Intermediate and Long-Term Outcome of Percutaneous Trans-catheter Device Closure of Ventricular Septal Defects

Background Ventricular septal defect (VSD) is the most common congenital heart defect in children and adults. Until recently, open-heart surgical closure has traditionally been considered the mainstay of intervention for the majority of VSDs. The development of a trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices that can safely and effectively close these defects was welcomed by cardiologists, patients, and their families making trans-catheter device closure an attractive and feasible alternative. Objective We aim to evaluate the intermediate and long-term follow-up outcome of patients who underwent percutaneous trans-catheter closure of isolated ventricular septal defects. Patients and Methods This study is an exploratory pilot single-tertiary center study. The study included 25 patients who have successfully undergone percutaneous ventricular septal closure in the cardiac catheterization unit of the cardiology department at Ain Shams university Hospitals in the period from June 2015 till June 2018. The follow up protocol includes detailed history taking, clinical examination, and full 2D echocardiography with additional circumferential and radial strain imaging by speckle tracking technique (STE), resting and Holter electrocardiograms. Results A significant increase in growth parameters were noticed during 6.3 month mean follow up time, with an overall mean weight increase by 10% and an overall mean height increase by 6.2%. Sequential echocardiographic follow-up showed highly significant decrease in LV dimensions and volumes, circumferential LV strain values, pulmonary to systemic circulation (Qp:Qs) ratio, RVSP and mPAP. Significant complications occurred in (12%) of patients: symptomatic/significant Brady-arrhythmia (Complete heart block) that required permanent pacemaker implantation (4%), significant residual shunt causing hemolytic anemia requiring re-intervention (4%) and significant valvular regurgitation (Severe Tricuspid Regurgitation) (4%) Conclusion The development of a VSD trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices is an attractive and feasible procedure with high success rates

Dysanapsis in men and women with obesity

Obesity alters chest wall mechanics, reduces lung volumes, and increases airway resistance. In addition, the luminal area of the larger conducting airways is smaller in women than in men when matched for lung size. We examined whether differences in pulmonary mechanics with obesity and sex were associated with the dysanapsis ratio (DR), an estimate of airway size when expiratory flow is maximal, in men and women with and without obesity. Additionally, we examined the ability to estimate DR using predicted versus measured static recoil pressure at 50%FVC (Pst50FVC). Participants completed pulmonary function testing and measurements of pulmonary mechanics. Flow, volume, and transpulmonary pressure were recorded while completing forced vital capacity (FVC) maneuvers in a body plethysmograph. Static compliance curves were collected using the occlusion technique. DR was calculated using measured values of forced mid-expiratory flow and Pst50FVC. DR was also calculated using Pst predicted from previously reported data. There was no significant group (lean vs. obese) by sex interaction or main effect of group on DR. However, women displayed significantly larger DR compared with men. Predicted Pst50FVC was significantly greater than measured Pst50FVC. DR calculated from measured Pst was significantly greater than when using predicted Pst. In conclusion, while obesity does not appear to alter airway size, women may have larger airways compared with men when mid-expiratory flow is maximal. Additionally, DR estimated using predicted Pst should be used with caution.

Echocardiographic Diagnosis of Congenital Arterial Catheter Function Changes

Arterial catheter is physiological flow channel between pulmonary artery and descending aorta in fetal circulation. Most right heart blood flow through artery catheter into descending aorta during embryo period. Most term neonates are usually stopped after fetal delivery. Functional closure occurs in 48 h after birth, while 88% should be closed completely at 8 weeks after birth. There was no significant difference between PDA occlusion technique guided by transthoracic echocardiography and conventional funnel PDA closure rate, total closure rate, long term closure rate, pulmonary systolic pressure before surgery and pulmonary artery pressure difference before and after operation (P < 0.05). Conversely, under similar therapeutic effects, funnel type PDA closure guided by transthoracic echocardiography has advantages such as shorter anesthesia time, less total ray volume and contrast agent, lower hospitalization expense and fewer complications. Therefore, through transthoracic echocardiography guidance delivery of order vein approach interventional closure therapy funnel type PDA especially suitable for children, worthy of clinical application.

Left atrial appendage closure in the presence of thrombus: incidence, technique and outcomes

Funding Acknowledgements Type of funding sources: None. Background Patients with left atrial appendage (LAA) thrombus are excluded for LAA occlusion (LAAO) in clinical trials. However, some of them may require this therapy due to repeated thromboembolisms despite accurate anticoagulation. Aim The aim of the study is to describe the prevalence of LAA thrombosis in patients submitted for LAAO in a high-volume center of LAAO procedures, explaining the employed technique and results in this scenario. Methods Single-center retrospective analysis including all consecutive patients referred for LAAO. Results LAA thrombus was detected by TEE in 8/76 patients referred for LAAO (10.5%). Five of them underwent LAAO despite the presence of thrombus due to clinical conditions. All the procedures were successfully performed with Amulet devices (Table). The following preventive measures were putting in place during the implants: avoidance of contrast injection into the LAA during the procedure (non-touch technique), TEE measure for device size election; and TEE device deployment guidance with special care to the the sheath orientation and depth enabling a slow and single implant of the device partially released in the LAA before complete implantation at the entrance of the LAA (Figure. A&B: Large LAA thrombus partially occupying the landing zone. C: Thrombus sealed by LAAO device. D&E: Non-touch technique: echo-guided progressive deployment of the LAAO device without thrombus shifting). No cerebral protection devices were used. TEE performed one month after the procedure ruled out the presence of residual thrombi or leaks in all cases. There were no events after a median follow-up of 17.1 months (range: 32.3-1.1) Conclusion LAAO in patient with LAA thrombus can be effectively and safely performed, in high-volume centers and with an accurate technique, under accurate TEE guidance. Abstract Figure. LAA thrombus and occlusion technique

A Review of Occlusion as a Tool to Assess Attentional Demand in Driving

Objective The aim of this review is to identify how visual occlusion contributes to our understanding of attentional demand and spare visual capacity in driving and the strengths and limitations of the method. Background The occlusion technique was developed by John W. Senders to evaluate the attentional demand of driving. Despite its utility, it has been used infrequently in driver attention/inattention research. Method Visual occlusion studies in driving published between 1967 and 2020 were reviewed. The focus was on original studies in which the forward visual field was intermittently occluded while the participant was driving. Results Occlusion studies have shown that attentional demand varies across situations and drivers and have indicated environmental, situational, and inter-individual factors behind the variability. The occlusion technique complements eye tracking in being able to indicate the temporal requirements for and redundancy in visual information sampling. The proper selection of occlusion settings depends on the target of the research. Conclusion Although there are a number of occlusion studies looking at various aspects of attentional demand, we are still only beginning to understand how these demands vary, interact, and covary in naturalistic driving. Application The findings of this review have methodological and theoretical implications for human factors research and for the development of distraction monitoring and in-vehicle system testing. Distraction detection algorithms and testing guidelines should consider the variability in drivers’ situational and individual spare visual capacity.

Results of surgical treatment of arterial aneurysms of the basilar artery bifurcation

Objective ‒ to analyze the results of surgical treatment of basilar artery (BA) bifurcation arterial aneurysms (AA), taking into account the method of BA obliteration, the type of disease, to summarize the results of surgical treatment of BA.Materials and methods. A retrospective analysis of the results of a comprehensive examination and surgical treatment of 132 patients with AA of BA bifurcation in a group of 387 operated patients with posterior cerebral circulation aneurysms, who were hospitalized and operated in the vascular departments of the State Institution Romodanov Neurosurgery Institute National Academy of Medical Sciences of Ukraine in the period from 1998 to 2019 years is made. Patients were divided into groups according to the type of disease and the method of surgical treatment of AA of BA bifurcation. The analysis of the results of surgical treatment AA of BA bifurcation was performed taking into account the method of occlusion and the clinical type.Results. The balloon occlusion technique was used in 16 (12.1 %) patients with AA of BA bifurcation, including hemorrhagic and other types of disease. Radical exclusion of AA of BA bifurcation was achieved only in 1 (6.25 %) patients of this group. Exclusion of AA of BA bifurcation at level IIR was also recorded in only 1 (6.25 %) patient. In 4 (25.0 %) patients, the level of AA occlusion corresponded to IIIR. In 10 (62.5 %) patients, after surgery using the balloon occlusion technique, AA of BA bifurcation remained not excluded. Satisfactory functional results of treatment using the balloon occlusion technique, according to mRs, were obtained in 7 (43.7 %) patients of this group, without taking into account the radicality of AA of BA bifurcation exclusion. Transcranial technique, taking into account hemorrhagic and other types of flow, was used in 5 (3.8 %) patients with AA of BA bifurcation. In 4 (80.0 %) patients of this group, radical exclusion from the bloodstream was achieved by clipping (occlusion level ‒ IR). In 1 (20.0 %) wrapping of aneurysm walls were strengthened (occlusion level ‒ AA of BA bifurcation is strengthened). Satisfactory functional treatment results in this group were obtained in 3 (60.0 %) observations. Using modern methods of aneurysm coil embolization, 111 (84.0 %) patients with AA of BA bifurcation were operated. Radical exclusion of AA from the bloodstream at the level of IR was achieved in 40 (36.0 %) patients. The level of occlusion IIR was observed in 48 (43.2 %) patients. In 26 (23.4 %) cases, the level of occlusion corresponded to IIIR. In 1 (0.9 %) case, the aneurysm was excluded at level IIID. Satisfactory functional results, according to mRs, in this group were obtained in 89 (80.2 %) observations.Conclusions. The main method of treatment of AA of BA bifurcation, regardless of the type of disease, should be considered endovascular with the use of modern methods of endovascular obliteration of aneurysm. Methods of transcranial clipping of aneurysms are possible in the surgical treatment of AA of BA bifurcation, but it is advisable to use them when it is impossible to perform endovascular intervention with modern methods of obliteration. The balloon occlusion technique is extremely ineffective in terms of radical shutdown and quality of life of operated patients with AA of BA bifurcation and can only be considered as a subject of the historical aspect of endovascular treatment of AA of BA bifurcation.