E-cigarette exposure with or without heating the e-liquid induces differential remodeling in the lungs and right heart of mice.

Various cardiopulmonary pathologies associated with electronic cigarette (EC) vaping have been reported. This study investigated the differential adverse effects of heating-associated by-products versus the intact components of EC aerosol to the lungs and heart of mice. We further dissected the roles of caspase recruitment domain-containing protein 9 (CARD9)-associated innate immune response and NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome in EC exposure-induced cardiopulmonary injury. C57BL/6 wild type (WT), CARD9-/-, and NLRP3-/- mice were exposed to EC aerosol 3 h/day, 5 days/week for 6 month with or without heating the e-liquid with exposure to ambient air as the control. In WT mice, EC exposure with heating (EwH) significantly increased right ventricle (RV) free wall thickness at systole and diastole. However, EC exposure without heating (EwoH) caused a significant decrease in the wall thickness at systole. RV fractional shortening was also markedly reduced following EwH in WT and NLRP3-/- mice. Further, EwH activated NF-κB and p38 MAPK inflammatory signaling in the lungs, but not in the RV, in a CARD9- and NLRP3-dependent manner. Levels of circulatory inflammatory mediators were also elevated following EwH, indicating systemic inflammation. Moreover, EwoH activated TGF-ß1/SMAD2/3/α-SMA fibrosis signaling in the lungs but not the RV of WT mice. In conclusion, EC aerosol exposure following EwH or EwoH induced differential cardiopulmonary remodeling and CARD9 innate immune response and NLRP3 inflammasome contributed to the adverse effects.

Dysregulated lipolysis and lipophagy in lipid droplets of macrophages from high fat diet-fed obese mice.

Obesity is associated with lipid droplet (LD) accumulation, dysregulated lipolysis and chronic inflammation. Previously, the caspase recruitment domain-containing protein 9 (CARD9) has been identified as a potential contributor to obesity-associated abnormalities including cardiac dysfunction. In the current study, we explored a positive feedback signalling cycle of dysregulated lipolysis, CARD9-associated inflammation, impaired lipophagy and excessive LD accumulation in sustaining the chronic inflammation associated with obesity. C57BL/6 WT and CARD9-/- mice were fed with normal diet (ND, 12% fat) or a high fat diet (HFD, 45% fat) for 5 months. Staining of LDs from peritoneal macrophages (PMs) revealed a significant increase in the number of cells with LD and the number of LD per cell in the HFD-fed WT but not CARD9-/- obese mice. Rather, CARD9 KO significantly increased the mean LD size. WT obese mice showed down regulation of lipolytic proteins with increased diacylglycerol (DAG) content, and CARD9 KO normalized DAG with restored lipolytic protein expression. The build-up of DAG in the WT obese mice is further associated with activation of PKCδ, NF-κB and p38 MAPK inflammatory signalling in a CARDD9-dependent manner. Inhibition of adipose triglyceride lipase (ATGL) by Atglistatin (Atg) resulted in similar effects as in CARD9-/- mice. Interestingly, CARD9 KO and Atg treatment enhanced lipophagy. In conclusion, HFD feeding likely initiated a positive feedback signalling loop from dysregulated lipolysis, CARD9-dependent inflammation, impaired lipophagy, to excessive LD accumulation and sustained inflammation. CARD9 KO and Atg treatment protected against the chronic inflammation by interrupting this feedforward cycle.

Eye movement influences on coupled and decoupled eye-hand coordination tasks.

Visually guided reaching precision and accuracy depend on the level of coupling between movements of the eyes and hand. In the present study, participants performed central fixations and either saccadic or smooth pursuit eye movements during fast and accurate reaching tasks involving eye-hand coupling and decoupling to better understand type of eye movement influence over upper limb control. Some eye-hand coupling and decoupling tasks also included hand reversals, where the hand moves away from the target to direct a cursor toward the target to account for various levels of hand-cursor and eye-cursor coupling. Regardless of eye-movement type, eye-hand-cursor coupling produced an endpoint accuracy advantage over decoupling. Use of hand reversal decreased peak speed and increased response time of the hand, whether considering fixation or a given eye movement. Use of smooth pursuit slowed hand movements relative to saccades, yet improved endpoint accuracy. Compared to central fixations, using smooth pursuit also slowed hand movements, while using saccades decreased, thus improved, hand reaction times. Data suggest an advantage, when using smooth pursuit to track the hand movement for the greatest endpoint accuracy, an advantage when using saccades for the fastest movements, and an eye-hand coupling advantage when using saccades for the shortest reactions. Researchers should provide clear eye-movement instructions for participants and/or monitor the eyes when assessing similar upper limb control to account for possible differences in eye movements used. Moreover, the type of eye movement chosen for participants should correspond to the primary goal of the task.

Selective Chemical Vapor Deposition Growth of Cubic FeGe Nanowires That Support Stabilized Magnetic Skyrmions.

Magnetic skyrmions are topologically stable vortex-like spin structures that are promising for next generation information storage applications. Materials that host magnetic skyrmions, such as MnSi and FeGe with the noncentrosymmetric cubic B20 crystal structure, have been shown to stabilize skyrmions upon nanostructuring. Here, we report a chemical vapor deposition method to selectively grow nanowires (NWs) of cubic FeGe out of three possible FeGe polymorphs for the first time using finely ground particles of cubic FeGe as seeds. X-ray diffraction and transmission electron microscopy (TEM) confirm that these micron-length NWs with ∼100 nm to 1 µm diameters have the cubic B20 crystal structure. Although Fe13Ge8 NWs are also formed, the two types of NWs can be readily differentiated by their faceting. Lorentz TEM imaging of the cubic FeGe NWs reveals a skyrmion lattice phase under small applied magnetic fields (∼0.1 T) at 233 K, a skyrmion chain state at lower temperatures (95 K) and under high magnetic fields (∼0.4 T), and a larger skyrmion stability window than bulk FeGe. This synthetic approach to cubic FeGe NWs that support stabilized skyrmions opens a route toward the exploration of new skyrmion physics and devices based on similar nanostructures.

Microgravity effects on nonequilibrium melt processing of neodymium titanate: thermophysical properties, atomic structure, glass formation and crystallization.

The relationships between materials processing and structure can vary between terrestrial and reduced gravity environments. As one case study, we compare the nonequilibrium melt processing of a rare-earth titanate, nominally 83TiO2-17Nd2O3, and the structure of its glassy and crystalline products. Density and thermal expansion for the liquid, supercooled liquid, and glass are measured over 300-1850 °C using the Electrostatic Levitation Furnace (ELF) in microgravity, and two replicate density measurements were reproducible to within 0.4%. Cooling rates in ELF are 40-110 °C s-1 lower than those in a terrestrial aerodynamic levitator due to the absence of forced convection. X-ray/neutron total scattering and Raman spectroscopy indicate that glasses processed on Earth and in microgravity exhibit similar atomic structures, with only subtle differences that are consistent with compositional variations of ~2 mol. % Nd2O3. The glass atomic network contains a mixture of corner- and edge-sharing Ti-O polyhedra, and the fraction of edge-sharing arrangements decreases with increasing Nd2O3 content. X-ray tomography and electron microscopy of crystalline products reveal substantial differences in microstructure, grain size, and crystalline phases, which arise from differences in the melt processes.

Closed globe macular injuries after blasts in combat.

PURPOSE: To describe the macular findings after closed globe ocular injuries sustained from blasts. METHODS: A retrospective chart review from February 2003 to March 2010 of all soldiers with closed globe ocular injuries sustained during combat with macular findings of trauma on examination was completed. RESULTS: There were 36 eyes that met the inclusion criteria. The mean age of the soldiers was 29.5 years and 97% were men. The average follow-up time was 18.6 months. Improvised explosive device blasts accounted for 86% of injuries. Forty-five percent of soldiers had bilateral ocular injuries. Eight of 36 eyes (22.2%) developed a macular hole. One eye had spontaneous closure and five eyes underwent surgical repair. There was a range of macular findings from retinal pigment epitheliopathy alone to retinal pigment epitheliopathy with full-thickness atrophy. Eight eyes (22.2%) had macular scarring on examination but no optical coherence tomography study. One eye (2.8%) developed phthisis bulbi. Fifteen eyes (42%) had an orbital fracture. Seven eyes (19%) sustained optic neuropathy. CONCLUSION: Closed globe injuries after blasts resulted in a spectrum of macular findings. The integrity of the foveal inner segment/outer segment junction was the most important retinal factor in visual outcomes. Orbital fractures were not found to be a risk factor for developing optic neuropathy and may improve visual outcomes. The rate of long-term complications is unknown, and it is important for ophthalmologists to follow these patients closely.

Prolonged eye-hand decoupling deficits in young adults with a history of concussion from adolescence.

Previous studies reported that adolescents with a sport-related concussion history showed prolonged visuomotor deficits during an eye-hand decoupling task until around 1.5-2 years post-event. The present study expands this work, examining whether such deficits do or do not emerge when testing individuals in young adulthood, i.e. later post-event. Twenty-one non-athlete college students with sport-related concussion history from adolescence (CH; M = 21 yrs.; M = 46 months post-concussion, range 10-90 months) and twenty controls with no history of concussion (NoH; M = 21 yrs.) performed two touchscreen-based visuomotor tasks. It included a coupled task where eyes and hand moved in similar directions, and decoupled-task with eyes and hand going to different directions. Movement planning (e.g. reaction time, initial direction error) and execution (e.g. movement time, path length) related variables were analyzed in both groups and conditions. Movement execution measures were similar for both groups and conditions (all p > 0.05). However, movement planning was impaired in the CH participants in the eye-hand decoupling condition (p < 0.05). CH's initial direction error was larger (i.e. worse spatial movement planning) than in the NoH group. Although movement execution deficits shown in earlier work in youth were not present in young adults, the present results suggest that a sport-related concussion sustained in adolescence can lead to prolonged deficits with spatial movement planning processes while performing eye-hand decoupling tasks about four years post-injury. Further research should investigate whether these deficits continue into adulthood and expand control on time since concussion and number of concussion metrics.Highlights Young adult college students with a history of a sport-related concussion from adolescence, tested about four years post-incident, showed spatial movement preparation deficits during an eye-hand decoupling visuomotor task.Eye-hand reversal decoupling errors also correlated with time since concussion in those with concussion history.These prolonged eye-hand decoupling deficits may emerge with ongoing time post-event, as comparable deficits were absent in previous work where youth were tested sooner post-injury.Our current findings point towards long-lasting performance impairments in young adult non-athletes after a sport-related concussion from adolescence.

Characterization of oscillation modes in levitated droplets using image and non-image based techniques.

The dynamics of levitated liquid droplets can be used to measure their thermophysical properties by correlating the frequencies at which normal modes of oscillation most strongly resonate when subject to an external oscillatory force. In two preliminary works, it was shown via electrostatic levitation and processing of various metals and alloys that (1) the resonance of the first principal mode of oscillation (mode n = 2) can be used to accurately measure surface tension and (2) that so-called "higher-order resonance" of n = 3 is observable at a predictable frequency. It was also shown, in the context of future space-based experimentation on the Electrostatic Levitation Furnace (ELF), a setup on the International Space Station (ISS) operated by Japan Aerospace Exploration Agency (JAXA), that while the shadow array method in which droplet behavior is visualized would be challenging to identify the n = 3 resonance, the normal mode n = 4 was predicted to be more easily identifiable. In this short communication, experimental evidence of the first three principal modes of oscillation is provided using molten samples of Tin and Indium and it is subsequently shown that, as predicted, an "image-less" approach can be used to identify both n = 2 and n = 4 resonances in levitated liquid droplets. This suggests that the shadow array method may be satisfactorily used to obtain a self-consistent benchmark of thermophysical properties by comparing results from two successive even-mode natural frequencies.

The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review.

A source of support during birth could be the solution to negative outcomes for the mother and her baby. To improve the birthing experience and increase positive birthing outcomes, sources of support during pregnancy should be evaluated and understood. The goal of this review was to synthesize the existing literature on how doulas might improve birth outcomes. This scoping review also aimed to shed light on the positive impact emotional support during childbirth can have on the health and well-being of mother and child. PubMed and EBSCOhost were used to identify articles using the search words with Boolean operators "doulas" AND "labor support" AND "birth outcomes" AND "pregnancy" AND "effects during labor." The eligibility criteria for article selection included primary studies investigating how doulas contributed to birth outcomes. The studies in this review indicated that doula guidance in perinatal care was associated with positive delivery outcomes including reduced cesarean sections, premature deliveries, and length of labor. Moreover, the emotional support provided by doulas was seen to reduce anxiety and stress. Doula support, specifically in low-income women, was shown to improve breastfeeding success, with quicker lactogenesis and continued breastfeeding weeks after childbirth. Doulas can be a great resource for birthing mothers, and consideration should be given to using them more, as they may have a positive impact on the well-being of the mother and child. This study raised questions about the accessibility of doulas and how they may help mitigate health disparities among women from different socioeconomic levels.

Physician-Pharmacist Collaborative Drug Therapy Management in Pediatric Hypertension.

OBJECTIVE: Pediatric hypertension affects 2% to 5% of children and adolescents in the United States and is frequently undertreated. The increasing prevalence of pediatric hypertension and worsening physician shortage create difficulties in closing this treatment gap. Physician-pharmacist collaborations have been shown to improve patient outcomes in adult patients. Our aim was to demonstrate a similar benefit for pediatric hypertension. METHODS: Pediatric patients whose hypertension was managed at a single pediatric cardiology clinic from January 2020 to December 2021 were enrolled in collaborative drug therapy management (CDTM). Patients whose hypertension was managed in the same clinic from January 2018 to December 2019 were used as a comparison group. The primary outcomes were achievement of at-goal blood pressure at 3, 6, and 12 months and time to control of hypertension. Secondary outcomes were appointment adherence and serious adverse events. RESULTS: A total of 151 patients were included in the CDTM group, and 115 patients were included in the traditional care group. Of those, 100 CDTM patients and 78 traditional care patients were assessed for the primary outcome. Fifty-four (54%) CDTM patients and 28 (36%) traditional care patients achieved at-goal blood pressure at 12 months (OR, 2.09; 95% CI, 1.14-3.85). Appointment non-adherence was 9.4% for CDTM and 16% for traditional care (OR, 0.54; 95% CI, 0.35-0.82). Adverse events were similar between groups. CONCLUSIONS: CDTM increased rates of at-goal blood pressure without increased adverse events. Physician-pharmacist collaboration may improve treatment of hypertension in pediatric patients.

Eye-hand decoupling deficits in young adults with concussion history from adolescence: Issues with task novelty or task demand?

The present study expands previous work that reported eye-hand decoupling (EHD) deficits in young adults with concussion history from adolescence. Here, we examine whether these deficits in movement planning (i.e., larger initial direction error) can be linked to difficulties with adapting to new task constraints or meeting ongoing task demands. Data from 21 young adults with concussion history from adolescence (CH) and 20 no history controls (NoH) were analyzed. All participants (Mean = 21 yrs.) performed two eye-hand coordination tasks, a standard task with vision and motor action in alignment, and an EHD task with eye- and hand movement direction spatially decoupled, with twenty trials per task condition. The re-analysis focused on the EHD condition as deficits were found for this task only in prior work. Trials were split into 5 blocks (trial 1-4, 5-8, 9-12, 13-16, 17-20), which included one movement to each of four target directions, and were analyzed across blocks and groups. The CH group had a larger initial direction error during blocks 1-2 but not in blocks 3-5. Our findings suggest that young adults with concussion history from adolescence can have difficulty with adapting to new task constraints associated with complex skill performance during a short series of trials.

Insurance status is not a predictor of rotator cuff tear magnitude.

Background: Rotator cuff tear (RCT) chronicity is an important factor in considering treatment options and outcomes for surgical repair. Many factors may contribute to delayed treatment, including timely access to care due to insurance status. The purpose of this study was to evaluate the relationship between the magnitude of RCT on presentation and insurance status. We hypothesize that publicly insured patients will have a greater incidence of chronic RCTs and shoulder pathology on initial presentation. Methods: Retrospective chart review of patients undergoing RCT repair at an academic tertiary care institution from 2005 to 2019. Demographic data, including age, race, sex, and insurance carrier, were collected. Insurance carriers were categorized into public (Medicare and Medicaid) or private insurance coverage. Individual magnetic resonance imagings were then reviewed by a board-certified musculoskeletal radiologist for supraspinatus (SS), infraspinatus (IS), subscapularis, and biceps tendon tears, as well as acromioclavicular arthritis. In addition, rotator cuff atrophy was evaluated by the scapular ratio. Univariate analysis of variance and logistic regression analyses were used to compare demographics and rotator cuff pathology between those with Medicaid and Medicare, as well as between publicly and privately insured patients. Results: Of the 492 patients in this study, 192 had private insurance, and 300 had public insurance (Medicaid: 50 and Medicare: 250). Insurance status was not found to be associated with differences in RCTs between Medicare and Medicaid patients. Those with Medicaid or Medicare (public), presented more frequently with SS or IS atrophy (SS atrophy, P = .002; IS atrophy, P = .039) than those with private insurance. However, after adjusting for age, no significant differences in rotator cuff tendon tear or atrophy frequencies were found between insurance groups. Conclusions: Patients with private and public insurance tend to present with similar chronicity and magnitude of RCTs. Insurance status does not appear to influence timely access to surgical care for patients with RCTs at an academic medical center.

Microstructural and Mechanical Characterization of Additive Friction Stir-Deposition of Aluminum Alloy 5083 Effect of Lubrication on Material Anisotropy.

Additive Friction Stir-Deposition (AFS-D) is a transformative, metallic additive manufacturing (AM) process capable of producing near-net shape components with a wide variety of material systems. The solid-state nature of the process permits many of these materials to be successfully deposited without the deleterious phase and thermally activated defects commonly observed in other metallic AM technologies. This work is the first to investigate the as-deposited microstructure and mechanical performance of a free-standing AA5083 deposition. An initial process parameterization was conducted to down-select optimal parameters for a large deposition to examine build direction properties. Microscopy revealed that constitutive particles were dispersed evenly throughout the matrix when compared to the rolled feedstock. Electron backscatter diffraction revealed a significant grain refinement from the inherent dynamic recrystallization from the AFS-D process. Tensile experiments determined a drop in yield strength, but an improvement in tensile strength in the longitudinal direction. However, a substantial reduction in tensile strength was observed in the build direction of the structure. Subsequent fractographic analysis revealed that the recommended lubrication applied to the feedstock rods, necessary for successful depositions via AFS-D, was ineffectively dispersed into the structure. As a result, lubrication contamination became entrapped at layer boundaries, preventing adequate bonding between layers.

Hydroxychloroquine retinopathy after short-term therapy.

PURPOSE: To report an unusual case of hydroxychloroquine toxicity after short-term therapy. METHODS: Observational case report. RESULTS: A 56-year-old woman presented to the Ophthalmology Clinic at Walter Reed Army Medical Center (WRAMC) with a 6-month history of gradually decreasing vision in both eyes. The patient had been taking hydroxychloroquine for the preceding 48 months for the treatment of rheumatoid arthritis. Examination of the posterior segment revealed bilateral "bull's eye" macular lesions. Fundus autofluorescence revealed hyperfluorescence of well-defined bull's eye lesions in both eyes. Optical coherence tomography revealed corresponding parafoveal atrophy with a loss of the retinal inner segment/outer segment junction. Humphrey visual field 10-2 white showed significant central and paracentral defects with a generalized depression. The patient was on a standard dose of 400 mg daily, which was above her ideal dose. The patient had no history of kidney or liver dysfunction. There were no known risk factors but there were several possible confounding factors. The patient was started on high-dose nabumetone, a nonsteroidal antiinflammatory drug, at the same time she was started on hydroxychloroquine. She also reported taking occasional ibuprofen. CONCLUSION: Retinal toxicity from chloroquine has been recognized for decades with later reports showing retinopathy from long-term hydroxychloroquine (Plaquenil) use for the treatment of antiinflammatory diseases. Hydroxychloroquine is now widely used and retinal toxicity is relatively uncommon. However, it can cause serious vision loss and is usually irreversible. The risk of hydroxychloroquine toxicity rises to nearly 1% with a total cumulative dose of 1,000 g, which is ∼5 years to 7 years of normal use. Toxicity is rare under this dose. For this reason, the American Academy of Ophthalmology has revised its recommendations such that annual screenings begin 5 years after therapy with hydroxychloroquine has begun unless there are known risk factors. This case report confirms the need for a baseline examination and annual ophthalmologic screening for patients taking hydroxychloroquine at a dose higher than the recommended dosage. It is also reasonable to consider annual examinations in patients taking high-dose nonsteroidal antiinflammatory drugs from the initiation of the medication.

Periorbital nodular fasciitis arising during pregnancy.

Nodular fasciitis (NF) is a benign proliferation of fibroblasts and myofibroblasts that rarely occurs in the periorbital region. We report what we believe to be the first case of periorbital NF associated with pregnancy. A case of intravascular fasciitis, a NF variant, has been reported during pregnancy, but it was not located in the periorbital region. A weak presence of estrogen receptors has been reported in NF. This may make it more susceptible to the hormone-related changes during pregnancy and contribute to the development of the lesion by stimulating fibroblasts and smooth muscle cell types. Although rare, NF should be considered in the differential diagnosis of periorbital soft-tissue masses arising during pregnancy.

Subclinical cardiomyopathy and long QT syndrome: an echocardiographic observation.

OBJECTIVE: Long QT syndrome (LQTS) is a cardiac channelopathy predisposing to syncope and sudden death secondary to LQT-triggered ventricular arrhythmias. Long QT syndrome has been regarded as a purely electrical disease. Recent reports have shown by echocardiography that LQTS patients have contraction abnormalities that are associated with cardiac arrhythmias. The purpose of this study was to determine the spectrum and prevalence of echocardiographic anomalies in a large cohort of patients diagnosed genetically and/or clinically with LQTS. OUTCOME MEASURES: Two-dimensional and Doppler echocardiographic studies performed during medical evaluation in Mayo's LQTS Clinic were reviewed for 216 LQTS patients. Echocardiograms were evaluated for morphologic abnormalities and atrial and ventricular size and function. Left atrial volume was indexed by body mass. Arrhythmic events were defined as a history of aborted cardiac arrest, documented ventricular tachycardia or fibrillation, and syncope. RESULTS: While 75% of patients had normal standard echocardiograms, 54 patients (25%) had at least one abnormal echocardiographic finding. Most common were subclinical cardiomyopathic changes, including increased left atrial volume index (n = 25), left or right ventricular enlargement (n = 7), and grade I-II diastolic dysfunction (n = 7). Left atrial volume index was higher in LQTS patients with arrhythmic events compared with those without (24.4 ± 5.5 mL/m(2) vs. 22.3 ± 6.1 mL/m(2) , P =.02). Corrected QT intervals and left atrial volume index correlated significantly albeit weakly (r(2) = 0.04, P <.01). Concomitant congenital heart disease was found in two patients. CONCLUSIONS: Subclinical cardiomyopathic changes were found in nearly 20% of LQTS patients. Left atrial enlargement was the most common finding and was associated with prolonged corrected QT and arrhythmic events. These changes may stem from underlying contraction abnormalities caused by ion channel dysfunction.

A retrospective review of oral low-dose sirolimus (rapamycin) for the treatment of active uveitis.

PURPOSE: The purpose of this study is to elicit the role of oral low-dose sirolimus as a corticosteriod-sparing agent for active uveitis. METHODS: A retrospective, interventional case series was performed by reviewing the clinical records of all patients treated with oral, low-dose sirolimus (1-4 mg daily) for severe uveitis. Data reviewed included symptomatic improvement, Snellen best-corrected visual acuity, corticosteroid requirement, sirolimus levels, intraocular inflammation, spectral-domain optical coherence tomography, and fluorescein angiogram. Primary outcome measures were determined by the ability to decrease the intraocular inflammation, corticosteroid requirement, and frequency of flares. RESULTS: Eight patients with varied diagnoses were treated with oral low-dose sirolimus for severe, chronic uveitis between 2008 and 2010. In four of the eight patients, there was an improvement of all primary outcome measures. While sirolimus monotherapy was successful in only one patient, a sirolimus/methotrexate combination was successful in three patients. Although there was a good initial response in three patients, treatment was a failure after serious side effects forced the cessation of sirolimus therapy. One patient was lost to follow-up. CONCLUSION: Sirolimus may have a limited role in severe uveitis as an adjunct corticosteroid-sparing agent in combination with more standard immunosuppressive agents. Oral low-dose sirolimus appeared to be better tolerated than higher doses, but there were a significant number of adverse events, requiring therapy to be stopped.

Procedural complications during congenital cardiac catheterization.

OBJECTIVE: We sought to identify complications that occurred during congenital cardiac catheterization (CCC) and determine factors that could improve the quality of care provided to patients with congenital heart disease during this procedure. DESIGN: We reviewed the electronic medical record for 903 CCC cases, (455 female; mean age = 29 +/- 22 years, range = birth to 91 years) performed in our catheterization laboratory from 2005 to 2007. Included in this cohort are 342 cases performed on patients less than 18 years of age. Clinical follow-up data were reviewed for 3 months postcatheterization. Complications were assigned a grade from 1 to 4 based on severity. RESULTS: The indication for catheterization was diagnostic in 459 (51%) patients, interventional in 386 (43%) patients, and endomyocardial biopsy in 58 (6%) patients. Mean intravenous contrast dose = 1.9 +/- 1.8 mL/kg. Mean fluoroscopy exposure = 22 +/- 13 minutes. Mean procedure duration = 122 +/- 42 minutes. Although 806 cases (89%) were performed without complication, 102 complications were observed in 97 cases. There were no deaths. Emergent surgery was performed in four patients. One patient notified us 16 days after catheterization that she was pregnant. The result of that pregnancy was normal. Thirty complications occurred during the CCC procedure and a first year fellow was involved in 17. Patient age, weight, gender, attending physician, or type of procedure (diagnostic vs. intervention) did not impact risk of complications. CONCLUSIONS: Patients of all ages with congenital heart disease can expect a safe procedure with minimal risk of serious complications. Procedural changes that have been implemented include pregnancy testing on all menstruating females prior to CCC regardless of history of sexual activity, and first-year fellows are now directly supervised by the attending physician rather than a more senior fellow throughout the procedure.