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Fontan fenestration decreases central venous pressure and preserves cardiac output while decreasing systemic oxygen saturation. Transcatheter fenestration closure increases oxygen saturation, though the persistence of this increase and the long-term incidence of adverse outcomes such as death and heart transplant remain unknown. We describe immediate and long-term clinical and adverse outcomes following fenestration closure. Catheterization, echocardiogram, and clinic reports were reviewed following transcatheter Fontan fenestration closure. Data were reported as n (%) and median (IQR). Continuous variables were compared using Wilcoxon ranked sum test. 51 patients had fenestration closure 0.9 (0.7–1.5) years following extracardiac Fontan operation. Most (84%) were closed with Amplatzer Septal Occluders. Systemic O2 saturation immediately increased from 87 (83–89) to 95 (94–97)%, P < 0.05. Cardiac index decreased from 4 (3–5) to 2.9 (2.6–3.5) L/min/m2. Fontan pressure and pulmonary vascular resistance were not significantly changed. Clinical follow-up duration for all patients was 7.3 (range 1.3–16) years. Oxygen saturation at last follow-up was 94.5 (92–97)% and did not decrease over time (P < 0.05). One patient (2%) developed protein losing enteropathy, 1 (2%) had heart transplant, and 1 (2%) patient died 9.4 years following fenestration closure. No patient required fenestration re-creation following closure. Transcatheter Fontan fenestration closure leads to sustained increases in systemic oxygen saturation and a low incidence of adverse outcomes such as death and transplant. Further study comparing fenestration closure to non-closure and longer follow-up duration are required to determine if there is a survival benefit to fenestration closure. [ABSTRACT FROM AUTHOR]

The present paper intends to develop an analytical condition for an interest rate swap (variable rate for fixed rate) to be beneficial and examines the incidence and effectiveness of swaps in the Canadian university sector. The paper demonstrates the lack of any cost advantage in a two-party swap through a contradiction analysis and then tests whether there is evidence that the use of this derivative is indeed acting (or not) as an effective risk management tool. The paper also applies a nonparametric Kruskal-Wallis test to determine whether the size of the university is a factor in the effectiveness of swap. Of the 31 Canadian universities using swaps, only five pass the analytical condition to be judged as an effective swap. The balance fails the test, indicating that the usage of the swap, in essence, unhedges a natural hedge that the institution had. The results also indicate that university size plays a role in whether the hedge is effective or not. This paper is unique in applying a quantitative test to determine swap effectiveness in the Canadian university sector. It also points to the necessity for management of these institutions to better understand the effects and uses of derivative financing instruments for hedging purposes. [ABSTRACT FROM AUTHOR]

Right ventricular outflow tract (RVOT) conduit stenosis remains a significant problem for patients with right ventricle-to-pulmonary artery (RV-to-PA) conduits placed as palliation for congenital heart disease. Previous reports on balloon dilation of RVOT conduits all describe small series with varying levels of success during limited follow-up evaluation. This study reviewed all patients with RV-to-PA conduits who underwent percutaneous balloon dilation for conduit stenosis at the authors' institution from 2000 to 2011. Patients with Carpentier-Edwards (CE) model 4300 porcine-valved conduits (Edwards Lifesciences Corp., Irvine, CA) ( n = 19) were compared with patients who had all other types of conduits ( n = 19). Successful balloon angioplasty was defined as a 20 % decrease in the RV-to-PA gradient, a 20 % decrease in the ratio of the RV systolic-to-aortic systolic pressure, or both. Balloon dilation was successful for 57.9 % of the patients with CE conduits and for 31.6 % of patients with other types of conduits ( p = 0.10, Chi square test). Logistic regression analysis showed that balloon dilation was significantly more likely to be successful with CE valves than with other types (odds ratio [OR], 6.59; 95 % confidence interval [CI], 1.22-35.49). In a continuous series of patients with stenotic RV-to-PA conduits, the CE porcine-valved conduit was more amenable to percutaneous balloon dilation than other types of RV-to-PA conduits at the midterm follow-up evaluation. This has important ramifications in terms of valve selection for patients with congenital heart disease who will require surgical reintervention for RVOT stenosis. [ABSTRACT FROM AUTHOR]