The Experts below are selected from a list of 213 Experts worldwide ranked by ideXlab platform
Siva P Namachivayam - One of the best experts on this subject based on the ideXlab platform.
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major adverse events following over Shunting are associated with worse outcomes than major adverse events after a blocked systemic to pulmonary artery Shunt procedure
Pediatric Critical Care Medicine, 2018Co-Authors: Kok Wai Soo, Johann Brink, Yves Dudekem, Warwick Butt, Siva P NamachivayamAbstract:OBJECTIVES Causes of major adverse event after systemic-to-pulmonary Shunt procedure are usually Shunt Occlusion or over-Shunting. Outcomes categorized on the basis of these causes will be helpful both for quality improvement and prognostication. DESIGN Retrospective cohort analysis of children who underwent a systemic-to-pulmonary Shunt after excluding those who had it for Norwood or Damus-Kaye-Stansel procedure. SETTING The Royal Children's Hospital, Melbourne, VIC, Australia. PATIENTS From 2008 to 2015, 201 children who had a systemic-to-pulmonary Shunt were included. INTERVENTIONS Major adverse event is defined as one or more of cardiac arrest, chest reopening, or requirement for extracorporeal membrane oxygenation. Study outcome is a "composite poor outcome," defined as one or more of acute kidney injury, necrotizing enterocolitis, brain injury, or in-hospital mortality. MEASUREMENTS AND MAIN RESULTS Median (interquartile range) age was 12 days (6-38 d) and median (interquartile range) time to major adverse event was 5.5 hours (2-17 hr) after admission. Overall, 36 (18%) experienced a major adverse event, and reasons were over-Shunting (n = 17), blocked Shunt (n = 13), or other (n = 6). Fifteen (88%) in over-Shunting group suffered a cardiac arrest compared with two (15%) in the blocked Shunt group (p < 0.001). The composite poor outcome was seen in 15 (88%) in over-Shunting group, four (31%) in the blocked Shunt group, and 56 (34%) in those who did not experience a major adverse event (p < 0.001). By multivariable analysis, predictors for composite poor outcome were major adverse event due to over-Shunting (no major adverse event-reference; over-Shunting odds ratio, 18.60; 95% CI, 3.87-89.4 and Shunt-block odds ratio, 1.57; 95% CI, 0.46-5.35), single ventricle physiology (odds ratio, 4.70; 95% CI, 2.34-9.45), and gestation (odds ratio, 0.84/wk increase; 95% CI, 0.74-0.96). CONCLUSIONS Infants who suffer major adverse event due to over-Shunting experience considerably poorer outcomes than those who experience events due to Shunt block. A mainly hypoxic event with maintenance of systemic perfusion (as often seen in a blocked Shunt) is less likely to result in poorer outcomes than those after a hypoxic-ischemic event (commonly seen in over-Shunting).
Kok Wai Soo - One of the best experts on this subject based on the ideXlab platform.
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major adverse events following over Shunting are associated with worse outcomes than major adverse events after a blocked systemic to pulmonary artery Shunt procedure
Pediatric Critical Care Medicine, 2018Co-Authors: Kok Wai Soo, Johann Brink, Yves Dudekem, Warwick Butt, Siva P NamachivayamAbstract:OBJECTIVES Causes of major adverse event after systemic-to-pulmonary Shunt procedure are usually Shunt Occlusion or over-Shunting. Outcomes categorized on the basis of these causes will be helpful both for quality improvement and prognostication. DESIGN Retrospective cohort analysis of children who underwent a systemic-to-pulmonary Shunt after excluding those who had it for Norwood or Damus-Kaye-Stansel procedure. SETTING The Royal Children's Hospital, Melbourne, VIC, Australia. PATIENTS From 2008 to 2015, 201 children who had a systemic-to-pulmonary Shunt were included. INTERVENTIONS Major adverse event is defined as one or more of cardiac arrest, chest reopening, or requirement for extracorporeal membrane oxygenation. Study outcome is a "composite poor outcome," defined as one or more of acute kidney injury, necrotizing enterocolitis, brain injury, or in-hospital mortality. MEASUREMENTS AND MAIN RESULTS Median (interquartile range) age was 12 days (6-38 d) and median (interquartile range) time to major adverse event was 5.5 hours (2-17 hr) after admission. Overall, 36 (18%) experienced a major adverse event, and reasons were over-Shunting (n = 17), blocked Shunt (n = 13), or other (n = 6). Fifteen (88%) in over-Shunting group suffered a cardiac arrest compared with two (15%) in the blocked Shunt group (p < 0.001). The composite poor outcome was seen in 15 (88%) in over-Shunting group, four (31%) in the blocked Shunt group, and 56 (34%) in those who did not experience a major adverse event (p < 0.001). By multivariable analysis, predictors for composite poor outcome were major adverse event due to over-Shunting (no major adverse event-reference; over-Shunting odds ratio, 18.60; 95% CI, 3.87-89.4 and Shunt-block odds ratio, 1.57; 95% CI, 0.46-5.35), single ventricle physiology (odds ratio, 4.70; 95% CI, 2.34-9.45), and gestation (odds ratio, 0.84/wk increase; 95% CI, 0.74-0.96). CONCLUSIONS Infants who suffer major adverse event due to over-Shunting experience considerably poorer outcomes than those who experience events due to Shunt block. A mainly hypoxic event with maintenance of systemic perfusion (as often seen in a blocked Shunt) is less likely to result in poorer outcomes than those after a hypoxic-ischemic event (commonly seen in over-Shunting).
Tsunehiko Nishimura - One of the best experts on this subject based on the ideXlab platform.
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Successful portal-systemic Shunt Occlusion with balloon-occluded retrograde transvenous obliteration for portosystemic encephalopathy without liver cirrhosis.
Journal of Vascular and Interventional Radiology, 2006Co-Authors: Osamu Tanaka, Kiyoshi Ishihara, Hirokazu Oyamada, Akihito Harusato, Taiji Yamaguchi, Masaru Ozawa, Koji Nakano, Takuji Yamagami, Tsunehiko NishimuraAbstract:A 68-year-old woman was admitted to the authors' hospital for hepatic encephalopathy. Her laboratory data and computed tomography findings were not suggestive of liver cirrhosis. Superior mesenteric angiography revealed an extrahepatic portal-systemic Shunt with a main cause of hepatic encephalopathy. Despite treatment with branched-chain amino acid, lactulose, and kanamycin, hyperammonemia was prolonged, and the portal-systemic Shunt was therefore treated with balloon-occluded retrograde transvenous obliteration. After the procedure, hyperammonemia was improved, and there were no signs of recurrent portal-systemic encephalopathy.
A Stiehl - One of the best experts on this subject based on the ideXlab platform.
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phenprocoumon for prevention of Shunt Occlusion after transjugular intrahepatic portosystemic stent Shunt a randomized trial
Hepatology, 1996Co-Authors: Pieter Sauer, L Theilmann, S Herrmann, Thomas Bruckner, T Roeren, Goetz M Richter, W Stremmel, A StiehlAbstract:Development of stenosis or Occlusion of the transjugular intrahepatic portosystemic stent Shunt (TIPSS) is one of the major limiting factors in the long-term viability of this procedure. The efficacy of anticoagulation with heparin which is used in different centers is still unclear. In the present study, we evaluated the effect of phenprocoumon on Shunt patency after TIPSS placement using Palmaz stents; 49 patients with Child's A and B cirrhosis, who underwent successful TIPSS placement were randomized into the treatment group (n = 24) who received phenprocoumon and a control group (n = 25). After 11 to 13 weeks, all patients were admitted and had a reevaluation that included control angiography by transjugular approach. Phenprocoumon treatment was stopped after the first reevaluation and both groups were followed for 1 year after randomization. During the 3-month treatment period 11 of 22 patients of the treatment group and 12 of 23 patients of the control group required reintervention because of an increased portosystemic gradient. Five of the 12 patients in the control group showed complete Occlusion of the Shunt, whereas no Occlusion in the treatment group was observed (P < .05). During the mean follow-up of 8 months after the treatment was stopped, in both groups stenosis occurred in 50% of patients, but no further Occlusion of the stent was observed. These data indicate that Occlusion of the stent is related to thrombosis, whereas stenosis does not appear to be dependent on blood coagulation. In patients with preserved liver function Occlusion of the Shunt may be prevented by phenprocoumon treatment in the first 3 months after TIPSS placement. Thereafter Shunt Occlusion was not observed and further phenprocoumon treatment seemed unnecessary.
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phenprocoumon for prevention of Shunt Occlusion after transjugular intrahepatic portosystemic stent Shunt a randomized trial
Hepatology, 1996Co-Authors: Peter Sauer, L Theilmann, S Herrmann, Thomas Bruckner, T Roeren, Goetz M Richter, W Stremmel, A StiehlAbstract:Abstract Development of stenosis or Occlusion of the transjugular intrahepatic portosystemic stent Shunt (TIPSS) is one of the major limiting factors in the long-term viability of this procedure. The efficacy of anticoagulation with heparin which is used in different centers is still unclear. In the present study, we evaluated the effect of phenprocoumon on Shunt patency after TIPSS placement using Palmaz stents; 49 patients with Child's A and B cirrhosis, who underwent successful TIPSS placement were randomized into the treatment group (n = 24) who received phenprocoumon and a control group (n = 25). After 11 to 13 weeks, all patients were admitted and had a reevaluation that included control angiography by transjugular approach. Phenprocoumon treatment was stopped after the first reevaluation and both groups were followed for 1 year after randomization. During the 3-month treatment period 11 of 22 patients of the treatment group and 12 of 23 patients of the control group required reintervention because of an increased portosystemic gradient. Five of the 12 patients in the control group showed complete Occlusion of the Shunt, whereas no Occlusion in the treatment group was observed (P
Warwick Butt - One of the best experts on this subject based on the ideXlab platform.
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major adverse events following over Shunting are associated with worse outcomes than major adverse events after a blocked systemic to pulmonary artery Shunt procedure
Pediatric Critical Care Medicine, 2018Co-Authors: Kok Wai Soo, Johann Brink, Yves Dudekem, Warwick Butt, Siva P NamachivayamAbstract:OBJECTIVES Causes of major adverse event after systemic-to-pulmonary Shunt procedure are usually Shunt Occlusion or over-Shunting. Outcomes categorized on the basis of these causes will be helpful both for quality improvement and prognostication. DESIGN Retrospective cohort analysis of children who underwent a systemic-to-pulmonary Shunt after excluding those who had it for Norwood or Damus-Kaye-Stansel procedure. SETTING The Royal Children's Hospital, Melbourne, VIC, Australia. PATIENTS From 2008 to 2015, 201 children who had a systemic-to-pulmonary Shunt were included. INTERVENTIONS Major adverse event is defined as one or more of cardiac arrest, chest reopening, or requirement for extracorporeal membrane oxygenation. Study outcome is a "composite poor outcome," defined as one or more of acute kidney injury, necrotizing enterocolitis, brain injury, or in-hospital mortality. MEASUREMENTS AND MAIN RESULTS Median (interquartile range) age was 12 days (6-38 d) and median (interquartile range) time to major adverse event was 5.5 hours (2-17 hr) after admission. Overall, 36 (18%) experienced a major adverse event, and reasons were over-Shunting (n = 17), blocked Shunt (n = 13), or other (n = 6). Fifteen (88%) in over-Shunting group suffered a cardiac arrest compared with two (15%) in the blocked Shunt group (p < 0.001). The composite poor outcome was seen in 15 (88%) in over-Shunting group, four (31%) in the blocked Shunt group, and 56 (34%) in those who did not experience a major adverse event (p < 0.001). By multivariable analysis, predictors for composite poor outcome were major adverse event due to over-Shunting (no major adverse event-reference; over-Shunting odds ratio, 18.60; 95% CI, 3.87-89.4 and Shunt-block odds ratio, 1.57; 95% CI, 0.46-5.35), single ventricle physiology (odds ratio, 4.70; 95% CI, 2.34-9.45), and gestation (odds ratio, 0.84/wk increase; 95% CI, 0.74-0.96). CONCLUSIONS Infants who suffer major adverse event due to over-Shunting experience considerably poorer outcomes than those who experience events due to Shunt block. A mainly hypoxic event with maintenance of systemic perfusion (as often seen in a blocked Shunt) is less likely to result in poorer outcomes than those after a hypoxic-ischemic event (commonly seen in over-Shunting).