Development of a Novel Adapter to Enable Less-Invasive Left Ventricular Assist Device Implantation via the Left Ventricular Apex.

The first prototype of an adapter to enable left ventricular assist device (LVAD) implantation solely via the left ventricular (LV) apex and without requiring cardiopulmonary bypass (CPB) was tested in healthy and acutely failing pig hearts. The adapter consists of a fixation, blood guiding, and connecting module fitting to a HeartMate 3 (HM3; Abbott, Chicago, IL) pump. Implantation was performed via a left thoracotomy in five pigs (96 ± 18 kg). Invasive blood pressure was measured before (CTRL), 30 minutes after HM3 initiation (HM3_CTRL), during acute heart failure (HF) induced by rapid pacing (CTRL_HF), and 5 minutes after initiating HM3 support (HM3_HF). To further estimate the LVAD performance, blood pressure amplitudes were calculated in the healthy heart without (CTRL) and with HM3 support (HM3_CTRL) as: systolic-diastolic blood pressure. Our adapter implantation and connection to the HM3 pump succeeded in all animals. Compared to the normal beating healthy heart, blood pressure amplitudes were significantly smaller during HM3 support (CTRL: 41 ± 5 mm Hg vs. HM3_CTRL: 20 ± 4 mm Hg; p < 0.05). Under HF conditions, mean blood pressure returned to normal values after pump initiation (CTRL_HF: 29 ± 6 mm Hg, HM3_HF: 83 ± 24 mm Hg). The adapter prototype allowed safe, straightforward, and less-invasive LVAD implantation solely via the LV apex without using CPB and support of the LV during acute HF in the pig heart.

Clinical and laboratory predictors of survival for pediatric patients on non-postcardiotomy extracorporeal membrane oxygenation (ECMO).

Extracorporeal membrane oxygenation (ECMO) is used in pediatric patients with severe cardiopulmonary failure who do not respond to conventional therapy; only a few studies have been conducted in Turkey. We present the experience of pediatric ECMO with the aim of showing factors affecting mortality. We retrospectively reviewed our ECMO database to identify patients who received ECMO from October 2015 to March 2018. Our population comprised 30 pediatric patients. The mean patient age was 41.31±53.35 months and 17 (56.7%) patients were male. The median duration of ECMO support was 8.9 (6.6-10.8) days. The rates of successful ECMO weaning and survival to discharge were 70.0% (n=21) and 66.7% (n=20), respectively. Indications for ECMO were respiratory failure (40.0%), cardiac failure (33.3%), and sepsis (26.7%). We found that pre-cannulation values of pH (p=0.034), leukocytes (p=0.029), C-reactive protein (p=0.045), creatinine (p=0.047), chloride (p=0.001) and post-cannulation pH (p=0.0001), bicarbonate (p=0.014), lactate (p=0.002), chloride (p=0.0001) were associated with mortality. The results showed that preexisting sepsis and renal conditions contributed to poor outcomes. Indications, ECMO onset time, and pre- and post-cannulation laboratory values such as leukocytes, CRP, creatinine, bicarbonate, lactate, and chloride are factors that affect outcomes.

Extracorporeal membrane oxygenation for the support of pediatric patients with acute fulminant myocarditis.

Sik G, Annayev A, Demirbuga A, Deliceo E, Aydin S, Erek E, Demir HI, Çitak A. Extracorporeal membrane oxygenation for the support of pediatric patients with acute fulminant myocarditis. Turk J Pediatr 2019; 61: 867-872. Acute fulminant myocarditis, is a severe, rapidly progressive disease. The clinical outcomes of children with severe acute myocarditis who are resist to medical treatment is not well known. We studied the clinical courses of patients with acute fulminant myocarditis supported by extracorporeal membrane oxygenation (ECMO). We performed a retrospective chart review of six children with acute fulminant myocarditis who were treated with ECMO. Demographic information, clinical and vital signs, as well as laboratory results were investigated. The median age of 63 months (13-140 months), the mean ECMO duration was 164 hours (79-402 hours), and median intensive care unit stay was 24 days. The most common symptoms were chest pain (66%) and fever (66%). Severe arrhythmia were seen in two patients. One patient received extracorporeal cardiopulmonary resuscitation. In two patients, right femoral arteries and right femoral veins were used, in others, right common carotid artery and right internal jugular veins were used. Five patients (83.3 %) survived to discharge. ECMO can be used effectively in pediatric patients with acute fulminant myocarditis to support the circulation while awaiting myocardial recovery. Timely use of ECMO can improve the survival rate and may be associated with better outcomes.

Transcatheter mitral valve chord repair.

The field of mitral valve disease diagnosis and management is rapidly evolving. New understanding of pathophysiology and improvements in the adoption of sophisticated multimodality imaging modalities have led to early diagnosis and to more complex treatment. The most common cause of mitral regurgitation (MR) in the western world is in the primary alteration of the valve, which leads to degenerative leaflet prolapse due to chordal elongation or rupture and annular dilatation. Untreated, significant MR has a negative impact prognosis, leading to reduction of survival. In the setting of degenerative MR, surgical repair currently represents the standard of care. Treatment of asymptomatic patients with severe MR in the Valve Center of Excellence, in which successful repair reaches more than 95% and surgical mortality less than 1%, symbolizes the direction for the next years. Transcatheter mitral valve repair with different devices, more recently the chordal replacement ones, is providing good outcomes and became a therapeutic option in high-risk patients with degenerative MR. In the future, more advances are expected from further development of interventional techniques, careful evaluation and better patient selection. This review will focus on long-term surgical outcomes of mitral valve repair with artificial chordae and on the emerging transcatheter chordal repair devices as therapeutic options for degenerative MR patients.

Long-term follow-up results of lung perfusion studies after transcatheter closure of patent ductus arteriosus.

OBJECTIVE: This study presents the long-term follow-up of patients who developed left lung perfusion (LLP) abnormalities following patent ductus arteriosus (PDA) closure with various device types. DESIGN: The study includes 23 adult and pediatric patients who had undergone transcatheter PDA closure and were shown to have decreased LLP (<40%) by the first scintigraphy performed within the average follow-up period of 14.0 ± 8.12 months (2.0-30 months). For PDA closure, the Amplatzer duct occluder was used in 12 patients, and coils were used in 11. Within the average period of 58.91 ± 12.93 months (37-85 months) after transcatheter PDA closure, a second lung perfusion scintigraphy was performed. RESULTS: In 13 out of 23 patients (56.5%), LLP improved by the time of the second scintigraphy. Improved and unimproved patients did not differ with regard to age, weight, body surface area, PDA diameter, ampulla diameter, and PDA length at the time of PDA closure and the second scintigraphy. There was no significant difference with regard to the percent of improved patients between the different device types (P =.88). The left pulmonary artery indexes were also insignificantly different (P =.446). Patients with persistent LLP abnormality had significantly higher average Doppler velocity index [(LPA blood flow velocity--RPA blood flow velocity) / MPA blood flow velocity] × 100 (P =.007) and PDA diameter/length. If Doppler velocity index ≥50% is taken as the cutoff value, it is possible to predict persisting LLP abnormality with 80% sensitivity and 76% specificity. Left lung perfusion abnormality was found to persist in patients with PDA diameter/length ≥0.5 with 80% sensitivity and 92.3% specificity. CONCLUSIONS: The LLP abnormalities seen after PDA closure with various devices eventually improve to normal in the majority of patients during long-term follow-up. Patients whose PDA length is shorter than its diameter are at risk of developing LLP abnormalities that persist long-term.

A comparative study of Cardi-O-Fix septal occluder versus Amplatzer septal occluder in percutaneous closure of secundum atrial septal defects.

AIM: We sought to investigate the safety and efficacy of Cardio-O-Fix septal occluder (CSO) in percutaneous closure of atrial septal defects (ASD) as compared to the Amplatzer septal occluder (ASO). METHODS: A consecutive of 351 patients received transcatheter ASD closure with CSO or ASO from July 2004 to October 2010 were studied. The ASDs were divided into simple- (isolated defects <26 mm) or complex-types (isolated defect ≥26 mm, double or multifenestrated defects). The procedures were guided by fluoroscopy and transthoracic or transesophageal echocardiography. Clinical and echocardiographic follow-ups were arranged before discharge, at 1 month and then every 6-month after implantation. RESULTS: During the study period, 185 (125 males, aged 18.5 ± 15.6 years) and 166 (103 males, aged 21.0 ± 15.7 years) patients attempted CSO and ASO implants, respectively. The CSO group had similar ASD and device sizes, prevalence of complex lesions (17 vs. 16%, P = 0.796), procedural times and success rates (97% vs. 96%, P = 0.635) as compared to the ASO group. Acute residual shunts were less prevalent in CSO than ASO group and most shunts closed spontaneously at 6-month follow-ups. The average equipment cost per patient was lower in CSO group (US$ 4,100 vs. US$ 5,900, P < 0.001). The prevalence of device embolization and atrial arrhythmia (all <2%) were similar in both patient groups. CONCLUSION: Transcatheter ASD occlusion with CSO is safe and effective and it appeared to be an attractive alternative to ASO in closing simple-type ASD because of its relatively low cost.

Transthoracic echocardiographic guidance during transcatheter closure of atrial septal defects in children and adults.

The purpose of this study was to evaluate the safety and efficacy of transcatheter atrial septal defect (ASD) closure guided by transthoracic echocardiography (TTE). Since 2004, ASD closure was performed successfully in total 337 patients. Transthoracic echocardiography guidance was used in 206 patients (61.1%) (group 1). Closure was guided by transesophageal echocardiography under general anesthesia in patients with poor transthoracic acoustic windows, defects with aneurysmatic septum and/or multiple defects in 131 patients (38.9%) (group 2). The median age (9 vs. 16 years, P < 0.001), mean defect diameter (14.9 ± 4 vs. 17.2 ± 5 mm, P < 0.001), ratio of complex atrial septal defect (14 vs. 34%, P = 0.01), the median balloon stretch dimensions (21 vs. 18.7 mm, P = 0.003) and the median device diameters (22 vs. 19 mm, P < 0.001) were significantly greater in group 2 compared to group 1. Both the median procedure time and the median fluoroscopy time was significantly shorter in group 1 (60 vs. 75; and 13 vs. 16.5 min; P < 0.0001 and P < 0.0001, respectively). The incidence of residual shunt did not differ significantly in two groups during follow up. Transthoracic echocardiography guidance during transcatheter ASD closure is safe and effective in children and in many adults. Even complex ASDs could be closed with TTE in patients with good acoustic windows. Performing the procedure under TTE guidance significantly reduces procedure time and also provides increased patient's comfort.

[Our medium-term results with aortic balloon valvuloplasty and factors affecting development of aortic regurgitation]. / Aort balon valvüloplastisi'nde orta-dönem sonuçlarimiz ve aort yetersizligi gelisimini etkileyen faktörler.

OBJECTIVE: The objective of this study was to assess medium-term results of aortic balloon valvuloplasty (ABV) in congenital aortic stenosis and to determine factors affecting development of aortic regurgitation (AR). METHODS: Between September 2003 and January 2010, 114 ABV procedures performed on 97 patients analyzed retrospectively. Patients were evaluated in terms of transvalvular gradients before and after procedure, development of new aortic insufficiency or increase in the current insufficiency and factors affecting the procedural success and development of aortic insufficiency. In addition, follow up results were also evaluated in terms of restenosis and increase or decrease of aortic regurgitation. Student's t-test, ANOVA for repeated measurements, linear discriminant and Kaplan-Meier survival analyses were used for statistical analysis. RESULTS: The mean age was 6.63±6.33 year (2 days-21 years). Mean follow-up was 32.6±25.1 months (1 to 75 months). Thirty-seven patients were infant (<1 year) and 18 of them were newborn. The peak systolic pressure gradient decreased from 77.2±24.9 mmHg to 28.5±12.9 mmHg (p=0.0001). Eighty-two procedures were optimal, 29 suboptimal and 3 were unsuccessful. AR developed in totally 53 patients, 16 of them were significant degree. Balloon /annulus ratio and the percentage of reduction in gradient was meaningfully higher in patients with significant aortic regurgitation (p=0.02 and p=0.03, respectively). Infants show more significant AR (9/37, 24%) in comparison with bigger patients (7/77, 9%) (p=0.02). Four patients died after procedure at intensive care unit, three of them were newborn. CONCLUSION: ABV is safe and effective palliative method for the treatment of congenital aortic stenosis. AR, which was the most common complication, incidence was increased in infancy and was related with high balloon/annulus ratio and high reduction in gradient.

Anomalous origin of one pulmonary artery branch from the ascending aorta: experience of our center.

OBJECTIVES: Anomalous origin of one pulmonary artery branch from the aorta in the presence of separate aortic and pulmonary valves is a rare but important entity necessitating early diagnosis and surgery to prevent irreversible vascular pulmonary disease. We evaluated our experience with seven infants having this anomaly. STUDY DESIGN: Between December 2003 and 2009, a total of seven infants (2 girls, 5 boys, age range 4 days to 84 days) were diagnosed as having anomalous origin of one pulmonary artery branch from the aorta. Clinical records were reviewed for clinical features, operative procedures, and postoperative follow-up. RESULTS: Common symptoms were dyspnea, tachypnea, and poor feeding. All the cases were diagnosed by echocardiography. The right pulmonary artery in six cases and the left pulmonary artery in one case originated from the ascending aorta. In addition, three patients had patent ductus arteriosus (PDA), five patients had patent foramen ovale, and one patient had interruption of the aortic arch and aortopulmonary window. All patients underwent surgical re-implantation of the anomalous pulmonary artery branch to the pulmonary trunk. Associated surgical procedures included PDA ligation in three patients, and total repair of interrupted aortic arch and aortopulmonary window in one patient. There were no in-hospital deaths. Two patients had prolonged intubation (10 and 16 days). All patients were discharged in good clinical condition. During a follow-up period ranging from two months to six years, only one patient developed stenosis at the site of anastomosis. CONCLUSION: Prompt diagnosis at infancy, improved surgical technique, and good patient care decrease mortality and morbidity associated with anomalous origin of the pulmonary artery from the aorta.

Control of the mushroom phorid fly, Megaselia halterata (Wood), with plant extracts.

BACKGROUND: The most serious insect pest problems affecting the cultivation of mushroom [Agaricus bisporus (Lange) Imbach] in Turkey are mushroom flies (sciarids, cecids and phorids). Mushroom phorid fly, Megaselia halterata (Wood), is the most common insect pest species during April-October. The aim of this study was to evaluate the potential for eight botanical materials (two commercial neem-based products and six hot-water plant extracts) to control M. halterata populations in three successive growing periods. RESULTS: Treatment efficacy was evaluated by assessing adult emergence and sporophore damage rates compared with that of a standard insecticide, chlorpyrifos-ethyl (positive control). All plant extracts caused significant reductions in the mean number of emerging adults and sporophore damage rates compared with the water-treated control (negative control). Reduction in adult emergence in both neem treatments, Neemazal and Greeneem oil, was greater than that in the positive control. While Neemazal and Origanum onites L. extract had significantly lower sporophore damage rates than the positive control, there were no significant differences between the chlorpyrifos-ethyl, Greeneem oil and Pimpinella anisum L. extract treatments. CONCLUSION: The results suggest that both neem products and hot-water extracts of O. onites and P. anisum may be potential alternatives to conventional pesticides for the control of mushroom phorid fly.

The effect of vegetable materials on the yield and productivity of agaricus bisporus / El efecto de materiales vegetales en el rendimiento y la productividad de agaricus bisporus / O efeito de materiais vegetais no rendimento e a produtividad de agaricus bisporus

To produce high yield, quality crops of mushrooms is an important component of the mushroom industry. The present study was carried out to evaluate the effect of seven vegetable materials (two commercial neem-based products, Neemazal-T/S® and Greeneem oil®, containing azadirachtin-A, and five hot water extracts from plants: Inula viscosa L., Ononis natrix L., Origanum onites L., Pimpinella anisum L. and Teucrium divericatum Sieber) on the yield and productivity of white button mushroom, Agaricus bisporus (Lange) Imbach. The concentration used was 5ml·l-1 water for the neem products, and 50g·l-1 dried material in water for the plant extracts tested. Dilute sprays of all the materials tested (150ml per bag, corresponding to 1200ml·m-2) were applied by soil drench to the casing layer using handgun sprayers. The effect of the test materials was evaluated by yield (kg per bag) and productivity (relation between fresh mushroom weight and fresh compost weight, as %). The applications of vegetable materials by soil drench to the casing layer had a stimulatory effect on mushroom yields. Yield increased with all vegetable treatments over the water-treated control. With the exception of O. natrix and O. onites extracts, significant productivity increases (7.7 to 21.9%) compared to the control were observed as a result of plant extract applications. The results suggest that plant materials may play an important role on the yield and productivity of A. bisporus, and may also be used in organic mushroom cultivation.

La producción de cosechas de frutos de calidad y alto rendimiento es un componente importante de la industria de champiñones. El presente estudio se llevó a cabo para evaluar el efecto de siete materiales vegetales (dos productos comerciales: Neemazal-T/S® y aceite Greeneem®, conteniendo azadirachtin-A, y cinco extractos en agua caliente de plantas: Inula viscosa L., Ononis natrix L., Origanum onites L., Pimpinella anisum L. y Teucrium divericatum Sieber) sobre el rendimento y productividad del champiñón Agaricus bisporus (Lange) Imbach. La concentración empleada fue de 5ml·l-1 en agua para los productos comerciales y de 50g·l-1 de material seco en agua para los extractos. Se aplicaron aspersiones diluidas empapando la superficie (150ml por bolsa, equivalente a 1200ml·m-2) por medio de aspersores manuales. El efecto de los materiales se evaluó en cuanto a rendimiento (kg por bolsa) y productividad (relación entre pesos frescos de hongos y compost, en porcentaje). La aplicación de los materiales vegetales estimuló el rendimiento, que fue mayor en todos los casos que en el control con agua. Con excepción de los extractos de O. natrix y O. onites, hubo aumentos significativos en productividad (7,7-21,9%) como resultado de las aplicaciones al comparar con el control. Los resultados sugieren que los materiales vegetales podrían tener un papel importante en el rendimiento y productividad de A. bisporus, y también pueden ser usados en cultivos orgánicos de champiñones.

A produção de colheitas de frutos de qualidade e alto rendimento é um componente importante da indústria de champinhons. O presente estudo foi realizado para avaliar o efeito de sete materiais vegetais (dois produtos comerciais: Neemazal-T/S® e óleo de Greeneem®, contendo azadirachtin-A, e cinco extratos em água quente de plantas: Inula viscosa L., Ononis natrix L., Origanum onites L., Pimpinella anisum L. e Teucrium divericatum Sieber) sobre o rendimento e produtividade do champinhon Agaricus bisporus (Lange) Imbach. A concentração empregada foi de 5 ml·l-1 em água para os produtos comerciais e de 50g·l-1 de material seco em água para o extrato. Aplicaram-se aspersões diluídas empapando a superfície (150 ml por saco, equivalente a 1.200 ml·m-2) por meio de aspersores manuais. O efeito dos materiais foi avaliado quanto ao rendimento (kg por saco) e produtividade (relação entre pesos frescos de cogumelos e compost, em porcentagem). A aplicação dos materiais vegetais estimulou o rendimento, o qual foi maior em todos os casos comparados ao controle com água. Com exceção dos extratos de O. natrix y O. onites, houve aumentos significativos em produtividade (7,7-21,9%) como resultado das aplicações ao comparar com o controle. Os resultados sugerem que os materiais vegetais poderiam ter um papel importante no rendimento e produtividade de A. bisporus, e também podem ser usados em cultivos orgânicos de champinhons.