scholarly journals A New Hydrolyzed Formula is Well Tolerated in Infants with Suspected Food Protein Allergy or Intolerance

2015 ◽  
Vol 9 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Marlene W. Borschel ◽  
Geraldine E. Baggs
Keyword(s):  
Primary Outcome ◽  
Food Protein ◽  
Z Score ◽  
Z Scores ◽  
Allergic Colitis ◽  
The Mean ◽  
New Formulation ◽  
High Level ◽  
Hydrolyzed Formula ◽  
Intended Use

Background: Extensively hydrolyzed formulas (eHF) are indicated for infants with food protein allergy. The purpose of the study was to assess the tolerance and compliance of an intended population of infants to a new formulation of a hypoallergenic eHF. Methods: A non-random, single-group, multicenter study was conducted. Infants with suspected food protein allergy, persistent feeding intolerance, or presenting conditions where an eHF was deemed appropriate were enrolled in a 15-day feeding trial. Intake, stool patterns, weight (wt), length, and questionnaires were collected. The primary outcome was maintenance of wt for age Z-score during the study. Results: 25 infants (85 ± 8.9 d of age) were enrolled; 7 were ≥ 4 months; 4 were preterm. At entry, 12 had symptoms of allergic colitis or food protein allergy/intolerance, 12 had persistent formula intolerance, 11 had hematochezia/heme positive stools, and 1 was recovering from necrotizing enterocolitis. Mean wt for age Z-score was -0.62 ± 0.19 at entry and -0.41 ± 0.16 at exit. Mean change in wt for age Z-score was 0.21 ± 0.10. Mean formula intake was 764 ± 48 mL/day. The mean number of stools/day was 1.8 ± 0.4 and the predominant stool consistencies were loose/mushy (48%) or soft (43%). Conclusion: The results suggest that this eHF was well accepted and tolerated by an intended use population of infants during the first 6 months of life which enabled adequate volume consumption, maintenance of wt for age Z-scores and a high level of parental satisfaction.

scholarly journals Growth, Tolerance, and Compliance of Infants Fed an Extensively Hydrolyzed Infant Formula with Added 2′-FL Fucosyllactose (2′-FL) Human Milk Oligosaccharide

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 186
Author(s):  
Carlett Ramirez-Farias ◽  
Geraldine E. Baggs ◽  
Barbara J. Marriage
Keyword(s):  
Primary Outcome ◽  
Clinical Symptoms ◽  
Food Protein ◽  
Feeding Intolerance ◽  
Feeding Trial ◽  
Study Results ◽  
Z Scores ◽  
Hydrolyzed Formula ◽  
Intended Use ◽  
Weight For Age

Background: The purpose of this study was to evaluate the growth, tolerance and compliance effects of an extensively hydrolyzed formula with added 2′-FL in an intended use population of infants. Methods: A non-randomized, single-group, multicenter study was conducted. Infants (0–60 days of age) with suspected food protein allergy, persistent feeding intolerance, or presenting conditions where an extensively hydrolyzed formula (eHF) was deemed appropriate were enrolled in a 2-month feeding trial. The primary outcome was maintenance of weight for age z-score during the study. Weight, length, head circumference, formula intake, tolerance measures, clinical symptoms and questionnaires were collected. Forty-eight infants were enrolled and 36 completed the study. Results: Weight for age z-scores of infants showed a statistically significant improvement from study day 1 to study day 60 (0.32 ± 0.11, p = 0.0078). Conclusions: Overall, the results of the study demonstrate that the study formula was well tolerated, safe and supported growth in the intended population.

scholarly journals Trials of the Automated Particle Counter for laboratory rearing of mosquito larvae

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241492
Author(s):  
Mark Q. Benedict ◽  
Priscila Bascuñán ◽  
Catherine M. Hunt ◽  
Erica I. Aviles ◽  
Rachel D. Rotenberry ◽  
...  
Keyword(s):  
Light Intensity ◽  
Z Score ◽  
Target Number ◽  
Water Stream ◽  
Throughput Rate ◽  
Laboratory Rearing ◽  
Particle Counter ◽  
Type Device ◽  
Z Scores ◽  
The Mean

As a means of obtaining reproducible and accurate numbers of larvae for laboratory rearing, we tested a large-particle flow-cytometer type device called the ‘Automated Particle Counter’ (APC). The APC is a gravity-fed, self-contained unit that detects changes in light intensity caused by larvae passing the detector in a water stream and controls dispensing by stopping the flow when the desired number has been reached. We determined the accuracy (number dispensed compared to the target value) and precision (distribution of number dispensed) of dispensing at a variety of counting sensitivity thresholds and larva throughput rates (larvae per second) using < 1-day old Anopheles gambiae and Aedes aegypti larvae. All measures were made using an APC algorithm called the ‘Smoothed Z-Score’ which allows the user to define how many standard deviations (Z scores) from the baseline light intensity a particle’s absorbance must exceed to register a count. We dispensed a target number of 100 An. gambiae larvae using Z scores from 2.5–8 and observed no difference among them in the numbers dispensed for scores from 2.5–6, however, scores of 7 and 8 under-counted (over-dispensed) larvae. Using a Z score ≤ 6, we determined the effect of throughput rate on the accuracy of the device to dispense An. gambiae larvae. For rates ≤ 98 larvae per second, the accuracy of dispensing a target of 100 larvae was - 2.29% ± 0.72 (95% CI of the mean) with a mode of 99 (49 of 348 samples). When using a Z score of 3.5 and rates ≤ 100 larvae per second, the accuracy of dispensing a target of 100 Ae. aegypti was - 2.43% ± 1.26 (95% CI of the mean) with a mode of 100 (6 of 42 samples). No effect on survival was observed on the number of An. gambiae first stage larvae that reached adulthood as a function of dispensing.

P122 SEX DIFFERENCES IN STATURAL GROWTH IMPAIRMENT IN PEDIATRIC CROHN’S DISEASE: EARLY FINDINGS FROM THE GROWTH STUDY

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S45-S46
Author(s):  
Neera Gupta ◽  
Robert Lustig ◽  
Howard Andrews ◽  
Francisco Sylvester ◽  
David Keljo ◽  
...  
Keyword(s):  
Sex Differences ◽  
Sex Difference ◽  
Z Score ◽  
Growth Study ◽  
Negatively Associated ◽  
Hormone Levels ◽  
Growth Impairment ◽  
Score Difference ◽  
Z Scores ◽  
The Mean

Abstract Background Statural growth impairment is both a marker and complication of poorly controlled Crohn’s disease (CD), and occurs more commonly in males than females. The specific molecular mechanisms responsible for this sex difference in growth impairment in CD remain poorly characterized. Methods We are conducting a prospective multicenter longitudinal study (Growth Study) examining sex differences in statural growth impairment in school-age children with CD with growth potential based on bone age (BA) [females (BA 4 yrs, 2 mos to 12 years, 0 months) and males (BA 5 years, 0 months to 14 yrs, 0 mos)]. We have enrolled 118 (65% male) patients. Variable Z scores calculated based on BA are denoted as Variable BA-Z scores; those calculated based on chronological age (CA) are denoted as Variable CA-Z scores. Height Z score difference was calculated as Height CA-Z score minus Height BA-Z score. We analyzed the concentration of selected cytokines in serum in 54 patients (56% male), using a V-Plex kit (Meso Scale Discovery, Rockville, MD). Serum hormone levels were analyzed at Esoterix Endocrinology (Calabasas Hills, CA). We used t-test and Chi-squared test to examine the sex difference for continuous variables and categorical variables respectively. We assessed the association between cytokines and hormones via linear regression. Results The mean height Z score difference was -0.4 ± 1.0 (SD) [range: -3.9 to 2.0] in males and -1.1 ± 1.1 [-3.9 to 0.9] in females (Figure). The absolute value of the mean height Z score difference was significantly lower in males (P= 0.021). The mean BA Z score was (0.0 ± .04 [-0.7 to 0.9]) in males and (0.0 ± 0.2 [-0.4 to 0.5]) in females (P= 0.952). Race/ethnicity [76% White], Tanner stage [63% pre/early puberty; 37% mid/late puberty], mean disease duration [2.3 ± 1.9 (SD) (range: 0.1 to 8.3) years], medication use [65% infliximab; 39% methotrexate; 13% azathioprine/6-mercaptopurine; 9% adalimumab], and mean disease activity indices (indicated remission) did not differ by sex (P= NS for all). TNF-α, IL-4, IL-6, IL-10, and IL-12 were significantly negatively associated with hormones important in growth in males, while IL-13 was significantly negatively associated with hormones important in growth in females (Table). Conclusions Statural growth remains compromised in males compared with females in a novel contemporary cohort of children with CD. Our early data suggest that the higher frequency of growth impairment in males appears to be due to less standardized height gain with skeletal maturation, rather than advanced BA progression. BA does not appear to be significantly delayed in this cohort. Furthermore, our preliminary data suggest that systemic inflammation exerts a greater negative impact on hormone levels important in growth in males, and that different molecular pathways lead to growth impairment in males versus females. We are further investigating these preliminary findings in the ongoing prospective multicenter longitudinal Growth Study.

Bone Mineral Density in Transfusion Independent Thalassemia Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3353-3353
Author(s):  
Zahra Pakbaz ◽  
Zhe Zhang ◽  
Ellen Fung ◽  
Nancy Sweeters ◽  
Sylvia Singer ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Family History ◽  
Bone Mineral ◽  
Z Score ◽  
Low Bone Mass ◽  
Mineral Density ◽  
Patients Âgés ◽  
Z Scores ◽  
History Of ◽  
The Mean

Abstract Low bone mineral density (BMD) is commonly seen in regularly transfused thalassemia patients; however, there have been few reports for bone mineral density assessment in transfusion independent thalassemia patients. The present report includes the results of BMD assessments in patients with transfusion independent thalassemia who were referred to the bone density clinic through 2002–2006. BMD was evaluated by dual energy x-ray absorptiometry (DXA, Hologic Delphi A). A convenience sample of 24 patients (Females=15) with transfusion independent thalassemia were measured with a mean age of 22.1 ± 13.8 years. Subjects younger than 10 yrs old (n = 7) underwent scans for Lumbar spine (LS; L1-L4) and whole body (WB), patients ages 10–20 (n = 5) were assessed for LS, WB, and non-dominant hip, and for patients older than 20 (n = 12), LS and hip scans were completed. Z-scores specific for age and gender were generated using Zemel BS et al.(J. Bone Min Res 2004) database. Z-scores less than −2.0 were considered as low bone density. Calcium intake was assessed by a brief food frequency questionnaire. Past medical history, medications, history of fractures, and family history of osteoporosis were obtained by chart review and patient interview. Data is presented as Mean ± SD. T-test was used to assess differences in continuous variables. The mean LS Z-score (n = 24) was −1.5 ± 1.0 and the mean hip Z-score (n = 17) was −0.5 ± 1.1. Mean WB Z-score (n = 10) was −2.0 ± 1.2. There was a significant (p<0.001) difference between spine and hip Z-scores. Overall 46% had a Z-score less than −2.0. Thirty-three percent of patients have spine Z-scores of less than −2.0 and 25% spine Z-scores between −2.0 and −1.0. Average spine Z-score in patients younger than 10 years old (n=7) was −1.6 ± 0.5. In WB scans, 50% of the patients had WB Z-scores worse than −2.0. None of the young patients (5–9 yrs; n = 7) consumed inadequate intake of calcium (< 2/3 of RDA age specific) while 75% of patients ages 10–20 (n = 4) years old consumed inadequate intake of calcium (dietary + supplement). Neither spine nor hip Z-score was related to patients’ gender, age, and calcium intake. Two patients reported fractures in the past and two reported family history of osteoporosis. Six patients had delayed puberty and one has hypogonadism. Seven patients have short stature. This data suggests that low bone mass is not only a problem in transfused thalassemia patients, but is also observed in non-transfused patients. The significance and pathophysiology of low bone mass should be studied further in non-transfused patient population, especially in younger children.

scholarly journals Introduction to and Screening Visit Results of the Multicenter Pediatric Crohn’s Disease Growth Study

2020 ◽  
Vol 26 (12) ◽  
pp. 1945-1950 ◽  
Author(s):  
Neera Gupta ◽  
Robert H Lustig ◽  
Howard Andrews ◽  
Francisco Sylvester ◽  
David Keljo ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bone Age ◽  
Skeletal Maturation ◽  
Delayed Puberty ◽  
Z Score ◽  
Growth Study ◽  
Score Difference ◽  
Z Scores ◽  
The Mean

Abstract Background Statural growth impairment is more common in males with Crohn’s disease (CD). We assessed sex differences in height Z score differences and bone age (BA) Z scores and characterized age of menarche in a novel contemporary cohort of pediatric CD patients undergoing screening for enrollment in the multicenter longitudinal Growth Study. Methods Crohn’s disease patients (females with chronological age [CA] 5 years and older and younger than 14 years; males with CA 6 years and older and younger than 16 years) participated in a screening visit for the Growth Study. Height BA-Z scores are height Z scores calculated based on BA. Height CA-Z scores are height Z scores calculated based on CA. The height Z score difference equals height CA-Z score minus height BA-Z score. Results One hundred seventy-one patients (60% male) qualified for this analysis. Mean CA was 12.2 years. Mean height CA-Z score was −0.4, and mean height BA-Z score was 0.4 in females. Mean height CA-Z score was −0.1, and mean height BA-Z score was 0.2 in males. The absolute value of the mean height Z score difference was significantly greater in females (0.8) than males (0.3; P = 0.005). The mean BA-Z score in females (−1.0) was significantly lower than in males (−0.2; P = 0.002). The median CA at menarche was 13.6 (95% CI, 12.6–14.6) years. Conclusions Our screening visit data suggest that standardized height gain is lower in males with skeletal maturation and delayed puberty is common in females in CD. We are investigating these findings in the ongoing Growth Study.

scholarly journals Testing Altman’s Z’’-Score to assess the level of accuracy of the model in Mexican companies

Nova Scientia ◽  
2021 ◽  
Vol 13 (27) ◽  
Author(s):  
Martín P. Pantoja Aguilar ◽  
Guadalupe de Montserrat Pizano Ramírez ◽  
Berenice Lerma Torres ◽  
Miguel Ángel Zavala Vargas
Keyword(s):  
Longitudinal Research ◽  
Stock Exchange ◽  
Total Error ◽  
Time Frame ◽  
Emerging Countries ◽  
Bankruptcy Prediction ◽  
Z Score ◽  
Z Scores ◽  
Score Model ◽  
High Level

Introduction: in 1968, Altman developed a multivariable predictive Z-score model to assess the probability of a public manufacturing company going to bankruptcy based on financial ratios. Later, Altman (1983) re-stated a more improved Z’’-Score model designed to apply in public or private, manufacturing, or non-manufacturing firms, but also in emerging countries. Prediction of the updated model proved to be highly efficient. This research was conducted to prove the level of accuracy of the Z’’-Score model applied to firms listed in the Mexican Stock Exchange (MSE) since there is little relevant research on this subject.                     Method: this research was conducted under a quantitative approach as a census and its scope was situational with a non-experimental and longitudinal research design. The period covered by this research was 2012-2019 since the data was available for those years under a somehow stable economic situation without significant economic ups and downs. This research considered the integration of a large financial database and the design of a typology to classify and analyze 155 firms based on a standard deviation and average results of 837 Z’’-scores. A second analysis was conducted to prove if the predicted situation (area) by the Z’’-Score corresponded to the real situation in the marketplace for every company. Results: the results showed that the accuracy level of the Altman model decreased when applied to Mexican firms. The error of the model applied to Mexican companies related to those classified in the bankruptcy prediction area was 75 % of misclassification cases. The total error of the model included all areas, or cases, was 18 % of misclassification cases. This model is supposed to be effective within a time frame of two years before a possible bankruptcy. Even considering a longer time frame, the companies located in the bankruptcy prediction area continued having misclassifications representing 57 % of error. The error for the model considering all cases and all areas, was 14 % of misclassification cases. This represented a high level of inefficiency of the model applied to an emerging country companies, such as Mexico. Discussion or conclusion: the model is certainly effective while predicting companies in the areas of non-bankrupt sector and grey, but it was inefficient when predicting the possibility of bankruptcy. It was also demonstrated that the time frame of two years is no longer effective when applying the model to Mexican companies. As a result, more research cases are needed to update the model to perform efficiently in emerging countries including country-specific conditions and considering a different time frame to predict bankruptcy.

scholarly journals Change In Nitrogen Dioxide (No2 ) Concentration Due To The Lockdown Amid The Covid-19 Pandemic In India

2021 ◽  
Vol 14 (4) ◽  
pp. 192-198
Author(s):  
Zubairul Islam ◽  
Sudhir Kumar Singh ◽  
Saroj Ahirwar
Keyword(s):  
Nitrogen Dioxide ◽  
Ordinary Least Squares ◽  
Z Score ◽  
Strong Positive Relationship ◽  
Independent Variable ◽  
The Mean ◽  
Spatio Temporal ◽  
High Level ◽  
Spatially Varying ◽  
Method Show

The study aimed to examine the change in the concentration of nitrogen dioxide due to the lockdown amid the COVID-19 pandemic in India at the district level using Sentinel-5P TROPOMI. The spatio-temporal characteristics of the tropospheric column NO2  concentration during 45 days of the lockdown were compared with the same days of 2019. Further, to model spatially varying relationships of NO2 during the lockdown period, it was given as a dependent variable whereas NO2 during the pre-lockdown period was considered as an independent variable. Results show that the mean NO2 concentration was reduced from 0.00406 mol/m2 before the lockdown (2019-03-25 to 2019-05-10) to 0.0036 mol/m2 during the lockdown period (2020-03-25 to 2020-05-10). The maximum decline of NO2 concentration was observed in Gautam Buddha Nagar and Delhi. This indicates the high level of atmospheric pollution due to the excess use of fuel in human activities. The results of the Ordinary Least Squares (OLS) method show a strong positive relationship between both variables. Positive standard residuals indicate that the concentration of NO2 has reduced more than expected as per the OLS model. The z-score (24.11) was obtained from spatial autocorrelation. It indicates that residuals are highly clustered and there is less than a 1% likelihood that this clustered pattern could be a result of a random chance. The highest decrease was observed in districts/urban agglomerations of Gautam Buddha Nagar (-40%), Delhi (-37%), Greater Bombay (-31%), Hyderabad (-29%), Faridabad (-29%), Bangalore Urban (-28%), Gandhinagar (-27%), Chennai (-27%) and Gurgaon (-26%) respectively.

scholarly journals Telomere Length in Inherited Bone Marrow Failure Syndromes

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1609-1609
Author(s):  
Blanche P. Alter ◽  
Neelam Giri ◽  
Sharon A Savage ◽  
Philip S. Rosenberg
Keyword(s):  
Bone Marrow ◽  
T Cells ◽  
Bone Marrow Failure ◽  
Canonical Variate ◽  
Dna Repeats ◽  
Z Score ◽  
Essentially Normal ◽  
Bone Marrow Failure Syndromes ◽  
Z Scores ◽  
The Mean

Abstract Background: Telomeres are short DNA repeats and a protein complex at chromosome ends that are essential for genome integrity. Telomeres are very short in patients with dyskeratosis congenita (DC) due to germline mutations in telomere biology genes. Telomere lengths (TL) were reported to be “short” in a few small studies of patients with other inherited bone marrow failure syndromes (IBMFS), specifically Fanconi anemia (FA), Diamond-Blackfan anemia (DBA), and Shwachman-Diamond syndrome (SDS), although their relation to the very short TL seen in DC was not clear, and various analytic methods were used. Objectives: 1) To compare TL in a cohort of patients with FA, DBA, and SDS, with TL in DC. 2) To determine whether any individuals with non-DC IBMFS had TL as short as in DC. Methods: Blood was obtained from 100 patients with DC, 30 FA, 34 DBA, and 14 SDS enrolled in the NCI IBMFS Cohort Study. TL was measured by flow cytometry with fluorescence in situ hybridization (flow-FISH) in 6 leukocyte subsets: granulocytes, total lymphocytes, CD45RA-positive/CD20-negative naïve T cells, CD45RA-negative memory T cells, CD20-positive B cells, and CD57-positive NK/NKT cells. “Very short” TL was below the 1st percentile for age (defined by 400 normal controls). The diagnosis of DC required very short TL in 3 of 4 lymphocyte lineages including total lymphocytes. Z-scores were used to adjust for age; a Z-score of -2.3 equals the 1st percentile. Canonical Variate Analysis (CVA) including all 6 Z-score measurements was used for group comparisons and outlier identification. Results: Two patients with FA and 1 each with DBA and SDS had TL slightly below the 1st percentile in 3 or more lymphocyte lineages. In univariate analysis, the mean of the DC TL Z-scores was approximately -4, versus approximately -0.5 in FA, DBA, and SDS. Most individual DC Z-score measurements were well below -2.3, and all were below zero (the mean for the control data). Seventy percent of the FA, DBA and SDS lymphocyte TL Z-scores clustered in the bottom half of the normal range (i.e. -2.3 to 0, p <0.001), compared with the expected 50% if the non-DC patients had essentially normal TLs. In addition, short lymphocyte TL correlated with severity of marrow failure in DC; there was a non-significant trend in FA and no trend in DBA or SDS. Further refinement of interpretation utilized the CVA analysis. The first canonical variate captured 89.7% of the total variance, and separated DC widely from the other three IBMFS. The second canonical variate captured 10% of the variance, and separated DBA, FA, and SDS. In the CVA analysis, only 2 patients with FA and 1 each with DBA and SDS had results closer to the mean for DC patients than to the mean for their own disorder. Conclusions: Only 5% of individuals with FA, DBA, or SDS had TL in the DC range, and thus non-DC IBMFS in general do not have “very short” TL. However, 70% of non-DC IBMFS patients did have average TLs below the average for normal individuals. Thus disorders of DNA repair or ribosome biogenesis may result in TL changes, but the deficit in TL is not nearly as extreme as in DC itself. Disclosures No relevant conflicts of interest to declare.

scholarly journals Changes in bone mineral density over 10 years in patients with early rheumatoid arthritis

RMD Open ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e001142
Author(s):  
Lisa Theander ◽  
Minna Willim ◽  
Jan Åke Nilsson ◽  
Magnus Karlsson ◽  
Kristina E Åkesson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Z Score ◽  
Mineral Density ◽  
Early Ra ◽  
Z Scores ◽  
The Mean

ObjectivesTo investigate changes in bone mineral density (BMD) in patients with early rheumatoid arthritis (RA) over a 10-year period.MethodsConsecutive patients with early RA (symptom duration <12 months) were followed according to a structured programme and examined with dual-energy X-ray absorptiometry (DXA) at inclusion and after 2, 5 and 10 years. Mean Z-scores over the study period were estimated using mixed linear effect models. Changes in Z-scores between follow-up visits were analysed using paired T-tests.ResultsAt inclusion, 220 patients were examined with DXA. At the femoral neck, the mean Z-score over 10 years was −0.33 (95 % CI −0.57 to −0.08) in men and −0.07 (−0.22 to 0.08) in women. Men had significantly lower BMD at the femoral neck than expected by age at inclusion (intercept Z-score value −0.35; 95 % CI −0.61 to −0.09), whereas there was no such difference in women. At the lumbar spine, the mean Z-score over the study period for men was −0.05 (−0.29 to 0.19) and for women 0.06 (−0.10 to 0.21). In paired comparisons of BMD at different follow-up visits, femoral neck Z-scores for men decreased significantly from inclusion to the 5-year follow-up. After 5 years, no further reduction was seen.ConclusionsIn this observational study of a limited sample, men with early RA had reduced femoral neck BMD at diagnosis, with a further significant but marginal decline during the first 5 years. Lumbar spine BMD Z-scores were not reduced in men or women with early RA. Data on 10-year follow-up were limited.

scholarly journals Impact of pulmonary artery reduction during arterial switch operation: 14 years follow-up

2020 ◽  
Vol 30 (6) ◽  
pp. 917-924
Author(s):  
Fernanda Lübe Antunes Pereira ◽  
Cristiane Nunes Martins ◽  
Roberto Max Lopes ◽  
Matheus Ferber Drummond ◽  
Fernando Antonio Fantini ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Z Score ◽  
Valve Regurgitation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Long Term Follow Up ◽  
Z Scores ◽  
The Mean

Abstract OBJECTIVES Pulmonary artery/aorta (PA/Ao) size discrepancy plays an important role in the development of neoaortic root growth and valve regurgitation. Since 2004, we started using PA reduction to manage severe great vessels root mismatch at the time of arterial switch operation. The purpose of this study is to evaluate the impact of this technique in the mid- and long-term follow-up. METHODS Patients considered to have severe PA/Ao mismatch (&gt;2:1 ratio) underwent resection of a 3- to 4-mm flap of the posterior PA wall. Patients submitted to this technique were followed up with clinical and image examinations. Echocardiographic findings were reviewed, and Z-scores were recorded to evaluate the incidence and progression of neoaortic root dilatation and valve regurgitation. RESULTS The median (Q1–Q3) follow-up time was 8 years (3–11). Before arterial switch operation, the median (Q1–Q3) Z-score of the PA annulus was 2.90 (2.75–3.75). At the latest follow-up, the median Z-score of the neoaortic annulus was 1.34 (0.95–1.66). The mean difference between the Z-scores of PA annulus and neoaortic annulus was 1.56 (P &lt; 0.0001). The mean value of the sinus of Valsalva was +0.29 ± 1, that of sinotubular junction was +0.71 ± 0.6 and that of ascending Ao was +1.09 ± 0.7. There was no severe dilatation of the neoaortic annulus, neoaortic root or ascending Ao during follow-up. Neoaortic valve regurgitation was none or mild in 93% of patients. CONCLUSIONS PA reduction proved to be a feasible and low-risk procedure to approach PA/Ao mismatch in arterial switch operation. Mid- and long-term follow-up showed a tendency towards stabilization of the neoaortic root dilatation and satisfactory valve performance after the procedure. Further investigation is required with a larger population and longer-term follow-up.

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