Cardiovascular magnetic resonance of pulmonary artery growth and ventricular function after Norwood procedure with Sano modification

For hypoplastic left heart syndrome (HLHS), there have been concerns regarding pulmonary artery growth and ventricular dysfunction after first stage surgery consisting of the Norwood procedure modified with a right ventricle-to-pulmonary artery conduit. We report our experience using cardiovascular magnetic resonance (CMR) to determine and follow pulmonary arterial growth and ventricular function in this cohort

Cardiac Surgery in Patients with Drug Eluting Stents: The Risk of Stopping Clopidogrel

Recommendations for the duration of clopidogrel (Plavix ® , Bristol Meyers Squibb, New York, NY) therapy following drug eluting stent (DES) insertion have been subject to recent criticism. Suggested recommendations for the continuation of clopidogrel have been extended to one year following DES insertion. However, patients with a previously inserted DES who now require cardiac surgery are requested to stop clopidogrel perioperatively. The safety of this practice is unclear. We report two cases of elective cardiac surgical intervention after the insertion of DES complicated by perioperative or intraoperative acute coronary ischemia attributed to DES closure

Endovascular repair of the thoracic aorta in the post-FDA approval era

ObjectiveEndovascular repair of thoracic aortic disease is rapidly progressing as an alternative to open surgical therapy. In March of 2005, the Gore TAG thoracic endoprosthesis (W. L. Gore & Associates, Inc, Flagstaff, Ariz) received Food and Drug Administration (FDA) approval for the treatment of descending thoracic aortic aneurysms. Subsequently, off-label use of the technology expanded to include additional thoracic aortic diseases. The purpose of this study was to examine whether the outcomes with this device changed after the inclusion and exclusion criteria of FDA-controlled trials no longer governed patient selection.MethodsA retrospective analysis was performed on all patients who underwent endovascular repair of the thoracic aorta with the Gore TAG device at our institution between March 23, 2005, and September 8, 2006.ResultsFifty consecutive patients with a broad range of aortic pathologic conditions were included in the study. The results in this group compared with those of the phase II trial included the following: length of stay, 7.5 versus 7.6 days (P = .97); intensive care unit stay, 3.7 versus 2.6 days (P = .61); 30-day mortality, 2.0% versus 1.5% (P = .68); spinal cord injury, 2% versus 3% (P = .89); stroke, 4% versus 4% (P = .67); early endoleaks, 26% versus 4% (P < .01); and late endoleaks, 18% versus 7% (P = .08). At 1 year, overall survival was 92% compared with 82% in the phase II trial.ConclusionsIn the post-FDA approval era, endovascular stent-graft therapy is frequently applied to patients with more challenging thoracic aortic anatomy and a wide range of pathologic conditions. Our results in this group are similar to outcomes reported for patients with descending thoracic aortic aneurysm exclusively

Hanford Immobilized LAW Product Acceptance: Initial Tanks Focus Area Testing Data Package

A matrix of 55 glasses was developed and tested with the aim to identify the impact of glass composition on the long-term corrosion behavior and to develop an acceptable low-activity waste glass composition region. Of the 55 glasses, 45 were designed to systematically vary the glass composition and 10 were selected because large and growing databases on their corrosion characteristics had accumulated. The performance of these 55 glasses in the vapor-phase hydration test (VHT) and product consistency test (PCT) were characterized. VHT's were performed at temperatures between 150?C and 300?C for times up to 280 days; preliminary corrosion rates and type of alteration products were identified. PCTs were performed at 90?C with glass surface area's to solution volumes (S/V) of 2000 m-1 for 7 days and S/V of 20 000 m-1 for 10 h, 100 h, and 1000 h. The corrosion extents by PCT were determined as functions of time from solution composition analyses