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Background Pulmonary artery acceleration time (PAAT) is a noninvasive method to assess pulmonary hemodynamics, but it lacks validity in children. The aim of this study was to evaluate the accuracy of Doppler echocardiography–derived PAAT in predicting right heart catheterization (RHC)–derived pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), and compliance in children. Methods Prospectively acquired and retrospectively measured Doppler echocardiography–derived PAAT and RHC-derived systolic PAP, mean PAP (mPAP), indexed PVR (PVRi), and compliance were compared using regression analysis in a derivation cohort of 75 children (median age, 5.3 years; interquartile range, 1.3–12.6 years) with wide ranges of pulmonary hemodynamics. To account for heart rate variability, PAAT was adjusted for right ventricular ejection time and corrected by the RR interval. Regression equations incorporating PAAT and PAAT/right ventricular ejection time from the derivation cohort were then evaluated for the accuracy of their predictive values for invasive pulmonary hemodynamics in a validation cohort of 50 age- and weight-matched children with elevated PAP and PVR. Results There were significant inverse correlations between PAAT and RHC-derived mPAP ( r = −0.82) and PVRi ( r = −0.78) and a direct correlation ( r = 0.78) between PAAT and pulmonary compliance in the derivation cohort. For detection of pulmonary hypertension (PRVi > 3 Wood units · m 2 and mPAP > 25 mm Hg), PAAT r = 0.88 and r = 0.83, respectively), small biases ( Conclusions PAAT inversely correlates with RHC-measured pulmonary hemodynamics and directly correlates with pulmonary arterial compliance in children. The study established PAAT-based regression equations in children to accurately predict RHC-derived PAP and PVR.

We aimed to study the prevalence of metabolic syndrome (MetS) in adults with congenital heart disease (ACHD), the data on which is lacking. A retrospective analysis using the Explorys platform (IBM Inc.), which provides aggregated electronic medical record data for more than 63 million unique

A 64-year-old woman with paroxysmal atrial fibrillation (CHA2DS2-VASc score of 5 and HAS-BLED score of 5), cervical cancer status post-surgical resection followed by adjuvant abdominal radiation therapy, and recurrent gastrointestinal bleeding requiring frequent transfusions while on warfarin was

BACKGROUND CONTEXT Precontoured spinal rods are growing in their utilization for spinal deformity. Although there are theoretical advantages to precontouring rods, no previous studies have compared precontoured and manually contoured rods for their ability to maintain sagittal contour and resist mechanical load. PURPOSE To compare the biomechanical properties of roll-formed precontoured spinal rods with manually contoured rods of the same diameter. STUDY DESIGN/SETTING Biomechanical study utilizing a rigid, thoracolumbar spinal deformity model. OUTCOME MEASURES Load to reduction, rod plastic deformation METHODS A spinal deformity model was utilized, simulating a rigid, thoracolumbar spinal deformity fixated with pedicle screws. Roll-formed precontoured and manually contoured 5.5 mm and 6.0 mm cobalt chromium (Co-Cr) rods were reduced to the model with a load cell attached to the apical screw to measure reduction force. Rods remained reduced in the model for 20 minutes and change in contour was assessed to characterize plastic deformation. Reduction loads and plastic deformation was compared between rod groups using paired T-tests. RESULTS Twenty-four rods were tested with 6 rods per group. The load to reduction was significantly lower in the 5.5 mm rods compared to the 6.0 mm rods (95% C.I. -254.0 - -61.42; p=0.008). Although there was no difference in the load to reduction for manual and precontoured 5.5 mm rods (437.01 N vs 428.38 N; p=0.722), the precontoured 6.0mm rod required significantly less load to reduction compared to the manually contoured 6.0 mm rods (586.09 N vs 655.97 N; 95% C.I. -134.42 - -5.317; p=0.039). Additionally, rod contour for the manual group showed significantly less plastic deformation than the pre-contoured group in both 5.5mm and 6.0mm rods (5.5mm: 57.1% vs 61.6%, p=0.006; 6.0mm: 54.3% vs 62.28%, p=0.003). CONCLUSIONS Roll formed, precontoured Co-Cr rods demonstrated significantly greater plastic deformation when compared with manually contoured rods of the same diameter. Furthermore, 6.0mm precontoured rods required significantly lower load for rod reduction. Post-manufacturing, roll-formed pre-contouring of larger diameter Co-Cr may impair the rods mechanical properties. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.

Left atrial appendage (LAA) occlusion is a second line therapy for prevention of stroke in patients with atrial fibrillation (AF). Patients with limited femoral venous access may require alternative access approaches. A 64 YO female with paroxysmal AF (CHADS2-VASc score 5 and HAS-BLED score 5)

The term "biker couple" is becoming an increasingly common site in emergency departments. The purpose of this study was to identify orthopaedic and non-orthopaedic injury patterns among this unique patient group. A 14-year (1993–2006) retrospective review of a Level I Trauma Institute Registry was performed. Patient demographic and injury data were obtained from 21 confirmed biker couples ( n =42). Nineteen of 21 biker couple pairs (90.5%) included a male driver and a female passenger. Drivers were more likely to have a positive blood alcohol concentration/toxicology test. Drivers had a greater incidence of scapular and rib fractures than passengers. Both drivers and passengers who sustained scapular fractures had a greater incidence of clavicle, rib, pelvis, and fibula fractures. Drivers with scapular fractures had a greater incidence of thoracic spine fractures, while passengers with scapular fractures had a greater incidence of arm–forearm–wrist–hand, femur, tibia, and foot–ankle fractures. Overall, biker couple drivers and passengers did not differ for head injury, pulmonary system, road rash, aortic injury or visceral injury. Both drivers and passengers with scapular fractures had a greater incidence of head injuries, and passengers had a greater incidence of pulmonary system, visceral injury and road rash. Both drivers and passengers who were not wearing a helmet had a greater incidence of head injuries. Unhelmeted drivers were more likely to sustain head injury than passengers. When a scapular fracture was present both drivers and passengers had a greater incidence of head injuries. Prospective investigations are needed to better delineate the precise mechanisms for these injury patterns.

Background Patients with diffuse pulmonary arteriovenous malformations (PAVM), a small but important subset of the PAVM population, have significant morbidity and mortality rates. Methods Thirty-six patients (21 female and 15 male) with diffuse PAVM from a cohort of 821 consecutive patients with PAVM were evaluated. Diffuse PAVM were categorized angiographically: involvement of one or more segmental pulmonary arteries in one or both lungs. Hereditary hemorrhagic telangiectasia (HHT) status, gender, presence or absence of large (≥ 3-mm diameter artery) focal PAVM, oxygen saturations, complications including hemoptysis, years of follow-up, and survival were tabulated. Results HHT was present in 29 of 36 patients (81%), and diffuse PAVM were more commonly bilateral (26 of 36 patients, 72%) than unilateral (10 of 36 patients, 28%) [p = 0.02]. Female gender was associated with bilateral diffuse PAVM (19 of 26 patients, 73%) [p = 0.01]. Focal PAVM were present in both groups but more commonly in patients with bilateral involvement (16 of 26 patients, 62%) [p = 0.02]. Initial oxygen saturations (pulse oximetry, standing) of patients with unilateral and bilateral diffuse PAVM were 87 ± 7% and 79 ± 8% (mean ± SD), respectively (p = 0.02). The last or current values for patients with unilateral and bilateral involvement are 95 ± 3% and 85 ± 7%, respectively (p Conclusions Patients with diffuse PAVM are a high-risk group, and yearly follow-up is recommended.

s S37 IL; 3University of Alabama at Birmingham, Birmingham, AL; 4Primary Children’s Medical Center, Salt Lake City, UT; 5Children’s Hospital of Wisconsin, Milwaukee, WI; 6Great Ormond Street Hospital, London, United Kingdom; 7Medical University of South Carolina, Charleston, SC; 8Children’s Healthcare of Atlanta, Atlanta, GA. Purpose: Current knowledge of antibody-mediated rejection (AMR) after heart transplantation (HT) stems largely from adult data with only a few small single-center pediatric studies. Using the multi-institutional Pediatric Heart Transplant Study (PHTS) database, we aimed to report the incidence of AMR, describe contemporary treatment, and evaluate outcomes for treated AMR in children after HT. Methods: We queried the PHTS database for patients < 18 yrs undergoing primary HT between 1/10 12/13. An AMR episode was defined as either a biopsy (bx) with histology and/or complement staining consistent with pathologic AMR or a rejection event attributed to donor specific antibodies based on immunotherapy augmentation directed against antibody production. Biopsy data, treatment strategies, and survival were analyzed. Results: AMR was reported in 118/1217 (10%) HT recipients and accounted for 142/467 (30%) rejection episodes. AMR was diagnosed by bx in 108 episodes and by Ab-directed therapy in 27 with negative bx and 7 with no bx performed. 106 episodes had concurrent acute cellular rejection (ACR) by bx. 91% and 88% of patients were free from AMR at 1 and 3 years, respectively. AMR therapies included IVIG (n= 81, 57%), plasmapheresis (n= 61, 43%), rituximab (n= 55, 39%), bortezomib (n= 16, 11%), and eculizumab (n= 1, 1%). 19 patients (16%) died after developing AMR. Mortality did not differ between the AMR, AMR+ACR, and no AMR groups. (Fig. 1) The 1 and 3 year patient survival after initial AMR diagnosis was 89% and 72%, respectively. Conclusion: This is the largest multi-institutional assessment to date of AMR in pediatric HT recipients. AMR was common and often occurred concurrently with ACR. This study highlights wide variability in both the diagnosis and treatment of AMR. The outcomes of those with AMR were comparable to those with rejection not due to AMR. Ongoing collaborative studies are needed to better characterize AMR and determine treatment effects specific to pediatric HT.

The shape of the RV outflow tract (RVOT) Doppler velocity envelope (DVE) has been shown to be a sensitive marker of altered pulmonary hemodynamics in adults, but this has not been validated in children. Systolic deceleration or ‘‘notching’’ of the RVOT DVE relates to the pathologic wave

Doppler echocardiography (DE) is widely used as a surrogate for right heart catheterization (RHC), the gold standard, to assess and monitor elevated right heart pressure in children. However, its accuracy has not been validated in children. Simultaneous pressure gradients between right ventricle