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OBJECTIVES Diaphragmatic paralysis following congenital cardiac surgery is associated with significant morbidity and mortality. Spontaneous recovery of diaphragmatic function has been described, contrasting with centres providing early diaphragmatic plication. We aimed to describe the outcomes of a conservative approach, as well as to identify factors associated with a failure of the strategy. METHODS This is a retrospective study of patients admitted after cardiac surgery and suffering unilateral diaphragmatic paralysis within 2 French Paediatric Cardiac Surgery Centers. The conservative approach, defined by the prolonged use of ventilation until successful weaning from respiratory support, was the primary strategy adopted in both centres. In case of unsuccessful evolution, a diaphragmatic plication was scheduled. Total ventilation time included invasive and non-invasive ventilation. Diaphragm asymmetry was defined by the number of posterior rib segments counted between the 2 hemi-diaphragms on the chest X-ray after cardiac surgery. RESULTS Fifty-one neonates and infants were included in the analysis. Patients’ median age was 12.0 days at cardiac surgery (5.0–82.0), and median weight was 3.5 kg (2.8–4.9). The conservative approach was successful for 32/51 patients (63%), whereas 19/51 patients (37%) needed diaphragm plication. There was no difference in patients’ characteristics between groups. Respiratory support prolonged for 21 days or more and diaphragm asymmetry more than 2 rib segments were independently associated with the failure of the conservative strategy [odds ratio (OR) 6.9 (1.29–37.3); P = 0.024 and OR 6.0 (1.4–24.7); P = 0.013, respectively]. CONCLUSIONS The conservative approach was successful for 63% of the patients. We identified risk factors associated with the strategy’s failure.

We have developed a new technique avoiding autograft distortion and narrowing at inclusion during Ross procedure, in order to preserve the functional anatomy and the process of adaptation.

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Leaflet reconstruction outcomes in young patients can be compromised by treated autologous pericardium utilization. We present a new and simple unicuspid/unicommissural aortic valve repair technique with an autologous pulmonary artery wall graft. With comparative and longitudinal follow-up studies, this technique could constitute a living reconstruction of the aortic valve that does not preclude a future Ross procedure.

Objective Right ventricular outflow tract reconstruction is a common feature for the treatment of congenital heart disease. However, the best substitute for pulmonary valvulation is still unknown, since the whole valves impair in above ten years. Pulmonary homograft appears to be the best substitute, but the lack of availability of this substitute, especially the low diameter, conducted to the development of other valves, biological or synthetic. The Contegra® valve is a bioprosthesis obtained from bovine jugular vein. Available in diameters from 12 to 22 mm, these conduits should constitute a good alternative to the homograft, especially concerning low weight children. The objective of this study was to describe the long-term evolution of Contegra® in our institution. Methods We conducted a retrospective monocentric observational study at the CHRU of Tours including all patients implanted with a Contegra® valve between January 2001 and December 2018. Results Over this 17-year period, 58 Contegra® implanted in 52 patients were included (average age 6.7 ± 5.4 years at valvulation). Survival without revision surgery for conduit failure was 87% (95 CI {79–97}) at 2 years, 67% (95 CI {54–84}) at 5 years and 60% (95 CI {43–82}) at 10 years ( Fig. 1 ). A lower age at implantation, a smaller diameter, and the occurrence of infective endocarditis was significantly associated with the revision surgery. Only 5 patients had infectious endocarditis over this period. Endocarditis-free survival was 94% (95 CI {88–100}) at 2 years, 92% (95 CI {84–100}) at 5 years and 92% (95 CI {84–100}) at 10 years. Conclusion Our study suggests that Contegra® valve could constitute an attractive substitute for right ventricular outflow tract reconstruction. A multicenter study comparing long-term evolution of the whole valves currently available for pulmonary valvulation could confirm our results.

Background Branch pulmonary artery (BPA) stenosis is frequently associated with congenital heart disease. Management of BPA stenosis is challenging for surgeons due to a high rate of recurrence. The purpose of this study was to assess the results of intraoperative pulmonary artery stenting associated with or without surgical angioplasty. Methods We included 33 children from our center between January 2008 and July 2014. Patients had pulmonary atresia with ventricular septal defect (13), tetralogy of Fallot (10), troncus arteriosus (4), double outlet right ventricle (2), and single left or right ventricle (4). A total of 44 balloon-expandable stents (mean diameter, 9.5 mm; range, 4 to 16 mm) were deployed in left or right PA under direct visualization, without the use of fluoroscopy, after branch angioplasty for 28 of them (64%). The mean age at surgery was 4.3 ± 4.3 years (range, 6 days to 15 years) and the mean weight was 14.3 ± 11.9 kg (range, 2.8 to 63 kg). Results Postoperative mortality was 9% (3 patients), but only 1 death was related to the stenting procedure. Twenty-five patients underwent angiographic control after a mean follow-up of 22 months after surgery. All stents were well positioned. The mean stented BPA Z-score increased from –2.6 ± 1.8 to –0.4 ± 1.6 ( p 0.0001). Eleven patients experienced intrastent proliferation (44%). Among them, 2 patients required a reoperation for severe intrastent stenosis, whereas the 9 others had mild intrastent neointimal proliferation, which was successfully managed by balloon expansion. Conclusions Intraoperative stenting of BPA is a safe and effective option to treat BPA stenosis and prevent recurrence.

Branch pulmonary artery stenosis complicates the management of congenital heart diseases. Surgical branch pulmonary artery angioplasty is associated with a high reintervention rate. As an alternative, percutaneous or intraoperative branch pulmonary artery stents have been implanted to improve efficiency, but long-term evaluations are limited.To describe the long-term evolution of branch pulmonary artery stents.We conducted a retrospective cohort study at Tours University Hospital. All stents implanted by surgery or catheterization in branch pulmonary arteries with a minimum follow-up of 12 months and at least one catheterization control were included. The primary endpoint combined cardiovascular mortality, surgical or percutaneous reintervention for stent complication or new stent implantation.Between 2007 and 2017, 76 stents in 51 patients were included (62 stents implanted by surgery, 14 by catheterization). At implantation, the patients' mean age and weight were 4.7years (interquartile range 4.2years) and 17.3kg (interquartile range 11.0kg), respectively. Mean branch pulmonary artery minimum diameter was 4.1±2.1mm (mean Z-score-4.9±2.9), and mean initial stent diameter was 9.1±3.1mm. During a follow-up of 5.3years (range 0-11.2 years), freedom from primary endpoint was 86.8% (95% confidence interval 79.6-94.8%) at 1 year, 71.5% (95% confidence interval 61.9-82.7%) at 5years and 69.6% (95% confidence interval 59.6-81.2%) at 10 years. We did not identify any factors associated with major adverse cardiovascular events. Among stents without major adverse cardiovascular events, the mean branch pulmonary artery diameter Z-score at last evaluation had increased by +4.8±3.2 compared with the initial diameter (P0.001). After stent implantation, a median of 2 re-expansions were performed for each stent (range 0-7).Stent implantation should offer a good long-term solution for branch pulmonary artery stenosis, although iterative re-expansions are required.

Sinkholes cause subsidence and collapse problems for many transportation infrastructure assets. Subsequently, transportation infrastructure management agencies dedicate a considerable amount of time and money to detect and map sinkholes as part of their asset management programs. Traditionally, sinkholes are detected through area reconnaissance, which includes visual inspection of a site to locate existing sinkholes or device inspection of a site to locate potential sinkholes or previously filled sinkholes. Another method for sinkhole detection is through a review of maps such as geological maps. These methods are expensive, time-consuming, and labor-intensive. Recent advances in remote sensing, especially airborne light detection and ranging (LiDAR), allows for the examination of the change in the Earth's surface elevation accurately and rapidly. The focus of this study is to develop a conceptual framework for sinkhole detection and mapping with airborne LiDAR. This conceptual framework lays the foundation for the future application of airborne LiDAR for sinkhole detection and mapping.

State transportation agencies regularly collect data on pavement surface distresses. These data are used to assess overall pavement conditions and to make maintenance and repair decisions. Routinely-acquired and publically-available high spatial resolution (hsr) multispectral digital aerial photography provides a potential method for collecting distress information that can supplement or replace currently-used technologies. Principal component analysis and linear least squares regression models were used to evaluate the potential of using HSR multispectral digital aerial photographs to estimate pavement surface overall distress conditions. Various models were developed using HSR multispectral digital aerial photographs of different spatial resolution (6-inch, 12-inch, and 24-inch) and reference pavement surface distress data collected manually at multiple sample sites using standard protocols. The results show that the spectral response of HSR multispectral digital aerial photographs correlate strongly with reference distress rates at all tested spatial resolutions, but the 6-inch aerial photos exhibit the strongest correlation (R 2 > 0.95), even when using only half of the sample sites (R 2 > 0.92). These results indicate that straightforward analysis of HSR multispectral digital aerial photographs, routinely acquired by most municipalities and states, can permit assessment of pavement surface distress conditions as well as current manual evaluation protocols.

Introduction Primary or secondary branch pulmonary artery (BPA) stenosis complicates the management of congenital heart diseases. Surgical pulmonary plasty is the gold standard treatment, but is associated with a low freedom from reintervention rate of 46% at 10 years [1] . As an alternative, percutaneous or intraoperative stents have been implanted to improve efficiency, but limited data are available concerning longterm outcome [2] , [3] , [4] , [5] . We hypothesized that prognosis of intraoperative or percutaneous stent implantation in BPA stenosis is good with further re-expansion and limited complications. Methods We conducted a retrospective cohort study at CHU de Tours. All stents implanted by surgery or catheterization in BPA with a minimum follow-up of 12 months and at least 1 catheterization control have been included. The primary endpoint was composite, combining cardiovascular mortality, surgical stent removing or percutaneous implantation of a new homolateral stent. Results Between February 2007 and December 2017, 76 stents in 51 patients were included (62 stents implanted by surgery, 14 by catheterization). At the time of implantation, patients had mean age and weight of 56.3 months (IQR 65.4) and 17.4 kgs (IQR 11.0) respectively. There was 68.4% of secondary stenosis. Mean BPA minimum size was 4.1 mm (mean Z-score of − 5.0), and mean initial stent diameter was 9.1 mm. During a mean follow-up of 5.3 years (range 0–11,2 years), freedom from primary endpoint was 86.8% (CI 79.6–94.8%) at 1 year, 78.9% (CI 70.2–88.6%) at 2 years, 71.5% (CI 61.9–82.7%) at 5 years and 69.6% (CI 59.6–81.2%) at 10 years ( Fig. 1 ). Among surviving stents, mean BPA size Z-score at last evaluation was increase of +4.69 compared to initial size (P Fig. 2 ). A lower BPA size at implantation seemed to be associated with a worse outcome of the stent (P Conclusion Our results suggest that percutaneous or intraoperative stent implantation could constitute a good alternative to BPA plasty alone.

Background Postoperative infections occur in about 10% of pediatric cardiac surgeries, involving Staphylococcus aureus in most of the cases. Nasal decontamination of Staphylococcus aureus with mupirocin has been reported to reduce postoperative Staphylococcus aureus infections after cardiac surgery in adults, but the effect of preoperative decontamination in children undergoing cardiac surgery has not been enough studied to determine a consensus. Aims We tried to evaluate the impact of systematic preoperative decolonization with intra nasal mupirocin application and chlorhexidine soap skin washing, on postoperative Staphylococcus infection in children undergoing cardiac surgery. Methods We conducted a monocentric retrospective study including children from 7days-old to 18 years-old undergoing cardiac surgery. Our population was divided in three groups according to decolonization protocol (group N: no decolonization, group T: targeted decolonization in Staphylococcus aureus carriers only, and group S: systematic decolonization). Results Three hundred and ninety three children were included between October 2011 and August 2015(122 in group N, 148 in group T and 123 in group S). Staphylococcus infection rate significantly decreased in group S compared to group N (0.8% vs. 7.7%; P Conclusion Our study suggests that systematic preoperative skin and nasal decontamination decrease postoperative SI in children undergoing cardiac surgery.

Rhabdomyomas are the most common benign cardiac tumors. They may often be associated with tuberous sclerosis. In many cases, cardiac rhabdomyomas undergo spontaneous regression. Here, we report the unusual case of an infant with a large nonobstructive right ventricular rhabdomyoma at birth and at four months of age, which subsequently caused severe right ventricle outflow tract obstruction at six months of age, prompting surgery to remove the tumor. Close monitoring should be done in infants with large nonobstructive cardiac rhabdomyomas.

BACKGROUND Several publications have considered results of percutaneous angioplasty for aortic recoarctation, but none focused on procedures performed in children aged

Roadway pavement surface distress information is critical for effective pavement asset management, and subsequently, transportation management agencies at all levels (i.e., federal, state, and local) dedicate a large amount of time and money to routinely evaluate pavement surface distress conditions as the core of their asset management programs. However, currently adopted ground-based evaluation methods for pavement surface conditions have many disadvantages, like being time-consuming and expensive. Aircraft-based evaluation methods, although getting more attention, have not been used for any operational evaluation programs yet because the acquired images lack the spatial resolution to resolve finer scale pavement surface distresses. Hyper-spatial resolution natural color aerial photography (HSR-AP) provides a potential method for collecting pavement surface distress information that can supplement or substitute for currently adopted evaluation methods. Using roadway pavement sections located in the State of New Mexico as an example, this research explored the utility of aerial triangulation (AT) technique and HSR-AP acquired from a low-altitude and low-cost small-unmanned aircraft system (S-UAS), in this case a tethered helium weather balloon, to permit characterization of detailed pavement surface distress conditions. The Wilcoxon Signed Rank test, Mann-Whitney U test, and visual comparison were used to compare detailed pavement surface distress rates measured from HSR-AP derived products (orthophotos and digital surface models generated from AT) with reference distress rates manually collected on the ground using standard protocols. The results reveal that S-UAS based hyper-spatial resolution imaging and AT techniques can provide detailed and reliable primary observations suitable for characterizing detailed pavement surface distress conditions comparable to the ground-based manual measurement, which lays the foundation for the future application of HSR-AP for automated detection and assessment of detailed pavement surface distress conditions.

Background Hepatic fibrosis increasing over time after a Fontan procedure is well documented, but the others potential risk factors of the severity of hepatopathy are still lacking. Method Since 2016, we started a systematic hepatic evaluation of patients undergoing a total cavo-pulmonary connection (TCPC) for at least 10 years, including clinical features, blood sample, abdominal ultrasound, liver elastography and liver biopsy. We look for clinical, biological and hemodynamic factors potentially associated with greater degree of fibrosis at biopsy. Results Fourteen patients had a complete evaluation with liver biopsy. Median time from TCPC to hepatic assessment was 15.9 years (range 3.0–25.9). Seventy one percent had biological cholestasis, and only 14% had cytolysis. Abdominal ultrasound revealed hepatomegaly in 4 patients and splenomegaly in 3, but no liver nodularity. METAVIR score of liver fibrosis at biopsies showed pre-cirrhotic or cirrhotic lesions (F3–4) in 9 patients out the 14 (F1 = 3; F2 = 2; F3 = 5; F4 = 4). The degree of fibrosis was significantly correlated to inferior vena cava pressure (IVCP) obtained by cardiac catheterization 1.4 years (range 0–3.9) after the Fontan procedure (r = 0.57, P = 0.05), and to IVCP*time from Fontan operation (r = 0.60, P = 0.03), and tended to be correlated with intrahepatic pressure recorded during the liver biopsy, but without statistical significance (r = 0.44, P = 0.11). There was no association between fibrosis and gender, age, age at the Fontan operation, type of systemic ventricle, functional status, liver stiffness at elastography, and blood markers of hepatic function. Conclusion In this study, two-thirds of patients undergoing TCPC experienced severe liver fibrosis, correlated with early measurement of IVCP and time from Fontan after the Fontan completion. Reduction of pulmonary pressure in this population should be considered to decrease the risk of severe fibrosis or cirrhosis.

Objective Percutaneous branch Pulmonary Artery (PA) stenting can be challenging, especially when associated with stenosis of the Right Ventricular Outflow Tract (RVOT), after previous angioplasty or with complexity of PAs branches. Surgical patch enlargement of Pas alone can be disappointing in these situations. A hybrid-approach, with PA stenting during surgery, may be an alternative to optimize surgical management in complex pulmonary artery stenosis.

Objective The main objective was to evaluate the safety and the efficacy of balloon angioplasty of post-surgical aortic recoarctation before one year of age. The secondary objective was to identify factors potentially associated with a failure of the procedure. Method Data from children who have one or more balloon angioplasty for aortic recoarctation before one year of age were retrospectively collected from 2006 to 2014. Results 14 children (17 procedures) have been included. The procedure immediately failed in 2 patients who underwent a new surgery. All the other 12 patients still remained free of recoarctation after one procedure for 10 of them, 2 procedures for another one and 3 procedures for the last one. Three complications due to the procedure occurred: one iliac artery thrombosis, one coronary embolism and one transitory stroke. These complications totally recovered before discharge. No aortic dissection or aneurysm has been reported. Comparing the 5 procedures which need a further intervention with the others, we observed that a higher peak gradient measured during the catheterization before (45mmHg (range 36-60) vs 32mmHg (range 10-47)) and after the angioplasty (36mmHg (range 30-50) vs 25mmHg (range 5-50)), and a lower ratio balloon size/transverse arch diameter (1.07 (range 0.88-1.20) vs 1.28 (range 0.94-1.82)) were associated with a failure of the procedure. Conclusion Balloon angioplasty of aortic recoarctation before one year of age is efficient. A lower ratio balloon size/transverse arch diameter was associated with a higher failure of the procedure that suggests the use of bigger balloon.

The second-generation Carpentier-Edwards bioprostheses, the supra-annular porcine valve and the PERIMOUNT pericardial valve, have been evaluated longitudinally for several years. This study compared clinical performance over 15 years. Aortic valve replacement was performed with a supra-annular porcine valve in 1,823 patients (group 1) aged 19–89 years (mean, 68.9 ± 10.9 years) and with a PERIMOUNT pericardial bioprosthesis in 1,430 patients (group 2) aged 16–90 years (mean, 69.5 ± 10.4 years). The groups were similar except for concomitant coronary artery bypass in 43% of group 1 and 18% of group 2 ( p < 0.001). Overall survival at 15 years was 29.3% ± 1.5% for group 1 and 35.2% ± 3.1% for group 2 ( p = 0.0009). The actual freedom from valve-related mortality was 88.5% ± 0.9% for group 1 and 84.9% ± 1.7% for group 2. The actual freedom from structural valve deterioration at 15 years was similar overall, and for patients aged > 60 years, between the groups, but was dissimilar (group 2 > group 1) for age ≤ 60 years. The predictors of structural valve deterioration were valve type (group 1 > group 2), sex (male > female), age, and concomitant coronary artery bypass. Both bioprostheses provided satisfactory clinical performance at 15 years after aortic valve replacement.

This paper compares monthly and seasonal rain rates derived from the Version 5 (V5) and Version 6 (V6) TRMM Precipitation Radar (TPR, TSDIS reference 2A25), TRMM Microwave Imager (TMI, 2A12), TRMM Combined Instrument (TCI, 2B31), TRMM calibrated IR rain estimates (3B42) and TRMM merged gauge and satellite analysis (3B43) algorithms over New Mexico (NM) with rain gauge analyses provided by the New Mexico water districts (WD). The average rain rates over the NM region for 1998–2002 are 0.91 mm d−1 for WD and 0.75, 1.38, 1.49, 1.27, and 1.07 mm d−1 for V5 3B43, 3B42, TMI, PR and TCA; and 0.74, 1.38, 0.87 and 0.97 mm d−1 for V6 3B43, TMI, TPR and TCA, respectively. Comparison of V5 3B43 with WD rain rates and the daily TRMM mission index (TPR and TMI) suggests that the low bias of V5 3B43 for the wet months (summer to early fall) may be due to the non-inclusion of some rain events in the operational gauge analyses that are used in the production of V5 3B43. Correlation analyses show that the WD rain rates vary in phase, with higher correlation between neighboring WDs. High temporal correlations (>0.8) exist between WD and the combined algorithms (3B42, 3B43 and TCA for both V5 and V6) while satellite instrument algorithms (PR, TMI and TCI) are correlated best among themselves at the monthly scale. Paired t-tests of the monthly time series show that V5 3B42 and TMI are statistically different from the WD rain rates while no significant difference exists between WD and the other products. The agreements between the TRMM satellite and WD gauge estimates are best for the spring and fall and worst for winter and summer. The reduction in V6 TMI (−7.4%) and TPR (−31%) rain rates (compared to V5) results in better agreement between WD estimates and TMI in winter and TPR during summer.

Lesser prairie-chickens (Tympanuchus pallidicinctus) occur in shinnery oak (Quercus havardii) and sand sagebrush (Artemisia filifolia) grassland habitats in New Mexico, Texas, Oklahoma, Kansas, and Colorado. Range-wide population reductions since the 1800s have been attributed to habitat loss, especially of nesting habitat. Using radio-telemetry and a vegetation map of the study area, we investigated habitat use by lesser prairie-chicken hens during the nesting season in herbicide-treated and untreated pastures (each about 1,000 ha in size). Herbicide treatment was effective in reducing shinnery oak cover. The most common vegetation types in hen home ranges were those dominated by shinnery oak. Hens were detected more often than randomly in or near untreated pastures. Although hens were detected in both treated and untreated habitats, 13 of 14 nests were located in untreated pastures, and all nests were located in areas dominated by shinnery oak. Areas immediately surrounding nests had higher shr...

In the Ninole ridges of Hawai'i we investigated how landslides influence ecosystem development and modify land cover and the distribution of biomass. We estimated above and below-ground biomass, and N and P concentration in leaves (Metrosideros polymorpha) and very fine roots (all species), for vegetation developing on landslides of three age classes (young, < 18 yr; intermediate, ≤ 42 yr; and old ca. 124 yr) and on undisturbed soils (ca. 430 yr). The undisturbed soils were derived from ash underlain by basalt. To quantify changes in land cover and the distribution of biomass we combined our estimates of biomass with estimates of the area covered by each vegetation class. The latter estimates were obtained from the analysis and classification of color-infrared aerial photographs. Average above- and below-ground biomass for the herbaceous vegetation (young landslides) was 10.4 and 3.2 t/ha, whereas for the ohia-non ash forest (intermediate and old landslides) was 37.5 and 5.2 t/ha, respectively. For the ohia-ash forest (undisturbed sites), average above and below-ground biomass was 354.6 and 9.5 t/ha, respectively. Average foliar N for the herbaceous and ohia-non ash forest ranged between 0.80–0.84%, whereas root P between 0.056–0.040%, respectively. For the ohia-ash forest, average foliar and root P was 0.918% and 0.036%, respectively. Based on changes in vegetation cover during the last 430 yr, we estimated rate of disturbance at 15% per century or equivalently that 53 t/ha biomass per century exited through the system. The removal of ash-derived soils by landslides significantly alters successional trajectories and by doing so may be transforming the Ninole ecosystems in irreversible ways.

International audience; BACKGROUND: Morbidity and mortality are higher for cardiac reoperations than first operation due to the presence of post-operative adhesions. We retrospectively evaluated the efficacy of the bioresorbable membrane Seprafilm to prevent pericardial adhesions after cardiac surgery in a paediatric congenital heart disease population. METHODS: Seventy-one children undergoing reoperations with sternotomy redo and cardiopulmonary bypass for congenital malformations were included. Twenty-nine of these patients were reoperated after previous application of Seprafilm (treatment group). The duration of dissection, aortic cross clamping and total surgery were recorded. A tenacity score was established for each intervention from the surgeon's description in the operating report. RESULTS: In multivariate analysis, the duration of dissection and the tenacity score were lower in the treatment than control group (p\

IntroductionPatients with Congenital Heart Diseases (CHD) often suffer from severe pulmonary artery (PA) stenosis. Management of PA stenosis is challenging for surgeons. The purpose of this study was to assess the results of intraoperative pulmonary artery stenting, performed additionally to, or instead of, conventional surgical angioplasty.Methods and resultsBetween January 2008 and August 2013, 31 children with hypoplastic or stenosed PA, median age of 23 months (range 6 days to 15 years), and median weight of 11,8kg (range 2,8 to 63kg), underwent intraoperative placement of stents in PA. Patients had pulmonary atresia (15) tetralogy of Fallot (10) troncus arteriosus (4), and complex CHD (2). The aim of the concomitant surgical procedure was palliative surgery (10), complete repair (12), or improvement of right ventricular outflow tract after complete repair (9). A total of 42 balloon-expandable stents were deployed in left or right PA. Maximum balloon diameters ranged from 3 to 16mm (mean=9). Post-operative mortality was 9,6% (3 patients) and 2 patients did not have complete follow-up. Eighteen patients underwent angiographic control, at a mean follow-up of 15 months (± SD 10 months) after surgery. Mean PA diameter increased from 5,19 to 7,57mm (p

The case of a 17-day-old infant who underwent correction of an aortic coarctation with pulmonary artery banding for ventricular septal defect is reported. Ischemic cardiac failure 3 weeks later led the authors to diagnose a single coronary artery originating from the pulmonary artery. At the age of 2 months, the infant underwent successful reimplantation of the coronary artery onto the ascending aorta and surgical closure of the septal defect. Normalization of the left ventricular function was observed at the 2-year follow-up assessment.

We estimated the ecological and economic impact of urban turfgrass production in a large city. A satellite image was used to evaluate the turfgrass area of Albuquerque, New Mexico, U.S.A. Turfgrass, the major vegetation component of the city, covers 7,650 ha and represents approximately 30.0% of the metropolitan area. Of the total grass area, 85.0% exists as home lawns, 8.3% occurs in parks, and 6.7% is on golf courses.

Currently, valve thrombosis, thromboembolic events and bleeding events account for 75% of all complications that occur after mechanical heart valve replacement. The study aim was to determine the main risk factors for valve-related complications in patients undergoing mechanical heart valve replacement.Data were available from the systematic follow up of patients who had received a CarboMedics bileaflet mechanical heart valve replacement at the authors' institution. Follow up examinations were conducted prospectively at two-year intervals, via questionnaires sent to the patients' general practitioners, or by telephone calls.Between January 1988 and December 2005, a total of 505 consecutive patients (300 males, 205 females; mean age 52 years; range: 5 to 77 years) underwent heart valve replacement using a CarboMedics mechanical prosthesis. Aortic valve replacement (AVR) was performed in 308 patients, mitral valve replacement (MVR) in 134 patients, and double-valve replacement (DVR) in 62 patients. The follow up was 95.4% complete; the mean follow up was 7.5 years, and the total follow up 3,718 patient-years. Thromboembolic and bleeding complications represented the leading cause of valve-related events (104/195), of valve-related mortality (15/25), and of the need for repeat surgery (9/16). Valve thrombosis occurred in 12 patients. Implantation in the mitral position was identified as a risk factor (HR = 15.07; CI: 8.41-23.07; p 0.0001). Thromboembolism occurred in 32 patients; the use of antiplatelet agents was found to be a protective factor (HR = 0.23; CI: 0.08-0.70; p = 0.01). Bleeding events occurred in 52 patients; risk factors for bleeding events included a history of thromboembolic or bleeding complications (HR = 2.70; CI: 1.33-5.26; p = 0.006) and an unstable International Normalized Ratio (INR) (HR = 2.86; CI: 1.01-8.08; p = 0.05).After mechanical heart valve replacement, the only risk factors for bleeding complications were an unstable INR and a history of thromboembolic or bleeding events. The use of antiplatelet agents proved to be a protective factor against thromboembolic events.

We propose a complete surgical approach by left retropectoral transaxillary implantation with no vein puncture to improve the aesthetic and psychological tolerance of the implantable cardioverter defibrillator and avoid the pneumothorax and the subclavian crush syndrome.

Elevational and latitudinal shifts occur in the flora of the Rocky Mountains due to long term climate change. In order to specify which species are successfully migrating with these changes, and which are not, an object-oriented, image-based geographic information system (GIS) is being created to animate evolving ecological regimes of temperature and precipitation. Research at the Earth Data Analysis Center (EDAC) is developing a landscape model that includes the spatial, spectral and temporal domains. It is designed to visualize migratory changes in the Rocky Mountain flora, and to specify future community compositions. The object-oriented database will eventually tag each of the nearly 6000 species with a unique hue, intensity, and saturation value, so their movements can be individually traced. An associated GIS includes environmental parameters that control the distribution of each species in the landscape, and satellite imagery is used to help visualize the terrain. Polygons for the GIS are delineated as landform facets that are static in ecological time. The model manages these facets as a triangular irregular net (TIN), and their analysis assesses the gradual progression of species as they migrate through the TIN. Using an appropriate climate change model, the goal will be to stop the modeling process to assess both the rate and direction of species' change and to specify the changing community composition of each landscape facet.

Aortic valve disease is the most common cardiac valve condition in developed countries, and its prevalence increases with patient age, especially due to calcified aortic stenosis [24]. Although aortic valve replacement (AVR) remains the most effective treatment in the majority of cases for significant aortic stenosis as well as aortic regurgitation, few data are available for long-term surgical outcome. Perimount pericardial valves offer excellent hemodynamic function, and the present authors’ 10 year experience proved to be satisfactory when these valves were implanted in both the aortic and mitral positions [2, 3]. However, the long-term durability and performance of the valve remained questionable. The study aim was to evaluate long-term results of valve replacement for significant aortic valve disease, and long-term behavior of the aortic Perimount pericardial bioprosthesis, which the present authors have been implanting since 1984.

Objectives The long-term patency rate of coronary artery bypass grafting for which arterial grafts are used is known to be high in the pediatric population. However, this issue remains uncertain in children under 3 years of age. Here, we report the outcome in this specific population. Methods From July 1988 to July 2007, 18 children less than 3 years of age (age at operation, 0.1–35 months; median, 4 months) underwent 20 coronary artery bypass graft operations using an arterial graft. Indications for bypass grafting were coronary artery complications related to the arterial switch operation for transposition of the great arteries in 12 patients (coronary obstruction in 8 patients, peroperative coronary anomalies precluding coronary transfer in 4 patients), congenital anomalies of the coronary arteries in 4 patients, and Kawasaki disease in 2 patients. Results After a mean follow-up of 55 months (range, 1–176 months; median, 41 months), patency of 19 bypass grafts was assessed. One was occluded and 2 have necessitated a percutaneous procedure. Two patients died suddenly (1 with an occluded graft and 1 with a patent graft and hypertrophic myocardiopathy) 3.5 and 4.6 months, respectively, after bypass grafting. Conclusions Coronary artery bypass grafting should be considered as a possible alternative for coronary revascularization in young children. Although our series shows quite a good patency rate, this procedure remains a technical challenge and requires careful follow-up.

Land covers mix and high input dimension are two important issues to affect the classification accuracy of remote sensing images. Fuzzy classification has been developed to represent the mixture of land covers. Two fuzzy classifiers of Fuzzy Rule-Based (FRB) and Fuzzy Neural Network (FNN) were studied to illustrate the interpretability of fuzzy classification. A hierarchical structure was proposed to simply multi-class classification to multiple binary classification to reduce computation time caused by high number of inputs. The classifiers were compared on the land cover classification of a Landsat 7 ETM+ image over Rio Rancho, New Mexico, and it was proved that Hierarchical Fuzzy Neural Network (HFNN) classifier is the best combination of better classification accuracy with shorter CPU time requirement.

This work presents a new application of a data-clustering algorithm in Landsat image classification, which improves on conventional classification methods. Neural networks have been widely used in Landsat image classification because they are unbiased by data distribution. However, they need long training times for the network to get satisfactory classification accuracy. The data-clustering algorithm is based on fuzzy inferences using radial basis functions and clustering in input space. It only passes training data once so it has a short training tune. It can also generate fuzzy classification, which is appropriate in the case of mixed, intermediate or complex cover pattern pixels. This algorithm is applied in the land cover classification of Landsat 7 ETM+ over the Rio Rancho area, New Mexico. It is compared with back-propagation neural network (BPNN) to illustrate its effectiveness and concluded that it can get a better classification using shorter training time.

Objectif Evaluer le resultat d’une decontamination preoperatoire des enfants porteurs au niveau nasal de Staphylocoque Aureus (SA) avant une chirurgie cardiaque. Materiels et methodes D’octobre 2011 a octobre 2013, les enfants devant beneficier d’une chirurgie cardiaque ont ete depistes pour le portage nasal de SA 15 jours avant la chirurgie. Depuis novembre 2012, les patients porteurs de SA ont ete decontamines par mupirocine intranasale et desinfection cutanee par un savon de gluconate de chlorexidine durant les 7 jours precedant la chirurgie. Nous avons compare le taux d’infections postoperatoires a SA entre ces 2 periodes. Resultats 237 patients ont ete inclus, 19,4% etaient porteurs. Avant l’instauration du traitement, 109 patients ont ete depistes, 16 (14,7%) etaient porteurs de SA. Quatre patients ont eu une infection postoperatoire a SA, dont 2 etaient colonises en preoperatoire. Sur 128 patients depistes apres novembre 2012, 30 (23,4%) etaient porteurs de SA nasal. Trois patients ont eu une infection a SA postoperatoire : aucun n’etait porteur de SA avant la chirurgie. Conclusion L’instauration d’une decontamination du SA, en preoperatoire d’une chirurgie cardiaque, semble diminuer le taux d’infection a SA postoperatoire chez les enfants porteurs.

We have developed a new technique for interrupted aortic arch repair in which the pulmonary artery anterior wall is cut off and tailored so as to re-establish aortic continuity with an autologous tube. We are describing this method herein, with an 8-year follow-up of the first patient.

Objectifs Evaluer l’efficacite et la securite de la dilatation au ballon de la recoarctation aortique (RCO) survenant chez des enfants operes d’une coarctation native avant l’âge de 3 mois. Materiel et Methodes Revue des dossiers de patients atteints de RCO traitee par dilatation au ballon entre 1990 et 2009. Analyse retrospective des donnees cliniques, echo-doppler cardiaque, hemodynamiques avant et apres la dilatation. Resultats 20 RCO chez des patients operes a l’âge moyen de 21 jours (2-75) et traites par dilatation a l’âge moyen de 19 mois (0,5-180). Il n’y eut aucune complication. Immediatement apres le geste, le gradient de pression aortique a diminue de 41 mmHg (25-70) a 23 mmHg (13-40), les arteres femorales etaient facilement palpables chez 17 patients (85 %) et aucun enfant n’avait de flux doppler continu au niveau de l’aorte isthmique. Parmi les 18 patients suivis sur une duree moyenne de 5,2 ans (1-18), 14 ont conserve un bon resultat et 4 avaient une coarctation residuelle traitee avec succes par chirurgie ( n = 3) ou dilatation ( n = 1). Conclusions La dilatation au ballon est une methode efficace et sure pour traiter la RCO d’enfants operes de coarctation native avant l’ âge de 3 mois. Ce resultat se maintient a long terme dans la majorite des cas.

Background and method: Asymmetric distribution of histologic lesions have been reported in grafted hearts that could hamper the interpretation of right ventricular endomyocardial biopsy. Heterotopic heart transplantations were performed in rats (na 59) and guinea pigs (na 20). Grafted hearts were examined by a pathologist who established the degree of cardiac rejection in the four cardiac cavities. Results: Forty cardiac rejections were diagnosed in rats and ten in guinea pigs. An asymmetric distribution of histologic lesions was observed in 34 (68%) rejected hearts with greater lesions in the auricular myocardium than in the ventricular myocardium (na 25, 50%). One (na 18) or two degrees (na 7) differentiated the severity of rejection between atria and ventricles. Cardiac rejection score was significantly greater in atria than in ventricles (3.12 ^ 0.18 vs. 2.6 ^ 0.2 (P , 0:01) in rats and 2.35 ^ 0.37 vs. 1.6 ^ 0.47 (P , 0:001) in guinea pigs. There were histologic lesions of rejection in the auricular myocardium in seven cases, although the ventricular myocardium was completely normal. In nine (18 %) other grafted hearts the degree of rejection was equal in the auricular myocardium and ventricular septum but was greater than the degree of rejection noted in the right and left ventricular free walls. Conclusion: The distribution of histologic lesions of acute cardiac rejection in rodents was heterogeneous in grafted hearts which exhibited greater lesions in the atria than in ventricles. This should be taken into consideration in the evaluation of new methods of detection of cardiac rejection and in the diagnosis of acute cardiac rejection in humans. q 2000 Elsevier Science B.V. All rights reserved.

Background . The first generation of pericardial valves was withdrawn from the market for a high rate of premature failure. With an original design, Carpentier-Edwards pericardial valves promised improved results. Methods . Seven hundred eighty-seven patients who underwent isolated aortic valve replacement and 182 patients who underwent isolated mitral valve replacement between July 1984 and December 1995 with Carpentier-Edwards pericardial bioprostheses in our institution were followed up. The patients' mean age was 68.3 (aortic valve replacement, AVR) and 63.9 (mitral valve replacement, MVR) years. All but five AVR patients were followed up for an average of 4.7 years after operation, with a total follow-up of 3,624 patient-years. All patients with MVR were followed up for an average of 5.3 years after operation, with a total follow-up of 969 patient-years. Results . After 12 years, actuarial survival rate is 53% for AVR and 54% for MVR. Freedom from valve-related complications for aortic versus mitral valve replacement is, respectively, 68% and 55%, freedom from valve-related death is 84% and 85%, freedom from thromboembolism 87% and 94%, and freedom from endocarditis 97% and 94%. The behavior of the aortic valve is better than that of the mitral valve: freedom from reoperation is 92% and 76%, respectively; freedom from valve failure is 94% and 78%. Age is an important factor, especially in the mitral position: freedom from valve failure is 52% in patients younger than 60 years and 100% in patients older than 60 years. Conclusions . With a low rate of valve-related events at 12 years and a low rate of structural deterioration, this prosthesis is a reliable choice for AVR and in patients over 60 years for MVR. A more durable mitral bioprosthesis is needed for patients younger than 60 years.

The purpose of this thesis is to review the pharmacology and toxicity of local anaesthetics, particularly highlighting the differences between bupivacaine and ropivacaine and to present an experiment attempting to establish whether ropivacaine is a safer drug, once cardiotoxicity has occurred.

Objective: The first generation of pericardial valves was withdrawn from the market because of a high rate of premature failure. With an original design, Carpentier-Edwards pericardial valves promised improved results. Methods: One hundred fifty patients who underwent isolated mitral valve replacement, between July 1984 and December 1993, with Carpentier-Edwards pericardial bioprostheses in our institution were followed up. Patient mean age was 62.9 ± 11.9 years. Operative mortality was 3.3%. All but three patients were followed up for an average of 4.7 years after operation, and total follow-up was 710 patient-years. Results: At the time this article was written, over 80% of patients were in New York Heart Association class I or II. After 10 years, actuarial survival rate was 71% (confidence limit 61% to 81%). Valve-related complications included the following: six valve-related deaths (0.8% patient-year), five thromboembolic episodes (0.7% patient-year), three cases of endocarditis (0.4% patient-year), four reoperations (0.5% patient-year), and four structural valve failures with calcification and stenosis (0.5% patient-year). After 10 years, freedom from valve-related complications was 66% (confidence limit 46% to 86%), from valve-related death 94% (confidence limit 89% to 99%), from reoperation 90% (confidence limit 82% to 98%), and from valve failure 76% (confidence limit 62% to 90%). Conclusions: With a low rate of valve-related events at 10 years and a low rate of structural deterioration with no leaflet tear, this prosthesis is a reliable choice for patients over 60 years of age. (J Thorac Cardiovasc Surg 1997;113:476-91)

From July 1984 to December 1991, 420 patients underwent isolated aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis in our Institution. Of the patients 71.5% were male, the mean age was 66.9 +/- 11.9 years and 48% were in NYHA clinical stage III or IV. The operative mortality rate was 2.9% (12/420). All patients but six were followed up for an average of 3.9 years after their operation and total follow-up was 1444 patient-years. At this time of the study, over 80% of the patients are in NYHA class I or II, 6% are in atrial fibrillation and 7% receive anticoagulation treatment. There were 41 late deaths. After 8 years the actuarial survival rate is 80% +/- 6%. Nine patients died of valve-related causes (three endocarditis, three thromboembolic complication, one structural failure, and two sudden deaths). The actuarial rate of freedom from valve-related death was 97% +/- 3% at 8 years. Valve-related complications included 12 thromboembolic episodes (0.8% patient-year), 7 endocarditis (0.5% patient-year), 4 anticoagulant-related complications (0.2% patient-year), 6 reoperations (0.4% patient-year) and 2 structural valve failures (0.1% patient-year). After 8 years, freedom from thromboembolic complication was 96% +/- 3%, from endocarditis 97% +/- 2%, from reoperation 98% +/- 2% and from valve failure 99% +/- 1%. There were only two structural deteriorations (calcification and stenosis) and one explanation. No leaflet tear was observed. We conclude that these intermediate results are better than those obtained with previous pericardial bioprostheses.

Elevational and latitudinal shifts will occur in the flora and vegetation of the Rocky Mountains due to climate warming. If we are to specify which species are successfully migrating in tune with these changes, and which are being adversely impacted, a 4-dimensional image-based GIS is required to visualize and animate new ecological regimes imposed by changing temperature and precipitation patterns. Research at TAC aims to develop a new algorithm for a terrain model that includes the spatial, spectral, and temporal domains. It is designed to visualize changes in the Rocky Mountain flora, and to specify the predicted community compositions at any future time. The strategy is to assign unique hue, intensity, and saturation values for each of the nearly 6000 species comprising the flora of the Rockies. Hue is assigned on the basis of elevational zone; intensity on the basis of slope and aspect; and saturation, on the basis of abundance. Polygons for an associated GIS are delineated as landform facets that are expected to be stable in ecological time (i.e., over the next few thousand years). The analysis then assesses the gradual progression of species as they migrate upslope and poleward through these polygons. At any future year over the next several thousand, the modeling process can be stopped to assess both the rate and directions of change, as well as the species composition of each plant community occupying a specific polygon.