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Doctor P, Sharma B, Greil G, Dillenbeck J, Abdulkarim M, Jaquiss R, Hussain T, Fares M. Dobutamine Stress Cardiovascular Magnetic Resonance Derived 2-Dimension Feature Tracking Strain Analysis in Pediatric Population with Anomalous Aortic Origin of Right Coronary Artery. Pediatr Cardiol 2024; 45:520-528. [PMID: 38233665 DOI: 10.1007/s00246-023-03401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Abstract
Anomalous aortic origin of right coronary artery (AAORCA) is associated with myocardial ischemia and sudden cardiac arrest/death. Risk stratification remains challenging and relies upon provocative test results. This study describes the utility of dobutamine stress cardiovascular magnetic resonance (DSCMR) and potential benefit of strain analysis in children with AAORCA. All patients less than 21 years of age with AAORCA who underwent DSCMR between July 2018 and December 2022 were included. Visual wall motion abnormalities (VWMA) at rest and during protocolized increments of dobutamine infusion were assessed. Regional and global left ventricular circumferential (GCS) and radial (GRS) strain using 2-dimension Feature tracking (2D-FT) analysis (cvi42, Circle Cardiovascular Imaging Inc.) were calculated at rest and peak response. Of the total 54 DSCMR studies performed in 51 children with median age (IQR) of 13.5 (11-15) years, FT analysis was reliably performed in 52 (96%) studies. None had VWMA. The absolute change in GCS and GRS from rest to peak dobutamine stress was 4% (1-6%) and 11% (4-18%), respectively. There was no significant difference in GCS and GRS in patients with exertional symptoms vs no/non-exertional symptoms as well as between those considered to be high-risk vs low-risk anatomical features. DSCMR-derived 2D-FT strain analysis is feasible to assess myocardial deformation in children with AAORCA and may enhance this method of provocative testing. Although there were no statically significant differences in GCS and GRS values between high and low-risk subgroups, the absolute change in GCS between rest and peak stress is diminished when compared to normal adult reports.
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Affiliation(s)
- Pezad Doctor
- Department of Pediatric Cardiology, Children's Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA.
| | - Bharti Sharma
- Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA
| | - Gerald Greil
- Department of Pediatric Cardiology, Children's Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA
- Department of Pediatric Radiology, Children's Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA
| | - Jeanne Dillenbeck
- Department of Pediatric Radiology, Children's Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA
| | - Mubeena Abdulkarim
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, 3100 SW 62n Ave, Miami, FL, 33155, USA
| | - Robert Jaquiss
- Department of Pediatric Cardiovascular Thoracic Surgery, Children's Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA
| | - Tarique Hussain
- Department of Pediatric Cardiology, Children's Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA
- Department of Pediatric Radiology, Children's Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA
| | - Munes Fares
- Department of Pediatric Cardiology, Children's Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA
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2
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Abdulkarim M, Loomba RS, Zaidi SJ, Li Y, Wilson M, Roberson D, Farias JS, Flores S, Villarreal EG, Husayni T. Echocardiographic Strain to Predict Need for Transplant or Mortality in Fontan Patients with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2023:10.1007/s00246-023-03187-w. [PMID: 37204486 DOI: 10.1007/s00246-023-03187-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/14/2023] [Indexed: 05/20/2023]
Abstract
Despite recent advances, hypoplastic left heart syndrome (HLHS) patients subsequent to the Fontan still have significant morbidity and mortality. Some require heart transplant due to systemic ventricular dysfunction. Limited data exist on timing for transplant referral. This study aims to correlate systemic ventricular strain by echocardiography to transplant-free survival. HLHS patients who had Fontan palliation at our institution were included. Patients were divided into: 1) Required transplant or experienced mortality (composite end point); 2) Did not require transplant or survived. For those who experienced the composite endpoint, the last echocardiogram prior to the composite outcome was used, while for those who did not experience the composite endpoint the last echocardiogram obtained was used. Several qualitative and quantitative parameters were analyzed with focus on strain parameters. Ninety-five patients with HLHS Fontan palliation were identified. Sixty-six had adequate images and eight (12%) experienced transplant or mortality. These patients had greater myocardial performance index by flow Doppler (0.72 versus 0.53, p = 0.01), higher systolic/diastolic duration ratio (1.51 versus 1.13, p = 0.02), lower fractional area change (17.65 versus 33.99, p < 0.01), lower global longitudinal strain (GLS) (-8.63 versus - 17.99, p < 0.01), lower global longitudinal strain rate (GLSR) (- 0.51 versus - 0.93, p < 0.01), lower global circumferential strain (GCS) (-6.68 versus -18.25, p < 0.01), and lower (GCSR) global circumferential strain rate (-0.45 versus -1.01, p < 0.01). ROC analysis demonstrated predictive value for GLS - 7.6 (71% sensitive, 97% specific, AUC 81%), GLSR -0.58 (71% sensitive, 88% specific, AUC 82%), GCS - 10.0 (86% sensitive, 91% specific, AUC 82%), and GCSR -0.85 (100% sensitive, 71% specific, AUC 90%). GLS and GCS can help predict transplant-free survival in patients with hypoplastic left heart syndrome having undergone Fontan palliation. Higher strain values (closer to zero) may be a helpful tool in determining when transplant evaluation is warranted in these patients.
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Affiliation(s)
- Mubeena Abdulkarim
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Rohit S Loomba
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - S Javed Zaidi
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatric Cardiology, Carle BroMenn Medical Center, Normal, IL, USA
| | - Yi Li
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Melissa Wilson
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - David Roberson
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | | | - Saul Flores
- Division of Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina Y Ciencias de La Salud, Monterrey, Nuevo Leon, Mexico.
| | - Tarek Husayni
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
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3
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Ganti VG, Gazi AH, An S, Srivatsa AV, Nevius BN, Nichols CJ, Carek AM, Fares M, Abdulkarim M, Hussain T, Greil FG, Etemadi M, Inan OT, Tandon A. Wearable Seismocardiography‐Based Assessment of Stroke Volume in Congenital Heart Disease. J Am Heart Assoc 2022; 11:e026067. [DOI: 10.1161/jaha.122.026067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Abstract
Background
Patients with congenital heart disease (CHD) are at risk for the development of low cardiac output and other physiologic derangements, which could be detected early through continuous stroke volume (SV) measurement. Unfortunately, existing SV measurement methods are limited in the clinic because of their invasiveness (eg, thermodilution), location (eg, cardiac magnetic resonance imaging), or unreliability (eg, bioimpedance). Multimodal wearable sensing, leveraging the seismocardiogram, a sternal vibration signal associated with cardiomechanical activity, offers a means to monitoring SV conveniently, affordably, and continuously. However, it has not been evaluated in a population with significant anatomical and physiological differences (ie, children with CHD) or compared against a true gold standard (ie, cardiac magnetic resonance). Here, we present the feasibility of wearable estimation of SV in a diverse CHD population (N=45 patients).
Methods and Results
We used our chest‐worn wearable biosensor to measure baseline ECG and seismocardiogram signals from patients with CHD before and after their routine cardiovascular magnetic resonance imaging, and derived features from the measured signals, predominantly systolic time intervals, to estimate SV using ridge regression. Wearable signal features achieved acceptable SV estimation (28% error with respect to cardiovascular magnetic resonance imaging) in a held‐out test set, per cardiac output measurement guidelines, with a root‐mean‐square error of 11.48 mL and
R
2
of 0.76. Additionally, we observed that using a combination of electrical and cardiomechanical features surpassed the performance of either modality alone.
Conclusions
A convenient wearable biosensor that estimates SV enables remote monitoring of cardiac function and may potentially help identify decompensation in patients with CHD.
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Affiliation(s)
- Venu G. Ganti
- Bioengineering Graduate Program Georgia Institute of Technology Atlanta GA
| | - Asim H. Gazi
- School of Electrical and Computer Engineering Georgia Institute of Technology Atlanta GA
| | - Sungtae An
- School of Interactive Computing Georgia Institute of Technology Atlanta GA
| | - Adith V. Srivatsa
- The Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology Atlanta GA
| | - Brandi N. Nevius
- School of Mechanical Engineering Georgia Institute of Technology Atlanta GA
| | - Christopher J. Nichols
- The Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology Atlanta GA
| | - Andrew M. Carek
- Department of Biomedical Engineering, McCormick School of Engineering Northwestern University Evanston IL
- Department of Anesthesiology, Feinberg School of Medicine Northwestern University Evanston IL
| | - Munes Fares
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
| | - Mubeena Abdulkarim
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
| | - Tarique Hussain
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
| | - F. Gerald Greil
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
| | - Mozziyar Etemadi
- Department of Biomedical Engineering, McCormick School of Engineering Northwestern University Evanston IL
- Department of Anesthesiology, Feinberg School of Medicine Northwestern University Evanston IL
| | - Omer T. Inan
- Bioengineering Graduate Program Georgia Institute of Technology Atlanta GA
- School of Electrical and Computer Engineering Georgia Institute of Technology Atlanta GA
| | - Animesh Tandon
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
- Cleveland Clinic Children’s Cleveland OH
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Das BB, Akam-Venkata J, Abdulkarim M, Hussain T. Parametric Mapping Cardiac Magnetic Resonance Imaging for the Diagnosis of Myocarditis in Children in the Era of COVID-19 and MIS-C. Children 2022; 9:children9071061. [PMID: 35884045 PMCID: PMC9320921 DOI: 10.3390/children9071061] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 12/03/2022]
Abstract
Myocarditis comprises many clinical presentations ranging from asymptomatic to sudden cardiac death. The history, physical examination, cardiac biomarkers, inflammatory markers, and electrocardiogram are usually helpful in the initial assessment of suspected acute myocarditis. Echocardiography is the primary tool to detect ventricular wall motion abnormalities, pericardial effusion, valvular regurgitation, and impaired function. The advancement of cardiac magnetic resonance (CMR) imaging has been helpful in clinical practice for diagnosing myocarditis. A recent Scientific Statement by the American Heart Association suggested CMR as a confirmatory test to diagnose acute myocarditis in children. However, standard CMR parametric mapping parameters for diagnosing myocarditis are unavailable in pediatric patients for consistency and reliability in the interpretation. The present review highlights the unmet clinical needs for standard CMR parametric criteria for diagnosing acute and chronic myocarditis in children and differentiating dilated chronic myocarditis phenotype from idiopathic dilated cardiomyopathy. Of particular relevance to today’s practice, we also assess the potential and limitations of CMR to diagnose acute myocarditis in children exposed to severe acute respiratory syndrome coronavirus-2 infections. The latter section will discuss the multi-inflammatory syndrome in children (MIS-C) and mRNA coronavirus disease 19 vaccine-associated myocarditis.
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Affiliation(s)
- Bibhuti B. Das
- Department of Pediatrics, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA;
- Correspondence: ; Tel.: +1-601-984-5250; Fax: +1-601-984-5283
| | - Jyothsna Akam-Venkata
- Department of Pediatrics, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Mubeena Abdulkarim
- Pediatric Cardiology, Nicklaus Children’s Hospital, Miami, FL 33155, USA;
| | - Tarique Hussain
- Pediatric Cardiology, Children’s Health, UTSW Medical Center, Dallas, TX 75235, USA;
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5
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Ganti V, Gazi A, An S, Srivatsa A, Nevius B, Nichols C, Fares M, Abdulkarim M, Hussain T, Inan O, Tandon A. SEISMOCARDIOGRAPHY-BASED MONITORING OF STROKE VOLUME FOR CONGENITAL HEART DISEASE PATIENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03028-5] [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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6
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Fares M, Abdulkarim M, Dillenbeck J, Hussain T. Ffr-ct To Augment Screening For Allograft Vasculopathy In Pediatric Patients Post Heart Transplantation - Feasibility Study. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.211] [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: 10/20/2022]
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7
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Tandon A, Mohan N, Jensen C, Burkhardt BEU, Gooty V, Castellanos DA, McKenzie PL, Zahr RA, Bhattaru A, Abdulkarim M, Amir-Khalili A, Sojoudi A, Rodriguez SM, Dillenbeck J, Greil GF, Hussain T. Retraining Convolutional Neural Networks for Specialized Cardiovascular Imaging Tasks: Lessons from Tetralogy of Fallot. Pediatr Cardiol 2021; 42:578-589. [PMID: 33394116 PMCID: PMC7990832 DOI: 10.1007/s00246-020-02518-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022]
Abstract
Ventricular contouring of cardiac magnetic resonance imaging is the gold standard for volumetric analysis for repaired tetralogy of Fallot (rTOF), but can be time-consuming and subject to variability. A convolutional neural network (CNN) ventricular contouring algorithm was developed to generate contours for mostly structural normal hearts. We aimed to improve this algorithm for use in rTOF and propose a more comprehensive method of evaluating algorithm performance. We evaluated the performance of a ventricular contouring CNN, that was trained on mostly structurally normal hearts, on rTOF patients. We then created an updated CNN by adding rTOF training cases and evaluated the new algorithm's performance generating contours for both the left and right ventricles (LV and RV) on new testing data. Algorithm performance was evaluated with spatial metrics (Dice Similarity Coefficient (DSC), Hausdorff distance, and average Hausdorff distance) and volumetric comparisons (e.g., differences in RV volumes). The original Mostly Structurally Normal (MSN) algorithm was better at contouring the LV than the RV in patients with rTOF. After retraining the algorithm, the new MSN + rTOF algorithm showed improvements for LV epicardial and RV endocardial contours on testing data to which it was naïve (N = 30; e.g., DSC 0.883 vs. 0.905 for LV epicardium at end diastole, p < 0.0001) and improvements in RV end-diastolic volumetrics (median %error 8.1 vs 11.4, p = 0.0022). Even with a small number of cases, CNN-based contouring for rTOF can be improved. This work should be extended to other forms of congenital heart disease with more extreme structural abnormalities. Aspects of this work have already been implemented in clinical practice, representing rapid clinical translation. The combined use of both spatial and volumetric comparisons yielded insights into algorithm errors.
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Affiliation(s)
- Animesh Tandon
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | - Navina Mohan
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Cory Jensen
- Circle Cardiovascular Imaging, Calgary, AB Canada
| | - Barbara E. U. Burkhardt
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s- Hospital Zurich, Zurich, Switzerland
| | - Vasu Gooty
- Department of Pediatrics, LeBonheur Children’s Hospital and University of Tennessee, Memphis, TN USA
| | - Daniel A. Castellanos
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | - Paige L. McKenzie
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Riad Abou Zahr
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Abhijit Bhattaru
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | - Mubeena Abdulkarim
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | | | | | - Stephen M. Rodriguez
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Jeanne Dillenbeck
- Department of Radiology, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Gerald F. Greil
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
| | - Tarique Hussain
- Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, UT Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX 75235 USA
- Division of Cardiology, Children’s Health Children’s Medical Center Dallas, Dallas, TX USA
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8
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Abdulkarim M, Weld J, Cohen W, Combs P, Patel D, El-Zein C, Ilbawi M, Vricella L, Hibino N. Congenitally Abnormal Aortic Valve Causing Coronary Obstruction and Cardiac Arrest in Infancy. Ann Thorac Surg 2020; 111:e339-e341. [PMID: 33069680 DOI: 10.1016/j.athoracsur.2020.07.070] [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: 05/12/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022]
Abstract
Many instances of coronary artery anomalies are documented in the literature; however, the detection and treatment of an asymmetric, large aortic cusp causing obstruction of a coronary ostium in a symptomatic infant remains unreported. We present a case of a 2-month-old infant with an enlarged right coronary cusp obstructing the left coronary ostium, requiring emergent repair by relocating the left coronary button and reconstructing the sinus of Valsalva with autologous pericardium. This procedure preserved native aortic valve function, and the child remains asymptomatic months after discharge.
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Affiliation(s)
- Mubeena Abdulkarim
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Julia Weld
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - William Cohen
- Section of Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Pamela Combs
- Section of Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Dhaval Patel
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Chawki El-Zein
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Michel Ilbawi
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Luca Vricella
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois; Section of Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Narutoshi Hibino
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois; Section of Cardiac Surgery, University of Chicago, Chicago, Illinois.
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9
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Loomba RS, Abdulkarim M, Bronicki RA, Villarreal EG, Flores S. Impact of sodium bicarbonate therapy on hemodynamic parameters in infants: a meta-analysis. J Matern Fetal Neonatal Med 2020; 35:2324-2330. [PMID: 32627614 DOI: 10.1080/14767058.2020.1786051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Sodium bicarbonate is a frequently used electrolyte for the acute treatment of metabolic acidosis in critically ill patients. We performed a systematic review and meta-analysis to determine the effect of sodium bicarbonate on hemodynamics, gas exchange and oximetry in critically children.Methods: A systematic review of published manuscripts was conducted to identify studies of children who received sodium bicarbonate as part of the treatment for metabolic acidosis. A meta-analysis was then conducted to determine the impact of sodium bicarbonate on hemodynamics, gas exchange and oximetry. The following parameters were captured: base deficit, heart rate, mean arterial pressure, blood concentration of carbon dioxide, blood concentration of hydrogen ion, and pulse oximetry.Results: A total of six studies with 341 patients were included in the analyses. All included studies were completed in critically ill infants with a mean age of 1.1 months. The mean dose of sodium bicarbonate was 1.7 meq/kg with a mean time of 67 min prior to repeat hemodynamics being collected after sodium bicarbonate administration. Base deficit significantly improved with a decrease of 2.80 (p = .001) and the partial pressure of carbon dioxide significantly decreased by a mean of -1.65 mmHg (p = .010). There was no change in heart rate, blood pressure, pH, partial pressure of oxygen, or saturation by pulse oximetry.Conclusion: Sodium bicarbonate has a statistically significant but not clinically significant impact on partial pressure of carbon dioxide and base deficit 60 min after sodium bicarbonate administration in critically ill infants. There is no difference noted in pH, partial pressure of oxygen, or saturation by pulse oximetry.
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Affiliation(s)
- Rohit S Loomba
- Division of Cardiology, Chicago Medical School, Advocate Children's Hospital, Chicago, IL, USA
| | - Mubeena Abdulkarim
- Division of Cardiology, Chicago Medical School, Advocate Children's Hospital, Chicago, IL, USA
| | - Ronald A Bronicki
- Department of Pediatrics, Section of Critical Care and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Enrique G Villarreal
- Department of Pediatrics, Section of Critical Care and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Saul Flores
- Department of Pediatrics, Section of Critical Care and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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10
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Karikari Y, Abdulkarim M, Li Y, Loomba RS, Zimmerman F, Husayni T. The Progress and Significance of QRS Duration by Electrocardiography in Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2020; 41:141-148. [PMID: 31722042 DOI: 10.1007/s00246-019-02237-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/24/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
Abstract
Patients with hypoplastic left heart syndrome (HLHS) are now surviving through to Fontan palliation and beyond, however, with increased morbidity and mortality. Prolonged QRSd has become one of the predictors of morbidity and mortality in certain congenital heart diseases. There is limited data characterizing the QRSd in patients with HLHS. We aimed to describe the changes in QRSd at various times during the lifetime and to evaluate whether QRSd correlates with a higher risk of developing a composite endpoint of heart failure, heart transplant, or death. We conducted a retrospective chart review of patients with HLHS who survived Fontan palliation. QRSd was measured on ECGs at various stages pre- and postsurgical palliations and subsequently at 5 year intervals. Patients with a composite endpoint were compared to those without. A total of 89 patients were included in the final analysis. The QRSd increased significantly with time from 68.7 ± 9.0 ms prior to Norwood to 91.0 ± 14.0 ms immediately following Fontan and 104.7 ± 13.6 ms 15 years after Fontan (p < 0.001). The composite endpoint was observed in 28 patients (31.4%). The time trends of QRSd differ so that the patients having the composite endpoint experienced a greater increase in QRSd over time (p = 0.009). Ever having a QRSd of 120 ms or more predicted the composite endpoint with 93% specificity. The area under the curve of the receiver operator curve analysis was 0.596. A Cox regression analysis demonstrated that QRS duration > 120 ms was independently related to a greater frequency of composite endpoint and this was confirmed by a Kaplan-Meier analysis (p = 0.011). This study unveils a novel relationship between QRSd of 120 ms or more with the composite endpoint. Despite the low sensitivity, this finding on a routine surveillance ECG could help identify HLHS Fontan patients at risk for heart failure, heart transplant, or death.
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Affiliation(s)
- Yaa Karikari
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Mubeena Abdulkarim
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Yi Li
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Rohit S Loomba
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA.
| | - Frank Zimmerman
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Tarek Husayni
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
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11
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Abdulkarim M, Karikari Y, Loomba RS, Anderson RH, Vricella L, El-Zein C. A Unique Case of Middle Aorta Syndrome With a "Corkscrew" Descending Aorta. World J Pediatr Congenit Heart Surg 2019; 10:799-800. [PMID: 31701825 DOI: 10.1177/2150135119873854] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Middle aortic syndrome is a rare anatomic defect of the descending aorta and presents with hypertension. We present a unique case with "corkscrew" configuration. This case highlights the need for evaluation with advanced imaging for diagnosis to facilitate surgical management and avoid hypertensive complications.
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Affiliation(s)
- Mubeena Abdulkarim
- Division of Cardiology, Advocate Children's Hospital, Advocate Heart Institute, Chicago, IL, USA
| | - Yaa Karikari
- Division of Cardiology, Advocate Children's Hospital, Advocate Heart Institute, Chicago, IL, USA
| | - Rohit S Loomba
- Division of Cardiology, Advocate Children's Hospital, Advocate Heart Institute, Chicago, IL, USA
| | - Robert H Anderson
- Institute of Genetics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Luca Vricella
- Division of Cardiology, Advocate Children's Hospital, Advocate Heart Institute, Chicago, IL, USA
| | - Chawki El-Zein
- Division of Cardiology, Advocate Children's Hospital, Advocate Heart Institute, Chicago, IL, USA
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Denzer UW, Sioulas AD, Abdulkarim M, Groth S, Rösch T, Busch P, Izbicki J, Ittrich H, Adam G, Schachschal G. Endoscopic ultrasound-guided drainage of abdominal fluid collections after pancreatic surgery: Efficacy and long-term follow-up. Z Gastroenterol 2016; 54:1047-53. [PMID: 27612217 DOI: 10.1055/s-0042-112032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE Endoscopic ultrasound-guided drainage (EUS-GD) of postoperative abdominal fluid collections (POFC) following pancreatic surgery is used as an alternative or complement to percutaneous drainage (PD) procedure. The present single-center retrospective study evaluates its efficacy and safety. METHOD We included consecutive cases with POFC treated by EUS-GD between September 2009 and November 2014 in our department. Technical success, long-term clinical success, recurrence rate and need for surgery were analyzed. RESULTS 24 procedures in 20 patients (95 % after pancreatic resection) were assessed. Indications for surgery included tumors/lesions located in the pancreas (15/20), chronic pancreatitis (3/20) and duodenal adenoma not completely resectable endoscopically (2/20). EUS-GD was performed within a median of 30 days (IQR: 8.25) for a median fluid collection size of 72.5 mm (IQR: 46.25), requiring a mean of 1.2 sessions with placement of a mean of 2.1 plastic stents (7 Fr/10 Fr) per patient for a mean of 89 days (IQR: 127). Microbiology of aspirated fluid revealed positive cultures in 13 patients, mostly polymicrobial, isolated positive for fungal and 3 multidrug-resistant gram negative (MRGN) in 4 cases. An additional transpapillary drainage was inserted in 1/20 patients. 4/20 patients received PD, mostly before EUS-GD. Technical and clinical success was achieved in 20/20 (100 %) and 18/20 (90 %) patients, respectively, while 2 patients required re-operation. During follow-up (median 630 days after stent removal, range: 45 - 2160), recurrence occurred in 1/18 (5.5 %) patient that was referred for surgery. No death or severe adverse events were noted. CONCLUSION EUS-GD is an effective, minimally invasive and safe method for therapy of POFC after pancreatic surgery offering long-term remission in about 95 % of cases.
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Affiliation(s)
- U W Denzer
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A D Sioulas
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Abdulkarim
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Groth
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Rösch
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Busch
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Ittrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Schachschal
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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