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PubMed2006

The future of adult patients after Mustard or Senning repair for transposition of the great arteries.

BACKGROUND: After Mustard or Senning repair for transposition of the great arteries (d-TGA), qualitative assessment of the systemic right ventricle remains difficult. We wanted to evaluate the relationship between demographic and echocardiographic variables, and exercise performance. METHODS: In 22 consecutive d-TGA patients (9 Mustard and 13 Senning) a standard transthoracic echocardiogram was performed. Peak oxygen consumption (peak VO2, ml/kg/min) was obtained by a bicycle stress test. Cardiac index (CI) at rest, 50 W, and 100 W was calculated from cardiac output, obtained by CO2 rebreathing. RESULTS: The group of patients consisted in 15 male and 7 female with a median age of 21 (range 17-34) years. On echocardiographic evaluation, right ventricular function was normal in one, slightly impaired in 11, moderately impaired in 9, and severely impaired in one. Peak VO2 was 27.4+/-7.9 ml/kg/min, which was 64+/-16% of predicted values in normals. CI at rest, 50 Watt, and 100 Watt, were 2.7+/-0.5, 5.6+/-1.2, and 6.8+/-1.1 l/min/m2, respectively. No relationship between echocardiographic parameters and exercise capacity was found. Age correlated significantly with CI at 50 and 100 W (rho=-0.44, P=0.045 and rho=-0.77, P=0.0001, respectively). Finally, simple regression analysis identified a linear relationship between age and CI at 100 W (bèta=-0.54 and R2=0.29, P=0.014). CONCLUSIONS: Maximal exercise capacity is reduced in adult patients after Mustard or Senning repair. Standard echocardiographic 2D-measurements are insufficient to determine the reduction in their functional capacity. The inverse relationship between age and the cardiac indices suggests an age dependent and progressive diminution of systemic ventricular function.

Adolescent↗
PubMed2000

Similarities and differences in the exercise performance of patients after a modified Fontan procedure compared to patients with complete transposition following a Senning operation.

OBJECTIVE: To investigate cardiopulmonary performance in patients after a Fontan procedure, comparing it to patients following a Senning operation. METHODS: We studied 21 children, with a mean age of 11.1 years, after a total cavopulmonary anastomosis, comparing them to 13 with complete transposition after a Senning procedure, having a mean age of 11.8 years, and 21 control subjects with a mean age of 11.2 years. All were tested on a bicycle ergospirometer. RESULTS: Peak consumption of oxygen, maximal work rate, peak oxygen pulse and endexpiratory pressure of carbon dioxide at a work rate of 1.5 Watt/kg were lowest in patients with a modified Fontan procedure, and highest in the control group (p < or = 0.0278). Production of carbon dioxide, and minute ventilation at a work rate of 1.5 Watt/kg, was highest in the patients after Fontan procedure, and lowest in the healthy subjects (p < or = 0.0163). Production of carbon dioxide per single breath was lower in those having a Fontan procedure (28.9 ml) than in the two other groups (35.1 ml; p = 0.0243). The tidal volume showed no significant differences between the three groups. CONCLUSIONS: The reaction to exercise was identical qualitatively in both groups of patients, and comparable to the behaviour of patients with chronic heart failure. Quantitatively, the results of the patients following a Senning procedure lay between those of control subjects and those who had undergone a Fontan operation. The only exception was dead space ventilation, where the patients after a Fontan procedure differed from the two other groups because of their increased ventilation-perfusion mismatch.

Anastomosis, Surgical↗
PubMed1983

Technical advances in the Senning operation.

Since March 1978, 59 patients with transposition of the great arteries (TGA) ranging in age from 2 months to 6 years have undergone the Senning operation. Forty-six patients (77.9%) had transposition with intact ventricular septum, 8 of them with patent ductus arteriosus; 8 patients (13.5%) had TGA with ventricular septal defect (VSD), 3 of them with previously performed banding; 4 patients (6.7%) had TGA with VSD and pulmonary stenosis (PS), and one (1.6%) had TGA with PS. Prior to correction, 38 cases had undergone a Rashkind septotomy and 15 had had a previous Blalock-Hanlon septectomy. During this time we have introduced some technical modifications of the original Senning operation: (A) right atrial incision, (B) large left atrial wall window, (C) infrasinal suture of the left atrial flap, (D) avoidance of damage to the hypothetical anterior atrioventricular conduction bundle, and recently, in 12 patients, we have used (E) an inverted left atrial appendage as an interatrial flap. There were 9 hospital deaths (15.2%) caused by low cardiac output (4 cases), severe hypoxemia and low cardiac output (4 cases) and one patient with pulmonary venous drainage obstruction died following reoperation. Two patients developed neurological complications that disappeared without sequela. Another complication was a right chylothorax (4 patients), which improved without the necessity of surgical repair. Eighteen patients developed a junctional rhythm for a period over 24 hours. We think that the technical modifications which we present here, partially contribute to improving the Senning operation.

Cardiac Output, Low↗
PubMed1987

The Senning procedure for repair of d-transposition of the great arteries.

We report our results with the Senning procedure for repair of d-transposition of the great arteries (d-TGA) including techniques that we feel facilitate the operation. When the atrial septal flap is deficient at the site of an atrial septal defect, the flap is filleted to enlarge it using living tissue. This also has the effect of thinning the septal flap which enlarges the left pulmonary vein pathway located posterior to the floor of the new caval tunnels. Another technique includes the use of the upper end of the sulcus terminalis in the construction of the roof of the new caval tunnels. The upper posterior rim of the right atriotomy is left external to this suture line and can be used in construction of the new pulmonary venous pathway. The latter suture line is inferior to the SA node and can be placed expeditiously and with less chance of damaging the SA node. Use of this technique has resulted in a reduced incidence of late arrhythmias. Following the Senning procedure in 40 patients there were no hospital deaths, but there were two late deaths. The Senning operation is currently a very satisfactory alternative for repair of d-TGA when arterial switch repair cannot be performed.

Anastomosis, Surgical↗
PubMed2006

SENS and the polarization of aging-related research.

The second Strategies for Engineered Negligible Senescence conference (SENS II) featured some very provocative ideas. The explicit objective of extending human life span indefinitely has opened a large rift between the meeting's organizer and those who believe he is acting unscientifically, perhaps recklessly. Two SENS conference participants present their views on the divisive nature of SENS.

Aging↗
PubMed2005

Inhibition of Bacillus subtilis scoC expression by multicopy senS.

The Bacillus subtilis aprE gene, which encodes the extracellular alkaline protease, is regulated by many positive and negative transcriptional regulators. SenS is one such positive regulator consisting of 65 amino acids. We found that the senS gene on a multicopy plasmid, pSEN24, caused an increase in aprE expression in strains carrying the upstream region of aprE up to -340 with respect to the transcription initiation site but not in a strain carrying the region up to -299, which is within the binding site of the negative regulator ScoC (Hpr). Epistatic analysis showed that the pSEN24 effect was lost in a scoC-deleted mutant. In accordance with these results, the scoC transcription level as assayed by a scoC-lacZ fusion and Northern analysis was greatly reduced in the cells carrying pSEN24. From these results we conclude that multicopy senS enhances aprE expression by suppressing the transcription of scoC.

Bacillus subtilis↗
PubMed1993

Medium-term clinical results after the Senning procedure with haemodynamic and angiographic evaluation of the venous pathways.

OBJECTIVE: To assess the clinical condition of patients and the adequacy of their newly constructed venous pathways after the Senning operation for simple transposition of the great arteries. PATIENTS AND DESIGN: All 34 patients who had the Senning operation between March 1983 and December 1986 were reviewed. Survivors had detailed cardiac catheterisation studies one to two years later and clinical evaluation two to six years after surgery. RESULTS: There were two operative deaths (6%), one sudden late death (after two years), and 31 survivors (91%). No clinical evidence of obstructed venous pathways was found and there was no need for reoperation for any reason. The average mean (SD) pressure gradient at the junction of the superior vena cava and systemic venous atrium was 2.0 (1.7) mm Hg, although two patients had gradients of 7 mm Hg. The average gradient was 0.7 (1) mm Hg in the inferior vena caval pathway, and 1.4 (1.1) mm Hg between the mean pulmonary arterial wedge and pulmonary venous atrial pressures. Only the two patients with gradients of 7 mm Hg at the junction of the superior vena cava and the systemic venous atrium had considerable narrowing of the pathway and retrograde flow in the azygos vein to below the diaphragm. CONCLUSION: A small series of patients were comprehensively studied after the Senning operation for simple transposition of the great arteries. Scrupulous technique in the construction of the venous pathways has had excellent results with no need for reoperation for obstruction in either the systemic or pulmonary pathways. Clinical observation alone may fail to identify patients with venous pathway obstruction, therefore careful assessment is required, even in patients who are physically normal.

Angiography↗
PubMed1993

Cardiorespiratory exercise performance after Senning operation for transposition of the great arteries.

OBJECTIVE: To assess the cardiorespiratory response to graded exercise in patients after the Senning operation for transposition of the great arteries. DESIGN: Cross sectional study. Exercise performance was assessed by determination of the ventilatory anaerobic threshold. This was defined as the exercise intensity at which the ventilatory equivalent for oxygen (VE/VO2) started to increase systematically without a concomitant increase in the ventilatory equivalent for carbon dioxide (VE/VCO2). SETTING: Outpatient department. PATIENTS: Sequential sample of 20 patients studied 5-10 years (mean 7.3 years) after the Senning operation. Age at exercise testing varied from 5 to 11 (mean 7.8) years. RESULTS: The ventilatory threshold in the patients was significantly lower than normal (p < 0.005) and averaged 79.3% (SD 13%) and 80% (12%) of the predicted normal value for age and weight, respectively. Also, the ventilatory threshold was surpassed sooner (mean 3.2 (range 2-5) minutes) in the patients than in normal controls (3.9 (2.6-4.6) minutes). The lower ventilatory threshold was associated with a subnormal oxygen uptake (ml/min/kg) during submaximal exercise, a higher than normal ventilatory equivalent for oxygen ratio, and a lower end tidal carbon dioxide tension in the patients compared with normal controls. In half of the patients heart rate was lower during graded exercise. This relative bradycardia was not associated with a normal ventilatory threshold, as often seen in fit young people. No major disturbances in rhythm were observed during exercise. CONCLUSION: Exercise performance, assessed by respiratory gas exchange, was slightly but significantly lower than normal in patients after the Senning operation. A subnormal ventilatory threshold, associated with a higher than normal ventilatory response during submaximal exercise, supports the hypothesis that oxygen delivery to tissues is slightly impaired in these patients.

Anaerobic Threshold↗
PubMed1986

Pulsed Doppler echocardiographic assessment of the pulmonary venous pathway after the Mustard or Senning procedure for transposition of the great arteries.

Pulsed Doppler evaluation of pulmonary venous flow was performed in three groups of patients who had undergone either a Mustard or Senning procedure. Group I consisted of 43 patients in sinus rhythm who had undergone the Mustard procedure 9 months or more before the Doppler examination and 16 who were evaluated immediately after surgery. Group II consisted of 12 patients in sinus rhythm who had undergone the Senning procedure 9 months or more before the Doppler evaluation. Group III consisted of eight patients with mid baffle obstruction of the pulmonary venous atrium and seven with isolated stenosis of the pulmonary vein of which all but one had previously had associated mid baffle obstruction. In those without obstruction, the pulmonary venous flow pattern mirrored the left atrial pressure trace, with peak forward flow occurring during the x and y descent. Obstruction produced a specific high-velocity turbulent pattern, whether at the mid baffle or pulmonary venous level. This technique provides reliable noninvasive information about pulmonary venous flow after the Mustard or Senning procedure.

Child↗
PubMed1996

A sennoside-hydrolyzing beta-glucosidase from Bifidobacterium sp. strain SEN is inducible.

Bifidobacterium sp. strain SEN was isolated and characterized by hydrolytic conversion of sennosides to sennidins (Akao et al., Appl. Environ. Microbiol., 60, 1041 (1994)). The sennoside-hydrolyzing capacity of the strain SEN was disappeared following the addition of glucose to the media in spite of good bacterial growth and potent activity hydrolyzing p-nitrophenyl beta-D-glucopyranoside (pNPG). In a fructose-containing medium, no such suppressing effect was shown. Following a 10 h incubation in 50 mM potassium phosphate buffer (pH 7.4), the sennoside-hydrolyzing activity of the bacterium increased, dose-dependently, with the addition of sennoside B. Inhibition of the substrate-induced increase in sennoside-hydrolyzing activity was observed following the addition of some antibiotics (chloramphenicol, streptomycin, and rifampicin). In particular, chloramphenicol completely inhibited the increase of sennoside-hydrolyzing activity while 38% pNPG-hydrolyzing activity remained. It is suggested that the strain SEN produces two different beta-glucosidases of which the sennoside-hydrolyzing enzyme is inducible. In addition, the glucosides pNPG, esculin, salicin, or amygdalin stimulated the induction of the sennoside beta-glucosidase, but less markedly than sennoside. Sennidin A or sugars (glucose, fructose, cellobiose, or maltose) did not induce the enzyme.

Anthraquinones↗
PubMed1993

An evaluation of the Sens-A-Ray digital dental imaging system.

The Sens-A-Ray digital imaging system was compared with group D- and E-speed intraoral radiographic film with respect to resolution, speed and image quality. Using a line-pair plate, resolution was determined to be 10 line-pairs per millimetre. With a constant potential X-ray source, the speed of the system was over three times that of E-speed emulsion and the response of pixel value to exposure was linear. Absorption curves with aluminium showed a similar response to D-speed film. An aluminium foil test object was used to compare the Sens-A-Ray system with both film types. Thirty observers were scored for successful identification of a pattern of holes in the test object. There was little difference between D- and E-speed film groups, and successful identification was significantly reduced with the Sens-A-Ray images when compared with D- and E-speed films.

Evaluation Studies as Topic↗
PubMed2004

Effect of SEN virus coinfection on outcome of lamivudine therapy in patients with hepatitis B.

AIM: Interactions between hepatitis B virus (HBV) and other viral hepatitis infections are well known, whether the newly discovered SEN virus (SENV) has any effect on lamivudine antiHBV activity is unclear. Our aim was to clarify the effect on treatment outcome of coinfection with SEN virus in patients with hepatitis B during lamivudine therapy. METHODS: Nested polymerase chain reaction (PCR) amplification was used to detect SENV-D and SENV-H strains in serum from 45 patients with chronic hepatitis B treated with lamivudine 100 mg daily for 12 mo. HBV DNA load was detected with fluorescence quantitative PCR (FQ-PCR) and YMDD (tyrosine, methionine, aspartate, aspartate) motif mutation of HBV DNA was investigated with cDNA microarray. RESULTS: SENV DNA was detected in 5 of 45(11.1%) cases after 12 mo they received lamivudine treatment. SENV-D and SENV-H were 4.4% and 6.7% respectively. HBV DNA failed to respond to lamivudine therapy in 4 of 5 SENV coinfected patients while only 10 of 40 patients became SENV positive and the difference was statistically significant. Response of ALT and HBeAg to lamivudine had no significant difference between coinfection patients and single HBV infection ones. CONCLUSION: Coinfection with SEN virus in chronic hepatitis B patients may adversely affect the outcome of lamivudine treatment.

Adult↗
PubMed2000

[Surgical results of the Senning operation and arterial switch operation for complete transposition of the great arteries].

From March 1980 to August 1997, 42 patients with complete transposition of the great arteries (TGA) type I and II underwent arterial switch procedure (n = 20) or Senning (n = 22) procedure in our institution. In arterial switch procedure group, there were two operative death. No late death occurred, and one patient underwent reoperation and one underwent balloon pulmonary angioplasty for right sided obstruction. The freedom from the intervention rate for right sided obstruction was 83.0% at 5 years, subsequently. In Senning procedure group, operative death occurred in two patients with TGA type II, and one patient with TGA type II and two patients with type I died because of cardiac events in the late stage. In this group, two patients died from accident. The survival rate excluding accidental deaths was 77.7% and 77.7% at 5 and 10 years, respectively. However, those patients who died in the late stage had severe pre-operative and post-operative complication. In conclusion, mid-term results of arterial switch procedure is satisfactory, however, reintervention rate was not so low. Long term results of Senning procedure without preoperative or postoperative complication was satisfactory.

Cardiac Surgical Procedures↗
PubMed1992

Surgical management of late right ventricular failure after Mustard or Senning repair.

BACKGROUND: Information on surgical management and outcome in patients who develop symptomatic right ventricular failure after prior Mustard or Senning operations is limited. METHODS AND RESULTS: From March 1987 to March 1991, 10 patients 3.6-23.5 years old (median, 7.0 years) with transposition of the great arteries and prior Mustard (six patients) or Senning (four patients) repairs (performed at ages 2 months to 5 years; median, 6 months) underwent surgical intervention for symptomatic right ventricular failure. In five of 10 patients, anatomic correction with either an arterial switch operation (three patients) or a pulmonary artery-to-aorta anastomosis and right ventricle-to-pulmonary artery conduit (two patients) was performed. Before anatomic correction in these five patients, four of five patients had a pulmonary artery band to prepare the left ventricle. The interval between preparation and correction ranged from 8 days to 12 months (median, 2 months). One patient died after an arterial switch operation. In the remaining five patients, coexisting left ventricular dysfunction precluded anatomic correction; all five patients survived cardiac transplantation. Survival for the entire group of 10 patients is 90%, and the median postoperative hospital stay was 17 days. During follow-up (12-62 months; median, 27 months), there were no deaths. Neoaortic insufficiency after anatomic correction was common (mild in one patient, moderate in two patients, and severe in one patient who required aortic valve replacement 4 months after surgery). In the transplantation group, one patient developed lymphoma 3 months after transplantation but is currently in remission after reduction of immunosuppression. CONCLUSIONS: In patients who develop late right ventricular failure after Mustard or Senning repair, surgical intervention with either anatomic correction or cardiac transplantation can be done with acceptable morbidity and low mortality. Neoaortic valve insufficiency demands close follow-up after anatomic correction.

Aorta, Thoracic↗
PubMed2005

[Congestive heart failure after the Senning operation. Case report].

From the early 1960s to the mid 1980s, the Mustard and Senning procedures were the treatment of choice for transposition of the great arteries (d-TGA). We report a case of a young girl who had undergone surgical repair of complete transposition by the Senning procedure in the early infancy. Twelve years later she developed a congestive heart failure. Based on the x-ray, echo and angiography study she was qualified for reoperation at German Heart Institute Berlin with a very good result. Long term follow-up of patients who underwent Mustard or Senning repair for d-TGA leads to identification of multiple residua and sequelae, as well as functional problems associated with these two procedures. Our patient illustrates the effective therapy which can improve the quality of life and postpone the time for the heart transplantation.

Adolescent↗
PubMedDate not supplied

[Investigation of SEN virus genotypes D and H among blood donors in Mersin University Medical School Hospital].

SEN virus is a recently discovered DNA virus, and eight genotypes (A to H) were detected by phylogenetic analysis. Genotype D (SENV-D) and H (SENV-H) are thought to be associated in the etiology of post-transfusion hepatitis. Although no strong association was revealed between liver pathology and SEN virus, the viral replication in hepatocytes and transmission by blood transfusions were well characterized. The aim of this study was to investigate the prevalence of SENV-D and SENV-H in blood donors. One hundred serum samples were included in the study which were obtained from blood donors comprised of 98 male and 2 female with a mean age 36.4 years who were enrolled at Mersin University Faculty of Medicine blood center. The DNAs of SENV-D and SENV-H were detected with polymerase chain reaction (PCR), by using D10S/L2AS and C5S/L2AS primers, respectively. SEN virus DNA positivity was detected in 25 of 100 (25%) sera, of which 10 (10%) were positive for SENV-D and 15 (15%) were positive for SENV-H DNA. Although, the number of samples were not sufficient to reflect the general prevalence, our study relatively reveals that asymptomatic carriage rate of these viruses were 25% in our province.

Adult↗
PubMed1990

[Correction of funnel chest using the Senning-Johanson method].

Between 1962 and 1987 52 patients underwent surgical reconstruction of pectus excavatum at the University Hospital of Zurich using the Senning-Johanson method, first published in 1974. The technique of Senning-Johanson consists of a Y-shaped sternotomy and a transsection of the involved ribs from inside of the thoracic cage, thereby avoiding a dissection of the anterior chest wall. The average age of the 36 men and 16 women was 20 years (range 12-33). The internal sterno-vertebral distance, which we consider to be a good parameter for determining the anatomic dimension of a funnel-chest, was extended by the operation from an average of 5.8 cm (range 2.5 to 10) to 10.1 cm (range 6.1 to 14) or 74% of the original value. The physical working capacity in sitting position was improved by 10%. The vital capacity was preoperatively normal and was not changed by the operation. Thirty-seven patients considered the operative result to be good, in twelve it was satisfactory, and in three bad. The funnel-chest repair using the Senning-Johanson method can be recommended as a successful procedure with relatively few complications for the adult patient.

Adolescent↗
PubMed1995

Brief communication: skeletal evidence of operations on cadavers from Sens (Yonne, France) at the end of the XVth century.

Human remains giving direct evidence concerning the history of dissection practices are rare. Thirteen cranial fragments which bear evidence of having been purposely cut and sawn were discovered in a crypt during excavations undertaken in Sens (Yonne, France). Ceramics date these remains to the period from the end of the XIVth to the end of the XVIth centuries. Nine individuals are represented: one adolescent and eight adults of both sexes. The position of the cutmarks, which were produced by a long, sharp cutting tool, show that the scalp was completely removed from the skull. The sawing, which was done with a large-toothed saw, was both clockwise and counterclockwise in direction. The sawn surfaces reveal a deliberate attempt not to damage the brain. This procedure is compared to that of modern autopsies. The remains from Sens are also compared with several other sawn cranial fragments recently discovered in France and England. Three hypotheses are discussed: embalmment, autopsy, and anatomical studies. Analysis of these remains and historical documentation suggest embalmment and/or autopsy as the probable purpose of the opening of the skull.

Adult↗