Interventional Pediatric Cardiology Introduction.
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Biomedical subjects
Publications and source records attributed to PS Rao.
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Balloon valvuloplasty provides optimal treatment for moderate and severe pulmonary valve stenosis. Dysplastic pulmonary valves may not respond to balloon dilation and frequently require surgical treatment. Balloon angioplasty with or without stenting is the preferred treatment of peripheral pulmonary stenosis.
Untreated, the prognosis for patients with tricuspid atresia (TA) is poor. Recent advances in medical and surgical therapy, particularly the application of Fontan principle, have markedly improved the long-term outlook for children with this condition. Palliative procedures to normalize the pulmonary blood flow and to relieve interatrial or interventricular obstruction should be undertaken promptly. Staged total cavopulmonary connection to bypass the right atrium and right ventricle by an initial bidirectional Glenn procedure and followed by extracardiac conduit diversion of inferior vena caval flow into the pulmonary arteries appears to be the current procedure of choice in the surgical management of TA. Total cavopulmonary diversion appears to be superior to conventional Fontan-Kreutzer operations, but long-term follow-up results are needed to confirm this impression.
In this review, historical developments related to transcatheter occlusion of atrial septal defects (ASDs) are discussed. Since the initial description by King of transvenous closure of secundum ASDs in the mid 1970s, a variety of double disc and single disc devices have been designed and tested in animal models and human subjects. Feasibility, safety, and effectiveness have been demonstrated. Further developments are likely to result in the availability of device closure technology to all patient subsets.
This article reviews the most recent results of the latest modification of the buttoned device (Custom Medical Devices, Amarillo, TX), the 4th generation. The latest advances in atrial septal defect (ASD) occlusion with further modifications of the buttoned device--inverted buttoned device, hybrid buttoned device, and centering- on-demand device (COD) (Custom Medical Devices)--that have led to the evolution of wireless and deviceless ASD occlusion are also presented.
A large number of atrial septal defect (ASD) closure devices have been investigated in an attempt to develop a nonsurgical, transvenous method of occlusion of ASD. Some of the devices have been discontinued and several are in clinical trials at this time, but none are approved for general clinical use. There are no prospective, randomized clinical trials to compare the available devices. Based on separate clinical trials, the feasibility, safety, and effectiveness of all devices appear similar. Considerations pertaining to the size of the device delivery sheath, ease of implantation, cost and availability are different with each of the devices; some devices have advantages in some aspects, and others with another. Approval by the regulatory authorities and larger clinical use with longer follow-up results may eventually determine the most appropriate device for a given clinical use.
Munchiwarin, a chalcone with the first 2,2, 6-tri-isoprenyl-cyclohex-5-ene-1,3-dione skeleton, was isolated from Crotalaria trifoliastrum and structurally identified by various NMR techniques in combination with X-ray crystallography.
The structure of crotaramosmin has been reassigned to 1-(5-hydroxy-2, 2-dimethyl-2H-chromen-6-yl)-3-(4-hydroxyphenyl)-propanone (1) as determined by extensive NMR investigation.
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