Publications by authors named "Doff B McElhinney"

Quantification of right ventricular (RV) size and function after tetralogy of Fallot repair is critical for determining timing of reintervention and outcomes. Tetralogy of Fallot patients with pulmonary atresia and major aortopulmonary collateral arteries (TOF/PA/MAPCAs) are a unique group in which the RV is subjected to various loading conditions, allowing for direct comparison. Retrospective evaluation of RV echocardiographic indices in repaired pediatric TOF/PA/MAPCAs patients (2/2002 - 4/2018).

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Background: In October 2022, the Heart Valve Collaboratory and Food and Drug Administration convened a global multidisciplinary workshop to address the unmet clinical need to promote and accelerate the development of pediatric-specific heart valve technologies.

Methods: The Pediatric Heart Valve Global Multidisciplinary Workshop was convened in October 2022. Key stakeholders, including expert clinicians in pediatric cardiology and cardiac surgery, valve manufacturers, engineers and scientists were assembled to review the current state-of-the-art, discuss unique challenges in the pre-and post-market evaluation of pediatric valve therapies, and highlight emerging technologies that show potential to address some of the key unmet needs of children with valve disease.

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Purpose: Pulmonary valve replacement (PVR) using bioprosthetic valves is a common procedure performed in patients with repaired Tetralogy of Fallot and other conditions, but these valves frequently become dysfunctional within 15 years of implantation. The causes for early valve failure are not clearly understood. The purpose of this study was to explore the impact of changing cardiac output (CO) and valve orientation on local hemodynamics and valve performance.

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Background: Preterm birth (PTB) is a serious health problem. PTB complications is the main cause of death in infants under five years of age worldwide. The ability to accurately predict risk for PTB during early pregnancy would allow early monitoring and interventions to provide personalized care, and hence improve outcomes for the mother and infant.

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Article Synopsis
  • Right ventricular outflow dysfunction is a common issue in patients with repaired tetralogy of Fallot, leading to increased health risks as they age.
  • The American Heart Association has released an update focusing on how to monitor and treat this condition effectively, including new therapies and techniques for managing complications.
  • The statement highlights the importance of understanding how other health issues and patients' perspectives affect their quality of life and includes discussions on when and how to perform pulmonary valve replacements.
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It is well-known that right ventricle-to-pulmonary artery homograft conduit durability is worse for smaller conduits and smaller/younger patients. However, there is limited literature on age and conduit-size specific outcomes, or on the role of conduit oversizing. Patients diagnosed with tetralogy of Fallot and major aortopulmonary collateral arteries undergoing right ventricular outflow tract (RVOT) reconstruction with a valved aortic homograft conduit from November 2001 through March 2023, at our institution were included.

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  • Primary central nervous system lymphoma (PCNSL) is a rare non-Hodgkin’s lymphoma that affects brain tissue, making diagnosis difficult due to similarities with other brain tumors and invasive biopsy procedures.
  • This study collected cerebrospinal fluid (CSF) samples from patients with PCNSL, other brain tumors, and controls, using advanced proteomic analysis to develop a diagnostic panel.
  • The resulting proteomic panel showed high accuracy in differentiating PCNSL from other conditions, suggesting a new approach to improve diagnosis and patient outcomes in clinical settings.
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  • Patients with d-transposition of the great arteries (d-TGA) who have had an arterial switch operation (ASO) may experience right ventricular outflow tract (RVOT) issues, leading to the consideration of transcatheter pulmonary valve replacement (TPVR) as a treatment option.
  • A study involving 33 patients showed a 66% success rate for TPVR, with most patients receiving either a Melody or SAPIEN valve, while some conditions like coronary compression prevented the procedure for a subset of patients.
  • Post-TPVR, there was a significant reduction in RVOT gradient and a majority of patients reported minimal or no pulmonary regurgitation; however, a higher rate of reinterventions was noted in this
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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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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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Article Synopsis
  • 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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  • - SOVA is a rare heart condition that can lead to serious complications if it ruptures.
  • - When SOVA ruptures, it has a high risk of mortality and is often found alongside other congenital heart issues like VSD and bicuspid AV.
  • - Repairing a ruptured SOVA is necessary, and percutaneous repair is a safe method, with echocardiograms being essential for diagnosis and guiding the repair process.
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Markers of aging hold promise in the context of colorectal cancer (CRC) care. Utilizing high-resolution metabolomic profiling, we can unveil distinctive age-related patterns that have the potential to predict early CRC development. Our study aims to unearth a panel of aging markers and delve into the metabolomic alterations associated with aging and CRC.

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This study describes right ventricle (RV) characteristics and right ventricle to pulmonary artery (RV-PA) conduit function pre- and post-repair in patients with tetraology of Fallot with major aortopulmonary collaterals (TOF/MAPCAs). We reviewed patients who underwent single-stage, complete unifocalization, and repair of TOF/MAPCAs between 2006 and 2019 with available pre- and early postoperative echocardiograms. For a subset of patients, 6-12 month follow-up echocardiogram was available.

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Blood pressure gradient ( ) across an aortic coarctation (CoA) is an important measurement to diagnose CoA severity and gauge treatment efficacy. Invasive cardiac catheterization is currently the gold-standard method for measuring blood pressure. The objective of this study was to evaluate the accuracy of estimates derived non-invasively using patient-specific 0D and 3D deformable wall simulations.

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Article Synopsis
  • The study analyzed real-world data from 4,513 transcatheter pulmonary valve replacement (TPVR) procedures conducted from April 2016 to March 2021, primarily involving patients around 19 years old.
  • It highlighted the growing preference for the SAPIEN valve over the Melody valve, with SAPIEN use rising from approximately 25% to 60% during the period, particularly for treating native or patched right ventricular outflow tracts.
  • The results indicated high acute success rates (around 95%) across different patient groups, but also noted a slightly increased risk of major complications in patients with homografts or native RVOTs compared to those with prior bioprosthetic valves.
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Background: Evidence for the efficacy of cardiac resynchronization therapy (CRT) in pediatric and congenital heart disease (CHD) has been limited to surrogate outcomes.

Objectives: This study aimed to assess the impact of CRT upon the risk of transplantation or death in a retrospective, high-risk, controlled cohort at 5 quaternary referral centers.

Methods: Both CRT patients and control patients were <21 years of age or had CHD; had systemic ventricular ejection fraction <45%; symptomatic heart failure; and significant electrical dyssynchrony (QRS duration z score >3 or single-site ventricular pacing >40%) at enrollment.

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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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Due to the poor prognosis and rising occurrence, there is a crucial need to improve the diagnosis of Primary Central Nervous System Lymphoma (PCNSL), which is a rare type of non-Hodgkin's lymphoma. This study utilized targeted metabolomics of cerebrospinal fluid (CSF) to identify biomarker panels for the improved diagnosis or differential diagnosis of primary central nervous system lymphoma (PCNSL). In this study, a cohort of 68 individuals, including patients with primary central nervous system lymphoma (PCNSL), non-malignant disease controls, and patients with other brain tumors, was recruited.

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Congenital heart disease (CHD) represents a significant contributor to both morbidity and mortality in neonates and children. There's currently no analogous dried blood spot (DBS) screening for CHD immediately after birth. This study was set to assess the feasibility of using DBS to identify reliable metabolite biomarkers with clinical relevance, with the aim to screen and classify CHD utilizing the DBS.

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Background: The Harmony TPV25 transcatheter pulmonary valve (Medtronic Inc.) is constructed with a self-expanding stent frame comprising six zigged nitinol wires sewn together and covered with knitted polyester fabric, with flared inflow and outflow ends and a porcine pericardial valve sutured to the central portion of the device. It was approved for treatment of pulmonary regurgitation after prior right ventricular outflow tract repair in 2021.

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Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date.

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