39 results on '"Derek G. Human"'
Search Results
2. Assessment of Liver Stiffness in Pediatric Fontan Patients Using Transient Elastography
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Becky Chen, Richard A. Schreiber, Derek G. Human, James E. Potts, and Orlee R. Guttman
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background. Hepatic fibrosis is a potential complication following Fontan surgery and heralds long-term risk for cirrhosis. Transient elastography (TE) is a rapid, noninvasive method to assess liver fibrosis by measuring liver stiffness. Objectives. To compare liver stiffness and liver biochemistries in pediatric Fontan patients with age- and sex-matched controls and to determine patients’ acceptance of TE. Methods. Patients were recruited from British Columbia Children’s Hospital. Twenty-two Fontan patients (15 males) were identified. Demographic information and cardiac data were collected. TE was measured using size-appropriate probes. Results. The median age of the Fontan cohort was 13.7 (5.9–16.8) years. Time from Fontan surgery to TE was 9.6 (1.0–12.9) years. The median Fontan circuit pressure was 13 (11–14) mmHg. TE values were higher in Fontan patients versus controls (18.6 versus 4.7 kPa, p
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- 2016
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3. The Registry and Follow-Up of Complex Pediatric Therapies Program of Western Canada: A Mechanism for Service, Audit, and Research after Life-Saving Therapies for Young Children
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Charlene M. T. Robertson, Reg S. Sauve, Ari R. Joffe, Gwen Y. Alton, Diane M. Moddemann, Patricia M. Blakley, Anne R. Synnes, Irina A. Dinu, Joyce R. Harder, Reeni Soni, Jaya P. Bodani, Ashok P. Kakadekar, John D. Dyck, Derek G. Human, David B. Ross, and Ivan M. Rebeyka
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Newly emerging health technologies are being developed to care for children with complex cardiac defects. Neurodevelopmental and childhood school-related outcomes are of great interest to parents of children receiving this care, care providers, and healthcare administrators. Since the 1970s, neonatal follow-up clinics have provided service, audit, and research for preterm infants as care for these at-risk children evolved. We have chosen to present for this issue the mechanism for longitudinal follow-up of survivors that we have developed for western Canada patterned after neonatal follow-up. Our program provides registration for young children receiving complex cardiac surgery, heart transplantation, ventricular assist device support, and extracorporeal life support among others. The program includes multidisciplinary assessments with appropriate neurodevelopmental intervention, active quality improvement evaluations, and outcomes research. Through this mechanism, consistently high (96%) follow-up over two years is maintained.
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- 2011
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4. Increasing age and atrial arrhythmias are associated with increased thromboembolic events in a young cohort of adults with repaired tetralogy of Fallot
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J. Grewal, Amanda Barlow, Derek G. Human, Darryl Wan, Santabhanu Chakrabarti, Clara Tsui, and Marla Kiess
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thromboembolic events ,medicine.medical_specialty ,business.industry ,atrial arrhythmia ,Atrial arrhythmias ,Original Articles ,medicine.disease ,congenital heart disease ,Internal medicine ,RC666-701 ,Cohort ,medicine ,Cardiology ,Diseases of the circulatory (Cardiovascular) system ,Original Article ,cardiovascular diseases ,tetralogy of Fallot ,Cardiology and Cardiovascular Medicine ,business ,Tetralogy of Fallot - Abstract
Background Adults with repaired Tetralogy of Fallot (rTOF) comprise one of the largest cohorts among adults with congenital heart disease (ACHD). These patients have a higher burden of atrial arrhythmias (AA), leading to increased adverse events, including stroke and transient ischemic attack (TIA). However, the data on factors associated with stroke/TIA in rTOF are limited, and classic risk factors may not apply. We studied event rates and associated factors for thromboembolism in a rTOF cohort. Methods Retrospective cohort study of all adult patients age >18 years with rTOF followed at a single ACHD tertiary care center. AA of interest were atrial fibrillation (AF) and atrial flutter (AFL). Results Data from 260 patients were identified, mean age 37.6 SD 13.3 years, followed over 5108 patient‐years (mean 16.6 SD 8.2 years). 43 patients had AF and/or AFL, and 30 patients had thromboembolic events, of which 19 patients had stroke/TIA. The event rate for any thromboembolism was 3.39 per 100 patient‐years follow‐up in patients with AA, compared to 1.80 in patients without (P = .07). In univariate analysis, older age and diabetes were associated with thromboembolic events. In multivariate analysis, only older age was associated with thromboembolic events. Conclusions In our relatively young cohort of adults with rTOF, there was a high prevalence of AA, associated with nearly double the rate of thromboembolic events compared to patients without AA. Older age alone is independently associated with thromboembolic events. Further studies into assessment of silent AA are required, and routine assessments should be considered at an earlier age., There is a high prevalence of atrial arrhythmias in our relatively young cohort of adults with repaired Tetralogy of Fallot. Atrial arrhythmias are associated with twofold increase in risk of thromboembolic events. Older age was identified as a key risk factor, and traditional risk factors were not applicable.
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- 2021
5. Arrhythmic Mitral Valve Prolapse and Mitral Annulus Disjunction in Heritable Aortic Disease
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Derek G. Human, Zachary Laksman, Amanda J. Barlow, Gnalini Sathananthan, Drake A. Comber, Praveen Indraratna, and Ashley DeGraaf
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medicine.medical_specialty ,Disease entity ,animal structures ,business.industry ,Overlap syndrome ,Case Report ,medicine.disease ,Aortic disease ,Sudden cardiac death ,Increased risk ,Internal medicine ,Concomitant ,medicine ,Cardiology ,cardiovascular system ,Mitral valve prolapse ,Mitral annulus ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients with heritable aortic disease (HAD) have an increased risk of ventricular arrhythmias and sudden cardiac death. Although mitral valve prolapse is common in HAD, mitral annulus disjunction (MAD) has only recently been described in these patients. This under-recognized condition may be a contributing factor to otherwise unexplained ventricular arrhythmias and sudden cardiac death in patients with HAD. This case series describes 3 patients in an adult HAD clinic who have concomitant mitral valve prolapse, MAD, and malignant arrhythmias. These cases may represent a unique disease entity or overlap syndrome, and they introduce MAD as a potential arrhythmogenic risk marker in HAD.
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- 2021
6. Physiological Responses to Exercise in Pediatric Heart Transplant Recipients
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George G.S. Sandor, Derek G. Human, Astrid M. De Souza, Anita T. Cote, Joshua M. Bovard, Martin C.K. Hosking, Kevin C. Harris, Kathryn Armstrong, and James E. Potts
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Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Cardiac index ,Hemodynamics ,Physical Therapy, Sports Therapy and Rehabilitation ,Ventricular Function, Left ,Fick principle ,Oxygen Consumption ,Heart Rate ,Internal medicine ,Arteriovenous oxygen difference ,Heart rate ,medicine ,Humans ,Orthopedics and Sports Medicine ,Child ,Exercise ,Retrospective Studies ,Heart transplantation ,Body surface area ,business.industry ,Stroke Volume ,Stroke volume ,Transplant Recipients ,Echocardiography ,Case-Control Studies ,Exercise Test ,Cardiology ,Heart Transplantation ,Female ,business - Abstract
INTRODUCTION Pediatric heart transplant (HTx) recipients have reduced exercise capacity typically two-thirds of predicted values, the mechanisms of which are not fully understood. We sought to assess the cardiorespiratory responses to progressive exercise in HTx relative to controls matched for age, sex, body size, and work rate. METHODS Fourteen HTx recipients and matched controls underwent exercise stress echocardiography on a semisupine cycle ergometer. Hemodynamics, left ventricular (LV) dimensions, and volumes were obtained and indexed to body surface area. Oxygen consumption (V˙O2) was measured, and arteriovenous oxygen difference was estimated using the Fick Principle. RESULTS At rest, LV mass index (P = 0.03) and volumes (P < 0.001) were significantly smaller in HTx, whereas wall thickness (P < 0.01) and LV mass-to-volume ratio (P = 0.01) were greater. Differences in LV dimensions and stroke volume persisted throughout exercise, but the pattern of response was similar between groups as HR increased. As exercise progressed, heart rate and cardiac index increased to a lesser extent in HTx. Despite this, V˙O2 was similar (P = 0.82) at equivalent work rates as HTx had a greater change in arteriovenous oxygen difference (P < 0.01). CONCLUSIONS When matched for work rate, HTx had similar metabolic responses to controls despite having smaller LV chambers and an attenuated increase in hemodynamic responses. These findings suggest that HTx may increase peripheral O2 extraction as a compensatory mechanism in response to reduced cardiovascular function.
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- 2019
7. Outcomes related to respiratory syncytial virus with an abbreviated palivizumab regimen in children with congenital heart disease: a descriptive analysis
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Lana Shaiba, Pascal M. Lavoie, Cheryl Christopherson, Derek G. Human, Constantin R. Popescu, Richard S. Taylor, Jennifer Claydon, and Alfonso Solimano
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Palivizumab ,education.field_of_study ,Pediatrics ,medicine.medical_specialty ,Heart disease ,business.industry ,Research ,Population ,General Medicine ,medicine.disease ,Regimen ,Interquartile range ,Lower respiratory tract infection ,Cohort ,medicine ,business ,education ,medicine.drug ,Cohort study - Abstract
Background It has been hypothesized that 4 doses of palivizumab, a neutralizing monoclonal antibody against respiratory syncytial virus (RSV), administered during a fixed-date RSV season may reduce hospital admissions comparably to the standard 5-dose schedule. We report outcomes in children with congenital heart disease approved to receive this 4-dose palivizumab schedule in British Columbia. Methods We performed a population-based descriptive cohort analysis of all 406 approved palivizumab courses over 4 seasons (2012/13 to 2015/16) in 325 children with hemodynamically significant congenital heart disease enrolled in the British Columbia RSV Immunoprophylaxis Program. The primary outcome was in-season hospital admission for potential RSV-related lower respiratory tract infection (LRTI). Secondary outcomes include timing of admission in relation to dosing. Analysis was by intention-to-treat. Results Of the 406 approved palivizumab courses, 391 were administered. In 33 cases (8.4%), an additional dose was given immediately after cardiac bypass surgery. There were 17 RSV-confirmed hospital admissions (median age of children 5.9 mo [interquartile range 4-10 mo]) and 8 admissions in which the child was not tested for RSV, for a maximum of 25 potential RSV-related admissions (6.2 per 100 approvals [95% confidence interval 4.0-9.0]). Twenty-four (96%) of the 25 admissions occurred within the 4-dose palivizumab dosing period, and the remaining admission occurred 52 days after the fourth dose. Sixty-four (72%) of 89 admissions were RSV-negative; the baseline clinical characteristics of these children were not different from those of children with RSV-confirmed admissions. Interpretation In infants with hemodynamically significant congenital heart disease, a 4-dose fixed-date palivizumab schedule over a 6-month season provided seasonal protection comparable to that in a clinical trial involving a standard 5-dose schedule. Because RSV was responsible for only 19% of admissions for LRTI in our cohort, it is critical to continue to emphasize other preventive measures, including family education toward proper hand hygiene, breast-feeding and limiting infectious exposures in children at high risk.
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- 2019
8. Coronary artery intimal thickening and ventricular dynamics in pediatric heart transplant recipients
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Derek G. Human, George G.S. Sandor, Martin C.K. Hosking, Christine Voss, Kevin C. Harris, and Anita T. Cote
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Male ,medicine.medical_specialty ,Adolescent ,Heart Ventricles ,medicine.medical_treatment ,Diastole ,Lumen (anatomy) ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Ventricular Function, Left ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Child ,Retrospective Studies ,Heart transplantation ,business.industry ,Stroke Volume ,General Medicine ,Stroke volume ,medicine.disease ,Coronary Vessels ,Echocardiography, Doppler ,Transplant Recipients ,Transplantation ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Heart Transplantation ,Female ,Surgery ,Thickening ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence ,Follow-Up Studies ,Artery - Abstract
Objective Pediatric heart transplant recipients are at risk of posttransplant coronary artery disease known as cardiac allograft vasculopathy (CAV), and also may develop diastolic dysfunction. As CAV begins with a process of progressive intimal thickening, these occult diffuse changes may be detected using optical coherence tomography (OCT). We hypothesized that the development of CAV, as identified via OCT, may be a mechanism of declining ventricular function. Accordingly, the purpose of this study was to assess coronary artery intimal thickening and LV strain in children who have undergone heart transplantation. Methods In 17 children, we analyzed OCT images for coronary intima and media thickness, and cross-sectional area (CSA). We also performed speckle tracking imaging (STI) of the LV to determine longitudinal strain and strain rate, in addition to standard echocardiographic measures. Results Longitudinal diastolic strain rate was associated with maximum intima thickness (r = -.497, P = .042), intima CSA, (r = -.489, P = .047), maximum media thickness (r = -.503, P = .039), and media CSA (r = -.614, P = .009). The intima maximum thickness, intima/media, and intima/lumen ratios were associated with stroke volume index (Std. β = -0.487, P = .023 and Std. β = -0.488, P = .022, respectively). Conclusions These findings suggest coronary artery intimal thickening may be mechanistically linked to changes in ventricular function following cardiac transplantation.
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- 2018
9. Adults With Complex Congenital Heart Disease: Cerebrovascular Considerations for the Neurologist
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Thalia S. Field, Jonathan M.C. Smith, Derek G. Human, and Jason G. Andrade
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cognition ,Pediatrics ,medicine.medical_specialty ,Heart disease ,Population ,Review ,030204 cardiovascular system & hematology ,Vascular risk ,lcsh:RC346-429 ,03 medical and health sciences ,0302 clinical medicine ,Adults with Congenital Heart Disease (ACHD) ,Cardiovascular Disease ,medicine ,cardiovascular diseases ,Complex congenital heart disease ,Cerebrovascular disease ,education ,Stroke ,lcsh:Neurology. Diseases of the nervous system ,Subclinical infection ,education.field_of_study ,business.industry ,medicine.disease ,stroke ,fontan ,Increased risk ,Neurology ,cyanotic ,Stroke prevention ,Neurology (clinical) ,Congenital Heart Disease (CHD) ,business ,030217 neurology & neurosurgery - Abstract
As infant and childhood mortality has decreased in congenital heart disease, this population is increasingly reaching adulthood. Adults with congenital heart disease (ACHD) represent a group with increased risk of stroke, silent brain infarcts, and vascular cognitive impairment. Cyanotic and other complex cardiac lesions confer the greatest risk of these cerebrovascular insults. ACHD patients, in addition to having an increased risk of stroke from structural cardiac issues and associated physiological changes, may have an accelerated burden of conventional vascular risk factors, including hypertension and impaired glucose metabolism. Adult neurologists should be aware of the risks of clinically evident and subclinical cerebrovascular disease in this population. We review the existing evidence on primary and secondary stroke prevention in individuals with complex congenital heart disease, and identify knowledge gaps in need of further research, including treatment of acute stroke in this population. Multisystemic genetic syndromes are outside the scope of this review.
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- 2019
10. Atrial arrhythmias and thromboembolic complications in adults post Fontan surgery
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Amanda J. Barlow, Darryl Wan, Derek G. Human, Andrew D. Krahn, M. Riahi, Santabhanu Chakrabarti, Jasmine Grewal, and Marla Kiess
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Adult ,Heart Defects, Congenital ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Time Factors ,Cirrhosis ,Multivariate analysis ,030204 cardiovascular system & hematology ,Fontan Procedure ,Risk Assessment ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Thromboembolism ,Atrial Fibrillation ,medicine ,Humans ,cardiovascular diseases ,Stroke ,Retrospective Studies ,business.industry ,Congenital Heart Disease ,Age Factors ,Atrial fibrillation ,Retrospective cohort study ,Atrial arrhythmias ,medicine.disease ,Pulmonary embolism ,Surgery ,Treatment Outcome ,lcsh:RC666-701 ,Cohort ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,arrhythmias ,030217 neurology & neurosurgery - Abstract
ObjectivePatients with Fontan surgery experience late complications in adulthood. We studied the factors associated with the development and maintenance of atrial arrhythmias and thromboembolic complications in an adult population with univentricuar physiology post Fontan surgery.MethodsSingle centre retrospective cohort study of patients ≥18 years of age with Fontan circulation followed at our quaternary care centre for more than 1 year were included. Univariate and multivariate regression models were used where applicable to ascertain clinically significant associations between risk factors and complications.Results93 patients were included (age 30.2±8.8 years, 58% men). 28 (30%) had atriopulmonary Fontan connection, 35 (37.6%) had lateral tunnel Fontan and 29 (31.1%) had extracardiac Fontan pathway. After a mean of 7.27±5.1 years, atrial arrhythmia was noted in 37 patients (39.8%), of which 13 developed had atrial fibrillation (14%). The presence of atrial arrhythmia was associated with the number of prior cardiac surgeries/procedures, increasing age and prior atriopulmonary Fontan operation. Thromboembolic events were present in 31 patients (33%); among them 14 had stroke (45%), 3 had transient ischaemic attack (9.7%), 7 had pulmonary embolism (22.6%) and 5 had atrial thrombus with imaging (16.1%). The presence of thromboembolic events was only associated with age and the presence of cirrhosis in multivariate analysis.ConclusionsAtrial arrhythmias are common in adults with Fontan circulation at an early age, and are associated with prior surgical history and increasing age. Traditional risk factors may not be associated with atrial arrhythmia or thromboembolism in this cohort.
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- 2020
11. Thromboembolic episodes related to atrial arrhythmias in adults with transposition of great arteries
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Clara Tsui, Jasmine Grewal, Darryl Wan, Amanda J. Barlow, Marla Kiess, Derek G. Human, Santabhanu Chakrabarti, and Andrew D. Krahn
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Tachycardia ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Heart disease ,Population ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,education ,Stroke ,Congenital heart disease ,education.field_of_study ,business.industry ,Atrial fibrillation ,Retrospective cohort study ,Atrial arrhythmia ,medicine.disease ,lcsh:RC666-701 ,Great arteries ,Cohort ,Cardiology ,medicine.symptom ,business - Abstract
Background: Atrial arrhythmias (AA) are common in adults with congenital heart disease (ACHD). Although Intra-atrial Reentrant Tachycardia (IART) is well described in ACHD, Atrial Fibrillation (AF) is uncommon, but increasingly recognized. Patients with Transposition of the Great Arteries (TGA) and congenitally corrected-TGA (CC-TGA) have a high burden of AA at a relatively young age. However, long-term data of AA and associated thromboembolic risk are lacking in these patients. The prevalence, associated clinical factors, and complications of AA in a longitudinal TGA cohort was studied. Methods: A retrospective cohort study of all TGA patients from a single tertiary care centre was conducted. Data regarding documented atrial arrhythmias, thromboembolic events, and factors associated with thromboembolism were extracted and analyzed. Mean values and standard deviations were calculated for normally distributed continuous variables. When frequencies and means were compared, the chi-squared test and student t-test were used, respectively. Results: One-hundred twenty-five patients with TGA (76 TGA, 49 CC-TGA) were followed for a mean of 20.8 ± 13.2 years. AF was confirmed in 20% (n = 25) and there were 5 (20%) thromboembolic complications within the AF population. AF was associated with an annual thromboembolic event rate of 2.7%/year (stroke/transient ischemic attack 1.7%, systemic embolism 1.0%). Conclusion: AF is relatively common in the TGA ACHD population in long-term follow up. Although annual risk of thromboembolism is low in this young group of patients, life-time cumulative risk is potentially high. TGA patients should be screened actively for AF and appropriate anticoagulation therapy initiated. It is unclear if established risk prediction scores in other non-valvular AF populations may be applicable to this cohort.
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- 2018
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12. 40 Respiratory syncytial virus-related outcomes from an abbreviated palivizumab dose regimen in children with congenital heart disease
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Derek G. Human, Richard J. K. Taylor, Constantin R. Popescu, Cheryl Christopherson, Jennifer Claydon, Pascal M. Lavoie, Lana Shaibah, and Alfonso Solimano
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Palivizumab ,Pediatrics ,medicine.medical_specialty ,Heart disease ,business.industry ,medicine.disease ,Virus ,Regimen ,Pediatrics, Perinatology and Child Health ,medicine ,Abstract / Résumés ,Respiratory system ,business ,medicine.drug - Abstract
BACKGROUND: Respiratory Syncytial Virus (RSV) is a leading cause of hospital admission for acute lower respiratory tract infections (LRTI) in young children. Infants with congenital heart disease (CHD) are at a higher risk of severe infection, specifically those with hemodynamically significant intra-cardiac shunts, impaired cardiac function or pulmonary hypertension. Palivizumab prevents RSV-related hospitalizations in children with higher risk indications, including CHD, however the number of doses required to achieve optimal protection remains controversial. We report the clinical outcomes of children with CHD who received an abbreviated Palivizumab 4-dose schedule, with an increased inter-dose interval in our region. OBJECTIVES: To report hospitalization outcomes in children with CHD who received an abbreviated 4-dose Palivizumab dose schedule through the centrally managed regional RSV Immunoprophylaxis Program. DESIGN/METHODS: Retrospective population-based study of children with CHD enrolled into the regional RSV Program between 2012–2016. Children received palivizumab between November and April. Eligibility was defined according to our provincial guidelines and this defined our sample size. The primary outcome was in-season hospitalizations for RSV-confirmed or potentially RSV-related (unknown) LRTI determined by cross referencing the RSV Program database and the Canadian Institute of Health Informatics (CIHI) discharge abstract database (DAD) using seven RSV-related ICD-10 diagnostic codes. Children were categorized according to CHD subtype. Analysis was by intention-to-treat. RESULTS: A total of 325 children ([mean ± SD] gestational age 37.9±6.2 weeks; birth weight 2870±871 grams) were approved to receive 406 palivizumab courses. Between November 2012 and April 2016, 89 hospitalizations occurred in CHD patients. Of this, seventeen were RSV-confirmed hospitalizations (median age 5.9 [IQR 4 to 10]months); 8 additional cases were not tested for RSV, for a maximum rate of hospitalizationsfor RSV-confirmed or unknown of 6.2 per 100 approvals (95%CI: 4.0 to 9.0%). 24/25 RSV-confirmed or potentially RSV-related hospitalizations occurred before the 4(th)Palivizumab dose. Only one RSV-confirmed hospitalization occurred (52 days) after the 4th Palivizumab dose. Clinical characteristics of children with RSV-confirmed hospitalizations (n=17) were similar to those with RSV-unrelated hospitalizations (n=40). CONCLUSION: Our data provide population-based evidence of the protection achieved by a 4-dose Palivizumab dose schedule in infants with CHD. This clinical practice yields substantial benefits to children, their families, and to the health care system, such as reduced visits, injections, and costs, compared to a standard 5-dose schedule. Our results warrant confirmation in other geographic areas.
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- 2019
13. Aspirin Dose and Prevention of Coronary Abnormalities in Kawasaki Disease
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Rosie Scuccimarri, Mathew Mathew, Anita Dhanrajani, Dania Basodan, Nagib Dahdah, Astrid M. De Souza, Derek G. Human, Joel Blanchard, Zoe Fortier-Morissette, Soha Rached-d'Astous, Audrey Dionne, Brian W. McCrindle, Claudia Renaud, Frederic Dallaire, Harrison Saulnier, Samuel Blais, and Kimberley Kaspy
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Male ,medicine.medical_specialty ,Coronary Disease ,030204 cardiovascular system & hematology ,Mucocutaneous Lymph Node Syndrome ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Aspirin ,Dose-Response Relationship, Drug ,business.industry ,Confounding ,Absolute risk reduction ,Immunoglobulins, Intravenous ,Infant ,Retrospective cohort study ,medicine.disease ,Confidence interval ,Surgery ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Kawasaki disease ,Drug Therapy, Combination ,Female ,business ,Cohort study ,medicine.drug - Abstract
BACKGROUND:Acetylsalicylic acid (ASA) is part of the recommended treatment of Kawasaki disease (KD). Controversies remain regarding the optimal dose of ASA to be used. We aimed to evaluate the noninferiority of ASA at an antiplatelet dose in acute KD in preventing coronary artery (CA) abnormalities.METHODS:This is a multicenter, retrospective, nonrandomized cohort study including children 0 to 10 years of age with acute KD between 2004 and 2015 from 5 institutions, of which 2 routinely use low-dose ASA (3–5 mg/kg per day) and 3 use high-dose ASA (80 mg/kg per day). Outcomes were CA abnormalities defined as a CA diameter with a z score ≥2.5. We assessed the risk difference of CA abnormalities according to ASA dose. All subjects received ASA and intravenous immunoglobulin within 10 days of fever onset.RESULTS:There were 1213 subjects included, 848 in the high-dose and 365 in the low-dose ASA group. There was no difference in the risk of CA abnormalities in the low-dose compared with the high-dose ASA group (22.2% vs 20.5%). The risk difference adjusted for potential confounders was 0.3% (95% confidence interval [CI]: −4.5% to 5.0%). The adjusted risk difference for CA abnormalities persisting at the 6-week follow-up was −1.9% (95% CI: −5.3% to 1.5%). The 95% CI of the risk difference of CA abnormalities adjusted for confounders was within the prespecified 5% margin considered to be noninferior.CONCLUSIONS:In conjunction with intravenous immunoglobulin, low-dose ASA in acute KD is not inferior to high-dose ASA for reducing the risk of CA abnormalities.
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- 2017
14. A novel treadmill protocol for exercise testing in children: the British Columbia Children's Hospital protocol
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Astrid M. De Souza, D. Kathryn Duff, James E. Potts, Kevin C. Harris, and Derek G. Human
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medicine.medical_specialty ,pediatrics ,Physical Therapy, Sports Therapy and Rehabilitation ,030204 cardiovascular system & hematology ,cardiorespiratory function ,Metabolic equivalent ,Broadcast control channel ,03 medical and health sciences ,0302 clinical medicine ,Bruce protocol ,Heart rate ,medicine ,Orthopedics and Sports Medicine ,treadmill protocol ,Treadmill ,Respiratory exchange ratio ,Original Research ,Protocol (science) ,validation ,business.industry ,030229 sport sciences ,Physical therapy ,business ,human activities ,Respiratory minute volume - Abstract
Background Exercise testing in children is widely recommended for a number of clinical and prescriptive reasons. Many institutions continue to use the Bruce protocol for treadmill testing; however, with its incremental changes in speed and grade, it has challenges for practical application in children. We have developed a novel institutional protocol (British Columbia Children’s Hospital (BCCH)), which may have better utility in paediatric populations. Aim To determine if our institutional protocol yields similar peak responses in minute ventilation (VE), oxygen consumption (VO 2 ), carbon dioxide production (VCO 2 ), respiratory exchange ratio (RER), metabolic equivalents (METS) and heart rate (HR) when compared with the traditional Bruce protocol. Methods On two different occasions, 70 children (boys=33; girls=37) aged 10–18 years completed an exercise test on a treadmill using each of the protocols. During each test, metabolic gas exchange parameters were measured. HR was monitored continuously during exercise using an HR monitor. Results Physiological variables were similar between the two protocols (median (IQR); r s ): VE (L/min) (BCCH=96.7 (72.0–110.2); Bruce=99.2 (75.6–120.0); r s =0.95), peak VO 2 (mL/min) (BCCH=2897 (2342–3807); Bruce=2901 (2427–3654); r s =0.94) and METS (BCCH=16.2 (14.8–17.7); Bruce=16.4 (14.7–17.9); r s =0.89). RERs were similar (BCCH=1.00 (0.96–1.02); Bruce=1.03 (0.99–1.07); r s =0.48). Total exercise time (in seconds) was longer for the BCCH protocol: BCCH=915 (829–1005); Bruce=810 (750-919); r s =0.67. Conclusion The BCCH protocol produces similar peak exercise responses to the Bruce protocol and provides an alternative for clinical exercise testing in children.
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- 2017
15. THROMBOEMBOLISM IN THE ADULT FONTAN POPULATION: A MARKER OF FONTAN CIRCULATORY DYSFUNCTION?
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M. Riahi, V. Tony, N. Johal, J. Grewal, Jonathan Leipsic, Gnalini Sathananthan, Derek G. Human, S. Sandhu, Marla Kiess, and S. Chakrabarti
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Internal medicine ,Circulatory system ,Population ,Cardiology ,medicine ,Cardiology and Cardiovascular Medicine ,business ,education - Published
- 2019
16. Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease
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Anne Fournier, Deborah Fruitman, Derek G. Human, Kenny K. Wong, Lisa Graves, Jennifer L. Russell, and Michael Narvey
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Position statement ,Heart Defects, Congenital ,Pediatrics ,medicine.medical_specialty ,Canada ,Consensus ,Heart disease ,Cardiology ,Physical examination ,03 medical and health sciences ,Prenatal ultrasound ,0302 clinical medicine ,Neonatal Screening ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Oximetry ,Critical congenital heart disease ,Societies, Medical ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Canadian Cardiovascular Society ,medicine.disease ,Pulse oximetry ,Cardiology and Cardiovascular Medicine ,business ,Pediatric cardiology - Abstract
Congenital heart disease is the most common congenital malformation and approximately 3 in 1000 newborns have critical congenital heart disease (CCHD). Timely diagnosis affects morbidity, mortality, and disability, and newborn pulse oximetry screening has been studied to enhance detection of CCHD. In this position statement we present an evaluation of the literature for pulse oximetry screening. Current detection strategies including prenatal ultrasound examination and newborn physical examination are limited by low diagnostic sensitivity. Pulse oximetry screening is safe, noninvasive, easy to perform, and widely available with a high specificity (99.9%) and moderately high sensitivity (76.5%). When an abnormal saturation is obtained, the likelihood of having CCHD is 5.5 times greater than when a normal result is obtained. The use of pulse oximetry combined with current strategies has shown sensitivities of up to 92% for detecting CCHD. False positive results can be minimized by screening after 24 hours, and testing the right hand and either foot might further increase sensitivity. Newborns with abnormal screening results should undergo a comprehensive assessment and echocardiography performed if a cardiac cause cannot be excluded. Screening has been studied to be cost neutral to cost effective. We recommend that pulse oximetry screening should be routinely performed in all healthy newborns to enhance the detection of CCHD in Canada.
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- 2016
17. Assessment of Liver Stiffness in Pediatric Fontan Patients Using Transient Elastography
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Orlee R. Guttman, Derek G. Human, Richard A. Schreiber, Becky Chen, and James E. Potts
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medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Cirrhosis ,Article Subject ,Liver fibrosis ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Patient age ,Liver stiffness ,Internal medicine ,medicine ,cardiovascular diseases ,lcsh:RC799-869 ,Hepatology ,business.industry ,Gastroenterology ,General Medicine ,medicine.disease ,Surgery ,surgical procedures, operative ,Cohort ,Cardiology ,cardiovascular system ,030211 gastroenterology & hepatology ,lcsh:Diseases of the digestive system. Gastroenterology ,business ,Complication ,Transient elastography ,Research Article - Abstract
Background. Hepatic fibrosis is a potential complication following Fontan surgery and heralds long-term risk for cirrhosis. Transient elastography (TE) is a rapid, noninvasive method to assess liver fibrosis by measuring liver stiffness.Objectives. To compare liver stiffness and liver biochemistries in pediatric Fontan patients with age- and sex-matched controls and to determine patients’ acceptance of TE.Methods. Patients were recruited from British Columbia Children’s Hospital. Twenty-two Fontan patients (15 males) were identified. Demographic information and cardiac data were collected. TE was measured using size-appropriate probes.Results. The median age of the Fontan cohort was 13.7 (5.9–16.8) years. Time from Fontan surgery to TE was 9.6 (1.0–12.9) years. The median Fontan circuit pressure was 13 (11–14) mmHg. TE values were higher in Fontan patients versus controls (18.6 versus 4.7 kPa,p<0.001). There was no association between TE values and patient age (r=0.41,p=0.058), time since Fontan surgery (r=0.40,p=0.062), or median Fontan circuit pressure (CVP) (r=0.35,p=0.111). Patients found TE to be nonpainful, convenient, and safe.Conclusions. TE is feasible to assess liver stiffness in children following Fontan surgery. Pediatric Fontan patients have markedly elevated liver stiffness values. TE may have important utility in liver care follow-up of pediatric Fontan patients.
- Published
- 2016
18. Response to: Comment on 'Assessment of Liver Stiffness in Pediatric Fontan Patients Using Transient Elastography'
- Author
-
Orlee R. Guttman, Richard A. Schreiber, Becky Chen, James E. Potts, and Derek G. Human
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,General Medicine ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Elasticity Imaging Techniques ,0302 clinical medicine ,Text mining ,Liver ,Liver stiffness ,medicine ,Humans ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,Radiology ,lcsh:RC799-869 ,business ,Transient elastography ,Letter to the Editor - Published
- 2017
19. ATRIAL ARRHYTHMIAS AND THROMBOEMBOLIC COMPLICATIONS IN ADULTS WITH FONTAN CIRCULATION
- Author
-
Marla Kiess, Derek G. Human, J. Grewal, S. Chakrabarti, Andrew D. Krahn, Darryl Wan, A. Barlow, and M. Riahi
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Atrial arrhythmias ,Cardiology and Cardiovascular Medicine ,business ,Fontan circulation - Published
- 2018
20. Infant Repair of Massive Aortic Aneurysm With Prosthetic Valved Conduit
- Author
-
Norbert Froese, Jake Hiebert, Derek G. Human, Melanie K. Ganshorn, Takashi Sasaki, Ben C. Auld, Sanjiv K. Gandhi, and Neil D. Casey
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Marfan syndrome ,medicine.medical_specialty ,Aortic Valve Insufficiency ,macromolecular substances ,Valved conduit ,Risk Assessment ,Severity of Illness Index ,Marfan Syndrome ,Aortic aneurysm ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Dilated aortic root ,Ultrasonography ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Aortic Aneurysm, Thoracic ,business.industry ,musculoskeletal, neural, and ocular physiology ,Infant ,Mitral Valve Insufficiency ,medicine.disease ,Combined Modality Therapy ,Surgery ,Treatment Outcome ,nervous system ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
A 4-month-old child with severe infantile Marfan syndrome underwent successful repair of an extremely dilated aortic root and severe aortic valve insufficiency using a prosthetic valved conduit.
- Published
- 2013
21. Kawasaki disease at British Columbia's Children's Hospital
- Author
-
Peter N. Malleson, Mark R Riley, Derek G. Human, Regan L. Ebbeson, and J.E. Potts
- Subjects
Coronary artery aneurysm ,education.field_of_study ,Pediatrics ,medicine.medical_specialty ,Aspirin ,Heart disease ,business.industry ,Population ,medicine.disease ,Pediatrics, Perinatology and Child Health ,medicine ,Original Article ,Kawasaki disease ,Vasculitis ,business ,education ,Exanthem ,Systemic vasculitis ,medicine.drug - Abstract
To describe the clinical features, diagnosis, treatment and outcome of children with Kawasaki disease (KD) treated at a large tertiary care Canadian paediatric hospital and to try to identify correlations between clinical features and the development of coronary artery abnormalities.The charts of 176 patients diagnosed with typical, atypical or incomplete KD between 1992 and 2000 at British Columbia's Children's Hospital were reviewed.The male to female ratio was 1.8:1. The median age was 2.5 years (range two months to 14 years), with 8% nine years or older (42% Caucasian, 43% Asian). Cases occurred steadily throughout the year. One hundred two (58%) patients had typical, 18 (10%) patients had atypical and 56 (32%) patients had incomplete KD. The median time from fever onset to first intravenous immunoglobulin (IVIG) was seven days (range two to 49 days), and treatment began within 10 days of fever onset in 134 (76%) patients. All patients received one or more doses of 2 g/kg IVIG. Forty-two (24%) patients received a second dose for nonresponsiveness, of whom 10 (6%) remained nonresponsive. Eight (5%) patients received intravenous methylprednisolone. Forty-eight (27%) patients developed coronary artery abnormalities, with 10 (6%) echogenic abnormalities, 25 (14%) dilatations and 13 (7%) aneurysms (seven giant). No patient with a normal echocardiogram at four to eight weeks developed an abnormality on subsequent study. Fourteen (8%) patients had persistent abnormalities at last follow-up (median 447 days, range 62 to 3272 days): seven dilations and seven aneurysms (six giant). Five of 13 children (39%) who developed aneurysms failed to meet diagnostic criteria for typical KD, and three of those five aneurysms were present at less than one year after diagnosis. Four of eight (50%) patients receiving intravenous methyl-prednisolone for IVIG nonresponsiveness had or developed aneurysms. One patient died.Some children diagnosed with KD who fail to meet the diagnostic description develop coronary artery abnormalities. There is a need for a more accurate means of diagnosis to more appropriately use IVIG, an expensive and increasingly scarce resource. The role of corticosteroids remains unclear and a randomized controlled clinical trial to determine their role is needed.
- Published
- 2004
22. Clipped tube fenestration after extracardiac Fontan allows for simple transcatheter coil occlusion
- Author
-
Michael W.H. Patterson, Jacques G. LeBlanc, Derek G. Human, J. A. Gordon Culham, Timothy J. Bradley, Suvro S. Sett, and Walter J. Duncan
- Subjects
Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Fontan Procedure ,Surgery ,Child, Preschool ,Complete occlusion ,cardiovascular system ,medicine ,Coil occlusion ,Humans ,Tube (fluid conveyance) ,cardiovascular diseases ,Transcutaneous oxygen ,Child ,Cardiology and Cardiovascular Medicine ,business ,Fenestration ,Shunt (electrical) ,Retrospective Studies ,Cardiac catheterization - Abstract
Background. Expensive devices are increasingly used to close a patent fenestration after a modified Fontan operation. We report our 5-year institutional experience of clipped tube fenestration after extracardiac Fontan operation, which allows for simple transcatheter coil occlusion. Methods. We retrospectively reviewed 30 children, median age of 4.0 years (range, 2.4 to 8.8 years) who underwent extracardiac Fontan operation between May 1996 and May 2001, and were fenestrated using a 4- to 8-mm diameter clipped tube graft. Results. Ten children had a patent fenestration occluded by transcatheter placement of 15 detachable coils (5- to 8-mm diameter). Aortic oxygen saturations increased on average by 5.5% (2% to 14%) and mean pressures in the Fontan circuit by 2.5 mm Hg (0 to 3 mm Hg). Four had immediate complete occlusion angiographically and 6 had trivial residual shunt, but complete occlusion by echocardiography at follow-up. There have been no immediate complications, late coil embolizations, thromboembolic events, or documented hemolysis within a follow-up after coil implantation of 1.7 years (0.4 to 4.5 years). Spontaneous fenestration closure was documented in 8 patients at cardiac catheterization and 9 patients by echocardiography with consistent improvement in resting transcutaneous oxygen saturation. Two children with a patent fenestration have been considered inappropriate for closure, and there was one early surgical death. There have been no complications related to the tube fenestration modification within a follow-up postoperation of 2.6 years (0.1 to 5.5 years). Conclusions. Clipped tube fenestration after extracardiac Fontan operation is a useful surgical modification that allows for simple transcatheter coil occlusion.
- Published
- 2003
23. Maternal Anti-Ro and Anti-La Antibody–Associated Endocardial Fibroelastosis
- Author
-
Glenn Taylor, John Finley, Derek G. Human, Lisa K. Hornberger, Robert M. Hamilton, Yuk M. Law, Earl D. Silverman, Norman H. Silverman, Lynne E. Nield, Brendan Mullen, Jeffrey F. Smallhorn, and P. Gareth R. Seaward
- Subjects
Adult ,Male ,Anti-La Antibody ,Pediatrics ,medicine.medical_specialty ,Pathology ,Heart disease ,Heart block ,Hydrops Fetalis ,Cardiomyopathy ,Mothers ,Autoantigens ,Ultrasonography, Prenatal ,Cohort Studies ,Fetus ,Pregnancy ,Physiology (medical) ,RNA, Small Cytoplasmic ,Ventricular Dysfunction ,medicine ,Humans ,Autoantibodies ,Retrospective Studies ,Autoimmune disease ,business.industry ,Cardiac Pacing, Artificial ,Infant, Newborn ,Infant ,Endocardial fibroelastosis ,Endocardial Fibroelastosis ,medicine.disease ,Immunohistochemistry ,Heart Block ,Ribonucleoproteins ,Echocardiography ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-SSA/Ro autoantibodies - Abstract
Background — Maternal anti-Ro and anti-La antibodies are associated with congenital heart block (CHB). Although endocardial fibroelastosis (EFE) has been described in isolated cases of autoantibody-mediated CHB, the natural history and pathogenesis of this disease are poorly understood. Methods and Results — We retrospectively reviewed the clinical history, echocardiography, and pathology of fetuses and children with EFE associated with CHB born to mothers positive for anti-Ro or anti-La antibodies at 5 centers. Thirteen patients were identified, 6 with a prenatal and 7 with a postnatal diagnosis. Six mothers were positive for anti-Ro and anti-La antibodies, and 7 were positive for anti-Ro antibodies only. Only 1 mother had autoimmune disease. Severe ventricular dysfunction was seen in all fetal and postnatal cases. Four fetal and 3 postnatal cases had EFE at initial presentation. However, 2 fetal and 4 postnatal cases developed EFE 6 to 12 weeks and 7 months to 5 years from CHB diagnosis, respectively, even despite ventricular pacing in 6 postnatal cases. Eleven (85%) either died (n=9) or underwent cardiac transplantation (n=2) secondary to the EFE. Pathologic assessment of the explanted heart, available in 10 cases, revealed moderate to severe EFE in 7 and mild EFE in 3 cases, predominantly involving the left ventricle. Immunohistochemistry in 4 cases (including 3 fetuses) demonstrated deposition of IgG in 4 and IgM in 3 and T-cell infiltrates in 3 cases, suggesting an immune response by the affected fetus or child. Conclusions — EFE occurs in the presence of autoantibody-mediated CHB despite adequate ventricular pacing. Autoantibody-associated EFE has a very high mortality rate, whether developing in fetal or postnatal life.
- Published
- 2002
24. Early and intermediate-term complications of self-expanding stents limit its potential application in children with congenital heart disease
- Author
-
Maurice P. Leung, Shubhayan Sanatani, Yiu-fai Cheung, J.A.Gordan Culham, Adolphus K.T Chau, and Derek G. Human
- Subjects
Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Adolescent ,Heart disease ,medicine.medical_treatment ,Hemodynamics ,Constriction, Pathologic ,Pulmonary Artery ,Prosthesis Design ,medicine.artery ,medicine ,Humans ,Child ,Intermediate term ,medicine.diagnostic_test ,business.industry ,Angiography ,Stent ,medicine.disease ,Surgery ,Equipment Failure Analysis ,Treatment Outcome ,Child, Preschool ,Retreatment ,Pulmonary artery ,Balloon dilation ,Pulmonary Veno-Occlusive Disease ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,Follow-Up Studies - Abstract
OBJECTIVESWe report on the early and intermediate-term follow-up results of self-expanding Wallstent (Schneider, Switzerland) implanted in children with congenital heart disease.BACKGROUNDThe inherent shortcomings of balloon-expandable stents prompted the trial of an alternative stent.METHODSTwenty patients underwent 22 implantations of 25 self-expanding Wallstents between December 1993 and June 1997 in two institutions. The mean age and weight were 10.8 ± 4.5 years and 30.5 ± 14.2 kg, respectively. The patients were divided into two groups: 1) Group I comprised 17 patients with pulmonary arterial stenoses, 2) Group II comprised four patients with venous stenoses (one belonged to both groups). Sixteen patients underwent recatheterization at a median of 5.8 months (range 0.5 to 31, mean 8.1 months) after stenting. Hemodynamic and angiographic changes after the interventional procedures and complications were documented.RESULTSAll the stents were successfully deployed in the intended position. In Group I, the narrowest diameter of the stented vessel increased from 4.1 ± 1.5 to 8 ± 2 mm (95% increase, p < 0.0001) while the systolic pressure gradient across decreased from 24.6 ± 15.8 to 12.1 ± 11.4 mm Hg (51% decrease, p = 0.001). In Group II, the dimensional changes of the narrowest segment increased from 4.3 ± 0.5 to 7.5 ± 0.4 mm (75% increase, p = 0.003), and the pressure gradient reduced from 5.0 ± 2.9 to 0.9 ± 1.0 mm Hg (82% decrease, p = 0.04) across the stented venous channel. Distal migration of two optimally positioned stents occurred within 24 h of implantation. At recatheterization, significant neointimal ingrowth (>30% of the expanded diameter) was noted in 7 (28%) of the 25 implanted stents. This responded poorly to balloon dilation. Predisposing factors for the neointimal ingrowth included stents of smaller diameter (
- Published
- 2000
25. Living with complex congenital heart disease
- Author
-
Derek G. Human
- Subjects
medicine.medical_specialty ,Pediatrics ,business.industry ,Stressor ,Alternative medicine ,Psychological intervention ,Ventricular failure ,Quality of life (healthcare) ,Pediatrics, Perinatology and Child Health ,medicine ,CME Article ,Major complication ,Complex congenital heart disease ,Intensive care medicine ,business ,Psychosocial - Abstract
A child with complex congenital heart disease in 2008 is very likely to survive a series of surgical and medical interventions, and confront an array of medical and psychosocial stressors that are presently poorly understood. As approaches to medical problems change, careful assessment of those results is essential, and the initial work of the multicentre Pediatric Heart Network is a huge step in the right direction, setting the stage for proper controlled trials of therapies. Major complications, notably ventricular failure, rhythm problems and thromboembolism, will affect nearly one-quarter of survivors, necessitating further interventions. Appropriate educational and psychosocial support for these children and their families is the next challenge for all of us in the field of paediatrics. How ironic would it be to have invested so much in early survival, only to allow the child to fail in life itself.
- Published
- 2009
26. Validating a new Treadmill Protocol for Clinical Exercise Testing in Children
- Author
-
Kathryn Duff, James E. Potts, Kevin M. Harris, Derek G. Human, and Astrid M. De Souza
- Subjects
Protocol (science) ,Broadcast control channel ,medicine.medical_specialty ,Bruce protocol ,Physical medicine and rehabilitation ,business.industry ,Physical therapy ,Medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Treadmill ,business - Published
- 2015
27. The Contegra conduit: Late outcomes in right ventricular outflow tract reconstruction
- Author
-
Jacques G. LeBlanc, Derek G. Human, Steve Co, Anthony A Holmes, and Andrew Campbell
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,pulmonary ,lcsh:Medicine ,Persistent truncus arteriosus ,Early death ,Electrical conduit ,Internal medicine ,Contegra ,medicine ,Ventricular outflow tract ,cardiovascular diseases ,Survival rate ,Right ventricle outflow tract ,reintervention ,business.industry ,lcsh:R ,lcsh:RJ1-570 ,lcsh:Pediatrics ,medicine.disease ,Surgery ,Stenosis ,risk factor ,lcsh:RC666-701 ,Pediatrics, Perinatology and Child Health ,outcome ,cardiovascular system ,Cardiology ,Original Article ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives: To report the clinical outcomes (early death, late death, and rate of reintervention) and performance of the Contegra conduit as a right ventricle outflow tract implant and to determine the risk factors for early reintervention. Methods: Forty-nine Contegra conduits were implanted between January 2002 and June 2009. Data collection was retrospective. The mean age and follow-up duration of Contegra recipients was 3.5 ± 4.6 years and 4.2 ± 2.0 years, respectively. Results: There were three deaths (two early, one late), giving a survival rate of 93.9%. The rate of conduit-related reintervention was 19.6% and was most often due to distal conduit stenosis. Age at implantation of 22 mm) remains the first choice of implant in older children. The rates of reintervention are significantly higher with a diagnosis of truncus arteriosus, age at implantation of
- Published
- 2012
28. Kingella kingae endocarditis: A rare case of mitral valve perforation
- Author
-
Tawny Hung, Anthony A Holmes, Andrew Campbell, and Derek G. Human
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,medicine.medical_treatment ,Perforation (oil well) ,lcsh:Medicine ,Case Report ,Kingella kingae ,Haemophilus parainfluenzae ,Mitral valve ,Medicine ,Endocarditis ,Mitral valve repair ,biology ,business.industry ,lcsh:R ,lcsh:RJ1-570 ,lcsh:Pediatrics ,biology.organism_classification ,medicine.disease ,Surgery ,pediatric ,medicine.anatomical_structure ,lcsh:RC666-701 ,Bacteremia ,Pediatrics, Perinatology and Child Health ,mitral regurgitation ,Cardiology and Cardiovascular Medicine ,business ,Cardiobacterium hominis - Abstract
Kingella kingae , a HACEK (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) organism, is a common resident of the upper airway in children; it has been associated with endocarditis in children with pre-existing heart conditions. This case report describes K. kingae endocarditis leading to valvular damage in a previously healthy 18-month-old child. Our patient developed a K. kingae bacteremia that was later complicated by meningitis, septic embolic stroke, and endocarditis of the mitral valve, leading to perforation of the posterolateral leaflet. The patient was initially treated conservatively with cefotaxime but, subsequently, required a mitral valve repair with a pericardial patch and annuloplasty. This report draws attention to the need for clinicians to be aware of the potentially serious complications of K. kingae infection in young children. If K. kingae infection is suspected then therapy should be initiated promptly with a β-lactam, followed by early echocardiographic assessment. This case also highlights the lack of specific guidelines available for K. kingae endocarditis.
- Published
- 2011
29. An Unusual Cause of Anterior Mediastinal Mass
- Author
-
Marla Kiess, Andrew Campbell, Derek G. Human, Jonathon Leipsic, Tawny Hung, and Jason G. Andrade
- Subjects
Adult ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Foreign-Body Reaction ,Mediastinum ,Mediastinal mass ,Exertional dyspnea ,Surgery ,medicine.anatomical_structure ,Mediastinal Diseases ,Humans ,Medicine ,Female ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Chest radiograph ,Ostium secundum atrial septal defect - Abstract
[Figure][1] A 27-year-old lady with exertional dyspnea was referred to our adult congenital heart clinic 13 years after operative closure of an ostium secundum atrial septal defect in India. (A) Routine chest radiograph showed an abnormal mediastinal contour with opacification of the
- Published
- 2010
30. Extracardiac fontan operation with tube fenestration allowing transcatheter coil occlusion
- Author
-
Shubhayan Sanatani, J. A. Gordon Culham, Derek G. Human, Jacques G. LeBlanc, and Suvro S. Sett
- Subjects
Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,Cardiac output ,medicine.medical_specialty ,medicine.medical_treatment ,Vena Cava, Inferior ,Pulmonary Artery ,Coronary Angiography ,Fontan Procedure ,Fontan procedure ,Blood Vessel Prosthesis Implantation ,Coil occlusion ,Humans ,Medicine ,Child ,Cardiac catheterization ,business.industry ,Anastomosis, Surgical ,Surgery ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Fenestration - Abstract
A fenestration may improve the immediate postoperative course after a Fontan procedure by preserving the cardiac output. We describe a simple and safe technique of fenestration amenable to coil occlusion, which can be carried out in most cardiac catheterization laboratories.
- Published
- 1998
31. 119 Indications for Use of Palivizumab for RSV Prophylaxis in Infants and Children with Congenital Heart Disease: A Guide for Physicians
- Author
-
Bosco Paes, P Kantor, B Simmons, Upton Allen, K-J Lee, Karel O'Brien, J Finley, M Blaney, M Giuffre, and Derek G. Human
- Subjects
Palivizumab ,medicine.medical_specialty ,Pediatrics ,Heart disease ,business.industry ,Pediatrics, Perinatology and Child Health ,Medicine ,business ,Intensive care medicine ,medicine.disease ,medicine.drug - Published
- 2004
32. DOPPLER ASSESSMENT OF AORTIC IMPEDENCE FOLLOWING ANTIFAILURE THERAPY FOR CARDIAC FAILURE IN CHILDREN. 202
- Author
-
George G.S. Sandor, Derek G. Human, Steven A. Webber, Brian G. Sinclair, and Amanda J. Barlow
- Subjects
symbols.namesake ,medicine.medical_specialty ,business.industry ,Internal medicine ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,symbols ,medicine ,Cardiology ,business ,Doppler effect - Abstract
DOPPLER ASSESSMENT OF AORTIC IMPEDENCE FOLLOWING ANTIFAILURE THERAPY FOR CARDIAC FAILURE IN CHILDREN. 202
- Published
- 1996
33. Database management in pediatric cardiology
- Author
-
Derek G. Human and Kenneth J. Sprenger
- Subjects
medicine.medical_specialty ,business.industry ,Emergency medicine ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Pediatric cardiology - Published
- 1990
34. Mitral valve replacement in children
- Author
-
C.N. Barnard, Derek G. Human, H.S. Joffe, and Fraser Cb
- Subjects
Pulmonary and Respiratory Medicine ,Mitral regurgitation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,medicine.disease ,Surgery ,Stenosis ,medicine.anatomical_structure ,Calcinosis ,Mitral valve ,medicine ,Etiology ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Cardiac catheterization - Abstract
Mitral valve replacement (MVR) is associated with higher mortality and morbidity rates in children than in adults, and the use of heterograft valves has been encouraged. The results of MVR in 56 consecutive patients, aged 2 to 12 years, presenting between January, 1972, and January 1979, were reviewed to test these beliefs. The etiology of mitral valve disease was rheumatic in 46, congenital in eight, and acute bacterial endocarditis in two. All children were seriously disabled (NYHA Classes III and IV). Cardiac catheterization in 36 patients revealed mixed valve disease in 26, pure mitral regurgitation in seven, and pure mitral stenosis in three. Seventeen Starr-Edwards (SE), five Lillehei (L), Bjork-Shiley (BS), eight Hancock (H), and 25 Carpentier-Edwards (CE) mitral prosthesis were inserted. Operative mortality was 2% (1 BS) and late mortality was 10% (three SE, one L, two CE). Serious late complications occurred in 30% of survivors, including 11 instances of calcific valve stenosis (five H, six CE), one case of valve thrombosis (1 L), and two embolic episodes (1 SER, 1 H). Survival curves were similar for patients with heterograft and mechanical valves (92% and 77% at 5 years). Event-free curves showed heterograft valves to have a far higher complication rate than mechanical valves (10% complication free at 4 years compared to 84% free at 5 years). Early operative results in children are excellent, and the overall mortality (10%) compares favorably with figures for MVR in adults. However the long-term durability and choice of prostheses remain problematical, since less than 10% of heterograft valves survive beyond 5 years.
- Published
- 1982
35. Frontonasal dysplasia associated with tetralogy of Fallot
- Author
-
Derek G. Human, M. M. A. De Moor, and R. Baruch
- Subjects
Male ,medicine.medical_specialty ,Nose ,Genetics ,Humans ,Medicine ,Abnormalities, Multiple ,Frontonasal dysplasia ,Hypertelorism ,Child ,Facial anomaly ,Genetics (clinical) ,Tetralogy of Fallot ,Bone Diseases, Developmental ,business.industry ,Infant ,Anatomy ,medicine.disease ,Nasal tip ,Surgery ,Mental deficiency ,Median cleft face syndrome ,Multifactorial Inheritance ,Female ,medicine.symptom ,business ,Research Article - Abstract
Three children with frontonasal dysplasia associated with tetralogy of Fallot are reported. All cases had true hypertelorism and a median nasal groove with absence of the nasal tip. There was no mental deficiency. The facial anomaly is a sporadic, non-genetic interference of the normal development of the face. This is the first report of frontonasal dysplasia associated with a cardiac defect. Multifactorial inheritance of this syndrome is proposed.
- Published
- 1987
36. Effect of kwashiorkor on the cardiovascular system
- Author
-
Derek G. Human, J. M. Schulz, M. M. A. De Moor, and Jack Bergman
- Subjects
medicine.medical_specialty ,business.industry ,Heart Ventricles ,Myocardium ,Kwashiorkor ,Infant ,Disease ,medicine.disease ,Myocardial Contraction ,Heart septum ,Text mining ,Echocardiography ,Internal medicine ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,medicine ,Cardiology ,Heart Septum ,Humans ,Decreased muscle mass ,business ,Research Article - Abstract
In kwashiorkor the heart is clinically and radiologically small. This study utilises echocardiography, a tool not previously used in this disease, to show that this is due to decreased muscle mass.
- Published
- 1988
37. Treatment choice in acute rheumatic carditis
- Author
-
Fraser Cb, Hill Id, and Derek G. Human
- Subjects
medicine.medical_specialty ,Myocarditis ,Blood Sedimentation ,Prednisone ,Internal medicine ,medicine ,Humans ,Child ,Aspirin ,medicine.diagnostic_test ,business.industry ,Rheumatic Heart Disease ,Carditis ,Acute rheumatic fever ,Acute rheumatic carditis ,Length of Stay ,medicine.disease ,Clinical trial ,Erythrocyte sedimentation rate ,Pediatrics, Perinatology and Child Health ,Acute Disease ,Cardiology ,business ,medicine.drug ,Research Article - Abstract
A trial was conducted using sequential analysis by pairs to compare the efficacy of corticosteroids and salicylates in the treatment of acute rheumatic carditis. The results show a significantly favourable effect of steroid treatment both in clinical response and in reduction of the erythrocyte sedimentation rate. In addition, patients receiving steroids usually had a shorter hospital stay. The use of steroids in acute rheumatic fever with carditis is recommended.
- Published
- 1984
38. The Contegra conduit: Late outcomes in right ventricular outflow tract reconstruction
- Author
-
Anthony A Holmes, Steve Co, Derek G Human, Jacques G LeBlanc, and Andrew IM Campbell
- Subjects
Contegra ,outcome ,pulmonary ,reintervention ,risk factor ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objectives: To report the clinical outcomes (early death, late death, and rate of reintervention) and performance of the Contegra conduit as a right ventricle outflow tract implant and to determine the risk factors for early reintervention. Methods: Forty-nine Contegra conduits were implanted between January 2002 and June 2009. Data collection was retrospective. The mean age and follow-up duration of Contegra recipients was 3.5 ± 4.6 years and 4.2 ± 2.0 years, respectively. Results: There were three deaths (two early, one late), giving a survival rate of 93.9%. The rate of conduit-related reintervention was 19.6% and was most often due to distal conduit stenosis. Age at implantation of 22 mm) remains the first choice of implant in older children. The rates of reintervention are significantly higher with a diagnosis of truncus arteriosus, age at implantation of
- Published
- 2012
- Full Text
- View/download PDF
39. Kingella kingae endocarditis: A rare case of mitral valve perforation
- Author
-
Anthony A Holmes, Tawny Hung, Derek G Human, and Andrew I M Campbell
- Subjects
Endocarditis ,Kingella kingae ,mitral regurgitation ,pediatric ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Kingella kingae , a HACEK (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) organism, is a common resident of the upper airway in children; it has been associated with endocarditis in children with pre-existing heart conditions. This case report describes K. kingae endocarditis leading to valvular damage in a previously healthy 18-month-old child. Our patient developed a K. kingae bacteremia that was later complicated by meningitis, septic embolic stroke, and endocarditis of the mitral valve, leading to perforation of the posterolateral leaflet. The patient was initially treated conservatively with cefotaxime but, subsequently, required a mitral valve repair with a pericardial patch and annuloplasty. This report draws attention to the need for clinicians to be aware of the potentially serious complications of K. kingae infection in young children. If K. kingae infection is suspected then therapy should be initiated promptly with a β-lactam, followed by early echocardiographic assessment. This case also highlights the lack of specific guidelines available for K. kingae endocarditis.
- Published
- 2011
- Full Text
- View/download PDF
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