Bilateral Branch Research Articles

Recanalization of the left pulmonary artery with radio-frequency perforation and stent angioplasty after failed intraoperative stent implant.

Patients with pulmonary atresia with a ventricular septal defect are often palliated with a right ventricle to pulmonary artery conduit. Pulmonary artery interventions can result in the development of stenosis, and less commonly, atresia. We describe a novel case where an 11-month-old infant male with pulmonary atresia, ventricular septal defect, and bilateral branch pulmonary artery stenosis developed discontinuity of the left pulmonary artery, and was successfully recanalized with radiofrequency perforation and stent angioplasty, after a failed attempt at an intraoperative stent implantation.

Role of MR Neurography for the Diagnosis of Peripheral Trigeminal Nerve Injuries in Patients with Prior Molar Tooth Extraction.

Clinical neurosensory testing is an imperfect reference standard to evaluate molar tooth extraction related peripheral trigeminal neuropathy. The purpose was to evaluate the diagnostic accuracy of MR neurography in this domain and correlation with neurosensory testing and surgery. In this retrospective study, nerve caliber, T2 signal intensity ratio, and contrast-to-noise ratios were recorded by 2 observers using MR neurography for bilateral branches of the peripheral trigeminal nerve, the inferior alveolar and lingual nerves. Patient demographics and correlation of the MR neurography findings with the Sunderland classification of nerve injury and intraoperative findings of surgical patients were obtained. Among 42 patients, the mean ± SD age for case and control patients were 35.8 ± 10.2 years and 43.2 ± 11.5 years, respectively, with male-to-female ratios of 1:1.4 and 1:5, respectively. Case subjects (peripheral trigeminal neuropathy or injury) had significantly larger differences in nerve thickness, T2 signal intensity ratio, and contrast-to-noise ratios than control patients for the inferior alveolar nerve and lingual nerve (P = .01 and .0001, .012 and .005, and .01 and .01, respectively). Receiver operating characteristic analysis showed a significant association among differences in nerve thickness, T2 signal intensity ratio, and contrast-to-noise ratios and nerve injury (area under the curve, 0.83-0.84 for the inferior alveolar nerve and 0.77-0.78 for the lingual nerve). Interobserver agreement was good for the inferior alveolar nerve (intraclass correlation coefficient, 0.70-0.79) and good to excellent for the lingual nerve (intraclass correlation coefficient, 0.75-0.85). MR neurography correlations with respect to clinical neurosensory testing and surgical classifications were moderate to good. Pearson correlation coefficients of 0.68 and 0.81 and κ of 0.60 and 0.77 were observed for differences in nerve thickness. MR neurography can be reliably used for the diagnosis of injuries to the peripheral trigeminal nerve related to molar tooth extractions, with good to excellent correlation of imaging with clinical findings and surgical results.

The Helsinki Face Transplantation: Surgical aspects and 1-year outcome

Since 2005, at least 38 facial transplantations have been performed worldwide. We herein describe the surgical technique and 1-year clinical outcome in Finland's first face transplant case. A 34-year-old male who had a severe facial deformity following ballistic trauma in 1999 underwent facial transplantation at the Helsinki University Hospital on 8th February 2016. Three-dimensional (3D) technology was used to manufacture donor and recipient patient-specific osteotomy guides and a donor face mask. The facial transplant consisted of a Le Fort II maxilla, central mandible, lower ⅔ of the midface muscles, facial and neck skin, oral mucosa, anterior tongue and floor of mouth muscles, facial nerve (three bilateral branches), and bilateral hypoglossal and buccal nerves. At 1-year follow-up, there have thus far been no clinical or histological signs of rejection. The patient has a good aesthetic outcome with symmetrical restoration of the mobile central part of the face, with recovery of pain and light touch sensation to almost the entire facial skin and intraoral mucosa. Electromyography at 1 year has confirmed symmetrical muscle activity in the floor of the mouth and facial musculature, and the patient is able to produce spontaneous smile. Successful social and psychological outcome has also been observed. Postoperative complications requiring intervention included early (nasopalatinal fistula, submandibular sialocele, temporomandibular joint pain and transient type 2 diabetes) and late (intraoral wound and fungal infection, renal impairment and hypertension) complications. At 1 year, we report an overall good functional outcome in Finland's first face transplant.

Comparison of hemostatic effect of bilateral uterine artery upstream ligation and gauze intrauterine caused by preoperative placenta cesarean section hemorrhage

Objective To compare hemostatic effect of bilateral uterine artery superior branch ligation and gauze intrauterine filling two methods for the placenta previa cesarean section bleeding. Methods 100 patients with bleeding in cesarean section were randomly divided into observation group (50 cases) and control group (50 cases). The patients in the observation group were treated with bilateral uterine artery ascending branch, and the control group was treated with gauze.The number of blood transfusion, the time of operation, the amount of bleeding, the time of hemostasis, the number of hysterectomy and the occurrence of complications were compared between the two groups. Results The success rate of hemostasis in the observation group (98.0%) was higher than that in the control group (86.0%), the difference was statistically significant (χ2=4.891, P<0.05). The bleeding volume and hemostasis time were (577.8±55.9) mL, (19.2±10.2)min, the differences between the two groups were statistically significant (t=2.50, 3.25, all P<0.05). The operation time between the two groups had no significant difference (P<0.05). The transfusion rate and incidence rate of complications in the observation group were 8.0% and 6.0%, which were significantly lower than those in the control group (22.0%, 20.0%), and the differences were statistically significant (χ2=3.843, 4.332, all P<0.05). Conclusion The use of bilateral uterine artery esophageal branching in the placenta previa is effective in controlling bleeding, it has rapid bleeding and low incidence of complications, and is worthy of clinical application. Key words: Cesarean section; Placenta previa; Hemorrhage; Controlled clinieal trial

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant.

Recognition of extralaryngeal branching of the recurrent laryngeal nerve is crucial because prevention of vocal cord paralysis requires preservation of all branches of the recurrent laryngeal nerve. We assessed the prevalence of extralaryngeal branching of the recurrent laryngeal nerve and the median branching distance from the point of bifurcation to the entry point of the nerve into the larynx. Prospective operative data on recurrent laryngeal nerve branching were collected from 94 patients who underwent thyroid or parathyroid surgery between September 2011 and May 2012. A total of 161 recurrent laryngeal nerves were examined (82 right, 79 left). Overall, 77 (47.8%) of 161 recurrent laryngeal nerves were bifurcated before entering the larynx. There were 36 (43.9%) branching nerves on the right and 41 (51.9%) branching nerves on the left, and there was no significant difference between the sides in terms of branching (p=0.471). Among 67 patients who underwent bilateral exploration, 28.4% were found to have bilateral branching, 40.3% had unilateral branching, and the remaining 31.3% had no branching. The median branching distance was 15 mm (5-60mm). Extralaryngeal division of recurrent laryngeal nerve is a common and asymmetric anatomical variant. These variations can be easily recognized if the recurrent laryngeal nerve is identified at the level of the inferior thyroid artery and then dissected totally to the entry point of the larynx. Inadvertent division of a branch may lead to vocal cord palsy postoperatively, even when the surgeon believes the integrity of the nerve has been preserved.

GORLIN-GOLTZ SYNDROME: CASE REPORT

Leucoderma, female patient, 49 years old, sought medical care complaining of “injury in the jaw.” She had a history of treatment of various squamous cell carcinoma (SCC) of the skin. In extraoral clinical examination noted papillomatous lesions on the face, suggestive clinical picture of CEC and intraoral examination revealed to be dentate upper and lower part without local changes. Radiographic examination detected 3 radiolucent lesions, well delineated with radiopaque halo body region, bilateral mandibular branch and left posterior maxilla. Biopsy was performed via fine-needle aspiration, which collected whitened liquid with keratin, suggesting keratocystic odontogenic tumor. Incisional biopsy of the lesions and chest and face radiographs were requested, which showed calcification of the falx cerebri, confirming the diagnosis of Gorli-Goltz syndrome. The patient had surgery under general anesthesia for enucleation and curettage of chemical injury and cauterized surgical site using Carnoy. The patient is currently under monitoring.

Changes in the upper airway after orthognathic jaw surgery and maxillar mandibular as the origin of sleep related respiratory disorders

Objective: Determinate volumetric dimensional changes in the upper way at the nasopharynx and oropharynx level, after bimaxillary orthognathic and monomaxilar. in patients class III skeletal deformity associated to sleep-related breathing disorders. Methods: 19 adult patients (12 males, 7 females) average age 27 years, with class III skeletal deformity, suitable for orthognathic surgery: Le Fort I osteotomy of maxillary advancement of bilateral sagittal backward branch. Cone-beam computed tomography was performed one week before the surgery and 3 months later, then, maxillofacial and otorhinolaryngologist clinical evaluation. Conclusions: The preoperative maxillofacial-ENT evaluation indicated signs and symptoms of increased resistance of the upper airway: predisposition mild in nine (47.4%), moderate in seven (36.8%) and severe in one (5.3%). The clinical revaluation three months after orthognathic surgery showed a change in the predispositions 23% of the patients submitted to bimaxillary surgery. 15% changed their resistance from moderate to mild and 8% severe to moderate. There is a tendency to increased volumetric dimension of the upper airways after orthognathic surgery in patients with class III skeletal dimorphism, mandibular prognathism and maxillary deficiency.

Prevalence of pulmonary embolism at autopsy among elderly patients in a Chinese general hospital.

ObjectivesTo investigate the prevalence and characteristics of pulmonary embolism (PE) at autopsy in a Chinese general hospital over a period of 10 years, and to evaluate the antemortem achievement of the prophylaxis, diagnosis, and treatment of PE.MethodsAll medical records of deaths from the West Branch of the Chinese People's Liberation Army (PLA) General Hospital were retrospectively reviewed, for the period of January 1, 2006 to December 31, 2015. Cases in which autopsies had been performed were identified and further analyzed. The numbers and detailed characteristics of patients who had PEs were noted. Prophylactic measures, along with diagnosis and treatment of PE, were recorded, if performed.ResultsDuring the 10-year period, 1057 patients died in the study hospital and 278 necropsies were performed (autopsy rate: 26.3%). Nine patients were found to have PE (3.2%), and in seven of these patients (2.5%), the PE was considered to be fatal. Embolisms were found in the trunk and bilateral main branches of the pulmonary artery tree in all seven of the fatal PE cases. Right intracardiac thrombosis was detected in five of the nine PE patients (55.6%). All patients with PE had been hospitalized in medical departments, and only one had undergone surgery during hospitalization. Antemortem prophylaxis was performed in two of the nine PE cases (22.2%). None of the 9 patients had received a clinical diagnosis of PE before death.ConclusionsThe incidence of and death rate associated with PE may vary among different races and regions. Continuous monitoring of PE by means of necropsy in certain representative medical institutions is necessary.

Understanding the Hybrid Stage I Approach for Hypoplastic Left Heart Syndrome.

Hybrid stage I palliation combines cardiothoracic surgery and interventional transcatheter procedures for treatment of hypoplastic left heart syndrome. The approach is an alternative to the Norwood procedure, the traditional first stage of surgical palliation. Hybrid stage I palliation involves placing bilateral branch pulmonary artery bands and a patent ductus arteriosus stent through a median sternotomy, performed without cardiopulmonary bypass. The purpose of the bands is to control blood flow to the lungs and protect the pulmonary bed while the stent sustains systemic cardiac output. A balloon atrial septostomy is performed to create an atrial septal defect for unobstructed blood flow from the left atrium to the right atrium. The second stage of palliative surgery is the comprehensive stage II, which incorporates removal of the stent and pulmonary artery bands, atrial septectomy, anastomosis of the diminutive ascending aorta to the main pulmonary artery, aortic arch augmentation, and bidirectional cavopulmonary anastomosis. The traditional Fontan procedure completes the series of palliation.

Analysis of related factors on effects of uterine artery embolization in the treatment of dysmenorrhea of adenomyosis and the construction and validation of prediction model

Objective: To investigate the related factors on effects of uterine artery embolization(UAE)in the treatment of dysmenorrhea in patients with adenomyosis, and to construct and validate the efficacy prediction model. Methods: A total of 127 cases of adenomyosis patients with symptoms of dysmenorrhea in Guangzhou No.1 People's Hospital and Nanfang Hospital of Southern Medical University from June 1999 to December 2009 were reviewed. The evaluation standard was to improve the degree of dysmenorrhea, the related factors of efficacy were analysed. Combined with artificial neural network theory, the effect prediction model was constructed, and the effectiveness of the model was evaluated using receiver operating characteristic(ROC)curve, and the effectiveness of the cut-off point was calculated. The model was validated by 68 cases of patients with adenomyosis in the Nanfang Hospital from January 2010 to November 2014. Results: (1)In 127 cases of dysmenorrhea patients, UAE treatment was effective in 98 cases, effective rate was 77.2%(98/127).(2)Age was an independent predictor of effective UAE treatment(HR= 1.129, P=0.026); in the range of this study, the greater the age, the higher the UAE treatment efficiency.(3)The developing situation of ovary branches of uterine artery was an independent predictor of effective UAE treatment(HR=0.460, P=0.020), the efficiency of patients whose intraoperative bilateral uterine artery ovarian branch did not develop was 89.7%(35/39), the efficiency of patients whose unilateral uterine artery ovarian branch was developing was 84.1%(37/44)and the efficiency of patients whose bilateral uterine artery ovarian branch were developing was 59.1%(26/44).(4)Blood supply of adenomyosisis was an independent predictor of effective UAE treatment(HR=0.313, P=0.001). Type Ⅰ(bilateral predominated)patients, efficiency was 93.5%(43/46); type Ⅱ(bilateral balanced)patients, efficiency was 78.0%(39/50); type Ⅲ(unilateral predominated)patients, efficiency was 51.6%(16/31).(5)UAE for the treatment of adenomyosis efficacy of artificial neural network prediction model was constructed, the model's area under the ROC curve was 0.808, the optimal cut-off point was 0.669 13. Actual verification of the model, sensitivity was 96.5%, specificity was 81.8%, positive predictive value was 96.5% and negative predictive value was 81.8%, the total accuracy was 94.1%. Conclusions: (1)Age, the developing situation of ovary branches and blood supply of adenomyosis are the independent predictors of effective UAE treatment.(2)The artificial neural network prediction model is satisfied with the accuracy and the accuracy of prediction.

Bilateral high branching pattern of femoral nerve – A clinico-anatomical study

Objective: The aim of reporting this case is to highlight the abnormal or higher branching pattern of the femoral nerve which is very rarely reported. Materials and Methods: The present anomaly was detected during routine course of cadaveric dissection of a 60 year old male cadaver. Result: The present case reports a very early division of the femoral nerve on both sides of the thigh of a 60 years old male cadaver. The femoral nerve descended through the psoas major muscle and divided into two branches; anterior and posterior, 4.1 cm above the midpoint of the inguinal ligament. Conclusion: Knowledge of this kind of variation in the branching pattern of femoral nerve has much academic and clinical value. Furthermore it will be extremely helpful to the surgeons to prevent iatrogenic injury to femoral nerve and for the anaesthetist to give successful block in the femoral nerve.

Bailout shunt/banding for backward left heart failure after adequate neonatal coarctectomy in borderline left hearts.

To determine the outcome of a bailout procedure using the right ventricle to re-assist the left ventricle in neonates after technically adequate coarctectomy but a failing borderline left heart. The surgical procedure was performed on bypass. A 'reversed' 6-mm surgical shunt was inserted between the pulmonary trunk and the descending aorta together with bilateral branch pulmonary artery banding. Over a 10-year period, 89 neonates presented with coarctation and small left hearts. In 9 neonates, a hybrid procedure was performed at the outset. The remaining 80 underwent extended end-to-end coarctectomy. Two of these, despite adequate coarctectomy, developed retrograde cardiac failure with supra-systemic pulmonary hypertension, dilating right ventricles and progressive cardiogenic shock. The progressively dilating right ventricles inhibited left ventricular filling. Reversed surgical shunts were performed at 9 and 7 days post-coarctectomy. Both infants recovered rapidly and could be extubated after 4 and 7 days, respectively. Patient 1 proceeded to a univentricular repair and Patient 2 to a biventricular repair. Reversed surgical shunt with bilateral banding of the branch pulmonary arteries after neonatal coarctectomy can be successfully employed as a bailout procedure in cases where a borderline left heart with growth potential cannot tolerate a biventricular circulation. It may act as an acute life-saving measure as well as a bridge to later repair. If high risk for backward failure exists in a borderline left heart with catch-up growth potential, a primary hybrid procedure is probably a more elegant and predictable strategy.

Bilateral frosted branch angiitis as the presenting sign of antiphospholipid antibody syndrome.

Background“Frosted branch retinal angiitis” is an encompassing term for a rare, typically bilateral diffuse retinal periphlebitis that may occur in a number of varying conditions. To our knowledge, we report the first case of frosted branch angiitis as the presenting sign of antiphospholipid antibody syndrome in a 28-year-old woman.FindingsThis study is a retrospective case report and literature review. Serial fundus photos, fluorescein angiogram, and ocular coherence tomography taken were before and after treatment, showing resolution of diffuse retinal perivascular sheathing and macular edema along with marked improvement in visual acuity 4 months after the treatment with corticosteroids.ConclusionsFrosted branch angiitis can be seen in association with antiphospholipid antibody syndrome. Prompt recognition and treatment with corticosteroids may result in good visual prognosis, and long-term immunosuppression and additional anticoagulation may be beneficial to prevent recurrence.

Bilateral variant branching pattern of posterior cord of brachial plexus

ObjectiveVariant branching pattern of the cords of brachial plexus has been an area of concern for surgeons opting to explore this region. Anaesthetic blocks and surgical approaches are the highlights of these interventions, where a keen familiarization of the anatomy of this region is mandatory. Material and methodsThe present case description reports a bilateral variant branching pattern of the posterior cord in an adult male cadaver. ObservationsRight posterior cord gave upper subscapular nerve and did not give the lower subscapular nerve. Axillary nerve arises proximal to the thoracodorsal nerve. After giving thoracodorsal nerve, posterior cord continued as radial nerve. There is an unusual branch from right axillary nerve, which supplied teres major and sent twig to lower fibres of subscapularis muscle. Left upper subscapular nerve divided into two branches and supplied the subscapularis muscle. Left axillary nerve enclosed by some fibre of subscapularis muscle, within the fibres of subscapularis axillary nerve, gave an unusual branch to teres major and then it continues in quadrangular space. DiscussionIn spite uncountable reports on variations of brachial plexus, descriptions regarding anomalous branching patterns hold enormous clinical significance for the radiologists, anaesthetists and surgeons, besides being of academic interest for the anatomists.

Anatomical variations in the brachial plexus roots: implications for diagnosis of neurogenic thoracic outlet syndrome

Neurogenic thoracic outlet syndrome (NTOS) is the most common type of TOS. Typically it results from impingement of the neurovasculature as it passes between the anterior and middle scalene muscles; this classic anatomical relationship being the foundation of clinical diagnosis. Positional testing relies on vascular compromise occurring when the subclavian artery is compressed in this space. This study describes several anatomical variations observed in this relationship. Sixty-five cadavers (35m/30f) were assessed to determine the frequency and extent of brachial plexus branching variants. A total of thirty-one variations from "classic" anatomy were observed (47.7%). In two specimens (3.1%), the entire superior trunk coursed completely anterior to the anterior scalene in a position of relative vulnerability. In 27 instances, a portion of or the entire superior trunk pierced the anterior scalene muscle, and in two, the middle trunk also pierced the muscle belly. Interestingly, while two bilateral branching variations were observed, the majority occurred unilaterally, and almost exclusively on the left side. There were no sex differences in frequency. The high frequency of these variations and their potential to predispose patients to neurogenic TOS suggest that current diagnostic methods may be insufficient in clinical diagnosis. Due to lack of vascular compromise, patients with the piercing variant would not display positive signs on the traditional positional tests. The use of ultrasound to determine the route of the brachial plexus could determine whether this variation is present in patients who suffer from TOS symptoms but lack a diagnosis based on traditional positional testing.

Prognostic impact of the site of portal vein invasion in patients with surgically resected perihilar cholangiocarcinoma

The aim of this study was to determine the impact of the site of portal vein invasion on survival after hepatectomy for perihilar cholangiocarcinoma. This study classified 168 patients undergoing resection for perihilar cholangiocarcinoma histologically as without portal vein resection or tumor invasion to the portal vein (PV0), with tumor invasion to unilateral branches of the portal vein (PVt3), or with tumor invasion to the main portal vein or its bilateral branches, or to unilateral second-order biliary radicals with contralateral portal vein involvement (PVt4). Patients in PVt4 were subclassified into the A-M group (cancer invasion limited to the tunica adventitia or media) or the I group (cancer invasion reaching the tunica intima). Of the patients, 121 were in PV0, 21 were in PVt3, and 26 were in PVt4. There was no difference in survival between the PV0 and PVt3 groups (P=.267). The PVt4 group had a worse prognosis than the PVt3 group (P=.046). In addition, the A-M (n=19) and I subgroups (n=7) of PVt4 had worse prognoses than the PV0 or PVt3 groups (P=.005 and<.001, respectively). All patients in the I subgroup of PVt4 died within 9months after resection. On multivariate analysis, PVt4 (P=.029) was identified as an independent prognostic factor. In perihilar cholangiocarcinoma, postoperative survival was no different between patients with and without ipsilateral portal vein invasion, although patients with tumor invasion to the main or contralateral branches of the portal vein, especially with tunica intima invasion, had extremely poor prognoses.

Abstract 9: A Novel Large Cerebral Aneurysm Model in Rats with Intraperitoneal Administration of Beta-AminoPropioNitril-Fumarate

Introduction: Mechanisms of formation, enlargement, and rupture of cerebral aneurysm (CA) are not fully understood. Unveiling the mechanisms lead to the prevention of a life-threatening subarachnoid hemorrhage. Although several CA models in rats have been reported, most of CAs in the models are immature and insufficient for the close investigation into the mechanisms of enlargement and rupture. The establishment of a large CA model is required for full disclosure of the mechanisms. Methods: A new CA model in rats was designed by modifying the Hashimoto model in that high-dose β-aminopropionitril fumarate (BAPN-F) was administrated intraperitoneally. Seven-week-old male Sprague-Dawley rats were deeply anesthetized, the left common carotid artery was dissected and the bilateral posterior branches of the renal artery were ligated. After the operation, rats were fed food with 8% sodium chloride and divided into 4 groups according to the weekly dose amount of BAPN-F as well as the breeding periods (group 1: n=31, 400mg/kg for 4weeks, group 2: n=31, 400mg/kg for 8weeks, group 3: n=27, 2800mg/kg for 8weeks, group 4: n=13, 2800mg/kg for 12weeks). We then investigated aneurysmal development pathologically along with calculating CA induction rate and mortality rate in each group. Results: Continuous hypertension were induced in all groups. CA induction rate was 19.4%, 29%, 85.2%, and 84.6% while mortality was 12.9%, 16.1%, 7.4% and 30.1% in the group 1, 2, 3, and 4, respectively. Group 3 has statistically significant differences in both the induction rate (p=0.018) and mortality (p=0.027). Among 4 groups, CAs were located at anterior cerebral artery - ophthalmic artery bifurcation, anterior communicating artery (Acom A), and posterior communication artery (Pcom A). We defined the large CA as over one and a half times the size of its parent artery. Large CAs were predominantly detected at Acom A and Pcom A in the group 3 (22.2%) and 4 (23.1%). In addition, all large CAs were morphologically and histologically similar to that of human. Conclusions: Intraperitoneal administration of 2800mg/kg BAPN-F enabled us to induce large CAs with 20% induction rate and low mortality. A further investigation of this model should be promising for full disclosure of the CAs mechanisms.

A Case of Bilateral Branch Retinal Vein Occlusion after Taking Tamoxifen

A Case of Bilateral Branch Retinal Vein Occlusion after Taking Tamoxifen

Two young stroke patients associated with regular intravenous immunoglobulin (IVIg) therapy

We recently experienced 2 young adult patients who developed ischemic stroke after regular intravenous immunoglobulin (IVIg) therapy for agammaglobulinemia with diagnosis of common variable immunodeficiency (CVID) in their childhood. Patient 1 was 26-year-old woman, who developed Wallenberg's syndrome 6days after the last IVIg therapy, but had no further stroke recurrence with cilostazol later. Patient 2 was 37-year-old man, who developed recurrent cerebral infarction in the territory of bilateral lenticulostriate branches like branch atheromatous disease (BAD) several days after the IVIg therapy. However, he had no further stroke recurrence after bone marrow transplantation (BMT) therapy for his lymphoproliferative disorder. It was suggested that IVIg therapy was associated to these different types of ischemic stroke in our 2 young adult patients with minimal vascular risk factors. Although IVIg therapy is widely used as a relatively safe medication for immunodeficiency disorders or autoimmune diseases, we need to pay more attention to stroke occurrence with regular IVIg therapy.

Assessment of branch pulmonary artery stenosis in children after repair of tetralogy of Fallot using lung perfusion scintigraphy comparison with echocardiography

The aim of this study was to compare the usefulness of lung perfusion scintigraphy and echocardiogram in the evaluation of the branch pulmonary arteries stenosis in children with tetralogy of Fallot (TOF). From February 2006 to November 2008, 74 children (mean age 7.8 years, range 1–18 years) who underwent repair of TOF at ages from 10 months to 13 years were suspected to have unilateral or bilateral branch pulmonary artery stenosis. In all patients, cardiac angiography was performed to confirm the diagnosis of branch pulmonary artery stenosis. Lung perfusion scintigraphy and two-dimensional transthoracic echocardiography were performed in all patients to compare their abilities to diagnose branch pulmonary artery stenosis. Of the 74 patients, 51 cases were found to have branch pulmonary artery stenosis by cardiac angiography. There was agreement between the scintigraphic and angiographic findings in 44 (86%) patients and there were discrepancies in 11 (15%) patients. The positive predictive value of our lung perfusion scintigraphy in detecting the branch pulmonary artery stenosis was 92 %. The positive and negative likelihood ratios of lung perfusion scintigraphy were 4.96 and 0.17, respectively. There was conformity between the echocardiographic and angiographic findings in 40 (78%) patients with discrepancies in 16 (21%) patients. The positive predictive value of our echocardiography in detecting the branch pulmonary artery stenosis was 89%. The positive and negative likelihood ratios of echocardiography were 3.61 and 0.28, respectively. Lung perfusion scintigraphy is a valuable, non-invasive screening tool in the assessment of branch pulmonary artery stenosis in children after TOF.