Andrew Crean

66 timestamped statements across 1 collection — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Single Ventricle / HLHS · guest expert

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▶ Ep 10 · 19:47
I think transesophageal echo to answer the question of is there a thrombus in an atrial pulmonary fontan, I think TE is a waste of time. I wouldn't do it. I wouldn't do it prior to cardioversion.
quote · Single Ventricle / HLHS
▶ Ep 10 · 19:47
I think transesophageal echo to answer the question of is there a thrombus in an atrial pulmonary fontan, I think TE is a waste of time. I wouldn't do it. I wouldn't do it prior to cardioversion.
quote · Single Ventricle / HLHS

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Single Ventricle / HLHS 66 entries

Advanced Imaging of the Fontan, What is Driving Fontan Failure: New Horizons...

▶ Ep 10 · 1:51
clinical T1 mapping in adolescent Fontan patients shows fibrosis content is higher than in normal controls and significantly higher in those with systemic right ventricles compared to systemic left ventricles. ↗
▶ Ep 10 · 1:51
host_summary T1 mapping in adolescent Fontan patients shows fibrosis content is higher than in normal controls and significantly higher in those with systemic right ventricles compared to systemic left ventricles. ↗
▶ Ep 10 · 2:37
clinical In adult Fontan patients, ventricular function is either moderately or severely dysfunctional but often does not change very much over the years. ↗
▶ Ep 10 · 2:37
clinical In adult Fontan patients, ventricular function is either moderately or severely dysfunctional but often does not change very much over the years. ↗
▶ Ep 10 · 2:50
clinical A change in ventricular function in a Fontan patient is an indicator to look at the ventricle more carefully, as this is not frequently seen. ↗
▶ Ep 10 · 2:50
clinical A change in ventricular function in a Fontan patient is an indicator to look at the ventricle more carefully, as this is not frequently seen. ↗
▶ Ep 10 · 3:57
epidemiological Embolic ventricular dysfunction is not a common feature of Fontans, but embolic complications are seen roughly once a year in the Toronto center. ↗
▶ Ep 10 · 3:57
epidemiological Embolic ventricular dysfunction is not a common feature of Fontans, but embolic complications are seen roughly once a year in the Toronto center. ↗
▶ Ep 10 · 4:11
opinion Thrombus imaging in Fontan circuits is generally not done very well, particularly in adult Fontan circulations. ↗
▶ Ep 10 · 4:11
opinion Thrombus imaging in Fontan circuits is generally not done very well, particularly in adult Fontan circulations. ↗
▶ Ep 10 · 6:07
clinical Timing is everything in imaging of the Fontan circulation, and usually imaging is performed too quickly, leading to false-positive thrombus diagnoses. ↗
▶ Ep 10 · 6:07
quote What does the Fontan circuit have in common with a good joke, the answer is timing. ↗
▶ Ep 10 · 6:07
quote What does the Fontan circuit have in common with a good joke, the answer is timing. ↗
▶ Ep 10 · 6:07
clinical Timing is everything in imaging of the Fontan circulation, and usually imaging is performed too quickly, leading to false-positive thrombus diagnoses. ↗
▶ Ep 10 · 6:13
clinical Premature contrast timing is a particular problem with on-call PE studies done in the middle of the night. ↗
▶ Ep 10 · 6:13
quote Timing is everything in the imaging of the fontan circulation, and usually we're too quick. ↗
▶ Ep 10 · 6:13
quote Timing is everything in the imaging of the fontan circulation, and usually we're too quick. ↗
▶ Ep 10 · 6:13
clinical Premature contrast timing is a particular problem with on-call PE studies done in the middle of the night. ↗
▶ Ep 10 · 7:07
clinical Radiologists imaging the chest typically want to image in the pulmonary arterial phase, which is too early to adequately opacify the IVC portion of Fontan circuits. ↗
▶ Ep 10 · 7:07
clinical Radiologists imaging the chest typically want to image in the pulmonary arterial phase, which is too early to adequately opacify the IVC portion of Fontan circuits. ↗
▶ Ep 10 · 8:02
clinical In large atriopulmonary Fontans, it can take up to 7 minutes for contrast to fully opacify the circuit and confidently exclude thrombus. ↗
▶ Ep 10 · 8:02
clinical In large atriopulmonary Fontans, it can take up to 7 minutes for contrast to fully opacify the circuit and confidently exclude thrombus. ↗
▶ Ep 10 · 10:16
quote I routinely ignore those reports. They're as likely to be right as they are wrong in my experience, particularly with the AP Fontans. ↗
▶ Ep 10 · 10:16
quote I routinely ignore those reports. They're as likely to be right as they are wrong in my experience, particularly with the AP Fontans. ↗
▶ Ep 10 · 10:23
clinical Late gadolinium enhancement imaging performed 10 minutes after contrast administration is effective for detecting thrombus in Fontan circuits. ↗
▶ Ep 10 · 10:23
clinical Late gadolinium enhancement imaging performed 10 minutes after contrast administration is effective for detecting thrombus in Fontan circuits. ↗
▶ Ep 10 · 10:40
clinical Both CT and MRI are exquisitely good at looking at the presence of thrombus in Fontan circuits, and CT allows easy volumetric measurement of thrombus over time. ↗
▶ Ep 10 · 10:40
clinical Both CT and MRI are exquisitely good at looking at the presence of thrombus in Fontan circuits, and CT allows easy volumetric measurement of thrombus over time. ↗
▶ Ep 10 · 11:16
quote We have a tried and tested approach to dealing with this kind of problem, uh, which largely involves doing this. And putting them on heparin and hoping for the best. ↗
▶ Ep 10 · 11:16
clinical The tried and tested approach to managing large atrial thrombus in Fontan patients involves anticoagulation with heparin. ↗
▶ Ep 10 · 11:16
quote We have a tried and tested approach to dealing with this kind of problem, uh, which largely involves doing this. And putting them on heparin and hoping for the best. ↗
▶ Ep 10 · 11:16
clinical The tried and tested approach to managing large atrial thrombus in Fontan patients involves anticoagulation with heparin. ↗
▶ Ep 10 · 12:36
clinical Resolution of Glenn shunt thrombus with TPA was associated with normalization of albumin levels, suggesting a link between venous obstruction and protein-losing enteropathy. ↗
▶ Ep 10 · 12:36
clinical Resolution of Glenn shunt thrombus with TPA was associated with normalization of albumin levels, suggesting a link between venous obstruction and protein-losing enteropathy. ↗
▶ Ep 10 · 13:21
clinical Fontan patients in their mid-80s oxygen saturation without open fenestrations are unusual and warrant investigation for causes of desaturation. ↗
▶ Ep 10 · 13:21
clinical Fontan patients in their mid-80s oxygen saturation without open fenestrations are unusual and warrant investigation for causes of desaturation. ↗
▶ Ep 10 · 14:06
clinical Veno-venous collaterals and arteriovenous malformations are easily seen by CT or MRI angiography but very difficult to detect in any other way. ↗
▶ Ep 10 · 14:06
clinical Veno-venous collaterals and arteriovenous malformations are easily seen by CT or MRI angiography but very difficult to detect in any other way. ↗
▶ Ep 10 · 14:39
clinical The spatial resolution of cross-sectional imaging, particularly CT, allows detection of very subtle features such as highly stenotic coronary sinus drainage to the left atrium. ↗
▶ Ep 10 · 14:39
clinical The spatial resolution of cross-sectional imaging, particularly CT, allows detection of very subtle features such as highly stenotic coronary sinus drainage to the left atrium. ↗
▶ Ep 10 · 16:05
clinical A Fontan patient presenting with a heart failure phenotype, particularly edema, does not necessarily have pump failure; conduit stenosis can present with anasarca. ↗
▶ Ep 10 · 16:05
clinical A Fontan patient presenting with a heart failure phenotype, particularly edema, does not necessarily have pump failure; conduit stenosis can present with anasarca. ↗
▶ Ep 10 · 17:21
clinical Plastic bronchitis has not been seen in adult Fontan patients in 10 years at the Toronto center, though it is easy to detect by CT. ↗
▶ Ep 10 · 17:21
clinical Plastic bronchitis has not been seen in adult Fontan patients in 10 years at the Toronto center, though it is easy to detect by CT. ↗
▶ Ep 10 · 18:13
quote I do not believe that in adult patients echocardiography is adequate for thrombus in a fontan circuit. ↗
▶ Ep 10 · 18:13
opinion In adult patients, echocardiography is not adequate for thrombus detection in a Fontan circuit. ↗
▶ Ep 10 · 18:13
opinion In adult patients, echocardiography is not adequate for thrombus detection in a Fontan circuit. ↗
▶ Ep 10 · 18:13
quote I do not believe that in adult patients echocardiography is adequate for thrombus in a fontan circuit. ↗
▶ Ep 10 · 19:47
quote I think transesophageal echo to answer the question of is there a thrombus in an atrial pulmonary fontan, I think TE is a waste of time. I wouldn't do it. I wouldn't do it prior to cardioversion. ↗
▶ Ep 10 · 19:47
opinion Transesophageal echo for detecting thrombus in an atriopulmonary Fontan is a waste of time and should not be done prior to cardioversion. ↗
▶ Ep 10 · 19:47
quote I think transesophageal echo to answer the question of is there a thrombus in an atrial pulmonary fontan, I think TE is a waste of time. I wouldn't do it. I wouldn't do it prior to cardioversion. ↗
▶ Ep 10 · 19:47
opinion Transesophageal echo for detecting thrombus in an atriopulmonary Fontan is a waste of time and should not be done prior to cardioversion. ↗
▶ Ep 10 · 20:03
quote It took me roughly 10 years to convert my colleagues in Toronto and many cases where. The CT or the MR were right and the echo were wrong. ↗
▶ Ep 10 · 20:03
clinical It took roughly 10 years and many cases where CT or MR were right and echo was wrong to convert colleagues in Toronto away from routine TEE for Fontan thrombus assessment. ↗
▶ Ep 10 · 20:03
clinical It took roughly 10 years and many cases where CT or MR were right and echo was wrong to convert colleagues in Toronto away from routine TEE for Fontan thrombus assessment. ↗
▶ Ep 10 · 20:03
quote It took me roughly 10 years to convert my colleagues in Toronto and many cases where. The CT or the MR were right and the echo were wrong. ↗
▶ Ep 10 · 20:13
clinical Cardiac CT can be obtained within about 1 hour, which is more practical than organizing space on the CCU for a TEE in a sick Fontan patient. ↗
▶ Ep 10 · 20:13
clinical Cardiac CT can be obtained within about 1 hour, which is more practical than organizing space on the CCU for a TEE in a sick Fontan patient. ↗
▶ Ep 10 · 20:32
quote I would be quite happy to cardiovert a Fontan patient on the basis of a CT scan and wait 10 minutes. ↗
▶ Ep 10 · 20:32
quote I would be quite happy to cardiovert a Fontan patient on the basis of a CT scan and wait 10 minutes. ↗
▶ Ep 10 · 20:53
clinical The spatial resolution of cardiac CT is at worst 0.5 millimeters isotropic, which is sufficient to detect small thrombi. ↗
▶ Ep 10 · 20:53
clinical The spatial resolution of cardiac CT is at worst 0.5 millimeters isotropic, which is sufficient to detect small thrombi. ↗
▶ Ep 10 · 21:25
clinical In 10 years of practice, there have been no cases requiring escalation from CT to echo based on doubt about thrombus detection. ↗
▶ Ep 10 · 21:25
clinical In 10 years of practice, there have been no cases requiring escalation from CT to echo based on doubt about thrombus detection. ↗
▶ Ep 10 · 24:05
clinical There are large series in the adult AF population with outcomes up to about a year suggesting no increased stroke risk when CT is used instead of TEE for pre-cardioversion thrombus assessment. ↗
▶ Ep 10 · 24:05
host_summary There are large series in the adult AF population with outcomes up to about a year suggesting no increased stroke risk when CT is used instead of TEE for pre-cardioversion thrombus assessment. ↗