gur mainzer - Academia.edu (original) (raw)

Papers by gur mainzer

Research paper thumbnail of Significant exercise limitations after recovery from MIS-C related myocarditis

World Journal of Pediatrics

Background Myocarditis is one of the presentations of multisystemic inflammatory syndrome in chil... more Background Myocarditis is one of the presentations of multisystemic inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). Although the reported short-term prognosis is good, data regarding medium-term functional capacity and limitations are scarce. This study aimed to evaluate exercise capacity as well as possible cardiac and respiratory limitations in children recovered from MIS-C related myocarditis. Methods Fourteen patients who recovered from MIS-C related myocarditis underwent spirometry and cardiopulmonary exercise testing (CPET), and their results were compared with an age-, sex-, weight-and activity level-matched healthy control group (n = 14). Results All participants completed the CPET with peak oxygen uptake (peak. V O 2), and the results were within the normal range (MIS-C 89.3% ± 8.9% and Control 87.9% ± 13.7% predicted. V O 2). Five post-MIS-C patients (35%) had exerciserelated cardio-respiratory abnormalities, including oxygen desaturation and oxygen-pulse flattening, compared to none in the control group. The MIS-C group also had lower peak exercise saturation (95.6 ± 3.5 vs. 97.6 ± 1.1) and lower breathing reserve (17.4% ± 7.5% vs. 27.4% ± 14.0% of MVV). Conclusions Patients who recovered from MIS-C related myocarditis may present exercise limitations. Functional assessment (e.g., CPET) should be included in routine examinations before allowing a return to physical activity in post-MIS-C myocarditis. Larger, longer term studies assessing functional capacity and focusing on physiological mechanisms are needed.

Research paper thumbnail of The Compatibility of Children with Obesity to Self-Report Aspects of Physical Activity Domains

Children

Questions about the different aspects of physical activity (PA) are commonly asked in the clinica... more Questions about the different aspects of physical activity (PA) are commonly asked in the clinical setting, yet their compatibility for use with children, particularly children with obesity (OB) is uncertain. Our aim was to investigate different PA-related questions when compared to an objective maximal cardiopulmonary exercise test (CPET) or validated questionnaires. For this study, 33 normal-weight (NW) (5 to less than 85% BMI percentile) and 35 OB (≥95% BMI percentile) children responded to three self-report PA questions evaluating PA domains (exercise capacity, limitations, and the maintenance of an active lifestyle); they also completed a maximal CPET and two validated questionnaires: the New York Heart Association (NYHA) questionnaire and the international physical activity questionnaire (IPAQ). The results regarding the NW children were highly compatible with their self-reports about exercise capacity (85%), whereas the compatibility was low (40%) in the OB group (p < 0.00...

Research paper thumbnail of Post Covid MIS-C Myocarditis Medium Term Exercise Limitations

Medicine & Science in Sports & Exercise

Research paper thumbnail of Individualized Assessment of Exercise Capacity in Response to Acute and Long-Term Enzyme Replacement Therapy in Pediatric Pompe Disease

Journal of Personalized Medicine, 2021

Background: Enzyme replacement therapy (ERT) with alglucosidase alfa improves the prospect of pat... more Background: Enzyme replacement therapy (ERT) with alglucosidase alfa improves the prospect of patients with infantile-onset Pompe disease (IOPD). However, a progressive decline has been reported. Objective quantification of the response to ERT when assessing newer strategies is warranted. Methods: This combined retrospective-prospective study assessed the acute and long-term effects of ERT on exercise in IOPD patients. Evaluation included cardiopulmonary exercise testing (CPET), 6-min walking test (6MWT), spirometry, motor function test (GMFM-88) and enzyme blood levels. Results: Thirty-four CPETs (17 pre- and 17 two days-post ERT) over variable follow-up periods were performed in four patients. Two days following ERT, blood enzyme levels increased (median, 1.22 and 10.15 μmol/L/h (p = 0.003)). However, FEV1, FVC and GMFM-88, the median 6MWD and the peak VO2 were unchanged. Long-term evaluations showed stabilization in young patients but progressive deterioration in adolescents. Cli...

Research paper thumbnail of Pulmonary Artery Sling And Exercise Capacity

Medicine & Science in Sports & Exercise, 2018

RESULTS: The regression models for FATMASS and %FAT were not statistically significant. The model... more RESULTS: The regression models for FATMASS and %FAT were not statistically significant. The model for WAIST showed an association with 5 of the 9 risk markers after partialling out the effects of aerobic fitness and age (r=.13 to .27, p<.01). The model for BMI demonstrated similar associations with 4 of the 9 risk markers (r=.10 to .15, p<.05). In contrast, aerobic fitness was not independently associated with any of the risk markers in either of the significant regression models. CONCLUSIONS: In police officers, body fatness is associated with CVD risk while aerobic fitness is not.

Research paper thumbnail of Exercise Capacity Vs. Mobile And Screen Time In Healthy Pediatric Population

Medicine & Science in Sports & Exercise, 2020

Research paper thumbnail of Cardiopulmonary Exercise Testing in Pediatric Idiopathic Bronchiectasis

Medicine & Science in Sports & Exercise, 2019

Research paper thumbnail of Adding Paracetamol to Ibuprofen for the Treatment of Patent Ductus Arteriosus in Preterm Infants: A Double-Blind, Randomized, Placebo-Controlled Pilot Study

American Journal of Perinatology, 2018

Objective The objective of this study was to compare the closure rate of hemodynamically signific... more Objective The objective of this study was to compare the closure rate of hemodynamically significant patent ductus arteriosus (hsPDA) of intravenous ibuprofen + paracetamol (acetaminophen) versus ibuprofen + placebo, in preterm infants of 24 to 316/7 weeks postmenstrual age. Study Design This is a single-center, double-blind, randomized controlled pilot study. Infants were assigned for treatment with either intravenous ibuprofen + paracetamol (n = 12) or ibuprofen + placebo (n = 12). Results There was no statistical difference in baseline characteristics of the two groups. Echocardiography parameters were comparable before treatment in both groups. There was a trend toward higher hsPDA closure rate in the paracetamol group in comparison to the placebo group (83 vs. 42%, p = 0.08). No adverse effects, clinical or laboratory, were associated with adding paracetamol. Conclusion Our pilot study was unable to detect a beneficial effect by adding intravenous paracetamol to ibuprofen for t...

Research paper thumbnail of Comparing the Performance of Amplatzer® and Occlutech® Figulla® Septal Occluders: The Pediatric Point of View. A Retrospective Study

The Israel Medical Association journal : IMAJ, 2017

The closure of an atrial septal defect is procedure that is frequently performed in both adults a... more The closure of an atrial septal defect is procedure that is frequently performed in both adults and children. Currently, the most commonly used devices are the Amplatzer® and Occlutech® Figulla® atrial septal occluders. Studies conducted in adults have shown that these devices all have similar performance efficiency for the closure of secundum atrial septal defects. No study to date has examined their performance in the pediatric population. To evaluate and compare the performance of Amplatzer® and Occlutech® Figulla® atrial septal occluders in the pediatric population. A consecutive retrospective study of exclusively pediatric patients who underwent percutaneous closure of atrial septal defect with these devices was conducted at our institute. The study comprised 110 children, 50 in the Amplatzer® device group and 60 in the Occlutech® Figulla® device group. The groups had similar demographic and defect characteristics, except for defect size per transesophageal echocardiography (TE...

Research paper thumbnail of Stenting of the inter-atrial septum in infants and small children: Indications, techniques and outcomes

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 11, 2018

To evaluate the procedural success and outcome of inter-atrial stenting. Inter-atrial stenting ha... more To evaluate the procedural success and outcome of inter-atrial stenting. Inter-atrial stenting has been shown to be an effective way to maintain inter-atrial blood flow, however it is considered a high risk procedure, usually performed urgently in patients with significant hemodynamic compromise. Between September 2004 and August 2016, inter-atrial stenting was attempted in 29 children. Procedural, clinical, and follow-up data were collected retrospectively. The procedures were completed successfully in 27 patients. Twenty-five procedures were undertaken percutaneously, with the remaining four being performed as hybrid procedures. The patients were considered as high risk for adverse events (82% scored as CRISP 4 and 5) with four deaths during the first 24 hr (14%). Procedural complications occurred in eight patients (28%) with related death in three patients (10%). One further patient died after an uncomplicated technically successful stent implantation performed as a salvage proce...

Research paper thumbnail of Cardiopulmonary exercise test to quantify enzyme replacement response in pediatric Pompe disease

Pediatric pulmonology, Jan 22, 2018

Enzyme replacement therapy (ERT) with Myozyme improved the prospect of Pompe disease patients. Ou... more Enzyme replacement therapy (ERT) with Myozyme improved the prospect of Pompe disease patients. Our aim was to evaluate ERT acute effect on exercise capacity in pediatric Pompe patients. Five Pompe patients (10-19 years, 4 infantile-onset and 1 diagnosed at 5 years) were evaluated before and 2 days after ERT using cardiopulmonary exercise testing (CPET), 6 min walking test (6MWT) and motor function test (GMFM-88). Preserved normal peak oxygen uptake, 6MWT and motor function were observed in the relative mild disease and impairment of these parameters in the more advanced disease. Two days following ERT, three patients demonstrated changes; one patient (relative mild disease) increased both oxygen uptake (11%) and walking distance (38%). Second patient (advanced disease) increased oxygen uptake (11%) while a small decrease in walking distance in the 6MWT (8%) was observed. Third patient (advanced disease) decreased oxygen uptake (39%) but increased walking distance (42%) and motor fun...

Research paper thumbnail of Interventional Correction of Sinus Venosus Atrial Septal Defect and Partial Anomalous Pulmonary Venous Drainage

JACC: Cardiovascular Imaging, 2017

drainage (PAPVD) are conventionally treated surgically. Cardiac magnetic resonance (CMR) (Figure ... more drainage (PAPVD) are conventionally treated surgically. Cardiac magnetic resonance (CMR) (Figure 1, Online Video 1), patient-specific 3-dimensional (3D) printing (Online Appendix) and in vitro simulation with rotational x-ray computed tomography (CT) (Figure 2, Online Videos 2 and 3) were used to explore a potential interventional catheterization treatment in 3 adult patients: placement of a custom-made covered Cheatham-Platinum stent in the superior vena cava to right atrium junction to close the SVASD while committing the anomalous pulmonary vein to the left atrium (Figures 3 and 4, Online Videos 4

Research paper thumbnail of Hybrid Approach for Recanalization and Stenting of Acquired Pulmonary Vein Occlusion

Pediatric cardiology, Jan 26, 2016

A 5-year-old child with a Fontan circulation presented with acquired left pulmonary vein occlusio... more A 5-year-old child with a Fontan circulation presented with acquired left pulmonary vein occlusion related to a previous surgical repair. We managed this lesion using a hybrid technique to perforate, dilate and stent the obstructed vessel. This approach should be considered when percutaneous access to the pulmonary veins is challenging (such as in a Fontan circulation). It also avoids the need for a high-risk redo sternotomy and cardiopulmonary bypass procedure.

Research paper thumbnail of Neonatal Atrial Fibrillation After Surgical Repair of Tracheoesophageal Fistula With Esophageal Atresia

Pediatric Cardiology, 2007

Atrial fibrillation is rare in childhood that had not been reported in neonates with normal cardi... more Atrial fibrillation is rare in childhood that had not been reported in neonates with normal cardiac morphology and function. The authors present a newborn who underwent surgical repair of a tracheoesophageal fistula with esophageal atresia at the age of 2 days and experienced atrial fibrillation 16 days after the procedure. A report of 35 pediatric patients in a single center over a period of 22 years identified atrial fibrillation in children with a variety of ailments including congenital cardiac anomalies before and after corrective surgery, rheumatic valve disease, Marfan's syndrome with mitral regurgitation, infective endocarditis, cardiomyopathy, endocardial fibroelastosis, paroxysmal atrial tachycardia of infants, and cardiac tumors [2]. All these patients had underlying cardiac disease.

Research paper thumbnail of Second Trimester Ultrasound: Reference Values for Two-Dimensional Speckle Tracking–Derived Longitudinal Strain, Strain Rate and Time to Peak Deformation of the Fetal Heart

Journal of the American Society of Echocardiography, 2012

Background: Data on myocardial deformation during the internationally widely used second-trimeste... more Background: Data on myocardial deformation during the internationally widely used second-trimester screening are scarce and confusing. Reference values of time to peak strain are missing. The aims of this study were to assess reference values derived from two-dimensional speckle-tracking echocardiography for global and regional longitudinal right ventricular (RV) and left ventricular (LV) strain, strain rate, and time to peak global strain and to determine the influence of heart rate and gender on these strain parameters. Methods: Seventy-five healthy fetuses were enrolled during second-trimester ultrasound (20-24 weeks). Clips with high frame rates (mean, 132 frames/sec) and two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses. Results: There were no statistically significant differences in global strain and strain rate between both ventricles (P = .679 and P = .734, respectively) or among the RV, septal, and LV free walls. Regional measurements, modeled also as an interaction of wall and segment (basal mid and apical), showed only a small, statistically significant difference between the basal RV and LV free walls. Strain and strain rate values were independent of heart rate. The mean time to peak LV global strain adjusted for heart rate was statistically significantly shorter than the RV value (P < .0001]). Strain, strain rate, and time to peak global strain were not found to be associated with gender. Conclusions: The establishment of second-trimester two-dimensional speckle-tracking echocardiographic reference values for global and regional strain, strain rate, and time to peak global strain in a healthy fetal cohort is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.

Research paper thumbnail of Changes in Fetal Left and Right Ventricular Strain Mechanics during Normal Pregnancy

Journal of the American Society of Echocardiography, 2013

Background: The aim of this study was to detect normal changes in fetal two-dimensional speckle-t... more Background: The aim of this study was to detect normal changes in fetal two-dimensional speckle-tracking echocardiography-derived values for global and regional longitudinal left and right ventricular strain, strain rate, and time to peak (T2P) global strain during pregnancy. Methods: Forty-four healthy fetuses were examined prospectively during the second-trimester and thirdtrimester ultrasound examinations (20-24 and 30-34 weeks, respectively). Clips with high frame rates (mean, 120 frames/sec) of two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses of global and regional walls and segments (basal, mid, and apical) of myocardial strain and strain rate as well as T2P global strain in the longitudinal direction. Results: There were statistically significant decreases in global and regional strain of the right ventricle between the second and third trimesters. No statistically significant changes were observed in global and regional strain of the left ventricle. Global and regional strain rates of both ventricles decreased in a similar way during pregnancy. The mean T2P longitudinal left ventricular global strain (adjusted for heart rate) increased mildly during fetal life. Whereas T2P longitudinal strain of the left ventricle at 20 to 24 weeks was statistically significantly shorter than that of the right ventricle, no difference in T2P longitudinal strain was found at 30 to 34 weeks of gestation between both ventricles. Conclusions: The establishment of these changes between the second-trimester and third-trimester twodimensional speckle-tracking echocardiography-derived reference values is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.

Research paper thumbnail of Morphologic, Mechanical, Conductive, and Hemodynamic Changes Following Transcatheter Closure of Atrial Septal Defect

Congenital Heart Disease, 2010

The secundum type of atrial septal defect (ASD) is a common congenital cardiac anomaly. Transcath... more The secundum type of atrial septal defect (ASD) is a common congenital cardiac anomaly. Transcatheter closure of the defect is the preferable therapeutic approach to avoid potential future complications. This work extends the data collected so far regarding the electrocardiographic, morphologic, hemodynamic, and mechanical changes following the procedure. Design. From April 2002 to October 2003, 42 consecutive patients underwent successful transcatheter closure of secundum type ASD. They were sampled for different parameters by transthoracic echocardiography before the procedure and at three different points over the next 4 years, and analyzed in two age groups: children and adults. Results. The dimensions of the chambers normalized throughout the study period. Abnormal movement of the interventricular septum normalized mostly during the first month, but its thickness increased gradually to normal levels during the 4 years of the study. High elevated pulmonary artery pressure values began declining to near normal levels from the second month following the procedure. The stroke volume and the right bundle branch block pattern improved throughout the study period. Conclusions. Transcatheter ASD closure is followed by morphologic, conductive, and hemodynamic changes at different time intervals during the first years and results in normalization or near normalization of the heart's structure and function.

Research paper thumbnail of Taming the “cobra”: An approach to “Cobra-Like” formation seen in the occlutech atrial septal defect and patent foramen ovale occluders

Catheterization and Cardiovascular Interventions, 2011

Percutaneous closure of secundum atrial septal defect and patent foramen ovale has gained widespr... more Percutaneous closure of secundum atrial septal defect and patent foramen ovale has gained widespread use in recent years. We present a small series of four cases in which a ''cobra-like'' formation occurred in an Occlutech Figulla device during the deployment of the left disk, and propose a technique that may resolve this problem.

Research paper thumbnail of Intrapericardial steroid treatment for recurrent pericardial effusion in a patient with acute lymphoblastic Leukaemia

Hematological Oncology, 2011

Intrapericardial corticosteroid therapy for pericardial effusion is an uncommon practice. We had ... more Intrapericardial corticosteroid therapy for pericardial effusion is an uncommon practice. We had an initial experience with this therapeutic measure but this was our first attempt in the context of malignant diseases and paraneoplastic syndrome. A patient with relapsed Acute Lymphoblastic Leukemia and recurrent pericardial effusion presented. She had been treated by pericardiocenthesis and systemic corticosteroids on two occasions. Following the second pericardiocenthesis and pericardial drainage, methylprednisolone was injected into the pericardium prior to withdrawal of the draining catheter. The patient had a dramatic clinical improvement with a short hospital stay and a lower dose of systemic steroids. We conclude that Intrapericardial steroids injection may be beneficial for patients with paraneoplastic syndrome and pericardial effusion.

Research paper thumbnail of Morphologic, Mechanical, Conductive, and Hemodynamic Changes Following Transcatheter Closure of Atrial Septal Defect

Congenital Heart Disease, 2010

Objective. The secundum type of atrial septal defect (ASD) is a common congenital cardiac anomal... more Objective. The secundum type of atrial septal defect (ASD) is a common congenital cardiac anomaly. Transcatheter closure of the defect is the preferable therapeutic approach to avoid potential future complications. This work extends the data collected so far regarding the electrocardiographic, morphologic, hemodynamic, and mechanical changes following the procedure.Design. From April 2002 to October 2003, 42 consecutive patients underwent successful transcatheter closure of secundum type ASD. They were sampled for different parameters by transthoracic echocardiography before the procedure and at three different points over the next 4 years, and analyzed in two age groups: children and adults.Results. The dimensions of the chambers normalized throughout the study period. Abnormal movement of the interventricular septum normalized mostly during the first month, but its thickness increased gradually to normal levels during the 4 years of the study. High elevated pulmonary artery pressure values began declining to near normal levels from the second month following the procedure. The stroke volume and the right bundle branch block pattern improved throughout the study period.Conclusions. Transcatheter ASD closure is followed by morphologic, conductive, and hemodynamic changes at different time intervals during the first years and results in normalization or near normalization of the heart's structure and function.

Research paper thumbnail of Significant exercise limitations after recovery from MIS-C related myocarditis

World Journal of Pediatrics

Background Myocarditis is one of the presentations of multisystemic inflammatory syndrome in chil... more Background Myocarditis is one of the presentations of multisystemic inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). Although the reported short-term prognosis is good, data regarding medium-term functional capacity and limitations are scarce. This study aimed to evaluate exercise capacity as well as possible cardiac and respiratory limitations in children recovered from MIS-C related myocarditis. Methods Fourteen patients who recovered from MIS-C related myocarditis underwent spirometry and cardiopulmonary exercise testing (CPET), and their results were compared with an age-, sex-, weight-and activity level-matched healthy control group (n = 14). Results All participants completed the CPET with peak oxygen uptake (peak. V O 2), and the results were within the normal range (MIS-C 89.3% ± 8.9% and Control 87.9% ± 13.7% predicted. V O 2). Five post-MIS-C patients (35%) had exerciserelated cardio-respiratory abnormalities, including oxygen desaturation and oxygen-pulse flattening, compared to none in the control group. The MIS-C group also had lower peak exercise saturation (95.6 ± 3.5 vs. 97.6 ± 1.1) and lower breathing reserve (17.4% ± 7.5% vs. 27.4% ± 14.0% of MVV). Conclusions Patients who recovered from MIS-C related myocarditis may present exercise limitations. Functional assessment (e.g., CPET) should be included in routine examinations before allowing a return to physical activity in post-MIS-C myocarditis. Larger, longer term studies assessing functional capacity and focusing on physiological mechanisms are needed.

Research paper thumbnail of The Compatibility of Children with Obesity to Self-Report Aspects of Physical Activity Domains

Children

Questions about the different aspects of physical activity (PA) are commonly asked in the clinica... more Questions about the different aspects of physical activity (PA) are commonly asked in the clinical setting, yet their compatibility for use with children, particularly children with obesity (OB) is uncertain. Our aim was to investigate different PA-related questions when compared to an objective maximal cardiopulmonary exercise test (CPET) or validated questionnaires. For this study, 33 normal-weight (NW) (5 to less than 85% BMI percentile) and 35 OB (≥95% BMI percentile) children responded to three self-report PA questions evaluating PA domains (exercise capacity, limitations, and the maintenance of an active lifestyle); they also completed a maximal CPET and two validated questionnaires: the New York Heart Association (NYHA) questionnaire and the international physical activity questionnaire (IPAQ). The results regarding the NW children were highly compatible with their self-reports about exercise capacity (85%), whereas the compatibility was low (40%) in the OB group (p < 0.00...

Research paper thumbnail of Post Covid MIS-C Myocarditis Medium Term Exercise Limitations

Medicine & Science in Sports & Exercise

Research paper thumbnail of Individualized Assessment of Exercise Capacity in Response to Acute and Long-Term Enzyme Replacement Therapy in Pediatric Pompe Disease

Journal of Personalized Medicine, 2021

Background: Enzyme replacement therapy (ERT) with alglucosidase alfa improves the prospect of pat... more Background: Enzyme replacement therapy (ERT) with alglucosidase alfa improves the prospect of patients with infantile-onset Pompe disease (IOPD). However, a progressive decline has been reported. Objective quantification of the response to ERT when assessing newer strategies is warranted. Methods: This combined retrospective-prospective study assessed the acute and long-term effects of ERT on exercise in IOPD patients. Evaluation included cardiopulmonary exercise testing (CPET), 6-min walking test (6MWT), spirometry, motor function test (GMFM-88) and enzyme blood levels. Results: Thirty-four CPETs (17 pre- and 17 two days-post ERT) over variable follow-up periods were performed in four patients. Two days following ERT, blood enzyme levels increased (median, 1.22 and 10.15 μmol/L/h (p = 0.003)). However, FEV1, FVC and GMFM-88, the median 6MWD and the peak VO2 were unchanged. Long-term evaluations showed stabilization in young patients but progressive deterioration in adolescents. Cli...

Research paper thumbnail of Pulmonary Artery Sling And Exercise Capacity

Medicine & Science in Sports & Exercise, 2018

RESULTS: The regression models for FATMASS and %FAT were not statistically significant. The model... more RESULTS: The regression models for FATMASS and %FAT were not statistically significant. The model for WAIST showed an association with 5 of the 9 risk markers after partialling out the effects of aerobic fitness and age (r=.13 to .27, p<.01). The model for BMI demonstrated similar associations with 4 of the 9 risk markers (r=.10 to .15, p<.05). In contrast, aerobic fitness was not independently associated with any of the risk markers in either of the significant regression models. CONCLUSIONS: In police officers, body fatness is associated with CVD risk while aerobic fitness is not.

Research paper thumbnail of Exercise Capacity Vs. Mobile And Screen Time In Healthy Pediatric Population

Medicine & Science in Sports & Exercise, 2020

Research paper thumbnail of Cardiopulmonary Exercise Testing in Pediatric Idiopathic Bronchiectasis

Medicine & Science in Sports & Exercise, 2019

Research paper thumbnail of Adding Paracetamol to Ibuprofen for the Treatment of Patent Ductus Arteriosus in Preterm Infants: A Double-Blind, Randomized, Placebo-Controlled Pilot Study

American Journal of Perinatology, 2018

Objective The objective of this study was to compare the closure rate of hemodynamically signific... more Objective The objective of this study was to compare the closure rate of hemodynamically significant patent ductus arteriosus (hsPDA) of intravenous ibuprofen + paracetamol (acetaminophen) versus ibuprofen + placebo, in preterm infants of 24 to 316/7 weeks postmenstrual age. Study Design This is a single-center, double-blind, randomized controlled pilot study. Infants were assigned for treatment with either intravenous ibuprofen + paracetamol (n = 12) or ibuprofen + placebo (n = 12). Results There was no statistical difference in baseline characteristics of the two groups. Echocardiography parameters were comparable before treatment in both groups. There was a trend toward higher hsPDA closure rate in the paracetamol group in comparison to the placebo group (83 vs. 42%, p = 0.08). No adverse effects, clinical or laboratory, were associated with adding paracetamol. Conclusion Our pilot study was unable to detect a beneficial effect by adding intravenous paracetamol to ibuprofen for t...

Research paper thumbnail of Comparing the Performance of Amplatzer® and Occlutech® Figulla® Septal Occluders: The Pediatric Point of View. A Retrospective Study

The Israel Medical Association journal : IMAJ, 2017

The closure of an atrial septal defect is procedure that is frequently performed in both adults a... more The closure of an atrial septal defect is procedure that is frequently performed in both adults and children. Currently, the most commonly used devices are the Amplatzer® and Occlutech® Figulla® atrial septal occluders. Studies conducted in adults have shown that these devices all have similar performance efficiency for the closure of secundum atrial septal defects. No study to date has examined their performance in the pediatric population. To evaluate and compare the performance of Amplatzer® and Occlutech® Figulla® atrial septal occluders in the pediatric population. A consecutive retrospective study of exclusively pediatric patients who underwent percutaneous closure of atrial septal defect with these devices was conducted at our institute. The study comprised 110 children, 50 in the Amplatzer® device group and 60 in the Occlutech® Figulla® device group. The groups had similar demographic and defect characteristics, except for defect size per transesophageal echocardiography (TE...

Research paper thumbnail of Stenting of the inter-atrial septum in infants and small children: Indications, techniques and outcomes

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 11, 2018

To evaluate the procedural success and outcome of inter-atrial stenting. Inter-atrial stenting ha... more To evaluate the procedural success and outcome of inter-atrial stenting. Inter-atrial stenting has been shown to be an effective way to maintain inter-atrial blood flow, however it is considered a high risk procedure, usually performed urgently in patients with significant hemodynamic compromise. Between September 2004 and August 2016, inter-atrial stenting was attempted in 29 children. Procedural, clinical, and follow-up data were collected retrospectively. The procedures were completed successfully in 27 patients. Twenty-five procedures were undertaken percutaneously, with the remaining four being performed as hybrid procedures. The patients were considered as high risk for adverse events (82% scored as CRISP 4 and 5) with four deaths during the first 24 hr (14%). Procedural complications occurred in eight patients (28%) with related death in three patients (10%). One further patient died after an uncomplicated technically successful stent implantation performed as a salvage proce...

Research paper thumbnail of Cardiopulmonary exercise test to quantify enzyme replacement response in pediatric Pompe disease

Pediatric pulmonology, Jan 22, 2018

Enzyme replacement therapy (ERT) with Myozyme improved the prospect of Pompe disease patients. Ou... more Enzyme replacement therapy (ERT) with Myozyme improved the prospect of Pompe disease patients. Our aim was to evaluate ERT acute effect on exercise capacity in pediatric Pompe patients. Five Pompe patients (10-19 years, 4 infantile-onset and 1 diagnosed at 5 years) were evaluated before and 2 days after ERT using cardiopulmonary exercise testing (CPET), 6 min walking test (6MWT) and motor function test (GMFM-88). Preserved normal peak oxygen uptake, 6MWT and motor function were observed in the relative mild disease and impairment of these parameters in the more advanced disease. Two days following ERT, three patients demonstrated changes; one patient (relative mild disease) increased both oxygen uptake (11%) and walking distance (38%). Second patient (advanced disease) increased oxygen uptake (11%) while a small decrease in walking distance in the 6MWT (8%) was observed. Third patient (advanced disease) decreased oxygen uptake (39%) but increased walking distance (42%) and motor fun...

Research paper thumbnail of Interventional Correction of Sinus Venosus Atrial Septal Defect and Partial Anomalous Pulmonary Venous Drainage

JACC: Cardiovascular Imaging, 2017

drainage (PAPVD) are conventionally treated surgically. Cardiac magnetic resonance (CMR) (Figure ... more drainage (PAPVD) are conventionally treated surgically. Cardiac magnetic resonance (CMR) (Figure 1, Online Video 1), patient-specific 3-dimensional (3D) printing (Online Appendix) and in vitro simulation with rotational x-ray computed tomography (CT) (Figure 2, Online Videos 2 and 3) were used to explore a potential interventional catheterization treatment in 3 adult patients: placement of a custom-made covered Cheatham-Platinum stent in the superior vena cava to right atrium junction to close the SVASD while committing the anomalous pulmonary vein to the left atrium (Figures 3 and 4, Online Videos 4

Research paper thumbnail of Hybrid Approach for Recanalization and Stenting of Acquired Pulmonary Vein Occlusion

Pediatric cardiology, Jan 26, 2016

A 5-year-old child with a Fontan circulation presented with acquired left pulmonary vein occlusio... more A 5-year-old child with a Fontan circulation presented with acquired left pulmonary vein occlusion related to a previous surgical repair. We managed this lesion using a hybrid technique to perforate, dilate and stent the obstructed vessel. This approach should be considered when percutaneous access to the pulmonary veins is challenging (such as in a Fontan circulation). It also avoids the need for a high-risk redo sternotomy and cardiopulmonary bypass procedure.

Research paper thumbnail of Neonatal Atrial Fibrillation After Surgical Repair of Tracheoesophageal Fistula With Esophageal Atresia

Pediatric Cardiology, 2007

Atrial fibrillation is rare in childhood that had not been reported in neonates with normal cardi... more Atrial fibrillation is rare in childhood that had not been reported in neonates with normal cardiac morphology and function. The authors present a newborn who underwent surgical repair of a tracheoesophageal fistula with esophageal atresia at the age of 2 days and experienced atrial fibrillation 16 days after the procedure. A report of 35 pediatric patients in a single center over a period of 22 years identified atrial fibrillation in children with a variety of ailments including congenital cardiac anomalies before and after corrective surgery, rheumatic valve disease, Marfan's syndrome with mitral regurgitation, infective endocarditis, cardiomyopathy, endocardial fibroelastosis, paroxysmal atrial tachycardia of infants, and cardiac tumors [2]. All these patients had underlying cardiac disease.

Research paper thumbnail of Second Trimester Ultrasound: Reference Values for Two-Dimensional Speckle Tracking–Derived Longitudinal Strain, Strain Rate and Time to Peak Deformation of the Fetal Heart

Journal of the American Society of Echocardiography, 2012

Background: Data on myocardial deformation during the internationally widely used second-trimeste... more Background: Data on myocardial deformation during the internationally widely used second-trimester screening are scarce and confusing. Reference values of time to peak strain are missing. The aims of this study were to assess reference values derived from two-dimensional speckle-tracking echocardiography for global and regional longitudinal right ventricular (RV) and left ventricular (LV) strain, strain rate, and time to peak global strain and to determine the influence of heart rate and gender on these strain parameters. Methods: Seventy-five healthy fetuses were enrolled during second-trimester ultrasound (20-24 weeks). Clips with high frame rates (mean, 132 frames/sec) and two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses. Results: There were no statistically significant differences in global strain and strain rate between both ventricles (P = .679 and P = .734, respectively) or among the RV, septal, and LV free walls. Regional measurements, modeled also as an interaction of wall and segment (basal mid and apical), showed only a small, statistically significant difference between the basal RV and LV free walls. Strain and strain rate values were independent of heart rate. The mean time to peak LV global strain adjusted for heart rate was statistically significantly shorter than the RV value (P < .0001]). Strain, strain rate, and time to peak global strain were not found to be associated with gender. Conclusions: The establishment of second-trimester two-dimensional speckle-tracking echocardiographic reference values for global and regional strain, strain rate, and time to peak global strain in a healthy fetal cohort is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.

Research paper thumbnail of Changes in Fetal Left and Right Ventricular Strain Mechanics during Normal Pregnancy

Journal of the American Society of Echocardiography, 2013

Background: The aim of this study was to detect normal changes in fetal two-dimensional speckle-t... more Background: The aim of this study was to detect normal changes in fetal two-dimensional speckle-tracking echocardiography-derived values for global and regional longitudinal left and right ventricular strain, strain rate, and time to peak (T2P) global strain during pregnancy. Methods: Forty-four healthy fetuses were examined prospectively during the second-trimester and thirdtrimester ultrasound examinations (20-24 and 30-34 weeks, respectively). Clips with high frame rates (mean, 120 frames/sec) of two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses of global and regional walls and segments (basal, mid, and apical) of myocardial strain and strain rate as well as T2P global strain in the longitudinal direction. Results: There were statistically significant decreases in global and regional strain of the right ventricle between the second and third trimesters. No statistically significant changes were observed in global and regional strain of the left ventricle. Global and regional strain rates of both ventricles decreased in a similar way during pregnancy. The mean T2P longitudinal left ventricular global strain (adjusted for heart rate) increased mildly during fetal life. Whereas T2P longitudinal strain of the left ventricle at 20 to 24 weeks was statistically significantly shorter than that of the right ventricle, no difference in T2P longitudinal strain was found at 30 to 34 weeks of gestation between both ventricles. Conclusions: The establishment of these changes between the second-trimester and third-trimester twodimensional speckle-tracking echocardiography-derived reference values is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.

Research paper thumbnail of Morphologic, Mechanical, Conductive, and Hemodynamic Changes Following Transcatheter Closure of Atrial Septal Defect

Congenital Heart Disease, 2010

The secundum type of atrial septal defect (ASD) is a common congenital cardiac anomaly. Transcath... more The secundum type of atrial septal defect (ASD) is a common congenital cardiac anomaly. Transcatheter closure of the defect is the preferable therapeutic approach to avoid potential future complications. This work extends the data collected so far regarding the electrocardiographic, morphologic, hemodynamic, and mechanical changes following the procedure. Design. From April 2002 to October 2003, 42 consecutive patients underwent successful transcatheter closure of secundum type ASD. They were sampled for different parameters by transthoracic echocardiography before the procedure and at three different points over the next 4 years, and analyzed in two age groups: children and adults. Results. The dimensions of the chambers normalized throughout the study period. Abnormal movement of the interventricular septum normalized mostly during the first month, but its thickness increased gradually to normal levels during the 4 years of the study. High elevated pulmonary artery pressure values began declining to near normal levels from the second month following the procedure. The stroke volume and the right bundle branch block pattern improved throughout the study period. Conclusions. Transcatheter ASD closure is followed by morphologic, conductive, and hemodynamic changes at different time intervals during the first years and results in normalization or near normalization of the heart's structure and function.

Research paper thumbnail of Taming the “cobra”: An approach to “Cobra-Like” formation seen in the occlutech atrial septal defect and patent foramen ovale occluders

Catheterization and Cardiovascular Interventions, 2011

Percutaneous closure of secundum atrial septal defect and patent foramen ovale has gained widespr... more Percutaneous closure of secundum atrial septal defect and patent foramen ovale has gained widespread use in recent years. We present a small series of four cases in which a ''cobra-like'' formation occurred in an Occlutech Figulla device during the deployment of the left disk, and propose a technique that may resolve this problem.

Research paper thumbnail of Intrapericardial steroid treatment for recurrent pericardial effusion in a patient with acute lymphoblastic Leukaemia

Hematological Oncology, 2011

Intrapericardial corticosteroid therapy for pericardial effusion is an uncommon practice. We had ... more Intrapericardial corticosteroid therapy for pericardial effusion is an uncommon practice. We had an initial experience with this therapeutic measure but this was our first attempt in the context of malignant diseases and paraneoplastic syndrome. A patient with relapsed Acute Lymphoblastic Leukemia and recurrent pericardial effusion presented. She had been treated by pericardiocenthesis and systemic corticosteroids on two occasions. Following the second pericardiocenthesis and pericardial drainage, methylprednisolone was injected into the pericardium prior to withdrawal of the draining catheter. The patient had a dramatic clinical improvement with a short hospital stay and a lower dose of systemic steroids. We conclude that Intrapericardial steroids injection may be beneficial for patients with paraneoplastic syndrome and pericardial effusion.

Research paper thumbnail of Morphologic, Mechanical, Conductive, and Hemodynamic Changes Following Transcatheter Closure of Atrial Septal Defect

Congenital Heart Disease, 2010

Objective. The secundum type of atrial septal defect (ASD) is a common congenital cardiac anomal... more Objective. The secundum type of atrial septal defect (ASD) is a common congenital cardiac anomaly. Transcatheter closure of the defect is the preferable therapeutic approach to avoid potential future complications. This work extends the data collected so far regarding the electrocardiographic, morphologic, hemodynamic, and mechanical changes following the procedure.Design. From April 2002 to October 2003, 42 consecutive patients underwent successful transcatheter closure of secundum type ASD. They were sampled for different parameters by transthoracic echocardiography before the procedure and at three different points over the next 4 years, and analyzed in two age groups: children and adults.Results. The dimensions of the chambers normalized throughout the study period. Abnormal movement of the interventricular septum normalized mostly during the first month, but its thickness increased gradually to normal levels during the 4 years of the study. High elevated pulmonary artery pressure values began declining to near normal levels from the second month following the procedure. The stroke volume and the right bundle branch block pattern improved throughout the study period.Conclusions. Transcatheter ASD closure is followed by morphologic, conductive, and hemodynamic changes at different time intervals during the first years and results in normalization or near normalization of the heart's structure and function.