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DiLorenzo MP, Lee S, Rathod RH, Raimondi F, Farooqi KM, Jain SS, Samyn MM, Johnson TR, Olivieri LJ, Fogel MA, Lai WW, Renella P, Powell AJ, Buddhe S, Stafford C, Johnson JN, Helbing WA, Pushparajah K, Voges I, Muthurangu V, Miles KG, Greil G, McMahon CJ, Slesnick TC, Fonseca BM, Morris SA, Soslow JH, Grosse-Wortmann L, Beroukhim RS, Grotenhuis HB. Design and implementation of multicenter pediatric and congenital studies with cardiovascular magnetic resonance: Big data in smaller bodies. J Cardiovasc Magn Reson 2024; 26:101041. [PMID: 38527706 PMCID: PMC10990896 DOI: 10.1016/j.jocmr.2024.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) has become the reference standard for quantitative and qualitative assessment of ventricular function, blood flow, and myocardial tissue characterization. There is a preponderance of large CMR studies and registries in adults; However, similarly powered studies are lacking for the pediatric and congenital heart disease (PCHD) population. To date, most CMR studies in children are limited to small single or multicenter studies, thereby limiting the conclusions that can be drawn. Within the PCHD CMR community, a collaborative effort has been successfully employed to recognize knowledge gaps with the aim to embolden the development and initiation of high-quality, large-scale multicenter research. In this publication, we highlight the underlying challenges and provide a practical guide toward the development of larger, multicenter initiatives focusing on PCHD populations, which can serve as a model for future multicenter efforts.
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Affiliation(s)
- Michael P. DiLorenzo
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, New York, NY 10032, USA
| | - Simon Lee
- Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | | | - Francesca Raimondi
- Children's Hospital Meyer, University of Florence, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy
| | - Kanwal M. Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, New York, NY 10032, USA
| | - Supriya S. Jain
- New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Margaret M. Samyn
- Medical College of Wisconsin/The Herma Heart Institute at Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI 53226, USA
| | - Tiffanie R. Johnson
- Indiana University School of Medicine, Riley Children’s Health, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
| | - Laura J. Olivieri
- Department of Pediatric Cardiology, Children's Hospital of Pittsburgh, Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA 15224, USA
| | - Mark A. Fogel
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Wyman W. Lai
- CHOC Children's Hospital, 1201 W La Veta Ave, Orange, CA 92868, USA
| | | | | | - Sujatha Buddhe
- Department of Pediatrics, Division of Pediatric Cardiology, Betty Irene Moore Heart Center, Lucile Packard Children’s Hospital, 725 Welch Rd Ste 325, Palo Alto, CA 94304, USA
| | | | - Jason N. Johnson
- Department of Pediatrics, University of Tennessee Health Sciences Center, 848 Adams Ave, Memphis, TN 38103, USA
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Sciences Center, 848 Adams Ave, Memphis, TN 38103, USA
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Sophia's Children's Hospital, Erasmus University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Rotterdam, the Netherlands
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Inga Voges
- German Centre for Cardiovascular Research, Ootsdamer Str. 58, 10785 Berlin, Germany
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Vivek Muthurangu
- UCL Center for Translational Cardiovascular Imaging, University College London, Gower Street, London WC1E 6BT, UK
| | - Kimberley G. Miles
- Heart Institute, Cincinnati Children's Hospital Medical Center, 333 Burnet Ave, Kimberley, Cincinnati, OH 45229, USA
| | - Gerald Greil
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Colin J. McMahon
- University College of Dublin, School of Medicine and Department of Paediatric Cardiology, Children's Health Ireland, Gate 5, Crumlin, Dublin 12, Ireland
| | - Timothy C. Slesnick
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, 738 Old Norcross Road, Lawrenceville, GA 30046, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, Division of Pediatric Cardiology, Emory University School of Medicine, 738 Old Norcross Road, Lawrenceville, GA 30046, USA
| | - Brian M. Fonseca
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave, Aurora, CO 80045, USA
| | - Shaine A. Morris
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine Texas Children's Hospital, 6651 Main Street, Houston, TX 77030, USA
| | - Jonathan H. Soslow
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, 700 SW Campus Dr, Portland, OR, USA 97239
| | | | - Heynric B. Grotenhuis
- Pediatric Cardiology, Wilhelmina Children’s Hospital, UMCU, Lundlaan 6, 3584 EA Utrecht, the Netherlands
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Sachdeva R, Armstrong AK, Arnaout R, Grosse-Wortmann L, Han BK, Mertens L, Moore RA, Olivieri LJ, Parthiban A, Powell AJ. Novel Techniques in Imaging Congenital Heart Disease: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:63-81. [PMID: 38171712 PMCID: PMC10947556 DOI: 10.1016/j.jacc.2023.10.025] [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: 07/21/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024]
Abstract
Recent years have witnessed exponential growth in cardiac imaging technologies, allowing better visualization of complex cardiac anatomy and improved assessment of physiology. These advances have become increasingly important as more complex surgical and catheter-based procedures are evolving to address the needs of a growing congenital heart disease population. This state-of-the-art review presents advances in echocardiography, cardiac magnetic resonance, cardiac computed tomography, invasive angiography, 3-dimensional modeling, and digital twin technology. The paper also highlights the integration of artificial intelligence with imaging technology. While some techniques are in their infancy and need further refinement, others have found their way into clinical workflow at well-resourced centers. Studies to evaluate the clinical value and cost-effectiveness of these techniques are needed. For techniques that enhance the value of care for congenital heart disease patients, resources will need to be allocated for education and training to promote widespread implementation.
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Affiliation(s)
- Ritu Sachdeva
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, Department of Pediatrics, Division of Cardiology, Ohio State University, Columbus, Ohio, USA
| | - Rima Arnaout
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - B Kelly Han
- Division of Cardiology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan A Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Laura J Olivieri
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anitha Parthiban
- Department of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Mandell JG, Romanowicz J, Loke YH, Ikeda N, Pena E, Siddiqi U, Hibino N, Alexander ME, Powell AJ, Olivieri LJ. Aortic arch shape after arch repair predicts exercise capacity: a multicentre analysis. Eur Heart J Open 2024; 4:oead138. [PMID: 38223303 PMCID: PMC10786438 DOI: 10.1093/ehjopen/oead138] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
Aims Coarctation of the aorta is associated with long-term morbidity including decreased exercise capacity, despite successful repair. In the absence of discrete recoarctation, the haemodynamic mechanism remains unknown. This multicentre study evaluated the relationship between aorta shape, flow, and exercise capacity in patients after arch repair, specifically through the lens of aortic size mismatch and descending aortic (DAo) flow and their association with exercise. Methods and results Cardiac magnetic resonance, cardiopulmonary exercise test, and echocardiogram data within 1 year were analysed from 58 patients (age 28 ± 10 years, 48% male) across four centres with history of isolated arch repair. Aortic arch measurements were correlated with % predicted VO2max with subgroup analyses of those with residual arch obstruction, bicuspid aortic valve, and hypertension. Ascending aorta (AAo) to DAo diameter ratio (DAAo/DDAo) was negatively correlated with % predicted VO2max. %DAo flow positively correlated with VO2max. Sub-analyses demonstrated that the negative correlation of DAAo/DDAo with VO2max was maintained only in patients without arch obstruction and with a bicuspid aortic valve. Smaller aortic arch measurements were associated with both hypertension and exercise-induced hypertension. Conclusion Aorta size mismatch, due to AAo dilation or small DAo, and associated decreased %DAo flow, correlated significantly with decreased exercise capacity after aortic arch repair. These correlations were stronger in patients without arch obstruction and with a bicuspid aortic valve. Aorta size mismatch and %DAo flow capture multiple mechanisms of altered haemodynamics beyond blood pressure gradient or discrete obstruction and can inform the definition of a successful repair.
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Affiliation(s)
- Jason G Mandell
- Division of Pediatric Cardiology, University of Rochester Medical Center, Golisano Children’s Hospital, 601 Elmwood Avenue, Box 631, Rochester, NY 14642, USA
| | - Jennifer Romanowicz
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Yue-Hin Loke
- Division of Pediatric Cardiology, Children’s National Hospital, Washington, DC, USA
| | - Nobuyuki Ikeda
- Division of Cardiology, Advocate Children’s Hospital, Oak Lawn, IL, USA
| | - Emily Pena
- Division of Cardiology, Advocate Children’s Hospital, Oak Lawn, IL, USA
| | - Umar Siddiqi
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
- Department of Cardiovascular Surgery, Advocate Children’s Hospital, Oak Lawn, IL, USA
| | - Mark E Alexander
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Laura J Olivieri
- Department of Pediatric Cardiology, University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
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Smith KL, Gordon EB, Gunsaulus ME, Christopher A, Olivieri LJ, Tadros SS, Harris T, Saraf AP, Kreutzer J, Feingold B, Alsaied T. Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation. J Clin Med 2023; 12:2689. [PMID: 37048773 PMCID: PMC10095035 DOI: 10.3390/jcm12072689] [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: 03/03/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Sarcopenia is an increasingly recognized marker of frailty in cardiac patients. Patients with a history of congenital heart disease and Fontan procedure have a higher risk of developing progressive muscle wasting. Our objective was to determine if we could use routine cardiac MRI (CMR) for the surveillance of muscle wasting. METHODS A retrospective study of all Fontan patients (n = 75) was conducted at our institution, with CMR performed from 2010 to 2022 and exercise stress testing performed within 12 months (4.3 ± 4.2 months). The skeletal muscle area (SMA) for the posterior paraspinal and anterior thoracic muscles were traced and indexed for body surface area (BSA). Patients were stratified by percentile into the upper and lower quartiles, and the two groups were compared. Multivariable regression was performed to control for sex and age. RESULTS There was a significant positive association of both anterior (r = 0.34, p = 0.039) and paraspinal (r = 0.43, p = 0.007) SMA to peak VO2. Similarly, paraspinal but not anterior SMA was negatively associated with the VE/VCO2 (r = -0.45, p = 0.006). The upper quartile group had significantly more males (18/19 vs. 8/20; p = 0.0003) and demonstrated a significantly higher peak VO2 (32.2 ± 8.5 vs. 23.8 ± 4.7, p = 0.009), a higher peak RER (1.2 ± 0.1 vs. 1.1 ± 0.04, p = 0.007), and a significantly lower VE/VCO2 (32.9 ± 3.6 vs. 40.2 ± 6.2, p = 0.006) compared to the lowest quartile. The association of SMA to VO2 peak and VE/VCO2 was redemonstrated after controlling for sex and age. CONCLUSION Thoracic skeletal muscle area may be an effective surrogate of muscle mass and is correlated to several measures of cardiorespiratory fitness post-Fontan. CMR would be an effective tool for the surveillance of sarcopenia in post-Fontan patients given its accessibility and routine use in these patients.
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Affiliation(s)
- Kevin L. Smith
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Emile B. Gordon
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Megan E. Gunsaulus
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Adam Christopher
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Laura J. Olivieri
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Sameh S. Tadros
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Tyler Harris
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Anita P. Saraf
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Jacqueline Kreutzer
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Brian Feingold
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Tarek Alsaied
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
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Alsaied T, Christopher AB, Da Silva J, Gupta A, Morell VO, Lanford L, Weinberg JG, Feingold B, Seery T, Hoskoppal A, Goldstein BH, Johnson JA, Olivieri LJ, De Fonseca Da Silva L. Multimodality Imaging in Ebstein Anomaly. Pediatr Cardiol 2023; 44:15-23. [PMID: 36151322 DOI: 10.1007/s00246-022-03011-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: 04/07/2022] [Accepted: 09/14/2022] [Indexed: 01/24/2023]
Abstract
Ebstein anomaly is the most common form of tricuspid valve congenital anomalies. The tricuspid valve is abnormal with different degrees of displacement of the septal leaflet and abnormal rotation of the valve towards the right ventricular outflow tract. In severe forms, it results in significant tricuspid regurgitation and requires surgical repair. There is an increased interest in understanding the anatomy of the tricuspid valve in this lesion as the surgical repair has evolved with the invention and wide adoption of the cone operation. Multimodality imaging plays an important role in diagnosis, follow-up, surgical planning and post-operative care. This review provides anatomical tips for the cardiac imagers caring for patients with Ebstein anomaly and will help provide image-based personalized medicine.
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Affiliation(s)
- Tarek Alsaied
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA.
| | - Adam B Christopher
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jose Da Silva
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Aditi Gupta
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Victor O Morell
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lizabeth Lanford
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jacqueline G Weinberg
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Brian Feingold
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Thomas Seery
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Arvind Hoskoppal
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jennifer A Johnson
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Laura J Olivieri
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Luciana De Fonseca Da Silva
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Opotowsky AR, Allen KY, Bucholz EM, Burns KM, del Nido P, Fenton KN, Gelb BD, Kirkpatrick JN, Kutty S, Lambert LM, Lopez KN, Olivieri LJ, Pajor NM, Pasquali SK, Petit CJ, Sood E, VanBuren JM, Pearson GD, Miyamoto SD. Pediatric and Congenital Cardiovascular Disease Research Challenges and Opportunities. J Am Coll Cardiol 2022; 80:2239-2250. [DOI: 10.1016/j.jacc.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
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Kollar SE, Udine ML, Mandell JG, Cross RR, Loke YH, Olivieri LJ. Impact of ferumoxytol vs gadolinium on 4D flow cardiovascular magnetic resonance measurements in small children with congenital heart disease. J Cardiovasc Magn Reson 2022; 24:58. [PMID: 36352454 PMCID: PMC9648014 DOI: 10.1186/s12968-022-00886-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) allows for time-resolved three-dimensional phase-contrast (4D Flow) analysis of congenital heart disease (CHD). Higher spatial resolution in small infants requires thinner slices, which can degrade the signal. Particularly in infants, the choice of contrast agent (ferumoxytol vs. gadolinium) may influence 4D Flow CMR accuracy. Thus, we investigated the accuracy of 4D Flow CMR measurements compared to gold standard 2D flow phase contrast (PC) measurements in ferumoxytol vs. gadolinium-enhanced CMR of small CHD patients with shunt lesions. METHODS This was a retrospective study consisting of CMR studies from complex CHD patients less than 20 kg who had ferumoxytol or gadolinium-enhanced 4D Flow and standard two-dimensional phase contrast (2D-PC) flow collected. 4D Flow clinical software (Arterys) was used to measure flow in great vessels, systemic veins, and pulmonary veins. 4D Flow accuracy was defined as percent difference or correlation against conventional measurements (2D-PC) from the same vessels. Subgroup analysis was performed on two-ventricular vs single-ventricular CHD, arterial vs venous flow, as well as low flows (defined as < 1.5 L/min) in 1V CHD. RESULTS Twenty-one ferumoxytol-enhanced and 23 gadolinium-enhanced CMR studies were included, with no difference in age (2.1 ± 1.6 vs. 2.3 ± 1.9 years, p = 0.70), patient body surface area (0.50 ± 0.2 vs. 0.52 ± 0.2 m2, p = 0.67), or vessel diameter (11.4 ± 5.2 vs. 12.4 ± 5.6 mm, p = 0.22). Ten CMR studies with single ventricular CHD were included. Overall, ferumoxytol-enhanced 4D flow CMR measurements demonstrated less percent difference to 2D-PC when compared to gadolinium-enhanced 4D Flow CMR studies. In subgroup analyses of arterial vs. venous flows (high velocity vs. low velocity) and low flow in single ventricle CHD, ferumoxytol-enhanced 4D Flow CMR measurements had stronger correlation to 2D-PC CMR. The contrast-to-noise ratio (CNR) in ferumoxytol-enhanced studies was higher than the CNR in gadolinium-enhanced studies. CONCLUSIONS Ferumoxytol-enhanced 4D Flow CMR has improved accuracy when compared to gadolinium 4D Flow CMR, particularly for infants with small vessels in CHD.
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Affiliation(s)
- Sarah E Kollar
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA.
| | - Michelle L Udine
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Jason G Mandell
- Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Russell R Cross
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Laura J Olivieri
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
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Kollar S, Balaras E, Olivieri LJ, Loke YH, Capuano F. Statistical shape modeling reveals the link between right ventricular shape, hemodynamic force, and myocardial function in patients with repaired tetralogy of Fallot. Am J Physiol Heart Circ Physiol 2022; 323:H449-H460. [PMID: 35839154 PMCID: PMC9394773 DOI: 10.1152/ajpheart.00228.2022] [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: 05/10/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022]
Abstract
Patients with repaired tetralogy of Fallot (rTOF) can develop chronic pulmonary insufficiency (PI) with right ventricular (RV) dilation, progressive RV dysfunction, and decreased exercise capacity. Pulmonary valve replacement (PVR) can help reduce the amount of PI and RV dilation; however, optimal timing remains controversial; a better understanding of rTOF pathophysiology is of fundamental importance to inform clinical management of patients with rTOF and optimal timing of PVR. In this study, we hypothesize a tight interplay between RV shape, intracardiac biomechanics, and ventricular function in patients with rTOF. To explore this hypothesis and derive quantitative measures, we combined statistical shape modeling with physics-based analysis of in vivo 4D flow data in 36 patients with rTOF. Our study demonstrated for the first time a correlation between regional RV shape variations, hemodynamic forces (HDF), and clinical dysfunction in patients with rTOF. The main findings of this work include 1) general increase in RV size, due to both volume overload and physiological growth, correlated with decrease in strain magnitude in the respective directions, and with increased QRS; 2) regional PI-induced remodeling accounted for ∼10% of the shape variability of the population, and was associated with increased diastolic HDF along the diaphragm-to-right ventricular outflow tract (RVOT) direction, resulting in a net RV deformation along the same direction and decreased tricuspid annular plane systolic excursion (TAPSE); and 3) three shape modes independently correlated with systolic HDF and exercise capacity. Identification of patients based on the shape variations described in this study could help identify those at risk for irreversible dysfunction and guide optimal timing of PVR.NEW & NOTEWORTHY We combine statistical shape modeling with physics-based analysis of 4D flow data to elucidate the interplay between RV shape, hemodynamic forces, and clinical dysfunction in repaired tetralogy of Fallot. We are the first to show that ventricular remodeling is related to hemodynamic force magnitude and direction, global and regional functional parameters, and exercise intolerance. Identification of patients based on the shape variations described in this study could help identify those at risk for irreversible dysfunction.
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Affiliation(s)
- Sarah Kollar
- Division of Cardiology, Children's National Medical Center, Washington, District of Columbia
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, District of Columbia
| | - Laura J Olivieri
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, Washington, District of Columbia
| | - Francesco Capuano
- Department of Fluid Mechanics, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain
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Loke YH, Capuano F, Balaras E, Olivieri LJ. Computational Modeling of Right Ventricular Motion and Intracardiac Flow in Repaired Tetralogy of Fallot. Cardiovasc Eng Technol 2022; 13:41-54. [PMID: 34169460 PMCID: PMC8702579 DOI: 10.1007/s13239-021-00558-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Patients with repaired Tetralogy of Fallot (rTOF) will develop dilation of the right ventricle (RV) from chronic pulmonary insufficiency and require pulmonary valve replacement (PVR). Cardiac MRI (cMRI) is used to guide therapy but has limitations in studying novel intracardiac flow parameters. This pilot study aimed to demonstrate feasibility of reconstructing RV motion and simulating intracardiac flow in rTOF patients, exclusively using conventional cMRI and an immersed-boundary method computational fluid dynamic (CFD) solver. METHODS Four rTOF patients and three normal controls underwent cMRI including 4D flow. 3D RV models were segmented from cMRI images. Feature-tracking software captured RV endocardial contours from cMRI long-axis and short-axis cine stacks. RV motion was reconstructed via diffeomorphic mapping (Deformetrica, deformetrica.org), serving as the domain boundary for CFD. Fully-resolved direct numerical simulations were performed over several cardiac cycles. Intracardiac vorticity, kinetic energy (KE) and turbulent kinetic energy (TKE) was measured. For validation, RV motion was compared to manual tracings, results of KE were compared between CFD and 4D flow. RESULTS Diastolic vorticity and TKE in rTOF patients were 4.12 ± 2.42 mJ/L and 115 ± 27/s, compared to 2.96 ± 2.16 mJ/L and 78 ± 45/s in controls. There was good agreement between RV motion and manual tracings. The difference in diastolic KE between CFD and 4D flow by Bland-Altman analysis was - 0.89910 to 2 mJ/mL (95% limits of agreement: - 1.351 × 10-2 mJ/mL to 1.171 × 10-2 mJ/mL). CONCLUSION This CFD framework can produce intracardiac flow in rTOF patients. CFD has the potential for predicting the effects of PVR in rTOF patients and improve the clinical indications guided by cMRI.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave NW W3-200, Washington, DC, 20010, USA.
| | - Francesco Capuano
- Department of Industrial Engineering, Università degli Studi di Napoli "Federico II", 80125, Naples, Italy
- Department of Mechanics, Mathematics and Management, Politecnico di Bari, 70126, Bari, Italy
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC, 20052, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave NW W3-200, Washington, DC, 20010, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
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10
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Alsaied T, Castrillon CD, Christopher A, Da Silva J, Morell VO, Lanford L, Goldstein BH, Feingold B, Seery T, Arora G, Hoskoppal A, Johnson JA, Tadros S, Olivieri LJ, Da Silva LDF. Cardiac MRI predictors of right ventricular dysfunction after the Da Silva cone operation for Ebstein's anomaly. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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11
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Rao S, Tseng SY, Pednekar A, Siddiqui S, Kocaoglu M, Fares M, Lang SM, Kutty S, Christopher AB, Olivieri LJ, Taylor MD, Alsaied T. Myocardial Parametric Mapping by Cardiac Magnetic Resonance Imaging in Pediatric Cardiology and Congenital Heart Disease. Circ Cardiovasc Imaging 2022; 15:e012242. [PMID: 34983186 DOI: 10.1161/circimaging.120.012242] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Parametric mapping, that is, a pixel-wise map of magnetic relaxation parameters, expands the diagnostic potential of cardiac magnetic resonance by enabling quantification of myocardial tissue-specific magnetic relaxation on an absolute scale. Parametric mapping includes T1 mapping (native and postcontrast), T2 and T2* mapping, and extracellular volume measurements. The myocardial composition is altered in various disease states affecting its inherent magnetic properties and thus the myocardial relaxation times that can be directly quantified using parametric mapping. Parametric mapping helps in the diagnosis of nonfocal disease states and allows for longitudinal disease monitoring, evaluating therapeutic response (as in Thalassemia patients with iron overload undergoing chelation), and risk-stratification of certain diseases. In this review article, we describe various mapping techniques and their clinical utility in congenital heart disease. We will also review the available literature on normative values in children, the strengths, and weaknesses of these techniques. This review provides a starting point for pediatric cardiologists to understand and implement parametric mapping in their practice.
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Affiliation(s)
- Sruti Rao
- Division of Pediatric Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, India (S.R.)
| | - Stephanie Y Tseng
- The Heart Institute, Cincinnati Children's Hospital, OH (S.Y.T., S.M.L., M.D.T.).,Department of Pediatrics, University of Cincinnati, OH (S.Y.T., S.M.L., M.D.T.)
| | - Amol Pednekar
- Department of Radiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, OH (A.P., M.K.)
| | - Saira Siddiqui
- Department of Pediatrics, Morristown Medical Center, NJ (S.S.)
| | - Murat Kocaoglu
- Department of Radiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, OH (A.P., M.K.)
| | - Munes Fares
- Pediatric Cardiology Division, UT Southwestern Medical Center, Dallas, TX (M.F.)
| | - Sean M Lang
- The Heart Institute, Cincinnati Children's Hospital, OH (S.Y.T., S.M.L., M.D.T.).,Department of Pediatrics, University of Cincinnati, OH (S.Y.T., S.M.L., M.D.T.)
| | - Shelby Kutty
- Taussig Heart Center, The Johns Hopkins Hospital Baltimore, MD (S.K.)
| | - Adam B Christopher
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, PA (A.B.C., T.A.)
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC (L.J.O.)
| | - Michael D Taylor
- The Heart Institute, Cincinnati Children's Hospital, OH (S.Y.T., S.M.L., M.D.T.).,Department of Pediatrics, University of Cincinnati, OH (S.Y.T., S.M.L., M.D.T.)
| | - Tarek Alsaied
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, PA (A.B.C., T.A.)
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12
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Johnson JN, Mandell JG, Christopher A, Olivieri LJ, Loke YH, Campbell MJ, Darty S, Kim HW, Clark DE, Frischhertz BP, Fish FA, Bailey AL, Mikolaj MB, Hughes SG, Oneugbu A, Chung J, Burdowski J, Marfatia R, Bi X, Craft J, Umairi RA, Kindi FA, Williams JL, Campbell MJ, Kharabish A, Gutierrez M, Arzanauskaite M, Ntouskou M, Ashwath ML, Robinson T, Chiang JB, Lee JCY, Lee MSH, Chen SSM. Society for Cardiovascular Magnetic Resonance 2020 Case of the Week series. J Cardiovasc Magn Reson 2021; 23:108. [PMID: 34629101 PMCID: PMC8504030 DOI: 10.1186/s12968-021-00799-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/26/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). Case of the week is a case series hosted on the SCMR website ( https://www.scmr.org ) that demonstrates the utility and importance of CMR in the clinical diagnosis and management of cardiovascular disease. Each case consists of the clinical presentation and a discussion of the condition and the role of CMR in diagnosis and guiding clinical management. The cases are all instructive and helpful in the approach to patient management. We present a digital archive of the 2020 Case of the Week series of 11 cases as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.
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Affiliation(s)
- Jason N Johnson
- Division of Pediatric Cardiology and Pediatric Radiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jason G Mandell
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Adam Christopher
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Michael J Campbell
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Steve Darty
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Han W Kim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Daniel E Clark
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin P Frischhertz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank A Fish
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison L Bailey
- Division of Cardiovascular Medicine, University of Tennessee College of Medicine Chattanooga/Erlanger Health System, Chattanooga, TN, USA
| | - Michael B Mikolaj
- Division of Cardiovascular Medicine, University of Tennessee College of Medicine Chattanooga/Erlanger Health System, Chattanooga, TN, USA
| | - Sean G Hughes
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Jina Chung
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA
| | | | - Ravi Marfatia
- Division of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Xiaoming Bi
- Siemens Medical Solutions, Los Angeles, CA, USA
| | - Jason Craft
- Division of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | | | - Faiza A Kindi
- Department of Radiology, The Royal Hospital, Muscat, Oman
| | - Jason L Williams
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael J Campbell
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Ahmed Kharabish
- Radiology Department, Cairo University Hospitals, Cairo, Egypt
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manuel Gutierrez
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Monika Arzanauskaite
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiovascular Research Center-ICCC, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Marousa Ntouskou
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mahi L Ashwath
- Division of Cardiology, University of Iowa Hospitals and Clinic, Iowa City, Iowa, USA
| | - Tommy Robinson
- Division of Cardiology, University of Iowa Hospitals and Clinic, Iowa City, Iowa, USA
| | - Jeanie B Chiang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - Jonan C Y Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - M S H Lee
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - Sylvia S M Chen
- Department of Cardiology and Adult Congenital Heart Disease, The Prince Charles Hospital, Brisbane, Australia.
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13
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Mandell JG, Loke YH, Mass PN, Cleveland V, Delaney M, Opfermann J, Aslan S, Krieger A, Hibino N, Olivieri LJ. Altered hemodynamics by 4D flow cardiovascular magnetic resonance predict exercise intolerance in repaired coarctation of the aorta: an in vitro study. J Cardiovasc Magn Reson 2021; 23:99. [PMID: 34482836 PMCID: PMC8420072 DOI: 10.1186/s12968-021-00796-3] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/14/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) is associated with decreased exercise capacity despite successful repair. Altered flow patterns have been identified due to abnormal aortic arch geometry. Our previous work demonstrated aorta size mismatch to be associated with exercise intolerance in this population. In this study, we studied aortic flow patterns during simulations of exercise in repaired CoA using 4D flow cardiovascular magnetic resonance (CMR) using aortic replicas connected to an in vitro flow pump and correlated findings with exercise stress test results to identify biomarkers of exercise intolerance. METHODS Patients with CoA repair were retrospectively analyzed after CMR and exercise stress test. Each aorta was manually segmented and 3D printed. Pressure gradient measurements from ascending aorta (AAo) to descending aorta (DAo) and 4D flow CMR were performed during simulations of rest and exercise using a mock circulatory flow loop. Changes in wall shear stress (WSS) and secondary flow formation (vorticity and helicity) from rest to exercise were quantified, as well as estimated DAo Reynolds number. Parameters were correlated with percent predicted peak oxygen consumption (VO2max) and aorta size mismatch (DAAo/DDAo). RESULTS Fifteen patients were identified (VO2max 47 to 126% predicted). Pressure gradient did not correlate with VO2max at rest or exercise. VO2max correlated positively with the change in peak vorticity (R = 0.55, p = 0.03), peak helicity (R = 0.54, p = 0.04), peak WSS in the AAo (R = 0.68, p = 0.005) and negatively with peak WSS in the DAo (R = - 0.57, p = 0.03) from rest to exercise. DAAo/DDAo correlated strongly with change in vorticity (R = - 0.38, p = 0.01), helicity (R = - 0.66, p = 0.007), and WSS in the AAo (R = - 0.73, p = 0.002) and DAo (R = 0.58, p = 0.02). Estimated DAo Reynolds number negatively correlated with VO2max for exercise (R = - 0.59, p = 0.02), but not rest (R = - 0.28, p = 0.31). Visualization of streamline patterns demonstrated more secondary flow formation in aortic arches with better exercise capacity, larger DAo, and lower Reynolds number. CONCLUSIONS There are important associations between secondary flow characteristics and exercise capacity in repaired CoA that are not captured by traditional pressure gradient, likely due to increased turbulence and inefficient flow. These 4D flow CMR parameters are a target of investigation to identify optimal aortic arch geometry and improve long term clinical outcomes after CoA repair.
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Affiliation(s)
- Jason G Mandell
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Paige N Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Vincent Cleveland
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Marc Delaney
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Justin Opfermann
- Department of Mechanical Engineering, Johns Hopkins University, Latrobe Hall 223, 3400 North Charles St, Baltimore, MD, 21218, USA
| | - Seda Aslan
- Department of Mechanical Engineering, Johns Hopkins University, Latrobe Hall 223, 3400 North Charles St, Baltimore, MD, 21218, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, Latrobe Hall 223, 3400 North Charles St, Baltimore, MD, 21218, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, USA
- Section of Cardiac Surgery, Department of Surgery, Advocate Children's Hospital, 4440 West 95th Street, Oak Lawn, IL, 60453, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
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14
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Loke YH, Capuano F, Cleveland V, Mandell JG, Balaras E, Olivieri LJ. Moving beyond size: vorticity and energy loss are correlated with right ventricular dysfunction and exercise intolerance in repaired Tetralogy of Fallot. J Cardiovasc Magn Reson 2021; 23:98. [PMID: 34412634 PMCID: PMC8377822 DOI: 10.1186/s12968-021-00789-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The global effect of chronic pulmonary regurgitation (PR) on right ventricular (RV) dilation and dysfunction in repaired Tetralogy of Fallot (rTOF) patients is well studied by cardiovascular magnetic resonance (CMR). However, the links between PR in the RV outflow tract (RVOT), RV dysfunction and exercise intolerance are not clarified by conventional measurements. Not all patients with RV dilation share the same intracardiac flow characteristics, now measurable by time resolved three-dimensional phase contrast imaging (4D flow). In our study, we quantified regional vorticity and energy loss in rTOF patients and correlated these parameters with RV dysfunction and exercise capacity. METHODS rTOF patients with 4D flow datasets were retrospectively analyzed, including those with transannular/infundibular repair and conduit repair. Normal controls and RV dilation patients with atrial-level shunts (Qp:Qs > 1.2:1) were included for comparison. 4D flow was post-processed using IT Flow (Cardioflow, Japan). Systolic/diastolic vorticity (ω, 1/s) and viscous energy loss (VEL, mW) in the RVOT and RV inflow were measured. To characterize the relative influence of diastolic vorticity in the two regions, an RV Diastolic Vorticity Quotient (ωRVOT-Diastole/ωRV Inflow-Diastole, RV-DVQ) was calculated. Additionally, RVOT Vorticity Quotient (ωRVOT-Diastole/ωRVOT-Systole, RVOT-VQ) and RVOT Energy Quotient (VELRVOT-Diastole/VELRVOT-Systole, RVOT-EQ) was calculated. In rTOF, measurements were correlated against conventional CMR and exercise stress test results. RESULTS 58 rTOF patients, 28 RV dilation patients and 12 controls were included. RV-DVQ, RVOT-VQ, and RVOT-EQ were highest in rTOF patients with severe PR compared to rTOF patients with non-severe PR, RV dilation and controls (p < 0.001). RV-DVQ positively correlated with RV end-diastolic volume (0.683, p < 0.001), PR fraction (0.774, p < 0.001) and negatively with RV ejection fraction (- 0.521, p = 0.003). Both RVOT-VQ, RVOT-EQ negatively correlated with VO2-max (- 0.587, p = 0.008 and - 0.617, p = 0.005) and % predicted VO2-max (- 0.678, p = 0.016 and - 0.690, p = 0.001). CONCLUSIONS In rTOF patients, vorticity and energy loss dominate the RVOT compared to tricuspid inflow, correlating with RV dysfunction and exercise intolerance. These 4D flow-based measurements may be sensitive biomarkers to guide surgical management of rTOF patients.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, W3-200, Washington, DC, 20010, USA.
| | - Francesco Capuano
- Department of Mechanics, Mathematics and Management, Polytechnic University of Bari, Bari, Italy
| | - Vincent Cleveland
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Jason G Mandell
- Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, W3-200, Washington, DC, 20010, USA
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC, 20052, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, W3-200, Washington, DC, 20010, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA
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15
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Mandell JG, Loke YH, Mass PN, Opfermann J, Cleveland V, Aslan S, Hibino N, Krieger A, Olivieri LJ. Aorta size mismatch predicts decreased exercise capacity in patients with successfully repaired coarctation of the aorta. J Thorac Cardiovasc Surg 2021; 162:183-192.e2. [PMID: 33131888 DOI: 10.1016/j.jtcvs.2020.09.103] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Coarctation of the aorta (CoA) is associated with decreased exercise capacity despite successful repair with no residual stenosis; however, the hemodynamic mechanism remains unknown. This study aims to correlate aortic arch geometry with exercise capacity in patients with successfully repaired CoA and explain hemodynamic changes using 3-dimensional-printed aorta models in a mock circulatory flow loop. METHODS A retrospective chart review identified patients with CoA repair who had cardiac magnetic resonance imaging and an exercise stress test. Measurements included aorta diameters, arch height to diameter ratio, left ventricular function, and percent descending aorta (%DAo) flow. Each aorta was printed 3-dimensionally for the flow loop. Flow and pressure were measured at the ascending aorta (AAo) and DAo during simulated rest and exercise. Measurements were correlated with percent predicted peak oxygen consumption (VO2 max). RESULTS Fifteen patients (mean age 26.8 ± 8.6 years) had a VO2 max between 47% and 126% predicted (mean 92 ± 20%) with normal left ventricular function. DAo diameter and %DAo flow positively correlated with VO2 (P = .007 and P = .04, respectively). AAo to DAo diameter ratio (DAAo/DDAo) negatively correlated with VO2 (P < .001). From flow loop simulations, the ratio of %DAo flow in exercise to rest negatively correlated with VO2 (P = .02) and positively correlated with DAAo/DDAo (P < .01). CONCLUSIONS This study suggests aorta size mismatch (DAAo/DDAo) is a novel, clinically important measurement predicting exercise capacity in patients with successful CoA repair, likely due to increased resistance and altered flow distribution. Aorta size mismatch and %DAo flow are targets for further clinical evaluation in repaired CoA.
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Affiliation(s)
- Jason G Mandell
- Division of Cardiology, Children's National Hospital, Washington, DC.
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC
| | - Paige N Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC
| | - Justin Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC
| | - Vincent Cleveland
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC
| | - Seda Aslan
- Department of Mechanical Engineering, University of Maryland, College Park, Md
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, University of Chicago/Advocate Children's Hospital Chicago, Ill
| | - Axel Krieger
- Department of Mechanical Engineering, University of Maryland, College Park, Md
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC; Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC
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16
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Desai MH, Olivieri LJ, Ramakrishnan KV, Downing TE. Spontaneous rupture of a coronary artery fistula presenting with post-exertional syncope and haemopericardium. Interact Cardiovasc Thorac Surg 2020; 32:658-660. [PMID: 33367810 DOI: 10.1093/icvts/ivaa317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 11/14/2022] Open
Abstract
An 8-year-old with a known diagnosis of an asymptomatic coronary artery fistula (CAF) presented with exertional syncope and haemopericardium due to contained rupture of CAF. A transcatheter closure was attempted, but the fistula ruptured again prompting emergency surgical repair. Spontaneous rupture is a catastrophic complication of CAF and warrants a high index of suspicion, timely diagnosis and team management.
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Affiliation(s)
- Manan H Desai
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA.,Division of Pediatric Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Karthik V Ramakrishnan
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA.,Division of Pediatric Cardiothoracic Surgery, Children's National Hospital, Washington, DC, USA
| | - Tacy E Downing
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
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17
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Mokshagundam D, Olivieri LJ, McCarter R, Kim A, Sable CA, Spurney CF, Dham N. Cardiac changes in pediatric cancer survivors. J Investig Med 2020; 68:1364-1369. [PMID: 32868378 DOI: 10.1136/jim-2020-001373] [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] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/03/2022]
Abstract
Cardiac damage from chemotherapy is a known phenomenon leading to significant morbidity and mortality in the cancer surviving population, and identifying high-risk pediatric patients early is challenging. The purpose of this pilot study was to evaluate whether echo strain, cardiac MRI (CMR), and serum biomarkers are more sensitive methods for detecting cardiac toxicity than standard echo and to examine the relationship between biomarkers in patients without decreased systolic function as determined by standard echo. In this pilot study, we prospectively enrolled pediatric subjects after completion of anthracycline inclusive chemotherapy. Each subject underwent a post-treatment echocardiogram (standard with strain), serum biomarkers (N-terminal brain natriuretic peptide (NT-pro-BNP) and interleukin 1 receptor-like 1 protein (ST2)), and CMR (standard and extracellular volumes (ECVs)). We correlated the markers using Pearson correlation. We enrolled 30 subjects, 11F/19M, aged 8-21 years. Cumulative anthracycline dose (CAD) correlated with BNP (p=0.06), CMR ECV 4-chamber (p=0.05) and sagittal (p=0.01), and mitral valve E/A (p=0.02). BNP correlated with CMR ECV 4-chamber (p=0.001) and sagittal (p=0.001) and with echo average longitudinal strain (ALS) (p=0.05). This study demonstrated a significant correlation of CAD with BNP and CMR ECV. There was also a significant correlation of NT-pro-BNP with CMR ECV and ALS. Combining these parameters with standard echo has the potential to identify high-risk patients early. Further studies are needed for long-term follow-up and management in this vulnerable population.
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Affiliation(s)
| | - Laura J Olivieri
- Cardiology, Children's National Health System, Washington, DC, USA
| | - Robert McCarter
- Biostatistics and Study Methodology, Children's National Health System, Washington, DC, USA
| | - Aerang Kim
- Oncology, Children's National Health System, Washington, DC, USA
| | - Craig A Sable
- Cardiology, Children's National Health System, Washington, DC, USA
| | | | - Niti Dham
- Cardiology, Children's National Health System, Washington, DC, USA
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Olivieri LJ, Jiang J, Hamann K, Loke YH, Campbell-Washburn A, Xue H, McCarter R, Cross R. Normal right and left ventricular volumes prospectively obtained from cardiovascular magnetic resonance in awake, healthy, 0- 12 year old children. J Cardiovasc Magn Reson 2020; 22:11. [PMID: 32013998 PMCID: PMC6998283 DOI: 10.1186/s12968-020-0602-z] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/13/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Pediatric z scores are necessary to describe size and structure of the heart in growing children, however, development of an accurate z score calculator requires robust normal datasets, which are difficult to obtain with cardiovascular magnetic resonance (CMR) in children. Motion-corrected (MOCO) cines from re-binned, reconstructed real-time cine offer a free-breathing, rapid acquisition resulting in cines with high spatial and temporal resolution. In combination with child-friendly positioning and entertainment, MOCO cine technique allows for rapid cine volumetry in patients of all ages without sedation. Thus, our aim was to prospectively enroll normal infants and children birth-12 years for creation and validation of a z score calculator describing normal right ventricular (RV) and left ventricular (LV) size. METHODS With IRB approval and consent/assent, 149 normal children successfully underwent a brief noncontrast CMR on a 1.5 T scanner including MOCO cines in the short axis, and RV and LV volumes were measured. 20% of scans were re-measured for interobserver variability analyses. A general linear modeling (GLM) framework was employed to identify and properly represent the relationship between CMR-based assessments and anthropometric data. Scatter plots of model fit and Akaike's information criteria (AIC) results were used to guide the choice among alternative models. RESULTS A total of 149 subjects aged 22 days-12 years (average 5.1 ± 3.6 years), with body surface area (BSA) range 0.21-1.63 m2 (average 0.8 ± 0.35 m2) were scanned. All ICC values were > 95%, reflecting excellent agreement between raters. The model that provided the best fit of volume measure to the data included BSA with higher order effects and gender as independent variables. Compared with earlier z score models, there is important additional growth inflection in early toddlerhood with similar z score prediction in later childhood. CONCLUSIONS Free-breathing, MOCO cines allow for accurate, reliable RV and LV volumetry in a wide range of infants and children while awake. Equations predicting fit between LV and RV normal values and BSA are reported herein for purposes of creating z scores. TRIAL REGISTRATION clinicaltrials.gov NCT02892136, Registered 7/21/2016.
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Affiliation(s)
- Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Jiji Jiang
- Children's Research Institute, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, USA
| | - Karin Hamann
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | | | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert McCarter
- Children's Research Institute, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, USA
| | - Russell Cross
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
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Loke YH, Capuano F, Mandell J, Cross RR, Cronin I, Mass P, Balaras E, Olivieri LJ. Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2019; 10:572-581. [PMID: 31496415 DOI: 10.1177/2150135119861358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. METHODS Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature (Rc), and normalized weighted radius of curvature (Rc-w). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. RESULTS Conventional measurements of proximal PA size correlated with differential pulmonary blood flow (r = 0.49, P = .001), but not with RV peak systolic pressures (r = -0.26, P = .18). In ASO patients, Rc-w correlated with higher RV systolic pressures (r = -0.57, P = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery Rc (r = -0.48, P = .001; r = 0.41, P = .01, respectively). Finally, both pulmonary arteries had significantly smaller Rc compared to normal controls. CONCLUSIONS Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Francesco Capuano
- Department of Industrial Engineering, Universita di Napoli Federico II, Naples, Italy
| | - Jason Mandell
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Russell R Cross
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Ileen Cronin
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Paige Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA.,Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
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Grant EK, Kanter JP, Olivieri LJ, Cross RR, Campbell-Washburn A, Faranesh AZ, Cronin I, Hamann KS, O’Byrne ML, Slack MC, Lederman RJ, Ratnayaka K. X-ray fused with MRI guidance of pre-selected transcatheter congenital heart disease interventions. Catheter Cardiovasc Interv 2019; 94:399-408. [PMID: 31062506 PMCID: PMC6823111 DOI: 10.1002/ccd.28324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/06/2018] [Revised: 03/15/2019] [Accepted: 04/14/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine whether X-ray fused with MRI (XFM) is beneficial for select transcatheter congenital heart disease interventions. BACKGROUND Complex transcatheter interventions often require three-dimensional (3D) soft tissue imaging guidance. Fusion imaging with live X-ray fluoroscopy can potentially improve and simplify procedures. METHODS Patients referred for select congenital heart disease interventions were prospectively enrolled. Cardiac MRI data was overlaid on live fluoroscopy for procedural guidance. Likert scale operator assessments of value were recorded. Fluoroscopy time, radiation exposure, contrast dose, and procedure time were compared to matched cases from our institutional experience. RESULTS Forty-six patients were enrolled. Pre-catheterization, same day cardiac MRI findings indicated intervention should be deferred in nine patients. XFM-guided cardiac catheterization was performed in 37 (median age 8.7 years [0.5-63 years]; median weight 28 kg [5.6-110 kg]) with the following prespecified indications: pulmonary artery (PA) stenosis (n = 13), aortic coarctation (n = 12), conduit stenosis/insufficiency (n = 9), and ventricular septal defect (n = 3). Diagnostic catheterization showed intervention was not indicated in 12 additional cases. XFM-guided intervention was performed in the remaining 25. Fluoroscopy time was shorter for XFM-guided intervention cases compared to matched controls. There was no significant difference in radiation dose area product, contrast volume, or procedure time. Operator Likert scores indicated XFM provided useful soft tissue guidance in all cases and was never misleading. CONCLUSIONS XFM provides operators with meaningful three-dimensional soft tissue data and reduces fluoroscopy time in select congenital heart disease interventions.
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Affiliation(s)
- Elena K. Grant
- Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia
- Division of Intramural Research, Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joshua P. Kanter
- Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia
| | - Laura J. Olivieri
- Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia
| | - Russell R. Cross
- Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia
| | - Adrienne Campbell-Washburn
- Division of Intramural Research, Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Anthony Z. Faranesh
- Division of Intramural Research, Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ileen Cronin
- Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia
| | - Karin S. Hamann
- Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia
| | - Michael L. O’Byrne
- Divison of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael C. Slack
- Children’s Heart Program, University of Maryland Children’s Heart Program, Baltimore, Maryland
| | - Robert J. Lederman
- Division of Intramural Research, Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kanishka Ratnayaka
- Division of Intramural Research, Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
- Department of Cardiology, Rady Children’s Hospital, San Diego, California
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Capuano F, Loke YH, Cronin I, Olivieri LJ, Balaras E. Computational Study of Pulmonary Flow Patterns After Repair of Transposition of Great Arteries. J Biomech Eng 2019; 141:2727821. [DOI: 10.1115/1.4043034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Indexed: 11/08/2022]
Abstract
Patients that undergo the arterial switch operation (ASO) to repair transposition of great arteries (TGA) can develop abnormal pulmonary trunk morphology with significant long-term complications. In this study, cardiovascular magnetic resonance was combined with computational fluid dynamics to investigate the impact of the postoperative layout on the pulmonary flow patterns. Three ASO patients were analyzed and compared to a volunteer control. Results showed the presence of anomalous shear layer instabilities, vortical and helical structures, and turbulent-like states in all patients, particularly as a consequence of the unnatural curvature of the pulmonary bifurcation. Streamlined, mostly laminar flow was instead found in the healthy subject. These findings shed light on the correlation between the post-ASO anatomy and the presence of altered flow features, and may be useful to improve surgical planning as well as the long-term care of TGA patients.
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Affiliation(s)
- Francesco Capuano
- Department of Industrial Engineering, Università di Napoli Federico II, Napoli 80125, Italy e-mail:
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Health System, Washington, DC 20010 e-mail:
| | - Ileen Cronin
- Division of Cardiology, Children's National Health System, Washington, DC 20010 e-mail:
| | - Laura J. Olivieri
- Division of Cardiology, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC 20010 e-mail:
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC 20052 e-mail:
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Deutsch N, Swink J, Matisoff AJ, Olivieri LJ, Cross RR, Waberski AT, Unegbu C, Cronin IF, Kanter JP, Schwartz JM. Anesthetic considerations for magnetic resonance imaging-guided right-heart catheterization in pediatric patients: A single institution experience. Paediatr Anaesth 2019; 29:8-15. [PMID: 30375141 PMCID: PMC8074513 DOI: 10.1111/pan.13512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/31/2018] [Accepted: 09/17/2018] [Indexed: 12/22/2022]
Abstract
Cardiac catheterization is an integral part of medical management for pediatric patients with congenital heart disease. Owing to age and lack of cooperation in children who need this procedure, general anesthesia is typically required. These patients have increased anesthesia risk secondary to cardiac pathology. Furthermore, multiple catheterization procedures result in exposure to harmful ionizing radiation. Magnetic resonance imaging-guided right-heart catheterization offers decreased radiation exposure and diagnostic imaging benefits over traditional fluoroscopy but potentially increases anesthetic complexity and risk. We describe our early experience with anesthetic techniques and challenges for pediatric magnetic resonance imaging-guided right-heart catheterization.
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Affiliation(s)
- Nina Deutsch
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children’s National Medical Center, Washington, DC
| | - Jonathan Swink
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children’s National Medical Center, Washington, DC
| | - Andrew J Matisoff
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children’s National Medical Center, Washington, DC
| | - Laura J Olivieri
- Division of Cardiology, Children’s National Medical Center, Washington, DC
| | - Russell R Cross
- Division of Cardiology, Children’s National Medical Center, Washington, DC
| | - Andrew T Waberski
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children’s National Medical Center, Washington, DC
| | - Chinwe Unegbu
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children’s National Medical Center, Washington, DC
| | - Ileen F Cronin
- Division of Cardiology, Children’s National Medical Center, Washington, DC
| | - Joshua P Kanter
- Division of Cardiology, Children’s National Medical Center, Washington, DC
| | - Jamie M Schwartz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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Olivieri LJ, Zurakowski D, Ramakrishnan K, Su L, Alfares FA, Irwin MR, Heichel J, Krieger A, Nath DS. Novel, 3D Display of Heart Models in the Postoperative Care Setting Improves CICU Caregiver Confidence. World J Pediatr Congenit Heart Surg 2018; 9:206-213. [PMID: 29544410 DOI: 10.1177/2150135117745005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative care delivered in the pediatric cardiac intensive care unit (CICU) relies on providers' understanding of patients' congenital heart defects (CHDs) and procedure performed. Novel, bedside use of virtual, three-dimensional (3D) heart models creates access to patients' CHD to improve understanding. This study evaluates the impact of patient-specific virtual 3D heart models on CICU provider attitudes and care delivery. METHODS Virtual 3D heart models were created from standard preoperative cardiac imaging of ten patients with CHD undergoing repair and displayed on a bedside tablet in the CICU. Providers completed a Likert questionnaire evaluating the models' value in understanding anatomy and improving care delivery. Responses were compared using two-tailed t test and Mann-Whitney U test and were also compared to previously collected CICU provider responses regarding use of printed 3D heart models. RESULTS Fifty-three clinicians (19 physicians, 34 nurses/trainees) participated; 49 (92%) of 53 and 44 (83%) of 53 reported at least moderate to high satisfaction with the virtual 3D heart's ability to enhance understanding of anatomy and surgical repair, respectively. Seventy-one percent of participants felt strongly that virtual 3D models improved their ability to manage postoperative problems. The majority of both groups (63% physicians, 53% nurses) felt that virtual 3D heart models improved CICU handoffs. Virtual 3D heart models were as effective as printed models in improving understanding and care delivery, with a noted provider preference for printed 3D heart models. CONCLUSIONS Virtual 3D heart models depicting patient-specific CHDs are perceived to improve understanding and postoperative care delivery in the CICU.
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Affiliation(s)
- Laura J Olivieri
- 1 Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - David Zurakowski
- 2 Department of Anesthesia, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA.,3 Department of Surgery, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA
| | - Karthik Ramakrishnan
- 1 Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Lillian Su
- 4 Division of Critical Care, Children's National Medical Center, Washington, DC, USA
| | - Fahad A Alfares
- 1 Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | | | - Jenna Heichel
- 4 Division of Critical Care, Children's National Medical Center, Washington, DC, USA
| | - Axel Krieger
- 6 Department of Bioengineering, Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC, USA.,7 Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Dilip S Nath
- 8 Division of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA
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Loke YH, Sinha L, Olivieri LJ, Jonas RA, Cross RR, Schidlow DN. One Truncal Valve or Two Semilunar Valves: An Unusual Case of Truncus Arteriosus. ACTA ACUST UNITED AC 2018; 2:27-30. [PMID: 30062302 PMCID: PMC6058763 DOI: 10.1016/j.case.2017.09.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Truncus arteriosus is generally considered a failure of septation in the ventricular outflow tracts, the semilunar valves, and the aorta and pulmonary arteries. This case involved the unusual finding of a partially septated truncal valve. This case highlights the embryologic aberrations resulting in this disease.
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Affiliation(s)
- Yue-Hin Loke
- Children's National Heart Institute, Children's National Health System, Washington, District of Columbia
| | - Lok Sinha
- Children's National Heart Institute, Children's National Health System, Washington, District of Columbia
| | - Laura J Olivieri
- Children's National Heart Institute, Children's National Health System, Washington, District of Columbia
| | - Richard A Jonas
- Children's National Heart Institute, Children's National Health System, Washington, District of Columbia
| | - Russell R Cross
- Children's National Heart Institute, Children's National Health System, Washington, District of Columbia
| | - David N Schidlow
- Children's National Heart Institute, Children's National Health System, Washington, District of Columbia
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25
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Ratnayaka K, Kanter JP, Faranesh AZ, Grant EK, Olivieri LJ, Cross RR, Cronin IF, Hamann KS, Campbell-Washburn AE, O’Brien KJ, Rogers T, Hansen MS, Lederman RJ. Radiation-free CMR diagnostic heart catheterization in children. J Cardiovasc Magn Reson 2017; 19:65. [PMID: 28874164 PMCID: PMC5585983 DOI: 10.1186/s12968-017-0374-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Children with heart disease may require repeated X-Ray cardiac catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right heart catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety. METHODS We performed 50 CMR fluoroscopy guided comprehensive transfemoral right heart catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac catheterization. CMR guided catheterizations were assessed by completion (success/failure), procedure time, and safety events (catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected. RESULTS During a twenty-two month period (3/2015 - 12/2016), enrolled subjects had the following clinical indications: post-heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular heart disease 3%, and other 3%. Radiation-free CMR guided right heart catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left heart catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy heart catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested. CONCLUSIONS Comprehensive CMR fluoroscopy guided right heart catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left heart) cardiac catheterization and future CMR guided cardiac intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT02739087 registered February 17, 2016.
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Affiliation(s)
- Kanishka Ratnayaka
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
- Division of Cardiology, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA 92123 USA
| | - Joshua P. Kanter
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Anthony Z. Faranesh
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
| | - Elena K. Grant
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Laura J. Olivieri
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Russell R. Cross
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Ileen F. Cronin
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Karin S. Hamann
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Adrienne E. Campbell-Washburn
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
| | - Kendall J. O’Brien
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
| | - Michael S. Hansen
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
| | - Robert J. Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538 USA
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Grant EK, Berul CI, Cross RR, Moak JP, Hamann KS, Sumihara K, Cronin I, O'Brien KJ, Ratnayaka K, Hansen MS, Kellman P, Olivieri LJ. Acute Cardiac MRI Assessment of Radiofrequency Ablation Lesions for Pediatric Ventricular Arrhythmia: Feasibility and Clinical Correlation. J Cardiovasc Electrophysiol 2017; 28:517-522. [PMID: 28245348 DOI: 10.1111/jce.13197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/28/2016] [Accepted: 01/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arrhythmia ablation with current techniques is not universally successful. Inadequate ablation lesion formation may be responsible for some arrhythmia recurrences. Periprocedural visualization of ablation lesions may identify inadequate lesions and gaps to guide further ablation and reduce risk of arrhythmia recurrence. METHODS This feasibility study assessed acute postprocedure ablation lesions by MRI, and correlated these findings with clinical outcomes. Ten pediatric patients who underwent ventricular tachycardia ablation were transferred immediately postablation to a 1.5T MRI scanner and late gadolinium enhancement (LGE) imaging was performed to characterize ablation lesions. Immediate and mid-term arrhythmia recurrences were assessed. RESULTS Patient characteristics include median age 14 years (1-18 years), median weight 52 kg (11-81 kg), normal cardiac anatomy (n = 6), d-transposition of great arteries post arterial switch repair (n = 2), anomalous coronary artery origin post repair (n = 1), and cardiac rhabdomyoma (n = 1). All patients underwent radiofrequency catheter ablation of ventricular arrhythmia with acute procedural success. LGE was identified at the reported ablation site in 9/10 patients, all arrhythmia-free at median 7 months follow-up. LGE was not visible in 1 patient who had recurrence of frequent premature ventricular contractions within 2 hours, confirmed on Holter at 1 and 21 months post procedure. CONCLUSIONS Ventricular ablation lesion visibility by MRI in the acute post procedure setting is feasible. Lesions identifiable with MRI may correlate with clinical outcomes. Acute MRI identification of gaps or inadequate lesions may provide the unique temporal opportunity for additional ablation therapy to decrease arrhythmia recurrence.
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Affiliation(s)
- Elena K Grant
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA.,Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles I Berul
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Russell R Cross
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Jeffrey P Moak
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Karin S Hamann
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Kohei Sumihara
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Ileen Cronin
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Kendall J O'Brien
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Kanishka Ratnayaka
- Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.,Department of Cardiology, Rady Children's Hospital, San Diego, California, USA
| | - Michael S Hansen
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA.,Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter Kellman
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA.,Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laura J Olivieri
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
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Morparia KG, Reddy SK, Olivieri LJ, Spaeder MC, Schuette JJ. Respiratory variation in peak aortic velocity accurately predicts fluid responsiveness in children undergoing neurosurgery under general anesthesia. J Clin Monit Comput 2017; 32:221-226. [PMID: 28299589 DOI: 10.1007/s10877-017-0013-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/07/2017] [Indexed: 01/25/2023]
Abstract
The determination of fluid responsiveness in the critically ill child is of vital importance, more so as fluid overload becomes increasingly associated with worse outcomes. Dynamic markers of volume responsiveness have shown some promise in the pediatric population, but more research is needed before they can be adopted for widespread use. Our aim was to investigate effectiveness of respiratory variation in peak aortic velocity and pulse pressure variation to predict fluid responsiveness, and determine their optimal cutoff values. We performed a prospective, observational study at a single tertiary care pediatric center. Twenty-one children with normal cardiorespiratory status undergoing general anesthesia for neurosurgery were enrolled. Respiratory variation in peak aortic velocity (ΔVpeak ao) was measured both before and after volume expansion using a bedside ultrasound device. Pulse pressure variation (PPV) value was obtained from the bedside monitor. All patients received a 10 ml/kg fluid bolus as volume expansion, and were qualified as responders if stroke volume increased >15% as a result. Utility of ΔVpeak ao and PPV and to predict responsiveness to volume expansion was investigated. A baseline ΔVpeak ao value of greater than or equal to 12.3% best predicted a positive response to volume expansion, with a sensitivity of 77%, specificity of 89% and area under receiver operating characteristic curve of 0.90. PPV failed to demonstrate utility in this patient population. Respiratory variation in peak aortic velocity is a promising marker for optimization of perioperative fluid therapy in the pediatric population and can be accurately measured using bedside ultrasonography. More research is needed to evaluate the lack of effectiveness of pulse pressure variation for this purpose.
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Affiliation(s)
- Kavita G Morparia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of New Jersey, Newark Beth Israel Medical Center, 201 Lyons Avneue, Newark, NJ, USA.
| | - Srijaya K Reddy
- Division of Anesthesiology, Children's National Medical Center, George Washington University, NW, Washington, DC, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, George Washington University, 111 Michigan Avenue NW, Washington, DC, USA
| | - Michael C Spaeder
- Division of Pediatric Critical Care Medicine, UVA Children's Hospital, University of Virginia, Charlottesville, VA, USA
| | - Jennifer J Schuette
- Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Loke YH, Harahsheh AS, Krieger A, Olivieri LJ. Usage of 3D models of tetralogy of Fallot for medical education: impact on learning congenital heart disease. BMC Med Educ 2017; 17:54. [PMID: 28284205 PMCID: PMC5346255 DOI: 10.1186/s12909-017-0889-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/20/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common human birth defect, and clinicians need to understand the anatomy to effectively care for patients with CHD. However, standard two-dimensional (2D) display methods do not adequately carry the critical spatial information to reflect CHD anatomy. Three-dimensional (3D) models may be useful in improving the understanding of CHD, without requiring a mastery of cardiac imaging. The study aimed to evaluate the impact of 3D models on how pediatric residents understand and learn about tetralogy of Fallot following a teaching session. METHODS Pediatric residents rotating through an inpatient Cardiology rotation were recruited. The sessions were randomized into using either conventional 2D drawings of tetralogy of Fallot or physical 3D models printed from 3D cardiac imaging data sets (cardiac MR, CT, and 3D echocardiogram). Knowledge acquisition was measured by comparing pre-session and post-session knowledge test scores. Learner satisfaction and self-efficacy ratings were measured with questionnaires filled out by the residents after the teaching sessions. Comparisons between the test scores, learner satisfaction and self-efficacy questionnaires for the two groups were assessed with paired t-test. RESULTS Thirty-five pediatric residents enrolled into the study, with no significant differences in background characteristics, including previous clinical exposure to tetralogy of Fallot. The 2D image group (n = 17) and 3D model group (n = 18) demonstrated similar knowledge acquisition in post-test scores. Residents who were taught with 3D models gave a higher composite learner satisfaction scores (P = 0.03). The 3D model group also had higher self-efficacy aggregate scores, but the difference was not statistically significant (P = 0.39). CONCLUSION Physical 3D models enhance resident education around the topic of tetralogy of Fallot by improving learner satisfaction. Future studies should examine the impact of models on teaching CHD that are more complex and elaborate.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Ashraf S. Harahsheh
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Axel Krieger
- Bioengineering Institute, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Laura J. Olivieri
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
- Bioengineering Institute, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
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Groves DW, Olivieri LJ, Shanbhag SM, Bronson KC, Yu JH, Nelson EA, Rollison SF, Stagliano MS, John AS, Kuehl K, Chen MY. Feasibility of low radiation dose retrospectively-gated cardiac CT for functional analysis in adult congenital heart disease. Int J Cardiol 2016; 228:180-183. [PMID: 27865183 PMCID: PMC6323633 DOI: 10.1016/j.ijcard.2016.11.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 08/11/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 11/28/2022]
Abstract
Background: The use of cardiac computed tomography (CT) in the evaluation of adult congenital heart disease patients is limited due to concerns of high radiation doses. The purpose of this study was to prospectively assess whether low radiation dose cardiac CT is feasible to evaluate ventricular systolic function in adults with congenital heart disease. Methods: The study group included 30 consecutive patients with significant congenital heart disease who underwent a total of 35 ECG-gated cardiac CT scans utilizing a 320-detector row CT scanner. Each study included a non-contrast scan and subsequent contrast-enhanced retrospectively-gated acquisition. Effective radiation dose was estimated by multiplying the dose length product by a k-factor of 0.014 mSv/mGy cm. Results: The mean age of the patients was 34.4 ± 8.9 years, 60% were men, and mean body mass index was 24.2 ± 4.3 kg/m2. A majority of patients (n = 28, 93.3%) had contraindications to cardiac MRI. A tube potential of 80 kV was used in 27 (77.1%) of the contrast-enhanced scans. The mean signal-to-noise and contrast-to-noise ratios were 11.5 ± 3.9 and 10.3 ± 3.7, respectively. The median radiation dose for non-contrast and contrast-enhanced images were 0.1 mSv (0.07–0.2 mSv) and 0.94 mSv (0.5–2.1 mSv), respectively. All 35 CT scans were successfully analyzed for ventricular systolic function. Conclusions: A low radiation contrast-enhanced, retrospectively-gated cardiac CT with a median radiation dose of less than 1 mSv was successful in evaluating ventricular systolic function in 30 consecutive adult congenital heart disease patients who underwent a total of 35 scans.
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Affiliation(s)
- Daniel W Groves
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura J Olivieri
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Sujata M Shanbhag
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathie C Bronson
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeannie H Yu
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Evan A Nelson
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shirley F Rollison
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael S Stagliano
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anitha S John
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Karen Kuehl
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Marcus Y Chen
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Kellman P, Xue H, Olivieri LJ, Cross RR, Grant EK, Fontana M, Ugander M, Moon JC, Hansen MS. Dark blood late enhancement imaging. J Cardiovasc Magn Reson 2016; 18:77. [PMID: 27817748 PMCID: PMC5098284 DOI: 10.1186/s12968-016-0297-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/18/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Bright blood late gadolinium enhancement (LGE) imaging typically achieves excellent contrast between infarcted and normal myocardium. However, the contrast between the myocardial infarction (MI) and the blood pool is frequently suboptimal. A large fraction of infarctions caused by coronary artery disease are sub-endocardial and thus adjacent to the blood pool. It is not infrequent that sub-endocardial MIs are difficult to detect or clearly delineate. METHODS In this present work, an inversion recovery (IR) T2 preparation was combined with single shot steady state free precession imaging and respiratory motion corrected averaging to achieve dark blood LGE images with good signal to noise ratio while maintaining the desired spatial and temporal resolution. In this manner, imaging was conducted free-breathing, which has benefits for image quality, patient comfort, and clinical workflow in both adults and children. Furthermore, by using a phase sensitive inversion recovery reconstruction the blood signal may be made darker than the myocardium (i.e., negative signal values) thereby providing contrast between the blood and both the MI and remote myocardium. In the proposed approach, a single T1-map scout was used to measure the myocardial and blood T1 using a MOdified Look-Locker Inversion recovery (MOLLI) protocol and all protocol parameters were automatically calculated from these values within the sequence thereby simplifying the user interface. RESULTS The contrast to noise ratio (CNR) between MI and remote myocardium was measured in n = 30 subjects with subendocardial MI using both bright blood and dark blood protocols. The CNR for the dark blood protocol had a 13 % loss compared to the bright blood protocol. The CNR between the MI and blood pool was positive for all dark blood cases, and was negative in 63 % of the bright blood cases. The conspicuity of subendocardial fibrosis and MI was greatly improved by dark blood (DB) PSIR as well as the delineation of the subendocardial border. CONCLUSIONS Free-breathing, dark blood PSIR LGE imaging was demonstrated to improve the visualization of subendocardial MI and fibrosis in cases with low contrast with adjacent blood pool. The proposed method also improves visualization of thin walled fibrous structures such as atrial walls and valves, as well as papillary muscles.
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Affiliation(s)
- Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
| | - Laura J. Olivieri
- Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010 USA
| | - Russell R. Cross
- Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010 USA
| | - Elena K. Grant
- Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010 USA
| | - Marianna Fontana
- National Amyloidosis Centre, University College London (UCL) Medical School, Royal Free Hospital, London, UK
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - James C. Moon
- Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
| | - Michael S. Hansen
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
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Olivieri LJ, Su L, Hynes CF, Krieger A, Alfares FA, Ramakrishnan K, Zurakowski D, Marshall MB, Kim PCW, Jonas RA, Nath DS. "Just-In-Time" Simulation Training Using 3-D Printed Cardiac Models After Congenital Cardiac Surgery. World J Pediatr Congenit Heart Surg 2016; 7:164-8. [PMID: 26957398 DOI: 10.1177/2150135115623961] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High-fidelity simulation using patient-specific three-dimensional (3D) models may be effective in facilitating pediatric cardiac intensive care unit (PCICU) provider training for clinical management of congenital cardiac surgery patients. METHODS The 3D-printed heart models were rendered from preoperative cross-sectional cardiac imaging for 10 patients undergoing congenital cardiac surgery. Immediately following surgical repair, a congenital cardiac surgeon and an intensive care physician conducted a simulation training session regarding postoperative care utilizing the patient-specific 3D model for the PCICU team. After the simulation, Likert-type 0 to 10 scale questionnaire assessed participant perception of impact of the training session. RESULTS Seventy clinicians participated in training sessions, including 22 physicians, 38 nurses, and 10 ancillary care providers. Average response to whether 3D models were more helpful than standard hand off was 8.4 of 10. Questions regarding enhancement of understanding and clinical ability received average responses of 9.0 or greater, and 90% of participants scored 8 of 10 or higher. Nurses scored significantly higher than other clinicians on self-reported familiarity with the surgery (7.1 vs. 5.8; P = .04), clinical management ability (8.6 vs. 7.7; P = .02), and ability enhancement (9.5 vs. 8.7; P = .02). Compared to physicians, nurses and ancillary providers were more likely to consider 3D models more helpful than standard hand off (8.7 vs. 7.7; P = .05). Higher case complexity predicted greater enhancement of understanding of surgery (P = .04). CONCLUSION The 3D heart models can be used to enhance congenital cardiac critical care via simulation training of multidisciplinary intensive care teams. Benefit may be dependent on provider type and case complexity.
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Affiliation(s)
- Laura J Olivieri
- Department of Cardiology, Children's National Health System, Washington, DC, USA
| | - Lillian Su
- Department of Critical Care Medicine and Board of Visitors Simulation Program, Children's National Health System, Washington, DC, USA
| | - Conor F Hynes
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
| | - Axel Krieger
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Fahad A Alfares
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
| | - Karthik Ramakrishnan
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
| | - David Zurakowski
- Department of Anesthesia and Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - M Blair Marshall
- Department of Thoracic Surgery, Georgetown University Hospital, Washington, DC, USA
| | - Peter C W Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Richard A Jonas
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
| | - Dilip S Nath
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
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Olivieri LJ, Kellman P, McCarter RJ, Cross RR, Hansen MS, Spurney CF. Native T1 values identify myocardial changes and stratify disease severity in patients with Duchenne muscular dystrophy. J Cardiovasc Magn Reson 2016; 18:72. [PMID: 27788681 PMCID: PMC5084339 DOI: 10.1186/s12968-016-0292-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/05/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is an X-linked, inherited disorder causing dilated cardiomyopathy with variable onset and progression. Currently we lack objective markers of the effect of therapies targeted towards preventing progression of subclinical cardiac disease. Thus, our aim was to compare the ability of native T1 and extracellular volume (ECV) measurements to differentiate risk of myocardial disease in DMD and controls. METHODS Twenty boys with DMD and 16 age/gender-matched controls without history predisposing to cardiac fibrosis, but with a clinical indication for cardiovascular magnetic resonance (CMR) evaluation, underwent CMR with contrast. Data points collected include left ventricular ejection fraction (LVEF), left ventricular mass, and presence of late gadolinium enhancement (LGE). Native T1, and ECV regional mapping were obtained using both a modified Look-Locker (MOLLI) and saturation recovery single shot sequence (SASHA) on a 1.5T scanner. Using ordinal logistic regression models, controlling for age and LVEF, LGE-free septal we evaluated the ability native T1 and ECV assessments to differentiate levels of cardiomyopathy. RESULTS Twenty DMD subjects aged 14.4 ± 4 years had an LVEF of 56.3 ± 7.4 %; 12/20 had LGE, all confined to the lateral wall. Sixteen controls aged 16.1 ± 2.2 years had an LVEF 60.4 ± 5.1 % and no LGE. Native T1 and ECV values were significantly higher in the DMD group (p < 0.05) with both MOLLI and SASHA imaging techniques. Native T1 demonstrated a 50 % increase in the ability to predict disease state (control, DMD without fibrosis, DMD with fibrosis). ECV demonstrated only the ability to predict presence of LGE, but could not distinguish between controls and DMD without fibrosis. CONCLUSIONS LGE-spared regions of boys with DMD have significantly different native T1 and ECV values compared to controls. Native T1 measurements can identify early changes in DMD patients without the presence of LGE and help predict disease severity more effectively than ECV. Native T1 may be a novel outcome measure for early cardiac therapies in DMD and other cardiomyopathies.
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Affiliation(s)
- Laura J. Olivieri
- Division of Cardiology, Children’s National Health System, 111 Michigan Avenue NW, W3-200, Washington, DC 20010 USA
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892 USA
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892 USA
| | - Robert J. McCarter
- Children’s National Health System, Clinical and Translational Science Institute, 111 Michigan Ave NW, Washington, DC 20010 USA
| | - Russell R. Cross
- Division of Cardiology, Children’s National Health System, 111 Michigan Avenue NW, W3-200, Washington, DC 20010 USA
| | - Michael S. Hansen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892 USA
| | - Christopher F. Spurney
- Division of Cardiology, Children’s National Health System, 111 Michigan Avenue NW, W3-200, Washington, DC 20010 USA
- Children’s National Health System, Center for Genetic Medicine Research, 111 Michigan Ave NW, Washington, DC 20010 USA
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Grant EK, Faranesh AZ, Cross RR, Olivieri LJ, Hamann KS, O'Brien KJ, Hansen MS, Donofrio MT, Lederman RJ, Ratnayaka K, Slack MC. Image Fusion Guided Device Closure of Left Ventricle to Right Atrium Shunt. Circulation 2016; 132:1366-7. [PMID: 26438770 DOI: 10.1161/circulationaha.115.013724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Affiliation(s)
- Elena K Grant
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.).
| | - Anthony Z Faranesh
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Russell R Cross
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Laura J Olivieri
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Karin S Hamann
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Kendall J O'Brien
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Michael S Hansen
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Mary T Donofrio
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Robert J Lederman
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Kanishka Ratnayaka
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
| | - Michael C Slack
- From Department of Cardiology, Children's National Medical Center, Washington, DC (E.K.G., A.Z.F., R.R.C., L.J.O., K.S.H., K.J.O., M.S.H., M.T.D., R.J.L., K.R.); Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (E.K.G., A.Z.F., M.S.H., R.J.L., K.R.); and University of Maryland Children's Heart Program, Baltimore, MD (M.C.S.)
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He D, Olivieri LJ, Jonas RA, Sinha P. Palliation of Truncus Arteriosus Associated With Complete Atrioventricular Canal--Results of Single Ventricle Palliation. World J Pediatr Congenit Heart Surg 2015; 6:663-6. [PMID: 26467884 DOI: 10.1177/2150135115578180] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Truncus arteriosus associated with complete atrioventricular canal defect is rare and continues to be a surgical challenge with high morbidity and mortality. In the absence of extension of the ventricular septal defect to the outlet septum, biventricular repair is precluded, and single ventricle palliation remains the only option. We present our experience with five patients with truncus arteriosus and complete atrioventricular canal defect who underwent single ventricular palliation. METHODS Five patients with truncus arteriosus and complete atrioventricular canal defect managed along the single ventricle palliation pathway were retrospectively reviewed. Demographic, echocardiographic, cardiac catheterization, and perioperative data were analyzed. RESULTS All patients underwent neonatal palliation tailored to their anatomy (excision of pulmonary arteries from the common trunk and systemic to pulmonary artery shunt in two patients, excision of pulmonary artery and right ventricle to pulmonary artery conduit in two patients, and bilateral branch pulmonary artery bands in one patient). There were two early deaths after neonatal palliation. At a median follow-up of 210 days (interquartile range 1,210 days), all three survivors have undergone second-stage palliation. Of these patients, one is interstage II to III, and two patients have completed their Fontan procedure and are doing well. CONCLUSION Truncus arteriosus with complete atrioventricular canal defect is a rare combination of defects. Single ventricle palliation pathway with a tailored neonatal approach may be employed for patients with uncommitted ventricular septal defects.
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Affiliation(s)
- Dingchao He
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC, WA, USA
| | - Laura J Olivieri
- Department of Cardiology, Children's National Health System, Washington, DC, WA, USA
| | - Richard A Jonas
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC, WA, USA
| | - Pranava Sinha
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC, WA, USA
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Olivieri LJ, Cross RR, O'Brien KE, Ratnayaka K, Hansen MS. Optimized protocols for cardiac magnetic resonance imaging in patients with thoracic metallic implants. Pediatr Radiol 2015; 45:1455-64. [PMID: 26040508 PMCID: PMC7610221 DOI: 10.1007/s00247-015-3366-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/31/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (MR) imaging is a valuable tool in congenital heart disease; however patients frequently have metal devices in the chest from the treatment of their disease that complicate imaging. Methods are needed to improve imaging around metal implants near the heart. Basic sequence parameter manipulations have the potential to minimize artifact while limiting effects on image resolution and quality. OBJECTIVE Our objective was to design cine and static cardiac imaging sequences to minimize metal artifact while maintaining image quality. MATERIALS AND METHODS Using systematic variation of standard imaging parameters on a fluid-filled phantom containing commonly used metal cardiac devices, we developed optimized sequences for steady-state free precession (SSFP), gradient recalled echo (GRE) cine imaging, and turbo spin-echo (TSE) black-blood imaging. We imaged 17 consecutive patients undergoing routine cardiac MR with 25 metal implants of various origins using both standard and optimized imaging protocols for a given slice position. We rated images for quality and metal artifact size by measuring metal artifact in two orthogonal planes within the image. RESULTS All metal artifacts were reduced with optimized imaging. The average metal artifact reduction for the optimized SSFP cine was 1.5+/-1.8 mm, and for the optimized GRE cine the reduction was 4.6+/-4.5 mm (P < 0.05). Quality ratings favored the optimized GRE cine. Similarly, the average metal artifact reduction for the optimized TSE images was 1.6+/-1.7 mm (P < 0.05), and quality ratings favored the optimized TSE imaging. CONCLUSION Imaging sequences tailored to minimize metal artifact are easily created by modifying basic sequence parameters, and images are superior to standard imaging sequences in both quality and artifact size. Specifically, for optimized cine imaging a GRE sequence should be used with settings that favor short echo time, i.e. flow compensation off, weak asymmetrical echo and a relatively high receiver bandwidth. For static black-blood imaging, a TSE sequence should be used with fat saturation turned off and high receiver bandwidth.
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Affiliation(s)
- Laura J Olivieri
- Division of Cardiology, Children's National Health System, W3-200, 111 Michigan Ave. NW, Washington, DC, 20010, USA,
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Costello JP, Olivieri LJ, Su L, Krieger A, Alfares F, Thabit O, Marshall MB, Yoo SJ, Kim PC, Jonas RA, Nath DS. Incorporating three-dimensional printing into a simulation-based congenital heart disease and critical care training curriculum for resident physicians. CONGENIT HEART DIS 2014; 10:185-90. [PMID: 25385353 DOI: 10.1111/chd.12238] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [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] [Accepted: 10/14/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Although simulation-based education is now commonly utilized in medicine, its use in the instruction of congenital heart disease remains limited. The objective of this study is to evaluate whether heart models created with three-dimensional printing technology can be effectively incorporated into a simulation-based congenital heart disease and critical care training curriculum for pediatric resident physicians. DESIGN Utilizing heart models created with a three-dimensional printer, pediatric residents participated in a 60-minute simulation seminar with three consecutive components: (1) didactic instruction on ventricular septal defect anatomy; (2) didactic/simulation-based instruction on echocardiographic imaging of ventricular septal defects and anatomical teaching/operative simulation of ventricular septal defect repair; (3) simulation-based instruction on postoperative critical care management of ventricular septal defects. SETTING Academic, free-standing, children's hospital with quaternary care referrals. PARTICIPANTS Twenty-three pediatric resident physicians. OUTCOME MEASURES Subjective, Likert-type questionnaires assessing knowledge acquisition, knowledge reporting, and structural conceptualization of ventricular septal defects. RESULTS Three-dimensional printing technology was successfully utilized to create heart models of five common ventricular septal defect subtypes. After using these models in a simulation-based curriculum, pediatric residents were found to have improvement in the areas of knowledge acquisition (P = .0082), knowledge reporting (P = .01), and structural conceptualization (P < .0001) of ventricular septal defects, as well as improvement in the ability to describe and manage postoperative complications in ventricular septal defect patients in the critical care setting. CONCLUSIONS The utilization of three-dimensional printing in a simulation-based congenital heart disease and critical care training curriculum is feasible and improves pediatric resident physicians' understanding of a common congenital heart abnormality.
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Affiliation(s)
- John P Costello
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA; The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
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Hansen MS, Olivieri LJ, O’Brien K, Cross RR, Inati SJ, Kellman P. Method for calculating confidence intervals for phase contrast flow measurements. J Cardiovasc Magn Reson 2014; 16:46. [PMID: 24962371 PMCID: PMC4079643 DOI: 10.1186/1532-429x-16-46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/13/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Phase contrast (PC) measurements play an important role in several cardiovascular magnetic resonance (CMR) protocols but considerable variation is observed in such measurements. Part of this variation stems from the propagation of thermal noise from the measurement data through the image reconstruction to the region of interest analysis used in flow measurement, which limits the precision. The purpose of this study was to develop a method for direct estimation of the variation caused by thermal noise and to validate this method in phantom and in vivo data. METHODS The estimation of confidence intervals in flow measurements is complicated by noise correlation among the image pixels and cardiac phases. This correlation is caused by sequence and reconstruction parameters. A method for the calculation of the standard deviation of region of interest measurements was adapted and expanded to accommodate typical clinical PC measurements and the region-of-interest analysis used for such measurements. This included the dependency between cardiac phases that arises due to retrospective cardiac gating used in such studies. The proposed method enables calculation of standard deviations of flow measurements without the need for repeated experiments or repeated reconstructions. The method was compared to repeated trials in phantom measurements and pseudo replica reconstructions of in vivo data. Three different flow protocols (free breathing and breath hold with various accelerations) were compared in terms of the confidence interval ranges caused by thermal noise in the measurement data. RESULTS Using the proposed method it was possible to accurately predict confidence intervals for flow measurements. The method was in good agreement with repeated measurements in phantom experiments and there was also good agreement with confidence intervals predicted by pseudo replica reconstructions in both phantom and in vivo data. The proposed method was used to demonstrate that the variation in cardiac output caused by thermal noise is on the order of 1% in clinically used free breathing protocols, and on the order of 3-5% in breath-hold protocols with higher parallel imaging factors. CONCLUSIONS It is possible to calculate confidence intervals for Cartesian PC contrast flow measurements directly without the need for time-consuming pseudo replica reconstructions.
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Affiliation(s)
- Michael S Hansen
- National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Laura J Olivieri
- National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010, USA
| | - Kendall O’Brien
- National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010, USA
| | - Russell R Cross
- National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010, USA
| | - Souheil J Inati
- National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
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Costello JP, Olivieri LJ, Krieger A, Thabit O, Marshall MB, Yoo SJ, Kim PC, Jonas RA, Nath DS. Utilizing Three-Dimensional Printing Technology to Assess the Feasibility of High-Fidelity Synthetic Ventricular Septal Defect Models for Simulation in Medical Education. World J Pediatr Congenit Heart Surg 2014; 5:421-6. [DOI: 10.1177/2150135114528721] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 02/24/2014] [Indexed: 01/17/2023]
Abstract
Background: The current educational approach for teaching congenital heart disease (CHD) anatomy to students involves instructional tools and techniques that have significant limitations. This study sought to assess the feasibility of utilizing present-day three-dimensional (3D) printing technology to create high-fidelity synthetic heart models with ventricular septal defect (VSD) lesions and applying these models to a novel, simulation-based educational curriculum for premedical and medical students. Methods: Archived, de-identified magnetic resonance images of five common VSD subtypes were obtained. These cardiac images were then segmented and built into 3D computer-aided design models using Mimics Innovation Suite software. An Objet500 Connex 3D printer was subsequently utilized to print a high-fidelity heart model for each VSD subtype. Next, a simulation-based educational curriculum using these heart models was developed and implemented in the instruction of 29 premedical and medical students. Assessment of this curriculum was undertaken with Likert-type questionnaires. Results: High-fidelity VSD models were successfully created utilizing magnetic resonance imaging data and 3D printing. Following instruction with these high-fidelity models, all students reported significant improvement in knowledge acquisition ( P < .0001), knowledge reporting ( P < .0001), and structural conceptualization ( P < .0001) of VSDs. Conclusions: It is feasible to use present-day 3D printing technology to create high-fidelity heart models with complex intracardiac defects. Furthermore, this tool forms the foundation for an innovative, simulation-based educational approach to teach students about CHD and creates a novel opportunity to stimulate their interest in this field.
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Affiliation(s)
- John P. Costello
- Division of Cardiovascular Surgery, Children’s National Health System, Washington, DC, USA
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Laura J. Olivieri
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
- Department of Cardiology, Children’s National Health System, Washington, DC, USA
| | - Axel Krieger
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Omar Thabit
- Division of Cardiac Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - M. Blair Marshall
- Division of Thoracic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shi-Joon Yoo
- Division of Cardiac Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter C. Kim
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Richard A. Jonas
- Division of Cardiovascular Surgery, Children’s National Health System, Washington, DC, USA
| | - Dilip S. Nath
- Division of Cardiovascular Surgery, Children’s National Health System, Washington, DC, USA
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Olivieri LJ, Baba RY, Arai AE, Bandettini WP, Rosing DR, Bakalov V, Sachdev V, Bondy CA. Spectrum of aortic valve abnormalities associated with aortic dilation across age groups in Turner syndrome. Circ Cardiovasc Imaging 2013; 6:1018-23. [PMID: 24084490 DOI: 10.1161/circimaging.113.000526] [Citation(s) in RCA: 36] [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] [Indexed: 01/09/2023]
Abstract
BACKGROUND Congenital aortic valve fusion is associated with aortic dilation, aneurysm, and rupture in girls and women with Turner syndrome. Our objective was to characterize aortic valve structure in subjects with Turner syndrome and to determine the prevalence of aortic dilation and valve dysfunction associated with different types of aortic valves. METHODS AND RESULTS The aortic valve and thoracic aorta were characterized by cardiovascular MRI in 208 subjects with Turner syndrome in an institutional review board-approved natural history study. Echocardiography was used to measure peak velocities across the aortic valve and the degree of aortic regurgitation. Four distinct valve morphologies were identified: tricuspid aortic valve, 64% (n=133); partially fused aortic valve, 12% (n=25); bicuspid aortic valve, 23% (n=47); and unicuspid aortic valve, 1% (n=3). Age and body surface area were similar in the 4 valve morphology groups. There was a significant trend, independent of age, toward larger body surface area-indexed ascending aortic diameters with increasing valve fusion. Ascending aortic diameters were (mean±SD) 16.9±3.3, 18.3±3.3, and 19.8±3.9 mm/m(2) (P<0.0001) for tricuspid aortic valve, partially fused aortic valve, and bicuspid aortic valve+unicuspid aortic valve, respectively. Partially fused aortic valve, bicuspid aortic valve, and unicuspid aortic valve were significantly associated with mild aortic regurgitation and elevated peak velocities across the aortic valve. CONCLUSIONS Aortic valve abnormalities in Turner syndrome occur with a spectrum of severity and are associated with aortic root dilation across age groups. Partial fusion of the aortic valve, traditionally regarded as an acquired valve problem, had an equal age distribution and was associated with an increased ascending aortic diameters.
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Affiliation(s)
- Laura J Olivieri
- National Institute of Child Health and Human Development and National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Olivieri LJ, Cross RR, Donofrio MT. Influence of fetal diagnosis on the clinical presentation of a vascular ring. Pediatr Cardiol 2012; 33:351-3. [PMID: 22271389 DOI: 10.1007/s00246-011-0129-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 09/13/2011] [Indexed: 11/24/2022]
Abstract
A fetus had a diagnosis of a vascular ring formed by a right aortic arch with an aberrant left subclavian artery. The infant experienced isolated dysphagia and vomiting 3 months after birth. Magnetic resonance imaging (MRI) confirmed the vascular ring and demonstrated profound, isolated esophageal dilation with normal airways. The severity of postnatal symptoms due to a vascular ring is difficult to determine in utero. Expectant management of the lesion is necessary, and use of MRI as the imaging method allows for both confirmation of the diagnosis and evaluation of the airway and esophagus while avoiding radiation.
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Olivieri LJ, de Zélicourt DA, Haggerty CM, Ratnayaka K, Cross RR, Yoganathan AP. Hemodynamic Modeling of Surgically Repaired Coarctation of the Aorta. Cardiovasc Eng Technol 2011; 2:288-295. [PMID: 22347895 DOI: 10.1007/s13239-011-0059-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE: Late morbidity of surgically repaired coarctation of the aorta includes early cardiovascular and cerebrovascular disease, shortened life expectancy, abnormal vasomodulator response, hypertension and exercise-induced hypertension in the absence of recurrent coarctation. Observational studies have linked patterns of arch remodeling (Gothic, Crenel, and Romanesque) to late morbidity, with Gothic arches having the highest incidence. We evaluated flow in native and surgically repaired aortic arches to correlate respective hemodynamic indices with incidence of late morbidity. METHODS: Three dimensional reconstructions of each remodeled arch were created from an anatomic stack of magnetic resonance (MR) images. A structured mesh core with a boundary layer was generated. Computational fluid dynamic (CFD) analysis was performed assuming peak flow conditions with a uniform velocity profile and unsteady turbulent flow. Wall shear stress (WSS), pressure and velocity data were extracted. RESULTS: The region of maximum WSS was located in the mid-transverse arch for the Crenel, Romanesque and Native arches. Peak WSS was located in the isthmus of the Gothic model. Variations in descending aorta flow patterns were also observed among the models. CONCLUSION: The location of peak WSS is a primary difference among the models tested, and may have clinical relevance. Specifically, the Gothic arch had a unique location of peak WSS with flow disorganization in the descending aorta. Our results suggest that varied patterns and locations of WSS resulting from abnormal arch remodeling may exhibit a primary effect on clinical vascular dysfunction.
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Affiliation(s)
- Laura J Olivieri
- Division of Cardiology, Children s National Medical Center, Washington, DC
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