The Amplatzer duct occluder (ADOII) and Piccolo devices for patent ductus arteriosus closure: a large single institution series

PurposeEvaluate Piccolo and ADOII devices for transcatheter patent ductus arteriosus (PDA) closure. Piccolo has smaller retention discs reducing risk of flow disturbance but residual leak and embolization risk may increase.MethodsRetrospective review of all patients undergoing PDA closure with an Amplatzer device between January 2008 and April 2022 in our institution. Data from the procedure and 6 months follow-up were collected.Results762 patients, median age 2.6 years (range 0–46.7) years and median weight 13 kg (range 3.5–92) were referred for PDA closure. Overall, 758 (99.5%) had successful implantation: 296 (38.8%) with ADOII, 418 (54.8%) with Piccolo, and 44 (5.8%) with AVPII. The ADOII patients were smaller than the Piccolo patients (15.8 vs. 20.5 kg, p < 0.001) and with larger PDA diameters (2.3 vs. 1.9 mm, p < 0.001). Mean device diameter was similar for both groups. Closure rate at follow-up was similar for all devices ADOII 295/296 (99.6%), Piccolo 417/418 (99.7%), and AVPII 44/44 (100%). Four intraprocedural embolizations occurred during the study time period: two ADOII and two Piccolo. Following retrieval the PDA was closed with an AVPII in two cases, ADOI in one case and with surgery in the fourth case. Mild stenosis of the left pulmonary artery (LPA) occurred in three patients with ADOII devices (1%) and one patient with Piccolo device (0.2%). Severe LPA stenosis occurred in one patient with ADOII (0.3%) and one with AVPII device (2.2%).ConclusionsADOII and Piccolo are safe and effective for PDA closure with a tendency to less LPA stenosis with Piccolo. There were no cases of aortic coarctation related to a PDA device in this study

Vigilance in the Decision-Making Process Regarding Termination of Pregnancy Following Prenatal Diagnosis of Congenital Heart Disease—Application of the ‘Conflict Decision-Making Model’

The decision-making process regarding termination of pregnancy following prenatal diagnosis of congenital heart disease is a stressful experience for future parents. Janis and Mann’s conflict decision-making model describes seven ideal stages that comprise vigilant information-gathering as an expression of the qualitative decision-making process. In our study, we attempted to determine whether parents who face the decision regarding termination of pregnancy undertake a qualitative decision-making process. Data were collected over 2-year period using structural questionnaires. The sample consisted of two hundred forty participants; sixty-nine (28.75%) declared that their decision was to terminate the pregnancy. A significant difference in the quality of the decision-making score was noted between parents who decided to continue with the pregnancy vs. parents who opted for termination (mean score of 10.15 (5.6) vs. 18.51 (3.9), respectively, p < 0.001). Sixty-two (90%) participants within the termination of pregnancy group went through all seven stages of vigilant decision-making process and utilized additional sources for information and consultation. Parents who decided to continue with the pregnancy made swift decisions, often without considering the negative and positive outcomes; this decision-making pattern is considered non-vigilant and ineffective. Identification of future parents at risk of going through an ineffective decision-making process may help health professionals to determine the best way to provide them with information and support

Duloxetine Contributing to a Successful Multimodal Treatment Program for Peripheral Femoral Neuropathy and Comorbid ‘Reactive Depression’ in an Adolescent

In the United States, duloxetine has been approved for the treatment of major depressive disorder, diabetic peripheral neuropathic pain and fibromyalgia in the adult population. Data regarding the use of duloxetine in the pediatric population, however, are very limited. Femoral nerve injury is a rare complication of cardiac catheterization. In the case described, duloxetine contributed to a successful multimodal treatment program for peripheral neuropathic pain due to femoral neuropathy in an adolescent with ‘reactive depression’ and conversion symptoms. To the best of the authors’ knowledge, the present article is only the third such report on this dual use of duloxetine in children and adolescents, and the first report of such treatment following femoral neuropathy induced by cardiac catheterization

Long-Lived αMUPA Mice Show Attenuation of Cardiac Aging and Leptin-Dependent Cardioprotection.

αMUPA transgenic mice spontaneously consume less food compared with their wild type (WT) ancestors due to endogenously increased levels of the satiety hormone leptin. αMUPA mice share many benefits with mice under caloric restriction (CR) including an extended life span. To understand mechanisms linked to cardiac aging, we explored the response of αMUPA hearts to ischemic conditions at the age of 6, 18, or 24 months. Mice were subjected to myocardial infarction (MI) in vivo and to ischemia/reperfusion ex vivo. Compared to WT mice, αMUPA showed functional and histological advantages under all experimental conditions. At 24 months, none of the WT mice survived the first ischemic day while αMUPA mice demonstrated 50% survival after 7 ischemic days. Leptin, an adipokine decreasing under CR, was consistently ~60% higher in αMUPA sera at baseline. Leptin levels gradually increased in both genotypes 24h post MI but were doubled in αMUPA. Pretreatment with leptin neutralizing antibodies or with inhibitors of leptin signaling (AG-490 and Wortmannin) abrogated the αMUPA benefits. The antibodies also reduced phosphorylation of the leptin signaling components STAT3 and AKT specifically in the αMUPA myocardium. αMUPA mice did not show elevation in adiponectin, an adipokine previously implicated in CR-induced cardioprotection. WT mice treated for short-term CR exhibited cardioprotection similar to that of αMUPA, however, along with increased adiponectin at baseline. Collectively, the results demonstrate a life-long increased ischemic tolerance in αMUPA mice, indicating the attenuation of cardiac aging. αMUPA cardioprotection is mediated through endogenous leptin, suggesting a protective pathway distinct from that elicited under CR

Functional and histological parameters after I/R in WT and αMUPA mice.

<p>Hearts excised from WT (n = 9) and αMUPA (n = 10) mice were treated for I/R as described in the Methods section. LVP was determined throughout the procedure. A, percentage of LVP recovery; B, maximum rate of LV contraction (+dP/dt max, mmHg/sec); C, maximum rate of LV relaxation (−dP/dt max, mmHg/sec); D, heart rate (beats/min); E, infarct size; F, creatine kinase released into the coronary effluent. LVP, +dP/dt max and -dP/dt max are presented as % of values measured in the stabilization period. Using ANOVA comparisons compared to WT hearts, αMUPA hearts demonstrated increased recovery of contractile parameters, (LVP, p<0.006) with a trend of higher values of positive dP/dtmax (p<0.13) and negative dP/dtmax (p<0.04) (Fig 3A–3C); a similar heart rate (Fig 3D), reduced infarct size (Fig 3E) and reduced levels of CK in effluent samples collected throughout the procedure (Fig 3F). Stab, stabilization; R, reperfusion. Data are means ±S.E.M. *, P< 0.05; **, P< 0.01</p

Functional and histological parameters after I/R in WT mice fed AL or CR.

<p>FVB/N mice were treated for short term CR (n = 4) or fed AL (n = 8) as described in the Methods section. Hearts were excised and treated for I/R as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0144593#pone.0144593.g003" target="_blank">Fig 3</a>. Parameters were monitored and are expressed as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0144593#pone.0144593.g003" target="_blank">Fig 3</a>. A, percentage of LVP recovery; B, maximum rate of LV contraction (+dP/dt max %); C, maximum rate of LV relaxation (−dP/dt max%); D, heart rate (beats/min); E, creatine kinase released to the coronary effluent. Stab, stabilization; R, reperfusion. Data are means ±S.E.M. *P< 0.05.</p

Functional and histological parameters after 24h MI in young and aged αMUPA and WT mice.

<p>6- and 18-month-old mice (young and aged, respectively) were subjected to LAD ligation for 24h and examined for functional and histological parameters. A, fractional shortening as measured by echocardiography; <u>B, representative LV slices stained to delineate area at risk and infarct zone; C, D,</u> quantitation of area at risk, and infarct size staining, respectively. E, IKBα levels analyzed in Western blots; F, quantification of neutrophil infiltration; G, quantitation of TUNEL staining F, TUNEL staining for DNA fragmentation. Scale bar: 200 μm. The number of mice is indicated in the figure. *, P< 0.05; **, P< 0.01.</p

Levels of adiponectin or leptin in the serum of WT mice fed AL vs. CR, and αMUPA vs. WT mice fed AL.

<p>A, Serum samples collected at baseline from WT mice fed CR or AL were tested for adiponectin levels; B, Serum samples collected at baseline from WT and αMUPA mice were tested for adiponectin levels; C, As in B, but the test was for leptin; D, Serum samples collected from WT and αMUPA mice before, 3h and 24h after LAD ligation were tested for leptin levels. The number and age of mice are indicated in the figure. Data are means ±S.E.M. m = months. *p<0.05, **p<0.01</p