RESUMEN
OBJECTIVES: This study was designed to compare outcomes of the most common pediatric cardiac interventions from the time of implementation with the current era. BACKGROUND: Since the introduction of semilunar valve balloon dilation and device closure of the arterial duct and septal defects, development of interventional techniques and devices has been rapid. However, few studies have compared outcomes between those initial interventions and those in the current era. METHODS: Five validated common catheter-based therapies were chosen for analysis, including atrial and duct device closure, balloon dilation of the aortic and pulmonary valves, and native coarctation of the aorta. A retrospective review of the first and most recent 10 consecutive patients in each group was performed. RESULTS: There was a high mortality (30%) among neonates who underwent aortic valve (AV) dilation in the early era, but no mortality noted in other groups. In the early era, transcatheter atrial defect closure and AV dilations were associated with a low success rate (60% for both lesions) and a high complication rate (40% for atrial septal defect, 30% for AV dilations). Among the last 10 children, the atrial defect occlusion was successful in 100% without complications and AV dilations where successful in all children with a 30% complication rate (one major, two minor). CONCLUSIONS: A learning curve with device development plays a significant role in the evolution of transcatheter techniques. These data provide baseline estimates of success and may be used as a template in the future when new techniques are adapted into practice.
Asunto(s)
Cateterismo Cardíaco , Cardiología , Cardiopatías Congénitas/terapia , Pediatría , Radiografía Intervencional , Adolescente , Factores de Edad , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/historia , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/mortalidad , Cateterismo Cardíaco/tendencias , Cardiología/historia , Cardiología/tendencias , Niño , Preescolar , Difusión de Innovaciones , Supervivencia sin Enfermedad , Cardiopatías Congénitas/historia , Cardiopatías Congénitas/mortalidad , Historia del Siglo XX , Humanos , Lactante , Recién Nacido , Estimación de Kaplan-Meier , Ontario , Pediatría/historia , Pediatría/tendencias , Exposición a la Radiación , Radiografía Intervencional/efectos adversos , Radiografía Intervencional/historia , Radiografía Intervencional/mortalidad , Radiografía Intervencional/tendencias , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Tissue inhibitor of matrix metalloproteinases type 4 (TIMP-4), the newest member in the mammalian TIMP family of inhibitors of matrix metalloproteinases (MMPs), differs from the other three TIMPs by its restricted expression pattern. This suggests that TIMP-4 could play a role in tissue-specific regulation of extracellular matrix (ECM) turnover. To define this role, modulation of TIMP-4 production by overexpression, aberrant expression and inactivation of the Timp4 gene in transgenic mice should be performed. In preparation for such experiments we have cloned and characterized the murine Timp4 gene and determined the tissue distribution of its mRNA in mice. The gene spans 7.1 kb, consists of five exons and shares considerable homology with the other Timp genes. The gene is located on mouse chromosome 6 in an antisense orientation between exons 5 and 6 of the mouse synapsin 2 (Syn2) gene. A similar organization is common to all four human/mouse TIMP and SYN genes and to the single synapsin/Timp locus in Drosophila. The highest levels of TIMP-4 mRNA were seen in postnatal mouse heart, ovary and brain. Determination of the spatial expression pattern of TIMP-4 mRNA by in situ hybridization in the heart revealed a diffuse distribution in cardiac muscle cells. In the ovary, cyclic variation was observed in TIMP-4 mRNA levels. In situ hybridization demonstrated the strongest expression of TIMP-4 mRNA in the corpus luteum. The data suggest that TIMP-4 plays a role in the normal physiology of the heart and the ovary, most likely related to maintenance of the delicate balance between MMPs and TIMPs.