20 results on '"Laura Gellis"'
Search Results
2. Long‐Term Fate of the Truncal Valve
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Laura Gellis, Geoffrey Binney, Laith Alshawabkeh, Minmin Lu, Michael J. Landzberg, John E. Mayer, Mary P. Mullen, Anne Marie Valente, Lynn A. Sleeper, and David W. Brown
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congenital heart disease ,truncal valve ,truncus arteriosus ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Long‐term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long‐term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention. Methods and Results We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow‐up time was 12.6 years (interquartile range, 5.0–22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow‐up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77; P
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- 2020
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3. Hemodynamic and anatomic changes after fetal aortic valvuloplasty are associated with procedural success and postnatal biventricular circulation
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Victoria R. Bradford, Wayne Tworetzky, Ryan Callahan, Louise E. Wilkins‐Haug, Carol B. Benson, Diego Porras, Stephanie H. Guseh, Minmin Lu, Lynn A. Sleeper, Laura Gellis, and Kevin G. Friedman
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Balloon Valvuloplasty ,Fetus ,Treatment Outcome ,Pregnancy ,Hemodynamics ,Humans ,Obstetrics and Gynecology ,Female ,Aortic Valve Stenosis ,Genetics (clinical) ,Retrospective Studies - Abstract
There are minimal data characterizing the trajectory of left heart growth and hemodynamics following fetal aortic valvuloplasty (FAV).This retrospective study included patients who underwent FAV between 2000 and 2019, with echocardiograms performed pre-FAV, immediately post-FAV, and in late gestation.Of 118 fetuses undergoing FAV, 106 (90%) underwent technically successful FAV, of which 55 (52%) had biventricular circulation. Technically successful FAV was associated with improved aortic valve growth (p 0.001), sustained antegrade aortic arch (AoA) flow (p = 0.02), improved mitral valve (MV) inflow pattern (p = 0.002), and favorable patent foramen ovale (PFO) flow pattern (p = 0.004) from pre-FAV to late gestation. Compared to patients with univentricular outcome, patients with biventricular outcome had less decrement in size of the left ventricle (LV) (p 0.001) and aortic valve (p = 0.005), as well as more physiologic PFO flow (p 0.001) and antegrade AoA flow (p 0.001) from pre-FAV to late gestation. In multivariable analysis, echocardiographic predictors of biventricular outcome were less decline in LV end diastolic dimension (p 0.001), improved PFO flow (p = 0.004), and sustained antegrade AoA flow (p = 0.002) from pre-FAV to late gestation.Stabilization of left heart growth and improved hemodynamics following successful FAV through late gestation are associated with postnatal biventricular circulation.
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- 2022
4. Left atrioventricular valve repair after primary atrioventricular canal surgery: Predictors of durability
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Laura Gellis, Patrick McGeoghegan, Minmin Lu, Eric Feins, Lynn Sleeper, Sitaram Emani, Kevin Friedman, and Christopher Baird
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
5. Comparison of coronary artery measurements between echocardiograms and cardiac CT in Kawasaki disease patients with aneurysms
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Jane W. Newburger, Rebecca Oduor, Kimberlee Gauvreau, Kevin G. Friedman, Laura Gellis, Daniel A. Castellanos, and Audrey Dionne
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medicine.medical_specialty ,genetic structures ,Concordance ,Coronary Artery Disease ,Mucocutaneous Lymph Node Syndrome ,Article ,Imaging modalities ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies ,Coronary artery aneurysm ,business.industry ,Coronary Aneurysm ,Clinical course ,Infant ,Reproducibility of Results ,medicine.disease ,Coronary Vessels ,Thrombosis ,eye diseases ,Stenosis ,medicine.anatomical_structure ,Echocardiography ,Cardiology ,Kawasaki disease ,sense organs ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
BACKGROUND: American Heart Association (AHA) guidelines for management of Kawasaki disease (KD) rely on coronary artery (CA) z-scores from echocardiograms. Compared with echocardiography, cardiac CT (CCT) offers better visualization of distal segments and evaluation for thrombosis and stenosis. Despite increasing use of CCT in KD, CA z-scores for CCT are not available and measurement concordance between imaging modalities is a critical knowledge gap. METHODS: We retrospectively reviewed KD patients with CA aneurysms who had concurrent echocardiography and CCT between 2016-2020. Patients were included if they had history of CA z-scores of ≥ 3 on echocardiography during their clinical course. Agreement between CCT and echocardiography was assessed using Bland-Altman analysis. RESULTS: Paired CCT and echocardiography studies were available in 18 patients (21 studies). The largest CA aneurysms were large/giant (z-score ≥10) in 14 studies, medium (z-score ≥5
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- 2022
6. CONTEMPORARY OUTCOMES AFTER ATRIOVENTRICULAR CANAL REPAIR IN PATIENTS WITH PARACHUTE LEFT AV VALVE
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Patrick McGeoghegan, Minmin Lu, Lynn Sleeper, Sitaram M. Emani, Christopher W. Baird, laura gellis, Kevin Friedman, and Eric Feins
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Cardiology and Cardiovascular Medicine - Published
- 2023
7. Tricuspid valve repair concomitant with the Norwood operation among babies with hypoplastic left heart syndrome
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Isaac Wamala, Kevin G Friedman, Mossab Y Saeed, Kimberlee Gauvreau, Laura Gellis, Michele Borisuk, Aditya Kaza, Sitaram Emani, Pedro J del Nido, and Christopher W Baird
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Pulmonary and Respiratory Medicine ,Treatment Outcome ,Hypoplastic Left Heart Syndrome ,Prolapse ,Humans ,Infant ,Surgery ,General Medicine ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,Norwood Procedures ,Tricuspid Valve Insufficiency ,Retrospective Studies - Abstract
OBJECTIVES Among patients with hypoplastic left heart syndrome (HLHS), tricuspid valve regurgitation (TR) portends a poor prognosis. Our goal was to describe the outcomes of tricuspid valve reconstruction (TVR) concomitant with the Norwood operation and using two-dimensional echocardiography and evaluate the structural factors associated with successful functional correction. METHODS We performed a retrospective, single-centre study of patients with HLHS undergoing TVR at the time of the Norwood operation. Structural echocardiographic parameters were compared between patients with successful correction (≤ mild TR) and those with ≥ moderate regurgitation at discharge. Preoperative dimensions of matched HLHS controls with ≤ trivial TR were used as a reference. RESULTS Of 205 patients with HLHS undergoing the Norwood operation, 18 patients had a concomitant TVR. Ten (56%) patients had an improved TR grade postoperatively, 8 (44%) of whom had ≤ mild TR at discharge. Improvement in TR grade (P = 0.001) and having ≤ mild TR at discharge (P = 0.011) were associated with an improved reintervention and TR-free survival. Patients with successful functional correction had smaller preoperative tricuspid annulus lateral dimensions (P = 0.023), tricuspid valve area (P = 0.007) and right ventricle mid-width (P = 0.064). Preoperatively, the successful TVR cases tended to have had higher anterior leaflet excursion (80 ± 20 vs 55 ± 11, P = 0.010), and a higher proportion of anterior leaflet prolapse (63% vs 10%, P = 0.043) compared to cases where TVR was not successful. CONCLUSIONS Patients with HLHS with significant tricuspid regurgitation undergoing the stage 1 operation were more likely to have successful concomitant tricuspid valve repair if they had less tricuspid annular dilation, less-severe RV enlargement and predominantly anterior leaflet prolapse. Successful tricuspid valve repair was associated with improved mid- and long-term outcomes.
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- 2021
8. Reply from authors: A new shared vision on survival analysis: Good news from Baltimore
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Pedro J. Del Nido, Sitaram M. Emani, Takashi Kido, Steven J. Staffa, Laura Gellis, Christopher W. Baird, Ilias P. Doulamis, John E. Mayer, Meena Nathan, Alvise Guariento, Nicholas A. Oh, and David Zurakowski
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Shared vision ,business.industry ,Internet privacy ,Psychology ,business ,Survival analysis - Published
- 2021
9. Long‐Term Fate of the Truncal Valve
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Laith Alshawabkeh, Geoffrey Binney, Laura Gellis, Michael J. Landzberg, Minmin Lu, Anne Marie Valente, John E. Mayer, David W. Brown, Mary P. Mullen, and Lynn A. Sleeper
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Male ,Reoperation ,medicine.medical_specialty ,Heart Valve Diseases ,Persistent truncus arteriosus ,030204 cardiovascular system & hematology ,03 medical and health sciences ,fluids and secretions ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,truncus arteriosus ,Original Research ,Retrospective Studies ,truncal valve ,business.industry ,Congenital Heart Disease ,Infant, Newborn ,Infant ,medicine.disease ,Truncal valve ,Truncus Arteriosus, Persistent ,Survival Rate ,body regions ,surgical procedures, operative ,Treatment Outcome ,030228 respiratory system ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
Background Long‐term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long‐term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention. Methods and Results We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow‐up time was 12.6 years (interquartile range, 5.0–22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow‐up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77; P P P z ‐score before truncus arteriosus full repair and during follow‐up was associated with worsening truncal valve regurgitation. Conclusions Long‐term rates of truncal valve intervention are significant. At least moderate initial truncal valve stenosis and initial or residual regurgitation are independent risk factors associated with truncal valve intervention. Larger truncal valve root z ‐score is associated with significant truncal valve regurgitation and may identify a subset of patients at risk for truncal valve dysfunction over time.
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- 2020
10. Abstract 15412: Long-term Outcomes of the Truncal Valve in Truncus Arteriosus
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Lynn A. Sleeper, Laura Gellis, Laith Alshawabkeh, David W. Brown, John E. Mayer, Mary P. Mullen, Minmin Lu, Geoffrey Binney, and Anne Marie Valente
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Aortic valve ,medicine.medical_specialty ,business.industry ,Persistent truncus arteriosus ,medicine.disease ,Truncal valve ,medicine.anatomical_structure ,Physiology (medical) ,Internal medicine ,medicine ,Long term outcomes ,Cardiology ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Pediatric cardiology - Abstract
Objectives: Long-term survival in patients with truncus arteriosus (TA) is favorable, but there remains significant morbidity associated with need for ongoing re-interventions. The purpose of this study was to understand the long-term outcomes of the truncal valve (TV) and identify risk factors associated with the need for TV intervention. Methods: We retrospectively reviewed 170 patients who underwent initial TA repair at our institution from 1985-2015. Analysis of long-term outcomes was performed on the 148 patients who survived greater than 30 days post-operatively and to hospital discharge using multivariable competing risks Cox regression modeling. Results: Median follow up time was 12.6 years (IQR 5.0, 22.1 years) after full repair. Freedom from death or transplant at 1, 5, 10, and 20 years was 93.1 ± 2.1%, 88.0 ± 2.7%, 86.2 ± 3.0% and 78.3 ± 4.1%. Thirty patients (20%) underwent at least one intervention on the TV (22 repairs, 21 replacements). Freedom from any TV intervention at 1, 5, 10 and 20 years was 99 ± 1%, 94 ± 8%, 82 ± 9%, and 70 ± 5%. Of those with TV repair, 59% subsequently underwent TV replacement. Independent risk factors for need for TV intervention included ≥moderate TV regurgitation (TVR) (HR 4.77, p Conclusion: Long-term need for TV intervention remains significant. Moderate or worse initial TVR or stenosis, residual TVR after initial TA repair, and single coronary ostium are risk factors associated with need for subsequent TV intervention.
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- 2020
11. Long-term outcomes of truncus arteriosus repair: A modulated renewal competing risks analysis
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Meena Nathan, John E. Mayer, Takashi Kido, Steven J. Staffa, Alvise Guariento, Ilias P. Doulamis, David Zurakowski, Christopher W. Baird, Nicholas A. Oh, Sitaram M. Emani, Laura Gellis, and Pedro J. del Nido
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Male ,Long Term Adverse Effects ,030204 cardiovascular system & hematology ,Postoperative Complications ,0302 clinical medicine ,Long term outcomes ,risk factors ,truncus arteriosus ,competing risks ,Hazard ratio ,Heart Valves ,Causality ,surgical procedures, operative ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,long-term outcomes ,Adult ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart Ventricles ,Persistent truncus arteriosus ,Pulmonary Artery ,Risk Assessment ,03 medical and health sciences ,statistical analysis ,medicine.artery ,Internal medicine ,Coronary artery anomaly ,medicine ,Humans ,Mortality ,Competing risks analysis ,modulated renewal ,Retrospective Studies ,business.industry ,Cardiovascular Surgical Procedures ,Infant ,medicine.disease ,Truncus Arteriosus, Persistent ,United States ,Confidence interval ,030228 respiratory system ,Ventricle ,Pulmonary artery ,Surgery ,business - Abstract
In this study, we sought to identify independent risk factors for mortality and reintervention after early surgical correction of truncus arteriosus using a novel statistical method.Patients undergoing neonatal/infant truncus arteriosus repair between January 1984 and December 2018 were reviewed retrospectively. An innovative statistical strategy was applied integrating competing risks analysis with modulated renewal for time-to-event modeling.A total of 204 patients were included in the study. Mortality occurred in 32 patients (15%). Smaller right ventricle to pulmonary artery conduit size and truncal valve insufficiency at birth were significantly associated with overall mortality (right ventricle to pulmonary artery conduit size: hazard ratio, 1.34; 95% confidence interval, 1.08-1.66, P = .008; truncal valve insufficiency: hazard ratio, 2.5; 95% confidence interval, 1.13-5.53, P = .024). truncal valve insufficiency at birth, truncal valve intervention at index repair, and number of cusps (4 vs 3) were associated with truncal valve reoperations (truncal valve insufficiency: hazard ratio, 2.38; 95%, confidence interval, 1.13-5.01, P = .02; cusp number: hazard ratio, 6.62; 95% confidence interval, 2.54-17.3, P .001). Right ventricle to pulmonary artery conduit size 11 mm or less was associated with a higher risk of early catheter-based reintervention (hazard ratio, 1.54; 95% confidence interval, 1.04-2.28, P = .03) and reoperation (hazard ratio, 1.96; 95% confidence interval, 1.33-2.89, P = .001) on the right ventricle to pulmonary artery conduit.Smaller right ventricle to pulmonary artery conduit size and truncal valve insufficiency at birth were associated with overall mortality after truncus arteriosus repair. Quadricuspid truncal valve, the presence of truncal valve insufficiency at the time of diagnosis, and truncal valve intervention at index repair were associated with an increased risk of reoperation. The size of the right ventricle to pulmonary artery conduit at index surgery is the single most important factor for early reoperation and catheter-based reintervention on the conduit.
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- 2022
12. Contrast volume to estimated glomerular filtration rate ratio for prediction of contrast‐induced acute kidney injury after cardiac catheterization in adults with congenital heart disease
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Lisa Bergersen, Kimberlee Gauvreau, Diego Porras, Laura Gellis, Michael A. J. Ferguson, and Keri M. Shafer
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Male ,Cardiac Catheterization ,Time Factors ,Heart disease ,medicine.medical_treatment ,Contrast Media ,030204 cardiovascular system & hematology ,Kidney ,urologic and male genital diseases ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,030212 general & internal medicine ,Cardiac catheterization ,education.field_of_study ,Acute kidney injury ,General Medicine ,Acute Kidney Injury ,Middle Aged ,Prognosis ,female genital diseases and pregnancy complications ,Creatinine ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Glomerular Filtration Rate ,Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Adolescent ,Population ,Renal function ,Risk Assessment ,Young Adult ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Male gender ,Dialysis ,Retrospective Studies ,business.industry ,medicine.disease ,chemistry ,business ,Biomarkers - Abstract
BACKGROUND Adults with congenital heart disease (ACHD) are vulnerable to contrast-induced acute kidney injury (CI-AKI) after cardiac catheterization. The aim of this study was to identify risk factors for clinically significant CI-AKI and evaluate the predictive value of contrast volume to estimated glomerular filtration rate ratio (V/eGFR) for the risk of CI-AKI following catheterization in the ACHD population. METHODS ACHD patients who underwent catheterization at Boston Children's hospital between 1/2011 and 1/2017 were retrospectively analyzed. CI-AKI was defined as an increase in serum creatinine ≥0.3 mg/dL within 48 hr or ≥1.5 times baseline within 7 days of procedure. Controls without CI-AKI were matched for calendar year of catheterization with cases using a 3:1 ratio. RESULTS Of 453 catheterizations meeting inclusion criteria, 27 catheterizations (5.9%) were complicated by CI-AKI, with dialysis being used to manage renal dysfunction in five of these events. Older age, male gender, admission prior to catheterization, and V/eGFR ratio were found to be related to risk of CI-AKI. Patients with a V/eGFR ≥ 2.6 had a significantly higher risk of CI-AKI (OR = 6.4; 95% CI = 2.0-20.4; P = 0.002). Survival at 3 years post-catheterization, was significantly shorter for CI-AKI cases compared to controls (49% versus 97%; P < 0.001) even in those with return to baseline renal function prior to discharge (60% versus 97%, P < 0.001). CONCLUSION In ACHD patients undergoing cardiac catheterization, a higher V/eGFR ratio is a strong predictor of clinically significant CI-AKI. Development of CI-AKI is a poor prognostic indicator and is associated with decreased survival in this population.
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- 2018
13. Echocardiographic predictors of neonatal illness severity in fetuses with critical left heart obstruction with intact or restrictive atrial septum
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Lynn A. Sleeper, Kevin G. Friedman, Monika Drogosz, Laura Gellis, Henry Cheng, Minmin Lu, Catherine K. Allan, Audrey C. Marshall, and Wayne Tworetzky
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Heart Septal Defects, Atrial ,Ultrasonography, Prenatal ,Pulmonary vein ,Hypoplastic left heart syndrome ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Internal medicine ,Hypoplastic Left Heart Syndrome ,Fetal intervention ,medicine ,Humans ,Genetics (clinical) ,Retrospective Studies ,Heart septal defect ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Hypoxia (medical) ,medicine.disease ,Fetal Diseases ,Stenosis ,Echocardiography ,Atresia ,Cardiology ,Female ,medicine.symptom ,business ,Boston - Abstract
Neonates with critical left heart obstruction and intact atrial septum (IAS) or restrictive atrial septum (RAS) are at risk for hypoxia within hours of birth and remain a group at high risk for mortality.Prenatally diagnosed fetuses with critical left heart obstruction and IAS or RAS with follow-up from January 1, 2005, to February 14, 2017, were included. Primary outcome was a composite measure of severe neonatal illness (pH 7.15, venous pH 7.10, bicarbonate 16 mmol/L, lactic acid 5 mmol/L, or median oxygen saturation 60% within 2 hours of birth).Of 68 live born fetuses, 52 (76.5%) had hypoplastic left heart syndrome, 14 (20.5%) had critical aortic stenosis, and two (3%) had complex anatomy with mitral stenosis/atresia. There were 27 (39.7%) fetuses with IAS and 41 (60.3%) with RAS. Severe neonatal illness was present in 36 (52.9%). The strongest discriminators for severe neonatal illness were a pulmonary vein A:R VTI ≤ 2.7 (P 0.001, AUC 0.93) and larger pulmonary vein diameter (P = 0.025, AUC 0.77). A:R VTI ≤ 2.7 predicted death or transplant (log-rank P = 0.03).In neonates with hypoplastic left heart syndrome and IAS or RAS, A:R VTI ≤ 2.7 is predictive of severe neonatal instability. This threshold can help guide resource planning, delivery management, and improve fetal intervention criteria.
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- 2018
14. Morphologic and histologic findings in bioprosthetic valves explanted from the mitral position in children younger than 5 years of age
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Michele Borisuk, Sitaram M. Emani, Christopher W. Baird, Stephen P. Sanders, Kimberlee Gauvreau, Robert F. Padera, and Laura Gellis
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Population ,Pannus ,030204 cardiovascular system & hematology ,Prosthesis Design ,Bioprosthetic valve ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Mitral Valve Stenosis ,Thrombus ,education ,Device Removal ,Retrospective Studies ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,education.field_of_study ,business.industry ,Foreign-Body Reaction ,Age Factors ,Mitral valve replacement ,Calcinosis ,Infant ,Mitral Valve Insufficiency ,Thrombosis ,Hospitals, Pediatric ,medicine.disease ,Prosthesis Failure ,Surgery ,Stenosis ,030228 respiratory system ,Child, Preschool ,Heart Valve Prosthesis ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Boston ,Calcification - Abstract
Mitral valve replacement (MVR) in very young children is challenging. This study investigates the mechanisms for early bioprosthetic valve failure in very young patients through review of the macroscopic and microscopic findings in explanted bioprosthetic valves.Patients who underwent MVR with a bioprosthetic valve at Boston Children's Hospital between January 2010 to April 2016 at5 years of age were the subjects of this study. Valve failure was defined as prosthetic mitral valve explantation with mitral valve re-replacement.Bioprosthetic valves were used in 31 of 77 MVRs during the study period. Valve failure occurred in 10 patients (32%). Freedom from valve failure was 80% at 1 year and was associated with older age at implantation. On gross and microscopic evaluation, valve failure (predominantly stenosis) was found to be due to pannus deposition and intrinsic leaflet calcification.Successful long-term use of bioprosthetic valves in the mitral position in very young children continues to be a challenge. In addition to intrinsic calcification, excessive pannus deposition can lead to early bioprosthetic valve failure in this population. Early exuberant pannus growth appears due to thrombus deposition on the valves themselves and to the host's reaction to foreign material.
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- 2018
15. Late-term development of an atrial defect and thrombus formation after device fracture following successful transcatheter closure of an atrial septal defect with a STARFlex device
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Molly J. Rose, Laura Gellis, Lisa Bergersen, and Priscila C. Cevallos
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Cardiac Catheterization ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Treatment outcome ,030204 cardiovascular system & hematology ,Heart Septal Defects, Atrial ,03 medical and health sciences ,0302 clinical medicine ,Device removal ,Internal medicine ,Humans ,Medicine ,Heart Atria ,cardiovascular diseases ,030212 general & internal medicine ,Thrombus ,Device Removal ,Cardiac catheterization ,business.industry ,Infant ,Thrombosis ,General Medicine ,Atrial septal defect closure ,medicine.disease ,Prosthesis Failure ,Treatment Outcome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Heart atrium - Abstract
Development of a new defect following transcatheter closure of an atrial septal defect has yet to be reported. In this study, we present an acutely successful atrial septal defect closure with a STARFlex device, resulting in surgical explantation after discovery of device fracture, thrombus formation, and a second atrial defect 5 years after catheterisation. This case highlights the need for ongoing device surveillance, even in late follow-up.
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- 2016
16. Transcatheter balloon dilation for recurrent right ventricular outflow tract obstruction following valve-sparing repair of tetralogy of Fallot
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Laura Gellis, Puja Banka, Audrey C. Marshall, Sitaram M. Emani, and Diego Porras
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General Medicine ,Ventricular Outflow Obstruction ,Doppler echocardiography ,medicine.disease ,Surgery ,Stenosis ,medicine.anatomical_structure ,Internal medicine ,Pulmonary valve ,Cardiology ,medicine ,Balloon dilation ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Cardiac catheterization ,Tetralogy of Fallot - Abstract
Background Valve-sparing repair in patients with tetralogy of Fallot (TOF) carries the risk of residual or recurrent right ventricular outflow tract (RVOT) obstruction, which is often treated with transcatheter balloon dilation (BD). The outcomes and associated complications of BD of the RVOT in this scenario remain unknown. Methods Retrospective review of the records of the Department of Cardiology at Boston Children's Hospital from 2000 to 2013 was performed. Results 34 patients had initial valve-sparing repair of tetralogy of Fallot followed by BD of the RVOT during the study period. Following BD, the RVOT gradient decreased from a median of 43 mm Hg (range 13 to 79 mm Hg) to 28 mm Hg (range 0 to 73 mm Hg) (P 1 and a final RVOT gradient of ≥40 post-BD were associated with shorter freedom from reintervention (P
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- 2015
17. The boundaries of fetal cardiac intervention: Expand or tighten?
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Laura Gellis and Wayne Tworetzky
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Heart Defects, Congenital ,medicine.medical_specialty ,Disease ,030204 cardiovascular system & hematology ,Ultrasonography, Prenatal ,Hypoplastic left heart syndrome ,03 medical and health sciences ,0302 clinical medicine ,Fetal Heart ,Pregnancy ,Internal medicine ,Fetal intervention ,medicine ,Humans ,Fetus ,030219 obstetrics & reproductive medicine ,Interventional cardiology ,business.industry ,Prenatal Care ,medicine.disease ,Stenosis ,Treatment Outcome ,Pulmonary Atresia ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,business ,Pulmonary atresia ,Hypoplastic right heart syndrome - Abstract
Fetal cardiac intervention (FCI) is a relatively new and continually evolving field, and, for select cardiac defects, offers the potential to alter the progression of the disease and improve outcomes. It is a procedure that requires a collaborative effort between maternal-fetal medicine, interventional cardiology and fetal echo/ultrasound specialists, as well as fetal and maternal anesthesiologists, nursing specialists, and social workers. This article reviews the most recently reported data and advances in FCI. Currently, FCI is most frequently performed in fetuses with severe aortic stenosis (AS) with evolving hypoplastic left heart syndrome (eHLHS), established HLHS with intact or highly restrictive atrial septum (IAS), and pulmonary atresia with intact ventricular septum (PA-IVS) with evolving hypoplastic right heart syndrome (eHRHS). The goal of FCI for eHLHS and eHRHS is to promote a postnatal biventricular circulation with, theoretically, the potential for better long-term outcomes. In HLHS with IAS the aim is to improve survival. Contemporary data for FCI demonstrate limited maternal risks and improving technical success. With experience, FCI in severe AS with eHLHS has shown improved rates of biventricular outcome and early survival. Limited data for PA-IVS show promise for improving postnatal biventricular outcomes; however, for HLHS with IAS, FCI has yet to clearly demonstrate improved survival. FCI has an evolving role in the management of congenital heart defects. Ongoing analysis of disease progression, patient selection and postnatal outcomes, in conjuncture with technologic innovations and a multicenter collaborative approach, is essential as the field expands.
- Published
- 2017
18. Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with 'ALARA' principles profoundly lowers total dose
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Scott R. Ceresnak, Lynn Nappo, Laura Gellis, Robert H. Pass, and Gregory G. Gates
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Male ,Adolescent ,Demographics ,Patient demographics ,Radiation Dosage ,Radiography, Interventional ,Risk Assessment ,Kerma ,Radiation Protection ,Risk Factors ,Tachycardia, Supraventricular ,medicine ,Humans ,Fluoroscopy ,Radiation Injuries ,Radiometry ,medicine.diagnostic_test ,business.industry ,Radiation dose ,General Medicine ,Radiation exposure ,Treatment Outcome ,Surgery, Computer-Assisted ,Dose area product ,Anesthesia ,Total dose ,Pediatrics, Perinatology and Child Health ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Background: “ALARA – As Low As Reasonably Achievable” protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose. Methods: From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2–3 frames/second), low fluoro dose/frame (6–18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with “fast anatomical mapping” (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols. Results: A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (pConclusions: Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.
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- 2014
19. Pediatric patient radiation dosage during endomyocardial biopsies and right heart catheterization using a standard 'ALARA' radiation reduction protocol in the modern fluoroscopic Era
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Robert H. Pass, Nicole J. Sutton, Laura Gellis, and Jacqueline M. Lamour
- Subjects
medicine.medical_specialty ,Cardiac output ,medicine.diagnostic_test ,business.industry ,Hemodynamics ,General Medicine ,Transplantation ,Kerma ,Dose area product ,Biopsy ,Medicine ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary wedge pressure - Abstract
Background: Surveillance endomyocardial biopsy (EMB) with right heart catheterization (RHC) is the standard of care for the assessment of post cardiac transplantation rejection. This procedure has traditionally relied upon fluoroscopy, which exposes both patient and staff to the risks of ionizing radiation. These risks may be of particular concern in the transplant patient who must undergo many such procedures lifelong. We present data on a new “ALARA – As Low As Reasonably Achievable” protocol to reduce radiation exposure during the performance of RHC with EMB. Methods: All cardiac transplantation patients
- Published
- 2013
20. Reducing Patient Radiation Dosage during Pediatric SVT Ablations Using an 'ALARA' Radiation Reduction Protocol in the Modern Fluoroscopic Era
- Author
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Scott R. Ceresnak, Lynn Nappo, Gregory J. Gates, Laura Gellis, and Robert H. Pass
- Subjects
Body surface area ,Tachycardia ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General Medicine ,Ablation ,medicine.disease ,Ionizing radiation ,Kerma ,Dose area product ,medicine ,Fluoroscopy ,Radiology ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Background Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new “ALARA—As Low As Reasonably Achievable” protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach. Methods All patients
- Published
- 2013
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