Mark A Fogel

The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

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Publications (159)612.64 Total impact

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    ABSTRACT: Elevated energy loss in the total cavopulmonary connection (TCPC) is hypothesised to have a detrimental effect on clinical outcomes in single-ventricle physiology, which may be magnified with exercise. This study investigates the relationship between TCPC haemodynamic energy dissipation and exercise performance in single-ventricle patients.
    Heart (British Cardiac Society) 09/2014; · 5.01 Impact Factor
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    ABSTRACT: Single-ventricle patients undergoing surgical reconstruction experience a high rate of brain injury. Incidental findings on preoperative brain scans may result in safety considerations involving hemorrhage extension during cardiopulmonary bypass that result in surgical postponement.
    The Annals of thoracic surgery. 08/2014;
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    ABSTRACT: OBJECTIVE. Protein-losing enteropathy (PLE) and plastic bronchitis are serious complications that occur after single-ventricle surgery. A lymphatic cause for these conditions has been proposed, but imaging correlation has not been reported. The objective of this study was to evaluate lymphatic abnormalities in patients after functional single-ventricle palliation compared with patients with non-single-ventricle congenital heart conditions using T2-weighted MR lymphangiography. MATERIALS AND METHODS. We retrospectively reviewed imaging data from 48 patients who underwent T2-weighted MR lymphangiography in our institution between May 1, 2012, and October 24, 2012. The patients were divided into four groups: patients who underwent superior cavopulmonary connection, patients who underwent total cavopulmonary connection, patients with total cavopulmonary connection and lymphatic complications, and patients with non-single-ventricle cardiac anomalies. RESULTS. There were 38 patients with single ventricles in this study. The lymphatic abnormalities observed in these patients included thoracic duct dilation greater than 3 mm (31%), lymphangiectasia and lymphatic collateralization (78%), and tissue edema (86%). There were five patients with PLE, one patient with plastic bronchitis, and one patient with chronic chylous effusions and superior cavopulmonary connection. The patients with PLE and plastic bronchitis had statistically significant larger thoracic duct maximal diameters (median, 3.9 mm; range, 3-7.2 mm) than did the other patients with total cavopulmonary connection (p < 0.01). In the two-ventricle patient group, there were no abnormal lymphatic findings. CONCLUSION. Lymphatic abnormalities are found in many patients after functional single-ventricle palliation. T2-weighted unenhanced MRI is capable of anatomic assessment of the lymphatic system in this patient population and has promise for guiding treatment in the future.
    AJR. American journal of roentgenology. 05/2014;
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    ABSTRACT: Tricuspid annular plane systolic excursion (TAPSE) reflects longitudinal myocardial shortening, the main component of right ventricular (RV) contraction in normal hearts. To date, TAPSE has not been extensively studied in patients with hypoplastic left heart syndrome (HLHS) and systemic RVs after Fontan palliation. This retrospective study investigated HLHS patients after Fontan with cardiac magnetic resonance (CMR) performed between 1 January 2010 and 1 August 2012 and transthoracic echocardiogram (TTE) performed within 6 months of CMR. The maximal apical displacement of the lateral tricuspid valve annulus was measured on CMR (using four-chamber cine images) and on TTE (using two-dimensional apical views). To create TTE-TAPSE z-scores, published reference data were used. Intra- and interobserver variability was tested with analysis of variance. Inter-technique agreement of TTE and CMR was tested with Bland-Altman analysis. In this study, 30 CMRs and TTEs from 29 patients were analyzed. The age at CMR was 14.1 ± 7.1 years, performed 11.9 ± 7.8 years after Fontan. For CMR-TAPSE, the intraclass correlation coefficients for inter- and intraobserver variability were 0.89 and 0.91, respectively. The TAPSE measurements were 0.57 ± 0.2 cm on CMR and 0.70 ± 0.2 cm on TTE (TTE-TAPSE z score, -8.7 ± 1.0). The mean difference in TAPSE between CMR and TTE was -0.13 cm [95 % confidence interval (CI) -0.21 to -0.05], with 95 % limits of agreement (-0.55 to 0.29 cm). The study showed no association between CMR-TAPSE and RVEF (R = 0.08; p = 0.67). In patients with HLHS after Fontan, TAPSE is reproducible on CMR and TTE, with good agreement between the two imaging methods. Diminished TAPSE suggests impaired longitudinal shortening in the systemic RV. However, TAPSE is not a surrogate for RVEF in this study population.
    Pediatric cardiology. 05/2014;
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    ABSTRACT: Background: Radiation exposure in the pediatric population may increase the risk of future malignancy. Children with congenital heart disease (CHD) who often undergo repeated catheterizations are at risk. One possible strategy to reduce radiation is to use X-ray Magnetic Resonance Fusion (XMRF) to facilitate cardiac catheterization. Methods: Catheterization data of patients who underwent diagnostic XMRF procedures between 1/1/2009 and 2/1/2012 were reviewed. Cases were matched 1:1 to contemporary controls who did not undergo XMRF based on weight and diagnosis and were compared in radiation exposure, contrast dose and procedural and anesthesia times. Results: 44 matched pairs were included. Baseline demographics were similar in both groups. Patients in the XMRF group had lower indices of radiation exposure measured by fluoroscopy time (14 v. 16.4 v. p = 0.047), dose-area product from fluoroscopy (513.2 v. 589.1 µGy·m(2) , p = 0.042), total dose-area product (625.8 v. 995.2 µGy·m(2) , p = 0.027) and total air kerma dose (94.5 v. 153.8 mGy, p = 0.017). There was also a significant reduction in contrast dose (2 v. 3.3 cc/kg, p <0.001). Procedural time tended to be shorter in the XMRF group but anesthesia time was significantly longer. Conclusion: Select diagnostic cardiac catheterization cases that utilized XMRF used less radiation and contrast than similar cases where XMRF was not used. Future work is needed to determine if similar benefits can be extended to other types of diagnostic and complex interventional procedures. © 2014 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 03/2014; · 2.51 Impact Factor
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    ABSTRACT: Typically, a Fontan connection is constructed as either a lateral tunnel (LT) pathway or an extracardiac (EC) conduit. The LT is formed partially by atrial wall and is assumed to have growth potential, but the extent and nature of LT pathway growth have not been well characterized. A quantitative analysis was performed to evaluate this issue. Retrospective serial cardiac magnetic resonance data were obtained for 16 LT and 9 EC patients at 2 time points (mean time between studies, 4.2 ± 1.6 years). Patient-specific anatomies and flows were reconstructed. Geometric parameters of Fontan pathway vessels and the descending aorta were quantified, normalized to body surface area (BSA), and compared between time points and Fontan pathway types. Absolute LT pathway mean diameters increased over time for all but 2 patients; EC pathway size did not change (2.4 ± 2.2 mm vs 0.02 ± 2.1 mm, p < 0.05). Normalized LT and EC diameters decreased, while the size of the descending aorta increased proportionally to BSA. Growth of other cavopulmonary vessels varied. The patterns and extent of LT pathway growth were heterogeneous. Absolute flows for all vessels analyzed, except for the superior vena cava, proportionally to BSA. Fontan pathway vessel diameter changes over time were not proportional to somatic growth but increases in pathway flows were; LT pathway diameter changes were highly variable. These factors may impact Fontan pathway resistance and hemodynamic efficiency. These findings provide further understanding of the different characteristics of LT and EC Fontan connections and set the stage for further investigation.
    The Annals of thoracic surgery 01/2014; · 3.45 Impact Factor
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    ABSTRACT: Total cavopulmonary connection (TCPC) geometries have great variability. Geometric features, such as diameter, connection angle, and distance between vessels, are hypothesized to affect the energetics and flow dynamics within the connection. This study aimed to identify important geometric characteristics that can influence TCPC hemodynamics. Anatomies from 108 consecutive patients were reconstructed from cardiac magnetic resonance (CMR) images and analyzed for their geometric features. Vessel flow rates were computed from phase contrast CMR. Computational fluid dynamics simulations were carried out to quantify the indexed power loss and hepatic flow distribution. TCPC indexed power loss correlated inversely with minimum Fontan pathway (FP), left pulmonary artery, and right pulmonary artery diameters. Cardiac index correlated with minimum FP diameter and superior vena cava (SVC) minimum/maximum diameter ratio. Hepatic flow distribution correlated with caval offset, pulmonary flow distribution, and the angle between FP and SVC. These correlations can have important implications for future connection design and patient follow-up.
    JACC. Cardiovascular imaging 01/2014; · 14.29 Impact Factor
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    ABSTRACT: The considerable blood mixing in the bidirectional Glenn (BDG) physiology further limits the capacity of the single working ventricle to pump enough oxygenated blood to the circulatory system. This condition is exacerbated under severe conditions such as physical activity or high altitude. In this study, the effect of high altitude exposure on hemodynamics and ventricular function of the BDG physiology is investigated. For this purpose, a mathematical approach based on a lumped parameter model was developed to model the BDG circulation. Catheterization data from 39 BDG patients at stabilized oxygen conditions was used to determine baseline flows and pressures for the model. The effect of high altitude exposure was modeled by increasing the pulmonary vascular resistance (PVR) and heart rate (HR) in increments up to 80% and 40% respectively. The resulting differences in vascular flows, pressures and ventricular function parameters were analyzed. By simultaneously increasing PVR and HR, significant changes (p <0.05) were observed in cardiac index (11% increase at an 80% PVR and 40% HR increase) and pulmonary flow (26% decrease at an 80% PVR and 40% HR increase). Significant increase in mean systemic pressure (9%) was observed at 80% PVR (40% HR) increase. The results show that the poor ventricular function fails to overcome the increased preload and implied low oxygenation in BDG patients at higher altitudes, especially for those with high baseline PVRs. The presented mathematical model provides a framework to estimate the hemodynamic performance of BDG patients at different PVR increments.
    Journal of biomechanics 01/2014; · 2.66 Impact Factor
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    ABSTRACT: This study sought to quantify average hemodynamic metrics of the Fontan connection as reference for future investigations, compare connection types (intra-atrial vs extracardiac), and identify functional correlates using computational fluid dynamics in a large patient-specific cohort. Fontan hemodynamics, particularly power losses, are hypothesized to vary considerably among patients with a single ventricle and adversely affect systemic hemodynamics and ventricular function if suboptimal. Fontan connection models were created from cardiac magnetic resonance scans for 100 patients. Phase velocity cardiac magnetic resonance in the aorta, vena cavae, and pulmonary arteries was used to prescribe patient-specific time-averaged flow boundary conditions for computational fluid dynamics with a customized, validated solver. Comparison with 4-dimensional cardiac magnetic resonance velocity data from selected patients was used to provide additional verification of simulations. Indexed Fontan power loss, connection resistance, and hepatic flow distribution were quantified and correlated with systemic patient characteristics. Indexed power loss varied by 2 orders of magnitude, whereas, on average, Fontan resistance was 15% to 20% of published values of pulmonary vascular resistance in single ventricles. A significant inverse relationship was observed between indexed power loss and both systemic venous flow and cardiac index. Comparison by connection type showed no differences between intra-atrial and extracardiac connections. Instead, the least efficient connections revealed adverse consequences from localized Fontan pathway stenosis. Fontan power loss varies from patient to patient, and elevated levels are correlated with lower systemic flow and cardiac index. Fontan connection type does not influence hemodynamic efficiency, but an undersized or stenosed Fontan pathway or pulmonary arteries can be highly dissipative.
    The Journal of thoracic and cardiovascular surgery 12/2013; · 3.41 Impact Factor
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    ABSTRACT: The Fontan procedure, although an imperfect solution for children born with a single functional ventricle, is the only reconstruction at present short of transplantation. The haemodynamics associated with the total cavopulmonary connection, the modern approach to Fontan, are severely altered from the normal biventricular circulation and may contribute to the long-term complications that are frequently noted. Through recent technological advances, spear-headed by advances in medical imaging, it is now possible to virtually model these surgical procedures and evaluate the patient-specific haemodynamics as part of the pre-operative planning process. This is a novel paradigm with the potential to revolutionise the approach to Fontan surgery, help to optimise the haemodynamic results, and improve patient outcomes. This review provides a brief overview of these methods, presents preliminary results of their clinical usage, and offers insights into its potential future directions.
    Cardiology in the Young 12/2013; 23(6):817-822. · 0.95 Impact Factor
  • Circulation Cardiovascular Imaging 11/2013; 6(6):1092-1101. · 5.80 Impact Factor
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    ABSTRACT: -Cardiac catheterization is routinely used as a diagnostic tool in single ventricle patients with superior cavopulmonary connection (SCPC). This physiology presents inherent challenges in applying the Fick principle to estimate flow. We sought to quantitatively define the error in oximetry-derived flow parameters, using phase-contrast cardiac MRI (CMR) as a reference. -Thirty patients with SCPC who underwent combined cardiac MRI and catheterization between July 2008 and June 2012 were retrospectively analyzed. Estimates of flow and resistance calculated using the Fick equation were compared to CMR measurements. Oximetry underestimated CMR-measured pulmonary blood flow (Qp) by an average of 1.1 L/min/m(2), or 32% of the CMR value (p < .0001). Oximetry overestimated systemic blood flow (Qs) by an average of 0.5 L/min/m(2), or 15% of the CMR value (p = .009). There was no correlation between the Qp:Qs ratio derived by Fick and that measured by CMR (ρc = 0.01). The error in Fick Qp correlated moderately with the measured systemic to pulmonary arterial collateral flow (r =0.39). The median total oxygen consumption calculated using combined CMR and oximetry data was 173 mL/min/m(2), higher than the assumed values used to calculate flows by the Fick equation. The upper body circulation received on average 51% of systemic blood flow while conducting only 39% of total body metabolism. -Fick-derived estimates of flow are inherently unreliable in patients with superior cavopulmonary connections. Integrating flows measured by CMR and pressures measured by catheter will provide the best characterization of SCPC physiology.
    Circulation Cardiovascular Imaging 10/2013; · 5.80 Impact Factor
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    ABSTRACT: Previous studies of outcome after operative correction of interrupted aortic arch (IAA) have focused on mortality and rates of reintervention. We sought to investigate the clinical status of children and adolescents after surgery for IAA. A cross-sectional study of subjects with IAA between the ages of 8 and 18 years was performed with the subjects undergoing simultaneous genetic testing, electrocardiogram, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and assessment of health status and health-related quality of life as well as concurrent retrospective cohort study reviewing their postoperative use of medical care, including operative and transcatheter reinterventions, noncardiac surgeries, and hospitalizations. Twenty-one subjects with IAA with median age of 9 years were studied. Reintervention rates were 38 % for left-ventricular outflow tract, 33 % for AA, and 24 % for both. Rates of reintervention were highest in the first year of life and decreased in subsequent years. Left-ventricular ejection fraction was preserved (72 ± 6 %). Maximal oxygen consumption, maximal work, and forced vital capacity were both significantly decreased from age and sex norms (p < 0.0001). Health status and quality of life were both severely decreased. Subjects with IAA demonstrate a significant burden of operative and transcatheter intervention and large magnitude deficits in exercise performance, health status, and health-related quality of life.
    Pediatric Cardiology 09/2013; · 1.20 Impact Factor
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    ABSTRACT: Studies of outcome after operative correction of truncus arteriosus communis (TA) have focused on mortality and rates of reintervention. We sought to investigate the clinical status of children and adolescents with surgically corrected TA. A cross-sectional study of subjects with TA was performed. Subjects underwent concurrent genetic testing, electrocardiogram, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and completed questionnaires assessing health status and health-related quality of life. Review of their medical history provided retrospective information on cardiac reintervention and use of medical care. Twenty-five subjects with a median age of 11.8 (8.1-18.99) years were enrolled. The prevalence of 22q11.2 deletion was 32%. Incidence of hospitalization, cardiac reintervention, and noncardiac operations was highest in the first year of life. Combined catheter-based and operative reintervention rates were 52% on the conduit and 56% on the pulmonary arteries. Right ventricular ejection fraction and end-diastolic volume were normal. Moderate or greater truncal valve insufficiency was seen in 11% of subjects, and truncal valve replacement occurred in 8% of subjects. Maximal oxygen consumption (P = .0002), maximal work (P < .0001), and forced vital capacity (P < .0001) were all lower than normal for age and sex. Physical health status and health-related quality of life were both severely diminished. Patients with TA demonstrate significant comorbid disease throughout childhood, significant burden of operative and catheter-based reintervention, and deficits in exercise performance, functional status, and health-related quality of life.
    American heart journal 09/2013; 166(3):512-8. · 4.65 Impact Factor
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    ABSTRACT: Congenital heart valve disease is one of the most common abnormalities in children. There are limited technological solutions available for treating children with congenital heart valve diseases. The aim of this study is to provide the details of the consensus reached in terms of pediatric definitions, design approach, in vitro testing, and clinical trials, which may be used as guidance for developing prosthetic heart valves for the pediatric indication. In stark contrast to the various designs of adult-sized replacement valves available in the market, there are no Food and Drug Administration (FDA)-approved prosthetic heart valves available for use in the pediatric population. There is a pressing need for FDA-approved pediatric valve devices in the United States. The pediatric patient population has been typically excluded from replacement heart valve trials for several reasons. In January 2010, heart valve manufacturers and pediatric clinicians collaborated with academicians and FDA staff in a workshop to suggest ways to successfully evaluate pediatric prosthetic valves and conduct pediatric clinical trials to provide acceptable heart valve replacement options for this patient population. Recommendations, derived from ISO 5840:2005 and the 2010 FDA Draft Replacement Heart Valve Guidance, are provided for hydrodynamic, durability, and fatigue testing. The article specifically addresses in vitro and premarket and postmarket approval clinical studies that should be considered by a heart valve manufacturer for obtaining regulatory approval of pediatric sizes of prosthetic heart valve designs that are already approved for adult clinical use.
    The Journal of thoracic and cardiovascular surgery 06/2013; · 3.41 Impact Factor
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    ABSTRACT: With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post Processing of the Society for Cardiovascular MR (SCMR). The aim of the task force is to recommend requirements and standards for image interpretation and post processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate.
    Journal of Cardiovascular Magnetic Resonance 05/2013; 15(1):35. · 4.44 Impact Factor
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    ABSTRACT: OBJECTIVES The total cavopulmonary connection (TCPC), the current palliation of choice for single-ventricle heart defects, is typically created with a single cylindrical tunnel or conduit routing inferior vena caval (IVC) flow to the pulmonary arteries. Previous studies have shown the haemodynamic efficiency of the TCPC to be sub-optimal due to the collision of vena caval flow, thus placing an extra energy burden on the single ventricle. The use of a bifurcated graft as the Fontan baffle (i.e. the 'Optiflo') has previously been proposed on the basis of theoretically improved flow efficiency; however, anatomical constraints may limit its effectiveness in some patients.METHODS In this study, an alternative approach to flow bifurcation is proposed, where a triangular insert is placed at the distal end of the IVC graft. The proof of concept for this design is demonstrated in two steps: first, determining the optimal insert size at a fixed Fontan graft size through a parametric study; then, characterizing the efficiency as a function of graft size when compared with a TCPC control. TCPC power loss and IVC flow distribution were the primary metrics of interest and were evaluated under both resting and simulated exercise conditions using an in-house computational fluid dynamics solver.RESULTSResults demonstrated that there was an optimal insert size that improved efficiency compared with the TCPC. For an 18-mm Fontan baffle, TCPC power loss was 4.1 vs 3.7 mW with the optimal flow-divider. The optimal insert was then scaled up for a 20-mm graft, with a similar reduction in power loss observed. Flow distribution results were inconsistent, based on sensitivity to the placement of the insert within the baffle.CONCLUSION This study demonstrated proof of concept that the flow-divider has the potential to reduce power loss and streamline IVC flow through the TCPC. An appropriate size for the insert in proportion to the Fontan baffle size was identified that reduced losses compared with a TCPC control under both resting and simulated exercise flow conditions.
    Interactive Cardiovascular and Thoracic Surgery 04/2013; · 1.11 Impact Factor
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    ABSTRACT: Background:Sodium bicarbonate (NaHCO3) is a common treatment for metabolic acidemia; however, little definitive information exists regarding its treatment efficacy and cerebral hemodynamic effects. This pilot observational study quantifies relative changes in cerebral blood flow (ΔrCBF) and oxy- and deoxyhemoglobin concentrations (ΔHbO2 and ΔHb) due to bolus administration of NaHCO3 in patients with mild base deficits.Methods:Infants and children with hypoplastic left heart syndrome (HLHS) were enrolled before cardiac surgery. NaHCO3 was given as needed for treatment of base deficit. Diffuse optical spectroscopies were used for 15 min postinjection to noninvasively monitor ΔHb, ΔHbO2, and ΔrCBF relative to baseline before NaHCO3 administration.Results:Twenty-two anesthetized and mechanically ventilated patients with HLHS (aged 1 d to 4 y) received a median (interquartile range) dose of 1.1 (0.8, 1.8) mEq/kg NaHCO3 administered intravenously over 10-20 s to treat a median (interquartile range) base deficit of -4 (-6, -3) mEq/l. NaHCO3 caused significant dose-dependent increases in ΔrCBF; however, population-averaged ΔHb and ΔHbO2 as compared with those of controls were not significant.Conclusions:Dose-dependent increases in cerebral blood flow (CBF) caused by bolus administration of NaHCO3 are an important consideration in vulnerable populations wherein risk of rapid CBF fluctuations does not outweigh the benefit of treating a base deficit.Pediatric Research (2013); doi:10.1038/pr.2013.25.
    Pediatric Research 02/2013; · 2.67 Impact Factor
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    ABSTRACT: BACKGROUND: THE SIGNIFICANCE AND OPTIMAL TREATMENT OF SYSTEMIC-TO-PULMONARY ARTERIAL COLLATERAL (SPC) VESSELS IN SINGLE VENTRICLE PATIENTS ARE POORLY UNDERSTOOD. THE ACUTE EFFICACY OF SPC EMBOLIZATION HAS NOT BEEN DEMONSTRATED IN A QUANTIFIABLE FASHION. WE SOUGHT TO ASSESS THE ACUTE EFFICACY OF SPC EMBOLIZATION ON BLOOD FLOW AS QUANTIFIED BY PHASE CONTRAST MAGNETIC RESONANCE IMAGING AND HYPOTHESIZED THAT EMBOLIZATION ACUTELY DECREASES SPC FLOW AND INCREASES SYSTEMIC BLOOD FLOW (Q(S)).METHODS AND RESULTS: SIX SUPERIOR CAVOPULMONARY CONNECTION PATIENTS UNDERWENT SPC FLOW QUANTIFICATION BY PHASE CONTRAST MAGNETIC RESONANCE IMAGING, INCLUDING QUANTIFICATION OF SUPERIOR AND INFERIOR CAVAL, TOTAL PULMONARY ARTERY, TOTAL PULMONARY VEIN, ASCENDING AND DESCENDING AORTIC FLOWS (Q(SVC), Q(IVC), Q(PA), Q(PV), Q(AO), AND Q(DAO), RESPECTIVELY), BOTH IMMEDIATELY BEFORE AND AFTER CARDIAC CATHETERIZATION WITH COIL AND PARTICLE EMBOLIZATION OF ANGIOGRAPHICALLY EVIDENT SPC VESSELS. ALL STUDIES WERE PERFORMED UNDER A SINGLE ANESTHETIC. AFTER EMBOLIZATION, WE FOUND A SIGNIFICANT DECREASE IN SPC FLOW OF 0.9 (RANGE, 0.61.3) L/(MINM(2)) (P=0.03); A MEDIAN REDUCTION OF 47% (RANGE, 3260). THERE WAS A SIGNIFICANT DECREASE IN THE MEDIAN Q(P):Q(S) FROM 1.3 BEFORE TO 0.8 AFTER EMBOLIZATION (P=0.03), AND AN INCREASE IN Q(S) FROM A MEDIAN OF 3.4 TO 4.4 L/(MINM(2)) (P0.05), AND Q(SVC) FROM A MEDIAN OF 1.7 TO 2.3 L/(MINM(2)) (P=0.03).CONCLUSIONS: We report on the acute efficacy of SPC embolization, demonstrating a significant decrease in SPC flow and Q(P):Q(S) and increase in Q(SVC) and Q(S). Further studies are needed to assess the durability of the procedure and the effect on Fontan and longer-term outcomes.
    Circulation Cardiovascular Interventions 01/2013; · 6.54 Impact Factor
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    Journal of Cardiovascular Magnetic Resonance 01/2013; 15(1). · 4.44 Impact Factor

Publication Stats

2k Citations
612.64 Total Impact Points

Institutions

  • 1992–2014
    • The Children's Hospital of Philadelphia
      • • Division of Cardiology
      • • Department of Radiology
      • • Department of Pediatrics
      Philadelphia, Pennsylvania, United States
  • 2003–2013
    • Georgia Institute of Technology
      • Department of Biomedical Engineering
      Atlanta, GA, United States
  • 2012
    • University of Pennsylvania
      • Department of Physics and Astronomy
      Philadelphia, PA, United States
  • 2011
    • University of Zurich
      Zürich, Zurich, Switzerland
    • Colorado State University
      • Mechanical Engineering
      Fort Collins, CO, United States
  • 1993–2011
    • Hospital of the University of Pennsylvania
      • • Department of Pediatrics
      • • Department of Radiology
      Philadelphia, Pennsylvania, United States
  • 2009
    • University of Nebraska at Omaha
      Omaha, Nebraska, United States
  • 2008
    • Carnegie Mellon University
      • Department of Biomedical Engineering
      Pittsburgh, PA, United States
  • 2007
    • Yale University
      New Haven, Connecticut, United States
  • 2005
    • Children's Hospital Los Angeles
      • Division of Cardiology
      Los Angeles, California, United States