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  • Open Access

    ARTICLE

    Educational intervention for improving the appropriateness of transthoracic echocardiograms ordered by pediatric cardiologists

    Ritu Sachdeva1, Pamela S. Douglas2, Michael S. Kelleman1, Courtney E. McCracken1, Leo Lopez3, Kenan W.D. Stern4, Benjamin W. Eidem5, Oscar J. Benavidez6, Rory B. Weiner6, Elizabeth Welch3, Robert M. Campbell1, Wyman W. Lai7

    Congenital Heart Disease, Vol.12, No.3, pp. 373-381, 2017, DOI:10.1111/chd.12455

    Abstract Objective: The objective of this study was to evaluate effectiveness of educational intervention (EI) in the Pediatric Appropriate Use of Echocardiography (PAUSE) study to improve appropriateness of transthoracic echocardiograms (TTEs) ordered in pediatric cardiology clinics.
    Design: Data were prospectively collected after the publication of the Appropriate Use Criteria (AUC) document during 2 phases: the pre-EI phase (1/1/15 to 4/30/15) and the post-EI phase (7/ 1/15 to 10/30/15). Pre-EI, site-investigators (SI) determined AUC indications, by reviewing the clinic records. Post-EI, providers assigned indications prior to obtaining TTE.
    Setting: Pediatric cardiology clinics at six centers.
    Patients: Those ≤18 years old, receiving initial… More >

  • Open Access

    ARTICLE

    Tissue plasminogen activator for neonatal coronary thrombosis presenting with mitral valve regurgitation and impaired ventricular function

    Delaram Molkara, Jose A. Silva Sepulveda, Thomas Do, Christopher Davis, Gregory P. Goldstein, John W. Moore, Howaida G El-Said

    Congenital Heart Disease, Vol.12, No.3, pp. 270-274, 2017, DOI:10.1111/chd.12432

    Abstract Objective: Neonatal coronary thrombosis is a rarely reported disorder, with variable outcomes described. This study assessed the feasibility and safety of an institutional protocol using tissue plasminogen activator (tPA) administration for the treatment of neonatal coronary artery thrombi.
    Methods: They reviewed the outcome of three neonates with clinical evidence of myocardial infarction secondary to coronary thrombosis. All three underwent the tPA treatment protocol.
    Results: The three described cases presented at 5 hours, 15 hours, and 10 days of life. The patients identified underwent the tPA protocol at least once. There was clinical evidence of improvement in coronary flow, as well… More >

  • Open Access

    ARTICLE

    Effect of solute temperature in the measurement of cardiac output in children using the thermodilution technique

    Shyam Sathanandam1, Pooja Kashyap1, David Zurakowski2, Lindsey Bird1, Vera McGhee3, Jeffrey Towbin1, Benjamin Rush Waller III1

    Congenital Heart Disease, Vol.12, No.2, pp. 181-187, 2017, DOI:10.1111/chd.12423

    Abstract Objectives: The primary aim of this study was to compare thermodilution (TD) cardiac index (TDCi) measured by injecting cold saline (C-TDCi) to saline at room temperature (R-TDCi). The secondary aim was to assess the change in body temperature with cold saline injections in children.
    Design: This is a prospective, case control study.
    Setting: Cardiac catheterization lab at Le Bonheur Children’s Hospital, Memphis, Tennessee.
    Patients: Eighty-six children ≤18 years of age that underwent cardiac catheterization between April 2013 and April 2015, excluding patients with admixing lesions, on inotropic support and with ejection fraction < 30%.
    Interventions: A TD catheter in the… More >

  • Open Access

    ARTICLE

    Appropriateness of pediatric outpatient transthoracic echocardiogram orders following cessation of an active educational intervention

    Shae Anderson1,2, Courtney E. McCracken2, Ritu Sachdeva1,2

    Congenital Heart Disease, Vol.13, No.6, pp. 1050-1057, 2018, DOI:10.1111/chd.12679

    Abstract Objective: The educational intervention (EI) through the Pediatric Appropriate Use of Echocardiography (PAUSE) multicenter study resulted in improved appropriate‐ ness of transthoracic echocardiogram (TTE) orders at our center. The current study evaluated if this pattern persisted after cessation of EI and the potential physician characteristics influencing appropriateness.
    Design: Outpatients (≤18 years old) seen for initial evaluation during the EI (July to October, 2015) and 6‐month post‐EI (May to August, 2016) phases were included. Comparison was made between TTE rates and appropriateness ratings during EI and post‐EI phase. Association between TTE rate and appropriateness with physician characteristics (age, experience, patient volume,… More >

  • Open Access

    ARTICLE

    Improving outpatient advance care planning for adults with congenital or pediatric heart disease followed in a pediatric heart failure and transplant clinic

    Lindsay A. Edwards1,2, Christine Bui2,3, Antonio G. Cabrera1,2, Jill Ann Jarrell2,4,5

    Congenital Heart Disease, Vol.13, No.3, pp. 362-368, 2018, DOI:10.1111/chd.12579

    Abstract Objective: To improve outpatient advanced care planning (ACP) for adults with congenital/pediatric heart disease followed in a pediatric heart failure (HF) and transplant clinic through quality improvement (QI) methodology.
    Design: A one-year QI project was completed. We conducted quarterly chart reviews and incorporated feedback from the providers to direct subsequent interventions.
    Patients and Setting: Patients ≥18 years of age seen in the HF and Transplant Clinic for followup visit were included in analysis.
    Interventions: Interventions focused on five main areas: identifying and training providers to have ACP discussions, standardizing the ACP discussion, standardizing ACP and advance directive (AD) documentation in… More >

  • Open Access

    ARTICLE

    Prolonged Tpeak‐Tend interval is a risk factor for sudden cardiac death in adults with congenital heart disease

    Jim T. Vehmeijer1, Zeliha Koyak1, A. Suzanne Vink1, Werner Budts2,3, Louise Harris4, Candice K. Silversides4, Erwin N. Oechslin4, Aeilko H. Zwinderman5, Barbara J.M. Mulder1,6, Joris R. de Groot1

    Congenital Heart Disease, Vol.14, No.6, pp. 952-957, 2019, DOI:10.1111/chd.12847

    Abstract Objective: Adult congenital heart disease (ACHD) patients are at risk of sudden cardiac death (SCD). However, methods for risk stratification are not yet well‐ defined. The Tpeak‐Tend (TpTe) interval, a measure of dispersion of ventricular repolari‐ zation, is a risk factor for SCD in non‐ACHD patients. We aim to evaluate whether TpTe can be used in risk stratification for SCD in ACHD patients.
    Design: From an international multicenter cohort of 25 790 ACHD patients, we iden‐ tified all SCD cases. Cases were matched to controls by age, gender, congenital de‐ fect, and (surgical) intervention.
    Outcome Measures: TpTe was measured on… More >

  • Open Access

    ARTICLE

    Role of Doppler echocardiography for assessing right ventricular cardiac output in patients with atrial septal defect

    Vidhushei Yogeswaran1, Rahul Kanade1, Camilo Mejia1, Ayotola Fatola1, Srikanth Kothapalli1, Maria Najam1, Harigopal Sandhyavenu1, Mounika Angirekula1, Karim Osma1, Mathews Jessey1, Donald Hagler2, Alexander C. Egbe1

    Congenital Heart Disease, Vol.14, No.5, pp. 713-719, 2019, DOI:10.1111/chd.12813

    Abstract Background: Although Doppler echocardiography is routinely used to assess left ventricle cardiac output, there are limited data about the feasibility of Doppler echo‐ cardiography for right ventricular (RV) cardiac output assessment in patients with left‐to‐right shunt. The purpose of the study was to determine the correlation be‐ tween Doppler‐derived and Fick‐derived RV cardiac index (CI), and the interobserver correlation in Doppler‐derived RV CI assessment.
    Methods: Retrospective study of patients (age ≥18 years) with unrepaired atrial septal defect who underwent cardiac catheterization and echocardiography (within 3 days), 2004‐2017. RV CI was calculated using the hydraulic orifice formula: [.785 × (right ventricle… More >

  • Open Access

    ARTICLE

    Application of pediatric Appropriate Use Criteria for initial outpatient evaluation of asymptomatic patients with abnormal electrocardiograms

    Soham Dasgupta1, Shae Anderson1, Michael Kelleman2, Ritu Sachdeva1

    Congenital Heart Disease, Vol.14, No.2, pp. 230-235, 2019, DOI:10.1111/chd.12687

    Abstract Introduction: In the pediatric Appropriate Use Criteria (AUC), abnormal electrocardiogram (ECG) in an asymptomatic patient has been rated as an “Appropriate” indication for transthoracic echocardiogram (TTE). We hypothesized that the yield of abnormal findings on TTE for this indication will be low.
    Methods: All asymptomatic patients (≤ 18 years) from January 1, 2015 to December 31, 2017 who underwent initial outpatient evaluation at our center and had a TTE ordered for an abnormal ECG, were included. Clinic records were reviewed to obtain ECG and TTE findings.
    Results: Of the 199 study patients, 13 (6.5%) had abnormal findings. Incomplete right bundle… More >

  • Open Access

    ARTICLE

    Toward a More Accurate Web Service Selection Using Modified Interval DEA Models with Undesirable Outputs

    Alireza Poordavoodi1, Mohammad Reza Moazami Goudarzi2,*, Hamid Haj Seyyed Javadi3, Amir Masoud Rahmani4, Mohammad Izadikhah5

    CMES-Computer Modeling in Engineering & Sciences, Vol.123, No.2, pp. 525-570, 2020, DOI:10.32604/cmes.2020.08854

    Abstract With the growing number of Web services on the internet, there is a challenge to select the best Web service which can offer more quality-of-service (QoS) values at the lowest price. Another challenge is the uncertainty of QoS values over time due to the unpredictable nature of the internet. In this paper, we modify the interval data envelopment analysis (DEA) models [Wang, Greatbanks and Yang (2005)] for QoS-aware Web service selection considering the uncertainty of QoS attributes in the presence of desirable and undesirable factors. We conduct a set of experiments using a synthesized dataset to show the capabilities of… More >

  • Open Access

    ARTICLE

    Innovative Design and Additive Manufacturing of Regenerative Cooling Thermal Protection System Based on the Triply Periodic Minimal Surface Porous Structure

    Xinglong Wang1,2, Cheng Wang1,2, Xin Zhou1,*, Mingkang Zhang3, Peiyu Zhang1, Lei Wang2

    CMES-Computer Modeling in Engineering & Sciences, Vol.123, No.2, pp. 495-508, 2020, DOI:10.32604/cmes.2020.09778

    Abstract The new regenerative cooling thermal protection system exhibits the multifunctional characteristics of load-carrying and heat exchange cooling, which are fundamental for the lightweight design and thermal protection of hypersonic vehicles. Triply periodic minimal surface (TPMS) is especially suitable for the structural design of the internal cavity of regenerative cooling structures owing to its excellent structural characteristics. In this study, test pieces were manufactured using Ti6Al4V lightweight material. We designed three types of porous test pieces, and the interior was filled with a TPMS lattice (Gyroid, Primitive, I-WP) with a porosity of 30%. All porous test pieces were manufactured via selective… More >

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