54. Fibrinolytic therapy and polyvalvular heart disease in pediatric patient

Novel therapy for a stuck mechanical heart valve in pediatric patient with multiple prosthetic valves. Not much is known with the use of anticoagulation and fibrinolysis in multiple mechanical valves in pediatric patients. Case presentation: 10 year, Saudi, male with poly-valvular disease with tricuspid, mitral, and aortic, and pulmonary valve regurgitation. Initially, he had repair of all his valves in June 2008. He required Mitral valve replacement #21, and repeat poly-valvar repair in July 2008. Eventually, tricuspid valve was replaced by CM #27, aortic valve was replaced by St.Jude #19 mm, and pulmonary valve replaced by Jan 2012. He presented to cardiology clinic on March 2014 in which found to have stuck disc of the tricuspid valve prosthesis on echo with increasing gradients of six mmHg, despite therapeutic INR with warfarin. Immediate fluoroscopy confirmed diagnosis. Physical exam positively mild tachypnea and liver of three cm below costal margin, with mechanical cardiac click sounds. Immediate admission to the intensive care for observation and planning starting the tPA with heparin infusion. TPA stated as a dose of 0.5 mg/kg/h over 6 h then repeated fluoroscopy done after 4 h of the completion of tPA showed mobile tricuspid disc. He was observed for a few days in ward with therapeutic INR and discharged home. Conclusion: As growing surgical skills we are facing many pediatric cases with prosthetic valves with stuck valves. Which tPA dose should be used? Is streptokinase better? How long do you wait before considering surgery

27. New echocardiogram index alternatives to MAPSE and TAPSE z-scores in children

Mitral annular plane systolic excursion (MAPSE), and tricuspid annular plane systolic excursion (TAPSE) are relatively load independent longitudinal left ventricle (LV) and right ventricle (RV) measurement in both adults and children. Normal paediatric values of MAPSE and TAPSE unlike adults are based on inconvenient z-scores. We hypothesize novel indexes of (LSI) LV longitudinal systolic index and (RSI) RV longitudinal systolic index are BSA, age, gender independent and nullifies the need for MAPSE and TAPSE z-scores. Methods: Normal echocardiograms were retrospectively reviewed from 2009 to 2011. Ejection fraction, LV dimensions, MAPSE, and TAPSE were determined. LSI and RSI were calculated using MAPSE and TAPSE divided by LV length. Echocardiogram indices were correlated. Regression analysis was done for BSA, age, and gender. Results: Two hundred and one patients had normal ejection fractions (67.3;± 5.1%). Mean MAPSE 10.4;± 3.3 mm, z-score −0.07;± 1.2, and LSI 0.20;± 0.03; Mean TAPSE 17.4;± 5.4 mm, z-score 0.74;± 1.7, and RSI 0.34;± 0.06. LSI and MAPSE z-scores correlated, r = 0.73, p < 0.001. Age, gender, and BSA did not correlate with LSI. RSI and TAPSE z-scores correlated with r = 0.76, p < 0.001. Age influences RSI, R2 = 0.58, p value <0.001, BSA and gender does not. RSI, with age stratification, is significantly decreased less than 2 months. Conclusion: LSI obviates need for-MAPSE z scores. RSI offers an additional non TAPSE z-score method to evaluate RV function, but does not nullify age effect. RSI, especially in the first two months is decreased

Putative neutralization epitopes and broad cross-genotype neutralization of Hepatitis E virus confirmed by a quantitative cell-culture assay

Monolayers of Hep G2/C3A cells were inoculated with genotype 1 Hepatitis E virus (HEV) mixed with either anti-HEV or an appropriate control. After 5 or 6 days, cell monolayers were stained with anti-HEV and infected cells were identified by immunofluorescence microscopy and counted. Anti-HEV from vaccinated or infected rhesus monkeys neutralized the virus, as did mAbs that recognized epitopes on the C terminus of a recombinant vaccine protein. Antibodies were broadly cross-reactive, since convalescent serum from animals infected with any one of the four mammalian genotypes all neutralized the genotype 1 virus