- Associate Professor, Pediatrics - (Clinical Scholar Track)
- M.S. Clinical Research
- University of Virginia, Charlottesville, Virginia
- M.D. Medicine
- University of Maryland at Baltimore, Baltimore, Maryland
- B.A. Linguistics
- University of Maryland, College Park, College Park, Maryland
- University of Arizona/Banner University Medical Center Tucson (2013 - Ongoing)
- Commonwealth Health Center (2006 - 2009)
- Top Doctor
- Castle Connolly, Summer 2019
- Society for Cardiovascular Angiography and Interventions, Spring 2018
- Best Poster
- University of Arizona College of Medicine Medical Education Research Day, Spring 2017
- Winner, Case Competition: Between a Rock and a Hard Case
- Society for Cardiovascular Angiography and Interventions, Spring 2017
- CVDY Early Career Investigator Award
- Council on Cardiovascular Disease in the Young, American Heart Association, Fall 2013
Licensure & Certification
- Pediatric Cardiology, American Board of Pediatrics (2012)
- General Pediatrics, American Board of Pediatrics (2006)
Congenital heart disease, interventional congenital cardiology
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
No activities entered.
- 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 infoPatients 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 infoCardiac 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.
- 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 infoChildren 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., 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
- 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 infoAsthma 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 infoPatients 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(3), 136-140.More infoDetailed 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 infoCoarctation 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
- 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 infoPatients 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.
- 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 infoCatheter-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 infoSingle 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 infoCongenital 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 infoChildren 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.
- 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 infoSleep-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.
- 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 infoYoung 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 infoTo 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 infoA 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 infoThe 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(6), 1045-1049.More infoApplications 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 infoThree-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 infoAtrial 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 infoWe 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 infoAdults 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 infoTo 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.
- 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 infoNeonatal 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 infoDiastolic 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 infoTelemedicine 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 infoAdults 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 infoPatients 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.
- 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 infoWe 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 infoTo 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 infoTo 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 infoSingle 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 infoPatients 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.
- 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 infoAcute 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 infoTo 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 infoChylothorax (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.
- 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 infoTo 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 infoNeo-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 infoTo identify and predict neo-aortic arch obstruction (NAAO) in children after Norwood/Sano operation (NO) for hypoplastic left heart syndrome (HLHS).
- 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 infoThe 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 infoThere 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 infoAcute 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 infoAcute 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 infoCompliance 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 infoAbetalipoproteinemia 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.
- 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.
- 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 infoOral 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 infoVirtual 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.
- Combs, D. A., Skrepnek, G., Seckeler, M., Barber, B. J., & Parthasarathy, S. (2016, June). Sleep-disordered breathing is associated with increased mortality among hospitalized infants with congenital heart disease. 2016 meeting of the Associated Professional Sleep Societies. Denver, CO.
- 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.
- Combs, D. A., Combs, D. A., Fernandez, V., Fernandez, V., Barber, B. J., Barber, B. J., Morgan, W. J., Morgan, W. J., Hsu, C., Hsu, C., Andrews, J. G., Andrews, J. G., Parthasarathy, S., Parthasarathy, S., Klewer, S. E., Klewer, S. E., Seckeler, M., & Seckeler, M. (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 infoEvent 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., 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.
- Barber, B. J., John, N., Seckeler, M., & Nayak, S. (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.
- 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/