bims-hylehe 2018-05-13 papers

Can J Cardiol. 2018 Apr 25. pii: S0828-282X(18)30320-9. [Epub ahead of print]

Early Hum Dev. 2018 May 03. pii: S0378-3782(18)30305-0. [Epub ahead of print]

WASP (Write a Scientific Paper): Special cases of selective non-treatment and/or DNR.

Fetuses at low gestational age limit of viability, neonates with life threatening or life limiting congenital anomalies and deteriorating acutely ill newborn babies in intensive care, pose taxing ethical questions on whether to forego or stop treatment and allow them to die naturally. Although there is essentially no ethical difference between end of life decision between neonates and other children and adults, in the former, the fact that we are dealing with a new life, may pose greater problems to staff and parents. Good communication skills and involvement of all the team and the parents should start from the beginning to see which treatment can be foregone or stopped in the best interests of the child. This article deals with the importance of clinical ethics to avoid legal and moral showdowns and discusses accepted moral practice in this difficult area.

Keywords: EU directive; Ethics approval; Information; Obligations; Research ethics committees; Rights

DOI: https://doi.org/10.1016/j.earlhumdev.2018.04.027

Int J Cardiovasc Imaging. 2018 May 05.

Yamasaki Y, Kawanami S, Kamitani T, Sagiyama K, Shin S, Hino T, Nagata H, Yabuuchi H, Nagao M, Honda H.

To investigate the performance of second-generation 320-row computed tomographic (CT) angiography (CTA) in detecting coronary arteries and identify factors influencing visibility of the coronary arteries in infants with complex congenital heart disease (CHD). Data of 60 infants (aged 0-2 years, median 2 months) with complex CHD who underwent examination using 320-row CTA with low-dose prospective electrocardiogram-triggered volume target scanning were reviewed. The coronary arteries of each infant were assessed using a 0-4-point scoring system based on the number of coronary segments with a visible course. Clinical parameters, the CT value in the ascending aorta, image noise, and the radiation dose were subjected to univariate and multivariate analyses. The mean coronary score for all examinations was 2.6 ± 1.5 points. The mean attenuation in the ascending aorta was 306.7 ± 66.2 HU and the mean standard deviation was 21.7 ± 4.4. The mean effective radiation dose was 1.27 ± 0.39 mSv. Multivariate regression analysis showed significant correlations between coronary score and body weight (p < 0.05) and between coronary score and the CT value in the ascending aorta (p < 0.02). Second-generation 320-row CTA with prospective electrocardiogram-triggered volume target scanning and hybrid iterative reconstruction allows good visibility of the coronary arteries in infants with complex CHD. Body weight and the CT value in the ascending aorta are important factors influencing the visibility of the coronary arteries in infants.

Keywords: CT angiography; Congenital heart defect; Coronary arteries; Coronary vessel anomalies; Infants

DOI: https://doi.org/10.1007/s10554-018-1363-8