Publications by authors named "Sanjeev Aggarwal"

136 Publications

Longitudinal Trends in Body Mass Index for Adults with Congenital Heart Disease.

Pediatr Cardiol 2021 Oct 19. Epub 2021 Oct 19.

Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA.

Obesity is a modifiable, independent risk factor for adverse long-term outcomes in children and adults. Our objective was to determine the prevalence of overweight and obese status in a cohort of adults with congenital heart disease (CHD) as well as to assess longitudinal trends over a 20-year period. The study group consisted of patients 18 years of age and older followed at our adult CHD clinic. Body mass index (BMI) data were collected from our index period, consisting of patient encounters from 2009 to 2012 (Period 2), as well as during 2000-2003 (Period 1) and 2017-2020 (Period 3) when available. The study cohort was subdivided into three groups per published guidelines: simple, moderate, and greater CHD complexity. The prevalence of obesity and overweight status was compared among the different groups as well as with published data (NHANES). Our cohort in Period 2 consisted of 261 subjects. The median age (25-75% interquartile range) for Period 2 was 27.6 (21.1-35.9) years and BMI was 25.2 (21.7-30.0) kg/m with 8.0% underweight, 40.0% with normal weight, 27.0% overweight, and 25% obese. 95 patients had follow-up data from each time period, with 96% of patients having moderate or greater complexity of CHD. The combined percentage of overweight and obese patients for the moderate and greater complex CHD groups increased from 42 and 37% in period 1 to 60% and 65% in period 3, respectively. The percentage of obese patients with moderate and greater CHD complexity increased by 250% and 55%, respectively, from Period 1 to 3. Our study cohort had a high prevalence of overweight and obese weight status. Given adults with CHD have high baseline cardiovascular morbidity, the presence of obesity can increase their risk for poor outcomes, highlighting the need for prevention of this modifiable risk factor.
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http://dx.doi.org/10.1007/s00246-021-02753-4DOI Listing
October 2021

Late health outcomes after dexrazoxane treatment: A report from the Children's Oncology Group.

Cancer 2021 Oct 13. Epub 2021 Oct 13.

Oishei Children's Hospital, Roswell Park Comprehensive Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.

Background: The objective of this study was to examine long-term outcomes among children newly diagnosed with cancer who were treated in dexrazoxane-containing clinical trials.

Methods: P9404 (acute lymphoblastic leukemia/lymphoma [ALL]), P9425 and P9426 (Hodgkin lymphoma), P9754 (osteosarcoma), and Dana-Farber Cancer Institute 95-01 (ALL) enrolled 1308 patients between 1996 and 2001: 1066 were randomized (1:1) to doxorubicin with or without dexrazoxane, and 242 (from P9754) were nonrandomly assigned to receive dexrazoxane. Trial data were linked with the National Death Index, the Organ Procurement and Transplantation Network, the Pediatric Health Information System (PHIS), and Medicaid. Osteosarcoma survivors from the Childhood Cancer Survivor Study (CCSS; n = 495; no dexrazoxane) served as comparators in subanalyses. Follow-up events were assessed with cumulative incidence, Cox regression, and Fine-Gray methods.

Results: In randomized trials (cumulative prescribed doxorubicin dose, 100-360 mg/m ; median follow-up, 18.6 years), dexrazoxane was not associated with relapse (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.63-1.13), second cancers (HR, 1.19; 95% CI, 0.62-2.30), all-cause mortality (HR, 1.07; 95% CI, 0.78-1.47), or cardiovascular mortality (HR, 1.45; 95% CI, 0.41-5.16). Among P9754 patients (all exposed to dexrazoxane; cumulative doxorubicin, 450-600 mg/m ; median follow-up, 16.6-18.4 years), no cardiovascular deaths or heart transplantation occurred. The 20-year heart transplantation rate among CCSS osteosarcoma survivors (mean doxorubicin, 377 ± 145 mg/m ) was 1.6% (vs 0% in P9754; P = .13). Among randomized patients, serious cardiovascular outcomes (cardiomyopathy, ischemic heart disease, and stroke) ascertained by PHIS/Medicaid occurred less commonly with dexrazoxane (5.6%) than without it (17.6%; P = .02), although cardiomyopathy rates alone did not differ (4.4% vs 8.1%; P = .35).

Conclusions: Dexrazoxane did not appear to adversely affect long-term mortality, event-free survival, or second cancer risk.
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http://dx.doi.org/10.1002/cncr.33974DOI Listing
October 2021

An echocardiographic finding mimicking tricuspid atresia in a neonate with dilated cardiomyopathy.

Cardiol Young 2021 Aug 5:1-3. Epub 2021 Aug 5.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Central Michigan University, Detroit, MI, USA.

We report a neonate with dilated cardiomyopathy and have echocardiographic findings consistent with "functional" tricuspid atresia. There was an echo-bright, plate-like tissue at the tricuspid valve position with no forward flow across it. This report underscores the role of right ventricle intracavitary haemodynamic influence on the tricuspid valve leaflet excursion and demonstrates a phenomenon of "pseudo or functional tricuspid atresia" mimicking tricuspid atresia in a patient with acute presentation of cardiomyopathy.
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http://dx.doi.org/10.1017/S104795112100322XDOI Listing
August 2021

The Identification and Impact of Abnormal Spirometry Patterns on Exercise Capacity in Pediatric Patients with Fontan Palliation.

Pediatr Cardiol 2021 Jun 14. Epub 2021 Jun 14.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.

Reduced exercise capacity and restrictive lung physiology are common in patients after Fontan palliation (FP). However, there is paucity of data regarding the association between specific spirometry patterns and key exercise parameters in this population. This is a single-center, cross-sectional, study correlating pulmonary function and exercise parameters in children with FP. Patients who were ≤ 18 years of age and underwent a comprehensive cardiopulmonary treadmill exercise stress test (CPT) and spirometry at the same time, were included. Patients were categorized as (i) normal or (ii) abnormal based on the results of spirometry. The abnormal group was subdivided into (a) restrictive, (b) obstructive, and (c) mixed patterns. Demographic and key exercise parameters were compared between groups. Our study included 82 patients who underwent CPT at 13.6 (IQR, 11.3-15.4) years of age. A reduced exercise capacity (%VO ≤ 85%) was noted in the majority (n = 50, 61%). Spirometry was abnormal in 47 (57%) patients [restrictive (n = 25, 30%), obstructive (n = 12, 15%), and mixed (n = 10, 12%)]. The abnormal spirometry group had significant lower %VO (77% vs. 92%, p = 0.01) and METS (8.4 vs. 9.6, p = 0.02). Subgroup analysis revealed that obstructive (p = 0.04) and mixed (p = 0.02) patterns were associated with a significant decrease in % VO. Majority of the children demonstrated an abnormal spirometry pattern post-FP. Abnormal pulmonary function was associated with the reduced exercise capacity. Identification and treatment of the abnormal lung function may improve the exercise capacity in these patients and improve the morbidity.
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http://dx.doi.org/10.1007/s00246-021-02661-7DOI Listing
June 2021

Rapid progression of aortic stenosis in a 3-month-old infant with bicuspid aortic valve and DeSanto-Shinawi syndrome.

Ann Pediatr Cardiol 2021 Apr-Jun;14(2):208-210. Epub 2021 Mar 26.

Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.

A 3-month-old female was diagnosed at 1 month of age with DeSanto-Shinawi syndrome (DSS) and bicuspid aortic valve with trivial stenosis. The aortic valve stenosis progressed to severe within 2 months and required balloon aortic valvuloplasty. This is the first case of aortic stenosis (AS) associated with DSS, and the syndrome may be the reason for the rapid worsening of AS in this case.
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http://dx.doi.org/10.4103/apc.APC_20_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174633PMC
March 2021

Left ventricular outflow tract obstruction in a patient with pulmonary atresia with intact ventricle septum following Fontan procedure: a rare complication.

Cardiol Young 2021 May 14:1-3. Epub 2021 May 14.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.

Left ventricular outflow tract obstruction in patients with pulmonary atresia with intact ventricular septum has been rarely reported. Data are lacking on the impact and management of systemic ventricular outflow tract obstruction that developed following the Fontan procedure. We report a case of an 8-year-old male who developed left ventricular outflow tract obstruction 6 months after the Fontan procedure.
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http://dx.doi.org/10.1017/S1047951121001888DOI Listing
May 2021

Echocardiographic Indicators Associated with Adverse Clinical Course and Cardiac Sequelae in Multisystem Inflammatory Syndrome in Children with Coronavirus Disease 2019.

J Am Soc Echocardiogr 2021 08 3;34(8):862-876. Epub 2021 May 3.

Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan. Electronic address:

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 causes significant cardiovascular involvement, which can be a determinant of clinical course and outcome. The aim of this study was to investigate whether echocardiographic measures of ventricular function were independently associated with adverse clinical course and cardiac sequelae in patients with MIS-C.

Methods: In a longitudinal observational study of 54 patients with MIS-C (mean age, 6.8 ± 4.4 years; 46% male; 56% African American), measures of ventricular function and morphometry at initial presentation, predischarge, and at a median of 3- and 10-week follow-up were retrospectively analyzed and were compared with those in 108 age- and gender-matched normal control subjects. The magnitude of strain is expressed as an absolute value. Risk stratification for adverse clinical course and outcomes were analyzed among the tertiles of clinical and echocardiographic data using analysis of variance and univariate and multivariate regression.

Results: Median left ventricular apical four-chamber peak longitudinal strain (LVA4LS) and left ventricular global longitudinal strain (LVGLS) at initial presentation were significantly decreased in patients with MIS-C compared with the normal cohort (16.2% and 15.1% vs 22.3% and 22.0%, respectively, P < .01). Patients in the lowest LVA4LS tertile (<13%) had significantly higher C-reactive protein and high-sensitivity troponin, need for intensive care, and need for mechanical life support as well as longer hospital length of stay compared with those in the highest tertile (>18.5%; P < .01). Initial LVA4LS and LVGLS were normal in 13 of 54 and 10 of 39 patients, respectively. There was no mortality. In multivariate regression, only LVA4LS was associated with both the need for intensive care and length of stay. At median 10-week follow-up to date, seven of 36 patients (19%) and six of 25 patients (24%) had abnormal LVA4LS and LVGLS, respectively. Initial LVA4LS < 16.2% indicated abnormal LVA4LS at follow-up with 100% sensitivity.

Conclusion: Impaired LVGLS and LVA4LS at initial presentation independently indicate a higher risk for adverse acute clinical course and persistent subclinical left ventricular dysfunction at 10-week follow-up, suggesting that they could be applied to identify higher risk children with MIS-C.
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http://dx.doi.org/10.1016/j.echo.2021.04.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089028PMC
August 2021

Crohn's disease with dilated cardiomyopathy in a child: An experience with heart transplantation.

Pediatr Transplant 2021 Sep 28;25(6):e14027. Epub 2021 Apr 28.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.

Background: DCM has rarely been reported in children with CD, but is a recognized complication in adults. DCM with uncontrolled heart failure may need heart transplantation, which could be challenging in CD.

Case Description: We present a 9-year-old female with CD who was diagnosed with DCM and a measured Ejection fraction ~25.8%. She was initiated on heart failure treatment, but continued to have progressive symptoms and underwent bicaval OHT three months after her initial presentation. Her post-operative course was complicated by perforation of the rectosigmoid junction requiring exploratory laparotomy and primary repair of the perforation. This was believed to be secondary to her underlying CD and possibly reperfusion injury after heart transplant. During the first-year post heart transplant, she had 4 episodes of acute cellular rejection. These episodes were treated with high dose steroids with good results. The patient has been in remission from CD since transplantation. For the last two years she is doing well, with no further rejection episodes on current immunosuppression.

Conclusion: DCM, though rare, can occur in patients with CD, whether active or in remission. The development of DCM could be insidious and keeping a high index of suspicion is important and subtle signs suggestive of cardiac involvement should warrant further investigation. The post-transplant management can be challenging with early morbidity in the first post-transplant year but overall good median survival and quality of life for our patient to date.
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http://dx.doi.org/10.1111/petr.14027DOI Listing
September 2021

Severe conduit stenosis in a patient with Fontan circulation with a Y-shaped Dacron conduit.

Cardiol Young 2021 Apr 8:1-3. Epub 2021 Apr 8.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.

Conduit stenosis is a major, albeit rare, complication following the Fontan palliation. A single-baffle conduit with polytetrafluoroethylene is widely used for an extracardiac type Fontan palliation. A polyethylene terephthalate conduit (Dacron) is sometimes used for the conduit when more flexibility is required. A Y-shaped conduit is rarely used, but it may reduce the energy loss and achieve better hepatic flow distribution. Data on the long-term patency and complications when using a Y-shaped Dacron conduit is lacking. We report a case of a severely stenotic Y-shaped Dacron conduit in a patient who underwent extracardiac Fontan palliation.
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http://dx.doi.org/10.1017/S1047951121001293DOI Listing
April 2021

A Rare Anomalous Systemic Venous Return With Bilateral Absence of Superior Vena Cava.

Ann Thorac Surg 2021 06 8;111(6):e461. Epub 2021 Mar 8.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.

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http://dx.doi.org/10.1016/j.athoracsur.2021.02.056DOI Listing
June 2021

Longitudinal Changes in Exercise Capacity in Patients Who Underwent Ross Procedure and Mechanical Aortic Valve Replacement: Does the Type of Surgery Matter?

Pediatr Cardiol 2021 Jun 8;42(5):1018-1025. Epub 2021 Mar 8.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.

The surgical options for significant aortic valve disease include either Ross procedure (RP) or aortic valve replacement (AVR). The exercise stress test is routinely performed in these patients to assess the objective functional capacity. This retrospective study was conducted to evaluate the differences and the longitudinal changes of exercise capacity in patients following the RP and AVR for aortic valve disease. This is an IRB approved retrospective study and included patients who had either RP or AVR performed for aortic valve disease and had at least one exercise stress test performed after the surgical procedure. Patients with other congenital heart disease, pacemaker or defibrillators, and those with inadequate data were excluded. Demographic data including age at surgery, type of surgery and type of aortic valve was collected. Data regarding treadmill cardiopulmonary exercise test (CPET) was also collected. A total of 47 patients met inclusion criteria and were equally represented in each group, i.e. RP [n = 23, 73.9% male, age at surgery 11.2 (4.5-15.9) years] vs. AVR [n = 24, 88% mechanical AVR, 60.9% male, age at surgery 15.1 (12.8-19.4) years]. There was a significant decline in predicted oxygen consumption (%VO) at time of first post-operative CPET in patients after AVR compared to RP (79 vs. 88%, p = 0.048) over a similar accrued median interval follow-up (4.6 vs. 6.2 years, p = 0.2). The longitudinal follow-up analysis of following AVR (n = 11, 54.5% male, median inter-test duration of 5 years) showed significant decline in peak exercise capacity or VO (34.2 vs. 26.2 vs., p = 0.006). In contrast, after RP (n = 12 patients [58.3% male, median inter-test duration 7.1 of years], exercise capacity and other key parameters remained preserved. In this small sentinel study, we report a better initial exercise capacity among patients after RP compared to AVR over an intermediate follow-up. During longitudinal follow-up in a subset of patients, exercise capacity remained preserved amongst the RP group while it further declined in the AVR group.
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http://dx.doi.org/10.1007/s00246-021-02575-4DOI Listing
June 2021

Inferior Vena Cava Collapsibility Index to Assess Central Venous Pressure in Perioperative Period Following Cardiac Surgery in Children.

Pediatr Cardiol 2021 Mar 22;42(3):560-568. Epub 2021 Jan 22.

Division of Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University College of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA.

The inferior vena cava collapsibility index (IVCCI) is an ultrasound method used to assess central venous pressure (CVP). Our objective was to evaluate the correlation between IVCCI and CVP in children during the early period following surgery for congenital heart disease (CHD). Prospective study performed in a single tertiary care center. Patients  ≤ 18 years old, who underwent cardiopulmonary bypass surgery for CHD, were enrolled. Ultrasound images of the inferior vena cava (IVC) were obtained at two time points; the first was within 2 h of arrival to the CICU and the second was 12-18 h from the first measurement. CVP measured by catheter placed during surgery was recorded within minutes of performing ultrasound. Maximum and minimum IVC diameters were measured by 2D images and M mode method. Seventy patients (47.1% males), with median age 7 months (IQR 4-47 months) and weight 6.9 kg (IQR 4.8-13.5 kg), were evaluated. The 2D IVCCI had inverse correlation with CVP in patients breathing spontaneously; r =  - 0.76 (p < 0.01) and r =  - 0.73 (p < 0.01), during the first and second measurements, respectively. The 2D IVCCI ≤ 0.24 had sensitivity, specificity, and negative predictive value of 94%, 79%, and 88.9% , respectively, to detect CVP ≥ 10 mmHg. No correlation was found between IVCCI and CVP during positive pressure ventilation. There is a significant inverse correlation between 2D IVCCI and CVP in spontaneously breathing children after surgery for CHD. Use of 2D IVCCI for monitoring CVP could reduce the frequency and duration of CVP catheters and their inherent complications.
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http://dx.doi.org/10.1007/s00246-020-02514-9DOI Listing
March 2021

Pneumocystis pneumonia with hypogammaglobulinemia in a pediatric patient who underwent heart transplantation.

Transpl Infect Dis 2021 Aug 4;23(4):e13571. Epub 2021 Feb 4.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.

A 23-month-old Caucasian female who had heart transplantation (HT) at 11 days of age was diagnosed with Pneumocystis pneumonia (PCP) in the setting of secondary hypogammaglobulinemia (HGG). She was diagnosed with HGG at 5 months of age and had been receiving monthly intravenous immunoglobulin infusion. This is the first case report describing the clinical course of PCP in a pediatric patient with HGG. She developed PCP 23 months after HT even when she was off steroids and was receiving timely IVIG. The case posed some clinical questions regarding PCP prophylaxis and HGG management.
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http://dx.doi.org/10.1111/tid.13571DOI Listing
August 2021

Does Premature Ventricular Contractions Affect Exercise Capacity in Teenagers with Normal Hearts?

Pediatr Cardiol 2021 Mar 4;42(3):606-613. Epub 2021 Jan 4.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, 48201, USA.

Premature ventricular contractions (PVCs) are common in teenagers even in the absence of structural heart disease or channelopathy. The suppression of PVCs with exercise is a favorable prognostic indicator. There is a paucity of data regarding the relationship between exercise capacity and PVC burden in this population. Our objective was to evaluate the association between various exercise stress parameters and PVC burden ascertained with a 24 h Holter in children without structural heart disease and/or channelopathy. In this retrospective study, 447 patient's charts with a diagnosis of PVC were reviewed at a single tertiary center. The study cohort consisted of ninety one patients with no structural heart disease or channelopathy who underwent an echocardiogram, maximal stress test, and 24 h Holter monitor. The cohort was divided into two groups based on PVC burden by 24-h Holter monitoring: < 10% and ≥ 10%. Peak oxygen uptake (VO in ml/kg/min), an indicator of maximal aerobic capacity, was collected. Other exercise parameters included a) percentage of predicted VO (%VO) based on age, weight, height, and gender b) percent oxygen pulse, c) Anaerobic threshold (AT), and d) Metabolic equivalents. Demographic and exercise stress test-derived parameters were compared between the two groups using student t test and a p value < 0.05 was considered significant. In our cohort of 91 patients, the mean (SD) age at exercise was 14.5 (3.2) years with 56 (62%) males. Left ventricle shortening fraction (LVFS) was ≥ 28% in all enrolled patients. PVCs were monomorphic in 72(80%) patients. The mean (SD) PVC burden was 14.43% (12.3) ranging from 0.1 to 49.8%. PVC burden was ≥ 10% in 48 (53%) patients. Eighty eight (97%) patients in the study cohort had suppression of PVCs with exercise. There were no significant differences between the two groups (< 10% vs. ≥ 10% PVC burden) with respect to demographic or exercise test-derived parameters. Univariate regression between PVC burden and %VO did not show significant correlation (r = - 0.04, p = 0.75). Children even with ≥ 10% PVC burden did not demonstrate any objective decrease in their exercise capacity. A plausible reason for no difference in exercise capacity in our cohort may be due to lower PVC load or shorter duration of PVCs compared to adults.
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http://dx.doi.org/10.1007/s00246-020-02521-wDOI Listing
March 2021

Left posterior fascicular ventricular tachycardia in a young infant with a structurally normal heart: Clinical course and caveats to electrocardiographic diagnosis.

J Electrocardiol 2021 Jan-Feb;64:85-90. Epub 2020 Dec 11.

Division of Pediatric Cardiology/Electrophysiology, Children's Hospital of Michigan, Detroit, MI, USA.

In this illustrative case report, we describe a rare case of left posterior fascicular ventricular tachycardia (LPFVT) in a 2 month-old infant with emphasis on electrocardiographic caveats to diagnosis. The clinical course, treatment, and eventual resolution of the VT over a 2 year follow-up is comprehensively compared and contrasted to a modicum of individual such case reports of infants. The corpus of each such case of infantile LPVT is systematically reviewed and succinctly summarized in a tabular compendium. The collective knowledge compiled here should allow for a refined approach to diagnosis and management of this unusual arrhythmia.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.12.003DOI Listing
June 2021

Vasoactive-ventilation-renal score: a reliable prognostic index for perioperative outcomes following congenital heart surgery in adults.

Cardiol Young 2021 May 17;31(5):762-768. Epub 2020 Dec 17.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.

Introduction: The number of adults requiring surgeries for CHD is increasing. We sought to evaluate the utility of the vasoactive-ventilation-renal (VVR) score as a predictor of prolonged length of stay in adults following CHD surgery.

Methods: This is a retrospective review of 158 adult patients who underwent CHD surgery involving cardiopulmonary bypass. VVR score was calculated upon arrival to ICU and every 6 hours for the first 48 hours post-operatively. Our primary outcome was prolonged length of stay defined as hospital length of stay greater than 75th percentile for the cohort (≥8 days).

Results: The study cohort had a median age of 25.6 years (18-60 years), and 83 (52.5%) were male. The groups with and without prolonged length of stay were comparable in age, gender, race, and surgical severity score. VVR score was significantly higher at all time points in the group with prolonged length of stay. The first post-operative day peak VVR score ≥13 had a sensitivity of 81% and specificity of 75% for predicting prolonged length of stay (p = 0.0001). On regression analysis, peak VVR score during the first day was independently associated with prolonged length of stay.

Conclusions: Peak VVR score during the first post-operative day was a strong predictor of prolonged length of stay in adults following CHD surgery.
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http://dx.doi.org/10.1017/S1047951120004588DOI Listing
May 2021

Characterization and timing of gastrointestinal bleeding in continuous flow left ventricular assist device recipients.

Heliyon 2020 Sep 1;6(9):e04695. Epub 2020 Sep 1.

Department of Gastroenterology, University of Missouri, Kansas-School of Medicine, USA.

Background And Aims: Heart failure is one of the leading causes of morbidity and mortality in the United States. The advent of left ventricular assist devices (LVAD) has improved the survival and quality of life in patients with end stage heart failure. Gastrointestinal bleeding (GIb) remains one of the limitations of LVADs.

Methods: A single center, retrospective review of records was performed for patients who underwent LVAD implantation between 2010 and 2015. All patients who survived more than 30 days were followed till March 2016 and are described below.

Results: A total of 79 patients were included in the study. The rate of GIb was 34.1% (27 patients) with a mean time to bleed of 267 days. Older patients were more likely to bleed. Upper GI bleeding was the source of bleeding in 54% patients. Arteriovenous malformations (AVM) were the source of bleeding in 74% bleeders and 80% of these patients had AVM formation. 14/27 (51%) patients had a re-bleeding event. Thrombotic events were 4.5 times more likely to occur in patients who also had a GI bleed.

Conclusions: GI bleeding in LVAD patients is common with the source of bleeding more commonly being in the upper GI tract. GI bleeding may occur as early as 10 days post procedure, despite previous negative screening endoscopies. There is an increased risk of thrombotic events in patients who have experienced a GI bleed.
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http://dx.doi.org/10.1016/j.heliyon.2020.e04695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479277PMC
September 2020

A rhabdomyoma in the right ventricle presenting as hemodynamics of hypoplastic right heart.

Cardiol Young 2020 Oct 5;30(10):1527-1529. Epub 2020 Aug 5.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.

Rhabdomyomas are the most common paediatric cardiac tumours. The natural history of these tumours is mostly benign, and the tumour usually regresses spontaneously. Although surgical resection of these tumours is one of the considerations in patients with ventricular outflow obstruction, a palliation with Blalock-Taussig shunt is an alternative approach with the hope of regression of the tumour over time. We report a case of prenatally diagnosed rhabdomyomas in the right ventricle and its outflow presenting as hemodynamic simulating hypoplastic right ventricle in a newborn. She required prostaglandin and Blalock-Taussig shunts palliation for pulmonary flow and subsequent regression of tumours.
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http://dx.doi.org/10.1017/S1047951120002358DOI Listing
October 2020

Saccular "Cauliflower" aneurysm of coarctation of aorta: a hybrid management.

Cardiol Young 2020 Sep 3;30(9):1360-1362. Epub 2020 Aug 3.

Division of Cardiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.

Aneurysm formation around the site of coarctation of aortic arch is a well-recognised complication of untreated coarctation and is associated with an increased risk of aortic rupture and mortality. We present a rare case in a teenage girl with the combination of significant aortic arch coarctation, a "cauliflower-like" saccular aneurysm, and stenosis at the origin of the left subclavian artery. She was successfully managed with a hybrid approach, which is a combination of an endovascular surgical repair (a bypass graft placement from left carotid artery to subclavian artery by a vascular surgeon) and a transcatheter covered stent placement across the stenosis and aneurysm. This case highlights the successful role of a hybrid approach in patient's who present with a combination of coarctation of the aorta and aortic arch aneurysms. This approach avoids the conventional surgical aortoplasty, which carries a higher mortality and morbidity risk in teenage patients.
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http://dx.doi.org/10.1017/S1047951120002140DOI Listing
September 2020

Nano-scale depth-varying recrystallization of oblique Ar sputtered Si(111) layers.

Sci Rep 2020 Jul 17;10(1):11905. Epub 2020 Jul 17.

Department of Physics, Kurukshetra University, Kurukshetra, 136119, India.

Silicon, the workhorse of semiconductor industry, is being exploited for various functional applications in numerous fields of nanotechnology. In this paper, we report the fabrication of depth controllable amorphous silicon (a-Si) layers under 80 keV Ar ion sputtering at off-normal ion incidences of 30°, 40° and 50° and crystallization of these amorphous Si(111) layers under thermal annealing. We find that the irradiated samples were not fully amorphized even for the lowest oblique incidence of 30°. Sputtering at off-normal incidences induces depth controllable surface amorphization in Si(111). Annealing at temperature of 1,073 K is characterized by formation of depth-varying buried amorphous layer due to defect recrystallization and damage recovery. Some remnant tensile stress has been observed for recrystallized samples even for lowest oblique incidence. The correlation of amorphization and stress due to sputtering induced by oblique incidence has been discussed systematically. The possible mechanism of recrystallization is discussed in terms of vacancies produced in sputtering dominated regime and their migration during annealing treatment. Our results reveal that with appropriate selection of oblique ion beam sputtering parameters, depth controllable surface amorphization and recrystallization may be fine-tuned to achieve co-existing amorphous and crystalline phases, playing a crucial role in fabrication of substrates for IC industry.
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http://dx.doi.org/10.1038/s41598-020-68873-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367853PMC
July 2020

A rare case of primary cardiac Hodgkin lymphoma in a child.

Cardiol Young 2020 Jun;30(6):866-868

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

Primary pediatric cardiac tumors are extremely rare. We report a 14-year-old girl with primary cardiac Hodgkin lymphoma. The large right atrial tumor extended upward and occluded the superior caval vein and left innominate vein.
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http://dx.doi.org/10.1017/S1047951120001183DOI Listing
June 2020

Silent in situ thrombus within a hypoplastic left ventricle in a teenager with Fontan palliation.

Cardiol Young 2020 Aug 9;30(8):1175-1177. Epub 2020 Jun 9.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.

Thrombosis, especially in the Fontan pathway, is one of the major concerns in patients who underwent Fontan surgery, with reported prevalence of 5-33%. We report a case of thrombus in a rudimentary left ventricle in teenager with no arrhythmia or neurological complications. We also report the special concerns of silent thrombus and role of cardiac MRI in diagnosing an intracardiac thrombus.
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http://dx.doi.org/10.1017/S1047951120001511DOI Listing
August 2020

Recurrent infective endocarditis in a patient after a second Melody valve placement.

Cardiol Young 2020 Jul 5;30(7):1050-1051. Epub 2020 Jun 5.

Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.

A 16-year-old Caucasian male was diagnosed with recurrent infective endocarditis associated with his second Melody valve placed inside a previously treated infected Melody valve. The replacement of Melody valve after the first infective endocarditis episode might increase the risk of the second episode of infective endocarditis.
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http://dx.doi.org/10.1017/S1047951120001389DOI Listing
July 2020

Influenza associated with circulatory collapse and atrioventricular block in an unvaccinated child with repaired CHD.

Cardiol Young 2020 May 20;30(5):740-742. Epub 2020 Apr 20.

The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA.

Symptomatic, circulatory collapse occurred in an unvaccinated child with repaired congenital heart and a backup pacemaker during an Influenza B viral infection with complete atrioventricular block and pacemaker non-capture. Ventricular arrhythmias occurred during her collapse. Atrioventricular conduction recovered within 24 hours. Influenza-associated cardiac inflammation can adversely affect patients with repaired CHD. Proactive immunisation is strongly recommended.
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http://dx.doi.org/10.1017/S1047951120000797DOI Listing
May 2020

Clinical Outcomes and Quality of Life With an Ambulatory Counterpulsation Pump in Advanced Heart Failure Patients: Results of the Multicenter Feasibility Trial.

Circ Heart Fail 2020 04 8;13(4):e006666. Epub 2020 Apr 8.

Department of Heart Failure and Transplant, AdventHealth Cardiovascular Institute, Orlando, FL (S.S., N.R.).

Background: The NuPulseCV intravascular ventricular assist system (iVAS) provides extended duration ambulatory counterpulsation via a durable pump placed through the distal subclavian artery.

Methods: We performed a prospective, single-arm, multicenter, US Food and Drug Administration-approved feasibility trial of iVAS therapy as a bridge to transplant or decision following the FIH (First-In-Human) trial.

Results: Forty-seven patients were enrolled, and 45 patients (median 61 years old, 37 males, and 30 listed on United Network of Organ Sharing) received iVAS support for median 44 (25-87) days. There were no intraoperative complications. Success was defined as survival or transplant on iVAS therapy free from disabling stroke. Outcome success at 30 days (the primary end point of this study) and at 6 months was 89% and 80%, respectively. During 6 months of iVAS support, 2 patients died and 2 patients experienced disabling neurological dysfunction. Six-minute walk distance, 2-minute step test, and Kansas City Cardiomyopathy Questionnaire score improved during 4-week iVAS support.

Conclusions: This feasibility trial demonstrated promising short-term outcomes of iVAS therapy with improved functional capacity and quality of life during the therapy. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02645539.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.119.006666DOI Listing
April 2020

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors.

Cardiooncology 2019 2;5:18. Epub 2019 Dec 2.

11Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Oishei Children's Hospital, 1001 Main Street, Buffalo, NY 14203 USA.

Cancer diagnostics and therapies have improved steadily over the last few decades, markedly increasing life expectancy for patients at all ages. However, conventional and newer anti-neoplastic therapies can cause short- and long-term cardiotoxicity. The clinical implications of this cardiotoxicity become more important with the increasing use of cardiotoxic drugs. The implications are especially serious among patients predisposed to adverse cardiac effects, such as youth, the elderly, those with cardiovascular comorbidities, and those receiving additional chemotherapies or thoracic radiation. However, the optimal strategy for preventing and managing chemotherapy-induced cardiotoxicity remains unknown. The routine use of neurohormonal antagonists for cardioprotection is not currently justified, given the marginal benefits and associated adverse events, particularly with long-term use. The only United States Food and Drug Administration and European Medicines Agency approved treatment for preventing anthracycline-related cardiomyopathy is dexrazoxane. We advocate administering dexrazoxane during cancer treatment to limit the cardiotoxic effects of anthracycline chemotherapy.
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http://dx.doi.org/10.1186/s40959-019-0054-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048046PMC
December 2019

Does obesity affect the short-term outcomes after cardiothoracic surgery in adolescents with congenital heart disease?

Cardiol Young 2020 Mar 9;30(3):372-376. Epub 2020 Jan 9.

Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine 3901 Beaubien Blvd, Detroit, MI48201-2119, USA.

Background: Obesity is a modifiable, independent risk factor for mortality and morbidity after cardiovascular surgery in adults. Our objective was to evaluate the impact of obesity on short-term outcomes in adolescents undergoing surgery for congenital heart disease (CHD).

Methods: This retrospective chart review included patients 10-18 years of age who underwent CHD surgery. Our exclusion criteria were patients with a known genetic syndrome, heart transplantation, and patients with incomplete medical records. The clinical data collected included baseline demographics and multiple perioperative variables. Charting the body mass index in the Centers for Disease Control and Prevention growth curves, the entire cohort was divided into three categories: obese (>95th percentile), overweight (85th-95th percentile), and normal weight (<85th percentile). The composite outcome included survival, arrhythmias, surgical wound infection, acute neurologic injury, and acute kidney injury.

Results: The study cohort (n = 149) had a mean standard deviation (SD), body mass index (BMI) of 22.6 ± 6.5 g/m2, and 65% were male. There were 27 obese (18.1%), 24 overweight (16.1%), and 98 normal weight (65.8%) patients. Twenty-seven (18%) patients had composite adverse outcomes. Overweight and obese patients had significantly higher adverse outcomes compared with normal weight patients (odds ratio (OR): 2.9; confidence interval (CI): 1-8.5, p = 0.04 and OR: 3; CI: 1-8.5, p = 0.03, respectively). In multivariate analysis, obesity was an independent predictor of adverse outcome in our cohort (p = 0.04).

Conclusions: Obesity is associated with short-term adverse outcome and increased health resource utilisation in adolescents following surgery for CHD. Further studies should evaluate if intervention in the preoperative period can improve outcomes in this population.
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http://dx.doi.org/10.1017/S1047951119003329DOI Listing
March 2020

Prechemotherapy subclinical left ventricular dysfunction: Do we know the mechanism?

Echocardiography 2020 01 6;37(1):156-157. Epub 2020 Jan 6.

Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.

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http://dx.doi.org/10.1111/echo.14556DOI Listing
January 2020

Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography.

Cardiol Young 2019 Dec 27;29(12):1494-1500. Epub 2019 Nov 27.

Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.

Aim: Anthracycline-associated cardiotoxicity in childhood cancer survivors may relate to global or segmental left ventricular abnormalities from associated thromboembolic events and myocardial microinfarcts. We characterized left ventricular segmental changes by two-dimensional speckle-tracking echocardiography in anthracycline-treated asymptomatic childhood cancer survivors.

Methods And Results: Childhood cancer survivors' echocardiograms with normal left ventricular fractional shortening >1 year after anthracycline chemotherapy were studied. Cancer-free control children had normal echocardiograms. Apical two-, three-, and four-chamber peak systolic left ventricular longitudinal and global longitudinal strain, and peak systolic left ventricular radial and circumferential strain at papillary muscle levels were analyzed. The mean (standard deviation) age was 12.7 (3.8) years in 41 childhood cancer survivors. The median (interquartile range) follow-up after anthracycline chemotherapy was 4.73 (2.15-8) years. The median (range) cumulative anthracycline dose was 160.2 (60-396.9) mg/m2. In childhood cancer survivors, the mean (standard deviation) left ventricular longitudinal strain was lower in two- (-18.6 [3.2] versus -21.3 [2.5], p < 0.001), three- (-16.3 [6.0] versus -21.7 [3.0], p < 0.001), and four- (-17.6 [2.7] versus -20.8 [2.0], p < 0.001) chamber views compared to controls. The left ventricular global longitudinal strain (-17.6 [2.7] versus -21.3 [2.0]) and circumferential strain (-20.8 [4.3] versus -23.5 [2.6], p < 0.001) were lower in childhood cancer survivors. Among childhood cancer survivors, 12 out of 16 left ventricular segments had significantly lower longitudinal strain than controls.

Conclusions: Asymptomatic anthracycline-treated childhood cancer survivors with normal left ventricular fractional shortening had lower global longitudinal and circumferential strain. The left ventricular longitudinal strain was lower in majority of the segments, suggesting that anthracycline cardiotoxicity is more global than regional.
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http://dx.doi.org/10.1017/S1047951119002622DOI Listing
December 2019
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