Michael Seckeler

Interests

Research

Interventional cardiac catheterization for children and adults with congenital heart disease, optimizing outcomes for single ventricle patients, outcomes in congenital heart disease, 3D models for congenital heart disease education, device development for interventional congenital cardiac catheterization, role of lymphatics in congenital heart disease, lymphatic imaging and interventions

Teaching

Congenital heart disease, interventional congenital cardiology

Courses

Scholarly Contributions

Chapters

• Seckeler, M. D., Guerrero, C. E., & Hoyer, A. (2023). 3D Printing in Congenital Heart Disease. In Magnetic Resonance Imaging of Congenital Heart Disease.

Journals/Publications

• Averin, K., Seckeler, M. D., Bauser-Heaton, H., Schwartz, M. C., Tannous, P., Seaman, C., Whiteside, W., Nicholson, G. T., Patel, P. M., Gordon, B. M., Romans, R. A., Devanagondi, R., Herbert, C. E., Batlivala, S. P., Boe, B., Hiremath, G., & Zampi, J. D. (2025). Hybrid Versus Percutaneous Left Atrial Decompression in Infants With Hypoplastic Left Heart Variants and an Intact or Highly Restrictive Atrial Septum: A Multicenter PICES Study. Circulation: Cardiovascular Interventions, 18(Issue 3). doi:10.1161/circinterventions.124.014243
  More info

  BACKGROUND: Neonates with hypoplastic left heart syndrome variants with an intact or highly restrictive atrial septum (HLH-IAS) require immediate postnatal intervention to survive. Emergent left atrial decompression (LAD) via a percutaneous or hybrid approach is standard, but the comparative effectiveness and outcomes of these approaches remain underexplored. METHODS: A multicenter retrospective analysis of all neonates with HLH-IAS who underwent LAD in the first 36 hours of life from January 2009 to March 2020 at 14 North American congenital cardiac programs was conducted. Patient and procedural characteristics and patient outcomes were compared between hybrid and percutaneous LAD. RESULTS: Among 128 patients with HLH-IAS, 105 (80%) underwent percutaneous LAD and 23 (17%) hybrid LAD. No significant differences were observed in preprocedural characteristics such as birth weight (3.1±0.6 versus 3.2±0.6 kg; P=0.453), presence of a baseline interatrial communication (66% versus 61%; P=0.659), interatrial communication gradient (14.4±6.9 versus 12.7±4.6 mm Hg; P=0.456), or lowest pH (7.13±0.14 versus 7.09±0.15; P=0.193). Hybrid LAD resulted in a shorter time from birth to procedure (120 versus 52 minutes; P=0.005) and to atrial septal defect creation (55 versus 29 minutes; P=0.002). All hybrid LAD were technically successful, although 11 (10%) percutaneous LAD were unsuccessful with 7 requiring conversion to surgical septectomy. There was a trend toward fewer serious adverse events with hybrid LAD (36% versus 17%; P=0.141). Most patients (67%) who underwent hybrid LAD had simultaneous pulmonary artery band placement and 21% of patients with percutaneous LAD required reoperation for pulmonary artery band. Long-term survival rates were comparably low between groups, with a 30% transplant-free survival at a median 8-month follow-up. CONCLUSIONS: In patients with HLH-IAS, hybrid LAD allows for faster atrial septal defect creation, has a higher technical success rate, and potentially fewer procedural serious adverse events compared with percutaneous LAD, alongside facilitating simultaneous pulmonary artery band. Our findings underscore the poor prognosis for patients with HLH-IAS despite intervention, highlighting the need for better treatment strategies.
• Batatinha, H., Niemiro, G. M., Peña, N. A., Hoskin, G. A., Zúñiga, T. M., Smith, K. A., Baker, F. L., Diak, D. M., Mylabathula, P. L., Kistner, T. M., Seckeler, M. D., Katsanis, E., & Simpson, R. J. (2025). Isoproterenol infusion enhances composition and function of G-CSF mobilized allogeneic peripheral blood hematopoietic cell grafts. Stem Cell Research and Therapy, 16(Issue 1). doi:10.1186/s13287-025-04725-4
  More info

  Background: Graft-versus-host disease (GvHD) and relapse remain critical challenges in allogeneic hematopoietic cell transplantation (alloHCT). Graft composition is pivotal, with naïve T cells increasing GvHD risk and NK cells improving graft-versus-leukemia (GvL) effects. Acute beta-adrenergic receptor activation mobilizes effector lymphocytes, favorably altering circulating immune cell composition. This study investigated whether infusing the non-selective beta-agonist isoproterenol (ISO) after granulocyte colony-stimulating factor (G-CSF) mobilization enhances peripheral blood hematopoietic cell (PBHC) graft composition and outcomes. Methods: Ten healthy volunteers received a 20-minute ISO infusion before and after five days of G-CSF hematopoietic cell mobilization. G-CSF and G-CSF + ISO mobilized PBHCs were phenotyped and assessed for in vitro cytotoxicity. NSG leukemia-bearing mice were injected with G-CSF or G-CSF + ISO mobilized PBHCs and monitored for GvHD, tumor burden, and overall survival. Results: After G-CSF mobilization, ISO increased the numbers of CD34 + cells in the blood and favorably altered graft composition, increasing NK (9.5% to 27.9%) and TCR-γδ T cells (5.0% to 7.5%) while reducing naïve CD4 (18.1% to 11.2%) and CD8 (8.9% to 5.8%) T cells. Effector lymphocytes mobilized by G-CSF + ISO, particularly effector-memory CD8 + T-cells and NK-cells, exhibited upregulated genes and enriched gene sets linked to anti-tumor activity (e.g. NKG7, GZMB, NK cells cytotoxicity). This resulted in an 8-fold increase in cytolysis against the K562 leukemia cell line compared to PBHC mobilized by G-CSF only. In xenogeneic mice, G-CSF + ISO grafts reduced GvHD, extended survival, and improved GvL effects, with 42% of mice surviving at day 40 compared to 21% for G-CSF grafts. Conclusions: ISO infusion post-G-CSF mobilization favorably enhances graft composition, mitigates GvHD, prolongs survival, and augments GvL effects. Our findings suggest that acute systemic beta-adrenergic receptor activation could be a valuable strategy to enhance outcomes in alloHCT.
• Batatinha, H., Niemiro, G. M., Peña, N. A., Hoskin, G. A., Zúñiga, T. M., Smith, K. A., Baker, F. L., Diak, D. M., Mylabathula, P. L., Kistner, T. M., Seckeler, M. D., Katsanis, E., & Simpson, R. J. (2025). Isoproterenol infusion enhances composition and function of G-CSF mobilized allogeneic peripheral blood hematopoietic cell grafts. Stem cell research & therapy, 16(1), 614.
  More info

  Graft-versus-host disease (GvHD) and relapse remain critical challenges in allogeneic hematopoietic cell transplantation (alloHCT). Graft composition is pivotal, with naïve T cells increasing GvHD risk and NK cells improving graft-versus-leukemia (GvL) effects. Acute beta-adrenergic receptor activation mobilizes effector lymphocytes, favorably altering circulating immune cell composition. This study investigated whether infusing the non-selective beta-agonist isoproterenol (ISO) after granulocyte colony-stimulating factor (G-CSF) mobilization enhances peripheral blood hematopoietic cell (PBHC) graft composition and outcomes.
• Bolouvi, E. H., Seckeler, M. D., Price, A., Morgan, W., Lightwine, B., & Liechty, K. W. (2025). Management of severe left main bronchomalacia in an infant with a balloon expandable bare metal coronary stent: a case report. Journal of Pediatric Surgery Case Reports, 120. doi:10.1016/j.epsc.2025.103042
  More info

  Introduction: Managing bronchomalacia in infants represents a significant challenge. Surgical strategies such as aortopexy and tracheopexy have variable outcomes in distal airway disease. Stent placement is typically reserved as a last resort in selected cases. Case presentation: A 4-month-old ex-34-weeker infant status-post neonatal repair of a large omphalocele was re-intubated six weeks post-operatively for severe respiratory distress. Despite escalating positive-end expiratory pressure, bronchodilators, and airway clearance, the respiratory function continued to decline. Bronchoscopy showed severe left main bronchomalacia and bronchial stenosis, confirmed by chest computerized tomography (CT). There was near complete occlusion of the left main bronchus, but with patent distal airway. A 4.5 mm × 15 mm bare metal coronary stent (Resolute Onyx Frontier) was placed in the left main bronchus under fluoroscopic and bronchoscopic guidance. This led to an immediate improvement in lung mechanics, with subsequent extubation. The stent was electively removed after 11 weeks. However, re-occlusion occurred within 24 hours due to airway compression, which was managed with the placement of a second stent (5 mm × 15 mm). The symptoms resolved completely, and the patient was discharged home at the age of 10 months. He was subsequently managed at a different hospital. At the age of 14 months the stent was removed. Shortly after the removal, he had a recurrence of the left lung collapse and a respiratory infection requiring extracorporeal membrane oxygenation (ECMO). An 8 mm × 20 mm stent was then placed to recruit the left lung and allow ECMO decannulation. He remains with the stent in place. Conclusion: Bare metal coronary stents appear to be an effective temporizing management option for infants with severe bronchomalacia who fail standard non-operative measures, allowing time for the airway to become more rigid.
• Galindo, M. K., Klewer, S. E., Downing, K. F., Takamatsu, C. L., Seckeler, M. D., Oster, M. E., Collins, R. T., Nembhard, W. N., Bolin, E. H., & Farr, S. L. (2025). Reproductive Health Counseling and Outcomes Among Women With Congenital Heart Defects: Results From the Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being, 2016–2019. Women's Health Issues, 35(Issue 2). doi:10.1016/j.whi.2025.01.005
  More info

  Background: Guidelines recommend tailored reproductive health counseling for women with congenital heart defects (CHDs) beginning in adolescence, yet provider adherence to recommendations remains understudied, particularly outside specialized cardiac care settings. Study Design: We conducted a cross-sectional cohort study among women aged 19 to 38 with CHDs, identified from active population-based birth defects registries in three states. Participants completed surveys from 2016 to 2019, including questions about contraception, pregnancy counseling, concerns, and experiences. Multivariable Poisson regression, adjusted for sociodemographic and health characteristics, assessed associations between CHD severity, counseling, and reproductive health outcomes. Results: Of 765 women, those with severe CHDs, compared with non-severe, were more likely to report receiving clinician counseling about safe contraceptive methods (44.0% and 13.7%; adjusted prevalence ratio [aPR] = 3.0; 95% confidence interval [95% CI] [2.2, 4.0]), pregnancy, (63.3% and 16.5%; aPR = 3.6; 95% CI [2.7, 4.6]), and pregnancy avoidance (32.0% and 6.4%; aPR = 4.3; 95% CI [2.9, 6.6]); be concerned about ability to have children (40.9% and 31.2%; aPR = 1.4; 95% CI [1.1, 1.8]), and delay/avoid pregnancy (26.6% and 10.7%; aPR = 2.2; 95% CI [1.5, 3.2]). No disparity was found in ever being pregnant (30.0% vs. 37.2%; aPR = 1.0; 95% CI [0.7, 1.2]). One-third of the respondents with any CHD reported concerns about their ability to have children (33.6%). Conclusion: We found that only a minority of women with CHDs reported receiving counseling on safe contraception and pregnancy, and about a third reported concerns about their ability to have children. These findings highlight a gap between guideline recommendations and clinical practice, underscoring the need for improved reproductive health discussions for women with CHDs.
• Hendrickson, A. M., Caryl, N. E., Meziab, O., Andrews, J. G., Barber, B. J., & Seckeler, M. D. (2025). Association Between G6PD Deficiency and Congenital Heart Disease Incidence and Hospital Outcomes. Pediatric Cardiology. doi:10.1007/s00246-025-04071-5
  More info

  G6PD deficiency classically presents with hemolytic anemia, but associations have been described with atherogenesis and coronary artery disease secondary to increased oxidative stress. There are limited data that also suggest a link between G6PD deficiency and the development of congenital heart disease (CHD), possibly through the same mechanism. We hypothesize a higher incidence of CHD among individuals with G6PD deficiency as well as worse hospital outcomes for those with CHD and G6PD deficiency. We performed a retrospective review of a national administrative database from 10/2019 to 3/2024 for admissions of individuals aged 0-25 years with ICD-10 codes for moderate-to-severe CHD with and without G6PD deficiency (D55.0, D75.A). Additional data included demographics, hospital outcomes, and costs. Hospital outcomes were compared. There were 213,708 admissions with CHD and
• Methuku, V., Kowalek, K. A., Price, N. B., Bliss, A., Fox, K. A., & Seckeler, M. D. (2025). Lightning Can Strike Twice: Management of an Infant With Anomalous Left Coronary Artery from the Pulmonary Artery Complicated by Coccidioidomycosis Infection. World Journal for Pediatric and Congenital Heart Surgery, 16(Issue 3). doi:10.1177/21501351241306044
  More info

  Cardiac disease in young children can be unrecognized until symptoms are unmasked by a precipitating event, such as an infection. We present a case of anomalous left coronary artery from the pulmonary artery causing clinically significant disease in a four-month-old male with concomitant mitral regurgitation and pulmonary coccidioidomycosis who required modification of his surgical management due to the infection. This case highlights how timely diagnosis and perioperative management and recovery can be affected by concurrent infections in patients with congenital heart disease.
• Meziab, O., Dereszkiewicz, E., Guerrero, C. E., Hoyer, A. W., Barber, B. J., Klewer, S. E., & Seckeler, M. D. (2025). Adverse Effect of Bundle Branch Block on Exercise Performance in Patients with Fontan Physiology: From the Pediatric Heart Network Fontan Public Data Set. Pediatric Cardiology, 46(Issue 4). doi:10.1007/s00246-024-03500-1
  More info

  Patients with Fontan physiology have reduced exercise performance compared to their peers as well as a higher incidence of bundle branch block (BBB). This study aims to investigate the association between BBB and exercise performance in the Fontan population through a retrospective review of the Pediatric Heart Network Fontan study public use dataset. “Low Performers” were defined as ≤ 25th percentile (for Fontan patients) for each exercise parameter at anaerobic threshold (AT) for gender and age and “Normal Performers” were all other patients. A total of 303 patients with Fontan physiology who underwent exercise testing reached AT and had complete data for BBB. BBB occurred more frequently in Low Performers for VO2 [OR (95% CI): 2.6 (1.4, 4.8)] and Work [OR (95% CI): 2.7 (1.4, 5.1)], suggesting that BBB in the Fontan population is associated with reduced exercise performance. This data adds to the existing clinical evidence of the adverse effects of conduction abnormalities on single ventricle cardiac output and adds support for consideration of cardiac resynchronization and multi-site ventricular pacing in this patient population.
• Seckeler, M. D., Andrews, J. G., & Klewer, S. E. (2025). Fontan Circulation in Complex Congenital Heart Disease: Do Early Benefits Outweigh Later Problems?. Circulation. Heart failure, e013765.
• Smith, K. A., Batatinha, H., Niemiro, G. M., Baker, F. L., Zúñiga, T. M., Diak, D. M., Mylabathula, P. L., Kistner, T. M., Davini, D., Hoffman, E., Colombo, J. N., Seckeler, M. D., Bond, R. A., Katsanis, E., & Simpson, R. J. (2025). Exercise-induced β-adrenergic receptor activation enhances effector lymphocyte mobilization in humans and suppresses lymphoma growth in mice through NK-cells. Brain, behavior, and immunity, 128, 751-765.
  More info

  Signaling through the β-adrenergic receptor (β2-AR) mobilizes immune cells during exercise and is implicated in tumor lymphocyte infiltration. We investigated mechanisms governing immune cell mobilization in humans and the role of adrenergic signaling in anti-cancer responses to a murine lymphoma. Human studies included double-blind, placebo-controlled, crossover trials with beta blocker drugs and a phosphodiesterase inhibitor during steady-state and graded exercise, and a synthetic β agonist (isoproterenol) infusion model. β + β-AR blockade reduced lymphocyte and NK-cell mobilization during steady-state exercise, while β-AR blockade enhanced the mobilization of NK-cells. Combining a β-AR antagonist with a phosphodiesterase-4 (PDE4) inhibitor during graded exercise further increased mobilization of CD8 + T-cells, γδ T-cells, and monocytes. Isoproterenol infusion also elevated lymphocyte and NK-cell levels similarly to exercise at 70 % VO. Single cell RNA sequencing revealed complex signaling downstream of cAMP that relate to lymphocyte activation and effector function. In murine models of voluntary wheel running, β-AR signaling and NK-cells were critical for exercise-induced protection against B-cell lymphoma, as β-AR blockade or NK-cell depletion abrogated these effects. These findings highlight the pivotal role of β-AR signaling in mobilizing cytotoxic immune cells and protecting against tumor progression through exercise, suggesting potential therapeutic strategies combining exercise with adrenergic modulation to enhance immune responses.
• Smith, K. A., Batatinha, H., Niemiro, G. M., Baker, F. L., Zúñiga, T. M., Diak, D. M., Mylabathula, P. L., Kistner, T. M., Davini, D., Hoffman, E., Colombo, J. N., Seckeler, M. D., Bond, R. A., Katsanis, E., & Simpson, R. J. (2025). Exercise-induced β2-adrenergic receptor activation enhances effector lymphocyte mobilization in humans and suppresses lymphoma growth in mice through NK-cells. Brain, Behavior, and Immunity, 128. doi:10.1016/j.bbi.2025.04.040
  More info

  Signaling through the β2-adrenergic receptor (β2-AR) mobilizes immune cells during exercise and is implicated in tumor lymphocyte infiltration. We investigated mechanisms governing immune cell mobilization in humans and the role of adrenergic signaling in anti-cancer responses to a murine lymphoma. Human studies included double-blind, placebo-controlled, crossover trials with beta blocker drugs and a phosphodiesterase inhibitor during steady-state and graded exercise, and a synthetic β agonist (isoproterenol) infusion model. β1 + β2-AR blockade reduced lymphocyte and NK-cell mobilization during steady-state exercise, while β1-AR blockade enhanced the mobilization of NK-cells. Combining a β1-AR antagonist with a phosphodiesterase-4 (PDE4) inhibitor during graded exercise further increased mobilization of CD8 + T-cells, γδ T-cells, and monocytes. Isoproterenol infusion also elevated lymphocyte and NK-cell levels similarly to exercise at 70 % VO2max. Single cell RNA sequencing revealed complex signaling downstream of cAMP that relate to lymphocyte activation and effector function. In murine models of voluntary wheel running, β2-AR signaling and NK-cells were critical for exercise-induced protection against B-cell lymphoma, as β2-AR blockade or NK-cell depletion abrogated these effects. These findings highlight the pivotal role of β2-AR signaling in mobilizing cytotoxic immune cells and protecting against tumor progression through exercise, suggesting potential therapeutic strategies combining exercise with adrenergic modulation to enhance immune responses.
• Webber, Z. R., Seckeler, M. D., & Largent-Milnes, T. M. (2025). Neonatal Opioid Withdrawal in History: Revisiting Pioneering Research. Neonatal Network, 44(Issue 4). doi:10.1891/nn-2024-0058
  More info

  In this perspective letter, we highlight the importance of revisiting early literature in the neonatal opioid withdrawal syndrome field. We summarize key examples of how early articles still are relevant to current research.
• Webber, Z., Grisham, L. M., Meziab, O. Z., Hoyer, A. W., Barber, B. J., Price, A. M., Klewer, S. E., Largent-Milnes, T. M., & Seckeler, M. D. (2025). Higher Incidence of Moderate and Severe Congenital Heart Disease in Patients With Neonatal Abstinence Syndrome. Neonatal Network, 44(Issue 4). doi:10.1891/nn-2024-0036
  More info

  Studies suggest that in utero opioid exposure may be associated with congenital heart disease (CHD). We sought to assess the incidence of CHD in infants with neonatal abstinence syndrome (NAS). A review of a national, administrative database from January 2019 to December 2022 was conducted for neonates with an ICD-10 code for NAS and moderate or severe CHD. The incidence of CHD in NAS (the main outcome variable) was compared to those without NAS using χ2 analysis and odds ratios for CHD with significant differences. There were 4,994,919 neonatal admissions during the study period: 26,284 with NAS (2.3% had CHD) and 4,968,715 without NAS (1.1% had CHD) (p
• Baker, F. L., Smith, K. A., Mylabathula, P. L., Zúñiga, T. M., Diak, D. M., Batatinha, H., Niemiro, G. M., Seckeler, M. D., Pedlar, C. R., O'Connor, D. P., Colombo, J., Katsanis, E., & Simpson, R. J. (2024). Exercise-induced β2-adrenergic Receptor Activation Enhances the Antileukemic Activity of Expanded γδ T-Cells via DNAM-1 Upregulation and PVR/Nectin-2 Recognition. Cancer research communications, 4(5), 1253-1267.
  More info

  Exercise mobilizes cytotoxic lymphocytes to blood which may allow superior cell products to be harvested and manufactured for cancer therapy. Gamma-Delta (γδ) T-cells have shown promise for treating solid tumors, but there is a need to increase their potency against hematologic malignancies. Here, we show that human γδ T-cells mobilized to blood in response to just 20 minutes of graded exercise have surface phenotypes and transcriptomic profiles associated with cytotoxicity, adhesion, migration, and cytokine signaling. Following 14 days ex vivo expansion with zoledronic acid and IL2, exercise mobilized γδ T-cells had surface phenotypes and transcriptomic profiles associated with enhanced effector functions and demonstrated superior cytotoxic activity against multiple hematologic tumors in vitro and in vivo in leukemia-bearing xenogeneic mice. Infusing humans with the β1+β2-agonist isoproterenol and administering β1 or β1+β2 antagonists prior to exercise revealed these effects to be β2-adrenergic receptor (AR) dependent. Antibody blocking of DNAM-1 on expanded γδ T-cells, as well as the DNAM-1 ligands PVR and Nectin-2 on leukemic targets, abolished the enhanced antileukemic effects of exercise. These findings provide a mechanistic link between exercise, β2-AR activation, and the manufacture of superior γδ T-cell products for adoptive cell therapy against hematologic malignancies.
• Batatinha, H., Niemiro, G. M., Pena, N., Hoskin, G., Mylabathula, P., Baker, F., Zuniga, T., Smith, K., Diak, D., Seckeler, M., Katsanis, E., & Simpson, R. (2024). Abstract LB066: Acute systemic beta-adrenergic receptor activation to improve graft composition and outcomes in hematopoietic stem cell transplantation. Cancer Research, 84(7_Supplement), LB066-LB066. doi:10.1158/1538-7445.am2024-lb066
• Bolin, E. H., Ali, M. M., Farr, S. L., Oster, M. E., Klewer, S. E., Thomas, R. C., Seckeler, M. D., & Nembhard, W. N. (2024). Health Insurance Status and Access to Healthcare Among Young Adults with Congenital Heart Disease: from the Congenital Heart Survey To Recognize Outcomes, Needs and Well-beinG (CH STRONG), 2016-2019. Pediatric cardiology, 45(6), 1308-1315.
  More info

  Having health insurance is associated with better access to healthcare and lower rates of comorbidity in the general population, but data are limited on insurance's impact on adults with congenital heart disease (ACHD). The Congenital Heart Survey To Recognize Outcomes, Needs and well-beinG (CH STRONG) was conducted among ACHD in three locations from 2016 to 2019. We performed multivariable logistic regression to determine the associations between health insurance and both access to healthcare and presence of comorbidities. We also compared health insurance and comorbidities among ACHD to similarly-aged individuals in the Behavioral Risk Factor Surveillance System (BRFSS) as a proxy for the general population. Of 1354 CH STRONG respondents, the majority were ≤ 30 years old (83.5%), and 8.8% were uninsured versus 17.7% in the BRFSS (p 
• Caryl, N. E., June, C., Culbert, M. H., Hellinger, R. D., Hoyer, A. W., Klewer, S. E., & Seckeler, M. D. (2024). Incidence of Radiation-Associated Cancer in Patients With Congenital Heart Disease. The American journal of cardiology, 210, 65-68.
• Meziab, O., Dereszkiewicz, E., Guerrero, C. E., Hoyer, A. W., Barber, B. J., Klewer, S. E., & Seckeler, M. D. (2024). Adverse Effect of Bundle Branch Block on Exercise Performance in Patients with Fontan Physiology: From the Pediatric Heart Network Fontan Public Data Set. Pediatric cardiology.
  More info

  Patients with Fontan physiology have reduced exercise performance compared to their peers as well as a higher incidence of bundle branch block (BBB). This study aims to investigate the association between BBB and exercise performance in the Fontan population through a retrospective review of the Pediatric Heart Network Fontan study public use dataset. "Low Performers" were defined as ≤ 25th percentile (for Fontan patients) for each exercise parameter at anaerobic threshold (AT) for gender and age and "Normal Performers" were all other patients. A total of 303 patients with Fontan physiology who underwent exercise testing reached AT and had complete data for BBB. BBB occurred more frequently in Low Performers for VO [OR (95% CI): 2.6 (1.4, 4.8)] and Work [OR (95% CI): 2.7 (1.4, 5.1)], suggesting that BBB in the Fontan population is associated with reduced exercise performance. This data adds to the existing clinical evidence of the adverse effects of conduction abnormalities on single ventricle cardiac output and adds support for consideration of cardiac resynchronization and multi-site ventricular pacing in this patient population.
• Meziab, O., Seckeler, M. D., Scherer, K., & Barber, B. J. (2024). Prevalence of cardiovascular implantable electronic devices in children with type 1 myotonic dystrophy. Muscle & nerve, 70(5), 1077-1081.
  More info

  Type 1 myotonic dystrophy (DM1) is a neuromuscular disorder of multiple organ systems with important electrophysiologic (EP) manifestations, leading to a cumulative incidence of sudden death of 6.6%. Due to genetic anticipation, there is a pediatric subset of this patient population. However, most EP research on DM1 patients has been in adults, making cardiac care for pediatric patients difficult and directed by adult guidelines which often leads to cardiovascular implantable electronic device (CIED) implants. We sought to investigate the prevalence of CIEDs in the pediatric DM1 population.
• Saferite, A., Blair, B., Price, A., Fox, K., & Seckeler, M. (2024). RETROGRADE THORACIC DUCT ACCESS FOR EMBOLIZATION OF LYMPHATIC MALFORMATIONS IN A CHILD WITH CONGENITAL HEART DISEASE AND A PLEXIFORM THORACIC DUCT VARIANT. Lymphology, 57(2). doi:10.2458/lymph.7090
  More info

  The physiologic sequelae of the atypical vasculature in patients with congenital heart disease can result in potentially fatal lymphatic complications, especially after corrective cardiac surgery. Transcatheter embolization of the thoracic duct or lymphatic collaterals can reduce morbidity and mortality in these patients. While typically performed transabdominally via an antegrade approach, retrograde embolization may be preferable in cases where this is not feasible, including in rare variants of thoracic duct anatomy. We present a case of a child with severe chylothorax after congenital cardiac surgery who was found to have thoracic lymphatic malformations and a plexiform thoracic duct variant who underwent successful embolization of the malformations.
• Seckeler, M. (2024). The Neo-Aortic Root After Arterial Switch Operation: Defining the New Normal. Journal of the American College of Cardiology, 83(4). doi:10.1016/j.jacc.2023.10.024
• Seckeler, M. D. (2024). Early Intervention for Tetralogy of Fallot, But at What Cost?. JACC. Advances, 3(10), 101240.
• Seckeler, M. D. (2024). FUELing Improved Treatment for Patients with Fontan Physiology. The American journal of cardiology, 210, 309-310.
• Andrews, J. G., Strah, D., Downing, K. F., Kern, M. C., Oster, M. E., Seckeler, M. D., Goudie, A., Nembhard, W. N., Farr, S. L., & Klewer, S. E. (2023). Cardiology Care and Loss to Follow-Up Among Adults With Congenital Heart Defects in CH STRONG. The American journal of cardiology, 197, 42-45.
  More info

  Many of the estimated 1.4 million adults with congenital heart defects (CHDs) in the United States are lost to follow-up (LTF) despite recommendations for ongoing cardiology care. Using 2016 to 2019 CH STRONG (Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG) data, we describe cardiac care among community-based adults with CHD, born in 1980 to 1997, identified through state birth defects registries. Our estimates of LTF were standardized to the CH STRONG eligible population and likely more generalizable to adults with CHD than clinic-based data. Half of our sample were LTF and more than 45% had not received cardiology care in over 5 years. Of those who received care, only 1 in 3 saw an adult CHD physician at their last encounter. Not knowing they needed to see a cardiologist, being told they no longer needed cardiology care, and feeling "well" were the top reasons for LTF, and only half of respondents report doctors discussing the need for cardiac follow-up.
• Baker, F. L., Zúñiga, T. M., Smith, K. A., Batatinha, H., Kulangara, T. S., Seckeler, M. D., Burgess, S. C., Katsanis, E., & Simpson, R. J. (2023). Exercise mobilizes diverse antigen specific T-cells and elevates neutralizing antibodies in humans with natural immunity to SARS CoV-2. Brain, behavior, & immunity - health, 28, 100600.
  More info

  Epidemiological data suggest that physical activity protects against severe COVID-19 and improves clinical outcomes, but how exercise augments the SARS-CoV-2 viral immune response has yet to be elucidated. Here we determine the antigen-specific CD4 and CD8 T-cell and humoral immunity to exercise in non-vaccinated individuals with natural immunity to SARS CoV-2, using whole-blood SARS-CoV-2 peptide stimulation assays, IFN-γ ELISPOT assays, 8-color flow cytometry, deep T-cell receptor (TCR) β sequencing, and anti-RBD-1 neutralizing antibody serology. We found that acute exercise reliably mobilized (∼2.5-fold increase) highly functional SARS-CoV-2-specific T-cells to the blood compartment in those with natural immunity to the virus. The mobilized cells reacted with spike protein (including alpha (α) and delta (δ)-variants), membrane, and nucleocapsid peptides in those previously infected but not in controls. Both groups reliably mobilized T-cells reacting with Epstein-Barr viral peptides. Exercise mobilized SARS-CoV-2 specific T-cells maintained broad TCR-β diversity with no impact on CDR3 length or V and J family gene usage. Exercise predominantly mobilized MHC I restricted (i.e. CD8) SARS-CoV-2 specific T-cells that recognized ORF1ab, surface, ORF7b, nucleocapsid, and membrane proteins. SARS-CoV-2 neutralizing antibodies were transiently elevated ∼1.5-fold during exercise after infection. In conclusion, we provide novel data on a potential mechanism by which exercise could increase SARS-CoV-2 immunosurveillance via the mobilization and redistribution of antigen-specific CD8 T-cells and neutralizing antibodies. Further research is needed to define the tissue specific disease protective effects of exercise as SARS-CoV-2 continues to evolve, as well as the impact of COVID-19 vaccination on this response.
• Batatinha, H., Diak, D. M., Niemiro, G. M., Baker, F. L., Smith, K. A., Zúñiga, T. M., Mylabathula, P. L., Seckeler, M. D., Lau, B., LaVoy, E. C., Gustafson, M. P., Katsanis, E., & Simpson, R. J. (2023). Human lymphocytes mobilized with exercise have an anti-tumor transcriptomic profile and exert enhanced graft-versus-leukemia effects in xenogeneic mice. Frontiers in immunology, 14, 1067369.
  More info

  Every bout of exercise mobilizes and redistributes large numbers of effector lymphocytes with a cytotoxic and tissue migration phenotype. The frequent redistribution of these cells is purported to increase immune surveillance and play a mechanistic role in reducing cancer risk and slowing tumor progression in physically active cancer survivors. Our aim was to provide the first detailed single cell transcriptomic analysis of exercise-mobilized lymphocytes and test their effectiveness as a donor lymphocyte infusion (DLI) in xenogeneic mice engrafted with human leukemia.
• Galindo, M. K., Klewer, S. E., Downing, K. F., Takamatsu, C. L., Seckeler, M. D., Oster, M. E., Collins, R. T., Nembhard, W. N., Bolin, E. H., & Farr, S. L. (2023). Abstract 13983: Reproductive Health Counseling and Experiences Among Females With Congenital Heart Defects: Results From the Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being. Circulation, 148(Suppl_1). doi:10.1161/circ.148.suppl_1.13983
• García, D., Huntsman, J., Sisk, D., Price, A. M., Schock, S. N., Klewer, S. E., & Seckeler, M. D. (2023). Congenital left atrial appendage ostial stenosis in an extremely premature infant diagnosed by transthoracic echocardiography. Echocardiography (Mount Kisco, N.Y.), 40(6), 587-591.
  More info

  Congenital left atrial appendage ostial stenosis is a very rare congenital cardiac condition. We present the case of an extremely premature infant with congenital left atrial appendage ostial stenosis diagnosed by transthoracic echocardiographic imaging.
• June, C., Crigler, C., Thoeny, A., Price, A. M., & Seckeler, M. D. (2023). Iliocaval Occlusion Treated with Angioplasty in a 1,500-g Infant. Journal of vascular and interventional radiology : JVIR, 34(10), 1856-1857.
• June, C., Culbert, M. H., Meziab, O., Caryl, N. E., Klewer, S. E., & Seckeler, M. D. (2023). Additional Burden of Esophageal and Gastric Varices on Hospitalized Patients With Moderate or Severe Congenital Heart Disease. The American journal of cardiology, 209, 163-164.
• Kops, S. A., Strah, D. D., Andrews, J., Klewer, S. E., & Seckeler, M. D. (2023). Contemporary pregnancy outcomes for women with moderate and severe congenital heart disease. Obstetric medicine, 16(1), 17-22.
  More info

  Women with congenital heart disease (CHD) are surviving into adulthood, with more undergoing pregnancy.
• Meziab, O., Hoyer, A. W., Fox, K. A., & Seckeler, M. D. (2023). 3-Dimensional Printing for Planning for Transvenous Pacemaker Placement in Complex Congenital Heart Disease. JACC. Clinical electrophysiology, 9(8 Pt 1), 1433-1435.
• Seckeler, M. D. (2023). The neo-aortic root after arterial switch operation: Defining the new normal. Journal of the American College of Cardiology.
• Simpson, R., Katsanis, E., Burgess, S. C., Seckeler, M., Kulangara, T., Batatinha, H., Smith, K. A., Zuniga, T. M., & Baker, F. L. (2023). Exercise mobilizes diverse antigen specific T-cells and elevates neutralizing antibodies in humans with natural immunity to SARS CoV-2. Brain, Behavior, and Immunity – Health.
• Simpson, R., Katsanis, E., Gustafson, M., LaVoy, E., Lau, B., Seckeler, M., Zuniga, T. M., Smith, K. A., Baker, F. L., Niemiro, G., Diak, D., & Batatinha, H. (2023). Human lymphocytes mobilized with exercise have an anti-tumor transcriptomic profile and exert enhanced graft-versus-leukemia effects in xenogeneic mice. Frontiers in Immunology.
• Strah, D. D., Hellinger, R. D., Lee, K. S., & Seckeler, M. D. (2023). Novel use of the double kissing crush technique to stent complex pulmonary artery stenosis in a child with Alagille syndrome. Annals of pediatric cardiology, 16(4), 290-292.
  More info

  Coronary bifurcation lesions and treatment with two-stent techniques have been developed, including the double kissing (DK) crush technique. The use of this technique in children or noncoronary vessels, including pulmonary arteries, has not been described. We present a 12-year-old girl with Alagille syndrome, a ventricular septal defect (VSD), and complex bilateral pulmonary artery (PA) stenoses who is status post six catheterizations for PA angioplasty and stenting to improve her marked right ventricular hypertension. With collaboration between the congenital and structural teams, she successfully underwent the DK crush technique for a complex lesion in her PA. This improved pulmonary flow and allowed for successful surgical VSD closure.
• Takamatsu, C., Ibrahim, R., Corban, M. T., Klewer, S. E., & Seckeler, M. D. (2023). Transcatheter Treatment of Right Ventricular Outflow Tract Compression by a Pseudoaneurysm in Tetralogy of Fallot. JACC. Cardiovascular interventions, 16(15), 1931-1934.
• Yrun-Duffy, M., Strah, D. D., Fox, K., Klewer, S. E., & Seckeler, M. D. (2023). An Unusual Congenital Aorto-pulmonary Shunt in Tetralogy of Fallot: Anomalous Left Innominate Artery off the Pulmonary Artery. The Journal of invasive cardiology, 35(6), E325-E326.
• Combs, D., Cooper, D., Edgin, J., Hsu, C., Klewer, S., Partha, M., Parthasarathy, S., & Seckeler, M. (2022). 0484 Trouble Sleeping Predicts Future Decreased Quality of Life in Young Children with Fontan Circulation. Sleep, 45(Supplement_1), A214-A214. doi:10.1093/sleep/zsac079.481
  More info

  Abstract Introduction Children with congenital heart disease who undergo a Fontan procedure are at higher risk of reduced health-related quality of life (HR-QOL) compared to age-matched peers. We have previously shown that current sleep disturbances are associated with decreased HR-QOL, but there is no existing longitudinal data on the relationship between sleep disturbance and HR-QOL in children with Fontan circulation. Methods We analyzed data from the Pediatric Heart Network Single Ventricle Reconstruction follow up study to evaluate associations between parent-reported trouble sleeping with HR-QOL as measured by the child health questionnaire (CHQ, measured at age 6 years) as well as the Pediatric Quality of Life questionnaire (PedsQL, measured at baseline as well as age 4, 5 and 6 years) in children with Fontan circulation. Presence of trouble sleeping was assessed at baseline and quality of life was assessed at baseline (age 3 years old) and annually for 3 years. Analysis was performed using the Wilcoxon sum rank test. Results 227 participants had data at baseline (age 3 years), and 196 participants completed HR-QOL measures at all time points. Parent-reported trouble sleeping was reported “often” or “almost always” in 11% of participants. Baseline trouble sleeping predicted decreased HR-QOL at all future time points, particularly psychosocial HR-QOL. Psychosocial HR-QOL as measured by the Peds QL was significantly lower at all time points in the group with trouble sleeping. At age 6 years, psychosocial HR-QOL remained significantly lower in the group with trouble sleeping at baseline on both the PedsQL (median score 78 [interquartile range 63, 90] vs 65 [58, 83], p=0.03) and the CHQ (median t-score 54 [47, 59] vs 47 [42, 53], p=0.002). Conclusion Trouble sleeping in children with Fontan circulation predicts future decreased HR-QOL. Better understanding of sleep problems is needed in children with Fontan circulation as sleep disorder treatment may lead to improved HR-QOL in this at-risk population. Support (If Any) Funding to DC from the American Heart Association and NIH-NHLBI. Single Ventricle Reconstruction study data obtained from the Pediatric Heart Network.
• Kops, S. A., White, S. C., Klewer, S. E., Andrews, J. G., & Seckeler, M. D. (2022). ECMO in adults with congenital heart disease - Analysis of a national discharge database. International Journal of Cardiology Congenital Heart Disease, 8. doi:10.1016/j.ijcchd.2022.100366
  More info

  Background: The number of adults with congenital heart disease (CHD) is increasing and long-term complications may lead to a need for extracorporeal membrane oxygenation (ECMO), but there are no large studies describing outcomes. We sought to describe the epidemiology for adult CHD patients who undergo ECMO and compare outcomes to adults without CHD (NO-CHD) requiring ECMO. Methods: Query of hospital discharge data from Vizient from October 2014–December 2017 for patients ≥18 years old with an ICD-9 or ICD-10 code for CHD (745–747.49, Q20.0 – Q26.4) and a procedure code for ECMO (39.65 or 5A15223). Demographics, diagnosis, length of stay (LOS), complications and in-hospital mortality were collected and compared. Results: There were 61,136 adult CHD admissions, 440 (0.7%) with ECMO, compared to 16,122,820 NO-CHD admissions, 11,905 (0.07%) with ECMO (p < 0.001). Adults with CHD were younger (49.2 ± 17 vs 52.5 ± 17.8 years, p < 0.001), had a longer LOS (33.7 ± 45.9 vs 29.4 ± 37.1 days, p = 0.020) and more complications (54% vs 40%, p < 0.001). Conclusions: Adults with CHD who require ECMO have longer hospitalizations and more complications than adults without CHD who require ECMO. ECMO for adults with CHD appears related to surgical admissions, compared to ECMO for adults without CHD, which appears related to acquired diseases. These data highlight the implications of ECMO for adults with CHD and their potential perioperative fragility.
• Patel, S. B., Webber, Z., Strah, D. D., Hellinger, R. D., Yrun-Duffy, M., Kowalek, K. A., & Seckeler, M. D. (2023). Acute Hospital Outcomes for Renal Transplantation in Patients With Moderate or Severe Congenital Heart Disease. The American journal of cardiology, 186, 87-90. doi:10.1016/j.amjcard.2022.10.034
  More info

  Children and adults with congenital heart disease (CHD) are increasingly recognized to be at risk for acute and chronic renal injury. Some of these may progress to the need for renal transplantation. We hypothesized that patients with underlying moderate or severe CHD who undergo renal transplantation will have worse acute hospital outcomes. Using a national administrative database, we queried for admissions aged 0 to 50 years with moderate or severe CHD and renal transplantation and compared these to admissions without CHD. There were 56 admissions for renal transplantation in the CHD group (0.04%) and 26,285 admissions in the group without CHD (0.21%, p
• Seckeler, M. D., Webber, Z., & Fox, K. (2022). Using 3D Printed Heart Models for Surgical and Catheterization Planning in Congenital Heart Disease. Current Treatment Options in Pediatrics, in press. doi:DOI 10.1007/s40746-022-00238-x
• Strah, D., Kowalek, K., Weinberger, K., Mendelson, J., Hoyer, A., Klewer, S., & Seckeler, M. (2022). Worse Hospital Outcomes for Children and Adults with COVID-19 and Congenital Heart Disease. Pediatric Cardiology, 43(3). doi:10.1007/s00246-021-02751-6
  More info

  The aim of the current study is to investigate hospitalization outcomes of COVID-19 positive children and adults with moderate or severe congenital heart disease to children and adults without congenital heart disease. Retrospective review using the Vizient Clinical Data Base for admissions of patients with an ICD-10 code for COVID-19 from April 2020 to March 2021. Admissions with COVID-19 and with and without moderate or severe congenital heart disease (CHD) were stratified into pediatric (< 18 years) and adult (≥ 18 years) and hospital outcomes were compared. There were 9478 pediatric COVID-19 admissions, 160 (1.7%) with CHD, and 658,230 adult COVID-19 admissions, 389 (0.06%) with CHD. Pediatric admissions with COVID-19 and CHD were younger (1 vs 11 years), had longer length of stay (22 vs 6 days), higher complication rates (6.9 vs 1.1%), higher mortality rates (3.8, 0.8%), and higher costs ($54,619 vs 10,731; p < 0.001 for all). Adult admissions with COVID-19 and CHD were younger (53 vs 64 years, p < 0.001), had longer length of stay (12 vs 9 days, p < 0.001), higher complication rates (8 vs 4.8%, p = 0.003), and higher costs ($23,551 vs 13,311, p < 0.001). This appears to be the first study to report the increased hospital morbidities and costs for patients with CHD affected by COVID-19. Our hope is that these findings will help counsel patients moving forward during the pandemic.
• Webber, Z., Seckeler, M., & Fox, K. (2022). Using 3D Printed Heart Models for Surgical and Catheterization Planning in Congenital Heart Disease. Current Treatment Options in Pediatrics. doi:DOI 10.1007/s40746-022-00238-x
• Alsaied, T., Erdmann, A., Goldstein, B. H., Halickman, R., Kreutzer, J., Seckeler, M. D., & Trucco, S. (2021). Abstract 9701: Hemodynamic Parameters Deteriorate Over Time, and Relate to Adverse Clinical Outcomes, in Children and Adults with Fontan Circulation. Circulation, 144(Suppl_1). doi:10.1161/circ.144.suppl_1.9701
  More info

  Introduction: In patients with univentricular heart disease, Fontan palliation allows for improved survival. However, Fontan circulatory function deteriorates over time, marked by the onset of functional limitations, morbidities, and mortality. Invasive surveillance offers insights into hemodynamic conditions and may facilitate identification of at-risk patients. Objective: To characterize longitudinal changes in invasive Fontan hemodynamics and evaluate for associations with adverse clinical outcomes. Methods: Single-center retrospective study of serial invasive hemodynamics (≥2 catheterizations) in Fontan patients from 2006-2020. The first and last procedures per patient were analyzed for Fontan pressure, ventricular end diastolic pressure (EDP), cardiac output (CO), systemic (SVR), pulmonary (PVR) and total vascular resistance (TVR). The composite clinical endpoint included death, heart transplant or listing, Fontan takedown, protein losing enteropathy, plastic bronchitis, admission for arrhythmia or congestive heart failure and Fontan revision. Results: Serial hemodynamic evaluations were analyzed in 71 Fontan patients, with first catheterization occurring at median age of 7.1 years (IQR 4.1, 14) and 8.4 years (4.7, 12.3) between assessments. The most common diagnosis was hypoplastic left heart syndrome (45%). Fontan pressure, CO and PVR did not significantly change between assessments, whereas EDP increased by 1.9±3.6 mmHg ( p
• Combs, D., Edgin, J. O., Hsu, C. H., Klewer, S. E., Lopez, S., Parthasarathy, S., Provencio-dean, N., Robertson, K., & Seckeler, M. D. (2021). 605 Sleep problems are associated with behavioral problems and decreased quality of life in children with Fontan circulation. Sleep, 44(Supplement_2), A238-A238. doi:10.1093/sleep/zsab072.603
  More info

  Abstract Introduction Children with congenital heart disease who undergo a Fontan procedure are at higher risk of behavior and attention problems as well as reduced quality of life compared to age-matched peers. While sleep problems are associated with behavior and attention problems in children without Fontan circulation, this relationship has never been examined in children with Fontan circulation. We hypothesized that sleep problems in this population may increase the risk of behavior problems and also reduce health related quality of life (HRQOL). Methods We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent-reported diagnosis of a sleep problem with reported behavioral concerns and HRQOL as measured by the child health questionnaire (CHQ) in 558 children with Fontan circulation. Analysis was performed using logistic regression or Wilcoxon sum rank test, as appropriate, with Bonferroni correction for multiple comparisons. Results Parent-reported sleep problems were present in 10% of participants. Sleep problems were associated with a 4.6x higher risk of attention problems, 10.2x higher risk of anxiety problems, 3.9x higher risk of behavioral problems, 9.5x higher risk of depression, 5.0x higher risk of developmental delay, 6.9x higher risk of learning problems and 2.2x higher risk of speech problems (p=0.04 for speech problems, p
• Knobbe, K., Partha, M., Seckeler, M. D., Klewer, S., Hsu, C. H., Edgin, J., Morgan, W. J., Provencio-Dean, N., Lopez, S., Parthasarathy, S., & Combs, D. (2021). Association Between Sleep Disturbances With Neurodevelopmental Problems and Decreased Health-Related Quality of Life in Children With Fontan Circulation. Journal of the American Heart Association, 10(21), e021749.
  More info

  Background Children with Fontan circulation are known to be at increased risk for neurodevelopmental problems and decreased health-related quality of life (HRQOL), but many factors that may contribute to this risk are unknown. Sleep disturbances may be one previously unidentified factor that contributes to this risk. Methods and Results We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent or child report of sleep disturbance with reported neurodevelopmental concerns and HRQOL in 558 children with Fontan circulation. Parent-reported sleep disturbance was present in 11% of participants and child-reported sleep disturbance was present in 15%. Parent-reported sleep disturbance was associated with a significantly higher risk of attention problems, anxiety, depression, behavioral problems, and developmental delay (
• Kops, S. A., Kylat, R. I., Bhatia, S., Seckeler, M. D., Barber, B. J., & Bader, M. Y. (2021). Genetic Characterization of a Model Ciliopathy: Bardet-Biedl Syndrome. Journal of pediatric genetics, 10(2), 126-130.
  More info

  Bardet-Biedl syndrome (BBS) is a rare ciliopathy affecting multiple organ systems. Patients with BBS are usually diagnosed later in childhood when clinical features of the disease become apparent. In this article, we presented a case of BBS discovered by whole genome sequencing in a newborn with heterotaxy, duodenal atresia, and complex congenital heart disease. Early diagnosis is important not only for prognostication but also to explore ways to mitigate the cone-rod dysfunction and for exploring newer therapies. Our case highlights the importance of a high index of suspicion and the utility of advanced genetic testing to provide an early diagnosis for a rare disease.
• Kops, S. A., Strah, D., Lee, K. S., & Seckeler, M. D. (2021). Intravascular Ultrasound for Pulmonary Vein Stenosis Interventions in Congenital Heart Disease. The Journal of invasive cardiology, 33(4), E259-E262.
  More info

  Pulmonary vein stenosis (PVS) is aggressive, with high morbidity and mortality. Surgical and catheter interventions yield modest success, at best. Refinements in catheter interventions could potentially improve outcomes in this patient population. The goal of this study was to determine the utility of intravascular ultrasound (IVUS) for patients with congenital heart disease and PVS.
• Kops, S., Strah, D., Lee, K., & Seckeler, M. (2020). Intravascular ultrasound to guide pulmonary vein interventions in a congenital heart disease. Journal of Invasive Cardiology.
• Munoz, F. A., Chin, C., Kops, S. A., Kowalek, K., & Seckeler, M. D. (2020). Increased length of stay and hospital charges in adolescents with type 1 diabetes and psychiatric illness.. Journal of pediatric endocrinology & metabolism : JPEM, 34(2), 183-186. doi:10.1515/jpem-2020-0373
  More info

  Type I diabetes mellitus (T1DM) is one of the most common chronic diseases of childhood. Diabetic ketoacidosis (DKA) in this population contributes to significant healthcare utilization, including emergency room visits, hospitalizations, and ICU care. Comorbid psychiatric illnesses (CPI) are additional risks for increased healthcare utilization. While CPI increased risk for DKA hospitalization and readmission, there are no data evaluating the relationship between CPI and hospital outcomes. We hypothesized that adolescents with T1DM and CPI admitted for DKA have increased length of stay (LOS) and higher charges compared to those without CPI..Retrospective review of 2000-2012 Healthcare Cost and Utilization Project's (HCUP) Kids' Inpatient Databases (KID). Patients 10-21 years old admitted with ICD-9 codes for DKA or severe diabetes (250.1-250.33) with and without ICD-9 codes for depression (296-296.99, 311) and anxiety (300-300.9). Comparisons of LOS, mortality, and charges between groups (No CPI, Depression and Anxiety) were made with one way ANOVA with Bonferroni correction, independent samples Kruskal-Wallis test with Bonferroni correction and χ2..There were 79,673 admissions during the study period: 68,573 (86%) No CPI, 8,590 (10.7%) Depression and 12,510 (15.7%) Anxiety. Female patients comprised 58.2% (n=46,343) of total admissions, 66% of the Depression group, and 71% of the Anxiety group. Patients with depression or anxiety were older and had longer LOS and higher mean charges (p
• Munoz, F. A., Chin, C., Kops, S. A., Kowalek, K., & Seckeler, M. D. (2021). Increased length of stay and hospital charges in adolescents with type 1 diabetes and psychiatric illness. Journal of pediatric endocrinology & metabolism : JPEM, 34(2), 183-186.
  More info

  Type I diabetes mellitus (T1DM) is one of the most common chronic diseases of childhood. Diabetic ketoacidosis (DKA) in this population contributes to significant healthcare utilization, including emergency room visits, hospitalizations, and ICU care. Comorbid psychiatric illnesses (CPI) are additional risks for increased healthcare utilization. While CPI increased risk for DKA hospitalization and readmission, there are no data evaluating the relationship between CPI and hospital outcomes. We hypothesized that adolescents with T1DM and CPI admitted for DKA have increased length of stay (LOS) and higher charges compared to those without CPI.
• Seckeler, M. D., Barber, B. J., Colombo, J. N., Bernardi, A. M., Hoyer, A. W., Andrews, J. G., & Klewer, S. E. (2021). Exercise Performance in Adolescents With Fontan Physiology (from the Pediatric Heart Network Fontan Public Data Set). The American journal of cardiology, 149, 119-125.
  More info

  In the pediatric population, exercise capacity differs between females and males and the gap widens through adolescence. However, specific age- and sex-based changes in adolescents with congenital heart disease and Fontan palliation have not been reported. The purpose of the current study is to identify age- and sex-specific changes in exercise performance at peak and ventilatory anaerobic threshold (AT) for adolescents with Fontan physiology. Retrospective review of the Pediatric Heart Network Fontan cross sectional study (Fontan 1) public use dataset. Comparisons were made for peak and AT exercise parameters for females and males at 2-year age intervals. In addition, normative values were generated by sex and age at 2-year intervals. χ test was used for comparison for categorical variables. Changes in exercise parameters between age groups by sex were compared by ANOVA with post-hoc analysis. Exercise testing was performed in 411 patients. AT was reached in 317 subjects (40% female), of whom, 166 (43% female) reached peak exercise. Peak oxygen consumption decreased 32% through adolescence in females and did not have the typical increase through adolescence for males. Oxygen consumption at AT also decreased with age in both sexes. In conclusion, age- and sex-based exercise performance for adolescents with Fontan physiology are predictably low, but there are additional significant decreases through adolescence for this population, especially in females. We have established normative exercise values for several parameters for this population which will better identify at risk patients and allow for earlier intervention.
• Seckeler, M. D., Boe, B. A., Barber, B. J., Berman, D. P., & Armstrong, A. K. (2021). Use of rotational angiography in congenital cardiac catheterisations to generate three-dimensional-printed models. Cardiology in the young, 31(9), 1407-1411.
  More info

  Three-dimensional printing is increasingly utilised for congenital heart defect procedural planning. CT or MR datasets are typically used for printing, but similar datasets can be obtained from three-dimensional rotational angiography. We sought to assess the feasibility and accuracy of printing three-dimensional models of CHD from rotational angiography datasets.
• Seckeler, M. D., Pineda, J. R., & Lotun, K. (2021). Successful Transcatheter Recanalization of a Chronically Occluded Left Pulmonary Artery Due to Fibrosing Mediastinitis. JACC. Cardiovascular interventions, 14(16), e215-e216.
• Strah, D. D., Kowalek, K. A., Weinberger, K., Mendelson, J., Hoyer, A. W., Klewer, S. E., & Seckeler, M. D. (2021). Worse Hospital Outcomes for Children and Adults with COVID-19 and Congenital Heart Disease. Pediatric cardiology.
  More info

  The aim of the current study is to investigate hospitalization outcomes of COVID-19 positive children and adults with moderate or severe congenital heart disease to children and adults without congenital heart disease. Retrospective review using the Vizient Clinical Data Base for admissions of patients with an ICD-10 code for COVID-19 from April 2020 to March 2021. Admissions with COVID-19 and with and without moderate or severe congenital heart disease (CHD) were stratified into pediatric (
• Strah, D., Seckeler, M., & Mendelson, J. (2021). Coronary artery spasm in a 15-year-old male in diabetic ketoacidosis. Cardiology in the young, 31(9), 1507-1509.
  More info

  Coronary artery disease and myocardial infarction are known complications of long-standing diabetes mellitus in adults, but coronary artery spasm is far more rare and has not been reported in children. We present a 15-year-old male in diabetic ketoacidosis who developed diffuse ST segment elevations and elevated troponin with normal coronary arteries on coronary angiography and no signs of pericarditis that was due to coronary artery spasm.
• Andrews, J., Barber, B. J., Combs, D., Fernandez, V., Hsu, C. H., Klewer, S. E., Morgan, W. J., Parthasarathy, S., & Seckeler, M. D. (2020). Abstract 14771: Obstructive Sleep Apnea is Associated With Cardiac Dysfunction in Children With Congenital Heart Disease. Circulation, 142(Suppl_3). doi:10.1161/circ.142.suppl_3.14771
  More info

  Introduction: Obstructive sleep apnea (OSA) is associated with cardiac dysfunction in children without congenital heart disease (CHD). Children with CHD are at increased risk for OSA and may be susceptible to further cardiovascular consequences due to OSA but the extent and nature of such cardiovascular effects of OSA are unknown. Methods: Children (6-17 years old) with corrected CHD without current cyanosis or Down syndrome were recruited from pediatric cardiology clinic. Home sleep tests were done to determine the presence and severity of OSA. OSA was defined as an obstructive apnea hypopnea index (oAHI) ≥1. Mild OSA was defined as an oAHI of ≥1 to
• Bernardi, A. M., Moses, S., Barber, B. J., Witte, M. H., & Seckeler, M. D. (2020). Higher Incidence of Protein-Losing Enteropathy in Patients with Single Systemic Right Ventricle. Pediatric cardiology.
  More info

  Patients with single ventricle congenital heart disease are at risk of unpredictable protein-losing enteropathy (PLE) after surgical palliation. Based on prior reports of physiologic differences for patients with single morphologic right versus left ventricles, we hypothesized that those with right ventricular morphology would have a higher incidence of PLE. We performed a retrospective review of > 15 million pediatric hospitalizations from the Healthcare Cost and Utilization Project KID 2000-2012 databases for admissions 5-21 years old with ICD-9 codes for hypoplastic left heart syndrome (HLHS) and tricuspid atresia (TA) with and without PLE. Incidence of PLE was compared between those with HLHS and TA. In addition, outcomes and costs were compared between admissions with and without PLE and between HLHS and TA. Of 1623 HLHS admissions, 289 (17.8%) had PLE, and of 926 TA admissions, 58 (5.9%) had PLE (p 
• Boyer, P. J., Yell, J. A., Andrews, J. G., & Seckeler, M. D. (2020). Anxiety reduction after pre-procedure meetings in patients with CHD. Cardiology in the young, 30(7), 991-994.
  More info

  Cardiac catheterisations for CHD produce anxiety for patients and families. Current strategies to mitigate anxiety and explain complex anatomy include pre-procedure meetings and educational tools (cardiac diagrams, echocardiograms, imaging, and angiography). More recently, three-dimensionally printed patient-specific models can be added to the armamentarium. The purpose of this study was to evaluate the efficacy of pre-procedure meetings and of different educational tools to reduce patient and parent anxiety before a catheterisation.
• Fox, K. A., Janardhanan, R., Kelly, T., Kern, M. C., Klewer, S. E., & Seckeler, M. D. (2020). Multimodality imaging for diagnosis and procedural planning for a ruptured sinus of Valsalva aneurysm.. Journal of cardiovascular computed tomography, 14(6), e139-e142. doi:10.1016/j.jcct.2019.09.018
  More info

  A 36-year-old man with bicuspid aortic valve and surgically ligated patent ductus arteriosus had a new murmur noted on follow-up. Work-up included a transthoracic echocardiogram which was concerning for an aorto-right atrial shunt without right atrial enlargement (*, Fig. 1). Cardiac MRI confirmed a ruptured sinus of Valsalva aneurysm communicating between the aorta and right atrium (*, Fig. 2). In order to plan transcatheter intervention it was critical to delineate particularly the location of the aortic valve and right coronary artery relative to the defect. Therefore, cardiac CT with 3D reconstruction was obtained and a 3D printed model generated, demonstrating that the aortic valve (V, Fig. 3a, c, e) and right coronary artery (R, Fig. 3b, d) were remote from the defect (*, Fig. 3a–e). Simulated device implantation using the 3D printed model showed that it would be reasonable to attempt transcatheter closure (arrow, Fig. 3f). Fig. 2Cardiac MRI confirming the presence of a ruptured sinus of Valsalva anuerysm with resultant aorto-right atrial shunt (*). View Large Image Figure Viewer Download Hi-res image Fig. 3a, b) Cardiac CT scan showing that the ruptured sinus of Valsalva aneurym (*) is remote from the aortic valve (V) and origin of the right coronary artery (R). c) Three-dimensional digital reconstruction better demonstrating the relationship between the ruptured sinus of Valsalva aneurysm (*) and origin of the right coronary artery (R). d-f) Three-dimensional printed model of the aortic root and ruptured sinus of Valsalva aneurysm (*) demonstrating the relationship between the origin of the right coronary artery (R) and aortic valve (V), followed by simulated device implantation to occlude the defect (arrow). View Large Image Figure Viewer Download Hi-res image
• Kops, S. A., Andrews, J. G., Klewer, S. E., & Seckeler, M. D. (2020). Effect of comorbid neuropsychiatric disorders on children and adolescents undergoing surgery for moderate and severe congenital heart disease. Journal of cardiac surgery, 35(11), 3048-3052.
  More info

  Children and adolescents with congenital heart disease (CHD) are at an increased risk of neuropsychiatric disorders (NPDs). The purpose of this study is to determine how a comorbid NPD affects hospital outcomes and costs for CHD patients undergoing cardiac surgery.
• Kops, S. A., Barber, B. J., Pangburn, S., & Seckeler, M. D. (2020). Transcatheter treatment of acquired coronary sinus ostium atresia in a child with complex congenital heart disease.. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 95(2), E62-E65. doi:10.1002/ccd.28489
  More info

  Congenital coronary sinus ostium atresia is a rare condition that is typically considered benign, as long as there is adequate drainage via another route. However, in children with single ventricle congenital heart disease, adequate drainage may not be assured after complex surgical interventions, putting them at risk for myocardial injury. We present a patient with complex single ventricle congenital heart disease who developed acquired coronary sinus ostium atresia after surgical intervention that was treated by a transcatheter approach to prevent the sequelae of coronary sinus hypertension.
• Kops, S. A., Kylathu, R., Bhatia, S., Seckeler, M., Barber, B. J., & Bader, M. (2020). Genetic Characterization of a Model Ciliopathy: Bardet–Biedl's Syndrome. Journal of Pediatric Genetics. doi:DOI: 10.1055/s-0040-1708844
• Lawson, E. N., & Seckeler, M. D. (2020). Successful Percutaneous Recanalization of a Chronically Occluded Inferior Vena Cava in a Young Child.. World journal for pediatric & congenital heart surgery, 11(4), NP186-NP189. doi:10.1177/2150135118771316
  More info

  Young children with congenital heart disease are undergoing an increasing number of catheter-based interventions. These procedures can lead to obstruction of large central veins, making future interventions more challenging or even impossible. We present a young child with a chronically occluded inferior vena cava (IVC) secondary to prior catheterization-based interventions for congenital heart disease. The IVC was recanalized with serial angioplasty and stent placement with continued patency for over two years. Despite the long duration of obstruction, the IVC was successfully recanalized, eliminating the potential consequences of long-term IVC obstruction and making it easier for future catheter-based interventions, if needed.
• Munoz, F. A., Benton, L. D., Kops, S. A., Kowalek, K. A., & Seckeler, M. D. (2020). Greater length of stay and hospital charges for severe asthma in children with depression or anxiety. Pediatric pulmonology, 55(11), 2908-2912.
  More info

  Asthma is one of the most common chronic disorders of childhood and is associated with significant healthcare utilization and costs. Comorbid psychiatric illnesses, specifically depression and anxiety, are more prevalent in patients with asthma and associated with worse asthma control, more emergency department visits, and increased hospitalization rates.
• Seckeler, M. D., Bliss, A., Rischard, F., & Klewer, S. E. (2020). Early bioprosthetic tricuspid valve stenosis due to size mismatch in Ebstein anomaly-Successful transcatheter treatment. Journal of cardiac surgery, 35(11), 3138-3140.
  More info

  Patients with congenital heart disease are surviving well into adulthood thanks to advances in medical and clinical care. We present a patient with Ebstein anomaly who underwent surgical tricuspid valve replacement and suffered early valve stenosis due to her unique anatomy. This case highlights the importance of the "unnatural" anatomy that can be encounter in this challenging patient population.
• Seckeler, M. D., Moedano, L., Mustacich, D., Kalb, B. T., Saranathan, M., Galons, J. P., & Witte, M. H. (2020). NON-CONTRAST MR LYMPHOGRAPHY OF RARE LYMPHATIC ABNORMALITIES. Lymphology, 53(Issue 3). doi:10.2458/lymph.4665
  More info

  Detailed imaging of the lymphatic system often requires direct injection of contrast into lymph nodes which can be technically challenging, time consuming, and produce painful stimuli. We sought to describe the use of non-contrast MR lymphography (NCMRL) for normal controls and patients with a variety of rare disorders associated with lymphatic pathologies. Two control subjects and five affected patients (decompensated Fontan circulation, central conducting lymphatic abnormality, familial lymphedema and two with Gorham-Stout disease) were studied. NCMRL images were segmented in a semi-automated fashion and the major lymphatic channels and thoracic duct (TD) highlighted for identification. Adequate imaging was available for both controls and 4/5 affected patients; the youngest patient could not be imaged given patient motion. For the two controls, the TD was seen in the expected anatomic location. For the decompensated Fontan patient, there were numerous tortuous lymphatic channels, predominantly in the upper chest and neck. For the familial lymphedema patient, a TD was not identified; instead, peripheral lymphatic collaterals near the lateral chest walls. For the first Gorham-Stout patient, the TD was enlarged with large intrathoracic lymph collections. For the second Gorham-Stout patient, there were bilateral TD with lymph collections in vertebral bodies. Using NCMRL, we were able to image normal and abnormal lymphatic systems. An important learning point is the potential need for sedation for younger patients due to long image acquisition times and fine resolution of the structures of interest.
• Seckeler, M. D., Moedano, L., Mustacich, D., Kalb, B. T., Saranathan, M., Galons, J. P., & Witte, M. H. (2020). Non-contrast MR lymphography of rare lymphatic abnormalities. Lymphology, 53(3), 136-140.
  More info

  Detailed imaging of the lymphatic system often requires direct injection of contrast into lymph nodes which can be technically challenging, time consuming, and produce painful stimuli. We sought to describe the use of non-contrast MR lymphography (NCMRL) for normal controls and patients with a variety of rare disorders associated with lymphatic pathologies. Two control subjects and five affected patients (decompensated Fontan circulation, central conducting lymphatic abnormality, familial lymphedema and two with Gorham-Stout disease) were studied. NCMRL images were segmented in a semiautomated fashion and the major lymphatic channels and thoracic duct (TD) highlighted for identification. Adequate imaging was available for both controls and 4/5 affected patients; the youngest patient could not be imaged given patient motion. For the two controls, the TD was seen in the expected anatomic location. For the decompensated Fontan patient, there were numerous tortuous lymphatic channels, predominantly in the upper chest and neck. For the familial lymphedema patient, a TD was not identified; instead, peripheral lymphatic collaterals near the lateral chest walls. For the first Gorham- Stout patient, the TD was enlarged with large intrathoracic lymph collections. For the second Gorham-Stout patient, there were bilateral TD with lymph collections in vertebral bodies. Using NCMRL, we were able to image normal and abnormal lymphatic systems. An important learning point is the potential need for sedation for younger patients due to long image acquisition times and fine resolution of the structures of interest.
• Shahanavaz, S., Aldoss, O., Carr, K., Gordon, B., Seckeler, M. D., Hiremath, G., Seaman, C., Zablah, J., & Morgan, G. (2020). Acute and medium term results of balloon expandable stent placement in the transverse arch-a multicenter pediatric interventional cardiology early career society study. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 96(6), 1277-1286.
  More info

  Coarctation of the aorta represents 5-8% of all congenital heart disease. Although balloon expandable stents provide an established treatment option for native or recurrent coarctation, outcomes from transverse arch (TAO) stenting, including resolution of hypertension have not been well studied. This study aims to evaluate immediate and midterm results of TAO stenting in a multi-center retrospective cohort.
• Strah, D., Boyer, P. J., Dobson, C., Rischard, F., & Seckeler, M. (2020). Improvement in ventilation-perfusion mismatch after percutaneous recanalization of near-atretic pulmonary artery due to non-small cell lung cancer. Current Problems in Cancer: Case Reports. doi:doi.org/10.1016/j.cpccr.2020.100025
• White, S. C., Fox, K. A., & Seckeler, M. D. (2020). Increased risk of intraventricular hemorrhage in low birth weight infants with aortic coarctation.. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 33(8), 1273-1275. doi:10.1080/14767058.2018.1517319
  More info

  Objective: To determine if there is an association between aortic coarctation (CoA) and intraventricular hemorrhage (IVH) in low birth weight (LBW) infants that may justify earlier intervention. While there is an increasing number of reports of successful early CoA intervention in LBW infants, there are no data to justify this approach.Material and methods: Retrospective review of the University Health System Consortium Clinical Data Base/Resource Manager, a national hospital discharge database. LBW (≤2 kg) infants, with and without IVH and isolated CoA were identified; IVH was stratified into low (grade 1 or 2) and high (grade 3 or 4) severity. Odds ratios were calculated for any, low and high-grade IVH with CoA.Results: Forty-six thousand and twenty LBW infants were identified; 3716 (8.1%) had IVH, 3001 (81%) with low, and 724 (19%) with high severity. Sixty-four infants had CoA, 13 had associated IVH (10 with low and three with high severity). The odds ratio for any IVH with CoA was 2.91 (95% CI 1.58-5.35), low severity 2.77 (95% CI 1.41-5.46) and high severity 3.45 (95% CI 1.07-11.07).Conclusions: In conclusion, this large retrospective database review found that LBW infants with CoA may be at increased risk of IVH. Further study is needed to determine if earlier catheter- or surgical-based intervention for CoA could reduce the risk of IVH in this population.
• Yell, J., Boyer, P. J., Bernardi, A., Klewer, S., & Seckeler, M. D. (2020). Improvement in Pulmonary Vascular Resistance After Relief of Fontan Circuit Obstruction. The Journal of invasive cardiology, 32(10), E254-E257.
  More info

  Patients with single-ventricle congenital heart disease undergo staged surgical palliations leading to a final Fontan procedure. After Fontan, cardiac index (CI) is primarily determined by pulmonary vascular resistance (PVR). Lower Fontan pressure has been achieved after relieving obstruction within the Fontan circuit, but to date the effect on PVR has not been quantified. We hypothesized that there would be significant reduction in PVR after relief of obstruction within the Fontan circuit; the purpose of this study is therefore to describe the change in PVR after relief of Fontan obstruction.
• Andrews, J., Boyer, P. J., Klewer, S. E., & Seckeler, M. D. (2019). IMPACT OF INSURANCE COVERAGE AND PHYSICIAN COMMUNICATION ON LOSS TO FOLLOW-UP IN ADULTS WITH CONGENITAL HEART DISEASE: RESULTS OF THE CONGENITAL HEART SURVEY TO RECOGNIZE OUTCOMES, NEEDS, AND WELL-BEING (CH STRONG). Journal of the American College of Cardiology, 73(9), 570. doi:10.1016/s0735-1097(19)31178-7
  More info

  Lifelong care for adults with congenital heart disease (ACHD) is challenging. New ACHD guidelines recommend minimum 2 year follow-up for most conditions, but many patients do not achieve this. Despite the large number of patients lost to follow-up (LTF), the causative factors remain largely unknown
• Haughey, B. S., White, S. C., & Seckeler, M. D. (2019). Catheter-associated bloodstream infection incidence and outcomes in congenital cardiac surgery. Congenital heart disease, 14(5), 811-813.
  More info

  Catheter-associated bloodstream infections complicate and prolong hospitalizations. The incidence of catheter-associated bloodstream infections in children undergoing congenital cardiac surgery has not been reported. This study sought to define the incidence of catheter-associated bloodstream infections after congenital cardiac surgery in neonates and infants ≤12 months old and compare hospital outcomes and costs to those who underwent surgery and did not have a catheter-associated bloodstream infections.
• Haughey, B. S., White, S. C., Pacheco, G. S., Fox, K. A., & Seckeler, M. D. (2019). Invasive Cardiac Procedures in Interstage Single Ventricle Patients in Emergent Hospitalizations. Pediatric cardiology.
  More info

  Single ventricle congenital heart disease (SV CHD) patients are at risk of morbidity and mortality between the first and second palliative surgical procedures (interstage). When these patients present acutely they often require invasive intervention. This study sought to compare the outcomes and costs of elective and emergent invasive cardiac procedures for interstage patients. Retrospective review of discharge data from The Vizient Clinical Data Base/Resource Manager™, a national health care analytics platform. The database was queried for admissions from 10/2014 to 12/2017 for children 1-6 months old with ICD-9 or ICD-10 codes for SV CHD who underwent invasive cardiac procedures. Demographics, length of stay (LOS), complication rate, in-hospital mortality and direct costs were compared between elective and emergent admissions using t test or χ, as appropriate. The three most frequently performed procedures were also compared. 871 admissions identified, with 141 (16%) emergent. Age of emergent admission was younger than elective (2.9 vs. 4 months p 
• Kern, M. C., Janardhanan, R., Kelly, T., Fox, K. A., Klewer, S. E., & Seckeler, M. D. (2019). Multimodality imaging for diagnosis and procedural planning for a ruptured sinus of Valsalva aneurysm. Journal of cardiovascular computed tomography.
• Kops, S. A., Pangburn, S., Barber, B. J., & Seckeler, M. D. (2019). Transcatheter treatment of acquired coronary sinus ostium atresia in a child with complex congenital heart disease. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.
  More info

  Congenital coronary sinus ostium atresia is a rare condition that is typically considered benign, as long as there is adequate drainage via another route. However, in children with single ventricle congenital heart disease, adequate drainage may not be assured after complex surgical interventions, putting them at risk for myocardial injury. We present a patient with complex single ventricle congenital heart disease who developed acquired coronary sinus ostium atresia after surgical intervention that was treated by a transcatheter approach to prevent the sequelae of coronary sinus hypertension.
• Seckeler, M. D., White, S. C., Klewer, S. E., & Ott, P. (2019). Transjugular Transseptal Approach for Left Ventricular Pacing Lead in an Adult With Criss-Cross Heart. JACC. Clinical electrophysiology, 5(8), 998-999.
• Vergales, J., Seckeler, M. D., Chew, J., & Gangemi, J. (2019). Prevalence of Culture-Negative Fever in Infants With Down Syndrome Undergoing Cardiac Surgery. World journal for pediatric & congenital heart surgery, 10(5), 599-603.
  More info

  Children with Down syndrome (DS) often have congenital heart disease that requires surgical repair in the first year. Anecdotally, we have noted that patients with DS seem to have a higher rate of culture-negative postoperative fever. The objective was to evaluate the prevalence of postoperative fever and recovery among patients with DS undergoing cardiac surgery.
• Andrews, J., Heller, E., Klewer, S. E., Meziab, O., Moe, T. G., Seckeler, M. D., & Thomas, I. D. (2018). Higher Cost of Hospitalizations for Non-cardiac Diagnoses in Adults with Congenital Heart Disease.. Pediatric cardiology, 39(3), 437-444. doi:10.1007/s00246-017-1770-y
  More info

  Adults with congenital heart disease (CHD) are a rapidly increasing population and their impact on healthcare resources is not fully understood. The purpose of this study was to describe the costs of hospitalizations for non-cardiac disease for adults with CHD. We conducted a retrospective review of hospital discharge data from the University HealthSystem Consortium Clinical Data Base/Resource Manager from January 2011 through December 2013. Patients were ≥ 18 years old at admission with any ICD-9 code for moderate or high severity CHD; cardiac surgical admissions were excluded. The comparison group consisted of patients ≥ 18 years old with no ICD-9 codes for any severity CHD. There were 9,169,700 non-CHD, 28,224 moderate CHD, and 3045 high severity CHD hospital admissions. Total length of stay was longer for acute kidney injury, depressive disorder, esophageal reflux, and obstructive sleep apnea for any severity CHD; ICU admission rates were higher for all diagnoses with any severity CHD. Mean observed direct costs were higher for all diagnoses for moderate CHD and all diagnoses except dehydration, type 2 diabetes, obesity, and obstructive sleep apnea for high severity CHD. This review identified significantly increased hospitalization costs for adults with moderate and high severity CHD who are admitted for non-cardiac medical conditions not associated with concomitant cardiac surgical procedures. Admissions with CHD diagnoses had higher ICU admission rates, longer lengths of stay, and higher mortality for most non-cardiac admission diagnoses. These data will add to our understanding of the economic impact of adults with CHD.
• Combs, D., Skrepnek, G., Seckeler, M. D., Barber, B. J., Morgan, W. J., & Parthasarathy, S. (2018). Sleep-Disordered Breathing is Associated With Increased Mortality in Hospitalized Infants With Congenital Heart Disease. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(9), 1551-1558.
  More info

  Sleep-disordered breathing (SDB) has adverse cardiovascular effects in children and adults. In adults with cardiac disease, SDB is highly prevalent and confers increased mortality risk. It is unknown if SDB confers a similar risk in infants with congenital heart disease (CHD). We evaluated clinical and economic outcomes associated with SDB among inpatient infants with CHD in the United States from 1997-2012.
• Haughey, B., Seckeler, M. D., & White, S. C. (2018). INCIDENCE, OUTCOMES AND COSTS OF CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN CHILDREN UNDERGOING CONGENITAL CARDIAC SURGERY. Journal of the American College of Cardiology, 71(11), A631. doi:10.1016/s0735-1097(18)31172-0
  More info

  Catheter-associated bloodstream infections (CABSI) complicate and prolong hospitalizations. The incidence of CABSI has not been reported for children undergoing congenital cardiac surgery (CCS). This study sought to define the incidence of CABSI after CCS in children ≤12 months old and compare
• Jones, T. W., Seckeler, M. D., Sedler, J., & White, S. C. (2018). USE OF THREE-DIMENSIONAL MODELS OF CONGENITAL HEART DEFECTS TO ENHANCE RESIDENT EDUCATION. Journal of the American College of Cardiology, 71(11), A2642. doi:10.1016/s0735-1097(18)33183-8
  More info

  Applications of three-dimensional (3D) printed models in medicine include pre-procedure planning, patient education and clinical training. The ability to reproduce complex anatomy as a tangible 3D printed model can be particularly useful for understanding congenital heart defects (CHD). We
• Lawson, E. N., & Seckeler, M. D. (2018). Successful Percutaneous Recanalization of a Chronically Occluded Inferior Vena Cava in a Young Child. World journal for pediatric & congenital heart surgery, 2150135118771316.
  More info

  Young children with congenital heart disease are undergoing an increasing number of catheter-based interventions. These procedures can lead to obstruction of large central veins, making future interventions more challenging or even impossible. We present a young child with a chronically occluded inferior vena cava (IVC) secondary to prior catheterization-based interventions for congenital heart disease. The IVC was recanalized with serial angioplasty and stent placement with continued patency for over two years. Despite the long duration of obstruction, the IVC was successfully recanalized, eliminating the potential consequences of long-term IVC obstruction and making it easier for future catheter-based interventions, if needed.
• Seckeler, M. D., White, S. C., & Fox, K. A. (2018). Increased risk of intraventricular hemorrhage in low birth weight infants with aortic coarctation. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 1-3.
  More info

  To determine if there is an association between aortic coarctation (CoA) and intraventricular hemorrhage (IVH) in low birth weight (LBW) infants that may justify earlier intervention. While there is an increasing number of reports of successful early CoA intervention in LBW infants, there are no data to justify this approach.
• Seckeler, M. D., White, S. C., Jenkins, J., & Klewer, S. E. (2018). Treatment of tricuspid regurgitation and para-ring leak in tetralogy of Fallot with oversized SAPIEN 3 valve-in-ring implantation. Journal of cardiac surgery, 33(9), 541-544.
  More info

  A 40-year-old female with previously repaired tetralogy of Fallot had recurrent severe tricuspid regurgitation with a para-ring leak after annuloplasty ring placement. Because of multiple prior sternotomies and co-morbidities, she was not felt to be a surgical candidate. Percutaneous placement of an oversized SAPIEN 3 valve-in-ring in the tricuspid position successfully treated the regurgitation and para-ring leak.
• Seckeler, M., White, S., & Fox, K. (2018). Increased risk of intraventricular hemorrhage in low birth weight infants with aortic coarctation. The Journal of Maternal-Fetal & Neonatal Medicine. doi:10.1080/14767058.2018.1517319
• Walpert, A. S., Thomas, I. D., Lowe, M. C., & Seckeler, M. D. (2018). RSV prophylaxis guideline changes and outcomes in children with congenital heart disease. Congenital heart disease, 13(3), 428-431.
  More info

  The aim of this study was to compare inpatient outcomes and costs for children with respiratory syncytial virus and congenital heart disease before and after the change in management guidelines for respiratory syncytial virus prophylaxis.
• White, S. C., Sedler, J., Jones, T. W., & Seckeler, M. (2018). Utility of three-dimensional models in resident education on simple and complex intracardiac congenital heart defects. Congenital Heart Disease, 13(Issue 6). doi:10.1111/chd.12673
  More info

  Objective: Applications of three-dimensional (3D) printed models in medicine include preprocedure planning, patient education, and clinical training. Reproducing complex anatomy as a 3D printed model can be useful for understanding congenital heart defects (CHD). We hypothesized that using 3D printed models during didactic sessions with resident physicians will improve trainees’ understanding of CHD. Design and intervention: We performed a prospective, randomized educational intervention for teaching pediatric and pediatric/emergency medicine residents about simple (ventricular septal defect [VSD]) and moderately complex (tetralogy of Fallot [ToF]) CHD. Residents were divided into two groups: intervention and control. Each group completed a subjective survey about their comfort with the anatomy, evaluation, and treatment of VSD and ToF and took an objective test on VSD and ToF. They separately received the same 20 min lecture, including projected two-dimensional digital images of VSD and ToF; the intervention group was given 3D printed models created using the same imaging data. After the lecture, the groups repeated the survey and test questions. Results: Twenty-six residents participated in the VSD session, 34 in the ToF. There were no differences in demographics between control and intervention groups. All residents had higher subjective comfort with VSD and ToF after the lectures. There was no difference in baseline test scores for VSD or ToF groups. The control group scored higher on the VSD postlecture test. The intervention group scored higher on the ToF postlecture test. Conclusion: Incorporation of 3D printed models into lectures about CHD imparts a greater acute level of understanding, both subjective and objective, for pediatric and combined pediatric/emergency medicine residents. There does not seem to be an added benefit for understanding ventricular septal defects, but there is for tetralogy of Fallot, likely due to increased complexity of the lesion and difficulty visualizing spatial relationships in CHD with multiple components.
• White, S. C., Sedler, J., Jones, T. W., & Seckeler, M. (2018). Utility of three-dimensional models in resident education on simple and complex intracardiac congenital heart defects. Congenital heart disease, 13(6), 1045-1049.
  More info

  Applications of three-dimensional (3D) printed models in medicine include preprocedure planning, patient education, and clinical training. Reproducing complex anatomy as a 3D printed model can be useful for understanding congenital heart defects (CHD). We hypothesized that using 3D printed models during didactic sessions with resident physicians will improve trainees' understanding of CHD.
• White, S., & Seckeler, M. (2018). 3D Printing in Congenital Heart Disease: How it Can Change Management Today and Tomorrow. American College of Cardiology Website.
• Jones, T. W., & Seckeler, M. D. (2017). Use of 3D models of vascular rings and slings to improve resident education. Congenital heart disease, 12(5), 578-582.
  More info

  Three-dimensional (3D) printing is a manufacturing method by which an object is created in an additive process, and can be used with medical imaging data to generate accurate physical reproductions of organs and tissues for a variety of applications. We hypothesized that using 3D printed models of congenital cardiovascular lesions to supplement an educational lecture would improve learners' scores on a board-style examination.
• Sanchez, J. N., & Seckeler, M. D. (2017). Lower Hospital Charges and Societal Costs for Catheter Device Closure of Atrial Septal Defects. Pediatric cardiology, 38(7), 1365-1369.
  More info

  Atrial septal defects (ASD) are among the most common congenital heart defects. As more ASDs are corrected by interventional catheterization instead of surgery, it is critical to understand the associated clinical and societal costs. The goal of this study was to use a national U.S. database to describe hospital charges and societal costs for surgical and catheter-based (ASD) closure. Retrospective review of hospital discharge data from the Kids' Inpatient Database from January 2010 to December 2012. The database was queried for admissions for
• Seckeler, M. D., Lawson, E., Barber, B. J., & Klewer, S. E. (2017). Percutaneous management of complex acquired aortic coarctation in an adult with tetralogy of Fallot and pulmonary atresia. Annals of pediatric cardiology, 10(3), 295-297.
  More info

  We present the case of a female adult with complex cyanotic congenital heart disease who had long-standing thoracic aortic obstruction due to scarring from earlier surgical procedures. She was symptomatic but felt to be too high risk for surgical intervention. With careful planning, she was able to undergo successful stenting of her aorta with subsequent clinical improvement. This case highlights some of the complexities of caring for adults with congenital heart disease and the importance of a thorough understanding of their anatomy and physiology and prior interventions before undertaking interventions.
• Seckeler, M. D., Thomas, I. D., Andrews, J., Meziab, O., Moe, T., Heller, E., & Klewer, S. E. (2017). Higher Cost of Hospitalizations for Non-cardiac Diagnoses in Adults with Congenital Heart Disease. Pediatric cardiology.
  More info

  Adults with congenital heart disease (CHD) are a rapidly increasing population and their impact on healthcare resources is not fully understood. The purpose of this study was to describe the costs of hospitalizations for non-cardiac disease for adults with CHD. We conducted a retrospective review of hospital discharge data from the University HealthSystem Consortium Clinical Data Base/Resource Manager from January 2011 through December 2013. Patients were ≥ 18 years old at admission with any ICD-9 code for moderate or high severity CHD; cardiac surgical admissions were excluded. The comparison group consisted of patients ≥ 18 years old with no ICD-9 codes for any severity CHD. There were 9,169,700 non-CHD, 28,224 moderate CHD, and 3045 high severity CHD hospital admissions. Total length of stay was longer for acute kidney injury, depressive disorder, esophageal reflux, and obstructive sleep apnea for any severity CHD; ICU admission rates were higher for all diagnoses with any severity CHD. Mean observed direct costs were higher for all diagnoses for moderate CHD and all diagnoses except dehydration, type 2 diabetes, obesity, and obstructive sleep apnea for high severity CHD. This review identified significantly increased hospitalization costs for adults with moderate and high severity CHD who are admitted for non-cardiac medical conditions not associated with concomitant cardiac surgical procedures. Admissions with CHD diagnoses had higher ICU admission rates, longer lengths of stay, and higher mortality for most non-cardiac admission diagnoses. These data will add to our understanding of the economic impact of adults with CHD.
• Seckeler, M. D., Typpo, K., Deschenes, J., Higgins, R., Samson, R., & Lichtenthal, P. (2017). Inaccuracy of a continuous arterial pressure waveform monitor when used for congenital cardiac catheterization. Congenital heart disease, 12(6), 815-819.
  More info

  To determine the accuracy of a continuous cardiac output monitor (FloTrac sensor) for measuring cardiac index in children with congenital heart disease undergoing cardiac catheterization. Cardiac index is a critical hemodynamic parameter measured during catheterizations in children with congenital heart disease. This has been challenging to measure accurately and many clinicians rely on predictive equations for calculating cardiac index.
• Andrews, J., Barber, B. J., Daines, C. L., Klewer, S. E., Scherer, K., Seckeler, M. D., & Zahedieh, S. (2016). Regional and Racial Variation in Hospitalization Costs in Patients with Duchenne Muscular Dystrophy. Pediatrics, 140, 28-28. doi:10.1542/peds.140.1_meetingabstract.28
  More info

  Advances in management for Duchenne muscular dystrophy (DMD) have improved survival. The purpose of this study was to describe hospital outcomes and costs for DMD patients and to identify regional and racial variation. Retrospective review of University Health System Consortium Clinical Data Base/Resource Manager, a …
• Ashfaq, A., Seckeler, M., Pophal, S., Rhee, E., Ryan, J., Rao, R., Klewer, S., & Nigro, J. J. (2016). Integration of Hybrid and Single Ventricle Rehabilitation Techniques to Treat a Neonate After Iatrogenic Mitral Injury. World journal for pediatric & congenital heart surgery, 7(4), 498-501.
  More info

  Neonatal critical aortic stenosis is life threatening and requires intervention shortly after birth. Early percutaneous aortic valvuloplasty is generally considered to be an effective way to obtain reliable prograde flow. We describe the integrated use of hybrid, open surgical, and single ventricle rehabilitation techniques to successfully treat a neonate with borderline left-sided cardiac structures, who sustained a complication from balloon aortic valvuloplasty.
• Averin, K., Hirsch, R., Seckeler, M. D., Whiteside, W., Beekman, R. H., & Goldstein, B. H. (2016). Diagnosis of occult diastolic dysfunction late after the Fontan procedure using a rapid volume expansion technique. Heart (British Cardiac Society), 102(14), 1109-14.
  More info

  Diastolic dysfunction (DD), a key driver of long-term Fontan outcomes, may be concealed during standard haemodynamic evaluation. We sought to identify Fontan patients with occult DD using 'ventricular stress testing' with rapid volume expansion (RVE).
• Colombo, J. N., Seckeler, M. D., Barber, B. J., Krupinski, E. A., Weinstein, R. S., Sisk, D., & Lax, D. (2016). Application and Utility of iPads in Pediatric Tele-echocardiography. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 22(5), 429-33.
  More info

  Telemedicine is used with increasing frequency to improve patient care in remote areas. The interpretation of medical imaging on iPad(®) (Apple, Cupertino, CA) tablets has been reported to be accurate. There are no studies on the use of iPads for interpretation of pediatric echocardiograms. We compared the quality of echo images, diagnostic accuracy, and review time using three different modalities: remote access on an iPad Air (iPad), remote access via a computer (Remote), and direct access on a computer linked through Ethernet to the server, the "gold standard" (Direct).
• Seckeler, M. D., Thomas, I. D., Andrews, J., Joiner, K., & Klewer, S. E. (2016). A review of the economics of adult congenital heart disease. Expert review of pharmacoeconomics & outcomes research, 16(1), 85-96.
  More info

  Adults living with congenital heart disease (CHD) now outnumber children with the disease. Thanks to medical advances over the past 75 years, many of these fatal childhood heart problems have changed to chronic medical conditions. As the population of adults with CHD increases, they will require increasingly complex medical, surgical and catheter-based therapies. In addition, social burdens including education, employment and insurability, which increase the societal costs of adult CHD, are now being recognized for adults living with CHD. This review summarizes the available literature on the economics of adult CHD.
• Thomas, I. D., & Seckeler, M. D. (2016). Resource Utilization for Noncardiac Admissions in Pediatric Patients With Single Ventricle Disease. The American journal of cardiology, 117(10), 1661-1666.
  More info

  Patients with single ventricle (SV) congenital heart disease (CHD) incur high hospital costs during staged surgical palliation. Health care resource utilization for noncardiac admissions in patients with SV has not been reported. This study sought to compare costs and outcomes for common noncardiac hospital admissions between patients with SV and patients without CHD. Hospital discharge data from the University Health System Consortium from January 2011 to December 2013 was queried for patients aged ≤18 years with International Classification of Diseases, Ninth Revision (ICD-9) codes for SV lesions: hypoplastic left heart syndrome (746.7), tricuspid atresia (746.1), or common ventricle (745.3). Primary diagnosis, direct cost, length of stay (LOS), intensive care unit admission rate and mortality data were obtained. The 10 most common noncardiac admission diagnoses were compared between patients with SV and patients without CHD using t test and Fisher's exact test. Total direct cost, LOS, and intensive care unit admission rate were higher for patients with SV for all diagnoses with the exception of LOS for dehydration, which was not different between groups. Hospital mortality was significantly higher for patients with SV admitted for acute kidney injury, esophageal reflux, failure to thrive, respiratory syncytial virus bronchiolitis and pneumonia. In conclusion, our study demonstrates that patients with SV CHD admitted with noncardiac diagnoses have higher health care resource utilization compared to those without CHD. As long-term survival increases, it can be expected that this patient group will use a disproportionate amount of medical dollars. Further characterization of costs will be important so steps can be taken to reduce or prevent hospitalization in these patients.
• Andrews, J., Heller, E., Klewer, S. E., Meziab, O., Moe, T. G., Seckeler, M. D., & Thomas, I. D. (2015). HIGH RESOURCE UTILIZATION FOR NON-CARDIAC HOSPITAL ADMISSIONS FOR ADULTS WITH CONGENITAL HEART DISEASE. Journal of the American College of Cardiology, 65(10), A543. doi:10.1016/s0735-1097(15)60543-5
• Rischard, F., Vanderpool, R., Jenkins, I., Dalabih, M., Colombo, J., Lax, D., & Seckeler, M. (2015). Selective pulmonary vasodilation improves ventriculovascular coupling and gas exchange in a patient with unrepaired single-ventricle physiology. Pulmonary circulation, 5(2), 407-11.
  More info

  We describe a 63-year-old patient with unrepaired tricuspid valve atresia and a hypoplastic right ventricle (single-ventricle physiology) who presented with progressive symptomatic hypoxia. Her anatomy resulted in parallel pulmonary and systemic circulations, pulmonary arterial hypertension, and uncoupling of the ventricle/pulmonary artery. Hemodynamic and coupling data were obtained before and after pulmonary vasoactive treatment, first inhaled nitric oxide and later inhaled treprostinil. The coupling ratio (ratio of ventricular to vascular elastance) shunt fractions and dead space ventilation were calculated before and after treatment. Treatment resulted in improvement of the coupling ratio between the ventricle and the vasculature with optimization of stroke work, equalization of pulmonary and systolic flows, a decrease in dead space ventilation from 75% to 55%, and a significant increase in 6-minute walk distance and improved hypoxia. Inhaled treprostinil significantly increased 6-minute walk distance and improved hypoxia. This is the first report to show that pulmonary vasoactive treatment can be used in a patient with unrepaired single-ventricle anatomy and describes the hemodynamic effects of inhaled therapy on ventriculovascular coupling and gas exchange in the pulmonary circulation in this unique physiology.
• Seckeler, M. D., Gordon, B. M., Williams, D. A., & Goldstein, B. H. (2015). Use of Smart Technology for Remote Consultation in the Pediatric Cardiac Catheterization Laboratory. Congenital heart disease, 10(6), E288-94.
  More info

  To evaluate the use of smartphone and tablet technology ("smart technology" or ST) in remote consultation for pediatric and congenital cardiac catheterization.
• Seckeler, M. D., Hirsch, R., Beekman, R. H., & Goldstein, B. H. (2015). A new predictive equation for oxygen consumption in children and adults with congenital and acquired heart disease. Heart (British Cardiac Society), 101(7), 517-24.
  More info

  To develop a new predictive equation for oxygen consumption (VO2) in children and adults with congenital and acquired heart disease.
• Seckeler, M. D., Moe, T. G., Thomas, I. D., Meziab, O., Andrews, J., Heller, E., & Klewer, S. E. (2015). Hospital Resource Utilization for Common Noncardiac Diagnoses in Adult Survivors of Single Cardiac Ventricle. The American journal of cardiology, 116(11), 1756-61.
  More info

  Single ventricle congenital heart disease (SV CHD) has transformed from a nearly universally fatal condition to a chronic illness. As the number of adults living with SV CHD continues to increase, there needs to be an understanding of health care resource utilization (HCRU), particularly for noncardiac conditions, for this patient population. We performed a retrospective database review of the University HealthSystem Consortium Clinical Database/Resource Manager for adult patients with SV CHD hospitalized for noncardiac conditions from January 2011 to November 2014. Patients with SV CHD were identified using International Classification of Disease (ICD)-9 codes associated with SV CHD (hypoplastic left heart, tricuspid atresia, and SV) and stratified into 2 groups by age (18 to 29 years and 30 to 40 years). Direct cost, length of stay (LOS), intensive care unit (ICU) admission rate and mortality data were compared with age-matched patients without CHD. There were 2,083,651 non-CHD and 590 SV CHD admissions in Group 1 and 2,131,046 non-CHD and 297 SV CHD admissions in Group 2. There was no difference in LOS in Group 1, but there were higher costs for several diagnoses. LOS and costs were higher for several diagnoses in Group 2. ICU admission rate and in-hospital mortality were higher for several diagnoses for patients with SV CHD in both groups. In conclusion, adults with SV CHD admitted for noncardiac diagnoses have higher HCRU (longer LOS and higher ICU admission rates) compared with similarly aged patients without CHD. These findings stress the importance of good primary care in this population with complex, chronic cardiac disease to prevent hospitalizations and higher HCRU.
• Seckeler, M. D., O'Leary, E., & Anitha Jayakumar, K. (2015). Ventricular morphology is a determinant of diastolic performance in patients with single ventricle physiology undergoing stage 3 palliative surgery. Pediatric cardiology, 36(4), 732-6.
  More info

  Patients with single ventricle anatomy undergo staged surgical palliation which results in pulmonary and systemic circulations in series with a single systemic pump. Single right ventricular morphology has been found to be an independent risk factor for worse survival. We sought to compare patients with single left (SLV) and single right (SRV) ventricular morphology to identify hemodynamic differences that may contribute to worse survival in patients with a single right ventricular. Single center, retrospective review of invasive hemodynamic data. All patients with single ventricle anatomy who underwent superior cavo-pulmonary anastomosis (Stage 2 palliation) and/or total cavo-pulmonary anastomosis (Stage 3 palliation) from August 1995 through May 2011 were identified. Patients were compared over time, and SLV and SRV patients were compared. Seventy-nine single ventricle patients (56 % SRV) underwent staged palliation and were analyzed. There was no difference in overall mortality (12 % SLV, 11 % SRV). There was no difference in hemodynamics at pre-Stage 2 catheterization between ventricular morphology, but SRV patients had higher ventricular end-diastolic pressure at pre-Stage 3 catheterization (7.6 vs. 6.4 mmHg, p = 0.026). End-diastolic pressure decreased after Stage 2 surgery for SLV patients, but not SRV patients. Intrinsic differences in morphology, function, and response to performing as the systemic ventricle between single right and left ventricles may lead to an elevated ventricular end-diastolic pressure. This could limit passive flow through the pulmonary circuit and coronary perfusion after Stage 3 palliation and potentially lead to poorer long-term performance for SRV patients.
• Averin, K., Beekman, R. H., Goldstein, B. H., Hirsch, R., & Seckeler, M. D. (2014). Abstract 12791: Acute Volume Loading During Invasive Testing Identifies Fontan Survivors With Occult Diastolic Dysfunction. Circulation, 130.
  More info

  Introduction: Invasive hemodynamic assessment of the Fontan patient is often unrevealing, even in the presence of clinical symptoms. Diastolic dysfunction (DD), a key driver of long-term clinical outcomes, may frequently be concealed during standard hemodynamic evaluation. Hypothesis: Volume loading during invasive assessment may identify Fontan patients with occult DD. Methods: Single center record review of cardiac catheterizations with volume loading in Fontan patients from 2012 - 2014. Patients with baseline DD, defined as a ventricular end diastolic pressure of ≥ 15 mmHg, were excluded. Following acquisition of baseline data, a 15 ml/kg normal saline intravenous bolus was administered rapidly. After a 5 min equilibration phase, hemodynamics were reassessed. Comparisons were made using paired Student’s t -test. Risk factors for occult DD were assessed using Wilcoxon rank-sum test. Results: Twenty-three Fontan patients (48% female, 74% left ventricular morphology) were included. Median age was 17.7 (IQR 7.5, 21.4) years and mean duration of Fontan circulation was 12.9 ± 9.1 years. Hemodynamic data are shown in Table 1. Volume loading revealed occult DD in 8 (35%) patients (Fig 1). Age (21.3 vs. 11.8 years, p=0.05) and duration of Fontan circulation (21.1 vs. 10.6 years, p=0.04) were associated with occult DD, whereas ventricular morphology was not. There were no adverse events related to volume loading. Conclusions: Occult DD is common in Fontan patients, and may be identified with volume loading during invasive hemodynamic assessment. Older age and longer duration of Fontan circulation were associated with a greater likelihood of occult DD.
• Carmody, J. B., Seckeler, M. D., Ballengee, C. R., Conaway, M., Jayakumar, K. A., & Charlton, J. R. (2014). Pre-operative renal volume predicts peak creatinine after congenital heart surgery in neonates. Cardiology in the young, 24(5), 831-9.
  More info

  Acute kidney injury is common in neonates following surgery for congenital heart disease. We conducted a retrospective analysis to determine whether neonates with smaller pre-operative renal volume were more likely to develop post-operative acute kidney injury.
• Seckeler, M. D., Hirsch, R., Beekman, R. H., & Goldstein, B. H. (2014). Validation of cardiac output using real-time measurement of oxygen consumption during cardiac catheterization in children under 3 years of age. Congenital heart disease, 9(4), 307-15.
  More info

  To validate a method for determination of cardiac index (CI) using real-time measurement of oxygen consumption (VO2 ) in young children undergoing cardiac catheterization.
• Seckeler, M. D., Villa, C., & Hirsch, R. (2014). Percutaneous recanalization of occluded brachiocephalic vein-superior vena cava connection after resection of mediastinal mass. JACC. Cardiovascular interventions, 7(7), e69-70.
• White, S. C., Seckeler, M. D., McCulloch, M. A., Buck, M. L., Hoke, T. R., & Haizlip, J. A. (2014). Patients with single ventricle anatomy may respond better to octreotide therapy for chylothorax after congenital heart surgery. Journal of cardiac surgery, 29(2), 259-64.
  More info

  Chylothorax (CTX) occurs in 3% to 6% of children after surgery for congenital heart disease with significant morbidity and mortality. Octreotide has been proposed as therapy, but there are no predictors of response. The objective of this study was to identify possible predictors of response to octreotide.
• Beekman, R. H., Goldstein, B. H., Hirsch, R., & Seckeler, M. D. (2013). Abstract 17467: Development and Validation of an Accurate Predictive Equation for Oxygen Consumption in Congenital Heart Disease. Circulation, 128.
• Beekman, R. H., Goldstein, B. H., Hirsch, R., & Seckeler, M. D. (2013). OXYGEN CONSUMPTION ASSUMPTIONS ARE INACCURATE IN YOUNG CHILDREN WITH COMPLEX CONGENITAL HEART DISEASE. Journal of the American College of Cardiology, 61(10), E546. doi:10.1016/s0735-1097(13)60546-x
  More info

  Oxygen consumption (VO2) is necessary for the determination of blood flow and vascular resistance during cardiac catheterization. Since measurement of VO2 is cumbersome, most catheterization labs forgo VO2 measurement (M-VO2) in favor of an assumed VO2 (A-VO2) derived from predictive equations, with
• Buck, M. L., Haizlip, J. A., Hoke, T. R., McCulloch, M. A., Seckeler, M. D., & White, S. C. (2013). Patients with Single Ventricle Anatomy May Respond Better to Octreotide Therapy for Chylothorax After Congenital Heart Surgery: OCTREOTIDE FOR CHYLOTHORAX. Journal of Cardiac Surgery, 29(2), 259-264. doi:10.1111/jocs.12263
  More info

  Background and Aims Chylothorax (CTX) occurs in 3% to 6% of children after surgery for congenital heart disease with significant morbidity and mortality. Octreotide has been proposed as therapy, but there are no predictors of response. The objective of this study was to identify possible predictors of response to octreotide. Methods Single-center retrospective review of patients who developed CTX after cardiac surgery. Data collected included demographics, cardiac lesion, surgical data, hospital course, CTX volume and duration, and interventions for CTX. Patients who received octreotide as part of their therapy were compared to those who did not. Results A total of 1150 patients underwent 1455 cardiac surgeries with 67 (4.6%) episodes of CTX. Patients with CTX were younger, lower weight, more likely to undergo cardiopulmonary bypass, and had higher RACHS-1 scores and mortality. Nineteen patients with CTX received octreotide as part of their treatment and six (32%) had at least 50% reduction in CTX volume. Patients who responded to octreotide had lower CTX volume (18 mL/kg/day vs. 55 mL/kg/day, p = 0.023) and a higher proportion of patients with single ventricle anatomy (67% vs. 18%, p = 0.046). Conclusions There is a subset of patients who seem to respond to octreotide, but they have lower CTX volume and may have already been improving before octreotide therapy. Patients with single ventricle anatomy seemed to respond to octreotide and may benefit from its use. doi: 10.1111/jocs.12263 (J Card Surg 2014;29:259–264)
• Hallowell, S., Jayakumar, K. A., Saunders, C. H., Schneider, D. S., Seckeler, M. D., & West, S. C. (2013). Predicting Myocardial Recovery in Children with Dilated Cardiomyopathy. Journal of Heart and Lung Transplantation, 32(4), S240. doi:10.1016/j.healun.2013.01.616
  More info

  Purpose Dilated cardiomyopathy (DCM) is a common indication for heart transplantation (Tx) in children but not all progress to Tx. Standard 2D echocardiography (2DE) and Doppler techniques do not predict which patients will recover function. Myocardial function can be reliably determined using Velocity Vector Imaging (VVI), an angle independent method of evaluating myocardial mechanics using conventional 2DE images. We believe VVI provides a valid and reproducible measure of myocardial function in DCM patients with correlation to clinical outcomes. Methods and Materials Medical records and 2DEs were retrospectively reviewed on patients with DCM. VVI analysis was performed offline using Siemens Syngo software. Using VVI on a 4 chamber image, longitudinal velocity (LVel), strain (S), strain rate (SR) were obtained. Ventricular functional parameters were compared to normal. Results 22 patients were treated for DCM − 8 patients recovered function, 4 patients underwent Tx, 3 patients were listed for Tx, 7 patients died without recovering or while awaiting Tx. Mortality was associated with mechanical, ventilatory support, and renal failure. The overall mortality rate was 36% (8/28). LVel, S, and SR were decreased compared to normal in all groups. LVel, S, and SR were statistically different in those who progressed to Tx and listed for Tx compared to those who did recover. S and SR did not return to normal even in the group who clinically recovered. Ejection fraction and 2DE dimensions correlated with VVI parameters. Conclusions VVI derived myocardial functional parameters do not return to normal despite clinical recovery and return to normal of conventional 2DE parameters. VVI is an effective tool to predict degree of myocardial recovery and serves as an adjunct to conventional 2DE measures of systolic and diastolic function.
• Han, L. M., Klewer, S. E., Blank, K. M., Seckeler, M. D., & Barber, B. J. (2013). Feasibility of pulse oximetry screening for critical congenital heart disease at 2643-foot elevation. Pediatric cardiology, 34(8), 1803-7.
  More info

  To evaluate the feasibility of implementing a pulse oximetry screening protocol at a city of mild elevation with a specific focus on the false-positive screening rate. Pulse oximetry screening was performed according to the proposed guidelines endorsed by the American Academy of Pediatrics at a center in Tucson, AZ, at an elevation of 2,643 ft (806 m). During a 10-month period in 2012, 1069 full-term asymptomatic newborns were screened ≥ 24 h after birth. The mean preductal oxygen saturation was 98.5 ± 1.3 % (range 92-100 %), and the mean postductal oxygen saturation was 98.6 ± 1.3 % (range 94-100 %). Of 1,069 patients screened, 7 were excluded secondary to protocol violations, and 1 screened positive. An echocardiogram was performed on the newborn with the positive screen, and it was normal with the exception of right-to-left shunting across a patent foramen ovale. The false-positive rate was 1/1,062 or 0.094 %. The pulse oximetry screening guidelines recommended by the American Academy of Pediatrics are feasible at an elevation of 2,643 ft (806 m) with a low false-positive rate. Adjustments to the protocol are not required for centers at elevations ≤ 2,643 ft. Future studies at greater elevations are warranted.
• Raucci, F. J., Seckeler, M. D., Saunders, C., Gangemi, J. J., Peeler, B. B., & Jayakumar, K. A. (2013). Right-ventricular global longitudinal strain may predict neo-aortic arch obstruction after Norwood/Sano procedure in children with hypoplastic left heart syndrome. Pediatric cardiology, 34(8), 1767-71.
  More info

  Neo-aortic arch obstruction (NAAO) is a common complication following the Norwood/Sano procedure (NP) for hypoplastic left heart syndrome (HLHS) and is associated with increased morbidity and mortality. However, there is currently no objective method for predicting which patients will develop NAAO. This study was designed to test the hypothesis that hemodynamic changes from development of NAAO after NP in patients with HLHS will lead to changes in myocardial dynamics that could be detected before clinical symptoms develop with strain analysis using velocity vector imaging. Patients with HLHS who had at least one cardiac catheterization after NP were identified retrospectively. Strain analysis was performed on all echocardiograms preceding the first catheterization and any subsequent catheterization performed for intervention on NAAO. Twelve patients developed NAAO and 30 patients never developed NAAO. Right ventricular strain was worse in the group that developed NAAO (-6.2 vs. -8.6 %, p = 0.040) at a median of 59 days prior to diagnosis of NAAO. Those patients that developed NAAO following NP were significantly younger at the time of first catheterization than those that did not develop NAAO (92 ± 50 vs. 140 ± 36 days, p = 0.001). This study demonstrates that right ventricular GLS is abnormal in HLHS patients following NP and worsening right ventricular strain may be predictive of the future development of NAAO.
• Seckeler, M. D., D'Souza, M. D., Gangemi, J. J., Hoyer, A. W., & Jayakumar, K. A. (2013). Thrombotic occlusion of extracardiac conduit 4 months after Fontan surgery. Texas Heart Institute journal, 40(3), 360-1.
• Seckeler, M. D., Raucci, F. J., Saunders, C., Gangemi, J. J., Peeler, B. B., & Jayakumar, K. A. (2013). Head and neck vessel size by angiography predicts neo-aortic arch obstruction after Norwood/Sano operation for hypoplastic left heart syndrome. The Journal of invasive cardiology, 25(2), 73-5.
  More info

  To identify and predict neo-aortic arch obstruction (NAAO) in children after Norwood/Sano operation (NO) for hypoplastic left heart syndrome (HLHS).
• Jayakumar, K. A., Saunders, C., Seckeler, M. D., West, S. C., & White, S. C. (2012). VENTRICULAR INTERDEPENDENCE: EFFECT OF CHRONIC RIGHT VENTRICULAR PRESSURE OR VOLUME LOAD ON BIVENTRICULAR MYOCARDIAL MECHANICS. Journal of the American College of Cardiology, 59(13), E1150. doi:10.1016/s0735-1097(12)61151-6
  More info

  Changes in right ventricle (RV) loading conditions and pressure alter left ventricle (LV) myocardial mechanics. Pediatric patients with chronic RV pressure load [valvar pulmonary stenosis – PS] or volume load [secundum atrial septal defect – ASD], who underwent catheter intervention
• Seckeler, M. D., Mery, C. M., Gangemi, J. J., Peeler, B. B., & Jayakumar, K. A. (2012). An angiographic predictor of pulmonary artery stenosis after the Norwood-Sano operation for hypoplastic left heart syndrome. Pediatric cardiology, 33(8), 1281-7.
  More info

  The objective of this study was to determine angiographic predictors of future pulmonary artery stenosis (PS) in patients with hypoplastic left heart syndrome (HLHS) at the time of pre-stage 2 cardiac catheterization (PS2C). The Sano modification of the Norwood operation (NSO) for HLHS includes placement of a right ventricle-to-pulmonary artery (RV-PA) conduit. Branch PS is a recognized complication. Data from patients with HLHS who underwent NSO from 2005 to 2009 and who underwent PS2C were reviewed retrospectively. Nakata and McGoon indices were calculated in the traditional fashion, and modified Nakata and McGoon indices were calculated using the narrowest branch PA diameters. Thirty-three patients underwent NSO and 28 patients underwent PS2C. Mean follow-up was 35.8 ± 7.5 months. Ten (36 %) patients had significant left branch PS, with two requiring balloon angioplasty and eight requiring stent placement, a median of 15.2 months after PS2C (interquartile range 1.2, 32.8). The modified Nakata index was predictive of future intervention for left PS (receiver operating characteristic curve area under the curve 0.811), with a cut-off of 135 mm(2)/m(2) and a sensitivity of 100 % and specificity of 72.2 %. A modified Nakata index
• Mery, C. M., Lapar, D. J., Seckeler, M. D., Chamberlain, R. S., Gangemi, J. J., Kron, I. L., & Peeler, B. B. (2011). Pulmonary artery and conduit reintervention rates after norwood using a right ventricle to pulmonary artery conduit. The Annals of thoracic surgery, 92(4), 1483-9; discussion 1489.
  More info

  There is a high incidence of cardiovascular reinterventions in patients undergoing a Norwood procedure (NP). The goal of this study was to analyze the rate of pulmonary artery (PA) and conduit stenosis using the right ventricle (RV)-to-PA modification of the NP.
• Seckeler, M. D., & Hoke, T. R. (2011). The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clinical epidemiology, 3, 67-84.
  More info

  Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns around the world. Despite decreasing incidence, there is still a significant disease burden, especially in developing nations. This review provides background on the history of ARF, its pathology and treatment, and the current reported worldwide incidence of ARF and prevalence of RHD.
• Seckeler, M. D., Lim, D. S., & Kron, I. L. (2011). Coronary abscess in an adolescent with a structurally normal heart. Journal of the American College of Cardiology, 58(7), e13.
• Seckeler, M. D., Barton, L. L., & Brownstein, R. (2010). The persistent challenge of rheumatic fever in the Northern Mariana Islands. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 14(3), e226-9.
  More info

  Acute rheumatic fever (ARF) is a major cause of morbidity and mortality in developing nations. The objective of this study was to determine the disease burden of ARF among the indigenous and non-indigenous populations of the Northern Mariana Islands.
• Seckeler, M. D., Hoke, T. R., Gurka, M. J., & Barton, L. L. (2010). No demonstrable effect of benzathine penicillin on recurrence of rheumatic Fever in pacific island population. Pediatric cardiology, 31(6), 849-52.
  More info

  Compliance with secondary antibiotic prophylaxis for acute rheumatic fever (ARF) should decrease the rate of recurrence; however, efficacy in a highly endemic area has not been studied. A retrospective chart review of patients
• Seckeler, M. D., & Linden, J. (2008). Maternal abetalipoproteinemia resulting in multiple fetal anomalies. Neonatology, 94(4), 310-3.
  More info

  Abetalipoproteinemia is a rare genetic condition that results in an inability of the body to absorb dietary fats, including fat-soluble vitamins. Deficiencies of these vitamins are known to cause a wide range of clinical effects ranging from blindness to coagulopathy and neuropathy. We present the case of a child with multisystem anomalies born to a mother with abetalipoproteinemia and provide a brief review of the literature about vitamin A and fetal development. Mothers at high risk for vitamin deficiencies should be screened and counseled on the potential benefits, and risks, of vitamin supplementation.

Proceedings Publications

• Benton, L. D., Kops, S. A., Kowalek, K., Munoz, F. A., & Seckeler, M. D. (2020). Longer Length of Stay and Higher Hospital Charges for Status Asthmaticus in Children with Comorbid Psychiatric Disorders. In B52. PEDIATRIC ASTHMA AND ALLERGY.
• Myles, R., Kylathu, R., Witte, M. H., Seckeler, M., & Klewer, S. E. (2019, September). The "Failing Fontan" Challenge to the Cardiolymphologist: Case Analysis. In 27th World Congress of Lymphology Abstract Booklet.

Presentations

• Barnes, T., Erickson, R. P., & Witte, M. H. (2023, Fall). Non-Invasive Peripheral and Central Lymphatic Imaging in Neonates and Young Children with Lymphatic Disorders. 29th World Congress of Lymphology. Genoa, Italy: International Society of Lymphology.
• Caryl, N., Hoyer, A., Yaddanapudi, K., Chandra, S., Camarena, M., Meziab, O., Chatterjee, A., & Seckeler, M. (2023, May). Not every TIA is a PFO – the importance of other shunts. The Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions. Phoenix, Arizona.
• Chandra, S., Seckeler, M., Meziab, O., Chatterjee, A., Caryl, N., Hoyer, A., Caryl, N., Hoyer, A., Chatterjee, A., Meziab, O., Chandra, S., & Seckeler, M. (2023, May). 3D printing of patient-specific intravascular stents for congenital heart disease – proof of concept. The Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions. Phoenix, Arizona.
• Dereszkiewicz, E., Meziab, O., Guerrero, C. E., Hoyer, A., Barber, B. J., Klewer, S. E., & Seckeler, M. (2023, March). Negative Effect of Bundle Branch Block on Exercise Performance in Patients with Fontan Physiology (from the Pediatric Heart Network Fontan Public Data Set) . American College of Cardiology ACC.23/WCC Scientific Sessions. New Orleans, Louisiana.
• Seckeler, M. (2023, August). 3D Imaging 101: From DICOM to STL to 3D printing and CFD. 8th World Congress of Pediatric Cardiology and Cardiac Surgery. Washington, DC.
• Seckeler, M. (2023, June). Cath Lab Café – Pulmonary Valve Implant. CSI Frankfurt 2023. Frankfurt, Germany.
• Seckeler, M. (2023, May). Panelist, "I Nailed It!" Session. The Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions. Phoenix, Arizona.
• Rischard, F., Seckeler, M., Chatterjee, A., Insel, M., Kubba, S., Tandon, S., Sher, A., & Habib, N. (2022, May). To Drain or Not to Drain: Hemodynamic Charcterization of Tamponade in Pulmonary Arterial Hypertension. American Thoracic Society 2022. San Francisco, CA.
• Strah, D. D., Weinberger, K., Kowalek, K., Hoyer, A., & Seckeler, M. (2021, September). Enalapril improves pulmonary artery pressure for infants with single systemic right ventricles – Analysis of the Pediatric Heart Network Infant Single Ventricle public use dataset. Pediatric and Adult Interventional Cardiac Symposium 2021. Las Vegas, Nevada.
• Yrun-Duffy, M., Strah, D., Fox, K., Klewer, S. E., & Seckeler, M. (2022, May). An unusual congenital aorto-pulmonary shunt in tetralogy of Fallot: Anomalous left innominate artery off the pulmonary artery. The Society for Cardiovascular Angiography and Interventions 2022 Scientific Sessions. Atlanta, GA.
• Seckeler, M., Pineda, J. E., & Lotun, K. (2020, March). Recanalization of a Chronically Occluded Left Pulmonary Artery Due to Fibrosing Mediastinitis. American College of Cardiology 69th Annual Scientific Session/World Congress of Cardiology. Chicago, IL.
  More info

  Oral presentation of interesting case. Conference cancelled due to COVID-19 pandemic.
• Vanderpool, R., Rischard, F., & Seckeler, M. (2020, September). Long-term hemodynamic benefits after ‘treat-to-close’ for intracardiac shunts and pulmonary hypertension. European Respiratory Society International Congress 2020. Vienna, Austria.
  More info

  Virtual event due to COVID-19 pandemic
• Bernardi, A., Moses, S., Barber, B. J., Witte, M. H., & Seckeler, M. (2019, October). Higher incidence of protein-losing enteropathy in patients with single systemic right ventricle. Finalist, Young Investigator Award, 2019 American Academy of Pediatrics National Conference & Exhibition. New Orleans, LA.
• Colombo, J., Bernardi, A., Andrews, J. G., Klewer, S. E., & Seckeler, M. (2019, November). Marked Decline in Exercise Performance for Adolescents with Fontan Physiology – An Analysis of the Pediatric Heart Network Fontan Public Data Set. American Heart Association 2019 Scientific Sessions. Philadelphia, PA.
• Klewer, S. E., Seckeler, M., Witte, M. H., Kylathu, R., & Myles, R. (2019, September). The "Failing Fontan" Challenge to the Cardiolymphologist: Case Analysis. 27th World Congress of Lymphology. Buenos Aires and Iguazu, Argentina: International Society of Lymphology.
• Seckeler, M., Moedano, L., Kalb, B. T., Saranathan, M., Galons, J., & Witte, M. H. (2019, September). Non-Contrast MR Lymphology of Rare Central Lymphatic Abnormalities. International Society of Lymphology XXVII World Congress 2019. Buenos Aires, Argentina.
• Witte, M. H., Galons, J., Saranathan, M., Kalb, B. T., Moedano, L., & Seckeler, M. (2019, September). Non-Contrast MR Lymphology of Rare Central Lymphatic Abnormalities. 27th World Congress of Lymphology 2019. Buenos Aires, Argentina.
• Boyer, P. J., & Seckeler, M. (2018, April). Adult Congenital Heart Catheterization: Pediatric or Adult Facility? Trends Accross Hospital Models. The Society for Cardiovascular Angiography and Interventions 2018 Scientific Sessions. San Diego, CA.
• Seckeler, M. (2018, March). Starting a 3D Printing Program. American College of Cardiology 67th Annual Scientific Sessions.
• Seckeler, M. (2018, May). You can start your own 3-D printing program. The Society for Cardiovascular Angiography and Interventions 2018 Scientific Sessions.
• Seckeler, M. (2016, October). Starting a 3-D printing program “on the cheap”. International Symposium on 3D Imaging for Interventional Catheterization in CHD. Columbus, Ohio.

Poster Presentations

• Batatinha, H., Niemiro, G. M., Pena, N., Hoskin, G., Mylabathula, P., Baker, F. L., Zuniga, T., Smith, K. A., Diak, D., Seckeler, M., Simpson, R., & Katsanis, E. (2024, April). Acute systemic beta-adrenergic receptor activation to improve graft composition and outcomes in hematopoietic stem cell transplantation. American Association for Cancer Research Annual Meeting 2024. San Diego.
• Bose, C., Chin, C., Caryl, N., Meziab, O., Barber, B. J., Andrews, J. G., & Seckeler, M. (2024, November). Hospital Outcomes of Patients With Type I Diabetes Mellitus and Moderate and Severe Congenital Heart Disease. American Heart Association 2024 Scientific Sessions. Chicago.
• Caryl, N., Macaraeg, M., Bose, C., Meziab, O., Guerrero, C., Andrews, J. G., Barber, B. J., & Seckeler, M. (2024, November). Incidence of Autoimmune Disease in Patients with Congenital Heart Disease. American Heart Association 2024 Scientific Sessions. Chicago.
• Habib, A., Ravi, S., Kim, N., Chatterjee, A., & Seckeler, M. (2024, June). Innovative Approaches: Solving ASD Device Retrieval Challenges Beyond the Cath Lab Norm. CRF New York Valves, The Structural Heart Summit, New York. New York.
• Hendrickson, A., Caryl, N., Meziab, O., Andrews, J. G., Barber, B. J., & Seckeler, M. (2024, November). Association Between G6PD Deficiency and Congenital Heart Disease Incidence and Hospital Outcomes. American Heart Association 2024 Scientific Sessions. Chicago.
• Kleinsasser, R., Meziab, O., Seckeler, M., & Klewer, S. E. (2024, November). No Change in Endocarditis Rates in Patients with Congenital Heart disease During the COVID-19 Pandemic. AMA Research Challenge (virtual event). Virtual.
• Maxfield, K., Melcher, L., Bottrill, K., Provencio-Dean, N., Hoyer, A., Seckeler, M., Klewer, S. E., Edgin, J., & Combs, D. A. (2024, June). Insomnia, Mood, and Quality of Life in Children and Young Adults with Congenital Heart Disease. SLEEP 2024. Houston.
• Methuku, V., Kowalek, K. A., Price, N., Bliss, A., Fox, K., & Seckeler, M. (2024, November).

  Lightning can strike twice: management of an infant with ALCAPA complicated by coccidioidomycosis infection

  . 2024 Arizona Chapter Annual Scientific Meeting. Tucson.
• Ravi, S., Habib, A., Kim, N., Seckeler, M., Ford, P., & Chatterjee, A. (2024, June). When the Watchman leaves the door ajar, just a bit!. CRF New York Valves, The Structural Heart Summit. New York.
• Seckeler, M., Hoyer, A., Klewer, S. E., Barber, B. J., & Chatterjee, A. (2024, September). 3D modelling to plan transcatheter closure of an inferior sinus venosus defect. Pediatric and Adult Interventional Cardiac Symposium 2024. San Diego.
• Yatsenko, V., Mathena, S., Andrews, J. G., Barber, B. J., Hoyer, A., Fox, K., Meziab, O., Guerrero, C., Klewer, S. E., & Seckeler, M. (2024, November). Healthcare utilization trends for adolescents and young adults with moderate and severe congenital heart disease. American Heart Association 2024 Scientific Sessions. Chicago.
• Zhang, B., Seckeler, M., & Ford, P. (2024, May). Acute Post-operative Outcomes of Coronary Artery Bypass Grafting with Regional Anesthesia; a Retrospective Study. 61st Annual Western Anesthesia Resident’s Conference (WARC) 2024. Irvine.
• Galindo, M. K., Klewer, S. E., Downing, K. F., Takamatsu, C. L., Seckeler, M., Oster, M. E., Collins, R. T., Nembhard, W., Bolin, E., & Farr, S. (2023, November). Reproductive Health Counseling and Experiences Among Females With Congenital Heart Defects: Results From the Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being. American Heart Association 2023 Scientific Sessions. Philadelphia, Pennsylvania.
• June, C., Crigler, C., Thoeny, A., Price, A., & Seckeler, M. (2023, March). Opening one door to close another: Treatment of severe iliocaval obstruction in a 1500g infant to allow for transcatheter PDA closure.. American College of Cardiology ACC.23/WCC Scientific Sessions. New Orleans, Louisiana.
• Meziab, O., Seckeler, M., Scherer, K., & Barber, B. J. (2023, August). Prevalence of Cardiovascular Implantable Electronic Devices in Children with Type 1 Myotonic Dystrophy. 8th World Congress of Pediatric Cardiology and Cardiac Surgery. Washington, DC.
• Schock, S., Thoeny, A., Garcia, G., Kowalek, K. A., Price, A., & Seckeler, M. (2023, March). High rates of congenital airway anomalies in neonates with single ventricle congenital heart disease. . American College of Cardiology ACC.23/WCC Scientific Sessions. New Orleans, Louisiana.
• Caryl, N., Culbert, H., June, C., Hellinger, R., Hoyer, A., Klewer, S. E., & Seckeler, M. (2022, November). Incidence of Cancer in Hospitalized Adults with Congenital Heart Disease. American Heart Association 2022 Scientific Sessions. Chicago, IL.
• Caryl, N., Culbert, H., June, C., Hellinger, R., Hoyer, A., Klewer, S. E., & Seckeler, M. (2022, November). Incidence of Cancer in Hospitalized Adults with Congenital Heart Disease. Arizona American College of Cardiology 2022 Annual Meeting. Scottsdale, AZ.
• Culbert, H., June, C., Meziab, O., Caryl, N., Klewer, S. E., & Seckeler, M. (2022, November). Additional Burden Of Esophageal And Gastric Varices On Hospitalized Patients With Moderate Or Severe Congenital Heart Disease. American Heart Association 2022 Scientific Sessions. Chicago, IL.
• Patel, S., Webber, Z., Strah, D., Hellinger, R., Yrun-Duffy, M., Kowalek, K., & Seckeler, M. (2022, October). Wish We Were Kidding: Kidney Transplantation Outcomes in Patients with Congenital Heart Disease. Annual Arizona ACP Scientific Meeting. Tucson, AZ.
• Shah, M., Goeken, B., Seckeler, M., Pariury, H., & Hoyer, A. (2022, October). Evaluation of change in QTc interval in children and young adults with cancer. First International Pediatric Cardio-Oncology Conference. Cincinnati, OH.
• Takamatsu, C., Ibrahim, R., Corban, M., Klewer, S. E., & Seckeler, M. (2022, November). Transcatheter reconstruction of right ventricular outflow tract after severe external compression by a pseudoaneurysm in an adult with tetralogy of Fallot. American Heart Association 2022 Scientific Sessions. Chicago, IL.
• Bishop, R., Seckeler, M., Anton, C., Hussain, T., McMahan, R., Scott, W., Ikemba, C., & Tandon, A. (2021, October). Virtual Reality in Vascular Ring Education: A Novel 2D-3D Comparison Study. American Academy of Pediatrics National Conference & Exhibition. Virtual (COVID-19).
• Halickman, R., Erdmann, A., Trucco, S., Kreutzer, J., Seckeler, M., Alsaied, T., & Goldstein, B. (2021, November). Hemodynamic Parameters Deteriorate Over Time, and Relate to Adverse Clinical Outcomes, in Children and Adults with Fontan Circulation. American Heart Association 2021 Scientific Sessions. Virtual (COVID-19).
• Strah, D. D., Kowalek, K., Patel, S., & Seckeler, M. (2021, April). Recurrent stenosis after extracellular matrix implantation for congenital heart disease. The Society for Cardiovascular Angiography and Interventions 2021 Scientific Sessions. Virtual (COVID-19).
• Strah, D. D., Lee, K. S., & Seckeler, M. D. (2021, September). Novel use of double kissing crush technique to stent complex pulmonary artery stenosis in a child with Alagille syndrome. Pediatric and Adult Interventional Cardiac Symposium 2021. Las Vegas, Nevada.
• Combs, D. A., Seckeler, M., Fernandez, V., Klewer, S. E., Barber, B. J., Parthasarathy, S., Morgan, W. J., Andrews, J. G., Hsu, C., Hsu, C., Andrews, J. G., Morgan, W. J., Parthasarathy, S., Barber, B. J., Fernandez, V., Klewer, S. E., Seckeler, M., & Combs, D. A. (2020, November). Obstructive Sleep Apnea Is Associated with Cardiac Dysfunction In Children With Congenital Heart Disease. 2020 American Heart Association Scientific SessionsAmerican Heart Association.
• Munoz, F., Benton, L., Kops, S., Kowalek, K., & Seckeler, M. (2020, May). Longer length of stay and higher hospital charges for status asthmaticus in children with comorbid psychiatric disorders. American Thoracic Society 2020. Philadelphia, PA.
  More info

  Event cancelled due to COVID-19 pandemic
• Seckeler, M., Andrews, J. G., Klewer, S. E., White, S., & Kops, S. A. (2019, May/Spring). ECMO in Adults with Congenital Heart Disease Analysis of a National Discharge Database. Annual International Symposium on Heart Disease in the Adult. Skamania, WA: OHSU.
• Boyer, P., Andrews, J. G., Jones, T., & Seckeler, M. (2018, September). Pilot Study for the Use of 3-D Printed Models to Reduce Anxiety About Congenital Cardiac Catheterizations. Pediatric and Adult Interventional Cardiac Symposium 2018.
• Gilpatrick, M., White, S., Andrews, J. G., Seckeler, M., & Klewer, S. E. (2018, November). Cost of childhood chest pain evaluation is higher in emergency departments with fewer pediatric resources. American Academy of Pediatrics National Conference. New Orleans: American Academy of Pediatrics.
• Haughey, B., White, S. C., & Seckeler, M. (2018, March). Incidence, Outcomes and Costs of Catheter-Associated Bloodstream Infection in Children Undergoing Congenital Cardiac Surgery. American College of Cardiology 67th Annual Scientific Session. Orlando, Florida.
• Haughey, B., White, S., Pacheco, G., Fox, K., & Seckeler, M. (2018, November). Outcomes and Costs of Invasive Cardiac Procedures in Interstage Single Ventricle Patients Admitted Through the Emergency Department. American Heart Association 2018 Scientific Sessions, Chicago, Illinois.
• Metcalf, C., Veldtman, G., Goldstein, S., Pitner, H., Radomsky, A., Bennett, M., Cooper, D., Seckeler, M., & Goldstein, B. (2018, November). Subclinical Chronic Kidney Disease is Common in Adolescent and Young Adult Patients with Fontan Circulation: Results of a Urinary Biomarker Study. 2018 American Academy of Pediatrics National Conference & Exhibition.
• Nayak, S., Seckeler, M., John, N., & Barber, B. J. (2018, May). Multimodality imaging and 3-D model of anatomically corrected malposition of the great arteries (S,L,D).. Arizona Chapter of the American College of Cardiology. Scottsdale, AZ: Arizona Chapter of the American College of Cardiology.
• Nayak, S., Seckeler, M., Nigro, J. J., & Barber, B. J. (2018, May). Multimodality Imaging and 3-D Model of Anatomically Corrected Malposition of the Great Arteries (S, L, D). Arizona Chapter of the American College of Cardiology Annual Meeting. Scottsdale, AZ.
• Seckeler, M., Boe, B., Berman, D., & Armstrong, A. (2018, September). Use of rotational angiography to generate 3-D printed models – proof of concept. Pediatric and Adult Interventional Cardiac Symposium 2018.
• Shahanavaz, S., Aldoss, O., Carr, K., Gordon, B., Lange, S., Seckeler, M., Hiremath, G., Seaman, C., Zablah, J., & Morgan, G. (2018, November). Short and Medium Term Outcomes of Transverse Aortic Arch Stenting: A Multicenter Pediatric Interventional Cardiology Early Career Society (PICES) Study. American Heart Association 2018 Scientific Sessions, Chicago, Illinois.
• Stout, J., Rischard, F., & Seckeler, M. (2018, April). Use of a New Predictive Equation for Oxygen Consumption in Adults With Pulmonary Hypertension Undergoing Cardiac Catheterization. The Society for Cardiovascular Angiography and Interventions 2018 Scientific Sessions. San Diego, CA.
• White, S. C., Sedler, J., Jones, T. W., & Seckeler, M. (2018, March). Use of Three-Dimensional Models of Congenital Heart Defects to Enhance Resident Education. American College of Cardiology 67th Annual Scientific Session. Orlando, Florida.
• Yell, J., & Seckeler, M. (2018, September). Quantification of improvement in pulmonary vascular resistance after relief of Fontan obstruction. Pediatric and Adult Interventional Cardiac Symposium 2018.
• Seckeler, M., Hudson, A., & Lee, K. S. (2017, January). Intravascular ultrasound in pulmonary vein stenosis interventions. Pediatric and Adult Interventional Cardiac Symposium 2017.
• Jones, T., & Seckeler, M. (2016, October). Use of 3-D Models of Congenital Heart Defects to Improve Pediatric Cardiology Education. 2016 American Academy of Pediatrics National Conference & Exhibition.
• Sanchez, J., & Seckeler, M. (2016, May). Higher Hospital Charges for Surgical Versus Catheter Atrial Septal Defect Closure: Review of a United States National Database. The Society for Cardiovascular Angiography and Interventions 2016 Scientific Sessions.

Others

• Strah, D., Yell, J., & Seckeler, M. (2020, September). 3D printing in congenital cardiology (invited editorial). 3DMedNet. https://www.3dmednet.com/3d-printing-in-congenital-cardiology/