scholarly journals Challenges in device closure of PDA in adults.

2021 ◽  
Vol 29 (01) ◽  
pp. 71-76
Author(s):  
Tauseef Asma Chaudhry ◽  
Muhammad Younas ◽  
Muhammad Ahsan Beg ◽  
Baqir Maqboool
Keyword(s):  
Pulmonary Hypertension ◽  
Pediatric Cardiology ◽  
Type B ◽  
Severe Pulmonary Hypertension ◽  
Device Closure ◽  
Cross Sectional ◽  
Large Size ◽  
Post Procedure ◽  
Adolescents And Adults ◽  
Type C

Objective: To describe the challenges and outcomes of per cutaneous closure of PDA in adolescents and adults. Study Design: Cross Sectional, Retrospective Analysis. Setting: Department of Pediatric Cardiology, CPE Institute of Cardiology, Multan. Period: 2017 to 2019. Material & Methods: A total of 111 adolescent and adult patients were included in the study. Patients with irreversible severe pulmonary hypertension were not included. Sampling with consecutive nonprobability was done. Procedure was done according to standard protocols. Different devices were used in different patients according to morphology of defect. Devices included SHSMA and Lifetech duct occluders. In two patients VSD muscular devices were also used. Results: Mean age was 22 + 7.88 years. Out of these 111 subjects, 72 (63%) were female and 39 (37%) were male with a ratio of 1.84:1. Two patients were of moderate size (3-5mm) PDA, 26 (27%) were of moderately large (5-7mm) size and majority of patients had large size (>7mm) PDA (55%). Majority of PDAs were type A (100, 90%), one was type B, 4 were type C and 6 were of type E according to Krichenko classification. No complications occurred except in one patient in which device was embolized. Foaming through the device was noted in 65 patients after 24 hours post procedure echocardiography. Conclusion: It was concluded that PDA device closure has its own challenges in adults but it is safe and effective as well.

Transcatheter closure of Abernethy malformation associated with interrupted inferior caval vein and other systemic venous anomalies

2021 ◽  
pp. 1-3
Author(s):  
Samir Shakya ◽  
Anita Saxena ◽  
Sivasubramanian Ramakrishnan
Keyword(s):  
Pulmonary Hypertension ◽  
Transcatheter Closure ◽  
Rare Entity ◽  
Severe Pulmonary Hypertension ◽  
Device Closure ◽  
Venous Anatomy ◽  
Vascular Plug ◽  
Caval Vein ◽  
Abernethy Malformation ◽  
Inferior Caval Vein

Abstract Abernethy malformation is a rare entity. We report a 5-year-old boy presenting with severe pulmonary hypertension in whom Abernethy malformation and inferior caval vein interruption were diagnosed by CT angiography. In addition, the iliac veins were thrombosed with multiple venous collateral drainage. This abnormal venous anatomy caused difficulty in device closure of the Abernethy malformation, which was successfully closed using a vascular plug.

Abstract 17022: Pericardial Decompression Syndrome: Incidence in a Large Consecutive Series of Echocardiographic-Guided Pericardiocentesis Procedures

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Chadi Ayoub ◽  
Annop Lekhakul ◽  
Chalailak Assawakawintip ◽  
Eric Fenstad ◽  
Sorin Pislaru ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiogenic Shock ◽  
Large Volume ◽  
Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Pericardial Fluid ◽  
Consecutive Series ◽  
Severe Pulmonary Hypertension ◽  
Clinical Events ◽  
Post Procedure

Introduction: Pericardial decompression syndrome (PDS) has been reported as a spectrum of cardiac decompensation following pericardiocentesis including ventricular failure, cardiogenic shock and pulmonary edema. PDS has been reported in patients undergoing drainage ≥450 mL of pericardial fluid. Hence judicious drainage of large volume effusions to avoid complication has been recommended Hypothesis: PDS complicating undergoing transthoracic echocardiography (TTE) guided pericardiocentesis is uncommen Methods: Consecutive patients undergoing TTE guided pericardiocentesis at our center from 1/2007 to 12/2016 were reviewed. Procedures were performed in a standard fashion under moderate conscious sedation with TTE determining the location of aspiration and determining adequate resolution of pericardial fluid post procedure. All fluid was removed at time of centesis regardless of the size of effusion, except for patients with severe pulmonary hypertension (n=9), who had staged removal of 100cc every 10 minutes. Post procedure, a pigtail catheter was left in the pericardial space for ongoing intermittent drainage and removed after the total net output was <50 mL/24 hours. Patients were monitored in an intermediate level care unit. All patients underwent repeat TTE at the time of catheter removal. Large volume was defined as ≥450 mL of fluid. Patients in whom pericardiocentesis was technically unsuccessful were excluded Results: Over a 10-year period a total of 1067 patients (57% male, mean age 62±16 years) underwent 1164 technically successful pericardiocentesis procedures. Of these, 561 patients had large volume (≥450 mL) aspirated (mean 750±345 mL aspirated, range 450 - 4300 mL). Patients had a pericardial catheter in place for a mean 2.9±2 days. One patient with pre-existing severe biventricular dysfunction after aspiration of 400cc developed hypotension that improved with reversal of sedation, but proceeded to have PEA arrest and die. No other patient developed clinical events of acute left or right heart failure, ventricular dysfunction, unexplained hypotension, cardiogenic shock or other clinical events that could relate to PDS Conclusions: At most one episode of PDS was observed after technically successful percutaneous pericardiocentesis in 1164 cases (561 were large volume), although whether this case was PDS is unclear. PDS appears to be very rare, and staging pericardial decompression over time may be unnecessary, other than, perhaps, in patients with severe ventricular dysfunction or severe pulmonary hypertension

scholarly journals Virtual Histology to Evaluate Mechanisms of Pulmonary Artery Lumen Enlargement in Response to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

2020 ◽  
Vol 9 (6) ◽  
pp. 1655
Author(s):  
Wojciech Magoń ◽  
Jakub Stępniewski ◽  
Marcin Waligóra ◽  
Kamil Jonas ◽  
Roman Przybylski ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Type B ◽  
Cross Sectional ◽  
Virtual Histology ◽  
Arterial Lumen ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Light Green

Chronic thromboembolic pulmonary hypertension (CTEPH) results from an obstruction of pulmonary arteries (PAs) by organized thrombi. The stenosed PAs are targeted during balloon pulmonary angioplasty (BPA). We aimed to evaluate the mechanism of BPA in inoperable patients with CTEPH. We analyzed stenosed PAs with intravascular grey-scale ultrasound (IVUS) to determine the cross-sectional area (CSA) of arterial lumen and of organized thrombi. The composition of organized thrombi was assessed using virtual histology. We distinguished two mechanisms of BPA: Type A with dominant vessel stretching, and type B with dominant thrombus compression. PAs were assessed before (n = 159) and after (n = 98) BPA in 20 consecutive patients. Organized thrombi were composed of dark-green (57.1 (48.0–64.0)%), light-green (34.0 (21.4–46.4)%), red (6.4 (2.9–11.7)%;) and white (0.2 (0.0–0.9)%) components. The mechanism type depended on vessel diameter (OR = 1.09(1.01–1.17); p = 0.03). In type B mechanism, decrease in the amount of light-green component positively correlated with an increase in lumen area after BPA (r = 0.50; p = 0.001). The mechanism of BPA depends on the diameter of the vessel. Dilation of more proximal PAs depends mainly on stretching of the vessel wall while dilation of smaller PAs depends on compression of the organized thrombi. The composition of the organized thrombi contributes to the effect of BPA.

Intermediate- and long-term follow-up of device closure of patent arterial duct with severe pulmonary hypertension: factors predicting outcome

2016 ◽  
Vol 27 (1) ◽  
pp. 26-36 ◽  
Author(s):  
Masood Sadiq ◽  
Asif U. Rehman ◽  
Najam Hyder ◽  
Ahmad U. Qureshi ◽  
Tehmina Kazmi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Resistance Index ◽  
Severe Pulmonary Hypertension ◽  
Device Closure ◽  
Pulmonary Vascular Resistance Index

AbstractBackgroundIn patients with large patent arterial ducts and severe pulmonary hypertension, the natural history of progression of pulmonary hypertension is very variable. Whether to close or not to close is often a difficult decision, as there are no established haemodynamic parameters predicting reversibility.ObjectivesThe objectives of this study were to evaluate the results of device closure of large patent arterial ducts with severe pulmonary hypertension after 2 years of age and to determine haemodynamic variables associated with its regression during long-term follow-up.MethodsA total of 45 patients, with median age of 10 (2–27) years, with large patent arterial ducts and severe pulmonary hypertension, were considered. Haemodynamic variables were assessed in air, oxygen, and after occlusion. The follow-up was performed to assess regression of pulmonary hypertension.ResultsDevice closure was successful in 43 (96%) patients. Pulmonary artery systolic and mean pressures decreased from 79 to 67 mmHg and from 59 to 50 mmHg, respectively (p<0.001). At a median follow-up of 80 (41–151) months, severe pulmonary hypertension persisted in four (9.7%) patients. Multivariate analysis showed pulmonary vascular resistance index ⩽6 WU m2 and pulmonary artery systolic and mean pressures ⩽75 and ⩽55 mmHg (all in oxygen), having 97.8% predictive value for regression of pulmonary hypertension (p<0.001) in the long term. In 24 patients with catheterisation-based criteria, regression of pulmonary hypertension was associated with pulmonary vascular resistance index <8 WU m2 (p=0.001) and its fall of >25% (both in oxygen) (p=0.007).ConclusionsDevice closure of large patent arterial ducts with severe pulmonary hypertension is safe and effective. Pulmonary vascular resistance index and systolic and mean pulmonary artery pressures in oxygen are the key prognostic variables predicting regression of pulmonary hypertension.

Magnetic spherules in Arctic Ocean sediments

1979 ◽  
Vol 16 (9) ◽  
pp. 1778-1788 ◽  
Author(s):  
B. D. Bornhold ◽  
M. Bonardi
Keyword(s):  
Major Elements ◽  
Type B ◽  
Quaternary Sediments ◽  
Volcanic Origin ◽  
Minor Elements ◽  
Type D ◽  
Large Size ◽  
Type C ◽  
Ti Content ◽  
Cosmic Origin

Five types of spherule were found in Quaternary sediments from the Canada Abyssal Plain. They include: type A spherules composed of magnetite and hematite surrounding metallic iron cores, exsolution blebs, or veinlets (Ni, Fe, Co); type B, of nearly pure homogeneous magnetite; type C, displaying intergrowths of magnetite and hematite and containing minor Ti (< 1%); type D, composed predominantly of magnetite with significant amounts of Ti (up to 4.8%); and type E, consisting of ilmenite and rutile with Ti, Si, Fe, Mn, Al, K, and Mg as major elements and Cr, Ca, and Na as minor elements. Ni and Co were detected only in a small metallic veinlet (with Fe) surrounded by magnetite containing significant amounts of Ti.Three possible sources are considered: industrial, volcanic, and extraterrestrial. Industrial input is unlikely in view of the great distances to possible sources and the relatively large size of the particles. The high Ti content of most of the spherules suggests a volcanic origin. The five type B spherules are the only possible candidates for a cosmic origin.

STUDY THE CLINICAL FEATURES, TYMPANOMETRY AND EVALUTE THE TREATMENT RESULTS ADENOIDECTOMY

2018 ◽  
Vol 8 (6) ◽  
pp. 50-58
Author(s):  
The Nguyen Tu ◽  
Trinh Nguyen Luu ◽  
Tuyen Tran Thi Kim
Keyword(s):  
Clinical Features ◽  
Nasal Obstruction ◽  
Type A ◽  
Nasal Discharge ◽  
Adenoid Hypertrophy ◽  
Type B ◽  
Treatment Results ◽  
Cross Sectional ◽  
Type C ◽  
Grade 3

Objective: Determined the clinical features, tympanometry of children who have adenoid hypertrophy operated and evalute the treatment reults adenoidectomy. Material and method: 56 patients were diagnosed adenoid hypertrophy, who have tympanometry operated adenoidectomy at Hue University of Medicine and Pharmacy. Methods are cross sectional and propective studies. Results: Percentage of male (64.3%), female (35.7%). The most common age group is > 3-6 years old (46.4%). Main reason for being hospitalized is nasal discharge (48.2%). Funtional symtoms: nasal discharge (98.2%), nasal obstruction (96.4%). Endoscopy: adenoids grade 3 (53.6%), adenoids grade 2 (26.8%), adenoids grade 4 (14.3%), adenoids grade 1 (5.3%). 33% tympanograme type A, 27.7% tympanograme type C, 26.8% tympanograme type B, 12.5% tympanograme type As. After 6 weeks, results through funtional symtoms: nasal discharge (14.3%), nasal obstruction (8.9%). There aren’t adenoids grade 3 and 4, tympanometry in 90 ears without tympanostomy tube, 83.4% tympanograme type A, 8.9% tympanograme type C, 4.4% tympanograme type As, 3.3% tympanograme type B. Conclusions: Treatment of adenoid hypertrophy by adenoidectomy have good result about clinical and tympanometry. Key words: adenoid hypertrophy, tympanometry

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