Searched for: in-biosketch:true
person:halped02
Clinical cases of electrosonography in adult congenital heart disease
Chapter by: Halpern, Dan G.; Small, Adam J.; Elitzur, Yair; Herzog, Eyal; Leibowitz, David
in: Cardiac Electrosonography by
[S.l.] : Springer International Publishing, 2023
pp. 323-348
ISBN: 9783031384684
CID: 5695472
Adult congenital heart disease care in a municipal public health system
Tinsay, Maria Andrea Francesca M; Halpern, Dan G; Feinberg, Jodi L; Vorsanger, Matthew; Keller, Norma; Small, Adam J
Specialty care is associated with improved outcomes for adults with adult CHD and must be extended to the underserved. A retrospective cohort study was performed to describe the provision of care to adult CHD patients in America's largest municipal public health system including patient demographics, diagnostic and therapeutic procedures, and adherence to guideline-recommended surveillance. We identified 229 adult CHD patients aged >18 years through electronic medical records. The most common diagnoses were atrial septal defect, ventricular septal defect, patent ductus arteriosus, and valvular pulmonary stenosis. In total, 65% had moderate or greater anatomic complexity. A large number of patients were uninsured (45%), non-white (96%), and non-English speaking (44%). One hundred forty-six patients (64%) presented with unrepaired primary defects. Fifty eight patients underwent primary repair during the study period; 48 of those repairs were surgical and 10 were transcatheter. Collaboration with an affiliated Comprehensive Care Center was utilised for 28% of patients. A high proportion of patients received adult CHD speciality visits (78%), echocardiograms (66%), and electrocardiograms (56%) at the guideline-recommended frequency throughout the study period. There was no significant difference in the rate of adherence to guideline-recommended surveillance based on insurance status, race/ethnicity, or primary language status. The proportion of patients who had guideline-recommended adult CHD visits, echocardiograms, and electrocardiograms was significantly lower for those with more advanced physiological stages. These results can inform the provision of adult CHD care in other public health system settings.
PMID: 37909409
ISSN: 1467-1107
CID: 5614462
Anatomical/Physiological Correlates of Functional Capacity in Adults With Repaired and Nonsevere Coarctation of the Aorta
Ramachandran, Abhinay; Talmor, Nina; Saric, Muhamed; Feinberg, Jodi; Small, Adam J; Halpern, Dan G
BACKGROUND/UNASSIGNED:There is limited data regarding the interplay of anatomic and physiologic parameters with exercise capacity in adults with native or recurrent nonsevere coarctation of the aorta (CoA). OBJECTIVES/UNASSIGNED:The objective of this study was to use exercise stress echocardiography and cardiac magnetic resonance imaging to identify anatomic and physiologic correlates of exercise capacity in these patients. METHODS/UNASSIGNED:We conducted a single-center retrospective analysis of 54 adults with nonsevere CoA (repaired or unrepaired) followed at our institution between 2015 and 2020. Resting coarctation gradients were obtained using echocardiography. Exercise gradients and functional capacity were assessed using exercise stress echocardiography. Aorta anatomy was obtained using magnetic resonance imaging. RESULTS/UNASSIGNED: < 0.05). CONCLUSIONS/UNASSIGNED:In patients with nonsevere native or recurrent CoA, reduced exercise capacity is correlated with coarctation severity by anatomic size and gradients. Those with a coarctation-to-diaphragm ratio ≤0.7 may represent a subset of patients with nonsevere CoA whose clinical symptoms are only elicited with exercise stress testing. Exercise stress testing and cross-sectional imaging may help identify those who could be considered for earlier coarctation intervention.
PMCID:11198206
PMID: 38938731
ISSN: 2772-963x
CID: 5733432
Reproductive Health in Congenital Heart Disease: Preconception, Pregnancy, and Postpartum
Halpern, Dan G; Penfield, Christina A; Feinberg, Jodi L; Small, Adam J
The prevalence of congenital heart disease (CHD) in pregnancy is rising due to the improved survival of patients with CHD into childbearing age. The profound physiological changes that occur during pregnancy may worsen or unmask CHD, affecting both mother and fetus. Successful management of CHD during pregnancy requires knowledge of both the physiological changes of pregnancy and the potential complications of congenital heart lesions. Care of the CHD patient should be based on a multidisciplinary team approach beginning with preconception counseling and continuing into conception, pregnancy, and postpartum periods. This review summarizes the published data, available guidelines and recommendations for the care of CHD during pregnancy.
PMCID:10219377
PMID: 37233153
ISSN: 2308-3425
CID: 5543922
Congenital anatomy, acquired pathology - A synergistic approach to echocardiographic evaluation of the adult with congenital heart disease [Comment]
Small, Adam J; Bhatla, Puneet; Saric, Muhamed; Halpern, Dan G; Kutty, Shelby
PMID: 36897538
ISSN: 1540-8175
CID: 5448652
Undiagnosed ventricular septal defect with resultant Eisenmenger syndrome presenting with diplopia [Case Report]
Duncan, Ellen; Small, Adam; Sulica, Roxana; Halpern, Dan
Ventricular septal defect (VSD) is the most common congenital heart lesion among children. In most cases, however, it is identified and corrected in childhood, before long-term sequelae such as pulmonary hypertension develop. In this case report, we present a young man with an undiagnosed VSD with consequent Eisenmenger syndrome who initially presented to medical attention with diplopia found to be caused by cerebral infarcts.
PMID: 36456362
ISSN: 1532-8171
CID: 5374132
Correlation of MRI premature ventricular contraction activation pattern in bigeminy with electrophysiology study-confirmed site of origin
Axel, Leon; Bhatla, Puneet; Halpern, Dan; Magnani, Silvia; Stojanovska, Jadranka; Barbhaiya, Chirag
Although PVCs commonly lead to degraded cine cardiac MRI (CMR), patients with PVCs may have relatively sharp cine images of both normal and ectopic beats ("double beats") when the rhythm during CMR is ventricular bigeminy, and only one beat of the pair is detected for gating. MRI methods for directly imaging premature ventricular contractions (PVCs) are not yet widely available. Localization of PVC site of origin with images may be helpful in planning ablations. The contraction pattern of the PVCs in bigeminy provides a "natural experiment" for investigating the potential utility of PVC imaging for localization. The purpose of this study was to evaluate the correlation of the visually assessed site of the initial contraction of the ectopic beats with the site of origin found by electroanatomic mapping. Images from 7 of 86 consecutive patients who underwent CMR prior to PVC ablation were found to include clear cine images of bigeminy. The visually apparent site of origin of the ectopic contraction was determined by three experienced, blinded CMR readers and correlated with each other, and with PVC site of origin determined by 3D electroanatomic mapping during catheter ablation. Blinded ascertainment of visually apparent initial contraction pattern for PVC localization was within 2 wall segments of PVC origin by 3D electroanatomic mapping 76% of the time. Our data from patients with PVCs with clear images of the ectopic beats when in bigeminy provide proof-of-concept that CMR ectopic beat contraction patterns analysis may provide a novel method for localizing PVC origin prior to ablation procedures. Direct imaging of PVCs with use of newer cardiac imaging methods, even without the presence of bigeminy, may thus provide valuable data for procedural planning.
PMID: 36598692
ISSN: 1875-8312
CID: 5395092
Isolated Left Ventricular Apical Hypoplasia: A Very Rare Congenital Anomaly Characterized by Multimodality Imaging and Invasive Testing
Maidman, Samuel D; Salerno, William D; Halpern, Dan G; Donnino, Robert; Saric, Muhamed
PMID: 36448445
ISSN: 1942-0080
CID: 5373972
Adherence and Exercise Capacity Improvements of Patients With Adult Congenital Heart Disease Participating in Cardiac Rehabilitation
Sheng, S Peter; Feinberg, Jodi L; Bostrom, John A; Tang, Ying; Sweeney, Greg; Pierre, Alicia; Katz, Edward S; Whiteson, Jonathan H; Haas, François; Dodson, John A; Halpern, Dan G
Background As the number of adults with congenital heart disease increases because of therapeutic advances, cardiac rehabilitation (CR) is increasingly being used in this population after cardiac procedures or for reduced exercise tolerance. We aim to describe the adherence and exercise capacity improvements of patients with adult congenital heart disease (ACHD) in CR. Methods and Results This retrospective study included patients with ACHD in CR at New York University Langone Rusk Rehabilitation from 2013 to 2020. We collected data on patient characteristics, number of sessions attended, and functional testing results. Pre-CR and post-CR metabolic equivalent task, exercise time, and maximal oxygen uptake were assessed. In total, 89 patients with ACHD (mean age, 39.0 years; 54.0% women) participated in CR. Referral indications were reduced exercise tolerance for 42.7% and post-cardiac procedure (transcatheter or surgical) for the remainder. Mean number of sessions attended was 24.2, and 42 participants (47.2%) completed all 36 CR sessions. Among participants who completed the program as well as pre-CR and post-CR functional testing, metabolic equivalent task increased by 1.3 (95% CI, 0.7-1.9; baseline mean, 8.1), exercise time increased by 66.4 seconds (95% CI, 21.4-111.4 seconds; baseline mean, 536.1 seconds), and maximal oxygen uptake increased by 2.5 mL/kg per minute (95% CI, 0.7-4.2 mL/kg per minute; baseline mean, 20.2 mL/kg per minute). Conclusions On average, patients with ACHD who completed CR experienced improvements in exercise capacity. Efforts to increase adherence would allow more patients with ACHD to benefit.
PMID: 35929458
ISSN: 2047-9980
CID: 5288322
Biatrial drainage of right superior vena cava with left superior vena cava: A diagnostic conundrum [Case Report]
Bhansali, Suneet; Cohen, Roi B; Halpern, Dan; Saharan, Sunil; Saric, Muhamed; Kumar, T K Susheel; Mosca, Ralph S
PMCID:9366530
PMID: 35967232
ISSN: 2666-2507
CID: 5299732