Bilateral branch pulmonary artery valve implantation in repaired tetralogy of fallot

BackgroundTranscatheter, bilateral branch pulmonary artery (PA) valve implantation is a novel treatment for patients with severe pulmonary insufficiency and oversized right ventricle (RV) outflow tract. There is scarce data on efficacy and safety of this approach.MethodsThis was a retrospective study of 8 patients with repaired tetralogy of fallot (TOF) who underwent bilateral branch PA valve implantation. Demographics, echocardiography, cardiac catheterization, and axial imaging data were reviewed. Variables were compared by a paired sample t‐test.ResultsAll patients were adult sized (weight 43–99 kg) with oversized RV outflow tract not suitable for conventional transcatheter pulmonary valve implantation. Staged bare metal PA stenting followed by valve implantation (interval 3–5 months) was technically successful in 7 patients with one stent embolization. In another patient, proximal stent migration prevented placement of bilateral pulmonary valve stents. There were a total of 14 valved branch PA stents placed (Melody valve n = 9, Sapien XT n = 2, Sapien 3 n = 3). In the 7 patients undergoing successful branch pulmonary valve placement, at median follow up of 10 months (range 3 months to 6 years), 13 (93%) valves had none/trivial insufficiency on echocardiography. Prevalve and postvalve implantation cardiac magnetic resonance imaging in five patients showed significant reduction of indexed RV end‐diastolic volume (152 ± 27 to 105 ± 15 mL/m2, P < .001).ConclusionsTranscatheter, bilateral branch PA valve implantation was technically feasible with satisfactory efficacy and safety in patients with repaired TOF, severe pulmonary insufficiency, and oversized RV outflow tracts. Elimination of pulmonary insufficiency with this method resulted in reduced RV end‐diastolic volume. This approach can be offered as an alternative to surgery, particularly in patients considered high risk for standard surgical placement and who are not candidates for the newer self‐expanding valve prosthesis for placement in RV outflow tracts larger than 30 mm diameter.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143803/1/ccd27489.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143803/2/ccd27489_am.pd

Contraceptive use and the risk of ovarian cancer among women with a BRCA1 or BRCA2 mutation

Background BRCA1 and BRCA2 (BRCA) mutation carriers face a high lifetime risk of developing ovarian cancer. Oral contraceptives are protective in this population; however, the impact of other types of contraception (e.g. intrauterine devices, implants, injections) is unknown. We undertook a matched case-control study to evaluate the relationship between type of contraception and risk of ovarian cancer among women with BRCA mutations. Methods A total of 1733 matched pairs were included in this analysis. Women were matched according to year of birth, date of study entry, country of residence, BRCA mutation type and history of breast cancer. Detailed information on hormonal, reproductive and lifestyle exposures were collected from a routinely administered questionnaire. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) associated with each contraceptive exposure. Results Ever use of any contraceptive was significantly associated with reduced risk of ovarian cancer (OR&nbsp;=&nbsp;0.62; 95% CI 0.52-0.75; P&nbsp;&lt;&nbsp;0.0001), which was driven by significant inverse associations with oral contraceptives (OR&nbsp;=&nbsp;0.66; 95% CI 0.54-0.79; P&nbsp;&lt;&nbsp;0.0001) and contraceptive implants (OR&nbsp;=&nbsp;0.30; 95% CI 0.12-0.73; P&nbsp;=&nbsp;0.008). We observed a similar effect with use of injections (OR&nbsp;=&nbsp;0.37; 95% CI 0.10-1.38; P&nbsp;=&nbsp;0.14), but this did not achieve significance. No significant associations were observed between patterns of intrauterine device use and risk of ovarian cancer. Conclusions These findings support a protective effect of oral contraceptives and implants on risk of ovarian cancer among women with BRCA mutations. The possible protective effect of injections requires further evaluation