Kawasaki disease (KD) is an acute inflammatory vasculitis of childhood which was initially descri... more Kawasaki disease (KD) is an acute inflammatory vasculitis of childhood which was initially described more than 4 decades ago, yet the specific etiology remains unknown. It has become the most common cause of acquired cardiovascular disease in children in the United States. Advances in clinical therapies have reduced, but not eliminated, the incidence of coronary artery abnormalities in affected children. Pathophysiology seems to include an intense elaboration of cytokines, endothelin, and other vasoactive mediators resulting in the development of vascular endothelial changes that may leave a permanent impact on vascular integrity. Treatment with intravenous immune globulin and aspirin remains the primary management strategy and steroid therapy remains contoversial. In severe circumstances, coronary reperfusion strategies are required, and coronary artery surgery in children with KD has been required, albeit infrequently. KD may be a harbinger for early onset coronary artery disease ...
Imaging of complex congenital heart diseases (CHDs) in children is challenging. This article revi... more Imaging of complex congenital heart diseases (CHDs) in children is challenging. This article reviews the complementary role of high temporal and high spatial resolution magnetic resonance (MR) angiographic imaging techniques in evaluation of a patient with complex congenital cardiovascular disease and related postsurgical complications. A 4-year-old female patient with complex CHD and multiple previous palliative surgical procedures underwent MR angiography to evaluate the cause of refractory hypoxia. High-resolution MR angiography demonstrated the complex postsurgical cardiovascular anatomy and also assisted in the evaluation of cavopulmonary shunt patency and secondary venovenous shunt formation. Time-resolved MR angiography evaluated pulmonary perfusion and demonstrated a significant pulmonary arteriovenous malformation. This information guided physicians in planning further managements, which resulted in a satisfactory clinical outcome.
Journal of the American Society of Echocardiography Official Publication of the American Society of Echocardiography, Aug 1, 2010
The grading of pulmonary regurgitation (PR) severity by two-dimensional (2D) and Doppler echocard... more The grading of pulmonary regurgitation (PR) severity by two-dimensional (2D) and Doppler echocardiography is not standardized. Cardiovascular magnetic resonance imaging is the clinical gold standard for PR quantification. The purpose of this study was to determine the best 2D and Doppler echocardiographic predictors of severe PR. Thirty-six patients with tetralogy of Fallot or pulmonary valve stenosis with prior pulmonary valvuloplasty or transannular or subannular patch repair underwent 2D and Doppler echocardiography and cardiovascular magnetic resonance. Two-dimensional and Doppler echocardiographic measurements used to predict severe PR included diastolic flow reversal in the main or branch pulmonary arteries, PR jet width > or = 50% of the pulmonary annulus, PR pressure half-time < 100 ms, and PR index < 0.77. With the exception of PR index, all indices were significant independent predictors of severe PR. The best univariate predictor of severe PR was branch pulmonary artery diastolic flow reversal. Two-dimensional and Doppler echocardiography reliably identified severe PR in this cohort.
While balloon dilation (BD) has become the initial treatment for congenital valvar aortic stenosi... more While balloon dilation (BD) has become the initial treatment for congenital valvar aortic stenosis (CVAS) at many institutions, repeat BD for recurrent obstruction has been reported only in a few. Between January 1985 and December 1996, 298 patients (70 neonates) underwent BD, 34 of whom underwent a repeat BD without mortality. A greater proportion of neonates had a repeat BD (26% vs. 8%, P F 0.001). At repeat BD (1 day-7.5 years post initial BD), the mean peak-to-peak gradient was reduced from 67 ؎ 24 to 36 ؎ 16 mm Hg (P F 0.0001). Aortic regurgitation (AR) increased immediately in 26%, being moderate or more in 24%. During a mean follow-up of 5.2 years, there was one surgically related death. Of the 33 survivors, 6 had surgery for residual stenosis and/or AR. Among the remaining 27 patients, 96% were asymptomatic, the peak instantaneous aortic valve Doppler gradient was 50 ؎ 15 mm Hg with AR absent in 8%, mild in 62%, and moderate or more in 31%. In conclusion, repeat BD is effective and without mortality. AR was at least moderate in 24% of patients immediately after a second BD. Repeat BD was more common in patients who underwent the initial BD as neonates. Cathet.
There is strong evidence that the onset of atherosclerosis occurs in childhood. Identifying and t... more There is strong evidence that the onset of atherosclerosis occurs in childhood. Identifying and treating children and adolescents at risk for hypercholesterolemia should lead to a decrease in adult atherosclerotic disease. Based on current information, and the National Cholesterol Education Program (NCEP) guidelines, screening in children and adolescents should be limited to those individuals with specific cardiac risk factors or those from families with a strong history of atherosclerotic disease. Treatment of identified patients should be initiated with dietary control. Subsequent use of cholesterol-lowering medication is best limited to those patients who fail at least 6 months of dietary control measures. Drug therapy includes the use of bile acid sequestrants, nicotinic acid and, more recently, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors. There has been limited experience with HMG CoA reductase inhibitors in children and adolescents. However, preliminary data suggests that they are both more effective and have less side effects than either bile acid sequestrants or niacin. Long-term cohort studies will be needed to determine whether screening and treating children and adolescents with hypercholesterolemia is truly of long-term benefit and, if so, which treatment strategies will be preferred.
Background-Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malf... more Background-Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature consists of small, single-center case series spanning several decades. We performed a multicenter study to assess the outcomes and factors associated with mortality after fetal diagnosis in the current era. Methods and Results-Fetuses diagnosed with Ebstein anomaly and tricuspid valve dysplasia from 2005 to 2011 were included from 23 centers. The primary outcome was perinatal mortality, defined as fetal demise or death before neonatal discharge. Of 243 fetuses diagnosed at a mean gestational age of 27±6 weeks, there were 11 lost to follow-up (5%), 15 terminations (6%), and 41 demises (17%). In the live-born cohort of 176 live-born patients, 56 (32%) died before discharge, yielding an overall perinatal mortality of 45%. Independent predictors of mortality at the time of diagnosis were gestational age <32 weeks (odds ratio, 8.6; 95% confidence interval, 3.5-21.0; P<0.001), tricuspid valve annulus diameter z-score (odds ratio, 1.3; 95% confidence interval, 1.1-1.5; P<0.001), pulmonary regurgitation (odds ratio, 2.9; 95% confidence interval, 1.4-6.2; P<0.001), and a pericardial effusion (odds ratio, 2.5; 95% confidence interval, 1.1-6.0; at Columbia University on September 22, 2015 http://circ.ahajournals.org/ Downloaded from 482 Circulation August 11, 2015 P=0.04). Nonsurvivors were more likely to have pulmonary regurgitation at any gestational age (61% versus 34%; P<0.001), and lower gestational age and weight at birth (35 versus 37 weeks; 2.5 versus 3.0 kg; both P<0.001). Conclusion-In this large, contemporary series of fetuses with Ebstein anomaly and tricuspid valve dysplasia, perinatal mortality remained high. Fetuses with pulmonary regurgitation, indicating circular shunt physiology, are a high-risk cohort and may benefit from more innovative therapeutic approaches to improve survival. (Circulation. 2015;132:481-489.
Cardiovascular Pediatric Critical Illness and Injury, 2009
30% of these cases involve children under the age of 6 years [2]. The principal agents responsibl... more 30% of these cases involve children under the age of 6 years [2]. The principal agents responsible for pyogenic pericarditis include Staphylococcus aureus, Neisseria meningitides, Streptococcus pneu-moniae, and other streptococci. Haemophilus influenzae pericar-ditis, once a ...
Coronary artery anomalies have an incidence of 0.6% to 1.3% in angiographic studies and 0.3% in a... more Coronary artery anomalies have an incidence of 0.6% to 1.3% in angiographic studies and 0.3% in an autopsy series. Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSOV) represents a small fraction (1.3%) of these anomalies, with an overall prevalence of 0.017% to 0.03% in angiographic studies. The high incidence of sudden cardiac death associated with this specific anomaly during or immediately after vigorous physical exercise makes identification and appropriate surgical intervention critical. We present a case report of a 14-year-old patient with an LMCA arising from the RSOV with an initial intramural course, presenting with acute myocardial infarction (AMI) as the first indication of the anomaly. Transthoracic echocardiogram suggested this anomaly, which was confirmed by cardiac catheterization and transesophageal echocardiogram.
Cardiovascular Pediatric Critical Illness and Injury, 2009
Table 20.3 reviews the more important microorganisms associated with IE [1]. Viridans group strep... more Table 20.3 reviews the more important microorganisms associated with IE [1]. Viridans group streptococci remain the most frequent causative organisms in childhood IE. Staphylococci are particu-larly associated with indwelling foreign bodies, such as central catheters and ...
Background Comprehensive assessment of pediatric congenital heart disease (CHD) at any field stre... more Background Comprehensive assessment of pediatric congenital heart disease (CHD) at any field strength mandates evaluation of both vascular and dynamic cardiac anatomy for which diagnostic quality contrast-enhanced magnetic resonance angiography (CEMRA) and cardiac cine are crucial. Objective To determine whether high-resolution (HR) CEMRA and steady-state free precession (SSFP) cine can be performed reliably at 3.0 T in children with CHD and to compare the image quality to similar techniques performed at 1.5 T. Materials and methods Twenty-eight patients with a median age of 5 months and average weight 9.0±7.8 kg with suspected or known CHD were evaluated at 3.0 T. SSFP cine (n=86 series) and HR-CEMRA (n=414 named vascular segments) were performed and images were scored for image quality and artifacts.
To determine the usefulness of heart size on chest radiograph (CXR) in predicting cardiac enlarge... more To determine the usefulness of heart size on chest radiograph (CXR) in predicting cardiac enlargement (CE) in children, we prospectively evaluated 95 consecutive outpatients, who had both a CXR and echocardiography performed. Their median age was 5.0 years (2 days to 19.9 years). All patients underwent CXR assessment by a pediatric radiologist, with classification of cardiac silhouette as normal, borderline, or enlarged. Echocardiographic assessment of CE was performed by a pediatric echocardiographer. Sensitivity, specificity, and predictive values of the pediatric radiologist's interpretation of heart size on CXR were estimated. The presence of CE by echocardiography was used as the gold standard. Seventy-nine patients (83.2%) had no CE on CXR, and 16 patients (16.8%) had CE. Sensitivity of the CXR to identify CE was 58.8%, 95% confidence interval (CI) [32.9, 81.6], with a positive predictive value of 62. 5% [35.4, 84.8]. Specificity was 92.3% [84.0, 97.1], with a negative predictive value of 91. 1% [82.6, 96.4]. These data suggest that the assessment of CE on CXR to predict CE by echocardiography has a relatively high specificity and negative predictive value, but a low sensitivity and positive predictive value. The limitations of CXR as a diagnostic test should be understood by clinicians using the test when screening children for cardiac disease.
Journal of the American College of Cardiology, 2014
P Pal al alo, o, o, A A Alto, CA A A; 14 A A Adv voca a ate e e Child d dre r r n n n's Ho Ho osp... more P Pal al alo, o, o, A A Alto, CA A A; 14 A A Adv voca a ate e e Child d dre r r n n n's Ho Ho osp, Oa O Oak k L La Law w wn, IL; 15 Te exa x x s Ch Chi ildren en n's Hos s sp, p p B B Baylor r r Co o olle ege o o of M M Medicin n ne, D D De e ept o o of P P Pedi ia a atr r rics, D Div of C C Car ar ardiolog og gy y y, Ho ous s ston, TX X; 16 16 6 Ch Ch Chil il ildr dr dren en en's 's 's H H Hosp p p Lo o os s An An Ange ge ele les, U U Uni n n ve ve vers rs rsit it ity of f f S S Sou ou outh th thern n n Ca Ca Cal li l fo fo forn rnia ia ia K K Kec ec eck k k Sc Sc Sch h of of of M M Med ed edic ic icin n ne, e, e, D D Dep ep ept t t of of of P P Ped ed ediatr tr trics, s, s, Div iv iv o
Kawasaki disease (KD) is an acute inflammatory vasculitis of childhood which was initially descri... more Kawasaki disease (KD) is an acute inflammatory vasculitis of childhood which was initially described more than 4 decades ago, yet the specific etiology remains unknown. It has become the most common cause of acquired cardiovascular disease in children in the United States. Advances in clinical therapies have reduced, but not eliminated, the incidence of coronary artery abnormalities in affected children. Pathophysiology seems to include an intense elaboration of cytokines, endothelin, and other vasoactive mediators resulting in the development of vascular endothelial changes that may leave a permanent impact on vascular integrity. Treatment with intravenous immune globulin and aspirin remains the primary management strategy and steroid therapy remains contoversial. In severe circumstances, coronary reperfusion strategies are required, and coronary artery surgery in children with KD has been required, albeit infrequently. KD may be a harbinger for early onset coronary artery disease ...
Imaging of complex congenital heart diseases (CHDs) in children is challenging. This article revi... more Imaging of complex congenital heart diseases (CHDs) in children is challenging. This article reviews the complementary role of high temporal and high spatial resolution magnetic resonance (MR) angiographic imaging techniques in evaluation of a patient with complex congenital cardiovascular disease and related postsurgical complications. A 4-year-old female patient with complex CHD and multiple previous palliative surgical procedures underwent MR angiography to evaluate the cause of refractory hypoxia. High-resolution MR angiography demonstrated the complex postsurgical cardiovascular anatomy and also assisted in the evaluation of cavopulmonary shunt patency and secondary venovenous shunt formation. Time-resolved MR angiography evaluated pulmonary perfusion and demonstrated a significant pulmonary arteriovenous malformation. This information guided physicians in planning further managements, which resulted in a satisfactory clinical outcome.
Journal of the American Society of Echocardiography Official Publication of the American Society of Echocardiography, Aug 1, 2010
The grading of pulmonary regurgitation (PR) severity by two-dimensional (2D) and Doppler echocard... more The grading of pulmonary regurgitation (PR) severity by two-dimensional (2D) and Doppler echocardiography is not standardized. Cardiovascular magnetic resonance imaging is the clinical gold standard for PR quantification. The purpose of this study was to determine the best 2D and Doppler echocardiographic predictors of severe PR. Thirty-six patients with tetralogy of Fallot or pulmonary valve stenosis with prior pulmonary valvuloplasty or transannular or subannular patch repair underwent 2D and Doppler echocardiography and cardiovascular magnetic resonance. Two-dimensional and Doppler echocardiographic measurements used to predict severe PR included diastolic flow reversal in the main or branch pulmonary arteries, PR jet width &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 50% of the pulmonary annulus, PR pressure half-time &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 100 ms, and PR index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.77. With the exception of PR index, all indices were significant independent predictors of severe PR. The best univariate predictor of severe PR was branch pulmonary artery diastolic flow reversal. Two-dimensional and Doppler echocardiography reliably identified severe PR in this cohort.
While balloon dilation (BD) has become the initial treatment for congenital valvar aortic stenosi... more While balloon dilation (BD) has become the initial treatment for congenital valvar aortic stenosis (CVAS) at many institutions, repeat BD for recurrent obstruction has been reported only in a few. Between January 1985 and December 1996, 298 patients (70 neonates) underwent BD, 34 of whom underwent a repeat BD without mortality. A greater proportion of neonates had a repeat BD (26% vs. 8%, P F 0.001). At repeat BD (1 day-7.5 years post initial BD), the mean peak-to-peak gradient was reduced from 67 ؎ 24 to 36 ؎ 16 mm Hg (P F 0.0001). Aortic regurgitation (AR) increased immediately in 26%, being moderate or more in 24%. During a mean follow-up of 5.2 years, there was one surgically related death. Of the 33 survivors, 6 had surgery for residual stenosis and/or AR. Among the remaining 27 patients, 96% were asymptomatic, the peak instantaneous aortic valve Doppler gradient was 50 ؎ 15 mm Hg with AR absent in 8%, mild in 62%, and moderate or more in 31%. In conclusion, repeat BD is effective and without mortality. AR was at least moderate in 24% of patients immediately after a second BD. Repeat BD was more common in patients who underwent the initial BD as neonates. Cathet.
There is strong evidence that the onset of atherosclerosis occurs in childhood. Identifying and t... more There is strong evidence that the onset of atherosclerosis occurs in childhood. Identifying and treating children and adolescents at risk for hypercholesterolemia should lead to a decrease in adult atherosclerotic disease. Based on current information, and the National Cholesterol Education Program (NCEP) guidelines, screening in children and adolescents should be limited to those individuals with specific cardiac risk factors or those from families with a strong history of atherosclerotic disease. Treatment of identified patients should be initiated with dietary control. Subsequent use of cholesterol-lowering medication is best limited to those patients who fail at least 6 months of dietary control measures. Drug therapy includes the use of bile acid sequestrants, nicotinic acid and, more recently, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors. There has been limited experience with HMG CoA reductase inhibitors in children and adolescents. However, preliminary data suggests that they are both more effective and have less side effects than either bile acid sequestrants or niacin. Long-term cohort studies will be needed to determine whether screening and treating children and adolescents with hypercholesterolemia is truly of long-term benefit and, if so, which treatment strategies will be preferred.
Background-Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malf... more Background-Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature consists of small, single-center case series spanning several decades. We performed a multicenter study to assess the outcomes and factors associated with mortality after fetal diagnosis in the current era. Methods and Results-Fetuses diagnosed with Ebstein anomaly and tricuspid valve dysplasia from 2005 to 2011 were included from 23 centers. The primary outcome was perinatal mortality, defined as fetal demise or death before neonatal discharge. Of 243 fetuses diagnosed at a mean gestational age of 27±6 weeks, there were 11 lost to follow-up (5%), 15 terminations (6%), and 41 demises (17%). In the live-born cohort of 176 live-born patients, 56 (32%) died before discharge, yielding an overall perinatal mortality of 45%. Independent predictors of mortality at the time of diagnosis were gestational age <32 weeks (odds ratio, 8.6; 95% confidence interval, 3.5-21.0; P<0.001), tricuspid valve annulus diameter z-score (odds ratio, 1.3; 95% confidence interval, 1.1-1.5; P<0.001), pulmonary regurgitation (odds ratio, 2.9; 95% confidence interval, 1.4-6.2; P<0.001), and a pericardial effusion (odds ratio, 2.5; 95% confidence interval, 1.1-6.0; at Columbia University on September 22, 2015 http://circ.ahajournals.org/ Downloaded from 482 Circulation August 11, 2015 P=0.04). Nonsurvivors were more likely to have pulmonary regurgitation at any gestational age (61% versus 34%; P<0.001), and lower gestational age and weight at birth (35 versus 37 weeks; 2.5 versus 3.0 kg; both P<0.001). Conclusion-In this large, contemporary series of fetuses with Ebstein anomaly and tricuspid valve dysplasia, perinatal mortality remained high. Fetuses with pulmonary regurgitation, indicating circular shunt physiology, are a high-risk cohort and may benefit from more innovative therapeutic approaches to improve survival. (Circulation. 2015;132:481-489.
Cardiovascular Pediatric Critical Illness and Injury, 2009
30% of these cases involve children under the age of 6 years [2]. The principal agents responsibl... more 30% of these cases involve children under the age of 6 years [2]. The principal agents responsible for pyogenic pericarditis include Staphylococcus aureus, Neisseria meningitides, Streptococcus pneu-moniae, and other streptococci. Haemophilus influenzae pericar-ditis, once a ...
Coronary artery anomalies have an incidence of 0.6% to 1.3% in angiographic studies and 0.3% in a... more Coronary artery anomalies have an incidence of 0.6% to 1.3% in angiographic studies and 0.3% in an autopsy series. Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSOV) represents a small fraction (1.3%) of these anomalies, with an overall prevalence of 0.017% to 0.03% in angiographic studies. The high incidence of sudden cardiac death associated with this specific anomaly during or immediately after vigorous physical exercise makes identification and appropriate surgical intervention critical. We present a case report of a 14-year-old patient with an LMCA arising from the RSOV with an initial intramural course, presenting with acute myocardial infarction (AMI) as the first indication of the anomaly. Transthoracic echocardiogram suggested this anomaly, which was confirmed by cardiac catheterization and transesophageal echocardiogram.
Cardiovascular Pediatric Critical Illness and Injury, 2009
Table 20.3 reviews the more important microorganisms associated with IE [1]. Viridans group strep... more Table 20.3 reviews the more important microorganisms associated with IE [1]. Viridans group streptococci remain the most frequent causative organisms in childhood IE. Staphylococci are particu-larly associated with indwelling foreign bodies, such as central catheters and ...
Background Comprehensive assessment of pediatric congenital heart disease (CHD) at any field stre... more Background Comprehensive assessment of pediatric congenital heart disease (CHD) at any field strength mandates evaluation of both vascular and dynamic cardiac anatomy for which diagnostic quality contrast-enhanced magnetic resonance angiography (CEMRA) and cardiac cine are crucial. Objective To determine whether high-resolution (HR) CEMRA and steady-state free precession (SSFP) cine can be performed reliably at 3.0 T in children with CHD and to compare the image quality to similar techniques performed at 1.5 T. Materials and methods Twenty-eight patients with a median age of 5 months and average weight 9.0±7.8 kg with suspected or known CHD were evaluated at 3.0 T. SSFP cine (n=86 series) and HR-CEMRA (n=414 named vascular segments) were performed and images were scored for image quality and artifacts.
To determine the usefulness of heart size on chest radiograph (CXR) in predicting cardiac enlarge... more To determine the usefulness of heart size on chest radiograph (CXR) in predicting cardiac enlargement (CE) in children, we prospectively evaluated 95 consecutive outpatients, who had both a CXR and echocardiography performed. Their median age was 5.0 years (2 days to 19.9 years). All patients underwent CXR assessment by a pediatric radiologist, with classification of cardiac silhouette as normal, borderline, or enlarged. Echocardiographic assessment of CE was performed by a pediatric echocardiographer. Sensitivity, specificity, and predictive values of the pediatric radiologist's interpretation of heart size on CXR were estimated. The presence of CE by echocardiography was used as the gold standard. Seventy-nine patients (83.2%) had no CE on CXR, and 16 patients (16.8%) had CE. Sensitivity of the CXR to identify CE was 58.8%, 95% confidence interval (CI) [32.9, 81.6], with a positive predictive value of 62. 5% [35.4, 84.8]. Specificity was 92.3% [84.0, 97.1], with a negative predictive value of 91. 1% [82.6, 96.4]. These data suggest that the assessment of CE on CXR to predict CE by echocardiography has a relatively high specificity and negative predictive value, but a low sensitivity and positive predictive value. The limitations of CXR as a diagnostic test should be understood by clinicians using the test when screening children for cardiac disease.
Journal of the American College of Cardiology, 2014
P Pal al alo, o, o, A A Alto, CA A A; 14 A A Adv voca a ate e e Child d dre r r n n n's Ho Ho osp... more P Pal al alo, o, o, A A Alto, CA A A; 14 A A Adv voca a ate e e Child d dre r r n n n's Ho Ho osp, Oa O Oak k L La Law w wn, IL; 15 Te exa x x s Ch Chi ildren en n's Hos s sp, p p B B Baylor r r Co o olle ege o o of M M Medicin n ne, D D De e ept o o of P P Pedi ia a atr r rics, D Div of C C Car ar ardiolog og gy y y, Ho ous s ston, TX X; 16 16 6 Ch Ch Chil il ildr dr dren en en's 's 's H H Hosp p p Lo o os s An An Ange ge ele les, U U Uni n n ve ve vers rs rsit it ity of f f S S Sou ou outh th thern n n Ca Ca Cal li l fo fo forn rnia ia ia K K Kec ec eck k k Sc Sc Sch h of of of M M Med ed edic ic icin n ne, e, e, D D Dep ep ept t t of of of P P Ped ed ediatr tr trics, s, s, Div iv iv o
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