scholarly journals Immediate & medium-term results of balloon dilatation in native coarctation of aorta: a reasonable initial management strategy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A K Singal ◽  
S Ramakrishnan ◽  
S S Kothari ◽  
S Shivdas ◽  
K Gupta ◽  
...  
Keyword(s):  
Balloon Dilatation ◽  
Heart Defects ◽  
Tertiary Care ◽  
Coarctation Of Aorta ◽  
Medium Term ◽  
Life Threatening ◽  
The Mean ◽  
Life Threatening Complication ◽  
Acceptable Outcome

Abstract Background Coarctation of aorta (CoA) accounts for 5–10% of all congenital heart defects. Despite >20 years of experience with balloon dilatation (BD) as an effective therapy, initial choice of procedure still remains controversial. Purpose This study was planned to identify the predictors of success of BD in native CoA and to evaluate immediate & medium-term outcomes of the same. Methods This is a retrospective analysis of all BDs done over five years in a tertiary care centre. Success was defined as residual gradient ≤20 mmHg in the absence of a serious or life-threatening complication. In view of the high pre-dilatation gradient in many patients, a strict cut-off of 20 mmHg was not considered to be clinically feasible. Clinically acceptable outcome was thus defined as reduction of gradient to ≤20 mmHg or by ≥50% of baseline, to a final value ≤30 mmHg, in the absence of a serious or life-threatening complication. Repeat intervention on follow-up was considered in patients satisfying any of these criteria: symptoms attributed to CoA, significant residual gradient (>20 mmHg) with diastolic spill on echo, LV dysfunction, or refractory hypertension. Results Of the 111 cases analysed, 85 (76.5%) were male. The mean age was 11.79±12.64 years (1 month to 57 years). Bicuspid aortic valve was the most common associated anomaly, present in 42 (38%) patients. The mean gradient fell from 53.15±22.37 mmHg to 14.83±12.24 mmHg. Overall, the procedure was successful in 83 (74.8%) patients, and clinically acceptable outcome was obtained in 97 (87.4%) patients. Success rate and clinically acceptable outcome rate in the <18 years group was 80.7% (67/83) and 92.7% (77/83) respectively. Complications were seen in 9 (8.1%) cases. There was no mortality associated with the procedure. Ascending aortic pressure ≥150 mmHg [OR 27.94; 95% CI 1.30–598.84; p<0.001], and balloon to isthmus ratio <1 [OR 9.70; 95% CI 2.18–43.02; p<0.001] were significant negative predictors for success. At median follow-up of 43.5 months, reintervention free survival rate was 79.5% (62/78) in the overall group, and 81.5% (53/65) in the <18 years age group; with most of the repeat interventions being required within the first-year of the index procedure (14/16, 87.5%). Conclusion Immediate and medium-term success rates of BD in CoA are acceptable in majority of children and adolescents. High ascending aorta pressure and inadequate balloon size are important negative predictors of successful dilatation. Considering the economic advantages and reasonable success, balloon dilatation alone can be considered as a first line management option for native coarctation of aorta. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Massive haemorrhagic complications of ruptured pulmonary arteriovenous malformations: outcomes from a 12 years’ retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xu Ma ◽  
Bing Jie ◽  
Dong Yu ◽  
Ling-Ling Li ◽  
Sen Jiang
Keyword(s):  
Arteriovenous Malformations ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Pulmonary Arteriovenous Malformations ◽  
Imaging Data ◽  
Peripheral Lung ◽  
Life Threatening ◽  
The Mean

Abstract Background The life-threatening haemorrhagic complications of pulmonary arteriovenous malformations (PAVMs) are extremely rare, and only described in isolated cases. This study was designed to comprehensively investigate management of ruptured PAVMs. Methods We retrospectively assessed clinical and imaging data of ruptured PAVMs to summarize incidence, clinical characteristics, and outcomes following embolisation between January 2008 and January 2021. Results Eighteen of 406 (4.4%) patients with PAVMs developed haemorrhagic complications. Twelve of 18 patients were clinically diagnosed with hereditary haemorrhagic telangiectasia (HHT). Haemorrhagic complications occurred with no clear trigger in all cases. Eight of 18 patients (44.4%) were initially misdiagnosed or had undergone early ineffective treatment. 28 lesions were detected, with 89.3% of them located in peripheral lung. Computed tomography angiography (CTA) showed indirect signs to indicate ruptured PAVMs in all cases. Lower haemoglobin concentrations were associated with the diameter of afferent arteries in the ruptured lesions. Successful embolotherapy was achieved in all cases. After embolotherapy, arterial oxygen saturation improved and bleeding was controlled (P < 0.05). The mean follow-up time was 3.2 ± 2.5 years (range, 7 months to 10 years). Conclusions Life threatening haemorrhagic complications of PAVMs are rare, they usually occur without a trigger and can be easily misdiagnosed. HHT and larger size of afferent arteries are major risk factors of these complications. CTA is a useful tool for diagnosis and therapeutic guidance for ruptured PAVMs. Embolotherapy is an effective therapy for this life-threatening complication.

scholarly journals Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fabrizio Rivera ◽  
Alessandro Bardelli ◽  
Andrea Giolitti
Keyword(s):  
Operating Room ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Medium Term ◽  
Operating Room Table ◽  
Sf 36 ◽  
Standard Operating ◽  
The Mean

Abstract Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

Follow-Up Care Barriers for Patients with Orofacial Clefts

2021 ◽  
pp. 105566562110421
Author(s):  
Joshua Van Swol ◽  
Bethany J. Wolf ◽  
Julia Toumey ◽  
Phayvanh Pecha ◽  
Krishna G. Patel
Keyword(s):  
Outcome Measure ◽  
Tertiary Care ◽  
University Hospital ◽  
Exclusion Criteria ◽  
Actual Patient ◽  
The Mean ◽  
Return Visits ◽  
Significant Factors ◽  
Patient Attendance

Objective The aim of this study was to evaluate whether a patient with a cleft's age, associated syndrome, cleft phenotype or travel distance affects their follow-up rate. Design This study is a retrospective review of patients with CL/P treated by a craniofacial clinic. Setting The setting was a craniofacial clinic at a tertiary care university hospital. Patients, Participants Candidates were patients seen by the craniofacial clinic between January 2007 and December 2019. An initial pool of 589 patients was then reduced to 440 due to exclusion criteria. Interventions None Main Outcome Measure(s) The outcome measure was actual patient attendance to the craniofacial team compared to the team goal expectation of annual return visits. Results The mean age of participants at the end of the study was 9.0 ±  5.4 years with a mean follow-up period (total possible follow-up period length based on patient age at presentation and study window) of 5.5 ±  3.6 years. There was no association between cleft phenotype, type of syndrome, or distance to the clinic with attendance. Children with syndromes had an 11% decrease in the odds of attending follow-up visits with each 1-year increase in age compared to a 4% decrease in children without syndromes. Conclusions The only significant factors determining patient attendance were the presence of a syndrome and increasing age.

Medium term follow-up after balloon dilatation of congenital aortic stenosis (AVBD) in children

2003 ◽  
Vol 12 (2) ◽  
pp. A90
Author(s):  
Nageswara R. Koneti ◽  
Gary F. Sholler ◽  
Stephen Cooper ◽  
Richard E. Hawker
Keyword(s):  
Aortic Stenosis ◽  
Balloon Dilatation ◽  
Medium Term ◽  
Congenital Aortic Stenosis

Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions

2020 ◽  
Vol 102-B (11) ◽  
pp. 1491-1496
Author(s):  
Pranai K. Buddhdev ◽  
Ivor S. Vanhegan ◽  
Tahir Khan ◽  
Aresh Hashemi-Nejad
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Adolescent And Young Adult ◽  
Medium Term ◽  
Total Hip ◽  
Custom Made ◽  
The Mean ◽  
Custom Made Prostheses

Aims Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. Methods Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). Results The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. Conclusion Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491–1496.

scholarly journals Surgical outcome of isolated congenital supravalvular pulmonary stenosis: a case series

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Vikas Kumar ◽  
Sachin Mahajan ◽  
Vivek Jaswal ◽  
Shyam Kumar Singh Thingnam
Keyword(s):  
Pulmonary Stenosis ◽  
Main Pulmonary Artery ◽  
Tertiary Care ◽  
Case Series ◽  
Surgical Correction ◽  
Medium Term ◽  
Constriction Band ◽  
Supravalvular Stenosis ◽  
Mid Term Results

Abstract Background Supravalvular stenosis of main pulmonary artery is a rare anomaly characterized by the presence of constriction band just above the pulmonary valve. It is mostly acquired after intervention on the pulmonary trunk or less commonly is congenital in origin associated with complex congenital cardiac malformations and very rarely can present as an isolated native congenital supravalvular pulmonary stenosis (SPS). Case summary We present a series of four cases of isolated congenital SPS who underwent surgical correction at our tertiary care institute over 8 years. Mean age of the patients was 2.25 ± 0.96 years with all of them being males. Mean peak systolic gradient across the stenosis was 82 ± 21.48 mmHg ranging from 60 mmHg to 110 mmHg. There was no early and medium-term mortality with 100% survival at mean follow-up of 31 months (range 7–85 months). Discussion Surgical correction of congenital SPS carries excellent early and mid-term results with almost no mortality and very low risk of re-intervention for restenosis.

scholarly journals 375. Cryptococcal Antigenemia in Advanced HIV Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S196-S196
Author(s):  
Jatin Ahuja ◽  
Manish Soneja ◽  
Naveet Wig ◽  
Immaculata Xess ◽  
Ashutosh Biswas ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Care Center ◽  
Tertiary Care ◽  
Latex Agglutination ◽  
Cd4 Count ◽  
North India ◽  
World Health ◽  
P Value ◽  
The Mean

Abstract Background Diagnostic importance of asymptomatic cryptococcal antigenemia is being increasingly recognized in the last few years. Recently, WHO (World Health Organization) has recommended routine screening of CrAg (cryptococcal antigen) among PLHA with CD4 ≤100/mm3, albeit this procedure is not yet adopted by many developing countries including India. Methods We conducted a prospective observational study in a large tertiary care center of North India, upon ethical clearance. Latex agglutination test was performed to assess serum CrAg levels, followed by the lumbar puncture for detection of CrAg levels in the CSF. We analyzed the prevalence and treatment outcomes of cryptococcal antigenemia among PLHA with CD4 ≤ 100 cells/mm3. Detailed clinical examination was conducted, with follow-up of upto 3 months. Multivariate analysis was performed for the estimation of risk factors. Results The mean age (years) and BMI (kg/m2) of all the participants were 41.4 ± 11.2 and 22.1 ± 2.6, respectively. Notably, the mean CD4 count (cu.mm) at the time of recruitment was 62.3 ± 20.5. Noteworthy, 62 (60.8%) of the patients were ART naïve. We found 9.8% (n = 10) of the patients were positive for serum CrAg, and only 2.9% (n = 3) had clinical features of meningitis and 6.8% (n = 7) were asymptomatic (subclinical) CrAg positive. Strikingly, 3.9% (n = 4) of the asymptomatic cryptococcal antigenemia patients were also positive for CrAg in CSF, with 1.9% (n = 2) were only serum CrAg positive, and 1 patient was lost to follow-up (Graph 1). Multivariate analysis revealed that patients with long duration of HIV (P = 0.04), headache symptoms (P = 0.004) and possessing features of meningismus (P value=0.08) are more likely to be CrAg positive. Conversely, patients on fluconazole were protective against cryptococcal antigenemia (P = 0.1) as shown in Table 1. Overall mortality observed was 11.3% among advanced HIV patients. Moreover, mortality in CrAg-positive patients was 33.3% in comparison to CrAg-negative patients who had 9% (P = 0.06) in 3-months follow-up. Conclusion Cryptococcal antigenemia is common (9.8%) among patients with CD4 count ≤100/mm3 in India. Screening for CrAg should be made routine for PLHA with CD4 count ≤100/mm3 and if required preemptive treatment to be given in this regard. Disclosures All authors: No reported disclosures.

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

2019 ◽  
Vol 161 (1) ◽  
pp. 123-129 ◽  
Author(s):  
C. Burton Wood ◽  
Robert Yawn ◽  
Anne Sun Lowery ◽  
Brendan P. O’Connell ◽  
David Haynes ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Ossicular Chain ◽  
Tertiary Care Center ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Hearing Outcomes

Objective(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.Study DesignCase series with chart review.SettingTertiary care center.Subject and MethodsThis study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.ResultsIn total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).ConclusionTitanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

scholarly journals Neuroendoscopic lavage and continuous drainage of ventricles: Treatment of pyocephalus in a newborn

2019 ◽  
Vol 1 (1) ◽  
pp. 55-59
Author(s):  
Ram Babu Joshi ◽  
Rupendra Bahadur Adhikari ◽  
Amit Thapa
Keyword(s):  
Clinical Cure ◽  
Obstructive Hydrocephalus ◽  
Primary Treatment ◽  
Direct Visualization ◽  
Pyogenic Meningitis ◽  
Continuous Drainage ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Ventriculo Peritoneal Shunt

Pyocephalus/Cerebral ventricular empyema is a serious life threatening complication of acute pyogenic meningitis. The primary treatment of ventriculitis is administration of antibiotics. With recent advances, neuroendoscopic lavage (NEL) of ventricles through direct visualization has helped save lives when multipronged approaches including intravenous (IV) antibiotics, intrathecal antibiotics and continuous drainage of cerebrospinal fluid (CSF) fails. We report a case of a 23-day old neonate who developed pyocephalus as a complication of pyogenic meningitis. He did not respond favorably to initial IV antibiotic treatment for two weeks. NEL of ventricles was performed. Thick pus/flakes inside the ventricles had caused obstructive hydrocephalus. Continuous CSF drainage was done through strategically placed multiple external ventricular drains. Interval ventriculo-peritoneal shunt was done bilaterally after the CSF was macroscopically/ microscopically clear of visible debris, and sterile. Microbiological and clinical cure was achieved and the child survived and is thriving well at last follow-up at the age of 6 months.

scholarly journals Tracheal development after left pulmonary artery reimplantation: an individual study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Xiaoyang Hong ◽  
Ruijie Li ◽  
Zhe Zhao ◽  
Jiangheng Guan ◽  
Hui Wang ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Weaning Failure ◽  
Threatening Condition ◽  
Ventilation Weaning ◽  
Life Threatening ◽  
The Mean ◽  
Tracheal Carina

Abstract Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.

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