Papers by Norman Silverman
Journal of the American Society of Echocardiography, 2019
Background: Left ventricular noncompaction cardiomyopathy (LVNC) is characterized by prominent le... more Background: Left ventricular noncompaction cardiomyopathy (LVNC) is characterized by prominent left ventricular trabeculations, often leading to myocardial dysfunction and death or heart transplantation. Although diagnostic echocardiographic criteria exist for LVNC, segmental speckle-tracking strain patterns have not been described in pediatric LVNC. The objectives of this study were to characterize segmental noncompaction, evaluate segmental speckle-tracking strain, and characterize peak strain values in children with LVNC with adverse clinical outcomes. Methods: Echocardiographic noncompaction/compaction ratios and segmental radial, circumferential, and longitudinal strain were measured retrospectively in children with LVNC (January 2000 to June 2013). Segmental strain of the cohort was compared with that in control subjects matched by age and body surface area. Results: One hundred one pediatric patients with LVNC were included (median age 2.8 years; range, 0-19.4 years); 71 patients survived (benign group) and 30 patients did not survive or required heart transplantation (adverse group). The adverse group was younger at diagnosis (P = .03), with lower ejection fractions (P < .0001) compared with the benign group. Both groups demonstrated increased noncompaction/compaction ratios within apical segments, with significantly increased involvement in antero-and inferolateral midpapillary segments in the adverse group (P < .005). Radial, circumferential, and longitudinal strain of nearly all left ventricular segments were significantly decreased in the adverse compared with the benign group and in pediatric LVNC patients compared with control subjects.
The American Journal of Cardiology, 1976
Cross sectional echocardiography can be used to determine left ventricular size and ejection frac... more Cross sectional echocardiography can be used to determine left ventricular size and ejection fraction in children. We used two orthogonal planes from the apical four and two chamber planes to calculate the left ventricular volume in 20 children with a variety of congenital heart lesions and compared these volumes with those calculated using angiography. Better correlations were achieved at end diastole than at end systole. Comparisons between ejection fraction calculated by angiography and echocardiography showed the correlation was closer for two-dimensional than M-mode techniques. Studies using newer two-dimensional methods suggest that an even closer correlation for volume and ejection fraction can be achieved than those reported in our initial studies. Most studies which have determined right ventricular volume have used biplane methods combining short axis and four chamber images. We used single plane area-length methods from parasternal short axis and apical four chamber planes to calculate right ventricular volume in 20 children undergoing angiocardiography for a variety of congenital heart diseases. The single plane volume method underestimated the volume calculated from angiography uniformly so that a good estimate of the angiographic ejection fraction was obtained. Adding the volumes derived from each plane provided a closer approximation of the angiographic volumes and a good estimate of the ejection fraction. High resolution ultrasound equipment and computer assisted tracing devices have made accurate noninvasive assessment of volume and function accurate and practical.
Over the last two decades, the value of examining the fetal heart has moved from an experimental ... more Over the last two decades, the value of examining the fetal heart has moved from an experimental procedure of diagnostic curiosity to a front-line form of evaluating fetal cardiac health and disease. There have been numerous advances in the associated technology, including high-resolution imaging, the introduction of reliable color flow and pulse Doppler, and M-Mode and continuous-wave Doppler recordings in some instruments. Such advances continue, with the potential for 3D imaging using spatiotemporal image correlation (STIC) and full-volume fetal technology. The techniques used by obstetric sonographers in all fields, including physicians from the fields of radiology, obstetrics, and pediatric cardiology, together with technologists who support and do most of the scanning, require a fundamental understanding of ultrasound as well as anatomy, physiology, and the various cardiac pathologies that occur in the fetus. This book addresses these fundamentals, providing correlations by means of diagrams and images of fetal cardiac morphology and pathology. The scans are quite unique, having been collected over several years by the principal author, Dr. Enrico M. Chiappa, from his laboratories in Italy, and provide exquisite echocardiography of normal and congenitally malformed hearts. These are complemented by the excellent pathological images of Dr. Andrew C. Cook and Dr. Gianni Botta, who provided high-quality images of normal and pathological fetal heart conditions, which are displayed as support for the echocardiographic images. The organization of this book is oriented toward practitioners. The first section provides general guidelines for imaging the fetal body and heart, for segmental analysis, and for diagnosis. The second section takes a view-oriented approach, describing first the transverse views and then the longitudinal views of the fetal body and how each echocardiographic projection best displays a particular pathological entity. The third section contains essential information pertaining to the new technique of 3D/4D echocardiography and the role of the pathologist in heart disease, which expands further the value of this text for providing references and comparisons with standard imaging techniques. The authors obviously gave a great deal of thought to this project-from the choice of images in the text, which include the clearest descriptions and labels, to the accompanying DVD, which contains complex moving echocardiographic images. The objective is to provide the reader with something greater than a static representation of the fetal cardiac morphology while retaining the ability to refer directly to morphological comparisons and consult with the text for greater detail. This work will have great appeal to physicians and technologists involved in obtaining and interpreting such images and will provide the obstetric, cardiological, and radiological communities with an excellent reference for comparing cases seen in their daily practice.
Annals of Pediatric Cardiology, 2009
Kingdom national data obtained between 1993 and 1995 reported a detection rate of 38% for atriove... more Kingdom national data obtained between 1993 and 1995 reported a detection rate of 38% for atrioventricular septal defects and 66% for hypoplastic left heart ("four chamber" abnormalities) compared to 3% for transposition of the great arteries (outflow tract views THE POTENTIAL FOR DETECTION OF CONGENITAL HEART LESIONS BY FETAL ECHOCARDIOGRAPHY A wide range of congenital heart defects can be identified during fetal life with a very high degree of diagnostic accuracy in specialist centers. [1] Virtually all forms of congenital heart disease have been described during prenatal life. In most countries, the major routes of ascertainment of congenital heart defects are, first, a suspicion of a cardiac defect during an obstetric anomaly scan, or second, because specific risk factors have led to a referral to a specialist unit for further evaluation. The types of risk factors that are widely accepted as referral reasons for detailed assessment of the heart are listed in [Table 1] and have been reviewed elsewhere [2] It should be emphasized that most cases of congenital heart disease occur in the "low risk" population. Detection of these cases rests with the sonographer who is assessing the fetal heart as part of obstetric anomaly scans involving an anatomic survey that is not restricted to the heart. Some cardiac lesions, particularly those evident on a "four chamber view" of the fetal heart are more easily detected by the nonspecialist sonographer than others, for which more extended views of the outflow tracts are required for detection. For example, United
Journal of the American College of Cardiology, 1989
Ten consecutive patients with a coronary artery fistula, aged 1 day to 4 years, were studied by t... more Ten consecutive patients with a coronary artery fistula, aged 1 day to 4 years, were studied by two-dimensional echocardiography, pulsed Doppler ultrasound and color flow imaging. All patients underwent cardiac catheterization, and seven patients had surgical closure of the fistula. The origin, course and site of drainage of the coronary artery fistula were correctly identified prospectively by echocardiographic examination in all patients. Color flow imaging was particularly helpful in visualizing the site of drainage of the fistula. Diameters of the right and left coronary arteries at their origin and of the aortic root were measured from twodimensional echocardiographic frames and compared with measurements obtained in normal children. The ratio of coronary artery diameter to aortic root diameter in normal A congenital coronary artery fistula is an uncommon cardiac anomaly that usually presents with a continuous murmur in otherwise asymptomatic children (1). Occasionally it may lead to congestive heart failure or bacterial endocarditis (1-3). If these fistulas are undetected or untreated in childhood, it has been reported (1,3) that they become symptomatic more frequently in adulthood because of chronic volume overload and myocardial ischemia. Although spontaneous closure occurs sporadically (4,5), elective surgical closure of the fistula has been the preferred mode of treatment (
Journal of the American College of Cardiology, 1988
;fwm<, simplified Doppler method in 42 children. 1 month to 16 years of age. Fifteen children had... more ;fwm<, simplified Doppler method in 42 children. 1 month to 16 years of age. Fifteen children had no evidence of shunt and Doppler echocardiographlc determination of pulmonary and sonic blood Row (l-5) and pulmonary to systemic blood Row @p/Qs) ratio @-Ill in children has become an establlthed noninvasive technique. However. the measwemen~a nccdcd to cakulatc the dplt& ratio by Doppler echocardiography are time-consuming. and the integration of the Doppler Row dmmeterr by the ratio of the peak zy~tobc ROW velocities. the pulmonary varrable being the nomeliltor in each ratio Methods Study patients. We srudied 42 mfanlr and children aged I monlh to 16 yews. Fifteen subject, tmean age 4.9 yean! bad no evidence of cardiac disease. and 27 patients (mean age 3. I yean) had an mtracard;ac left to right shunt. Among ihe latw. I6 had an atrial wotal communication of the ost~um that was associated with an atrial ~eplat defect in three. Pauentc with a moderate to marked left to right ductus xteriosns shunt were excluded from the study becaure. under these circumstances. the pulmonary Row cannot be measured wcurately from the main pulmonary artery (I 1.12). All 21 children with an intracardiac shunt *ere admitted for cardiac catheterization and underwent this procedure wthin 24 hours of the Doppler study. At cardiac cathetwz;rtion. the Qp/Qs ratio as derived from oxygen sntuwtions obtained with a Hemoximeter OVA2 IRadioi,,cu, j ml ranged from I.):1 'o 4.3:). No prior approval for Doppler eeborardiographic Icchniqurr. All children underuenr a complcw Iwo-dimensional Voppl?, echocnrdlographic eumfnntion wrlh rccordinz of Doppler Row velocity exammauon. and ln.rhc left lateral dccubmx prnition for the left parac~ernal view<. Scdmion using chloral hydmle at a dose of 75 mfikg body weight (not exceeding I .5 gl was used if indicated. Sludier were performed wfh a commercially available duolei Doppler mechamcal seaor scanner (Advanced T&nolopy kbomtory. Ultramark 8). Two-dlmensiornl cchocardiographic images and pulsed Doppler Row veiociiy curves were ohtained with the same lransducer (either 3 or 5 ?~fHz). The Doppler sample volume could be posil~oned at any depth along any scan line for measurement of Doppler Row
Journal of the American College of Cardiology, 1989
To determine which morphologic features are associated with early death, the complete echocardiog... more To determine which morphologic features are associated with early death, the complete echocardiograms and medical records of 16 consecutive patients with Ebsteht's anomaly and concordant atrioventricular connections who presented in the fetal (n = 5) or neonatal (n = 11) period were reviewed. The cohort was classified into two groups on the basis of survival at 3 months. Group 1 consisted of seven patients who died at 13 months of age, and Group 2 consisted of the nine surviving patients. Comparing Groups 1 and 2, the respective incidence rates of morphologic features that correlated with early death (p < 0.05) included tethered distal attachments of the anterosuperior tricuspid leaflet (86% versus ll%), right ventricular dysplasia (86% versus 0%), left ventricular compression by right heart dilation (71% versus 11%) and the area of the combined right atrium and atriaiized right ventricle being greater than the combined area of the functional right ventricle, left atrium and left ventricle (57% versus 0%) measured in the apical four chamber view. Right ventricular dysplasia was present in all patients with marked right atria1 and atrialized right ventricular enlargement, in 86% of patients with tethered anterior leaflets and in 83% of those with left ventricular compression; 86% of patients with right ventricular dysplasia had tethered distal attachments. In conclusion, echocardiography defines morphologic features in the fetus and neonate that are highly predictive of death by 3 months of age.
Journal of Diagnostic Medical Sonography, 1991
The clinical course and outcome of 55 fetuses with complete atrioventricular (A V) block detected... more The clinical course and outcome of 55 fetuses with complete atrioventricular (A V) block detected prenatally were studied to identify factors that affect the natural history of this lesion. In 29 fetuses (53%) complete A V block was associated with complex structural heart defects, usually left atrial isomerism (n = 17) or discordant A V connection (n = 7). The other 26 fetuses had normal cardiac anatomy; in 19 cases the mother had connective tissue disease or tested positive for antinuclear antibodies. Six fetuses showed progression from sinus rhythm or second degree block to complete A V block. Of the 55 pregnancies, 5 were terminated and 24 fetuses or neonates died; at the end of the neonatal period 26 fetuses were still alive. Fetal or neonatal death correlated significantly with the presence of structural heart defects (4 of 29 surviving, p < 0.001), hydrops (0 of 22 surviving, p < 0.001), an atrial rate ::0;120 beats/min (1 of 12 surviving, p < 0.005) or a ventricular rate ::0;55 beats/min (3 of 21 surviving, p < 0.001). Mean atrial and Complete atrioventricular (A V) block is an uncommon congenital lesion, occurring in about I of 20,000 newborns (I). Previously, this diagnosis was usually made after birth; only rarely was it suspected before delivery (2). Because fetal arrhythmias can now be evaluated prenatally by twodimensional and M-mode echocardiographic (3-5) and Doppler ultrasound techniques (6), complete A V block is more frequently identified during the fetal period. Recent reports (7-11) on fetal complete A V block were based on relatively few cases. To gain a greater understanding of factors that influence the natural history of fetal complete A V block and that might indicate the need for therapeutic intervention, we
Heart, 2005
To assess the safety, efficacy, and long term results of mitral balloon valvotomy (MBV) for rheum... more To assess the safety, efficacy, and long term results of mitral balloon valvotomy (MBV) for rheumatic mitral stenosis in children and adolescents in comparison to adults. Methods: The results of 468 patients with mitral stenosis who underwent successful MBV and were followed up for 0.5-13 years were analysed. Patients were divided according to age at the time of MBV into group 1 consisting of 84 patients (20 years of age (children and adolescents) and group 2 that included 384 patients, age. 20 (adults). Results: Patients in group 1 had a lower mitral echo score (mean (SD) 7.5 (1.3) v 8 (1.1), p , 0.001), smaller Doppler mitral valve area (MVA) (0.84 (0.17) v 0.92 (0.18) cm 2 , p , 0.001), and higher Doppler mitral valve gradient (15.0 (5.3) v 12.7 (4.5) mm Hg, p , 0.001) than group 2. Immediately after MBV group 1 had larger MVA, whether measured by Doppler (2.0 (0.30) v 1.96 (0.28) cm 2 , p , 0.05) or by catheter (2.0 (0.59) v 1.8 (0.52) cm 2 , p , 0.001), and similar complication rates, compared to group 2. After a mean follow up of 5 (3.5) years there was no significant difference between groups 1 and 2 in the incidence of restenosis (14.3% v 16.1%, NS). Event-free survival rates at 5, 10, and 12.5 years were 93%, 79%, and 79% for group 1 and 94%, 90%, and 84% for group 2 (p = 0.18). Conclusions: MBV is safe and effective in children and adolescents with rheumatic mitral stenosis. It provides better immediate results than in adults and excellent long term results that are comparable to those seen in adults.
Circulation, 1979
The echocardiographic features of the enlarged coronary sinus are described in eight patients wit... more The echocardiographic features of the enlarged coronary sinus are described in eight patients with a left superior vena cava draining to the coronary sinus and two patients with total anomalous pulmonary venous connection to the coronary sinus. The diagnosis was confirmed in each patient by cardiac catheterization and surgery. On the M-mode echocardiogram, a dense echo was present posterior to the mitral valve at the level of the atrioventricular junction. The clear space immediately behind this echo represented the enlarged coronary sinus. On the two-dimensional echocardiographic examination, the enlarged coronary sinus was seen in several planes; however, the structure was imaged best with the parasternal long-axis view. In the long-axis plane in the eight patients with a left superior vena cava, the coronary sinus was visualized as a distinct circular structure lying posteriorly in the atrioventricular junction. In the two patients with total anomalous pulmonary venous connection, the confluence of the pulmonary veins and its connection to the coronary sinus were imaged in the long-axis plane. These findings were substantiated by contrast M-mode and two-dimensional echocardiograms in five patients. The M-mode and two-dimensional echocardiographic examinations allowed detection of the enlarged coronary sinus and diagnosis of certain venous anomalies that caused increased coronary sinus blood flow. The two-dimensional echocardiographic examination easily distinguished the enlarged coronary sinus from other congenital lesions that cause anomalous echoes behind the anterior mitral valve leaflet on M-mode echocardiographic examination.
The American Journal of Cardiology, 1989
The diagnosis of dilated cardiomyopathy was established and subsequently confirmed in 6 of 625 fe... more The diagnosis of dilated cardiomyopathy was established and subsequently confirmed in 6 of 625 fetuses studied by echocardiography. All 6 had structurally normal hearts. Abnormal findings included reduced fractional shortening index in 5, atrioventricular valve regurgitation in 3, abnormal chamber dimensions in 3 and nonimmune hydrops in 4. In 2 fetuses referred because of a family history of dilated cardiomyopathy in previous siblings, echocardiographic abnormalities were absent on a first examination performed at 20 weeks of gestation. This suggested that a normal fetal echocardiogram in a midtrimester fetus does not always rule out the subsequent development of dilated cardiomyopathy. However, all fetuses followed serially developed some abnormality later in pregnancy. Only 2 neonates survived, 1 of whom required a heart transplant during infancy. Death from cardiac failure occurred in 1 fetus and 3 neonates. This study demonstrates that dilated cardiomyopathy may develop during fetal life and might be diagnosed by echocardiography if serial studies are performed. Dilated cardiomyopathy presenting prenatally appears to have a poor prognosis.
Journal of the American College of Cardiology, 1998
Objectives. The purpose of this study was to determine the effect of accessory or anomalous atrio... more Objectives. The purpose of this study was to determine the effect of accessory or anomalous atrioventricular valvar apparatus on relief of outflow tract obstruction. Background. Outflow tract obstruction due to accessory tissue or anomalous attachments of the atrioventricular valvar apparatus is an unusual but well-recognized problem. In addition to obstruction, anomalous attachments of the atrioventricular valvar apparatus may interfere with procedures to relieve outflow tract obstruction or perform outflow tract reconstruction. Methods. Since 1992, we have operated on 21 patients (median age 4 years) with systemic (n ؍ 13), pulmonary (n ؍ 5) or bilateral (n ؍ 3) outflow tract obstruction due to accessory atrioventricular valvar tissue and/or anomalous attachments of the subvalvar apparatus. Primary diagnoses were isolated obstruction of the systemic outflow tract or aortic arch (n ؍ 7), transposition complexes (n ؍ 6), previously repaired atrioventricular septal defect (n ؍ 3), functionally single ventricle (n ؍ 3) and ventricular septal defect with pulmonary outflow obstruction (n ؍ 2). Outflow tract gradients ranged from 20-110 mm Hg (median 58 mm Hg). Results. Complete relief of obstruction due to atrioventricular valvar anomalies was possible in 14 patients. In six patients, the planned procedure either had to be modified or only partial relief of the obstruction was achieved. In the remaining patient, who had borderline functionally single ventricle heart disease (unbalanced atrioventricular septal defect) and systemic outflow obstruction due to accessory and functional valvar apparatus, support was withdrawn because the parents refused univentricular palliation and the valvar anomalies precluded a Ross-Konno procedure. There were two early deaths. At follow-up ranging from 1 to 66 months (median 27 months), there was one death, and there has been no recurrence of outflow tract obstruction or residual atrioventricular valvar tissue. Conclusions. Outflow tract obstruction caused by accessory or anomalous atrioventricular valvar structures is an uncommon and heterogeneous group of conditions that can have significant surgical implications. In the majority of cases, tailoring of surgical techniques will permit complete relief of obstruction. However, such anomalies may limit standard surgical options and necessitate an innovative approach in some patients.
European Journal of Cardio-Thoracic Surgery, 1999
Objectives: Discrete subaortic stenosis causes left ventricular outflow tract (LVOT) obstruction ... more Objectives: Discrete subaortic stenosis causes left ventricular outflow tract (LVOT) obstruction and often produces aortic regurgitation (AR) which alone may precipitate surgical intervention. Conventional resection relieves the obstruction, but the recurrence rate is high, and the AR is little changed as the thick fibrous membrane which extends onto the valve leaflets remains. We studied whether an aggressive surgical approach could reduce both the severity of AR and rate of recurrence of obstruction associated with discrete subaortic stenosis, and whether this aggressive approach could be justified. Methods: Between June 1992 and April 1996, 37 patients aged 0.5-35 years (median 7.5) underwent resection of a discrete subaortic membrane. Ten underwent re-operation for recurrent obstruction and eight followed previous ventricular septal defect closure. LVOT gradient was measured using the modified Bernoulli equation and AR was graded on a scale of 0-4 (0 = none, 4 = severe). Postoperative assessment was performed early (Ͻ7 days) and at mid-term (27.0 months; range 2-59 months). Results: There was significant improvement in AR from mild/moderate to none/trivial (P = 0.019) immediately postoperatively and LVOT gradient from 66.9 ± 30.4 to 15.1 ± 12.2 mmHg (P Ͻ 0.0001). By stepwise logistic regression preoperative gradient correlated significantly with postoperative mild/moderate AR (P = 0.015) and LVOT gradient (P = 0.0036). Preoperative mild/moderate AR also correlated with postoperative mild/moderate AR (P = 0.034). Five patients developed complete heart block, four undergoing reoperation for recurrent obstruction, and one preoperatively had right bundle branch block from previous ventricular septal defect repair. At mid-term follow-up there was no increase in AR or LVOT gradient (14.8 ± 12.8 mmHg). Early post-operative AR was the strongest predictor of late mild/moderate AR (P = 0.02). Early post-operative gradient was a weaker predictor (P = 0.04). Pre-operative and early post-operative gradient were significant predictors of late gradient (P = 0.0038; Ͻ0.0001, respectively). No patient required reoperation for recurrent obstruction; one underwent late aortic valve replacement for severe AR. Conclusions: An aggressive surgical approach to discrete subaortic stenosis produces excellent relief of obstruction and frees the valve leaflets, significantly reducing associated AR at early and mid-term follow-up with low morbidity for primary operation. Long-term follow-up is required to confirm whether this early benefit is maintained.
Cardiology in the Young, 1999
Heart, 1984
The precise method of surgical repair of double outlet right ventricle depends both on the relati... more The precise method of surgical repair of double outlet right ventricle depends both on the relation of the interventricular communication to the cardiac outlets and on the course and insertion of the atrioventricular valve tension apparatus. It may be difficult to connect the interventricular communication with one or other outlet or both either because the interventricular communication is too far from the outlets or because atrioventricular tension apparatus interposes between them. This study was carried out in order to establish whether these details could be recognised preoperatively using cross sectional echocardiography. Forty two echocardiograms were reviewed retrospectively from patients with double outlet right ventricle, excluding those with atrioventricular septal defects and atrioventricular discordance. Ten further such patients were studied prospectively. The diagnosis was confirmed at open heart surgery in 19 patients. The relation of the great arteries and their outlet tracts to each other and to the interventricular communication was readily and accurately predicted. Four patients (7.7%) had no infundibular septum. The remaining 48 had such a septum. In 27 (52%) the interventricular communication was overridden by a great artery. In 14 (27%) it was roofed by the ventriculoinfundibular fold, and in 11 (21%) it was confined to the inlet or trabecular septa. The insertion of chordae tendineae limited the possible surgical options in 12 patients (23. 1%) who were distributed unpredictably among the above groups. Four patients had straddling atrioventricular valves. In five, tricuspid tension apparatus inserted into the underside of the infundibular septum and, in two, into the roof of the defect. In one patient the mitral valve inserted into the defect floor. Tricuspid tension apparatus inserted into the floor of the defect in a further nine patients, but this does not compromise surgery. Thus in double outlet right ventricle cross sectional echocardiography can provide unique information necessary for planning of rational surgical management. Double outlet right ventricle is a condition in which eral descriptions of the cross sectional echocardioboth great arteries are connected completely or pre-graphic findings have been reported.'-8 dominantly to the right ventricle. There is almost Of key surgical importance in double outlet right always an associated ventricular septal defect through ventricle is the relation of the interventricular comwhich blood can escape from the left ventricle. Sevmunication to the great arteries.9-"1 Cross sectional echocardiography has been shown accurately to predict this relation, 67 but there has been little or no Requests for reprints to Professor FJ Macartney, The Hospital for attempt to demonstrate anatomically why this should Sick Children, Great Ormond Street, London WC1N 3JH. be so. Furthermore, the key question of the relation tCaliforia, between the atrioventricular valves (including their
Ultrasound in Obstetrics & Gynecology, Sep 7, 2021
The mitral-aortic intervalvular fibrosa (MAIVF) is an avascular, fibrous structure that provides ... more The mitral-aortic intervalvular fibrosa (MAIVF) is an avascular, fibrous structure that provides continuity between the anterior leaflet of the mitral valve and the aortic valve. Pseudoaneurysms of this area are rare and more commonly have been described in adult patients following trauma, cardiac surgery, or endocarditis.1,2 Limited case studies describe the occurrence in children following cardiac surgery3, 9 or endocarditis,4,5 with few case reports describing the congenital nature of these pseudoaneurysms.4,6-9 Here, we describe 5 cases of congenital pseudoaneurysms in the MAIVF area identified prenatally, with an additional 6 cases diagnosed postnatally. This is an unusual finding of varying clinical significance that can be isolated or associated with complex congenital heart disease, but importantly, can be identified and monitored in the fetus. This article is protected by copyright. All rights reserved.
Pediatrics, 1977
A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care uni... more A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care unit. Many of the artifacts resemble arrhythmias, and unless they are recognized as artifacts they may lead to serious errors of diagnosis and therapy. Many of the artifacts are caused by patient movement such as seizures, tremulousness, or hiccups. Others may be introduced by the monitor itself or be caused by electrical equipment in the vicinity. A group of ECC tracings is presented to illustrate the various artifacts encountered. Features that distinguish the artifacts from the arrhythmias they mimic are described, as are suggestions for elimination of the artifacts.
Cardiology in the Young, 2020
In 1966, Rudolph and Hoffman joined the Paediatric Department at the University of California in ... more In 1966, Rudolph and Hoffman joined the Paediatric Department at the University of California in San Francisco (UCSF) and also were appointed as Senior Staff of the Cardiovascular Research Institute. Although their clinical interests in Paediatric Cardiology were similar, Rudolph's research interests centred on fetal and neonatal cardiovascular function, whereas Hoffman was primarily interested in physiology of the coronary circulation; separate research laboratories were established. After 32 years, he became an Emeritus Professor in 1994, but continued to actively participate in clinical care and particularly, teaching. He also continued to consult with and advise former Fellows and to contribute to the literature. During his achievement of his BSc Degree in Anatomy in 1945, Hoffman developed his first interests in research, directed to studies of spermatogenesis. He also began to appreciate the importance of statistics. While in Johannesburg, he assisted members of the faculty in Medicine in statistical analysis and expanded his expertise by association with John Kerrich, Chief of the Statistics Department at the University of the Witwatersrand. In 1964, he introduced a course in statistics for Fellows in the Cardiovascular Research Institute and taught this course for about 30 years. He was a member of the Biostatistics Group of UCSF, responsible for coordinating statistics practice and also served as a consultant in statistics for several medical journals. In 2015, he published the book "Biostatistics for Medical and Biomedical Practitioners", which reviews the basic aspects, the applications and the reliability of statistics. Early in his career in Paediatric Cardiology, Hoffman reported on the high incidence of spontaneous closure of ventricular septal defects, particularly in young children. This stimulated a continuing interest in the natural history of all congenital cardiovascular malformations. During the 50 years of practice in clinical paediatric cardiology, he has pursued this interest in natural history and has also assessed the effectiveness of various surgical procedures. He authored a book-The Natural and Unnatural History of Congenital Heart Disease, published in 2009. This presents an outstanding review of the natural history of the various congenital cardiovascular anomalies and how they respond to surgical procedures. He also discusses how variations in morphology and haemodynamics of the various lesions influence outcomes. .
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Papers by Norman Silverman