Frandics Chan

All Publications

• 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

• Evolution of hemodynamic forces in the pulmonary tree with progressively worsening pulmonary arterial hypertension in pediatric patients. Biomechanics and modeling in mechanobiology Yang, W., Dong, M., Rabinovitch, M., Chan, F. P., Marsden, A. L., Feinstein, J. A. 2019

  Abstract

  Pulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling resulting in right ventricular (RV) dysfunction and ultimately RV failure. Mechanical stimuli acting on the vessel walls of the full pulmonary tree have not previously been comprehensively characterized. The goal of this study is to characterize wall shear stress (WSS) and strain in pediatric PAH patients at different stages of disease severity using computational patient-specific modeling. Computed tomography, magnetic resonance imaging and right heart catheterization data were collected and assimilated into pulmonary artery (PA) models for patients with and without PAH. Patients were grouped in three disease severity groups (control, moderate and severe) based on clinical evaluations. A finite element solver was employed to quantify hemodynamics and wall strains. To estimate WSS in the distal small PAs with diameters ranging from 50 to 500[Formula: see text], a morphometric tree model was created, with inputs coming from outlets of the 3D model. WSS in the proximal PAs decreased with disease severity (control 20.5 vs. moderate 15.8 vs. severe 6.3[Formula: see text], [Formula: see text]). Oscillatory shear index increased in the main pulmonary artery (MPA) with disease severity (0.13 vs. 0.13 vs. 0.2, [Formula: see text]). Wall strains measured by the first invariant of Green strain tensor decreased with disease severity (0.16 vs. 0.12 vs. 0.11, [Formula: see text]). Mean WSS for the distal PAs between 100 and 500[Formula: see text] significantly increased with disease severity (20 vs. 52 vs. 116 [Formula: see text], [Formula: see text]). In conclusion, 3D flow simulations showed that WSS is significantly decreased in the MPA with disease while the mathematical morphometric model suggested increased WSS in the distal small vessels. Computational models can reveal mechanical stimuli acting on vessel walls that may inform patient risk stratification and flow shear experiments.

  View details for PubMedID 30635853

• Repair of Untreated Older Patients with Tetralogy of Fallot with Major Aortopulmonary Collaterals. The Annals of thoracic surgery Vaikunth, S., Bauser-Heaton, H., Lui, G. K., Wise-Faberowski, L., Chan, F. P., Asija, R., Hanley, F. L., McElhinney, D. B. 2018

  Abstract

  BACKGROUND: Our programmatic approach to tetralogy of Fallot with major aortopulmonary collaterals emphasizes single-stage unifocalization with complete intracardiac repair during infancy. Little is known about suitability for complete repair in patients beyond infancy. We sought to analyze outcomes of our approach in older patients with previously untreated tetralogy of Fallot with major aortopulmonary collaterals.METHODS: Any patient with this lesion not treated prior to 2 years of age referred to our center from 2002-17 met inclusion criteria.RESULTS: Of 33 patients, 32 were out-of-state (64% international) referrals, and 33% (n=11) were >9 years old, had polycythemia, and/or at least 1 high pressure collateral (>25 mm Hg). Complete repair was achieved in 94% (n=31) of patients, 82% (n=27) in one stage and 12% (n=4) after unifocalization to a central shunt. The median right ventricular to aortic pressure ratio was 0.31 after surgery and 0.37 at follow-up. At a median of 4.8 years after repair, 9 patients (19%) underwent reintervention, including 5 conduit and 7 branch pulmonary artery interventions. Three patients also underwent aortic valve replacement.CONCLUSIONS: In this selected cohort of older patients with previously unoperated tetralogy of Fallot with major aortopulmonary collaterals, outcomes were comparable to infants undergoing treatment according to our approach. These findings support the notion that patients who are either born in low-resource settings or present to healthcare providers beyond infancy should be considered candidates and evaluated for complete repair.

  View details for PubMedID 30550802

• Ultrafast pediatric chest computed tomography: comparison of free-breathing vs. breath-hold imaging with and without anesthesia in young children. Pediatric radiology Kino, A., Zucker, E. J., Honkanen, A., Kneebone, J., Wang, J., Chan, F., Newman, B. 2018

  Abstract

  BACKGROUND: General anesthesia (GA) or sedation has been used to obtain good-quality motion-free breath-hold chest CT scans in young children; however pulmonary atelectasis is a common and problematic accompaniment that can confound diagnostic utility. Dual-source multidetector CT permits ultrafast high-pitch sub-second examinations, minimizing motion artifact and potentially eliminating the need for a breath-hold.OBJECTIVE: The purpose of this study was to evaluate the feasibility of free-breathing ultrafast pediatric chest CT without GA and to compare it with breath-hold and non-breath-hold CT with GA.MATERIALS AND METHODS: Young (≤3years old) pediatric outpatients scheduled for chest CT under GA were recruited into the study and scanned using one of three protocols: GA with intubation, lung recruitment and breath-hold; GA without breath-hold; and free-breathing CT without anesthesia. In all three protocols an ultrafast high-pitch CT technique was used. We evaluated CT images for overall image quality, presence of atelectasis and motion artifacts.RESULTS: We included 101 scans in the study. However the GA non-breath-hold technique was discontinued after 15 scans, when it became clear that atelectasis was a major issue despite diligent attempts to mitigate it. This technique was therefore not included in statistical evaluation (86 remaining patients). Overall image quality was higher (P=0.001) and motion artifacts were fewer (P<.001) for scans using the GA with intubation and recruitment technique compared to scans in the non-GA free-breathing group. However no significant differences were observed regarding the presence of atelectasis between these groups.CONCLUSION: We demonstrated that although overall image quality was best and motion artifact least with a GA-breath-hold intubation and recruitment technique, free-breathing ultrafast pediatric chest CT without anesthesia provides sufficient image quality for diagnostic purposes and can be successfully performed both without and with contrast agent in young infants.

  View details for PubMedID 30413857

• Safety of ferumoxytol in children undergoing cardiac MRI under general anaesthesia. Cardiology in the young Wise-Faberowski, L., Velasquez, N., Chan, F., Vasanawala, S., McElhinney, D. B., Ramamoorthy, C. 2018; 28 (7): 916–21

  Abstract

  BACKGROUND: Ferumoxytol, an "off-label" contrast agent, allows for better cardiac MRI quality as compared with gadolinium-based contrast agents. However, hypotension has been reported with the use of ferumoxytol for indications other than cardiac MRI. The purpose of our investigation was to evaluate the safety of ferumoxytol in children undergoing general anaesthesia for cardiac MRI.METHODS: Medical records of children undergoing general anaesthesia for cardiac MRI were reviewed. Baseline demographic and medical characteristics, as well as imaging and anaesthetic duration and technique, were collected. The incidence of hypotension or other adverse events', need for vasoactive support, or airway intervention throughout the anaesthetic, was recorded.RESULTS: A total of 95 patients were identified, 61 received ferumoxytol and 34 received gadolinium. There were no significant differences between groups with respect to age, weight, or baseline blood pressure. The incidence of low blood pressure - systolic or mean - after contrast administration did not differ between groups, and there was no difference in sustained hypotension or use of vasopressors between groups. One patient who received ferumoxytol had possible anaphylaxis. The image acquisition time (45 versus 68 min, p=0.002) and anaesthesia duration (100 versus 132 min, p=0.02) were shorter in the ferumoxytol group.CONCLUSION: Transient low blood pressure was common in children undergoing cardiac MRI with anaesthesia, but the incidence of hypotension did not differ between ferumoxytol and gadolinium groups. The use of ferumoxytol was associated with significantly shorter scan time and anaesthesia duration, as well as a decreased need for airway intervention.

  View details for PubMedID 29848399

• Echocardiography-Derived Left Ventricular Outflow Tract Gradient and Left Ventricular Posterior Wall Thickening Are Associated with Outcomes for Anatomic Repair in Congenitally Corrected Transposition of the Great Arteries. Journal of the American Society of Echocardiography Moodley, S., Balasubramanian, S., Tacy, T. A., Chan, F., Hanley, F. L., Punn, R. 2017

  Abstract

  Congenitally corrected transposition of the great arteries is a rare form of congenital heart disease. Management is controversial; options include observation, physiologic repair, and anatomic repair. Assessment of morphologic left ventricle preparedness is key in timing anatomic repair. This study's purpose was to review the modalities used to assess the morphologic left ventricle preoperatively and to determine if any echocardiographic variables are associated with outcomes.A retrospective review of patients with congenitally corrected transposition of the great arteries eligible for anatomic repair at Lucile Packard Children's Hospital from 2000 to 2016 was conducted. Inclusion criteria were (1) presurgical echocardiography, magnetic resonance imaging, and cardiac catheterization and (2) clinical follow-up information. Echocardiographic measurements included left ventricular (LV) single-plane Simpson's ejection fraction, LV eccentricity index, LV posterior wall thickening, pulmonary artery band (PAB)/LV outflow tract (LVOT) pressure gradient, and LV and right ventricular strain. Magnetic resonance imaging measurements included LV mass, ejection fraction, eccentricity index, and LV thickening. LV pressure, PAB/LVOT gradient, right ventricular pressure, pulmonary vascular resistance, and Qp/Qs constituted catheterization data. Outcomes included achieving anatomic repair within 1 year of assessment in patients with LVOT obstruction or within 1 year of pulmonary artery banding and freedom from death, transplantation, or heart failure at last follow-up.Forty-one patients met the inclusion criteria. PAB/LVOT gradients of 85.2 ± 23.4 versus 64.0 ± 32.1 mm Hg (P = .0282) by echocardiography and 60.1 ± 19.4 versus 35.9 ± 18.9 mm Hg (P = .0030) by catheterization were associated with achieving anatomic repair and freedom from death, transplantation, and heart failure. Echocardiographic LV posterior wall thickening of 35.4 ± 19.8% versus 20.6 ± 15.0% (P = .0017) and MRI LV septal wall thickening of 37.1 ± 18.8% versus 19.3 ± 18.8% (P = .0306) were associated with achieving anatomic repair. Inter- and intraobserver variability for echocardiographic measurements was very good.PAB/LVOT gradient and LV posterior wall thickening are highly reproducible echocardiographic measurements that reflect morphologic LV performance and can be used in assessing patients with congenitally corrected transposition of the great arteries undergoing anatomic repair.

  View details for DOI 10.1016/j.echo.2017.03.019

  View details for PubMedID 28579248

• A PET/MR Imaging Approach for the Integrated Assessment of Chemotherapy-induced Brain, Heart, and Bone Injuries in Pediatric Cancer Survivors: A Pilot Study. Radiology Theruvath, A. J., Ilivitzki, A. n., Muehe, A. n., Theruvath, J. n., Gulaka, P. n., Kim, C. n., Luna-Fineman, S. n., Sakamoto, K. M., Yeom, K. W., Yang, P. n., Moseley, M. n., Chan, F. n., Daldrup-Link, H. E. 2017: 170073

  Abstract

  Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session. Materials and Methods Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20-30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review board-approved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests. Results Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects. Conclusion The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors. (©) RSNA, 2017 Online supplemental material is available for this article.

  View details for PubMedID 28777701

• Computational simulation of postoperative pulmonary flow distribution in Alagille patients with peripheral pulmonary artery stenosis Computational simulation of postoperative pulmonary flow distribution in Alagille patients with peripheral pulmonary artery stenosis Yang, W., Feinstein, J., Marsden, A., Vignon-Clementel, I. 2017; 00: 1–10

  View details for DOI 10.1111/chd.12556

• Congenital Variants and Anomalies of the Aortic Arch. Radiographics Hanneman, K., Newman, B., Chan, F. 2017; 37 (1): 32-51

  Abstract

  Congenital variants and anomalies of the aortic arch are important to recognize as they may be associated with vascular rings, congenital heart disease, and chromosomal abnormalities, and can have important implications for prognosis and management. The purpose of this article is to review cross-sectional imaging techniques used in the evaluation of the aortic arch, describe the embryology and anatomy of the aortic arch system, discuss aortic arch variants and anomalies, and review other malformations of the aortic arch, including interrupted aortic arch, hypoplastic aortic arch, and aortic coarctation. Aortic arch variants and anomalies will be reviewed in the context of a theoretical double aortic arch system. Arch anomalies can be associated with symptoms, such as dysphagia lusoria in the setting of left aortic arch with aberrant right subclavian artery. Arch variants that form a vascular ring, such as double aortic arch, can result in respiratory distress due to tracheal compression. Certain arch anomalies are strongly associated with congenital heart disease, including right aortic arch with mirror image branching. Other malformations of the aortic arch have important associations, such as type B interrupted aortic arch, which is associated with a locus 22q11.2 microdeletion. Noninvasive imaging at CT angiography and MR angiography allows for comprehensive evaluation of the aortic arch and branch vessels in relation to surrounding structures. Familiarity with the spectrum and imaging appearances of aortic arch variants, anomalies, and malformations is essential for accurate diagnosis and classification and to guide management. Online supplemental material is available for this article. (©)RSNA, 2016.

  View details for DOI 10.1148/rg.2017160033

  View details for PubMedID 27860551

• Myocardial Bridges on Coronary Computed Tomography Angiography　- Correlation With Intravascular Ultrasound and Fractional Flow Reserve. Circulation journal : official journal of the Japanese Circulation Society Forsdahl, S. H., Rogers, I. S., Schnittger, I. n., Tanaka, S. n., Kimura, T. n., Pargaonkar, V. S., Chan, F. P., Fleischmann, D. n., Tremmel, J. A., Becker, H. C. 2017

  Abstract

  Myocardial bridges (MB) are commonly seen on coronary CT angiography (CCTA) in asymptomatic individuals, but in patients with recurrent typical angina symptoms, yet no obstructive coronary artery disease (CAD), evaluation of their potential hemodynamic significance is clinically relevant. The aim of this study was to compare CCTA to invasive coronary angiography (ICA), including intravascular ultrasound (IVUS), to confirm MB morphology and estimate their functional significance in symptomatic patients.Methods and Results:We retrospectively identified 59 patients from our clinical databases between 2009 and 2014 in whom the suspicion for MB was raised by symptoms of recurrent typical angina in the absence of significant obstructive CAD on ICA. All patients underwent CCTA, ICA and IVUS. MB length and depth by CCTA agreed well with length (0.6±23.7 mm) and depth (CT coverage) as seen on IVUS. The product of CT length and depth (CT coverage), (MB muscle index (MMI)), ≥31 predicted an abnormal diastolic fractional flow reserve (dFFR) ≤0.76 with a sensitivity and specificity of 74% and 62% respectively (area under the curve=0.722).In patients with recurrent symptoms of typical angina yet no obstructive CAD, clinicians should consider dynamic ischemia from an MB in the differential diagnosis. The product of length and depth (i.e., MMI) by CCTA may provide some non-invasive insight into the hemodynamic significance of a myocardial bridge, as compared with invasive assessment with dFFR.

  View details for PubMedID 28690285

• Persistent fifth arch anomalies - broadening the spectrum to include a variation of double aortic arch vascular ring PEDIATRIC RADIOLOGY Newman, B., Hanneman, K., Chan, F. 2016; 46 (13): 1866-1872

  Abstract

  Fifth arch anomalies are rare and complex and frequently misdiagnosed or mistaken for other entities. We report a double arch vascular ring that is thought to consist of right fourth arch and left fifth arch components, a previously undescribed persistent fifth arch variant. The currently recognized spectrum and classification of fifth arch vascular anomalies are expanded along with illustrative images to justify the proposed changes. Reviewing and expanding the classification of fifth arch anomalies to include a double arch ring variant will promote recognition, correct diagnosis and appropriate management of these anomalies.

  View details for DOI 10.1007/s00247-016-3693-9

  View details for Web of Science ID 000388743000013

  View details for PubMedID 27669708

• CT-defined phenotype of pulmonary artery stenoses in Alagille syndrome PEDIATRIC RADIOLOGY Rodriguez, R. M., Feinstein, J. A., Chan, F. P. 2016; 46 (8): 1120-1127

  Abstract

  Alagille syndrome is a rare disorder commonly associated with pulmonary artery stenosis. Studies exist discussing the cardiovascular sequela but no consistent phenotype, or pattern of pulmonary artery stenosis, has been described.The objective of this study was to characterize the distribution and severity of pulmonary artery stenosis in patients with Alagille syndrome based on computed tomography angiography.A retrospective chart review identified patients with Alagille syndrome who had undergone CT angiography. Pulmonary trunk (MPA), left main pulmonary artery (LPA) and right main pulmonary artery (RPA) diameters in Alagille patients were compared with those from matched control subjects. Stenoses at lobar and segmental pulmonary arteries were categorized as: Grade 1 (<33% stenosis), Grade 2 (33-66% stenosis) or Grade 3 (>66% stenosis). Involvement among the different lung regions was then compared.Fifteen patients ages 6 months to 17 years were identified; one had surgical augmentation of the central pulmonary arteries and was excluded from the central (main, right and left) pulmonary artery analysis. The proximal LPA and RPA, but not the MPA, were significantly smaller than those of the control subjects (P<0.01). The proximal LPA was significantly smaller than the proximal RPA (P<0.01) in the Alagille group (0.55 LPA:RPA ratio). Within the Alagille group, 75% of the lobar and segmental branches showed mild or no stenoses (Grade 1), 17% showed moderate stenosis (Grade 2) and 8% showed severe stenosis (Grade 3). While not statistically significant, the right lung demonstrated a greater percentage of Grades 2 and 3 stenoses (28%, right vs. 20% left, P=0.1). The right middle and lingula lobes of both lungs showed more Grade 2 and 3 stenoses (33% upper/middle vs. 18% lower, P<0.01).We describe a common pattern pulmonary artery stenosis in Alagille patients consisting of severe proximal LPA stenosis, heavy involvement of the lobar and segmental branches (more often right than left), and a greater involvement of the upper lobes. Knowledge of this phenotypic pattern can help in the diagnosis of Alagille syndrome in patients presenting with pulmonary artery stenosis.

  View details for DOI 10.1007/s00247-016-3580-4

  View details for PubMedID 27041277

• Postoperative Outcomes of Children With Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals Undergoing Reconstruction of Occluded Pulmonary Artery Branches ANNALS OF THORACIC SURGERY Asija, R., Koth, A. M., Velasquez, N., Chan, F. P., Perry, S. B., Hanley, F. L., McElhinney, D. 2016; 101 (6): 2329-2334

  Abstract

  Patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals (TOF/PA/MAPCAs) undergoing unifocalization surgery are at risk for prolonged postoperative respiratory failure. We sought to understand whether patients undergoing reconstruction and incorporation of occluded pulmonary arterial branches were at risk for worse postoperative outcomes.We performed a retrospective chart review to identify patients who underwent unifocalization or unifocalization revision with incorporation of occluded pulmonary artery branches. Patients with and without occluded branches were compared, with a focus on clinical outcomes.We studied 92 patients who underwent unifocalization procedures between 2010 and 2014, 17 (18%) of whom underwent reconstruction of occluded pulmonary artery branches. Patients with occluded vessels were more likely to require staged unifocalization procedures, although more than two thirds of this cohort eventually underwent complete intracardiac repair. Durations of mechanical ventilation, intensive care, hospital stay, and the need for early reoperation were similar between the two groups.Occluded pulmonary arterial branches can be safely recruited into the pulmonary vasculature in patients with TOF/PA/MAPCAs without a significant difference in postoperative outcomes compared with patients who did not have an occluded branch. Incorporation of occluded branches may also facilitate ultimate complete intracardiac repair in this complex population of patients.

  View details for DOI 10.1016/j.athoracsur.2015.12.049

  View details for PubMedID 26947013

• Surgical Repair of 115 Patients With Anomalous Aortic Origin of a Coronary Artery From a Single Institution. World journal for pediatric & congenital heart surgery Mainwaring, R. D., Murphy, D. J., Rogers, I. S., Chan, F. P., Petrossian, E., Palmon, M., Hanley, F. L. 2016; 7 (3): 353-359

  Abstract

  Anomalous aortic origin of a coronary artery (AAOCA) has been associated with myocardial ischemia and sudden death. The past decade has provided important insights into the natural history and typical patterns of presentation. However, there are also a number of unresolved controversies regarding the indications for surgery and the efficacy of that surgery. The purpose of this study was to review our surgical experience with AAOCA in 115 patients at a single institution.One hundred and fifteen patients have undergone surgical repair of AAOCA at our institution. There were 82 males and 33 females, and the median age at surgery was 16 years. Fifty-nine patients had preoperative symptoms of myocardial ischemia, including 56 with exertional chest pain or syncope and 3 sudden death events. Twenty-four patients had associated congenital heart defects. Seven patients had an associated myocardial bridge.Surgical repair was accomplished by unroofing of an intramural coronary in 86, reimplantation in 9, and pulmonary artery translocation in 20. There has been no early or late mortality. Fifty-seven (97%) of the 59 symptomatic patients have been free of any cardiac symptoms postoperatively. Two patients had recurrent symptoms and underwent reoperation (one had revision of the initial repair and one had repair of a myocardial bridge).Surgical repair of AAOCA can be safely performed and is highly efficacious in relieving symptoms of myocardial ischemia. The two "surgical failures" in this series had an anatomic basis and underscore the need to reassess both the proximal and distal anatomy in these patients.

  View details for DOI 10.1177/2150135116641892

  View details for PubMedID 27142404

• Pre- and Postoperative Imaging of the Aortic Root. Radiographics Hanneman, K., Chan, F. P., Mitchell, R. S., Miller, D. C., Fleischmann, D. 2016; 36 (1): 19-37

  Abstract

  Three-dimensional datasets acquired using computed tomography and magnetic resonance imaging are ideally suited for characterization of the aortic root. These modalities offer different advantages and limitations, which must be weighed according to the clinical context. This article provides an overview of current aortic root imaging, highlighting normal anatomy, pathologic conditions, imaging techniques, measurement thresholds, relevant surgical procedures, postoperative complications and potential imaging pitfalls. Patients with a range of clinical conditions are predisposed to aortic root disease, including Marfan syndrome, bicuspid aortic valve, vascular Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Various surgical techniques may be used to repair the aortic root, including placement of a composite valve graft, such as the Bentall and Cabrol procedures; placement of an aortic root graft with preservation of the native valve, such as the Yacoub and David techniques; and implantation of a biologic graft, such as a homograft, autograft, or xenograft. Potential imaging pitfalls in the postoperative period include mimickers of pathologic processes such as felt pledgets, graft folds, and nonabsorbable hemostatic agents. Postoperative complications that may be encountered include pseudoaneurysms, infection, and dehiscence. Radiologists should be familiar with normal aortic root anatomy, surgical procedures, and postoperative complications, to accurately interpret pre- and postoperative imaging performed for evaluation of the aortic root. Online supplemental material is available for this article. (©)RSNA, 2015.

  View details for DOI 10.1148/rg.2016150053

  View details for PubMedID 26761529

• Improved Quantification and Mapping of Anomalous Pulmonary Venous Flow With Four-Dimensional Phase-Contrast MRI and Interactive Streamline Rendering JOURNAL OF MAGNETIC RESONANCE IMAGING Hsiao, A., Yousaf, U., Alley, M. T., Lustig, M., Chan, F. P., Newman, B., Vasanawala, S. S. 2015; 42 (6): 1765-1776

  View details for DOI 10.1002/jmri.24928

  View details for Web of Science ID 000368258100034

• Diagnosis of Anomalous Aortic Origin of the Left Coronary Artery in a Pediatric Patient. World journal for pediatric & congenital heart surgery Arunamata, A., Buccola Stauffer, K. J., Punn, R., Chan, F. P., Maeda, K., Balasubramanian, S. 2015; 6 (3): 470-473

  Abstract

  Anomalous aortic origin of the left coronary artery is rare and confers increased risk of sudden cardiac death. Accurate diagnosis is crucial and often requires many diagnostic modalities. This case report highlights the echocardiographic characteristics and pitfalls in diagnosing the anomaly in addition to the advantages of using computed tomography and magnetic resonance imaging in a pediatric patient.

  View details for DOI 10.1177/2150135114558689

  View details for PubMedID 26180168

• Contrast-Enhanced C-arm Computed Tomography Imaging of Myocardial Infarction in the Interventional Suite INVESTIGATIVE RADIOLOGY Girard, E. E., Al-Ahmad, A., Rosenberg, J., Luong, R., Moore, T., Lauritsch, G., Chan, F., Lee, D. P., Fahrig, R. 2015; 50 (6): 384-391

  Abstract

  Cardiac C-arm computed tomography (CT) uses a standard C-arm fluoroscopy system rotating around the patient to provide CT-like images during interventional procedures without moving the patient to a conventional CT scanner. We hypothesized that C-arm CT can be used to visualize and quantify the size of perfusion defects and late enhancement resulting from a myocardial infarction (MI) using contrast-enhanced techniques similar to previous CT and magnetic resonance imaging studies.A balloon occlusion followed by reperfusion in a coronary artery was used to study acute and subacute MI in 12 swine. Electrocardiographically gated C-arm CT images were acquired the day of infarct creation (n = 6) or 4 weeks after infarct creation (n = 6). The images were acquired immediately after contrast injection, then at 1 minute, and every 5 minutes up to 30 minutes with no additional contrast. The volume of the infarct as measured on C-arm CT was compared against pathology.The volume of acute MI, visualized as a combined region of hyperenhancement with a hypoenhanced core, correlated well with pathologic staining (concordance correlation, 0.89; P < 0.0001; mean [SD] difference, 0.67 [2.98] cm). The volume of subacute MI, visualized as a region of hyperenhancement, correlated well with pathologic staining at imaging times 5 to 15 minutes after contrast injection (concordance correlation, 0.82; P < 0.001; mean difference, -0.64 [1.94] cm).C-arm CT visualization of acute and subacute MI is possible in a porcine model, but improvement in the imaging technique is important before clinical use. Visualization of MI in the catheterization laboratory may be possible and could provide 3-dimensional images for guidance during interventional procedures.

  View details for Web of Science ID 000354380900003

  View details for PubMedID 25635589

• Computed Tomography and Magnetic Resonance Imaging in Neonates With Congenital Cardiovascular Disease SEMINARS IN ULTRASOUND CT AND MRI Chan, F. P., Hanneman, K. 2015; 36 (2): 146-160

  Abstract

  Most cardiac diseases in the newborn are caused by structural abnormalities developed in utero. With few exceptions, palliative and definitive treatments require cardiac surgery. The diagnosis and management decisions regarding uncomplicated lesions, such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, and tetralogy of Fallot, can be accomplished by echocardiography alone. Abnormalities beyond the sonographic window, complex 3-dimensional lesions, and detailed functional information require additional imaging. In the past, this was fulfilled by catheter angiography, but today much of the information can be obtained from noninvasive computed tomography angiography and magnetic resonance imaging. This article discusses the design and application of these imaging techniques to the newborn, with emphasis on safety, efficacy, and image quality. Understanding the capabilities and limitations of these techniques is crucial for making rational choices among imaging options based on sound risk and benefit considerations. Important examples of congenital heart lesions have been illustrated with 3-dimensional reconstruction from computed tomography and magnetic resonance images.

  View details for DOI 10.1053/j.sult.2015.01.006

  View details for Web of Science ID 000355575300005

  View details for PubMedID 26001944

• Flow simulations and validation for the first cohort of patients undergoing the Y-graft Fontan procedure JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Yang, W., Chan, F. P., Reddy, V. M., Marsden, A. L., Feinstein, J. A. 2015; 149 (1): 247-255

  Abstract

  In this study, with the use of computational fluid dynamics, we evaluate the postoperative hemodynamic performance of the first cohort of patients undergoing a handcrafted Y-graft Fontan procedure and validate simulation predictions of hepatic blood flow distribution against in vivo clinical data.An 18-12 × 2-mm handcrafted Y-graft modification of the Fontan procedure was performed in 6 patients. Early (at the time of discharge) and 6-month postoperative 3-dimensional magnetic resonance imaging data were collected. Patient-specific models were constructed for flow simulations.Hepatic blood flow distribution varied among patients. Lung perfusion data (n = 3) showed good agreement with simulations. Postoperative asymmetry in hepatic blood flow distribution was reduced 6 months postoperatively. In 1 patient, low wall shear stress was found in the left limb of the Y-graft, corresponding to the location of subsequent thrombosis in the patient.The credibility and accuracy of simulation-based predictions of postoperative hepatic flow distribution for the Fontan surgery have been validated by in vivo lung perfusion data. The performance of the Y-graft design is highly patient-specific. The anastomosis location is likely the most important factor influencing hepatic blood flow distribution. Although the development of thrombosis is multifactorial, the occurrence in 1 patient suggests that simulations should not solely consider the hepatic blood flow distribution but also aim to avoid low wall shear stress in the limbs.

  View details for DOI 10.1016/j.jtcvs.2014.08.069

  View details for PubMedID 25439766

• Technical feasibility and intermediate outcomes of using a handcrafted, area-preserving, bifurcated Y-graft modification of the Fontan procedure JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Martin, M. H., Feinstein, J. A., Chan, F. P., Marsden, A. L., Yang, W., Reddy, V. M. 2015; 149 (1): 239-U381

  Abstract

  To demonstrate the technical feasibility and describe intermediate outcomes for the initial patients undergoing handcrafted, area-preserving, Y-graft modification of the Fontan procedure.A retrospective review of a pilot study was undertaken to describe preoperative, intraoperative, and postoperative results.Six patients underwent successful procedures and remain alive 3 to 4 years later. The median age at operation was 3.3 years, and median weight was 13.2 kg. Five operations were done without cardiopulmonary bypass and no intraoperative pressure gradients were found. Five patients were extubated by postoperative day 1, Fontan pressures were 12 to 14 mm Hg, transpulmonary gradients were 6 to 8 mm Hg, and no renal or hepatic function abnormalities were found. Length of stay was 10 to 64 days. One patient required venovenous extracorporeal membrane oxygenation for previously undiagnosed plastic bronchitis (64-day stay); another required reoperation for an incidentally diagnosed aortic thrombus (44-day stay). One patient had occlusion of a Y-graft limb noted on magnetic resonance imaging follow-up at 3 months. Catheterization showed excellent hemodynamic parameters and no Fontan obstruction. Occlusion was believed to be due to right-sided pulmonary arteriovenous malformations and widely discrepant flow (80%) to the right lung leading to low flow in the left limb.The area-preserving, bifurcated Y-graft Fontan modification is technically feasible and shows excellent intermediate outcomes. Additional study is required to determine whether the advantages seen in the computational models will be realized in patients over the long-term, and to optimize patient selection for each of the various Fontan options now available.

  View details for DOI 10.1016/j.jtcvs.2014.08.058

  View details for Web of Science ID 000350550100068

  View details for PubMedID 25439786

• Technical feasibility and intermediate outcomes of using a handcrafted, area-preserving, bifurcated Y-graft modification of the Fontan procedure. journal of thoracic and cardiovascular surgery Martin, M. H., Feinstein, J. A., Chan, F. P., Marsden, A. L., Yang, W., Reddy, V. M. 2015; 149 (1): 239-45 e1

  Abstract

  To demonstrate the technical feasibility and describe intermediate outcomes for the initial patients undergoing handcrafted, area-preserving, Y-graft modification of the Fontan procedure.A retrospective review of a pilot study was undertaken to describe preoperative, intraoperative, and postoperative results.Six patients underwent successful procedures and remain alive 3 to 4 years later. The median age at operation was 3.3 years, and median weight was 13.2 kg. Five operations were done without cardiopulmonary bypass and no intraoperative pressure gradients were found. Five patients were extubated by postoperative day 1, Fontan pressures were 12 to 14 mm Hg, transpulmonary gradients were 6 to 8 mm Hg, and no renal or hepatic function abnormalities were found. Length of stay was 10 to 64 days. One patient required venovenous extracorporeal membrane oxygenation for previously undiagnosed plastic bronchitis (64-day stay); another required reoperation for an incidentally diagnosed aortic thrombus (44-day stay). One patient had occlusion of a Y-graft limb noted on magnetic resonance imaging follow-up at 3 months. Catheterization showed excellent hemodynamic parameters and no Fontan obstruction. Occlusion was believed to be due to right-sided pulmonary arteriovenous malformations and widely discrepant flow (80%) to the right lung leading to low flow in the left limb.The area-preserving, bifurcated Y-graft Fontan modification is technically feasible and shows excellent intermediate outcomes. Additional study is required to determine whether the advantages seen in the computational models will be realized in patients over the long-term, and to optimize patient selection for each of the various Fontan options now available.

  View details for DOI 10.1016/j.jtcvs.2014.08.058

  View details for PubMedID 25439786

• Pediatric CT quality management and improvement program PEDIATRIC RADIOLOGY Larson, D. B., Molvin, L. Z., Wang, J., Chan, F. P., Newman, B., Fleischmann, D. 2014; 44: 519-524

  View details for DOI 10.1007/s00247-014-3039-4

  View details for Web of Science ID 000343721300023

• Physiologic and molecular characterization of a murine model of right ventricular volume overload. American journal of physiology. Heart and circulatory physiology Reddy, S., Zhao, M., Hu, D., Fajardo, G., Katznelson, E., Punn, R., Spin, J. M., Chan, F. P., Bernstein, D. 2013; 304 (10): H1314-27

  Abstract

  Pulmonary insufficiency (PI) is a common long-term sequel after repair of tetralogy of Fallot, causing progressive right ventricular (RV) dilation and failure. We describe the physiologic and molecular characteristics of the first murine model of RV volume overload. PI was created by entrapping the pulmonary valve leaflets with sutures. Imaging, catheterization, and exercise testing were performed at 1, 3, and 6 mo and compared with sham controls. RNA from the RV free wall was hybridized to Agilent whole genome oligonucleotide microarrays. Volume overload resulted in RV enlargement, decreased RV outflow tract shortening fraction at 1 mo followed by normalization at 3 and 6 mo (39 ± 2, 44 ± 2, and 41 ± 2 vs. 46 ± 3% in sham), early reversal of early and late diastolic filling velocities (E/A ratio) followed by pseudonormalization (0.87 ± 0.08, 0.82 ± 0.08, and 0.96 ± 0.08 vs. 1.04 ± 0.03; P < 0.05), elevated end-diastolic pressure (7.6 ± 0.7, 6.9 ± 0.8, and 7 ± 0.5 vs. 2.7 ± 0.2 mmHg; P < 0.05), and decreased exercise duration (26 ± 0.4, 26 ± 1, and 22 ± 1.3 vs. 30 ± 1.1 min; P < 0.05). Subendocardial RV fibrosis was evident by 1 mo. At 1 mo, 372 genes were significantly downregulated. Mitochondrial pathways and G protein-coupled receptor signaling were the most represented categories. At 3 mo, 434 genes were upregulated and 307 downregulated. While many of the same pathways continued to be downregulated, TNF-α, transforming growth factor-β(1) (TGF-β(1)), p53-signaling, and extracellular matrix (ECM) remodeling transitioned from down- to upregulated. We describe a novel murine model of chronic RV volume overload recapitulating aspects of the clinical disease with gene expression changes suggesting early mitochondrial bioenergetic dysfunction, enhanced TGF-β signaling, ECM remodeling, and apoptosis.

  View details for DOI 10.1152/ajpheart.00776.2012

  View details for PubMedID 23504182

• Physiologic and molecular characterization of a murine model of right ventricular volume overload. American journal of physiology. Heart and circulatory physiology Reddy, S., Zhao, M., Hu, D., Fajardo, G., Katznelson, E., Punn, R., Spin, J. M., Chan, F. P., Bernstein, D. 2013; 304 (10): H1314-27

  View details for DOI 10.1152/ajpheart.00776.2012

  View details for PubMedID 23504182

• Magnetic resonance imaging of the right ventricle in pediatric pulmonary arterial hypertension. Pulmonary circulation Blalock, S., Chan, F., Rosenthal, D., Ogawa, M., Maxey, D., Feinstein, J. 2013; 3 (2): 350-355

  Abstract

  Pulmonary arterial hypertension (PAH) causes changes in the right ventricle (RV), affecting RV size and function, ultimately leading to death. These changes have been evaluated by cardiac MRI (CMR) in adults with PAH, but not in children. Using CMR in pediatric patients with PAH, we examined how RV size and function (1) compare to normal data, (2) change over time, and (3) compare to similar studies in the adult population. Data from two institutions were retrospectively reviewed. Subjects with PAH and a CMR were included. Baseline CMR variables (right and left ventricular end-diastolic and end-systolic volumes indexed for body surface area, and calculated stroke volume and ejection fraction) were compared to normative data and follow-up CMR data. Twenty-six subjects (15 female), age 2-16 (mean 11) years, with idiopathic PAH were included. All patients were on PAH medication, and 65% on prostacyclin therapy. The baseline 6-Minute Walk Distance (6MWD; 481 ± 137) was normal. RV volumes and ejection fraction were markedly abnormal compared to normal data (P < 0.001). Follow-up CMRs were analyzed in 15 patients. RV volumes and function and LV stroke volume showed no significant change over one year. Our pediatric patients with PAH have markedly abnormal right ventricles by CMR but have normal walk distances. The lack of change in CMR parameters over one year may represent a stable cohort and is different than similar studies in adults.

  View details for DOI 10.4103/2045-8932.114763

  View details for PubMedID 24015335

  View details for PubMedCentralID PMC3757829

• Magnetic resonance imaging of the right ventricle in pediatric pulmonary arterial hypertension PULMONARY CIRCULATION Blalock, S., Chan, F., Rosenthal, D., Ogawa, M., Maxey, D., Feinstein, J. 2013; 3 (2): 350-355

  Abstract

  Pulmonary arterial hypertension (PAH) causes changes in the right ventricle (RV), affecting RV size and function, ultimately leading to death. These changes have been evaluated by cardiac MRI (CMR) in adults with PAH, but not in children. Using CMR in pediatric patients with PAH, we examined how RV size and function (1) compare to normal data, (2) change over time, and (3) compare to similar studies in the adult population. Data from two institutions were retrospectively reviewed. Subjects with PAH and a CMR were included. Baseline CMR variables (right and left ventricular end-diastolic and end-systolic volumes indexed for body surface area, and calculated stroke volume and ejection fraction) were compared to normative data and follow-up CMR data. Twenty-six subjects (15 female), age 2-16 (mean 11) years, with idiopathic PAH were included. All patients were on PAH medication, and 65% on prostacyclin therapy. The baseline 6-Minute Walk Distance (6MWD; 481 ± 137) was normal. RV volumes and ejection fraction were markedly abnormal compared to normal data (P < 0.001). Follow-up CMRs were analyzed in 15 patients. RV volumes and function and LV stroke volume showed no significant change over one year. Our pediatric patients with PAH have markedly abnormal right ventricles by CMR but have normal walk distances. The lack of change in CMR parameters over one year may represent a stable cohort and is different than similar studies in adults.

  View details for DOI 10.4103/2045-8932.114763

  View details for Web of Science ID 000209981500008

  View details for PubMedCentralID PMC3757829

• Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions. journal of thoracic and cardiovascular surgery Coogan, J. S., Chan, F. P., LaDisa, J. F., Taylor, C. A., Hanley, F. L., Feinstein, J. A. 2013; 145 (2): 489-495 e1

  Abstract

  The cardiac workload associated with various types of aortic obstruction was determined using computational fluid dynamic simulations.Computed tomography image data were collected from 4 patients with 4 distinct types of aortic arch obstructions and 4 controls. The categorization of arch hypoplasia corresponded to the "A, B, C" nomenclature of arch interruption; a type "D" was added to represent diffuse arch hypoplasia. Measurements of the vessel diameter were compared against the normal measurements to determine the degree of narrowing. Three-dimensional models were created for each patient, and additional models were created for type A and B hypoplasia to represent 25%, 50%, and 75% diameter narrowing. The boundary conditions for the computational simulations were chosen to achieve realistic flow and pressures in the control cases. The simulations were then repeated after changing the boundary conditions to represent a range of cardiac and vascular adaptations. The resulting cardiac workload was compared with the control cases.Of the 4 patients investigated, 1 had aortic coarctation and 3 had aortic hypoplasia. The cardiac workload of the patients with 25% narrowing type A and B hypoplasia was not appreciably different from that of the control. When comparing the different arch obstructions, 75% type A, 50% type B, and 50% type D hypoplasia required a greater workload increase than 75% coarctation.The present study has determined the hemodynamic significance of aortic arch obstruction using computational simulations to calculate the cardiac workload. These results suggest that all types of hypoplasia pose more of a workload challenge than coarctation with an equivalent degree of narrowing.

  View details for DOI 10.1016/j.jtcvs.2012.03.051

  View details for PubMedID 22516390

• Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Coogan, J. S., Chan, F. P., LaDisa, J. F., Taylor, C. A., Hanley, F. L., Feinstein, J. A. 2013; 145 (2): 489-U535

  View details for DOI 10.1016/j.jtcvs.2012.03.051

  View details for Web of Science ID 000313634700032

  View details for PubMedID 22516390

• Wall shear stress is decreased in the pulmonary arteries of patients with pulmonary arterial hypertension: An image-based, computational fluid dynamics study. Pulmonary circulation Tang, B. T., Pickard, S. S., Chan, F. P., Tsao, P. S., Taylor, C. A., Feinstein, J. A. 2012; 2 (4): 470-476

  Abstract

  Previous clinical studies in pulmonary arterial hypertension (PAH) have concentrated predominantly on distal pulmonary vascular resistance, its contribution to the disease process, and response to therapy. However, it is well known that biomechanical factors such as shear stress have an impact on endothelial health and dysfunction in other parts of the vasculature. This study tested the hypothesis that wall shear stress is reduced in the proximal pulmonary arteries of PAH patients with the belief that reduced shear stress may contribute to pulmonary endothelial cell dysfunction and as a result, PAH progression. A combined MRI and computational fluid dynamics (CFD) approach was used to construct subject-specific pulmonary artery models and quantify flow features and wall shear stress (WSS) in five PAH patients with moderate-to-severe disease and five age- and sex-matched controls. Three-dimensional model reconstruction showed PAH patients have significantly larger main, right, and left pulmonary artery diameters (3.5 ± 0.4 vs. 2.7 ± 0.1 cm, P = 0.01; 2.5 ± 0.4 vs. 1.9 ± 0.2 cm, P = 0.04; and 2.6 ± 0.4 vs. 2.0 ± 0.2 cm, P = 0.01, respectively), and lower cardiac output (3.7 ± 1.2 vs. 5.8 ± 0.6 L/min, P = 0.02.). CFD showed significantly lower time-averaged central pulmonary artery WSS in PAH patients compared to controls (4.3 ± 2.8 vs. 20.5 ± 4.0 dynes/cm(2), P = 0.0004). Distal WSS was not significantly different. A novel method of measuring WSS was utilized to demonstrate for the first time that WSS is altered in some patients with PAH. Using computational modeling in patient-specific models, WSS was found to be significantly lower in the proximal pulmonary arteries of PAH patients compared to controls. Reduced WSS in proximal pulmonary arteries may play a role in the pathogenesis and progression of PAH. This data may serve as a basis for future in vitro studies of, for example, effects of WSS on gene expression.

  View details for DOI 10.4103/2045-8932.105035

  View details for PubMedID 23372931

• Murine Model of Chronic Right Ventricular Diastolic Heart Failure Is Associated with Energetic Alterations and Extracellular Matrix Remodeling Basic Cardiovascular Sciences Scientific Session Reddy, S., Zhao, M., Hu, D., Fajardo, G., Katznelson, E., Spin, J., Chan, F. P., Bernstein, D. LIPPINCOTT WILLIAMS & WILKINS. 2012

  View details for Web of Science ID 000312506400316

• CONTRAST-ENHANCED ROTATIONAL ANGIOGRAPHIC C-ARM CT IMAGING OF MYOCARDIAL INFARCTION IN THE INTERVENTIONAL SUITE: OPTIMIZED IMAGING PROTOCOL FOR ACUTE AND CHRONIC INFARCTS 61st Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC)/Conference on ACC-i2 with TCT Girard, E., Moore, T., Lauritsch, G., Rosenberg, J., Al-Ahmad, A., Chan, F., Lee, D., Fahrig, R. ELSEVIER SCIENCE INC. 2012: E169–E169

  View details for Web of Science ID 000302326700170

• Rapid Pediatric Cardiac Assessment of Flow and Ventricular Volume With Compressed Sensing Parallel Imaging Volumetric Cine Phase-Contrast MRI AMERICAN JOURNAL OF ROENTGENOLOGY Hsiao, A., Lustig, M., Alley, M. T., Murphy, M., Chan, F. P., Herfkens, R. J., Vasanawala, S. S. 2012; 198 (3): W250-W259

  Abstract

  The quantification of cardiac flow and ventricular volumes is an essential goal of many congenital heart MRI examinations, often requiring acquisition of multiple 2D phase-contrast and bright-blood cine steady-state free precession (SSFP) planes. Scan acquisition, however, is lengthy and highly reliant on an imager who is well-versed in structural heart disease. Although it can also be lengthy, 3D time-resolved (4D) phase-contrast MRI yields global flow patterns and is simpler to perform. We therefore sought to accelerate 4D phase contrast and to determine whether equivalent flow and volume measurements could be extracted.Four-dimensional phase contrast was modified for higher acceleration with compressed sensing. Custom software was developed to process 4D phase-contrast images. We studied 29 patients referred for congenital cardiac MRI who underwent a routine clinical protocol, including cine short-axis stack SSFP and 2D phase contrast, followed by contrast-enhanced 4D phase contrast. To compare quantitative measurements, Bland-Altman analysis, paired Student t tests, and F tests were used.Ventricular end-diastolic, end-systolic, and stroke volumes obtained from 4D phase contrast and SSFP were well correlated (ρ = 0.91-0.95; r(2) = 0.83-0.90), with no statistically significant difference. Ejection fractions were well correlated in a subpopulation that underwent higher-resolution compressed-sensing 4D phase contrast (ρ = 0.88; r(2) = 0.77). Four-dimensional phase contrast and 2D phase contrast flow rates were also well correlated (ρ = 0.90; r(2) = 0.82). Excluding ventricles with valvular insufficiency, cardiac outputs derived from outlet valve flow and stroke volumes were more consistent by 4D phase contrast than by 2D phase contrast and SSFP.Combined parallel imaging and compressed sensing can be applied to 4D phase contrast. With custom software, flow and ventricular volumes may be extracted with comparable accuracy to SSFP and 2D phase contrast. Furthermore, cardiac outputs were more consistent by 4D phase contrast.

  View details for DOI 10.2214/AJR.11.6969

  View details for Web of Science ID 000301069000006

  View details for PubMedID 22358022

  View details for PubMedCentralID PMC3515670

• Computed tomography angiography in children with cardiovascular disease: low dose techniques and image quality INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING Greenberg, S. B., Bhutta, S., Braswell, L., Chan, F. 2012; 28 (1): 163-170

  Abstract

  Dose reduction techniques for computed tomography angiography (CTA) in children with cardiovascular diseases have the potential of reducing risks of radiation-induced cancer. To evaluate effectiveness of these techniques, both radiation dose and image quality must be compared. While clinically practical methods of estimating effective dose are available, there are no generally accepted metrics for the assessment of image quality in CTA. We introduce a measurable and reproducible image quality index, CTA QI. Using this index, along with calculated effective dose, we test the hypothesis that volume scan CTA delivers comparable image quality at substantially reduced radiation dose when compared to helical CTA. CTA QI is a measure of intraluminal contrast variation in three-dimensions, and it is calculated from standardized measurements of means and standard deviations of Hounsfield units in the thoracic descending aorta. From institutional database, 83 studies of CTA for thoracic cardiovascular diseases were retrospectively identified. CTA QI values were independently measured by two radiologists and compared using correlation. CTA QI and DLP-derived effective dose were compared for the following groups: non-cardiac gated wide-detector and helical CTA, ECG-synchronized retrospective wide-detector and helical CTA, ECG-synchronized wide detector retrospective and target technique CTA. Statistical significance was evaluated with the Student-t test. The correlations of CTA QI values between the radiologists were 0.83 and 0.92 for non-gated studies and ECG-synchronized studies respectively. Comparing non-gated volume scan CTA to helical CTA, there was a radiation dose reduction of 69% (P < 0.0001) without a significant change in CTA QI (1.4 ± 1.0 vs. 1.9 ± 1.4, P = 0.13). Comparing retrospective ECG-synchronized wide-detector CTA to helical CTA, there was a radiation dose reduction of 46% (P < 0.0001) with and improvement in CTA QI (1.0 ± 0.8 vs. 3.7 ± 3.4, P < 0.01). Comparing ECG-synchronized wide-detector target CTA to retrospective CTA, there was a radiation dose reduction of 68% (P < 0.0001, but at the cost of a significant reduction in CTA QI (2.0 ± 1.0 vs. 0.8 ± 0.4, P < 0.0044). CTA QI is a simple, reproducible metric of image quality suited for comparing CTA studies. Using this quality index, we establish that CTA performed with wide-detector scan techniques can yield substantially lower radiation dose without compromising diagnostic imaging quality. A wide-detector target technique can further reduce effective dose compared to wide-detector retrospective ECG-synchronization, but with a reduction in image quality.

  View details for DOI 10.1007/s10554-010-9782-1

  View details for Web of Science ID 000300309800017

  View details for PubMedID 21213049

• COMPARISON OF CLINICAL AND SIMULATION RESULTS FOR THE STANFORD Y-GRAFT FONTAN PILOT TRIAL ASME Summer Bioengineering Conference (SBC) Yang, W., Feinstein, J. A., Reddy, V. M., Chan, F. P., Marsden, A. L. AMER SOC MECHANICAL ENGINEERS. 2012: 463–464

  View details for Web of Science ID 000325036600231

• Combined respiratory and cardiac triggering improves blood pool contrast-enhanced pediatric cardiovascular MRI PEDIATRIC RADIOLOGY Vasanawala, S. S., Chan, F. P., Newman, B., Alley, M. T. 2011; 41 (12): 1536-1544

  Abstract

  Contrast-enhanced cardiac MRA suffers from cardiac motion artifacts and often requires a breath-hold.This work develops and evaluates a blood pool contrast-enhanced combined respiratory- and ECG-triggered MRA method.An SPGR sequence was modified to enable combined cardiac and respiratory triggering on a 1.5-T scanner. Twenty-three consecutive children referred for pediatric heart disease receiving gadofosveset were recruited in HIPAA-compliant fashion with IRB approval and informed consent. Children underwent standard non-triggered contrast-enhanced MRA with or without suspended respiration. Additionally, a free-breathing-triggered MRA was acquired. Triggered and non-triggered studies were presented in blinded random order independently to two radiologists twice. Anatomical structure delineation was graded for each triggered and non-triggered acquisition and the visual quality on triggered MRA was compared directly to that on non-triggered MRA.Triggered images received higher scores from each radiologist for all anatomical structures on each of the two reading sessions (Wilcoxon rank sum test, P < 0.05). In direct comparison, triggered images were preferred over non-triggered images for delineating cardiac structures, with most comparisons reaching statistical significance (binomial test, P < 0.05).Combined cardiac and respiratory triggering, enabled by a blood pool contrast agent, improves delineation of most anatomical structures in pediatric cardiovascular MRA.

  View details for DOI 10.1007/s00247-011-2196-y

  View details for Web of Science ID 000297621800005

  View details for PubMedID 21786125

• Computational Simulations for Aortic Coarctation: Representative Results From a Sampling of Patients JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME LaDisa, J. F., Figueroa, C. A., Vignon-Clementel, I. E., Kim, H. J., Xiao, N., Ellwein, L. M., Chan, F. P., Feinstein, J. A., Taylor, C. A. 2011; 133 (9)

  Abstract

  Treatments for coarctation of the aorta (CoA) can alleviate blood pressure (BP) gradients (Δ), but long-term morbidity still exists that can be explained by altered indices of hemodynamics and biomechanics. We introduce a technique to increase our understanding of these indices for CoA under resting and nonresting conditions, quantify their contribution to morbidity, and evaluate treatment options. Patient-specific computational fluid dynamics (CFD) models were created from imaging and BP data for one normal and four CoA patients (moderate native CoA: Δ12 mmHg, severe native CoA: Δ25 mmHg and postoperative end-to-end and end-to-side patients: Δ0 mmHg). Simulations incorporated vessel deformation, downstream vascular resistance and compliance. Indices including cyclic strain, time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) were quantified. Simulations replicated resting BP and blood flow data. BP during simulated exercise for the normal patient matched reported values. Greatest exercise-induced increases in systolic BP and mean and peak ΔBP occurred for the moderate native CoA patient (SBP: 115 to 154 mmHg; mean and peak ΔBP: 31 and 73 mmHg). Cyclic strain was elevated proximal to the coarctation for native CoA patients, but reduced throughout the aorta after treatment. A greater percentage of vessels was exposed to subnormal TAWSS or elevated OSI for CoA patients. Local patterns of these indices reported to correlate with atherosclerosis in normal patients were accentuated by CoA. These results apply CFD to a range of CoA patients for the first time and provide the foundation for future progress in this area.

  View details for DOI 10.1115/1.4004996

  View details for Web of Science ID 000295882200008

  View details for PubMedID 22010743

• Computational Simulations Demonstrate Altered Wall Shear Stress in Aortic Coarctation Patients Treated by Resection with End-to-end Anastomosis CONGENITAL HEART DISEASE LaDisa, J. F., Dholakia, R. J., Figueroa, C. A., Vignon-Clementel, I. E., Chan, F. P., Samyn, M. M., Cava, J. R., Taylor, C. A., Feinstein, J. A. 2011; 6 (5): 432-443

  Abstract

  Atherosclerotic plaque in the descending thoracic aorta (dAo) is related to altered wall shear stress (WSS) for normal patients. Resection with end-to-end anastomosis (RWEA) is the gold standard for coarctation of the aorta (CoA) repair, but may lead to altered WSS indices that contribute to morbidity.Computational fluid dynamics (CFD) models were created from imaging and blood pressure data for control subjects and age- and gender-matched CoA patients treated by RWEA (four males, two females, 15 ± 8 years). CFD analysis incorporated downstream vascular resistance and compliance to generate blood flow velocity, time-averaged WSS (TAWSS), and oscillatory shear index (OSI) results. These indices were quantified longitudinally and circumferentially in the dAo, and several visualization methods were used to highlight regions of potential hemodynamic susceptibility.The total dAo area exposed to subnormal TAWSS and OSI was similar between groups, but several statistically significant local differences were revealed. Control subjects experienced left-handed rotating patterns of TAWSS and OSI down the dAo. TAWSS was elevated in CoA patients near the site of residual narrowings and OSI was elevated distally, particularly along the left dAo wall. Differences in WSS indices between groups were negligible more than 5 dAo diameters distal to the aortic arch.Localized differences in WSS indices within the dAo of CoA patients treated by RWEA suggest that plaque may form in unique locations influenced by the surgical repair. These regions can be visualized in familiar and intuitive ways allowing clinicians to track their contribution to morbidity in longitudinal studies.

  View details for DOI 10.1111/j.1747-0803.2011.00553.x

  View details for Web of Science ID 000294919100005

  View details for PubMedID 21801315

  View details for PubMedCentralID PMC3208403

• Improved cardiovascular flow quantification with time-resolved volumetric phase-contrast MRI PEDIATRIC RADIOLOGY Hsiao, A., Alley, M. T., Massaband, P., Herfkens, R. J., Chan, F. P., Vasanawala, S. S. 2011; 41 (6): 711-720

  Abstract

  Cardiovascular flow is commonly assessed with two-dimensional, phase-contrast MRI (2-D PC-MRI). However, scan prescription and acquisition over multiple planes is lengthy, often requires direct physician oversight and has inconsistent results. Time-resolved volumetric PC-MRI (4-D flow) may address these limitations.We assess the degree of agreement and internal consistency between 2-D and 4-D flow quantification in our clinical population.Software enabling flow calculation from 4-D flow was developed in Java. With IRB approval and HIPAA compliance, 18 consecutive patients without shunts were identified who underwent both (1) conventional 2-D PC-MRI of the aorta and main pulmonary artery and (2) 4-D flow imaging. Aortic and pulmonary flow rates were assessed with both techniques.Both methods showed general agreement in flow rates (ρ: 0.87-0.90). Systemic and pulmonary arterial flow rates were well-correlated (ρ: 4-D 0.98-0.99, 2-D 0.93), but more closely matched with 4-D (P < 0.05, Brown-Forsythe). Pulmonary flow rates were lower than systemic rates for 2-D (P < 0.05, two-sample t-test). In a sub-analysis of patients without pulmonary or aortic regurgitation, 2-D showed improved correlation of flow rates while 4-D phase-contrast remained tightly correlated (ρ: 4-D 0.99-1.00, 2-D 0.99).4-D PC-MRI demonstrates greater consistency than conventional 2-D PC-MRI for flow quantification.

  View details for DOI 10.1007/s00247-010-1932-z

  View details for Web of Science ID 000290544500005

  View details for PubMedID 21221566

• Computational Fluid Dynamic Simulations of Aortic Coarctation Comparing the Effects of Surgical- and Stent-Based Treatments on Aortic Compliance and Ventricular Workload CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Coogan, J. S., Chan, F. P., Taylor, C. A., Feinstein, J. A. 2011; 77 (5): 680-691

  Abstract

  In this work, we examine the effects of stent-induced aortic stiffness on cardiac workload and blood pressure using computational fluid dynamic simulations.Treatment of aortic coarctation (CoA) consists of either open, surgical repair or angioplasty with or without stenting. Although stenting is a minimally invasive alternative to surgery, aortic stiffness increases in the stented section. Concern over this increased stiffness has long been argued to be detrimental to the overall vascular health of the patient.MR imaging was performed on a 15-year-old female with CoA. A 3D model of the large thoracic arteries was created, and the heart and downstream vasculature were represented by lumped parameter models at the model inlet and outlets, respectively. A deformable wall assumption was used in conjunction with variable wall properties and tissue support, and 3D velocity, pressure, and wall dynamics were computed. The lumped parameter values and wall properties were tuned to match the mean flow and aortic deformation as measured by MRI. The CoA was then virtually removed from the model representing an end-to-end surgical correction. In a second model, the repaired section was prescribed to be nearly rigid, representing stenting. All other variables remained the same.When compared to surgery, stenting resulted in clinically negligible increases in cardiac work (0.4%) and no change in mean blood pressure.This pilot study suggests CoA stenting may not affect cardiac work to any significant degree as is commonly believed in the clinical community.

  View details for DOI 10.1002/ccd.22878

  View details for PubMedID 21061250

• MRI Evaluation of the Right Ventricle in Pediatric Pulmonary Arterial Hypertension 31st Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT) Blalock, S. E., Ogawa, M., Chan, F., MAXEY, D., Rosenthal, D. N., Feinstein, J. A. ELSEVIER SCIENCE INC. 2011: S81–S81

  View details for Web of Science ID 000288924300224

• Three-Dimensional Hemodynamics in the Human Pulmonary Arteries Under Resting and Exercise Conditions ANNALS OF BIOMEDICAL ENGINEERING Tang, B. T., Fonte, T. A., Chan, F. P., Tsao, P. S., Feinstein, J. A., Taylor, C. A. 2011; 39 (1): 347-358

  Abstract

  The biomechanical forces associated with blood flow have been shown to play a role in pulmonary vascular cell health and disease. Therefore, the quantification of human pulmonary artery hemodynamic conditions under resting and exercise states can be useful in investigating the physiology of disease development and treatment outcomes. In this study, a combined magnetic resonance imaging and computational fluid dynamics approach was used to quantify pulsatile flow fields, wall shear stress (WSS), oscillations in WSS (OSI), and energy efficiency in six subject-specific models of the human pulmonary vasculature with high spatial and temporal resolution. Averaging over all subjects, WSS was found to increase from 19.8±4.0 to 51.8±6.7 dynes/cm2, and OSI was found to decrease from 0.094±0.016 to 0.081±0.015 in the proximal pulmonary arteries between rest and exercise conditions (p<0.05). These findings demonstrate the localized, biomechanical effects of exercise. Furthermore, an average decrease of 10% in energy efficiency was noted between rest and exercise. These data indicate the amount of energy dissipation that typically occurs with exercise and may be useful in future surgical planning applications.

  View details for DOI 10.1007/s10439-010-0124-1

  View details for PubMedID 20640512

• Behcet's disease and heart transplantation: A word of caution JOURNAL OF HEART AND LUNG TRANSPLANTATION Hollander, S. A., Yasnovsky, J. R., Reinhartz, O., Chan, F., Sandborg, C., Hunt, S., Bernstein, D., Chin, C. 2010; 29 (11): 1306-1308

  Abstract

  Behcet's disease is a rare autoimmune disease characterized by oral and genital ulcers, and by multisystem disease, including arthritis, neurologic complications and vasculitis. Large-vessel and coronary artery aneurysms are often an indication for surgery, but the return of aneurysms, thrombosis, and the tendency to exhibit an exaggerated inflammatory response at puncture sites (pathergy) complicate surgical recovery. As such, cardiac transplantation, which requires atrial and large-vessel anastomoses, has not been reported in patients with Behcet's disease. We report the first orthotopic heart transplant with >1-year survival in a patient with Behcet's disease despite major complications. The investigators remain pessimistic about cardiac transplantation in patients with Behcet's disease until advances in preventing recurrent vascular pathology ensue.

  View details for DOI 10.1016/j.healun.2010.07.010

  View details for PubMedID 20822920

• Institutional experience with laparoscopic partial splenectomy for hereditary spherocytosis JOURNAL OF PEDIATRIC SURGERY Slater, B. J., Chan, F. P., Davis, K., Dutta, S. 2010; 45 (8): 1682-1686

  Abstract

  Moderate to severe hereditary spherocytosis (HS) is treated with splenectomy. However, total splenectomy leads to decreased immunologic function with the risk of overwhelming postsplenectomy sepsis. Splenic preservation is postulated as a method to avoid this potentially fatal complication. Although mainly performed through laparotomy, we report our experience with a laparoscopic approach to partial splenectomy for HS.A retrospective review was conducted on 9 laparoscopic partial splenectomies performed for HS at our institution. Follow-up was from 1 to 3.5 years. Data included preoperative and postoperative hemoglobin, absolute reticulocyte count, splenic size, operative time, complications, and length of stay.All patients successfully underwent laparoscopic partial splenectomy with a radiologically determined upper-pole remnant of 10% to 30% and preservation of the blood supply through the upper short gastric arteries. The mean preoperative spleen length was 13 cm. Mean hospital stay was 3.6 days (range, 1-6 days). There was 1 intraoperative complication (a small bowel tear during spleen extraction) and 2 minor postoperative complications (ileus and wound infection). One patient underwent completion total splenectomy 2 years after partial splenectomy.Laparoscopic partial splenectomy is a feasible and effective procedure that addresses the hematologic consequences of HS while retaining a portion of functional spleen, in addition to conferring the advantages of laparoscopy.

  View details for DOI 10.1016/j.jpedsurg.2010.01.037

  View details for Web of Science ID 000280933100018

  View details for PubMedID 20713220

• Congenital extrahepatic portosystemic shunt associated with heterotaxy and polysplenia PEDIATRIC RADIOLOGY Newman, B., Feinstein, J. A., Cohen, R. A., Feingold, B., Kreutzer, J., Patel, H., Chan, F. P. 2010; 40 (7): 1222-1230

  Abstract

  Heterotaxy with polysplenia is associated with many cardiovascular anomalies including the occasional occurrence of congenital extrahepatic portosystemic shunts (CEPS). Missing this anomaly can lead to inappropriate and ineffective therapy.To emphasize the importance and associated anatomy of CEPS in conjunction with heterotaxy with polysplenia.Review of three young children who presented with cyanosis and pulmonary hypertension without a cardiac etiology. They were known (1) or discovered (2) to have heterotaxy with polysplenia.There was absence of the intrahepatic inferior vena cava (IVC) with azygos or hemiazygos continuation in all three cases. In spite of normal liver function, they were discovered to have large portosystemic shunts, splenorenal in location, along with diffuse peripheral pulmonary arterial dilatation suggestive of CEPS (Abernethy malformation) with hepatopulmonary or, more accurately, portopulmonary syndrome. All CEPS were ipsilateral to the spleens. Patency of the portal veins in these cases allowed for percutaneous shunt closure with resolution of cyanosis.CEPS is associated with heterotaxy with polysplenia and can be symptomatic because of pulmonary arteriovenous (AV) shunting. Portal and hepatic vein patency are critical for determining feasibility of CEPS closure.

  View details for DOI 10.1007/s00247-009-1508-y

  View details for PubMedID 20069288

• Breathheld Autocalibrated Phase-Contrast Imaging JOURNAL OF MAGNETIC RESONANCE IMAGING Lew, C., Alley, M. T., Spielman, D. M., Bammer, R., Chan, F. P. 2010; 31 (4): 1004-1014

  Abstract

  To compare generalized autocalibrating partially parallel acquisitions (GRAPPA), modified sensitivity encoding (mSENSE), and SENSE in phase-contrast magnetic resonance imaging (PC-MRI) applications.Aliasing of the torso can occur in PC-MRI applications. If the data are further undersampled for parallel imaging, SENSE can be problematic in correctly unaliasing signals due to coil sensitivity maps that do not match that of the aliased volume. Here, a method for estimating coil sensitivities in flow applications is described. Normal volunteers (n = 5) were scanned on a 1.5 T MRI scanner and underwent PC-MRI scans using GRAPPA, mSENSE, SENSE, and conventional PC-MRI acquisitions. Peak velocity and flow through the aorta and pulmonary artery were evaluated.Bland-Altman statistics for flow in the aorta and pulmonary artery acquired with mSENSE and GRAPPA methods (R = 2 and R = 3 cases) have comparable mean differences to flow acquired with conventional PC-MRI. GRAPPA and mSENSE PC-MRI have more robust measurements than SENSE when there is aliasing artifact caused by insufficient coil sensitivity maps. For peak velocity, there are no considerable differences among the mSENSE, GRAPPA, and SENSE reconstructions and are comparable to conventional PC-MRI.Flow measurements of images reconstructed with autocalibration techniques have comparable agreement with conventional PC-MRI and provide robust measurements in the presence of wraparound.

  View details for DOI 10.1002/jmri.22127

  View details for Web of Science ID 000276328200028

  View details for PubMedID 20373447

  View details for PubMedCentralID PMC2903748

• A New Multiparameter Approach to Computational Simulation for Fontan Assessment and Redesign CONGENITAL HEART DISEASE Marsden, A. L., Reddy, V. M., Shadden, S. C., Chan, F. P., Taylor, C. A., Feinstein, J. A. 2010; 5 (2): 104-117

  Abstract

  Despite an abundance of prior Fontan simulation articles, there have been relatively few clinical advances that are a direct result of computational methods. We address a few key limitations of previous Fontan simulations as a step towards increasing clinical relevance. Previous simulations have been limited in scope because they have primarily focused on a single energy loss parameter. We present a multi-parameter approach to Fontan modeling that establishes a platform for clinical decision making and comprehensive evaluation of proposed interventions.Time-dependent, 3-D blood flow simulations were performed on six patient-specific Fontan models. Key modeling advances include detailed pulmonary anatomy, catheterization-derived pressures, and MRI-derived flow with respiration. The following performance parameters were used to rank patients at rest and simulated exercise from best to worst performing: energy efficiency, inferior and superior vena cava (IVC, SVC) pressures, wall shear stress, and IVC flow distribution.Simulated pressures were well matched to catheterization data, but low Fontan pressure did not correlate with high efficiency. Efficiency varied from 74% to 96% at rest, and from 63% to 91% with exercise. Distribution of IVC flow ranged from 88%/12% (LPA/RPA) to 53%/47%. A "transcatheter" virtual intervention demonstrates the utility of computation in evaluating interventional strategies, and is shown to result in increased energy efficiency.A multiparameter approach demonstrates that each parameter results in a different ranking of Fontan performance. Ranking patients using energy efficiency does not correlate with the ranking using other parameters of presumed clinical importance. As such, current simulation methods that evaluate energy dissipation alone are not sufficient for a comprehensive evaluation of new Fontan designs.

  View details for DOI 10.1111/j.1747-0803.2010.00383.x

  View details for Web of Science ID 000289417500004

  View details for PubMedID 20412482

• Pediatric Computed Tomographic Angiography: Imaging the Cardiovascular System Gently RADIOLOGIC CLINICS OF NORTH AMERICA Hellinger, J. C., Pena, A., Poon, M., Chan, F. P., Epelman, M. 2010; 48 (2): 439-?

  Abstract

  Whether congenital or acquired, timely recognition and management of disease is imperative, as hemodynamic alterations in blood flow, tissue perfusion, and cellular oxygenation can have profound effects on organ function, growth and development, and quality of life for the pediatric patient. Ensuring safe computed tomographic angiography (CTA) practice and "gentle" pediatric imaging requires the cardiovascular imager to have sound understanding of CTA advantages, limitations, and appropriate indications as well as strong working knowledge of acquisition principles and image post processing. From this vantage point, CTA can be used as a useful adjunct along with the other modalities. This article presents a summary of dose reduction CTA methodologies along with techniques the authors have employed in clinical practice to achieve low-dose and ultralow-dose exposure in pediatric CTA. CTA technical principles are discussed with an emphasis on the low-dose methodologies and safe contrast medium delivery strategies. Recommended parameters for currently available multidetector-row computed tomography scanners are summarized alongside recommended radiation and contrast medium parameters. In the second part of the article an overview of pediatric CTA clinical applications is presented, illustrating low-dose and ultra-low dose techniques, with an emphasis on the specific protocols.

  View details for DOI 10.1016/j.rcl.2010.03.005

  View details for Web of Science ID 000279865000013

  View details for PubMedID 20609882

• Evaluation of a novel Y-shaped extracardiac Fontan baffle using computational fluid dynamics JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Marsden, A. L., Bernstein, A. J., Reddy, V. M., Shadden, S. C., Spilker, R. L., Chan, F. P., Taylor, C. A., Feinstein, J. A. 2009; 137 (2): 394-U187

  Abstract

  The objective of this work is to evaluate the hemodynamic performance of a new Y-graft modification of the extracardiac conduit Fontan operation. The performance of the Y-graft design is compared to two designs used in current practice: a t-junction connection of the venae cavae and an offset between the inferior and superior venae cavae.The proposed design replaces the current tube grafts used to connect the inferior vena cava to the pulmonary arteries with a Y-shaped graft. Y-graft hemodynamics were evaluated at rest and during exercise with a patient-specific model from magnetic resonance imaging data together with computational fluid dynamics. Four clinically motivated performance measures were examined: Fontan pressures, energy efficiency, inferior vena cava flow distribution, and wall shear stress. Two variants of the Y-graft were evaluated: an "off-the-shelf" graft with 9-mm branches and an "area-preserving" graft with 12-mm branches.Energy efficiency of the 12-mm Y-graft was higher than all other models at rest and during exercise, and the reduction in efficiency from rest to exercise was improved by 38%. Both Y-graft designs reduced superior vena cava pressures during exercise by as much as 5 mm Hg. The Y-graft more equally distributed the inferior vena cava flow to both lungs, whereas the offset design skewed 70% of the flow to the left lung. The 12-mm graft resulted in slightly larger regions of low wall shear stress than other models; however, minimum shear stress values were similar.The area-preserving 12-mm Y-graft is a promising modification of the Fontan procedure that should be clinically evaluated. Further work is needed to correlate our performance metrics with clinical outcomes, including exercise intolerance, incidence of protein-losing enteropathy, and thrombus formation.

  View details for DOI 10.1016/j.jtcvs.2008.06.043

  View details for Web of Science ID 000262919000020

  View details for PubMedID 19185159

• MR and CT imaging of the pediatric patient with structural heart disease. Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual Chan, F. P. 2009: 99-105

  Abstract

  Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are imaging modalities increasingly used in the diagnosis and management of structural heart disease. They are powerful imaging tools that have individual strengths and weaknesses. Rational choice between MRI and CT should be based on a sound understanding of these issues. Management guidelines that incorporate the use of MRI and CT are currently being developed, and their utilizations are expected to grow rapidly in the future.

  View details for DOI 10.1053/j.pcsu.2009.01.009

  View details for PubMedID 19349022

• Morphological studies of pulmonary arteriovenous shunting in a lamb model of superior cavopulmonary anastomosis PEDIATRIC CARDIOLOGY McMullan, D. M., Reddy, V. M., Gottliebson, W. M., Silverman, N. H., Perry, S. B., Chan, F., Hanley, F. L., Riemer, R. K. 2008; 29 (4): 706-712

  Abstract

  We sought to identify and characterize the abnormal vascular structures responsible for pulmonary arteriovenous shunting following the Glenn cavopulmonary shunt. Superior cavopulmonary shunt is commonly performed as part of the staged pathway to total cavopulmonary shunt to treat univentricular forms of congenital heart disease, however, clinically significant pulmonary arteriovenous malformations develop in some patients after the procedure. The causes of pulmonary arteriovenous malformations and other pulmonary vascular changes that occur after cavopulmonary shunt are not known. Using a juvenile lamb model of superior cavopulmonary anastomosis that reliably produces pulmonary arteriovenous malformations, we performed echocardiography and morphological analyses to determine the anatomic site of shunting and to identify the vascular structures involved. Pulmonary arteriovenous shunting was identified by contrast echocardiography in all surviving animals (n = 40) following superior cavopulmonary anastomosis. Pulmonary vascular corrosion casts revealed abnormal tortuous vessels joining pulmonary arteries and veins in cavopulmonary shunt animals but not control animals. In conclusion, unusual channels that bridged pulmonary arteries and veins were identified. These may represent the vascular structures responsible for arteriovenous shunting following the classic Glenn cavopulmonary shunt. Detailed analysis of these structures may elucidate factors responsible for their development.

  View details for DOI 10.1007/s00246-007-9152-5

  View details for Web of Science ID 000257393800003

  View details for PubMedID 18043856

  View details for PubMedCentralID PMC2970565

• Time-resolved three-dimensional imaging of the left atrium and pulmonary veins in the interventional suite - A comparison between muttisweep gated rotational three-dimensional reconstructed fluoroscopy and multislice computed tomography HEART RHYTHM Al-Ahmad, A., Wigstroem, L., Sandner-Porkristl, D., Wang, P. J., Zei, P. C., Boese, J., Lauritsch, G., Moore, T., Chan, F., Fahrig, R. 2008; 5 (4): 513-519

  Abstract

  Cardiac computed tomography (CT) is commonly used to visualize left atrial (LA) anatomy for ablation of atrial fibrillation. We have developed a new imaging technique that allows acquisition and visualization of three-dimensional (3D) cardiac images in the catheter lab.We sought to compare LA and pulmonary vein (PV) dimensions acquired using gated multisweep rotational fluoroscopy (C-arm CT) system and multislice computed tomography (MSCT) in an in vivo porcine model.A Siemens AXIOM Artis dTA C-arm system (Siemens AG, Medical Solutions) was modified to allow acquisition of four bidirectional sweeps during synchronized acquisition of the electrocardiogram signal to allow retrospective gating. C-arm CT image volumes were then reconstructed. Gated MSCT (SOMATOM Sensation 16 and 64, Siemens AG, Medical Solutions) and C-arm CT images were acquired in six animals. The two main PV diameters were measured in orthogonal axes. LA volumes were calculated. C-arm CT measurements were compared with the MSCT measurements.The average PV diameters using the C-arm CT were 2.24 x 1.35 cm, versus 2.27 x 1.38 cm for CT. The average difference was 0.034 cm (1.9%) between the C-arm CT and standard CT. The average LA volume using MSCT was 49.1 +/- 12.7 cm(3), as compared with 51.0 +/- 8.7 cm(3) obtained by the C-arm CT. The average difference between the C-arm CT and the MSCT was 1.9 cm(3) (3.7%). There were no significant differences in either the PV or LA measurements.Visualization of 3D cardiac anatomy during ablation procedures is possible and highly accurate. The 3D cardiac reconstructions acquired during ablation procedures will be valuable for procedural planning and guidance.

  View details for DOI 10.1016/j.hrthm.2007.12.027

  View details for Web of Science ID 000254596600003

  View details for PubMedID 18362018

• MR and CT imaging of the pediatric patient with structural heart disease. Seminars in thoracic and cardiovascular surgery Chan, F. P. 2008; 20 (4): 393-399

  Abstract

  Cardiac MRI and CT are imaging modalities increasingly employed in the diagnosis and management of structural heart disease. They are powerful imaging tools that have individual strengths and weaknesses. Rational choice between MRI and CT should be based on a sound understanding of these issues. Management guidelines that incorporate the use of MRI and CT are currently being developed, and their utilizations are expected to grow rapidly in the future.

  View details for DOI 10.1053/j.semtcvs.2008.11.006

  View details for PubMedID 19251181

• SENSE phase-constrained magnitude reconstruction with iterative phase refinement MAGNETIC RESONANCE IN MEDICINE Lew, C., Pineda, A. R., Clayton, D., Spielman, D., Chan, F., Bammer, R. 2007; 58 (5): 910-921

  Abstract

  Conventional sensitivity encoding (SENSE) reconstruction is based on equations in the complex domain. However, for many MRI applications only the magnitude is relevant. If there exists an estimate of the underlying phase information, a magnitude-only phase-constrained reconstruction can help to improve the conditioning of the SENSE reconstruction problem. Consequently, this reduces g-factor-related noise enhancement. In previous attempts at phase-constrained SENSE reconstruction, image quality was hampered by strong aliasing artifacts resulting from inadequate phase estimates and high sensitivity to phase errors. If a full-resolution phase image is used, a significant reduction in aliasing errors and better noise properties compared to SENSE can be obtained. An iterative scheme that improves the phase estimate to better approximate the phase is presented. The mathematical framework of the new approach is provided together with comparisons of conventional SENSE, phase-constrained SENSE, and the new phase-refinement method. Both theory and experimental verification demonstrate significantly better noise performance at high reduction factors, i.e., close to the theoretical limit. For applications that need only magnitude data, an iterative phase-constrained SENSE reconstruction can provide substantial SNR improvement over SENSE reconstruction and less artifacts than phase-constrained SENSE.

  View details for DOI 10.1002/mrm.21284

  View details for Web of Science ID 000250560000008

  View details for PubMedID 17969127

• Large differences in efficiency among Fontan patients demonstrated in patient specific models of blood flow simulations 80th Annual Scientific Session of the American-Heart-Association (AHA) Marsden, A. L., Bernstein, A. J., Spilker, R. L., Chan, F. P., Taylor, C. A., Feinstein, J. A. LIPPINCOTT WILLIAMS & WILKINS. 2007: 480–80

  View details for Web of Science ID 000250394302214

• Comparison of left atrial volume using gated cardiac fluoroscopy 3-D image rendering vs. cardiac computed tomography 56th Annual Scientific Session of the American-College-of-Cardiology Al-Ahmad, A., Sander-Porkristl, D., Wigstrom, L., Wang, P. J., Zei, P. C., Hsia, H. H., Boese, J., Lauritsch, G., Moore, T., Chan, F., Fahrig, R. ELSEVIER SCIENCE INC. 2007: 9A–9A

  View details for Web of Science ID 000244651800035

• Peak velocity and flow quantification validation for sensitivity-encoded phase-contrast MR imaging ACADEMIC RADIOLOGY Lew, C. D., Alley, M. T., Bammer, R., Spielman, D. M., Chan, F. P. 2007; 14 (3): 258-269

  Abstract

  Phase-contrast (PC) magnetic resonance imaging (MRI) technique has important clinical applications in blood flow quantification and pressure gradient estimation by velocity measurement. Parallel imaging using sensitivity encoding (SENSE) may substantially reduce scan time. We demonstrate the utility of PC-MRI measurements accelerated by SENSE under clinical conditions.Accuracy and repeatability of a SENSE-PC implementation was evaluated by comparison with a commercial PC sequence with five normal volunteers. Twenty-six patients were then scanned with SENSE-PC at reduction factors (R = 1, 2, and 3). Blood flow and peak velocity were measured in the aorta and pulmonary trunk in 16 patients and peak velocity was measured at the coarctation of 10 patients. Quantitative flow, shunt ratio, and peak velocity measurements obtained with different reduction factors were compared using correlation, linear regression, and Bland-Altman statistics. All studies were approved by an Institutional Review Board, and informed consent was acquired from all subjects.The correlation coefficients for all comparisons were >0.962 and with high statistical significance (P < .01). Linear regression slopes ranged between 0.96 and 1.11 for flow and 0.88 to 1.05 for peak velocity. For flow, the Bland-Altman statistics yielded a total mean difference ranging from -0.02 to 0.05) L/minute with 2 standard of deviation limits ranging from -0.52 to 0.75 L/minute. For peak velocity, the total mean difference ranged from -0.10 to -0.004) milliseconds with 2-SD limits ranging from -0.062 to 0.46 milliseconds. R = 3 to R = 1 comparisons had greater 2-SD limits than R = 2 to R = 1 comparisons.SENSE PC-MRI measurements for flow and pressure gradient estimation were comparable to conventional PC-MRI.

  View details for DOI 10.1016/j.acra.2006.11.008

  View details for Web of Science ID 000246861100003

  View details for PubMedID 17307658

  View details for PubMedCentralID PMC1993829

• Echocardiographic diagnosis of persistent fifth aortic arch ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES Bernheimer, J., Friedberg, M., Chan, F., Silverman, N. 2007; 24 (3): 258-262

  Abstract

  We describe echocardiography and computerized tomographic imaging findings in the two subtypes of fifth aortic arch in infants. In the first form, the fifth aortic arch creates a systemic to systemic connection extending from the ascending to the descending aorta. When this form appears in isolation, it does not cause hemodynamic disturbance, although associated cardiac lesions, such as aortic coarctation or interruption and patent ductus arteriosus, may influence the clinical presentation. In the second form the fifth aortic arch connects the systemic and pulmonary circulations from persistent connections between the embryological fifth and sixth arches, which may cause significant hemodynamic disturbance from left to right shunting. Although this form has been associated with a wide array of congenital cardiac lesions, this is the first description of 5th aortic arch in association with atrioventricular septal defect and double outlet right ventricle.

  View details for DOI 10.1111/j.1540-8175.2007.00383.x

  View details for Web of Science ID 000244343900007

  View details for PubMedID 17313637

• Effects of exercise and respiration on hemodynamic efficiency in CFD simulations of the total cavopulmonary connection ANNALS OF BIOMEDICAL ENGINEERING Marsden, A. L., Vignon-Clementel, I. E., Chan, F. P., Feinstein, J. A., Taylor, C. A. 2007; 35 (2): 250-263

  Abstract

  Congenital heart defects with a single functional ventricle, such as hypoplastic left heart syndrome and tricuspid atresia, require a staged surgical approach to separate the systemic and pulmonary circulations. Ultimately, the venous or pulmonary side of the heart is bypassed by directly connecting the vena cava to the pulmonary arteries with a modified t-shaped junction. The Fontan procedure (total cavopulmonary connection, TCPC) completes this process of separation. To date, computational fluid dynamics (CFD) simulations in this low pressure, passive flow, intrathoracic system have neglected the presumed important effects of respiration on physiology and higher "stress" states such as with exercise have never been considered. We hypothesize that incorporating effects of respiration and exercise would provide more realistic estimates of TCPC performance. Time-dependent, 3D blood flow simulations are performed by a custom finite element solver for two patient-specific Fontan models with a novel respiration model, developed to generate physiologic time-varying flow conditions. Blood flow features, pressure, and energy efficiency are analyzed at rest and with increasing flow rates to simulate exercise conditions. The simulations produce realistic pressure and flow data, comparable to that measured by catheterization and echocardiography, and demonstrate substantial increases in energy dissipation (i.e. decreased performance) with exercise and respiration due to increasing intensity of small scale vortices in the flow. As would be expected, these changes are highly dependent on patient-specific anatomy and Fontan geometry. We propose that respiration and exercise should be incorporated into TCPC CFD simulations to provide increasingly realistic evaluations of TCPC performance.

  View details for DOI 10.1007/s10439-006-9224-3

  View details for PubMedID 17171509

• Use of computational fluid dynamics for the replication of clinical blood flow and pressure measurements and characterization of hemodynamics in the normal ascending and thoracic aorta ASME Summer Bioengineering Conference LaDisa, J. F., Figueroa, C. A., Vignon-Clernentel, I. E., Chan, F. P., Feinstein, J. A., Taylor, C. A. AMER SOC MECHANICAL ENGINEERS. 2007: 511–512

  View details for Web of Science ID 000252105700256

• Images in cardiovascular medicine. Cardiac magnetic resonance imaging for myocarditis: effective use in medical decision making. Circulation Fenster, B. E., Chan, F. P., Valentine, H. A., Yang, E., McConnell, M. V., Berry, G. J., Yang, P. C. 2006; 113 (22): e842-3

  View details for PubMedID 16754807

• Cardiac magnetic resonance imaging for myocarditis - Effective use in medical decision making CIRCULATION Fenster, B. E., Chan, F. P., Valentine, H. A., Yang, E., McConnell, M. V., Berry, G. J., Yang, P. C. 2006; 113 (22): E842-E843

  View details for DOI 10.1161/CIRCULATIONAHA.104.532481

  View details for Web of Science ID 000238033400019

• Images in cardiovascular medicine. Near sudden death from cardiac lipoma in an adolescent. Circulation Friedberg, M. K., Chang, I. L., Silverman, N. H., Ramamoorthy, C., Chan, F. P. 2006; 113 (21): e778-9

  View details for PubMedID 16735681

• Peri-infarct ischemia determined by cardiovascular magnetic resonance evaluation of myocardial viability and stress perfusion predicts future cardiovascular events in patients with severe ischemic cardiomyopathy JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE Tsukiji, M., Nguyen, P., Narayan, G., Hellinger, J., Chan, F., Herfkens, R., Pauly, J. M., McConnell, M. V., Yang, P. C. 2006; 8 (6): 773-779

  Abstract

  We assessed whether cardiovascular magnetic resonance imaging (CMR) of peri-infarct ischemia provides prognostic information in severe ischemic cardiomyopathy (ICM) patients referred for revascularization.Twenty-one patients with severe ICM were recruited prospectively for combined stress adenosine perfusion, late gadolinium enhancement, and rest perfusion studies. The patients were followed for in-hospital and post-discharge cardiovascular events.During 12+/- 9.8 months follow-up, 67% of the patients with peri-infarct ischemia and 13% of the patients without peri-infarct ischemia had cardiovascular events (p = 0.03). CONCLUSION. In severe ICM patients, the presence of peri-infarct ischemia was associated with a higher incidence of cardiovascular events.

  View details for DOI 10.1080/10976640600737615

  View details for PubMedID 17060098

• Primary interpretation of thoracic MDCT images using coronal reformations AMERICAN JOURNAL OF ROENTGENOLOGY Kwan, S. W., Partik, B. L., Zinck, S. E., Chan, F. P., Kee, S. T., Leung, A. N., Voracek, M., Rubin, G. D. 2005; 185 (6): 1500-1508

  Abstract

  The objective of this study was to evaluate the accuracy and efficiency of primary interpretation of thoracic MDCT using coronal reformations as compared with transverse images.Fifty patients (18 females, 32 males; age range, 15-93 years; mean age, 63.6 years) underwent 4-MDCT of the chest (detector width, 1 mm; beam pitch, 1.5). Contrast material was administered in 20 of the 50 patients. Coronal and transverse sections were reformatted into 5-mm-thick sections at 3.5-mm intervals. All available image and clinical data consensually reviewed by two thoracic radiologists served as the reference standard. Subsequently, three other thoracic radiologists independently evaluated reformatted coronal and transverse images at two separate review sessions. Each image set was assessed in 58 categories for abnormalities of the lungs, mediastinum, pleura, chest wall, diaphragm, abdomen, and skeleton. Interpretation times and number of images assessed were recorded. Sensitivity, specificity, and interobserver concordance were calculated. Differences in mean sensitivities and specificities were evaluated with Wilcoxon's signed rank test.The most common findings identified were pulmonary nodules (n = 73, transverse images; n = 72, coronal images) and emphysema (n = 45, transverse; n = 40, coronal). The mean detection sensitivity of all lesions was significantly (p = 0.001) lower on coronal (44% +/- 26% [SD]) than on transverse (51% +/- 22%) images, whereas the mean detection specificity was significantly (p = 0.005) higher (96% +/- 5% vs 95% +/- 6%, respectively). Reporting findings for significantly (p < 0.001) fewer coronal images (mean, 63.0 +/- 4.6 images) than transverse images (mean, 91.9 +/- 8.8 images) took significantly (p = 0.025) longer (mean, 263 +/- 56 sec vs 238 +/- 45 sec, respectively).Primary interpretation of thoracic MDCT is less sensitive and more time-consuming using 5-mm-thick coronal reformations as compared with transverse images.

  View details for DOI 10.2214/AJR.04.1335

  View details for Web of Science ID 000233510600019

  View details for PubMedID 16304004

• Magnetic resonance imaging of myocardial viability predicts future cardiovascular events in patients with severe ischemic cardiomyopathy 78th Annual Scientific Session of the American-Heart-Association Tsukiji, M., Nguyen, P., Narayan, G., Hellinger, J., Chan, F. P., Herfkens, R., McConnell, M. V., Yang, P. C. LIPPINCOTT WILLIAMS & WILKINS. 2005: U529–U530

  View details for Web of Science ID 000232956403186

• Peri-infarct ischemia determined by comprehensive MR evaluation of myocardial viability and stress perfusion predicts future cardiovascular events in patients with severe ischemic cardiomyopathy 54th Annual Scientific Session of the American-College-of-Cardiology Tsukiji, M., Nguyen, P., Narayan, G., Hellinger, J., Chan, F., Herfkens, R., McConnell, M. V., Yang, P. ELSEVIER SCIENCE INC. 2005: 446A–446A

  View details for Web of Science ID 000226808201931

• MDCT angiography of pediatric vascular diseases of the abdomen, pelvis, and extremities PEDIATRIC RADIOLOGY Chan, F. P., Rubin, G. D. 2005; 35 (1): 40-53

  Abstract

  Multi-detector-row computed tomography (MDCT) enables rapid, noninvasive, high-resolution, and three-dimensional imaging of pediatric vascular diseases. In this paper, we explore the adaptation of the MDCT angiographic principles to pediatric patients for vascular diseases of the abdomen, pelvis, and extremities. Special emphasis is placed on the practical aspects of how to perform these studies. Optimizations of scan parameters, contrast medium usage, radiation dose, and three-dimensional image processing are discussed in detail. We provide practical guidance on how to choose between MR angiography and CT angiography. Finally, we review important pediatric vascular diseases, categorized into traumatic injuries, inherited vascular diseases, congenital vascular diseases, vasculitides, and surgical planning and assessment. In each category, we discuss how CT angiography can be tailored to maximize its clinical benefits.

  View details for DOI 10.1007/s00247-004-1371-9

  View details for Web of Science ID 000226382100006

  View details for PubMedID 15692842

• Computed tomography angiography - State-of-the-art imaging using multidetector-row technology Conference on Advances in Multi-Detector CT Napoli, A., Fleischmann, D., Chan, F. P., Catalano, C., Hellinger, J. C., Passariello, R., Rubin, G. D. LIPPINCOTT WILLIAMS & WILKINS. 2004: S32–S45

  Abstract

  Multidetector-row computed tomography (MDCT) is an essential diagnostic modality for many clinical algorithms. This is particularly true with regard to the evaluation of cardiovascular disease. As a result of increased image acquisition speed, improved spatial resolution, and greater scan volume, MDCT angiography (computed tomography angiography [CTA]) has become an excellent noninvasive imaging technique, replacing intra-arterial digital subtraction angiography for most vascular territories. The clinical success of CTA depends on precise synchronization of image acquisition with optimal vascular enhancement. As technology continuously evolves, however, this task can be challenging. It remains important to have a fundamental knowledge of the principles behind technical parameters and contrast medium administration. This article reviews these essential principles, followed by an overview of current clinical applications.

  View details for Web of Science ID 000222968800008

  View details for PubMedID 15258492

• Time-resolved 3-dimensional velocity mapping in the thoracic aorta - Visualization of 3-directional blood flow patterns in healthy volunteers and patients JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Markl, M., Draney, M. T., Hope, M. D., Levin, J. M., Chan, F. P., Alley, M. T., Pelc, N. J., Herfkens, R. J. 2004; 28 (4): 459-468

  Abstract

  An analysis of thoracic aortic blood flow in normal subjects and patients with aortic pathologic findings is presented. Various visualization tools were used to analyze blood flow patterns within a single 3-component velocity volumetric acquisition of the entire thoracic aortaTime-resolved, 3-dimensional phase-contrast magnetic resonance imaging (3D CINE PC MRI) was employed to obtain complete spatial and temporal coverage of the entire thoracic aorta combined with spatially registered 3-directional pulsatile blood flow velocities. Three-dimensional visualization tools, including time-resolved velocity vector fields reformatted to arbitrary 2-dimensional cut planes, 3D streamlines, and time-resolved 3D particle traces, were applied in a study with 10 normal volunteers. Results from 4 patient examinations with similar scan prescriptions to those of the volunteer scans are presented to illustrate flow features associated with common pathologic findings in the thoracic aorta.Previously reported blood flow patterns in the thoracic aorta, including right-handed helical outflow, late systolic retrograde flow, and accelerated passage through the aortic valve plane, were visualized in all volunteers. The effects of thoracic aortic disease on spatial and temporal blood flow patterns are illustrated in clinical cases, including ascending aortic aneurysms, aortic regurgitation, and aortic dissection.Time-resolved 3D velocity mapping was successfully applied in a study of 10 healthy volunteers and 4 patients with documented aortic pathologic findings and has proven to be a reliable tool for analysis and visualization of normal characteristic as well as pathologic flow features within the entire thoracic aorta.

  View details for PubMedID 15232376

• Steady-state free precession MR imaging: Improved myocardial tag persistence and signal-to-noise ratio for analysis of myocardial motion 88th Scientific Assembly and Annual Meeting of the Radiological-Society-of-North-America Markl, M., Reeder, S. B., Chan, F. P., Alley, M. T., Herfkens, R. J., Pelc, N. J. RADIOLOGICAL SOC NORTH AMERICA. 2004: 852–61

  Abstract

  Tagging with balanced steady-state free-precession (SSFP) magnetic resonance (MR) imaging by using a steady-state storage scheme for myocardial motion analysis was evaluated. Signal-to-noise ratio (SNR), blood-tissue contrast, and tag persistence in volunteers and phantoms showed improved performance of SSFP imaging with tagging compared with that of radiofrequency spoiled gradient-echo (SPGR) MR imaging with tagging. Choice of flip angle with SSFP imaging involved a trade-off among SNR, blood-tissue contrast, and tag persistence. Increased SNR and tag persistence can be achieved simultaneously with SSFP imaging compared with SPGR tagging methods. As a result, the proposed technique may be useful for analysis of diastolic ventricular function.

  View details for DOI 10.1148/radiol.2303030181

  View details for Web of Science ID 000189186500037

  View details for PubMedID 14990847

• Cardiac multidetector-row computed tomography: Principles and applications SEMINARS IN ROENTGENOLOGY Chan, F. P. 2003; 38 (4): 294-302

  View details for DOI 10.1053/S0037-198X(03)00059-2

  View details for Web of Science ID 000186265700003

  View details for PubMedID 14621370

• Composite spirometric-computed tomography outcome measure in early cystic fibrosis lung disease AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE Robinson, T. E., Leung, A. N., Northway, W. H., Blankenberg, F. G., Chan, F. P., Bloch, D. A., Holmes, T. H., Moss, R. B. 2003; 168 (5): 588-593

  Abstract

  With the advent of therapies aimed at young patients with cystic fibrosis, who have mildly reduced pulmonary function, the need for improved outcome measures that discriminate treatment effects has become important. Pulmonary function measurements or chest high-resolution computed tomography (HRCT) scores have been separately used to assess interventions. We evaluated these modalities separately and together during a treatment study to develop a more sensitive outcome measure. In a 1-year trial, 25 children randomized either to daily Pulmozyme or to normal saline aerosol were evaluated at randomization and at 3 and 12 months. Outcome variables were pulmonary function test (PFT) results, a global HRCT score, and a composite score incorporating PFTs and HRCT scoring. Regression analyses with generalized estimating equations permitted estimation of the difference in treatment effect between groups over time for each outcome. The largest difference in treatment effects observed at 12 months, measured by the percentage change from baseline, were with the composite total and maximal CT/PFT scores (35.4 and 30.4%), compared with mean forced expiratory flow during the middle half of the FVC (FEF25-75%) (13.0%) and total and maximal global HRCT scores (6.2%, 7.2%). The composite total and maximal CT/PFT scores were the most sensitive outcome measures for discriminating a treatment effect in children with cystic fibrosis with normal or mildly reduced pulmonary function during a 1-year trial of Pulmozyme.

  View details for DOI 10.1164/rccm.200209-1093OC

  View details for PubMedID 12746252

• Active lower gastrointestinal hemorrhage diagnosed by magnetic resonance angiography: case report ABDOMINAL IMAGING Chan, F. P., Chhor, C. M. 2003; 28 (5): 637-639

  Abstract

  Contrast-enhanced magnetic resonance angiography (MRA) has demonstrated the potential for detecting gastrointestinal bleeding in animal studies. We report a case of active lower gastrointestinal bleed diagnosed with MRA in an elderly patient. Clinical, radiologic, and surgical findings are described.

  View details for DOI 10.1007/s00261-003-0017-y

  View details for Web of Science ID 000184936800008

  View details for PubMedID 14628866

• An automated approach to quantitative air trapping measurements in mild cystic fibrosis CHEST Goris, M. L., Zhu, H. Y., Blankenberg, F., Chan, F., Robinson, T. E. 2003; 123 (5): 1655-1663

  Abstract

  To automatically derive the degree of air trapping in mild cystic fibrosis (CF) disease from high-resolution CT (HRCT) data, and to evaluate the discriminating power of the measurement.The data consist of six pairs of anatomically matched tomographic slices, obtained during breath-holding in triggered HRCT acquisitions. The pairs consist of an inspiratory slice, at > or = 95% of slow vital capacity, and an expiratory slice at near residual volume (nRV). The subjects are 25 patients with mild CF and 10 age-matched, normal control subjects.Lung segmentation is automatic. The limits defining air trapping in the expiratory slices are determined by the distribution of densities in the expanded lung. They are modulated by density changes between expiration and inspiration. Air trapping defects consist of contiguous low-density voxels. The difference between patients and control subjects was evaluated in comparison to pulmonary function test (PFT) results and lung density distribution descriptors (global density descriptors).In mild CF, air trapping does not correlate with global PFT results, except for the ratio of residual volume (RV) to total lung capacity (TLC); however, the size of air trapping defects was the best discriminator between patients and control subjects (p < 0.005). Of PFT results, only RV/TLC reached significance at p < 0.05. The global density descriptors reached near significance in the nRV images only.Air trapping defined as defect size and measured in an objective automated manner is a powerful discriminator for mild CF.

  View details for PubMedID 12740287

• Time-resolved three-dimensional phase-contrast MRI 10th Annual Meeting of the International-Society-for-Magnetic-Resonance-in-Medicine (ISMRM) Markl, M., Chan, F. P., Alley, M. T., Wedding, K. L., Draney, M. T., Elkins, C. J., Parker, D. W., Wicker, R., Taylor, C. A., Herfkens, R. J., Pelc, N. J. JOHN WILEY & SONS INC. 2003: 499–506

  Abstract

  To demonstrate the feasibility of a four-dimensional phase contrast (PC) technique that permits spatial and temporal coverage of an entire three-dimensional volume, to quantitatively validate its accuracy against an established time resolved two-dimensional PC technique to explore advantages of the approach with regard to the four-dimensional nature of the data.Time-resolved, three-dimensional anatomical images were generated simultaneously with registered three-directional velocity vector fields. Improvements compared to prior methods include retrospectively gated and respiratory compensated image acquisition, interleaved flow encoding with freely selectable velocity encoding (venc) along each spatial direction, and flexible trade-off between temporal resolution and total acquisition time.The implementation was validated against established two-dimensional PC techniques using a well-defined phantom, and successfully applied in volunteer and patient examinations. Human studies were performed after contrast administration in order to compensate for loss of in-flow enhancement in the four-dimensional approach.Advantages of the four-dimensional approach include the complete spatial and temporal coverage of the cardiovascular region of interest and the ability to obtain high spatial resolution in all three dimensions with higher signal-to-noise ratio compared to two-dimensional methods at the same resolution. In addition, the four-dimensional nature of the data offers a variety of image processing options, such as magnitude and velocity multi-planar reformation, three-directional vector field plots, and velocity profiles mapped onto selected planes of interest.

  View details for DOI 10.1002/jmri.10272

  View details for Web of Science ID 000182453200016

  View details for PubMedID 12655592

• A comprehensive approach to MR imaging of mesenteric ischemia ABDOMINAL IMAGING Chow, L. C., Chan, F. P., Li, K. C. 2002; 27 (5): 507-516

  View details for DOI 10.1007/s00261-001-0077-9

  View details for Web of Science ID 000177561500003

  View details for PubMedID 12172988

• In vivo validation of numerical prediction of blood flow in arterial bypass grafts ANNALS OF BIOMEDICAL ENGINEERING Ku, J. P., Draney, M. T., Arko, F. R., Lee, W. A., Chan, F. P., Pelc, N. J., Zarins, C. K., Taylor, C. A. 2002; 30 (6): 743-752

  Abstract

  In planning operations for patients with cardiovascular disease, vascular surgeons rely on their training, past experiences with patients with similar conditions, and diagnostic imaging data. However, variability in patient anatomy and physiology makes it difficult to quantitatively predict the surgical outcome for a specific patient a priori. We have developed a simulation-based medical planning system that utilizes three-dimensional finite-element analysis methods and patient-specific anatomic and physiologic information to predict changes in blood flow resulting from surgical bypass procedures. In order to apply these computational methods, they must be validated against direct experimental measurements. In this study, we compared in vivo flow measurements obtained using magnetic resonance imaging techniques to calculated flow values predicted using our analysis methods in thoraco-thoraco aortic bypass procedures in eight pigs. Predicted average flow rates and flow rate waveforms were compared for two locations. The predicted and measured waveforms had similar shapes and amplitudes, while flow distribution predictions were within 10.6% of the experimental data. The average absolute difference in the bypass-to-inlet blood flow ratio was 5.4 +/- 2.8%. For the aorta-to-inlet blood flow ratio, the average absolute difference was 6.0 +/- 3.3%.

  View details for DOI 10.1114/1.1496086

  View details for Web of Science ID 000177640900001

  View details for PubMedID 12220075

• Magnetic resonance imaging in the diagnosis and follow up of Takayasu's arteritis in children ANNALS OF THE RHEUMATIC DISEASES Aluquin, V. P., Albano, S. A., Chan, F., Sandborg, C., Pitlick, P. T. 2002; 61 (6): 526-529

  Abstract

  Takayasu's arteritis (TA) has a mortality rate of up to 40% in children. Because the clinical presentation of TA is often non-specific, accurate and prompt diagnosis depends on a high degree of awareness and appropriate laboratory and imaging studies.To examine the use of advanced magnetic resonance imaging (MRI) in evaluating, gauging activity, and following the complications of TA.T1 weighted, T2 weighted, contrast enhanced MR images, and MR angiograms of the chest and abdomen were obtained in three children (age range 11-14 years). The MRI studies confirmed the diagnosis of active TA and were repeated to evaluate response to treatment. Two patients showed complete resolution of lesions found on MRI at six and 12 months' follow up, while the third patient showed no significant improvement.MRI can be used to help establish the initial diagnosis of TA in children, and it can also be used to monitor disease activity and to guide treatment.

  View details for PubMedID 12006326

• Can a multiphasic contrast-enhanced three-dimensional fast spoiled gradient-recalled echo sequence be sufficient for liver MR imaging? AMERICAN JOURNAL OF ROENTGENOLOGY Coulam, C. H., Chan, F. P., Li, K. C. 2002; 178 (2): 335-341

  Abstract

  The purpose of this study was to determine the accuracy of a multiphasic gadolinium-enhanced three-dimensional (3D) fast spoiled gradient-recalled echo sequence alone in the detection and characterization of focal liver lesions compared with a comprehensive liver evaluation using multiphasic gadolinium-enhanced 3D fast spoiled gradient-recalled echo, T1-weighted, and fat-suppressed fast spin-echo T2-weighted sequences.A retrospective review of abdominal MR imaging examinations in 61 patients was performed. All MR examinations included unenhanced spin-echo T1-weighted, unenhanced fat-suppressed fast spin-echo T2-weighted, and multiphasic gadolinium-enhanced 3D fast spoiled gradient-recalled echo sequences obtained during successive breath-holds. The liver was evaluated for focal lesions first with the 3D spoiled gradient-recalled echo sequences and then, during a separate sitting, with the T1- and T2-weighted sequences. The usefulness of each sequence in the detection and characterization of lesions was recorded. The gold standard for lesion detection and characterization was all three imaging sequences reviewed together.A total of 114 focal liver lesions were identified, 54 of which were simple cysts. The 3D spoiled gradient-recalled echo sequence alone detected 92 (81%) of the 114 lesions, and the T1- and T2-weighted sequences detected 95 (83%) of the 114 lesions. Of the 60 lesions that were not simple cysts, the 3D spoiled gradient-recalled echo sequence alone detected 58 (97%), and T1- and T2-weighted sequences detected 51 (85%). In 24% of the patients with lesions, the T1- and T2-weighted sequences were found to be helpful for the characterization of lesions.A multiphasic contrast-enhanced 3D fast spoiled gradient-recalled echo sequence alone detects most of the clinically relevant focal liver lesions. Additional liver examination using both unenhanced T1- and T2-weighted sequences is helpful for lesion characterization but increases the detection rate only minimally.

  View details for Web of Science ID 000173486500010

  View details for PubMedID 11804888

• Images in clinical medicine. Paradoxical embolus. New England journal of medicine Chan, F. P., JONES, T. R. 2001; 345 (11): 803-?

  View details for PubMedID 11556300

• Paradoxical embolus. NEW ENGLAND JOURNAL OF MEDICINE Chan, F. P., JONES, T. R. 2001; 345 (11): 803-803

  View details for Web of Science ID 000170906800005

• Validation of in vivo MR measurement of oxygen saturation after resuscitation with a hemoglobin-based oxygen carrier in a rabbit model ACADEMIC RADIOLOGY Chan, F. P., Jahr, J. S., Driessen, B., Daunt, D. A., Li, K. C. 2001; 8 (7): 583-590

  Abstract

  The authors tested whether noninvasive magnetic resonance (MR) oximetry is accurate in the in vivo measurement of oxygen saturation in a stroma-free, hemoglobin-based oxygen carrier (HBOC).A central venous catheter was placed in the inferior vena cava (IVC) of 10 New Zealand white rabbits (weight range, 2.5-3.2 kg). Each rabbit underwent removal of 20% of blood volume followed by resuscitation with 10 mL/kg of bovine HBOC-200. Oxygen saturation of the blood mixture was measured in vivo at the IVC with MR oximetry, with separate in vitro calibration for each animal. Blood drawn from the IVC was measured with ex vivo oximetry, which was used as the standard of reference. The in vivo and ex vivo measurements were compared.There was no significant difference (P > .1) between measurements obtained with MR oximetry and ex vivo oximetry. The results with in vivo MR oximetry demonstrated excellent correlation with those from ex vivo oximetry (r = 0.99) over a wide range of physiologic oxygen saturation values (16.7%-74.9%) in venous blood.Noninvasive in vivo MR measurement of oxygen saturation is valid for whole blood mixed with stroma-free hemoglobin. Therefore, MR oximetry may be clinically useful for assessing the oxygenation status in patients resuscitated with a HBOC.

  View details for Web of Science ID 000169561100003

  View details for PubMedID 11450958

• Coronary artery calcium scoring with a multiple row detector CT scanner: Comparison of single-sector (SSR) and multi-sector (MSR) reconstruction methods Coulam, C. H., Chan, F. P., Gao, S. Z., Schroeder, J. S., Pan, T. S., Iatrou, M., Betts, B. J., Rubin, G. D. LIPPINCOTT WILLIAMS & WILKINS. 2000: 603–4

  View details for Web of Science ID 000090072302917

• New approaches to the investigation of focal hepatic lesions BEST PRACTICE & RESEARCH IN CLINICAL GASTROENTEROLOGY Li, K. C., Chan, F. 1999; 13 (4): 529-543

  Abstract

  In the past few years, tremendous advances have been made in the fields of magnetic resonance imaging, computed tomography and ultrasonography. These include the development of novel contrast agents and new approaches to image acquisition and processing. This review provides an overview of the state-of-the-art of imaging investigation of focal hepatic lesions and highlights some of the most exciting emerging technologies.

  View details for Web of Science ID 000084893800004

  View details for PubMedID 10654918

• A comprehensive approach using MR imaging to diagnose acute segmental mesenteric ischemia in a porcine model AMERICAN JOURNAL OF ROENTGENOLOGY Chan, F. P., Li, K. C., Heiss, S. G., Razavi, M. K. 1999; 173 (3): 523-529

  Abstract

  Acute mesenteric ischemia is a lethal disease that lacks a noninvasive diagnostic test. We evaluated the abilities of contrast-enhanced MR angiography, MR oximetry, and real-time interactive MR imaging to diagnose segmental mesenteric ischemia in a porcine model.Segmental mesenteric ischemia was created by subselective Gelfoam embolization of the mesenteric circulation in eight pigs. Conventional digital subtraction angiography (DSA), MR oximetry, and real-time interactive MR imaging of the small bowel were performed before and after embolization. Changes in the perfusion pattern seen on DSA established the regions of true ischemia. Postembolization DSA and MR angiography were compared with this gold standard.Both MR angiography and DSA had high sensitivity (91% and 100%, respectively) for detecting ischemic regions. The difference was not statistically significant (p > .2). MR angiography yielded lower specificity than DSA (80% and 90%, respectively; p < .01). After embolization, the oxygen saturation in the superior mesenteric vein (SMV) dropped significantly (p < .005). After embolization, the SMV also showed oxygen saturation significantly lower than that in the inferior vena cava (p < .005). In two of the animals, segmental hypomotility of the small bowel was observed.MR oximetry is capable of detecting oxygen desaturation caused by segmental ischemia. A loss of oxygen saturation in the SMV relative to that in the inferior vena cava provides a convenient marker of mesenteric ischemia. Contrast-enhanced MR angiography has sensitivity and specificity approaching those of DSA. Both MR techniques hold promise for the detection of acute mesenteric ischemia.

  View details for Web of Science ID 000082125100002

  View details for PubMedID 10470873

• Advances in imaging techniques for the diagnosis of focal hepatic lesions 1st University-of-California-San-Francisco/Stanford Asia Liver Symposium Li, K. C., Chan, F. WILEY-BLACKWELL PUBLISHING, INC. 1999: S22–S27

  Abstract

  In the past few years, tremendous advances have been made in the fields of ultrasound, computed tomography, magnetic resonance imaging and contrast agent development. The purpose of this article is to highlight the important developments in imaging techniques that can be used for detection and characterization of focal hepatic lesions.

  View details for Web of Science ID 000081033600006

  View details for PubMedID 10382634

• EFFECTS OF RF AMPLIFIER DISTORTION ON SELECTIVE EXCITATION AND THEIR CORRECTION BY PREWARPING MAGNETIC RESONANCE IN MEDICINE Chan, F., Pauly, J., Macovski, A. 1992; 23 (2): 224-238

  Abstract

  In a magnetic resonance imaging system, an RF power amplifier is employed to boost an RF pulse to sufficient strength to excite the nuclear spins in a subject. The nonideal behavior of this amplifier distorts a selective-excitation pulse, and this distortion in turn degrades the slice profile. We have found two types of nonideal behavior particularly troublesome: nonlinearity and incidental phase modulation. One of their effects is the introduction of an unwanted "skirt" in the out-of-slice region of a slice profile. We present an effective method of correction in which a selective-excitation pulse is prewarped to compensate for the distortion.

  View details for Web of Science ID A1992HD21300003

  View details for PubMedID 1549038