Publications by authors named "Mohamed Zghouzi"

13 Publications

  • Page 1 of 1

Thrombotic superior vena cava syndrome: a national emergency department database study.

J Thromb Thrombolysis 2021 Aug 3. Epub 2021 Aug 3.

Department of Internal Medicine, Detroit Medical Center, Wayne State University, 4201, St Antoine St., Detroit, MI, 48201, USA.

Literature regarding etiology and trends of incidence of major thoracic vein thrombosis in the United States is limited. To study the causes, complications, in-hospital mortality rate, and trend in the incidence of major thoracic vein thrombosis which could have led to superior vena cava syndrome (SVCS) between 2010 and 2018. Data from the nationwide emergency department sample (NEDS) that constitutes 20% sample of hospital-owned emergency departments (ED) and in-patient sample in the United States were analyzed using diagnostic codes. A linear p-trend was used to assess the trends. Of the total 1082 million ED visits, 37,807 (3.5/100,000) (mean age 53.81 ± 18.07 years, 55% females) patients were recorded with major thoracic vein thrombosis in the ED encounters. Among these patients, 4070 (10.6%) patients had one or more cancers associated with thrombosis. Pacemaker/defibrillator-related thrombosis was recorded in 2820 (7.5%) patients, while intravascular catheter-induced thrombosis was recorded in 1755 (4.55%) patients. Half of the patients had associated complication of pulmonary embolism. A total of 59 (0.15%) patients died during these hospital encounters. The yearly trend for the thrombosis for every 100,000 ED encounters in the United States increased from 2.17/100,000 in 2010 to 5.98/100,000 in 2018 (liner p-trend < 0.001). Yearly trend for catheter/lead associated thrombosis was also up-trending (p-trend 0.015). SVCS is an uncommon medical emergency related to malignancy and indwelling venous devices. The increasing trend in SVCS incidence, predominantly catheter/lead induced, and the high rate of associated pulmonary embolism should prompt physicians to remain vigilant for appropriate evaluation.
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http://dx.doi.org/10.1007/s11239-021-02548-7DOI Listing
August 2021

Characteristics and hospital outcomes of coronary atherectomy within the united states: a multivariate and propensity-score matched analysis.

Expert Rev Cardiovasc Ther 2021 Jul 30. Epub 2021 Jul 30.

Detroit Medical Center, Detroit, Michigan, USA.

Background: Suboptimal stent delivery and deployment in calcified coronary lesions is associated with a poor clinical outcome. We investigated the rate of utilization and in-hospital outcomes of patients undergoing coronary intervention with and without atherectomy.

Methods: Using the National Inpatient Sample database, we identified patients undergoing percutaneous coronary intervention (PCI). Comparison between procedural and hospital outcomes between patients who underwent atherectomy and those who did not.

Results: A total of 2,035,039 patients underwent PCI, of which 50,095 (2.4%) underwent lesion modification using atherectomy. After adjustment for baseline differences, patients who underwent atherectomy were found to have higher rates of in-hospital mortality (3.3% vs 2.2% adjusted Odds Ratio, aOR, 1.39; 95% confidence interval [CI], 1.31-1.46, P< 0.001), coronary artery dissection (1.7% vs 1.1%, aOR, 1.56; 95%, 1.45-1.67, P<0.001) vascular complications (1.6% vs 1.0%, aOR, 1.52; 95%, 1.42-1.64, P<0.001), major bleeding (6.3% vs 4.7%, aOR, 1.24; 95%, 1.18-1.28, P<0.001) and acute kidney injury (AKI) (10.9%vs 9.1%, aOR, 1.07; 95%, 1.04-1.11, P<0.001) when compared with non-atherectomy patients. Concomitant intravascular ultrasound (IVUS) imaging improved mortality, while other complication rates were not affected by imaging.

Conclusion: Coronary atherectomy was performed in patients with multiple comorbidities and was associated with higher in-hospital mortality and complications than the non-atherectomy group.
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http://dx.doi.org/10.1080/14779072.2021.1963233DOI Listing
July 2021

Description and Clinical Implications of Myocardial Clefts Using Echocardiography.

Cureus 2021 Jun 2;13(6):e15407. Epub 2021 Jun 2.

Cardiology, Wayne State University, Detroit, USA.

Background Myocardial clefts (MCs) are rare anomalies with debatable clinical significance. Increased use of cardiac magnetic resonance (CMR) has led to the appreciation of subtle left ventricular (LV) wall structural defects, and studies showed varying clinical significance, ranging from asymptomatic incidental findings to being considered a novel imaging marker of hypertrophic cardiomyopathy. Sparse data are available about the utility of two-dimensional echocardiography (2DE) to visualize these anomalies. We describe our institutional experience categorizing MCs using 2DE. Methods The echocardiography database was retrospectively queried for diagnosing MCs using Synapse® Cardiovascular Picture Archiving and Communication System (PACS) (Fujifilm, Tokyo, Japan). Identified patients were admitted to Detroit Medical Center (DMC) between January 2012 and May 2019. MCs were defined as recesses filled with luminal blood, obliterate during systole, and have U, wedge, and tunnel shapes. Images were interpreted by a cardiologist blinded to the data. Baseline demographics and clinical characteristics were documented. The study was descriptive; no intervention was done. Results Sixteen patients with a mean age of 62.43 were included; 68.75% were women, and 81.25% were African American. The prevalence of cardiac comorbidities was primary hypertension 12 (75%), coronary artery disease 5 (31.25%), heart failure with reduced ejection fraction (HFrEF) 4 (25.0%), valvular heart disease 4 (25.0%), arrhythmia/heart block 4 (25.0%), and heart failure with preserved ejection fraction (HFpEF) 2 (12.5%). The indications for 2DE evaluation were heart failure/cardiogenic shock 2 (12.5%), acute coronary syndrome 2 (12.5%), syncope/presyncope 2 (12.5%), atypical chest pain 2 (12.5%), and others 8 (50.0%). Twenty-one MCs were visualized in eight segments of LV walls and septum as follows: basal inferior 7, mid inferoseptal 6, mid inferior 3, mid anteroseptal 2, mid inferolateral 1, mid anterolateral 1, basal inferoseptal 1, apical inferoseptal 1, and apical septal 1. Morphology was classified as tunnel in 66.66%, wedge in 23.8%, and U in 9.5%. Conclusion In various LV and septal walls, MCs detected on 2DE were benign and incidental findings without significant implications for preclinical hypertrophic cardiomyopathy (HCM).
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http://dx.doi.org/10.7759/cureus.15407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253701PMC
June 2021

Safety and Efficacy of Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19 Population.

High Blood Press Cardiovasc Prev 2021 Jul 28;28(4):405-416. Epub 2021 Jun 28.

Detroit Medical Center, DMC Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA.

Introduction: The safety of renin-angiotensin-aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic.

Methods: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR).

Results: A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n = 34,691; non-RAASi n = 48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99-1.15; p > 0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93-0.99; p < 0.05). There was no association between RAASi versus control with progression to ICU admission (OR 0.99; 95% CI 0.79-1.23; p > 0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97-1.11; p > 0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes.

Conclusions: COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance.
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http://dx.doi.org/10.1007/s40292-021-00462-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237039PMC
July 2021

In-hospital outcomes of endovascular versus surgical revascularization for chronic total occlusion in peripheral artery disease.

Catheter Cardiovasc Interv 2021 Jun 23. Epub 2021 Jun 23.

Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA.

Background: The outcome of endovascular intervention (EVI) compared vs. surgical revascularization in patients with peripheral artery disease (PAD) due to chronic total occlusion (CTO) is unknown.

Methods: Using the National Inpatient Sample database between 2007 and 2014, we identified all PAD patients with CTO who had limb revascularization. Multivariate analysis was performed to estimate the odds of in-hospital mortality and adverse outcomes between both groups.

Results: A total of 168,420 patients who had peripheral CTO and underwent limb revascularization were identified. 99,279 underwent EVI, and 69,141 underwent surgical revascularization. The patients who underwent EVI were younger, more likely to be women and African American, and less likely to be white (p < 0.001 for all). EVI was associated with lower in-hospital mortality (1.2% vs 1.7%, adjusted odds ratio [aOR]: 0.54; 95% confidence interval [CI] 0.50-0.59). The EVI group had higher vascular complications, major bleeding, acute kidney injury (AKI), and major amputation compared with surgical revascularization. A subgroup analysis on patients with critical limb ischemia showed lower mortality in the EVI group (1.4% vs. 1.9, aOR 0.56; 95% CI 0.50-0.63). Although there was no difference in the incidence of AKI or major amputation between the two groups, the EVI group had higher vascular complication rates and major bleeding events.

Conclusion: EVI in PAD with CTO is associated with lower in-hospital mortality, likely due to the procedure's less-invasive nature; however, it is associated with higher postprocedural complications likely due to the CTO's complexity.
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http://dx.doi.org/10.1002/ccd.29827DOI Listing
June 2021

Comparative safety of percutaneous ventricular assist device and intra-aortic balloon pump in acute myocardial infarction-induced cardiogenic shock.

Open Heart 2021 Jun;8(1)

Cardiology, Detroit Medical Center, Detroit, Michigan, USA

Background: The relative safety of percutaneous left ventricular assist device (pVAD) and intra-aortic balloon pump (IABP) in patients with cardiogenic shock after acute myocardial infarction remain unknown.

Methods: Multiple databases were searched to identify articles comparing pVAD and IABP. An unadjusted OR was used to calculate hard clinical outcomes and mortality differences on a random effect model.

Results: Seven studies comprising 26 726 patients (1110 in the pVAD group and 25 616 in the IABP group) were included. The odds of all-cause mortality (OR 0.57, 95% CI 0.47 to 0.68, p=<0.00001) and need for revascularisation (OR 0.16, 95% CI, 0.07 to 0.38, p=<0.0001) were significantly reduced in patients receiving pVAD compared with IABP. The odds of stroke (OR 1.12, 95% CI 0.14 to 9.17, p=0.91), acute limb ischaemia (OR=2.48, 95% CI 0.39 to 15.66, p=0.33) and major bleeding (OR 0.36, 95% CI 0.01 to 25.39, p=0.64) were not significantly different between the two groups. A sensitivity analysis based on the exclusion of the study with the largest weight showed no difference in the mortality difference between the two mechanical circulatory support devices.

Conclusions: In patients with acute myocardial infarction complicated by cardiogenic shock, there is no significant difference in the adjusted risk of all-cause mortality, major bleeding, stroke and limb ischaemia between the devices. Randomised trials are warranted to investigate further the safety and efficacy of these devices in patients with cardiogenic shock.
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http://dx.doi.org/10.1136/openhrt-2021-001662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204163PMC
June 2021

Horner Syndrome Secondary to Osteochondroma of the First Rib: A Case Report.

Cureus 2021 Apr 17;13(4):e14531. Epub 2021 Apr 17.

Internal Medicine, Detroit Medical Center (DMC), Detroit, USA.

Osteochondroma is the most common benign tumor of bone that often produces no symptoms unless the enlarged mass affects nearby structures. Rarely, Horner syndrome can be caused by an osteochondroma. A five-year-old female with a past medical history of seizure-like activity presented to the emergency department on three separate occasions within one month. She exhibited neurological deficits, including miosis and ptosis, resulting in the diagnosis of Horner syndrome. Computerized tomography (CT) demonstrated a calcified and ossified lesion arising from the right first rib and transverse process that was suspicious for an osteochondroma or chondrosarcoma with neuroblastoma lower on the differential diagnosis. Given the patient's escalating clinical symptomatology and suspicious features of the lesion, a CT guided-bone biopsy was performed. Pathology revealed an osteochondroma that was eventually resected by neurologic and orthopedic surgeries. In this case report, we review the sympathetic innervation to the head, eye, and neck, the most common etiologies of Horner syndrome, and elucidate imaging modalities useful for diagnosing osteochondroma. Horner syndrome secondary to osteochondroma of the first rib has been documented only once before.
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http://dx.doi.org/10.7759/cureus.14531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159331PMC
April 2021

Partial vena cava occlusion (VCO) to counteract refractory heart failure: A new era in interventional heart failure strategy.

Ann Med Surg (Lond) 2021 Jun 12;66:102387. Epub 2021 May 12.

Detroit Medical Center, Detroit, MI, USA.

Background: Patients with acute decompensated heart failure are prone to recurrent exacerbation leading to poor quality of life when they do not respond to an optimal medical regimen. Due to the lack of linear positive inotropy response to increasing preload in heart failure patients, increasing preload is associated with poor outcomes. Partial occlusion of either IVC or SVC is a proposed novel treatment that can improve cardiac function or quality of life by altering preload/pressure in heart failure (HF) patients unresponsive to diuretics.

Methods: PubMed, Ovid (MEDLINE), and Cochrane database we searched using the MeSH terms including "Superior vena cava occlusion," "Inferior vena cava occlusion," "Heart failure exacerbation." The inclusion criteria included studies that enrolled patients > 18 years with diagnosed NYHA II-IV HF with reduced ejection fraction (HFrEF) on optimal medical treatment (OMT).

Results: The analysis involved two studies with 14 patients; the mean age was 64.4 ± 10 and 100% males. The difference in the mean pulmonary pressures between pre-and-post VCO devices were 1.56 (95% CI 0.66-2.46, p-value = 0.006). There was no heterogeneity among the study of mean pulmonary pressures. With the use of VC occlusion devices, the mean difference in pulmonary artery systolic pressure decreased by 1.70 (95% CI 0.68-2.71, p-value = 0.001) (Fig. 1B). The heterogeneity of mean pressure was minimal 14%.

Conclusion: In conclusion, VCO can help decrease pulmonary pressure that can indirectly prevent heart failure exacerbations and possibly hospitalization in this cohort of patients.
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http://dx.doi.org/10.1016/j.amsu.2021.102387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141653PMC
June 2021

Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis.

Expert Rev Cardiovasc Ther 2021 May 28;19(5):433-444. Epub 2021 Apr 28.

Department of Cardiology, Detroit Medical Center, Detroit, MI, USA.

Background: Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial.

Methods: PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality. The odds ratio (OR) was calculated using the random-effect model.

Results: We included 56 studies comprising of 68,733 patients (TR, n = 26,179; TF, n = 42,537). TR-PCI was associated with statistically significant lower odds of MACCE (OR = 0.66, 95% CI: 0.49-0.88, p-value = 0.005), major bleeding (OR = 0.47, 95% CI 0.32-0.68, p-value<0.001), mortality (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001) at in hospital follow-up. TR-PCI was associated with statistically significant lower MACCE (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001), major bleeding (OR = 0.58, 95% CI 0.49-0.68, p-value<0.001), and mortality (OR = 0.61, 95% CI 0.44-0.86, p-value = 0.005) at 30-day follow-up. The same difference was seen at 1-year.

Conclusion: TR-PCI was associated with lower odds of MACCE, major bleeding, and mortality during short- and long-term follow-up.
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http://dx.doi.org/10.1080/14779072.2021.1915768DOI Listing
May 2021

Successful Treatment of Spontaneous Coronary Artery Dissection With Cutting Balloon Angioplasty.

Cureus 2021 Mar 4;13(3):e13706. Epub 2021 Mar 4.

Cardiology, Detroit Medical Center, Detroit, USA.

Spontaneous coronary artery dissection (SCAD) is a rare but serious condition that requires immediate attention. It has a similar presentation to acute coronary syndrome in terms of chest pain, electrocardiogram changes, and an increase in troponins, and is considered to be a significant cause of myocardial infarction. Coronary angiography is needed to confirm the diagnosis, and subsequent repair should be pursued when needed. We describe a case of SCAD in a 72-year-old female treated using the cutting balloon angioplasty technique to create communication between the true and false lumens.
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http://dx.doi.org/10.7759/cureus.13706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016528PMC
March 2021

Predictors and risk factors of short-term readmission of acute pericarditis.

Expert Rev Cardiovasc Ther 2021 Mar 26;19(3):261-268. Epub 2021 Jan 26.

Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.

: The 30-day readmission risk factors for acute pericarditis are not well known. We investigated the risk factors and predictors of pericarditis from a national cohort.: Readmission data from the National Readmission Database (NRD) from the year 2016 were used to analyze the prevalence of risk factors and predictors of pericarditis 30-day readmission.: From the year 2016, 16,475 acute pericarditis hospitalizations were recorded. The rate of readmission from the year 2016 is similar to 2012 reported data (18%). A total of 13,844 patients (mean age 55.2 years, 40% of women) were found for acute pericarditis readmissions. The incidence rate of 30-day readmission of acute pericarditis patients in our study was 17.8% with the major cause of readmission was related to cardiovascular (pericarditis, endocarditis, and myocarditis) during 30-day follow-up. The median cost of the index and 30 days pericarditis admission $10,048 and $9,932, respectively.: Chronic comorbidities, prolonged hospitalization, and admission to a short-term hospital/left against medical advice admission to metropolitan teaching hospital were associated with a higher risk of 30-day readmission.
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http://dx.doi.org/10.1080/14779072.2021.1876564DOI Listing
March 2021

Meta-Analysis Comparing the Safety and Efficacy of Single vs Dual Antiplatelet Therapy in Post Transcatheter Aortic Valve Implantation Patients.

Am J Cardiol 2021 04 15;145:111-118. Epub 2021 Jan 15.

Detroit Medical Center, Heart Hospital, Detroit, Michigan. Electronic address:

The relative safety and efficacy of aspirin versus dual antiplatelet therapy (DAPT; aspirin+clopidogrel) in patients who underwent transcatheter aortic valve implantation (TAVI) and did not have a long-term indication for oral anticoagulation remains controversial. Digital databases were searched to identify relevant articles. The major safety end point was bleeding, while the efficacy end points included after-TAVI ischemic and thrombotic events. Data were analyzed using a random effect model to calculate the pooled unadjusted odds ratio (OR) for dichotomous outcomes. Eleven studies comprising 4805 patients (aspirin 2258, DAPT 2547) were included in the quantitative analysis. Patients receiving aspirin-alone had significantly lower odds of all cause bleeding (OR 0.41, 95% CI 0.29 to .057, p <0.00001), major vascular bleeding (OR 0.51, 95% CI 0.34 to 0.77, p = 0.001), Valve Academic Research Consortium 2 (VARC-2) major bleeding (OR 0.50, 95% CI 0.30 to 0.83 p = 0.008), VARC-2 minor bleeding (OR 0.55, 95% CI 0.31 to 0.97, p = 0.04), transfusion requirement (OR 0.39, 95%CI 0.15 to 0.0.98, p = 0.05) and major vascular complications (OR0.41, 95% CI 0.26 to 0.66, p = 0.0002) compared with after-TAVI patients receiving both aspirin and clopidogrel. These was no significant difference in the odds of VARC-2 life threatening bleeding (OR 0.52, 95% CI 0.25 to 1.07, p = 0.08), prosthetic valve thrombosis (OR 1.17, 95% CI 0.22 to 6.30, p = 0.85), cardiac tamponade (OR 0.77, 95% CI 0.20 to 2.98, p = 0.70), conversion to open procedure (OR 1.99, 95 % CI 0.42 to 9.44, p = 0.39), MI (OR 0.79 95% CI 0.38 to 1.64, p = 0.52), transient ischemic attack (TIA) (OR 0.89, 95% CI 0.12 to 6.44, p = 0.91), major stroke (OR 0.68 95 % CI 0.43 to 1.08, p = 0.10), disabling stroke (0R 1.01, 95% CI 0.41 to 2.48, p = 0.99), cardiovascular mortality (OR 0.81 95% CI 0.38 to 1.74, p = 0.59) and all-cause mortality (OR 0.86, 95% CI 0.63 to 1.16, p = 0.31) between the 2 groups. In conclusion, after-TAVI patients who received aspirin alone had lower bleeding events with no significant differences in mortality and stroke rate compared with those who received DAPT.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.087DOI Listing
April 2021

Prenatal diagnosis of isolated levocardia and a structurally normal heart: two case reports and a review of the literature.

Pediatr Cardiol 2013 Apr 22;34(4):1034-7. Epub 2012 May 22.

Rush University Medical Center, Rush Center for Congenital and Structural Heart Disease, 1653, W. Congress Parkway, Jones 770, Chicago, IL, USA.

Isolated levocardia (ILC) is a developmental abnormality involving an abnormal abdominal situs with a normal cardiac situs. This abnormality is especially rare when it is associated with a normal cardiac anatomy. The prenatal diagnoses of seven cases were reported in the English literature. This report presents two cases referred to the authors' echocardiography laboratory for maternal diabetes mellitus in case 1 and suspected dextrocardia in case 2. In both cases, ILC with a structurally normal heart was diagnosed prenatally. The child in the first case was found to have a normal inferior vena cava (IVC) prenatally. Postnatally, he was found to have intestinal malrotation with duodenal obstruction and multiple splenules. Interruption of the IVC was shown by abdominal ultrasound. The child in the second case was found to have an interrupted IVC with azygos continuation prenatally. Postnatally, intestinal malrotation with no evidence of intestinal obstruction or asplenia was detected. Neither of the cases had reported cardiac arrhythmias. Early diagnosis is crucial in these cases due to the high incidence of associated anomalies and potential life-threatening conditions. Management of patients with ILC is dictated by the associated anomalies. Long-term follow-up assessment is recommended for these patients to monitor the development of rhythm abnormalities.
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http://dx.doi.org/10.1007/s00246-012-0359-8DOI Listing
April 2013
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