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Search Results for all work with filters:

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Work 1-10 of 32

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Article

Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial

by Sarah T. Plummer; Christoph P. Hornik; Hamilton Baker; Gregory A. Fleming; Susan Foerster; Matthew Ferguson; Andrew C. Glatz; Russel Hirsch; Jeffrey P. Jacobs; Kyong-Jin Lee; Alan B. Lewis; Jennifer S. Li; Mary Martin; Diego Porras; Wolfgang A. K. Radtke; John F. Rhodes; Julie A. Vincent; Jeffrey D. Zampi; Kevin D. Hill

2016

Subjects
  • Health Sciences, Medicine and Surgery
  • Biology, Physiology
  • File Download
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Abstract:Close

Objectives: Aortic arch reconstruction in children with single ventricle lesions may predispose to circulatory inefficiency and maladaptive physiology leading to increased myocardial workload. We sought to describe neoaortic anatomy and physiology, risk factors for abnormalities, and impact on right ventricular function in patients with single right ventricle lesions after arch reconstruction. Methods: Prestage II aortic angiograms from the Pediatric Heart Network Single Ventricle Reconstruction trial were analyzed to define arch geometry (Romanesque [normal], crenel [elongated] , or gothic [angular]), indexed neoaortic dimensions, and distensibility. Comparisons were made with 50 single-ventricle controls without prior arch reconstruction. Factors associated with ascending neoaortic dilation, reduced distensibility, and decreased ventricular function on the 14-month echocardiogram were evaluated using univariate and multivariable logistic regression. Results: Interpretable angiograms were available for 326 of 389 subjects (84%). Compared with controls, study subjects more often demonstrated abnormal arch geometry (67% vs 22%, P  <  .01) and had increased ascending neoaortic dilation (Z score 3.8 ± 2.2 vs 2.6 ± 2.0, P  <  .01) and reduced distensibility index (2.2 ± 1.9 vs 8.0 ± 3.8, P  <  .01). Adjusted odds of neoaortic dilation were increased in subjects with gothic arch geometry (odds ratio [OR], 3.2 vs crenel geometry, P  <  .01) and a right ventricle-pulmonary artery shunt (OR, 3.4 vs Blalock–Taussig shunt, P  <  .01) but were decreased in subjects with aortic atresia (OR, 0.7 vs stenosis, P  <  .01) and those with recoarctation (OR, 0.3 vs no recoarctation, P = .04). No demographic, anatomic, or surgical factors predicted reduced distensibility. Neither dilation nor distensibility predicted reduced right ventricular function. Conclusions: After Norwood surgery, the reconstructed neoaorta demonstrates abnormal anatomy and physiology. Further study is needed to evaluate the longer-term impact of these features.

Article

Modeling Left Ventricular Blood Flow Using Smoothed Particle Hydrodynamics

by Andres Caballero; Wenbin Mao; Liang Liang; John Oshinski; Charles Primiano; Raymond McKay; Susheel Kodali; Wei Sun

2017

Subjects
  • Health Sciences, Epidemiology
  • Engineering, Biomedical
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This study aims to investigate the capability of smoothed particle hydrodynamics (SPH), a fully Lagrangian mesh-free method, to simulate the bulk blood flow dynamics in two realistic left ventricular (LV) models. Three dimensional geometries and motion of the LV, proximal left atrium and aortic root are extracted from cardiac magnetic resonance imaging and multi-slice computed tomography imaging data. SPH simulation results are analyzed and compared with those obtained using a traditional finite volume-based numerical method, and to in vivo phase contrast magnetic resonance imaging and echocardiography data, in terms of the large-scale blood flow phenomena usually clinically measured. A quantitative comparison of the velocity fields and global flow parameters between the in silico models and the in vivo data shows a reasonable agreement, given the inherent uncertainties and limitations in the modeling and imaging techniques. The results indicate the capability of SPH as a promising tool for predicting clinically relevant large-scale LV flow information.

Article

Coronary artery flow measurement using navigator echo gated phase contrast magnetic resonance velocity mapping at 3.0 T

by Kevin Johnson; Puneet Sharma; John Oshinski

2008

Subjects
  • Engineering, Biomedical
  • Health Sciences, Radiology
  • Health Sciences, General
  • File Download
  • View on PubMed Central
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Abstract:Close

A validation study and early results for noninvasive, in vivo measurement of coronary artery blood flow using phase contrast magnetic resonance imaging (PC-MRI) at 3.0 Tesla is presented. Accuracy of coronary artery blood flow measurements by phase contrast MRI is limited by heart and respiratory motion as well as the small size of the coronary arteries. In this study, a navigator-echo gated, cine phase velocity mapping technique is described to obtain time-resolved velocity and flow waveforms of small diameter vessels at 3.0 Tesla. Phantom experiments using steady, laminar flow are presented to validate the technique and show flow rates measured by 3.0 Tesla phase contrast MRI to be accurate within 15% of true flow rates. Subsequently, in vivo scans on healthy volunteers yield velocity measurements for blood flow in the right, left anterior descending, and left circumflex arteries. Measurements of average, cross-sectional velocity were obtainable in 224/243 (92%) of the cardiac phases. Time-averaged, cross-sectional velocity of the blood flow was 6.8±4.3 cm/s in the LAD, 8.0±3.8 cm/s in the LCX, and 6.0±1.6 cm/s in the RCA.

Article

Association of Coronary Wall Shear Stress With Atherosclerotic Plaque Burden, Composition, and Distribution in Patients With Coronary Artery Disease

by Parham Eshtehardi; Michael C McDaniel; Jin Suo; Saurabh Dhawan; Lucas Timmins; Jose N Binongo; Lucas J Golub; Michel T Corban; Aloke Finn; John Oshinski; Arshed Ali Quyyumi; Don P Giddens; Habib Samady

2012

Subjects
  • Engineering, Biomedical
  • Biology, Biostatistics
  • Health Sciences, Public Health
  • File Download
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Abstract:Close

BACKGROUND: Extremes of wall shear stress (WSS) have been associated with plaque progression and transformation, which has raised interest in the clinical assessment of WSS. We hypothesized that calculated coronary WSS is predicted only partially by luminal geometry and that WSS is related to plaque composition. METHODS AND RESULTS: Twenty-seven patients with coronary artery disease underwent virtual histology intravascular ultrasound and Doppler velocity measurement for computational fluid dynamics modeling for WSS calculation in each virtual histology intravascular ultrasound segment (N=3581 segments). We assessed the association of WSS with plaque burden and distribution and with plaque composition. WSS remained relatively constant across the lower 3 quartiles of plaque burden (P=0.08) but increased in the highest quartile of plaque burden (P<0.001). Segments distal to lesions or within bifurcations were more likely to have low WSS (P<0.001). However, the majority of segments distal to lesions (80%) and within bifurcations (89%) did not exhibit low WSS. After adjustment for plaque burden, there was a negative association between WSS and percent necrotic core and calcium. For every 10 dynes/cm(2) increase in WSS, percent necrotic core decreased by 17% (P=0.01), and percent dense calcium decreased by 17% (P<0.001). There was no significant association between WSS and percent of fibrous or fibrofatty plaque components (P=NS). CONCLUSIONS: IN PATIENTS WITH CORONARY ARTERY DISEASE: (1) Luminal geometry predicts calculated WSS only partially, which suggests that detailed computational techniques must be used to calculate WSS. (2) Low WSS is associated with plaque necrotic core and calcium, independent of plaque burden, which suggests a link between WSS and coronary plaque phenotype. (J Am Heart Assoc. 2012;1:e002543 doi: 10.1161/JAHA.112.002543.).

Article

Cerebellar tonsil ectopia measurement in type I Chiari malformation patients show poor inter-operator reliability

by Braden J. Lawrence; Aintzane Urbizu; Philip A. Allen; Francis Loth; R. Shane Tubbs; Alexander C. Bunck; Jan-Robert Kroeger; Brandon G. Rocque; Casey Madura; Jason A. Chen; Mark G. Luciano; Richard G. Ellenbogen; John Oshinski; Bermans J. Iskandar; Bryn A. Martin

2018

Subjects
  • Biology, Neuroscience
  • Engineering, Biomedical
  • Health Sciences, Medicine and Surgery
  • File Download
  • View Abstract

Abstract:Close

Background: Type 1 Chiari malformation (CM-I) has been historically defined by cerebellar tonsillar position (TP) greater than 3-5 mm below the foramen magnum (FM). Often, the radiographic findings are highly variable, which may influence the clinical course and patient outcome. In this study, we evaluate the inter-operator reliability (reproducibility) of MRI-based measurement of TP in CM-I patients and healthy controls. Methods: Thirty-three T2-weighted MRI sets were obtained for 23 CM-I patients (11 symptomatic and 12 asymptomatic) and 10 healthy controls. TP inferior to the FM was measured in the mid-sagittal plane by seven expert operators with reference to McRae's line. Overall agreement between the operators was quantified by intraclass correlation coefficient (ICC). Results: The mean and standard deviation of cerebellar TP measurements for asymptomatic (CM-Ia) and symptomatic (CM-Is) patients in mid-sagittal plane was 6.38 ± 2.19 and 9.57 ± 2.63 mm, respectively. TP measurements for healthy controls was 0.48 ± 2.88 mm. The average range of TP measurements for all data sets analyzed was 7.7 mm. Overall operator agreement for TP measurements was relatively high with an ICC of 0.83. Conclusion: The results demonstrated a large average range (7.7 mm) of measurements among the seven expert operators and support that, if economically feasible, two radiologists should make independent measurements before radiologic diagnosis of CM-I and surgery is contemplated. In the future, an objective diagnostic parameter for CM-I that utilizes automated algorithms and results in smaller inter-operator variation may improve patient selection.

Article

High wall shear stress and high-risk plaque: an emerging concept

by Parham Eshtehardi; Adam J Brown; Ankit Bhargava; Charis Costopoulos; Olivia Y Hung; Michel T Corban; Hossein Hosseini; Bill D Gogas; Don P Giddens; Habib Samady

2017

Subjects
  • Engineering, Biomedical
  • Health Sciences, Medicine and Surgery
  • File Download
  • View Abstract

Abstract:Close

In recent years, there has been a significant effort to identify high-risk plaques in vivo prior to acute events. While number of imaging modalities have been developed to identify morphologic characteristics of high-risk plaques, prospective natural-history observational studies suggest that vulnerability is not solely dependent on plaque morphology and likely involves additional contributing mechanisms. High wall shear stress (WSS) has recently been proposed as one possible causative factor, promoting the development of high-risk plaques. High WSS has been shown to induce specific changes in endothelial cell behavior, exacerbating inflammation and stimulating progression of the atherosclerotic lipid core. In line with experimental and autopsy studies, several human studies have shown associations between high WSS and known morphological features of high-risk plaques. However, despite increasing evidence, there is still no longitudinal data linking high WSS to clinical events. As the interplay between atherosclerotic plaque, artery, and WSS is highly dynamic, large natural history studies of atherosclerosis that include WSS measurements are now warranted. This review will summarize the available clinical evidence on high WSS as a possible etiological mechanism underlying high-risk plaque development.

Article

Hydrodynamic modulation of pluripotent stem cells

by Krista M Fridley; Melissa A Kinney; Todd McDevitt

2012

Subjects
  • Engineering, Biomedical
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Abstract:Close

Controlled expansion and differentiation of pluripotent stem cells (PSCs) using reproducible, high-throughput methods could accelerate stem cell research for clinical therapies. Hydrodynamic culture systems for PSCs are increasingly being used for high-throughput studies and scale-up purposes; however, hydrodynamic cultures expose PSCs to complex physical and chemical environments that include spatially and temporally modulated fluid shear stresses and heterogeneous mass transport. Furthermore, the effects of fluid flow on PSCs cannot easily be attributed to any single environmental parameter since the cellular processes regulating self-renewal and differentiation are interconnected and the complex physical and chemical parameters associated with fluid flow are thus difficult to independently isolate. Regardless of the challenges posed by characterizing fluid dynamic properties, hydrodynamic culture systems offer several advantages over traditional static culture, including increased mass transfer and reduced cell handling. This article discusses the challenges and opportunities of hydrodynamic culture environments for the expansion and differentiation of PSCs in microfluidic systems and larger-volume suspension bioreactors. Ultimately, an improved understanding of the effects of hydrodynamics on the self-renewal and differentiation of PSCs could yield improved bioprocessing technologies to attain scalable PSC culture strategies that will probably be requisite for the development of therapeutic and diagnostic applications.

Article

Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions

by Phillip M. Trusty; Timothy C. Slesnick; Zhenglun Alan Wei; Jarek Rossignac; Kirk R Kanter; Mark A. Fogel; Ajit Yoganathan

2018

Subjects
  • Engineering, Biomedical
  • Health Sciences, Medicine and Surgery
  • File Download
  • View Abstract

Abstract:Close

The ultimate goal of Fontan surgical planning is to provide additional insights into the clinical decision-making process. In its current state, surgical planning offers an accurate hemodynamic assessment of the pre-operative condition, provides anatomical constraints for potential surgical options, and produces decent post-operative predictions if boundary conditions are similar enough between the pre-operative and post-operative states. Moving forward, validation with post-operative data is a necessary step in order to assess the accuracy of surgical planning and determine which methodological improvements are needed. Future efforts to automate the surgical planning process will reduce the individual expertise needed and encourage use in the clinic by clinicians. As post-operative physiologic predictions improve, Fontan surgical planning will become an more effective tool to accurately model patient-specific hemodynamics.

Article

Hypoplastic Left Heart Syndrome Current Considerations and Expectations

by Jeffrey A. Feinstein; D. Woodrow Benson; Anne M. Dubin; Meryl S. Cohen; Dawn M. Maxey; William Mahle; Elfriede Pahl; Juan Villafane; Ami B. Bhatt; Lynn F. Peng; Beth Ann Johnson; Alison L. Marsden; Curt J. Daniels; Nanacy A. Rudd; Christopher A. Caldarone; Kathleen A. Mussatto; David L. Morales; D. Dunbar Ivy; J. William Gaynor; James S. Tweddell; Barbara J. Deal; Anke K. Furck; Geoffrey L. Rosenthal; Richard G. Ohye; Nancy S. Ghanayem; John P. Cheatham; Wayne Tworetzky; Gerard R. Martin

2012

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, General
  • File Download
  • View Abstract

Abstract:Close

In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). During this time, survival to the age of 5 years (including Fontan) has ranged from 50% to 69%, but current expectations are that 70% of newborns born today with HLHS may reach adulthood. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. In this white paper, we present the current state of the art in our understanding and treatment of HLHS during the stages of care: 1) pre-Stage I: fetal and neonatal assessment and management; 2) Stage I: perioperative care, interstage monitoring, and management strategies; 3) Stage II: surgeries; 4) Stage III: Fontan surgery; and 5) long-term follow-up. Issues surrounding the genetics of HLHS, developmental outcomes, and quality of life are addressed in addition to the many other considerations for caring for this group of complex patients.

Article

Neural Tissue Motion Impacts Cerebrospinal Fluid Dynamics at the Cervical Medullary Junction: A Patient-Specific Moving-Boundary Computational Model

by Soroush Heidari Pahlavian; Francis Loth; Mark Luciano; John Oshinski; Bryn A. Martin

2015

Subjects
  • Biology, Neuroscience
  • Engineering, Biomedical
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Abstract:Close

Central nervous system (CNS) tissue motion of the brain occurs over 30 million cardiac cycles per year due to intracranial pressure differences caused by the pulsatile blood flow and cerebrospinal fluid (CSF) motion within the intracranial space. This motion has been found to be elevated in type 1 Chiari malformation. The impact of CNS tissue motion on CSF dynamics was assessed using a moving-boundary computational fluid dynamics (CFD) model of the cervical-medullary junction (CMJ). The cerebellar tonsils and spinal cord were modeled as rigid surfaces moving in the caudocranial direction over the cardiac cycle. The CFD boundary conditions were based on in vivo MR imaging of a 35-year old female Chiari malformation patient with ~150–300 µm motion of the cerebellar tonsils and spinal cord, respectively. Results showed that tissue motion increased CSF pressure dissociation across the CMJ and peak velocities up to 120 and 60%, respectively. Alterations in CSF dynamics were most pronounced near the CMJ and during peak tonsillar velocity. These results show a small CNS tissue motion at the CMJ can alter CSF dynamics for a portion of the cardiac cycle and demonstrate the utility of CFD modeling coupled with MR imaging to help understand CSF dynamics.
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