Jennifer Woo, MD

All Publications

• Percutaneous Closure of a Ruptured Sinus of Valsalva Aneurysm under Transesophageal Echocardiography Guidance. CASE (Philadelphia, Pa.) Li, X. E., McElhinney, D. B., Lui, G. K., Clark, D. E., Woo, J. P. 2024; 8 (3Part A): 186-192

  Abstract

  • SOVA is a rare cardiac anomaly. • Ruptured SOVA carries a high mortality rate. • SOVA often coexists with other congenital lesions, most commonly VSD and bicuspid AV. • Ruptured SOVA needs repair; percutaneous repair is a safe alternative to surgery. • Echo plays a vital role in both diagnosing SOVA and guiding percutaneous closure.

  View details for DOI 10.1016/j.case.2023.12.006

  View details for PubMedID 38524988

  View details for PubMedCentralID PMC10954579

• Multimodality Imaging in Management of Adults with Dextro-Transposition of the Great Arteries Post Arterial Switch Operation. CASE (Philadelphia, Pa.) Conrad, D. R., Woo, J. P., Lui, G. K., Clark, D. E. 2024; 8 (3Part A): 162-166

  Abstract

  • Echo is an essential tool for monitoring long-term complications of D-TGA with ASO. • Multimodality imaging is complementary to echo in the assessment of complications. • 4D flow CMR can assess supravalvular PS post ASO. • Branch pulmonary arteries after LeCompte maneuver can be challenging to image.

  View details for DOI 10.1016/j.case.2023.12.028

  View details for PubMedID 38524978

  View details for PubMedCentralID PMC10954704

• Response by Loube et al to Letter Regarding Article "Stroke Caused by a Paradoxical Embolus From a Rare Congenital Anomaly in the Adult: Persistent Left Superior Vena Cava Draining Into the Left Upper Pulmonary Vein". Circulation. Cardiovascular imaging Loube, D. K., Sreekrishnan, A., Woo, J. P., Shen, J., Collins, R. T., Schwartz, N. 2023; 16 (9): e015862

  View details for DOI 10.1161/CIRCIMAGING.123.015862

  View details for PubMedID 37725668

• Stroke Caused by a Paradoxical Embolus From a Rare Congenital Anomaly in the Adult: Persistent Left Superior Vena Cava Draining into the Left Upper Pulmonary Vein. Circulation. Cardiovascular imaging Loube, D. K., Sreekrishnan, A., Woo, J. P., Shen, J., Collins, R. T., Schwartz, N. 2023: e014205

  View details for DOI 10.1161/CIRCIMAGING.122.014205

  View details for PubMedID 37283055

• Improved Right Ventricular Energy Efficiency by 4-Dimensional Flow Magnetic Resonance Imaging After Harmony Valve Implantation. JACC. Advances Woo, J. P., Dong, M. L., Kong, F., McElhinney, D. B., Schiavone, N., Chan, F., Lui, G. K., Haddad, F., Bernstein, D., Marsden, A. 2023; 2 (3)

  View details for DOI 10.1016/j.jacadv.2023.100284

  View details for PubMedID 37691969

  View details for PubMedCentralID PMC10487049

• High Prevalence of Abnormal Hemoglobin A1c in the Adolescent and Young Adult Fontan Population. Pediatric cardiology Woo, J. P., Romfh, A., Levin, G., Norris, J., Han, J., Grover, M., Chen, S. 2023

  Abstract

  Little is known about diabetes risk in adolescents and young adults with Fontan palliation. We sought to understand the prevalence of abnormal hemoglobin A1c (HbA1c) in the adolescent and young adult population with Fontan palliation. Between 2015 and 2021, 78 Fontan patients > 10 years of age were seen in our single ventricle clinic; 66 underwent screening with HbA1c. 50% of the study cohort (n = 33) had HbA1c ≥ 5.7%; 2% (n = 1) had HbA1c ≥ 6.5%. There was no correlation between BMI and HbA1c, with no difference in the prevalence of overweight or obesity (BMI ≥ 85th percentile) between those with and without abnormal HbA1c (31% versus 27%, p = 0.69). While 20% of the cohort had a family history of diabetes, there was no difference in family history between those with and without abnormal HbA1c (21% versus 19%, p = 0.85). There were no differences in other risk factors and characteristics (race, glomerular filtration rate, liver function, liver elastography, hematocrit, and years from Fontan surgery) between those with and without abnormal HbA1c. Our results highlight the importance of recognizing that abnormal HbA1c is highly prevalent in the Fontan population. Whether abnormal HbA1c in this population correlates with atherosclerotic cardiovascular disease in adulthood is not known. The mechanism for an abnormal HbA1c in the adolescent and young adult Fontan population remains unclear and further studies are needed.

  View details for DOI 10.1007/s00246-023-03139-4

  View details for PubMedID 36943450

  View details for PubMedCentralID 4859356

• Improved Right Ventricular Energy Efficiency by 4-Dimensional Flow Magnetic Resonance Imaging After Harmony Valve Implantation JACC:Advances Woo, J. P., Dong, M. L., Kong, F., McElhinney, D. B., Schiavone, N., Chan, F., Lui, G. K., Haddad, F., Bernstein, D., Marsden, A. 2023; 2 (3)

  View details for DOI 10.1016/j.jacadv.2023.100284

• Tetralogy of Fallot and Aortic Dissection: Implications in Management. JACC. Case reports Vaikunth, S. S., Chan, J. L., Woo, J. P., Bykhovsky, M. R., Lui, G. K., Ma, M., Romfh, A. W., Lamberti, J., Mastrodicasa, D., Fleischmann, D., Fischbein, M. P. 2022; 4 (10): 581-586

  Abstract

  We present the case of a 61-year-old man with tetralogy of Fallot postrepair and mechanical aortic valve replacement with an aortic root/ascending/arch aneurysm with chronic type A aortic dissection. He underwent uncomplicated aortic root and total arch replacement. Continued surveillance for aortic aneurysm is necessary in the tetralogy of Fallot population. (Level of Difficulty: Intermediate.).

  View details for DOI 10.1016/j.jaccas.2022.02.021

  View details for PubMedID 35615213

• The challenges of an aging Tetralogy of Fallot population. Expert review of cardiovascular therapy Woo, J. P., McElhinney, D. B., Lui, G. K. 2021

  Abstract

  INTRODUCTION: Advancements in surgery and management have resulted in a growing population of aging adults with tetralogy of Fallot (TOF). As a result, there has been a parallel growth in late complications associated with the sequelae from the underlying cardiac anomalies as well as the surgical and other interventional treatments.AREAS COVERED: Here, we review challenges related to an aging population of patients with TOF, particularly late complications, and highlight advances in management and key areas for future research. Pulmonary regurgitation, heart failure, arrhythmias, and aortic complications are some of these late complications. There is also a growing incidence of acquired cardiovascular disease, obesity, and diabetes associated with aging. Management of these late complications and acquired comorbidities continues to evolve as research provides insights into long-term outcomes from medical therapies and surgical interventions.EXPERT OPINION: The management of an aging TOF population will continue to transform with advances in imaging technologies to identify subclinical disease and valve replacement technologies that will prevent and mitigate disease progression. In coming years, we speculate there will be more data to support the use of novel heart failure therapies in TOF and consensus guidelines on management of refractory arrhythmias and aortic complications.

  View details for DOI 10.1080/14779072.2021.1940960

  View details for PubMedID 34102942

• Early Cardiovascular Health Outreach SMS (ECHOS): A Preventive Health Text Messaging Program Pilot Study Journal of Healthcare Communications Markaroff , K., Woo , J., Uehisa , K., Branche , K., Press , M., Horwich , T., Watson , K. 2021
• The Rogue P-wave: Atrial Dissociation Following Bicaval Heart Transplantation. The Journal of innovations in cardiac rhythm management Huang, W. A., Woo, J. P., Boyle, N. G. 2019; 10 (1): 3472-3475

  Abstract

  We report the first case, to our knowledge, of atrial dissociation in a patient who underwent bicaval orthotopic heart transplantation. It was believed that atrioventricular dissociation prompting pacemaker implantation likely represented donor sinus bradycardia/arrest with intact atrioventricular conduction with surgically isolated recipient atrial activity.

  View details for DOI 10.19102/icrm.2019.100106

  View details for PubMedID 32494402

  View details for PubMedCentralID PMC7252805

• Successful Orthotopic Heart Transplantation in a Patient With Chronic Pancreatitis: Selective Medical and Surgical Considerations. Pancreas Woo, J. P., Reardon, L. C., Cadeiras, M. 2018; 47 (7): e41-e42

  View details for DOI 10.1097/MPA.0000000000001081

  View details for PubMedID 29912855

• Clinical phenomapping and outcomes after heart transplantation JOURNAL OF HEART AND LUNG TRANSPLANTATION Bakir, M., Jackson, N. J., Han, S. X., Bui, A., Chang, E., Liem, D. A., Ardehali, A., Ardehali, R., Baas, A. S., Press, M., Cruz, D., Deng, M. C., DePasquale, E. C., Fonarow, G. C., Khuu, T., Kwon, M. H., Kubak, B. M., Nsair, A., Phung, J. L., Reed, E. F., Schaenman, J. M., Shemin, R. J., Zhang, Q. J., Tseng, C., Cadeiras, M. 2018; 37 (8): 956–66

  Abstract

  Survival after heart transplantation (HTx) is limited by complications related to alloreactivity, immune suppression, and adverse effects of pharmacologic therapies. We hypothesize that time-dependent phenomapping of clinical and molecular data sets is a valuable approach to clinical assessments and guiding medical management to improve outcomes.We analyzed clinical, therapeutic, biomarker, and outcome data from 94 adult HTx patients and 1,557 clinical encounters performed between January 2010 and April 2013. Multivariate analyses were used to evaluate the association between immunosuppression therapy, biomarkers, and the combined clinical end point of death, allograft loss, retransplantation, and rejection. Data were analyzed by K-means clustering (K = 2) to identify patterns of similar combined immunosuppression management, and percentile slopes were computed to examine the changes in dosages over time. Findings were correlated with clinical parameters, human leucocyte antigen antibody titers, and peripheral blood mononuclear cell gene expression of the AlloMap (CareDx, Inc., Brisbane, CA) test genes. An intragraft, heart tissue gene coexpression network analysis was performed.Unsupervised cluster analysis of immunosuppressive therapies identified 2 groups, 1 characterized by a steeper immunosuppression minimization, associated with a higher likelihood for the combined end point, and the other by a less pronounced change. A time-dependent phenomap suggested that patients in the group with higher event rates had increased human leukocyte antigen class I and II antibody titers, higher expression of the FLT3 AlloMap gene, and lower expression of the MARCH8 and WDR40A AlloMap genes. Intramyocardial biomarker-related coexpression network analysis of the FLT3 gene showed an immune system-related network underlying this biomarker.Time-dependent precision phenotyping is a mechanistically insightful, data-driven approach to characterize patterns of clinical care and identify ways to improve clinical management and outcomes.

  View details for DOI 10.1016/j.healun.2018.03.006

  View details for Web of Science ID 000441535600005

  View details for PubMedID 29802085

  View details for PubMedCentralID PMC6064662

• The Frontier of Transition Medicine: A Unique Inpatient Model for Transitions of Care. Journal of hospital medicine Lonquich, B., Woo, J. P., Stutz, M., Agnihotri, N., Kuo, A. A. 2018; 13 (1): 69-70

  View details for DOI 10.12788/jhm.2926

  View details for PubMedID 29309440

• Fevers and abnormal blood and cerebrospinal fluid studies after pediatric cerebral hemispherectomy: impact of etiology and age at surgery. Journal of neurosurgery. Pediatrics Phung, J., Krogstad, P., Mathern, G. W. 2013; 12 (6): 595-603

  Abstract

  The object of this study was to determine if etiology and age at surgery were linked with fevers and altered white blood cell and CSF laboratory values after cerebral hemispherectomy.Seizure etiologies (n = 76) were classified into hemimegalencephaly (HME), cortical dysplasia (CD), infarcts (stroke), Rasmussen encephalitis (RE), history of infections, and Sturge-Weber syndrome (SWS) and were compared with clinical variables, maximum daily temperature (Tmax), and blood and CSF studies through Day 12 posthemispherectomy.The Tmax on Days 2-4 and 9-12 postsurgery were higher for HME and RE cases than for stroke cases. Patients with RE showed positive correlations, whereas those with SWS had negative correlations between Tmax and age at surgery. Blood WBC counts on postsurgery Days 3, 6, and 9-12 were higher in the HME and CD cases than in the stroke and RE cases. The percentage of blood polymorphonuclear cells (%bloodPMNs) was higher in the RE cases than in the HME, CD, and SWS cases. The RE, HME, and CD cases showed positive correlations between %bloodPMNs and age at surgery. The percentage of blood monocytes (%bloodMono) was higher in the patients with HME than in those with stroke or RE. The HME and CD cases showed negative correlations between %bloodMono and age at surgery. The CSF red blood cell counts were higher in the RE than in the CD and stroke cases. The percentage of CSF monocytes was higher in patients with CD than in those with stroke and RE. The percentage of CSF lymphocytes positively correlated with age at surgery.Seizure etiology and age at surgery were associated with developing fevers and altered blood and CSF values after pediatric cerebral hemispherectomy. These findings indicate that besides infections, other clinical variables have an impact on developing fevers and abnormal laboratory values posthemispherectomy. Cultures appear to be the most reliable predictor of infections.

  View details for DOI 10.3171/2013.9.PEDS13264

  View details for PubMedID 24116983

• Etiology associated with developing posthemispherectomy hydrocephalus after resection-disconnection procedures. Journal of neurosurgery. Pediatrics Phung, J., Krogstad, P., Mathern, G. W. 2013; 12 (5): 469-75

  Abstract

  The authors sought to determine if clinical epilepsy variables, maximum daily temperature (Tmax), and blood and CSF findings were associated with the risk of developing hydrocephalus after first-time resection-disconnection hemispherectomy.Patients who underwent cerebral hemispherectomy in whom a standardized perioperative protocol was used, including the use of ventriculostomies (n = 79), were classified into those who developed and those who did not develop hydrocephalus requiring CSF shunts. The authors compared these 2 groups for clinical variables, Tmax, and blood and CSF studies through postoperative Day 12.In this cohort, 30% of the patients required CSF shunts, of which 8% developed late hydrocephalus up to 3 years posthemispherectomy. Multivariate analysis found that etiology was associated with developing posthemispherectomy hydrocephalus. Higher shunt rates were observed for patients with hemimegalencephaly (40%; n = 15) and a history of CNS infection (100%; n = 4) compared with cortical dysplasia (17%; n = 23) and Rasmussen encephalitis (17%; n = 12). In univariate analysis, other factors associated with developing hydrocephalus were elevated maximum daily temperatures, elevated white blood cell counts, decreased CSF protein, and increased CSF red blood cell counts.The findings of the study indicate that etiology was the factor most strongly associated with developing posthemispherectomy hydrocephalus. These findings suggest that there are variable mechanisms for developing hydrocephalus after cerebral hemispherectomy depending on the procedure, and in resection-disconnection operations the mechanism may involve changes in CSF bulk flow that varies by histopathology.

  View details for DOI 10.3171/2013.8.PEDS13212

  View details for PubMedID 24011367

• Timing and Predictors of Fever and Infection After Craniotomy for Epilepsy in Children PEDIATRIC INFECTIOUS DISEASE JOURNAL Phung, J., Mathern, G. W., Krogstad, P. 2013; 32 (5): 450–59

  Abstract

  Fevers and leukocytosis after pediatric craniotomy trigger diagnostic evaluation and antimicrobial therapy for possible brain infection. This study determined the incidence and predictors of infection in infants and children undergoing epilepsy neurosurgery.We reviewed the postoperative course of 100 consecutive surgeries for pediatric epilepsy, comparing those with and without infections for clinical variables and daily maximum temperatures, blood white blood cell (WBC) and differential and cerebrospinal fluid (CSF) studies.Infections were the most common adverse events after these surgeries. Four patients (4%) had CSF infections and 12 had non-CSF infections (including 1 with distinct CSF and bloodstream infections). Most (88%) infections occurred before postoperative day 12 and were associated with larger resections involving ventriculostomies. Fevers (T ≥ 38.5°C) were observed in the first 12 days postsurgery in 43% of cases, and were associated with patients undergoing hemispherectomy and multilobar resections. Fevers in the first 3 days postsurgery identified infections with 73% sensitivity, 69% specificity and 70% accuracy; 2 (13%) patients with infections never developed fevers. Peripheral blood WBC >15,000 was found in 49% of patients and 5 cases of infections never had elevated WBC counts. WBC differential, CSF protein, red blood cell, WBC and red blood cell/WBC ratios were poor predictors of infections. Longer hospital stays were associated with infections and hemispherectomy and multilobar resections. Patients with and without infections were equally likely to be seizure free after surgery.Fevers and elevated blood WBC counts were common after pediatric epilepsy surgery, but CSF infections were uncommon. Positive cultures and other confirmatory microbiologic tests should drive changes in antimicrobial therapy after surgery.

  View details for DOI 10.1097/INF.0b013e318287b408

  View details for Web of Science ID 000318684400012

  View details for PubMedID 23348815

  View details for PubMedCentralID PMC3717398

• Epitope-based vaccination against pneumonic tularemia VACCINE Gregory, S. H., Mott, S., Phung, J., Lee, J., Moise, L., McMurry, J. A., Martin, W., De Groot, A. S. 2009; 27 (39): 5299–5306

  Abstract

  Francisella tularensis, the etiological agent of tularemia, is one of the most infectious bacterial pathogens known. No vaccine is currently approved for public use. Previously, we identified epitopes recognized specifically by T cells obtained from individuals following infection with F. tularensis. Here, we report that a subunit vaccine constructed based upon these epitopes elicited protective immunity in "humanized" HLA class II (DRB1*0401) transgenic mice. Vaccinated mice challenged intratracheally with a lethal dose of F. tularensis (Live Vaccine Strain) exhibited a rapid increase in pro-inflammatory cytokine production and diminished number of organisms in the lungs, and a concurrent increased rate of survival. These results demonstrate the efficacy of an epitope-based tularemia vaccine and suggest that such an approach might be widely applicable to the development of vaccines specific for intracellular bacterial pathogens.

  View details for DOI 10.1016/j.vaccine.2009.06.101

  View details for Web of Science ID 000269629800003

  View details for PubMedID 19616492

  View details for PubMedCentralID PMC2772204