ABSTRACT
BACKGROUND: In a cohort of congenitally corrected transposition of the great arteries (cc-TGA) and transposition of the great arteries after atrial switch procedure (d-TGA) the study objectives were: 1) to assess the change of quantitative systemic right ventricle (sRV) parameters over time and; 2) to examine the relationship of quantitative sRV parameters with adverse clinical outcomes. METHODS AND RESULTS: Single-center cohort study that included 49 (39%) cc-TGA and 76 (61%) d-TGA patients >18years who had at least one MUGA sRV assessment, 18/39 had more than one respectively. The primary clinical endpoint was all-cause mortality, heart transplantation and/or heart failure hospitalization. At a median clinical follow-up of 7years following the first MUGA, the primary endpoint occurred more often in cc-TGA versus d-TGA patients (18 (36.7%) vs. 9 (11.8%), p=0.03). Median time between the MUGA assessments was 5.8 (cc-TGA) and 4.9years (d-TGA). At last MUGA follow-up: 6 (33%) cc-TGA/14 (36%) d-TGA patients showed a significant decline in sRVEF (>5%); 6 (33%) cc-TGA/17 (44%) d-TGA patients had a significant increase in sRVEDVi; and 7 (39%) cc-TGA/19 (49%) PA-TGA patients had a significant increase in sRVESVi. Baseline sRV parameters were not associated with the primary end point or sRV changes over time. CONCLUSIONS: An important proportion of both patient cohorts demonstrated a significant change in sRV parameters over time and these are likely related to multiple factors that vary between individuals given population heterogeneity. The TGA patients have distinct clinical trajectories with increased adverse heart failure outcomes in the cc-TGA population and sRV parameters were not related to adverse heart failure events in either group.
Subject(s)
Transposition of Great Vessels/diagnostic imaging , Transposition of Great Vessels/mortality , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/mortality , Adult , Cohort Studies , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Middle Aged , Mortality/trends , Transposition of Great Vessels/surgery , Treatment OutcomeSubject(s)
Biopsy/adverse effects , Cervix Uteri/surgery , Adult , Age Factors , Carcinoma in Situ/diagnosis , Female , Hospitalization , Humans , Length of Stay , Methods , Middle Aged , Patient Readmission , Postoperative Complications , Pregnancy , Pregnancy Complications/surgery , Suture Techniques , Time Factors , Uterine Cervical Diseases/diagnosis , Uterine Cervical Diseases/surgery , Uterine Cervical Neoplasms/diagnosis , Uterine Hemorrhage/etiology , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/therapeutic useABSTRACT
The number of therapeutic abortions performed at the Vancouver General Hospital in 1969 was double the average number for the previous four years and in 1970 the total reached 1465. The more liberal attitude towards abortion has resulted in a decided reduction in the number of children available for adoption in the community. This policy has required a streamlining of the duties of the Therapeutic Abortion Committee and an alteration in the pattern of bed and operating-room utilization. By far the greatest number of abortions were performed on psychiatric-social grounds. The complication rate of 17% was influenced chiefly by the advanced duration of the gestation in a high proportion of cases. Gynecologists and hospitals must be prepared to assume their altered role in providing abortion and sterilization in today's society.
