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Craniofacial Regeneration—Bone
Published in Vincenzo Guarino, Marco Antonio Alvarez-Pérez, Current Advances in Oral and Craniofacial Tissue Engineering, 2020
Laura Guadalupe Hernandez, Lucia Pérez Sánchez, Rafael Hernández González, Janeth Serrano-Bello
Maternal illnesses could be because of congenital craniofacial disorder, the greatest risks associated with type 1 diabetes mellitus are a cleft lip, Cleft Palate (CP), and Pierre Robin Sequence (PRS). On the other hand, illness relating to craniofacial anomalies are phenylketonuria affecting women who do not follow a phenylalanine-restricted diet. The elevated levels of the metabolites of phenylalanine can cause multiple anomalies, including microcephaly, ear anomalies, congenital heart defects and CP.
Biomechanical evaluation of a novel mandibular distraction osteogenesis protocol: an in-vitro validation and the practical use of the method
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
A. T. Şensoy, I. Kaymaz, Ü. Ertaş
MDO is one of the most important and difficult CMF operations, and has been accepted as a reliable procedure to correct severe mandibular retrognathia and Pierre Robin sequence (Lam et al. 2014; Breik et al. 2016). However, one of the most critical points in this process is callus stability. If sufficient stability is not provided, hypertrophic nonunion develops in the osteotomy site and thus may lead to the failure of MDO operation (Kocaoğlu et al. 2003). Therefore, in order to prevent the MDO failure, this study aims to optimize the most important operation parameters such as the osteotomy line, distraction vector and the screw configuration. Even though this method was numerically validated in the previous study of the authors’ (Şensoy et al. 2020), an experimental validation of the proposed method is required for further clinical studies, thus presented in this paper.
Intermediate outcomes of transcatheter pulmonary valve replacement with the Edwards Sapien 3 valve – German experience
Published in Expert Review of Medical Devices, 2019
Anja Lehner, Tsvetina Dashkalova, Sarah Ulrich, Silvia Fernandez Rodriguez, Guido Mandilaras, Andre Jakob, Robert Dalla-Pozza, Marcus Fischer, Heike Schneider, Gleb Tarusinov, Christoph Kampmann, Michael Hofbeck, Ingo Dähnert, Majed Kanaan, Nikolaus A. Haas
The cohort comprises a 0% mortality and low complication rate. In two patients valve deployment was not successful due to balloon rupture during inflation within the prestented RVOT. Retrieval of the partial opened valve was not possible so that surgical salvage procedures and valve replacement had been necessary. Both were patients with one-stage procedures and access from the right jugular vein. In the first case already prestenting had been difficult due to repetitive kinking of the delivering sheath. The second case was the smallest patient with only 11,8 kg and multiple comorbidities (i.e. Pierre-Robin-Sequence) in whom intense sheath maneuvering was necessary until prestent and valve were in place. Apart from these two patients, we experienced no procedural complications with the delivery system; The increased flexibility of the Commander system allowed smooth twists and turns toward the RVOT also via the left jugular vein when advanced slowly and carefully. However, in patients where already prestenting comes with difficulties to bring the stent in place, a transapical hybrid access for valve replacement might be the approach of choice [18]. The ability to be used with smaller sheaths (14–16 F) is one of the main advantages of the Edwards Sapien 3 valves. The lower profile is amongst others due to the intravascular aligning maneuver: Once positioned within the inferior vena cava, the crimped valve is moved onto the balloon of the delivery catheter using a pusher. This maneuver may cause damages to the delivery balloon already. Further manipulation and twisting toward the RVOT may be another obstacle. An often-noted drawback of the current system is that the valve has to be delivered more or less unprotected and can get captured within the tricuspid valve apparatus, causing severe tricuspid valve damage. This complication is pointed out in recent reports about TPVR with the Sapien valves [18,19]. Future systems might deal with this weakness facing a revised delivery design. Another approach may be the usage of long sheaths, as proposed by some other authors [20,21]. In our cohort, however, no severe tricuspid impairment or problems with the tricuspid valve were encountered, even in smaller patients. Concerning the balloon rupture in two of our patients, this could have happened – apart from the aligning process – due to the interaction of the system with the prestent struts. Prestenting was performed in 100% of our cases. For the Melody valve, prestenting is essential as it is known to reduce stent fractures which predestine to valve dysfunction and endocarditis [1,22]. The Sapien valve, designed for aortic pressure gradients, comes with a more rigid cobalt chromium stents and might not be as susceptible for strut fractures [23]. However, due to its smaller height, a predefined landing-zone was considered to be beneficial especially in cases with long segment outflow stenosis [18,24]. A recent report by Morgan et al. suggests TPVR with the Sapien XT and S3 valves completely without prestenting in selected cases. The authors can show that the procedure without prestenting was successful in all their 57 cases. No valve embolization or misplacement occurred. During follow-up (range 1 month to 2.2 years) no frame fractures and no significant obstruction or regurgitation were registered [24].