Coexisting Bicuspid Aortic and Pulmonary Valves with Normally Related Great Vessels Diagnosed by Live/Real Time Three‐Dimensional Transesophageal Echocardiography

Coexistence of bicuspid aortic and pulmonary valves in the same patient is a very rare entity identified mainly during surgery and postmortem. To the best of our knowledge, only one case has been diagnosed by two‐dimensional echocardiography in a newborn with malposition of the great arteries but no images were presented. Here, we are reporting the first case of bicuspid pulmonary and aortic valves diagnosed by live/real time three‐dimensional transesophageal echocardiography in an adult with normally related great arteries.     

A rare complication of mechanical aortic valve replacement: Separation in the region of the mitral‐aortic intervalvular fibrosa

A 28‐year‐old man was admitted to our emergency service with a shortness of breath and palpitation. On admission, his blood pressure was high and he was in hypertensive pulmonary edema. His physical examination showed rales in both lungs and pansystolic murmur at mitral focus. His medical history included aortic valve replacement (AVR) because of native aortic valve infective endocarditis. Transthoracic echocardiography (TTE) showed normal functional aortic valve. Color flow imaging demonstrated severe mitral regurgitation with posterior eccentric jet. To examine in detail, transesophageal echocardiography (TEE) and three‐dimensional (3D) echocardiography were performed. TEE disclosed a separation in the subaortic curtain leading to severe mitral regurgitation from the left ventricle to the left atrium. In addition to severe mitral regurgitation with posterior eccentric jet, 26‐mm‐long pouch was seen in mitral‐aortic intervalvular fibrosa (MAIVF) at 120° TEE view. This pouch was separated from the mitral anterior leaflet junction releasing the mitral anterior leaflet and causing prolapse and chorda rupture in the A2 scallop of the mitral anterior leaflet. The MAIVF connects the anterior mitral leaflet to the posterior portion of the aortic annulus. The separation of the MAIVF represents a complication of the aortic valve replacement.     

Sexual function may be impaired during pregnancy in adolescent women

Prevalence of sexual dysfunctions is reported as high as 70% during pregnancy. However, there are limited data about the burden of sexual dysfunction in pregnant adolescents. This cross-sectional study was conducted in the outpatient antenatal clinic of our institution between October and December 2014. The total female sexual function index scores and domain scores were compared between adolescent and adult pregnant women. A total of 121 pregnant women participated in the study. Of those women, 29 (24.0%) were 21 years old or younger (Group 1), whereas the remaining were older (Group 2). The sexual dysfunction ratios were 41.4% and 23.9% in Groups 1 and 2, respectively (p = 0.068). The desire (3.29 vs. 2.79, p = 0.024) and arousal (3.48 vs. 2.71, p = 0.008) domain scores of adolescent pregnant women were significantly higher whereas the remaining domain scores (i.e. lubrication, orgasm, satisfaction and pain) were not significantly different. The adolescent women seem to be more prone to sexual dysfunctions during the course of pregnancy, especially in the third trimester. The health care providers should consider discussing the sexual life during pregnancy as a part of routine antenatal visit to improve sexual function and quality of life, especially among adolescent pregnant population.     

Do longer formula feeding and later introduction of solids increase risk for pediatric acute lymphoblastic leukemia?

Milk formula feeding can elevate insulin-like growth factor-1 levels, possibly impacting leukemogenesis. The intent of the current study is to examine the associations between infant feeding practices and age at introduction of solids on risk of childhood acute lymphoblastic leukemia (ALL). Incident cases of infant and childhood (aged ≤14 years) ALL (n = 142) were enrolled in a case–control study. Cases were frequency matched on age, sex, race, and ethnicity to two sets of controls (n = 284 total). Multivariable logistic regression was used to determine the association between infant feeding practices and age at the introduction of solids and the odds ratio of ALL. In adjusted multivariable analyses, each additional month of formula feeding was associated with a 1.17 (1.09–1.25) odds ratio; each additional month of age at introduction of solids was associated with a 1.18 (1.07–1.30) odds ratio. In this study, longer duration of formula feeding and later age at the introduction of solid foods were independently associated with increased risk of ALL. Additional studies are needed to address the factors influencing duration of formula feeding and delayed introduction of solids. The results support the potential role of energy balance in early life as a contributor to risk for pediatric acute lymphoblastic leukemia.