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Gould SW, Harty MP, Cartoski M, Krishnan V, Givler N, Ostrowski J, Tsuda T. Efficacy and safety of coronary computed tomography angiography in diagnosing coronary lesions in children. Cardiol Young 2024; 34:838-845. [PMID: 37877254 DOI: 10.1017/s1047951123003438] [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] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Identification of paediatric coronary artery abnormalities is challenging. We studied whether coronary artery CT angiography can be performed safely and reliably in children. MATERIALS Retrospective analysis of consecutive coronary CT angiography scans was performed for image quality and estimated radiation dose. Both factors were assessed for correlation with electrocardiographic-gating technique that was protocoled on a case-by-case basis, radiation exposure parameters, image noise artefact parameters, heart rate, and heart rate variability. RESULTS Sixty scans were evaluated, of which 96.5% were diagnostic for main left and right coronaries and 91.3% were considered diagnostic for complete coronary arteries. Subjective image quality correlated significantly with lower heart rate, increasing patient age, and higher signal-to-noise ratio. Estimated radiation dose only correlated significantly with choice of electrocardiographic-gating technique with median doses as follows: 2.42 mSv for electrocardiographic-gating triggered high-pitch spiral technique, 5.37 mSv for prospectively triggered axial sequential technique, 3.92 mSv for retrospectively gated technique, and 5.64 mSv for studies which required multiple runs. Two scans were excluded for injection failure and one for protocol outside the study scope. Five non-diagnostic cases were attributed to breathing motion, scanning prior to peak contrast enhancement, or scan acquisition during the incorrect portion of the R-R interval. CONCLUSIONS Diagnostic-quality coronary CT angiography can be performed reliably with a low estimated radiation exposure by tailoring each scan protocol to the patient's body habitus and heart rate. We propose coronary CT angiography is a safe and effective diagnostic modality for coronary artery abnormalities in children.
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Affiliation(s)
- Sharon W Gould
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - M Patricia Harty
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Mark Cartoski
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Vijay Krishnan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA
| | - Nicole Givler
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - John Ostrowski
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
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Edelson JB, Zak V, Goldberg D, Fleming G, Mackie AS, Patel JK, Files M, Downing T, Richmond M, Acheampong B, Cartoski M, Detterich J, McCrindle B, McHugh K, Hansen JE, Wagner J, Maria MD, Weingarten A, Nowlen T, Yoon JK, Kim GB, Williams R, Whitehill R, Kirkpatrick E, Yin S, Ermis P, Lubert AM, Stylianou M, Freemon D, Hu C, Garuba OD, Frommelt P, Goldstein BH, Paridon S, Garg R. The Effect of Udenafil on Heart Rate and Blood Pressure in Adolescents With the Fontan Circulation. Am J Cardiol 2024; 210:183-187. [PMID: 37918818 PMCID: PMC10872492 DOI: 10.1016/j.amjcard.2023.09.115] [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: 08/31/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 11/04/2023]
Abstract
The Fontan Udenafil Exercise Longitudinal (FUEL) trial showed that treatment with udenafil was associated with improved exercise performance at the ventilatory anaerobic threshold in children with Fontan physiology. However, it is not known how the initiation of phosphodiesterase 5 inhibitor therapy affects heart rate and blood pressure in this population. These data may help inform patient selection and monitoring after the initiation of udenafil therapy. The purpose of this study is to evaluate the effects of udenafil on vital signs in the cohort of patients enrolled in the FUEL trial. This international, multicenter, randomized, double-blind, placebo-controlled trial of udenafil included adolescents with single ventricle congenital heart disease who had undergone Fontan palliation. Changes in vital signs (heart rate [HR], systolic [SBP] and diastolic blood pressure [DBP]) were compared both to subject baseline and between the treatment and the placebo groups. Additional exploratory analyses were performed to evaluate changes in vital signs for prespecified subpopulations believed to be most sensitive to udenafil initiation. Baseline characteristics were similar between the treatment and placebo cohorts (n = 200 for each). The groups demonstrated a decrease in HR, SBP, and DBP 2 hours after drug/placebo administration, except SBP in the placebo group. There was an increase in SBP from baseline to after 6-min walk test in the treatment and placebo groups, and the treatment group showed an increase in HR (87.4 ± 15.0 to 93.1 ± 19.4 beats/min, p <0.01) after exercise. When comparing changes from baseline to the 26-week study visit, small decreases in both SBP (-1.9 ± 12.3 mm Hg, p = 0.03) and DBP (-3.0 ± 9.6 mm Hg, p <0.01) were seen in the treatment group. There were no clinically significant differences between treatment and placebo group in change in HR or blood pressure in the youngest age quartile, lightest weight quartile, or those on afterload-reducing agents. In conclusion, initiation of treatment with udenafil in patients with Fontan circulation was not associated with clinically significant changes in vital signs, implying that for patients similar to those enrolled in the FUEL trial, udenafil can be started without the requirement for additional monitoring after initial administration.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania.
| | | | - David Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Greg Fleming
- Duke Children's Pediatric and Congenital Heart Center, Durham, North Carolina
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, California
| | - Jyoti K Patel
- Division of Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew Files
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Tacy Downing
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia
| | - Marc Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Ben Acheampong
- Children's Hospital and Medical Center, University of Nebraska, Omaha, Nebraska
| | - Mark Cartoski
- Nemours Cardiac Center, Nemours / Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Brian McCrindle
- Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Kimberly McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Jesse E Hansen
- Division of Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Wagner
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, Missouri; Division of Clinical Pharmacology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Michael Di Maria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Angela Weingarten
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Nowlen
- Heart Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Ja Kyoung Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Gi Beom Kim
- Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Richard Williams
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Robert Whitehill
- Emory University, School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Edward Kirkpatrick
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Suellen Yin
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Peter Ermis
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Adam M Lubert
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mario Stylianou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood, Institute, National Institutes of Health, Bethesda, Maryland
| | - D'Andrea Freemon
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood, Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Olukayode D Garuba
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Peter Frommelt
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Bryan H Goldstein
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ruchira Garg
- Departments of Cardiology and Pediatrics, Cedars-Sinai Guerin Children's and Smidt Heart Institute, Los Angeles, California
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Detterich J, Taylor MD, Slesnick TC, DiLorenzo M, Hlavacek A, Lam CZ, Sachdeva S, Lang SM, Campbell MJ, Gerardin J, Whitehead KK, Rathod RH, Cartoski M, Menon S, Trachtenberg F, Gongwer R, Newburger J, Goldberg C, Dorfman AL. Cardiac Magnetic Resonance Imaging to Determine Single Ventricle Function in a Pediatric Population is Feasible in a Large Trial Setting: Experience from the Single Ventricle Reconstruction Trial Longitudinal Follow up. Pediatr Cardiol 2023; 44:1454-1461. [PMID: 37405456 PMCID: PMC10435402 DOI: 10.1007/s00246-023-03216-8] [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: 03/10/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
The Single Ventricle Reconstruction (SVR) Trial was a randomized prospective trial designed to determine survival advantage of the modified Blalock-Taussig-Thomas shunt (BTTS) vs the right ventricle to pulmonary artery conduit (RVPAS) for patients with hypoplastic left heart syndrome. The primary aim of the long-term follow-up (SVRIII) was to determine the impact of shunt type on RV function. In this work, we describe the use of CMR in a large cohort follow up from the SVR Trial as a focused study of single ventricle function. The SVRIII protocol included short axis steady-state free precession imaging to assess single ventricle systolic function and flow quantification. There were 313 eligible SVRIII participants and 237 enrolled, ages ranging from 10 to 12.5 years. 177/237 (75%) participants underwent CMR. The most common reasons for not undergoing CMR exam were requirement for anesthesia (n = 14) or ICD/pacemaker (n = 11). A total of 168/177 (94%) CMR studies were diagnostic for RVEF. Median exam time was 54 [IQR 40-74] minutes, cine function exam time 20 [IQR 14-27] minutes, and flow quantification time 18 [IQR 12-25] minutes. There were 69/177 (39%) studies noted to have intra-thoracic artifacts, most common being susceptibility artifact from intra-thoracic metal. Not all artifacts resulted in non-diagnostic exams. These data describe the use and limitations of CMR for the assessment of cardiac function in a prospective trial setting in a grade-school-aged pediatric population with congenital heart disease. Many of the limitations are expected to decrease with the continued advancement of CMR technology.
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Affiliation(s)
- Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles and the University of Southern California, 4650 Sunset Blvd MS34, Los Angeles, CA, 90027, USA.
| | - Michael D Taylor
- Department of Pediatrics, Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy C Slesnick
- Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, GA, USA
| | - Michael DiLorenzo
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anthony Hlavacek
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher Z Lam
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Division of Pediatric Imaging, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shagun Sachdeva
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sean M Lang
- Department of Pediatrics, Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Gerardin
- Departments of Internal Medicine and Pediatrics, Children's Hospital Wisconsin-Herma Heart Institute, Medical College of Wiscosin, Milwaukee, WI, USA
| | - Kevin K Whitehead
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rahul H Rathod
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Cartoski
- Division of Pediatric Cardiology, Nemours Cardiac Center, Nemours Children's Hospital, Wilmington, DE,, USA
| | - Shaji Menon
- Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jane Newburger
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Caren Goldberg
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Adam L Dorfman
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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