Dilatation of the ductus arteriosus by diazoxide in fetal and neonatal rats.

BACKGROUND: Diazoxide, an ATP-sensitive potassium channel opener, is the main therapeutic agent for treating hyperinsulinemic hypoglycemia. The aim of this study was to determine the in vivo ductus arteriosus (DA)-dilating effects of diazoxide in fetal and neonatal rats. METHODS: Near-term rat pups delivered via cesarean section were housed at 33°C. After rapid whole-body freezing, the ductus arteriosus (DA) diameter was measured using a microscope and a micrometer. Full-term pregnant rats (gestational day 21) were injected i.p. with diazoxide (10 and 100 mg/kg) 4 h before delivery, and the neonatal DA diameter was measured at 0, 30, or 60 min after birth. The newborn rats were also injected i.p. with diazoxide (10 and 100 mg/kg) at birth or 60 min after birth. DA was measured at 0, 30, or 60 min after injection. In the fetal investigation, the effect of diazoxide was studied via simultaneous application of indomethacin (10 mg/kg) and L-nitroarginine methyl ester (L-NAME) on gestational days 21 and 19. RESULTS: The control rats had rapid postnatal DA constriction (diameter, 0.80 and 0.08 mm at 0 and 60 min after birth, respectively). Diazoxide had a dose-dependent inhibitory effect on postnatal DA constriction. Prenatal diazoxide (10 mg/kg) inhibited postnatal DA closure (0.20 mm at 60 min after birth). The diazoxide injection (10 mg) at birth inhibited postnatal DA closure (0.14 mm at 60 min after birth). Diazoxide injection in 60-min-old rats dilated the constricted DA at 60 min (0.10 mm vs. 0.02 mm in the controls). In the fetal investigation, diazoxide inhibited the fetal DA constrictive effect of indomethacin and L-NAME. CONCLUSION: Diazoxide attenuates postnatal DA constriction and dilates a closing DA in fetal and neonatal rats.

Dual origin multiple plexus-like coronary to pulmonary artery fistulas - Consideration of their etiology and therapeutic strategy.

BACKGROUND: Multiple plexus-like coronary to pulmonary fistulas (CAPFs) originating from bilateral coronary arteries are a rare type of coronary artery fistula (CAF). Their etiology and therapeutic strategy are discussed. METHODS AND RESULTS: Three patients were diagnosed with dual origin plexus-like CAFs drained to the pulmonary artery trunk. Their ages ranged from 40 to 78 years. Enhanced computed tomography could clearly demonstrate three-dimensional anatomy of CAPFs. Four catheter interventions were performed in all 3 patients. Antegrade approach was applied in 2 procedures and retrograde approach in 2 procedures. A detachable coil was used in 3 procedures and a combination of a vascular plug and detachable coils for 1 procedure. The effective occlusion was achieved in all patients without complications. Follow-up myocardial scintigraphy showed no perfusion defect in all patients. CONCLUSIONS: CAPFs in our cases, which developed in their adulthood, anatomically correspond with the vasa vasorum of the proximal of the great arteries. The dual origin multiple plexus-like CAPFs might develop from the vasa vasorum of the proximal portion of the great arteries with age. The antegrade approach would be effective because even dual origin multiple plexus-like CAFs converged and drained to a single major exit of the pulmonary trunk. Catheter occlusion could be feasible and safe for dual origin multiple plexus-like CAPFs.

Long-term Outcomes after Truncus Arteriosus Repair: A Single-center Experience for More than 40 Years.

OBJECTIVES: This study aimed to analyze long-term survival and functional outcomes after truncus arteriosus repair in a single institution with more than 40 years of follow-up. METHODS: Medical records were analyzed retrospectively in 52 patients who underwent the Rastelli procedure for truncus arteriosus repair between 1974 and 2002. Thirty-five patients survived the initial repair. The median age at the initial operation was 2.8 months (range, 0.1-123 months) and the body weight was 3.9 kg (range, 1.6 to 15.0 kg). RESULTS: The median age at follow-up was 23.6 years (range, 12.4 to 44.5 years). The median follow-up duration was 23.4 years (range, 12.3 to 40.7 years). The actuarial survival rate was 97% at 10 years and 93% at both 20 years and 40 years after the initial operation. At follow-up, most patients were in New York Heart Association (NYHA) functional classes I (73%) and II (24%). Thirty-six percent of patients had full-time jobs, 40% were students, and 21% were unemployed. Most patients (97%) had undergone conduit reoperations. Freedom from reoperation for right ventricular (RV) outflow and pulmonary artery (PA) stenosis was 59% at 5 years, 28% at 10 years, and 3% at 20 years after the initial operation. Freedom from catheter interventions for RV outflow and PA stenosis was 59% at 5 years, 47% at 10 years, and 38% at 20 years after the initial operation. Freedom from truncal valve replacement was 88% at 5 years, 85% at 10 years, and 70% at 20 years after the initial operation. CONCLUSIONS: In this single-center retrospective study, with long-term follow-up after repair of truncus arteriosus, long-term survival and functional outcomes were acceptable, despite the requirement for reoperation and multiple catheter interventions for RV outflow and PA stenosis in almost all patients, and the frequent requirement for late truncal valve operations.

Successful coil embolization for Fontan-rout to aorta communication-recovery from complication of Brockenbrough procedure in Fontan patient.

The Brockenbrough (BB) procedure is becoming the necessary procedure for radiofrequency ablation for supravalvular tachycardia in patients after a Fontan procedure. We experience Fontan-rout to aorta communication caused by the BB procedure. The communication was successfully occluded using a detachable coil. This complication was rare but could still happen as an increasing necessity of the catheter ablation in patients with a Fontan procedure. Coil embolization is a potential option for recovery from this complication.

Impact of novel balloon catheter on static balloon atrial septostomy with double balloon technique in infants with congenital heart disease.

BACKGROUND: The aim of this study was to investigate the feasibility of static balloon atrial septostomy (BAS) with the double balloon technique for infants. TMP PED balloon catheter, newly designed for static BAS in small children, was used in 3 infants. The balloon catheter has a low profile, short and round shoulder, and smooth deflation without slippage. METHODS AND RESULTS: Three infants (transposition of the great arteries, n=2; pulmonary atresia with intact ventricular septum, n=1) underwent static BAS with double balloon for restrictive interatrial communication between December 2014 and March 2015. Hemodynamic and echocardiographic assessment was done before and after the procedure. Pressure gradient between left and right atrium decreased from 6, 7 and 9 mmHg to 2, 2 and 1 mmHg, respectively. Oxygen saturation in systemic artery increased from 72, 68 and 73% to 78, 70 and 79%, respectively. Maximum defect diameter increased from 3.5, 3.0 and 3.3 mm to 6.6×5.2, 9.0×6.2 and 8.1×5.1 mm, respectively. No complication was recorded. CONCLUSIONS: Static BAS with double balloon technique using the novel TMP PED balloon catheter was safe and effective in producing sufficient interatrial communication for 8-20 weeks in infants. Static BAS is a promising procedure to create interatrial communication in infants.

Ventricular strain in fetuses with aortic stenosis and evolving hypoplastic left heart syndrome before and after prenatal aortic valvuloplasty.

OBJECTIVE: The impact of prenatal intervention on fetal cardiac function has not been well defined. We assessed standard ventricular function parameters and strain in fetuses with evolving hypoplastic left heart syndrome (HLHS) treated with fetal aortic valvuloplasty (fAVP). METHODS: Fetuses with valvar aortic stenosis that underwent fAVP were studied. Echocardiographic images prior to intervention (Pre), within 1 week after fAVP (Post), and at the last prenatal follow-up examination (FU) were analyzed. Left ventricular (LV) circumferential (LVCS) and longitudinal strain (LVLS), right ventricular (RV) longitudinal strain (RVLS), and LV end-diastolic dimension Z-scores (LVIDD-Z) were documented and compared according to postnatal outcome. RESULTS: Among 57 fetuses studied, the postnatal outcome was biventricular in 23 and univentricular in 34. Prior to fAVP, strain was <4 in most cases, regardless of outcome. Biventricular fetuses had higher LVCS and LVLS segmental strain than univentricular fetuses. Among fetuses with a biventricular outcome, LVCS and LVLS increased as LVIDD-Z decreased in late gestation, whereas LVCS and LVLS remained <4 in univentricular fetuses, although the LVIDD-Z decreased to <0 in all cases. Septal RVLS increased after fAVP in the biventricular but not the univentricular outcome group. CONCLUSION: In utero aortic valve dilation appears to have a beneficial effect on both LV and RV function in some fetuses with evolving HLHS.

Circumferential and longitudinal ventricular strain in the normal human fetus.

BACKGROUND: Echocardiography with speckle tracking is a novel, angle-independent technique for assessing global and regional cardiac function. Normal data on longitudinal strain have been reported for human fetuses. The aim of this study was to define circumferential left ventricular (LV) strain in a normal fetal population. METHODS: Singleton fetuses between 17 and 42 weeks in gestational age with no adverse maternal health issues or fetal abnormalities were studied. Regional and averaged cardiac strain were measured using syngo Velocity Vector Imaging software. RESULTS: Data from 81 fetuses were analyzed (mean gestational age, 29.2 ± 5.7 weeks). Overall, average midventricular circumferential strain was 18.7 ± 3.3%, LV longitudinal strain was 15.2 ± 2.7%, and right ventricular longitudinal strain was 16.0 ± 3.3%, with no correlation with gestational age. CONCLUSION: This is the first study to report normal fetal LV circumferential strain. These data may be useful as a reference for assessing fetal cardiac function. The retrospective study design and relatively low frame rates used in this study were important limitations.

Unshielded fetal magnetocardiography system using two-dimensional gradiometers.

We developed a fetal magnetocardiography (fMCG) system that uses a pair of two-dimensional gradiometers to achieve high signal-to-noise ratio. The gradiometer, which is based on a low-Tc superconducting quantum interference device, detects the gradient of a magnetic field in two orthogonal directions. Gradiometer position is easy to adjust by operating the gantry to drive the cryostat in both the swinging and axial directions. As a result, a fMCG waveform for 25 weeks' gestation was measured under an unshielded environment in real time. Moreover, the P and T waves for 25 and 34 weeks' gestation, respectively, were obtained by averaging. These results indicate that this two-dimensional gradiometer is one of the most promising techniques for measuring fetal heart rate and diagnosing fetal arrhythmia.

Method for the elucidation of the elemental composition of low molecular mass chemicals using exact masses of product ions and neutral losses: application to environmental chemicals measured by liquid chromatography with hybrid quadrupole/time-of-flight mass spectrometry.

A method for elucidating the elemental compositions of low molecular weight chemicals, based primarily on mass measurements made using liquid chromatography (LC) with time-of-flight mass spectrometry (TOFMS) and quadrupole/time-of-flight mass spectrometry (LC/QTOFMS), was developed and tested for 113 chemicals of environmental interest with molecular masses up to approximately 400 Da. As the algorithm incorporating the method is not affected by differences in the instrument used, or by the ionization method and other ionization conditions, the method is useful not only for LC/TOFMS, but also for all kinds of mass spectra measured with higher accuracy and precision (uncertainties of a few mDa) employing all ionization methods and on-line separation techniques. The method involves calculating candidate compositions for intact ionized molecules (ionized forms of the sample molecule that have lost or gained no more than a proton, i.e., [M+H](+) or [M-H](-)) as well as for fragment ions and corresponding neutral losses, and eliminating those atomic compositions for the molecules that are inconsistent with the corresponding candidate compositions of fragment ions and neutral losses. Candidate compositions were calculated for the measured masses of the intact ionized molecules and of the fragment ions and corresponding neutral losses, using mass uncertainties of 2 and 5 mDa, respectively. Compositions proposed for the ionized molecule that did not correspond to the sum of the compositions of a candidate fragment ion and its corresponding neutral loss were discarded. One, 2-5, 6-10, 11-20, and >20 candidate compositions were found for 65%, 39%, 1%, 1%, and 0%, respectively, for the 124 ionized molecules formed from the 113 chemicals tested (both positive and negative ions were obtained from 11 of the chemicals). However, no candidate composition was found for 2% of the test cases (i.e., 3 chemicals), for each of which the measured mass of one of the product ions was in error by 5-6.7 mDa.

Hemoptysis from collateral arteries 12 years after a fontan-type operation.

A 20-year-old patient who had a single ventricle and pulmonary stenosis presented with recurrent hemoptysis 12 years after a Fontan-type operation. He was referred to us because of unsuccessful treatment with a tentative diagnosis of lung tuberculosis for 3 months. He had been relatively well for the prior 12 years, although he had attacks of paroxysmal supraventricular tachycardia and had underwent successful catheter ablation 3 years ago. Aortography revealed multiple collateral arteries as a cause of hemoptysis and coil embolization of these collateral arteries successfully stopped the hemoptysis. This case illustrates that collateral arteries may stay open or develop, and these collateral arteries can become a source of hemoptysis long after a Fontan-type operation.

1 H and 13 C NMR spectra of 4,4'-substituted chalcones.

1 H and 13 C NMR spectra of chalcone (trans-benzylideneacetophenone) and 54 4,4'-substituted chalcones were studied. The 400 MHz 1 H NMR and the 13 C NMR spectra were observed, analysed and assigned and the substituent constants were calculated by the least-squares method.