PubMed Health⌕ Search

Biomedical subjects

M S Sklansky

Publications and source records attributed to M S Sklansky.

At least 19 recordsLinked to original sources
PubMed2004

The 'spin' technique: a new method for examination of the fetal outflow tracts using three-dimensional ultrasound.

BACKGROUND AND OBJECTIVE: The prenatal detection of congenital heart defects remains one of the most difficult challenges for the sonologist/sonographer when performing the second- or third-trimester screening examination. The four-chamber view has been used for a number of years as the primary screening image for detection of heart defects, but the inclusion of the right and left outflow tracts increases the detection of cardiac malformations. One of the difficulties, however, is obtaining and interpreting two-dimensional images of the outflow tracts. This paper reviews a new technique using three-dimensional (3D) multiplanar imaging that allows the examiner to identify the outflow tracts within a few minutes of acquiring the 3D volume dataset by rotating the volume dataset around the x- and y-axes. METHODS: 3D multiplanar imaging of the fetal heart using static 3D or spatio-temporal image correlation (STIC) imaging allows the examiner to obtain a volume of data that can be manipulated along the x- and y-axes using reference points from the four-chamber view, five-chamber view, three-vessel view at the level of the bifurcation of the pulmonary arteries, and three-vessel view at the level of the transverse aortic arch and trachea. RESULTS: The full length of the main pulmonary artery, ductus arteriosus, aortic arch and superior vena cava could be identified easily in the normal fetus by rotating the volume dataset along the x- and y-axes. The vessels were identified using the four-chamber view, the five-chamber view, and the two three-vessel views. The technique was useful in identification of d-transposition of the great vessels and evaluation of the outflow tracts in hypoplastic left heart syndrome. CONCLUSION: 3D multiplanar evaluation of the fetal heart allows the examiner to identify the outflow tracts using a simple technique that requires only rotation around x- and y-axes from reference images obtained in a transverse sweep through the fetal chest.

Aorta, Thoracic↗
PubMed2003

Spatio-temporal image correlation (STIC): new technology for evaluation of the fetal heart.

Spatio-temporal image correlation (STIC) is a new approach for clinical assessment of the fetal heart. It offers an easy to use technique to acquire data from the fetal heart and to aid in visualization with both two-dimensional and three-dimensional (3D) cine sequences. The acquisition is performed in two steps: first, images are acquired by a single, automatic volume sweep. Second, the system analyzes the image data according to their spatial and temporal domain and processes an online dynamic 3D image sequence that is displayed in a multiplanar reformatted cross-sectional display and/or a surface rendered display. The examiner can navigate within the heart, re-slice, and produce all of the standard image planes necessary for a comprehensive diagnosis. The advantages of STIC for use in evaluation of the fetal heart are as follows: the technique delivers a temporal resolution which corresponds to a B-mode frame rate of approximately 80 frames/s; it provides the examiner with an unlimited number of images for review; it allows for correlation between image planes that are perpendicular to the main image acquisition plane; it may shorten the evaluation time when complex heart defects are suspected; it enables the reconstruction of a 3D rendered image that contains depth and volume which may provide additional information that is not available from the thin multiplanar image slices (e.g. for pulmonary veins, septal thickness); it lends itself to storage and review of volume data by the examiner or by experts at a remote site; it provides the examiner with the ability to review all images in a looped cine sequence.

Artifacts↗
PubMed2001

Reptilian echocardiography: insights into ontogeny and phylogeny?

We describe the echocardiographic findings in a large reptile-the carpet python. If ontogeny recapitulates phylogeny, the study of reptilian hearts may provide insights into human cardiac development. In addition, the reptilian heart has unique structural and physiological adaptations that may broaden our perspective on evolutionary cardiac adaptation.

Adaptation, Physiological↗
PubMed2000

Evaluation of calibration methods for size estimation in the pediatric cardiac catheterization laboratory.

Limited data are available on the accuracy of various calibration methods used to estimate the size of cardiovascular structures during interventional pediatric cardiac catheterizations. The aim of this study was to evaluate, in an experimental model, several of these commonly used calibration methods. Thoracic box models were constructed in 4 sizes to simulate average chest sizes of infants, children, adolescents, and adults. Four anatomic positions were studied: aortic valve in posteroanterior projection, pulmonary valve in lateral projection, and isthmus in posteroanterior and lateral projections. The following calibration methods were examined: (1) a 5Fr pigtail catheter or a 1-cm radio-opaque marker catheter, placed at the level of the anatomic structure, (2) a body surface marker in multiple positions, and (3) a 1 x 1-cm radio-opaque rectilinear grid placed either at the center of the thorax or in an anatomic position. Three independent observers made size estimations. The most accurate method for size estimation, in all anatomic positions and for all box sizes, was the 1-cm radio-opaque marker catheter (mean error </=4%). The surface marker was moderately accurate in the smallest box (mean error 3% to 6%), but had a mean error as high as 33% in the adult-sized box. The 5Fr pigtail angiographic catheter overestimated the size of the structure by 3% to 13% (mean 7%). Intra- and interobserver differences in size estimations were not statistically significant. Among the size calibration methods used during pediatric cardiac catheterizations, catheters with radio-opaque markers within the structure of interest were the most accurate. The use of surface markers in larger patients may introduce significant error, risking a potentially inadequate or adverse outcome from the intervention.

Adolescent↗
PubMed2000

Wire-snare technique with distal flow control for coil occlusion of a modified Blalock-Taussig shunt.

Coil occlusion of Blalock-Taussig shunts has been associated with a high rate of device embolization. We describe a technique consisting of transvenous snaring and exteriorization of a guidewire advanced through a modified left Blalock-Taussig shunt, allowing distal shunt flow control and successful coil occlusion of the shunt. Cathet. Cardiovasc. Intervent. 49:51-54, 2000.

Anastomosis, Surgical↗
PubMed2000

Sources and impact of artifacts on clinical three-dimensional ultrasound imaging.

The purpose of this paper is to investigate, identify and discuss artifacts and their sources arising in three-dimensional ultrasound (3D US) in clinical practice in order to increase the awareness of clinicians and sonographers with respect to common 3D US artifacts and to use this increased awareness to avoid or reduce the occurrence of misdiagnosis in 3D US studies. Patient 3D US data were acquired using several different scanners and reviewed interactively on the scanner and graphics workstations. Artifacts were catalogued according to artifact origin. Two-dimensional ultrasound (2D US) artifacts were classified whether they were of a B-mode or color/power Doppler origin and their presentation in the original scan planes and the resulting volume re-sliced planes and rendered images was identified. Artifacts unique to 3D US were observed, noted and catalogued on the basis of whether they arose during acquisition, rendering or volume editing operations. Acoustic artifacts identified included drop-out, shadowing, etc. whose presentation depended on the relationship between slice and imaging plane orientation. Color/power Doppler artifacts were related to gain, aliasing, and flash which could add apparent structure or confusion to the volume images. Rendered images also demonstrated artifacts due to shadowing and motion of adjacent structures, cardiac motion or pulsatility of the cardiac septum or vessel walls. Editing artifacts potentially removed important structures. Three-dimensional ultrasound is prone to the same types of artifacts encountered in 2D US imaging plus others unique to volume acquisition and visualization. The consequences of these diagnostically significant artifacts include mimicking of abnormal development, masses, or missing structures thus requiring careful study before reaching a diagnosis.

Artifacts↗
PubMed2000

Three-dimensional ultrasound in the evaluation of fetal anomalies.

OBJECTIVES: To determine the additional information and clinical impact provided by three-dimensional ultrasound (3D US) imaging of fetal anomalies compared to conventional 2-dimensional ultrasound (2D US). MATERIALS AND METHODS: Sixty-three patients with 103 anomalies were scanned prospectively with both 2D and 3D US. Each anomaly was reviewed by one or more fetal imaging specialists to determine whether the 3D US data were advantageous, equivalent, or disadvantageous when compared with 2D US images. Clinical impact and pathologic or clinical outcome were determined in all cases. RESULTS: The 3D US images provided additional information in 53 anomalies (51%), were equivalent to 2D US images in 46 anomalies (45%), and were disadvantageous in four anomalies (4%). The 3D US was most helpful in evaluating fetuses with facial anomalies, hand and foot abnormalities and axial spine and neural tube defects. Planar images derived from 3D US volume data sets generally were more helpful for diagnostic purposes, whereas rendered 3D US images were more useful as a point of reference and were better appreciated by patients in understanding fetal abnormalities. Additional information provided by 3D US images impacted clinical management in 5% of patients. The 3D US images were disadvantageous in two fetuses with multiple anomalies and two with cardiac anomalies. CONCLUSION: The 3D US offered diagnostic advantages in about one-half of the selected cases studied and had effect on patient management in 5% of cases. This modality can be a powerful adjunctive tool to 2D US in providing a more comprehensible, 3D US impression of congenital anomalies. Thus, 3D US is currently most helpful as a targeted study complementing 2D US.

Congenital Abnormalities↗
PubMed1999

Atrial septostomy as a bridge to lung transplantation in patients with severe pulmonary hypertension.

Long waiting times for lung transplantation have limited the survival of patients with advanced pulmonary hypertension. Atrial septostomy has been used in this group of patients in an attempt to prolong survival. We evaluated the results of atrial septostomy in 12 patients using the static graded balloon dilation technique. Between December 1990 and May 1998, 10 women and 2 men (ages 13 to 56 years, mean 37 years) underwent atrial septostomy. Nine patients had primary and 3 patents had secondary pulmonary hypertension. Five patients deteriorated despite long-term intravenous prostacyclin infusions. The atrial septum was crossed with a Brockenbrough needle, followed by an 0.035-J exchange wire and progressively larger catheter balloons for atrial septal dilation, until systemic oxygen saturation decreased 5% to 10%. An atrial septal defect was successfully created in each patient. The mean right atrial pressure decreased from 23 to 18 mm Hg and the mean systemic oxygen saturation decreased from 93% to 85%. The mean cardiac index increased from 1.7 to 2.1 L/min/m2 and the mean systemic oxygen transport increased from 268 to 317 ml/min/m2. Complications occurred in 3 patients: transient hypotension during transesophageal echocardiography, a femoral pseudoaneurysm, and a femoral arteriovenous fistula. After septostomy, 6 patients had clinical improvement (resolution of ascites, edema, and no further episodes of syncope); 5 of these 6 patients underwent lung transplantation a mean of 6.1 months after septostomy. Six patients did not have clinical improvement after septostomy. Atrial septostomy improves the hemodynamic status and may be useful as a bridge to lung transplantation in selected patients with pulmonary hypertension.

Adolescent↗
PubMed1999

Real-time three-dimensional fetal echocardiography: initial feasibility study.

Real-time three-dimensional echocardiography acquires data as a volume rather than as a series of planar images, thereby obviating cardiac or respiratory gating and limiting artifacts generated by random motion. This study was undertaken to evaluate the feasibility of using real-time three-dimensional echocardiography to evaluate fetal cardiac anatomy and function. Ten human fetuses were evaluated in utero, four of whom had congenital heart disease. Freehand transabdominal scanning was performed on each pregnant woman using a real-time three-dimensional echocardiography system. Four volume clips at 20 volumes/s of duration 1.5 s each were obtained on each fetal heart and stored for off-line analysis. Data were displayed immediately as a series of four simultaneous planes, with the ability for the observer to manipulate the position of each plane within the acquired volume data set. Cardiac motion could be slowed, stopped, or viewed at its original speed. Most structures and views, as well as cardiac function, could be visualized consistently. Abnormal structures could be detected readily. Off-line analysis was rapid and easy. We conclude that fetal real-time three-dimensional echocardiography is a feasible, facile, and rapid new technique.

Echocardiography, Three-Dimensional↗
PubMed1999

Prevalence of aneuploidy with a cardiac intraventricular echogenic focus in an at-risk patient population.

The objective of this study was to determine the relative risk for aneuploidy in the presence of a cardiac intraventricular echogenic focus in a patient population at high risk for aneuploidy. A retrospective cohort study was conducted on patients referred to a fetal diagnostic center who were undergoing amniocentesis. Records and second trimester sonograms were reviewed. Approximately 5100 comprehensive prenatal sonograms were obtained over a 2 year study period. Karyotyping by amniocentesis was done in 2412 women; 84 of the karyotypes (3.5%) were abnormal. Fetuses with no ultrasonographic findings suggestive of aneuploidy had a 1.4% (28 of 1940) prevalence of significant chromosomal abnormalities. An intraventricular echogenic focus was found in 149 of the women with karyotype analysis; 15 had an abnormal karyotype. Fetuses with intraventricular echogenic foci had a relative risk of 3.30 of aneuploidy when compared to fetuses without echogenic cardiac foci. The presence of an isolated intraventricular echogenic focus carried a relative risk of 4.08 compared to those fetuses in which ultrasonography had no finding associated with aneuploidy. In conclusion, these preliminary data indicate that presence of an intraventricular echogenic cardiac focus carries an increased risk of fetal aneuploidy.

Aneuploidy↗
PubMed1998

Percutaneous coil occlusion of ascending aorta to pulmonary artery shunts.

Two patients with pulmonary atresia and intact ventricular septum each underwent early palliative surgery with a pulmonary valvotomy and an ascending aorta to pulmonary artery shunt. Adequate right ventricular growth and relief of pulmonary stenosis rendered the shunts unnecessary. The shunts were successfully occluded percutaneously with Gianturco coils.

Aorta↗
PubMed1998

Three-dimensional ultrasonography of normal fetal heart: comparison with two-dimensional imaging.

Thirty-one high-risk patients (16 to 35 weeks' gestation) underwent two-dimensional and three-dimensional ultrasonography to compare two-dimensional and non-cardiac-gated three-dimensional ultrasonography of the normal fetal heart. After normal two-dimensional studies, three-dimensional sonographic volumes were acquired without cardiac gating in transverse and longitudinal planes. Standard cardiac views were derived from three-dimensional data, analyzed, and rated as follows: (1) not identifiable, (2) identifiable but inadequate for diagnosis, (3) adequate, and (4) excellent. Two-dimensional ultrasonography demonstrated better yields of diagnostically acceptable images of basic echocardiographic views (four-chamber view, 100% for two-dimensional sonography versus 10 to 71% for three-dimensional sonography; right ventricular outflow tract, 42% for two-dimensional versus 6 to 26% for three-dimensional ultrasonography; left ventricular outflow tract, 71% for two-dimensional versus 13 to 45% for three-dimensional sonography). In one subject three-dimensional ultrasonography was superior to two-dimensional sonography in demonstrating an outflow tract. Aortic and ductal arches were not imaged with the two-dimensional technique but were available from the acquired three-dimensional volumes in 3 to 32% and 23%, respectively. False-positive and false-negative findings were observed on three-dimensional ultrasonograms. Overall, compared to two-dimensional ultrasonography, non-cardiac-gated three-dimensional sonography yielded inadequate reconstructed image quality of basic echocardiographic views (four-chamber view, right ventricular outflow tract, left ventricular outflow tract). Three-dimensional ultrasonography, however, shows potential for allowing nonechocardiographers to acquire some diagnostically acceptable views of the aortic and ductal arches.

Echocardiography, Three-Dimensional↗
PubMed1998

Three-dimensional fetal echocardiography: gated versus nongated techniques.

The purpose of this study was to compare gated with nongated three-dimensional fetal echocardiography in terms of the ability to demonstrate fetal cardiac anatomy. We examined nine fetuses in utero using conventional two-dimensional sonographic imaging equipment, an electromagnetic position sensor, and a computer-graphics workstation. Free-hand sweeps were performed through the fetal heart and great vessels in either transverse or sagittal orientations with respect to the fetal heart. Seven transverse and five sagittal sweeps were selected for reconstruction and analysis. Cardiac gating was performed by using a temporal Fourier transform to determine the fundamental frequency of cardiac motion. Two-dimensional data from each sweep were reprojected to a series of volume data sets. Each series was then condensed to a single volume, so that each two-dimensional sweep could be compared with its respective gated and nongated volume data sets. The two-dimensional data were reviewed utilizing a display with forward and backward cineloop capability. The gated and nongated volume data sets were displayed interactively as a series of three orthogonal planes, with the ability of the observer to control the location of each image plane within the volume. The gated data were animated with variable display frame rates. Conventional two-dimensional imaging provided a fairly complete evaluation of the fetal heart when scanning included the four-chamber view with a sweep across the outflow tracts. Nongated three-dimensional fetal echocardiography allowed visualization of some structures and views not demonstrated with two-dimensional ultrasonography. Gated three-dimensional fetal echocardiography provided significantly better visualization and comprehension of cardiac anatomy than nongated three-dimensional fetal echocardiography. The superiority of gated over nongated three-dimensional fetal echocardiography appears to come from both improved image quality and the anatomic clues that derive from the ability to view cardiac motion.

Echocardiography, Three-Dimensional↗
PubMed1997

Familial occurrence of pulmonary atresia with intact ventricular septum.

Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare disease, accounting for less than 3% of all congenital heart lesions. The cause of PA/IVS is unknown. We report the occurrence of two first cousins with PA/IVS, suggestive of autosomal dominant inheritance with incomplete penetrance. The study of such families should ultimately lead to the identification of the gene(s) that cause congenital heart disease.

Adult↗
PubMed1997

Usefulness of gated three-dimensional fetal echocardiography to reconstruct and display structures not visualized with two-dimensional imaging.

Cardiac-gated 3-dimensional fetal echocardiography can reconstruct and display cardiac structures and views not visualized with conventional 2-dimensional ultrasonography. This new technique may become an integral part of screening ultrasonography, complementing 2-dimensional fetal echocardiography when real-time imaging is incomplete.

Data Display↗
PubMed1997

Balloon angioplasty of native aortic coarctation in infants 3 months of age and younger.

The use of balloon dilation to treat native aortic coarctation is controversial, particularly in infants. Between January 1991 and September 1996, 12 patients < or = 3 months of age with native coarctation of the aorta (CoA) underwent balloon angioplasty (BA). All 12 lesions were dilated successfully with a mean reduction in peak systolic gradient from 49.3 +/- 16.5 mm Hg to 6.8 +/- 4.0 mm Hg (p < 0.001) and a mean increase in minimum CoA diameter from 2.4 +/- 0.6 mm to 5.5 +/- 1.3 mm (p < 0.001). Intimal flaps or tears were detected immediately after BA in 4 (33%) of 12 patients by angiography and in 8 (89%) of 9 patients by intravascular ultrasonography. No deaths or major complications related to the BA occurred. One patient had documented asymptomatic femoral artery obstruction, and one patient with hydrops fetalis and congenital pleural effusions died with gram-negative sepsis 1 week after the procedure. Follow-up was available for 10 patients (1 was lost to follow-up) between 2 months and 4.1 years (mean 2.4 +/- 1.3 years) after BA. No patient had an aortic aneurysm. Restenosis occurred in 5 (50%) of 10 patients, requiring reintervention a mean of 2.6 +/- 2.1 months after BA. One patient underwent surgical repair. Repeat BAs were performed in the other four patients; three were successful, and one with partial gradient relief required surgical repair. Five patients have not required reintervention a mean of 2.9 +/- 1.0 years after the initial BA. Among these five patients, follow-up intravascular ultrasound performed in three patients a mean of 2.0 +/- 1.9 years after BA showed favorable endovascular remodeling. There was a tendency for early reintervention in patients < 1 month of age and coexistence of a patent ductus arteriosus at the time of BA. In conclusion, selected infants < or = 3 months of age with discrete native CoA may be treated initially with balloon dilation. Most patients who have restenosis respond successfully to repeat BA.

Age Factors↗
PubMed1997

Percutaneous coil occlusion of patent ductus arteriosus.

OBJECTIVE: To determine the success rate and safety of percutaneous patient ductus arteriosus (PDA) coll occlusion. DESIGN: Thirty consecutive pediatric patients with small to moderate-size PDAs (minimum diameter < or = 4 mm) underwent percutaneous coll occlusion. The results were assessed by angiography and echocardiography. The mean age was 5.1 +/- 4.2 years (range, 0.8 to 18.8 years); mean weight was 19.2 +/- 10.3 kg (range, 8.1 to 40.0 kg). The mean minimum diameter of the PDA was 1.8 +/- 0.8 mm (range, 1.0 to 4.0 mm). RESULTS: PDA occlusion was achieved with one coil in 24 patients, 2 coils in 3 patients and 3 coils in 3 patients. The mean coil/PDA diameter ratio was 2.5 +/- 0.5. Immediately after coil occlusion, 29 PDAs had no flow by anglography; one had a small residual shunt. There were no significant complications. In the first 24 hours after coil implantation, echocardiography showed complete occlusion in 28 patients, a small left-to-right shunt in the same patient that had a residual shunt by anglography, and a trace shunt in one additional patient. In the two patients with residual flow by echocardiography, follow-up ultrasonography revealed no residual shunt 1 and 3 months later. At a mean follow-up of 11.8 +/- 9.3 months (range, 0 to 36.0 months), there was no PDA flow by color Doppler echocardiography in any of the 30 patients. CONCLUSION: Coil occlusion is a safe and effective method of percutaneous closure of small to moderate-size PDAs. The largest PDA that can be closed with this technique remains to be determined.

Child, Preschool↗