Cardiology Commons^™

The Beat Goes On

Syracuse University Magazine

To those who would relegate the permanent artificial heart to medical history, we offer Robert Jarvik. He did it once, and he'll do it again.

Safety And Efficacy Of Drug-Eluting Balloons In The Treatment Of Drug-Eluting In-Stent Restenosis: Experience Of A Tertiary Care Hospital, Sajid H. Dhakam, Asif Jafferani, Hafeez Ahmed, Nasir Rahman, Ambreen Gowani

Section of Cardiology

Background: The advent of drug-eluting balloons (DEBs) is a promising development for coronary revascularization procedures, especially for in-stent restenosis (ISR). This study aims to highlight our experience with DEBs in the treatment of drug-eluting ISR at a tertiary care hospital in Pakistan.

Methods: All Patients presenting to our institution from August 2008 to February 2011 with significant drug-eluting in-stent restenosis (DES-ISR) who were eligible to receive treatment via DEB were included in the analysis. Patient baseline characteristics and angiographic data about the lesion characteristics were obtained. Postprocedural and follow-up endpoints, including cardiac death, myocardial infarction, and repeat revascularization, ie, major …

Intermediate-Term Mortality And Cardiac Transplantation In Infants With Single-Ventricle Lesions: Risk Factors And Their Interaction With Shunt Type., James S. Tweddell, Lynn A. Sleeper, Richard G. Ohye, Ismee A. Williams, Lynn Mahony, Christian Pizarro, Victoria L. Pemberton, Peter C. Frommelt, Scott M. Bradley, James F. Cnota, Jennifer Hirsch, Paul M. Kirshbom, Jennifer S. Li, Nancy Pike, Michael Puchalski, Chitra Ravishankar, Jeffrey P. Jacobs, Peter C. Laussen, Brian W. Mccrindle, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The study objective was to identify factors associated with death and cardiac transplantation in infants undergoing the Norwood procedure and to determine differences in associations that might favor the modified Blalock-Taussig shunt or a right ventricle-to-pulmonary artery shunt.

METHODS: We used competing risks methodology to analyze death without transplantation, cardiac transplantation, and survival without transplantation. Parametric time-to-event modeling and bootstrapping were used to identify independent predictors.

RESULTS: Data from 549 subjects (follow-up, 2.7 ± 0.9 years) were analyzed. Mortality risk was characterized by early and constant phases; transplant was characterized by only a constant phase. Early phase factors associated …

Cardiopulmonary Resuscitation: Is The Emergency Department Visit An Opportunity To Recommend Education? (Poster), Marna R. Greenberg Do, Mph, Facep, Gavin C. Barr Jr. Md, Jon D. Willardson Do, Nicholas M. Dowling Do, Jennifer L. Sears Do, Valerie Rupp Rn, Bsn, Kimberly Hamilton Ba, Kevin Weaver Do

Department of Emergency Medicine

No abstract provided.

Thrombocytosis And Coronary Occlusion, Amit N. Nanavati Md, Nainesh C. Patel Md, James A. Burke Md, Phd

Department of Medicine

No abstract provided.

Does Initial Shunt Type For The Norwood Procedure Affect Echocardiographic Measures Of Cardiac Size And Function During Infancy?: The Single Vventricle Reconstruction Trial., Peter C. Frommelt, Lin T. Guey, L Luann Minich, Majeed Bhat, Tim J. Bradley, Steve D. Colan, Greg Ensing, Jessica Gorentz, Haleh Heydarian, J Blaine John, Wyman W. Lai, Jami C. Levine, William T. Mahle, Stephen G. Miller, Richard G. Ohye, Gail D. Pearson, Girish S. Shirali, Pierre C. Wong, Meryl S. Cohen, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The Pediatric Heart Network trial comparing outcomes in 549 infants with single right ventricle undergoing a Norwood procedure randomized to modified Blalock-Taussig shunt or right ventricle-pulmonary artery shunt (RVPAS) found better 1-year transplant-free survival in those who received RVPAS. We sought to compare the impact of shunt type on echocardiographic indices of cardiac size and function up to 14 months of age.

METHODS AND RESULTS: A core laboratory measured indices of cardiac size and function from protocol exams: early after Norwood procedure (age 22.5 ± 13.4 days), before stage II procedure (age 4.8 ± 1.8 months), and at 14 …

Posttraumatic Stress And Myocardial Infarction Risk Perceptions In Hospitalized Acute Coronary Syndrome Patients, Donald Edmondson, Jonathan A. Shaffer, Ellen-Ge Denton, Daichi Shimbo, Lynn Clemow

Publications and Research

Posttraumatic stress disorder (PTSD) is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina) recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n = 420). Participants completed a brief PTSD screen 3-7 days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or women their age. Most participants exhibited optimistic bias (mean recurrence risk estimate between "average" and "below average"). Further, participants who screened positive for current PTSD (n …

Inflammatory Biomarkers And Subclinical Atherosclerosis In African-American Women With Systemic Lupus Erythematosus (Sle), Edith Williams, Carlos Crespo, Joan Dorn

Journal of Health Disparities Research and Practice

Women with lupus are at increased risk for developing cardiovascular disease (CVD). Previous studies of atherosclerosis in SLE have not been representative of the minority groups most affected by lupus and its complications. Therefore, a study of 41 lupus cases and 83 controls was conducted to investigate the relationship between carotid atherosclerosis and inflammation in African-American women. Participation consisted of a questionnaire, physical examination, fasting blood draw, and ultrasound of the carotid arteries. There were observed differences between cases and controls with regard to carotid intima media thickness (IMT) and traditional cardiovascular risk factors, although few reached statistical significance. Tumor …

Stop Atherosclerosis In Native Diabetics Study (Sands): Baseline Characteristics Of The Randomized Cohort, Angela Silverman, Chun-Chih J. Huang, Marie Russell, Mihriye Mete, Mary J. Roman, Mario Stylianou, Elisa T. Lee, Fawn Yeh, Jerome Fleg, Charlton Wilson, Jeffrey A. Henderson, Matthew R. Weir, Robert E. Ratner, Barbara V. Howard

Journal of Health Disparities Research and Practice

Objectives: To present baseline characteristics of American Indians in the Stop Atherosclerosis in Native Diabetics Study (SANDS) and compare them with population-based data from American Indians and other ethnic groups. Design: 499 people with type 2 diabetes ≥ age 40, without known CVD, were recruited for a randomized 3-year trial to evaluate treatment targets for LDL-C (70 vs. 100 mg/dL) and systolic blood pressure (BP) (115 vs. 130 mmHg). Baseline evaluations included physical exam, collection of blood and urine samples, and carotid ultrasound and echocardiographic measures. Results: Mean age was 56 years; 66% were female. Average BMI was 33 kg/m2. …

Influence Of The Menstrual Cycle On The Incidence Of Nausea And Vomiting After Laparoscopic Gynecological Surgery: A Pilot Study., Tatjana Simurina, Boris Mraovic, Neven Skitarelić, Tatjana Andabaka, Zdenko Sonicki

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective laparoscopic gynecological surgery.

DESIGN: Prospective, observational, blinded study.

SETTING: General hospital, Postanesthesia Care Unit, and gynecologic floor room.

PATIENTS: 111 ASA physical status 1 and 2 women, aged 18 to 53 years.

INTERVENTIONS: Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal …

Stabilization Of The Cardiac Nervous System During Cardiac Stress Induces Cardioprotection, David D. Gibbons

Electronic Theses and Dissertations

The cardiac nervous system consists of nested reflex feedback loops that interact to regulate regional heart function. Cardiac disease affects multiple components of the cardiac nervous system and the myocytes themselves. This study aims to determine: 1) how select components of the cardiac nervous system respond to acute cardiac stress, including myocardial ischemia (MI) and induced neural imbalance leading to cardiac electrical instability, and 2) how neuromodulation can affect neural-myocyte interactions to induce cardioprotection. Thoracic spinal cord stimulation (SCS) is recognized for its anti-anginal effects and ability to reduce apoptosis in response to acute MI, primarily via modulation of adrenergic …

Cardiac G-Protein-Coupled Receptor Kinase 2 Ablation Induces A Novel Ca2+ Handling Phenotype Resistant To Adverse Alterations And Remodeling After Myocardial Infarction., Philip W Raake, Xiaoying Zhang, Leif E Vinge, Henriette Brinks, Erhe Gao, Naser Jaleel, Yingxin Li, Mingxin Tang, Patrick Most, Gerald W Dorn, Steven R Houser, Hugo A Katus, Xiongwen Chen, Walter J Koch

Center for Translational Medicine Faculty Papers

BACKGROUND: G-protein-coupled receptor kinase 2 (GRK2) is a primary regulator of β-adrenergic signaling in the heart. G-protein-coupled receptor kinase 2 ablation impedes heart failure development, but elucidation of the cellular mechanisms has not been achieved, and such elucidation is the aim of this study.

METHODS AND RESULTS: Myocyte contractility, Ca(2+) handling and excitation-contraction coupling were studied in isolated cardiomyocytes from wild-type and GRK2 knockout (GRK2KO) mice without (sham) or with myocardial infarction (MI). In cardiac myocytes isolated from unstressed wild-type and GRK2KO hearts, myocyte contractions and Ca(2+) transients were similar, but GRK2KO myocytes had lower sarcoplasmic reticulum (SR) Ca(2+) content …

Regulation Of Protein Degradation In The Heart By Amp-Activated Protein Kinase, Kedryn K. Baskin

Dissertations and Theses (Open Access)

The degradation of proteins by the ubiquitin proteasome system is essential for cellular homeostasis in the heart. An important regulator of metabolic homeostasis is AMP-activated protein kinase (AMPK). During nutrient deprivation, AMPK is activated and intracellular proteolysis is enhanced through the ubiquitin proteasome system (UPS). Whether AMPK plays a role in protein degradation through the UPS in the heart is not known. Here I present data in support of the hypothesis that AMPK transcriptionally regulates key players in the UPS, which, under extreme conditions can be detrimental to the heart. The ubiquitin ligases MAFbx /Atrogin-1 and MuRF1, key regulators of …

Early Developmental Outcome In Children With Hypoplastic Left Heart Syndrome And Related Anomalies: The Single Ventricle Reconstruction Trial., Jane W. Newburger, Lynn A. Sleeper, David C. Bellinger, Caren S. Goldberg, Sarah Tabbutt, Minmin Lu, Kathleen A. Mussatto, Ismee A. Williams, Kathryn E. Gustafson, Seema Mital, Nancy Pike, Erica Sood, William T. Mahle, David S. Cooper, Carolyn Dunbar-Masterson, Catherine Dent Krawczeski, Alan Lewis, Shaji C. Menon, Victoria L. Pemberton, Chitra Ravishankar, Teresa W. Atz, Richard G. Ohye, J William Gaynor, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Survivors of the Norwood procedure may experience neurodevelopmental impairment. Clinical trials to improve outcomes have focused primarily on methods of vital organ support during cardiopulmonary bypass.

METHODS AND RESULTS: In the Single Ventricle Reconstruction trial of the Norwood procedure with modified Blalock-Taussig shunt versus right-ventricle-to-pulmonary-artery shunt, 14-month neurodevelopmental outcome was assessed by use of the Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development-II. We used multivariable regression to identify risk factors for adverse outcome. Among 373 transplant-free survivors, 321 (86%) returned at age 14.3 ± 1.1 (mean ± SD) months. Mean …

St Elevation: Telling Pathology From The Benign Patterns, Waleed Tallat Kayani, Henry D. Huang, Salman Bandeali, Salim S. Virani, James M. Wilson, Yochai Birnbaum

Office of the Provost

Benefits of early reperfusion in patients presenting with acute ST elevation myocardial infarction (STEMI) are well known. The American College of Cardiology / American Heart Association guidelines recommend triage decisions are made within 10 minutes of performing initial electrocardiogram (ECG). Since many patients presenting with ischemic symptoms may have ST elevation (STE) at baseline, not all STE signify transmural ischemia. Benign patterns can be easy to find in some cases. However, patients with benign STE at baseline (left ventricular hypertrophy, early repolarization pattern) may have ongoing ischemia and present with Non-ST elevation myocardial infarction (NSTEMI) or even STEMI superimposed on …

Ketamine As An Adjunct For The Long-Term Sedation And Analgesia Of A Patient With A Left Ventricular Assist Device (Lvad) And An Open Chest, Avni Gupta, Charles S. Kato, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Conclusion:

A multimodal sedative and analgesic regimen that incorporates ketamine offers important therapeutic advantages in select patients who require very high doses of opioids and benzodiazepines, but warrants futher study.

Effect Of Obstructive Sleep Apnea On Mitral Valve Tenting., Gregg S. Pressman, Vincent M. Figueredo, Abel Romero-Corral, Ganesan Murali, Morris N Kotler

Division of Cardiology Faculty Papers

Obstructive apneas produce high negative intrathoracic pressure which imposes an afterload burden on the left ventricle. Such episodes might produce structural changes in the left ventricle over time. Doppler echocardiograms were obtained within 2 months of attended polysomnography. Patients were grouped according to apnea-hypopnea index (AHI): mild/no OSA (AHI < 15) and mod/severe OSA (AHI ≥ 15). Mitral valve tenting height and area, left ventricular (LV) long and short axis, and LV end-diastolic volume (LVEDV), were measured along with tissue Doppler parameters. Comparisons of measurements at baseline and follow up between and within groups were obtained; correlations between absolute changes (deltas) in echocardiographic parameters were also performed. After a mean follow up of 240 days mitral valve tenting height increased significantly (1.17 ± 0.12 cm to 1.28 ± 0.17 cm, p=0.001) in mod/severe OSA as did tenting area (2.30 ± 0.41 cm² to 2.66 ± 0.60 cm², p=0.0002); delta tenting height correlated with delta LVEDV (rho 0.43, p=0.01) and delta tenting area (rho 0.35, p=0.04). In mild/no OSA patients there was no significant change in tenting height; there was a borderline significant increase in tenting area (2.20 ± 0.44 cm …

Coronary Artery Bypass Grafting: Quality Of Life Of Patients In Karachi, Rozina Barolia, Fauziya Ali, Salma Jaffar

School of Nursing & Midwifery

In the Third World, cardiac Patients often suffer not only from the nature of their illnesses, but also the insufficiency of the facilities available. Although the effectiveness of coronary artery bypass grafting (CABG) is being evaluated in terms of mortality, complications or recurrence of symptoms, empirical studies assessing the change in Patients' quality of life (QOL) after CABG within the Pakistani cultural context are lacking.
Aims: The aims of the present study are to assess and compare the change in health-related quality of life before and 1 month after CABG and to assess the differences in QOL with respect to …

Hyperphosphorylation Of The Cardiac Ryanodine Receptor At Serine 2808 Is Not Involved In Cardiac Dysfunction After Myocardial Infarction., Hongyu Zhang, Catherine A Makarewich, Hajime Kubo, Wei Wang, Jason M Duran, Ying Li, Remus M Berretta, Walter J Koch, Xiongwen Chen, Erhe Gao, Héctor H Valdivia, Steven R Houser

Division of Cardiology Faculty Papers

RATIONALE: Abnormal behavior of the cardiac ryanodine receptor (RyR2) has been linked to cardiac arrhythmias and heart failure (HF) after myocardial infarction (MI). It has been proposed that protein kinase A (PKA) hyperphosphorylation of the RyR2 at a single residue, Ser-2808, is a critical mediator of RyR dysfunction, depressed cardiac performance, and HF after MI.

OBJECTIVE: We used a mouse model (RyRS2808A) in which PKA hyperphosphorylation of the RyR2 at Ser-2808 is prevented to determine whether loss of PKA phosphorylation at this site averts post MI cardiac pump dysfunction.

METHODS AND RESULTS: MI was induced in wild-type (WT) and S2808A …

Lpl Gene Variants Affect Apoc-Iii Response To Combination Therapy Of Statins And Fenofibric Acid In A Randomized Clinical Trial Of Individuals With Mixed Dyslipidemia, Ariel Brautbar, Salim S. Virani, John Belmont, Vijay Nambi, Peter H. Jones, Christie M. Ballantyne

Office of the Provost

ApoC-III is a proatherogenic protein associated with elevated triglycerides; its deficiency is associated with reduced atherosclerosis. Mixed dyslipidemia, characterized by elevated triglyceride and apoC-III levels and low HDL cholesterol level, with or without elevated LDL cholesterol, increases cardiovascular disease risk and is commonly treated with combined statin and fibrate therapy. We sought to identify single nucleotide polymorphisms (SNPs) associated with apoC-III level response to combination therapy with statins and fenofibric acid (FA) in individuals with mixed dyslipidemia. Participants (n = 1,250) in a multicenter, randomized, double-blind, active-controlled study examining response to FA alone and in combination with statin were genotyped …

Invited Commentary On: Orthotopic Heart Transplantation In Patients With Metabolic Risk Factors, Nicholas C. Cavarocchi, Paul Mather

Department of Surgery Faculty Papers

This is invited commentary to the following article:

Kilic, A., Conte, J. V., Shah, A. S., & Yuh, D. D. (2012). Orthotopic heart transplantation in patients with metabolic risk factors. Annals of Thoracic Surgery, 93(3), 718-724.

Relation Of Torsion And Myocardial Strains To Lv Ejection Fraction In Hypertension, Mustafa I. Ahmed Md, Ravi V. Desai Md, Krishna K. Gaddam Md, Bharath A. Venkatesh Phd, Shilpi Agarwal Ms, Md, Seidu Inusah Ms, Steven G. Lloyd Md, Thomas S. Denney Jr Phd, David Calhoun Md, Louis J. Dell'italia Md, Himanshu Gupta Md

Department of Medicine

No abstract provided.

Effects Of Preoperative Aspirin On Cardiocerebral And Renal Complications In Non-Emergent Cardiac Surgery Patients: A Sub-Group And Cohort Study., Longhui Cao, Scott Silvestry, Ning Zhao, James Diehl, Jianzhong Sun

Department of Anesthesiology Faculty Papers

BACKGROUND AND OBJECTIVE: Postoperative cardiocerebral and renal complications are a major threat for patients undergoing cardiac surgery. This study was aimed to examine the effect of preoperative aspirin use on patients undergoing cardiac surgery.

METHODS: An observational cohort study was performed on consecutive patients (n = 1879) receiving cardiac surgery at this institution. The patients excluded from the study were those with preoperative anticoagulants, unknown aspirin use, or underwent emergent cardiac surgery. Outcome events included were 30-day mortality, renal failure, readmission and a composite outcome - major adverse cardiocerebral events (MACE) that include permanent or transient stroke, coma, perioperative myocardial …

The Influence Of Antiretroviral Therapy On The Qtc Interval In An African Cohort, J. Shavadia, Reena Shah, Gerald Yonga, R. Patel, J. Stebbing, M. Nelson

Internal Medicine, East Africa

Cardiovascular disease in human immunodeficiency virus (HIV) infection encompasses a wide range of pathologic entities, including myocardial, pericardial, and endocardial disease, atherosclerosis, arrhythmias, and vasculitis. The most common manifestations of HIV-associated heart disease in sub- Saharan Africa are pericarditis, cardiomyopathy, and pulmonary hypertension [1]. Coronary artery disease, lipodystrophy, and metabolic syndrome, although common in developed countries, are traditionally thought to be less clinically significant problems in the African subcontinent [2]. It is well known that prolongation of the QTC interval can predispose patients to potentially fatal ventricular tachyarrhythmias, particularly torsades de pointes, and thus is an independent predictor of cardiovascular …

Improved Cardiac Management With A Disease Management Program Incorporating Comprehensive Lipid Profiling., John F Mcana, Neil I Goldfarb, Joseph Couto, Michelle A Henry, Gary Piefer, George M Rapier

College of Population Health Faculty Papers

The objective of this study was to evaluate the improved effectiveness of a disease management treatment protocol incorporating comprehensive lipid profiling and targeted lipid care based on lipid profile findings in patients with ischemic heart disease (IHD) or congestive heart failure (CHF) enrolled in a managed care plan. This retrospective cohort study, conducted over a 2-year period, compared outcomes between patients with a standard lipid profile to those evaluated with a comprehensive lipid profile. All adult members of the WellMed Medical Management, Inc. managed care health plan diagnosed with IHD or CHF, and continuously enrolled between July 1, 2006 and …

Direct Evidence For Inhibition Of Mitochondrial Permeability Transition Pore Opening By Sevoflurane Preconditioning In Cardiomyocytes: Comparison With Cyclosporine A., Anna Onishi, Masami Miyamae, Kazuhiro Kaneda, Junichiro Kotani, Vincent M. Figueredo

Division of Cardiology Faculty Papers

To assess whether sevoflurane preconditioning is associated with inhibition of mitochondrial permeability transition pore (MPTP), the effects of sevoflurane were compared with those of cyclosporine A, a known inhibitor of MPTP opening. Isolated perfused guinea pig hearts underwent 30 min global ischemia and 120 min reperfusion (control). Sevoflurane preconditioning was elicited by administration of 2% sevoflurane for 10 min with 10 min washout before ischemia (sevoflurane). A preconditioning-like cardioprotection was also induced by administering cyclosporine A (0.2 μM) for 15 min, starting 5 min before ischemia and for 10 min after the onset of reperfusion (cyclosporine A). Left ventricular developed …

Feasibility And Compliance With Daily Home Ecg Monitoring Of The Qt Interval In Heart Transplant Recipients, Erik V. Carter, Kathleen T. Hickey, David M. Pickham, Lynn V. Doering, Belinda Chen, Patricia R. E. Harris, Barbara J. Drew

Collected Faculty Scholarship

About 13% of adult heart transplant recipients do not survive to one year and a major cause of death is acute cellular allograft rejection.^1,2 According to the 2009 annual United States data published from the International Society for Heart Lung Transplantation Registry, acute rejection occurs in 25 – 35% of transplant recipients within the first year following transplant surgery.³ In order to detect the early stages of rejection so that more aggressive and early immunosuppressant therapy can be initiated, frequent biopsies of heart tissue are performed (typically, weekly or every other week in the first 3 months and …

Hypertension In A Young Boy: An Energy Drink Effect, Asma Usman, Ambreen Jawaid

Department of Family Medicine

Background: Use of energy drinks has significantly increased in recent times. Besides athletes, teenagers and students are among the most common consumers. However, popularity is also increasing among the younger and older age groups. Most of the users believe that they are a good source of instant energy and are unaware of its high Caffeine content resulting in harmful effects on health.Case Presentation: We report the case of a young boy who presented with palpitations and high blood pressure as a result of energy drinks usage. He had been consuming a "Sting" energy drink on regular basis while studying …

Trends In Hospital Admissions For Myocardial Infarcts For Women In Arizona, Florida And Maryland In 2000 To 2010, Rebecca Farmer Mcintyre

MUSC Theses and Dissertations

Coronary arterial disease is the leading cause of death and morbidity in developing countries. Acute myocardial infarction (AMI) has traditionally been considered a disease affecting mostly men, yet women are increasingly at risk due to obesity and diabetes. However, current trends in the AMI risk for women are not well understood. This study used archival data on hospital discharges from three states within the USA to examine the 10-year trend in presentations of patients to emergency rooms (ER) with a presenting diagnosis of chest pain and AMI, to document rate changes by gender over time. We observed a decreasing number …

The Influence Of The Method Of Cerebral Protection During Neonatal Cardiac Surgery On The Development Of Attention Deficit/Hyperactivity Disorder, Joseph J. Sistino

MUSC Theses and Dissertations

Complex congenital heart disease is a common birth defect requiring surgery soon after birth. Surgery can use a complete interruption of cerebral blood flow (DHCA) or it can be performed using regional low flow perfusion (RLFP). Either approach places the neonate at risk for oxygen deprivation resulting in neurodevelopmental impairment and Attention Deficit/Hyperactivity Disorder (ADHD). RLFP has been widely adopted but its effect on ADHD has not been elucidated. We extracted surgical records data and surveyed parents of 5-16 year old children who had neonatal surgery using DHCA or RLFP in 1995-2006 to determine the prevalence of ADHD after DHCA …