Shelby Kutty

University of Nebraska Medical Center, Omaha, Nebraska, United States

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Publications (96)298.8 Total impact

  • American Heart Association, Chicago , IL 2014; 11/2014
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    ABSTRACT: No expert consensus guides practice for intensity of ongoing pediatric cardiology surveillance of hemodynamically insignificant small and moderate muscular ventricular septal defect (mVSD). Therefore, despite the well-established benign natural history of mVSD, there is potential for widely divergent follow up practices. The purpose of this investigation was to evaluate (1) variations in follow up of mVSD within an academic children's hospital based pediatric cardiology practice, and (2) the frequency of active medical or surgical management resulting from follow up of mVSD.
    BMC Pediatrics 11/2014; 14(1):282. · 1.98 Impact Factor
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    ABSTRACT: The purpose of this investigation was to test the hypothesis that flow patterns in the right ventricle are abnormal in patients with repaired tetralogy of Fallot (TOF). High-resolution echocardiographic contrast particle imaging velocimetry was used to investigate rotation intensity and kinetic energy dissipation of right ventricular (RV) flow in patients with TOF compared with normal controls. Forty-one subjects (16 with repaired TOF and varying degrees of RV dilation and 25 normal controls) underwent prospective contrast imaging using the lipid-encapsulated microbubble (Definity) on Sequoia systems. A mechanical index of 0.4, three-beat high-frame rate (>60 Hz) captures, and harmonic frequencies were used. Rotation intensity and kinetic energy dissipation of flow in the right and left ventricles were studied (Hyperflow). Ventricular volumes and ejection fractions in all subjects were derived from same-day cardiac magnetic resonance (CMR). Measurable planar maps were obtained for the left ventricle in 14 patients and the right ventricle in 10 patients among those with TOF and for the left ventricle in 23 controls and the right ventricle in 21 controls. Compared with controls, the TOF group had higher RV indexed end-diastolic volumes (117.8 ± 25.5 vs 88 ± 15.4 mL/m(2), P < .001) and lower RV ejection fractions (44.6 ± 3.6% vs 51.8 ± 3.6%, P < .001). Steady-streaming (heartbeat-averaged) flow rotation intensities were higher in patients with TOF for the left ventricle (0.4 ± 0.13 vs 0.29 ± 0.08, P = .012) and the right ventricle (0.53 ± 0.15 vs 0.26 ± 0.12, P < .001), whereas kinetic energy dissipation in TOF ventricles was lower (for the left ventricle, 0.51 ± 0.29 vs 1.52 ± 0.69, P < .001; for the right ventricle, 0.4 ± 0.24 vs 1.65 ± 0.91, P < .001). It is feasible to characterize RV and left ventricular flow parameters and planar maps in adolescents and adults with repaired TOF using echocardiographic contrast particle imaging velocimetry. Intraventricular flow patterns in the abnormal and/or enlarged right ventricle in patients with TOF differ from those in normal young adults. The rotation intensity and energy dissipation trends in this investigation suggest that they may be quantitative markers of RV and left ventricular compliance abnormalities in patients with repaired TOF. This hypothesis merits further investigation. Copyright © 2014 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 10/2014; 27(12):1311-1318. · 2.98 Impact Factor
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    ABSTRACT: Cardiovascular magnetic resonance feature tracking (CMR-FT) offers quantification of myocardial deformation from routine cine images. However, data using CMR-FT to quantify left ventricular (LV) torsion and diastolic recoil are not yet available. We therefore sought to evaluate the feasibility and reproducibility of CMR-FT to quantify LV torsion and peak recoil rate using an optimal anatomical approach.
    PLoS ONE 10/2014; 9(10):e109164. · 3.53 Impact Factor
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    ABSTRACT: We present the anatomic constellation of mitral stenosis/aortic atresia variant of hypoplastic left heart syndrome, Ebstein's anomaly, and partial anomalous pulmonary venous return, an exceeding rare congenital heart defect. Prenatal echocardiography led to concern about the capacity of the right ventricle to increase cardiac output with lung expansion and pulmonary arterial runoff at birth, prompting the precaution of extracorporeal membrane oxygenator standby at delivery. Stage I palliation was not attempted, and control of pulmonary arterial blood flow was achieved with pulmonary artery banding, allowing sufficient ongoing hemodynamic stability. Orthotopic cardiac transplantation, repair of hypoplastic aortic arch, and primary sutureless repair of left pulmonary veins was performed, using dual-site arterial cannulation and continuous mild hypothermic cardiopulmonary bypass. We discuss how this unique echocardiographic anatomy influenced the surgical decision and point out how it guided therapy toward a strategy of primary transplantation rather than standard staged surgical palliation.
    Echocardiography 10/2014; · 1.26 Impact Factor
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    ABSTRACT: Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect. We aimed to examine the role of cardiac magnetic resonance imaging (MRI) in the long-term surveillance of repaired ALCAPA with regard to myocardial scarring, wall motion abnormalities, perfusion deficits, and myocardial function. Methods Twenty-one patients after direct reimplantation of ALCAPA (median age at operation, 2.8 years) were examined after a median 10.6 years by MRI at rest and under dobutamine stress conditions, echocardiography, and ergometry. Results were compared with preoperative, immediately postoperative (5 days), and intermediate-term (5.8 years) echocardiography. Results No early or late deaths occurred. Improvements in indexed left ventricular end-diastolic dimension, ejection fraction, and mitral valve function were observed in all patients. However, MRI at rest showed wall motion abnormalities in 67% and perfusion deficits in 28%. Myocardial scars were seen in 67%. Dobutamine stress MRI detected wall motion abnormalities in 19% and perfusion deficits in 14%, which were not seen on MRI at rest. Exercise testing did not reflect cardiac dysfunction. Conclusions Although long-term follow-up showed global left ventricular function had improved after ALCAPA repair, MRI showed left ventricular wall motion abnormalities, perfusion deficits, and myocardial scarring were seen in many patients. Dobutamine stress MRI identified deficits that were not evident on MRI at rest, and can therefore be considered a valuable surveillance tool. These results suggest the need for lifelong surveillance of repaired ALCAPA.
    The Annals of Thoracic Surgery 10/2014; · 3.45 Impact Factor
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    ABSTRACT: Cardiovascular Magnetic Resonance myocardial feature tracking (CMR-FT) is a quantitative technique tracking tissue voxel motion on standard steady-state free precession (SSFP) cine images to assess ventricular myocardial deformation. The importance of left atrial (LA) deformation assessment is increasingly recognized and can be assessed with echocardiographic speckle tracking. However atrial deformation quantification has never previously been demonstrated with CMR. We sought to determine the feasibility and reproducibility of CMR-FT for quantitative derivation of LA strain and strain rate (SR) myocardial mechanics.
    Journal of Cardiovascular Magnetic Resonance 08/2014; 16(1):60. · 4.44 Impact Factor
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    ABSTRACT: -Our purpose was to test the following hypotheses: (1) Patients with hypoplastic left heart syndrome (HLHS) who develop significant tricuspid regurgitation (TR) or require tricuspid valve (TV) surgery in the medium-term, have detectable TV abnormalities by three-dimensional echocardiography (3DE) pre-stage 1 palliation; (2) TR is associated with reduced survival and increased TV intervention.
    Circulation Cardiovascular Imaging 07/2014; · 5.80 Impact Factor
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    ABSTRACT: We describe a relatively long left ventricular recruitment pathway consisting of early and serial aortic valvuloplasties and multiple endocardial fibroelastosis resections resulting in successful biventricular conversion of hypoplastic left heart syndrome.
    World journal for pediatric & congenital heart surgery. 06/2014; 5(3):449-452.
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    ABSTRACT: Oxygen-induced contraction of the ductus arteriosus (DA) involves a mitochondrial oxygen sensor, which signals pO2 in the DA smooth muscle cell (DASMC) by increasing production of diffusible hydrogen peroxide (H2O2). H2O2 stimulates vasoconstriction by regulating ion channels and Rho kinase, leading to calcium influx and calcium sensitization. Because epidermal growth factor receptor (EGFR) signaling is also redox regulated and participates in oxygen sensing and vasoconstriction in other systems, we explored the role of the EGFR and its signaling cascade (p38 and c-Jun N-amino-terminal kinase (JNK)) in DA contraction. Experiments were performed in DA rings isolated from full-term New Zealand white rabbits and human DASMC. In human DASMCs, increasing pO2 from hypoxia to normoxia (40 to 100 mmHg) significantly increased cytosolic calcium, p < 0.01. This normoxic rise in intracellular calcium was mimicked by EGF and inhibited by EGFR siRNA. In DA rings, EGF caused contraction while the specific EGFR inhibitor (AG1478) and the tyrosine kinase inhibitors (genistein or tyrphostin A23) selectively attenuated oxygen-induced contraction (p < 0.01). Conversely, orthovanadate, a tyrosine phosphatase inhibitor known to activate EGFR signaling, caused dose-dependent contraction of hypoxic DA and superimposed increases in oxygen caused minimal additional contraction. Anisomycin, an activator of EGFR's downstream kinases, p38 and JNK, caused DA contraction; conversely, oxygen-induced DA contraction was blocked by inhibitors of p38 mitogen-activated protein kinases (MAPK) (SB203580) or JNK (JNK inhibitor II). O2-induced phosphorylation of EGFR occurred within 5 min of increasing pO2 and was inhibited by mitochondrial-targeted overexpression of catalase. AG1478 prevented the oxygen-induced p38 and JNK phosphorylation. In conclusion, O2-induced EGFR transactivation initiates p38/JNK-mediated increases in cytosolic calcium and contributes to DA contraction. The EGFR/p38/JNK pathway is regulated by mitochondrial redox signaling and is a promising therapeutic target for modulation of the patent ductus arteriosus.
    Journal of molecular medicine (Berlin, Germany). 06/2014;
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    ABSTRACT: -The classification of clinical severity of Ebstein's Anomaly (EA) still remains a challenge. The aim of this study was to focus on the interaction of the pathologically altered right heart with the anatomically -supposedly- normal left heart and to derive from cardiac magnetic resonance (CMR) a simple imaging measure for the clinical severity of EA. -Twenty-five patients at a mean age of 26 ± 14 years with unrepaired EA were examined in a prospective study. Disease severity was classified using CMR volumes and functional measurements in comparison with heart failure markers from clinical data, Electrocardiography, laboratory and cardiopulmonary exercise testing and echocardiography. All exams were completed within 24 hours. A Total Right/Left-Volume-Index was defined from end diastolic volume measurements in CMR: Total R/L-Volume-Index = (RA+aRV+fRV)÷(LA+LV). Mean Total R/L-Volume-Index was 2.6 ± 1.7 [normal values: 1.1 ± 0.1]. This new Total R/L-Volume-Index correlated with almost all clinically employed biomarkers of heart failure: BNP (r=0.691,p=0.0003), QRS (r=0.432,p=0.039), peak VO2/kg (r=-0.479,p=0.024), VE/VCO2 (r=0.426,p=0.048), the severity of tricuspid regurgitation (r=0.692,p=0.009), tricuspid valve offset (r=0.583,p=0.004) and TAPSE (r=0.554,p=0.006). Previously described severity indices ((RA+aRV)/(fRV+LA+LV)) and fRV/LV EDV corresponded only to some parameters. -In patients with EA, the easily acquired index of right sided to left sided heart volumes from CMR correlated well with established heart failure markers. Our data suggest that the Total R/L-Volume-Index should be used as a new and simplified CMR measure, allowing more accurate assessment of disease severity than previously described scoring systems.
    Circulation Cardiovascular Imaging 05/2014; · 5.80 Impact Factor
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    ABSTRACT: Background and PurposeRyanodine receptors (RyRs) are Ca2+-release channels on the sarco(endo)plasmic reticulum that modulate a wide array of physiological functions. Three RyR isoforms are present in cells, RyR1, RyR2, and RyR3. To date there are no reports on ligands that modulate RyR in an isoform-selective manner. Such ligands are not only valuable research tools, but could serve as intermediates for development of therapeutics.Experimental ApproachPyrrole-2-carboxylic acid and 1,3-dicyclohexylcarbodiimide were allowed to react in carbon tetrachloride for 24 hr at low temperatures and pressures. The chemical structures of the two products isolated were elucidated using nuclear magnetic resonance spectrometry, mass spectrometry and elemental analyses. [3H]ryanodine binding, lipid bilayer and time-lapsed confocal imaging were used to determine their effects on RyR isoforms.Key ResultsThe major product, 2-cyclohexyl-3-cyclohexylimino-2, 3, dihydro–pyrrolo[1,2-c]imidazol-1-one (CCDI) dose-dependently potentiated Ca2+-dependent binding of [3H]ryanodine to RyR1, with no significant effects on [3H]ryanodine binding to RyR2 or RyR3. CCDI also reversibly increased the open probability (Po) of RyR1 with minimal effects on RyR2 and RyR3. CCDI induced Ca2+ transients in C2C12 skeletal myotubes but not in rat ventricular myocytes. This effect was blocked by pre-treating cells with ryanodine. The minor product 2-cyclohexyl-pyrrolo[1,2-c]imidazole-1,3-dione had no effects on [3H]ryanodine binding and Po of RyR1, RyR2 and RyR3.Conclusions and ImplicationsA new ligand that preferentially modulates RyR1 was identified. In addition to being an important research tool, the pharmacophore of this small molecule could serve as a template for the synthesis of other isoforms-selective modulators of RyRs.
    British Journal of Pharmacology 05/2014; · 5.07 Impact Factor
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    ABSTRACT: Although transthoracic echocardiography is commonly performed in the PICU, its utility is not specifically known. The purpose of this investigation was to evaluate the clinical impact of echocardiography in the PICU in terms of frequency of unanticipated findings and the frequency and nature of clinical management changes attributed to the results of echocardiography. Prospective cohort study. Nineteen-bed combined medical-surgical-cardiac PICU at a tertiary care children's hospital. All patients in PICU undergoing transthoracic echocardiography. Data collected included echocardiography indications, pre-echocardiography clinical assessment of anticipated echocardiography findings, height, weight, primary diagnosis, age, and urgency (stat vs routine) of echocardiography. Input of the attending care team (intensivist, cardiologist, and/or cardiovascular surgeon) allowed classification of echocardiography results as either confirming the pre-echocardiography impression, altering the pre-echocardiography clinical impression regarding the indication for which the test was performed, or altering the impression by virtue of new findings unrelated to the specific indication. The nature of the new findings were recorded and categorized. The team recorded clinical management changes made in response to the echocardiography results; the nature of these were listed and categorized. Echocardiograms (n = 416) were performed in 132 patients. Of these, 244 echocardiograms (59%) were ordered on male patients, 31% were under 30 days old, median age was 103 days, 379 (91%) had a primary cardiac diagnosis, and 92 (22%) were ordered stat. Sixty-three percent of echocardiograms confirmed and 24% altered the pre-echocardiography impression regarding the indication for the echocardiography; 13% introduced new findings unrelated to the indication. Cardiac surgical revision was the management change required in 26 patients (6.3%). Stat echocardiography was more likely to alter the pre-echocardiography assessment than routine echocardiography (p < 0.001). Management changes were more commonly associated with stat echocardiograms (p = 0.002) and those with new unexpected findings (p < 0.001) but had no demonstrable association with age less than 30 days (p = 0.332). Unanticipated echocardiography results are common in the PICU, and they often alter the clinical impressions that prompted the echocardiogram or introduce new findings unrelated to the reason for which the echocardiogram was recorded. Clinical management changes attributable to echocardiography findings are frequent in the PICU, including occasional surgical intervention. Echocardiography adds diagnostic value and contributes to the management approach in the PICU, accounting for its frequent use.
    Pediatric Critical Care Medicine 03/2014; · 2.35 Impact Factor
  • Shelby Kutty, David A Danford
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 02/2014; · 2.98 Impact Factor
  • Thorac cardiovasc Surg. 01/2014; 62(S 02):v29.
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    ABSTRACT: Palliative shunts in congenital heart disease patients are vulnerable to thrombotic occlusion. High mechanical index (MI) impulses from a modified diagnostic ultrasound (US) transducer during a systemic microbubble (MB) infusion have been used to dissolve intravascular thrombi without anticoagulation, and we sought to determine whether this technique could be used prophylactically to reduce thrombus burden and prevent occlusion of surgically placed extracardiac shunts. Heparin-bonded ePTFE tubular vascular shunts of 4 mm×2.5 cm (Propaten; W.L Gore) were surgically placed in 18 pigs: a right-sided side-to-side arteriovenous (AV, carotid-jugular) shunt, and a left-sided arterio-arterial (AA, carotid-carotid) interposition shunt in each animal. After shunt implantation, animals were randomly assigned to one of 3 groups. Transcutaneous, weekly 30-minute treatments (total of 4 treatments) of either guided high MI US+MB (Group 1; n=6) using a 3% MRX-801 MB infusion, or US alone (Group 2; n=6) were given separately to each shunt. The third group of 6 pigs received no treatments. The shunts were explanted after 4 weeks and analyzed by histopathology to quantify luminal thrombus area (mm(2)) for the length of each shunt. No pigs received antiplatelet agents or anticoagulants during the treatment period. The median overall thrombus burden in the 3 groups for AV shunts was 5.10 mm(2) compared with 4.05 mm(2) in AA (P=0.199). Group 1 pigs had significantly less thrombus burden in the AV shunts (median 2.5 mm(2)) compared with Group 2 (median 5.6 mm(2)) and Group 3 (median 7.5 mm(2)) pigs (P=0.006). No difference in thrombus burden was seen between groups for AA shunts. Transcutaneous US with intravenous MB is capable of preventing thrombus accumulation in arteriovenous shunts without the need for antiplatelet agents, and may be a method of preventing progressive occlusion of palliative shunts.
    Journal of the American Heart Association. 01/2014; 3(1):e000689.
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    ABSTRACT: Journal of Cardiovascular Magnetic Resonance 2014, 16:O108. doi:10.1186/1532-429X-16-S1-O108
    Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. 01/2014; 16:O108.
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    ABSTRACT: The long-term prognosis of hypoplastic left heart syndrome is limited by progressive right ventricular dysfunction. The aim of this study was to determine the trends in single right ventricular systolic function between staged palliative surgeries using speckle-tracking and conventional echocardiography. There were 76 patients with functionally single right ventricles at the (1) pre-Norwood (n = 26), (2) pre-bidirectional cavopulmonary anastomosis (BCPA; n = 19), (3) pre-Fontan (n = 16), and (4) post-Fontan (n = 15) stages, compared with 30 controls of similar ages. Speckle-tracking-derived longitudinal and circumferential strain and strain rate, postsystolic strain index, and mechanical dyssynchrony index were compared with conventional measures of ventricular function. Differences between stages were analyzed using analysis of variance (P < .05). Strain rate was highest at the pre-Norwood stage and decreased at the other stages (longitudinal P < .0001, circumferential P = .0002), as opposed to controls, in whom strain rate was maintained. Longitudinal strain was significantly decreased at the pre-BCPA stage compared with the pre-Norwood stage (P = .004), but circumferential strain was maintained, resulting in a corresponding decrease in the ratio of longitudinal to circumferential strain, which failed to resemble that of controls. Longitudinal (P = .003) and circumferential (P = .002) postsystolic strain indices were greatest at the pre-BCPA stage. A decline in contractility occurred at the pre-BCPA stage. Although there was evidence of adaptation of the single right ventricle, this failed to resemble the normal left ventricle and may be insufficient to handle the chronic volume load or insult from previous surgery. These findings suggest an intrinsic inability of the single right ventricular myocardium to fully adapt to chronic systemic pressures.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2013; · 2.98 Impact Factor
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    ABSTRACT: Congenital mitral valve abnormalities are rare and cause mitral stenosis, regurgitation, or a combination of the two. Three-dimensional echocardiography has provided new insight into the structure and function of both normal and abnormal mitral valves. Three-dimensional imaging permits accurate anatomic diagnosis and enhances two-dimensional echocardiographic data. Moreover, it enables echocardiographers to communicate effectively with cardiothoracic surgeons when displaying, analyzing, and describing pathology. The purpose of this report is to review congenital mitral valve disease, focusing on the benefits of three-dimensional echocardiography in its evaluation.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2013; · 2.98 Impact Factor
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    ABSTRACT: Precise quantification of left ventricular (LV) cavity dimensions assumes great importance in clinical cardiology. Pediatric guidelines recommend the left parasternal short axis (PSA) imaging plane for measuring LV cavity dimensions, while measuring from the long axis (PLA) plane is the convention in adult echocardiography. We sought to compare measurements obtained by two-dimensional (2D) and M-mode (MM) techniques in the two imaging planes. Healthy subjects were prospectively recruited for research echocardiography. Complete 2D, spectral and color flow Doppler examinations were performed in a non-sedated state. All subjects had structurally and functionally normal hearts. LV cavity dimensions were obtained in PLA and PSA views using 2D and MM yielding four measurement sets for each subject: PLA direct 2D; PLA 2D-guided MM, PSA direct 2D, PSA 2D-guided MM. A commercially available ultrasound system (Vivid E9, GE) was used and data stored digitally for subsequent analysis (EchoPAC BT11, GE). Acquisition and measurements were made by a single observer from at least three consecutive cardiac cycles, and averaged for each of the four categories. The study cohort consisted of 114 subjects (mean age 9 years, range 1-18; mean BSA 1.1 m(2), range 0.42-2.6). The smallest estimate of LV end-diastolic dimension (LVED) was obtained by PLA 2D, with larger estimates by PLA MM, PSA 2D, and PSA MM. Largest estimates of LV end-systolic dimension (LVES) are by 2D methods, with smaller estimates by both MM techniques. The smallest shortening fraction (SF) was by PLA 2D; other methods yielded larger SF. Temporal resolution is limited in 2D methodology and may account for the smaller LVED, larger LVES and smaller SF observed. Long axis methodology may predispose to off-center or non-perpendicular data acquisition and the potential for dimensional underestimation, particularly in diastole. Consistency in method for assessment of LV dimensions in children is an important factor for serial comparisons.
    The international journal of cardiovascular imaging 12/2013; · 2.15 Impact Factor

Publication Stats

409 Citations
298.80 Total Impact Points


  • 2011–2014
    • University of Nebraska Medical Center
      • • Division of Pediatric Cardiology
      • • Department of Pharmacology and Experimental Neuroscience
      Omaha, Nebraska, United States
    • Riley Hospital for Children
      Indianapolis, Indiana, United States
    • Boston Children's Hospital
      • Department of Cardiac Surgery
      Boston, Massachusetts, United States
  • 2008–2014
    • University of Nebraska at Omaha
      • • Division of Cardiology
      • • Department of Pharmacology and Experimental Neuroscience
      Omaha, Nebraska, United States
  • 2013
    • Guy's and St Thomas' NHS Foundation Trust
      Londinium, England, United Kingdom
    • Deutsches Herzzentrum Berlin
      • The Department of Congenital Heart Disease / Pediatric Cardiology
      Berlín, Berlin, Germany
  • 2012–2013
    • University of Chicago
      • Section of Cardiology
      Chicago, Illinois, United States
    • King's College London
      • Division of Imaging Sciences and Biomedical Engineering
      London, ENG, United Kingdom
  • 2008–2012
    • Creighton University
      Omaha, Nebraska, United States
  • 2009
    • Children's Hospital of Michigan
      Detroit, Michigan, United States
  • 2007–2008
    • Children's Hospital of Wisconsin
      Madison, Wisconsin, United States