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Static balloon atrial septostomy is a widely accepted intervention for children with CHD. Successful surgical palliation is creating increasing numbers of adult CHD patients who need subsequent left heart intervention requiring transseptal access. In these patients, the interatrial septum is usually thick and fibrotic because of a previous open heart surgery or catheter intervention, and conventional transseptal puncture may be unsuccessful. Static balloon atrial septostomy to access the left atrium may facilitate intervention via the interatrial septum in such situations. The purpose of this study was to investigate the usefulness and the safety of static balloon atrial septostomy, and the evolution of an iatrogenic atrial septal defect post procedure in adult CHD.
We retrospectively reviewed six procedures in five adults with CHD and collected demographic characteristics, details of the procedures, clinical outcome, and size changes of the iatrogenic atrial septal defect.
The mean age at the time of the procedure was 35 years. The intended primary interventions were pulmonary vein isolation, stenting for pulmonary vein obstruction, and catheter ablation for focal atrial tachycardia. All static balloon atrial septostomies were effective, and the left heart interventions were successfully achieved via transseptal sheaths. There were no major complications associated with the static balloon atrial septostomy. There were no adverse clinical outcomes related to iatrogenic atrial septal defect, and the size of the defects regressed over time in all cases.
Static balloon atrial septostomy can be a safe and useful technique in adult CHD patients needing left heart procedures. The thick interatrial septum found in postoperative patients may reduce the risk of persistent iatrogenic atrial septal defect.
We discuss room temperature CW operation of AlGaAs/GaAs SQW lasers and GaAs MESFETs with good pinch-off characteristic on SiO2 -back coated Si. The all-MOCVD-grown,SQW laser on Si with thermal-cycle annealing, which has the EPD of 1.5 × 107 cm−2, has the threshold current as low as 55 mA (1.41 kA/cm2) under CW operation at room temperature. The pinch-off and the sidegating effect characteristics of GaAs MESFETs on Si have been improved by using SiO2-back coating of Si and higher growth temperature. The maximum transconductance of 160 mS/mm has been obtained for the MESFET with a 2.5 × 15 µm gate. The main origin of sidegating effect associates with the channel layer-undoped GaAs layer beneath it interface. The SiO2 -back coating is found effective to obtain a lower background electron concentration in undoped GaAs layer and to control doping of the active layer in GaAs/Si.
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