Doreen DeFaria Yeh

Massachusetts General Hospital, Boston, Massachusetts, United States

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Publications (24)87.89 Total impact

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    ABSTRACT: Aims: The impact of coronary computed tomographic angiography (CTA) on management of anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) remains uncertain. We examined the prevalence, anatomical characterization, and outcomes of ACAOS patients undergoing CTA. Methods and results: Among 5991 patients referred for CTA at two tertiary hospitals between January 2004 and June 2014, we identified 103 patients (1.7% prevalence) with 110 ACAOS vessels. Mean age was 52 years (range 5-83, 63% male), with 55% previously known ACAOS and 45% discovered on CTA. ACAOS subtypes included: 39% interarterial (n = 40 anomalous right coronary artery, n = 3 anomalous left coronary artery), 38% retroaortic, 15% subpulmonic, 5% prepulmonic, and 2% other. ACAOS patients were assessed for symptoms, ischaemic test results, revascularization, all-cause or cardiovascular (CV) death, and myocardial infarction. CTAs were reviewed for ACAOS course, take-off height and angle, length and severity of proximal narrowing, intramural course, and obstructive coronary artery disease (CAD). In follow-up (median 5.8 years), there were 20 surgical revascularizations and 3 CV deaths. After adjusting for obstructive CAD (n = 21/103, 20%), variables associated with ACAOS revascularization included the following: CV symptoms, proximal vessel narrowing ≥50%, length of narrowing >5.4 mm, and an interarterial course. Conclusion: The prevalence of ACAOS on CTA was 1.7%, including 45% of cases discovered incidentally. CTA provided excellent characterization of ACAOS features associated with coronary revascularization, including the length and severity of proximal vessel narrowing.
    No preview · Article · Feb 2016 · European Heart Journal Cardiovascular Imaging
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    ABSTRACT: Background: Anomalous aortic origin of the coronary artery (AAOCA) with an interarterial (IAC) course is an uncommon congenital anomaly. Surgical indications and repair techniques have evolved. We have managed 259 adult patients with AAOCA over 40 years. Our management strategy includes anatomic- and function-based surveillance to select surgical candidates. We reviewed our surgical cohort and analyzed anatomic and functional outcomes. Methods: We queried our heart center databases to obtain the names of all patients with AAOCA managed at our institution between 1974 and 2014. We performed a retrospective chart review. Results: Two hundred fifty-nine patients were managed for AAOCA. Sixty-one underwent surgical intervention. Twenty-six with associated coronary atherosclerosis were excluded. Thirty-one who underwent surgical repair were analyzed. Mean age was 42.5 ± 2.7 years. Twenty-four patients (77.4%) had right AAOCA. Six (19.4%) had left AAOCA. One (3.2%) had bilateral coronary anomalies. Repair techniques included 21 unroofing procedures (67.7%), 6 translocations (19.4%), and 4 coronary artery bypass grafting (CABG) procedures (12.9%). Mean follow-up was 3.8 ± 0.8 years. Thirteen patients underwent follow-up anatomic testing with computed tomography. Twelve of these patients had widely patent coronary arteries, and 1 patient had mild coronary artery stenosis. Seventeen patients underwent functional testing. Fifteen of these patients had no evidence of ischemia. One patient had reversible ischemia after CABG, and 1 had subclinical ischemia after unroofing. There was 1 late mortality from endocarditis. Conclusions: Our multidisciplinary program uses a treatment algorithm to select patients with AAOCA for surgical intervention. Only a small subset requires an operation, and we favor unroofing and translocation techniques. With this paradigm, outcomes are excellent, as validated with anatomic- and function-based testing.
    No preview · Article · Oct 2015 · The Annals of thoracic surgery
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    ABSTRACT: We report the case of a 62-year-old woman who presented with classic symptoms of stable angina. Cardiac images and catheterization results revealed absent pulmonary valve syndrome and compression of the left main coronary artery by a massively dilated pulmonary artery aneurysm. The patient's anginal symptoms were relieved after pulmonary arterioplasty. Others have described proximal left main coronary artery compression in the presence of a dilated and hypertensive pulmonary artery To our knowledge, this is the first case in which a pulmonary artery aneurysm caused left main coronary insufficiency in the absence of pulmonary hypertension a clinically important complication of congenital pulmonary valve-related pulmonary arteriopathy.
    No preview · Article · Oct 2015 · Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
  • Ami B. Bhatt · Doreen DeFaria Yeh
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    ABSTRACT: Most women with known congenital heart disease can have successful pregnancy, labor, and delivery. Preconception assessment is essential in understanding anatomy, repairs, and current physiology, all of which can influence risk in pregnancy. With that foundation, a multidisciplinary cardio-obstetric team can predict and prepare for complications that may occur with superimposed hemodynamic changes of pregnancy. Individuals with Eisenmenger syndrome, pulmonary hypertension, cyanosis, significant left heart obstruction, ventricular dysfunction, or prior major cardiac event are among the highest risk for complications.
    No preview · Article · Aug 2015 · Cardiology Clinics
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    ABSTRACT: Patients with single-ventricle (SV) anatomy now live to adulthood. Little is known about the cost of care and outcomes for patients with SV anatomy, especially those who develop heart failure (HF) cared for in adult hospitals in the United States. We analyzed the Nationwide Inpatient Sample from 2000 to 2011 for patients >14 years admitted to adult hospitals with the International Classifications of Diseases, Ninth Revision, codes for SV anatomy. Demographics, outcomes, co-morbidities, and cost were assessed. From 2000 to 2011, the number of SV admissions was stable with a trend toward increased cost per admission over time. Coexistent hypertension, obesity, and liver, pulmonary, and renal diseases significantly increased over time. The most common reason for admission was atrial arrhythmia followed by HF. Patients with SV with HF had significantly higher inhospital mortality, length of stay, and more medical co-morbidities than those with SV and without HF. In conclusion, the cohort of patients with SV admitted to adult hospitals has changed in the modern era. Patients with SV have medical co-morbidities including renal and liver diseases, hypertension, and obesity at a surprisingly young age. Aggressive and proactive management of HF and arrhythmia may reduce cost of care for this challenging population. Patients with SV with HF have particularly high mortality, more medical co-morbidities, and increased cost of care and deserve more focused attention to improve outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · The American Journal of Cardiology
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    Ami B Bhatt · Doreen Defaria Yeh

    Full-text · Article · May 2015 · Heart (British Cardiac Society)
  • Doreen DeFaria Yeh · Mary Etta King
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    ABSTRACT: There is an increasing population of adults with congenital heart disease (CHD) due to successful pediatric medical and surgical intervention, and commensurate with this increase is a rise in heart failure, hospital admissions, and hospital costs among adult CHD patients. This group of patients requires careful long-term evaluation and follow-up of the residua and sequelae of their cardiac anomalies that arise in adulthood to prevent late complications. This article addresses congenital heart defects that are encountered in a general adult cardiology practice and reviews clinical, anatomic, and imaging features of each lesion, fundamental management issues, indications for interventions (and often re-interventions), issues related to endocarditis prophylaxis, pregnancy, and appropriateness of referral to a dedicated adult CHD program for long-term care.
    No preview · Article · Apr 2015 · Current Cardiology Reports

  • No preview · Article · Mar 2015 · Journal of the American College of Cardiology
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    Full-text · Article · Mar 2015 · Journal of the American College of Cardiology
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    ABSTRACT: Background Adults with congenital heart disease (CHD) face increased risk for morbidity and mortality with age, but few prognostic models exist.Objective This study aims to assess whether the Heart Failure Survival Score (HFSS), which risk stratifies patients for heart transplantation, predicts outcomes in adults with moderate or complex CHD.Methods This was a multicenter, retrospective study which identified 441 patients with moderate or complex CHD between 2005 and 2013, of whom 169 had all the HFSS parameters required to calculate the risk score. Because all study patients were deemed low risk by the HFSS, the score was dichotomized at the median (10.4). Outcomes included death, transplant or ventricular assist device (VAD), arrhythmia requiring treatment, nonelective cardiovascular (CV) hospitalizations, and the composite. Associations of mean HFSS and HFSS <10.4 with each outcome were assessed.ResultsThe cohort had mean ± standard deviation age of 33.6 ± 12.6 years, peak VO2 21.8 ± 7.5 mL/kg/min, HFSS of 10.45 ± 0.88, and median years follow-up of 2.7 (1.1, 5.2). There were five deaths (2.8%), no transplants or VADs, 25 arrhythmias (14.8%), 22 CV hospitalizations (13%), and 39 composites (23.1%). Lower mean HFSS was observed for patients who died (9.6 ± 0.83 vs. 10.5 ± 0.87, P = .02), arrhythmia requiring treatment (10.0 ± 0.70 vs. 10.5 ± 0.89, P = .005), CV hospitalizations (9.9 ± 0.73 vs. 10.5 ± 0.88, P = .002), and the composite (10.0 ± 0.70 vs. 10.6 ± 0.89, P < .001). The positive and negative predictive values of HFSS <10.4 for the composite were 34% and 88% respectively, with sensitivity and specificity 74% and 56%.Conclusions Although a low HFSS was significantly associated with outcomes, it did not adequately risk stratify adults with CHD, whose heterogeneous pathophysiology differs from that of the acquired heart failure population. Further studies are warranted to provide a more accurate prognosis.
    Full-text · Article · Nov 2014 · Congenital Heart Disease
  • Ada Stefanescu · Doreen DeFaria Yeh · David M Dudzinski
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    ABSTRACT: Opinion statement: Adult congenital heart disease (ACHD) patients represent a special population in modern cardiology: though their numbers are growing, and they represent a high-resource utilization subgroup, a robust evidence-base of randomized trials is lacking. Much of the standard therapy is adapted from the treatment of ischemic and idiopathic left ventricle systolic failure, with a small, but growing body of evidence on medical therapy in select ACHD diagnoses. At our institution, for instance, there is a long tradition of using angiotensin antagonists in patients with a systemic right ventricle to prevent deleterious remodeling. The effects of beta-blockers on functional class in ACHD are yet unproven, but there is promising data on pulmonary vasodilators. Control of coronary risk factors and aerobic exercise should be considered for all. Prevention of arrhythmias is important, and multi-site pacing is an emerging therapy. New prognostic tools including natriuretic peptides and CPET are increasingly used to guide earlier initiation of these therapies.
    No preview · Article · Sep 2014 · Current Treatment Options in Cardiovascular Medicine
  • Doreen DeFaria Yeh · Elyse Foster

    No preview · Article · Mar 2014 · Circulation Cardiovascular Imaging
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    Doreen Defaria Yeh · Elyse Foster

    Preview · Article · Jan 2014 · Circulation Cardiovascular Imaging
  • Doreen DeFaria Yeh · Richard R. Liberthson · Ami B. Bhatt
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    ABSTRACT: The population of adults with congenital heart disease (CHD) is rapidly growing and presently exceeds one million individuals in the United States. It is a heterogeneous patient group comprising those with previously unrecognized and untreated lesions, as well as many prior palliated or corrective interventions. Most congenital heart disease patients benefit from ongoing cardiac supervision and a substantial number require highly specialized management and further intervention [1].
    No preview · Chapter · Jan 2014
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    Full-text · Article · Jan 2014
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    ABSTRACT: Our objective was to determine whether the Seattle Heart Failure Model (SHFM) differentiates patients with adult congenital heart disease (ACHD) at high versus low risk for cardiovascular outcomes and poor exercise capacity. The ACHD population is growing and presents increasingly for care in the community and at tertiary centers. Few strategies exist to identify the patients with ACHD at high risk for heart failure and mortality.We studied 153 adults with transposition of the great arteries, Ebstein anomaly, tetralogy of Fallot, double outlet right ventricle, and single ventricle from 2 ACHD centers. The primary outcome was cardiovascular death, with a secondary composite outcome of death, transplant, ventricular assist device, cardiovascular admission, and treatment for arrhythmia. We defined risk groups based on SHFM 5-year predicted survival: high (predicted survival <70%), intermediate (70% to 85%), and low risk (>85%). Ten patients had the primary outcome of death, and 46 the combined end point. The hazard of death in the SHFM high- versus the intermediate-risk group was 7.09 (95% confidence interval 1.5 to 33.4, p = 0.01; no deaths in the low-risk group) and the hazard of the composite outcome between the high- versus low-risk group was 6.64 (95% confidence interval 2.5 to 17.6, p = 0.0001). Kaplan-Meier survival analysis showed greater probability of all-cause mortality (p = 0.003) in the high-risk group. In conclusion, the SHFM can help identify subjects with ACHD at risk for adverse outcome and poor cardiopulmonary efficiency. This may add to the care of patients with ACHD in the community and streamline care at tertiary centers.
    Full-text · Article · Dec 2013 · The American journal of cardiology
  • Doreen DeFaria Yeh · Mary Etta King
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    ABSTRACT: There is a burgeoning population of adults with congenital heart disease (CHD) due to successful medical and surgical intervention in childhood. This group of patients requires careful echocardiographic evaluation and follow-up of the residua and sequellae of their cardiac anomalies. This review addresses the guidelines for evaluation and management of the grown-up with CHD, the contributions of 3D echo in their assessment, and the current status and new developments in noninvasive determination of ventricular volumes and function. The contribution of stress and contrast echocardiography for the adult with CHD is considered. The application of transcatheter interventions for this population is included with particular regard for the role of echocardiography pre- and postprocedure. Particular problems presented by pregnancy for the adult CHD patient are also reviewed.
    No preview · Article · Dec 2013 · Current Cardiovascular Imaging Reports
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    ABSTRACT: Adults with congenital heart disease (ACHD) face noncardiac healthcare challenges as the population ages. We assessed whether women with ACHD have comparable cancer screening rates to non-ACHD women in a cardiac practice and to the general population. We performed a retrospective review of 175 adult women seen in a cardiac care center in 2009-2011. Data on Pap tests, mammography, and colonoscopies, were collected through electronic medical records and primary care provider records. Adequate documentation was available for 100 individuals with ACHD and 40 comparator cardiac patients. The adequacy of screening was determined using guidelines set forth by the American Cancer Society in 2010. Compared with the national average, ACHD patients had significantly lower rates of Pap tests (60% versus 83%, P < 0.001) and mammography (48% versus 72%, P < 0.001). Compared with non-ACHD women in the same practice, ACHD patients had consistently lower rates of mammography (48% versus 81%, P = 0.02) and colonoscopies (54% versus 82%, P = 0.23). As the population of ACHD individuals ages, attention to cancer screening becomes increasingly important but may be overlooked in this population. Primary care physicians and cardiologists should collaborate to ensure appropriate cancer screening for this growing population.
    Full-text · Article · Aug 2013
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    ABSTRACT: Adult congenital heart disease patients present a unique challenge to the cardiac imager. Patients may present with both acute and chronic manifestations of their complex congenital heart disease and also require surveillance for sequelae of their medical and surgical interventions. Multimodality imaging is often required to clarify their anatomy and physiology. Radiation dose is of particular concern in these patients with lifelong imaging needs for their chronic disease. The second-generation dual-source scanner is a recently available advanced clinical cardiac computed tomography (CT) scanner. It offers a combination of the high-spatial resolution of modern CT, the high-temporal resolution of dual-source technology, and the wide z-axis coverage of modern cone-beam geometry CT scanners. These advances in technology allow novel protocols that markedly reduce scan time, significantly reduce radiation exposure, and expand the physiologic imaging capabilities of cardiac CT. We present a case series of complicated adult congenital heart disease patients imaged by the second-generation dual-source CT scanner with extremely low-radiation doses and excellent image quality.
    No preview · Article · Oct 2012 · Congenital Heart Disease
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    ABSTRACT: Temporary leadless cardiac pacing using ultrasound energy is feasible in patients. An implantable left ventricular stimulation system being developed for cardiac resynchronization therapy transfers energy from a subcutaneous transmitter to an endocardial receiver through tissue free of interfering lung or rib ('acoustic window'). The aim was to use transthoracic echocardiography to evaluate acoustic window (AW) locations and sizes to determine the implant site for a transmitter, and to investigate clinical predictors of AW location and size. Inclusion criteria were ejection fraction ≤35%, and New York Heart Association functional class III or IV. Acoustic windows were evaluated in intercostal spaces (ICSs) measured in the supine, right lateral, sitting, and standing position during normal respiration and held inspiration. Among 42 patients, at least one adequate AW (≥2 cm(2)) was identified in 41, 19 patients had adequate AWs in 2 ICSs and 20 patients had adequate AWs in 3. Acoustic window areas were generally smallest in the lateral position with held inspiration and largest in the standing position with normal respiration. Patients with ischaemic cardiomyopathy compared with non-ischaemic cardiomyopathy had smaller heart size [left ventricular end-systolic volume index (LVESVI) 78 ± 38 mL/m(2) vs. 104 ± 46 mL/m(2), P = 0.03] but larger AWs in the right lateral position (11.4 ± 6.5 cm(2) vs. 7.3 ± 3.4 cm(2), P = 0.01) and standing position (14.0 ± 7.2 cm(2) vs. 9.4 ± 3.3 cm(2), P = 0.02). Adequate AWs were present in nearly all patients. Despite smaller hearts, ischaemic cardiomyopathy patients had adequate AWs. A simple procedure performed as an adjunct to pre-implant echocardiography can screen patients and identify transmitter implant locations for an ultrasound-mediated leadless pacing system.
    Preview · Article · Jul 2011 · Europace

Publication Stats

40 Citations
87.89 Total Impact Points

Institutions

  • 2011-2015
    • Massachusetts General Hospital
      • Division of Cardiology
      Boston, Massachusetts, United States
  • 2014
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2007-2013
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2007-2010
    • University of California, San Francisco
      • Division of Cardiology
      San Francisco, California, United States