of the aforementioned 6 patients required anticoagulation therapy. No symptoms suggestive of pulmonary embolism were observed. Prothrombin time-international normalized ratio and the addition of 5% ethanolamine oleate iopamidol, on the second day, were related to the development of thrombus. Development of a thrombus in a systemic vein such as the inferior vena cava or iliac vein, caused by indwelling of the B-RTO catheter, is relatively frequent. Physicians should be aware of the possibility of pulmonary embolism due to iliocaval thrombosis.

  14. Effect of naringin on hemodynamic changes and left ventricular function in renal artery occluded renovascular hypertension in rats

    Directory of Open Access Journals (Sweden)

    Asjad Visnagri

    2015-01-01

    Full Text Available Background: Renal artery occlusion (RAO induced hypertension is a major health problem associated with structural and functional variations of the renal and cardiac vasculature. Naringin a flavanone glycoside derived possesses metal-chelating, antioxidant and free radical scavenging properties. Objective: The objective of this study was to investigate the antihypertensive activity of naringin in RAO induced hypertension in rats.Material and Methods: Male Wistar rats (180-200 g were divided into five groups Sham, RAO, naringin (20, 40 and 80 mg/kg. Animals were pretreated with naringin (20, 40 and 80 mg/kg p.o for 4 weeks. On the last day of the experiment, left renal artery was occluded with renal bulldog clamp for 4 h. After assessment of hemodynamic and left ventricular function various biochemical (superoxide dismutase [SOD], glutathione [GSH] and malondialdehyde [MDA] and histological parameters were determined in the kidney. Results: RAO group significantly (P < 0.001 increased hemodynamic parameters at 15, 30 and 45 min of clamp removal. Naringin (40 and 80 mg/kg treated groups showed a significant decrease in hemodynamic parameters at 15 min. after clamp removal that remained sustained for 60 min. Naringin (40 and 80 mg/kg treated groups showed significant improvement in left ventricular function at 15, 30 and 45 min after clamp removal. Alteration in level of SOD, GSH and MDA was significantly restored by naringin (40 and 80 mg/kg treatment. It also reduced histological aberration induced in kidney by RAO. Conclusion: It is concluded that the antihypertensive activity of naringin may result through inhibition of oxidative stress.

  15. Septal localization by membrane targeting sequences and a conserved sequence essential for activity at the COOH-terminus of Bacillus subtilis cardiolipin synthase.

    Science.gov (United States)

    Kusaka, Jin; Shuto, Satoshi; Imai, Yukiko; Ishikawa, Kazuki; Saito, Tomo; Natori, Kohei; Matsuoka, Satoshi; Hara, Hiroshi; Matsumoto, Kouji

    2016-04-01

    The acidic phospholipid cardiolipin (CL) is localized on polar and septal membranes and plays an important physiological role in Bacillus subtilis cells. ClsA, the enzyme responsible for CL synthesis, is also localized on septal membranes. We found that GFP fusion proteins of the enzyme with NH2-terminal and internal deletions retained septal localization. However, derivatives with deletions starting from the COOH-terminus (Leu482) ceased to localize to the septum once the deletion passed the Ile residue at 448, indicating that the sequence responsible for septal localization is confined within a short distance from the COOH-terminus. Two sequences, Ile436-Leu450 and Leu466-Leu478, are predicted to individually form an amphipathic α-helix. This configuration is known as a membrane targeting sequence (MTS) and we therefore refer to them as MTS2 and MTS1, respectively. Either one has the ability to affect septal localization, and each of these sequences by itself localizes to the septum. Membrane association of the constructs of this enzyme containing the MTSs was verified by subcellular fractionation of the cells. CL synthesis, in contrast, was abolished after deleting just the last residue, Leu482, in the COOH-terminal four amino acid residue sequence, Ser-Pro-Ile-Leu, which is highly conserved among bacterial CL synthases.

  16. Inhibition of tumor necrosis factor-α reduces alveolar septal cell apoptosis in passive smoking rats

    Institute of Scientific and Technical Information of China (English)

    ZHANG Cheng; CAI Shan; CHEN Ping; CHEN Jian-bo; WU Jie; WU Shang-jie; ZHOU Rui

    2008-01-01

    Background Recent studies have revealed that lung cell apoptosis plays an important role in pathogenesis of cigarette-induced chronic obstructive pulmonary disease (COPD).Tumor necrosis factor alpha(TNF-α)is one of the most important cytokines which are involved in COPD.This study aimed at investigating the jnfluence of its inhibitor,recombinant human necrosis factor-alpha receptor Ⅱ:IgG Fc fusion protein(rhTNFR:Fc)on alveolar septal cell apoptosis in passive smoking rats.Methods Forty-eight rats were randomly divided into a normal control group,a passive smoking group,an rhTNFR:Fc intervention group and a sham intervention group.The passive smoking rats were treated by exposure to cigarette smoking daily for 80 days.Afcer smoking for one month the rhTNFR:Fc Intervention group was treated with rhTNFR:Fc by subcutaneous injection,the sham intervention group injected subcutaneousIv with a neutral preparation(normal saline 0.1 ml,manicol 0.8 ml,cane sugar 0.2 mg,Tris 0.024 mg as a control.Lung function was determined and the levels of TNF-α in serum and broncho-alveolar lavage fluid(BALF)were measured with enzyme-linked immunosorbnent assay (ELISA).Lung tissue sections stained by hematoxylin and eosin(HE)were observed for study of morphological alternations.Mean linear intercept(MLI)and mean alveolar numbers(MAN)were measured and the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)method was carried out to determine the percentage of positive cells and distribution of apoptotic cells.Results Increased MLI and decreased MAN were found in the passive smoking group compared with both the normal control group and the rhTNFR:Fc intervention group(P<0.05).Forced expiratory volume in 0.3 second(FEV0.3)/forced vital capacity(FVC)and peak expiratory flow(PEF)were lower in the passive smoking group than that in the normal control group(P<0.05).Compared with the sham intervention group,FEV0.3/FVC and PEF increased in the rhTNFR:Fc intervention

  17. Surgical Closer of Atrial Septal Defect in Adults after 40 Years Old

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    Salehi Rezvanieh

    2014-01-01

    Full Text Available Objective: Atrial septal defect (ASD is the most common congenital heart disease in adults. The aim of this study was to determine the value of surgical closure of ASD in patients over 40 years of age. Materials and Methods: Retrospective analysis of 96 patients with the mean age of 47.58 ± 6.59, who had undergone surgical repair of ASD, was carried out. Pre and postoperative clinical status, New York Heart Association (NYHA functional class and systolic pulmonary artery pressure before and after surgical repair, complications of post operation were assessed and analyzed. The follow-up period was between 1 month and 16 years. Results: Before the operations, 62 patients (89.8% were placed in NYHA functional classes of II and III. However, after the surgeries most of the patients could be placed in the functional classes I and II. The mean of pulmonary artery pressure before the surgeries was about 46.68 ± 14.18 and dropped to 32 ± 11.89 mm Hg after the operations (P < 0.0001. Atrial fibrillation rhythm was present in 18 cases preoperatively which was reduced to 3 patients at the discharge time (16.6%. The mean right ventricular (RV sizes were reduced from 4.1 to 2.5 cm after the surgical repairs. In 35 cases (36.64%, we had no tricuspid valve regurgitation after surgery for RV systolic presser estimation. Conclusion: Surgical closure of ASD in patients over 40 years of age could improve their clinical status, and lead to a reduced pulmonary systolic as well as smaller RV sizes.

  18. Diagnosis of asymptomatic atrial septal aneurysms using two-dimensional color Doppler and contrast transthoracic echocardiography

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective To evaluate the dimensions of atrial septal aneurysm (ASA), the presence and characteristics of interatrial shunt, the movement of the wall of the aneurysm, and correlation between these findings and sign and/or symptoms suggesting embolism in Manisa, a district of a western Anatolian city of Turkey. Methods Two thousand five hundred cases were examined by routine transthoracic echocardiography (TTE) in both pediatric and adult cardiology outpatient clinics. ASA was detected in 20 cases and evaluated by two-dimensional color Doppler echocardiography (CDE). The length of the base, the maximum radius and the maximum displacement of ASA were measured. The shunt between the atria was examined by CDE. In cases where a shunt could not be found, galactose and palmitic acid was injected. Standard 12-lead electrocardiogram (ECG) and exercise stress test were also performed. Results No clinical signs or symptoms were found, suggesting a systemic or cerebral embolism. The maximum displacement of ASA was between 2 and 5 mm. All of the aneurysms were localized in the right atrium, and the walls of the aneurysm did not move beyond the base of the left atrium during the maximum displacement. Interatrial shunt was detected in 14 of 20 patients (70%) by CDE and in the remaining six cases by contrast TTE. Frequent ventricular ectopic beats were observed in one patient. Conclusions During routine TTE we observed 0.8% asymptomatic ASA in our population. The use of a contrast agent was found to be a valuable additional method in patients with ASA when the shunt could not be detected by CDE. The risk for embolism is not high when the maximum displacement of the wall of ASA was 5 mm or less and no bulge into the left atrium was observed. Based on our experience with this method, TTE is easy to perform, well-tolerated and acceptable.

  19. Swiss cheese ventricular septal defect with myocarditis - A rare coexistence in a neonate

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    A R Saboo

    2012-01-01

    Full Text Available Myocarditis is defined as acute inflammation of the myocardium, usually following a non-specific flu-like illness, and encompasses a wide range of clinical presentations ranging from mild or subclinical disease to heart failure. We report a 12-day-old healthy full-term neonate who presented with abrupt onset of congestive cardiac failure (CCF following a viral prodrome. Examination revealed persistent sinus tachycardia, lymphocytosis, gross cardiomegaly, nonspecific electrocardiogram changes with echocardiography showing Swiss cheese ventricular septal defect (VSD. VSD alone very rarely presents as early-onset cardiac failure in the absence of other precipitating factors like anemia, sepsis, hypoglycemia etc. Myocarditis, however, can mimic VSD and can present as fulminant cardiac failure in an otherwise healthy newborn. Myocarditis is usually diagnosed based on circumstantial evidence such as a recent viral infection and the sudden onset of cardiac dysfunction while ruling out other diagnostic possibilities. Elevated troponin T level is one of the most crucial noninvasive diagnostic modalities. Several trials have concluded that levels >0.055 ng/ml are statistically significant for diagnosing myocarditis in children. In our case an abrupt onset of cardiac failure following a viral prodrome and markedly elevated cardiac troponin T without sepsis and in the presence of normal coronary anatomy clinched the diagnosis of myocarditis. An early and aggressive treatment for CCF along with regular long-term follow-up plays a key role in the management of myocarditis. Role of high-dose Intravenous immunoglobulin in myocarditis has been studied by many trials with different outcomes. This is the first case report showing coexistence of VSD with myocarditis in a neonate presenting as early-onset acute cardiac failure. The report highlights the importance of screening for myocarditis in all previously normal babies presenting primarily with cardiogenic

  20. Repair of Atrial Septal Defect via Right Submammary Minithoracotomy in Children

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    Hamid Bigdelian

    2015-03-01

    Full Text Available Background: Atrial Septal Defect (ASD is one of the most common congenital heart diseases that may lead to pulmonary hypertension. Advantages of ASD closure by limited thoracotomy as a minimally invasive approach includes reduction of post-operative complications and improvement of post-operative recovery. Objectives: The present study aimed to assess the safety of right submammary minithoracotomy for repair of ASD in children and to evaluate the cosmetic and functional results of this approach. Patients and Methods: Between August 2010 and August 2013, 35 children underwent heart operations for ASD closure via right submammary thoracotomy. The standard anterolateral thoracotomy technique entailed a 4 - 5 cm right submammary incision. After establishment of cardiopulmonary bypass, the right atrium was opened and defect was closed by pericardial patch. The thoracotomy was closed in a routine fashion. Results: The study patients included 5 males (14.29% and 30 females (85.71% whose age ranged from 1 to 7 years. Among the patients, 30 had ASD and 5 had a sinus venosus type. There were no intraoperative complications regarding exposure, cannulation, or bleeding. There were also no deaths in the post-operative period. Postoperative complications included significant hemorrhage from the suture line in one case and sick sinus syndrome requiring pacemaker implantation in another case. The mean length of stay in the intensive care unit was 2 days and the mean length of hospital stay was 4.5 days. Conclusions: Our study findings indicated that use of right submammary thoracotomy technique to repair ASD could be accomplished safely and provided good short-term results in terms of cosmetics, especially in female patients.

  1. Nicotine induction of theta frequency oscillations in rodent medial septal diagonal band in vitro

    Institute of Scientific and Technical Information of China (English)

    Cheng-biao LU; Cheng-zhang LI; Dong-liang LI; Zaineb HENDERSON

    2013-01-01

    Aim:This study aimed to examine the role of the nicotinic receptor (nAChR) in the generation of theta oscillations (4-12 Hz) in vitro.Methods:Electrophysiological studies were performed on medial septal diagonal band area (MSDB) slices to measure theta oscillation.Immunofluorescence and confocal microscopy studies were carried out to detect α4 nAChR and β2 nAChR subunits in perfused-fixed tissue from VGluT2-GFP and GAD67-GFP transgenic mice.Results:Application of nicotine to MSDB slices produced persistent theta oscillations in which area power increased in a doseresponsive manner.This activity was inhibited by GABAA receptor antagonists and partially by ionotropic glutamate receptor antagonists,indicating the involvement of local GABAergic and glutamatergic neurons in the production of the rhythmic activity.The nicotineinduced theta activity was also inhibited selectively by non-α7*nAChR antagonists,suggesting the presence of these receptor types on GABAergic and glutamatergic neuron populatjons in the MSDB.This was confirmed by immunofluorescence and confocal microscopy studies in transgenic mice in which the GABAergic and glutamatergic neurons express green fluorescent protein (GFP),showing Iocalisation of β2 nAChR and α4 nAChR subunits,the most common constituents of non-α7*nAChRs,in both cell types in the MSDB.Conclusion:Theta activity in the MSDB may be generated by tonic stimulation of non-α7*nAChRs.

  2. Experiences with surgical treatment of ventricle septal defect as a post infarction complication

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    Stich Kathrin

    2009-01-01

    Full Text Available Abstract Background Complications of acute myocardial infarction (AMI with mechanical defects are associated with poor prognosis. Surgical intervention is indicated for a majority of these patients. The goal of surgical intervention is to improve the systolic cardiac function and to achieve a hemodynamic stability. In this present study we reviewed the outcome of patients with post infarction ventricular septal defect (PVSD who underwent cardiac surgery. Methods We analysed retrospectively the hospital records of 41 patients, whose ages range from 48 to 81, and underwent a surgical treatment between 1990 and 2005 because of PVSD. Results In 22 patients concomitant coronary artery bypass grafting (CAGB was performed. In 15 patients a residual shunt was found, this required re-op in seven of them. The time interval from infarct to rupture was 8.7 days and from rupture to surgery was 23.1 days. Hospital mortality in PVSD group was 32%. The mortality of urgent repair within 3 days of intractable cardiogenic shock was 100%. The mortality of patients with an anterior VSD and a posterior VSD was 29.6% vs 42.8%, respectively. All patients who underwent the surgical repair later than day 36 survived. Conclusion Surgical intervention is indicated for a majority of patients with mechanical complications. Cardiogenic shock remains the most important factor that affects the early results. The surgical repair of PVSD should be performed 4–5 weeks after AMI. To improve surgical outcome and hemodynamics the choice of surgical technique and surgical timing as well as preoperative management should be tailored for each patient individually.

  3. Potts shunt in a child with end-stage pulmonary hypertension after late repair of ventricular septal defect

    DEFF Research Database (Denmark)

    Petersen, Cecilie; Helvind, Morten; Jensen, Tim;

    2013-01-01

    We report on a 10-year-old boy with medically refractory pulmonary arterial hypertension (PAH) and end-stage right heart failure after closure of a ventricular septal defect. The boy was a candidate for lung transplantation (LTX), but an alternative option was to create an Eisenmenger physiology...... on the right ventricle. The boy's clinical condition improved markedly, so he was discharged two weeks after the procedure. The ultimate therapeutic option for medically refractory PAH is LTX or heart-lung transplantation, but because of the short life span after LTX, time was bought by postponing the time...

  4. Maternal MTHFR C677T genotype and septal defects in offspring with Down syndrome: A pilot study

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    Ghada M. Elsayed

    2014-01-01

    Conclusions: MTHFR 677CT genotype could be implicated as a maternal risk factor for septal defects especially in children with DS. Carriers of this genotype may have more risk of development of AV canal in their children. A major limitations of this study was the small sample size and so further studies on a larger sample of patients and their mothers in addition to measurement of homocysteine level in this population is needed to investigate this theory and to clarify the actual role of MTHFR polymorphism and the risk of development of CHD in DS.

  5. Use of sildenafil citrate in a cat with Eisenmenger’s syndrome and an atrial septal defect

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    Ke Shuan Chow

    2015-04-01

    Full Text Available A 2-year-old male neutered Siamese cat presenting with weakness and dyspnoea was diagnosed with an atrial septal defect and pulmonary hypertension, which resulted in right-to-left shunting (Eisenmenger’s syndrome. The cat was treated with sildenafil (0.25–0.6 mg/kg for 10 months. There were no apparent treatment-related adverse effects. Improvement in clinical signs was noted, although increasing doses of sildenafil were required. After 10 months the cat significantly deteriorated and was euthanased.

  6. Unusual Case of Left Bronchial Compression by Aneurysmal Pulmonary Arteries in a Child With Atrial Septal Defect.

    Science.gov (United States)

    Pawar, Ranjit; Kumar, Gaurav; Sharma, Vipul; Dalal, S S

    2016-07-01

    We report an uncommon case of large ostium secundum atrial septal defect (ASD) with severe pulmonary arterial hypertension, with associated aneurysmal dilatation of the pulmonary arteries (PAs) leading to compression of the left main bronchus and collapse of the entire left lung in a 15-month-old female child. The patient was managed by surgical closure of the ASD, translocation of the right PA anterior to the aorta with PA aneurysmorrhaphy. Left bronchial compression was relieved with complete lung expansion on the third postoperative day. PMID:26865068

  7. Visualization of a Small Ventricular Septal Defect at First-pass Contrast-enhanced Cardiac Magnetic Resonance Imaging

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    Francesco Secchi

    2013-01-01

    Full Text Available Ventricular septal defect (VSD is a congenital heart disease that accounts for up to 40% of all congenital cardiac malformations. VSD is a connection between right and left ventricle, through the ventricular septum. Echocardiography and magnetic resonance imaging (MRI help identify this entity. This case presents a 12-year-old male diagnosed with a small muscular apical VSD of 3 mm in diameter, at echocardiography. Cardiac MRI using first-pass perfusion sequence, combining the right plane of acquisition with a short bolus of contrast material, clearly confirmed the presence of VSD.

  8. Differential modulation of lateral septal vasopressin receptor blockade in spatial learning, social recognition, and anxiety-related behaviors in rats

    OpenAIRE

    Everts, HGJ; Koolhaas, JM

    1999-01-01

    The role of lateral septal vasopressin (VP) in the modulation of spatial memory, social memory, and anxiety-related behavior was studied in adult, male Wistar rats. Animals were equipped with osmotic minipumps delivering the VP-antagonist d(CH2)5-D-Tyr(Et)VAVP (1 ng/0.5 mu l per h) bilaterally into the lateral septum (LS). Subsequently, all rats were subjected to four behavioral tests. First, animals were tested in a spatial learning paradigm (Morris water maze; 12 trials), followed by the so...

  9. Dendritic excitability microzones and occluded long-term depression after classical conditioning of the rabbit's nictitating membrane response.

    Science.gov (United States)

    Schreurs, B G; Tomsic, D; Gusev, P A; Alkon, D L

    1997-01-01

    underwent a long-term (> 20 min) reduction in peak amplitude (-24%) in cells (n = 12) from animals given unpaired stimulus presentations but to a far less extent (-9%) in cells (n = 20) from animals given in vivo paired training. Whereas 92% of cells from unpaired animals showed pairing-specific depression, 50% of cells from paired animals showed no depression and in several cases showed potentiation. Our data establish that there are localized learning-specific changes in membrane and synaptic excitability of Purkinje cells in rabbit lobule HVI that can be detected in slices 24 h after classical conditioning. Long-term changes within Purkinje cells that effect this enhanced excitability may occlude pairing-specific long-term depression.

  10. Clinical analysis and risk stratification of ventricular septal rupture following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    HU Xiao-ying; QIU Hong; QIAO Shu-bin; KANG Lian-ming; SONG Lei; ZHANG Jun; TAN Xiao-yan

    2013-01-01

    Background Ventricular septal rupture (VSR) remains an infrequent but devastating complication of acute myocardial infarction (AMI).The best time to undergo surgical repair is controversial and there is currently no risk stratification for patients with VSR to guide treatment.The purpose of this study was to review the clinical outcomes of 70 patients with VSR,to analyze the short-term prognosis factors of VSR following AMI,and to make a risk stratification for patients with VSR.Methods A total of 70 consecutive VSR patients following AMI treated in our hospital from January 2002 to October 2010 were enrolled in this study retrospectively.The difference of clinical characteristics were observed between patients with VSR who survived <30 days and survived >30 days.We analyzed the short-term prognosis factors of VSR and established the short-term prognosis index of VSR (SPIV) based on the Logistic regression analysis to stratify patients with VSR.Results Among 12 354 patients with acute ST-segment elevation myocardial infarction,70 (0.57%) patients (33 males and 37 females) were found to have VSR.The average age was (68.1±8.5) years.Fifty-four (77.1%) patients were diagnosed with an acute anterior infarction.Patients with VSR selected for surgical repair had better outcomes than patients treated conservatively; 1-year mortality 9.5% versus 87.8%,P <0.005.Logistic regression analysis revealed that female (P=-0.013),anterior AMI (P=0.023),non-ventricular aneurysm (P=0.023),non-diabetes (P=0.009),Killip class 3 or 4 (P=0.022) and time from AMI to VSR less than 4 days (P=0.027) were independent risk determinants for shortterm mortality.SPIV >9 indicates a high risk as the 30-day mortality is 77.4%; SPIV <8 indicates a low risk as the 30-day mortality is 28.6%; SPIV between 8 and 9 indicates a moderate risk.Conclusions VSR remains a rare but devastating complication of AMI.The independent risk determinants for short-term mortality of VSR were female

  11. Analysis of MTHFR and MTRR Gene Polymorphisms in Iranian Ventricular Septal Defect Subjects

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    Ali Etemad

    2013-01-01

    Full Text Available Ventricular septal defect (VSD is one of the most common types of congenital heart defects (CHD. There are vivid multifactorial causes for VSD in which both genetic and environmental risk factors are consequential in the development of CHD. Methionine synthase reductase (MTRR and methylenetetrahydrofolate reductase (MTHFR are two of the key regulatory enzymes involved in the metabolic pathway of homocysteine. Genes involved in homocysteine/folate metabolism may play an important role in CHDs. In this study; we determined the association of A66G and C524T polymorphisms of the MTRR gene and C677T polymorphism of the MTHFR gene in Iranian VSD subjects. A total of 123 children with VSDs and 125 healthy children were included in this study. Genomic DNA was extracted from the buccal cells of all the subjects. The restriction fragment length polymorphism polymerase chain reaction (PCR-RFLP method was carried out to amplify the A66G and C524T polymorphism of MTRR and C677T polymorphism of MTHFR genes digested with Hinf1, Xho1 and Nde1 enzymes, respectively. The genotype frequencies of CC, CT and TT of MTRR gene among the studied cases were 43.1%, 40.7% and 16.3%, respectively, compared to 52.8%, 43.2% and 4.0%, respectively among the controls. For the MTRR A66G gene polymorphism, the genotypes frequencies of AA, AG and GG among the cases were 33.3%, 43.9% and 22.8%, respectively, while the frequencies were 49.6%, 42.4% and 8.0%, respectively, among control subjects. The frequencies for CC and CT genotypes of the MTHFR gene were 51.2% and 48.8%, respectively, in VSD patients compared to 56.8% and 43.2% respectively, in control subjects. Apart from MTHFR C677T polymorphism, significant differences were noticed (p < 0.05 in C524T and A66G polymorphisms of the MTRR gene between cases and control subjects.

  12. Analysis of MTHFR and MTRR Gene Polymorphisms in Iranian Ventricular Septal Defect Subjects.

    Science.gov (United States)

    Pishva, Seyyed Reza; Vasudevan, Ramachandran; Etemad, Ali; Heidari, Farzad; Komara, Makanko; Ismail, Patimah; Othman, Fauziah; Karimi, Abdollah; Sabri, Mohammad Reza

    2013-01-01

    Ventricular septal defect (VSD) is one of the most common types of congenital heart defects (CHD). There are vivid multifactorial causes for VSD in which both genetic and environmental risk factors are consequential in the development of CHD. Methionine synthase reductase (MTRR) and methylenetetrahydrofolate reductase (MTHFR) are two of the key regulatory enzymes involved in the metabolic pathway of homocysteine. Genes involved in homocysteine/folate metabolism may play an important role in CHDs. In this study; we determined the association of A66G and C524T polymorphisms of the MTRR gene and C677T polymorphism of the MTHFR gene in Iranian VSD subjects. A total of 123 children with VSDs and 125 healthy children were included in this study. Genomic DNA was extracted from the buccal cells of all the subjects. The restriction fragment length polymorphism polymerase chain reaction (PCR-RFLP) method was carried out to amplify the A66G and C524T polymorphism of MTRR and C677T polymorphism of MTHFR genes digested with Hinf1, Xho1 and Nde1 enzymes, respectively. The genotype frequencies of CC, CT and TT of MTRR gene among the studied cases were 43.1%, 40.7% and 16.3%, respectively, compared to 52.8%, 43.2% and 4.0%, respectively among the controls. For the MTRR A66G gene polymorphism, the genotypes frequencies of AA, AG and GG among the cases were 33.3%, 43.9% and 22.8%, respectively, while the frequencies were 49.6%, 42.4% and 8.0%, respectively, among control subjects. The frequencies for CC and CT genotypes of the MTHFR gene were 51.2% and 48.8%, respectively, in VSD patients compared to 56.8% and 43.2% respectively, in control subjects. Apart from MTHFR C677T polymorphism, significant differences were noticed (p < 0.05) in C524T and A66G polymorphisms of the MTRR gene between cases and control subjects. PMID:23358257

  13. Resultados da correção simplificada com enxerto único no defeito septal atrioventricular completo

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    Ana Paula Tagliari

    2013-03-01

    Full Text Available FUNDAMENTO: Desde que Wilcox, em 1997, descreveu uma forma simplificada de correção do Defeito Septal Atrioventricular (DSAV com enxerto único, diversos estudos têm sido realizados comparando-a à técnica com duplo enxerto. OBJETIVO: Relatar os resultados em médio e longo prazos da correção de DSAV completo pela técnica simplificada de enxerto único. MÉTODOS: Estudo retrospectivo de 16 casos consecutivos arrolados entre janeiro de 2001 e dezembro de 2011. A idade média foi 18,31 ± 34,19 meses (2 meses - 11 anos e o peso 7,80 ± 6,12 Kg (3,77 - 25,0 Kg; 6 pacientes eram do sexo masculino e 14 eram portadores de Síndrome de Down. O tempo de seguimento médio foi de 54,97 ± 47,79 meses. RESULTADOS: O tempo médio de circulação extracorpórea foi 74,63 ± 18,48 min (49 - 112 min e o de pinçamento aórtico, de 46,44 ± 11,89 min (34 - 67 min. Foram observados dois óbitos hospitalares (12,5%, ambos por causa cardiovascular. Três pacientes foram reoperados por regurgitação da valva atrioventricular (VA esquerda e dois apresentaram bloqueio atrioventricular (BAV completo com necessidade de implante de marca-passo definitivo. Não houve nenhum caso de obstrução da via de saída do ventrículo esquerdo. Os 14 pacientes sobreviventes permanecem assintomáticos, 10 deles com insuficiência da valva VA esquerda leve (71,42%. CONCLUSÃO: A técnica simplificada com enxerto único para correção de DSAV completo mostrou-se factível, associada à correção adequada dos defeitos e à favorável evolução clínica e ecocardiográfica nos 57,97 meses de seguimento médio avaliados.

  14. Genetic polymorphisms of the TYMS gene are not associated with congenital cardiac septal defects in a Han Chinese population.

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    Jian-Yuan Zhao

    Full Text Available BACKGROUND: Clinical research indicates that periconceptional administration of folic acid can reduce the occurrence of congenital cardiac septal defects (CCSDs. The vital roles of folate exhibits in three ways: the unique methyl donor for DNA expression regulation, the de novo biosynthesis of purine and pyrimidine for DNA construction, and the serum homocysteine removal. Thymidylate synthase (TYMS is the solo catalysis enzyme for the de novo synthesis of dTMP, which is the essential precursor of DNA biosynthesis and repair process. To examine the role of TYMS in Congenital Cardiac Septal Defects (CCSDs risk, we investigated whether genetic polymorphisms in the TYMS gene associated with the CCSDs in a Han Chinese population. METHOD: Polymorphisms in the noncoding region of TYMS were identified via direct sequencing in 32 unrelated individuals composed of half CCSDs and half control subjects. Nine SNPs and two insertion/deletion polymorphisms were genotyped from two independent case-control studies involving a total of 529 CCSDs patients and 876 healthy control participants. The associations were examined by both single polymorphism and haplotype tests using logistic regression. RESULT: We found that TYMS polymorphisms were not related to the altered CCSDs risk, and even to the changed risk of VSDs subgroup, when tested in both studied groups separately or in combination. In the haplotype analysis, there were no haplotypes significantly associated with risks for CCSDs either. CONCLUSION: Our results show no association between common genetic polymorphisms of the regulatory region of the TYMS gene and CCSDs in the Han Chinese population.

  15. Interatrial shunt. Diagnosis of patent foramen ovale and atrial septal defect with 64-row coronary computed tomography angiography

    International Nuclear Information System (INIS)

    The aim of this study was to investigate the frequency with which interatrial shunts are found during routine coronary computed tomography (CT) angiography and to describe imaging characterizations of patent foramen ovale (PFO), atrial septal defect (ASD), and atrial septal aneurysm (ASA). A total of 1081 adult patients were evaluated retrospectively for interatrial shunting; 77 were excluded from the study. CT diagnosis of PFO was defined as (1) a channel-like appearance of the interatrial septum (IAS) and (2) a contrast agent jet flow from the left atrium (LA) to the right atrium (RA). ASD was defined as (1) the IAS resembling a membrane with a hole and (2) a contrast jet flow between the two atria. ASA was identified by detecting a minimum 10-mm protrusion of the LA beyond the IAS into the RA. Among 1004 patients, 86 patients (8.6%) were diagnosed to have PFO. Another 23 patients (2.3%) had a hole in the IAS and were diagnosed as having ASD: 21 with an ostium secundum-type ASD and 2 with the sinus venosus type. ASA accompanied ASD in three patients. Electrocardiography-gated CT using the saline-chaser contrast injection technique that is routinely used for coronary arterial imaging can be used to detect interatrial shunts. The technique can also serve as a method for differentiating PFO, ASD, and ASA. (author)

  16. ANAESTHETIC MANAGEMENT OF AN ADULT PATIENT WITH UNCORRECTED VENTRICULAR SEPTAL DEFECT POSTED FOR OBSTRUCTED INGUINAL HERNIA REPAIR

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    Shivaramu

    2015-08-01

    Full Text Available Adults with unrepaired acyanotic heart disease scheduled for a non - cardiac surgery present serious concerns for the anaesthesiologists. Ventricular septal defect (VSD, is an acyanotic congenital heart disease, characterized by a left to right shunt. The incidence varies between 2 to 6 per 1000 live births. It is found in 30% to 60% of all the newborns with congenital heart disease, thus making it one of the most common congenital heart diseases VSD is the commonest form of CHD. Unlike ASD, the majority will undergo spontaneous closure : 40% by the age of 2yr and 90% by the age of 10 yr . 1 The goal of anesthetic management should be to maintain intravascular volume. Systemic and pulmonary vascular resistance changes, such as might occur due to acidosis, hypothermia, hypercarbia or excessive airway pressures, should be avoided. Maintenance of preload, contractility and sinus rhythm is of major importance. The c omplex pathophysiologies of such heart disease, in addition to the circumstances of emergency operation, exacerbate the total anesthetic risk. We present here a rare case of obstructed right sided inguinal hernia repair with successful outcome in an adult with ventricular septal defect.

  17. Anaesthetic management of a child with "cor-triatriatum" and multiple ventricular septal defects - A rare congenital anomaly

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    Sriram Sabade

    2010-01-01

    Full Text Available Cor-triatriatum is a rare congenital cardiac anomaly. It accounts for 0.1% of congenital heart diseases. Its association with multiple ventricular septal defects (VSD is even rarer. A five-month-old baby was admitted with respiratory distress and failure to thrive. Clinical examination revealed diastolic murmur over mitral area. Chest X-ray showed cardiomegaly. Haematological and biochemical investigations were within normal limits. Electrocardiogram showed left atrial enlargement. 2D echo showed double-chambered left atrium (cor-triatriatum, atrial septal defect (ASD and muscular VSD with moderate pulmonary arterial hypertension. The child was treated with 100% oxygen, diuretics and digoxin and was stabilized medically. We used balanced anaesthetic technique using oxygen, air, isoflurane, fentanyl, midazolam and vecuronium. Patient was operated under cardiopulmonary bypass (CPB with moderate hypothermia. Through right atriotomy abnormal membrane in the left atrium was excised to make one chamber. VSD were closed with Dacron patches and ASD was closed with autologous pericardial patch. Patient tolerated the whole procedure well and was ventilated electively for 12h in the intensive care unit. He was discharged on the 10 th postoperative day.

  18. Diffusion of hyperpolarized 129Xe in the lung: a simplified model of 129Xe septal uptake and experimental results

    International Nuclear Information System (INIS)

    We used hyperpolarized 129Xe NMR to measure pulmonary alveolar surface area per unit gas volume SA/Vgas, alveolar septal thickness h and capillary transit time τ, three critical determinants of the lung's primary role as a gas exchange organ. An analytical solution for a simplified diffusion model is described, together with a modification of the xenon transfer contrast imaging technique utilizing 900 radio-frequency pulses applied to the dissolved phase, rather than traditional 1800 pulses. With this approach, three-dimensional (3D) maps of SA/Vgas were obtained. We measured global SA/Vgas, h and τ in four normal subjects, two subjects with mild interstitial lung disease (ILD) and two subjects with mild chronic obstructive pulmonary disease (COPD). In normals, SA/Vgas decreased with increasing lung volume from ∼320 to 80 cm-1; both h∼13 μm and τ∼1.5 s were relatively constant. For the two ILD subjects, h was, respectively, 36 and 97% larger than normal, quantifying an increased gas/blood tissue barrier; SA/Vgas and τ were normal. The two COPD subjects had SA/Vgas values ∼25% that of normals, quantifying septal surface loss in emphysema; h and τ were normal. These are the first noninvasive, non-radiation-based, quantitative measurements of h and τ in patients with pulmonary disease.

  19. Transcatheter closure of secundum atrial septal defect in adults: report of our first experience in a developing country

    Directory of Open Access Journals (Sweden)

    Animasahun BA

    2014-04-01

    Full Text Available B Adeola Animasahun,1 Yele Aluko,2 Adeyemi Johnson,3 Kofo Ogunyankin,3 Sunita Maheshwari41Department of Paediatrics and Child Health, Lagos State University College of Medicine, Lagos, Nigeria; 2Mid Carolina Cardiology, Charlotte, NC, USA; 3First Cardiology Consultants, Lagos, Nigeria; 4Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore, IndiaBackground: Since the first report on device closure of atrial septal defect (ASD in 1976, the procedure has gained wide acceptance and has been used worldwide, including parts of Africa. The advantages when compared to surgical closure include a shorter procedure time and hospital stay and no scarring. This mode of treatment was not available in Nigeria prior to the cases reported here, requiring patients to travel abroad for the procedure.Methods: A cardiac catheterization laboratory became available in Lagos, Nigeria in 2009, and in December 2010 the laboratory collaborated with Lagos State University College of Medicine and Lagos State University Teaching Hospital to perform the device closure on two women (aged 34 and 62 years with secundum ASD. To the best of our knowledge, these are the first times the procedure has been performed in Nigeria.Results: Both patients made successful recovery and are stable.Conclusion: Transcatheter closure of ASD is now safe and available in Nigeria.Keywords: atrial septal defect, transcatheter closure, Nigeria

  20. Diffusion of hyperpolarized 129Xe in the lung: a simplified model of 129Xe septal uptake and experimental results

    Science.gov (United States)

    Patz, Samuel; Muradyan, Iga; Hrovat, Mirko I.; Dabaghyan, Mikayel; Washko, George R.; Hatabu, Hiroto; Butler, James P.

    2011-01-01

    We used hyperpolarized 129Xe NMR to measure pulmonary alveolar surface area per unit gas volume SA/Vgas, alveolar septal thickness h and capillary transit time τ, three critical determinants of the lung's primary role as a gas exchange organ. An analytical solution for a simplified diffusion model is described, together with a modification of the xenon transfer contrast imaging technique utilizing 90° radio-frequency pulses applied to the dissolved phase, rather than traditional 180° pulses. With this approach, three-dimensional (3D) maps of SA/Vgas were obtained. We measured global SA/Vgas, h and τ in four normal subjects, two subjects with mild interstitial lung disease (ILD) and two subjects with mild chronic obstructive pulmonary disease (COPD). In normals, SA/Vgas decreased with increasing lung volume from ~320 to 80 cm-1 both h~13 μm and τ~1.5 s were relatively constant. For the two ILD subjects, h was, respectively, 36 and 97% larger than normal, quantifying an increased gas/blood tissue barrier; SA/Vgas and τ were normal. The two COPD subjects had SA/Vgas values ~25% that of normals, quantifying septal surface loss in emphysema; h and τ were normal. These are the first noninvasive, non-radiation-based, quantitative measurements of h and τ in patients with pulmonary disease.

  1. Widespread blunting of hypothalamic and amygdala-septal activity and behavior in rats with long-term hyperglycemia.

    Science.gov (United States)

    Moreno-Cortés, M L; Gutiérrez-García, A G; Guillén-Ruiz, G; Romo-González, T; Contreras, C M

    2016-09-01

    Anxiety and depression in diabetic patients contributes to a poor prognosis, but possible causal relationships have been controversial. Anxiety, fear, and anhedonia are mediated by interactions between different deep structures of the temporal lobe (e.g., amygdala complex and hippocampus) and other forebrain-related structures (e.g., lateral septal nucleus). Connections between these structures and the hypothalamic orexinergic system are necessary for the maintenance of energy and wakefulness. However, few studies have explored the impact of long-term hyperglycemia in these structures on anxiety. We induced long-term hyperglycemia (glucose levels of ∼500mg/dl) in Wistar rats by injecting them with alloxan and simultaneously protecting them from hyperglycemia by injecting them daily with a low dose of insulin (i.e., just enough insulin to avoid death), thus maintaining hyperglycemia and ketonuria for as long as 6 weeks. Compared with controls, long-term hyperglycemic rats exhibited a significant reduction of Fos expression in the lateral septal nucleus and basolateral amygdala, but no differences were found in cerebellar regions. Orexin-A cells appeared to be inactive in the lateral hypothalamus. No differences were found in sucrose consumption or behavior in the elevated plus maze compared with the control group, but a decrease in general locomotion was observed. These data indicate a generalized blunting of the metabolic brain response, accompanied by a decrease in locomotion but no changes in hedonic- or anxiety-like behavior. PMID:27173433

  2. Coronary to pulmonary fistula as the primary source of pulmonary blood supply in pulmonary atresia with ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Isman Firdaus

    2004-12-01

    Full Text Available A communication between the coronary and pulmonary arteries, so called coronary to pulmonary fistula, is a rare source of pulmonary supply in pulmonary atresia (PA with ventricular septal defect (VSD. A 4 year old girl referred to National Cardiovascular Center Harapan Kita, Jakarta with symptoms and signs of increased pulmonary blood flow since infancy and was confirmed by the chest x-rays. Heart examination revealed normal first heart sound with single loud second heart sound and an ejection systolic murmur at the pulmonary area. ECG demonstrated sinus rhythm with normal axis and biventricular hypertrophy. Echocardiography was performed and truncus arteriosus (TA type I was suspected with perimembranus VSD, overriding of the aorta, and dilated main pulmonary artery. But on cardiac catheterization studies, a non obstructive fistula was found between the left coronary and main pulmonary artery coexisted with PA and VSD. A successful surgery was performed subsequently and confirmed the above diagnosis. Although there were episodes of pulmonary hypertension crisis during early post operative course, she was then discharge from the hospital in a good condition. Since irreversible pulmonary vascular disease may develop in a non restrictive coronary to pulmonary fistula, early recognition of this anomaly is very important for better surgical result. (Med J Indones 2004; 13: 237-40Keywords: coronary to pulmonary fistula, pulmonary atresia, ventricular septal defect

  3. Impact of percutaneous coronary intervention on biomarker levels in patients in the subacute phase following myocardial infarction: the Occluded Artery Trial (OAT) biomarker ancillary study

    OpenAIRE

    Kruk, Mariusz; Menon, Venu; Kądziela, Jacek; Sadowski, Zygmunt; Rużyłło, Witold; Janas, Jadwiga; Roik, Marek; Opolski, Grzegorz; Zmudka, Krzysztof; Czunko, Piotr; Kurowski, Michal; Busz-Papież, Benita; Zinka, Elzbieta; Jablonski, Wojciech; Jaworska, Krystyna

    2013-01-01

    Background The purpose of the Occluded Artery Trial (OAT) Biomarker substudy was to evaluate the impact of infarct related artery (IRA) revascularization on serial levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and dynamics of other biomarkers related to left ventricular remodeling, fibrosis and angiogenesis. Methods Patients were eligible for OAT-Biomarker based on the main OAT criteria. Of 70 patients (age 60.8 ± 8.8, 25% women) enrolled in the substudy, 37 were ra...

  4. Use of a Yankauer suction tip combined with the Colpo-Pneumo Occluder balloon to suction the surgical field at the vaginal cuff during robotic hysterectomy.

    Science.gov (United States)

    Stitely, Michael L; Hashmi, Mahreen; Jain, Preiya; Hochberg, Charles

    2011-01-01

    A 39-year-old patient with complex endometrial hyperplasia without atypia underwent robotic total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. The procedure was technically challenging because of the patient's obesity (body mass index 50 kg/m(2)). Concomitant suction of pooled blood and retraction of bowel and omentum were necessary to close the vaginal cuff. An endoscopic retractor was used through the assistant's port, and a Yankauer suction tip was placed through an inflated Colpo-Pneumo Occluder balloon in the vagina to provide directed suction to the vagina cuff. This technique enabled efficient closure of the vaginal cuff.

  5. 小儿膜周部室间隔缺损封堵术后心电图长期随访%Long-term follow-up of electrocardiogram after transcatheter closure of perimembranous ventricular septal defect in children

    Institute of Scientific and Technical Information of China (English)

    王慧深; 李淑娟; 林约瑟; 李轩狄; 李运泉; 孙芸芸

    2012-01-01

    目的 长期随访儿童经导管介入封堵膜周部室间隔缺损(ventricular septal defect,VSD)后心电图(ECG)各值,了解ECG改变规律及其转归.方法 对患膜周部VSD并成功介入封堵的290例患儿进行术后ECG随访.所有患儿术前术后均检查ECG,术后分别于1、3、6个月及1、2、3、5、8年复查ECG,电脑自动测算心率(V)、P-R间期、QRS间期、QT间期及校正的QT(QTc)值,观察心律及ST-T的变化.结果 随访时间:1~96个月[平均(40.16±29.2)个月].行多因素分析发现小儿膜周部VSD引起心电改变的危险因素是年龄在6周岁以内,膜部瘤样VSD,选择封堵器大于VSD直径3 mm以上者.封堵术后290例中115例(39.7%)出现各种轻重不等的ECG改变,进入5年以上长期随访的200例中持续ECG改变者43例(21.5%).但这些患儿均无症状,生长发育良好.随访80例经过应用激素和营养心肌治疗者中仅17例仍存在ECG的改变(21.3%),未经过治疗的35例,持续存在ECG改变者有26例(74.3%).随访5年以上仍需特别关注并定期随访的ECG改变者有25例(25/200例,12.5%).持续ECG改变组与术前组及无ECG改变组的各值对比,均有显著差异.对于出现重度房室传导阻滞(AVB)的患儿及时放置临时起搏器以及激素和营养心肌等治疗的病例预后较好.结论 本组随访提示封堵膜周部VSD慎重选择封堵器型号至关重要.对封堵术后ECG出现异常改变者,应用激素、果糖和维生素等营养心肌治疗,对心律失常的恢复或缓解有帮助.封堵术后早期发生ECG改变大部分轻微或可恢复,对一些明显的ECG改变,随访中未发现有转为三度AVB并影响患儿生长发育的病例,但对于一些ECG值的改变需要更长期随访以了解其转归和预后.%Objective To observe the long-term follow-up data of electrocardiographic (ECG) changes and prognosis after transcatheter closure of perimembranous ventricular septal defect (VSD)in children. Methods 290

  6. Surgical repair of true left ventricular aneurysm in an infant: a rare complication after unsuccessful perventricular VSD closure.

    Science.gov (United States)

    Ozyilmaz, Isa; Saygi, Murat; Yildiz, Okan; Erek, Ersin; Guzeltas, Alper

    2014-10-01

    A 2.5-month-old female patient presented for closure of a ventricular septal defect (VSD). Transthoracic echocardiography showed a large muscular ventricular septal defect. After perventricular closure of the defect was performed with an Amplatzer muscular VSD occluder, peroperative transesophageal echocardiography revealed that the device had been implanted in the wrong area of the ventricular septum. The device was retrieved and a large mid-muscular defect with extension to the outlet septum was closed with a patch of Dacron which was secured with 5-0 sutures. A perforation in the ventricular septum due to attempted perventricular device delivery was seen, and it was repaired primarily. In the eighth month of follow-up, transthoracic echocardiography revealed an aneurysm in the posterior wall of the left ventricle. The patient's electrocardiogram showed pathological Q waves and ST-segment elevation in leads DII, DIII, and aVF consistent with subacute inferior myocardial infarction. At subsequent surgery, this was found to be a true aneurysm, located in area of distribution of the obtuse marginal branch of the left circumflex coronary artery in the posterior wall of the left ventricle. The aneurysm was closed off using a Dacron patch, and the sac was resected. Development of a true aneurysm is a rare but important complication of attempted perventricular VSD closure.

  7. Mineral associated and aggregate-occluded soil carbon decreased with increasing nitrogen and residue input for three decades

    Science.gov (United States)

    Shahbaz, Muhammad; Kuzyakov, Yakov; Heitkamp, Felix

    2016-04-01

    Cropland soils may be a source or sink for atmospheric CO2. Therefore, effects of cropland management and fertilization on soil organic carbon (SOC) can be assessed best in long-term experiments. Generally, it is assumed that change in SOC is linearly related to C-input into the soil. However, recently it has been shown that residue incorporation resulted to only small extents in the increase of SOC levels. This gives rise to environmental concerns regarding the efficient use of crop residue. Such concerns are also applicable for the well designed and documented long-term experiment of Puch, Germany, in a silt-loam soil. The crop rotation is winter barley - winter wheat - silage maize. Five organic amendments were combined with N-fertiliser rates. The levels of organic amendments are unamended control (CON), straw was removed; farmyard manure (FYM), straw was removed; straw incorporation (STR); slurry application (SLU), straw was removed; and straw incorporation combined with slurry application (STSL). Three levels of mineral fertilizer application were selected: no nitrogen (N0); medium, 100 kg N ha-1year-1 (N2); and high, 200 kg N ha-1 year-1 (N4). These treatments resulted in a wide range of mean annual carbon input (1 - 5 t C ha-1 year-1). We hypothesize that the amount of soil carbon stored in different fractions will increase with C-input, but the effect will decrease in the order free light fraction (f-LF), occluded light fraction (o-LF) and heavy mineral-associated fraction (HF). Soil samples were fractionated by density using sodium polytungstate (1.6 g cm-3). Compared to the starting value SOC was lost in STR and CON and increased in SLU and STSL, whereas FYM showed no differences to initial carbon stocks. However, N additions resulted in only slightly increase in SOC contents with reference to C-input. The lower amount of o-LF carbon in CON and STR demonstrated the low ability of crop residue in comparison to animal manures to build up SOC contents

  8. Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspectives

    OpenAIRE

    Neelam Aggarwal; Shrinivas Gadhinglajkar; Rupa Sreedhar; Baiju S Dharan; Keerthi Chigurupati; Saravana Babu

    2016-01-01

    Objective: Review of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair. Design: A retrospective observational case series. Methodolgy: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperat...

  9. Spectral pulsed-wave tissue Doppler imaging lateral-to-septal delay fails to predict clinical or echocardiographic outcome after cardiac resynchronization therapy

    NARCIS (Netherlands)

    O.I.I. Soliman (Osama Ibrahim Ibrahim); D.A.M.J. Theuns (Dominic); M.L. Geleijnse (Marcel); A. Nemes (Attila); K. Caliskan (Kadir); W.B. Vletter (Wim); L.J.L.M. Jordaens (Luc); F.J. ten Cate (Folkert)

    2007-01-01

    textabstractAims: The current study sought to assess if pre-implantation lateral-to-septal delay (LSD) ≥60 ms assessed by spectral pulsed-wave myocardial tissue Doppler imaging (PW-TDI) could predict successful long-term outcome after cardiac resynchronization therapy (CRT). Methods and results Sixt

  10. Assessment of the Utility of the Septal E/(E′ × S′) Ratio and Tissue Doppler Index in Predicting Left Ventricular Remodeling after Acute Myocardial Infarction

    Science.gov (United States)

    Kenar Tiryakioglu, Selma; Yalin, Kıvanc; Coskun, Senol

    2016-01-01

    Background. The aim of this study is to show whether the septal E/(E′ × S′) ratio assessed by tissue Doppler echocardiography can predict left ventricular remodeling after first ST segment elevation myocardial infarction treated successfully with primary percutaneous intervention. Methods. Consecutive patients (n = 111) presenting with acute anterior myocardial infarction for the first time in their life were enrolled. All patients underwent successful primary percutaneous coronary intervention. Standard and tissue Doppler echocardiography were performed in the first 24-36 hours of admission. Echocardiographic examination was repeated after 6 months to reassess left ventricular volumes. Septal E/(E′ × S′) ratio was assessed by pulsed Doppler echocardiography. Results. Group 1 consisted of 33 patients with left ventricular (LV) remodeling, and Group 2 had 78 patients without LV remodeling. E/(E′ × S′) was significantly higher in Group 1 (4.1 ± 1.9 versus 1.65 ± 1.32, p = 0.001). The optimal cutoff value for E/(E′ × S′) ratio was 2.34 with 87.0% sensitivity and 82.1% specificity. Conclusion. Septal E/(E′ × S′) values measured after the acute anterior myocardial infarction can strongly predict LV remodeling in the 6-month follow-up. In the risk assessment, the septal E/(E′ × S′) can be evaluated together with the conventional echocardiographic techniques.

  11. MORPHOLOGICAL STUDIES OF OCCLUDED PROCESSES IN THALASSIOSIRA SPECIES FROM CHINA%我国沿海闭合突海链藻的形态学研究

    Institute of Scientific and Technical Information of China (English)

    李扬; 赵秋兰; 吕颂辉

    2012-01-01

    Thalassiosira along Chinese coastal waters, water samples were collected from different locations. Thalassiosira specimens within these samples as well as several clonal strains isolated from natural samples were studied using scanning electron microscopy. All samples were fixed with Lugo's solution and were concentrated to a final volume about 2?0 mL by settling overnight for several times. For observation under scanning electron microscope, sub-samples were taken and treated in several steps. Firstly, after the same volume of concentrated H2SO4 was added, these samples were boiled in the water bath for about 10?5 minutes to remove organic materials. Secondly, these samples were rinsed with distilled water several times to rid the acid. Then, these samples were coated by gold and thus could be observed, identified, and photographed under scanning electron microscope. The morphology and pattern of processes, including three types, fultoportula, rimoportula and occluded process, are key taxonomic characteristics for Thalassiosira species, even for some pennatae diatoms. Fultoportula and rimoportula are very common structures in all Thalassiosira taxa, while occluded process is just found in no more than 20 taxa from presently known 150 reported Thalassiosira species. The different features between occluded process and other two types of process is that occluded process does not penetrate the valve, so there is no structure of occluded process on the internal valve face. Previous reports about Thalassiosira species with occluded processes from China coast were rare, and almost no EM photos of occluded processes have been provided. In present study, five Thalassiosira species with occluded processes were observed and they were T. ce-darkeyensis Prasad, T. eccentrica (Ehrenberg) Cleve, T. lundiana Fryxell, T. punctigera (Castracane) Hasle and T. tubif-era Fryxell. Three of them are newly recorded species for China, T. cedarkeyensis, T punctigera and T. tubifera. The detailed

  12. Differential modulation of changes in hippocampal-septal synaptic excitability by the amygdala as a function of either elemental or contextual fear conditioning in mice.

    Science.gov (United States)

    Desmedt, A; Garcia, R; Jaffard, R

    1998-01-01

    Recent data obtained using a classic fear conditioning paradigm showed a dissociation between the retention of associations relative to contextual information (dependent on the hippocampal formation) and the retention of elemental associations (dependent on the amygdala). Furthermore, it was reported that conditioned emotional responses (CERs) could be dissociated from the recollection of the learning experience (declarative memory) in humans and from modifications of the hippocampal-septal excitability in animals. Our aim was to determine whether these two systems ("behavioral expression" system and "factual memory" system) interact by examining the consequences of amygdalar lesions (1) on the modifications of hippocampal-septal excitability and (2) on the behavioral expression of fear (freezing) resulting from an aversive conditioning during reexposure to conditional stimuli (CSs). During conditioning, to modulate the predictive nature of the context and of a discrete stimulus (tone) on the unconditional stimulus (US) occurrence, the phasic discrete CS was paired with the US or randomly distributed with regard to the US. After the lesion, the CER was dramatically reduced during reexposure to the CSs, whatever the type of acquisition. However, the changes in hippocampal-septal excitability persisted but were altered. For controls, a decrease in septal excitability was observed during reexposure to the conditioning context only for the "unpaired group" (predictive context case). Conversely, among lesioned subjects this decrease was observed in the "paired group" (predictive discrete CS case), whereas this decrease was significantly reduced in the unpaired group with respect to the matched control group. The amplitude and the direction of these modifications suggest a differential modulation of hippocampal-septal excitability by the amygdala to amplify the contribution of the more predictive association signaling the occurrence of the aversive event.

  13. Pathway for interferon-gamma to promote the differentiation of cholinergic neurons in rat embryonic basal forebrain/septal nuclei

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: The supernatant of interferon-gamma (IFN γ ) co-cultured with neonatal rat cortical glia can promote the cells in embryonic basal forebrain/septal nuclei to differentiate into cholinergic neurons, but the mechanism is still unclear.OBJECTIVE: To analyze the pathways for IFN γ to promote the differentiation of primarily cultured cholinergic neurons in rat embryonic basal forebrain/septal nuclei through culture in different conditioned medium.DESIGN: A controlled experiment taking cells as the observational target.SETTINGS: Department of Biochemistry and Molecular Biology, Youjiang Medical College for Nationalities; Department of Cell Biology, Beijing University Health Science Center.MATERIALS: Sixty-four pregnant Wistar rats for 16 days (250 - 350 g) and 84 Wistar rats (either male or female, 5 - 7 g) of 0 - 1 day after birth were provided by the experimental animal department of Beijing University Health Science Center. Rat IFN γ were provided by Gibco Company; Glial fibrillary acidic protein by Huamei Company.METHODS: The experiments were carried out in the Department of Cell Biology, Beijing University Health Science Center and Daheng Image Company of Chinese Academy of Science from July 1995 to December 2002. ① Interventions: The nerve cells in the basal forebrain/septal nuclei of the pregnant Wistar rats for 16 days were primarily cultured, and then divided into four groups: Blank control group (not any supernatant and medium was added); Control group (added by mixed glial cell or astrocyte conditioned medium); IFN γ group (added by mixed glial cell or astrocyte conditioned medium+IFN γ ). Antibody group (added by mixed glial cell or astrocyte conditioned medium+IFN γ +Ab-IFN γ ). Mixed glial cell or astrocyte conditioned medium was prepared using cerebral cortex of Wistar rats of 0 - 1 day after birth. ② Evaluation: The immunohistochemical method was used to perform the choline acetyltransferase (ChAT) staining of cholinergic neurons

  14. Defecto septal atrioventricular: Estudio anatomopatológico y correlación embriológica

    OpenAIRE

    Kuri Nivon,Magdalena; Martínez Martínez,Edith; Muñoz Castellanos,Luis; Espínola Zavaleta,Nilda

    2008-01-01

    El defecto septal atrioventricular es una cardiopatía congénita compleja en la que no sólo están deficientes los tabiques cardíacos, sino que muestra otras alteraciones anatómicas en el corazón expresadas en un amplio espectro a nivel de la unión atrioventricular común. En este trabajo se muestra la experiencia anatomopatológica de esta cardiopatía en el Instituto Nacional de Cardiología "Ignacio Chávez" y se elabora una correlación anatomoembriológica para inferir su patogenia. Se analizaron...

  15. [Maze procedure in a case of dextrocardia with atrial septal defect and persistent left superior vena cava].

    Science.gov (United States)

    Muraoka, Arata; Kawada, Masaaki; Misawa, Yoshio

    2014-08-01

    A 52-year-old man was diagnosed with dextrocardia at the age of 1 year and was asymptomatic until 1 year before admission. He was transferred to our hospital for management of atrial fibrillation. A transthoracic echocardiogram showed dextrocardia with atrial septal defect;moderate tricuspid valve regurgitation; and a large, persistent left superior vena cava. A cardiac catheterization study revealed that pulmonary flow/systemic flow (Qp/Qs) was 3.6 and that pulmonary vascular resistance was 2.5 Wood U·m². Intracardiac repair with tricuspid annuloplasty and a maze procedure was scheduled. When establishing cardiopulmonary bypass, venous drainage was initially obtained from the inferior vena cava and the left superior vena cava, and the small superior vena cava was then directly cannulated after opening the right atrium. The patient's postoperative course was uneventful, and serial electrocardiograms have demonstrated maintenance of normal sinus rhythm for 3.5 years after the operation.

  16. Study on ventilation-perfusion lung scintigraphy before and after closed surgery for atrial septal defect with persistent ostium secundum

    International Nuclear Information System (INIS)

    To examine changes of ventilation and perfusion distribution before and after closed surgery in atrial septal defect (ASD), a total of 25 ventrilation-perfusion lung scintigraphies were performed in a supine position in 15 ASD patients. Their ages ranged from one year and 11 months to 23 years (an average age of 7 years and one month). Ventilation and perfusion distribution was almost uniform before surgery. Preoperative time constant obtained from Xe-133 washout curve had a positive correlation with pulmonary blood flow per pulmonary volume. Although preoperative higher perfusion was seen in the upper lobe, perfusion tended to be uniform after surgery. Non-uniform distribution of ventilation/perfusion ratio became uniform within a few weeks after surgery. (N.K.)

  17. Sinus Venosus Atrial Septal Defect as a Cause of Palpitations and Dyspnea in an Adult: A Diagnostic Imaging Challenge

    Directory of Open Access Journals (Sweden)

    Michael S. Donovan

    2015-01-01

    Full Text Available Sinus venosus atrial septal defects (SV-ASD have nonspecific clinical presentations and represent a diagnostic imaging challenge. Transthoracic echocardiography (TTE remains the initial diagnostic imaging modality. However, detection rates have been as low as 12%. Transesophageal echocardiography (TEE improves diagnostic accuracy though it may not detect commonly associated partial anomalous pulmonary venous return (PAPVR. Cardiac magnetic resonance (CMR imaging provides a noninvasive, highly sensitive and specific imaging modality of SV-ASD. We describe a case of an adult male with exercise-induced, paroxysmal supraventricular tachycardia who presented with palpitations and dyspnea. Despite nondiagnostic imaging results on TTE, CMR proved to be instrumental in visualizing a hemodynamically significant SV-ASD with PAPVR that ultimately led to surgical correction.

  18. A hazardous finding of a rare anomalous left main coronary artery in a patient with a secundum atrial septal defect

    Directory of Open Access Journals (Sweden)

    Michael Emery

    2008-02-01

    Full Text Available Michael Emery1, Waqas Ghumman1, Shawn Teague2, Jo Mahenthiran11Krannert Institute of Cardiology, 2Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USAAbstract: A 23-year-old male referred for evaluation of a “choking” sensation with exertion and a murmur. A transthoracic echocardiogram demonstrated right atrial and ventricular dilatation, right ventricular volume overload, and a large secundum atrial septal defect (ASD with left to right shunt and a calculated pulmonary-to-systemic blood flow ratio (Qp/Qs estimated at 2.3 to 1. Cardiac catheterization also demonstrated evidence of the ASD with Qp/Qs of 4.6 to 1 with a significant step-up in oxygen saturation at the right atrial level. Additionally, an anomalous left main coronary artery (ALMCA origin from the anterior right coronary cusp was suspected. Using 64-slice multidetector computed tomography coronary angiography (CCTA the left main coronary artery was seen to arise from the right coronary cusp then traverse between the pulmonary trunk and the proximal ascending aorta before bifurcating into the left anterior descending and circumflex arteries that followed their normal courses distally. Based on the high risk nature of associated sudden death from an anomalous left main coronary artery (ALMCA coursing between the aorta and the pulmonary trunk, the patient underwent surgical re-implantation of the ALMCA to the left coronary cusp and repair of the ASD. This case highlights a rare finding of a hazardous ALMCA in a patient with a secundum ASD and the utility of CCTA in evaluating the course of coronary anomalies along with other cardiac pathology.Keywords: atrial septal defect, anomalous coronary artery, congenital heart disease

  19. Post-septal upper eyelid loading for treatment of exposure keratopathy secondary to non-cicatricial lagophthalmos.

    Science.gov (United States)

    Wagh, Vijay Kumar; Lim, Wei S; Cascone, Nikhil C; Morley, A M S

    2016-10-01

    Exposure keratopathy may result in ocular surface dryness, pain, corneal ulceration and loss of vision. Upper eyelid loading is an effective surgical treatment for paralytic lagophthalmos but has been criticised for complications of implant exposure and poor cosmesis. We therefore reviewed the safety and efficacy of our technique of upper eyelid post-septal loading for exposure keratopathy in this context. A retrospective case notes analysis was undertaken of 38 patients who had upper eyelid loading, all with post-septal weight placement, for correction of lagophthalmos. Patient demographics, indications for surgery, outcomes and complications were analysed. The mean age of all patients was 59.6 years. Exposure keratopathy was secondary to facial nerve paralysis in all but two patients, with tumor excision being the commonest underlying aetiology (63.8%). The mean implant weight used was 1.4 grams. Pre-operatively, all 38 patients had ocular discomfort despite maximal use of lubricating eye drops but post-operatively, 29 patients (76.3%) were comfortable without any such drops. Mean lagophthalmos on blink and gentle closure improved from 7.42mm and 5.47mm pre-operatively to 2.18mm and 1.18mm post-operatively (p < 0.001). Similarly, before surgery all patients had some corneal staining but after surgery 37 patients (97.4%) had none. The gold weight was removed in four patients (10.5%), due to chronic inflammation in three and due to mild astigmatism in one. No patient had exposure of the weight and one patient had a ptosis repair 6 months after surgery. Upper eyelid loading was effective in reducing both signs and symptoms of exposure keratopathy related to lagophthalmos in our series. Patients were very satisfied with the surgical outcome and complications related to exposure and cosmesis were very rare. PMID:27541938

  20. Adrenoceptors of the medial septal area modulate water intake and renal excretory function induced by central administration of angiotensin II

    Directory of Open Access Journals (Sweden)

    Saad W.A.

    2002-01-01

    Full Text Available We investigated the role of alpha-adrenergic antagonists and clonidine injected into the medial septal area (MSA on water intake and the decrease in Na+, K+ and urine elicited by ANGII injection into the third ventricle (3rdV. Male Holtzman rats with stainless steel cannulas implanted into the 3rdV and MSA were used. ANGII (12 nmol/µl increased water intake (12.5 ± 1.7 ml/120 min. Clonidine (20 nmol/µl injected into the MSA reduced the ANGII-induced water intake (2.9 ± 0.5 ml/120 min. Pretreatment with 80 nmol/µl yohimbine or prazosin into the MSA also reduced the ANGII-induced water intake (3.0 ± 0.4 and 3.1 ± 0.2 ml/120 min, respectively. Yohimbine + prazosin + clonidine injected into the MSA abolished the ANGII-induced water intake (0.2 ± 0.1 and 0.2 ± 0.1 ml/120 min, respectively. ANGII reduced Na+ (23 ± 7 µEq/120 min, K+ (27 ± 3 µEq/120 min and urine volume (4.3 ± 0.9 ml/120 min. Clonidine increased the parameters above. Clonidine injected into the MSA abolished the inhibitory effect of ANGII on urinary sodium. Yohimbine injected into the MSA also abolished the inhibitory effects of ANGII. Yohimbine + clonidine attenuated the inhibitory effects of ANGII. Prazosin injected into the MSA did not cause changes in ANGII responses. Prazosin + clonidine attenuated the inhibitory effects of ANGII. The results showed that MSA injections of alpha1- and alpha2-antagonists decreased ANGII-induced water intake, and abolished the Na+, K+ and urine decrease induced by ANGII into the 3rdV. These findings suggest the involvement of septal alpha1- and alpha2-adrenergic receptors in water intake and electrolyte and urine excretion induced by central ANGII.

  1. Measurement of Atrial Septal Defect Size: A Comparative Study between Transesophageal Echocardiography and Balloon Occlusive Diameter Method

    Directory of Open Access Journals (Sweden)

    Bahareh Eslami

    2010-05-01

    Full Text Available Background: Transcatheter closure of atrial septal defect secundum (ASD-II has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography (TEE method for measuring atrial septal defect with balloon occlusive diameter (BOD in transcatheter ASD-II closure.Methods: A total of 39 patients (71.1% female, mean age: 35.31 ± 15.37 years who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography (TTE and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1 – 2 mm larger than the BOD of the defect.Results: The mean defect size obtained by TEE and BOD was 18.50 ± 5.08 mm and 22.86 ± 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 ± 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD = 0.773 × ASD size by TEE+8.562; r2 = 67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values (r = -0.394, p value = 0.013.Conclusion: In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure.

  2. Development of an in vitro quantal assay in primary cell cultures for a non-occluded baculo-like virus of penaeid shrimp.

    Science.gov (United States)

    Tapay, L M; Lu, Y; Gose, R B; Nadala, E C; Brock, J A; Loh, P C

    1997-02-01

    An in vitro quantal assay (TCID50) for a non-occluded baculo-like virus isolate from naturally infected Penaeus japonicus obtained from China and experimentally infected P. stylirostris was developed using primary shrimp lymphoid cell cultures in Primaria 24-well tissue culture plates. The virus caused cytopathogenic effect (CPE) in the cell cultures as early as 2 day post-infection (p.i.). Initially, the cells rounded up and finally detached from the culture vessel as the infection progressed. At the present time, there is no established quantitative in vitro cell culture protocol for the assay of this baculo-like virus which has been reported by our laboratory to be highly pathogenic for P. stylirostris and P. vannamei, the two species of penaeid shrimp commercially cultured in Hawaii and the Western hemisphere. This quantal assay thus provides a simple and convenient method for the detection and assay of infectious virus in cultured penaeid shrimp.

  3. Balloon-Occluded Antegrade Transvenous Sclerotherapy to Treat Rectal Varices: A Direct Puncture Approach to the Superior Rectal Vein Through the Greater Sciatic Foramen Under CT Fluoroscopy Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Ono, Yasuyuki, E-mail: onoyasy@hirakata.kmu.ac.jp; Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp; Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp; Kono, Yumiko, E-mail: kohnoy@hirakata.kmu.ac.jp; Kan, Naoki, E-mail: kanna@takii.kmu.ac.jp; Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp; Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp; Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp [Kansai Medical University, Department of Radiology (Japan)

    2015-10-15

    Rectal varices occur in 44.5 % of patients with ectopic varices caused by portal hypertension, and 48.6 % of these patients are untreated and followed by observation. However, bleeding occurs in 38 % and shock leading to death in 5 % of such patients. Two patients, an 80-year-old woman undergoing treatment for primary biliary cirrhosis (Child-Pugh class A) and a 63-year-old man with class C hepatic cirrhosis (Child-Pugh class A), in whom balloon-occluded antegrade transvenous sclerotherapy was performed to treat rectal varices are reported. A catheter was inserted by directly puncturing the rectal vein percutaneously through the greater sciatic foramen under computed tomographic fluoroscopy guidance. In both cases, the rectal varices were successfully treated without any significant complications, with no bleeding from rectal varices after embolization.

  4. Avaliação geoquímica de biomarcadores ocluídos em estruturas asfaltênicas Geochemical evaluation of occluded biomarkers in asphaltenic structures

    Directory of Open Access Journals (Sweden)

    Débora de Almeida Azevedo

    2009-01-01

    Full Text Available Asphaltenes from two Brazilian crude oils were submitted to mild oxidation to disrupt their structure, releasing the occluded oil. The released hydrocarbons were compared with those from the original crude oil, and used to evaluate the alteration of the oils, especially as a result of biodegradation, but also thermal maturity. The crude oils used are depleted in n-alkanes, which are usually related to biodegradation. However, the released products from the corresponding asphaltenes have n-alkane distributions from nC10 to nC40, suggesting a protection effect from biodegradation. The m/z 191 mass chromatograms showed higher relative intensities for tricyclic terpanes than the hopanes in the crude in comparison with the released ones.

  5. Occluded Vehicle Segmentation Method Based on Corner Feature%基于角点特征的粘连车辆分割方法

    Institute of Scientific and Technical Information of China (English)

    陈舒; 刘秉瀚

    2013-01-01

    在智能交通系统粘连车辆的分割中,已有方法不能很好地保留车辆目标的轮廓细节.为此,提出一种基于角点特征的粘连车辆分割方法.采用帧差法提取运动车辆,借助数学形态学方法进行修复,引入长宽比、面积比等形态参数,判定粘连类别,结合Harris角点和K-means算法,检测并还原粘连区的角点,以实现粘连车辆的分割.实验结果表明,该方法能较好地保留车辆的轮廓细节信息,达到预期的实验效果.%How to segment the occluded vehicle is a key problem in Intelligent Transportation System(ITS).But the available algorithms can not preserve the edge characteristics of vehicle.This paper presents a new occluded vehicle segmentation method based on comer feature.It chooses the frame difference method to extract object and uses the mathematical morphology to repair,introduces two geometric parameters to judge the overlapping type,combines Harris comer detection with the K-means algorithm to identify the comer points which is in the overlapping area,realizes the segmentation for overlapping vehicle according to the axial symmetry.Experimental results show that this method can keep the vehicle's profile details information,and realizes the desired results.

  6. 小儿先天性心脏病介入治疗手术73例临床分析%Clinical analysis of intercurrent treatment on congenital heart disease in 73 patients

    Institute of Scientific and Technical Information of China (English)

    钱炜; 沙红

    2009-01-01

    Objective: To evaluate the therapeutic effect of intercurrent treatment of congenital heart disease. Mehods: The clinal effects of intercurrent treatment in consecutive 73 patients with congenital heart disease at Wuxi children hospital this years were retrospectively analyzed, and the patient distribution included patent ductus arteriosus (PDA) 35, atrial septal defect (ASD) 30, ventricular septal defect (VSD) 5, pulmonary stenosis (PS) 3, using AGA Amplatzer occluder homemade occluder and percutaneous ballon catheter, results: The technical successful rate was 100%, No complications were found in later 3 months to 2 years followup. Conclusions : intercurrent treatment of congenital heart disease is characterized with a high successful rate, less invasive, low complication and as well as shorter hospital day, and it has become promising alternative therapy.%目的 评价介入治疗手术在小儿先天性心脏病治疗中的价值.方法 总结我院近五年来73例经导管介入治疗的先天性心脏病患儿.其中动脉导管未闭(PDA)35例,继发孔房间隔缺损(ASD)30例,室间隔缺损(VSD)5例,肺动脉瓣狭窄(PS)3例.应用AGA Amplatzer封堵器、国产封堵器及球囊扩张导管.结果 成功率为100%,术后随访3月-2年,无不良并发症.结论 经导管介入治疗小儿先天性心脏病安全,有效,创伤小,操作简单,住院时间短,是一项有发展前景的治疗方法.

  7. Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total Risk factors analysis in the surgical repair of complete atrioventricular septal defect

    Directory of Open Access Journals (Sweden)

    Eduardo Keller Saadi

    1993-06-01

    Full Text Available Pacientes com defeito septal atrioventricular de forma total (DSAVT freqüentemente apresentam insuficiência cardíaca intratável e hipertensão arterial pulmonar nos primeiros meses de vida, e apenas uma minoria sobrevive sem tratamento cirúrgico precoce. Por essa razão, indica-se a correção definitiva para alterar favoravelmente a história natural da doença. Entretanto, vários fatores são responsáveis pela alta mortalidade cirúrgica. O presente trabalho estuda a experiência na correção cirúrgica do DSAVT com o objetivo de identificar alguns fatores de risco estatisticamente significativos para a ocorrência de morte operatória. Analisaram-se, retrospectivamente, 52 pacientes submetidos, entre janeiro de 1974 e dezembro de 1990, a cirurgia definitiva para correção de DSAVT no Royal Brompton and National Heart and Lung Institute, sendo estudadas as seguintes variáveis: idade, peso, sexo, ano da operação, presença de síndrome de Down, grau de regurgitação da valva AV, bandagem prévia do tronco pulmonar, presença de anomalias associadas, pressão sistólica pulmonar, duplo orifício mitral, classificação do defeito segundo Rastelli, emprego de parada circulatória e técnica de correção (1 x 2 retalhos. Todos os fatores foram avaliados isoladamente, mediante a análise univariada. Para determinar quais os fatores que, independentemente da ação de outros, contribuíram significativamente para maior mortalidade cirúrgica, foi utilizada a análise multivariada com regressão logística. A análise multivariada demonstrou que o baixo peso na época da operação e a técnica de correção com um retalho aumentam significativamente a mortalidade cirúrgica.Patients with complete atrioventricular septal defects (CAVSD frequently present with severe heart failure which cannot be controllable medically and pulmonary hypertension in infancy. Just a small number survives without early surgical treatment. For this reason

  8. Association of coronary to left ventricular microfistulae (vessels of Wearn) with atrial septal defect in an adult without cyanotic heart disease.

    Science.gov (United States)

    Hussain, Munem; Roberts, Elved Bryn

    2015-07-02

    Vessels of Wearn are rare findings during coronary angiography in adults. They are known to be associated with forms of cyanotic congenital heart disease in infants but we are not aware of any published cases of association with non-cyanotic left to right shunts in adults. We present the case of a 69-year-old man with angiographically evident vessels of Wearn draining from the left and right coronary arteries into the left ventricle associated with an asymptomatic atrial septal defect. We postulate a developmental phase association between atrial septal maturation and closure of perfusing microchannels from the ventricular cavities to the epicardial coronary arteries on the same spectrum as that which leads to more widespread defects in infants. We also highlight a common medication side effect that might have been mistaken as a manifestation of the congenital anomalies.

  9. [Tetralogy of Fallow with Total Anomalous Pulmonary Vein Return and Atrial Septal Defect;Successful Two-staged Surgical Management;Report of a Case].

    Science.gov (United States)

    Maekawa, Yoshiyuki; Miyahara, Yoshinori; Yoshizumi, Ko; Kawada, Masaaki; Minami, Takaomi; Sato, Tomoyuki; Yokomizo, Akiko; Oka, Kensuke; Furui, Sadahiro; Kataoka, Koichi

    2016-09-01

    A combination of tetralogy of Fallot( TOF) and total anomalous pulmonary venous return(TAPVR) is rare and results in chronic volume and pressure load of the right side of the heart and underfilling of the left heart. We report a successful 2-staged surgical correction of TOF associated with TAPVR and atrial septal defect. The patient was unsuitable for total primary intracardiac correction because the volume of the left ventricle was considered to be small. First, repair of anomalous pulmonary venous return and palliative right ventricle outflow tract reconstruction were simultaneously performed in 2 months of birth. One year after 1st operation, cardiac catheterization revealed that normalization of left ventricle volume, so 2nd operation was planned. Total correction of ventricular septal defect and right ventricle outflow reconstruction was performed and the patient was discharged on the 21st postoperative day with good hemodynamic status. PMID:27586317

  10. Post-traumatic fulminant paradoxical fat embolism syndrome in conjunction with asymptomatic atrial septal defect: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Nerlich Michael

    2011-04-01

    Full Text Available Abstract Introduction Fat embolism syndrome with respiratory failure after intramedullary nailing of a femur fracture is a rare but serious complication in trauma patients. Case presentation We present the case of a 20-year-old Caucasian man who experienced paradoxical cerebral fat embolism syndrome with fulminant progression after intramedullary nailing of a femur fracture, in conjunction with a clinically asymptomatic atrial septal defect in a high position resulting in a right-to-left shunt. Conclusion Fat embolism syndrome may occur as a fulminant complication following femoral fracture repair in the presence of a concomitant atrial septal defect with right-to-left shunt. Thus, in patients with cardiac right-to-left shunts, femurs should not be nailed intramedullary, not even in cases of isolated injuries.

  11. Clinical analysis of nasal septal perforation%鼻中隔穿孔57例临床分析

    Institute of Scientific and Technical Information of China (English)

    李泳鹏; 何盛华; 姚东方; 邹帆; 周永; 李杰恩

    2013-01-01

    目的 分析鼻中隔穿孔的原因、部位和大小.方法 收集57例鼻中隔穿孔患者的临床资料.以四方软骨与筛骨垂直板的交界线将鼻中隔分为前部和后部.根据穿孔大小将鼻中隔穿孔分为大(>2 cm)、中(1 ~2 cm)、小穿孔(<1 cm).结果 57例鼻中隔穿孔患者中,因传统鼻中隔偏曲矫正术引起33例,其中前部穿孔30例,后部穿孔3例;小穿孔 8例,中等穿孔15例,大穿孔10例.原发性因素(未知因素)引起7例,均为前部穿孔,其中小穿孔1例,中等穿孔4例,大穿孔2例.创伤引起5例,其中前部穿孔 3例,后部穿孔2例;中等穿孔3例,大穿孔2例.化疗引起5例,其中前部穿孔2例,后部穿孔3例;小穿孔1例,中等穿孔3例,大穿孔1例.感染引起5例,均为前部穿孔;其中小穿孔2例,中等穿孔2例,大穿孔1例.肿瘤侵犯引起2例,均为后部穿孔及中等穿孔.结论 传统鼻中隔偏曲矫正术是鼻中隔穿孔的主要原因,其部位以前部多见,大多为中等穿孔.%Objective To briefly review the clinical characteristics including the causes , positions , and sizes of nasal septal perforations. Methods Clinical data of 57 patients with nasal septal perforation was analyzed retrospectively. Nasal septum was divided into anterior portion and posterior portion by the border line between the quadrilateral cartilage and the perpendicular plate of the ethmoid. According to their maximal diameters, the perforations were classified into small ( 2 cm ) perforations. Results Of all the 57 cases, perforations were induced by conventional nasal septoplasty in 33 cases including 30 of anterior portion and 3 of posterior. As for the size of perforation , the case number of small, moderate, and large type was 8 , 15, and 10 respectively. Idiopathic factors ( unknown factors ) caused perforation of anterior portion in 7 cases with the case number of 1 , 4 and 2 of small , moderate and large type. Trauma induced perforation in 5 cases

  12. A novel snare assistance safeguards against early embolization of devices and facilitates quick retrieval of malpositioned devices in atrial septal defects with deficient margins

    OpenAIRE

    Sreeja Pavithran; Kothandam Sivakumar

    2015-01-01

    Background : Embolization might complicate device closure of large atrial septal defects (ASDs) with deficient margins. When margins are deficient, a precariously placed device can appear to be held in good position by the rigid delivery cable. Once the cable is unscrewed, the device adopts the natural lie of the interatrial septum. This can occasionally expose the inadequately captured margins and lead to device embolization. Most embolizations occur immediately after release. Retrieval of t...

  13. Axotomy-induced neurotrophic withdrawal causes the loss of phenotypic differentiation and downregulation of NGF signalling, but not death of septal cholinergic neurons

    Directory of Open Access Journals (Sweden)

    Inestrosa Nibaldo C

    2010-01-01

    Full Text Available Abstract Background Septal cholinergic neurons account for most of the cholinergic innervations of the hippocampus, playing a key role in the regulation of hippocampal synaptic activity. Disruption of the septo-hippocampal pathway by an experimental transection of the fimbria-fornix drastically reduces the target-derived trophic support received by cholinergic septal neurons, mainly nerve growth factor (NGF from the hippocampus. Axotomy of cholinergic neurons induces a reduction in the number of neurons positive for cholinergic markers in the medial septum. In several studies, the reduction of cholinergic markers has been interpreted as analogous to the neurodegeneration of cholinergic cells, ruling out the possibility that neurons lose their cholinergic phenotype without dying. Understanding the mechanism of cholinergic neurodegeneration after axotomy is relevant, since this paradigm has been extensively explored as an animal model of the cholinergic impairment observed in neuropathologies such as Alzheimer's disease. The principal aim of this study was to evaluate, using modern quantitative confocal microscopy, neurodegenerative changes in septal cholinergic neurons after axotomy and to assess their response to delayed infusion of NGF in rats. Results We found that there is a slow reduction of cholinergic cells labeled by ChAT and p75 after axotomy. However, this phenomenon is not accompanied by neurodegenerative changes or by a decrease in total neuronal number in the medial septum. Although the remaining axotomized-neurons appear healthy, they are unable to respond to delayed NGF infusion. Conclusions Our results demonstrate that at 3 weeks, axotomized cholinergic neurons lose their cholinergic phenotype without dying and down-regulate their NGF-receptors, precluding the possibility of a response to NGF. Therefore, the physiological role of NGF in the adult septal cholinergic system is to support phenotypic differentiation and not survival

  14. Septal co-infusions of glucose with the benzodiazepine agonist chlordiazepoxide impair memory, but co-infusions of glucose with the opiate morphine do not

    OpenAIRE

    Krebs-Kraft, Desiree L.; Parent, Marise B.

    2009-01-01

    We have found repeatedly that medial septal (MS) infusions of glucose impair memory when co-infused with the γ-amino butyric acid (GABA) agonist muscimol. The present experiment sought to determine whether the memory-impairing effects of this concentration of glucose would generalize to another GABAA receptor agonist and to an agonist from another neurotransmitter system that is known to impair memory. Specifically, we determined whether the dose of glucose that produces memory deficits when ...

  15. The Role of Nasopharyngeal Temperature Monitoring in Detection of a Malpositioned Superior Vena Cava Cannula in an Emergency Coronary Artery Bypass in a Patient With Ventricular Septal Defect

    OpenAIRE

    Dabbagh, A; M Shahzamani; M Foroughi; K Ghods; M Ghomeisi; Rahimian, H.

    2010-01-01

    A 55 year-old woman was admitted to the CCU ward of our university hospital due to typical chest pain. The patient received supportive care and was transferred to the operating room for an emergency repair of the ventricular septal defect (VSD) and myocardial revascularization. The surgical team was notified regarding the tolerance to cooling detected by the temperature monitoring and also, the congestion of eye and blanching of forehead. After a few maneuvers, the cannula was repositioned. I...

  16. Post-traumatic fulminant paradoxical fat embolism syndrome in conjunction with asymptomatic atrial septal defect: a case report and review of the literature

    OpenAIRE

    Nerlich Michael; Englert Carsten; Kinner Bernd; Pfeifer Christian; Mueller Franz; Neumann Carsten

    2011-01-01

    Abstract Introduction Fat embolism syndrome with respiratory failure after intramedullary nailing of a femur fracture is a rare but serious complication in trauma patients. Case presentation We present the case of a 20-year-old Caucasian man who experienced paradoxical cerebral fat embolism syndrome with fulminant progression after intramedullary nailing of a femur fracture, in conjunction with a clinically asymptomatic atrial septal defect in a high position resulting in a right-to-left shun...

  17. Three-dimensional transesophageal echocardiography with agitated saline injection to differentiate between atrial septal defects and echo drop-out artifacts.

    Science.gov (United States)

    Alherbish, Aws; Shanks, Miriam; Choy, Jonathan

    2014-12-01

    The diagnosis of multiple atrial septal defects is less challenging with 3-D transesophageal echocardiography. However, the common occurrence of echo drop-out (acoustic shadow) artifacts with 3-D echocardiography can make the differentiation between a second defect and an artifact challenging. Agitated saline injection with direct visualization using 3-D echocardiography can help resolve this by allowing visualization of the bubbles crossing from true defects.

  18. Impact of incidental amyloidosis on the prognosis of patients with hypertrophic cardiomyopathy undergoing septal myectomy for left ventricular outflow tract obstruction.

    Science.gov (United States)

    Helder, Meghana R K; Schaff, Hartzell V; Nishimura, Rick A; Gersh, Bernard J; Dearani, Joseph A; Ommen, Steve R; Mereuta, Oana M; Theis, Jason D; Dogan, Ahmet; Edwards, William D

    2014-11-01

    To determine the impact of amyloid on the prognosis of patients with hypertrophic cardiomyopathy (HC), we reviewed outcomes of patients who underwent septal myectomy for HC from March 7, 1996, to October 9, 2012, with amyloid deposits identified in operative specimens. Amyloid subtypes were differentiated by mass spectrometry-based proteomics. The survival rate was compared with that of an age-matched population (2:1) without amyloid who underwent septal myectomy for HC. Sixteen patients (mean age ± SD 71 ± 8 years; 12 men) met study criteria. All 16 had intraventricular peak systolic gradients reduced intraoperatively from 105 ± 53 mm Hg to 3 ± 7 mm Hg (p Amyloid deposits in specimens ranged from minimal to mild. Nine patients had senile (transthyretin-type) amyloidosis, 4 had immunoglobulin-associated amyloidosis, 2 had apolipoprotein A4 amyloidosis type, and 1 had serum amyloid A type. There were no deaths before 30 days. Twelve patients had New York Heart Association class III or IV function preoperatively, and at last follow-up (median 3 years), class I or II. Only 1 patient received postoperative amyloidosis treatment. The postoperative survival rate at 2 and 4 years was 100% (n = 11 at risk) and 91% (n = 6 at risk), respectively, similar to that of the age-matched population with HC without amyloid who underwent myectomy (p = 0.13). Patients undergoing septal myectomy for HC who have histologic evidence of mild amyloidosis have early outcomes and midterm survival similar to those of patients with HC without amyloidosis who undergo myectomy. In conclusion, although longer follow-up is necessary, small amounts of amyloid, regardless of subtype, do not confer a poor prognosis on patients with HC who undergo septal myectomy. PMID:25217455

  19. Visualization of transcoronary ablation of septal hypertrophy in patients with hypertrophic obstructive cardiomyopathy: a comparison between cardiac MRI, invasive measurements and echocardiography

    OpenAIRE

    Sohns, Christian; Sossalla, Samuel; Schmitto, Jan D; Jacobshagen, Claudius; Raab, Björn; Obenauer, Silvia; Maier, Lars S.

    2010-01-01

    Objective Hypertrophic obstructive cardiomyopathy (HOCM) is treated by surgical myectomy or transcoronary ablation of septal hypertrophy (TASH). The aim of this study was to visualize the feasibility, success and short-term results of TASH on the basis of cardiac MRI (CMR) in comparison with cardiac catheterization and echocardiography. Methods In this in vivo study, nine patients with HOCM were treated with TASH. Patients were evaluated by transthoracic echocardiography, invasive cardiac ang...

  20. Nuclear magnetic resonance solution structure of the peptidoglycan-binding SPOR domain from Escherichia coli DamX: insights into septal localization.

    Science.gov (United States)

    Williams, Kyle B; Yahashiri, Atsushi; Arends, S J Ryan; Popham, David L; Fowler, C Andrew; Weiss, David S

    2013-01-29

    SPOR domains are present in thousands of bacterial proteins and probably bind septal peptidoglycan (PG), but the details of the SPOR-PG interaction have yet to be elucidated. Here we characterize the structure and function of the SPOR domain for an Escherichia coli division protein named DamX. Nuclear magnetic resonance revealed the domain comprises a four-stranded antiparallel β-sheet buttressed on one side by two α-helices. A third helix, designated α3, associates with the other face of the β-sheet, but this helix is relatively mobile. Site-directed mutagenesis revealed the face of the β-sheet that interacts with α3 is important for septal localization and binding to PG sacculi. The position and mobility of α3 suggest it might regulate PG binding, but although α3 deletion mutants still localized to the septal ring, they were too unstable to use in a PG binding assay. Finally, to assess the importance of the SPOR domain in DamX function, we constructed and characterized E. coli mutants that produced DamX proteins with SPOR domain point mutations or SPOR domain deletions. These studies revealed the SPOR domain is important for multiple activities associated with DamX: targeting the protein to the division site, conferring full resistance to the bile salt deoxycholate, improving the efficiency of cell division when DamX is produced at normal levels, and inhibiting cell division when DamX is overproduced.

  1. Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Kappetein A Pieter

    2007-02-01

    Full Text Available Abstract Background This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD. Methods 12 data sets from intraoperative epicardial echocardiographic studies in 5 operations (patient age at operation 3 weeks to 4 years and bodyweight at operation 3.8 to 17.2 kg after surgical closure of VSD were included in the study. The data sets were analysed as two-dimensional (2D images on the screen of the ultrasound system as well as holograms in an I-space virtual reality (VR system. The 2D images were assessed for tricuspid valve function. In the I-Space, a 6 degrees-of-freedom controller was used to create the necessary projectory positions and cutting planes in the hologram. The holograms were used for additional assessment of tricuspid valve leaflet mobility. Results All data sets could be used for 2D as well as holographic analysis. In all data sets the area of interest could be identified. The 2D analysis showed no tricuspid valve stenosis or regurgitation. Leaflet mobility was considered normal. In the virtual reality of the I-Space, all data sets allowed to assess the tricuspid leaflet level in a single holographic representation. In 3 holograms the septal leaflet showed restricted mobility that was not appreciated in the 2D echocardiogram. In 4 data sets the posterior leaflet and the tricuspid papillary apparatus were not completely included. Conclusion This report shows that dynamic holographic imaging of intraoperative postoperative echocardiographic data regarding tricuspid valve function after VSD closure is feasible. Holographic analysis allows for additional tricuspid valve leaflet mobility analysis. The large size of the probe, in relation to small size of the patient, may preclude a complete data set. At the moment the requirement of an I

  2. A novel two-stage complete repair method for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries

    Institute of Scientific and Technical Information of China (English)

    MEI Ju; DING Fang-bao; ZHU Jia-quan; BAO Chun-rong; XIE Xiao; ZHANG Yun-jiao

    2010-01-01

    Background Pulmonary atresia with ventricular septal defect (PA-VSD) and major aortopulmonary collateral arteries (MAPCAs) remains a challenging complex congenital heart disease nowadays. In the present study, we aimed to develop a two-stage surgical method and to evaluate outcomes of this method in managing PA-VSD and MAPCAs.Methods Between December 2003 and December 2008, 7 female and 4 male patients between the age of 5 and 10 years who were suffering from PA-VSD and MAPCAs were selected and recruited. The native pulmonary artery trunks were absent in all patients; the lungs were solely supplied by major aortopulmonary collaterals, and the numbers of supplied lung segments ranged from 15 to 20 (17.9±1.6). There were a total of 43 MAPCAs in all the patients (3-5 (3.9±0.7) MAPCAs per patient). The accumulated Nakata index was (222.9±29.9) mm~2/m~2 (ranged from 182 to 272). All the patients underwent two sequential operations. Stage one included left major aortopulmonary collateral unifocalization and modified Blalock-Taussig shunt from left posterior lateral thoracotomy; stage two comprised right unifocalization, ligation of the shunt, followed by ventricular septal defect closure and right ventricular outflow tract reconstruction assisted with cardiopulmonary bypass from midline stemotomy.Results All the patients survived the initial surgery, but one of them died of low cardiac output syndrome on the third day after the second operation. Postoperative complications included pneumonia in one case and capillary leak syndrome in another. Postoperative oxygen saturation maintained about 95%-100%, which was significantly higher than pre-operation (P <0.01). During the follow-up period of 3-51 (25.4±15.2) months, there were no late death and no need for re-intervention. All the patients enjoyed their lives with good conditions.Conclusions This two-stage complete repair strategy was well-tolerated and effective with good outcome, thus offering an alternative

  3. Application of caudal septal advancement technique in nasal tip plasty%鼻中隔尾段前徙术在鼻尖成形中的应用

    Institute of Scientific and Technical Information of China (English)

    徐航

    2012-01-01

    Objective To build the steady framework of the nasal tip by using caudal septal advancement technique to obtain the permanent nasorostral configuration.Methods From Oct 2009 to Apr 2011,the caudal septal advancement technique was used to reconstruct the septum to make the septal anterior angel and the caudal septal margin reach the anticipated height and length of the tip,then medial crus and the vault of the lower lateral cartilage were sutured to the caudal septum to form the steady supporting structure of the nasal tip.Results 3-16 months follow-up in 26 cases showed that 2 cases appeared the staircase deformity in the junction of the bone and the cartilage in the dorsum,but the nasorostral configuration was good.3 cases whose tip and columella were deviated before the operation appeared the deviation again after 3 months but the nasorostral configuration was better than before.The other 21 cases were good.Conclusions It is a available method of using caudal septal advancement technique to form the steady nasorostral configuration.%目的 通过鼻中隔尾段前徙术,建立稳定的鼻尖支撑结构,以获得持久的鼻尖形态.方法 应用鼻中隔尾段前徙术重构鼻中隔,使鼻中隔前角及尾侧缘达到鼻尖预计的高度和长度;再将下外侧软骨穹窿、鼻翼内侧脚与鼻中隔尾侧缝合,从而形成稳定的鼻尖支撑结构.结果 26例受术者随访3~16个月,其中2例出现鼻背骨与软骨衔接处阶梯状改变,但鼻尖形态良好;3例原有鼻尖鼻小柱偏斜的患者,在3个月后出现再次偏斜,但较原先有一定改善;其余21例均鼻尖形态良好.结论 利用鼻中隔尾段前徙术可形成稳定的鼻尖形态,是一种有效的方法.

  4. Effect of interferon-alpha on experimental septal fibrosis of the liver - study with a new model

    Directory of Open Access Journals (Sweden)

    Marcia Maria de Souza

    2001-04-01

    Full Text Available Interferon-alpha is used in antiviral therapy in humans, mainly for viral hepatitis B and C. An anti-fibrotic effect of interferon has been postulated even in the absence of anti-viral response, which suggests that interferon directly inhibits fibrogenesis. Rats infected with the helminth Capillaria hepatica regularly develop diffuse septal fibrosis of the liver, which terminates in cirrhosis 40 days after inoculation. The aim of this study was to test the anti-fibrotic effect of interferon in this experimental model. Evaluation of fibrosis was made by three separate methods: semi-quantitative histology, computerized morphometry and hydroxyproline measurements. Treatment with interferon-alpha proved to inhibit the development of fibrosis in this model, especially when doses of 500,000 and 800,000 IU were used for 60 days. Besides confirming the anti-fibrotic potential of interferon-alpha on a non-viral new experimental model of hepatic fibrosis, a clear-cut dose-dependent effect was observed.

  5. Pulmonary Valve Infective Endocarditis in an Adult Patient with Severe Congenital Pulmonary Stenosis and Ostium Secundum Atrial Septal Defect

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    Juan Lacalzada

    2010-01-01

    Full Text Available A hypertensive 76-year-old man with severe pulmonary valve stenosis (PVS and recent initiation of haemodialysis was referred with fever, chills, and asthenia. One month prior, he had been admitted with similar symptoms. Transthoracic echocardiography (TTE had shown a PVS and no valve vegetations were observed. Following discharge, he was readmitted with fever and blood cultures positive for Staphylococcus haemolyticus. A new TTE revealed two pulmonary valve vegetations and a previously undetected ostium secundum-type atrial septal defect (ASD, confirmed by transesophageal echocardiography. The clinical course was uneventful with intravenous antibiotic treatment and the patient was safely discharged. This is a case of pulmonary valve infective endocarditis (IE. The incidence of right-sided IE is on the rise due to the increased number of patients using central venous lines, pacing, haemodialysis and other intravascular devices. Pulmonary valve IE is extremely rare, especially in structurally normal hearts. The case reported here, presents a combination of predisposing factors, such as severe congenital PVS, the presence of a central venous catheter, and haemodialysis. The fact that it was an older patient with severe congenital PVS and associated with a previously undiagnosed ASD, is also an unusual feature of this case, making it even more interesting.

  6. The reducing agent dithiothreitol (DTT) does not abolish the inhibitory nicotinic response recorded from rat dorsolateral septal neurons

    Science.gov (United States)

    Sorenson, E. M.; Gallagher, J. P.

    1993-01-01

    Previous intracellular recordings have demonstrated that dorsolateral septal nucleus (DLSN) neurons express a novel nicotinic receptor which produces a direct membrane hyperpolarization when activated by nicotinic agonists. Activation of the classical excitatory nicotinic receptors has been shown to require a disulfide bond involving the cysteines at positions 192 and 193 of the alpha subunits of the receptor. Reduction of this cystine bond with dithiothreitol (DTT) abolishes agonist activation of excitatory nicotinic receptors. We have now examined whether DTT treatment of the inhibitory nicotinic receptor on DLSN neurons also abolishes the inhibitory nicotinic response. We find that the inhibitory response persists after treatment of the neurons with 1 mM DTT, even if the reduction is followed by alkylation of the receptor with bromoacetylcholine to prevent possible reformation of disulfide bonds. This result suggests that the agonist binding site on the inhibitory nicotinic receptor does not require an intact disulfide bond, similar to the bond on the alpha subunit of the excitatory nicotinic receptor, for agonist activation of the receptor. Some of these results have been previously reported in abstract form.

  7. Preventive echocardiographic examination in athletes and workers – Quadricuspid aortic valve and atrial septal aneurysm in a young basketball player

    Directory of Open Access Journals (Sweden)

    Karina Wierzbowska-Drabik

    2015-02-01

    Full Text Available Ensuring safety of young athletes and employees who perform hard physical work within the scope of their professional duties, with a special focus on prevention of a sudden cardiac death at sports fields or during hard physical work is one of the most important tasks, which demands joint effort of cardiologists and sport physicians or occupational physicians, who qualify patients for a job or a sport discipline. Apart from hypertrophic and arhythmogenic right ventricular cardiomyopathy, coronary anomalies and aortic dissection belong to the most frequent causes of dramatic complications during competitive exercise or work with an increased energy expenditure. Although a detailed medical history and a physical examination combined with 12-lead ECG assessment may significantly improve the safety in competitive sports, adding echocardiography examination gives a detailed and noninvasive insight into the heart morphology and function. Therefore, in our opinion, it should constitute a standard part of the evaluation of candidates for competitive sports. The practice indicates that beyond subjects with severe heart diseases and those classified as normal, there is a group of individuals with abnormalities which should be more closely monitored, but are not contraindications against professional sports or work with an increased energy expenditure. We describe the case of a young female with a diagnosis of rare congenital aortic valve disease, quadricuspid valve, with mild regurgitation and atrial septal aneurysm which was established during transthoracic echocardiography and confirmed and expanded during TEE examination.

  8. Characterization of SMAD3 Gene Variants for Possible Roles in Ventricular Septal Defects and Other Congenital Heart Diseases.

    Directory of Open Access Journals (Sweden)

    Fei-Feng Li

    Full Text Available Nodal/TGF signaling pathway has an important effect at early stages of differentiation of human embryonic stem cells in directing them to develop into different embryonic lineages. SMAD3 is a key intracellular messenger regulating factor in the Nodal/TGF signaling pathway, playing important roles in embryonic and, particularly, cardiovascular system development. The aim of this work was to find evidence on whether SMAD3 variations might be associated with ventricular septal defects (VSD or other congenital heart diseases (CHD.We sequenced the SMAD3 gene for 372 Chinese Han CHD patients including 176 VSD patients and evaluated SNP rs2289263, which is located before the 5'UTR sequence of the gene. The statistical analyses were conducted using Chi-Square Tests as implemented in SPSS (version 13.0. The Hardy-Weinberg equilibrium test of the population was carried out using the online software OEGE.Three heterozygous variants in SMAD3 gene, rs2289263, rs35874463 and rs17228212, were identified. Statistical analyses showed that the rs2289263 variant located before the 5'UTR sequence of SMAD3 gene was associated with the risk of VSD (P value=0.013 <0.05.The SNP rs2289263 in the SMAD3 gene is associated with VSD in Chinese Han populations.

  9. Defective T wave combined with incomplete right bundle branch block: a new electrocardiographic index for diagnosing atrial septal defect

    Institute of Scientific and Technical Information of China (English)

    WANG Mu-xuan; Andrew D.Michaels; MA Hong; WU Gui-fu; GU Jing-li; LI Li; LU Kun; YANG Da; CHEN Long; ZHANG Xi; LUO Fu-tian

    2012-01-01

    Background Incomplete right bundle branch block (ICRBBB) is commonly associated with atrial septal defect (ASD),but lacks sufficient diagnostic test characteristics.An abnormal T wave is also often observed in ASD,with horizontal or inverted displacement of the proximal T wave limb in the right precordial leads,termed "defective T wave" (DTW).Methods We examined the diagnostic test characteristics of combining ICRBBB with DTVV as a new index to diagnose ASD.A total of 132 consecutive patients with ASD and 132 cases of age/gender-matched controls without ASD were enrolled.Results Sensitivities of DTW,ICRBBB,and both were 87.1%-87.9%.Specificities were 97.0%,96.2%,and 100%,respectively.Positive predictive values were 1.3%,1.1%,and 100.0% respectively,while negative predictive values were 99.9% for each.Conclusion Combining ICRBBB with DTW in electrocardiogram (ECG) as a new index significantly increased the specificity and positive predictive values while maintaining a high sensitivity in diagnosing ASD.

  10. Surgical closure of apical multiple muscular septal defects via right ventriculotomy using a single patch with intermediate fixings

    Institute of Scientific and Technical Information of China (English)

    LI Gang; WANG Qiang; LIU Ying-long; XU Yu-lin; GUO Yan

    2013-01-01

    Background Multiple apical muscular ventricular septal defects (VSDs) remain a challenge for surgeons because of their anatomical features.We used single patch with intermediate fixations to repair multiple apical muscular VSDs through right ventriculotomy.Methods We analysed the data of 16 children (median age 8 months,range 2 months to 144 months) with multiple apical muscular VSDs who underwent a single patch technique via apical right ventriculotomy.Perioperative data were collected and analysed,and the patients were followed up for three months to 66 months (median,46 months) to investigate the outcomes.Results All patients recovered from cardiopulmonary bypass easily with median of cardiopulmonary bypass time 87 minutes and of aortic crossclamp time 53 minutes.No surgically related death occurred and no patient required reoperation.One patient died of pseudomonas pyocyanea infection on day 11 postoperatively.Residual shunt happened in one patient with a diameter of 2 mm and spontaneously closed in 12 months after operation.Two patients presented slightly reduced right ventricular volume and apical hypokinesia postoperatively and recovered 24 and 36 months later respectively.No other complication was found during the three months to 66 months follow-up.Conclusion Our experiences using a single patch technique with intermediate fixations via right ventriculotomy in the management of multiple muscular VSDs had favourable outcomes.

  11. Measurement of void volume of a fuel rod and the exchange of occluded gases from mixed carbide fuel with filling gas helium

    Energy Technology Data Exchange (ETDEWEB)

    Rama Rao, G.A. [Bhabha Atomic Res. Centre, Bombay (India). Fuel Chem. Div.; Kulkarni, S.G. [Bhabha Atomic Res. Centre, Bombay (India). Fuel Chem. Div.; Venugopal, V. [Bhabha Atomic Res. Centre, Bombay (India). Fuel Chem. Div.; Manchanda, V.K. [Radiochemistry Division, Bhabha Atomic Research Centre, Bombay 400 085 (India); Goswami, G.L. [Atomic Fuels Division, Bhabha Atomic Research Centre, Bombay 400 085 (India)

    1995-02-01

    The presence of gaseous impurities in the filling gas of a fuel pin is detrimental to the thermal performance of a nuclear reactor fuel. The composition of the filling gas does not remain constant throughout the life of the fuel pin. The gas exchange phenomena that occur between the cover gas and impurity gases affect the fuel performance more severely in (U, Pu)O{sub 2} fuel pin due to its inherently poor thermal conductivity than in advanced fuels such as mixed carbides and nitrides. In the present study the exchange phenomenon of the occluded gases present in our Fast Breeder Test Reactor (FBTR) fuel pellets [(U{sub 0.30}, Pu{sub 0.70})C with 6500 ppm O] with the cover gas helium was observed as a function of time and temperature. Quantitative analysis of the released gases namely H{sub 2}, O{sub 2}+Ar, N{sub 2}, CH{sub 4} and CO was carried out at subambient pressure by gas chromatography. The void volume of the fuel element is determined experimentally by gas equilibration with known volume. ((orig.))

  12. Measurement of void volume of a fuel rod and the exchange of occluded gases from mixed carbide fuel with filling gas helium

    Science.gov (United States)

    Rao, G. A. Rama; Kukarni, S. G.; Venugoopal, V.; Manchanda, V. K.; Goswami, G. L.

    1995-02-01

    The presence of gaseous impurities in the filling gas of a fuel pin is detriental to the thermal performance of a nuclear reactor fuel. The composition of the filling gas does not remain constant throughout the life of the fuel pin. The gas exchange phenomena that occur between the cover gas and impurity gases affect the fuel performance more severely in (U, Pu)O 2 fuel pin due to its inherently poor thermal conductivity than in advanced fuels such as mixed carbides and nitrides. In the present study the exchange phenomenon of the occluded gases present in our Fast Breeder Test Reactor (FBTR) fuel pellets [(U 0.30, Pu 0.70)C with 6500 ppm o] with the cover gas helium was observed as a function of time and temperature. Quantitative analysis of the released gases namely H 2, O 2 + Ar, N 2, CH 4 and CO was carried out at subambient pressure by gas chromatography. The void volume of the fuel element is determined experimentally by gas equilibration with known volume.

  13. Comparison of Coil Embolization and Sclerotherapy of Collateral Veins during Balloon Occluded Retrograde Transvenous Obliteration: Its Long Term Effect for Gastric Varix Treatment

    Energy Technology Data Exchange (ETDEWEB)

    An, Eun Jung; Kim, Young Hwan; Kim, Seee Hyung [Dept. of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2011-10-15

    We compared the long term effect gastric varix treatment between coil embolization and sclerotherapy of collateral veins during balloon occluded retrograde transvenous obliteration (BRTO). Between February 2004 and November 2008 48 patients with gastric varix bleeding successfully treated with BRTO 23 underwent embolization of collateral veins during BRTO were enrolled in this study. In patients, collateral veins were embolized with the use of microcoil (group 1). Agent (5% ethanolamine oleate + lipiodol) was used in the remaining 7 patients (Group 2). Recurrence and rebleeding of gastric varix were evaluated by endoscopy or CT. Gastric varix recurred in 4 patients (17.4%) and rebleeding occurred in 2 (8.7%). Recurrence (57.1%, p 0.001) and rebleeding (28.6%, p = 0.029) of gastric occurred in group 2. CT finding within 6 months in partial or complete thrombosis without lipiodol uptake in gastric varix, gastric varix recurred on follow up CT. Coil embolization of collateral veins during BRTO may promote complete obliteration of gastric varix, provide lower recurrence and rebleeding rates of gastric sclerosing agent on long term follow-up.

  14. Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non-Resectable Malignant Biliary Obstruction: A Single-Institution Experience.

    Directory of Open Access Journals (Sweden)

    Xu-Hua Duan

    Full Text Available To determine the safety and feasibility of intraductal radiofrequency ablation (RFA followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion.Fourteen patients with malignant biliary obstruction and blocked metal stents were studied retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were monitored clinically and radiologically. The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.Combination treatment was successful for all patients. There were no severe complications during RFA or local treatments. All patients had stent patency restored, with a decline in serum bilirubin. Three patients had recurrent jaundice by 195, 237 and 357 days; two patients underwent repeat intraductal RFA; and one required an internal-external biliary drain. The average stent patency time was 234 days (range 187-544 days. With a median follow-up of 384 days (range 187-544 days, six patients were alive, while eight had died. There was no mortality at 30 days. The 3, 6, 12 and 18 month survival rates were 100%, 100%, 64.3% and 42.9%, respectively.Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

  15. Energy landscape of the reactions governing the Na+ deeply occluded state of the Na+/K+-ATPase in the giant axon of the Humboldt squid.

    Science.gov (United States)

    Castillo, Juan P; De Giorgis, Daniela; Basilio, Daniel; Gadsby, David C; Rosenthal, Joshua J C; Latorre, Ramon; Holmgren, Miguel; Bezanilla, Francisco

    2011-12-20

    The Na(+)/K(+) pump is a nearly ubiquitous membrane protein in animal cells that uses the free energy of ATP hydrolysis to alternatively export 3Na(+) from the cell and import 2K(+) per cycle. This exchange of ions produces a steady-state outwardly directed current, which is proportional in magnitude to the turnover rate. Under certain ionic conditions, a sudden voltage jump generates temporally distinct transient currents mediated by the Na(+)/K(+) pump that represent the kinetics of extracellular Na(+) binding/release and Na(+) occlusion/deocclusion transitions. For many years, these events have escaped a proper thermodynamic treatment due to the relatively small electrical signal. Here, taking the advantages offered by the large diameter of the axons from the squid Dosidicus gigas, we have been able to separate the kinetic components of the transient currents in an extended temperature range and thus characterize the energetic landscape of the pump cycle and those transitions associated with the extracellular release of the first Na(+) from the deeply occluded state. Occlusion/deocclusion transition involves large changes in enthalpy and entropy as the ion is exposed to the external milieu for release. Binding/unbinding is substantially less costly, yet larger than predicted for the energetic cost of an ion diffusing through a permeation pathway, which suggests that ion binding/unbinding must involve amino acid side-chain rearrangements at the site. PMID:22143771

  16. Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes

    Directory of Open Access Journals (Sweden)

    Fumio Uchiyama

    2013-01-01

    Full Text Available Our aim was to evaluate the long-term efficacy and safety of percutaneous transhepatic obliteration (PTO alone and combined with balloon-occluded retrograde transvenous obliteration (BRTO for gastroesophageal varices refractory to BRTO alone. Between July 1999 and December 2010, 13 patients with gastroesophageal varices refractory to BRTO were treated with PTO (n = 6 or a combination of PTO and BRTO (n = 7. We retrospectively investigated the rates of survival, recurrence, or worsening of the varices; hepatic function before and after the procedure; and complications. The procedure achieved complete obliteration or significant reduction of the varices in all 13 patients without major complications. During follow-up, the varices had recurred in 2 patients, of which one had hepatocellular carcinoma, and the other died suddenly from variceal rebleeding 7 years after PTO. The remaining 11 patients did not experience worsening of the varices and showed significant improvements in the serum ammonia levels and prothrombin time. The mean follow-up period was 90 months, and the cumulative survival rate at 1, 3, and 5 years was 92.9%, 85.7%, and 85.7%, respectively. Both PTO and combined PTO and BRTO seem as safe and effective procedures for the treatment of gastroesophageal varices refractory to BRTO alone.

  17. Application of percutaneous transluminal septal myocardial ablation on hypertrophic obstructive cardiomyopathy%经皮导管室间隔心肌化学消融术治疗肥厚型梗阻性心肌病的近期疗效

    Institute of Scientific and Technical Information of China (English)

    刘红明; 王钰; 张宏杰

    2011-01-01

    Objective:To evaluate the feasibility and efficiency of percutaneous transluminal septal myocardial ablation (PTSMA) for treatment of hypertrophic obstructive cardiomyopathy (HOCM).Method: Eleven patients with 1 to 10 year history of HOCM underwent the PTSMA.Left ventricular outflow tract gradient (LVOTG)were measured before and after septal branches occluded by 96%-99% alcohol.The thickness of septal myocar dium, width of LVOT and amplitude of systolic anterior motion (SAM) were also measured before, at the time of discharge and 1 month after PTSMA by echocardiography.Result: Ten patients were accomplished by Sigwart method and only one patient died from acute myocardial infartion 4 hours after ablation.In survival cases, one of them was implanted DDD pacemaker because of permanent complete heart block 5 days later.Once the operation finished, LVOTG was immediately decreased from (90.40 ± 41.95) mmHg to (52.90 ± 34.12) mmHg (P<0.01).At the time of discharge, LVOTG and amplitude of SAM were improved significantly([82.98±36.46]vs [44.56±28.87]mmHg;[4.10±1.37]vs [2.30±1.06]mmHg, P<0.01) compared with those before operation.At the end of 1 month of following up, LVOTG, thickness of septal myocardium, width of LVOT and amplitude of SAM were all showed a good improvement respectively (P<0.01).Conclusion: PTSMA can significantly reduce LVOTG and has a satisfactory short term efficacy in the treatment of HOCM.Risk control must be emphasized during the ablation procedure and further careful evaluation is needed.%目的:探讨经皮导管室间隔心肌化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)方法及近期疗效.方法:11例HOCM患者,经心脏超声及导管测压证实存在左室流出道压力阶差(LVOTG),选择靶间隔支注入无水乙醇消融后记录LVOTG变化,出院时及出院后1个月复查超声心动图.结果:11例患者中消融第1间隔支者9例,消融第2间隔支者1例,同时消融第1、第2间隔支者1例;

  18. Comparação de parâmetros eletrofisiológicos das estimulações cardíacas endocárdicas septal e apical Comparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation

    Directory of Open Access Journals (Sweden)

    Juan Carlos Pachón Mateos

    2012-06-01

    Full Text Available FUNDAMENTO: A estimulação endocárdica convencional do ventrículo direito (VD ocasiona alargamento do QRS e dessincronização do miocárdio, comprometendo a função ventricular. Com a necessidade de estimulação menos deletéria, a estimulação septal do VD tem sido mais utilizada. Eventualmente têm sido relatados limiares mais altos e ondas R menores na estimulação septal. OBJETIVO: Comparar os parâmetros das estimulações apical e septal, intrapaciente, para verificar se existem diferenças que possam interferir na escolha do ponto de estimulação. MÉTODOS: Estudo prospectivo controlado. Foram incluídos 25 pacientes, com 67,2 ± 9 anos, 10 (40% mulheres, com indicações de marca-passo por bradiarritmias. Etiologias foram degenerativa em nove (36%, coronariopatia em oito (32%, doença de Chagas em sete (28%, e valvopatia em um (4% pacientes. Foram utilizados eletrodos de fixação ativa e avaliados os limiares de comando, impedância e onda R uni e bipolares no implante e após seis meses. RESULTADOS: A média aguda dos limiares de comando, ondas R e impedâncias unipolares/bipolares septais x apicais foram, respectivamente, 0,73x0,74V e 0,73x0,78V; 10x9,9 mV e 12,3x12,4 mV; 579x621 Ω e 611x629 Ω. Comparações entre parâmetros septais e apicais com teste t-pareado bicaudal demonstraram um P > 0,1. Após seis meses, a média dos limiares de comando, ondas R e Impedâncias unipolares/ bipolares septais x apicais foram, respectivamente, 0,5 x 0,72 V e 0,71 x 0,87 V; 11,4x9,5 mV e 12x11,2 mV; 423x426Ω e 578x550Ω, com P > 0,05, exceto comparando-se limiar de estimulação unipolar septal com apical unipolar p de 0,02. CONCLUSÃO: Utilizando comparações intrapaciente, não existem diferenças expressivas entre parâmetros eletrofisiológicos de estimulação septal e apical sendo que não há restrições para a escolha da estimulação septal em ventrículo direito.BACKGROUND: The conventional right ventricle (RV endocardial

  19. Ventricular Septal Defect: a Literature Review Comunicación interventricular: revisión de la literatura

    Directory of Open Access Journals (Sweden)

    Luis Ángel Osorio Góngora

    2011-12-01

    Full Text Available Congenital heart defects occur in approximately eight of every 1000 live births. Ventricular septal defect occupies a large percentage of them and is the most commonly associated with chromosomal syndromes presenting multifactorial etiology. In 1879, Roger was the first to define the underlying clinical signs. New milestones in its history are marked by Einsenmenger, Dalrymple, Heath and Edwards. In 1979, the use of two-dimensional echocardiography in real time, dramatically improved non-invasive anatomical diagnosis. The main pathophysiologic alteration is part of the injuries that produce volume overload and left to right short-circuit. It is a model for the study of anatomical and physiological relationship in the different injuries that allow communication between the pulmonary and systemic circuits. The imperfections of the sites of origin of the interventricular septum result in different types of ventricular septal defects. The most commonly used classification is the anatomical, from Soto. Homodynamic effects after birth depend on the physiological changes of systemic and pulmonary circulation, as well as on the diameter of the hole. The clinical case depends on the defect and the pulmonary and vascular resistance. The diagnosis is clinical and echocardiographic. Treatment is medical, palliative, surgical and with rehabilitation. Currently, rehabilitation is approached as an essential part of care and therapy.Las cardiopatías congénitas se presentan aproximadamente en 8 de cada 1000 recién nacidos vivos. La comunicación interventricular ocupa un gran porcentaje entre todas, y es la que más se asocia a los síndromes cromosómicos con etiología multifactorial. En 1879 Roger fue el primero en definir los signos clínicos subyacentes. Nuevos hitos en su historia marcan: Einsenmenger, Dalrymple, Heath y Edwards, hasta 1979 en que, con el uso de la ecocardiografía bidimensional en tiempo real, se mejora dramáticamente el diagn

  20. Behavioral and autonomic responses to acute restraint stress are segregated within the lateral septal area of rats.

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    Daniel G Reis

    Full Text Available BACKGROUND: The Lateral Septal Area (LSA is involved with autonomic and behavior responses associated to stress. In rats, acute restraint (RS is an unavoidable stress situation that causes autonomic (body temperature, mean arterial pressure (MAP and heart rate (HR increases and behavioral (increased anxiety-like behavior changes in rats. The LSA is one of several brain regions that have been involved in stress responses. The aim of the present study was to investigate if the neurotransmission blockade in the LSA would interfere in the autonomic and behavioral changes induced by RS. METHODOLOGY/PRINCIPAL FINDINGS: Male Wistar rats with bilateral cannulae aimed at the LSA, an intra-abdominal datalogger (for recording internal body temperature, and an implanted catheter into the femoral artery (for recording and cardiovascular parameters were used. They received bilateral microinjections of the non-selective synapse blocker cobalt chloride (CoCl(2, 1 mM/ 100 nL or vehicle 10 min before RS session. The tail temperature was measured by an infrared thermal imager during the session. Twenty-four h after the RS session the rats were tested in the elevated plus maze (EPM. CONCLUSIONS/SIGNIFICANCE: Inhibition of LSA neurotransmission reduced the MAP and HR increases observed during RS. However, no changes were observed in the decrease in skin temperature and increase in internal body temperature observed during this period. Also, LSA inhibition did not change the anxiogenic effect induced by RS observed 24 h later in the EPM. The present results suggest that LSA neurotransmission is involved in the cardiovascular but not the temperature and behavioral changes induced by restraint stress.

  1. Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects

    Science.gov (United States)

    Rangaswamy Balasubramanian, Vidhyakar; Selvaraj, Raja; Saktheeswaran, Maheshkumar; Satheesh, Santhosh; Jayaraman, Balachander

    2014-01-01

    Background Very few published data is available on the outcomes of balloon assisted techniques (BATs) for trans catheter closure (TCC) of very large (Defined as ≥35 mm size) ostium secundum atrial septal defect (ASD). Objective To study the utility of BAT as against conventional techniques (CT) in TCC of very large ostium secundum ASD (≥35 mm) over the past 5-year period and to find out the association of different morphological features of the defects in relation to TCC outcomes. Study design and methods Descriptive single center retrospective study of patients with very large ostium secundum ASD (≥35 mm size) who were subjected to TCC. Results Thirty-three out of 36 patients with ≥35 mm ASD and complex morphological features underwent successful TCC. The study patients had high prevalence of absent aortic and posterior rims with posterior mal-alignment of the septum. BAT was successful in 28/31 (90.3%) patients while CT had a success rate of 16%. The mean trans-esophageal echocardiography (TEE) ASD size with BAT success 37 (SD 1.3) mm and CT failure 36.2 (SD 1.1) mm was not different (P=0.06). On univariate analysis of different morphological features, posterior mal alignment of the septum was associated failure of CT (P=0.01). There was no urgent referral for surgery and patients did well on follow up. Conclusions Balloon assisted device closure of (≥35 mm) ASD had 90% success rate. BAT helps in controlled delivery and device alignment in very large ASD with posterior malalignment of the septum and is often helpful when CT fails. PMID:24649421

  2. De Novo and Rare Variants at Multiple Loci Support the Oligogenic Origins of Atrioventricular Septal Heart Defects

    Science.gov (United States)

    Priest, James R.; Osoegawa, Kazutoyo; Mohammed, Nebil; Nanda, Vivek; Kundu, Ramendra; Schultz, Kathleen; Girirajan, Santhosh; Scheetz, Todd; Waggott, Daryl; Haddad, Francois; Reddy, Sushma; Bernstein, Daniel; Burns, Trudy; Steimle, Jeffrey D.; Yang, Xinan H.; Moskowitz, Ivan P.; Hurles, Matthew; Lifton, Richard P.; Nickerson, Debbie; Bamshad, Michael; Eichler, Evan E.; Mital, Seema; Sheffield, Val; Quertermous, Thomas; Gelb, Bruce D.; Portman, Michael; Ashley, Euan A.

    2016-01-01

    Congenital heart disease (CHD) has a complex genetic etiology, and recent studies suggest that high penetrance de novo mutations may account for only a small fraction of disease. In a multi-institutional cohort surveyed by exome sequencing, combining analysis of 987 individuals (discovery cohort of 59 affected trios and 59 control trios, and a replication cohort of 100 affected singletons and 533 unaffected singletons) we observe variation at novel and known loci related to a specific cardiac malformation the atrioventricular septal defect (AVSD). In a primary analysis, by combining developmental coexpression networks with inheritance modeling, we identify a de novo mutation in the DNA binding domain of NR1D2 (p.R175W). We show that p.R175W changes the transcriptional activity of Nr1d2 using an in vitro transactivation model in HUVEC cells. Finally, we demonstrate previously unrecognized cardiovascular malformations in the Nr1d2tm1-Dgen knockout mouse. In secondary analyses we map genetic variation to protein-interaction networks suggesting a role for two collagen genes in AVSD, which we corroborate by burden testing in a second replication cohort of 100 AVSDs and 533 controls (p = 8.37e-08). Finally, we apply a rare-disease inheritance model to identify variation in genes previously associated with CHD (ZFPM2, NSD1, NOTCH1, VCAN, and MYH6), cardiac malformations in mouse models (ADAM17, CHRD, IFT140, PTPRJ, RYR1 and ATE1), and hypomorphic alleles of genes causing syndromic CHD (EHMT1, SRCAP, BBS2, NOTCH2, and KMT2D) in 14 of 59 trios, greatly exceeding variation in control trios without CHD (p = 9.60e-06). In total, 32% of trios carried at least one putatively disease-associated variant across 19 loci,suggesting that inherited and de novo variation across a heterogeneous group of loci may contribute to disease risk. PMID:27058611

  3. Supramammillary serotonin reduction alters place learning and concomitant hippocampal, septal, and supramammillar theta activity in a Morris water maze

    Science.gov (United States)

    Hernández-Pérez, J. Jesús; Gutiérrez-Guzmán, Blanca E.; López-Vázquez, Miguel Á.; Olvera-Cortés, María E.

    2015-01-01

    Hippocampal theta activity is related to spatial information processing, and high-frequency theta activity, in particular, has been linked to efficient spatial memory performance. Theta activity is regulated by the synchronizing ascending system (SAS), which includes mesencephalic and diencephalic relays. The supramamillary nucleus (SUMn) is located between the reticularis pontis oralis and the medial septum (MS), in close relation with the posterior hypothalamic nucleus (PHn), all of which are part of this ascending system. It has been proposed that the SUMn plays a role in the modulation of hippocampal theta-frequency; this could occur through direct connections between the SUMn and the hippocampus or through the influence of the SUMn on the MS. Serotonergic raphe neurons prominently innervate the hippocampus and several components of the SAS, including the SUMn. Serotonin desynchronizes hippocampal theta activity, and it has been proposed that serotonin may regulate learning through the modulation of hippocampal synchrony. In agreement with this hypothesis, serotonin depletion in the SUMn/PHn results in deficient spatial learning and alterations in CA1 theta activity-related learning in a Morris water maze. Because it has been reported that SUMn inactivation with lidocaine impairs the consolidation of reference memory, we asked whether changes in hippocampal theta activity related to learning would occur through serotonin depletion in the SUMn, together with deficiencies in memory. We infused 5,7-DHT bilaterally into the SUMn in rats and evaluated place learning in the standard Morris water maze task. Hippocampal (CA1 and dentate gyrus), septal and SUMn EEG were recorded during training of the test. The EEG power in each region and the coherence between the different regions were evaluated. Serotonin depletion in the SUMn induced deficient spatial learning and altered the expression of hippocampal high-frequency theta activity. These results provide evidence in

  4. Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    Liang Chen; Yuan Bai; Fei-Yu Wang; Zhi-Gang Zhang; Xing-Hua Shan; Tao Chen; Xian-Xian Zhao

    2015-01-01

    Background:Permanent atrial fibrillation (AF) is the most common form of dysrhythmia associated with atrial septal defects (ASDs) in patients older than 40 years.However,little is known about cardiac remodeling after transcatheter closure in patients with permanent AF.This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients.Methods:Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively.Of them,63 patients with permanent AF were assigned to the case group,and the other 226 patients without permanent AF were assigned to the control group.Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups.Results:Patients in the case group were significantly older than those in the control group.The right ventricular (RV) volume and right atrial (RA) volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001).The left atrial dimensions,left ventricular end-systolic dimensions,left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups.Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P =0.005 and P < 0.001).The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period.Conclusions:The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.

  5. Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Liang Chen

    2015-01-01

    Full Text Available Background: Permanent atrial fibrillation (AF is the most common form of dysrhythmia associated with atrial septal defects (ASDs in patients older than 40 years. However, little is known about cardiac remodeling after transcatheter closure in patients with permanent AF. This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients. Methods: Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively. Of them, 63 patients with permanent AF were assigned to the case group, and the other 226 patients without permanent AF were assigned to the control group. Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups. Results: Patients in the case group were significantly older than those in the control group. The right ventricular (RV volume and right atrial (RA volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001. The left atrial dimensions, left ventricular end-systolic dimensions, left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups. Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P = 0.005 and P < 0.001. The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period. Conclusions: The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.

  6. An Excess of Deleterious Variants in VEGF-A Pathway Genes in Down-Syndrome-Associated Atrioventricular Septal Defects

    Science.gov (United States)

    Ackerman, Christine; Locke, Adam E.; Feingold, Eleanor; Reshey, Benjamin; Espana, Karina; Thusberg, Janita; Mooney, Sean; Bean, Lora J.H.; Dooley, Kenneth J.; Cua, Clifford L.; Reeves, Roger H.; Sherman, Stephanie L.; Maslen, Cheryl L.

    2012-01-01

    About half of people with trisomy 21 have a congenital heart defect (CHD), whereas the remainder have a structurally normal heart, demonstrating that trisomy 21 is a significant risk factor but is not causal for abnormal heart development. Atrioventricular septal defects (AVSD) are the most commonly occurring heart defects in Down syndrome (DS), and ∼65% of all AVSD is associated with DS. We used a candidate-gene approach among individuals with DS and complete AVSD (cases = 141) and DS with no CHD (controls = 141) to determine whether rare genetic variants in genes involved in atrioventricular valvuloseptal morphogenesis contribute to AVSD in this sensitized population. We found a significant excess (p < 0.0001) of variants predicted to be deleterious in cases compared to controls. At the most stringent level of filtering, we found potentially damaging variants in nearly 20% of cases but fewer than 3% of controls. The variants with the highest probability of being damaging in cases only were found in six genes: COL6A1, COL6A2, CRELD1, FBLN2, FRZB, and GATA5. Several of the case-specific variants were recurrent in unrelated individuals, occurring in 10% of cases studied. No variants with an equal probability of being damaging were found in controls, demonstrating a highly specific association with AVSD. Of note, all of these genes are in the VEGF-A pathway, even though the candidate genes analyzed in this study represented numerous biochemical and developmental pathways, suggesting that rare variants in the VEGF-A pathway might contribute to the genetic underpinnings of AVSD in humans. PMID:23040494

  7. Characteristics of mesenchymal stem cells originating from the bilateral inferior turbinate in humans with nasal septal deviation.

    Directory of Open Access Journals (Sweden)

    Se Hwan Hwang

    Full Text Available Nasal septal deviation (NSD is often associated with overgrowth of the unilateral inferior turbinate. In vivo and in vitro studies indicate that human mesenchymal stem cells (MSCs are able to differentiate into multiple cell types, including osteoblasts. We tested the hypothesis that turbinate size affects human turbinate-derived MSC (hTMSCs quantity, proliferation, and differentiation into osteogenic lineages, and that hypertrophic turbinates may predispose to NSD on the contralateral side.The hypertrophic and contralateral inferior turbinate tissues used in our study were obtained and cultured from the tissue discarded from 10 patients who underwent septoplasty and partial turbinectomy. After isolating the hTMSCs from both turbinates, the cells were enumerated using an automated cell counter. The expression of surface markers for MSCs over four passages was assessed by fluorescent-activated cell sorting analysis (FACS, and cell proliferation was assessed using a cell counting kit (CCK-8 according to turbinate size. In addition, osteogenic differentiation of hTMSCs was identified using alkaline phosphatase (ALP and alizarin red S staining, after which osteoblastic gene expression was evaluated.There was no significant difference in the number of hTMSCs. FACS analysis revealed that the hTMSCs were negative for CD14, CD19, CD34, and HLA-DR, and positive for CD29, CD73, and CD90, representing a characteristic MSC phenotype, with no significant difference between the two groups. The cellular proliferation and osteogenic differentiation potential of the hTMSCs were also not significantly different between the two groups.We conclude that turbinate size does not affect the characterization, proliferation, and osteogenic differentiation potential of hTMSCs in vitro test, and therefore should not affect the clinical decision of whether to use autologous or allogenic hTMSCs. However, more experiments are required to definitively state the relationship of

  8. Repair of complete atrioventricular septal defect in infants with down syndrome: outcomes and long-term results.

    Science.gov (United States)

    Tumanyan, Margarita R; Filaretova, Olga V; Chechneva, Vera V; Gulasaryan, Ruben S; Butrim, Iuliia V; Bockeria, Leo A

    2015-01-01

    In clinical practice, the combination of congenital heart disease (CHD) with malformations of other organs occurs in about 10 % of cases, including chromosomal disease with heart defects, which are observed mainly with certain syndromes. In the Bakoulev SCCS (Moscow, Russian Federation), from 01.2005 to 01.2011, complete atrioventricular septal defect (CAVSD) repair was performed on 163 patients (5.6 ± 3.0 months) with Down Syndrome (DS) using the single-patch (n = 40) and the two-patch (n = 123) methods. The control group consisted of 214 infants aged 6.49 ± 3.03 months with CAVSD and normal karyotype. A retrospective cohort study was made, as well as a comparative analysis of the immediate (up to 30 days) and long-term (12-75 months, at the average of 56 ± 15) results of the repair of CAVSD in infants with DSand normal karyotype/chromosome set (NK). During the hospital treatment period, we registered the following complications: pulmonary hypertensive crises in 6 % (n = 9) of patients with DS and in 10 % (n = 21) of infants with NK, infectious complications in 21% (n = 34) of patients with DS and in 8% (n = 17) of infants with NK. Squeal structures in groups were differentiated. The doses and duration of cardiotonic support in the NK patients were significantly higher in comparison with the DS patients (7.5 ± 2.1 days vs 3.4 ± 1.15 days, p Down syndrome. Concerning the long-term results, there was no significant difference (Gehan-Wilcoxon test) in actuarial freedom from reoperation after repair of CAVSD between DS and NK groups (p Down Syndrome in patients significantly increases the risk of severe co-morbidities that have a significant impact on the recovery period, as well as on life expectancy even after successful CHD correction. PMID:25099029

  9. Discussion of Operation Coding of Atrial Septal Defect Neoplasty%房间隔缺损修补术的手术编码探讨

    Institute of Scientific and Technical Information of China (English)

    刘晶; 林海丽; 郑琳

    2015-01-01

    With the innovation and development of cardiac surgery technology, atrial septal defect neoplasty methods are varied. Coders have difficulty in coding this operation because of clinicians General writing atrial septal defect neoplasty in the front page of medical record and the records. Through an introduction to the atrial septal defect neoplasty, encode the operations according to the 2011 edition of the ICD-9-CM-3. In the process of coding, coding workers should carefully read operation records, and familiar with coding principle, to ensure the code accurately.%随着心脏外科技术的创新发展,房间隔缺损修补术的手术方式多种多样,由于临床医师在病案首页填写和病历记录中只笼统的书写“房间隔缺损修补术”,从而在手术编码的过程中常常给编码工作者带来困扰。通过对房间隔缺损修补术的手术方式介绍,依据2011版ICD-9-CM-3手术与操作对不同术式的房间隔缺损修补术进行编码。在编码的过程中,编码工作者应仔细阅读手术记录,熟练掌握编码原则,确保房间隔缺损修补术的手术编码准确。

  10. Sellar repair with autologous muscle and composite septal cartilage grafts for treatment of cerebrospinal fluid leakage following trans-sphenoidal pituitary surgery

    Science.gov (United States)

    El Shazly, Ayman A.; El Wardany, Mohammed A.; Abo El Ezz, Tamer A.

    2016-01-01

    Context: Many reconstructive techniques have been proposed to prevent postoperative cerebrospinal fluid (CSF) leakage after trans-sphenoidal pituitary surgery. However, no total agreement has been reached to the best technique. Aim: Assessment of the efficacy of sellar repair with autologous muscle and composite septal cartilage grafts for treatment of intraoperative and delayed postoperative CSF leakage following trans-sphenoidal pituitary surgery without the use of postoperative external lumbar CSF drain. Study Design: This is a retrospective case series study, level IV evidence. Materials and Methods : Twenty three patients were involved in this study. Seventeen patients had intraoperative CSF leakage and were treated immediately by our technique. Six patients had postoperative CSF rhinorrhea and had delayed treatment with our technique after failure of conservative measures and external lumbar CSF drainage for more than three days. The technique involved intradural placement of autologous muscle graft supplemented with extradural composite septal cartilage graft, composed of a piece of the posterior cartilaginous septum with its covering mucoperichondrium on one side only to fit into the sellar defect as a double layer button. Results: CSF leak was of grade 1 in 6 patients (26.1%), grade 2 in 10 patients (43.5%) and grade 3 in 7 patients (30.4%). None of the patients in our study had postoperative CSF leak after the use of our technique during the follow up period (mean 24 ± 10.47 standard deviation months). None of the patients developed treatment-related complications. All the patients had well developed mucosal covering of the sellar defect after two months. Conclusion: Our technique of sellar repair by using autologous muscle and composite septal cartilage grafts is effective in treatment of intraoperative and delayed postoperative CSF leakage following trans-sphenoidal pituitary surgery without the use of postoperative external lumbar CSF drain even in

  11. Alcohol septal ablation and hypertrophic cardiomyopathy%酒精室间隔消融术与肥厚型心肌病

    Institute of Scientific and Technical Information of China (English)

    Carey Kimmelstiel; Barath Krishnamurthy; Andrew Weintraub; Navin Kapur; 王新国

    2009-01-01

    Patients with hypertrophic cardiomyopathy who experience refractory symptoms due to left ventricular outflow tract obstruction are often referred for definitive therapy consisting of either surgical myectomy or alcohol septal ablation ( ASA). There currently exists clinical equipoise regarding which therapy is the most efficacious in this challenging patient population. ASA utilizes common interventional techniques usually employed to treat atherosclerotic coronary artery disease to inject small aliquots of ethanol into a branch of the appropriate septal vessel to cause necrosis of the obstructing basal septal tissue. Myocardial contrast echocardiography is used to facilitate location of the most appropriate septal branch with success determined by an acute reduction in the resting and/or provoked gradient. Recent comparative data have suggested similar rates of long and short-term mortality in when comparing patients undergoing ASA and surgical myectomy, with ASA patients experiencing a higher rate of requirement for permanent pacemakers. In addition, patients treated by both techniques appear to have similar gradient reductions and improvement in symptomatic status. Comparisons of these two methods of treatment are limited by the non-randomized nature of the studies, retrospective data collection and the allocation of higher-risk patients to ASA treatment. Concern for the wide-spread adoption of ASA to drug-resistant HCM patients is warranted due to the potential for arrhythmogenesis is a patient population already at risk for life-threatening arrhythmias. There have been case reports of such arrhythmias, however, clinical series to date have not suggested an enhanced risk of sudden cardiac death in patients treated with ASA. Definitive answers concerning which patient subsets with drug-refractory hypertrophic cardiomyopathy would benefit from the two competing therapies can only be answered by a randomized clinical trial. However, for a variety of clinical and

  12. Role of hybrid operating room in surgery for the right atrial thrombus, pulmonary thrombi, and ventricular septal rupture after myocardial infarction

    Science.gov (United States)

    Singh, Ajmer; Mehta, Yatin; Parakh, Rajiv; Kohli, Vijay; Trehan, Naresh

    2016-01-01

    Free-floating right heart thrombi are uncommon and need emergency treatment in view of their tendency to dislodge and cause pulmonary embolism. We report a successful surgical management of a patient who had large mobile right atrial thrombus, bilateral pulmonary thrombi, coronary artery disease, and postmyocardial infarction ventricular septal rupture (VSR). The patient underwent coronary angiography, inferior vena cava filter placement, removal of thrombi from the right atrium and pulmonary arteries, repair of VSR, and coronary artery bypass graft surgery in a hybrid operating room. PMID:27716704

  13. Preoperative and postoperative pulmonary function tests in patients with atrial septal defect and their relation to pulmonary artery pressure and pulmonary:systemic flow ratio.

    OpenAIRE

    Schofield, P. M.; Barber, P V; Kingston, T

    1985-01-01

    Pulmonary diffusing properties and lung volumes were investigated in 44 patients with atrial septal defect, and in 30 of them preoperative and postoperative data were obtained. The patients were divided into three groups according to mean pulmonary artery pressure: less than or equal to 15 mm Hg (group 1), 16-29 mm Hg (group 2), and greater than or equal to 30 mm Hg (group 3). Patients in groups 1 and 2 had a high carbon monoxide transfer test which became normal after surgical correction of ...

  14. En bloc aortic and mitral valve replacement and left ventricular outflow tract enlargement using a combined transaortic and trans-septal atrial approach.

    Science.gov (United States)

    Hassan, Mohammed; Windsor, Jimmy; Ricci, Marco

    2015-12-01

    Aortic and mitral valve replacement with division and reconstruction of the inter-valvular fibrous body has been described in clinical situations involving infective endocarditis, extensive annular calcifications and diminutive valve annuli. Herein, we describe a combined transaortic and trans-septal approach with division of the inter-valvular fibrosa for combined aortic and mitral valve replacement. The reconstruction of the inter-valvular fibrous body, atrial walls and aortic root was carried out using a 'three-patch' technique with bovine pericardium. PMID:26409564

  15. Aesthetic correction of septal deviation with nasal deformify%鼻中隔偏曲歪鼻畸形的矫正

    Institute of Scientific and Technical Information of China (English)

    曾高; 马海欢; 薛志强; 胡晓根

    2011-01-01

    目的 探讨鼻中隔偏曲歪鼻畸形的矫正方法,以求在改善通气功能的基础上,最大程度的实现鼻外形的美学重建.方法 综合运用鼻中隔软骨部分切除、鼻中隔偏曲矫正支撑重建、鼻骨截骨、鼻尖整形或隆鼻假体置入等多种修复手段,通过Ⅰ期手术矫正鼻中隔畸形的同时,并对鼻外形进行美学重建.结果 对48例患者进了1年以上的随访,非常满意者30例,满意者14例,不满意者3例,非常不满意者1例.外形满意率91.7%(44/48).术前鼻通气障碍,术后均得到不同程度缓解.结论 在全面掌握鼻解剖的基础上综合运用多种手术方法,鼻中隔偏曲歪鼻畸形的矫正能获得较好的美学效果,同时改善了患者的鼻通气功能.%Objectives To explore a comprehensive approach for the functional and aesthetic correction of septal deviation. Methods From Jan. 2007 to Dec. 2009, 48 patients with deviation of the frontier and ceiling border of the septal cartilage, 6 males, 42 females, average age of 26.5 years, were surgically treated with a comprehensive use of several techniques, such as septoplasty, reconstruction of septal support, precise osteotomies and nasal tip plasty. Results Functional improvement achieved in all the patients, contour satisfaction achieved in 91.7 % patients; 30 patients were very satisfied, and 14 satisfied with the outcome. Conclusions With the thorough understanding of surgical anatomy of the nose and the use of comprehensive surgical approach, satisfactory outcomes can be achieved both functionally and aesthetically in patients with septal deviation.

  16. Right ventricular electrical and mechanical synchronization by properly timed septal pacing in a patient with right bundle branch block and first degree AV block--a case report.

    Science.gov (United States)

    Siliste, Calin; Suran, Maria-Claudia-Berenice; Margulescu, Andrei-Dumitru; Vinereanu, Dragos

    2015-03-01

    We present a case of near-normalization of the QRS by septal pacing in a patient with dual-chamber pacemaker and underlying complete right bundle branch block and first degree atrioventricular block. The right ventricular mechanical synchronization suggested by the ECG was validated as such by strain echo. To the best of our knowledge, this is the first time it has been shown that the narrowing of the QRS corresponds to mechanical synchronization in a case of this seldom-recognized phenomenon.

  17. Determinant Factors in the Production of a Co-Occluded Binary Mixture of Helicoverpa armigera Alphabaculovirus (HearNPV) Genotypes with Desirable Insecticidal Characteristics

    Science.gov (United States)

    Arrizubieta, Maite; Simón, Oihane; Williams, Trevor; Caballero, Primitivo

    2016-01-01

    A co-occluded binary mixture of Helicoverpa armigera nucleopolyhedrovirus genotypes HearSP1B and HearLB6 at a 1:1 ratio (HearSP1B+HearLB6) was selected for the development of a virus-based biological insecticide, which requires an efficient large-scale production system. In vivo production systems require optimization studies in each host-virus pathosystem. In the present study, the effects of larval instar, rearing density, timing of inoculation, inoculum concentration and temperature on the production of HearSP1B+HearLB6 in its homologous host were evaluated. The high prevalence of cannibalism in infected larvae (40–87%) indicated that insects require individual rearing to avoid major losses in OB production. The OB production of recently molted fifth instars (7.0 x 109 OBs/larva), combined with a high prevalence of mortality (85.7%), resulted in the highest overall OB yield (6.0 x 1011 OBs/100 inoculated larvae), compared to those of third or fourth instars. However, as inoculum concentration did not influence final OB yield, the lowest concentration, LC80 (5.5 x 106 OBs/ml), was selected. Incubation temperature did not significantly influence OB yield, although larvae maintained at 30°C died 13 and 34 hours earlier than those incubated at 26°C and 23°C, respectively. We conclude that the efficient production of HearSP1B+HearLB6 OBs involves inoculation of recently molted fifth instars with a LC80 concentration of OBs followed by individual rearing at 30°C. PMID:27732657

  18. Efficacy of balloon-occluded retrograde transvenous obliteration,percutaneous transhepatic obliteration and combined techniques for the management of gastric fundal varices

    Institute of Scientific and Technical Information of China (English)

    Hirotaka Arai; Takehiko Abe; Hitoshi Takagi; Masatomo Mori

    2006-01-01

    AIM: To evaluate the effect of three interventional treatments involving transvenous obliteration for the treatment of gastric varices, and to compare the efficacy and adverse effects of these methods.METHODS: From 1995 to 2004, 93 patients with gastric fundal varices underwent interventional radiologic embolotherapy at our hospital. Of the 93 patients, 75 were treated with the balloon-occluded retrograde transvenous obliteration (BRTO) procedure; 8 were with the percutaneous transhepatic obliteration (PTO)procedure; and 10 were with the combined BRTO and PTO therapy. A follow-up evaluation examined the rates of survival, recurrence and rebleeding of the gastric varices, worsening of esophageal varices and complications in each group.RESULTS: The BRTO, PTO, and combined therapy were technically successful in 81% (75/93), 44% (8/18),and 100% (10/10) patients, respectively. Recurrence of gastric varices was found in 3 patients in the BRTO group and in 3 patients in the PTO group. Rebleeding was observed in 1 patient in the BRTO group and in 1 patient in the PTO group. The 1- and 3-year survival rates were 98% and 87% in the patients without hepatocellular carcinoma (HCC) in the BRTO group, 100% and 100% in the PTO group, and 90% and 75% in the combined therapy group, respectively.CONCLUSION: Combined BRTO and PTO therapy may rescue cases with uncontrollable gastric fundal varices that remained even after treatment with BRTO and/or PTO, though there were limitations of our study,including retrospective nature and discrepancy in sample size between the BRTO, PTO and combined therapy groups.

  19. Prediction of early-onset atrial tachyarrhythmia after successful trans-catheter device closure of atrial septal defect.

    Science.gov (United States)

    Park, Kyoung-Min; Hwang, Jin Kyung; Chun, Kwang Jin; Park, Seung-Jung; On, Young Keun; Kim, June Soo; Park, Seung Woo; Kang, I-Seok; Song, Jinyoung; Huh, June

    2016-08-01

    Atrial tachyarrhythmia is a well-known long-term complication of atrial septal defect (ASD) in adults, even after successful trans-catheter closure. However, the risk factors for early-onset atrial tachyarrhythmia after trans-catheter closure remain unclear. This retrospective study enrolled adults with secundum ASD undergoing trans-catheter closure from January 2000 to March 2014. We analyzed the clinical characteristics of patients and assessed risk factors for new-onset atrial tachyarrhythmia defined as a composite of atrial fibrillation or flutter (AF/AFL) after ASD closure. We enrolled a total of 427 patients; 123 were male (28.8%) and the median age was 37.0 (interquartile range [IQR]: 18.3-49.0). Nineteen (4.4%) patients had documented atrial tachyarrhythmia during the follow-up period (median: 11.4 months [IQR: 5.4-24]). Patients with transient AF/AFL during closure showed a greater incidence of new-onset atrial tachyarrhythmia during the follow-up period than patients with consistent sinus rhythm during closure (27.3% vs 3.8%; P = 0.01). Most new-onset atrial tachyarrhythmias were documented within 6 months (median: 2.6 [IQR: 1.2-4.1] months) of closure. In the multivariate analysis, the risk for new-onset atrial tachyarrhythmia was significant in patients with AF/AFL during closure (hazard ratio [HR]: 9.90, 95% confidence interval [CI]: 2.86-34.20; P < 0.001), deficient posteroinferior rim (HR: 5.48, 95% CI: 1.15-25.72; P = 0.04), and age of closure over 48 years (HR: 3.30, 95% CI: 1.30-8.38; P = 0.01). In conclusion, transient AF/AFL during trans-catheter closure of ASD as well as deficient posteroinferior rim and age of closure over 48 years may be useful for predicting early new-onset atrial tachyarrhythmia after device closure. PMID:27583905

  20. Inaccuracy of doppler echocardiographic estimates of pulmonary artery pressures in adult atrial septal defect patients with pulmonary arterial hypertension

    Institute of Scientific and Technical Information of China (English)

    Zhang Caojin; Huang Tao; Huang Xinsheng; Huang Yigao; Chen Jimei; Chen Jiyan; Wu Shulin

    2014-01-01

    Background While echocardiography has been a pivotal screening test in pulmonary arterial hypertension (PAH),the presence of structural cardiac defects may affect the ability to reliably predict pulmonary artery pressures (PAPs).This study sought to evaluate the accuracy of Doppler echocardiography (DE) for estimating PAPs in adult atrial septal defect (ASD) patients with PAH.Methods A prospective study was carried out to compare the echocardiographic assessment of PAP with the same pressures obtained by right heart catheterization (RHC) in adult ASD patients with PAH who underwent simultaneous DE and RHC.Bland-Altman analyses were performed to evaluate the agreement between DE and RHC measurements of PAPs.Results Two hundred and fifty-seven patients were included in the study.A significant overestimation of the systolic pulmonary arterial pressure (sPAP) and mean pulmonary artery pressure (mPAP) was reported by echocardiography compared with those by catheterization ((81.8±26.9) mmHg vs.(72.9±26.9) mmHg,P <0.01; (51.9±16.4) mmHg vs.(41.4±17.2) mmHg,P <0.01,respectively).Twenty-one percent (55/257) of the patients had PAH when estimated by echocardiography whereas showed normal results in the subsequent catheterization test.Using Bland-Altman analytic methods,the bias for the echocardiographic assessment of the sPAP was 9.1 mmHg with 95% limits of agreement ranging from-24.4 to 42.6 mmHg.For mPAP measurement,the bias was 10.5 mmHg with 95% limits of agreement ranging from-12.4 to 33.4 mmHg.On multiple linear regression analysis,age,gender,body surface area,ASDs' diameter,PVR,diastolic blood pressure,and echocardiographic assessment of right atrial pressure (RAP) explained 68.8% of the total variability in the model (r2=0.688,P <0.01).Conclusion Inaccuracy was frequently reported in Doppler echocardiographic assessment of the PAP in adult ASD patients with PAH and was often associated with age,gender,body surface area,ASDs' diameter

  1. The Role of Nasopharyngeal Temperature Monitoring in Detection of a Malpositioned Superior Vena Cava Cannula in an Emergency Coronary Artery Bypass in a Patient With Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    A Dabbagh

    2010-03-01

    Full Text Available A 55 year-old woman was admitted to the CCU ward of our university hospital due to typical chest pain. The patient received supportive care and was transferred to the operating room for an emergency repair of the ventricular septal defect (VSD and myocardial revascularization. The surgical team was notified regarding the tolerance to cooling detected by the temperature monitoring and also, the congestion of eye and blanching of forehead. After a few maneuvers, the cannula was repositioned. In a few seconds, the forehead was cooled, while the airlocking episodes were lifted completely and the blanching and chemosis in the face and eyes all resolved. The septal defect was approached through the left ventricle; a 15 in 20 mm foramen, due to the ischemic rupture of the superior portion of the anteroseptal wall, was repaired with a patch of hemoshield. The incision over the LV was then repaired with 2 parallel bands of felt. The patient was operated on and transferred to the intensive care unit.

  2. Comparison of left ventricular diastolic function in obstructive hypertrophic cardiomyopathy in patients undergoing percutaneous septal alcohol ablation versus surgical myotomy/myectomy

    Science.gov (United States)

    Sitges, Marta; Shiota, Takahiro; Lever, Harry M.; Qin, Jian Xin; Bauer, Fabrice; Drinko, Jeannie K.; Agler, Deborah A.; Martin, Maureen G.; Greenberg, Neil L.; Smedira, Nicholas G.; Lytle, Bruce W.; Tuzcu, E. Murat; Garcia, Mario J.; Thomas, James D.

    2003-01-01

    Both percutaneous transcoronary alcohol septal reduction (ASR) and surgical myectomy are effective treatments to relieve left ventricular (LV) outflow tract obstruction in obstructive hypertrophic cardiomyopathy (HC). LV diastolic function was assessed by echocardiography in 57 patients with obstructive HC at baseline and 5 +/- 4 months after ASR (n = 37) or surgical myectomy (n = 20). LV outflow tract pressure gradient decreased from 65 +/- 40 to 23 +/- 21 mm Hg (p treatment. The ratio of the early-to-late peak diastolic LV inflow velocities, and the ratio of the early peak diastolic LV inflow velocity to the lateral mitral annulus early diastolic velocity determined by tissue Doppler imaging significantly decreased after the procedures (1.6 +/- 1.7 vs 1.0 +/- 0.7 and 15 +/- 8 vs 11 +/- 5, respectively), whereas LV inflow propagation velocity significantly increased (60 +/- 24 vs 71 +/- 36 cm/s). Left atrial size decreased from 29 +/- 7 to 25 +/- 6 cm(2) (p <0.05). Patients had a significant improvement in New York Heart Association functional class and in exercise performance. When comparing ASR with myectomy, no difference was found in the degree of change in any parameter of diastolic function. Thus, diastolic function indexes obtained by echocardiography changed after septal reduction interventions in patients with obstructive HC; this change was similar to that after surgical myectomy and ASR.

  3. Atrial septal defect (ASD)

    Science.gov (United States)

    ... ncbi.nlm.nih.gov/pubmed/17015547 . Marelli AJ. Congenital heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ... Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ...

  4. Ventricular Septal Defect

    Science.gov (United States)

    ... restricted in any way. Recovery Recovery A typical stay in the hospital after surgical closure is 4 to 5 days, if there are no problems. After repair, most children go on to live healthy, productive lives. Reviewed ...

  5. Oclusión transitoria de comunicación interauricular en el síndrome de Lutembacher Temporary occlusion of atrial septal defect in the Lutembacher syndrome

    Directory of Open Access Journals (Sweden)

    Alejandro E. Contreras

    2011-08-01

    Full Text Available Se describe una paciente de 82 años de edad, con síntomas de insuficiencia cardíaca avanzada e hipertensión arterial pulmonar. Un ecocardiograma transtorácico mostró una comunicación interauricular tipo ostium secundum y estenosis valvular mitral concomitante (síndrome de Lutembacher. La valoración ecocardiográfica de la enfermedad mitral se vio dificultada por la presencia del defecto interauricular. Se realizó test de oclusión percutánea transitoria de la comunicación interauricular, observándose la aparición de estenosis valvular mitral grave. El tamaño del defecto interauricular modificó las manifestaciones clínicas y el test de oclusión transitoria ayudó a decidir la conducta terapéutica.We report the case of an 82 year-old woman with symptoms of advanced heart failure and pulmonary arterial hypertension. An echocardiogram showed an ostium secundum type atrial septal defect and concomitant mitral valve stenosis (Lutembacher syndrome. Echocardiographic assessment of mitral pathology was hampered by the interatrial septal defect. Transient percutaneous occlusion test of the atrial septal defect was performed and severe mitral valve stenosis was detected. Atrial septal defect size modified the clinical manifestations and the transient occlusion test helped to decide the therapeutic strategy.

  6. 隔瓣后室间隔缺损并假性室隔瘤的手术治疗%Surgical Treatment of Ventricular Septal Defect With False Aneurysm of Membrane Septum

    Institute of Scientific and Technical Information of China (English)

    毛志福; 高尚志; 陈俊堂; 姚震; 涂仲凡

    1996-01-01

    Objective:To introduce the procedure for better exposure of the ventricular septal defect(VSD)from fused septal leaflet pouch.Method:Among the 28 cases,the septal leaflet of tricuspid valve in 22 cases was incised and the papillary muscle in 6 cases was dissected to expose the rim of the hidden VSD for proper anatomic repair.Results:There was no death,no significant intraoperative or postoperative complications and tricuspid valve dysfunction.Conclusion: Opening the fused septal leaflet pouch is safe and beneficial to a better exposure and repair of the hidden defect.%采用隔瓣切开或圆锥乳头肌切断术治疗假性室隔瘤型VSD并予以评价.全组共28例,其中22例采用隔瓣切开,6例采用圆锥乳头肌切断片显露缺损,再以涤纶片或自体心包片修补VSD.全组无手术死亡,无重大并发症及三尖瓣功能不全.此法安全,有利于VSD的显露和对VSD准确可靠的修补,值得推荐使用.

  7. Current knowledge of occluder device-associated endocarditis%封堵器植入后感染性心内膜炎的初步认识及诊治进展

    Institute of Scientific and Technical Information of China (English)

    杨呈伟; 李炯佾; 徐仲英; 赵世华; 吴文辉

    2014-01-01

    The percutaneous approach remains an increasingly utilization and valuable method of treating congenital heart disease (CHD) and perivalvular leak. Although reportedly rare, infective endocarditis (IE) as a complication may become more widely recognized as the use of percutaneous occluder devices increases and the population of patients with indwelling prostheses grows. Eighteen previous cases of IE after occluder device implantation have been reported. The increasing use of intracardiac devices may require a reevaluation of the possible need for administration of prophylactic antibiotics before, during, or after the procedure and the type of antibiotics to be given. The current knowledge of occluder device-associated IE was reviewed in this article.%经导管封堵术主要用于治疗先天性心脏病间隔缺损,也用于其他心内或心外异常分流,如瓣膜置换术后瓣周漏。封堵器植入后感染性心内膜炎(IE)非常罕见,资料较完整者仅有18例报道,但是一旦发生则非常严重,随着经皮封堵装置临床应用的日益广泛,该类并发症须引起足够重视,甚至对封堵术前、术中及术后预防性应用抗生素方案也可能需要重新评价。本文对封堵器植入后IE的初步认识及诊治进展进行综述。

  8. 室间隔缺损介入封堵治疗失败原因分析%Analysing on failure in transcatheter closure of ventricular septal defect

    Institute of Scientific and Technical Information of China (English)

    李军; 张军; 刘利勋; 朱霆; 刘丽文; 朱永胜; 李梅

    2010-01-01

    目的 分析室间隔缺损介入封堵失败病例,提高术前超声心动图筛选患者的手术成功率.方法 对50例室间隔缺损介入封堵手术失败患者的超声心动图检查结果进行分析.结果 14例术中出现房室传导阻滞,13例术后有残余分流,19例无法建立封堵轨道,2例嵴内置人封堵器后出现较明显的主动脉瓣反流,1例冠心病、1例急性心肌梗死伴室间隔穿孔,以上患者均未能完成手术.结论 应用超声心动图注意观察室间隔缺损的左右室侧大小及周边结构.对年龄较小、缺损复杂或年龄较大合并冠心病的患者,应慎用封堵方法.%Objective To analyse the failure reason in transcatheter closure of ventricular septal defect(VSD) ,in order to improve the succeeding rate of occlusive operation on screening VSD patients with echocardiography. Methods Echocardiographic datas were summarized in 50 cases who were failed in VSD occlusion. Results Atrio-ventricular block was occurred in 14 patients,residual shunt was visualized in 13 cases,transcatheter occlusive track could not be set up in 19 cases,arotic valve regurgitation in two cases were screened obviously after occlusive device was released into the intracristal VSD. One case was suffered from cononary heart disease(CAD) and another one was suffered from acute myocardial infarction with ventricular septal perforation. All these patients did not succeed in closure procedure. Conclusions The defect sizes of left and right sides of ventricular septal, structure close to defect must be considered in selecting patients before operation by echocardiography. Occlusion operation should be strictly chosen in cases who were children,or suffered from complex VSD,or senior patients with CAD.

  9. Postoperative Residual Shunt After Repair of Ventricular Septal Defect Among Children%小儿室间隔缺损术后残余漏

    Institute of Scientific and Technical Information of China (English)

    蒋雄刚

    1995-01-01

    8例小儿室间隔缺损修补术后残余漏再次手术病例分析:残余漏表现为5例术后残留心前区Ⅲ级以上收缩期杂音,7例血红蛋白尿,2例右心衰,8例超声心动图(UCG)证实心室水平残余左向右分流.均于术后2~112天行残余漏修补.术中见残余漏原因为不同部位缝针处组织撕裂6例,修补不全2例.8例均经带垫片褥式缝合加固,7例痊愈,1例再次发生残余漏.本文对残余漏特点、诊断、手术适应证及时机进行了讨论.%Eight cases of postoperative residual shunt after repair of venticular septal defect (VSD) were analysed in this paper.Their clinical features disclosed:hemofiubinuria in 7 cases,cardiac murmur in 5 and residual shunt signs on echocardiograph in 8.In the operation for residual shunt,it was found:the tear in septal leaflet in aneurysm-like VSD in 2 cases,the tear in septal leaflet of tricuspid in 4,infundibular muscular 2 and residual triangle defect under the patch repair in VSD 2.Residual shunt in all the 8 cases were repaired with mattress suture under cardiopulmonary bypass,seven patients recovered without hemogiobinuria or cardiac murmur,but one had residual shunt again and cerebral insufficiency,which was improved by medical therapy.The harmfulness,the diagnosis and prevention of postoperative residual shunt,the operative indication,optimal time and surgical procedures were discussed.

  10. Viability of porcine nasal septal cartilage grafts following Nd:YAG (n=1.32μm) laser radiation

    Science.gov (United States)

    Chao, Kenneth K. H.; Wong, Brian J.; Kim, Hong K.; Milner, Thomas E.; Sung, Chung-Ho; Sobol, Emil N.; Nelson, J. Stuart

    2000-06-01

    , internal stress, and backscattered light were simultaneously recorded. Individual specimens underwent either one, two, or three sequential laser exposures with the duration of each exposure determined in real-time from observation of characteristic changes in integrated backscattered light intensity that correlate with thermal mediated stress relaxation. A five-minute time interval between each irradiation was given to allow the cartilage to return to thermal equilibrium. Average laser exposure for each irradiation sequence was recorded (5, 8.3, 12.2 sec). PTG synthesis decreased with increasing laser exposure, but was noted to remain above baseline levels for NO treated tissue. To further refine these results and minimize the effect of regional tissue variations, 7 mm diameter discs excised from the most cephalic portions and a middle region of the pig nasal septal cartilages were irradiated. A reduction of PTG synthesis rates was noted with each successive irradiation, suggesting that laser mediated cartilage reshaping acutely does not eliminate the population of viable chondrocytes. The degree of reduction in PTG synthesis is dependent upon the time-temperature dependent heating profile created during laser irradiation, and carefully monitored dosimetry is necessary to ensure chondrocyte viability.

  11. Percutaneous transfemoral closure of a pseudoaneurysm at the left ventricular apical access site for transcatheter aortic valve implantation.

    Science.gov (United States)

    Karimi, Ashkan; Beaver, Thomas M; Fudge, James C

    2015-02-01

    This case report illustrates a left ventricular pseudoaneurysm that developed at the transapical access site for transcatheter aortic valve implantation and was successfully excluded percutaneously through a femoral approach using an Amplatzer muscular VSD occluder (St. Jude Medical). We also discuss various currently available devices and technical pearls for percutaneous closure of left ventricular pseudoaneurysms. PMID:25661768

  12. Percutaneous device occlusion of hepatocardiac venous collateral via left transhepatic access in a patient with heterotaxy syndrome following Fontan procedure.

    Science.gov (United States)

    Kuo, James A

    2015-04-01

    Venovenous collateral vessels are a common cause for desaturation in patients who have undergone a Fontan procedure. We describe a patient with heterotaxy syndrome (leftward pointing apex) and complex single ventricle with Fontan physiology that was desaturated due to a hepatocardiac vein. The vessel was entered via a left transhepatic access and was successfully occluded using an Amplatzer Vascular Plug.

  13. [Mitral Valve Replacement with a Low-Profile Bioprosthesis in Combination with Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy;Report of a Case].

    Science.gov (United States)

    Furukawa, Koji; Sakaguchi, Shuhei; Nakamura, Eisaku; Yano, Mitsuhiro

    2015-06-01

    An 83-year-old woman diagnosed with hypertrophic obstructive cardiomyopathy was referred to our hospital. Her echocardiogram revealed diffuse left ventricular hypertrophy, severe mitral valve regurgitation with systolic anterior motion of the mitral valve, and left ventricular obstruction with a peak outflow gradient of 142 mmHg. Cardiac catheterization revealed a peak pressure gradient of 60 mmHg across the left ventricular outflow tract. Because of the patient's advanced age, as well as uncertainty regarding our ability to resolve her mitral regurgitation, we performed mitral valve replacement with a St. Jude Medical Epic porcine low-profile bioprosthesis in combination with septal myectomy. The patient's postoperative course was uneventful. At 1 year after the operation, her functional status was New York Heart Association class I. The echocardiogram showed the peak outflow gradient markedly decreased to 9 mmHg. PMID:26066877

  14. Results of beating heart mitral valve surgery via the trans-septal approach Resultados da abordagem transeptal para a valva mitral com coração batendo

    Directory of Open Access Journals (Sweden)

    Tomas A Salerno

    2009-03-01

    Full Text Available OBJECTIVE: Mitral valve surgery can be performed through the trans-atrial or the trans-septal approach. Although the trans-atrial is the preferred method, the trans-septal approach has also been used recently and has a particular value in beating-heart mitral valve surgery. Herein we report our experience with beating-heart mitral valve surgery via trans-septal approach, and discuss its advantages and pitfalls. METHODS: Between 2000 and 2007, 214 consecutive patients were operated upon utilizing beating heart technique for mitral valve surgery. The operation was performed via transseptal approach with the aorta unclamped, the heart beating, with normal electrocardiogram and in sinus rhythm. RESULTS: Mean age was 56.03 ± 13.93 years (range: 19-86 years; median: 56 years. There were 131 (61.2% males and 83 (38.8% females. Of the prostheses used, 108 (50.5% were biological, and 39 (18.2% were mechanical. Mitral repairs were performed in 67 (31.3% patients. Mean hospital stay was 17.4 ± 20.0 days (range: 3-135 days; median: 11 days. Intra-aortic balloon pump (IABP utilization was required in 12 (5.6% of 214 patients. One-month mortality was 7.4%, and re-operation for bleeding was needed in 15 (7% patients. CONCLUSIONS: Beating-heart mitral valve surgery is an option for myocardial protection in patients undergoing mitral valve surgery. This technique is facilitated by the trans-septal approach due to reduced aortic insufficiency and improved visualization of the mitral apparatus.OBJETIVO: A cirurgia da valva mitral pode ser feita via transatrial ou transeptal. Embora a transatrial seja a preferida, a via transeptal tem sido utilizada mais recentemente e tido um grande valor nas operações com o coração batendo. Mostramos a nossa experiência na cirurgia da valva mitral via transeptal com coração batendo e discutimos seus benefícios e problemas. MÉTODOS: Entre 2000 e 2007, 214 pacientes consecutivos foram operados com o coração batendo. A

  15. Intra-lateral septal infusions of folic acid alone or combined with various antidepressant drugs produce antidepressant-like actions in male Wistar rats forced to swim.

    Science.gov (United States)

    Molina-Hernández, Miguel; Téllez-Alcántara, N Patricia; Olivera-López, Jorge I; Jaramillo, M Teresa

    2012-01-10

    Intra-cerebral administrations of folic acid produce antidepressant-like effects; either alone or combined with several antidepressant drugs. However, the specific limbic structures implied in the antidepressant-like actions of folic acid are un-known. Thus, intra-lateral septal infusions of folic acid (5.0 nmol, Pimmobility by increasing swimming behavior in the forced swimming test (FST) of male Wistar rats. Conversely, desipramine (10.0 mg/kg, Pimmobility by increasing climbing behavior. Subthreshold doses of folic acid (2.5 nmol/intra-LSN) combined with subthreshold doses of folic acid (25.0 mg/kg, p.o., Pimmobility in the FST. These antidepressant-like actions, probably, were due to modifications of the serotonergic system since swimming behavior was increased and these effects were canceled by ketanserin.

  16. Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Yilmaz Yozgat

    2013-01-01

    Full Text Available Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs. Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA.

  17. Importance of close follow-up in the fetus with premature atrial contractions accompanied by atrial septal aneurysm: a case report.

    Science.gov (United States)

    Yozgat, Yilmaz; Kilic, Ayhan; Karadeniz, Cem; Ozdemir, Rahmi; Doksoz, Onder; Mese, Timur; Unal, Nurettin

    2013-01-01

    Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA) on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA. PMID:24455349

  18. Diffusion of hyperpolarized {sup 129}Xe in the lung: a simplified model of {sup 129}Xe septal uptake and experimental results

    Energy Technology Data Exchange (ETDEWEB)

    Patz, Samuel; Muradyan, Iga; Dabaghyan, Mikayel; Washko, George R; Hatabu, Hiroto; Butler, James P [Center for Pulmonary Functional Imaging, Departments of Radiology and Pulmonary Medicine, Brigham and Women' s Hospital and Harvard Medical School, Boston, MA 02115 (United States); Hrovat, Mirko I, E-mail: patz@bwh.harvard.edu [Mirtech, Inc., Brockton, MA 02301 (United States)

    2011-01-15

    We used hyperpolarized {sup 129}Xe NMR to measure pulmonary alveolar surface area per unit gas volume S{sub A}/V{sub gas}, alveolar septal thickness h and capillary transit time {tau}, three critical determinants of the lung's primary role as a gas exchange organ. An analytical solution for a simplified diffusion model is described, together with a modification of the xenon transfer contrast imaging technique utilizing 90{sup 0} radio-frequency pulses applied to the dissolved phase, rather than traditional 180{sup 0} pulses. With this approach, three-dimensional (3D) maps of S{sub A}/V{sub gas} were obtained. We measured global S{sub A}/V{sub gas}, h and {tau} in four normal subjects, two subjects with mild interstitial lung disease (ILD) and two subjects with mild chronic obstructive pulmonary disease (COPD). In normals, S{sub A}/V{sub gas} decreased with increasing lung volume from {approx}320 to 80 cm{sup -1}; both h{approx}13 {mu}m and {tau}{approx}1.5 s were relatively constant. For the two ILD subjects, h was, respectively, 36 and 97% larger than normal, quantifying an increased gas/blood tissue barrier; S{sub A}/V{sub gas} and {tau} were normal. The two COPD subjects had S{sub A}/V{sub gas} values {approx}25% that of normals, quantifying septal surface loss in emphysema; h and {tau} were normal. These are the first noninvasive, non-radiation-based, quantitative measurements of h and {tau} in patients with pulmonary disease.

  19. Differences in global and regional left ventricular myocardial mechanics in various morphologic subtypes of patients with obstructive hypertrophic cardiomyopathy referred for ventricular septal myotomy/myectomy.

    Science.gov (United States)

    Kobayashi, Taisei; Dhillon, Ashwat; Popovic, Zoran; Bhonsale, Aditya; Smedira, Nicholas G; Thamilarasan, Maran; Lytle, Bruce W; Lever, Harry M; Desai, Milind Y

    2014-06-01

    Patients with obstructive hypertrophic cardiomyopathy (HC) have various left ventricular (LV) shapes: reverse septal curvature (RSC, commonly familial), sigmoid septum (SS, common in hypertensives), and concentric hypertrophy (CH). Longitudinal (systolic and early diastolic) strain rate (SR) is sensitive in detecting regional myocardial dysfunction. We sought to determine differences in longitudinal SR of patients with obstructive HC, based on LV shapes. We studied 199 consecutive patients with HC (50% men) referred for surgical myectomy. Clinical and echocardiographic parameters were recorded. LV shapes were classified on echocardiography, using basal septal 1/3 to posterior wall ratio: RSC = ratio >1.3 (extending to mid and distal septum), SS = ratio >1.3 (extending only to basal 1/3), and concentric = ratio ≤1.3. Longitudinal systolic and early diastolic SRs were measured from apical 4- and 2-chamber views (VVI 2.0; Siemens, Erlangen). Distribution of RSC, SS, and CH was 50%, 28%, and 22%, respectively. Patients with RSC were significantly younger (47 ± 12 vs 64 ± 10 and 57 ± 11, respectively) with lower hypertension (40% vs 71% and 67%, respectively) than patients with SS or CH (both p RSC had lower global systolic (-0.99 ± 0.3 vs -1.05 ± 0.3 and -1.17 ± 0.3) and early diastolic SR (0.95 ± 0.4 vs 0.98 ± 0.3 and 1.16 ± 0.4) versus patients with SS and CH (in 1/s, both p RSC was associated with abnormal global LV systolic (beta 0.16) and early diastolic (beta -0.17) SR (both p <0.01). In conclusion, patients with HC with RCS have significantly abnormal LV mechanics, despite being younger and less hypertensive. A combination of LV mechanics and shapes could help differentiate between genetically mediated and other causes of obstructive HC.

  20. Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect Closure.

    Science.gov (United States)

    Schmitt, Katharina Rose Luise; Fedarava, Katsiaryna; Justus, Georgia; Redlin, Mathias; Böttcher, Wolfgang; Delmo Walter, Eva Maria; Hetzer, Roland; Berger, Felix; Miera, Oliver

    2016-05-01

    Minimizing the systemic inflammatory response caused by cardiopulmonary bypass is a major concern. It has been suggested that the perfusion temperature affects the inflammatory response. The aim of this prospective study was to compare the effects of moderate hypothermia (32°C) and normothermia (36°C) during cardiopulmonary bypass on markers of the inflammatory response and clinical outcomes (time on ventilator) after surgical closure of ventricular septal defects. During surgical closure of ventricular septal defects under cardiopulmonary bypass, 20 children (median age 4.9 months, range 2.3-38 months; median weight 7.2 kg, range 5.2-11.7 kg) were randomized to a perfusion temperature of either 32°C (Group 1, n = 10) or 36°C (Group 2, n = 10). The clinical data and blood samples were collected before cardiopulmonary bypass, directly after aortic cross-clamp release, and 4 and 24 h after weaning from cardiopulmonary bypass. Time on ventilation as primary outcome did not differ between the two groups. Other clinical outcome parameters like fluid balance or length of stay in the intensive care were also similar in the two groups. Compared with Group 2, Group 1 needed significantly higher and longer inotropic support (P Perfusion temperature did not influence cytokine release, organ injury, or coagulation. Cardiopulmonary bypass temperature does not influence time on ventilation or inflammatory marker release. However, in the present study, with a small patient cohort, patients operated under hypothermic bypass needed higher and longer inotropic support. The use of hypothermic cardiopulmonary bypass in infants and children should be approached with care. PMID:26581834

  1. Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect Closure.

    Science.gov (United States)

    Schmitt, Katharina Rose Luise; Fedarava, Katsiaryna; Justus, Georgia; Redlin, Mathias; Böttcher, Wolfgang; Delmo Walter, Eva Maria; Hetzer, Roland; Berger, Felix; Miera, Oliver

    2016-05-01

    Minimizing the systemic inflammatory response caused by cardiopulmonary bypass is a major concern. It has been suggested that the perfusion temperature affects the inflammatory response. The aim of this prospective study was to compare the effects of moderate hypothermia (32°C) and normothermia (36°C) during cardiopulmonary bypass on markers of the inflammatory response and clinical outcomes (time on ventilator) after surgical closure of ventricular septal defects. During surgical closure of ventricular septal defects under cardiopulmonary bypass, 20 children (median age 4.9 months, range 2.3-38 months; median weight 7.2 kg, range 5.2-11.7 kg) were randomized to a perfusion temperature of either 32°C (Group 1, n = 10) or 36°C (Group 2, n = 10). The clinical data and blood samples were collected before cardiopulmonary bypass, directly after aortic cross-clamp release, and 4 and 24 h after weaning from cardiopulmonary bypass. Time on ventilation as primary outcome did not differ between the two groups. Other clinical outcome parameters like fluid balance or length of stay in the intensive care were also similar in the two groups. Compared with Group 2, Group 1 needed significantly higher and longer inotropic support (P bypass temperature does not influence time on ventilation or inflammatory marker release. However, in the present study, with a small patient cohort, patients operated under hypothermic bypass needed higher and longer inotropic support. The use of hypothermic cardiopulmonary bypass in infants and children should be approached with care.

  2. Surgical experience for the treatment of aortopulmonary septal defect%主肺间隔缺损的外科治疗

    Institute of Scientific and Technical Information of China (English)

    李进华; 来永强; 李景伟; 赖以恒; 崔永超; 郝兴海; 章良; 周其文

    2009-01-01

    目的 探讨主肺间隔缺损的外科治疗经验.方法 1987年12月至2007年3月,16例主肺间隔缺损病儿(人),其中男11例,女5例,年龄5个月~22岁,平均(8.2±7.1)岁;体重5.8~50.0 kg,平均(22.2±13.9)kg.Mori分型Ⅰ型7例,Ⅱ型7例,Ⅲ型2例.主肺间隔缺损大小10~35mm,平均(22.6±7.3)mm.其中合并室间隔缺损、房间隔缺损和肺主动脉弓离断畸形(B型)各2例,动脉导管未闭1例.术前10例行心导管检查,肺动脉收缩压50~120 mm Hg(1 mm Hg=0.133 kPa),平均(75.4±25.2)mm Hg,肺动脉平均压21~100 mm Hg,平均(60.3±24.8)m Hg.14例在中低温体外循环下完成手术,2例在深低温停循环完成手术.结果 主动脉阻断(70.6±48.1)min,体外循环(110.5±62.9)min.术后10例肺动脉收缩压(50.2±18.5)mm Hg,平均肺动脉压(40.0±15.2)mm Hg,术后呼吸机使用(22.6±14.5)h,滞留蕈症监护室1~70 d,总住院14~127 d.2例合并主动脉弓离断者围术期分别死于急性肾衰和术后低心排出量综合征.14例痊愈,平均随访(8.8±7.5)年,1例主肺动脉间隔小残余漏,余心功能明显改善.结论 主肺间隔缺损者肺血管病理改变早,早期诊断、及时手术,能降低病死率.%Objective Aortopulmonary septal defect is rare and accounted for abont 0.15% to0.60% of infants and children with congenital heart malformation. Aortopulmonary septal defect has similar pathophysiologic findings with patent ductus. Early pul-monary hypertension and congestive heart failure may develop as a result of large left to right shunt from the ascending aorta to the pul-monary artery, with a relatively rapid progression of pathological changes in the pulmonary vessels associated with pulmonary hyperten-sion. This article will describe our surgical experience in the treatment of this disease. Methods From December 1987 to March 2000,16 cases with aortopulmonary septal defect underwent surgical treatment, 11 were males and 5 were females. The mean age and weight were (8

  3. The combined occluding effect of fluor protector and Nd:YAG laser irradiation on human dentinal tubules%激光促进氟保护漆对牙本质小管的 封闭作用

    Institute of Scientific and Technical Information of China (English)

    张成飞; 林琼光; 赵宝红; 邱华

    2001-01-01

    Objective To evaluate the combined occluding effect of fluor protector and Nd:YAG Laser irradiation on human dentinal tubules. Methods Twenty-four dentin specimens with exposed dentinal tubule orifices treated by 37% H3PO4 were randomly divided into four groups. Group B, C and D were vanished by fluor protector, group A served as a control. Group D was lased by Nd:YAG laser. Group C and D were brushed with normal force. Results Under SEM, group A showed numerous exposed dentinal tubule orifices, the diameter of which is 2-3 μm. Group B showed closure of dentinal tubule orifices. Group C showed that most of the fluor protector were brushed away and group D showed over 80% of the dentinal tubule orifices were occluded. Conclusions Fluor protector combined with Nd:YAG laser can make most of the dentinal tubule orifices occluded even after brushed.%目的探讨Nd:YAG激光与氟保护漆联合应用对牙本质小管的封闭作用。方法将24个牙本质块随机分为A、B、C、D4组,均用37%H3PO4处理表面。A组作为对照。B、C、D组均涂以一薄层氟保护漆,然后D组标本经Nd:YAG激光照射。以正常刷牙力度同时刷C、D 2组牙本质块10 min。所有标本以扫描电镜(scanning electron microscope,SEM)观察并照相。结果 A组显示大量牙本质小管口开放,管口直径约2~3 μm。B组显示牙本质表面被氟保护漆均匀覆盖。C组显示氟保护漆大部分被刷去。D组显示仍有超过80%的牙本质小管口被氟保护漆所封闭。结论在同样的刷牙条件下,将Nd:YAG激光与氟保护漆联合应用,仍有大部分牙本质小管口被封闭。

  4. 婴幼儿完全性房室隔缺损的外科治疗%Surgical correction of complete atrioventricular septal defect in infants

    Institute of Scientific and Technical Information of China (English)

    胡型锑; 赵琦峰; 吴国伟; 杜杰; 费建斌; 夏杰

    2014-01-01

    目的 总结婴幼儿完全性房室隔缺损外科治疗的临床经验.方法 本院2004年6月至2013年12月共手术治疗婴幼儿完全性房室间隔缺损56例,年龄53 d至12个月.全部患者术前经心脏超声检查确诊,其中18例患儿同时行心脏血管CTA检查.Rastelli A型44例,B型3例,C型9例.手术采用单片法修补37例,双片法修补3例,改良单片法修补16例.术后机械通气时间26 ~ 172 h,住ICU时间3~19d.结果 术后早期院内死亡5例,死亡原因分别为严重低心排2例,肾功能衰竭2例,严重肺部感染1例;晚期死亡1例,术后2个月因二尖瓣中、重度返流,死于心肺功能衰竭.手术死亡率10.7% (6/56).47例患儿术后随访3个月至5年,心功能恢复良好.结论 完全性房室间隔缺损一旦诊断明确应在生后6个月至1周岁及时手术,早期手术临床效果满意.手术效果关键取决于对心内结构的仔细探查以及彻底纠正心内畸形.%Objective To summarize the clinical experience of surgical treatment for complete atrioventricular septal defect in infants.Methods From December 2013 to June 2004,56 patients aged from 53 days to 12 months with complete atrioventricular septal defect were undergone operations.All patients were diagnosed by 2D-echocardiography,and 18 patients underwent cardiovascular computed angiography (CTA).Rastelli type A had 44 cases,type B 3 cases,and type C 9 cases.The single pericardium patch repair was used for 37 cases,the two-patch repair for 3 cases,and the modified single-patch repair for 16 cases.The time of mechanical ventilation was 26 to 172 hours,and the time of staying at Intensive Care Unit (ICU) was 3 to 19 days.Results There were 5 early deaths caused by severe low cardiac output in 2 cases,renal failure in 2 cases,and severe pulmonary inflammation in 1 case.One late death was due to severe mitral regurgitation with pneumonia and heart failure.The operative mortality was 10.7%.A total of 47 patients was

  5. Application of nasal septal suture in septoplasty%鼻中隔缝合在鼻中隔偏曲矫正术中的应用

    Institute of Scientific and Technical Information of China (English)

    张国华; 邓明朝; 容庆丰

    2015-01-01

    目的:探讨鼻中隔缝合在鼻中隔偏曲矫正术中的疗效及安全性。方法2010年6月至2012年12月南方医科大学附属小榄医院耳鼻咽喉科行62例鼻中隔偏曲矫正术,术后31例采用鼻中隔缝合处理,31例行鼻腔填塞。采用视觉模拟评分法(VAS)对所有患者术后的主观感受进行评分,术后门诊随访,记录患者有无出血、鼻中隔穿孔及鼻腔粘连。结果在术后鼻塞、鼻部疼痛、头痛、溢泪、口干、吞咽困难、睡眠困难等方面,填塞组的 VAS 评分大于缝合组,差异有统计学意义(P <0.05)。填塞组抽出填塞物时有不同程度的鼻部疼痛及出血,并有3例出现晕厥,术后随访中发现1例鼻出血,2例鼻中隔血肿,1例鼻中隔穿孔,1例鼻腔粘连。缝合组无上述并发症发生。结论鼻中隔缝合在鼻中隔偏曲矫正术中安全、效果可靠,可以替代鼻腔填塞,值得临床推广应用。%Objective To explore the efficacy and safety of nasal septal suture in septoplasty.Methods A total of 62 patients who had undergone septoplasty were randomly divided into two groups:the suturing group (n =31)and the packing group (n =31).Suturing group were treated with septal suture after septoplasty without nasal packing.Mercel was used for nasal packing after septoplasty in the packing group.The visual analogur scale(VAS)was used to analyze the symptoms of the two groups.Results The clinical symptoms in the suturing group were significantly reduced com-pared with the packing group(P <0.05).The VAS scores of post operative stuffy,nasal pain,headache,dyaphagia, difficult swallowing and sleep disturbance were higher in the packing group than in the suture group(P <0.05).The complication rate of the suturing group was lower than that in the packing group.Conclusion Nasal septal suture has excellent therapeutic effects and deserves further dissemination.

  6. 经食管超声心动图引导下微创小切口室间隔缺损封堵治疗%Transcatheter closure of ventricular septal defects through minimally invasive port -access surgery guided by transesophageal echocardiography

    Institute of Scientific and Technical Information of China (English)

    侯永波; 王国祥; 谭胜; 刘金东

    2015-01-01

    目的:总结经食管超声心动图(TEE)引导下,微创经胸室间隔缺损(VSD)封堵治疗的临床经验。方法11例 VSD 患者接受微创经胸封堵治疗,年龄3~6岁,体重12~65 kg,VSD 直径3~8 mm。手术在 TEE 引导,胸骨下段小切口微创下进行,于右心室表面选择适当的穿刺点,建立输送轨道并完成 VSD 封堵。术后密切随访1~6个月。结果11例中9例一次性安放成功,2例首次安放有残余分流,术中更换大号伞;心内操作时间10~36 min,平均(21±12)min。全部患者均于术后4~5天出院,随访1~6个月,效果良好。11例患者均无心律失常、残余分流等并发症发生。结论TEE 引导下微创经胸 VSD 封堵是一种安全有效的治疗方法,但远期结果有待进一步观察。%Abstrat: Objectve To summarize the clinical experience of transcatheter closure of ventricular septal defects (VSD) through minimally invasive port -access surgery guided by transesophageal echocardiography (TEE).Methods A total of 11 patients aged from 3 to 6, weighting 12 kg to 65 kg were subjected to transcatheter closure of VSD with a diameter ranging from 3 mm to 8 mm.The surgery was performed under the guidance of TEE, where a small transthoracic incision was made.A proper site was chosen at the surface of the right ventricle for punctuation, in order to establish de-livery pathway.Patients were closely followed up for 1 to 6 months.Results Among the patients were nice ones who successfully completed the surgery at one time.Residual shunts were seen in two cases which required the replacement of larger occluders.The time of intracardiac procedures was 10 -36 min [(21 ±12)min].All patients were discharged 4 to 5 days after operation.During fellow -up period, neither arrhythmia nor residual shunt occurred.Conclusion Tran-sthoracic minimally invasive closure is a safe and efficient method for the treatment of VSD.Meanwhile, long -term fel

  7. Simultaneous transfemoral transcatheter mitral and tricuspid valve edge-to-edge repair (using MitraClip system) completed by atrial septal defect occlusion in a surgically inoperable patient. First-in-human report

    OpenAIRE

    Kowalski, Marek; Franz, Norbert; Ritter, Frank; Hofmann, Steffen; Stabel-Mahassine, Chourok; Warnecke, Henning; Thale, Joachim

    2015-01-01

    Transcatheter transfemoral mitral valve repair using the MitraClip system (Abbott Vascular, USA) is used in high-risk or inoperable patients with severe mitral regurgitation. We report the first-in-human simultaneous transfemoral clipping of the mitral and tricuspid valve completed by occlusion of an atrial septal defect (ASD). The procedure was performed in an 84-year-old patient in October 2015. After effective reduction of mitral and tricuspid regurgitations using the MitraClip system a PF...

  8. Significant reduction of left atrial volume concomitant with clinical improvement after percutaneous transluminal septal myocardial ablation for drug-refractory hypertrophic obstructive cardiomyopathy, and its precise detection with multidetector CT

    OpenAIRE

    Maekawa, Yuichiro; Akita, Keitaro; Tsuruta, Hikaru; Yamada, Yoshitake; Hayashida, Kentaro; Yuasa, Shinsuke; Murata, Mitsushige; Jinzaki, Masahiro; Fukuda, Keiichi

    2016-01-01

    Objective In patients with hypertrophic obstructive cardiomyopathy (HOCM), left atrial (LA) volume measurement is very important to provide prognostic information. Recent studies demonstrated that multidetector CT (MDCT) is useful to assess the changes in LA volume. Our aim was to examine the utility of a follow-up cardiac MDCT for long-term evaluation of the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on LA volume. Methods We studied a consecutive cohort of 20 pati...

  9. Trauscather closure guided by color Doppler ultrasound in treatment of ventricular septal defect%彩色多普勒超声对室间隔缺损封堵术的临床应用

    Institute of Scientific and Technical Information of China (English)

    徐红伟; 李玉珍; 张鑫

    2008-01-01

    Objective To explore the clinical value of the transcather closure guided by color Doppler ultrasound in treatment of ventricular septal defect. Methods Occlusion device was placed on 31 cases of ventticular septal defect of congenital heart disease guided by colour Doppler ultrasound. Results Total 31 cases received transcatber closure successfully, among them 1 case had different from left to right after interventional therapy, because there were two parts of ventricular septal defect, one was 8 mm,the another was 2 mm which was diagnosed omittedly before interventional therapy. Conclusion The method of transcather closure guided by color Doppler ultrasound is direct, convenient, safe, practical and credible in the treatment of the patients with ventricular septal defect.%目的 探讨彩色多普勒超声直视引导下行室间隔缺损(VSD)封堵术的临床价值.方法 本组31例先天性心脏病室间隔缺损患者,经导管应用VSD封堵器行室间隔缺损封堵术,应用彩色多普勒超声直视引导放置封堵器.结果 本组31例患者均一次封堵成功,其中1例患者术后发现仍有左向右分流,但分流处不在封堵处,为术前漏诊的小室间隔缺损.该患者为两处室间隔缺损,一处8 mm,一处2mm.结论 利用彩色多普勒超声引导室间隔缺损封堵术是一种直观、便捷、安全、实用、可靠的方法.

  10. 室间隔切除术:治疗梗阻性肥厚型心肌病的金标准%Septal myectomy for obstructive hypertrophic cardiomyopathy:the gold standard

    Institute of Scientific and Technical Information of China (English)

    Joseph A Dearani; Hartzell V Schaff; Steve R Ommen

    2009-01-01

    Septal myectomy effectively and definitively relieves LVOT obstruction and cardiac symptoms in adults and children with obstructive hypertrophic cardiomyopathy(HCM).Abnormalities of the mitral valve can be addressed without the need for mitral valve replacement in almost all circumstances.Concomitant mitral valve repair for myxomatous disease requires minor modifications when performed in conjunction with septal myectomy;mitral valve replacement is rarely necessary.In experienced centers,early mortality for isolated septai myectomy is low(~1%)and overall results are excellent and continue to improve in the current era.Symptomatic improvement with myectomy is expected for most;90% of patients improve by at least one functional class,and most remain improved on late follow-up.Late survivorship is improved compared to nonopereted patients with obstructive HCM,and myectomy may be associated with reduced risk of sudden cardiac death.These results should serve as the gold standard and a basis for comparison with newer nonsurgical medalities,i.e.,septal alcohol ablation.

  11. Management of Gastric Varices in the Pediatric Population with Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Utilizing Sodium Tetradecyl Sulfate Foam Sclerosis with or without Partial Splenic Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Saad, Wael E. A., E-mail: wspikes@yahoo.com; Anderson, Curtis L., E-mail: dranderson@southfloridavascular.com [University of Virginia Health System, Department of Radiology, Division of Vascular Interventional Radiology (United States); Patel, Rahul S., E-mail: patelr516@gmail.com [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States); Schwaner, Sandra, E-mail: sls5c@virginia.edu [University of Virginia Health System, Department of Radiology, Division of Vascular Interventional Radiology (United States); Caldwell, Stephen, E-mail: shc5c@virginia.edu [University of Virginia Health System, Department of Medicine, Division of Gastroenterology (United States); Pelletier, Shawn, E-mail: sjp7t@virginia.edu; Angle, John, E-mail: jfa2h@virginia.edu; Matsumoto, Alan H., E-mail: ahm4d@virginia.edu [University of Virginia Health System, Department of Radiology, Division of Vascular Interventional Radiology (United States); Fischman, Aaron M., E-mail: aaron.fischman@mountsinai.org [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States)

    2015-02-15

    It is unknown whether spontaneous gastrorenal shunts actually develop in the pediatric population. The minimum age documented in studies from Asia is 32 (range 32–44) years. This study describes three pediatric patients undergoing balloon-occluded retrograde transvenous obliteration (BRTO) for bleeding gastric varices with two of the three patients undergoing combined partial splenic embolization. The first BRTO is a selective-BRTO via a surgical splenorenal shunt (15 years old) and the other two patients underwent conventional-BRTO via a spontaneous gastrorenal shunt (8 and 14 years old). The recurrent significant bleeding that they exhibited before the combined endovascular therapy did not recur for an average of 7.1 (range 1.4–14) months. In the second patient, quantitative digitally subtracted angiography was utilized to evaluate the inline portal venous flow before and after BRTO.

  12. 红光理疗对改善鼻中隔成形术后黏膜缺血的疗效观察%The effect of red light for improving ischemia in nasal septal mocosa after septoplasty

    Institute of Scientific and Technical Information of China (English)

    张德军; 管国芳; 孙开; 刘瑶; 于多娇; 郝延茹

    2011-01-01

    目的:观察红光理疗对改善鼻中隔成形术后鼻中隔黏膜局部缺血状态的疗效。方法:对30例行鼻中隔成形术,术后发现鼻中隔黏膜局部缺血的患者,将其随机分成两组,一组为红光理疗组即实验组,另一组为常规治疗组即对照组。实验组每日先行鼻部红光理疗15分钟,然后以浸有重组人表皮生长因子及金霉素软骨的明胶海绵贴敷于鼻中隔缺血处黏膜;对照组则单纯给予后者治疗。观察两组鼻中隔黏膜恢复时间。结果:实验组患者鼻中隔黏膜平均恢复时间10±3天,对照组患者鼻中隔黏膜平均恢复时间14±3天,两组经统计学检验,p〈0.0l,差异有显著性。结论:红光理疗可以明显促进鼻中隔成形术后鼻中隔黏膜缺血状态的恢复,有利于预防鼻中隔成形术后鼻中隔穿孔。%Objective: To study the therapeutic effects of red light for improving ischemia in nasal septal mocosa after septoplasty.Methods: 30 patients who had ischemia in nasal septal mocosa after septoplasty were divided into two groups randomly.One group were irradiated 15 minutes with red light everyday,and then applied gelatin sponge which had been soaked with rEGF and chlortetracycline to the nasal septal mocosa.The other group were given the latter treatment only.Results: The recovery time of ischemia in nasal septal mocosa in the group which were irradiated with red light was 10±3 days.The other group was 14±3 days.There was a significant difference between the two groups(p0.01).Conclusion :Irradiation with red light can improve the ischemia in nasal septal mocosa significantly after septoplasty.

  13. Morphological classification of patent ductus and its implications to the method of occlusion

    International Nuclear Information System (INIS)

    Objective: To classify the morphology of patent ductus arteriosis according of their sites of narrowing into 5 groups. Methods: From 1986-1997, totally 120 cases of angiogram were studied. The authors used Ivalon plug, Gianturco coil and Amplatzer method for occlusion. Results: Cases with Ivalon plug and Amplatzer device were all successful, no residual shunt or recanalization were found in the follow-up. Among 30 cases using coil, 3 had residual shunt, 2 had dislodgement of coil. Conclusions: In using coil to occluding PDA type A ductus was most successful, and in type B and C reopen may occur in follow-up

  14. Midterm results of diagnostic treatment and repair strategy in older patients presenting with nonrestrictive ventricular septal defect and severe pulmonary artery hypertension

    Institute of Scientific and Technical Information of China (English)

    Liu Aijun; Li Zhiqiang; Li Xiaofeng; Fan Xiangming; Su Junwu; Zhang Jing; He Yan

    2014-01-01

    Background Congenital heart disease with severe pulmonary arterial hypertension (SPAH),previously thought to have irreversible pulmonary vascular disease (PVD),has been recently successfully corrected using diagnostic treatment and repair strategy by our surgery team.This study aimed to evaluate the midterm results of a selected cohort of older patients with nonrestrictive ventricular septal defect (VSD) and SPAH using diagnostic treatment and repair strategy.Methods The records of 56 patients older than six years with nonrestrictive VSD and SPAH undergoing diagnostic treatment and repair strategy from 2006 to 2012 were retrospectively reviewed.All patients received advanced pulmonary arterial hypertension (PAH) therapy and radical repairs were performed when transcutaneous oxygen saturation (SPO2) increased up to 93%.Results There were no operative deaths.SPO2 and baseline six-minute walk test (SMWT) distance of all selected patients increased significantly and mean pulmonary artery pressure (MPAP) regressed significantly after diagnostic treatment and at late follow-up (P <0.01).The incidence of late postoperative PAH was seen in six (10.7%) patients and by Logistic regression analysis,early postoperative PAH was an independent risk factor related to late postoperative PAH.Conclusions Diagnostic treatment and repair strategy was effective and safe for treatment of nonrestrictive VSD and SPAH and the midterm results were excellent.Diagnostic treatment strategy was effective in assessing the reversibility of SPAH in older patients associated with nonrestrictive VSD and the PVD in these selective patients is generally reversible.

  15. Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspective

    Directory of Open Access Journals (Sweden)

    Neelam Aggarwal

    2016-01-01

    Full Text Available Objective: Review of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair. Design: A retrospective observational case series. Methodolgy: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperative events were recorded from the medical records. The categorical variables and the continuous variables were expressed as number (percentages and mean ΁ SD respectively. Results: A total of 35 patients were operated for Warden repair during the study period. Anesthesia was induced with the aim to prevent any fall in pulmonary vascular resistance. The right internal jugular vein was cannulated under ultrasound guidance using a short length cannula to monitor right superior vena cava pressure. Intraoperative TEE revealed the drainage of PAPVC high into RSVC in 22 patients. Persistent LSVC was found in 9 patients. After repair, TEE imaging detected a high gradient at Warden anastomotic site in 5 patients and 3 of them required revision of surgery. Rerouted pulmonary veins required surgical correction in 2 patients in view of obstruction. None of them had pulmonary venous and SVC obstruction in the postoperative period. Conclusion: The primary aim of anesthesia is to avoid any fall in PVR. Right IJV cannulation can be beneficial. The intraoperative TEE can help in delineating the anatomy of lesion and detecting anastomotic site obstruction.

  16. Isolation, characterization and genetic analysis of canine GATA4 gene in a family of Doberman Pinschers with an atrial septal defect

    Indian Academy of Sciences (India)

    Shin-Aeh Lee; Seung-Gon Lee; Hyeong-Sun Moon; Lopeti Lavulo; Kyoung-Oh Cho; Changbaig Hyun

    2007-12-01

    GATA4 is expressed early in the developing heart where it plays a key role in regulating the expression of genes encoding myocardial contractile proteins. Gene mutations in the human GATA4 have been implicated in various congenital heart defects (CHD), including atrial septal defect (ASD). Although ASD is the third most common CHD in humans, it is generally rare in dogs and cats. There is also no obvious predilection for ASD in dogs and cats, based on sex or breed. However, among dogs, the incidence rate of ASD is relatively high in Samoyeds and Doberman Pinschers, where its inheritance and genetic aetiology are not well understood. In this study, we identified and investigated the genetic aetiology of an ASD affected family in a pure breed dog population. Although the GATA4 gene was screened, we did not find any mutations that would result in the alteration of the coding sequence and hence, the predicted GATA4 structure and function. Although the aetiology of ASD is multifactorial, our findings indicate that GATA4 may not be responsible for the ASD in the dogs used in this study. However, this does not eliminate GATA4 as a candidate for ASD in other dog breeds.

  17. Comparison of Long-Term Effect of Dual-Chamber Pacing and Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Jan Krejci

    2013-01-01

    Full Text Available Introduction. Nonpharmacological treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM comprises surgical myectomy (SME, alcohol septal ablation (ASA, and dual-chamber (DDD pacing. The aim of the study was to compare the long-term effect of DDD pacing and ASA in symptomatic HOCM patients. Patients and Methods. We evaluated retrospective data from three cardiocenters; there were 24 patients treated with DDD pacing included and 52 treated with ASA followed for 101 ± 49 and 87 ± 23 months, respectively. Results. In the group treated with DDD pacing, the left ventricle outflow tract gradient (LVOTG decreased from 82 ± 44 mmHg to 21 ± 21 mmHg, and NYHA class improved from 2.7 ± 0.5 to 2.1 ± 0.6 (both P<0.001. In the ASA-treated group, a decline in LVOTG from 73 ± 38 mmHg to 24 ± 26 mmHg and reduction in NYHA class from 2.8 ± 0.5 to 1.7 ± 0.8 were observed (both P<0.001. The LVOTG change was similar in both groups (P=0.264, and symptoms were more affected by ASA (P=0.001. Conclusion. ASA and DDD pacing were similarly effective in reducing LVOTG. The symptoms improvement was more expressed in patients treated with ASA.

  18. Allopregnanolone reduces immobility in the forced swimming test and increases the firing rate of lateral septal neurons through actions on the GABAA receptor in the rat.

    Science.gov (United States)

    Rodrìguez-Landa, Juan Francisco; Contreras, Carlos M; Bernal-Morales, Blandina; Gutièrrez-Garcìa, Ana G; Saavedra, Margarita

    2007-01-01

    Since allopregnanolone reduces the total time of immobility in rats submitted to the forced swimming test, we decided to explore whether this neuroactive steroid shares other antidepressant-like actions, such as increasing the neuronal firing rate in the lateral septal nucleus (LSN). In order to discard the influence of the oestrous cycle on immobility and on the firing rate of LSN neurons, all Wistar rats used in the study underwent ovariectomy before treatments. A group of rats received different doses of allopregnanolone (0.5, 1.0, 2.0 and 3.0 mg/kg, i.p.) 1 hour before being forced to swim in order to identify the minimum effective dose diminishing immobility. None of the tested doses of allopregnanolone produced significant changes in motor activity in the open-field test. The minimum dose of allopregnanolone producing a significant reduction in the total time of immobility (pimmobility (pimmobility in the forced swimming test (1.0 mg/kg) significantly (p immobility and LSN firing rate. In conclusion, allopregnanolone produces an antidepressant-like effect in the forced swimming test, associated with an increase in the LSN neuronal firing rate, seemingly mediated by the GABAA receptor.

  19. 胎儿先天性室间隔缺损的染色体核型分析%Study of chromosome karyotype in congenital ventricular septal defect of fetus

    Institute of Scientific and Technical Information of China (English)

    高金梅; 关云萍; 项宇识; 闫峰; 李冬梅

    2013-01-01

    目的:通过产前诊断分析先天性胎儿室间隔缺损与染色体核型的相关性。方法:回顾性分析我院产前超声诊断胎儿发育异常并进行脐静脉血穿刺染色体核型分析的患者387例,对其中单纯室间隔缺损或室间隔缺损伴发其他结构异常的病例74例进行分析。结果:74例病例中,脐血穿刺血细胞培养成功72例,培养失败2例。72例病例中,产前超声诊断单纯室间隔缺损12例,染色体核型结果均正常;产前超声诊断室间隔缺损伴发其他结构异常60例,其中染色体核型异常者17例(18-三8例、13-三体3例、21-三体4例、其他2例),染色体核型正常者43例。结论:胎儿心脏室间隔缺损伴发其他结构异常时较单纯室间隔缺损出现染色体异常的几率大。%Objective:To analyse the correlations between congenital ventricular septal defects and fetal karyotype through prenatal diagnosis.Methods:A retrospective analysis of 387 cases who diagnosed with fetal abnormalities and carried on umbilical vein puncture for karyotype analysis in our hospital through prenatal ultrasound diagnosis. among which, 74 cases with the ventricular septal defect or ventricular septal defect simply associated with other structural abnormalities were analyzed.Results:In the 74 cases, 72 cases were successful y cultured in the umbilical cord blood cells, 2 cases were cultured failure. 12 cases were diagnosed with ventricular septal defect simply in prenatal ultrasound diagnosis in the 72 cases, karyotype of the 12 cases were al normal; 60 cases were diagnosed with ventricular septal defect associated with other structural abnormalities in prenatal ultrasound diagnosisin the 72 cases, in which chromosome abnormalities were 17 cases (8 cases of 18-trisomy syndrome;3 cases of 13-trisomy syndrom;4 cases of 21-trisomy syndrom;2 cases of other chromosomal abnormalities), normal karyotype were 43 cases.Conclusion:Fetal cardiac

  20. 一个锢囚状中尺度对流系统的多尺度结构分析%An analysis of the multi-scale structure and evolution of a meso-scale occluding convective system

    Institute of Scientific and Technical Information of China (English)

    易笑园; 李泽椿; 姚学祥; 王红艳; 孙晓磊

    2011-01-01

    The composite Doppler radar data at the Beijing, Tianjin and Qinhuangdao stations, the satellite data, the automatic meteorological observing stations data and the NCEP 1° × 1° reanalysis data were used to analyze the multi-scale structure and evolution of a meso-scale occluding convective system in the east part of the Huabei plain, which caused severe heavy rainfall on 18 July 2007. The methods of the meso-scale filtering, the 4DVAR single Doppler radar retrieval, and the horizontal and vertical section analyses were employed in this paper. The results show that firstly, this MaCS experienced 3 phases including the intialization and developing, the maturation and the dissipation. The cold cloud top of the MαCS changed from an elongated top to a circle one with only single center again to a polygon top with several centers as shown in the satellite images. It is seen from the radar data that a meso-scale convective system under the cold top was a occluding squall-line mesoscale convective system, whose two cross meso-β-scale line-squall convective systems were composed of several MγCSs arranged in the form of a line with independent strong radar reflectivity center and life-cycle. In the occluding phase of the MaCS the active MγCSs caused local severe rainfall. In the occluded phase, those MγCSs were closely organized together so as to make their edges become obscured with the occluded point corresponding to the cold cloud top center of the MαCS. In the dissipation phase, with the pattern of crossing disappearing and cloud top dropping, the radar echo-top and the reflectivity both showed an eddy feature. Secondly, severe ascending motion existed in the MαCS whose center appears from 600 hPa to 500 hPa. At the height of 200 hPa, an anti-cyclonic circulation had an effect on the shape of cold cloud top. At the height of 700 hPa, the cold air flow brought by the cyclonic circulation weakened physically the intensity of MαCS. Thirdly, the structure and