Single-Center Outcome Analysis Comparing Reintervention Rates of Surgical Arterioplasty With Stenting for Branch Pulmonary Artery Stenosis in a Pediatric Population

Although catheter-based intervention is generally accepted as the treatment of choice for branch pulmonary artery (PA) stenosis, there are no data directly comparing both the need for reintervention and time to reintervention in patients undergoing transcatheter stenting versus surgical arterioplasty. We compared children who underwent surgical branch pulmonary arterioplasty and branch PA stent placement between January 2008 and May 2012 at a single tertiary center. Need for reintervention and mean time to reintervention were assessed using chi-square and independent sample Student t test. Thirty-seven patients were included (surgery n = 18, stent n = 19). Mean weight at initial intervention was 11.3 ± 8.8 kg for surgical and 20.1 ± 15.5 kg for stent (p = 0.041). Intervention was performed on the left PA in 17 patients, the right PA in 12 patients, and both PAs in 8 patients. Five patients had undergone previous intervention. On mean follow-up of 807 ± 415 days, 50 % (9 of 18) of the surgery cohort and 5.3 % (1 of 19) of the stent cohort required reintervention (p = 0.002). In all but one case reintervention was catheter-based. Mean time to reintervention for the surgery cohort was 272 ± 162 days and for the single stent cohort it was 150 days. When comparable age and weight groups were analyzed, reintervention was still more common in the surgery cohort (p = 0.007). Children undergoing surgical branch pulmonary arterioplasty are more likely to require reintervention than those undergoing stent placement.     

Percutaneous replacement of pulmonary valve using the Edwards-Cribier percutaneous heart valve: first report in a human patient.

We report on the use of the Edwards-Cribier percutaneous heart valve (PHV) in a stenotic right ventricle to pulmonary artery homograft in a 16-year old patient who underwent the Ross operation. Initially, the homograft was stented and at the same procedure, the PHV was deployed inside it. This is the first human case of the application of this valve in the pulmonary valve position.     

Impact of Calcium and Two Doses of Vitamin D on Bone Metabolism in the Elderly: A Randomized Controlled Trial

The optimal dose of vitamin D to optimize bone metabolism in the elderly is unclear. We tested the hypothesis that vitamin D, at a dose higher than recommended by the Institute of Medicine (IOM), has a beneficial effect on bone remodeling and mass. In this double‐blind trial we randomized 257 overweight elderly subjects to receive 1000 mg of elemental calcium citrate/day, and the daily equivalent of 3750 IU/day or 600 IU/day of vitamin D3 for 1 year. The subjects’ mean age was 71 ± 4 years, body mass index 30 ± 4 kg/m², 55% were women, and 222 completed the 12‐month follow‐up. Mean serum 25 hydroxyvitamin D (25OHD) was 20 ng/mL, and rose to 26 ng/mL in the low‐dose arm, and 36 ng/mL in the high‐dose arm, at 1 year (p < 0.05). Plasma parathyroid hormone, osteocalcin, and C‐terminal telopeptide (Cross Laps) levels decreased significantly by 20% to 22% in both arms, but there were no differences between the two groups for any variable, at 6 or 12 months, with the exception of serum calcitriol, which was higher in the high‐dose group at 12 months. Bone mineral density (BMD) increased significantly at the total hip and lumbar spine, but not the femoral neck, in both study arms, whereas subtotal body BMD increased in the high‐dose group only, at 1 year. However, there were no significant differences in percent change BMD between the two study arms at any skeletal site. Subjects with serum 25OHD <20 ng/mL and PTH level >76 pg/mL showed a trend for higher BMD increments at all skeletal sites, in the high‐dose group, that reached significance at the hip. Adverse events were comparable in the two study arms. This controlled trial shows little additional benefit in vitamin D supplementation at a dose exceeding the IOM recommendation of 600 IU/day on BMD and bone markers, in overweight elderly individuals. © 2017 American Society for Bone and Mineral Research.     

Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta.

BACKGROUND: We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques. METHODS AND RESULTS: Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5-92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections (n = 5) and aneurysm (n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup (n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up. CONCLUSIONS: Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA.     

Double jeopardy: assessing the association between internal displacement,housing quality and chronic illness in a low-income neighborhood

Purpose  

This study analyzed associations between war-related internal displacement, housing quality and the prevalence of chronic illness in Nabaa, a low-income neighborhood on the outskirts of Beirut, Lebanon.     

用Amplatzer房间隔封堵器堵闭边缘不足的房间隔缺损效果观察

目的　探讨用Amplatzer房间隔缺损封堵器经导管堵闭部分边缘缺乏或不足(<5mm)的房间隔缺损的可行性。方法　1999年7月至2 0 0 1年9月对芝加哥大学儿童医院的2 3例边缘<5mm的房间隔缺损患儿试用Amplatzer封堵器进行堵闭,其中男10例,女13例,平均年龄10 7岁。2 0例经食管超声心动图或心内超声心动图测量的房间隔缺损前缘0～4mm ,2例下缘为2mm ,1例后缘为2mm。同期,4 8例房间隔缺损边缘>5mm的患儿作对照。结果　全部2 3例边缘<5mm的房间隔缺损患儿和4 8例对照儿均成功安装了封堵器。两组间年龄、缺损大小和所用封堵器大小差异无显著性意义(P >0 . 0 5 )。2 3例边缘<5mm的患儿中17例(73. 9% )即刻完全堵闭,对照组4 4例(91 .7% )即刻完全堵闭(P <0 .0 5 ) ;2 4h复查边缘<5mm患儿及对照组的完全堵闭率分别是91 3%和93 8% (P >0. 0 5 ) ;6个月复查两组完全堵闭率分别是95 7%和95 8% (P >0 . 0 5 )。缺损边缘<5mm患儿及对照组手术时间分别为(72 . 5±2 6 .5 )min和(6 1. 4±2 1 .9)min ;X线暴光时间分别为(12 .6±7 .0 )min和(9. 8±4 . 2 )min ,与对照组比较手术时间稍长。两组患儿术中和术后均未出现并发症。结论　前、后或下缘<5mm的房间隔缺损仍可以用Amplatzer房间隔缺损封堵器经导管堵闭,但长期手术     

孤立性心肌致密化不全一例

患儿女 ,4岁 10个月。因心律失常安装室内除颤器入院。患儿第 1胎第 1产 ,足月顺产 ,产前胎儿超声检查发现心功能降低 ,疑及肌部室间隔缺损。生后 1ｄ超声检查示左心室壁中至重度增厚 ,呈海绵样改变 ,轻度左室功能降低。给予地高辛口服 ,门诊随访。患儿 6个月时 ,无诱因哭闹、烦躁 ,进而青紫 12ｈ ,在当地门诊心电图检查诊断为室性心动过速 ,急诊入院。入院时患儿面色青紫 ,心律不齐 ,血压 96 / 34ｍｍＨｇ (1ｍｍＨｇ =0 133ｋＰａ) ,心电图示间断心动过速 ,室率 2 5 0～ 2 70次 /ｍｉｎ ,遂停用地高辛 ,改用利多卡因 7ｍｇ静脉滴注 (简称…     

Practice patterns of nonvascular interventional radiology procedures at academic centers in the United States?

RATIONALE AND OBJECTIVES: To determine and analyze the patterns of practice of nonvascular interventional procedures in academic centers in the United States. MATERIALS AND METHODS: A survey was administered via e-mail to the chief residents of 112 academic radiology departments in the United States. Recipients of the survey were asked to identify which sections within their respective radiology departments performed each of 43 types of nonvascular interventional procedures. An additional entry for performance of procedures by non-radiologists was provided. A total of 66 (59%) recipients responded. The statistical method used was the analysis of contingency tables. RESULTS: Percutaneous abdominal biopsies are performed mainly by abdominal and body imaging sections (43/66, 65%), followed by vascular/interventional sections (21/66, 32%). Percutaneous abdominal drainages are performed mostly by abdominal, body imaging, and computed tomography sections (40/66, 61%), followed by vascular/interventional sections. Fluoroscopically guided procedures were performed most commonly by vascular/interventional sections, including percutaneous gastrostomy (40/66, 61%), percutaneous nephrostomy (42/66, 64%), and biliary interventions such as percutaneous transhepatic cholangiography (47/66, 71%). Breast and musculoskeletal procedures are performed by their respective sections most frequently. Non-radiologists perform a significant portion of certain types of procedures: paracenteses, thoracenteses, biliary interventions (particularly stone extractions), enterostomies (particularly percutaneous jejunostomies and cecostomies), and certain biopsies (kidney and prostate). CONCLUSIONS: Academic US radiology sections perform nonvascular interventional radiology procedures in a complex and nonuniform manner. The vascular/interventional sections and organ system and modality (especially CT) sections perform the bulk of the procedures included in the survey. Breast imaging sections predominate in procedures in their disciplines. A substantial number and amount of interventional radiology procedures are performed by non-radiologists.