Right ventricular outfl ow tract revalvulation using the Melody Valve: The next frontier

Congenital heart lesions with abnormal right ventricular outfl ow tract anatomy will require early surgical intervention. Re-intervention rates in these patients are high due to homograft degeneration. Until recently, surgery was the onlytreatment option for right ventricular outfl ow tract dysfunction. Percutaneous pulmonary valve implantation has been introduced as a new therapeutic alternative to prolong conduit life span and to reduce surgical re-intervention rates. Short- and mid-term results have been favourable and showed that it is a safe and effective therapy. These are reviewed with emphasis on the Melody valve

Stenting the arterial duct: Practical aspects and review of outcomes

Cyanotic congenital heart lesions with duct-dependent pulmonary blood fl ow often require early intervention. Surgical palliation remains the treatment of choice, but is associated with substantial morbidity and mortality. Ductal stent implantation is becoming a recognised alternative to maintain pulmonary blood fl ow. Results of ductal stenting have improved and outcomes are good. We discuss the outcomes of published data and the practical aspects of ductal stenting

ASD and PDA closure with CeraTM and CeraFlexTM devices

Introduction and aim: Percutaneous closure of congenital cardiac defects is common practice. The aim of the study was to describe our experience in closing PDAs, PFOs and an ASD using the new CeraTM and CeraFlexTM devices. Methods: Twenty patients were included in this retrospectivereview. All patients underwent device closure with the Cera TM and CeraFlexTM devices. Results: All attempts at device closure were successful (n=20). Indications included PDA (n=16), ASD (n=1) and PFO (n=3). Median age at procedure was: PDA 1y 10mo (4mo - 10y 4mo), ASD 27y and PFO 50y 9mo (38y - 70y). Median weight at procedure was: PDA 10.5kg (4.9kg - 70kg), ASD 56kg and PFO 82.5kg (80kg - 113kg). Periprocedural complications consisted of embolisation of 2 PDA devices, which could be repositioned. Conclusion: The CeraTM and CeraFlexTM devices are effective for closure of PDAs, ASDs and PFOs

The use of small stents to delay surgical intervention in very young children with critical congenital heart disease

Introduction: Surgery in very young children with critical obstructive congenital heart disease has a high morbidity and mortality. The aim of this study was to determine whether the use of small stents is feasible and if it could delay surgery. Materials and methods: Nineteen children were included in a retrospective review spanning 7 years. Patients were included in circumstances where surgery needed to be delayed and the use of a small stent could alleviate the underlying obstruction. Results: All attempts at stenting were successful (100%). Indications were diverse and included: aortic obstruction (n=9), right ventricular outfl ow tract obstruction (n=3), systemic-to-pulmonary artery shunt occlusion (n=5), infradiaphragmatic pulmonary vein obstruction (n=1) and salvage of a discontinuous left pulmonary artery (n=1). Reasons patients were not fi t for surgical intervention included: low weight (n=4), poor general clinical condition (n=12), surgical technical diffi culty (n=2) and unavailability of a critical care bed (n=1). Median age and weight at procedure was 4.6 months (range: 0.1 - 18.3) and 4.5kg (range: 1.7 - 9.5), respectively. Pressure gradients and saturations showed signifi cant improvement post stenting. Periprocedural complications were few (n=3) and there were no fatalities. Last follow-up was at a median of 7.8 months (range: 0.1 -9.0) post initial procedure. Nine cases proceeded to corrective surgery. Surgery was delayed by a median 13.5 months (range: 0.3 - 69.0 months) and weight increased to a median of 10.3kg (p<0.001). Five cases demised at a median of 73 days (range: 1 - 422) post initial stent placement, most at home secondary to unknown causes. Four patients remain in follow-up. One patient was lost to follow-up. Conclusion: The placement of stents in small, ill children is feasible. It immediately relieves the obstruction and improves the general clinical condition. Surgery can be delayed for weeks or months, thus giving the opportunity for somatic growth

Physical activity, sedentary time and breast cancer risk: a Mendelian randomisation study

Objectives: Physical inactivity and sedentary behaviour are associated with higher breast cancer risk in observational studies, but ascribing causality is difficult. Mendelian randomisation (MR) assesses causality by simulating randomised trial groups using genotype. We assessed whether lifelong physical activity or sedentary time, assessed using genotype, may be causally associated with breast cancer risk overall, pre/post-menopause, and by case-groups defined by tumour characteristics. Methods: We performed two-sample inverse-variance-weighted MR using individual-level Breast Cancer Association Consortium case-control data from 130 957 European-ancestry women (69 838 invasive cases), and published UK Biobank data (n=91 105–377 234). Genetic instruments were single nucleotide polymorphisms (SNPs) associated in UK Biobank with wrist-worn accelerometer-measured overall physical activity (nsnps=5) or sedentary time (nsnps=6), or accelerometer-measured (nsnps=1) or self-reported (nsnps=5) vigorous physical activity. Results: Greater genetically-predicted overall activity was associated with lower breast cancer overall risk (OR=0.59; 95% confidence interval (CI) 0.42 to 0.83 per-standard deviation (SD;~8 milligravities acceleration)) and for most case-groups. Genetically-predicted vigorous activity was associated with lower risk of pre/perimenopausal breast cancer (OR=0.62; 95% CI 0.45 to 0.87,≥3 vs. 0 self-reported days/week), with consistent estimates for most case-groups. Greater genetically-predicted sedentary time was associated with higher hormone-receptor-negative tumour risk (OR=1.77; 95% CI 1.07 to 2.92 per-SD (~7% time spent sedentary)), with elevated estimates for most case-groups. Results were robust to sensitivity analyses examining pleiotropy (including weighted-median-MR, MR-Egger). Conclusion: Our study provides strong evidence that greater overall physical activity, greater vigorous activity, and lower sedentary time are likely to reduce breast cancer risk. More widespread adoption of active lifestyles may reduce the burden from the most common cancer in women

Left ventricular diverticulum presenting as a pulsating umbilical mass

A six-week old girl presented at Paediatric Cardiology after a pulsatile umbilical mass was noticed during routine post-natal visit. The baby was asymptomatic with no feeding difficulties and no history of cardiac failure

Ex-PRESS glaucoma filter: an MRI compatible metallic orbital foreign body imaged at 1.5 and 3T

AIM: To report on the MRI compatibility of the Ex-PRESS glaucoma filtration device, a tiny metallic implant placed into the anterior chamber of the eye that is much smaller than traditional glaucoma shunts, and to educate the radiology community regarding its appearance. MATERIALS AND METHODS: Seven patients with Ex-PRESS glaucoma filtration devices were identified that had undergone MRI at San Francisco General Hospital/University of California San Francisco Medical Center by searching and cross-referencing the radiology reporting system and the electronic medical record. MRI images were reviewed for artefact interfering with interpretation. Ophthalmology examinations were reviewed for evidence of complications. RESULTS: Eighteen individual MRI examinations were performed during 12 unique MRI events on these 7 patients. 13/18 individual MRI examinations and 7/12 MRI events were performed at 3 T with the others performed at 1.5 T. Mean time from Ex-PRESS implantation to MRI was 17.5 months. Mean time from MRI to first ophthalmology examination was 1.1 months and from MRI to latest ophthalmology examination was 6.6 months. Susceptibility artefact did not interfere with image interpretation and no complications related to MRI were encountered. CONCLUSION: The Ex-PRESS glaucoma filtration device appears to be safe for MRI at 1.5 and 3 T and does not produce significant susceptibility artefact to affect diagnostic interpretation adversely