Repeat Radiofrequency Catheter Ablation of Atrial Tachycardias in Patients with Congenital Heart Disease

INTRODUCTION

Atrial tachycardias (AT) in patients with congenital heart disease (CHD) are significantly contributing to morbidity and mortality. Aim of this study was to evaluate the long-term course of CHD patients requiring repeat ablation procedures (RAP) of AT.

PATIENTS AND METHODS

All 144 patients with CHD who had undergone ablation of AT at our center between January 2003 and October 2018 were enrolled. Patients were classified according to complexity of CHD: complex CHD (cCHD), moderate CHD (mCHD) and simple CHD (sCHD).

RESULTS

A total of 101 RAP were performed in 64 patients. One RAP was performed in n=40, two in n=13, three in n=10 and 5 in n=1. Acute success rate was 82% (83/101) and was not associated with complexity of CHD (p=1.0). Number of procedures was lower in patients with sCHD than in patients with mCHD and cCHD (sCHD 1.3±0.6, mCHD 1.8±1.0 and cCHD 1.8±1.1, p=0.04). RAP were most frequent in patients after Fontan palliation or Atrial switch procedure (2.0±1.1 (n=41) vs. 1.6±0.9 all others, p=0.016) and in patients with multiple unstable AT´s (2.5±1.1 (n=11) vs. 1.7±1.0, p=0.008). Major complications occurred in 4/101 procedures. Complete follow-up was available in 125 patients. Since last RAP 73% of the patients were in sinus/atrial rhythm and 34/125 patients (27%) with AT recurrence did not require re-ablation with mean follow-up of 52±40 months.

CONCLUSIONS

Recurrences after ablation of AT in CHD patients were frequent. After RAP promising long-term results could be achieved. Data encourage repetitive ablation procedures in this patient population. This article is protected by copyright. All rights reserved.

Velocity and Shear Stress Distribution Downstream of Mechanical Heart Valves in Pulsatile Flow

Ten mechanical valves (TAD 27 mm): Starr-Edwards Silastic Ball, Björk-Shiley Standard, Björk-Shiley Concave-Convex, Björk-Shiley Monostrut, Hall-Kaster (Medtronic-Hall), OmniCarbon, Bicer Val, Sorin, Saint-Jude Medical and Hemex (Duromedics) are investigated in a comparative in vitro study. The velocity and turbulent shear stress profiles of the valves were determined by Laser Doppler anemometry in two different downstream axes within a model aortic root. Depending on the individual valve design, velocity peaks up to 1.5 m/s and turbulent shear stress peaks up to 150 N/m2 were measured during the systolic phase. These shear stress peaks mainly occurred in areas of flow separation and intense momentum exchange. Directly downstream of the valves (measuring axis 0.55.dAorta) turbulent shear stress peaks occurred at peak systole and during the deceleration phase, while in the second measuring axis (1.5.dAorta) turbulence levels were lower. Shear stress levels were high at the borders of the fluid jets. The results are discussed from a fluid-dynamic point of view.

Ossäre Metastasierung des Prostata-Karzinoms in Abhängigkeit von Tumorgröße und Geschwulstdifferenzierung

Bei 153 Patienten mit Prostata-Karzinom wurde eine Ganzkörper-Skelettszintigraphie durchgeführt. In 101 Fällen waren Knochenmetastasen auszuschließen, bei 46 Patienten hingegen nachzuweisen. Sechs Patienten mit fraglichem Befund wurden in die weiteren Untersuchungen nicht mit einbezogen. Es zeigte sich, daß die ossäre Metastasierungstendenz mit zunehmender Entdifferenzierung der Geschwulst deutlich ansteigt: so wiesen Patienten mit Prostata-Karzinom von geringem Malignitätsgrad in 7,3%, von mittlerem Malignitätsgrad in 40% und von hohem Malignitätsgrad in 38,5% Absiedlungen im Skelett auf. Auch die Turmorgröße korrelierte mit dem Metastasennachweis: von Patienten mit dem Tumorstadium T1 zeigten lediglich 7,1%, mit T2 19,3%, mit T3 39,2% und mit T4 bereits 65% ossäre Fernmetastasen. Die Entdifferenzierung der Geschwulst nahm mit der Tumorgröße ebenfalls zu. Die erhobenen Befunde beweisen die Notwendigkeit der Früherkennung eines Prostata-Karzinoms.

Abstract P3-05-09: Interlaboratory variability of Ki67 labeling index in breast cancer tissue microarrays

Objective: Assessment of tumor proliferation using the Ki67 labeling index (Ki67-LI) is increasingly recommended for prognostication and adjuvant chemotherapy decisions in breast cancer. Our aim was to investigate interlaboratory variance of Ki67-LI results using TMA and centralised assessment to exclude preanalytic influences and postanalytic variance, respectively.

Methods: Nine pathology laboratories (8 German and 1 Dutch) performed Ki67 staining of a TMA slide according to their routine in house protocol (including internal and external quality assurance). 40 samples per lab were centrally analyzed. The Ki67-LI was calculated after counting first all tumor cells and subsequently all Ki67 positive tumor cells of each sample regardless of staining intensity. For each tissue sample we evaluated the range of Ki67-LIs between different labs. Further 20 labs of the German Breast Screening Pathology Initiative will participate in 2013.

Results: The range of Ki67-LIs between the labs was: 1-5% in 4 (10%), 6-10% in 6 (15%), 11-15% in 7 (17,5%), 16-20% in 2 (5%), 21-25% in 7 (17%), 26-30% in 4 (10%), 31-35% in 1 (1%), 36-40% in 4 (10%), 41-45% in 2 (5%), 46-50 in 0 (0%) and >50% in 3 samples (7%), respectively. Thus, in 35% of results of the 9 labs (26 of the 40 TMA specimens) the Ki67-LI differed by more than 25%. The analysis of variance (ANOVA) came out with F = 4.24 which is much larger than the critical F value of 1.97 for these study results (p = 7.74902E-05). This means that the observed interlaboratory variance of 4.24 is systematic and not due to sampling error. The respective standard deviation is 33.4%.

Conclusion: In a setting strictly standardised in terms of preanalytic influences by using TMA and postanalytic variance by centralised quantification, Ki67-LI seems to be heavily influenced by laboratory-specific analytic variables. Taking this into consideration, there may be a risk of prognostic or predictive misclassification in some breast cancer patients in daily practice.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-05-09.

Always expect the unexpected: lung abscess due to pseudomonas aeruginosa mimicking pulmonary aspergilloma in acute B-cell leukemia

We report on a case of Pseudomonas aeruginosa sepsis and consecutive lung abscess in a 13-year-old patient with acute B-cell leukemia. At first, radiographic findings strongly suggested presence of pulmonary aspergilloma and only microbiological testing of the surgically enucleated mass revealed the correct underlying pathogen and confirmed final diagnosis.

Thrombosis of the aorta abdominalis in infants--diagnosis and thrombolytic therapy

Aortic thrombosis is rarely observed in neonates and infants. Underlying conditions include the presence of umbilical artery catheters, thrombosed aneurysm of the ductus arteriosus, sepsis and different states of inherited thrombophilia. Treatment options include anticoagulation, thrombolytic therapy and thrombectomy. Due to the lack of large studies, neither diagnosis nor treatment of neonatal aortic thrombosis are standardized.From 2008-2010, 1 neonate and 1 infant were admitted to our hospital with symptomatic aortic thrombosis.In both patients, diagnosis was made by Doppler ultrasound. Both patients were effectively treated with recombinant tissue type plasminogen activator. Diagnosis and treatment of 2 infants with symptomatic aortic thrombosis are discussed and the literature is reviewed.Since aortic thrombosis is a life-threatening condition, early diagnosis by Doppler ultrasound is mandatory to initiate treatment without delay. Thrombolytic therapy is a safe measure to treat this condition if administered with caution and if the patient has not suffered from serious complications such as mesenteric infarction or renal failure prior to begin of therapy.

The influence of testosterone substitution on bone mineral density in patients with Klinefelter's syndrome

The aim of this study was to clarify the extent of bone mineral deficiency in patients with Klinefelter's syndrome on the premise that testosterone substitution could prevent this deficiency. Bone mineral density was measured by single-photon absorptiometry in 42 patients with Klinefelter's syndrome, (21 patients without therapy, 10 with testosterone substitution before the age of 20 and 11 patients with testosterone substitution beginning after the age of 20). We found significantly lower bone mineral density in patients without therapy and in patients when the therapy began later compared to normal individuals. Patients with early therapy showed a high proportion of normal values of bone mineral density. We found a positive correlation between bone mineral density and plasma testosterone and a negative correlation between plasma testosterone and age for patients without therapy. These findings suggest that low testosterone levels before or during puberty cause inadequate bone development and low bone mineral density in Klinefelter's syndrome. Only early testosterone substitution may prevent bone mineral deficiency. Later substitution no longer affects bone mineral density.

Time-related effects of thyrotropin-releasing hormone (TRH) on the pituitary-thyroid axis and extrathyroidal targets

Thyrotropin-releasing hormone (TRH) is a tripeptide and acts as a stimulator of the pituitary-thyroid axis as well as having a great number of well defined extrathyroidal functions. Studies in experimental animals have shown, that TRH also has a role as a neuromodulator within the autonomous nervous system. In this study we analyzed the effects following peripheral administration of TRH (200 micrograms, 400 micrograms) in patients with endocrinological disorders and in healthy females and males. By means of a questionnaire, patients were asked about possible (side-) effects; ventilatory and cardiovascular monitoring was performed during steady state. The pulsatile TSH-secretion pattern was analyzed and thyroid and stress hormones were measured in the blood prior to and following TRH i.v. Frequent symptoms afer TRH were feeling of heat (58%), stimulation of respiration (61%), palpitations (39%), micturition urge (52%) and restlessness (32%). Apparative monitoring demonstrated a short stimulation of respiration and an increase of heart rate. After 400 micrograms TRH i.v., blood levels of ACTH decreased slightly (p less than 0.01) but levels of T3, T4, epinephrine, norepinephrine and cortisol remained unchanged (p greater than 0.05). TSH-levels were low during daytime and showed a surge at night.

Prevalence of exfoliation syndrome in Finland

Three separate investigations are reported, covering a total of 795 patients from different parts of Finland, two of them consisting of inmates of old people's homes in two towns (N = 205 and 262) and one a randomly selected population from a rural commune (N = 328). They show the mean prevalence of exfoliation syndrome (PS) to be 14.2% in age group 60 less than or equal to 69 years, 21.9% in age group 70-79 and 34.7% in age group greater than or equal to 80. The prevalence increases statistically significantly with age. The mean prevalence of PS in all three groups was 22.4%. No isolate-like accumulation of PS could be demonstrated. The figures seem representative of the hole country.

Histopathology of clinically successful intraocular lens implant

A 50-year-old man had an intracapsular cataract extraction with placement of a Worst medallion iris-supported lens. After 6 days postoperatively the eye appeared quiet, the cornea was clear and the implant in place. The patient died 17 days postoperatively of subarachnoid haemorrhage. Histopathological examination revealed slight loss of endothelial cells in the upper corneal region, pressure atrophy without signs of repair of the iris stroma, loss of pigment epithelial cells of the iris in places as well as local pigment epithelial cell proliferations. The chamber angle was open and the anterior uvea revealed only a minimal inflammatory cell reaction. The unoperated opposite eye showed cortical cataract as well as advanced hypertensive retinopathy.