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Over the past 2 decades, several categorizations have been proposed for the abnormalities of the aortic root. These schemes have mostly been devoid of input from specialists of congenital cardiac disease. The aim of this review is to provide a classification, from the perspective of these specialists, based on an understanding of normal and abnormal morphogenesis and anatomy, with emphasis placed on the features of clinical and surgical relevance. We contend that the description of the congenitally malformed aortic root is simplified when approached in a fashion that recognizes the normal root to be made up of 3 leaflets, supported by their own sinuses, with the sinuses themselves separated by the interleaflet triangles. The malformed root, usually found in the setting of 3 sinuses, can also be found with 2 sinuses, and very rarely with 4 sinuses. This permits description of trisinuate, bisinuate, and quadrisinuate variants, respectively. This feature then provides the basis for classification of the anatomical and functional number of leaflets present. By offering standardized terms and definitions, we submit that our classification will be suitable for those working in all cardiac specialties, whether pediatric or adult. It is of equal value in the settings of acquired or congenital cardiac disease. Our recommendations will serve to amend and/or add to the existing International Paediatric and Congenital Cardiac Code, along with the Eleventh iteration of the International Classification of Diseases provided by the World Health Organization.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
Deaths due to opioid overdose have reached unprecedented levels in Canada; over 12,800 opioid-related deaths occurred between January 2016 and March 2019, and overdose death rates increased by approximately 50% from 2016 to 2018.1 In 2016, Health Canada declared the opioid epidemic a national public health crisis,2 and life expectancy increases have halted in Canada for the first time in decades.3 Children are not exempt from this crisis, and the Chief Public Health Officer of Canada has recently prioritized the prevention of problematic substance use among Canadian youth.4
The unique nature of the Ogallala Aquifer presents interesting and confounding problems for water policymakers who are coping with changing groundwater rules in Texas. The purpose of this article is to link previous efforts in water policy research for the Ogallala Aquifer in Texas with current collaborations that are ongoing with regional water planners. A chronological progression of economic water modeling efforts for the region is reviewed. The results of two recent collaborative studies are presented that provide estimates of impacts of alternative policies on groundwater saturated thickness, water use, net farm income, and regional economic activities.
The fort of Hayton, south-east of Pocklington, North Humberside (Yorkshire), was first located from the air by Professor J. K. St. Joseph in 1974. His photographs showed a small fort surrounded by double ditches: the crop-mark of these was distinct on the SE, NE and NW sides (PL. IX) and at the rounded northern and eastern angles. Further reconnaissance in 1975 produced more photographs which introduced the possibility that the fort also had an annexe to its north-east. A single ditch appears to continue the line of the inner fort ditch on the south-eastern side and form an enclosure with rounded angles to the north-east of the fort. Examination of Ordnance Survey photographs taken in 1968 showed that the platform of the fort had been just visible then. In view of the sudden clarity of the fort cropmarks, it was decided to undertake a small-scale excavation to discover whether the remains of the fort were being eroded by the constant ploughing to which thearea is subject. The first campaign, in February 1975) took place in the field south of the minor road which runs through the fort site (FIG. I, Areas A–F) and located the eastern angle, parts of the angle-tower and the south-east gateway. A second season, in October and November of the same year, examined the state of preservation of the remains in the northern field after removal of the crop (FIG. I, Areas G–S) locating the line of the ditches on the three remaining sides as well as the north-east gateway, the north angle-tower and remains of two of the interior buildings.
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