Mid-term follow-up of the transcatheter closure of perimembranous ventricular septal defects in children using the Amplatzer

Background: The ventricular septal defect (VSD) is the most common form of congenital heart defects. The purpose of this study was to evaluate the results of the early complications and mid-term follow-up of the transcatheter closure of the VSD using the Amplatzer VSD Occluder. Methods: Between April 2012 and October 2013, 110 patients underwent the percutaneous closure of the perimembranous VSD. During the procedure, the size and type of the VSD were obtained via ventriculography. A device at least 2 mm larger than the VSD diameter measured via ventriculography was deployed. The size of the VSD, size of the Amplatzer, and devicesize to VSD-size ratio were calculated. After the confirmation of the suitable position of the device via echocardiography and left ventriculography, the device was released. Follow-up evaluations were done at discharge as well as at 1, 6, and 12 months and yearly thereafter for the VSD occlusion and complete heart block. Results: The study population comprised 62 females and 48 males. The mean age and weight of the patients at procedure were 4.3 ± 5.6 years (range: 2 to 14) and 14.9 ± 10.8 kg (range: 10 to 43). The average device size was 7.0 ± 2.5 mm (range: 4 to 14). The VSD occlusion rate was 72.8 at the completion of the procedure and rose up to 99.0 during the follow-up. The most serious significant complication was complete atrioventricular block, which was seen in 2 patients. The mean follow-up duration was 10.9 ± 3.6 months. Conclusion: The transcatheter closure of the perimembranous VSD was a safe and effective treatment with excellent closure rates in our study population. This procedure had neither mortality nor serious complications. © 2015, Tehran Heart Center. All right recived

Efficacy and safety of using amplatzer ductal occluder for transcatheter closure of perimembranous ventricular septal defect in pediatrics

Background: Perimembranous Ventricular Septal Defect (PMVSD) is the most common subtype of ventricular septal defects. Transcatheter closure of PMVSD is a challenging procedure in management of moderate or large defects. Objectives: The purpose of this study was to show that transcatheter closure of perimembranous ventricular septal defect with Amplatzer Ductal Occluder (ADO) is an effective and safe method. Patients and Methods: Between April 2012 and April 2013, 28 patients underwent percutaneous closure of PMVSD using ADO. After obtaining the size of VSD from the ventriculogram a device at least 2 mm larger than the narrowest diameter of VSD at right ventricular side was chosen. The device deployed after confirmation of its good position by echocardiography and left ventriculography. Follow up evaluations were done 1 month, 6 months, 12 months and yearly after discharge with transthoracic echocardiography and 12 lead electrocardiography. Results: The mean age of patients at procedure was 4.7 ± 6.3 (range 2 to 14) years, mean weight 14.7 ± 10.5 (range 10 to 40) kg. The mean defect size of the right ventricular side was 4.5 ± 1.6 mm. The average device size used was 7.3 ± 3.2mm (range 4 to 12 mm). The ADOs were successfully implanted in all patients. The VSD occlusion rate was 65.7 at completion of the procedure, rising up to 79.5 at discharge and 96.4 during follow-up. Small residual shunts were seen at completion of the procedure, but they disappeared during follow-up in all but one patient. The mean follow-up period was 8.3 ± 3.6 months (range 1 to 18 months). Complete atrioventricular block (CAVB), major complication or death was not observed in our study. Conclusions: Transcatheter closure of PMVSD with ADO in children is a safe and effective treatment associated with excellent success and closure rates, but long-term follow-up in a large number of patients would be warranted. © 2015, Growth & Development Research Center

Surgical repair of Tetralogy of Fallot following primary palliation: Right ventricular outflow track stenting versus modified Blalock-Taussig shunt

Background: Tetralogy of Fallot (TOF) is a cyanotic disease requiring early intervention. We assessed the effect of right ventricular outflow tract (RVOT) stenting versus modified Blalock-Taussig shunt (mBTS) on outcomes of surgical repair of TOF. Methods: Fifteen palliated TOF infants underwent complete repair surgery. RVOT stenting was performed in seven infants and mBTS was done in eight infants. Data on sequential patients who underwent surgery were collected and reviewed retrospectively. Results: Stenting group were significantly younger (1.62 ± 0.34 vs 2.80 ± 0.52, p = 0.001), had lower body weight (3.28 ± 0.48 vs 5.03 ± 0.67, p = 0.001) and lesser body surface area (0.20 ± 0.01 vs 0.26 ± 0.20, p = 0.001) than the mBTS group at palliation. Mean right pulmonary artery (RPA) diameter in stenting group at palliation was 2.9 ± 0.54 mm (z-score -3.08 ± 0.97) and increased at surgery to 4.6 ± 0.49 mm (z-score �0.79 ± 0.66) (p = 0.001). The mean left pulmonary artery (LPA) diameter was 2.5 ± 0.42 mm (z-score -3.3 ± 0.86), which increased to 3.3 ± 0.40 mm (z-score -2.2 ± 0.74) at surgery (p = 0.005). The mean RPA diameter in mBTS group at palliation was 3.2 ± 0.32 mm (z-score �2.9 ± 0.70) and increased at surgery to 4.3 ± 0.55 mm (z-score �1.1 ± 0.94) (p = 0.001). The mean LPA diameter was 2.8 ± 0.26 mm (z-score -3.3 ± 0.62), which increased to 3.2 ± 0.24 mm (z-score �2.4 ± 0.52) at surgery (p = 0.032). Repeat echocardiography showed significant increase in McGoon ratio and Nakata index in both groups (p = 0.001). No significant differences were seen between the two groups regarding surgical procedure and postoperative complications. Conclusion: RVOT stenting is a safe and effective approach instead of mBTS in hazardous TOF infants with hypercyanotic spell, small PAs and complex anatomies. © 201

Accumulation of lead and zinc by plants colonizing a metal mining area in Central Iran

The Irankouh area, located in Central Iran, is a vast mountainous region with mineralized soils and several active zinc and lead mining and smelting sites. In this study plants and soils from 5 different sites in this area were collected and analyzed for Zn and Pb. Analysis of soils from different sites showed the expected high concentrations of Zn and Pb - up to 23,000 and 18,000 μg g-1 for total, 30 and 20 μg g-1 for exchangeable, 1 and 0.6 μg g-1 for water-soluble fractions, respectively. Plants collected from these sites total 67 species from 66 genera and 29 families. Most of these are annual herbs found also on non-metalliferous soils in this region. The concentrations of Zn and Pb in the leaf dry matter of plants were variable, with up to 4800 μg g-1 for Zn and 740 μg g-1 Pb in Matthiola chenopodiifolia and Pinus elderica, respectively. A significant positive correlation was detected between the concentrations of Zn and Pb in plant dry matter and those in soils. The concentrations of Zn and Pb in the leaves of most species collected were significantly higher than for other plants from non-metalliferous soils. Some accumulator plants found in this area could have potential for soil clean-up by phytoextraction

Surgical repair of Tetralogy of Fallot following primary palliation: Right ventricular outflow track stenting versus modified Blalock-Taussig shunt

Background: Tetralogy of Fallot (TOF) is a cyanotic disease requiring early intervention. We assessed the effect of right ventricular outflow tract (RVOT) stenting versus modified Blalock-Taussig shunt (mBTS) on outcomes of surgical repair of TOF. Methods: Fifteen palliated TOF infants underwent complete repair surgery. RVOT stenting was performed in seven infants and mBTS was done in eight infants. Data on sequential patients who underwent surgery were collected and reviewed retrospectively. Results: Stenting group were significantly younger (1.62 ± 0.34 vs 2.80 ± 0.52, p = 0.001), had lower body weight (3.28 ± 0.48 vs 5.03 ± 0.67, p = 0.001) and lesser body surface area (0.20 ± 0.01 vs 0.26 ± 0.20, p = 0.001) than the mBTS group at palliation. Mean right pulmonary artery (RPA) diameter in stenting group at palliation was 2.9 ± 0.54 mm (z-score -3.08 ± 0.97) and increased at surgery to 4.6 ± 0.49 mm (z-score �0.79 ± 0.66) (p = 0.001). The mean left pulmonary artery (LPA) diameter was 2.5 ± 0.42 mm (z-score -3.3 ± 0.86), which increased to 3.3 ± 0.40 mm (z-score -2.2 ± 0.74) at surgery (p = 0.005). The mean RPA diameter in mBTS group at palliation was 3.2 ± 0.32 mm (z-score �2.9 ± 0.70) and increased at surgery to 4.3 ± 0.55 mm (z-score �1.1 ± 0.94) (p = 0.001). The mean LPA diameter was 2.8 ± 0.26 mm (z-score -3.3 ± 0.62), which increased to 3.2 ± 0.24 mm (z-score �2.4 ± 0.52) at surgery (p = 0.032). Repeat echocardiography showed significant increase in McGoon ratio and Nakata index in both groups (p = 0.001). No significant differences were seen between the two groups regarding surgical procedure and postoperative complications. Conclusion: RVOT stenting is a safe and effective approach instead of mBTS in hazardous TOF infants with hypercyanotic spell, small PAs and complex anatomies. © 201

PCSK9 SNP rs11591147 association study with coronary artery disease risk in Iran

Pro-protein convertase subtilisin/kexin type 9 (PCSK9) has been implicated in the regulation of the plasma levels of LDL-cholesterol. The SNP rs11591147 variant in PCSK9 gene is associated with low levels of LDL and reduced risk of coronary artery disease (CAD) in various populations. We therefore, investigated the association and protective role of the SNP rs11591147 with CAD in 94 patients and 94 healthy participants as controls. rs11591147 T>G was genotyped in all subjects by TaqMan Probe Real Time PCR, although we could not observe neither positive or insignificant association between SNP genotypes with CAD incidence. Allele frequencies also remained insignificant after performing comparison analyses between cases and controls. LDL-cholesterol and total cholesterol levels were not associated with the genotypes. Our data indicated that CAD or the plasma level of LDL-cholesterol was not associated with the reduction of CAD incidence in Iranian population, even in a population with high frequency of lipid-connected CAD risk factors. Prospective investigations should include more cases to accurately analyze the effect of SNP rs11591147 in protecting patients from CAD

Geochemical assessment of metal transfer from rock and soil to water in serpentine areas of Sabah (Malaysia)

The mobility of metals in ultramafic rock–soil systems and metal contamination in serpentine soils were investigated from the Ranau area in Sabah, East Malaysia. Metal concentrations were analysed after division into seven operationally defined fractions by selective sequential extraction (SSE). Geochemical studies showed that the soils are exceptionally high in Cr (95%) residing in refractory residual fractions. Metal speciation studies will shed further light on toxicities in the Malaysian ultramafic tropical environment, reconciled against elemental metal tenure, adopted by common standards

Ultramafic vegetation and soils in the circumboreal region of the Northern Hemisphere

The paper summarizes literature on climate, soil chemistry, vegetation and metal accumulation by plants found on ultramafic substrata in the circumboreal zone (sensu Takhtajan, Floristic regions of the world, 1986) of the Northern Hemisphere. We present a list of 50 endemic species and 18 ecotypes obligate to ultramafic soils from the circumboreal region of Holarctic, as well as 30 and 2 species of Ni and Zn hyperaccumulators, respectively. The number of both endemics and hyperaccumulators are markedly lower compared to that of the Mediterranean and tropical regions. The diversity of plant communities on ultramafics soils of the circumboral region is also described. The underlying causes for the differences of ultramafic flora between arctic, cold, cool temperate and Mediterranean and tropical regions are also discussed. © 2018, The Ecological Society of Japan