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PubMed1989

Dietary folate as a risk factor for neural-tube defects: evidence from a case-control study in Western Australia.

A population-based case-control study was conducted to test the hypothesis that the risk of the occurrence of neural-tube defects in infants with no other birth defects (isolated neural-tube defects) is associated inversely with the maternal dietary intake of free and/or total folate in early pregnancy. Information was collected from the mothers of 77 case subjects with isolated neural-tube defects who were born in Western Australia from 1982 to 1984, from the mothers of 77 control subjects with birth defects other than neural-tube defects (control group 1) and from the mothers of 154 control subjects with no birth defects (control group 2). The case and control subjects were matched individually by the date of the mother's last menstrual period. Odds ratios were adjusted for a number of potentially-confounding variables, such as the country of birth of the parents, paternal social class, previous pregnancy outcome, interval between index and previous pregnancy and pregnancy order. Crude and adjusted odds ratios showed a protective effect of an increasing intake of free folate in the first six weeks of pregnancy. Adjusted odds ratios, with reference to the lowest quartile of intake, (and their 95% confidence intervals) were 0.72 (0.25-2.08), 0.37 (0.11-1.23) and 0.31 (0.10-0.97) for quartiles 2-4 when control group 1 was used, and 0.44 (0.17-1.13), 0.34 (0.13-0.90) and 0.16 (0.06-0.49) when control group 2 was used. Similar, but weaker, trends were seen when total folate intake was the exposure variable. These findings support the hypothesis that the dietary intake of folate in early pregnancy protects against the occurrence of isolated neural-tube defects in infants. Measures of postpartum dietary folate and of postpartum serum and red-cell folate levels showed no association with the occurrence of neural-tube defects in infants.

Diet↗
PubMed2004

[Incidence and survival in children with selected types of congenital defects in the Czech Republic from 1994 to 2001. (Part 1)].

OBJECTIVE: Analysis of prenatal and postnatal incidence of selected types of birth defects in the Czech Republic in the period of 1994-2001. In the postnatally diagnosed cases the survival in the course of the first year of life was analyzed. Selected birth defects--anencephaly, spina bifida, encephalocele, neural tube defects, congenital hydrocephalus, Down syndrome, were investigated. TYPE OF STUDY: Retrospective analysis from registry of birth defects in the UZIS Czech Republic in the period of 1994-2001. METHOD: The authors analyzed frequency of prenatally and postnatally diagnosed cases of 6 selected types of birth defects in the period of 1994-2001 in the Czech Republic. In cases where the diagnosis was established after birth, analysis of survival and death rate during the first year of life was performed for selected birth defects. RESULTS: In the period of 1994-2001, 745,410 children were born in the Czech Republic. There were 3,572 children with one or more birth defects diagnosed in this cohort during the first year of life. The mean incidence of all cases in this period of observation was 304.52 per 10,000 live born children. The percentage of prenatally diagnosed cases, ended for this diagnosis in the above mentioned period of observation, was on the average 72.5% in neural tube and the highest in anencephaly--more than 96%. In cases of congenital hydrocephalus it was higher than 45% and in Down syndrome it represented 56.5%. The survival in children with neural tube defects was 82.5% on the average, being obviously zero in anencephaly. The children with congenital hydrocephalus survive in more than 75% and those with Down syndrome survive in almost 95%. CONCLUSION: Incidence of these types of birth defects in newborns in the Czech Republic is presently lower than in previous years particularly due to successful prenatal diagnostics. Cases, where the diagnosis is established after delivery, represent an important part of perinatal, neonatal and post-neonatal mortality and morbidity.

Czech Republic↗
PubMed2004

Three-dimensional echocardiography in children with atrial septal defect.

The selection of patients for transcatheter or surgical closure of a secundum atrial septal defect requires accurate information regarding the anatomy of the defect such as its maximal diameter and the amount of circumferential tissue rim. Two-dimensional echocardiography is wanting as a means to define selection criteria for atrial septal defect closure. Since the defect is visualised from multiple orthogonal planes, maximal atrial septal defect diameter is widely under-estimated. The transcatheter approach measures the stretched diameter, but cannot be applied alone for patient selection since it does not provide information on the tissue rim. Three-dimensional echocardiography allows unique en face views of the atrial septum. Previous studies have shown the ability of 3-dimensional echocardiography to depict information regarding the shape, the maximal diameter and the rims surrounding the defect. Transthoracic 3-dimensional echocardiography is accurate to measure atrial septal defect maximal diameter and rims surrounding the defect. Such a non-invasive method could be applied to children selection for atrial septal defect closure. The transcatheter balloon method provides additional information such as the resistance of the septum. Device sizing and placement should take into account both 3-dimensional echocardiography and transcatheter findings.

Adolescent↗
PubMed1992

Spectrum of neural-tube defects in 34 infants prenatally exposed to antiepileptic drugs.

We analyzed the spectrum of neural-tube defects associated with maternal exposure to antiepileptic drugs (AEDs) and the possible contribution of familial and genetic factors to epilepsy or neural-tube defects. No specific association with maternal family history of neural-tube defects or epilepsy was seen. The ratio of spina bifida to anencephaly (33:1) suggested a specific association with caudal defects. Hydrocephaly was documented in at least 21 cases. Other midline defects, all associated with valproate (VPA), were hypospadias (two), hypertelorism (two), partial agenesis of corpus callosum, agenesis of septum pellucidum with lissencephaly of medial sides of occipital lobes, Dandy-Walker anomaly, and ventricular septal defect. This study shows that most neural-tube defects following maternal VPA use are severe open defects. They are frequently complicated by hydrocephaly and other midline defects. Prenatal diagnosis is possible.

Anticonvulsants↗
PubMedDate not supplied

Transcatheter closure of perimembranous ventricular septal defect with amplatzer membranous occluder.

BACKGROUND: Use of trancatheter device closure for membranous ventricular septal defect is still in evolving phase. We report the early and mid-term results of our experience with the new asymmetric Amplatzer membranous ventricular septal defect occluder. METHODS AND RESULTS: We attempted, transcatheter closure of perimembranous ventricular septal defect using asymmetric Amplatzer occluder in 26 patients. The patients were selected on the basis of transthoracic and transesophageal echocardiographic assessment of the ventricular septal defect. The procedure was successful in 21 (81%) patients. The age ranged from 3 to 23 years, weight from 10 to 59 kg and defect size ranged from 3 to 9 mm (mean: 5 +/- 1.8 mm). One patient had situs inversus with dextrocardia: 11 had aneurysmal tissue partly occluding the defect and the device was deployed either across (n=6) or within the aneurysmal sac (n=5). Three patients developed high degree atrioventricular block on attempts to cross the defect with the sheath and the procedure was discontinued. In two patients it was not possible to place the sheath in left ventricle despite repeated attempts. There was a residual flow in 4 (19%) patients at 24 hours. Two patients developed bundle branch block and none had complete heart block. At follow-up (1-9 months, n=20), residual flow was seen in two patients. None developed late conduction defect, aortic regurgitation, infective endocarditis or hemolysis. CONCLUSIONS: Transcatheter closure of perimembranous ventricular septal defect can be performed safely and effectively with the new asymmetric Amplatzer occluder device in selected patients with good short- and midterm results. These devices can be deployed safely in and across and the aneurysmal sacs. In selected cases, this procedure is a satisfactory alternative to surgery.

Adolescent↗
PubMed1992

Ventricular septal defect with tricuspid pouch with and without transposition. Anatomic and surgical considerations.

In a 10-year review, patients operated on for ventricular septal defect and tricuspid valve pouch were divided into two groups, because the effect of the tricuspid valve pouch is influenced by which ventricle has the higher pressure. Group I comprised patients with ventricular septal defect without transposition of the great arteries and group II, ventricular septal defect with transposition. In 72 of 392 group I patients, the septal tricuspid valve leaflet was incised to expose the edges of the hidden ventricular septal defect to accomplish proper anatomic repair. Forty-eight patients had a tricuspid valve pouch, the diagnosis being established by angiography, echocardiography, or at operation. Ages at operation ranged from 5 months to 22 years and the pulmonary-systemic flow ratio ranged from 1 to 3.4, with 16 being less than 1.5. In one patient the pouch produced a 40 mm Hg pressure gradient in the right ventricular outflow tract. At operation, through a transatrial approach, the tricuspid valve pouch was opened radially, the actual ventricular septal defect patched, and the tricuspid valve leaflet repaired. There were no deaths, no significant intraoperative or postoperative morbidity, and no tricuspid valve dysfunction. The average postoperative hospital stay was 4.8 days. In group II, six of 83 patients operated on for transposition with ventricular septal defect had significant left ventricular outflow tract obstruction from the tricuspid valve pouch. Five of six had a Mustard procedure, two requiring a left ventricular-pulmonary artery conduit, and in two of the six the ventricular septal defect was closed through the pulmonary artery. One patient had heart transplantation after a Mustard repair and tricuspid valve replacement. The sixth patient in group II had a successful arterial switch at 9 years of age, after the presence of left ventricular outflow tract obstruction was proved to be due to the pouch. The presence of a tricuspid valve pouch in group I may lead the surgeon to close false small openings produced by the pouch rather than the actual ventricular septal defect. Incising the pouch is safe and essential for proper exposure and secure closure of the true defect. In group II, the systemic right ventricular pressure can push the pouch into the left ventricular outflow tract, causing significant obstruction, and may contribute to tricuspid valve insufficiency after atrial baffle repair. Arterial switch is preferred because it returns the obstructive tricuspid valve pouch and abnormal tricuspid leaflet to the lower pressure pulmonic right ventricle.

Child↗
PubMed1991

Surgical management of the conal (supracristal) ventricular septal defect.

Surgical management of the conal (supracristal) ventricular septal defect differs significantly from the management of the perimembranous (infracristal) ventricular septal defect. The absence of a portion of the conal septum can lead to prolapse of the right cusp of the aortic valve, which predisposes these patients to aortic insufficiency. Between January 1980 and December 1989, 36 children with conal ventricular septal defect underwent intracardiac repair. Diagnosis was by echocardiography, cardiac catheterization, and intraoperative exploration. Preoperative evaluation showed that 26 patients (72%) had aortic valve prolapse and 16 (44%) had aortic insufficiency. Pulmonary-to-systemic flow ratios ranged from 1:1 to 3.5:1 (mean 2.0:1.0). Ten patients (27%) were believed to have clinical congestive heart failure. Age at the time of operation ranged from 2 weeks to 18 years (mean 5.5 years). Operative exposure was through the pulmonary artery (26), aorta (4), right ventricle (3), or right atrium (3). Simultaneous aortic valve suspension for aortic insufficiency was performed in four patients. Operative survival was 100%. Follow-up is complete in all patients and ranges from 0.5 to 9 years (mean 4.3 years). All patients are in normal sinus rhythm. No residual ventricular septal defects have been identified. Twenty-three of 36 patients (64%) have no evidence of aortic insufficiency; 12 of 36 (33%) have trivial or mild aortic insufficiency. One patient with initial severe aortic insufficiency underwent repeat aortic valvuloplasty 3 years after ventricular septal defect closure and aortic valve suspension. No patients have required aortic valve replacement. Surgical management of the conal ventricular septal defect differs from that of the perimembranous ventricular septal defect in two critical aspects. The operative approach should be through the pulmonary artery. This allows the best exposure of the remaining conal septum and the pulmonary and aortic valve leaflets, facilitating closure of the defect without injury to the valves or conduction system. Conal ventricular septal defects should undergo early closure, regardless of shunt volume, to prevent progressive aortic insufficiency.

Adolescent↗
PubMed1990

[Children with congenital heart defects in Vestfold 1982-88. Increase in the incidence resulting from improved diagnostics methods].

In the population of live born children in the County of Vestfold, Norway, during the seven-year period 1982-88 (N = 15,307), 138 cases of congenital heart defects were diagnosed (patent ductus arteriosus in preterm infants excluded), an incidence of 0.9%. In 114 infants (83%) the defect was diagnosed before discharge from hospital after birth (nursery, neonatal unit), in 20 infants (14%) it was diagnosed later during the first year of life, and in four (3%) during the second year of life. In 24 children (17%) congenital heart defect was associated with a syndrome (Down syndrome eight, Edwards syndrome three, other syndromes three), or other congenital malformations (single eight, multiple two). Diagnosis was made clinically only (including ECG, phonocardiography and X-ray pictures) in 15 patients (11%). 13 were classified as having ventricular septal defects, and two were unclassified. Echocardiography was performed in 120 children (87%), heart catheterization in 44 (32%), surgery in 47 (34%), and autopsy in 12 (9%). 15 children (11%) died, all during the first year after birth. 45 children (33%) are healthy after spontaneous closure of a ventricular (41 children) or atrial septal defect (four children), and 15 (11%) after surgical repair. 63 (46%) are alive with a defect. We found a tendency towards increasing incidence of congenital heart defects. This increase was explained by echocardiographic diagnosis of small muscular ventricular septal defects in the early neonatal period, with spontaneous closure of the defect during the first year of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Defects, Congenital↗
PubMed1984

The morphology of ventricular septal defects.

Ventricular septal defect (VSD) is the most common congenital cardiac lesion, occurring either in isolation or in hearts containing more complex lesions. Usually, the defect is between two ventricles, each of which is connected to a separate atrium and to a separate great artery, and surgical or spontaneous closure of the VSD basically corrects the circulation if the effects of any associated lesion are ignored. In other situations, the VSD is an integral part of the circulation, either because the atria connect to only one ventricle or because the ventricles give rise to only one patent great artery or else both great arteries arise from the same ventricle. When in such circumstances the circulation is VSD-dependent and the defect cannot be surgically closed without bypassing it with a conduit or similar device. In all of these situations, the VSD takes one of three basic forms. Usually, the VSD abuts directly upon the fibrous skeleton of the heart formed by the conjoined rings of the cardiac valves. The membranous part of the ventricular septum is an integral part of this skeleton, and these defects are termed perimembranous. These defects do not always occupy the same part of the septum. They may extend mostly into either the inlet, trabecular, or outlet parts of the muscular septum, or else be confluent extending into two or all these parts. Less commonly, VSD may be exclusively contained within the muscular septum. Such muscular defects can also be confined to either the inlet, trabecular, or outlet parts of the septum. They may be multiple or coexist with one of the other types. The third and least common type is a VSD which is roofed by the conjoined rings of the aortic and pulmonary valves because of absence of the outer septum. Such a defect may have a muscular posteroinferior rim or may extend to become perimembranous. Identifying a defect as perimembranous or muscular, together with its location relative to the different parts of the muscular septum, gives at the same time information concerning the site of the conduction axis in relation to the defect and its chances of spontaneous closure.

Aorta↗
PubMed1984

Transposition of the great arteries with ventricular septal defects. Surgical considerations concerning the Rastelli operation.

We studied the anatomy of the ventricular septal defect in 20 heart specimens and eight operated patients with transposition of the great arteries regarding the feasibility of the Rastelli operation. They were divided into three groups. In Group I, comprising eight cases, creation of a left ventricle-aorta connection was not prevented by interposition of the atrioventricular valve tissue, and the ventricular septal defect was large or could be enlarged sufficiently. Thus, the Rastelli operation was feasible in all cases. In Group II, comprising 12 cases, interposition of the atrioventricular valves was not present, but the ventricular septal defect was inadequate in size for a good left ventricle-aorta connection. Small or even medium-sized ventricular septal defects were not enlargeable because of surrounding structures or inadequate septum for resection. In all cases, the ventricular septal defect was a tunnellike structure with two orifices; attempted enlargement would be more difficult at the left ventricular end (not obvious to the surgeon's view) than at the right one. The Rastelli operation was judged inadvisable in these cases. In Group III, comprising eight cases, the Rastelli operation was considered inadvisable because of interposition of atrioventricular valve tissue. The size of the ventricular septal defect and the presence of interposed atrioventricular valves can be diagnosed preoperatively. The presence of enough available space for resection, especially at the left ventricular end, should be determined preoperatively and/or intraoperatively in patients with medium-sized ventricular septal defects requiring enlargement. The anatomy of the ventricular septal defect may significantly alter the surgical approach for patients with transposition of the great arteries and ventricular septal defect.

Echocardiography↗
PubMed1984

Modification of the precise relationship of the atrioventricular conduction bundle to the margins of the ventricular septal defects by the trabecula septomarginalis.

There is a widely recognized relationship between the atrioventricular conduction bundle and the margins of the ventricular septal defects according to whether the defect is perimembranous or muscular. We have shown that this relationship may in turn be markedly influenced by the precise topography of the trabecula septomarginalis. Fifteen hearts, each with a ventricular septal defect, were studied by serial sectioning. Four hearts had an isolated ventricular septal defect in the setting of normal chamber connections and relations. One heart had a truncus arteriosus, seven hearts had Fallot's tetralogy, and three hearts exhibited complete transposition. In those hearts with outlet defects in which a bar of muscle separated the rim of the defect from the position of the conduction bundle, deficiency of the posterior limb of the trabecula septomarginalis permitted the right-sided margin of the conduction axis to "surface" in directly subendocardial position. Moreover, in some of these outlet defects, the conduction axis in the region of the branching bundle was exposed directly upon the crest of the muscular septum. The position of the medial papillary muscle complex was the best landmark to this potential danger area. In some of the examples of Fallot's tetralogy, we observed a firm muscle bar overlying the posteroinferior margin of the defect, which nonetheless was perimembranous. This protected the nonbranching component of the conduction axis in the anticipated danger area. Paradoxically, a deficiency in the trabecula septomarginatis then permitted the branching bundle to sit directly astride the septum along the inferior rim of the defect. We noted particularly marked variability of the atrioventricular conduction axis among the hearts with tetralogy. Our results suggest that close inspection during the operation may reveal whether or not a well-developed trabecula septomarginalis is present and permit conclusions to be drawn concerning the precise position of the atrioventricular conduction axis.

Adult↗
PubMed1994

[Percutaneous closure of interatrial defect using the buttoned double-disk prosthesis].

BACKGROUND: Surgical repair is the procedure of choice for atrial septal defect correction. Even though surgical mortality is low (< 1%), morbidity is significant (anesthesia, thoracotomy, cardiopulmonary bypass, longer hospitalization and intensive care unit monitoring). Transcatheter methods to occlude atrial septal defects have been in development during the last two decades. We report our experience in Italy with the Sideris buttoned double-disk device. METHODS: From March 1992 to April 1993, 14 patients aged 20 months to 52 years, weight 10 to 82 kg, underwent transcatheter atrial septal defect occlusion with the Sideris buttoned device. The buttoned device is a miniaturized two disk device introduced through small venous sheaths (8-9 F). The diameter of atrial septal defects by echocardiography varied between 9 and 23 mm, while the balloon stretched diameter of the defects varied between 13 and 24 mm. The devices selected were 19 +/- 4 mm larger than the stretched diameter of the defect, but less than the total length of the septum (33-56 mm) by echo. RESULTS: Pulmonary-to-systemic flow ratio varied between 1.5 to 4.0. Mean pulmonary artery pressure varied between 10 and 24 mmHg (mean value 17 +/- 3.5 mm Hg). The relationship between different atrial septal defect measurements (echo, shunt flow, stretched diameter) was statistically analysed: transthoracic echo diameter had a good correlation with the balloon stretched diameter (r = 0.63, p < 0.001). The atrial septal defect was occluded in 12 patients (86% success rate). There was one early "unbuttoning" which was surgically corrected with success. The other patient underwent surgical correction 3 months later because of unsuitability for transcatheter closure. Minimal residual shunt detected by color flow mapping at 1 month follow-up was seen in 4 patients (33%). No complications occurred in any of our patients. CONCLUSIONS: This initial experience with the Sideris buttoned double-disk device demonstrated that transcatheter closure of atrial septal defect is feasible and effective. It can be accomplished through small introducing sheaths. Further clinical trials are justified. This method could become the procedure of choice for the correction of small ASDs.

Adolescent↗
PubMed1997

Quantitative analysis of the morphology of secundum-type atrial septal defects and their dynamic change using transesophageal three-dimensional echocardiography.

BACKGROUND: A noninvasive method for the determination of size and spatial relationships of atrial septal defects to adjacent cardiac structures, which would be advantageous to those contemplating device closure, is described. The aim of the study was to examine the value of transesophageal three-dimensional echocardiography for this purpose. METHODS AND RESULTS: Three-dimensional reconstruction of transesophageal two-dimensional echocardiography was performed in 17 patients. Left-to-right shunt (by oximetry in 16 of 17 patients) was 2.4 to 16.2 L/min, and the Qp/QS ratio was 1.4 to 4.7. The defect area of the atrial septal defect was measured throughout the whole cardiac cycle each 40 ms from the three-dimensional data set. Results were compared with shunt parameters by oximetry and with intraoperative measurements. Distances between atrial septal defect and mitral and tricuspid annulus and the orifices of the caval and pulmonary veins were also measured. The atrial septal defect area ranged from 0.2 to 2.4 cm2 (diastole) to 0.5 to 5.6 cm2 (systole). The maximal area at end-systole was 108% of the area at beginning of systole, and the minimal area at end-diastole was 43%. The defect area correlated significantly with the Qp/QS ratio (r=.70), and the maximal atrial septal defect diameters as measured by using three-dimensional echocardiography correlated well with intraoperative measurements (r=.87). Distances to mitral and tricuspid annulus and to the superior caval vein were determined in all patients. Distances to orifice of the inferior caval vein were measured in 12 patients, and orifices of right pulmonary veins were visible in 5 patients. CONCLUSIONS: Transesophageal three-dimensional echocardiography of atrial septal defects allows the determination of the instantaneous defect area and its dynamic changes and thus provides valuable information about the distances to adjacent cardiac structures. This may have clinical implications for the selection of patients suitable for interventional closure and for the assessment of procedural success.

Adult↗
PubMed1998

Volumetric changes following barrier regeneration procedures for the surgical management of grade II molar furcation defects in baboons: II. Bone, cementum, epithelium, and connective tissue.

In Part I, a computer imaging technique was used to measure the volumetric fill that occurred in surgically created grade II molar furcation defects after they had been treated using the principles of guided tissue regeneration. In Part II, the volumetric fill for each of the specific tissues comprising the defect fill (epithelium, connective tissue, bone, and cementum) was compared. The histologic material consisted of defects treated using one of three types of surgical treatment as well as untreated control sites. All volumetric measurements were expressed as a percentage of the original surgically created defect size, with 100% indicating complete healing of the defect. The results indicate that none of the defects achieved complete healing. Teeth receiving flap debridement had the most overall defect fill (79.50% comprised of 17.13% bone, 35.81% connective tissue, 37.35% epithelium, and 9.71% cementum). Teeth that received a biodegradable barrier showed a mean overall defect fill of 74.98% (7.41% bone, 47.13% connective tissue, 36.20% epithelium, and 9.26% cementum. Sites treated with an exclusion barrier showed 70.75% overall fill (9.63% bone, 40.89% connective tissue, 39.00% epithelium, and 10.48% cementum). The untreated control teeth showed a mean overall fill of 78.70% (5.56% bone, 59.11% connective tissue, 31.06% epithelium, and 4.27% cementum). No significant differences were found among teeth within the same animal and between treatment and controls. The following conclusions were drawn: (1) connective tissue comprised nearly one half of the total fill of the surgically created defects; (2) the percentage of new bone growth was significantly lower than anticipated; and (3) no significant differences were found among the treatment modalities and the untreated control sites for each of the specific tissue types.

Animals↗
PubMed1998

Extending the limits of transcatheter closure of atrial septal defects with the double umbrella device (CardioSEAL).

OBJECTIVE: To report initial findings from a selected group of patients with morphological variations of the atrial septal defect who underwent transcatheter closure with a second generation redesigned double umbrella device. PATIENTS: Two patients with abnormal location of the oval fossa and partial deficiency of the septal rim, three patients with multiple defects, and two patients with a multiperforated aneurysm of the interatrial septum (age range, 3.6-25.5 years). METHODS: Defects were closed with the double umbrella device (CardioSEAL) consisting of two sets of flexible arms (with central and two mid-arm hinges) covered with sewn Dacron patches. The implantation procedure was monitored by transoesophageal echocardiography. RESULTS: The diameter of the defect measured during transoesophageal echocardiography ranged from 7-18 mm and the balloon stretched diameter ranged from 13-21 mm. The size of the devices varied from 28-33 mm and the ratio of device size to defect size varied from 1.6-2.1. Two devices (23 and 28 mm) were chosen in a patient with two separated defects. No complications or serious arrhythmias were observed during implantation or follow up (median, 1.8 months). Residual shunting was trivial in three patients and mild in one patient (inferiorly located additional defect). CONCLUSIONS: To extend the selection critera of an isolated central interatrial defect for transcatheter closure, some modifications of the implantation technique are needed. Using the redesigned double umbrella device, effective closure in patients with multiple or irregularly shaped atrial septal defects was achieved, indicating a broadening of the spectrum of transcatheter closure.

Adolescent↗
PubMed2003

Left-to-right shunting in common congenital heart defects: which patients are eligible for percutaneous interventions?

Atrial septal defects, atrio-ventricular septal defects, ventricular septal defects and the persistent arterial duct are the most common congenital heart defects which may cause, in the presence of a significant left-to-right shunt, chronic volume overload of the heart and lead to the development of pulmonary arterial hypertension. Repair is indicated to avoid these complications and evolution to right-to-left shunting (Eisenmenger syndrome). Although the long-term results of surgical interventions in uncomplicated congenital heart defects were excellent, percutaneous techniques to repair the defects became a focus of attention. The persistent arterial duct, the secundum type atrial septal defect, and, more recently, the muscular and perimembranous ventricular septal defect are currently eligible for percutaneous closure. By avoiding a sternotomy or a thoracotomy, complaints of pain become exceptional and the duration of hospitalisation is shortened. Percutaneous closure is not only better tolerated than surgery, it may also imply favourable economical aspects.

Cardiac Catheterization↗
PubMed1990

Atypical nerve fiber layer defects in high myopes with high-tension glaucoma.

The incidence of atypical optic nerve head and retinal nerve fiber layer defects was studied in 61 high myopic eyes (greater than or equal to -5 diopters) and 91 emmetropic or hyperopic eyes (0 to +3 diopters) of 152 patients with chronic high-tension glaucoma, and in 45 control myopic eyes (greater than or equal to -5 diopters). Horizontal ovalness or cyclotorsion, oblique insertion of the optic disc, and bean pot disc were more common in the high myopes. In the eyes with high myopia with glaucoma, inferior dominant nerve fiber layer defects, ectopic fiber defects, and multiple nerve fiber layer defects were common. The incidence of superior nerve fiber layer defects or superior-inferior equal nerve fiber layer defects was high in round or vertically oval discs and low in cyclotorted or horizontal oval discs. The oblique insertion of the discs correlated positively with a higher incidence of ectopic defects in high myopic eyes with glaucoma. The incidence of focal type nerve defects is higher in older patients and high myopes with oblique insertion of the optic disc. Atypical shape of the optic disc correlates positively with atypical retinal nerve fiber layer defects in eyes with high-tension glaucoma.

Adolescent↗
PubMed1997

Histomorphometric and molecular biologic comparison of bioactive glass granules and autogenous bone grafts in augmentation of bone defect healing.

The applicability of bioactive glass (BG) granules as a substitute for bone grafts was tested by comparing the histologic, histomorphometric, and molecular biologic healing patterns to those of bone autografts and ungrafted bone defects in a rat model. The cellular response in defects filled with BG granules was characterized by continuous overexpression of type III collagen. Osteogenic mesenchymal cells, prior to their differentiation to osteoblasts, organized as a dense periosteumlike layer on the surface of the BG granules. By day 14 new bone formation was more extensive in autografted defects than in BG filled defects (p = 0.039). No cartilage-specific type II collagen mRNA was detectable, confirming the uniformity of intramembranous bone formation. The difference in the initiation of new bone formation was further confirmed by the mRNA analyses of the de novo production of TGF-beta 1 and type I collagen. Autografted defects demonstrated the highest levels of TGF-beta 1 and type I collagen mRNAs during the first 2 weeks of healing, whereas BG-filled defects showed biphasic expression patterns of the same genes. Spontaneous new bone formation in ungrafted bone defects was also characterized by biphasic expression of type I collagen gene. Osteonectin mRNA declined gradually over time in autografted and BG filled defects, whereas unfilled defects showed a gradual increase of osteonectin mRNA during healing. By 8 weeks, about 70% of the BG surface showed evidence of direct new bone contact. Energy-dispersing X-ray analyses confirmed the presence of silica-rich and CaP-rich zones at the bonding interface. In conclusion, the osteoconductive surface of bioactive glass granules efficiently bonds to ongrowing new bone but the material does not reach the capacity of autogenous bone graft in promotion of osteogenesis.

Animals↗