Publications by authors named "Gurumurthy Hiremath"

28 Publications

  • Page 1 of 1

His bundle pacing after Senning baffle operation.

Europace 2021 May 25. Epub 2021 May 25.

Adult Congenital Cardiology and Pediatric Cardiology, University of Minnesota, 5th Floor East Building, 2450 Riverside Ave, Minneapolis, MN 55454, USA.

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http://dx.doi.org/10.1093/europace/euab069DOI Listing
May 2021

Immediate angiographic residual shunt using the Nit-Occlud device for patent ductus arteriosus closure.

Postepy Kardiol Interwencyjnej 2020 Dec 29;16(4):460-465. Epub 2020 Dec 29.

Department of Pediatrics, Division of Pediatric Cardiology, University of Minnesota, Masonic Children's Hospital, Minneapolis, United States.

Introduction: The Nit-Occlud PDA device is a newer coil-type device with a high degree of efficacy and safety. There are concerns about the high incidence of immediate angiographic residual shunt with this device.

Aim: To compare immediate angiographic residual shunts and their outcomes following PDA device closure with the Nit-Occlud device.

Material And Methods: A single-institution, retrospective chart review of PDA closures was performed. Thirty patients who underwent Nit-Occlud PDA closure were compared with 34 patients who underwent PDA closure with an Amplatzer Duct Occluder-1 (ADO-1) and 25 patients who underwent PDA closure with coils.

Results: The three groups were similar in age, weight, and procedural characteristics. The PDA dimensions were smaller in the coils group. Technical success in the ADO-1 and Nit-Occlud groups was 100%. A small angiographic residual shunt was seen more often in the Nit-Occlud group (70%) than in the ADO-1 (59%) and coils (26%) groups ( = 0.005). Most residual shunts in the Nit-Occlud group disappeared in the echocardiogram performed 4 h later (90% echocardiographic closure). Echocardiographic closure (100%) was seen at 2 months and 6 months in the Nit-Occlud group. No correlation was noted between the angiographic residual shunt and Nit-Occlud device orientation with respect to the ductus, the device-ductal angle or the number of loops at the pulmonary artery end.

Conclusions: Despite the higher immediate angiographic residual shunt rate in the Nit-Occlud group than the other groups, high echocardiographic closure rates were seen within hours after device closure, which persisted at follow-up. The angiographic residual shunt is not related to the device orientation and should not be a deterrent in using this device.
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http://dx.doi.org/10.5114/aic.2020.101772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863818PMC
December 2020

Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis.

Pediatr Cardiol 2021 Apr 16;42(4):918-925. Epub 2021 Feb 16.

Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA.

Pericardiocentesis is traditionally performed using a subxiphoid approach. Hepatomegaly or loculated and noncircumferential effusions warrant nonstandard approaches to drain effusions; echocardiographic guidance has made these less traditional, non-subxiphoid approaches feasible. The study is aimed at comparing clinical outcomes of the subxiphoid and non-subxiphoid approaches to percutaneous pericardiocentesis in a pediatric population. This is a retrospective chart review of all children undergoing percutaneous pericardiocentesis from August 2008 to December 2019 at a single-center. A total of 104 patients underwent echocardiography-guided pericardiocentesis during the timeframe. Additionally, fluoroscopy was also used in 80 patients. Hematopoietic stem cell transplantation was the most common underlying diagnosis (n = 53, 50.9%). A non-subxiphoid approach was used in 58.6% (n = 61) of patients. The fifth and sixth intercostal spaces were the most commonly used (n = 17 each). The non-subxiphoid group tended to be older (95.9 vs. 21.7 months, p = 0.006) and weighed more (23.6 vs. 11.2 kgs, p = 0.013) as compared to the subxiphoid group. Non-subxiphoid approach was associated with shorter procedure times (21 vs. 37 min, p = 0.005). No major complications were seen. Five minor complications occurred and were equally distributed in the two groups. Complications were more likely in younger patients (p = 0.047). The technique and anatomic approach to pericardiocentesis, and the location or size of effusion did not influence the risk of complications. Echocardiography-guided percutaneous pericardiocentesis in children was associated with low complication rates in this single-center pediatric experience. The use of a non-traditional, non-subxiphoid approach was associated with shorter procedure times and did not significantly affect complication rates.
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http://dx.doi.org/10.1007/s00246-021-02563-8DOI Listing
April 2021

Pulmonary valve replacement via left anterior minithoracotomy: Lessons learned and early experience.

J Card Surg 2021 Apr 2;36(4):1305-1312. Epub 2021 Feb 2.

Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota, USA.

Objective: Median sternotomy has been the standard for pulmonary valve replacement (PVR) in patients with free pulmonary regurgitation (PR) and right ventricular enlargement. With the introduction of transcatheter therapy, the search for an alternate to sternotomy is mandated. We present our early experience with a limited anterior left thoracotomy approach.

Methods: We used a left anterior mini-thoracotomy in six male patients (15 ± 1.94 years of age) who developed progressive right ventricular enlargement due to chronic PR.

Results: Primary diagnoses were tetralogy of Fallot in five patients and pulmonary atresia with an intact septum in another. Four patients had previous median sternotomy with transannular patch repair. The mean right ventricular end-diastolic volume index was 189 ± 27.13 ml/m . The procedure was feasible in all patients. All patients had satisfactory adult size pulmonary bioprosthesis (25 or 27 mm valve), with a mean peak gradient of 18 ± 2.40 mmHg across the prosthesis at discharge. All patients were extubated intraoperatively at the end of the procedure and required no intraoperative transfusions. There were no early or late mortalities. Early morbidities included left hemidiaphragm paralysis in one patient, and re-sternotomy for prosthetic valve endocarditis in one. One patient required late reoperation for a common femoral artery pseudoaneurysm.

Conclusions: Minimally invasive access for PVR is feasible in both primary and repeat settings, through a limited anterior left minithoracotomy in the absence of intracardiac shunts and the need for other concomitant cardiac procedures. Longer-term studies with a larger number of patients are needed to compare the efficacy of this approach to standard sternotomy.
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http://dx.doi.org/10.1111/jocs.15382DOI Listing
April 2021

Pediatric SubQ-ICD implantation, a single center review of the inter-muscular technique.

Indian Pacing Electrophysiol J 2021 Jan-Feb;21(1):25-28. Epub 2020 Nov 19.

University of Minnesota/Masonic Children's Hospital, Minneapolis, USA.

Introduction: Pediatric patients with cardiomyopathies are at risk for sudden death and may need implantable cardioverter defibrillators (ICD's), but given their small size and duration of use, children are at increased risk for complications associated with ICD use. The subcutaneous ICD presents a favorable option for children without pacing indications. Unfortunately, initial pediatric studies have demonstrated a high complication rate, likely due to the 3-incision technique employed.

Material And Methods: Patients with ICD but no pacing indication were retrospectively reviewed after implantation of subcutaneous ICD via the two-incision technique. In half of the patients, 10-J impedance test was also performed to compare with impedance obtained after defibrillation threshold testing with 65-J.

Results: Twelve patients were included. The median age was 14 years (range 10-16 years) with eight males included (72.7%). The median weight was 55 kg (range 29 kg-75.1 kg). Follow-up had a median of 11.5 months (range 2-27 months). The median body mass index was 18.4 kg/m squared (range 15.5-27.9 kg/m squared). One patient suffered a minor complication after tearing off the incisional adhesive strips early and required a non-invasive repair in clinic. Shock impedance had a median of 55 J (range 48-68 J). There was one appropriate shock/charge and no inappropriate shocks during follow-up.

Conclusion: The two-incision, intermuscular technique appears to have a lower acute complication rate than prior reports, in our cohort of 12 pediatric patients.
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http://dx.doi.org/10.1016/j.ipej.2020.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854380PMC
November 2020

Acute and medium term results of balloon expandable stent placement in the transverse arch-a multicenter pediatric interventional cardiology early career society study.

Catheter Cardiovasc Interv 2020 11 9;96(6):1277-1286. Epub 2020 Sep 9.

The Heart Institute, Children's Hospital of Colorado, Anschutz Medical Campus, Denver, Colorado, USA.

Objectives And Background: Coarctation of the aorta represents 5-8% of all congenital heart disease. Although balloon expandable stents provide an established treatment option for native or recurrent coarctation, outcomes from transverse arch (TAO) stenting, including resolution of hypertension have not been well studied. This study aims to evaluate immediate and midterm results of TAO stenting in a multi-center retrospective cohort.

Methods: TAO stenting was defined as stent placement traversing any head and neck vessel, with the primary intention of treating narrowing in the transverse aorta. Procedural details, complications and medications were assessed immediately post procedure, at 6 month follow-up and at most recent follow-up.

Results: Fifty-seven subjects, 12 (21%) native, and 45 (79%) surgically repaired aortic arches, from seven centers were included. Median age was 14 years (4 days-42 years), median weight 54 kg (1.1-141 kg). After intervention, the median directly measured arch gradient decreased from 20 mmHg (0-57 mmHg) to 0 mmHg (0-23 mmHg) (p < .001). The narrowest arch diameter increased from 9 mm (1.4-16 mm) to 14 mm (2.9-25 mm) (p < .001), with a median increase of 4.9 mm (1.1-10.1 mm). One or more arch branches were covered by the stent in 55 patients (96%). There were no serious adverse events. Two patients warranted stent repositioning following migration during deployment. There were no late complications. There were 8 reinterventions, 7 planned, and 1 unplanned (6 catheterizations, 2 surgeries). Antihypertensive management was continued in 19 (40%) at a median follow-up of 3.2 years (0.4-7.3 years).

Conclusions: TAO stenting can be useful in selected patients for resolution of stenosis with minimal complications. This subset of patients are likely to continue on antihypertensive medications despite resolution of stenosis.
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http://dx.doi.org/10.1002/ccd.29248DOI Listing
November 2020

Unroofing of Myocardial Bridging After Septal Myectomy in a Child With Noonan Syndrome.

World J Pediatr Congenit Heart Surg 2020 Aug 10:2150135120943869. Epub 2020 Aug 10.

Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA.

Myocardial bridging is a controversial topic that remained with no well-defined management protocol. We present a ten-year-old child with Noonan syndrome and a myocardial bridge.
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http://dx.doi.org/10.1177/2150135120943869DOI Listing
August 2020

Feasibility Study of Catheter-Based Interventions for Anisotropic Expanded Polytetrafluoroethylene Cardiovascular Conduits in a Growing Lamb Model.

J Invest Surg 2020 Jul 20:1-7. Epub 2020 Jul 20.

Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.

Background: Cardiovascular repair in children often requires implant of conduits which do not have growth potential and will require reoperation. In the current study we sought to determine the feasibility of catheter-based interventions of anisotropic conduits inserted as interposition grafts in the main pulmonary artery (MPA) of growing lambs.

Methods: Lambs underwent interpositional implant of either an anisotropic expanded polytetrafluoroethylene (ePTFE) (Test) conduit or conventional PTFE (Control) conduit. In the postoperative period, lambs were anesthetized and underwent catheter-based interventions consisting of hemodynamic and angiographic data collection, balloon dilation and/or stenting of the conduit at 3, 6 or 9 month postoperative time point.

Results: At 3 months, control lambs showed significant increases in right ventricular pressures and trans-conduit gradients in comparison to test lambs. Test conduit diameters were significantly larger compared to controls due to spontaneous radial expansion of the anisotropic conduit. Balloon dilation of test conduits at 3 and 6 months showed a reduction in RV pressure and statistically significant improvement in the RV outflow tract gradient as well as significant increase in graft diameter, compared to both control and pre-dilation conditions. Furthermore, the test conduit diameter increased significantly compared to the pre-balloon and control conditions at each time point. Necropsy of test conduits showed no evidence of tears, perforations, or clot and smooth interiors with well-healed anastomoses.

Conclusions: Anisotropic conduits implanted as interposition grafts in the MPA show spontaneous expansion, and can safely and effectively undergo catheter-based interventions, with significant increases in graft diameter occurring after balloon dilation.
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http://dx.doi.org/10.1080/08941939.2020.1795324DOI Listing
July 2020

Anomalous Aortic Origin of the Right Pulmonary Artery From the Ascending Aorta With Spontaneous Dissection and Thrombosis.

World J Pediatr Congenit Heart Surg 2020 07;11(4):531-533

Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA.

Anomalous aortic origin of the pulmonary artery is rare. It can affect either of the main branches and can be an important cause of neonatal respiratory distress. Early diagnosis and surgical repair is associated with improved survival and long-term outcomes.
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http://dx.doi.org/10.1177/2150135120913804DOI Listing
July 2020

Transcatheter balloon atrial septostomy in thoraco-omphalopagus conjoined twins.

Postepy Kardiol Interwencyjnej 2020 Jun 23;16(2):209-212. Epub 2020 Jun 23.

Department of Pediatrics, Division of Pediatric Cardiology, University of Minnesota, Masonic Children's Hospital, Minneapolis, MN, USA.

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http://dx.doi.org/10.5114/aic.2020.96067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333194PMC
June 2020

Highlights from the Paediatric and Congenital Interventional Cardiology Early-Career Society (PICES) 2019 Activities.

Postepy Kardiol Interwencyjnej 2020 Mar 3;16(1):15-18. Epub 2020 Apr 3.

Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.5114/aic.2020.93908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189140PMC
March 2020

Effects of Systemic Steroid Administration on Recurrence of Pericardial Effusion in Pediatric Patients After Hematopoietic Stem Cell Transplantation.

J Pediatr Hematol Oncol 2020 05;42(4):256-260

Masonic Children's Hospital, University of Minnesota, Minneapolis, MN.

Although rare in the general pediatric population, the incidence of pericardial effusion is significantly higher in pediatric patients undergoing hematopoietic stem cell transplant (HCT) with a reported incidence of up to 16.9%. The development of pericardial effusion in this setting is associated with higher mortality. Although pericardiocentesis is a relatively safe procedure for treating pericardial effusion, it is invasive, painful, and exposes an immunosuppressed patient to the risks of infection, bleeding, and injury to surrounding structures. Given the procedural risks of pericardiocentesis, systemic steroids are often administered for the treatment of pericardial effusion given their use for pericarditis in the general population. However, the effectiveness of systemic steroids for the treatment of pericardial effusion in the pediatric HCT population has not been confirmed. We studied the role of systemic steroids, administered at the time of initial pericardiocentesis performed for pericardial effusion, in preventing repeat pericardiocentesis. A total of 37 pericardiocenteses after HCT were performed during the study period with 25 patients undergoing first-time pericardiocentesis and 15 of those patients receiving systemic steroids. Eight patients required repeat pericardiocentesis; 5 of 15 (33%) received steroids and 3 of 10 (30%) did not receive steroids. Our data in this small cohort of pediatric HCT patients did not show a significant difference in the need for repeat pericardiocentesis with the use of systemic steroids, initiated within 48 hours of pericardiocentesis.
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http://dx.doi.org/10.1097/MPH.0000000000001775DOI Listing
May 2020

Treatment approach to unilateral branch pulmonary artery stenosis.

Trends Cardiovasc Med 2021 04 10;31(3):179-184. Epub 2020 Feb 10.

Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN 55454, USA.

Unilateral proximal pulmonary artery stenosis is often seen in the setting of postoperative congenital heart disease. Accurate assessment of the hemodynamic significance of such a lesion is important so as to determine "When to intervene?" A thorough evaluation should include symptom assessment, anatomical assessment through detailed imaging, functional assessment using differential pulmonary blood flow measurement and cardiopulmonary exercise testing. Symptoms of exertional dyspnea or intolerance, decreased pulmonary blood flow to stenosed lung, and abnormal exertional performance would be factors to pursue therapy in the setting of significant anatomical narrowing. Safe and effective therapy can be offered through transcatheter or surgical techniques and has been shown to improve exertional performance.
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http://dx.doi.org/10.1016/j.tcm.2020.02.001DOI Listing
April 2021

Current clinical management of dysfunctional bioprosthetic pulmonary valves.

Expert Rev Cardiovasc Ther 2020 Jan 30;18(1):7-16. Epub 2020 Jan 30.

The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.

: As with any bioprosthetic valve, bioprosthetic valves in the pulmonary position have a finite life span and patients with bioprosthetic pulmonary valves require lifetime management to treat valve dysfunction.: In this article, authors discuss the current medical management for the treatment of dysfunctional bioprosthetic valves. This review is based on both an extensive review of the recent cardiac surgical/interventional cardiology literature (PubMed and MEDLINE database searches from 1958 to 2019) and personal experience.: Valve technology is rapidly progressing and with a coordinated effort from cardiac surgeons and interventional cardiologists, patients suffering from bioprosthetic pulmonary valve dysfunction can expect to have a decreased number of procedures and less invasive procedures over their lifetime now.
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http://dx.doi.org/10.1080/14779072.2020.1715796DOI Listing
January 2020

Device Closure of Iatrogenic Left Ventricular Perforation Through the Chest Wall.

JACC Cardiovasc Interv 2020 04 25;13(7):897-898. Epub 2019 Dec 25.

Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota. Electronic address:

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http://dx.doi.org/10.1016/j.jcin.2019.10.011DOI Listing
April 2020

Balloon expandable covered stents as primary therapy for hemodynamically stable traumatic aortic injuries in children.

Catheter Cardiovasc Interv 2020 02 9;95(3):477-483. Epub 2019 Nov 9.

Division of Cardiology, Department of Pediatrics, University of Texas, Health Science Center, San Antonio, Texas.

Objectives: To expand on the limited available literature regarding the use of balloon expandable covered stents for the treatment of traumatic aortic injuries (TAI) in the pediatric population.

Background: Although endovascular grafts have largely replaced surgery for TAI repair, there are significant limitations to the use of these grafts in pediatric patients.

Methods: Multicenter, retrospective chart review of pediatric patients with TAI following blunt chest wall trauma. Procedural characteristics, follow-up, and reinterventions are described.

Results: Six covered stents implanted in five patients. Median patient age was 12 years (11-13 years) and median weight 50 kg (44-54 kg). Procedural success was achieved in all cases. No procedural or postprocedural complications were noted. Median follow-up time was 24 months (11-36 months).

Conclusions: Balloon expandable covered stent treatment of pediatric patients with TAI is a feasible alternative to open surgical repair, and preferred over endovascular grafts due to graft size limitations and the large delivery systems.
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http://dx.doi.org/10.1002/ccd.28575DOI Listing
February 2020

Echocardiographic imaging of the Medtronic Micro Vascular Plug during off label placement in the premature infant with patent ductus arteriosus.

Echocardiography 2019 05 22;36(5):944-947. Epub 2019 Apr 22.

Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota.

Objectives: To report the usefulness of harmonic imaging in echocardiography to visualize and direct the implantation of the Medtronic micro vascular plug (MVP).

Background: Off label use of the MVP was reported for transcatheter occlusion of patent ductus arteriosus (PDA) in premature infants. The device is poorly visible on fluoroscopy and echocardiography.

Methods: In 9 consecutive premature infants, the MVP was used for transcatheter closure of the PDA. In each, the ability of conventional echocardiographic imaging was compared to harmonic imaging, and the device was deployed in the PDA using echocardiography.

Results: In each subject, harmonic imaging proved superior to conventional echocardiography to visualize the MVP in premature infants using 12 and 8 MHz probes. Once the delivery, catheter was across the PDA into the descending aorta, and the MVP advanced to the catheter tip, positioning, and deployment of the device was possible without fluoroscopy. All devices were deployed appropriately with immediate occlusion and no obstruction to the left pulmonary artery or aorta.

Conclusions: The MVP can be accurately imaged using harmonic imaging, even in the near field in premature infants. Precise implantation of the MVP in the PDA of premature infants is possible with echocardiographic imaging of the device and vascular structures.
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http://dx.doi.org/10.1111/echo.14335DOI Listing
May 2019

Upper-Extremity Venous Access for Children and Adults in Pediatric Cardiac Catheterization Laboratory.

J Invasive Cardiol 2019 May 15;31(5):141-145. Epub 2019 Feb 15.

Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX 77030 USA.

Background: Traditional approaches to pediatric cardiac catheterization have relied on femoral venous access. Upper- extremity venous access may enable cardiac catheterization procedures to be performed safely for diagnostic and interventional catheterizations. The objective of this multicenter study was to demonstrate the feasibility and safety of upper-extremity venous access in a pediatric cardiac catheterization laboratory.

Methods: A retrospective chart review of all patients who underwent cardiac catheterization via upper-extremity vascular access was performed.

Results: Eighty-two cardiac catheterizations were attempted via upper-extremity vein on 72 patients. Successful access was obtained in 75 catheterizations (91%) in 67 patients. Median age at catheterization was 18.79 years (interquartile range [IQR], 13.02-32.75 years; n = 75) with a median weight of 59.4 kg (IQR, 43.3-76.5 kg; n = 75). The youngest patient was 4.1 months old, weighing 4.3 kg. Local anesthesia or light sedation was utilized in 46 procedures (61%). Diagnostic right heart catheterization was the most common procedure (n = 65; 87%), with intervention performed via the upper extremity in 8 cases (11%). Median fluoroscopy time was 10.02 min (IQR, 2.87-36.26 min; n = 75), with dose area product/kg of 3.765 μGy•m²/kg (IQR, 0.74-34.12 μGy•m²/kg; n = 64). Median sheath duration time was 48 min (IQR, 19.5-147 min; n = 57) and median total procedure time was 116 min (IQR, 80.5-299 min; n = 65). Median length of stay for outpatient procedures was 5.37 hr (IQR, 4.25-6.92 hr; n = 27). There were no procedural complications.

Conclusion: Upper-extremity venous access is a useful, feasible, and safe modality for cardiac catheterization in the pediatric cardiac catheterization laboratory.
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May 2019

Balloon Angioplasty and Stenting for Unilateral Branch Pulmonary Artery Stenosis Improve Exertional Performance.

JACC Cardiovasc Interv 2019 02;12(3):289-297

Department of Pediatrics, UCSF Benioff Children's Hospital and the University of California, San Francisco, San Francisco, California.

Objectives: This study sought to determine whether pulmonary artery intervention in patients with unilateral proximal pulmonary artery stenosis (PAS) improves exercise capacity, abnormal ventilatory response to exercise, and symptoms.

Background: Stenosis of the branch pulmonary arteries results in pulmonary blood flow maldistribution (PBFM). The resulting ventilation-perfusion mismatch is associated with an increased ventilatory response to exercise and decreased exercise capacity. It is unclear if technical success in relieving branch PAS translates to clinical improvement in exercise capacity and ventilatory response.

Methods: Twenty patients with biventricular circulation and a minimum 10% PBFM who underwent transcatheter relief of PAS were enrolled in a multi-institutional prospective cohort study. Pre- and post-procedure assessment of the degree of PBFM, exercise capacity, ventilatory response to exercise, and subjective assessment of breathlessness were collected and analyzed.

Results: Technical success was achieved in all patients with significant angiographic improvement in minimal lumen diameter (p = 0.001) and peak gradient (p = 0.001). Median PBFM improved (19.5% [range 12.0% to 31.0%] before vs. 7.0% [range 0% to 33.0%] after; p = 0.003). Exercise capacity was low at baseline and improved significantly post-intervention; percent predicted peak oxygen consumption improved from 70% (range 45% to 96%) to 83% (range 47% to 121%) (p = 0.02). Percent predicted oxygen pulse improved (p = 0.02). Ventilatory response to exercise improved; ventilatory equivalent of carbon dioxide slope post-intervention decreased to 29.3 versus 32.5 pre-intervention (p = 0.01). Subjective assessment of dyspnea improved. Five patients with minimal improvement in PBFM also showed minimal improvement in exercise parameters.

Conclusions: Successful relief of unilateral branch PAS results in significant improvements in exercise capacity, ventilatory efficiency, and symptoms.
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http://dx.doi.org/10.1016/j.jcin.2018.11.042DOI Listing
February 2019

Anesthetic Management During Atrial Septostomy in a Conjoined Thoraco-Omphalopagus Twin With Tricuspid Atresia and d-Transposition of the Great Arteries Before Separation: A Case Report.

A A Pract 2018 Jun;10(11):298-301

From the Departments of Anesthesiology.

Conjoined twins are uncommon with reported incidences of 1 in 30,000-200,000 births. They represent a heterogeneous population in regard to location of joint body parts and presence/extent of internal organ fusion. Positioning, airway management, possible presence of cross-circulation, and the fact that 2 patients require anesthesia for each procedure present significant challenges to the anesthesiologist. We report the anesthetic care of a conjoined twin set in which one of the patients presented with tricuspid atresia, d-transposition of the great arteries, and both atrial and ventricular septal defect. A balloon atrial septostomy was performed to allow survival after a separation procedure.
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http://dx.doi.org/10.1213/XAA.0000000000000691DOI Listing
June 2018

Diagnostic considerations in infants and children with cyanosis.

Pediatr Ann 2015 Feb;44(2):76-80

Cyanosis is defined by bluish discoloration of the skin and mucosa. It is a clinical manifestation of desaturation of arterial or capillary blood and may indicate serious hemodynamic abnormality. The goal of this article is to help the reader understand the etiology and pathophysiology of cyanosis and to formulate an approach to its differential diagnosis.
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http://dx.doi.org/10.3928/00904481-20150203-12DOI Listing
February 2015

How Slow Can We Go? 4 Frames Per Second (fps) Versus 7.5 fps Fluoroscopy for Atrial Septal Defects (ASDs) Device Closure.

Pediatr Cardiol 2015 Jun 25;36(5):1057-61. Epub 2015 Jan 25.

Department of Pediatrics, UCSF School of Medicine, University of California, San Francisco, 505 Parnassus, Room M-1235, San Francisco, CA, 94143, USA,

Radiation exposure remains a significant concern for ASD device closure. In an effort to reduce radiation exposure, the default fluoroscopy frame rate in our Siemens biplane pediatric catheterization laboratory was reduced to 4 fps in November 2013 from an earlier 7.5 fps fluoro rate. This study aims to evaluate the components contributing to total radiation exposure and compare the procedural success and radiation exposure during ASD device closure using 4 versus 7.5 fps fluoroscopy rates. Twenty ASD device closures performed using 4 fps fluoro rate were weight-matched to 20 ASD closure procedures using 7.5 fps fluoro rate. Baseline characteristics, procedure times and case times were similar in the two groups. Device closure was successful in all but one case in the 4 fps group. The dose area product (DAP), normalized DAP to body weight, total radiation time and fluoro time were lower in the 4 fps group but not statistically different than the 7.5 fps. The number of cine images and cine times were identical in both groups. Fluoroscopy and cineangiography contributed equally to radiation exposure. Fluoroscopy at 4 fps can be safe and effective for ASD device closure in children and adults. There was no increase in procedure time, cine time, fluoro time or complications at this slow fluoro rate. There was a trend toward decreased radiation exposure as measured by indexed DAP although not statistically significant in this small study. Further study with multiple operators using 4 fps fluoroscopy for simple interventional procedures is recommended.
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http://dx.doi.org/10.1007/s00246-015-1122-8DOI Listing
June 2015

Verapamil-sensitive idiopathic left ventricular tachycardia in a 6-month-old: unique considerations in diagnosis and management in an infant.

Pediatr Emerg Care 2015 Jan;31(1):50-3

From the School of Medicine, University of California San Francisco, San Francisco, CA.

Idiopathic left ventricular tachycardia of the Belhassen type is rare in infants. We present a 6-month-old infant girl with a wide-complex tachycardia with right bundle branch block QRS morphology, a superior axis, and atrioventricular dissociation, consistent with a left anterior fascicular tachycardia. Initial echocardiogram revealed depressed ventricular function. The tachycardia was unresponsive to therapeutic trials of adenosine, esmolol, procainamide, and lidocaine. There was brief conversion of the tachycardia to sinus rhythm with transesophageal atrial overdrive pacing, suggesting a reentrant mechanism of the arrhythmia. Ultimately, the judicious administration of intravenous verapamil resulted in termination of the arrhythmia, which has been sustained on oral therapy.
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http://dx.doi.org/10.1097/PEC.0000000000000307DOI Listing
January 2015

When to call the cardiologist: treatment approaches to neonatal heart murmur.

Pediatr Ann 2013 Aug;42(8):329-33

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

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http://dx.doi.org/10.3928/00904481-20130723-13DOI Listing
August 2013

Central venous catheter-associated pericardial tamponade in a 6-day old: a case report.

Int J Pediatr 2009 9;2009:910208. Epub 2010 Feb 9.

The Carman and Ann Adams Department of Pediatrics, Wayne State University and Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI 48201, USA.

Introduction. Pericardial effusion (PCE) and tamponade can cause significant morbidity and mortality in neonates. Such cases have been reported in the literature in various contexts. Case Presentation. A 6-day old neonate with meconium aspiration syndrome and persistent pulmonary hypertension of newborn on high frequency oscillator ventilation and inhaled nitric oxide was referred to our hospital with a large pericardial effusion causing hemodynamic compromise. Prompt pericardiocentesis led to significant improvement in the cardio-respiratory status and removal of the central line prevented the fluid from reaccumulating. Cellular and biochemical analysis aided in the diagnosis of catheter related etiology with possibility of infusate diffusion into the pericardial space. Conclusion. We present this paper to emphasize the importance of recognizing this uncommon but serious complication of central venous catheters in intensive care units. We also discuss the proposed hypothesis for the mechanism of production of PCE.
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http://dx.doi.org/10.1155/2009/910208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821761PMC
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