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Hutchison R, Hudson S, Wang D, Ruckdeschel E, Gentile K, Middleton F. TARGETED THERAPY INCREASES PD-L1 PROTEIN EXPRESSION IN CELL LINES OF MEDIASTINAL LYMPHOMA. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00257-0] [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: 11/05/2022]
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Kim YY, Levine LD, Partington SL, Patel PA, Ruckdeschel E, Senapati S, Gracia CR. Successful in vitro fertilization in women with Fontan physiology. J Assist Reprod Genet 2020; 37:3017-3023. [PMID: 33040295 DOI: 10.1007/s10815-020-01969-2] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Patients with single ventricle anatomy palliated with Fontan operation are at risk for thromboembolism, arrhythmia, and heart failure rendering pregnancy high risk or even contraindicated. Infertility and high rates of first trimester miscarriage are not uncommon. In vitro fertilization (IVF) with or without gestational surrogacy can be an option, but poses risks during ovarian stimulation, oocyte retrieval, and the post-procedural period. We present six cases of women with complex congenital heart disease status post Fontan operation who underwent successful IVF. METHODS Case series from a single-center tertiary care setting. RESULTS Indications for referral were cardiac or fertility concerns for pregnancy of the congenital cardiologist. One woman had mild volume overload after oocyte retrieval requiring furosemide and one experienced post-operative colitis. There were no thrombotic complications. CONCLUSIONS A multidisciplinary team-based approach can result in successful oocyte retrieval and IVF in women with complex congenital heart disease and Fontan physiology.
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Affiliation(s)
- Yuli Y Kim
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, PCAM 2nd Floor E. Pavilion, Philadelphia, PA, 19104, USA.
| | - Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L Partington
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, PCAM 2nd Floor E. Pavilion, Philadelphia, PA, 19104, USA
| | - Prakash A Patel
- Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Ruckdeschel
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, PCAM 2nd Floor E. Pavilion, Philadelphia, PA, 19104, USA
| | - Suneeta Senapati
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Clarisa R Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Patel B, Serper M, Ruckdeschel E, Partington SL, Andrade L, Tobin L, Kim Y, Hoteit M. PREDICTORS OF ADVERSE LIVER-RELATED OUTCOMES IN ADULTS AFTER THE FONTAN OPERATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31264-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Carducci J, Kim Y, Patel B, Awh K, Andrade L, Fuller S, Mascio C, Tobin L, Ruckdeschel E. LYMPHOPENIA IN ADULT PATIENTS WITH FONTAN PHYSIOLOGY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31237-7] [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: 11/30/2022]
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Kim YY, Awh K, Acker M, Atluri P, Bermudez C, Crespo M, Diamond JM, Drajpuch D, Forde-Mclean R, Fuller S, Goldberg L, Mazurek J, Mascio C, Menachem JN, Rame E, Ruckdeschel E, Tobin L, Wald J. Pulmonary arterial hypertension in adults with systemic right ventricles referred for cardiac transplantation. Clin Transplant 2019; 33:e13496. [PMID: 30770573 DOI: 10.1111/ctr.13496] [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] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Systemic right ventricular (RV) failure may progress necessitating referral for orthotropic heart transplantation (OHT). Pulmonary hypertension (PH) frequently coexists in adult congenital heart disease and can complicate the assessment for OHT. METHODS Single-center case series of six patients (median age 34.9 years [IQR, 31.9-42.4]) with systemic RV physiology with PH referred for OHT evaluation from 2008 to 2017. RESULTS One-third (n = 6) of 18 patients with systemic RV physiology referred for OHT evaluation had pulmonary arterial hypertension (PAH) defined as mean pulmonary artery pressure (mPAP) > 25 mm Hg and pulmonary vascular resistance (PVR) > 3 Wood Units. Two of the six patients were considered OHT-ineligible due to PH and comorbidities. Of the remaining four, two had pre-capillary PH and underwent heart-lung transplant (HLTx). The other two demonstrated reversibility of PVR with vasodilator testing and underwent OHT alone, one of whom died post-transplant from PH crisis. CONCLUSIONS Pulmonary arterial hypertension is common in systemic RV patients referred for OHT. Systemic RV dysfunction places these patients at risk for post-capillary PH but pre-capillary PH can exist. Despite management with selective pulmonary vasodilators and afterload reduction, criteria for listing patients for HLTx vs OHT are not known and need further elucidation.
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Affiliation(s)
- Yuli Y Kim
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katherine Awh
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael Acker
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christian Bermudez
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria Crespo
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua M Diamond
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Drajpuch
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rhondalyn Forde-Mclean
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lee Goldberg
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy Mazurek
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher Mascio
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan N Menachem
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eduardo Rame
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Ruckdeschel
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lynda Tobin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joyce Wald
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Kim YY, Goldberg LA, Awh K, Bhamare T, Drajpuch D, Hirshberg A, Partington SL, Rogers R, Ruckdeschel E, Tobin L, Venuti M, Levine LD. Accuracy of risk prediction scores in pregnant women with congenital heart disease. CONGENIT HEART DIS 2019; 14:470-478. [PMID: 30729681 DOI: 10.1111/chd.12750] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 09/11/2018] [Revised: 11/21/2018] [Accepted: 01/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess performance of risk stratification schemes in predicting adverse cardiac outcomes in pregnant women with congenital heart disease (CHD) and to compare these schemes to clinical factors alone. DESIGN Single-center retrospective study. SETTING Tertiary care academic hospital. PATIENTS Women ≥18 years with International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating CHD who delivered between 1998 and 2014. CARPREG I and ZAHARA risk scores and modified World Health Organization (WHO) criteria were applied to each woman. OUTCOME MEASURES The primary outcome was defined by ≥1 of the following: arrhythmia, heart failure/pulmonary edema, transient ischemic attack, stroke, dissection, myocardial infarction, cardiac arrest, death during gestation and up to 6 months postpartum. RESULTS Of 178 women, the most common CHD lesions were congenital aortic stenosis (15.2%), ventricular septal defect (13.5%), atrial septal defect (12.9%), and tetralogy of Fallot (12.9%). Thirty-five women (19.7%) sustained 39 cardiac events. Observed vs expected event rates were 9.9% vs 5% (P = .02) for CARPREG I score 0 and 26.1% vs 7.5% (P < .001) for ZAHARA scores 0.51-1.5. ZAHARA outperformed CARPREG I at predicting adverse cardiovascular outcomes (AUC 0.80 vs 0.72, P = .03) but was not significantly better than modified WHO. Clinical predictors of adverse cardiac event were symptoms (P = .002), systemic ventricular dysfunction (P < .001), and subpulmonary ventricular dysfunction (P = .03) with an AUC 0.83 comparable to ZAHARA (P = .66). CONCLUSIONS CARPREG I and ZAHARA scores underestimate cardiac risk for lower risk pregnancies in these women. Of the three risk schemes, CARPREG I performed least well in predictive capacity. Clinical factors specific to the population studied are comparable to stratification schemes.
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Affiliation(s)
- Yuli Y Kim
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Leah A Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katherine Awh
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tanmay Bhamare
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David Drajpuch
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adi Hirshberg
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Sara L Partington
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Rogers
- Biostatistics and Data Management Core, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Emily Ruckdeschel
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lynda Tobin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Morgan Venuti
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
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Affiliation(s)
- Emily Ruckdeschel
- Philadelphia Adult Congenital Heart Center, Penn Medicine and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yuli Y Kim
- Philadelphia Adult Congenital Heart Center, Penn Medicine and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Cortez D, Barham W, Ruckdeschel E, Sharma N, McCanta AC, von Alvensleben J, Sauer WH, Collins KK, Kay J, Patel S, Nguyen DT. Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement. Clin Cardiol 2017; 40:591-596. [PMID: 28394443 DOI: 10.1002/clc.22707] [Citation(s) in RCA: 7] [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: 11/07/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patients with tetralogy of Fallot (TOF) have increased risk of atrial arrhythmias. HYPOTHESIS A measure of atrial dispersion, the P-wave vector magnitude (Pvm), can identify patients at risk for perioperative atrial flutter (AFL) or intra-atrial re-entrant tachycardia (IART) in a large TOF cohort. METHODS We performed a blinded, retrospective analysis of 158 TOF patients undergoing pulmonary valve replacement between 1997 and 2015. History of AFL/IART was documented using electrocardiogram, Holter monitor, exercise stress test, implanted cardiac device, and electrophysiology study. P-R intervals, Pvm, QRS duration, and QRS vector magnitude were assessed from resting sinus-rhythm 12-lead electrocardiograms and identification of those with AFL/IART was determined. RESULTS Fourteen patients (8.9%) were found to have AFL/IART. Pvm, QRS duration, and QRS vector magnitude significantly differentiated those with AFL/IART from those without on univariate analysis: 0.09 ± 0.04 vs 0.18 ± 0.07 mV, 161.3 ± 21.9 vs 137.7 ± 31.4 ms, and 1.2 (interquartile range, 1.0-1.2) vs 1.6 mV (1.0-2.3), respectively (P < 0.05 for each). The Pvm had the highest area under the ROC curve (0.88) and was the only significant predictor on multivariate analysis, with odds ratio of 0.02 (95% confidence interval: 0.01-0.53). P-R duration, MRI volumes, and right-heart hemodynamics did not significantly differentiate those with vs those without AFL/IART. CONCLUSIONS In TOF patients undergoing pulmonary valve replacement, Pvm has significant value in predicting those with perioperative AFL/IART. These clinical features may help further evaluate TOF patients at risk for perioperative atrial arrhythmias. Prospective studies are warranted.
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Affiliation(s)
- Daniel Cortez
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora.,Division of Cardiovascular Sciences, Lund University, Sweden.,Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Waseem Barham
- Division of Cardiovascular Sciences, Lund University, Sweden
| | - Emily Ruckdeschel
- Department of Cardiology, Children's Hospital of Philadelphia, Pennsylvania
| | - Nandita Sharma
- Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Johannes von Alvensleben
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora
| | | | - Kathryn K Collins
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora.,Department of Cardiology, University of Colorado Denver School of Medicine
| | - Joseph Kay
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora.,Department of Cardiology, University of Colorado Denver School of Medicine
| | - Sonali Patel
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora.,Department of Cardiology, University of Colorado Denver School of Medicine
| | - Duy T Nguyen
- Department of Cardiology, University of Colorado, Aurora
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Kim YY, Ruckdeschel E. Approach to residual pulmonary valve dysfunction in adults with repaired tetralogy of Fallot. Heart 2016; 102:1520-6. [DOI: 10.1136/heartjnl-2015-309067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/23/2016] [Indexed: 12/28/2022] Open
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Cortez D, Ruckdeschel E, McCanta AC, Collins K, Sauer W, Kay J, Nguyen D. Vectorcardiographic predictors of ventricular arrhythmia inducibility in patients with tetralogy of Fallot. J Electrocardiol 2014; 48:141-4. [PMID: 25483288 DOI: 10.1016/j.jelectrocard.2014.11.009] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Vectorcardiography (VCG) may have predictive value in Tetralogy of Fallot (TOF) patients undergoing ventricular arrhythmia inducibility (VAI) electrophysiology studies (EPs). MATERIALS AND METHODS Blinded, retrospective analyses of 37 adult TOF patients undergoing EPs prior to pulmonary valve replacements were performed (21 female, median age 37years). VAI was evaluated from EPs and resting 12-lead electrocardiograms, respectively using QRS and heart rate adjusted Q-T intervals, spatial QRS-T angles (peaks), T-wave and QRS-wave (QRSwave vc) component vector root mean squares. Differences were assessed (Student t-tests, Mann Whitney U-tests, Analysis of Variance). Relative risks were calculated. RESULTS 16 patients had VAI (6 monomorphic, 10 polymorphic). Only the QRSwave vc showed significant differences between those with and without VAI, 10.5±2.4 dmV vs. 13.9±4.5dmV, respectively (p=0.002), area under the ROC curve of 0.78 and relative risk of 2.52. CONCLUSION VCG evidence of depolarization differences was significant between TOF patients with and without inducible VA.
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Affiliation(s)
- Daniel Cortez
- Children's Hospital of Colorado, Aurora, USA; University of Colorado, Aurora, USA.
| | - Emily Ruckdeschel
- Children's Hospital of Colorado, Aurora, USA; University of Colorado, Aurora, USA
| | - Anthony C McCanta
- Children's Hospital of Colorado, Aurora, USA; University of Colorado, Aurora, USA
| | - Kathryn Collins
- Children's Hospital of Colorado, Aurora, USA; University of Colorado, Aurora, USA
| | | | - Joseph Kay
- Children's Hospital of Colorado, Aurora, USA; University of Colorado, Aurora, USA
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Ruckdeschel E, Nicolarsen J, Yeung E, Khanna A, Kay J. Echocardiographic parameters of systemic right ventricular size and function compared to cardiac MRI. J Cardiovasc Magn Reson 2014. [PMCID: PMC4044782 DOI: 10.1186/1532-429x-16-s1-p130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gurkan OU, O'Donnell C, Brower R, Ruckdeschel E, Becker PM. Differential effects of mechanical ventilatory strategy on lung injury and systemic organ inflammation in mice. Am J Physiol Lung Cell Mol Physiol 2003; 285:L710-8. [PMID: 12754185 DOI: 10.1152/ajplung.00044.2003] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with acute respiratory distress syndrome are at increased risk for developing multiorgan system dysfunction. The goal of this study was to establish an in vivo murine model to assess the differential effects of ventilation-protective strategies on the development of acute lung injury and systemic organ inflammation. C57B/6 mice were randomized to mechanical ventilation (MV) with conventional, high (17 ml/kg) or protective, low (6 ml/kg) tidal volume (VT) after intratracheal hydrochloric acid or no intervention. Mean arterial pressure was continuously monitored during MV and did not differ between groups. After 4 h, lung injury was assessed by measurement of wet/dry lung weight, lung lavage protein concentration and cell count, and histology. Concentration of IL-6, TNF-alpha, VEGF, and VEGF receptor-2 (VEGFR2) was measured in lung, liver, kidney, and heart. Results were compared with control, spontaneously breathing mice. Lung injury and altered pulmonary cytokine expression were not detected after MV of healthy mice with low or high VT. Although MV did not significantly alter IL-6 or TNF-alpha in systemic organs, VEGF concentration significantly increased in liver and kidney. After acid aspiration, mice ventilated with high VT manifested lung injury and increased IL-6 and VEGFR2 in lung, liver, and kidney, whereas VEGF increased only in liver and kidney. MV with low VT after acid aspiration attenuated lung injury, both IL-6 and VEGFR2 expression in lung and systemic organs, and hepatic, but not renal, increased VEGF. Our data suggest that MV strategy has differential effects on systemic inflammatory changes and thus may selectively predispose to systemic organ dysfunction.
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Affiliation(s)
- Ozlem U Gurkan
- Div. of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Rm. 4B74, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
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Gurkan OU, O'Donnell C, Brower R, Ruckdeschel E, Becker PM. Differential effects of mechanical ventilatory strategy on lung injury and systemic organ inflammation in mice. Am J Physiol Lung Cell Mol Physiol 2003. [PMID: 12754185 DOI: 0.1152/ajplung.00044.2003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Patients with acute respiratory distress syndrome are at increased risk for developing multiorgan system dysfunction. The goal of this study was to establish an in vivo murine model to assess the differential effects of ventilation-protective strategies on the development of acute lung injury and systemic organ inflammation. C57B/6 mice were randomized to mechanical ventilation (MV) with conventional, high (17 ml/kg) or protective, low (6 ml/kg) tidal volume (VT) after intratracheal hydrochloric acid or no intervention. Mean arterial pressure was continuously monitored during MV and did not differ between groups. After 4 h, lung injury was assessed by measurement of wet/dry lung weight, lung lavage protein concentration and cell count, and histology. Concentration of IL-6, TNF-alpha, VEGF, and VEGF receptor-2 (VEGFR2) was measured in lung, liver, kidney, and heart. Results were compared with control, spontaneously breathing mice. Lung injury and altered pulmonary cytokine expression were not detected after MV of healthy mice with low or high VT. Although MV did not significantly alter IL-6 or TNF-alpha in systemic organs, VEGF concentration significantly increased in liver and kidney. After acid aspiration, mice ventilated with high VT manifested lung injury and increased IL-6 and VEGFR2 in lung, liver, and kidney, whereas VEGF increased only in liver and kidney. MV with low VT after acid aspiration attenuated lung injury, both IL-6 and VEGFR2 expression in lung and systemic organs, and hepatic, but not renal, increased VEGF. Our data suggest that MV strategy has differential effects on systemic inflammatory changes and thus may selectively predispose to systemic organ dysfunction.
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Affiliation(s)
- Ozlem U Gurkan
- Div. of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Rm. 4B74, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
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