Imaging of Antiferroelectric Dark Modes in an Inverted Plasmonic Lattice.

Plasmonic lattice nanostructures are of technological interest because of their capacity to manipulate light below the diffraction limit. Here, we present a detailed study of dark and bright modes in the visible and near-infrared energy regime of an inverted plasmonic honeycomb lattice by a combination of Au+ focused ion beam lithography with nanometric resolution, optical and electron spectroscopy, and finite-difference time-domain simulations. The lattice consists of slits carved in a gold thin film, exhibiting hotspots and a set of bright and dark modes. We proposed that some of the dark modes detected by electron energy-loss spectroscopy are caused by antiferroelectric arrangements of the slit polarizations with two times the size of the hexagonal unit cell. The plasmonic resonances take place within the 0.5-2 eV energy range, indicating that they could be suitable for a synergistic coupling with excitons in two-dimensional transition metal dichalcogenides materials or for designing nanoscale sensing platforms based on near-field enhancement over a metallic surface.

Atrial approaches in mitral valve surgery: a propensity analysis of differences in the incidence of clinically relevant adverse effects.

BACKGROUND: The lack of evidence on complications using mitral valve approaches leaves the choice of risk exposure to the surgeon's preference, based on individual experience, speed, ease, and quality of exposure. METHODS: The present study analysed patients undergoing mitral valve surgery using a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first-time elective mitral valve procedures, isolated, or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. The primary endpoint was the association between the superior transeptal approach and clinically significant adverse outcomes, including arrhythmias, need for a permanent pacemaker, cerebrovascular events, and mortality. RESULTS: A total of 652 patients met the inclusion criteria; 391 received the left atrial approach, and 261 received the superior transseptal approach. After matching, 96 patients were compared with 69 patients, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias or the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, but the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period or in the long-term follow-up. CONCLUSION: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome. Therefore, the superior transeptal approach is useful and safe for mitral valve exposure.

Brachiocephalic Vein and Superior Vena Cava Reconstruction with a Superficial Femoral Vein Graft

Abstract Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.

Repair with a pulmonary neovalve in tetralogy of Fallot: does this avoid ventricular dysfunction?

OBJECTIVES: Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches (TAPs) are the most commonly used technique; they are associated with right ventricular dysfunction, the incidence of which can be reduced through pulmonary valve preservation. METHODS: Between January 2010 and July 2019, we performed 274 surgical corrections of tetralogy of Fallot at Fundación Cardioinfantil; 63 patients (23%) underwent repair with a TAP in addition to a pulmonary neovalve (Group I), 66 patients (24.1%) received a TAP without a pulmonary valve (Group II) and 145 patients (52.9%) had a repair with valve preservation (Group III). We analysed patient's characteristics before, during and after surgery at a 30-day follow-up. RESULTS: We found that patients in Group III were older (P = 0.04). Group II had the lowest level of O2 saturation before surgery (82%, P = 0.001). Cardiopulmonary bypass and aortic cross-clamp times were longer in Group I (P < 0.001). Right ventricular dysfunction was less frequent in Group III (15.9%, P = 0.011). Severe residual pulmonary regurgitation was more common in Group II (21.9%, P = 0.001). CONCLUSIONS: Preservation of the pulmonary valve is an important factor for immediate postoperative management of tetralogy of Fallot. Patients who were repaired with a TAP with or without a pulmonary neovalve had a higher incidence of right ventricular dysfunction than those with pulmonary valve preservation.

2640 Meters Closer to the Stars: Does High Altitude Affect Fontan Results?

BACKGROUND: Risk factors for and postoperative results of the Fontan operation in patients living at high altitude (>2500 meters above sea level) in the Andean region remain unknown. This study was conducted to evaluate immediate postoperative outcomes and to assess short- and long-term functional class after the Fontan operation. METHODS: From June 2003 to February 2019, 104 patients receiving the Fontan procedure at 2640 meters (8661 feet) above sea level were retrospectively studied. Preoperative catheterization, intraoperative variables, and postoperative outcomes were described. Functional class was evaluated in patients living permanently below (group I) and at or higher than 2500 meters (8202 feet) above sea level (group II). Risk factors for mortality were analyzed. RESULTS: Median age at operation was 8.5 ± 4.4 years; pulmonary artery pressure, 16.2 ± 3.6 mm Hg; end-diastolic systemic ventricular pressure, 13.3 ± 3.8 mm Hg; and pulmonary vascular resistance index, 2.1 (interquartile range, 07-3.7) Wood units. Chest tube duration was 8.5 (6-12) days. Mortality was 4.8%, with 0 in the last 5 years. Higher preoperative pulmonary pressure (16.2 ± 3.6 mm Hg vs 21.2 ± 3.40 mm Hg; P = .01), aortic cross-clamp time (P < .001), and renal failure (P < .01) were associated with mortality. Functional class improved to class I in 86.4%. Overall survival was 90.7% at 10 years of follow-up. CONCLUSIONS: Increased pulmonary pressure and pulmonary vascular resistance index are directly related to high altitude. The Fontan-Kreutzer operation performed at high altitude in the Andean region is feasible with good results. We routinely fenestrate all cases to avoid dysfunction in the early postoperative period. Functional status is adequate after the operation.

Brachiocephalic Vein and Superior Vena Cava Reconstruction with a Superficial Femoral Vein Graft.

Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.

An Inverted Honeycomb Plasmonic Lattice as an Efficient Refractive Index Sensor.

We present an efficient refractive index sensor consisting of a heterostructure that contains an Au inverted honeycomb lattice as a main sensing element. Our design aims at maximizing the out-of-plane near-field distributions of the collective modes of the lattice mapping the sensor surroundings. These modes are further enhanced by a patterned SiO2 layer with the same inverted honeycomb lattice, an SiO2 spacer, and an Au mirror underneath the Au sensing layer that contribute to achieving a high performance. The optical response of the heterostructure was studied by numerical simulation. The results corresponding to one of the collective modes showed high sensitivity values ranging from 99 to 395 nm/RIU for relatively thin layers of test materials within 50 and 200 nm. In addition, the figure of merit of the sensor detecting slight changes of the refractive index of a water medium at a fixed wavelength was as high as 199 RIU-1. As an experimental proof of concept, the heterostructure was manufactured by a simple method based on electron beam lithography and the measured optical response reproduces the simulations. This work paves the way for improving both the sensitivity of plasmonic sensors and the signal of some enhanced surface spectroscopies.

Sobrevida y libertad de reoperación en pacientes sometidos a tratamiento endovascular de enfermedades de la aorta / Reoperation-free survival in patients subjected to endovascular treatment of diseases of the aorta

Resumen Introducción: El manejo endovascular para patologías de la aorta ha aumentado como opción para pacientes de alto riesgo quirúrgico de cirugía convencional abierta. Los resultados a corto plazo para mortalidad, libertad de enfermedad y reintervención, evidencian resultados favorables respecto a la cirugía abierta, pero a mediano (1-12 meses) y largo plazo (>1 año) no existen resultados en nuestro medio. Métodos: Estudio de cohorte bidireccional, en el cual se realizó el segmento retrospectivo en pacientes sometidos a manejo endovascular con prótesis aórtica y el segmento prospectivo en el seguimiento de los pacientes. Resultados: Se identificaron 194 pacientes entre abril de 2002 y diciembre de 2015 sometidos a tratamiento endovascular, que cumplían con los criterios de inclusión. El seguimiento se completó en el 82,2%. 92 casos (56.8%) de aorta abdominal con un seguimiento de 4,9 años (RIC 2,5-8,9. La sobrevida calculada fue 92% al año, 86% 2 años y 66.4% a los 5 años. El periodo libre de enfermedad fue 88.7% al año, 86.4% 2 años y 78.5% a los 10 años y 13 pacientes requirieron reintervención. 67 casos de aorta torácica con un seguimiento de 5,3 años (RIC 2,9-10.2), la sobrevida calculada 94% al año, 90.7% 2 años y 75.2% a los 5 años. El periodo libre de enfermedad fue 88.7% al año, 86.4% 2 años y 78.5% a los 10 años y 9 pacientes requirieron reintervención. Conclusiones: Los resultados obtenidos son favorables e incentivan para continuar ofreciendo el abordaje endovascular ya que la supervivencia y la libertad de reoperación se encuentran de acuerdo con lo reportado en la literatura.

Abstract Introduction: The endovascular management for diseases of the aorta has increased as an option for patients of high risk for conventional open surgery. The short-term mortality, disease-free and reoperation results, show favourable outcomes compared to open surgery, but there are no results available in this country for the medium (1-12 months) and long-term (>1 year). Methods: A bi-directional cohort study, in which the retrospective segment was conducted on patients subjected to endovascular management with an aortic replacement, and the prospective segment on the follow-up of the patients. Results: A total of 194 patients, subjected to endovascular treatment and met the inclusion criteria, were identified between April 2002 and December 2015. The follow-up was completed in 82.2% of cases. There were 92 (56.8%) cases of abdominal aorta with a mean follow-up of 4.9 years (95% range; 2.5-8.9). The calculated survival was 92% at one year, 86% at 2 years, and 66.4% at 5 years. The period free of disease was 88.7% at one year, 86.4% at 2 years, and 78.5% at 10 years, with 13 patients requiring re-operation. There were 67 cases of thoracic aorta, with a mean follow-up of 5.3 years (95% range; 2.9-10.2). The calculated survival was 94% at one year, 90.7% at 2 years, and 75.2% at 5 years. The period free of disease was 88.7% at one year, 86.4% at 2 years, and 78.5% at 10 years, and 9 patients required re-operation. Conclusions: The results obtained are favourable and are encouraging to continue offering the endovascular approach since the re-operation survival is similar to that reported in the literature.

Evaluation of Microscopic Structure-Function Relationships of PEGylated Small Intestinal Submucosa Vascular Grafts for Arteriovenous Connection.

Vascular grafts are used as vascular access for hemodialysis, the most common renal replacement therapy to artificially clean blood waste after kidney malfunction. Despite that they are widely used in clinical practice, upon implantation, synthetic vasculars show complications such as thrombogenesis, reduced patency rates, low blood pressure, or even complete collapse. In this study, a C-shaped vascular graft was manufactured with small intestinal submucosa (SIS) and modified on the surface and the bulk of the material via conjugation of polyethylene glycol (PEG) to obtain a biocompatible and less thrombogenic vascular graft than the commercially available polytetrafluoroethylene (ePTFE) vascular grafts. Molecular weight and concentration of PEG molecules were systematically varied to gain insights into the underlying structure-function relationships. We analyzed the chemical, thermal, and mechanical properties of vascular grafts modified with 6 equiv of SIS-PEG 400 as well as cytotoxicity and in vitro platelet deposition. Immune response, patency rates, and extent of regeneration were also tested in vivo with the aid of swine animal models. Results showed that the conjugation levels achieved were sufficient to improve graft compliance, therefore approaching that of native vessels, while platelet deposition was altered leading to a 95% reduction compared with pristine SIS and 92% with respect to ePTFE. H&E staining on explanted samples corroborated SIS-PEG 400 biocompatibility and the ability to promote regeneration. The obtained results set solid foundations for the rational design and manufacture of a regenerative, small diameter vascular graft model and introduce an alternative to ePTFE vascular grafts for hemodialysis access.

Wide Dissection and Intercostal Vessel Division Allows for Repair of Hypoplastic Aortic Arch Through Thoracotomy.

BACKGROUND: The approach to coarctation of the aorta with hypoplastic aortic arch is controversial. We evaluated the outcomes in patients with coarctation of the aorta with or without hypoplastic aortic arch operated through a posterior left lateral thoracotomy. METHODS: A retrospective cohort of patients with aortic coarctation, who underwent repair between January 2009 and October 2017, was analyzed. Preoperative, postoperative, and echocardiographic characteristics were reviewed. Statistical analysis examined survival, freedom from reintervention, and freedom from recoarctation. RESULTS: In nine years, 389 patients who underwent surgical treatment for coarctation of the aorta were identified; after exclusion criteria and complete echocardiographic reports, 143 patients were analyzed, of which 29 patients had hypoplastic aortic arch. The modification in the extended end-to-end anastomosis technique was a wide dissection and mobilization of the descending aorta that was achieved due to the ligation and division of 3 to 5 intercostal vessels. In both groups, patients were close to one month of age and had a median weight of 3.6 and 3.4 kg for hypoplastic and nonhypoplastic arch, respectively. In postoperative events, there was no statistically significant difference between the groups ( P = .57 for renal failure, P = .057 for transient, nonpermanent neurologic events, P = .496 for sepsis), as for intensive care unit ( P = .502) and total in-hospital stay ( P = .929). There was one case of postoperative mortality in each group and both were associated with noncardiac comorbidities. Regarding survival (log-rank = 0.060), freedom from reintervention (log-rank = 0.073), and freedom from recoarctation (log-rank = 0.568), there was no statistically significant difference between the groups. CONCLUSION: We believe that it is the modified technique that allowed greater mobilization of the aorta and successful repair of hypoplastic arch through thoracotomy, without an increase in paraplegia or other adverse outcomes.

Functional Characterization of Preadipocytes Derived from Human Periaortic Adipose Tissue.

Adipose tissue can affect the metabolic control of the cardiovascular system, and its anatomic location can affect the vascular function differently. In this study, biochemical and phenotypical characteristics of adipose tissue from periaortic fat were evaluated. Periaortic and subcutaneous adipose tissues were obtained from areas surrounding the ascending aorta and sternotomy incision, respectively. Adipose tissues were collected from patients undergoing myocardial revascularization or mitral valve replacement surgery. Morphological studies with hematoxylin/eosin and immunohistochemical assay were performed in situ to quantify adipokine expression. To analyze adipogenic capacity, adipokine expression, and the levels of thermogenic proteins, adipocyte precursor cells were isolated from periaortic and subcutaneous adipose tissues and induced to differentiation. The precursors of adipocytes from the periaortic tissue accumulated less triglycerides than those from the subcutaneous tissue after differentiation and were smaller than those from subcutaneous adipose tissue. The levels of proteins involved in thermogenesis and energy expenditure increased significantly in periaortic adipose tissue. Additionally, the expression levels of adipokines that affect carbohydrate metabolism, such as FGF21, increased significantly in mature adipocytes induced from periaortic adipose tissue. These results demonstrate that precursors of periaortic adipose tissue in humans may affect cardiovascular events and might serve as a target for preventing vascular diseases.

Fibroelastoma papilar incidental o sintomático ¿Debeintervenirse? / Incidental or symptomatic papillary fibroelastoma: Should it be treated?

Resumen El fibroelastoma papilar, también conocido como papiloma fibroelástico, es un tumor benigno poco común, que se puede observar en las válvulas cardíacas o, en algunas ocasiones, en el endocardio ventricular. Se describen dos casos; el primero corresponde a un paciente de 72 años con fibrilación auricular paroxística, asintomático por lo demás, en quien en estudio de su fibrilación auricular se evidenció masa pediculada de 1 y 1 cm dependiente de la válvula pulmonar y por riesgo de embolia se llevó a cirugía en la que se resecó masa, sin complicaciones. El reporte de histopatología fue positivo para fibroelastoma papilar. El segundo caso es una paciente de 67 años, sintomática, con angina de esfuerzo en quien, mediante ecocardiograma transtorácico, se documentó masa de 1,5 y 1,5 cm dependiente de la valva coronariana derecha, se consideraron síntomas secundarios a la masa. Se llevó a cirugía por técnica mínimamente invasiva y se resecó la masa. El reporte de histopatología fue positivo para fibroelastoma papilar. Conclusión: el fibroelastoma papilar es una causa poco frecuente pero cada vez más reconocida de fenómenos embólicos. Su identificación oportuna permite la extirpación de la lesión, que es aparentemente curativa, segura y bien tolerada.

Abstract The papillary fibroelastoma, also known as fibroelastic papilloma, is a fairly uncommon benign tumour that can be found in cardiac valves or, in some occasions in the ventricular endocardium. Two cases are presented, with the first corresponding to a 72 year-old patient with intermittent atrial fibrillation, with no other symptoms. During the study of the atrial fibrillation, a pedunculated mass of 1 × 1 cm was observed hanging from the pulmonary valve. Due to the risk of emboli, the patient was taken to surgery where the mass was resected with no complications. The histopathology reported positive for a papillary fibroelastoma. The second case was a 67 year-old patient with symptoms of with angina of effort, which on observing a mass of 1.5 × 1.5 cm hanging from the right coronary valve, they were considered as symptoms secondary induced by the mass. He was taken to surgery, and the mass was resected using a minimally invasive technique. The histopathology reported positive for a papillary fibroelastoma. Conclusion: Papillary fibroelastoma is a rare cause, but increasingly recognised due to its embolic phenomena. Their timely identification allows the lesion to be extirpated, which is apparently curative, safe and well tolerated.

Disrupción auriculoventricular posterior a reoperación de reemplazo valvular mitral: reparación y evaluación ecocardiográfica / Atrioventricular disruption posterior to reoperation of mitral valve replacement: repair and echocardiographic evaluation

La disrupción auriculoventricular después del reemplazo valvular mitral es una rara pero letal complicación. Este caso es el de una mujer de 72 años de edad, con antecedentes de: reemplazo valvular aórtico, mitral, plastia tricúspide y Maze. Se llevó al reemplazo valvular mitral con prótesis Hancock 29 mitral. Se trasladó a la UCI y el curso postoperatorio fue normal hasta las 24 horas después de la cirugía, cuando presentó disnea y requirió soporte inotrópico. Se le realizó un angiotac y un ecocardiograma transtorácico que evidenció pseudoaneurisma ventricular. Fue llevada a cirugía, se inició circulación extracorpórea. Se evidenció disrupción auriculoventricular en el anillo posterior de la válvula mitral (tipo I perforación). La ruptura fue cerrada con un parche mixto de pericardio bovino y dacron con sutura continua. Actualmente, la paciente está en buenas condiciones sin recurrencia. Investigamos: el caso, la etiología, el reparo quirúrgico y la prevención de esta rara complicación y se discute.

Atrioventricular disruption after a mitral valve replacement is a rare but fatal complication. A case of 72 year-old woman is presented. She had a medical history of aortic and mitral valve replacement and Maze and tricuspid valve surgery. Mitral valve replacement was performed with Hancock 29 mitral prosthesis. She was taken to ICU and postoperative progress was normal until 24 hours after the surgery, when she developed dyspnea and required inotropic support. A CT angiography and transthoracic echocardiogram were performed, which evidence a ventricular pseudoaneurysm. She was taken to the operating room to start extracorporeal circulation. Atrioventricular disruption was evidenced in the posterior mitral annulus (type I perforation). Rupture was closed with a using a mixed Dacron and bovine pericardial patch with continuous suture. Patient is currently in good condition with no recurrence. Case, etiology, surgical repair and prevention of this rare complication were investigated and discussed.

Hiperplasia nodular focal hepática / Focal nodal hyperplasia

La hiperplasia nodal focal es el segundo tumor benigno más frecuente del hígado, y debe incluirse en el diagnóstico diferencial de las lesiones sólidas hepáticas. Se presenta el caso de una paciente adolescente con dolor abdominal crónico y hallazgo de masa abdominal al examen físico y en los estudios de imágenes. Se realizó resección quirúrgica de la masa debido a la persistencia de la sintomatología y la incertidumbre en el diagnóstico. Se realiza una revisión de la literatura sobre este tema con el objetivo de conocer las indicaciones quirúrgicas en este tipo de patología...

Focal nodal hyperplasia is the second most common benign tumor of the liver and should be included in the differential diagnosis of solid liver lesions. We present a case of an adolescent with chronic abdominal pain and abdominal mass fi nding on physical examination and imaging studies. Surgical resection of the mass was performed, due to the persistent symptoms and uncertainty in diagnosis. We make a literature review on this topic with the objective of known the surgical indications in this pathology...

Textiloma en cavidad intraabdominal: una causa de diagnóstico equívoco / Textiloma in intraabdominal cavity: a cause of wrong diagnosis

Se presenta el caso de una paciente de 71 años, con antecedente de colecistectomía hace 27 años, remitida al departamento de cirugía para evaluación de masa intraabdominal, por hallazgo imagenológico de masa calcificada sugestiva de lesión tumoral tanto por ecografía como por tomografía axial computarizada abdominal, por lo cual fue llevada a cirugía en donde se evidenció textiloma quirúrgico. El hallazgo de calcificación en la tomografía axial computarizada probablemente fue el factor de confusión causante del diagnóstico erróneo. El textiloma debe ser incluido dentro de los diagnósticos diferenciales de masas abdominales, especialmente en pacientes con antecedentes de cirugías abdominales previas, incluso ante hallazgos típicos sugestivos de características tumorales en los estudios de imágenes preoperatorias. Se exponen imágenes de los estudios prequirúrgicos del caso, de la pieza quirúrgica extraída durante el procedimiento y se realiza una revisión de la literatura.

The case of a 71 year-old patient is presented, with a history of cholecystectomy 27 years ago, who was referred to the surgery department for evaluation of an intrabdominal mass. On imaging studies there was a calcificated mass suggestive of tumoral lesion either by abdominal ecography and abdominal computed tomography, because of this she was carried to surgery where a textiloma was found. The calcification on the abdominal computed tomography probably was the factor which caused the wrong diagnosis. Textiloma should be included in the differential diagnosis of abdominal masses, especially in patients with a prior history of abdominal surgery, even with typical tumorous characteristics on preoperative imaging studies. Hereafter are exposed image of preoperative studies of the case, of the surgical piece removed during the procedure and a literature review is made.

Síndrome de Prune Belly: presentación de un caso y revisión de la literatura / Prune Belly Syndrome: case report and review

INTRODUCCIÓN: El síndrome de Prune Belly (SPB), también conocido como el síndrome de Eagle Barrett, se caracteriza por una triada de anomalías que incluye grados variables de hipoplasia de la musculatura abdominal, anomalías del tracto urinario y criptorquidia bilateral. OBJETIVO: Se describe el caso de un paciente masculino con Síndrome de Prune Belly y se realiza una revisión de la literatura sobre esta rara enfermedad. CONCLUSIÓN: La característica arrugada del abdomen similar a una ciruela pasa, le da el nombre al síndrome. Además, puede estar asociado a alteraciones cardiovasculares, respiratorias, ortopédicas y gastrointestinales.

INTRODUCTION: Prune-belly syndrome, also known as Eagle-Barrett syndrome is characterized by a triad of anomalies that include varying degrees of abdominal musculature hypoplasia, urinary tract anomalies, and bilateral cryptorchidism. OBJECTIVE: We describe the case of a male patient with Prune Belly Syndrome and we review the literature on this rare disease. CONCLUSIONS: The characteristic wrinkled, prune-like abdomen, gives the name to the syndrome. Can also be associated with cardiovascular, respiratory, orthopedic and gastrointestinal anomalies.