Joaquim Miró

• Agence de la Santé et des Services Sociaux

PurposeMedical image analysis suffers from a sparsity of annotated data necessary in learning-based models. Cardiorespiratory simulators have been developed to counter the lack of data. However, the resulting data often lack realism. Hence, the proposed method aims to synthesize realistic and fully customizable angiograms of coronary arteries for t...

A ventricular septal defect (VSD) may be a risk factor for brain development in transposition of the great arteries (TGA). Brain hemodynamics and oxygen metabolism assessed by optical monitoring in TGA&VSD were compared to controls.

Image-guided cardiac interventions are highly affected by cardio-respiratory motion. This study presents a novel patient-specific cardio-respiratory motion prediction approach for X-ray angiography time series based on a simple Long Short-Term Memory (LSTM) model. The model can facilitate the navigation process of the cardiac intervention. The card...

Purpose: Transesophageal echocardiography (TEE) is the preferred imaging modality in a hybrid procedure used to close ventricular septal defects (VSDs). However, the limited field of view of TEE hinders the maneuvering of surgical instruments inside the beating heart. This study evaluates the accuracy of a method that aims to support navigation gu...

Purpose: Ventricular septal defects (VSD) are congenital heart malformations and, in severe cases, they require complex interventions under echocardiography guidance. Heart phantoms can be helpful to train and to understand the complex hemodynamics of VSD. The goal of this study was to characterize the best blood mimicking fluids in such heart pha...

Background Navigation guidance in cardiac interventions is provided by X‐ray angiography. Cumulative radiation exposure is a serious concern for pediatric cardiac interventions. Purpose A generative learning‐based approach is proposed to predict X‐ray angiography frames to reduce the radiation exposure for pediatric cardiac interventions while pre...

Fontan palliation results in a hemodynamically complex circulation with multisystem consequences, which in the long term adversely affect many body processes. Systemic venous hypertension, non-pulsatile low shear pulmonary blood flow and low cardiac output are the three main characteristics of a Fontan circulation leading to unavoidable slowly prog...

Purpose: Ventricular septal defects (VSDs) are common congenital heart malformations. Echocardiography used during VSD hybrid cardiac procedures requires extensive training for image acquisition and interpretation. Cardiac surgery simulators with heart phantoms have shown usefulness for such training, but they are limited in visualization and char...

Supravalvular pulmonary stenosis (SVPS) is considered a rare form of pulmonary stenosis (PS) and represents both a diagnostic and therapeutic challenge. There currently exist no reliable echocardiographic criteria to accurately predict the supravalvular form. The aims of the study were to describe the response to treatment of the different PS prese...

We present a novel model-free approach for cardiorespiratory motion prediction from X-ray angiography time series based on Long Short-Term Memory Recurrent Neural Networks (LSTM-RNN). Cardiorespiratory motion prediction is defined as a problem of estimating the future displacement of the coronary vessels in the next image frame in an X-ray angiogra...

X-ray angiograms are currently the gold-standard in percutaneous guidance during cardiovascular interventions. However, due to lack of contrast, to overlapping artifacts and to the rapid dilution of the contrast agent, they remain difficult to analyze either by cardiologists, or automatically by computers. Providing, a general yet accurate multi-ar...

Background: The Inoue balloon technique is the standard technique for mitral valve balloon commissurotomy at this stage. However, the hardware for this technique is expensive and may not always be available in resource-limited settings. Objective: This article reports our experience with percutaneous transmitral balloon commissurotomy using a si...

Purpose: Early detection of blood vessel pathologies can be made through the evaluation of functional and structural abnormalities in the arteries, including the arterial distensibility measure. We propose a feasibility study on computing arterial distensibility automatically from monoplane 2D X-ray sequences for both small arteries (such as coron...

Objectives: To report the initial clinical experience with a novel atrial septal defect (ASD) closure device, the GORE(®) CARDIOFORM ASD Occluder (GCO). Background: Transcatheter closure has become the treatment of choice for secundum ASD. A wide range of occluder devices are available, but concern has been raised about the risk of cardiac erosi...

The segmentation and tracking of coronary arteries (CAs) are critical steps for the computation of biophysical measurements in pediatric interventional cardiology. In the literature, most methods are focused on either segmenting the vessel lumen or on tracking the vessel centerline. However, they do not simultaneously combine the segmentation and t...

Background: Shone complex consists of a constellation of left-sided, usually obstructive, cardiac lesions, including supravalvar mitral ring, parachute mitral valve, subaortic stenosis, and aortic coarctation. Incomplete Shone complex consists of a mitral valve anomaly associated with lesions involving the subaortic region, aortic valve, or thorac...

Percutaneous treatment of totally occluded coarctation of the aorta has been reported predominantly in adults. The success and challenges of this procedure in children is reported in few patients. We report an outcome of percutaneous treatment of three children with completely occluded coarctation of the aorta. The age range was 9-14 years. All the...

Stent size selection and placement is one of the most challenging steps in the treatment of pulmonary artery stenosis, especially for pediatric patients with smaller vasculature. The goal of this studyis to visually simulate stent placement and deployment, to assist the physician in choosing an appropriate stent length and placement. First a 3D mod...

Introduction: Echo-based coronary artery (CA) Z-value is the current standard for the case definition of CA dilatation (Z>2.5) in KD. Extrapolating Z-value equations to selective angiography has not been evaluated. CA to aortic valve (AV) ratio is stable versus BSA (Figure). Methods: CA measurements from selective angiography were compared to echo...

Medical and surgical breakthroughs in the care of children born with heart defects have generated a growing population of adult survivors and spawned a new subspecialty of cardiology: adult congenital heart disease. The prevalence of adult congenital heart disease is escalating at a rampant rate, outpacing the relatively static prevalence of pediat...

Background: Lesions of adjacent structures have been reported after closure of large atrial septal defects with the Amplatzer septal occluder. In children, growth of the heart should modify the initial relationship between the device and surrounding structures. Aim: To compare the relationship between large Amplatzer septal occluder and adjacent...

Balloon angioplasty (BAP) used to manage native coarctation of the aorta (CoAo) in infants remains controversial. This study aimed to compare short- and midterm results of BAP between native CoAo (NaCo) and postsurgical recoarctations (ReCo) in infants younger than 1 year. This retrospective study compared the clinical, echocardiographic, hemodynam...

Objectives To describe the initial world experience and mid‐term follow‐up of perimembranous ventricular septal defect (pmVSD) closure with a newly designed occluder. Background Transcatheter closure of pmVSDs has been associated with a substantial risk of complete heart block, prompting many centers to abandon this intervention. Methods A prospe...

Purpose: Transcatheter closure of peri-membranous ventricular septal defects (pmVSDs) has been associated with a significant risk of complete heart block, leading most groups to abandon the technique. We describe the initial world experience of pmVSD closure with a newly designed occluder. Methods: Patients with pmVSD underwent catheter closure usi...

Fontan surgery represents a milestone in the evolution of congenital heart disease management. It achieved the seemingly improbable (ie, restoration of a noncyanotic state by entirely bypassing the subpulmonary ventricle). In so doing, it has allowed a generation of children who may have otherwise succumbed to their severe congenital heart defect t...

Tetralogy of Fallot is the most common form of cyanotic congenital heart disease and accounts for 10% of all congenital heart defects. Corrective surgery has dramatically improved long-term prognosis, with nearly 90% of patients now surviving well into adulthood. Aortic root dilation is a well-recognized feature of unrepaired tetralogy of Fallot, a...

Background: Many adults with repaired tetralogy of Fallot have had prior Blalock-Taussig shunts. These shunts may theoretically hinder growth and development of the ipsilateral arm. Methods: We prospectively enrolled consecutive patients with tetralogy of Fallot in a cross-sectional study to measure arm length and assess handgrip strength. Bilat...

The purpose of this study is to evaluate the position and the progress of large Amplatzer septal occluder (ASO) devices relevant to adjacent cardiac structures in growing children using MRI. Institutional review board approval for this study was obtained. Twenty-five children who underwent large ASO implantation were evaluated using MRI. All subjec...

A 57-year-old woman suffering from recurrent pneumonia and considered to be high risk for surgical correction of an atrial septal defect (ASD) associated with a right lung sequestration vascularized by arteries coming from the abdominal aorta and an abnormal venous drainage into the inferior vena cava (Scimitar syndrome). Therefore stepwise transca...

Though effective, transcatheter closure of perimembranous ventricular septal defects (pmVSD) with the Amplatzer Membranous VSD Occluder (AGA Medical Corporation, MN, USA) carries a substantial risk of complete heart block, prompting many to abandon this intervention. A newly designed Amplatzer device for pmVSD was modified, in part, to minimize thi...

Percutaneous cardiac interventions rely mainly on the experience of the cardiologist to safely navigate inside soft tissues vessels under X-ray angiography guidance. Additional navigation guidance tool might contribute to improve reliability and safety of percutaneous procedures. This study focus on major aorta-pulmonary collateral arteries (MAPCAs...

Unlabelled: Generalized arterial calcification of infancy (GACI, MIM#208000) is a rare autosomal recessive disorder characterized by extensive calcifications in the media of large- and medium-sized muscular arteries. Most affected children die in early infancy because of cardiac failure. GACI is linked to mutations in the ENPP1 gene, which encodes...

As a result of major achievements in pediatric cardiac care, a growing number of patients with congenital heart disease (CHD) are flourishing well into adulthood. This heterogeneous and aging population of patients, many of whom represent the first generation of middle-age survivors, faces unique issues and challenges. As a field, adult CHD has evo...

The management of pediatric discrete subaortic stenosis remains controversial. Document the natural history and surgical outcomes for discrete subaortic stenosis to adolescence. Retrospective review of clinical and echocardiographic findings in 74 patients diagnosed in childhood between 1985 and 1998. Twenty-five patients were followed only medical...

Isolated hemodynamically significant ventricular septal defects (VSD) were previously treated surgically. Since the introduction of percutaneous (PC) devices, the management of isolated VSD has evolved. In our center, Amplatzer devices have been implanted for selected isolated perimembranous VSD since 2002. The charts of all isolated PC perimembran...

Rejection of transplanted hearts remains one of the principal reasons for death of paediatric patients, but an appropriate diagnostic tool for the mild rejection in early stages is still missing. Tissue autofluorescence (AF) is one of the most versatile non-invasive tools for mapping the metabolic state in living tissues. Increasing interest in the...

Therapeutic strategies for isolated unilateral absence of a proximal pulmonary artery remain unclear. The natural history of the disease, or thrombosis of primary surgical anastomosis, leads to exclusion of the affected lung with increased risk of intrapulmonary bleeding, impaired quality of life, and shortened life expectancy. We herein describe o...

Kawasaki disease (KD) related coronary artery (CA) aneurysms may lead to significant and potentially insidious progressive stenosis. It is also well recognized that CA scarring leads to heavy calcification in KD. We intended to correlate the angiographic anomalies associated with coronary calcifications in KD and to evaluate the chronology and the...

We report the experience in a single institution with balloon aortic valvoplasty for congenital aortic stenosis. Unlike most other reported series, we included patients with associated lesions involving the left side of the heart. Between November, 1986, and November, 2006, we performed 161 interventions on 143 patients, of whom 33 were neonates, 3...

Interventional paediatric and congenital cardiology is expanding at a rapid pace. Validated techniques (such as aortic or pulmonary valve dilatations and occlusion of persistent ductus arteriosus and atrial septal defects) are improving thanks to the use of smaller introducers and sheaths, low-profile balloons and novel devices. Moreover, catheter-...

High quality three-dimensional imaging is one of the cornerstones in structural heart disease interventions. Current mainstream technology to acquire three-dimensional imaging utilises computed tomography or magnetic resonance imaging. Incorporation of these data with conventional angiographic images may not be sufficient. We describe a new imaging...

Tissue autofluorescence is one of the most versatile non-invasive tools for mapping the metabolic state in living tissues. Increasing interest in the imaging and diagnosis of living cells and tissues, based on their intrinsic fluorescence rather than fluorescence labeling, is closely connected to the latest developments in high-performance spectros...

This report describes the rapid buildup of an intraluminal thrombus and secondary myocardial ischemia after a brief therapeutic withdrawal of warfarin in a case of Kawasaki-related chronic giant coronary aneurysm. The importance of tight antithrombotic control in such cases is underscored.

Because of anatomical proximity, closure of paramembranous ventricular septal defect (pm-VSD) with an Amplatzer occluder has the potential to affect the atrioventricular (AV) conduction system. Electrophysiology studies (EPS) were performed prior to and following closure of the pm-VSD in 19 children aged 8.9 +/- 4.5 years. Data from electrocardiogr...

Reduced left lung perfusion has been described following percutaneous occlusion of the patent ductus arteriosus (PDA). We aimed to identify the incidence of lung perfusion abnormalities and the associated risk factors in our consecutive series. Between November 1994 and December 2003, 150 procedures were performed on 145 patients, age 4.6 +/- 4 yea...

Recanalization of a complete coarctation with isthmus occlusion was successfully accomplished in a 16-year-old patient using radiofrequency. This allowed the insertion and deployment of a covered stent to reestablish flow continuity across the isthmus. No complications were encountered. To the authors' knowledge this is the first case of radiofrequ...

INTRODUCTION: We previously reported the clinical outcomes of a large pediatric cohort with discrete subaortic stenosis (SubAS) ¹ . While patients with more significant left ventricular outflow tract obstruction (LVOTO) at diagnosis progressed rapidly others with mild LVOTO at presentation showed little progression of obstruction or aortic insuffic...

Complete transposition of the great arteries has been historically managed by the Mustard (atrial switch) operation. This procedure is associated with longterm complications such as baffle occlusion, which also precludes the insertion of a permanent transvenous pacemaker. Transcatheter techniques have allowed the successful angioplasty and stenting...

Rejection of transplanted hearts remains an important reason for death of transplanted children. Finding diagnostic tools for its detection can therefore improve the prognosis in this population of patients. Endomyocardial biopsy (EMB) by cardiac catheterization is currently accepted as the "gold standard" for the diagnosis of rejection. Here, we i...

The objectives of this study were to compare, in the current era, the immediate results, complications, and midterm outcomes obtained by surgical repair versus transcatheter treatment of coarctation of the aorta (CoA). The study was of retrospective nature and included 80 consecutive patients > or = 1 year old (mean age 12 +/- 10 years) treated for...

We report the case of a young girl with a mixed total anomalous pulmonary venous return (cardiac and supracardiac) treated sequentially by partial neonatal surgery, and then catheterization at age 19 with installation of an Amplatzer device as a treatment of the remaining anomaly. We describe the usefulness of magnetic resonance imaging in both the...

We sought to determine the incidence, nature, and predisposing factors of atrioventricular block (AVB) associated with closure of atrial septal defects (ASDs) using the Amplatzer septal occluder (ASO). In our institution, 162 patients underwent ASD closure using ASO between December 1997 and December 2001. This includes small children with large de...

Congenital anomalies of the thoracic veins, although uncommon, can be of the utmost clinical and surgical significance. These venous anomalies may be subdivided into systemic and pulmonary. Most systemic venous abnormalities are incidental findings, whereas pulmonary vein malformations coexist with coronary heart disease, especially atrial septal d...

Magnetic resonance (MR) imaging was used to evaluate the position of a large atrial septal occluder (ASO) with regard to adjacent cardiac valves and veins and to assess any negative effects of the ASO on these vital structures. A total of 26 pediatric patients (mean age, 4.5 years; mean interval after implantation, 18.8 months) were evaluated with...

To compare ease of recording and reliability of ultrasonographic approaches used to time fetal heart atrial and ventricular contractions. Seventeen consecutive fetuses seen at our fetal cardiology unit for possible fetal cardiac arrhythmia were included in this study. The same ultrasonographer obtained M-mode tracings of atrial and ventricular free...

The objective of this study was to establish the echocardiographic modality that best correlates with electrical events in the fetal heart. No documentation on the relationship between electrical events recorded with a surface ECG and fetal M-mode or Doppler echocardiographic measurements is available. The following ultrasound tracings were recorde...

Manual measurement of Doppler flow velocity waveforms is time-consuming and carries unavoidable and significant intraobserver and interobserver variability. Those drawbacks limit the routine use of Doppler-derived indexes of systolic and diastolic function. This report describes a system that performs automatically all relevant measurements current...

Seven patients underwent cardiac transplantation at Ste-Justine Hospital between June 1984 and October 1988 (age 3-16 years). Indices derived from M-mode echocardiography--left ventricular mass (LVM), isovolumetric relaxation time (IRT), shortening fraction (SF), velocity of circumferential fiber shortening (VCF), ejection fraction (EF), LV pre-eje...