45 results on '"Kevin A. Whitehead"'
Search Results
2. Systemic and CNS manifestations of inherited cerebrovascular malformations
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Leslie Morrison, Helen Kim, Marc C. Mabray, Blaine L. Hart, and Kevin J. Whitehead
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Diagnostic Imaging ,Hemangioma, Cavernous, Central Nervous System ,business.industry ,Cortical malformations ,Arteriovenous malformation ,CAPILLARY MALFORMATION-ARTERIOVENOUS MALFORMATION ,Cerebral Arteries ,Bioinformatics ,medicine.disease ,Cerebral cavernous malformations ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Intestinal Microbiome ,Humans ,Medicine ,Telangiectasia, Hereditary Hemorrhagic ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,business ,Telangiectasia ,Skin - Abstract
Cerebrovascular malformations occur in both sporadic and inherited patterns. This paper reviews imaging and clinical features of cerebrovascular malformations with a genetic basis. Genetic diseases such as familial cerebral cavernous malformations and hereditary hemorrhagic telangiectasia often have manifestations in bone, skin, eyes, and visceral organs, which should be recognized. Genetic and molecular mechanisms underlying the inherited disorders are becoming better understood, and treatments are likely to follow. An interaction between the intestinal microbiome and formation of cerebral cavernous malformations has emerged, with possible treatment implications. Two-hit mechanisms are involved in these disorders, and additional triggering mechanisms are part of the development of malformations. Hereditary hemorrhagic telangiectasia encompasses a variety of vascular malformations, with widely varying risks, and a more recently recognized association with cortical malformations. Somatic mutations are implicated in the genesis of some sporadic malformations, which means that discoveries related to inherited disorders may aid treatment of sporadic cases. This paper summarizes the current state of knowledge of these conditions, salient features regarding mechanisms of development, and treatment prospects.
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- 2021
3. CHILDREN WITH RECURRENT MYOCARDITIS HAVE LOWER LEFT VENTRICULAR FUNCTION AND STRAIN AND HIGHER END DIASTOLIC VOLUMES BY CMR ON INITIAL PRESENTATION
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Danish Vaiyani, Matthew A. Harris, Kevin K. Whitehead, David M. Biko, Sara L. Partington, Kathryn Restaino, Kimberly Y. Lin, and Mark A. Fogel
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Cardiology and Cardiovascular Medicine - Published
- 2023
4. CONTRACTION FRACTION AND MALDISTRIBUTION OF LUNG FLOW IS ASSOCIATED WITH EXERCISE PERFORMANCE IN TETRALOGY OF FALLOT: A SUBSTUDY THE SINGLE CENTER CARDIAC MAGNETIC RESONANCE OUTCOMES REGISTRY-TETRALOGY OF FALLOT
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Mark A. Fogel, Elizabeth Donnelly, Elizabeth Goldmuntz, Matthew A. Harris, David Biko, Sara L. Partington, Stephen M. Paridon, Victor A. Ferrari, Kevin K. Whitehead, and Laura Mercer-Rosa
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Cardiology and Cardiovascular Medicine - Published
- 2023
5. Cardiovascular 3-D Printing: Value-Added Assessment Using Time-Driven Activity-Based Costing
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Elizabeth Silvestro, Kevin K. Whitehead, Sarah E. Luery, David R. Ho, Cleo K. Maehara, Raymond W. Sze, Kim-Lien Nguyen, William Hsu, and Reena M. Ghosh
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business.industry ,Process assessment ,Computer science ,Process Assessment, Health Care ,MEDLINE ,3 d printing ,Article ,Printing, Three-Dimensional ,Health care ,Value (economics) ,Costs and Cost Analysis ,Radiology, Nuclear Medicine and imaging ,Operations management ,business ,Activity-based costing - Published
- 2020
6. Curaçao diagnostic criteria for hereditary hemorrhagic telangiectasia is highly predictive of a pathogenic variant in ENG or ACVRL1 (HHT1 and HHT2)
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Desiree DeMille, Pinar Bayrak-Toydemir, Kevin J. Whitehead, Whitney Wooderchak-Donahue, and Jamie McDonald
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0301 basic medicine ,Proband ,medicine.medical_specialty ,business.industry ,Consensus criteria ,ACVRL1 ,030105 genetics & heredity ,Confidence interval ,Molecular analysis ,03 medical and health sciences ,030104 developmental biology ,Clinical diagnosis ,Internal medicine ,Medicine ,In patient ,medicine.symptom ,business ,Telangiectasia ,Genetics (clinical) - Abstract
Determine the variant detection rate for ENG, ACVRL1, and SMAD4 in individuals who meet consensus (Curacao) criteria for the clinical diagnosis of hereditary hemorrhagic telangiectasia. Review of HHT center database for individuals with three or more HHT diagnostic criteria, in whom molecular genetic analysis for ENG, ACVRL1, and SMAD4 had been performed. A variant known or suspected to be causal was detected in ENG in 67/152 (44.1%; 95% confidence interval [CI], 36.0–52.4%), ACVRL1 in 79/152 (52.0%; 95% CI, 43.7–60.1%), and SMAD4 in 2/152 (1.3%; 95% CI, 0.2–4.7%) family probands with definite HHT. Only 4/152 (2.6%; 95% CI, 0.7–6.6%) family probands did not have a variant in one of these genes. Previous reports of the variant detection rate for ENG and ACVRL1 in HHT patients have come from laboratories, which receive samples from clinicians with a wide range of expertise in recognizing clinical manifestations of HHT. These studies suggest a significantly lower detection rate (~75–85%) than we have found in patients who meet strictly applied consensus criteria (96.1%). Analysis of SMAD4 adds an additional detection rate of 1.3%. HHT as defined by the Curacao criteria is highly predictive of a causative variant in either ENG or ACVRL1.
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- 2020
7. Referring to somebody: Generic person reference as an interactional resource
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Kevin A. Whitehead and Gene H. Lerner
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050101 languages & linguistics ,Linguistics and Language ,05 social sciences ,Context (language use) ,Referent ,050105 experimental psychology ,Language and Linguistics ,Linguistics ,Resource (project management) ,Action (philosophy) ,Artificial Intelligence ,Identity (object-oriented programming) ,Relevance (law) ,0501 psychology and cognitive sciences ,Psychology ,Simple (philosophy) - Abstract
A growing body of research, examining a wide spectrum of reference forms across diverse languages, cultures, and identities, has shown how references to persons can be selected for context-specific interactional outcomes. This report describes how even such simple forms of person reference as somebody (along with someone and a/the person) can be selected on the basis of their relevance for the specific interactional context in which they are employed. We consider how the particular circumstances of some person reference occasions can make these generic person reference forms specially relevant (even when other, more elaborated forms of reference, either recognitional or non-recognitional, were evidently available to the speaker), and we demonstrate how even these barest forms of person reference can be called on to perform delicate, context-sensitive interactional work. Specifically, we show that speakers can select these generic reference forms for non-recognitional references that a) contribute to the formation of the action of a turn, and, when used in a story, b) contribute to the story's telling. Finally, we show how a generic person reference can be selected in place of a recognitional reference, thereby openly concealing a referent's identity.
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- 2020
8. Localization and age distribution of telangiectases in children and adolescents with hereditary hemorrhagic telangiectasia: A retrospective cohort study
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Jamie McDonald, David A. Stevenson, Sheryll L. Vanderhooft, Angela P. Presson, Cristian D. Gonzalez, Christina Topham, Kevin J. Whitehead, and Sarah D. Cipriano
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Male ,medicine.medical_specialty ,Adolescent ,Activin Receptors, Type II ,Population ,Dermatology ,Telangiectases ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Interquartile range ,medicine ,Humans ,Child ,Telangiectasia ,education ,Retrospective Studies ,Mouth ,education.field_of_study ,business.industry ,Vascular malformation ,Endoglin ,Infant, Newborn ,Infant ,Retrospective cohort study ,Hand ,medicine.disease ,Child, Preschool ,Face ,030220 oncology & carcinogenesis ,Cohort ,Female ,Telangiectasia, Hereditary Hemorrhagic ,Age distribution ,medicine.symptom ,business - Abstract
Background The location of telangiectases in hereditary hemorrhagic telangiectasia (HHT), as set forth in the consensus diagnostic (Curacao) criteria, is based primarily on adults. Objective Document the locations and numbers of telangiectases in a cohort of pediatric patients with HHT. Methods A retrospective chart review using a standardized data collection form for site and number of telangiectases was performed for pediatric patients with HHT (age, 0-18 years) from 2005 to 2016. Results Of 90 pediatric patients with HHT, 71% had one or more telangiectases. Of all the telangiectases counted (N = 319), cutaneous telangiectases were more common (73%) than oral telangiectases (27%). The hands were the most frequent site, accounting for 33% of all telangiectases. Adolescents were more likely than children to have cutaneous telangiectases (85% vs 50% [Q = 0.005]). The most frequent sites in children younger than 10 years were the hands excluding the fingers (27%), fingers (25%), and face (23%). Only 23% of subjects (21 of 90) presented with multiple (≥3) telangiectases at locations considered characteristic for the current consensus diagnosis guidelines (lips, oral cavity, and fingers). Limitations Ascertainment bias based on recruitment. Conclusions In this pediatric population, telangiectases at sites not included as “characteristic” by the Curacao diagnostic criteria were common. The Curacao criteria in regard to both number and location of telangiectases may be inadequate in the pediatric HHT population.
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- 2019
9. Relationship of Aortic Stiffness to Exercise and Ventricular Volumes in Single Ventricles
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Phillip M. Trusty, Sara L. Partington, David M. Biko, J. William Gaynor, Mark A. Fogel, Kevin K. Whitehead, Matthew A. Harris, and Ajit P. Yoganathan
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Adult ,Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Cardiac Volume ,Heart Ventricles ,Oxygen pulse ,Magnetic Resonance Imaging, Cine ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,Vascular Stiffness ,0302 clinical medicine ,Afterload ,medicine.artery ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Cardiac Surgical Procedures ,Exercise physiology ,Child ,Exercise ,Pulse wave velocity ,Aorta ,business.industry ,Plastic Surgery Procedures ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Exercise Test ,cardiovascular system ,Cardiology ,Female ,Surgery ,Aortic stiffness ,Cardiology and Cardiovascular Medicine ,business ,Anaerobic exercise ,Blood Flow Velocity ,Follow-Up Studies - Abstract
Background Patients with single ventricle (SV) may often undergo aortic reconstruction that creates a stiff large vessel, increasing afterload and affecting exercise performance. The objective of this study was to determine the relationship of pulse wave velocity (PWV) and distensibility in reconstructed and normal aortic arches after Fontan with exercise variables. Methods PWV and distensibility of the descending aorta at the level of the diaphragm (DAo) were calculated with real-time exercise cardiac magnetic resonance in 48 patients with SV after Fontan (18 after aortic reconstruction; 30 without aortic reconstruction) and compared with metabolic exercise stress test variables. Results PWV was greater in the reconstructed group than in the non-reconstructed group (median 4.4 m/s [range: 2.3 to 9.8 m/s] versus 3.6 [range: 2.6 to 6.3 m/s], respectively, p = 0.003). Statistically significant inverse correlations were found between PWV and end-diastolic, end-systolic, and stroke volumes at rest and at exercise in the reconstructed group. In addition, inverse correlations also existed in the reconstructed group between distensibility of the DAo and the exercise variables such as peak oxygen pulse (R = 0.56, p = 0.02), peak oxygen consumption (R = 0.63, p = 0.008), oxygen consumption at ventilatory anaerobic threshold (R = 0.48, p = 0.04), and peak work (R = 0.54, p = 0.02). Similar correlations were not seen in patients with non-reconstructed aortas. Conclusions Patients with SV with reconstructed aortas have increased aortic stiffness, increasing afterload on the ventricle. Native DAo stiffness distal to the reconstruction is inversely correlated with exercise performance, presumably to decrease impedance mismatch to maintain homogeneity of the aortic wall. This information suggests a possible mechanism for decreased exercise performance in patients with SV with aortic reconstructions.
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- 2019
10. PATIENTS WITH POST-COVID-19 VACCINATION MYOCARDITIS HAVE GREATER STRAIN THAN THOSE WITH NON-VACCINE MYOCARDITIS
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Danish Vaiyani, Matthew David Elias, David M. Biko, Kevin K. Whitehead, Matthew A. Harris, Sara L. Partington, and Mark A. Fogel
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Cardiology and Cardiovascular Medicine - Published
- 2022
11. Clinical presentation and treatment paradigms of brain arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia
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Jamie McDonald, Richard H. Schmidt, M. Yashar S. Kalani, Min S. Park, Ilyas M. Eli, Kevin J. Whitehead, Nicholas T. Gamboa, Philipp Taussky, and Evan Joyce
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Adult ,Intracranial Arteriovenous Malformations ,Male ,medicine.medical_specialty ,Adolescent ,Activin Receptors, Type II ,medicine.medical_treatment ,Mucocutaneous zone ,Telangiectases ,030204 cardiovascular system & hematology ,Radiosurgery ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,otorhinolaryngologic diseases ,medicine ,Humans ,Embolization ,Angiodysplasia ,Child ,Telangiectasia ,Retrospective Studies ,business.industry ,Vascular malformation ,Endoglin ,Infant, Newborn ,Infant ,Curacao ,ACVRL1 ,General Medicine ,Middle Aged ,medicine.disease ,Neurology ,Child, Preschool ,Mutation ,Female ,Telangiectasia, Hereditary Hemorrhagic ,Surgery ,Neurology (clinical) ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Hereditary hemorrhagic telangiectasia (HHT) is characterized by recurrent spontaneous epistaxis, mucocutaneous telangiectases, and multisystem arteriovenous malformations (AVMs). Brain AVMs typically present at birth and are identified in approximately 10-20% of patients with HHT. A retrospective review was undertaken of all HHT patients with known single or multiple brain AVMs treated at our institution. Thirty-nine patients with brain AVM(s) were diagnosed with HHT. Most patients presented with at least one Curaçao criterion. A total of 78 brain AVMs were identified in 39 patients. Two-thirds of patients had solitary brain AVMs, whereas 33% of patients harbored at least two lesions (range: 2-16). Brain AVMs of the supratentorial cerebral hemispheres comprised 83% of all lesions, whereas infratentorial lesions accounted for only 17%. Of the 55 brain AVMs assigned Spetzler-Martin grading, the majority of patients were Grade 1 (73%), and 23% and 4% were Grades 2 and 3, respectively. Patients were treated with surgery alone (51%), embolization alone (6%), embolization followed by surgery (9%), stereotactic radiosurgery (11%), stereotactic radiosurgery followed by surgery (3%), or observation (20%). Of patients who underwent genetic analysis, 62% possessed mutations in ENG (HHT type 1), whereas 38% had mutations in ACVRL1 (HHT type 2). This robust patient cohort of brain AVMs in 39 patients with HHT advances the collective understanding of this disease's varied presentation, diagnostic workup, genetic underpinnings, and available treatment options.
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- 2018
12. Imposition of Fontan physiology: Effects on strain and global measures of ventricular function
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Sara L. Partington, Nazire Ozcelik, Mark A. Fogel, David M. Biko, Kevin K. Whitehead, Matthew A. Harris, and Kazuhiro Shiraga
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Male ,Pulmonary and Respiratory Medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,medicine.medical_treatment ,Strain (injury) ,030204 cardiovascular system & hematology ,Fontan Procedure ,Univentricular Heart ,Fontan procedure ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,Heart rate ,Humans ,Ventricular Function ,Medicine ,cardiovascular diseases ,Child ,End-systolic volume ,Retrospective Studies ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Infant ,Stroke Volume ,Fontan physiology ,medicine.disease ,Biomechanical Phenomena ,030228 respiratory system ,Child, Preschool ,cardiovascular system ,Cardiology ,End-diastolic volume ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
Objective We sought to evaluate contractile function in single-ventricle patients before and after imposition of Fontan physiology. Methods Single right ventricle (SRV; n = 38) and single left ventricle (SLV; n = 11) patients underwent cardiac magnetic resonance imaging pre and post Fontan operation. Global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain were measured along with ejection fraction (EF) and atrioventricular valve regurgitation (AVVR). Results Age at cardiac magnetic resonance imaging before the Fontan operation was 3.1 ± 1.3 years and after the Fontan procedure was 5.8 ± 2.7 years. There were no significant EF differences between SRV and SLV patients before and after the Fontan procedure, and EF did not deteriorate significantly after the Fontan operation. GRS was significantly lower for SRV patients than for SLV patients before (24.3% vs 32.1%; P = .048) and after (21.8% vs 29.7%; P = .045) the Fontan procedure. GRS and GCS of the SRV patients deteriorated significantly after the Fontan operation (GRS, P = .01; GCS, P = .009). Strains showed positive correlations before and after the Fontan operation with positive correlations among each strain. Within all patients, strains correlated positively with EF. Strains and EF negatively correlated with AVVR (GRS P = .03, r = −0.22; GCS P = .03, r = −0.23; EF P Conclusions Strains were lower for SRV than for SLV patients before and after the Fontan operation and deteriorated after the Fontan operation. Our study suggests that strain measures might detect ventricular deterioration earlier than EF. Because strains before and after the Fontan operation were positively correlated, and negatively correlated with AVVR, the early institution of myocardial protective therapy including AVVR management, especially for SRV patients, might have benefit.
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- 2021
13. CARDIOVASCULAR DISEASE RISK FACTORS IN CHILDREN AND ADULTS WITH CONGENITAL HEART DISEASE ARE ASSOCIATED WITH HEART FAILURE: A POPULATION-BASED MULTI-SITE CROSS SECTIONAL ANALYSIS
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Wendy Book, Kristin M. Sommerhalter, Daphne T. Hsu, Karen Chiswell, Tracy Spears, Andrew P. Landstrom, Tessa L. Crume, Aida Soim, Kevin J. Whitehead, Lorenzo D. Botto, Jennifer S. Li, Alfred D’Ottavio, and Sherry L. Farr
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Pediatrics ,medicine.medical_specialty ,Heart disease ,business.industry ,Cross-sectional study ,Heart failure ,medicine ,Disease risk ,Multi site ,Population based ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2021
14. 964: Does pregnancy impact subsequent cardiac outcomes of women with congenital heart disease (CHD)?
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Kevin J. Whitehead, Shannon L. Son, Dan Cox, Arvind Hoskoppal, Torri D. Metz, Anna Catino, Ian M. Lindsay, Lauren L. Hosek, Amanda A. Allshouse, Miranda C. Stein, and Sean Esplin
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medicine.medical_specialty ,Pregnancy ,Heart disease ,Obstetrics ,business.industry ,medicine ,Obstetrics and Gynecology ,medicine.disease ,business - Published
- 2020
15. Cardiac magnetic resonance imaging characterizes stenosis, perfusion, and fibrosis preoperatively and postoperatively in children with anomalous coronary arteries
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Julie A. Brothers, Timothy S. Kim, Mark A. Fogel, Kevin K. Whitehead, Tonia M. Morrison, Stephen M. Paridon, and Matthew A. Harris
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Coronary Vessel Anomalies ,Magnetic Resonance Imaging, Cine ,Angioscopy ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Sudden cardiac death ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,medicine.artery ,Humans ,Medicine ,Prospective Studies ,Cardiac Surgical Procedures ,Child ,Aorta ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Prognosis ,medicine.disease ,Coronary Vessels ,Fibrosis ,Coronary arteries ,Ostium ,medicine.anatomical_structure ,030228 respiratory system ,Child, Preschool ,Anomalous aortic origin of a coronary artery ,Cardiology ,Female ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Artery - Abstract
Using cardiac magnetic resonance imaging (MRI) with virtual angioscopy, we sought to evaluate coronary anatomy, myocardial injury, and left ventricular function in children with interarterial anomalous aortic origin of coronary artery before and after surgery.We prospectively enrolled children 5 to 19 years old with interarterial anomalous coronary artery. Cardiac MRI was performed with respiratory-navigated steady-state free-precession 3-dimensional data set acquisition. Virtual angioscopy was used to evaluate the coronary ostia directly. Surgery consisted of the modified unroofing procedure.We enrolled 9 subjects between February 2009 and May 2015. Subjects were male, with an average age at surgery of 14.1 years. Anomalous coronary was right in 7 patients (77%) and left in 2. In all subjects, the proximal anomalous coronary arose tangential to the aorta with an elliptical, slitlike ostium. Before the operation, the proximal coronary artery was significantly smaller proximally than distally (2 vs 3.1 mm; P .0001. After the operation, neo-orifices were round and patent in 7 subjects; however, 2 subjects still had narrowed neo-orifices. New postoperative MRI findings included flattened septal wall motion (N = 1), small region of midmyocardial partial-thickness scar (N = 1), and dyskinetic septal wall motion with mild aortic insufficiency (N = 1). Left ventricular function was normal both before and after surgery (P = .85).Cardiac MRI with virtual angioscopy is an important tool for evaluating anomalous coronary anatomy, myocardial function, and ischemia and should be considered for initial and postoperative assessment of children with anomalous coronary arteries.
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- 2016
16. Usefulness of Insulinlike Growth Factor 1 as a Marker of Heart Failure in Children and Young Adults After the Fontan Palliation Procedure
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Catherine M. Avitabile, Kevin K. Whitehead, Mary B. Leonard, Jack Rychik, Jill L. Brodsky, J. William Gaynor, Chitra Ravishankar, Meryl S. Cohen, and David J. Goldberg
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Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Time Factors ,Palliative care ,Adolescent ,medicine.medical_treatment ,Population ,Standard score ,Fontan Procedure ,Sensitivity and Specificity ,Severity of Illness Index ,Article ,Fontan procedure ,Young Adult ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,Insulin-Like Growth Factor I ,Child ,education ,Heart Failure ,education.field_of_study ,business.industry ,Body Weight ,Palliative Care ,Reproducibility of Results ,Prognosis ,medicine.disease ,Brain natriuretic peptide ,Body Height ,Cross-Sectional Studies ,Child, Preschool ,Predictive value of tests ,Heart failure ,Cohort ,Cardiology ,Female ,Natriuretic Agents ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Growth hormone and its mediator, insulinlike growth factor 1 (IGF-1), are key determinants of growth in children and young adults. As patients with Fontan physiology often experience diminished longitudinal growth, we sought to describe IGF-1 levels in this population and to identify factors associated with IGF-1 deficiency. Forty-one Fontan subjects ≥5 years were evaluated in this cross-sectional study. Age- and gender-specific height Z scores were generated using national data. Laboratory testing included IGF-1 and brain natriuretic peptide (BNP) levels. IGF-1 levels were converted to age-, gender-, and Tanner stage–specific Z scores. BNP levels were log transformed to achieve a normal distribution (log-BNP). Medical records were reviewed for pertinent clinical variables. Predictors of IGF-1 Z score were assessed through the Student t test and Pearson's correlation. Median age was 11.1 years (range 5.1 to 33.5 years), and time from Fontan was 8.2 years (1.1 to 26.7). Mean height Z score was −0.2 ± 0.9 with a mean IGF-1 Z score of −0.1 ± 1.3. There was no association between IGF-1 Z score and height Z score. Longer interval since Fontan ( R = −0.32, p = 0.04), higher log-BNP ( R = −0.40; p = 0.01), and lower indexed systemic flow on cardiac magnetic resonance ( R = 0.55, p = 0.02) were associated with lower IGF-1 Z scores. In conclusion, in this cohort with Fontan physiology, higher BNP and lower systemic flow were associated with lower IGF-1 Z score. Longitudinal studies are needed to determine if these relations represent a mechanistic explanation for diminished growth in children with this physiology and with other forms of congenital heart disease.
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- 2015
17. Energetic Implications of Vessel Growth and Flow Changes Over Time in Fontan Patients
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Doff B. McElhinney, Reza H. Khiabani, Maria Restrepo, Ajit P. Yoganathan, James Bethel, Kevin K. Whitehead, Mark A. Fogel, Anne Marie Valente, Christopher M. Haggerty, Lucia Mirabella, and Elaine Tang
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Vena Cava, Superior ,Adolescent ,Population ,Flow (psychology) ,Hemodynamics ,Pulmonary Artery ,Fontan Procedure ,Internal medicine ,Humans ,Medicine ,Mean flow ,Child ,education ,Retrospective Studies ,Body surface area ,education.field_of_study ,business.industry ,Infant ,Left pulmonary artery ,Magnetic Resonance Imaging ,Right pulmonary artery ,Cardiac Imaging Techniques ,Regional Blood Flow ,Child, Preschool ,Cohort ,cardiovascular system ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background As patients with a single-ventricle physiology age, long-term complications inherent to this population become more evident. Previous studies have focused on correlating anatomic and hemodynamic performance, but there is little information of how these variables change with time. Vessel growth and flow rate changes were quantified using cardiac magnetic resonance and their effects on hemodynamics were assessed, which could affect the long-term outcome. Methods Forty-eight patients with a lateral tunnel or extracardiac conduit Fontan who underwent two cardiac magnetic resonance scans (average interval, 5.1 ± 2.3 years) were studied. Total cavopulmonary connection anatomic and flow variables were reconstructed and normalized to body surface area 1/2 . Total cavopulmonary connection hemodynamic efficiency (indexed power loss) was obtained through computational fluid dynamic modeling. Results Absolute vessel diameters increased with time, normalized diameters decreased, and vessel mean flow rates remained unchanged. Indexed power loss changed significantly in the cohort, as well as in patients in whom the minimum normalized left pulmonary artery decreased. Age at first scan and connection type (lateral tunnel or extracardiac conduit) were not associated with changes in indexed power loss. Conclusions We present the largest serial cardiac magnetic resonance Fontan cohort to date. Although flow rates increased proportionally to body surface area, vessel diameters did not match somatic growth. As a result, energy losses increased significantly with time in the cohort analyzed.
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- 2015
18. The Cerebral Cavernous Malformation Pathway Controls Cardiac Development via Regulation of Endocardial MEKK3 Signaling and KLF Expression
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Lauren M. Goddard, J. Simon C. Arthur, Kevin J. Whitehead, Dean Y. Li, David R. Rawnsley, Hui Zheng, Zinan Zhou, Xiangjian Zheng, Zoltán Jakus, Mark L. Kahn, Benjamin A. Garcia, Xing Jun Cao, Jisheng Yang, Wei Pan, and Bin Zhou
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medicine.medical_specialty ,MAP Kinase Signaling System ,Transgene ,Kruppel-Like Transcription Factors ,Mice, Transgenic ,MAP Kinase Kinase Kinase 3 ,Biology ,General Biochemistry, Genetics and Molecular Biology ,Article ,Kruppel-Like Factor 4 ,Mice ,Internal medicine ,Gene expression ,medicine ,Animals ,Protein kinase A ,Molecular Biology ,Transcription factor ,Endocardium ,Cardiac Jelly ,Endothelial Cells ,Cell Biology ,3. Good health ,Cell biology ,Endocrinology ,KLF4 ,KLF2 ,Mitogen-Activated Protein Kinases ,Carrier Proteins ,Microtubule-Associated Proteins ,Developmental Biology - Abstract
SummaryThe cerebral cavernous malformation (CCM) pathway is required in endothelial cells for normal cardiovascular development and to prevent postnatal vascular malformations, but its molecular effectors are not well defined. Here we show that loss of CCM signaling in endocardial cells results in mid-gestation heart failure associated with premature degradation of cardiac jelly. CCM deficiency dramatically alters endocardial and endothelial gene expression, including increased expression of the Klf2 and Klf4 transcription factors and the Adamts4 and Adamts5 proteases that degrade cardiac jelly. These changes in gene expression result from increased activity of MEKK3, a mitogen-activated protein kinase that binds CCM2 in endothelial cells. MEKK3 is both necessary and sufficient for expression of these genes, and partial loss of MEKK3 rescues cardiac defects in CCM-deficient embryos. These findings reveal a molecular mechanism by which CCM signaling controls endothelial gene expression during cardiovascular development that may also underlie CCM formation.
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- 2015
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19. Comparison by Magnetic Resonance Phase Contrast Imagingof Pulse-Wave Velocity in Patients With Single Ventricle Who Have Reconstructed Aortas Versus Those Without
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Matthew A. Harris, Ajit P. Yoganathan, Christine Li, Stephanie Fuller, J. William Gaynor, Thomas L. Spray, Marc S. Keller, Mark A. Fogel, Kevin K. Whitehead, and Susan C. Nicolson
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Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Heart Ventricles ,Cardiac index ,Contrast Media ,Magnetic Resonance Imaging, Cine ,Aorta, Thoracic ,Pulse Wave Analysis ,Article ,Vascular Stiffness ,Afterload ,medicine.artery ,Internal medicine ,Ascending aorta ,Image Processing, Computer-Assisted ,medicine ,Humans ,Thoracic aorta ,cardiovascular diseases ,Child ,Pulse wave velocity ,Retrospective Studies ,business.industry ,Reproducibility of Results ,medicine.disease ,medicine.anatomical_structure ,Ventricle ,Descending aorta ,cardiovascular system ,Arterial stiffness ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,circulatory and respiratory physiology - Abstract
Pulse-wave velocity (PWV), a measure of arterial stiffness, is a known independent risk factor for cardiovascular events. Patients with single ventricle who undergo aortic to pulmonary anastomosis (recon) have noncompliant patch material inserted into the neoaorta, possibly increasing vessel stiffness and afterload. The purpose of this study is to determine if PWV in patients with single ventricle differed between those who did and those who did not undergo aortic reconstruction (nonrecon). We retrospectively reviewed cardiac magnetic resonance anatomic, cine, and phase contrast evaluations in the ascending aorta and descending aorta (DAo) at the level of the diaphragm data from 126 patients with single ventricle (8.6 ± 8.0 years) from January 2012 to May 2013. Significance = p0.05. Seventy-five patients underwent recon and 51 did not. PWV in recon was significantly higher than in nonrecon (3.9 ± 0.9 m/s vs 3.2 ± 1.0 m/s, p = 0.008); in recon, patients13 years old had a higher PWV than those7 years (4.5 ± 0.6 vs 3.5 ± 0.7 m/s, p = 0.004). Whether7 or13 years old, PWV of those with recon was higher than nonrecon DAo distensibility was similar between both groups. There was no difference in age, body surface area, or cardiac index between recon and nonrecon. No correlations between various hemodynamic and ventricular function parameters with PWV were noted. In conclusion, PWV in recon is higher than in nonrecon with similar DAo distensibility implicating the aortic reconstruction as a possible cause of increased afterload; older recon patients have stiffer aortas than younger ones, possibly imposing an additional cardiovascular risk in the future. Other biomaterials may potentially moderate PWV if clinical outcome is adversely affected.
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- 2014
20. Fontan hemodynamics from 100 patient-specific cardiac magnetic resonance studies: A computational fluid dynamics analysis
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Maria Restrepo, James Bethel, Christopher M. Haggerty, Kartik S. Sundareswaran, Kevin K. Whitehead, Lucia Mirabella, Elaine Tang, Ajit P. Yoganathan, Diane de Zélicourt, Mark A. Fogel, University of Zurich, and Yoganathan, Ajit P
- Subjects
Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac index ,Hemodynamics ,Fontan Procedure ,Inferior vena cava ,Article ,2705 Cardiology and Cardiovascular Medicine ,10052 Institute of Physiology ,Internal medicine ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Child ,Aorta ,business.industry ,Models, Cardiovascular ,Left pulmonary artery ,Magnetic Resonance Imaging ,Right pulmonary artery ,2746 Surgery ,medicine.anatomical_structure ,medicine.vein ,2740 Pulmonary and Respiratory Medicine ,Ventricle ,Hemorheology ,cardiovascular system ,Cardiology ,Vascular resistance ,570 Life sciences ,biology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives 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. Methods 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. Results 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. Conclusions 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.
- Published
- 2014
21. Constitutive Activation of Nrf2 Causes Hyper-Reductive State and Heart Failure
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Silvio H. Litovsky, Kevin J. Whitehead, John R. Hoidal, Gobinath Shanmugam, Jolyn Fernandes, E. Dale Abel, Madhusudhanan Narasimhan, Dean P. Jones, Namakkal-Soorapppan Rajasekaran, and Thomas W. Kensler
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Heart failure ,Cardiology ,medicine ,State (functional analysis) ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Molecular Biology - Published
- 2017
22. Cardiac Magnetic Resonance and the Need for Routine Cardiac Catheterization in Single Ventricle Patients Prior to Fontan: A Comparison of 3 Groups
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Mark A. Fogel, Thomas Pawlowski, Laura K. Diaz, Matthew A. Harris, Jonathan J. Rome, Winnie Zhu, Marc S. Keller, Kevin K. Whitehead, David Shore, and Andrew C. Glatz
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Arterial anatomy ,medicine.medical_treatment ,Hemodynamics ,Magnetic resonance imaging ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,cardiovascular system ,Cardiology ,medicine ,In patient ,cardiovascular diseases ,Radiology ,business ,Cardiac magnetic resonance ,Cardiology and Cardiovascular Medicine ,Cardiac catheterization - Abstract
Objectives This study investigated whether cardiac magnetic resonance (CMR) and echocardiography (echo) can replace catheterization (cath) for routine evaluation prior to Fontan and under what circumstances CMR and cath are used together. Background Routine cath prior to Fontan has been utilized for years; noninvasive methods, however, may be sufficient. Methods This study reviews clinical data in 119 consecutive patients investigating 3 groups: those who underwent CMR alone (MR; n = 41), cath alone (C; n = 41), or both cath and CMR (C+M; n = 37) prior to Fontan. Results No clinically significant differences were noted in patient characteristics, hemodynamics, or clinical status prior to or after surgery between the C and MR groups. CMR added information in 82%. There were no discrepant findings between CMR and cath data in the C+M group. Diagnostic success was ≥95% in all groups. Of those undergoing Fontan completion, the C+M group had similar outcomes to C and MR; C and CMR were utilized in combination to assess aortopulmonary collaterals or the need for an intervention or evaluate its success. Echo could not delineate pulmonary arterial anatomy in 46% to 53% of patients. The C+M and C groups were exposed to 6.8 ± 4.1 mSv of radiation. Conclusions Single ventricle patients not requiring an intervention can undergo successful Fontan completion with CMR and echo alone with similar short-term outcomes to C, which was used as a control, preventing an invasive test and exposure to radiation. CMR can add information in a significant number of patients. Cath and CMR are utilized together for interventions and assessment of aortopulmonary collaterals.
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- 2012
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23. Relation of Left Ventricular End Diastolic Pressure to Right Ventricular End Diastolic Volume After Operative Treatment of Tetralogy of Fallot
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Matthew C. Schwartz, Mark A. Fogel, Kevin K. Whitehead, Matthew A. Harris, Matthew J. Gillespie, Jonathan J. Rome, and Andrew C. Glatz
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Adult ,Male ,Cardiac Catheterization ,medicine.medical_specialty ,Adolescent ,Cardiac Volume ,medicine.medical_treatment ,Diastole ,Magnetic Resonance Imaging, Cine ,Ventricular Function, Left ,Young Adult ,Internal medicine ,Ventricular Pressure ,Humans ,Medicine ,Postoperative Period ,Retrospective Studies ,Cardiac catheterization ,Tetralogy of Fallot ,business.industry ,Infant, Newborn ,Infant ,Recovery of Function ,Left pulmonary artery ,medicine.disease ,Myocardial Contraction ,Right pulmonary artery ,Preload ,Treatment Outcome ,Blood pressure ,Child, Preschool ,Ventricular Function, Right ,Ventricular pressure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Left ventricular (LV) diastolic dysfunction is associated with poor outcomes after tetralogy of Fallot (TOF) repair, although its cause is not known, and its relation to right ventricular (RV) performance has never been examined. The aim of this study was to test the hypothesis that RV dilation leads to LV diastolic dysfunction after TOF repair. Patients with repaired TOF who underwent cardiac catheterization and cardiac magnetic resonance imaging within 6 months from January 2003 and April 2011 were reviewed to assess the relation of LV end-diastolic pressure (LVEDP) and indexed RV end-diastolic volume (RVEDVi). Thirty-eight patients were included at a median age of 10.1 years (range 0.6 to 54.7). There was a significant linear association between RVEDVi and LVEDP (p = 0.05). RV end-diastolic pressure (p
- Published
- 2012
24. Comparison and Usefulness of Cardiac Magnetic Resonance Versus Computed Tomography in Infants Six Months of Age or Younger With Aortic Arch Anomalies Without Deep Sedation or Anesthesia
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Deanna Tipton, Thomas Pawlowski, Justine Wilson, Matthew A. Harris, Kevin K. Whitehead, Mark A. Fogel, Marc S. Keller, and Christine Harris
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Aortic arch ,medicine.medical_specialty ,Vascular Malformations ,Sedation ,Conscious Sedation ,Magnetic Resonance Imaging, Cine ,Aorta, Thoracic ,Computed tomography ,Severity of Illness Index ,Diagnosis, Differential ,Internal medicine ,medicine.artery ,medicine ,Humans ,Anesthesia ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,fungi ,Angiography ,Infant, Newborn ,Aortic arch anomalies ,Infant ,Reproducibility of Results ,food and beverages ,Magnetic resonance imaging ,equipment and supplies ,Circulatory system ,cardiovascular system ,Cardiology ,Radiology ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance ,human activities ,Follow-Up Studies - Abstract
The present project investigated whether cardiac magnetic resonance (CMR) of aortic arch anomalies can be performed successfully in infants6 months of age without the use of cardiac anesthesia or deep sedation. We performed a retrospective review of infants ≤6 months old from 2005 to 2009 who underwent either CMR or computed tomography angiography to investigate aortic arch abnormalities. The CMR procedure used a "feed and swaddle" protocol without deep sedation or cardiac anesthesia. Of the 52 infants referred for CMR, 24 underwent the feed and swaddle protocol (aged 2.6 ± 1.4 months). One patient awoke during the study, and examination of the remaining 23 yielded a definitive diagnosis (success rate 96%). The scanning time was 6.2 ± 3.1 minutes, with the large airways evaluation accounting for 1/2 the time. Single-shot axial steady-state free precession, in which the definitive diagnosis was made, accounted for 0.59 ± 0.3 minutes. Fifteen infants were diagnosed with a vascular ring. Of the 8 infants who underwent surgery, the diagnostic accuracy was 100%. During the same period, 19 patients, who had undergone computed tomography angiography (aged 1.67 ± 1.20 months), were referred for aortic arch evaluation. Of these 19 patients, 6 (32%) underwent sedation or anesthesia. The imaging time was 0.08 ± 0.06 minutes, significantly different from the CMR times (p0.01). However, the overall room times (31.3 ± 22.3 and 35.8 ± 3.86 minutes, respectively) were not different between the CMR and angiographic groups. The radiation dose was 1.41 ± 1.03 mSv. In conclusion, CMR evaluation of aortic arch anomalies in children6 months old can be successfully completed quickly using a feed and swaddle approach with high diagnostic accuracy. This protocol avoids the risks of sedation, as well as the radiation associated with computed tomography angiography.
- Published
- 2011
25. Pre-Fontan cardiac magnetic resonance predicts post-Fontan length of stay and avoids ionizing radiation
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Paul M. Weinberg, Michael T. Cosulich, Mark A. Fogel, Timothy I Liu, Matthew A. Harris, Matthew J. Gillespie, and Kevin K. Whitehead
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac output ,medicine.medical_treatment ,Magnetic Resonance Imaging, Cine ,Pulmonary Artery ,Fontan Procedure ,Fontan procedure ,medicine.artery ,Internal medicine ,Humans ,Medicine ,Cardiac Output ,Cardiac catheterization ,medicine.diagnostic_test ,business.industry ,Infant ,Stroke Volume ,Magnetic resonance imaging ,Left pulmonary artery ,Length of Stay ,Magnetic Resonance Imaging ,Right pulmonary artery ,Surgery ,Aortic Valve ,Child, Preschool ,Pulmonary artery ,Cardiology ,End-diastolic volume ,Female ,business ,Cardiology and Cardiovascular Medicine ,human activities ,Blood Flow Velocity - Abstract
Objective Patients frequently undergo cardiac catheterization before the Fontan operation because of the limited echocardiographic windows in the region of the superior cavopulmonary connection and branch pulmonary arteries. Patients with obstruction to pulmonary blood flow are at increased risk for prolonged length of hospital stay after the Fontan operation. Cardiac magnetic resonance has unlimited imaging windows and can quantify both the branch pulmonary artery size and net flow distribution and thereby serve as a method for identifying patients at increased risk for prolonged length of stay. Methods We retrospectively reviewed 24 cardiac magnetic resonance studies of patients (mean age, 3.1 ± 1.0 years) referred before the Fontan operation. Cardiac magnetic resonance measured the cross-sectional area and flow to each branch pulmonary artery. Post-Fontan hospital course data were acquired from the medical record. Results Prolonged length of stay after the Fontan operation is observed among patients with one branch that is less than 25% of the total cross-sectional area (18.0 ± 5.5 vs 8.2 ± 3.8 days, P = .01) or with less than 40% flow to one branch (12.5 ± 6.9 vs 7.6 ± 1.5 days, P = .04). There is moderate correlation between the total branch pulmonary area and length of stay ( r = −0.75). Conclusions Cardiac magnetic resonance noninvasively assesses the branch pulmonary area size and flow before the Fontan operation. These data predict which patients are more likely to experience a prolonged hospital course.
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- 2009
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26. Blood flow distribution in a large series of patients having the Fontan operation: A cardiac magnetic resonance velocity mapping study
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Matthew A. Harris, Ajit P. Yoganathan, W. James Parks, Mark A. Fogel, Kartik S. Sundareswaran, and Kevin K. Whitehead
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Pulmonary and Respiratory Medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Anastomosis ,Inferior vena cava ,030218 nuclear medicine & medical imaging ,Fontan procedure ,03 medical and health sciences ,0302 clinical medicine ,Superior vena cava ,Internal medicine ,medicine ,cardiovascular diseases ,business.industry ,Left pulmonary artery ,Right pulmonary artery ,3. Good health ,Surgery ,surgical procedures, operative ,medicine.vein ,Circulatory system ,cardiovascular system ,Cardiology ,Venae cavae ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives Our goal was to determine flow distribution in the cavopulmonary connections of patients with and without bilateral superior venae cavae who had the Fontan procedure. No large series exists that establishes the flow distributions in Fontan patients, which would be an important resource for everyday clinical use and may affect future surgical reconstruction. Methods We studied 105 Fontan patients (aged 2–24 years) with through-plane phase contrast velocity mapping to determine flow rates in the inferior and superior venae cavae and left and right pulmonary arteries. Superior caval anastomosis type included 40 bidirectional Glenn shunts (of which 15 were bilateral) and 53 hemi-Fontan anastomoses; Fontan type included 69 intra-atrial baffles, 28 extracardiac conduits, and 4 atriopulmonary connections. Results Total caval flow was 2.9 ± 1.0 L · min −1 · m −2 , with an inferior vena cava contribution of 59% ± 15%. Total pulmonary flow was 2.5 ± 0.8 L · min −1 · m −2 , statistically less than caval flow and not explained by fenestration presence. The right pulmonary artery contribution (55% ± 13%) was statistically greater than the left. In patients with bilateral superior cavae, the right cava accounted for 52% ± 14% of the flow, with no difference in pulmonary flow splits (50% ± 16% to the right). Age and body surface area correlated with percent inferior caval contribution ( r = 0.60 and 0.74, respectively). Superior vena cava anastomosis and Fontan type did not significantly affect pulmonary flow splits. Conclusions Total Fontan cardiac index was 2.9 L · min −1 · m −2 , with normal pulmonary flow splits (55% to the right lung). Inferior vena caval contribution to total flow increases with body surface area and age, consistent with data from healthy children.
- Published
- 2009
27. Fontan hemodynamics: Importance of pulmonary artery diameter
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Resmi KrishnankuttyRema, Kirk R. Kanter, Kerem Pekkan, Mark A. Fogel, Hiroumi D. Kitajima, Kartik S. Sundareswaran, Ajit P. Yoganathan, Lakshmi Prasad Dasi, Shiva Sharma, and Kevin K. Whitehead
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac output ,Vena Cava, Superior ,Adolescent ,medicine.medical_treatment ,Cardiac index ,Hemodynamics ,Pulmonary Artery ,Fontan Procedure ,Inferior vena cava ,Article ,Fontan procedure ,Internal medicine ,medicine.artery ,Humans ,Medicine ,Child ,Retrospective Studies ,business.industry ,Infant ,Left pulmonary artery ,Right pulmonary artery ,medicine.vein ,Child, Preschool ,Pulmonary artery ,cardiovascular system ,Cardiology ,Surgery ,business ,Cardiology and Cardiovascular Medicine - Abstract
ObjectiveWe quantify the geometric and hemodynamic characteristics of extracardiac and lateral tunnel Fontan surgical options and correlate certain anatomic characteristics with their hemodynamic efficiency and patient cardiac index.Methods and ResultsThe study was conducted retrospectively on 22 patients undergoing Fontan operations (11 extracardiac and 11 lateral tunnel operations). Total cavopulmonary connection geometric parameters such as vessel areas, curvature, and offsets were quantified using a skeletonization method. Energy loss at the total cavopulmonary connection junction was available from previous in vitro experiments and computational fluid dynamic simulations for 5 and 9 patients, respectively. Cardiac index data were available for all patients. There was no significant difference in the mean and minimum cross-sectional vessel areas of the pulmonary artery between the extracardiac and lateral tunnel groups. The indexed energy dissipation within the total cavopulmonary connection was strongly correlated to minimum cross-sectional area of the pulmonary arteries (R2 value of 0.90 and P < .0002), whereas all other geometric features, including shape characteristics, had no significant correlation. Finally, cardiac index significantly correlated with the minimum pulmonary artery area (P = .006), suggesting that total cavopulmonary connection energy losses significantly affect resting cardiac output.ConclusionsThe minimum outlet size of the total cavopulmonary connection (ie, minimum cross section of pulmonary artery) governs the energy loss characteristics of the total cavopulmonary connection more strongly than variations in the shapes corresponding to extracardiac and lateral tunnel configurations. Differences in pulmonary artery sizes must be accounted for when comparing energy losses between extracardiac and lateral tunnel geometries.
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- 2009
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28. Usefulness of Branch Pulmonary Artery Regurgitant Fraction to Estimate the Relative Right and Left Pulmonary Vascular Resistances in Congenital Heart Disease
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Matthew A. Harris, Paul M. Weinberg, Kevin K. Whitehead, and Mark A. Fogel
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Heart disease ,Pulmonary Artery ,Severity of Illness Index ,Risk Factors ,Internal medicine ,medicine.artery ,medicine ,Humans ,Cardiac Surgical Procedures ,Child ,Pulmonary wedge pressure ,Retrospective Studies ,Ultrasonography ,Lung ,Vascular disease ,business.industry ,Infant ,Prognosis ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Regurgitant fraction ,Pulmonary artery ,Circulatory system ,Vascular resistance ,Cardiology ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity ,Follow-Up Studies - Abstract
In postoperative congenital heart patients with pulmonary regurgitation, individual branch pulmonary artery regurgitant fractions estimate relative pulmonary vascular resistance independent of pulmonary blood flow distribution.
- Published
- 2005
29. LEFT CORONARY ARTERY ANGLE OF TAKEOFF IN PATIENTS WITH TRANSPOSITION OF THE GREAT ARTERIES AFTER ARTERIAL SWITCH OPERATION IS NOT RELATED TO FUNCTION BUT IS RELATED TO LEFT VENTRICULAR MASS: A CMR STUDY
- Author
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Matthew A. Harris, Mark A. Fogel, Stephen M. Paridon, Marc S. Keller, Thomas Pawlowski, and Kevin K. Whitehead
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medicine.medical_specialty ,business.industry ,Aortic root ,Transposition (music) ,Left ventricular mass ,medicine.anatomical_structure ,Left coronary artery ,Great arteries ,medicine.artery ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,In patient ,Takeoff ,business ,Cardiology and Cardiovascular Medicine ,Artery - Abstract
Pts with transposition of the great arteries (TGA) may have varied coronary artery patterns; reimplantation during arterial switch operation (ASO) may necessitate acute angles of takeoff from the aortic root impacting left ventricular (LV) performance. Retrospective review of CMR scans from 2005–
- Published
- 2013
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30. INCREASED POWER LOSS IN THE TOTAL CAVOPULMONARY CONNECTION IS RELATED TO DECREASED SINGLE VENTRICLE VOLUME
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Kevin K. Whitehead, Lucia Mirabella, Ajit P. Yoganathan, James Bethel, Christopher M. Haggerty, and Mark A. Fogel
- Subjects
Power loss ,medicine.medical_specialty ,business.industry ,Total cavopulmonary connection ,medicine.anatomical_structure ,Volume (thermodynamics) ,Ventricle ,Internal medicine ,medicine ,Cardiology ,cardiovascular system ,cardiovascular diseases ,business ,Cardiology and Cardiovascular Medicine - Published
- 2013
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31. LEFT VENTRICULAR DIFFUSE MYOCARDIAL FIBROSIS IN SURVIVORS OF TETRALOGY OF FALLOT REPAIR AND CORRELATION WITH MYOCARDIAL STRAIN BY CARDIAC MAGNETIC RESONANCE: INSIGHT INTO MECHANISM OF LEFT VENTRICULAR FUNCTION
- Author
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Kevin K. Whitehead, Frederick H. Epstein, Matthew A. Harris, Christine Li, Mark A. Fogel, Christopher M. Kramer, and Marc S. Keller
- Subjects
medicine.medical_specialty ,Ventricular function ,business.industry ,Electrocardiography in myocardial infarction ,medicine.disease ,Internal medicine ,Exercise performance ,Myocardial strain ,cardiovascular system ,Cardiology ,medicine ,Myocardial fibrosis ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,Cardiac magnetic resonance ,business ,circulatory and respiratory physiology ,Tetralogy of Fallot - Abstract
2 important complications after tetralogy of Fallot (TOF) repair are left ventricular (LV) dysfunction and poor exercise performance. Cardiac magnetic resonance (CMR) can assess myocardial strain and determine diffuse myocardial fibrosis (DMF) using T1 mapping. Pts underwent CMR for ventricular
- Published
- 2016
32. PRELIMINARY INVESTIGATION INTO THE LINK OF CEREBRAL BLOOD FLOW IN SINGLE VENTRICLE PATIENTS AFTER SUPERIOR CAVOPULMONARY CONNECTION AND NEURODEVELOPMENTAL OUTCOME AFTER FONTAN
- Author
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Matthew A. Harris, Marc S. Keller, Kevin K. Whitehead, and Mark A. Fogel
- Subjects
medicine.medical_specialty ,business.industry ,medicine.anatomical_structure ,nervous system ,Cerebral blood flow ,Ventricle ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance ,circulatory and respiratory physiology - Abstract
In multiple studies across disease states and age ranges, cerebral blood flow (CBF) has been linked to neurodevelopmental outcome (ND). The correlation between the two in patients with single ventricle has not been proven. 7 pts underwent cardiac magnetic resonance to determine CBF and CBF response
- Published
- 2016
33. COMPARISON OF DIRECT AND INDIRECT MEASUREMENTS OF AORTIC VALVE REGURGITATION USING PHASE CONTRAST MAGNETIC RESONANCE VELOCITY MAPPING
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Matthew A. Harris, Gregory L. Fu, Marc S. Keller, Mark A. Fogel, and Kevin K. Whitehead
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Phase contrast microscopy ,Magnetic resonance imaging ,medicine.disease ,law.invention ,Nuclear magnetic resonance ,Velocity mapping ,law ,Internal medicine ,medicine ,Cardiology ,business ,Cardiology and Cardiovascular Medicine ,Aortic valve regurgitation - Published
- 2012
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34. IN VITRO VALIDATION OF MRI MEASUREMENT OF SYSTEMIC TO PULMONARY COLLATERAL FLOW
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Kevin K. Whitehead, Ravi Doddasomayajula, and Yoav Dori
- Subjects
medicine.medical_specialty ,Collateral flow ,business.industry ,Internal medicine ,medicine ,Cardiology ,business ,Cardiology and Cardiovascular Medicine ,In vitro - Published
- 2011
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35. CARDIAC MAGNETIC RESONANCE CAN OBVIATE THE NEED FOR ROUTINE CARDIAC CATHETERIZATION PRIOR TO FONTAN: A STUDY OF 3 GROUPS
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Jack Rome, Marc S. Keller, Kevin J. Whitehead, Mark A. Fogel, Matthew A. Harris, and Thomas Pawlowski
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,Cardiology ,medicine ,business ,Cardiac magnetic resonance ,Cardiology and Cardiovascular Medicine ,Cardiac catheterization - Published
- 2010
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36. The Cardiovascular Effects of Obesity on Ventricular Function and Mass in Patients after Tetralogy of Fallot Repair
- Author
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Meryl S. Cohen, Laura K. Diaz, Thomas Pawlowski, Elizabeth Goldmuntz, Matthew A. Harris, Kevin K. Whitehead, Mark A. Fogel, Christine Li, and Marc S. Keller
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Male ,medicine.medical_specialty ,Adolescent ,Heart Ventricles ,Cardiac index ,Magnetic Resonance Imaging, Cine ,Overweight ,Body Mass Index ,Heart Rate ,Internal medicine ,Prevalence ,medicine ,Humans ,Ventricular Function ,Obesity ,cardiovascular diseases ,Child ,Retrospective Studies ,Tetralogy of Fallot ,Body surface area ,Ejection fraction ,business.industry ,Stroke Volume ,Stroke volume ,medicine.disease ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,End-diastolic volume ,Female ,medicine.symptom ,business ,Body mass index - Abstract
To determine the cardiovascular effects of obesity on patients with tetralogy of Fallot (TOF) repair.Ventricular performance measures were compared between obese (body mass index [BMI] ≥95%), overweight (85% ≤BMI95%), and normal weight subjects (BMI85%) in a retrospective review of patients with TOF who underwent cardiac magnetic resonance from 2005-2010. Significance was P.05.Of 260 consecutive patients with TOF, 32 were obese (12.3%), 48 were overweight (18.5%), and 180 were normal weight (69.2%). Biventricular mass was increased in obese compared with normal weight patients with right ventricular mass more affected than left ventricular mass. Obese patients demonstrated decreased biventricular end-diastolic volume (EDV) and stroke volume (SV) when indexed to body surface area (BSA) with an increased heart rate when compared with normal weight patients; cardiac index, ejection fraction, and pulmonary regurgitation fraction were similar. When indexed to ideal BSA, biventricular EDV and SV were similar. EDV and SV for overweight patients were nearly identical to normal weight patients with ventricular mass in between the other 2 groups.Approximately 12% of patients after TOF repair referred for cardiac magnetic resonance in a tertiary referral center are obese with increased biventricular mass. Obese patients and normal weight patients have similar cardiac indices, however, when indexed to actual BSA, obese patients demonstrate decreased EDV and SV with increased heart rate and similar cardiac indices. When indexed to ideal BSA, no differences in biventricular volumes were noted.
- Published
- 2015
37. Chronic Endurance Stress Induces Cardiac Remodeling in Aged Nrf2-Null Mice
- Author
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Rajasekaran Namakkal-Soorappan, Kevin S Whitehead, E. Dale Abel, John R. Hoidal, Dinesh Devadoss, Naqser Abu-Rmaileh, Sankaranarayanan Kannan, and Sellamuthu S. Gounder
- Subjects
Stress (mechanics) ,Null mice ,medicine.medical_specialty ,Endocrinology ,business.industry ,Physiology (medical) ,Internal medicine ,Medicine ,business ,Biochemistry - Published
- 2012
38. THE EFFECTS OF RESPIRATION ON FLOW IN THE FONTAN PATHWAY USING REAL TIME PHASE CONTRAST MAGNETIC RESONANCE IMAGING AT RESTING CONDITIONS
- Author
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Kevin J. Whitehead, Ajit P. Yoganathan, Jefferon Losse, Reza H. Khiabani, and Mark A. Fogel
- Subjects
Fontan pathway ,Nuclear magnetic resonance ,Flow (mathematics) ,business.industry ,Respiration ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Phase contrast magnetic resonance imaging - Published
- 2014
39. COMPARISON OF LYMPHATIC ABNORMALITIES IN PATIENTS WITH PROTEIN LOSING ENTEROPATHY AND PLASTIC BRONCHITIS
- Author
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Jack Rychik, Jonathan J. Rome, Matthew A. Harris, Matthew J. Gillespie, Maxim Itkin, Kevin K. Whitehead, Marc S. Keller, David J. Goldberg, Andrew C. Glatz, Mark A. Fogel, and Yoav Dori
- Subjects
medicine.medical_specialty ,Pathology ,Plastic bronchitis ,business.industry ,Internal medicine ,Protein losing enteropathy ,medicine ,In patient ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Gastroenterology ,Lymphatic abnormality - Published
- 2014
40. RELATIONSHIP BETWEEN TOTAL CAVOPULMONARY CONNECTION GEOMETRY AND EXERCISE HEMODYNAMICS
- Author
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Elaine Tang, James Bethel, Reza H. Khiabani, Ajit P. Yoganathan, Mark A. Fogel, Kevin J. Whitehead, and Maria Restrepo
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Total cavopulmonary connection ,Exercise hemodynamics ,Cardiology and Cardiovascular Medicine ,business - Published
- 2014
41. Nrf2 Deficiency Prevents Reductive Stress Induced Hypertrophic Cardiomyopathy
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John R. Hoidal, Aldrin V. Gomes, Rajasekaran Namakkal Soorappan, Thomas W. Kensler, Li Wang, Sheldon E. Litwin, Kevin J. Whitehead, E. Dale Abel, and Sankarnarayanan Kannan
- Subjects
medicine.medical_specialty ,Endocrinology ,business.industry ,Physiology (medical) ,Internal medicine ,Stress induced ,medicine ,Hypertrophic cardiomyopathy ,business ,medicine.disease ,Biochemistry - Published
- 2013
42. A RETROSPECTIVE COHORT OF 100 FONTAN CONNECTIONS: RELATIONSHIP BETWEEN GEOMETRIC FEATURES AND HEMODYNAMICS OUTCOMES
- Author
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Christopher M. Haggerty, Ajit P. Yoganathan, Elaine Tang, Maria Restrepo, James Bethel, Kevin K. Whitehead, Lucia Mirabella, and Mark A. Fogel
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,cardiovascular system ,Medicine ,Hemodynamics ,Retrospective cohort study ,Cardiology and Cardiovascular Medicine ,business - Published
- 2013
43. Disruption of Nrf2 Induces Early Onset of Atrial Remodeling and Fibrillation on Aging
- Author
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Kevin S Whitehead, Sellamuthu S. Gounder, Rajasekaran Namakkal-Soorappan, Sankaranarayanan Kannan, Naser Abu-Ramelah, Dinesh Devadoss, Nassir F. Marrouche, and E. Dale Abel
- Subjects
Fibrillation ,medicine.medical_specialty ,business.industry ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,medicine.symptom ,business ,Biochemistry ,Atrial Remodeling ,Early onset - Published
- 2012
44. A rationale for rapid staging of patients with aortopulmonary shunts: Increased oscillatory work
- Author
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Edward G. Cape, Eric T. Lee, Kevin K. Whitehead, and Theresa A. Tacy
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medicine.medical_specialty ,Work (electrical) ,business.industry ,Medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 1996
45. Estimation of pulmonary artery pressure using Doppler flow velocity in modified blalock-taussig shunts: An in vitro pulsatile flow study
- Author
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Kevin K. Whitehead, Edward G. Cape, and Theresa A. Tacy
- Subjects
medicine.medical_specialty ,Doppler flow ,business.industry ,medicine.artery ,Internal medicine ,Pulmonary artery ,Pulsatile flow ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Published
- 1995
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