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Schloeglhofer T, Gross C, Abart T, Schaefer A, Widhalm G, Marko C, Röhrich M, Weigel I, Kaufmann F, Karner B, Riebandt J, Wiedemann D, Laufer G, Schima H, Granegger M, Zimpfer D. Beyond the Limits of Current Pump Monitoring - HeartMate 3 SNOOPY in Echocardiographic Speed Ramp Tests. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1273] [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: 04/05/2023] Open
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Deveza e Silva RC, Jain P, Adji A, Shehab S, Muthiah K, Robson D, Koppe F, Granegger M, Jansz P, MacDonald P, Hayward C. Left Ventricular Contractile Reserve is Associated with Optimal Exercise Hemodynamics in Cf-lvad Patients: A Pressure-Volume Loop Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1685] [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: 04/05/2023] Open
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Granegger M, Küng S, Bollhalder O, Quandt D, Scheifele C, Drozdov D, Held U, Callegari A, Kretschmar O, Hübler M, Schweiger M, Knirsch W. Serial assessment of somatic and cardiovascular development in patients with single ventricle undergoing Fontan procedure. Int J Cardiol 2020; 322:135-141. [PMID: 32798629 DOI: 10.1016/j.ijcard.2020.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/18/2020] [Accepted: 08/07/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The palliation of patients with single ventricle (SV) undergoing Fontan procedure led to improved long-term survival but is still limited due to cardiovascular complications. The aim of this study was to describe the somatic and cardiovascular development of Fontan patients until adolescence and to identify determining factors. METHODS We retrospectively assessed somatic growth, vascular growth of pulmonary arteries, and cardiac growth of the SV and systemic semilunar valve from 0 to 16 years of age using transthoracic echocardiography. The Doppler inflow pattern of the atrioventricular valve was quantified by E-, A-wave and E/A ratio. All data were converted to z-scores and analyzed using linear mixed effect models to identify associations with age at Fontan procedure, gender, and ventricular morphology. RESULTS 134 patients undergoing Fontan procedure at a median age of 2.4 (IQR 2.12 to 2.8) years were analyzed. A catch-up of somatic growth after Fontan procedure until school age was found, with lower body height and weight z-scores in male patients and patients with systemic right ventricles. An early time of Fontan procedure was favorable for somatic growth, but not for vascular growth. Cardiac development indicated a decrease of SV end-diastolic diameter z-score until adolescence. Despite a trend towards normalization, E-wave and E/A ratio z-scores were diminished over the entire period. CONCLUSIONS There is a catch-up growth of somatic, vascular and cardiac parameters after Fontan procedure, which in our cohort depends on the time of Fontan procedure, ventricular morphology, and gender. Beside other factors, diastolic function of the SV remains altered.
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Affiliation(s)
- M Granegger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Küng
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - O Bollhalder
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - D Quandt
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Switzerland
| | - C Scheifele
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - D Drozdov
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - U Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - A Callegari
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Switzerland
| | - O Kretschmar
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Switzerland
| | - M Hübler
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Schweiger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - W Knirsch
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Switzerland.
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Aigner P, Schweiger M, Fraser K, Choi Y, Lemme F, Cesarovic N, Kertzscher U, Schima H, Hübler M, Granegger M. Ventricular Flow Field Visualization During Mechanical Circulatory Support in the Assisted Isolated Beating Heart. Ann Biomed Eng 2019; 48:794-804. [PMID: 31741229 PMCID: PMC6949310 DOI: 10.1007/s10439-019-02406-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/07/2019] [Indexed: 01/17/2023]
Abstract
Investigations of ventricular flow patterns during mechanical circulatory support are limited to in vitro flow models or in silico simulations, which cannot fully replicate the complex anatomy and contraction of the heart. Therefore, the feasibility of using echocardiographic particle image velocimetry (Echo-PIV) was evaluated in an isolated working heart setup. Porcine hearts were connected to an isolated, working heart setup and a left ventricular assist device (LVAD) was implanted. During different levels of LVAD support (unsupported, partial support, full support), microbubbles were injected and echocardiographic images were acquired. Iterative PIV algorithms were applied to calculate flow fields. The isolated heart setup allowed different hemodynamic situations. In the unsupported heart, diastolic intra-ventricular blood flow was redirected at the heart’s apex towards the left ventricular outflow tract (LVOT). With increasing pump speed, large vortex formation was suppressed, and blood flow from the mitral valve directly entered the pump cannula. The maximum velocities in the LVOT were significantly reduced with increasing support. For the first time, cardiac blood flow patterns during LVAD support were visualized and quantified in an ex vivo model using Echo-PIV. The results reveal potential regions of stagnation in the LVOT and, in future the methods might be also used in clinical routine to evaluate intraventricular flow fields during LVAD support.
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Affiliation(s)
- P Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, AKH-4L, 1090, Vienna, Austria. .,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
| | - M Schweiger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - K Fraser
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Y Choi
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - F Lemme
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - N Cesarovic
- Division of Surgical Research, Department of Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - U Kertzscher
- Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - H Schima
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, AKH-4L, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - M Hübler
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Granegger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Jain N, Vickers D, Granegger M, Schima H, Moscato F, Macdonald P, Jansz P, Hayward C. Circadian variation of haemodynamic parameters during continuous-flow ventricular assist device support. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.209] [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: 12/01/2022]
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Granegger M, Schlöglhofer T, Ober H, Riebandt J, Zimpfer D, Schima H, Moscato F. Daily Activity in Rotary Blood Pump Recipients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.569] [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: 11/17/2022] Open
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Granegger M, Mahr S, Horvat J, Aigner P, Zimpfer D, Schima H, Moscato F. An isolated large animal heart platform for cardiac research and cardiac device testing. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332285] [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: 10/27/2022]
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Moscato F, Granegger M, Edelmayer M, Zimpfer D, Wieselthaler G, Schima H. 778 Monitoring of Heart Rate Variability in Rotary Blood Pump Recipients Is Possible Using the Pump Flow Only. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.795] [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: 11/26/2022] Open
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Granegger M, Werther T, Roehrich M, Losert U, Gilly H. Human ECGs corrupted with real CPR artefacts in an animal model: generating a database to evaluate and refine algorithms for eliminating CPR artefacts. Resuscitation 2010; 81:730-6. [PMID: 20381230 DOI: 10.1016/j.resuscitation.2010.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 02/04/2010] [Accepted: 03/01/2010] [Indexed: 11/16/2022]
Abstract
AIM For the analysis of ECG rhythms during ongoing CPR, single- or two-channel methods have been proposed to eliminate artefacts from the CPR-corrupted ECG. To refine, test and evaluate these algorithms with a realistic data set, we introduce an animal model with which we created an extended database of human ECGs with real CPR artefacts. MATERIAL AND METHODS In a pig model real CPR-related artefacts were added to annotated human emergency ECGs. Via a special catheter placed in the oesophagus, ECG sequences (duration>10s) were fed in close to the dead pig's heart. The resulting surface potential was recorded on the thorax without and during ongoing chest compressions, which were monitored using a miniature force sensor. RESULTS The animals served as a vehicle for human ECGs, making it possible to create a database in which 918 real human ECG sequences (437 shockable and 481 non-shockable) were corrupted with CPR-induced artefacts. The achieved signal-to-noise ratios (SNR) ranged from -17 to +15 dB, sensitivity was 93.5% and specificity was 50.51%. The fed-in ECG and the uncorrupted surface ECG correlated almost perfectly (r=0.926+/-0.081; n=918), indicating negligible signal distortion due to the dead pig itself. CONCLUSION As the generated database includes both the original and the corrupted ECG covering a wide range of SNRs as well as the compression force signal, it provides an extended data set to evaluate the reconstruction performance of CPR artefact-removal algorithms.
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Affiliation(s)
- M Granegger
- Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Waehringerguertel, Vienna, Austria.
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