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Background Increasing globalization has led to more families with children being relocated each year, highlighting the importance of issues, such as adjustment and psychological well-being, in this population. These children, commonly known as third culture kids, often spend a significant part of their developmental years in countries and cultures foreign to them. Objective Our longitudinal study aims to examine the roles of cognitive, psychological, sociocultural, and family factors in the longitudinal trajectories of the well-being and sociocultural adjustment of third culture kids and their families over time. Methods This study adopts both quantitative and qualitative procedures. Data from both procedures will be collected at baseline and at a 1-year follow-up. We aim to recruit 150 to 200 participants between 7 and 17 years old and one of their primary caregivers. After providing informed consent, participants will complete an online survey. Outcome measures include validated questionnaires on well-being and sociocultural adjustment. Predictor measures include validated questionnaires on negative self-thoughts, emotion regulation, resilience, psychological attributes, self-esteem, stress, acculturative stress, cultural intelligence, couple satisfaction, and family functioning. A multiple regression model will be used to analyze quantitative data. In addition, 15 to 20 families who participate in the online survey will be randomly selected to take part in a family interview focusing on questions related to well-being, relocation experiences, cultural issues, and challenges. A concurrent triangulation mixed methods design will be used to analyze and interpret data from both quantitative and qualitative methods. Results As of March 15, 2022, a total of 138 children and 126 parents have completed the baseline online survey. In addition, 44 children and 48 parents have completed the 1-year follow-up online survey. A total of 8 families have completed the baseline family interview, while 4 families have completed the 1-year follow-up interview. Data analyses, transcription of the interview, and preparation for publication are on-going. Conclusions Findings from this study would enable us to understand the adjustment processes, and risk and protective factors associated with the well-being and sociocultural adjustment of third culture kids and their families in Switzerland, which could have implications on the development of intervention programs for individuals and families to address acculturation and adjustment issues. International Registered Report Identifier (IRRID) RR1-10.2196/30088

Nowadays the Zika virus (ZIKV) has been one of the most studied vector-borne diseases due to the considerable outbreaks that have generated around the world as well as due to the new transmission mechanisms and health complications originated. According to statistics of the INS-Colombia for July 2016, 68% of the population infected by ZIKV (confirmed cases) are pregnant women. Furthermore, the Quindio department belongs to the states with more than 50% of the total infected persons being pregnant women. Taking into account those characteristics, a theoretical model is proposed and analyzed to describe the population dynamics considering the sexual and vectorial transmission of ZIKV, with special emphasis in the consequences of the non-vectorial transmission in the population. The obtained results with simulations through the beta parameter indicate that the probability of sexual transmission between susceptible women and infected men points out the importance of campaigns to inculcate prevention measures for the safe sexual relationships between ZIKV infected population.

With the launch of the Sentinel-2 satellites, a European capacity has been created to ensure continuity of Landsat and SPOT observations. In contrast to previous sensors, Sentinel-2′s multispectral imager (MSI) incorporates three additional spectral bands in the red-edge (RE) region, which are expected to improve the mapping of vegetation traits. The objective of this study was to compare Sentinel-2 MSI and Landsat-8 OLI data for the estimation of leaf area index (LAI) in temperate, deciduous broadleaf forests. We used hemispherical photography to estimate effective LAI at 36 field plots. We then built and compared simple and multiple linear regression models between field-based LAI and spectral bands and vegetation indices derived from Landsat-8 and Sentinel-2, respectively. Our main findings are that Sentinel-2 predicts LAI with comparable accuracy to Landsat-8. The best Landsat-8 models predicted LAI with a root-mean-square error (RMSE) of 0.877, and the best Sentinel-2 model achieved an RMSE of 0.879. In addition, Sentinel-2′s RE bands and RE-based indices did not improve LAI prediction. Thirdly, LAI models showed a high sensitivity to understory vegetation when tree cover was sparse. According to our findings, Sentinel-2 is capable of delivering data continuity at high temporal resolution.

Monitoring analytes during the transfer step from the first to the second dimension in multidimensional electrophoretic separations is crucial to determine and control the optimal time point for sample transfer and thus to avoid band broadening or unwanted splitting of the sample band with consequent sample loss. A spatially resolved intermediate on-chip LED-induced fluorescence detection system was successfully implemented for a hybrid capillary-chip glass interface. The setup includes a high-power 455-nm LED prototype as an excitation light source and a linear light fiber array consisting of 23 light fibers with a diameter of 100 μm for spatially resolved fluorescence detection in combination with a push-broom imager for hyperspectral detection. Using a basic FITC solution, the linear working range was determined to be 0.125 to 25 μg/ml for a single light guide and the absolute detection limit was 0.04 fmol at a signal-to-noise ratio of 4. With the setup presented here, labeled β-lactoglobulin focused via capillary isoelectric focusing was detectable on-chip with a sufficient intensity to monitor the analyte band transfer in the glass-chip interface demonstrating its applicability for full or intermediate on-chip detection. Fil: Sydes, Daniel. Eberhard Karls Universität Tübingen; Alemania Fil: Kler, Pablo Alejandro. Eberhard Karls Universität Tübingen; Alemania. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Centro de Investigaciones en Métodos Computacionales. Universidad Nacional del Litoral. Centro de Investigaciones en Métodos Computacionales; Argentina Fil: Meyer, Hans. J&M Analytik AG; Alemania Fil: Zipfl, Peter. University of Applied Sciences Aalen. Optoelectronics and Laser Technology Department; Alemania Fil: Lutz, Daniel. CalvaSens GmbH; Alemania Fil: Huhn, Carolin. Eberhard Karls Universität Tübingen; Alemania

It has been introduced and analyzed a mathematical model based on integral equations, which turns into a dynamical system of non-linear differential equations to account for the risk of microcephaly incidence caused by the Zika virus. A specific pregnant women susceptible group has been accounted for. The epidemic threshold (basic reproduction number) has been obtained by implementing the next generation matrix method. A sensitivity analysis with respect to each parameter has been applied to that threshold. Finally, the incidence to the exposure is obtained by performing several system simulations.

It is set and analyzed a simulation model based on non-linear ordinary differential equations to interpret the dynamics of the microcephaly incidence caused by the Zika virus in a risk group of pregnant women. This one is induced by a population of men in a reproductive age. Also, some parameters of the model were estimated for an average temperature of 23℃ and by using the adjusted functions from references [1] [2]. All system simulations were done with the Maple software and parameters values obtained from several sources (estimated, hypothetic, and form literature). It has been found that the application of contraceptive measures impacts the population of sexually active women. As result, the exposure to congenital abnormalities increases, particularly, microcephaly.

Pre-surgical diffusion weighted imaging (DWI) is increasingly important in the context of thyroid cancer for identification of the optimal treatment strategy. It has exemplarily been shown that DWI at 3T can distinguish undifferentiated from well-differentiated thyroid carcinoma, which has decisive implications for the magnitude of surgery. This study used DWI histogram analysis of whole tumor apparent diffusion coefficient (ADC) maps. The primary aim was to discriminate thyroid carcinomas which had already gained the capacity to metastasize lymphatically from those not yet being able to spread via the lymphatic system. The secondary aim was to reflect prognostically important tumor-biological features like cellularity and proliferative activity with ADC histogram analysis. Fifteen patients with follicular-cell derived thyroid cancer were enrolled. Lymph node status, extent of infiltration of surrounding tissue, and Ki-67 and p53 expression were assessed in these patients. DWI was obtained in a 3T system using b values of 0, 400, and 800 s/mm2. Whole tumor ADC volumes were analyzed using a histogram-based approach. Several ADC parameters showed significant correlations with immunohistopathological parameters. Most importantly, ADC histogram skewness and ADC histogram kurtosis were able to differentiate between nodal negative and nodal positive thyroid carcinoma. Conclusions: histogram analysis of whole ADC tumor volumes has the potential to provide valuable information on tumor biology in thyroid carcinoma. However, further studies are warranted.

High production output of solid pharmaceutical formulations requires fast methods to ensure their quality. Likewise, fast analytical procedures are required in forensic sciences, for example at customs, to substantiate an initial suspicion. We here present the design and the optimization of an instrumental setup for rapid and non-invasive characterization of tablets by laser-induced fluorescence spectroscopy (with a UV-laser (λ ex = 266 nm) as excitation source) in reflection geometry. The setup was first validated with regard to repeatability, bleaching phenomena, and sensitivity. The effect on the spectra by the physical and chemical properties of the samples, e.g. their hardness, homogeneity, chemical composition, and granule grain size of the uncompressed material, using a series of tablets, manufactured in accordance with design of experiments, was investigated. Investigation of tablets with regard to homogeneity, especially, is extremely important in pharmaceutical production processes. We demonstrate that multiplicative scatter correction is an appropriate tool for data preprocessing of fluorescence spectra. Tablets with different physical and chemical characteristics can be discriminated well from their fluorescence spectra by subjecting the results to principal component analysis. Fil: Woltmann, Eva. Central Institute for Engineering, Electronics and Analytics: Analytics (ZEA-3); Alemania Fil: Meyer, Hans. J&M Analytik AG; Alemania Fil: Weigel, Diana. Federal Criminal Police Office, Forensic Science Institute, KT 34 – Toxicology; Alemania Fil: Pritzke, Heinz. Glatt Systemtechnik GmbH; Alemania Fil: Posch, Tjorben N.. Central Institute for Engineering, Electronics and Analytics: Analytics (ZEA-3); Alemania Fil: Kler, Pablo Alejandro. Universität Tübingen. Institute of Physical and Theoretical Chemistry, Eberhard Karls ; Alemania. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Centro de Investigaciones En Metodos Computacionales. Universidad Nacional del Litoral. Centro de Investigaciones En Metodos Computacionales; Argentina. Central Institute for Engineering, Electronics and Analytics: Analytics (ZEA-3); Alemania Fil: Schürmann, Klaus. LabCognition Analytical Software GmbH & Co. KG; Alemania Fil: Roscher, Jörg. Universität Münster. Institute of Inorganic and Analytical Chemistry, Westfälische Wilhelms; Alemania Fil: Huhn, Carolin. Universität Tübingen. Institute of Physical and Theoretical Chemistry, Eberhard Karls ; Alemania. Central Institute for Engineering, Electronics and Analytics: Analytics (ZEA-3); Alemania

To evaluate the diagnostic benefit of time-resolved CENTRA-keyhole contrast-enhanced cardiovascular magnetic resonance angiography (CE-CMRA) for improving arterial-venous separation of pulmonary vessels.Twenty-three patients (18 males; age = 58 +/- 11y) after radiofrequency pulmonary vein isolation to treat atrial fibrillation were examined using CENTRA-keyhole based multi-phase 3D CE-CMRA yielding 6 near-isotropic 3D datasets every 1.6 s (50-60 coronal partitions, 1.4 x 1.4 x 1.3 mm, SENSE-factor 3). Results were compared with conventional non-keyhole CE-CMRA (identical parameters, SENSE-factor 2).Data acquisition was accelerated by a speedup factor of approximately 9 compared with the reference CE-CMRA (SENSE 1.5*, keyhole 6*). No pulmonary venous stenoses were detected by either method, overall pulmonary venous diameters were 17.1 +/- 3.6 mm. Applying Bland-Altman analysis, vessel diameters differed by a mean of 0.1 mm + 2.1 mm/-2.0 mm (mean +/- 2 SD), indicating close agreement between both techniques. Interobserver variability was higher for CENTRA-keyhole (mean = 0.1 mm; mean +/- 2 SD: +2.5 mm/-2.3 mm) compared to conventional technique (0.0 mm; +1.6 mm/-1.5 mm), corresponding to a percentual deviation (mean +/- 2 SD) of the mean diameter of approximately +/- 15% (keyhole CE-CMRA) and +/- 10% (conventional CE-CMRA), respectively. Using keyhole-based time-resolved CE-CMRA, the contrast between pulmonary veins versus aorta/pulmonary artery was significantly increased (p0.05), which improved vessel depiction. In 12 cases, the contrast bolus arrival was delayed in one of the pulmonary veins by 1 dynamic frame (= 1.6 seconds); in 7 cases by 2 frames (= 3.2 seconds) and in 1 subject by 3 frames (= 4.8 seconds). The bolus usually appeared first in the upper right pulmonary vein whereas a delay occurred most often in the lower left pulmonary vein.Conventional CE-CMRA may be advantageous for accurate vessel size measures as evidenced by superior interobserver reproducibility in this study. Multi-dynamic CE-CMRA using CENTRA-keyhole with SENSE, however, allows for improved arterio-venous separation of pulmonary vessels and additional dynamical information on pulmonary venous perfusion, while maintaining high spatial resolution. Exact bolus timing is no longer needed.

Background— Operator-independent isotropic 3D MRI may greatly simplify the assessment of complex morphology in congenital heart disease. We sought to evaluate the reliability of this new approach. Methods and Results— In 31 adolescent and adult patients (age, 6 to 42 years; median, 16 years) with congenital heart disease, cardiac morphology was determined with free-breathing (navigator-gated), isotropic, 3D steady-state free-precession (3D SSFP) MRI and independently evaluated by 2 observers. Cardiac diagnoses and multiple distance measurements were compared with conventional MR reference sequences (ie, spin-echo, cine gradient-echo, contrast-enhanced MR angiography) and with echocardiography/cine cardioangiography or surgery. Of the 31 patients, 24 had native congenital heart defects or residual defects after repair that warranted immediate treatment. None of these defects was missed by 3D SSFP. Novel diagnostic issues were discovered in 4 of 31 patients (coronary anomalies, n=3; left juxtaposition of the right atrial appendage in double-outlet right ventricle and transposition of the great arteries, 1). For sizes of valves and vessels, we found minor mean differences of −1.1 to 1.6 mm, with SD ranging from 1.2 to 2.9 mm, demonstrating overall good agreement with standard MRI (Bland-Altman analysis). Interobserver variability of 3D SSFP distance measures was low; mean differences ranged from −1.5 to 1.0 mm, and SD ranged from 0.8 to 2.5 mm. Scatter was lower for extracardiac than intracardiac measures. Conclusions— In adolescents and adults, isotropic 3D SSFP MRI allows reliable assessment of complex cardiac morphology. Distance measurements are accurate and reproducible. Thus, a single operator-independent acquisition may substitute for conventional 2D MRI sequences to accelerate and simplify MR scanning in congenital heart disease.

Background— Parallel imaging by sensitivity encoding (SENSE) may considerably reduce scan time in MRI. For rapid flow quantification in children with congenital heart disease, we evaluated phase-contrast MRI (PC-MRI) techniques combined with SENSE. Methods and Results— In 22 pediatric patients (mean age, 7.2±6.2 years) with cardiac left-to-right shunt, blood flow rate in the pulmonary artery (Q p ) and ascending aorta (Q s ) and flow ratio Q p /Q s were determined by PC-MRI with SENSE reduction-factor 2 and 3 (SF-2 and SF-3). Additionally, we used PC-MRI with higher spatial in-plane resolution (1.6×2.1 versus 2.3×3.1 mm) with and without SF-3. Results were compared with a recently validated standard PC-MRI protocol and tested in vitro using a pulsatile flow phantom. Reduction of signal averages from 2 to 1 and application of SENSE accelerated flow measurements by a factor of 3.5 (5.2) using PC-MRI with SF-2 (SF-3) compared with standard PC-MRI. For blood flow rate through the pulmonary artery and aorta, as well as for the Q p /Q s ratio we found negligible differences of ±3%, lower limits of agreement (mean±2 SD) of −7% to −18%, and upper limits of agreement (mean±2 SD) of +3 to +24%, demonstrating good agreement with standard PC-MRI. Mean Q p /Q s ratio by standard PC-MRI was 1.69±0.45 (range, 1.27 to 2.79). Interobserver variability was low, and high accuracy was confirmed in vitro for all protocols. Conclusions— PC-MRI for flow quantitation may be combined with SENSE to achieve a substantive reduction of scanning time. In children with left-to-right shunt, Q p /Q s quantification is possible by PC-MRI+SF-3 in

Fatty acid influx into human myocardium was studied in 15 patients during the cooling phase of cardiopulmonary bypass at myocardial temperatures of 37 degrees to 25 degrees C. The fitting of the data to a functional relation, developed in this study, revealed fatty acid influx to be a temperature-dependent saturable process corresponding to a Michaelis-Menten constant (Km) at 37 degrees C of 0.26 +/- 0.084 mumol/g, a maximal fatty acid influx velocity (Vmax) at 37 degrees C of 0.28 +/- 0.045 mumol/g per minute, activation energy for fatty acid binding to the putative carrier (E) of 23.8 +/- 5.6 kcal/mol, and a free energy for conformational change of the carrier (U) of 10.9 +/- 8.0 kcal/mol. In short-term cultured hepatocytes, Km increased in the absence of Na+ from 171 +/- 48 to 301 +/- 71 nmol/L, and Vmax of [3H]oleate decreased from 1063 +/- 69 to 847 +/- 68 pmol/min per milligram protein. The fitting of these data to a functional relation revealed a transmembrane potential-dependent component of parameters E and U to be -0.479 and -0.374 kcal/mol, respectively. It is proposed that for fatty acid influx a protonated fatty acid form is preferred that consists of a Na+ complex with the mesomeric form of nondissociated fatty acid from which Na+ and H+ are released during collision with the carrier.

Fatty acid binding protein has been found in rat aortic endothelial cell membrane. It has been identified to be a 40-kDa protein that corresponds to a 40-kDa fatty acid binding protein with high affinity for a variety of long chain fatty acids isolated from rat heart myocytes. It is proposed that this endothelial membrane fatty acid binding protein might mediate the myocardial uptake of fatty acids. For evaluation of this hypothesis in vivo, influx kinetics of tracer-labeled fatty acids was examined in 15 normal subjects by scintigraphic techniques. Variation of the plasma fatty acid concentration and plasma perfusion rate has been achieved by modulation of nutrition state and exercise conditions. The clinical results suggest that the myocardial fatty acid influx rate is saturable by increasing fatty acid plasma concentration as well as by increasing plasma flow. For analysis of these data, functional relations describing fatty acid transport from plasma into myocardial tissue in the presence and absence of an "unstirred layer" were developed. The fitting of these relations to experimental data indicate that the free fatty acid influx into myocardial tissue reveals the criteria of a reaction on a capillary surface in the vicinity of flowing plasma but not of a reaction in extravascular space or in an unstirred layer and that the fatty acid influx into normal myocardium is a saturable process that is characterized by the quantity corresponding to the Michaelis-Menten constant, Km, and the maximal velocity, Vmax, 0.24 +/- 0.024 mumol/g and 0.37 +/- 0.013 mumol/g(g.min), respectively. These data are compatible with a nondiffusional uptake process mediated by the initial interaction of fatty acids with the 40-kDa membrane fatty acid binding protein of cardiac endothelial cells.

We retrospectively reviewed 104 consecutive patients who underwent orthotopic heart transplantation between November 1989 and February 2004.From November 1989 to February 2004, the total number of heart transplantations were 1,340 cases at our institute. One hundred four (7.8%) of these 1,340 patients were pediatrics. Average age was 6.2 years, ranging from 4 months to 16 years. The cause of heart disease before transplantation was: idiopathic dilated cardiomyopathy (DCM) in 74 patients (71%), and congenital heart disease (CHD) in 30 (29%).Hospital mortality rate was 14.4% (15 patients). Late complications were rejection in 23 (22.1%), infection in 11 (10.6%), gingival hyperplasia in 28 (26.9%), hypertention in 22 (21.1%), coronary artery disease (CAD) in 12 (12.5%), graft failure in 11(10.5%), and malignancy in 2 (1.9%). Late mortality occurred in 11 (10.6%) patients. Causes of death were sudden death in 2 (1.9%), CAD in 3 (2.8%), graft failure in 1 (1.0%), acute rejection in 4 (4.6%), and infection in 1 (1.0%). Actuarial survival rates in pediatrics at 1, 5, 10 years were 82%, 80%, and 78%, respectively. On the other hand, actuarial survival rates in adults at 1, 5, 10 years were 78%, 75%, 59%, respectively.Heart transplantation for pediatrics is an effective therapy with acceptable morbidity and mortality. The long-term survival results in pediatrics are comparable to those of adult heart transplantations. However, the actuarial survival rate in pediatrics after 10 years is significantly better than in adults' cases. Renal function in pediatric heart transplantation recipients treated with cyclosporine remains stable during long-term follow-up.

A 68-year-old woman with a relevant cardiovascular risk profile presented with atypical chest pain. Ergometric exercise demonstrated an insignificant ST-segment deviation in the precordial leads and premature beats increasing in frequency during exercise. Calcium scoring by multislice computed tomography (MSCT; Sensation Cardiac) revealed a very high calcium volume score of 3639 mm3, a mass score of …

To evaluate the feasibility of rapid free-breathing phase-contrast MRI (PC-MRI) at different in-plane resolutions combined with sensitivity encoding (SENSE) for flow quantification in the great arteries in healthy adult volunteers.In 13 volunteers (mean age 33.0 +/- 7.4 years), blood flow rates in the pulmonary artery (Qp), ascending aorta (Qs), and flow ratio Qp/Qs were determined by PC-MRI with SENSE reduction-factor 2 and 3 (SF-2, SF-3). Additionally, we used PC-MRI with higher spatial in-plane resolution (1.6 x 2.1 mm vs. 2.3 x 3.1 mm) with/without SF-3. Standard (= reference) PC-MRI, which used two excitations (NEX=2), was compared with PC-MRI sequences with NEX=1.Reduction of signal averages and application of SENSE accelerated flow measurements by a factor of 3.8 (5.5) using PC-MRI with SF-2 (SF-3): Scan time was 36 sec (SF-2) and 25 sec (SF-3) at average heart rate of 69/min. The mean Qp/Qs by reference PC-MRI was 1.03 +/- 0.07 (range, 0.89-1.16), and 1.0 +/- 0.11 (range, 0.86-1.24) by PC-MRI + SF-3, respectively. For blood flow rate through the pulmonary artery and aorta, and for Qp/Qs ratio, we found differences of -3% to +4%. The lower limits of agreement (mean - 2 SD) ranged between -14% and -21%, and upper limits (mean + 2 SD) between +9% and +30%, demonstrating clinically acceptable agreement with standard PC-MRI (Bland-Altman analysis). PC-MRI at higher in-plane resolution both with/without SENSE yielded slightly smaller aortic and pulmonary flows (mean differences 5% to 7%, p0.05). CONCLUSIONS. In adults, PC-MRI may be safely combined with SENSE to reduce scan time for a quantitative flow measurement in the great arteries to "30 seconds. High in-plane resolution was not advantageous.

Background— Flow quantification in real time by phase-contrast MRI (PC-MRI) may provide unique hemodynamic information in congenital heart disease, but available techniques have important limitations. We sought to validate a novel real-time magnetic resonance flow sequence in children. Methods and Results— In 14 pediatric patients (mean age 5.2±2.0 years) with cardiac left-to-right shunt, pulmonary (Q p ) and aortic (Q s ) flow rates were determined by nontriggered free-breathing real-time PC-MRI with single-shot echo-planar imaging combined with sensitivity encoding, which yielded 25 phase images per second at 2.7×2.7-mm in-plane resolution (field of view 30×34 cm 2 ). Over a 9.5-second period that included 2 to 5 respiratory cycles, 16.6±2.6 subsequent stroke volumes (range 13 to 22) were acquired in each vessel. Results were compared with conventional retrospectively ECG-gated PC-MRI. Mean Q p /Q s by conventional PC-MRI was 1.91±0.64, and it was 1.94±0.68 (mean±SD) by real-time PC-MRI. For blood flow rate through pulmonary artery and aorta, we found differences of 2% to 3% (Bland-Altman analysis), with lower limits of agreement of −11% to −13% (mean−2 SD) and upper limits of 18% to 19% (mean+2 SD), which demonstrated good agreement between both methods. Mean difference for Q p /Q s was 1%, with limits of agreement ranging between −18% and 22% (mean±2 SD). High repeatability but some flow overestimation was observed in vitro (pulsatile flow phantom) with real-time PC-MRI, whereas conventional PC-MRI was accurate. Beat-to-beat stroke-volume variation was 6.1±2.3% in vivo and 3.7±0.3% in vitro. Conclusions— Beat-to-beat quantification of pulmonary and aortic flows and hence left-to-right shunt within a few seconds is reliable by nontriggered real-time PC-MRI with echo-planar imaging and sensitivity encoding. Good spatial/temporal resolution and a large field of view may render the sequence valuable for multiple applications in congenital heart disease.

Background —Blood flow can be quantified noninvasively by phase-contrast cine MRI (PC-MRI) in adults. Little is known about the feasibility of the method in children with congenital heart disease. Methods and Results —In 50 children (mean age 6.2 years, range 1.1 to 17.7 years) with an atrial- or ventricular-level shunt, blood flow rate in the great vessels was determined by PC-MRI, and the ratio of pulmonary to aortic flow (Q̇p/Q̇s) was compared with Q̇p/Q̇s by oximetry. We found a difference of 2% and a range of −20% to +26% (limits of agreement, mean±2 SD). In another 7 children with congenital heart disease but no cardiac shunting (mean age 7.9 years, range 1.3 to 13.5 years), Q̇p/Q̇s by PC-MRI was 1.02 (SD ±0.06). No difference between systemic venous and aortic flow volumes was found (range −17% to +20%, n=37). Blood flow through a secundum atrial septal defect as assessed by PC-MRI (n=24) overestimated the shunt compared with the difference between pulmonary and aortic flows. The mean difference between 3 repeated PC-MRI measurements in each location was 5.3% (SD ±4.0%, n=522), demonstrating good precision. The interobserver variability was low. The accuracy of PC-MRI was confirmed by in vitro experiments. Conclusions —Determination of Q̇p/Q̇s by PC-MRI in children is quick, safe, and reliable compared with oximetry. Systemic venous flow can be quantified by PC-MRI, whereas through-plane shunt measurement within an atrial septal defect is inaccurate.

We report the use of a recently developed stentless porcine valve in a 2-year-old child with truncus arteriosus communis (type I). The child had received no previous surgical palliation. Despite a markedly increased pulmonary arteriolar resistance the right ventricle was connected to the pulmonary artery with a homograft. The postoperative course was complicated at first by right ventricular failure due to pulmonary hypertension and secondarily by left ventricular failure caused by rapidly increasing truncal valve incompetence. Because we did not have a suitable homograft at hand we replaced the truncal valve with a stentless porcine xenograft valve.

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