Daily walking is effective for the management of pregnant women with gestational diabetes mellitus.

AIM: This study evaluated the usefulness of daily walking for gestational diabetes mellitus (GDM) management by analyzing the relationship between daily walking and glucose tolerance in pregnant women with GDM who were in the second trimester. METHODS: This longitudinal study was conducted at TOYOTA Memorial Hospital in Toyota, Japan, from January 2015 to June 2016. Pregnant women with GDM wore accelerometers on the waist for 7-12 weeks. RESULTS: Seventy-three women with GDM were included in the present study; data collected from 24 women were analyzed. The estimated number of steps walked daily showed a significant positive correlation (r = 0.798, P = 0.000) with energy expenditure related to physical activity. There was a significant negative correlation (r = -0.603, P = 0.014) between the post- to pre-research casual glucose level (CGL) ratio and the number of steps walked daily. No significant correlation (r = -0.004, P = 0.986) was detected between the ratio of hemoglobin A1c and the number of steps taken. When the study was completed, the 11 participants who walked ≥6000 steps/day showed significantly lower CGL (95 + 10 mg/dL [mean + SD]) than the 13 participants in the <6000 steps/day group (111 + 18 mg/dL) (P = 0.013). CONCLUSION: Simple walking for light intensity physical activity is effective for controlling the CGL in pregnant women with GDM. We recommend that pregnant women with GDM should walk a minimum of 6000 steps/day.

Prenatal Diagnosis of Congenital Absence of Aortic Valve: A Report of Two Cases with Different Outcomes and a Literature Review.

Congenital absence of aortic valve (AAV) is a rare cardiac anomaly associated with high mortality. We present 2 prenatally diagnosed cases of AAV. In both cases, fetal echocardiography showed no aortic valve tissue and free aortic regurgitation. At 24 weeks' gestation, case 1 showed a hypoplastic hypocontractile left ventricle and mitral atresia, but did not develop hydrops and was born at term. Bilateral pulmonary arterial banding was performed with continuous infusion of prostaglandin E1 at 5 days of age followed by Norwood and bidirectional Glenn procedures at 3 months of age. The hypoplastic non-compliant left ventricle and mitral atresia might have limited aortic regurgitation. Case 2 showed hydrops at 23 weeks' gestation. An enlarged hypocontractile left ventricle and massive mitral insufficiency were noted. The regurgitant flow was directed to the right atrium through a foramen ovale. This peculiar hemodynamic established a malignant circuit which was arbitrarily called 'inverse circulatory shunt'. Intrauterine death occurred at 28 weeks' gestation. An autopsy showed absent aortic valve leaflets but three tiny membranous remnants. Hemodynamic evaluation by fetal echocardiography should include the documentation of the presence of and assessment of the grade of aortic regurgitation, mitral regurgitation and blood flow through a foramen ovale as well as left ventricular function.

Factors associated with symptoms of depression among pregnant women with gestational diabetes mellitus in Japan.

The objective of this study was to explore the factors associated symptoms of depression among pregnant women with gestational diabetes mellitus (GDM) in Japan. This cross-sectional study was conducted at a hospital in Toyota, Japan, from January 2015 to June 2016. Pregnant women who visited the hospital and were diagnosed with GDM in the second trimester were enrolled. We analyzed depression symptoms using the Centers for Epidemiological Studies Depression Scale (CES-D) and considered related factors of depression symptoms, such as dietary intake and daily walking. Dietary intake during the past month was assessed using a brief self-administered diet history questionnaire, and daily walking was assessed using an accelerometer. The prevalence rate for GDM was 8.8%, and 25 pregnant women with GDM were analyzed. The CES-D was not significantly correlated with pre-pregnancy BMI, postprandial plasma glucose, hemoglobin A1c, and the number of steps walked. In contrast, a significant negative correlation was observed between the CES-D score and intake of fish with bones, simmered fish, pickles, green leaves, mushrooms, and green tea. Furthermore, a significant positive correlation was found between Coke® and CES-D scores. For nutrient intake, a significant negative correlation was found between the CES-D score and vitamin K, folate, and ß-carotene levels. The present study suggests that depression symptoms among pregnant women with GDM in the second trimester may be associated with diet.

Rescue procedure for left main bronchus obstruction after patent ductus arteriosus clipping: a case report.

BACKGROUND: Obstruction of the left main bronchus is a rare but life-threatening complication following the closure of patent ductus arteriosus by surgical clips. We report a successful rescue procedure for this complication in a premature infant. CASE PRESENTATION: A 24-week gestational age premature girl weighing 903 g underwent surgical clipping for patent ductus arteriosus at the age of 24 days after birth. Bronchoscopy revealed the left main bronchus obstruction due to the clip compression at 6 h later after the surgery. The patient underwent a rescue re-exploration for this serious complication. New clips were applied to both the intrapericardial and the aortic ends of the patent ductus arteriosus respectively. And then the previous clips, compressing the left main bronchus, were gently removed from the ductus without ductus injury through a re-thoracotomy. CONCLUSIONS: Surgeons should be aware of the possible complication and take care not to place patent ductus arteriosus clips obliquely toward the bronchus.

Staged Fontan operation for children with heterotaxy syndrome, bilateral ductus arteriosus, and nonconfluent pulmonary artery.

We report two cases of successful Fontan operation in children with heterotaxy syndrome associated with univentricular physiology and absent and nonconfluent central pulmonary arteries with both distal pulmonary arteries directly connected to the ipsilateral ductus arteriosus. After unilateral systemic-pulmonary shunt, the central pulmonary artery was reconstructed with a polytetrafluoroethylene prosthetic graft concomitantly with bidirectional cavopulmonary shunt. Finally, extracardiac total cavopulmonary connection was performed as an off-pump procedure. Children with bilateral ductus arteriosus and a nonconfluent pulmonary artery with univentricular physiology present a particular challenge in regard to completing Fontan operations. Careful attention should be directed at ensuring balanced growth of the bilateral distal pulmonary arteries. When planning reconstruction of the central pulmonary artery with a prosthesis, late reconstruction may be beneficial, as it enables utilization of a larger-caliber graft, obviating the need for replacement during a subsequent Fontan operation.

Kawashima procedure after staged unifocalizations in asplenia with major aortopulmonary collateral arteries.

We report a Kawashima procedure (total cavopulmonary shunt) successfully carried out for asplenia syndrome, pulmonary atresia, and major aortopulmonary collateral arteries. At the age of 8, the patient underwent staged bilateral unifocalizations using confluent central pulmonary arteries concomitant with bilateral modified Blalock-Taussig shunts. As the result of an interrupted inferior vena cava with azygous continuation, the patient required a Kawashima procedure with augmentation of the central pulmonary arteries for definitive palliation 1 year later. Cyanosis, respiratory distress, and ventricular function improved.

Two cases of tetralogy of Fallot with absent pulmonary valve repaired by modified Kreutzer's technique.

Two severely symptomatic infants of tetralogy of Fallot with absent pulmonary valve successfully repaired by a modified Kreutzer's technique are described. In addition to the standard repair of tetralogy of Fallot, our surgical technique consists of extensive pulmonary reduction arterioplasty, which allows tracheobronchial decompression. Both patients tolerated surgery and showed significant relief of airway compression and clinical symptoms, although they required prolonged mechanical ventilatory support. The modified Kreutzer's technique is relatively simple and could be sufficiently efficacious even for symptomatic infants of tetralogy of Fallot with absent pulmonary valve.