Closure of atrial septal defects: is there still a place for surgery?

BACKGROUND: The purpose of this study is to assess the current management of atrial septal defect closure in an era of increasing feasibility of transcatheter device occlusion. METHODS: Atrial septal defect (ASD) closure was performed surgically through complete sternotomy in 165 patients (group 1) and through partial inferior sternotomy in 53 patients (group 2). Transcatheter device occlusion was achieved in 82 patients with only ASD type II and patent foramen ovale (group 3). RESULTS: Overall complications were minor and more frequent in group 1: 26.7% versus 13.2% in group 2 and 14.6% in group 3 (p = 0.04). Compared to complete sternotomy, a partial sternotomy led to less chest tube loss (7.1 +/- 2.9 versus 11.6 +/- 14.5 ml/kg) (p < 0.05) and less postoperative pericardial effusion (11.3% versus 13.5%)(p = 0.55). ASD closure was effective in 99.4% in group 1, 100% in group 2 but only in 86.6% in group 3 (p < 0.05). Two major complications of device implantation required early surgery: 1 femoral arteriovenous fistula and 1 device embolization. Hospital stay was significantly shorter in group 3, as well as in group 2 compared to group 1 (8.3 +/- 4.2 versus 5.9 +/- 1.1 versus 2.1 +/- 7.3 days) (p < 0.05). Midterm results were excellent, with only 1 non-cardiac death and 1 re-operation for residual shunt in group 1, and 1 device removal for thrombosis in group 3. CONCLUSION: Transcatheter device occlusion has become an established treatment for ASD closure, achieving optimal results in older children and adults with anatomically suited ASD type II and PFO. However, a partial inferior sternotomy offers a valuable and complementary operative approach for all ASD variants, maintaining the predictable success of surgery, with the obvious advantages of minimal access in terms of morbidity, cosmetics and hospital stay.

Intermittent biotelemetric monitoring of electrocardiograms and temperature in male broilers at risk for sudden death syndrome.

Biotelemetry was used to acquire electrocardiograms (ECG) and temperature measurements in a study of male broilers at risk for sudden death syndrome (SDS), a fatal condition that may have underlying cardiovascular mechanisms. Day-old (Day 1) Arbor Acres x Arbor Acres male chicks were randomly assigned to two different diets: control (Diet A) and one that contained elements that contribute to SDS (Diet B). The heaviest birds in each group on Day 13 underwent surgery on Day 15 to have transmitters with temperature sensors and ECG electrodes implanted. After surgery, three controls and three implanted birds from each diet group were kept in individual cages and exposed to 23 h of light and 1 h of darkness during each 24-h cycle. Implantation did not affect weight gain between Days 13 and 22 (P = 0.396). Temperature measurements and 1-min ECG were taken every 15 min. Heart rate and heart rate variability were measured from three 2-s segments in two dark and two light period samples during Days 17 to 19. Diet B decreased weight gain (P = 0.045), lowered heart rate (P < 0.0001), and increased internal temperature (P < 0.0001). Heart rate variability was lower during dark versus light periods (P = 0.004), which indicates that the birds rested during the dark periods, but was not affected by diet (P = 0.651). Thus, biotelemetry provided a useful method for intermittent physiological monitoring of poultry on different diets and under changing environmental conditions.

[Vaccination policy in Flanders]. / Vaccinatiebeleid in Vlaanderen.

In the recent past (1997) the Flemish authorities have turned the vaccination policy into one of the top priorities of their health policy. Following the WHO-guidelines they have brought forward a health objective anticipating a significant increase of the vaccination rate for a number of infectious diseases by 2002. Recent research shows that attention should be paid especially to measles, mumps and rubella (83% vaccination rate at 18-24 months), hepatitis B (74-69%) and type b haemophilus influenzae (78%). The vaccination rate in Flanders for polio, diphtheria, tetanus and whooping cough is good or adequate at the age of 18-24 months. In 2000, the Flemish authorities reserve about BEF 80 million for the purchase of basic vaccines distributed for free through their health inspections, just like in the previous years. In order to realise this objective, all medical bodies carrying responsibility in this field are appealed to. Moreover, the local regional consultative bodies, financially supported by the Flemish Community, may be expected to play a stimulating role in, so far, four out of the five Flemish provinces. A strong management from a central Flemish vaccination umbrella organisation is considered to be indispensable in order to have the vaccinating bodies deliberate, have them build a consensus and motivate them. This should result in clear and generally accepted vaccination schedules and a well-informed and sensitised population. A project in view of a rapid and efficient registration of vaccination data in a central Flemish vaccination database, accessible for vaccinating doctors is now running with 'Child and Family' and can subsequently be extended to the entire target group.

A functioning double aortic arch in an infant: a case report.

A case of a functioning double aortic arch is presented in a 4-month-old boy with recurrent respiratory infections and poor feeding. An esophagogram, Doppler echocardiography and aortography were performed. We describe the typical findings of this rare disorder.

Reversible cardiopathy after accidental overdose of mitoxantrone.

Mitoxantrone is an anthraquinone structurally related to the anthracycline drugs doxorubicin and daunorubicin. In animal tumor models, it was equally cytotoxic as but less cardiotoxic than the parent compounds. We here describe the clinical course of a 9-year old girl who inadvertently received 100 mg/m2 of mitoxantrone as a bolus injection. Hemoperfusion carried out twice with the objective of increasing the drug clearance was totally inefficient. Severe but transient myelotoxicity was induced. Sequential echocardiograms demonstrated a reversible decrease of the shortening fraction of the left ventricle.

Maternal and paternal disciplinary styles: relations with preschoolers' playground behavioral orientations and peer status.

To explore relations among parents' self-reported disciplinary styles, preschoolers' playground behavioral orientations, and peer status, 106 mothers and fathers of preschool-age children (age range = 40-71 months) participated in home disciplinary style interviews. Observations of their children's playground behavior in preschool settings and measures of sociometric status were also obtained. Results indicated that children of more inductive mothers and fathers (i.e., less power assertive) exhibited fewer disruptive playground behaviors. In addition, daughters and older preschoolers of inductive mothers exhibited more prosocial behavior. Children of inductive mothers were also more preferred by peers. Few significant relations were found between paternal discipline and child behavior/peer status. Age-related patterns of behavior also indicated that older preschoolers who engaged in more prosocial and less antisocial and disruptive playground behavior were more preferred by peers. In addition, child behaviors were found to mediate maternal discipline and peer status.