Search

Cardiopulmonary bypass, the extreme of non-obstetric surgery during pregnancy, presents unique challenges to minimize maternal and fetal risk. We present our experience with a woman who was diagnosed with a left atrial myxoma following an ischemic cerebrovascular accident. We discuss clinical management specific to cardiopulmonary bypass during pregnancy and delivery in the context of a multidisciplinary team approach. We recommend using intermittent Doppler ultrasound as a non-invasive real-time assessment of uteroplacental perfusion during non-obstetric surgery in pregnancy. Monitoring of perfusion facilitates active feedback for appropriate in utero resuscitation in these cases.

Sustained Ca2+ burst signaling is crucial for endothelial vasodilator production and is disrupted by growth factors and cytokines. Conjugated linoleic acid (CLA), a Src inhibitor in certain preparations, is generally regarded as safe during pregnancy by the FDA. Multiple CLA preparations; t10, c12 or c9, t11 CLA, or a 1:1 mixture of the two were administered before growth factor or cytokine treatment. Growth factors and cytokines caused a significant decrease in Ca2+ burst numbers in response to ATP stimulation. Both t10, c12 CLA and the 1:1 mixture rescued VEGF165 or TNFα inhibited Ca2+ bursts and correlated with Src-specific phosphorylation of connexin 43. VEGF165, TNFα, and IL-6 in combination at physiologic concentrations revealed IL-6 amplified the inhibitory effects of lower dose of VEGF165 and TNFα. Again, the 1:1 CLA mixture was most effective at rescue of function. Therefore, CLA formulations may be a promising treatment for endothelial dysfunction in diseases such as preeclampsia.

Patients with diabetes mellitus (DM) have poorer outcomes after percutaneous coronary intervention than those without diabetes. We evaluate the 2-year safety and efficacy profile of the Abluminus DES+ in patients with diabetes within the population enrolled in the large multicenter en-ABL e-registry

In-stent restenosis is associated with high recurrences after implantation of a DES. The drug-coated balloon is a novel approach to treat in-stent restenosis characterized by the absence of an additional metal scaffold at lesion site. The aim of this study is to assess the safety and efficacy of

Drug-coated balloons are developed to address the in-stent restenosis (ISR) and stenosis in small coronary vessels. The present study aimed to investigate the immediate performance, mid and long-term results of Magic touch Sirolimus coated balloon (SCB) (Concept Medical) for the treatment coronary

This registry aims to evaluate the safety and effectiveness of the sirolimus eluting stent with unique fusion coating (coated on stent and exposed parts of balloon), Abluminus DES+ (Envision Scientific), in all-comers real-world population. This prospective, multi-centre, real world, all-comers

The aim of this registry is to evaluate the clinical performance the Abluminus DES+ (Envision Scientific), Novel Abluminal coated sirolimus eluting stent coated on stent and parts of balloon in a large patient population. Between January 2012 and October 2017, 2372 patients were enrolled

Over past the decade, drug-coated balloons have emerged as an effective treatment for coronary stenosis with and advantage of delivering the anti-proliferative agent to the clogged vessel without any metallic implant. We sought to assess the world’s first sirolimus-coated balloon (SCB) -Magictouch

Objective: We sought to examine the current perinatal correlates and neonatal morbidity associated with intrauterine growth failure among neonates born at term gestation. Study Design: We compared 372 small for gestational age (SGA, birth weight

Hypertensive disorders of pregnancy are prototypical of maternal conditions associated with reduced uteroplacental blood flow. Hypertensive disorders in pregnancy include chronic hypertension, preeclampsia-eclampsia, superimposed preeclampsia, and gestational hypertension. Pathophysiology of these disorders include deficient uterine vascular modeling in the process of placentation and aberrations of vasomotor regulation. Aberrations of uterine renin-angiotensin system may play a proximate role in the pathogenesis of preeclampsia syndrome. Clinical manifestations are explained in this review based on resultant vasoconstriction and ischemia in systemic and regional circulations. Perinatal implications of hypertensive disorders both in terms of early neonatal outcome and long-term neurodevelopmental effects are described. Methods of antenatal assessment of the fetus and, briefly, principles of clinical management are described.

Objectives We evaluated role of sFlt-1 and VEGF in a preeclampsia model driven by RAS activation. We hypothesized as transgenic crossbreeds develop preeclampsia, features of hypertension, proteinuria, kidney and placenta end-organ damage will occur concurrently with (1) sFlt1 rising higher in preeclamptic mice, (2) VEGF remaining high in preeclamptic mice but equivalent to controls; and, (3) preeclamptic kidneys demonstrating increased VEGF binding. Methods Transgenic hAGT and hREN, or wild type (WT) mice were used. Non-gravid females underwent telemetric transmitter implantation for blood pressure (BP) measurements. Mice were cross-bred: hAGT × hREN for RAS preeclamptic model and pregnant controls (WT × WT). Blood and urine collected on days (GD) 12, 15, and 18. Vascular reactivity in mesenteric arteries investigated by wire myography using KCl, acetylcholine (ACH), phenylephrine (PE). ELISA performed on urine for albumin and on plasma for VEGF and sFlt-1. Necropsies were performed GD 18-19. Kidneys and placenta were sectioned for HE and immunostain. Results 11 RAS pregnancies and 9 WT pregnancies (WTP) compared. 12,414 h of BP data analyzed. RAS mice demonstrated higher BP and proteinuria. RAS mice had glomerular endotheliosis (80% vs. 11%; p = 0.02), and placental necrosis (60% vs. 0%; p Conclusions While RAS model of preeclampsia recapitulates human preeclamptic state with high fidelity, renal injury may actually be mediated by increased VEGF binding. Disclosures J.M. Denney: None. C.E. Shaw: None. A. Gendron-Fitzpatrick: None. I. Bird: None. D. Shah: None.

The output of water from conventional and experimental humidification devices was determined under conditions similar to those encountered by a patient who is intubated and spontaneously breathing. Absolute humidity was measured by a modified dewpoint hygrometer, and relative humidity at 37°C was then calculated. Only two of the unheated pneumatic nebulizers tested were capable of delivering near 100 percent relative humidity at 37°C, while both ultrasonic nebulizers tested were able (at maximum outputs) to more than double this humidity content. An external heat source was necessary to increase the water content of gases delivered from pure humidifiers (no particulate water output) to above 50 percent relative humidity at 37°C. No correlation could be made between visible fog and actual water content in the humidified gases. Frequent changes in control were necessary to maintain a constant output when the heated humidifier was run continuously for a six-hour period, while prolonged warm-up periods were necessary prior to achieving stable outputs when the ultrasonics were so tested. The most efficient unheated pneumatics, however, maintained a stable and satisfactory output throughout the six-hour test period. It was concluded that the newer pneumatically driven, unheated nebulizers are capable of delivering gases with nearly 100 percent relative humidity at 37°C, therefore eliminating the need for heated or ultrasonically driven nebulizers for routine clinical use.