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Colín Ortiz JL, Sánchez González SK, Aguirre Alfredo B, Guerrero Carlos GR, Carlos Alfonso CV. Percutaneous transient occlusion of the transtricuspid flow: a new method to evaluate the right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum. Cardiol Young 2024; 34:120-125. [PMID: 37231590 DOI: 10.1017/s1047951123001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Pulmonary atresia with an intact ventricular septum is characterised by heterogeneity in right ventricle morphology and coronary anatomy. In some cases, the presence of ventriculocoronary connections may promote coronary artery stenosis or interruption, and aortic diastolic pressure may not be sufficient to drive coronary blood flow. This requires a correct evaluation (currently done by angiography) which depends on whether the patient can be offered decompression of the right ventricle. To date, there is no objective method to do so, so we designed a percutaneous, transitory technique with the purpose of occluding the transtricuspid anterograde flow. The manoeuverer was performed in a 25-day-old female with pulmonary atresia with intact ventricular septum, right ventricle at suprasystemic level, and selective coronarography was not conclusive, the anterior descendant with stenosis in its middle third and from this point, thinner with to-fro flow. Occlusion was performed with a balloon catheter. We re-evaluated the coronary flow and the normalised anterior descendant flow. We hope that with this new method, we can give a more accurate diagnosis and determine the cases in which the coronary circulation is truly not right ventricle dependent to offer a greater number of patients biventricular or 1.5 ventricular repairs and thereby improve their quality of life and survival, the ones that turn out to be right ventricular dependant; offer them an early reference for cardiac transplant or in case it is not available to consider univentricular palliation knowing that this probably would not reduce the risk of ischaemia and/or death over time.
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Affiliation(s)
- José Luis Colín Ortiz
- Department of Paediatric Cardiology, National Institute of Paediatrics, México City, México
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2
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Najm HK, Costello JP, Karamlou T, Amdani S, Suntharos P, Marino B. Revascularization of coronary circulation in pulmonary atresia with intact ventricular septum and right ventricular-dependent coronary circulation. J Thorac Cardiovasc Surg 2023; 166:e154-e158. [PMID: 37156366 DOI: 10.1016/j.jtcvs.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Hani K Najm
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio.
| | - John P Costello
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Tara Karamlou
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Shahnawaz Amdani
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Patcharapong Suntharos
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bradley Marino
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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3
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Kohbodi GA, Ashrafi AH, Levy VY. Assessment and management of neonates with unrepaired congenital heart disease. Curr Opin Cardiol 2023; 38:385-389. [PMID: 37016942 DOI: 10.1097/hco.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
PURPOSE OF REVIEW To review preoperative assessment and management of neonates with congenital heart disease (CHD). RECENT FINDINGS The spectrum for neonates with CHD can be wide and complex. An in-depth understanding of their physiology is the first step in assessing their hemodynamics and developing an effective therapeutic strategy. SUMMARY There is significant heterogeneity in the anatomy and physiology in newborns with CHD. Their complex pathophysiology can be simplified into seven basic subtypes, which include systolic dysfunction, diastolic dysfunction, excessive pulmonary blood flow, obstructed pulmonary blood flow, obstructed systemic blood flow, transposition physiology, and single ventricle physiology. It is important to note these physiologies are not mutually exclusive, and this review summarizes the hemodynamic and therapeutic strategies available for the preoperative neonate with CHD.
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Affiliation(s)
| | | | - Victor Y Levy
- Logan Health Children's Hospital, Kalispell, Montana, USA
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Boucek K, Hlavacek A. The Utility of CT Angiography in Neonates with Pulmonary Atresia with Intact Ventricular Septum and Concern for Right Ventricular Dependent Coronary Circulation: Case Series. Pediatr Cardiol 2023:10.1007/s00246-022-03055-z. [PMID: 36729238 DOI: 10.1007/s00246-022-03055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/21/2022] [Indexed: 02/03/2023]
Abstract
Up to one third of patients with pulmonary atresia with intact ventricular septum (PA-IVS) will have inadequate anterograde coronary blood flow and rely on fistulous connections from the right ventricle (RV) for myocardial perfusion, known as RV-dependent coronary circulation (RVDCC). Historically, identification of the extent of ventriculocoronary connections and coronary stenosis has required invasive imaging with cardiac catheterization and angiography. Cardiac computed tomography (CCT) potentially provides a less invasive imaging option for therapeutic planning in this group of patients. We describe six neonates with PA-IVS who underwent both CCT and cardiac catheterization at our institution prior to any surgical or transcatheter intervention between 2009 and 2019. Imaging was concerning for RVDCC in all six patients. The average tricuspid Z-score was - 4.19 (2.1 to - 5.34). Two patients underwent cardiac transplantation and two patients underwent ductal stenting. The overall mortality rate was 50%. CCT findings closely mirrored the findings of invasive cardiac catheterization and identified important morphological variations. The average radiation exposure (DLP) per CCT was (10.5 mGy cm, range 6-20). Technological improvements in CCT have enabled adequate visualization of coronary anomalies in children with comparable accuracy to cardiac catheterization, but considerably less radiation exposure. However, diagnosis of RVDCC requires direct right ventricular angiography. Therefore, the potential benefit of obtaining a CCT prior to catheterization for infants with PA-IVS is the ability to risk stratify, assist with procedural planning, and improve family counseling.
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Affiliation(s)
- Katerina Boucek
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 10 McClennan Banks Dr, Charleston, SC, 29425, USA.
| | - Anthony Hlavacek
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 10 McClennan Banks Dr, Charleston, SC, 29425, USA
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Ashrafi AH, Mazwi M, Sweeney N, van Dorn CS, Armsby LB, Eghtesady P, Ringle M, Justice LB, Gray SB, Levy V. Preoperative Management of Neonates With Congenital Heart Disease. Pediatrics 2022; 150:e2022056415F. [PMID: 36317975 DOI: 10.1542/peds.2022-056415f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
Clinicians caring for neonates with congenital heart disease encounter challenges in clinical care as these infants await surgery or are evaluated for further potential interventions. The newborn with heart disease can present with significant pathophysiologic heterogeneity and therefore requires a personalized therapeutic management plan. However, this complex field of neonatal-cardiac hemodynamics can be simplified. We explore some of these clinical quandaries and include specific sections reviewing the anatomic challenges in these patients. We propose this to serve as a primer focusing on the hemodynamics and therapeutic strategies for the preoperative neonate with systolic dysfunction, diastolic dysfunction, excessive pulmonary blood flow, obstructed pulmonary blood flow, obstructed systemic blood flow, transposition physiology, and single ventricle physiology.
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Affiliation(s)
| | - Mjaye Mazwi
- Hospital for Sick Children, Toronto, Ontario
| | | | | | | | | | - Megan Ringle
- Lucile Packard Children's Hospital, Palo Alto, California
| | | | - Seth B Gray
- Hospital for Sick Children, Toronto, Ontario
| | - Victor Levy
- Lucile Packard Children's Hospital, Palo Alto, California
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Joong A, Zuckerman WA, Koehl D, Cantor R, Alejos JC, Ameduri RK, Boyle GJ, Rothkopf AC, Kirklin JK, Gajarski RJ. Outcomes of infants with pulmonary atresia with intact ventricular septum listed for heart transplantation: A multi-institutional study. Pediatr Transplant 2022; 26:e14338. [PMID: 35768886 DOI: 10.1111/petr.14338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/30/2022] [Accepted: 05/28/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Management of infants with pulmonary atresia/intact ventricular septum (PA/IVS) is variable. Because of higher mortality in more severe forms, heart transplant (HT) is an acceptable approach, but waitlist and post-transplant outcomes are unclear. This study compared outcomes of infants with PA/IVS vs. other single ventricle (SV) anatomies listed for HT. METHODS Data from the Pediatric Heart Transplant Society (1993-2018) were analyzed for survival and risk factors for mortality. RESULTS Of 1617 SV infants, 300 had PA/IVS (19%) and 1317 had other SV (81%). Overall, 1-, 5-, and 10-year survival was higher among PA/IVS (74%, 65%, 61%) versus other SV infants (62%, 54%, 50%, p = .004). While waitlist mortality was similar between groups (p = .09), PA/IVS was an independent predictor of improved waitlist survival (HR 0.68, p = .03), and PA/IVS infants had higher incidence of waitlist removal (8% vs. 5.5%, p = .03), most commonly for being "too well." Post-transplant survival was superior among PA/IVS versus other SV infants (1- and 5-year survival 93% and 81% vs. 80% and 71%, p < .0001). Risk factors for PA/IVS waitlist mortality (2008-2018) included extracorporeal membrane oxygenation and mechanical ventilation. Prior aortopulmonary (AP) shunt among PA/IVS infants was associated with improved waitlist survival. CONCLUSIONS Overall survival among PA/IVS infants listed for HT exceeds that of other SV infants with PA/IVS identified as an independent predictor of improved waitlist and post-transplant survival. Prior AP shunt among listed PA/IVS infants was associated with improved waitlist outcomes, though, which may reflect a listing selection bias.
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Affiliation(s)
- Anna Joong
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Warren A Zuckerman
- Division of Pediatric Cardiology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University, New York, New York, USA
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama, USA
| | - Ryan Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama, USA
| | - Juan C Alejos
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, University of California, Los Angeles, California, USA
| | - Rebecca K Ameduri
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gerard J Boyle
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Amy C Rothkopf
- Division of Pediatric Cardiology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University, New York, New York, USA
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama, USA
| | - Robert J Gajarski
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
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Malone LJ, Browne LP, Morgan GJ, Lovell MA, Campbell DN, Jaggers JJ, Leahy RA, Mitchell MB, Mong DA, Weinman JP, Zablah JE, Stone ML. Computed Tomographic Angiography Provides Reliable Coronary Artery Evaluation in Infants With Pulmonary Atresia Intact Ventricular Septum. Semin Thorac Cardiovasc Surg 2022:S1043-0679(22)00255-6. [PMID: 36244628 DOI: 10.1053/j.semtcvs.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
Evaluate the use of coronary CTA as an initial assessment for determining Right Ventricle Dependent Coronary Circulation (RVDCC) in neonates with Pulmonary Atresia with Intact Ventricular Septum (PA IVS). Retrospective review of cases with coronary CTA and compare with available catheter angiography, pathology, surgical reports, and outcomes from Mar 2015 to May 2022. In our cohort of 16 patients, 3 were positive for RVDCC, confirmed by pathologic evaluation, and there was concordance for presence or absence of RVDCC with catheter angiography in 5 patients (4 negatives for RVDCC, 1 positive). Clinical follow up for the 8 patients that underwent RV decompression had no clinical evidence of myocardial ischemia. Our findings suggest that coronary CTA is reliable as first-line imaging for determination of RVDCC in neonates with PA IVS. These findings, if supported by further prospective study, may reserve invasive coronary angiography for cases with diagnostic uncertainty or at the time of necessary transcatheter interventions.
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Affiliation(s)
- LaDonna J Malone
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado.
| | - Lorna P Browne
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Gareth J Morgan
- Department of Cardiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Mark A Lovell
- Department of Pathology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - David N Campbell
- Department of Cardiothoracic Surgery, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - James J Jaggers
- Department of Cardiothoracic Surgery, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Ryan A Leahy
- Department of Cardiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Max B Mitchell
- Department of Cardiothoracic Surgery, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - David A Mong
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Jason P Weinman
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Jenny E Zablah
- Department of Cardiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Matthew L Stone
- Department of Cardiothoracic Surgery, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
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Cheung EW, Mastropietro CW, Flores S, Amula V, Radman M, Kwiatkowski D, Puente BN, Buckley JR, Allen K, Loomba R, Kakri K, Chiwane S, Cashen K, Piggott K, Kapileshwarkar Y, Gowda KMN, Badheka A, Raman R, Costello JM, Zang H, Iliopoulos I. Procedural Outcomes of Pulmonary Atresia Intact Ventricular Septum in Neonates: A Multicenter Study. Ann Thorac Surg 2022; 115:1470-1477. [PMID: 36070807 DOI: 10.1016/j.athoracsur.2022.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/10/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multicenter contemporary data describing short-term outcomes following initial interventions of neonates with pulmonary atresia intact ventricular septum (PA-IVS) are limited. This multicenter study aims to describe characteristics and outcomes of PA-IVS neonates following their initial catheter or surgical intervention and identify factors associated with major adverse cardiac events (MACE). METHODS Neonates with PA-IVS who underwent surgical or catheter intervention between 2009-2019 in 19 centers were reviewed. Risk factors for MACE, defined as cardiopulmonary resuscitation, mechanical circulatory support, stroke, or in-hospital mortality, were analyzed using multivariable logistic regression model. RESULTS We reviewed 279 neonates: 79 (28%) underwent right ventricular decompression, 151 (54%) underwent systemic-to-pulmonary shunt or ductal stent placement only, 36 (13%) underwent right ventricular decompression with shunt or ductal stent placement, and 11 (4%) underwent transplantation. MACE occurred in 57 patients (20%): 26 (9%) received mechanical circulatory support, 37 (13%) received cardiopulmonary resuscitation, 16 (6%) suffered stroke, 23 (8%) died. The presence of two major coronary artery stenoses (adjusted OR: 4.99; 95% CI: 1.16-21.39) and lower weight at first intervention (adjusted OR: 1.52, 95% CI: 1.01-2.27) were significantly associated with MACE. Coronary ischemia was the most frequent presumed mechanism of death (n=10). CONCLUSIONS In a multicenter cohort, one in five neonates with PA-IVS experienced MACE following their initial intervention. Patients with two major coronary artery stenoses or lower weight at time of initial procedure were most likely to experience MACE and warrant vigilance during pre-intervention planning and post-intervention management.
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Affiliation(s)
- Eva W Cheung
- Division of Pediatric Critical Care & Hospital Medicine, Columbia University Irving Medical Center, New York, New York.
| | - Christopher W Mastropietro
- Division of Pediatric Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Saul Flores
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Venugopal Amula
- Division of Pediatric Critical Care, University of Utah Health, Salt Lake City, Utah
| | - Monique Radman
- Division of Pediatric Critical Care, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - David Kwiatkowski
- Division of Pediatric Cardiology, Stanford University School of Medicine, Lucille Packard Children's Hospital, Palo Alto, California
| | - Bao Nguyen Puente
- Division of Cardiac Critical Care, Children's National Health System, Washington, District of Columbia
| | - Jason R Buckley
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Kiona Allen
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rohit Loomba
- Department of Pediatrics, Chicago Medical School, Advocate Children's Hospital, Chicago, Illinois
| | - Karan Kakri
- Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Saurabh Chiwane
- Division of Pediatric Critical Care, Saint Louis University, Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Katherine Cashen
- Division of Critical Care Medicine, Duke University, Duke Children's Hospital, Durham, North Carolina
| | - Kurt Piggott
- Department of Pediatrics, LSU School of Medicine Children's Hospital, New Orleans, Louisiana
| | | | | | - Aditya Badheka
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Rahul Raman
- Department of Pediatrics, Mercy Medical Center, Des Moines, Iowa
| | - John M Costello
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Huaiyu Zang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ilias Iliopoulos
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Sukhavasi A, McHugh-Grant S, Glatz AC, Mondal A, Griffis H, Burnham N, Chen JM, Mascio CE, Gaynor JW, Spray TL, Fuller SM. Pulmonary Atresia with Intact Ventricular Septum: Intended Strategies. J Thorac Cardiovasc Surg 2022; 164:1277-1288. [DOI: 10.1016/j.jtcvs.2021.11.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/06/2021] [Accepted: 11/24/2021] [Indexed: 10/31/2022]
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Spigel ZA, Qureshi AM, Adachi I. Stratification of the Right Ventricle Dependent Coronary Circulation: Relevance to Treatment Strategy. J Thorac Cardiovasc Surg 2022; 164:765-769. [DOI: 10.1016/j.jtcvs.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
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Kawakubo M, Nagao M, Yamamoto A, Nakao R, Matsuo Y, Kaneko K, Watanabe E, Sakai A, Sasaki M, Sakai S. 13 N-ammonia PET-derived right ventricular longitudinal strain and myocardial flow reserve in right coronary artery disease. Eur J Nucl Med Mol Imaging 2021; 49:1870-1880. [PMID: 34897553 DOI: 10.1007/s00259-021-05647-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We developed a feature-tracking algorithm for use with electrocardiography-gated high-resolution 13 N-ammonia positron emission tomography (PET) imaging, and we hypothesized it could be used to clarify the association between right ventricular (RV) longitudinal strain (LS) and right coronary artery (RCA) ischemia. The aim of this study was to investigate the association between the reduction of regional myocardial flow reserve (MFR) in RCA territories and PET-derived LS of the RV free wall. METHODS Ninety-three patients with coronary artery stenosis > 50%, diagnosed by coronary computed tomography angiography, and 10 controls were retrospectively analyzed. RV-LS in the free wall was measured by a feature-tracking technique on the resting and stressed 13 N-ammonia PET images of horizontal long axis slices. The patients were sub-grouped according to regional MFR values at the territories of RCA, left anterior descending artery (LAD), and left circumflex coronary artery (LCx): RCA-MFR < 2.0 [n = 34], RCA-MFR ≥ 2.0 but MFR < 2.0 at LAD or LCx territories [n = 11], and MFR ≥ 2.0 for all territories [n = 48]. Stress and resting RV-LS were compared in each of the four groups. Multiple comparisons of RV-LS among the four groups were performed in the stress and resting state. RESULTS Decreased stress RV-LS in patients with an RCA-MFR < 2.0 was observed. In the patients with MFR ≥ 2.0 for all territories, the stressed RV-LS was significantly increased compared to that in the resting state. Significantly decreased RV free wall LS during adenosine stress in patients with RCA-MFR < 2.0 was observed in the other three groups. CONCLUSIONS We measured RV myocardial LS using feature tracking in cine imaging of 13 N-ammonia PET. The results of this study suggest that PET-derived stressed RV-LS is useful for detecting reduced RV myocardial motion due to ischemia in the RCA territory.
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Affiliation(s)
- Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuka Matsuo
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Koichiro Kaneko
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Eri Watanabe
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Subramanian S, Mery CM. Commentary: 1V, 1.5V, 2V- Does It Really Matter? Semin Thorac Cardiovasc Surg 2021; 34:1320-1321. [PMID: 34785352 DOI: 10.1053/j.semtcvs.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Sujata Subramanian
- Texas Center for Pediatric and Congenital Heart Disease; UT Health Austin / Dell Children's Medical Center; Austin, TX; Department of Surgery and Perioperative Care; Dell Medical School at The University of Texas at Austin; Austin, TX
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease; UT Health Austin / Dell Children's Medical Center; Austin, TX; Department of Surgery and Perioperative Care; Dell Medical School at The University of Texas at Austin; Austin, TX.
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13
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Nealon E, Berman D, Rowland D, Boe B, Lloyd E, Cua CL. Absent pulmonary valve or pulmonary atresia with intact ventricular septum: Which is it? Echocardiography 2020; 37:1869-1872. [PMID: 33011997 DOI: 10.1111/echo.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
A fetal echocardiogram noted valvar pulmonary atresia vs critical pulmonary valve stenosis, confluent pulmonary arteries, patent ductus arteriosus, and an apical muscular ventricular septal defect vs coronary sinusoid. Postnatal echocardiogram documented an absent pulmonary valve, coronary artery fistula to the right ventricle, confluent pulmonary arteries, and a patent ductus arteriosus. Catheterization confirmed the postnatal echocardiographic findings except there was no antegrade flow from the right ventricle to the pulmonary arteries. Close evaluation of all imaging modalities revealed the final diagnosis of absent pulmonary valve with a double-chambered right ventricle with no egress from the right ventricle to pulmonary artery.
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Affiliation(s)
- Erin Nealon
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Darren Berman
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel Rowland
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Eric Lloyd
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
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