Anthony Hlavacek

Publications

• 2.95

  Impact points

  Developmental Aortic Arch Anomalies in Infants and Children Assessed With CT Angiography.

  Luis Ramos-Duran, John W Nance, U Joseph Schoepf, Thomas Henzler, Paul Apfaltrer, Anthony M Hlavacek

  AJR. American journal of roentgenology. 05/2012; 198(5):W466-74.

  OBJECTIVE: The purpose of this article is to review the normal anatomy of the aortic arch and the most common variations of congenital aortic arch anomalies using low-radiation-dose, defined as a dose-length product of 7-15 mGy × cm, MDCT angiography. CONCLUSION: Radiologists should be prepared to f... [more] OBJECTIVE: The purpose of this article is to review the normal anatomy of the aortic arch and the most common variations of congenital aortic arch anomalies using low-radiation-dose, defined as a dose-length product of 7-15 mGy × cm, MDCT angiography. CONCLUSION: Radiologists should be prepared to fully describe congenital aortic arch anomalies; recognize them on CT angiography, especially the presence or absence of vascular rings or aberrant arteries; and explain their association with the trachea and esophagus.
• 1.15

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  Challenges in echocardiographic assessment of mitral regurgitation in children after repair of atrioventricular septal defect.

  Ashwin Prakash, Ronald V Lacro, Lynn A Sleeper, L Luann Minich, Steven D Colan, Brian McCrindle, Wesley Covitz, Fraser Golding, Anthony M Hlavacek, Jami C Levine, Meryl S Cohen

  Pediatric cardiology. 09/2011; 33(2):205-14.

  The validity and reproducibility of echocardiographic methods used to quantify mitral regurgitation (MR) in children with congenital heart disease are unknown. We evaluated the usefulness of methods used to quantify MR in children enrolled in a multicenter trial of enalapril 6 months after surgical ... [more] The validity and reproducibility of echocardiographic methods used to quantify mitral regurgitation (MR) in children with congenital heart disease are unknown. We evaluated the usefulness of methods used to quantify MR in children enrolled in a multicenter trial of enalapril 6 months after surgical repair of an atrioventricular septal defect (AVSD). MR severity in this trial was assessed using body surface area (BSA)-adjusted vena contracta lateral (i-VCW(lat)) and anterior-posterior (i-VCW(ap)) dimensions and cross-sectional area (i-VCA), regurgitant volume/BSA, regurgitant fraction, and qualitative MR grade. For each method, association with left ventricular end-diastolic volume (LVEDVz) and end-diastolic dimension (LVEDDz) z-scores and interobserver agreement were assessed. In 149 children (median age 1 year), i-VCW(lat), i-VCW(ap), and i-VCA were best associated with LVEDVz (r (2) = 0.54, r (2) = 0.24, and r (2) = 0.46, respectively; p < 0.001 for all) and showed the highest interobserver agreement (intraclass correlation coefficient = 0.62, 0.73, and 0.68, respectively). Qualitative MR grade was also associated with LVEDVz (r (2) = 0.31, p < 0.001) and showed modest interobserver agreement (kappa 0.56). Regurgitant volume/BSA and regurgitant fraction were associated with LVEDVz (r (2) = 0.45 and r (2) = 0.45, p < 0.001 for both) but showed poor interobserver agreement [ICC = 0.28 (n = 91) and ICC = 0.17 (n = 76), respectively], and their values were negative in 75% of subjects. In conclusion, echocardiographic assessment of MR severity after AVSD remains challenging. Among the quantitative methods used in this trial, i-VCW and i-VCA performed the best but offered little advantage compared with qualitative MR grade. The utility of regurgitant volume and fraction was severely limited by poor interobserver agreement and frequently negative values.
• 12.54

  Impact points

  Characterization of cardiac tumors in children by cardiovascular magnetic resonance imaging: a multicenter experience.

  Rebecca S Beroukhim, Ashwin Prakash, Emanuela R Valsangiacomo Buechel, Joseph R Cava, Adam L Dorfman, Pierluigi Festa, Anthony M Hlavacek, Tiffanie R Johnson, Marc S Keller, Rajesh Krishnamurthy, Nilanjana Misra, Stephane Moniotte, W James Parks, Andrew J Powell, Brian D Soriano, Monvadi B Srichai, Shi-Joon Yoo, Jing Zhou, Tal Geva

  Journal of the American College of Cardiology. 08/2011; 58(10):1044-54.

  The aim of this study was to report the results of an international multicenter experience of cardiac magnetic resonance imaging (MRI) evaluation of cardiac tumors in children, each with histology correlation or a diagnosis of tuberous sclerosis, and to determine which characteristics are predictive... [more] The aim of this study was to report the results of an international multicenter experience of cardiac magnetic resonance imaging (MRI) evaluation of cardiac tumors in children, each with histology correlation or a diagnosis of tuberous sclerosis, and to determine which characteristics are predictive of tumor type. Individual centers have relatively little experience with diagnostic imaging of cardiac tumors in children, because of their low prevalence. The accuracy of cardiac MRI diagnosis on the basis of a pre-defined set of criteria has not been tested. An international group of pediatric cardiac imaging centers was solicited for case contribution. Inclusion criteria comprised: 1) age at diagnosis ≤18 years; 2) cardiac MRI evaluation of cardiac tumor; and 3) histologic diagnosis or diagnosis of tuberous sclerosis. Data from the cardiac MRI images were analyzed for mass characteristics. On the basis of pre-defined cardiac MRI criteria derived from published data, 3 blinded investigators determined tumor type, and their consensus diagnoses were compared with histologic diagnoses. Cases (n = 78) submitted from 15 centers in 4 countries had the following diagnoses: fibroma (n = 30), rhabdomyoma (n = 14), malignant tumor (n = 12), hemangioma (n = 9), thrombus (n = 4), myxoma (n = 3), teratoma (n = 2), and paraganglioma, pericardial cyst, Purkinje cell tumor, and papillary fibroelastoma (n = 1, each). Reviewers who were blinded to the histologic diagnoses correctly diagnosed 97% of the cases but included a differential diagnosis in 42%. Better image quality grade and more complete examination were associated with higher diagnostic accuracy. Cardiac MRI can predict the likely tumor type in the majority of children with a cardiac mass. A comprehensive imaging protocol is essential for accurate diagnosis. However, histologic diagnosis remains the gold standard, and in some cases malignancy cannot be definitively excluded on the basis of cardiac MRI images alone.
• 1.18

  Impact points

  Veno-venous bridges: the forerunners of the sinus venosus defect.

  Ryan J Butts, Andrew M Crean, Anthony M Hlavacek, Diane E Spicer, Andrew C Cook, Erwin N Oechslin, Robert H Anderson

  Cardiology in the young. 05/2011; 21(6):623-30.

  Differentiation of the so-called sinus venosus defect from other defects permitting shunting between the atrial chambers remains problematic. The lesion is not a true septal defect, and current theories to explain the existence of the sinus venosus defect fall short. The presence of persistent syste... [more] Differentiation of the so-called sinus venosus defect from other defects permitting shunting between the atrial chambers remains problematic. The lesion is not a true septal defect, and current theories to explain the existence of the sinus venosus defect fall short. The presence of persistent systemic to pulmonary venous connections has been proposed to explain the existence of the sinus venosus defect. Clinical histories and radiological findings of six patients are reviewed. Three patients have veno-venous bridges, two have partial anomalous pulmonary venous connections, and one patient has a sinus venosus defect. The clinical information is reviewed, along with current developmental and morphological considerations. We provide radiographic, developmental, and morphological evidence to support the theory that a so-called sinus venosus defect is the consequence of persistence of foetal systemic to pulmonary veno-venous bridges, rather than of deficiencies in atrial septation.

• Recurrent subaortic membrane causing subvalvular aortic stenosis 13 years after primary surgical resection.

  Richard Takx, U Joseph Schoepf, Brad Friedman, Anthony M Hlavacek, Thomas Henzler

  Journal of cardiovascular computed tomography. 01/2011; 5(2):127-8.

  This case demonstrates the use of cardiac CT angiography as part of the preoperative evaluation of a recurrent subaortic membrane in a 23-year-old women. A subaortic membrane is a rare finding on coronary CT angiography and typically consists of a thin fibrous membrane in the left ventricular outflo... [more] This case demonstrates the use of cardiac CT angiography as part of the preoperative evaluation of a recurrent subaortic membrane in a 23-year-old women. A subaortic membrane is a rare finding on coronary CT angiography and typically consists of a thin fibrous membrane in the left ventricular outflow tract (LVOT). The resulting turbulent flow may lead to LVOT obstruction and aortic insufficiency.
• 1.18

  Impact points

  Anomalous origin and course of the coronary arteries.

  Anthony Hlavacek, Marios Loukas, Diane Spicer, Robert H Anderson

  Cardiology in the young. 12/2010; 20 Suppl 3:20-5.

  In the normal heart, the right and left coronary arteries arise from the aortic valvar sinuses adjacent to the pulmonary trunk. The right coronary artery then directly enters the right atrioventricular groove, whereas the main stem of the left coronary artery runs a short course before dividing to b... [more] In the normal heart, the right and left coronary arteries arise from the aortic valvar sinuses adjacent to the pulmonary trunk. The right coronary artery then directly enters the right atrioventricular groove, whereas the main stem of the left coronary artery runs a short course before dividing to become the anterior interventricular and circumflex arteries. These arteries can have an anomalous origin from either the aorta or pulmonary trunk; their branches can have various anomalous origins relative to arterial pedicles. Other abnormal situations include myocardial bridging, abnormal communications, solitary coronary arteries, and duplicated arteries. Understanding of these variations is key to determining those anomalous patterns associated with sudden cardiac death. In the most common variant of an anomalous origin from the pulmonary trunk, the main stem of the left coronary artery arises from the sinus of the pulmonary trunk adjacent to the anticipated left coronary arterial aortic sinus. The artery can, however, arise from a pulmonary artery, or the right coronary artery can have an anomalous pulmonary origin. The key feature in the anomalous aortic origin is the potential for squeezing of the artery, produced by either the so-called intramural origin from the aorta, or the passage of the abnormal artery between the aortic root and the subpulmonary infundibulum.
• 5.39

  Impact points

  Coronary artery dilation in LEOPARD syndrome: surveillance with low radiation dose cardiac CT.

  Matthias Renker, U Joseph Schoepf, Anthony M Hlavacek

  Heart (British Cardiac Society). 09/2010; 96(17):1429.
• 3.54

  Impact points

  Evaluation of the myocardial performance index and tissue doppler imaging by comparison to near-simultaneous catheter measurements in pediatric cardiac transplant patients.

  Andrew Savage, Anthony Hlavacek, Jeremy Ringewald, Girish Shirali

  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 08/2010; 29(8):853-8.

  Parameters derived from Doppler echocardiography, such as the myocardial performance index (MPI) and the ratio of peak velocity of early diastolic prograde flow (E) across the atrioventricular valve (AVV) divided by the peak velocity of early diastolic tissue motion at the AVV annulus (E') (E:E&... [more] Parameters derived from Doppler echocardiography, such as the myocardial performance index (MPI) and the ratio of peak velocity of early diastolic prograde flow (E) across the atrioventricular valve (AVV) divided by the peak velocity of early diastolic tissue motion at the AVV annulus (E') (E:E' ratio), are routinely used to assess ventricular function. However, they have not been compared with measurements obtained by cardiac catheterization (CC) in children. We prospectively studied post-cardiac transplant children undergoing CC with near-simultaneous echocardiographic imaging for MPI and E:E'. CC data included right atrial pressure (RAp), pulmonary artery wedge pressure (PAWp) and cardiac index (CI). One investigator, who was blinded to the CC data, measured right ventricular (RV) and left ventricular (LV) MPI and E:E' offline. Correlations between echocardiographic and catheter measurements were calculated. Receiver-operating-characteristics (ROC) curves were created to evaluate the utility of echocardiographic measurements that exhibited statistically significant correlations with CC measurements. Twenty-four patients (age range 0.8 to 21 years) underwent 142 CCs during the study period. Of the 12 correlations studied, 3 met statistical significance (p < 0.05) (RV E:E' vs RAp, RV E:E' vs PAWp and LV MPI vs CI). The ROC areas for these correlations were 0.38, 0.42 and 0.68, respectively. There were no cut-off points where both the sensitivity and specificity for any measurement were >0.80. Our data suggest that MPI and E:E' are poor predictors of simultaneously obtained, catheter-derived hemodynamic parameters in post-transplant children. These limitations should be carefully considered before ascribing diagnostic value to these measurements.
• 1.42

  Impact points

  Imaging of congenital cardiovascular disease: the case for computed tomography.

  Anthony Marcus Hlavacek

  Journal of thoracic imaging. 08/2010; 25(3):247-55.

  Computed tomographic angiography is a rapidly evolving modality that is well suited for congenital cardiac imaging. Although echocardiography and magnetic resonance imaging carry an established role for evaluating patients with congenital cardiovascular disease, computed tomographic angiography prov... [more] Computed tomographic angiography is a rapidly evolving modality that is well suited for congenital cardiac imaging. Although echocardiography and magnetic resonance imaging carry an established role for evaluating patients with congenital cardiovascular disease, computed tomographic angiography provides important advantages over each of these modalities in certain clinical scenarios. Its practicality, high spatial resolution, inherent 3-dimensional nature, and decreased need for sedation make it a very useful tool in this patient population. This study reviews the utility of computed tomographic angiography and addresses the risks and benefits of this modality in comparison with other imaging modalities. Despite the exposure to ionizing radiation, newer technologies and techniques are being introduced that are decreasing the risks associated with computed tomographic imaging to exceedingly small levels. When viewed in the context of other risks these patients encounter, computed tomographic angiography is a useful adjunct to echocardiography in patients with congenital heart disease and is often preferable to magnetic resonance imaging in certain patients.
• 1.18

  Impact points

  Utility of computed tomographic angiography in the pre-operative planning for initial and repeat congenital cardiovascular surgery.

  Alexander R Ellis, Denise Mulvihill, Scott M Bradley, Anthony M Hlavacek

  Cardiology in the young. 03/2010; 20(3):262-8.

  To investigate the utility of computed tomographic angiography as an adjunctive imaging modality before congenital cardiac surgery. We evaluated 33 patients who underwent a pre-operative computed tomographic angiogram. They were classified according to the anatomic site of repair. Post-operatively, ... [more] To investigate the utility of computed tomographic angiography as an adjunctive imaging modality before congenital cardiac surgery. We evaluated 33 patients who underwent a pre-operative computed tomographic angiogram. They were classified according to the anatomic site of repair. Post-operatively, the surgeon completed a questionnaire assessing the utility of the study. Computed tomographic angiography was found to be either "essential" or "very useful" for pre-operative planning in 94% of the patients. Specifically, the scan was consistently useful for procedures involving the aorta (14/15, 93%) or the pulmonary veins (4/4, 100%) and obviated pre-operative catheterisations in 14 patients (42%). Furthermore, when compared with other diagnostic groups, computed tomographic angiography determined the need for peripheral cannulation in patients undergoing re-operations (6/7; 86%, p = 0.02). Computed tomographic angiography was found to be useful in the pre-operative planning of virtually all patients undergoing repair of congenital cardiac malformations, regardless of diagnosis. Specifically, the studies were essential in select populations, such aortic arch or pulmonary vein repairs, and helped to determine cannulation sites for repeat operations while significantly reducing the need for invasive imaging.

• Clinico-morphological correlations in the categorization of holes between the ventricles

  Brad Friedman, Anthony Hlavacek, Karen Chessa, Girish Shirali, Eowyn Corcrain, Diane Spicer, Robert Anderson, Sinai Zyblewski

  Annals of Pediatric Cardiology. 01/2010;

  Controversy still exists in the categorization of holes between the ventricles, although they are the most common congenital cardiac malformation. Advanced imaging techniques such as three-dimensional echocardiography and computed tomographic angiography offer superb anatomical details of these defe... [more] Controversy still exists in the categorization of holes between the ventricles, although they are the most common congenital cardiac malformation. Advanced imaging techniques such as three-dimensional echocardiography and computed tomographic angiography offer superb anatomical details of these defects. In this review, we have sought to collate the features highlighted in different categorizations and identify their similarities, but also emphasize their differences. We hope that an analysis of this type, now achievable during life, using advanced imaging, might lead to the appearance of a unified system for diagnosis and description of holes between the ventricles.

• Clinico-morphological correlations in the categorization of holes between the ventricles.

  Brad A Friedman, Anthony Hlavacek, Karen Chessa, Girish S Shirali, Eowyn Corcrain, Diane Spicer, Robert H Anderson, Sinai Zyblewski

  Annals of pediatric cardiology. 01/2010; 3(1):12-24.

  Controversy still exists in the categorization of holes between the ventricles, although they are the most common congenital cardiac malformation. Advanced imaging techniques such as three-dimensional echocardiography and computed tomographic angiography offer superb anatomical details of these defe... [more] Controversy still exists in the categorization of holes between the ventricles, although they are the most common congenital cardiac malformation. Advanced imaging techniques such as three-dimensional echocardiography and computed tomographic angiography offer superb anatomical details of these defects. In this review, we have sought to collate the features highlighted in different categorizations and identify their similarities, but also emphasize their differences. We hope that an analysis of this type, now achievable during life, using advanced imaging, might lead to the appearance of a unified system for diagnosis and description of holes between the ventricles.
• 1.18

  Impact points

  Innovation in three-dimensional echocardiography and cardiac computed tomographic angiography.

  Anthony M Hlavacek, G Hamilton Baker, Girish S Shirali

  Cardiology in the young. 11/2009; 19 Suppl 2:35-42.
• 1.15

  Impact points

  Chromosomal Anomalies Influence Parental Treatment Decisions in Relation to Prenatally Diagnosed Congenital Heart Disease.

  Sinai Zyblewski, Elizabeth Hill, Girish Shirali, Andrew Atz, Geoffrey Forbus, Javier Gonzalez, Anthony Hlavacek

  Pediatric cardiology. 09/2009;

  This study aimed to identify the variables that influence parental treatment decisions after a prenatal diagnosis of congenital heart disease (CHD). The authors reviewed all cases of prenatally diagnosed structural CHD from August 1998 to December 2006 at their center. The following variables were s... [more] This study aimed to identify the variables that influence parental treatment decisions after a prenatal diagnosis of congenital heart disease (CHD). The authors reviewed all cases of prenatally diagnosed structural CHD from August 1998 to December 2006 at their center. The following variables were studied as potential predictors of parental intent to treat: maternal age, race, insurance status, obstetric history, fetal gender, univentricular versus biventricular cardiac physiology, and fetal chromosomal abnormality. Uni- and multivariable logistic regression analyses were performed. In the review, 252 consecutive cases of prenatally diagnosed CHD were identified. Of these, 204 women pursued full medical treatment, whereas 25 women sought termination of pregnancy or comfort care. Parental intent to treat was unknown for 23 cases. Multivariable logistic regression analysis identified fetal chromosomal abnormality as the only variable that influenced parental intent to treat (odds ratio [OR], 14.33; 95% confidence interval [CI], 3.28-62.66; p = 0.0006). An associated chromosomal abnormality rather than the severity of the heart defect influences the decision to choose termination of pregnancy or comfort care for a fetus with prenatally diagnosed CHD. Women were 14 times more likely to terminate a pregnancy or seek comfort care for a fetus with CHD if a chromosomal abnormality was present.
• 1.15

  Impact points

  Computed Tomographic Angiography of Infants with Congenital Heart Disease Receiving Extracorporeal Membrane Oxygenation.

  Brad Friedman, U Schoepf, Gorka Bastarrika, Anthony Hlavacek

  Pediatric cardiology. 08/2009;

  Patients with respiratory and/or cardiac failure occasionally require the use of extracorporeal membrane oxygenation (ECMO), which presents an obstacle for standard imaging modalities. Computed tomographic angiography (CTA) can be used in patients with congenital heart disease, usually to define ext... [more] Patients with respiratory and/or cardiac failure occasionally require the use of extracorporeal membrane oxygenation (ECMO), which presents an obstacle for standard imaging modalities. Computed tomographic angiography (CTA) can be used in patients with congenital heart disease, usually to define extra-cardiac anatomy in the chest. We describe the use of CTA to evaluate two infants with congenital heart disease while on ECMO. The first infant had totally anomalous pulmonary venous connection, and the second had a pulmonary sling that resulted in tracheal stenosis. The studies achieved high diagnostic quality with minimal radiation exposure. Subsequently, both infants had successful surgical repairs.
• 1.15

  Impact points

  Universal Screening for Extracardiac Abnormalities in Neonates with Congenital Heart Disease.

  Javier Gonzalez, Girish Shirali, Andrew Atz, Sarah Taylor, Geoffrey Forbus, Sinai Zyblewski, Anthony Hlavacek

  Pediatric cardiology. 12/2008;

  Extracardiac or genetic abnormalities (EGA) represent a factor in the morbidity of patients with congenital heart disease. We evaluated the way neonates with CHD are screened at our institution and determined the yield for the screening tests. We reviewed the charts of 223 neonates with structural C... [more] Extracardiac or genetic abnormalities (EGA) represent a factor in the morbidity of patients with congenital heart disease. We evaluated the way neonates with CHD are screened at our institution and determined the yield for the screening tests. We reviewed the charts of 223 neonates with structural CHD. Subjects were categorized into 6 groups: univentricular, left-sided obstructive lesions, right-sided obstructive lesions, septal defects, conotruncal defects (CTD), and other. We reviewed which patients underwent cranial ultrasonogram (CUS), abdominal ultrasonogram (AUS), and/or genetic studies (GS) as well as their results. There was a high prevalence of EGA in each group by CUS (32% to 42%), AUS (32% to 69%), and GS (10% to 60%). There was considerable variability in the proportion within each group that underwent screening tests, and the consistency of screening often was not congruent with the likelihood of abnormal results. Approximately 50% of our patients had >/=1 EGA identified, resulting in a cost-yield ratio of $4,508/patient with EGA. Screening for EGA at our institution is not uniform and is often at odds with the prevalence of such patients. Given the high prevalence of EGA, we advocate for a universal screening program for neonates with CHD using cranial/abdominal ultrasonography and genetic testing.
• 2.98

  Impact points

  Left ventricular dysfunction is associated with intraventricular dyssynchrony by 3-dimensional echocardiography in children.

  G Hamilton Baker, Anthony M Hlavacek, Karen S Chessa, Dawn M Fleming, Girish S Shirali

  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 04/2008; 21(3):230-3.

  INTRODUCTION: We used 3-dimensional (3D) echocardiography to identify and quantify left ventricular (LV) dyssynchrony in children with LV dysfunction compared with control subjects. METHODS: The 3D echocardiography LV full volumes were acquired in 18 children, 9 with LV dysfunction and 9 control sub... [more] INTRODUCTION: We used 3-dimensional (3D) echocardiography to identify and quantify left ventricular (LV) dyssynchrony in children with LV dysfunction compared with control subjects. METHODS: The 3D echocardiography LV full volumes were acquired in 18 children, 9 with LV dysfunction and 9 control subjects. The LV was subdivided into 16 segments (apex excluded). Time from end diastole to the minimal systolic volume for each segment was expressed as a percent of the R-R interval. The SD of these times provided a 16-segment dyssynchrony index (16-SDI). The second index (12-SDI) was similarly calculated using 6 basal and 6 mid segments. The third index consisted of 6 basal segments (6-SDI). RESULTS: The dysfunction group exhibited significantly increased 16-SDI (P = .008) and 12-SDI (P = .01). The 16-SDI was negatively correlated with 3D ejection fraction and 2-dimensional fractional shortening. CONCLUSIONS: Children with LV dysfunction demonstrate increased intraventricular LV dyssynchrony by 3D echocardiography, in a pattern that is negatively correlated with LV systolic function.
• 1.58

  Impact points

  Contrasting effects of convective flow on catheter ablation lesion size: cryo versus radiofrequency energy.

  Thomas A Pilcher, J Philip Saul, Anthony M Hlavacek, Dieter Haemmerich

  Pacing and clinical electrophysiology : PACE. 03/2008; 31(3):300-7.

  BACKGROUND: Cryoablation has now become an alternative to treat many cardiac arrhythmias, and may be the treatment of choice in some patient populations. We compared the effects of convective flow on large-tip cryo and radiofrequency (RF) lesions dimensions. METHODS: Cryoablation and RF ablation wer... [more] BACKGROUND: Cryoablation has now become an alternative to treat many cardiac arrhythmias, and may be the treatment of choice in some patient populations. We compared the effects of convective flow on large-tip cryo and radiofrequency (RF) lesions dimensions. METHODS: Cryoablation and RF ablation were performed on porcine heart sections in a saline bath with varying directed flow rates. Cryoablation was performed for 4 minutes on 50 tissue pieces with tip temperature controlled at -80 degrees C. RF ablation was performed on 50 tissue pieces for 60 seconds at 60 degrees C tip temperature. The pieces were placed in culture media for 24 hours, and then sectioned, stained, and measured. RESULTS: Cryoablation and RF lesion sizes varied significantly with flow such that higher flow rates produced smaller cryoablation lesions and larger RF lesions (mean cryoablation volumes: 854 +/- 402, 808 +/- 217, 781 +/- 217, 359 +/- 114, and 292 +/- 117 mm(3), and mean RF volumes: 211 +/- 35, 304 +/- 79, 439 +/- 125, 525 +/- 187, and 597 +/- 126 mm(3) for 0, 1, 2, 3, and 5 L/min flow rates, respectively, P < 0.0005). Trabeculated pieces had larger cryoablation lesions and smaller RF lesions than nontrabeculated ones at higher flow rate (P < 0.005). Cryoablation lesion volume increased as the time to reach -80 degrees C decreased (r(2)= 0.72). CONCLUSION: In contrast to RF ablation, cryoablation lesion size is smaller at high flow rates, and larger at low flow rates due to the warming effects of local convective flow. The effects of high flow are reduced in areas of trabeculation, and the time to reach -80 degrees C predicts cryoablation lesion size.

• Variability and resource utilization of bedside three-dimensional echocardiographic quantitative measurements of left ventricular volume in congenital heart disease.

  George Baker, English Flack, Anthony Hlavacek, Karen Chessa, Dawn Fleming, Mark Scheurer, Girish Shirali

  Congenital heart disease. 12/2006; 1(6):309-14.

  OBJECTIVES: This study evaluated the variability and time resource utilization of bedside 3-dimensional echocardiographic left ventricular volume analysis (3D-LVVA) in congenital heart disease (CHD). Background. There are currently limited data on the resource utilization and variability of 3D-LVVA ... [more] OBJECTIVES: This study evaluated the variability and time resource utilization of bedside 3-dimensional echocardiographic left ventricular volume analysis (3D-LVVA) in congenital heart disease (CHD). Background. There are currently limited data on the resource utilization and variability of 3D-LVVA in the CHD. METHODS: Four reviewers of varying experience levels were timed performing 15 on-scanner 3D-LVVAs. Inter- and intraobserver variability for left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF) was evaluated. RESULTS: Median age was 12.7 years (0.6-33 years). Diagnoses were: normal (n = 4), cardiomyopathy (n = 4), ventricular septal defect (n = 2), and atrioventricular canal, tricuspid atresia, bicuspid aortic valve, left ventricular hypertrophy, and heart transplant (n = 1 each). For interobserver variability, intraclass correlation coefficients (ICCs) for all possible combinations of reviewers were: LVEDV, 0.991-0.999 (P < .01); LVESV, 0.98-0.99 (P < .01); LVEF, 0.95-0.98 (P < .01). Bland-Altman plot mean differences (+/-2SD) were: LVEDV, -3 +/- 14%; LVESV, -5.4 +/- 21.4%; LVEF, 1.2 +/- 14.7%. Interobserver variability of LVESV was not dependent on ventricular volumes (P = .25; r(2) = 0.01) or heart rate (P = .43; r(2) = 0.003). For intraobserver variability, ICCs for 2 reviewers were LVEDV, 0.99, 0.99 (P < .01); LVESV, 0.99, 0.99 (P < .01); and LVEF, 0.94, 0.94 (P < .01), respectively. Bland-Altman plot mean differences (+/-2SD) were: LVEDV, -1 +/- 9.2%; LVESV, 0 +/- 19.6%; LVEF, -2.2 +/- 24%. CONCLUSION: Reviewers with varying experience levels can accomplish 3D-LVVA at the bedside with acceptable inter- and intraobserver reproducibility, providing the rationale for integrating 3D-LVVA into the care of CHD patients.

• Transcatheter device occlusion of multiple large pulmonary arteriovenous malformations in two symptomatic pediatric patients.

  Alexander R Ellis, Anthony M Hlavacek, Varsha M Bandisode, Jeremy M Ringewald

  Congenital heart disease. 12/2006; 1(6):327-31.

  Pulmonary arteriovenous malformations (AVMs) large enough to lead to clinically significant cyanosis are rare in the pediatric population. To date, there has been some experience with transcatheter embolization of pulmonary AVMs in children, primarily with coils or balloons. Herein, we report 2 case... [more] Pulmonary arteriovenous malformations (AVMs) large enough to lead to clinically significant cyanosis are rare in the pediatric population. To date, there has been some experience with transcatheter embolization of pulmonary AVMs in children, primarily with coils or balloons. Herein, we report 2 cases of children who were progressively symptomatic and had physical manifestations of hypoxemia arising from large pulmonary AVMs. Both improved after successful catheter-based placement of multiple occlusion devices (Amplatzer vascular plugs) in the pulmonary arterial segments feeding the AVMs produced a rapid, sustained increase in oxygen saturations, and a subsequent amelioration of their symptoms. This represents the first case series of multiple Amplatzer vascular plugs placed into numerous arteriovenous formations, exclusively in children. This approach represents an additional nonsurgical option for children or adults with symptomatic pulmonary AVMs.