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Assessment of morphological left ventricular function in congenitally corrected transposition of great arteries - Can we use conventional tools for an unconventional assessment? 先天性大动脉转位左心室形态学功能的评估-我们可以使用传统工具进行非常规评估吗?
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_72_23
Mani Ram Krishna, Usha Nandhini Sennaiyan
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引用次数: 0
Life long surveillance is warranted as coronary artery remodels variably after treatment of adult patients with anomalous left coronary artery origin from pulmonary artery. 成年患者的异常左冠状动脉起源于肺动脉,治疗后冠状动脉重塑变化,因此终身监测是必要的。
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_45_23
Pramod Sagar, Kothandam Sivakumar

Anomalous left coronary artery origin from pulmonary artery causes heart failure in infancy from ischemia and secondary mitral regurgitation. Rich intramyocardial collateralization may permit survival to adult age, where coronaries become tortuous and aneurysmally dilated. Surgery in adults involves left coronary ligation and providing a bypass graft to the left system, unlike coronary translocation adopted in infants. Unfavorable coronary remodeling in operated adults may lead to late coronary thrombotic occlusions. Two adults with markedly dilated tortuous coronary arteries showed variable remodeling after corrective intervention that impacted outcomes on follow-up. We stress the need for lifelong angiographic surveillance in older patients.

起源于肺动脉的异常左冠状动脉在婴儿期因缺血和继发性二尖瓣反流而导致心力衰竭。丰富的心肌内侧支循环可以存活到成年,在成年后,冠状动脉会弯曲,动脉瘤扩张。与婴儿冠状动脉移位不同,成人的手术包括左冠状动脉结扎和左系统旁路移植。成人手术后不良的冠状动脉重塑可能导致晚期冠状动脉血栓闭塞。两名冠状动脉明显扩张弯曲的成年人在矫正干预后表现出可变的重塑,这影响了随访的结果。我们强调需要对老年患者进行终身血管造影监测。
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引用次数: 0
Three-dimensional spatiotemporal imaging correlation in the diagnosis of isolated infracardiac total anomalous pulmonary venous connection in fetal life. 胎儿期孤立性心下全肺静脉连接异常的三维时空影像相关性诊断。
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_34_23
Mani Ram Krishna, Usha Nandhini Sennaiyan

Total anomalous pulmonary venous connection (TAPVC) is a critical congenital heart disease which is often missed on prenatal echocardiography because of the decreased pulmonary blood flow in fetal life. Improvement in technology has resulted in increasing prenatal diagnosis of this condition. We report a foetus with infra cardiac TAPVC in whom prenatal diagnosis was facilitated by the use of STIC technology.

完全性肺静脉异常连接(TAPVC)是一种严重的先天性心脏病,由于胎儿生命中肺血流量减少,产前超声心动图经常遗漏该病。随着技术的进步,这种疾病的产前诊断越来越多。我们报告了一名患有心脏下TAPVC的胎儿,该胎儿通过STIC技术的使用促进了产前诊断。
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引用次数: 0
Association of adiposity and fitness with triglyceride-to-high-density lipoprotein cholesterol ratio in youth. 青少年肥胖和健康与甘油三酯与高密度脂蛋白胆固醇比值的关系。
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_1_23
Danladi Ibrahim Musa, Abel Lamina Toriola, Nurudeen O Abubakar, Sunday Omachi, Victor B Olowoleni, Kolade B Ayodele

Background: The ratio of triglycerides-to-high-density lipoprotein cholesterol (TG/HDL-C) is considered a robust biomarker of metabolic syndrome (MetS) and is associated with several diseases, including type 2 diabetes mellitus (T2DM) and hypertension (HTN). This study examined the independent association of adiposity and fitness with the TG/HDL-C ratio.

Materials and methods: This is a cross-sectional study comprising 403 (201 girls) Nigerian adolescents aged 11-19 years. Participants were evaluated for body mass index, cardiorespiratory fitness, and TG/HDL-C. Regression models adjusting for age and biological maturity were used to evaluate the association of adiposity and fitness with TG/HDL-C ratio. The TG/HDL-C ratios of 1.0 mmol/L and 1.1 mmol/L were used to stratify female and male participants into low- and high-risk groups, respectively.

Results: Of the 135 high-risk adolescents, 21.1%, 5.5%, 12.7%, 14.9%, and 0.5% were at risk of T2DM, systolic HTN, diastolic HTN, abdominal obesity, and MetS, respectively. The independent variables were significantly associated with TG/HDL-C ratio only in boys but not girls. In boys, high adiposity (β = 0.193; P = 0.025) and low fitness (β = -0.169; P = 0.048) were independently associated with the dependent variable. Unfit boys were 3.9 (95% confidence interval [CI] =1.37-10.94, P = 0.011) times more likely to develop elevated TG/HDL-C ratio than their fit peers. The likelihood of girls at risk of MetS developing a high TG/HDL-C ratio was 13.7 (95% CI = 3.89-48.32, P < 0.001) times compared to their counterparts without MetS.

Conclusions: Adiposity and fitness were independently associated with TG/HDL-C in boys but not in girls. Health promotion intervention focusing on lowering TG/HDL-C ratio among Nigerian adolescents should include an emphasis on healthy diet and endurance activity programs.

背景:甘油三酯与高密度脂蛋白胆固醇(TG/HDL-C)的比值被认为是代谢综合征(MetS)的一个强有力的生物标志物,并与多种疾病有关,包括2型糖尿病(T2DM)和高血压(HTN)。本研究检验了肥胖和健康与TG/HDL-C比率的独立相关性。材料和方法:这是一项横断面研究,包括403名(201名女孩)11-19岁的尼日利亚青少年。对参与者的体重指数、心肺功能和TG/HDL-C进行评估。使用调整年龄和生物成熟度的回归模型来评估肥胖和健康与TG/HDL-C比率的关系。使用1.0 mmol/L和1.1 mmol/L的TG/HDL-C比率将女性和男性参与者分别分为低风险组和高风险组。结果:在135名高危青少年中,分别有21.1%、5.5%、12.7%、14.9%和0.5%的人有T2DM、收缩性高血压、舒张性高血压、腹部肥胖和代谢综合征的风险。自变量仅与男孩的TG/HDL-C比率显著相关,而与女孩无关。在男孩中,高肥胖(β=0.193;P=0.025)和低体质(β=0.169;P=0.048)与因变量独立相关。与健康的同龄人相比,不健康的男孩发生TG/HDL-C比率升高的可能性高3.9倍(95%置信区间[CI]=1.37-10.94,P=0.011)。与未患代谢综合征的女孩相比,有代谢综合征风险的女孩出现高TG/HDL-C比率的可能性为13.7倍(95%CI=3.89-48.32,P<0.001)。以降低尼日利亚青少年TG/HDL-C比率为重点的健康促进干预措施应包括强调健康饮食和耐力活动计划。
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引用次数: 0
Fibronectin enhances attachment of human adipose-derived mesenchymal stem cells into polytetrafluoroethylene patch during surgical closure of the atrial and ventricular septal defect. 纤维连接蛋白增强人脂肪源性间充质干细胞在心房和室间隔缺损手术中与聚四氟乙烯贴片的附着。
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_9_23
I Gde Rurus Suryawan, Anudya Kartika Ratri, Andrianto Andrianto, Meity Ardiana, Ricardo Adrian Nugraha

Background: Polytetrafluoroethylene (PTFE) patch is commonly used during surgical closure for atrial septal defect (ASD) and ventricular septal defect (VSD). However, this patch has several limitations such as its inability to grow or remodel, especially in children and young adults. To tackle these limitations, we have tried to use fibronectin and human adipose-derived mesenchymal stem cells (hAMSCs) in the PTFE patch.

Objective: To understand the impact of fibronectin to enhance hAMSCs cell-to-cell adherence and cell-to-patch surface attachment into PTFE patches used in the surgical closure of ASD or VSD.

Materials and methods: The hAMSCs were plated and fixated with 15 mL methanol and cluster of differentiation (CD) 90+, CD105+, and CD45 - antibodies were labeled with fluorescein isothiocyanate, rinsed with phosphate-buffered saline, and analyzed under a fluorescence microscope. Fibronectin solution (0.1%) was used to soak patch scaffolds for approximately 2-h duration and then dried for 20 min in the treatment group. The samples were examined with a scanning electron microscope (SEM).

Results: SEM examination showed incomplete attachment of the cells even after 10 days in the control group at 1.14 ± 1.13. In contrast, the treatment group showed more cells attached to the patch surface at 31.25 ± 13.28 (P ≤ 0.0001). The observation at 5 days was 17.67 ± 20.21, at 7 days was 12.11 ± 10.94, and at 10 days was 18.83 ± 23.25. There was no significant statistical difference in mean cell per view among each treatment group (P = 0.802).

Conclusion: Our work demonstrates that fibronectin has a positive impact on hAMSC attachment seeded onto the PTFE patch. These properties, in combination with their developmental plasticity, have generated tremendous interest in regenerative medicine.

背景:聚四氟乙烯(PTFE)贴片是房间隔缺损(ASD)和室间隔缺损(VSD)外科闭合术中常用的贴片。然而,这种贴片有几个局限性,例如无法生长或重塑,尤其是在儿童和年轻人中。为了解决这些局限性,我们尝试在PTFE贴片中使用纤连蛋白和人脂肪来源的间充质干细胞(hAMSCs)。目的:了解纤维连接蛋白对增强hAMSCs细胞对细胞粘附和细胞对贴片表面附着到用于ASD或VSD外科闭合的PTFE贴片中的影响。材料和方法:hAMSCs用15mL甲醇铺板和固定,分化簇(CD)90+、CD105+和CD45-抗体用异硫氰酸荧光素标记,用磷酸盐缓冲盐水冲洗,并在荧光显微镜下分析。在治疗组中,使用纤连蛋白溶液(0.1%)浸泡贴片支架约2小时,然后干燥20分钟。用扫描电子显微镜(SEM)对样品进行检查。结果:扫描电镜检查显示,即使在10天后,对照组的细胞也不完全附着,为1.14±1.13。相反,治疗组在31.25±13.28(P≤0.0001)时有更多的细胞附着在贴片表面。第5天的观察值为17.67±20.21,第7天的观察结果为12.11±10.94,第10天的观察数据为18.83±23.25。结论:纤连蛋白对植入PTFE贴片的hAMSC附着有积极影响。这些特性,加上它们的发育可塑性,引起了再生医学的极大兴趣。
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引用次数: 0
Pediatric Bentall procedure for giant ascending aortic aneurysm in Loeys-Dietz syndrome. 小儿本特尔手术治疗Loeys-Dietz综合征巨大升主动脉瘤。
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_22_23
Hüseyin Sicim, Ali Ertan Ulucan, Okan Yurdakök, Numan Ali Aydemir

Ascending aortic aneurysm is very rare in children, and is usually seen in patients with underlying connective tissue disorders such as Marfans and Ehler-Danlos syndrome. Loeys-Dietz syndrome (LDS) is less commonly seen as a cause of ascending aortic aneurysms in children. In this case report, we describe pediatric Bentall procedure, which we successfully performed to a child with LDS (Type I) with giant ascending aortic enlargement and significant aortic regurgitation.

升主动脉瘤在儿童中非常罕见,通常见于有潜在结缔组织疾病的患者,如Marfans和Ehler-Danlos综合征。Loeys-Dietz综合征(LDS)是儿童升主动脉瘤的常见病因。在本病例报告中,我们描述了儿科Bentall手术,我们成功地对一名患有LDS(I型)的儿童进行了该手术,该儿童患有巨大的升主动脉增大和严重的主动脉反流。
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引用次数: 0
Percutaneous hepatic vein recanalization in pediatric Budd-Chiari syndrome - 10 years' experience from a tertiary center. 经皮肝静脉再通治疗小儿布-恰利综合征-三级中心10年经验。
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_160_22
Usha Mandikal Kodandarama Sastry, Madhu Swandenahalli Doddaiah, Priyadarshini Arunakumar, Varun Marimuthu, Sowmya Kasturi, Budnur C Srinivas, Mahimarangaiah Jayranganath, Cholenahally Nanjappa Manjunath

Background: Budd - Chiari syndrome (BCS) due to hepatic venous outflow obstruction is a rare cause of liver disease with dismal outcome, often amenable to catheter intervention.

Materials and methods: This retrospective single-center study analyzed the clinical profile and medium-term outcome of interventional treatment with balloon angioplasty ± stenting in all pediatric BCS over a 10-year period. Clinical, laboratory, imaging, and interventional data were retrieved. Transhepatic (TH) access was utilized in the recent 3 years.

Results: We included a total of 27 patients. Acute and subacute BCS comprised 93% of subjects. Ascites was the most common symptom. COVID-19 infection and Takayasu arteritis were two novel etiologies in our study. There was isolated hepatic vein (HV) narrowing in 11 (41%), isolated inferior vena cava obstruction in 4, and combined occlusion in 12 (44%). Intervention was successful in 22 (82%) patients. Stenting was required in 14 (64%) patients and the rest underwent balloon angioplasty. The immediate outcome was better with stenting than balloon (91% vs. 64%). Transhepatic access in 6 patients allowed HV cannulation in all and achieved patency in five patients. Two patients from the balloon group (25%) and 9 from the stent group (64%) are alive with patent veins at a median follow-up of 60 months, indicating a high attrition rate.

Conclusion: Catheter interventions restored physiological blood flow in pediatric BCS. TH route improved cannulation of occluded HV compared to other accesses. Immediate and medium-term outcomes were better after stenting with lower rates of reinterventions than balloon angioplasty. Life-long surveillance is required as mortality is high on follow-up.

背景:肝静脉流出道阻塞引起的布-加综合征(BCS)是一种罕见的肝病病因,预后不佳,通常需要导管介入治疗。材料和方法:这项回顾性单中心研究分析了10年来所有儿童BCS球囊血管成形术±支架置入介入治疗的临床特点和中期结果。检索临床、实验室、影像学和介入性数据。经肝(TH)通路是近3年来使用的。结果:我们总共纳入了27名患者。急性和亚急性BCS占受试者的93%。腹水是最常见的症状。在我们的研究中,新冠肺炎感染和大动脉炎是两种新的病因。孤立性肝静脉狭窄11例(41%),孤立性下腔静脉阻塞4例,合并闭塞12例(44%)。干预成功的患者有22例(82%)。14名(64%)患者需要支架,其余患者接受球囊血管成形术。支架置入术的近期疗效优于球囊(91%对64%)。6例患者经肝入路均允许HV插管,5例患者实现通畅。球囊组的2名患者(25%)和支架组的9名患者(64%)在中位随访60个月时存活,静脉通畅,这表明磨损率很高。结论:导管介入治疗可恢复儿童BCS的生理血流量。与其他通路相比,TH通路改善了闭塞HV的插管。支架植入术后的近期和中期结果更好,再干预率低于球囊血管成形术。由于随访死亡率高,需要进行终生监测。
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引用次数: 0
A rare unreported complication following transcatheter correction of sinus venosus defect. 经导管矫正静脉窦缺损后罕见的未报道并发症。
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_41_23
Pramod Sagar, Puthiyedath Thejaswi, Kothandam Sivakumar

Transcatheter correction of superior sinus venosus defects using covered stent is increasingly reported in the literature and provides an alternative option to surgery in appropriately selected adults. Being a new intervention, meticulous attention to procedural techniques and precise surveillance imaging modalities are vital to detect and avoid potential early and late complications. This report highlights the occurrence of a residual interatrial communication following covered stent placement and large subclinical asymptomatic nonocclusive thrombus formation at the right atrial end of the stent. The management of both these complications is also highlighted in this report.

文献中越来越多地报道了使用覆膜支架经导管矫正上静脉窦缺损,并为适当选择的成年人提供了手术的替代选择。作为一种新的干预措施,对手术技术和精确的监测成像模式的细致关注对于检测和避免潜在的早期和晚期并发症至关重要。本报告强调了覆膜支架置入后残余的试验间沟通的发生,以及支架右心房端形成的大型亚临床无症状非闭塞性血栓。本报告还强调了对这两种并发症的处理。
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引用次数: 1
Progressive changes in residual gradient after aortic coarctation repair and its role in the prediction of reintervention: A longitudinal data analysis. 主动脉缩窄修复后残余梯度的进行性变化及其在再干预预测中的作用:一项纵向数据分析。
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_140_22
Osama M Eldadah, Asseel Ali Alsalmi, Obayda M Diraneyya, Abdah A Hrfi, Mohammed H A Mohammed, Maria L Valls, Abdullah A Alghamdi

Background: Repair of aortic coarctation through left thoracotomy is the standard treatment when anatomically feasible. Long-term outcomes are well studied, including the need for reintervention. However, the timely variation in residual gradients across the repaired segment is ill-defined. The aim of this work was to study the progressive changes of estimated peak gradient (ePG) acquired by transthoracic continuous-wave Doppler echocardiography across the aortic arch after repair and to assess the role of timing of assessment and values of ePG in prediction of reintervention.

Materials and methods: All eligible patients for this study who underwent aortic coarctation repair through left thoracotomy from 2001 to 2017 were reviewed. Details of the aortic arch dimensions and associated lesions were obtained by transthoracic echocardiography (TTE). The primary outcome was the ePG across the aortic arch after repair. Longitudinal data analyses with mixed effect modeling were used to determine independent predictors for ePGs.

Results: A total of 312 patients were included. Median age and weight were 30 days and 4 kg, respectively. Associated lesions included ventricular septal defect (VSD) (53%), bicuspid aortic valve (53%) and mitral stenosis (25%). Over 15-years follow-up the freedom from reintervention was 92.3%, while 24 out of the 312 patients underwent reintervention (7.7%). Longitudinal data analyses of serial 2566 TTE studies were done. The graphical display showed that the ePG across coarctation area in the first postoperative TTE was the most notable difference between those who underwent reintervention and those who did not. Further testing with proportional hazard and logistic regression modeling confirmed this finding. The area under receiver operating curve statistics showed that an ePG of 25 mmHg is an optimal cutoff value for the prediction of the reintervention.

Conclusions: The ePG acquired in the first postoperative TTE is the most important predictor for reinterventions. The presence of VSD is associated with decreased ePGs. We propose that an ePG in the first postoperative TTE of 25 mmHg or more is a strong predictor for the need of reintervention.

背景:在解剖学上可行的情况下,通过左开胸修补主动脉缩窄是标准的治疗方法。长期结果得到了很好的研究,包括重新干预的必要性。然而,修复段上残余梯度的及时变化是不明确的。本工作的目的是研究主动脉弓修复后经胸连续波多普勒超声心动图获得的估计峰值梯度(ePG)的渐进变化,并评估评估时间和ePG值在预测再干预中的作用。材料和方法:回顾2001年至2017年通过左胸切开术进行主动脉缩窄修复的所有符合本研究条件的患者。通过经胸超声心动图(TTE)获得主动脉弓尺寸和相关病变的详细信息。主要结果是修复后穿过主动脉弓的ePG。采用混合效应模型的纵向数据分析来确定ePG的独立预测因素。结果:共纳入312名患者。中位年龄和体重分别为30天和4公斤。相关病变包括室间隔缺损(VSD)(53%)、二尖主动脉瓣(53%)和二尖瓣狭窄(25%)。在15年的随访中,没有再干预的患者为92.3%,而312名患者中有24名接受了再干预(7.7%)。对2566项经胸超声心动图系列研究进行了纵向数据分析。图形显示显示,术后第一次经胸超声心动图中缩窄区的ePG是接受再干预和未接受再干预的患者之间最显著的差异。比例风险和逻辑回归模型的进一步测试证实了这一发现。受试者工作曲线下面积统计表明,25mmHg的ePG是预测再干预的最佳截止值。结论:术后第一次经胸超声心动图获得的ePG是再干预最重要的预测指标。VSD的存在与ePG的减少有关。我们提出,术后第一次经胸超声心动图中ePG为25mmHg或以上是需要再次干预的有力预测因素。
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引用次数: 0
Secondary penicillin prophylaxis for latent rheumatic heart disease: A naïve realism? 潜伏性风湿性心脏病的二次青霉素预防:naïve现实主义?
IF 0.7 Q3 Medicine Pub Date : 2023-05-01 Epub Date: 2023-09-08 DOI: 10.4103/apc.apc_61_23
Shyam S Kothari
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引用次数: 0
期刊
Annals of Pediatric Cardiology
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