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Search Results for all work with filters:

  • procedur
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Work 1-6 of 6

Sorted by relevance

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
  • View Abstract

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

Standard Operating Procedures for Biospecimen Collection, Processing, and Storage: From the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer

by William E. Fisher; Zobeida Cruz-Monserrate; Amy L. McElhany; Gregory Lesinski; Phil A. Hart; Ria Ghosh; George Van Bure, II.; Douglas S. Fishman; Jo Ann S. Rinaudo; Jose Serrano; Sudhir Srivastava; Thomas Mace; Mark Topazian; Ziding Feng; Dhiraj Yadav; Stephen J. Pandol; Steven J. Hughes; Robert Y. Liu; Emily Lu; Robert Orr; David C. Whitcomb; Amer S. Abouhamze; Hanno Steen; Zachary M. Sellers; David M. Troendle; Aliye Uc; Mark E. Lowe; Darwin L. Conwell

2018

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

Abstract:Close

High-quality and well-annotated biorepositories are needed to better understand the pathophysiology and biologic mechanisms of chronic pancreatitis (CP) and its consequences. We report a methodology for the development of a robust standard operating procedure (SOP) for a biorepository based on the experience of the clinical centers within the consortium to study Chronic Pancreatitis, Diabetes and Pancreas Cancer Clinical Centers (CPDPC), supported by the National Cancer Institute and the National Institute for Diabetes and Digestive and Kidney Diseases as a unique multidisciplinary model to study CP, diabetes, and pancreatic cancer in both children and adults. Standard operating procedures from the CPDPC centers were evaluated and consolidated. The literature was reviewed for standard biorepository operating procedures that facilitated downstream molecular analysis. The existing literature on biobanking practices was harmonized with the SOPs from the clinical centers to produce a biorepository for pancreatic research. This article reports the methods and basic principles behind the creation of SOPs to develop a biorepository for the CPDPC. These will serve as a guide for investigators developing biorepositories in pancreas research. Rigorous and meticulous adherence to standardized biospecimen collection will facilitate investigations to better understand the pathophysiology and biologic mechanisms of CP, diabetes, and pancreatic cancer.

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

Numerical and experimental investigation of pulsatile hemodynamics in the total cavopulmonary connection

by Elaine Tang; Christopher M. Haggerty; Reza H. Khiabani; Diane de Zelicourt; Jessica Kanter; Fotis Sotiropoulos; Mark A. Fogel; Ajit Yoganathan

2013

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

Abstract:Close

Computational fluid dynamics (CFD) tools have been extensively applied to study the hemodynamics in the total cavopulmonary connection (TCPC) in patients with only a single functioning ventricle. Without the contraction of a sub-pulmonary ventricle, pulsatility of flow through this connection is low and variable across patients, which is usually neglected in most numerical modeling studies. Recent studies suggest that such pulsatility can be non-negligible and can be important in hemodynamic predictions. The goal of this work is to compare the results of an in-house numerical methodology for simulating pulsatile TCPC flow with experimental results. Digital particle image velocimetry (DPIV) was acquired on TCPC in vitro models to evaluate the capability of the CFD tool in predicting pulsatile TCPC flow fields. In vitro hemodynamic measurements were used to compare the numerical prediction of power loss across the connection. The results demonstrated the complexity of the pulsatile TCPC flow fields and the validity of the numerical approach in simulating pulsatile TCPC flow dynamics in both idealized and complex patient specific models.

Article

Imaging for Preintervention Planning Pre- and Post-Fontan Procedures

by Mark A. Fogel; Reza H. Khiabani; Ajit Yoganathan

2013

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, Radiology
  • File Download

Article

Effect of Flow Pulsatility on Modeling the Hemodynamics in the Total Cavopulmonary Connection

by Reza H. Khiabani; Maria Restrepo; Elaine Tang; Diane De Zelicourt; Fotis Sotiropoulos; Mark Fogel; Ajit Yoganathan

2012

Subjects
  • Engineering, Biomedical
  • Biophysics, General
  • File Download
  • View Abstract

Abstract:Close

Total cavopulmonary connection is the result of a series of palliative surgical repairs performed on patients with single ventricle heart defects. The resulting anatomy has complex and unsteady hemodynamics characterized by flow mixing and flow separation. Although varying degrees of flow pulsatility have been observed in vivo, non-pulsatile (time-averaged) boundary conditions have traditionally been assumed in hemodynamic modeling, and only recently have pulsatile conditions been incorporated without completely characterizing their effect or importance. In this study, 3D numerical simulations with both pulsatile and non-pulsatile boundary conditions were performed for 24 patients with different anatomies and flow boundary conditions from Georgia Tech database. Flow structures, energy dissipation rates and pressure drops were compared under rest and simulated exercise conditions. It was found that flow pulsatility is the primary factor in determining the appropriate choice of boundary conditions, whereas the anatomic configuration and cardiac output had secondary effects. Results show that the hemodynamics can be strongly influenced by the presence of pulsatile flow. However, there was a minimum pulsatility threshold, identified by defining a weighted pulsatility index (wPI), above which the influence was significant. It was shown that when wPI < 30%, the relative error in hemodynamic predictions using time-averaged boundary conditions was less than 10% compared to pulsatile simulations. In addition, when wPI < 50, the relative error was less than 20%. A correlation was introduced to relate wPI to the relative error in predicting the flow metrics with non-pulsatile flow conditions.
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