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Rücker B, Vigneswaran TV, Zidere V, Simpson JM. Association of Prenatally Diagnosed Isolated Single Left Superior Vena Cava and Postnatal Development of Coarctation of the Aorta. Pediatr Cardiol 2024; 45:749-758. [PMID: 38381183 DOI: 10.1007/s00246-024-03407-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
To report the prevalence of coarctation of the aorta (CoA) in fetuses with single left superior vena cava (SL-SVC) and to evaluate changes in echocardiographic measurements. Additionally, to report the prevalence of associated malformations. Retrospective observational study of fetuses diagnosed with SL-SVC between 2012 and 2021 at a tertiary fetal cardiology unit. In fetuses without intracardiac abnormalities, Z-scores of the ventricles, great arteries, and Doppler flow patterns are reported. We identified 47 fetuses with SL-SVC of which 8/47 (17%) had abnormal intracardiac anatomy. One fetus was lost to follow-up. Of those with normal intracardiac anatomy and postnatal follow-up (38), karyotype abnormalities were confirmed in 2/38 (5%) and ECA in 8/38 (21%). 33/38 were live-born. None developed CoA postnatally. Paired analysis of Z-scores between early and late scans of 24 fetuses showed that diameters of the right heart structures and Doppler flows of tricuspid valve increased significantly during pregnancy, while the left heart structures and flow patterns did not change. The median risk of CoA did not change between the early and the late scan. We did not observe CoA in this cohort. A degree of ventricular asymmetry was present, but this was due to right heart dominance rather than hypoplasia of left heart structures. This likely reflects redistribution of blood and does not appear to confer increased risk of CoA. Predictive models of the postnatal development of CoA which set the dimensions of right and left heart structures in relation might not be applicable in this situation.
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Affiliation(s)
- Beate Rücker
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK.
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
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Freud LR, Galloway S, Crowley TB, Moldenhauer J, Swillen A, Breckpot J, Borrell A, Vora NL, Cuneo B, Hoffman H, Gilbert L, Nowakowska B, Geremek M, Kutkowska-Kaźmierczak A, Vermeesch JR, Devriendt K, Busa T, Sigaudy S, Vigneswaran T, Simpson JM, Dungan J, Gotteiner N, Gloning KP, Digilio MC, Unolt M, Putotto C, Marino B, Repetto G, Fadic M, Garcia-Minaur S, Achón Buil A, Thomas MA, Fruitman D, Beecroft T, Hui PW, Oskarsdottir S, Bradshaw R, Criebaum A, Norton ME, Lee T, Geiger M, Dunnington L, Isaac J, Wilkins-Haug L, Hunter L, Izzi C, Toscano M, Ghi T, McGlynn J, Romana Grati F, Emanuel BS, Gaiser K, Gaynor JW, Goldmuntz E, McGinn DE, Schindewolf E, Tran O, Zackai EH, Yan Q, Bassett AS, Wapner R, McDonald-McGinn DM. Prenatal vs postnatal diagnosis of 22q11.2 deletion syndrome: cardiac and noncardiac outcomes through 1 year of age. Am J Obstet Gynecol 2024; 230:368.e1-368.e12. [PMID: 37717890 DOI: 10.1016/j.ajog.2023.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/15/2023] [Revised: 08/24/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The 22q11.2 deletion syndrome is the most common microdeletion syndrome and is frequently associated with congenital heart disease. Prenatal diagnosis of 22q11.2 deletion syndrome is increasingly offered. It is unknown whether there is a clinical benefit to prenatal detection as compared with postnatal diagnosis. OBJECTIVE This study aimed to determine differences in perinatal and infant outcomes between patients with prenatal and postnatal diagnosis of 22q11.2 deletion syndrome. STUDY DESIGN This was a retrospective cohort study across multiple international centers (30 sites, 4 continents) from 2006 to 2019. Participants were fetuses, neonates, or infants with a genetic diagnosis of 22q11.2 deletion syndrome by 1 year of age with or without congenital heart disease; those with prenatal diagnosis or suspicion (suggestive ultrasound findings and/or high-risk cell-free fetal DNA screen for 22q11.2 deletion syndrome with postnatal confirmation) were compared with those with postnatal diagnosis. Perinatal management, cardiac and noncardiac morbidity, and mortality by 1 year were assessed. Outcomes were adjusted for presence of critical congenital heart disease, gestational age at birth, and site. RESULTS A total of 625 fetuses, neonates, or infants with 22q11.2 deletion syndrome (53.4% male) were included: 259 fetuses were prenatally diagnosed (156 [60.2%] were live-born) and 122 neonates were prenatally suspected with postnatal confirmation, whereas 244 infants were postnatally diagnosed. In the live-born cohort (n=522), 1-year mortality was 5.9%, which did not differ between groups but differed by the presence of critical congenital heart disease (hazard ratio, 4.18; 95% confidence interval, 1.56-11.18; P<.001) and gestational age at birth (hazard ratio, 0.78 per week; 95% confidence interval, 0.69-0.89; P<.001). Adjusting for critical congenital heart disease and gestational age at birth, the prenatal cohort was less likely to deliver at a local community hospital (5.1% vs 38.2%; odds ratio, 0.11; 95% confidence interval, 0.06-0.23; P<.001), experience neonatal cardiac decompensation (1.3% vs 5.0%; odds ratio, 0.11; 95% confidence interval, 0.03-0.49; P=.004), or have failure to thrive by 1 year (43.4% vs 50.3%; odds ratio, 0.58; 95% confidence interval, 0.36-0.91; P=.019). CONCLUSION Prenatal detection of 22q11.2 deletion syndrome was associated with improved delivery management and less cardiac and noncardiac morbidity, but not mortality, compared with postnatal detection.
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Affiliation(s)
- Lindsay R Freud
- Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Stephanie Galloway
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, NY
| | | | - Julie Moldenhauer
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ann Swillen
- University Hospitals Leuven, Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Jeroen Breckpot
- University Hospitals Leuven, Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Antoni Borrell
- Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Neeta L Vora
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bettina Cuneo
- Children's Hospital Colorado, University of Colorado, Denver, CO
| | - Hilary Hoffman
- Children's Hospital Colorado, University of Colorado, Denver, CO
| | - Lisa Gilbert
- Children's Hospital Colorado, University of Colorado, Denver, CO
| | | | | | | | - Joris R Vermeesch
- University Hospitals Leuven, Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Koen Devriendt
- University Hospitals Leuven, Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Tiffany Busa
- Hôpital de la Timone, Marseille University, Marseille, France
| | - Sabine Sigaudy
- Hôpital de la Timone, Marseille University, Marseille, France
| | - Trisha Vigneswaran
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust and Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - John M Simpson
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust and Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Jeffrey Dungan
- Prentice Women's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nina Gotteiner
- Prentice Women's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Marta Unolt
- Children's Hospital of Philadelphia, Philadelphia, PA; Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | | | - Gabriela Repetto
- Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Magdalena Fadic
- Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | | | - Mary Ann Thomas
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Deborah Fruitman
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Taylor Beecroft
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Pui Wah Hui
- Queen Mary Hospital, Tsan Yuk Hospital, University of Hong Kong, Hong Kong, China
| | | | - Rachael Bradshaw
- SSM Health Cardinal Glennon St. Louis Fetal Care Institute, Saint Louis University, St. Louis, MO
| | - Amanda Criebaum
- SSM Health Cardinal Glennon St. Louis Fetal Care Institute, Saint Louis University, St. Louis, MO
| | - Mary E Norton
- University of California, San Francisco, San Francisco, CA
| | - Tiffany Lee
- University of California, San Francisco, San Francisco, CA
| | - Miwa Geiger
- Kravis Children's Hospital, Mount Sinai Medical Center, New York City, NY
| | - Leslie Dunnington
- Memorial Hermann-Texas Medical Center, University of Texas Health Science Center at Houston, Houston, TX
| | | | | | - Lindsey Hunter
- Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
| | - Claudia Izzi
- Children's Hospital of Philadelphia, Philadelphia, PA; Azienda Socio Sanitaria Territoriale (ASST) degli Spedali Civili di Brescia, Brescia, Italy
| | | | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Beverly S Emanuel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kimberly Gaiser
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J William Gaynor
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Goldmuntz
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel E McGinn
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica Schindewolf
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Oanh Tran
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elaine H Zackai
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Qi Yan
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, NY
| | - Anne S Bassett
- Centre for Addiction and Mental Health and Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Ronald Wapner
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, NY
| | - Donna M McDonald-McGinn
- Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Day TG, Matthew J, Budd SF, Venturini L, Wright R, Farruggia A, Vigneswaran TV, Zidere V, Hajnal JV, Razavi R, Simpson JM, Kainz B. Interaction between clinicians and artificial intelligence to detect fetal atrioventricular septal defects on ultrasound: how can we optimize collaborative performance? Ultrasound Obstet Gynecol 2024. [PMID: 38197584 DOI: 10.1002/uog.27577] [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] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Artificial intelligence (AI) has shown promise in improving the performance of fetal ultrasound screening in detecting congenital heart disease (CHD). The effect of giving AI advice to human operators has not been studied in this context. Giving additional information about AI model workings, such as confidence scores for AI predictions, may be a way of improving performance further. Our aims were to investigate whether AI advice improved overall diagnostic accuracy (using a single CHD lesion as an exemplar), and to see what, if any, additional information given to clinicians optimized the overall performance of the clinician-AI team. METHODS An AI model was trained to classify a single fetal CHD lesion (atrioventricular septal defect, AVSD), using a retrospective cohort of 121,130 cardiac four chamber images extracted from 173 ultrasound scan videos (98 with normal hearts, 75 with AVSD). A ResNet50 model architecture was used. Temperature scaling of model prediction probability was performed on a validation set, and gradient-weighted class activation maps (grad-CAMs) produced. Ten clinicians (two consultant fetal cardiologists, three trainees in pediatric cardiology, and five fetal cardiac sonographers) were recruited from a center of fetal cardiology to participate. Each participant was shown 2000 fetal four chamber images in a random order (1,000 normal and 1,000 AVSD). The dataset was comprised of 500 images, each shown in four conditions: 1) image alone without AI output; 2) image with binary AI classification; 3) image with AI model confidence; 4) image with gradient-weighted class activation map image overlays. The clinicians were asked to classify each image as normal or AVSD. RESULTS 20,000 image classifications were recorded from 10 clinicians. The AI model alone achieved an accuracy of 0.798 (95% CI 0.760 - 0.832), sensitivity of 0.868 (95% CI 0.834 - 0.902) and specificity of 0.728 (95% CI 0.702 - 0.754, and the clinicians without AI achieved an accuracy of 0.844 (95% CI 0.834 - 0.854), sensitivity of 0.827 (95% CI 0.795 - 0.858) and specificity of 0.861 (95% CI 0.828 - 0.895). Showing a binary (normal or AVSD) AI model output resulted in significant improvement in accuracy to 0.865 (p <0.001). This effect was seen in both experienced and less experienced participants. Giving incorrect AI advice resulted in significant deterioration in overall accuracy from 0.761 to 0.693 (p <0.001), which was driven by an increase in both type I and type II error by the clinicians. This effect was worsened by showing model confidence (accuracy 0.649, p <0.001) or grad-CAM (accuracy 0.644, p <0.001). CONCLUSIONS AI has the potential to improve performance when used in collaboration with clinicians, even if the model performance does not reach expert level. Giving additional information about model workings such as model confidence and class activation map image overlays did not improve overall performance, and actually worsened performance for images where the AI model was incorrect. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- T G Day
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Matthew
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S F Budd
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - L Venturini
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - R Wright
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Farruggia
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - T V Vigneswaran
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - V Zidere
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Harris Birthright Centre, King's College London NHS Foundation Trust, London, UK
| | - J V Hajnal
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - R Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J M Simpson
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Kainz
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Department of Computing, Faculty of Engineering, Imperial College London, London, UK
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Day TG, Budd S, Tan J, Matthew J, Skelton E, Jowett V, Lloyd D, Gomez A, Hajnal JV, Razavi R, Kainz B, Simpson JM. Prenatal diagnosis of hypoplastic left heart syndrome on ultrasound using artificial intelligence: How does performance compare to a current screening programme? Prenat Diagn 2023. [PMID: 37776084 DOI: 10.1002/pd.6445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Artificial intelligence (AI) has the potential to improve prenatal detection of congenital heart disease. We analysed the performance of the current national screening programme in detecting hypoplastic left heart syndrome (HLHS) to compare with our own AI model. METHODS Current screening programme performance was calculated from local and national sources. AI models were trained using four-chamber ultrasound views of the fetal heart, using a ResNet classifier. RESULTS Estimated current fetal screening programme sensitivity and specificity for HLHS were 94.3% and 99.985%, respectively. Depending on calibration, AI models to detect HLHS were either highly sensitive (sensitivity 100%, specificity 94.0%) or highly specific (sensitivity 93.3%, specificity 100%). Our analysis suggests that our highly sensitive model would generate 45,134 screen positive results for a gain of 14 additional HLHS cases. Our highly specific model would be associated with two fewer detected HLHS cases, and 118 fewer false positives. CONCLUSION If used independently, our AI model performance is slightly worse than the performance level of the current screening programme in detecting HLHS, and this performance is likely to deteriorate further when used prospectively. This demonstrates that collaboration between humans and AI will be key for effective future clinical use.
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Affiliation(s)
- Thomas G Day
- Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Samuel Budd
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jeremy Tan
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jacqueline Matthew
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Emily Skelton
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- School of Health Sciences, University of London, London, UK
| | - Victoria Jowett
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Lloyd
- Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alberto Gomez
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jo V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Reza Razavi
- Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Bernhard Kainz
- Department of Computing, Imperial College London, London, UK
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Rato J, Zidere V, François K, Boon M, Depypere A, Simpson JM, Speggiorin S, Vigneswaran TV. Post-operative Outcomes for Vascular Rings: A Systematic Review and Meta-analysis. J Pediatr Surg 2023; 58:1744-1753. [PMID: 36967253 DOI: 10.1016/j.jpedsurg.2023.02.058] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/22/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Vascular rings may cause tracheal and/or oesophageal compression. For many patients, symptoms/signs have been present for a long period before diagnosis. However, in the era of prenatal diagnosis, some units advocate universal early surgery. The risks and efficacy of surgery must be known to adequately counsel for the operation. This meta-analysis sought to define the morbidity and mortality associated with surgical correction, and persistent post-operative symptoms. METHODS PubMed, Cochrane Library and CINAHL databases were searched for studies that described the outcome of patients undergoing surgery for a double or right aortic arch (DAA or RAA). Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled rates of mortality, surgical complications, reintervention, and persistent follow-up symptoms. RESULTS Nineteen eligible studies were included comprising 18 studies describing outcomes for DAA surgery and 15 for RAA surgery. For DAA surgery, overall mortality rate was 0% [95% confidence interval (CI) 0.0-1.0], post-surgical complication rate 18% [95% CI: 12.0-23.0], prevalence of reintervention 3% [95% CI: 1.0-5.0] and prevalence of symptoms at last follow-up was 33% [95% CI: 17.0-52.0]. For RAA surgery, overall pooled mortality was 0% [95% CI: 0.0-0.0], prevalence of post-surgical complications was 15% [95% CI: 8.0-23.0], reintervention rate was 2% [95% CI: 0.0-4.0], prevalence of symptoms at last follow-up was 40% [95% CI: 26.0-55.0]. CONCLUSIONS While surgery to correct a vascular ring is safe, the rate of persistent symptoms is high and further strategies must be sought to reduce this burden.
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Affiliation(s)
- Joao Rato
- Department of Pediatric Cardiology, Hospital de Santa Cruz - Centro Hospitalar Universitário Lisboa Ocidental, Carnaxide, Portugal; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK; Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | | | - Mieke Boon
- Department of Pediatrics, Pediatric Pulmonology, University Hospital Gasthuisberg Leuven, Belgium
| | - Anouk Depypere
- Department of Pediatrics, Pediatric Pulmonology, University Hospital Gasthuisberg Leuven, Belgium
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Simone Speggiorin
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
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6
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Day TG, Matthew J, Budd S, Hajnal JV, Simpson JM, Razavi R, Kainz B. Sonographer interaction with artificial intelligence: collaboration or conflict? Ultrasound Obstet Gynecol 2023; 62:167-174. [PMID: 37523514 DOI: 10.1002/uog.26238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 08/02/2023]
Affiliation(s)
- T G Day
- Department of Congenital Cardiology, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - J Matthew
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - S Budd
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - J V Hajnal
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - J M Simpson
- Department of Congenital Cardiology, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - R Razavi
- Department of Congenital Cardiology, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - B Kainz
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Computing, Faculty of Engineering, Imperial College London, London, UK
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Chivers S, Cleary A, Knowles R, Babu-Narayan SV, Simpson JM, Nashat H, Dimopoulos K, Gatzoulis MA, Wilson D, Prica M, Anthony J, Clift PF, Jowett V, Jenkins P, Khodaghalian B, Jones CB, Hardiman A, Head C, Miller O, Chung NA, Mahmood U, Bu'Lock FA, Ramcharan TK, Chikermane A, Shortland J, Tometzki A, Crossland DS, Reinhardt Z, Lewis C, Rittey L, Hares D, Panagiotopoulou O, Smith B, Najih L M, Bharucha T, Daubeney PE. COVID-19 in congenital heart disease (COaCHeD) study. Open Heart 2023; 10:e002356. [PMID: 37460271 PMCID: PMC10357297 DOI: 10.1136/openhrt-2023-002356] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care. OBJECTIVE Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes. METHODS Multicentre UK study undertaken 1 March 2020-30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation. RESULTS There were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)). CONCLUSIONS Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD.
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Affiliation(s)
- Sian Chivers
- Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Aoife Cleary
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
- Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Rachel Knowles
- Department of Public Health Medicine, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Sonya V Babu-Narayan
- Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - John M Simpson
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Heba Nashat
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Konstantinos Dimopoulos
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Michael A Gatzoulis
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Dirk Wilson
- Department of Congenital Cardiology, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Milos Prica
- Department of Adult Congenital heart disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Anthony
- Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul F Clift
- Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Victoria Jowett
- Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Petra Jenkins
- Department of Adult Congenital heart disease, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Bernadette Khodaghalian
- Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Caroline B Jones
- Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Antonia Hardiman
- Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Catherine Head
- Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Owen Miller
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Natali Ay Chung
- Department of Adult Congenital heart disease, St Thomas' Hospital, London, UK
| | - Umar Mahmood
- Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK
| | - Frances A Bu'Lock
- Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK
| | - Tristan Kw Ramcharan
- Department of Congenital Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ashish Chikermane
- Department of Congenital Cardiology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jennifer Shortland
- Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Andrew Tometzki
- Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - David S Crossland
- Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Zdenka Reinhardt
- Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Clive Lewis
- Department of Adult Congenital heart disease, Papworth Hospital, Cambridge, UK
| | - Leila Rittey
- Department of Congenital Cardiology, Leeds Children's Hospital, Leeds, UK
| | - Dominic Hares
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Olga Panagiotopoulou
- Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK
| | - Benjamin Smith
- Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK
| | - Muhammad Najih L
- Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK
| | - Tara Bharucha
- Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK
| | - Piers Ef Daubeney
- Department of Congenital Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
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8
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Hermida U, van Poppel MPM, Lloyd DFA, Steinweg JK, Vigneswaran TV, Simpson JM, Razavi R, De Vecchi A, Pushparajah K, Lamata P. Learning the Hidden Signature of Fetal Arch Anatomy: a Three-Dimensional Shape Analysis in Suspected Coarctation of the Aorta. J Cardiovasc Transl Res 2023; 16:738-747. [PMID: 36301513 PMCID: PMC10299929 DOI: 10.1007/s12265-022-10335-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
Abstract
Neonatal coarctation of the aorta (CoA) is a common congenital heart defect. Its antenatal diagnosis remains challenging, and its pathophysiology is poorly understood. We present a novel statistical shape modeling (SSM) pipeline to study the role and predictive value of arch shape in CoA in utero. Cardiac magnetic resonance imaging (CMR) data of 112 fetuses with suspected CoA was acquired and motion-corrected to three-dimensional volumes. Centerlines from fetal arches were extracted and used to build a statistical shape model capturing relevant anatomical variations. A linear discriminant analysis was used to find the optimal axis between CoA and false positive cases. The CoA shape risk score classified cases with an area under the curve of 0.907. We demonstrate the feasibility of applying a SSM pipeline to three-dimensional fetal CMR data while providing novel insights into the anatomical determinants of CoA and the relevance of in utero arch anatomy for antenatal diagnosis of CoA.
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Affiliation(s)
- Uxio Hermida
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 5Th Floor Becket House, 1 Lambeth Palace Road, London, SE1 7EH, UK
| | - Milou P M van Poppel
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - David F A Lloyd
- Department of Perinatal Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
| | - Johannes K Steinweg
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
| | - Adelaide De Vecchi
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 5Th Floor Becket House, 1 Lambeth Palace Road, London, SE1 7EH, UK
| | - Kuberan Pushparajah
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
| | - Pablo Lamata
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 5Th Floor Becket House, 1 Lambeth Palace Road, London, SE1 7EH, UK.
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9
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Oakley C, Hurn A, Suckling C, Moriarty G, Simpson JM, Turcu S, Heraghty J, Zidere V, Nyman A, Vigneswaran TV. Impact on the trachea in children with prenatally diagnosed vascular ring formed by a right aortic arch. Pediatr Pulmonol 2023. [PMID: 37212498 DOI: 10.1002/ppul.26463] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/28/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE There has been a rise in the prenatal detection of right sided aortic arch (RAA). When associated with a left-sided arterial duct (LD), this forms a vascular ring encircling the trachea. Infants may have symptoms or signs suggestive of tracheoesophageal compression but many are asymptomatic. The objective of this study was to investigate the relationship between symptoms and severity of tracheobronchial compression assessed by bronchoscopy. METHODS Retrospective review of all cases of prenatally diagnosed RAA-LD in the absence of associated congenital heart disease at Evelina London Children's Hospital and Kings College Hospital over a 4-year period between April 2015-2019. Clinical records, fetal echocardiograms, and free-breathing flexible bronchoscopy (FB) data were reviewed. RESULTS One hundred and twelve cases of isolated RAA-LD were identified of whom 82 cases (73%) underwent FB. FB was performed median age of 11 months (range 1-36 months), no complications occurred. Aberrant left subclavian artery (ALSA) was present in 86% (96/112) and mirror image branching (MIB) in 13% (15/112). 34/112 (30%) reported symptoms during follow-up. 36/77 (47%) with ALSA who underwent FB showed moderate-severe compression mostly at distal tracheal and carinal level of whom 38% had parent-reported symptoms. Moderate-severe compression was seen in 3/5 (60%) with MIB mostly at mid tracheal level; 3 were symptomatic but only 2 had tracheal compression. In total 36% (18/50) of investigated asymptomatic patients showed moderate-severe compression. Respiratory symptoms were poorly predictive of moderate-severe tracheal compression (positive predictive value 66%, negative predictive value 64%). CONCLUSION The absence of symptoms did not exclude significant tracheal compression. The anatomical effect of the vascular ring is under appreciated when symptoms alone are used as a marker of tracheal compression.
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Affiliation(s)
- Christopher Oakley
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Alice Hurn
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Claire Suckling
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Grace Moriarty
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Simona Turcu
- Paediatric Respiratory Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Jane Heraghty
- Paediatric Respiratory Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
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10
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Stephenson N, Pushparajah K, Wheeler G, Deng S, Schnabel JA, Simpson JM. Extended reality for procedural planning and guidance in structural heart disease - a review of the state-of-the-art. Int J Cardiovasc Imaging 2023:10.1007/s10554-023-02823-z. [PMID: 37103667 DOI: 10.1007/s10554-023-02823-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
Extended reality (XR), which encompasses virtual, augmented and mixed reality, is an emerging medical imaging display platform which enables intuitive and immersive interaction in a three-dimensional space. This technology holds the potential to enhance understanding of complex spatial relationships when planning and guiding cardiac procedures in congenital and structural heart disease moving beyond conventional 2D and 3D image displays. A systematic review of the literature demonstrates a rapid increase in publications describing adoption of this technology. At least 33 XR systems have been described, with many demonstrating proof of concept, but with no specific mention of regulatory approval including some prospective studies. Validation remains limited, and true clinical benefit difficult to measure. This review describes and critically appraises the range of XR technologies and its applications for procedural planning and guidance in structural heart disease while discussing the challenges that need to be overcome in future studies to achieve safe and effective clinical adoption.
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Affiliation(s)
- Natasha Stephenson
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK.
- St Thomas' Hospital, 3rd Floor, Lambeth Wing, SE1 7EH, London, UK.
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK
| | - Gavin Wheeler
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Shujie Deng
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Julia A Schnabel
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Technical University of Munich, Munich, Germany
- Institute of Machine Learning in Biomedical Imaging, Helmholtz Center Munich, Munich, Germany
| | - John M Simpson
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK
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11
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Savis A, Simpson JM, Kabir S, Peacock K, Beardsley H, Sinha MD. Prevalence of cardiac valvar abnormalities in children and young people with autosomal dominant polycystic kidney disease. Pediatr Nephrol 2023; 38:705-709. [PMID: 35763085 DOI: 10.1007/s00467-022-05500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Valvar abnormalities in children and adults with autosomal dominant polycystic kidney disease (ADPKD) have previously been reported as a frequent occurrence. Mitral valve prolapse (MVP), in particular, has been reported in almost one-third of adult patients and nearly 12% of children with ADPKD. Our objective in this study was to establish the prevalence of valvar abnormalities in a large, contemporary series of children and young people (CYP) with ADPKD. METHODS A retrospective, single centre, cross-sectional analysis of the echocardiograms performed on all consecutive children seen in a dedicated paediatric ADPKD clinic. Full anatomical and functional echocardiograms were performed and analysed for valvar abnormalities. RESULTS The echocardiograms of 102 CYP with ADPKD (range 0.25-18 years, mean age 10.3 years, SD ± 5.3 years) were analysed. One (0.98%), 3-year-old boy, had MVP. There was no associated mitral regurgitation. Evaluating variations in normal valvar anatomy, 9 (8.8%) patients, aged 7.1 to 18 years, had minor bowing ± visual elongation of either the anterior or posterior leaflet of the mitral valve, none of which fell within the criteria of true MVP. Three (1.9%) patients, 2 boys and 1 girl aged between 7 and 14 years, had trivial or mild aortic regurgitation. No patients had echocardiographic evidence of tricuspid valve prolapse (TVP). CONCLUSION In this contemporary cohort of CYP with ADPKD, the incidence of MVP and other valvar lesions is significantly lower than previously reported. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Alexandra Savis
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - John M Simpson
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Saleha Kabir
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Kelly Peacock
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Hayley Beardsley
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
- Kings College London, London, UK.
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12
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Sinha MD, Gu H, Douiri A, Cansick J, Finlay E, Gilbert R, Kerecuk L, Lunn A, Maxwell H, Morgan H, Shenoy M, Shroff R, Subramaniam P, Tizard J, Tse Y, Rezavi R, Simpson JM, Chowienczyk PJ. Intensive compared with less intensive blood pressure control to prevent adverse cardiac remodelling in children with chronic kidney disease (HOT-KID): a parallel-group, open-label, multicentre, randomised, controlled trial. The Lancet Child & Adolescent Health 2023; 7:26-36. [PMID: 36442482 PMCID: PMC10202819 DOI: 10.1016/s2352-4642(22)00302-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Optimal target blood pressure to reduce adverse cardiac remodelling in children with chronic kidney disease is uncertain. We hypothesised that lower blood pressure would reduce adverse cardiac remodelling. METHODS HOT-KID, a parallel-group, open-label, multicentre, randomised, controlled trial, was done in 14 clinical centres across England and Scotland. We included children aged 2-15 years with stage 1-4 chronic kidney disease-ie, an estimated glomerular filtration rate (eGFR) higher than 15 mL/min per 1·73 m2-and who could be followed up for 2 years. Children on antihypertensive medication were eligible as long as it could be changed to angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) if they were not already receiving these therapies. Participants were randomly assigned (1:1) to standard treatment (auscultatory office systolic blood pressure target between the 50th and 75th percentiles) or intensive treatment (systolic target <40th percentile) by the chief investigator using a rapid, secure, web-based randomisation system. ACE inhibitors or ARBs were used as first-line agents, with the dose titrated every 2-4 weeks to achieve the target blood pressure levels. The primary outcome was mean annual difference in left ventricular mass index (LVMI) by echocardiography measured by a masked observer and was assessed in the intention-to-treat population, defined as all the children who underwent randomisation irrespective of the blood pressure reached. Secondary and safety outcomes were the differences between groups in mean left ventricular relative wall thickness, renal function, and adverse effects and were also assessed in the intention-to-treat population. This trial is registered with ISRCTN, ISRCTN25006406. FINDINGS Between Oct 30, 2012, and Jan 5, 2017, 64 participants were randomly assigned to the intensive treatment group and 60 to the standard treatment group (median age of participants was 10·0 years [IQR 6·8-12·6], 69 [56%] were male and 107 [86%] were of white ethnicity). Median follow-up was 38·7 months (IQR 28·1-52·2). Blood pressure was lower in the intensive treatment group compared with standard treatment group (mean systolic pressure lower by 4 mm Hg, p=0·0012) but in both groups was close to the 50th percentile. The mean annual reduction in LVMI was similar for intensive and standard treatments (-1·9 g/m2·7 [95% CI -2·4 to -1·3] vs -1·2 g/m2·7 [-1·5 to 0·8], with a treatment effect of -0·7 g/m2·7 [95% CI -1·9 to 2·6] per year; p=0·76) and mean value in both groups at the end of follow-up within the normal range. At baseline, elevated relative wall thickness was more marked than increased LVMI and a reduction in relative wall thickness was greater for the intensive treatment group than for the standard treatment group (-0·010 [95% CI 0·015 to -0·006] vs -0·004 [-0·008 to 0·001], treatment effect -0·020 [95% CI -0·039 to -0·009] per year, p=0·0019). Six (5%) participants reached end-stage kidney disease (ie, an eGFR of <15 mL/min per 1·73 m2; three in each group) during the course of the study. The risk difference between treatment groups was 0·02 (95% CI -0·15 to 0·19, p=0·82) for overall adverse events and 0·07 (-0·05 to 0·19, p=0·25) for serious adverse events. Intensive treatment was not associated with worse renal outcomes or greater adverse effects than standard treatment. INTERPRETATION These results suggest that cardiac remodelling in children with chronic kidney disease is related to blood pressure control and that a target office systolic blood pressure at the 50th percentile is close to the optimal target for preventing increased left ventricular mass. FUNDING British Heart Foundation.
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Affiliation(s)
- Manish D Sinha
- British Heart Foundation Centre, King's College London, London, UK; Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Haotian Gu
- British Heart Foundation Centre, King's College London, London, UK
| | - Abdel Douiri
- Department of Medical Statistics, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Janette Cansick
- Department of Paediatrics, Medway Maritime Hospital, Medway, UK
| | - Eric Finlay
- Department of Paediatric Nephrology, Leeds General Infirmary, Leeds, UK
| | - Rodney Gilbert
- Department of Paediatric Nephrology, Southampton General Hospital, Southampton, UK
| | - Larissa Kerecuk
- Department of Paediatric Nephrology, Birmingham Children's Hospital, Birmingham, UK
| | - Andrew Lunn
- Department of Paediatric Nephrology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Heather Maxwell
- Department of Paediatric Nephrology, Glasgow Royal Infirmary, Glasgow, UK
| | - Henry Morgan
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Liverpool, UK
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Rukshana Shroff
- Department of Paediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | | | - Jane Tizard
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Reza Rezavi
- Division of Imaging Sciences, King's College London, London, UK
| | - John M Simpson
- British Heart Foundation Centre, King's College London, London, UK; Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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Stephenson N, Pushparajah K, Wheeler G, Deng S, Schnabel JA, Simpson JM. Evaluation of a Linear Measurement Tool in Virtual Reality for Assessment of Multimodality Imaging Data-A Phantom Study. J Imaging 2022; 8:jimaging8110304. [PMID: 36354877 PMCID: PMC9696690 DOI: 10.3390/jimaging8110304] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to evaluate the accuracy and reliability of a virtual reality (VR) system line measurement tool using phantom data across three cardiac imaging modalities: three-dimensional echocardiography (3DE), computed tomography (CT) and magnetic resonance imaging (MRI). The same phantoms were also measured using industry-standard image visualisation software packages. Two participants performed blinded measurements on volume-rendered images of standard phantoms both in VR and on an industry-standard image visualisation platform. The intra- and interrater reliability of the VR measurement method was evaluated by intraclass correlation coefficient (ICC) and coefficient of variance (CV). Measurement accuracy was analysed using Bland−Altman and mean absolute percentage error (MAPE). VR measurements showed good intra- and interobserver reliability (ICC ≥ 0.99, p < 0.05; CV < 10%) across all imaging modalities. MAPE for VR measurements compared to ground truth were 1.6%, 1.6% and 7.7% in MRI, CT and 3DE datasets, respectively. Bland−Altman analysis demonstrated no systematic measurement bias in CT or MRI data in VR compared to ground truth. A small bias toward smaller measurements in 3DE data was seen in both VR (mean −0.52 mm [−0.16 to −0.88]) and the standard platform (mean −0.22 mm [−0.03 to −0.40]) when compared to ground truth. Limits of agreement for measurements across all modalities were similar in VR and standard software. This study has shown good measurement accuracy and reliability of VR in CT and MRI data with a higher MAPE for 3DE data. This may relate to the overall smaller measurement dimensions within the 3DE phantom. Further evaluation is required of all modalities for assessment of measurements <10 mm.
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Affiliation(s)
- Natasha Stephenson
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
- Department of Congenital Heart Disease, Evelina Children’s Hospital, London SE1 7EH, UK
- Correspondence:
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
- Department of Congenital Heart Disease, Evelina Children’s Hospital, London SE1 7EH, UK
| | - Gavin Wheeler
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
| | - Shujie Deng
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
| | - Julia A. Schnabel
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
- Faculty of Informatics, Technical University of Munich, 80333 Munich, Germany
- Institute of Machine Learning in Biomedical Engineering, Helmholtz Centre Munich, 85764 Munich, Germany
| | - John M. Simpson
- Department of Congenital Heart Disease, Evelina Children’s Hospital, London SE1 7EH, UK
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14
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Drury NE, Herd CP, Biglino G, Brown KL, Coats L, Cumper MJ, Guerrero RR, Miskin A, Murray S, Pender F, Rooprai S, Simpson JM, Thomson JDR, Weinkauf J, Wootton J, Jones TJ, Cowan K. Research priorities in children and adults with congenital heart disease: a James Lind Alliance Priority Setting Partnership. Open Heart 2022; 9:e002147. [PMID: 36600635 PMCID: PMC9843188 DOI: 10.1136/openhrt-2022-002147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To bring together patients, parents, charities and clinicians in a Priority Setting Partnership to establish national clinical priorities for research in children and adults with congenital heart disease. METHODS The established James Lind Alliance methodology was used to identify and prioritise research on the management of congenital heart disease, focusing on diagnosis, treatment and outcomes. An initial open survey was used to gather potential uncertainties which were filtered, categorised, converted into summary questions and checked against current evidence. In a second survey, respondents identified the unanswered questions most important to them. At two final workshops, patients, parents, charities and healthcare professionals agreed the top 10 lists of priorities for child/antenatal and adult congenital heart disease research. RESULTS 524 respondents submitted 1373 individual questions, from which 313 out of scope or duplicate questions were removed. The remaining 1060 questions were distilled into summary questions and checked against existing literature, with only three questions deemed entirely answered and removed. 250 respondents completed the child/antenatal survey (56 uncertainties) and 252 completed the adult survey (47 uncertainties). The questions ranked the highest by clinicians and non-clinicians were taken forward to consensus workshops, where two sets of top 10 research priorities were agreed. CONCLUSIONS Through an established and equitable process, we determined national clinical priorities for congenital heart disease research. These will be taken forward by specific working groups, a national patient and public involvement group, and through the establishment of a UK and Ireland network for collaborative, multicentre clinical trials in congenital heart disease.
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Affiliation(s)
- Nigel E Drury
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Clare P Herd
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Katherine L Brown
- Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Louise Coats
- Adult Congenital Heart Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Rafael R Guerrero
- Department of Paediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | | | | | | | - John M Simpson
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - John D R Thomson
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, UK
- Department of Paediatric Cardiology, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | | | | | - Timothy J Jones
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
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15
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Zidere V, Vigneswaran TV, Dumitrascu-Biris I, Regan W, Simpson JM, Homfray T. Presentation and genetic confirmation of long QT syndrome in the fetus. HeartRhythm Case Rep 2022; 8:674-678. [PMID: 36310718 PMCID: PMC9596364 DOI: 10.1016/j.hrcr.2022.07.007] [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] [Received: 01/13/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
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16
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Swarnkar P, Speggiorin S, Austin BC, Nyman A, Salih C, Zidere V, Simpson JM, Vigneswaran TV. Contemporary surgical outcome and symptomatic relief following vascular ring surgery in children: effect of prenatal diagnosis. Eur J Cardiothorac Surg 2022; 61:1260-1268. [PMID: 35022705 DOI: 10.1093/ejcts/ezab527] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/05/2021] [Accepted: 10/24/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Our goal was to describe postoperative complications and outcomes in a large contemporary cohort of children with an isolated double aortic arch (DAA) or a right aortic arch (RAA) with left arterial ligament and to assess the impact of foetal diagnosis on outcomes. METHODS We performed a retrospective analysis of all patients who underwent surgery for DAA or RAA with left arterial ligament between 2005 and 2019. RESULTS A total of 132 children were operated on for a DAA (n = 77) or a RAA (n = 55). Prenatal diagnosis was made in 100/132 (75.8%). Median age at surgery for DAA was 5.0 (1.7-13.3) months and for RAA was 13.9 (6.4-20.1) months. There was no difference in the age at surgery between the prenatal and postnatal cases (8.6 [4.0-15.6] vs 5.4 months [1.8-17.7]; P = 0.37). No surgical deaths occurred. Vocal cord palsy was the most common complication, occurring in 12/132 (9%): of these, 11 resolved spontaneously and 1 required a temporary tracheostomy. Logistic regression demonstrated that older age at operation was the only predictor for a postoperative complication (P = 0.02). Overall, 21/67 (31%) of prenatally detected, symptomatic cases reported residual symptoms/signs 1 year after surgery compared to 18/28 (64%) of postnatally detected cases. Postnatal diagnosis was associated with persistent postoperative symptoms/signs [P = 0.006, odds ratio = 3.9 (95% confidence interval 1.5-9.4)]. CONCLUSIONS Surgery to relieve a vascular ring resolves trache-oesophageal compressive symptoms in most cases, but parents/patients should be aware that symptoms/signs may persist in the first postoperative year despite effective release of the vascular ring. Earlier surgery and prenatal diagnosis may improve outcomes.
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Affiliation(s)
- Parinita Swarnkar
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Guy's, King's & St Thomas' School of Medicine, King's College London, London, UK
| | - Simone Speggiorin
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - B Conal Austin
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Caner Salih
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
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17
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Van Poppel MPM, Zidere V, Simpson JM, Vigneswaran TV. Fetal echocardiographic markers to differentiate between a right and double aortic arch. Prenat Diagn 2022; 42:419-427. [PMID: 35060138 DOI: 10.1002/pd.6104] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To describe the fetal echocardiographic features of a double aortic arch (DAA) and secondly, to assess the performance of these features to differentiate between a right aortic arch with left duct (RAA-LD) in a blinded cohort of vascular rings. METHODS Review of records to identify surgically confirmed cases of DAA diagnosed prenatally from 2014 to 2018 (cohort-A). Prenatal echocardiograms were reviewed and the segments of the aortic arches anterior and posterior to the trachea, aortic isthmuses and the presence/absence of the Z-sign were described. The utility of these markers were assessed in a separate cohort (B) of fetuses with surgically confirmed cases of DAA or RAA-LD. RESULTS Cohort-A comprised 34 cases with DAA; there was a dominant RAA in 32/34 (94%) and balanced left aortic arch (LAA) and RAA in two cases. The proximal LAA was seen in 29/34 (85%), distal LAA in 15/34 (44%) and the LAA aortic isthmus in 4/34 (12%). The "Z" configuration was present in 29/34 (85%) cases. The most predictive marker for DAA in cohort-B was the Z-sign (sensitivity: 100%, specificity: 81%). CONCLUSION The "Z" sign is a useful differentiator between RAA-LD and DAA. The absence of visualization of the left aortic isthmus does not preclude the presence of a DAA.
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Affiliation(s)
- Milou P M Van Poppel
- Division of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - John M Simpson
- Division of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Trisha V Vigneswaran
- Division of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
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18
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Chivers SC, Vasavan T, Nandi M, Hayes-Gill BR, Jayawardane IA, Simpson JM, Williamson C, Fifer WP, Lucchini M. Measurement of the cardiac time intervals of the fetal ECG utilising a computerised algorithm: A retrospective observational study. JRSM Cardiovasc Dis 2022; 11:20480040221096209. [PMID: 35574238 PMCID: PMC9102181 DOI: 10.1177/20480040221096209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Establish whether the reliable measurement of cardiac time intervals of the fetal ECG can be automated and to address whether this approach could be used to investigate large datasets. Design Retrospective observational study. Setting Teaching hospitals in London UK, Nottingham UK and New York USA. Participants Singleton pregnancies with no known fetal abnormality. Methods Archived fetal ECG's performed using the MonicaAN24 monitor. A single ECG (PQRST) complex was generated from 5000 signal-averaged beats and electrical cardiac time intervals measured in an automated way and manually. Main Outcome measure Validation of a newly developed algorithm to measure the cardiac time intervals of the fetal ECG. Results 188/236 (79.7%) subjects with fECGs of suitable signal:noise ratio were included for analysis comparing manual with automated measurement. PR interval was measured in 173/188 (92%), QRS complex in 170/188 (90%) and QT interval in 123/188 (65.4%). PR interval was 107.6 (12.07) ms [mean(SD)] manual vs 109.11 (14.7) ms algorithm. QRS duration was 54.72(6.35) ms manual vs 58.34(5.73) ms algorithm. QT-interval was 268.93 (21.59) ms manual vs 261.63 (36.16) ms algorithm. QTc was 407.5(32.71) ms manual vs 396.4 (54.78) ms algorithm. The QRS-duration increased with gestational age in both manual and algorithm measurements. Conclusion Accurate measurement of fetal ECG cardiac time intervals can be automated with potential application to interpretation of larger datasets.
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Affiliation(s)
- SC Chivers
- Department of Women and Children’s Health, King’s College London, London, UK
- Department of Fetal cardiology, Evelina London Children’s Hospital, London, UK
| | - T Vasavan
- Department of Women and Children’s Health, King’s College London, London, UK
| | - M Nandi
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - BR Hayes-Gill
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - IA Jayawardane
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - JM Simpson
- Department of Fetal cardiology, Evelina London Children’s Hospital, London, UK
| | - C Williamson
- Department of Women and Children’s Health, King’s College London, London, UK
| | - WP Fifer
- Department of Pediatrics, Columbia University Medical Center, Morgan Stanley Children’s Hospital, New York, USA
- Department of Psychiatry, Columbia University, New York, USA
| | - M Lucchini
- Department of Pediatrics, Columbia University Medical Center, Morgan Stanley Children’s Hospital, New York, USA
- Department of Psychiatry, Columbia University, New York, USA
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19
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Vigneswaran TV, Jabak S, Syngelaki A, Charakida M, Simpson JM, Nicolaides KH, Zidere V. Prenatal incidence of isolated right aortic arch and double aortic arch. J Matern Fetal Neonatal Med 2021; 34:2985-2990. [PMID: 31578117 DOI: 10.1080/14767058.2019.1676413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 06/17/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To define the incidence of variants of aortic arch sidedness in fetuses undergoing routine first trimester ultrasound examination. METHODS The data for this study were derived from prospective routine ultrasound examination at 11+0 to 13+6 weeks' gestation in singleton pregnancies examined in a local population between January 2014 and March 2018. We examined the incidence of isolated right aortic arch (RAA) and double aortic arch (DAA) in the local, screened population and compared the groups with and without these abnormalities. RESULTS The study population of 33,202 pregnancies included 18 (5.4 per 10,000) cases with isolated RAA and 5 (1.5 per 10,000) with DAA. In the group with isolated RAA or DAA, compared to those without, the median maternal age was higher and the incidence of conceptions from in vitro fertilization (IVF) was eight-fold higher. The prevalence of 22q11microdeletion was 5% in patients with RAA from this local population. CONCLUSIONS The incidence of isolated RAA and DAA in a local population undergoing routine first-trimester ultrasound examination is 2-3-fold higher than that reported in postnatal studies and the risk for these abnormalities is substantially increased in fetuses conceived by IVF.
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Affiliation(s)
- Trisha V Vigneswaran
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Salma Jabak
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Argyro Syngelaki
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Marietta Charakida
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - John M Simpson
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Kypros H Nicolaides
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Vita Zidere
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
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20
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Deng S, Wheeler G, Toussaint N, Munroe L, Bhattacharya S, Sajith G, Lin E, Singh E, Chu KYK, Kabir S, Pushparajah K, Simpson JM, Schnabel JA, Gomez A. A Virtual Reality System for Improved Image-Based Planning of Complex Cardiac Procedures. J Imaging 2021; 7:151. [PMID: 34460787 PMCID: PMC8404926 DOI: 10.3390/jimaging7080151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
The intricate nature of congenital heart disease requires understanding of the complex, patient-specific three-dimensional dynamic anatomy of the heart, from imaging data such as three-dimensional echocardiography for successful outcomes from surgical and interventional procedures. Conventional clinical systems use flat screens, and therefore, display remains two-dimensional, which undermines the full understanding of the three-dimensional dynamic data. Additionally, the control of three-dimensional visualisation with two-dimensional tools is often difficult, so used only by imaging specialists. In this paper, we describe a virtual reality system for immersive surgery planning using dynamic three-dimensional echocardiography, which enables fast prototyping for visualisation such as volume rendering, multiplanar reformatting, flow visualisation and advanced interaction such as three-dimensional cropping, windowing, measurement, haptic feedback, automatic image orientation and multiuser interactions. The available features were evaluated by imaging and nonimaging clinicians, showing that the virtual reality system can help improve the understanding and communication of three-dimensional echocardiography imaging and potentially benefit congenital heart disease treatment.
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Affiliation(s)
- Shujie Deng
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Gavin Wheeler
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Nicolas Toussaint
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Lindsay Munroe
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Suryava Bhattacharya
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Gina Sajith
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Ei Lin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Eeshar Singh
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Ka Yee Kelly Chu
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
| | - Saleha Kabir
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ National Health Service Foundation Trust, London SE1 7EH, UK;
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ National Health Service Foundation Trust, London SE1 7EH, UK;
| | - John M. Simpson
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ National Health Service Foundation Trust, London SE1 7EH, UK;
| | - Julia A. Schnabel
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
- Department of Informatics, Technische Universität München, 85748 Garching, Germany
- Helmholtz Zentrum München—German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Alberto Gomez
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (S.D.); (G.W.); (N.T.); (L.M.); (S.B.); (G.S.); (E.L.); (E.S.); (K.Y.K.C.); (K.P.); (J.M.S.); (J.A.S.)
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21
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Hunter L, Vigneswaran TV, Pasupathy D, Callaghan N, Tenenbaum J, Zidere V, Simpson JM. Effects and side effects of maternal administration of indomethacin for fetal tricuspid valve dysplasia. Ultrasound Obstet Gynecol 2021; 58:322-323. [PMID: 32939846 DOI: 10.1002/uog.23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- L Hunter
- Department of Congenital Heart Disease, Royal Hospital for Children, Glasgow, UK
| | - T V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - D Pasupathy
- Institute of Reproduction, Westmead Clinical School, University of Sydney, Sydney, Australia
- Department of Fetal Medicine, St Thomas' Hospital, London, UK
| | - N Callaghan
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - J Tenenbaum
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - V Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
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22
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Theocharis P, Wong J, Pushparajah K, Mathur SK, Simpson JM, Pascall E, Cleary A, Stewart K, Adhvaryu K, Savis A, Kabir SR, Uy MP, Heard H, Peacock K, Miller O. Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19. Eur Heart J Cardiovasc Imaging 2021; 22:896-903. [PMID: 32766671 PMCID: PMC7454452 DOI: 10.1093/ehjci/jeaa212] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 12/26/2022] Open
Abstract
Aims Following the peak of the UK COVID-19 epidemic, a new multisystem inflammatory condition with significant cardiovascular effects emerged in young people. We utilized multimodality imaging to provide a detailed sequential description of the cardiac involvement. Methods and Results Twenty consecutive patients (mean age 10.6 ± 3.8 years) presenting to our institution underwent serial echocardiographic evaluation on admission (median day 5 of illness), the day coinciding with worst cardiac function (median day 7), and the day of discharge (median day 15). We performed cardiac computed tomography (CT) to assess coronary anatomy (median day 15) and cardiac magnetic resonance imaging (CMR) to assess dysfunction (median day 20). On admission, almost all patients displayed abnormal strain and tissue Doppler indices. Three-dimensional (3D) echocardiographic ejection fraction (EF) was <55% in half of the patients. Valvular regurgitation (75%) and small pericardial effusions (10%) were detected. Serial echocardiography demonstrated that the mean 3D EF deteriorated (54.7 ± 8.3% vs. 46.4 ± 8.6%, P = 0.017) before improving at discharge (P = 0.008). Left main coronary artery (LMCA) dimensions were significantly larger at discharge than at admission (Z score –0.11 ± 0.87 vs. 0.78 ± 1.23, P = 0.007). CT showed uniform coronary artery dilatation commonly affecting the LMCA (9/12). CMR detected abnormal strain in all patients with global dysfunction (EF <55%) in 35%, myocardial oedema in 50%, and subendocardial infarct in 5% (1/20) patients. Conclusions Pancarditis with cardiac dysfunction is common and associated with myocardial oedema. Patients require close monitoring due to coronary artery dilatation and the risk of thrombotic myocardial infarction.
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Affiliation(s)
| | - James Wong
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Sujeev K Mathur
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - John M Simpson
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Emma Pascall
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Aoife Cleary
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kirsty Stewart
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kaitav Adhvaryu
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Alex Savis
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Saleha R Kabir
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Mirasol Pernia Uy
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Hannah Heard
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Kelly Peacock
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
| | - Owen Miller
- Department of Paediatric Cardiology, Evelina London Children's Hospital, UK.,Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, UK
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23
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Lloyd DF, van Poppel MP, Pushparajah K, Vigneswaran TV, Zidere V, Steinweg J, van Amerom JF, Roberts TA, Schulz A, Charakida M, Miller O, Sharland G, Rutherford M, Hajnal JV, Simpson JM, Razavi R. Analysis of 3-Dimensional Arch Anatomy, Vascular Flow, and Postnatal Outcome in Cases of Suspected Coarctation of the Aorta Using Fetal Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2021; 14:e012411. [PMID: 34187165 PMCID: PMC8300852 DOI: 10.1161/circimaging.121.012411] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be lifesaving but is notoriously challenging in clinical practice with a high rate of false positives. Novel fetal 3-dimensional and phase-contrast magnetic resonance imaging (MRI) offers an unprecedented means of assessing the human fetal cardiovascular system before birth. We performed detailed MRI assessment of fetal vascular morphology and flows in a cohort of fetuses with suspected CoA, correlated with the need for postnatal intervention. METHODS Women carrying a fetus with suspected CoA on echocardiography were referred for MRI assessment between 26 and 36 weeks of gestation, including high-resolution motion-corrected 3-dimensional volumes of the fetal heart and phase-contrast flow sequences gated with metric optimized gating. The relationship between aortic geometry and vascular flows was then analyzed and compared with postnatal outcome. RESULTS Seventy-two patients (51 with suspected fetal CoA and 21 healthy controls) underwent fetal MRI with motion-corrected 3-dimensional vascular reconstructions. Vascular flow measurements from phase-contrast sequences were available in 53 patients. In the CoA group, 25 of 51 (49%) required surgical repair of coarctation after birth; the remaining 26 of 51 (51%) were discharged without neonatal intervention. Reduced blood flow in the fetal ascending aorta and at the aortic isthmus was associated with increasing angulation (P=0.005) and proximal displacement (P=0.006) of the isthmus and was seen in both true positive and false positive cases. A multivariate logistic regression model including aortic flow and isthmal displacement explained 78% of the variation in outcome and correctly predicted the need for intervention in 93% of cases. CONCLUSIONS Reduced blood flow though the left heart is associated with important configurational changes at the aortic isthmus in fetal life, predisposing to CoA when the arterial duct closes after birth. Novel fetal MRI techniques may have a role in both understanding and accurately predicting severe neonatal CoA.
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Affiliation(s)
- David F.A. Lloyd
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Milou P.M. van Poppel
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Kuberan Pushparajah
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Trisha V. Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Johannes Steinweg
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Joshua F.P. van Amerom
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Thomas A. Roberts
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Alexander Schulz
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Marietta Charakida
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Gurleen Sharland
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Mary Rutherford
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Joseph V. Hajnal
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - John M. Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Reza Razavi
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
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24
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Pushparajah K, Chu KYK, Deng S, Wheeler G, Gomez A, Kabir S, Schnabel JA, Simpson JM. Virtual reality three-dimensional echocardiographic imaging for planning surgical atrioventricular valve repair. JTCVS Tech 2021; 7:269-277. [PMID: 34100000 PMCID: PMC8169455 DOI: 10.1016/j.xjtc.2021.02.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To investigate how virtual reality (VR) imaging impacts decision-making in atrioventricular valve surgery. METHODS This was a single-center retrospective study involving 15 children and adolescents, median age 6 years (range, 0.33-16) requiring surgical repair of the atrioventricular valves between the years 2016 and 2019. The patients' preoperative 3-dimesnional (3D) echocardiographic data were used to create 3D visualization in a VR application. Five pediatric cardiothoracic surgeons completed a questionnaire formulated to compare their surgical decisions regarding the cases after reviewing conventionally presented 2-dimesnional and 3D echocardiographic images and again after visualization of 3D echocardiograms using the VR platform. Finally, intraoperative findings were shared with surgeons to confirm assessment of the pathology. RESULTS In 67% of cases presented with VR, surgeons reported having "more" or "much more" confidence in their understanding of each patient's pathology and their surgical approach. In all but one case, surgeons were at least as confident after reviewing the VR compared with standard imaging. The case where surgeons reported to be least confident on VR had the worst technical quality of data used. After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases. CONCLUSIONS The main impact of viewing imaging on VR is the improved clarity of the anatomical structures. Surgeons reported that this would have impacted the surgical approach in the majority of cases. Poor-quality 3D echocardiographic data were associated with a negative impact of VR visualization; thus. quality assessment of imaging is necessary before projecting in a VR format.
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Affiliation(s)
- Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ka Yee Kelly Chu
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Shujie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Gavin Wheeler
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alberto Gomez
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Saleha Kabir
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Julia A. Schnabel
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - John M. Simpson
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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25
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Vigneswaran TV, Van Poppel MP, Griffiths B, James P, Jogeesvaran H, Rahim Z, Simpson JM, Speggiorin S, Zidere V, Nyman A. Postnatal impact of a prenatally diagnosed double aortic arch. Arch Dis Child 2021; 106:564-569. [PMID: 33115711 DOI: 10.1136/archdischild-2020-318946] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND A double aortic arch (DAA) is increasingly identified before birth; however, there are no published data describing the postnatal outcome of a large prenatal cohort. OBJECTIVE To describe the associations, symptoms and impact of prenatally diagnosed DAA. METHODS Retrospective review of consecutive cases seen at two fetal cardiology units from 2014 to 2019. Clinical records including symptoms and assessment of tracheobronchial compression using flexible bronchoscopy were reviewed. Moderate-severe tracheal compression was defined as >75% occlusion of the lumen. RESULTS There were 50 cases identified prenatally and 48 with postnatal follow-up. Array comparative genomic hybridisation (aCGH) was abnormal in 2/50 (4%), aCGH was normal in 33/50 (66%) and of those reviewed after birth, 13 were phenotypically normal. After birth, there was a complete DAA with patency of both arches in 8/48 (17%) and in 40/48 (83%) there was a segment of the left arch which was a non-patent, ligamentous connection.Stridor was present in 6/48 (13%) on the day of birth. Tracheo-oesophageal compressive symptoms/signs were present in 31/48 (65%) patients at median age of 59 days (IQR 9-182 days). Tracheal/carinal compression was present in 40/45 (88%) cases. Seven of 17 (41%) asymptomatic cases demonstrated moderate-severe tracheal compression. All morphologies of DAA caused symptoms and morphology type was not predictive of significant tracheal compression (p=0.3). CONCLUSIONS Genetic testing should be offered following detection of double aortic arch. Early signs of tracheal compression are common and therefore delivery where onsite neonatal support is available is recommended. Significant tracheal compression may be present even in the absence of symptoms.
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Affiliation(s)
- Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK .,Harris Birthright Centre for Fetal Medicine, King's College Hospital NHS Foundation Trust, London, UK.,Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Milou Pm Van Poppel
- Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benedict Griffiths
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Paul James
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Haran Jogeesvaran
- Department of Radiology, Evelina London Children's Hospital, London, UK
| | - Zehan Rahim
- Paediatric Respiratory Medicine, Evelina London Children's Hospital, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.,Harris Birthright Centre for Fetal Medicine, King's College Hospital NHS Foundation Trust, London, UK.,Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Simone Speggiorin
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.,Harris Birthright Centre for Fetal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
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26
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Zidere V, Vigneswaran TV, Syngelaki A, Charakida M, Allan LD, Nicolaides KH, Simpson JM, Akolekar R. Reference Ranges for Pulsed-Wave Doppler of the Fetal Cardiac Inflow and Outflow Tracts from 13 to 36 Weeks' Gestation. J Am Soc Echocardiogr 2021; 34:1007-1016.e10. [PMID: 33957251 DOI: 10.1016/j.echo.2021.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/03/2021] [Revised: 04/02/2021] [Accepted: 04/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Doppler assessment of ventricular filling and outflow tract velocities is an integral part of fetal echocardiography, to assess diastolic function, systolic function, and outflow tract obstruction. There is a paucity of prospective data from a large sample of normal fetuses in the published literature. The authors report reference ranges for pulsed-wave Doppler flow of the mitral valve, tricuspid valve, aortic valve, and pulmonary valve, as well as heart rate, in a large number of fetuses prospectively examined at a single tertiary fetal cardiology center. METHODS The study population comprised 7,885 fetuses at 13 to 36 weeks' gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective pulsed-wave Doppler blood flow measurements were taken of the mitral, tricuspid, aortic, and pulmonary valves. The fetal heart rate was recorded at the time of each assessment. Regression analysis, with polynomial terms to assess for linear and nonlinear contributors, was used to establish the relationship between each measurement and gestational age. RESULTS The measurement for each cardiac Doppler measurement was expressed as a Z score (difference between observed and expected values divided by the fitted SD corrected for gestational age) and percentile. Analysis included calculation of gestation-specific SDs. Regression equations are provided for the cardiac inflow and outflow tracts. CONCLUSIONS This study establishes reference ranges for fetal cardiac Doppler measurements and heart rate between 13 to 36 weeks' gestation that may be useful in clinical practice.
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Affiliation(s)
- Vita Zidere
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom.
| | - Trisha V Vigneswaran
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Argyro Syngelaki
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Marietta Charakida
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Lindsey D Allan
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Kypros H Nicolaides
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - John M Simpson
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway Maritime Hospital, Gillingham, United Kingdom; Institute of Medical Sciences, Canterbury Christ Church University, Chatham, United Kingdom
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27
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Steinweg JK, Hui GTY, Pietsch M, Ho A, van Poppel MP, Lloyd D, Colford K, Simpson JM, Razavi R, Pushparajah K, Rutherford M, Hutter J. T2* placental MRI in pregnancies complicated with fetal congenital heart disease. Placenta 2021; 108:23-31. [PMID: 33798991 DOI: 10.1016/j.placenta.2021.02.015] [Citation(s) in RCA: 7] [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: 12/22/2020] [Revised: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is one of the most important and common group of congenital malformations in humans. Concurrent development and close functional links between the fetal heart and placenta emphasise the importance of understanding placental function and its influence in pregnancy outcomes. The aim of this study was to evaluate placental oxygenation by relaxometry (T2*) to assess differences in placental phenotype and function in CHD. METHODS In this prospective cross-sectional observational study, 69 women with a fetus affected with CHD and 37 controls, whole placental T2* was acquired using a 1.5-Tesla MRI scanner. Gaussian Process Regression was used to assess differences in placental phenotype in CHD cohorts compared to our controls. RESULTS Placental T2* maps demonstrated significant differences in CHD compared to controls at equivalent gestational age. Mean T2* values over the entire placental volume were lowest compared to predicted normal in right sided obstructive lesions (RSOL) (Z-Score 2.30). This cohort also showed highest lacunarity indices (Z-score -1.7), as a marker of lobule size. Distribution patterns of T2* values over the entire placental volume were positively skewed in RSOL (Z-score -4.69) and suspected, not confirmed coarctation of the aorta (CoA-) (Z-score -3.83). Deviations were also reflected in positive kurtosis in RSOL (Z-score -3.47) and CoA- (Z-score -2.86). CONCLUSION Placental structure and function appear to deviate from normal development in pregnancies with fetal CHD. Specific patterns of altered placental function assessed by T2* deliver crucial complementary information to antenatal assessments in the presence of fetal CHD.
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Affiliation(s)
- Johannes K Steinweg
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom.
| | - Grace Tin Yan Hui
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Maximilian Pietsch
- Centre for the Developing Brain, King's College London, London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - Alison Ho
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Milou Pm van Poppel
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - David Lloyd
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - John M Simpson
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Kuberan Pushparajah
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
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28
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Karmegaraj B, Kumar S, Srimurugan B, Sudhakar A, Simpson JM, Vaidyanathan B. 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography provides incremental benefit over 2D fetal echocardiography in predicting postnatal surgical approach in double-outlet right ventricle. Ultrasound Obstet Gynecol 2021; 57:423-430. [PMID: 32022380 DOI: 10.1002/uog.21988] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyze the incremental benefit of 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography over 2D fetal echocardiography with respect to the accuracy of identification of anatomic details crucial for surgical decision-making and in predicting surgical approach in fetuses with double-outlet right ventricle (DORV). METHODS This was a retrospective study of fetuses with DORV which had undergone both 2D echocardiography and 3D/4D STIC echocardiography and which underwent surgery postnatally in a tertiary pediatric cardiac center in Kerala between October 2015 and March 2019. All such cases with normal atrial arrangement, concordant atrioventricular connections and balanced ventricles were included. 2D and 3D/4D STIC fetal echocardiographic data were analyzed by two experienced observers blinded to the other dataset. Anatomic variables crucial for surgical decision-making, i.e. location and routability of the ventricular septal defect, relationship of the great arteries and presence of outflow obstruction, were compared between the two modalities with respect to agreement with postnatal echocardiography. The accuracy of prenatal prediction of the surgical pathway was compared between 2D and 3D/4D modalities with respect to the procedure undertaken. RESULTS Included in the study were 22 fetuses with DORV which had undergone both 2D and 3D/4D imaging as well as postnatal surgery. Accuracy of prenatal interpretation of all four anatomic variables was significantly higher using 3D/4D STIC than using 2D fetal echocardiography (19/22 (86.4%) vs 8/22 (36.4%), P < 0.001). Surgical procedures included single-stage repair in 14 (63.5%) patients and a multistage approach in eight (36.4%). Prenatal prediction of the surgical pathway was significantly more accurate on 3D/4D STIC than on 2D echocardiography (20/22 (90.9%) vs 12/22 (54.5%), P = 0.021). Prenatal predictive accuracy of single-stage biventricular repair was significantly better for 3D/4D STIC than for 2D echocardiography (14/14 (100%) vs 8/14 (57.1%), P = 0.04). CONCLUSION Addition of 3D/4D STIC to conventional 2D fetal echocardiography confers incremental benefit on the accuracy of identification of anatomic details crucial for surgical decision-making and the prediction of postnatal surgical approach in fetuses with DORV, thereby potentially aiding prenatal counseling. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Karmegaraj
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - S Kumar
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - B Srimurugan
- Department of Cardiovascular Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - A Sudhakar
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Vaidyanathan
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Bhattacharya S, Lin E, Sajith G, Munroe L, Pushparajah K, Schnabel JA, Simpson JM, Gomez A, De Vecchi A, Deng S, Wheeler G. Immersive visualisation of intracardiac blood flow in virtual reality on a patient with HLHS. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): NIHR i4i funded 3D Heart project Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z]
onbehalf
3D Heart Project
Background/Introduction: Virtual Reality (VR) for surgical and interventional planning in the treatment of Congenital Heart Disease (CHD) is an emerging field that has the potential to improve planning. Particularly in very complex cases, VR permits enhanced visualisation and more intuitive interaction of volumetric images, compared to traditional flat-screen visualisation tools. Blood flow is severely affected by CHD and, thus, visualisation of blood flow allows direct observation of the cardiac maladaptions for surgical planning. However, blood flow is fundamentally 3D information, and viewing and interacting with it using conventional 2D displays is suboptimal.
Purpose
To demonstrate feasibility of blood flow visualisation in VR using pressure and velocity obtained from a computational fluid dynamic (CFD) simulation of the right ventricle in a patient with hypoplastic left heart syndrome (HLHS) as a proof of concept.
Methods
We extend an existing VR volume rendering application to include CFD rendering functionality using the Visualization Toolkit (VTK), an established visualisation library widely used in clinical software for visualising medical imaging data. Our prototype displays the mesh outline of the segmented heart, a slicing plane showing blood pressure on the plane within the heart, and streamlines of blood flow from a spherical source region. Existing user tools were extended to enable interactive positioning, rotation and scaling of the pressure plane and streamline origin, ensuring continuity between volume rendering and CFD interaction and, thus, ease of use. We evaluated if rendering and interaction times were low enough to ensure a comfortable, interactive VR experience. Our performance benchmark is a previous study showing VR is acceptable to clinical users when rendering speed is at least 90 fps.
Results
CFD simulations were successfully rendered, viewed and manipulated in VR, as shown in the Figure. Evaluating performance, we found that visualisation of the mesh and streamlines was at an acceptably high and stable frame rate, over 150fps. User interactions of moving, rotating or scaling the mesh or streamlines origin did not significantly reduce this frame rate. However, rendering the pressure slicing plane reduced frame rate by an unacceptable degree, to less than 10fps.
Conclusion
Visualisation of and interaction with CFD simulation data was successfully integrated into an existing VR application. This aids in surgery and intervention planning for defects heavily relying on blood flow simulation, and lays a foundation for a platform for clinicians to test interventions in VR. Pressure plane rendering performance will require significant optimisation, potentially addressed by updating the pressure plane data separately from the main, VR rendering.
Abstract Figure. An example render of CFD simulation
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Affiliation(s)
- S Bhattacharya
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lin
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - G Sajith
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - L Munroe
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - K Pushparajah
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - JA Schnabel
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - JM Simpson
- Evelina Children"s Hospital, Department of Congenital Heart Disease, London, United Kingdom of Great Britain & Northern Ireland
| | - A Gomez
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - A De Vecchi
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Deng
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - G Wheeler
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
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Munroe L, Sajith G, Lin E, Bhattacharya S, Pushparajah K, Simpson JM, Schnabel J, Wheeler G, Gomez A, Deng S. Automatic orientation cues for intuitive immersive interrogation of 3D echocardiographic images in virtual reality using deep learning. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): NIHR i4i funded 3D Heart Project Wellcome / EPSRC Centre for Medical Engineering (WT 203148/Z/16/Z)
onbehalf
3D Heart Project
Background/Introduction:
In echocardiography (echo), image orientation is determined by the position and direction of the transducer during examination, unlike cardiovascular imaging modalities such as CT or MRI. As a result, when echo images are first shown their display orientation has no external anatomical landmarks, thus the user has to identify anatomical landmarks in the regions of interest to understand the orientation.
Purpose
To display an anatomical model of a standard heart, automatically aligned to an acquired patient’s 3D echo image - assisting image interpretation by quickly orienting the viewer.
Methods
47 echo datasets from 13 pediatric patients with hypoplastic left heart syndrome (HLHS) were annotated by manually indicating the cardiac axes in both ES and ED volumes. We chose a view akin to the standard four chamber view in healthy hearts as the reference view, showing the AV valves, the right atrium, the left atrium and the hypoplastic ventricle. We then trained a deep convolutional neural network (CNN) to predict the rotation required for re-orientation to the reference view. Three data strategies were explored: 1) using 3D images to estimate orientation, 2) using three orthogonal slices only (2.5D approach) and 3) using the central slice only (2D approach). Three different algorithms were investigated: 1) an orientation classifier, 2) an orientation regressor with mean absolute angle error, and 3) an orientation regressor with geodesic loss. The data was split into training, validation and test sets with a 8:1:1 ratio. The training data was augmented by applying random rotations in the range [−10◦, +10◦] and updating labels accordingly. The model with smallest validation error was applied in tandem with the VR visualisation of the echo volumes.
Results
Experimental results suggest that a 2.5D CNN classifying discrete integer angles performs best in re-orienting volumetric images to the reference view, with a mean absolute angle error on the test set of 9.0 deg (test set error ranges from 10.8 to 25.9 deg. for other algorithms). An HLHS volumetric data (left) is automatically aligned with the cardiac model (right) using our trained network when loaded in VR as shown in Figure 1. The volume and the model are both cropped at the referencing plane.
Conclusion
A deep learning network to align 3D echo images to a reference view was successfully trained and then integrated into VR to reorient echo volumes to match a standard anatomical view. This work demonstrates the potential of combining artificial intelligence and VR in medical imaging, although further user study is expected to evaluate its clinical impact.
Caption for Abstract Picture
The VR user interface informs the user of the 3D echo image orientation, automatically aligning it with an anatomical model, here showing the four chamber apical view.
Abstract Figure. Deep learning model integrated into VR
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Affiliation(s)
- L Munroe
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - G Sajith
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lin
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - S Bhattacharya
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - K Pushparajah
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - JM Simpson
- Evelina Children"s Hospital, Department of Congenital Heart Disease, London, United Kingdom of Great Britain & Northern Ireland
| | - J Schnabel
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - G Wheeler
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - A Gomez
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - S Deng
- King"s College London, School of Imaging Sciences & Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
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Affiliation(s)
- Thomas G. Day
- Faculty of Life Sciences and Medicine School of Biomedical Engineering and Imaging Sciences King's College London London UK
- Department of Congenital Cardiology Evelina London Children's Healthcare Guy's and St Thomas' NHS Foundation Trust London UK
| | - Bernhard Kainz
- Department of Computing Faculty of Engineering Imperial College London London UK
| | - Jo Hajnal
- Faculty of Life Sciences and Medicine School of Biomedical Engineering and Imaging Sciences King's College London London UK
| | - Reza Razavi
- Faculty of Life Sciences and Medicine School of Biomedical Engineering and Imaging Sciences King's College London London UK
- Department of Congenital Cardiology Evelina London Children's Healthcare Guy's and St Thomas' NHS Foundation Trust London UK
| | - John M. Simpson
- Faculty of Life Sciences and Medicine School of Biomedical Engineering and Imaging Sciences King's College London London UK
- Department of Congenital Cardiology Evelina London Children's Healthcare Guy's and St Thomas' NHS Foundation Trust London UK
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Vigneswaran TV, Zidere V, Chivers S, Charakida M, Akolekar R, Simpson JM. Impact of prospective measurement of outflow tracts in prediction of coarctation of the aorta. Ultrasound Obstet Gynecol 2020; 56:850-856. [PMID: 31875324 DOI: 10.1002/uog.21957] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Prenatal diagnosis of coarctation of the aorta (CoA) is associated with reduced mortality and morbidity, however, accurate prenatal prediction remains challenging. To date, studies have used retrospective measurements of the outflow tracts to evaluate their potential to predict CoA. Our primary objective was to evaluate prospectively acquired measurements of the outflow tracts in fetuses with prenatally suspected CoA. A secondary aim was to report the postnatal prevalence of bicuspid aortic valve in this cohort. METHODS Pregnancies with suspicion of isolated CoA and with a minimum of 6 months' postnatal follow-up available were identified from the cardiac database of a tertiary fetal cardiology center in the UK, between January 2002 and December 2017. Measurement of the aortic valve, pulmonary valve, distal transverse aortic arch (DTAA) and arterial duct (AD) diameters were undertaken routinely in fetuses with suspected CoA during the study period. Z-scores were computed using published reference ranges based on > 7000 fetuses from our own unit. RESULTS Of 149 pregnancies with prenatally suspected CoA included in the study, CoA was confirmed within 6 months after birth in 77/149 (51.7%) cases. DTAA diameter Z-score and the Z-score of second-trimester DTAA/AD diameter ratio were smaller in fetuses with postnatally confirmed CoA than those in false-positive cases (-2.8 vs -1.9; P = 0.039 and -3.13 vs -2.61; P = 0.005, respectively). Multiple regression analysis demonstrated that the Z-scores of DTAA and AD diameters were the only significant predictors of postnatal CoA (P = 0.001). Bicuspid aortic valve was identified in 30% of the false-positive cases. CONCLUSIONS Measurement of DTAA and AD diameter Z-scores can be used to ascertain risk for postnatal CoA in a selected cohort. The high incidence of bicuspid aortic valve in false-positive cases merits further study with respect to both etiology and longer-term significance. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T V Vigneswaran
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Department of Biomedical Engineering, King's College Hospital, London, UK
| | - V Zidere
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - S Chivers
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - M Charakida
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Department of Biomedical Engineering, King's College Hospital, London, UK
| | - R Akolekar
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Obstetrics & Gynaecology, Medway Maritime Hospital, Gillingham, Kent, UK
| | - J M Simpson
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Department of Biomedical Engineering, King's College Hospital, London, UK
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Van Poppel MPM, Pushparajah K, Lloyd DFA, Razavi R, Speggiorin S, Nyman A, Simpson JM, Zidere V, Vigneswaran TV. Insights from fetal cardiac magnetic resonance imaging in double aortic arch. Ultrasound Obstet Gynecol 2020; 56:636-639. [PMID: 32484274 DOI: 10.1002/uog.22110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Affiliation(s)
- M P M Van Poppel
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - K Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - D F A Lloyd
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - R Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - S Speggiorin
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - A Nyman
- Department of Paediatric Intensive Care, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - J M Simpson
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - V Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - T V Vigneswaran
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
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Vigneswaran TV, Rosenthal E, Bakalis S, Nelson-Piercy C, Chappell L, Simpson JM. Transplacental metoprolol for fetal supraventricular tachycardia. Ultrasound Obstet Gynecol 2020; 56:462-464. [PMID: 31743523 DOI: 10.1002/uog.21924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Affiliation(s)
- T V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - E Rosenthal
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - S Bakalis
- Department of Women's Health, Guy's & St Thomas' Hospital, London, UK
| | - C Nelson-Piercy
- Department of Women's Health, Guy's & St Thomas' Hospital, London, UK
| | - L Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Rato J, Vigneswaran TV, Simpson JM. Speckle-Tracking Echocardiography for the Assessment of Atrial Function during Fetal Life. J Am Soc Echocardiogr 2020; 33:1391-1399. [PMID: 32828625 DOI: 10.1016/j.echo.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/15/2019] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Speckle-tracking echocardiography has become a major tool in the evaluation of heart function. Atrial strain has emerged as an important component in the assessment of cardiac function, but there is a paucity of prenatal data. The aim of this study was to describe our initial experience of measurement of atrial strain in fetuses, with respect to both feasibility and the strain patterns observed. METHODS Four-chamber Digital Imaging and Communications in Medicine loops were acquired prospectively for deformation imaging. Fifty-three normal fetuses with no morphologic or functional abnormalities were selected for analysis. The three strain components of atrial cycle for both left atrium (LA) and right atrium (RA) were acquired-reservoir (LAres or RAres), conduit, and contraction (LAct or RAct)-and are expressed as a percentage. Ratios of these components were calculated. Simple linear regression was used to analyze how the dependent variables changed according to gestational age and frame rate. RESULTS The median gestational age was 30 weeks (range, 23-35), and the frame rate was 74 frames per second (fps; range, 35-121). Left atrial strain was feasible in 48/53 (91%), and right atrial strain in 46/53 (87%) of cases. The onset of LA contraction could be identified on the strain curves in 32 of 48 (67%) cases, and of the RA in 17 of 46 (37%) cases. The values of RAres and RAct were higher compared with those of LAres and LAct (33.9% vs 30.3%, P = .014; and 21.5% vs 16.8%, P = .005), and the contraction:reservoir ratio was also higher for RA (0.63 vs 0.55 for LA, P = .003). Higher values for LAres, LAct, RAres, and RAct were associated with higher frame rate (P = .007, .020, .049, and .012, respectively). The onset of LA contraction was better identified with a higher frame rate (mean 77 vs 59 fps when not seen, P = .007). A higher LA contraction:reservoir ratio was associated with a lower gestational age (P = .042). CONCLUSION Measurement of atrial strain is feasible in the fetal heart. The values are influenced by gestational age and frame rate, so it is necessary to account for these variables. Comparison of left versus right atrial strain values contrasts with those observed postnatally. Atrial function merits further study during fetal life, to aid understanding of maturational changes and disease states.
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Affiliation(s)
- Joao Rato
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Department of Pediatric Cardiology, Hospital de Santa Cruz-Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
| | - Trisha V Vigneswaran
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - John M Simpson
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Semmler J, Day TG, Georgiopoulos G, Garcia-Gonzalez C, Aguilera J, Vigneswaran TV, Zidere V, Miller OI, Sharland G, Charakida M, Simpson JM. Fetal Speckle-Tracking: Impact of Angle of Insonation and Frame Rate on Global Longitudinal Strain. J Am Soc Echocardiogr 2020; 33:1141-1146.e2. [PMID: 32423727 DOI: 10.1016/j.echo.2020.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/13/2019] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is a growing body of research on fetal speckle-tracking echocardiography because it is considered to be an angle-independent modality. The primary aim of this study was to investigate whether angle of insonation and acquisition frame rate (FR) influence left ventricular endocardial global longitudinal peak strain (GLS) in the fetus. METHODS Four-chamber views of 122 healthy fetuses were studied at three different angles of insonation (apex up/down, apex oblique, and apex perpendicular) at high and low acoustic FRs. GLS was calculated, and a linear mixed-model analysis was used for analysis. Six hundred fifty-six fetal echocardiographic clips were analyzed (288 in the second trimester, at a median gestation of 21 weeks [interquartile range (IQR), 1 week], and 368 in the third trimester, at a median gestation of 36 weeks [IQR, 2 weeks]). RESULTS Angle of insonation and FRs were significant determinants of GLS. Ventricular septum perpendicular to the ultrasound beam was associated with higher (more negative) GLS compared with apex up/down (at high FR: -21.8% vs -19.7%, P < .001; at low FR: -24.1% vs -21.4%, P < .001). Higher frames per second (FPS; median 149 FPS [IQR, 33 FPS] = 61 frames per cycle [FPC] [IQR, 17 FPC]) compared with lower FPS (median 51 FPS [IQR, 15 FPS] = 22 FPC [IQR, 7 FPC]) at the same insonation angle resulted in lower GLS (apex up/down: -19.7% vs -21.4%, P < .001; apex oblique: -21.2% vs -22.7%, P < .001; apex perpendicular: -21.8% vs -24.1%, P < .001). CONCLUSIONS The present findings show that insonation angle and FR influence GLS significantly. These factors need to be considered when comparing studies with different acquisition protocols, when establishing normative values, and when interpreting pathology. Speckle-tracking echocardiography cannot be considered an angle-independent modality during fetal life.
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Affiliation(s)
- Janina Semmler
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom; Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Thomas G Day
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom; Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Coral Garcia-Gonzalez
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Jesica Aguilera
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Trisha V Vigneswaran
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom; Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Vita Zidere
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom; Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Owen I Miller
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom
| | - Gurleen Sharland
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom
| | - Marietta Charakida
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom; Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - John M Simpson
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom; Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
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Simpson JM, Sinha MD. Cardiac Function in Young Patients With Elevated Blood Pressure. Hypertension 2020; 75:1417-1418. [PMID: 32401644 DOI: 10.1161/hypertensionaha.120.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John M Simpson
- From Kings College London, United Kingdom (J.M.S., M.D.S.).,Department of Congenital Heart Disease (J.M.S.) and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas NHS Trust, United Kingdom
| | - Manish D Sinha
- From Kings College London, United Kingdom (J.M.S., M.D.S.)
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Patel ND, Nageotte S, Ing FF, Armstrong AK, Chmait R, Detterich JA, Galindo A, Gardiner H, Grinenco S, Herberg U, Jaeggi E, Morris SA, Oepkes D, Simpson JM, Moon-Grady A, Pruetz JD. Procedural, pregnancy, and short-term outcomes after fetal aortic valvuloplasty. Catheter Cardiovasc Interv 2020; 96:626-632. [PMID: 32216096 DOI: 10.1002/ccd.28846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/29/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We aimed to evaluate the effect of technical aspects of fetal aortic valvuloplasty (FAV) on procedural risks and pregnancy outcomes. BACKGROUND FAV is performed in cases of severe mid-gestation aortic stenosis with the goal of preventing hypoplastic left heart syndrome (HLHS). METHODS The International Fetal Cardiac Intervention Registry was queried for fetuses who underwent FAV from 2002 to 2018, excluding one high-volume center. RESULTS The 108 fetuses had an attempted cardiac puncture (mean gestational age [GA] 26.1 ± 3.3 weeks). 83.3% of attempted interventions were technically successful (increased forward flow/new aortic insufficiency). The interventional cannula was larger than 19 g in 70.4%. More than one cardiac puncture was performed in 25.0%. Intraprocedural complications occurred in 48.1%, including bradycardia (34.1%), pericardial (22.2%) or pleural effusion (2.7%) requiring drainage, and balloon rupture (5.6%). Death within 48 hr occurred in 16.7% of fetuses. Of the 81 patients born alive, 59 were discharged home, 34 of whom had biventricular circulation. More than one cardiac puncture was associated with higher complication rates (p < .001). Larger cannula size was associated with higher pericardial effusion rates (p = .044). On multivariate analysis, technical success (odds ratio [OR] = 10.9, 95% confidence interval [CI] = 2.2-53.5, p = .003) and later GA at intervention (OR = 1.5, 95% CI = 1.2-1.9, p = .002) were associated with increased odds of live birth. CONCLUSIONS FAV is an often successful but high-risk procedure. Multiple cardiac punctures are associated with increased complication and fetal mortality rates. Later GA at intervention and technical success were independently associated with increased odds of live birth. However, performing the procedure later in gestation may miss the window to prevent progression to HLHS.
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Affiliation(s)
- Neil D Patel
- Division of Pediatric Cardiology, Children's Hospital, University of Southern California Keck School of Medicine of USC, Los Angeles, California, USA
| | - Stephen Nageotte
- Division of Pediatric Cardiology, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri, USA
| | - Frank F Ing
- Divison of Pediatric Cardiology, University of California Davis Children's Hospital, Sacramento, California, USA
| | | | - Ramen Chmait
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jon A Detterich
- Division of Pediatric Cardiology, Children's Hospital, University of Southern California Keck School of Medicine of USC, Los Angeles, California, USA.,Department of Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alberto Galindo
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Helena Gardiner
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA
| | | | - Ulrike Herberg
- Division of Pediatric Cardiology, Children's Hospital, University of Bonn, Germany
| | - Edgar Jaeggi
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaine A Morris
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Anita Moon-Grady
- Division of Pediatric Cardiology, Department of Pediatrics and the Fetal Treatment Center at UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Jay D Pruetz
- Division of Pediatric Cardiology, Children's Hospital, University of Southern California Keck School of Medicine of USC, Los Angeles, California, USA
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Affiliation(s)
- John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, United Kingdom. Division of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, United Kingdom
| | - Kuberan Pushparajah
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, United Kingdom. Division of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, United Kingdom
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Affiliation(s)
- Esther Dempsey
- Molecular and Clinical Sciences, St George’s University of London, London, UK
| | - Tessa Homfray
- SW Thames Regional Genetics Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Steve Jeffery
- Molecular and Clinical Sciences, St George’s University of London, London, UK
| | - Sahar Mansour
- Molecular and Clinical Sciences, St George’s University of London, London, UK
- SW Thames Regional Genetics Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Pia Ostergaard
- Molecular and Clinical Sciences, St George’s University of London, London, UK
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Wheeler G, Deng S, Pushparajah K, Schnabel JA, Simpson JM, Gomez A. Virtual linear measurement system for accurate quantification of medical images. Healthc Technol Lett 2020; 6:220-225. [PMID: 32038861 PMCID: PMC6952242 DOI: 10.1049/htl.2019.0074] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022] Open
Abstract
Virtual reality (VR) has the potential to aid in the understanding of complex volumetric medical images, by providing an immersive and intuitive experience accessible to both experts and non-imaging specialists. A key feature of any clinical image analysis tool is measurement of clinically relevant anatomical structures. However, this feature has been largely neglected in VR applications. The authors propose a Unity-based system to carry out linear measurements on three-dimensional (3D), purposefully designed for the measurement of 3D echocardiographic images. The proposed system is compared to commercially available, widely used image analysis packages that feature both 2D (multi-planar reconstruction) and 3D (volume rendering) measurement tools. The results indicate that the proposed system provides statistically equivalent measurements compared to the reference 2D system, while being more accurate than the commercial 3D system.
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Affiliation(s)
- Gavin Wheeler
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Shujie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Julia A Schnabel
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - John M Simpson
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Alberto Gomez
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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Wheeler G, Deng S, Pushparajah K, Schnabel JA, Simpson JM, Gomez A. P1417 Acceptability of a virtual reality system for examination of congenital heart disease patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Work supported by the NIHR i4i funded 3D Heart project [II-LA-0716-20001]
Background/Introduction
Virtual Reality (VR) has recently gained great interest for examining 3D images from congenital heart disease (CHD) patients. Currently, 3D printed models of the heart may be used for particularly complex cases. These have been found to be intuitive and to positively impact clinical decision-making. Although positively received, such printed models must be segmented from the image data, generally only CT/MR may be used, the prints are static, and models do not allow for cropping / slicing or easy manipulation. Our VR system is designed to address these issues, as well as providing a simple interface compared to standard software. Building such a VR system, one with intuitive interaction which is clinically useful, requires studying user acceptance and requirements.
Purpose: We evaluate the usability of our VR system
can a prototype VR system be easily learned and used by clinicians unfamiliar with VR.
Method
We tested a VR system which can display 3D echo images and enables the user to interact with them, for instance by translating, rotating and cropping. Our system is tested on a transoesophageal echocardiogram from a patient with aortic valve disease. 13 clinicians evaluated the system including 5 imaging cardiologists, 5 physiologists, 2 surgeons and an interventionist, with their clinical experience ranging from trainee to more than 5 years’ of experience. None had used VR regularly in the past. After a brief training session, they were asked to place three anatomical landmarks and identify a particular cardiac view. They then completed a questionnaire on system ease of learning and image manipulation.
Results: Results are shown in the figure below. Learning to use the system was perceived as easy for all but one participant, who rated it as ‘Somewhat difficult’. However, once trained, all users found the system easy to use. Participants found the interaction, where objects in the scene are picked up using the controller and then track the controller’s motion in a 1:1 way, to be particularly easy to learn and use.
Conclusion
Our VR system was accepted by the vast majority of clinicians, both for ease of learning and use. Intuitiveness and the ability to interact with images in a natural way were highlighted as most useful - suggesting that such a system could become accepted for routine clinical use in the future.
Abstract P1417 Figure. VR system evaluation participant feedbac
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Affiliation(s)
- G Wheeler
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Deng
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - K Pushparajah
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - J A Schnabel
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Simpson
- Evelina Children"s Hospital, Department of Congenital Heart Disease, London, United Kingdom of Great Britain & Northern Ireland
| | - A Gomez
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
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Morrison ML, Kabir S, Salih C, Valverde I, Tometzki A, Simpson JM. P1730 Multimodality assessment of complex ventricular septal defect. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Abstract
Abstract
Case Summary
A 16 month old, 8.2 kg patient came forward for evaluation of complex cardiac anatomy with multimodality imaging assessment to ascertain suitability for biventricular repair. A large ventricular septal defect was diagnosed before birth but possible straddling of the tricuspid valve identified postnatally.
The patient developed symptoms of congestive cardiac failure and was palliated with a pulmonary artery band. In view of the difficult nature of the defect they were reviewed with 3D-transthoracic echo, transoesophageal echo and cardiac MRI.
Their transthoracic echo confirmed situs solitus with levocardia, atrioventricular and ventriculoarterial concordance. There was a well placed pulmonary artery band with peak velocity of 5 m/s. Biventricular systolic function appeared good. There was a large ventricular septal defect at the inlet extending to the muscular septum. There were 2 prominent muscle bundles arising from the ventricular apex and it was difficult to distinguish on echocardiography which of these formed the true ventricular septum (Figures A & B). Although the tricuspid valve opened normally, there were multiple chords extending to overlie the right ventricular aspect of the ventricular septal defect (Figure C), some of which appeared to cross the through defect (*) and attach to the more leftward of the apical trabeculations (Figure D white dotted line illustrates the true plane of ventricular septum which overlies the attachments. Red dotted line represents the plane followed by the leftward apical trabeculation). Cardiac MRI showed that the trabeculation positioned to the left was the true ventricular septum, as it seemed to be in line with the plane of the atrial septum at the crux of the heart (Figure E & F). At surgery her heart was found to be unseptatable due to multiple straddling chords from the tricuspid valve inserting into multiple papillary muscle heads with the left ventricle.
Conclusions
The key issue in this case is which of the muscular structures positioned at the ventricular apex is considered to be the true ventricular septum as this determines whether on not there is straddle of the tricuspid valve. In addition the complex and multiple nature of the chordal attachments below the valve made accessing and closing the defect not feasible.
Even in the present era with wide availability of advanced, multimodality imaging techniques demonstrating anatomy can still prove challenging in planning surgical repair, especially within the setting of complex congenital heart disease. Many aspects of such cases still only become apparent at the time of surgery and this remains a key issue when counselling parents.
Abstract P1730 Figure.
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Affiliation(s)
- M L Morrison
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Kabir
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Salih
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - I Valverde
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Tometzki
- Bristol Royal Hospital for Children, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - J M Simpson
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Wheeler G, Deng S, Pushparajah K, Schnabel JA, Simpson JM, Gomez A. P801 A virtual reality tool for measurement of 3D echocardiographic images. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Work supported by the NIHR i4i funded 3D Heart project [II-LA-0716-20001]
Background/Introduction
Cardiac measurements are clinically important and are invariably required in any clinical imaging software. The advent of Virtual Reality (VR) imaging systems is introducing intuitive and natural ways of visualising and interrogating echo images in a 3D environment. The 3D nature of the VR experience requires purpose-designed measurement tools, which may benefit from better depth perception and easier localisation of 3D landmarks.
Purpose
Comparison of the accuracy of our VR 3D linear measurement system to commercial clinical imaging software, using both multi-plane reformatting (MPR) and volume rendered views.
Method
Each virtual reality measurement was made by selecting two points in 3D, directly in the volume rendering. The participants could edit the measurements until satisfied with their accuracy. 5 expert clinicians carried out 26 measurements each - 6 measurements on a calibration phantom, and 5 anatomically meaningful measurements (for example: aortic valve, left atrium, left ventricle) on 4 datasets. The same measurements were made by all participants using our VR system (volume rendering), Philips" QLAB (MPR) and Tomtec (volume rendering). The frame number and view (for example: long axis) were consistent for each measurement across the 3 packages used.
Results
Preliminary results are shown in the figure below. MPR measurements made on Philips’ QLAB are used as a reference, as this is the most commonly used software for this purpose at our institution. We compare measurements made in Tomtec and VR, both using volume rendering, using Bland-Altman plots. Each measurement data point is the mean of all participants measurements for each dataset/measurement combination. The mean of the measurement differences for the VR system is closer to zero, compared to Tomtec. However, the variation of these differences is larger for the VR system than for Tomtec.
Conclusion
Our preliminary results suggest that the accuracy of line measurements made using volume rendering within a VR system is comparable to measurements made using approved software packages for volume rendering displayed on a 2D screen. This shows promise for more complex interrogation methods.
Abstract P801 Figure. Comparison of Tomtec and VR with QLAB
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Affiliation(s)
- G Wheeler
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Deng
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - K Pushparajah
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - J A Schnabel
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Simpson
- Evelina Children"s Hospital, Department of Congenital Heart Disease, London, United Kingdom of Great Britain & Northern Ireland
| | - A Gomez
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
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Deng S, Singh E, Wheeler G, Pushparajah K, Schnabel JA, Simpson JM, Gomez Herrero A. P1566 Evaluation of haptic feedback for interaction with volumetric image data in virtual reality. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Work supported by the NIHR i4i funded 3D Heart project [II-LA-0716-20001]
Background
3D printing is used for surgical planning of complex congenital heart disease (CHD) because it provides an intuitive 3D representation of the image data. However, the 3D print is static and it can be costly and time consuming to create. Virtual Reality (VR) is a cheaper alternative that is able to visualise volumetric images in 3D directly from the scanner, both statically (CT and MR) and dynamically (cardiac ultrasound). However, VR visualisation is not as tangible as a 3D print - this is because it lacks the haptic feedback which would make the interactions feel more natural.
Purpose
Evaluate if adding haptic feedback (vibration) to the visualisation of volume image data in VR improves measurement accuracy and user experience.
Method
We evaluated the effect of vibration haptic feedback in our VR system using a synthetic cylinder volume dataset. The cylinder was displayed in two conditions: (1) with no haptic feedback, and (2) with haptic feedback. Ten non-clinical participants volunteered in the evaluation. They were blinded to these two test conditions. The participants were asked to measure the cylinder’s diameter horizontally and vertically, and its length, in each test condition. The measurement results were compared to the ground truth to assess the measurement accuracy. Each participant also completed a questionnaire comparing their experience of the two test conditions during the experiment.
Results
The results show a marginal improvement of measurement accuracy with haptic feedback, compared to no haptics (see Figure a). However, this improvement was not statistically significant. The haptic feedback did improve the participants’ confidence about their performance and increased the ease of use in VR, hence, they preferred the haptics condition to the no haptics condition (see Figure b). Moreover, although 70% of the participants reported relying on the visual cue more than on the haptic cue, 90% found that the haptic cue was helpful for deciding where to place the measurement point. Also, 88.9% of the participants felt more immersed in the VR scene with haptic feedback.
Conclusion
Our evaluation suggests that although haptic feedback may only marginally improve measurement accuracy, participants nevertheless preferred it because it improved confidence in their performance, increased ease of use, and facilitated a more immersive user experience.
Abstract P1566 Figure.
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Affiliation(s)
- S Deng
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - E Singh
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - G Wheeler
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - K Pushparajah
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J A Schnabel
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Simpson
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Gomez Herrero
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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Day TG, Charakida M, Simpson JM. Using speckle-tracking echocardiography to assess fetal myocardial deformation: are we there yet? Ultrasound Obstet Gynecol 2019; 54:575-581. [PMID: 30740804 DOI: 10.1002/uog.20233] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/07/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Affiliation(s)
- T G Day
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Charakida
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Imaging Science and Biomedical Engineering, King's College London, London, UK
| | - J M Simpson
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Imaging Science and Biomedical Engineering, King's College London, London, UK
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Simpson JM, Charakida M, Day TG. Reply. Ultrasound Obstet Gynecol 2019; 54:704. [PMID: 31688994 DOI: 10.1002/uog.21877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- J M Simpson
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Imaging Science and Biomedical Engineering, King's College London, London, UK
| | - M Charakida
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Imaging Science and Biomedical Engineering, King's College London, London, UK
| | - T G Day
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Zidere V, Gebb J, Vigneswaran T, Charakida M, Simpson JM, Bower S. Spontaneous resolution of large pericardial effusion associated with right ventricular outpouching in four fetuses. Ultrasound Obstet Gynecol 2019; 54:701-702. [PMID: 30549363 DOI: 10.1002/uog.20194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Affiliation(s)
- V Zidere
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - J Gebb
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, PA, USA
| | - T Vigneswaran
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
- Division of Imaging Sciences, King's College London British Heart Foundation Centre, NIHR Biomedical Research Centre, Guy's & St Thomas', NHS Foundation Trust, London, UK
| | - J M Simpson
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - S Bower
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Jabak S, Vigneswaran TV, Charakida M, Kasapoglu T, de Jesus Cruz J, Simpson JM, Zidere V. Initial Experience of Superb Microvascular Imaging for Key Cardiac Views in Foetal Assessment before 15 Weeks Gestation. Fetal Diagn Ther 2019; 47:268-276. [PMID: 31597155 DOI: 10.1159/000502839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/04/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the first trimester, ultrasound confirmation of normal or abnormal cardiac anatomy is difficult. B-mode and colour flow Doppler (CFD) are used to assess the foetal heart. Superb microvascular imaging (SMI) can visualise blood flow within the heart and vessels in early gestation. OBJECTIVE We report an initial experience of SMI for visualisation of normal and abnormal cardiac anatomy in the first trimester. METHODS Transabdominal foetal echocardiography was performed between 11 + 6 and 14 + 3 weeks (Aplio 500 US system, Toshiba Medical Systems, Tokyo, Japan) from January 2017 to December 2017. All scans were performed at a tertiary foetal cardiology unit. To assess the potential utility of the technique for early gestation screening, normal scans were reviewed by foetal medicine trainees with respect to the B-mode, CFD and SMI. Three key views were selected to compare modalities: the 4-chamber view, outflow tracts and the 3-vessel and trachea view (VTV). Visualisation rates of key echocardiographic features of significant cardiac abnormalities by SMI were reviewed. RESULTS Fifty-five normal echocardiograms and 34 cardiac abnormalities were included. In the normal heart, when B-mode, CFD and SMI were assessed separately, SMI had the highest rate of visualisation of 4-chamber, outflow tracts and 3-VTV (93, 85 and 83%, respectively). Intra-observer reliability was moderate for SMI of the 3 standard views (kappa 1, 0.64 and 0.64); inter-observer for 4-chamber and outflow tract views was moderate (kappa 0.64 and 0.77). In 29/34 abnormal cases, SMI showed key features, enhancing greyscale visualisation. CONCLUSION SMI has potential to become a useful, complementary modality for early foetal echocardiography. Further prospective studies are warranted to establish the place of the technique in assessment of the first trimester foetal heart.
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Affiliation(s)
- Salma Jabak
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Trisha V Vigneswaran
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' Hospitals, London, United Kingdom
| | - Marietta Charakida
- School of Biomedical Engineering and Imaging Sciences, Kings College London, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Taner Kasapoglu
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom
| | | | - John M Simpson
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' Hospitals, London, United Kingdom
| | - Vita Zidere
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom, .,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' Hospitals, London, United Kingdom,
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