Intracardiac device associated interference with tricuspid valve apparatus on echocardiography: What can we learn from pathology?

Funding Acknowledgements

Type of funding sources: None.

Background

 New or worsening tricuspid regurgitation (TR) is associated with right-sided heart failure and worsened outcomes. Cardiac Implantable Electronic Devices (CIEDs), which are being implanted at growing rates worldwide, are increasingly being recognized as associated with TR occurrence related to interference with the tricuspid valve (TV) apparatus. Purpose: We sought to identify echocardiographic features in the right ventricle and TV that differentiate patients who have anatomically demonstrated interference with the TV on direct pathology inspection. 

Methods

 Explanted hearts from 44 consecutive patients undergoing orthotopic heart transplant (55 ±13 yrs, 68% men) with known implanted CIEDs were dissected to assess the presence (n = 18) or absence (n = 26) of CIED interference with the TV (Figure). Echocardiographic measurements performed prior to transplantation, including left and right ventricular (LV, RV) size and performance metrics as well as TR severity, were compared between both groups using non-parametric testing. 

Results

 Echocardiographic features of patients with and without anatomically demonstrated TV interference are shown in the Table. Although overall LV dimensions and volumes were not different between the two groups and LV ejection fraction was severely reduced in both groups, patients demonstrating CIED interference trended towards larger right atrial volumes (Table) and also larger RV and tricuspid annular sizes. Importantly, however, they were more than 4 times likely to have abnormal right ventricular function. Lastly, patients with tricuspid apparatus interference tended to have more significant TR, although these differences have not reached statistical significance (Table). 

Conclusion

 CIED interreference with tricuspid valve apparatus occurs frequently (41%) among patients with CIEDs, who undergo orthotopic heart transplantation. This may be associated with worsening TV function with subsequent changes in right atrial and ventricular geometry and function. In light of prior data showing poor outcomes with CIED associated TR, this study emphasizes the importance of non-invasive assessment of CIED interference with the tricuspid valve, in order to improve device placement and patient outcomes. Abstract Figure  Abstract Table

Removal and recovery of U(VI) from aqueous effluents by flax fiber: Adsorption, desorption and batch adsorber proposal

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Removal and recovery of uranium were investigated in a batch process.

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Adsorbent characteristics were scientifically analyzed.

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The maximum obtained U(VI) removal was ≈94.50% at pH of 4 and adsorbent dose of 1.2 g.

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Adsorption data were analyzed using kinetic, isotherm and thermodynamic models.

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Full scale batch adsorber unit was recommended.

Flax fiber (Linen fiber), a valuable and inexpensive material was used as sorbent material in the uptake of uranium ion for the safe disposal of liquid effluent. Flax fibers were characterized using BET, XRD, TGA, DTA and FTIR analyses, and the results confirmed the ability of flax fiber to adsorb uranium. The removal efficiency reached 94.50% at pH 4, 1.2 g adsorbent dose and 100 min in batch technique. Adsorption results were fitted well to the Langmuir isotherm. The recovery of U (VI) to form yellow cake was investigated by precipitation using NH₄OH (33%). The results show that flax fibers are an acceptable sorbent for the removal and recovery of U (VI) from liquid effluents of low and high initial concentrations. The design of a full scale batch unit was also proposed and the necessary data was suggested.

HIV-1 p24 antigen testing in blood banks: results from Saudi Arabia

HIV-1 p24 antigen testing was introduced to increase sensitivity in the early detection of HIV infection in blood donors. Since the introduction of HIV-1 p24 antigen testing in Saudi Arabia, we have failed to detect a single positive case. Over a three-year period, only four indeterminates were detected out of 24,654 blood donors. All four proved negative by confirmatory testing. Based on this experience, we believe that resources would be better directed to pooled nucleic acid testing and that p24 serological testing should be abandoned.

Clinical, fluorine-18 labeled 2-fluoro-2-deoxyglucose positron emission tomography of the brain, MR spectroscopy, and therapeutic attempts in methylenetetrahydrofolate reductase deficiency

The cases of three infants, two Saudi and one Bahraini, with methylenetetrahydrofolate reductase (MTHFR) deficiency are reported. They presented in the neonatal period with lethargy, poor feeding, hypotonia, and frequent apneas. Tandem mass spectrometry (MS/MS) of a blood spot indicated very low methionine level and of urine revealed high homocysteine. The diagnosis was confirmed by demonstrating severe deficiency of MTHFR in the cultured skin fibroblast. All patients were treated with folinic acid, vitamin B12, betaine, and methionine, with good initial response to the therapy. In two patients, the diagnosis was late and their disease was severe, resulting in neurological crippling. However, in the third patient, who was diagnosed and treated early, the current neurological status is normal. In her case, at 1 month of age, the brain FDG PET scan documented very faint cerebral and cerebellar cortical activities. After 5 months of intensive therapy, that included 200-600 mg/kg per day methionine, she had a dramatic clinical and biochemical recovery as well as a parallel improvement in FDG PET. Brain MR spectroscopy indicated normal neuronal glial and myelin markers for her age. We conclude that the functional changes confirmed by the FDG PET study were better correlated with the clinical course of the patient and adequately monitored the response to therapy. This disease warrants early detection through neonatal screening program, since the beneficial effect of early administration of adequate therapy with combined use of betaine and a high dose of methionine is rewarding and may be the treatment of choice for MTHFR deficiency.

Automated analysis for scintigraphic evaluation of gastric emptying using invariant moments

This study introduces a method for automated analysis of the standard solid-meal gastric emptying test. The purpose was to develop a diagnostic tool to characterize more reproducibly abnormalities of solid-phase gastric emptying. The processing of gastric emptying is automated using geometrical moments that are invariant to scaling, rotation, and shift. Twenty subjects were studied. The first step was to obtain images of the stomach using a nuclear gamma camera immediately after the subject had eaten a radio-labeled meal. The second step was to process and analyze the images by a recently developed automated gastric emptying analysis (AGEA) method, which determines the gastric contour and the geometrical properties include such parameters as area, centroid, orientation, and moments of inertia. Statistical tests showed that some of the moments were sensitive to the patient's gastric status (normal versus abnormal). The difference between the normal and abnormal patients became noticeable approximately 1 h after meal ingestion.