Publications by authors named "Johannes Breuer"

39 Publications

Prenatal detection of a giant isolated coronary fistula.

Clin Case Rep 2021 Mar 4;9(3):1393-1396. Epub 2021 Feb 4.

Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany.

Prenatal detection of an isolated congenital coronary artery fistula (ICCAF) requires an examination of the affected fetal hemodynamic situation by the fistula. Early pediatric cardiological presentation is needed, since prenatal changes may have relevant postpartal consequences.
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http://dx.doi.org/10.1002/ccr3.3779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981625PMC
March 2021

Perioperative urinary NT-ProBNP values and their usefulness as diagnostic and prognostic markers in children with congenital heart disease.

Clin Chim Acta 2021 Jul 17;518:28-32. Epub 2021 Mar 17.

Department of Paediatric Cardiology, Childrens Hospital, University of Bonn, Germany.

Introduction: NT-proBNP and especially the changes in values are important markers in patients with congenital heart disease (CHD). NT-proBNP values determined from a urine sample correlate well with the plasma values of NT-proBNP. This study investigated the perioperative development of plasma and urinary values, examining their diagnostic and prognostic value.

Methods: 83 children undergoing cardiac surgery for a myriad of CHDs were included. Urine and plasma samples were collected at different points in time. Urinary values were corrected for urine creatinine concentration and transformed into Lg10-values.

Results: The correlation between urine and plasma is weaker postoperatively (r = 0.70-0.80) in comparison to preoperatively (r = 0.87). Neonates had higher urinary values than older children. A ROC-analysis for the differentiation between complex and simple CHD showed an area under the curve of 0.854 for zlog-NT-proBNP plasma values and 0.826 for creatinine corrected urine values. A decline of NT-proBNP plasma values from the day before surgery to the time after intubation correlated with the duration of postoperative non-invasive ventilation (r = 0.9, sig. < 0.001).

Conclusion: Urinary NT-proBNP shows potential in discriminating between complex and simple CHD. This study is the first to show a prognostic role of NT-proBNP in establishing spontaneous respiration postoperatively in children with CHD.
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http://dx.doi.org/10.1016/j.cca.2021.03.005DOI Listing
July 2021

[Therapy and Outcome of Neonates with Congenital Diaphragmatic Hernia and Congenital Heart Defects].

Z Geburtshilfe Neonatol 2021 Mar 10. Epub 2021 Mar 10.

Abteilung für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.

Die Mortalität von Patienten mit isoliert auftretenden angeborenen Zwerchfellhernien liegt in spezialisierten Zentren bei 20-40%. Wesentliche, das Outcome beeinflussende Faktoren, sind die bestehende Lungenhypoplasie, eine daraus resultierende pulmonale Hypertonie, sowie das Vorliegen weiterer Fehlbildungen. Begleitfehlbildungen wie angeborene Herzfehler treten bei ca. 18% aller Neonaten mit Zwerchfellhernie auf. Schwere angeborene Herzfehler wie das hypoplastische Linksherz Syndrom zeigen sich in ca. 8% der Fälle. In einer retrospektiven Analyse des Patientenkollektivs unserer Klinik zwischen 01/2012 und 12/2018 wurde das prä- und postnatale Management, sowie das Outcome von Neugeborenen mit der Kombination aus angeborenen Herzfehlern und Zwerchfellhernien untersucht. Im Studienzeitraum wurden in unserer Klinik 156 Neugeborene mit Zwerchfellhernie behandelt. Bei 10 Patienten (6,4%) lag zusätzlich ein schwerer, bei 11 Patienten (7,1%) ein moderater Herzfehler vor. 6/21 Patienten verstarben im Verlauf des Krankenhausaufenthaltes, davon 3 am ersten Lebenstag. Es zeigte sich eine deutlich geringere Mortalität bei Patienten mit Zwerchfellhernie und moderatem Herzfehler im Vergleich zu schwerem Herzfehler (9 vs. 50%). Besonders hoch lag die Mortalität bei Kindern mit einem univentrikulären Herzen. Trotz einer deutlich reduzierten Prognose bei der Kombination aus angeborenem Herzfehler und Zwerchfellhernie muss nicht generell mit einer infausten Prognose gerechnet werden. In spezialisierten Zentren kann ein kurativer Ansatz erfolgen.The mortality of patients with isolated congenital diaphragmatic hernia (CDH) in specialized centers is 20-40%. The main factors influencing the outcome are the underlying pulmonary hypoplasia, the resulting pulmonary hypertension and the presence of other malformations. Concomitant malformations such as congenital heart defects occur in around 18% of all neonates with a diaphragmatic hernia. Serious congenital heart defects such as hypoplastic left heart syndrome occur in approximately 8% of cases. In a retrospective analysis of the patient collective of our hospital between 01/2012 and 12/2018, the prenatal and postnatal management as well as the outcome of newborns with a combination of congenital heart defects and diaphragmatic hernias were examined. During the study period, 156 newborns with diaphragmatic hernias were treated at our institution. In 10 patients (6.4%) there was also a severe, and in 11 patients (7.1%) a moderate heart defect. 6/21 patients died during their hospital stay, 3 of them on the first day of life. There was a significantly lower mortality in patients with diaphragmatic hernia and moderate heart defects compared to severe heart defects (9 vs. 50%). The mortality in children with a univentricular heart was particularly high. Despite a significantly reduced prognosis for the combination of congenital heart defects and diaphragmatic hernia, generally a poor prognosis does not have to be expected. A curative approach can be achieved in specialized centers.
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http://dx.doi.org/10.1055/a-1392-1460DOI Listing
March 2021

Assessment of pressure-volume relations in univentricular hearts: Comparison of obtainment by real-time 3D echocardiography and mini pressure-wire with conductance technology.

PLoS One 2021 1;16(2):e0246031. Epub 2021 Feb 1.

Department of Pediatric Cardiology, Children's Hospital, University Hospital Bonn, Bonn, Germany.

Objectives: The gold standard to obtain pressure-volume relations (PVR) of the heart, the conductance technology (PVRCond), is rarely used in children. PVR can also be obtained by 3D-echocardiography volume data combined with simultaneously measured pressure data by a mini pressure-wire (PVR3DE). We sought to investigate the feasibility of both methods in patients with univentricular hearts and to compare them, including hemodynamic changes.

Methods: We studied 19 patients (age 2-29 years). PVR3DE and PVRCond were assessed under baseline conditions and stimulation with dobutamine.

Results: Obtaining PVR3DE was successful in all patients. Obtaining PVRCond was possible in 15 patients during baseline (79%) and in 12 patients under dobutamine (63%). Both methods showed that end-systolic elastance (Ees) and arterial elastance (Ea) increased under dobutamine and that Tau showed a statistically significant decrease. Intraclass correlation (95% confidence interval) showed moderate to good agreement between methods: Ees: 0.873 (0.711-0.945), Ea: 0.709 (0.336-0.873), Tau: 0.867 (0.697-0.942). Bland-Altman analyses showed an acceptable bias with wider limits of agreement: Ees: 1.63 mmHg/ml (-3.83-7.08 mmHg/ml), Ea: 0.53 mmHg/ml (-5.23-6.28 mmHg/ml), Tau: -0,76 ms (-10.73-9.21 ms).

Conclusion: Changes of PVR-specific parameters under dobutamine stimulation were reflected in the same way by both methods. However, the absolute values for these parameters could vary between methods and, therefore, methods are not interchangeable. Obtaining PVR3DE in a single ventricle was easier, faster and more successful than PVRCond. PVR3DE provides a promising and needed alternative to the conductance technology for the assessment of cardiac function in univentricular hearts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246031PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850469PMC
February 2021

Estimation of left ventricular stroke work based on a large cohort of healthy children.

Comput Biol Med 2020 08 9;123:103908. Epub 2020 Jul 9.

Department of Pediatric Cardiology, University Hospital of Bonn, Germany.

Left ventricular stroke work is an important prognostic marker to analyze cardiac function. Standard values for children are, however, missing. For clinicians, standards can help to improve the treatment decision of heart failures. For engineers, they can help to optimize medical devices. In this study, we estimated the left ventricular stroke work for children based on modeled pressure-volume loops. A lumped parameter model was fitted to clinical data of 340 healthy children. Reference curves for standard values were created over age, weight, and height. Left ventricular volume was measured with 3D echocardiography, while maximal ventricular pressure was approximated with a regression model from the literature. For validation of this method, we used 18 measurements acquired by a conductance catheter in 11 patients. The method demonstrated a low absolute mean difference of 0.033 J (SD: 0.031 J) for stroke work between measurement and estimation, while the percentage error was 21.66 %. According to the resulting reference curves, left ventricular stroke work of newborns has a median of 0.06 J and increases to 1.15 J at the age of 18 years. Stroke work increases over weight and height in a similar trend. The percentile curves depict the distribution. We demonstrate how reference curves can be used for quantification of differences and comparison in patients.
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http://dx.doi.org/10.1016/j.compbiomed.2020.103908DOI Listing
August 2020

Urinary values of NT-proBNP in children with congenital heart disease - Is it feasible?

Clin Chim Acta 2020 Oct 9;509:224-227. Epub 2020 Jun 9.

Department for Pediatric Cardiology, Children's Hospital, University of Bonn, Germany.

Plasma NT-proBNP (N-terminal prohormone of brain natriuretic peptide) is an established clinical biomarker for children with congenital heart disease. In adult studies the relation between plasma and urinary NT-proBNP has been investigated with a good correlation. Considering the age dependence of NT-proBNP in healthy children and the age dependence of kidney function, an investigation of the correlation between NT-proBNP plasma and urinary values in children of different ages is necessary. We analyzed plasma and urine samples of 33 children (mean age 7 months) with congenital heart disease before surgery. Plasma and urinary creatinine were also measured to evaluate the influence of kidney function. A Pearson correlation between Lg10-plasma and Lg10-urine values of NT-proBNP corrected for urine creatinie showed a correlation coefficient of r = 0,902 (P < 0,000) without discriminating for age. This study demonstrates that urinary NT-proBNP values correlate well with plasma NT-proBNP values in infants and toddlers and that single random urine sample corrected to urine-creatinine can be used as an alternative to plasma samples. The use of urinary biomarkers could help reduce the need of stressful blood sampling in infants and children.
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http://dx.doi.org/10.1016/j.cca.2020.06.015DOI Listing
October 2020

Physical activity and heart rate monitoring in Fontan patients - Should we recommend activities in higher intensities?

PLoS One 2020 30;15(1):e0228255. Epub 2020 Jan 30.

Department for Paediatric Cardiology, University Hospital Bonn, Bonn, Germany.

Objective: Exercise capacity is impaired in Fontan palliated patients. The change in daily activity behaviour with an increase in sedentary lifestyle results in low physical activity levels. This might have a greater impact on patients with chronic heart disease in contrast to healthy controls. For a better understanding, we compared data from cardiopulmonary exercise testing (CPET) with heart rates and physical activity in daily life.

Methods: 21 Fontan patients and 20 age, sex and BMI matched controls underwent CPET and 5 days of daily life activity tracking with a triaxial accelerometer (wGT3x-BT, Actigraph) including heart rate monitoring with an optical heart rate sensor.

Results: 27% of our Fontan teenagers and 71% of the Fontan adults reached the specific WHO recommendations for moderate to vigorous physical activity (MVPA) during everyday life (EDL), without differences to controls. There was a strong correlation between MVPA and [Formula: see text] for all Fontan patients (p = 0.0035, Pearson r = 0.788). Daily MVPA correlated to peak oxygen uptake and lactate production. Up to workloads of 2 W/kg and in daily life heart rates in Fontan patients were similar to controls.

Conclusions: Daily MVPA is alarmingly low without any differences between Fontan patients and controls. Heart rate behaviour was similar and does not seem to be a limiting factor for physical activity in daily life. Higher intensity activities should be implemented regularly in EDL for Fontan patients. Proof is needed as to whether sports in moderate or possibly even in vigorous activity (e.g. high-intensity interval training) improve exercise capacity the most.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228255PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992185PMC
May 2020

How social network sites and other online intermediaries increase exposure to news.

Proc Natl Acad Sci U S A 2020 02 27;117(6):2761-2763. Epub 2020 Jan 27.

GESIS Leibniz Institute for the Social Sciences, 50667 Cologne, Germany.

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http://dx.doi.org/10.1073/pnas.1918279117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7022199PMC
February 2020

Altered Hemorheology in Fontan Patients in Normoxia and After Acute Hypoxic Exercise.

Front Physiol 2019 22;10:1443. Epub 2019 Nov 22.

Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany.

Background: The Fontan circulation is a unique palliation procedure for several congenital heart defects. Impaired exercise capacity has previously been demonstrated in these patients and also a higher risk for cardiopulmonary mortality. Hemorheology was shown to affect cardiopulmonary capacity and in turn to be affected by regular exercise and hypoxia but none of these have been investigated in Fontan patients so far. The aim of this study was to detect general differences in hemorheology in normoxia as well as possible altered hemorheological responses to hypoxia exposure and hypoxic exercise between Fontan patients and healthy controls.

Methods And Findings: 26 Fontan patients and 20 healthy controls performed an acute exercise test (AET) on a bicycle ergometer under hypoxia with ambient 15.2% oxygen saturation (sO). Blood samples were taken at rest in normoxia (T0), at rest in hypoxia (T1), after maximum exhaustion in hypoxia (T2), and after 50 min recovery in normoxia (T3). Hemorheological and blood parameters were investigated. Additionally, arterial stiffness was tested at T0. Red blood cell (RBC) deformability, NOx, erythropoietin (EPO) concentration, RBC count, hemoglobin (Hb) concentration and hematocrit (hct) were significantly increased in Fontan patients compared to controls. Same was observed for arterial stiffness. No changes were observed for RBC aggregation, fibrinogen concentration, free radical levels and vascular endothelial growth factor (VEGF). Hypoxia exposure did not change parameters, whereas exercise in hypoxia increased aggregation and hct significantly in both groups. Fontan patients showed significantly increased aggregation-disaggregation balance compared to controls.

Conclusion: Acute hypoxia exposure and exercise under hypoxia might have similar impact on hemorheology in Fontan patients and controls and was clinically well tolerated. Nevertheless, exercise alters aggregation and possibly hemodynamics which requires special attention in Fontan patients.
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http://dx.doi.org/10.3389/fphys.2019.01443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883377PMC
November 2019

Fetal Cardiac Intervention in Critical Aortic Stenosis with Severe Mitral Regurgitation, Severe Left Atrial Enlargement, and Restrictive Foramen Ovale.

Fetal Diagn Ther 2020 8;47(5):440-447. Epub 2019 Oct 8.

Division of Prenatal Medicine and Gynecologic Sonography, University of Cologne, Cologne, Germany.

Objective: To assess the intrauterine course and outcome of fetal cardiac intervention (FCI) in fetuses with critical aortic stenosis (CAS), severe mitral regurgitation (MR), severe left atrial dilatation (LAD), and restrictive foramen ovale (RFO) or intact atrial septum.

Methods: All fetuses with a prenatal diagnosis of CAS, severe MR, severe LAD, and RFO were retrospectively collected in one tertiary center for fetal medicine over a period of 10 years. Video recordings, pre- and postnatal charts were reviewed for cardiac and extracardiac anomalies, intrauterine course, and postnatal outcome.

Results: Nineteen fetuses with CAS, severe MR, severe LAD, and RFO were diagnosed in the study period. In 5 cases, FCI was not considered as the parents either opted for expectative management or for termination. In the remaining 14 fetuses, 21 FCI were performed: 14 balloon valvuloplasties, 2 atrioseptostomies, and 5 fetal atrial stent insertions. Seven of 14 fetuses (50%) had fetal hydrops, 5 of 14 fetuses (36%) presented with intact atrial septum. Procedure-related death occurred in 5 fetuses after aortic valvuloplasty or concomitant atrioseptostomy but in none after fetal atrial stenting. Due to progressive hydrops, two terminations of pregnancy were performed. Among the 7 live births, 3 died in the neonatal period. The remaining 4 received single ventricle palliation, 2 following fetal aortic valvuloplasty and 2 after fetal atrial stent insertion.

Conclusions: CAS with severe MR, severe LAD, and RFO has a high overall mortality even in cases undergoing intrauterine intervention. Parameters that accurately predict the intrauterine and postnatal outcome have yet to be defined.
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http://dx.doi.org/10.1159/000502840DOI Listing
March 2021

Severe Pulmonary Stenosis or Atresia with Intact Ventricular Septum in the Fetus: The Natural History.

Fetal Diagn Ther 2020 27;47(5):420-428. Epub 2019 Aug 27.

Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany.

Purpose: To assess the intrauterine course, the outcome, and to establish a new prenatal echocardiographic scoring system to predict biventricular (BV) versus univentricular (UV) outcome of fetuses with severe pulmonary stenosis or atresia with intact ventricular septum (PSAIVS).

Methods: All cases of PSAIVS diagnosed prenatally over a period of 14years were retrospectively collected in 2 tertiary referral centers.

Results: Forty-nine fetuses with PSIVS (n = 11) or PAIVS (n = 38) were identified prenatally. Nineteen (38.8%) fetuses had additional ventriculocoronary connections (VCCs) and 21 (42.9%) fetuses had right ventricular hypoplasia. Four (8.2%) pregnancies were terminated, 2 (4.1%) ended in intrauterine fetal death, 4 (8.2%) in neonatal death, and 5 (10.2%) children died in infancy or childhood, including one case with compassionate care. Thirty-four of 44 (77.3%) fetuses with the intention-to-treat were alive at latest follow-up, 25 (73.5%) with BV, and 9 (26.5%) with UV circulation. Most significant predictive markers of UV circulation were Vmax of tricuspid regurgitation (TR) <2 m/s, right ventricle/left ventricle length ratio ≤0.6, and presence of VCC. A scoring system including these 3 markers had 100% sensitivity and 100% specificity predicting an UV outcome if more than one of these criteria was fulfilled. All 25 liveborn infants that were suitable for BV repair survived, whereas only 9 out of 14 candidates for UV repair survived. None of the 14 fetuses with predicted UV outcome would have met the inclusion criteria for fetal intervention, as 10 of them had VCC and the remaining 4 had absent TR or Vmax <2 m/s.

Conclusion: The prognosis of prenatally diagnosed PSAIVS is good if BV circulation can be achieved, while postnatal mortality in UV circulation is high within the first 4 months of life. Postnatal outcome can be predicted prenatally with high accuracy using a simple scoring system. This information is mandatory for parental counseling and may be useful in selecting fetuses for intrauterine valvuloplasty.
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http://dx.doi.org/10.1159/000502178DOI Listing
March 2021

Left Atrial Volumes and Phasic Function in Healthy Children: Reference Values Using Real-Time Three-Dimensional Echocardiography.

J Am Soc Echocardiogr 2019 08 27;32(8):1036-1045.e9. Epub 2019 May 27.

Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany.

Background: Evaluation of left atrial (LA) size and function is important in congenital and acquired pediatric cardiac disease. Real-time three-dimensional echocardiography (3DE) offers noninvasive assessment of cardiac volumes and phasic function independent of geometric assumptions. The aim of this prospective multicenter study was to establish pediatric reference values for LA 3DE volumes and phasic function based on a large cohort of healthy children.

Methods: LA data sets of 432 subjects (0 days-222 months) were analyzed prospectively using a vendor-independent software. LA volumes (maximal [Vmax], minimal [Vmin], and before atrial contraction) as well as phasic function (active and passive emptying fraction [EF]) were assessed. For volumes, sex-specific reference values, percentiles, and z-scores were calculated by the LMS method of Cole and Green.

Results: Absolute volumes increased with age and body surface area. Active EF and relative duration of atrial emptying tended to increase with increasing R-R intervals, while passive EF decreased. Reproducibility of volumes was very good (intra- and interobserver variability for Vmax and Vmin (mean bias ± SD, 0.1 ± 0.9 mL and 0.7 ± 2.8 mL). Volumes were well correlated with cardiac magnetic resonance measurements showing known underestimation of volumes by 3DE (mean bias ± SD, Vmax -14.2 ± 14 mL; Vmin -11.5 ± 10 mL).

Conclusions: Pediatric LA volumes and phasic function indices were reproducibly measured by 3DE. The provided pediatric reference values can be the basis for evaluation of the LA by 3DE and contribute to detection of LA dysfunction and follow-up of patients with congenital heart diseases.
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http://dx.doi.org/10.1016/j.echo.2019.03.018DOI Listing
August 2019

Prenatal diagnosis, associated findings and postnatal outcome of fetuses with double outlet right ventricle (DORV) in a single center.

J Perinat Med 2019 Apr;47(3):354-364

Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.

Objective To assess the spectrum of associated anomalies, the intrauterine course, postnatal outcome and management of fetuses with double outlet right ventricle (DORV). Methods All cases of DORV diagnosed prenatally over a period of 8 years were retrospectively collected in a single tertiary referral center. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. Results Forty-six cases of DORV were diagnosed prenatally. The mean gestational age at first diagnosis was 21+4 weeks (range, 13-37). A correct prenatal diagnosis of DORV was made in 96.3% of the cases. If the relation of the great arteries, the position of the ventricular septal defect (VSD) and additional cardiac anomalies are taken into account, the prenatal diagnosis was correct in 92.6% of the cases. One case was postnatally classified as transposition of the great arteries with subpulmonary VSD and was excluded from further analysis. A total of 41 (91.1%) fetuses with DORV had major additional cardiac anomalies, 30 (66.7%) had extracardiac anomalies and 13 (28.9%) had chromosomal or syndromal anomalies. Due to their complex additional anomalies, five (11.1%) of our 45 fetuses had multiple malformations and were highly suspicious for non-chromosomal genetic syndromes, although molecular diagnosis could not be provided. Disorders of laterality occurred in 10 (22.2%) fetuses. There were 17 terminations of pregnancy (37.8%), two (4.4%) intrauterine and seven (15.6%) postnatal deaths. Nineteen of 22 (86.4%) live-born children with an intention to treat were alive at last follow-up. The mean follow-up among survivors was 32 months (range, 2-72). Of 21 children who had already undergone postnatal surgery, eight (38.1%) achieved biventricular repair and 13 (61.9%) received univentricular palliation. One recently born child is still waiting for surgery. All children predicted prenatally to need a single ventricle palliation, and all children predicted to achieve biventricular repair, ultimately received the predicted type of surgery. After surgery, 14 of 18 (77.8%) children were healthy without any impairment. Conclusion DORV is a rare and often complex cardiac anomaly that can be diagnosed prenatally with high precision. DORV is frequently associated with major additional anomalies, leading to a high intrauterine and postnatal loss rate due to terminations or declined postnatal therapy. Without additional anomalies, the prognosis is good, although approximately 60% of children will have single ventricle palliation.
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http://dx.doi.org/10.1515/jpm-2018-0316DOI Listing
April 2019

The Relationship Between Networking, LinkedIn Use, and Retrieving Informational Benefits.

Cyberpsychol Behav Soc Netw 2019 Mar 16;22(3):180-185. Epub 2019 Jan 16.

3 Department of Data Linking and Data Security, GESIS Leibniz Institute for the Social Sciences, Colonge, Germany.

Previous research has shown that users of social network sites designed for professional purposes, such as LinkedIn, report higher professional informational benefits than nonusers. However, this effect could only be partly explained by social media use as there was also a selection effect, such that people who have more informational benefits were more likely to use LinkedIn. The goal of this study was to explore whether differences in networking, defined as a set of behaviors with the aim of building, maintaining, and using internal and external contacts for instrumental purposes, can explain this selection effect. We used data from a panel study with a representative sample of Dutch Internet users (n = 685; 259 LinkedIn users) to examine the relationships between networking and LinkedIn use as well as professional informational benefits, that is, timely access to relevant information. The results showed that people scoring high on external networking (but not internal networking within their organization) are also more likely to use LinkedIn. External networking was also positively correlated with active and passive use as well as the number of strong and latent ties on LinkedIn. However, in a mediation model the direct effect of networking on informational benefits was not mediated by actual social media use and network composition; instead, the number of weak ties had a direct effect on informational benefits. The results thus indicate that networking is a major driver of informational benefits from LinkedIn use.
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http://dx.doi.org/10.1089/cyber.2018.0294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444899PMC
March 2019

Prenatal Diagnosis and Postnatal Outcome of Fetuses with Pulmonary Atresia and Ventricular Septal Defect.

Ultraschall Med 2020 Oct 7;41(5):514-525. Epub 2019 Jan 7.

Division of Prenatal Medicine, University-Hospital of Cologne, Germany.

Purpose:  To assess the intrauterine course, associated conditions and postnatal outcome of fetuses with pulmonary atresia with ventricular septal defect (PAVSD).

Methods:  All cases of PAVSD diagnosed prenatally over a period of 10 years with a minimum follow-up of 6.5 years were retrospectively collected in 3 tertiary referral centers.

Results:  50 cases of PAVSD were diagnosed prenatally. 44.0 % of fetuses had isolated PAVSD, 4.0 % had associated cardiac anomalies, 10.0 % had extra-cardiac anomalies, 38.0 % had chromosomal anomalies, 4.0 % had non-chromosomal syndromes. Among the 32 liveborn children, 56.3 % had reverse flow in the patent arterial duct, 25.0 % had major aortopulmonary collateral arteries (MAPCAs) with ductal agenesis and 18.7 % had a double supply. 17 pregnancies were terminated (34.0 %), there was 1 intrauterine fetal death (2.0 %), 1 neonatal death (2.0 %), and 6 deaths (12.0 %) in infancy. 25 of 30 (83.3 %) liveborn children with an intention to treat were alive at the latest follow-up. The mean follow-up among survivors was 10.0 years (range 6.5-15.1). 56.0 % of infants underwent staged repair, 44.0 % had one-stage complete repair. After exclusion of infants with additional chromosomal or syndromal anomalies, 88.9 % were healthy, and 11.1 % had mild limitations. The presence of MAPCAs did not differ significantly between survivors and non-survivors (p = 0.360), between one-stage or staged repair (p = 0.656) and healthy and impaired infants (p = 0.319).

Conclusion:  The prognosis in cases without chromosomal or syndromal anomalies is good. MAPCAs did not influence prognosis or postoperative health. The incidence of repeat interventions due to recurrent stenoses is significantly higher after staged compared with single-stage repair.
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http://dx.doi.org/10.1055/a-0770-2832DOI Listing
October 2020

CB2-deficiency is associated with a stronger hypertrophy and remodeling of the right ventricle in a murine model of left pulmonary artery occlusion.

Life Sci 2018 Dec 4;215:96-105. Epub 2018 Nov 4.

Department of Cardiac Surgery, University Clinical Center Bonn, Germany.

Aims: Pulmonary hypertension (PH) leads to right ventricular (RV) adaptation and remodeling and has deleterious long-term effects on RV function. The endocannabinoid receptor CB2 has been associated with protective effects in adaptation and remodeling of the left ventricle after ischemia. Therefore, we investigated the role of CB2 receptor in RV adaptation after occlusion of the left pulmonary artery (LPA) in a murine model.

Main Methods: C57/Bl6 (WT)- and CB2 receptor-deficient (Cnr2/)-mice underwent paramedian sternotomy and LPA was occluded using a metal clip. Right heart hemodynamic study (Millar®) preceded organ harvesting for immunohistochemistry and mRNA analysis 7 and 21 days (d) post-occlusion.

Key Findings: LPA occlusion led to higher RV systolic pressure in Cnr2/-hearts, while hemodynamics were comparable with WT-hearts after 21d. Cnr2/-hearts showed higher macrophage infiltration and lower interleukin-10 expression after 7 d, but otherwise a comparable inflammatory mediator expression profile. Cardiomyocyte-hypertrophy was stronger in Cnr2/-mice, presenting with higher tenascin-C expression than WT-hearts. Planimetry revealed higher collagen area in Cnr2/-hearts and small areas of cardiomyocyte-loss. Surrounding cardiomyocytes were cleaved caspase-3- and TUNEL positive in Cnr2/-hearts. This was associated by maladaptation of myosin heavy-chain isoforms and lower reactive oxygen scavenger enzymes induction in Cnr2/-hearts. We found comparable morphological changes in both lungs between the two genotypes.

Significance: LPA occlusion led to increased systolic pressure and adaptation of RV in CB2-deficient mice. CB2 receptor seems to modulate RV adaptation through expression of contractile elements, reactive oxygen scavenger enzymes, and inflammatory response in order to prevent cardiomyocyte apoptosis.
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http://dx.doi.org/10.1016/j.lfs.2018.11.003DOI Listing
December 2018

Real-Time Three-Dimensional Echocardiography of the Left Ventricle-Pediatric Percentiles and Head-to-Head Comparison of Different Contour-Finding Algorithms: A Multicenter Study.

J Am Soc Echocardiogr 2018 06 28;31(6):702-711.e13. Epub 2018 Mar 28.

Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany. Electronic address:

Background: Real-time three-dimensional echocardiography (RT3DE) is a promising method for accurate assessment of left ventricular (LV) volumes and function, however, pediatric reference values are scarce. The aim of the study was to establish pediatric percentiles in a large population and to compare the inherent influence of different evaluation software on the resulting measurements.

Methods: In a multicenter prospective-design study, 497 healthy children (ages 1 day to 219 months) underwent RT3DE imaging of the LV (ie33, Philips, Andover, MA). Volume analysis was performed using QLab 9.0 (Philips) and TomTec 4DLV2.7 (vendor-independent; testing high (TomTec) and low (TomTec) contour-finding activity). Reference percentiles were computed using Cole's LMS method. In 22 subjects, cardiovascular magnetic resonance imaging (CMR) was used as the reference.

Results: A total of 370/497 (74.4%) of the subjects provided adequate data sets. LV volumes had a significant association with age, body size, and gender; therefore, sex-specific percentiles were indexed to body surface area. Intra- and interobserver variability for both workstations was good (relative bias ± SD for end-diastolic volume [EDV] in %: intraobserver: QLab = -0.8 ± 2.4; TomTec = -0.7 ± 7.2; TomTec = -1.9 ± 6.7; interobserver: QLab = 2.4 ± 7.5; TomTec = 1.2 ± 5.1; TomTec = 1.3 ± 4.5). Intervendor agreement between QLab and TomTec showed larger bias and wider limits of agreement (bias: QLab vs TomTec: end-systolic volume [ESV] = 0.8% ± 23.6%; EDV = -2.2% ± 17.0%) with notable individual differences in small children. QLab and TomTec underestimated CMR values, with the highest agreement between CMR and QLab.

Conclusions: RT3DE allows reproducible noninvasive assessment of LV volumes and function. However, intertechnique variability is relevant. Therefore, our software-specific percentiles, based on a large pediatric population, serve as a reference for both commonly used quantification programs.
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http://dx.doi.org/10.1016/j.echo.2018.01.018DOI Listing
June 2018

The β agonist terbutaline specifically decreases pulmonary arterial pressure under normoxia and hypoxia via α adrenoceptor antagonism.

FASEB J 2018 05 2;32(5):2519-2530. Epub 2018 Jan 2.

Life and Brain Center, Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany.

Pulmonary hypertension is a severe, incurable disease with a poor prognosis. Although treatment regimens have improved during the last 2 decades, current pharmacologic strategies are limited and focus on the modulation of only a few pathways related to endothelin, NO, and prostacyclin signaling. Therefore, the identification of novel molecular targets is urgently needed. We found that the β adrenoceptor (AR) agonists terbutaline (TER) and salbutamol induced a dose-dependent vasorelaxation in large pulmonary arteries but not aortas of mouse. This effect was found to be independent of β ARs and the endothelium but was determined by the type of the preconstrictor. Vasodilation by β AR agonists occurred after pretreatment of pulmonary arteries with phenylephrine and serotonin, both agonists of α ARs, but was absent after preconstriction with the thromboxane analog U46619. These data indicated α-adrenolytic activity of β AR agonists, which was confirmed by a right shift of the phenylephrine dose-response curve by TER. This effect was physiologically relevant because TER also relaxed small intrapulmonary arteries in lung slices and diminished pulmonary arterial pressure in an isolated perfused lung model under normoxia and hypoxia. Finally, TER applied as an aerosol also selectively decreased pulmonary arterial pressure without effects on systemic blood pressure and heart rate in mouse in vivo. Thus, β AR agonists display α-adrenolytic activity in pulmonary arteries ex vivo and in vivo, and may provide a novel option to reduce pulmonary arterial pressure in pulmonary hypertension.-Neumann, V., Knies, R., Seidinger, A., Simon, A., Lorenz, K., Matthey, M., Breuer, J., Wenzel, D. The β agonist terbutaline specifically decreases pulmonary arterial pressure under normoxia and hypoxia via α adrenoceptor antagonism.
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http://dx.doi.org/10.1096/fj.201700684RRDOI Listing
May 2018

The Relationship Between Use of Social Network Sites, Online Social Support, and Well-Being: Results From a Six-Wave Longitudinal Study.

J Media Psychol 2017 1;29(3):115-125. Epub 2017 Sep 1.

Knowledge Media Research Center, Tübingen, Germany.

Existing work on the effects of social network sites (SNS) on well-being has often stressed that SNS can help people gain social support from their online networks, which positively affects their well-being. However, the majority of studies in this area have been cross-sectional in nature and/or relied on student samples. Using data from six waves of a longitudinal study with a representative sample of Dutch Internet users, we first examined whether users and nonusers of SNS differ in online social support and well-being (as indicated by life satisfaction and stress). In a second step, we investigated in more detail how SNS use - more specifically, asking for advice and the number of strong ties on these SNS - are related to online social support, stress, and satisfaction with life. Overall, our results provide no evidence for SNS use and online social support affecting either stress or life satisfaction. SNS users reported more online social support than nonusers did, but also higher levels of stress; the two groups did not differ in overall life satisfaction. With regard to the underlying processes, we found positive cross-sectional and longitudinal relationships between asking for advice on SNS and online social support, indicating that SNS can be an effective tool for receiving social support. However, online social support was not related to higher life satisfaction or reduced stress 6 months later; instead, it seems that SNS users with lower life satisfaction and/or higher stress seek more social support online by asking for advice on SNS.
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http://dx.doi.org/10.1027/1864-1105/a000222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683734PMC
September 2017

3D Real-Time Echocardiography Combined with Mini Pressure Wire Generate Reliable Pressure-Volume Loops in Small Hearts.

PLoS One 2016 24;11(10):e0165397. Epub 2016 Oct 24.

Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Bonn, Germany.

Background: Pressure-volume loops (PVL) provide vital information regarding ventricular performance and pathophysiology in cardiac disease. Unfortunately, acquisition of PVL by conductance technology is not feasible in neonates and small children due to the available human catheter size and resulting invasiveness. The aim of the study was to validate the accuracy of PVL in small hearts using volume data obtained by real-time three-dimensional echocardiography (3DE) and simultaneously acquired pressure data.

Methods: In 17 piglets (weight range: 3.6-8.0 kg) left ventricular PVL were generated by 3DE and simultaneous recordings of ventricular pressure using a mini pressure wire (PVL3D). PVL3D were compared to conductance catheter measurements (PVLCond) under various hemodynamic conditions (baseline, alpha-adrenergic stimulation with phenylephrine, beta-adrenoreceptor-blockage using esmolol). In order to validate the accuracy of 3D volumetric data, cardiac magnetic resonance imaging (CMR) was performed in another 8 piglets.

Results: Correlation between CMR- and 3DE-derived volumes was good (enddiastolic volume: mean bias -0.03ml ±1.34ml). Computation of PVL3D in small hearts was feasible and comparable to results obtained by conductance technology. Bland-Altman analysis showed a low bias between PVL3D and PVLCond. Systolic and diastolic parameters were closely associated (Intraclass-Correlation Coefficient for: systolic myocardial elastance 0.95, arterial elastance 0.93, diastolic relaxation constant tau 0.90, indexed end-diastolic volume 0.98). Hemodynamic changes under different conditions were well detected by both methods (ICC 0.82 to 0.98). Inter- and intra-observer coefficients of variation were below 5% for all parameters.

Conclusions: PVL3D generated from 3DE combined with mini pressure wire represent a novel, feasible and reliable method to assess different hemodynamic conditions of cardiac function in hearts comparable to neonate and infant size. This methodology may be integrated into clinical practice and cardiac catheterization programs and has the capability to contribute to clinical decision making even in small hearts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165397PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5077139PMC
June 2017

Ebstein's Anomaly of the Tricuspid Valve in the Fetus - A Multicenter Experience.

Ultraschall Med 2017 Aug 1;38(4):427-436. Epub 2016 Jun 1.

Division of Prenatal Medicine and Gynecologic Sonography, Department of Obstetrics and Gynecology, University of Köln, Germany.

 To assess the spectrum of associated anomalies, the intrauterine course, the outcome and possible prognostic markers in prenatally diagnosed Ebstein's anomaly (EA).  All cases of EA diagnosed over a period of 13 years with a minimum follow-up of 1 year were retrospectively collected in 4 tertiary referral centers in Germany.  In the study period 76 cases of EA were prenatally diagnosed. The mean gestational age at diagnosis was 25.0 weeks (range: 13 - 35). 41 (53.9 %) cases were isolated and 35 (46.1 %) had other cardiac and/or extracardiac anomalies. 19 (25.0 %) pregnant women opted for termination of pregnancy, intrauterine fetal death occurred in 7 cases (9.2 %), neonatal death in 14 cases (18.4 %), death in infancy or childhood in 9 cases (11.8 %) and 27 children (35.5 %) were alive at the last follow-up. After exclusion of terminations, the only parameter inversely correlated with intrauterine survival was hydrops fetalis. Prognostic parameters significantly associated with postnatal non-survival were an abnormal Celermajer index (right atrium/heart ratio > 0.7), cardiomegaly (cardiothoracic circumference ratio > 0.5), absence of antegrade flow over the pulmonary valve and earlier diagnosis in pregnancy.  Prenatally diagnosed EA has a high morbidity and mortality with the highest loss rate in the intrauterine and neonatal period. In our study, hydrops fetalis was the only parameter significantly associated with intrauterine demise, while other prenatal markers were only significantly associated with postnatal mortality.
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http://dx.doi.org/10.1055/s-0042-107151DOI Listing
August 2017

Comparison of stroke volumes assessed by three-dimensional echocardiography and transpulmonary thermodilution in a pediatric animal model.

J Clin Monit Comput 2017 Apr 17;31(2):353-360. Epub 2016 Feb 17.

Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.

To compare stroke volumes (SV) in small hearts assessed by real-time three-dimensional echocardiography (3DE) with SV measured by transpulmonary thermodilution (TPTD) and continuous pulse contour analysis (PC) under various hemodynamic conditions. In thirteen anesthetized piglets (range 3.6-7.1 kg) SV were measured by 3DE, TPTD and PC at baseline and during phenylephrine and esmolol administration. 3DE and TPTD measurements were done successively while SV calculated by PC was documented at the time of 3DE. 3DE and TPTD showed a good correlation (r = 0.74) and a bias of -1.3 ml (limits of agreement -4.1 to 1.5 ml). While TPTD measured higher SV than 3DE, both methods tracked SV changes with a concordance rate of 91 %. PC and 3DE showed a lower correlation coefficient of r = 0.57 and a bias of -2.1 ml (limits of agreement -5.9 to 1.8 ml). Inter- and intra-observer variability of SV measured by 3DE was good with a mean bias <5 %. SV showed a small variance and tracked acute small changes in SV in acceptable concordance with TPTD. PC measured SV with a higher variance and mean difference compared to 3DE. In an experimental setting 3DE has the possibility to offer non-invasive assessments of ventricular volumes volume changes. To determine whether 3DE could be used for SV assessment in a clinical routine our results need confirmation in a clinical setting.
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http://dx.doi.org/10.1007/s10877-016-9843-7DOI Listing
April 2017

Sexist games=sexist gamers? A longitudinal study on the relationship between video game use and sexist attitudes.

Cyberpsychol Behav Soc Netw 2015 Apr 6;18(4):197-202. Epub 2015 Apr 6.

1 Department of Psychology, University of Cologne , Cologne, Germany .

From the oversexualized characters in fighting games, such as Dead or Alive or Ninja Gaiden, to the overuse of the damsel in distress trope in popular titles, such as the Super Mario series, the under- and misrepresentation of females in video games has been well documented in several content analyses. Cultivation theory suggests that long-term exposure to media content can affect perceptions of social realities in a way that they become more similar to the representations in the media and, in turn, impact one's beliefs and attitudes. Previous studies on video games and cultivation have often been cross-sectional or experimental, and the limited longitudinal work in this area has only considered time intervals of up to 1 month. Additionally, previous work in this area has focused on the effects of violent content and relied on self-selected or convenience samples composed mostly of adolescents or college students. Enlisting a 3 year longitudinal design, the present study assessed the relationship between video game use and sexist attitudes, using data from a representative sample of German players aged 14 and older (N=824). Controlling for age and education, it was found that sexist attitudes--measured with a brief scale assessing beliefs about gender roles in society--were not related to the amount of daily video game use or preference for specific genres for both female and male players. Implications for research on sexism in video games and cultivation effects of video games in general are discussed.
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http://dx.doi.org/10.1089/cyber.2014.0492DOI Listing
April 2015

Foetal therapy: what works? Closed interatrial septum.

Cardiol Young 2014 Oct 27;24 Suppl 2:47-54. Epub 2014 Aug 27.

1Department of Pediatric Cardiology,University of Bonn,Bonn,Germany.

Hypoplastic left-heart syndrome and critical aortic stenosis with severely restricted or intact foramen ovale are associated with high neonatal mortality and poor long-term outcome. Despite accurate foetal diagnosis and successful postnatal catheter-based and surgical intervention, the 1-month survival rate is about 33%. Changes in pulmonary vascular architecture resulting in pulmonary hypertension result in important long-term morbidity. Prenatal relief of left atrial and pulmonary hypertension may promote normal pulmonary vascular and parenchymal development and improve short- and long-term outcomes. Foetal atrial balloon septostomy, laser perforation, and stenting of the foetal interatrial septum are the current options for foetal therapy. This paper provides an overview of foetal diagnosis, selection of patients for foetal intervention, and interventional techniques, and also reviews the current status of foetal and postnatal outcomes after intrauterine intervention.
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http://dx.doi.org/10.1017/S104795111400122XDOI Listing
October 2014

Intertwin cardiac status at 10-year follow-up after intrauterine laser coagulation therapy of severe twin-twin transfusion syndrome: comparison of donor, recipient and normal values.

Arch Dis Child Fetal Neonatal Ed 2014 Sep 27;99(5):F380-5. Epub 2014 Jun 27.

Division of Pediatric Cardiology, University of Bonn, Bonn, Germany.

Background: In twin-to-twin transfusion syndrome (TTTS), genetically identical twins are exposed to different haemodynamic conditions during fetal life, which are considered to be the cause of prenatal and postnatal cardiovascular differences between the donor and the recipient.

Objective: To assess intertwin differences on childhood cardiac outcome after intrauterine laser coagulation therapy (LC) of severe TTTS.

Design And Patients: Prospective, detailed, echocardiographic follow-up of 31 twin pairs aged 9.95±0.8 years (mean±SD) with severe TTTS treated by LC, and the comparison with reference values.

Results: Cardiac function was normal and did not show intertwin differences in twins without structural heart disease. Discordant birth weight or birth weight <3rd centile for gestational age had no influence on blood pressure and cardiac indices. Pulmonary stenosis was more common (5/62; 8.1%) than in the general population (prevalence 0.066%, relative risk 134.4, 95% CI 42.1 to 428.8, p<0.0001) and affected both donor and recipient. Intertwin differences in late diastolic right ventricular filling (peak velocities: recipient 0.51±0.11 m/s vs donor 0.45±0.10 m/s, mean difference 0.74 m/s, 95% CI 0.23 to 1.24, p=0.009) and early septal relaxation (mean myocardial velocities: recipient -8.2±1.5 cm/s vs donor -8.9±1.2 cm/s, mean difference 0.7 cm/s, 95% CI 0.02 to 1.38, p=0.044) were found only when twins with right heart disease were included.

Conclusions: Despite severe prenatal cardiac involvement, childhood cardiac function is normal in the majority of surviving donors and recipients after successful LC of severe TTTS. This underlines the favourable impact of intrauterine LC on postnatal cardiovascular performance.
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http://dx.doi.org/10.1136/archdischild-2013-305034DOI Listing
September 2014

Press CRTT to measure aggressive behavior: the unstandardized use of the competitive reaction time task in aggression research.

Psychol Assess 2014 Jun 20;26(2):419-32. Epub 2014 Jan 20.

Department of Communication, University of Münster.

The competitive reaction time task (CRTT) is the measure of aggressive behavior most commonly used in laboratory research. However, the test has been criticized for issues in standardization because there are many different test procedures and at least 13 variants to calculate a score for aggressive behavior. We compared the different published analyses of the CRTT using data from 3 different studies to scrutinize whether it would yield the same results. The comparisons revealed large differences in significance levels and effect sizes between analysis procedures, suggesting that the unstandardized use and analysis of the CRTT have substantial impacts on the results obtained, as well as their interpretations. Based on the outcome of our comparisons, we provide suggestions on how to address some of the issues associated with the CRTT, as well as a guideline for researchers studying aggressive behavior in the laboratory.
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http://dx.doi.org/10.1037/a0035569DOI Listing
June 2014

A new transventricular aproach for pulmonary valve implantation in a patient with severe valve disease after tetralogy-of-Fallot repair.

Heart 2013 Oct 4;99(19):1469-70. Epub 2013 Jun 4.

Department of Cardiac Surgery, University Clinical Center of Bonn, Bonn, NRW, Germany.

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http://dx.doi.org/10.1136/heartjnl-2013-303858DOI Listing
October 2013

Ventricular pressure-volume loops obtained by 3D real-time echocardiography and mini pressure wire-a feasibility study.

Clin Res Cardiol 2013 Jun 9;102(6):427-38. Epub 2013 Feb 9.

Department of Pediatric Cardiology, University of Bonn, Germany.

Introduction: Pressure-volume relations (PVR) provide vital information regarding ventricular performance and cardiac pathophysiology. Acquiring PVR by conductance catheter technology is invasive and laborious, which explains why the assessment of PVR is not used in clinical practice. Real-time three-dimensional echocardiography (3DE) allows almost instantaneous capture of ventricular volume changes throughout the cardiac cycle. The aim of the study was to assess the feasibility of 3DE combined with pressure data to calculate PVR in children and adolescents.

Methods: In 31 patients with congenital heart disease (age 3 days-22.7 years, weight 2.75-80.0 kg), ventricular pressure was recorded by a mini pressure wire during routine catheterization. Simultaneously, 3D datasets of the left or right ventricle were acquired for calculation of volume. PVR were generated from contemporaneous 3D volume and pressure data. Systolic myocardial elastance, ventriculo-arterial coupling, diastolic relaxation constant Tau and end-diastolic PVR were determined using a single-beat approach.

Results: Computation of PVR using non-invasive 3D volume data and pressure curves obtained by mini pressure wire was easy, feasible and reproducible. On average, 6 [3-11] PVR, needing an additional examination time of 6.5 ± 3.5 min, were acquired. Both intra- and interobserver variability were good for all measured parameters (coefficient of variation <10%).

Conclusions: Calculation of PVR from 3DE volume curves and simultaneous pressure data obtained by a mini pressure wire is a feasible method to assess cardiac function. Due to the tiny size of the pressure wire used, PVR can be acquired even in small neonates with congenital heart disease.
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http://dx.doi.org/10.1007/s00392-013-0548-3DOI Listing
June 2013

Propofol administration to the fetal-maternal unit reduces cardiac injury in late-preterm lambs subjected to severe prenatal asphyxia and cardiac arrest.

Pediatr Res 2013 Apr 17;73(4 Pt 1):427-34. Epub 2013 Jan 17.

Department of Paediatrics, Maastricht University Medical Center, School of Oncology, Maastricht, The Netherlands.

Background: Cardiac dysfunction is reported to occur after severe perinatal asphyxia. We hypothesized that anesthesia of the mother with propofol during emergency cesarean section (c-section) would result in less cardiac injury (troponin T) in preterm fetuses exposed to global severe asphyxia in utero than anesthesia with isoflurane. We tested whether propofol decreases the activity of proapoptotic caspase-3 by activating the antiapoptotic AKT kinase family and the signal transducer and activator of transcription-3 (STAT-3).

Methods: Pregnant ewes were randomized to receive either propofol or isoflurane anesthesia. A total of 44 late-preterm lambs were subjected to in utero umbilical cord occlusion (UCO), resulting in asphyxia and cardiac arrest, or sham treatment. After emergency c-section, each fetus was resuscitated, mechanically ventilated, and supported under anesthesia for 8 h using the same anesthetic as the one received by its mother.

Results: At 8 h after UCO, the fetuses whose mothers had received propofol anesthesia had lower plasma troponin T levels, and showed a trend toward a higher median left ventricular ejection fraction (LVEF) of 84% as compared with 74% for those whose mothers had received isoflurane. Postasphyxia activation of caspase-3 was lower in association with propofol anesthesia than with isoflurane. Postasphyxia levels of STAT-3 and the AKT kinase family rose 655% and 500%, respectively with the use of propofol anesthesia for the mother.

Conclusion: The use of propofol for maternal anesthesia results in less cardiac injury in late-preterm lambs subjected to asphyxia than the use of isoflurane anesthesia. The underlying mechanism may be activation of the antiapoptotic STAT-3 and AKT pathways.
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http://dx.doi.org/10.1038/pr.2013.10DOI Listing
April 2013

Variables influencing the accuracy of 2-dimensional and real-time 3-dimensional echocardiography for assessment of small volumes, areas, and distances: an in vitro study using static tissue-mimicking phantoms.

J Ultrasound Med 2011 Jul;30(7):899-908

Department of Pediatric Cardiology, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany.

Objectives: The aim of this study was to assess the validity, accuracy, and reproducibility of real-time 3-dimensional (3D) echocardiography for small distances, areas, and volumes.

Methods: Real-time 3D echocardiography using matrix technology was performed in small calibrated tissue-mimicking phantoms and compared with 2-dimensional (2D) echocardiography. In a systematic variation of variables on data acquisition and analysis including different 3D workstations (manual disk summation versus semiautomatic border detection), the relative contributions of sources of errors were determined. The clinical relevance of the in vitro findings was assessed in 5 neonates and infants.

Results: Distance calculation was valid (mean relative error ± SD, -0.15% ± 1.2%). Underestimation of areas and volumes was significant for both 2D and 3D echocardiography (area: 2D, -7.0% ± 2.9%; 3D, -6.0% ± 2.8%; volume: 2D, -13.1% ± 4.5%; 3D, -6.7% ± 2.5%; P < .05). Adjustment of compression and gain on data acquisition (difference of the means: 2D, 11.6%; 3D, 17.9%), gain on postprocessing (3D, 3.4%), and the border detection algorithm on analysis (2D, 4.8%; 3D, 16.6%) had a highly significant effect on volume and area calculations (P < .001). In vivo, compression and gain on acquisition (3D, 19.1%) and the 3D workstation on analysis (3D, 22.2%) had a highly significant impact on left ventricular volumetry (P < .001).

Conclusions: Real-time 3D echocardiography is a reliable method for calculation of small distances, areas, and volumes comparable with the size of the neonatal and infant heart. Variables influencing boundary identification during image acquisition and analysis have a significant impact on 2D and 3D area and volume calculations. Standardized protocols are mandatory to avoid these sources of error in both clinical practice and research.
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http://dx.doi.org/10.7863/jum.2011.30.7.899DOI Listing
July 2011