Changes in left heart hemodynamics after technically successful in-utero aortic valvuloplasty.

OBJECTIVE: Severe aortic stenosis in the mid-gestation fetus can progress to hypoplastic left heart syndrome (HLHS). @ In-utero aortic valvuloplasty is an innovative therapy to promote left ventricular growth and function and potentially to prevent HLHS. This study evaluated the effects of mid-gestation fetal balloon aortic valvuloplasty on subsequent fetal left ventricular function and left heart Doppler characteristics. METHODS: We reviewed fetuses with aortic stenosis that underwent attempted in-utero aortic valvuloplasty between 2000 and 2006. Pre-intervention and the latest post-intervention fetal echocardiograms were analyzed to characterize changes in left heart function and Doppler characteristics in utero. RESULTS: Forty-two fetuses underwent attempted aortic valvuloplasty during the study period, 12 of which were excluded from analysis secondary to inadequate follow-up data, termination or fetal demise. Study fetuses (n = 30) underwent pre-intervention echocardiography at a median gestational age of 23 weeks, and were followed for a median of 66 +/- 23 days post-intervention. In 26 fetuses, aortic valvuloplasty was technically successful. Among these 26, left heart physiology was abnormal pre-intervention and improved or normalized after intervention in most cases: biphasic mitral inflow was present in 5/25 (20%) cases pre-intervention and in 21/23 (91%) post-intervention (P < 0.001); moderate or severe mitral regurgitation was present in 14/26 (54%) cases pre-intervention and in 5/23 (22%) post-intervention (P = 0.02); bidirectional flow across the patent foramen ovale was present in 0/26 cases pre-intervention and in 6/25 (24%) post-intervention (P = 0.01); antegrade flow in the transverse arch was present in 0/25 cases pre-intervention and in 17/26 (65%) post-intervention (P < 0.001). The left ventricular ejection fraction increased from 19 +/- 10% pre-intervention to 39 +/- 14% post-intervention (P < 0.001). These changes were not observed in control fetuses (n = 18). CONCLUSION: Fetal aortic valvuloplasty, when technically successful, improves left ventricular systolic function and left heart Doppler characteristics.

Lower alveolar carcinoma. Segmental v marginal resection.

Fifty-three patients were treated for squamous cell carcinoma of the lower alveolar ridge during a 24-year period. Comparison two-year survival rates and no evidence of disease (NED) figures were obtained for segmental and marginal resection of the mandible in these patients for each stage of the disease. Analysis of these two treatment modalities disclosed that marginal resection, especially when combined with radiation, is as effective in controlling disease in stages I and II and, possibly, in stage III. Stage IV carcinomas should be treated by combined segmental therapy. The comparatively high two-year NED rate for marginal resection found in this series suggests that this therapy should be considered as the initial form of therapy in selected patients with stage I and II disease.

The transoral treatment of mandibular fractures using noncompression miniplates: a prospective study.

A prospective study was performed to evaluate the efficacy of noncompression miniplates in the repair of mandible fractures treated at a large regional trauma center. The study included 54 cases of all types of adult mandible fractures with the exception of fractures of the condylar neck and ascending ramus. Cases were excluded in which preexisting infection was present. The technique consisted of a transoral approach followed by monocortical juxtaalveolar and subapical osteosynthesis without long-term intermaxillary fixation. Overall, there were 7 complications associated with this technique (13%): 4 infections (7.4%), 1 malunion (1.9%), and 2 mental nerve paresthesias (3.7%). These results compare favorably with those reported in the literature and suggest that mandibular osteosynthesis using miniature malleable plates is a useful and effective method for the repair of selected mandible fractures.