Influence of xanthines on gastroesophageal reflux in infants at risk for sudden infant death syndrome

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Simultaneous delivery of two patent arterial duct coils via one venous sheath

A female child, 10 months of age, weighing 7.2 kg, was catheterised for closure of a patent arterial duct. Aortography was performed in the lateral projection and the minimum diameter of the arterial duct was assessed by comparing it to the size of the catheter. The duct size was estimated between 3 and 3.5 mm at the narrowest point, therefore, it was decided to deliver two 5 mm patent arterial duct coils to avoid placement of an 8 mm coil in this small child. Similar operations were subsequently performed in two further children. Simultaneous delivery of two coils via a single long venous sheath is easy, fast, and safe. This simple and inexpensive procedure can reduce irradiation and anaesthesia time

Local DRLs and automated risk estimation in paediatric interventional cardiology

Introduction : Cardiac catheterization procedures result in high radiation doses and often multiple procedures are necessary for congenital heart disease patients. However, diagnostic reference levels (DRL) remain scarce. Our first goal was finding the optimal DRL parameter and determining appropriate DRLs. The second goal was to calculate organ doses (OD), effective doses (ED) and lifetime attributable risks (LAR) per procedure and to provide conversion factors based on dose area product (DAP). Materials and methods : DRLs are calculated for each procedure type, as the 75th percentile of the cumulative value per procedure from the corresponding parameter. All irradiation events in the DICOM Structured Reports were automatically processed and simulated using PCXMC, resulting in OD, ED and LAR. Using a Kruskal Wallis H test and subsequent pairwise comparisons, differences in median values of the DRL parameter between procedure types were assessed. Results : Linear regression showed a strong correlation and narrow confidence interval between DAP and product of body weight and fluoroscopy time (BWxFT), even when all procedures (diagnostic and interventional) are combined. Only 15% of the pairwise comparisons were statistically significant for DAP normalized to BWxFT (DAP(BWxFT)). The latter pairs contained less frequent procedure types with significant outliers. For DAP normalized to BW (DAP(BW)), 38% of the pairwise comparisons showed statistically significant differences. Conversion factors from DAP(BW) to OD and ED were reported for various weight groups, due to the higher correlation between DAP(BW) and both OD and ED than between DAP and both OD and ED. Conclusions : The P75 of DAP(BWxFT) for all procedures combined serves as an appropriate DRL value. This facilitates local DRL determination in smaller paediatric centres, which often have insufficient data to produce appropriate DRLs for different procedure types. Conversion factors are more reliable starting from DAP(BW) instead of DAP and should be used according to the appropriate BW group

Echocardiography during submaximal isometric exercise in children with repaired coarctation of the aorta compared with controls

Objective Patients with repaired coarctation (RCoA) remain at higher risk of cardiac dysfunction, initially often only detected during exercise. In this study, haemodynamics of isometric handgrip (HG) and bicycle ergometry (BE) were compared in patients with RCoA and matched controls (MCs). Methods Case-control study of 19 children with RCoA (mean age 12.9 +/- 2.3 years; mean age of repair 7 months) compared with 20 MC. HG with echocardiography followed by BE was performed in both groups. Results During HG (blood pressure) BP increased from 114 +/- 11/64 +/- 4 mm Hg to 132 +/- 14/79 +/- 7 mm Hg, without significant differences. During HG as well as BE, HR increased less in patients with RCoA. There were no significant differences in (left ventricle) LV dimensions or LV mass. The RCoA group had diastolic dysfunction: both at rest and during HG they had significantly higher transmitral E and A velocities and lower tissue Doppler E' and A' velocities. E/E' was higher, reaching statistical significance during HG (p<0001). Conventional parameters of systolic function (FS and EF) were similar at rest and HG. More sensitive tissue Doppler S' was significantly lower at rest in CoA subjects (5.1 +/- 1.5 cm/s vs 6.5 +/- 1 +/- 1 cm/s; p<0.01), decreasing further during HG by 5% in the CoA group (NS) while unchanged in controls. Conclusions We provide first evidence that HG with echocardiography is feasible, easy and patient-friendly. A decreased systolic (tissue Doppler) and impaired diastolic LV function was measured in the RCoA group, a difference that tended to increase during HG

Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial

OBJECTIVE: To evaluate the effect of combined exercise training on metabolic control, physical fitness and quality of life in adolescents with type 1 diabetes. DESIGN: A double-blind randomized controlled trial with patients receiving combined aerobic and strength or no training. SETTING: University Hospital Ghent (Belgium). SUBJECTS: Sixteen children with type 1 diabetes were randomized into a control group (n = 8) and an intervention group (n = 8). INTERVENTIONS: Patients participated twice a week for 20 weeks in the combined aerobic and strength group. The control group continued their normal daily activities. MAIN MEASURES: Before and after the intervention anthropometric variables (weight, length, BMI, body composition), metabolic control (glycaemia, HbA1c, daily insulin injected), aerobic capacity (peak Vo(2), peak power, peak heart rate, 6-minute walk distance), strength (1 repetition maximum of upper and lower limb, hand grip strength, muscle fatigue resistance, sit-to-stand) and quality of life (SF-36) were assessed. RESULTS: At baseline, none of the measured parameters differed significantly between the two groups. There was no significant evolution in the groups concerning anthropometric indices, glycaemia and HbA1c. However, the daily doses of insulin injected were significantly lowered in the training group (0.96 IU/kg.day pre versus 0.90 IU/kg.day post; P < 0,05), while it was increased in the control group. Physical fitness increased significantly in the training group. General health, vitality and role emotional had a tendency to improve. CONCLUSION: Combined exercise training seemed to lower daily insulin requirement and improve physical fitness, together with better well-being

Percutaneous closure of PFO in patients with reduced oxygen saturation at rest and during exercise : short- and long-term results

Background. A patent foramen ovale (PFO) is a rare cause of hypoxemia and clinical symptoms of dyspnea. Due to a right-to-left shunt, desaturated blood enters the systemic circulation in a subset of patients resulting in dyspnea and a subsequent reduction in quality of life (QoL). Percutaneous closure of PFO is the treatment of choice. Objectives. This retrospective multicentre study evaluates short- and long-term results of percutaneous closure of PFO in patients with dyspnea and/or reduced oxygen saturation. Methods. Patients with respiratory symptoms were selected from databases containing all patients percutaneously closed between January 2000 and September 2018. Improvement in dyspnea, oxygenation, and QoL was investigated using pre- and postprocedural lung function parameters and two postprocedural questionnaires (SF-36 and PFSDQ-M). Results. The average follow-up period was 36 [12-43] months, ranging from 0 months to 14 years. Percutaneous closure was successful in 15 of the 16 patients. All patients reported subjective improvement in dyspnea immediately after device deployment, consistent with their improvement in oxygen saturation (from 90 +/- 6% to 94 [92-97%] on room air and in upright position) (p<0.05). Both questionnaires also indicated an improvement of dyspnea and QoL after closure. The two early and two late deaths were unrelated to the procedure. Conclusion. PFO-related dyspnea and/or hypoxemia can be treated successfully with a percutaneous intervention with long-lasting benefits on oxygen saturation, dyspnea, and QoL

Sleep apnea and the impact on cardiovascular risk in patients with Marfan syndrome

Background: Marfan syndrome (MFS) is an inherited connective tissue disorder characterized by ectopia lentis, aortic root dilation and dissection and specific skeletal features. Obstructive sleep apnea (OSA) in MFS has been described earlier but the prevalence and its relation with the cardiovascular risk is still controversial. This study aimed to further investigate these aspects. Methods: In this prospective longitudinal study, we performed an attended polysomnography in 40 MFS patients (60% women, 37 +/- 12.8 years) and evaluated several cardiovascular parameters through echocardiography, resting electrocardiogram, 24 hr-Holter monitoring and serum NT-ProBNP measurements. Results: We found that OSA was present in 42.5% of the patients and that higher body mass index was the most important factor associated with the presence of OSA. We observed that overweight was present in 27.5% of the patients in the whole cohort and in 55.6% if >40 years. Furthermore, when evaluating the impact of OSA on the cardiovascular system, we observed that patients with OSA tended to have higher systolic blood pressure, larger distal aortic diameters and a higher prevalence of ventricular arrhythmia. These differences were, however, not significant after adjusting for confounders. Conclusions: Our study shows a high prevalence of OSA and a high prevalence of overweight in MFS patients. We found some trends between OSA and cardiovascular features but we could not establish a solid association. Our study, however might be underpowered, and a multicenter collaborative study could be very useful to answer some important open questions

Effect of aortic stiffness versus stenosis on ventriculo-arterial interaction in an experimental model of coarctation repair

Objectives: The aim of this study was to investigate the effect of short- versus long-segment aortic stiffness and stenosis on ventriculo-arterial interaction in a porcine model of coarctation repair. Methods: Short-long aortic stiffness was created by transection/suture [coarctation (CoA) suture, n = 6] and stenting (stent, n = 5) of the proximal descending aorta. Short-long aortic stenosis was achieved by wrapping a prosthetic graft around the aorta to 1/3-circumference reduction, over a segment length of 1 cm (CoA suture stenosis, n = 5) and 4.5 cm (stent stenosis, n = 6). After 3 months, aortic pressure-flow haemodynamics, aortic distensibility by intravascular ultrasound and left ventricular performance by pressure-volume loops were compared to a Sham group (n = 5) at baseline and during dobutamine administration. Results: The aortic impedance increased with 30.3 (12.6%) and 41.3 (20.9%) (P < 0.001) in CoA stenosis and stent stenosis during inotropic response. Impaired haemodynamic aortic compliance was associated with lower aortic distensibility by intravascular ultrasound, specifically in long-segment stenosis. The ventriculo-arterial coupling was disturbed in both groups with stenosis, with blunted contractile response [Sham 140.3 (19.8%), CoA suture 101.3 (14.5%), CoA suture stenosis 75.0 (8.4%), stent 115.5 (12.7%), stent stenosis 55.1 (14.6%), P < 0.001] and increased myocardial stiffness during dobutamine in the long-segment aortic stenosis group [Sham -26.0 (12.9%), CoA suture -27.5 (15.9%), CoA stenosis -9.5 (8.6%), stent -23.4 (4.8%), stent stenosis 19.9 (23.1%), P < 0.001]. Conclusions: This animal study on the sequelae of coarctation repair demonstrated that aortic stiffness had little effect on aortic pressure-flow characteristics in the absence of stenosis. However, the negative chronic effect of stenosis on aortic haemodynamics-especially a longer segment-leads to the rapid impairment of ventriculo-arterial interaction, which is accentuated by inotropy. Therefore, therapeutical management needs to focus on improving aortic remodelling after coarctation repair, preferably by minimizing residual stenosis, even at the cost of inducing aortic stiffness

Different patterns of cerebral and muscular tissue oxygenation 10 years after coarctation repair

The purpose of this study was to assess whether the lower exercise tolerance in children after coarctation repair is associated with alterations in peripheral tissue oxygenation during exercise. A total of 16 children after coarctation repair and 20 healthy control subjects performed an incremental ramp exercise test to exhaustion. Cerebral and locomotor muscle oxygenation were measured by means of near infrared spectroscopy. The responses of cerebral and muscle tissue oxygenation index (cTOI, mTOI), oxygenated (O(2)Hb), and deoxygenated hemoglobin (HHb) as a function of work rate were compared. Correlations between residual continuous wave Doppler gradients at rest, arm-leg blood pressure difference and local oxygenation responses were evaluated. Age, length, and weight was similar in both groups. Patients with aortic coarctation had lower peak power output (Ppeak) (72.3 +/- 20.2% vs. 106 +/- 18.7%, P < 0.001), VO(2)peak/kg (37.3 +/- 9.1 vs. 44.2 +/- 7.6 ml/kg, P = 0.019) and %VO(2)peak/kg (85.7 +/- 21.9% vs. 112.1 +/- 15.5%, P < 0.001). Cerebral O(2)Hb and HHb had a lower increase in patients vs. controls during exercise, with significant differences from 60 to 90% Ppeak (O(2)Hb) and 70% to 100% Ppeak (HHb). Muscle TOI was significantly lower in patients from 10 to 70% Ppeak and muscle HHb was significantly higher in patients vs. controls from 20 to 80% Ppeak. Muscle O(2)Hb was not different between both groups. There was a significant correlation between residual resting blood pressure gradient and Delta muscle HHb/Delta P at 10-20W and 20-30W (r = 0.40, P = 0.039 and r = 0.43, P = 0.034). Children after coarctation repair have different oxygenation responses at muscular and cerebral level. This reflects a different balance between O-2 supply to O-2 demand which might contribute to the reduced exercise tolerance in this patient population