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Rudiger Lange - One of the best experts on this subject based on the ideXlab platform.
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atrioventricular valve regurgitation in patients undergoing total Cavopulmonary Connection impact of valve morphology and underlying mechanisms on survival and reintervention
The Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Julie Cleuziou, Jelena Pabst Von Ohain, Elisabeth Beran, Melchior Burri, Martina Strbad, Alfred Hager, Jurgen Horer, Christian Schreiber, Rudiger LangeAbstract:Abstract Objective The study objective was to determine the mechanisms of atrioventricular valve regurgitation in single-ventricle physiology and their influence on outcomes after total Cavopulmonary Connection. Methods Among 460 patients who underwent a total Cavopulmonary Connection, 101 (22%) had atrioventricular valve surgery before or coincident with total Cavopulmonary Connection. Results Atrioventricular valve morphology showed 2 separated in 33 patients, mitral in 11 patients, tricuspid in 41 patients, and common in 16 patients. Patients with a tricuspid and a common atrioventricular valve underwent atrioventricular valve surgery frequently, 27% and 36%, respectively. Atrioventricular valve regurgitation was due to 1 or more of the following mechanisms: dysplastic leaflet (62), prolapse (53), annular dilation (27), cleft (22), and chordal anomaly (14). Structural anomalies were observed in 89 patients (88%). The procedure was atrioventricular valve repair in 81 patients, atrioventricular valve closure in 16 patients, and atrioventricular valve replacement in 4 patients. Among 81 patients who underwent initial repair, repeat repair was required in 20 patients, atrioventricular valve replacement was required in 7 patients, and atrioventricular valve closure was required in 3 patients. Among patients undergoing atrioventricular valve surgery, overall survival after total Cavopulmonary Connection (88% vs 95% at 15 years, P = .01), freedom from atrioventricular valve reoperation after total Cavopulmonary Connection (75% vs 99% at 15 years, P P Conclusions Atrioventricular valve regurgitation in univentricular heart is more frequently associated with a tricuspid or a common atrioventricular valve, and structural anomalies are the primary cause. Significant atrioventricular valve regurgitation requiring surgery influences survival after total Cavopulmonary Connection, especially when atrioventricular valve replacement was needed. Surgical management based on mechanisms of regurgitation is mandatory.
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bidirectional Cavopulmonary Connection without additional pulmonary blood flow as an ideal staging for functional univentricular hearts
European Journal of Cardio-Thoracic Surgery, 2008Co-Authors: Christian Schreiber, Julie Cleuziou, Jurgen Horer, Andreas Eicken, Juliane Karen Cornelsen, Rudiger LangeAbstract:Objective: Our institutional policy differs from others substantially, as we never leave any additional blood flow at the time of performing bidirectional Cavopulmonary Connection (BCPC). The aim was to evaluate the influence of this strategy on hemodynamics and pulmonary artery development.Methods:Between 2001 and 2006 a total of 124 patients had completionto a total Cavopulmonary Connection (TCPC).Review of 84 angiograms before BCPC and TCPC allowed for analysis of hemodynamic findings and measurement of the pulmonary arteries (PA). Results: Mean age at BCPC was 12.6 15.3 months. Mean age at time of TCPC was 31.3 18.7 months, with an interval of 18.6 11.8 months between BCPC and completion to extracardiac TCPC. There was no postoperative mortality after BCPC, one patient died after TCPC (1.2%). The mean oxygen saturation increased after BCPC from 74.4% to 79.6% (p < 0.01). The mean PA pressures decreased after BCPC from 15.1 to 13.5 mmHg (n.s.). The mean left atrial pressure decreased from 5.8 to 4.9 mmHg prior to TCPC (p = 0.06). The pulmonary/systemic blood flow ratio was 1.4 prior to BCPC and decreased to 0.67 prior to TCPC (p = 0.04). The pulmonary/systemic resistance ratio decreased also from 0.19 to 0.07 prior to TCPC (p < 0.01). The right PA, as well as the right lower lobe PA, showed a significant increase in diameter after BCPC (p < 0.01). The left PA also increased in size, although this was not statisticallysignificant.Conclusions:After BCPCwithout additional bloodflow, hemodynamicfindings are favorable for completion of TCPC. Our findings support our institutional policy not only for an early staging to a BCPC, but likewise a swift completion towards a TCPC.
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nonfenestrated extracardiac total Cavopulmonary Connection in 132 consecutive patients
The Annals of Thoracic Surgery, 2007Co-Authors: Christian Schreiber, Julie Cleuziou, Jurgen Horer, Manfred Vogt, Zsolt Prodan, Rudiger LangeAbstract:Background The study was conducted to assess the need for fenestration for completion of a total Cavopulmonary Connection (TCPC) with the most recent modification of an extracardiac conduit. Methods The extracardiac approach was introduced to our institution in January 1999. Between June 2000 and June 2006, 132 consecutive patients were treated without a fenestration. At the time of TCPC, the median age was 31 months (range, 16 251), with 93 patients (70%) being younger than 48 months. Median patient weight was 12.5 kg (range, 9 to 66 kg). A previous partial Cavopulmonary Connection (PCPC) was accomplished in 117 patients (88.6%), without additional pulmonary blood flow. Results Thirty-day-mortality was 1.5%. Median time to extubation was 14 hours (range, 3 hours to 126 days). Initial pulmonary artery pressure value was 16.5 ± 2.2 mm Hg, and 13.1 ± 1.8 after extubation. Median drainage requirement was 4 days (range, 1 to 45), and median duration of hospitalization was 20 days (range, 5 to 128). Thirty-one (24%) required repeat drainage insertion. No subsequent fenestration was performed, and at hospital discharge no significant repeat effusions were observed. Multiple covariate logistic regression revealed longer time interval from PCPC to extracardiac TCPC ( p = 0.006) as a significant predictor of pleural drainage lasting longer than 4 days, and older age at the time of extracardiac TCPC ( p = 0.040) as a risk factor for hospitalization more than 20 days. Higher pulmonary artery pressure 3 hours postoperatively was a significant predictor for both outcome variables in the multivariate model ( p = 0.013, p = 0.001). Conclusions In general, an extracardiac TCPC can be performed without fenestration. Early staging of patients with functional single ventricle physiology may be one of the keys for these findings.
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Surgical Management of an Extracardiac Total Cavopulmonary Connection in Heterotaxy Syndrome with Isolated Hepatic Drainage
Herz, 2005Co-Authors: Christian Schreiber, Jurgen Horer, Martin Kostolny, Klaus Holper, Andreas Eicken, Rudiger LangeAbstract:The extracardiac modification for completion of a Cavopulmonary Connection has added a further option for direction of inferior vena cava and/or hepatic venous drainage to the pulmonary arteries. The authors describe a technique of isolating a hepatic vein and connecting it to the inferior caval vein in a side-by-side fashion prior to anastomosing it to the tubegraft in a patient with heterotaxy syndrome.
Toshihide Nakano - One of the best experts on this subject based on the ideXlab platform.
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results of extracardiac conduit total Cavopulmonary Connection in 500 patients
European Journal of Cardio-Thoracic Surgery, 2015Co-Authors: Toshihide Nakano, Hideaki Kado, Naoki Fusazaki, Hideki Tatewaki, Kazuhiro Hinokiyama, Hiroya Ushinohama, Koichi Sagawa, Makoto Nakamura, Shiro IshikawaAbstract:OBJECTIVES: This single-institution study aimed to evaluate the early to mid-term outcomes of extracardiac conduit total Cavopulmonary Connection (EC-TCPC).
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excellent midterm outcome of extracardiac conduit total Cavopulmonary Connection results of 126 cases
The Annals of Thoracic Surgery, 2007Co-Authors: Toshihide Nakano, Hideaki Kado, Kazuhiro Hinokiyama, Tsuyoshi Tachibana, Akira Shiose, Masaki Kajimoto, Yusuke AndoAbstract:Background Extracardiac conduit total Cavopulmonary Connection has shown good early results; however, its long-term outcome has yet to be reported. Methods Of 282 patients who underwent extracardiac conduit total Cavopulmonary Connection since 1994, 126 patients who have been followed up for more than 5 years were included in this retrospective study. Actuarial survival rate, incidence of late complications, hemodynamic variables, and results of exercise tolerance test were reviewed. Results Follow-up time was 96.4 ± 23.0 months. There was 1 operative death and 6 late deaths. Actuarial survival rate was 95.2% and 93.6% at 5 and 10 years, respectively. Seven patients had late complications including new-onset supraventricular arrhythmia in 3, protein-losing enteropathy in 2, thromboembolism in 1, and bleeding complication in 1. Seven patients underwent reoperation not related to the conduit. Freedom from Fontan-related events was 88.8% at 5 years and 84.3% at 10 years. Late cardiac catheterization in 119 survivors showed central venous pressure of 9.9 ± 2.9 mm Hg, cardiac index of 3.6 ± 0.8 L · min -1 · m -2 and arterial oxygen saturation of 94.5 ± 2.3%. No patient showed conduit stenosis. Plasma concentration of atrial and brain natriuretic peptide (pg/mL) were 28.9 ± 20.0 and 25.8 ± 44.5. Exercise test performed in 101 patients showed endurance time of 75.7 ± 12.9% of normal value, peak heart rate of 92.3 ± 14.4% of normal, and peak oxygen consumption of 90.0 ± 20.0% of normal. The latest echocardiogram showed ejection fraction of 60.4 ± 11.7%. Three patients had pacemaker rhythm, 1 had junctional rhythm, and 115 patients had sinus rhythm. Conclusions Midterm outcome of extracardiac conduit total Cavopulmonary Connection was satisfactory with low incidence of late mortality and morbidity, and excellent hemodynamic state.
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midterm surgical results of total Cavopulmonary Connection clinical advantages of the extracardiac conduit method
The Journal of Thoracic and Cardiovascular Surgery, 2004Co-Authors: Toshihide Nakano, Hideaki Kado, Yuichi Shiokawa, Naoki Fusazaki, Shiro Ishikawa, Hiroya Ushinohama, Koichi Sagawa, Yosuke Nishimura, Yoshihisa Tanoue, Tsuneyuki NakamuraAbstract:Abstract Objective We evaluated the midterm surgical outcomes of intra-atrial lateral tunnel and extracardiac conduit total Cavopulmonary Connection to clarify the clinical superiority. Methods Patients (n = 167) underwent total Cavopulmonary Connection (88 with lateral tunnel and 79 with extracardiac conduit) from November 1991 to March 1999. Survival, incidence of reoperation and late complications, exercise tolerance, hemodynamic variables, and plasma concentration of natriuretic peptide type A were compared. In the lateral tunnel group, time-related change in lateral tunnel size was investigated for its relationship to postoperative arrhythmias. Results The 8-year survival was 93.2% in the lateral tunnel group and 94.9% in the extracardiac conduit group. Seven reoperations were performed in the lateral tunnel group but none in the extracardiac conduit group. Supraventricular arrhythmias developed in 14 patients (15.9%) in the lateral tunnel group and in 4 patients (5.1%) in the extracardiac conduit group ( P = .003). Freedom from cardiac-related events was 72.5% in the lateral tunnel group and 89.8% in the extracardiac conduit group at 8 years ( P = .0098). Hemodynamic variables and exercise tolerance were similar in both groups but plasma natriuretic peptide type A concentration, a parameter of atrial wall tension, was higher in the lateral tunnel group. In the lateral tunnel group, intra-atrial tunnel size increased by 19.4% during the 44.2-month interval and the percent increase in tunnel size was an independent predictor of supraventricular arrhythmias. Conclusions The midterm survival, hemodynamic variables, and exercise tolerance were similar and satisfactory in both lateral tunnel and extracardiac conduit groups; however, the incidence of cardiac-related events was significantly less frequent in the extracardiac conduit group. In the lateral tunnel group, careful observation is required to monitor the relationship of the dilating tendency of the intra-atrial tunnel and the development of late complications.
Shiro Ishikawa - One of the best experts on this subject based on the ideXlab platform.
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results of extracardiac conduit total Cavopulmonary Connection in 500 patients
European Journal of Cardio-Thoracic Surgery, 2015Co-Authors: Toshihide Nakano, Hideaki Kado, Naoki Fusazaki, Hideki Tatewaki, Kazuhiro Hinokiyama, Hiroya Ushinohama, Koichi Sagawa, Makoto Nakamura, Shiro IshikawaAbstract:OBJECTIVES: This single-institution study aimed to evaluate the early to mid-term outcomes of extracardiac conduit total Cavopulmonary Connection (EC-TCPC).
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midterm surgical results of total Cavopulmonary Connection clinical advantages of the extracardiac conduit method
The Journal of Thoracic and Cardiovascular Surgery, 2004Co-Authors: Toshihide Nakano, Hideaki Kado, Yuichi Shiokawa, Naoki Fusazaki, Shiro Ishikawa, Hiroya Ushinohama, Koichi Sagawa, Yosuke Nishimura, Yoshihisa Tanoue, Tsuneyuki NakamuraAbstract:Abstract Objective We evaluated the midterm surgical outcomes of intra-atrial lateral tunnel and extracardiac conduit total Cavopulmonary Connection to clarify the clinical superiority. Methods Patients (n = 167) underwent total Cavopulmonary Connection (88 with lateral tunnel and 79 with extracardiac conduit) from November 1991 to March 1999. Survival, incidence of reoperation and late complications, exercise tolerance, hemodynamic variables, and plasma concentration of natriuretic peptide type A were compared. In the lateral tunnel group, time-related change in lateral tunnel size was investigated for its relationship to postoperative arrhythmias. Results The 8-year survival was 93.2% in the lateral tunnel group and 94.9% in the extracardiac conduit group. Seven reoperations were performed in the lateral tunnel group but none in the extracardiac conduit group. Supraventricular arrhythmias developed in 14 patients (15.9%) in the lateral tunnel group and in 4 patients (5.1%) in the extracardiac conduit group ( P = .003). Freedom from cardiac-related events was 72.5% in the lateral tunnel group and 89.8% in the extracardiac conduit group at 8 years ( P = .0098). Hemodynamic variables and exercise tolerance were similar in both groups but plasma natriuretic peptide type A concentration, a parameter of atrial wall tension, was higher in the lateral tunnel group. In the lateral tunnel group, intra-atrial tunnel size increased by 19.4% during the 44.2-month interval and the percent increase in tunnel size was an independent predictor of supraventricular arrhythmias. Conclusions The midterm survival, hemodynamic variables, and exercise tolerance were similar and satisfactory in both lateral tunnel and extracardiac conduit groups; however, the incidence of cardiac-related events was significantly less frequent in the extracardiac conduit group. In the lateral tunnel group, careful observation is required to monitor the relationship of the dilating tendency of the intra-atrial tunnel and the development of late complications.
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total Cavopulmonary Connection with an extracardiac conduit experience with 100 patients
The Annals of Thoracic Surgery, 2002Co-Authors: Shigehiko Tokunaga, Hideaki Kado, Yutaka Imoto, Munetaka Masuda, Yuichi Shiokawa, Kouji Fukae, Naoki Fusazaki, Shiro Ishikawa, Hisataka YasuiAbstract:Abstract Background . In the Fontan procedures total Cavopulmonary Connection with an extracardiac conduit is a concern. The potential benefits of an extracardiac conduit may be the avoidance of postoperative supraventricular arrhythmias over the long-term, hemodynamic benefits due to laminar flow, possibility of completion without anoxic arrest, and applicability to anomalous systemic or pulmonary venous return, or both anomalous systemic and pulmonary venous return. We demonstrate early to midterm results of total Cavopulmonary Connection with an extracardiac conduit. Methods . Between March 1994 and February 2000, a total of 100 patients underwent total Cavopulmonary Connection with an extracardiac conduit. In 27 patients, who underwent a single stage total Cavopulmonary Connection operation, 7 were done without palliation. Seventy-three patients had undergone a bidirectional Glenn shunt before completion of the total Cavopulmonary Connection. We used an expanded polytetrafluoroethylene tube graft as the extracardiac conduit. Results . Cardiopulmonary bypass time was 133.2 ± 55.2 minutes. Myocardial ischemic time was 38.5 ± 23.2 minutes in 40 patients who needed cardioplegic cardiac arrest for intracardiac procedures. Intraoperative fenestration was done in only 1 patient. There were no operative deaths. During follow-up of 37.3 months, there were 5 late deaths. When compared with the patients treated by the lateral tunnel technique in our institute, there was no significant difference in actuarial survival rate, but the event free rate of the extracardiac conduit group was significantly superior to the lateral tunnel group. Conclusions . Total Cavopulmonary Connection with the extracardiac conduit produced good results in short to midterm follow-up.
Hideaki Kado - One of the best experts on this subject based on the ideXlab platform.
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results of extracardiac conduit total Cavopulmonary Connection in 500 patients
European Journal of Cardio-Thoracic Surgery, 2015Co-Authors: Toshihide Nakano, Hideaki Kado, Naoki Fusazaki, Hideki Tatewaki, Kazuhiro Hinokiyama, Hiroya Ushinohama, Koichi Sagawa, Makoto Nakamura, Shiro IshikawaAbstract:OBJECTIVES: This single-institution study aimed to evaluate the early to mid-term outcomes of extracardiac conduit total Cavopulmonary Connection (EC-TCPC).
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excellent midterm outcome of extracardiac conduit total Cavopulmonary Connection results of 126 cases
The Annals of Thoracic Surgery, 2007Co-Authors: Toshihide Nakano, Hideaki Kado, Kazuhiro Hinokiyama, Tsuyoshi Tachibana, Akira Shiose, Masaki Kajimoto, Yusuke AndoAbstract:Background Extracardiac conduit total Cavopulmonary Connection has shown good early results; however, its long-term outcome has yet to be reported. Methods Of 282 patients who underwent extracardiac conduit total Cavopulmonary Connection since 1994, 126 patients who have been followed up for more than 5 years were included in this retrospective study. Actuarial survival rate, incidence of late complications, hemodynamic variables, and results of exercise tolerance test were reviewed. Results Follow-up time was 96.4 ± 23.0 months. There was 1 operative death and 6 late deaths. Actuarial survival rate was 95.2% and 93.6% at 5 and 10 years, respectively. Seven patients had late complications including new-onset supraventricular arrhythmia in 3, protein-losing enteropathy in 2, thromboembolism in 1, and bleeding complication in 1. Seven patients underwent reoperation not related to the conduit. Freedom from Fontan-related events was 88.8% at 5 years and 84.3% at 10 years. Late cardiac catheterization in 119 survivors showed central venous pressure of 9.9 ± 2.9 mm Hg, cardiac index of 3.6 ± 0.8 L · min -1 · m -2 and arterial oxygen saturation of 94.5 ± 2.3%. No patient showed conduit stenosis. Plasma concentration of atrial and brain natriuretic peptide (pg/mL) were 28.9 ± 20.0 and 25.8 ± 44.5. Exercise test performed in 101 patients showed endurance time of 75.7 ± 12.9% of normal value, peak heart rate of 92.3 ± 14.4% of normal, and peak oxygen consumption of 90.0 ± 20.0% of normal. The latest echocardiogram showed ejection fraction of 60.4 ± 11.7%. Three patients had pacemaker rhythm, 1 had junctional rhythm, and 115 patients had sinus rhythm. Conclusions Midterm outcome of extracardiac conduit total Cavopulmonary Connection was satisfactory with low incidence of late mortality and morbidity, and excellent hemodynamic state.
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midterm surgical results of total Cavopulmonary Connection clinical advantages of the extracardiac conduit method
The Journal of Thoracic and Cardiovascular Surgery, 2004Co-Authors: Toshihide Nakano, Hideaki Kado, Yuichi Shiokawa, Naoki Fusazaki, Shiro Ishikawa, Hiroya Ushinohama, Koichi Sagawa, Yosuke Nishimura, Yoshihisa Tanoue, Tsuneyuki NakamuraAbstract:Abstract Objective We evaluated the midterm surgical outcomes of intra-atrial lateral tunnel and extracardiac conduit total Cavopulmonary Connection to clarify the clinical superiority. Methods Patients (n = 167) underwent total Cavopulmonary Connection (88 with lateral tunnel and 79 with extracardiac conduit) from November 1991 to March 1999. Survival, incidence of reoperation and late complications, exercise tolerance, hemodynamic variables, and plasma concentration of natriuretic peptide type A were compared. In the lateral tunnel group, time-related change in lateral tunnel size was investigated for its relationship to postoperative arrhythmias. Results The 8-year survival was 93.2% in the lateral tunnel group and 94.9% in the extracardiac conduit group. Seven reoperations were performed in the lateral tunnel group but none in the extracardiac conduit group. Supraventricular arrhythmias developed in 14 patients (15.9%) in the lateral tunnel group and in 4 patients (5.1%) in the extracardiac conduit group ( P = .003). Freedom from cardiac-related events was 72.5% in the lateral tunnel group and 89.8% in the extracardiac conduit group at 8 years ( P = .0098). Hemodynamic variables and exercise tolerance were similar in both groups but plasma natriuretic peptide type A concentration, a parameter of atrial wall tension, was higher in the lateral tunnel group. In the lateral tunnel group, intra-atrial tunnel size increased by 19.4% during the 44.2-month interval and the percent increase in tunnel size was an independent predictor of supraventricular arrhythmias. Conclusions The midterm survival, hemodynamic variables, and exercise tolerance were similar and satisfactory in both lateral tunnel and extracardiac conduit groups; however, the incidence of cardiac-related events was significantly less frequent in the extracardiac conduit group. In the lateral tunnel group, careful observation is required to monitor the relationship of the dilating tendency of the intra-atrial tunnel and the development of late complications.
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total Cavopulmonary Connection with an extracardiac conduit experience with 100 patients
The Annals of Thoracic Surgery, 2002Co-Authors: Shigehiko Tokunaga, Hideaki Kado, Yutaka Imoto, Munetaka Masuda, Yuichi Shiokawa, Kouji Fukae, Naoki Fusazaki, Shiro Ishikawa, Hisataka YasuiAbstract:Abstract Background . In the Fontan procedures total Cavopulmonary Connection with an extracardiac conduit is a concern. The potential benefits of an extracardiac conduit may be the avoidance of postoperative supraventricular arrhythmias over the long-term, hemodynamic benefits due to laminar flow, possibility of completion without anoxic arrest, and applicability to anomalous systemic or pulmonary venous return, or both anomalous systemic and pulmonary venous return. We demonstrate early to midterm results of total Cavopulmonary Connection with an extracardiac conduit. Methods . Between March 1994 and February 2000, a total of 100 patients underwent total Cavopulmonary Connection with an extracardiac conduit. In 27 patients, who underwent a single stage total Cavopulmonary Connection operation, 7 were done without palliation. Seventy-three patients had undergone a bidirectional Glenn shunt before completion of the total Cavopulmonary Connection. We used an expanded polytetrafluoroethylene tube graft as the extracardiac conduit. Results . Cardiopulmonary bypass time was 133.2 ± 55.2 minutes. Myocardial ischemic time was 38.5 ± 23.2 minutes in 40 patients who needed cardioplegic cardiac arrest for intracardiac procedures. Intraoperative fenestration was done in only 1 patient. There were no operative deaths. During follow-up of 37.3 months, there were 5 late deaths. When compared with the patients treated by the lateral tunnel technique in our institute, there was no significant difference in actuarial survival rate, but the event free rate of the extracardiac conduit group was significantly superior to the lateral tunnel group. Conclusions . Total Cavopulmonary Connection with the extracardiac conduit produced good results in short to midterm follow-up.
Mark A Fogel - One of the best experts on this subject based on the ideXlab platform.
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studying effect of respiration on total Cavopulmonary Connection flows using real time cardiac magnetic resonance
Journal of Cardiovascular Magnetic Resonance, 2014Co-Authors: Reza H. Khiabani, Kevin K Whitehead, Mark A Fogel, Jefferson D Losse, Ajit P YoganathanAbstract:Background Accurate measurement of vessel flows in the Total Cavopulmonary Connection (TCPC) can lead to better estimation of hemodynamics, which has been related to clinical outcomes in single ventricle patients. CMR is usually acquired in breath held conditions; however, respiratory effects can be considerable since the blood is passively routed to the lungs in Fontan patients. Here, we assessed the effect of respiration on caval and aortic flows using real time CMR images.
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accuracy of conventional oximetry for flow estimation in patients with superior Cavopulmonary Connection a comparison with phase contrast cardiac mri
Circulation-cardiovascular Imaging, 2013Co-Authors: Tacy E. Downing, Kevin K Whitehead, Mark A Fogel, Yoav Dori, Matthew J. Gillespie, Matthew A. Harris, Jonathan J. Rome, Andrew C GlatzAbstract:Background— Cardiac catheterization is routinely used as a diagnostic tool in single ventricle patients with superior Cavopulmonary Connection. This physiology presents inherent challenges in applying the Fick principle to estimate flow. We sought to quantitatively define the error in oximetry-derived flow parameters using phase-contrast cardiac MRI (CMR) as a reference. Methods and Results— Thirty patients with superior Cavopulmonary Connection who underwent combined CMR and catheterization between July 2008 and June 2012 were retrospectively analyzed. Estimates of flow and resistance calculated using the Fick equation were compared with CMR measurements. Oximetry underestimated CMR-measured pulmonary blood flow ( Q p) by an average of 1.1 L/min per m2 or 32% of the CMR value ( P <0.0001). Oximetry overestimated systemic blood flow ( Q s) by an average of 0.5 L/min per m2 or 15% of the CMR value ( P =0.009). There was no correlation between the Q p: Q s ratio derived by Fick and that measured by CMR ( ρ c=0.01). The error in the Fick Q p correlated moderately with the measured systemic-to-pulmonary arterial collateral flow ( r =0.39). The median total oxygen consumption calculated using combined CMR and oximetry data was 173 mL/min per m2, higher than the assumed values used to calculate flows by the Fick equation. The upper body circulation received on average 51% of systemic blood flow while conducting only 39% of total body metabolism. Conclusions— Fick-derived estimates of flow are inherently unreliable in patients with superior Cavopulmonary Connections. Integrating flows measured by CMR and pressures measured by catheter will provide the best characterization of superior Cavopulmonary Connection physiology.
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Accuracy of conventional oximetry for flow estimation in patients with superior Cavopulmonary Connection: a comparison with phase-contrast cardiac MRI.
Circulation-cardiovascular Imaging, 2013Co-Authors: Tacy E. Downing, Kevin K Whitehead, Mark A Fogel, Yoav Dori, Matthew J. Gillespie, Matthew A. Harris, Jonathan J. Rome, Andrew C GlatzAbstract:Background— Cardiac catheterization is routinely used as a diagnostic tool in single ventricle patients with superior Cavopulmonary Connection. This physiology presents inherent challenges in applying the Fick principle to estimate flow. We sought to quantitatively define the error in oximetry-derived flow parameters using phase-contrast cardiac MRI (CMR) as a reference. Methods and Results— Thirty patients with superior Cavopulmonary Connection who underwent combined CMR and catheterization between July 2008 and June 2012 were retrospectively analyzed. Estimates of flow and resistance calculated using the Fick equation were compared with CMR measurements. Oximetry underestimated CMR-measured pulmonary blood flow ( Q p) by an average of 1.1 L/min per m2 or 32% of the CMR value ( P
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numerical and experimental investigation of pulsatile hemodynamics in the total Cavopulmonary Connection
Journal of Biomechanics, 2013Co-Authors: Elaine Tang, Mark A Fogel, Reza H. Khiabani, Christopher M. Haggerty, Diane De Zelicourt, Jessica Kanter, Fotis Sotiropoulos, Ajit P YoganathanAbstract:Computational fluid dynamics (CFD) tools have been extensively applied to study the hemodynamics in the total Cavopulmonary Connection (TCPC) in patients with only a single functioning ventricle. Without the contraction of a sub-pulmonary ventricle, pulsatility of flow through this Connection is low and variable across patients, which is usually neglected in most numerical modeling studies. Recent studies suggest that such pulsatility can be non-negligible and can be important in hemodynamic predictions. The goal of this work is to compare the results of an in-house numerical methodology for simulating pulsatile TCPC flow with experimental results. Digital particle image velocimetry (DPIV) was acquired on TCPC in vitro models to evaluate the capability of the CFD tool in predicting pulsatile TCPC flow fields. In vitro hemodynamic measurements were used to compare the numerical prediction of power loss across the Connection. The results demonstrated the complexity of the pulsatile TCPC flow fields and the validity of the numerical approach in simulating pulsatile TCPC flow dynamics in both idealized and complex patient specific models.
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the total Cavopulmonary Connection resistance a significant impact on single ventricle hemodynamics at rest and exercise
American Journal of Physiology-heart and Circulatory Physiology, 2008Co-Authors: Kartik S Sundareswaran, Kerem Pekkan, Lakshmi Prasad Dasi, Kevin K Whitehead, Shiva Sharma, Kirk R Kanter, Mark A Fogel, Ajit P YoganathanAbstract:Little is known about the impact of the total Cavopulmonary Connection (TCPC) on resting and exercise hemodynamics in a single ventricle (SV) circulation. The aim of this study was to elucidate thi...