Case Report: An unusual case of a transposition of the great arteries with a double aortic arch: a highly complex fetal diagnosis with an unpredictable outcome.

Published data estimate the prevalence of the vascular ring at approximately 7 per 10,000 live births. The association of a double aortic arch with a D-transposition of the great arteries has been rarely described in the literature. In this study, we report the prenatal diagnosis of a 28-year-old woman. A fetal echocardiography at a gestational age of 24 weeks + 6 days showed a D-transposition of the great arteries and a double aortic arch with a ventricular septal defect and pulmonary stenosis. On the first night after birth, the baby experienced an increase in lactate levels, with the rate of oxygen saturation consistently below 80%. A few hours after birth, the patient underwent a Rashkind procedure. An echocardiography, CT chest x-ray, and CT angiogram confirmed a diagnosis with a severe reduction of the tracheal lumen (>85%) and bronchomalacia. Then, the patient underwent posterior tracheopexy and aortopexy and later an arterial switch operation, ventricular septal defect closure, and resection of a part of the infundibular septum, accepting the risk of potential neoaortic obstruction. The literature has reported only two cases of patients with a fetal echocardiogram diagnosis. Therefore, our patient is only the third one with a fetal diagnosis and the second one with a complex intracardiac anatomy, characterized not only by a ventricular septal defect but also by two separate components of the obstruction (a bicuspid valve and a dysplastic valve with a posterior deviation of the infundibular septum). In conclusion, a D-transposition of the great arteries with a double aortic arch remains an extremely unusual association. The clinical outcome of these patients presents a high degree of variability and is entirely unpredictable in prenatal life. Our greatest aim as fetal and perinatal cardiologists is to improve the management and outcome of these patients through a fetal diagnosis, recognizing types of congenital heart disease in newborns who require early neonatal invasive procedures.

SARS-CoV-2 in a Neonate with Truncus Arteriosus: Management and Surgical Correction Timing.

Children seem to be less affected by SARS-CoV-2 infection. High risk categories should include patients with Congenital Heart Disease (CHD), both children and adults. We describe the case of a newborn with a postnatal diagnosis of Truncus Arteriosus (TA) type A1 without 22.q.11 deletion syndrome. Soon after birth, SARS-CoV-2 infection was transmitted by the father. Due to the onset of heart failure symptoms, diuretic therapy has been set up. For worsening of clinical conditions, inotropic support with milrinone was added. A progressive reduction of N-terminal-pro hormone BNP over the days has been observed. Fourteen days after the negativization of the nasopharyngeal swab, the patient underwent surgical repair with Cardiopulmonary Bypass (CPB). Postoperative course was not complicated and the patient was discharged in good clinical conditions. There is very little evidence suggesting the optimal timing for surgery in SARS-CoV-2 positive patients. With a lack of specific guidelines, current strategy suggests a symptom-based or a polymerase chain reaction (PCR) test-based approach. In our case it was challenging to determine COVID-19 impact on heart failure symptoms. Our case is the first describing the surgical correction of CHD in a 40 days year old patient, performed in CPB after 14 days from SARS-CoV-2 infection negativization.

Reliability of Fetal Echocardiography in Predicting Postnatal Critical Hypoxia in Patients with Transposition of Great Arteries and Intact Ventricular Septum.

Critical hypoxemia soon after birth is the most critical preoperative determinant of neurological outcomes and survival in newborns with Dextro Transposition of the Great Arteries and Intact Ventricular Septum (D-TGAIVS). Our study aimed to define fetal echocardiographic aspects that can better predict neonates with D-TGAIVS at risk for restricted interatrial communication after birth. 31 fetuses with a prenatal diagnosis of D-TGAIVS were included in our study. We divided patients with D-TGAIVS according to the timing of balloon atrial septostomy: Urgent, Not-Urgent and no BAS. We identified five fetal echocardiographic aspects of the interatrial septum (redundant, aneurysmal, flat, fixed, hypermobile). No significant differences in these fetal echocardiographic features were found between the three different groups of D-TGAIVS according to the timing of balloon atrial septostmy. However, only two patients showed flat appearance of interatrial communication: both needed Urgent balloon atrial septostomy. The prevalence of hypermobile septum primum was significantly lower in the control group compared to patients with D-TGAIVS. Fetal echocardiographic aspects cannot predict patients with D-TGAIVS who will not need Urgent balloon atrial septostomy. Therefore, we recommended a delivery in a tertiary center, equipped for Urgent balloon atrial septostomy, for all patients with D-TGAIVS regardless of fetal echocardiographic features.

Industrial solution contaminated by polyacrylates: their elimination by electrochemical combustion.

The electrochemical combustion of polyacrylates was studied through both direct and indirect oxidation. The obtained results indicate the non elimination of the polyacrylates with the direct oxidation, while the indirect oxidation with NaCl completely eliminates these organic compounds. In the last case the effects of different initial concentrations of NaCl, anode materials and current densities was studied.

CZE determination of somatostatin in pharmaceutical preparations.

We propose a simple and accurate method for CE quantitative determination of somatostatin in pharmaceutical preparations. The method is specific for somatostatin as indicated by the resolution between the analyte and the analogue peptides which differ from somatostatin by one aminoacid. The linearity range is from 0.02 to 0.35 mg/ml. The recovery of the somatostatin from a pharmaceutical product is about 100.0%.

Determination of cows' milk in goats' milk and cheese by capillary electrophoresis of the whey protein fractions.

The use of capillary zone electrophoresis to determine the adulteration of cows' milk in goats' milk products is described. The detection and quantification of cows' milk was based on the presence of the specific whey proteins: the relative calibration curve is reported. The peaks of interest were well resolved by using sodium borate at pH 9.2 as background electrolyte in methyl-silanized capillaries. The minimum amount detectable of cows' milk was 2% in milk mixtures and 4% in cheeses. Restrictions due to genetic variability and possible heat treatments, on only one of the two types of milk employed, are taken into account. Qualitative analysis of goat-ewe-cow and goat-ewe samples are also reported.

The use of PTFE graft to correct anomalous drainage of persistent left superior vena cava.

A new technique to correct persistent left superior vena cava (LSVC) drainage into the left atrium is described in a 14-year-old patient with situs inversus, left atrial isomerism common atrium, and mitral valve regurgitation. During surgery, occlusion of the LSVC markedly increased the venous pressure, precluding its ligation. Because of the malposition of the heart and the unusual atrial anatomy, correction with an intra-atrial baffle was not attempted. After correcting the intra-cardiac anomaly, the LSVC was divided and anastomosed to the "right" atrial appendage using a segment of PTFE graft. The postoperative course was uneventful and an angiogram demonstrated excellent performance of the graft.

[Tetralogy of Fallot associated with total anomalous drainage of the pulmonary veins. Report of 2 cases]. / Tetralogia de Fallot associada a drenagem anômala total de veias pulmonares. Relato de dois casos.

The authors report on two cases of tetralogy of Fallot (TF) associated with total anomalous pulmonary venous return to the coronary sinus. The clinical manifestations in both children were the same as of classical TF and diagnosis was confirmed by cineangiography. The patients underwent total surgical correction and the first one died in the immediate post-operative period. The second patient had an uneventful recovery. The rarity of this association is the main reason of this report where clinical and surgical findings are discussed.

Síndrome de hombre rígido: una única entidad? / Stiff-man syndrome

Se estudiaron 4 pacientes con un cuadro clínico en el que se combinaron fasciculaciones, contracturas, calambres, parestesias y rigidez muscular progresiva. En ellos se realizó el estudio electrofisiológico que involucró EMG, estudio de la excitabilidad de la motoneurona espinal alfa (MN), del coeficiente de excitabilidad de la MN, de la velocidad de conducción motora y sensitiva, de la transmisión neuromuscular y de la actividad gamma. Los hallazgos evidenciaron compromiso del SNP expresado en reducción del número de unidades motoras (UM), pérdida del trazadoEMG interferencial, presencia de fibrilaciones, fasciculaciones y disminución de la velocidad de conducción motora con preservación de la conducción sensitiva. A ello se sumó aumento de la excitabilidad de la MN alfa evidenciado en la curva de recuperación de la onda H; la relación H/M se halló dentro de límites normales en todos los casos, en tanto que los cocientes T/M y T/H se vieron incrementados en tres de los casos; en dos de los pacientes se realizó el bloqueo gamma, lográndose la desaparición de la actividad contínua de UM. El estudio de la transmisión neuromuscular, período silente y coeficiente de excitabilidad de la MN no mostraron alteraciones. Esta serie de hallazgos sugieren indemnidad de la unión neuromuscular, de los mecanismos inhibitorios segmentarios mediados por interneuronas de acción postsináptica y de las estructuras corticales, señalando un incremento de la actividad de las fibras gamma. La presencia de diferentes cuadros que presentan aspectos signosintomatológicos comunes impulsó una revisión sobre las diferentes entidades clínicas descriptas, pruebas electrofisiológicas utilizadas para su estudio, aspectos etiopatogénicos y la aproximación terapéutica a ellas

Correção cirúrgica da estenose supra aórtica localizada. Relato de 2 casos / Surgical correction of localized supra-aortic stenosis. Report of 2 cases

Dois casos de estenose supra-aortica localizada foram submetidos a correcao cirurgica por tecnica de aortoplastia alargada.Um dos pacientes apresentava uma associacao rara de agenesia da arteria pulmonar direita, nao sendo encontrada nenhuma referencia a este repeito na literatura consultada. Ambos exibiam estenoses supra-aorticas severas com gradientes superiores a 90 mmHg e obtiveram excelente resultado pos-operatorio, comprovado pelo segmento clinico e estudo hemodinamico. Sao discutidos os aspectos relacionados com a tecnica empregada e suas vantagens perante os metodos tradicionais de correcao

[Comparative study of bacterial sensitivity to antibiotics with the "abac" automatic system and the agar diffusion disk method]. / Studio comparativo della sensibilità batterica agli antibiotici con il sistema automatico "abac" e il metodo per diffusione in agar con dischi.

654 bacterial strains isolated from different biological materials have been tested either with "abac" automatic system or diffusion system on disks according to the Bauer-Kirby standardized method. The higher discrepancy has been observed to Co-trimoxazol antibiotic. Some other discrepancies, non significative, are shown in figures. The use of "abac" provides increased efficiency and convenience improving the quality of routine antimicrobic susceptibility results.