BackgroundCar Seat Tolerance Screening (CSTS) and Critical Congenital Heart Disease (CCHD) screens were both implemented to identify infants with cardiorespiratory distress. We hypothesized that the CCHD screen would be poorly sensitive to predict a failed CSTS for many reasons.MethodsRetrospective record review of infants in 2013 who qualified for CSTS. Calculated sensitivity, specificity, predictive value (PV) of a failed CCHD screen to identify those infants who failed their CSTS.Results270 subjects underwent both screens and 14 failed a CSTS (5.2%). Of these, 1 failed the CCHD and 1 had an equivocal result. None were diagnosed with CCHD. An abnormal CCHD (failed or equivocal) had a sensitivity = 14.3% and a PV = 40% for predicting CSTS failure.ConclusionsCCHD screening is poorly sensitive and has poor PV for identifying those infants who are at risk of failing a CSTS. We therefore cannot recommend replacement of the CSTS with routine CCHD screening. 相似文献
Objectives. This report evaluates the use of Gianturco coils to close large patent ductus arteriosus (PDAs) (≥3.5 mm) and describes transvenous delivery of 0.052-in. (0.132-cm) Gianturco coils.
Background. Coil closure of PDAs has become increasingly popular. However, the technique has significant limitations when used to close large PDAs. This report evaluates patient characteristics, PDA anatomy, hemodynamic variables, delivery technique and coil geometry to determine predictors of success.
Methods. Between January 1995 and January 1997, 16 of 118 patients undergoing catheterization for PDA closure were found to have large PDAs. Their median age and weight were 14 months (range 3 months to 43 years) and 8.5 kg (range 3.5 to 73), respectively. The mean PDA diameter was 4.3 mm (range 3.5 to 5.9). Closure of PDAs was attempted using transcatheter delivery of 0.038-in. (0.096-cm) and 0.052-in. coils. Differences in clinical, anatomic, hemodynamic and technical variables between successes and failures were compared.
Results. Eleven (69%) of 16 patients had successful closure of their PDA. Failures occurred only in patients <8 months of age with an indexed PDA diameter >7 mm/m and a pulmonary/systemic flow ratio ≥2.8:1. Use of 0.052-in. coils tended to reduce the incidence of embolization and the number of coils needed for closure.
Conclusions. Patients >8 months of age can have successful closure of large PDAs with currently available Gianturco coils. The 0.052-in. Gianturco coils can be used safely to close large PDAs in infants as small as 6 kg. Increased experience and improved coil design may improve closure rates of large PDAs in infants. 相似文献
We report a 12-month old patient who presented for murmur evaluation after percutaneous closure of type C patent ductus arteriosus (PDA) using a 10 mm Amplatzer Vascular Plug (AGA Medical Corporation, Golden Valley, MN) at an outside institution. Echocardiography revealed a large left-to-right shunt through the implanted device, inadvertently stenting the PDA instead of closing it. The patient underwent repeat catheterization with successful coil implantation within the Amplatzer Vascular Plug, completely eliminating the large residual ductal shunt. Although challenging, this case illustrates the technique of implanting coils within this occlusion device. This case also illustrates that occlusion of type C PDA utilizing the Amplatzer Vascular Plug may not only result in incomplete occlusion but also create a potentially worse clinical situation in which the PDA is stretched larger and stented open. Without consideration of simultaneous coil implantation within this device, use of the Amplatzer Vascular Plug might be contraindicated in type C PDA, because there may be no way to ensure successful closure by the Vascular Plug alone. 相似文献
Successful transcatheter closure of a large PDA in a pregnant patient is reported using the Amplatzer ductal occluder device. This procedure was safe and uncomplicated, obviating the need for surgery in this high risk patient. 相似文献
Dietary oleic acid may prevent pancreatic ductal adenocarcinoma (PDA) by reducing hyperinsulinaemia which can otherwise promote DNA damage and tumour growth. Results from previous epidemiological studies investigating oleic acid are inconsistent. This study aims to clarify the relationship between dietary oleic acid intake and the risk of developing PDA using nutritional information from food diaries plus published serum biomarker data from HbA1c.
Methods
23,658 participants, aged 40–74 years, were recruited into EPIC-Norfolk and completed 7-day food diaries which recorded; foods, brands and portion sizes to calculate nutrient intakes. Serum HbA1c was measured at recruitment in 11,147 participants (48.7% of cohort). Hazard ratios (HRs) for quintiles of dietary oleic acid intake and serum HbA1c were estimated using Cox regression. Additional analyses were made according to whether body mass index (BMI) was greater or less than 25?kg/m2 as this influences hyperinsulinaemia.
Results
88 participants (55% women) developed PDA after a mean follow-up of 8.4 years (SD?=?3.9) (mean age at diagnosis?=?72.6 years, SD?=?8.8). A decreased risk of PDA was associated with increased dietary oleic acid intake (highest vs lowest quintile, HR?=?0.29, 95% CI?=?0.10–0.81, P trend across quintiles?=?0.011), with statistical significance maintained when BMI>25?kg/m2 but not if BMI<25?kg/m2. An elevated serum HbA1c was associated with increased risk of disease (highest vs lowest quintiles, HR?=?6.32, 95% CI?=?1.38–28.89, P for trend?=?0.004).
Conclusions
The data supports a protective role of oleic acid against development of PDA in those with higher BMIs possibly through influencing hyperinsulinaemia. Oleic acid intake should be accurately measured in future aetiological studies. 相似文献