Candice K Silversides

University of British Columbia - Vancouver, Vancouver, British Columbia, Canada

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Publications (131)734.57 Total impact

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    ABSTRACT: 22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome in humans. Survival to reproductive age and beyond is now the norm. Several manifestations of this syndrome, such as congenital cardiac disease and neuropsychiatric disorders, may increase risk for adverse pregnancy outcomes in the general population. However, there are limited data on reproductive health in 22q11.2DS. We performed a retrospective chart review for 158 adults with 22q11.2DS (75 male, 83 female; mean age 34.3 years) and extracted key variables relevant to pregnancy and reproductive health. We present four illustrative cases as brief vignettes. There were 25 adults (21 > age 35 years; 21 female) with a history of one or more pregnancies. Outcomes for women with 22q11.2DS, compared with expectations for the general population, showed a significantly elevated prevalence of small for gestational age liveborn offspring (p < 0.001), associated mainly with infants with 22q11.2DS. Stillbirths also showed elevated prevalence (p < 0.05). Not all observed adverse events appeared to be attributable to transmission of the 22q11.2 deletion. Recurring issues relevant to reproductive health in 22q11.2DS included the potential impact of maternal morbidities, inadequate social support, unsafe sexual practices, and delayed diagnosis of 22q11.2DS and/or lack of genetic counseling. These preliminary results emphasize the importance of early diagnosis and long term follow-up that could help facilitate genetic counseling for men and women with 22q11.2DS. We propose initial recommendations for pre-conception management, educational strategies, prenatal planning, and preparation for possible high-risk pregnancy and/or delivery.
    Journal of Genetic Counseling 01/2015; · 1.75 Impact Factor
  • Luke J Burchill, Heleen Lameijer, Jolien W Roos-Hesselink, Jasmine Grewal, Titia Pe Ruys, Julia D Kulikowski, Laura A Burchill, M A Oudijk, Rachel M Wald, Jack M Colman, Samuel C Siu, Petronella G Pieper, Candice K Silversides
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    ABSTRACT: The objective of this study was to determine outcomes in pregnant women with pre-existing coronary artery disease (CAD) or following an acute coronary syndrome (ACS) including myocardial infarction (MI). The physiological changes of pregnancy can contribute to myocardial ischaemia. The pregnancy risk for women with pre-established CAD or a history of ACS/MI is not well studied. This was a retrospective multicentre study. Adverse maternal cardiac, obstetric and fetal/neonatal events were examined. The primary outcome was a composite endpoint of cardiac arrest, ACS/MI, ventricular arrhythmia or congestive heart failure. The prevalence of new or progressive angina during pregnancy was also examined. Fifty pregnancies in 43 women (mean age 35±5 years) were included. Coronary atherosclerosis (40%) and coronary thrombus (36%) were the most common underlying diagnoses. The primary outcome occurred in 10% (5/50) of pregnancies and included one maternal death secondary to cardiac arrest. Other events included ACS/MI (3/50) and heart failure (1/50). New or progressive angina occurred in 18% of pregnancies. Ischaemic complications of any type (new or progressive angina, ACS/MI, ventricular arrhythmia, cardiac arrest) occurred more commonly in women with coronary atherosclerosis compared with those without (50% vs 10%, p=0.003). A high rate of adverse obstetric (16%) and fetal/neonatal (30%) events was observed. Pregnant women with pre-existing CAD or ACS/MI before pregnancy are at increased risk of adverse events during pregnancy. Those with coronary atherosclerosis are at highest risk of adverse maternal cardiac events due to myocardial ischaemia during pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Heart (British Cardiac Society) 01/2015; · 6.02 Impact Factor
  • Journal of the American College of Cardiology 10/2014; 64(17):1862–1864. · 15.34 Impact Factor
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    ABSTRACT: Late arrhythmias are common in adults undergoing Rastelli repair with a right ventricle (RV) to pulmonary artery (PA) conduit. The mechanism of arrhythmias has not been described. We sought to describe the prevalence, clinical predictors and mechanisms of supraventricular (SVT) and ventricular tachycardia (VT) in this population.
    Europace 10/2014; 16 Suppl 3:iii19. · 3.05 Impact Factor
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    ABSTRACT: Purpose:Recurrent 15q13.3 deletions are enriched in multiple neurodevelopmental conditions including intellectual disability, autism, epilepsy, and schizophrenia. However, the 15q13.3 microdeletion syndrome remains ill-defined.Methods:We systematically compiled all cases of 15q13.3 deletion published before 2014. We also examined three locally available cohorts to identify new adults with 15q13.3 deletions.Results:We identified a total of 246 cases (133 children, 113 adults) with deletions overlapping or within the 15q13.3 (breakpoint (BP)4-BP5) region, including seven novel adult cases from local cohorts. No BP4-BP5 deletions were identified in 23,838 adult controls. Where known, 15q13.3 deletions were typically inherited (85.4%) and disproportionately of maternal origin (P < 0.0001). Overall, 198 cases (121 children, 77 adults; 80.5%) had at least one neuropsychiatric diagnosis. Accounting for ascertainment, developmental disability/intellectual disability was present in 57.7%, epilepsy/seizures in 28.0%, speech problems in 15.9%, autism spectrum disorder in 10.9%, schizophrenia in 10.2%, mood disorder in 10.2%, and attention deficit hyperactivity disorder in 6.5%. By contrast, major congenital malformations, including congenital heart disease (2.4%), were uncommon. Placenta previa occurred in the pregnancies of four cases.Conclusion:The 15q13.3 microdeletion syndrome is predominantly characterized by neuropsychiatric expression. There are implications for pre- and postnatal detection, genetic counseling, and anticipatory care.Genet Med advance online publication 31 July 2014Genetics in Medicine (2014); doi:10.1038/gim.2014.83.
    Genetics in medicine: official journal of the American College of Medical Genetics 07/2014; · 3.92 Impact Factor
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    ABSTRACT: Delayed gas exchange kinetics in the early recovery period after exercise testing has been reported in children and adults with congenital heart disease (ACHD). Our objective was to compare early and late phase recovery kinetics in three groups of ACHD-patients.
    International Journal of Cardiology 07/2014; · 6.18 Impact Factor
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    ABSTRACT: Background Progress in management of congenital heart disease has shifted mortality largely to adulthood. However, adult survivors with complex congenital heart disease are not cured and remain at risk of premature death as young adults. Thus, our aim was to describe the evolution and mortality risk of adult patient cohorts with complex congenital heart disease.Methods Among 12 644 adults with congenital heart disease followed at a single center from 1980 to 2009, 176 had Eisenmenger syndrome, 76 had unrepaired cyanotic defects, 221 had atrial switch operations for transposition of the great arteries, 158 had congenitally corrected transposition of the great arteries, 227 had Fontan palliation, and 789 had repaired tetralogy of Fallot. We depict the 30-year evolution of these 6 patient cohorts, analyze survival probabilities in adulthood, and predict future number of deaths through 2029.ResultsSince 1980, there has been a steady increase in numbers of patients followed, except in cohorts with Eisenmenger syndrome and unrepaired cyanotic defects. Between 1980 and 2009, 308 patients in the study cohorts (19%) died. At the end of 2009, 85% of survivors were younger than 50 years. Survival estimates for all cohorts were markedly lower than for the general population, with important differences between cohorts. Over the upcoming two decades, we predict a substantial increase in numbers of deaths among young adults with subaortic right ventricles, Fontan palliation, and repaired tetralogy of Fallot.Conclusions Anticipatory action is needed to prepare clinical services for increasing numbers of young adults at risk of dying from complex congenital heart disease.
    Congenital Heart Disease 07/2014; · 1.01 Impact Factor
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    ABSTRACT: Background Cardiac disease is the leading cause of maternal death. Non-fatal ischemic events may go unnoted during the time of delivery. The aim of this study was to assess the incidence of subclinical myocardial ischemia amongst parturients, as evidenced by a raised troponin assay in the postpartum period. Methods We undertook a prospective observational pilot study in a tertiary obstetric hospital with over 7000 deliveries a year. Targeted sampling was used to enter subjects in pre-defined high- or low-risk groups for myocardial strain, according to their clinical history and a brief questionnaire. Troponin T levels of 140 women were assessed between 8 and 24 h postpartum. Results Ninety-one women considered to be at high risk and 49 at low risk women for myocardial strain were enrolled. The overall mean (± SD) serum troponin T level at 24 h postpartum was 8.7 ± 19.7 ng/L (normal range <14 ng/L). The incidence of a positive troponin result was 4.3% (95% CI 1.6, 9.1). Four patients (8.2%) of the low-risk group and two (2.2%) in the high-risk group had elevated troponin T assays. Conclusion This study found that 4% of women had elevated postpartum troponin assays, within levels in the range suggestive of myocardial damage. However, we were unable to ascertain how to identify this group of women prospectively. At this time, we recommend a low threshold for investigation should be maintained.
    International Journal of Obstetric Anesthesia 07/2014; · 1.83 Impact Factor
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    ABSTRACT: Background Chronic hemodynamically relevant pulmonary regurgitation (PR) resulting in important right ventricular (RV) dilation and ventricular dysfunction is commonly seen after tetralogy of Fallot (TOF) repair. Late adverse clinical outcomes, including exercise intolerance, arrhythmias, heart failure and/or death, accelerate in the third decade of life and are cause for considerable concern. Timing of pulmonary valve replacement (PVR) to address chronic PR is controversial, particularly in asymptomatic individuals, and impact of PVR on clinical measures has not been determined. Methods Canadian Outcomes Registry Late After Tetralogy of Fallot Repair (CORRELATE) is a prospective, multi-centre, Canada-wide cohort study. Candidates will be included if they are ≥12 years of age, have had surgically repaired TOF resulting in moderate or severe PR, and are able to undergo cardiovascular magnetic resonance imaging (CMR). Enrollment of >1000 individuals from 15 participating centres (Toronto, Montreal, Quebec City, Sherbrooke, Halifax, Calgary, Edmonton and Vancouver) is anticipated. Clinical data, health-related quality of life metrics and adverse outcomes will be entered into a web-based database. A central core lab will analyze all CMR studies (PR severity, RV volumes and ventricular function). Major adverse outcomes (sustained ventricular tachycardia and cardiovascular cause of death) will be centrally adjudicated. Conclusions CORRELATE will be the first prospective pan-Canadian cohort study of congenital heart disease in children and adults. CORRELATE will uniquely link clinical, imaging and functional data in those with repaired TOF and important PR, thereby enabling critical evaluation of clinically relevant outcomes in those managed conservatively as compared with those referred for PVR.
    The Canadian journal of cardiology 06/2014; · 3.94 Impact Factor
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    ABSTRACT: In women with valvular heart disease, pregnancy-associated cardiovascular changes can contribute to maternal, fetal, and neonatal complications. Ideally, a woman with valvular heart disease should receive preconception assessment and counselling from a cardiologist with expertise in pregnancy. For women with moderate- and high-risk valve lesions, appropriate risk stratification and management during pregnancy will optimise outcomes. Pregnancy in women with high-risk lesions, such as severe aortic stenosis, severe mitral stenosis, and those with mechanical valves, requires careful planning and coordination of antenatal care by a multidisciplinary team. The purpose of this overview is to describe the expected haemodynamic changes in pregnancy, review pregnancy risks for women with valvular heart disease, and discuss strategies for management.
    Best practice & research. Clinical obstetrics & gynaecology 05/2014; · 1.87 Impact Factor
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    ABSTRACT: Background22q11.2 deletion syndrome (22q11.2DS) is a relatively common yet under-recognized genetic syndrome that may present with endocrine features. We aimed to address the factors that contribute to the high prevalence of hypocalcemia.Methods We investigated hypocalcemia in a well characterized sample of 138 adults with 22q11.2DS (65 M, 73 F; mean age 34.2, SD 11.8, years) using laboratory studies and lifelong medical records. Logistic regression modelling was used to identify features associated with lifetime prevalence of hypocalcemia.ResultsOf the total sample, 111 (80.4%) had a lifetime history of hypocalcemia. Eleven (84.6%) of 13 subjects with neonatal hypocalcemia had documented recurrence of hypocalcemia. Lifetime history of hypocalcemia was associated with lifetime prevalences of hypoparathyroidism (p < 0.0001) and hypothyroidism (p = 0.04), as statistically independent factors. Hypomagnesemia was associated with concurrent hypocalcemic measurements, especially in the presence of concurrent hypoparathyroidism (p = 0.02).Conclusions The results suggest that, in addition to the major effect of hypoparathyroidism, hypothyroidism may play a role in hypocalcemia in 22q11.2DS, and that there is a high recurrence rate of neonatal hypocalcemia. Hypomagnesemia may contribute to hypocalcemia by further suppressing PTH. Although further studies are needed, the findings support regular lifelong follow-up of calcium, magnesium, PTH, and TSH levels in patients with 22q11.2DS. At any age, hypocalcemia with hypoparathyroidism and/or hypothyroidism may suggest a diagnosis of 22q11.2DS.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 04/2014; · 3.35 Impact Factor
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    ABSTRACT: -Individuals with tetralogy of Fallot (TOF) now routinely survive to reproductive age and beyond. Reproductive fitness of adults with TOF and recurrence risks to offspring are of increasing interest in the modern era, especially given recent molecular genetic discoveries. -After excluding individuals with known genetic syndromes, 543 unrelated adults with TOF underwent a detailed family history assessment and molecular characterization for rare copy number variations (CNVs) using high resolution genome-wide microarrays. Men and women with TOF had significantly fewer offspring compared to an age-matched comparison group without congenital heart disease (CHD) (p=0.0004). No aspect of rare CNV burden was a predictor of decreased reproductive fitness. Corresponding with the advent of modern surgical repairs, reproductive fitness of women began to exceed that of men (p=0.0490) Recurrence risk for CHD in offspring was 4.8%, with no significant differences between men and women with TOF. The risk of severe CHD in offspring (2.3%) far exceeded population expectations (RR=15.6, 95% CI 7.9-31.0). Most cases of vertical transmission of CHD were not explained by the transmission of a large rare CNV. Although conotruncal lesions (31.5%) were the most commonly reported CHD in relatives, the familial spectrum of disease included many anatomically discordant lesions. -Men and women with TOF have reduced reproductive fitness. Their offspring are at significantly elevated risk for severe CHD. These results support the importance of genetic counseling for both men and women with complex CHD. Many inherited genetic variants remain to be discovered.
    Circulation Cardiovascular Genetics 02/2014; · 5.34 Impact Factor
  • Jasmine Grewal, Candice K Silversides, Jack M Colman
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    ABSTRACT: Heart disease, present in 0.5% to 3% of pregnant women, is an important cause of morbidity and the leading cause of death among pregnant women in the developed world. Certain heart conditions are associated with an increased risk of heart failure during pregnancy or the postpartum period; for these conditions, management during pregnancy benefits from multidisciplinary care at a center with expertise in pregnancy and heart disease. This article focuses on cardiac risks and management strategies for women with acquired and congenital heart disease who are at increased risk of heart failure during pregnancy.
    Heart Failure Clinics 01/2014; 10(1):117-29. · 1.41 Impact Factor
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    ABSTRACT: Background Patent foramen ovale (PFO) may be a risk factor for unexplained (“cryptogenic”) stroke or transient ischemic attack (TIA). We sought to determine the efficacy and safety of transcatheter PFO closure compared with antithrombotic therapy for secondary prevention of cerebrovascular events among patients with cryptogenic stroke. Methods We performed a systematic review and meta-analysis of Medline and Embase (inception – March 2013) for randomized clinical trials (RCTs) comparing transcatheter PFO closure to medical therapy in subjects with cryptogenic stroke. Data were independently extracted on trial conduct quality, baseline characteristics, efficacy, and safety events from published manuscripts and appendices. Risk ratios (RR) and 95% CIs for the composite of stroke or TIA, and adverse cardiovascular events including atrial fibrillation/flutter were constructed. Results Three RCTs of 2,303 subjects with prior stroke, TIA, or systemic arterial embolism (mean age 45.7 years, 47.3% women, mean follow-up 2.6 years) were included. PFO closure did not significantly reduce the risk of recurrent stroke/TIA (3.7% vs. 5.2%; RR 0.73, 95% CI, 0.50-1.07; P=0.10); however, an increased risk of incident atrial fibrillation/flutter was detected (3.8% vs. 1.0%; RR 3.67, 95% CI, 1.95-6.89; P<0.0001). No significant heterogeneity was detected for any endpoint among subgroups of patients stratified by age, sex, index cardiovascular event, device type, inter-atrial shunt size, and presence of an atrial septal aneurysm (all P-interactions ≥0.09). Conclusions Meta-analysis of RCTs assessing transcatheter PFO closure for secondary prevention of cerebrovascular events in subjects with cryptogenic stroke does not demonstrate benefit compared with antithrombotic therapy, and suggests potential risks.
    The Canadian journal of cardiology 01/2014; · 3.12 Impact Factor
  • Tracy Yuen, Eva W C Chow, Candice K Silversides, Anne S Bassett
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    ABSTRACT: The literature on idiopathic schizophrenia has consistently reported that poor premorbid functioning precedes onset of psychosis. Individuals with 22q11.2 deletion syndrome (22q11.2DS) are at heightened risk of developing schizophrenia. The present study examined the relationship between adult-onset schizophrenia and social and academic functioning across childhood and early adolescent development in 22q11.2DS. Premorbid adjustment in social and academic domains during childhood (ages 5-11years) and early adolescence (ages 12-15years) of 103 adults with 22q11.2DS was assessed using the Premorbid Adjustment Scale (PAS). Linear mixed-models were used to compare PAS scores between the 43 subjects who later developed schizophrenia and the 60 subjects who did not. Social functioning and academic functioning deteriorated from childhood to early adolescence among those who later developed schizophrenia compared to stable functioning, on average, in those who did not later develop a psychotic disorder. Those who developed schizophrenia had significantly higher PAS scores (indicating poorer functioning) in social (β=0.118, 95% CI: 0.046-0.189) and academic (β=0.072, 95% CI: 0.015-0.129) domains between childhood and early adolescence, independent of the presence of intellectual disability. The two groups had similar PAS scores during childhood. Consistent with the literature on idiopathic schizophrenia, deterioration in social and academic functioning between childhood and early adolescence preceded onset of schizophrenia in this cohort of 22q11.2DS patients, regardless of functioning at baseline. These findings suggest that monitoring for changes in functioning, in addition to emergence of typical symptoms, may help to prevent delays in diagnosis and treatment of major psychotic illness in 22q11.2DS.
    Schizophrenia Research 11/2013; · 4.43 Impact Factor
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    ABSTRACT: The aim of this study was to determine associations between aortic morphometry evaluated by cardiovascular magnetic resonance (CMR) and pregnancy outcomes in women with aortic coarctation (CoA). Consecutive women with CoA seen with CMR within 2 years of delivery were reviewed. Aortic dimensions were measured on CMR angiography. Adverse outcomes (cardiovascular, obstetric, and foetal/neonatal) were documented. We identified 28 women (4 with native and 24 with repaired CoA) who had 30 pregnancies. There were 29 live births (1 stillbirth) at mean gestation 38 ± 2 weeks. Mean maternal ages at first cardiac intervention and pregnancy were 6 ± 8 and 29 ± 6 years, respectively. There were nine cardiovascular events (hypertensive complications in five; stroke in two and arrhythmia in two) occurring in seven pregnancies. Minimum aortic dimensions were smaller in women with cardiovascular events (12.1 vs. 14.3 mm, P = 0.001), specifically in those with hypertensive complications (11.6 vs. 14.4 mm, P < 0.001). From receiver operator curve analysis, optimal discrimination for the development of adverse cardiovascular events occurred at the 12 mm diameter threshold [sensitivity 78%, specificity 91%, area under the curve 0.86 (95% CI: 0.685-1)]. All hypertensive events occurred in conjunction with a minimum aortic diameter of 12 mm (7mm/m(2)) or less. No adverse outcomes occurred if minimum diameter exceeded 15 mm. Smaller aortic dimensions relate to increased risk of hypertensive events in pregnant women with CoA. CMR can aid in stratification of risk for women with CoA who are considering pregnancy.
    European heart journal cardiovascular Imaging. 09/2013;
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    ABSTRACT: To assess the impact of aortic root asymmetry on the relationship between aortic dimensions derived from two-dimensional transthoracic echocardiography (TTE) as compared with cross-sectional cardiovascular magnetic resonance (CMR) imaging in adults with a bicuspid aortic valve (BAV). Maximal CMR cross-sectional aortic measurements at the level of the sinuses of Valsalva, including cusp-commissure, cusp-cusp diameters and aortic root areas, from 68 consecutive patients (65 % male) were retrospectively analyzed. The degree of aortic root asymmetry on CMR was expressed using the coefficient of variance of the root diameters in each dimension for an individual (CoeffVi) as compared with the median of the entire population (CoeffVp) and asymmetry was defined as CoeffVi > CoeffVp. Values obtained from CMR were compared with standard root measurements using TTE from contemporary studies (48 patients, 71 %). Reproducibility of CMR measurements was assessed using the intra-class correlation coefficient (ICC). Echocardiography systematically underestimated aortic root dimensions in comparison with CMR, particularly in asymmetric roots with cusp-cusp measurements in systole (bias: -4.9 mm). Best agreement between modalities existed in symmetric roots with cusp-commissure measurements in diastole (bias: -0.01 mm). CMR measurements showed excellent intra-reader (ICC ≥ 0.98) and moderate inter-reader (ICC range 0.37-0.95) reproducibility, particularly aortic root area (inter/intra-reader ICC ≥ 0.94). In comparison to cross-sectional CMR diameters, standard TTE measurements consistently underestimates maximum aortic root diameter in adults with a BAV and aortic root asymmetry further decreases the agreement between CMR and TTE. CMR-derived aortic root measurements are reproducible and aortic root area showed the best reproducibility.
    The international journal of cardiovascular imaging 08/2013; · 2.15 Impact Factor
  • The Annals of thoracic surgery 08/2013; 96(2):705. · 3.45 Impact Factor
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    ABSTRACT: Purpose:Hypocalcemia is a common endocrinological condition in 22q11.2 deletion syndrome. Neonatal hypocalcemia may affect neurodevelopment. We hypothesized that neonatal hypocalcemia would be associated with rare, more severe forms of intellectual disability in 22q11.2 deletion syndrome.Methods:We used a logistic regression model to investigate potential predictors of intellectual disability severity, including neonatal hypocalcemia, neonatal seizures, and complex congenital heart disease, e.g., interrupted aortic arch, in 149 adults with 22q11.2 deletion syndrome. Ten subjects had moderate-to-severe intellectual disability.Results:The model was highly significant (P < 0.0001), showing neonatal seizures (P = 0.0018) and neonatal hypocalcemia (P = 0.047) to be significant predictors of a more severe level of intellectual disability. Neonatal seizures were significantly associated with neonatal hypocalcemia in the entire sample (P < 0.0001), regardless of intellectual level. There was no evidence for the association of moderate-to-severe intellectual disability with other factors such as major structural brain malformations in this sample.Conclusion:The results suggest that neonatal seizures may increase the risk for more severe intellectual deficits in 22q11.2 deletion syndrome, likely mediated by neonatal hypocalcemia. Neonatal hypocalcemia often remains unrecognized until the postseizure period, when damage to neurons may already have occurred. These findings support the importance of early recognition and treatment of neonatal hypocalcemia and potentially neonatal screening for 22q11.2 deletions.Genet Med advance online publication 13 June 2013Genetics in Medicine (2013); doi:10.1038/gim.2013.71.
    Genetics in medicine: official journal of the American College of Medical Genetics 06/2013; · 3.92 Impact Factor
  • Jonathan D Windram, Samuel C Siu, Rachel M Wald, Candice K Silversides
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    ABSTRACT: Advances in pediatric surgical and interventional techniques and medical care over the past 50 years have revolutionized the care of children with congenital heart disease. Survival to adulthood is now expected and, as such, there is a growing population of adults which is exceeding the pediatric population with congenital heart disease. Noninvasive cardiac imaging with modalities such as echocardiography, computed tomography, and cardiac magnetic resonance imaging are integral to the care of adults with congenital heart disease. These modalities are used for diagnosis, surveillance for complications late after surgery and catheter-based interventions, and in decision-making for medical, interventional, and surgical therapies. In this review we will discuss noninvasive imaging modalities used to assess congenital cardiac lesions, imaging strategies for select congenital lesions, and comment on the future of cardiac imaging in congenital heart disease.
    The Canadian journal of cardiology 05/2013; · 3.12 Impact Factor

Publication Stats

2k Citations
734.57 Total Impact Points

Institutions

  • 2014
    • University of British Columbia - Vancouver
      • Division of Cardiology
      Vancouver, British Columbia, Canada
  • 2008–2014
    • Mount Sinai Hospital, Toronto
      • Department of Cardiology
      Toronto, Ontario, Canada
    • Mount Sinai Hospital
      New York City, New York, United States
  • 2003–2014
    • University of Toronto
      • • Department of Medicine
      • • Division of Cardiology
      Toronto, Ontario, Canada
  • 2013
    • SickKids
      Toronto, Ontario, Canada
  • 2002–2013
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada
  • 2012
    • St. Paul's Hospital
      Saskatoon, Saskatchewan, Canada
  • 2003–2012
    • University Health Network
      • • Department of Cardiology
      • • Department of Diagnostic Imaging
      Toronto, Ontario, Canada
  • 2011
    • Erasmus MC
      • Department of Cardiology
      Rotterdam, South Holland, Netherlands
  • 2010
    • McGill University
      Montréal, Quebec, Canada
    • The University of Western Ontario
      • Division of Cardiology
      London, Ontario, Canada
    • University of Groningen
      • Department of Cardiology
      Groningen, Province of Groningen, Netherlands
  • 2004
    • Harvard University
      Cambridge, Massachusetts, United States