Stenting of native right ventricular outflow tract obstructions in symptomatic infants: histological work-up of explanted specimen

BACKGROUND Stenting of stenotic right ventricular outflow tract is a palliative measure for severely impaired small babies with Tetralogy of Fallot or similar pathologies. Little is known about the histopathological fate of the stents in the right ventricular outflow tract. METHODS Eight samples of surgically removed right ventricular outflow tract stents were histologically analysed according to a predefined protocol. RESULTS The most frequent diagnosis was Tetralogy of Fallot in four patients, pulmonary atresia with ventricular septal defect in two patients, double outlet right ventricle with pulmonary obstruction in one patient, and muscular obstruction of the right ventricular outflow tract in one patient with a syndromic disease with hypertrophic cardiomyopathy. Stents mean implantation duration was 444 days ranging from 105 to 1117 days (median 305.5 days). Histology revealed a variable degree of pseudointima formation consisting of fibromuscular cells surrounded by extracellular matrix. Four of the specimen contained adjacent myocardial tissue fragments, which showed regressive changes. Neither myocardium nor pseudointima tissue or tissue parts locally related to stent struts were infiltrated by inflammatory cells. CONCLUSIONS Histological analysis after explantation of early-in-life implanted right ventricular outflow tract stents revealed predominantly pronounced neo-intimal proliferation with a visible endothelial layer, no signs of inflammation, and no prolapse of muscular tissue through the stent struts. Thus, implantation of stents in early life seems to interfere little with the hosts' immune system and might help to open up the right ventricular outflow tract by mechanical forces and regressive changes in adjacent muscular tissue

Cardiac output measurement in children: comparison of Aesculon® cardiac output monitor and thermodilution

Background We compared cardiac output (CO) measurements by the non-invasive electrical velocimetry (Aesculon®) monitor with the pulmonary artery catheter (PAC) thermodilution method in children. Methods CO values using the Aesculon® monitor and PAC thermodilution were simultaneously recorded during cardiac catheterization in children. Measurements were performed under general anaesthesia. To compare, three consecutive measurements for each patient within 3 min were obtained. The means of the three values were compared using simple regression and Bland-Altman analysis. Data were presented as mean (sd). A mean percentage of <30% was defined to indicate clinical useful reliability of the Aesculon® monitor. Results A total of 50 patients with a median (range) age of 7.5 (0.5-16.5) yr were enrolled in the study. Mean CO values were 3.7 (1.5) litre min−1 (PAC thermodilution) and 3.1 (1.7) litre min−1 (Aesculon® monitor). Analysis for CO measurement showed a good correlation between the two methods (r=0.894; P<0.0001). The bias between the two methods was 0.66 litre min−1 with a precision of 1.49 litre min−1. The mean percentage error for CO measurements was 48.9% for the Aesculon® monitor when compared with PAC thermodilution. Conclusions Electrical velocimetry using the Aesculon® monitor did not provide reliable CO values when compared with PAC thermodilution. Whether the Aesculon® monitor can be used as a CO trend monitor has to be assessed by further investigations in patients with changing haemodynamic

Tracheal tube-tip displacement in children during head-neck movement—a radiological assessment

Background. Aims of this study were to assess the maximum displacement of tracheal tube tip during head-neck movement in children, and to evaluate the appropriateness of the intubation depth marks on the Microcuff Paediatric Endotracheal Tube regarding the risk of inadvertent extubation and endobronchial intubation. Methods. We studied children, aged from birth to adolescence, undergoing cardiac catheterization. The patients' tracheas were orally intubated and the tracheal tubes positioned with the intubation depth mark at the level of the vocal cords. The tracheal tube tip-to-carina distances were fluoroscopically assessed with the patient supine and the head-neck in 30° flexion, 0° neutral position and 30° extension. Results. One hundred children aged between 0.02 and 16.4 yr (median 5.1 yr) were studied. Maximum tracheal tube-tip displacement after head-neck 30° extension and 30° flexion demonstrated a linear relationship to age [maximal upward tube movement (mm)=0 0.71×age (yr)+9.9 (R2=0.893); maximal downward tube movement (mm)=0.83×age (yr)+9.3 (R2=0.949)]. Maximal tracheal tube-tip downward displacement because of head-neck flexion was more pronounced than upward displacement because of head-neck extension. Conclusions. The intubation depth marks were appropriate to avoid inadvertent tracheal extubation and endobronchial intubation during head-neck movement in all patients. However, during head-neck extension the tracheal tube cuff may become positioned in the subglottic region and should be re-adjusted when the patient remains in this position for a longer tim

INTEGRAL observations of the Large Magellanic Cloud region

We present the preliminary results of the INTEGRAL survey of the Large Magellanic Cloud. The observations have been carried out in January 2003 (about 10^6 s) and January 2004 (about 4x10^5 s). Here we concentrate on the bright sources LMC X-1, LMC X-2, LMC X-3 located in our satellite galaxy, and on the serendipitous detections of the Galactic Low Mass X-ray Binary EXO 0748-676 and of the Seyfert 2 galaxy IRAS 04575-7537.Comment: 4 pages, 7 figures. To be published in the Proceedings of the 5th INTEGRAL Workshop: "The INTEGRAL Universe", February 16-20, 2004, Munic

Spectral Formation in Accreting X-Ray Pulsars: Bimodal Variation of the Cyclotron Energy with Luminosity

Accretion-powered X-ray pulsars exhibit significant variability of the Cyclotron Resonance Scattering Feature (CRSF) centroid energy on pulse-to-pulse timescales, and also on much longer timescales. Two types of spectral variability are observed. For sources in group 1, the CRSF energy is negatively correlated with the variable source luminosity, and for sources in group 2, the opposite behavior is observed. The physical basis for this bimodal behavior is currently not understood. We explore the hypothesis that the accretion dynamics in the group 1 sources is dominated by radiation pressure near the stellar surface, and that Coulomb interactions decelerate the gas to rest in the group 2 sources. We derive a new expression for the critical luminosity such that radiation pressure decelerates the matter to rest in the supercritical sources. The formula for the critical luminosity is evaluated for 5 sources, using the maximum value of the CRSF centroid energy to estimate the surface magnetic field strength. The results confirm that the group 1 sources are supercritical and the group 2 sources are subcritical, although the situation is less clear for those highly variable sources that cross over the critical line. We also explain the variation of the CRSF energy with luminosity as a consequence of the variation of the characteristic emission height. The sign of the height variation is opposite in the supercritical and subcritical cases, hence creating the observed bimodal behavior.Comment: Accepted for publication in Astronomy & Astrophysic

Two years of INTEGRAL monitoring of GRS 1915+105 Part 1: multiwavelength coverage with INTEGRAL, RXTE, and the Ryle radio Telescope

(Abridged) We report the results of monitoring observations of the Galactic microquasar GRS 1915+105 performed simultaneously with INTEGRAL and RXTE Ryle . We present the results of the whole \integral campaign, report the sources that are detected and their fluxes and identify the classes of variability in which GRS 1915+105 is found. The accretion ejection connections are studied in a model independent manner through the source light curves, hardness ratio, and color color diagrams. During a period of steady ``hard'' X-ray state (the so-called class chi) we observe a steady radio flux. We then turn to 3 particular observations during which we observe several types of soft X-ray dips and spikes cycles, followed by radio flares. During these observations GRS 1915+105 is in the so-called nu, lambda, and beta classes of variability. The observation of ejections during class lambda are the first ever reported. We generalize the fact that a (non-major) discrete ejection always occurs, in GRS 1915+105, as a response to an X-ray sequence composed of a spectrally hard X-ray dip terminated by an X-ray spike marking the disappearance of the hard X-ray emission above 18 keV. We also identify the trigger of the ejection as this X-ray spike. A possible correlation between the amplitude of the radio flare and the duration of the X-ray dip is found in our data. In this case the X-ray dips prior to ejections could be seen as the time during which the source accumulates energy and material that is ejected later.Comment: 17 pages, 14 figures. Accepted for publication in ApJ, scheduled for the March 20, 2008, vol676 issue. Table 3 has been degrade

NuSTAR observation of GRO J1744-28 at low mass accretion rate

We present the spectral analysis of the LMXB GRO J1744-28 using $\sim$29 ks of NuSTAR data taken in 2017 February at a low luminosity of $3.2\times 10^{36}$ erg/s (3-50 keV). The continuum spectrum is modeled with an absorbed power-law with exponential cut-off, and an additional iron line component. We find no obvious indications for a CRSF and therefore perform a detailed cyclotron line search using statistical methods on the pulse phase-averaged as well as phase-resolved spectra. The previously detected Type II X-ray bursts are absent. Clear pulsations at a period of 2.141124(9) Hz are detected. The pulse profile shows an indication of a secondary peak, which was not seen at higher flux. The 4$\sigma$ upper limit for the strength of a CRSF in the 3-20 keV band is 0.07 keV, lower than the strength of the line found at higher luminosity. The detection of pulsations shows that the source did not enter the "propeller" regime, even though the source flux of $4.15\times 10^{-10}$ erg/cm$^{2}$/s was almost one order of magnitude below the threshold for the propeller regime claimed in previous studies on this source. The transition into the propeller regime in GRO J1744-28 must therefore be below a luminosity of $3.2\times 10^{36}$ erg/s, which implies a surface magnetic field $\lesssim 2.9\times 10^{11}$ G and mass accretion rate $\lesssim 1.7\times 10^{16}$ g/s. A change of the CRSF depth as function of luminosity is not unexpected and has been observed in other sources. This result possibly implies a change in emission geometry as function of mass accretion rate to reduce the depth of the line below our detection limit

Magnetic Fields of Accreting X-Ray Pulsars with the Rossi X-Ray Timing Explorer

Using a consistent set of models, we parameterized the X-ray spectra of all accreting pulsars in the Rossi X-ray Timing Explorer database which exhibit Cyclotron Resonance Scattering Features (CRSFs, or cyclotron lines). These sources in our sample are Her X-1, 4U 0115+63, Cen X-3, 4U 1626-67, XTE J1946-274, Vela X-1, 4U 1907+09, 4U 1538-52, GX 301-2, and 4U 0352+309 (X Per). We searched for correlations among the spectral parameters, concentrating on how the cyclotron line energy relates to the continuum and therefore how the neutron star B-field influences the X-Ray emission. As expected, we found a correlation between the CRSF energy and the spectral cutoff energy. However, with our consistent set of fits we found that the relationship is more complex than what has been reported previously. Also, we found that not only does the width of the cyclotron line correlate with the energy (as suggested by theory), but that the width scaled by the energy correlates with the depth of the feature. We discuss the implications of these results, including the possibility that accretion directly affects the relative alignment of the neutron star spin and dipole axes. Lastly, we comment on the current state of fitting phenomenological models to spectra in the RXTE/BeppoSAX era and the need for better theoretical models of the X-Ray continua of accreting pulsars.Comment: 36 Pages, 9 Figures, 9 Tables, ApJ in pres

A multi-model approach to X-ray pulsars: Connecting spectral and timing models to pin down the intrinsic emission characteristics of magnetized, accreting neutron stars

The emission characteristics of X-ray pulsars are governed by magnetospheric accretion within the Alfvén radius, leading to a direct coupling of accretion column properties and interactions at the magnetosphere. The complexity of the physical processes governing the formation of radiation within the accreted, strongly magnetized plasma has led to several sophisticated theoretical modelling efforts over the last decade, dedicated to either the formation of the broad band continuum, the formation of cyclotron resonance scattering features (CRSFs) or the formation of pulse profiles. While these individual approaches are powerful in themselves, they quickly reach their limits when aiming at a quantitative comparison to observational data. Too many fundamental parameters, describing the formation of the accretion columns and the systems' overall geometry are unconstrained and different models are often based on different fundamental assumptions, while everything is intertwined in the observed, highly phase-dependent spectra and energy-dependent pulse profiles. To name just one example: the (phase variable) line width of the CRSFs is highly dependent on the plasma temperature, the existence of B-field gradients (geometry) and observation angle, parameters which, in turn, drive the continuum radiation and are driven by the overall two-pole geometry for the light bending model respectively. This renders a parallel assessment of all available spectral and timing information by a compatible across-models-approach indispensable. In a collaboration of theoreticians and observers, we have been working on a model unification project over the last years, bringing together theoretical calculations of the Comptonized continuum, Monte Carlo simulations and Radiation Transfer calculations of CRSFs as well as a General Relativity (GR) light bending model for ray tracing of the incident emission pattern from both magnetic poles. The ultimate goal is to implement a unified fitting model for phase-resolved spectral and timing data analysis. We present the current status of this project