Clinical Assistant Professor, Pediatrics - Cardiology
Board Certification: American Board of Pediatrics, Pediatric Cardiology (2020)
Fellowship: Boston Children's Hospital Cardiac Imaging Fellowship (2020) MA
Fellowship: Boston Childrens Hospital Pediatric Cardiology Fellowship (2019) MA
Board Certification: American Board of Pediatrics, Pediatrics (2015)
Residency: UCSF Pediatric Residency (2015) CA
Medical Education: UCLA David Geffen School Of Medicine Registrar (2012) CA
Late Gestation Predictors of a Postnatal Biventricular Circulation after Fetal Aortic Valvuloplasty.
OBJECTIVES: Fetal aortic valvuloplasty (FAV) for severe aortic stenosis (AS) has shown promise in averting progression to hypoplastic left heart syndrome. After FAV, predicting which fetuses will achieve a biventricular (BiV) circulation after birth remains challenging. Identifying predictors of postnatal circulation on late gestation echocardiography will improve parental counseling.METHODS: Liveborn patients who underwent FAV and had late gestation echocardiography available were included (2000-2017, n=96). Multivariable logistic regression and classification and regression tree analysis were utilized to identify independent predictors of BiV circulation.RESULTS: Among 96 fetuses, 50 (52.1%) had BiV circulation at the time of neonatal discharge. In multivariable analysis, independent predictors of biventricular circulation included LV long axis z-score (OR 3.2, 95% CI 1.8-5.7, p<0.001), LV ejection fraction (OR 1.3, 95% CI 1.0-1.8, p=0.023), anterograde aortic arch flow (OR 5.0, 95% CI 1.2-20.4, p=0.024), and bidirectional or right-to-left foramen ovale flow (OR 4.6, 95% CI 1.4-15.8, p=0.015).CONCLUSION: Several anatomic and physiologic parameters in late gestation were found to be independent predictors of BiV circulation after FAV. Identifying these predictors adds to our understanding of LV growth and hemodynamics after FAV and may improve parental counseling. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/pd.5885
View details for PubMedID 33462820
Toward Improving the Fetal Diagnosis of Coarctation of the Aorta
2017; 38 (2): 344–52
Coarctation of the aorta (CoA) is the most common ductal-dependent lesion missed on neonatal exam screening. Prenatal diagnosis of CoA improves outcomes through early initiation of prostaglandin. Fetal echocardiographic parameters including 2D and Doppler findings have been studied as predictive measures for fetal diagnosis of CoA, but diagnosis rates remain variable. A comprehensive set of predictor variables was applied to fetuses suspected of CoA to analyze which parameters were associated with postnatal CoA. UCSF Fetal Cardiovascular Program databases were queried for fetuses suspected of CoA (2008-2014). Retrospective measurements of aorta/pulmonary artery ratio (AoPA), LV/RV ratio, ascending aorta Z-score (AscAo), isthmus Z-score, isthmus/duct ratio (I/D), posterior "shelf" of descending aorta, and diastolic flow persistence at the isthmus were recorded. ROC analysis identified the parameters most predictive of postnatal CoA. Among 97 fetuses with probable CoA, 62 had complete follow-up. Of these fetuses, 45 (72.5%) had postnatal confirmation of CoA and 17 did not have CoA. The parameters most predictive of postnatal CoA included AscAo, isthmus Z-score, and I/D, with respective AUC of 0.80, 0.89, and 0.90. Diastolic flow persistence was seen more often in fetuses with postnatal CoA, but did not reach statistical significance. Combining 2D and Doppler criteria (AoPA < 0.65 or diastolic flow persistence) improved sensitivity to 87%, but introduced several false positives. Isthmus imaging and AoPA ratio are useful predictors of CoA. Doppler information was most helpful when 2D imaging was equivocal; its addition resulted in high sensitivity in an enriched cohort referred for fetal echocardiography.
View details for DOI 10.1007/s00246-016-1520-6
View details for Web of Science ID 000395096700019
View details for PubMedID 27888318
Safety and efficacy of drug-eluting stents compared with bare metal stents in ST-elevation myocardial infarction.
Reviews in cardiovascular medicine
2010; 11 (2): 57–73
Drug-eluting stents (DES) reduce restenosis and the need for repeat revascularization, but patients with ST-segment elevation myocardial infarction (STEMI) were excluded from many of the trials that established the safety and efficacy of DES. Because of the unstable nature of lesions associated with STEMI, these patients are considered high risk, and often experience higher rates of adverse events. There is concern that DES may increase the risk of stent thrombosis, particularly late and very late stent thrombosis, in STEMI patients. Evidence also suggests that although DES reduce target vessel revascularization, this benefit may be lost after extended follow-up due to procedures necessitated by increased stent thrombosis. Several randomized trials, meta-analyses, and registry studies have been conducted to compare DES with bare metal stents in patients with STEMI, but many of the studies are not large scale and the length of follow-up has been limited in duration. This review summarizes the data comparing DES with bare metal stents in patients with STEMI.
View details for PubMedID 20700088
Synthesis of spiro-1,2-dioxolanes and their activity against Plasmodium falciparum.
Bioorganic & medicinal chemistry letters
2008; 18 (24): 6521–24
Artemisinin-derived compounds play an integral role in current malaria chemotherapy. Given the virtual certainty of emerging resistance, we have investigated spiro-1,2-dioxolanes as an alternative scaffold. The endoperoxide functionality was generated by the SnCl(4)-mediated annulation of a bis-silylperoxide and an alkene. The first set of eight analogs gave EC(50) values of 50-150 nM against Plasmodium falciparum 3D7 and Dd2 strains, except for the carboxylic acid analog. A second series, synthesized by coupling a spiro-1,2-dioxolane carboxylic acid to four separate amines, afforded the most potent compound (EC(50) approximately 5 nM).
View details for DOI 10.1016/j.bmcl.2008.10.083
View details for PubMedID 18993067