1
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Agha MS, Ermis PR, Franklin WJ, Parekh DR, Opina AD, Kim JJ, Miyake CY, Valdes SO, Lam WW. Dronedarone for the Treatment of Atrial Arrhythmias in Adults With Congenital Heart Disease. Tex Heart Inst J 2024; 51:e227993. [PMID: 38686681 DOI: 10.14503/thij-22-7993] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Atrial tachyarrhythmias are common and difficult to treat in adults with congenital heart disease. Dronedarone has proven effective in patients without congenital heart disease, but data are limited about its use in adults with congenital heart disease of moderate to great complexity. METHODS A single-center, retrospective chart review of 21 adults with congenital heart disease of moderate to great complexity who were treated with dronedarone for atrial tachyarrhythmias was performed. RESULTS The median (IQR) age at dronedarone initiation was 35 (27.5-39) years. Eleven patients (52%) were male. Ten patients (48%) had New York Heart Association class I disease, 10 (48%) had class II disease, and 1 (5%) had class III disease. Ejection fraction at initiation was greater than 55% in 11 patients (52%), 35% to 55% in 9 patients (43%), and less than 35% in 1 patient (5%). Prior treatments included β-blockers (71%), sotalol (38%), amiodarone (24%), digoxin (24%), and catheter ablation (38%). Rhythm control was complete in 5 patients (24%), partial in 6 (29%), and inadequate in 10 (48%). Two patients (10%) experienced adverse events, including nausea in 1 (5%) and cardiac arrest in 1 (5%), which occurred 48 months after initiation of treatment. There were no deaths during the follow-up period. The median (IQR) follow-up time for patients with complete or partial rhythm control was 20 (1-54) months. CONCLUSION Dronedarone can be effective for adult patients with congenital heart disease and atrial arrhythmias for whom more established therapies have failed, and with close monitoring it can be safely tolerated.
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Affiliation(s)
- Mahdi S Agha
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Peter R Ermis
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Wayne J Franklin
- Department of Pediatrics, Division of Cardiology, The University of Arizona College of Medicine, Phoenix, Arizona
| | - Dhaval R Parekh
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Angeline D Opina
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jeffrey J Kim
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Christina Y Miyake
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Santiago O Valdes
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Wilson W Lam
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
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2
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Doan TT, Pignatelli RH, Parekh DR, Parthiban A. Imaging and guiding intervention for tricuspid valve disorders using 3-dimensional transesophageal echocardiography in pediatric and congenital heart disease. Int J Cardiovasc Imaging 2023; 39:1855-1864. [PMID: 37341949 DOI: 10.1007/s10554-023-02898-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
In the pediatric and congenital heart disease (CHD) population, tricuspid valve (TV) disorders are complex due to the variable TV morphology, its sophisticated interaction with the right ventricle as well as associated congenital and acquired lesions. While surgery is the standard of care for TV dysfunction in this patient population, transcatheter treatment for bioprosthetic TV dysfunction has been performed successfully. Detailed and accurate anatomic assessment of the abnormal TV is essential in the preoperative/preprocedural planning. Three-dimensional transthoracic and 3D transesophageal echocardiography (3DTEE) provides added value to 2-dimensional imaging in the characterization of the TV to guide therapy and 3DTEE serves as an excellent tool for intraoperative assessment and procedural guidance of transcatheter treatment. Notwithstanding advances in imaging and therapy, the timing and indication for intervention for TV disorders in this population are not well defined. In this manuscript, we aim to review the available literature, provide our institutional experience with 3DTEE, and briefly discuss the perceived challenges and future directions in the assessment, surgical planning, and procedural guidance of (1) congenital TV malformations, (2) acquired TV dysfunction from transvenous pacing leads, or following cardiac surgeries, and (3) bioprosthetic TV dysfunction.
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Affiliation(s)
- Tam T Doan
- Echocardiography Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX, 77030, USA.
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Ricardo H Pignatelli
- Echocardiography Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX, 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Dhaval R Parekh
- Texas Adult Congenital Heart Center, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Anitha Parthiban
- Echocardiography Laboratory, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX, 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
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3
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Kazerouninia A, Georgekutty J, Kendsersky P, Byrne RD, Seto B, Chu PY, Wang Y, Rodriguez FH, Smith C, Saraf A, Lloyd MS, Frischhertz BP, Parekh DR, Ermis PR, Franklin WJ, Lam WW. A Multisite Retrospective Review of Direct Oral Anticoagulants Compared to Warfarin in Adult Fontan Patients. Cardiovasc Drugs Ther 2023; 37:519-527. [PMID: 35022950 PMCID: PMC11040449 DOI: 10.1007/s10557-021-07298-5] [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] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Direct oral anticoagulants (DOACs) are not recommended in adult Fontan patients (Level of Evidence C). We hypothesized that DOACs are comparable to warfarin and do not increase thrombotic and embolic complications (TEs) or clinically significant bleeds. METHODS We reviewed the medical records of adult Fontan patients on DOACs or warfarin at three major medical centers. We identified 130 patients: 48 on DOACs and 107 on warfarin. In total, they were treated for 810 months on DOACs and 5637 months on warfarin. RESULTS The incidence of TEs in patients on DOACs compared to those on warfarin was not increased in a statistically significant way (hazard ratio [HR] 1.7 and p value 0.431). Similarly, the incidence of nonmajor and major bleeds in patients on DOACs compared to those on warfarin was also not increased in a statistically significant way (HR for nonmajor bleeds in DOAC patients was 2.8 with a p value of 0.167 and the HR for major bleeds was 2.0 with a p value 0.267). In multivariate analysis, congestive heart failure (CHF) was a risk factor for TEs across both groups (odds ratio [OR] = 4.8, 95% confidence interval [CI] = 1.3-17.6) and bleed history was a risk factor for clinically significant bleeds (OR = 6.8, 95% CI = 2.7-17.2). CONCLUSION In this small, retrospective multicenter study, the use of DOACs did not increase the risk of TEs or clinically significant bleeds compared to warfarin in a statistically significant way.
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Affiliation(s)
- Amir Kazerouninia
- Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Justin Georgekutty
- Division of Pediatric Cardiology, Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY, USA
| | - Payton Kendsersky
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Ryan D Byrne
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brendan Seto
- University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Patricia Y Chu
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yunfei Wang
- Division of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Fred H Rodriguez
- Departments of Pediatrics and Internal Medicine, Division of Cardiology, Emory University, Atlanta, GA, USA
- Sibley Heart Center Cardiology, Atlanta, GA, USA
| | - Clayton Smith
- Departments of Pediatrics and Internal Medicine, Division of Cardiology, Emory University, Atlanta, GA, USA
- Sibley Heart Center Cardiology, Atlanta, GA, USA
| | - Anita Saraf
- Departments of Pediatrics and Internal Medicine, Division of Cardiology, Emory University, Atlanta, GA, USA
- Sibley Heart Center Cardiology, Atlanta, GA, USA
| | - Michael S Lloyd
- Department of Internal Medicine, Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Benjamin P Frischhertz
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dhaval R Parekh
- Division of Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Peter R Ermis
- Division of Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Wayne J Franklin
- Division of Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Wilson W Lam
- Division of Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
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4
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Broda CR, Frankel WC, Nair AP, Dreyer WJ, Tunuguntla HP, Frazier OH, Dolgner SJ, Anders MM, Tume SC, Qureshi AM, Parekh DR, Hickey EJ, Adachi I, Civitello AB. Continuous-Flow Ventricular Assist Device Support in Adult Congenital Heart Disease: A 15-Year, Multicenter Experience of Temporary and Durable Support. ASAIO J 2023; 69:429-437. [PMID: 36730653 DOI: 10.1097/mat.0000000000001853] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Heart failure (HF) is common in adult congenital heart disease (ACHD) patients; however, use of continuous-flow ventricular assist devices (CF-VADs) remains rare. We reviewed outcomes of patients with congenital heart disease greater than or equal to 18 years of age at the time of CF-VAD implant at the affiliated pediatric and adult institutions between 2006 and 2020. In total, 18 ACHD patients (15 with great anatomical complexity) received 21 CF-VADs. Six patients (median age 34 years) received seven percutaneous CF-VADs with a median duration of support of 20 days (3-44 days) with all patients survived to hospital discharge and two patients were bridged to durable CF-VADs. Fourteen patients (median age 38 years) received durable CF-VADs. Thirteen patients (93%) survived to hospital discharge and the median duration of support was 25.8 months (6.4-52.1 months). Estimated survival on durable CF-VAD at 1, 3, and 5 years was 84%, 72%, and 36%, respectively. Three patients were successfully bridged to transplantation. Device-related complications include cerebrovascular accident (n = 5), driveline infection (n = 3), device infection requiring chronic antibiotic therapy (n = 4), gastrointestinal bleeding (n = 6), and presumed pump thrombosis (n = 5). These results show percutaneous and durable CF-VADs can support ACHD patients with advanced HF.
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Affiliation(s)
- Christopher R Broda
- From the Section of Pediatric and Adult Congenital Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - William C Frankel
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ajith P Nair
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas
| | - W Jeffrey Dreyer
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Hari P Tunuguntla
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - O Howard Frazier
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas
| | - Stephen J Dolgner
- From the Section of Pediatric and Adult Congenital Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Marc M Anders
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sebastian C Tume
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Dhaval R Parekh
- From the Section of Pediatric and Adult Congenital Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Edward J Hickey
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Andrew B Civitello
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas
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5
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Bishop T, Kostelyna S, Weyland C, Dolgner S, Lam WW, Qureshi AM, Parekh DR, Salciccioli KB. UTILITY OF SURVEILLANCE ECHOCARDIOGRAMS FOLLOWING TRANSCATHETER PULMONARY VALVE REPLACEMENT IN ADULTS WITH CONGENITAL HEART DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02024-7] [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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6
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Eilers LF, Gowda ST, Lam WW, Parekh DR. Use of AngioVac Vacuum Aspiration for Refractory Endocarditis in a Postoperative Mustard Patient. Tex Heart Inst J 2022; 49:488731. [PMID: 36448943 PMCID: PMC9809078 DOI: 10.14503/thij-20-7506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Lindsay F. Eilers
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Srinath T. Gowda
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Wilson W. Lam
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dhaval R. Parekh
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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7
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Kim SE, Parekh DR, Lam WW. NOVEL APPROACH TO DIAGNOSTIC HEART CATHETERIZATION IN A PATIENT WITH MECHANICAL PROSTHETIC TRICUSPID VALVE AND TORTUOUS PULMONARY ARTERIES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04167-5] [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: 10/18/2022]
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8
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Parekh DR, Qureshi AM. Transcatheter pulmonary valve in failed bioprosthesis. Ann Cardiothorac Surg 2021; 10:720-722. [PMID: 34733707 DOI: 10.21037/acs-2021-tviv-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Dhaval R Parekh
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, TX, USA.,Texas Heart Institute, Houston, TX, USA
| | - Athar M Qureshi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, TX, USA
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9
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Abstract
Platypnea-orthodeoxia syndrome, a rare condition characterized by posture-related dyspnea, is usually caused by an intracardiac shunt, hepatopulmonary syndrome, or shunting resulting from severe pulmonary disease. We report the case of a 33-year-old woman who presented with increasing dyspnea and oxygen desaturation when she sat up or arose. Our diagnosis was platypnea-orthodeoxia syndrome. A lead of a previously implanted pacemaker exacerbated a severe tricuspid regurgitant jet that was directed toward the patient's intra-atrial septum. Percutaneous closure of a small secundum atrial septal defect eliminated right-to-left shunting and substantially improved the patient's functional status. In addition to this case, we discuss this unusual condition.
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Affiliation(s)
- Sanket P Borgaonkar
- Department of Medicine, Texas Heart Institute and Baylor-St. Luke's Medical Center; Houston, Texas 77030
| | - Wilson W Lam
- Department of Medicine, Texas Heart Institute and Baylor-St. Luke's Medical Center; Houston, Texas 77030.,Texas Heart Institute; and Department of Cardiology, Texas Heart Institute and Baylor-St. Luke's Medical Center; Houston, Texas 77030
| | - Mehdi Razavi
- Department of Medicine, Texas Heart Institute and Baylor-St. Luke's Medical Center; Houston, Texas 77030.,Baylor College of Medicine; Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute and Baylor-St. Luke's Medical Center; Houston, Texas 77030
| | - Dhaval R Parekh
- Department of Medicine, Texas Heart Institute and Baylor-St. Luke's Medical Center; Houston, Texas 77030
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10
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Parekh DR, Krajcer Z. Balloon expandable covered stents for aortic injury: It's a thing. Catheter Cardiovasc Interv 2020; 95:484. [DOI: 10.1002/ccd.28762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Dhaval R. Parekh
- Division of Cardiology, Department of Internal MedicineBaylor College of Medicine Houston Texas
- Department of CardiologyTexas Heart Institute Houston Texas
| | - Zvonimir Krajcer
- Division of Cardiology, Department of Internal MedicineBaylor College of Medicine Houston Texas
- Department of CardiologyTexas Heart Institute Houston Texas
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11
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Parekh DR, Krajcer Z. Implantable hemodynamic monitors: New hope or old hype? Catheter Cardiovasc Interv 2020; 95:280-281. [DOI: 10.1002/ccd.28747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Dhaval R. Parekh
- Division of Cardiology, Department of Internal MedicineBaylor College of Medicine Houston Texas
- Department of Internal MedicineCHI St. Luke's Health—Baylor St. Luke's Medical Center Houston Texas
- Department of CardiologyTexas Heart Institute Houston Texas
| | - Zvonimir Krajcer
- Division of Cardiology, Department of Internal MedicineBaylor College of Medicine Houston Texas
- Department of Internal MedicineCHI St. Luke's Health—Baylor St. Luke's Medical Center Houston Texas
- Department of CardiologyTexas Heart Institute Houston Texas
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12
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Gold BM, Parekh DR, Kearney DL, Silva GV, Fish RD, Stainback RF. Forme Fruste Cor Triatriatum Dexter by Transesophageal Echocardiography and Its Impact on Percutaneous Heart Procedures: A Case Series. ACTA ACUST UNITED AC 2019; 3:189-199. [PMID: 31709369 PMCID: PMC6833460 DOI: 10.1016/j.case.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 11/17/2022]
Abstract
Cor triatriatum dexter (CTD) can complicate percutaneous atrial septal interventions. Clinically silent (forme fruste) CTD is detectable by new echocardiography techniques. Using these techniques could improve patient selection and guide interventions.
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Affiliation(s)
- Benjamin M Gold
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Dhaval R Parekh
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Debra L Kearney
- Department of Pathology, Texas Children's Hospital, Houston, Texas.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Guilherme V Silva
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - R David Fish
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas
| | - Raymond F Stainback
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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13
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Parekh DR, Krajcer Z. Transapical transcatheter aortic valves. Down but definitely not out for the count. Catheter Cardiovasc Interv 2019; 94:745. [PMID: 31675157 DOI: 10.1002/ccd.28553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Dhaval R Parekh
- Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.,Department of Internal Medicine, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas
| | - Zvonimir Krajcer
- Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.,Department of Internal Medicine, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas.,Department of Cardiology, Texas Heart Institute, Houston, Texas
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14
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Follansbee CW, Qureshi AM, Parekh DR, Howard TS, Kim JJ. Guidewire pacing during transcatheter aortic valve implantation in a patient with complex congenital heart disease. Pacing Clin Electrophysiol 2019; 42:1408-1410. [PMID: 31155732 DOI: 10.1111/pace.13736] [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] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
We present a case of temporary guidewire pacing in a patient with Fontan anatomy during transcatheter aortic valve implantation. Temporary pacing was successfully achieved utilizing this method without complications. There is an increasing population of patients with complex congenital heart disease and expanding variety of transcatheter interventions. Due to limitations in vascular access and surgical anatomies, guidewire pacing may have a wide array of potential applications in pediatrics and the congenital heart disease population.
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Affiliation(s)
- Christopher W Follansbee
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Athar M Qureshi
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Dhaval R Parekh
- Department of Cardiology, Baylor College of Medicine, Houston, Texas.,Texas Heart Institute, Houston, Texas
| | - Taylor S Howard
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Jeffrey J Kim
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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15
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Parekh DR, Krajcer Z. Branch pulmonary artery stenting in children by using premounted stents: Can we benefit from slenderization? Catheter Cardiovasc Interv 2019; 93:E198-E199. [DOI: 10.1002/ccd.28010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/08/2022]
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16
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Parekh DR, Krajcer Z. Percutaneous pulmonary valve implantation: It's not like the aortic valve. Catheter Cardiovasc Interv 2019; 93:464-465. [PMID: 30770667 DOI: 10.1002/ccd.28141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/08/2022]
Abstract
The Edwards Sapien S3 demonstrated clinical and technical feasibility in this cohort undergoing percutaneous pulmonary valve implantation. Traversing the tricuspid apparatus with an unsheathed delivery system continues to pose a risk for tricuspid valve injury. Future design innovations need to accommodate for large outflow tracts without adjacent aortic or coronary compression and allow for safe device delivery with minimal trauma to the tricuspid apparatus.
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Affiliation(s)
- Dhaval R Parekh
- Department of Cardiology, Texas Heart Institute, Houston, Texas
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17
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Parekh DR, Krajcer Z. Percutaneous atrial septal occluders: Are we there yet? Catheter Cardiovasc Interv 2019; 93:322-323. [DOI: 10.1002/ccd.28080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Dhaval R. Parekh
- Department of CardiologyTexas Heart Institute Houston Texas
- Division of Cardiology, Department of Internal MedicineBaylor College of Medicine Houston Texas
- Department of Internal MedicineCHI St. Luke's Health—Baylor St. Luke's Medical Center Houston Texas
| | - Zvonimir Krajcer
- Department of CardiologyTexas Heart Institute Houston Texas
- Division of Cardiology, Department of Internal MedicineBaylor College of Medicine Houston Texas
- Department of Internal MedicineCHI St. Luke's Health—Baylor St. Luke's Medical Center Houston Texas
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Georgekutty J, Kazerouninia A, Wang Y, Ermis PR, Parekh DR, Franklin WJ, Lam WW. Novel oral anticoagulant use in adult Fontan patients: A single center experience. CONGENIT HEART DIS 2018; 13:541-547. [DOI: 10.1111/chd.12603] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/16/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Justin Georgekutty
- Division of Pediatric Cardiology; Cohen Children's Medical Center/Northwell Health; New Hyde Park New York USA
| | - Amir Kazerouninia
- Department of Internal Medicine/Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
| | - YunFei Wang
- Section of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine; Houston Texas USA
| | - Peter R. Ermis
- Division of Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine; Houston Texas USA
| | - Dhaval R. Parekh
- Division of Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine; Houston Texas USA
| | - Wayne J. Franklin
- Division of Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine; Houston Texas USA
| | - Wilson W. Lam
- Division of Adult Congenital Cardiology, Texas Children's Hospital/Baylor College of Medicine; Houston Texas USA
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19
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Parekh DR, Krajcer Z. Recurrent coarctation of aorta after Norwood operation in single ventricle patients; the case of the missing ideal stent. Catheter Cardiovasc Interv 2017; 90:980-981. [PMID: 29148248 DOI: 10.1002/ccd.27395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/07/2022]
Abstract
Recurrent coarctation postoperative Norwood is poorly tolerated in single ventricle patients. Although transcatheter balloon angioplasty is considered first line, it often leads to inadequate or non-durable relief of obstruction. Transcatheter stent implantation provides excellent relief of obstruction but necessitates staged redilation to account for somatic growth in children. Stent technology, delivery systems, and procedural techniques will need to evolve to obviate reported adverse events mainly due to patient size.
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Affiliation(s)
- Dhaval R Parekh
- Department of Cardiology, Texas Heart Institute, 6624 Fannin, Suite 2780, Houston, TX
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, 6624 Fannin, Suite 2780, Houston, TX
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20
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Li AH, Hanchard NA, Furthner D, Fernbach S, Azamian M, Nicosia A, Rosenfeld J, Muzny D, D'Alessandro LCA, Morris S, Jhangiani S, Parekh DR, Franklin WJ, Lewin M, Towbin JA, Penny DJ, Fraser CD, Martin JF, Eng C, Lupski JR, Gibbs RA, Boerwinkle E, Belmont JW. Whole exome sequencing in 342 congenital cardiac left sided lesion cases reveals extensive genetic heterogeneity and complex inheritance patterns. Genome Med 2017; 9:95. [PMID: 29089047 PMCID: PMC5664429 DOI: 10.1186/s13073-017-0482-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 04/03/2017] [Accepted: 10/12/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Left-sided lesions (LSLs) account for an important fraction of severe congenital cardiovascular malformations (CVMs). The genetic contributions to LSLs are complex, and the mutations that cause these malformations span several diverse biological signaling pathways: TGFB, NOTCH, SHH, and more. Here, we use whole exome sequence data generated in 342 LSL cases to identify likely damaging variants in putative candidate CVM genes. METHODS Using a series of bioinformatics filters, we focused on genes harboring population-rare, putative loss-of-function (LOF), and predicted damaging variants in 1760 CVM candidate genes constructed a priori from the literature and model organism databases. Gene variants that were not observed in a comparably sequenced control dataset of 5492 samples without severe CVM were then subjected to targeted validation in cases and parents. Whole exome sequencing data from 4593 individuals referred for clinical sequencing were used to bolster evidence for the role of candidate genes in CVMs and LSLs. RESULTS Our analyses revealed 28 candidate variants in 27 genes, including 17 genes not previously associated with a human CVM disorder, and revealed diverse patterns of inheritance among LOF carriers, including 9 confirmed de novo variants in both novel and newly described human CVM candidate genes (ACVR1, JARID2, NR2F2, PLRG1, SMURF1) as well as established syndromic CVM genes (KMT2D, NF1, TBX20, ZEB2). We also identified two genes (DNAH5, OFD1) with evidence of recessive and hemizygous inheritance patterns, respectively. Within our clinical cohort, we also observed heterozygous LOF variants in JARID2 and SMAD1 in individuals with cardiac phenotypes, and collectively, carriers of LOF variants in our candidate genes had a four times higher odds of having CVM (odds ratio = 4.0, 95% confidence interval 2.5-6.5). CONCLUSIONS Our analytical strategy highlights the utility of bioinformatic resources, including human disease records and model organism phenotyping, in novel gene discovery for rare human disease. The results underscore the extensive genetic heterogeneity underlying non-syndromic LSLs, and posit potential novel candidate genes and complex modes of inheritance in this important group of birth defects.
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Affiliation(s)
- Alexander H Li
- Human Genetics Center, University of Texas Health Science Center, Houston, TX, USA
| | - Neil A Hanchard
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Dieter Furthner
- Department of Paediatrics, Children's Hospital, Krankenhausstr. 26-30, 4020, Linz, Austria
| | - Susan Fernbach
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Mahshid Azamian
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Annarita Nicosia
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jill Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Donna Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Shaine Morris
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Shalini Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Dhaval R Parekh
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Wayne J Franklin
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Mark Lewin
- Division of Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Jeffrey A Towbin
- Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Daniel J Penny
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Charles D Fraser
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - James F Martin
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, and the Texas Heart Institute, Houston, TX, USA
| | - Christine Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center, Houston, TX, USA.,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - John W Belmont
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA. .,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. .,, 5200 Illumina Way, San Diego, CA, USA.
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21
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Vecchione T, Hall SR, Brady KM, Qureshi AM, Parekh DR, McKenzie ED, Easley RB. Two Cases of Postoperative Right Coronary Artery Intervention in Pediatric Patients Following Congenital Heart Surgery. J Cardiothorac Vasc Anesth 2017; 32:429-432. [PMID: 28927696 DOI: 10.1053/j.jvca.2017.06.006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Tricia Vecchione
- Department of Pediatric Anesthesiology, Pain and Perioperative Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Stuart R Hall
- Department of Pediatric Anesthesiology, Pain and Perioperative Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Ken M Brady
- Department of Pediatric Anesthesiology, Pain and Perioperative Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Dhaval R Parekh
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - E Dean McKenzie
- Department of Surgery, Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - R Blaine Easley
- Department of Pediatric Anesthesiology, Pain and Perioperative Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
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22
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Parekh DR, Krajcer Z. Melody valve within a dysfunctional freestyle bioprosthesis: Yes, you can fit a round peg in a calcified hole. Catheter Cardiovasc Interv 2017; 89:1231. [PMID: 28612421 DOI: 10.1002/ccd.27140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/12/2022]
Abstract
Transcatheter pulmonary valve implantation (TPVI) within a failed bioprosthetic valve is safe and effective Coronary artery compression is a potential risk, requiring careful preimplantation balloon dilation testing Prestenting is required for TPVI in stentless conduits Improvements in right ventricular volume, pressure, pulmonary stenosis, and regurgitation can be maintained in the intermediate term Long-term risk for Melody valve endocarditis and valve dysfunction necessitates careful monitoring.
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23
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Morray BH, Dimas VV, Lim S, Balzer DT, Parekh DR, Van Mieghem NM, Ewert P, Kim DW, Justino H, McElhinney DB, Jones TK. Circulatory support using the impella device in fontan patients with systemic ventricular dysfunction: A multicenter experience. Catheter Cardiovasc Interv 2017; 90:118-123. [DOI: 10.1002/ccd.26885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/12/2016] [Accepted: 11/20/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Brian H. Morray
- Division of Cardiology; Seattle Children's Hospital; Seattle Washington
| | - Vivian V. Dimas
- Division of Cardiology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Scott Lim
- Division of Pediatric Cardiology; University of Virginia; Charlottesville Virginia
| | - David T. Balzer
- Division of Pediatric Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Dhaval R. Parekh
- Division of Pediatric Cardiology, Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Nicolas M. Van Mieghem
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease; Deutsches Herzzentrum München; München Germany
| | - Dennis W. Kim
- Division of Pediatric Cardiology; Children's Healthcare of Atlanta, Emory University; Atlanta Georgia
| | - Henri Justino
- Division of Pediatric Cardiology, Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Doff B. McElhinney
- Department of Cardiothoracic Surgery; Lucille Packard Children's Hospital at Stanford; Palo Alto California
| | - Thomas K. Jones
- Division of Cardiology; Seattle Children's Hospital; Seattle Washington
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Shatila W, Almanfi A, Massumi M, Dougherty KG, Parekh DR, Strickman NE. Endovascular Treatment of Superior Vena Cava Syndrome via Balloon-in-Balloon Catheter Technique with a Palmaz Stent. Tex Heart Inst J 2016; 43:520-523. [PMID: 28100973 DOI: 10.14503/thij-15-5479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Superior vena cava syndrome is a well-known disease entity that carries substantial rates of morbidity and mortality. Although most cases of superior vena cava syndrome are secondary to a malignant process, additional causes (such as mediastinal fibrosis, pacemaker lead implantation, or central venous catheter placement) have been reported. Multiple treatment options include percutaneous transluminal angioplasty, stent implantation, thrombolysis, mechanical thrombectomy, and venous grafting. We present a case of superior vena cava syndrome in a symptomatic 30-year-old woman who obtained complete relief of obstruction and marked symptomatic improvement through venoplasty and stenting, aided by our use of a balloon-in-balloon catheter system.
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25
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Klouda L, Franklin WJ, Saraf A, Parekh DR, Schwartz DD. Neurocognitive and executive functioning in adult survivors of congenital heart disease. CONGENIT HEART DIS 2016; 12:91-98. [DOI: 10.1111/chd.12409] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Leda Klouda
- Department of Pediatrics; Section of Cardiology, Baylor College of Medicine; Houston Texas USA
| | - Wayne J. Franklin
- Department of Pediatrics; Section of Cardiology, Baylor College of Medicine; Houston Texas USA
| | - Anita Saraf
- Department of Pediatrics; Section of Cardiology, Baylor College of Medicine; Houston Texas USA
- Department of Medicine, Division of Cardiology; Emory University; Atlanta Georgia USA
| | - Dhaval R. Parekh
- Department of Pediatrics; Section of Cardiology, Baylor College of Medicine; Houston Texas USA
| | - David D. Schwartz
- Department of Pediatrics; Section of Psychology, Baylor College of Medicine; Hoston Texas USA
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26
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Mery CM, Guzmán-Pruneda FA, Trost JG, McLaughlin E, Smith BM, Parekh DR, Adachi I, Heinle JS, McKenzie ED, Fraser CD. Contemporary Results of Aortic Coarctation Repair Through Left Thoracotomy. Ann Thorac Surg 2015. [PMID: 26209490 DOI: 10.1016/j.athoracsur.2015.04.129] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although surgical results for repair of coarctation of the aorta (CoA) have steadily improved, management of this condition remains controversial. The purposes of this study were to analyze the long-term outcomes of patients undergoing CoA repair through left thoracotomy and to define risk factors for reintervention. METHODS All patients who were less than 18 years old and who underwent initial repair of CoA through left thoracotomy from 1995 to 2013 at Texas Children's Hospital (Houston, TX) were included. Patients were classified into 3 groups: 143 (42%) neonates (0 to 30 days old), 122 (36%) infants (31 days to 1 year old), and 78 (23%) older children (1 to 18 years old). Univariate and multivariate analyses were performed. RESULTS A total of 343 patients (129 [38%] girls) with median age of 53 days (interquartile range [IQR],12 days to 9 months) and weight of 4.1 kg (IQR, 3.1 to 8.0) underwent repair with extended end-to-end anastomosis (291 patients [85%]), end-to-end anastomosis (44 patients [13%]), interposition graft (2 patients [0.6%]), or subclavian flap (6 patients [2%]). Concomitant diagnoses included genetic abnormalities (48 patients [14%]), isolated ventricular septal defects (58 patients [17%]), small left-sided structures (53 patients,16%), or other complex congenital heart disease (18 patients [5%]). Perioperative mortality was 1% (n = 4, all neonates). At a median follow-up of 6 years (7 days to 19 years), only 14 (4%) patients required reintervention (10 catheter-based procedures, 6 surgical repairs). A postoperative peak velocity of 2.5 m/s or greater was an independent risk factor for reintervention (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.4 to 11.6). Within the cohort, 95 (33%) patients were hypertensive or remained on cardiac medications a median of 12 years (6 months to 19 years) after the surgical procedure. Development of perioperative hypertension was associated with higher risk of chronic hypertension or cardiac medication dependency (OR, 1.9; 95% CI, 1.1 to 3.3). CONCLUSIONS CoA repair through left thoracotomy is associated with low rates of morbidity, mortality, and reintervention. Aortic arch obstruction should be completely relieved at the time of surgical intervention to minimize the risk of long-term recoarctation.
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Affiliation(s)
- Carlos M Mery
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
| | - Francisco A Guzmán-Pruneda
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Jeffrey G Trost
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Ericka McLaughlin
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Brendan M Smith
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Dhaval R Parekh
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
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Parekh DR, Cabrera MS, Ing FF. Simultaneous transcatheter implantation of systemic and pulmonary venous baffle stents after mustard operation for d-transposition of the great arteries. Catheter Cardiovasc Interv 2015; 86:708-13. [PMID: 25914375 DOI: 10.1002/ccd.25951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/15/2015] [Indexed: 11/09/2022]
Abstract
We report a case of simultaneous transcatheter systemic and pulmonary venous baffle obstruction stenting in a post operative Mustard patient with d-transposition of the great arteries.
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Affiliation(s)
- Dhaval R Parekh
- Texas Children's Hospital/ Baylor College of Medicine, Houston, TX
| | | | - Frank F Ing
- Children's Hospital LA, Keck School of Medicine, USC, Los Angeles, CA
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Lam WW, Patel MB, Rodriguez FH, Parekh DR, Franklin WJ. Atriopulmonary Fontan spontaneous echo contrast improved after cardioversion. Tex Heart Inst J 2014; 41:100-2. [PMID: 24512415 DOI: 10.14503/thij-13-3292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Wilson W Lam
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital; Department of Pediatric Cardiology, Texas Heart Institute; and Departments of Internal Medicine and Pediatrics, Section of Cardiology, Baylor College of Medicine; Houston, Texas 77030
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Paruchuri V, Mahlstedt A, Parekh DR, Franklin W. MANAGEMENT OF SUPERIOR VENA CAVA THROMBUS IN A COMPLEX CONGENITAL HEART PATIENT WITH A SINGLE LUNG. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60649-5] [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: 11/29/2022]
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Rodriguez FH, Moodie DS, Parekh DR, Franklin WJ, Morales DL, Zafar F, Adams GJ, Friedman RA, Rossano JW. Outcomes of Heart Failure-Related Hospitalization in Adults with Congenital Heart Disease in the United States. CONGENIT HEART DIS 2012; 8:513-9. [DOI: 10.1111/chd.12019] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 01/10/2023]
Affiliation(s)
- Fred H. Rodriguez
- Baylor College of Medicine; Department of Pediatrics, Division of Cardiology and Congenital Heart Surgery; Houston Tex USA
- Sibley Heart Center Cardiology and Emory University School of Medicine; Atlanta GA USA
| | - Douglas S. Moodie
- Baylor College of Medicine; Department of Pediatrics, Division of Cardiology and Congenital Heart Surgery; Houston Tex USA
| | - Dhaval R. Parekh
- Baylor College of Medicine; Department of Pediatrics, Division of Cardiology and Congenital Heart Surgery; Houston Tex USA
| | - Wayne J. Franklin
- Baylor College of Medicine; Department of Pediatrics, Division of Cardiology and Congenital Heart Surgery; Houston Tex USA
| | - David L.S. Morales
- The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
| | - Farhan Zafar
- Baylor College of Medicine; Department of Pediatrics, Division of Cardiology and Congenital Heart Surgery; Houston Tex USA
| | - Gerald J. Adams
- Baylor College of Medicine; Department of Pediatrics, Division of Cardiology and Congenital Heart Surgery; Houston Tex USA
| | - Richard A. Friedman
- Columbia University College of Physicians and Surgeons; Department of Pediatrics, Division of Cardiology; New York NY USA
| | - Joseph W. Rossano
- University of Pennsylvania School of Medicine; Department of Pediatrics, Divisions of Pediatric Cardiology and Critical Care Medicine; Philadelphia Pa USA
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Shah NR, Rodriguez FH, Lam W, Ermis PR, Simpson L, Frazier O, Franklin WJ, Parekh DR. Clinical Outcomes After Ventricular Assist Device Implantation in Six Adult Patients With Complex Congenital Heart Disease. J Card Fail 2012. [DOI: 10.1016/j.cardfail.2012.06.128] [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: 11/30/2022]
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Franklin WJ, Parekh DR, Safdar Z. Adult congenital heart disease and pulmonary arterial hypertension: the Texas Adult Congenital Heart Program experience. Postgrad Med 2012; 123:32-45. [PMID: 22104452 DOI: 10.3810/pgm.2011.11.2493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Congenital heart disease (CHD) is a common structural defect of the heart or major blood vessels. Patients with adult congenital heart disease (ACHD) have medical needs that are distinct from those of pediatric patients with CHD, and the transition into adult health care is important for management of the patient with ACHD. A large proportion of patients with CHD develop diseases and complications associated with the long-term stress of intracardiac shunts. Pulmonary arterial hypertension (PAH) is a significant complication of some CHD lesions. The treatment of these patients remains challenging due to their combined heart and lung disease, and multidisciplinary care is ofen necessitated for a variety of secondary conditions. A number of treatment options are available for the management of PAH associated with CHD, including prostanoids, phosphodiesterase type-5 inhibitors, and endothelin receptor antagonists. This article discusses the diagnosis and management of such ACHD patients with PAH.
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Affiliation(s)
- Wayne J Franklin
- Baylor College of Medicine, Department of Medicine, Cardiology Section, Houston, TX 77030, USA.
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Abstract
The nearly one-million estimated adult congenital heart disease (ACHD) patients in the United States now outnumber children with congenital heart disease (CHD). With continued improvement in survival due to surgical and medical management of patients born with CHD, there is an overall shift in the burden of care from childhood to adulthood. Due to this transitioning population, the probability of heart failure continues to increase with age and represents nearly one-quarter of all mortality in ACHD. Despite these sobering figures adult cardiologist and fellows continue to have limited exposure in the care of patients with congenital heart disease. The syndrome of heart failure represents a complex derangement of neurohormones, natriuretic peptides, and cytokines leading to progressive symptoms of exercise intolerance, dyspnea, and fatigue. Congenital heart patients represent a unique challenge in both categorization and protocol management of heart failure (HF). It remains unclear if the current four-stage ACC/AHA guidelines for diagnosis and treatment of HF in adults can serve as a meaningful framework for congenital heart patients. Additionally, widely used conventional HF therapy of beta-blockers and angiotensin converting enzyme inhibitors (ACE-I) have not demonstrated clear survival benefit in this population. Unfortunately, adequately powered and controlled randomized studies are grossly lacking and remain challenging to conduct. Nonetheless, a review of heart failure associated with ACHD is provided.
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Rodriguez FH, Moodie DS, Parekh DR, Franklin WJ, Morales DL, Zafar F, Graves DE, Rossano JW. OUTCOMES OF HEART FAILURE RELATED ADMISSIONS IN ADULTS WITH CONGENITAL HEART DISEASE IN THE UNITED STATES: A POPULATION BASED STUDY. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60460-9] [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: 10/18/2022]
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Parekh DR, Khan MS, Lee VV, Moller JH. PRIMARY OPERATIONS IN ADULTS WITH CONGENITAL HEART DISEASE: SURGICAL TRENDS OVER TWO AND A HALF DECADES. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60458-0] [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: 10/18/2022]
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Parekh DR. A Review of Heart Failure in Adults with Congenital Heart Disease. Methodist Debakey Cardiovasc J 2011. [DOI: 10.14797/mdcvj.266] [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: 11/08/2022] Open
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Franklin WJ, Benton MK, Parekh DR. Cardiac disease in pregnancy. Tex Heart Inst J 2011; 38:151-153. [PMID: 21494524 PMCID: PMC3066821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Wayne J Franklin
- Texas Adult Congenital Heart Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA.
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