Publications by authors named "Ray Lowery"
Objective(s): To examine feasibility, acceptability, and preliminary effectiveness of a novel group-based telemedicine psychoeducation programme aimed at supporting psychological well-being among adolescents with Fontan-palliated CHD.
Study Design: A 5-week telemedicine psychoeducation group-based programme (WE BEAT) was developed for adolescents ( = 20; 13-18 years) with Fontan-palliated CHD aimed at improving resiliency and psychological well-being. Outcome measures included surveys of resilience (Connor-Davidson Resilience Scale), benefit finding (Benefit/Burden Scale for Children), depression, anxiety, peer relationships, and life satisfaction (National Institutes of Health Patient-Reported Outcomes Measurement Information System scales).
In the pediatric cardiac intensive care unit (PCICU), predicting the complications and long-term impact of extracorporeal membrane oxygenation (ECMO) and cardiopulmonary resuscitation (CPR) is influenced by the providers' perceptions. Little is understood about such perceptions as they relate to provider role and experience. A multi-disciplinary group in the PCICU of a single center was surveyed regarding two patient scenarios: (1) ECMO after cardiac surgery, and (2) cardiac arrest with need for CPR.
View Article and Find Full Text PDFBackground: Patient and caregiver education following pediatric heart transplant (HTx) is a cornerstone of post-HTx care. Despite the importance of post-HTx education, there are no standardized guidelines for topics and content. Education practices vary across clinicians and centers.
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- Hybrid stage I palliation is a procedure used mainly for high-risk patients with single ventricle heart disease, serving various roles such as a starter treatment or a bridge to more complex surgeries or transplants.
- A survey sent to congenital heart centers in the U.S. and Canada revealed that about 45 out of 106 centers perform this type of palliation, with a majority using pulmonary artery bands and ductal stents for management.
- There is significant variation in the practices and indications for hybrid stage I palliation among centers, highlighting the need for multicenter studies to establish standardized protocols and improve patient outcomes.
Hybrid stage 1 palliation (HS1P) is used as an alternative to the surgical Norwood for single ventricle patients and specific other conditions. Necrotizing enterocolitis (NEC) occurs in 5%-18% of infants after surgical Norwood, contributing to significant morbidity. We sought to compare the NEC incidences in HS1P versus Norwood patients.
View Article and Find Full Text PDFBackground: Emerging evidence suggests that routine physical activity may improve exercise capacity, long-term outcomes, and quality of life in individuals with Fontan circulation. Despite this, it is unclear how active these individuals are and what guidance they receive from medical providers regarding physical activity. The aim of this study was to survey Fontan patients on personal physical activity behaviours and their cardiologist-directed physical activity recommendations to set a baseline for future targeted efforts to improve this.
View Article and Find Full Text PDFPatients with a single ventricle heart who had Fontan palliation (S/P Fontan) are at increased risk for acquired morbidity. Insulin resistance (IR) is a predictor of cardiac morbidity and mortality. A single-center, cross-sectional study using S/P Fontan and controls was designed to assess IR S/P Fontan.
View Article and Find Full Text PDFFrailty is a clinical syndrome common in adults with chronic disease with resultant vulnerability to adverse health outcomes. Little is known about frailty in pediatric patients, including those with single-ventricle heart disease. This study aimed to examine the prevalence of frailty and its associated risk factors in patients with Fontan circulation.
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- The study investigates how well wrist-worn activity trackers, specifically Garmin and Fitbit, can measure heart rates in adolescents and young adults with Fontan physiology during exercise testing compared to standard electrocardiogram (ECG) readings.
- A total of 47 Fontan patients participated in cardiopulmonary exercise testing (CPET), where heart rate data from both the activity trackers and CPET ECG were collected and compared.
- Results showed the activity trackers had a mean absolute percentage error of less than 10%, indicating promising accuracy for heart rate monitoring, but further validation is needed with different exercise types.
Use of Hybrid Stage I to Stratify Between Single Ventricle Palliation and Biventricular Repair.
World J Pediatr Congenit Heart Surg
September 2024
Article Synopsis
- Hybrid stage I palliation (HS1P) has been applied to patients with single ventricle congenital heart disease, and this study examines its use for biventricular outcomes as well.
- A total of 39 patients were analyzed, with significant findings indicating that resolving intracardiac risk factors (ICRF) was linked to successful biventricular (BiV) repairs, while persistence of these risk factors pointed to poorer outcomes.
- Despite common complications and high mortality rates in certain cases, the study suggests HS1P can effectively delay the decision-making process regarding the type of surgical intervention needed for these high-risk patients.
Article Synopsis
- This study investigates the use of atrial septal intervention (ASI) in patients with hypoplastic left heart syndrome (HLHS) who underwent hybrid stage I palliation (HS1P), an alternative initial treatment method.
- Researchers analyzed data from HLHS patients over 12 years, comparing outcomes between those who had ASI during HS1P and those who had it later.
- Results showed that while ASI is common and well-tolerated, having ASI during HS1P significantly reduced the need for further ASIs later, without affecting overall patient outcomes.
Necrotizing enterocolitis (NEC) increases morbidity and mortality for infants with single ventricle heart disease (SVHD). While hematochezia often proceeds NEC not all hematochezia progresses to NEC. We aimed to examine the incidence, risk-factors, and outcomes associated with hematochezia and NEC for infants with SVHD.
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- Mitral stenosis/aortic atresia (MS/AA) is a serious form of hypoplastic left heart syndrome (HLHS), linked to complications such as ventriculocoronary connections and endocardial fibroelastosis, which may affect survival outcomes.
- A study of 141 HLHS MS/AA patients from 2000 to 2020 examined echocardiographic factors and clinical characteristics to predict early death or transplant before stage II palliation, finding 27.7% of patients experienced these outcomes.
- Key findings included a smaller ascending aorta size, lower birth weight, younger gestational age, longer cardiopulmonary bypass time
Article Synopsis
- Patients aged 13-30 with complex congenital heart disease (CHD) often face significant neurocognitive impairments and lower quality of life, especially after undergoing pulmonary valve replacement procedures.
- A study involving 68 patients found that while executive function deficits and reduced quality of life were prevalent, there were no noticeable differences between those receiving surgical or transcatheter valve replacements.
- Understanding how different treatment methods impact long-term neurocognitive and quality of life outcomes could provide valuable information for improving care in adolescents and young adults with severe CHD.
Heart failure is the leading cause of morbidity and mortality in patients with Fontan circulation. Sodium-glucose-cotransporter 2 inhibitors (SGLT2i) have become a mainstay of heart failure therapy in adult patients, however, there remains a paucity of literature to describe its use in pediatric heart failure patients, especially those with single ventricle physiology. We describe our early experience using SGLT2i in patients with single ventricle congenital heart disease surgically palliated to the Fontan circulation.
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- A study explored the feasibility of converting 3D rotational angiography (3DRA) scans of patients with congenital heart disease into augmented reality (AR) models, assessing their utility and impact on medical workflow.
- The study included 30 patients and found that AR and computer models (CM) had high image quality, with AR models being particularly effective for visualizing 3D relationships in most cases.
- Physicians viewed AR models as beneficial for identifying pathologies and aiding in interventional planning, with potential future applications in patient education and training.
Recent studies have suggested worse outcomes in patients exposed to hyperoxia while supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, there are no data regarding the effect of reducing hyperoxia exposure in this population by adjusting the fraction of inspired oxygen (FiO) of the sweep gas of the ECMO circuit. A retrospective review of 143 patients less than 1 year of age requiring VA-ECMO following cardiac surgery from 2007 to 2018 was completed.
View Article and Find Full Text PDFObjectives: To describe factors associated with failed extubation (FE) in neonates following cardiovascular surgery, and the relationship with clinical outcomes.
Design: Retrospective cohort study.
Setting: Twenty-bed pediatric cardiac ICU (PCICU) in an academic tertiary care children's hospital.
Importance: Despite high disease morbidity and mortality and complex treatment decisions, little is known about the medical and end-of-life decision-making preferences of adolescents and young adults (AYA) with advanced heart disease. AYA decision-making involvement is associated with important outcomes in other chronic illness groups.
Objective: To characterize decision-making preferences of AYAs with advanced heart disease and their parents and determine factors associated with these preferences.
Background: Studies have shown that diverse care teams optimize patient outcomes. Describing the current representation of women and minorities has been a critical step in improving diversity across several fields.
Objectives: To address the lack of data specific to pediatric cardiology, the authors conducted a national survey.
Contemporary Outcomes of Tracheostomy in Patients With Single Ventricle Heart Lesions.
World J Pediatr Congenit Heart Surg
March 2023
Objectives: Approximately 0.2% to 2.7% of children with congenital heart disease require a tracheostomy after cardiac surgery with the majority having single ventricle (SV) type heart lesions.
View Article and Find Full Text PDFBackground: Burnout is well characterised in physicians and residents but not in paediatric cardiology fellows, and few studies follow burnout longitudinally. Training-specific fears have been described in paediatric cardiology fellows but also have not been studied at multiple time points. This study aimed to measure burnout, training-specific fears, and professional fulfilment in paediatric cardiology fellows with the attention to time of year and year-of-training.
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- Patients with d-looped transposition of the great arteries (d-TGA) are at risk of severe health issues in their first days of life, which can be alleviated through an urgent procedure called balloon atrial septostomy (BAS).
- A study examined the time it took for d-TGA infants to receive BAS at a specific hospital versus those transported from other facilities and how that timing affected their health outcomes.
- The results showed that infants born at the study hospital received BAS significantly faster than those transported, and longer wait times correlated with increased ICU stays and higher chances of heart issues post-surgery, highlighting the importance of planning for urgent care in these cases.
Introduction: Prolonged pleural effusions are common post Fontan operation and are associated with morbidity. Fontan pleural effusions have elevated proinflammatory cytokines. Little is known about the chest tube drainage after a superior cavopulmonary connection.
View Article and Find Full Text PDFObjectives: Virtual reality has emerged as a unique educational modality for medical trainees. However, incorporation of virtual reality curricula into formal training programmes has been limited. We describe a multi-centre effort to develop, implement, and evaluate the efficacy of a virtual reality curriculum for residents participating in paediatric cardiology rotations.
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