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  1. Article ; Online: Longitudinal Cardiac Testing in Patients with Kawasaki Disease with No Coronary Involvement: How Much Is Too Much?

    Gellis, Laura A / Friedman, Kevin G

    The Journal of pediatrics

    2021  Volume 244, Page(s) 10–12

    MeSH term(s) Coronary Aneurysm/diagnosis ; Coronary Aneurysm/etiology ; Coronary Vessels/diagnostic imaging ; Heart ; Humans ; Mucocutaneous Lymph Node Syndrome/complications ; Mucocutaneous Lymph Node Syndrome/diagnosis
    Language English
    Publishing date 2021-12-24
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 3102-1
    ISSN 1097-6833 ; 0022-3476
    ISSN (online) 1097-6833
    ISSN 0022-3476
    DOI 10.1016/j.jpeds.2021.12.048
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Um IV Zs.116: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Cleft closure and other predictors of contemporary outcomes after atrioventricular canal repair in patients with parachute left atrioventricular valve.

    McGeoghegan, Patrick B / Lu, Minmin / Sleeper, Lynn A / Emani, Sitaram M / Baird, Christopher W / Feins, Eric N / Gellis, Laura A / Friedman, Kevin G

    Interdisciplinary cardiovascular and thoracic surgery

    2024  Volume 38, Issue 4

    Abstract: Objectives: Parachute left atrioventricular valve (LAVV) complicates atrioventricular septal defect (AVSD) repair. We evaluate outcomes of AVSD patients with parachute LAVV and identify risk factors for adverse outcomes.: Methods: We evaluated all ... ...

    Abstract Objectives: Parachute left atrioventricular valve (LAVV) complicates atrioventricular septal defect (AVSD) repair. We evaluate outcomes of AVSD patients with parachute LAVV and identify risk factors for adverse outcomes.
    Methods: We evaluated all patients undergoing repair of AVSD with parachute LAVV from 2012 to 2021. The primary outcome was a composite of time-to-death, LAVV reintervention and development of greater than or equal to moderate LAVV dysfunction (greater than or equal to moderate LAVV stenosis and/or LAVV regurgitation). Event-free survival for the composite outcome was estimated using Kaplan-Meier methodology and competing risks analysis. Cox proportional hazards regression was used to identify predictors of the primary outcome.
    Results: A total of 36 patients were included with a median age at repair of 4 months (interquartile range 2.3-5.5 months). Over a median follow-up of 2.6 years (interquartile range 1.0-5.6 years), 6 (17%) patients underwent LAVV reintervention. All 6 patients who underwent LAVV reintervention had right-dominant AVSD. Sixteen patients (44%) met the composite outcome, and all did so within 2 years of initial repair. Transitional AVSD (versus complete), prior single-ventricle palliation, leaving the cleft completely open and greater than or equal to moderate preoperative LAVV regurgitation were associated with a higher risk of LAVV reintervention in univariate analysis. In multivariate analysis, leaving the cleft completely open was associated with the composite outcome.
    Conclusions: Repair of AVSD with parachute LAVV remains a challenge with a significant burden of LAVV reintervention and dysfunction in medium-term follow-up. Unbalanced, right-dominant AVSDs are at higher risk for LAVV reintervention. Leaving the cleft completely open might independently predict poor overall outcomes and should be avoided when possible.
    Clinical trial registration number: IRB-P00041642.
    Language English
    Publishing date 2024-03-27
    Publishing country England
    Document type Journal Article
    ISSN 2753-670X
    ISSN (online) 2753-670X
    DOI 10.1093/icvts/ivae048
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Technically successful fetal aortic valvuloplasty acutely improves left heart output.

    Asrani, Priyanka P / Gellis, Laura A / Schidlow, David / Callahan, Ryan / Porras, Diego / Wilkins-Haug, Louise / Guseh, Stephanie / Tworetzky, Wayne / Friedman, Kevin G

    Prenatal diagnosis

    2022  Volume 42, Issue 11, Page(s) 1466–1470

    MeSH term(s) Aortic Valve Stenosis/surgery ; Balloon Valvuloplasty ; Fetal Heart/diagnostic imaging ; Fetal Heart/surgery ; Humans ; Treatment Outcome
    Language English
    Publishing date 2022-09-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.6240
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1625: Show issues Location:
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  4. Article ; Online: Pediatric patient radiation dosage during endomyocardial biopsies and right heart catheterization using a standard "ALARA" radiation reduction protocol in the modern fluoroscopic era.

    Sutton, Nicole J / Lamour, Jacqueline / Gellis, Laura A / Pass, Robert H

    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

    2014  Volume 83, Issue 1, Page(s) 80–83

    Abstract: Background: Surveillance endomyocardial biopsy (EMB) with right heart catheterization (RHC) is the standard of care for the assessment of post cardiac transplantation rejection. This procedure has traditionally relied upon fluoroscopy, which exposes ... ...

    Abstract Background: Surveillance endomyocardial biopsy (EMB) with right heart catheterization (RHC) is the standard of care for the assessment of post cardiac transplantation rejection. This procedure has traditionally relied upon fluoroscopy, which exposes both patient and staff to the risks of ionizing radiation. These risks may be of particular concern in the transplant patient who must undergo many such procedures lifelong. We present data on a new "ALARA - As Low As Reasonably Achievable" protocol to reduce radiation exposure during the performance of RHC with EMB.
    Methods: All cardiac transplantation patients < 21 years of age who underwent RHC with EMB at The Children's Hospital at Montefiore from 6/11-12/11 were included. EMB was performed after all right heart pressures including wedge pressure and thermodilution cardiac output were measured. A novel ALARA protocol consisting of multiple features including ultra-low frame rates (2-3 fps), low fluoro dose/frame (10-18 nGy/frame), use of the "air-gap" technique for patients < 20 kg, and multiple other techniques aimed at minimizing use of fluoroscopy were employed in all cases. Demographics, procedural data and patient radiation exposure levels were collected and analyzed.
    Results: 18 patients underwent 45 surveillance RHC with EMB in the study period and were the subject of this analysis. The mean age was 5.9 ± 6.1 years, weight was 20.4 kg ± 16.6 kg, and BSA was 0.75 ± 45 m(2) . PA fluoroscopy was used exclusively in 45/45. Vascular access was RFV (21/45; 47%), RIJV (17/45; 38%), LFV (4/45; 9%) and LIJV (3/45; 7%). The median number of EMB specimens obtained was 5 (range, 4-7). The median fluoroscopy time was 3.7 min (range, 1.2-9). The median air Kerma product (K) was 1.4 mGy (range, 0.4-14), and dose area product (DAP) was 15.8 uGym(2) (range, 3.5-144.5). The K and DAP are substantially lower than any prior published data for RHC/EMB in this patient group. There were no procedural complications.
    Conclusions: The use of a novel ALARA protocol for RHC and EMB in pediatric cardiac transplantation patients markedly reduced radiation exposure to levels far below any previously reported values without negatively affecting the safety or efficacy of these procedures.
    MeSH term(s) Age Factors ; Biopsy/adverse effects ; Cardiac Catheterization/adverse effects ; Child ; Child, Preschool ; Clinical Protocols ; Fluoroscopy ; Graft Rejection/diagnosis ; Graft Rejection/diagnostic imaging ; Graft Rejection/etiology ; Heart Transplantation/adverse effects ; Humans ; Infant ; Infant, Newborn ; Myocardium/pathology ; Predictive Value of Tests ; Radiation Dosage ; Radiation Injuries/etiology ; Radiation Injuries/prevention & control ; Radiation Protection/methods ; Radiography, Interventional/adverse effects ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors
    Language English
    Publishing date 2014-01-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1459995-8
    ISSN 1522-726X ; 1522-1946
    ISSN (online) 1522-726X
    ISSN 1522-1946
    DOI 10.1002/ccd.25058
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1226: Show issues Location:
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  5. Article ; Online: Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with "ALARA" principles profoundly lowers total dose.

    Pass, Robert H / Gates, Gregory G / Gellis, Laura A / Nappo, Lynn / Ceresnak, Scott R

    Cardiology in the young

    2015  Volume 25, Issue 5, Page(s) 963–968

    Abstract: Background: "ALARA--As Low As Reasonably Achievable" protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose.: Methods: From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing ... ...

    Abstract Background: "ALARA--As Low As Reasonably Achievable" protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose.
    Methods: From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2-3 frames/second), low fluoro dose/frame (6-18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with "fast anatomical mapping" (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols.
    Results: A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical-fluoroscopy technique.
    Conclusions: Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.
    MeSH term(s) Adolescent ; Catheter Ablation/methods ; Female ; Fluoroscopy ; Humans ; Male ; Radiation Dosage ; Radiation Injuries/prevention & control ; Radiation Protection/methods ; Radiography, Interventional/adverse effects ; Radiometry/statistics & numerical data ; Risk Assessment ; Risk Factors ; Surgery, Computer-Assisted/statistics & numerical data ; Tachycardia, Supraventricular/diagnostic imaging ; Tachycardia, Supraventricular/surgery ; Treatment Outcome
    Language English
    Publishing date 2015-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1078466-4
    ISSN 1467-1107 ; 1047-9511
    ISSN (online) 1467-1107
    ISSN 1047-9511
    DOI 10.1017/S1047951114001474
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 4050: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  6. Article ; Online: Reducing patient radiation dosage during pediatric SVT ablations using an "ALARA" radiation reduction protocol in the modern fluoroscopic era.

    Gellis, Laura A / Ceresnak, Scott R / Gates, Gregory J / Nappo, Lynn / Pass, Robert H

    Pacing and clinical electrophysiology : PACE

    2013  Volume 36, Issue 6, Page(s) 688–694

    Abstract: Background: Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA--As Low As Reasonably Achievable" protocol ... ...

    Abstract Background: Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA--As Low As Reasonably Achievable" protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach.
    Methods: All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed.
    Results: Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m(2) (range 0.72- 1.94 m(2)). Seventeen (41%) had Wolff-Parkinson-White syndrome, 14 (33%) atrioventricular nodal reentrant tachycardia, and 11 (26%) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym(2) (range 38.2-3,172 uGym(2)); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95%; no procedural complications.
    Conclusions: An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM.
    MeSH term(s) Adolescent ; Adult ; Catheter Ablation/statistics & numerical data ; Child ; Child, Preschool ; Comorbidity ; Female ; Fluoroscopy/statistics & numerical data ; Humans ; Male ; New York/epidemiology ; Prevalence ; Radiation Dosage ; Radiation Injuries/epidemiology ; Radiation Injuries/prevention & control ; Radiation Protection ; Radiometry/statistics & numerical data ; Retrospective Studies ; Surgery, Computer-Assisted/statistics & numerical data ; Tachycardia, Supraventricular/diagnostic imaging ; Tachycardia, Supraventricular/epidemiology ; Tachycardia, Supraventricular/surgery ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2013-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 424437-0
    ISSN 1540-8159 ; 0147-8389
    ISSN (online) 1540-8159
    ISSN 0147-8389
    DOI 10.1111/pace.12124
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    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 399: Show issues

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