ABSTRACT
With the global pandemic and the continuous mutations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the need for effective and broadly neutralizing treatments has become increasingly urgent. This study introduces a novel strategy that targets two aspects simultaneously, using bifunctional antibodies to inhibit both the attachment of SARS-CoV-2 to host cell membranes and viral fusion. We developed pioneering IgG4-(HR2)4 bifunctional antibodies by creating immunoglobulin G4-based and phage display-derived human monoclonal antibodies (mAbs) that specifically bind to the SARS-CoV-2 receptor-binding domain, engineered with four heptad repeat 2 (HR2) peptides. Our in vitro experiments demonstrate the superior neutralization efficacy of these engineered antibodies against various SARS-CoV-2 variants, ranging from original SARS-CoV-2 strain to the recently emerged Omicron variants, as well as SARS-CoV, outperforming the parental mAb. Notably, intravenous monotherapy with the bifunctional antibody neutralizes a SARS-CoV-2 variant in a murine model without causing significant toxicity. In summary, this study unveils the significant potential of HR2 peptide-driven bifunctional antibodies as a potent and versatile strategy for mitigating SARS-CoV-2 infections. This approach offers a promising avenue for rapid development and management in the face of the continuously evolving SARS-CoV-2 variants, holding substantial promise for pandemic control.
Subject(s)
Antibodies, Bispecific , COVID-19 , Humans , Animals , Mice , SARS-CoV-2/genetics , Antibodies, Monoclonal/therapeutic use , Immunoglobulin G , Peptides/genetics , Power, PsychologicalABSTRACT
BACKGROUND: Diagnosis of actinic keratosis (AK) based only on clinical findings can be misleading, and histopathological diagnosis results in scars. Dynamic thermal imaging is a potential non-invasive tool for the diagnosis of AK. This imaging technique quantifies the infrared (IR) radiation emitted by a subject after exposure to external thermal stimuli, such as heat or cold. METHODS: Twenty-six histopathologically confirmed AK patients participated in the study. We compared the dynamic thermal images of AK lesions and normal skin (control sites). Temperature changes were plotted as a thermal response graph. After fitting exponential curves to the thermal response graph, the curve was converted to a logarithmic form. RESULTS: Comparison of the early thermal response graphs of lesions and control sites showed faster thermal recovery of AK lesions. There was a significant difference in the gradient component of the calculated logarithmic equation between the AK lesions and control sites (P < 0.001). CONCLUSION: Dynamic thermal imaging can be used as an auxiliary diagnostic tool for AK.
Subject(s)
Keratosis, Actinic/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Thermography/methods , Aged , Aged, 80 and over , Algorithms , Female , Humans , Infrared Rays/adverse effects , Keratosis, Actinic/metabolism , Keratosis, Actinic/pathology , Male , Middle Aged , Republic of Korea/epidemiology , Skin Neoplasms/metabolism , Skin Neoplasms/pathologyABSTRACT
Evidence regarding the use of Korean medicine (KM) for the conservative treatment of meniscus tears remains lacking. We aimed to evaluate clinical effectiveness and long-term follow-up outcomes in patients undergoing integrative KM treatment for meniscus tears. We analyzed the electronic medical records (EMRs) of 86 patients with meniscus tears and administered a follow-up survey. Patients treated at 1 of 4 KM hospitals between June 1, 2015, and June 30, 2020, were reviewed. KM treatment comprised herbal medicine, acupuncture, pharmacopuncture, bee venom pharmacopuncture, Chuna therapy, and KM physiotherapy. The primary outcome was the numeric rating scale (NRS) score for knee pain; secondary outcomes were the Western Ontario and McMaster Universities Arthritis Index (WOMAC), EuroQol 5-dimension (EQ-5D) score, range of motion, and patient global impression of change. The NRS for knee pain was reduced by an average of 2.49 (95% confidence interval [CI]: 2.03-2.95) at discharge and 1.97 (95% CI: 2.03-2.95) at follow-up. The WOMAC decreased by an average of 15.52 (95% CI: 10.14-20.89) during hospital stay and 30.72 (95% CI: 24.58-36.87) at follow-up. The EQ-5D score increased by an average of 0.06 (95% CI: -0.14 to 0.02) at discharge and 0.19 (95% CI: -0.29 to -0.09) at follow up. KM treatment effectively reduced knee pain, improved knee joint function, and enhanced the quality of life in patients with a meniscus tear for a relatively long period after treatment.
Subject(s)
Inpatients , Meniscus , Humans , Follow-Up Studies , Retrospective Studies , Quality of Life , Treatment Outcome , Pain , Republic of KoreaABSTRACT
The emergence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has posed a significant global health concern due to its severe respiratory illness and high fatality rate. Currently, despite the potential for resurgence, there are no specific treatments for MERS-CoV, and only supportive care is available. Our study aimed to address this therapeutic gap by developing a potent neutralizing bispecific antibody (bsAb) against MERS-CoV. Initially, we isolated four human monoclonal antibodies (mAbs) that specifically target the MERS-CoV receptor-binding domain (RBD) using phage display technology and an established human antibody library. Among these four selected mAbs, our intensive in vitro functional analyses showed that the MERS-CoV RBD-specific mAb K111.3 exhibited the most potent neutralizing activity against MERS-CoV pseudoviral infection and the molecular interaction between MERS-CoV RBD and human dipeptidyl peptidase 4. Consequently, we engineered a novel bsAb, K207.C, by utilizing K111.3 as the IgG base and fusing it with the single-chain variable fragment of its non-competing pair, K111.1. This engineered bsAb showed significantly enhanced neutralization potential against MERS-CoV compared to its parental mAb. These findings suggest that K207.C may serve as a potential candidate for effective MERS-CoV neutralization, further highlighting the promise of the bsAb dual-targeting approach in MERS-CoV neutralization.
Subject(s)
Antibodies, Bispecific , Antibodies, Neutralizing , Antibodies, Viral , Middle East Respiratory Syndrome Coronavirus , Middle East Respiratory Syndrome Coronavirus/immunology , Humans , Antibodies, Bispecific/immunology , Antibodies, Bispecific/chemistry , Antibodies, Bispecific/pharmacology , Antibodies, Bispecific/genetics , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , Animals , Spike Glycoprotein, Coronavirus/immunology , Spike Glycoprotein, Coronavirus/chemistry , Antibodies, Monoclonal/immunology , Protein Binding , Coronavirus Infections/immunology , Coronavirus Infections/virology , Dipeptidyl Peptidase 4/immunology , Mice , Neutralization TestsABSTRACT
OBJECTIVE: To show that transcatheter closure of perimembranous ventricular septal defect (PMVSD) with the Amplatzer ductal occluder (ADO, AGA Medical Corp, Plymouth, Minnesota) is a safe and effective treatment option. BACKGROUND: Transcatheter closure of PMVSD is a challenging procedure. Recently, the Amplatzer PMVSD occluder (APMVSDO, AGA Medical Corp, Plymouth, Minnesota) has been shown to be effective in closing hemodynamically significant PMVSDs. However, the high incidence of complete atrioventricular block (CAVB) after device occlusion of a PMVSD has been a hot issue as well. METHODS: Among several devices used in closing PMVSD percutaneously, we prefer the ADO because of the anatomic resemblance between PMVSD with aneurysm and patent ductus arteriosus, and it has no right ventricular disc which may contribute to the occurrence of CAVB. RESULTS: Between August 2009 and May 2012, 21 patients (5 males and 16 females) underwent percutaneous PMVSD closure using ADO. The patients' ages ranged from 3 to 42 years (median: 7 years), and their weights ranged from 18 kg to 60 kg (median: 27 kg). All patients showed echocardiographic signs of left ventricular volume overload and trivial to small mitral regurgitation (Qp/Qs = 1.7 ± 0.4). The mean defect size of the right ventricular side was 4.3 ± 1.0 mm. Devices 2 mm larger than the measured narrowest VSD diameter were selected in most patients. The ADOs were successfully implanted in all patients without any significant complications except one transient CAVB, one case of delivery wire fracture, and one case of surgery due to significant residual leak. Small residual shunts were observed immediately after the device implantation, but they disappeared during follow-up for 18 of 20 patients. The mean follow-up period was 20 ± 9 months, and CAVB or aortic regurgitation was not observed in all patients. CONCLUSION: Transcatheter closure of PMVSD with the ADO is a safe and promising treatment option, but long-term follow-up in a large number of patients would be warranted.
Subject(s)
Cardiac Catheterization/instrumentation , Heart Septal Defects, Ventricular/therapy , Septal Occluder Device , Adolescent , Adult , Atrioventricular Block/etiology , Cardiac Catheterization/adverse effects , Child , Child, Preschool , Female , Heart Septal Defects, Ventricular/diagnosis , Heart Septal Defects, Ventricular/physiopathology , Hemodynamics , Humans , Male , Prosthesis Design , Time Factors , Treatment Outcome , Ventricular FunctionABSTRACT
Intravascular or intracardiac stenosis occurs in various congenital heart diseases or after surgical repair. Although balloon angioplasty is the first option for relieving stenosis, frequently restenosis occurs because of elastic recoil or kingking component. The use of a self-expandable stent and covered stent in congenital heart disease has been reported for selected cases. In general, they have been performed for coarctation of the aorta or aortic aneurysm. We now report successful implantation of a self-expandable stent with a self-expandable covered stent graft in a case of lateral tunnel dehiscence with stenosis after a Fontan operation.
Subject(s)
Constriction, Pathologic/surgery , Heart Atria , Heart Defects, Congenital/surgery , Pulmonary Artery , Stents , Constriction, Pathologic/complications , Fontan Procedure , Heart Defects, Congenital/complications , Humans , Male , Treatment Outcome , Young AdultABSTRACT
STATEMENT OF PROBLEM: Airborne-particle abrasion of the inner and outer surfaces of an yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) core is used in an attempt to enhance the bond strength between the core and the veneering porcelain and to increase the surface area for cementation. However, airborne-particle abrasion introduces surface flaws that act as stress concentrators that may compromise the mechanical strength of the ceramic. PURPOSE: The purpose of this study was to investigate the effect of airborne-particle abrasion and heat treatment on the microstructure, biaxial flexural strength, and reliability of Y-TZP zirconia ceramics before veneering and cementation. MATERIAL AND METHODS: Forty-eight disks (15 mm in diameter, 0.5 mm in thickness) of Y-TZP were divided into 6 groups. Three treatments (untreated, airborne-particle abrasion, and heat treatment after airborne-particle abrasion) were applied to the upper surfaces, and 2 treatments (untreated and airborne-particle abrasion) were applied to the lower surfaces to mimic the preparation for veneering and cementation. For airborne-particle abrasion, 110 µm Al2O3 particles were used. The maximum load at fracture was calculated with a biaxial flexural strength test. The upper surfaces were facing the loading piston, and the lower surfaces were facing the supporting jig during testing. Results were analyzed with 2-way ANOVA (α=.05). The treated and fractured surfaces were observed with a scanning electron microscope. The relative content of the monoclinic phase was quantified with an x-ray diffraction analysis. RESULTS: The group with airborne-particle abraded lower surfaces showed significantly higher flexural strength than the untreated group (P<.001). The SEM images of the airborne-particle abraded zirconia specimens showed rough and irregular surfaces. The fracture initiated from the tension side, which was opposite to the applied load. CONCLUSIONS: Within the limits of this in vitro study, the results showed that airborne-particle abrasion of the lower surfaces increases the flexural strength of Y-TZP zirconia.
Subject(s)
Dental Etching/methods , Dental Materials/chemistry , Yttrium/chemistry , Zirconium/chemistry , Aluminum Oxide/chemistry , Cementation/methods , Dental Bonding , Dental Polishing/methods , Dental Porcelain/chemistry , Dental Stress Analysis/instrumentation , Dental Veneers , Diamond/chemistry , Hot Temperature , Humans , Materials Testing , Microscopy, Electron, Scanning , Pliability , Stress, Mechanical , Surface Properties , X-Ray DiffractionABSTRACT
BACKGROUND: Cardiovascular involvement in pediatric patients with connective tissue disease (CTD) is life-threatening, with aortic root dilatation being the most prevalent cardiovascular abnormality. We attempted to determine long-term outcomes of valve-sparing root replacement (VSRR) in this group, including cardiovascular reoperations for aortic aneurysm and dissection. METHODS: We conducted a retrospective analysis of pediatric patients with CTD who received VSRR in a single center from 2002 to 2021. The primary end point was a composite event of all-cause death and cardiovascular reoperations. The median follow-up duration was 8.3 years, with a maximum of 20.7 years. RESULTS: The median age of 24 pediatric patients who had VSRR was 14.4 years. Marfan syndrome and Loeys-Dietz syndrome affected 19 (79.2%) and 5 (20.8%) patients, respectively. There was no early death. The 15-year survival rate was 91.7%. At 10 years after VSRR, the cumulative incidence of reoperation for aortic regurgitation was 15.6%, and for aortic aneurysm or dissection, it was 29.1%. The 10-year rate of freedom from the primary end point was 53.1%. The Cox multivariable analysis revealed younger age at surgery (hazard ratio, 1.279; 95% confidence interval, 1.086-1.505; P = .003) and VSRR before 13 years of age (hazard ratio, 5.005; 95% confidence interval, 1.146-21.850; P = .032) as independent prognostic factors for the primary endpoint. CONCLUSIONS: VSRR for aortic root dilatation in pediatric patients with CTD demonstrated good long-term survival and low reoperation rates for aortic regurgitation. However, several patients developed later aortic aneurysm or dissection, and careful surveillance may be required, particularly in those who received VSRR at younger age.
ABSTRACT
Total correction of tetralogy of Fallot (TOF) is typically performed within the first year of life. However, subsequently, right-ventricular dysfunction often progresses by pulmonary stenosis or regurgitation. Although most patients with corrected TOF require additional surgery for right-ventricular outflow tract, intervention could be an alternative to palliative surgery and associated morbidities, especially in children. We describe a palliative application of the self-expandable stent in a patient with pulmonary stenosis after total correction of TOF who lacked a conduit between the right ventricle and pulmonary artery.
Subject(s)
Palliative Care/methods , Pulmonary Valve Stenosis/etiology , Pulmonary Valve Stenosis/surgery , Stents , Tetralogy of Fallot/complications , Tetralogy of Fallot/surgery , Ventricular Outflow Obstruction/etiology , Ventricular Outflow Obstruction/surgery , Child , Coronary Angiography , Echocardiography , Humans , Prosthesis DesignABSTRACT
We present a rare case of a patient with a dilated unroofed coronary sinus mimicking cor triatriatum that altered mitral inflow in a cardiac-type total anomalous pulmonary venous connection. The membranous tissue in the left atrium, thought to be cor triatriatum tissue preoperatively, was actually a remnant of a dilated coronary sinus tissue. Although this tissue did not create a significant pressure gradient and merely induced a turbulent mitral inflow, we resected it to avoid future problems with mitral leaflet function.
Subject(s)
Abnormalities, Multiple/surgery , Cor Triatriatum/surgery , Coronary Sinus/abnormalities , Heart Atria/abnormalities , Pulmonary Veins/abnormalities , Vascular Malformations/surgery , Abnormalities, Multiple/diagnostic imaging , Cardiac Surgical Procedures/methods , Cardiopulmonary Bypass/methods , Child , Cor Triatriatum/diagnosis , Coronary Sinus/diagnostic imaging , Coronary Sinus/surgery , Diagnosis, Differential , Dilatation, Pathologic , Echocardiography , Female , Follow-Up Studies , Heart Atria/diagnostic imaging , Heart Atria/surgery , Humans , Imaging, Three-Dimensional , Pulmonary Veins/surgery , Risk Assessment , Tomography, X-Ray Computed/methods , Treatment Outcome , Vascular Malformations/diagnostic imaging , Vascular Surgical Procedures/methodsABSTRACT
Clinical experience with coronary stent implantation in children is very limited. In-stent restenosis, thrombosis, and aneurysm formation are known complications. Recently, fracture of a drug-eluting stent was reported to be a cause of in-stent restenosis, but the natural course of stent fracture and proper management options remain uncertain. This report describes the case of a 7-year-old boy with a sirolimus-eluting stent implanted to treat stenosis of a coronary artery bypass graft who showed complete stent fracture and aneurysm formation. During the 2-year follow-up period, the boy experienced complete regression of the aneurysm without in-stent restenosis.
Subject(s)
Coronary Aneurysm/etiology , Drug-Eluting Stents/adverse effects , Sirolimus/administration & dosage , Child , Constriction, Pathologic , Coronary Angiography , Coronary Artery Bypass , Humans , Male , Prosthesis Failure , Remission, Spontaneous , Subclavian Artery/pathology , Subclavian Artery/transplantationABSTRACT
Cirsium rhinoceros (H.Lév. & Vaniot) Nakai has been used a traditional medicine. Complete chloroplast genome of C. rhinoceros is 152,576 bp long and has four subregions: 87,262 bp of large single copy (LSC) and 21,486 bp of small single copy (SSC) regions that are separated by 18,742 bp of inverted repeat (IR) regions including 133 genes (88 protein-coding genes, 8 rRNAs, and 37 tRNAs). The overall GC content of this chloroplast genome is 37.7% and in the LSC, SSC, and IR regions are 36.0%, 31.4%, and 43.8%, respectively. Phylogenetic trees show that Cirsium species are clustered along with their distribution.
ABSTRACT
BACKGROUND: Peripheral pulmonary arterial stenosis (PPAS) in childhood is frequently associated with other syndromes; however, PPAS in adolescents and adults is rare and its etiology is not well understood. We report the clinical characteristics of adult-onset nonsyndromic PPAS associated with the p.Arg4810Lys variant of the RNF213 gene. METHODS: We recently encountered an index case of severe pulmonary hypertension with multiple PPAS and intra- and extracranial arteriopathy. Because of a family history of Moyamoya disease (MMD), genetic analysis was performed, and revealed that this patient was homozygous for RNF213 p.Arg4810Lys. We searched for PPAS by reviewing the pulmonary hypertension registry and the MMD registry, and found four more cases of PPAS. Clinical features of the five patients and their families were analyzed. RESULTS: Mean age at diagnosis of pulmonary hypertension was 26 years, and the male to female ratio was 4:1. Genetic analysis of four patients revealed that all these patients were homozygous for the RNF213 p.Arg4810Lys variant. Pulmonary angiograms showed a string of beads pattern and/or diffuse stenosis of peripheral pulmonary arteries. Notably, three patients had MMD, whereas two patients did not. The three MMD patients had multiple stenoses of extracranial arteries other than the pulmonary artery. CONCLUSIONS: PPAS in segmental or subsegmental arteries in adulthood with multiple extracranial vasculopathies was found to be associated with homozygosity for RNF213 p.Arg4810Lys. RNF213 variant-associated vasculopathy should be categorized as a discrete disease entity of adulthood-onset PPAS regardless of the presence of MMD.
Subject(s)
Adenosine Triphosphatases/genetics , Moyamoya Disease , Stenosis, Pulmonary Artery/genetics , Ubiquitin-Protein Ligases/genetics , Adolescent , Adult , Comorbidity , Female , Genetic Predisposition to Disease , Genetic Variation , Homozygote , Humans , Male , Young AdultABSTRACT
BACKGROUND AND OBJECTIVES: The aims of this study were to determine the early and late outcomes of anatomic repair of congenitally corrected transposition of the great arteries (ccTGA) and to evaluate effectiveness of the hemi-Mustard procedure. SUBJECTS AND METHODS: We conducted a retrospective, single-center study of patients who underwent anatomic repair for ccTGA between July 1996 and December 2013. Sixteen patients were included in the study. The median age at the time of the operation was 3.5 years (range: 0.5-29.7), and the median body weight was 13.3 kg (range: 5.8-54). The median follow-up duration was 7.7 years (range: 0.2-17.4). RESULTS: Atrial switch was achieved using the Mustard procedure in 12 patients (hemi-Mustard procedure in 11) or the Senning procedure in four patients. The ventriculoarterial procedure was performed using the Rastelli procedure in 11 patients and arterial switch in five patients. Six patients underwent tricuspid valvuloplasty. The survival rate was 93.8±6.1%. The rate of freedom from reoperation at 5 years was 92.3±7.4% in the Rastelli group. All patients except one were New York Heart Association class I. All patients except one had mild tricuspid regurgitation. CONCLUSION: Anatomic repair can be performed with a low risk of in-hospital mortality. The hemi-Mustard strategy for selected patients is one solution for reducing early mortality and morbidity, and long-term complications such as venous pathway stenosis or sinus node dysfunction.
Subject(s)
Heart Septal Defects, Atrial/surgery , Pneumopericardium/etiology , Postoperative Complications/etiology , Respiration, Artificial/adverse effects , Female , Humans , Infant , Pneumopericardium/diagnostic imaging , Pneumopericardium/therapy , Postoperative Complications/diagnostic imaging , Postoperative Complications/therapy , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/etiology , Pulmonary Edema/therapy , Radiography , Severity of Illness IndexABSTRACT
Obesity is a common disorder with many complications. Although chronodisruption plays a role in obesity, few epidemiological studies have investigated the association between artificial light at night (ALAN) and obesity. Since sleep health is related to both obesity and ALAN, we investigated the association between outdoor ALAN and obesity after adjusting for sleep health. We also investigated the association between outdoor ALAN and sleep health. This cross-sectional survey included 8526 adults, 39-70 years of age, who participated in the Korean Genome and Epidemiology Study. Outdoor ALAN data were obtained from satellite images provided by the US Defense Meteorological Satellite Program. We obtained individual data regarding outdoor ALAN; body mass index; depression; and sleep health including sleep duration, mid-sleep time, and insomnia; and other demographic data including age, sex, educational level, type of residential building, monthly household income, alcohol consumption, smoking status and consumption of caffeine or alcohol before sleep. A logistic regression model was used to investigate the association between outdoor ALAN and obesity. The prevalence of obesity differed significantly according to sex (women 47% versus men 39%, p < 0.001) and outdoor ALAN (high 55% versus low 40%, p < 0.001). Univariate logistic regression analysis revealed a significant association between high outdoor ALAN and obesity (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.14-1.35, p < 0.001). Furthermore, multivariate logistic regression analyses showed that high outdoor ALAN was significantly associated with obesity after adjusting for age and sex (OR 1.25, 95% CI 1.14-1.37, p < 0.001) and even after controlling for various other confounding factors including age, sex, educational level, type of residential building, monthly household income, alcohol consumption, smoking, consumption of caffeine or alcohol before sleep, delayed sleep pattern, short sleep duration and habitual snoring (OR 1.20, 95% CI 1.06-1.36, p = 0.003). The findings of our study provide epidemiological evidence that outdoor ALAN is significantly related to obesity.
Subject(s)
Lighting/adverse effects , Obesity/epidemiology , Sleep Wake Disorders/epidemiology , Sleep , Adult , Aged , Chi-Square Distribution , Cross-Sectional Studies , Health Status , Health Surveys , Humans , Life Style , Logistic Models , Male , Middle Aged , Multivariate Analysis , Obesity/diagnosis , Odds Ratio , Republic of Korea/epidemiology , Risk Factors , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/physiopathology , Time FactorsABSTRACT
BACKGROUND: We reviewed our 20-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly) to assess the early and long-term outcomes. METHODS: Between January 1995 and December 2014, 139 consecutive patients who underwent ASO for TGA or Taussig-Bing anomaly were included in this retrospective study. The median age at the operation was 9 (0-485) days, and 97 patients (70 %) underwent ASO less than 2 weeks. The median weight was 3.3 (2.1-10.3) kg. The patients were divided into three groups; simple TGA (n = 78) included patients with TGA with intact ventricular septum, complex TGA (n = 46) included those who had TGA with ventricular septal defect or other anomalies, and Taussig-Bing anomaly (n = 15). Median follow-up duration was 72.5 (0.4-230) months. RESULTS: There were 3(2.2 %) in-hospital deaths. One patient (0.7 %) underwent early reoperation due to coronary insufficiency. Late deaths occurred in 3 (2.2 %) of 136 survivors. The Kaplan-Meier's survival rate was 97.6 ± 1.4 % at 15 years. Twenty-three patients (16.9 %) required 26 reintervention. The freedom from reintervention rates were 82.5 ± 3.7 % at 5 years and 75.8 ± 4.7 % at 10 years, respectively. Median interval between ASO and first reintervention was 22.8 (6.4-89.2) months. The multivariate analysis showed that diagnosis of Taussig-Bing anomaly (hazard ratio, 7.09; P < 0.001) and side by side great artery relationship (hazard ratio, 7.98; P = 0.001) were independent risk factors for reoperation. Five patients (3.9 %) had developed at least moderate neo-aortic regurgitation during the follow-up and one patient underwent reoperation mainly for neo-aortic regurgitation. By multivariate analysis, Taussig-Bing anomaly was the risk factor for at least moderate neo-aortic regurgitation (P = 0.035). CONCLUSIONS: ASO can be performed with a low risk of early mortality and satisfactory long-term outcomes even in a small volume center. Close long-term surveillance is mandatory to detect structural or hemodynamic changes.
Subject(s)
Arterial Switch Operation , Double Outlet Right Ventricle/surgery , Heart Septal Defects, Ventricular/surgery , Transposition of Great Vessels/surgery , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/surgery , Arterial Switch Operation/adverse effects , Double Outlet Right Ventricle/mortality , Female , Follow-Up Studies , Heart Septal Defects, Ventricular/mortality , Humans , Infant , Infant, Newborn , Male , Reoperation , Retrospective Studies , Risk Factors , Survival Rate , Transposition of Great Vessels/mortality , Treatment OutcomeABSTRACT
As the extracardiac Fontan operation evolves, a reliable method for creating and subsequently closing communications between the systemic and pulmonary venous chambers would become useful. We describe a simple and safe technique of fenestration amenable to coil occlusion, which can be carried out in most cardiac catheterization laboratories.
Subject(s)
Cardiac Catheterization , Fontan Procedure/methods , Heart Defects, Congenital/surgery , Abnormalities, Multiple/surgery , Child , Child, Preschool , Female , Humans , Male , Pulmonary Artery/pathology , Pulmonary Artery/surgery , Pulmonary Atresia/surgery , Pulmonary Valve Stenosis/surgery , Vena Cava, Inferior/pathology , Vena Cava, Inferior/surgeryABSTRACT
Coronary aneurysm formation and subsequent stenosis resulting in ischemic heart disease are the most important complications of Kawasaki disease (KD). Reported is the evolution of severe calcific coronary artery stenosis in an 8-year-old boy managed with percutaneous transluminal coronary rotational ablation (PTCRA) after failed balloon angioplasty. No restenosis occurred 6 months after RA. Reports on PTCRA in children are limited and it may be a good therapeutic option as a definite or a palliative one to postpone coronary artery bypass surgery in the young children with calcific coronary artery stenosis after Kawasaki disease.
Subject(s)
Calcinosis , Catheter Ablation/methods , Coronary Stenosis/surgery , Child , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Humans , MaleABSTRACT
OBJECTIVES: Treatment of long-segment congenital tracheal stenosis (CTS) remains challenging. Recently, slide tracheoplasty has become the standard approach in many centres. The aim of this study was to evaluate the clinical outcomes of slide tracheoplasty. METHODS: Between 2004 and 2011, 18 patients underwent slide tracheoplasty in our centre. The median patient age was 2.5 months (range, 18 days-4 years) and the median body weight was 4.2 (range, 2.2-17.7) kg at operation. Eleven (61%) patients were on a mechanical ventilator prior to surgery. The median stenotic segment estimated by a computed tomography scan was 52% of the length of total trachea (range, 18-84%). Five (28%) patients had proximal bronchial stenosis, 3 (17%) had tracheal bronchus, 2 (11%) had tracheobronchomalacia and 1 (6%) had agenesis of the right lung. Thirteen (72%) patients had a combined cardiac anomaly, including 8 patients with a pulmonary artery sling. Ten (56%) patients had associated extracardiac anomalies. Slide tracheoplasty was performed on cardiopulmonary bypass in all patients, and cardiac lesions were corrected. RESULTS: There was no early death. The patient with agenesis of the right lung died of left bronchial stenosis 3 months after the surgery. Two (11%) patients were reoperated on for tracheal restenosis. In the other 15 patients, the median duration of ventilator support was 8 (range, 5-34) days and the median duration of hospitalization was 31 (range, 12-79) days. During the follow-up (median duration of 17 months; range, 2-77 months), 13 (72%) patients were symptom-free and 2 (11%) underwent tracheostomy for tracheomalacia. CONCLUSIONS: Based on this study, slide tracheoplasty seems to be an effective technique for CTS. However, shortening of the trachea after reconstruction may give rise to recurrent obstruction.