Cardiologist (heart), Pediatricians
37 years of experience

Accepting new patients
Audubon
1514 Jefferson Hwy
New Orleans, LA 70121
504-842-4000
Locations and availability (2)

Education ?

Medical School Score
Saint Louis University (1973)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Congenital Heart Defects
Coronary Vessel Anomalies
Associations
American Board of Pediatrics

Affiliations ?

Dr. Pinsky is affiliated with 1 hospitals.

Hospital Affilations

Score

Rankings

  • Harper University Hospital
    Cardiology
    3990 John R St, Detroit, MI 48201
    • Currently 4 of 4 crosses
    Top 25%
  • Publications & Research

    Dr. Pinsky has contributed to 55 publications.
    Title Academics Flourishing in New Orleans Post-katrina and Rita: Perspective from Ochsner Clinic Foundation.
    Date September 2008
    Journal The American Journal of the Medical Sciences
    Title The Medical Education Commission Report 2004: the Competition for Physician Recruitment is Increasing.
    Date August 2005
    Journal The Journal of the Louisiana State Medical Society : Official Organ of the Louisiana State Medical Society
    Excerpt

    The Louisiana annual match entry into graduate medical education (GME), the renewal of the practicing physician workforce, is consistent year to year and essentially parallel to the United States as a whole. The State of Louisiana Medical Education Commission offers reports compiling yearly and trend data and analysis which are published in the Journal of the Louisiana State Medical Society. The 2004 result of the match follows the trend of successful completion over the last 6 years. Louisiana is similar in many comparable categories to the United States; current trends continue to show a physician steady supply now stabilized and leveling and a growing shortage as demand increases. The GME system, and medical practice to follow, will be under an increasingly competitive environment. Physician recruitment at all levels will need to be augmented to meet national competition.

    Title The Medical Education Commission Report 2003: Gme Production Renews Physician Supply.
    Date June 2004
    Journal The Journal of the Louisiana State Medical Society : Official Organ of the Louisiana State Medical Society
    Excerpt

    Louisiana data for the match entry into Graduate Medical Education, and the renewal of the practicing physician workforce, are essentially parallel to comparable data for the United States as a whole. The State of Louisiana Medical Education Commission offers reports and publications in the Journal of the Louisiana State Medical Society compiling yearly and trend data and analysis. The 2003 result of the match follows the trend of successful completion over the last five years. While Louisiana is similar in many comparable categories to the United States, the state is somewhat higher in primary care growth, now stabilized and leveling, as are total GME and total physicians. Relatively small changes may be baseline fluctuations, and not a trend of longer-term change. The GME system is remarkably stable and successful overall, though complex right down to individual variation.

    Title The Medical Education Commission Report 2002: Trends Indicate a Steady State Supply of Physicians.
    Date December 2002
    Journal The Journal of the Louisiana State Medical Society : Official Organ of the Louisiana State Medical Society
    Excerpt

    This summary report for 2002 provides the detailed and updated data on all Graduate Medical Education (GME) residents and fellows in Louisiana for the last academic year. The 2002 match results and the trend in matching over the last 4 years depict the consistent successful match by Louisiana institutions. The totals and components of GME in Louisiana are steady. The infusion of gradually increasing numbers of physicians over the last 30 years in the United States and in Louisiana is quantified to indicate the present consistent steady state production and supply. The ripple effect into the physician population of this infusion now shows the expected beginning stabilization, although incomplete at this juncture. While demand for physician services for healthcare delivery is difficult to define and quantify, the inexorable increase of utilization of healthcare services portends a future mismatch of supply and demand, a shortage not a surplus.

    Title Cardiopulmonary Performance During Exercise in Patients with Repaired Tetralogy of Fallot with Absent Pulmonary Valve.
    Date August 1995
    Journal Pediatric Cardiology
    Excerpt

    In patients with tetralogy of Fallot and absent pulmonary valve, the dilated pulmonary arteries sometimes result in bronchial compression and pulmonary symptoms due to airway obstruction, recurrent pulmonary infection, and development of bronchiectasis. After complete intracardiac repair, residual pulmonary disease may be expected to result in impaired cardiopulmonary performance during exercise. To assess this hypothesis, nine patients with tetralogy of Fallot and absent pulmonary valve underwent exercise testing and were compared to 38 patients with tetralogy of Fallot repaired using a transannular patch. All patients were exercised to maximum volition using a 1 minute incremental treadmill protocol with monitoring of pulmonary functions and expired gases. Maximal heart rate, maximal oxygen consumption, oxygen consumption at anaerobic threshold, and maximal respiratory exchange ratio were similar for the two groups. There was no significant difference for ventilation and gas exchange parameters at rest or at maximal exercise, and values for both groups were below the predicted normal for healthy subjects. Breathing reserve, however, did tend to be somewhat lower in the group with tetralogy of Fallot with absent pulmonary valve. In summary, despite significant preoperative symptoms, cardiopulmonary performance during exercise in patients with tetralogy of Fallot and absent pulmonary valve is similar to patients with tetralogy of Fallot repaired with a transannular patch.

    Title Guidelines for Training in Adult Cardiovascular Medicine. Core Cardiology Training Symposium (cocats). Task Force 9: Training in the Care of Adult Patients with Congenital Heart Disease.
    Date January 1995
    Journal Journal of the American College of Cardiology
    Title The Cost of Congenital Heart Disease in Children and Adults. A Model for Multicenter Assessment of Price and Practice Variation.
    Date October 1994
    Journal Archives of Pediatrics & Adolescent Medicine
    Excerpt

    OBJECTIVE: To assess the cost of congenital heart disease (CHD) and to assess whether practice pattern or price was more responsible for variation. RESEARCH DESIGN AND SETTING: Data were collected from Charleston, NC; Columbus, Ohio; Detroit, Mich; Houston, Tex; Los Angeles, Calif; and New York, NY. The CHD was first classified as to physiologic characteristics and severity. For each type of CHD, the number of clinic visits, hospitalizations, and years of medication use were estimated. RESULTS: On the basis of actual charges, the "prices" were calculated as follows, in 1992 dollars: for patients from birth to 21 years: benign disease (19% of patients), $3940; acyanotic disease (45%), $49,730; cyanotic disease (36%), $102,084; and average for all CHD categories, $59,877; for patients 22 to 40 years of age (of whom 24% had resolved defects or were dead): benign disease (19%), $3470; acyanotic disease (52%), $12,981; cyanotic disease (29%), $39,187; and average for all CHD, $18,773. The cost for the group from birth to 21 years varied from $47,500 to $73,600, accounting for 55% by practice (number of echocardiograms and cardiac catheterizations) and 45% by price, although mortality was similar. CONCLUSIONS: The treatment of CHD is comparatively inexpensive, especially in adult survivors. The variation in both practice and price bears further study, with comparison to determine the most cost-effective strategies for treating these patients.

    Title Delayed Sternal Closure After Neonatal Cardiac Operations.
    Date April 1994
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    We retrospectively compared the use of primary elective open sternum coupled with delayed sternal closure with the use of primary sternal closure in neonates after cardiac operations. Primary elective open sternum/delayed sternal closure was selectively used in patients who demonstrated hemodynamic or respiratory deterioration, or both, during an intraoperative trial of sternal closure; otherwise primary sternal closure was used. Primary elective open sternum was used in 55 (61.8%) and primary sternal closure in 34 (38.2%) of the 89 patients studied. Eleven (20%) patients having primary elective open sternum died compared with 5 (14.7%) patients having primary sternal closure (p = 0.6). Six (10.9%) of the patients with primary elective open sternum died before delayed sternal closure; the remaining 49 patients comprise the primary elective open sternum/delayed sternal closure group. The durations of mechanical ventilation (9.7 +/- 0.9 days [mean plus or minus standard error of the mean], median 7.7 versus 9.9 +/- 3.4 days, median 4.9; p = 0.0005) and hospital stay (21.1 +/- 1.4 days, median 17.7 versus 19.6 +/- 4.1 days, median 12.9; p = 0.004) were shorter in the primary sternal closure group. The overall morbidity and duration of inotropic support were not significantly different between the two groups, although seven (20.6%) of the patients with primary sternal closure did have to undergo delayed sternal reopening for refractory postoperative low cardiac output. There was one superficial wound infection in the primary elective open sternum/delayed sternal closure group. Primary elective open sternum/delayed sternal closure is an effective treatment for postoperative neonatal mediastinal compression for the following reasons: (1) the morbidity is low; (2) the mortality of the critically ill group of neonates in whom primary elective open sternum/delayed sternal closure was used was similar to that of the less critically ill primary sternal closure group; and (3) 20.6% of the primary sternal closure group eventually had to undergo delayed sternal reopening to treat refractory postoperative low cardiac output.

    Title Congenital Coronary Artery Fistulae: a Review of 18 Cases with Special Emphasis on Spontaneous Closure.
    Date January 1994
    Journal Pediatric Cardiology
    Excerpt

    Between 1972 and 1990, 18 patients (median age 3 years, range 0.1-14 years) with coronary artery fistulae (CAF) were seen at this institution. Of the 16 patients without associated heart defects, two patients presented with congestive heart failure and the remaining 14 were asymptomatic. Fifteen patients had normal origin of two coronary arteries. Two patients had atresia of the proximal right coronary artery and, in one patient, the right coronary artery originated from the left main coronary artery. The QP/QS ranged between 1.0 and 2.8, with a mean of 1.4. Fifteen patients underwent operative closure without any deaths. One patient is being followed medically at present. Two patients showed spontaneous clinical improvement of CAF (complete closure in one and near complete in the other) and remained asymptomatic during a decade of follow-up. Review of the literature suggests operative closure of symptomatic and asymptomatic small CAF during childhood. However, the natural history of minute CAF remains unclear. In addition, symptoms from CAF may spontaneously improve with time.

    Title Cardiopulmonary Performance at Rest and Exercise After Repair of Total Anomalous Pulmonary Venous Connection.
    Date January 1994
    Journal The American Journal of Cardiology
    Excerpt

    Although long-term evaluations of patients after repair of total anomalous pulmonary venous connection have generally shown them to be clinically asymptomatic, assessment of their cardiovascular and pulmonary systems have been limited. Residual cardiopulmonary abnormalities undetected at rest may result in impaired function during exercise. To evaluate this hypothesis 9 patients underwent exercise testing after repair of total anomalous pulmonary venous connection. Pulmonary function testing was performed before exercise. Patients exercised using a 1-minute incremental bicycle or treadmill protocol monitoring heart rate, oxygen consumption, carbon dioxide production and minute ventilation. Compared with healthy children, the study patients had reduced maximal oxygen consumption and reduced oxygen consumption at ventilatory anaerobic threshold. Chronotropic response was impaired in 5 patients. Resting pulmonary functions showed evidence of mild restrictive lung disease. Breathing reserve was within normal limits. It is concluded that (1) aerobic capacity is mildly reduced after repair of total anomalous pulmonary venous connection, (2) chronotropic impairment is a common occurrence, and (3) pulmonary testing suggests mild restrictive lung disease that does not compromise exercise performance.

    Title The Effects of Rate Responsive Pacing on Exercise Performance in the Postoperative Univentricular Heart.
    Date August 1993
    Journal Pacing and Clinical Electrophysiology : Pace
    Excerpt

    Following the Fontan operation for definitive palliation of the univentricular heart, sinus node dysfunction, and/or atrioventricular block requiring pacemaker therapy is common. In previous studies ventricular rate responsive pacing (VVI,R) resulted in improved exercise performance over VVI pacing in anatomically normal hearts with either sinus node disease or atrioventricular block. In this study, the usefulness of both VVI,R and DDD,R pacing are evaluated in the postoperative univentricular heart following the Fontan operation. Eight postoperative Fontan patients with sinus node disease or atrioventricular block underwent exercise testing using a treadmill protocol. Six patients had single chamber ventricular pacemakers and two patients had dual chambered rate responsive pacemakers. Median age at exercise testing was 14 years. Patients were tested in the VVI, VVI,R, and DDD,R modes acting as their own controls. Heart rate, work rate, oxygen consumption, and respiratory exchange ratio were monitored continuously. Heart rate was significantly increased in the rate responsive modes compared to the VVI mode. In spite of the significant increase in heart rate, there was no change in maximal work rate or oxygen consumption. There was also no significant change in oxygen consumption at ventilatory anaerobic threshold. From these data we would conclude that VVI,R pacing in postoperative univentricular hearts does not result in improved exercise performance and that further study with DDD,R pacing is needed to determine its usefulness in this group of patients.

    Title Acute Changes in Endothelin-1 After Hemodialysis for Chronic Renal Failure.
    Date June 1993
    Journal The Journal of Pediatrics
    Excerpt

    Endothelin is a recently described, potent renal vascular and systemic vasoconstrictor peptide. To evaluate the response of this peptide to volume contraction, we measured eight baseline and posthemodialysis samples from seven children, aged 14.5 +/- 3 years, with chronic renal failure. Plasma was extracted and endothelin-1 was measured by radioimmunoassay. Dialysis was performed for a 3- to 3 1/2-hour period, and body weight decreased from 38.0 +/- 14.3 to 36.2 +/- 13.8 kg (p < 0.01) during this time. There were no significant changes in heart rate or respiratory rate after dialysis, but blood pressure fell from 127/80 +/- 22/16 to 114/72 +/- 20/21 mm Hg (p = 0.05 for the systolic pressure). Plasma endothelin-1 concentration increased from 1.5 +/- 1.2 pg/ml at baseline to 7.3 +/- 8.9 pg/ml (p = 0.06) after dialysis; the fall in body weight from dialysis correlated with the increase in endothelin (r = -0.75; p = 0.05). Thus volume contraction from hemodialysis is associated with a rise in plasma endothelin-1, which is related to the acute change in body weight.

    Title Relation of Elevated Plasma Endothelin in Congenital Heart Disease to Increased Pulmonary Blood Flow.
    Date May 1993
    Journal The American Journal of Cardiology
    Excerpt

    Endothelin-1 (ET), a potent vasoconstrictor peptide, has been found to be elevated in children with pulmonary hypertension associated with congenital heart defects. To evaluate the effect of pulmonary blood flow on ET concentrations, 5 ml blood samples were obtained peripherally at cardiac catheterization from 35 patients, ages 0.13 to 17 years (median 2). Plasma was extracted and ET measured by radioimmunoassay. Patients were classified into 2 groups based on the presence (group A) or absence (group B) of increased pulmonary blood flow defined as a Qp/Qs > or = 1.5. When the 13 patients (37%) in group A were compared with the 22 patients (63%) in group B there were no significant differences in age, cardiac index, or pulmonary and systemic resistances. ET concentrations were significantly higher in group A patients (median 3.25, range 0 to 16.5 vs median 0, range 0 to 6.35 pg/ml; p < or = 0.05). Pulmonary blood flow and pulmonary artery pressure were also higher in group A patients (p < or = 0.01). When patients within group A were subdivided into those with and without pulmonary hypertension, no difference was present in their ET concentrations (mean/SD: 4.4/4.3 vs 4.0/6.4 pg/ml, p = NS). Thus, ET is elevated in patients with congenital heart disease associated with left-to-right shunts and it appears that this increase is related to increased pulmonary blood flow independent of pulmonary artery pressure.

    Title Grading the Severity of Congestive Heart Failure in Infants.
    Date July 1992
    Journal Pediatric Cardiology
    Excerpt

    To determine which variables most accurately define congestive heart failure (CHF) in infants, 41 patients (median age 2.5 months) were graded by four pediatric cardiologists for the presence and severity of CHF based on the following variables: amount of formula consumed per feeding, feeding time, history of diaphoresis or tachypnea, growth parameters, respiratory and heart rates, respiratory pattern, perfusion, presence of edema, diastolic filling sounds, and hepatomegaly. There were 19 patients graded as having no CHF, nine as mild, seven moderate, and six severe CHF. The most sensitive and specific variables (p less than 0.0001) for the presence of CHF were a history of less than 3.5 oz/feed, respiratory rate greater than 50/min, an abnormal respiratory pattern, diastolic filling sounds, and hepatomegaly. Moderate to severe CHF was present when patients took less than 3 oz/feed or greater than 40 min/feed, had an abnormal respiratory pattern with a resting respiratory rate greater than 60/min, and had a diastolic filling sound and moderate hepatomegaly. Severe CHF was accompanied by a heart rate greater than 170/min, decreased perfusion, and severe hepatomegaly. Thus, the grading of the severity of CHF in infants should include an accurate description of these historical and clinical variables.

    Title Increased Atrial Natriuretic Factor Response to Exercise After Coarctation Repair.
    Date June 1992
    Journal The American Journal of Cardiology
    Title Augmented Norepinephrine and Renin Output in Response to Maximal Exercise in Hypertensive Coarctectomy Patients.
    Date June 1992
    Journal American Heart Journal
    Excerpt

    To evaluate a possible neural or renal contribution to the hypertension that occurs in some patients following coarctation of aorta repair, 35 patients underwent graded bicycle exercise with serial measurements of plasma norepinephrine concentrations and plasma renin activity. Sixteen patients with coarctectomy who had systolic or diastolic hypertension at peak exercise were compared with 19 normotensive patients with coarctectomy. The average time interval between coarctation repair and study was significantly longer (p less than 0.05) in the hypertensive group than in the normotensive patients (12.8 +/- 4.8 versus 8.7 +/- 2.2 years). The heart rate response to exercise was similar for both patient groups. The systolic blood pressure in the hypertensive group was higher than in the normotensive group at rest in the supine and upright positions and at 5 minutes of recovery, in addition to peak exercise, and the diastolic blood pressure was increased at peak exercise. Plasma norepinephrine concentrations were significantly higher at peak exercise and during recovery in the hypertensive group than in the normotensive patients. Plasma renin activity was also significantly higher in the hypertensive group at peak exercise. These data suggest that patients with coarctectomy who have a hypertensive response to exercise have an augmented sympathetic nervous system output and increased plasma renin activity that may lead to peripheral vasoconstriction at peak exercise and that may contribute to the development of their hypertension.

    Title Failure of Rate Responsive Ventricular Pacing to Improve Physiological Performance in the Univentricular Heart.
    Date January 1992
    Journal Pacing and Clinical Electrophysiology : Pace
    Excerpt

    The physiological efficacy of single chamber, rate responsive ventricular pacing (VVIR) is unknown for symptomatic patients following the Fontan procedure for univentricular hearts. A total of six postoperative children, ages 6-21 years (mean 13), with symptomatic bradycardia requiring pacing therapy, underwent comparative treadmill exercise testing in randomized fixed rate (VVI) and VVIR pacing modes. In all instances, implanted activity pulse generators (Medtronic Model 8403) were programmed to identical age-appropriate low paced rates during VVI and VVIR modes with the upper rate response at 150 ppm. All studies were performed at least 2 weeks apart. Physiological values of heart rate, blood pressure, work rate (watts), oxygen consumption (VO2), carbon dioxide production (VCO2), and respiratory exchange ratio (RER) were monitored continuously during each test using a 1 minute incremental treadmill protocol. Ventilatory anaerobic threshold (VAT) was calculated from VO2, VCO2, and minute ventilation. The results demonstrated that although there was a significant increase in paced heart rate per minute throughout exercise (P less than 0.01) with VVIR pacing, maximum watts, VO2, and VAT remained unchanged. These findings indicate that in spite of an improved chronotropic response to exercise, children with univentricular hearts following the Fontan procedure continue to demonstrate altered hemodynamics which negate potential benefits of VVIR pacing.

    Title Exercise Performance with Single Chamber Rate-responsive Pacing in Congenital Heart Defects After Operation.
    Date November 1991
    Journal The American Journal of Cardiology
    Title Pharmacologic Therapy for Fetal Arrhythmias.
    Date September 1991
    Journal Clinical Obstetrics and Gynecology
    Excerpt

    Although great strides have been made in diagnosing fetal cardiac anatomic and functional abnormalities, in utero cardiac therapy is limited to the treatment of significant arrhythmias. The fetal prognosis may change if the dysrhythmia persists or if the condition results in intrauterine heart failure. When either complication is evident, intrauterine drug therapy may be indicated if the fetus is considered too immature for delivery. Information from case reports has shown several drugs to be useful to cardiovert the fetus, with digitalis being the pharmacologic agent used most often. At present, treatment consists mainly of transplacental administration of antiarrhythmic agents with the object of normalizing FHR and rhythm and abolishing, or preventing, fetal cardiac failure. Various agents have been used with variable success. More direct fetal therapy by intramuscular injection or umbilical vein infusion may replace unsuccessful indirect maternal therapy. It is unclear why some fetuses respond (or appear to respond) and others have hydrops and die in the absence of congenital heart disease or documented infection. With proper therapy, many fetuses survive and have a satisfactory prognosis, depending on the form of arrhythmia and the nature of any cardiac structural defects.

    Title Atrial Natriuretic Factor and Sympathetic Nervous Output in Response to Volume Shifts in the Immature Canine Circulation.
    Date July 1991
    Journal Peptides
    Excerpt

    This study evaluated the immature circulation's response to acute shifts in intravascular volume with respect to atrial natriuretic factor and plasma catecholamines. Serial measurements were performed on thirteen beagle puppies during volume expansion with a saline and albumin solution followed by volume contraction with furosemide. Atrial natriuretic factor correlated with right (r = .73, p less than 0.001) and left (r = .62, p less than 0.001) atrial pressures and increased to much greater levels than previously reported for mature animals. Simultaneously, 10 puppies had a progressive decrease in plasma norepinephrine over the 60-minute infusion (p less than 0.05) while two puppies demonstrated a marked increase between the 30- and 60-minute samples. Furosemide increased urine output and reversed the hormonal changes caused by volume expansion. Thus a greatly augmented output of atrial natriuretic factor occurs in the immature canine circulation in response to increased atrial and pulmonary pressures, while sympathetic output remains unchanged or falls with increasing intravascular volume until a critical decrease in cardiac output triggers a catecholamine surge.

    Title Spontaneous Regression of Cardiac Rhabdomyoma.
    Date May 1991
    Journal The American Journal of Cardiology
    Title The Role of Chronotropic Impairment During Exercise After the Mustard Operation.
    Date March 1991
    Journal Journal of the American College of Cardiology
    Excerpt

    To better understand the role of chronotropic impairment on exercise performance after the atrial switch (Mustard) operation, 20 patients who had undergone this operation for uncomplicated d-transposition of the great arteries exercised to maximal volition using a 1 min incremental treadmill protocol. Heart rate, oxygen consumption, carbon dioxide production and minute ventilation were monitored continuously. Two-dimensional echocardiograms were obtained before testing to calculate the right ventricular inflow volume indexed to body surface area. All patients achieved maximal aerobic capacity based on their ventilatory patterns and respiratory exchange ratio. Maximal heart rate was reduced (175 beats/min; 87% of predicted for age) and maximal oxygen consumption was decreased (31 ml/kg per min; 75% of predicted for age and gender). There was no correlation between maximal oxygen consumption and maximal heart rate. Right ventricular volume index, however, had a significant inverse correlation with maximal heart rate (r = -0.62, p less than 0.005). There was no correlation between right ventricular volume index and heart rate at rest. These results suggest that decreased maximal oxygen consumption in patients after the Mustard procedure is not a result of chronotropic impairment. Right ventricular dilation may be a compensatory response to chronotropic impairment.

    Title Extracorporeal Membrane Oxygenation for the Circulatory Support of Children After Repair of Congenital Heart Disease.
    Date November 1990
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    We have treated 39 infants and children with congenital heart disease with extracorporeal membrane oxygenation during the past 5 years. Thirty-six were treated for low cardiac output or pulmonary vasoreactive crisis after repair of congenital heart defects. Twenty-two (61%) survived. Most patients were cannulated from the neck via the right internal jugular vein and the right common carotid artery. Six patients were cannulated from the chest, including three who had separate drainage of the left side of the heart with a left atrial cannula. Two of these patients survived and were the only survivors of the nine patients cannulated in the operating room because they could not be weaned from cardiopulmonary bypass after open cardiac operations. We also reviewed 312 patients (the predictor study series) having open cardiac operations before the availability of extracorporeal membrane oxygenation; 27 of these patients died. Data were collected at 1 and 8 hours postoperatively to determine if any parameters might predict early mortality. With these parameters used as criteria, patients who went on extracorporeal membrane oxygenation were as sick as those who died before extracorporeal membrane oxygenation was available. The most common complication was bleeding related to heparinization. The mean transfusion requirement in survivors was 1.50 +/- 1.13 ml/kg/hr, 5.63 +/- 7.0 ml/kg/hr in the nonsurvivors, and 7.46 +/- 8.29 ml/kg/hr in those cannulated in the operating room because they could not be weaned from bypass. Four children had intracranial hemorrhage, and two of them died. There was one late death. Nine of the 22 survivors are entirely normal. All survivors who do not have Down's syndrome are considered to have normal central nervous system function. We conclude that extracorporeal membrane oxygenation can improve survival in patients with both pulmonary artery hypertension and low cardiac output after operations for congenital heart disease.

    Title Down's Syndrome, Complete Atrioventricular Canal, and Pulmonary Vascular Obstructive Disease.
    Date August 1990
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    We reviewed our experience over a 10-year period to determine whether children with Down's syndrome and complete atrioventricular canal develop pulmonary vascular obstructive disease earlier than children with normal chromosomes and this defect. Comparisons were made between Down's syndrome and normal chromosome children regarding (1) pulmonary blood flow and pulmonary vascular resistance at initial catheterization, (2) operability as related to elevation in pulmonary vascular resistance, and (3) age at diagnosis of fixed pulmonary vascular obstructive disease. The 45 patients with Down's syndrome catheterized under 1 year of age had a lower mean pulmonary blood flow (3.2 versus 5.7; p = 0.0001) and higher mean pulmonary vascular resistance (8.3 versus 4.6 Wood units.m2; p = 0.0003) than their 34 normal chromosome counterparts. When all ages were included, 38 of 81 (47%) of the children with Down's syndrome and 32 of 40 (80%) of the normal children were considered operable. Non-Down's syndrome patients who had operations had a higher pulmonary blood flow (5.8 versus 3.3; p = 0.004) and lower pulmonary vascular resistance (3.6 versus 6.0 Wood units.m2; p = 0.005) than Down's syndrome patients. Of the 34 patients who did not have operations because of pulmonary vascular obstructive disease, 31 had Down's syndrome. In 10 of 81 children with Down's syndrome, fixed pulmonary vascular obstructive disease was diagnosed before the age of 1 year, while this was found in none of 40 normal children. Our data demonstrate that Down's syndrome patients with complete atrioventricular canal have a greater degree of elevation of pulmonary vascular resistance in the first year of life and more rapid progression to fixed pulmonary vascular obstructive disease than children with normal chromosomes.

    Title Exercise Performance After Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery.
    Date May 1990
    Journal Circulation
    Excerpt

    Eleven patients underwent exercise testing after operative repair of anomalous origin of the left coronary artery from the pulmonary artery. Five patients repaired after 2 years of age comprised a childhood surgery group, and six patients repaired before 2 years of age comprised an infant surgery group. All patients were exercised using either a treadmill or electronically braked bicycle with simultaneous thallium 201 scintigraphy. Oxygen consumption, carbon dioxide production, pulmonary functions, and electrocardiogram were all monitored continuously. Pulmonary reserve was normal in all patients. Based on heart rate reserve, respiratory exchange ratio, and oxygen-consumption response to work load, two patients in the infant surgery group stopped exercise before achieving maximum aerobic capacity. All remaining patients achieved their maximum aerobic capacity. There was no difference in work rate or oxygen consumption during exercise between the infant and childhood surgical group. Four patients (two in each surgical group) had an impaired chronotropic response to exercise. Three of these four patients demonstrated perfusion defects by thallium scintigraphy. Thallium scintigraphy was normal in all remaining patients. Electrocardiographic abnormalities were noted in seven of 11 patients having ventricular arrhythmias or ST segment depression. It is concluded from this study that exercise performance after repair of anomalous origin of the left coronary artery from the pulmonary artery is not affected by the age at which surgery is performed. Exercise is frequently associated with electrocardiographic evidence of abnormal myocardial perfusion despite frequently negative simultaneous 201Tl scintigraphy.

    Title Tetralogy of Fallot.
    Date April 1990
    Journal Pediatric Clinics of North America
    Excerpt

    Tetralogy of Fallot is the most common malformation of children born with cyanotic heart disease, with an incidence of approximately 10 per cent of congenital heart disease. There can be a wide spectrum as to the severity of the anatomic defects, which include ventricular septal defect, aortic override, right ventricular outflow tract obstruction, and right ventricular hypertrophy. Cyanosis may vary from mild to severe, and patients may present as newborns or, more commonly, young infants. Infants with classic tetralogy of Fallot and stable anatomy should undergo primary complete intracardiac repair. The overall hospital mortality is approximately 3 to 5 per cent, with most patients who survive having an excellent clinical and hemodynamic result.

    Title Myocardial Performance and Perfusion During Exercise in Patients with Coronary Artery Disease Caused by Kawasaki Disease.
    Date February 1990
    Journal The Journal of Pediatrics
    Excerpt

    For a study of the natural history of coronary artery lesions after Kawasaki disease and their effect on myocardial blood flow reserve with exercise, five such patients underwent exercise testing on a bicycle. Oxygen consumption, carbon dioxide production, minute ventilation, and electrocardiograms were monitored continuously. Thallium-201 scintigraphy was performed for all patients. One patient stopped exercise before exhaustion of cardiovascular reserve but had no evidence of myocardial perfusion abnormalities. Four patients terminated exercise because of exhaustion of cardiovascular reserve; one had normal cardiovascular reserve and thallium scintiscans, but the remaining patients had diminished cardiovascular reserve. Thallium scintigrams showed myocardial ischemia in two and infarction in one. No patient had exercise-induced electrocardiographic changes. These results indicate that patients with residual coronary artery lesions after Kawasaki disease frequently have reduced cardiovascular reserve during exercise. The addition of thallium scintigraphy and metabolic measurements to exercise testing improved the detection of exercise-induced abnormalities of myocardial perfusion.

    Title Primary Pulmonary Artery Sarcoma in Two Children.
    Date April 1989
    Journal Pediatric Cardiology
    Excerpt

    The clinical and pathological features of primary pulmonary artery sarcoma in two children are reported. The first patient presented with right ventricular outflow obstruction and underwent successful surgical resection of his tumor. The second patient developed cardiac arrest following a relatively short period of symptoms of right heart failure and could not be revived. The pathological diagnosis in both patients was hemangiopericytoma. To the best of our knowledge, primary pulmonary artery sarcoma in children has not been previously reported.

    Title Intracardiac Teratoma in a Newborn.
    Date April 1989
    Journal Clinical Cardiology
    Excerpt

    Primary tumors of the heart are infrequent at all ages. We present a newborn with hypoxia and a heart murmur, in whom an echocardiogram revealed a large tumor filling the right ventricle and the pulmonary annulus. To maintain pulmonary blood flow, the patency of the ductus arteriosus was achieved by infusion of prostaglandin E1. Successful surgical resection was accomplished. The pathological examination was characteristic of a benign teratoma. The patient remains asymptomatic and has shown no evidence of recurrence of the tumor during a follow-up period of 34 months. This represents the eleventh case of intracardiac teratoma and only the fourth case to undergo successful surgical resection.

    Title Torsade De Pointes: Successful Acute Control by Lidocaine and Chronic Control by Tocainide in Two Patients--one Each with Acquired Long Qt and the Congenital Long Qt Syndrome.
    Date September 1986
    Journal American Heart Journal
    Title The 10-minute Talk: Organization, Slides, Writing, and Delivery.
    Date March 1986
    Journal American Heart Journal
    Title Drug-electrophysiology Studies in Infants, Children, and Adolescents.
    Date August 1985
    Journal American Heart Journal
    Title Improvement of Left Ventricular Dysfunction After Control of Persistent Tachycardia.
    Date November 1984
    Journal The Journal of Pediatrics
    Excerpt

    Five children are described who had persistent, chronic tachycardia and left ventricular dysfunction manifested by decreased left ventricular percent fractional shortening on echocardiogram (five patients) cardiomegaly on chest roentgenogram (three), ventricular or atrial hypertrophy on ECG (three), and symptoms of congestive heart failure (three). After antidysrhythmia therapy and control of the tachycardia, signs and symptoms of congestive heart failure resolved in two infants. Moreover, in each patient signs of cardiomegaly resolved on chest roentgenogram, hypertrophy resolved on ECG, and the fractional shortening improved to normal (mean 20.2% +/- 2.4% SEM before vs 36.2% +/- 2.4%, P = 0.02, after treatment). Evaluation in the child who has dilated cardiomyopathy should include assessment of heart rate and rhythm. Moreover, when persistent tachycardia is found in an asymptomatic child, evaluation of left ventricular function is indicated.

    Title False-negative Findings in Pericardial Effusion Using M-mode Echocardiography.
    Date January 1984
    Journal Pediatric Cardiology
    Excerpt

    M-mode echocardiography in a 3-year-old patient with suspected pericardial effusion was negative for the presence of an effusion. A subsequent 2-dimensional echocardiogram demonstrated a large effusion lateral to the right atrium and right ventricle. The reasons for the false-negative M-mode echocardiogram and a discussion of the literature are presented.

    Title Kawasaki Disease in Nebraska: a Review of the Literature.
    Date December 1983
    Journal The Nebraska Medical Journal
    Title Cardiac Pacing for the Young at Heart.
    Date August 1983
    Journal Cvp
    Title Sustained Ventricular Tachycardia After Repair of Tetralogy of Fallot: New Electrophysiologic Findings.
    Date May 1983
    Journal The American Journal of Cardiology
    Excerpt

    Ventricular arrhythmia originating from the outflow tract of the right ventricle is a presumed cause of late sudden death in patients after repair of tetralogy of Fallot. Exercise testing has been shown to enhance detection, and phenytoin has been shown to control ventricular arrhythmias in these patients. This study reports new findings in 3 patients who underwent electrophysiologic studies at postoperative cardiac catheterization; in each, sustained ventricular tachycardia was induced and found to originate from the inflow-septal area of the right ventricle. Using serial studies, the same sustained ventricular tachycardia was induced during therapeutic serum concentrations of phenytoin but not after propranolol. No patient had ventricular arrhythmia during a 24-hour electrocardiogram or during exercise. Although no patient had normal hemodynamic function, only 1 patient had right ventricular pressure greater than two-thirds systemic pressure. Each patient had undergone initial intracardiac repair at a relatively late age (3, 9, and 9 years).

    Title Current Treatment of Reye's Syndrome.
    Date December 1982
    Journal The Nebraska Medical Journal
    Title Continuous Enteral Feedings. An Important Adjunct to the Management of Complex Congenital Heart Disease.
    Date October 1982
    Journal American Journal of Diseases of Children (1960)
    Excerpt

    Eleven infants with complex congenital heart lesions were given continuous enteral infusions after failure to gain weight adequately despite use of hypercaloric formulas and nutritional supplementation. Formulas used before institution of enteral feedings were continued. Dietary and caloric intake and weight measurements were obtained at weekly or monthly intervals. Both mean daily caloric intake and mean daily weight gain were greater after initiation of continuous enteral feedings. Rate of weight gain improved in all 11 children after institution of enteral feedings. Continuous enteral feeding increases weight gain in babies with complex congenital heart disease, allowing earlier and safer surgical intervention.

    Title Diagnosis, Management, and Long-term Results of Patients with Congenital Complete Atrioventricular Block.
    Date July 1982
    Journal Pediatrics
    Excerpt

    Sixty-five patients with congenital complete atrioventricular block have been studied. The median age at time of diagnosis was 7 months with 26 infants being diagnosed prior to 1 month of age. Anatomic heart disease was present in 25/65 (39%) infants, with ventricular inversion/L-transposition of great arteries complex occurring in 20/25 infants (80%). The site of block was above the bundle of His in 11 of 18 (61%) patients studied, in the bundle of His in three of 18 (17%), and below the bundle of His in two of 18 (11%). Permanent pacemakers were implanted in 17 (26%). Ten patients (15%) have died. The highest risk was in patients with anatomic heart disease and patients diagnosed early in life.

    Title Nonsurgical Removal of Severed Central Venous Line in an Infant.
    Date February 1982
    Journal American Journal of Diseases of Children (1960)
    Title Ruptured Mycotic Aneurysm of Abdominal Aorta: Successful Treatment in a Child.
    Date July 1981
    Journal American Journal of Diseases of Children (1960)
    Title Myocardial Protection from Ischemic Arrest: Potassium and Verapamil Cardioplegia.
    Date May 1981
    Journal The American Journal of Physiology
    Excerpt

    Prolonged normothermic myocardial ischemic arrest results in myocardial dysfunction. This study has investigated the technique of preserving myocardial function by a single bolus intracoronary infusion of combination potassium and verapamil at the onset of ischemic arrest. Sixty-one dogs underwent cardiopulmonary bypass with 60 min of ischemic arrest: 25 received no myocardial protection, 12 received a single intracoronary bolus of KCl, 12 received combination verapamil and KCl, and 12 received verapamil alone. Following the ischemic arrest, hearts protected by combination of potassium and verapamil demonstrated better survival evidenced by the ability of all 12 dogs to resume normal hemodynamic function. The hemodynamic function in the combination potassium and verapamil group also demonstrated better cardiac output, left ventricular dF/dt, and myocardial segment shortening than survivors in the other groups. Subsarcolemmal (SSL) and intermyofibrillar IMF) mitochondria were isolated from these hearts and function evaluated. NADH-linked oxygen consumption was impaired as was calcium transport in the SSL from unprotected ischemic hearts. Intermyofibrillar mitochondria were not different from control or sham. The hearts protected by verapamil and potassium demonstrated normal mitochondrial function.

    Title Thallium-201 Myocardial Perfusion Imaging in Infants and Children. Value in Distinguishing Anomalous Left Coronary Artery from Congestive Cardiomyopathy.
    Date April 1980
    Journal Circulation
    Excerpt

    In infants and children, anomalous origin of the left coronary artery (ALCA) from the pulmonary artery may be difficult to distinguish from congestive cardiomyopathy (CCM) of other causes. We performed thallium-201 myocardial perfusion imaging in seven children with ALCA and in nine with CCM to study the usefulness of this technique in distinguishing between these lesions. Localized abnormalities of thallium uptake were present in each of the seven patients with ALCA, including two asymptomatic 4-year-old children. Thallium distribution was normal in five patients with CCM, diffusely irregular in three, and was absent in the lateral and posterobasal portions of the left ventricle in one patient. We conclude that thallium-201 imaging is a sensitive noninvasive method of detecting ALCA. However, perfusion abnormalities are not limited to patients with coronary artery abnormalities, and may be present in patients with myocardial ischemia or infarction of other causes.

    Title Permanent Changes of Ventricular Contractility and Compliance in Chronic Volume Overload.
    Date December 1979
    Journal The American Journal of Physiology
    Excerpt

    Left ventricular volume overload (LVVO) has been created in 18 dogs by anastomosing a Dacron conduit between the infrarenal abdominal aorta and inferior vena cava. The dogs previously were instrumented so that in the awake state LV pressure, systemic arterial pressure, LV dP/dt, myocardial segment length and excursion, and coronary and renal artery velocities could be monitored. The animals were stressed with separate infusions of alpha-adrenergic and beta-adrenergic agonists. Both at rest and with stress, over a 12-wk period, preejection, ejection, and contractility indices decreased. Left ventricular compliance decreased as exemplified by the increased ratio of end-diastolic pressure to end-diastolic length. The shunt was ablated in 7 dogs, and monitoring in conjuction with alpha- and beta-adrenergic stress foan additional 12 wk demonstrated an initial improvement in the previous indices. However, the amelioration plateaued and values similar to the control state were not attained. This suggests that potentially permanent alterations in ventricular function and compliance have occurred.

    Title Left and Right Ventricular Systolic Time Intervals in the Newborn. Usefulness and Limitation in Distinguishing Respiratory Disease from Transposition of the Great Arteries.
    Date November 1979
    Journal British Heart Journal
    Title Dosage of Digoxin in Premature Infants.
    Date June 1979
    Journal The Journal of Pediatrics
    Excerpt

    The pharmacokinetics and pharmacodynamics of digoxin in premature infants was studied. During maintenance therapy, after a total digitalizing dose of 30 microgram/kg, the measured digoxin level was related inversely to body weight at birth and to estimated gestational age. The serum digoxin levels found in the immature and smaller infants were two to three times the values usually reported to be toxic in older children. Based on these findings, a second group of premature infants was digitalized with 20 microgram/kg; in this group, the serum digoxin levels were below the toxic range, irrespective of gestational age or birth weight. The cardiac effects of digoxin, i.e., shortened left ventricular pre-ejection period and ejection time as determined by echocardiography, were similar in the two groups. For both groups, the half-life of digoxin in the serum was twice that reported for term infants and children. Since digitalis effect is obtained with lower dose and serum concentration, we recommend that this dose be used in premature infants.

    Title Myocardial Depression After Elective Ischemic Arrest. Subcellular Biochemistry and Prevention.
    Date May 1979
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    The hemodynamic and cardiac biochemical effects of global ischemic arrest during cardiopulmonary bypass (CPB) were studied in 54 animals and compared to seven animals without ischemic arrest. Ischemic arrest alone reduced the first derivative of left ventricular force of contraction (LV dF/dt) to 52 percent of control 10 minutes after resuming function and to 64 percent after 1 hour of reperfusion. Cardiac output was depressed to 52 percent of control after 10 minutes of reperfusion, and to 74 percent of control after 60 minutes of reperfusion. In six animals, moderate hypothermia (26 degrees C.) resulted in no protection of cardiac function from ischemic arrest, whereas profound hypothermia to 18 degrees C. resulted in values of LV dF/dt and cardiac output nearly equivalent to the CPB control group (no arrest). A continuous infusion of a hyperkalemic hypothermic solution slightly improved the degree of protection over hypothermia alone. The sarcoplasmic reticulum (SR) isolated from hearts which had undergone 60 minutes of ischemic arrest bound significantly less calcium when the isolation was done after 10 minutes of reperfusion as well as when it was done after 60 minutes of reperfusion. The time to spontaneous release of calcium from the SR also was significantly longer. Moderate hypothermia did not result in improved SR function, whereas deep hypothermia induced by local cooling or by hypothermic potassium infusion retained SR function at normal levels. Oxidative phosphorylation of mitochondria isolated after 60 minutes of reperfusion was also depressed. The mitochondrial respiration rate after normothermic ischemic arrest was 155 natoms of oxygen per minutes versus 237 natoms for the hypothermic hyperkalemic group. Respiratory control index was 5.5 for the normothermic group versus 9.4 for the hypothermic group. It is concluded that hypothermia, whether effected by surface cooling or by hypothermic potassium infusion, allowed full recovery of hemodynamic and biochemical functions within 1 hour of reperfusion.

    Title Anomalous Origin of Circumflex Coronary Artery from Right Pulmonary Artery: Report of a Rare Anomaly.
    Date October 1978
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    A heretofore unreported anomaly of the coronary arteries in which a large circumflex artery arises from the pulmonary artery is described. The circumflex coronary artery in an 8-year-old girl was filled in a retrograde fashion via collaterals from a dominant left anterior descending coronary artery, and the right coronary artery was small and nondominant. Successful surgical correction of this defect was performed by use of total cardiopulmonary bypass and cardioplegic arrest. The orifice of the anomalous vessel and detached from the right pulmonary artery and implanted into the posterolateral aspect of the ascending aorta. Cardiopulmonary bypass with cardioplegic arrest is recommended for reconstruction of coronary arterial anomalies with abnormal sites of origin.

    Title Anomalous Origin of Left Coronary Artery from the Pulmonary Artery with Ventricular Septal Defect.
    Date June 1978
    Journal Circulation
    Excerpt

    Only two cases have been reported previously of the association of ventricular septal defect (VSD) with anomalous origin of the left coronary artery (ALCA) arising from the pulmonary artery. The purpose of this paper is to present two additional cases, to describe the pathophysiology, and to emphasize how the clinical course of this combination of defects differs from that of isolated ALCA. Patients with both of these anomalies present in infancy with manifestations only of a large left-right ventricular shunt and pulmonary hypertension. Initially the ALCA is well perfused from the high pressure in the pulmonary artery. In these instances in which the pulmonary artery pressure subsequently decreased because of spontaneous reduction in size of the VSD, the left coronary arterial system became less well perfused. Because of this decreased perfusion in association with the left ventricular myocardial stress initially caused by volume overload, myocardial ischemia and ultimately infarction occurred. Early identification and repair of the anatomic abnormality could prevent irreversible myocardial damage.

    Title The Absent Pulmonary Valve Syndrome. Considerations of Management.
    Date January 1978
    Journal Circulation
    Excerpt

    The absent pulmonary valve syndrome consists of a severely hypoplastic pulmonary valve with anular stenosis, aneurysmal dilatation of the main pulmonary artery with one or both pulmonary branches also dilated, and a ventricular septal defect. From 1955 to 1975, 15 patients were seen at Texas Children's Hospital with this syndrome. Although anatomically similar to tetralogy of Fallot, the most significant symptoms during early infancy were secondary to bronchial compression resulting from the dilated pulmonary arteries and enlarged left atrium. Intracardiac repair performed on two infants at four months of age failed to ameliorate the respiratory symptoms and both died. Seven patients from 2.3 to 16 years of age were operated upon, with one late postoperative death. Five other patients have not yet received surgical intervention. We recommend vigorous continual respiratory therapy for for infants and small children and intracardiac repair in older children since repair in infancy does not relieve respiratory symptoms. We do not recommend a prosthetic pulmonary valve unless there is persistently elevated main pulmonary artery pressure.

    Title A Current View of Acute Rheumatic Fever.
    Date September 1977
    Journal Texas Medicine
    Title Subclavian-coronary Artery Anastomosis in Infancy for the Bland-white-garland Syndrome: a Three-year and Five-year Follow-up.
    Date August 1976
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    Two infants, 4 months and 8 months of age, with anomalous origin of the left coronary artery, underwent direct anastomosis of the left subclavian artery to the left coronary artery. In the patient operated upon at 4 months of age, the anastomosis proved to be patent by angiographic study 3 years postoperatively. However, in the patient operated upon at 8 months of age, the study 5 years postoperatively revaled clinically unsuspected occlusion at the anastomosis site. After operation, both patients symptomatically improved. The heart size decreased on radiograms, the left ventricular ejection fraction improved, and the electrocardiographic abnormality resolved to a great extent. Since the preferred treatment for this abnormality and the ideal age for operation are yet to be established, long-term angiographic follow-up of all such surgically treated patients is needed. An advantage of the subclavian-coronary artery anastomosis is its applicability in the infant.

    Title Letter: Lca Ligation Effectiveness Questioned.
    Date February 1976
    Journal Circulation
    Title Anomalous Left Coronary Artery. Report of Two Cases.
    Date June 1973
    Journal The Journal of Thoracic and Cardiovascular Surgery

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