1
|
Carbonell Prat B, Dos L, Gordon B, Ligero C, Gonzalez V, Vilte G, Pijuan A, Miranda B, Ferre M, Lorente M, Guedes P, Ferreira I, Castro MA. Predictors of long term tricuspid regurgitation after pulmonary valve replacement: a single center study on the cohort of significant preoperative tricuspid regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Almost one-third of repaired tetralogy of Fallot (TOF) and pulmonary stenosis (PS) patients referred for pulmonary valve replacement (PVR) have at least moderate tricuspid regurgitation (TR). Predictors of long term TR in this population are not well defined and the role of Tricuspid Annuloplasty (TA) in addition to PVR in this setting is controversial.
Purpose
Patients with preoperative severe TR or moderate TR with dilated tricuspid annulus (>40mm) undergo TA at the time of PVR as per protocol in our instititution. The aim of this observational study was to evaluate the long term results of this approach and to identify predictors of significant TR at the end of follow-up.
Material and methods
We retrospectively reviewed 35 repaired TOF and PS patients who underwent surgical PVR with (n=17, group 1) or without (n=18, group 2) TA in a single tertiary hospital between June-2009 and June-2021. Pre- and postoperative echocardiographic and cardiac magnetic resonance data were assessed for TR severity and right ventricle size and systolic function. Baseline and clinical follow up data were collected. Uni- and multivariable tests were used to analyze predictors of at least moderate TR after PVR.
Results
Mean age at PVR and baseline image parameters were comparable between groups, except for TR grade (p 0.006), tricuspid annulus size (p 0.018) and right ventricle outflow tract diameter (p 0.04) which were greater in group 1. TA did not confer and increased risk of surgical and peroperative complications. Intensive care unit (p 0.94) and total hospital admission days (p 0.59) did not differ among groups. At one year, TR grade significantly improved regardless of TA. At the end of follow-up (5.29±2.9 years), the degree of TR increased in both groups with no differences between groups (p 0.38) (see table 1). In univariable analysis, two independent predictors of at least moderate TR at end of follow-up were identified; mixed TR mechanism (OR 12.5, p 0.006) and severe preoperative TR grade (OR 10.21, p 0.003). Mixed TR mechanism (OR 15.78, p 0.01) and a right ventricle ejection fraction below 45% (OR 1.47, p 0.01) were identified as risk factors of significant TR in multivariable analysis (see Table 2).
Conclusions
TA seems a reasonable approach at the time of PVR in patients with severe TR or moderate TR with dilated annulus. Mixed TR mechanism and a worse right ventricular function have been identified as independent predictors factors of long term significant postoperative TR in our study cohort.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
| | - L Dos
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - B Gordon
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - C Ligero
- University Hospital Sant Joan de Reus , Reus , Spain
| | - V Gonzalez
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - G Vilte
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - A Pijuan
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - B Miranda
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - M Ferre
- University Hospital Sant Joan de Reus , Reus , Spain
| | - M Lorente
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - P Guedes
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - I Ferreira
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - M A Castro
- University Hospital Vall d'Hebron , Barcelona , Spain
| |
Collapse
|
2
|
Alves A, Bourbon M, Miranda B. Update of the study of rare monogenic familial dyslipidaemias in Portugal. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
3
|
Miranda B, Alves A, Bourbon M. Molecular diagnosis of genetic dyslipidaemias by next generation sequencing. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
4
|
Bañeras J, Pariggiano I, Ródenas-Alesina E, Oristrell G, Escalona R, Miranda B, Rello P, Soriano T, Gordon B, Belahnech Y, Calabrò P, García-Dorado D, Ferreira-González I, Radua J. Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how. PLoS One 2022; 17:e0266955. [PMID: 35446875 PMCID: PMC9022883 DOI: 10.1371/journal.pone.0266955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care. Objective We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit from pulse palpation and, if positive, receive an ECG to detect AF. Methods Nurses from four Cardiology outpatient clinics palpated 7,844 pulses according to a randomized list of arterial territories and durations of measure and immediately followed by a 12-lead ECG, which we used as the reference standard. We calculated the sensitivity and specificity of the palpation parameters. We also assessed whether diagnostic accuracy depended on the nurse’s experience or on a list of clinical factors of the patients. With this information, we estimated the positive predictive values and false omission rates according to very few clinical factors readily available in primary care (age, sex, and diagnosis of heart failure) and used them to create the algorithm. Results The parameters associated with the highest diagnostic accuracy were palpation of the radial artery and classifying as irregular those palpations in which the nurse was uncertain about pulse regularity or unable to palpate pulse (sensitivity = 79%; specificity = 86%). Specificity decreased with age. Neither the nurse’s experience nor any investigated clinical factor influenced diagnostic accuracy. We provide the algorithm to select the ≥40 years old individuals that would benefit from a pulse palpation screening: a) do nothing in <60 years old individuals without heart failure; b) do ECG in ≥70 years old individuals with heart failure; c) do radial pulse palpation in the remaining individuals and do ECG if the pulse is irregular or you are uncertain about its regularity or unable to palpate it. Conclusions Opportunistic screening for AF using optimal pulse palpation in candidate individuals according to a simple algorithm may have high effectiveness in detecting AF in primary care.
Collapse
Affiliation(s)
- Jordi Bañeras
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Vall d’Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISC-III, Madrid, Spain
- * E-mail:
| | - Ivana Pariggiano
- Division of Clinical Cardiology, A.O.R.N. "Sant’Anna e San Sebastiano", Caserta, Italy
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Gerard Oristrell
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Roxana Escalona
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Berta Miranda
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Pau Rello
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Toni Soriano
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Blanca Gordon
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Yassin Belahnech
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Paolo Calabrò
- Division of Clinical Cardiology, A.O.R.N. "Sant’Anna e San Sebastiano", Caserta, Italy
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - David García-Dorado
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Vall d’Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISC-III, Madrid, Spain
| | - Ignacio Ferreira-González
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Vall d’Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER ESP, ISC-III, Madrid, Spain
| | - Joaquim Radua
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERSAM, ISC-III, Madrid, Spain
- King’s College London, London, United Kingdom
- Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Rivas-Gándara N, Francisco-Pascual J, Pijuan-Domenech A, Ribera-Solé A, Dos-Subirá L, Benito B, Terricabras M, Pérez-Rodon J, Subirana MT, Santos-Ortega A, Roses-Noguer F, Miranda B, Moya-Mitjans À, Ferreira-González I. Risk stratification of ventricular arrhythmias in repaired tetralogy of Fallot. ACTA ACUST UNITED AC 2021; 74:935-942. [DOI: 10.1016/j.rec.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022]
|
6
|
Miranda B, Jica R, Pinto-Lopes R, Mopuri N, Sood M, Tare M, Shelley O, El-Muttardi N. 1164 St Andrew’s COVID Surgery Safety (StACS) Study: Skin Cancer. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Skin cancer represents the most common malignancy worldwide and it is imperative that we develop strategies to ensure safe and sustained delivery of cancer care which are resilient to the ongoing impact of COVID-19.
Objective
This study prospectively evaluates the COVID-19 related patient risk and skin cancer management at a single tertiary referral centre, which rapidly implemented national COVID-safety guidelines.
Method
A prospective cohort study was performed in all patients who underwent surgery for elective skin cancer service management, during the UK COVID-19 pandemic peak (April-May 2020). ‘Real-time’ 30-day hospital database deceased data were collected. Random selection was undertaken for patients who either underwent operative (surgery group) management or remained on the waiting list (control group); these groups were also prospectively followed-up within a controlled cohort study design and telephoned at the end of June 2020 for the control group or 30 days post-operatively.
Results
Of the 767 patients who had operations, there were no COVID-19 related deaths. Both the surgery (n = 384) and control (n = 100) groups were matched for age, sex, ethnicity, BMI, presence of comorbidities, smoking and positive COVID-19 contact. There were no differences in post-operative versus any symptom development (1.3%, 5/384 vs. 4%, 4/100, p = 0.093), or proportion of positive tests (8.6%, 33/384 vs. 8%, 8/100; p = 0.849), between the surgery and control groups.
Conclusions
These data support continued and safe service provision, and no increased risk to skin cancer patients who require surgical management, which is vital for continuation of cancer treatment in the context of a pandemic.
Collapse
Affiliation(s)
- B Miranda
- Mid and South Essex Hospital, Chelmsford, United Kingdom
| | - R Jica
- Mid and South Essex Hospital, Chelmsford, United Kingdom
| | - R Pinto-Lopes
- Mid and South Essex Hospital, Chelmsford, United Kingdom
| | - N Mopuri
- Mid and South Essex Hospital, Chelmsford, United Kingdom
| | - M Sood
- Mid and South Essex Hospital, Chelmsford, United Kingdom
| | - M Tare
- Mid and South Essex Hospital, Chelmsford, United Kingdom
| | - O Shelley
- Mid and South Essex Hospital, Chelmsford, United Kingdom
| | - N El-Muttardi
- Mid and South Essex Hospital, Chelmsford, United Kingdom
| | | |
Collapse
|
7
|
Rivas-Gándara N, Dos-Subirá L, Francisco-Pascual J, Rodríguez-García J, Pijuan-Domenech A, Benito B, Valente F, Pascual-González G, Santos-Ortega A, Miranda B, Pérez-Rodon J, Ribera-Solé A, Burcet-Rodriguez G, Roses-Noguer F, Gordon B, Rodríguez-Palomares J, Ferreira-González I. Substrate characterization of the right ventricle in repaired tetralogy of Fallot using late enhancement cardiac magnetic resonance. Heart Rhythm 2021; 18:1868-1875. [PMID: 34098087 DOI: 10.1016/j.hrthm.2021.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Three-dimensional (3D) substrate characterization by high-resolution late gadolinium enhancement cardiac magnetic resonance (LE-CMR) is useful for guiding ventricular tachycardia ablation of the left ventricle in ischemic heart disease. OBJECTIVE The purpose of this study was to validate the substrate characterization and 3D reconstruction of LE-CMR images of the right ventricle (RV) in patients with repaired tetralogy of Fallot (rTOF) and to identify the algorithm that best fits with electroanatomic mapping (EAM). METHODS RV LE-CMR images were compared with RV EAM in 10 patients with rTOF. RV LE-CMR images were postprocessed and analyzed to identify fibrotic tissue on 3D color maps. The 3D RV substrate reconstructions were created using an adjustable percentage of the maximum voxel signal intensity (MSI) of the scar region to define the threshold between core, transitional zone (TZ), and healthy tissue. Extensions of the core and TZ areas were compared with the scar (<0.5 mV) and low-voltage (0.5-1.5 mV) areas obtained by RV EAM. Agreement on anatomic isthmi identification was quantified. RESULTS The best match between core and scar was obtained at 65% MSI cutoff (mean areas 17.4 ± 9.9 cm2 vs 16.9 ± 10.0 cm2, respectively; r = 0.954; P <.001). Agreement on anatomic isthmi identification was best at 60% MSI cutoff, which identified 95% of isthmi and achieved a total fit in 90% of patients. CONCLUSION This study demonstrates that characterization of the RV substrate by postprocessing LE-CMR images in rTOF patients is feasible and validates the technique against RV EAM, which could help in planning target ablation.
Collapse
Affiliation(s)
- Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Laura Dos-Subirá
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Julián Rodríguez-García
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antonia Pijuan-Domenech
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Begoña Benito
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Filipa Valente
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiac Imaging Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Berta Miranda
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Aida Ribera-Solé
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Epidemiology Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Ferran Roses-Noguer
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Cardiology and Pediatric Cardiac Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Blanca Gordon
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiac Imaging Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ignacio Ferreira-González
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
8
|
Gordon B, Buendia Fuentes F, Dos L, Miranda B, Osa A, Gonzalez A, Gallego P, Meras P, Adsuar A, Rodriguez M, Montserrat S, Carbonell B, Oliver J, Rueda J. Clinical features and outcomes of adult patients with single ventricle physiology not undergoing Fontan repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Adult patients with single ventricle (SV) physiology who had not undergone Fontan palliation are uncommon. Little is known about their clinical features and outcomes.
Objective
This study aims to describe the clinical features, cardiovascular outcomes and long-term survival of patients with SV physiology without Fontan palliation.
Methods
Data were collected retrospectively from SV physiology patients followed in adult congenital heart disease (ACHD) units of five tertiary referral centers. None of them had Fontan palliation. Baseline data were recorded on the first visit at ACHD unit. Death was considered as main endpoint. Other outcomes such as atrial or ventricular arrhythmias, endocarditis, ICD or pacemaker implantation, admission for heart failure and heart transplant were also collected and analyzed. Association between clinical/analytical baseline variables and death was also evaluated by univariate Cox regression.
Results
128 patients were included. On the first visit, mean age was 32.3±10.9 years, being the most common defect double inlet left ventricle (63p, 49.2%). The single ventricle had left morphology in 106 cases (82.8%). At baseline mean heaemglobin was 19.1±2.8 g/dl, mean O2 Sat 83±6.9% and 46 patients (36%) had a NYHA status III or IV. 4 different groups were found: a) Unrestricted pulmonary flow with Eisenmenger physiology (24p, 18.8%); b) Restricted forward pulmonary flow with or without pulmonary banding (46p, 35.9%); c) Aortopulmonary shunts as a source of pulmonary flow (20p, 15.5%) and d) cavopulmonary shunt (Glenn) as a definitive palliation (38p, 29.7%). After 7.3±4.1 years follow-up, mortality was 22.7% (29 patients), being sudden death (9p, 7%) the most frequent cause. Survival rate at 5 and 10 years of follow-up were 85% and 76% respectively (Figure 1). About of the rest of the outcomes, highlighting a high rate of atrial tachycardia (38.3%), admission for heart failure (23.4%), stroke (17.2%), endocarditis (9.4%), pacemaker/ICD implantation (11.8%). Baseline variables associated with higher mortality were: older age (HR=1.1 [1.004–1–087]); NYHA III or IV (HR=5.5 [2.4–12.4]); thrombocytopenia (HR=1.01 [1.001–1.003]); anticoagulant treatment (HR=2.6 [1.7–3.9]); glomerular filtration rate below 60 ml/min (HR=3.77 [1.5–9.6]); QRS width (HR=1.03 [1.01–1.05]); atrial arrhythmias (HR=3.1 [1.5–6.5]); moderate or severe AV valve regurgitation (HR=1.5 [1.15–1.97]) and ventricular ejection fraction (HR=0.94 [0.91-0.97]).
Conclusions
Adults survivors with SV physiology without Fontan palliation have a high mortality and frequently suffer from serious cardiovascular events. Several clinical (NYHA status, previous atrial arrhythmias, anticoagulant treatment), analytical (renal function, thrombocytopenia), ECG (QRS width) and echocardiography (AV valve regurgitation and EF) factors can identify patients at higher risk of death.
Figure 1. Survival curve
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- B Gordon
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | - L Dos
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - B Miranda
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Osa
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - A Gonzalez
- University Hospital La Paz, Madrid, Spain
| | - P Gallego
- Complex Public Hospital Virgen del Rocio Regional, Sevilla, Spain, Spain
| | - P Meras
- University Hospital La Paz, Madrid, Spain
| | - A Adsuar
- Complex Public Hospital Virgen del Rocio Regional, Sevilla, Spain, Spain
| | - M.J Rodriguez
- Complex Public Hospital Virgen del Rocio Regional, Sevilla, Spain, Spain
| | | | | | - J.M Oliver
- University Hospital Gregorio Maranon, Madrid, Spain
| | - J Rueda
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| |
Collapse
|
9
|
Buendia F, Ramirez B, Gallego P, Oliver J, Montserrat S, Osa A, Miranda B, Rodriguez Puras M, Gonzalez A, Carbonell B, Meras P, Adsuar A, Ruiz Cantador J, Rueda Soriano J, Dos L. Long term outcome of single ventricle physiology with pulmonary restriction not undergoing Fontan repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with univentricular physiology who do not complete the palliation to Fontan are a heterogeneous group with unknown long term outcome.
Aims
This study aimed at describing the clinical course and long-term survival of patients with SV physiology with restricted pulmonary flow that had not undergone a Fontan type of repair.
Methods
From the prospectively maintained databases of the adult congenital cardiac units of five tertiary referral centers, data from all SV physiology patients were obtained. Patients completing a Fontan type palliation or developing Eisenmenger physiology and segmental pulmonary hypertension were excluded. Baseline data were recorded on the first visit at adult congenital heart disease (ACHD) unit. The primary end point was death.
Results
101 patients (50.5% females) were identified. Mean age at end of follow up was 39.3±11.3 years. Of these, 45 (44.6%) were unoperated (group 1, restricted forward pulmonary flow with or without pulmonary banding), 38 (37.6%) had undergone a cavopulmonary shunt as a definitive palliation (group 2) and 18 (17.8%) had aortopulmonary shunts (group 3). The main diagnosis was double inlet left ventricle (DILV) (N: 52, 51.5%) and most of the ventricle was left (82.2%). The principal reason for not performing a Fontan repair was mean pulmonary artery pressure >18 mmHg. At initial visit at the ACHD unit patients were 32.2±11.1 years of age. 35% of the patients were in NYHA class III-IV, with no differences between groups. However, patients in group 2 had worse oxygen saturation (p=002) and higher haemoglobin (p=0.037). After a mean follow-up of 7.3±4.1 years, mortality was 20.8% (21 patients), being sudden death (7p, 6.9%) the most frequent cause. Patients in group 3 showed worse ventricular function (p=0.0001) and a trend to higher mortality that did not reach statistical significance (HR 2.7, CI 95% 0.91–8.14, P=0.07).
Conclusions
Patients with single ventricle physiology not undergoing Fontan repair are a population of high risk, with sudden death as main driver of mortality. Patients palliated with aortopulmonary shunts are prone to worse ventricular function and a trend to higher mortality.
Funding Acknowledgement
Type of funding source: Public hospital(s)
Collapse
Affiliation(s)
- F Buendia
- University Hospital La Fe, 2Adult Congenital Cardiac Unit. Hospital Universitari i Politècnic La Fe, Valencia, Spain, Valencia, Spain
| | - B Ramirez
- University Hospital Vall d'Hebron, Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Barcelona, Spain
| | - P Gallego
- Complex Public Hospital Virgen del Rocio Regional, Sevilla, Spain, Spain
| | - J.M Oliver
- University Hospital Gregorio Maranon, Madrid, Spain
| | | | - A Osa
- University Hospital La Fe, 2Adult Congenital Cardiac Unit. Hospital Universitari i Politècnic La Fe, Valencia, Spain, Valencia, Spain
| | - B Miranda
- University Hospital Vall d'Hebron, Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Barcelona, Spain
| | | | | | - B Carbonell
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - P Meras
- University Hospital La Paz, Madrid, Spain
| | - A Adsuar
- Complex Public Hospital Virgen del Rocio Regional, Sevilla, Spain, Spain
| | | | - J Rueda Soriano
- University Hospital La Fe, 2Adult Congenital Cardiac Unit. Hospital Universitari i Politècnic La Fe, Valencia, Spain, Valencia, Spain
| | - L Dos
- University Hospital Vall d'Hebron, Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, Barcelona, Spain
| |
Collapse
|
10
|
Scognamiglio G, Fusco F, Hankel TC, Bouma BJ, Greutmann M, Khairy P, Ladouceur M, Dimopoulos K, Niwa K, Broberg CS, Miranda B, Budts W, Bouchardy J, Schwerzmann M, Lipczyńska M, Tobler D, Tsai SF, Egbe AC, Aboulhosn J, Fernandes SM, Garr B, Rutz T, Mizuno A, Proietti A, Alonso-Gonzalez R, Mulder BJM, Sarubbi B. Safety and efficacy of non-vitamin K antagonist oral anticoagulants for prevention of thromboembolism in adults with systemic right ventricle: Results from the NOTE international registry. Int J Cardiol 2020; 322:129-134. [PMID: 32805330 DOI: 10.1016/j.ijcard.2020.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with systemic right ventricle (sRV), including transposition of great arteries (TGA) after atrial switch procedure and congenitally corrected transposition of great arteries (ccTGA), may require anticoagulation for thromboembolism (TE) prevention. In the absence of data on non-vitamin K antagonist oral anticoagulants (NOACs), vitamin K antagonists (VKAs) remain the agent of choice. We investigated the safety, efficacy and feasibility of NOACs treatment in adults with sRV in a worldwide study. METHODS This is an international multicentre prospective study, using data from the NOTE registry on adults with sRV taking NOACs between 2014 and 2019. The primary endpoints were TE and major bleeding (MB). The secondary endpoint was minor bleeding. RESULTS A total of 76 patients (42.5 ± 10.0 years, 76% male) with sRV (74% TGA, 26% ccTGA) on NOACs were included in the study. During a median follow-up of 2.5 years (IQR1.5-3.9), TE events occurred in 3 patients (4%), while no MB episodes were reported. Minor bleeding occurred in 9 patients (12%). NOAC treatment cessation rate was 1.4% (95%CI:0.3-4%) during the first year of follow-up. All the patients with TE events had a CHA2DS2-VASc score ≥ 2 and impaired sRV systolic function at baseline. The total incidence of major events during follow-up was significantly lower compared to historical use of VKAs or aspirin before study inclusion (1.4% (95%CI:0.29-4%) vs 6,9% (95%CI:2.5-15.2%); p = .01). CONCLUSIONS In this prospective study, NOACs appear to be well-tolerated, with excellent efficacy and safety at mid-term in patients with sRV.
Collapse
Affiliation(s)
- Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy.
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Tara C Hankel
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Matthias Greutmann
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Disease Centre, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Centre de Référence M3C, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital and Imperial College of London, London, United Kingdom
| | - Koichiro Niwa
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Craig S Broberg
- Department of Cardiology, Oregon Health & Science University Hospital, Portland, United States of America
| | - Berta Miranda
- Integrated Adult Congenital Heart Disease Unit of Vall d' Hebron-Sant Pau University Hospitals, Division of Cardiology, Vall d'Hebron Hospital, Barcelona, Spain
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Judith Bouchardy
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland; Department of Cardiology, University Hospital Geneva, Genève, Switzerland
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Magdalena Lipczyńska
- Adult Congenital Heart Center, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Shane F Tsai
- Department of Cardiology, University of Nebraska Medical Centre, NE, United States of America
| | - Alexander C Egbe
- Department of Cardiology, Mayo Clinic, Rochester, United States of America
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, LosAngeles, United States of America
| | - Susan M Fernandes
- Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital, Stanford Health Care, Stanford School of Medicine, Palo Alto, CA, United States of America
| | - BreAnn Garr
- Department of Cardiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, United States of America
| | - Tobias Rutz
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Anna Proietti
- Electrophysiology Service and Adult Congenital Heart Disease Centre, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Rafael Alonso-Gonzalez
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital and Imperial College of London, London, United Kingdom
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Netherlands Heart Institute, Utrecht, the Netherlands
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | |
Collapse
|
11
|
Llerena Butron SI, Francisco Pascual J, Perez Rodon J, Santos Ortega A, Benito B, Rodriguez Garcia J, Dos Subira L, Pijuan A, Subirana MT, Miranda B, Gonzalez V, Escalona Silva R, Ferreira Gonzalez I, Rivas Gandara N. P921Feasibility of multipoint, high-definition mapping with grid cathether of SVTs in patients with D-Transposition of the great arteries treated with atrial switch surgery. Europace 2020. [DOI: 10.1093/europace/euaa162.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Patients with D-transposition of the great arteries (TGA) treated with Senning or Mustard surgery develop supraventricular tachycardias (SVTs) that require treatment with ablation. The use of multipoint, high-density, wavefront-activation-orientation independent mapping catheters hasn’t been reported in literature.
Purpose
To describe the feasibility of using a specific mapping catheter in SVTs in this set of patients.
Methods
Prospective observational study in patients with history of SVT and atrial switch surgery, that underwent EP study and electroanatomic (EA) mapping with a new 8Fr deflectable, multipoint (16 equidistant electrodes along 4 splines), with magnetic sensor, wavefront-activation-orientation independent catheter, in a third level hospital since April 2018 until May 2019, with medium-term follow-up.
Results
A total of 8 EPS (electrophysiologic studies) were performed in 7 patients (clinical data in Table 1). One patient had a tachycardia recurrence, accounting for a second EPS. The pulmonary venous atrium (PVA) was mapped in all procedures, whereas the systemic venous atrium (SVA) was mapped only in 75% of them, A total of 15 EA maps were obtained, with a ratio of 1.9 maps/patient, and an average of 20 375 ± 13 045 total points per patient. In all cases, PVA mapping was performed via retrograde transaortic approach, without transbaffle puncture. Tachycardia was induced in 5 out of 8 procedures, obtaining 6 different tachycardias (4 CTI dependent macro-reentry: 3 w/anticlockwise activation; 1 localized re-entry in SVA; 1 focal AT in SVA). No arrhythmia was induced in the other 3 procedures, however, in a patient with a previous CTI ablation, evidence of a gap in the ablation line on the voltage map was found. Ablation was performed with an irrigated, contact force, 3.5 mm catheter in 6 of the 8 procedures (75%). A retrograde transaortic approach was used in 3 of CTI dependent macro-reentries (75%). In one patient (who underwent two procedures) ablation was performed through a baffle leak. We report an acute success rate of ablation of 100%, and a recurrence rate of 20% on medium-term follow up. There were no major complications; nonetheless, one patient with history of morbid obesity had a minor vascular complication on the femoral puncture site treated medically.
Conclusions
it’s feasible and safe to use this new mapping catheter in patients with history of atrial switch surgery, both via retrograde and anterograde approach on the PVA and SVA respectively. The most frequent tachycardia observed in this study was anticlockwise CTI-dependent atrial flutter.
Abstract Figure. Patient characteristics
Collapse
Affiliation(s)
| | | | - J Perez Rodon
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | - A Santos Ortega
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | - B Benito
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | | | - L Dos Subira
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | - A Pijuan
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | - M T Subirana
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | - B Miranda
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | - V Gonzalez
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | | | | | - N Rivas Gandara
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| |
Collapse
|
12
|
Galian-Gay L, Gordon B, Marsal JR, Rafecas A, Pijuan Domènech A, Castro MA, Subirana Domènech MT, Sureda C, Miranda B, Martí G, García-Dorado D, Dos Subirà L. Determinantes del resultado a largo plazo de la estenosis de válvula pulmonar reparada. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
13
|
Ródenas E, Escalona R, Pariggiano I, Oristrell G, Miranda B, Belahnech Y, Soriano T, Rello P, Gordon B, Barrabés JA, García-Dorado D, Bañeras J. Individual trends in LDL-C control in patients with previous myocardial infarction. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.rccl.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
14
|
Miranda B, Vieira N, Monteiro N. Correction to: Pregnant pipefish with a simple brooding surface lose less weight when carrying heavier eggs: evidence of compensation for low oocyte quality? Acta Ethol 2019. [DOI: 10.1007/s10211-019-00330-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Sambola A, Bueno H, Miranda B, Hernandez AV, Limeres J, Del Blanco BG, García-Dorado D. Safe and Efficacious Use of 1-Month Triple Therapy in Patients with Atrial Fibrillation and High Bleeding Risk Undergoing PCI. Cardiovasc Drugs Ther 2019; 33:425-433. [PMID: 31332653 DOI: 10.1007/s10557-019-06889-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of short or prolonged use of triple therapy (TT) on outcomes in patients with atrial fibrillation (AF) and high risk of bleeding undergoing percutaneous coronary intervention (PCI) is unclear. We compared clinical outcomes according to the duration of TT in patients with AF and HAS-BLED ≥ 3 at 1 year of follow-up. METHODS A prospective observational cohort enrolled 735 patients with AF between 2010 and 2015. Of these, 521 (70.9%) had HAS-BLED ≥ 3 and 380 (72.9%) were discharged on TT. TT was prescribed for 1 month in 233 patients (61.3%). The primary endpoint was the incidence of Bleeding Academic Research Consortium (BARC ≥ 3). The secondary endpoint was the occurrence of ischemic events (cardiac death, MI, stroke, or stent thrombosis). RESULTS Patients on 1-month TT had a higher median HAS-BLED. Intracraneal hemorrhage was twofold more frequently in patients on > 1-month TT but without statistical significance (0.9% vs 2.1%, p = 0.20). Rates of the primary endpoint (bleeding BARC ≥ 3) were 8.2% vs 10.9% and did not differ between groups, while secondary endpoint did not occur more frequently in the 1-month TT group compared with the > 1-month TT group (26.6% vs 23.1%). In adjusted multivariate analyses, patients receiving 1-month TT had a similar risk of the primary endpoint compared to those with > 1-month TT (HR 1.47; 95% CI 0.48-4.47, p = 0.50). No difference was found in the secondary ischemic endpoint (HR 1.24; 95% CI 0.77-2.00, p = 0.38). CONCLUSIONS In patients with AF undergoing PCI at lower ischemic risk and higher bleeding risk, 1 month of TT seems safe and efficacious. Further studies are warranted in patients at high ischemic risk.
Collapse
Affiliation(s)
- Antonia Sambola
- Department of Cardiology, Hospital Vall d'Hebron University, Barcelona, Spain. .,Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129, 08035, Barcelona, Spain.
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Cardiovascular Research Area, Research Institute CCU, Department of Cardiology, Hospital 12 de Octubre University, Madrid, Spain
| | - Berta Miranda
- Department of Cardiology, Hospital Vall d'Hebron University, Barcelona, Spain.,Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129, 08035, Barcelona, Spain
| | - Adrian V Hernandez
- University of Connecticut/Hartford Hospital Evidence-based Practice Center, Hartford, CT, 06102, USA.,Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru
| | - Javier Limeres
- Department of Cardiology, Hospital Vall d'Hebron University, Barcelona, Spain.,Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129, 08035, Barcelona, Spain
| | - Bruno García Del Blanco
- Department of Cardiology, Hospital Vall d'Hebron University, Barcelona, Spain.,Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129, 08035, Barcelona, Spain
| | - David García-Dorado
- Department of Cardiology, Hospital Vall d'Hebron University, Barcelona, Spain.,Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129, 08035, Barcelona, Spain
| |
Collapse
|
16
|
Galian-Gay L, Gordon B, Marsal JR, Rafecas A, Pijuan Domènech A, Castro MA, Subirana Domènech MT, Sureda C, Miranda B, Martí G, García-Dorado D, Dos Subirà L. Determinants of long-term outcome of repaired pulmonary valve stenosis. ACTA ACUST UNITED AC 2019; 73:131-138. [PMID: 31130344 DOI: 10.1016/j.rec.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/27/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Although pulmonary valve stenosis (PVS) is considered a low risk congenital heart disease, there have been reports of complications and the need for reintervention throughout follow-up. The aims of this study were to evaluate the long-term outcome of repaired PVS and to identify predictors of cardiovascular complications and reintervention. METHODS We studied 158 adult patients with repaired PVS (repair procedures performed from 1957 to 2010) receiving active follow-up in a tertiary referral center. RESULTS A total of 95 patients (60%) received surgical treatment, and 63 patients (40%) received percutaneous pulmonary balloon valvuloplasty. At the end of follow-up (27 years, IQR, 20-33 years), most patients (n=134, 84.8%) were in New York Heart Association functional class I, but 61 patients (38.6%) required a reintervention, mainly pulmonary valve replacement (17.7%, n=28), and 19 patients (12%) had at least one cardiovascular complication: 13 (8.2%) supraventricular arrhythmias, 6 (3.8%) heart failure, 5 (3.2%) stroke, 1 (0.6%) death, 1 (0.6%) thromboembolism, and 1 (0.6%) ventricular arrhythmia. Multivariate analysis showed that age at PVS repair (HR, 1.08; 95%CI, 1.04-1.12; P <.001) and the presence of cyanosis before PVS repair (HR, 5.23; 95%CI, 1.99-13.78; P=.001) were independent predictors for cardiovascular complications. CONCLUSIONS Good long-term outcome can be expected after PVS repair, but complications and the need for reintervention may appear. Older age and the presence of cyanosis at PVS repair emerged as predictors of cardiovascular complications and identified a population that may merit stricter control.
Collapse
Affiliation(s)
- Laura Galian-Gay
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España.
| | - Blanca Gordon
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - Josep Ramón Marsal
- Unitat d'Epidemiologia, Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERESP, Barcelona, España
| | - Agnès Rafecas
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - Antonia Pijuan Domènech
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| | - Miguel Angel Castro
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| | - Maria T Subirana Domènech
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| | - Carlos Sureda
- Servei de Cirurgia Cardiaca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Berta Miranda
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| | - Gerard Martí
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - David García-Dorado
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - Laura Dos Subirà
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| |
Collapse
|
17
|
Roca-Luque I, Rivas Gándara N, Dos Subirà L, Francisco Pascual J, Pérez-Rodon J, Pijuan Domenech A, Subirana MT, Miranda B, Santos Ortega A, Casaldàliga Ferrer J, García-Dorado García D, Moya Mitjans A. Intra-atrial re-entrant tachycardia in patients with congenital heart disease: factors associated with disease severity. Europace 2018; 20:1343-1351. [PMID: 29016882 DOI: 10.1093/europace/eux180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/03/2017] [Indexed: 11/14/2022] Open
Abstract
Aim Intra-atrial re-entrant tachycardia (IART) is a common complication in patients with congenital heart disease (CHD) and is related to increased morbidity and mortality. Few reports have been published about factors associated to IART severity. The aim of this study is to analyse factors associated to severe clinical presentation of IART. Methods and Results Observational study of all consecutive CHD patients who underwent a first IART ablation from January 2009 to December 2015 (94 patients, 39.4% female, and age: 36.55 ± 14.9 years). Severe clinical presentation was defined as heart failure, syncope, shock, electromechanical dissociation (EMD), or aborted sudden death. The majority of patients had moderately or highly complex cardiac defect (90.4%). Types of IART included cavotricuspid isthmus(CTI) dependent in 51% (48), non-CTI-related in 22.3% (20), and both types in 27.7% (26). In 38 patients (40.4%), a severe event occurred and in 16 (17%), the symptoms included shock, syncope, sudden death, or EMD. In 21 (22.3%), severe symptoms were the first manifestation of IART. In multivariate analysis, transposition of the great arteries (TGA) with right systemic ventricle (OR 5.32, 95% C.I. 1.6-7.02, P = 0.0005) and severe dilation of the venous atrium (VsA) (OR 4.17; 95% CI 1.4-8.12, P = 0.0009) were factors independently associated with severity. Conclusion In our series of 94 CHD patients with a high proportion of moderately to highly complex cardiac defects, severe consequences of IART were frequent. Transposition of the great arteries with systemic right ventricle and severe dilation of VsA were independently associated to severity. Early invasive procedures should be considered for these high-risk patients.
Collapse
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Nuria Rivas Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Laura Dos Subirà
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Jaume Francisco Pascual
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Antònia Pijuan Domenech
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Ma Teresa Subirana
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Berta Miranda
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Alba Santos Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Casaldàliga Ferrer
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | | | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| |
Collapse
|
18
|
Conceição I, Miranda B, Castro J, de Carvalho M. Hereditary amyloidosis related to transthyretin V30M: disease progression in treated and untreated patients. Eur J Neurol 2018; 25:1320-e115. [DOI: 10.1111/ene.13724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/19/2018] [Indexed: 01/14/2023]
Affiliation(s)
- I. Conceição
- Department of Neurosciences and Mental Health, Neurology; Hospital de Santa Maria-CHLN; Lisbon Portugal
- Faculty of Medicine; Institute of Physiology, Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
| | - B. Miranda
- Department of Neurosciences and Mental Health, Neurology; Hospital de Santa Maria-CHLN; Lisbon Portugal
- Faculty of Medicine; Institute of Physiology, Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
| | - J. Castro
- Department of Neurosciences and Mental Health, Neurology; Hospital de Santa Maria-CHLN; Lisbon Portugal
- Faculty of Medicine; Institute of Physiology, Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
| | - M. de Carvalho
- Department of Neurosciences and Mental Health, Neurology; Hospital de Santa Maria-CHLN; Lisbon Portugal
- Faculty of Medicine; Institute of Physiology, Instituto de Medicina Molecular; University of Lisbon; Lisbon Portugal
| |
Collapse
|
19
|
Pascarella A, Ferrandino G, Credendino SC, Moccia C, D'Angelo F, Miranda B, D'Ambrosio C, Bielli P, Spadaro O, Ceccarelli M, Scaloni A, Sette C, De Felice M, De Vita G, Amendola E. DNAJC17 is localized in nuclear speckles and interacts with splicing machinery components. Sci Rep 2018; 8:7794. [PMID: 29773831 PMCID: PMC5958099 DOI: 10.1038/s41598-018-26093-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/04/2018] [Indexed: 01/23/2023] Open
Abstract
DNAJC17 is a heat shock protein (HSP40) family member, identified in mouse as susceptibility gene for congenital hypothyroidism. DNAJC17 knockout mouse embryos die prior to implantation. In humans, germline homozygous mutations in DNAJC17 have been found in syndromic retinal dystrophy patients, while heterozygous mutations represent candidate pathogenic events for myeloproliferative disorders. Despite widespread expression and involvement in human diseases, DNAJC17 function is still poorly understood. Herein, we have investigated its function through high-throughput transcriptomic and proteomic approaches. DNAJC17-depleted cells transcriptome highlighted genes involved in general functional categories, mainly related to gene expression. Conversely, DNAJC17 interactome can be classified in very specific functional networks, with the most enriched one including proteins involved in splicing. Furthermore, several splicing-related interactors, were independently validated by co-immunoprecipitation and in vivo co-localization. Accordingly, co-localization of DNAJC17 with SC35, a marker of nuclear speckles, further supported its interaction with spliceosomal components. Lastly, DNAJC17 up-regulation enhanced splicing efficiency of minigene reporter in live cells, while its knockdown induced perturbations of splicing efficiency at whole genome level, as demonstrated by specific analysis of RNAseq data. In conclusion, our study strongly suggests a role of DNAJC17 in splicing-related processes and provides support to its recognized essential function in early development.
Collapse
Affiliation(s)
- A Pascarella
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - G Ferrandino
- Istituto di Ricerche Genetiche G. Salvatore, Biogem s.c.ar.l, Ariano Irpino (AV), Italy
| | - S C Credendino
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - C Moccia
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - F D'Angelo
- Istituto di Ricerche Genetiche G. Salvatore, Biogem s.c.ar.l, Ariano Irpino (AV), Italy
| | - B Miranda
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - C D'Ambrosio
- Proteomics & Mass Spectrometry Laboratory, ISPAAM, National Research Council, Napoli, Italy
| | - P Bielli
- Laboratory of Neuroembryology, Fondazione Santa Lucia, 00143, Rome, Italy.,Department of Biomedicine and Prevention, Università di Roma Tor Vergata, 00133, Rome, Italy
| | - O Spadaro
- Istituto di Ricerche Genetiche G. Salvatore, Biogem s.c.ar.l, Ariano Irpino (AV), Italy
| | - M Ceccarelli
- Istituto di Ricerche Genetiche G. Salvatore, Biogem s.c.ar.l, Ariano Irpino (AV), Italy
| | - A Scaloni
- Proteomics & Mass Spectrometry Laboratory, ISPAAM, National Research Council, Napoli, Italy
| | - C Sette
- Laboratory of Neuroembryology, Fondazione Santa Lucia, 00143, Rome, Italy.,Institute of Human Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - M De Felice
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy.,Istituto di Ricerche Genetiche G. Salvatore, Biogem s.c.ar.l, Ariano Irpino (AV), Italy
| | - G De Vita
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy.
| | - E Amendola
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy.
| |
Collapse
|
20
|
Fernández-Hidalgo N, Ferreria-González I, Marsal JR, Ribera A, Aznar ML, de Alarcón A, García-Cabrera E, Gálvez-Acebal J, Sánchez-Espín G, Reguera-Iglesias JM, De La Torre-Lima J, Lomas JM, Hidalgo-Tenorio C, Vallejo N, Miranda B, Santos-Ortega A, Castro MA, Tornos P, García-Dorado D, Almirante B. A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE. Clin Microbiol Infect 2018; 24:1102.e7-1102.e15. [PMID: 29408350 DOI: 10.1016/j.cmi.2018.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/13/2018] [Accepted: 01/20/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To simplify and optimize the ability of EuroSCORE I and II to predict early mortality after surgery for infective endocarditis (IE). METHODS Multicentre retrospective study (n = 775). Simplified scores, eliminating irrelevant variables, and new specific scores, adding specific IE variables, were created. The performance of the original, recalibrated and specific EuroSCOREs was assessed by Brier score, C-statistic and calibration plot in bootstrap samples. The Net Reclassification Index was quantified. RESULTS Recalibrated scores including age, previous cardiac surgery, critical preoperative state, New York Heart Association >I, and emergent surgery (EuroSCORE I and II); renal failure and pulmonary hypertension (EuroSCORE I); and urgent surgery (EuroSCORE II) performed better than the original EuroSCOREs (Brier original and recalibrated: EuroSCORE I: 0.1770 and 0.1667; EuroSCORE II: 0.2307 and 0.1680). Performance improved with the addition of fistula, staphylococci and mitral location (EuroSCORE I and II) (Brier specific: EuroSCORE I 0.1587, EuroSCORE II 0.1592). Discrimination improved in specific models (C-statistic original, recalibrated and specific: EuroSCORE I: 0.7340, 0.7471 and 0.7728; EuroSCORE II: 0.7442, 0.7423 and 0.7700). Calibration improved in both EuroSCORE I models (intercept 0.295, slope 0.829 (original); intercept -0.094, slope 0.888 (recalibrated); intercept -0.059, slope 0.925 (specific)) but only in specific EuroSCORE II model (intercept 2.554, slope 1.114 (original); intercept -0.260, slope 0.703 (recalibrated); intercept -0.053, slope 0.930 (specific)). Net Reclassification Index was 5.1% and 20.3% for the specific EuroSCORE I and II. CONCLUSIONS The use of simplified EuroSCORE I and EuroSCORE II models in IE with the addition of specific variables may lead to simpler and more accurate models.
Collapse
Affiliation(s)
- N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - I Ferreria-González
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - J R Marsal
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Unitat de Suport a la Recerca Lleida-Pirineus, IDIAP Jordi Gol, Lleida, Spain
| | - A Ribera
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - M L Aznar
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A de Alarcón
- Universitat Autònoma de Barcelona, Barcelona, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain
| | - E García-Cabrera
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain
| | - J Gálvez-Acebal
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - G Sánchez-Espín
- Unidad de Gestión Clínica del Corazón, Instituto de Investigación Biomédica de Málaga (BIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J M Reguera-Iglesias
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - J De La Torre-Lima
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J M Lomas
- Unitat de Suport a la Recerca Lleida-Pirineus, IDIAP Jordi Gol, Lleida, Spain; Unidad de Enfermedades Infecciosas, Hospitales Juan Ramón Jiménez-Infanta Elena, Huelva, Spain
| | - C Hidalgo-Tenorio
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - N Vallejo
- Servicio de Cardiología, Grupo de Trabajo de Endocarditis Infecciosa, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - B Miranda
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Santos-Ortega
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M A Castro
- Servei de Cirurgia Cardíaca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Tornos
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D García-Dorado
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - B Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
21
|
Roca-Luque I, Rivas Gándara N, Dos Subirà L, Pascual JF, Domenech AP, Pérez-Rodon J, Subirana MT, Santos Ortega A, Miranda B, Rosés-Noguer F, Ferreira-Gonzalez I, Ferrer JC, García-Dorado García D, Mitjans AM. Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage. Europace 2017; 20:353-361. [PMID: 29016802 DOI: 10.1093/europace/eux250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
MESH Headings
- Action Potentials
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Atrial Function
- Catheter Ablation
- Child
- Child, Preschool
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Atria/physiopathology
- Heart Atria/surgery
- Heart Conduction System/physiopathology
- Heart Conduction System/surgery
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Rate
- Humans
- Male
- Middle Aged
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/etiology
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Young Adult
Collapse
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Nuria Rivas Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Dos Subirà
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Francisco Pascual
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Antònia Pijuan Domenech
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - M Teresa Subirana
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Alba Santos Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Berta Miranda
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Ferran Rosés-Noguer
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Ciber CV Research Unit, Hospital Universitari Vall d' Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Casaldàliga Ferrer
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - David García-Dorado García
- Ciber CV Research Unit, Hospital Universitari Vall d' Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| |
Collapse
|
22
|
Gordon Ramirez B, Sambola A, Gonzalez Fernandez V, Miranda B, Limeres J, Santos A, Garcia Del Blanco B, Barrabes J, Baneras J, Garcia Dorado D. P4297Bleeding complications in patients with indication for oral anticoagulation and an acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
23
|
Corral-Vázquez C, Aguilar-Quesada R, Catalina P, Lucena-Aguilar G, Ligero G, Miranda B, Carrillo-Ávila JA. Cell lines authentication and mycoplasma detection as minimun quality control of cell lines in biobanking. Cell Tissue Bank 2017; 18:271-280. [PMID: 28255773 PMCID: PMC5429902 DOI: 10.1007/s10561-017-9617-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 02/23/2017] [Indexed: 11/24/2022]
Abstract
Establishment of continuous cell lines from human normal and tumor tissues is an extended and useful methodology for molecular characterization of cancer pathophysiology and drug development in research laboratories. The exchange of these cell lines between different labs is a common practice that can compromise assays reliability due to contamination with microorganism such as mycoplasma or cells from different flasks that compromise experiment reproducibility and reliability. Great proportions of cell lines are contaminated with mycoplasma and/or are replaced by cells derived for a different origin during processing or distribution process. The scientific community has underestimated this problem and thousand of research experiment has been done with cell lines that are incorrectly identified and wrong scientific conclusions have been published. Regular contamination and authentication tests are necessary in order to avoid negative consequences of widespread misidentified and contaminated cell lines. Cell banks generate, store and distribute cell lines for research, being mandatory a consistent and continuous quality program. Methods implementation for guaranteeing both, the absence of mycoplasma and authentication in the supplied cell lines, has been performed in the Andalusian Health System Biobank. Specifically, precise results were obtained using real time PCR detection for mycoplasma and 10 STRs identification by capillary electrophoresis for cell line authentication. Advantages and disadvantages of these protocols are discussed.
Collapse
Affiliation(s)
- C Corral-Vázquez
- Andalusian Public Health System Biobank, Avenida Del Conocimiento S/N, 18016, Granada, Spain
| | - R Aguilar-Quesada
- Andalusian Public Health System Biobank, Avenida Del Conocimiento S/N, 18016, Granada, Spain
| | - P Catalina
- Andalusian Public Health System Biobank, Avenida Del Conocimiento S/N, 18016, Granada, Spain
| | - G Lucena-Aguilar
- Andalusian Public Health System Biobank, Avenida Del Conocimiento S/N, 18016, Granada, Spain
| | - G Ligero
- Andalusian Public Health System Biobank, Avenida Del Conocimiento S/N, 18016, Granada, Spain
| | - B Miranda
- Andalusian Public Health System Biobank, Avenida Del Conocimiento S/N, 18016, Granada, Spain
| | - J A Carrillo-Ávila
- Andalusian Public Health System Biobank, Avenida Del Conocimiento S/N, 18016, Granada, Spain.
| |
Collapse
|
24
|
Pérez-Rodon J, Doiny D, Miranda B, Rivas-Gandara N, Roca-Luque I, Francisco-Pascual J, Lidón RM, García-Dorado D, Moya Mitjans A. Life-threatening and life-saving inappropriate implantable cardioverter defibrillator shocks. Clin Case Rep 2017; 5:521-525. [PMID: 28396781 PMCID: PMC5378847 DOI: 10.1002/ccr3.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/18/2017] [Accepted: 02/13/2017] [Indexed: 11/22/2022] Open
Abstract
An implantable cardioverter defibrillator (ICD) lead dislodgement into the right atrium is a dangerous situation, particularly in patients in atrial fibrillation because atrial fibrillation can be sensed as ventricular fibrillation and true ventricular fibrillation induced with an inappropriate shock. In the presence of shocks, ICD interrogation should be performed as soon as possible.
Collapse
Affiliation(s)
- Jordi Pérez-Rodon
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - David Doiny
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Berta Miranda
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Nuria Rivas-Gandara
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Ivo Roca-Luque
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Jaume Francisco-Pascual
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Rosa Maria Lidón
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - David García-Dorado
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Angel Moya Mitjans
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| |
Collapse
|
25
|
Bañeras J, Oristrell G, Pineda V, Cuellar H, Buera I, Miranda B, Barrabés JA, Dorado DG. Acute myocardial injury during strenuous physical activity. Int J Cardiol 2016; 203:440-2. [PMID: 26547731 DOI: 10.1016/j.ijcard.2015.10.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/13/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Jordi Bañeras
- Department of Cardiology, Hospital Universitari Vall Hebron, Barcelona, Spain.
| | - Gerard Oristrell
- Department of Cardiology, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Victor Pineda
- Department of Radiology, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Hug Cuellar
- Department of Radiology, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Irene Buera
- Department of Cardiology, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Berta Miranda
- Department of Cardiology, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - José A Barrabés
- Department of Cardiology, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - David García Dorado
- Department of Cardiology, Hospital Universitari Vall Hebron, Barcelona, Spain
| |
Collapse
|
26
|
Miranda B, Barrabés JA, Figueras J, Pineda V, Rodríguez-Palomares J, Lidón RM, Sambola A, Bañeras J, Otaegui I, García-Dorado D. Plasma bilirubin values on admission and ventricular remodeling after a first anterior ST-segment elevation acute myocardial infarction. Ann Med 2016; 48:1-9. [PMID: 26631587 DOI: 10.3109/07853890.2015.1112027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Bilirubin may elicit cardiovascular protection and heme oxygenase-1 overexpression attenuated post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and post-infarction remodeling is unknown. MATERIALS AND METHODS In 145 patients with a first anterior ST-segment elevation acute myocardial infarction (STEMI), we assessed whether plasma bilirubin on admission predicted adverse remodeling (left ventricular end-diastolic volume [LVEDV] increase ≥20% between discharge and 6 months, estimated by magnetic resonance imaging). RESULTS Patients' baseline characteristics and management were comparable among bilirubin tertiles. LVEDV increased at 6 months (P < 0.001) with respect to the initial exam, but the magnitude of this increase was similar across increasing bilirubin tertiles (10.8 [30.2], 10.1 [22.9], and 12.7 [24.3]%, P = 0.500). Median (25-75 percentile) bilirubin values in patients with and without adverse remodeling were 0.75 (0.60-0.93) and 0.73 (0.60-0.92) mg/dL (P = 0.693). Absence of final TIMI flow grade 3 (odds ratio 3.92, 95% CI 1.12-13.66) and a history of hypertension (2.04, 0.93-4.50), but not admission bilirubin, were independently associated with adverse remodeling. Bilirubin also did not predict the increase in ejection fraction at 6 months. CONCLUSIONS Admission bilirubin values are not related to LVEDV or ejection fraction progression after a first anterior STEMI and do not predict adverse ventricular remodeling. Key messages Bilirubin levels are inversely related to cardiovascular disease, and overexpression of heme oxygenase-1 (the enzyme that determines bilirubin production) has prevented post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and the progression of ventricular volumes and function in patients with acute myocardial infarction remained unexplored. In this cohort of patients with a first acute anterior ST-segment elevation myocardial infarction receiving contemporary management, bilirubin levels on admission were not predictive of the changes in left ventricular volumes or ejection fraction at 6 months measured by serial cardiac magnetic resonance imaging. The data are contrary to a significant protective effect of bilirubin against post-infarction ventricular remodeling.
Collapse
Affiliation(s)
- Berta Miranda
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - José A Barrabés
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Jaume Figueras
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Victor Pineda
- b Servicio de Radiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - José Rodríguez-Palomares
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Rosa-Maria Lidón
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Antonia Sambola
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Jordi Bañeras
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Imanol Otaegui
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - David García-Dorado
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| |
Collapse
|
27
|
Andrews PW, Baker D, Benvinisty N, Miranda B, Bruce K, Brüstle O, Choi M, Choi YM, Crook JM, de Sousa PA, Dvorak P, Freund C, Firpo M, Furue MK, Gokhale P, Ha HY, Han E, Haupt S, Healy L, Hei DJ, Hovatta O, Hunt C, Hwang SM, Inamdar MS, Isasi RM, Jaconi M, Jekerle V, Kamthorn P, Kibbey MC, Knezevic I, Knowles BB, Koo SK, Laabi Y, Leopoldo L, Liu P, Lomax GP, Loring JF, Ludwig TE, Montgomery K, Mummery C, Nagy A, Nakamura Y, Nakatsuji N, Oh S, Oh SK, Otonkoski T, Pera M, Peschanski M, Pranke P, Rajala KM, Rao M, Ruttachuk R, Reubinoff B, Ricco L, Rooke H, Sipp D, Stacey GN, Suemori H, Takahashi TA, Takada K, Talib S, Tannenbaum S, Yuan BZ, Zeng F, Zhou Q. Points to consider in the development of seed stocks of pluripotent stem cells for clinical applications: International Stem Cell Banking Initiative (ISCBI). Regen Med 2015; 10:1-44. [PMID: 25675265 DOI: 10.2217/rme.14.93] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- P W Andrews
- Department of Biomedical Science, The University of Sheffield, Sheffield, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Martinez V, García Caballero J, Muñoz I, Celadilla O, Miranda B, Selgas R. Heat sterilization of safe.lock connectors using Thermoclav in experimental conditions. Contrib Nephrol 2015; 89:59-61. [PMID: 1893742 DOI: 10.1159/000419750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- V Martinez
- Servicio de Nefrologia, Hospital La Paz, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
29
|
Miranda B, Selgas R, Celadilla O, Muñoz J, Sánchez Sicilia L. Peritoneal resting and heparinization as an effective treatment for ultrafiltration failure in patients on CAPD. Contrib Nephrol 2015; 89:199-204. [PMID: 1893727 DOI: 10.1159/000419767] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- B Miranda
- Servicio de Nefrologia, Hospital La Paz, Madrid, Spain
| | | | | | | | | |
Collapse
|
30
|
Bartczak A, Plaskota K, Trojnarska O, Szczepaniak-Chichel L, Popiel M, Grajek S, Eindhoven JA, Van Den Bosch A, Ruys T, Opic P, Cuypers J, Mc Ghie - Vletter J, Witsenburg M, Boersma H, Roos-Hesselink J, Carro A, Sanz M, Galuppo V, Maldonado G, Santos A, Miranda B, Huguet F, Gonzalez N, Abad C, Evangelista A, Eindhoven JA, Van Den Bosch A, Menting M, Cuypers J, Witsenburg M, Vletter- Mcghie J, Ruys P, Boermsa H, Roos-Hesselink J, Dragulescu A, Mroczek D, Chaturvedi R, Benson L, Friedberg M, Mertens L, Nastase O, Enache R, Popescu B, Botezatu D, Aschie D, State S, Rosca M, Calin A, Beladan C, Ginghina C, Huang F, Zhong L, Tan J, Le T, Tan R, Pietrzak R, Werner B, Scognamiglio G, Karonis T, Gatzoulis M, Babu-Narayan S, Li W, Gonzalez-Gonzalez A, Alonso-Gonzalez R, West C, Senior R, Li W. Moderated Posters session * Congenital heart disease: 12/12/2013, 14:00-18:00 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
31
|
Ben Abda A, Hachulla E, Polge A, Richardson M, Duva Penthia A, De Groote P, Montaigne D, Lamblin N, Lamer M, Cinotti R, Delater A, Asehnoune K, Blanloeil Y, Le Tourneau T, Rozec B, Piriou N, Moon J, Kim T, Ahn T, Chung W, Chimura M, Oonishi T, Tukishiro Y, Yamada S, Taniguchi Y, Yasaka Y, Kawai T, Elmissiri A, Andres Lahuerta A, Alonso Fernandez P, Igual Munoz B, Osca Asensi J, Cano Perez O, Jimenez Carreno R, Sancho-Tello De Carranza M, Olague De Ros J, Salvador Sanz A, Atas H, Samadov F, Kepez A, Sunbul M, Cincin A, Direskeneli H, Tigen K, Yildiz A, Karakas M, Cimen T, Tuncez A, Korkmaz A, Uygur B, Isleyen A, Tufekcioglu O, Melao F, Paiva M, Goncalves A, Pinho T, Madureira A, Martins E, Macedo F, Maciel M, Guvenc T, Erer H, Kul S, Oz D, Koroglu B, Kaya Y, Koc S, Sayar N, Degirmencioglu A, Eren M, Stapor M, Condemi F, Bapat V, Gianstefani S, Catibog N, Monaghan MJ, Carro A, Pijuan A, Dos L, Huguet F, Abad C, Gonzalez N, Miranda B, Galian L, Casaldaliga J, Evangelista A, Gurzun MM, Ionescu A, Kahraman E, Sen T, Guven S, Keskin G, Topaloglu S, Korkmaz S, Moatemri F, Mahdhaoui A, Bouraoui H, Jeridi G, Ernez S, Basaran O, Gozubuyuk G, Dundar C, Tasar O, Bulut M, Karaahmet T, Pala S, Tigen K, Izgi A, Kirma C, Baronaite-Dudoniene K, Urbaite L, Smalinskas V, Veisaite R, Vasylius T, Vaskelyte J, Puodziukynas A, Carro A, Teixido-Tura G, Rodriguez-Palomares J, Cuellar H, Pineda V, Gruosso D, Gutierrez L, Moral S, Gonzalez-Alujas M, Evangelista A, Oprescu N, Micheu M, Calmac L, Pitic D, Dorobantu M, Brugger N, Huerzeler M, Wustmann K, Wahl A, Steck H, Seiler C, Ismail H, Linde J, Kofoed K, Dixen U, Soergaard M, Hove J, Willis J, Oxborough D, Augustine D, Knight D, Coghlan G, Shah R, Easaw J, Verseckaite R, Pilkauskaite G, Lapinskas T, Miliauskas S, Sakalauskas R, Jurkevicius R, Ozeke O, Turak O, Ozcan F, Cay S, Topaloglu S, Aras D, Tufekcioglu O, Golbasi Z, Aydogdu S. Club 35 Poster session Friday 13 December: 13/12/2013, 08:30-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
32
|
Manyalich M, Navarro A, Koller J, Loty B, de Guerra A, Cornu O, Vabels G, Fornasari PM, Costa AN, Siska I, Hirn M, Franz N, Miranda B, Kaminski A, Uhrynowska I, Van Baare J, Trias E, Fernández C, de By T, Poniatowski S, Carbonell R. European quality system for tissue banking. Transplant Proc 2010; 41:2035-43. [PMID: 19715826 DOI: 10.1016/j.transproceed.2009.06.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The aims of this project were to analyze the factors that influence quality and safety of tissues for transplantation and to develop the method to ensure standards of quality and safety in relation to tissue banking as demanded by European Directive 2004/23/EC and its technical annexes. It is organized in 4 Working Groups, the objectives of each one being focused in a specific area. STANDARDS The Guide of Recommendations for Tissue Banking is structured into 4 parts: (1) quality systems that apply to tissue banking and general quality system requirements, (2) regulatory framework in Europe, (3) standards available, and (4) recommendations of the fundamental quality and safety keypoints. REGISTRY This Working Group handled design of a multinational musculoskeletal tissue registry prototype. TRAINING This Working Group handled design and validation of a specialized training model structured into online and face-to-face courses. The model was improved with suggestions from students, and 100% certification was obtained. AUDIT The Guide for Auditing Tissue Establishments provides guidance for auditors, a self-assessment questionnaire, and an audit report form. The effectiveness and sustainability of the outputs were assessed. Both guides are useful for experienced tissue establishments and auditors and also for professionals that are starting in the field. The registry prototype proves it is possible to exchange tissues between establishments throughout Europe. The training model has been effective in educating staff and means having professionals with excellent expertise. Member states could adapt/adopt it. The guides should be updated periodically and perhaps a European organization should take responsibility for this and even create a body of auditors.
Collapse
Affiliation(s)
- M Manyalich
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Rodríguez-Villar C, Paredes D, Ruiz A, Alberola M, Montilla C, Vilardell J, Manyalich M, Miranda B. Attitude of Health Professionals Toward Cadaveric Tissue Donation. Transplant Proc 2009; 41:2064-6. [DOI: 10.1016/j.transproceed.2009.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
34
|
Molinos L, Clemente MG, Miranda B, Alvarez C, del Busto B, Cocina BR, Alvarez F, Gorostidi J, Orejas C. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect 2009; 58:417-24. [PMID: 19329187 DOI: 10.1016/j.jinf.2009.03.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 03/02/2009] [Accepted: 03/05/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to analyse the possible differences, especially those regarding mortality, between patients hospitalized for community-acquired pneumonia (CAP) with and without chronic obstructive pulmonary disease (COPD), and the risk factors related to mortality in the COPD group. METHODS 710 patients with CAP were included in a prospective multicenter observational study. 244 of the patients had COPD confirmed by spirometry. RESULTS COPD was associated with mortality in patients with CAP (OR=2.62 CI: 1.08-6.39). Patients with COPD and CAP had a significantly higher 30-day mortality rate as compared to patients without COPD. Multivariate analysis showed that PaO(2)< or =60 mmHg (OR=7.95; 95% CI: 3.40-27.5), PaCO(2)> or =45 mmHg (OR=4.6; CI: 2.3-15.1); respiratory rate > or =30/min (OR=12.25; CI: 3.45-35.57), pleural effusion (OR=8.6; 95% CI: 2.01-24.7), septic shock (OR=12.6; 95% CI: 3.4-45.66) and renal failure (OR=13.4; 95% CI: 3.2-37.8) were significantly related to mortality. Purulent sputum and fever were considered as protective factors. CONCLUSIONS COPD was an independent risk factor for mortality in patients with CAP. Hypoxemia and hypercapnia are associated with mortality in patients with CAP with and without COPD. Chronic obstructive pulmonary disease and PaCO(2) value could be useful prognostic factors and should be incorporated in risk stratification in patients with CAP.
Collapse
Affiliation(s)
- L Molinos
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Miranda B, Madureira S, Verdelho A, Ferro J, Pantoni L, Salvadori E, Chabriat H, Erkinjuntti T, Fazekas F, Hennerici M, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitarion D. Self-perceived memory impairment and cognitive performance in an elderly independent population with age-related white matter changes. J Neurol Neurosurg Psychiatry 2008; 79:869-73. [PMID: 18077477 DOI: 10.1136/jnnp.2007.131078] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether self-perceived memory impairment is associated with the severity of white matter changes (WMC) and is related to cognitive impairment. METHODS Data were drawn from the multinational Leukoaraiosis and Disability Study (LADIS), which investigates the impact of WMC on global functioning. WMC severity was rated using the Fazekas scale. Medial temporal lobe atrophy (MTA) was scored visually and mean values were calculated. The neuropsychological battery consisted of the Mini-Mental State Examination, a modified version of the VADAS-Cog, Trail making and Stroop tests. A question about self-perceived memory impairment was used as a measure for presence of memory complaints. Cognitive performance was analysed test-by-test and in three main domains: memory, executive functions and speed/motor control. The Geriatric Depression Scale (GDS) was used as a measure of depressive symptoms. RESULTS Six hundred and thirty-eight subjects were included in this study. No association was found between memory complaints and the severity of WMC. Subjects with memory complaints (n = 399) had a higher GDS score [t((637)) = -7.15; p<0.02] and performed worse on almost all cognitive tests and on the three cognitive domains. Multiple linear regression showed that the worse performance on the memory domain was associated with memory complaints independently of depressive symptoms, WMC severity and MTA (R(2) = 0.183; F = 17.09, beta = -0.126; p<0.05). CONCLUSION In a sample of non-disabled elderly subjects with WMC, self-perceived memory impairment is significantly associated with objective memory impairment independently of the WMC severity, depressive symptoms and MTA.
Collapse
Affiliation(s)
- B Miranda
- Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Kaminski A, Uhrynowska-Tyszkiewicz I, Miranda B, Navarro A, Manyalich M. Design and validation of a specialized training model for tissue bank personnel as a result of the European Quality System for Tissue Banking (EQSTB) project. Transplant Proc 2007; 39:2698-700. [PMID: 18021961 DOI: 10.1016/j.transproceed.2007.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The main objective of European Quality System for Tissue Banking (EQSTB) project was to analyze throughout different working areas the factors that may influence the final tissue quality and safety for transplantation, providing greater benefit to recipients. Fifteen national organizations and tissue establishments from 12 European countries took part in this project. The Sanco-EQSTB project was organized in four Working Groups. The objectives of each was focused on a specific area. The Standards Working Group analyzed different standards or guides used in various European tissue banks as a quality and safety system. The Registry Working Group created a Tissue Registry through a multinational European network database. The Education Working Group created a specialized training model for tissue bank personnel. The Audit Working Group created an European model of Auditing for tissue establishments. The aim of this article was to describe the activities of Working Group 3 in designing and validating a specialized training model among tissue bank personnel that could become the approved education system recommended by European Union members.
Collapse
Affiliation(s)
- A Kaminski
- National Centre of Tissue and Cell Banking, Warsaw, Poland.
| | | | | | | | | |
Collapse
|
37
|
Gargallo´ L, Leiva A, Alegría L, Miranda B, González A, Radic D. Interfacial Properties of Poly(N‐Vinyl‐2‐Pyrrolidone) at the Air/Water Interface. J MACROMOL SCI B 2007. [DOI: 10.1081/mb-200033255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- L. Gargallo´
- a Depto. de Química Física, Facultad de Química , Pontificia Universidad Católica de Chile , Casilla 306, Correo 22, Santiago , Chile
| | - A. Leiva
- a Depto. de Química Física, Facultad de Química , Pontificia Universidad Católica de Chile , Casilla 306, Correo 22, Santiago , Chile
| | - L. Alegría
- a Depto. de Química Física, Facultad de Química , Pontificia Universidad Católica de Chile , Casilla 306, Correo 22, Santiago , Chile
| | - B. Miranda
- a Depto. de Química Física, Facultad de Química , Pontificia Universidad Católica de Chile , Casilla 306, Correo 22, Santiago , Chile
| | - A. González
- a Depto. de Química Física, Facultad de Química , Pontificia Universidad Católica de Chile , Casilla 306, Correo 22, Santiago , Chile
| | - D. Radic
- a Depto. de Química Física, Facultad de Química , Pontificia Universidad Católica de Chile , Casilla 306, Correo 22, Santiago , Chile
| |
Collapse
|
38
|
Gargallo L, Miranda B, Leiva A, González A, Sandoval C, Radic´ D, Tagle LH. Poly(ester)s Containing Germanium and Silicon in the Main Chain. 1. Langmuir Monolayer Characterization. J MACROMOL SCI B 2007. [DOI: 10.1080/00222340500407988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- L. Gargallo
- a Pontificia Universidad Católica de Chile, Departamento de Química Física, Facultad de Química (502) , Santiago, Chile
| | - B. Miranda
- a Pontificia Universidad Católica de Chile, Departamento de Química Física, Facultad de Química (502) , Santiago, Chile
| | - A. Leiva
- a Pontificia Universidad Católica de Chile, Departamento de Química Física, Facultad de Química (502) , Santiago, Chile
| | - A. González
- a Pontificia Universidad Católica de Chile, Departamento de Química Física, Facultad de Química (502) , Santiago, Chile
| | - C. Sandoval
- a Pontificia Universidad Católica de Chile, Departamento de Química Física, Facultad de Química (502) , Santiago, Chile
| | - D. Radic´
- a Pontificia Universidad Católica de Chile, Departamento de Química Física, Facultad de Química (502) , Santiago, Chile
| | - L. H. Tagle
- a Pontificia Universidad Católica de Chile, Departamento de Química Física, Facultad de Química (502) , Santiago, Chile
| |
Collapse
|
39
|
Mahillo B, Miranda B, Martin E, Garrido G, Matesanz R. 311: Expanded thoracic donors: Beyond elderly, hypertensive and metabolic disorders. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
40
|
Valentín M, Martín Escobar E, de la Rosa G, Garrido G, Miranda B, Matesanz R. [Renal and pancreatic donation and transplantation activity in Spain 2005]. Nefrologia 2006; 26:318-24. [PMID: 16892819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
|
41
|
Feigl G, Rosmarin W, Weninger B, Likar R, Hoogland PV, Groen RJM, Vorster W, Grobbelaar M, Muller CJF, du Toit DF, Moriggl B, Greher M, Klauser A, Eichenberger U, Prades JM, Timoshenko A, Faye M, Martin CH, Baroncini M, Baiz H, Ben Henda A, Fontaine C, Baksa G, Toth M, Patonay L, Gonçalves-Ferreira A, Gonçalves C, Neto L, Fonseca T, Gaspar H, Rino J, Fernandes M, Fernandes P, Cardoso H, Miranda B, Rego J, Hamel A, Guillouche P, Hamel O, Garçon M, Lager S, Blin Y, Armstrong O, Robert R, Rogez JM, Le Borgne J, Kahilogulları G, Comert A, Esmer AF, Tuccar E, Tekdemir I, Ozdemir M, Odabasi AB, Elhan A, Anand MK, Singh PR, Verma M, Raibagkar CJ, Kim HJ, Kwak HH, Hu KS, Francke JP, Macchi V, Porzionato A, Parenti A, Metalli P, Zanon GF, De Caro R, Bernardes A, Dionísio J, Messias P, Patrício J, Apaydin N, Uz A, Evirgen O, Shim KS, Park HD, Youn KH, Cajozzo M, Bartolotta T, Cappello F, Sunseri A, Romeo M, Altieri G, Modica G, La Barbera G, La Marca G, Valentino F, Valentino B, Martino A, Dees G, Kleintjes WA, Williams R, Herpe B, Leborgne J, Lagier S, Cordova A, Pirrello R, Moschella F, Mahajan MV, Bhat UB, Abhayankar SV, Ambiye MV, Kachlík DK, Stingl JS, Sosna BS, Fára PF, Lametschwandtner AL, Minnich BM, Straka ZS, Ifrim M, Ifrim CF, Botea M, Latorre R, Sun F, Henry R, Crisóstomo V, Cano FG, Usón J, Mtez-Gomaríz F, Climent S, Hurmusiadis V, Barrick S, Barrow J, Clifford N, Morgan F, Wilson R, Wiseman L, Fogg OA, Loukas M, Tedman RA, Capaccioli N, Capaccioli L, Mannini A, Guazzi G, Mangoni M, Paternostro F, Vagnoli PT, Gulisano M, Pacini S, Grignon B, Jankowski R, Hennion D, Zhu X, Roland J, Mutiu G, Tessitore V, Uzzo ML, Bonaventura G, Milio G, Spatola GF, Ilkan T, Selcuk T, Mustafa AM, Hamdi CH, Emel TC, Faruk U, Hamdi CH, Bulent G, Báča V, Doubková A, Kachlík D, Stingl J, Saylam C, Kitiş Ö, Üçerler H, Manisahı E, Gönül AS, Dashti GHR, Nematbaksh M, Mardani M, Hami J, Rezaian M, Radmehr B, Akbari M, Paryani MR, Gilanpour H, Zamfir C, Zamfir M, Lupusoru C, Raileanu C, Lupusoru R, Bordei P, Iliescu D, Şapte E, Adam S, Baker C, Sergi C, Barberini F, Ripani M, Di Nitto V, Zani A, Magnosi F, Heyn R, Familiari G, Elgin U, Demiryurek D, Berker N, Ilhan B, Simsek T, Batman A, Bayramoglu A, Fogg QA, Bartczak A, Kamionek M, Kiedrowski M, Fudalej M, Wagner T, Artibani W, Tiengo C, Taglialavoro G, Mazzoleni F, Scapinelli R, Ardizzone E, Cannella V, Peri D, Pirrone R, Peri G. Platform session. Surg Radiol Anat 2005. [DOI: 10.1007/bf03371475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Alvarez M, Martín E, García A, Miranda B, Oppenheimer F, Arias M. [Opinion survey on renal donation from living donor]. Nefrologia 2005; 25 Suppl 2:57-61. [PMID: 16050404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Spain is the leader country in cadaver kidney transplantation. However the percentage of those transplants coming from living donors represents only a 2% of the total activity. To analyze the cause of this situation the Spanish Society of Nephrology and the National Transplant Organization carried out an opinion pole between patients and health professionals including nephrologists, surgeons/urologists and nurses implicated in kidney transplantation. 60% out the patients consider that the time into the waiting list is to long and 59% don't have any information about living donor kidney transplantation. All the health professionals believe that living donor share better results than get cadaver donors and that the number of the procedure are not enough. Considering that scarcely motivation of professionals and the family of the patients are the main cause. Parents, brothers and sister were considered the best match between donor and recipients and non genetically/emotionally-related donors were accepted by only 2.5%. A 55.7% out of the health professionals considered that the nephrologists are the people that must inform the patients and family about living kidney donation.
Collapse
|
43
|
Valentín M, Miranda B, De la Rosa G, Martín-Escobar E, Garrido G, Matesanz R. [Renal donation and transplantation in Spain 2004]. Nefrologia 2005; 25:350-60. [PMID: 16231500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
|
44
|
|
45
|
Cuende N, Sánchez J, Cañón J, Álvarez J, Romero J, Martínez J, Macías S, Miranda B. Mortalidad hospitalaria en unidades de críticos y muertes encefálicas según los códigos de la Clasificación Internacional de Enfermedades. Med Intensiva 2004. [DOI: 10.1016/s0210-5691(04)70006-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
46
|
Abstract
BACKGROUND The maintenance of an equitable system for access to transplantation is a matter of concern to all professionals involved in this field. Any national system must ensure equity. METHODS The rates of indication for liver transplantation have been reviewed for all Spanish regions. The time to transplantation was evaluated with respect to different recipient characteristics and donor rates. The indication rates for liver transplantation are similar in the different countries with liver transplant programs but are far from similar among different regions in Spain. This suggests that there is not equity in the access to liver transplantation. RESULTS A review of the factors affecting the waiting times to transplantation after being registered for the waiting list shows that some groups of patients are currently waiting less time than others. Shorter waiting times occur in patients of the AB group, children, patients with hepatocarcinoma, and patients living in the zone of Valencia, despite similar organ donation rates in all transplant zones. CONCLUSION Neither the rate nor the probability of liver transplantation is affected exclusively by the organ donation rate in Spain but also depends on the number of patients admitted to the waiting list. Despite the existence of an organ allocation system that is center-oriented, liver patients are receiving grafts mainly based on the severity of the illness, because clearance rates from the waiting list of both dead patients and grafted patients are the same.
Collapse
Affiliation(s)
- B Miranda
- National Organization of Transplants, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
The need to face the increasing gap between the supply and the demand of transplants has led to the development of a permanent network of trained medical staff responsible for the organ donation and removal process in all centers accredited for that process. In Spain, this activity received a specific budget, like any other medical activity in hospitals, and the responsible staff became accountable for performance. This system dramatically increased the number of potential donors referred, not only young donors with trauma, but also elderly donors dying from stroke. The effect was that the donation rate increased by more than 100% in 10 years (from 14 to 34 donors per million population). Consequently, so did all the transplant figures. In some areas, such as Catalonia, it has been demonstrated that sustained kidney transplant activity of over 60 procedures per million population can maintain or slightly decrease the waiting list, despite increasing incidence and prevalence of end-stage renal failure. Quality monitoring of the donation and retrieval process shows that there are still opportunities for improvement if all potential donors are referred and all technical problems are overcome. Living donation and nonheart beating organ retrieval should also be promoted.
Collapse
Affiliation(s)
- B Miranda
- Organización Nacional de Trasplantes, Madrid, Spain
| | | | | |
Collapse
|
48
|
Cuende N, Cañón JF, Alonso M, Miranda B, Martín C, Sagredo E. [Results of the period 1998-2001 of the ONT quality control programme]. Nefrologia 2003; 23 Suppl 5:68-72. [PMID: 12833629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
|
49
|
Cuende N, Cañón JF, Alonso M, Martín C, Sagredo E, Miranda B. [ONT Quality control programme for the donation process evaluation]. Nefrologia 2003; 23 Suppl 5:28-31. [PMID: 12833624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
- N Cuende
- Organización Nacional de Trasplantes, Madrid
| | | | | | | | | | | |
Collapse
|
50
|
Rico J, Cañón JF, Cobo C, López MJ, Martín C, Ramón S, Sagredo E, Segovia C, Sánchez M, Serrano M, Miranda B. [Coordination of donation and transplantation activities. Donation alarm ]. Nefrologia 2003; 23 Suppl 5:15-27. [PMID: 12833623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
- J Rico
- Organización Nacional de Trasplantes, Madrid
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|