Patent ductus arteriosus.
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Abnormalities, Multiple↗
Biomedical subjects
John W Moore
Publications and source records attributed to John W Moore.
Radiographic appearance of pediatric cardiovascular transcatheter devices.
The treatment of congenital heart disease has been revolutionized by the availability of transcatheter devices. These advances in interventional pediatric cardiology require that both treating physicians and radiologists develop a more thorough understanding of the appearance of these devices on chest radiographs. Furthermore, recognition of appropriate versus inappropriate placement of transcatheter devices is essential to the care of patients with congenital heart disease. Knowledge of the radiographic appearance of devices used by interventional pediatric cardiologists can allow a radiologist to make better clinical assessments and detect possible complications given a limited clinical history.
Cardiac Catheterization↗
ADHD drugs and cardiovascular risk.
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Adolescent↗
Transcatheter closure of coronary artery fistulae using the Amplatzer Duct Occluder.
OBJECTIVE: The aim of this study is to report our experience using the Amplatzer Duct Occluder (ADO) for occlusion of significant coronary artery fistulae (CAF). BACKGROUND: Transcatheter closure of CAF with coils is well described. Use of newer devices may offer advantages such as improved control of device placement, use of a single instead of multiple devices, and high rates of occlusion. METHODS: A retrospective review of all patients catheterized for CAF from July 2002 through August 2005 was performed. RESULTS: Thirteen patients with CAF underwent cardiac catheterization, of which a total of 6 patients had ADO placement in CAF (age, 21 days to 56 years; median age, 4.3 years and weight, 3.8 kg to 74.6 kg; median weight, 13.3 kg). An arteriovenous wire loop was used to advance a long sheath antegrade to deploy the ADO in the CAF. Immediate and short-term outcomes (follow-up, 3 months to 14 months; median follow-up, 8.5 months) demonstrated complete CAF occlusion in 5 patients and minimal residual shunt in 1 patient (who had resolution of right atrial and right ventricular enlargement). On follow-up clinical evaluation, all 6 patients had absence of fistula-related murmurs, and 2 previously symptomatic patients had resolution of congestive heart failure symptoms. Early complications included transient palpitations and atrial arrhythmia in the 2 oldest patients (52 and 56 years old). CONCLUSIONS: Use of the ADO is applicable for transcatheter closure of significant CAF. Advantages of using the ADO include the antegrade approach, use of a single device, and effective CAF occlusion.
Cardiac Catheterization↗
A Cartesian reflex assessment of face processing.
Commands to blink were embedded within pictures of faces and simple geometric shapes or forms. The faces and shapes were conditioned stimuli (CSs), and the required responses were conditioned responses, or more properly, Cartesian reflexes (CRs). As in classical conditioning protocols, response times (RTs) were measured from CS onset. RTs provided a measure of the processing cost (PC) of attending to a CS. A PC is the extra time required to respond relative to RTs to unconditioned stimulus (US) commands presented alone. They reflect the interplay between attentional processing of the informational content of a CS and its signaling function with respect to the US command. This resulted in longer RTs to embedded commands. Differences between PCs of faces and geometric shapes represent a starting place for a new mental chronometry based on the traditional idea that differences in RT reflect differences in information processing.
Adult↗
Quantitation of RNA by ribonuclease protection assay.
A robust ribonuclease protection assay is described here. In brief, total cellular RNA, carrier yeast transfer RNA, and 32P-labeled antisense riboprobes, (one or more designed to detect the RNA species being studied and another to detect a suitable RNA species to act as a loading control) are combined and made 0.5 M with respect to ammonium acetate. Absolute alcohol (2.5 vol) is added, and tubes are incubated at -20 degrees C for 30 min. Precipitated RNA and riboprobes are pelleted by centrifugation and, after removal of the supernatants, dissolved in a small volume of hybridization buffer. After hybridization for 16 h at 55 degrees C, a ribonuclease cocktail is added to digest the unhybridized RNA. This is followed by a proteinase K digestion step that degrades the ribonucleases. Finally, the hybridized complex is precipitated at -20 degrees C using isopropanol:4 M guanidium thiocyanate (2:1), with added glycogen as a coprecipitant, and harvested by centrifugation. The pellet is dissolved in loading buffer, and the sample is electrophoresed in a polyacrylamide gel. The intensities of the bands in the gel representing the protected fragments for the target RNA and the loading control are quantitated by phosphorimager analysis.
Biological Assay↗
Interventional treatment of patent ductus arteriosus in 2004.
In 2004, the interventional treatment of patent ductus arteriosus (PDA) is definitive and curative. In current practice, coils are used for smaller PDA, and devices are employed for larger PDA. Developing technologies offer small improvements in control and results, but do not appear to promise major changes in practice. This review summarizes the current and emerging interventional technologies directed at PDA closures.
Coronary Angiography↗
Percutaneous closure of perimembranous ventricular septal defect associated with a ventricular septal aneurysm using the Amplatzer ductal occluder.
Amplatzer ductal occluders were used for percutaneous closure of perimembranous ventricular septal defects with associated ventricular septal aneurysm in three patients. The device was well positioned and the ventricular left-to-right shunt was significantly decreased in all three patients. The procedure was tolerated well without complications in each case.
Adult↗
Reliable atrial septostomy by stenting of the atrial septum.
The aim of this report was to describe our experience with creating an interatrial communication by stenting the interatrial septum. In many forms of congenital heart disease, the presence of an appropriate interatrial shunt is critical. After the first several weeks of life, balloon atrial septostomy is not effective, and success with other methods is limited. Clinical records, echocardiograms, and catheterization data in patients who had an atrial septal stent placed between 2001 and 2004 at UCLA were reviewed. Changes in atrial pressures and systemic saturations were analyzed. Follow-up data and explant pathology were reviewed as available. Thirteen patients had stenting of the atrial septum (four restrictive, nine nonrestrictive). In patients with elevated right and left atrial pressures, there was a mean reduction of 2.4 and 7.4 mm Hg in right atrial and left atrial pressures, respectively. In patients with transposition physiology, there was a mean increase in oxygen saturation of 11.3%. Follow-up echocardiograms revealed patent stents with excellent position relative to the atrial septum. In six cases, the stents were removed during subsequent surgery and appeared endothelialized and patent. Stenting of the atrial septum is safe and effective in selected cases, allowing for a reliable, long-lasting, restrictive or nonrestrictive interatrial communication.
Adolescent↗
Transthoracic echocardiographic guidance of transcatheter atrial septal defect closure.
This study examines the safety and efficacy of transthoracic echocardiographic (TTE) guidance of atrial septal defect (ASD) device closure. We evaluated 74 patients for TTE-guided ASD closure. Fifty-six patients had successful device implantation using TTE guidance. Twelve patients were referred for surgical ASD closure on the basis of TTE evaluation. Five patients with multiple ASDs or poor transthoracic acoustic windows had ASD device closure guided by transesophageal echocardiography (TEE).
Adolescent↗
Transcatheter closure of atrial shunts. Focus on a lingering issue.
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Anticoagulants↗
Embolization and retrieval of the Amplatzer septal occluder.
Embolization and percutaneous retrieval of the Amplatzer septal occluder (ASO) after release have been reported. However, the incidence, the causes of embolization, and the methods for effective retrieval have not been systematically described. In a survey of the ASO company-designated proctors, the incidence of ASO embolization in this group's experience was 0.55% (21 embolizations in 3824 device placements) with a wide range of patient demographics, atrial septal defect (ASD) sizes, and device sizes. Most embolizations occurred because of inadequate rim or undersized devices. Of the 21 embolizations, 15 of the devices were retrieved percutaneously with a gooseneck snare without morbidity or mortality. Six were retrieved at surgery. Of the 21 patients, 12 had ASO closure of their ASDs, and 9 had surgical ASD closure. In vitro, all devices could be retrieved with sheathes 2 Fr sizes larger than their recommended delivery sheath. Any device larger than 26 mm could be retrieved with its delivery sheath. The ability to pull the snared button into a sheath was variable and was assisted by pulling the device from above with a bioptome and by using a rigid notched sheath. Because the incidence of ASO embolization is about 1 in 200 in the most experienced hands, all operators should be prepared with the techniques and equipment required for percutaneous ASO retrieval.
Adolescent↗
Predominant role of hypoxia-inducible transcription factor (Hif)-1alpha versus Hif-2alpha in regulation of the transcriptional response to hypoxia.
Tumor hypoxia induces the up-regulation of a gene program associated with angiogenesis, glycolysis, adaptation to pH, and apoptosis via the hypoxia-inducible transcription factors (Hifs) 1 and 2. Disruption of this pathway has been proposed as a cancer therapy. Here, we use short interfering RNAs to compare specific inactivation of Hif-1alpha or Hif-2alpha and show markedly different cell type-specific effects on gene expression and cell migration. Remarkably, among a panel of hypoxia-inducible genes, responses were critically dependent on Hif-1 alpha but not Hif-2 alpha in both endothelial and breast cancer cells but critically dependent on Hif-2 alpha in renal carcinoma cells.
Basic Helix-Loop-Helix Proteins↗
EndoPDI, a novel protein-disulfide isomerase-like protein that is preferentially expressed in endothelial cells acts as a stress survival factor.
We have identified a novel protein-disulfide isomerase and named it endothelial protein-disulfide isomerase (EndoPDI) because of its high expression in endothelial cells. Isolation of the full-length cDNA showed EndoPDI to be a 48 kDa protein that has three APWCGHC thioredoxin motifs in contrast to the two present in archetypal PDI. Ribonuclease protection and Western analysis has shown that hypoxia induces EndoPDI mRNA and protein expression. In situ hybridization analysis showed that EndoPDI expression is rare in normal tissues, except for keratinocytes of the hair bulb and syncytiotrophoblasts of the placenta, but was present in the endothelium of tumors and in other hypoxic lesions such as atherosclerotic plaques. We have compared the function of EndoPDI to that of PDI in endothelial cells using specific siRNA. PDI was shown to have a protective effect on endothelial cells under both normoxia and hypoxia. In contrast, EndoPDI has a protective effect only in endothelial cells exposed to hypoxia. The loss of EndoPDI expression under hypoxia caused a significant decrease in the secretion of adrenomedullin, endothelin-1, and CD105; molecules that protect endothelial cells from hypoxia-initiated apoptosis. The identification of an endothelial PDI further extends this increasing multigene family and EndoPDI, unlike archetypal PDI, may be a molecule with which to target tumor endothelium.
Amino Acid Motifs↗
Cerebellar neuronal activity expresses the complex topography of conditioned eyeblink responses.
Pavlovian eyeblink conditioning is a useful model system for studying how the temporal relationship between a conditioned stimulus and an unconditioned stimulus is represented in the brain. As an example, the response topography formed under a complex conditioning paradigm, involving 2 randomly alternating interstimulus intervals (ISIs), manifests a conditioned response (CR) with 2 distinctive peaks that correspond to the 2 ISIs. The authors present the first full report of neuronal activities in the cerebellar interpositus nucleus of rabbits performing bimodal responses. All CR-related activities exhibited firing patterns that highly correlated with and preceded eyeblink responses. The striking similarity between the time course of bimodal CRs and neuronal responses indicates that neuronal activities in the cerebellum are causally related to the production of behavioral CRs.
Animals↗
Techniques and applications of transcatheter embolization procedures in pediatric cardiology.
Transcatheter embolization of congenital or acquired superfluous vascular structure has become routine procedures performed by interventional pediatric cardiologists. Embolization procedure is often part of a collaborative effort with cardiac surgeons to palliate complex congenital heart defect, such as in embolizing aortopulmonary collateral arteries in patient with single ventricle physiology. In other cases, the procedure is the definitive treatment as in embolizing coronary artery fistula. Pediatric cardiologists performing embolization procedures should be familiar with available technologies as well as understand the underlying cardiac anatomy and pathophysiology. This article provides a comprehensive review of presently available embolization agents and technologies. Some of the technologies are used only by interventional radiologists but may be useful to pediatric cardiologists. Specific clinical applications in pediatric cardiology are also discussed with summary of current literature. With continue advancement in transcatheter technology and operator expertise, all unwanted vascular communication should be amenable to transcatheter embolization.
Cardiac Catheterization↗
Future of interventional cardiology in pediatrics.
A trend toward use of less invasive, nonsurgical approaches to the treatment of congenital heart disease has developed. Although transcatheter valve replacements and ventricular septal defect closures have already been performed in children, many other techniques and devices are being developed for the palliation of children with a single ventricle. Several groups have already established catheter-based procedures for the creation of Fontan communications, and others have performed nonsurgical pulmonary artery banding. Additionally, fetal catheter-based interventions are being developed for the treatment of severe congenital heart disease in utero. Because this trend toward catheter-mediated treatment is certain to continue, care must be taken to regulate safely the introduction of novel techniques and devices into clinical use in pediatric cardiology.
Aortic Valve↗
Balloon sizing of pulmonary branch stenosis: a useful method to guide stent implantation.
UNLABELLED: Among patients with congenital heart disease, pulmonary branch stenosis is a common indication for stent implantation. Selective calibrated angiography is the standard method of vessel sizing to guide angioplasty balloon and stent selection. Our aim was to compare vessel dimensions from standard calibrated selective angiography with those obtained using a compliant sizing balloon catheter. METHODS: 9 patients with 11 pulmonary branch stenoses underwent selective calibrated angiography. Amplatzer sizing balloon catheters positioned across the stenoses were inflated with dilute contrast agent. Digital angiograms were repeated in the same projections. Measurements from both methods were analyzed statistically. Minimum, maximum proximal and maximum distal vessel diameters were all significantly larger (p < 0.01) when measured by the sizing balloon method. Angioplasty balloons and stent diameters were chosen according to the sizing balloon measurements. In 7 of 8 stented lesions, larger angioplasty balloon diameters were selected for stent implantation than would have been chosen by standard angiography. Calibrated selective angiography may undersize vessel diameters. Use of a compliant sizing balloon appears to offer an accurate method to guide stent implantation in pulmonary branch stenosis.
Adolescent↗