Optimizing Surgical Selection for Transposition With Left Ventricular Outflow Tract Obstruction.

BACKGROUND: Studies that have assessed the Rastelli and Nikaidoh operations for transposition of the great arteries (TGA) with obstructed left ventricular outflow tract obstruction (LVOTO) have not fully evaluated the anatomic drivers that may contribute to surgical selection. We present our procedural selection process for optimizing outcomes of complex TGA in the modern era. METHODS: This is a single-center, retrospective study that included pediatric patients who underwent either a Nikaidoh or Rastelli operation for the treatment of TGA-LVOTO, congenitally corrected TGA-LVOTO, or double-outlet right ventricle TGA type-LVOTO from June 2004 to June 2021. RESULTS: There were 34 patients stratified by Nikaidoh (n = 16) or Rastelli (n = 18) operation. The incidence of all postoperative complications and mortality was low, and the incidence of complications between the groups was similar. Patients were more likely to have undergone a Nikaidoh than a Rastelli if they had a pulmonary annulus >5 mm (87.5% vs 11.1%), anteriorly/posteriorly oriented great vessels (88% vs 8%), remote (80% vs 11%) or restrictive (75% vs 6%) ventricular septal defect, and right ventricular hypoplasia (50% vs 0%; all, P < .05). The resulting rates of reoperation were similar between the groups (44.0% vs 37.5%; P = .24) and largely composed of conduit replacements in the Rastelli patients and valvular repairs or replacements in the Nikaidoh group. Rates of catheter-based interventions were also similar. CONCLUSIONS: These findings suggest that for the optimal treatment of conotruncal anomalies with discordant ventriculoarterial connections, procedural selection should be based on pathoanatomic criteria that can ensure patients undergo the operation most suited to their anatomy.

Differential Expression of miRNAs Contributes to Tumor Aggressiveness and Racial Disparity in African American Men with Prostate Cancer.

Prostate cancer is the leading cancer in incidence and second leading cause of cancer mortality in US men. African American men have significantly higher incidence and mortality rates from prostate cancer than European American men. Previous studies reported that the disparity in prostate cancer survival or mortality can be explained by different biological backgrounds. microRNAs (miRNAs) regulate gene expression of their cognate mRNAs in many cancers. Therefore, miRNAs may be a potentially promising diagnostic tool. The role of miRNAs in prostate cancer aggressiveness and racial disparity has not been fully established. The goal of this study is to identify miRNAs associated with aggressiveness and racial disparity in prostate cancer. Here we report miRNAs that are associated with tumor status and aggressiveness in prostate cancer using a profiling approach. Further, downregulated miRNAs in African American tissues were confirmed by qRT-PCR. These miRNAs have also been shown to negatively regulate the expression of the androgen receptor in prostate cancer cells. This report provides a novel insight into understanding tumor aggressiveness and racial disparities of prostate cancer.

Successful outcomes of surgery procedures in patient with Glanzmann´s Thrombasthenia

We report a 35-year-old female patient with Glanzmann's thrombasthenia (GT) and severe anemia due to abnormal uterine bleeding secondary to uterine myomatosis. She required several admissions of red blood cells and platelet transfusions. An elective subtotal hysterectomy with salpingo-oophorectomy was proposed and recombinant factor VII was required. Surgical and postoperative outcomes were successful, without surgical complications, bleeding, or hemogram alterations. 4 years later, she required tooth extraction because of periodontal disease and pulp necrosis. In Peru, reports of GT patients requiring major and minor surgical procedures are lacking, given the low disease prevalence and the difficulties related to surgery. The report of these successful cases becomes relevant to continue improving GT management.

Presentamos el caso de una paciente de 35 años con trombastenia de Glanzmann (GT) y anemia severa por sangrado uterino anormal secundario a miomatosis uterina. Requirió varias admisiones de transfusiones de glóbulos rojos y plaquetas. Se propuso histerectomía subtotal electiva con salpingo-ooforectomía y se requirió factor VII recombinante. Los resultados quirúrgicos y postoperatorios fueron exitosos, sin complicaciones quirúrgicas, sangrado ni alteraciones del hemograma. 4 años después, requirió extracción dental por enfermedad periodontal y necrosis pulpar. En Perú faltan reportes de pacientes con GT que requieran procedimientos quirúrgicos mayores y menores, dada la baja prevalencia de la enfermedad y las dificultades relacionadas con la cirugía. El reporte de estos casos de éxito cobra relevancia para seguir mejorando la gestión de GT

Assessment of the humoral response to the homologous Gam-COVID-Vac (Sputnik V) or heterologous Sputnik V/mRNA-1273 (Moderna) vaccination against SARS-CoV-2 in dialysis patients.

IntroductionThe humoral response to vaccines is the most used tool to evaluate the protection against SARS-CoV-2 infection. Dialysis patients are a high-risk population and have a reduced immune response to vaccination. ObjectiveTo assess the humoral response to homologous Gam-COVID-Vac (Sputnik V) and heterologous Sputnik V/mRNA-1273 (Moderna) vaccination in dialysis patients. MethodsSARS-CoV-2 anti-spike IgG (RBD) concentration was estimated 3-16 weeks after complete vaccination. Reactogenicity was evaluated until day 7 by patients s self-reported side events. Results107 participants were enrolled [n=84 homologous (SpV/SpV), n=23 heterologous (SpV/Mod)]. Median (IQR) age was 64 (50-75) years old and 79 (73.8%) were male. Additionally, 19 (22.6%) of the SpV/SpV and 4 (17.4%) of the SpV/Mod group had a prior confirmed SARS-CoV-2 infection (p=0.589). In the overall population, 103 patients reached seroconversion (96.3%). Anti-S-RBD IgG median titers (IQR) were higher in the heterologous [1222 (288-5680) BAU/mL] than in the homologous scheme [447 (100-1551) BAU/mL], p=0.022. In a linear model adjusted for age and gender, previous SARS-COV-2 infection (B: 1944.3; CI95: 1136.2-2753.4; p<0.001), and SpV/Mod vaccination scheme (B: 1241.5; CI95: 420.39-2062.6; p=0.003) were independently associated with anti-S-RBD levels. Finally, a higher frequency of adverse effects was associated with the heterologous scheme, although they were well tolerated by all individuals. ConclusionThe present study provides evidence that the homologous SpV/SpV and heterologous SpV/Mod schemes showed good efficacy and safety under dialysis conditions. These results could be useful for future vaccination strategies, especially aimed at this risk group.

Topical use of hyperoxygenated fatty acids decreases surgical site infection in patients following laparoscopic cholecystectomy. A randomized controlled trial.

BACKGROUND: To date, the topically effect of hyperoxygenated fatty acids (HOFA) on the control of surgical site infection (SSI) is still unclear. OBJECTIVE: To assess the effect of topical application of a HOFA solution on the umbilical trocar site after laparoscopic cholecystectomy on SSI. The occurrence of trocar site incisional hernia (TSIH) was also analyzed. METHODS: A prospective, double-blind, randomized trial was conducted in patients undergoing laparoscopic cholecystectomy, who also presented at least one of the following associated risk factors for SSI and TSIH such as Body Mass Index (BMI) above 30 kg/m2, Diabetes Mellitus (DM), age over 65 years and Chronic Obstructive Pulmonary Disease (COPD). Patients were randomly allocated to topical application of a HOFA solution (HOFA arm) or saline physiological solution (non-HOFA arm) during closure of the umbilical trocar site with a polypropylene mesh. SSI was the primary outcome. TSIH was also assessed as a secondary outcome. RESULTS: 103 patients were included, 51 (49.5%) in the HOFA group and 52 (50.5%) in the non-HOFA group. SSI rate was significantly lower in the HOFA group in comparison with the non-HOFA group (19.6% vs. 3.8%; p = 0.028). TSIH rates were similar in both groups (3.8% vs. 2%). Multivariate analyses showed that only HOFA decreased significantly SSI rate. CONCLUSION: Topical application of a HOFA solution at the umbilical trocar site after laparoscopy cholecystectomy decreased SSI rate.

Dysregulation of DNA Methylation and Epigenetic Clocks in Prostate Cancer among Puerto Rican Men.

In 2021, approximately 248,530 new prostate cancer (PCa) cases are estimated in the United States. Hispanic/Latinos (H/L) are the second largest racial/ethnic group in the US. The objective of this study was to assess DNA methylation patterns between aggressive and indolent PCa along with ancestry proportions in 49 H/L men from Puerto Rico (PR). Prostate tumors were classified as aggressive (n = 17) and indolent (n = 32) based on the Gleason score. Genomic DNA samples were extracted by macro-dissection. DNA methylation patterns were assessed using the Illumina EPIC DNA methylation platform. We used ADMIXTURE to estimate global ancestry proportions. We identified 892 differentially methylated genes in prostate tumor tissues as compared with normal tissues. Based on an epigenetic clock model, we observed that the total number of stem cell divisions (TNSC) and stem cell division rate (SCDR) were significantly higher in tumor than adjacent normal tissues. Regarding PCa aggressiveness, 141 differentially methylated genes were identified. Ancestry proportions of PR men were estimated as African, European, and Indigenous American; these were 24.1%, 64.2%, and 11.7%, respectively. The identification of DNA methylation profiles associated with risk and aggressiveness of PCa in PR H/L men will shed light on potential mechanisms contributing to PCa disparities in PR population.

Initial experience in Mexico with convalescent plasma in COVID-19 patients with severe respiratory failure, a retrospective case series

IntroductionHospital mortality due to COVID-19 in Mexico is high (32%) and as of today, effective treatment options are limited. More effective treatments that shorten hospital stay and reduce mortality are needed. Initial reports for the use of convalescent plasma (CP) therapy for COVID-19 appear promising. We describe a case series of eight patients with impending respiratory failure, who underwent CP therapy. MethodsSix male and two female (ages 31 to 79) patients that were admitted to the intensive-care unit for severe COVID-19 were transfused with two doses of CP (250 mL per dose, anti-SARS-CoV-2 IgG titers > 1:100). Donors were six SARS-CoV-2 infected males who remained asymptomatic for > 7 days and were negative for two nasopharyngeal RT-PCR tests. Clinical characteristics, inflammatory and cellular injury markers, chest X-ray findings and viral loads were analyzed before and after CP administration. Viral load association to disease severity was further analyzed on a separate cohort of asymptomatic vs hospitalized patients with COVID-19. ResultsEight patients with respiratory failure were successfully discharged with a median length of stay of 22.5 (IQR 18.25-29.00). After CP therapy, we observed a reduction of C-reactive protein (CRP) (median, 22.80 mg/dL vs. 1.63 mg/dL), and of procalcitonin (median, 0.27 ng/mL vs. 0.13 ng/mL). High-Sensitivity Cardiac Troponin I (hs-cTnI), Brain Natriuretic Peptide (BNP) and Lactate Dehydrogenase (LDH) were lower, and a mild reduction of pulmonary infiltrates by chest X-ray was observed. Lastly, a reduction of viral load was after CP therapy was found. (log, median [IQR], 1.2 [0.70-2.20] vs. 0.25 [0.00-1.78]). We observed no adverse effects. ConclusionsCP could potentially be an effective therapeutic option for patients with severe COVID-19. Clinical benefit needs to be studied further through randomized controlled trials.

Association Between ACEIs or ARBs Use and Clinical Outcomes in COVID-19 Patients: A Systematic Review and Meta-analysis

ImportanceThere is a controversy regarding whether or not to continue angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). ObjectiveTo evaluate the association between ACEIs or ARBs use and clinical outcomes in COVID-19 patients. Data SourcesSystematic search of the PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from database inception to May 31, 2020. We also searched the preprint servers medRxiv and SSNR for additional studies. Study SelectionObservational studies and randomized controlled trials reporting the effect of ACEIs or ARBs use on clinical outcomes of adult patients with COVID-19. Data Extraction and SynthesisRisk of bias of observational studies were evaluated using the Newcastle-Ottawa Scale. Meta-analyses were performed using a random-effects models and effects expressed as Odds ratios (OR) and mean differences with their 95% confidence interval (95%CI). If available, adjusted effects were pooled. Main Outcomes and MeasuresThe primary outcome was all-cause mortality and secondary outcomes were COVID-19 severity, hospital discharge, hospitalization, intensive care unit admission, mechanical ventilation, length of hospital stay, and troponin, creatinine, procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), and D-dimer levels. Results40 studies (21 cross-sectional, two case-control, and 17 cohorts) involving 50615 patients were included. ACEIs or ARBs use was not associated with all-cause mortality overall (OR 1.11, 95%CI 0.77-1.60, p=0.56), in subgroups by study design and using adjusted effects. ACEI or ARB use was independently associated with lower COVID-19 severity (aOR 0.56, 95%CI 0.37-0.87, p<0.01). No significant associations were found between ACEIs or ARBs use and hospital discharge, hospitalization, mechanical ventilation, length of hospital stay, and biomarkers. Conclusions and RelevanceACEIs or ARBs use was not associated with higher all-cause mortality in COVID-19. However, ACEI or ARB use was independently associated with lower COVID-19 severity. Our results support the current international guidelines to continue the use of ACEIs and ARBs in COVID-19 patients with hypertension. Key pointsO_ST_ABSQuestionC_ST_ABSWhat is the association between angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) use and clinical outcomes in coronavirus disease 2019 (COVID-19) patients? FindingsIn this systematic review and meta-analysis of 40 observational studies, the use of ACEIs or ARBs was not associated with higher all-cause mortality in COVID-19 patients. Additionally, ACEIs or ARBs use was independently associated with lower COVID-19 severity. MeaningThese results support the current international guidelines to continue the use of ACEIs and ARBs in COVID-19 patients with hypertension.

Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer

Purpose@#To study those factors that influence the occurrence of surgical complications and local relapse in patients intervened for breast cancer and receiving intraoperative radiotherapy. @*Methods@#Observational study on patients intervened for breast cancer with conservative surgery and intraoperative radiotherapy with low-voltage X-ray energy source (INTRABEAM), from 2015 to 2017 with 24 months minimum followup. Variables possibly associated to the occurrence of postoperative complications were analyzed with the Student t-test and the Fisher exact test; P < 0.05 considered significant. Subsequently, the construction of multiple multivariate analysis models began, thus building a logistic regression analysis using the IBM SPSS Statistics ver. 23 software. Local relapse was described. @*Results@#The study included 102 patients, mean age of 61.2 years; mean global size of tumor, 12.2 mm. Complications occurred in 29.4%. Fibrosis was the most frequently observed complication, followed by postoperative seroma. Using a 45 mm or larger applicator were significantly associated with the occurrence of complications. Tumor size 2 cm or larger and reintervention showed borderline significant association. Only one case of local relapse was observed. @*Conclusion@#Certain factors may increase the risk of complication after the use of intraoperative radiotherapy. Using external complementary radiotherapy does not seem to increase the rate of complications. Select patients and the involvement of a multidisciplinary team are essential for achieving good results.

Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer

Purpose@#To study those factors that influence the occurrence of surgical complications and local relapse in patients intervened for breast cancer and receiving intraoperative radiotherapy. @*Methods@#Observational study on patients intervened for breast cancer with conservative surgery and intraoperative radiotherapy with low-voltage X-ray energy source (INTRABEAM), from 2015 to 2017 with 24 months minimum followup. Variables possibly associated to the occurrence of postoperative complications were analyzed with the Student t-test and the Fisher exact test; P < 0.05 considered significant. Subsequently, the construction of multiple multivariate analysis models began, thus building a logistic regression analysis using the IBM SPSS Statistics ver. 23 software. Local relapse was described. @*Results@#The study included 102 patients, mean age of 61.2 years; mean global size of tumor, 12.2 mm. Complications occurred in 29.4%. Fibrosis was the most frequently observed complication, followed by postoperative seroma. Using a 45 mm or larger applicator were significantly associated with the occurrence of complications. Tumor size 2 cm or larger and reintervention showed borderline significant association. Only one case of local relapse was observed. @*Conclusion@#Certain factors may increase the risk of complication after the use of intraoperative radiotherapy. Using external complementary radiotherapy does not seem to increase the rate of complications. Select patients and the involvement of a multidisciplinary team are essential for achieving good results.

Rgnef promotes ovarian tumor progression and confers protection from oxidative stress.

Ovarian cancer is the fifth-leading cause of cancer death among women. The dissemination of ovarian tumors and growth as spheroids accompanies late-stage disease. In cell culture, ovarian tumor cell spheroids can exhibit elevated resistance to environmental stressors, such as reactive oxygen species. Homeostatic balance of the antioxidant response is a protective mechanism that prevents anoikis, a form of programmed cell death. Signaling pathways activated by integrin receptors suppress anoikis. Rgnef (ARHGEF28/p190RhoGEF) is a guanine nucleotide exchange factor that is activated downstream of integrins. We find that Rgnef protein levels are elevated in late-stage serous ovarian cancer, high Rgnef mRNA levels are associated with decreased progression-free and overall survival, and genomic ARHGEF28 loss is associated with increased patient survival. Using transgenic and transplantable Rgnef knockout mouse models, we find that Rgnef is essential for supporting three-dimensional ovarian spheroid formation in vitro and tumor growth in mice. Using RNA-sequencing and bioinformatic analyses, we identify a conserved Rgnef-supported anti-oxidant gene signature including Gpx4, Nqo1, and Gsta4; common targets of the NF-kB transcription factor. Antioxidant treatment enhanced growth of Rgnef-knockout spheroids and Rgnef re-expression facilitated NF-κB-dependent tumorsphere survival. These studies reveal a new role for Rgnef in ovarian cancer to facilitate NF-κB-mediated gene expression protecting cells from oxidative stress.

Efficacy of Acetic Acid or Chitosan for Reducing the Prevalence of Salmonella- and Escherichia coli O157:H7-Contaminated Leafy Green Plants in Field Systems.

Outbreaks associated with fresh-cut leafy greens continue to occur despite efforts to implement horticultural practices that minimize introduction of enteric pathogens to the crop. The experimental trials in this study were designed to examine the efficacy of an acetic acid (AA)- and chitosan-based spray treatment, applied 1 day prior to harvest, for reducing the prevalence of Escherichia coli O157:H7 (O157) and Salmonella in field-grown leafy greens contaminated at levels detectable only through enrichment culture. Responses to the treatment solution were variable and depended on the type of leafy green (leafy lettuce, spinach, or cabbage), cultivar, pathogen, and AA concentration (0.3 to 0.7%). No significant differences in E. coli O157 prevalence were found for untreated and treated cabbage heads and spinach plants (P > 0.05). In contrast, treatment significantly affected Salmonella on 'Bravo F1' green cabbage and '7-Green' spinach (P < 0.05), with odds ratios of 2.2 and 3.3 for finding the pathogen on untreated versus treated greens, respectively. Salmonella was also 7.1 times more likely to be found on an untreated lettuce plant than on a lettuce plant sprayed with a 0.7% AA treatment solution (95% confidence interval [CI], 4.1 to 12.2; P < 0.0001). In studies addressing the efficacy of chitosan (0.1 or 0.3%), this chemical failed to reduce the prevalence of either pathogen on lettuce (P > 0.05). Similarly, spraying with 0.3% AA did not affect the prevalence of Salmonella on lettuce plants (P > 0.05); however, treatment solutions with 0.4% AA reduced the likelihood of detecting Salmonella in treated versus untreated plants by 6.6 times (95% CI, 2.1 to 20.9; P = 0.0007). After the lettuce was harvested and hand washed, consumers failed to distinguish either visually or organoleptically between untreated lettuce and lettuce sprayed with an acetic acid solution (P > 0.05). These results indicate that acetic acid could be used to reduce the microbiological risk of preharvest leafy greens.

Pre-harvest internalization and surface survival of Salmonella and Escherichia coli O157:H7 sprayed onto different lettuce cultivars under field and growth chamber conditions.

Plant genotype has been advocated to have an important role in the fate of enteric pathogens residing in lettuce foliage. This study was therefore undertaken under the premise that different pathogen responses could occur in lettuce cultivars with cultivar selection being one of several hurdles in an overall strategy for controlling foodborne pathogens on field-grown produce. Up to eight lettuce cultivars ('Gabriella', 'Green Star', 'Muir', 'New Red Fire', 'Coastal Star', 'Starfighter', 'Tropicana', and 'Two Star') were examined in these experiments in which the plants were subjected to spray contamination of their foliage with pathogens. In an experiment that addressed internalization of Salmonella, cultivar was determined to be a significant variable (P < 0.05) with 'Gabriella' and 'Muir' being the least and most likely to exhibit internalization of this pathogen, respectively. Furthermore, antimicrobials (total phenols and antioxidant capacity chemicals) could be part of the plant's defenses to resist internalization as there was an inverse relationship between the prevalence of internalization at 1 h and the levels of these antimicrobials (r = -0.75 to -0.80, P = 0.0312 to 0.0165). Internalized cells appeared to be transient residents in that across all cultivars, plants sampled 1 h after being sprayed were 3.5 times more likely to be positive for Salmonella than plants analyzed 24 h after spraying (95% CI from 1.5 to 8.2, P = 0.0035). The fate of surface-resident Salmonella and Escherichia coli O157:H7 was addressed in subsequent growth chamber and field experiments. In the growth chamber study, no effect of cultivar was manifested on the fate of either pathogen when plants were sampled up to 12 days after spray contamination of their foliage. However, in the field study, five days after spraying the plants, Salmonella contamination was significantly affected by cultivar (P < 0.05) and the following order of prevalence of contamination was observed: 'Muir' < 'Gabriella' < 'Green Star' = 'New Red Fire' < 'Coastal Star'. Nine days after spray contamination of plants in the field, no effect of cultivar was exhibited due primarily to the low prevalence of contamination observed for Salmonella (8 of 300 plant samples positive by enrichment culture) and E. coli O157 (4 of 300 plant samples positive by enrichment culture). Given the narrow window of time during which cultivar differences were documented, it is unlikely that cultivar selection could serve as a viable option for reducing the microbiological risk associated with lettuce.

First Human Evaluation of Endothelial Healing after a Pipeline Flex Embolization Device with Shield Technology Implanted in Posterior Circulation Using Optical Coherence Tomography.

A 64-year-old female presented with an incidentally-discovered right posterior inferior cerebral artery (PICA) aneurysm, initially treated in 2015 by simple coiling. Follow-up demonstrated significant coil compaction that required retreatment. Retreatment was done uneventfully using a Pipeline embolization device (PED) shield deployed starting from the basilar artery and ending at the V4 segment of the vertebral artery. Eight-weeks post-deployment, a follow-up digital subtraction imaging (DSA) and intravascular imaging with optical coherence tomography were obtained. The intravascular imaging demonstrated that the flow diverter had good wall apposition and concentric neointimal growth over the braid with exception to the areas that the PED was not in contact with the endothelial wall, such as at the right PICA ostium and at the vertebrobasilar junction. The entire procedure was safe, and the patient had no complications. In this article, we describe for the first time the assessment of the status of endothelial "healing" of the PED shield at 8-weeks.

Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis.

Aims: The long-term outcomes of left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) have corroborated the significant role of the LAA in this arrhythmia. We sought to investigate the incremental benefit of LAAEI in patients undergoing catheter ablation for persistent AF or long-standing persistent AF (LSPAF). Methods and results: A systematic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed. The benefit of LAAEI in patients with AF was analysed from seven studies that enrolled a total of 930 patients [mean age 63 ± 5 years; male: 69%]. All studies included patients with either persistent AF or LSPAF or the combination of them. The overall freedom from all-arrhythmia recurrence at 12 months of follow-up off antiarrhythmic medications in patients who underwent LAAEI was 75.5% vs. 43.9% in those in whom only standard ablation was performed [56% relative reduction and 31.6% absolute reduction; risk ratio (RR) 0.44, 95% confidence interval (95% CI) 0.31-0.64; P < 0.0001]. The rate of ischaemic stroke in the LAAEI group was 0.4% and in the control group 2.1% at 12 months follow-up (RR 0.40, 95% CI 0.12-1.30; P = 0.13). Acute complications rates were identical between groups [LAAEI 5.5%, control 5.5% (RR 0.99, 95% CI 0.46-2.16; P = 0.99)]. Conclusion: Left atrial appendage electrical isolation in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of ischaemic stroke.

First Human Evaluation of Endothelial Healing after a Pipeline Flex Embolization Device with Shield Technology Implanted in Posterior Circulation Using Optical Coherence Tomography / 신경중재치료의학

A 64-year-old female presented with an incidentally-discovered right posterior inferior cerebral artery (PICA) aneurysm, initially treated in 2015 by simple coiling. Follow-up demonstrated significant coil compaction that required retreatment. Retreatment was done uneventfully using a Pipeline embolization device (PED) shield deployed starting from the basilar artery and ending at the V4 segment of the vertebral artery. Eight-weeks post-deployment, a follow-up digital subtraction imaging (DSA) and intravascular imaging with optical coherence tomography were obtained. The intravascular imaging demonstrated that the flow diverter had good wall apposition and concentric neointimal growth over the braid with exception to the areas that the PED was not in contact with the endothelial wall, such as at the right PICA ostium and at the vertebrobasilar junction. The entire procedure was safe, and the patient had no complications. In this article, we describe for the first time the assessment of the status of endothelial “healing” of the PED shield at 8-weeks.

Ablación de fibrilación auricular: primera serie colombiana de crioablación con balón / Atrial fibrillation ablation: first Colombian series of balloon cryoablation

Resumen Introducción: El aislamiento de las venas pulmonares mediante la crioablación con balón es una técnica innovadora para el manejo de la fibrilación auricular con una alta tasa de efectividad. Su reciente introducción y aprobación por el Instituto Nacional de Vigilancia de Medicamentos y Alimentos de Colombia en nuestro medio aporta una alternativa al aislamiento tradicional punto a punto con la radiofrecuencia. Métodos: A partir de mayo de 2014, todos los pacientes que fueron llevados a aislamiento de las venas pulmonares con la crioablación fueron registrados de manera prospectiva en un formulario previamente diseñado para tal fin. Resultados: Entre mayo de 2014 y agosto de 2015 se realizaron 31 procedimientos de la crioablación con balón en 31 pacientes (23 hombres, 74%) con una edad promedio de 59 ±11,4 años (rango de 34 a 72 años). La indicación más común fue la fibrilación auricular paroxística (23 pacientes, 74%), con 4 casos de la fibrilación auricular persistente (13%) en presencia de un corazón estructuralmente sano. El procedimiento tuvo una duración total de 152,6 ± 46,1 minutos con un tiempo de la fluoroscopia de 51± 16 minutos, observándose una disminución en los tiempos a medida que se progresó en la curva de aprendizaje. Tres de los 31 pacientes (9,7%) presentaron parálisis diafragmática; dos de ellos recuperaron la motilidad durante el mismo procedimiento y el otro paciente recuperó la motilidad al mes. Conclusiones: La crioablación es una técnica rápida y reproducible para el aislamiento de las venas pulmonares en un servicio de electrofisiología de alta complejidad. Con una curva de aprendizaje corta, es una alternativa valiosa al aislamiento eléctrico punto a punto con la radiofrecuencia, en un grupo con experiencia previa en el aislamiento de venas pulmonares por la técnica convencional de radiofrecuencia. La tasa de complicaciones menores fue comparable a lo reportado en la literatura y no se presentaron complicaciones mayores en este grupo inicial.

Abstract Introduction: Pulmonary vein isolation using balloon cryoablation is a innovative technique for managing atrial fibrillation with a high efficacy rate. Its recent introduction and approval by the Colombian National Institute for Medicine and Food Surveillance in our field offers an alternative to the traditional point-by-point radiofrequency isolation. Methods: Starting May 2014, all patients who underwent pulmonary vein isolation with cryoablation were registered prospectively in a form that had been previously designed specifically for this purpose. Results: Between May 2014 and August 2015, 31 balloon cryoablations were performed in 31 patients (23 men, 74%) with an average age of 59 ± 11.4 years (range from 34 to 72 years). The most frequent indication was paroxysmal atrial fibrillation (23 patients, 74%), with 4 cases of persistent atrial fibrillation (13%) in the presence of a structurally normal heart. The procedure lasted a total of 152.6 ± 46.1 minutes with a fluoroscopy time of 51 ± 16 minutes, observing a decrease in the time as the learning curve progressed. Three of the 31 patients (9.7%) developed diaphragmatic paralysis, two of whom recovered motility during the procedure and the other patient recovered motility after one month. Conclusions: Cryoablation is a fast and reproducible technique for pulmonary vein isolation in a high complexity electrophysiology service. With a short learning curve, it is a valuable alternative to point-by-point radiofrequency isolation, in a group with previous experience in pulmonary vein isolation by means of the traditional radiofrequency technique. Minor complications rate was similar to what was reported in literature and no major complications were developed in this initial group.

Ablación de taquicardia por reentrada intraauricular en paciente con circulación de Fontan / Ablation of tachycardia by intraatrial reentry in patient with Fontan circulation

Introducción y objetivos: La circulación de Fontan incrementa el riesgo de desarrollar arritmias a largo plazo, con importantes repercusiones sobre la morbilidad. La terapia médica es ineficiente en estas arritmias y los procedimientos de mapeo y ablación han tenido resultados variables. Se describe el caso de una paciente con circulación de Fontan quien desarrolló una taquicardia por reentrada intraauricular. Caso clínico: Paciente con antecedente de atresia tricuspídea y circulación de Fontan valorada por síncope, palpitaciones e intolerancia al ejercicio. Se documentó taquicardia por reentrada intraauricular que fue llevada a mapeo tridimensional y ablación exitosa. Discusión: Múltiples mecanismos arrítmicos complejos han sido descritos en los pacientes con circulación de Fontan. Típicamente se desarrolla una macrorreentrada auricular que tiene similitudes con el flutter auricular. El uso de tecnología con mapeo electroanatómico tridimensional ha permitido identificar y tratar de manera exitosa un número reducido de pacientes, como la presentada en este caso. Conclusiones: Las cardiopatías congénitas intervenidas con derivación de Fontan presentan arritmias auriculares de muy difícil manejo con medicamentos y tecnología convencional. El desarrollo tecnológico del mapeo tridimensional ha permitido conocer y entender de mejor manera los mecanismos de las arritmias en este tipo de circulación, lo que a su vez permite lograr el control definitivo mediante ablación.

Introduction and objectives: Fontan circulation increased long-term risk of developing arrhythmias, with significant impact on morbidity. The medical therapy is ineffective in these arrhythmias and mapping and ablation procedures have had varying results. A patient with Fontan circulation who developed tachycardia by intraauricular reentry is described. Case report: Patient with history of tricuspid atresia and Fontan circulation is assessed by syncope, palpitations and exercise intolerance. A tachycardia by intraauricular reentry was documented, and it was mapped and ablated successfully. Discussion: Multiple complex arrhythmic mechanisms have been described in patients with Fontan circulation. Typically, a macro reentrant that has similarities with atrial flutter develops. The use of technology that allow electroanatomical (three-dimensional) mapping has identified and successfully treated a small number of patients, as presented in this case. Conclusions: Congenital heart diseases treated with Fontan circulation have a significant prevalence of atrial arrhythmias very difficult to treat with medications and conventional technology. Technological developments in three-dimensional mapping and ablation have allowed to know and better understand arrhythmia's mechanisms in this type of circulation and as a result got a definitive control trough ablation.