Publications by authors named "Neil D Patel"

25 Publications

  • Page 1 of 1

Utility of Surveillance Ambulatory Rhythm Monitoring in the Pediatric Fontan Population.

Pediatr Cardiol 2021 May 7. Epub 2021 May 7.

Division of Cardiology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS #34, Los Angeles, CA, 90049, USA.

Our institution established a Fontan surveillance plan, which included ambulatory rhythm monitoring (ARM) at 6, 10, 13, 16 and 19 years old, for early detection of Fontan-associated complications. We conducted a retrospective chart review of Fontan patients followed at our institution 2014-2018 to determine the utility of surveillance ARMs. 139 ARMs from 83 patients were included. ARMs with supraventricular tachycardia, sinus node dysfunction, accelerated junctional rhythm, > 1st degree atrioventricular block, and complex ventricular ectopy were classified as positive for arrhythmia. Arrhythmias were occult if detected on surveillance ARM. The ARM indication was surveillance in 78 (56%) and clinically indicated in 61 (44%). 52 (37%) ARMs in 27 (33%) patients had an arrhythmia. There was no difference in the age of patients with and without arrhythmias [median 10.9 (6.5, 17.1 years) vs. 8.8 (7, 13.6 years), p = 0.5]. Clinically indicated ARMs more frequently demonstrated arrhythmias than surveillance ARMs (52% vs. 26%, p < 0.01). Compared to patients without arrhythmias, those with arrhythmias were more likely to be female (48% vs. 23%, p = 0.02), have a single right ventricle (46% vs. 19%, p < 0.01) and longer QRS duration on ECG [100 (91, 116 ms) vs. 94 (84, 104 ms), p = 0.046]. Patients with occult arrhythmias were less likely to have moderate to severe atrioventricular valvar regurgitation (0% vs. 46%; p = 0.04) or ventricular dysfunction (0% vs. 46%; p = 0.04) than those with clinical arrhythmia(s). Arrhythmia findings resulted in change in management for 16/52 (31%) ARMs. The findings suggest the frequent presence of arrhythmias on periodic ARMs in patients following the Fontan procedure regardless of symptomatic status.
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http://dx.doi.org/10.1007/s00246-021-02630-0DOI Listing
May 2021

Progression in Fontan conduit stenosis and hemodynamic impact during childhood and adolescence.

J Thorac Cardiovasc Surg 2020 Oct 29. Epub 2020 Oct 29.

Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif. Electronic address:

Objective: To characterize changes in Fontan conduit size over time and determine if cross-sectional area (CSA) affects cardiac output, pulmonary artery growth, and exercise capacity.

Methods: We conducted a retrospective cross-sectional study of patients with Fontan physiology who underwent cardiac magnetic resonance imaging or cardiac catheterization between January 2013 and October 2019. We collected Fontan and pulmonary artery measurements, hemodynamic data, and cardiopulmonary exercise test data. We identified 158 patients with an extracardiac Fontan. We measured minimum and mean Fontan conduit CSA and assessed whether these correlated with Nakata index, cardiac index, or exercise capacity.

Results: Minimum Fontan CSA decreased by a median of 33% (24%, 40%) during a mean follow-up of 9.6 years. Median percentage decrease in Fontan CSA did not differ among 16-, 18-, and 20-mm conduits (P = .29). There was a significant decrease in the minimum Fontan CSA (33% [25%, 41%]) starting less than 1-year post-Fontan. Median Nakata index was 177.6 mm/m (149.1, 210.8) and was not associated with Fontan CSA/BSA (ρ = 0.09, P = .29). Fontan CSA/BSA was not associated with cardiac index (ρ = -0.003, P = .97). A larger Fontan CSA/BSA had a modest correlation with % predicted oxygen consumption (ρ = 0.31, P = .013).

Conclusions: Fontan conduit CSA decreases as early as 6 months post-Fontan. The minimum Fontan CSA/BSA was not associated with cardiac index or pulmonary artery size but did correlate with % predicted peak oxygen consumption.
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http://dx.doi.org/10.1016/j.jtcvs.2020.09.140DOI Listing
October 2020

Procedural, pregnancy, and short-term outcomes after fetal aortic valvuloplasty.

Catheter Cardiovasc Interv 2020 09 26;96(3):626-632. Epub 2020 Mar 26.

Division of Pediatric Cardiology, Children's Hospital, University of Southern California Keck School of Medicine of USC, Los Angeles, California, USA.

Objectives: We aimed to evaluate the effect of technical aspects of fetal aortic valvuloplasty (FAV) on procedural risks and pregnancy outcomes.

Background: FAV is performed in cases of severe mid-gestation aortic stenosis with the goal of preventing hypoplastic left heart syndrome (HLHS).

Methods: The International Fetal Cardiac Intervention Registry was queried for fetuses who underwent FAV from 2002 to 2018, excluding one high-volume center.

Results: The 108 fetuses had an attempted cardiac puncture (mean gestational age [GA] 26.1 ± 3.3 weeks). 83.3% of attempted interventions were technically successful (increased forward flow/new aortic insufficiency). The interventional cannula was larger than 19 g in 70.4%. More than one cardiac puncture was performed in 25.0%. Intraprocedural complications occurred in 48.1%, including bradycardia (34.1%), pericardial (22.2%) or pleural effusion (2.7%) requiring drainage, and balloon rupture (5.6%). Death within 48 hr occurred in 16.7% of fetuses. Of the 81 patients born alive, 59 were discharged home, 34 of whom had biventricular circulation. More than one cardiac puncture was associated with higher complication rates (p < .001). Larger cannula size was associated with higher pericardial effusion rates (p = .044). On multivariate analysis, technical success (odds ratio [OR] = 10.9, 95% confidence interval [CI] = 2.2-53.5, p = .003) and later GA at intervention (OR = 1.5, 95% CI = 1.2-1.9, p = .002) were associated with increased odds of live birth.

Conclusions: FAV is an often successful but high-risk procedure. Multiple cardiac punctures are associated with increased complication and fetal mortality rates. Later GA at intervention and technical success were independently associated with increased odds of live birth. However, performing the procedure later in gestation may miss the window to prevent progression to HLHS.
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http://dx.doi.org/10.1002/ccd.28846DOI Listing
September 2020

Routine Surveillance Catheterization is Useful in Guiding Management of Stable Fontan Patients.

Pediatr Cardiol 2020 Mar 24;41(3):624-631. Epub 2020 Jan 24.

Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Blvd, Mailstop #34, Los Angeles, CA, 90027, USA.

We developed a Fontan surveillance catheterization protocol as part of routine assessment of stable patients 10 years after Fontan completion. The surveillance catherization includes hemodynamic assessment with inhaled nitric oxide, angiography, liver biopsy, and transcatheter intervention if indicated. We aimed to describe hemodynamic and liver biopsy findings, response to pulmonary vasoreactivity testing, rates of transcatheter intervention, and changes in medical therapy following surveillance catheterization in stable Fontan patients. A single-center retrospective review of Fontan patients undergoing surveillance catheterization between November 2014 and May 2019 was performed. Liver biopsies were independently scored by two pathologists. Sixty-three patients underwent surveillance catheterization (mean age 14.6 ± 3.0 years). The mean Fontan pressure was 11.8 ± 2.1 mmHg. The mean cardiac index was 2.9 ± 0.6 L/min/m. In the 51 patients who underwent pulmonary vasoreactivity testing, there was a significant decrease in median pulmonary vascular resistance (1.8 [range 0.8-4.1] vs 1.4 [range 0.7-3.0] Wood units × m; p < 0.001). The mean cardiac index increased (3.0 ± 0.6 vs 3.2 ± 0.7 L/min/m, p = 0.009). The Fontan pressure did not change significantly. Fifty-seven patients underwent liver biopsy, and all but one showed fibrosis. Nineteen patients (33.3%) demonstrated bridging fibrosis or cirrhosis. Twenty-five patients underwent 34 transcatheter interventions. Pulmonary artery or Fontan stent placement was performed in 19 patients. Phosphodiesterase type 5 inhibitors were initiated in nine patients following surveillance catheterization. Routine surveillance catheterization with liver biopsy in adolescent Fontan patients reveals information that can guide interventional and medical management. Further long-term follow-up and assessment are indicated to assess the benefit of these interventions.
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http://dx.doi.org/10.1007/s00246-020-02293-3DOI Listing
March 2020

Stent treatment of ostial branch pulmonary artery stenosis: initial and medium-term outcomes and technical considerations to avoid and minimise stent malposition.

Cardiol Young 2020 Feb 13;30(2):256-262. Epub 2019 Dec 13.

Divison of Pediatric Cardiology, University of California Davis Children's Hospital, Sacramento, CA, USA.

Objective: Stenting of ostial pulmonary artery stenosis presents several unique challenges. These include difficulty in defining anatomy and need for precise stent placement in order to avoid missing the ostial stenosis or jailing either the contralateral branch pulmonary artery or the ipsilateral upper lobe branch.

Design: A retrospective review of outcomes was conducted in 1.5 or 2-ventricle patients who underwent stent placement for ostial branch pulmonary artery stenosis. Specific catheterisation lab techniques were reviewed.

Results: Forty-seven branch pulmonary arteries underwent stent placement for ostial stenosis in 43 patients. The median age and weight were 3.7 (0.3-18.1) years and 14.2 (5.6-70.0) kg, respectively. Three (2-8) angiographic projections were needed to profile the ostial stenosis. Open-cell stents were used in 23 and stents were modified in 5 cases. Following stent implantation, the minimum diameter improved from 3.6 (0.8-10.5) to 8.1 (4.2-16.5) mm (p < 0.001). The gradient improved from 21 (0-66) to 4 (0-27) mmHg (p < 0.001). Stent malposition occurred in eight (17%) of the stents placed. Five migrated distally causing suboptimal ostial coverage necessitating placement of a second stent in four. Three migrated proximally and partially jailed the contralateral pulmonary artery. Intentional jailing of the upper lobe branch occurred in four additional cases. At a follow-up of 2.4 (0.3-4.9) years, 15 stents underwent further dilation and 1 had a second stent placed within the exiting stent.

Conclusion: Ostial branch pulmonary artery stenosis may require additional angiography to accurately define the ostial stenosis. Treatment with stents is effective but carries high rates of stent malposition.
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http://dx.doi.org/10.1017/S1047951119003032DOI Listing
February 2020

Effect of a prospective opioid reduction intervention on opioid prescribing and use after radical prostatectomy: results of the Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery (ORIOLES) Initiative.

BJU Int 2020 03 15;125(3):426-432. Epub 2019 Nov 15.

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Objectives: To evaluate the effect of a prospective opioid reduction intervention after radical prostatectomy (RP; based on a surgery-specific guideline and education) on post-discharge opioid prescribing, use, disposal, and need for additional opioid medication.

Patients And Methods: A prospective, non-randomised, pre-post interventional trial of patients undergoing RP for prostate cancer (August 2017-November 2018) was conducted as part of the Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery (ORIOLES) Initiative. An evidence-based intervention including: a discharge sheet, nursing education, and standardised prescribing guideline, was applied with the primary outcome of total oral morphine equivalents (OMEQ) used after RP. Secondary outcomes included opioid prescribing, opioid disposal, need for additional opioid medication, and presence of incisional/post-surgical abdominal pain at 30 days after RP.

Results: A total of 214 (Pre-Intervention arm) and 229 (Post-Intervention arm) adult patients were enrolled (100% follow-up). The intervention reduced post-discharge opioid prescribing (from 224.3 to 120.3 mg; -46.4%, P = 0.01), reduced opioid use (from 52.1 to 38.3 mg; -26.5%, P < 0.01), and increased opioid disposal (+13.5%, P < 0.01). Greater prescribing of opioids at discharge, higher body mass index, and use of opioid medication prior to surgery, were independently associated with greater post-discharge opioid use, while history of a chronic pain diagnosis was not statistically significant. In the Post-Intervention cohort, 2.2% of patients needed additional medication for post-surgical pain (0.9% obtained a prescription) and 1.3% initiated long-term use.

Conclusions: A prospective, evidence-based intervention reduced post-discharge opioid prescribing and use, while increasing disposal after RP. Risk factors for increased opioid use were identified. The results support expanding the use of evidence-based opioid reduction interventions to other surgical specialties.
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http://dx.doi.org/10.1111/bju.14932DOI Listing
March 2020

Hybrid approach to ventricular septal defect enlargement.

Catheter Cardiovasc Interv 2019 Nov 14;94(5):732-737. Epub 2019 Apr 14.

Division of Cardiology, Department of Pediatrics, UC Davis Children's Hospital, Sacramento, California.

The need for creation or enlargement of a ventricular septal defect (VSD) is a rare occurrence. It is most frequently required in patients with double-outlet right ventricle who develop restriction of a remote muscular VSD or obstruction of a perimembranous VSD secondary to atrioventricular (AV) valve attachments to the interventricular septum. Surgical and transcatheter options for VSD creation or enlargement are associated with several risks including heart block, AV valve injury, and perforation. We report the first description of a hybrid approach to VSD creation and enlargement in two patients.
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http://dx.doi.org/10.1002/ccd.28227DOI Listing
November 2019

Retained Intrauterine Device (IUD): Triple Case Report and Review of the Literature.

Case Rep Obstet Gynecol 2018 5;2018:9362962. Epub 2018 Dec 5.

Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, New York 10451, USA.

Background: Throughout the world, intrauterine contraceptive devices (IUDs) are a frequently used, reversible, popular contraceptive method. They are usually placed without major complications. Uterine perforation is a rarely observed complication. Migration of the IUD to the pelvic/abdominal cavity or adjacent structures can occur after perforation. We present 3 cases of uterine perforation, possibly due to scarred myometrium associated with a cesarean delivery. We describe 3 perforations with IUDs lodged in the bladder serosa, the posterior cul-de-sac, and tissue adjacent to the cardinal ligament and external iliac artery.

Cases:  .  26-year-old, Gravid 4, Para 2113, nonpregnant female with a history of a cesarean delivery underwent placement of an IUD one year after an elective pregnancy termination, presenting with abdominal pain requesting removal of the IUD. On speculum, although the IUD strings were visualized, the IUD could not be removed. Sonogram imaging identified an empty endometrial cavity with the IUD in posterior cul-de-sac. The IUD was removed via laparoscopy.

Case  2: 34-year-old Gravida 5, Para 4004, at 27 weeks and 3 days gestation, female with history of two previous cesarean deliveries underwent a third cesarean after spontaneous rupture of membranes with comorbid chorioamnionitis. Reproductive history was significant for placement of an IUD that had not been removed or imaged during obstetrical sonograms. The clinical evaluation revealed that the IUD had been spontaneously expelled. On the fifth operative day, the patient is febrile with CT demonstrating the IUD penetrating the anterior surface of bladder. On cystoscopy the bladder mucosa was intact. The IUD was removed via laparotomy with repair of the bladder, serosa, and muscular layer.

Case  3: 26-year-old, Gravid 4, P3013, nonpregnant female with three previous Cesarean deliveries had an IUD in place. However, with the IUD in situ, the patient conceived and had a spontaneous abortion. After the spontaneous abortion, she presented to clinic to have the IUD removed due to pain that was present since placement. Although the IUD strings were visualized, attempts to remove it were unsuccessful. Imaging identified the IUD outside the uterine cavity. Palpation with a blunt probe laparoscopically revealed a hard object within the adhesion band, close to the cardinal ligament. As per radiology evaluation, IUD was embedded 1cm from the external iliac artery on the right side outside the uterus in the adnexal region. A multidisciplinary procedure with gynecologic-oncologist was scheduled for removal due to the high risk of perioperative bleeding.

Conclusion: Patients in whom uterine perforation and IUD migration are suspected should have appropriate evaluation that includes transvaginal or transabdominal ultrasound or radiographs to confirm the position of the IUD, regardless of whether they are asymptomatic or present with symptoms. It is particularly important in the presence of a scarred uterus that imaging is used to identify the location of a missing IUD. The uterine scar of a cesarean may facilitate migration of the IUD. Cross sectional imaging, such as CT or MRI scan, may be needed to rule out adjacent organ involvement before surgical removal.
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http://dx.doi.org/10.1155/2018/9362962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304543PMC
December 2018

A Prospective Cohort Study of Postdischarge Opioid Practices After Radical Prostatectomy: The ORIOLES Initiative.

Eur Urol 2019 02 21;75(2):215-218. Epub 2018 Oct 21.

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Opioid pain medications are overprescribed, but few data are available to help in appropriate tailoring of postdischarge opioid prescriptions after surgery. Prior studies are retrospective and based on incomplete responses (<50%) to questionnaires, with small sample sizes for any particular surgery. The ORIOLES initiative was a prospective cohort study (2017-2018) designed to measure postdischarge opioid prescribing and use and clinical predictors of use for consecutive patients after radical prostatectomy. The objectives were to establish a postdischarge opioid reference value to meet the needs of >80% of patients and compare open and robotic surgery. A total of 205 adult patients were enrolled, with 100% completing follow-up. In units of oral morphine equivalents (OMEQ), a median of 225mg was prescribed and 22.5mg used. There was no difference by surgical approach or among patients with a history of pain-related diagnoses. Overall, 77% of postdischarge opioid medication was unused, with 84% of patients requiring ≤112.5mg OMEQ. Only 9% of patients appropriately disposed of leftover medication. Approximately 5% reported continued incisional pain due to surgery at 30d, but none required continued opioid medication use. Prescribing more opioids was independently associated with greater opioid use in adjusted models. PATIENT SUMMARY: In this report, we looked at opioid medication use following discharge after radical prostatectomy. We found that 77% of opioid pain medication prescribed was unused, with 84% of patients using less than half of their prescription. Prescribing more opioids was associated with greater use; only 9% of patients appropriately disposed of leftover medication.
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http://dx.doi.org/10.1016/j.eururo.2018.10.013DOI Listing
February 2019

Morphology of intramural ventricular septal defects: Clinical imaging and autopsy correlation.

Ann Pediatr Cardiol 2018 Sep-Dec;11(3):308-311

Division of Pediatric Cardiology, Children's Hospital Los Angeles, California, USA.

An intramural ventricular septal defect (IVSD) is a type of interventricular communication that can occur following biventricular repair of a conotruncal malformation. There have been no previous reports depicting the actual pathologic anatomy of this defect. We describe two cases of IVSDs with their clinical imaging and postmortem pathology.
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http://dx.doi.org/10.4103/apc.APC_139_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146864PMC
October 2018

Decreased Surgical Site Infection Rate in Hysterectomy: Effect of a Gynecology-Specific Bundle.

Obstet Gynecol 2018 10;132(4):1064-1065

Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, New York.

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http://dx.doi.org/10.1097/AOG.0000000000002893DOI Listing
October 2018

Unmasking the borderline coarctation: the utility of isoproterenol in the paediatric cardiac catheterisation laboratory.

Cardiol Young 2018 Jun 14;28(6):804-810. Epub 2018 Mar 14.

3Divison of Pediatric Cardiology,University of California Davis Children's Hospital,Sacramento,CA,USA.

Background: One indication for intervention in coarctation of the aorta is a peak-to-peak gradient >20 mmHg. Gradients may be masked in patients under general anaesthesia and may be higher during exercise. Isoproterenol was given during cardiac catheterisation to simulate a more active physiologic state.

Objectives: We aimed to describe the haemodynamic effects of isoproterenol in patients with coarctation and the impact of intervention on the elicited gradients.

Methods: A retrospective study was performed on two-ventricle patients who underwent cardiac catheterisation for coarctation with isoproterenol testing.

Results: 25 patients received isoproterenol before and after intervention. With isoproterenol, the mean diastolic (p=0.0015) and mean arterial (p=0.0065) blood pressures proximal to the coarctation decreased significantly. The mean systolic, diastolic, and mean arterial blood pressures distal to the coarctation decreased significantly (p20 mmHg. Post intervention, the median gradient decreased to 2 (0-29) mmHg, versus baseline, p=0.005, and with isoproterenol it decreased to 8 (0-27) mmHg, versus pre-intervention isoproterenol, p<0.0001. There were significant improvements in the gradients by Doppler (<0.0001) and by blood pressure cuff (p=0.0313). The gradients on isoproterenol best correlated with gradients by blood pressure cuff in the awake state (R2=0.76, p<0.0001).

Conclusions: Isoproterenol can be a useful tool to assess the significance of a coarctation and the effectiveness of an intervention. Percutaneous interventions can effectively reduce the gradients elicited by isoproterenol.
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http://dx.doi.org/10.1017/S1047951118000239DOI Listing
June 2018

Melody valve implantation through a recanalized occluded femoral vein.

Ann Pediatr Cardiol 2018 Jan-Apr;11(1):111-113

Division of Pediatric Cardiology, Children's Hospital Los Angeles, and the Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA E-mail:

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http://dx.doi.org/10.4103/apc.APC_69_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803967PMC
February 2018

Pediatric Hypertension: Are Pediatricians Following Guidelines?

J Clin Hypertens (Greenwich) 2016 12 23;18(12):1230-1234. Epub 2016 Sep 23.

Abbvie, North Chicago, IL.

The National Heart, Lung, and Blood Institute recommends that children older than 3 years seen in the medical setting have their blood pressure (BP) measured. The authors aimed to determine whether BPs are measured at well-child visits and whether elevated readings are recognized. A retrospective chart review of 3- to 18-year-old children seen for well-child visits was performed. Age, sex, weight, height, BP, extremity measured, and type of intervention were collected. BP was measured in 777 of 805 patients (97%). BP was elevated in 158 patients (20%). A total of 95 patients (60%) did not receive any intervention. Not recognizing elevated BP was associated with increased daily patient load (17.9±6.5 vs 12.6±5.5, P=.001). Higher body mass index was associated with elevated BP (P=.0008) but was not associated with improved recognition. Findings show that BP is almost always measured at well-child visits but is not being measured appropriately, and general pediatric clinics are not consistently following BP management recommendations.
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http://dx.doi.org/10.1111/jch.12915DOI Listing
December 2016

Anomalous left coronary artery from the pulmonary artery discovered following total anomalous pulmonary venous return repair: a rare entity.

Cardiol Young 2017 Mar 30;27(2):385-387. Epub 2016 Aug 30.

Divison of Pediatric Cardiology,Children's Hospital Los Angeles,Los Angeles,California,United States of America.

We describe a case of anomalous left coronary artery from the pulmonary artery in association with total anomalous pulmonary venous return. The infant was diagnosed with total anomalous pulmonary venous return at 6 weeks of age and underwent successful surgical repair. On routine follow-up, he was found to have an anomalous left coronary artery from the pulmonary artery without evidence of mitral regurgitation or left ventricular dysfunction. The presence of the left-to-right shunt and secondary elevation in pulmonary artery pressures likely masked the usual findings associated with this coronary anomaly.
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http://dx.doi.org/10.1017/S1047951116001220DOI Listing
March 2017

Tetralogy of Fallot with left superior vena cava and coronary sinus atrial septal defect: a rare association.

Pediatr Cardiol 2015 Jun 12;36(5):1100-1. Epub 2015 Mar 12.

, 4650 Sunset Blvd, Mailstop #34, Los Angeles, CA, 90027, USA.

This report describes a rare case of Tetralogy of Fallot with associated left superior vena cava and coronary sinus atrial septal defect. The initial diagnosis was made by echocardiography. The patient underwent complete repair at 2 months of age. Her postoperative course was complicated by low cardiac output requiring ECMO. She was subsequently weaned off of ECMO and discharged home. She continues to do well on serial follow-up.
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http://dx.doi.org/10.1007/s00246-015-1137-1DOI Listing
June 2015

Atrial flutter demonstrated by M-mode echocardiography.

Pediatr Cardiol 2014 Jun;35(5):893-5

This report and images describe a case of atrial flutter with 2:1 conduction pattern in a 3 year-old male with d-TGA, ASD, and VSD status-post repair, which was demonstrated by M-mode echocardiography.
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http://dx.doi.org/10.1007/s00246-014-0892-8DOI Listing
June 2014

Single-center outcome analysis comparing reintervention rates of surgical arterioplasty with stenting for branch pulmonary artery stenosis in a pediatric population.

Pediatr Cardiol 2014 Mar 6;35(3):419-22. Epub 2013 Oct 6.

Rush Center for Congenital & Structural Heart Disease, Rush University Medical Center, 1653 West Congress Parkway, Jones 770, Chicago, IL, 60612, USA.

Although catheter-based intervention is generally accepted as the treatment of choice for branch pulmonary artery (PA) stenosis, there are no data directly comparing both the need for reintervention and time to reintervention in patients undergoing transcatheter stenting versus surgical arterioplasty. We compared children who underwent surgical branch pulmonary arterioplasty and branch PA stent placement between January 2008 and May 2012 at a single tertiary center. Need for reintervention and mean time to reintervention were assessed using chi-square and independent sample Student t test. Thirty-seven patients were included (surgery n = 18, stent n = 19). Mean weight at initial intervention was 11.3 ± 8.8 kg for surgical and 20.1 ± 15.5 kg for stent (p = 0.041). Intervention was performed on the left PA in 17 patients, the right PA in 12 patients, and both PAs in 8 patients. Five patients had undergone previous intervention. On mean follow-up of 807 ± 415 days, 50% (9 of 18) of the surgery cohort and 5.3% (1 of 19) of the stent cohort required reintervention (p = 0.002). In all but one case reintervention was catheter-based. Mean time to reintervention for the surgery cohort was 272 ± 162 days and for the single stent cohort it was 150 days. When comparable age and weight groups were analyzed, reintervention was still more common in the surgery cohort (p = 0.007). Children undergoing surgical branch pulmonary arterioplasty are more likely to require reintervention than those undergoing stent placement.
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http://dx.doi.org/10.1007/s00246-013-0795-0DOI Listing
March 2014

Double-outlet right ventricle with an intact ventricular septum: a unique stage 1 palliation.

Pediatr Cardiol 2013 11;34(8):2086-8. Epub 2013 Jul 11.

Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, 1653 West Congress Parkway, Jones 770, Chicago, IL, 60612, USA,

This report describes a case of double-outlet right ventricle with intact ventricular septum diagnosed in a newborn male. The initial diagnosis was made by echocardiography. The baby underwent a hybrid procedure including pulmonary artery banding and stenting of the patent ductus arteriosus. He subsequently underwent stenting of the atrial communication. The patient was discharged at 55 days of life with the intent to perform palliative repair at a later date.
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http://dx.doi.org/10.1007/s00246-013-0741-1DOI Listing
July 2014

Energy drinks: a review of use and safety for athletes.

Phys Sportsmed 2010 Jun;38(2):171-9

Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, MI.

Energy drinks have increased in popularity in adolescents and young adults; however, concerns have been raised regarding the ingredients in energy drinks and their potential negative effects on health. Caffeine, the most physiologically active ingredient in energy drinks, is generally considered safe by the US Food and Drug Administration (FDA), although adverse effects can occur at varying amounts. Guarana, which contains caffeine in addition to small amounts of theobromine, theophylline, and tannins, is also recognized as safe by the FDA, although it may lead to caffeine toxicity when combined with caffeine. The amount of ginseng in energy drinks is typically far below the amount used as a dietary supplement, and is generally considered safe. Taurine, an intracellular amino acid, has been reported to have positive inotropic effects; however, this claim is not supported by research. Most energy drinks also contain sugar in an amount that exceeds the maximum recommended daily amount. Young athletes are increasingly using energy drinks because of the ergogenic effects of caffeine and the other ingredients found in these beverages. Energy drinks combined with alcohol are also gaining popularity in young adults, which poses significant concerns about health risks. Other health concerns related to consumption of energy drinks include case reports of seizures and cardiac arrest following energy drink consumption and dental enamel erosion resulting from the acidity of energy drinks.
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http://dx.doi.org/10.3810/psm.2010.06.1796DOI Listing
June 2010

Resistance training for adolescents.

Pediatr Clin North Am 2010 Jun;57(3):671-82

HPER Department, Western Michigan University, Kalamazoo, MI 49008, USA.

The benefits and possible detriment of resistance training have been noted extensively in the literature. Although the benefits of resistance training are well known, many professionals fail to heed scientific advice or follow appropriate recommendations for resistance training in adolescents. When developing a resistance training program for adolescents, be cognizant of any pre-existing health conditions and experience level of the adolescent. For strength training, the adolescent should begin with exercises that involve all major muscle groups with relatively light weight, one to three sets of 6 to 15 repetitions, 2 to 3 non-consecutive days per week. As the adolescent becomes more experienced, gradually increase loads and add multijoint exercises. Each exercise session should be properly supervised for safety, and to provide feedback on technique and form, regardless of the resistance training experience of the adolescent. This article reviews the guidelines for resistance training for health-related fitness for adolescents.
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http://dx.doi.org/10.1016/j.pcl.2010.02.009DOI Listing
June 2010

Pharmacologic agents for smoking cessation: a clinical review.

Clin Pharmacol 2010 7;2:17-29. Epub 2010 Apr 7.

Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, MI, USA.

Tobacco use has been clearly demonstrated to have negative health consequences. Smoking cigarettes is the predominant method of tobacco use. The tar contained within cigarettes and other similar products is also harmful. Other tarless tobacco containing products do exist but carry no significantly decreased risk. While nicotine is considered to be principally responsible for tobacco addiction, other chemicals in the cigarette smoke including acetaldehyde may contribute to the addictive properties of tobacco products. The adverse health consequences of tobacco use have been well documented. Studies have shown that a combined behavioral and pharmacological approach is more effective in smoking cessation than either approach alone. Pharmacotherapy can achieve 50% reduction in smoking. With pharmacotherapy the estimated 6-month abstinence rate is about 20%, whereas it is about 10% without pharmacotherapy. The first-line of drugs for smoking cessation are varenicline, bupropion sustained release, and nicotine replacement drugs, which are approved for use in adults. Data are insufficient to recommend their use in adolescents. This article reviews the use of pharmacological agents used for smoking cessation. A brief overview of epidemiology, chemistry, and adverse health effects of smoking is provided.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262366PMC
http://dx.doi.org/10.2147/CPAA.S8788DOI Listing
June 2012

The use of a photoionization detector to detect harmful volatile chemicals by emergency personnel.

Open Access Emerg Med 2009 21;1:5-9. Epub 2009 Sep 21.

Michigan State University Kalamazoo Center for Medical Studies, Kalamazoo, MI, USA; Portage Fire Department, Portage, MI, USA.

Objective: The objective of this investigation was to determine if a photoionization detector (PID) could be used to detect the presence of a simulated harmful chemical on simulated casualties of a chemical release.

Methods: A screening protocol, based on existing radiation screening protocols, was developed for the purposes of the investigation. Three simulated casualties were contaminated with a simulated chemical agent and two groups of emergency responders were involved in the trials. The success-failure ratio of the participants was used to judge the performance of the PID in this application.

Results: A high success rate was observed when the screening protocol was properly adhered to (97.67%). Conversely, the success rate suffered when participants deviated from the protocol (86.31%). With one exception, all failures were noted to have been the result of a failure to correctly observe the established screening protocol.

Conclusions: The results of this investigation indicate that the PID may be an effective screening tool for emergency responders. However, additional study is necessary to both confirm the effectiveness of the PID and refine the screening protocol if necessary.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806818PMC
http://dx.doi.org/10.2147/oaem.s6855DOI Listing
May 2016

Team processes and team care for children with developmental disabilities.

Pediatr Clin North Am 2008 Dec;55(6):1375-90, ix

Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, MI, USA.

Professionals who work with children and adolescents who have developmental disabilities find themselves working with several other professionals on various "teams." These teams are typically composed of practitioners from more than one discipline working toward the single goal of providing comprehensive patient care. Research on medical and psychosocial teams confirms the overwhelming importance of clarity, commitment, and close positive exchanges among team members to promoting successful teamwork. The effectiveness of teams largely depends on how the professionals work to accomplish meeting the needs of their patients. This article reviews multidisciplinary, interdisciplinary, and transdisciplinary approaches to delivering health care to children and adolescents who have developmental disabilities.
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http://dx.doi.org/10.1016/j.pcl.2008.09.002DOI Listing
December 2008

Acute isolated acetabular fracture following a game of squash: a case report.

J Med Case Rep 2007 Nov 28;1:156. Epub 2007 Nov 28.

Specialist Registrar, Trauma and Orthopaedics, St George's Hospital, London, UK.

Although hip injuries do not account a large amount of the Sports Physician's workload they can result in significant morbidity. We present a case where an acetabular fracture was sustained in a relatively young female while playing squash without any history of fall or injury but was treated successfully non-operatively. Such patients who present with acute hip pain must not be dismissed as simply having a soft tissue injury.
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http://dx.doi.org/10.1186/1752-1947-1-156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213672PMC
November 2007