Sethuraman Swaminathan

University of Miami Miller School of Medicine, Miami, FL, United States

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Publications (7)11.27 Total impact

  • Marjorie Gayanilo, Michael Nares, Ofelia Alvarez, Sethuraman Swaminathan
    Journal of Pediatric Hematology/Oncology 12/2013; · 0.97 Impact Factor
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    ABSTRACT: Background: Left to right (L-R) shunting through a patent ductus arteriosus (PDA) can reduce systemic and cerebral blood flow in preterm infants. To minimize this, the positive end-expiratory pressure (PEEP) is often raised to increase pulmonary vascular resistance and reduce L-R shunting. The effects of this maneuver on systemic and cerebral hemodynamics and oxygenation are not well documented. Objective: To compare the effects of different PEEP on the left ventricular output (LVO), superior vena cava (SVC) flow, LVO/SVC flow ratio, cerebral oxygenation (CrSO2) and gas exchange in mechanically ventilated preterm infants with PDA. Methods: Sixteen mechanically ventilated infants of 23-30 weeks' gestational age with L-R shunting through the PDA were studied. Ultrasound measurements of LVO and SVC flow, CrSO2, arterial oxygen saturation and transcutaneous CO2 tension (TcPCO2) obtained at PEEP of 2 and 8 cm H2O were compared with baseline values at 5 cm H2O. Results: There was a small but significant reduction in LVO and the LVO/SVC flow ratio at PEEP of 8 compared to 5 cm H2O. SVC flow and CrSO2 did not differ significantly. Conclusions: Increasing PEEP to 8 cm H2O in ventilated preterm infants with a PDA produced a modest decrease in L-R ductal shunting as indicated by a lower LVO/SVC flow ratio. The higher PEEP did not have a significant effect on cerebral perfusion or oxygenation. © 2013 S. Karger AG, Basel.
    Neonatology 11/2013; 105(1):9-13. · 2.57 Impact Factor
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    ABSTRACT: Conventional 2-dimensional, M-mode, and spectral Doppler echocardiographic techniques have documented abnormal ventricular function in adults with sickle cell disease (SCD), but assessments in children are conflicting. Tissue Doppler echocardiography (TDE) provides additional information about myocardial function. Two-dimensional, M-mode, tricuspid regurgitation jet velocity (TRJV) data, and tissue Doppler echocardiographically derived myocardial velocity measurements of left ventricular (LV) and right ventricular function were taken from children with SCD compared to those of similar healthy historical controls and correlated with clinical characteristics and hemoglobin levels. Compared to 55 controls, 54 children with SCD (mean age 14.2 years, range 6 to 21) had a larger left ventricle, greater LV mass, and higher LV fractional shortening; 30% had increased pulmonary artery pressure (TRJV ≥2.5 m/s). Conventional echocardiographic measurements of LV systolic function and spectral Doppler measurements of LV and right ventricular diastolic function were essentially normal, but TDE indicated that 31% of SCD children had evidence of LV diastolic dysfunction (peak early diastolic velocity of LV inflow Doppler/peak early diastolic velocity at lateral mitral valve annulus >8), a finding that correlated with lower hemoglobin levels. Although decreasing hemoglobin levels in children with SCD correlated with LV hypertrophy, LV dilation, and LV diastolic dysfunction, long-term transfusion or hydroxyurea therapy did not affect these measurements. In conclusion, 1/3 of children with SCD had tissue Doppler echocardiographic evidence of LV diastolic dysfunction, which was correlated with hemoglobin levels. Adding serial assessments of ventricular function with TDE to conventional echocardiography may detect early cardiac changes, especially in children with severe anemia.
    The American journal of cardiology 02/2012; 109(9):1358-64. · 3.58 Impact Factor
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    ABSTRACT: Purpose: The aim of this study was to assess the usefulness of tissue Doppler echocardiography (TDE) in assessing the left ventricular (LV) and right ventricular (RV) function in children with sickle cell anemia (SCA). Few studies have used this new modality in this population to assess RV function. Methods: 55 children with SCA (age 6-21 years) who underwent echocardiography including TDE were the subjects in this study. Systolic and diastolic TDE myocardial velocities of the LV were obtained at the lateral mitral annulus (Em, Am, Sm); similar data for the right ventricle were obtained at the lateral tricuspid annulus (Et, At, St). These data were compared with TDE data in healthy children. Sm and St were used to assess LV and RV systolic function respectively; Em, peak Em/Am ratio and E-MV/Em ratio to assess LV and RV diastolic function; corresponding TDE data on the right side used to assess the RV function. We studied the correlation of cardiac function parameters obtained by TDE with hemoglobin (Hb), chronic transfusion therapy, systemic arterial hypertension and reactive airway disease. Results: TDE parameters of LV systolic and diastolic function are decreased to statistical significance in the SCA group compared to the controls (Table 1). TDE parameters of RV systolic and diastolic function are slightly higher/better in the SCA group compared to control population. We found a statistically significant positive correlation between Hemoglobin (Hb) level and LV diastolic function. The presence of systemic hypertension or reactive airway disease had no significant difference in their TDE parameters among patients with SCA. The TDE parameters were not different in SCA patients receiving chronic transfusion therapy when compared to the group of SCA patients who are not receiving chronic transfusion. Conclusion: We found subclinical TDE abnormalities of LV systolic and diastolic function in children with SCA. The RV function appears to be well preserved in these children. Lower Hb level correlated with worsening of LV diastolic function by TDE. All these children had no evidence of systolic or diastolic dysfunction by conventional Doppler. TDE should be included in surveillance echocardiogram of children with SCA. Table 1: Comparison of TDE parameters between SCA patients and healthy controls MV-Mitral valve; TV-Tricuspid Valve Control SCA Variable Mean ± SD Mean ± SD p-value Age 13.31 ± 2.48 14.44 ± 4.31 0.096 Sm 10.34 ± 2.13 9.21 ± 1.55 0.002 Em 18.26 ± 1.92 16.02 ± 3.62 <0.001 Am 7.01 ± 1.65 5.79 ± 2.18 0.001 Em/Am 2.77 ± 0.81 2.95 ± 0.81 0.237 E-MV/Em 5.01 ± 1.08 7.45 ± 2.55 <0.001 St 12.39 ± 1.68 15.63 ± 2.16 <0.001 Et 14.83 ± 2.85 16.87 ± 2.99 <0.001 At 8.12 ± 1.62 9.75 ± 2.88 <0.001 Et/At 1.91 ± 0.58 1.85 ± 0.52 0.608 E-TV/Et 3.91 ± 1.05 3.99 ± 1.18 0.720
    2009 American Academy of Pediatrics National Conference and Exhibition; 10/2009
  • Sethuraman Swaminathan, Anitha Parthiban
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    ABSTRACT: We report a fetus with left isomerism, in whom the atrioventricular block progressed from low grade second degree to complete block and fetal hydrops. While it is known that there is a high incidence of heart block in the fetus with left isomerism, as far as we are aware, ours is the first report of Wenckebach type block documented in the fetus by Doppler echocardiography, and demonstration of the progression of heart block during fetus life in the setting of left isomerism.
    Cardiology in the Young 09/2007; 17(4):432-4. · 0.95 Impact Factor
  • Christopher Ratnasamy, Amethyst Kurbegov, Sethuraman Swaminathan
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    ABSTRACT: We describe a child with tricuspid atresia associated with a porto-systemic shunt and complete absence of the portal vein, the latter known as the Abernethy malformation. As far as we are aware, this association has not previously been reported. We review the various cardiac defects that have been reported in children with the Abernethy malformation, emphasizing the interesting clinical presentations of this rare malformation of the portal venous system.
    Cardiology in the Young 05/2007; 17(2):212-4. · 0.95 Impact Factor
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    ABSTRACT: Inhaled nitric oxide (iNO) reduces pulmonary vascular resistance by preferential vasodilation in ventilated lung units. In experimental animals, iNO also reduces airway resistance by smooth muscle relaxation. Hence, there may be a therapeutic role for iNO in evolving bronchopulmonary dysplasia (BPD). To evaluate the acute effects of low-dose iNO on lung mechanics, ventilation distribution, oxygenation, and cardiac function in preterm infants with evolving BPD. Measurements of lung compliance (C(L)), airway resistance (R(L)), ventilation-distribution (N(2) clearance in multiple-breath washout), oxygenation (SpO(2)), left ventricular ejection fraction (LVEF) and right ventricular shortening fraction were obtained before and during 2 hours of iNO (10 ppm) in a group of ventilated preterm infants with evolving BPD. A total of 13 preterm infants with (mean+/-SD) BW: 663.8+/-116 g, GA: 24.9+/-1.2 weeks, age: 32+/-14 days, mean airway pressure: 6.7+/-0.9 cmH(2)O and fraction of inspired oxygen: 0.35+/-0.06 were studied. iNO did not affect C(L), R(L) or N(2) clearance. There was a small increase in LVEF. Mean SpO(2) remained unchanged, but the duration of spontaneous hypoxemic episodes increased during iNO. Low-dose iNO had no acute effects on lung function, cardiac function and oxygenation in evolving BPD.
    Journal of Perinatology 01/2005; 24(12):769-74. · 2.25 Impact Factor