Andrew Crean

64 statements · 1 topic · summaries given as host listed separately

Single Ventricle / HLHS · guest expert

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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
I do not believe that in adult patients echocardiography is adequate for thrombus in a fontan circuit.
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Andrew's statements about Single Ventricle / HLHS 64 statements

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

Statement 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. Open
Statement In adult Fontan patients, ventricular function is either moderately or severely dysfunctional but often does not change very much over the years. Open
Statement In adult Fontan patients, ventricular function is either moderately or severely dysfunctional but often does not change very much over the years. Open
Statement 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. Open
Statement 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. Open
Statement Embolic ventricular dysfunction is not a common feature of Fontans, but embolic complications are seen roughly once a year in the Toronto center. Open
Statement Embolic ventricular dysfunction is not a common feature of Fontans, but embolic complications are seen roughly once a year in the Toronto center. Open
Statement Thrombus imaging in Fontan circuits is generally not done very well, particularly in adult Fontan circulations. Open
Statement Thrombus imaging in Fontan circuits is generally not done very well, particularly in adult Fontan circulations. Open
Statement Timing is everything in imaging of the Fontan circulation, and usually imaging is performed too quickly, leading to false-positive thrombus diagnoses. Open
Quotation What does the Fontan circuit have in common with a good joke, the answer is timing. Open
Quotation What does the Fontan circuit have in common with a good joke, the answer is timing. Open
Statement Timing is everything in imaging of the Fontan circulation, and usually imaging is performed too quickly, leading to false-positive thrombus diagnoses. Open
Quotation Timing is everything in the imaging of the fontan circulation, and usually we're too quick. Open
Quotation Timing is everything in the imaging of the fontan circulation, and usually we're too quick. Open
Statement Premature contrast timing is a particular problem with on-call PE studies done in the middle of the night. Open
Statement Premature contrast timing is a particular problem with on-call PE studies done in the middle of the night. Open
Statement 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. Open
Statement 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. Open
Statement In large atriopulmonary Fontans, it can take up to 7 minutes for contrast to fully opacify the circuit and confidently exclude thrombus. Open
Statement In large atriopulmonary Fontans, it can take up to 7 minutes for contrast to fully opacify the circuit and confidently exclude thrombus. Open
Quotation I routinely ignore those reports. They're as likely to be right as they are wrong in my experience, particularly with the AP Fontans. Open
Quotation I routinely ignore those reports. They're as likely to be right as they are wrong in my experience, particularly with the AP Fontans. Open
Statement Late gadolinium enhancement imaging performed 10 minutes after contrast administration is effective for detecting thrombus in Fontan circuits. Open
Statement Late gadolinium enhancement imaging performed 10 minutes after contrast administration is effective for detecting thrombus in Fontan circuits. Open
Statement 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. Open
Statement 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. Open
Statement The tried and tested approach to managing large atrial thrombus in Fontan patients involves anticoagulation with heparin. Open
Quotation 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. Open
Statement The tried and tested approach to managing large atrial thrombus in Fontan patients involves anticoagulation with heparin. Open
Quotation 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. Open
Statement Resolution of Glenn shunt thrombus with TPA was associated with normalization of albumin levels, suggesting a link between venous obstruction and protein-losing enteropathy. Open
Statement Resolution of Glenn shunt thrombus with TPA was associated with normalization of albumin levels, suggesting a link between venous obstruction and protein-losing enteropathy. Open
Statement Fontan patients in their mid-80s oxygen saturation without open fenestrations are unusual and warrant investigation for causes of desaturation. Open
Statement Fontan patients in their mid-80s oxygen saturation without open fenestrations are unusual and warrant investigation for causes of desaturation. Open
Statement Veno-venous collaterals and arteriovenous malformations are easily seen by CT or MRI angiography but very difficult to detect in any other way. Open
Statement Veno-venous collaterals and arteriovenous malformations are easily seen by CT or MRI angiography but very difficult to detect in any other way. Open
Statement 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. Open
Statement 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. Open
Statement A Fontan patient presenting with a heart failure phenotype, particularly edema, does not necessarily have pump failure; conduit stenosis can present with anasarca. Open
Statement A Fontan patient presenting with a heart failure phenotype, particularly edema, does not necessarily have pump failure; conduit stenosis can present with anasarca. Open
Statement 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. Open
Statement 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. Open
Statement In adult patients, echocardiography is not adequate for thrombus detection in a Fontan circuit. Open
Quotation I do not believe that in adult patients echocardiography is adequate for thrombus in a fontan circuit. Open
Quotation I do not believe that in adult patients echocardiography is adequate for thrombus in a fontan circuit. Open
Statement In adult patients, echocardiography is not adequate for thrombus detection in a Fontan circuit. Open
Statement Transesophageal echo for detecting thrombus in an atriopulmonary Fontan is a waste of time and should not be done prior to cardioversion. Open
Quotation 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. Open
Statement Transesophageal echo for detecting thrombus in an atriopulmonary Fontan is a waste of time and should not be done prior to cardioversion. Open
Quotation 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. Open
Statement 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. Open
Quotation 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. Open
Quotation 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. Open
Statement 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. Open
Statement 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. Open
Statement 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. Open
Quotation I would be quite happy to cardiovert a Fontan patient on the basis of a CT scan and wait 10 minutes. Open
Quotation I would be quite happy to cardiovert a Fontan patient on the basis of a CT scan and wait 10 minutes. Open
Statement The spatial resolution of cardiac CT is at worst 0.5 millimeters isotropic, which is sufficient to detect small thrombi. Open
Statement The spatial resolution of cardiac CT is at worst 0.5 millimeters isotropic, which is sufficient to detect small thrombi. Open
Statement In 10 years of practice, there have been no cases requiring escalation from CT to echo based on doubt about thrombus detection. Open
Statement In 10 years of practice, there have been no cases requiring escalation from CT to echo based on doubt about thrombus detection. Open
Statement 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. Open

Summaries Andrew gave as host · 2 summaries

Recaps of other experts' statements, not Andrew's own clinical position.

Summaries Andrew gave as host · Single Ventricle / HLHS 2 summaries

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

Host summary Andrew Crean summarizes what Dr. Mike Takahashi said: 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. Open
Host summary Andrew Crean summarizes what Dr. Mike Takahashi said: 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. Open