Ethnic differences in fraction of exhaled nitric oxide and lung function in healthy young children.

Background: Ethnic differences in lung function in school-aged children and adults are well recognized, but little is known about such differences in preschool children. We investigated whether differences exist in fraction of exhaled nitric oxide (Feno), multiple-breath washout (MBW) indices, specific airways resistance (sRaw), and spirometry indices between healthy preschool children of South Asian and white European origin.

Methods: Feno, MBW indices (lung clearance index, functional residual capacity, conductive airways inhomogeneity, and acinar airways inhomogeneity), sRaw, and spirometry were measured in healthy South Asian and white children aged 4 to 6 years, and comparisons were made between the two groups.

Continuous transcutaneous submental electrical stimulation in obstructive sleep apnea: a feasibility study.

Background: The therapeutic value of transcutaneous electrical stimulation of the genioglossus muscle in patients with obstructive sleep apnea (OSA) to reduce sleep-disordered breathing is unclear.

Methods: Contraction of the genioglossus muscles during transcutaneous stimulation was investigated using ultrasonography in 11 healthy subjects (seven men, mean [SD] age 30 [6] years; BMI, 24.2 [3.

Low prevalence of fibrosis in thalassemia major assessed by late gadolinium enhancement cardiovascular magnetic resonance.

Background: Heart failure remains a major cause of mortality in thalassaemia major. The possible role of cardiac fibrosis in thalassemia major in the genesis of heart failure is not clear. It is also unclear whether cardiac fibrosis might arise as a result of heart failure.

Case report: Completely unroofed coronary sinus with a left superior vena cava draining into the left atrium studied by cardiovascular magnetic resonance.

A persistent left superior vena cava (LSVC) draining through a dilated coronary sinus into the right atrium is a relatively common congenital cardiovascular anomaly. It is readily identified by cardiovascular magnetic resonance (CMR). However, a LSVC draining into the left atrium (LA) and associated with unroofing of the coronary sinus, with resulting interatrial communication, is rare and may have important clinical consequences.

Myocardial T2* is not affected by ageing, myocardial fibrosis, or impaired left ventricular function.

Purpose: To evaluate the influence of alterations in myocardial structure and function from increasing age, myocardial fibrosis, or impaired left ventricular function on myocardial T2*.

Materials And Methods: Myocardial T2* was measured in 126 subjects without cardiac iron loading, of whom 63 were normals of varying ages, 39 were patients with impaired left ventricular function from various nonsiderotic cardiac causes, and 24 were patients with chronic myocardial infarction affecting the interventricular septum (where myocardial T2* measurements are normally made).

Results: The median (Q1, Q3) of myocardial T2* in the normals was 36.

Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis.

Aims: Multiple trials in patients with ST-segment elevation myocardial infarction (STEMI) compared early routine percutaneous coronary intervention (PCI) after successful fibrinolysis vs. standard therapy limiting PCI only to patients without evidence of reperfusion (rescue PCI). These trials suggest that all patients receiving fibrinolysis should receive mechanical revascularization within 24 h from initial hospitalization.

Percutaneous coronary intervention following thrombolysis: for whom and when?

Primary percutaneous coronary intervention (PPCI) is the treatment of choice for patients with ST segment elevation myocardial infarction (STEMI). In the attempt to reduce the unfavourable effects of time delays before PPCI, the administration of thrombolysis has been advocated (facilitated-PCI), but this treatment was shown to be ineffective and harmful, and should be avoided in patients who can receive PPCI promptly. Fibrinolysis is still indicated when PPCI is not available within 90-120 min but 1/3 of STEMI patients undergoing fibrinolysis does not show signs of reperfusion and even when reperfusion is achieved they have a considerable risk of death and recurrent MI.

Pulmonary regurgitation: the effects of varying pulmonary artery compliance, and of increased resistance proximal or distal to the compliance.

Background: Pulmonary regurgitation is common after repair of tetralogy of Fallot, predisposing to right ventricular dilatation and potentially fatal arrhythmias. Magnetic resonance studies of such patients led us to hypothesize that the amount of regurgitation, in the absence of an effective valve, depends on pulmonary arterial compliance and on the location of resistance relative to the compliance.

Methods And Results: Using a pre-existing mathematical model representing the cardiovascular system, removal of the virtual pulmonary valve gave a triphasic pulmonary artery flow curve similar in shape to those recorded in patients with free regurgitation, with a regurgitant fraction of 30%.

Cystic lung lesions - prenatal diagnosis and management.

With increasing use of fetal ultrasound comes an increase in the detection of clinically silent 'abnormalities' which pose diagnostic and management dilemmas for perinatologists and paediatricians. Congenital thoracic malformations (CTMs) (excluding congenital diaphragmatic hernia) are one such example, where a few cases are symptomatic in early life and management options are clear, but the majority are clinically asymptomatic, giving rise to difficulties in defining postnatal management of the well child with a sonographic or radiological lesion. Here, we will outline the prenatal presentation and natural history of CTMs that are not congenital diaphragmatic herniae and briefly discuss the approach to postnatal management, which is covered in more detail in the review by Laje and Liechty in this issue.

Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial.

Background: Thrombolysis remains the treatment of choice in ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be done within 90 min. However, the best subsequent management of patients after thrombolytic therapy remains unclear. To assess the best management, we randomised patients with STEMI treated by thrombolysis and abciximab at a non-interventional hospital to immediate transfer for PCI, or to standard medical therapy with transfer for rescue angioplasty.

Heavily calcified coronary lesions preclude strut apposition despite high pressure balloon dilatation and rotational atherectomy: in-vivo demonstration with optical coherence tomography.

Heavily calcified lesions (HCL) continue to present challenges that are not always solved by modern low-profile, non-compliant high-pressure balloons, or bladed balloons. Uncrossable or unexpandable lesions need lesion modification, using ablating devices such as rotational atherectomy. Three cases of HCL treated with drug-eluting stents, using a new intravascular imaging device, Optical Coherence Tomography with 10-fold superior resolution and fewer artifacts compared with conventional intravascular ultrasound, are presented.

Myocardial tissue characterization and the role of chronic anemia in sickle cell cardiomyopathy.

Purpose: To use cardiovascular magnetic resonance (CMR) techniques to examine possible causes for the left ventricular (LV) dilatation that occurs in sickle cell disease (SCD), including the effects of chronic anemia, iron-induced cardiomyopathy, and regional fibrosis due to sludge infarcts that occur during sickle crises.

Materials And Methods: A total of 47 patients with sickle cell anemia were assessed for LV function and myocardial iron levels using CMR measurements; 30 of these were also assessed for regional fibrosis using late gadolinium-enhancement CMR. The LV function was compared to both normal controls and transfusion dependent non-iron-loaded (NIL) thalassemia major (TM) patients.

Black-blood T2* technique for myocardial iron measurement in thalassemia.

Purpose: To compare the effectiveness and reproducibility of a new black-blood sequence vs. a conventional bright-blood gradient-echo T2* sequence for myocardial iron overload measurement in thalassemia.

Materials And Methods: Twenty thalassemia patients were studied.

Normalized left ventricular volumes and function in thalassemia major patients with normal myocardial iron.

Purpose: To determine the reference range in thalassemia major (TM) for left ventricular (LV) function.

Materials And Methods: We used cardiovascular magnetic resonance (CMR) to measure heart volumes and function in 81 TM patients with normal myocardial T2* measurements (T2* > 20 msec) and by inference without excess myocardial iron. Forty age- and gender-matched healthy controls were also studied.

Geometry of the left ventricular outflow tract in fixed subaortic stenosis and intact ventricular septum: an echocardiographic study in children and adults.

Objective: We compared the echocardiographic geometry of the preoperative and postoperative left ventricular outflow tract in children and adults with isolated fixed subaortic stenosis with age- and weight-matched controls to elucidate whether the geometry can be modified when surgical intervention is performed at a younger age.

Methods: The mitral-aortic valve distance, aortic valve diameter, aorto-left ventricular septal angle, degree of aortic valve dextroposition, aortic valve-subaortic stenosis distance, width of left ventricular outflow tract, left ventricle wall thickness, and septal thickness were determined preoperatively and postoperatively in 21 patients and 21 controls. The measurements were indexed to body surface area.

Genetic factors in pulmonary fibrotic disorders.

Identifying genetic determinants of pulmonary fibrotic disorders remains at an early stage of evolution. It is now well-recognized that "pulmonary fibrosis" covers a broad range of lung diseases, including most topically the idiopathic interstitial pneumonias that have been classified recently. Additionally, it is recognized that the fibrosing lung disorders that are seen in the rheumatological diseases, notably systemic sclerosis, are quite different from those of the idiopathic variety.

Development of a novel optimized breathhold technique for myocardial T2 measurement in thalassemia.

Purpose: To develop a reproducible fast spin-echo (FSE) technique for accurate myocardial T2 measurement with application to iron overload assessment in thalassemia.

Materials And Methods: An FSE sequence was developed to permit acquisition of multiple TE images in one breathhold (BH-FSE). A dynamic black-blood scheme was introduced to better cancel blood signal.

Current developments in the treatment of pulmonary disease in patients with cystic fibrosis.

Cystic fibrosis is a genetic disease that affects one in 2500 live births. A basic defect in chloride transport leads to impaired clearance of airway secretions and a susceptibility to bacterial infection. Once infection is established there is a vicious cycle that leads to progressive inflammation and infection.

Left ventricular diastolic function compared with T2* cardiovascular magnetic resonance for early detection of myocardial iron overload in thalassemia major.

Purpose: To compare left ventricular (LV) diastolic function with myocardial iron levels in beta thalassemia major (TM) patients, using cardiovascular magnetic resonance (CMR).

Materials And Methods: We studied 67 regularly transfused patients with TM and 22 controls matched for age, gender, and body surface area. The early peak filling rate (EPFR) and atrial peak filling rate (APFR) were determined from high-temporal-resolution ventricular volume-time curves.

Electromechanical left ventricular resynchronisation by coronary artery bypass surgery.

Objective: In patients with coronary artery disease (CAD), the normal electromechanical response to dobutamine stress is deranged: QRS duration lengthens rather than shortens, left ventricular asynchrony develops, post-ejection shortening appears, and total isovolumic time (the time in the cardiac cycle when the ventricle is neither ejecting nor filling) increases rather than falls, all of which blunt the normal rise in cardiac output. We aimed to study the effect of revascularisation on these stress-induced electromechanical abnormalities and their effect on peak cardiac output after coronary artery bypass grafting (CABG).

Method: 20 unselected patients were studied before and after CABG.