Publications by authors named "Athar Qureshi"

Background: Pulmonary hypertension in children often progresses despite optimal therapy. This document provides an evidence-based clinical practice guideline for the management of children with progressive pulmonary hypertension despite optimal therapy.

Methods: A multidisciplinary panel identified pertinent questions regarding the management of children with pulmonary hypertension that has progressed despite optimal therapy, conducted systematic reviews of the relevant literature, and applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to develop clinical recommendations.

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  • * Researchers found that while most children had normal neurodevelopmental scores, a significant number displayed issues, especially as they grew older; specific factors like low birth weight and maternal education influenced outcomes.
  • * The findings suggest that children with sTOF may have elevated developmental concerns, and although the type of surgical intervention didn't seem to affect these outcomes, other risks like genetic syndromes are important to consider for early intervention.
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Background: The GORE CARDIOFORM ASD Occluder (GCA, W. L. Gore & Associates) was approved in 2019 for ostium secundum atrial septal defect (ASD) closure.

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To evaluate the association between initial management strategy of neonatal symptomatic Tetralogy of Fallot (sTOF) and later health-related quality of life (HRQOL) outcomes. We performed a multicenter, cross-sectional evaluation of a previously assembled cohort of infants with sTOF who underwent initial intervention at ≤ 30 days of age, between 2005 and 2017. Eligible patients' parents/guardians completed an age-appropriate Pediatric Quality of Life Inventory, a Pediatric Quality of Life Inventory Cardiac Module Heart Disease Symptoms Scale, and a parental survey.

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  • Neonates with symptomatic tetralogy of Fallot (sTOF) often require early surgical intervention, which can involve either staged repair (SR) or primary repair (PR), but both strategies expose them to low-dose ionizing radiation that may raise cancer risk.
  • This study analyzed the cumulative radiation exposure and lifetime attributable risk (LAR) of cancer in sTOF patients who underwent either SR or PR, using data from 242 neonates across multiple centers.
  • Results showed that SR resulted in significantly higher radiation exposure compared to PR and highlighted an increased LAR of cancer, particularly for females, emphasizing the need to consider radiation risk when choosing treatment options for this vulnerable group.*
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Background: Hepatic and splenic venous access are specialised techniques used to perform diagnostic and interventional procedures in the cardiac catheterisation laboratory. Bleeding events are the most commonly reported complication following hepatic or splenic venous access. The VASCADE Vascular Closure System (Cardiva Medical Inc.

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  • * An international registry collected data from ten patients across six centers, revealing a significant increase in the inner diameter of the tricuspid valve after the procedure without any major complications noted.
  • * Results indicated that the method led to a notable decrease in heart pressure gradients, suggesting improved blood flow and potentially reducing the risk of prosthesis mismatch.
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Background: A bioprosthetic valve is recommended for women of childbearing age who require cardiac valve replacement in order to minimize the risk of blood clot formation. However, it should be noted that compared to mechanical valves, bioprosthetic valves have a shorter lifespan and a higher likelihood of requiring reoperation during follow-up. To assess the long-term postoperative results, including the incidence of structural valve deterioration (SVD) and other clinical outcomes, in female patients aged 50 years and younger who underwent BalMedic bovine pericardial bioprosthetic valve replacement, a multicenter retrospective study was implemented in China.

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Background: The Alterra adaptive prestent is a novel self-expanding device designed to provide a landing zone for the 29 mm SAPIEN 3 valve to treat pulmonary regurgitation in patients with a right ventricular outflow tract that is too large for a balloon expandable valve alone. The mechanism of fixation for the Alterra prestent is radial force from the self-expanding stent frame, combined with a unique set of flared "tines" that protrude from both ends of the stent.

Aims, Methods, And Results: In this report, we describe 6 patients who underwent uncomplicated transcatheter pulmonary valve replacement with an Alterra adaptive prestent and SAPIEN 3 valve and had surveillance chest computed tomography (CT) scans performed 1 day to 21 months after implant.

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  • - Recent advancements in detecting congenital heart disease before birth are leading to innovative fetal cardiac interventions that aim to improve outcomes for high-risk conditions.
  • - Key procedures include fetal aortic valvuloplasty and atrial septoplasty for various forms of hypoplastic left heart syndrome, as well as pulmonary valvuloplasty for severe pulmonary issues.
  • - The review covers the reasons for these interventions, how they are performed, and their success rates based on existing research.
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  • The study aimed to compare the outcomes of neonates with symptomatic tetralogy of Fallot (TOF) based on whether they had a ductus arteriosus (DA) or absent DA (ADA).
  • Researchers conducted a retrospective multi-center study involving 519 neonates to assess the risks of death and need for reintervention, focusing on ADA and critically deficient pulmonary blood flow (CDPBF).
  • Findings indicated that neonates with ADA faced a significantly higher mortality risk compared to those with DA, highlighting the rare but critical nature of CDPBF among these patients.
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Pediatric pulmonary vein stenosis (PVS) is often progressive and treatment-refractory, requiring multiple interventions. Hybrid pulmonary vein interventions (HPVIs), involving intraoperative balloon angioplasty or stent placement, leverage surgical access and customization to optimize patency while facilitating future transcatheter procedures. We review our experience with HPVI and explore potential applications of this collaborative approach.

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Background: We describe outcomes and management strategies for single-ventricle and bilaterally discontinuous pulmonary arteries (PAs) originating from bilateral ductus arteriosus.

Methods: We reviewed 22 patients with aforementioned anatomy and PA centralization from 1995 to 2023, excluding those with biventricular repair.

Results: Median age at centralization was 9 days (minimum-maximum, 0 days-2 years).

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Background: Anatomic selection for Harmony valve implant is determined with the aid of a screening report and perimeter plot (PP) that depicts the perimeter-derived radius along the right ventricular outflow tract (RVOT) and projects device oversizing. The PP provides an estimation of suitability for implant, but its sensitivity as a screening method is unknown. This study was performed to describe anatomic features and outcomes in patients who underwent Harmony TPV25 implant despite a PP that predicted inadequate oversizing.

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  • Percutaneous pulmonary valve implantation (PPVI) is a catheter-based treatment for right ventricular outflow tract (RVOT) dysfunction, which can lead to serious complications if valves are improperly sized.
  • Researchers developed a more efficient method using patient-specific finite element (FE) models to assess risks before the PPVI procedure, significantly reducing computation time from hundreds of hours to just 2-6 minutes on a desktop computer.
  • The study showed that changes in the diameter of surrounding arteries predicted complications like aortic valve insufficiency and coronary artery compression accurately for all patients evaluated, indicating strong agreement between the FE model predictions and actual clinical outcomes.
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  • Transcatheter pulmonary valve replacement (TPVR) using the Harmony valve is a new treatment for patients with pulmonary regurgitation, showing promising short-term safety and efficacy since FDA approval in 2021.
  • In a study involving 243 patients, the majority of whom had tetralogy of Fallot, acute technical success was achieved in nearly all cases, with a low rate of serious complications.
  • At a median follow-up of 13 months, 98% of patients maintained good hemodynamic function, indicating excellent short-term outcomes, while ongoing monitoring is needed for long-term results.
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Pulmonary embolism is increasing in prevalence among pediatric patients; although still rare, it can create a significant risk for morbidity and death within the pediatric patient population. Pulmonary embolism presents in various ways depending on the patient, the size of the embolism, and the comorbidities. Treatment decisions are often driven by the severity of the presentation and hemodynamic effects; severe presentations require more invasive and aggressive treatment.

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  • The study aimed to analyze clinical and surgical outcomes in pediatric patients with myocardial bridge (MB), using a standardized evaluation process over nearly a decade.
  • Out of 39 evaluated patients, 38% were found to have significant MB, with symptoms ranging from sudden cardiac arrest to exertional discomfort; most underwent successful surgical intervention.
  • Follow-up data showed that the surgical procedures improved patient symptoms and allowed for unrestricted physical activity, confirming the efficacy and safety of the surgical approach.
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The removal of balloon fragments from the pulmonary artery without damaging the pulmonary and tricuspid valves can be difficult. Four cases during transcatheter pulmonary valve replacement are described in which a novel retrieval system was used to facilitate safe removal. ().

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  • Congenital heart disease (CHD) is a prevalent birth defect that significantly impacts healthcare costs and families in the western highlands of China, necessitating a study to evaluate hospitalization costs over a decade.
  • An analysis of 3,087 patients revealed that hospitalization costs increased by an average of 4.6% per year, primarily due to surgery, materials, and drugs, with factors like length of stay and age influencing costs.
  • Strategies to reduce drug costs and hospital stay duration could help alleviate the financial burden on patients and families dealing with CHD.
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Background: The modified Blalock-Taussig-Thomas shunt is the gold standard palliation for securing pulmonary blood flow in infants with ductal-dependent pulmonary blood flow. Recently, the ductus arteriosus stent (DAS) has become a viable alternative.

Methods And Results: This was a retrospective multicenter study of neonates ≤30 days undergoing DAS or Blalock-Taussig-Thomas shunt placement between January 1, 2017 and December 31, 2020 at hospitals reporting to the Pediatric Health Information Systems database.

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