👤 Shilpa Deodhar

Right ventricular outflow tract (RVOT) anomalies in neonates and infants necessitate early intervention to restore adequate pulmonary blood flow and promote pulmonary artery (PA) growth. This study aimed to evaluate the immediate and intermediate-term outcomes of various transcatheter RVOT interventions in this vulnerable population. This prospective, single-center descriptive study enrolled 52 infants (aged <1 year) undergoing balloon pulmonary valvotomy (BPV, n=29), RVOT perforation with BPV and patent ductus arteriosus (PDA) stenting (n=11), or RVOT stenting (n=12) between February 2021 and November 2022. Key immediate outcomes included hemodynamic changes, procedural success, and in-hospital complications. Intermediate outcomes at three and six months assessed oxygen saturation (SpO2), weight gain, PA growth, and re-intervention rates. Overall six-month survival was high at 96.2% (50/52), with minimal procedural complications, which included two transient arrhythmias. In-hospital mortalities occurred in one BPV patient and one RVOT perforation patient, both attributed to non-procedural causes such as septic shock. BPV procedures achieved significant reductions in RV pressure (from 106±26.18 mmHg to 40.74±9.91 mmHg, p=0.04) and RVOT gradient (from 85.41±26.04 mmHg to 15.67±4.2 mmHg, p<0.0001), with a 14.3% re-intervention rate for restenosis by three months. For RVOT perforation with BPV and PDA stenting, there was marked hemodynamic improvement, with RV pressure decreasing from 105.36±18.98 mmHg to 40±12.06 mmHg (p<0.0001) and robust PA growth (RPA measuring 5.72±1.13 mm and LPA 5.10±0.93 mm at six months). Lastly, RVOT stenting was 100% successful, significantly improving SpO2 (from 73.83±5.46% to 86.83±4.61% at discharge) and enabling five infants to become candidates for complete intracardiac repair by six months. Transcatheter RVOT interventions are safe and effective strategies for managing RVOT anomalies in neonates and infants. These intervention strategies offer targeted benefits and improve clinical outcomes. Show less

Background Anacetrapib is the only cholesteryl ester transfer protein inhibitor proven to reduce coronary heart disease (CHD). However, its effects on reverse cholesterol transport have not been fully elucidated. Macrophage cholesterol efflux (CEC), the initial step of reverse cholesterol transport, is inversely associated with CHD and may be affected by sex as well as haptoglobin copy number variants among patients with diabetes mellitus. We investigated the effect of anacetrapib on CEC and whether this effect is modified by sex, diabetes mellitus, and haptoglobin polymorphism. Methods and Results A total of 574 participants with CHD were included from the DEFINE (Determining the Efficacy and Tolerability of CETP Inhibition With Anacetrapib) trial. CEC was measured at baseline and 24-week follow-up using J774 macrophages, boron dipyrromethene difluoride-labeled cholesterol, and apolipoprotein B-depleted plasma. Haptoglobin copy number variant was determined using an ELISA assay. Anacetrapib increased CEC, adjusted for baseline CEC, risk factors, and changes in lipids/apolipoproteins (standard β, 0.23; 95% CI, 0.05-0.41). This CEC-raising effect was seen only in men ( Show less