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Biomedical subjects

Norman H Silverman

Publications and source records attributed to Norman H Silverman.

At least 19 recordsLinked to original sources
PubMed2006

Morphology and function of the bicuspid aortic valve with and without coarctation of the aorta in the young.

This study sought to determine the morphology and function of bicuspid aortic valves (BAVs) with and without coarctation of the aorta (CoA) in a young population. The transthoracic echocardiograms of 117 patients with BAVs and 62 patients with CoA were retrospectively reviewed and compared with normal transthoracic echocardiographic results. In each patient, the area subtended by the aortic cusps and valve and the diameters of the aortic root at different levels were measured, and additionally in each BAV, the type of cusp fusion and the presence and degree of aortic stenosis and/or regurgitation were evaluated. The median age of patients with BAVs was 4 years (range 0 days to 34 years), and the median age of patients with CoA was 1.9 years (range 0 days to 16.5 years). BAVs with right and left coronary cusp fusion were significantly associated with CoA (p <0.0001) and cardiac anomalies (p <0.0001), whereas BAVs with noncoronary and right coronary cusp fusion were affected by valvar dysfunction (p <0.001). Compared with normal tricuspid aortic valves, BAVs had aortic root dilation, even in patients with no hemodynamic disturbance, particularly at the level of the ascending aorta (p <0.0001); the difference was still significant comparing BAVs and CoA with tricuspid aortic valves and CoA (p <0.0001). In conclusion, different morphologies of BAVs are associated with different cardiac abnormalities, valvar function, and aortic root dilation. Although detectable early in life, valvar dysfunction and aortic root dilation progress with age.

Adolescent↗
PubMed2006

Diagnosis and prognosis of fetuses with double outlet right ventricle.

OBJECTIVES: To examine the echocardiographic features, associated anomalies, and outcomes of fetuses diagnosed with double outlet right ventricle (DORV). METHODS: Fetuses with DORV were identified from 987 fetal echocardiograms performed from August 1, 2002 to August 1, 2004. The medical records of 19 fetuses with DORV were reviewed. RESULTS: Nineteen fetuses were diagnosed with DORV. The pregnancy was terminated in 15.8% (3/19) of cases. Postnatal assessment was not obtained in 26.3% (5/19) cases. Accurate prenatal diagnosis of the relationship of the ventricular septal defect (VSD) with the great arteries was achieved in 14 of 14 cases (100%). Chromosomal abnormalities (21.4%), abnormalities of body situs (35.7%), and other extracardiac abnormalities were diagnosed in association. Only 4 of 13 (30.8%) infants with confirmed DORV survived beyond 28 days. CONCLUSIONS: DORV is found in fetuses with a large spectrum of associated cardiac and extracardiac lesions. The overall prognosis for fetuses with DORV is poor throughout the spectrum of these lesions, not only related to the primary lesion but also depending on the associated intra- and extracardiac abnormalities. While the complexity of the heart disease in fetuses with DORV makes detailed fetal diagnosis challenging, it can be accomplished with a high degree of accuracy.

Abnormalities, Multiple↗
PubMed2006

The systolic to diastolic duration ratio in children with heart failure secondary to restrictive cardiomyopathy.

Systole (S) and diastole (D) are fundamental to cardiac function, yet their durations are not routinely evaluated. We defined the S/D duration ratio in 11 children with restrictive cardiomyopathy (CM) and 31 control subjects, using tricuspid regurgitant flow duration. We correlated S/D ratio, S duration, and D duration with heart rate and compared groups. Heart rates of control subjects and patients with restrictive CM were similar (P = .995). The S/D ratio was higher in patients with restrictive CM than in control subjects (1.6 +/- 0.81 vs 0.8 +/- 0.19, P < .001) as a result of shortened D (0.43 +/- 0.13 vs 0.56 +/- 0.06, P < .01) and prolonged S (0.58 +/- 0.12 vs 0.44 +/- 0.06, P < .01). The S/D ratio was highly correlated to heart rate in restrictive CM (r = 0.95, P < .0001). The high S/D ratio found in restrictive CM, found also in dilated CM, suggests that this index is generic to heart failure rather than to a specific disease. The S/D ratio is easily measured using Doppler flow, enhancing echocardiographic assessment of D function in children.

Cardiomyopathy, Restrictive↗
PubMed2006

Segmental wall-motion abnormalities after an arterial switch operation indicate ischemia.

We prospectively studied 29 consecutive neonates undergoing an arterial switch operation to determine if segmental wall motion abnormalities (SWMA) represented myocardial ischemia. Intraoperative transesophageal echocardiogram was recorded at baseline and twice after cardiopulmonary bypass. Cardiac troponin I (cTnI) levels were measured before sternal incision and 3, 6, 12, 24, 48, and 72 h after removal of the aortic cross-clamp. Immediate postoperative Holter and 15-lead electrocardiograms (ECG) were evaluated for ischemia. Transthoracic echocardiograms were obtained before hospital discharge. At bypass termination, immediately after protamine administration, segmental wall motion was normal in nine neonates and abnormal in 20. SWMA were transient in five and present at the time of chest closure in 15 neonates. Neonates in whom SWMA were present at chest closure had more segments involved than those in whom SWMA were transient (P > 0.001). Neonates with SWMA at chest closure had higher cTnI levels postoperatively versus neonates with normal wall motion (P = 0.02). Postoperative ECG data were available in 26 neonates. There was ECG evidence of myocardial ischemia in two of eight neonates with normal wall motion, one of five with transient SWMA, and nine of 13 with SWMA at chest closure. CTnI levels at 12, 24, and 48 h and intraoperative SWMA were predictive of postoperative SWMA. We believe these data indicate that SWMA, which persist at the completion of an arterial switch operation, and which are present in multiple myocardial segments, correlate with myocardial ischemia. Further follow-up of these patients is needed to determine if increased intraoperative myocardial ischemia correlates with long-term outcomes.

Cardiac Surgical Procedures↗
PubMed2005

Aortopulmonary window with anomalous origin of the right coronary artery from the pulmonary artery: two cases highlighting the importance of complete pre-operative echocardiographic evaluation of the coronary arteries in all conotruncal anomalies.

This report describes two infants with an aortopulmonary window in association with anomalous origin of the right coronary artery from the pulmonary artery. In both cases the diagnosis was made pre-operatively by transthoracic echocardiography, with the initial clue being extensive collateral flow within the myocardium. In each case there was surgical confirmation of the echocardiographic findings. These two cases demonstrate that coronary artery evaluation should be an integral part of every new echocardiographic evaluation, particularly in the setting of conotruncal anomalies.

Aortopulmonary Septal Defect↗
PubMed2005

Cardiac ventricular diastolic and systolic duration in children with heart failure secondary to idiopathic dilated cardiomyopathy.

Systole and diastole are the fundamental periods of the cardiac cycle, yet little emphasis has been placed on their relative duration when evaluating heart failure. Cardiac intervals are used to assess ventricular function, but the relative duration of systole and diastole for defining function have not been evaluated. We hypothesized that in heart failure, systole is prolonged and diastole shortened. We defined systole and diastole in 16 children with idiopathic dilated cardiomyopathy and in 16 normal controls, matched for age and gender, using the mitral regurgitant (MR) and tricuspid regurgitant (TR) flow duration. The systole and diastole durations (expressed as a fraction of the cardiac cycle) were correlated with heart rate and age and compared between groups. The subjects were compared with gender- and age-matched controls (9.98 +/- 6.1 vs 9.88 +/- 6.08 years, p = NS). The 2 groups had similar heart rates (104 +/- 31 vs 92 +/- 34 beats/min, p = NS). The systole duration was not significantly different when measured by MR versus TR duration (0.60 +/- 0.10 vs 0.57 +/- 0.11 of the cardiac cycle, respectively, p = NS). Systole was prolonged in subjects compared with controls (0.60 +/- 0.1 vs 0.42 +/- 0.08, respectively, using MR duration, p < 0.0001 and 0.57 +/- 0.11 vs 0.41 +/- 0.07, respectively, using TR duration, p = 0.0008). The systolic/diastolic ratio was 0.77 +/- 0.24 in the controls versus 1.57 +/- 0.98 in the patients with idiopathic dilated cardiomyopathy using the TR duration (p < 0.005) and 1.67 +/- 0.68 using the MR duration (p < 0.0001). The systole duration correlated with heart rate in subjects (r = 0.79, p = 0.0003) and controls (r = 0.69, p = 0.003). In conclusion, systole is significantly prolonged and diastole correspondingly shortened in heart failure. Reversal of the normal systolic/diastolic ratio may compromise cardiac filling and function. The systole and diastole duration are easily measured using routine Doppler flow, enhancing assessment of cardiac function in children.

Adolescent↗
PubMed2005

Mitral valve leaflet excursion velocity in the pediatric population: a comparable diastolic index to the color M-mode propagation velocity.

Color M-mode (CMM) Doppler flow propagation velocity (Vp) is a reliable diastolic index, but may be difficult to define. We hypothesized that because the valve is opened by flow, the anterior mitral leaflet excursion velocity (MEVApex ), interrogated from the cardiac apex, may be similar to the CMM-Vp. We investigated the MEVApex by apical M-mode echocardiography in 49 children and adolescents with normal echocardiograms, and compared it with the CMM-Vp and other indices. The mean CMM-Vp and MEVApex were similar (41.5 +/- 6 vs 40 +/- 5.7, respectively, mean +/- SD; P = .5) and correlated positively ( r = 0.71, P < .0001, Bland-Altman analysis). The peak velocity of mitral inflow (E wave) divided by the Vp (E/Vp) and E/MEVApex correlated well (2.54 +/- 0.58 vs 2.52 +/- 0.58, respectively, mean +/- SD; r = 0.857, P < .001, Bland-Altman analysis). The MEVApex is comparable with the CMM-Vp and the E/MEVApex with E/Vp. The Vp may be assessed either by CMM or conventional M-mode from the apex. In our experience, the latter is easier to do. Study in other populations is warranted.

Adolescent↗
PubMed2004

Changing indications for fetal echocardiography in a University Center population.

OBJECTIVES: We hypothesized that increased facility with fetal echocardiographic diagnosis by obstetricians is associated with changes in its indications and yields. METHODS: We reviewed 300 fetal echocardiograms (December 2002-August 2003) and compared our findings with previous studies. RESULTS: Mean maternal age was 31 +/- 6 (range 16-44) years. Gestational age was 24 +/- 5 weeks (mean +/- SD; median 22, range 15-38). Indications for fetal echocardiography included family history of congenital heart disease (CHD) (23%), maternal diabetes (18%), obstetrical scan suspicious for CHD (13%), arrhythmia (12%) maternal rheumatologic disease (7%), extracardiac congenital anomalies (6%), chromosomal anomaly (6%) and exposure to a potential fetal teratogen (5%). High yield indications included chromosomal anomaly (47%) and a suspicious obstetrical scan (42%). Low yield indications included family history of CHD (4%) and teratogen exposure (0%). 1/7 of the patients with increased nuchal translucency had pulmonary atresia/intact ventricular septum. No anomalies were associated with the single umbilical artery. CONCLUSION: Indications and yields of fetal echocardiography have changed over the last decade. The frequency of an obstetrical scan suspicious for CHD has increased 2.5 to 3 times over a decade and continues to have high yield. Thus, increasing prenatal detection of CHD depends, to a large extent, on increasing the skills of obstetricians.

Academic Medical Centers↗
PubMed2004

Accuracy of coronary artery anatomy using two-dimensional echocardiography in d-transposition of great arteries using a two-reviewer method.

We evaluated echocardiographic accuracy for defining coronary artery course in d-transposition of great arteries and the impact of a 2-reviewer method on this accuracy. The echocardiogram reports of 108 patients with d-transposition of great arteries were reviewed for coronary anatomy and compared with the operative report. In method 1, from January 1995 to December 1997, a single reader performed the echocardiogram. In method 2, from January 1998 to December 2000, 2 readers scanned individually and a consensus diagnosis was made. Comparing methods 1 and 2, the sensitivity of the echocardiogram to detect variants in coronary anatomy was 68% versus 86%, and negative predictive value was 72% versus 91%. Using a 2-reviewer method improved the accuracy of echocardiographic diagnosis of coronary anatomy with d-transposition of great arteries, aiding in risk assessment and treatment of the patient preoperatively. This study also illustrates that echocardiographic accuracy may be lower in an institution with a surgical volume more representative of the usual pediatric cardiothoracic surgical center.

Coronary Vessels↗
PubMed2004

Measurement of the Tei index: a comparison of M-mode and pulse Doppler methods.

BACKGROUND: The Tei index is a useful echocardiographic measure of ventricular function in adults and children. Most studies have used pulse or tissue Doppler imaging to calculate this index. M-mode, with its higher frame rate and sharp deflections, may be an accurate method of calculating the Tei index. METHODS: M-mode and pulse Doppler (PD) measurement of the Tei index were performed in 68 children. The mitral closure to opening time ("a") and ejection time ("b") intervals for calculating the Tei index were measured by M-mode and PD methods. RESULTS: Both M-mode and PD were found to be reproducible methods of calculating the Tei index. There was a close correlation between measurements of the "a" and "b" intervals by M-mode and PD, with less variability with M-mode than with PD. CONCLUSION: M-mode is a simple, reproducible echocardiographic alternative method for calculating the Tei index in children and has a lower variance than PD.

Child↗