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VW

Heparin as a risk factor for perigraft seroma complicating the modified Blalock-Taussig shunt

OBJECTIVE: The purpose of this study was to determine the risk factors associated with the occurrence of perigraft seromas complicating systemic-to-pulmonary polytetrafluoroethylene grafts. METHODS: Clinical and perioperative variables were reexamined, blinded for the outcome variable perigraft seroma, in 60 patients undergoing 67 consecutive graft procedures in a 3.5-year period. RESULTS: Eight cases of perigraft seroma were diagnosed in six patients. Univariate analysis revealed age (p = 0.02), a diagnosis of pulmonary atresia with ventricular septal defect and systemic-pulmonary collaterals (p = 0.001), reimplantation of collaterals during the procedure (p < 0.001), and intravenous heparin administered after operation (p < 0.0001) as risk factors for symptomatic perigraft seroma. Multivariable analysis defined heparin as the only significant factor associated with symptomatic perigraft seroma. Consolidation of the upper lobe on chest radiograph, ipsilateral to the shunt, directly after operation (p = 0.01), but especially 8 to 10 days after operation (p < 0.0001), or the need for prolonged drainage of pleural fluid (p < 0.0001) were correlated with the occurrence of perigraft seroma. Perigraft seroma led to four early rethoracotomies in three patients and to accelerated corrective surgery in three cases. Consolidation and absent perfusion of lung segments persisted in two patients. CONCLUSIONS: Our data suggest that the use of heparin leads to an increased risk of perigraft seroma, complicating systemic-pulmonary polytetrafluoroethylene grafts. Prolonged pleural drainage and/or postoperative consolidation of the upper lobe indicate the development of symptomatic perigraft seroma. Treatment is controversial and results are unpredictable. Expectative management seems to be justified so long as permitted by the clinical condition

PKS 1018-42: A Powerful Kinetically Dominated Quasar

We have identified PKS 1018-42 as a radio galaxy with extraordinarily powerful jets, over twice as powerful as any 3CR source of equal or lesser redshift except for one (3C196). It is perhaps the most intrinsically powerful extragalactic radio source in the, still poorly explored, Southern Hemisphere. PKS 1018-42 belongs to the class of FR II objects that are kinetically dominated, the jet kinetic luminosity, $Q \sim 6.5 \times 10^{46}\mathrm{ergs/s}$ (calculated at 151 MHz), is 3.4 times larger than the total thermal luminosity (IR to X-ray) of the accretion flow, $L_{bol} \sim 1.9 \times 10^{46}\mathrm{ergs/s}$. It is the fourth most kinetically dominated quasar that we could verify from existing radio data. From a review of the literature, we find that kinetically dominated sources such as PKS 1018-42 are rare, and list the 5 most kinetically dominated sources found from our review. Our results for PKS 1018-42 are based on new observations from the Australia Telescope Compact Array.Comment: To appear in ApJ Letter

Dynamic prediction of outcome for patients with severe aortic stenosis: Application of joint models for longitudinal and time-to-event data

Background: Physicians utilize different types of information to predict patient prognosis. For example: confronted with a new patient suffering from severe aortic stenosis (AS), the cardiologist considers not only the severity of the AS but also patient characteristics, medical history, and markers such as BNP. Intuitively, doctors adjust their prediction of prognosis over time, with the change in clinical status, aortic valve area and BNP at each outpatient clinic visit. With the help of novel statistical approaches to model outcomes, it is now possible t

PO-0891: Clinical implementation and experience with real-time anatomy tracking and gating during MR-IGRT

Cardiolog

Atrial fibrillation fingerprinting; spotting bio-electrical markers to early recognize atrial fibrillation by the use of a bottom-up approach (AFFIP): Rationale and design

Background: The exact pathophysiology of atrial fibrillation (AF) remains incompletely understood and treatment of AF is associated with high recurrence rates. Persistence of AF is rooted in the presence of electropathology, defined as complex electrical conduction disorders caused by structural damage of atrial tissue. The atrial fibrillation fingerprinting (AFFIP) study aims to characterize electropathology, enabling development of a novel diagnostic instrument to predict AF onset and early progression. Hypotheses: History of AF, development of post-operative AF, age, gender, underlying heart disease, and other clinical characteristics impact the degree of electropathology. Methods: This study is a prospective observational study with a planned duration of 48 months. Three study groups are defined: (1) patients with (longstanding) persistent AF, (2) patients with paroxysmal AF, and (3) patients without a history of AF, all undergoing open-chest cardiac surgery. Intra-operative high-resolution epicardial mapping is performed to identify the patient-specific electrical profile, whereas the patient-specific biological profile is assessed by evaluating proteostasis markers in blood samples and atrial appendage tissue samples. Post-operative continuous rhythm monitoring is perfo

Cardiologist and cardiac surgeon view on decision-making in prosthetic aortic valve selection: does profession matter?

Cardiolog

Dysrhythmias in patients with a complete atrioventricular septal defect: From surgery to early adulthood

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