Preliminary results following reinforcement of the pulmonary autograft to prevent dilatation after the Ross procedure

OBJECTIVE: The Ross operation remains a controversially discussed procedure, because concern exists regarding late dilatation of the neoaortic root and progressive regurgitation of the autograft valve. We present our early experience with an external reinforcement of the autograft, which is inserted into a prosthetic Dacron graft with an artificial aortic root configuration. This detail should help to prevent neoaortic root dilatation. PATIENTS AND METHODS: Between 2006 and 2007, 12 patients (mean age 16 +/- 38 years; range 15-38 years) underwent a Ross procedure by this technique. Indications were aortic regurgitation (n = 2), aortic stenosis (n = 5), and combined aortic stenosis and insufficiency (n = 5). A bicuspid aortic valve was present in 9 patients. Balloon valvuloplasty had been performed in 7 patients. Follow-up was performed by clinical and echocardiographic examinations. RESULTS: No early or late deaths occurred in this small series, and freedom from reoperation is 100%. Echocardiographic follow-up confirmed absence of aortic insufficiency in 11 patients after a mean of 11 months (range 2-30 months). In 1 patient, a small asymmetric regurgitation jet was already observed at discharge echocardiography. As expected, no neoaortic root dilatation was observed during follow-up. All patients are in New York Heart Association class I. CONCLUSIONS: The present technique is a simple and reproducible technical step that does not require significant additional time. Inclusion of the autograft within a root prosthesis may be especially indicated in situations known for late autograft dilatation, namely, bicuspid aortic valve, predominant aortic insufficiency, and ascending aortic enlargement.

The Ross procedure in infants and young children

BACKGROUND: This study reviews our experience with the Ross procedure in infants and young children. METHODS: From September 1993 to September 2004, 52 children less than 15 years of age underwent a Ross procedure. The patients ranged in age from 4 days to 15 years old (median, 5 years). Fifteen patients (29%) were less than 2 years of age. The predominant indication for the Ross procedure was aortic stenosis. Sixteen patients underwent a Ross-Konno procedure for severe left ventricular outflow tract obstruction. Thirty-four patients had 48 previous interventions. Preoperatively, 6 patients showed severe left ventricular dysfunction, and 2 of the patients required ventilation and inotropic support. Concomitant procedures were performed in 8 patients. Three patients had a mitral valve replacement, 2 patients had a ventricular septal defect closure and an aortic arch reconstruction, 2 patients had aortic arch reconstructions, and 1 patient had resection of a coarctation and a ventricular septal defect closure. RESULTS: Patients were followed up for a median of 43 months (range, 1 to 130). Overall survival was 85% +/- 5% at 1 and 82% +/- 5% at 2, 5, and 10 years. Hospital mortality was 5 of 52 patients (9.6%). All deaths occurred in neonates or infants less than 2 months of age, who needed urgent surgery. Three patients died late of noncardiac causes. At last follow-up, all patients were classified in New York Heart Association functional class I or II. No patient had endocarditis of the autograft or the right ventricular outflow tract replacement. During the follow-up, no event of thrombembolism was observed. No patient required the insertion of a permanent pacemaker. Overall freedom from reoperation is 57% +/- 15% at 10 years. One patient required the replacement of the autograft at 6 months postoperatively. The development of mild aortic insufficiency was observed in 24 patients, and moderate aortic insufficiency in 1 patient during follow-up. Freedom from reoperation for the right ventricular outflow tract replacement is 60% +/- 15% at 10 years. CONCLUSIONS: The Ross procedure represents an attractive approach to aortic valve disease in young children. However, a high early mortality rate has to be considered when performing this procedure in neonates or infants who present in critical preoperative condition.

The lifestyle of our kids (LOOK) project: outline of methods

This methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7-8-year-old (grade 2) school children followed to age 11-12 years (grade 6), their average family income being very close to that of Australia. We will test two hypotheses, that (a) the quantity and quality of physical activity undertaken by primary school children will influence their psychological and physical health and development; (b) compared with existing practices in primary schools, a physical education program administered by visiting specialists will enhance health and development, and lead to a more positive perception of physical activity. To test the first hypothesis we will monitor all children longitudinally over the 4 years. To test the second we will involve an intervention group of 430 children who receive two 50min physical education classes every week from visiting specialists and a control group of 400 who continue with their usual primary school physical education with their class-room teachers. At the end of grades 2, 4, and 6 we will measure several areas of health and development including blood risk factors for chronic disease, cardiovascular structure and function, physical fitness, psychological characteristics and perceptions of physical activity, bone structure and strength, motor control, body composition, nutritional intake, influence of teachers and family, and academic performance.

The history of subaquatic volcanism recorded in the sediments of Lake Kivu

Subaquatic volcanic activity has been ongoing in Lake Kivu since the early Holocene and has a dynamic effect on the biological productivity in the surface water, and the preservation of carbonate in the deep anoxic water. Groundwater discharge into the lake’s deepwater propels the upward advection of the water column that ultimately supplies nutrients to the surface water for biological production. The amount of nutrients supplied from the deepwater can be increased suddenly by (1) a cold meteorological event that drives deep seasonal mixing resulting in increased nutrients from below and oxygen from above, or (2) subaquatic volcanic activity that induces a buoyant hydrothermal plume, which entrains nutrients from the deepwater and results in anoxia or suboxic conditions in the surface water. Previous sedimentological studies in Lake Kivu have hypothesized that regional climatic changes are responsible for sudden changes in the preservation of carbonates in the Main Basin. Here we reveal that sublacustrine volcanic events most likely induce the abrupt changes to the geochemistry in the sediment in Lake Kivu. An unprecedented look into the sediment stratigraphy and geochemistry from high-resolution seismic-reflection, and 15N-isotope analyses was conducted in the Main Basin. The results reveal that buoyant hydrothermal plumes caused by subaquatic volcanic activity are a possible trigger for increased biological productivity and organic matter preservation, and that ongoing hydrothermal activity increases the alkalinity in the deepwater, leading to carbonate preservation. The onset of carbonate preservation since the 1970s that is currently observed in the sediment could indicate that hydrothermal discharge has recently increased in the lake.

Lake-level rise in the late Pleistocene and active subaquatic volcanism since the Holocene in Lake Kivu; East African Rift

The history of Lake Kivu is strongly linked to the activity of the Virunga volcanoes. Subaerial and subaquatic volcanoes, in addition to lake-level changes, shape the subaquatic morphologic and structural features in Lake Kivu's Main Basin. Previous studies revealed that volcanic eruptions blocked the former outlet of the lake to the north in the late Pleistocene, leading to a substantial rise in the lake level and subsequently the present- day thermohaline stratification. Additional studies have speculated that volcanic and seismic activities threaten to trigger a catastrophic release of the large amount of gases dissolved in the lake. The current study presents a bathymetric mapping and seismic profiling survey that covers the volcanically active area of the Main Basin at a resolution that is unprecedented for Lake Kivu. New geomorphologic features identified on the lake floor can accurately describe related lake-floor processes for the first time. The late Pleistocene lowstand is observed at 425 m depth, and volcanic cones, tuff rings, and lava flows observed above this level indicate both subaerial and subaquatic volcanic activities during the Holocene. The geomorphologic analysis yields new implications on the geologic processes that have shaped Lake Kivu's basin, and the presence of young volcanic features can be linked to the possibility of a lake overturn.