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Leiria TLL, Cabral IW, Schäfer S, Nicoloso LHS, Filho RIR, Kruse ML, Saffi MAL, de Lima GG. Catheter ablation of typical right atrial flutter in a 20-day-old neonate with tachycardiomyopathy. J Arrhythm 2024; 40:184-190. [PMID: 38333389 PMCID: PMC10848628 DOI: 10.1002/joa3.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 02/10/2024] Open
Abstract
Background Fetal echocardiography can diagnose neonatal atrial flutter, which can cause heart failure in newborns. Little is known about catheter ablation in this population. Methods Case report that aimed to review a successful ablation in a 20-day-old patient with refractory atrial flutter. Results This is the first report of a successful neonatal atrial flutter ablation without any early recurrence after the procedure. Conclusions Atrial flutter ablation performed on newborns is a reliable and long-lasting treatment option.
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Affiliation(s)
- Tiago Luiz Luz Leiria
- Cardiology InstitutePorto AlegreBrazil
- Postgraduation Program in Cardiology UFRGSPorto AlegreBrazil
| | | | | | | | | | | | - Marco Aurélio Lumertz Saffi
- Postgraduation Program in Cardiology UFRGSPorto AlegreBrazil
- Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | - Gustavo Glotz de Lima
- Cardiology InstitutePorto AlegreBrazil
- Federal University of Health SciencesPorto AlegreBrazil
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2
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Svintsova LI, Krivolapov SN, Dzhaffarova OY, Plotnikova IV. Long-term follow-up in preschool children after radiofrequency catheter ablation of arrhythmias. J Arrhythm 2023; 39:405-411. [PMID: 37324759 PMCID: PMC10264725 DOI: 10.1002/joa3.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 03/12/2023] Open
Abstract
Background Radiofrequency ablation (RFA) is the standard method of treatment for tachyarrhythmias in school children, and it leads to complete recovery in children without structural heart disease. However, RFA in young children is limited by the risk of complications and unstudied remote effects of radiofrequency lesions. Objective To present the experience of RFA of arrhythmias and the results of follow-up of younger children. Materials and Methods RFA procedures (n = 255) were performed in 209 children with arrhythmias from 0 to 7 years old. The arrhythmias were presented with atrioventricular reentry tachycardia with Wolff-Parkinson-White (WPW) syndrome (56%), atrial ectopic tachycardia (21.5%), atrioventricular nodal reentry tachycardia (4.8%), and ventricular arrhythmia (17.2%). Results The overall effectiveness of RFA, considering the repeated procedures performed due to the primary ineffectiveness and recurrencies, was 94.7%. There was no mortality associated with RFA in patients, including young patients. All cases of "major" complications are associated with RFA of the left-sided accessory pathway and tachycardia foci and are represented by the mitral valve damage in three patients (1.4%). Tachycardia and preexcitation recurred in 44 (21%) patients. There was a correlation between recurrences and parameters of RFA (odds ratio 0.894; 95% confidence interval: 0.804-0.994; p = .039). Reducing the maximum power of effective applications in our study increased the risk of recurrence. Conclusion The use of the minimum effective parameters of RFA in children reduces the risk of complications, but increases arrhythmia recurrence rate.
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He J, Yi Z, Meiting L, Huiming Z, Jinhao L, Danlei C, Xiaomei L. A novel image integration technology mapping system significantly reduces radiation exposure during ablation for a wide spectrum of tachyarrhythmias in children. Front Pediatr 2023; 11:1148745. [PMID: 37090928 PMCID: PMC10117812 DOI: 10.3389/fped.2023.1148745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023] Open
Abstract
Objective Radiofrequency catheter ablation (RFCA) has evolved into an effective and safe technique for the treatment of tachyarrhythmia in children. Concerns about children and involved medical staff being exposed to radiation during the procedure should not be ignored. "Fluoroscopy integrated 3D mapping", a new 3D non-fluoroscopic navigation system software (CARTO Univu Module) could reduce fluoroscopy during the procedure. However, there are few studies about the use of this new technology on children. In the present study, we analyzed the impact of the CARTO Univu on procedural safety and fluoroscopy in a wide spectrum of tachyarrhythmias as compared with CARTO3 alone. Methods The data of children with tachyarrhythmias who underwent RFCA from June 2018 to December 2021 were collected. The CARTO Univu was used for mapping and ablation in 200 cases (C3U group) [boys/girls (105/95), mean age (6.8 ± 3.7 years), mean body weight (29.4 ± 7.9 kg)], and the CARTO3 was used in 200 cases as the control group (C3 group) [male/female (103/97), mean age (7.2 ± 3.9 years), mean body weight (32.3 ± 19.0 kg)]. The arrhythmias were atrioventricular reentrant tachycardia (AVRT, n = 78), atrioventricular node reentrant tachycardia (AVNRT, n = 35), typical atrial flutter (AFL, n = 12), atrial tachycardia (AT, n = 20) and ventricular arrhythmias [VAs, premature ventricular complexes or ventricular tachycardia, n = 55]. Results ① There was no significant difference in the acute success rate, recurrence rate, and complication rate between the C3 and C3U groups [(94.5% vs. 95.0%); (6.3% vs. 5.3%); and (2.0% vs. 1.5%); P > 0.05]. ② The CARTO Univu reduced radiation exposure: fluoroscopy time: AVRT C3: 8.5 ± 7.2 min vs. C3U: 4.5 ± 2.9 min, P < 0.05; AVNRT C3: 10.7 ± 3.2 min vs. C3U: 4.3 ± 2.6 min, P < 0.05; AT C3: 15.7 ± 8.2 min vs. C3U: 4.5 ± 1.7 min, P < 0.05; AFL C3: 8.7 ± 3.2 min vs. C3U: 3.7 ± 2.7 min, P < 0.05; VAs C3: 7.7 ± 4.2 min vs. C3U: 3.9 ± 2.3 min, P < 0.05. Corresponding to the fluoroscopy time, the fluoroscopy dose was also reduced significantly. ③ In the C3U group, the fluoroscopy during VAs ablation was lower than that of other arrhythmias (P < 0.05). Conclusion The usage of the "novel image integration technology" CARTO Univu might be safe and effective in RFCA for a wide spectrum of tachyarrhythmias in children, which could significantly reduce fluoroscopy and has a more prominent advantage for VAs ablation.
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Affiliation(s)
- Jiang He
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Zhang Yi
- Department of Pediatrics, Heart Center, The First Affiliated Hospital of Tsinghua University, Beijing,China
| | - Li Meiting
- Department of Pediatrics, Heart Center, The First Affiliated Hospital of Tsinghua University, Beijing,China
| | - Zhou Huiming
- Department of Pediatrics, Heart Center, The First Affiliated Hospital of Tsinghua University, Beijing,China
| | - Li Jinhao
- Department of Pediatrics, Heart Center, The First Affiliated Hospital of Tsinghua University, Beijing,China
| | - Chen Danlei
- Department of Pediatrics, Heart Center, The First Affiliated Hospital of Tsinghua University, Beijing,China
| | - Li Xiaomei
- Department of Pediatrics, Heart Center, The First Affiliated Hospital of Tsinghua University, Beijing,China
- Correspondence: Li Xiaomei
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Dubin AM, Bar‐Cohen Y, Berul CI, Cannon BC, Saarel EV, Shah MJ, Triedman JK. Pediatric Electrophysiology Device Needs: A Survey from the Pediatric and Congenital Electrophysiology Society Taskforce on Pediatric‐Specific Devices. J Am Heart Assoc 2022; 11:e026904. [DOI: 10.1161/jaha.122.026904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background
There are few US Food and Drug Administration (FDA)–approved devices specifically aimed at the pediatric patient with arrhythmia. This has led to a high off‐label utilization of devices in this vulnerable population. The Pediatric and Congenital Electrophysiology Society (PACES), the international organization representing pediatric and congenital heart disease arrhythmia specialists, developed a task force to comprehensively address device development issues relevant to pediatric patients with congenital arrhythmia.
Methods and Results
As a first step, the taskforce developed a 26‐question survey for the pediatric arrhythmia community to assess providers’ understanding of the FDA approval process, specifically in regard to pediatric labeling. There were 92/211 respondents (44%) with a >90% completion rate. The vast majority of respondents believed there was a paucity of devices available for children (96%). More than 60% of respondents stated that they did not understand the FDA regulatory process and were not aware of whether the devices they used were labeled for pediatric use.
Conclusions
Pediatric electrophysiologists are keenly aware of the deficit of available pediatric devices for their patients. The majority do not understand the FDA approval process and could benefit from additional educational resources regarding this. A collaborative forum including PACES, FDA, patients and their families, and Industry would be an important next step in clarifying opportunities and priorities to serve this vulnerable population.
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Affiliation(s)
- Anne M. Dubin
- Lucile Packard Children’s Hospital at Stanford Stanford University Palo Alto CA
| | - Yaniv Bar‐Cohen
- Children’s Hospital Los Angeles University of Southern California Los Angeles CA
| | | | | | | | - Maully J. Shah
- Children’s Hospital of Philadelphia University of Pennsylvania Philadelphia PA
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5
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Melo SLD, Carvalho JND, Monge NMS, Sousa IBDS, Pisani CF, Scanavacca M. Catheter Ablation in Neonate with Heart Failure Due to Incessant Atrioventricular Reentrant Tachycardia. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pre-excitation cardiac problems in children: recognition and treatment. Eur J Pediatr 2020; 179:1197-1204. [PMID: 32529398 DOI: 10.1007/s00431-020-03701-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
The prevalence of ventricular pre-excitation is 0.07-0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber is relatively rare. Approximately, 30-60% of children with ventricular pre-excitation have onset of atrioventricular reentrant tachycardia. Persistent atrioventricular reentrant tachycardia can lead to tachycardiomyopathy. The anterograde conduction of right accessory pathway might lead to ventricular systolic dyssynchrony which might result in cardiac dysfunction even in patients with no tachycardia onset. This type of dilated cardiomyopathy was named as accessory pathway-induced dilated cardiomyopathy. Antiarrhythmic drugs can be used to acutely terminate tachycardia or taken orally to decrease tachycardia recurrence in the long term. However, antiarrhythmic drugs that can be chosen for children are quite limited. Sotalol has become a new choice. With the maturation of radiofrequency catheter ablation technique, progress in three-dimensional electro-anatomic mapping, use of cryoablation, and accumulation of experience in children with small age and weight, catheter ablation has become the first choice for children with pre-excitation syndrome.Conclusion: For ventricular pre-excitation co-exists with dilated cardiomyopathy, differential diagnosis of tachycardiomyopathy or accessory pathway-induced dilated cardiomyopathy should be considered. Catheter ablation (radiofrequency and cryoablation) is a relatively safe and effective treatment option and has become the first choice to treat children with ventricular pre-excitation. What is Known: • Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy; • Antiarrhythmic drugs that can be chosen for children are quite limited. What is New: • The anterograde conduction of right accessory pathway (not related to supraventricular tachycardia) might lead to accessory pathway-induced dilated cardiomyopathy. • Catheter ablation (including radiofrequency and cryoablation) has become the first choice for children with pre-excitation syndrome.
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Kilinc OU, Zhao X, Jenkins MW, Snyder CS, Rollins AM. Imaging of Atrioventricular Nodal Conduction Tissue in Porcine Hearts Using Optical Coherence Tomography. J Innov Card Rhythm Manag 2020; 10:3675-3680. [PMID: 32477734 PMCID: PMC7252643 DOI: 10.19102/icrm.2019.100601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
Optical coherence tomography (OCT) employs near-infrared light to image the microstructure of different tissues. Clinically, it has been used to image the walls of coronary arteries. In research settings, one of the applications for OCT is visualizing endocardial and subendocardial structures. The present experiment sought to determine whether OCT can identify native conduction tissues in adult porcine hearts. During the study, the right atrial endocardial surfaces of excised adult porcine hearts were exposed. The triangle of Koch was imaged with the OCT system and the conduction tissue was identified. The area was then prepared for histologic examination with Masson's trichrome stain. The results of histologic preparations and OCT images were then compared. Ultimately, nine porcine hearts were examined using this methodology. OCT imaging successfully identified subendocardial structures presumed to be the compact atrioventricular node. Histologic images of the preparations delineated the different tissue types and conduction tissue was easily identified. The location of distinctive hyporeflective areas in the OCT images correlated with the location of conduction tissue in the histology images. In light of the findings of this study, it is suggested that atrioventricular nodal tissue can be identified by OCT in freshly dissected unfixed porcine hearts. OCT images distinguished the differentiated conduction tissue in close proximity with the endocardium, myofibers, and fibrous tissue, and the success of this was verified with histology. This technology may be useful for the direct visualization of the native conduction system during procedures in the operating room and electrophysiology laboratory. Further studies with perfused tissue samples and live animal experiments are needed to better assess the efficacy of this novel application.
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Affiliation(s)
- Orhan U Kilinc
- Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA
| | - Xiaowei Zhao
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Michael W Jenkins
- Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Christopher S Snyder
- Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA
| | - Andrew M Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Wang G, Chen G, Huang X, Hu J, Yu X. Application of Radiofrequency Ablation in Treatment of Tachyarrhythmia based on CartoUnivu and Carto3 Intelligent System (Preprint). JMIR Med Inform 2020. [DOI: 10.2196/18573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Fogelman R, Birk E, Dagan T, Fogelman M, Einbinder T, Bruckheimer E, Swissa M. Catheter ablation of left-sided accessory pathways in small children. J Arrhythm 2019; 35:742-747. [PMID: 31624515 PMCID: PMC6787155 DOI: 10.1002/joa3.12219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/17/2019] [Accepted: 06/17/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Accessory pathways (APs) are a common reason for supraventricular tachycardia in small children. Trans-septal puncture (TSP) approach is commonly used for the ablation of left-sided APs, however it may be challenging in small children. The aim of this study was to assess the efficacy and safety of trans-septal approach radiofrequency (RF) ablation of left-sided APs in children weighing up to 30 kg. METHODS Of the 658 children who underwent catheter ablation of APs since 06/2002, 86 children had left-sided AP and weighed less than 30 kg. TSP approach guided with TEE and fluoroscopy was used for left atrium access. RESULTS The mean age, height, and body weight were 7.6 ± 1.9 years, 122.4 ± 9.3 cm and 24.0 ± 4.2 kg, respectively. Forty-three children (50%) were male, 46 of 86 (53%) had manifest AP, 17 of 86 (20%) weighed less than 20 kg and in 24 of 86 children (28%) a three-dimensional system (3DS) was used to reduce fluoroscopy time. The acute success rate was 98.8% (85/86), with a recurrence rate of 2.4% (2/85) in a mean follow-up of 66.2 ± 42.7 (9.1-184.2) months. The mean procedure time and fluoroscopy time were significantly lower for the 3DS group compared to the standard fluoroscopy group 131 ± 41 (55-262) and 2.4 ± 1.5 (1-6) minutes vs 164 ± 51 (62-249) and 27 ± 13 (8-77) minutes, P < 0.01 and P < 0.0001, respectively. There were no ablation-related complications. CONCLUSIONS RF ablation of left-sided APs using TSP approach in small children had an excellent efficacy and safety profile. The use of 3DS significantly reduces the procedure and fluoroscopy time.
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Affiliation(s)
- Rami Fogelman
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Einat Birk
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Tamir Dagan
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Michal Fogelman
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Tom Einbinder
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Elchanan Bruckheimer
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Moshe Swissa
- Kaplan Medical Center, The Hebrew UniversityRehovotJerusalemIsrael
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Moore EF, Pak J, Jefferis-Kirk C, Armatage A, Kronmal RA, Salerno JC, Files MD. Development and Implementation of a Standardized Heparin Protocol for Left-Sided Pediatric Electrophysiology Procedures. Pediatr Cardiol 2018; 39:941-947. [PMID: 29500504 DOI: 10.1007/s00246-018-1843-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/23/2018] [Indexed: 11/29/2022]
Abstract
Heparin is used to decrease the risk of thromboembolic complications during electrophysiology studies (EPS); however, there is wide practice variation and minimal evidence to guide heparin dosing, particularly in pediatric patients. This study retrospectively analyzed heparin dosing and response, measured via activated clotting time (ACT), in patients undergoing EPS and used these data (pre-protocol cohort, n = 40), as well as guidance from available literature to implement a standardized heparin protocol (phase 1, n = 43). We utilized quality improvement methodology to refine this protocol (phase 2, n = 40) to improve therapeutic heparin response. Prior to the protocol, patients achieved therapeutic ACT levels (250-350 s) only 35% of the time which improved to 60% during phase 1 (p < 0.05) and to 73% during phase 2 (p < 0.001 compared to pre-protocol). There were no thromboses or significant adverse events in any group. These results demonstrate the effectiveness of a standardized heparin protocol in achieving effective antithrombotic therapy during left-sided pediatric EPS.
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Affiliation(s)
- Emily F Moore
- Division of Cardiology and Cardiac Surgery, Heart Center at Seattle Children's Hospital, 4800 Sand Point way NE Mail Stop RC 2.820, Seattle, WA, 98105, USA.
| | - Jennifer Pak
- Department of Pharmacy, Seattle Children's Hospital, 4800 Sand Point Way NE, Mail stop BM.5.420, Seattle, WA, 98105, USA
| | - Christa Jefferis-Kirk
- Department of Pharmacy, Seattle Children's Hospital, 4800 Sand Point Way NE, Mail stop BM.5.420, Seattle, WA, 98105, USA
| | - Arlene Armatage
- Division of Cardiology and Cardiac Surgery, Heart Center at Seattle Children's Hospital, 4800 Sand Point way NE Mail Stop RC 2.820, Seattle, WA, 98105, USA
| | - Richard A Kronmal
- Department of Biostatistics, Collaborative Health Studies Coordinating Center, University of Washington, Bldg. 29, 6200 NE 74th St., Seattle, WA, 98115, USA
| | - Jack C Salerno
- Division of Pediatric Cardiology, Department of Pediatrics, University of Washington, 1959 NE Pacific St., Health Sciences Bldg., Seattle, WA, 98195, USA
| | - Matthew D Files
- Division of Pediatric Cardiology, Department of Pediatrics, University of Washington, 1959 NE Pacific St., Health Sciences Bldg., Seattle, WA, 98195, USA
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