Operation For Transposition Research Articles

Coronary Artery Dimensions on Computed Tomography Following the Neonatal Arterial Switch Operation for the Complete Transposition of the Great Arteries.

Coronary events are life-threatening long-term complications of the arterial switch operation for complete transposition of the great arteries. The aim of our study was to assess the dimensions of the reimplanted coronary arteries and their relationship with the various geometric characteristics to gain a better understanding of the involved mechanisms. Coronary computed tomography angiography (CCTA) scans of 78 asymptomatic pediatric patients were performed at the age of 10.7 (6.3-17.8) years. The position of the ostia, the branching angles, and the diameters of the coronary arteries were determined in a subgroup of 51 patients presenting the usual preoperative coronary anatomy. Mean Z-score of the left main coronary artery (LMCA), left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery (RCA) diameters were 0.7 ± 1.2, - 0.4 ± 1.1, - 0.3 ± 1.1, and - 0.3 ± 1.1, respectively. The Z-score of the ostial LMCA diameter had a positive correlation with the remoteness from the main pulmonary artery (p < 0.001) and the branching angle (p = 0.001). The ostial diameter Z-score of the LMCA had a negative correlation with the interval between the arterial switch operation and the CCTA (p = 0.004). Even though most of the coronary diameters fell within the accepted range, which suggests normal overall development, acute branching angle and more anterior origin were associated with smaller ostial coronary artery diameter Z-scores. To prove the clinical relevance of the smaller ostial diameter of high-risk left coronary arteries and the decrease of ostial coronary artery Z-scores over time needs further follow-up studies.

Verification of Adjoint Solution Commutativity with the New OpenNode Nodal Diffusion Code

This paper presents in-depth exploration and verification of the OpenNode nodal diffusion code, a robust tool designed for multigroup neutron diffusion simulations under steady-state conditions. Leveraging the Nodal Expansion Method with a quartic polynomial and moments weighting method, OpenNode demonstrates exceptional accuracy in approximating nodal surface fluxes, further enhanced by the Quadratic Transverse Leakage approximation. The critical concept of commutativity between adjoint and forward solutions is thoroughly investigated, serving as a benchmark for the code’s reliability in predicting system responses, determining single-point reactor kinetics parameters, and facilitating perturbation analyses. The paper meticulously details OpenNode’s methodology for adjoint neutron flux computation, unraveling its rigorous approach through transposition operations and intricate mathematical transformations. Noteworthy features, including support for second and fourth polynomial orders; versatile computation modes; different mesh points; and seamless integration with Python, PyQt5, and Blender, underscore OpenNode’s adaptability. Results from comprehensive analysis of the two-dimensional and three-dimensional International Atomic Energy Agency core benchmark problem showcase OpenNode’s prowess. The code excels in reactor geometry visualizations, benchmark parameters, and neutronic analysis, with a particular emphasis on commutativity verification against various benchmarked codes. The precision of OpenNode is further demonstrated in power distribution analyses, revealing remarkable proximity to reference values and symmetrical power distribution patterns.

Increased aortic pressures and pulsatile afterload components promote concentric left ventricular remodeling in adults with transposition of the great arteries and arterial switch operation

BackgroundFunctional abnormalities of the ascending aorta (AA) have been mainly reported in young patients who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA). ObjectivesTo compare systolic, diastolic brachial and central blood pressures (bSBP, bDBP, cSBP, cDBP), aortic biomechanical parameters, and left ventricular (LV) afterload criteria in adult ASO patients with healthy controls and to assess their relationships with LV remodeling and aortic size. Materials and methodsForty-one prospectively enrolled patients (16.8 to 35.8 years) and 41 age- and sex-matched healthy volunteers underwent cardiac MRI to assess LV remodeling with simultaneous brachial BP estimation. After MRI, carotid-femoral tonometry was performed to measure pulse wave velocity (cfPWV), cSBP and cDBP for further calculation of pulse pressure (cPP), AA distensibility (AAD), and AA and LV elastance (AAE, LVE). ResultsbSBP, bDBP, cSBP,cDBP and cPP were all significantly higher in ASO group than in controls: cSBP (116.5 ± 13.8 vs 106.1 ± 12.0, p < 0.001), cDBP (72.5 ± 6.9 vs 67.1 ± 9.4, p = 0.002), cPP (44.0 ± 12.1 vs 39.1 ± 8.9, p = 0.003) and not related to aortic size. AAD were decreased in ASO patients vs controls (4.70 ± 2.72 vs 6.69 ± 2.16, p < 0.001).LV mass was correlated with bSBP, cSBP, cPP (ρ = 0.48; p < 0.001), while concentric LV remodeling was correlated with AAE (ρ = 0.60, p < 0.001) and LVE (ρ = 0.32, p = 0.04), but not with distensibility. ConclusionEven without reaching arterial hypertension, aortic sBP and PP are increased in the adult TGA population after ASO, altering the pulsatile components of afterload and contributing to LV concentric remodeling.

Surgical treatment of aortic root aneurysms with aortic regurgitation after double-switch surgery for transposition of the great vessels

Surgical treatment of aortic root aneurysms with aortic regurgitation after double-switch surgery for transposition of the great vessels

Left atrial strain in adults after the arterial switch operation for transposition of the great arteries.

No study has focused on left atrial (LA) function assessed by echocardiography in adult patients with simple D-TGA after arterial switch operation (ASO). We aimed to describe LA strain parameters in these patients. A prospective cohort study including 42 adult patients with simple D-TGA after ASO and 33 aged-matched controls. Phasic LA and LV global longitudinal strain (GLS) were obtained by transthoracic 2D-speckle tracking echocardiography (STE). Volumetric and functional analysis of LA and LV were also evaluated by 2D and 3D analysis. A multivariable model was performed to investigate the variables that best differentiate patients with D-TGA from healthy controls. LA strain parameters in D-TGA patients were within the normal range described for healthy subjects. However, the three LA strain parameters (Reservoir, Conduit, and Contraction) were lower in patients (LASr: 31.13±7.67vs. 49.71±8.38; LAS cd: -22.91±5.69vs. -34.55±6.54; LASct: -8.14±4.93vs. -15.15±6.07, p<.001 for all three comparisons). LA volumes were similar between patients and controls. LV-GLS remained significantly lower in the D-TGA group than in controls (-17.29±2.68vs. -21.98±1.84, p<.001). D-TGA patients had evidence of worse LV ejection fraction measured by the Teichholz method (63.38±8.23vs. 69.28±5.92, p=.001) and 3D analysis (57.97%±4.16vs. 60.67±3.39, p=.011) and diastolic dysfunction as compared to healthy controls. LV-GLS and conduit LAS were the variables best differentiating patients with D-TGA from healthy controls. LA strain is impaired in young adults with simple D-TGA late after the ASO, probably in agreement with some degree of LV dysfunction previously described.

Clinical Course of TGA After Arterial Switch Operation in the Current Era

BackgroundThe number of patients with an arterial switch operation (ASO) for transposition of the great arteries (TGA) is steadily growing; limited information is available regarding the clinical course in the current era. ObjectivesThe purpose was to describe clinical outcome late after ASO in a national cohort, including survival, rates of (re-)interventions, and clinical events. MethodsA total of 1,061 TGA-ASO patients (median age 10.7 years [IQR: 2.0-18.2 years]) from a nationwide prospective registry with a median follow-up of 8.0 years (IQR: 5.4-8.8 years) were included. Using an analysis with age as the primary time scale, cumulative incidence of survival, (re)interventions, and clinical events were determined. ResultsAt the age of 35 years, late survival was 93% (95% CI: 88%-98%). The cumulative re-intervention rate at the right ventricular outflow tract and pulmonary branches was 36% (95% CI: 31%-41%). Other cumulative re-intervention rates at 35 years were on the left ventricular outflow tract (neo-aortic root and valve) 16% (95% CI: 10%-22%), aortic arch 9% (95% CI: 5%-13%), and coronary arteries 3% (95% CI: 1%-6%). Furthermore, 11% (95% CI: 6%-16%) of the patients required electrophysiological interventions. Clinical events, including heart failure, endocarditis, and myocardial infarction occurred in 8% (95% CI: 5%-11%). Independent risk factors for any (re-)intervention were TGA morphological subtype (Taussig-Bing double outlet right ventricle [HR: 4.9, 95% CI: 2.9-8.1]) and previous pulmonary artery banding (HR: 1.6, 95% CI: 1.0-2.2). ConclusionsTGA-ASO patients have an excellent survival. However, their clinical course is characterized by an ongoing need for (re-)interventions, especially on the right ventricular outflow tract and the left ventricular outflow tract indicating a strict lifelong surveillance, also in adulthood.

Left atrial strain in patients after arterial switch operation for transposition of the great arteries

Background Left atrial (LA) strain, comprising LA reservoir, conduit and contractile function could add mechanistic information of patients after arterial switch operation (ASO) for transposition of the great arteries (TGA). ASO patients might have abnormal ventriculoarterial coupling, which makes them vulnerable to left ventricle (LV) dysfunction and results in reduced exercise capacity. This explorative study aimed to evaluate the relation between LA strain, atrial size, ventricular function, and exercise data obtained by cardiopulmonary exercise testing (CPET). Methods In a cohort of 44 patients (71% male, mean age 25 ± 4 years) LA strain was measured using transthoracic speckle-tracking echocardiography. Further assessment involved standard echocardiography, CPET evaluation, and blood sampling. LA strain values were compared to normal values. Correlations were calculated. Regression analysis with all strain variables to the CPET data was performed. Results LA reservoir, conduit and contractile strain were normal in 30%, 89% and 50% of the patients, respectively. LA reservoir/contractile strain correlated to LV ejection fraction (ρ 0.310/−0.159, respectively) and LA reservoir/conduit strain correlated to the LA volume index (ρ 0.336/−0.357, respectively). None of the individual LA strain parameters were associated with the CPET variables. In multivariate regression analysis, LA contractile strain was significantly associated with the percentage of predicted maximal heart rate (β − 2.555). Conclusions These data suggest that in TGA patients after ASO repair LA strain is impaired and correlates with LA size and LV function. However, impaired LA strain wasn’t associated with the standard CPET parameters. As such, clinical significance needs to be further unravelled.

Doctrinal Debate on the Age of Contracting of Marital in Ibero-America

In this article, I intend to identify, within the frame of the semiotic theories of C.S. Peirce and U. Eco, some indications that may help to shed light on a remarkable phenomenon of constitutional interpretation, namely the influence exerted, in the determination process of the constitutional provisions which attribute fundamental rights, by the set of beliefs, expectations, purposes, etc., sedimented within a socially oriented linguistic practice. Through this operation of analogical transposition, I aim to highlight how the identification of the theoretical-doctrinal backgrounds related to the complex of ethical-political conceptions incorporated by the constitutions is strongly influenced by various elements of an intra- and extra-textual nature. Furthermore, by placing the interpretative processes in a broader hermeneutic-semiotic framework that considers legal cases as sign functions, the text seeks to demonstrate in a relatively easy-to-understand manner that the theoretical complications present in the legal field are ultimately not dissimilar to those found in any other interpretative activity that involves the use of a natural-historical language.

Outcomes of coronary artery obstructions after the arterial switch operation for transposition of the great arteries

ObjectiveCoronary obstruction is a rare but common complication of the arterial switch operation for transposition of the great arteries. The majority of patients remain asymptomatic and no risk factors allow targeting for reinforced surveillance. We aim to review the natural history of patients diagnosed with coronary obstruction after arterial switch operation for transposition of the great arteries and occurrence of coronary-related outcomes. MethodsWe retrospectively reviewed medical records of the 102 patients diagnosed with coronary obstruction after arterial switch operation for transposition of the great arteries in our institution from 1981 to 2022. Outcomes were anti-ischemic treatment introduction, revascularization (surgical or percutaneous angioplasty), and death; investigations that motivated revascularization were also reviewed. ResultsTwenty-eight out of 102 patients presented with myocardial ischemia during the immediate postoperative phase, 31 were diagnosed when symptomatic, and 43 were identified at the presymptomatic stage, according to our screening policy in preschool-aged children. Stenosis-related event occurrence was, respectively, 29 out of 31 and 32 out of 43 in the latter 2 subgroups. Coronary-related mortality reached 10% in patients diagnosed when symptomatic; no patients died in the presymptomatic subgroup. Of the 28 low-risk patients with no signs of ischemia at diagnosis, 10 developed obstruction warranting reintervention during follow-up. Revascularization was motivated by appearance of symptoms in patients with severe stenosis in normal coronary dispositions, and by clinical symptoms or documented silent ischemia in abnormal coronary patterns. ConclusionsOccurrence of stenosis-related events remains significant in patients after arterial switch operation, underlining the importance of early diagnosis for timely intervention. Initial anatomical evaluation identifies stenotic and at-risk patients; this will require periodical function testing. Follow-up modalities can be tailored to a patient’s individual anatomic characteristics.

Health-related quality of life of children who have undergone surgery for transposition of the great arteries in a developing country-the outlook is good but meaningful measurement is challenging.

Health-related quality of life of children who have undergone surgery for transposition of the great arteries in a developing country-the outlook is good but meaningful measurement is challenging.

Late follow-up of neo-aortic dimensions and coronary arteries in adult patients after the arterial switch operation

BackgroundAfter the arterial switch operation (ASO) for transposition of the great arteries (TGA), neo-aortic dilatation and coronary arterial anomalies, especially an interarterial course and acute coronary artery take-off angle, are commonly found. Long-term follow-up data after ASO is scarce. Aim of this study was to determine the prevalence of neo-aortic dilatation and coronary abnormalities, with special emphasis on acute coronary take-off angle, in adult TGA-ASO patients. MethodsIn this retrospective cohort study, all adult TGA-ASO patients with ≥1 CT-angiography (CTA) at the age of ≥16 years were included. ResultsEighty-one patients, 69 % male and median age 21.0 [18.5–22.8] years, were included. At baseline, maximum neo-aortic diameter was 39.2 ± 5.3 mm; 35 (43 %) patients had neo-aortic dilatation (neo-aortic diameter of >40 mm), 22 (27 %) patients had an acute coronary take-off angle (<30°), and 5 (6 %) patients had an interarterial course of the RCA (2 %) or LCA (4 %). Neo-aortic or coronary artery re-intervention occurred in 10 (12 %) patients. All 10 patients had neo-aortic dilatation or coronary take-off angle of <30° on baseline CTA. ConclusionThis study reports a prevalence of 43 % of neo-aortic dilatation, 6 % of interarterial coronary course and 27 % for acute coronary take-off angle (<30°) at a median term of 21.0 years post ASO. All patients with a neo-aortic re-intervention or coronary artery re-intervention during follow-up had a maximum neo-aortic diameter of >40 mm or a coronary take-off angle of <30° at baseline CTA. This hypothesis generating study suggests that an active surveillance in patients with neo-aortic dilation and/or an acute angulation of < 30° post ASO might be considered and requires prospective evaluation.

Optimizing Surgical Selection for Transposition With Left Ventricular Outflow Tract Obstruction

BackgroundStudies that have assessed the Rastelli and Nikaidoh operations for transposition of the great arteries (TGA) with obstructed left ventricular outflow tract obstruction (LVOTO) have not fully evaluated the anatomic drivers that may contribute to surgical selection. We present our procedural selection process for optimizing outcomes of complex TGA in the modern era. MethodsThis is a single-center, retrospective study that included pediatric patients who underwent either a Nikaidoh or Rastelli operation for the treatment of TGA-LVOTO, congenitally corrected TGA–LVOTO, or double-outlet right ventricle TGA type–LVOTO from June 2004 to June 2021. ResultsThere were 34 patients stratified by Nikaidoh (n = 16) or Rastelli (n = 18) operation. The incidence of all postoperative complications and mortality was low, and the incidence of complications between the groups was similar. Patients were more likely to have undergone a Nikaidoh than a Rastelli if they had a pulmonary annulus >5 mm (87.5% vs 11.1%), anteriorly/posteriorly oriented great vessels (88% vs 8%), remote (80% vs 11%) or restrictive (75% vs 6%) ventricular septal defect, and right ventricular hypoplasia (50% vs 0%; all, P < .05). The resulting rates of reoperation were similar between the groups (44.0% vs 37.5%; P = .24) and largely composed of conduit replacements in the Rastelli patients and valvular repairs or replacements in the Nikaidoh group. Rates of catheter-based interventions were also similar. ConclusionsThese findings suggest that for the optimal treatment of conotruncal anomalies with discordant ventriculoarterial connections, procedural selection should be based on pathoanatomic criteria that can ensure patients undergo the operation most suited to their anatomy.

Paediatric quality of life in toddlers and children who underwent arterial switch operation beyond early neonatal period.

The aim of this study was to evaluate the quality of life (QOL) of children who underwent the arterial switch operation (ASO) for Transposition of Great Arteries in our population and, specifically, to explore early modifiable factors and the influence of parental and socioeconomic factors on the QOL of these children. Cross-sectional study using Paediatric Quality of Life Inventory™ 3.0 Cardiac Module was carried out on 3- to 12-year-old children who had undergone ASO between the years 2012-2018. Socioeconomic status was calculated using the modified Kuppuswamy scale (2019). Other clinical factors with possible bearing on the outcome were also analysed. Immediate survival after surgery was 196 out of 208 (94.2%) with an attrition of 19 patients (9.6%) over the follow-up period. Most surviving children (98.9%) had started formal schooling in age-appropriate classes. Two children had severe neuromotor impairment. The median cumulative health-related QOL score of the children was 97.9 (interquartile range 4.2) at 5.6 ± 1.27 years of life. The median scores each of the health-related QOL parameters, viz, heart problem symptoms, treatment compliance, perceived physical appearance, treatment-related anxiety, cognitive problems, and communication was 100 with negative skewing. Excellent QOL was observed in most children after ASO with the median total paediatric QOL scores in all domains of 97.9. Social factors did not show a statistically significant influence on the QOL parameters in the current cohort. The gradually declining trend across the age groups emphasizes the need for continued follow-up for early identification of possible correctable factors and initiating intervention to ensure good QOL into teenage and adulthood.

Valve-Sparing Neo-Aortic Root Replacement for Neo-Aortic Root Dilatation 20 Years after Arterial Switch Operation for Transposition of the Great Arteries: A Case Report.

A 25-year-old man returned to Seoul National University Children's Hospital with mild dyspnea on exertion. He had undergone an arterial switch operation at 1 month after birth to correct a complete transposition of the great arteries and a ventricular septal defect. When the patient was 15 years old, dilatation of the neo-aortic sinus and annulus was first identified; since then, it had gradually increased. Given the young age of the patient and the degree of aortic regurgitation (AR), which was mild to moderate, we opted to perform a valve-sparing neo-aortic root replacement with aortic valve repair. Postoperative echocardiography showed successful reductions in the sizes of the aortic sinus and annulus, with only mild AR remaining.

Comparison of Four-Dimensional Flow MRI, Two-Dimensional Phase-Contrast MRI and Echocardiography in Transposition of the Great Arteries

Pulmonary artery (PA) stenosis is a common complication after the arterial switch operation (ASO) for transposition of the great arteries (TGA). Four-dimensional flow (4D flow) CMR provides the ability to quantify flow within an entire volume instead of a single plane. The aim of this study was to compare PA maximum velocities and stroke volumes between 4D flow CMR, two-dimensional phase-contrast (2D PCMR) and echocardiography. A prospective study including TGA patients after ASO was performed between December 2018 and October 2020. All patients underwent echocardiography and CMR, including 2D PCMR and 4D flow CMR. Maximum velocities and stroke volumes were measured in the main, right, and left PA (MPA, LPA, and RPA, respectively). A total of 39 patients aged 20 ± 8 years were included. Maximum velocities in the MPA, LPA, and RPA measured by 4D flow CMR were significantly higher compared to 2D PCMR (p < 0.001 for all). PA assessment by echocardiography was not possible in the majority of patients. 4D flow CMR maximum velocity measurements were consistently higher than those by 2D PCMR with a mean difference of 65 cm/s for the MPA, and 77 cm/s for both the RPA and LPA. Stroke volumes showed good agreement between 4D flow CMR and 2D PCMR. Maximum velocities in the PAs after ASO for TGA are consistently lower by 2D PCMR, while echocardiography only allows for PA assessment in a minority of cases. Stroke volumes showed good agreement between 4D flow CMR and 2D PCMR.

MAGIC-DHT: Fast in-memory computing for Discrete Hadamard Transform

Discrete Hadamard transform (DHT) is a signal processing tool that decomposes an arbitrary input vector into a superposition of Walsh functions. Due to its wide range of applications in processing big data, a fast and energy-efficient hardware design for DHT with high throughput capability is essential. Processing in memory (PIM) allows the in-place computation to reduce the data traffic, which is a major speed bottleneck in the existing computing. In this work, we propose an efficient hybrid parallel PIM-based computation for DHT. Our proposed method explores the recursive computation of DHT and is based on the memristor-aided logic (MAGIC) gates in which the arithmetic operations are carried out via simple logic NOR operation. We propose two in-memory computing methods for the DHT encoding process. At the arithmetic level, to improve efficiency, we propose to share the intermediate results between addition and subtraction in DHT in the first method called MAGIC-DHT-1D which provides an average speedup of 1.12× over the recently proposed DigitalPIM for 1D DHT. Furthermore,MAGIC-DHT-1D also outperforms SIMPLER in terms of energy and energy density in average. We also propose a second method, called MAGIC-DHT-2D, to share the carrier independent computation cycles among multi-bit parallel addition and subtraction. At the algorithm level, we also explore both row and column-based PIM NOR computing in the same crossbar to avoid the transposition operation required in the 2D DHT process. MAGIC-DHT-2D provides an average speedup of 4.84× and 7.25× over two state-of-the-art methods DigitalPIM and SIMPLER, respectively for each complete set of 2D DHT computing cycles. Our numerical results further show that our proposed optimized methods can lead up to 56.19× and 6.90× speed-up, as well as 57.84× and 5.96× higher throughput over NVIDIA RTX Titan GPU to compute 1D DHT and 2D DHT, respectively.

Gene expression programming with dual strategies and neighborhood search for symbolic regression problems

As an evolutionary algorithm for automatic generation of computer programs, Gene expression programming (GEP) has received a lot of attention because it can generate concise and highly accurate solutions. However, GEP also has some unsatisfactory aspects, such as too many control parameters and a lack of balance between exploration and exploitation. Therefore, a new GEP with dual strategies and neighborhood search (DNSGEP) is proposed in this paper for symbolic regression problems. As the core part, a new multi-parent crossover operator with neighborhood search is proposed to replace the original transposition and recombination operators in GEP, which greatly reduces the excessive control parameters in GEP. To assist the multi-parent crossover operator in selecting parents, selection weight is used to assess the quality of individuals in the population. The multi-parent crossover operator combines selection weight to learn more from the better parents. In order to satisfy the different needs of global search and local search of the algorithm, two different crossover strategies are extended on the basis of the multi-parent crossover operator. Furthermore, a population distribution entropy strategy to GEP is proposed for determining when the algorithm should choose which crossover strategy to use. DNSGEP is compared with GEP and three GEP variants on 14 symbolic regression problems and 6 even parity problems. Experimental results show that DNSGEP has the success rate and accuracy that are fully superior to GEP, GEPADF and OGEP, not inferior to SLGEP.

Decreased cardiac reserve in asymptomatic patients after arterial switch operation for transposition of the great arteries

BackgroundExercise capacity is impaired in patients after arterial switch operation (ASO) for complete transposition of the great arteries. Maximal oxygen consumption is related with outcome. ObjectivesThis study assessed ventricular function by advanced echocardiography and cardiac magnetic resonance (CMR) imaging at rest and during exercise, to determine exercise capacity in ASO patients, and to correlate exercise capacity with ventricular function as potential early marker of subclinical impairment. MethodsForty-four patients (71% male, mean age 25 ± 4 years - range 18–40 years) were included during routine clinical follow-up. Assessment involved physical examination, 12‑lead ECG, echocardiography, and cardiopulmonary exercise test (CPET) (day 1). On day 2 CMR imaging at rest and during exercise was performed. Blood was sampled for biomarkers. ResultsAll patients reported New York Heart Association class I, the overall cohort had an impaired exercise capacity (80 ± 14% of predicted peak oxygen consumption). Fragmented QRS was present in 27%. Exercise CMR showed that 20% of patients had abnormal contractile reserve (CR) of the left ventricle (LV) and 25% had reduced CR of the right ventricle (RV). CR LV and CR RV were significantly associated with impaired exercise capacity. Pathological patterns on myocardial delayed enhancement and hinge point fibrosis were detected. Biomarkers were normal. ConclusionThis study found that in some asymptomatic ASO patients electrical, LV and RV changes at rest, and signs of fibrosis are present. Maximal exercise capacity is impaired and seems to be linearly related to the CR of the LV and the RV. Therefore, exercise CMR might play a role in detecting subclinical deterioration of ASO patients.

Symmetry resolved entanglement of excited states in quantum field theory. Part III. Bosonic and fermionic negativity

In two recent works, we studied the symmetry resolved Rényi entropies of quasi-particle excited states in quantum field theory. We found that the entropies display many model-independent features which we discussed and analytically characterised. In this paper we extend this line of investigation by providing analytical and numerical evidence that a similar universal behavior arises for the symmetry resolved negativity. In particular, we compute the ratio of charged moments of the partially transposed reduced density matrix as an expectation value of twist operators. These are “fused” versions of the more traditionally used branch point twist fields and were introduced in a previous work. The use of twist operators allows us to perform the computation in an arbitrary number of spacial dimensions. We show that, in the large-volume limit, only the commutation relations between the twist operators and local fields matter, and computations reduce to a purely combinatorial problem. We address some specific issues regarding fermionic excitations, whose treatment requires the notion of partial time-reversal transformation, and we discuss the differences and analogies with their bosonic counterpart. We find that although the operation of partial transposition requires a redefinition for fermionic theories, the ratio of the negativity moments between an excited state and the ground state is universal and identical for fermions and bosons as well as for a large variety of very different states, ranging from simple qubit states to the excited states of free quantum field theories. Our predictions are tested numerically on a 1D Fermi chain.

P61: Novel use of newer intravascular ambulatory systemic ventricular assist devices as a bridging strategy for cardiogenic shock with pulmonary hypertension in patients with complex congenital cardiac conditions

Background: Cardiogenic shock [CS] in patients with failing systemic ventricles is associated with high mortality. Suitable patients maybe successfully bridged using newer intravascular ambulatory left ventricular assist devices [Impella 5.5, Abiomed, Danvers, MA] as a bridge to transplantation. We report our successful experience with two such patients. Methods: Between January 2022 and January 2023, 2 patients underwent trans-axillary artery placement of LV Impella 5.5 for CS as a bridge to heart transplant. Both these patients had previously undergone a Senning operation for transposition of the great arteries, and presented with failing systemic ventricle with pulmonary hypertension. Results: Two patients [patient 1: 36 years, patient 2: 38 years] presented to our unit with cardiogenic shock. They underwent trans-axillary artery placement of LV Impella 5.5 into the systemic ventricle for CS as a bridge to decision for high pulmonary vascular resistance [PVR]. Heart and lung transplantation was considered, but the patients declined and opted to pursue strategy for heart transplant alone. Following 30 and 50 days on impella 5.5 support in patients 1 and 2 respectively, along with intravenous diuretics and milrinone 0.25mcg/kg/min, there was reversal of pulmonary hypertension [Table-1]. Both patients underwent successful redo-sternotomy and heart transplantation. Second patient required 48-hours of extra-corporeal membrane oxygenator [ECMO] support for primary graft dysfunction, increased immunosuppression for grade 2 rejection, and temporary renal replacement therapy. Both patients recovered and were discharged home. Conclusions: We report successful outcomes in these two patients who had previously undergone complex congenital heart surgery, and had presented to us in cardiogenic shock with failing systemic ventricles and severe pulmonary hypertension, which hitherto would have precluded cardiac transplantation alone. Utilization of Impella 5.5 for cardiogenic shock in these patients facilitated successful reversal of pulmonary hypertension and therefore, a successful cardiac transplantation without resorting to durable VAD placement or heart-lung transplantation in this difficult cohort of patients. Furthermore, impella 5.5 placement helped avoid femoral ECMO completely, with its inherent problems of immobility, bleeding, infections, limb ischemia, and muscle wasting, and greatly facilitated early ambulation and rehabilitation while awaiting a suitable organ. Table 1. - Pre transplant hemodynamics in both patients PAS PAD PAM PCWP TPG PVR RA CI CO PA Sat P1 Baseline 80 50 60 38 22 10 22 1.1 2.2 34% P1 Day-30 impella 45 20 28 18 10 2 7 2.7 5 59% P2 Baseline 88 50 64 41 23 4.8 18 3 4.7 58% P2 Day-50 impella 57 26 36 16 20 2.5 7 4 7.3 74% PAS/D/M: pulmonary artery systolic/diastolic/mean pressures; PCWP: pulmonary capillary wedge pressure; TPG: trans pulmonary gradient; RA: right atrial pressure. All in mmHg. PVR: pulmonary vascular resistance in wood units CI: cardiac index in liters/minute/square meter body surface area; CO: cardiac output in liters/minute; PA sat: pulmonary artery oxygen saturation