Shunt Group Research Articles

Pulmonary arterial hypertension associated with congenital heart disease in children: clinical characterisation, outcomes and changes in demographics over time

Abstract Background/Introduction Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) in children and is associated with significant morbidity and mortality. The impact of different phenotypes on management and survival remains unclear. Purpose To examine the clinical features, management and outcomes of paediatric PAH-CHD patients based on the 20-year experience of the UK National Paediatric Pulmonary Hypertension (PH) Service. Methods Consecutive PAH-CHD patients entering the service between January 2001 and January 2021 were included and classified into: Eisenmenger syndrome (ES, group A), PAH related to a significant systemic-pulmonary shunt (group B), PAH with small or co-incidental CHD (group C) and PAH following defect repair (group D). Incident patients (without pre-existing PAH) were included in survival analysis. Results Of the overall PH paediatric cohort of 1104 patients, 819 (74.2%) had co-existing CHD and 354 (32.1%) patients received a diagnosis of PAH-CHD: 57.1% female, median [IQR] 4.6 [1.7–10.9] years. Group D PAH-CHD was the commonest subgroup, accounting for 36%, while the least frequent subtype was group C (14%). Group A and group B PAH-CHD represented 26% and 24%, respectively. Down syndrome was present in over one third (122, 34.5%) of PAH-CHD patients and was more commonly associated with ES (p=0.02). PAH therapy was started in 79.9% of PAH-CHD patients. At the end of follow-up, patients with group C PAH-CHD were more likely to be on combination therapy than any other group (64.6% vs. 28.4%, p<0.0001). Prostanoid therapy was used in a minority (11%) of patients. The subgroup distribution of PAH-CHD at diagnosis changed from the early (2000–2005) to late (2015–2020) period (Figure 1). The proportion of ES patients decreased from 43.4% to 14.6% of PAH-CHD (p<0.0001). The proportion of group B PAH-CHD patients increased (9.4% vs. 33.3%, p<0.0001), with the majority (59.3%) deemed “operable” on specialist assessment. There was a trend for an increase in repaired PAH-CHD patients between the early and late era (31.1% vs. 43.8%, p=0.09). Transplant-free survival in PAH-CHD was 90.9% (95% CI: 87.8–94%) at 1 year, 77.9% (95% CI: 73.1–83.1%) at 5 years, and 74.9% (95% CI: 69.6–80.7%) at 10 years (Figure 2). Group C PAH-CHD had a lower transplant-free survival than the other 3 groups (HR 2.54, 95% CI: 1.51–4.28, p=0.0005). There was no difference in outcome between group A and group D PAH-CHD (HR 1.19, 95% CI: 0.62–2.28, p=0.6). Conclusions Repaired PAH-CHD, not ES, was the most common subtype in this large paediatric cohort. Over time, there were fewer ES patients and more “operable” patients with left-right shunts, suggesting an improvement in early diagnosis and management. Despite widespread use of PAH therapy, PAH-CHD remains a life-limiting disease with the poorest outcomes in PAH with co-incidental CHD. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Constantine received a personal PhD fellowship grant (CHAMPION PhD Fellowship) Figure 1Figure 2

The genomic basis of army ant chemosensory adaptations.

The evolution of mass raiding has allowed army ants to become dominant arthropod predators in the tropics. Although a century of research has led to many discoveries about behavioural, morphological and physiological adaptations in army ants, almost nothing is known about the molecular basis of army ant biology. Here we report the genome of the iconic New World army ant Eciton burchellii, and show that it is unusually compact, with a reduced gene complement relative to other ants. In contrast to this overall reduction, a particular gene subfamily (9‐exon ORs) expressed predominantly in female antennae is expanded. This subfamily has previously been linked to the recognition of hydrocarbons, key olfactory cues used in insect communication and prey discrimination. Confocal microscopy of the brain showed a corresponding expansion in a putative hydrocarbon response centre within the antennal lobe, while scanning electron microscopy of the antenna revealed a particularly high density of hydrocarbon‐sensitive sensory hairs. E. burchellii shares these features with its predatory and more cryptic relative, the clonal raider ant. By integrating genomic, transcriptomic and anatomical analyses in a comparative context, our work thus provides evidence that army ants and their relatives possess a suite of modifications in the chemosensory system that may be involved in behavioural coordination and prey selection during social predation. It also lays the groundwork for future studies of army ant biology at the molecular level.

A new enemy of Apis mellifera (Hymenoptera: Apidae): First report of Nomamyrmex esenbeckii (Hymenoptera: Formicidae) attacking honey bee colonies

Nomamyrmex esenbeckii, commonly known as the legionary ant, belongs to the group of army ants. This social insect employs a cooperative hunting method that is considered more evolved than solitary hunting ants. Their main preys are other ants and termites. However, in this article, we report for the first time in Mexico the predatory behavior of N. esenbeckii on Apis mellifera colonies.

Primary central pulmonary artery plasty for right atrial isomerism with pulmonary coarctation.

Patients with unbalanced pulmonary artery growth resulting from pulmonary coarctation are considered unsuitable candidates for the Fontan procedure. Particularly, patients with right isomerism pose a challenge. We aimed to investigate the use of primary central pulmonary artery plasty at initial palliation in patients with right isomerism. We recruited 34 right isomerism patients with pulmonary atresia and pulmonary coarctation who underwent modified Blalock-Taussig shunt with or without primary central pulmonary artery plasty between 1998 and 2014. We classified them into the primary central pulmonary artery plasty (group P) and no primary central pulmonary artery plasty (group N) groups. We retrospectively analyzed reintervention for pulmonary artery after initial palliation, difference in size between the left and right pulmonary arteries, overall survival, success of the Fontan procedure. The group P and group N included 25 and 9 patients, respectively. Five (20%) and six (67%) patients in group P and group N, respectively, required reintervention for pulmonary artery after initial palliation (p = 0.017). No patient underwent reintervention for the pulmonary artery before bidirectional cavopulmonary shunt in group P. There was a significant difference in the bilateral pulmonary artery size balance between the groups before bidirectional cavopulmonary shunt (p = 0.041). The two-lung Fontan procedure was successful in 14 (56%) and 1 (11%) patient in group P and group N. Primary central pulmonary artery plasty may contribute toward improving the balance in the size of the PA and preclude the need for reintervention for PA.

Postoperative Renal Failure, Shunt Type, and Mortality After Norwood Palliation

BackgroundThe Single Ventricle Reconstruction Trial demonstrated increased risk of death or heart transplant 1 year after Norwood among subjects randomly assigned to modified Blalock-Taussig shunts compared with right ventricle to pulmonary artery (RV-PA) shunts. We used the Single Ventricle Reconstruction Trial public use database to evaluate incidence and risk factors for postoperative renal failure and relationships between renal failure, shunt type, and outcomes after Norwood. MethodsPostoperative renal failure was defined a priori as a threefold rise in creatinine from baseline, or dialysis use, within 7 days of Norwood. We used multivariate logistic regression to evaluate risk factors for postoperative renal failure and Cox hazard regression to determine the association between postoperative renal failure and 1 year after Norwood mortality. ResultsOverall, postoperative renal failure occurred in 8.4% (46 of 544) patients with risk factors including receipt of a modified Blalock-Taussig shunt (adjusted odds ratio [aOR] 3.3, P = .02), low center volume (aOR 2.7, P = .005), two or more preoperative complications (aOR 4.0, P < .001), low birth weight (aOR 3.2, P = .002), postoperative heart block (aOR 8.5, P = .001), and delayed sternal closure (aOR 5.3, P = .026). Renal failure was an independent risk factor for 1-year mortality (aHR 1.9, P = .019). Assessing interaction by shunt type, mortality risk associated with renal failure was greatest in the RV-PA shunt group (aHR 3.3 vs RV-PA shunt without renal failure, P = .001), but was also increased in the modified Blalock-Taussig shunt group (aHR 1.9, P = .03). ConclusionsPostoperative renal failure is common after Norwood and is independently associated with mortality. Although renal failure is more common after modified Blalock-Taussig shunt, the highest mortality risk with renal failure occurs after RV-PA shunt.

Neuropsychological assessments and cognitive profile mostly associated with shunt surgery in idiopathic normal pressure hydrocephalus patients: diagnostic and predictive parameters and practical implications.

Cognitive decline is a well-documented feature of idiopathic normal pressure hydrocephalus (iNPH) that can be reversible following cerebrospinal fluid tap tests (CSF-TT). The current gold standard for selecting iNPH patients for shunt surgery is measurable improvement in gait tests following CSF-TT. However, the diagnostic significance and predictive role of pre-surgical cognitive evaluations in probable iNPH patients is still controversial. To find the neuropsychological (NPSY) tests and cognitive aspects mostly associated with shunt surgery in iNPH. A retrospective comparison between probable iNPH patients who, after undergoing CSF-TT with gait and cognitive evaluations, ended up receiving a shunt (group 1) and probable iNPH patients who ended up with no shunt surgery (group 2). Differences in the diagnostic and predictive results of variety of NPSY tests at baseline, pre-CSF-TT, and post-CSF-TT were used for thorough statistical calculations. A total of 147 patients with probable iNPH were included. Of those, 58 (39.45%, group 1) patients underwent shunt surgery, while 89 (60.55%, group 2) did not. For the vast majority of the cognitive tests used, no statistically significant differences were found between the groups at baseline (pre-CSF-TT). Following CSF-TT, the "naming" component of the Cognistat test was the only single test to show statically significant difference in improvement between the two groups. Combining at least two tests led to increased levels of accuracy and specificity; however, the sensitivity remained < 50. The only two combinations that were associated with sensitivity ≥ 70 were either any improvement in the Cognistat test (p = 0.627) or any improvement in either its naming, memory, or judgment components (p = 0.015). Cognitive tests, even when combined to cover several cognitive aspects, are not sensitive enough to act as an independent reliable diagnostic and predictive tool, especially when relying on their scores as baseline. In order to avoid cumbersome and unnecessary tests to our patients and to reduce the number of patients who are denied proper treatment due to misdiagnosis, we recommend to use NPSY tests that examine the cognitive aspects of naming and memory, in addition to 2-3 tests for executive functions.

No evidence for conspecific recruitment for cooperative hunting in lionfish Pterois miles.

Lionfish are common piscivores in the Indo-Pacific and invasive in the Caribbean. A fin flaring pattern, involving a rapid undulation of the caudal fin and sequential turning of both pectoral fins, was described in zebra lionfish as a signal to initiate cooperative hunting, and it was hypothesized that such hunting tactics may also exist in other lionfish species and contribute to their successful invasion in the Caribbean. Here, we investigated one of those invasive species, Pterois miles, in its natural range in the Red Sea. We did not observe evidence for cooperative hunting in the field. We complemented field observations with a laboratory experiment aimed at inducing subjects to recruit partners for cooperative hunts, exposing subjects to inaccessible prey in transparent housing as well as to a potential partner. We regularly observed the fin flaring pattern, but importantly, it was not directed at the partner. Thus, rather than being a signal, the fin flaring movement pattern seems to be a swimming mode in a confined environment. Furthermore, the two lionfish did not aggregate at the prey housing, reinforcing the field results that this species in the Red Sea does not depend on cooperation to hunt fish.

Perceptions of ebola virus disease among the bambuti hunter group: a mixed-methods study

ABSTRACT The second largest Ebola virus disease (EVD) epidemic occurred in the Democratic Republic of the Congo (DRC) from 2018–20. The Bambuti, a hunter population in the Ituri Forest of the DRC, may be vulnerable to the zoonotic spread of EVD due to their frequent handling of forest animals. We conducted five focus group discussions and surveyed 113 Bambuti and 91 Bantu (control group), to discern how the Bambuti perceived and responded to EVD. Thematic analysis of focus group discussions revealed three major themes: (1) deprivation and discrimination; (2) mistrust; and (3) epistemic dissonance with public health messages emphasizing risks posed by forest animals. In surveys, 98% of Bambuti were deprived using the multidimensional poverty index (versus 78% of Bantu controls, p < 0.0001) and 77% had no formal education (versus 29% of controls, p < 0.0001). Bambuti were more dependent on wild meat for survival (51% versus 32% of controls, p = 0.008) and more frequently opposed the implementation of a bushmeat ban (48% versus 19% of controls, p < 0.0001). Trust in government was similar among Bambuti and Bantu. Comprehensive EVD knowledge was poor overall, and lower among the Bambuti (2% versus 8% of controls, p = 0.041). Compliance with public health measures was associated with higher levels of education and trust in government but did not differ between Bambuti and Bantu survey respondents. Together, our findings point to a particular vulnerability of the Bambuti to the effects of EVD, attributable at least in part to multidimensional poverty.

An eco-epidemiological model with social predation subject to a component Allee effect

Allee effect plays important roles in social species’ survival, invasion and evolution. The dynamical characteristics of populations incorporating component Allee effect and infectious disease remain unclear. In this paper, we propose an eco-epidemiological model of prey and predator interactions with assumptions that (1) The predator has cooperative social behavior in hunting prey; (2) The predator experiences component Allee effect generated from limited mating; (3) The disease can spread among predators. Our proposed model is novel to study the joint effects of cooperative behavior, mating limitation and disease in predator. We first investigate the dynamics of the disease-free model in four cases based on whether predators have mate limitation or cooperation as well as one- and two-parameter bifurcations. Analytical results show that the introduction of mate limitation generates a strong Allee effect and Hopf bifurcation. It is found that increasing mate limitation in a reasonable region stabilizes the system, but excessive limiting strength would lead the coexistence equilibrium to go extinction. We also study the dynamics of the predator-prey model in presence of disease. The theoretical result shows that the model always has a predator-extinction equilibrium which is always locally stable. We then explore how mate limitation affect the transmissibility of disease among cooperative predators. The results show that mating limitation can save the predator from disease-driven extinction and lead the disease to disappear from the system when the cooperation coefficient is large, while it drives the predators to die out if the cooperation coefficient is small. Our results indicate that the proposed model incorporating component Allee effect exhibits rich and complex dynamic behaviors. The interesting findings provide more perspectives on protection and disease control of populations in complex communities.

Socialization and motivational pathways among different groups of non-traditional hunters in Alabama reveal unique recruitment and retention opportunities

ABSTRACT Participation in hunting has been declining and organizations have increased efforts to recruit non-traditional path hunters (NTPHs) such as adults who did not hunt as children, urban residents, and women. Anecdotal evidence suggests that NTPHs could be interested in hunting if recruiters emphasized certain aspects of the hunting experience such as connecting to nature or harvesting sustainable meat. To explore effects of non-traditional backgrounds on recruitment and retention, we measured the importance of socialization pathways, recruitment motives, and retention motives of a group of current hunters in Alabama Wildlife Management Areas (n = 700). A generalized ordinal logit regression model determined effects of different non-traditional backgrounds (e.g., non-hunting family, adult-onset hunters, urban resident, female, millennial) on recruitment and retention. We found that each non-traditional background has a unique influence on recruitment and retention, indicating a need for investigating specific NTPH backgrounds rather than a single homogenous NTPH group.

Group size, partner choice and collaborative actions in male Indo-Pacific bottlenose dolphins (Tursiops aduncus).

Due to the diversity of the phenomenon, dolphin cooperation has attracted considerable research interest in both wild populations and those under human care. Dolphins cooperate in various contexts, including group hunting, alloparental care, social learning, social play and alliance formation for securing mates. This investigation focused on the effect of group size and partner choice in a cooperative task using systematic group testing. A cooperative enrichment device was made of a PVC tube containing fish and ice that was temporarily sealed with two PVC caps with rope handles attached. The device was designed to be operated by pairs of dolphins, opened by simultaneous pull of its two handles. The analysis focused on two behaviours, cooperative opening and cooperative play with the device. Testing focused on an adult male dolphin group including four to six individuals and using a single or two devices. Altogether five group testing arrangements and a pairwise testing phase were conducted. Out of the six dolphins, five showed active involvement. All ten possible pairs of the five active dolphins were successful in opening and playing with the device cooperatively. Cooperation increased with group size, but the social networks showed no significant differences among group arrangements. However, the cooperative pairs showed a significant difference in success rate during pairwise vs group testing, while demonstrating a strong partner preference. This study provides the first evidence for partner choice with regards to cooperation in male dolphins.

Influence of Landscape Characteristics on Hunter Space Use and Success

ABSTRACTSport hunting of ungulates is a predominant recreational pursuit and the primary tool for managing their populations in North America and beyond, given its influence on ungulate distributions, social organization, and population performance. Similarly, land management, such as motorized vehicle access, influences ungulate distributions during and outside hunting seasons. Although research on ungulate responses to hunting and land use is widespread, knowledge gaps persist about space use of hunters and what landscape features discriminate among hunt types and between successful and unsuccessful hunters. We used telemetry location data from hunters (n = 341) to estimate space use from 2008–2013 during 3 types of controlled, 5‐day hunts for antlered mule deer (Odocoileus hemionus) and elk (Cervus canadensis) in northeastern Oregon, USA: archery elk, rifle deer, and rifle elk. To evaluate space use, we developed utilization distributions for each hunter, created core areas (50% contours) for groups of hunters, and derived several metrics of space‐use overlap between successful and unsuccessful hunters. We also modeled predictors of space use using resource utilization functions with beta regression and stepwise model building. Hunter space use was compressed, with even the largest core area (unsuccessful rifle elk hunters) encompassing &lt;16% (1,178 ha) of the area. We found strong similarities in space use of rifle hunters compared to archers, and core areas of successful hunters were markedly smaller than those of unsuccessful hunters (e.g., = 104 ha vs. 681 ha, respectively, for archers). Percentage cover and distance from open roads were the most consistent covariates in the 6 final models (successful vs. unsuccessful for each of 3 hunts) but with different signs. For example, predicted use of archery and rifle elk hunters increased with cover but decreased for rifle deer hunters. Although the same covariates were in the final models for unsuccessful and successful rifle elk hunters, their negligible spatial overlap suggested they sought those features in different locales, a pattern also documented for rifle deer hunters. Our models performed well (Spearman's rank correlation coefficients = 0.99 for 5 of 6 models), reflecting their utility for managing hunters and landscapes. Our results suggest that strategic management of open roads and forest cover can benefit managers seeking to balance hunter opportunity and satisfaction with harvest objectives, especially for species of special concern such as mule deer, and that differences in space use among hunter groups should be accounted for in hunting season designs. © 2021 The Wildlife Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Complete Genome Assembly of Myxococcus xanthus Strain DZ2 Using Long High-Fidelity (HiFi) Reads Generated with PacBio Technology.

ABSTRACTMyxococcus xanthus is a Gram-negative social bacterium belonging to the order Myxococcales of the class Deltaproteobacteria. It is a facultative social predator found in soils across the globe and is thought to be crucial for the microbial ecosystem. Here, we report a complete high-quality reference genome of the M. xanthus strain DZ2.

Cooperation and opportunism in Galapagos sea lion hunting for shoaling fish.

For predators, cooperation can decrease the cost of hunting and potentially augment the benefits. It can also make prey accessible that a single predator could not catch. The degree of cooperation varies substantially and may range from common attraction to a productive food source to true cooperation involving communication and complementary action by the individuals involved. We here describe cooperative hunting of Galapagos sea lions (Zalophus wollebaeki) for Amberstripe scad (Decapterus muroadsi), a schooling, fast swimming semipelagic fish. A group of 6–10 sea lions, usually females only, drove scad over at least 600–800 m from open water into a cove where, in successful hunts, they drove them ashore. Frequently, these “core hunters” were joined toward the final stages of the hunt by another set of opportunistic sea lions from a local colony at that beach. The “core hunters” did not belong to that colony and apparently were together coming toward the area specifically for the scad hunt. Based on the observation of 40 such hunts from 2016 to 2020, it became evident that the females performed complementary actions in driving the scad toward the cove. No specialization of roles in the hunt was observed. All “core hunters” and also opportunistically joining sea lions from the cove shared the scad by randomly picking up a few of the 25–300 (mean 100) stranded fish as did scrounging brown pelicans. In one of these hunts, four individual sea lions were observed to consume 7–8 fish each in 25 s. We conclude that the core hunters must communicate about a goal that is not present to achieve joint hunting but presently cannot say how they do so. This is a surprising achievement for a species that usually hunts singly and in which joint hunting plays no known role in the evolution of its sociality.

Citizen Led Policing in the Digital Realm: Paedophile Hunters and Article 8 in the case of Sutherland v Her Majesty's Advocate

AbstractIn Sutherland v Her Majesty's Advocate, the Supreme Court unanimously dismissed an appeal which argued that the use of communications obtained by a paedophile hunter group as evidence in criminal prosecution was a violation of Article 8 of the European Convention on Human Rights. The case raises fundamental questions of the scope of the right to private life as regards to the content of communications and the role played by private actors in the criminal justice process. This note argues that by limiting the protection of Article 8 to private communications which satisfy a contents‐based test, the Court has bypassed the Article 8(2) balancing test to the detriment of the due process rights of the accused. The note concludes that the decision opens up the prospect of the state circumventing the accused's Article 8 privacy rights by lending tacit approval to the proactive investigations of these private ‘paedophile hunter’ groups.

A Ricker–type predator–prey system with hunting cooperation in discrete time

A predator–prey system in discrete-time for which the predators engage in cooperative hunting and the prey population is subject to scramble intra-specific competition is developed and analyzed. We prove that the number of positive equilibrium points depends not only on the predator’s basic reproduction number but also on the intensity of predator cooperation. The model exhibits a discrete Hopf bifurcation when the unique positive equilibrium point loses its stability. Two-parameter bifurcation diagrams using MATLAB conclude that hunting cooperation can increase the likelihood of predator persistence but may destabilize the predator–prey interaction and drive the predator to extinction.

Seasonal fission and fusion of killer whale, Orcinus orca, social structure at sub-Antarctic Marion Island

Variation in the distribution and abundance of food resources are key factors affecting animal sociality. In environments with variable resources, dynamic social organization, such as the fission and fusion of groups, is thought to increase the benefits of group living, while reducing the costs. We investigated the relationship between social organization and prey abundance in a highly social predator, the killer whale. This was achieved by analysing 12 years (2006–2018) of seasonally delineated (coinciding with high and low prey abundances) association data obtained from nearly 90 000 identification photographs of killer whales in-shore at Marion Island in the sub-Antarctic Indian Ocean. Association network measures were compared between periods using randomized association matrices. Half-weight association index, degree, number of modules and group size were all greater during periods of high prey abundance while mean distance, centrality and modularity were lower during this same period. Results suggest that killer whales at Marion Island were more social, formed larger groups and had more associations during periods of high prey abundance. During periods of lower prey abundance, fewer interactions, stronger clustering and more division in the association network were observed. These results indicate that the social organization of this population of killer whales is seasonally dynamic, with increased sociality measures coinciding with periods of higher prey abundance. These results are similar to those of other social species, emphasizing the importance of resource abundance as a driver of social structure in animal societies.

Colony expansions underlie the evolution of army ant mass raiding

The mass raids of army ants are an iconic collective phenomenon, in which many thousands of ants spontaneously leave their nest to hunt for food, mostly other arthropods. While the structure and ecology of these raids have been relatively well studied, how army ants evolved such complex cooperative behavior is not understood. Here, we show that army ant mass raiding has evolved from a different form of cooperative hunting called group raiding, in which a scout directs a small group of ants to a specific target through chemical communication. We describe the structure of group raids in the clonal raider ant, a close relative of army ants in the subfamily Dorylinae. We find evidence that the coarse structure of group raids and mass raids is highly conserved and that all doryline ants likely follow similar behavioral rules for raiding. We also find that the evolution of army ant mass raiding occurred concurrently with expansions in colony size. By experimentally increasing colony size in the clonal raider ant, we show that mass raiding gradually emerges from group raiding without altering individual behavioral rules. This suggests that increasing colony size can explain the evolution of army ant mass raids and supports the idea that complex social behaviors may evolve via mechanisms that need not alter the behavioral interaction rules that immediately underlie the collective behavior of interest.

Surgical versus transcatheter palliation for insufficient pulmonary blood supply in infants with cyanotic CHD.

Infants with complex cyanotic CHD can become symptomatic from insufficient pulmonary blood supply following either ductal closure or due to outflow tract obstruction. Blalock-Taussig shunt mortality remains significant and recent studies have highlighted the advantages of using transcatheter alternatives. We present here our experience in changing our primary choice of palliation from the Blalock-Taussig shunt to transcatheter palliation with either a ductal stent or, if antegrade flow is present, a right ventricular outflow tract stent.This is a retrospective, single-unit cohort study. Eighty-seven infants underwent palliation for insufficient pulmonary blood flow at under 3 months of age between 2012 and 2019. On an intention-to-treat basis, 29 underwent insertion of a Blalock-Taussig shunt, 36 duct stents, and 22 right ventricular outflow tract stents at median ages of 15, 9, and 32 days, respectively, and median weights of 3.3, 3.1, and 3.1 kg, respectively. No primary Blalock-Taussig shunts have been performed in our institution since 2017.At 30-days there had been one death in each group (univariable p = 0.93) and deaths prior to repair totalled three in the shunt group, four in the ductal stent group, and two in the right ventricular outflow tract stent group (univariable p = 0.93). Reintervention on the pulmonary circuit prior to next stage of surgery was more frequent in those undergoing transcatheter intervention, reaching statistical significance by logrank (p = 0.012).In conclusion, within this work we provide further evidence of the safety and efficacy of transition from a primary surgical to primary transcatheter palliation pathway in infants with insufficient pulmonary blood supply.

RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure.

Retrospective case-control study. Nine-hundred seventy-three-bed pediatric hospital with a 54-bed cardiovascular ICU. Seventy-three neonates with hypoplastic left heart syndrome following the Norwood procedure, 38 with a Blalock-Taussig shunt and 35 with a right ventricle to pulmonary artery shunt. RBC transfusion. High-frequency physiologic data were captured 30 minutes prior to the initiation of (baseline) and during the 120 minutes of the transfusion. A rate pressure product was calculated for each subject and used as an indicator of myocardial oxygen demand. Electrocardiogram leads (aVL, V1, II) were used to construct a 3D ST segment vector to assess ST segment variability and functioned as a surrogate indicator of myocardial ischemia. One-hundred thirty-eight transfusions occurred in the Blalock-Taussig shunt group and 139 in the right ventricle to pulmonary artery shunt group. There was no significant change in the rate pressure product for either group; however, ST segment variability progressively increased for the entire cohort during the transfusion, becoming statistically significant by the end of the transfusion. Upon subgroup analysis, this finding was noted with statistical significance in the Blalock-Taussig shunt group and trending toward significance in the right ventricle to pulmonary artery shunt group. We found a significant increase in the ST segment variability and evidence of myocardial ischemia temporally associated with RBC transfusions in neonates following the Norwood procedure, specifically among those in the Blalock-Taussig shunt group, which may impact immediate and long-term outcomes.