Palliative Stenting of the Venous Duct in a Premature Neonate with Obstructed Infradiaphragmatic Total Anomalous Pulmonary Venous Connection

In infracardiac, infradiaphragmatic total anomalous pulmonary venous connection, all four pulmonary veins connect to a descending vertical vein that usually drains to the portal vein or one of its tributaries. Obstruction is common, and definitive treatment is surgical repair. We present a case of late-diagnosed infradiaphragmatic total anomalous pulmonary venous connection in a premature neonate who was too high risk for surgery and underwent palliative stenting of the venous duct. We demonstrate the feasibility of a transhepatic approach when umbilical access is no longer available

Transcatheter valve implantation for right atrium‐to‐right ventricle conduit obstruction or regurgitation after modified Björk–fontan procedure

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136276/1/ccd26648_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136276/2/ccd26648.pd

Experiences of being exposed to intimate partner violence during pregnancy

In this study a phenomenological approach was used in order to enter deeply into the experience of living with violence during pregnancy. The aim of the study was to gain a deeper understanding of women's experiences of being exposed to intimate partner violence (IPV) during pregnancy. The data were collected through in-depth interviews with five Norwegian women; two during pregnancy and three after the birth. The women were between the age of 20 and 38 years. All women had received support from a professional research and treatment centre. The essential structure shows that IPV during pregnancy is characterized by difficult existential choices related to ambivalence. Existential choices mean questioning one's existence, the meaning of life as well as one's responsibility for oneself and others. Five constituents further explain the essential structure: Living in unpredictability, the violence is living in the body, losing oneself, feeling lonely and being pregnant leads to change. Future life with the child is experienced as a possibility for existential change. It is important for health professionals to recognize and support pregnant women who are exposed to violence as well as treating their bodies with care and respect

Hydrogel Expandable Coils for Vascular Occlusion in Congenital Cardiovascular Disease: A Single Center Experience

Objective.  The objective of this study is to evaluate the safety and feasibility of the AZUR hydrogel‐polymer coated platinum coil (hydrocoil) for vascular occlusion in patients with congenital cardiovascular disease (CCVD). Design.  Retrospective case review. Patients.  Eight patients with CCVD who underwent attempted vascular occlusion procedure with the hydrocoil at the University of Michigan between January 1, 2008 and March 1, 2011. Median patient age was 1.6 years (range 0.6–27.5 years) and median weight was 10.6 kg (3.9–74.8 kg). Outcome Measures.  Complete vascular occlusion of the target vessel was assessed at procedural completion with angiography and noninvasive imaging at follow‐up. Key procedural variables and adverse events were also evaluated. Results.  A total of 21 hydrocoils were successfully placed in seven vessels, in six patients. Vessels included four (57%) veno‐venous collaterals, two (29%) aortopulmonary collaterals, and one (14%) main pulmonary artery. Hydrocoils could not be placed successfully in two patients, including one baffle leak and one veno‐venous collateral. Pretreatment of the hydrocoil with steam to soften the coil, prior to vascular introduction, increased the likelihood of successful implant (100% vs. 60%). Complete occlusion was observed in 100% of vessels either at the time of catheterization or at follow‐up. There were no complications attributable to the hydrocoil. Conclusions.  Hydrocoils are safe and effective devices that can be utilized for vascular occlusion in a variety of blood vessels in patients with CCVD. Coil pretreatment may increase the likelihood of procedural success.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92067/1/j.1747-0803.2011.00583.x.pd

Degradation properties of a biodegradable shape memory elastomer, poly(glycerol dodecanoate), for soft tissue repair.

Development of biodegradable shape memory elastomers (SMEs) is driven by the growing need for materials to address soft tissue pathology using a minimally invasive surgical approach. Composition, chain length and crosslinking of biocompatible polymers like PCL and PLA have been investigated to control mechanical properties, shape recovery and degradation rates. Depending on the primary mechanism of degradation, many of these polymers become considerably stiffer or softer resulting in mechanical properties that are inappropriate to support the regeneration of surrounding soft tissues. Additionally, concerns regarding degradation byproducts or residual organic solvents during synthesis accelerated interest in development of materials from bioavailable monomers. We previously developed a biodegradable SME, poly(glycerol dodecanoate) (PGD), using biologically relevant metabolites and controlled synthesis conditions to tune mechanical properties for soft tissue repair. In this study, we investigate the influence of crosslinking density on the mechanical and thermal properties of PGD during in vitro and in vivo degradation. Results suggest polymer degradation in vivo is predominantly driven by surface erosion, with no significant effects of initial crosslinking density on degradation time under the conditions investigated. Importantly, mechanical integrity is maintained during degradation. Additionally, shifts in melt transitions on thermograms indicate a potential shift in shape memory transition temperatures as the polymers degrade. These findings support the use of PGD for soft tissue repair and warrant further investigation towards tuning the molecular and macromolecular properties of the polymer to tailor degradation rates for specific clinical applications

Self-Expanding Transcatheter Pulmonary Valve Implant in the Right Pulmonary Artery

Newer self-expanding transcatheter pulmonary valves (TPVs) are approved for the treatment of severe pulmonary regurgitation in patients with large right ventricular outflow tracts. We present a patient with Tetralogy of Fallot whose right ventricular outflow tract was too large for self-expanding TPV, who was treated successfully with a self-expanding TPV in the right pulmonary artery. (Level of Difficulty: Advanced.

Zn2+-dependent suppression of vascular smooth muscle intimal hyperplasia from biodegradable zinc implants

Biodegradable arterial implants based on zinc have been found to suppress neointimal hyperplasia, suggesting that biodegradable materials containing zinc may be used to construct vascular implants with a reduced rate of restenosis. However, the molecular mechanism has remained unclear. In this report, we show that zinc-containing materials can be used to prevent neointimal formation when implanted into the rat aorta. Indeed, neointimal cells were significantly more TUNEL positive and alpha-actin negative at the interface of biodegradable zinc vs. biostable platinum implants, in association with greater caspase-3 activity. Although zinc stimulated extensive neointimal smooth muscle cell (SMC) death, macrophage and proinflammatory markers CD68 and iNOS were not increased in neointimal tissue relative to biostable platinum control implants. Using arterial explants, ionic zinc was confirmed to promote SMC apoptosis by activating the caspase apoptotic signaling pathway. These observations suggest that zinc-containing materials can be used to construct vascular implants such as stents with reduced neointimal hyperplasia

In-vivo evaluation of molybdenum as bioabsorbable stent candidate

Biodegradable stents have tremendous theoretical potential as an alternative to bare metal stents and drug-eluting stents for the treatment of obstructive coronary artery disease. Any bioresorbable or biodegradable scaffold material needs to possess optimal mechanical properties and uniform degradation behavior that avoids local and systemic toxicity. Recently, molybdenum (Mo) has been investigated as a potential novel biodegradable material for this purpose. With its proven moderate degradation rate and excellent mechanical properties, Mo may represent an ideal source material for clinical cardiac and vascular applications. The present study was performed to evaluate the mechanical performance of metallic Mo in vitro and the biodegradation properties in vivo. The results demonstrated favorable mechanical behavior and a uniform degradation profile as desired for a new generation ultra-thin degradable endovascular stent material. Moreover, Mo implants in mouse arteries avoided the typical cellular response that contributes to restenosis. There was minimal neointimal hyperplasia over 6 months, an absence of excessive smooth muscle cell (SMC) proliferation or inflammation near the implant, and avoidance of significant harm to regenerating endothelial cells (EC). Qualitative inspection of kidney sections showed a potentially pathological remodeling of kidney Bowman\u27s capsule and glomeruli, indicative of impaired filtering function and development of kidney disease, although quantifications of these morphological changes were not statistically significant. Together, the results suggest that the products of Mo corrosion may exert beneficial or inert effects on the activities of inflammatory and arterial cells, while exerting potentially toxic effects in the kidneys that warrant further investigation

Conventional Platinum Metal Implants Provoke Restenosis Responses in Atherogenic but Not Healthy Arteries

Platinum-containing stents are commonly used in humans with hypercholesterolemia, whereas preclinical stent evaluation has commonly been performed in healthy animal models, providing inadequate information about stent performance under hypercholesterolemic conditions. In this investigation, we used an ApoE−/− mouse model to test the impact of hypercholesterolemia on neointima formation on platinum-containing implants. We implanted 125 μm diameter platinum wires into the abdominal aortas of ApoE−/− and ApoE+/+ mice for 6 months, followed by histological and immunofluorescence examination of neointimal size and composition. It was found that ApoE−/− mice developed neointimas with four times larger area and ten times greater thickness than ApoE+/+ counterparts. Neointimas developed in the ApoE−/− mice also contained higher amounts of lipids quantified as having 370 times more coverage compared to ApoE+/+, a 3-fold increase in SMCs, and a 22-fold increase in macrophages. A confluent endothelium had regenerated in both mouse strains. The ApoE−/− mice experienced luminal reductions more closely resembling clinically relevant restenosis in humans. Overall, the response to platinum arterial implants was highly dependent upon the atherogenic environment