The Experts below are selected from a list of 45 Experts worldwide ranked by ideXlab platform
Richard A Krasuski - One of the best experts on this subject based on the ideXlab platform.
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incremenal value of cardiac magnetic resonance for assessing Pulmonic valve Regurgitation
Journal of Heart Valve Disease, 2015Co-Authors: Michael Zdradzinski, Scott D Flamm, Rachel Elkin, Richard A KrasuskiAbstract:BACKGROUND AND AIM OF THE STUDY Cardiac magnetic resonance (CMR) is the 'gold standard' for quantifying Pulmonic Regurgitation (PR) in adults with congenital heart disease, but remains costly and is less readily available than echocardiography. Qualitative echocardiographic assessment of PR is challenging, and guiding criteria are limited. It is unknown if echocardiography is sufficient to screen for significant PR. The study aim was to determine whether cardiac MRI provides additional benefit in the assessment of PR in adults with congenital heart disease. METHODS Patients with repaired tetralogy of Fallot or congenital Pulmonic stenosis after valvotomy undergoing transthoracic echocardiography and CMR with no interval intervention were identified from a prospective registry. Patients with greater than mild Pulmonic stenosis, residual ventricular septal defect or poor echocardiographic windows were excluded. Whole-cohort and subgroup (tetralogy of Fallot versus Pulmonic stenosis) analyses for inter-modality agreement were performed. RESULTS A total of 48 patients (24 men, 24 women; mean age 43 +/- 12 years) was included in the analysis. The unweighted kappa value for the two modalities was 0.30, suggesting 'fair' agreement, though only 52% had matching PR assessments. The indexed right ventricular end-systolic volume (RVESVi) correlated closely with cardiac MRI-monitored PR (p = 0.011 by analysis of variance), but not with that monitored with echocardiography (p = 0.081). Subgroup analysis demonstrated less inter-modality agreement in the tetralogy of Fallot population (kappa 0.25) than in the Pulmonic stenosis population (kappa 0.35). CONCLUSION CMR measurement of PR correlates closely with the RVESVi, and appears superior to echocardiography when assessing patients at risk for PR. The study results suggest a vital role for CMR whenever significant PR is suspected in the adult congenital heart disease population.
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comparison of long term postoperative sequelae in patients with tetralogy of fallot versus isolated Pulmonic stenosis
American Journal of Cardiology, 2014Co-Authors: Michael Zdradzinski, Athar M Qureshi, Robert W Stewart, Gosta B Pettersson, Richard A KrasuskiAbstract:Patients with tetralogy of Fallot (TOF) after complete repair and Pulmonic stenosis (PS) after surgical valvotomy often develop significant Pulmonic Regurgitation (PR) that eventually requires valve replacement. Although criteria exist for the timing of pulmonary valve replacement in TOF, it remains less clear when to intervene in valvotomy patients and whether TOF recommendations can be applied. Our aim was to compare the structural and functional sequelae of valvotomy for PS with complete repair for TOF. We compared the clinical characteristics, electrocardiograms, echocardiograms, cardiac magnetic resonance imaging (MRI), and invasive hemodynamics of 109 adults (34 PS and 75 TOF) newly referred to a congenital heart disease center for evaluation of PR between 2005 and 2012. Both cohorts were similar in terms of baseline demographics and presenting New York Heart Association function class. Valvotomy patients had a slightly greater degree of PR by echocardiogram, although it was similar by cardiac MRI. Electrocardiography QRS width was greater in patients with TOF (114 ± 27 vs 150 ± 28 ms, p
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can selective pulmonary vasodilator therapy be used to target Pulmonic Regurgitation results of the pinot noir trial
Journal of the American College of Cardiology, 2012Co-Authors: Stephen A Hart, Ganesh P Devendra, Yuli Kim, Vidyasagar Kalahasti, Scott D Flamm, Richard A KrasuskiAbstract:Both tetralogy of Fallot (TOF) repair and pulmonary valvotomy for Pulmonic stenosis (PS) result in progressive pulmonary insufficiency (PI), which eventually necessitates repeat surgery. Though percutaneous therapy is growing in popularity, it remains ill-suited for native right ventricular (RV)
Michael Zdradzinski - One of the best experts on this subject based on the ideXlab platform.
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incremenal value of cardiac magnetic resonance for assessing Pulmonic valve Regurgitation
Journal of Heart Valve Disease, 2015Co-Authors: Michael Zdradzinski, Scott D Flamm, Rachel Elkin, Richard A KrasuskiAbstract:BACKGROUND AND AIM OF THE STUDY Cardiac magnetic resonance (CMR) is the 'gold standard' for quantifying Pulmonic Regurgitation (PR) in adults with congenital heart disease, but remains costly and is less readily available than echocardiography. Qualitative echocardiographic assessment of PR is challenging, and guiding criteria are limited. It is unknown if echocardiography is sufficient to screen for significant PR. The study aim was to determine whether cardiac MRI provides additional benefit in the assessment of PR in adults with congenital heart disease. METHODS Patients with repaired tetralogy of Fallot or congenital Pulmonic stenosis after valvotomy undergoing transthoracic echocardiography and CMR with no interval intervention were identified from a prospective registry. Patients with greater than mild Pulmonic stenosis, residual ventricular septal defect or poor echocardiographic windows were excluded. Whole-cohort and subgroup (tetralogy of Fallot versus Pulmonic stenosis) analyses for inter-modality agreement were performed. RESULTS A total of 48 patients (24 men, 24 women; mean age 43 +/- 12 years) was included in the analysis. The unweighted kappa value for the two modalities was 0.30, suggesting 'fair' agreement, though only 52% had matching PR assessments. The indexed right ventricular end-systolic volume (RVESVi) correlated closely with cardiac MRI-monitored PR (p = 0.011 by analysis of variance), but not with that monitored with echocardiography (p = 0.081). Subgroup analysis demonstrated less inter-modality agreement in the tetralogy of Fallot population (kappa 0.25) than in the Pulmonic stenosis population (kappa 0.35). CONCLUSION CMR measurement of PR correlates closely with the RVESVi, and appears superior to echocardiography when assessing patients at risk for PR. The study results suggest a vital role for CMR whenever significant PR is suspected in the adult congenital heart disease population.
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comparison of long term postoperative sequelae in patients with tetralogy of fallot versus isolated Pulmonic stenosis
American Journal of Cardiology, 2014Co-Authors: Michael Zdradzinski, Athar M Qureshi, Robert W Stewart, Gosta B Pettersson, Richard A KrasuskiAbstract:Patients with tetralogy of Fallot (TOF) after complete repair and Pulmonic stenosis (PS) after surgical valvotomy often develop significant Pulmonic Regurgitation (PR) that eventually requires valve replacement. Although criteria exist for the timing of pulmonary valve replacement in TOF, it remains less clear when to intervene in valvotomy patients and whether TOF recommendations can be applied. Our aim was to compare the structural and functional sequelae of valvotomy for PS with complete repair for TOF. We compared the clinical characteristics, electrocardiograms, echocardiograms, cardiac magnetic resonance imaging (MRI), and invasive hemodynamics of 109 adults (34 PS and 75 TOF) newly referred to a congenital heart disease center for evaluation of PR between 2005 and 2012. Both cohorts were similar in terms of baseline demographics and presenting New York Heart Association function class. Valvotomy patients had a slightly greater degree of PR by echocardiogram, although it was similar by cardiac MRI. Electrocardiography QRS width was greater in patients with TOF (114 ± 27 vs 150 ± 28 ms, p
Karen K. Stout - One of the best experts on this subject based on the ideXlab platform.
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Management of Pulmonic Regurgitation and Right Ventricular Dysfunction in the Adult with Repaired Tetralogy of Fallot
Current Treatment Options in Cardiovascular Medicine, 2013Co-Authors: Elisa Zaragoza-macias, Karen K. StoutAbstract:With surgical repair most children with Tetralogy of Fallot survive into adulthood. The main complications seen after Tetralogy of Fallot repair include arrhythmias, sudden cardiac death, pulmonary Regurgitation, and right ventricular dysfunction/heart failure. Pulmonary Regurgitation over time may lead to right ventricular dilation and failure. In this article, we will review the literature regarding management of pulmonary Regurgitation with specific focus on timing for pulmonary valve replacement and prevention of right ventricular dysfunction.
Emily Ruckdeschel - One of the best experts on this subject based on the ideXlab platform.
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Pulmonic Regurgitation and Management Challenges in the Adult with Tetralogy of Fallot
Current Treatment Options in Cardiovascular Medicine, 2014Co-Authors: Emily RuckdeschelAbstract:Patients with tetralogy of Fallot (TOF) are living longer than ever because of advances in surgery in childhood since the 1950s. However, surgery in childhood is not a cure and remains only a palliative procedure because almost all patients will require further intervention throughout life. The most common intervention required in adulthood is pulmonary valve replacement (PVR) because of residual pulmonary Regurgitation leading to right ventricular dilation and eventual dysfunction. The most appropriate timing for PVR remains difficult to determine and is based on many factors. Our practice is to weigh not only objective factors such as right ventricular size and function but also careful objective assessment of the patient’s current quality of life and functional status.
M Stephen D Fess - One of the best experts on this subject based on the ideXlab platform.
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pathology of Pulmonic valve stenosis and pure Regurgitation
Clinical Cardiology, 1995Co-Authors: F Bruce M D Waller, M Jane D Howard, M Stephen D FessAbstract:: Little morphologic information is available on operatively excised Pulmonic valves. The causes of Pulmonic stenosis are limited to a few conditions: (1) rheumatic and (2) nonrheumatic (congenital, carcinoid, infective endocarditis). Congenital causes of Pulmonic stenosis constitute well over 95% of these conditions. Congenital types of Pulmonic stenosis include acommissural dome-shaped, dysplastic, and bicuspid. Rare acquired causes of Pulmonic stenosis include carcinoid, rheumatic, and infective endocarditis. Of the acquired causes of Pulmonic stenosis, carcinoid is the most common condition. In contrast, causes of pure Pulmonic Regurgitation are multiple. Two major categories of pure Pulmonic Regurgitation include (1) conditions associated with anatomically abnormal valve cusps (congenital, rheumatic, carcinoid, trauma, and infective endocarditis) and (2) conditions associated with anatomically normal cusps (elevated pulmonary artery systolic pressures, idiopathic dilated pulmonary trunk, and Marfan's syndrome).
