30^th European Pediatrics Conference October 07-08, 2019 Dublin, Ireland

Anne-Frederique Naviaux is a Consultant Psychiatrist and Child Psychiatrist, who finished her Masters in Psychiatry in 2004 (Universite Catholique de Louvain, Belgium). She worked in France as a ‘hospital practitioner’ in Child Psychiatry and for the World Health Organization, before joining the research department in Trinity College (Dublin, Ireland) in 2011. She has been a lecturer in France (IFSI) since 2004 but has also joined the College of Psychiatrists of Ireland in 2012. She currently works for the Health Service Executive in Ireland as Head of Service in Summerhill Adult Mental Health Centre (Wexford) and as Clinical Lead for Liaison Psychiatry in Wexford General Hospital (WGH). Since 2016, she has been developing in collaboration with the Paediatric Team in WGH and University Hospital Waterford, an out of hour’s emergency service for young people with Mental Health Issues.

Background: At the cross roads of feeding and eating disorders, Avoidant/Restrictive Food Intake Disorder (ARFID) is sometimes used as an “umbrella diagnosis” as it covers a certainly large and rather heterogeneous list of eating symptoms. It appeared in the DSM5 in 2013, but still, there are no clear guidelines re both diagnosis and treatment.

 

Purpose: Review and synthetize the latest publications on ARFID as a relatively new and emerging diagnostic category and also regarding the current pharmacological management/treatment options.

 

Subjects and methods: Between March 2018 and May 2019, a literature search based on electronic bibliographic databases as well as other sources of information (grey literature) was conducted in order to investigate the current ARFID characteristic and treatment modalities, especially regarding medication.

 

Results: ARFID patients have some identified characteristics that separate them from other patients with other eating disorders. Multiple molecules have been successfully tried in the ARFID management, usually in combination with at least one psycho-dynamic approach and various models of care.

 

Conclusion: This research offers the opportunity to discuss how to currently diagnose and manage this newly identified condition and more specifically the different pharmacological molecules that have been helpful for young patients with ARFID.

Donna Eaton is an internationally trained thoracic surgeon who was appointed at the Mater hospital Dublin in 2013. She has extensive experience in minimally invasive surgery including thoracoscopic and robotic surgery. Since taking up practice in Ireland, she has expanded the range of minimally invasive surgical approaches and specialist procedures offered to patients in the Republic of Ireland.

Introduction: There is a clear relationship between the left atrial appendage (LAA) and stroke in patients with nonvalvular AF. Recently, device closure of the LAA has emerged as a safe and effective alternative to anti-coagulation forsome patients. We present our experience of minimally invasive clipping of the LAA.

 

Results: We have performed thoracoscopic occlusion of the LAA using an epicardial clip (AtriClip) in 15 patients. LAA clipping was performed as a stand alone procedure, a hybrid procedure (in combination with catheter based ablation), part of a totally thoracoscopic AF ablation procedure or as an adjuvant in patients undergoing left thoracoscopic operations (e.g. lobectomy, lung biopsy). The clip is deployed epicardially over the base of the LAA under direct vision, effectively and reproducibly occluding the LAA.

 

In all cases the clip achieved complete LAA exclusion. It can be easily deployed via a minimally invasive surgical approach requiring only a short (30-45 minute) general anaesthetic. We have found minimally invasive LAA closure to be a safe, reliable and well-tolerated procedure.

 

Discussion: Unlike endocardial devices this method allows immediate cessation of anticoagulation medications, as the clip is placed epicardially there is no requirement for anticoagulation post deployment and no risk of complications related to device migration.

 

Thoracoscopic clipping of the LAA is an ideal option for:

• Patients who cannot tolerate/have contraindications to anticoagulation

• Patients in whom compliance to oral anticoagulation maybe an issue

Patients who experience thromboembolic events despite oral anti-coagulation.