PDA Closure in ELBW Infants: If, When, and How to Do It

Patent ductus arteriosus (PDA) is the most common cardiovascular condition afflicting premature neonates especially those born extremely low birth weight (ELBW). Despite five decades of scientific inquiry which has produced thousands of publications including over 65 randomized controlled trials, cardiologists, neonatologists, and surgeons still cannot answer simple questions such as if, when and how to close to the PDA in ELBW infants. This chapter will examine current evidence in order to answer these fundamental questions. The chapter will specifically focus on transcatheter PDA closure (TCPC), which albeit a new therapy, has displayed great potential to be the best therapeutic option in the future. It is about time that physicians from all sub-specialties come together and integrate the evidence to develop a management algorithm for ELBW infants with hemodynamically significant PDA

Cardiac Catheterization in Congenital Heart Disease

Interventional pediatric cardiology is a specialty of pediatric cardiology that deals specifically with the catheter-based treatment of congenital heart diseases. Cardiac catheterization involves the evaluation and manipulation of the heart and surrounding vessels through catheters place in peripheral vessels. In this chapter we begin by discussing the significant difference between adult and pediatric interventional cardiology. We will discuss basic hemodynamic measurements performed in cardiac catheterization and its application to congenital heart disease. Stent and balloon catheters are briefly discussed. Finally, specific catheter based interventional techniques, indications, and complications for various pediatric congenital heart disease is described

Low carbon building: Experimental insight on the use of fly ash and glass fibre for making geopolymer concrete

Due to the environmental impacts resulting from the production of Ordinary Portland cement (OPC), the drive to develop alternative binders that can totally replace OPC is gaining huge consideration in the construction field. In the current study, attempt was made to determine the strength characteristics of glass fibre-reinforced fly ash based geopolymer concrete. Sodium hydroxide (NaOH) and sodium silicate (Na2SiO3) were used as alkaline solutions (for activation of geopolymer reaction) at 12, 16, 20 M. Glass fibres were added to the geopolymer concrete in varying proportions of 0.1e0.5% (in steps of 0.1%) by weight of concrete. A constant weight ratio of alkaline solution to fly ash content of 0.43 was adopted for all mixes. British standard concrete test specimens were cast for measuring compressive strength, splittensile strength, and flexural strength. Concrete specimens were cured by heating in oven at 90 �C for 24 h and natural environment, respectively. From the results, thermally cured concrete samples had better mechanical properties than the ambient (natural) cured samples. Thermally cured concrete specimen, containing 0.3% glass fibre and 16 M NaoH, achieved a maximum compressive strength of 24.8 MPa after 28 d, while naturally cured samples achieved a strength of 22.2 MPa. There was substantial increase in tensile strength of geopolymer concrete due to the addition of glass fibres. Split tensile strength increased by 5e10% in glass fibre-reinforced geopolymer concrete, containing 0.1e0.5% glass fibre and 16 M NaoH when compared to the unreinforced geopolymer concrete (1.15 MPa)

Aortic cusp extension valvuloplasty with or without tricuspidization in children and adolescents: Long-term results and freedom from aortic valve replacement

ObjectiveAortic cusp extension valvuloplasty is increasingly used in the management of children and adolescents with aortic stenosis or regurgitation. The durability of this approach and the freedom from valve replacement are not well defined. A study was undertaken to investigate outcomes.MethodsFrom July 1987 to November 2008, 142 patients aged less than 19 years underwent aortic cusp extension valvuloplasty in the form of pericardial cusp extension and tricuspidization (when needed). Three patients with truncus arteriosus and severe truncal valve insufficiency were excluded. From the available follow-up data of 139 patients, 50 had bicuspid aortic valves, 40 had congenital aortic valve stenosis, 41 had combined congenital aortic valve stenosis/insufficiency, and 8 had other diagnoses. Median follow-up was 14.4 years (0.1–21.4). Long-term mortality and freedom from aortic valve replacement were studied.ResultsThere were no early, intermediate, or late deaths. Z-values of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter, and sinotubular junction diameter before aortic valve replacement were 4.2 ± 3.11, 2.3 ± 1.25, 4.4 ± 1.23, and 1.84 ± 1.28, respectively. During the follow-up period, 64 patients underwent aortic valve reinterventions. The Ross procedure was performed in 32 of 139 patients (23%) undergoing aortic cusp extension valvuloplasty. Other aortic valve replacements were undertaken after 16 aortic cusp extension valvuloplasties (11.5%). Freedom from a second aortic cusp extension valvuloplasty or aortic valve replacement at 18 years was 82.1% ± 4.2% and 60.0% ± 7.2%, respectively.ConclusionAortic cusp extension valvuloplasty is a safe and effective surgical option with excellent survival and good long-term outcomes in children and adolescents. The procedure provides acceptable durability and satisfactory freedom from aortic valve replacement

Acute and mid‐term outcomes of stent implantation for recurrent coarctation of the aorta between the Norwood operation and fontan completion: A multi‐center Pediatric Interventional Cardiology Early Career Society Investigation

ObjectivesWe sought to evaluate outcomes of stent implantation (SI) for recurrent coarctation of the aorta (RC) following the Norwood operation.BackgroundRC is common following the Norwood operation. Balloon angioplasty (BA) is standard treatment but may result in unsatisfactory relief of RC. SI may improve RC, but outcome data are limited.MethodsWe performed a multi‐center retrospective study of patients who underwent SI for RC between the Norwood operation and Fontan completion. Outcomes were examined, including procedural success, serious adverse events (SAE), and freedom from re‐intervention. A core laboratory was utilized to review angiograms. Coarctation Index (CI) was calculated before and after SI. Paired t‐test and Wilcoxon signed‐rank test were used to compare pre‐ and post‐SI variables.ResultsThirty‐three patients at 8 centers underwent SI for RC at a median age of 5 months (IQR 4.1, 13.3) and weight of 5.9 kg (5.2, 8.6). Aortic arch gradient improved from 20 (15, 24) to 0 (0, 2) mmHg following SI (P < 0.0001). The median CI improved from 0.54 (0.43, 0.62) to 0.97 (0.89, 1.06) following SI (P < 0.0001). There were no procedural deaths but SAEs occurred in 12 (36%) patients. During a median follow‐up duration of 29.7 months (6.8, 48.0), freedom from death or heart transplant was 82%, and from re‐intervention was 45%, with median time to re‐intervention of 20.1 months (11.4, 40.3).ConclusionsSI for treatment of RC in patients after the Norwood operation provides excellent acute relief of obstruction. Intraprocedural hemodynamic instability is common and re‐intervention is frequent at mid‐term follow‐up.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140022/1/ccd27231_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/140022/2/ccd27231.pd

International criteria for electrocardiographic interpretation in athletes: Consensus statement.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD