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Article ; Online: Imaging and guiding intervention for tricuspid valve disorders using 3-dimensional transesophageal echocardiography in pediatric and congenital heart disease.

Doan, Tam T / Pignatelli, Ricardo H / Parekh, Dhaval R / Parthiban, Anitha

The international journal of cardiovascular imaging

2023 Volume 39, Issue 10, Page(s) 1855–1864

Abstract: In the pediatric and congenital heart disease (CHD) population, tricuspid valve (TV) disorders are complex due to the variable TV morphology, its sophisticated interaction with the right ventricle as well as associated congenital and acquired lesions. ... ...

Abstract	In the pediatric and congenital heart disease (CHD) population, tricuspid valve (TV) disorders are complex due to the variable TV morphology, its sophisticated interaction with the right ventricle as well as associated congenital and acquired lesions. While surgery is the standard of care for TV dysfunction in this patient population, transcatheter treatment for bioprosthetic TV dysfunction has been performed successfully. Detailed and accurate anatomic assessment of the abnormal TV is essential in the preoperative/preprocedural planning. Three-dimensional transthoracic and 3D transesophageal echocardiography (3DTEE) provides added value to 2-dimensional imaging in the characterization of the TV to guide therapy and 3DTEE serves as an excellent tool for intraoperative assessment and procedural guidance of transcatheter treatment. Notwithstanding advances in imaging and therapy, the timing and indication for intervention for TV disorders in this population are not well defined. In this manuscript, we aim to review the available literature, provide our institutional experience with 3DTEE, and briefly discuss the perceived challenges and future directions in the assessment, surgical planning, and procedural guidance of (1) congenital TV malformations, (2) acquired TV dysfunction from transvenous pacing leads, or following cardiac surgeries, and (3) bioprosthetic TV dysfunction.
Language	English
Publishing date	2023-06-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2055311-0
ISSN	1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
ISSN (online)	1875-8312 ; 1573-0743
ISSN	1569-5794 ; 0167-9899
DOI	10.1007/s10554-023-02898-8
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Article ; Online: Single tertiary center experience using Gore Cardioform Atrial Septal Defect Occluder for secundum atrial septal defect closure with a focus on deficient rims.

Lahiri, Subhrajit / Qureshi, Athar M / Pignatelli, Ricardo H / Eilers, Lindsay / Khan, Asra / Bansal, Manish / Webb, Melissa K / Stapleton, Gary / Gowda, Srinath T

The Journal of invasive cardiology

2023 Volume 35, Issue 11

Abstract: Background: The data on the use of Gore Cardioform Septal Occluder (GCA; W. L. Gore and Associates, Inc.) for atrial septal defect (ASD) with deficient rims is limited.: Methods: All patients evaluated by transesophageal echocardiogram (TEE) for ASD ... ...

Abstract	Background: The data on the use of Gore Cardioform Septal Occluder (GCA; W. L. Gore and Associates, Inc.) for atrial septal defect (ASD) with deficient rims is limited. Methods: All patients evaluated by transesophageal echocardiogram (TEE) for ASD occlusion were included. TEE planes at 35°, 0°, and 90° were assessed for anterior-superior (AS) and posterior (P), anterior-inferior (AI) and posterior-superior (PS), as well as superior (S) and inferior (I) rims. ASD size >20 mm, and rims less than 5 mm were defined as large and deficient, respectively. We included patients who had a procedural failure along with the patients in whom the procedure was not attempted after echocardiogram in the unsuccessful group. Results: In 148 patients, the median weight, age, and ASD size were 36 kg (range, 8-60 kg), 11.8 years (range, 1-60 years), and 14.2 ± 8.28 mm, respectively. One or more deficient rims were noted in 112 of 148 (75.7%): 99 (67%) AS, 36 (24%) P, 17 (11%) AI, 30 (20%) PS, 26 (18%) S, and 33 (22%) I. ASD closure was performed in 115 (78%) patients. The procedure was successful in 111 (96.5%) patients with procedural failure in 4 (3.4%) patients. Multiple deficient rims were associated with reduced procedural success (OR 0.36, 95% CI, 0.25-0.56). On multivariate analysis deficient P, PS, and I rims were associated with an unsuccessful group (P = .001, .046, and .005, respectively). Complications included 1 device embolization, 1 vascular injury, and 5 arrhythmias. Conclusions: Transcatheter closure of ASDs with deficient rims is feasible using GCA. Large ASDs with deficient P, PS, and I rims were associated with unsuccessful closure. Risk stratification and comprehensive evaluation of ASD rims is vital for the use of GCA.
MeSH term(s)	Humans ; Cardiac Catheterization ; Heart Septal Defects, Atrial/diagnosis ; Heart Septal Defects, Atrial/surgery ; Echocardiography, Transesophageal ; Echocardiography ; Arrhythmias, Cardiac ; Septal Occluder Device ; Treatment Outcome
Language	English
Publishing date	2023-10-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1154372-3
ISSN	1557-2501 ; 1042-3931
ISSN (online)	1557-2501
ISSN	1042-3931
DOI	10.25270/jic/23.00119
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Article ; Online: Strain Imaging: The Emergence of Speckle Tracking Echocardiography into Clinical Pediatric Cardiology.

Colquitt, John L / Pignatelli, Ricardo H

Congenital heart disease

2016 Volume 11, Issue 2, Page(s) 199–207

Abstract: Speckle tracking echocardiography measures myocardial strain and allows for the quantification of regional and global left and right ventricular function. A growing body of literature is supporting its transition from research into clinical practice. ... ...

Abstract	Speckle tracking echocardiography measures myocardial strain and allows for the quantification of regional and global left and right ventricular function. A growing body of literature is supporting its transition from research into clinical practice. This article aims to provide a practical review of strain imaging as it applies to congenital and pediatric heart disease, with the goals of increasing literacy and advocating for greater clinical integration.
MeSH term(s)	Child ; Echocardiography/methods ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/physiopathology ; Humans ; Reproducibility of Results ; Ventricular Function/physiology
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2274321-2
ISSN	1747-0803 ; 1747-079X
ISSN (online)	1747-0803
ISSN	1747-079X
DOI	10.1111/chd.12334
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Article ; Online: Single systemic right ventricle longitudinal strain: Intravendor reproducibility and intervendor agreement in children.

Colquitt, John L / Wilkinson, J Chris / Liu, Asela M / Pignatelli, Ricardo H / Loar, Robert W

Echocardiography (Mount Kisco, N.Y.)

2021 Volume 38, Issue 3, Page(s) 402–409

Abstract: Purpose: Strain derived from speckle-tracking echocardiography is emerging as a useful tool in the assessment of single ventricle function. The purpose of this study is to compare layer-specific longitudinal strain values in children with single, ... ...

Abstract	Purpose: Strain derived from speckle-tracking echocardiography is emerging as a useful tool in the assessment of single ventricle function. The purpose of this study is to compare layer-specific longitudinal strain values in children with single, systemic right ventricles (sRV) using two commercially available software platforms (GE EchoPAC (EP) and TomTec (TT)). Methods: Two readers analyzed two-dimensional longitudinal strain on EP (v 202) and TT (v 2.21.25) in 40 pediatric sRV patients. Intravendor reproducibility and intervendor agreement between layer-specific measurements were assessed by intraclass correlation coefficient and Bland-Altman analysis. Absolute difference (AbΔ) and relative mean errors (RME) were calculated. Subgroup comparisons (stratified by age, heart rate (HR), and frames per second (FPS): HR ratio) were made. Results: Median age was 4.4 years. 32 (80%) patients had hypoplastic left heart syndrome; 19 (48%) were post-Fontan. Intravendor reproducibility was excellent with high ICC (0.86-0.97). AbΔ between readers was small (1.2%-1.5%) with interobserver RME slightly higher for TT (11%-12% vs 8%-9% for EP). Layer-specific intervendor agreement was poor (ICC 0.45-0.62). Default layer comparisons (EP mid vs TT endo) showed good agreement (ICC 0.72-0.77) and less variability (AbΔ 2%, RME 15%) than layer-to-layer. There were no differences in ICC for groups dichotomized by age, HR, or FPS:HR ratio. sRV strain values are more negative when using EP. Conclusion: Intravendor reproducibility for sRV peak longitudinal strain in children is excellent with acceptable variability between experienced users. Intervendor, layer-specific strain agreement is poor. Vendor default layer strain values show better agreement but are not interchangeable.
Language	English
Publishing date	2021-02-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	843645-9
ISSN	1540-8175 ; 0742-2822
ISSN (online)	1540-8175
ISSN	0742-2822
DOI	10.1111/echo.14985
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Article ; Online: Global Longitudinal Strain Analysis of the Single Right Ventricle: Leveling the Playing Field.

Wilkinson, James C / Colquitt, John L / Doan, Tam T / Liu, Asela M / Lilje, Christian G / Denfield, Susan W / Pignatelli, Ricardo H / Loar, Robert W

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

2022 Volume 35, Issue 6, Page(s) 657–663

Abstract: Background: All available echocardiographic methods to assess single systemic right ventricular systolic function have limitations. Subjective grading is prone to bias and varies among readers. Quantitative methods that require significant manual input, ...

Abstract	Background: All available echocardiographic methods to assess single systemic right ventricular systolic function have limitations. Subjective grading is prone to bias and varies among readers. Quantitative methods that require significant manual input, such as fractional area change (FAC), are often not reproducible. The aim of this study was to determine whether global longitudinal strain (GLS) is more reproducible than FAC and subjective grading in patients with systemic right ventricle among individual readers and across different levels of experience. Methods: Clinically indicated echocardiograms from 40 patients with functional systemic right ventricles were assessed by five readers with varying reading experience: one sonographer, one cardiology fellow, and three attending cardiologists at different career stages. All readers were blinded to patient data and other reader responses. Each reader reviewed the same images for subjective grade (on a scale ranging from 1 [normal] to 8 [severely depressed]), right ventricular end-diastolic and end-systolic area measurements, and longitudinal strain analysis. A repeat analysis was performed under identical conditions after ≥2 weeks on all 40 patients. Inter- and intrareader reproducibility was assessed using intraclass correlation coefficients (ICCs). Correlations between responses were assessed using Spearman's correlation coefficient. Results: The subjective method had fair to good reproducibility (ICC = 0.7; interquartile range [IQR], 0.60-0.72), while the FAC method was poor (ICC = 0.46; IQR, 0.39-0.51) among readers. Reproducibility for GLS was excellent (ICC = 0.88; IQR, 0.88-0.89). Intrareader reproducibility was excellent by subjective grading (ICC = 0.85; IQR, 0.73-0.88), poor by FAC (ICC = 0.63; IQR, 0.35-0.66), and excellent by GLS (ICC = 0.93; IQR, 0.88-0.96). Attending-level readers were more consistent with their subjective grading, while all readers were excellent with GLS. Conclusions: GLS is more reproducible than conventional methods at assessing systemic right ventricular systolic function among readers with different levels of experience. For most readers it was more consistent than their own subjective grades of right ventricular function. Laboratories staffed by multiple readers are likely to be more consistent in grading systemic right ventricular systolic function using GLS.
MeSH term(s)	Echocardiography/methods ; Heart Ventricles/diagnostic imaging ; Humans ; Reproducibility of Results ; Systole ; Ventricular Function, Right/physiology
Language	English
Publishing date	2022-03-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1016/j.echo.2022.03.003
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Article ; Online: Imaging of the pulmonary valve in the adults.

Pignatelli, Ricardo H / Noel, Cory / Reddy, S Chandra B

Current opinion in cardiology

2017 Volume 32, Issue 5, Page(s) 529–540

Abstract: Purpose of review: Pulmonary valve is the least imaged of the cardiac valves in adults. This review will address the strengths and the limitations of various imaging modalities that are commonly used for evaluation of pulmonary valve diseases in the ... ...

Abstract	Purpose of review: Pulmonary valve is the least imaged of the cardiac valves in adults. This review will address the strengths and the limitations of various imaging modalities that are commonly used for evaluation of pulmonary valve diseases in the adults. Recent findings: Valvular pulmonary stenosis is mostly congenital and pulmonary regurgitation is usually an acquired pulmonary valve disease. Combined pulmonary stenosis and pulmonary regurgitation as sequel to previous surgeries for congenital heart diseases is the most common form of pulmonary valve disease in the adults. Transthoracic echocardiography (TTE) is the first-line imaging for the pulmonary valve, however, TTE pose considerable technical limitations in adults secondary to the body habitus, previous surgeries, and imaging artifacts by the interposed foreign tissue. Transesophageal echocardiography is infrequently used because of farther location of the imaging probe from the pulmonary valve precluding optimal imaging. Cardiac computerized tomography (CT) and cardiac MRI are fast emerging as the most preferred imaging modalities for pulmonary valve diseases in the adults.CT is used to obtain precise anatomic information about the pulmonary valve and the contiguous anatomy such as the right ventricular outflow tract, the distal pulmonary arteries including the coronary arteries. MRI by virtue of its high temporal resolution has the unique advantage of obtaining hemodynamic information related to the pulmonary valve; such as quantification of the pulmonary regurgitation, the right ventricle volumes, mass, and the systolic function. Combined imaging with CT and MRI provide anatomic and hemodynamic information in a variety of pulmonary valve diseases; is useful for understanding of the right ventricle adaptive mechanism and remodeling process, for preprocedure planning during percutaneous pulmonary valve implantation and for surveillance of different pulmonary valve diseases. Summary: Multimodality imaging involving a combination of TTE, CT, and (or) MRI are useful to delineate the anatomic and hemodynamic abnormalities associated with different pulmonary valve diseases in the adults.
Language	English
Publishing date	2017-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	645186-x
ISSN	1531-7080 ; 0268-4705
ISSN (online)	1531-7080
ISSN	0268-4705
DOI	10.1097/HCO.0000000000000436
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Article ; Online: Excessive Trabeculation of the Left Ventricle: JACC: Cardiovascular Imaging Expert Panel Paper.

Petersen, Steffen E / Jensen, Bjarke / Aung, Nay / Friedrich, Matthias G / McMahon, Colin J / Mohiddin, Saidi A / Pignatelli, Ricardo H / Ricci, Fabrizio / Anderson, Robert H / Bluemke, David A

JACC. Cardiovascular imaging

2023 Volume 16, Issue 3, Page(s) 408–425

Abstract: Excessive trabeculation, often referred to as "noncompacted" myocardium, has been described at all ages, from the fetus to the adult. Current evidence for myocardial development, however, does not support the formation of compact myocardium from ... ...

Abstract	Excessive trabeculation, often referred to as "noncompacted" myocardium, has been described at all ages, from the fetus to the adult. Current evidence for myocardial development, however, does not support the formation of compact myocardium from noncompacted myocardium, nor the arrest of this process to result in so-called noncompaction. Excessive trabeculation is frequently observed by imaging studies in healthy individuals, as well as in association with pregnancy, athletic activity, and with cardiac diseases of inherited, acquired, developmental, or congenital origins. Adults with incidentally noted excessive trabeculation frequently require no further follow-up based on trabecular pattern alone. Patients with cardiomyopathy and excessive trabeculation are managed by cardiovascular symptoms rather than the trabecular pattern. To date, the prognostic role of excessive trabeculation in adults has not been shown to be independent of other myocardial disease. In neonates and children with excessive trabeculation and normal or abnormal function, clinical caution seems warranted because of the reported association with genetic and neuromuscular disorders. This report summarizes the evidence concerning the etiology, pathophysiology, and clinical relevance of excessive trabeculation. Gaps in current knowledge of the clinical relevance of excessive trabeculation are indicated, with priorities suggested for future research and improved diagnosis in adults and children.
MeSH term(s)	Adult ; Child ; Infant, Newborn ; Humans ; Heart Ventricles/diagnostic imaging ; Predictive Value of Tests ; Myocardium ; Cardiomyopathies/diagnostic imaging ; Diagnostic Imaging ; Heart Diseases ; Isolated Noncompaction of the Ventricular Myocardium/diagnostic imaging ; Isolated Noncompaction of the Ventricular Myocardium/therapy
Language	English
Publishing date	2023-02-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2022.12.026
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Article ; Online: Reply: Discourage LVNC or Revise the Criteria of LVNC?

Petersen, Steffen E / Jensen, Bjarke / Aung, Nay / Friedrich, Matthias G / McMahon, Colin J / Mohiddin, Saidi A / Pignatelli, Ricardo H / Ricci, Fabrizio / Anderson, Robert H / Bluemke, David A

JACC. Cardiovascular imaging

2023 Volume 16, Issue 6, Page(s) 869

MeSH term(s)	Humans ; Predictive Value of Tests ; Magnetic Resonance Imaging, Cine ; Isolated Noncompaction of the Ventricular Myocardium
Language	English
Publishing date	2023-04-12
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2023.03.023
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Article ; Online: Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: Recommendations From the American Society of Echocardiography.

Mertens, Luc / Singh, Gautam / Armenian, Saro / Chen, Ming-Hui / Dorfman, Adam L / Garg, Ruchira / Husain, Nazia / Joshi, Vijaya / Leger, Kasey J / Lipshultz, Steven E / Lopez-Mattei, Juan / Narayan, Hari K / Parthiban, Anitha / Pignatelli, Ricardo H / Toro-Salazar, Olga / Wasserman, Melissa / Wheatley, Jacqueline

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

2023 Volume 36, Issue 12, Page(s) 1227–1253

MeSH term(s)	Child ; Humans ; Echocardiography ; Heart ; Multimodal Imaging ; Neoplasms/diagnosis ; United States/epidemiology
Language	English
Publishing date	2023-12-03
Publishing country	United States
Document type	Journal Article ; Practice Guideline
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1016/j.echo.2023.09.009
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Article ; Online: Correlating decline in left ventricular ejection fraction and longitudinal strain in pediatric cancer patients.

Sanchez Mejia, Aura A / Pignatelli, Ricardo H / Rainusso, Nino / Lilje, Christian / Sachdeva, Shagun / Tunuguntla, Hari P / Doan, Tam T / Gandhi, Anusha A / Walters, Nicole C / Trajtenberg, Daniela Plana / Loar, Robert W

The international journal of cardiovascular imaging

2022 Volume 39, Issue 4, Page(s) 747–755

Abstract: Purpose: Left ventricular ejection fraction (LVEF) is routinely used to monitor cardiac function in cancer patients. Global longitudinal strain (GLS) detects subclinical myocardial dysfunction. There is no consensus on what constitutes a significant ... ...

Abstract	Purpose: Left ventricular ejection fraction (LVEF) is routinely used to monitor cardiac function in cancer patients. Global longitudinal strain (GLS) detects subclinical myocardial dysfunction. There is no consensus on what constitutes a significant change in GLS in pediatric cancer patients. We aim to determine the change in GLS associated with a simultaneous decline in LVEF in pediatric cancer patients. Methods: This is a retrospective longitudinal study of pediatric cancer patients treated with anthracyclines between October 2017 and November 2019. GLS was measured by 2-dimensional speckle tracking. The study outcome was a decline in LVEF, defined as a decrease in LVEF of ≥ 10% points from baseline or LVEF < 55%. We evaluated two echocardiograms per patient, one baseline, and one follow-up. The follow-up echocardiogram was either (1) the first study that met the outcome or (2) the last echocardiogram available in patients without the outcome. Statistical analyses included receiver operator characteristic curves and univariable and multivariable Cox proportional hazards regression. Results: Out of 161 patients, 33 (20.5%) had a decline in LVEF within one year of follow-up. GLS reduction by ≥ 15% from baseline and follow-up GLS >-18% had sensitivities of 85% and 78%, respectively, and specificities of 86% and 83%, respectively, to detect LVEF decline. GLS reduction by ≥ 15% from baseline and follow-up GLS >-18% were independently associated with simultaneous LVEF decline [hazard ratio (95% confidence intervals): 16.71 (5.47-51.06), and 12.83 (4.62-35.63), respectively]. Conclusion: Monitoring GLS validates the decline in LVEF in pediatric cancer patients.
MeSH term(s)	Child ; Humans ; Ventricular Function, Left ; Stroke Volume ; Longitudinal Studies ; Retrospective Studies ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/etiology ; Predictive Value of Tests ; Neoplasms/diagnostic imaging ; Neoplasms/drug therapy
Language	English
Publishing date	2022-12-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2055311-0
ISSN	1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
ISSN (online)	1875-8312 ; 1573-0743
ISSN	1569-5794 ; 0167-9899
DOI	10.1007/s10554-022-02780-z
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