Real time magnetic resonance assessment of septal curvature accurately tracks acute hemodynamic changes in pediatric pulmonary hypertension

International audienceBACKGROUND:This study assesses the relationship between septal curvature and mean pulmonary artery pressure and indexed pulmonary vascular resistance in children with pulmonary hypertension. We hypothesized that septal curvature could be used to estimate right ventricular afterload and track acute changes in pulmonary hemodynamics.METHODS AND RESULTS:Fifty patients with a median age of 6.7 years (range, 0.45-16.5 years) underwent combined cardiac catheterization and cardiovascular magnetic resonance. The majority had idiopathic pulmonary arterial hypertension (n=30); the remaining patients had pulmonary hypertension associated with repaired congenital heart disease (n=17) or lung disease (n=3). Mean pulmonary artery pressure and pulmonary vascular resistance were acquired at baseline and during vasodilation. Septal curvature was measured using real-time cardiovascular magnetic resonance. There was a strong correlation between mean pulmonary artery pressure and SCmin at baseline and during vasodilator testing (r=-0.81 and -0.85, respectively; P<0.01). A strong linear relationship also existed between pulmonary vascular resistance and minimum septal curvature indexed to cardiac output both at baseline and during vasodilator testing (r=-0.88 and -0.87, respectively; P<0.01). Change in septal curvature metrics moderately correlated with absolute change in mean pulmonary artery pressure and pulmonary vascular resistance, respectively (r=0.58 and -0.74; P<0.01). Septal curvature metrics were able to identify vasoresponders with a sensitivity of 83% (95% confidence interval, 0.36-0.99) and a specificity of 91% (95% confidence interval, 0.77-0.97), using the Sitbon criteria. Idiopathic pulmonary arterial hypertension subgroup analysis revealed 3 responders with ΔSCmin values of 0.523, 0.551, and 0.568. If the middle value of 0.551 is taken as a cutoff, the approximate sensitivity would be 67% and the specificity would be 93%.CONCLUSIONS:Septal curvature metrics are able to estimate right ventricular afterload and track acute changes in pulmonary hemodynamics during vasodilator testing. This suggests that septal curvature could be used for continuing assessment of load in pulmonary hypertension

Chronic Outpatient Sildenafil Therapy for Pulmonary Hypertension in a Child After Cardiac Surgery

We report the case of a 14-month-old male with d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension successfully treated with long-term sildenafil following cardiac surgery. To our knowledge, this is the first published report of long-term sildenafil treatment in a child after corrective cardiac surgery

Problems of modern programming used in the technology of transport processes

It is well known that information technologies are the most rapidly developing areas of modern life. New technology, designs, names and abbreviations appear almost every day.While creating the products application programming, depending on the industry in which a project is, at the forefront come priority challenges that require extraordinary solutions. This could be accuracy of the solution in the physics-mathematical calculations, the speed of calculations in the programs that implement the reaction or improved interface in products aimed for users, as well as solutions for tasks that implement specific requirements for group work.Mankind has shown interest in the search of the optimal route of application programming and mathematical solution of transportation tasks, allowing to calculate the best route at the lowest cost

Система анализа геологических карт с помощью инструментов компьютерного зрения и машинного обучения

Несколько областей компьютерного зрения было исследовано в данной работе для того, чтобы разработать два модуля системы анализа структурных геологических карт – модуль анализа изображений и модуль исправления результатов анализа. Ряд различных современных методов машинного и глубокого обучения был применен на практике. Все подходы были оценены на синтетической выборке. На тестовой выборке были рассчитаны метрики mAP, IOU, F1 score.Several areas of computer vision were researched in order to develop two modules of a structural maps analysis system – image analysis and results correction modules. Multiple modern machine learning and deep learning methods were applied in this master’s thesis, such as. Different approaches were tested in the development process. All of them were validated on synthetic data. Three evaluation metrics (mAP, IOU, F1 score) were calculated during validation

Issues related to the management and therapy of paediatric pulmonary hypertension

An increasing number of medical services dedicated to the diagnosis, treatment and follow-up of pulmonary hypertension (PH) in children are being established. This has, in turn, increased the need to adapt current guidelines for the treatment of PH to be more relevant to paediatric patients with PH. This article will summarise the data obtained so far from paediatric registries, national cohorts and clinical trials and discuss the best approach for developing a treatment algorithm designed for children with different types of PH. The many unanswered questions, challenges and issues relating to the PH in the paediatric population will also be discussed

Sildenafil as a selective pulmonary vasodilator in childhood primary pulmonary hypertension

Primary pulmonary hypertension is a rare disease of childhood, which carries a poor prognosis. Patients often present with severe exercise limitation, and untreated life expectancy is less than 1 year. Pharmacological intervention is directed towards reduction of the raised pulmonary artery pressure with vasodilator treatment, initially with calcium antagonists, although more recently long term prostacyclin treatment has shown benefit in some patients. Heart-lung transplantation remains an option for children with severe disease refractory to therapeutic treatment.   A 4 year old Bangladeshi girl with dyspnoea, cyanosis, and signs of a low cardiac output, is described. Initial treatment with prostacyclin was gradually reduced, and maintenance treatment with oral sildenafil (Viagra; Pfizer) instituted. At follow up 3 months later, her exercise capacity was greatly improved and she continues to enjoy a good quality of life without obvious side effects. In view of the encouraging initial results, this may become an acceptable adjunct in treating this patient group.


Keywords: primary pulmonary hypertension; sildenafil; prostacycli