Early postoperative interventional ASD-closure for severe atrial right to left shunt in a neonate with common arterial trunk

Although closure of an atrial septal defect (ASD II) with an occluding device in the first year of life is not a routine procedure, it is a feasible treatment, even in neonates. Case reports on the off-label use of Amplatzer devices have been repeatedly published, but there are no reports on using the Amplatzer Duct Occluder (ADO) to close an atrial septal defect in a neonate. We report on a successful catheter closure of an ASD II with ADO in a severely cyanotic neonate, seven days after surgical repair of common arterial trunk. Due to progressive cyanosis and clinical signs of right ventricular failure, which developed after common arterial trunk repair, the neonate underwent cardiac catheterization. Diastolic filling impairment of the right ventricle (right ventricle hypertrophy, pulmonary regurgitation, and residual right ventricle outflow tract obstruction) was thought to be the cause of impaired right ventricle diastolic filling, resulting in the right-to-left shunt at the atrial level. Under transesophageal echocardiographic guidance, ADO was delivered through a 5 French sheath into the atrial septal defect. Amplatzer duct occluder closed the defect and proved to be stable in position after disconnection. During the procedure, the child was stable and then transferred to the intensive care unit with significantly improved oxygen saturation. This is the first report on placing a duct occluder in the atrial septal position, which is a novel procedure for-small neonates

Intracardiac thrombus formation after the Fontan operation

AbstractObjectives: Intracardiac thrombus formation is suspected to be a specific sequela after the Fontan operation and is difficult to determine by means of routine transthoracic echocardiography. The aim of our study was to evaluate the occurrence of intracardiac thrombi in the different types of Fontan modifications and to identify predisposing risk factors. Methods: We evaluated 52 patients who had undergone a Fontan-type operation and were free of symptoms regarding thrombosis as determined by transesophageal echocardiography. Results: In 17 (33%) patients thrombus formation could be found without clinical evidence of thromboembolic complications. Neither underlying morphologic disease nor age at operation, type of Fontan operation, sex, follow-up interval, arrhythmias, or laboratory or hemodynamic findings could be identified as predisposing risk factors. Conclusion: In patients having had a Fontan operation with inadequate or without anticoagulation medication, we would recommend routine transesophageal echocardiography to exclude eventual thrombi. Because of the high incidence of thrombi, we suggest oral anticoagulation therapy in all patients. (J Thorac Cardiovasc Surg 2000;119:745-52

A Pan-Arctic Airborne Sea Ice Observation System

We present an Arctic sea-ice observation system that focuses on unique direct observations of sea ice plus snow thickness. A network of research institutions, the Alfred Wegener Institute, York University and the Norwegian Polar Institute, maintain an observation system that is embedded in several national and international projects and supported by research partners. Activities in the field include the use of long-range polar research aircraft and helicopter operations from research icebreakers and bases on land. Data collections are based on electromagnetic induction sounding and consistent time series are available in key regions of the Arctic Ocean since 2001. The increased use of polar research aircrafts in recent years has resulted in several initiatives that aim for long-term observations of ice thickness during seasonal minimum and maximum sea-ice extent in the Arctic. The scientific payload of the research aircraft of type Basler BT-67 and its capability to fly low-altitude surveys makes it an ideal tool for the validation and on-going verification of various satellite remote sensing products. The availability of airborne sea-ice thickness information spans the periods of different satellite sea-ice thickness retrieval concepts, such as the radar altimeters from Envisat and CryoSat-2 as well as the laser altimeter from ICESat-1 and -2. Wherever possible, the airborne surveys are accompanied by in-situ observations on the ice surface to compile a hierarchy of validation data from local to basin scales. Results of the observation network have found broad use for studying inter-annual variability and changes of sea ice thickness as well as the validation of satellite data products. We identify a gap of observations over the multi-year sea ice zone during the melt season and early freeze-up. We also stress the need for the continuation of a coordinated observational program that has produced a time series of sea ice thickness only paralleled by submarine observations. We plan to augment the observation system by simultaneous measurements of snow depth and to investigate opportunities for technological advances, such as the utilization of unmanned aerial systems

A model of melt pond evolution on sea ice

A one-dimensional, thermodynamic, and radiative model of a melt pond on sea ice is presented that explicitly treats the melt pond as an extra phase. A two-stream radiation model, which allows albedo to be determined from bulk optical properties, and a parameterization of the summertime evolution of optical properties, is used. Heat transport within the sea ice is described using an equation describing heat transport in a mushy layer of a binary alloy (salt water). The model is tested by comparison of numerical simulations with SHEBA data and previous modeling. The presence of melt ponds on the sea ice surface is demonstrated to have a significant effect on the heat and mass balance. Sensitivity tests indicate that the maximum melt pond depth is highly sensitive to optical parameters and drainage. INDEX TERMS: 4207 Oceanography: General: Arctic and Antarctic oceanography; 4255 Oceanography: General: Numerical modeling; 4299 Oceanography: General: General or miscellaneous; KEYWORDS: sea ice, melt pond, albedo, Arctic Ocean, radiation model, thermodynami

The Adult Patient with Eisenmenger Syndrome: A Medical Update After Dana Point Part I: Epidemiology, Clinical Aspects and Diagnostic Options

Eisenmenger syndrome is the most severe form of pulmonary arterial hypertension and arises on the basis of congenital heart disease with a systemic-to-pulmonary shunt. Due to the chronic slow progressive hypoxemia with central cyanosis, adult patients with the Eisenmenger syndrome suffer from a complex and multisystemic disorder including coagulation disorders (bleeding complications and paradoxical embolisms), renal dysfunction, hypertrophic osteoarthropathy, heart failure, reduced quality of life and premature death

The Adult Patient with Eisenmenger Syndrome: A Medical Update after Dana Point Part III: Specific Management and Surgical Aspects

Eisenmenger syndrome is the most severe form of pulmonary arterial hypertension and arises on the basis of congenital heart disease with a systemic-to-pulmonary shunt. Due to the chronic slow progressive hypoxemia with central cyanosis, adult patients with the Eisenmenger syndrome suffer from a complex and multisystemic disorder including coagulation disorders (bleeding complications and paradoxical embolisms), renal dysfunction, hypertrophic osteoarthropathy, heart failure, reduced quality of life and premature death

The Adult Patient with Eisenmenger Syndrome: A Medical Update after Dana Point Part II: Medical Treatment - Study Results

Eisenmenger syndrome is the most severe form of pulmonary arterial hypertension and arises on the basis of congenital heart disease with a systemic-to-pulmonary shunt. Due to the chronic slow progressive hypoxemia with central cyanosis, adult patients with the Eisenmenger syndrome suffer from a complex and multisystemic disorder including coagulation disorders (bleeding complications and paradoxical embolisms), renal dysfunction, hypertrophic osteoarthropathy, heart failure, reduced quality of life and premature death

Kongenitalne konorarne arterijske fistule: kliničko i terapijsko razmatranje [Congenital coronary artery fistulas: clinical and therapeutic consideration]

A coronary artery fistula is a link between one or more coronary arteries with another heart cavity or a segment of systemic or pulmonary circulation. Arterial blood from a coronary vessel enters another segment via myocardial capillary bed. These are very rare anomalies which constitute approximately 0.2 - 0.4% of all congenital heart defects. Still, they are clinically significant if they are of medium or large size and are manifested with a series of clinical symptoms such as angina pectoris, arrhythmias, myocardial infarction, endocarditis, progressive dilatation, heart failure and cardiomyopathy, pulmonary hypertension, thrombosis of the fistula and formation of aneurysms with possible ruptures. We present six patients with a coronary arterial fistula, their history, diagnostic procedures and outcomes. Therapeutic closure of coronary artery fistulas is recommended in all symptomatic, but also in asymptomatic patients, if there are significant roentgenographic, electrocardiographic and other abnormalities. In recent times transcatheter closure of coronary fistulas has become a possible alternative to surgery and is becoming increasingly used thanks to improved diagnostic possibilities and technology. If possible, interventional closure of fistulas is precisely the method preferred in pediatric patients. The choice of method depends on the anatomy of the fistula, presence or absence of additional defects, and on the experience of an interventional cardiologist or a heart surgeon. If performed well, the effects of both methods are good. This paper presents two children with a fistula between the right coronary artery and the right ventricle (RV), one child with a fistula between LAD and RV, one child with a fistula between the main tree of the left coronary artery (LCA) and RV, one child with a fistula between LCA and the right ventricular outflow tract (RVOT), and one child with a fistula between LCA and the right atrium (RA). The last one (LCA-RA) is not described in the latest classification of anomalies of coronary blood vessels in children based on MSCT coronarography, so we consider our presentation to be a contribution to the new classification. Along with the descriptions of fistulas and presentations of interventional and cardiosurgical interventions, we are also presenting a rare case of spontaneous closing of the fistula within the first six months and of a reopening of the fistula between the right coronary artery and the right ventricle after six years