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Howley L, Eyerly-Webb S, Killen SAS, Paul E, Krishnan A, Gropler MRF, Drewes B, Dion E, Lund A, Buyon JP, Cuneo BF. Variation in prenatal surveillance and management of anti-SSA/Ro autoantibody positive pregnancies. J Matern Fetal Neonatal Med 2024; 37:2323623. [PMID: 38443062 PMCID: PMC11005667 DOI: 10.1080/14767058.2024.2323623] [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] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To describe international surveillance and treatment strategies for managing anti-SSA/Ro autoantibody positive pregnancies. STUDY DESIGN An electronic REDCap questionnaire was distributed to Fetal Heart Society and North American Fetal Therapy Network members which queried institution-based risk stratification, surveillance methods/frequency, conduction abnormality treatments, and postnatal anti-SSA/Ro pregnancy assessment. RESULTS 101 responses from 59 centers (59% US, 17% international) were collected. Most (79%) do not risk stratify pregnancies by anti-SSA/Ro titer; those that do use varied cutoff values. Many pregnant rheumatology patients are monitored for cardiac abnormalities regardless of maternal anti-SSA/Ro status. Surveillance strategies were based on maternal factors (anti-SSA/Ro status 85%, titer 25%, prior affected child 79%) and monitoring durations varied. Most respondents treat 2° and 3° fetal atrioventricular block, commonly with dexamethasone and/or IVIG. CONCLUSIONS Wide variation exists in current fetal cardiac surveillance and treatment for anti-SSA/Ro autoantibody positive pregnancies, highlighting the need for evidence-based protocols to optimize care.
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Affiliation(s)
- Lisa Howley
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
- The Children’s Heart Clinic, Children’s Minnesota, Minneapolis, MN USA
| | | | - Stacy A. S. Killen
- Vanderbilt University Medical Center, Monroe Carell Jr. Children’s Hospital, Nashville, TN, USA
| | - Erin Paul
- Icahn School of Medicine, Mount Sinai Children’s Heart Center, New York, NY, USA
| | | | | | - Bailey Drewes
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Eric Dion
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
| | - Amy Lund
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
- The Children’s Heart Clinic, Children’s Minnesota, Minneapolis, MN USA
| | - Jill P. Buyon
- New York University Grossman School of Medicine, NYU Langone Medical Center, New York, NY, USA
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Eyerly-Webb SA, Howley L, Brock CO, Lillegard JB, Fisher J, Reynolds B, Barthel EF, Dion E, Snowise S. Continuous Fetal Cardiac Monitoring During Fetoscopic Myelomeningocele Repair and Relationship to Spectral Doppler Changes. Fetal Diagn Ther 2024:000538122. [PMID: 38643759 DOI: 10.1159/000538122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/21/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION No evidence-based protocols exist for fetal cardiac monitoring during fetoscopic myelomeningocele (fMMC) repair and intraprocedural spectral Doppler data is limited. We determined the feasibility of continuous fetal echocardiography during fMMC repair and correlated Doppler changes with qualitative fetal cardiac function during each phase of fMMC repair. METHODS Patients undergoing fMMC repair had continuous fetal echocardiography interpreted in real-time by pediatric cardiology. Fetal data included fetal heart rate (FHR), qualitative cardiac function, mitral and tricuspid valve inflow waveforms, and umbilical artery (UA), umbilical vein (UV), ductus arteriosus (DA) and ductus venosus (DV) Dopplers. RESULTS UA abnormalities were noted in 14/25 patients, UV abnormalities were observed in two patients, and DV and DA abnormalities were each noted in 4 patients. Qualitative cardiac function was normal for all patients with the exception of one with isolated left ventricular dysfunction during myofascial flap creation, concurrent with an abnormal UA flow pattern. All abnormalities resolved by the first postoperative day. CONCLUSIONS Continuous fetal echocardiography was feasible during all fMMC repairs. Spectral Doppler changes in the UA were common during fMMC procedures but qualitative cardiac dysfunction was rare. Abnormalities in the UV, DV and DA Dopplers, FHR, and cardiac function were less common findings.
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Johnson JA, Canavan T, Alsaied T, Howley L, Hancock HS, Suthar D, Marcuccio E, Trussell TM, Cuneo B. Prenatal Predictors for Pulmonary Balloon Valvuloplasty in the Newborn. Pediatr Cardiol 2024; 45:722-728. [PMID: 38411710 DOI: 10.1007/s00246-024-03430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024]
Abstract
Pulmonary balloon valvuloplasty (PBV) is the treatment of choice for subjects with isolated pulmonary valve stenosis (IPS). The purpose of this study was to define fetal echocardiographic features associated with an inpatient PBV prior to newborn hospital discharge and characterize resource utilization of IPS fetuses among participating centers. Six center, retrospective case series of singleton fetuses identified between 2010 and 2020 with IPS. Third-trimester echocardiogram data was compared with postnatal data, included pulmonary valve Doppler velocities, pulmonary valve insufficiency and ductus arteriosus flow direction. Comparison between subjects who underwent inpatient PBV during their newborn hospital admission versus those infants referred for outpatient PBV after initial hospital discharge. We analyzed data by logistic regression, student t test and Chi-Square testing with a p value of ≤ 0.05 considered statistically significant. Forty-nine IPS fetuses were identified. Thirty-eight (78%) underwent inpatient PBV at 5 (range 1-58) days and 11 (22%) underwent outpatient PBV at 51.8 (11-174) days. Newborns requiring an inpatient PBV were more likely to have one or more characteristics on 3rd-trimester fetal echocardiogram: left to right or bidirectional ductus arteriosus flow (61% vs 0%), and/or a peak pulmonary valve velocity > 3.0 m/s (odds ratio 16.9, 95% confidence interval 3.02-94.17) with a sensitivity of 90.4% and specificity of 97.7%. Ductus arteriosus flow direction and pulmonary valve peak velocity in the 3rd trimester can successfully predict the need for newborn inpatient PBV. We speculate these findings may be useful in choosing delivery site for the pregnancy complicated by fetal IPS.
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Affiliation(s)
- Jennifer A Johnson
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
- Pediatric Cardiology, Methodist Children's Hospital, San Antonio, TX, USA.
- Pediatric Cardiology, Mednax/Pediatrix, San Antonio, TX, USA.
| | - Timothy Canavan
- Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee Womens Hospital, Pittsburgh, PA, USA
| | - Tarek Alsaied
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Howley
- Pediatric Cardiology, The Children's Heart Clinic/Children's Minnesota, Minneapolis, MN, USA
| | - Hayley S Hancock
- Pediatric Cardiology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Divya Suthar
- Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Elisa Marcuccio
- Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Taylor M Trussell
- Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bettina Cuneo
- Pediatric Cardiology, Children's Hospital Colorado, Denver, CO, USA
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Buyon JP, Masson M, Izmirly CG, Phoon C, Acherman R, Sinkovskaya E, Abuhamad A, Makhoul M, Satou G, Hogan W, Pinto N, Moon-Grady A, Howley L, Donofrio M, Krishnan A, Ahmadzia H, Levasseur S, Paul E, Owens S, Cumbermack K, Matta J, Joffe G, Lindblade C, Haxel C, Kohari K, Copel J, Strainic J, Doan T, Bermudez-Wagner K, Holloman C, Sheth SS, Killen S, Tacy T, Kaplinski M, Hornberger L, Carlucci PM, Izmirly P, Fraser N, Clancy RM, Cuneo BF. Prospective Evaluation of High Titer Autoantibodies and Fetal Home Monitoring in the Detection of Atrioventricular Block Among Anti-SSA/Ro Pregnancies. Arthritis Rheumatol 2024; 76:411-420. [PMID: 37947364 DOI: 10.1002/art.42733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This prospective study of pregnant patients, Surveillance To Prevent AV Block Likely to Occur Quickly (STOP BLOQ), addresses the impact of anti-SSA/Ro titers and utility of ambulatory monitoring in the detection of fetal second-degree atrioventricular block (AVB). METHODS Women with anti-SSA/Ro autoantibodies by commercial testing were stratified into high and low anti-52-kD and/or 60-kD SSA/Ro titers applying at-risk thresholds defined by previous evaluation of AVB pregnancies. The high-titer group performed fetal heart rate and rhythm monitoring (FHRM) thrice daily and weekly/biweekly echocardiography from 17-26 weeks. Abnormal FHRM prompted urgent echocardiography to identify AVB. RESULTS Anti-52-kD and/or 60-kD SSA/Ro met thresholds for monitoring in 261 of 413 participants (63%); for those, AVB frequency was 3.8%. No cases occurred with low titers. The incidence of AVB increased with higher levels, reaching 7.7% for those in the top quartile for anti-60-kD SSA/Ro, which increased to 27.3% in those with a previous child who had AVB. Based on levels from 15 participants with paired samples from both an AVB and a non-AVB pregnancy, healthy pregnancies were not explained by decreased titers. FHRM was considered abnormal in 45 of 30,920 recordings, 10 confirmed AVB by urgent echocardiogram, 7 being second-degree AVB, all <12 hours from normal FHRM and within another 0.75 to 4 hours to echocardiogram. The one participant with second/third-degree and two participants with third-degree AVB were diagnosed by urgent echocardiogram >17 to 72 hours from an FHRM. Surveillance echocardiograms detected no AVB when the preceding interval FHRM recordings were normal. CONCLUSION High-titer antibodies are associated with an increased incidence of AVB. Anti-SSA/Ro titers remain stable over time and do not explain the discordant recurrence rates, suggesting that other factors are required. Fetal heart rate and rhythm (FHRM) with results confirmed by a pediatric cardiologist reliably detects conduction abnormalities, which may reduce the need for serial echocardiograms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gary Satou
- University of California, Los Angeles, California
| | | | | | | | - Lisa Howley
- Midwest Fetal Care Center, Children's Minnesota/Allina Health, Minneapolis, Minnesota
| | | | | | | | | | - Erin Paul
- Mount Sinai Hospital, New York City, New York
| | | | | | | | - Gary Joffe
- Perinatal Associates of New Mexico, Rio Rancho, New Mexico
| | | | - Caitlin Haxel
- University of Vermont Children's Hospital, Burlington, Vermont
| | | | | | - James Strainic
- UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Tam Doan
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Conisha Holloman
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Shreya S Sheth
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
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Teramachi Y, Hornberger LK, Howley L, van der Velde ME, Al-Aklabi M, Eckersley LG. Impact of Neonatal Intervention on Left Ventricular Performance in Ebstein's Anomaly and Tricuspid Valve Dysplasia. J Am Soc Echocardiogr 2024; 37:248-254. [PMID: 38013061 DOI: 10.1016/j.echo.2023.11.019] [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: 09/29/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Severe neonatal Ebstein's anomaly (EA) and tricuspid valve dysplasia (TVD) are associated with high perinatal morbidity and mortality. The authors recently demonstrated left ventricular (LV) dysfunction and dyssynchrony to be prevalent in affected newborns and to contribute to poor outcomes. The aim of this study was to investigate the impact of patent ductus arteriosus (PDA) closure, spontaneous or surgical ligation, or right ventricular exclusion (Starnes procedure) on LV performance in neonatal EA and TVD. METHODS Neonates with EA or TVD encountered from 2004 to 2018 at three institutions were identified. Pre- and postoperative LV function was assessed using two-dimensional, Doppler-derived deformation (six-segment vector velocity imaging) and two measures of mechanical dyssynchrony (the SD of time to peak and global dyssynchrony index), and values were compared using paired t test analysis or the Wilcoxon rank sum test. RESULTS Before the intervention, LV function was impaired in the PDA (n = 18) and Starnes (n = 6) groups and was similar between groups. After PDA closure, LV performance did not change. After the Starnes procedure, however, LV function, including synchrony, improved significantly: fractional area change from 45 ± 5% to 58 ± 8% (P = .003), global circumferential strain from -18.2 ± 5.0% to -32.5 ± 5.5% (P = .01), cardiac index from 1.9 ± 0.3 to 3.9 ± 1.5 L/min/m2 (P = .05), and circumferential strain dyssynchrony (dyssynchrony index from 0.19 ± 0.09 to 0.04 ± 0.02 [P = .009] and SD of time to peak from 59.8 ± 18.5 to 29.9 ± 8.2 [P = .02]). CONCLUSION The Starnes procedure results in early improvements in LV dysfunction and dyssynchrony, not observed after PDA closure in neonatal severe EA and TVD, which may benefit critically unwell neonates.
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Affiliation(s)
- Yozo Teramachi
- Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's and Children Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa K Hornberger
- Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's and Children Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Howley
- Division of Cardiology, Department of Pediatrics, University of Colorado, Denver, Colorado
| | - Mary E van der Velde
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Mohammed Al-Aklabi
- Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's and Children Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Luke G Eckersley
- Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's and Children Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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Holmes S, Hornberger LK, Jaeggi E, Howley L, Moon-Grady AJ, Uzun O, Kaizer A, Gilicze O, Cuneo BF. Treatment, not delivery, of the late preterm and term fetus with supraventricular arrhythmia. Ultrasound Obstet Gynecol 2023; 62:552-557. [PMID: 37128167 DOI: 10.1002/uog.26239] [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] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE While in-utero treatment of sustained fetal supraventricular arrhythmia (SVA) is standard practice in the previable and preterm fetus, data are limited on best practice for late preterm (34 + 0 to 36 + 6 weeks), early term (37 + 0 to 38 + 6 weeks) and term (> 39 weeks) fetuses with SVA. We reviewed the delivery and postnatal outcomes of fetuses at ≥ 35 weeks of gestation undergoing treatment rather than immediate delivery. METHODS This was a retrospective case series of fetuses presenting at ≥ 35 weeks of gestation with sustained SVA and treated transplacentally at six institutions between 2012 and 2022. Data were collected on gestational age at presentation and delivery, SVA diagnosis (short ventriculoatrial (VA) tachycardia, long VA tachycardia or atrial flutter), type of antiarrhythmic medication used, interval between treatment and conversion to sinus rhythm and postnatal SVA recurrence. RESULTS Overall, 37 fetuses presented at a median gestational age of 35.7 (range, 35.0-39.7) weeks with short VA tachycardia (n = 20), long VA tachycardia (n = 7) or atrial flutter (n = 10). Four (11%) fetuses were hydropic. In-utero treatment led to restoration of sinus rhythm in 35 (95%) fetuses at a median of 2 (range, 1-17) days; this included three of the four fetuses with hydrops. Antiarrhythmic medications included flecainide (n = 11), digoxin (n = 7), sotalol (n = 11) and dual therapy (n = 8). Neonates were liveborn at 36-41 weeks via spontaneous vaginal delivery (23/37 (62%)) or Cesarean delivery (14/37 (38%)). Cesarean delivery was indicated for fetal SVA in two fetuses, atrial ectopy or sinus bradycardia in three fetuses and obstetric reasons in nine fetuses that were in sinus rhythm at the time of delivery. Twenty-one (57%) cases were treated for recurrent SVA after birth. CONCLUSION In-utero treatment of the near term and term (≥ 35-week) SVA fetus is highly successful even in the presence of hydrops, with the majority of cases delivered vaginally closer to term, thereby avoiding unnecessary Cesarean section. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Holmes
- The Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - L K Hornberger
- Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - E Jaeggi
- Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - L Howley
- Children's Hospital Minnesota, Minneapolis, MN, USA
| | - A J Moon-Grady
- University of California San Francisco, San Francisco, CA, USA
| | - O Uzun
- School of Medicine and University Hospital of Wales, Cardiff, UK
| | - A Kaizer
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - O Gilicze
- University of California San Francisco, San Francisco, CA, USA
| | - B F Cuneo
- The Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
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Howley L, Grbic D, Speicher MR, Roskovensky LB, Jayas A, Andriole DA. The Resident Readiness Survey: A National Process for Program Directors to Provide Standardized Feedback to Medical Schools About Their Graduates. J Grad Med Educ 2023; 15:572-581. [PMID: 37781420 PMCID: PMC10539134 DOI: 10.4300/jgme-d-23-00061.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/18/2023] [Accepted: 07/09/2023] [Indexed: 10/03/2023] Open
Abstract
Background The process for program directors (PDs) to provide feedback to medical schools about their graduates' readiness for postgraduate year 1 (PGY-1) training is burdensome and does not generate national benchmarking data. Objective The Association of American Medical Colleges (AAMC) tested the feasibility of administering a standardized Resident Readiness Survey (RRS) to PDs nationally about their PGY-1 residents' preparedness for residency. Methods In 2020 and 2021, the AAMC invited PDs via email to complete RRSs for their PGY-1s who graduated from participating schools; the AAMC provided schools with reports of identified RRS data for their graduates. Outcome measures included school participation rates, PD response rates, PGY-1s' coverage rates (RRSs completed/RRSs PDs invited to complete), RRS completion time (time-stamp difference: RRS opening-submission), and participating schools' feedback about the process collected via AAMC evaluation questionnaires sent to school leaders. Chi-square tested significance of differences between proportions. Results School participation increased from 43.8% (2020: 77 of 176) to 72.4% (2021: 131 of 181). PD response rates, similar in both years overall (2020: 1786 of 2847 [62.7%]; 2021: 2107 of 3406 [61.9%]; P=.48), varied by specialty (P<.001; range 65 of 154 [42.2%], neurology; 109 of 136 [80.1%], internal medicine-pediatrics, both years combined). PGY-1s' coverage rates were similar (P=.21) in 2020 (5567 of 10 712 [52.0%]) and 2021 (9688 of 18 372 [52.7%]). RRS completion time averaged less than 3 minutes. Numerous school leaders reported that RRS data stimulated new, or supported ongoing, curricular quality improvement. Conclusions Administration of a standardized RRS to PDs nationally about PGY-1s preparedness for residency is feasible and will continue.
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Affiliation(s)
- Lisa Howley
- Lisa Howley, PhD, is Senior Director, Transforming Medical Education, Association of American Medical Colleges (AAMC)
| | - Douglas Grbic
- Douglas Grbic, PhD, is Manager, Medical Education Research, AAMC
| | - Mark R. Speicher
- Mark R. Speicher, PhD, MHA, is Senior Vice President, American Association of Colleges of Osteopathic Medicine
| | | | - Amy Jayas
- Amy Jayas, MPH, is Research Analyst II, Medical Education Research, AAMC; and
| | - Dorothy A. Andriole
- Dorothy A. Andriole, MD, is Senior Director, Medical Education Research, AAMC
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Lopez KN, Morris SA, Krishnan A, Jacobs MB, Bhat AH, Chelliah A, Chiu JS, Cuneo BF, Freire G, Hornberger LK, Howley L, Husain N, Ikemba C, Kavanaugh-McHugh A, Kutty S, Lee C, McBrien A, Michelfelder EC, Pinto NM, Schwartz R, Stern KWD, Taylor C, Thakur V, Tworetzky W, Wittlieb-Weber C, Woldu K, Donofrio MT, Peyvandi S. Associations Between Maternal Sociodemographics and Hospital Mortality in Newborns With Prenatally Diagnosed Hypoplastic Left Heart Syndrome. Circulation 2023; 148:283-285. [PMID: 37459407 PMCID: PMC10361626 DOI: 10.1161/circulationaha.123.064476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Keila N Lopez
- Department of Cardiology, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (K.N.L., S.A.M.)
| | - Shaine A Morris
- Department of Cardiology, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (K.N.L., S.A.M.)
| | - Anita Krishnan
- Children's National Heart Institute, Washington, DC (A.K., R.S., M.T.D.)
| | - Marni B Jacobs
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla (M.B.J.)
| | - Aarti H Bhat
- Division of Cardiology, University of Washington, Seattle (A.H.B.)
| | - Anjali Chelliah
- Division of Cardiology, Columbia University, New York, NY (A.C.)
| | - Joanne S Chiu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.)
- Division of Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston (J.S.C.)
| | - Bettina F Cuneo
- Division of Cardiology, The Heart Institute, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.)
| | - Grace Freire
- Johns Hopkins University All Children's Hospital, St. Petersburg, FL (G.F.)
| | - Lisa K Hornberger
- Division of Cardiology, Department of Pediatrics, University of Alberta, EDM, Canada (L.K.H., A.M.)
| | - Lisa Howley
- Division of Cardiology, The Heart Institute, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.)
- Division of Cardiology, The Children's Heart Clinic/Children's Minnesota, Minneapolis (L.H.)
| | - Nazia Husain
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL (N.H.)
| | - Catherine Ikemba
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (C.I., K.W.)
| | - Ann Kavanaugh-McHugh
- Thomas P. Graham Jr Division of Pediatric Cardiology, Monroe Carell Children's Hospital, Nashville, TN (A.K.-M.)
| | - Shelby Kutty
- Division of Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.)
- Division of Cardiology, University of Nebraska Medical Center, Omaha (S.K.)
| | - Caroline Lee
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.L.)
| | - Angela McBrien
- Division of Cardiology, Department of Pediatrics, University of Alberta, EDM, Canada (L.K.H., A.M.)
| | - Erik C Michelfelder
- Emory University School of Medicine, Children's Healthcare of Atlanta/Sibley Heart Center, GA (E.C.M.)
| | - Nelangi M Pinto
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (N.M.P.)
| | - Rachel Schwartz
- Children's National Heart Institute, Washington, DC (A.K., R.S., M.T.D.)
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.)
| | - Kenan W D Stern
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY (K.W.D.S.)
- Icahn School of Medicine at Mount Sinai, Children's Heart Center, New York, NY (K.W.D.S.)
| | | | - Varsha Thakur
- Division of Cardiology, University of Toronto, ON, Canada (V.T.)
| | - Wayne Tworetzky
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.)
| | | | - Kris Woldu
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (C.I., K.W.)
- Division of Cardiology, Cook Children's Heart Center, Fort Worth, TX (K.W.)
| | - Mary T Donofrio
- Children's National Heart Institute, Washington, DC (A.K., R.S., M.T.D.)
| | - Shabnam Peyvandi
- Division of Cardiology, University of California, San Francisco (S.P.)
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Klein J, Gourishankar A, Cuneo BF, Howley L, Kavanaugh-McHugh AL, Taylor C, Donofrio MT, Krishnan AN. GEOSPATIAL ANALYSIS AS A TOOL TO UNDERSTAND PRENATAL DETECTION OF CONGENITAL HEART DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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10
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Hoops K, Fahimi J, Khoeur L, Studenmund C, Barber C, Barnhorst A, Betz ME, Crifasi CK, Davis JA, Dewispelaere W, Fisher L, Howard PK, Ketterer A, Marcolini E, Nestadt PS, Rozel J, Simonetti JA, Spitzer S, Victoroff M, Williams BH, Howley L, Ranney ML. Consensus-Driven Priorities for Firearm Injury Education Among Medical Professionals. Acad Med 2022; 97:93-104. [PMID: 34232149 DOI: 10.1097/acm.0000000000004226] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE Firearm injury is a leading cause of morbidity and mortality in the United States. However, many medical professionals currently receive minimal or no education on firearm injury or its prevention. The authors sought to convene a diverse group of national experts in firearm injury epidemiology, injury prevention, and medical education to develop consensus on priorities to inform the creation of learning objectives and curricula for firearm injury education for medical professionals. METHOD In 2019, the authors convened an advisory group that was geographically, demographically, and professionally diverse, composed of 33 clinicians, researchers, and educators from across the United States. They used the nominal group technique to achieve consensus on priorities for health professions education on firearm injury. The process involved an initial idea-generating phase, followed by a round-robin sharing of ideas and further idea generation, facilitated discussion and clarification, and the ranking of ideas to generate a prioritized list. RESULTS This report provides the first national consensus guidelines on firearm injury education for medical professionals. These priorities include a set of crosscutting, basic, and advanced learning objectives applicable to all contexts of firearm injury and all medical disciplines, specialties, and levels of training. They focus on 7 contextual categories that had previously been identified in the literature: 1 category of general priorities applicable to all contexts and 6 categories of specific contexts, including intimate partner violence, mass violence, officer-involved shootings, peer (nonpartner) violence, suicide, and unintentional injury. CONCLUSIONS Robust, data- and consensus-driven priorities for health professions education on firearm injury create a pathway to clinician competence and self-efficacy. With an improved foundation for curriculum development and educational program-building, clinicians will be better informed to engage in a host of firearm injury prevention initiatives both at the bedside and in their communities.
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Affiliation(s)
- Katherine Hoops
- K. Hoops is assistant professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jahan Fahimi
- J. Fahimi is associate professor, Department of Emergency Medicine, University of California, San Francisco School of Medicine and Institute for Health Policy Studies, San Francisco, California
| | - Lina Khoeur
- L. Khoeur is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Christine Studenmund
- C. Studenmund is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Catherine Barber
- C. Barber is senior researcher, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amy Barnhorst
- A. Barnhorst is associate professor, Department of Psychiatry and Behavioral Sciences and Department of Emergency Medicine, University of California, Davis School of Medicine, Davis, California
| | - Marian E Betz
- M.E. Betz is associate professor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Cassandra K Crifasi
- C.K. Crifasi is assistant professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John A Davis
- J.A. Davis is professor and associate dean for curriculum, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - William Dewispelaere
- W. Dewispelaere is a resident, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Lynn Fisher
- L. Fisher is assistant professor, Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Patricia K Howard
- P.K. Howard is adjunct assistant professor, University of Kentucky, Lexington, Kentucky
| | - Andrew Ketterer
- A. Ketterer is clinical instructor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Evie Marcolini
- E. Marcolini is assistant professor, Department of Emergency Medicine and Department of Neurology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Paul S Nestadt
- P.S. Nestadt is assistant professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John Rozel
- J. Rozel is associate professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph A Simonetti
- J.A. Simonetti is assistant professor, Department of Medicine, University of Colorado School of Medicine, and Veterans Health Administration, Aurora, Colorado
| | - Sarabeth Spitzer
- S. Spitzer is a resident, Department of Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Victoroff
- M. Victoroff is clinical professor, Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian H Williams
- B.H. Williams is associate professor, Department of Surgery, University of Chicago Pritzker School of Medicine and Biological Sciences, Chicago, Illinois
| | - Lisa Howley
- L. Howley is senior director of strategic initiatives and partnerships, Association of American Medical Colleges, Washington, DC
| | - Megan L Ranney
- M.L. Ranney is associate professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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11
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Teramachi Y, Hornberger LK, Howley L, van der Velde ME, Eckersley LG. Left Ventricular Dysfunction in Neonatal Ebstein’s Anomaly and Tricuspid Valve Dysplasia. J Am Soc Echocardiogr 2022; 35:503-512.e3. [DOI: 10.1016/j.echo.2022.01.010] [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: 03/12/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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12
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Fisher J, Howley L, Lillegard J, Amin V, Engstrom B, Snowise S. Successful Treatment of Placental Chorangiomas by Ultrasound-Guided Percutaneous in utero Microcoil Embolization. Fetal Diagn Ther 2021; 48:560-566. [PMID: 34412059 DOI: 10.1159/000516625] [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: 12/11/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
Placental chorangiomas can cause a high-output fetal state and increase neonatal morbidity and mortality. There is a paucity of data published describing the optimal treatment of these cases, and methods for occlusion to date include placement of vascular clips, bipolar cautery, injection of alcohol or surgical glue, interstitial laser, and microcoil embolization. We report 2 cases of prenatally diagnosed chorangiomas that caused a high-output fetal state and were successfully treated with microcoil embolization. This case series describes our technique and supports microcoil embolization as a potentially safe and effective antenatal treatment option in symptomatic chorangiomas.
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Affiliation(s)
- James Fisher
- Midwest Fetal Care Center, Children's Minnesota, Minneapolis, Minnesota, USA.,Pediatric Surgical Associates, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Lisa Howley
- Midwest Fetal Care Center, Children's Minnesota, Minneapolis, Minnesota, USA.,Division of Cardiology, Department of Pediatrics, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Joseph Lillegard
- Midwest Fetal Care Center, Children's Minnesota, Minneapolis, Minnesota, USA.,Pediatric Surgical Associates, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Vinit Amin
- Department of Interventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bjorn Engstrom
- Department of Interventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Saul Snowise
- Midwest Fetal Care Center, Children's Minnesota, Minneapolis, Minnesota, USA.,Minnesota Perinatal Physicians, Minneapolis, Minnesota, USA
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13
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Krishnan A, Jacobs MB, Morris SA, Peyvandi S, Bhat AH, Chelliah A, Chiu JS, Cuneo BF, Freire G, Hornberger LK, Howley L, Husain N, Ikemba C, Kavanaugh-McHugh A, Kutty S, Lee C, Lopez KN, McBrien A, Michelfelder EC, Pinto NM, Schwartz R, Stern KWD, Taylor C, Thakur V, Tworetzky W, Wittlieb-Weber C, Woldu K, Donofrio MT. Impact of Socioeconomic Status, Race and Ethnicity, and Geography on Prenatal Detection of Hypoplastic Left Heart Syndrome and Transposition of the Great Arteries. Circulation 2021; 143:2049-2060. [PMID: 33993718 DOI: 10.1161/circulationaha.120.053062] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prenatal detection (PND) has benefits for infants with hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA), but associations between sociodemographic and geographic factors with PND have not been sufficiently explored. This study evaluated whether socioeconomic quartile (SEQ), public insurance, race and ethnicity, rural residence, and distance of residence (distance and driving time from a cardiac surgical center) are associated with the PND or timing of PND, with a secondary aim to analyze differences between the United States and Canada. METHODS In this retrospective cohort study, fetuses and infants <2 months of age with HLHS or TGA admitted between 2012 and 2016 to participating Fetal Heart Society Research Collaborative institutions in the United States and Canada were included. SEQ, rural residence, and distance of residence were derived using maternal census tract from the maternal address at first visit. Subjects were assigned a SEQ z score using the neighborhood summary score or Canadian Chan index and separated into quartiles. Insurance type and self-reported race and ethnicity were obtained from medical charts. We evaluated associations among SEQ, insurance type, race and ethnicity, rural residence, and distance of residence with PND of HLHS and TGA (aggregate and individually) using bivariate analysis with adjusted associations for confounding variables and cluster analysis for centers. RESULTS Data on 1862 subjects (HLHS: n=1171, 92% PND; TGA: n=691, 58% PND) were submitted by 21 centers (19 in the United States). In the United States, lower SEQ was associated with lower PND in HLHS and TGA, with the strongest association in the lower SEQ of pregnancies with fetal TGA (quartile 1, 0.78 [95% CI, 0.64-0.85], quartile 2, 0.77 [95% CI, 0.64-0.93], quartile 3, 0.83 [95% CI, 0.69-1.00], quartile 4, reference). Hispanic ethnicity (relative risk, 0.85 [95% CI, 0.72-0.99]) and rural residence (relative risk, 0.78 [95% CI, 0.64-0.95]) were also associated with lower PND in TGA. Lower SEQ was associated with later PND overall; in the United States, rural residence and public insurance were also associated with later PND. CONCLUSIONS We demonstrate that lower SEQ, Hispanic ethnicity, and rural residence are associated with decreased PND for TGA, with lower SEQ also being associated with decreased PND for HLHS. Future work to increase PND should be considered in these specific populations.
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Affiliation(s)
- Anita Krishnan
- Divisions of Cardiology (A.K., M.T.D.), Children's National Hospital, Washington, DC
| | - Marni B Jacobs
- Biostatistics (M.B.J.), Children's National Hospital, Washington, DC.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego (M.B.J.)
| | - Shaine A Morris
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX (S.A.M., K.N.L.)
| | - Shabnam Peyvandi
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco (S.P.)
| | - Aarti H Bhat
- Division of Cardiology, Seattle Children's Hospital, University of Washington (A.H.B.)
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York (A.C.)
| | - Joanne S Chiu
- Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.).,Division of Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston (J.S.C.)
| | - Bettina F Cuneo
- Division of Cardiology, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.)
| | - Grace Freire
- Division of Cardiology, Johns Hopkins University All Children's Hospital, St. Petersburg, FL (G.F.)
| | - Lisa K Hornberger
- Division of Pediatric Cardiology, University of Alberta, Edmonton, Canada (L.K.H., A.M.)
| | - Lisa Howley
- Division of Cardiology, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.).,Division of Cardiology, The Children's Heart Clinic/Children's Minnesota, Minneapolis (L.H.)
| | - Nazia Husain
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL (N.H.)
| | - Catherine Ikemba
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (C.I., K.W.)
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (A.K.-M.)
| | - Shelby Kutty
- Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.).,University of Nebraska Medical Center, Omaha (S.K.)
| | - Caroline Lee
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.L.)
| | - Keila N Lopez
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX (S.A.M., K.N.L.)
| | - Angela McBrien
- Division of Pediatric Cardiology, University of Alberta, Edmonton, Canada (L.K.H., A.M.)
| | - Erik C Michelfelder
- Emory University School of Medicine, Children's Healthcare of Atlanta/Sibley Heart Center, GA (E.C.M.)
| | - Nelangi M Pinto
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (N.M.P.)
| | - Rachel Schwartz
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.).,The George Washington School of Medicine, Washington, DC (R.S.)
| | - Kenan W D Stern
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York (K.W.D.S.)
| | - Carolyn Taylor
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston (C.T.)
| | - Varsha Thakur
- Division of Cardiology, University of Toronto, Ontario, Canada (V.T.)
| | - Wayne Tworetzky
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.)
| | - Carol Wittlieb-Weber
- Division of Pediatric Cardiology, University of Rochester, NY (C.W.-W.).,Division of Cardiology, Children's Hospital of Philadelphia, PA (C.W.-W.)
| | - Kris Woldu
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (C.I., K.W.).,Division of Cardiology, Cook Children's Heart Center, Ft. Worth, TX (K.W.)
| | - Mary T Donofrio
- Divisions of Cardiology (A.K., M.T.D.), Children's National Hospital, Washington, DC
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14
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Zebhi B, Wiputra H, Howley L, Cuneo B, Park D, Hoffman H, Gilbert L, Yap CH, Bark D. Right ventricle in hypoplastic left heart syndrome exhibits altered hemodynamics in the human fetus. J Biomech 2020; 112:110035. [PMID: 32971490 DOI: 10.1016/j.jbiomech.2020.110035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) represents approximately 9% of all congenital heart defects and is one of the most complex, with the left side of the heart being generally underdeveloped. Numerous studies demonstrate that intracardiac fluid flow patterns in the embryonic and fetal circulation can impact cardiac structural formation and remodeling. This highlights the importance of quantifying the altered hemodynamic environment in congenital heart defects, like HLHS, relative to a normal heart as it relates to cardiac development. Therefore, to study human cardiovascular fetal flow, computational fluid dynamic simulations were performed using 4D patient-specific ultrasound scans in normal and HLHS hearts. In these simulations, we find that the HLHS right ventricle exhibits a greater cardiac output than normal; yet, hemodynamics are relatively similar between normal and HLHS right ventricles. Overall, this study provides detailed quantitative flow patterns for HLHS, which has the potential to guide future prevention and therapeutic interventions, while more immediately providing additional functional detail to cardiologists to aid in decision making.
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Affiliation(s)
- Banafsheh Zebhi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Hadi Wiputra
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Lisa Howley
- The Children's Heart Clinic at the Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Bettina Cuneo
- The Colorado Fetal Care Center, Children's Hospital Colorado and the University of Colorado, Aurora, CO, USA
| | - Dawn Park
- The Colorado Fetal Care Center, Children's Hospital Colorado and the University of Colorado, Aurora, CO, USA
| | - Hilary Hoffman
- The Colorado Fetal Care Center, Children's Hospital Colorado and the University of Colorado, Aurora, CO, USA
| | - Lisa Gilbert
- The Colorado Fetal Care Center, Children's Hospital Colorado and the University of Colorado, Aurora, CO, USA
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, UK
| | - David Bark
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA; School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, Washington University in Saint Louis, Saint Louis, MO, USA.
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15
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Hogan WJ, Grinenco S, Armstrong A, Devlieger R, Dangel J, Ferrer Q, Frommelt M, Galindo A, Gardiner H, Gelehrter S, Herberg U, Howley L, Jaeggi E, Miranda J, Morris SA, Oepkes D, Pedra S, Peterson R, Sholler G, Simpson J, Strainic J, Vigneswarran TV, Wacker-Gussmann A, Moon-Grady AJ. Fetal Cardiac Intervention for Pulmonary Atresia with Intact Ventricular Septum: International Fetal Cardiac Intervention Registry. Fetal Diagn Ther 2020; 47:1-9. [PMID: 32634804 DOI: 10.1159/000508045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/12/2020] [Accepted: 04/19/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Invasive fetal cardiac intervention (FCI) for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (PS) has been performed with small single-institution series reporting technical and physiological success. We present the first multicenter experience. OBJECTIVES Describe fetal and maternal characteristics of those being evaluated for FCI, including pregnancy/neonatal outcome data using the International Fetal Cardiac Intervention Registry (IFCIR). METHODS We queried the IFCIR for PAIVS/PS cases evaluated from January 2001 to April 2018 and reviewed maternal/fetal characteristics, procedural details, pregnancy and neonatal outcomes. Data were analyzed using standard descriptive statistics. RESULTS Of the 84 maternal/fetal dyads in the registry, 58 underwent pulmonary valvuloplasty at a median gestational age of 26.1 (21.9-31.0) weeks. Characteristics of fetuses undergoing FCI varied in terms of tricuspid valve (TV) size, TV regurgitation, and pulmonary valve patency. There were fetal complications in 55% of cases, including 7 deaths and 2 delayed fetal losses. Among those who underwent successful FCI, the absolute measurement of the TV increased by 0.32 (±0.17) mm/week from intervention to birth. Among 60 liveborn with known outcome, there was a higher percentage having a biventricular circulation following successful FCI (87 vs. 43%). CONCLUSIONS Our data suggest a possible benefit to fetal therapy for PAIVS/PS, though rates of technically unsuccessful procedures and procedure-related complications, including fetal loss were substantial. FCI criteria are extremely variable, making direct comparison to nonintervention patients challenging and potentially biased. More uniform FCI criteria for fetuses with PAIVS/PS are needed to avoid unnecessary procedures, expose only fetuses most likely to sustain a benefit, and to enable comparisons to be made with nonintervention patients.
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Affiliation(s)
- Whitnee J Hogan
- University of California-San Francisco, San Francisco, California, USA,
| | - Sofia Grinenco
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Roland Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Joanna Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | | | - Alberto Galindo
- Hospital Universitario, Universidad Complutense de Madrid, Madrid, Spain
| | - Helena Gardiner
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Sarah Gelehrter
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Lisa Howley
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Edgar Jaeggi
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Dick Oepkes
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gary Sholler
- Heart Center for Children, Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
| | - John Simpson
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust Hospitals, London, United Kingdom
| | - James Strainic
- Rainbow Babies and Children's Hospital Division of Pediatric Cardiology, University Hospitals, Cleveland, Ohio, USA
| | - Trisha V Vigneswarran
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust Hospitals, London, United Kingdom
| | - Annette Wacker-Gussmann
- German Heart Center, Department of Pediatric Cardiology and Adult Congenital Heart Disease, Munich, Germany
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16
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Cuneo BF, Olson CA, Haxel C, Howley L, Gagnon A, Benson DW, Kaizer AM, Thomas JF. Risk Stratification of Fetal Cardiac Anomalies in an Underserved Population Using Telecardiology. Obstet Gynecol 2020; 134:1096-1103. [PMID: 31599844 DOI: 10.1097/aog.0000000000003502] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate a fetal telecardiology program in a medically underserved area. METHODS We conducted a prospective case series of pregnant women at 18-38 weeks of gestation with risk factors for fetal congenital heart disease. Obstetric ultrasonographers performed fetal echocardiograms (local site) that were read in real time. The results were given to the mother by a fetal cardiologist at a children's hospital 243 miles and two mountain passes away (distant site). We evaluated the fetal telecardiology program in five domains: 1) education of obstetric ultrasonographers before initiation of telecardiology services, 2) process and efficiency, 3) patient satisfaction, 4) economic effects, and 5) accuracy of cardiac diagnosis and success of risk stratification. RESULTS The program was initiated on November 12, 2015, and here we describe its first 37 months. Over the initial training period of 3 months and about 70 examinations, obstetric ultrasonographers improved their identification of fetal congenital heart disease. Telecardiology was performed once a week and also for suspected fetal congenital heart disease or arrhythmia outside clinic hours, for a total of 455 examinations. All mothers preferred having their fetal cardiac evaluations performed locally as opposed to traveling to the distant center. The estimated cost to parents for fetal cardiac evaluation at the distant center was nine times greater than that of telecardiology ($581 vs $61). Congenital heart disease or arrhythmia was diagnosed in 28 and 15 fetuses, respectively; there was one false-negative result. All fetuses were correctly risk-stratified with respect to delivery location. CONCLUSIONS Neither diagnostic quality nor patient satisfaction were sacrificed with telecardiology. The program was feasible, empowered the local health care providers and ultrasonographers, offered strong economic advantages to families, and offered the benefit of timely standard-of-care, face-to-face consultation without travel. Based on the success of this program, further studies are warranted to assess its replicability.
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Affiliation(s)
- Bettina F Cuneo
- Colorado Fetal Care Center, the Heart Institute, the Department of Pediatrics, and the TeleHealth Department, Children's Hospital Colorado, and the University of Colorado School of Medicine, Aurora, and St. Mary's Medical Center, Grand Junction, Colorado; the Department of Pediatrics, Children's Hospital of Wisconsin; Milwaukee Wisconsin; and the Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado
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17
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Wehrmann M, Patel SS, Haxel C, Cassidy C, Howley L, Cuneo B, Gien J, Kinsella JP. Implications of Atrial-Level Shunting by Echocardiography in Newborns with Congenital Diaphragmatic Hernia. J Pediatr 2020; 219:43-47. [PMID: 32014282 DOI: 10.1016/j.jpeds.2019.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/08/2019] [Accepted: 12/17/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine whether postnatal echocardiographic indices of left ventricular (LV) size and function are associated with atrial-level shunt direction and investigate whether a relationship exists between LV function and LV size in patients with congenital diaphragmatic hernia (CDH). STUDY DESIGN This was a single-center retrospective study of 51 neonates with CDH evaluated at Children's Hospital Colorado. Initial postnatal echocardiograms were analyzed for cardiac dimensions, valvar integrity, cardiac time intervals, and biventricular function. Comparisons were made between neonates with left-to-right vs right-to-left atrial-level shunting, as well as between those with decreased (ejection fraction <55%) vs normal (ejection fraction ≥55%) LV function. RESULTS The majority (82.4%) of infants with CDH had a left-to-right atrial-level shunt, and 84.3% had systemic or suprasystemic pulmonary artery pressure. Decreased LV function was demonstrated in 37.2% and was associated with smaller LV volumes and worse outcomes, including the need for extracorporeal membrane oxygenation (ECMO) and survival. CONCLUSIONS Left-to-right atrial-level shunting is common in neonates with severe CDH, even in the presence of suprasystemic pulmonary artery pressure. LV dysfunction correlates with decreased LV volumes and is associated with adverse neonatal outcomes, including increased need for ECMO and decreased survival.
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Affiliation(s)
- Melissa Wehrmann
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
| | - Sonali S Patel
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Caitlin Haxel
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Division of Pediatric Cardiology, University of Vermont Lerner College of Medicine, University of Vermont Children's Hospital, Burlington, VT
| | - Courtney Cassidy
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Lisa Howley
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Division of Pediatric Cardiology, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Bettina Cuneo
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Jason Gien
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - John P Kinsella
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
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18
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Frank BS, Runciman M, Manning WA, Ivy DD, Abman SH, Howley L. Pulmonary Hypertension Secondary to Scurvy in a Developmentally Typical Child. J Pediatr 2019; 208:291-291.e2. [PMID: 30738657 DOI: 10.1016/j.jpeds.2018.12.068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Benjamin S Frank
- Section of Cardiology, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Martin Runciman
- Section of Cardiology, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - William A Manning
- Section of Internal Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - D Dunbar Ivy
- Section of Cardiology, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Steven H Abman
- Pediatric Heart Lung Center, Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Lisa Howley
- Section of Cardiology, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
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Cuneo BF, Sonesson SE, Levasseur S, Moon-Grady AJ, Krishnan A, Donofrio MT, Raboisson MJ, Hornberger LK, Van Eerden P, Sinkovskaya E, Abuhamad A, Arya B, Szwast A, Gardiner H, Jacobs K, Freire G, Howley L, Lam A, Kaizer AM, Benson DW, Jaeggi E. Home Monitoring for Fetal Heart Rhythm During Anti-Ro Pregnancies. J Am Coll Cardiol 2018; 72:1940-1951. [DOI: 10.1016/j.jacc.2018.07.076] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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20
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Yamamoto Y, Hirose A, Howley L, Savard W, Jain V, Hornberger LK. Parameters of fetal pulmonary vascular health: baseline trends and response to maternal hyperoxia in the second and third trimesters. Ultrasound Obstet Gynecol 2017; 50:618-623. [PMID: 27943455 DOI: 10.1002/uog.17383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/01/2016] [Revised: 10/20/2016] [Accepted: 12/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Several parameters, including branch pulmonary artery (PA) diameter and Doppler-derived PA acceleration-to-ejection time ratio (AT/ET), peak late-systolic/early-diastolic reversed flow (PEDRF) and pulsatility index (PI) response to maternal hyperoxia, have been used to investigate fetal pulmonary health. Lower AT/ET, increased PEDRF and lack of PI response to hyperoxia have been observed in fetuses with severe lung hypoplasia and are considered markers of pulmonary vascular resistance. We sought to further define the evolution of PA diameter and Doppler parameters and their response to maternal hyperoxia in healthy fetuses. METHODS Fifty-four prospectively recruited women with healthy pregnancy underwent fetal echocardiography from 18-36 weeks of gestation. After baseline branch PA diameter and Doppler assessment, oxygen (8-10 L/min) was administered by non-reservoir facemask for 10 min and PA Doppler parameters were reassessed. RESULTS Branch PA diameters and AT/ET increased linearly with gestational age, while PEDRF increased quadratically (P < 0.001 for all) and PA-PI did not change. In response to maternal hyperoxia, although most fetuses demonstrated a significant decrease in PI for both branch PAs (right PA, P = 0.025; left PA, P = 0.040) ≥ 30 weeks, significant variability was observed in PI response with 31% of cases demonstrating either no response or a slight decrease. No other parameter demonstrated a measurable change in response to maternal hyperoxia. CONCLUSIONS From the mid-trimester, fetal branch PA diameters and AT/ET increase linearly and PEDRF increases quadratically, whereas PI remains unchanged. Although maternal hyperoxia triggers a significant decrease in PA-PI after 30 weeks, variability in this response may reduce its utility in clinical practice. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Y Yamamoto
- Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, Women's & Children's Health Research Institute and Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - A Hirose
- Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, Women's & Children's Health Research Institute and Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L Howley
- Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, Women's & Children's Health Research Institute and Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - W Savard
- Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, Women's & Children's Health Research Institute and Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - V Jain
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - L K Hornberger
- Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, Women's & Children's Health Research Institute and Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
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Zaretsky MV, Patel S, Howley L, Galan H, Behrendt N, Liechty K, Cuneo B. 127: Biventricular diastolic but not systolic function is impaired in fetal lower urinary tract obstruction. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ehrig J, Meyers M, Behrendt N, Howley L, Cuneo B, Mirsky D, Zaretsky M, Liechty K, Crombleholme T, Galan HL. 608: Abnormal fetal vascular studies in Twin Twin Transfusion Syndrome (TTTS) and their association to abnormalities in fetal brain MRI. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Howley L, Wood C, Patel SS, Zaretsky MV, Crombleholme T, Cuneo B. Flow patterns in the ductus arteriosus during open fetal myelomeningocele repair. Prenat Diagn 2015; 35:564-70. [DOI: 10.1002/pd.4573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/28/2015] [Accepted: 02/01/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Lisa Howley
- Department of Pediatric Cardiology, The Fetal Heart Program, Colorado Fetal Care Center; Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine; Aurora CO USA
| | - Cristina Wood
- Department of Anesthesiology; Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine; Aurora CO USA
| | - Sonali S. Patel
- Department of Pediatric Cardiology, The Fetal Heart Program, Colorado Fetal Care Center; Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine; Aurora CO USA
| | - Michael V. Zaretsky
- Department of Maternal-Fetal Medicine; Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine; Aurora CO USA
- Department of Fetal Surgery; Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine; Aurora CO USA
| | - Timothy Crombleholme
- Department of Fetal Surgery; Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine; Aurora CO USA
| | - Bettina Cuneo
- Department of Pediatric Cardiology, The Fetal Heart Program, Colorado Fetal Care Center; Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine; Aurora CO USA
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Peng E, Howley L, Cromblehome TM, Jaggers J. Ex-utero intrapartum treatment as a novel bridging strategy to surgery in hypoplastic left heart syndrome with intact atrial septum—cross-circulation revisited. J Thorac Cardiovasc Surg 2015; 149:935-7. [DOI: 10.1016/j.jtcvs.2014.11.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/12/2014] [Accepted: 11/19/2014] [Indexed: 11/30/2022]
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Fagan T, Eisdorfer S, Landeck B, Howley L, Aldoss O, Twite M, Jaggers J, Ing RJ. Interventional cardiac catheterization in a newborn with hypoplastic left heart syndrome, severely restricted interatrial septum and cor triatriatum. Interv Cardiol 2014. [DOI: 10.2217/ica.14.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chelliah A, Bulas D, Carroll S, Davey B, Divanovic A, Gillespie C, Howley L, Kavanaugh-McHugh A, Kovalchin J, Levasseur S, Lindblade C, Moon-Grady A, Morris S, Pruetz J, Puchalski M, Rychik J, Samai C, Tacy T, Vernon M, Weinberg J, Yeh J, Donofrio M. FETAL ECHOCARDIOGRAPHY PREDICTS CLINICAL PRESENTATION AND OUTCOME IN TETRALOGY OF FALLOT WITH ABSENT PULMONARY VALVE: A MULTICENTER STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McBrien A, Howley L, Yamamoto Y, Hutchinson D, Hirose A, Sekar P, Jain V, Motan T, Trines J, Savard W, Hornberger LK. Changes in fetal cardiac axis between 8 and 15 weeks' gestation. Ultrasound Obstet Gynecol 2013; 42:653-658. [PMID: 24273201 DOI: 10.1002/uog.12478] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 09/17/2012] [Revised: 03/25/2013] [Accepted: 03/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To document changes in the normal embryonic/fetal cardiac axis in the late first and early second trimesters of pregnancy. METHODS Images from 188 fetal echocardiograms performed prospectively between 8 and 15 weeks' gestation in 166 healthy pregnancies and in 10 pregnancies with severe fetal heart disease were reviewed. For each echocardiogram, three measurements of the cardiac axis were taken in the axial plane at the level of the four-chamber view. Differences in mean embryonic/fetal cardiac axis at different gestational ages in the healthy pregnancies were compared. RESULTS The mean ± SD embryonic/fetal cardiac axis was 25.5 ± 11.5° from 8 + 0 to 9 + 6 weeks (Group 1), 40.4 ± 9.2° from 10 + 0 to 11 + 6 weeks (Group 2), 49.2 ± 7.4° from 12 + 0 to 12 + 6 weeks (Group 3), 50.6 ± 5.7° from 13 + 0 to 13 + 6 weeks (Group 4) and 48.6 ± 7.3° from 14 + 0 to 14 + 6 weeks (Group 5). Groups 1 and 2 were significantly different from each other and all other groups (P < 0.05). The results for 22 cases with repeat measurements from 8 + 0 to 11 + 6 and 12 + 0 to 14 + 6 weeks confirmed that the embryonic/fetal cardiac axis increased significantly (P < 0.001). In the cases with severe congenital heart disease, the cardiac axis was > 90th centile in four cases and < 10th centile in two cases. CONCLUSIONS The embryonic cardiac axis is relatively midline at 8 weeks and levorotates in the late first trimester. By 12 weeks' gestation, the normal leftward fetal cardiac axis is established and remains stable until at least 14 + 6 weeks. Observation of an abnormal cardiac axis in some cases of severe congenital heart disease prior to 15 weeks' gestation may assist in prenatal detection.
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Affiliation(s)
- A McBrien
- Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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Hutchinson D, McBrien A, Howley L, Yamamoto Y, Hirose A, Motan T, Jain V, Savard W, Hornberger LK. EARLY FIRST TRIMESTER FETAL ECHOCARDIOGRAPHY: IDENTIFICATION OF CARDIAC STRUCTURES BY 2D IMAGING AND COLOR DOPPLER FROM SIX WEEKS GESTATION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60556-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Belyansky I, Martin T, Prabhu A, Phillips R, Sindram D, Norton J, Howley L, Stefanidis D. Poor Resident- Attending Intraoperative Communication May Compromise Patient Safety. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Howley L, Szauter K, Perkowski L, Clifton M, McNaughton N. Quality of standardised patient research reports in the medical education literature: review and recommendations. Med Educ 2008; 42:350-8. [PMID: 18298448 DOI: 10.1111/j.1365-2923.2007.02999.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
CONTEXT In order to assess or replicate the research findings of published reports, authors must provide adequate and transparent descriptions of their methods. We conducted 2 consecutive studies, the first to define reporting standards relating to the use of standardised patients (SPs) in research, and the second to evaluate the current literature according to these standards. METHODS Standards for reporting SPs in research were established by representatives of the Grants and Research Committee of the Association of Standardized Patient Educators (ASPE). An extensive literature search yielded 177 relevant English-language articles published between 1993 and 2005. Search terms included: 'standardised patient(s)'; 'simulated patient(s)'; 'objective structured clinical examination (OSCE)', and 'clinical skills assessment'. Articles were limited to those reporting the use of SPs as an outcome measure and published in 1 of 5 prominent health sciences education journals. Data regarding the SP encounter, SP characteristics, training and behavioural measure(s) were gathered. RESULTS A random selection of 121 articles was evaluated according to 29 standards. Reviewers judged that few authors provided sufficient details regarding the encounter (21%, n = 25), SPs (16%, n = 19), training (15%, n = 15), and behavioural measures (38%, n = 44). Authors rarely reported SP gender (27%, n = 33) and age range (22%, n = 26), whether training was provided for the SPs (39%, n = 47) or other raters (24%, n = 29), and psychometric evidence to support the behavioural measure (23%, n = 25). CONCLUSIONS The findings suggest that there is a need for increased rigor in reporting research involving SPs. In order to support the validity of research findings, journal editors, reviewers and authors are encouraged to provide adequate detail when describing SP methodology.
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Affiliation(s)
- Lisa Howley
- Department of Educational Leadership, University of North Carolina at Charlotte, Charlotte, North Carolina, USA.
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Howley L. A strategy for company improvement. Med Device Technol 2000; 11:33-6. [PMID: 10915491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Strategies based on the kaizen methodology are designed to continuously improve company performance without the need for large capital investments. This article looks at how one company used simple kaizen principles to its advantage, achieving 67% increase in productivity and 10% reduction in the standard cost of product.
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Affiliation(s)
- L Howley
- Stryker Howmedica Osteonics, Limerick, Ireland.
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