Potential Late Complications Research Articles

Delayed-Onset Orbital Abscess After Orbital Blowout Fracture Repair Using Porous Polyethylene Implant.

This study aims at documenting a rare case of delayed-onset orbital abscess following the use of a nonabsorbable porous polyethylene implant in orbital fracture repair, highlighting the potential long-term risks associated with non-biodegradable orbital implants. A 44-year-old man presented with diplopia on down gaze, proptosis, and eyelid edema for 2 weeks. He had undergone repair of an inferior orbital wall fracture with a porous polyethylene implant 5 years ago. Computed tomography (CT) evaluation revealed a significant intraorbital abscess related to implant infection. Surgical interventions included abscess drainage and implant replacement, which led to patient recovery. Nonabsorbable implants, which are beneficial for orbital reconstruction, may pose a risk of occurrence of delayed infections several years following surgery. This report highlights the importance of long-term monitoring to mitigate the risks of potential late complications, which necessitate early diagnosis, appropriate intervention, and management strategies.

TREATMENT OF PATIENTS WITH PIERRE ROBIN SYNDROME THROUGH OSTEOGENIC DISTRACTION SURGERY

The Pierre Robin sequence is defined as a congenital anomaly characterized by the presence of glossoptosis, micrognathia, and airway obstruction, leading to various complications. Mandibular distraction osteogenesis (MDO) emerges as a surgical treatment option that has been yielding positive results for individuals with Pierre Robin sequence (PRS), directly addressing craniofacial correction, aiming for improved respiratory quality, and enabling adequate mandibular elongation. This study aims to evaluate mandibular distraction osteogenesis and its efficacy in patients with PRS. The literature search encompassed PubMed, Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, and the Scientific Electronic Library Online, using the DeCS descriptors: "Pierre Robin Syndrome" AND "Distraction Osteogenesis" AND "Micrognathism". Studies have demonstrated the efficacy of MDO as a therapeutic approach to correcting respiratory and feeding problems, with the FEMOD protocol showing promise in improving upper airways and correcting micrognathia. Although studies point to MDO as a good solution for treating mandibular retrognathia in PRS patients, further research is still needed to validate results, compare different treatment approaches, assess long-term surgery effects, and identify potential late complications. This underscores the importance of a multidisciplinary approach to treating these patients.

Early Impairment of Paracrine and Phenotypic Features in Resident Cardiac Mesenchymal Stromal Cells after Thoracic Radiotherapy.

Radiotherapy-induced cardiac toxicity and consequent diseases still represent potential severe late complications for many cancer survivors who undergo therapeutic thoracic irradiation. We aimed to assess the phenotypic and paracrine features of resident cardiac mesenchymal stromal cells (CMSCs) at early follow-up after the end of thoracic irradiation of the heart as an early sign and/or mechanism of cardiac toxicity anticipating late organ dysfunction. Resident CMSCs were isolated from a rat model of fractionated thoracic irradiation with accurate and clinically relevant heart dosimetry that developed delayed dose-dependent cardiac dysfunction after 1 year. Cells were isolated 6 and 12 weeks after the end of radiotherapy and fully characterized at the transcriptional, paracrine, and functional levels. CMSCs displayed several altered features in a dose- and time-dependent trend, with the most impaired characteristics observed in those exposed in situ to the highest radiation dose with time. In particular, altered features included impaired cell migration and 3D growth and a and significant association of transcriptomic data with GO terms related to altered cytokine and growth factor signaling. Indeed, the altered paracrine profile of CMSCs derived from the group at the highest dose at the 12-week follow-up gave significantly reduced angiogenic support to endothelial cells and polarized macrophages toward a pro-inflammatory profile. Data collected in a clinically relevant rat model of heart irradiation simulating thoracic radiotherapy suggest that early paracrine and transcriptional alterations of the cardiac stroma may represent a dose- and time-dependent biological substrate for the delayed cardiac dysfunction phenotype observed in vivo.

Late Complications in Long-Term Childhood Cancer Survivors: What the Oral Health Professional Needs to Know.

With diagnostic and therapeutic advances, over 80% of children diagnosed with cancer become long-term survivors. As the number of childhood cancer survivors (CCS) continues to increase, dental practitioners become more likely to have CCS among their patients. CCS may develop late complications from damage caused by their cancer treatment to endocrine, cardiovascular, musculoskeletal, and other organ systems. These complications may surface decades after the completion of treatment. Adverse outcomes of childhood cancer treatment frequently involve oral and craniofacial structures including the dentition. Tooth development, salivary gland function, craniofacial growth, and temporomandibular joint function may be disturbed, increasing oral health risks in these individuals. Moreover, CCS are at risk of developing subsequent malignancies, which may manifest in or near the oral cavity. It is important that dental practitioners are aware of the childhood cancer history of their patients and have knowledge of potential late complications. Therefore, this narrative review aims to inform dental practitioners of late oral complications of cancer treatment modalities commonly used in pediatric oncology. Furthermore, selected common non-oral late sequelae of cancer therapy that could have an impact on oral health and on delivering dental care will be discussed.

Simultaneous Transcatheter Closure of Coexistent Superior Sinus Venosus Defects and Oval Fossa Defects.

Device closure has become the preferred procedure for treating oval fossa defects in the last two decades. More recently, transcatheter sinus venosus defect (SVD) closure has emerged as an alternative to surgery. Transcatheter stenting aims to overcome potential late surgical complications such as stenosis of the superior vena cava (SVC) and right upper pulmonary vein (RUPV), as well as sinus node dysfunction. Balloon interrogation of the cavoatrial junction is able to identify patients who are suitable candidates for nonsurgical closure. Successful closure is possible when the balloon seals the SVD and redirects the RUPV towards the left atrium. Oval fossa (secundum) defects can coexist in approximately 9-16% of patients with SVD. Among a group of 80 patients who underwent transcatheter closure of SVD, five adult patients aged between 22 and 52years also required device closure of an associated oval fossa defect. The procedure involved simultaneous balloon interrogation of both the SVD and oval fossa defect, with continuous monitoring of the RUPV using bilateral femoral venous sheaths. Covered stent exclusion of the SVD was performed with concurrent device closure of the oval fossa defect using 12-36mm atrial septal occluders. During the procedure, two patients required protective balloon inflation in the RUPV while expanding the covered stent. In one patient, a higher small accessory RUPV was intentionally left to drain into the SVC through the struts of a bare stent anchoring the covered stent in the upper SVC. In another patient, a second overlapping covered stent was used to address residual flows from a fabric tear that became apparent after balloon deflation. There were no vascular complications and only one patient exhibited an insignificant 6mm residual flow from the caudal edge of the SVD during a follow-up of 5 to 72months. In conclusion, the closure of both SVD and associated oval fossa defects can be successfully performed in a single procedure, with comparable procedural times and favourable mid-term outcomes.

Gender-inclined Young Age Glycosuria: Contribution to Late Age Chronic Renal Diseases, Type 2 Diabetes Mellitus and Cardiovascular Diseases.

Chronic kidney diseases (CKD), Type 2 Diabetes Mellitus (T2DM) and cardiovascular diseases (CVDs) are the recent worldwide late age chronic conditions that could be a consequence of renal glycosuria during childhood. This study aimed at determining the extent of glycosuria in secondary school students to obtain information that could be predictive of the situation in late age life of Tanzanians living in Mkuranga District. This was school-based cross-sectional study that was conducted in assenting and consenting 800 students from July to October 2019 in Mkuranga district, Pwani-Tanzania. Socio-demographic information was collected using well-structured questionnaires while weight and height were measured using beam balance and tape measure, respectively. Dipstick strip was used to determine urine glucose on clean catch mid-stream urine collected specimens. From a total of 800 enrolled students, 0.6% (5/800) had glycosuria from whom 80% were males and 20% (1/5) were females (p = 0.37). The proportion of glycosuric males was 4 folds higher than that found in females. While height, body mass index (BMI) and waist-hip circumference ratio were associated with renal glycosuria (p < 0.05), other factors showed no association (p > 0.05). Despite the low proportion (0.6%) of glycosuria in this study, the contribution of young age renal glycosuria to old age CKD, T2DM and CVDs cannot be ruled out with males being more prone than females. Thus, it signals for consideration of regular screening for glycosuria in the school health programmes as an intervention strategy to prevent potential late age chronic disease complications.

Pregnant women's knowledge of obstetrical danger signs: A cross-sectional survey in Kigali, Rwanda.

Maternal mortality remains critically high in low- and middle-income countries (LMIC), particularly in sub-Saharan Africa. Rwanda's leading causes of maternal death include postpartum hemorrhage and obstructed labor. Maternal recognition of obstetrical danger signs is critical for timely access to emergency care to reduce maternal mortality.To assess maternal knowledge of obstetrical danger signs among pregnant women attending antenatal care services in Kigali, Rwanda. We conducted a cross-sectional study between September and December 2018. The outcome of interest was maternal knowledge of ODS during pregnancy, labor and delivery, and the immediate postpartum period. We recruited pregnant women at five health centers, one district hospital, and one referral hospital, and we had them complete a structured questionnaire. Reporting three correct ODS was defined as having good knowledge of ODS. A total of 382 pregnant women responded to the survey. Most women (48.9%) were aged 26-35, and 50.5% had completed secondary or higher education. The knowledge of ODS was 56%, 9%, and 17% during pregnancy, labor and delivery, and postpartum, respectively. Women aged 26 to 35 had two times (OR: 1.80, 95% CI: 1.05, 3.06) higher odds of ODS knowledge during pregnancy than women aged 16 to 25. Attending three antenatal care visits was associated with 2.6 times (OR: 2.59, 95% CI: 1.17, 5.66) higher odds of ODS knowledge during pregnancy than not attending any visit. Longer distances to the nearby health facility were associated with significantly lower knowledge during pregnancy, and Muslim women had substantially higher postpartum ODS knowledge than any other religion. In conclusion, women's knowledge of ODS associated with labor and delivery and postpartum was low. Antenatal care must be encouraged and its content revised to ensure it covers potential late pregnancy complications.

Valve embolization during transcatheter aortic valve implantation: Incidence, risk factors and follow-up by computed tomography.

BackgroundIn most cases of transcatheter valve embolization and migration (TVEM), the embolized valve remains in the aorta after implantation of a second valve into the aortic root. There is little data on potential late complications such as valve thrombosis or aortic wall alterations by embolized valves.AimsThe aim of this study was to analyze the incidence of TVEM in a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) and to examine embolized valves by computed tomography (CT) late after TAVI.MethodsThe patient database of our center was screened for cases of TVEM between July 2009 and July 2021. To identify risk factors, TVEM cases were compared to a cohort of 200 consecutive TAVI cases. Out of 35 surviving TVEM patients, ten patients underwent follow-up by echocardiography and CT.Results54 TVEM occurred in 3757 TAVI procedures, 46 cases were managed percutaneously. Horizontal aorta (odds ratio [OR] 7.51, 95% confidence interval [CI] 3.4–16.6, p < 0.001), implantation of a self-expanding valve (OR 4.63, 95% CI 2.2–9.7, p < 0.01) and a left ventricular ejection fraction < 40% (OR 2.94, 95% CI 1.1–7.3, p = 0.016) were identified as risk factors for TVEM. CT scans were performed on average 26.3 months after TAVI (range 2–84 months) and detected hypoattenuated leaflet thickening (HALT) in two patients as well as parts of the stent frame protruding into the aortic wall in three patients.ConclusionTVEM represents a rare complication of TAVI. Follow up-CT detected no pathological findings requiring intervention.

Primary heart involvement in systemic sclerosis, from conventional to innovative targeted therapeutic strategies.

Primary heart involvement is frequent in systemic sclerosis, even though often sub-clinical, and includes cardiac abnormalities that are predominantly attributable to systemic sclerosis rather than other causes and/or complications. A timely diagnosis is crucial to promptly start the appropriate therapy and to prevent the potential life-threatening early and late complications. There is little evidence on how to best manage systemic sclerosis-primary heart involvement as no specific treatment recommendations for heart disease are available, and a shared treatment approach is still lacking. The objective of this review is to summarize the state of the art of current literature and the overall management strategies and therapeutic approaches for systemic sclerosis-primary heart involvement. Novel insights into pathogenic mechanisms of systemic sclerosis-primary heart involvement are presented to facilitate the comprehension of therapeutic targets and novel treatment strategies.

Management of placenta percreta – case report and clinic experience

The incidence of placenta percreta is currently increasing. The treatment strategies are not clearly defined as there are a lot of inconsistencies in the literature regarding severity criteria. This pathology has a high risk for massive hemorrhage, therefore it is very challenging to agree on a standardized management. The therapeutic approaches include expectant management with placenta left in situ, conservative management and radical treatment. Cesarean hysterectomy currently represents the approach of choice for this condition, ideally performed by a multidisciplinary team. Conservative alternatives have been proposed to reduce maternal morbidity and maintain future fertility. The expectant management has benefits on reducing uterine perfusion and blood loss, useful in case of bladder or parametrial invasion. Potential late complications of placenta percreta left in situ often require further emergency surgery. Delayed hysterectomy has the aim to overcome these difficulties, but the reported outcomes are still contradictory. For these reasons, the most recent recommendation is not to perform a second elective surgery in a hemodynamically stable patient. In this paper we present the late complications of a case treated by expectative approach and the overall management in our clinic for the last five years with placenta accreta spectrum disorders.

Long term outcomes for adults with complete atrioventricular septal defects

Abstract Background/Introduction Complete Atrio-Ventricular septal defect (AVSD) is a complex congenital cardiac disease, characterised by malformation at the atrio-ventricular junction and AV valve abnormalities. Long- term outcome data is limited. Purpose We sought to describe the long-term outcomes of adults with repaired complete AVSD in a tertiary adult congenital heart centre. Methods We retrospectively recruited patients with complete AVSD who underwent surgical repair between 1973 and 2001 in our centre. All clinical and echocardiographic data were collected and analysed for evidence of atrio-ventricular valve (AVV) deterioration, or cardiac dysfunction. We also assessed for the requirement for further surgical intervention throughout the follow up period. Results A total of 345 patients with AVSD were identified, partial AVSD 211, unrepaired 82. Fifty-two with repaired complete AVSD formed study group, female 36 (69%) and male 16 (31%), Trisomy 21 (23, 44%). Mean age at initial repair was 44 months (median 12, IQR 31.5). Mean follow up was 25.3 years (Median 24, IQR 9.75). Clinical status: At the latest follow-up, most patient were asymptomatic with NYHA I-II (n=46) Majority (n=36, 69%) required only initial repair and no further intervention. Further surgeries were performed in 16 patients including AVV repair (n=9) and LVOTO relief (n=3). Permanent pacemaker insertion needed in 6 (12%), all for heart block following valve repair. 7 patients (14%) had documented arrythmia, 4 (8%) requiring ablations and only 1 had endocarditis. Echo findings: AV Valve dysfunction was more commonly regurgitant rather than stenotic. More than moderate AVV regurgitation was present in 83% of patients, Left AVV (n=25, 48%), Right AVV (n=18, 35%) compared to 4% stenosis (LAVV n=1, RAVV n=1). Ventricular outflow tract obstruction was present in 8% of patients, RVOT obstruction (2, one native, one secondary to prior banding), LVOT obstruction (2, both native, one requiring surgical intervention). Right ventricular systolic dysfunction was present in 6% of patients (n=3), with mean TAPSE 14.1mm (SD± 3.1mm). Left ventricular dysfunction was present in 4% (n=2), mean LVEF 58.9% (SD±7.1%) and mean LV EDVi 55.06mL/m2 (SD±13.2 mL/m2). Only one patient had significant pulmonary hypertension (Mean PAP 48 mmHg). Conclusion Long-term outcomes of surgically repaired AVSD are highly favourable. Left AVV regurgitation is the most common residual lesion requiring further surgical intervention. Ventricular outflow tract obstruction was much less common, as was ventricular systolic dysfunction. Complete heart block was associated with surgical repair and arrhythmias were potential late complications. Funding Acknowledgement Type of funding sources: None.

Long-term morphological appearance of transcatheter valves left in the ascending aorta after valve dislocation during transcatheter aortic valve implantation

Abstract Background Transcatheter valve embolization and migration (TVEM) is a potential complication of transcatheter aortic valve implantation (TAVI) (1). Registries suggest low incidence but clinical relevance due to increased acute and mid-term mortality with the majority embolizing in the aorta. However, there is little data on potential late complications such as leaflet and stent thrombosis or aortic wall alterations by migrated valves. Purpose The aim of our study was to analyze the incidence and clinical characteristics of TVEM in a large single center cohort of TAVI patients and to examine dislocated valves by ECG-gated computed tomography (CT). Methods and results Between July 2009 and May 2020, 40 TVEM occurred in 3387 TAVI procedures performed in our center (1.18%). TVEM was defined according to Valve Academic Research Consortium-2 (VARC-2) criteria (3). Majority of TVEM were left in the ascending aorta (31 ascending, 3 arch, 1 descending aorta). 90% of TVEM occurred with a self-expanding valve (SEV), with no difference between older and newer valve generations, 10% with a ballon-expandable valve. Analyzing a TAVI sample cohort (n=200), horizontal aorta (p&amp;lt;0.001, OR 11.7, 95% CI: [3.9:34.8]), defined as aortic angulation &amp;gt;48°(4), as well as the use of SEV (p&amp;lt;0.001, OR 12.8, 95% CI: [3.1:53.9]) were identified as a predisposing risk factor for TVEM. OR in SEV was severely increased when isolating the analysis for patients with horizontal aorta only (p=0.003, OR 23.75, 95% CI: [2.8:129]). No other predisposing risk factors were identified in this cohort. Out of 35 patients still alive, 6 patients were willing to participate in our imaging sub-study. CT exams were performed on average 47 months after TAVI (IQR 50 months [25%Q: 16.8, 75%Q: 72.8]). We detected no leaflet or stent thrombosis, yet CT identified pin protrusions in the aorta in 3 out of 6 patients. Conclusions TVEM is a rare complication of TAVI. TVEM was significantly associated to the use of self-expanding valves and the presence of horizontal aorta. CT did detect pin protrusions in several cases which could bear the possible risk of perforation but showed no signs of long-term damage. Funding Acknowledgement Type of funding sources: None. Representative CT images after TVEM

Pharmacotherapy of atrial fibrillation in COVID-19 patients.

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases - especially ones as common as atrial fibrillation (AF) - and the possible interactions between patients' chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients.

Late Complications of COVID-19;a Systematic Review of Current Evidence

Introduction: COVID-19 is a new rapidly spreading epidemic. The symptoms of this disease could be diverse as the virus can affect any organ in the body of an infected person. This study aimed to investigate the available evidence for long-term complications of COVID-19. Methods: This study was a systematic review of current evidence conducted in November 2020 to investigate probable late and long-term complications of COVID-19. We performed a systematic search, using the keywords, in online databases including PubMed, Scopus, Science Direct, Up to Date, and Web of Science, to find papers published from December 2019 to October 2020. Peer-reviewed original papers published in English, which met the eligibility criteria were included in the final report. Addressing non-human studies, unavailability of the full-text document, and duplicated results in databases, were characteristics that led to exclusion of the papers from review. Results: The full-texts of 65 articles have been reviewed. We identified 10 potential late complications of COVID-19. A review of studies showed that lung injuries (n=31), venous/arterial thrombosis (n=28), heart injuries (n=26), cardiac/brain stroke (n=23), and neurological injuries (n=20) are the most frequent late complications of COVID-19. Conclusion: Since we are still at the early stages of the COVID-19 epidemic, it is too soon to predict what long-term complications are likely to appear in the survivors of the disease in years after recovery. Furthermore, the complexity of COVID-19 behaviors and targets in the human body creates uncertainty in anticipating long-term complications.

The Adult Patient with a Fontan.

The authors summarize the most important anatomic and physiologic substrates of Fontan circulation. Common anatomic substrates include hypoplastic left heart syndrome, tricuspid atresia, double inlet left ventricle, and unbalanced atrioventricular septal defects. After the Fontan operation exercise capacity is limited and the key hemodynamic drivers is limited preload due to a relatively fixed pulmonary vascular resistance. The authors provide contemporary data on survival, morbidity, and need for reintervention. Operative morality is now expected to be less than 1% and 30 year survival approximately 89%. The authors delineate potential therapeutic approaches for the potential late complications.

Long-term Hodgkin Lymphoma Survivors: A Glimpse of What Happens 10 Years After Treatment

IntroductionThis retrospective study was focused on 96 patients (median age at diagnosis, 35 years) with newly diagnosed Hodgkin lymphoma (HL) treated at the University Hospital of Bari (Italy) between 2005 and 2008, to evaluate the outcome and the long-term toxicity. Patients and MethodsFirst-line chemotherapy was ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in all patients; 49 (51%) patients had undergone radiotherapy. At the end of treatment, 75 (78%) patients were in complete remission (CR); 18 (24%) of 75 patients relapsed after first-line treatment; 20 (21%) underwent autologous hematopoietic stem cell transplantation, and 3 (3%) underwent allogeneic stem cell transplantation. ResultsAfter a median follow-up of 12 years, 85 (88%) patients are alive in CR, and 11 (14%) have died (2 of a second neoplasia, 1 of infection, and 8 of the disease). The 140-month Kaplan-Meier survival estimates were 86%. Three women became pregnant and each gave birth to a healthy child. The most prevalent chronic conditions at last follow-up were: a reduction in lung transfer factor for carbon monoxide (40%), fatigue (31%), hypothyroidism (30%), and infertility (16%). ConclusionsResults of this study offer indications about how long after the initial treatment excess deaths from causes other than HL begin to occur. However, challenges remain, namely establishing the optimal time to begin screening for potential late complications and developing better surveillance guidelines. Further work is needed to identify risk factors that may predict specific late effects.

Long-term follow-up of patients with tetralogy of Fallot and implantable cardioverter defibrillator

Ventricular arrhythmias and sudden death are potential late complications in patients with tetralogy of Fallot. Data regarding the value of implantable cardioverter defibrillators (ICD) are scarce in this population. To assess long-term rates of appropriate ICD therapies and ICD-related complications in a large registry. The DAI-T4F study is an ongoing national French registry including all patients with tetralogy of Fallot and ICD ( NCT03837574 ). Information has been collected prospectively since 2010 with annual update. Cox proportional hazard models were used to identify factors associated with appropriate ICD therapies and complications. A total of 134 patients (median age 41.7 years, 70.7% males) were enrolled, including 47 (35.1%) for primary prevention. The median (IQR) follow-up duration was 6.1 (2.7–10.2) years. Overall, 14 (29.8%) and 45 (51.7%) patients received at least one appropriate ICD therapy in primary and secondary prevention, respectively, giving annual incidences of 5.5% and 7.1% ( P = 0.06). Patients with altered left ventricle ejection fraction (LVEF) at inclusion ≤ 35% experienced less appropriate ICD therapies (HR = 0.31, 95% CI: 0.11-0.86, P = 0.02), whereas a history of sustained or non-sustained ventricular arrhythmia (HR = 2.7, 95% CI: 1.2–3.9, P = 0.03) was positively associated with appropriate therapies. Fifty-seven (42.5%) patients had ICD-related complications, including 32 (24.2%) inappropriate ICD shocks. During follow-up, 7 (5.2%) patients underwent cardiac transplantation and 12 (9.0%) patients died, mainly from progressive heart failure ( n = 5). Only one sudden death due to electrical storm was recorded ( Fig. 1 ). Appropriate therapies are frequent in patients with tetralogy of Fallot and ICDs, including in primary prevention. The relatively important proportion of ICD-related complication highlights the need for improving risk stratification in this population.

Bone and hormonal status 10 years post-allogeneic bone marrow transplantation.

Bone loss and endocrine dysfunction are potential late complications of allogeneic stem cell transplant (allo-SCT); however, scant information concerning the long-term effects in SCT adult patients is available. In the present study, we evaluated bone status, expressed as bone mineral density (BMD), and endocrine functions including PTH, TSH, free T4, testosterone, SHBG, FSH, LH, and IGF-1, in 20 adult leukemia patients >10years after allo-SCT. A low BMD (Z score <-2.0) was observed in two patients; two patients had osteoporotic fractures, and two had a unilateral avascular necrosis of the femoral head. Elevated PTH was observed in 30% of patients, and 25-hydroxy vitamin D (25(OH)D) was low (<50nmol/L) in 45% of the patients. The majority of the patients had thyroid tests within the reference range, while elevated FSH values were present in 8 of 12 males. We conclude that adult leukemia patients have relatively well-preserved BMD >10years post-allo-SCT. Prophylactic treatment of osteoporosis should be individualized, but control of BMD is necessary for long-term follow-up. Control of PTH and vitamin D levels before and after allo-SCT is recommended, and vitamin D supplementation should be considered if indicated. Estrogen replacement therapy is a routine treatment in females, whereas gonadal function in males requires further investigation.

2396Long-term follow-up of patients with tetralogy of Fallot and implantable cardioverter defibrillator

Abstract Background Ventricular arrhythmias and sudden death are potential late complications in patients with tetralogy of Fallot. Data regarding the value of implantable cardioverter defibrillators (ICD) are scarce in this population. Purpose To assess long-term rates of appropriate ICD therapies and ICD-related complications in a large registry of ICD recipients with tetralogy of Fallot. Methods The DAI-T4F study is an ongoing national French registry including all patients with tetralogy of Fallot and ICD (NCT03837574). Information have been collected prospectively since 2010 with annual update. Baseline patient characteristics and clinical events during follow-up were analyzed with central adjudication. Cox proportional hazard models were used to identify factors associated with appropriate ICD therapies and complications. Results A total of 134 patients (median age 41.7 years, 70.7% males) were enrolled. The median (IQR) follow-up duration was 6.1 (2.7–10.2) years. ICDs were implanted for primary prevention in 47 (35.1%) patients and for secondary prevention in 87 (64.9%) patients. Overall, 14 (29.8%) and 45 (51.7%) patients received at least one appropriate ICD therapy in primary and secondary prevention, respectively, giving annual incidences of 5.5% and 7.1% (p=0.06). Patients with altered left ventricle ejection fraction (LVEF) at inclusion ≤35% experienced less appropriate ICD therapies (HR=0.31, 95% CI: 0.11–0.86, p=0.02), whereas a history of sustained or non-sustained ventricular arrhythmia (HR=2.7, 95% CI: 1.2–3.9, p=0.03) was positively associated with appropriate therapies. Fifty-seven (42.5%) patients had ICD-related complications, including 32 (24.2%) inappropriate ICD shocks, 22 (16.4%) significant lead dysfunction, 14 (10.4%) device infection, and 5 (3.7%) generator dysfunction/recall. History of supraventricular arrhythmias (HR=2.2, 95% CI: 1.2–3.7, p=0.01) and congestive heart failure (HR=2.0, 95% CI: 1.2–3.6, p=0.01) were both associated with a higher risk of complications. During follow-up, 7 (5.2%) patients underwent cardiac transplantation and 12 (9.0%) patients died, mainly from progressive heart failure (n=5). Only one sudden death due to electrical storm was recorded. Figure 1 Conclusions Appropriate therapies are frequent in patients with tetralogy of Fallot and ICDs, including in primary prevention. The relatively important proportion of ICD-related complication highlights the need for improving risk stratification in this population, considering associated conditions in the individual benefit-risk equation.

Can It Be Safe and Aesthetic? An Eight-year Retrospective Review of Mastopexy with Concurrent Breast Augmentation.

The safety of concurrently performing mastopexy and breast augmentation is controversial, due to the risk of breast tissue and nipple neurovascular compromise and overall potential high complications rates. This article describes a concurrent procedure of augmentation with implants and a "Tailor-Tack" mastopexy that consistently achieves an aesthetically pleasing breast with acceptable complication rates. This is a retrospective chart review of all consecutive breast augmentations performed concurrently with mastopexy using the "Tailor-Tack" technique by the 2 senior authors (M.M. and O.T.) over an 8-year period. Independent variables were patient demographics, surgical approach, implant type, shape, size, duration of follow-up, and complications. Complications were categorized as "early" (ie, first 30 days) or "late" (ie, after 30 days). Potential early complications include hematoma, skin necrosis, infection, and nipple loss. Potential late complications include recurrent breast ptosis, poor shape of the nipple areolar complex, hypertrophic scarring, implant rupture, capsular contracture, decreased nipple sensation, implant extrusion, reoperation, and scar revisions. The key principle of the technique is to place the breast implant in the dual plane first, and then perform the tailor tacking of the skin for the mastopexy second. Fifty-six consecutive patients underwent augmentation and mastopexy over 8 years with this technique. The average age of the studied patients was 41.2 years. The average follow-up time period was 2.1 years (±8.9 months). Fifty-four patients (96.4%) had implants placed through the periareolar approach, 2 patients (3.6%) had implants placed via the inframammary approach. All implants were placed in a dual plane. Fifty-two patients (92.9%) received silicone implants and 4 patients (7.1%) received saline implants. Patient preference determined implant choice. All but 5 patients had textured implants. Average implant size was 277 cm3 (range 120-800 cm3). Ten patients had complications (17.9%). Complications included hypertrophic scarring in 5 (8.9%) patients; poor nipple-areola complex shape in 4 patients (7.1%); implant ruptures in 3 patients (5.4%); capsular contracture in 3 patients (5.4%); and recurrent ptosis in 2 patients (3.6%). There were no reported early complications such as nipple loss, breast skin necrosis, decreased nipple sensation, implant infections, or extrusions. However, 6 patients (10.7%) required return trips to the operating room for revisions, and 1 patient (1.8%) had a nipple areolar complex scar revised in the office, yielding a 12.5% surgical revision rate for the late complications. It is safe to concurrently perform mastopexy and breast augmentation. In our 8-year review, there were no early catastrophic complications such as skin loss, nipple loss, implant extrusion, or infection. The complications that occurred were the same complications known to occur with the independent performance of mastopexy alone or breast augmentation alone, and they occurred at rates comparable to or less than the national averages for those procedures when they are performed independently. The paramount principle for the success of this technique is to first adjust breast volume and then perform an intraoperatively determined skin resection to fit the new breast volume.