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Ahmed H, Files M, Saarela K, Morray B, Shivaram G, Greene C, Choi C, Mauchley D, McMullan D, Bohuta L, Hong B, Albers E, Kemna M, Rubio A, Law Y, Reed R, Friedland-Little J, Pacheco M, Hsu E. Initial Experience with a Decision Tree to Assess the Need for Concurrent Liver Transplantat in Fontan Patients Undergoing Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Law Y. "To biopsy, or not to biopsy"? That is the clinical conundrum. Pediatr Transplant 2023; 27:e14481. [PMID: 36860158 DOI: 10.1111/petr.14481] [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: 01/18/2023] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Yuk Law
- Pediatrics, Seattle Children's Hospital, Seattle, USA
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Schauer J, Newland D, Hong B, Albers E, Friedland-Little J, Kemna M, Wagner T, Law Y. Treating Pediatric Myocarditis with High Dose Steroids and Immunoglobulin. Pediatr Cardiol 2023; 44:441-450. [PMID: 36097060 PMCID: PMC9467425 DOI: 10.1007/s00246-022-03004-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023]
Abstract
There is considerable variability in practice among pediatric centers for treatment of myocarditis. We report outcomes using high dose steroids in conjunction with IVIG. This is a single center retrospective study of children < 21 years of age diagnosed with myocarditis and treated with high dose steroids and IVIG from January 2004-April 2021. Diagnostic criteria for myocarditis included positive endomyocardial biopsy, cardiac magnetic resonance (CMR) imaging meeting Lake Louise criteria, or strictly defined clinical diagnosis. Forty patients met inclusion criteria. Median age at diagnosis was 11.6 years (0.7-14.6). Diagnosis was made clinically in 70% of cases (N = 28), by CMR in 12.5% (N = 5) and by biopsy in 17.5% (N = 7). Median ejection fraction (EF) at diagnosis was 35% (IQR 24-48). Median duration of IV steroids was 7 days (IQR 4-12) followed by an oral taper. Median cumulative dose of IV immunoglobulin (IVIG) was 2 g/kg. There were no serious secondary bacterial infections after steroid initiation. Ten patients (25%) required mechanical circulatory support. Overall transplant free survival was 92.5% with median follow-up of 1 year (IQR 0-6 years). Six patients required re-admission for cardiovascular reasons. By 3 months from diagnosis, 70% of patients regained normal left ventricular function. High dose steroids in conjunction with IVIG to treat acute myocarditis can be safe without significant infections or long-term side effects. Our cohort had excellent recovery of ventricular function and survival without transplant. Prospective comparison of a combination of high dose steroids with IVIG versus other therapies is needed.
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Affiliation(s)
| | | | - Borah Hong
- Seattle Children’s Hospital, Seattle, WA USA
| | - Erin Albers
- Seattle Children’s Hospital, Seattle, WA USA
| | | | | | - Thor Wagner
- Seattle Children’s Hospital, Seattle, WA USA
| | - Yuk Law
- Seattle Children’s Hospital, Seattle, WA USA
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Amdani S, Korang AA, Law Y, Cantor R, Koehl D, Kirklin JK, Ybarra M, Rusconi P, Azeka E, Ruiz ACP, Schowengerdt K, Bostdorff H, Joong A. Waitlist and post-transplant outcomes for children with myocarditis listed for heart transplantation over 3 decades. J Heart Lung Transplant 2023; 42:89-99. [PMID: 36038480 DOI: 10.1016/j.healun.2022.07.013] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/09/2022] [Accepted: 07/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is limited and conflicting information on waitlist and transplant outcomes for children with myocarditis. METHODS Retrospective review included children with myocarditis and dilated cardiomyopathy (DCM) listed for HT from January 01, 1993 to December 31, 2019 in the Pediatric Heart Transplant Society database. Clinical characteristics, waitlist and post-HT outcomes (graft loss, rejection, cardiac allograft vasculopathy, infection and malignancy) for children listed from early (1993-2008) and current era (2009-2019) with myocarditis were evaluated and compared to those with DCM. RESULTS Of 9755 children listed, 322 (3.3%) had myocarditis and 3178 (32.6%) DCM. Compared to DCM, children with myocarditis in the early and the current era were significantly more likely to be listed at higher urgency; be in intensive care unit; on mechanical ventilation; extracorporeal membrane oxygenation and ventricular assist device (p < 0.05 for all). While unadjusted analysis revealed lower transplant rates and higher waitlist mortality for children with myocarditis, in multivariable analysis, myocarditis was not a risk factor for waitlist mortality. Myocarditis, however, was a significant risk factor for early phase post-HT graft loss (HR 2.46; p = 0.003). Waitlist and post-HT survival for children with myocarditis were similar for those listed and transplanted in the early era to those listed and transplanted in the current era (p > 0.05 for both). CONCLUSIONS Children with myocarditis have a higher acuity of illness at listing and at HT and have inferior post-HT survival compared to children with DCM. Outcomes for children with myocarditis have not improved over the 3 decades and efforts are needed to improve outcomes for this cohort.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Ohio.
| | | | - Yuk Law
- Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington
| | - Ryan Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marion Ybarra
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Paolo Rusconi
- Department of Pediatrics, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Estela Azeka
- Heart Institute (InCor) University of Sao Paulo Medical School, Brazil
| | | | - Kenneth Schowengerdt
- Division of Pediatric Cardiology, Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, St. Louis, Missouri
| | - Hannah Bostdorff
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Ohio
| | - Anna Joong
- Division of Pediatric Cardiology, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Schauer J, Buddhe S, Gulhane A, Sagiv E, Studer M, Colyer J, Chikkabyrappa SM, Law Y, Portman MA. Persistent Cardiac Magnetic Resonance Imaging Findings in a Cohort of Adolescents with Post-Coronavirus Disease 2019 mRNA Vaccine Myopericarditis. J Pediatr 2022; 245:233-237. [PMID: 35351530 PMCID: PMC8957353 DOI: 10.1016/j.jpeds.2022.03.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
We describe the evolution of cardiac magnetic resonance imaging findings in 16 patients, aged 12-17 years, with myopericarditis after the second dose of the Pfizer mRNA coronavirus disease 2019 vaccine. Although all patients showed rapid clinical improvement, many had persistent cardiac magnetic resonance imaging findings at 3- to 8-month follow-up.
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Affiliation(s)
- Jenna Schauer
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA.
| | - Sujatha Buddhe
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Avanti Gulhane
- Department of Radiology, University of Washington, Seattle, WA
| | - Eyal Sagiv
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Matthew Studer
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Jessica Colyer
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | | | - Yuk Law
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Michael A Portman
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
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Schauer J, Buddhe S, Colyer J, Sagiv E, Law Y, Mallenahalli Chikkabyrappa S, Portman MA. Myopericarditis After the Pfizer Messenger Ribonucleic Acid Coronavirus Disease Vaccine in Adolescents. J Pediatr 2021; 238:317-320. [PMID: 34228985 PMCID: PMC8253718 DOI: 10.1016/j.jpeds.2021.06.083] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
Reports have emerged of myocarditis and pericarditis predominantly after the second dose of the coronavirus disease messenger ribonucleic acid vaccine. We describe 13 patients aged 12-17 years who presented with chest pain within 1 week after their second dose of the Pfizer vaccine and were found to have elevated serum troponin levels and evidence of myopericarditis.
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Affiliation(s)
- Jenna Schauer
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA.
| | - Sujatha Buddhe
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Jessica Colyer
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Eyal Sagiv
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Yuk Law
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | | | - Michael A Portman
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
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Amdani S, Boyle GJ, Cantor RS, Conway J, Godown J, Kirklin JK, Koehl D, Lal AK, Law Y, Lorts A, Rosenthal DN. Significance of pre and post-implant MELD-XI score on survival in children undergoing VAD implantation. J Heart Lung Transplant 2021; 40:1614-1624. [PMID: 34598872 DOI: 10.1016/j.healun.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 04/12/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Derangements in liver and renal function often accompany end-stage heart failure. We sought to assess the utility of an objective risk assessment tool, the Model for End-stage Liver Disease eXcluding INR (MELD-XI), to identify pediatric patients at increased risk for adverse outcomes post-ventricular assist device (VAD) implantation. METHODS The Pedimacs database was queried for all pediatric patients who underwent VAD implantation from September 19, 2012 to December 31, 2019. Pre-implant and early (1-week) post-implant MELD-XI scores were used to stratify patients into low, intermediate and high score cohorts. Comparison of pre-implant characteristics and post-implant outcomes were conducted across groups. Multiphase parametric hazard modeling was utilized to identify independent predictors of post-implant mortality. RESULTS A total of 742 patients had a calculable MELD-XI score pre-implant. When stratified by MELD-XI scores pre-implant, patients in the high MELD-XI score cohort (score >13.6) had inferior survival and increased bleeding, renal dysfunction and respiratory failure post-implant compared to intermediate and low score cohorts. Risk factors for mortality post-VAD implantation were: increasing MELD-XI scores (HR 1.1 per 1 unit rise), Pedimacs profile 1 (HR 1.6), congenital heart disease (HR 2.3) and being on a percutaneous VAD (HR 2.7). Importantly, MELD-XI score was a better predictor of post-VAD implant mortality than bilirubin or creatinine alone, neither of which were significant in the final model. Patients with increasing or continued high MELD-XI scores early post-implant had the worst survival. CONCLUSION The MELD-XI is an easily calculated score that serves as a promising risk assessment tool in identifying children at risk for poor outcomes post VAD implantation.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
| | - Gerard J Boyle
- Department of Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer Conway
- Department of Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashwin K Lal
- Division of Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Yuk Law
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington
| | - Angela Lorts
- Department of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - David N Rosenthal
- Department of Cardiology, Stanford University, Palo Alto, California
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Schauer J, Newland D, Friedland-Little J, Albers E, Hong B, Kemna M, Wagner T, Law Y. Treating Pediatric Myocarditis with High Dose Steroids and Immunoglobulin. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Amdani S, Korang A, Law Y, Cantor R, Koehl D, Kirklin J, Ybarra M, Rusconi P, Azeka E, Ruiz AP, Schowengerdt K, Bostdorff H, Joong A. Waitlist and Post-Transplant Outcomes for Children with Myocarditis Listed for Heart Transplantation over Three Decades: A Multi-Institutional Analysis. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1831] [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: 11/15/2022] Open
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Tsilimparis N, Law Y, Rohlffs F, Spanos K, Debus ES, Kölbel T. Fenestrated endovascular repair for diseases involving the aortic arch. J Vasc Surg 2020; 71:1464-1471. [DOI: 10.1016/j.jvs.2019.06.205] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
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Kirk C, Tong M, Shivaram G, Law Y. Herding CATs? The Incidence and Prevention of Catheter-Associated Thromboses (CATs) in Pediatric Patients after Cardiac Transplant. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.311] [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: 11/25/2022] Open
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Makaloski V, Kölbel T, Fiorucci B, Rohlffs F, Carpenter S, Law Y, Debus ES, Tsilimparis N. Fascial Suture Technique Vs. Open Femoral Access for Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.1144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Law Y, Kölbel T, Detter C, Rohlffs F, Kodolitsch YV, Makaloski V, Debus S, Tsilimparis N. Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.821] [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: 11/28/2022]
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Law Y, Tsilimparis N, Rohlffs F, Makaloski V, Behrendt CA, Heidemann F, Wipper SH, Debus ES, Kölbel T. Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm. J Vasc Surg 2019; 70:404-412. [DOI: 10.1016/j.jvs.2018.10.117] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022]
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Law Y, Kölbel T, Detter C, Rohlffs F, von Kodolitsch Y, Makaloski V, Debus ES, Tsilimparis N. Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies. Ann Thorac Surg 2019; 107:1799-1806. [DOI: 10.1016/j.athoracsur.2018.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/21/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Otero J, Albers E, Friedland-Little J, Hong B, Kemna M, Gimferrer I, Law Y. Use of Bortezomib in the Treatment of Antibody Mediated Rejection (AMR) in Pediatric Heart Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1192] [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: 11/25/2022] Open
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Law Y, Kölbel T, Rohlffs F, Behrendt C, Heidemann F, Debus ES, Tsilimparis N. Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm. J Vasc Surg 2019; 69:334-340. [DOI: 10.1016/j.jvs.2018.04.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/11/2018] [Indexed: 12/12/2022]
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Affiliation(s)
- Yuk Law
- Cardiac Transplant and Heart Failure Services, Seattle Children's Hospital, Seattle, Washington.
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Wong PC, Chan YC, Law Y, Cheng SWK. Percutaneous mechanical thrombectomy in the treatment of acute iliofemoral deep vein thrombosis: a systematic review. Hong Kong Med J 2019; 25:48-57. [DOI: 10.12809/hkmj187491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
AIM We present the clinical outcomes of patients who underwent delayed (>30 days) open surgical repair after endovascular aortic aneurysm repair. METHODS All patients receiving delayed open repair of infrarenal and juxtarenal aortic aneurysms after endovascular repair from July 2001 to December 2017 were retrospectively reviewed. Patients' baseline characteristics, indications for delayed open conversion, and time between endovascular repair and open conversion are described. Early outcomes included operative approach, morbidity, and mortality. Midterm outcomes included survival. RESULTS Twenty-two (3.3%) of 667 patients with prior infrarenal endovascular aortic aneurysm repair had delayed open conversion (20 elective and 2 emergency). The time from endovascular repair to open conversion was 60 ± 36 months. The indications were 6 (27%) type Ia endoleaks, 6 (27%) type II endoleaks with enlarging sac size, 2 (9%) endotensions, 7 (32%) unknown types of endoleak, and 1 (5%) graft infection. The 7 minutes unknown endoleaks were confirmed as lumbar leaks in 4 cases and fabric leaks in 3. Operative time was 222 ± 48 min with blood loss of 2211 ± 2057 mL. Hospital stay after conversion was 12 ± 8 days. There was no 30-day mortality. Estimated survival rates were 96%, 91%, 86%, 79% and 57% at 1, 2, 3, 4, and 5 years postoperatively. CONCLUSION Delayed conversion to open surgery after endovascular aortic aneurysm repair by endograft explantation appears to be safe with good short- and mid-term outcomes. With careful preoperative assessment, open conversion remained a realistic and viable option in patients with failed endovascular treatment.
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Affiliation(s)
- Y Law
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Y C Chan
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - S W Cheng
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Makaloski V, Kölbel T, Rohlffs F, Behrendt CA, Law Y, Debus ES, Tsilimparis N. Early Outcomes After Branched and Fenestrated Endovascular Aortic Repair in Octogenarians. Eur J Vasc Endovasc Surg 2018; 56:818-825. [DOI: 10.1016/j.ejvs.2018.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022]
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Tsilimparis N, Detter C, Law Y, Rohlffs F, Heidemann F, Brickwedel J, von Kodolitsch Y, Debus ES, Kölbel T. Single-center experience with an inner branched arch endograft. J Vasc Surg 2018; 69:977-985.e1. [PMID: 30477941 DOI: 10.1016/j.jvs.2018.07.076] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/20/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Whereas open repair is the "gold standard" for most aortic arch diseases, a subgroup of patients might benefit from an endovascular approach. The introduction of branched stent grafts with dedicated design to address the challenges of the ascending aorta and the aortic arch has opened an entirely new area of treatment for these patients. We investigated the early outcomes of branched thoracic endovascular aortic repair (b-TEVAR) in various types of disease of the aortic arch. METHODS A retrospective analysis was conducted of prospectively collected data from a single center of all consecutive patients treated with b-TEVAR. The indication for elective endovascular repair was consented in an interdisciplinary case conference. All patients were treated with a custom-made inner branched arch endograft with two internal branches (Cook Medical, Bloomington, Ind) and left-sided carotid-subclavian bypass. Study end points were technical success, 30-day mortality, and complications as well as late complications and reinterventions. RESULTS Between 2012 and 2017, there were 54 patients (38 male; median age, 71 years) treated with diseases of the aortic arch. Indications for therapy involved degenerative aortic arch or proximal descending aortic aneurysms requiring arch repair (n = 24), dissection with or without false lumen aneurysms (n = 26), and penetrating aortic ulcers (n = 4). Forty-three cases (80%) were performed electively and 11 urgently for contained ruptures (n = 3) or symptomatic aneurysms (n = 8) with endografts already available for the patient or with grafts of other patients with similar anatomy. Technical success was achieved in 53 cases (98%). The 30-day mortality and major stroke incidence were 5.5% (3/54) and 5.5% (3/54), respectively; in-hospital mortality was 7.4% (n = 4), and minor strokes (including asymptomatic new cerebral lesions) occurred in 5.5% (n = 3). There were two cases of transient spinal cord ischemia with complete recovery and one of paraplegia. No retrograde type A dissections or cardiac injuries were observed. Three early stent graft-related reinterventions were necessary to correct proximal endograft kinking with type IA endoleak in one patient, a bridging stent graft stenosis in another patient, and false lumen persistent perfusion from dissected supra-aortic vessels in the last patient. Mean in-hospital stay was 14 ± 8 days. During a mean follow-up of 12 ± 9 months, three nonaorta-related deaths and one aorta-related death distal to the arch repair were observed. CONCLUSIONS Treatment of aortic arch diseases with b-TEVAR is feasible and safe with acceptable mortality and stroke rates.
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Affiliation(s)
- Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany.
| | - Christian Detter
- Department of Cardiovascular Surgery, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Yuk Law
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Franziska Heidemann
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Jens Brickwedel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of Cardiology, German Aortic Center, University Heart Center, Hamburg, Germany
| | - E Sebastian Debus
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
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Law Y, Chan YC, Cheng SWK. Comparing polymer-filled versus self-expanding endografts in Chinese patients. Asian Cardiovasc Thorac Ann 2018; 26:667-676. [PMID: 30354181 DOI: 10.1177/0218492318810108] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. METHODS Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. RESULTS Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were -2.1 mm and -5.1 mm ( p = 0.144) at one year, and -3.5 mm and -7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46-64.88, p < 0.001). CONCLUSION Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.
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Affiliation(s)
- Yuk Law
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Stephen Wing-Keung Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Law Y, Tsilimparis N, Aleed S, Rohlffs F, Schofer N, Debus ES, Müller G, Kölbel T. Treatment of Aortic Coarctation by Self-expanding Thoracic Endograft with Left Subclavian In Situ Laser Fenestration. Ann Vasc Surg 2018; 56:350.e9-350.e13. [PMID: 30342211 DOI: 10.1016/j.avsg.2018.07.068] [Citation(s) in RCA: 2] [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] [Received: 05/16/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) with self-expanding endograft is increasingly used as a viable treatment option for adult aortic coarctation (AC). METHODS We hereby reported a 55-year-old gentleman with late presentation of AC, treated by a novel strategy with thoracic endograft and in situ laser fenestration for left subclavian artery (LSA) revascularization. RESULTS AC was incidentally discovered during coronary angiogram as an investigation for his angina pectoris. TEVAR with self-expanding endograft was chosen because preoperative computer tomography scan showed ectatic thoracic aorta and stenosis just distal to the LSA. The patient was planned for a timely second-stage aortic valve replacement and coronary artery bypass grafting using left internal mammary artery shortly after TEVAR, which required a patent LSA. The procedure was arranged semiurgently. A 34-mm thoracic tube endograft was placed across the coarctation with proximal landing distal to the left common carotid artery. In situ fenestration was created by laser catheter through retrograde left brachial access. The fenestration was then enlarged by balloon dilatation and bridged to the left subclavian origin with a 16-mm balloon-expandable covered stent. CONCLUSIONS TEVAR with in situ fenestration for LSA is a reliable choice for adult AC. The technique added to the armamentarium of treatment options.
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Affiliation(s)
- Yuk Law
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany; Division of Vascular Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| | - Shadi Aleed
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
| | - Goetz Müller
- Department of General and Interventional Cardiology, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany
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Law Y, Chan Y, Cheng S. Predictors of early operative mortality and long-term survival in octogenarians undergoing open and endovascular repair of abdominal aortic aneurysm. Asian J Surg 2018; 41:490-497. [DOI: 10.1016/j.asjsur.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 07/17/2017] [Accepted: 09/07/2017] [Indexed: 11/15/2022] Open
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Law Y, Tsilimparis N, Rohlffs F, Makaloski V, Debus ES, Kölbel T. Combined Ascending Aortic Stent-Graft and Inner Branched Arch Device for Type A Aortic Dissection. J Endovasc Ther 2018; 25:561-565. [DOI: 10.1177/1526602818790568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report the use of the Zenith Ascend stent-graft in conjunction with the Zenith inner branched arch device to treat type A aortic dissection. Case Report: Five patients (mean age 66 years, range 52–78; 4 men) with type A aortic dissection (2 acute) and insufficient distal landing zones were treated with the Zenith Ascend stent-graft and inner branched arch devices to extend the distal landing zone. Left carotid–subclavian bypass was performed in a staged or simultaneous setting depending on the urgency of the condition. Technical success (no type I or III endoleak and successful revascularization of all supra-aortic vessels) was achieved in all patients. Median intensive care unit stay was 5 days (range 4–23) and the median hospital stay was 16 days (range 8–25). The 2 patients with acute dissection died in hospital and at 5 months, respectively. The 3 elective patients were followed for 7, 13, and 19 months, respectively. All had false lumen thrombosis with either a reduced or stable aneurysm diameter. Conclusion: This limited experience demonstrated the feasibility and safety of the combined use of the Ascend stent-graft and inner branched arch devices. This strategy may sometimes be more beneficial than either stent-graft used alone.
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Affiliation(s)
- Yuk Law
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
- Division of Vascular Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
| | - Vladimir Makaloski
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
| | - E. Sebastian Debus
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
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Law Y, Kölbel T, Schirmer J, Aleed S, Mogensen J, Debus ES, Detter C, Tsilimparis N. Transapical Access for Antegrade Catheterization of the Inner Branches of an Arch Stent-Graft Deployed Distal to an Ascending Arch Stent-Graft. J Endovasc Ther 2018; 25:542-546. [DOI: 10.1177/1526602818792042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Propose: To describe a technique for antegrade cannulation and bridging of the supra-aortic branches through a transapical access in the treatment of an arch aneurysm using combined ascending and branched arch stent-grafts. Technique: An 81-year-old man with a past history of open infrarenal aortic repair, emergent endovascular aortic repair for thoracic aortic rupture, and later perivisceral 4-vessel branched endovascular repair of type I thoracoabdominal aneurysm presented for repair of a concomitant 7.5-cm arch aneurysm. Because of a 44-mm ascending aorta, a tapered 50/44-mm ascending stent-graft was delivered through a transapical access to establish an adequate landing zone before implantation of a 46-mm inner branched arch device via a transfemoral route. Innominate and left subclavian arteries were antegradely cannulated and bridged through the existing transapical path. Conclusion: Our case demonstrates the feasibility of transapical access for cannulation of an arch branched device, while introducing the theoretical possibility of completing the entire procedure through a transapical access.
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Affiliation(s)
- Yuk Law
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
- Division of Vascular Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
| | - Johannes Schirmer
- German Aortic Center Hamburg, Department of Cardiac Surgery, University Heart Center of Hamburg, Germany
| | - Shadi Aleed
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
| | | | - E. Sebastian Debus
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
| | - Christian Detter
- German Aortic Center Hamburg, Department of Cardiac Surgery, University Heart Center of Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, Germany
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Tam CHA, Chan YC, Law Y, Cheng SWK. The Role of Three-Dimensional Printing in Contemporary Vascular and Endovascular Surgery: A Systematic Review. Ann Vasc Surg 2018; 53:243-254. [PMID: 30053547 DOI: 10.1016/j.avsg.2018.04.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/16/2018] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Three-dimensional (3D) printing, also known as rapid prototyping or additive manufacturing, is a novel adjunct in the medical field. The aim of this systematic review is to evaluate the role of 3D printing technology in the field of contemporary vascular surgery in terms of its technical aspect, practicability, and clinical outcome. METHODS A systematic search of literatures published from January 1, 1980 to July 15, 2017 was identified from the EMBASE, MEDLINE, and Cochrane library database with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The predefined selection inclusion criterion was clinical application of 3D printing technology in vascular surgery of large and small vessel pathology. RESULTS Forty-two articles were included in this systematic review, including 2 retrospective cohorts and 1 prospective case control study. 3D printing was mostly applied to abdominal aortic aneurysm (n = 20) and thoracic aorta pathology (n = 8), other vessels included celiac, splenic, carotid, subclavian, femoral artery, and portal vein (n = 10). The most commonly quoted materials were acrylonitrile-butadiene-styrene (n = 2), polylactic acid (n = 4), polyurethane resin (n = 3) and nylon (n = 3). The cost per replica ranged from USD $4-2,360. Cost for a commercial printer was around USD $2,210-50,000. CONCLUSION 3D printing was recognized and gradually incorporated as a useful adjunct in the field of vascular and endovascular surgery. The production of an accurate anatomic patient-specific replica was shown to bring significant impact in patient management in terms of anatomic understanding, procedural planning, and intraoperative navigation, education, and academic research as well as patient communication. Further analysis on cost-effectiveness was indicated to guide decisions on applicability of such promising technology on a routine basis.
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Affiliation(s)
- Chun Hei Adrian Tam
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
| | - Yuk Law
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Stephen Wing Keung Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Law Y, Chan YC, Cheng SW. Arch branch endografts for arch aneurysms associated with bovine anomaly. Asian Cardiovasc Thorac Ann 2018; 27:127-131. [PMID: 30012000 DOI: 10.1177/0218492318788780] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bovine aortic arch is known to be associated with an increased rate of aortic arch expansion. The most frequently observed human variant of bovine aortic arch is a common origin of the innominate trunk and left common carotid artery. This is a report of two patients who had successful custom-made arch branch endograft treatment for an arch aneurysm associated with bovine arch anomaly. Modular endovascular repair of aortic arch aneurysms using an inner-branched device adds to the armamentarium of treatment options, and is a minimally invasive management modality without the need for sternotomy or intraoperative extracorporeal bypass.
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Affiliation(s)
- Y Law
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Y C Chan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - S W Cheng
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Tsilimparis N, Rohlffs F, Detter C, Law Y, von Kodolitsch Y, Debus S, Kölbel T. SS02. Single-Center Experience With a Double-Branched Aortic Arch Endograft. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.075] [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: 11/28/2022]
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Musa N, Law Y, Richardson N, Albers E, Kemna M, Friedland-little J, Hong B, Mazor R. Use of Isosorbide Dinitrate/Hydralazine Combination in Pediatric Patients with Heart Failure. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1003] [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: 11/29/2022] Open
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Dipchand A, Zuckerman W, Auerbach S, Conway J, Cherikh W, Peng D, Barnes A, Kaufman B, Thrush P, Sadavarte A, Almond C, Pahl E, Azeka E, Gajarski R, Law Y, Lorts A, VanderPluym C, Kirk R. The First Analysis of the International Pediatric Heart Failure Registry (iPHFR) - Heart Failure Hospitalizations. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Pak J, Herzog T, Nemeth T, Jorgensen N, Friedland-Little J, Hong B, Albers E, Kemna M, Law Y. Mycophenolic Acid Trough Levels Underestimate Drug Exposure in Pediatric Heart Transplant Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.140] [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: 11/29/2022] Open
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Hong B, Jorgensen N, Albers E, Friedland-Little J, Kemna M, Law Y. Long-term Outcomes of Adult Survivors of Pediatric Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Dentel J, Keeshan B, Grijalva J, Law Y, Chen J, McMullan D. Poor Out-patient Clinic Appointment Compliance is a Predictor of Post-Heart Transplant Mortality in Children. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Abstract
Background Fluorine-18-fluorodeoxyglucose positron-emission tomography with computed tomography has revolutionized medical diagnosis by adding functional activity to anatomic imaging. We report our experience with this technique in patients with mycotic aortic pathology and aortic vascular graft infection. Methods We conducted a retrospective review of a prospective database of patients who underwent 18F-fluorodeoxyglucose positron-emission tomography with computed tomography for suspected infective aortic disease. From 2012 to 2016, 13 patients underwent 18F-fluorodeoxyglucose positron-emission tomography. Of these, 9 (69%) had a vascular graft infection (5 infrarenal aorta, 1 para-visceral, 2 descending, and 1 arch; 2 had previous open surgery and 7 had endovascular interventions) and 4 (31%) had a mycotic aneurysm (2 aortic arch, 1 infrarenal aorta, and 1 distal aorta and common iliac; 3 had endografts). The indications for imaging, location of pathology, 18F uptake, and clinical outcomes were analyzed. Results Eight (62%) patients had a single scan and 5 (38%) had serial scans performed. Among the 5 patients who had serial imaging, 3 showed decreased 18F uptake and 2 had increased uptake. Only one patient underwent subsequent endograft removal; the others were treated with lifelong antibiotics. There were 5 (38%) deaths on follow-up. Conclusion 18F-fluorodeoxyglucose positron-emission tomography with computed tomography could be a valuable adjunct in the diagnosis and surveillance of patients with aortic infection. Serial scans may be useful for monitoring disease activity and response to antibiotic therapy.
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Affiliation(s)
- Julian S Tsang
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yuk Law
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Stephen W Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Higgins D, Otero J, Jefferis Kirk C, Pak J, Jorgensen N, Kemna M, Albers E, Hong B, Friedland-Little J, Law Y. Iron Laboratory Studies in Pediatric Patients With Heart Failure from Dilated Cardiomyopathy. Am J Cardiol 2017; 120:2049-2055. [PMID: 28942941 DOI: 10.1016/j.amjcard.2017.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/12/2022]
Abstract
Iron deficiency (FeD), with or without anemia, in adults with heart failure (HF) is associated with poor outcomes, which can be improved with replacement therapy. A similar therapeutic opportunity may exist for children; however, iron laboratory measurements and FeD have not been described in pediatric patients with HF. A single-center, retrospective study was conducted on 28 patients <21 years old with a diagnosis of dilated cardiomyopathy and HF who had iron laboratories (serum iron, iron saturation, and ferritin) performed. The mean (standard deviation) age at time of laboratory collection was 10.3 (5.5) years. Twenty-seven patients (96.4%) met the criteria for FeD. Serum iron and iron saturation were significantly associated with inpatient hospitalization, being on inotropic medications, or having stage D HF. Low-serum iron was associated with a higher left ventricular end-diastolic dimension and left ventricular end-systolic dimension z-score by echocardiography ((β -2.58, 95% confidence interval [CI] -4.76, -0.40, p = 0.02) and (β -2.43, 95% CI -4.70, -0.17, p = 0.04)), respectively. Low ferritin was associated with higher mortality (relative risk 0.29, 95% CI 0.12, 0.70, p = 0.006). In conclusion, FeD was common in this pediatric cohort with more advanced HF. Iron profile abnormalities were associated with worse HF severity and outcomes including mortality.
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Abstract
Two patients with locally advanced squamous cell carcinoma of the mid-esophagus, with esophageal stents in situ, suffered sudden onset of massive hematemesis and hemodynamic instability due to an aortoesophageal fistula. Although their esophageal neoplasms were deemed inoperable and treatment was palliative, the bleeding was successfully stopped with an endovascular aortic stent-graft. They both remained stable with no septic or hemorrhagic complications, and survived for 14 and 16 weeks after the operation. We emphasize that even if esophageal tumors are locally advanced, emergency endovascular management of aortoesophageal fistula is worthwhile for prolongation of survival.
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Affiliation(s)
- Pak Chiu Wong
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yuk Law
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Stephen Wing Keung Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Law Y. Does standardization improve care or stifle innovation? Pediatr Transplant 2017; 21. [PMID: 28707756 DOI: 10.1111/petr.12773] [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] [Indexed: 11/30/2022]
Affiliation(s)
- Yuk Law
- Division of Cardiology, Seattle Children's Hospital, Seattle, WA, USA
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Chan Y, Law Y, Cheung G, Cheng S. Predictors of Recanalization for Incompetent Great Saphenous Veins Treated With Cyanoacrylate Glue. J Vasc Surg Venous Lymphat Disord 2017. [DOI: 10.1016/j.jvsv.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Law Y, Chan YC, Cheng SWK. Impact of Ambient Temperature on Incidence of Acute Lower Limb Ischemia. Ann Vasc Surg 2017; 44:393-399. [PMID: 28479471 DOI: 10.1016/j.avsg.2017.03.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/19/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND This was a retrospective study to explore the possible association between atmospheric temperatures with the occurrence of acute leg ischemia (ALI). METHODS A linear regression analysis was performed for a period of 10 years on the impact of ambient temperature on the incidence of ALI. Mean ambient temperature on a daily basis was retrieved electronically from our observatory, and the daily incidence of ALI was retrieved from the Clinical Data Analysis and Reporting (CDAR) system. CDAR system could retrieve clinical data from all 42 public hospitals in our region, which provided almost 90% inpatient care of the population. Daily incidence was defined as total number of emergency admissions from all 42 pubic hospitals due to ALI from 00:00 till 23:59 hr of that day. RESULTS For the 10-year period, spanning from January 2005 to December 2014, there were a total of 634 recorded ALI with revascularization, 608 (95.9%) of which underwent emergency femoral embolectomy, 15 (2.4%) underwent thrombolysis, and 11 (1.7%) underwent thrombolysis and embolectomy. ALIs with primary amputation or conservative management were excluded from the study. The average daily incidence of ALI was 0.170. A linear regression model was built using mean ambient temperature as independent variable and incidence of ALI as dependent variables. The line of best fit was drawn through the data points. The daily incidence of ALI could be predicted by ambient temperature (in °C) with the equation: incidence = 0.274-0.004 × temperature (linear regression; r = -0.053, r2 = 0.003, F = 10.42, and P = 0.001). In other words, daily incidence was 0.274 at 0°C; and for every 10°C increase, the incidence would drop by 0.040. At 30°C, daily incidence of ALI was 0.154. CONCLUSIONS This study showed an association of cold temperature and ALI in our population. Measures to protect the susceptible population from cold temperatures should be considered.
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Affiliation(s)
- Yuk Law
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
| | - Yiu Che Chan
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Stephen Wing-Keung Cheng
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Chan YC, Law Y, Cheung GC, Cheng SW. Predictors of Recanalization for Incompetent Great Saphenous Veins Treated with Cyanoacrylate Glue. J Vasc Interv Radiol 2017; 28:665-671. [DOI: 10.1016/j.jvir.2017.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 11/26/2022] Open
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Albers E, Jorgensen N, Friedland-Little J, Hong B, Kemna M, Warner P, Law Y. HLA Eplet Mismatching Is Associated with Increased Risk of Graft Loss in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Evers P, Jorgensen N, Hong B, Albers E, Kemna M, Friedland-Little J, Law Y. A Minimal Biopsy Reliant Surveillance for Rejection in Children Is Not Associated with Inferior Outcomes Post-Heart Transplant. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lui R, Chan YC, Law Y, Cheng SW. Chest Pain After Endovascular Aortic Intervention Due to Esophageal Intramural Dissection. J Cardiothorac Vasc Anesth 2017; 31:e38-e42. [PMID: 28215498 DOI: 10.1053/j.jvca.2016.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/09/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan Lui
- University of New South Wales, St. Vincent's Hospital Clinical School Sydney, Australia
| | - Yiu Che Chan
- The University of Hong Kong, Queen Mary Hospital Hong Kong, China
| | - Yuk Law
- The University of Hong Kong, Queen Mary Hospital Hong Kong, China
| | - Stephen W Cheng
- The University of Hong Kong, Queen Mary Hospital Hong Kong, China
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Chung MM, Chan YC, Law Y, Cheng SW. Infectious anastomotic pseudoaneurysm complicating renal allograft: case report and review of literature. Int J Nephrol Renovasc Dis 2017; 10:55-60. [PMID: 28260939 PMCID: PMC5325110 DOI: 10.2147/ijnrd.s122725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/13/2023] Open
Abstract
Infectious anastomotic pseudoaneurysm complicating renal transplant is rare, but probably under-reported with <30 cases worldwide. We report a 45-year-old man with hypertension, diabetes mellitus and end stage renal failure, who had a renal transplant anastomosed to the right external iliac artery and vein. Postoperatively, he made a slow recovery with malaise and persistent vague right iliac fossa discomfort. Ultrasound scan 1 month postoperatively showed perinephric collection, and fluid culture grew Enterococcus faecium and Pseudomonas aeruginosa. He was started on vancomycin, daptomycin and colistin. MAG-3 scan also showed suboptimal function in the renal allograft. His symptoms persisted with fever, and blood culture yielded P. aeruginosa. Repeated ultrasound scan, and subsequent computed tomography scan a few weeks later, showed perinephric collection and a large, 3.8×3.5 cm pseudoaneurysm posteromedial to the graft kidney. He underwent emergency graft excision, together with resection of the pseudoaneurysm with in situ reversed great saphenous vein interposition graft, and made a good recovery on hemodialysis. The aneurysm wall grew P. aeruginosa, and he was put on imipenem and cilastatin (tienam), colistin, ciprofloxacin and daptomycin. To our knowledge, this is one of very few cases in the world’s literature in which a P. aeruginosa infectious anastomotic pseudoaneurysm developed after a renal allograft.
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Affiliation(s)
- Marvin Mt Chung
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yuk Law
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Stephen Wk Cheng
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Law Y, Chan YC, Cheng SWK. Effectiveness of proximal intra-operative salvage Palmaz stent placement for endoleak during endovascular aneurysm repair. Hong Kong Med J 2016; 22:538-45. [DOI: 10.12809/hkmj154799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Joffe DC, Jones TK, Reisman M, Perpetua E, Law Y, Schuler A, Mackensen GB. Not for adults only: MitraClip use in a paediatric patient. EUROINTERVENTION 2016; 12:e1065-e1070. [DOI: 10.4244/eijv12i8a172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Reuter DG, Law Y, Levy WC, Seslar SP, Zierler RE, Ferguson M, Chattra J, McQuinn T, Liu LL, Terry M, Coffey PS, Dimer JA, Hanevold C, Flynn JT, Stapleton FB. Can preeclampsia be considered a renal compartment syndrome? A hypothesis and analysis of the literature. ACTA ACUST UNITED AC 2016; 10:891-899. [PMID: 27751879 DOI: 10.1016/j.jash.2016.09.002] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
The morbidity and mortality associated with preeclampsia is staggering. The physiology of the Page kidney, a condition in which increased intrarenal pressure causes hypertension, appears to provide a unifying framework to explain the complex pathophysiology. Page kidney hypertension is renin-mediated acutely and ischemia-mediated chronically. Renal venous outflow obstruction also causes a Page kidney phenomenon, providing a hypothesis for the increased vulnerability of a subset of women who have what we are hypothesizing is a "renal compartment syndrome" due to inadequate ipsilateral collateral renal venous circulation consistent with well-known variation in normal venous anatomy. Dynamic changes in renal venous anatomy and physiology in pregnancy appear to correlate with disease onset, severity, and recurrence. Since maternal recumbent position is well known to affect renal perfusion and since chronic outflow obstruction makes women vulnerable to the ischemic/inflammatory sequelae, heightened awareness of renal compartment syndrome physiology is critical. The anatomic and physiologic insights provide immediate strategies to predict and prevent preeclampsia with straightforward, low-cost interventions that make renewed global advocacy for pregnant women a realistic goal.
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Affiliation(s)
- David G Reuter
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA; General Pediatrics, Allegro Pediatrics, Bellevue, WA.
| | - Yuk Law
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA
| | - Wayne C Levy
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Stephen P Seslar
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA
| | - R Eugene Zierler
- Division of Vascular Surgery, University of Washington School of Medicine, Seattle, WA
| | - Mark Ferguson
- Department of Radiology, Seattle Children's Hospital, Seattle, WA
| | - James Chattra
- General Pediatrics, Allegro Pediatrics, Bellevue, WA
| | - Tim McQuinn
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA
| | - Lenna L Liu
- Division of General Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Mark Terry
- Science Department, The Northwest School, Seattle, WA
| | | | - Jane A Dimer
- Division of Obstetrics, University of Washington School of Medicine, Seattle, WA
| | - Coral Hanevold
- Department of Nephrology, Seattle Children's Hospital, Seattle, WA
| | - Joseph T Flynn
- Department of Nephrology, Seattle Children's Hospital, Seattle, WA
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