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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
Approach to Congenital Heart Disease
Chapter by: Tretter, Justin T.; Bhatla, Puneet
in: Problem Solving in Pediatric Imaging by
[S.l.] : Elsevier, 2023
pp. 53-77
ISBN: 9780323430456
CID: 5349062
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
Strain in children with MIS-C and acute COVID-19
Minocha, Prashant; Srinivasan, Ranjini; Babb, James; Singh, Rakesh; Phoon, Colin L.; Better, Donna; Bhatla, Puneet
Context: Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. Aims: We sought to describe strain findings in both the groups on initial presentation and follow-up. Settings and Design: A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. Subjects and Methods: TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. Results: Forty-five patients (34 - MIS-C and 11 - COVID-19) met the inclusion criteria. There was a statistically significant decrease in LV longitudinal strain (P < 0.001), LV circumferential strain (P < 0.001), and left atrial strain (P = 0.014) in the MIS-C group when compared to the control group. There was a statistically significant decrease in LV longitudinal strain (P = 0.028) in the acute COVID-19 group. All patients with abnormal left ventricular EF (LVEF) had abnormal strain. However, 14 (41%) patients in the MIS-C group and 3 (27%) in the acute COVID-19 group had preserved LVEF but abnormal strain. There was a significant correlation with LV longitudinal strain (P = 0.005) and LVEF (P = 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. Conclusions: Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.
SCOPUS:85151906148
ISSN: 0974-2069
CID: 5460742
Reply [Letter]
Minocha, Prashant K; Bhatla, Puneet; Singh, Rakesh K
PMCID:8763407
PMID: 35051414
ISSN: 1097-6833
CID: 5190002
Preservation of Antegrade Pulmonary Blood Flow in Kawashima Procedure With Prior Right Ventricular Outflow Tract Stent
Bhansali, Suneet; Bhatla, Puneet; Argilla, Michael; Saharan, Sunil; Mosca, Ralph; Kumar, Tk Susheel
Surgical management of single ventricle with interrupted inferior vena cava and azygos continuation typically requires a Kawashima procedure with subsequent completion of Fontan. However, this group is at risk of development of pulmonary arteriovenous malformations. Evidence suggests preservation of hepatic venous flow into the pulmonary circulation can potentially delay this development. We hereby describe a method of preserving antegrade pulmonary blood flow during the Kawashima procedure in the setting of prior right ventricular outflow tract stents.
PMID: 35171728
ISSN: 2150-136x
CID: 5163502
Three-Dimensional Printed Model Guiding Transcutaneous Device Closure of a Complex Residual Ventricular Septal Defect: Comparing Apples to Apples
Chapter by: Tretter, Justin T.; Bhatla, Puneet
in: Modelling Congenital Heart Disease: Engineering a Patient-specific Therapy by
[S.l.] : Springer International Publishing, 2022
pp. 221-225
ISBN: 9783030888916
CID: 5499422
Double Outlet Right Ventricle: Introductory Concepts and Applications
Chapter by: Tretter, Justin T.; Capelli, Claudio; Bhatla, Puneet
in: Modelling Congenital Heart Disease: Engineering a Patient-specific Therapy by
[S.l.] : Springer International Publishing, 2022
pp. 101-109
ISBN: 9783030888916
CID: 5499462
Strain in children with MIS-C and acute COVID-19
Minocha, Prashant K; Srinivasan, Ranjini; Babb, James; Singh, Rakesh K; Phoon, Colin K L; Better, Donna; Bhatla, Puneet
CONTEXT/UNASSIGNED:Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. AIMS/UNASSIGNED:We sought to describe strain findings in both the groups on initial presentation and follow-up. SETTINGS AND DESIGN/UNASSIGNED:A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. SUBJECTS AND METHODS/UNASSIGNED:TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. RESULTS/UNASSIGNED:= 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. CONCLUSIONS/UNASSIGNED:Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.
PMCID:10158472
PMID: 37152504
ISSN: 0974-2069
CID: 5544462
Periscopic technique in Norwood operation is associated with better preservation of early ventricular function
Bhatla, Puneet; Kumar, Tk Susheel; Makadia, Luv; Winston, Brandon; Bull, Catherine; Nielsen, James C; Williams, David; Chakravarti, Sujata; Ohye, Richard G; Mosca, Ralph S
Objective/UNASSIGNED:Although the right ventricle (RV) to pulmonary artery conduit in stage 1 Norwood operation results in improved interstage survival, the long-term effects of the ventriculotomy used in the traditional technique remain a concern. The periscopic technique (PT) of RV to pulmonary artery conduit placement has been described as an alternative technique to minimize RV injury. A retrospective study was performed to compare the effects of traditional technique and PT on ventricular function following Norwood operation. Methods/UNASSIGNED:A retrospective study of all patients who underwent Norwood operation from 2012 to 2019 was performed. Patients with baseline RV dysfunction and significant tricuspid valve regurgitation were excluded. Prestage 2 echocardiograms were reviewed by a blinded experienced imager for quantification of RV function (sinus and infundibular RV fractional area change) as well as for regional conduit site wall dysfunction (normal or abnormal, including hypokinesia, akinesia, or dyskinesia). Wilcoxon rank-sum tests were used to assess differences in RV infundibular and RV sinus ejection fraction and the Fisher exact test was used to assess differences in regional wall dysfunction. Results/UNASSIGNED:Â =Â .002). Conclusions/UNASSIGNED:The PT for RV to pulmonary artery conduit in Norwood operation results in better preservation of early RV global and regional systolic function. Whether or not this benefit translates to improved clinical outcome still needs to be studied.
PMCID:8350951
PMID: 34401829
ISSN: 2666-2507
CID: 4989292