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Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (MAPCAs) is a relatively rare and complex form of congenital heart disease. Unifocalization of MAPCAs has been advocated by some groups for the treatment of this condition. The purpose of this study was to assess the midterm fate of unifocalized MAPCAs in a cohort of patients with retroesophageal MAPCAs. This was a retrospective review of 37 patients who underwent a unifocalization procedure. All patients in this study had 1 or more retroesophageal MAPCAs, and detailed mapping of the MAPCAs was made based on a combination of the cardiac catheterization and surgical findings. The 37 patients had a total of 166 MAPCAs, or 4.5 MAPCAs per patient. One hundred twenty-nine (78%) MAPCAs were unifocalized, whereas 37 (22%) were ligated because they were dual supply. Median follow-up was 69 months. At follow-up cardiac catheterization, evaluation of the 129 unifocalized MAPCAs demonstrated that 123 (95%) had antegrade flow, whereas 6 were occluded. For the 123 MAPCAs with antegrade flow, 97 (80%) were widely patent, whereas 26 were stenotic. Thirteen of the 37 patients have subsequently undergone reintervention on MAPCAs that were determined to be stenotic following unifocalization. Seven of these patients had mild disease and had complete resolution with balloon (n = 5) or surgical revision (n = 2). Six patients with moderate or severe disease underwent surgical revision with confirmed resolution in 4 of 6. The data demonstrate that the majority of unifocalized MAPCAs remain widely patent following unifocalization. However, one-quarter of unifocalized MAPCAs develop stenoses or occlusion. These results suggest the fate for most unifocalized MAPCAs is favorable but highlight the need for close vigilance. Midterm fate of unifocalized MAPCAs. Ninety-five percent of unifocalized MAPCAs had antegrade flow at follow-up evaluation. Of these, 80% were widely patent, whereas 20% had some degree of stenosis. Reinterventions on MAPCAs with stenoses were 100% successful. [Display omitted] [ABSTRACT FROM AUTHOR]

Peripheral pulmonary artery stenosis (PPAS) is a relatively rare form of congenital heart disease often associated with Williams syndrome, Alagille syndrome, and elastin arteriopathy. This disease is characterized by stenoses at nearly all lobar and segmental ostia and results in systemic-level right ventricular pressures. The current study summarizes our experience with the surgical treatment of PPAS. This was a retrospective review of 145 patients who underwent surgical repair of PPAS. This included 43 patients with Williams syndrome, 39 with Alagille syndrome, and 21 with elastin arteriopathy. Other diagnoses include tetralogy of Fallot with PPAS (n = 21), truncus arteriosus (n = 5), transposition (n = 3), double-outlet right ventricle (n = 2), arterial tortuosity syndrome (n = 3), and other (n = 8). The median preoperative right ventricle to aortic peak systolic pressure ratio was 1.01 (range, 0.50-1.60) which was reduced to 0.30 (range, 0.17-0.60) postoperatively. The median number of ostial repairs was 17 (range, 6-34) and median duration of cardiopulmonary bypass was 398 minutes (range, 92-844). There were 3 in-hospital deaths (2.1%). The median duration of follow-up was 26 months (range, 1-220) with 4 late deaths (2.9%). Eighty-two patients have subsequently undergone catheterization and 74 had a pressure ratio <0.50. The surgical treatment of PPAS resulted in a 70% reduction in right ventricular pressures. At 3 years, freedom from death was 94% and 90% of those evaluated maintained low pressures. These results suggest that the surgical treatment of PPAS is highly effective in most patients. [Display omitted] [Display omitted] [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD)-related mortality has declined substantially in the United Kingdom (UK) in recent decades, but the continued relevance of conventional risk factors for prediction of CVD mortality throughout the life-course is uncertain. We compared the 10-year risks and lifetime risks of CVD mortality associated with conventional risk factors recorded in middle and old age. The Whitehall study was a prospective study of 19,019 male London civil servants (mean age 52 years) when enrolled in 1967–1970 and followed-up for 50 years for cause-specific mortality. In 1997, 7044 (83%) survivors (mean age 77 years) were re-surveyed. The 10-year and lifetime risks of CVD mortality were estimated by levels of CVD risk factors recorded in middle-age and old-age, respectively. By July 2020, 97% had died (22%, 51% and 80% before age 70, 80 and 90 years, respectively) and 7944 of 17,673 deaths (45%) were from CVD. The 10-year and lifetime risks of CVD death increased linearly with higher levels of CVD risk factors recorded in middle-age and in old-age. Individuals in the top versus bottom 5% of CVD risk scores in middle age had a 10.3% (95% CI:7.2–13.4) vs 0.6% (0.1–1.2) 10-year risk of CVD mortality, a 61.4% (59.4–65.3) vs 31.3% (24.1–34.5) lifetime risk of CVD mortality and a 12-year difference in life expectancy from age 50 years. The corresponding differences using a CVD risk score in old-age were 11.0% (4.4–17.5) vs 0.8% (0.0–2.2) for 10-year risk and 42.1% (28.2–50.0) vs 30.3% (6.0–38.0) for lifetime risk of CVD mortality and a 6-year difference in life expectancy from age 70 years. Conventional risk factors remained highly predictive of CVD mortality and life expectancy through the life-course. The findings highlight the relevance of estimation of both lifetime risks of CVD and 10-year risks of CVD for primary prevention of CVD. [ABSTRACT FROM AUTHOR]

• Conducted latent profile analyses of emerging adults' social media use. • Distinguished screen time from engagement and general from alcohol-related. • Various forms of engagement seem to matter more than screen time. • The highest active engagers online might be the most at-risk for alcohol misuse. Nearly all U.S. emerging adults use social media at least daily, and most discuss their offline activities online, including their alcohol misuse. As a result, developing evidence finds a correlation between social media use and offline alcohol drinking, suggesting that social media may be a novel risk factor for alcohol misuse. However, there are conflicting findings about what specific function of social media use is risker – does the amount of time spent online or the types of online activities matter more? Our multidisciplinary team of human–computer interactionists, social workers, and public health scholars aimed to refine our understanding of the association between emerging adult social media use and alcohol misuse. To do so, we conceptualized social media use as a multidimensional construct, examining how much time emerging adults spend online (i.e., screen time) and their different online activities (i.e., social media engagement , such as posting pictures or reacting to posted content [e.g., liking shared pictures]). Taking this conceptualization a step further, we distinguished general online activities (i.e., general social media engagement , such as sharing pictures of food) from those explicitly related to offline alcohol consumption (i.e., alcohol-related social media engagement , such as sharing a video of someone drinking alcohol at a party). Finally, we examined if different levels of these three conceptualizations of social media use were risk factors for alcohol misuse and related negative consequences. We collected survey data from 249 emerging adults on Amazon Mechanical Turk. Using latent profile analyses, we attempted to distinguish the different ways we conceptualized social media use (i.e., screen time from general social media engagement and alcohol-related social media engagement.) We then examined whether significant differences existed between identified profiles and various alcohol-related outcomes in a typical and heavy drinking week. We identified 3-profile solutions for both screen time (low, medium, and high) and general social media engagement (minimum, moderate, and high) and a 2-profile solution for alcohol-related social media engagement (minimal and moderate). When we assessed for alcohol risk, screen time was not related to drinking at all (neither frequency nor quantity), not even for emerging adults who reported using social media almost constantly. However, during a heavy drinking week, those who moderately post alcohol-related content online drank more heavily and had more binge drinking days. Notably, and contrary to previous research, emerging adults who reported high general social media engagement were most at risk for binge drinking and experiencing more alcohol-related negative consequences. Findings underscore the importance of considering various forms of social media engagement – and not screen time – when studying the harms associated with using social media, including offline risk-taking behaviors like alcohol misuse. Results indicate that research, interventions, and clinical practice that target and treat emerging adult alcohol misuse should assess their social media behavior, concentrating on their engagement. This is especially true for the highest general engaging emerging adults who almost constantly post, respond, and react while online; these individuals might be the most at-risk and need support. [ABSTRACT FROM AUTHOR]