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Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation.
Materials and Methods:
Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry.
There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10–0.14) and for controls was 0.11 mm (IQR, 0.10–0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12–0.16) and for controls was 0.13 (IQR, 0.11–0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients.
OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.
Congenitally corrected transposition of the great arteries is commonly associated with left ventricular outflow tract obstruction. We describe a case of congenitally corrected transposition of the great arteries and previous surgical ventricular septal defect repair with recurrent left ventricular outflow tract obstruction. The patient underwent a hybrid procedure to stent the left ventricular outflow tract, which was successful with no re-intervention through 3 years of follow-up.
Aorto-left ventricular tunnel is a rare congenital heart lesion, with an incidence of <0.1% of all CHD. We present a unique case of a valvar aorto-left ventricular tunnel in a neonate, in belief that our findings may shed some light on the developmental origins of this lesion.
The A3+2B4+2O7 pyrochlores have fast-ion conduction properties that make them attractive candidates for applications in fuel cells. Rietveld powder-profile analysis of x-ray diffraction data has been used to determine structural parameters for Gd2(Ti1-ySny)2O7 solid solutions (y = 0.20, 0.40, 0.60, and 0.80) for correlation with composition-dependence of the specimens' electrical conductivity. In accord with Vegard's law, the lattice constants increase linearly with y as the larger Sn ion replaces Ti4+. The structures in the system remain remarkably ordered in view of the fact that it had been suggested that increasing the average radius of the ions that occupy the B4+ site relative to A3+ drives the system toward a disordered defect-fluorite state. A small but significant increase in mixing of the occupancy of the cation sites was found with increasing y to a maximum of [GdB] = 0.05. We could detect no significant disorder in the anion array. The activation energy and pre-exponential term for oxygen ion conduction were found to increase linearly and exponentially with y, respectively, such that at a given temperature, the ionic conductivity changes by less than an order of magnitude across the system. The behavior is in marked contrast to other systems where the substitution of a larger cation in the B site increases conductivity by up to three orders of magnitude as a consequence of substantial disorder that is introduced in both the cation and anion arrays.
The tegumentary ultrastructure of Leucochloridiomorpha constantiae metacercariae and adults has been described. A filamentous glycocalyx invests the tegument of metacercariae and large numbers of biconcave, disk-shaped secretion vesicles are found in its outer zone, cytoplasmic bridges and cytons. Mitochondria within the outer tegumentary zone of metacercariae are restricted to its basal half. The transformation of metacercariae to adults involves the loss of the glycocalyx, a decrease in the number of disk-shaped secretion vesicles, a more uniform distribution of mitochondria through the outer tegumentary zone, an apparent degeneration of cytons, a thinning of the fibrous basal lamina and a decrease in the number of visible cytoplasmic bridges traversing it. The significance of these events for a metacercaria which does not encyst within the molluscan host is discussed. In addition, crystalline, spine-like inclusions in the outer tegumentary zone of adult L. constantiae are described and their possible function discussed.
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