Maternity an essential deliberation over the psychological dimension

In-hospital mortality and 1-year mortality were measured. A total of 527 neonates were included; 251 (47.6%) comprised the pre-mandatory pulse oximetry screening cohort (2009-2010). Only 3.6% of the 2009-2010 cohort and 4.3% of the 2015-2016 cohort were diagnosed late (p = 0.66). GLPG3970 nmr One-year mortality decreased during the study period (17.2% in 2009-2010 vs 10.5% in 2015-2016, p = 0.03). There were no deaths in the late CCHD diagnosis groups. Mandatory pulse oximetry screening legislation has not changed the late postnatal diagnosis rate at our institution. Mortality for neonatal CCHD has declined, but this decline is not attributable to mandatory pulse oximetry screening.Aortic coarctation is a common congenital heart defect that often requires correction at a young age. Currently, success is defined by the achievement of a durable repair with low morbidity and mortality. We sought to systematically review the literature on risk factors for recoarctation and mortality in infants submitted to aortic arch coarctation repair under 1 year of age. PubMed and Scopus were searched for studies reporting risk factors for recoarctation and mortality from January 1989 to August 2019. Among the 1038 retrieved articles, 18 met the inclusion criteria, with a total of 2891 patients. The extracted risk factors for recoarctation were comprehensively summarized in the following categories demographic variables, associated anomalies, clinical and repair variables, and morphometric variables. Younger age and lower weight were weak determinants of need for reintervention, while smaller aortic arch was a strong predictor of recoarctation. While balloon angioplasty is a clear risk factor for arch restenosis, the chosen surgical technique is not a strong risk factor. Associated minor cardiac anomalies and lower weight at surgery were important risk factors for death. Younger and smaller infants are at increased risk for adverse outcomes when submitted to aortic arch coarctation repair. This is particularly important when associated with smaller arch morphology. Strategies to improve the management of these patients may play a key role in improving their outcomes. Notably, surgical technique was not a strong predictor of recoarctation and mortality, suggesting that the choice of one over the other should be tailored.Tetralogy of Fallot (ToF) treatment is difficult in patients with surgical risk factors or unfavorable anatomy. Stent implantation in the right ventricular outflow tract (RVOT) is an option for these patients. We report our initial experience in Chile with RVOT stenting in patients with ToF. Retrospective and descriptive study conducted in three pediatric cardiovascular centers in Chile between 2012 and 2015, including all ToF patients with stent in the RVOT as first procedure. Clinical records, echocardiographic, interventional, and surgical reports were reviewed for demographics and information of RVOT and pulmonary arteries. 12 newborns with ToF were included (75% female). Median age was 20 days (1-70) and mean weight was 2178 g (1400-3414). Saturations increased after the procedure from 74.3% (55-88) to 88.5% (80-98%), (p  less then  0.01). No complications or mortality were related to interventions. Follow-up was 11 months (7-36). Median right and left pulmonary arteries Z-score increased from - 4.0 (- 5.2 to - 0.3) and - 1.5 (- 4.8 to - 0.26) to + 0.53 (0.0 to 2.2) and + 1.1 (0.5 to 2.9), (p  less then  0.05), respectively. Nakata index increased from 63 mm2/mm2 (35 to 143) to 162 mm2/mm2 (107 to 197), (p  less then  0.05). Surgical repair was performed at a median of 4 months (2-7). Transannular patch repair was necessary in all patients and there was no surgical mortality. RVOT stenting is a safe and useful option for patients with ToF and surgical risk factors or unfavorable anatomy. It increases the pulmonary blood flow, improving saturation and pulmonary artery growth as a bridge for surgical repair.The implantation of pacemakers (PM) in neonates and infants requires particular consideration of small body size, marked body growth potential, and the decades of future pacing therapy to be expected. The aim of this study is to quantify the complications of implantation and outcome occurring at our center and to compare these with other centers. Retrospective analysis of 52 consecutive patients undergoing PM implantation at a single tertiary care center within the first year of life. PMs were implanted at a median age of 3 months (range 0-10 months). Structural heart defects were present in 44 of 52 patients. During a median follow-up time of 40.4 months (range 0.1-114 months), measurements for sensing, pacing thresholds, and lead impedance remained stable. No adverse pacing effect was observed in left ventricular function or dimensions over time. There were 20 reoperations in 13 patients at a median time of 4.7 years (range 0.05-8.2 years) after implantation, for end of battery life (n = 10), lead dysfunction (n = 3), device dislocation (n = 3), infection (n = 3), and diaphragmatic paresis (n = 1). No PM-related mortality occurred. Epicardial pacemaker implantation in neonates and infants is an invasive but safe and effective procedure with a relatively low risk of complications. Our current implantation technique and the use of bipolar steroid-eluting electrodes, which we prefer to implant on the left ventricular apex, lead to favorable long-term results.PURPOSE To evaluate the rapeutic effectiveness of Angio-CT or cone-beam CT (CBCT)-guided immediate radiofrequency ablation (RFA) after transcatheter arterial chemoembolization (TACE) for large hepatocellular carcinoma (HCC). METHODS 117 large HCC patients (mean maximum diameter 9.3 cm; range 5.3-17.7 cm) were retrospective studied and divided into Angio-CT group (n = 66 cases), CBCT group (n = 21 cases), and single TACE group (n = 30 cases) according to treatment (Angio-CT/CBCT-guided immediate RFA after TACE, single TACE, respectively). The operative time, effective radiation dose, local-regional tumor responses, overall survival (OS), and progression‑free survival (PFS) time and complications were recorded. RESULTS The operative time and effective radiation dose of Angio-CT group and CBCT group were higher than those of TACE group (P  less then  0.01). The local-regional tumor responses on 1-month follow-up MRI (complete response + partial response) of Angio-CT group and CBCT group were 100%, which were significantly higher than that of single TACE group (76.