Techniques and outcomes of transcatheter closure of complex atrial septal defects – Single center experience

Objective

To prospectively study the techniques and outcomes of transcatheter closure of complex Atrial septal defects (ASD).

Study design and settings

Prospective single center study with experience in catheter closure of ASD. All patients with complex ASD suitable for device closure.

Objective

Analysis of outcomes of transcatheter closure of complex ASD in JIPMER Hospital over the past 5-year period.

Methods

Complex ASD was predefined and patients satisfying inclusion and exclusion criteria are included. All the patients had meticulous Transesophageal echocardiography (TEE) imaging beforehand. Modifications of the conventional techniques were allowed on a case per case basis according to operator preference. Successfully intervened patients were followed up clinically.

Results

Out of the 75 patients enrolled, 69 patients had successful device closure (success rate 92%) despite challenging anatomy. Fifty-six (74%) patients had ASD ≥25 mm. Fifteen patients (20%) had defect size ≥35 mm and 20 patients (26.6%) had devices implanted with ≥35 mm waist size. Fifty percent of patients had complete absence of aortic rim and 25% had deficient posterior rim. Twenty percent of patients had malaligned septum. Mean follow up period was 3.2 years.

Conclusions

Trans catheter closure is feasible in anatomically complex substrates of Secundum ASD. Careful case selection, scrupulous imaging protocol, and expertise in modified techniques are mandatory for successful outcomes.     

Effects of Nonpharmaceutical COVID-19 Interventions on Pediatric Hospitalizations for Other Respiratory Virus Infections,Hong Kong

To determine the effects of nonpharmaceutical interventions (NPIs) for coronavirus disease on pediatric hospitalizations for infection with respiratory viruses other than severe acute respiratory syndrome coronavirus 2, we analyzed hospital data for 2017–2021. Compared with 2017–2019, age-specific hospitalization rates associated with respiratory viruses greatly decreased in 2020, when NPIs were in place. Also when NPIs were in place, rates of hospitalization decreased among children of all ages for infection with influenza A and B viruses, respiratory syncytial virus, adenovirus, parainfluenza viruses, human metapneumovirus, and rhinovirus/enterovirus. Regression models adjusted for age and seasonality indicated that hospitalization rates for acute febrile illness/respiratory symptoms of any cause were reduced by 76% and by 85%–99% for hospitalization for infection with these viruses. NPIs in Hong Kong were clearly associated with reduced pediatric hospitalizations for respiratory viruses; implementing NPIs and reopening schools were associated with only a small increase in hospitalizations for rhinovirus/enterovirus infections.     

Multidisciplinary management of patients with post-inflammatory pancreatic necrosis

正Current knowledge of the pathophysiology of acute pancreatitis indicates that pancreatic injury originates at the acinar cell level and then extends through a spectrum of damage ranging from mild peri-acinar inflammatory infiltration and edema to extensive pancreatic parenchymal and peri-pancreatic necrosis [1, 2]. Clinical acute pancreatitis correlates closely with this range of injury with the majority of patients experiencing mild disease,     

Clinical Impact of Atrial Fibrillation in Patients With the HeartMate II Left Ventricular Assist Device

Background

Atrial fibrillation (AF) is common in patients with the HeartMate II (HMII) left ventricular assist device (LVAD), but the impact of AF on clinical outcomes is uncertain.

Objectives

This study sought to determine the effect of AF on outcomes in patients with the HMII LVAD.

Methods

Records of 106 patients who underwent HMII implantation at a single center were reviewed. The associations of paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PeAF) with survival, heart failure (HF) hospitalization, bleeding, and thromboembolism were examined using Kaplan-Meier survival analysis and Cox proportional hazards regression.

Results

Mean age was 56.6 ± 11.4 years, 87.7% of the implants were intended as a bridge to transplantation, and median length of support was 217 days (range: 1 to 952 days). AF was present in 55 patients (51.9%); 36 patients (34.0%) had PAF and 19 (17.9%) had PeAF. Twenty-one patients (19.8%) died, and 18 (17.0%) were hospitalized for HF. There were 0.75 major bleeding events and 0.28 thromboembolic events per patient year of follow-up. PAF was not associated with increased mortality, HF hospitalization, bleeding, or thromboembolism. PeAF, however, was an independent predictor of the composite endpoint of death or HF hospitalization (hazard ratio: 3.54; 95% confidence interval: 1.52 to 8.25; p < 0.01). Although there was no increase in bleeding or thromboembolism, patients with AF had thromboembolic events at higher international normalized ratios (INRs).

Conclusions

Although PAF is not associated with worse outcomes in patients with the HMII LVAD, PeAF may be associated with increased mortality and HF hospitalization. Patients with AF also may have thromboembolic events at higher INR levels.     

Carotid endarterectomy in patients with contralateral internal carotid artery occlusion without intraoperative shunting

BACKGROUND: Controversy about the optimal method of performing a carotid endarterectomy (CEA) exists despite its widespread application and support from various randomized clinical trials. Many surgeons selectively or routinely use electroencephalography (EEG) monitoring as well as shunting when performing this operation. ETHODS: We conducted this retrospective study to assess the maximum carotid clamp time without shunting or EEG monitoring during a CEA without the development of neurological deficits in an already compromised cerebral circulation. RESULTS: Fifteen consecutive patients who underwent CEAs between 1988 and 1999 met our criteria of angiographically documented ipsilateral internal carotid artery (ICA) stenosis with contralateral ICA occlusion. The patient presentations included asymptomatic (14%), transient ischemic attack (TIA) (50%), and stroke (36%). All patients were operated under general anesthesia without shunting and only 4 patients underwent EEG monitoring. On angiography, all 15 patients had ipsilateral ICA stenosis (70-99%) and contralateral occlusion. In 54% of patients, the vertebral arteries (VAs) were both patent, while in 46% of patients only 1 VA was patent. Eighty-five percent of patients had at least 1 patent anterior communicating (Pcomm) artery, while 15% had nonvisualized Pcomm arteries bilaterally. Of the 15 patients, 14 had a patent anterior communicating artery. The mean clamp time of the CCA was 18.5 minutes (range 14-30 minutes). None of the 15 patients had new neurological changes immediately postoperatively or during the 6 weeks of follow-up. CONCLUSION: We propose that shunting may not be necessary during CEA for high-grade stenosis with contralateral ICA occlusion, presumably because of adequate distal small vessel collaterals.     

Effect of exogenous histidine and Garcinia cambogia on histamine formation in skipjack (Katsuwonus pelamis) homogenates

Histamine consumed with food gives rise to allergic reactions. Dark muscle fish, for example skipjack (Katsuwonus pelamis) has been shown to contain histamine. Studies using TLC (acetone: NH4OH, 80:20.5) on silica gel G60 plates and densitometry after spraying with ninhydrin, using a computerized densitometer, showed that freshly harvested skipjack has no detectable histamine (detection limit, 50 micrograms.g-1 fish). However, with time histamine (Rf 0.84) is formed > 1.5 mg.g-1 probably through microbial action. Skipjack contains high levels of free histidine at levels of > 10 mg.g-1 (Rf 0.41) but fish like seer (Scomberamous spp.), which are not reported to be allergenic, contain < 4 mg.g-1 histidine. Addition of exogenous histidine (50 mg.g-1) results in histamine formation in seer 2.2-fold that of skipjack under the same conditions. A type of herring (Amblygaster spp., sinhala-hurulla) is not a histamine former, but had been shown to cause allergenic reactions, resulting in a ninhydrin positive spot (Rf 0.79) on incubating for 24 hours. Addition of arginine and lysine to blended skipjack results in their loss probably by decarboxylation. Addition of the spice Garcinia cambogia (extracts 0.2 g ml-1) known as 'goraka' in Sri Lanka (sinhala) and 'kukum' in India (hindhi), to fresh skipjack incubates prevents histamine formation as a results of lowering pH to 3.2-3.6 whereas Avverhoea bilimbi (bilin) and Tamarindus indica (tamarind) extracts did not prevent histamine formation.