23 results on '"Shabnam Peyvandi"'
Search Results
2. A Measurement-Based Protocol Improves Interrater Agreement and Accuracy of Right Ventricular Systolic Pressure Assessment by Echocardiography in Children: A Call for Quality Improvement
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Hythem Nawaytou, Christine Springston, Ann Lazar, Samuel Keller, Whitnee Hogan, Nicole Cresalia, Shabnam Peyvandi, Mark Cocalis, Anita Moon-Grady, and Michael Brook
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Echocardiography ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,Ventricular Function, Right ,Humans ,Reproducibility of Results ,Blood Pressure ,Radiology, Nuclear Medicine and imaging ,Hypertrophy ,Child ,Cardiology and Cardiovascular Medicine ,Quality Improvement - Abstract
Echocardiographic measurements carry the promise of improving interrater (IR) agreement over subjective assessment. The aim of this study was to assess the effect of implementing a measurement-based protocol on IR agreement and accuracy in reporting of right ventricular (RV) systolic pressure in children. The effect of this reporting protocol on IR agreement in reporting RV dilation, hypertrophy, and systolic function was also evaluated.Five echocardiography readers reported their assessment of RV systolic pressure, dilation, hypertrophy, and systolic function on 40 deidentified echocardiograms using their individual accustomed methods and then using an agreed-upon protocol based solely on RV measurements. IR agreement was assessed using κ statistics. Accuracy of RV systolic pressure ratings was assessed using the McNemar test in comparison with hemodynamic data obtained by cardiac catheterization. The reliability of the RV measurements was assessed using intraclass correlation coefficient (ICC) and coefficient of variation.IR agreement and accuracy of RV systolic pressure assessment improved after using the measurement-based protocol (agreement from 0.39 [95% CI, 0.27-0.5] to 0.62 [95% CI, 0.48-0.76] and accuracy from 18 of 40 to 29 of 40 [P = .03]). IR agreement of RV dilation improved (from 0.36 [95% CI, 0.25-0.48] to 0.63 [95% CI, 0.48-0.79]), while IR agreement of RV hypertrophy (from 0.29 [95% CI, 0.17-0.42] to 0.35 [95% CI, 0.15-0.55]) and RV systolic function (from 0.57 [95% CI, 0.45-0.69] to 0.53 [95% CI, 0.41-0.66]) did not improve. The reliability of the measurements was good (ICC0.8), except for RV free wall thickness (ICC = 0.62, coefficient of variation = 24%) and RV fractional area change (ICC = 0.47, coefficient of variation = 22%), suggesting a possible reason for the lack of improvement in IR agreement of RV hypertrophy and RV systolic function. Heteroscedasticity was observed in the reliability of RV measurements, with the ICC being significantly lower at larger magnitudes for all RV measurements.Standardization of reporting protocols using RV measurements in place of subjective assessment improved IR agreement and accuracy of RV systolic pressure assessment. Reliable measurements (RV systolic pressure and dilation) resulted in improvement in IR agreement while unreliable measurements (RV hypertrophy and systolic function) did not. Special attention to measurements' reliability and heteroscedasticity of reliability is required when designing clinical protocols to decrease IR disagreement as a source of error.
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- 2022
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3. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography
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Anita J. Moon-Grady, Mary T. Donofrio, Sarah Gelehrter, Lisa Hornberger, Joe Kreeger, Wesley Lee, Erik Michelfelder, Shaine A. Morris, Shabnam Peyvandi, Nelangi M. Pinto, Jay Pruetz, Neeta Sethi, John Simpson, Shubhika Srivastava, and Zhiyun Tian
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2023
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4. Fetal growth and gestational age improve outcome predictions in neonatal heart surgery
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Martina A, Steurer, Kurt, Schuhmacher, Jill J, Savla, Mousumi, Banerjee, Nikhil K, Chanani, Aaron, Eckhauser, Justin, Elhoff, Jeffrey P, Jacobs, Katherine, Mikesell, Shabnam, Peyvandi, Jennifer, Romano, Wenying, Zhang, J William, Gaynor, and Sarah, Tabbutt
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Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,Infant, Newborn ,Infant ,Gestational Age ,Cohort Studies ,Fetal Development ,Infant, Small for Gestational Age ,Humans ,Birth Weight ,Surgery ,Cardiac Surgical Procedures ,Child ,Cardiology and Cardiovascular Medicine ,Infant, Premature - Abstract
Current risk adjustment models for congenital heart surgery do not fully incorporate multiple factors unique to neonates such as granular gestational age (GA) and birth weight (BW) z score data. This study sought to develop a Neonatal Risk Adjustment Model for congenital heart surgery to address these deficiencies.Cohort study of neonates undergoing cardiothoracic surgery during the neonatal period captured in the Pediatric Cardiac Critical Care Consortium database between 2014 and 2020. Candidate predictors were included in the model if they were associated with mortality in the univariate analyses. GA and BW z score were both added as multicategory variables. Mortality probabilities were predicted for different GA and BW z scores while keeping all other variables at their mean value.The C statistic for the mortality model was 0.8097 (95% confidence interval, 0.7942-0.8255) with excellent calibration. Mortality prediction for a neonate at 40 weeks GA and a BW z score 0 to 1 was 3.5% versus 9.8% for the same neonate at 37 weeks GA and a BW z score -2 to -1. For preterm infants the mortality prediction at 34 to 36 weeks with a BW z score 0 to 1 was 10.6%, whereas it was 36.1% for the same infant atlt;32 weeks with a BW z score of -2 to -1.This Neonatal Risk Adjustment Model incorporates more granular data on GA and adds the novel risk factor BW z score. These 2 factors refine mortality predictions compared with traditional risk models. It may be used to compare outcomes across centers for the neonatal population.
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- 2022
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5. Neonatal Brain Injury and Timing of Neurodevelopmental Assessment in Patients With Congenital Heart Disease
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Anne Synnes, Duan Xu, Kenneth J. Poskitt, A. James Barkovich, Steven P. Miller, Ting Guo, Shabnam Peyvandi, Hannah C. Glass, Vann Chau, and Patrick S. McQuillen
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Male ,Heart disease ,Transposition of Great Vessels ,Cardiorespiratory Medicine and Haematology ,030204 cardiovascular system & hematology ,Cardiovascular ,Bayley Scales of Infant Development ,neurodevelopmental outcomes ,Postoperative Complications ,0302 clinical medicine ,Longitudinal Studies ,Prospective Studies ,Critical congenital heart disease ,Child ,Stroke ,Pediatric ,education.field_of_study ,medicine.diagnostic_test ,Brain ,Magnetic Resonance Imaging ,congenital heart disease ,Heart Disease ,Great arteries ,Public Health and Health Services ,Cardiology ,Biomedical Imaging ,Injury Severity Score ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,Heart Defects, Congenital ,medicine.medical_specialty ,Population ,Neuroimaging ,Article ,Perioperative Care ,03 medical and health sciences ,Clinical Research ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,education ,business.industry ,Neurosciences ,Infant, Newborn ,Infant ,Magnetic resonance imaging ,Perinatal Period - Conditions Originating in Perinatal Period ,Newborn ,brain injury ,medicine.disease ,Brain Disorders ,Cardiovascular System & Hematology ,Neurodevelopmental Disorders ,Brain Injuries ,business - Abstract
BACKGROUND:Brain injury (BI) is reported in 60% of newborns with critical congenital heart disease as white matter injury (WMI) or stroke. Neurodevelopmental (ND) impairments are reported in these patients. The relationship between neonatal BI and ND outcome has not been established. OBJECTIVES:This study sought to determine the association between peri-operative BI and ND outcomes in infants with single ventricle physiology (SVP) and d-transposition of the great arteries (d-TGA). METHODS:Term newborns with d-TGA and SVP had pre-operative and post-operative brain magnetic resonance imaging and ND outcomes assessed at 12 and 30months with the Bayley Scales of Infant Development-II. BI was categorized by the brain injury severity score and WMI was quantified by volumetric analysis. RESULTS:A total of 104 infants had follow-up at 12months and 70 had follow-up at 30months. At 12months, only clinical variables were associated with ND outcome. At 30months, subjects with moderate-to-severe WMI had significantly lower Psychomotor Development Index (PDI) scores (13 points lower) as compared with those with none or minimal WMI for d-TGA and SVP (p=0.03 and p=0.05, respectively) after adjusting for various factors. Quantitative WMI volume was likewise associated. Stroke was not associated with outcome. The Bland-Altman limits of agreement for PDI scores at 12 and 30months were wide (-40.3 to 31.2) across the range of mean PDI values. CONCLUSIONS:Increasing burden of WMI is associated with worse motor outcomes at 30months for infants with criticalcongenital heart disease, whereas no adverse association was seen between small strokes and outcome. Theseresults support the utility of neonatal brain magnetic resonance imaging in this population to aid in predictinglateroutcomes and the importance of ND follow-up beyond 1 year of age.
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- 2018
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6. Resolving the Fontan paradox: Addressing socioeconomic and racial disparities in patients with a single ventricle
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Tara Karamlou, Shabnam Peyvandi, Myke Federman, Donna Goff, Raghav Murthy, S. Ram Kumar, Reshmi Binwale, Brian Reemsten, Anita Moon-Grady, Sarah Tabbutt, Jay Pruetz, Grace Kung, Nancy Pike, Anees Razzouk, Andrew Shin, Frank Hanley, Steve Roth, Kathy VanCamp, John J. Nigro, John Lamberti, Shaun Setty, Joanne Starr, Ahmad Reza Ellini, Gary Raff, and Stephanie Marie Falwell
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Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,030204 cardiovascular system & hematology ,Fontan Procedure ,Univentricular Heart ,Fontan procedure ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,In patient ,030212 general & internal medicine ,Socioeconomic status ,business.industry ,Racial Groups ,Univentricular heart ,medicine.anatomical_structure ,Socioeconomic Factors ,Ventricle ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
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7. Association between Z-score for birth weight and postoperative outcomes in neonates and infants with congenital heart disease
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V.M. Reddy, Marshall L. Jacobs, Martina A. Steurer, John M. Costello, Anita J. Moon-Grady, Sara K. Pasquali, Robert H. Habib, Laura L. Jelliffe-Pawlowski, Roberta L. Keller, Shabnam Peyvandi, Sarah Tabbutt, Satish Rajagopal, and Kevin D. Hill
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Male ,postoperative outcomes ,Heart disease ,Respiratory System ,Intrauterine growth restriction ,Reproductive health and childbirth ,Cardiorespiratory Medicine and Haematology ,030204 cardiovascular system & hematology ,Cardiovascular ,Low Birth Weight and Health of the Newborn ,Logistic regression ,Z-score for birth weight ,fetal growth restriction ,Congenital ,Postoperative Complications ,0302 clinical medicine ,Reference Values ,Infant Mortality ,Birth Weight ,Heart Defects ,Pediatric ,Fetal Growth Retardation ,Obstetrics ,Gestational age ,congenital heart disease ,Cardiac surgery ,Heart Disease ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,6.4 Surgery ,Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Birth weight ,Clinical Sciences ,7.3 Management and decision making ,03 medical and health sciences ,Preterm ,Clinical Research ,medicine ,Humans ,Retrospective Studies ,business.industry ,Infant, Newborn ,Infant ,Odds ratio ,Perinatal Period - Conditions Originating in Perinatal Period ,Newborn ,medicine.disease ,Confidence interval ,030228 respiratory system ,Congenital Structural Anomalies ,Surgery ,business - Abstract
Objective We hypothesized that infants with fetal growth restrictions have increased mortality and morbidity after congenital heart disease surgery. Methods The study included patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2016) who underwent cardiac surgery at a corrected gestational age of ≤44 weeks. Patients were classified as severely (birth weight Z-score −4 to −2), moderately (Z-score −2 to −1), and mildly growth restricted (Z-score −1.0 to −0.5) and compared with a reference population (Z-score 0-0.5). Multivariable logistic regression clustering on center was used to evaluate the association of birth weight Z-score with operative mortality and postoperative complications and its interaction with gestational age was assessed. Results In 25,244 patients, operative mortality was 8.6% and major complications occurred in 19.4%. Compared with the reference group, the adjusted odds ratio (AOR) of mortality was increased in infants with severe (AOR, 2.4; 95% confidence interval [CI], 2.0-3.0), moderate (AOR, 1.7; 95% CI, 1.4-2.0), and mild growth restriction (AOR, 1.4; 95% CI, 1.2-1.6). The AOR for major postoperative complications was increased for severe (AOR, 1.4; 95% CI, 1.2-1.7) and moderate growth restriction (AOR, 1.2; 95% CI, 1.1-1.4). There was significant interaction between birth weight Z-score and gestational age (P = .007). Conclusions Even birth weight Z-scores slightly below average are independent risk factors for mortality and morbidity in infants who undergo cardiac surgery. The strongest association between poor fetal growth and operative mortality exists in early-term infants. These novel findings might account for some of the previously unexplained variation in cardiac surgical outcomes.
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- 2021
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8. THE IMPACT OF SOCIOECONOMIC STATUS ON NEURODEVELOPMENTAL OUTCOMES IN CONGENITAL HEART DISEASE
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Shabnam Peyvandi, Patrick S. McQuillen, Whitnee Hogan, and Yensy Zetino
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Pediatrics ,medicine.medical_specialty ,Heart disease ,business.industry ,Long term outcomes ,Neonatal brain ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Socioeconomic status - Abstract
Socioeconomic status (SES) is associated with long term outcomes in congenital heart disease (CHD). In other high-risk populations, like prematurity, lower SES has been associated with both early (e.g. neonatal brain injury) and later neurodevelopmental (ND) outcomes. Since this has not been
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- 2020
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9. Commentary: Is the brain spared when the heart is broken?
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Shabnam Peyvandi and Patrick S. McQuillen
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Sheep ,business.industry ,MEDLINE ,Brain ,Heart ,Hypoxia (medical) ,Article ,Internal medicine ,Cardiology ,Animals ,Medicine ,Surgery ,medicine.symptom ,Hypoxia ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVE: We tested the hypothesis that chronic fetal hypoxia, at a severity present in many types of congenital heart disease, would lead to abnormal neurodevelopment. METHODS: Eight mid-gestation fetal sheep were cannulated onto a pumpless extracorporeal oxygenator via the umbilical vessels and supported in a fluid-filled environment for 22 ± 2 days under normoxic or hypoxic conditions. Total parenteral nutrition was provided. Control fetuses (n = 7) were harvested at gestational age 133 ± 4 days. At necropsy, brains were fixed for histopathology. Neurons were quantified in white matter tracts, and the thickness of the external granular layer of the cerebellum was measured to assess neuronal migration. Capillary density and myelination were quantified in white matter. Data were analyzed with unpaired Student t tests or 1-way analysis of variance, as appropriate. RESULTS: Oxygen delivery was reduced in hypoxic fetuses (15.6 ± 1.8 mL/kg/min vs 24.3 ± 2.3 mL/kg/min, P
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- 2019
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10. The many faces of hydrops
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Jody A. Farrell, Tippi C. MacKenzie, Shabnam Peyvandi, Lily S. Cheng, Anita J. Moon-Grady, Roberta L. Keller, Shinjiro Hirose, Shannon Fleck, Juan M. Gonzalez, S. Christopher Derderian, and Cerine Jeanty
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medicine.medical_specialty ,Hydrops Fetalis ,Gestational Age ,Reproductive health and childbirth ,Disease ,Cardiovascular ,Pediatrics ,Article ,Ultrasonography, Prenatal ,Paediatrics and Reproductive Medicine ,Pregnancy ,Hydrops fetalis ,Fetal hydrops ,medicine ,Humans ,Prenatal ,Ultrasonography ,Retrospective Studies ,Cardiovascular profile score ,Pediatric ,Fetal Therapies ,Fetus ,Fetal echocardiography ,medicine.diagnostic_test ,Obstetrics ,business.industry ,fungi ,food and beverages ,Gestational age ,Hydrops ,Retrospective cohort study ,General Medicine ,Prognosis ,medicine.disease ,Fetal ultrasonography ,Brain Disorders ,Heart Disease ,Good Health and Well Being ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Female ,Surgery ,business - Abstract
PurposeFetal hydrops arises from multiple disease processes and can portend a grim prognosis. We reviewed our experience with hydropic fetuses to understand relevant antenatal anatomic and physiologic predictors of survival.MethodsWe reviewed fetal ultrasounds and echocardiograms of hydropic fetuses evaluated from 1996 to 2013.ResultsOverall neonatal survival in 167 fetuses was 44% (range, 0-75%) and was influenced by the underlying disease process. The anatomic distribution of fluid varied and was not significantly different between survivors and nonsurvivors. Univariate analysis indicated that resolution of hydrops and delivery at a later gestational age were predictive of survival (OR: 5.7 (95% CI: 2.5-13.2) and OR: 1.3 (95% CI: 1.1-1.4), respectively). Fetal intervention also improved survival in some diseases. Echocardiograms were reviewed to group fetuses with similar cardiac physiology and defined categories with high or low/normal cardiothoracic ratio (CTR). Among patients with a high CTR, the cardiovascular profile score was predictive of survival (p=0.009).ConclusionSurvival in hydrops depends on the underlying disease, available fetal therapies to resolve hydrops, and the gestational age of delivery and not on the specific anatomic manifestations of hydrops. In hydropic fetuses with high CTRs, the cardiovascular profile score may be a useful prognostic indicator.
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- 2015
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11. 907: Multi-institutional practice patterns in fetal CHD following a standardized clinical assessment and management plan
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Anita J. Moon-Grady, Jennifer Duffy, Charlotte L. Conturie, Nina M. Boe, Gary Satou, Sherzana Sunderji, Kerry Holliman, Shabnam Peyvandi, Yalda Afshar, Whitnee Hogan, and Aisling Murphy
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medicine.medical_specialty ,Practice patterns ,business.industry ,Family medicine ,Obstetrics and Gynecology ,Medicine ,Plan (drawing) ,business - Published
- 2020
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12. IDENTIFYING SOCIOECONOMIC AND GEOGRAPHIC BARRIERS TO PRENATAL DETECTION OF HYPOPLASTIC LEFT HEART SYNDROME AND TRANSPOSITION OF THE GREAT ARTERIES
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Caroline Lee, Lisa Howley, Varsha Thakur, Shabnam Peyvandi, Grace Freire, Nelangi Pinto, Bettina F. Cuneo, Aarti Bhat, Anita Krishnan, Nazia Husain, Catherine Ikemba, Lisa Hornberger, Kenan W.D. Stern, Keila N. Lopez, Shelby Kutty, Joanne Chiu, Carol A. Wittlieb-Weber, Marni Jacobs, Mary T. Donofrio, Erik C. Michelfelder, Ann Kavanaugh-McHugh, Carolyn L. Taylor, Anjali Chelliah, Rachel Schwartz, and Shaine A. Morris
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medicine.medical_specialty ,Socioeconomic position ,business.industry ,Public health insurance ,Obstetrics ,Ethnic group ,medicine.disease ,Hypoplastic left heart syndrome ,Transposition (music) ,Great arteries ,mental disorders ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Socioeconomic status - Abstract
Prenatal detection (PND) has benefits for hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA), but socioeconomic and geographic barriers are unknown. We evaluated the association between socioeconomic position, public insurance, race/ethnic group, and distance from
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- 2019
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13. THE IMPACT OF PERIOPERATIVE BRAIN INJURY AND DEVELOPMENT ON FEEDING TUBE DEPENDENCY IN INTER-STAGE SINGLE VENTRICLE PATIENTS
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Duan Xu, Sarah Tabbutt, Shabnam Peyvandi, Anyir Hsieh, and Patrick S. McQuillen
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medicine.medical_specialty ,medicine.anatomical_structure ,Ventricle ,business.industry ,Internal medicine ,medicine ,Cardiology ,Perioperative ,Stage (cooking) ,Cardiology and Cardiovascular Medicine ,business ,Feeding tube ,Dependency (project management) - Published
- 2019
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14. THE EFFECT OF BIRTH WEIGHT ON MORTALITY IN INFANTS WITH CRITICAL CONGENITAL HEART DISEASE
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Satish Rajagopal, Molly McCarthy, Mary E. Norton, Edmund C. Burke, Laura L. Jelliffe-Pawlowski, Shabnam Peyvandi, Sky K. Feuer, Scott P. Oltman, Rebecca J. Baer, Randi A. Paynter, Martina A. Steurer, Larry Rand, Kelli Ryckman, Anita Moon Grady, Christina D. Chambers, and Liang Liang
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medicine.medical_specialty ,Obstetrics ,business.industry ,Birth weight ,010501 environmental sciences ,medicine.disease ,01 natural sciences ,female genital diseases and pregnancy complications ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Fetal growth ,Small for gestational age ,030212 general & internal medicine ,Critical congenital heart disease ,Cardiology and Cardiovascular Medicine ,business ,reproductive and urinary physiology ,0105 earth and related environmental sciences - Abstract
Infants with critical congenital heart disease (CCHD) are more likely to have fetal growth restriction and subsequently be small for gestational age (SGA) at birth. While SGA infants with CCHD are known to have poor postnatal outcomes, birth weight (BW) has only been evaluated as a dichotomous
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- 2018
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15. FETAL CARDIOVASCULAR PHYSIOLOGY AND POSTNATAL BRAIN DEVELOPMENT AND INJURY IN CRITICAL CONGENITAL HEART DISEASE
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Duan Xu, Whitnee Hogan, Patrick S. McQuillen, Shabnam Peyvandi, and Anita J. Moon-Grady
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medicine.medical_specialty ,Fetus ,business.industry ,Pulsatility index ,nervous system diseases ,Cardiovascular physiology ,Internal medicine ,medicine.artery ,Middle cerebral artery ,cardiovascular system ,Cardiology ,Medicine ,cardiovascular diseases ,Critical congenital heart disease ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology ,Postnatal brain - Abstract
Fetal cerebrovascular resistance, as measured clinically by the middle cerebral artery pulsatility index (MCA-PI), has been shown to be associated with neurodevelopmental outcomes in critical congenital heart disease (CCHD). We investigated the relationship between fetal MCA-PI and postnatal, pre
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- 2018
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16. FETAL SVT AND POSTNATAL OUTCOMES: A COLLABORATIVE MULTI-INSTITUTIONAL STUDY
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Stacy A.S. Killen, Susan P. Etheridge, Shabnam Peyvandi, Corey Stiver, Michael D. Puchalski, and Kevin Hinkle
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Pregnancy ,Fetus ,medicine.medical_specialty ,Obstetrics ,business.industry ,medicine.disease ,In utero ,cardiovascular system ,medicine ,Gestation ,cardiovascular diseases ,Supraventricular tachycardia ,Complication ,business ,Cardiology and Cardiovascular Medicine - Abstract
Supraventricular tachycardia (SVT) is the most common arrhythmia in the fetus and can be difficult to manage in utero. Recognizing that preterm birth before 37 weeks gestation is the most common catastrophic complication of pregnancy, we sought to better understand the pre and postnatal clinical
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- 2015
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17. Towards standardization: Analysis of specific modifiable perioperative process measures among neonates undergoing arterial switch operation for transposition of the great arteries with intact ventricular septum – A mini-pilot for the California Congenital Cardiac Consortium
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Orestes Mavrothalassitis, Daud Lodin, Naveen Swami, Anita Moon-Grady, Sarah Tabbutt, Sherzana Sunderji, Shabnam Peyvandi, Tara Karamlou, John Lamberti, Raghav Murthy, Ram Subramanyan, Gary Raff, Amy Rahm, Brian Reemsten, Myriam E. Almeida-Jones, Joanne Pajer Starr, Richard Gates, and Shaun Setty
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Transposition (music) ,medicine.medical_specialty ,Great arteries ,business.industry ,Pediatrics, Perinatology and Child Health ,medicine ,Perioperative ,Cardiology and Cardiovascular Medicine ,business ,Process Measures ,Surgery - Published
- 2016
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18. Revisiting the utility of technical performance scores following tetralogy of Fallot repair
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Kim Haberer, Anita J. Moon-Grady, Tara Karamlou, Ruben G.W. Quek, Daud Lodin, Sherzana Sunderji, Shabnam Peyvandi, and Orestes Mavrothalassitis
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,law ,Cardiopulmonary bypass ,Humans ,Medicine ,Major complication ,Cardiac Surgical Procedures ,Hospital Costs ,education ,Quality Indicators, Health Care ,Retrospective Studies ,Tetralogy of Fallot ,education.field_of_study ,business.industry ,Medical record ,Infant ,Length of Stay ,medicine.disease ,Surgery ,Technical performance ,Treatment Outcome ,030228 respiratory system ,Echocardiography ,Female ,Clinical Competence ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Although an important quality metric, current technical performance scores may not be generalizable and may omit operative factors that influence outcomes. We examined factors not included in current technical performance scores that may contribute to increased postoperative length of stay, major complications, and cost after primary repair of tetralogy of Fallot.This is a retrospective single site study of patients younger than age 2 years with tetralogy of Fallot undergoing complete repair between 2007 and 2015. Medical record data and discharge echocardiograms were reviewed to ascertain component and composite technical performance scores. Primary outcomes included postoperative length of stay, major complications, and total hospital costs. Multivariable logistic and linear regression identified determinants of each outcome.Patient population (n = 115) had a median postoperative length of stay of 8 days (interquartile range, 6-10 days), and a median total cost of $71,147. Major complications occurred in 33 patients (29%) with 1 death. Technical performance scores assigned were optimum in 28 patients (25%), adequate in 59 patients (52%), and inadequate in 26 patients (23%). Neither technical performance score components nor composite scores were associated with increased postoperative length of stay. Optimum or adequate repairs versus inadequate had equal risk of a complication (P = .79), and equivalent mean total cost ($100,000 vs $187,000; P = .25). Longer cardiopulmonary bypass time per 1-minute increase (P .01) was associated with longer postoperative length of stay and reintervention (P = .02). The need to return to bypass also increased total cost (P .01).Current tetralogy of Fallot technical performance scores were not associated with selected outcomes in our postoperative population. Although returning to bypass and bypass length are not included as components in the current score, these are important factors influencing complications and resource use in our population. Revisions anticipated from a prospective trial should consider including these variables.
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- 2017
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19. Epidemiology of Live Born Infants with Nonimmune Hydrops Fetalis—Insights from a Population-Based Dataset
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Laura L. Jelliffe-Pawlowski, Tippi C. MacKenzie, Ben Li, Anita J. Moon-Grady, Shabnam Peyvandi, Martina A. Steurer, Mary E. Norton, and Rebecca J. Baer
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Male ,Polyhydramnios ,medicine.medical_specialty ,Pediatrics ,Databases, Factual ,Hydrops Fetalis ,Population ,Gestational Age ,California ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,030225 pediatrics ,Hydrops fetalis ,Infant Mortality ,Epidemiology ,medicine ,Humans ,Critical congenital heart disease ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Incidence ,Incidence (epidemiology) ,Hazard ratio ,Infant, Newborn ,Infant ,Gestational age ,medicine.disease ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Objective To evaluate the incidence, etiology, and 1-year mortality of nonimmune hydrops fetalis (NIHF) and to identify risk factors for mortality in a contemporary population-based dataset. Study design The California Office of Statewide Health Planning and Development maintains a database linking maternal and infant hospital discharge, readmissions, and birth and death certificate date from 1 year before to 1 year after birth. We searched the database (2005-2012) for infants with NIHF (identified by the International Classification of Diseases, 9th Revision, Clinical Modification code). Hazard models were used to identify risk factors for mortality in infants with NIHF; results are presented as hazard ratios (HRs, 95% CI). Results The incidence of NIHF was 2.5 out of 10 000 among live born infants. Neonatal mortality was 35.1% (364 out of 1037) and overall mortality was 43.2% (448 out of 1037) at 1 year of age. Gestational age (GA) was predictive of mortality with a HR of 2.4 (95% CI 1.9-3.2) for preterm compared with term infants. The GA-adjusted HR for mortality was 1.3 (95% CI 1.1-1.6) for polyhydramnios and 1.5 (95% CI 1.2-2.0) for large for gestational age infants compared with appropriate for GA infants. Aneuploid infants with critical congenital heart disease had an adjusted HR of 2.3 (95% CI 1.5-3.6) compared with euploid infants without a structural birth defect. Conclusions In this large, population-based study, prematurity, polyhydramnios, and large for gestational age were predictors of increased mortality. Mortality is highly variable among euploid and aneuploid infants with and without structural birth defects and critical congenital heart disease.
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- 2017
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20. TIMING AND MODE OF DELIVERY IN PRENATALLY DIAGNOSED CRITICAL CONGENITAL HEART DISEASE: AN ANALYSIS OF PRACTICES WITHIN THE UNIVERSITY OF CALIFORNIA FETAL CONSORTIUM
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Anita J. Moon-Grady, Mark S. Sklansky, Shabnam Peyvandi, Tracy Anton, Tina A. Nguyen, Maryam Tarsa, Nina M. Boe, and Laila Rhee-Morris
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Fetus ,Pediatrics ,medicine.medical_specialty ,Mode of delivery ,business.industry ,medicine ,Critical congenital heart disease ,business ,Cardiology and Cardiovascular Medicine - Published
- 2014
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21. Hybrid versus Norwood: 'Fifty shades of grey'
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Tara Karamlou and Shabnam Peyvandi
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Palliative care ,business.industry ,General surgery ,medicine.medical_treatment ,Medicine ,Surgery ,Norwood procedure ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Hypoplastic left heart syndrome - Published
- 2015
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22. 615: Non-immune hydrops, aneuploidy and anomalies: contemporary survival statistics from a population-based cohort
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Mary E. Norton, Shabnam Peyvandi, Anita J. Moon-Grady, Tippi C. MacKenzie, Ben Li, Rebecca J. Baer, and Laura L. Jelliffe-Pawlowski
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Genetics ,Oncology ,Population based cohort ,medicine.medical_specialty ,Immune system ,business.industry ,Internal medicine ,medicine ,Obstetrics and Gynecology ,Aneuploidy ,medicine.disease ,business - Published
- 2015
- Full Text
- View/download PDF
23. RISK OF CONGENITAL HEART DISEASE IN RELATIVES OF PROBANDS WITH CONOTRUNCAL CARDIAC DEFECTS: AN EVALUATION OF 1622 FAMILIES
- Author
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Shabnam Peyvandi, Elizabeth Goldmuntz, Eitan M. Ingall, Jennifer Garbarini, Stacy Woyciechowski, and Laura E. Mitchell
- Subjects
Proband ,medicine.medical_specialty ,Heart disease ,business.industry ,Internal medicine ,medicine ,Cardiology ,Conotruncal cardiac defects ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2013
- Full Text
- View/download PDF
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