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Expression of Streptococcus mutans aspartate-semialdehyde dehydrogenase gene cloned into plasmid pBR322.

Streptococcus mutans chromosomal DNA cloned into the vector plasmid pBR322 in Escherichia coli is able to complement the metabolic defect of an aspartate-semialdehyde dehydrogenase (EC 1.2.1.11) gene (asd) deletion in the host strain. We constructed two Asd+ recombinant plasmids, pYA570 and pYA571, containing 4.7 and 4.5 kilobases, respectively, of S. mutans chromosomal DNA inserted into the HindIII restriction endonuclease site of pBR322 in the same orientation. The S. mutans UAB62 Asd+ DNA did not hybridize with E. coli DNA which contained an intact asd gene, but did not hybridize with S. mutans UAB62 chromosomal DNA. Derivative Asd+ plasmids were then constructed from pYA570. One, pYA574, had a 4.5 kilobase S. mutans insert DNA in the opposite direction from pYA570. In another pYA575, the S. mutans insert DNA was reduced in size to 1.3 kilobases. It was seen that the orientation of the S. mutans DNA fragment inserted into the promotor region of the pBR322 tetracycline resistance (Tcr) gene affected expression of Tcr. Orientation of the S. mutans insert also affected the stability of the plasmid in certain E. coli strains. Restriction maps for pYA570, pYA571, pYA574 and pYA575 using the endonucleases EcoRI, BamHI, HindIII, PstI and SalI were determined, Asd+ plasmid-directed protein synthesis was studied in E. coli minicells. The plasmids pYA570, pYA574 and pYA575 each produced large amounts of a protein with a monomeric molecular weight of about 45000, that was distinct from both pBR322 and E.coli specified proteins: this protein is the S. mutans asd gene product. Smaller derivatives of recombinant plasmid pYA575 that were Asd- allowed the location of the S. mutans asd gene promotor and the direction of transcription to be determined.

Aspartate-Semialdehyde Dehydrogenase↗

Retrospective study of 156 atrial septal defects in dogs and cats (2001-2005).

Atrial septal defect (ASD) is a common congenital heart disease (CHD) in humans, but considered relatively rare in veterinary medicine. However, modern echocardiographic and Doppler techniques currently offer a good view of the morphology of the interatrial septum, thus facilitating earlier detection of ASD in awake animals. In this context, we carried out a retrospective study of cases of recently diagnosed ASD in dogs and cats at the Cardiology Unit of Alfort (2001-2005) using echocardiography combined with colour Doppler mode. ASD was diagnosed in 156 animals and represented 37.7% of all canine and feline CHDs (n = 414). ASD was the most common CHD after mitral dysplasia in both species. Boxer and Domestic shorthair were the most common canine and feline breeds affected. Most defects (98.7%) were secundum-type ASD, without clinical signs in 73.7% of cases. The most common clinical signs included systolic murmur heard over the left heart base (20.2%), exercise intolerance (7.0%), syncope (5.3%), dyspnoea (2.6%) and cough (2.6%). Animals that presented a systolic heart murmur over the left base had a significantly larger ASD than others (P < 0.05). These data suggest that the incidence of ASD is higher than previously assumed. ASD should be suspected, for example, in instances of left basal systolic heart murmur, although its clinical and haemodynamic consequences are usually minor.

Animals↗

No effect of MMR withdrawal on the incidence of autism: a total population study.

BACKGROUND: A causal relationship between the measles, mumps, and rubella (MMR) vaccine and occurrence of autism spectrum disorders (ASD) has been claimed, based on an increase in ASD in the USA and the UK after introduction of the MMR vaccine. However, the possibility that this increase is coincidental has not been eliminated. The unique circumstances of a Japanese MMR vaccination program provide an opportunity for comparison of ASD incidence before and after termination of the program. METHODS: This study examined cumulative incidence of ASD up to age seven for children born from 1988 to 1996 in Kohoku Ward (population approximately 300,000), Yokohama, Japan. ASD cases included all cases of pervasive developmental disorders according to ICD-10 guidelines. RESULTS: The MMR vaccination rate in the city of Yokohama declined significantly in the birth cohorts of years 1988 through 1992, and not a single vaccination was administered in 1993 or thereafter. In contrast, cumulative incidence of ASD up to age seven increased significantly in the birth cohorts of years 1988 through 1996 and most notably rose dramatically beginning with the birth cohort of 1993. CONCLUSIONS: The significance of this finding is that MMR vaccination is most unlikely to be a main cause of ASD, that it cannot explain the rise over time in the incidence of ASD, and that withdrawal of MMR in countries where it is still being used cannot be expected to lead to a reduction in the incidence of ASD.

Autistic Disorder↗

Assessment of atrial septal defect morphology by transthoracic three dimensional echocardiography using standard grey scale and Doppler myocardial imaging techniques: comparison with magnetic resonance imaging and intraoperative findings.

OBJECTIVE: To determine whether transthoracic three dimensional echocardiography is an accurate non-invasive technique for defining the morphology of atrial septal defects (ASD). METHODS: In 34 patients with secundum ASD, mean (SD) age 20 (17) years (14 male, 20 female), the measurements obtained from three dimensional echocardiography were compared to those obtained from magnetic resonance imaging (MRI) or surgery. Three dimensional images were constructed to simulate the ASD view as seen by a surgeon. Measured variables were: maximum and minimum vertical and horizontal ASD dimension, and distances to inferior and superior vena cava, coronary sinus, and tricuspid valve. In each patient two ultrasound techniques were used to acquire three dimensional data: standard grey scale imaging (GSI) and Doppler myocardial imaging (DMI). RESULTS: Good correlation was found in maximum ASD dimension (both horizontal and vertical) between three dimensional echocardiography and both MRI (GSI r = 0.96, SEE = 0.05 cm; DMI r = 0.97, SEE = 0.04 cm) and surgery (GSI r = 0.92, SEE = 0.06 cm; DMI r = 0.95, SEE = 0.06 cm). The systematic error was similar for both three dimensional techniques when compared to both MRI (GSI = 0.40 cm (27%); DMI = 0.38 cm (25%)) and surgery (GSI = 0.50 cm (29%); DMI = 0.37 cm (22%)). A significant difference was found in both horizontal and vertical ASD dimension changes during the cardiac cycle. This change was inversely correlated with age. These findings were consistent for both DMI and GSI technique. In children (age < or = 17 years), the feasibility of detecting structures and undertaking measurements was similar for both echo techniques. However, in adult ASD patients (age > or = 18 years) this feasibility was higher for DMI than for GSI. CONCLUSIONS: Transthoracic three dimensional imaging using both GSI and DMI accurately displayed the varying morphology, dimensions, and spatial relations of ASD. However, DMI was a more effective technique than GSI in describing ASD morphology in adults.

Adult↗

Brain structural abnormalities in young children with autism spectrum disorder.

OBJECTIVE: To explore the specific gross neuroanatomic substrates of this brain developmental disorder, the authors examine brain morphometric features in a large sample of carefully diagnosed 3- to 4-year-old children with autism spectrum disorder (ASD) compared with age-matched control groups of typically developing (TD) children and developmentally delayed (DD) children. METHODS: Volumes of the cerebrum, cerebellum, amygdala, and hippocampus were measured from three-dimensional coronal MR images acquired from 45 children with ASD, 26 TD children, and 14 DD children. The volumes were analyzed with respect to age, sex, volume of the cerebrum, and clinical status. RESULTS: Children with ASD were found to have significantly increased cerebral volumes compared with TD and DD children. Cerebellar volume for the ASD group was increased in comparison with the TD group, but this increase was proportional to overall increases in cerebral volume. The DD group had smaller cerebellar volumes compared with both of the other groups. Measurements of amygdalae and hippocampi in this group of young children with ASD revealed enlargement bilaterally that was proportional to overall increases in total cerebral volume. There were similar findings of cerebral enlargement for both girls and boys with ASD. For subregion analyses, structural abnormalities were observed primarily in boys, although this may reflect low statistical power issues because of the small sample (seven girls with ASD) studied. Among the ASD group, structural findings were independent of nonverbal IQ. In a subgroup of children with ASD with strictly defined autism, amygdalar enlargement was in excess of increased cerebral volume. CONCLUSIONS: These structural findings suggest abnormal brain developmental processes early in the clinical course of autism. Research currently is underway to better elucidate mechanisms underlying these structural abnormalities and their longitudinal progression.

Amygdala↗

Supplementing transesophageal echocardiography with transthoracic echocardiography for monitoring transcatheter closure of atrial septal defects with attenuated anterior rim: a case series.

UNLABELLED: The use of transesophageal echocardiography (TEE) for guidance of transcatheter closure of secundum-type atrial septal defect (ASD) is increasingly becoming a routine procedure. ASD with attenuated anterior superior (SA) rim is a variant of secundum-type ASD and is suitable for transcatheter closure. The success rate of TEE guidance for device deployment in these patients is not known. Therefore, we assessed 124 consecutive patients with ASD (57 secundum-type, 67 with attenuated SA rim) closed with an Amplatzer Septal Occluder under TEE guidance. Our results show that the TEE was successful in depicting all 4 corners and corresponding edges of each Amplatzer disk, as well as the septal rims of all 57 secundum-type ASDs. However, in 6 of 67 ASDs (9%) with attenuated SA rim in which TEE failed to visualize the adequate placement of occluder on the anterior inferior (IA) rim, the additional use of transthoracic echocardiography helped to resolve this inadequacy. Four of these six patients had the unusual morphology of the IA rim tissue. Two had severe right axis deviation of the heart with large Q angle (>90 degrees ). The SA rim was absent in 35 of 67 ASDs with attenuated SA rim and in these cases TEE demonstrated the anterior surface of the disk against the wall of the aorta but without distortion. We conclude that TEE can be useful for confirming successful deployment of the occluder in most patients with ASDs. In a small number of ASDs with attenuated SA rim who have unusual IA morphology, supplemental transthoracic echocardiography is required to verify successful deployment of the occluder when TEE visualization fails to reliably diagnose adequate placement of the occluder. IMPLICATIONS: Transesophageal echocardiography can be useful for confirming successful deployment of the occluder in the majority of patients with atrial septal defect. In a small number of atrial septal defects with attenuated anterior superior rim which have unusual anterior inferior morphology, supplemental transthoracic echocardiography is required to verify successful deployment of the occluder when transesophageal echocardiography visualization fails to reliably diagnose adequate placement of the occluder.

Adolescent↗

Risk factors for acute stress disorder in children with burns.

The purpose of this study was to (1) estimate the prevalence of acute stress disorder (ASD) in a sample of burned children, and (2) determine risk factors for ASD in these children. Seventy-two children were assessed for acute stress disorder approximately 10 days after being hospitalized for a burn. Variables hypothesized to predict ASD symptoms (i.e., size of the burn, prior behavioral symptoms, body image, parents' symptoms, heart rate) were also assessed. Based on a diagnosis derived from the ASD module of the Diagnostic Interview for Children and Adolescents (DICA), 31% of children met criteria for ASD. Path analyses revealed that the variables of heart rate, body image, and parents' acute stress symptoms were directly related to the development of ASD symptoms and accounted for 41% of its variance. These variables also mediated the relationship between the size of the burn and ASD symptoms. ASD is found in almost one third of children hospitalized for a burn. A high resting heart rate, lowered body image, and parent's acute stress symptoms were found to be significant risk factors for ASD symptoms.

Adolescent↗

[Statistic analysis for the association of hormone dynamics and biochemical parameters with bone turnover in surgically induced menopause].

The association between hormone dynamics and bone turnover was statistically examined in 52 women with surgically induced menopause. The mean values of 19 laboratory items which included hormones as well as parameters of bone metabolism were obtained and analyzed by Spearman's rank test. Linear regression models were established. Based on Pearson's correlation matrices, the principal components were analyzed. Matrices were formed from factor loading derived from Varimax's rotation, and their statistical significance was evaluated. 1. Significant correlations were determined from both the examination of the data analyzed separately at the levels of artificial menopause (bilateral and unilateral) and oophorectomy (OVX) method (bilateral or unilateral). For the patients who had bilateral OVX, the pairs showing a positive correlation (0.01 < P, 0.05 < P) were 1-25-(OH)2D with E2 or ASD, 25-(OH)D with E2, E3, Progesterone, or ASD, CT with Progesterone, ASD, or Testosterone, S.A1-P with FSH or LH, and S.Ca with LH. The pairs showing a weaker positive correlation were PTH with E2 or E3, CT with E2, E3 with S.Acid-P or U.Ca/CRN, and S.Ca with FSH. The pairs showing a negative correlation (0.01 < P, 0.05 < P) were S.A1-P with E2 or Progesterone, and S.Ca with Testosterone. The pairs showing a weaker negative correlation were S.A1-P with ASD. For the patients who had unilateral OVX, the pairs showing a positive correlation were 1-25-(OH)2D with E2, ASD, or Testosterone, 25-(OH)D with E2, E3, Progesterone, or ASD, CT with Progesterone, ASD, or Testosterone, and PTH with ASD. The pairs showing a weaker positive correlation were PTH with E2 or E3, and CT with E2. The pairs showing a negative correlation were S.Ca with Testosterone. The pairs showing a weaker negative correlation were S.A1-P with ASD. There was a small but significant difference between the two groups. However, Estrogen and Androgen in sex steroids, and S.A1-P, S.Ca, CT, PTH, 1-25-(OH)2D, and 25-(OH)D in bone parameters, all changed early or late at different rates but participated concomitantly with the high bone turn-over induced by OVX, particularly in bilateral. 2. Significant correlations among all parameters were determined for data analyzed at the level of artificial menopause.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

[Three different types of atrial septal defects in the same family].

Most of the time atrial septal defects (ASD) are sporadic. Familial forms are characterised by the same type of the ASD, and are frequently associated by other cardiac, osteoarticular (Holt-Oram syndrome) or atrioventricular conductions abnormalities (ostium secundum ASD with prolonged PR, sinus venosus ASD with sinusal bradyarrhythmia). This report describes a family in which the father and his two children present an ASD, each one of a different type (ostium primum ASD, ostium secundum ASD, sinus venosus ASD), without any other associated malformations. To the best of our knowledge, this is the first report of a family in which three different ASD types are present.

Adult↗

[Transcatheter closure of atrial septal defects in adults with the Amplatzer atrial septal occluder].

UNLABELLED: In many centres the Amplatzer Septal Occluder (ASO) (AGA Med. Corp. Minnesota, USA) has become the device of choice for secundum atrial septal defect (ASD) closure in children. Current trend towards transcatheter closure of ASD in children could be translated to adults and many patients (pts) may avoid the need of open heart surgery. Assessment the efficacy and complication of device occlusion of ASD in adults, using ASO. Between October 1997 and April 2001 transcatheter closure of ASD was attempted in 51 pts who fulfilled the inclusion criteria--significant shunt with sufficient rims of interatrial septum. Mean age of pts was 29 (16-63) y, mean ASD diameter assessed by transesophageal echocardiography (TEE) was 14.7 (7-24) mm, assessed during catheterization by balloon sizing (stretched diameter) was 20.2 (8-36) mm. There were 9 pts with multiple ASDs, 2 pts with aneurysm of interatrial septum and 2--after previous surgery (recanalization of ASD). The ASO devices were successfully implanted in all, but one pt. In one patient because of unstable position of ASO (floppy rims), device was removed and bigger one was applied during next session. In one case early embolization to abdominal aorta occurred, ASO was translocated to aortic arch with Dotter basket and removed from aorta during simultaneous surgical closure of ASD. Mean fluoroscopy time was 15 (4-50) min. The occlusion rate after 24 h was 90%, after 1 month (m) 92%, after 3 m 93.5%, after 1 year (y) 93.3% and after 2 y 93.3%. All residual shunts were trivial. There were no late complication. CONCLUSIONS: The excellent results of ASD closure with ASO in adults indicate this treatment as a method of choice in selected patients, but long term follow-up is necessary to state final judgement.

Adolescent↗

[Atrial septal defect calibration: comparison of methods using balloons and 3D-transesophageal echocardiography].

The atrial septal defects (ASDs) occlusion by cardiac catheterization is an alternative to the surgical technique. The use of stretching by balloon is considered as the gold-standard for the ASDs calibration. Three dimensional transesophageral echocardiography (3D-TEE) brings an imaging of the ASD surface and allows the measurement of its maximal diameter. With the goal of a percutaneous ASD occlusion, seventy patients had a simultaneous calibration of the ASDs by 3D-TEE and the balloon method. The mean maximal diameter measured by 3D-TEE was at 20 + 15 mm (range 10-28 mm) compared to the mean balloon-stretched diameter at 22 + 5 mm (range 9-31 mm). The correlation between both methods is good (y = 3.15 + 0.77x, r = 0.8, p < 0.0001). The mean difference between the diameters measured by both methods was 1.85 + 3.17 mm. The ASD visualized by 3D-TEE was single in 54 cases and multiple in 16 cases. The correlation between both methods was excellent in those with a single ASD (y = 1.74 + 0.84x; r = 0.85. p < 0.0001) but it was poor in those with multiple ASD (y = 12.4 + 0.4x; r = 0.45). The calibration by the balloon method which tests the septum resistance is an additive method to 3D-TEE which measures the anatomic diameter of ASD.

Adolescent↗

Cardiac magnetic resonance imaging of atrial septal defect for transcatheter closure.

BACKGROUND: The location, size of the defect and age of the patient are the major determining factors for transcatheter closure of an atrial septal defect (ASD). The precise shape and anatomy surrounding the defect cannot always be understood by the traditional transesophageal (TEE) echocardiographic technique. OBJECTIVES: The authors compared the measurement of ASD size and atrial septal rim using cardiac Magnetic Resonance Imaging (MRI) and TEE to the balloon sizing technique and device size. PATIENTS AND METHOD: Patients having an ASD which met established criteria were selected for evaluation with cardiac MRI and TEE for a closure procedure. Comparison of the ASD imaging and sizing between the different methods was made. RESULTS: There were 22 patients who had complete transcatheter closure. The mean age and standard deviation of the patients was 33.2+/-15.1 (8-67) years old. The mean weight of the patients was 51.6+/-13.1 (20-99) kg. The average cardiac MRI measurement of the ASD was 24.9+/-6.4 mm compared to the TEE measurement of 20.8+/-5.5 mm. The transcatheter balloon measurement of the ASD was 25.2+/-6.9 (11-36) mm and the device closure size was 24.8+/-6.6 (11-36) mm. The correlation coefficient of cardiac MRI to device closure size was r = 0.784 (p < 0.001) when compared to TEE measurement to device closure size; r = 0.761 (p = 0.001). CONCLUSION: The authors demonstrated the capability of the cardiac MRI in assessment of the ASD morphology and anatomy for transcatheter closure of the ASD with an Amplatzer Septal Occluder. Cardiac MRI can provide information about the type, location, size of the defect and direct visualization of the atrial septum anatomy. This detailed information enabled us to provide a safer, more effective application of the ASD occluder.

Adolescent↗

[Influence factors of adjacent segment degeneration after instrumented lumbar fusion].

OBJECTIVE: To investigate the influence factors of adjacent segment degeneration (ASD) after instrumented lumbar fusion. METHODS: Thirty-three patients who had undergone an instrumented lumbar fusion from March 1998 to May 2002 were reviewed. The incidence, age, position, radiographic characteristics and clinical manifestations of ASD were studied. Then the relations between "floating fusion" and ASD were compared, the range of fusion and ASD and investigated the incidences of different adjacent segments. RESULTS: The mean follow-up period for the patients was 4 years and 7 months (24 - 82 months). Adjacent segment degeneration mainly occurred in patients older than 60. Ten patients (10%) were found to have radiographic characteristics of ASD. Nine of the ten patients had ASD at cranial segments. Using "floating fusion" or not did not show difference in the risk of ASD. There was a trend of more ASDs after long-segment fusion than short-segment fusion. As an adjacent segment, L(2)/L(3) had a high risk of ASD, while L(5)/S(1) had a much lower risk. CONCLUSIONS: The cranial segment has a higher degeneration risk than the caudal segment. If L(2)/L(3) has degenerative appearance and has chance to be the adjacent segment, we'd better fuse it. If there is no evidence of obvious degeneration, L(5)/S(1) should not be fused. During instrumented lumbar fusion, long-segment fusion should be avoided if possible.

Adult↗

Acute traumatic stress symptoms in child occupants and their parent drivers after crash involvement.

BACKGROUND: Approximately 1 in 4 children hospitalized with injuries from traffic crashes and their parents experience symptoms of acute stress disorder (ASD). These families represent a minority of those exposed to the trauma of a crash. To date, no studies have explored the prevalence of ASD symptoms in the broader population of children and parents exposed to crashes. OBJECTIVE: To describe the prevalence of and risk factors for ASD symptoms in children and their driver parents after vehicle crashes. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study via telephone survey of parent drivers and children (aged 5-15 years), using an exposure-based crash surveillance system. A probability sample of 1091 crashes involving 1483 children weighted to represent 24 376 children in 18 422 crashes was collected. MAIN OUTCOME MEASURE(S): Parent-reported ASD symptoms and impairment. RESULTS: Significant ASD symptoms occurred in 1.6% (95% confidence interval, 0.9%-2.3%) of children in crashes and 4.7% (95% confidence interval, 4.0%-5.5%) of parents. In children, ASD symptoms were independently associated with sustaining an injury and with receiving medical care; in parents, symptoms were independently associated with child injury, child receiving medical care, Hispanic ethnicity, lower income (< USD 40 000), and higher crash severity. CONCLUSIONS: Sustaining injuries and receiving medical treatment were strong predictors for developing ASD symptoms after crashes but ASD symptoms often occurred in the absence of these risk factors. Health care professionals should consider screening for traumatic stress symptoms in children and their parents when children are involved in traffic crashes, particularly if they sustain injuries.

Accidents, Traffic↗

Differences among states in the identification of autistic spectrum disorders.

OBJECTIVE: To explore variation among the 50 US states in the administrative prevalence of autistic spectrum disorders (ASDs) and factors associated with that variation. DESIGN: This survey study used secondary data from all 50 states obtained from the US Department of Education, Washington, DC, and the American Board of Pediatrics, Chapel Hill, NC. MAIN OUTCOME MEASURE: The outcome of interest was the proportion of children identified with ASD in the academic year 2000-2001. Linear regression was used to examine its association with education and health system characteristics. RESULTS: States ranged in the proportion of children diagnosed with ASD from 0.6 per 1000 to 4.6 per 1000 in 2000-2001. In adjusted analyses, education-related spending, the number of pediatricians in the state, and the number of school-based health centers in the state were positively associated with the administrative prevalence of ASD. CONCLUSIONS: Variation in the administrative prevalence of ASD is associated with education-related spending, which may be associated with better-trained educational staff who can recognize the problem, and more and better trained in-school specialists who can provide screening. It is also associated with the availability of health care resources. Increased access to pediatricians and school-based health centers may lead to improved recognition of ASD. Interstate variability in the identification of ASD should be taken into account when interpreting the results of prevalence studies based on administrative data and the associated system characteristics taken into account by policy makers working to improve the recognition of ASD.

Adolescent↗

Advancing paternal age and autism.

CONTEXT: Maternal and paternal ages are associated with neurodevelopmental disorders. OBJECTIVE: To examine the relationship between advancing paternal age at birth of offspring and their risk of autism spectrum disorder (ASD). DESIGN: Historical population-based cohort study. SETTING: Identification of ASD cases from the Israeli draft board medical registry. PARTICIPANTS: We conducted a study of Jewish persons born in Israel during 6 consecutive years. Virtually all men and about three quarters of women in this cohort underwent draft board assessment at age 17 years. Paternal age at birth was obtained for most of the cohort; maternal age was obtained for a smaller subset. We used the smaller subset (n = 132 271) with data on both paternal and maternal age for the primary analysis and the larger subset (n = 318 506) with data on paternal but not maternal age for sensitivity analyses. MAIN OUTCOME MEASURES: Information on persons coded as having International Classification of Diseases, 10th Revision ASD was obtained from the registry. The registry identified 110 cases of ASD (incidence, 8.3 cases per 10 000 persons), mainly autism, in the smaller subset with complete parental age data. RESULTS: There was a significant monotonic association between advancing paternal age and risk of ASD. Offspring of men 40 years or older were 5.75 times (95% confidence interval, 2.65-12.46; P<.001) more likely to have ASD compared with offspring of men younger than 30 years, after controlling for year of birth, socioeconomic status, and maternal age. Advancing maternal age showed no association with ASD after adjusting for paternal age. Sensitivity analyses indicated that these findings were not the result of bias due to missing data on maternal age. CONCLUSIONS: Advanced paternal age was associated with increased risk of ASD. Possible biological mechanisms include de novo mutations associated with advancing age or alterations in genetic imprinting.

Adult↗

Intracardiac echocardiography to guide closure of atrial septal defects in children less than 15 kilograms.

BACKGROUND: Intracardiac echocardiography (ICE) is increasingly replacing transesophageal echocardiography (TEE) as the primary imaging technique to guide device closure of atrial septal defects (ASD). Owing to the length of the procedure, the use of TEE requires general anesthesia. Investigators have reported the usefulness of ICE in adults and children. However, little is known about the use of ICE in children whose weight is <15 kg. Therefore, this study examines the use of ICE guided secundum ASD closure in children <15 kg. METHODS: Nineteen patients with a median age of 3.1 years (range 1.8-4.8), and median weight of 13.2 kg (range 8.0-14.4) underwent transcatheter occlusion (Amplatzer occluder) of a secundum ASD using ICE guidance. ICE was performed using an Acunav catheter. The ICE catheter (10 F shaft) was introduced into an 11 F sheath in a contralateral femoral vein. Diagnostic as well as periprocedure imaging was obtained. RESULTS: Sixteen patients had single, and three had multiple defects. Median defect size as measured by ICE was 16 mm (range 2.5-25). The median balloon stretched diameter (obtained in eight patients) was 18 mm (range 10-21); the median size of the defect for these eight patients was 15 mm (range of 8-20). Both techniques for measuring the defect correlated well with r = 0.94. The ASD occluder size ranged from 7 to 26 mm with a median of 18 mm. The procedure was successful in 16 patients who had a device implanted and no residual shunt. ASD occlusion was not attempted in two patients due to deficient rims and in one patient, the attempt failed due to left atrial disk prolapse through the ASD. Four patients experienced transient complications during the catheter procedure, including supra ventricular tachycardia, sinus bradycardia, and two with complete heart block (resolving with device removal); all had subsequent successful device placement. No complications were attributed to the use of ICE and specifically, no vascular injury was noted. CONCLUSIONS: Comparable to results with larger patients, ICE provides adequate imaging (preprocedure diagnosis and periprocedure guidance) during device occlusion of secundum ASDs with no significant complications. Thus, ICE can successfully be used in the closure of ASD in smaller patients (<15 kg) and eliminate the need for endotracheal intubation.

Body Weight↗

Perioperative respiratory compliance in children undergoing repair of atrial septal defects.

Children with atrial septal defects (ASD) have less respiratory compliance (Crs) than normal cohorts. There could be implications for anaesthetic management if these children also have decreased compliance during anaesthesia. To examine the changes in Crs before, during and following surgical correction of the atrial defect, Crs was measured in 29 infants and children, 15 undergoing correction of secundum type atrial septal defects, and a group of 14 children of similar weight undergoing non-thoracic surgery. During sedation, Crs was measured using the single breath technique (SBT) and during anaesthesia, both before and after the surgical procedure, an inflation technique was applied to determine Crs. To investigate the aetiology of the difference in Crs, the pulmonary to systemic flow ratio (Qp:Qs) was determined using echocardiography during sedation in the ASD patients. During sedation, Crs in the ASD group was 52.7 +/- 19.5% less than in the control group. The slope of the line of regression of Crs vs height for the ASD group was significantly less (P less than 0.05) than that of the control group during sedation. However, during anaesthesia, Crs in the ASD group was not significantly different from the control group either before or after surgery. The per cent decrease in Crs during sedation in the children with ASD, in comparison with the control group, did not correlate with the Qp:Qs ratio of the ASD group (r2 = 0.012,NS). We conclude that, in spite of lower Crs during sedation, infants and children with ASD do not have lower Crs during anaesthesia and cardiopulmonary bypass than normal controls undergoing non-thoracic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗