Papers by Victor Fernandez Garcia
PloS one, 2017
To investigate the right ventricular (RV) strain in pectus excavatum (PE) patients using cardiac ... more To investigate the right ventricular (RV) strain in pectus excavatum (PE) patients using cardiac magnetic resonance tissue tracking (CMR TT). Fifty consecutive pectus excavatum patients, 10 to 32 years of age (mean age 15 ± 4 years), underwent routine cardiac magnetic resonance imaging (CMR) including standard measures of chest geometry and cardiac size and function. The control group consisted of 20 healthy patients with a mean age of 17 ± 5 years. RV longitudinal and circumferential strain magnitude was assessed by a dedicated RV tissue tracking software. Fifty patients with images of sufficient quality were included in the analysis. The mean right and left ventricular ejection fractions were 55 ± 5% and 59 ± 4%. The RV global longitudinal strain was -21.88 ± 4.63%. The RV circumferential strain at base, mid-cavity and apex were -13.66 ± 3.09%, -11.31 ± 2.79%, -20.73 ± 3.45%, respectively. There was no statistically significant decrease in right ventricular or left ventricular eje...
Surgery for Obesity and Related Diseases, 2007
Background: An increasing number of young people are developing severe obesity with adult-like co... more Background: An increasing number of young people are developing severe obesity with adult-like co-morbidities and undergoing bariatric surgery. Although a number of studies have described major weight loss after bariatric surgery, none have examined the proportions of lean body and fat mass lost or the potentially more important issue of changes in regional fat mass distribution after laparoscopic gastric bypass surgery. Methods: Five morbidly obese females (mean age 18) were evaluated by standard anthropometric measures and dual energy x-ray absorptiometry at baseline and 1 year after bariatric surgery. The mean and SD values for the anthropometric and dual energy x-ray absorptiometry body composition variables were calculated, and the differences were evaluated using paired t tests. Results: Significant body mass index and weight loss were seen in all subjects at 1 year, with the percentage of excess weight loss at 63.4%. Overall fat mass loss exceeded lean mass loss by threefold in this cohort (P Ͻ.01), demonstrating the relative sparing of lean mass. Their waist circumference also decreased significantly. Using dual energy x-ray absorptiometry analysis, the vast majority (83%) of central mass loss consisted of adipose tissue. Central fat loss significantly exceeded peripheral fat loss by 1.6-fold (P ϭ .03). Conclusion: These results have demonstrated the preferential loss of central adiposity in morbidly obese young women after 1 year of surgical weight loss and may be more informative than anthropometric measurements alone. Given the association between central adiposity and the risk of subsequent cardiovascular disease, these results are suggestive of reduced cardiac risk.
Journal of the American College of Cardiology, 2008
The purpose of this study was to evaluate changes in cardiac geometry, systolic and diastolic fun... more The purpose of this study was to evaluate changes in cardiac geometry, systolic and diastolic function before and after weight loss in morbidly obese adolescents. Background Cardiac abnormalities are present in morbidly obese adolescents; however, it is unclear if they are reversible with weight loss. Methods Data from 38 adolescents (13 to 19 years; 29 females, 9 males, 33 Caucasians, 5 African Americans) were evaluated before and after bariatric surgery. Left ventricular mass (LVM), left ventricular (LV) geometry, systolic and diastolic function were assessed by echocardiography. Mean follow up was 10 Ϯ 3 months. Results Weight and body mass index decreased post-operatively (mean weight loss 59 Ϯ 15 kg, pre-operative body mass index 60 Ϯ 9 kg/m 2 vs. follow-up 40 Ϯ 8 kg/m 2 , p Ͻ 0.0001). Change in LVM index (54 Ϯ 13 g/m 2.7 to 42 Ϯ 10 g/m 2.7 , p Ͻ 0.0001) correlated with weight loss (r ϭ 0.41, p ϭ 0.01). Prevalence of concentric left ventricular hypertrophy (LVH) improved from 28% at pre-operative to only 3% at follow up (p ϭ 0.007), and normal LV geometry improved from 36% to 79% at follow up (p ϭ 0.009). Diastolic function also improved (mitral E/Ea lateral 7.7 Ϯ 2.3 at pre-operative vs. 6.3 Ϯ 1.6 at post-operative, p ϭ 0.003). In addition, rate-pressure product improved suggesting decreased cardiac workload (p Ͻ 0.001). Conclusions Elevated LVM index, concentric LVH, altered diastolic function, and cardiac workload significantly improve following surgically induced weight loss in morbidly obese adolescents. Large weight loss due to bariatric surgery improves predictors of future cardiovascular morbidity in these young people.
Journal of Pediatric Surgery, 2011
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Journal of Pediatric Surgery, 1990
This study was undertaken to assess the significance of thoracic trauma as a marker of morbidity ... more This study was undertaken to assess the significance of thoracic trauma as a marker of morbidity and mortality in children. During a 34-month period, 2,086 children younger than 15 years old were consecutively admitted to a Level I pediatric trauma center with blunt or penetrating trauma. For each child we prospectively recorded Trauma Score (TS), Injury Severity Score, (ISS), medical, and etiologic data. One hundred four children (4.4%) presented with thoracic trauma. The most common mechanisms of injury were pedestrian injury (36%), motor vehicle crashes (32%), and armed assault (12%). The most common injuries were pulmonary contusion (48%), pneumothorax, hemothorax, or pneumohemothorax (39%), and rib fractures (32%). Multisystem injury was present in 82% of the children. The mean TS and ISS were 11 and 27, respectively, significantly worse than scores for children without thoracic injury (15 and 7; P less than .0001). Seventy-one percent of the children were admitted to the intensive care unit, where they stayed an average of 6 days; 20% required surgery. The mortality rate was 26%. Injuries to the heart or great vessels had the highest mortality rate (75%), followed by hemothorax (53%), lung laceration (43%), and rib fracture (42%). Mortality for children with isolated chest injury was 5%, compared with rates of 20% for abdominal and chest trauma, 35% for head and chest trauma, and 39% for trauma to the head, chest, and abdomen. Less than 5% of the admissions to a pediatric trauma center incurred thoracic injury.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Pediatric Surgery, 1990
Journal of Pediatric Surgery, 2006
During repair of an esophageal atresia with tracheoesophageal fistula (EA/TEF), a right-sided aor... more During repair of an esophageal atresia with tracheoesophageal fistula (EA/TEF), a right-sided aortic arch (RAA) presents a technical challenge. We reviewed our experience with EA/TEF focusing on the impact of RAA. Methods: A retrospective review of patients with EA/TEF at our institution from 1990 to 2004 was performed. Of 61 patients, 53 had a left aortic arch (LAA) and 8 had RAA. Results: The mean gestational age and birth weight were similar between patients with LAA and RAA. There were more vascular rings in patients with RAA than with LAA (37.5% vs 3.8%, P = .009). A preoperative echocardiogram correctly identified the location of the arch in all with LAA but only 62.5% of those with RAA. Operative complications occurred in 25% of patients with RAA and 11% of patients with LAA. Conclusions: Management of a child with RAA and EA/TEF is technically challenging. Preoperative identification of the great vessel anomalies may impact operative decision making. Therefore, careful diagnostic evaluation of a patient with an aortic arch that cannot be easily defined by ECHO should be considered before definitive repair.
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Papers by Victor Fernandez Garcia