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Derek A Fyfe - One of the best experts on this subject based on the ideXlab platform.
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successful biventricular repair after initial norwood operation for interrupted aortic arch with severe left ventricular outflow tract obstruction
The Annals of Thoracic Surgery, 2001Co-Authors: Eldad Erez, Kirk R Kanter, Derek A FyfeAbstract:Abstract Background . Management of newborns with interrupted aortic arch (IAA) remains challenging. Associated severe left ventricular outflow tract obstruction (LVOTO) have often led to increased mortality with neonatal biventricular repair. We review our experience with an alternative approach for this complex surgical problem. Methods . From May 1991 to June 1999, 28 neonates were treated for IAA. Thirteen of 28 neonates (46%) had type B IAA, ventricular septal defect (VSD) and severe LVOTO (Z value –2 to –7; mean –5 ± 1.7). Mean age was 8 days (3 to 23 days old) with average weight of 3.3 kg (2.4 to 4.2 kg). Eight of 13 (62%) had anomalous right subclavian artery. Ten of 13 (77%) had thymic aplasia and chromosome 22 region q11 deletion. All 13 patients were treated initially with a modified Norwood procedure. Results . There were no perioperative deaths. Complications included 2 patients with recurrent arch stenosis treated with balloon dilatation. Two patients had systemic arterial Shunt revision. Follow-up ranged from 2 to 99 months old (mean 39 months). There were 2 late deaths unrelated to any operation. Nine of 12 patients had a second stage palliation consisting of a bidirectional Glenn Shunt. Six patients went on to have biventricular repairs (3 Ross-Konno, 2 Rastelli, 1 VSD closure with LVOT resection). One patient had a modified Fontan operation and 5 patients are awaiting potential biventricular repair. Conclusions . Children with IAA and severe LVOTO may be managed by initial Norwood palliation with an excellent outcome likely. This initial "univentricular" approach has enabled eventual successful biventricular repair despite severe LVOTO.
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successful biventricular repair after initial norwood operation for interrupted aortic arch with severe left ventricular outflow tract obstruction
The Annals of Thoracic Surgery, 2001Co-Authors: Eldad Erez, Kirk R Kanter, Vincent K H Tam, Derek A FyfeAbstract:Abstract Background . Management of newborns with interrupted aortic arch (IAA) remains challenging. Associated severe left ventricular outflow tract obstruction (LVOTO) have often led to increased mortality with neonatal biventricular repair. We review our experience with an alternative approach for this complex surgical problem. Methods . From May 1991 to June 1999, 28 neonates were treated for IAA. Thirteen of 28 neonates (46%) had type B IAA, ventricular septal defect (VSD) and severe LVOTO (Z value –2 to –7; mean –5 ± 1.7). Mean age was 8 days (3 to 23 days old) with average weight of 3.3 kg (2.4 to 4.2 kg). Eight of 13 (62%) had anomalous right subclavian artery. Ten of 13 (77%) had thymic aplasia and chromosome 22 region q11 deletion. All 13 patients were treated initially with a modified Norwood procedure. Results . There were no perioperative deaths. Complications included 2 patients with recurrent arch stenosis treated with balloon dilatation. Two patients had systemic arterial Shunt revision. Follow-up ranged from 2 to 99 months old (mean 39 months). There were 2 late deaths unrelated to any operation. Nine of 12 patients had a second stage palliation consisting of a bidirectional Glenn Shunt. Six patients went on to have biventricular repairs (3 Ross-Konno, 2 Rastelli, 1 VSD closure with LVOT resection). One patient had a modified Fontan operation and 5 patients are awaiting potential biventricular repair. Conclusions . Children with IAA and severe LVOTO may be managed by initial Norwood palliation with an excellent outcome likely. This initial "univentricular" approach has enabled eventual successful biventricular repair despite severe LVOTO.
Robert J Ascuitto - One of the best experts on this subject based on the ideXlab platform.
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abstract 12056 computational fluid dynamics description of blood flow in a bidirectional Glenn Shunt supplemented with a modified blalock taussig Shunt relevance to thrombosis and power loss
Circulation, 2016Co-Authors: Seda Aslan, Nancy T Rossascuitto, Martin J Guillot, Robert J AscuittoAbstract:Introduction: A bidirectional Glenn Shunt (BGS) has been supplemented with a modified Blalock-Taussig Shunt (BTS), to enhance growth of the pulmonary arteries (PAs). However, the hemodynamics is incompletely understood. Hypothesis: High velocity BTS flow imposed on low velocity BGS flow can create secondary currents (vortices) in the PAs conducive to clot deposition and power dissipation. Methods: We employed a computational model (Fluent) of pulsatile flow (viscosity 5 cPa-s), using the finite volume method, and a schematic representation of a BGS with a BTS, to determine velocity field, wall shear stress (WSS) and power (W) efficiency (PE). The region studied included the internal jugular, subclavian and innominate veins, BGS (12.5 mm), BTS (4 mm) and PAs (9 mm). Vessel sizes and flow rates were derived from reported values. Flow rates were fixed at the inlet of the veins, and in the BGS was 1L/min. Aortic pressure (82/42 mmHg) was used at the inlet to the BTS, and a mean pressure (12 mmHg) at the outle...
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abstract 12056 computational fluid dynamics description of blood flow in a bidirectional Glenn Shunt supplemented with a modified blalock taussig Shunt relevance to thrombosis and power loss
Circulation, 2016Co-Authors: Seda Aslan, Nancy T Rossascuitto, Martin J Guillot, Robert J AscuittoAbstract:Introduction: A bidirectional Glenn Shunt (BGS) has been supplemented with a modified Blalock-Taussig Shunt (BTS), to enhance growth of the pulmonary arteries (PAs). However, the hemodynamics is incompletely understood. Hypothesis: High velocity BTS flow imposed on low velocity BGS flow can create secondary currents (vortices) in the PAs conducive to clot deposition and power dissipation. Methods: We employed a computational model (Fluent) of pulsatile flow (viscosity 5 cPa-s), using the finite volume method, and a schematic representation of a BGS with a BTS, to determine velocity field, wall shear stress (WSS) and power (W) efficiency (PE). The region studied included the internal jugular, subclavian and innominate veins, BGS (12.5 mm), BTS (4 mm) and PAs (9 mm). Vessel sizes and flow rates were derived from reported values. Flow rates were fixed at the inlet of the veins, and in the BGS was 1L/min. Aortic pressure (82/42 mmHg) was used at the inlet to the BTS, and a mean pressure (12 mmHg) at the outle...
Venty Venty - One of the best experts on this subject based on the ideXlab platform.
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Ventrikel Kiri dengan Jalan Masuk dan Keluar Ganda, Trasnposisi Arteri Besar, Duktus Arteriosus Paten Defek Septum Ventricle Inlet
'Indonesian Journal of Cardiology', 2017Co-Authors: Sakasasmita Sylvie, Harimurti, Ganesja M., Fakhri Dicky, Venty VentyAbstract:Congenital heart disease is an interesting area which present a great various arrangement of the cardiac stucture. We present a rare case of 11 months old male with complex congenital heart disease consisted of Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV) with Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus (PDA).Patient was an eleven months old male who was admitted in our institution for cardiac operation. He was diagnosed with congenital heart disease since three days old with initial presentation of cyanosis when he was crying. His physical growth was retarded but his developmental Milestones was considered normal. On admission, his oxygen saturation was 88% with ambient air. The diagnosis was confirmed by echocardiography. He was planned to undergo staging surgery which would end to Fontan Procedure. Pulmonary Artery (PA) banding was performed to reduce blood flow to pulmonary circulation, distribute more blood from the left ventricle to aorta and systemic circulation and prepare for bidirectional Glenn Shunt procedure one year later and Fontan procedure a year after that.Penyakit jantung kongenital merupakan area kardiologi yang menarik karena presentasi dari stuktur jantung yang terjadidapat sangat bervariasi. Disini kami memaparkan sebuah kasus pada anak laki-laki berusia 11 bulan dengan penyakit jantungkongenital kompleks yang terdiri dari inlet ventrikel kiri ganda, outlet ventrikel kiri ganda dengan malposisi arteri besar, defekseptum ventrikel inlet dan duktus arteriosus paten.Pasien laki-laki sebelas bulan dirawat di institusi kami dengan perencanaan tindakan operasi. Sebelumnya, pasien terdiagnosamemiliki penyakit jantung congenital sejak usia tiga hari dengan presentasi awal berupa sianosis ketika menangis. Pertumbuhanfisiknya pun terhambat namun perkembangannya menurut Milestones masih tergolong normal. Saat masuk ruangperawatan saturasi oksigen 88% tanpa suplementasi oksigen. Diagnosis dikonfirmasi dengan menggunakan echokardiografidan pasien direncanakan untuk mendapatkan tindakan pembedahan yang berakhir pada prosedur Fontan. Pengikatan arteripulmonaris dilakukan telebih dahulu pada perawatan ini dengan tujuan untuk mengurangi aliran darah ke sirkulasi pulmonal,mendistribusikan lebih banyak darah dari ventrikel kiri ke aorta dan sirkulasi sistemik dan mempersiapakan untuk prosedurbidirectional Glenn Shunt satu tahun kemudian dan prosedur Fontan satu tahun setelahnya
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Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV), Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus
Indonesian Heart Association, 2017Co-Authors: Sylvie Sakasasmita, Ganesja M. Harimurti, Dicky Fakhri, Venty VentyAbstract:Congenital heart disease is an interesting area which present a great various arrangement of the cardiac stucture. We present a rare case of 11 months old male with complex congenital heart disease consisted of Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV) with Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus (PDA). Patient was an eleven months old male who was admitted in our institution for cardiac operation. He was diagnosed with congenital heart disease since three days old with initial presentation of cyanosis when he was crying. His physical growth was retarded but his developmental Milestones was considered normal. On admission, his oxygen saturation was 88% with ambient air. The diagnosis was confirmed by echocardiography. He was planned to undergo staging surgery which would end to Fontan Procedure. Pulmonary Artery (PA) banding was performed to reduce blood flow to pulmonary circulation, distribute more blood from the left ventricle to aorta and systemic circulation and prepare for bidirectional Glenn Shunt procedure one year later and Fontan procedure a year after that
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Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV), Malposisi Pembuluh Darah Besar, Ventricle Septal Defect (VSD) Inlet, dan Patent Ductus Arteriosus
'Indonesian Journal of Cardiology', 2016Co-Authors: Sakasasmita Sylvie, Harimurti, Ganesja M., Fakhri Dicky, Venty VentyAbstract:Congenital heart disease is an interesting area which present a great various arrangement of the cardiac stucture. We present a rare case of 11 months old male with complex congenital heart disease consisted of Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV) with Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus (PDA).Patient was an eleven months old male who was admitted in our institution for cardiac operation. He was diagnosed with congenital heart disease since three days old with initial presentation of cyanosis when he was crying. His physical growth was retarded but his developmental Milestones was considered normal. On admission, his oxygen saturation was 88% with ambient air. The diagnosis was confirmed by echocardiography. He was planned to undergo staging surgery which would end to Fontan Procedure. Pulmonary Artery (PA) banding was performed to reduce blood flow to pulmonary circulation, distribute more blood from the left ventricle to aorta and systemic circulation and prepare for bidirectional Glenn Shunt procedure one year later and Fontan procedure a year after that.Penyakit jantung kongenital merupakan area kardiologi yang menarik karena presentasi dari stuktur jantung yang terjadi dapat sangat bervariasi. Disini kami memaparkan sebuah kasus pada anak laki-laki berusia 11 bulan dengan penyakit jantung kongenital kompleks yang terdiri dari inlet ventrikel kiri ganda, outlet ventrikel kiri ganda dengan malposisi arteri besar, defek septum ventrikel inlet dan duktus arteriosus paten.Pasien laki-laki sebelas bulan dirawat di institusi kami dengan perencanaan tindakan operasi. Sebelumnya, pasien terdiagnosa memiliki penyakit jantung congenital sejak usia tiga hari dengan presentasi awal berupa sianosis ketika menangis. Pertumbuhan fisiknya pun terhambat namun perkembangannya menurut Milestones masih tergolong normal. Saat masuk ruang perawatan saturasi oksigen 88% tanpa suplementasi oksigen. Diagnosis dikonfirmasi dengan menggunakan echokardiografi dan pasien direncanakan untuk mendapatkan tindakan pembedahan yang berakhir pada prosedur Fontan. Pengikatan arteri pulmonaris dilakukan telebih dahulu pada perawatan ini dengan tujuan untuk mengurangi aliran darah ke sirkulasi pulmonal, mendistribusikan lebih banyak darah dari ventrikel kiri ke aorta dan sirkulasi sistemik dan mempersiapakan untuk prosedur bidirectional Glenn Shunt satu tahun kemudian dan prosedur Fontan satu tahun setelahnya
Kirk R Kanter - One of the best experts on this subject based on the ideXlab platform.
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factors affecting death and progression towards next stage following modified blalock taussig Shunt in neonates
European Journal of Cardio-Thoracic Surgery, 2016Co-Authors: Bahaaldin Alsoufi, Scott Gillespie, Makoto Mori, Martha L Clabby, Kirk R Kanter, Brian KogonAbstract:The modified Blalock-Taussig Shunt (BTS) is utilized to palliate neonates born with restrictive pulmonary blood flow including those with single ventricle (SV) or biventricular (BV) cardiac anomalies. We aim in the current study to report palliation outcomes of neonates with BTS and to examine factors affecting death and progression to the subsequent stage of palliation or repair.Between 2002 and 2012, 341 patients underwent BTS including 175 with SV and 166 with BV anomalies. Competing risk analysis modelled events after BTS (death or transplantation, transition to Glenn Shunt or biventricular repair) and examined risk factors affecting outcomes.SV patients had a higher incidence of extracorporeal membrane oxygenation (ECMO) support requirement (12 vs 4%, P = 0.004) and unplanned cardiac reoperation (14 vs 7%, P = 0.051) than their BV counterparts. Additionally, hospital mortality was higher in SV than in BV patients (15 vs 3%, P < 0.001). In SV patients, competing risk analysis showed that, 2 years following BTS, 27% of patients had died or received transplantation and 73% had undergone the Glenn Shunt. On multivariable analysis, factors associated with time until death or transplantation prior to Glenn were cardiopulmonary bypass [hazard ratio (HR) 3.6 (2.0-6.4), P < 0.001], unplanned cardiac reoperation [HR 2.4 (1.3-4.6), P = 0.007], pulmonary atresia [HR 2.0 (1.1-3.7), P = 0.026] and the Shunt size/weight ratio [HR 1.3 (1.1-1.4) per 0.1 increase, P = 0.001]. In BV patients, competing risk analysis showed that, 2 years following BTS, 13% of patients had died or received transplantation, 85% had undergone biventricular repair and 2% were alive without biventricular repair. On multivariable analysis, factors associated with time until death or transplantation prior to biventricular repair were genetic syndromes and extracardiac malformations [HR 6.1 (2.0-18.2), P = 0.001], weight ≤2.5 kg [HR 5.6 (2.0-16.0), P = 0.001] and male gender [HR 3.4 (1.1-11.0), P = 0.041].Palliation with BTS continues to be associated with significant operative morbidity and mortality. In addition to hospital death, there is an important interstage attrition risk prior to subsequent palliation or biventricular repair. Inherent patient characteristics (i.e. genetic syndromes and low weight) and anatomical details (i.e. SV, pulmonary atresia and concomitant cardiac anomalies) are associated with worse survival.
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successful biventricular repair after initial norwood operation for interrupted aortic arch with severe left ventricular outflow tract obstruction
The Annals of Thoracic Surgery, 2001Co-Authors: Eldad Erez, Kirk R Kanter, Derek A FyfeAbstract:Abstract Background . Management of newborns with interrupted aortic arch (IAA) remains challenging. Associated severe left ventricular outflow tract obstruction (LVOTO) have often led to increased mortality with neonatal biventricular repair. We review our experience with an alternative approach for this complex surgical problem. Methods . From May 1991 to June 1999, 28 neonates were treated for IAA. Thirteen of 28 neonates (46%) had type B IAA, ventricular septal defect (VSD) and severe LVOTO (Z value –2 to –7; mean –5 ± 1.7). Mean age was 8 days (3 to 23 days old) with average weight of 3.3 kg (2.4 to 4.2 kg). Eight of 13 (62%) had anomalous right subclavian artery. Ten of 13 (77%) had thymic aplasia and chromosome 22 region q11 deletion. All 13 patients were treated initially with a modified Norwood procedure. Results . There were no perioperative deaths. Complications included 2 patients with recurrent arch stenosis treated with balloon dilatation. Two patients had systemic arterial Shunt revision. Follow-up ranged from 2 to 99 months old (mean 39 months). There were 2 late deaths unrelated to any operation. Nine of 12 patients had a second stage palliation consisting of a bidirectional Glenn Shunt. Six patients went on to have biventricular repairs (3 Ross-Konno, 2 Rastelli, 1 VSD closure with LVOT resection). One patient had a modified Fontan operation and 5 patients are awaiting potential biventricular repair. Conclusions . Children with IAA and severe LVOTO may be managed by initial Norwood palliation with an excellent outcome likely. This initial "univentricular" approach has enabled eventual successful biventricular repair despite severe LVOTO.
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successful biventricular repair after initial norwood operation for interrupted aortic arch with severe left ventricular outflow tract obstruction
The Annals of Thoracic Surgery, 2001Co-Authors: Eldad Erez, Kirk R Kanter, Vincent K H Tam, Derek A FyfeAbstract:Abstract Background . Management of newborns with interrupted aortic arch (IAA) remains challenging. Associated severe left ventricular outflow tract obstruction (LVOTO) have often led to increased mortality with neonatal biventricular repair. We review our experience with an alternative approach for this complex surgical problem. Methods . From May 1991 to June 1999, 28 neonates were treated for IAA. Thirteen of 28 neonates (46%) had type B IAA, ventricular septal defect (VSD) and severe LVOTO (Z value –2 to –7; mean –5 ± 1.7). Mean age was 8 days (3 to 23 days old) with average weight of 3.3 kg (2.4 to 4.2 kg). Eight of 13 (62%) had anomalous right subclavian artery. Ten of 13 (77%) had thymic aplasia and chromosome 22 region q11 deletion. All 13 patients were treated initially with a modified Norwood procedure. Results . There were no perioperative deaths. Complications included 2 patients with recurrent arch stenosis treated with balloon dilatation. Two patients had systemic arterial Shunt revision. Follow-up ranged from 2 to 99 months old (mean 39 months). There were 2 late deaths unrelated to any operation. Nine of 12 patients had a second stage palliation consisting of a bidirectional Glenn Shunt. Six patients went on to have biventricular repairs (3 Ross-Konno, 2 Rastelli, 1 VSD closure with LVOT resection). One patient had a modified Fontan operation and 5 patients are awaiting potential biventricular repair. Conclusions . Children with IAA and severe LVOTO may be managed by initial Norwood palliation with an excellent outcome likely. This initial "univentricular" approach has enabled eventual successful biventricular repair despite severe LVOTO.
Eldad Erez - One of the best experts on this subject based on the ideXlab platform.
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successful biventricular repair after initial norwood operation for interrupted aortic arch with severe left ventricular outflow tract obstruction
The Annals of Thoracic Surgery, 2001Co-Authors: Eldad Erez, Kirk R Kanter, Derek A FyfeAbstract:Abstract Background . Management of newborns with interrupted aortic arch (IAA) remains challenging. Associated severe left ventricular outflow tract obstruction (LVOTO) have often led to increased mortality with neonatal biventricular repair. We review our experience with an alternative approach for this complex surgical problem. Methods . From May 1991 to June 1999, 28 neonates were treated for IAA. Thirteen of 28 neonates (46%) had type B IAA, ventricular septal defect (VSD) and severe LVOTO (Z value –2 to –7; mean –5 ± 1.7). Mean age was 8 days (3 to 23 days old) with average weight of 3.3 kg (2.4 to 4.2 kg). Eight of 13 (62%) had anomalous right subclavian artery. Ten of 13 (77%) had thymic aplasia and chromosome 22 region q11 deletion. All 13 patients were treated initially with a modified Norwood procedure. Results . There were no perioperative deaths. Complications included 2 patients with recurrent arch stenosis treated with balloon dilatation. Two patients had systemic arterial Shunt revision. Follow-up ranged from 2 to 99 months old (mean 39 months). There were 2 late deaths unrelated to any operation. Nine of 12 patients had a second stage palliation consisting of a bidirectional Glenn Shunt. Six patients went on to have biventricular repairs (3 Ross-Konno, 2 Rastelli, 1 VSD closure with LVOT resection). One patient had a modified Fontan operation and 5 patients are awaiting potential biventricular repair. Conclusions . Children with IAA and severe LVOTO may be managed by initial Norwood palliation with an excellent outcome likely. This initial "univentricular" approach has enabled eventual successful biventricular repair despite severe LVOTO.
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successful biventricular repair after initial norwood operation for interrupted aortic arch with severe left ventricular outflow tract obstruction
The Annals of Thoracic Surgery, 2001Co-Authors: Eldad Erez, Kirk R Kanter, Vincent K H Tam, Derek A FyfeAbstract:Abstract Background . Management of newborns with interrupted aortic arch (IAA) remains challenging. Associated severe left ventricular outflow tract obstruction (LVOTO) have often led to increased mortality with neonatal biventricular repair. We review our experience with an alternative approach for this complex surgical problem. Methods . From May 1991 to June 1999, 28 neonates were treated for IAA. Thirteen of 28 neonates (46%) had type B IAA, ventricular septal defect (VSD) and severe LVOTO (Z value –2 to –7; mean –5 ± 1.7). Mean age was 8 days (3 to 23 days old) with average weight of 3.3 kg (2.4 to 4.2 kg). Eight of 13 (62%) had anomalous right subclavian artery. Ten of 13 (77%) had thymic aplasia and chromosome 22 region q11 deletion. All 13 patients were treated initially with a modified Norwood procedure. Results . There were no perioperative deaths. Complications included 2 patients with recurrent arch stenosis treated with balloon dilatation. Two patients had systemic arterial Shunt revision. Follow-up ranged from 2 to 99 months old (mean 39 months). There were 2 late deaths unrelated to any operation. Nine of 12 patients had a second stage palliation consisting of a bidirectional Glenn Shunt. Six patients went on to have biventricular repairs (3 Ross-Konno, 2 Rastelli, 1 VSD closure with LVOT resection). One patient had a modified Fontan operation and 5 patients are awaiting potential biventricular repair. Conclusions . Children with IAA and severe LVOTO may be managed by initial Norwood palliation with an excellent outcome likely. This initial "univentricular" approach has enabled eventual successful biventricular repair despite severe LVOTO.