Closure of transcatheter ventricular septal defect using LifetechTM Konar-MF Occluder in children weighing less than 10 kilograms: mid-term results, a tertiary single center experience.

OBJECTIVE: Transcatheter closure of medium and large ventricular septal defects (VSDs) in young children is limited due to the use of over-sized devices that can cause hemodynamic instability and arrhythmia. In this study, we aimed to retrospectively evaluate the safety and efficacy of the device in the mid-term in children weighing less than 10 kg whose transcatheter VSD was closed only with the Konar-MFO device. PATIENTS AND METHODS: Among 70 children whose transcatheter VSD was closed between January 2018 and January 2023, 23 patients weighing less than 10 kg were included in the study. Retrospectively, the medical records of all patients were reviewed. RESULTS: The mean age of the patients was 7.3 (4.5-26) months. 17 of the patients were females, 6 of them were males, F/M: 2.83. The average weight was 6.1 (3.7-9.9) kg. The mean the pulmonary blood flow/ systemic blood flow (Qp/Qs) was 3.3 (1.7-5.5). The mean defect diameter was 7.8 mm (5.7-11) for the left ventricle (LV) side, and 5.7 mm (3-9.3) for the right ventricle (RV) side. Based on the utilized device dimensions, the measurements on the LV side were recorded as 8.6 mm (range 6-12), while those on the RV side were recorded as 6.6 mm (range 4-10). Antegrade technique was applied to 15 (65.2%) patients and retrograde technique was applied to 8 (34.8%) patients in the closure procedure. The procedure success rate was 100%. The incidence of death, device embolization, hemolysis, or infective endocarditis was zero. CONCLUSIONS: Perimembranous and muscular VSDs in children under 10 kg can be successfully closed under the management of an experienced operator with the Lifetech Konar-MFO device. This is the first study in the literature to evaluate the efficacy and safety of the device in children under 10 kg in whom only Konar-MFO VSD occluder device is used for transcatheter VSD closure.

The analysis of human health risk with a detailed procedure operating in a GIS environment.

An approach for quantifying the human health risk caused by industrial sources, which, daily or accidentally, emit dangerous pollutants able to impact on different environmental media, is introduced. The approach is performed by the HHRA-GIS tool which employs an integrated, multimedia, multi-exposure pathways and multi-receptors risk assessment model able to manage all the steps of the analysis in a georeferenced structure. Upper-bound excess lifetime cancer risk and noncarcinogenic hazards are the risk measures, the spatial distribution of which is calculated and mapped on the involved territory, once all the pathways and receptors of the study area are identified. A sensitivity analysis completes the calculations allowing to understand how risk estimates are dependent on variability in the factors contributing to risk. The last part of the paper makes use of a case study concerning a working industrial site to put in evidence in which way the designed tool can help local authorities and policy makers in managing risks and planning remedial and reduction actions. The considered geographical area is a hypothetical territory characterized by residential, agricultural and industrial zones. The presence of two sources of contamination, a municipal waste incinerator (MWI) and a contaminated site, are evaluated by the tool application. Various typologies of receptors have been taken into account, each of them characterized by different anatomical and dietary properties. The achieved results are analyzed, compared with acceptable and background values and alternatives of minor environmental impact calculated.