Late fenestration of the extracardiac conduit in a Fontan circuit by sequential stent flaring.

Recent Fontan circuits frequently involve an extracardiac conduit. We report on a new technique to create a late fenestration in such an extracardiac circuit by sequential flaring of a stent in the fenestration.     

肺部超声在支气管肺泡灌洗治疗新生儿肺不张效果评估中的应用价值

目的 探讨肺部超声动态评估支气管肺泡灌洗(BLA)治疗新生儿肺不张的效果.方法 收集我院新生儿重症监护室收治的60例肺不张患儿,经肺部超声标记肺不张的部位后行纤维支气管镜下BLA治疗.每次治疗后均行肺部超声检查观察肺不张恢复程度以决定是否继续进行灌洗.记录肺部啰音消失时间、机械通气时间及抗生素使用时间;比较治疗前及治疗...     

Parents' voices: “Our process of advocating for our child with autism.” A meta‐synthesis of parents' perspectives

Background

Advocacy has been described by parents of children with autism as an important coping strategy, enabling them to move forward by redirecting emotions into actions. A key factor in the development of collaborative and constructive partnerships between service providers and parents is having an understanding of how parents engage in advocacy and the support needed to do so. This meta‐synthesis was undertaken to consolidate in‐depth qualitative data from parents' perspectives of the process that they use to advocate for their children with autism.

Methods

A qualitative meta‐synthesis was conducted, whereby 15 databases were systematically searched. Thirty‐one studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesized into themes through the steps of review, meta‐aggregation, integration, and interpretation.

Results

The voices of 1,662 parents are presented describing the process of advocacy in the stages of seeking a diagnosis, seeking self‐education, and taking action. Taking action includes 2 subthemes: seeking, access, and use of support services and community engagement and educating others.

Conclusions

Results highlight the significant impact that positive experiences with first‐line professionals have during the diagnosis process and how these experiences lay the foundation for all future relationships with other service providers. Important implications arise from this meta‐synthesis for service providers in supporting parents' advocacy and hence building constructive relationships with families with a child with autism.     

Bailout stenting for critical coarctation in premature/critical/complex/early recoarcted neonates

Background: Surgical repair of critical coarctation can be problematic in premature, critical, complex, or early postoperative neonates. Objectives: We aimed to review our experience with stent implantation to defer urgent surgery to an elective time. Methods: Fifteen neonates with severe aortic coarctation: five premature‐hypotrophic (1,400–2,000 g), six critical and complex cardiac malformation, four early (1 day [0–2 days]; median [range]) after surgical coarctectomy or complex arch reconstruction. Bare coronary stents (diameter 4.0 [3.5–5.0] mm; length 10 [8–16] mm) were used. Stents were removed surgically depending on clinical needs. Results: Adequate aortic flow was obtained in 15 patients. The femoral artery was preserved in 13/15 patients. Two deaths occurred before stent removal and were nonprocedure related. In patients with simple stented coarctation, the stent was removed after 2.8 [0.2–5.0] months. In complex cardiac malformation, stents were finally removed 3.0 [0.2–78] months after implantation. Surgical technique: simple coarctectomy end‐to‐end in eight, extensive arch patch reconstruction in four. One patient is awaiting stent removal. The final maximum systolic velocity (cw‐Doppler) across the aortic arch was 1.7 [1.2–2.5] m/sec. Conclusions: In premature/critical/complex neonates with severe coarctation, bailout stenting followed by early or late surgical coarctectomy appears a promising concept. © 2009 Wiley‐Liss, Inc.     

A multicenter randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1

To determine the efficacy and safety of 2 inexpensive and easily deliverable antiretroviral (ARV) regimens for the prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) type 1 during labor and delivery, HIV-infected pregnant women were screened at 11 maternity health institutions in South Africa and were enrolled in an open-label short course ARV regimen of either nevirapine (Nvp) or multiple-dose zidovudine and lamivudine (Zdv/3TC). The overall estimated HIV-1 infection rates in 1307 infants by 8 weeks were 12.3% (95% confidence interval [CI], 9.7-15.0) for Nvp and 9.3% (95% CI, 7.0-11.6) for Zdv/3TC (P=.11). Excluding infections detected within 72 h (intrauterine), new HIV-1 infections were detected in 5.7% (95% CI, 3.7-7.8) and 3.6% (95% CI, 2.0-5.3) of infants in the Nvp and Zdv/3TC groups, respectively, in the 8 weeks after birth. There were no drug-related maternal or pediatric serious adverse events. Common complications were obstetrical for mothers (Nvp group, 24.3%; Zdv/3TC group, 26.3%) and respiratory for infants (Nvp group, 16.1%; Zdv/3TC group, 17.0%). This study further confirms the efficacy and safety of short-course ARV regimens in reducing MTCT rates in developing countries.     

Transcatheter closure of a Potts' shunt with subsequent surgical repair of tetralogy of fallot.

Closure of a Potts' aortopulmonary anastomosis during repair of a congenital heart malformation has been associated with high morbidity and mortality, especially due to technical problems encountered at closure of the shunt. A case is presented of a 40-year-old patient with tetralogy of Fallot and pulmonary atresia after palliation during infancy with a Potts' shunt. The anastomosis was successfully occluded using an Amplatzer ventricular septal defect occluder, immediately followed by complete surgical repair of his tetralogy of Fallot.     

Percutaneous management of a Fontan fenestration: In search for the ideal restriction—occlusion device

Objective: Most devices devices available for percutaneous closure of Fontan fenestrations tend to be bulky. The aim of this study was to evaluate a low profile custom made device and assess its efficacy and safety. Patients and Methods: A 15 mm PFO star was used as the basis. The following modifications were made: removal of the left disc to reduce thrombogenicity in the left atrium, increase the length of the LA legs from 2 by 15 mm to 3 by 20 mm to prevent dislodgement and later adding a pivot between the left and right umbrella. A partial occluder was made by removing two opposite quadrants from the proximal disk. Results: Device deployment was possible in 93% (63 of 68) patients. In five patients, the device could not be deployed and an alternative device was used. In 45 patients complete closure of the fenestration was obtained and saturations increased from 84% ± 4% to 95% ± 2% (P < 001). In 18 high risk patients with suboptimal Fontan circulation, a modified device was used to effect partial occlusion: saturations increased from 79% ± 7% to 90% ± 4% (P < 0.001); a residual shunt persisted in most patients for several months. No thrombotic events were recorded during follow‐up. Conclusions: The modified PFO star device can safely be deployed in Fontan patients to occlude or restrict flow through a fenestration. It has a low profile with minimal foreign material, is non‐obstructive and minimally thrombogenic. © 2009 Wiley‐Liss, Inc.