| 1. |
- Aburawi, Elhadi, et al.
(författare)
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A transthoracic Doppler echocardiography study of C-reactive protein and coronary microcirculation in children after open heart surgery.
- 2007
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Ingår i: Cardiology in the Young. - 1467-1107. ; 17:5, s. 472-477
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Tidskriftsartikel (refereegranskat)abstract
- Background Systemic inflammation has been suggested to underlie in part the elevated risk of arrhythmias and myocardial dysfunction during the first weeks after cardiac surgery. Recent transthoracic Doppler studies from our centre indicated increased basal coronary arterial flow in children 5 days after cardiopulmonary bypass surgery. In these children, we investigated whether the inflammatory mediator, C-reactive protein, could influence this association. Methods The peak flow velocity, velocity time-integral in diastole and systole, and basal blood flow in the proximal part of the left anterior descending artery, were assessed by transthoracic Doppler echocardiography 1 day before, and 5 days after, cardiac surgery in 17 children with ventricular and atrioventricular septal defects whose mean age at surgery was 6 months. Levels of C-reactive protein in the plasma were measured at both time-points. Results Prior to surgery, all children had levels of C-reactive protein under the limit for detection, that is less than 0.8 milligrams per litre. The levels of the protein had increased significantly by the second day, when the median value was 25, and the range from 20 to 142 milligrams per litre. They remained elevated on the fifth day after surgery, when the median was 11, and the range from 3 to 20 milligrams per litre. On the fifth day, the percentage increase in velocity time integral corrected for left ventricular mass was significantly lower in those patients with C-reactive protein greater than or equal to 10 milligrams per litre than in the remaining patients. Also, both the velocity time integral and the velocity of diastolic peak flow correlated inversely with log C-reactive protein, r being equal to −0.54 and p less than 0.02 and r equal to −0.74 and p less than 0.01, respectively, particularly among those patients in whom clamping of the aorta lasted for more than 1 hour, r for this statistic being equal to −0.8. Conclusion The postsurgical increase in the velocity of coronary arterial flow in children is inversely associated with rising levels of C-reactive protein. The duration of the aortic cross-clamping during surgery strengthens the association between levels of C-reactive protein and the microcirculatory changes.
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| 2. |
- Aburawi, Elhadi, et al.
(författare)
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Acute respiratory viral infections aggravate arterial endothelial dysfunction in children with type 1 diabetes.
- 2004
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 27:11, s. 2733-2735
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Tidskriftsartikel (refereegranskat)abstract
- Despite improvements in therapy for children with type 1 diabetes, the prevalence of cardiovascular morbidity in adulthood due to accelerated atherosclerosis remains significant (1). Similar to other cardiovascular risk factors, the diabetic state facilitates arterial endothelial injury, a primary event in the pathogenesis of atherosclerosis (2). Although several pediatric studies have reported an association of diabetes with arterial endothelial dysfunction (3,4), pathogenic animal studies have suggested that even though this disease predisposes to endothelial dysfunction and atherosclerosis, it might not be sufficient to cause them (5). Notably, type 1 diabetes increases the propensity for both chronic and acute infections in part by weakening the immune mechanisms (6). The risk is particularly increased for respiratory tract infections, but other infections have also been associated with diabetes (7). Furthermore, diabetic patients are at greater risk for infection-related mortality (8), and the excess risk appears to be linked to cardiovascular diseases (9). In the present study, we investigated whether viral respiratory tract infections in children with type 1 diabetes might impose an additional burden on the arterial endothelial function.
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| 3. |
- Aburawi, Elhadi, et al.
(författare)
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Coronary Blood Flow by Transthoracic Echocardiography in Children with Endomyocardial Fibrosis.
- 2009
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Ingår i: Pediatric Cardiology. - : Springer Science and Business Media LLC. - 0172-0643 .- 1432-1971. ; 30, s. 371-373
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Tidskriftsartikel (refereegranskat)abstract
- We report herein the coronary flow (CF) pattern determined by transthoracic Doppler echocardiography (TTDE) in two children with biventricular endomyocardial fibrosis (EMF). Endomyocardial biopsy showed various degrees of cardiac fibrosis in both patients as well as signs of chronic inflammation in one of the patients. TTDE showed a significant increase in CF in both the left anterior descending coronary artery and the posterior descending coronary artery compared with age-matched healthy controls. The diastolic flow in patients with EMF appeared to terminate earlier than in controls. The mechanisms and the potential significance of these novel findings are discussed.
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| 4. |
- Aburawi, Elhadi, et al.
(författare)
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Coronary flow before and after surgical versus device closure of atrial septal defect.
- 2009
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 135, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiopulmonary bypass (CPB) affects coronary flow after the operation. Surgical as compared to device closure of atrial septal defect (ASD) serves as a good model to clarify the effects of surgery with CPB on coronary flow. METHODS: Coronary flow parameters were determined by transthoracic Doppler echocardiography before and after ASD closure. Thirteen children underwent surgery on CPB and fourteen children had device closure of their ASD under interventional cardiac catheterisation. Fourteen age-matched healthy controls were studied. RESULTS: Left ventricular fractional shortening increased and cardiac output increased after the device closure but there were no significant changes after the surgery. After the surgery the mean diameter of left anterior descending coronary artery increased from 1.7+/-0.6 to 2.1 +/-0.4 mm (p=0.03), the peak flow velocity in diastole (PFVd) from 48+/-10 to 70+/-12 cm/s (p=0.0001) and basal blood flow (BF) from 62+/-18 to 105+/-35 ml/min (p=0.0001). Flow parameters in the right coronary artery increased similarly. In contrast, all coronary flow parameters decreased substantially after catheter interventions, but still remained significantly elevated as compared with controls. CONCLUSIONS: Surgery with cardiopulmonary bypass but not the device closure affects coronary flow beyond the pure effects of anatomical correction. Cardiac output increases after the device closure. The reported decrease of coronary flow reserve is obviously due to increased basal coronary flow.
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| 5. |
- Aburawi, Elhadi, et al.
(författare)
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Coronary flow dynamics in children after repair of Tetralogy of Fallot.
- 2014
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 172:1, s. 122-126
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Tidskriftsartikel (refereegranskat)abstract
- To assess the possible effect of a stiff right ventricle on the coronary flow (CF) in patients with post-operative Tetralogy of Fallot (TOF).
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| 6. |
- Aburawi, Elhadi, et al.
(författare)
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Coronary Flow in Neonates with Impaired Intrauterine Growth.
- 2012
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 1097-6795 .- 0894-7317. ; 25:3, s. 313-318
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subclinical myocardial injury has been reported in newborns with fetal weights < 2 SDs for gestational age. Intrauterine growth restriction might affect cardiac function and coronary flow (CF). METHODS: Seventeen newborns with intrauterine growth restriction and 15 age-matched healthy controls were enrolled in the study. Blood flow in the umbilical artery and maternal uterine artery was assessed using Doppler velocimetry. Cardiac function and left anterior descending coronary artery CF were measured using transthoracic Doppler echocardiography at 1 week of age. RESULTS: The mean growth deviation of the newborns from normal was -2.5 ± 0.2 SDs. Percentage left ventricular shortening fraction was 39 ± 4.3% in patients and 42 ± 4.1% in controls (P = .40), and the mean left ventricular mass index was 86.6 g/m(2) in patients and 73.7 g/m(2) in controls (P < .01). The mean left anterior descending coronary artery diameter was 0.99 ± 0.1 mm in patients and 0.8 ± 0.1 mm in controls (P = .002). The left anterior descending coronary artery flow velocity-time integral was correlated with left ventricular mass index (r = 0.31, P = .007) and with mitral peak E/A ratio (r = 0.74, P = .01). Intrauterine growth restriction was associated with increased peak flow velocity in diastole (34.5 ± 4 vs 19 ± 6 cm/sec in controls, P = .0001), as well as increased CF (37 ± 7.3 vs 8.2 ± 3.0 mL/min in controls, P = .001). CONCLUSIONS: CF is significantly increased in neonates with impaired intrauterine growth. Left ventricular mass index is increased, but systolic and diastolic function remains normal. The clinical significance of increased CF is unclear, but it might lead to decreased CF reserve.
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| 7. |
- Aburawi, Elhadi, et al.
(författare)
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Early changes in myocardial repolarization and coronary perfusion after cardiopulmonary bypass surgery for ASD repair in children
- 2013
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: In adults, impaired myocardial repolarization and increased risk of arrhythmia are known consequences of open heart surgery. Little is known, however, about post-operative consequences of cardiopulmonary bypass surgery in children. The aim of this study was to assess ventricular repolarization and coronary perfusion after bypass surgery for atrial septal defect (ASD) repair in children. Methods: Twelve patients with ASD were assessed one day before and 5-6 days after ASD repair. Myocardial repolarization (corrected QT interval, QTc, QT dispersion, QTd, and PQ interval) was determined on 12-lead electrocardiograms. Coronary flow in proximal left anterior descending artery (peak flow velocity in diastole, PFVd) was assessed by transthoracic Doppler echocardiography. Results: Ten of the 12 (83%) children had normal myocardial repolarization before and after surgery. After surgery, QTc increased 1-9% in 5 (42%) patients, decreased 2-11% in 5 (42%) patients and did not change in 2 (16%) patients. Post-op QTc positively correlated with bypass time (R=0.686, p=0.014) and changes in PFVd (R=0.741, p=0.006). After surgery, QTd increased 33-67% in 4 (33%) patients, decreased 25-50% in 6 patients (50%) and did not change in 2 (16%) patients. After surgery, PQ interval increased 5-30% in 4 (33%) patients, decreased 4-29% in 6 (50%) patients and did not change in 1 (8%) patient. Post-op PQ positively correlated with bypass time (R=0.636, p=0.027). As previously reported, PFVd significantly increased after surgery (p<0.001). Conclusions: Changes in QTc, PQ and PFVd are common in young children undergoing surgery for ASD repair. Post-op QTc significantly correlates with bypass time, suggesting prolonged cardiopulmonary bypass may impair ventricular repolarization. Post-op QTc significantly correlates with PFVd changes, suggesting increased coronary flow may also impair ventricular repolarization. The clinical significance and reversibility of these alternations require further investigations.
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| 8. |
- Aburawi, Elhadi, et al.
(författare)
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Effects of Balloon Valvuloplasty on Coronary Blood Flow in Neonates With Critical Pulmonary Valve Stenosis Assessed With Transthoracic Doppler Echocardiography.
- 2009
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 1097-6795 .- 0894-7317. ; 22, s. 165-169
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Treating pulmonary valve stenosis with balloon valvuloplasty (BV) is a good model to study the effect of right ventricular (RV) pressures on coronary flow. METHODS: Transthoracic Doppler echocardiography was used to register coronary flow in 10 age-matched healthy controls and 7 neonates before and 1 day after BV. RESULTS: Left ventricular fractional shortening and cardiac output increased significantly after BV. Right coronary artery diameter decreased from 1.2 +/- 0.2 to 1.1 +/- 0.1 mm (P < .02). Posterior descending coronary artery flow parameters decreased significantly, with blood flow decreasing from 8.4 to 5.7 +/- 1.9 mL/s (P < .003). RV end-diastolic pressure and RV systolic pressure explained almost totally the variation in coronary flow (r(2) = 0.87). CONCLUSIONS: RV end-diastolic pressure and RV systolic pressure determined coronary flow in neonates with critical pulmonary valve stenosis. Cardiac output and left ventricular fractional shortening increased after pulmonary valve BV.
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| 9. |
- Aburawi, Elhadi, et al.
(författare)
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Effects of cardio-pulmonary bypass surgery on coronary flow in children assessed with transthoracic Doppler echocardiography.
- 2007
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Ingår i: American Journal of Physiology: Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 293:2, s. 1138-1143
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Tidskriftsartikel (refereegranskat)abstract
- Perturbation of coronary blood flow (CF) is an important contributor to myocardium-related complications. The study was primarily designed to assess the impact of cardiopulmonary bypass (CPB) surgery on CF by aid of transthoracic Doppler echocardiography. Changes in CF after off-pump coarctation surgery were also studied. All ultrasounds were performed before and 5 ± 1 days after surgery. Eighteen children underwent CPB surgery of ventricular left-to-right shunts at the mean age of 6 mo, while off-pump surgery (aortic coarctectomy) was undertaken at the mean age of 10 days in 12 children. After CPB surgery, both left anterior descending coronary artery mean diameter and basal CF increased from 1.7 ± 0.3 to 2.1 ± 0.4 mm (P = 0.001) and 27 ± 10 to 47 ± 15 ml/min (P = 0.0001), respectively. These two coronary variables decreased after off-pump coarctectomy: left anterior descending coronary artery mean diameter from 1.8 ± 0.1 to 1.7 ± 0.1 mm (P = 0.06), and CF from 44 ± 12 to 25 ± 8 ml/min (P = 0.001). The findings are in keeping with the hypothesis that the previously reported impairment of coronary flow reserve after CPB surgery could be due to increase in basal coronary flow after CPB. Off-pump coarctectomy seems to have little impact on CF, as the postsurgical decline in flow in these patients seems to relate to the reduction in cardiac pressure afterload.
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| 10. |
- Aburawi, Elhadi H., et al.
(författare)
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Effects of N-3 Polyunsaturated Fatty Acids on Left Ventricular Function and Coronary Flow in Children with Type 1 Diabetes Mellitus
- 2011
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 1530-0447 .- 0031-3998. ; 70:227
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Konferensbidrag (refereegranskat)abstract
- Purposes: Dietary supplementation with N-3 Polyunsaturated Fatty Acids (n-3 PUFAs) could have beneficial effects on cardiovascular system in patients with type 1 diabetes mellitus (DM1). Methods: In a double-blind placebo controlled crossover study, 33 children with DM1 duration of more than one year were randomly and equally assigned to either n-3 PUFAs (2 gm/day, Nycoplus® Omega-3, 1000 mg) or placebo treatment for 8 weeks. Following a 4-week period recovery, the groups were crossovered with above treatments for another 8 weeks. Transthoracic Doppler echocardiography (TTDE) study was done on pre and post treatment visits, and after one month's treatment free recovery for left ventricular function and flow in the left anterior descending coronary artery (LAD). Results: Of recruited children 28 (85%) completed the study. n-3 PUFAs treatment was associated with increase in mean cardiac index (CI; from 2.7±0.4 to 3.7±0.8 l/min/m2, p< 0.0001) and left ventricular fractional shortening (FS; from 31±2.5 to 39±3%, p< 0.0001). The treatment decreased both LAD peak flow velocity (PFVd) from 96±17 to 68±12 cm/s, p< 0.0001 and LAD CF from 105±31 to 66±15 ml/min, p< 0.0001). One month after stopping the treatment CI decreased from 3.7±0.8 to 2.6±0.5 l/min/m2, p< 0.0001 and mean FS from 39±3 to 32±2, p< 0.0001. Mean PFVd increased from 68±12 to 90±12 cm/s, p< 0.0001 and CF from 66±15 to 108±30 ml/min, p< 0.0001. Conclusions: In patients with DM1 n-3 PUFA therapy increased cardiac index and LV systolic function. The basal coronary flow decrease improving the circumstances for better coronary flow reserve.
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| 11. |
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| 12. |
- Aburawi, Elhadi, et al.
(författare)
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Pathophysiology of coronary blood flow in congenital heart disease.
- 2011
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; Jul 1, s. 273-277
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim was to investigate the effects of volume and pressure overload and increased coronary perfusion pressure on coronary flow (CF) in congenital heart disease (CHD) patients. BACKGROUND: The effects of CHD on CF are poorly mapped. METHODS: A total of 65 patients with acyanotic CHD and 49 age-matched healthy controls were examined by transthoracic Doppler echocardiography. Posterior descending artery flow was measured in patients with pulmonary valve stenosis (PS) and atrial septal defects (ASDs) i.e. in lesions with right ventricular pressure or volume overload, and left anterior descending artery flow in patients with coarctation of the aorta (CoA) and ventricular septal defect (VSD), in lesions with left ventricular pressure or volume overload. The CF data in each patient group were expressed as the percent of the median for healthy controls from the same age group. RESULTS: The CF values were in VSD 172%, ASD 185%, PS 233%, and CoA 773% patients. In CoA patients body surface area (r=0.90, p<0.0001), systolic blood pressure (r=0.72, p<0.0001), diastolic blood pressure (r=0.77, p<0.0001), systolic wall tension (r=-0.77, p=0.004), and signs of inflammation (log CRP, r=-0.75, p=0.007) correlated with CF. CONCLUSIONS: The increase in CF and velocity was most significant in patients with CoA. In newborns, increased coronary perfusion pressure seems to be the most important factor for increased CF, even if the pressure is not assumed to cause a significant increase in flow over the auto-regulatory range of 70-130mmHg. We also showed that inflammation decreases CF.
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| 13. |
- Aburawi, Elhadi, et al.
(författare)
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QTc and QTd Changes after Cardiopulmonary Bypass Surgery in Children
- 2014
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Ingår i: European Journal of Cardiovascular Medicine. - : Healthcare Bulletin. - 2042-4884. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to assess the impact of cardiopulmonary bypass surgery on corrected QT (QTc) and QT dispersion (QTd) intervals. The possible role of inflammation on these variables was investigated.
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| 14. |
- Andersson, Sven Ingmar, et al.
(författare)
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Perspectives that lay persons with and without health problems show toward coronary heart disease: An integrated biopsychosocial approach.
- 2007
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Ingår i: Heart & Lung. - : Elsevier BV. - 1527-3288 .- 0147-9563. ; 36:5, s. 330-338
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We studied what patients with acute coronary heart disease (CHD) considered the three most stressful factors experienced during the month before testing and what they attributed their heart disease to. Methods: We studied the occurrence and severity of physiologic, psychologic, and psychosocial stressors in 117 patients with acute CHD and 117 referents, not diagnosed with CHD, matched by age,, sex, and municipality. The subjects were first to select the factors they considered stressful from a list of potentially stressful factors. They were then to select the three they regarded as most stressful and to provide situational accounts of these. Results: The patients with CHD were found to less frequently live with a partner, to more frequently have a body mass index higher than 30.0, and to report a greater number of stressors. The stressors best differentiating them from the referents were fatigue, shortness of breath, pain, and high blood pressure. The causal factors they most frequently named were heart problems, smoking, heredity, high workload, and poor eating habits. Conclusions: The situational accounts the patients provided illustrate the biopsychosocial complexities involved in the various categories of stressful factors.
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| 15. |
- Bennhagen, Rolf, et al.
(författare)
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Coil embolization of a neonatal pulmonary arteriovenous malformation.
- 2002
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Ingår i: Pediatric Cardiology. - : Springer Science and Business Media LLC. - 0172-0643 .- 1432-1971. ; 23:2, s. 235-238
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Tidskriftsartikel (refereegranskat)abstract
- Pulmonary arteriovenous malformation (PAVM), as a part of Osler-Weber-Rendu Syndrome, in the neonate, is a rare hereditary vascular malformation. Large intrapulmonary right-to-left shunting, causing hypoxaemia and cyanosis, can be a life-threatening condition. Repeated transcatheter coil embolization procedures proved to be a favorable strategy to improve systemic arterial oxygen saturation, with a good outcome in a newborn child. While the radiation dose was high, the use of this amount of radiation was felt to be justified and its effects considered tolerable in the treatment of this patient's serious malformation.
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| 16. |
- Bennhagen, Rolf, et al.
(författare)
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High-frequency components in ECG analysed in guinea-pig Langendorf preparations
- 2001
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Ingår i: Clinical Physiology. - : Wiley. - 1365-2281 .- 0144-5979. ; 21:5, s. 576-583
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Tidskriftsartikel (refereegranskat)abstract
- High-frequency components in ECG during global ischaemia were studied in isolated guinea-pig hearts perfused ad modum Langendorf. Electrocardiograph recordings were carried out from the epicardial surface both in normo- and low-flow perfusion. After bandpass filtering (5-500 Hz), signal-averaging, was undertaken. The high-frequency components either increased or decreased after low-flow perfusion was instituted. Root-mean-square voltage (RMS) of the depolarization signal correlated poorly with the signal amplitude, but highly with the first and second derivative, i.e. the velocity and the acceleration of the signal. It is concluded that high-frequency components are not pathological phenomena per se, but reflect the shape of the original electrocardiographic signal.
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| 17. |
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| 18. |
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| 19. |
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| 20. |
- Birck, Malene M., et al.
(författare)
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Infection-induced coronary dysfunction and systemic inflammation in piglets are dampened in hypercholesterolemic milieu
- 2011
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Ingår i: American Journal of Physiology: Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 300:5, s. 1595-1601
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Tidskriftsartikel (refereegranskat)abstract
- Birck MM, Pesonen E, Odermarsky M, Hansen AK, Persson K, Frikke-Schmidt H, Heegaard PM, Liuba P. Infection-induced coronary dysfunction and systemic inflammation in piglets are dampened in hypercholesterolemic milieu. Am J Physiol Heart Circ Physiol 300: H1595-H1601, 2011. First published February 25, 2011; doi:10.1152/ajpheart.01253.2010.-The synergism of infection with conventional cardiovascular risk factors in atherosclerosis is much debated. We hypothesized that coronary arterial injury correlates with infection recurrence and pathogen burden and is further aggravated by hypercholesterolemia. Forty-two Gottingen minipigs were assigned to repeated intratracheal inoculation of PBS, Chlamydia pneumoniae (Cpn), or both Cpn and influenza virus at 8, 11, and 14 wk of age. Animals were fed either standard or 2% cholesterol diet (chol-diet.). At 19 wk of age coronary vasomotor responses to acetylcholine (ACh) and adenosine were assessed in vivo and blood and tissue samples were collected. Nonparametric tests were used to compare the groups. In cholesterol-fed animals, total cholesterol/HDL was significantly increased in infected animals compared with noninfected animals [3.13 (2.17-3.38) vs. 2.03 (1.53-2.41), respectively; P = 0.01]. C-reactive protein (CRP) rose in infected animals [10.60 (4.96-18.00) vs. 2.47 (1.44-3.01) mu g/ml in noninfected; P < 0.01] without significant difference between the mono- and coinfected groups. Among coinfected animals, both CRP and haptoglobin were lower in those fed chol-diet than in those fed standard diet (P < 0.05). The vasoconstricting response to ACh was most prominent in coinfected animals (769.3 (594-1,129) cm; P = 0.03 vs. noninfected [342 (309-455) cm] and P = 0.07 vs. monoinfected [415 (252.5-9711.8) cm]}. Among monoinfected animals, similar to CRP, a trend for less vasoconstriction was observed in those fed chol-diet (P = 0.08). Coinfection of piglets appears to be associated with more pronounced coronary muscarinic vasomotor dysfunction. In monoinfected animals, use of chol-diet seems to dampen both coronary dysfunction and systemic inflammation induced by infection.
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| 21. |
- Chubb, Henry, et al.
(författare)
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Long-Term Outcome Following Catheter Valvotomy for Pulmonary Atresia With Intact Ventricular Septum
- 2012
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 59:16, s. 1468-1476
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Tidskriftsartikel (refereegranskat)abstract
- Objectives This study investigated the outcome for all patients undergoing catheter valve perforation for pulmonary atresia with intact ventricular septum (PAIVS) 21 years after the first procedure at their center. Background Catheter perforation for PAIVS is now an established procedure. However, the management of the borderline right ventricle (RV) is controversial, and there may be a place for novel techniques such as stenting of the arterial duct. Methods There were 37 successful valve perforations (total 39 patients). Median length of follow-up was 9.2 years (range 2.2 to 21.0 years). Seventeen patients had stenting of the arterial duct. The mean (SD) initial z-score for the tricuspid valve was -5.1 (+/- 3.4), and a further 142 sets of measurements were taken to assess the growth of the RV of survivors. Results There were 8 deaths (21%), and no deaths after the first 35 days. There were no late arrhythmias or ischemic events. Twenty-five patients (83% of survivors) have a biventricular circulation. For patients who had stenting of the arterial duct, significant reductions in early reintervention (0 vs. 7 patients, p = 0.009) and hospital stay (17.4 +/- 18.1 days vs. 33.8 +/- 28.6 days, p = 0.012) occurred, with no increase in mortality or morbidity. There was no catch-up growth of the RV in patients who had a biventricular outcome (z-score increase +0.08/year, p = 0.26). Conclusions Long-term survival is good, and even small RVs may be amenable to this procedure. Multiple interventions may be required to achieve biventricular circulation, but stenting of the arterial duct may reduce hospital stay and repeat procedures. (J Am Coll Cardiol 2012;59:1468-76) (C) 2012 by the American College of Cardiology Foundation
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| 22. |
- El-Segaier, Milad, et al.
(författare)
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Atrial septal defect: a diagnostic approach
- 2006
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Ingår i: Medical & Biological Engineering & Computing. - : Springer Science and Business Media LLC. - 0140-0118 .- 1741-0444. ; 44:9, s. 739-745
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Tidskriftsartikel (refereegranskat)
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| 23. |
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| 24. |
- El-Segaier, Milad, et al.
(författare)
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Detection of cardiac pathology: time intervals and spectral analysis.
- 2007
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 96:7, s. 1036-1042
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To develop an objective diagnostic method that facilitates detection of noncyanotic congenital heart diseases. METHODS: Heart sounds and murmurs were recorded from 60 healthy children and 173 children with noncyanotic congenital heart disease. Time intervals were measured and spectrum of the systolic murmurs analyzed. Stepwise logistic regression analysis was used to distinguish physiological from pathological signals. The receiver operating characteristic (ROC) curve was plotted to show the classification performance of the model and the area under the curve (AUC) was calculated. The probability cut-off points for calculation of sensitivities and specificities were estimated. RESULTS: The distinguishing variables were the interval from the end of the first heart sound (S(1)) and the beginning of the systolic murmur, respiratory variation of the splitting of the second heart sound, intensity of the systolic murmur, and standard deviation of the interval from the end of the S(1) to the maximum intensity of the murmur. The AUC was 0.95, indicating an excellent classification performance of the model. The sensitivity of 95% and specificity of 72% was achieved at a probability cut-off point of 0.45. Significant cardiac defects were correctly classified. CONCLUSION: Interval measurements and spectral analysis can be used to confirm significant noncyanotic congenital heart diseases. Further development of the method is necessary to detect also insignificant heart defects.
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| 25. |
- El-Segaier, Milad, et al.
(författare)
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Late coronary complications after arterial switch operation and their treatment.
- 2010
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Ingår i: Catheterization and Cardiovascular Interventions. - : Wiley. - 1522-726X .- 1522-1946. ; 76, s. 1027-1032
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:: To report the late coronary complications and their treatment after ASO. BACKGROUND:: Asymptomatic patients after arterial switch operation (ASO) may have coronary ostial stenosis or obstruction. METHODS:: Since 1980, 279 patients were operated with ASO. At the time of preparing this article, selective follow-up coronary angiograms were done on 81 patients. RESULTS:: Coronary stenosis was found in six patients. A six year-old patient with left coronary artery (LCA) ostial stenosis and a nine year-old patient with conus branch occlusion had good collaterals without a need for further treatment. One patient with LCA obstruction, myocardial infarction, and left ventricular failure was operated with osteoplasty at age of 16 years. In three essentially asymptomatic patients stenting of LCA ostium stenosis was done: in two of them with drug-eluting stents at nine and ten years of age and in one with bare-metal stent at 18 years of age. One of these patients was earlier treated with balloon dilatation at five years of age which caused intimal dissection. CONCLUSIONS:: Asymptomatic patients with an uneventful course after ASO may have coronary obstruction. This necessitates follow-up coronary evaluation in all patients. Stenting of the coronary arteries is an option for treatment. (c) 2010 Wiley-Liss, Inc.
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