Fetal pulmonary venous Doppler patterns in hypoplastic left heart syndrome: relationship to atrial septal restriction.

OBJECTIVE: Pulmonary venous Doppler (PVD) patterns are abnormal in fetuses with hypoplastic left heart syndrome (HLHS) with restricted foramen ovale (rFO) when compared with healthy fetuses. The objective of this study was to define PVD patterns in HLHS fetuses with an unrestricted or patent foramen ovale (pFO). DESIGN: 27 fetuses with HLHS and 66 healthy fetuses underwent echocardiography between 19 and 38 weeks of gestation. The pulmonary venous peak systolic (S), diastolic (D) and atrial reversal (A) velocities were measured; S/D ratio, velocity time integral of forward (VTI(f)) and reversed (VTI(r)) flows and VTI(r) expressed as percentage of VTI(f) (%R) were calculated. Independent examiners classified HLHS subjects into HLHS-pFO and HLHS-rFO (rFO or intact atrial septum). SETTING: Tertiary referral centre for paediatric cardiology. RESULTS: Compared with healthy controls, the HLHS-pFO group (n = 16) had higher S (32.9 (3.2) vs 23.5 (1.6) cm/s (adjusted mean (SE)); p = 0.01), A (10.5 (3.4) vs 0.17 (1.6) cm/s; p = 0.01), VTI(r) (0.78 (0.3) vs 0.01 (0.13) cm; p = 0.01) and %R (14.2% (3.2 %) vs -1.3% (1.5%); p<0.001). D velocity, S/D and VTI(f) showed no difference. In HLHS-rFO, further increase in S, A, VTIr and %R, decrease in D, increase in S/D and no change in VTI(f) were noted. CONCLUSIONS: PVD flow patterns are abnormal in HLHS even in the absence of rFO, suggesting that factors other than impaired left atrial egress play a role. Future studies of PVD patterns can provide important insights into left atrial dynamics, pulmonary venous return and pulmonary vascular development in fetal HLHS.

Altered prostaglandin E1 dosage during extracorporeal membrane oxygenation in a newborn with ductal-dependent congenital heart disease.

We describe a neonate with ductal-dependent congenital heart disease on extracorporeal membrane oxygenation (ECMO) for persistent pulmonary hypertension, who required markedly high doses of prostaglandin E1 (PGE1) to maintain patency of the ductus arteriosus: The effects of ECMO on the pharmacokinetics of PGE1 are discussed.

Expression and the role of cathepsin H in human glioma progression and invasion.

Proteinases and their inhibitors may play a role in the development and progression of many cancers. Several studies suggested that lysosomal proteinases cathepsin B, L, and D may be involved in the malignant progression of some human neoplastic diseases. In this study, we determined the levels of cathepsin H in human glioma progression and the significance of cathepsin H in glioma cell invasion. Levels of cathepsin H antigen were found to be significantly higher in glioblastomas and anaplastic astrocytoma when compared with normal brain tissue and low-grade gliomas. Western blotting confirmed the presence of authentic cathepsin H with a doublet at 27 and 25 kDa in normal brain tissue and tumor samples. However, the intensity of the band increased significantly in glioblastoma samples. Cathepsin H antibody inhibited the invasion of glioblastoma cell lines through Matrigel invasion assay. These data suggest that the tumor-specific increase in antigen may be a useful independent marker of tumor progression in central nervous system neoplasms.