Dual Drainage Research Articles

Transcatheter device closure of partial anomalous pulmonary venous return with “intrapulmonary duplicating drainage” — A newly described entity and a single center experience

We are grateful for the interesting article by Luciano et al. [1] describing a series of 10 cases from 5 different institutions of successful transcatheter closure of the partial anomalous pulmonary venous return (PAPVR). Their observations also included characteristics of patients with PAPVR in previously published 8 case reports. Two anatomic types of anomalous partial venous were described; the vertical vein (VV) type in which an abnormal left upper pulmonary vein connects to the innominate trunk via the VV and the scimitar vein (SV) type in which anomalous pulmonary venous connections from the middle and/or lower right pulmonary vein connect to the inferior vena cava (Fig.1a and b). It should be noted that both types are “extrapulmonary” dual drainage types of PAPVR. We hereby describe our own experience and follow-up of 4 patients (from 2004 to 2013) with PAPVR. Unlike Luciano et al., our patients had “intrapulmonary” duplicating pulmonary venous return in which a single lobar segment has separate venous channels draining to the left atrium as well as to a systemic vein (Fig. 1c and d). This remained undetected via preprocedural MRI but was successfully delineated in the catheterization lab using balloon occlusion angiography leading to successful device embolization. The clinical characteristics of these cases are shown in Table 1. Similar to the cases described by Luciano et al., we have closed the “extrapulmonary” PAPVR in few other patients which are not being described here. Previously, Snellen et al. [2] had elegantly described various patterns of anomalous pulmonary venous connections verified at surgery or autopsy in 124 patients. Even in that large series, therewas nodescription of intra-pulmonary anomalous pulmonary venous connections. Therefore, we believe that our cases may represent a unique and newly described entity. The embryological explanation of abnormal pulmonary venous connection based upon the differential time of development of primitive pulmonary vein and the atrial septum and the principle of preference of shortest path to the anastomosis between pulmonary veins and splanchnic complexes may also be applicable to “intrapulmonary” anomalous pulmonary venous connections as well. This newly described entity may remain underdiagnosed even with advanced imaging modalities and high index of suspicion is warranted in appropriate clinical settings.

Application and comparison of two different dual drainage models to assess urban flooding

Two types of dual drainage models were set up to assess urban flooding for a study area in Germany: (1) a static model based on a conventional method in Germany; the overflow volumes of the manholes are gained by the sewer solver HYSTEM-EXTRAN. Using these water volumes and geographic information system (GIS) tools, an overland flow network, composed of flow paths and accumulated water in sinks, is produced, (2) a HYSTEM-EXTRAN 2D model; a two-dimensional (2D) overland flow module is coupled bi-directionally with HYSTEM-EXTRAN. The overland flow and the flow in the sewer system are simulated alternately.Both models were supplied with a synthetic design rainfall and 25 extreme storms. After comparing the models and the results, a practical approach to assess urban flooding is proposed. In this approach the 2D model will compute the depth, extent, and propagation of floods only in the prone areas specified by the static model.

Dual Left Pulmonary Venous Drainage in a Child with Right Atrial and Right Ventricular Dilatation

We report the case of dual pulmonary venous drainage, normal to left atrium and abnormal to left innominate vein, as a very rare cause of right ventricular dilatation in an otherwise normal and asymptomatic child.

URBFEP Model for Basin Scale Simulation of Urban Floods Constrained by Sewerage's Size Limitations

Rain drainage in urban catchments is highly complex and depends on numerous and widespread restrictions to water flows caused by the layout of urban areas and building morphology, as well as by the size of sewers which are usually designed for low return period values (2÷10 years). The higher the rainfall return period, the higher the influence of such limitations and the correspondent hydrographs show reductions in peak values due to the reservoir effect generated by flood waters. The modelling of such processes is based on mathematical algorithms of transients associated with rainfall-runoff phenomena and with 1D/2D flow routing processes that, during more intense rainfall, occur simultaneously in the sewer and on the surface (dual drainage systems). However, when flood risk planning relates to the catchment scale for a vast territory with many urban areas, the model no longer focuses on a detailed simulation of what happens inside each urban area, but rather on an estimate of the main characteristics of the urban floods and of the hydrographs discharged into the receivers. In this case, it is necessary to use simpler models, but which are still able to provide a reliable representation of such phenomena. For such purpose, the conceptual model URBFEP (URBan Flood Equivalent Pipe) has been developed in order to obtain a reliable representation of these restricted urban flood processes. This model is presented here, demonstrating its ability to represent the real behaviour of urban sub-catchments in comparison to the results obtained in physically based simulations in a set of real urban areas selected as pilot cases.

Transcatheter therapy in partially abnormal pulmonary venous return with additional drainage to the left atrium

BackgroundA persistent anastomosis between the pulmonary veins that connect with the left atrium and the systemic vein that drains into the right atrium has occasionally been reported. We report characteristics and transcatheter therapy in partially abnormal pulmonary venous return with additional drainage to the left atrium. MethodsWe retrospectively studied such patients in 5 institutions. ResultsTen patients (6 girls) presented at a median age of 8 (0.1 to 54) years with 2 anatomic types: 8 vertical vein types with drainage of the left upper lobe to the innominate vein via a large vertical vein (left superior cardinal vein) and to the left atrium via the left upper pulmonary vein; and 2 scimitar vein (SV) types with drainage of the right middle and lower pulmonary veins into the inferior vena cava and to the left atrium via an anomalous connecting vein. Associated malformations were aortic coarctation (n=2) and secundum atrial septal defects (n=3). Two patients of the vertical vein type were operated. Transcatheter occlusion of the abnormal pulmonary venous return was performed in 7 cases, associated with occlusion of systemic arterial supply (n=2), secundum atrial septal closure (n=2), left upper pulmonary vein stenosis stenting (n=1), and coarctation stenting (n=1). Including previously published cases, 18 patients (13 vertical veins and 5 scimitar veins) underwent transcatheter repair. Patients over 40years of age tend to be symptomatic at presentation (p=0.056). ConclusionIn partially abnormal pulmonary venous return with dual drainage, transcatheter therapy can be offered in the majority of patients.

Numerical and experimental investigation of a gully under surcharge conditions

This paper deals with numerical and experimental investigation of a gully under exceptional situations after the sewer system becomes pressurized. These results are useful for the calibration and validation of the linking elements found in Dual Drainage (DD) models. The experimental results were obtained in the MLE (Multiple-Linking-Element) experimental installation that allows the simulation of full surcharge flow through a gully. The installation consists of an 8 m long and 0.5 m wide channel, fitted with a 0.6 × 0.3 × 0.3 m gully with a 80 mm diameter pipe inlet at the bottom. The numerical results were obtained using a three-dimensional structured mesh simulated in the OpenFOAMTM Toolbox. The results characterization focuses mainly on the jet area, whereby pressure-flow relations were derived for this specific gully. The good agreement found between numerical and experimental results, allowed the extrapolation to larger flow rates.

635 Dual Modality Drainage for Infected and Symptomatic Walled off Pancreatic Necrosis: Clinical Outcomes in 98 Consecutive Patients

75 patients (87.2%) had severe disease {Atlanta (1992)}, and persistent organ failure was observed in 30 (34.9%) patients. The mean CT severity index (CTSI) score was 7.4±2.25. Twenty two (25.6%) patients underwent intervention (percutaneous radiologic catheter/ endoscopic drainage) for the local complications. Nine patients (10.5%) succumbed to their illness. Themean plasmaOPN levels on admissionwere 13.6±8.10 ng/mL (normal: 3.58±1.43 ng/mL). The mean CRP levels on admission were 57.8±10.7 mg/L (normal ,10mg/L). Plasma OPN level were significantly higher in patients who developed persistent organ failure (p,0.001), necrosis (p=0.015), CTSI≥7 (P=0.006) and severe pancreatitis (p=0.015) compared to those who did not. However, OPN levels were similar between non survivors & survivors (p=0.733) & those who did & did not require intervention (p=0.968). CRP levels were significantly higher in patients with persistent organ failure (p ,0.001) compared to those who did not (Table 1). However, CRP levels were comparable between survivors & non survivors (p=0.866), with & without necrosis (p=0.986), with and without severe disease (p=0.986) & those who did & did not require intervention (p=0.669) On ROC curve, OPN levels of 12.1 ng/mL could predict necrosis with a sensitivity and specificity of 65% and 64% (AUROC: 0.733), of 12.1 ng/mL could predict severe disease with a sensitivity and specificity of 65% and 64% (AUROC: 0.733), and levels of 16.3 ng/mL could predict POF with a sensitivity and specificity of 66% and 66% (AUROC: 0.721). CRP levels at 57.6 mg/L could predict POF with a sensitivity and specificity of 53% and 54% (AUROC: 0.550). Conclusion: Plasma OPN level at admission is a useful predictor of the severity and complications in AP. Plasma OPN and CRP Levels and Relation to the Outcome Parameters in Acute Pancreatitis

Coronary Sinus Ostial Atresia Associated With Functionally Single Ventricle: Persistent Left Superior Vena Cava Should Be Ligated Upon Coronary Sinus Unroofing and Bidirectional Glenn Shunt

An 11-month-old boy with a functionally single ventricle, coronary sinus ostial atresia, and bilateral superior vena cava (SVC) underwent coronary sinus unroofing upon a right bidirectional cavopulmonary shunt. A persistent left SVC left open to guarantee dual coronary venous drainage became dilated with cephalocaudal blood flow reversal and desaturation. The left SVC was surgically ligated on postoperative day 35.

Dual drainage of the right pulmonary veins: a rare variant of Scimitar syndrome

Dual drainage of the right pulmonary veins: a rare variant of Scimitar syndrome

Visualization of dual coronary artery fistulae drainage to the right ventricle by transthoracic echocardiography

Coronary artery fistula is a rare abnormality of coronary circulation. It is mostly congenital but acquired forms can also occur. Fistulae are usually asymptomatic and can sometimes be visualized during cardiac imaging such as transthoracic echocardiogram, cardiac magnetic resonance imaging, coronary computed tomography angiography and coronary angiography.

Partial Anomalous Pulmonary Venous Return: Transcatheter Repair

This report describes a case of partial anomalous pulmonary venous return in a young white girl for whom transcatheter intervention successfully replaced surgical correction. This intervention was feasible because the left lung had dual pulmonary venous drainage.

Long Term Outcomes Following Dual Modality Drainage of Organized Pancreatic Necrosis

Long Term Outcomes Following Dual Modality Drainage of Organized Pancreatic Necrosis

Updated Results for Dual Modality Versus Percutaneous Drainage for the Treatment of Symptomatic Walled off Pancreatic Necrosis

Updated Results for Dual Modality Versus Percutaneous Drainage for the Treatment of Symptomatic Walled off Pancreatic Necrosis

Intra-Individual Comparison of Lymphatic Drainage Patterns Using Subareolar and Peritumoral Isotope Injection for Breast Cancer

Controversy exists in the literature regarding the optimal site for lymphatic mapping in breast cancer. This study was designed to characterize lymphatic drainage patterns within the same patient after subareolar (SA) and peritumoral (PT) radiopharmaceutical injections and examine the impact of reader interpretation on reported drainage. In this prospective trial, 27 women with breast cancer underwent sequential preoperative SA and PT injections of 0.5 to 2.7 mCi of technetium-99 m filtered sulfur colloid 3 days or more apart. Patterns of radiopharmaceutical uptake were reviewed independently by two nuclear medicine physicians. Inter-reader agreement and injection success were assessed in conjunction with observed drainage patterns. There was near perfect inter-reader agreement observed on identification of axillary LN drainage after PT injection (P = 0.0004) and substantial agreement with SA injection (P = 0.0344). SA injection was more likely to drain to only axillary LNs, whereas PT injection appeared more likely to drain to both axillary and extra-axillary LNs, although no statistically significant differences were found. All patients with extra-axillary drainage after PT injection (n = 6 patients) had only axillary drainage after SA injection. Dual drainage was observed for six patients with PT injection and one patient with SA injection. Our findings suggest that radiopharmaceutical injected in the SA location has a high propensity to drain to axillary LNs only. After controlling for patient factors and demonstrating inter-reader agreement, the inability to demonstrate statistically significant differences in drainage based on injection site suggests that lymphatic drainage patterns may be a function of patient and tumor-specific features.

Hydraulic Efficiency of Continuous Transverse Grates for Paved Areas

The hydraulic behavior of several continuous transverse gully grates is studied. Their use is common in some urban or impervious areas (squares, airport pavements, parks, pedestrian areas, etc.) where isolated inlets turn out to be ineffective in collecting the whole runoff into the sewer system during a storm event. Normally, manufacturers of such structures provide information about the bearing capacity, but little concerning their hydraulic behavior. Some grates with various widths were tested at the Technical University of Catalonia hydraulic laboratory for different approach flows and a large set of longitudinal slopes. Experimental equations were obtained to relate hydraulic efficiency of these structures to some relevant flow parameters such as the Froude number and the hydraulic depth. The first equation achieved may be used as a first approach to design a surface drainage system considering a constant circulating flow, whereas the second expression does not depend on flow values and could be used in storm-water and wastewater software packages to design surface drainage systems and for dual drainage modeling.

HYDROLOGIC CYCLE AND HEAT TRANSPORT MODELING AND ITS APPLICATION TO AN URBANIZED WATERSHED

A physically distributed hydrological model (WEP model) was coupled with a newly developed physically distributed model of heat transport in river water to simulate watershed scale hydrological and heat transport processes and resulting effects on stream environment. The model is characterized by the capability of simulating runoff from a highly urbanized watershed with a dual drainage system of river channels and a sewer network, which enables appropriate prediction of inflows to wastewater treatment plants and river floods. Also, this model is designed to investigate factors affecting spatial and temporal variations of stream temperature by incorporating anthropogenic heat impacts and urban canopy processes. Applying the model to the Kanda River Watershed, stream flow and temperature as well as inflows to a WWTP are well simulated. The anthropogenic heat impact on stream temperature was also simulated.

Mapping Melanoma Lymphoscintigraphy Data onto a 3D Anatomically Based Model

This study describes three-dimensional (3D) visualization of two-dimensional (2D) melanoma lymphatic mapping data, to provide a framework for analysis of melanoma spread patterns and a platform for recording new lymphoscintigraphy (LS) data more accurately in 3D. Specifically, the Sydney Melanoma Unit's LS database of over 5000 patients' primary cutaneous melanoma sites and sentinel lymph nodes have been mapped from 2D images onto a 3D anatomically based model. Anatomically accurate model geometries were created using the Visible Human dataset, giving a bicubic finite element skin mesh and discrete sentinel lymph node model. The full dataset of 2D melanoma site coordinates, excluding the head and neck, has been transformed onto this 3D skin mesh via free-form deformation and projection techniques. Sentinel lymph nodes were mapped onto the generic lymph node model for each patient. Preliminary spatial analysis indicates that a patient with a primary melanoma on the torso around the waist (on the standardized 3D model this region is 180 mm above and 130 mm below the umbilicus) with lymphatic drainage to the left axilla or left groin, will have a 17.7% probability of dual drainage to both node fields, with 95% confidence limits between 14.5 and 21.0%.

건물영향을 고려한 GIS기반 도시침수해석 모형

e o최근에 들어 도시지역에서는 국지성 집중호우에 의한 홍수피해가 증가하고 있다. 심지어 우수설비 시스템이 비교적 잘 갖추어진 개발 지역에서도 기존의 우수설비시스템의 용량이 초과되어 큰 침수피해가 발생하고 있다. 이로 인해 건물， 공공기반시설 등 재산 및 인명 등에 있어 많은 피해를 야기하고 있으며, 도로의 침수는 운송 시스템의 기능에 문제를 일으키게 되어 도시의 산업과 기능을 마비시킨다. 이러한 도시지역 홍수에 대비하여 도시지역의 복잡한 지형 형상과 인위적 배수시스템을 함께 고려하여 해석할 수 있는 적절한 침수해석모형이 필요하다. 본 연구에서는 배수시스템 해석 모형인 SWMM모형과 도시침수해석 모형인 DEM 기반 침수해석모형을 통합하고, 두 모형간의 유량의 전송과정을 수리학적 관계를 고려한 이중 배수(Dual-Drainage) 개념에 의한 도시침수해석모형을 이용하였다. 본 연구에서는 이중배수 침수해석모형을 수정하여 건물의 영향을 고려할 수 있도록 구성하였다. 본 모형의 개발로 침수상황의 시간별 진행과정을 분석함으로써 도시홍수에 대한 침수위험지점 파악 및 홍수 취약지점에서의 긴급대피 계획수립 등에 활용될 수 있을 것으로 판단된다. Recently in urban area flood damages increase due to local concentrated heavy rainfall. Even in the cities where stormwater drainage systems are relatively well established flood damage still occurs because of the capacity limitations of the existing stormwater drainage systems. When the flood exceeds the capacity limitation of the urban storm sewer system, it yields huge property losses of public facilities involving roadway inundation to paralyze industrial and transportation system of the city. To prevent such flood damages in urban area, it is necessary to develop adequate inundation analysis model which can consider complicated geometry of urban area and artificial drainage system simultaneously. The Dual-Drainage model used in this study is the urban inundation analysis model which combines SWMM with DEM based 2-dimensional surface flood inundation model. In this study, the dual drainage model has been modified to consider the effect of complex buildings in urban area. Through the simulation of time variable inundation process, it is possible to identify inundation alert locations as well as to establish emergency action plan for the residencial area vulnerable to flood inundation.

Quantifying drainage components and salt and water balance in YinNan Irrigation District, China, based on a controlled drainage experiment

AbstractYinNan Irrigation District (YNID) is located in the upper reaches of the Yellow River in NingXia, China. Its irrigated area is about 80 000 ha, with one‐third of it for rice production. The major part of its drainage system was constructed between the 1950s and 1970s to maintain the salt and water balances of the district. The system, however, has been reported as draining the agricultural lands excessively by several studies. In addition to field, lateral and main drainage ditches, agricultural fields of YNID are also under the influence of the Yellow River channel and some low‐lying depressions, thus forming a dual drainage system. Owing to difficulties in irrigation inflow measurement, evaluation of the existing drainage system often appears to be elusive. Based on a dual drainage assumption and an on‐site controlled drainage experiment, we present a detailed analysis on drainage components and the salt and water balance of YNID. Results show that, by implementing controlled drainage, shallow drainage from field ditches can be reduced by 60%. Deep drainage from main ditches, the Yellow River channel and low‐lying depressions is relatively stable year around, and it neutralized the potential effect of controlled drainage on salinity increase. Drainage water salinity calculated from the dual subsurface drainage model was consistent with field observations, proving that the dual drainage assumption is valid for the study area. Based on this study, field water management practices of the irrigation district can be better targeted and fairly evaluated. Copyright © 2006 John Wiley & Sons, Ltd.

Endograft repair of partially anomalous pulmonary venous connection with dual drainage

A 73-year-old woman with dyspnea and fatigue was found to have a partially anomalous pulmonary venous connection with communication between the right upper lobe pulmonary vein and the superior vena cava, as well as a normal pulmonary vein confluence with the left atrium. She was successfully treated with an endograft implanted in the superior vena cava, covering the defect. The unique dual drainage of the pulmonary vein allowed percutaneous treatment of a condition that ordinarily requires complex caval and intracardiac reconstruction. Except for several episodes of arrhythmias, she has been doing well, with exercise tolerance improving from New York Heart Association class III at baseline to class I after treatment. Follow-up imaging and clinical findings at 36 months showed no migration of the stents and significant improvement of quality of life.