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324 results on '"Punn, Rajesh"'

10. Left Ventricular Strain, Arch Angulation, and Velocity-Time Integral Ratio Improve Performance of a Clinical Pathway for Fetal Diagnosis of Neonatal Coarctation of the Aorta.

Author

Phillips, Aaron Anthony, Punn, Rajesh, Algaze, Claudia, Blumenfeld, Yair J., Chock, Valerie Y., Kwiatkowski, David M., Quirin, Amy, Tacy, Theresa A., Thorson, Kelly, and Maskatia, Shiraz A.

Subjects
*THORACIC aorta, *FETAL diseases, *FETAL echocardiography, *CONGENITAL heart disease, *FETAL heart, *AORTIC coarctation
Abstract

Introduction: Neonatal presentation of coarctation of the aorta (CoA) is a potentially life-threatening condition that is difficult to diagnose in fetal life. We therefore sought to validate and compare novel metrics that may add diagnostic value for fetal CoA, including the diastolic to systolic aortic isthmus VTI ratio (VTId:VTIs), ascending aorta to descending aorta angle (AAo-DAo), transverse aorta to descending aorta angle (TAo-DAo), and LV longitudinal strain (LVS), then to evaluate whether these novel metrics improve specificity to identify fetuses at the highest risk for postnatal CoA without compromising sensitivity. Methods: Retrospective cohort study of fetuses followed a prospective clinical pathway and previously classified as mild, moderate, or high-risk for CoA based on standard fetal echo metrics. Novel metrics were retrospectively measured in a blinded manner. Results: Among fetuses with prenatal concern for CoA, VTId:VTIs, AAo-DAo angle, TAo-DAo angle, and LVS were significantly different between surgical and non-surgical cases (p < 0.01 for all variables). In the subgroup of moderate- and high-risk fetuses, the standard high-risk criteria (flow reversal at the foramen ovale or aortic arch) did not discriminate effectively between surgical and non-surgical cases. VTId:VTIs, AAo-Dao angle, Tao-DAo angle, and LVS all demonstrated greater discrimination than standard high-risk criteria, with specificity of 100% and PPV (positive predictive value) of 78–100%. Conclusions: The incorporation of novel metrics added diagnostic value to our clinical pathway for fetal CoA with higher specificity than the previous high-risk criteria. The incorporation of these metrics into the evaluation of fetuses at moderate- or high-risk for surgical CoA may improve prenatal counseling, allow for more consistent surgical planning, and ultimately optimize hospital resource allocation. Plain Language Summary: Coarctation of the aorta is challenging to diagnosis in fetal life. New fetal echocardiographic techniques have been developed to help predict the development of surgical coarctation of the aorta after birth but have not been externally validated or compared to each other. We sought to validate these metrics and compare their utility in predicting surgical coarctation of the aorta in a retrospective cohort of previously identified fetuses at risk for coarctation of the aorta. We found that among fetuses with prenatal concern for coarctation of the aorta, novel metrics were significantly different between surgical and non-surgical cases. Our results indicate that the incorporation of novel metrics can add diagnostic value for fetal coarctation of the aorta with higher specificity than previous high-risk criteria, without compromising the sensitivity of the low-risk group. The ability to identify fetuses at the highest risk for surgical coarctation may improve prenatal counseling, allow for more consistent surgical planning, and ultimately optimize hospital resource allocation. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Predictors of bronchopulmonary dysplasia or death in premature infants with a patent ductus arteriosus

Author

Chock, Valerie Y, Punn, Rajesh, Oza, Anushri, Benitz, William E, Van Meurs, Krisa P, Whittemore, Alice S, Behzadian, Fariborz, and Silverman, Norman H

Subjects
Infant Mortality, Prevention, Neonatal Respiratory Distress, Clinical Research, Perinatal Period - Conditions Originating in Perinatal Period, Lung, Pediatric, Preterm, Low Birth Weight and Health of the Newborn, Cardiovascular, Reproductive health and childbirth, Good Health and Well Being, Bronchopulmonary Dysplasia, Ductus Arteriosus, Patent, Humans, Infant, Newborn, Infant, Premature, Paediatrics and Reproductive Medicine, Public Health and Health Services, Pediatrics
Abstract

BackgroundPreterm infants with a patent ductus arteriosus (PDA) are at risk for death or development of bronchopulmonary dysplasia (BPD). However, PDA treatment remains controversial. We investigated if PDA treatment and other clinical or echocardiographic (ECHO) factors were associated with the development of death or BPD.MethodsWe retrospectively studied clinical and ECHO characteristics of preterm infants with birth weight

Published
2014

19. Hemodynamic and Echocardiographic Predictors of Mortality in Pediatric Patients on Venoarterial Extracorporeal Membrane Oxygenation: A Multicenter Investigation

Author

Punn, Rajesh, primary, Falkensammer, Christine B., additional, Blinder, Joshua J., additional, Fifer, Carlen G., additional, Thorsson, Thor, additional, Perens, Gregory, additional, Federman, Myke, additional, Gupta, Punkaj, additional, Best, Thomas, additional, Arya, Bhawna, additional, Chan, Titus, additional, Sherman-Levine, Sara, additional, Smith, Shea N., additional, Axelrod, David M., additional, Roth, Stephen J., additional, and Tacy, Theresa A., additional

Published
2023
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