The Y-stenting technique for pulmonary artery bifurcation stenosis : Initial results and mid-term outcomes

BACKGROUND: Treatment for main or peripheral PBS is challenging. An interventional approach is generally preferred as surgical angioplasty often results in residual stenosis. However, there is limited data on the mid- and long-term results of the different interventional approaches. The aim of this study is to report on initial and mid-term results of the Y-stenting technique for pulmonary artery bifurcation stenosis (PBS). METHODS: A single centre retrospective study of all Y-stenting procedures for main or peripheral PBS was conducted. Patient and procedural data as well as mid-term outcomes were analysed. RESULTS: 11 Y-stenting procedures were performed, 9 in the main pulmonary bifurcation and 2 in the PA periphery. In 8 patients the bifurcation stents were connected, in 3 patients there was no connection between the stents. Y-stenting creates a geometry close to the physiological PA bifurcation anatomy with complete alignment to the vessel wall without flow separation. Control angiography showed unrestricted blood flow after all procedures. Median right/left ventricle pressure ratio decreased from 0.9 to 0.5. No immediate or delayed adverse events were seen. During a median follow-up of 33.5 months, 2 patients in the non-connected group and 3 patients in the connected group needed a total of 6 re-interventions. No intima proliferation was seen in patients with connected stents. CONCLUSIONS: Y-stenting is a safe and effective treatment for PBS. When both bifurcation stents are connected, this may result in lower rates of in-stent intima proliferation in comparison to other PBS stenting techniques

Normative Values of Aortic Arch Structures in Premature Infants

BACKGROUND: Aortic arch abnormalities represent 5% to 8% of all congenital heart disease. Measurements of the aortic arch dimensions on two-dimensional echocardiographic images remain of critical importance in the diagnosis of aortic arch pathology. To define aortic hypoplasia or coarctation, measured dimensions must be compared with normal values. Normal values have been described for children of all ages in earlier studies. However, normative data for premature infants are not yet available. Therefore, the aim of this study was to develop normative data in a cohort of premature infants, which could be used in the diagnosis of aortic arch abnormalities. METHODS: A single-center study was conducted in a large population of premature infants with gestational ages of </=32 weeks without hemodynamically important congenital heart disease, chromosomal abnormalities, and/or major cerebral congenital malformations. Two-dimensional echocardiographic measurements of four aortic arch structures were made on the second, fourth, and sixth days after birth. RESULTS: Three hundred eighty-five preterm patients were included. No differences in dimensions were found among days 2, 4, and 6. The dimension of the isthmus showed no significant relation to the existence of a patent ductus arteriosus. Reference intervals with mean and SD were calculated across the range of birth weight. Regression analysis was performed with multiple determinants in different models. The best predictive value was found for birth weight in a cubic model. CONCLUSIONS: This work provides regression equations for the calculation of Z scores and reference intervals for aortic arch dimensions in a cohort of preterm infants born at gestational ages of </=32 weeks. The normative data can be used in diagnosis and decision making involving aortic arch pathology in premature infants

The Y-stenting technique for pulmonary artery bifurcation stenosis : Initial results and mid-term outcomes

BACKGROUND: Treatment for main or peripheral PBS is challenging. An interventional approach is generally preferred as surgical angioplasty often results in residual stenosis. However, there is limited data on the mid- and long-term results of the different interventional approaches. The aim of this study is to report on initial and mid-term results of the Y-stenting technique for pulmonary artery bifurcation stenosis (PBS). METHODS: A single centre retrospective study of all Y-stenting procedures for main or peripheral PBS was conducted. Patient and procedural data as well as mid-term outcomes were analysed. RESULTS: 11 Y-stenting procedures were performed, 9 in the main pulmonary bifurcation and 2 in the PA periphery. In 8 patients the bifurcation stents were connected, in 3 patients there was no connection between the stents. Y-stenting creates a geometry close to the physiological PA bifurcation anatomy with complete alignment to the vessel wall without flow separation. Control angiography showed unrestricted blood flow after all procedures. Median right/left ventricle pressure ratio decreased from 0.9 to 0.5. No immediate or delayed adverse events were seen. During a median follow-up of 33.5 months, 2 patients in the non-connected group and 3 patients in the connected group needed a total of 6 re-interventions. No intima proliferation was seen in patients with connected stents. CONCLUSIONS: Y-stenting is a safe and effective treatment for PBS. When both bifurcation stents are connected, this may result in lower rates of in-stent intima proliferation in comparison to other PBS stenting techniques

Endovascular coil embolization of a complex aortic arch pseudoaneurysm following arch stenting

Pseudoaneurysm formation is a life-threatening complication of thoracic aortic stenting due to the high risk of rupture. When located in the aortic arch, anatomic features may pose difficulties in choosing the optimal treatment strategy. Here, we describe the first poststenting aortic arch pseudoaneurysm treated by endovascular coil embolization. This approach, which we performed in a multidisciplinary setting, may be a feasible alternative in patients not considered suitable for open repair or stent-grafting. As an acute pseudoaneurysm may develop and rapidly expand during the first days after aortic stenting, early follow-up imaging is preferable

Bedreigingen en intimidaties tegen publieke ambtsdragers

Monitor Agressie en Geweld Openbaar BestuurDe Monitor Agressie en Geweld Openbaar Bestuur geeft inzicht in hoe agressie en geweld tegen politici en ambtenaren in het decentrale bestuur zich ontwikkelt. Onderzoekers van het Lectoraat Ondermijning van Avans Hogeschool onderzochten in hoeverre deze monitor en de maatregelen uit het Programma Veilige Publieke Taak onder politici, bestuurders en ambtenaren bekend zijn.Kleine rol als aanjager beleidUit het onderzoek blijkt dat de monitor onder burgemeesters de meeste bekendheid geniet. Onder griffiers en gemeentesecretarissen is ongeveer de helft bekend met de monitor. Het instrument lijkt vooral een functie te vervullen in het vergroten van de bewustwording en agendasetting rond het thema. De monitor speelt slechts een kleine rol als aanjager van beleid. Incidenten worden vaak gemeld en geregistreerd, maar daarnaast blijft er sprake van een grijs gebied. Voor agressie en geweld tegen ambtenaren geldt veelal een zerotolerance-beleid terwijl de burgemeesters, gemeentesecretarissen en griffiers voor zichzelf de grenzen enigszins oprekken.AanbevelingenOp basis van het onderzoek is een aantal aanbevelingen gedaan. Deze hebben onder meer betrekking hebben op het zichtbaar maken van dit vraagstuk in de media, het versterken van het bewustzijn, scholing en training, samenwerking met politie en Openbaar Ministerie en het monitoren van de veiligheidsbeleving

Effective radiation dosage of three-dimensional rotational angiography in children

AIMS: Three-dimensional rotational angiography (3DRA) is a relatively new but promising imaging technique in the paediatric catheterization laboratory. However, data on effective dose (ED) of this technique in children are lacking. The purpose of this study is to provide ED of 3DRA and to correlate this with parameters readily available in daily practice. Furthermore, the effect of dose-reducing techniques is evaluated. METHODS AND RESULTS: Effective doses were calculated with Monte Carlo PCXMC 2.0 in 14 patients who underwent a total of 17 3DRAs at our paediatric catheterization laboratory. Median age was 5.7 years (range 1 day-16.6 years). Median ED was 1.6 milliSievert (mSv) (range 0.7-4.9). Effective dose did not correlate with age and body surface area but did correlate with dose area product (DAP) and milliGray (mGy) with r(2) of 0.75 and 0.83, respectively. Reduction of the total amount of frames from 248 to 133 per rotation resulted in further dose reduction of over 50% with preserved image quality. CONCLUSION: The median ED of 3DRA in children is 1.6 mSv and correlates with DAP and mGy. This dose can be halved by applying frame reduction. A significant further dose reduction can be achieved by obtaining additional knowledge of the equipment used