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Biomedical subjects

E Bruckheimer

Publications and source records attributed to E Bruckheimer.

17 recordsLinked to original sources
PubMed2001

Transcatheter closure of secundum atrial septal defects with the amplatzer septal occluder: early experience.

BACKGROUND: Secundum atrial septal defect is a common congenital heart defect that causes right heart volume overload and produces symptoms usually after the third decade of life. Treatment until the last few years has been open heart surgery. OBJECTIVES: To review our early experience with transcatheter closure of ASD2 using the Amplatzer septal occluder. METHODS: Between November 1999 and February 2000, 20 children and young adults with a median age of 9.1 years (4.2-35.1 years) were referred for transcatheter closure of ASD2. Diagnosis was established by transthoracic echocardiography. Implantation was performed under general anesthesia through the femoral vein with the guidance of transesophageal echocardiography and fluoroscopy. Femoral arterial puncture was performed for blood pressure monitoring during the procedure. The device size chosen was similar to the balloon-stretched diameter of the ASD2. RESULTS: Implantation was completed successfully in 18 patients. Two patients were referred for elective surgery: one had an unsuitable anatomy for transcatheter closure by TEE in the catheterization laboratory and the device could not be implanted properly, the other patient had a large multiperforated septal aneurysm that was retrieved. Mean ASD2 diameter by TTE and TEE was similar (13.9 +/- 3 mm, 13.4 +/- 3.5 mm) and mean stretched diameter was 18.3 +/- 4.3 mm. Mean Qp:Qs (pulmonary flow:systemic flow) was 2.2 +/- 0.6. Mean fluoroscopy time for the procedure was 14.8 +/- 4.8 minutes. The patients were discharged the day after the procedure. Four patients had a tiny leak immediately post-procedure, and none had a leak at one month follow-up. The only complication was a small pseudoaneurysm of the femoral artery in one patient, that resolved spontaneously. CONCLUSIONS: Transcatheter closure of ASD2 with the Amplatzer septal occluder is a safe and effective alternative to surgical closure. Long-term outcome has to be evaluated.

Adolescent↗
PubMed2000

Balloon angioplasty of postsurgical recoarctation in infants: the risk of restenosis and long-term follow-up.

OBJECTIVES: This study was undertaken to evaluate the long-term results of balloon angioplasty (BA) for postsurgical recoarctation in infants. BACKGROUND: Balloon angioplasty is a well-accepted modality for the treatment of recoarctation. However, infants remain a group of concern because of their size, risk for complications and the potential for restenosis with growth. Age <12 months has been determined to be a risk factor for the development of recoarctation after angioplasty for native coarctation. Although studies on postsurgical coarctation have found no relationship between age at angioplasty and the development of recoarctation, few studies specifically addressing infants have been performed. METHODS: Clinical, echocardiographic, hemodynamic and angiographic data on 22 consecutive children <1 year of age who underwent BA between 1986 and 1996 were reviewed. RESULTS: A successful result, defined as a postprocedure gradient of < or =20 mm Hg, was achieved in 20 of 22 (91%) infants with a reduction in the systolic peak pressure gradient from 48 +/- 27 to 9 +/- 10 mm Hg (p < 0.001) and an increase in coarctation diameter from 2.7 +/- 1.1 to 5.2 +/- 1.5 mm (p < 0.001). At long-term follow-up of a median of 56 months (0.6 to 12 years), the restenosis rate after an initial optimal result was 16% (3 of 19). Five (24%) infants required reintervention (2 initially unsuccessful; 3 recoarctation), with a success rate of 95% after two procedures. Suboptimal long-term outcome correlated with a lower infant weight. CONCLUSIONS: Balloon angioplasty can be safely performed in infants, with good long-term results. The risk of restenosis is low and can be successfully managed with repeat angioplasty.

Angioplasty, Balloon↗
PubMed2000

Measurement of endogenous nitric oxide production.

The measurement of exhaled pulmonary nitric oxide concentrations requires that contamination from the upper respiratory tract and inhaled gases be eliminated. This can be achieved with no risk in the clinical setting of intubated patients of all ages in the operating room or intensive care unit. Further modifications of the anesthetic/ventilatory circuit allow for accurate determination of tidal volume and minute ventilation.

Anesthesia, Inhalation↗
PubMed1996

Implantation of balloon-expandable stents for coarctation of the aorta: implantation data and short-term results.

We report the immediate results and the short-term follow-up in a group of selected patients with coarctation of the aorta who underwent endovascular stent implantation. Balloon-expandable stents were implanted in 6 patients (mean age 19.8 +/- 5.1 years) with coarctation of the aorta (4 recurrent and 2 native) who underwent a total of 7 procedures (6 implantation and 1 further expansion). The systolic peak pressure gradient was decreased from 36.7 +/- 16.9 to 13.3 +/- 23.2 mm Hg (P < 0.005). There was a 66% increase in the mean coarctation diameter from 9.3 +/- 1.7 to 15.6 +/- 3.1 mm (P = 0.001) with the ratio of the coarctation to descending aorta diameter, measured at the level of the diaphragm, increasing from 0.49 +/- 0.1 to 0.81 +/- 0.2 (P < 0.005). The dilatation was successful in expanding the stent to an acceptable diameter in 5 of 6 patients. One patient underwent successful further expansion of a stent implanted 22 months previously. There were no immediate complications during balloon expansion and stent implantation. One patient suffered a femoral arterial bleed requiring surgical repair. There was one unrelated death. All patients were hypertensive (systolic blood pressure > 140 mm Hg) prior to stent implantation. At mean follow-up of 8 months, 3 patients are normotensive. There was no recurrence of coarctation, aortic dissection, or aneurysm formation in the patients in whom stent implantation was successful. These findings indicate that balloon-expandable stent implantation for coarctation of the aorta in selected patients is a safe and effective alternative approach for relieving the obstruction with a low complication rate and no recoarctation at short-term follow-up.

Adolescent↗
PubMed1996

Cell death signal transduction and Bcl-2 function.

The mechanism by which Bcl-2 can insulate cells against multiple diverse apoptotic signals is largely undefined. How is it possible that Bcl-2, which possesses no known catalytic function, can protect against multiple cell-death signals? A proposal to address this question postulates that Bcl-2 functions at convergence points common to most cell-death signal-transduction pathways. This review attempts to integrate observations regarding cell-death signalling in an effort to define points of convergence. The ceramide/ SAPK/JNK and NF kappa B pathways, in particular, were emphasized. Potential points at which Bcl-2 may function frequently involve the transmembrane trafficking of molecules implicated in the mediation of apoptosis. The selectivity of this process and the effector proteins with which Bcl-2 associated remain to be elucidated.

Animals↗
PubMedDate not supplied

Kingella kingae endocarditis in a child with hair-cartilage hypoplasia.

Abstract. Kingella kingae is a fastidious Gram-negative rod that since the 1980s has been appreciated as a cause of a variety of human infections, including bone and joint infections, bacteremia, and rarely endocarditis [2, 6, 7, 9]. K. kingae endocarditis is rare, and only a few cases occur in normal, native valves. We report a case of K. kingae endocarditis in a patient with hair-cartilage hypoplasia who had previously undergone bone marrow transplantation. The combination of these rare conditions is discussed.

Adolescent↗
PubMedDate not supplied

Inhaled nitric oxide therapy in a critically ill neonate with Ebstein's anomaly.

The successful use of nitric oxide (NO) inhalation in a critically ill neonate with Ebstein's anomaly of the tricuspid valve is reported for the first time. This use of inhaled NO therapy suggests a therapeutic intervention that directly addresses the pathophysiologic process of severe neonatal Ebstein's anomaly.

Administration, Inhalation↗