Publications by authors named "Alexander Lowenthal"

25 Publications

  • Page 1 of 1

Transient Cardiac Injury in Adolescents Receiving the BNT162b2 mRNA COVID-19 Vaccine.

Pediatr Infect Dis J 2021 Jun 2. Epub 2021 Jun 2.

From the Department of Pediatrics C Department of Pediatrics B Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Cardiology Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel Pediatric Intensive Care Unit, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel Pediatric Intensive Care Unit, Meir Medical Center, Kfar Saba, Israel Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.

Background: Vaccines are paramount in the effort to end the coronavirus disease 2019 global epidemic. BNT162b2 is approved for the vaccination of adolescents over 16 years of age. Systemic adverse events were scarce though the pretested cohort of this age group was relatively small. The aim of the current study is to raise awareness for potential adverse reactions.

Methods: This is a case series of patients diagnosed with perimyocarditis following vaccination. Patients were compiled from 3 pediatric medical centers in Israel through a network of pediatricians and data regarding those cases was collected. In addition, incidence of perimyocarditis during the vaccination period was compared with previous years.

Results: All patients were males 16-18 years old, of Jewish descent, who presented with chest pain that began 1-3 days following vaccination (mean, 2.1 days). In 6 of the 7 patients, symptoms began following the 2nd dose and in 1 patient following the 1st dose. All cases were mild and none required cardiovascular or respiratory support. The incidence of perimyocarditis during the vaccination period was elevated in comparison to previous years.

Conclusions: This case series describes a time association between coronavirus disease 2019 vaccine and perimyocarditis in adolescents. All cases were mild, although only long-term follow-up can reveal the true impact of this cardiac injury. While it seems that the incidence of perimyocarditis during the vaccination campaign period is increased, a more comprehensive data collection on a wider scale should be done. We hope this report will serve as a reminder to report events and allow for analysis of potential adverse reactions.
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http://dx.doi.org/10.1097/INF.0000000000003235DOI Listing
June 2021

Clinical Features and Comparison of Kingella and Non-Kingella Endocarditis in Children, Israel.

Emerg Infect Dis 2021 Mar;27(3):703-709

Kingella spp. have emerged as an important cause of invasive pediatric diseases. Data on Kingella infective endocarditis (KIE) in children are scarce. We compared the clinical features of pediatric KIE cases with those of Streptococcus species IE (StIE) and Staphylococcus aureus IE (SaIE). A total of 60 patients were included in the study. Throughout the study period, a rise in incidence of KIE was noted. KIE patients were significantly younger than those with StIE and SaIE, were predominately boys, and had higher temperature at admission, history of oral aphthae before IE diagnosis, and higher lymphocyte count (p<0.05). Pediatric KIE exhibits unique features compared with StIE and SaIE. Therefore, in young healthy children <36 months of age, especially boys, with or without a congenital heart defect, with a recent history of oral aphthae, and experiencing signs and symptoms compatible with endocarditis, Kingella should be suspected as the causative pathogen.
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http://dx.doi.org/10.3201/eid2703.203022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920667PMC
March 2021

Hospitalization for Respiratory Syncytial Virus Bronchiolitis in the Palivizumab Prophylaxis Era: Need for Reconsideration of Preventive Timing and Eligibility.

Isr Med Assoc J 2019 Feb;21(2):110-115

Department of Pediatrics A, Schneider Children's Medical Center, Petah Tikva, Israel.

Background: Respiratory syncytial virus (RSV)-related bronchiolitis is a common cause of morbidity in young infants. The recommendations for its passive prevention by palivizumab are currently under intensive debate.

Objectives: To elucidate the optimal prevention strategy by studying the morbidity of RSV disease under the current recommendations for palivizumab prophylaxis in Israel.

Methods: We collected demographic and clinical data of all children hospitalized with microbiologically confirmed RSV bronchiolitis during 2015-2016 at Schneider Children's Medical Center. The seasonality of RSV disease was also studied for the period 2010-2017 in sentinel clinics scattered throughout Israel.

Results: Of the 426 hospitalized children, 106 (25%) had underlying diseases but were not eligible for palivizumab prophylaxis according to the current criteria in Israel. Their course was severe, with a mean hospital stay of 6.7 days and a 12% admission rate to the pediatric intensive care unit (PICU). Palivizumab-eligible children who did not receive the prophylaxis before hospitalization had the most severe course, with 22% admitted to the PICU. More children were diagnosed with RSV disease in October than in March among both hospitalized and ambulatory children; 44% of the palivizumab-eligible hospitalized children were admitted in the last 2 weeks of October, before 1 November which is the recommended date for starting palivizumab administration in Israel.

Conclusions: According to the results of the present study we suggest advancing RSV prophylaxis in Israel from 1 November to mid-October. The precise palivizumab-eligible categories should be reconsidered.
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February 2019

Urgent Surgical Treatment of Aortic Endocarditis in Infants and Children.

Pediatr Cardiol 2019 Mar 2;40(3):580-584. Epub 2019 Jan 2.

Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.

Infective endocarditis (IE) in the pediatric population can present as a life-threatening condition. Optimal timing for surgical intervention should consider surgical risks versus the risk of neurologic complications. We herein report our experience with this group of critically ill children. Retrospective analysis of patient charts of all patients who underwent urgent surgical treatment of aortic IE from 1994 to 2014 was performed. Nine patients with acute storming IE of the aortic valve or the ascending aorta were urgently operated (eight normal heart, one congenital aortic stenosis), age ranged from 8 weeks to 4.2 years. Causative organisms were Staphylococcus aureus (2), Staphylococcus coagulase negative (1), Kingella kingae (2), Streptococcus pneumoniae (2), or culture negative (2). Presenting symptoms other than hemodynamic instability were neurologic decompensation (5) coronary embolization (1) and cardiogenic shock due to scalded skin syndrome (1). CT and MRI demonstrated significant brain infarcts in four patients. Operations performed were the Ross operation (7) and ascending aortic reconstruction (2). There were no operative deaths. At a median follow-up of 6 years (range 2-196 months), all patients are alive and well. Re-intervention included homograft replacement (2) and transcatheter Melody valve implantation (1). At their last follow-up, the neo-aortic valve was functional in all patients with minimal regurgitation and all had full resolution of the neurological deficits. Urgent surgical treatment for aortic valve IE in infants is challenging. Although surgery is complex and pre-disposing conditions such as sepsis, neurologic and cardiac decompensations are prevalent, operative results are excellent and gradual and significant neurologic improvement was noted over time.
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http://dx.doi.org/10.1007/s00246-018-2030-5DOI Listing
March 2019

Plasma microvesicle analysis identifies microRNA 129-5p as a biomarker of heart failure in univentricular heart disease.

PLoS One 2017 31;12(8):e0183624. Epub 2017 Aug 31.

Department of Pediatrics and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, United States of America.

Biomarkers of heart failure in adults have been extensively studied. However, biomarkers to monitor the progression of heart failure in children with univentricular physiology are less well understood. We proposed that as mediators of diverse pathophysiology, miRNAs contained within circulating microvesicles could serve as biomarkers for the presence and progression of heart failure in univentricular patients. To test this, we studied the association of heart failure with elevations in specific miRNAs isolated from circulating microvesicles in a cohort of children with univentricular heart disease and heart failure. We conducted a single site cross-sectional observational study of 71 children aged 1 month-7 years with univentricular heart disease and heart failure. We demonstrated that levels of miR129-5p isolated from plasma microvesicles were inversely related to the degree of clinical heart failure as assessed by Ross score. We then showed that miR129-5p levels are downregulated in HL1 cells and human embryonic stem cell-derived cardiomyocytes exposed to oxidative stress. We demonstrated that bone morphogenetic protein receptor 2, which has been implicated in the development of pulmonary vascular disease, is a target of miR129-5p, and conversely regulated in response to oxidative stress in cell culture. Levels of miR129-5p were inversely related to the degree of clinical heart failure in patients with univentricular heart disease. This study demonstrates that miR129-5p is a sensitive and specific biomarker for heart failure in univentricular heart disease independent of ventricular morphology or stage of palliation. Further study is warranted to understand the targets affected by miR129-5p with the development of heart failure in patients with univentricular physiology.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183624PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578659PMC
October 2017

Neonatal Cardiac Surgery in the New Era: Lessons learned from 1000 Consecutive Cases.

Isr Med Assoc J 2016 Nov;18(11):645-648

Division of Pediatric Heart Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.

Background: neonatal cardiac surgery has evolved over the last 50 years with a large percentage of the patients achieving complete physiological repair in the neonatal period. The remaining patients achieve staged palliation with an increasing amount of success.

Objectives: To report our experience with 1000 neonatal cardiac surgical procedures performed in the last 10 years.

Methods: We conducted a retrospective analysis of surgical outcome in all neonatal patients who underwent cardiac surgery between January 2007 and July 2016 at Schneider Children's Medical Center of Israel.

Results: A total of 1003 neonates aged < 30 days underwent surgery for congenital heart defects at our center. Neonatal surgery accounted for 22.5% of all cardiac surgeries. Neonatal operative mortality was 7.3%, Operative mortality for individual lesions were: simple aortic coarctation (CoA) (198 patients, 2.5%), CoA with hypoplastic arch (24, 4%), CoA with ventricular septal defect (VSD) (84, 2.3%), transposition of the great arteries (TGA, simple and complex, 185, 6.3%), TGA with VSD (37, 0%), truncus arteriosus (26, 3.8%), interrupted aortic arch (25, 4%), Norwood Sano (71, 19.7%), neonatal tetralogy of Fallot (41, 0%), and shunt (131 patients, 12%).

Conclusions: Neonatal surgical capabilities have improved substantially over the last decades. Excellent results can be expected for lesions that can be repaired to create biventricular circulation. Improved results can be attributed in part to the evolution of surgical strategies and assistive technologies, but essential is the collaborative effort of surgeons, cardiologists, anesthesiologists, and intensive care specialists acting as a cohesive team whose performance far exceeds the sum of its individual members' contributions.
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November 2016

Extremely elevated C-reactive protein levels are associated with unfavourable outcomes, including death, in paediatric patients.

Acta Paediatr 2016 Jan 23;105(1):e17-21. Epub 2015 Nov 23.

Department of Paediatrics A, Schneider Children's Medical Centre, Petach Tikva (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv), Israel.

Aim: The aim of this study was to investigate the clinical significance of extremely elevated C-reactive protein (CRP) levels in hospitalised children.

Methods: We searched the electronic database of a tertiary paediatric medical centre for all patients admitted in 2010-2013 with a CRP of ≥ 30 mg/dL, and these comprised the study group. The controls were the other admissions. Data were collected on demographics, admission details, pre-existing conditions, discharge diagnosis, laboratory results and clinical outcomes.

Results: Our study group comprised 435 (0.72%) of the 59,997 patients hospitalised during the study period. The mortality rate and mean hospital stays were significantly higher in the study group, and infectious diseases were the most common diagnoses, affecting 389 patients (89.4%), particularly pneumonia (47.1%). Higher CRP was correlated with low albumin levels (p < 0.01). Bacteraemia was the most prevalent diagnosis (38%) in the 84 oncology patients, with a crude mortality rate of 17.6%.

Conclusion: Infectious diseases, mainly bacterial, were the most common diagnoses in previously healthy children with CRP ≥ 30 mg/dL. Extremely elevated CRP levels were associated with an unfavourable clinical outcome, including high mortality, particularly in oncology patients. Paediatricians should be aware of the significance of extremely elevated CRP levels.
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http://dx.doi.org/10.1111/apa.13226DOI Listing
January 2016

Ventricular fibrillation storm in a child.

Europace 2014 Nov;16(11):1654

Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Kaplan 14, Petach Tikva 49202, Israel.

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http://dx.doi.org/10.1093/europace/euu280DOI Listing
November 2014

Feasibility of neonatal pulse wave velocity and association with maternal hemoglobin A1c.

Neonatology 2015 4;107(1):20-6. Epub 2014 Oct 4.

Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, Calif., USA.

Background: Use of non-invasive peripheral arterial tonometry to assess arterial stiffness has not been studied in neonates. Perinatal factors impact childhood vascular health, but the effect in neonates remains to be examined.

Objectives: To examine the feasibility of pulse wave velocity (PWV) among healthy term neonates, and to evaluate the effects of perinatal factors on neonatal PWV.

Methods: Pregnant women with singleton gestation presenting for routine care were enrolled. Postnatally, PWV measurements of their neonates were obtained using an arterial tonometer. A variability index was calculated for each PWV measurement. Intra- and inter-observer reproducibility were illustrated with Bland-Altman plots. Medical records were reviewed. Relationships between neonatal PWV and perinatal factors were examined.

Results: PWV measurements were attempted in 76 neonates and successfully obtained in 67 (88%). Using PWV measurements with a variability index ≤ 0.25 (48 neonates), the intra-class coefficient was 0.69. The mean differences (limits of agreement) for intra- and inter-rater reproducibility were 0.02 (-3.64 to 3.60) and 0.34 (-2.23 to 2.39), respectively. Median neonatal PWV was 2.80 m/s (range 0.60-8.40). Neonates of mothers with HgbA1c ≥6% had significantly higher PWV than neonates of mothers with HgbA1c <6% (4.12 m/s, 95% CI 3.22-5.02, vs. 2.78 m/s, 95% CI 2.28-3.28, p = 0.02).

Conclusions: Neonatal PWV using peripheral arterial tonometry is feasible and reproducible when using measurements with a variability index ≤ 0.25. Neonates of mothers with increased HgbA1c had higher PWV, suggesting an effect of maternal hyperglycemia on neonatal vasculature. The long-term implications of this finding warrant further investigation.
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http://dx.doi.org/10.1159/000366467DOI Listing
January 2016

Ebstein anomaly and Trisomy 21: A rare association.

Ann Pediatr Cardiol 2014 Jan;7(1):67-9

Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California, USA.

This is a case report of a patient with Trisomy 21 with Ebstein anomaly, a ventricular septal defect, and acquired pulmonary vein stenosis; a rare combination, diagnosed during a routine neonatal examination.
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http://dx.doi.org/10.4103/0974-2069.126569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959069PMC
January 2014

The value of noninvasive measurement of the compensatory reserve index in monitoring and triage of patients experiencing minimal blood loss.

Shock 2014 Aug;42(2):93-8

*The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israeli Defense Forces, Ramat Gan, Israel; †US Army Institute of Surgical Research, Fort Sam Houston, Texas; ‡Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel; and §Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel.

Currently available triage and monitoring tools are often late to detect life-threatening clinically significant physiological aberrations and provide limited data in prioritizing bleeding patients for treatment and evacuation. The Compensatory Reserve Index (CRI) is a novel means of assessing physiologic reserve, shown to correlate with central blood volume loss under laboratory conditions. The purpose of this study was to compare the noninvasive CRI device with currently available vital signs in detecting blood loss. Study subjects were soldiers volunteering for blood donation (n = 230), and the control group was composed of soldiers who did not donate blood (n = 34). Data collected before and after blood donation were compared, receiver operator characteristic curves were generated after either donation or the appropriate time interval, and areas under the curves (AUCs) were compared. Compared with pre-blood loss, blood donation resulted in a mean reduction of systolic blood pressure by 3% (before, 123 mmHg; after, 119 mmHg; P < 0.01). The CRI demonstrated a 16% reduction (before, 0.74; after, 0.62; P < 0.01). Heart rate, diastolic blood pressure, and oxygen saturation remained unchanged. The AUC for change in CRI was 0.81, 0.56 for change in heart rate, 0.53 for change in systolic blood pressure, 0.55 and 0.58 for pulse pressure and shock index, respectively. The AUCs for detecting mild blood loss at a single measurement were 0.73 for heart rate, 0.60 for systolic blood pressure, 0.62 for diastolic blood pressure, 0.45 for pulse oximetry, and 0.84 for CRI. The CRI was better than standard indices in detecting mild blood loss. Single measurement of CRI may enable a more accurate triage, and CRI monitoring may allow for earlier detection of casualty deterioration.
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http://dx.doi.org/10.1097/SHK.0000000000000178DOI Listing
August 2014

Arterial applanation tonometry: feasibility and reproducibility in children and adolescents.

Am J Hypertens 2014 Sep 13;27(9):1218-24. Epub 2014 Mar 13.

Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California;

Background: Aortic pulse wave velocity (PWV) and augmentation index (AIx) are markers of vascular health and have recently been used in pediatric clinical trials. However, there are limited data on standardization of these measurements in pediatrics. The objective of this study was to prospectively test the feasibility and reproducibility of PWV and AIx in children and adolescents.

Methods: We performed arterial tonometry on 2 different days within 2 weeks in 40 healthy subjects aged 10-19 years. PWV and AIx were measured in triplicate on each visit.

Results: The visits were separated by a mean of 3.08±3.7 days. We obtained PWV in 77 of 80 (96%) visits and AIx in 76 of 80 (95%) visits in triplicate. Intraclass correlation coefficients (ICCs) for PWV were 0.61 (95% confidence interval (CI) = 0-0.86) when at least 2 measurements and 0.92 (95% CI = 0-1) when 3 measurements were obtained at each visit that met the quality criteria established for adults by the manufacturer (n = 17 and 3 paired visits, respectively). For AIx, ICCs were 0.78 (95% CI = 0.58-0.88) and 0.81 (95% CI = 0.63-0.90) when measurements with an operator index ≥80, a measure of the quality of the waveform, were included (n = 39 and 36 paired visits, respectively).

Conclusions: Arterial applanation tonometry is feasible and reproducible in healthy children and adolescents. AIx has excellent intervisit reproducibility, whereas the intervisit reproducibility of PWV relies on acquisition of multiple measurements that meet quality criteria established for adults. These results have implications for the methodology of future pediatric clinical trials in a population at increasingly higher risk for premature atherosclerosis.
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http://dx.doi.org/10.1093/ajh/hpu034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184354PMC
September 2014

Prenatal tricuspid valve size as a predictor of postnatal outcome in patients with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum.

Fetal Diagn Ther 2014 23;35(2):101-7. Epub 2014 Jan 23.

Department of Pediatrics, University of California, San Francisco, Calif., USA.

Introduction: Tricuspid valve (TV) size at birth correlates with intervention strategy in patients with severe pulmonary stenosis (SPS) or pulmonary atresia/intact ventricular septum (PA/IVS). Prenatal features that might predict postnatal TV size have not been well studied. We hypothesized that prenatal echocardiographic measurements predict the postnatal TV Z-score in fetuses with SPS and PA/IVS.

Materials And Methods: We identified 16 neonates (gestational age 28 ± 4.8 weeks) with a fetal diagnosis of SPS or PA/IVS from 2001 to 2010. Measurements were performed offline. ROC (receiver operating characteristic) analysis was used to generate AUC (areas under the curve) for each of the variables.

Results: AUC was 0.94 for tricuspid to mitral valve (TV/MV) ratio, 0.88 for TV Z-score, and 0.85 for TV inflow duration. A cut-off value of >0.63 for TV/MV yielded a sensitivity of 78%, specificity of 100% for predicting postnatal TV Z-score >-3. Neonates with TV Z-score ≥-3 and all fetuses with antegrade flow across the pulmonary valve or more than moderate tricuspid regurgitation had biventricular circulation in follow-up.

Conclusion: Fetal TV/MV >0.63 predicts favorable TV Z-score at birth in patients with SPS and PA/IVS. Antegrade pulmonary valve flow and more than moderate tricuspid regurgitation also conferred a favorable outcome.
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http://dx.doi.org/10.1159/000357429DOI Listing
November 2014

Expanding the phenotype of cardiovascular malformations in Adams-Oliver syndrome.

Am J Med Genet A 2013 Jun 23;161A(6):1386-9. Epub 2013 Apr 23.

Division of Pediatric Cardiology, Department of Pediatrics Lucile Packard Children's Hospital, Stanford University, Stanford, California, USA.

We describe a newborn with a phenotype consistent with Adams-Oliver syndrome and truncus arteriosus. Although cardiovascular malformations associated with this syndrome have been previously published in the literature, this is the first description of truncus arteriosus in a patient with Adams-Oliver syndrome. We review other reports of Adams-Oliver syndrome previously described with cardiovascular malformations, consider possible genetic and embryologic mechanisms, and emphasize the need for cardiology consultation when a diagnosis of Adams-Oliver syndrome is suspected in the differential diagnosis.
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http://dx.doi.org/10.1002/ajmg.a.35864DOI Listing
June 2013

Echocardiographic predictors of early postsurgical myocardial dysfunction in pediatric patients with aortic valve insufficiency.

Pediatr Cardiol 2013 Aug 7;34(6):1335-43. Epub 2013 Feb 7.

Echocardiography Laboratory, Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite # 325, Palo Alto, CA 94304, USA.

In chronic aortic insufficiency (AI), left-ventricular (LV) dysfunction must be detected early to allow timely surgery. Strain and strain rate have been used for this purpose in adults, but the value of this method in pediatric AI has not been established. Forty patients with moderate to severe AI were included in this retrospective study. LV function was assessed by strain analysis and conventional echocardiography both before and after surgery. Of the 32 patients with preserved preoperative ejection fraction (EF; >50 %), 8 had postoperative dysfunction (<50 %). Mean conventional indices of global LV systolic performance for the entire cohort of patients with AI were predominantly in the normal range before surgery. Preoperative values for LV global longitudinal strain (GLS) and strain rate (GLSr) were normal. After surgery, there was a significant decrease in shortening and EF. There was a significant decrease from preoperative to postoperative values for both GLS (-16.07 ± 3.82 vs. -11.06 ± 3.88; p < 0.0001) and GLSr (-0.89 ± 0.24 vs. -0.72 ± 0.27; p = 0.0021). A preoperative GLS of -15.3 (AUC = 0.83, CI = 0.69-0.98, p < 0.0001) and a GLSr of -0.79/s (AUC = 0.86, CI = 0.73-0.98, p < 0.0001) were determined to be predictors of early postoperative dysfunction after surgical repair of moderate to severe AI. A preoperative GLS value of ≤-15.3 and GLSr value of -0.79/s or less are predictors of postoperative ventricular dysfunction, which is defined by EF <50 %. GLS and GLSr value determination may be useful as part of the echocardiographic assessment AI and may help determine the optimal timing of surgery in pediatric patient with at least moderate AI.
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http://dx.doi.org/10.1007/s00246-013-0646-zDOI Listing
August 2013

Tricuspid atresia with progressive ductal restriction in a fetus.

Pediatr Cardiol 2013 Aug 23;34(6):1499-501. Epub 2012 Jun 23.

Echocardiography Laboratory, Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite # 325, Palo Alto, CA 94304, USA.

We report a unique case of tricuspid and pulmonary atresia with idiopathic progressive ductus arteriosus restriction in utero. Diligent predelivery planning and a controlled delivery environment led to a favorable outcome.
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http://dx.doi.org/10.1007/s00246-012-0391-8DOI Listing
August 2013

Prenatal diagnosis of atrial restriction in hypoplastic left heart syndrome is associated with decreased 2-year survival.

Prenat Diagn 2012 May 17;32(5):485-90. Epub 2012 Apr 17.

Division of Pediatric Cardiology, University of California, San Francisco, San Francisco, CA, USA.

Objective: To compare the course of hypoplastic left heart syndrome (HLHS) patients diagnosed prenatally with any degree of atrial restriction with those without evidence of atrial restriction.

Design: Retrospective, cohort.

Methods: Prenatally diagnosed HLHS patients from August 1999 to January 2009 were categorized as nonrestrictive versus restrictive, defined by left atrial hypertension on pulmonary venous Doppler and/or an intact interatrial septum.

Results: Of 73 total fetal patients identified, 49 were live-born. Survival at 2 years was 29/35 [83% confidence interval (CI): 59.5%-88.9%] for the nonrestrictive group and 6/14 (43% CI: 17.7%-6.0%) for the restrictive group (p<0.0001). Of those who underwent stage 1 palliation (35 with nonrestrictive and 10 with restrictive atrial septa), both groups had a similar incidence of preoperative acidosis and need for ventilation and inotropic support. Postoperatively, there was no difference between groups in ventilator days, length of stay, or survival to discharge. There was decreased survival at 2 years in the restrictive group, 60% (CI: 26.2%-87.8%) versus 83% (CI: 66.4%-93.4%) in the nonrestrictive group. Furthermore, a disproportionate number of interstage deaths was evident in the restrictive group.

Conclusions: Prenatal presence of any degree of atrial septal restriction in the setting of HLHS confers a significant survival disadvantage, with increases in both early and late mortality.
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http://dx.doi.org/10.1002/pd.3850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348961PMC
May 2012

Usefulness of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide as biomarkers for heart failure in young children with single ventricle congenital heart disease.

Am J Cardiol 2012 Mar 22;109(6):866-72. Epub 2011 Dec 22.

Department of Pediatrics, University of California, San Francisco, California, USA.

Children with single ventricle (SV) physiology have increased ventricular work and are at risk of heart failure (HF). However, a HF diagnosis is especially difficult, because few objective measures of HF have been validated in this cohort. We have previously shown that plasma B-type natriuretic peptide (BNP) levels are sensitive and specific for detecting HF in a small, heterogeneous SV cohort. The aim of the present study was to define the effect of SV morphology and stage of palliation on the correlation between BNP and HF. We also examined the utility of N-terminal pro-BNP (NT-proBNP), a more stable product of pre-BNP processing, as a biomarker of HF in these patients. A cross-sectional observational study of SV children aged 1 month to 7 years was conducted. The presence of HF was defined as a Ross score > 2. The association of BNP or NT-proBNP with HF was assessed using logistic regression analysis and receiver operating characteristic curves. Of the 71 included children, 22 (31%) had clinical HF. A doubling of BNP was associated with an odds ratio for HF of 2.20 (95% confidence interval 1.36 to 3.55, p = 0.001) with a c-statistic > 75%, yielding a detection threshold of ≥ 45 pg/ml. This threshold was preserved when patients were stratified by the right ventricular morphology or stage of surgical palliation. Similarly, a doubling of NT-proBNP was associated with an odds ratio for HF of 1.92 (95% confidence interval 1.17 to 3.14, p = 0.009). In contrast to BNP, the threshold value of NT-proBNP for predicting HF decreased with the stage of palliation. In conclusion, plasma BNP and NT-proBNP are reliable tests for clinical HF in young children with SV physiology, specifically those with right ventricular morphology, regardless of the stage of palliation.
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http://dx.doi.org/10.1016/j.amjcard.2011.10.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294194PMC
March 2012

Severe reversible myocardial depression in septic abortion.

Acta Obstet Gynecol Scand 2006 ;85(4):502-3

Medical Intensive Care Unit, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev Beer-Sheva, Israel.

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http://dx.doi.org/10.1080/00016340600607693DOI Listing
May 2006

Secondary bacteremia after rotavirus gastroenteritis in infancy.

Pediatrics 2006 Jan;117(1):224-6

Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.

We describe 1 neonate and 3 infants with bacteremia secondary to rotavirus gastroenteritis. All had a typical course of an increase in temperature several days after admission. The causative organisms were Enterobacter cloacae and Klebsiella pneumoniae, both normal commensals of the small intestine. Pediatricians should be aware of this complication.
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http://dx.doi.org/10.1542/peds.2005-0177DOI Listing
January 2006

Undercover and overlooked.

N Engl J Med 2004 Dec;351(27):2881; author reply 2881

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http://dx.doi.org/10.1056/NEJM200412303512722DOI Listing
December 2004

Sub-arachnoid hemorrhage following cardiopulmonary resuscitation.

Resuscitation 2004 Nov;63(2):221-3

Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, P.O. Box 151, Beer-Sheva 84101, Israel.

We report the case of a 20-year-old male who developed unexplained sub-arachnoid haemorrhage following cardiopulmonary resuscitation. Computed tomography and lumbar puncture performed within 24 h were normal. A CT performed on day 5 revealed massive sub-arachnoid hemorrhage. The patient expired due to brain herniation. We conclude that sub-arachnoid hemorrhage (SAH) may be a late complication of aborted sudden death. We suggest ischaemia-reperfusion injury as a possible mechanism.
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http://dx.doi.org/10.1016/j.resuscitation.2004.05.015DOI Listing
November 2004

Acetylcholinesterase/paraoxonase genotype and expression predict anxiety scores in Health, Risk Factors, Exercise Training, and Genetics study.

Proc Natl Acad Sci U S A 2004 Apr 1;101(15):5512-7. Epub 2004 Apr 1.

Department of Biological Chemistry, Hebrew University of Jerusalem, Jerusalem 91904, Israel.

Anxiety involves complex, incompletely understood interactions of genomic, environmental, and experience-derived factors, and is currently being measured by psychological criteria. Here, we report previously nonperceived interrelationships between expression variations and nucleotide polymorphisms of the chromosome 7q21-22 acetylcholinesterase-paraoxonase 1 (ACHE-PON1) locus with the trait- and state-anxiety measures of 461 healthy subjects from the Health, Risk Factors, Exercise Training, and Genetics Family Study. The AChE protein controls the termination of the stress-enhanced acetylcholine signaling, whereas the PON protein displays peroxidase-like activity, thus protecting blood proteins from oxidative stress damages. Serum AChE and PON enzyme activities were both found to be affected by demographic parameters, and showed inverse, reciprocal associations with anxiety measures. Moreover, the transient scores of state anxiety and the susceptibility score of trait anxiety both appeared to be linked to enzyme activities. This finding supported the notion of corresponding gene expression relationships. Parallel polymorphisms in the ACHE and PON1 genes displayed apparent associations with both trait- and state-anxiety scores. Our findings indicate that a significant source of anxiety feelings involves inherited and acquired parameters of acetylcholine regulation that can be readily quantified, which can help explaining part of the human variance for state and trait anxiety.
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http://dx.doi.org/10.1073/pnas.0307659101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC397414PMC
April 2004

Secondary hypertrophic osteoarthropathy (HOA) mimicking primary HOA (pachydermoperiostitis or Touraine-Solente-Golé) syndrome.

Isr Med Assoc J 2004 Jan;6(1):64

Meonot Maccabi Facility for Complicated Nursing, Ganei Omer, Omer 84965, Israel.

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January 2004