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4. Retroaortic left innominate vein - Incidence, association with congenital heart defects, embryology, and clinical significance

Author

Kulkarni Snehal, Jain Shreepal, Kasar Pankaj, Garekar Swati, and Joshi Suresh

Subjects
Retroaortic left innominate vein, right aortic arch, tetralogy of Fallot, Medicine, Pediatrics, RJ1-570, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

In a retrospective analysis of echocardiograms, the incidence of retroaortic innominate vein was found to be 0.55% amongst children with congenital heart disease. It was most commonly associated with tetralogy of Fallot and right aortic arch.

Published
2008

7. Fontan procedure on deep hypothermic circulatory arrest: Short-term results and technique.

Author

Malankar, Dhananjay, Mali, Shivaji, Dhake, Shyam, Mhatre, Amit, Bind, Dilip, Soni, Bharat, Kandavel, Dinesh, Raj, Jinil, Patel, Parvez, and Garekar, Swati

Subjects
INDUCED hypothermia, CARDIAC surgery, RETROSPECTIVE studies, TREATMENT effectiveness, CARDIOPULMONARY bypass, PATIENT safety
Abstract

Background : Various operative strategies are described for the Fontan procedure. In this study, we describe our short-term results and technique of Fontan procedure on cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). Methods : This was a retrospective study of 32 patients, median age of 6 years (4–19 years) and median weight of 20 kg (13–51 kg), who underwent Fontan procedure on CPB and DHCA from July 2016 to July 2021. Results : The median CPB time was 125 min (77–186 min), the median DHCA time was 42 min (27–50 min), and the median Fontan pressure was 14 mmHg (10–18 mmHg). The median time to extubation was 4 h (1–20 h), the duration of chest tube drainage was 8 days (5–24 days), and the median intensive care unit stay was 4 days (3–8 days). The presence of heterotaxy was associated with longer duration of pleural drainage (P = 0.01). There was no operative mortality and no major adverse events such as seizures, gross neurological deficits, or arrhythmias in the postoperative period. Conclusions : Fontan procedure can be safely performed on CPB and DHCA with good operative results. This operative strategy may be used in special circumstances like in patients with situs and systemic venous anomalies and those requiring repair of a complex intracardiac defect. Long-term follow-up will be required to evaluate if this strategy has any impact on the neurodevelopmental outcome and the long-term sequelae of Fontan. [ABSTRACT FROM AUTHOR]

Published
2022
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8. Single-Stage Unifocalization and Intracardiac Repair Using Two Tube Grafts.

Author

Malankar, Dhananjay Prakash, Mali, Shivaji, Garekar, Swati, and Sheth, Ronak

Abstract

Unifocalization of the major aortopulmonary collaterals (MAPCAs) followed by intracardiac repair with ventricular septal defect (VSD) closure and restoration of right ventricle-to-pulmonary artery continuity is the ultimate treatment goal in a case of VSD with pulmonary atresia and MAPCAs. It may be achieved in a single stage or may require multiple surgeries. We present a case of a 2-year-old boy with VSD with pulmonary atresia who underwent single-stage unifocalization of MAPCAs through the midline followed by intracardiac repair using 2 polytetrafluoroethylene tube grafts: one for unifocalization and other as a bicuspid valved right ventricle-to-pulmonary artery conduit. [ABSTRACT FROM AUTHOR]

Published
2022
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9. Use of Bosentan in neonatal post cardiac surgery pulmonary hypertension

Author

Pawar Ravindra, Kasar Pankaj, Garekar Swati, and Kulkarni Snehal

Subjects
Bosentan, neonatal pulmonary hypertension, total anomalous pulmonary venous connection, Medicine, Pediatrics, RJ1-570, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

We report the use of Bosentan in the post-operative period of a neonate with obstructed infradiaphragmatic total anomalous pulmonary venous connection and severe pulmonary arterial hypertension. To our knowledge, this is the first report of use of Bosentan in this situation.

Published
2009

10. Early experience with pediatric cardiac transplantation in a limited resource setting

Author

Garekar, Swati, primary, Meeran, Talha, additional, Patel, Vinay, additional, Patil, Sachin, additional, Dhake, Shyam, additional, Mali, Shivaji, additional, Mhatre, Amit, additional, Bind, Dilip, additional, Gaur, Ashish, additional, Sinha, Sandeep, additional, Shetty, Vijay, additional, Sabnis, Kirtis, additional, Soni, Bharat, additional, Malankar, Dhananjay, additional, and Mulay, Anvay, additional

Published
2020
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15. Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta

Author

Children's Hospital of Michigan, Wayne State University, Detroit, Michigan ; Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, University of California at San Francisco, Division of Cardiology, San Francisco, California, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil, The Congenital Heart Institute at Miami, Children's Hospital and Arnold Palmer Women and Children's Hospital, Orlando, Florida, Children's Hospital of Omaha, University of Nebraska Creighton University, Omaha, Nebraska, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, Guy's Hospital, London, England, Columbus Children's Hospital, Ohio State University, Columbus, Ohio, Children's Hospital of Mississippi, University of Mississippi/Jackson, Mississipi, University of Chicago, Division of Cardiology, Chicago, Illinois, Mayo Clinic, Rochester, Minnesota, Cardiovascular Center Bethanien, Frankfurt, Germany, Children's Hospital of Iowa, University of Iowa, Iowa City, Iowa, Medical University of South Carolina, Division of Cardiology, Charleston, South Carolina, Children's Memorial Hospital, Northwestern University, Lincoln Park, Illinois, Duke Children's Heart Program, Duke University, Durham, North Carolina, Seattle Children's Hospital, University of Washington, Seattle, Washington, Babies and Children's Hospital of New York, Columbia Presbyterian, New York, New York, Forbes, Thomas J., Moore, Phillip, Pedra, Carlos A. C., Zahn, Evan M., Nykanen, David, Amin, Zahid, Garekar, Swati, Teitel, David, Qureshi, Shakeel A., Cheatham, John P., Ebeid, Makram R., Hijazi, Ziyad M., Sandhu, Satinder, Hagler, Donald J., Sievert, Horst, Fagan, Thomas E., Ringwald, Jeremy, Du, Wei, Tang, Liwen, Wax, David F., Rhodes, John, Johnston, Troy A., Jones, Thomas K., Turner, Daniel R., Pass, Robert, Torres, Alejandro, Hellenbrand, William E., Children's Hospital of Michigan, Wayne State University, Detroit, Michigan ; Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, University of California at San Francisco, Division of Cardiology, San Francisco, California, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil, The Congenital Heart Institute at Miami, Children's Hospital and Arnold Palmer Women and Children's Hospital, Orlando, Florida, Children's Hospital of Omaha, University of Nebraska Creighton University, Omaha, Nebraska, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, Guy's Hospital, London, England, Columbus Children's Hospital, Ohio State University, Columbus, Ohio, Children's Hospital of Mississippi, University of Mississippi/Jackson, Mississipi, University of Chicago, Division of Cardiology, Chicago, Illinois, Mayo Clinic, Rochester, Minnesota, Cardiovascular Center Bethanien, Frankfurt, Germany, Children's Hospital of Iowa, University of Iowa, Iowa City, Iowa, Medical University of South Carolina, Division of Cardiology, Charleston, South Carolina, Children's Memorial Hospital, Northwestern University, Lincoln Park, Illinois, Duke Children's Heart Program, Duke University, Durham, North Carolina, Seattle Children's Hospital, University of Washington, Seattle, Washington, Babies and Children's Hospital of New York, Columbia Presbyterian, New York, New York, Forbes, Thomas J., Moore, Phillip, Pedra, Carlos A. C., Zahn, Evan M., Nykanen, David, Amin, Zahid, Garekar, Swati, Teitel, David, Qureshi, Shakeel A., Cheatham, John P., Ebeid, Makram R., Hijazi, Ziyad M., Sandhu, Satinder, Hagler, Donald J., Sievert, Horst, Fagan, Thomas E., Ringwald, Jeremy, Du, Wei, Tang, Liwen, Wax, David F., Rhodes, John, Johnston, Troy A., Jones, Thomas K., Turner, Daniel R., Pass, Robert, Torres, Alejandro, and Hellenbrand, William E.

Abstract

Background : We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques. Methods and Results : Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5–92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections ( n = 5) and aneurysm ( n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup ( n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up. Conclusions : Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We r

Published
2007

16. Is it safe to perform cardiac catheterizations on adults with congenital heart disease in a pediatric catheterization laboratory?

Author

Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, Central Michigan University, Mount Pleasant, Michigan, Department of Pediatrics, Hurley Medical Center, Michigan State University, Flint, Michigan, Division of Cardiology, Harper Hospital, Wayne State University, Detroit, Michigan, Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan ; 3901 Beaubien Blvd, Children's Hospital of Michigan, Division of Pediatric Cardiology, Detroit, MI 48201, Garekar, Swati, Paules, Melissa M., Reddy, Surendranath V., Turner, Daniel R., Sanjeev, Sanjeev, Wynne, Joshua, Epstein, Michael L., Karpawich, Peter P., Ross, Robert D., Forbes, Thomas J., Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, Central Michigan University, Mount Pleasant, Michigan, Department of Pediatrics, Hurley Medical Center, Michigan State University, Flint, Michigan, Division of Cardiology, Harper Hospital, Wayne State University, Detroit, Michigan, Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan ; 3901 Beaubien Blvd, Children's Hospital of Michigan, Division of Pediatric Cardiology, Detroit, MI 48201, Garekar, Swati, Paules, Melissa M., Reddy, Surendranath V., Turner, Daniel R., Sanjeev, Sanjeev, Wynne, Joshua, Epstein, Michael L., Karpawich, Peter P., Ross, Robert D., and Forbes, Thomas J.

Abstract

Objective : To determine the complication rate during the catheterization in adults with congenital heart disease (CHD) in a pediatric catheterization laboratory (PCL). Background : An increasing number of patients with CHD are surviving into adulthood, with diagnostic and interventional cardiac catheterization being essential for the management of their disease. The complication rate during the catheterization of adults with CHD has not been reported. Methods : A retrospective chart review was performed on all adult patients (>18 years) with CHD who underwent diagnostic or interventional catheterization in our PCL within the past 8.5 years. Results : A total of 576 procedures were performed on 436 adult patients (median age 26 years). Complex heart disease was present in 387/576 (67%) procedures. An isolated atrial septal defect or patent foramen ovale was present in 115/576 (20%) procedures, and 51/576 (9%) procedures were performed on patients with structurally normal hearts with arrhythmias. Interventional catheterization was performed in 378/576 (66%) procedures. There were complications during 61/576 (10.6%) procedures; 19 were considered major and 42 minor. Major complications were death (1), ventricular fibrillation (1), hypotension requiring inotropes (7), atrial flutter (3), retroperitoneal hematoma, pneumothorax, hemothorax, aortic dissection, renal failure, myocardial ischemia and stent malposition (1 each). The most common minor complications were vascular entry site hematomas and hypotension not requiring inotropes. Procedures performed on patients ≥ 45 years of age had a 19% occurrence of complications overall compared with 9% occurrence rate in patients of age < 45 years ( P < 0.01). Conclusions : The complication rate during the catheterization of adults with CHD in a PCL is similar to the complication rate of children with CHD undergoing cardiac catheterization. The older subset of patients are more likely to encounter complications overall. The en

Published
2006

21. Horse-shoe lung-rediscovered via volume rendered images.

Author

Bharati, Alpa, Merchant, Suleman A., Garekar, Swati, and Patel, Tapan

Subjects
MULTIDETECTOR computed tomography, LUNG abnormalities, SCIMITAR syndrome, TOMOGRAPHY, COMORBIDITY, SYMPTOMS, DIAGNOSIS
Abstract

Horseshoe lung, usually associated with pulmonary venolobar syndrome, is a rare congenital anomaly involving the fusion of the postero-basal segments of the right and left lungs across the midline. The fused segment or the isthmus lies posterior to the pericardium and anterior to the aorta.The associated pulmonary venolobar syndrome involves anomalous systemic arterial supply and anomlaous systemic venous drainage of the right lung. With the advent of MDCT imaging, we can diagnose this rare condition as well all its associated anomalies non-invasively. Volume-rendered techniques greatly simplify the complex anatomy and provide easy understanding of the same. [ABSTRACT FROM AUTHOR]

Published
2013
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24. MRA-based 3D-printed heart model-an effective tool in the pre-surgical planning of DORV.

Author

Bharati A, Garekar S, Agarwal V, Merchant SA, and Solanki N

Abstract

A three-dimensional (3D) printed heart model based on contrast-enhanced MR angiography data was obtained in an 8-month-old male child with double-outlet right ventricle. The model could successfully show the spatial relationship between the aortic annulus, the pulmonary valve and the ventricular septal defect. The patient underwent complete intracardiac repair based on the 3D model. MR angiography images could be successfully used to create a true-size 3D heart model, which significantly helped in assessing the routability of the ventricular septal defect to the aorta, leading to successful intracardiac repair in our patient.

Published
2016
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