Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder.

Introduction: Endoscopic techniques are now considered the first-line approach for the management of bariatric surgery-related fistulas. The off-label use of cardiac septal defect occluders (CSDO) is an emerging technique that has demonstrated favorable outcomes for the closure of extravascular defects, including gastrointestinal (GI) disruptions. Previous case reports have reported similar results with the CSDO Amplatzer™ for the management of GI disruptions following bariatric surgery.

Percutaneous Closure of Ductus Arteriosus in Preterm Babies: The Initial Brazilian Experience.

Background: The presence of patent ductus arteriosus can be as high as 50% in preterm babies. Hemodynamically significant patent ductus arteriosus is a common cause of delayed weaning of respiratory support and an important risk factor of necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia in this population.

Objective: The aim of this study is to describe an initial experience of percutaneous closure of the ductus arteriosus in preterm infants weighing less than 2 kg.

Standardizing Radiation Exposure during Cardiac Catheterization in Children with Congenital Heart Disease: Data from a Multicenter Brazilian Registry.

Background: In recent years the increasing number of interventional procedures has resulted in growing concerns regarding radiation exposure for patients and staff. The evaluation of radiation exposure in children is difficult due to the great variability in body weight. Therefore, reference levels of radiation are not well defined for this population.

A comparison of radiation dose between standard and 3D angiography in congenital heart disease.

Background: The use of three-dimensional rotational angiography (3D-RA) to assess patients with congenital heart diseases appears to be a promising technique despite the scarce literature available.

Objectives: The objective of this study was to describe our initial experience with 3D-RA and to compare its radiation dose to that of standard two-dimensional angiography (2D-SA).

Methods: Between September 2011 and April 2012, 18 patients underwent simultaneous 3D-RA and 2D-SA during diagnostic cardiac catheterization.

From bare to covered: 15-year single center experience and follow-up in trans-catheter stent implantation for aortic coarctation.

Background: Bare stents has become the first line therapy for aortic coarctation. Covered stents has been reported more recently in clinical practice.

Objectives: The present study, reports comparatively 15-year experience of bare and covered stent implantation for aortic coarctation in a single tertiary referral center.

Source effects in analyzer-based X-ray phase contrast imaging with conventional sources.

Several recent papers have shown the implementation of analyzer based X-ray phase contrast imaging (ABI) with conventional X-ray sources. The high flux is always a requirement to make the technique useful for bio-medical applications. Here, we present and discuss three important parameters, which need to be taken into account, when searching for the high flux ABI: anisotropic magnification, double image, and source size spread due to intrinsic dispersive diffraction by asymmetrically cut crystals.

Fetal ductal constriction caused by maternal ingestion of green tea in late pregnancy: an experimental study.

Objectives: The aim of this study was to test the hypothesis that experimental maternal intake of green tea in late pregnancy causes fetal ductus arteriosus constriction, probably because of prostaglandin inhibition.

Methods And Results: Twelve fetal lambs (pregnancy > 120 days) were assessed before and after maternal administration of green tea (n = 8) or water (n = 4; controls) as the only source of liquid. After 1 week, echocardiography showed signs of constriction of the ductus arteriosus in all fetuses from mothers ingesting green tea, with increase in mean systolic velocity(from 0.

The use of a wire control catheter to treat complex pulmonary artery or vein anatomy.

The difficult performance of certain percutaneous interventions in the field of congenital heart disease is well known. Crossing pulmonary arteries in patients who have previously undergone surgical repair or stenotic pulmonary veins in infants can be typical examples of these technical challenges in the catheterization laboratory. The Venture wire 6 Fr control catheter (St Jude Medical) is compatible with a steerable tapered radiopaque tip that can be manually angulated (up to 90°) by clockwise rotation of a knob located in the proximal handle.

Covered-stent implantation to treat aortic coarctation.

Aortic coarctation comprises approximately 7% of all known congenital heart defects. Surgery and balloon angioplasty have been performed for many years but are associated with a significant incidence of recoarctation and aneurysm formation. Although bare-stent implantation decreases the incidence of recoarctation, the risk of aortic dissection or aneurysm formation is not eliminated.

Reversal of fetal ductal constriction after maternal restriction of polyphenol-rich foods: an open clinical trial.

Objective: To test the hypothesis that maternal restriction of polyphenol-rich foods (PRF), which, like non-steroidal anti-inflammatory drugs (NSAID), inhibit prostaglandin synthesis in the third trimester, reverse fetal ductal constriction (DC).

Study Design: An open clinical trial of 51 third trimester fetuses with DC with no history of NSAID intake was designed. All mothers were submitted to a food frequency questionnaire and were oriented to withdrawl PRF, being reassessed after 3 weeks.

Aortic isthmus blood flow in fetuses of diabetic mothers.

Objective: To test the hypothesis that the aortic isthmus flow index (IFI) is lower in fetuses of diabetic mothers than in fetuses of nondiabetic mothers.

Study Design: We performed a cross-sectional observational study to assess the IFI in fetuses, with (n = 13) and without (n = 37) myocardial hypertrophy, of mothers with diabetes mellitus and in fetuses of nondiabetic mothers (n = 23). Analysis of variance and Tukey test were used to assess differences among the groups.

Balloon aortic valvuloplasty for congenital aortic stenosis using the femoral and the carotid artery approach: a 16-year experience from a single center.

Objectives: The aim of this article is to report a 16-year experience with percutaneous balloon aortic valvuloplasty (BAVP) in newborns and young infants up to 3 months of age in a tertiary care cardiac reference center in a developing country and to determine its value in postponing open heart surgery.

Background: Congenital aortic stenosis (AS) is a potentially life threatening disorder. BAVP and surgical procedures have similar short and medium-term efficacy.

New insights on fetal ductal constriction: role of maternal ingestion of polyphenol-rich foods.

Fetal ductus arteriosus constriction is a clinical disorder that occurs as a result of inhibition of the prostaglandin synthesis pathway, and has long been associated to maternal intake of nonsteroidal antiinflammatory drugs in late pregnancy. As a consequence of an increased right ventricular pressure, with tricuspid regurgitation and heart failure, there is a risk for the development of neonatal pulmonary artery hypertension. This article reviews the basic knowledge of the mechanisms involved in this important disorder.

Relief of severe immediate postoperative superior vena cava stenosis with covered stent: case report with midterm follow up.

Sinus venous atrial septal defects are commonly associated with abnormal pulmonary venous connection. Numerous surgical techniques have been proposed with excellent short- and long-term outcomes. Pulmonary and superior vena cava obstructions, as well as rhythm disturbances, are the most common problems seen during follow up.

Maternal consumption of polyphenol-rich foods in late pregnancy and fetal ductus arteriosus flow dynamics.

Objective: To test the hypothesis that maternal consumption of polyphenol-rich foods during third trimester interferes with fetal ductal dynamics by inhibition of prostaglandin synthesis.

Study Design: In a prospective analysis, Doppler ductal velocities and right-to-left ventricular dimensions ratio of 102 fetuses exposed to polyphenol-rich foods (daily estimated maternal consumption >75th percentile, or 1089 mg) were compared with 41 unexposed fetuses (flavonoid ingestion <25th percentile, or 127 mg).

Result: In the exposed fetuses, ductal velocities were higher (systolic: 0.

Myocardial tissue Doppler assessment of diastolic function in the growth-restricted fetus.

Objectives: Myocardial tissue Doppler (MTD) is a technique for the measurement of myocardial velocities in systole and diastole. This study evaluates the use of MTD in the assessment of cardiac diastolic function in fetuses with intrauterine growth restriction (IUGR) with placental insufficiency and in appropriate-for-gestational age (AGA) fetuses with hypertensive mothers.

Methods: This study included 14 IUGR fetuses with placental insufficiency (Group 1), 13 AGA fetuses with hypertensive mothers (Group 2), and 29 AGA fetuses with healthy mothers (Group 3).

Dynamics of the septum primum in fetuses with intrauterine growth restriction.

Purpose: To test the hypothesis that the linear displacement of the septum primum (SP) is lower in fetuses with intrauterine growth restriction (IUGR) than in fetuses with appropriate growth for gestational age (AGA).

Methods: In a cross-sectional study, the ratio between the SP displacement and left atrial diameter (excursion index [EI]) was compared in 27 fetuses with IUGR (group 1), 24 fetuses with AGA of hypertensive mothers (group 2), and 35 controls (group 3). Flow through the atrioventricular (AV) valves and the umbilical artery resistance index (RI) were also compared.

Left atrial shortening fraction in fetuses with and without myocardial hypertrophy in diabetic pregnancies.

Objective: To test the hypothesis that, in diabetic pregnancies, left atrial shortening fraction (LASF) is decreased in fetuses with myocardial hypertrophy, compared to those without hypertrophy and to fetuses of non-diabetic mothers.

Methods: Fetal echocardiography was performed in women with pre-existing or gestational diabetes and in non-diabetic controls between 25 weeks' gestation and term. LASF was calculated using the formula: (end-systolic diameter-end-diastolic diameter)/end-systolic diameter, and data were compared between diabetic women with and without fetal myocardial hypertrophy and controls.

Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler.

Objective: To identify the presence of ventricular diastolic dysfunction by tissue Doppler in fetuses of diabetic mothers, with or without septal hypertrophy, in comparison to fetuses of nondiabetic mothers.

Methods: A contemporary transverse study in fetuses with a gestational age between 25 weeks to term, studying diastolic function by assessment using tissue Doppler and pulsed wave Doppler of the atrioventricular diastolic flow. The mothers of the fetuses all had previous or gestational diabetes, and were referred to the Fetal Cardiology Unit of the Institute of Cardiology in Porto Alegre, Brazil.

Morphological basis for the study of the interatrial septum in the human fetus.

Objective: To describe morphological features of the interatrial septum in normal fetuses, especially foramen ovale (FO) and septum primum (SP), in order to compare septum primum excursion with foramen ovale diameter.

Methods: Septum primum excursion (SPE) toward the left atrium (LA) and foramen ovale diameter (FOD) were measured in the hearts of ten formaldehyde-fixed human fetuses ranging from 28 to 36 weeks of gestation. Histological sections were obtained from the foramen ovale (FO), septum primum (SP), septum secundum (SS), left atrium (LA), and right atrium (RA).

Effectiveness of acetylcysteine in prevention of contrast nephropathy.

Background: Acetylcysteine may provide prophylaxis against contrast nephropathy (CN) in some patients. Its benefit may vary according to the characteristics of patients and contrast used. The objective is to evaluate the effectiveness of oral acetylcysteine in preventing CN after coronary procedures in our practice.

Study of global left atrial shortening in fetuses of diabetic mothers.

Objective: To test the hypothesis that left atrial shortening fraction is lower in fetuses of diabetic mothers than in fetuses of mothers with no systemic disease.

Methods: Forty-two fetuses of mothers with previous diabetes or gestational diabetes and 39 healthy fetuses of mothers with no systemic disease (controls) underwent echocardiographic examination. Their gestational ages ranged from 25 weeks to term.

Mobility of the Septum primum does not depend on the foramen ovale diameter in normal fetuses.

Objective: To test the hypothesis that a correlation exists between the maximum foramen ovale diastolic diameter and the excursion index (EI) of the septum primum in normal fetuses.

Methods: One hundred and two normal fetuses with gestational ages ranging from 20 to 40 weeks were submitted to echocardiography. The foramen ovale diameter and the "maximal excursion" of the septum primum were measured in a 4-chamber view.

Ductus venosus flow and myocardial hypertrophy in fetuses of diabetic mothers.

Objective: To test the hypothesis that the pulsatility index of ductus venosus (PIDV) is greater in the fetuses of diabetic mothers (FDM) with myocardial hypertrophy (MH) than in the FDM with no MH and in the control fetuses of nondiabetic mothers (FNDM). Comparing the results with mitral and tricuspid diastolic peak flows.

Methods: The cross-sectional study included fetuses with gestational ages ranging from 20 weeks to term, divided into the following 3 groups: 56 FDM with MH (group I), 36 FDM with no MH (group II), and 53 FNDM (group III, control).

Pulmonary vein pulsatility in fetuses of diabetic mothers: prenatal Doppler echocardiographic study.

Objective: To verify the hypothesis that the pulmonary vein pulsatility index is higher in fetuses of diabetic mothers than it is in normal fetuses of nondiabetic mothers.

Methods: Twenty-four fetuses of mothers with either gestational or previous diabetes (cases), and 25 normal fetuses of mothers without systemic disease (control) were examined. Fetuses were examined through prenatal Doppler and color flow mapping.