A novel "in-situ tulip-bud deployment" method for transcatheter closure of secundum atrial septal defect.

OBJECTIVE: We devised a new technique for interventional closure of atrial septal defect (ASD) using the Amplatzer Septal Occluder (ASO), and validated this by comparing it with a cohort using the conventional method. BACKGROUND: Transcatheter closure of ASD is a widely accepted modality of treatment. Although the outcome is good, there are occasional technical difficulties encountered. METHOD: In this three-step technique, the device is protruded to form a "tulip bud." This "tulip bud" is then aligned adjacent to and along the plane of the ASD. The second step involves withdrawing the sheath in quick succession to deploy atrial discs over the septal defect. Finally, good placement of the occluder is checked before release. RESULTS: Twenty-seven consecutive patients (1.4-77.2 years of age, median = 15) underwent device closure by this method. Nineteen (70.4%) had a deficient aortic rim (< 5 mm). Mean (+/- SD) ASD size by transesophageal echocardiography (TEE) was 16.0 +/- 5.1 mm. The chosen ASO size was 122 +/- 8% of the ASD size. The mean (+/- SD) duration of deployment and of deployment to release was 1.27 +/- 1.91 minutes and 5.18 +/- 2.63 minutes, respectively. The total fluoroscopy and procedure time was 9.93 +/- 5.61 minutes and 68.67 +/- 28.39 minutes, respectively. Twenty-one out of 27 patients (77.8%) had closure in one attempt. Comparing these 27 patients with the previous 48 consecutive patients with a deficient aortic rim by the conventional method, there was no difference in age, body weight, Qp/Qs, ASD size and ASO size or degree of oversizing (p > 0.05). The percentage of patients with aortic root deficiency was slightly higher in "tulip-bud" group compared to the conventional group (63.2% vs. 58.4%; p = 0.039). No complications were observed in either series. CONCLUSION: This is a promising new method to circumvent some of the difficulties associated with closure of large ASDs and deficient aortic rim.

Cardiovascular risks associated with obesity in children and adolescents.

INTRODUCTION: The aim of this paper is to review the cardiovascular (CVS) risks associated with obesity in children and adolescents. Both short-term and long-term CVS consequences, the mechanisms of how these develop and the measures that can alter or reverse these CVS events are reviewed. MATERIALS AND METHODS: Selected publications include original articles and review papers that report on studies of CVS risks and consequences related to childhood obesity. Some papers that contain data from adults studies are also included if the contents help to explain some underlying mechanisms or illustrate the continuation of related CVS changes into adulthood. RESULTS: Obese children and adolescents have an increased risk for CVS complications that include elevation of blood pressure, clustering of CVS risk factors (Metabolic Syndrome), changes to arterial wall thickness, elasticity and endothelium, as well as changes in left ventricular structure and function. Some of these cardiovascular problems may be initiated or potentiated by obstructive sleep apnoea that can accompany obesity in children. Many of such changes have been noted to reverse or improve with weight reduction. CONCLUSIONS: Early development of CVS risks in obese children and the possible continuation of CVS complications into adulthood have been observed. Obstructive sleep apnoea in obese children can further contribute to such CVS risks. These findings underscore the importance of prevention of childhood obesity as a priority over management of obesity in children.

Plasma endotoxin and immune responses during a 21-km road race under a warm and humid environment.

INTRODUCTION: This study investigated the responses of plasma endotoxin and pro- and antiinflammatory cytokines during a 21-km road race in warm and humid conditions. The influence of carbohydrate-electrolyte (CE)-water (WA) drink mix ingested on leukocyte subset responses and the association between plasma lipopolysaccharide (LPS) concentration and fluid balance, exercise intensity, and body core temperature (Tc) were also studied. MATERIALS AND METHODS: Thirty runners provided blood samples before and after the half-marathon for leukocyte, LPS and cytokine analyses. Tc was measured by the ingestible telemetric temperature sensor and fluid intake and split-times were recorded at 3 km intervals. Exercise intensity was determined by matching running speed and heart rate during the race with the corresponding speed-oxygen uptake relationship and heart rate measured in the laboratory 2 to 6 weeks before the race. RESULTS: Plasma LPS concentration increased from 1.9 +/- 1.9 pg/mL before, to 2.5 +/- 1.9 pg/mL after running (P <0.05). Peak plasma LPS concentration was 7.5 pg/mL. Plasma IL-1beta and TNF-concentration did not change significantly, whereas significant increases in IL-10 (50%), IL-1ra (23.2%) and IL-6 (65.2%) were observed after the race. No significant correlation between plasma LPS concentration and exercise intensity, hydration and Tc was observed. CONCLUSION: Leukocyte subset responses were not related to the ratio of CE and water drink mix ingested. Running a half-marathon can induce mild endotoxaemia, which is not related to exercise intensity, fluid balance, and Tc responses. Mixing CE drink with water did not mitigate postexercise leukocytosis and lymphopenia.

Cardiac time intervals of normal fetuses using noninvasive fetal electrocardiography.

OBJECTIVES: To evaluate the fetal cardiac time intervals from the longitudinal analysis of noninvasive fetal electrocardiography (fECG) in normal pregnancies. METHODS: One hundred singleton pregnancies were examined in this longitudinal study. Cardiac time intervals were derived from fetal electrocardiograms obtained noninvasively using three electrodes placed on the maternal abdomen. The variables measured included the durations of the P wave, PR interval, QRS complex, QT interval and T wave. RESULTS: Success rates for detecting the P, QRS and T waves were 74.6, 91.0 and 79.3%, respectively. Cardiac time intervals were significantly influenced by fetal age. The mean P-wave duration increased from 43.9 (18--22 weeks) to 52.9 ms (>/=37 weeks) (p < 0.001). PR intervals were 102.1 and 110.1 ms, for fetuses at 18 to 22 and >/=37 weeks (p < 0.001), respectively. QRS intervals were 47.2 and 52.6 ms (p < 0.001), while QT intervals were 224.0 and 242.7 ms (p < 0.001), at 18 to 22 and >/=37 weeks respectively. From 18 to 22 weeks to >/=37 weeks, QT(c) values increased from 343.8 to 367.7 ms (p < 0.001), while T-wave durations increased from 123.8 to 152.4 ms (p < 0.001). CONCLUSIONS: Serial noninvasive fECG of normal fetuses from 18 to 41 weeks of gestation show good success rates of fECG detection. Cardiac time intervals generally increased with increasing gestational age.

Ventricular bigeminy misdiagnosed as fetal bradycardia by cardiotocography--the value of non-invasive fetal electrocardiography.

We document the value of non-invasive fetal electrocardiography (fECG) in a case of fetal arrhythmia in which an unnecessary cesarean section was almost performed. The fetal heart rate (fHR) was 60-70 beats per minute (bpm) on the cardiotocography (CTG), with occasional, sudden fluctuations to 130 bpm. This was probably a result of the technical limitations of the CTG.