Publications by authors named "Marc Lee"

6 Publications

  • Page 1 of 1

The role of imaging in characterizing the cardiac natural history of Duchenne muscular dystrophy.

Pediatr Pulmonol 2021 Apr 2;56(4):766-781. Epub 2021 Mar 2.

Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.

Duchene muscular dystrophy (DMD) is a rare but devastating disease resulting in progressive loss of ambulation, respiratory failure, DMD-associated cardiomyopathy (DMD-CM), and premature death. The use of corticosteroids and supportive respiratory care has improved outcomes, such that DMD-CM is now the leading cause of death. Historically, most programs have focused on skeletal myopathy with less attention to the cardiac phenotype. This omission is rather astonishing since patients with DMD possess an absolute genetic risk of developing cardiomyopathy. Unfortunately, heart failure signs and symptoms are vague due to skeletal muscle myopathy leading to limited ambulation. Traditional assessment of cardiac symptoms by the New York Heart Association American College of Cardiology/American Heart Association Staging (ACC/AHA) classification is of limited utility, even in advanced stages. Echocardiographic assessment can detect cardiac dysfunction late in the disease course, but this has proven to be a poor surrogate marker of early cardiovascular disease and an inadequate predictor of DMD-CM. Indeed, one explanation for the paucity of cardiac therapeutic trials for DMD-CM has been the lack of a suitable end-point. Improved outcomes require a better proactive treatment strategy; however, the barrier to treatment is the lack of a sensitive and specific tool to assess the efficacy of treatment. The use of cardiac imaging has evolved from echocardiography to cardiac magnetic resonance imaging to assess cardiac performance. The purpose of this article is to review the role of cardiac imaging in characterizing the cardiac natural history of DMD-CM, highlighting the prognostic implications and an outlook on how this field might evolve in the future.
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http://dx.doi.org/10.1002/ppul.25227DOI Listing
April 2021

Triage and management of the ACHD patient with COVID-19: A single center approach.

Int J Cardiol 2020 12 19;320:178-182. Epub 2020 Jun 19.

The Ohio State University Wexner Medical Center, Columbus Ohio, Division of Cardiovascular Medicine, Department of Internal Medicine, United States of America. Electronic address:

With the recent emergence of SARS-CoV-2 and COVID-19, healthcare facilities and personnel are expected to rapidly triage and care for patients with even the most complex medical conditions. Adults with congenital heart disease (ACHD) represent an often-intimidating group of complex cardiovascular disorders. Given that general internists and general cardiologists will often be asked to evaluate this group during the pandemic, we propose here an abbreviated triage algorithm that will assist in identifying the patient's overarching ACHD phenotype and baseline cardiac status. The strategy outlined allows for rapid triage and groups various anatomic CHD variants into overarching phenotypes, permitting care teams to quickly review key points in the management of moderate to severely complex ACHD patients.
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http://dx.doi.org/10.1016/j.ijcard.2020.06.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303038PMC
December 2020

Improved Outcomes in Management of Hypoplastic Left Heart Syndrome Associated With Congenital Diaphragmatic Hernia: an Algorithmic Approach.

Semin Thorac Cardiovasc Surg 2018 12;30(2):191-196. Epub 2018 Feb 12.

Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address:

Hypoplastic left heart syndrome (HLHS) is the second most common congenital heart disease associated with congenital diaphragmatic hernia (CDH). The reported survival rate of neonates with CDH and HLHS is only 1%-5%. We review our experience with CDH and HLHS and compare our outcomes with published literature. Retrospective review of all neonates with CDH and HLHS at our institution over a 10-year period was performed. The morphology of cardiac and diaphragm defects, clinical course, treatment strategies, and outcomes were reviewed, and an algorithmic approach was proposed. Five patients with CDH and HLHS were treated between 2006 and 2016. All had mitral stenosis with aortic stenosis. Four patients had a left-sided Bochdalek diaphragmatic hernia and 1 patient had a large bilateral Morgagni hernia. Two (2/4) of the Bochdalek hernias were associated with significant pulmonary hypoplasia and required patch closure of the CDH; both were palliated with percutaneous ductal stents and both died. Three patients underwent primary Norwood operation followed by repair of less severe CDH defect. All 3 patients are currently well and have survived bidirectional Glenn anastomosis; one patient is well after Fontan operation. Successful palliation of neonates with HLHS and associated CDH is possible in the current era. Outcome is determined primarily by the severity of the CDH and the degree of associated pulmonary hypoplasia. An algorithmic team approach is helpful in management of this difficult group of patients.
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http://dx.doi.org/10.1053/j.semtcvs.2018.02.010DOI Listing
November 2018

Double aortic arch presenting as neonatal respiratory failure in the delivery room.

Cardiol Young 2018 Mar 17;28(3):476-478. Epub 2017 Dec 17.

Le Bonheur Children's Hospital Department of Pediatric Cardiology,Memphis, TN,United States of America.

Respiratory symptoms are prevalent in vascular ring anomalies, including double aortic arch, which is considered the most common type of vascular ring. However, respiratory failure owing to critical airway obstruction in the neonatal period is rare with few reported cases in the literature. We report a case of a newborn patient who required emergent intubation within the first few hours of life and was later discovered to have a double aortic arch.
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http://dx.doi.org/10.1017/S1047951117002335DOI Listing
March 2018

Ultrasound of the knee.

Semin Musculoskelet Radiol 2007 Jun;11(2):137-48

Department of Radiology, Saint Joseph Medical Center, Burbank, California 90404, USA.

Ultrasound of the knee is best suited for the evaluation of tendons, fluid collections and effusion, synovitis, periarticular soft tissue masses, muscles, and the collateral ligaments. Advantages of sonographic evaluation include the lack of ionizing radiation, the noninvasive nature of the examination, focused evaluation correlated with the specific site of pain, multiplanar capability, and utility in patients for whom magnetic resonance imaging (MRI) is contraindicated. The ability to visualize the microanatomy of tendons, ligaments, nerves, and muscles is also an advantage over MRI. Moreover, ultrasound is generally readily accessible and of lower cost than MRI. Ultrasound is less suited for the evaluation of internal derangement. Certain structures that are exquisitely evaluated by MRI, including the menisci, cruciate ligaments, bone marrow, and articular cartilage, are suboptimally evaluated by sonography. This article reviews the structures and pathological processes for which ultrasound has been shown useful, emphasizing appropriate technique and normal anatomy, appearance of pathological processes, and advantages and limitations of sonographic evaluation.
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http://dx.doi.org/10.1055/s-2007-1001879DOI Listing
June 2007

Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum.

Skeletal Radiol 2008 Jan 26;37(1):19-25. Epub 2007 Oct 26.

Department of Radiology, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 165-59, Box 956952, Los Angeles, CA 90095, USA.

Objective: The purpose of this study was to determine the utility of fat-suppressed gradient-recalled echo (GRE) compared with conventional spin echo T1-weighted (T1W) sequences in direct shoulder MR arthrography for evaluating labral tears.

Materials And Methods: Three musculoskeletal radiologists retrospectively reviewed MR arthrograms performed over a 12-month period for which surgical correlation was available. Of 180 serial arthrograms, 31 patients had surgery with a mean of 48 days following imaging. Paired coronal oblique and axial T1W or GRE sequences were analyzed by consensus for labral tear (coronal oblique two-dimensional multi-echo data image combination, 2D MEDIC; and axial three-dimensional double-echo steady-state, 3D DESS; Siemens MAGNETOM Sonata 1.5-T MR system). Interpretations were correlated with operative reports.

Results: Of 31 shoulders, 25 had labral tears at surgery. The GRE sequences depicted labral tears in 22, while T1W images depicted tears in 16 (sensitivity 88% versus 64%; p<0.05). Subdividing the labrum, GRE was significantly more sensitive for the posterior labrum (75% versus 25%; p<0.05) with a trend toward greater sensitivity at the anterior labrum (78% versus 56%; p=0.157) but not significantly different for the superior labrum (50% versus 57%; p>0.7). Specificities were somewhat lower for GRE.

Conclusion: Thin section GRE sequences are more sensitive than T1W for the detection of anterior and posterior labral tears. As the specificity of GRE was lower, it should be considered as an adjunctive imaging sequence that may improve depiction of labral tears, particularly smaller tears, in routine MR arthrography protocols.
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http://dx.doi.org/10.1007/s00256-007-0398-zDOI Listing
January 2008