Salim F Idriss

Duke University, Durham, North Carolina, United States

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Publications (3)20.89 Total impact

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    ABSTRACT: -The Pediatric Heart Network's (PHN) Single Ventricle Reconstruction Trial (SVR) randomized infants with single right ventricles (RV) undergoing a Norwood procedure to a modified Blalock-Taussig or RV-to-pulmonary artery shunt. This report compares RV parameters in the two groups using 3-dimensional echocardiography (3DE). -3DE studies were obtained at 10/15 SVR centers. Of the 549 subjects, 314 underwent 3DE studies at one to four time points (pre-Norwood, post-Norwood, pre-stage II, and 14 months) for a total of 757 3DEs. Of these, 565 (75%) were acceptable for analysis. RV volume, mass, mass:volume ratio, ejection fraction (EF), and severity of tricuspid regurgitation did not differ by shunt type. RV volumes and mass did not change after the Norwood, but increased from pre-Norwood to pre-stage II (end-diastolic volume [EDV, ml]/body surface area [BSA](1.3), end-systolic volume [ESV, ml]/BSA(1.3) and mass[g]/BSA(1.3) mean difference [95% confidence interval] = 25.0 [8.7, 41.3], 19.3 [8.3, 30.4], and 17.9 [7.3, 28.5], then decreased by 14 months (EDV/BSA(1.3), ESV/BSA(1.3) and mass/BSA(1.3) mean difference [95% confidence interval] = -24.4 [-35.0, -13.7], -9.8 [-17.9, -1.7], and -15.3 [-22.0, -8.6]. EF decreased from pre-Norwood to pre-stage II (mean difference [95% confidence interval] = -3.7% [-6.9%, -0.5%]), but did not decrease further by 14 months. -We found no statistically significant differences between study groups in 3DE measures of RV size and function, or magnitude of tricuspid regurgitation. Volume unloading was seen after stage II, as expected, but EF did not improve. This study provides insights into the remodeling of the operated univentricular RV in infancy. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00115934.
    Circulation Cardiovascular Imaging 10/2013; · 5.80 Impact Factor
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    ABSTRACT: OBJECTIVE.: Although many Fontan patients undergo pacemaker placement, there are few studies characterizing this population. Our purpose was to compare clinical characteristics, functional status and measures of ventricular performance in Fontan patients with and without a pacemaker. PATIENTS AND DESIGN.: The National Heart, Lung, and Blood Institute funded Pediatric Heart Network Fontan Cross-Sectional Study characterized 546 Fontan survivors. Clinical characteristics, medical history and study outcomes (Child Health Questionnaire [CHQ]), echocardiographic evaluation of ventricular function, and exercise testing) were compared between subjects with and without pacemakers. RESULTS.: Of 71 subjects with pacemakers (13%), 43/71 (61%) were in a paced rhythm at the time of study enrollment (age 11.9 ± 3.4 years). Pacemaker subjects were older at study enrollment, more likely to have single left ventricles, and taking more medications. There were no differences in age at Fontan or Fontan type between the pacemaker and no pacemaker groups. There were no differences in exercise performance between groups. CHQ physical summary scores were lower in the pacemaker subjects (39.7 ± 14.3 vs. 46.1 ± 11.2, P =.001). Ventricular ejection fraction z-score was also lower (-1.4 ± 1.9 vs. -0.8 ± 2.0, P =.05) in pacemaker subjects. CONCLUSIONS.: In our cohort of Fontan survivors, those with a pacemaker have poorer functional status and evidence of decreased ventricular systolic function compared to Fontan survivors without a pacemaker.
    Congenital Heart Disease 07/2012; · 1.01 Impact Factor
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    ABSTRACT: Our aim was to examine the prevalence of arrhythmias and identify independent associations of time to arrhythmia development. Since introduction of the Fontan operation in 1971, long-term results have steadily improved with newer modifications. However, atrial arrhythmias are frequent and contribute to ongoing morbidity and mortality. Data are lacking regarding the prevalence of arrhythmias and risk factors for their development in the current era. The Pediatric Heart Network Fontan Cross-Sectional study evaluated data from 7 centers, with 520 patients age 6 to 18 years (mean 8.6 +/- 3.4 years after the Fontan operation), including echocardiograms, electrocardiograms, exercise testing, parent-reported Child Health Questionnaire (CHQ) results, and medical history. Supraventricular tachycardias were present in 9.4% of patients. Intra-atrial re-entrant tachycardia (IART) was present in 7.3% (32 of 520). The hazard of IART decreased until 4 to 6 years post-Fontan, and then increased with age thereafter. Cardiac anatomy and resting heart rate (including marked bradycardia) were not associated with IART. We identified 3 independent associations of time to occurrence of IART: lower CHQ physical summary score (p < 0.001); predominant rhythm (p = 0.002; highest risk with paced rhythm), and type of Fontan operation (p = 0.037; highest risk with atriopulmonary connection). Time to IART did not differ between patients with lateral tunnel and extracardiac conduit types of Fontan repair. Ventricular tachycardia was noted in 3.5% of patients. Overall prevalence of IART was lower in this cohort (7.3%) than previously reported. Lower functional status, an atriopulmonary connection, and paced rhythm were determined to be independently associated with development of IART after Fontan. (Relationship Between Functional Health Status and Ventricular Performance After Fontan-Pediatric Heart Network; NCT00132782).
    Journal of the American College of Cardiology 09/2010; 56(11):890-6. · 14.09 Impact Factor