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Amir G, Lowenthal A, Bruckheimer E, Dagan T, Schiller O, Shostak E, Frenkel G, Birk E. Three-Patch Reconstruction of Hourglass Supravalvar Pulmonary Artery Stenosis Mid-Term Results. World J Pediatr Congenit Heart Surg 2024; 15:89-93. [PMID: 37853700 DOI: 10.1177/21501351231196485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Some patients with pulmonary stenosis present with a complex multilevel disease that involves the valve, the leaflets, and the sinotubular junction (STJ) forming an hourglass appearance. We herein report the mid-term results of our experience with the reconstruction of the supravalvar narrowing using three pericardial patches. MATERIAL AND METHODS Retrospective analysis of patient charts and echocardiography studies of patients who underwent three-patch reconstruction of the pulmonary valve (PV) from 2013 to 2022. After PV transection distal to STJ, vertical incisions into the sinuses were performed, and leaflets were trimmed and thinned. The three sinuses were augmented using three pericardial patches. RESULTS Nineteen patients underwent repair of hourglass supravalvar pulmonary stenosis. Mean weight at surgery was 9.4 kg (median 7.2, range 4.7-35); 16 patients underwent previous catheterization with unsuccessful balloon dilatation of the PV (13 pts.). Preoperative aortic/pulmonary annulus ratio was 1.02 (median 1, range 0.89-1.25). After surgery, gradients across the PV were significantly reduced (94 ± 26 vs 29 ± 9 mm Hg, P = .02). Postoperatively, 14 patients had mild or no pulmonary insufficiency (PI) and five had mild to moderate PI. At a mean follow-up of 71 months (median 78 months, range 8-137), gradients continued to decrease (29 ± 9 vs 15 ± 5 mm Hg, P < .001). CONCLUSION The three-patch technique for the repair of supravalvar pulmonary stenosis is simple, reproducible, and achieves excellent and long-standing relief of the right ventricular outflow tract gradient.
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Affiliation(s)
- Gabriel Amir
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lowenthal
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Elchanan Bruckheimer
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Tamir Dagan
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ofer Schiller
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Eran Shostak
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Georgy Frenkel
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Einat Birk
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Soffair N, Shostak E, Dagan O, Manor-Shulman O, Feinstein Y, Amir G, Frenkel G, Rotstein A, Dvir-Orgad M, Birk E, Yacobovich J, Schiller O. Pediatric Mechanical Circulatory Support: Introduction and Schneider's Experience. Isr Med Assoc J 2023; 25:819-825. [PMID: 38142322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
BACKGROUND Ventricular assist devices (VADs) play a critical and increasing role in treating end-stage heart failure in pediatric patients. A growing number of patients are supported by VADs as a bridge to heart transplantation. Experience with VADs in the pediatric population is limited, and experience in Israel has not been published. OBJECTIVES To describe this life-saving technology and our experience with VAD implantation in children with heart failure, including characteristics and outcomes. METHODS We conducted a retrospective chart review of all patients who underwent VAD implantation at Schneider Children's Medical Center from 2018 to 2023. RESULTS We analyzed results of 15 children who underwent VAD implantation. The youngest was 2.5 years old and weighed 11 kg at implantation. In eight patients, HeartMate 3, a continuous-flow device, was implanted. Seven patients received Berlin Heart, a pulsatile-flow device. Three children required biventricular support; 11 underwent heart transplants after a median duration of 169 days. Two patients died due to complications while awaiting a transplant; two were still on VAD support at the time of submission of this article. Successful VAD support was achieved in 86.6% of patients. In the last 5 years,79% of our heart transplant patients received VAD support prior to transplant. CONCLUSIONS Circulatory assist devices are an excellent bridge to transplantation for pediatric patients reaching end-stage heart failure. VADs should be carefully selected, and implantation techniques tailored to patient's weight and diagnosis at a centralized pediatric cardiac transplantation center. Israeli healthcare providers should be cognizant of this therapeutic alternative.
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Affiliation(s)
- Niv Soffair
- Pediatric Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Eran Shostak
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ovadia Dagan
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Manor-Shulman
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yael Feinstein
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Amir
- Department of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Georgy Frenkel
- Department of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Amichai Rotstein
- Heart Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Merav Dvir-Orgad
- Heart Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Einat Birk
- Heart Institute, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joanne Yacobovich
- Department of Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Schiller
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Einbinder T, Machtei A, Birk E, Schamroth Pravda N, Frenkel G, Amir G, Fogelman R. Low Risk of Inappropriate Shock Among Pediatric Patients With an Implantable Cardioverter Defibrillator: A Single Center Experience. Pediatr Cardiol 2023:10.1007/s00246-023-03280-0. [PMID: 37668692 DOI: 10.1007/s00246-023-03280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
Implantable cardioverter-defibrillators (ICD) are increasingly being used among the pediatric population for indications of both primary and secondary prevention. There is limited long-term data on the outcomes of pediatric patients following ICD implantation. The aim of this study was to investigate the characteristics of this population, burden of appropriate and inappropriate shock and complication rate in a large tertiary pediatric medical center. Included were children under the age of 18 years who underwent ICD implantation and had clinical follow up at our center. Data were retrospectively collected between study period 2005-2020. Primary outcome was the incidence of ICD shock appropriate and inappropriate. Secondary outcome was defining our patient population characteristics. Our cohort included 51 patients who underwent ICD implantation. Mean age at implantation was 10.9 ± 4.7 years and average follow-up time was 67 months. Diagnoses of implanted patients were: 28 (55%) patients with syndromes with risk for sudden death, cardiomyopathy in 14 patients (27%) and congenital heart disease (CHD) in 9 patients (18%). Forty-two (82%) patients had an ICD implanted for secondary prevention after experiencing a life-threatening arrhythmia and 9 (18%) for primary prevention. An endocardial system was implanted in 39 (76%) patients and an epicardial systems in 12 (24%) patients. A total of 20 (39%) patients received appropriate shocks for ventricular fibrillation(VF). 5 patients received inappropriate shocks, 4 due to sinus tachycardia and 1 due to rapidly conducted atrial fibrillation. Those who received an inappropriate shock had a significantly shorter ICD-programmed VF detection cycle length compared to those who did not receive an inappropriate shock (320 ms versus 270 ms, p = 0.062). This single center study demonstrates a high rate of appropriate ICD shocks (39%) and a low rate of inappropriate ICD shocks. Accurate programming of ICD devices in the pediatric population is paramount to avoid inappropriate ICD shocks.
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Affiliation(s)
- Tom Einbinder
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ayelet Machtei
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
| | - Einat Birk
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - George Frenkel
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
| | - Gabriel Amir
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Fogelman
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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4
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Bruckheimer E, Steiner K, Barak-Corren Y, Slanovic L, Levinzon M, Lowenthal A, Amir G, Dagan T, Birk E. The Amplatzer duct occluder (ADOII) and Piccolo devices for patent ductus arteriosus closure: a large single institution series. Front Cardiovasc Med 2023; 10:1158227. [PMID: 37215550 PMCID: PMC10193946 DOI: 10.3389/fcvm.2023.1158227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose Evaluate Piccolo and ADOII devices for transcatheter patent ductus arteriosus (PDA) closure. Piccolo has smaller retention discs reducing risk of flow disturbance but residual leak and embolization risk may increase. Methods Retrospective review of all patients undergoing PDA closure with an Amplatzer device between January 2008 and April 2022 in our institution. Data from the procedure and 6 months follow-up were collected. Results 762 patients, median age 2.6 years (range 0-46.7) years and median weight 13 kg (range 3.5-92) were referred for PDA closure. Overall, 758 (99.5%) had successful implantation: 296 (38.8%) with ADOII, 418 (54.8%) with Piccolo, and 44 (5.8%) with AVPII. The ADOII patients were smaller than the Piccolo patients (15.8 vs. 20.5 kg, p < 0.001) and with larger PDA diameters (2.3 vs. 1.9 mm, p < 0.001). Mean device diameter was similar for both groups. Closure rate at follow-up was similar for all devices ADOII 295/296 (99.6%), Piccolo 417/418 (99.7%), and AVPII 44/44 (100%). Four intraprocedural embolizations occurred during the study time period: two ADOII and two Piccolo. Following retrieval the PDA was closed with an AVPII in two cases, ADOI in one case and with surgery in the fourth case. Mild stenosis of the left pulmonary artery (LPA) occurred in three patients with ADOII devices (1%) and one patient with Piccolo device (0.2%). Severe LPA stenosis occurred in one patient with ADOII (0.3%) and one with AVPII device (2.2%). Conclusions ADOII and Piccolo are safe and effective for PDA closure with a tendency to less LPA stenosis with Piccolo. There were no cases of aortic coarctation related to a PDA device in this study.
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Affiliation(s)
- Elchanan Bruckheimer
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Kristoffer Steiner
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Yuval Barak-Corren
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Leonel Slanovic
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Michael Levinzon
- Section of Pediatric Anesthesiology, Schneider Children’s, Medical Center of Israel, Petach Tikva, Israel
| | - Alexander Lowenthal
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Gabriel Amir
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Tamir Dagan
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
| | - Einat Birk
- Section of Pediatric Cardiology, Schneider Children’s Medical, Center of Israel, Petach Tikva, Israel
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5
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Witberg G, Magen O, Hoss S, Talmor-Barkan Y, Richter I, Wiessman M, Aviv Y, Grinberg T, Shiyovich A, Schamroth-Pravda N, Auster O, Dagan N, Birk E, Balicer R, Kornowski R. Myocarditis after BNT162b2 Vaccination in Israeli Adolescents. N Engl J Med 2022; 387:1816-1817. [PMID: 36260842 PMCID: PMC9634859 DOI: 10.1056/nejmc2207270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Ori Magen
- Clalit Health Services, Tel Aviv, Israel
| | - Sara Hoss
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | - Yaron Aviv
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | | | - Noa Dagan
- Clalit Health Services, Tel Aviv, Israel
| | - Einat Birk
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Thurner L, Kessel C, Fadle N, Regitz E, Seidel F, Kindermann I, Lohse S, Kos I, Tschöpe C, Kheiroddin P, Kiblboeck D, Hoffmann MC, Bette B, Carbon G, Cetin O, Preuss KD, Christofyllakis K, Bittenbring JT, Pickardt T, Fischer Y, Thiele H, Baldus S, Stangl K, Steiner S, Gietzen F, Kerber S, Deneke T, Jellinghaus S, Linke A, Ibrahim K, Grabmaier U, Massberg S, Thilo C, Greulich S, Gawaz M, Mayatepek E, Meyer-Dobkowitz L, Kindermann M, Birk E, Birk M, Lainscak M, Foell D, Lepper PM, Bals R, Krawczyk M, Mevorach D, Hasin T, Keren A, Kabesch M, Abdul-Khaliq H, Smola S, Bewarder M, Thurner B, Böhm M, Pfeifer J, Klingel K. IL-1RA Antibodies in Myocarditis after SARS-CoV-2 Vaccination. N Engl J Med 2022; 387:1524-1527. [PMID: 36130012 PMCID: PMC9513854 DOI: 10.1056/nejmc2205667] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Igor Kos
- Saarland University, Homburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Yvan Fischer
- Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | | | | | - Karl Stangl
- Charité University Medicine Berlin, Berlin, Germany
| | | | - Frank Gietzen
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | - Sebastian Kerber
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | - Thomas Deneke
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | | | - Axel Linke
- Technische Universität Dresden, Dresden, Germany
| | | | | | | | | | | | | | - Ertan Mayatepek
- University Children's Hospital Duesseldorf, Duesseldorf, Germany
| | | | | | - Einat Birk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Merav Birk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | | | - Dirk Foell
- University Children's Hospital Muenster, Muenster, Germany
| | | | | | | | | | - Tal Hasin
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andre Keren
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Michael Kabesch
- University Children's Hospital Regensburg, Regensburg, Germany
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Gendler Y, Birk E, Tabak N, Koton S. Vigilance in the Decision-Making Process Regarding Termination of Pregnancy Following Prenatal Diagnosis of Congenital Heart Disease-Application of the 'Conflict Decision-Making Model'. Int J Environ Res Public Health 2022; 19:ijerph19159137. [PMID: 35897499 PMCID: PMC9331975 DOI: 10.3390/ijerph19159137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022]
Abstract
The decision-making process regarding termination of pregnancy following prenatal diagnosis of congenital heart disease is a stressful experience for future parents. Janis and Mann’s conflict decision-making model describes seven ideal stages that comprise vigilant information-gathering as an expression of the qualitative decision-making process. In our study, we attempted to determine whether parents who face the decision regarding termination of pregnancy undertake a qualitative decision-making process. Data were collected over 2-year period using structural questionnaires. The sample consisted of two hundred forty participants; sixty-nine (28.75%) declared that their decision was to terminate the pregnancy. A significant difference in the quality of the decision-making score was noted between parents who decided to continue with the pregnancy vs. parents who opted for termination (mean score of 10.15 (5.6) vs. 18.51 (3.9), respectively, p < 0.001). Sixty-two (90%) participants within the termination of pregnancy group went through all seven stages of vigilant decision-making process and utilized additional sources for information and consultation. Parents who decided to continue with the pregnancy made swift decisions, often without considering the negative and positive outcomes; this decision-making pattern is considered non-vigilant and ineffective. Identification of future parents at risk of going through an ineffective decision-making process may help health professionals to determine the best way to provide them with information and support.
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Affiliation(s)
- Yulia Gendler
- Department of Nursing, School of Health Sciences, Ariel University, Ariel 40700, Israel
- Department of Nursing, School of Health Professions, Tel-Aviv University, Tel-Aviv 69978, Israel; (N.T.); (S.K.)
- Correspondence:
| | - Einat Birk
- Pediatric Heart Institute, Schneider Children’s Medical Center of Israel, Petah-Tikva 4920235, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Nili Tabak
- Department of Nursing, School of Health Professions, Tel-Aviv University, Tel-Aviv 69978, Israel; (N.T.); (S.K.)
| | - Silvia Koton
- Department of Nursing, School of Health Professions, Tel-Aviv University, Tel-Aviv 69978, Israel; (N.T.); (S.K.)
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Amir G, Arfi-Levy E, Shostak E, Schiller O, Barak-Corren Y, Bruckheimer E, Rotstein A, Frenkel G, Birk E. Transthoracic intracardiac lines-A double edged sword. J Card Surg 2022; 37:3253-3258. [PMID: 35842808 DOI: 10.1111/jocs.16774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Routine use of central venous access is needed in children undergoing open heart surgery for pressure monitoring and inotrope infusion. We sought to evaluate the efficiency and safety of routine use of transthoracic intracardiac lines (ICLs) in patients undergoing cardiac surgery and to compare them to patients who have been previously treated with traditional central venous lines (non-ICLs). METHODS Retrospective review of charts of all patients who underwent cardiac surgery and had an ICL inserted in the operating room. Case control matching was done with similar patient in which ICL was not inserted. Patients characteristics, diagnosis, operative, and intensive care data were collected for each patient and analyzed. RESULTS A total number of 376 patient records were reviewed (198 ICL patients and 178 non-ICL patients). Umbilical line and non-ICL durations were longer in the non-ICL group. ICL duration was the longest of all lines, averaging 12.87 ± 10.82 days. The necessity for multiple line insertions (˃2 insertions) was significantly higher in the non-ICL group, with a relative risk ratio of 3.24 (95% confidence interval: 1.617-6.428). There was no statistical difference of infections rate and line complications between the two groups. CONCLUSION ICLs are safe in infants undergoing cardiac surgery and can be kept in place for a long period of time with a low rate of line complications and infection. Routine use of ICLs reduces the number of central venous catheter placement in this complex patient population.
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Affiliation(s)
- Gabriel Amir
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esther Arfi-Levy
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Eran Shostak
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ofer Schiller
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yuval Barak-Corren
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Predictive Medicine Group, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Elchanan Bruckheimer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Amichai Rotstein
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Georgy Frenkel
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Einat Birk
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Ashkenazi-Hoffnung L, Shmueli E, Ehrlich S, Ziv A, Bar-On O, Birk E, Lowenthal A, Prais D. Long COVID in Children: Observations From a Designated Pediatric Clinic. Pediatr Infect Dis J 2021; 40:e509-e511. [PMID: 34371507 PMCID: PMC8575093 DOI: 10.1097/inf.0000000000003285] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/26/2022]
Abstract
Systematic data are lacking on pediatric long COVID. This study prospectively assessed 90 children with persistent symptoms who presented to a designated multidisciplinary clinic for long COVID. In nearly 60%, symptoms were associated with functional impairment at 1-7 months after the onset of infection. A comprehensive structured evaluation revealed mild abnormal findings in approximately half the patients, mainly in the respiratory aspect.
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Affiliation(s)
- Liat Ashkenazi-Hoffnung
- From the Day Care Hospitalization, Pulmonary Institute and Heart Institute, Schneider Children’s Medical Center of Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Shmueli
- From the Day Care Hospitalization, Pulmonary Institute and Heart Institute, Schneider Children’s Medical Center of Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Ehrlich
- From the Day Care Hospitalization, Pulmonary Institute and Heart Institute, Schneider Children’s Medical Center of Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Ziv
- From the Day Care Hospitalization, Pulmonary Institute and Heart Institute, Schneider Children’s Medical Center of Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Bar-On
- From the Day Care Hospitalization, Pulmonary Institute and Heart Institute, Schneider Children’s Medical Center of Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Birk
- From the Day Care Hospitalization, Pulmonary Institute and Heart Institute, Schneider Children’s Medical Center of Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lowenthal
- From the Day Care Hospitalization, Pulmonary Institute and Heart Institute, Schneider Children’s Medical Center of Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dario Prais
- From the Day Care Hospitalization, Pulmonary Institute and Heart Institute, Schneider Children’s Medical Center of Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Gendler Y, Birk E. Developing a standardized approach to prenatal counseling following the diagnosis of a complex congenital heart abnormality. Early Hum Dev 2021; 163:105507. [PMID: 34794106 DOI: 10.1016/j.earlhumdev.2021.105507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/26/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Yulia Gendler
- The Department of Nursing, School of Health Sciences, Ariel University, Ariel, Israel.
| | - Einat Birk
- Pediatric Heart Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Amir G, Soffair N, Bruckheimer E, Nachum E, Shoenfeld T, Rotstein A, Frenkel G, Birk E. Mid-term results of vascular ring surgery. Cardiol Young 2021; 32:1-6. [PMID: 34776035 DOI: 10.1017/s1047951121004224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Vascular rings cause respiratory symptoms in children. Treatment consists of surgical division; however, data regarding mid-term results are scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery. METHODS Retrospective chart review of consecutive patients who underwent vascular ring surgery. Mid-term follow-up consisted of clinic visits and telephone questionnaire over a 1-year period sampling at five points in time. RESULTS Follow-up of 85 patients who underwent vascular rings surgery revealed significant symptomatic improvement within 6 months. In total, 50% were symptomatic to some degree at their last documented clinic visit complaining of stridor (36.8%), cough (34.2%), wheezing (10.5%), dyspnoea on exertion (10.5%), or recurrent respiratory infections (23.7%). By telephone questionnaires, 83% described a significant improvement in respiratory symptoms, 63.4% had some residual symptoms, 36.6% stridor, 38.8% chronic cough, 32.4% bronchodilator use,18.3% had at least one episode of pneumonia per year, 31% of children had dyspnoea or respiratory limitation, and 12.7% while doing physical activities. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. CONCLUSIONS Surgical division of vascular rings results in significant clinical improvement within 1 year; nevertheless, some patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. Further evaluation is warranted to assess the nature of residual symptoms and explore whether anatomical causes can be identified leading to surgical modifications.
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Affiliation(s)
- Gabriel Amir
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Niv Soffair
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Bruckheimer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Elchanan Nachum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Tommy Shoenfeld
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Amichai Rotstein
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Georgy Frenkel
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Einat Birk
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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12
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Bruckheimer E, Birk E, Benson L, Butera G, Martin R, Roberts PA, Schneider MBE, Schubert S, Sievert H, Pedra CCA. Large Diameter Advanta V12 Covered Stent Trial for Coarctation of the Aorta: COARC Study. Circ Cardiovasc Interv 2021; 14:e010576. [PMID: 34749516 DOI: 10.1161/circinterventions.121.010576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Covered stent implantation for treatment of coarctation of the aorta (CoA) is effective and can prevent aortic wall injury. Prospective studies with long-term follow-up, including imaging, are lacking. We report the acute and long-term outcomes for use of the Large Diameter Advanta V12 covered stent for treatment of native and recurrent CoA. METHODS A prospective, multicenter, nonrandomized study was performed including 70 patients (43 male), median age 17 years, median weight 57.4 kg with CoA who underwent implantation of the Large Diameter Advanta V12 covered stent. Annual follow-up for 5 years included Doppler echocardiography to calculate diastolic velocity: systolic velocity ratio. RESULTS CoA diameter increased from 5.6±3.6 to 14.9±3.9 mm (P<0.0001) and the pressure gradient decreased from 35.8±16.2 to 5.6±7.9 mm Hg (P<0.0001). Preimplantation diastolic velocity:systolic velocity of 0.6±0.16 dropped to 0.34±0.13 (P<0.0001) and was maintained at 5 years. Computed tomography angiograms at 12 months postimplantation demonstrated the stent:transverse arch diameter to be similar, 0.91±0.09 to postprocedure 0.86±0.14. Major adverse vascular events at 30 days and 12 months were 1.4% and 4.3%, respectively. Significant adverse events included three patients who required stent implantation to treat infolding. There were no mortalities. CONCLUSIONS The Large Diameter Advanta V12 covered stent is safe and effective for the treatment of CoA with an immediate and sustained reduction of the pressure gradient over 12 months and 5 years as assessed by preimplantation and postimplantation Doppler echocardiography and 12-month computed tomography angiography. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00978952. URL: http://www.anzctr.org.au; Unique identifier: ACTRN12612000013864.
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Affiliation(s)
- Elchanan Bruckheimer
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel (E. Bruckheimer, E. Birk)
| | - Einat Birk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel (E. Bruckheimer, E. Birk)
| | - Lee Benson
- The Hospital for Sick Children, Toronto, Canada (L.B.)
| | | | - Robin Martin
- Bristol Royal Hospital for Children, United Kingdom (R.M.)
| | | | | | - Stephan Schubert
- Deutsches Herzzentrum Berlin and Herz- und Diabeteszentrum Bad Oeynhausen, Germany (S.S.)
| | | | - Carlos C A Pedra
- Instituto Dante Pazzanese de Cardiologia, Sao Paolo, Brazil (C.C.A.P.)
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13
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Schamroth Pravda N, Kornowski R, Vaknin Assa H, Bruckheimer E, Birk E, Shapira Y, Belenky A, Hirsch R. Complex Catheter-Based Structural Heart Reconstruction in a Patient With Tricuspid Atresia and Björk Palliative Conduit. JACC Case Rep 2021; 3:212-216. [PMID: 34317504 PMCID: PMC8310959 DOI: 10.1016/j.jaccas.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
Björk conduit failure is a common reason for reintervention after a Björk modification of the Fontan procedure. We describe a first performed in human percutaneous procedure for the treatment of a failing Björk circuit in an adult with congenital heart disease and complex anatomic features. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Bruckheimer
- Department of Cardiology, Schneider Children's Hospital, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Birk
- Department of Cardiology, Schneider Children's Hospital, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Shapira
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Belenky
- Department of Interventional Radiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rafael Hirsch
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Lowenthal A, Weisblum-Neuman H, Birk E, Ashkenazi-Hoffnung L, Levy I, Ben-Zvi H, Amir G, Frenkel G, Bruckheimer E, Yarden-Bilavsky H, Marom D, Shostak E, Nahum E, Dagan T, Chodick G, Scheuerman O. Clinical Features and Comparison of Kingella and Non-Kingella Endocarditis in Children, Israel. Emerg Infect Dis 2021; 27:703-709. [PMID: 33622463 PMCID: PMC7920667 DOI: 10.3201/eid2703.203022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Kingella spp. have emerged as an important cause of invasive pediatric diseases. Data on Kingella infective endocarditis (KIE) in children are scarce. We compared the clinical features of pediatric KIE cases with those of Streptococcus species IE (StIE) and Staphylococcus aureus IE (SaIE). A total of 60 patients were included in the study. Throughout the study period, a rise in incidence of KIE was noted. KIE patients were significantly younger than those with StIE and SaIE, were predominately boys, and had higher temperature at admission, history of oral aphthae before IE diagnosis, and higher lymphocyte count (p<0.05). Pediatric KIE exhibits unique features compared with StIE and SaIE. Therefore, in young healthy children <36 months of age, especially boys, with or without a congenital heart defect, with a recent history of oral aphthae, and experiencing signs and symptoms compatible with endocarditis, Kingella should be suspected as the causative pathogen.
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15
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Gendler Y, Birk E, Tabak N, Koton S. Factors That Influence Parents' Decision-Making Regarding Termination of Pregnancy After Prenatal Diagnosis of Fetal Congenital Heart Disease. J Obstet Gynecol Neonatal Nurs 2021; 50:475-484. [PMID: 33991490 DOI: 10.1016/j.jogn.2021.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To explore factors that influence parents' decisions regarding the termination of pregnancy after the detection of fetal congenital heart disease (CHD). DESIGN A prospective descriptive study. SETTING The Institute of Pediatric Cardiology in the Schneider Children's Medical Center. PARTICIPANTS One hundred twenty couples (240 participants) with fetuses prenatally diagnosed with CHD, which was defined as conditions requiring surgical treatment. METHODS We obtained data from a structured questionnaire for the pediatric cardiologist, the medical records, and structured self-report questionnaires for the participants. RESULTS Thirty-six of 120 couples (30%) decided to terminate the pregnancy after a prenatal diagnosis of fetal CHD. The main factors associated with the decision to terminate were low gestational age (OR = 0.83 per week, 95% confidence interval [CI] [0.75, 0.96]), severe cardiac malformation (OR = 2.23, 95% CI [1.40, 3.53]), religious affiliation (OR = 10.0 for secular participants vs. others, 95% CI [4.61, 22.46], population group (OR = 2.96 for Jewish participants vs. others, 95% CI [1.63, 11.3]), and education (OR = 1.34 per year of education, 95% CI [1.15, 1.55]). CONCLUSIONS Our findings describe the profiles of couples who decided to terminate their pregnancies after a prenatal diagnosis of fetal CHD. Early identification of the couple's decision can help health care providers provide adequate support, counseling, and guidance. Future research is needed to understand parents' needs for support through the process of decision-making, with attention to their religious and cultural values and contexts.
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16
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Dagan T, Bruckheimer E, Amir G, Frenkel G, Levinson M, Lowenthal A, Birk E. The effects of oral pulmonary vasodilator therapy on poor candidates for fenestration closure in patients with a fontan circulation. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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17
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Weissbach A, Rotstein A, Lakovsky Y, Kaplan E, Kadmon G, Birk E, Nahum E. Ultrasound Cardiac Output Monitor (USCOM™) Measurements Prove Unreliable Compared to Cardiac Magnetic Resonance Imaging in Adolescents with Cardiac Disease. Pediatr Cardiol 2021; 42:692-699. [PMID: 33394105 DOI: 10.1007/s00246-020-02531-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
The purpose of this stuy is to prospectively assess the reliability of the ultrasound cardiac output monitor (USCOM™) for measuring stroke volume index and predicting left ventricular outflow tract diameter in adolescents with heart disease. Sixty consecutive adolescents with heart disease attending a tertiary medical center underwent USCOM™ assessment immediately after cardiac magnetic resonance imaging. USCOM™ measured stroke volume index and predicted left ventricular outflow tract diameter were compared to cardiac magnetic resonance imaging-derived values using Bland-Altman analysis. Ten patients with an abnormal left ventricular outflow tract were excluded from the analysis. An adequate USCOM™ signal was obtained in 49/50 patients. Mean stroke volume index was 46.1 ml/m2 by the USCOM™ (range 22-66.9 ml/m2) and 42.9 ml/m2 by cardiac magnetic resonance imaging (range 24.7-59.9 ml/m2). The bias (mean difference) was 3.2 ml/m2; precision (± 2SD of differences), 17 ml/m2; and mean percentage error, 38%. The mean (± 2SD) left ventricular outflow tract diameter was 0.445 ± 0.536 cm smaller by the USCOM™ algorithm prediction than by cardiac magnetic resonance imaging. Attempted adjustment of USCOM™ stroke volume index using cardiac magnetic resonance imaging left ventricular outflow tract diameter failed to improve agreement between the two modalities (bias 28.4 ml/m2, precision 44.1 ml/m2, percentage error 77.3%). Our study raises concerns regarding the reliability of USCOM™ for stroke volume index measurement in adolescents with cardiac disease, which did not improve even after adjusting for its inaccurate left ventricular outflow tract diameter prediction.
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Affiliation(s)
- Avichai Weissbach
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
| | - Amichay Rotstein
- Institute of Pediatric Cardiology, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Yaniv Lakovsky
- Department of Imaging, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Eytan Kaplan
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Gili Kadmon
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Einat Birk
- Institute of Pediatric Cardiology, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Elhanan Nahum
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
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18
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Abstract
Abstract
Background
Vascular anomalies of the Aortic arch can cause respiratory symptoms in children due to tracheal compression. Treatment consists of division of the vascular rings, nevertheless data regarding mid- term results is scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery.
Methods
Between2007–2014, 85 children underwent vascular ring surgery. 51 had Double Aortic Arch (DAA, 60%), 31 Right Arch with Aberrant Subclavian Artery (RAA & ALSA, 36.5%) and 3 had RAA, mirror image branching & left ductus arteriosus (3.5%). Mean age and weight at operation were 12.4±13months and 8.6±4.1 kg respectively. Mid-term follow-up included clinical follow up by a pulmonologist (38 patients, 44.7%) and a telephone questionnaire (71 patients, 83%) performed 57±25.7 months after surgery.
Results
In most patients, symptomatic relief occurred in less than 6 months (table 1). Mid –term follow up revealed that although most parents described a significant improvement in their child's respiratory symptoms (95%), a significant number of patients described some residual respiratory symptoms (table 2). We did not find any significant association between age at surgery (under 6 month), or vascular ring anatomy (DAA vs. RAA&ASA) and the presence of residual symptoms at follow up
Conclusions
Surgical division of vascular rings results in a significant clinical improvement within one year, nevertheless many patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms in mid- term follow up. Further evaluation whether a more aggressive surgical approach is warranted in order to decrease the incidence long-term symptoms.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Amir
- Schneider Children's Medical Center of Israel, Pediatric Cardiac Surgery, Petach Tikva, Israel
| | - N Soffair
- Schneider Childrens Medical Center of Israel, Petah Tikva, Israel
| | - G Frenkel
- Schneider Children's Medical Center of Israel, Pediatric Cardiac Surgery, Petach Tikva, Israel
| | - E Bruckheimer
- Schneider Children's Medical Center of Israel, Pediatric Cardiology, Petach Tikva, Israel
| | - E Nachum
- Schneider Childrens Medical Center of Israel, Petah Tikva, Israel
| | - A Rotshtein
- Schneider Children's Medical Center of Israel, Pediatric Cardiology, Petach Tikva, Israel
| | - T Sheinfeld
- Schneider Childrens Medical Center of Israel, Petah Tikva, Israel
| | - E Birk
- Schneider Children's Medical Center of Israel, Pediatric Cardiology, Petach Tikva, Israel
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19
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Iff J, Gerrits C, Birk E, Tuttle E, Zheng Y, Henricson E, McDonald C. DMD – THERAPY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Mei-Zahav M, Gendler Y, Bruckheimer E, Prais D, Birk E, Watad M, Goldschmidt N, Soudry E. Topical Propranolol Improves Epistaxis Control in Hereditary Hemorrhagic Telangiectasia (HHT): A Randomized Double-Blind Placebo-Controlled Trial. J Clin Med 2020; 9:jcm9103130. [PMID: 32998220 PMCID: PMC7601781 DOI: 10.3390/jcm9103130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 02/07/2023] Open
Abstract
Epistaxis is a common debilitating manifestation in hereditary hemorrhagic telangiectasia (HHT), due to mucocutaneous telangiectases. The epistaxis can be difficult to control despite available treatments. Dysregulated angiogenesis has been shown to be associated with telangiectases formation. Topical propranolol has demonstrated antiangiogenic properties. We performed a two-phase study, i.e., a double-blind placebo-controlled phase, followed by an open-label phase. The aim of the study was assessment of safety and efficacy of nasal propranolol gel in HHT-related epistaxis. Twenty participants with moderate-severe HHT-related epistaxis were randomized to eight weeks of propranolol gel 1.5%, or placebo 0.5 cc, applied to each nostril twice daily; and continued propranolol for eight weeks in an open-label study. For the propranolol group, the epistaxis severity score (ESS) improved significantly (-2.03 ± 1.7 as compared with -0.35 ± 0.68 for the placebo group, p = 0.009); hemoglobin levels improved significantly (10.5 ± 2.6 to 11.4 ± 2.02 g/dL, p = 0.009); and intravenous iron and blood transfusion requirement decreased. The change in nasal endoscopy findings was not significant. During the open-label period, the ESS score improved significantly in the former placebo group (-1.99 ± 1.41, p = 0.005). The most common adverse event was nasal mucosa burning sensation. No cardiovascular events were reported. Our results suggest that topical propranolol gel is safe and effective in HHT-related epistaxis.
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Affiliation(s)
- Meir Mei-Zahav
- Pulmonary Institute, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel; (Y.G.); (D.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.B.); (E.B.); (M.W.); (E.S.)
- The National HHT Center, Pulmonary Institute, Schneider CMCI, 14 Kaplan St., Petach Tikva 49202, Israel
- Correspondence:
| | - Yulia Gendler
- Pulmonary Institute, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel; (Y.G.); (D.P.)
- The Department of Nursing, Ariel University, Ariel 40700, Israel
| | - Elchanan Bruckheimer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.B.); (E.B.); (M.W.); (E.S.)
- Cardiology Department, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
| | - Dario Prais
- Pulmonary Institute, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel; (Y.G.); (D.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.B.); (E.B.); (M.W.); (E.S.)
- The National HHT Center, Pulmonary Institute, Schneider CMCI, 14 Kaplan St., Petach Tikva 49202, Israel
| | - Einat Birk
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.B.); (E.B.); (M.W.); (E.S.)
- Cardiology Department, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
| | - Muhamad Watad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.B.); (E.B.); (M.W.); (E.S.)
| | - Neta Goldschmidt
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Ethan Soudry
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (E.B.); (E.B.); (M.W.); (E.S.)
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva 49202, Israel
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21
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Johnston JR, Landim-Vieira M, Marques MA, de Oliveira GAP, Gonzalez-Martinez D, Moraes AH, He H, Iqbal A, Wilnai Y, Birk E, Zucker N, Silva JL, Chase PB, Pinto JR. The intrinsically disordered C terminus of troponin T binds to troponin C to modulate myocardial force generation. J Biol Chem 2019; 294:20054-20069. [PMID: 31748410 PMCID: PMC6937556 DOI: 10.1074/jbc.ra119.011177] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/13/2019] [Indexed: 12/15/2022] Open
Abstract
Aberrant regulation of myocardial force production represents an early biomechanical defect associated with sarcomeric cardiomyopathies, but the molecular mechanisms remain poorly defined. Here, we evaluated the pathogenicity of a previously unreported sarcomeric gene variant identified in a pediatric patient with sporadic dilated cardiomyopathy, and we determined a molecular mechanism. Trio whole-exome sequencing revealed a de novo missense variant in TNNC1 that encodes a p.I4M substitution in the N-terminal helix of cardiac troponin C (cTnC). Reconstitution of this human cTnC variant into permeabilized porcine cardiac muscle preparations significantly decreases the magnitude and rate of isometric force generation at physiological Ca2+-activation levels. Computational modeling suggests that this inhibitory effect can be explained by a decrease in the rates of cross-bridge attachment and detachment. For the first time, we show that cardiac troponin T (cTnT), in part through its intrinsically disordered C terminus, directly binds to WT cTnC, and we find that this cardiomyopathic variant displays tighter binding to cTnT. Steady-state fluorescence and NMR spectroscopy studies suggest that this variant propagates perturbations in cTnC structural dynamics to distal regions of the molecule. We propose that the intrinsically disordered C terminus of cTnT directly interacts with the regulatory N-domain of cTnC to allosterically modulate Ca2+ activation of force, perhaps by controlling the troponin I switching mechanism of striated muscle contraction. Alterations in cTnC-cTnT binding may compromise contractile performance and trigger pathological remodeling of the myocardium.
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Affiliation(s)
- Jamie R Johnston
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, Florida 32306
| | - Maicon Landim-Vieira
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, Florida 32306
| | - Mayra A Marques
- Programa de Biologia Estrutural, Instituto de Bioquímica Médica, Instituto Nacional de Biologia Estrutural e Bioimagem, Centro Nacional de Ressonância Magnética Nuclear Jiri Jonas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Guilherme A P de Oliveira
- Programa de Biologia Estrutural, Instituto de Bioquímica Médica, Instituto Nacional de Biologia Estrutural e Bioimagem, Centro Nacional de Ressonância Magnética Nuclear Jiri Jonas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - David Gonzalez-Martinez
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, Florida 32306
| | - Adolfo H Moraes
- Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Huan He
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, Florida 32306
- Institute of Molecular Biophysics, Florida State University, Tallahassee, Florida 32306
| | - Anwar Iqbal
- Programa de Biologia Estrutural, Instituto de Bioquímica Médica, Instituto Nacional de Biologia Estrutural e Bioimagem, Centro Nacional de Ressonância Magnética Nuclear Jiri Jonas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Yael Wilnai
- Department of Pediatrics, Dana-Dwek ChildrenγÇÖs Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel 6423906
| | - Einat Birk
- Department of Cardiology, Schneider ChildrenγÇÖs Medical Center, Tel Aviv University, Petah Tikva, Israel 4920235
| | - Nili Zucker
- Department of Cardiology, Schneider ChildrenγÇÖs Medical Center, Tel Aviv University, Petah Tikva, Israel 4920235
| | - Jerson L Silva
- Programa de Biologia Estrutural, Instituto de Bioquímica Médica, Instituto Nacional de Biologia Estrutural e Bioimagem, Centro Nacional de Ressonância Magnética Nuclear Jiri Jonas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - P Bryant Chase
- Department of Biological Science, Florida State University, Tallahassee, Florida 32306
| | - Jose Renato Pinto
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, Florida 32306
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Silvestry S, Mahr C, Slaughter M, Levy W, Cheng R, May D, Ismyrloglou E, Tsintzos S, Tuttle E, Cook K, Birk E, Cotts W. Cost-Effectiveness of a Small Intrapericardial Centrifugal LVAD versus Medical Management and Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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24
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Amir G, Frenkel G, Rotstein A, Nachum E, Bruckheimer E, Lowenthal A, Einbinder T, Birk E. Urgent Surgical Treatment of Aortic Endocarditis in Infants and Children. Pediatr Cardiol 2019; 40:580-584. [PMID: 30604277 DOI: 10.1007/s00246-018-2030-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
Infective endocarditis (IE) in the pediatric population can present as a life-threatening condition. Optimal timing for surgical intervention should consider surgical risks versus the risk of neurologic complications. We herein report our experience with this group of critically ill children. Retrospective analysis of patient charts of all patients who underwent urgent surgical treatment of aortic IE from 1994 to 2014 was performed. Nine patients with acute storming IE of the aortic valve or the ascending aorta were urgently operated (eight normal heart, one congenital aortic stenosis), age ranged from 8 weeks to 4.2 years. Causative organisms were Staphylococcus aureus (2), Staphylococcus coagulase negative (1), Kingella kingae (2), Streptococcus pneumoniae (2), or culture negative (2). Presenting symptoms other than hemodynamic instability were neurologic decompensation (5) coronary embolization (1) and cardiogenic shock due to scalded skin syndrome (1). CT and MRI demonstrated significant brain infarcts in four patients. Operations performed were the Ross operation (7) and ascending aortic reconstruction (2). There were no operative deaths. At a median follow-up of 6 years (range 2-196 months), all patients are alive and well. Re-intervention included homograft replacement (2) and transcatheter Melody valve implantation (1). At their last follow-up, the neo-aortic valve was functional in all patients with minimal regurgitation and all had full resolution of the neurological deficits. Urgent surgical treatment for aortic valve IE in infants is challenging. Although surgery is complex and pre-disposing conditions such as sepsis, neurologic and cardiac decompensations are prevalent, operative results are excellent and gradual and significant neurologic improvement was noted over time.
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Affiliation(s)
- Gabriel Amir
- Department of Pediatric Cardiac Surgery, Schneider Children's Medical Center of Israel, 14 Kaplan st., Petach Tikva, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Georgy Frenkel
- Department of Pediatric Cardiac Surgery, Schneider Children's Medical Center of Israel, 14 Kaplan st., Petach Tikva, Israel
| | - Amichay Rotstein
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Nachum
- Department of Pediatric Intensive Care, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Bruckheimer
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lowenthal
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tom Einbinder
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Birk
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gabbay U, Carmi D, Birk E, Dagan D, Shatz A, Kidron D. The Sudden Infant Death Syndrome mechanism of death may be a non-septic hyper-dynamic shock. Med Hypotheses 2018; 122:35-40. [PMID: 30593418 DOI: 10.1016/j.mehy.2018.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/15/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sudden Infant Death Syndrome (SIDS) mechanisms of death remains obscured. SIDS' Triple Risk Model assumed coexistence of individual subtle vulnerability, critical developmental period and stressors. Prone sleeping is a major risk factor but provide no clues regarding the mechanism of death. The leading assumed mechanisms of death are either an acute respiratory crisis or arrhythmias but neither one is supported with evidence, hence both are eventually speculations. Postmortem findings do exist but are inconclusive to identify the mechanism of death. WHAT DOES THE PROPOSED HYPOTHESIS BASED ON?: 1. The stressors (suggested by the triple risk model) share a unified compensatory physiological response of decrease in systemic vascular resistant (SVR) to facilitate a compensatory increase in cardiac output (CO). 2. The cardiovascular/cardiorespiratory control of the vulnerable infant during a critical developmental period may be impaired. 3. A severe decrease in SVR is associated with hyper-dynamic state, high output failure and distributive shock. THE HYPOTHESIS Infant who is exposed to one or more stressors responds normally by decrease in SVR which increases CO. In normal circumstances once the needs are met both SVR and CO are stabilized on a new steady state. The incompetent cardiovascular control of the vulnerable infant fails to stabilize SVR which decreases in an uncontrolled manner. Accordingly CO increases above the needs to hyper-dynamic state, high output heart failure and hyper-dynamic shock. CONCLUSIONS The proposed hypothesis provides an appropriate alternative to either respiratory crises or arrhythmia though both speculations cannot be entirely excluded.
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Affiliation(s)
- Uri Gabbay
- Quality Unit, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Doron Carmi
- Shoham Pediatric Clinic, Southern District, Clalit Health Services, Shoham, Israel
| | - Einat Birk
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Cardiology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - David Dagan
- Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Anat Shatz
- ENT, Shaare Zedek Medical Center, Jerusalem, Israel; Atid, the Israeli Society for the Study and Prevention of SIDS, Jerusalem, Israel
| | - Debora Kidron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pathology Department, Meir Medical Center, Kfar Saba, Israel
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26
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Dagan T, Bruchheimer E, Amir G, Frenkel G, Birk E. P6046The hemodynamic effect of oral pulmonary vasodilator therapy on fenestrated fontan circulation and fenestration closure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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Swissa M, Birk E, Dagan T, Naimer SA, Fogelman M, Einbinder T, Bruckheimer E, Fogelman R. Radiofrequency catheter ablation of atrioventricular node reentrant tachycardia in children with limited fluoroscopy. Int J Cardiol 2017; 236:198-202. [PMID: 28202257 DOI: 10.1016/j.ijcard.2017.01.128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/04/2017] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited fluoroscopy cryo-ablation using a 3D electro-anatomical system (3DS) has been used for AVNRT in children. We aimed to facilitate a fluoroscopy limited approach of RF ablation of AVNRT in children. METHODS A retrospective study was performed of procedure parameters in children undergoing RF ablation of AVNRT in 75 consecutive children (June 2011 to November 2013 - Group A) using standard fluoroscopy techniques compared to those of 64 consecutive children (December 2013 to May 2015 - Group B), using a fluoroscopy limited approach with 3DS. RESULTS The acute success rate was 98.7% (74/75) and 98.4% (63/64) for groups A and B, respectively. The recurrence rate was 2.7% (2/74) and 0% (0/63) with a mean follow-up period of 45.5±12.1 and 14.3±6.1months for group A and group B, respectively. The mean procedure and fluoroscopy times were significantly lower for group B compared to group A (119±37 (43-203) and 0.83±1.04 (0.05-3.83) minutes versus 146±53 (72-250) and 16.1±8.9 (4.39-55) minutes, p<0.003 and p<0.0001, respectively). There were no ablation-related complications. CONCLUSIONS A fluoroscopy limited approach for RF ablation of AVNRT in children using a 3DS is easily acquired and adapted, and significantly reduces the fluoroscopy and procedure time with excellent efficacy, safety and low recurrence rate. CONDENSED ABSTRACT This study confirmed that a 3D mapping system (3DS) to guide ablations of AVNRT in children reduces radiation exposure. Combined, limited fluoroscopy and 3DS in a methodology that resembles the familiar conventional fluoroscopy approach for RF ablation of AVNRT in children is proposed. Combined limited fluoroscopy and RF-energy in children with AVNRT are associated with a shorter procedure time, minimal fluoroscopy time, a high success rate and a low recurrence rate.
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Affiliation(s)
- Moshe Swissa
- Kaplan Medical Center, Rehovot, Israel; The Hebrew University, Jerusalem, Israel.
| | - Einat Birk
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Tamir Dagan
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Sody Abby Naimer
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Fogelman
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Tom Einbinder
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Elchanan Bruckheimer
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Rami Fogelman
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
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28
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Swissa M, Birk E, Dagan T, Abby Naimer S, Fogelman M, Einbinder T, Bruckheimer E, Fogelman R. Limited fluoroscopy catheter ablation of accessory pathways in children. J Cardiol 2017; 70:382-386. [PMID: 28274505 DOI: 10.1016/j.jjcc.2016.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/20/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children. METHODS Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30° and left anterior oblique-60° views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8±4.1 (4.2-18) years, 61.7% males] with Wolf-Parkinson-White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP). RESULTS The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean follow-up of 13±5.5 (4.4-22.9) months. Mean procedure and fluoroscopy times were 144±45 (55-262)min and 1.8±1.4 (0.1-5.6)min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171±53min vs 135±38min, p<0.005), however the fluoroscopy time, the number of long applications, the time to effect, and the acute success rate were similar. There were no permanent ablation-related complications. CONCLUSIONS A limited fluoroscopy approach for ablation of AP in children using 3DS is easily acquired, adapted, reduces the fluoroscopy time, and has an excellent efficacy and safety profile.
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Affiliation(s)
- Moshe Swissa
- Kaplan Medical Center, Rehovot, The Hebrew University, Jerusalem, Israel.
| | - Einat Birk
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Tamir Dagan
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Sody Abby Naimer
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Fogelman
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Tom Einbinder
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Elchanan Bruckheimer
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Rami Fogelman
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
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Johnston J, Gonzalez-Martinez D, Birk E, Zucker N, Landim-Vieira M, Chase PB, Wilnai Y, Pinto JR. A Novel DCM-Associated Mutation in the N-Helix of Cardiac Troponin C Exhibits Impaired Contractile Kinetics and Reduced Ca 2+ -Sensitivity In Vitro. Biophys J 2017. [DOI: 10.1016/j.bpj.2016.11.3011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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30
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Kadmon G, Schiller O, Dagan T, Bruckheimer E, Birk E, Schonfeld T. Pulmonary hypertension specific treatment in infants with bronchopulmonary dysplasia. Pediatr Pulmonol 2017; 52:77-83. [PMID: 27333438 DOI: 10.1002/ppul.23508] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/15/2016] [Accepted: 06/08/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE When bronchopulmonary dysplasia (BPD) is complicated by pulmonary hypertension (PH), morbidity and mortality are significantly increased. BPD-associated PH is not included in the current indications for PH medications. However, limited data demonstrate hemodynamic improvement and decreased mortality with PH-specific treatment. This report describes our 6-year experience treating BPD-associated PH with PH medications, mainly sildenafil. STUDY DESIGN The medical records of 20 infants diagnosed with BPD-associated PH at a tertiary pediatric pulmonary hypertension clinic in 2008-2014 were reviewed. Clinical improvement was defined as a decrease in Ross functional class by at least one degree. PH severity was classified by echocardiography as mild, moderate, or severe. Hemodynamic improvement was defined as a decrease in PH severity by at least one level. RESULTS Eighteen out of 20 patients were treated with PH medications: 12 sildenafil, 5 sildenafil and bosentan, and 1 bosentan. Median follow-up time was 2 years. Mean functional class significantly decreased from 3.2 ± 0.9 at diagnosis to 1.7 ± 0.9 at the last follow-up. Improvement in functional class was observed in 15/16 children (94%). Moderate or severe PH was found in 13/18 children (72%) at diagnosis, and in three (17%, all moderate PH) at the last follow-up. Improvement in PH class by echocardiography was demonstrated in 14/18 children (78%). The survival rate was 95%. CONCLUSION Treatment of BPD complicated by PH with PH-specific medications, mainly sildenafil, is associated with improvement in both clinical and hemodynamic parameters and a low mortality rate. Pediatr Pulmonol. 2017;52:77-83. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Gili Kadmon
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Schiller
- Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Dagan
- Heart Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Bruckheimer
- Heart Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Birk
- Heart Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tommy Schonfeld
- Pulmonary Outpatient Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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31
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Amir G, Frenkel G, Bruckheimer E, Lowenthal A, Rotstein A, Katz J, Zeitlin Y, Schiller O, Birk E. Neonatal Cardiac Surgery in the New Era: Lessons learned from 1000 Consecutive Cases. Isr Med Assoc J 2016; 18:645-648. [PMID: 28466610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND neonatal cardiac surgery has evolved over the last 50 years with a large percentage of the patients achieving complete physiological repair in the neonatal period. The remaining patients achieve staged palliation with an increasing amount of success. OBJECTIVES To report our experience with 1000 neonatal cardiac surgical procedures performed in the last 10 years. METHODS We conducted a retrospective analysis of surgical outcome in all neonatal patients who underwent cardiac surgery between January 2007 and July 2016 at Schneider Children's Medical Center of Israel. RESULTS A total of 1003 neonates aged < 30 days underwent surgery for congenital heart defects at our center. Neonatal surgery accounted for 22.5% of all cardiac surgeries. Neonatal operative mortality was 7.3%, Operative mortality for individual lesions were: simple aortic coarctation (CoA) (198 patients, 2.5%), CoA with hypoplastic arch (24, 4%), CoA with ventricular septal defect (VSD) (84, 2.3%), transposition of the great arteries (TGA, simple and complex, 185, 6.3%), TGA with VSD (37, 0%), truncus arteriosus (26, 3.8%), interrupted aortic arch (25, 4%), Norwood Sano (71, 19.7%), neonatal tetralogy of Fallot (41, 0%), and shunt (131 patients, 12%). CONCLUSIONS Neonatal surgical capabilities have improved substantially over the last decades. Excellent results can be expected for lesions that can be repaired to create biventricular circulation. Improved results can be attributed in part to the evolution of surgical strategies and assistive technologies, but essential is the collaborative effort of surgeons, cardiologists, anesthesiologists, and intensive care specialists acting as a cohesive team whose performance far exceeds the sum of its individual members' contributions.
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Affiliation(s)
- Gabriel Amir
- Division of Pediatric Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Georgy Frenkel
- Division of Pediatric Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Elchanan Bruckheimer
- Division of Pediatric Heart Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Alexander Lowenthal
- Division of Pediatric Heart Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Amichay Rotstein
- Division of Pediatric Heart Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Jacob Katz
- Division of Department of Anesthesia, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yelena Zeitlin
- Division of Department of Anesthesia, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ofer Schiller
- Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Einat Birk
- Division of Pediatric Heart Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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32
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Bruckheimer E, Rotschild C, Dagan T, Amir G, Kaufman A, Gelman S, Birk E. Computer-generated real-time digital holography: first time use in clinical medical imaging. Eur Heart J Cardiovasc Imaging 2016; 17:845-9. [DOI: 10.1093/ehjci/jew087] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 11/12/2022] Open
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Tau N, Atar E, Mei-Zahav M, Bachar GN, Dagan T, Birk E, Bruckheimer E. Amplatzer Vascular Plugs Versus Coils for Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia. Cardiovasc Intervent Radiol 2016; 39:1110-4. [DOI: 10.1007/s00270-016-1357-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/18/2016] [Indexed: 01/14/2023]
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Levy E, Kornowski R, Gavrieli R, Fratty I, Greenberg G, Waldman M, Birk E, Shainberg A, Akirov A, Miskin R, Hochhauser E. Long-Lived αMUPA Mice Show Attenuation of Cardiac Aging and Leptin-Dependent Cardioprotection. PLoS One 2015; 10:e0144593. [PMID: 26673217 PMCID: PMC4681471 DOI: 10.1371/journal.pone.0144593] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/20/2015] [Indexed: 12/18/2022] Open
Abstract
αMUPA transgenic mice spontaneously consume less food compared with their wild type (WT) ancestors due to endogenously increased levels of the satiety hormone leptin. αMUPA mice share many benefits with mice under caloric restriction (CR) including an extended life span. To understand mechanisms linked to cardiac aging, we explored the response of αMUPA hearts to ischemic conditions at the age of 6, 18, or 24 months. Mice were subjected to myocardial infarction (MI) in vivo and to ischemia/reperfusion ex vivo. Compared to WT mice, αMUPA showed functional and histological advantages under all experimental conditions. At 24 months, none of the WT mice survived the first ischemic day while αMUPA mice demonstrated 50% survival after 7 ischemic days. Leptin, an adipokine decreasing under CR, was consistently ~60% higher in αMUPA sera at baseline. Leptin levels gradually increased in both genotypes 24h post MI but were doubled in αMUPA. Pretreatment with leptin neutralizing antibodies or with inhibitors of leptin signaling (AG-490 and Wortmannin) abrogated the αMUPA benefits. The antibodies also reduced phosphorylation of the leptin signaling components STAT3 and AKT specifically in the αMUPA myocardium. αMUPA mice did not show elevation in adiponectin, an adipokine previously implicated in CR-induced cardioprotection. WT mice treated for short-term CR exhibited cardioprotection similar to that of αMUPA, however, along with increased adiponectin at baseline. Collectively, the results demonstrate a life-long increased ischemic tolerance in αMUPA mice, indicating the attenuation of cardiac aging. αMUPA cardioprotection is mediated through endogenous leptin, suggesting a protective pathway distinct from that elicited under CR.
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Affiliation(s)
- Esther Levy
- The Cardiac Research Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Dept., Rabin Medical Center, Petah Tikva, Israel
| | - Reut Gavrieli
- The Cardiac Research Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Petah Tikva, Israel
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Ilana Fratty
- The Cardiac Research Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Petah Tikva, Israel
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | | | - Maayan Waldman
- The Cardiac Research Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Petah Tikva, Israel
| | - Einat Birk
- Cardiology Dept. and Schneider Children’s Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Asher Shainberg
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Amit Akirov
- The Cardiac Research Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Petah Tikva, Israel
| | - Ruth Miskin
- Weizmann Institute of Science, Rehovot, Israel
| | - Edith Hochhauser
- The Cardiac Research Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Petah Tikva, Israel
- * E-mail:
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Geißler B, Birk E, Anthuber M. [Report of 12 years experience in the surgical treatment of 286 paraesophageal hernias]. Chirurg 2015. [PMID: 26223669 DOI: 10.1007/s00104-015-0066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In contrast to axial hiatus hernias, paraesophageal hernias are rare but can lead to chronic iron deficiency anemia and severe acute complications. Treatment is manifold and consistent standards are lacking. OBJECTIVES The aim of this study was to describe our experiences of 286 patients with paraesophageal hernias, who underwent surgery from 2003 to 2014 at a tertiary referral center. The study was particularly concerned with morbidity, mortality, quality of life and recurrence rates. MATERIAL AND METHODS In 12 years a total of 286 paraesophageal hernias were surgically treated, 255 with a minimally invasive procedure and 31 with an open approach. In 138 patients (48 %) the suture-based hiatoplasty was reinforced by means of a lightweight mesh, which was fixed with fibrin glue in 90 cases. Abdominal fixation of the stomach consisted of a gastropexy and anterior (n = 244) or posterior (n = 42) fundoplication. RESULTS Complications arose in 8.4 % of the patients. The mean hospital stay was 5.3 (± 2.8) days for elective surgery and 24.7 (± 17.8) days for emergency operations. The gastrointestinal quality of life index according to Eypasch significantly increased from mean preoperative values of 92.8 (± 22.5) to 109.6 (± 20.2) in the postoperative course (p < 0.001). Of the patients 20 (7 %) suffered a recurrence requiring surgery, including 7 early and 13 late recurrences. During the immediate postoperative period radiographically detected recurrences were promptly revised. The strategy of late recurrences in the long-term course was based on patient symptoms and asymptomatic hernias were treated conservatively while symptomatic hernias were surgically treated. Symptomatic late recurrences developed in 4.6 % of the patients, including 7.4 % (11 out of 148) without and 1.4 % (2 out of 138) with primary mesh repair. CONCLUSION The repair of paraesophageal hernias in 286 patients provided excellent patient satisfaction and symptom improvement with low perioperative morbidity and mortality. Mesh reinforcement reduced the recurrence rate. The quality of life index is a suitable clinical course parameter for evaluation of paraesophageal hernias.
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Affiliation(s)
- B Geißler
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| | - E Birk
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - M Anthuber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
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Feldman LF, Hersh Z, Birk E, Amir G, Wertheimer G. [MYCOTIC ANEURYSM OF THE ASCENDING AORTA AND CEREBRAL INFARCTS IN A 17-MONTH OLD CHILD WITH KINGELLA KINGAE ENDOCARDITIS]. Harefuah 2015; 154:369-405. [PMID: 26281080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Endocarditis is an uncommon presentation of Kingella kingae infection in children. A previously healthy 17 month old child was referred to our emergency department for evaluation of fever lasting eleven days, aphthous stomatitis and a new systolic murmur. Within a few hours of admission, antibiotic therapy was initiated for a presumptive diagnosis of bacteremia and within 24 hours after admission, gram negative coccobacilli were growing in the blood culture. In addition, echocardiography demonstrated a mycotic aneurysm of the ascending aorta with a mobile vegetation. The presumptive diagnosis of Kingella kingae endocarditis was made. Further evaluation by MRI revealed frontal and occipital cerebral infarcts. Due to the presence of presumed septic emboli in conjunction with progressive left ventricular dysfunction, the child was urgently taken to the operating room where aggressive debridement of the infected tissue was performed and the aortic aneurysm was repaired. The patient had an uneventful post-operative course. This case emphasizes the need for a high index of suspicion when evaluating children with community acquired infection. In addition, it also demonstrates the importance of early diagnosis and appropriate treatment of K. kingae endocarditis.
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Swissa M, Birk E, Dagan T, Fogelman M, Einbinder T, Bruckheimer E, Goldenberg I, Klempfner R, Kirsh JA, Fogelman R. Cryotherapy ablation of parahisian accessory pathways in children. Heart Rhythm 2015; 12:917-25. [DOI: 10.1016/j.hrthm.2015.01.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Indexed: 11/25/2022]
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Merin O, Fink D, Fink DL, Shahroor S, Schlesinger Y, Amir G, Birk E. Salvage ECMO deployment for fatal aluminum phosphide poisoning. Am J Emerg Med 2015; 33:1718.e1-3. [PMID: 25910669 DOI: 10.1016/j.ajem.2015.03.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ofer Merin
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel 91031
| | - Daniel Fink
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel 91031.
| | - Daniel L Fink
- Pediatric Cardiology Unit, Division of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel 91031
| | - Sarit Shahroor
- Pediatric Intensive Care Unit, Division of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel 91031
| | - Yechiel Schlesinger
- Division of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel 91031
| | - Gabriel Amir
- Department of Cardiothoracic Surgery, Schneider's Children Medical Center, Petach Tikva, Israel 4920235
| | - Einat Birk
- Cardiology Institute, Schneider's Children Medical Center, Petach Tikva, Israel 4920235
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Schiller O, Dagan O, Birk E, Bitan S, Amir G, Frenkel G, Nahum E. Adrenal insufficiency in children undergoing heart surgery does not correlate with more complex postoperative course. Pediatr Cardiol 2014; 34:1860-7. [PMID: 23794011 DOI: 10.1007/s00246-013-0728-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
Although some evidence suggests benefit of steroid supplementation after pediatric cardiac surgery, data correlating adrenal function with the postoperative course is scarce. This study sought to determine if adrenal insufficiency (AI) after cardiac surgery is associated with a more complicated postoperative course in children. A prospective study was performed during a 6-month period at a pediatric medical center. Included were 119 children, 3 months and older, who underwent heart surgery with cardiopulmonary bypass. Cortisol levels were measured before and 18 h after surgery. Patients were divided into two groups by procedure complexity (low or high), and clinical and laboratory parameters were compared between patients with and without AI within each complexity group. In the low-complexity group, 45 of the 65 patients had AI. The normal adrenal function (NAF) subgroup had greater inotropic support at 12, 24, and 36 h after surgery and a higher lactate level at 12 and 24 h after surgery. There were no significant differences between subgroups in duration of ventilation, sedation, intensive care unit (ICU) stay, or urine output. In the high-complexity group, 27 patients had AI, and 27 did not. There were no significant differences between subgroups in inotropic support or urine output during the first 36 h or in mechanical ventilation, sedation, or ICU stay duration. Children with AI after heart surgery do not have a more complex postoperative course than children with NAF. The adrenal response of individual patients seems to be appropriate for their cardiovascular status.
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Affiliation(s)
- Ofer Schiller
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petach Tikva, Israel,
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Bruckheimer E, Godfrey M, Dagan T, Levinzon M, Amir G, Birk E. The Amplatzer duct occluder II additional sizes device for transcatheter PDA closure: Initial experience. Catheter Cardiovasc Interv 2014; 83:1097-101. [DOI: 10.1002/ccd.25445] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 12/28/2013] [Accepted: 02/08/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Elchanan Bruckheimer
- Section of Pediatric Cardiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Max Godfrey
- Section of Pediatric Cardiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Tamir Dagan
- Section of Pediatric Cardiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Michael Levinzon
- Section of Pediatric Anesthesiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Gabriel Amir
- Section of Pediatric Cardiothoracic Surgery; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Einat Birk
- Section of Pediatric Cardiology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
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Marom D, Ashkenazi S, Samra Z, Birk E. Infective endocarditis in previously healthy children with structurally normal hearts. Pediatr Cardiol 2013; 34:1415-21. [PMID: 23483241 DOI: 10.1007/s00246-013-0665-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/09/2013] [Indexed: 12/20/2022]
Abstract
Structural heart disease, intravascular catheters, and invasive procedures are predisposing factors for infective endocarditis (IE). Data on IE in children with structurally normal hearts and no predisposing factors are limited. We aim to characterize IE (definite or possible by Duke criteria) in such a subgroup of pediatric patients (age <18 years) who were treated at our medical center. Of 51 events of IE in 50 children, 9 (18 %) had no predisposing factors. These infections were all community-acquired and presented with fever, a newly detected heart murmur, diagnostic echocardiographic findings, and left-sided infection. Clinical course was characterized by acute onset (n = 8 of 9) with a 100 % complication rate (heart failure or embolic phenomena). Emergency cardiac surgery was performed in 7 children (Ross surgery [n = 4], mitral valve replacement [MVR; n = 2], and valve repair [n = 1]). Causative organisms were S. aureus (n = 3), S. pneumoniae (n = 2), H. parainfluenzae (n = 1), and K. kingae (n = 1). In contrast, IE in children with predisposing factors (42 of 51 [82 %]) was frequently health care-associated (30 of 42), right-sided (20 of 42, p = 0.041), and with lower rates of diagnostic echocardiographic findings (28 of 42, p = 0.041), complications (16 of 42, p < 0.001), and surgical intervention (9 of 42, p = 0.002). Causative organisms were mainly viridans streptococci (n = 9), Candida species (n = 8), coagulase-negative staphylococci (n = 6), enteric Gram-negative bacilli (n = 6), S. aureus (n = 5), and K. kingae (n = 3). Mortality was 11 % in both groups. We conclude that pediatric IE in children with and without predisposing factors differs significantly. Due to the acute and complicated course of the latter, high awareness among pediatricians and prompt diagnosis are crucial.
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Affiliation(s)
- Daphna Marom
- Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, Israel.
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Nahum E, Pollak U, Dagan O, Amir G, Frenkel G, Birk E. Predictive value of B-type natriuretic peptide level on the postoperative course of infants with congenital heart disease. Isr Med Assoc J 2013; 15:216-220. [PMID: 23841240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) has been shown to have prognostic value for morbidity and mortality after cardiac surgery. Less is known about its prognostic value in infants. OBJECTIVES To investigate the predictive value of BNP levels regarding the severity of the postoperative course in infants undergoing surgical repair of congenital heart disease. METHODS We conducted a prospective comparative study. Plasma BNP levels in infants aged 1-12 months with congenital heart disease undergoing complete repair were measured preoperatively and 8, 24 and 48 hours postoperatively. Demographic and clinical data included postoperative inotropic support and lactate level, duration of mechanical ventilation, intensive care unit (ICU) and hospitalization stay. RESULTS Cardiac surgery was performed in 19 infants aged 1-12 months. Preoperative BNP level above 170 pg/ml had a positive predictive value of 100% for inotropic score > or = 7.5 at 24 hours (specificity 100%, sensitivity 57%) and 48 hours (specificity 100%, sensitivity 100%), and was associated with longer ICU stay (P = 0.05) and a trend for longer mechanical ventilation (P = 0.12). Similar findings were found for 8 hours postoperative BNP above 1720 pg/ml. BNP level did not correlate with measured fractional shortening. CONCLUSIONS In infants undergoing heart surgery, preoperative and 8 hour BNP levels were predictive of inotropic support and longer ICU stay. These findings may have implications for preplanning ICU loads in clinical practice. Further studies with larger samples are needed.
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Affiliation(s)
- Elhanan Nahum
- Department of Pediatric Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
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Averbuch N, Birk E, Frenkel G, Gogia O, Shulman OM, Bruckheimer E, Nachum E, Amir G. Percutaneous Intraperitoneal Catheters in Neonates Following Open Heart Surgery. J Intensive Care Med 2013; 29:160-4. [DOI: 10.1177/0885066613482086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Ascitic fluid in the peritoneal cavity may severely impair respiratory and renal function following neonatal heart surgery. It has been our practice to liberally insert percutaneous peritoneal catheters (PPCs) in order to manage fluid balance and thereby improve ventilatory function. We herein report our experience with PPC. Methods: Retrospective analysis of charts of all surviving neonates that underwent PPC insertion from January 2007 through March 2010. Charts were reviewed for demographic and clinical variables from the preoperative, operative, and postoperative periods. Results: A total of 1268 patients underwent surgery, 292 (23%) were neonates. 17 (5.8%) patients required PPC. Mean age and weight were 16 days and 3.1 kg, respectively. Mean amount drained upon insertion was 55 ± 46 ml. Catheters were maintained for a mean of 5 days and drained an average of 201 ml on the first postinsertion day. Ventilatory settings did not change significantly prior to and postcatheter insertion (respiratory rate [29 ± 3.8 vs 28.7 ± 3.9; P = .93], inspiratory pressures [26.3 ± 3.6 vs 26.1 ± 3.3 cm H2O; P = .34], and fraction of inspired oxygen [0.66 ± 0.21 vs 0.63 ± 0.18; P = .53]). Carbon dioxide values decreased significantly (43.2 ± 9.7 vs 37 ± 4.9 mm Hg; P = .01), and PO2 values increased (78 ± 69 vs 104 ± 57 mm Hg; P = .05). Conclusions: The PPC insertion can be easily performed at the bedside with minimal complications. Fluid balance management is facilitated, and ventilation is improved. The PPC insertion is a valuable addition to the armamentarium of the physician treating neonates in the intensive care unit after complex congenital heart surgery.
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Affiliation(s)
- Noa Averbuch
- Division of Pediatric Cardiothoracic Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Einat Birk
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Georgy Frenkel
- Division of Pediatric Cardiothoracic Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Omar Gogia
- Division of Pediatric Cardiothoracic Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Orit Manor Shulman
- Division of Pediatric Cardiac Intensive Care, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Elchanan Bruckheimer
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Elchanan Nachum
- Division of Pediatric Intensive Care, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Gabriel Amir
- Division of Pediatric Cardiothoracic Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Kapusta L, Zucker N, Frenckel G, Medalion B, Ben Gal T, Birk E, Mandel H, Nasser N, Morgenstern S, Zuckermann A, Lefeber DJ, de Brouwer A, Wevers RA, Lorber A, Morava E. From discrete dilated cardiomyopathy to successful cardiac transplantation in congenital disorders of glycosylation due to dolichol kinase deficiency (DK1-CDG). Heart Fail Rev 2013; 18:187-96. [PMID: 22327749 PMCID: PMC3593007 DOI: 10.1007/s10741-012-9302-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Congenital disorders of glycosylation are a growing group of inborn errors of protein glycosylation. Cardiac involvement is frequently observed in the most common form, PMM2-CDG, especially hypertrophic cardiomyopathy. Dilated cardiomyopathy, however, has been only observed in a few CDG subtypes, usually with a lethal outcome. We report on cardiac pathology in nine patients from three unrelated Israeli families, diagnosed with dolichol kinase deficiency, due to novel, homozygous DK1 gene mutations. The cardiac symptoms varied from discrete, mild dilation to overt heart failure with death. Two children died unexpectedly with acute symptoms of heart failure before the diagnosis of DK1-CDG and heart transplantation could take place. Three other affected children with mild dilated cardiomyopathy at the time of the diagnosis deteriorated rapidly, two of them within days after an acute infection. They all went through successful heart transplantation; one died unexpectedly and 2 others are currently (after 1-5 years) clinically stable. The other 4 children diagnosed with mild dilated cardiomyopathy are doing well on supportive heart failure therapy. In most cases, the cardiac findings dominated the clinical picture, without central nervous system or multisystem involvement, which is unique in CDG syndrome. We suggest to test for DK1-CDG in patients with dilated cardiomyopathy. Patients with discrete cardiomyopathy may remain stable on supportive treatment while others deteriorate rapidly. Our paper is the first comprehensive study on the phenotype of DK1-CDG and the first successful organ transplantation in CDG syndrome.
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Affiliation(s)
- Livia Kapusta
- Children's Heart Centre, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Barzelay A, Hochhauser E, Entin-Meer M, Chepurko Y, Birk E, Afek A, Barshack I, Pinhas L, Rivo Y, Ben-Shoshan J, Maysel-Auslender S, Keren G, George J. Islet-1 gene delivery improves myocardial performance after experimental infarction. Atherosclerosis 2012; 223:284-90. [DOI: 10.1016/j.atherosclerosis.2012.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 05/09/2012] [Accepted: 05/21/2012] [Indexed: 11/24/2022]
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Marom D, Birk E, Ashkenazi S. [Trends in pediatric infective endocarditis in a tertiary pediatric center in Israel]. Harefuah 2012; 151:464-497. [PMID: 23350291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The characteristics of pediatric infective endocarditis (IE) are continuously changing. OBJECTIVES To describe trends in pediatric IE over a period of 25 years. STUDY METHODS Children (< 18 years old] treated at Schneider Children's Medical Center during 1992-2004 who met Duke criteria for definite or possible IE were included in the study. Demographic, clinical and laboratory data were collected and compared to data gathered during 1980-1991. RESULTS Compared to 1980-1991, during 1992-2004 we noted a decrease in the mean age from 6.5 to 4 years and in the incidence of congenital heart defects from 96% to 61% (p = 0.001). Incidence of significant underlying diseases and non-cardiac predisposing factors rose from 4% to 43%. Significantly Less children presented with fever, splenomegaly and murmur during 1992-2004; a 4-fold increase in surgical intervention [p = 0.024) and a 3-fold increase in mortality p = 0.257 were observed. Viridans streptococci (37.5%), Staphylococcus aureus (20.8%) and gram-negative bacilli 2.5%] caused most of IE during 1980-1992, whereas viridians streptococci (19.1%), Candida spp (17%), S. aureus (17%) and coagulase-negative staphylococci (12.8%) were the common causes during 1992-2004. CONCLUSIONS Considerable changes in pediatric IE were observed. DISCUSSION AND SUMMARY Pediatric IE became an infection of young children, especially those with significant noncardiac underlying diseases. It is less commonly caused by viridans streptococci and is increasingly caused by Candida spp and coagulase-negative staphylococci. These trends may affect the management of pediatric IE.
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Affiliation(s)
- Daphna Marom
- Department of Pediatrics A, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Kachko L, Birk E, Simhi E, Tzeitlin E, Freud E, Katz J. Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases. Paediatr Anaesth 2012; 22:647-53. [PMID: 22833874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE/AIM To compare hemodynamic parameters in infants with congenital heart disease (CHD) undergoing noncardiac surgery (NCS) under awake spinal anesthesia (SA) with controls without CHD also undergoing SA. BACKGROUND NCS poses a twofold higher mortality risk in infants with CHD. SA might be a good alternative to general anesthesia (GA) in this setting. METHODS The files of 84 infants were reviewed; 42 had CHD and 42 were controls without CHD. Primary outcome measures were percent decrease in mean arterial pressure (%MAP decrease) and heart rate (%HR decrease)from baseline to the lowest intraoperative value. One-way analysis of variance(ANOVA), ANOVA with repeated measures, Pearson chi-square test, Fisher's exact test, and Pearson correlation were used for statistical analysis.Time to discharge was analyzed with the nonparametric Mann–Whitney U-test. RESULTS There were no significant between-group differences in %MAP decrease and %HR decrease; no significant associations and correlations between %MAP decrease or %HR decrease and other variables; and no correlation between %MAP decrease and %HR decrease. A %MAP decrease of >20% was documented in 11 patients with CHD (26.2%) and 10 controls (23.8%); a lowest intraoperative HR of <100 b.min)1 was recorded in two study patients (4.8%) and four controls (9.5%) (P = NS for both). There were no cases of high SA or conversion to GA and no need for mechanical ventilation or inotropic support intra/postoperatively. CONCLUSIONS These preliminary findings show that hemodynamic parameters in infants with CHD undergoing NCS under awake SA are not different from controls without CHD and that SA appears to be safe in infants with CHD.
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Affiliation(s)
- Ludmyla Kachko
- Department of Anesthesia, Schneider Children’s Medical Center of Israel, 14 Kaplan St., Petah Tiqwa, Israel.
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Cohen R, Shainberg A, Hochhauser E, Cheporko Y, Tobar A, Birk E, Pinhas L, Leipziger J, Don J, Porat E. UTP reduces infarct size and improves mice heart function after myocardial infarct via P2Y2 receptor. Biochem Pharmacol 2011; 82:1126-33. [PMID: 21839729 DOI: 10.1016/j.bcp.2011.07.094] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/06/2011] [Accepted: 07/21/2011] [Indexed: 10/18/2022]
Abstract
Pyrimidine nucleotides are signaling molecules, which activate G protein-coupled membrane receptors of the P2Y family. P2Y(2) and P2Y(4) receptors are part of the P2Y family, which is composed of 8 subtypes that have been cloned and functionally defined. We have previously found that uridine-5'-triphosphate (UTP) reduces infarct size and improves cardiac function following myocardial infarct (MI). The aim of the present study was to determine the role of P2Y(2) receptor in cardiac protection following MI using knockout (KO) mice, in vivo and wild type (WT) for controls. In both experimental groups used (WT and P2Y(2)(-/-) receptor KO mice) there were 3 subgroups: sham, MI, and MI+UTP. 24h post MI we performed echocardiography and measured infarct size using triphenyl tetrazolium chloride (TTC) staining on all mice. Fractional shortening (FS) was higher in WT UTP-treated mice than the MI group (44.7±4.08% vs. 33.5±2.7% respectively, p<0.001). However, the FS of P2Y(2)(-/-) receptor KO mice were not affected by UTP treatment (34.7±5.3% vs. 35.9±2.9%). Similar results were obtained with TTC and hematoxylin and eosin stainings. Moreover, troponin T measurements demonstrated reduced myocardial damage in WT mice pretreated with UTP vs. untreated mice (8.8±4.6 vs. 12±3.1 p<0.05). In contrast, P2Y(2)(-/-) receptor KO mice pretreated with UTP did not demonstrate reduced myocardial damage. These results indicate that the P2Y(2) receptor mediates UTP cardioprotection, in vivo.
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Affiliation(s)
- R Cohen
- The Mina & Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
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Bruckheimer E, Harris M, Kornowski R, Dagan T, Birk E. Transcatheter closure of large congenital coronary-cameral fistulae with Amplatzer devices. Catheter Cardiovasc Interv 2010; 75:850-4. [PMID: 20146207 DOI: 10.1002/ccd.22365] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To report on the methods and results of treatment of large congenital coronary-cameral fistulae by transcatheter closure with Amplatzer devices. BACKGROUND Large coronary-cameral fistulae cause a steal phenomenon from the normal coronary circulation. Surgical closure is an option. However, transcatheter methods allow for temporary occlusion, definition of anatomy, and online assessment of successful closure. Amplatzer devices are compact occluders that can be fully delivered, collapsed, and repositioned until a satisfactory position is attained. METHODS Coronary and fistula anatomy were defined by selective coronary angiography with or without temporary occlusion. Device closure of the fistula was performed at the most distal point accessible, often from the cameral side using an arteriovenous loop method. RESULTS Ten patients of median age 2.6 years (0.5-52.2) and weight 14.4 kg (6.1-67) underwent an attempt at transcatheter closure of a large fistula. In nine patients, the fistula was closed successfully with a device. There were no complications. CONCLUSIONS Transcatheter closure of coronary-cameral fistula with Amplatzer devices is safe and effective.
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Affiliation(s)
- Elchanan Bruckheimer
- Section of Pediatric Cardiology, Schneider Children's Medical Center Israel, Petach Tikva, Israel.
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