Effect of Pressure Recovery on Pressure Gradients in Congenital Stenotic Outflow Lesions in Pediatric Patients—Clinical Implications of Lesion Severity and Geometry: A Simultaneous Doppler Echocardiography and Cardiac Catheter Correlative Study

Singh, Gautam K.; Mowers, Katie L.; Marino, Cynthia J.; Balzer, David T.; Rao, P. Syamasundar

doi:10.1016/j.echo.2019.09.001

Cited by 24 publications

(33 citation statements)

References 34 publications

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“…The pressure differences are collated in Figure 9 and indicate that, in case 1, both the measured and the predicted gradient is in excess of the 20-mmHg standard, indicating the presence of a stenosis that requires repair. The measured pressure difference was somewhat higher than the predicted value, which is in part anticipated, due to the use of the simplified Bernoulli equation in the echoderived measurement (Singh et al, 2019), which implies no flow separation. As observed from the predicted flow field in Figure 7, this is a significant assumption.…”

Section: Pressure Resultsmentioning

confidence: 69%

A Patient-Specific CFD Pipeline Using Doppler Echocardiography for Application in Coarctation of the Aorta in a Limited Resource Clinical Context

Swanson

Owen

Keshmiri

et al. 2020

Front. Bioeng. Biotechnol.

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Congenital heart disease (CHD) is the most common birth defect globally and coarctation of the aorta (CoA) is one of the commoner CHD conditions, affecting around 1/1800 live births. CoA is considered a CHD of critical severity. Unfortunately, the prognosis for a child born in a low and lower-middle income country (LLMICs) with CoA is far worse than in a high-income country. Reduced diagnostic and interventional capacities of specialists in these regions lead to delayed diagnosis and treatment, which in turn lead to more cases presenting at an advanced stage. Computational fluid dynamics (CFD) is an important tool in this context since it can provide additional diagnostic data in the form of hemodynamic parameters. It also provides an in silico framework, both to test potential procedures and to assess the risk of further complications arising post-repair. Although this concept is already in practice in high income countries, the clinical infrastructure in LLMICs can be sparse, and access to advanced imaging modalities such as phase contrast magnetic resonance imaging (PC-MRI) is limited, if not impossible. In this study, a pipeline was developed in conjunction with clinicians at the Red Cross War Memorial Children's Hospital, Cape Town and was applied to perform a patient-specific CFD study of CoA. The pipeline uses data acquired from CT angiography and Doppler transthoracic echocardiography (both much more clinically available than MRI in LLMICs), while segmentation is conducted via SimVascular and simulation is realized using OpenFOAM. The reduction in cost through use of open-source software and the use of broadly available imaging modalities

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Section: Pressure Resultsmentioning

confidence: 69%

A Patient-Specific CFD Pipeline Using Doppler Echocardiography for Application in Coarctation of the Aorta in a Limited Resource Clinical Context

Swanson

Owen

Keshmiri

et al. 2020

Front. Bioeng. Biotechnol.

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“…Although, peak instantaneous and/or mean Doppler gradients were initially thought to reflect the peak-to-peak catheter gradients [22], because of pressure recovery phenomenon [5,23,24], the Doppler gradients are not accurate in estimating the catheterization-derived gradients. The author generally uses an average of peak instantaneous and mean Doppler aortic valve gradients to estimate the catheterization gradients.…”

Section: Echo-doppler Studies In the Evaluation Of Results Of Bavmentioning

confidence: 99%

“…Therefore, the Doppler gradients are usually used in making a decision on the need for BAV. It was initially thought that peak instantaneous and/or mean Doppler gradients reflect the peak-to-peak catheter-measured gradients [22] but, because of factors related to pressure recovery phenomenon [23,24], the Doppler gradients are not necessarily accurate in predicting catheter gradients. I use an average of peak instantaneous and mean Doppler gradients as an alternative to calculate pressure recovery.…”

Section: Indications For Balloon Aortic Valvuloplastymentioning

confidence: 99%

Role of Balloon Aortic Valvuloplasty in the Management of Aortic Stenosis

Rao¹

2021

JCCI

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Balloon aortic valvuloplasty (BAV) provides an excellent alternative to surgical intervention and has become the preferred intervention for initial palliation for aortic stenosis in neonates, infants, children, adolescents, and young adults. The elderly patients with calcific aortic stenosis do not benefit from BAV. With the exception of neonates, most patients can be discharged home within 24-hours of the procedure. Although there is definitive evidence for pressure gradient relief immediately after as well as at follow-up and postponement of surgical intervention following BAV, the progression of aortic insufficiency at late follow up remain a major concern. In the neonatal population, severe aortic insufficiency may develop requiring surgical intervention. Despite these limitations, balloon aortic valvuloplasty is currently considered as therapeutic procedure of choice in the management of congenital aortic stenosis in the pediatric and young adult population. Careful follow-up to detect recurrence of stenosis and development of significant aortic insufficiency is recommended.

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“…Recently, a complete manuscript was prepared and submitted for publication and the manuscript was published [43].…”

Section: Role Of Pressure Recovery In Explaining Differences Between mentioning

confidence: 99%

The Author’s Contributions to Echocardiography Literature (Part II—1991–2020)

Rao¹

2020

Children

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The author’s contribution up to 1990 was reviewed in part I and the echo contributions from 1991 to 2020 will be reviewed in part II. These include defining the relationship between the quantity of shunt across the atrial septal defect (ASD) and the diameter of ASD by echo and angio on the one side and the stretched diameter of the ASD on the other; echocardiographic assessment of balloon-stretched diameter of secundum ASDs; development of echocardiographic predictors of accomplishment of percutaneous closure of ASDs with the buttoned device, highlighting limitations of echocardiography in comprehensive assessment of mixed type of total anomalous pulmonary venous connection; description of follow-up echocardiographic results of transcatheter closure of ASD with buttoned device; review of ultrasound studies; depiction of collaborative echocardiographic and Doppler studies; echocardiographic appraisal of the outcome of balloon pulmonary valvuloplasty; editorials; ventricular septal aneurysm causing pulmonary outflow tract obstruction in the morphologic left ventricle in corrected transposition of the great arteries; dependability of echocardiographic assessment of angiographic minimal diameter of the ductus; occurrence of supravalvular pulmonary artery stenosis after a Nuss procedure; echocardiographic assessment of neonates who were suspected of having heart disease; role of echocardiographic studies in the appraisal of patent ductus arteriosus in the premature babies; and the role of pressure recovery in explaining differences between simultaneously measured Doppler and cardiac catheterization pressure gradients across outflow tract stenotic lesions.

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Effect of Pressure Recovery on Pressure Gradients in Congenital Stenotic Outflow Lesions in Pediatric Patients—Clinical Implications of Lesion Severity and Geometry: A Simultaneous Doppler Echocardiography and Cardiac Catheter Correlative Study

Cited by 24 publications

References 34 publications

A Patient-Specific CFD Pipeline Using Doppler Echocardiography for Application in Coarctation of the Aorta in a Limited Resource Clinical Context

A Patient-Specific CFD Pipeline Using Doppler Echocardiography for Application in Coarctation of the Aorta in a Limited Resource Clinical Context

Role of Balloon Aortic Valvuloplasty in the Management of Aortic Stenosis

The Author’s Contributions to Echocardiography Literature (Part II—1991–2020)

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