Publications

Cardiomyopathy (VVV) Study (Observational)

Cardiomyopathy (VVV) Publications

Editorial

  • Left Ventricular Dysfunction is Associated with Intraventricular Dyssynchrony by 3-Dimensional Echocardiography in Children. G. Baker, J Am Soc Enchocardiogr 2008; 21(3):230-233.
    “Dyssynchrony” means that parts of the heart do not squeeze at the same time. This causes less efficient ejection of blood and contributes to heart failure. There is little data on dyssynchrony in children. This small study looked at whether 3-dimensional echocardiography (heart ultrasound) can be used to identify dyssynchrony in healthy children and children with poor heart function. The results show that 3D echocardiography can be used to look at dyssynchrony in children, and that patients with poorer heart function have more dyssynchrony.

Collaborative Learning (Observational)

Collaborative Learning Publications

Primary

  • Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery. W. T. Mahle, Pediatr Crit Care Med; 2016 Oct;17(10):939-947.
    This study compared how well babies did after surgery, for Tetralogy of Fallot or coarctation of the aorta, at research sites where babies were removed from the ventilator early (called early extubation) versus at research sites where babies were not taken off the ventilators early. The clinical practice guideline used at the intervention sites significantly increased the rate of early extubation with no change in the rate of reintubation or postoperative ICU length of stay.

Design

Echo Z-Score (Observational)

Echo Z-Score Publications

Primary

Enalapril after Single Ventricle Fontan Surgery (Enalapril vs Placebo)

Enalapril after Single Ventricle Fontan Surgery Publications

Primary

Design

  • Rationale and Design of a Trial of Angiotensin-Converting Enzyme Inhibition in Infants With Single Ventricle. D. Hsu, Am Heart J 2009; 157:37-45.
    Angiotensin-converting enzyme (ACE) inhibitors are medicines that improve heart function in adults with heart failure. Infants with a particular type of congenital heart defect (known as single ventricle) have been shown to have abnormal heart function and poor growth. This study was designed to determine if giving ACE inhibitors to babies with single-ventricles would improve their growth, heart function and development. This article describes the design, the participants and the procedures of this trial.

Additional Publications

Fontan Study (Observational)

Fontan Publications

Primary

  • Contemporary Outcomes After the Fontan Procedure: A Pediatric Heart Network Multicenter Study. P. Anderson, J Am Coll Cardiol 2008; 52:85-98.
    The Fontan study was designed to study children born with a single ventricle or heart pumping chamber who underwent a type of surgery called the Fontan procedure Data was collected from 546 children between 6 and 18 years of age about their heart structure and function after surgery, ability to exercise, heart rhythm and certain lab tests. Questions were asked to assess physical, mental, and emotional well being. The study showed that most Fontan survivors had a normal sense of well being. Most had normal ability for the heart to squeeze, but the majority had decreased relaxation of the heart muscle. Ability to exercise was also decreased in most. Children with a single right ventricle (pumping chamber) had decreased function of the heart and its valves compared with children with a single left ventricle. If the Fontan procedure was done at an older age, heart valves did not work as well and children were less likely to have a normal heart rhythm.

Design

  • Design of a Large Cross-Sectional Study to Facilitate Future Clinical Trials in Children with the Fontan Palliation. L. Sleeper, Am Heart J 2006; 152:427-433.
    This article describes how the Fontan study was designed and implemented in the Pediatric Heart Network. The purpose of the study was to determine whether clinical measures of how well the heart is working (such as lab tests, exercise testing, and echocardiogram) compare with health status (quality of life) in patients who have had a Fontan procedure for congenital heart disease. The data will help researchers design future clinical trial. 

Additional Publications

Ancillary Studies
  • Sustained Effects of Cardiac Rehabilitation in Children with Serious Congenital Heart Disease. J. Rhodes, Pediatrics 2006; 118(3):e586-593.
    Previous studies have shown immediate benefits when children with congenital heart disease are enrolled in a cardiac rehabilitation (exercise) program. This study aimed to see if the benefits lasted after the exercise program ended. The results showed, compared with children who did not undergo cardiac rehabilitation after the Fontan procedure, children who did participate had significant improvements in exercise function, behavior, self-esteem and emotional state 6 months after their program ended.
  • Impact of Cardiac Rehabilitation on the Exercise Function of Children with Serious Congenital Heart Disease. J. Rhodes, Pediatrics 2005; 116(6):1339-1345.
    Children with congenital heart disease (CHD) often can’t exercise as well as their peers. Part of this may be due to their heart defect and part may be that they may not be very physically active. A 12-week cardiac rehabilitation program was designed to see if children could improve their ability to exercise safely. Sixteen patients completed the program. Improvements were found in 15 of 16 patients and no patient had any heart problems from the exercise.

Fontan Follow-Up Study 2 (Observational)

Fontan Follow-Up Study 3 (Observational)

Fontan Follow-Up Study 3

Primary

Fontan Udenafil Exercise Longitudinal Trial (Udenafil vs Placebo)

Fontan Udenafil Exercise Longitudinal Trial (Udenafil vs Placebo) Publications

Design

  • Design and rationale of the Fontan Udenafil Exercise Longitudinal (FUEL) trial. D.J. Goldberg, Am Heart J. 2018 Jul; 201:1-8.
    This manuscript describes the design of the Fontan Udenafil Exercise Longitudinal (FUEL) trial.  It is a trial comparing udenafil to placebo in children and adolescents with single ventricle heart disease who have undergone the Fontan operation. This study will examine changes in exercise capacity, heart performance, and vascular function. These outcomes are important in understanding whether udenafil may be a beneficial medication to maintain health for a longer period in this population. 

Kawasaki Disease Trial (Methylprednisolone vs Placebo)

Kawasaki Disease (KD) Trial Publications

Primary

  • Randomized Trial of Pulsed Corticosteroid Therapy for Primary Treatment of Kawasaki Disease. J. Newburger, N Engl J Med 2007; 356(7):663-675.
    Children with Kawasaki Disease (KD) are at risk for developing aneurysms (out-pouchings) and enlargement of the coronary arteries, the arteries which bring blood and oxygen to the heart muscle itself. Medications are used to reduce the risk of damage to the coronary arteries and to decrease inflammation. Yet, some children still develop aneurysms and coronary artery enlargement. This trial tested whether adding another type of medication (a corticosteroid) to the standard treatment of aspirin and immune globulin would decrease the amount of coronary artery dilation. The results did not support the use of a steroid in addition for the routine treatment of children with KD.
  • Treatment of Kawasaki Disease: Response to Letter to the Editor. J. Newburger, N Engl J Med 2007; 356(26):2748.

Additional Publications

Marfan Trial (Atenolol vs Losartan)

Marfan Trial Publications

Primary

  • Atenolol versus Losartan in Children and Young Adults with Marfan's Syndrome. R. Lacro, N Engl J Med 2014; 371:2061-2071.Among 608 children and young adults with Marfan's syndrome (ages 6 months to 26 years) who were randomly assigned to losartan or atenolol, we found no significant difference in the rate of aortic-root dilatation between the two treatment groups over a 3-year period. Aortic-root surgery, aortic dissection, death, and a composite of these events did not differ significantly between the two treatment groups.  

Design

  • Rationale and Design of a Randomized Clinical Trial of B-Blocker Therapy (Atenolol) Versus Angiotensin II Receptor Blocker Therapy (Losartan) in Individuals with Marfan Syndrome. R. Lacro, Am Heart J2007; 154:624-631.
    The leading cause of death in people with Marfan syndrome is dilation, tearing and rupture of the aorta, the large artery that delivers blood from the heart to the body. Recent studies in mice with Marfan syndrome showed that treatment with Losartan, a medication used to treat high blood pressure, prevented dilation and improved the structure of the wall of the aorta. This article describes the design of a trial to compare Losartan to the standard medication (Atenolol) for patients with Marfan syndrome. The goal of the trial is to follow over 600 children and young adults for 3 years to determine which drug does a better job slowing the rate of growth of the aorta.

Additional Publications

  • Predictors of Rapid Aortic Root Dilation and Referral for Aortic Surgery in Marfan Syndrome. A. Hoskoppal, Pediatr Cardiol 2018 Jun 11. doi: 10.1007/s00246-018-1916-6.This was a secondary analysis of the PHN randomized clinical trial of atenolol vs. losartan in patients with Marfan syndrome that attempted to identify factors that predict rapid aortic root dilation and referral for aortic surgery. We found some statistically significant but only weakly predictive associations between more rapid aortic root dilation and older age, non-white race, and one aortic measurement: higher sinotubular junction z-score. We found similarly statistically significant but only weakly predictive associations between referral for aortic root surgery and some aortic measurements (larger aortic root diameter, higher ascending aorta z-score, and higher ratio between the diameters of the sinotubular junction and ascending aorta). Future studies may clarify whether monitoring generalized proximal aortic dilation and effacement of the sinotubular junction will help to risk-stratify young patients with Marfan syndrome and inform medical and surgical management.
  • Influence of Aortic Stiffness on Aortic-Root Growth Rate and Outcome in Patients With the Marfan Syndrome. ES. Selamet Tierney, Am J Cardiol 2018 May 1;121(9):1094-1101.The PHN randomized trial of atenolol versus losartan in Marfan Syndrome showed no treatment differences in the rates of aortic-root growth or clinical outcomes. This analysis examined treatment effects on aortic stiffness and determined whether baseline aortic stiffness predicts aortic-root growth and clinical outcomes. There was no treatment effect on the rate of change for ascending-aorta stiffness index, aortic-root elastic modulus, or ascending-aorta elastic modulus. We found that atenolol therapy was associated with a fall in aortic-root stiffness index, while losartan therapy was not. Higher baseline aortic-root stiffness index and elastic modulus were associated with a smaller decrease in aortic root z-score and increased risk for clinical outcomes. These data suggest that non-invasive aortic stiffness measures may identify patients at higher risk for progressive aortic enlargement and adverse clinical outcomes, potentially allowing for closer monitoring and more aggressive therapy for such patients.
  • Characteristics of children and young adults with Marfan syndrome and aortic root dilation in a randomized trial comparing atenolol and losartan therapy. R. Lacro, Am Heart J 2013; 165:828-835.e3.This paper describes the population that was screened and then enrolled in the clinical trial.  The average age at study entry was 11.2 years, 60% were male, and 25% were older teenagers and young adults. Aortic root diameter z-score was 4.0 and wasn’t different by age. Mitral valve prolapse and mitral regurgitation were more common in females. 56% had a family member with aortic surgery and 32% had a family member with a history of aortic dissection.
  • Echocardiographic Methods, Quality Review, and Measurement Accuracy in a Randomized Multicenter Clinical Trial of Marfan Syndrome. E. Selamet Tierney, J Am Soc Echocardiogr 2013; 26(6):657-666.This study describes the characteristics of the echocardiograms for subjects enrolled in the clinical trial.  Even when different doctors reviewed and measured the aortas and heart structures of the trial participants, there was excellent agreement in the measurements.  Having good agreement is important for accurately reporting the results of the clinical trial.  

Mitral Regurgitation Study (Observational)

Mitral Regurgitation Publications

Primary

  • Partial and Transitional Atrioventricular Septal Defect Outcomes. L. Minich, Ann Thorac Surg 2010; 89:530-536.
    There have been many improvements in the surgery and care of children with atrioventricular septal defects (AVSD. This article describes the outcomes at 1 and 6 months after repair for children with two particular types of AVSD: partial and transitional AVSDs. Children had short hospital stays and few adverse events around the time of surgery. Also, children who were growing poorly before surgery showed good catch-up growth if the surgery was performed between 3 and 18 months of age. Some children have leaking of the left-sided atrioventricular valve after surgery, particularly if surgery is performed after age four.

Additional Publications

  • Challenges in echocardiographic assessment of mitral regurgitation in children after repair of Atrioventricular Septal Defect. A. Prakash, Pediatr Cardiol 2012; 33:205-214.
    It is difficult to quantify the amount of regurgitation from the mitral valve using echocardiography.  Since children who have an atrioventricular septal defect repaired continue to have varying amounts of mitral regurgitation,  the accuracy of proposed echocardiographic methods was proposed to evaluate the severity of the regurgitation.  No method performed well. No method proved to be better than the echocardiographer’s subjective assessment of the size of the color Doppler jet and surrounding structures. Reliable assessment of mitral regurgitation remains challenging in this population.
  • Surgical interventions for Atrioventricular Septal defect subtypes: The Pediatric Heart Network experience. A. Kaza, Ann Thorac Surg 2011;92:1468-75.
    Atrioventricular septal defects (AVSD) include abnormalities involving the walls between the heart chambers (atrial and ventricular septa) and the heart valves. The investigators compared patient characteristics, resource utilization, center differences, and outcomes among different types of AVSD.  Survival in the current era is excellent, with few residual defects after surgical repair for all AVSD subtypes.  Repair of the valves failed to decrease moderate or severe valve regurgitation at the 6-month follow-up.  Being older when the heart is repaired increases the risk of moderate or severe valve regurgitation.
  • Surgical management of complete atrioventricular septal defect: Associations with surgical technique, age and Trisomy 21. A. Atz, J Thorac Cardiovasc Surg 2011; 141:1371-9.
    This study evaluated contemporary results after repair of a complete atrioventricular septal defect (AVSD) and to determine factors associated with poorer outcomes. Particular attention was paid to type of surgical repair, age at surgery, and presence of Trisomy 21.  The type of surgical repair and having Trisomy 21 did not increase the risk of death or serious medical problems.  Mortality and morbidity were low. Age at repair ≤2.5 months and need for concurrent surgical procedures were not associated with residual defects or degree of heart valve regurgitation, but were associated with higher resource utilization.
  • Lessons learned from a pediatric clinical trial: The Pediatric Heart Network Angiotensin Converting Enzyme Inhibition in Mitral Regurgitation Study. J. Li, Am Heart J 2011; 161:233-40.
    The Pediatric Heart Network designed a placebo-controlled randomized trial to test the effect of enalapril on the amount of left heart valve regurgitation after atrioventricular septal defect (AVSD) repair. Prior to the launch of the trial, a feasibility study was performed to estimate the number of patients with at least moderate mitral regurgitation following AVSD repair. The study was subsequently terminated due to low patient accrual. Several factors led to the problems with enrolling patients: 1) the feasibility study used chart review to assess for valve regurgitation but the trial used echocardiography measurements; 2) clinicians and referring physicians were already believing that enalapril was a good drug to give and many patients eligible for the study were already taking the drug; 3) the echocardiography methods used were developed in adult populations and not children; 4) there are no good data to define the natural history of the disease process. 

Normal Electrocardiogram (ECG) Project (Observational)

Normal Electrocardiogram (ECG) Project

Primary

  • Electrocardiograms in Healthy North American Children in the Digital Age. E.V. Saarel, Circ Arrhythm Electrophysiol 2018 Jul;11(7):e005808.
    Electrocardiography is a cornerstone in the cardiac evaluation of children. Wide variation in previously published data, much of which was obtained before the digital era, provided a strong motivation to obtain more reliable data on electrocardiogram (ECG) measurements in healthy children from North America. This study found that most ECG measurements varied by sex and race and differed from prior studies done in smaller, more racially and ethnically homogeneous populations. This study provides valuable data that can be used clinically for interpreting pediatric ECGs in the modern era for diagnosis or screening of heart disease in North America, particularly for Long QT syndrome and left ventricular hypertrophy.

PHN Scholars

PHN Scholars Publications

  • The Pediatric Heart Network Scholar Award programme: a unique mentored award embedded within a multicentre network. L.L. Minich, Cardiol Young 2018 Jun;28(6):854-861.
    The Pediatric Heart Network designed a career development award to train the next generation of clinician-scientists in pediatric cardiology-related research, a historically underfunded area. This manuscript described strengths and weaknesses of the program and the scholars’ academic achievements for the first two funding cycles. Strengths included clarity and fairness of the review, but feedback on the application was not considered useful. The highest rated benefits were expanding the scholar’s collaborative network and increasing publication potential. The 13 scholars were first/senior authors for 97 abstracts and 109 manuscripts, served on 22 PHN committees, and were awarded $9,673,660 in subsequent extramural funding for a return of ~$10 for every Scholar dollar spent.

Residual Lesion Score (Observational)

Residual Lesion Score (RLS) Publications

Design

  • Completeness and Accuracy of Local Clinical Registry Data for Children Undergoing Heart Surgery. M. Nathan, Ann Thorac Surg 2016 Oct 7. pii: S0003-4975(16)30916-X.
    The purpose of this study was to assess the accuracy of heart surgery data obtained from a registry compared with data copied from babies’ medical charts by research coordinators.  Most PHN sites participate in a registry called “the Society of Thoracic Surgeons- Congenital Heart Surgery Database” in which each site collects data around the time of surgeries.   For a select set of variables (like blood pressure, length of hospital stay etc), we found that 94.7% of data elements were both complete and accurate within the registry, suggesting that registry data can be an efficient source for research studies.

Single Ventricle Reconstruction Surgery Trial (RV-PA shunt vs MBT shunt)

Single Ventricle Reconstruction Surgery Trial Publications

Primary

  • Comparison of Shunt Types in the Norwood Procedure for Single-Ventricle Lesions. R. Ohye, N Engl J Med 2010; 362(21):1980-1992.
    In children with a single heart ventricle undergoing the Norwood procedure, a trial was conducted to determine if one of two different shunts resulted in better survival after 12 months without the need for a heart transplant. Babies were randomly assigned to receive either the traditional modified Blalock-Taussig shunt (MBTS) or the right ventricle- pulmonary artery (RV-PA) conduit. The study showed that babies who received the RV-PA conduit had better survival without needing a heart transplant 12 months after entering the study. However, when the babies were followed for a longer period of time, there was no difference between the two groups. The results also revealed that babies who received the RV-PA conduit needed more procedures and had more complications than those receiving the MBTS. 

Design

  • Design and Rationale of a Randomized Trial Comparing the Blalock-Taussig and Right Ventricle-Pulmonary Artery Shunts in the Norwood Procedure. R. Ohye, J Thorac Cardiovasc Surg 2008; 136:968-975.
    The first of the three surgeries (the Norwood procedure) for babies born with a single heart ventricle is one of the highest risk procedures in congenital heart surgery. Two types of shunts (tubes) may be used for the first surgery: the traditional modified Blalock-Taussig shunt (MBTS) and the right ventricle to pulmonary artery (RV-PA) shunt. Some research has shown one technique to be better than the other, but other research has shown no differences in the outcomes for each technique. This article describes a trial designed by the Pediatric Heart Network to compare the two types of shunts. In the study, babies were randomly assigned to receive either the MBTS or the RV-PA shunt, and they were followed over time to compare the outcomes.

Additional Publications

Single Ventricle Reconstruction Follow-Up Study (Observational)

Single Ventricle Reconstruction Follow-Up Study

1-3 years post-Norwood outcomes

  • Transplantation-free survival and interventions at 3 years in the single ventricle reconstruction trial. J. Newburger, Circulation 2014; 129:2013-2020.
    In the Single Ventricle Reconstruction (SVR) trial, 1-year transplant-free survival was better for the Norwood procedure with right ventricle-to-pulmonary artery shunt (RVPAS) compared with a modified Blalock-Taussig shunt (MBTS).  At 3 years, we compared transplantation-free survival, echocardiographic right ventricular ejection fraction, and unplanned interventions in the treatment groups.  By 3 years, the Norwood procedure with RVPAS compared with MBTS was no longer associated with better transplant-free survival. Moreover, RVPAS subjects had slightly worse right ventricular ejection fraction and underwent more catheter interventions.
  • Factors associated with neurodevelopment for children with single ventricle lesions. C. Goldberg, J Pediatr 2014; 165(3): 490-496.
    This study measured neurodevelopment at 3 years of age and compared it to neurodevelopment at 14 months of age in children enrolled in the Single Ventricle Reconstruction trial.  Scores on tests to evaluate neurodevelopment were lower at 3 years of age when compared to a normal population. The results suggest that even when 14-month scores are within the normal range, children with single ventricle heart defects may be at risk for developmental impairment at pre-school age and beyond.  Therefore, all children with HLHS and related single ventricle malformations should be followed longitudinally to improve recognition of delays and potential for intervention.  
  • Longitudinal assessment of growth in hypoplastic left heart syndrome: results from the single ventricle reconstruction trial. P. Burch, J Am Heart Assoc 2014; 3(3):e000079.
    Poor growth is associated with poor prognosis in several disease processes. While children with single ventricle heart disease are known to be smaller than their peers at birth, there is limited information regarding growth and development in survivors. In this paper we show that single ventricle survivors continue to grow poorly with regards to both height and weight through the first two surgical palliations and at three years of age. 
  • Impact of Initial Shunt Type on Cardiac Size and Function in Children with Single Right Ventricle Anomalies prior to the Fontan Procedure—The Single Ventricle Reconstruction Extension Trial. P. Frommelt, J Am Coll Cardiol 2014; 64(19):2026-35.
    The initial shunt type at the Norwood procedure used to supply blood flow to the lungs in infants with single right ventricle anomalies may influence heart muscle function during the second and third years of life.  This study tested heart muscle function in children in the SVR trial, comparing those who had a right ventricle-to-pulmonary artery shunt versus the modified Blalock-Taussig shunt. While there were no differences between the groups, a markedly enlarged heart, poor heart muscle function, and significant heart valve enlargement/dysfunction at 14 months of age was associated with poorer survival to the Fontan operation.
  • Factors affecting Fontan length of stay: Results from the Single Ventricle Reconstruction trial. C. Ravishankar, J Thorac Cardiovasc Surg. 2016; 151(3):669-675.
    In the Single Ventricle Reconstruction trial, infants with hypoplastic left heart syndrome (HLHS) who received a right-ventricle-to-pulmonary-artery shunt (RVPAS) versus a modified Blalock-Taussig shunt (MBTS) had lower early postoperative mortality, but more complications at 14 months. This study explored the effect of shunt type and other patient, medical, and surgical factors on postoperative length of stay (LOS) after the Fontan operation.  The type of shunt received at the Norwood surgery did not affect how long a baby stayed in the hospital for the Fontan surgery. Rather, more medical complications before the operation resulted in longer LOS after the Fontan operation.

3 year post-Norwood outcomes

  • Assessment of Growth Six Years after the Norwood Procedure: Results from the Single Ventricle Reconstruction Trial. P. Burch, J. Pediatr. 2017; 180:270-274.e6.
    There is limited information regarding the long-term growth and development in survivors with single ventricle heart disease. This paper assesses growth in these patients after their final palliative surgery until they are school age. These children continue to grow poorly with regards to both height and weight with height being affected to a greater extent than weight.
  • Heart failure after the Norwood procedure: An analysis of the Single Ventricle Reconstruction Trial. W.T. Mahle, J Heart Lung Transplant. 2018 Jul;37(7):879-885.
    Heart failure is a known complication following the Norwood procedure for single ventricle anomalies. Examination of the Single Ventricle Reconstruction (SVR) trial cohort revealed that almost 15% of participants developed heart failure following discharge from the Norwood procedure. Shunt type had no association with heart failure. The risk for developing heart failure was highest in the first year of life. Over half of the children who developed heart failure were listed for transplant, though a significant number died while awaiting a transplant. Among transplant-free survivors to 6 years of age, fewer than 5% of children with palliated single ventricle congenital heart disease had class IV symptomatic heart failure. Several procedure and patient-related factors were associated with development of heart failure, including impaired right ventricular function after the Norwood procedure.
  • Utilisation of early intervention services in young children with hypoplastic left heart syndrome. K. Mussatto, Cardiol Young. 2018; 28(1):126-133.
    Children with hypoplastic left heart syndrome are at a risk for neurodevelopmental delays.  This study looked at the types of early intervention services (e.g. speech, occupational, physical therapy) and how frequently services were used from age 1 to 4 years in children who participated in the SVR trial.   Significant delay was reported by parents in 18-43% of children at ages 3 and 4.  More than half of the children (52-69%) were not receiving services at any age and 20-32% were receiving two or more therapies each year. Despite significant neurodevelopmental delays, early intervention service utilization was low in this group of children.  
  • Transplant-Free Survival and Interventions at 6 Years in the Single Ventricle Reconstruction Trial. J.W. Newburger, Circulation. 2018 May; 137(21):2246-2253.
    We examined transplant-free survival and other outcomes at 6 years after the Norwood procedure with a right ventricle-to-pulmonary artery shunt (RVPAS) compared to a modified Blalock‒Taussig shunt (MBTS) in children enrolled in the PHN’s Single Ventricle Reconstruction (SVR) trial. The RVPAS group had similar survival without needing a heart transplant at 6 years but required more catheter interventions before the Fontan procedure. After the Fontan procedure, the two shunt groups had similar rates of transplant-free survival and of catheter interventions, as well as similar right heart function, cardiac symptoms, and complications. However, children in both groups had a steady increase in complications over time; by 6 years, 20% had suffered a blood clot, 15% a seizure, and 7.5% a stroke. These data emphasize the importance of close follow-up and the need to find new strategies to improve the long-term outlook for children with single ventricle anomalies.

TEAM 4 Growth Passive Range of Motion Study

TEAM 4 Growth Passive Range of Motion Study Publications

Primary

Udenafil Dosing Study

Udenafil Dosing Study Publications

Primary

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