Current outcomes of live-born children with double outlet right ventricle in Norway

Objectives: This population-based, comprehensive, retrospective study presented the clinical outcomes of all children born in Norway between 2003 and 2017 with double outlet right ventricle (DORV). Methods: All children born with DORV between 2003 and 2017 were identified in the Oslo University Hospital registry. Patients' characteristics, interventions, complications and deaths were recorded. Echocardiographic data were reviewed for classification according to current standards. We investigated time-dependent surgical reintervention and mortality using Kaplan-Meier analyses and determinants of treatment complications, reintervention and death using regression analyses. Results: Ninety-three children with DORV represented an annual median prevalence of 1.18 per 10 000 births in Norway. Six children received palliative care. With an intention to treat, a surgical route with the primary biventricular repair was followed for 62 children, staged biventricular repair for 15 and univentricular repair for 10 children. Major complications occurred in 1.0% and 6.2% of children following catheter or surgical intervention, respectively. No significant determinants of the complications were identified. Overall survival following treatment was 91.9%, 90.8%, 89.5% and 89.5% and corresponding freedom from surgical reintervention was 88.0%, 79.0%, 74.9% and 69.4% at 1, 2, 5 and 10 years, respectively. The presence of atrioventricular septal defect predicted an increased risk of mortality (hazard ratio: 7.16) but did not increase the risk of surgical reintervention. Conclusions: In Norway, most children receive tailored treatment for DORV with low rates of complications, surgical reinterventions and mortality. However, atrioventricular septal defect remains a potential determinant of postoperative death. Keywords: Biventricular; Complication; DORV; Double outlet right ventricle; Reintervention; Univentricular. © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.publishedVersio

Trajectories of Maternal Mental Health: A Prospective Study of Mothers of Infants With Congenital Heart Defects From Pregnancy to 36 Months Postpartum

Objective To chart mothers' trajectories of mental health from pregnancy to 36 months postpartum in order to investigate the association between infants' congenital heart defects (CHD) and compromised maternal mental health. Methods Mothers of infants with mild, moderate, or severe CHD (n = 141) and mothers (n = 36,437) enrolled in the Norwegian Mother and Child Cohort Study were assessed at regular intervals from pregnancy up to 36 months postpartum, including measurements at 6 and 18 months, using an 8-item version of the Hopkins Symptom Checklist-25. Results Mean score trajectories of SCL-8 for mothers of infants with severe CHD deviated significantly from cohort controls 6, 18, and 36 months postpartum, indicating heightened symptoms of depression and anxiety. Conclusions Mothers of infants with severe CHD are at risk of compromised mental health from delivery to 36 months postpartum. Strain due to CHD-related interventions is identified as a possible partial mediator of the distres

Relationship Satisfaction Among Mothers of Children With Congenital Heart Defects: A Prospective Case-Cohort Study

Objective To assess the level of partner relationship satisfaction among mothers of children with different severity of congenital heart defects (CHD) compared with mothers in the cohort. Methods Mothers of children with mild, moderate, or severe CHD (n = 182) and a cohort of mothers of children without CHD (n = 46,782) from the Norwegian Mother and Child Cohort Study were assessed at 5 time points from pregnancy to 36 months postpartum. A 5-item version of the Relationship Satisfaction scale was used, and relevant covariates were explored. Results The trajectories of relationship satisfaction among mothers of children with varying CHD severity did not differ from the trajectories in the cohort. All women in the cohort experienced decreasing relationship satisfaction from 18 months after delivery up to 36 months after delivery. Conclusions Having a child with CHD, regardless of severity, does not appear to exacerbate the decline in relationship satisfactio

Behaviour and Modelling of Self-piercing Screw and Self-piercing Rivet Connections : An Experimental and Numerical Investigation

Accurate and reliable models of connections are essential for the design of aluminium parts in cars. Today, there exist a few models customized for self-piercing rivets (SPR), but none for self-piercing screws (SPS). This thesis presents an experimental and numerical study on the behaviour of SPR and SPS connections for different loading situations. For the rolled base material, AA6016 in the T4 condition, uniaxial tension, plane strain tension and in-plane single shear tests were performed. The Voce isotropic hardening rule and the YLD-2004-18P anisotropic yield function were calibrated using MatPrePost. The calibration was validated by simulations of the material tests. Cross tests in three directions, single lap-joint tests and peeling tests were performed for SPR and SPS, and a point-connector model developed for self-piercing rivets was calibrated by a reverse engineering approach based on the cross tests. Single lap-joint and peeling tests were used for validation. Forming process simulations were performed to account for initial plastic deformations in bent specimens. In all tests except for pure normal loading, failure of SPR was initiated from the top sheet, while failure of SPS was caused by pull-out from the bottom sheet in all cases. For SPR, good predictions were found, except for over-prediction of the peeling resistance. The model was not able to describe mixed tension and shear loading accurately for SPS, but other tests were well reproduced. Static and dynamic crash box tests were performed and deformation and failure modes of SPR and SPS were characterized. The same progressive buckling mode was found in all tests. Higher force was observed for riveted crash boxes compared to the screwed. Relative movement between the sheets was observed for SPS. During dynamic testing, 7 % of the SPR and 19 % of the SPS connections failed. Simulations of dynamic crash box tests investigated effects of forming history, yield surface and mesh size. The deformation mode was well reproduced, but the force was under-predicted with 5 % to 20 %. The simulations predicted some connection failure for SPS, but not for SPR. A more fundamental understanding of the behaviour of SPS connections is required to develop a new point-connector model. Further studies could include investigation of the effects of screw diameter, sheet thickness, sheet material, screw material and dynamic effects of the connection

Paediatric cardiac catheterisation in Norway: Rates and types of complications in new terms

We determined the incidence, type, and severity of complications after cardiac catheterisation in children with heart disease in Norway, and we present the results in terms of the International Paediatric and Congenital Cardiac Code (IPCCC) nomenclature for complications. All paediatric cardiac catheterisations in Norway are performed in one clinical centre. All procedures performed during a 5-year period beginning in 2010 were prospectively registered, and medical records for cases with complications were reviewed to confirm the event and to re-classify the type, severity, and attributability of the complication according to the IPCCC nomenclature. Univariate and multivariate analyses were performed to identify possible risk predictors. A total of 1318 catheterisations performed on 941 patients were included in the present study, of which 68% were interventional. The complication and major complication rates were 5.5 and 1.4%, respectively. Trauma to the vessels or the myocardium, haemodynamic adverse events, and arrhythmias were the most common types of complications. In the multivariate model, weight <4 kg (odds ratios, 3.0; 95% confidence intervals: 1.6–5.8) and risk category 5 (odds ratios, 5.1; 95% confidence intervals: 2.1–12.3) were significant risk predictors for any complication. In spite of a high rate of interventions, the complication rates in this study were similar to older studies, but diverging methods and terminology limit the comparability. We strongly suggest general use of the proposed IPCCC classification system for registration and reports of complications for paediatric cardiac catheterisations

Birth prevalence of congenital heart defects in Norway 1994-2009—A nationwide study

Background The reasons for decreasing birth prevalence of congenital heart defects (CHDs) in several European countries and Canada are not fully understood. We present CHD prevalence among live births, stillbirths, and terminated pregnancies in an entire nation over a period of 16 years. Methods Information on all births in the Medical Birth Registry of Norway, 1994-2009, was updated with information on CHD from the hospitals' Patient Administrative Systems, the National Hospital's clinical database for children with heart disease, and the Cause of Death Registry. Individuals with heart defects were assigned specific cardiac phenotypes. Results Among 954,413 births, 13,081 received a diagnosis of CHD (137.1 per 10,000 births, 133.2 per 10,000 live births). The prevalence per 10,000 births was as follows: heterotaxia, 1.6; conotruncal defects, 11.6; atrioventricular septal defects, 5.6; anomalous pulmonary venous return, 1.1; left outflow obstructions, 8.7; right outflow obstructions, 5.6; septal defects, 65.5; isolated patent ductus arteriosus, 24.6; and other specified or unspecified CHD, 12.7. Excluding preterm patent ductus arteriosus, the CHD prevalence was 123.4 per 10,000; per year, the prevalence increased with 3.5% (95% CI 2.5-4.4) in 1994-2005 and declined with 9.8%(−16.7 to −2.4) from2005 onwards. SevereCHDprevalencewas 30.7 per 10,000; per-year increase was 2.3% (1.1-3.5) in 1994-2004, and per-year decrease was 3.4% (−6.6 to −0.0) in 2004-2009. Numbers included severe CHD in stillbirths and terminated pregnancies. Conclusions The birth prevalence of CHD declined from around 2005. Specifically, the prevalence of severe CHD was reduced by 3.4% per year from 2004 through 2009. (Am Heart J 2014;168:956-64.

Macroscopic strength and failure properties of flow-drill screw connections

Force–displacement responses and failure behaviour of connections using flow-drill screws to join aluminium sheets were investigated under various quasi-static loading conditions. This included single connector tests under tensile, shear and combined tensile and shear loadings, using cross test coupons in a new test set-up, and peeling and single lap-joint tests. The strength of the connection increased with the amount of shear loading, while the ductility decreased. No effect of the anisotropy of the sheets on the behaviour in the single connector tests was found. Axial crushing tests of aluminium single-hat sections joined with flow-drill screws were also performed. Two connection failure modes not observed during the single connector test were found in these tests. For comparison, equivalent single connector and component tests were carried out for self-piercing rivet connections. Similar trends with respect to the ductility, maximum force and shape of force–displacement curves were observed for the two connections, but the local failure modes were different

Long-time sickness absence among parents of pre-school children with cerebral palsy, spina bifida and down syndrome: a longitudinal study

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Extra-adrenal composite phaeochromocytoma/neuroblastoma in a 15-month-old child

A 15-month-old boy was diagnosed with malignant hypertension caused by a catecholamine excreting retroperitoneal paraganglioma consisting of a composite phaeochromocytoma/differentiating neuroblastoma. After alpha-blockade the tumor was excised. No adjuvant treatment was given, and he is doing well eight years after the diagnosis. The patient is the first child known to have an extra-adrenal retroperitoneal composite tumor, and also the youngest child with a composite phaeochromocytoma/neuroblastoma reported in the English literature