Percutaneous closure of the patent foramen ovale: A cardiological perspective

A patent foramen is commonly found in the general population.Evidence exists that a patent foramen ovale (PFO) and atrial septal aneurysm are strongly associated with cryptogenic stroke. Associations with migraine have also been described, but the status of cause and effect is less clear. Management of PFO is controversial and no form of therapy has been properly evaluated. PFO closure devices are readily available and can be safely and effectively implanted percutaneously. Complication rates are low and symptoms are improved in most patients. At present, there is a lack of guidelines for the treatment of PFO and results of prospective randomised trials are eagerly awaited

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

Management of severe aortic valve stenosis in the neonate

Aortic valve stenosis (AS) causing obstruction to the left ventricular outfl ow, and hence reduction of the cardiac output, remains a therapeutic challenge for paediatric cardiologists and cardiothoracic surgeons. Infants that present at birth may have very dysplastic valves with severe or critical AS and are typically the most diffi cult to treat. This article therefore focuses on the managementof severe AS in the neonate. This article also revises the embryology of the semi-lunar valves, as the morphology of the aortic valve often dictates the treatment pathway

Management of right ventricular outfl ow tract obstruction: Evolution to revolution

Percutaneous pulmonary valves have opened up new avenues of treatment in patients requiring pulmonary valve replacement. The management of tetralogy of Fallot demonstrated the evolution of treatment: from palliativecare to modern day early complete surgical repair. Use of trans-annular patches to treat right ventricle outfl ow obstruction gave rise to signifi cant pulmonary regurgitation. Clinicians considered this a benign condition until,three decades later patients started dying unexpectedly. Surgical pulmonary valve replacement was the only treatment, but these showed dysfunction after some years. Clear guidelines for intervention do not exist. Current guidelines recommend treatment at upper limits of tolerance. Arguments for earlier intervention are presented, but none of the guidelines have been scientifically validated

Organisms associated with burrowing whelks of the genus Bullia

Organisms found associated with the psammophilic neogastropod Bullia include hydroids, a boring sponge and algae which grow on, and burrow into, the shell. The shell may also be the recipient of the egg capsules of other species of gastropods. Peridinian ciliates are commonly found attached in some numbers to the tentacles and an occasional rotifer occurs on the soft parts of the animal. The gut is rich in bacteria, some of which are symbiotic, Digenetic trematode larvae are the mosl common internal parasites and larval cestodes also occur. Preliminary descriptions are given of two apparently new trematode larvae and of a cestode cysti-cercoid. A nematode worm is occasionally present in the gut. The absence of external parasites is noted and it is suggested that the shells of the whelk represent a refuge for smaller organisms or their eggs in an unstable environment lacking geological diversity

Chronic pulmonary arterial hypertension in children

Pulmonary arterial hypertension, although not common in children, has a poor prognosis. The definition, modern classification, causes and pathogenesis are discussed. Although the pathogenesis is complex and not completely understood, we now have a better understanding of it. The mechanisms and structural alterations underlying vasoconstriction of the pulmonary vasculature, remodelling of the pulmonary vessel wall and progressive obstruction and obliteration of the vascular bed with thrombosis are set out with the different mediators involved. Diagnosis can be difficult and a high level of suspicion is necessary to achieve an early diagnosis. The approach to management includes a methodical workup. The medication options discussed are based on an understanding of the pathophysiology

Organisms associated with the sandy-beach bivalve Donax serra Röding, with a description of Cercaria serrae sp. nov. (Trematoda)

Examination of two collections of Donax serra from a South African west coast beach revealed the presence of Ciliophora, Trematoda, Nematoda and a parasitic pycnogonid. This is the first record of a pycnogonid from the genus Donax and the first published report of such a parasite from any southern African bivalve mollusc. One of the two trematode species found is described as new and its epidemiology is discussed briefly. No epibiota were found on the bivalve shell

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

Percutaneous closure of ventricular septal defects in childhood

Ventricular septal defect is the most common congenital cardiac lesion. Surgery was, until recently, the only modality of treatment available. Since the first percutaneous closure was attempted, new devices have been developed and used to close these defects. The procedure is safe and effective if the defects are selected correctly with closure being achieved in more than 90% of patients. Morbidity and mortality are acceptable and comparable to surgery. However, percutaneous ventricular septal defect closure is difficult, technically challenging and should only be attempted in units with adequate experience, equipment and support