Device Closure of Secundum Atrial Septal Defects in Children <15 kg Complication Rates and Indications for Referral

ObjectivesThis study sought to determine institutional complication rates in a previously underreported patient population and discuss referral indications.BackgroundThere has been a trend over the years for referral of younger and smaller patients for “elective” closure of atrial septal defects (ASD). In general, the risks associated with ASD device closure are believed and reported to be relatively low. Complication rates in this group of smaller patients are not well described in the literature for either percutaneous or surgical approaches.MethodsRetrospective review of all patients who underwent elective transcatheter closure of secundum ASD between March 2000 and April 2010. We excluded all children >15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated.ResultsWe identified 128 patients meeting criteria with a median procedural age of 1.92 years (3 months to 4.92 years), and median weight of 10.8 kg (4.3 to 14.9 kb). There were 7 major (5.5%) and 12 minor (9.4%) complications. Nearly two-thirds of referrals were for right heart enlargement or poor growth. Rate of resolution of residual shunt was 99%. When compared with age, there was no difference in the rate of resolution of right heart enlargement. No clinically significant improvement in growth was observed.ConclusionsTranscatheter ASD closure in small children is highly successful, but with an increase in previously perceived complication rates. In small, asymptomatic patients, deferral of closure until the historically established timeline of around 4 to 5 years of age should be strongly considered

NHC-catalysed aerobic aldehyde-esterifications with alcohols: no additives or cocatalysts required

A highly efficient, broad scope, additive-free mild protocol for the oxidative carbene-catalysed esterification of aldehydes (including the related aqueous oxidation to acids) has been developed

The Genesis stent: A new low-profile stent for use in infants, children, and adults with congenital heart disease

Placement of intravascular stents that can reach adult size in infants and smaller children has been limited by the large profile and poor flexibility of currently available stents. In vitro and in vivo testing of the Genesis stent was performed to evaluate crimpability, predeployment flexibility, and radial strength. Comparisons were made to the Palmaz iliac and IntraStent (IS) LD stents. Nine physicians placed 30 Genesis stents in swine pulmonary and systemic arteries to evaluate stent deliverability/crimpability. Two swine were recovered and underwent a second catheterization 8 weeks later, where the stents (n = 8) were reexpanded to maximal size. Angiographic and intravascular ultrasound (IVUS) assessments were performed. In vitro testing revealed the Genesis stent to have superior crimpability, flexibility, and comparable radial strength to the Palmaz iliac stent, and superior crimpability and radial strength and comparable flexibility to the IS LD series. During in vivo testing, the physicians graded the Genesis stent superior to the Palmaz stent regarding crimpability and deliverability, and superior to the IS LD stent in regard to crimpability, and comparable to or superior in deliverability. In the chronic animals, the Genesis stent was expanded up to maximal diameter 8 weeks following implantation. Angiographic and IVUS revealed no fractures no in-stent restenosis. The Genesis stent can be easily delivered through smaller sheaths, which will facilitate their use in infants and smaller children with vascular stenosis. Cathet Cardiovasc Intervent 2003;59:406–414. © 2003 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35255/1/10547_ftp.pd

Transcatheter valve implantation for right atrium‐to‐right ventricle conduit obstruction or regurgitation after modified Björk–fontan procedure

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136276/1/ccd26648_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136276/2/ccd26648.pd

Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta

Background : We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques. Methods and Results : Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5–92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections ( n = 5) and aneurysm ( n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup ( n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up. Conclusions : Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA. © 2007 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57392/1/21191_ftp.pd

CO2 hydrogenation to methanol on intermetallic PdGa and PdIn catalysts and the effect of Zn co-deposition

The behaviour of Pd deposited on Ga2O3 and In2O3 by CVI is compared for the hydrogenation of CO2 to methanol. Ga2O3 alone is inactive, but In2O3 has good conversion, and selectivity as high as 89 % to CH3OH. The addition of Pd to the catalysts had relatively little effect for In2O3, but in contrast, the addition of Pd to Ga2O3, has a very big effect, inducing high activity and selectivity to methanol. Both oxides form Pd intermetallics - Pd2In3 and Pd2Ga. However, for the In catalysts there is also a thick (∼3 nm) overlayer of the oxide, while for the Ga catalyst there was no such overlayer. Hence this is why addition of Pd to the Indium catalysts has relatively little effect on performance compared with Ga. Furthermore, the effect of Pd and Zn co-deposition on Ga₂O₃ and In₂O₃ was investigated, as well as the effect of the support morphology. Upon co-deposition of Pd and Zn, and after reduction, the Pd2In3 catalyst remains phase stable, whereas the Pd2Ga alloy is replaced by PdZn, and is improved in methanol yield

No straight lines – young women’s perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography

Background: Young mothers face mental health challenges during and after pregnancy including increased rates of depression compared to older mothers. While the prevention of teenage pregnancy in countries such as the United States and the United Kingdom has been a focus for policy and research in recent decades, the need to understand young women’s own experiences has been highlighted. The aim of this meta-ethnography was to examine young women’s perceptions of their mental health and wellbeing during and after pregnancy to provide new understandings of those experiences. Methods: A systematic review and meta-ethnographic synthesis of qualitative research was conducted. Seven databases were systematically searched and forward and backward searching conducted. Papers were included if they were from Organisation for Economic Co-operation and Development countries and explored mental health and wellbeing experiences of young mothers (age under 20 in pregnancy; under 25 at time of research) as a primary research question – or where evidence about mental health and wellbeing from participants was foregrounded. Nineteen papers were identified and the Critical Appraisal Skills Programme checklist for qualitative research used to appraise the evidence. Following the seven-step process of meta-ethnography, key constructs were examined within each study and then translated into one another. Results: Seven translated themes were identified forming a new line of argument wherein mental health and wellbeing was analysed as relating to individual bodily experiences; tied into past and present relationships; underpinned by economic insecurity and entangled with feelings of societal surveillance. There were ‘no straight lines’ in young women’s experiences, which were more complex than dominant narratives around overcoming adversity suggest. Conclusions: The synthesis concludes that health and social care professionals need to reflect on the operation of power and stigma in young women’s lives and its impact on wellbeing. It adds to understanding of young women’s mental health and wellbeing during and after pregnancy as located in physical and structural factors rather than individual capacities alone

Estimating Distribution of Hidden Objects with Drones: From Tennis Balls to Manatees

Unmanned aerial vehicles (UAV), or drones, have been used widely in military applications, but more recently civilian applications have emerged (e.g., wildlife population monitoring, traffic monitoring, law enforcement, oil and gas pipeline threat detection). UAV can have several advantages over manned aircraft for wildlife surveys, including reduced ecological footprint, increased safety, and the ability to collect high-resolution geo-referenced imagery that can document the presence of species without the use of a human observer. We illustrate how geo-referenced data collected with UAV technology in combination with recently developed statistical models can improve our ability to estimate the distribution of organisms. To demonstrate the efficacy of this methodology, we conducted an experiment in which tennis balls were used as surrogates of organisms to be surveyed. We used a UAV to collect images of an experimental field with a known number of tennis balls, each of which had a certain probability of being hidden. We then applied spatially explicit occupancy models to estimate the number of balls and created precise distribution maps. We conducted three consecutive surveys over the experimental field and estimated the total number of balls to be 328 (95%CI: 312, 348). The true number was 329 balls, but simple counts based on the UAV pictures would have led to a total maximum count of 284. The distribution of the balls in the field followed a simulated environmental gradient. We also were able to accurately estimate the relationship between the gradient and the distribution of balls. Our experiment demonstrates how this technology can be used to create precise distribution maps in which discrete regions of the study area are assigned a probability of presence of an object. Finally, we discuss the applicability and relevance of this experimental study to the case study of Florida manatee distribution at power plants