Total repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: An integrated approach

AbstractBackground: Predicting postrepair right ventricular/left ventricular pressure ratio has prognostic relevance for patients undergoing total repair of pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. To this purpose, we currently rely on 2 novel parameters: (1) preoperative total neopulmonary arterial index and (2) mean pulmonary artery pressure changes during an intraoperative flow study. Methods: Since January 1994, 15 consecutive patients (aged 64 ± 54 months) with pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals were managed according to total neopulmonary arterial index. Seven patients with hypoplastic pulmonary arteries and a total neopulmonary arterial index less than 150 mm2/m2 underwent palliative right ventricular outflow tract reconstruction followed by secondary 1-stage unifocalization and ventricular septal defect closure. The other 8 patients with a preoperative index of more than 150 mm2/m2 underwent primary single-stage unifocalization and repair. The ventricular septal defect was closed in all cases (reopened in 1). In 9, such decision was based on an intraoperative flow study. Results: Patients treated by right ventricular outflow tract reconstruction had a significant increase of pulmonary artery index (P = .006) within 22 ± 6 months. Repair was successful in 14 cases (postrepair right ventricular/left ventricular pressure ratio = 0.47 ± 0.1). One hospital death occurred as a result of pulmonary vascular obstructive disease, despite a reassuring intraoperative flow study. Accuracy of this test in predicting the postrepair mean pulmonary artery pressure was 89% (95% CI: 51%-99%). At follow-up (18 ± 12 months), all patients are free of symptoms, requiring no medications. Conclusion: The integrated approach to total repair of pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals by preoperative calculation of total neopulmonary arterial index, right ventricular outflow tract reconstruction (when required), and intraoperative flow study may lead to optimal intermediate results. (J Thorac Cardiovasc Surg 1998;116:914-23

Risk Factors of Right Ventricular Dysfunction and Adverse Cardiac Events in Patients with Repaired Tetralogy of Fallot

Aim: This study evaluates the risk factors associated with right ventricular (RV) dilation and dysfunction leading to pulmonary valve replacement (PVR) or adverse cardiac events in repaired Tetralogy of Fallot (rToF) patients. Methods: Data from all rToF patients who underwent magnetic resonance imaging (MRI) evaluation at our hospital between February 2007 and September 2020 were collected. Results: Three hundred and forty-two patients (60% males, 42% older than 18 years), with a median age of 16 years (IQR 13–24) at the time of MRI, were included. All patients underwent complete repair at a median age of 8 months (IQR 5–16), while palliation was performed in 56 patients (16%). One hundred and forty-four patients (42%) subsequently received pulmonary valve replacement (PVR). At the multivariate analysis, male gender was an independent predictor for significant RV dilation, RV and left ventricular (LV) dysfunction. Transventricular ventricular septal defect (VSD) closure and previous palliation significantly affected LV function and RV size, respectively. Male gender and the transventricular VSD closure were independent predictors for PVR. Conclusions: Male gender and surgical history (palliation, VSD closure approach) significantly affected the long-term outcomes in rToF patients and should be taken into consideration in the follow-up management and in PVR timing in this patient population

Design of f-SCAN Acquisition Mode for Synthetic Aperture Radar

This paper presents the design and processing of the SAR acquisition technique named frequency scanning (f-SCAN), aimed to obtain high sensitivity to targets with low backscattering and to improve the signal-to-noise ratio (SNR) in wide-swath systems. The f-SCAN is an interesting alternative to the scanning on receive method (SCORE), which needs multiple phase centres achieved using the digital beam forming (DBF) technique. f-SCAN requires less hardware complexity than SCORE; at the same time, it improves the sidelobes and ambiguities’ suppression. The elements used in f-SCAN to generate the pencil beam are the true time delay lines (TTDLs) and the phase shifters (PSs). The general methodology to design an f-SCAN spaceborne SAR high-resolution wide-swath (HRWS) system is introduced; emphasis is put on the mathematical definition of the timing parameters and on a novel method of using TTDLs to achieve the full spanning of wide swaths. The processing of f-SCAN data is also considered: we introduce a novel algorithm to limit the data volume and to guarantee an almost invariant slant range impulse response function (IRF) by removing spectral distortions. Eventually, new definitions, specific for f-SCAN, of the well-known SAR performance parameters, are provided. Simulation results and performances are presented. The advantages and disadvantages with respect to SCORE are discussed using the design of a real case system

Asma en el adulto: características clínicas, comorbilidades y riesgo para apnea obstructiva de sueño

Introducción: Escasos reportes sobre asma existen en la literatura nacional. El objetivo del estudio es describir ciertas características clínicas, las comorbilidades y el riesgo para apnea obstructiva del sueño (AOS) en este colectivo. Material y métodos: Mediante un estudio observacional tipo caso-control, se incluyeron pacientes portadores de asma de ambos sexos y un grupo control pareado por sexo y edad. Se consignaron datos demográficos, características de la enfermedad, datos relativos al control del asma y espirometría, comorbilidades y riesgo de apnea de sueño medido por el cuestionario STOP-BANG durante una entrevista estructurada. Resultados: Se incluyeron 132 individuos en el grupo caso y 132  en el grupo control. Entre los asmáticos, se consignaron 38,63% de formas no controladas y 9% severas. También se constató mayor frecuencia de hipertensión arterial, obesidad, rinitis alérgica y trastornos de la memoria. Riesgo mayor para AOS, aunque no significativo, se consignó en el grupo de casos. En el subgrupo de asmáticos con obesidad o en adultos mayores, la diferencia fue estadísticamente significativa- Discusión: Aun disponiendo de medicamentos preventivos, la tasa de control de los asmáticos en esta muestra es llamativa y merece estudios sistemáticos. Es extremadamente importante tener en cuenta algunas comorbilidades para el manejo de este grupo de pacientes, incluyendo la estratificación de riesgo para AOS

Double-outlet left ventricle: single-center experience and literature review

Double-outlet left ventricle (DOLV) is an abnormal ventriculo-arterial connection characterized by origin of both great arteries, or more than 50% of each arterial root, from the morphological left ventricle. The aim of our paper is to describe the anatomic, echocardiographic, and multi-modality imaging characteristics of DOLV and associated malformations, and to assess its surgical outcomes. Methods: From 2011 to 2022, we retrospectively reviewed case records, intra-operatory reports and follow-up data of patients diagnosed with DOLV at Bambino Gesu Children’s Hospital. A systematic search was developed in MEDLINE, EMBASE and Web of Science databases, to identify original reports between January 1, 1975 and May 30, 2022, assessing the morphology and surgical outcomes of DOLV. Retrospective cohort studies, cross-sectional and case series were included in the analysis. Single case reports and reviews were excluded. Results: At our center, four cases of DOLV were identified. Patient 1 was diagnosed with (S,D,D) DOLV and hypoplastic right ventricle. The aorta overrode a large, doubly-committed VSD with absence of infundibular septum. A tenuous mitro-aortic discontinuity and a well-developed subpulmonary conus were present. Associated abnormalities included crossed pulmonary arteries and two adjacent, side-by-side coronary ostia, located in the anterior facing sinus, which gave origin to the left anterior descending (LAD) and the right coronary artery (RCA). Left circumflex artery (LCx) had a retro-aortic course and originated from the RCA. After pulmonary artery banding, Damus-Kaye-Stansel and Glenn intervention were proposed as first-stage of univentricular palliation. Patient 2 and 3 were diagnosed with (S,D,D) DOLV, subaortic VSD and pulmonary stenosis. Patient 2 underwent Rastelli operation and no anatomic detail were available. Patient 3 showed absence of the infundibular septum and mitro-pulmonary continuity, whereas subaortic conus was well developed. Anomalous origin of the LCx, originating from the posterior facing sinus with retro-aortic course was present. Rastelli procedure was performed to reconstruct right ventricular outflow tract. LCA and RCA were respectively caudal to subvalvular and supravalvular segments of the RV-to-PA conduit. After a 6-years follow-up, severe stenosis of the RV-to-PA conduit was present, nevertheless percutaneous conduit dilatation was contraindicated, due to coronary abnormality, and an aortic homograft was implanted Patient 4 was diagnosed with (S,D,L) DOLV with subaortic VSD and mitro-pulmonary fibrous continuity. A large subaortic conus was present. Reparation à l’etage ventriculaire was performed to reconstruct RVOT. Follow-up MRI at 8 years showed severe pulmonary artery regurgitation with mild RV dilatation (indexed volume 99mL/m2) and normal RV ejection fraction (54 %) Systematic review:Through our systematic research strategy we scrutinized 96 records for inclusion criteria (Figure 4). After systematic evaluation, a total of 9 reports fulfilled eligibility criteria and were included in our study. Morphological findings and surgical outcomes are summarized in Table 1. Among 191 cases of DOLV included, the most common subtypes of VSD were subaortic (128/191), subpulmonary (23/191) or doubly committed (14/191) (Figure 5). d-transposition of the aorta was present in 117/191 (61%) cases, whereas l-transposition was reported in 63/191 (32%) (Figure 6