Maria C. Escobar-Diaz
Boston Children's Hospital
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Featured researches published by Maria C. Escobar-Diaz.
Circulation | 2015
Lindsay R. Freud; Maria C. Escobar-Diaz; Brian T. Kalish; Rukmini Komarlu; Michael D. Puchalski; Edgar Jaeggi; Anita Szwast; Grace Freire; Stéphanie M. Levasseur; Ann Kavanaugh-McHugh; Erik Michelfelder; Anita J. Moon-Grady; Mary T. Donofrio; Lisa W. Howley; Elif Seda Selamet Tierney; Bettina F. Cuneo; Shaine A. Morris; Jay D. Pruetz; Mary E. van der Velde; John P. Kovalchin; Catherine Ikemba; Margaret M. Vernon; Cyrus Samai; Gary Satou; Nina L. Gotteiner; Colin K.L. Phoon; Norman H. Silverman; Doff B. McElhinney; Wayne Tworetzky
Background— Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature consists of small, single-center case series spanning several decades. We performed a multicenter study to assess the outcomes and factors associated with mortality after fetal diagnosis in the current era. Methods and Results— Fetuses diagnosed with Ebstein anomaly and tricuspid valve dysplasia from 2005 to 2011 were included from 23 centers. The primary outcome was perinatal mortality, defined as fetal demise or death before neonatal discharge. Of 243 fetuses diagnosed at a mean gestational age of 27±6 weeks, there were 11 lost to follow-up (5%), 15 terminations (6%), and 41 demises (17%). In the live-born cohort of 176 live-born patients, 56 (32%) died before discharge, yielding an overall perinatal mortality of 45%. Independent predictors of mortality at the time of diagnosis were gestational age <32 weeks (odds ratio, 8.6; 95% confidence interval, 3.5–21.0; P<0.001), tricuspid valve annulus diameter z-score (odds ratio, 1.3; 95% confidence interval, 1.1–1.5; P<0.001), pulmonary regurgitation (odds ratio, 2.9; 95% confidence interval, 1.4–6.2; P<0.001), and a pericardial effusion (odds ratio, 2.5; 95% confidence interval, 1.1–6.0; P=0.04). Nonsurvivors were more likely to have pulmonary regurgitation at any gestational age (61% versus 34%; P<0.001), and lower gestational age and weight at birth (35 versus 37 weeks; 2.5 versus 3.0 kg; both P<0.001). Conclusion— In this large, contemporary series of fetuses with Ebstein anomaly and tricuspid valve dysplasia, perinatal mortality remained high. Fetuses with pulmonary regurgitation, indicating circular shunt physiology, are a high-risk cohort and may benefit from more innovative therapeutic approaches to improve survival.
Ultrasound in Obstetrics & Gynecology | 2015
Maria C. Escobar-Diaz; Lindsay R. Freud; A. Bueno; David W. Brown; Kevin G. Friedman; David N. Schidlow; Sitaram E. Emani; P.J. del Nido; Wayne Tworetzky
To evaluate temporal trends in the prenatal diagnosis of transposition of the great arteries with intact ventricular septum (TGA/IVS) and its impact on neonatal morbidity and mortality.
American Journal of Cardiology | 2014
Maria C. Escobar-Diaz; Kevin G. Friedman; Yishay Salem; Gerald R. Marx; Brian T. Kalish; Terra Lafranchi; Rahul H. Rathod; Sitaram M. Emani; Tal Geva; Wayne Tworetzky
Patients with heterotaxy syndrome (HS) have a range of anomalies and outcomes. There are limited data on perinatal outcomes after prenatal diagnosis. To determine the factors influencing perinatal and infant outcomes, we analyzed prenatal and postnatal variables in fetuses with HS from 1995 to 2011. Of 154 fetuses with HS, 61 (40%) had asplenia syndrome (ASP) and 93 (60%) had polysplenia syndrome (PSP). In the ASP group, 22 (36%) patients were elected for termination of pregnancy, 4 (10%) had fetal death, and 35 of 39 (90%) continued pregnancies were live born. In the PSP group, 12 (13%) patients were elected for termination of pregnancy, 5 (6%) had fetal death (4 with bradyarrhythmia), and 76 of 81 (94%) continued pregnancies were live born. Bradyarrhythmia was the only predictor of fetal death. In the live-born ASP group, 43% (15 of 35) died, 7 because of pulmonary vein stenosis, 4 postoperatively, and 4 because of noncardiac causes. In the live-born PSP group, 13% (10 of 76) died, 5 postoperatively, 2 from bradyarrhythmia, 1 from a cardiac event, and 2 from noncardiac causes. Pulmonary vein stenosis and noncardiac anomalies were independent risk factors for postnatal death. Only 8% of ASP patients achieved biventricular circulation, compared with 65% of PSP patients. In the live-born cohort, the 5-year survival rate was 53% for ASP and 86% for PSP. In conclusion, most PSP patients are currently alive with biventricular circulation in contrast with few ASP patients. Bradyarrhythmia was the only predictor of fetal death. Pulmonary vein stenosis and noncardiac anomalies were predictors of postnatal death.
Ultrasound in Obstetrics & Gynecology | 2015
Lindsay R. Freud; Anita J. Moon-Grady; Maria C. Escobar-Diaz; Nina L. Gotteiner; Luciana T. Young; Doff B. McElhinney; Wayne Tworetzky
To better understand the natural history and spectrum of fetal aortic stenosis (AS), we aimed to (1) determine the prenatal diagnosis rate of neonates with critical AS and a biventricular (BV) outcome, and (2) describe the findings at fetal echocardiography in patients diagnosed prenatally.
Journal of the American College of Cardiology | 2014
Lindsay R. Freud; Maria C. Escobar-Diaz; Brian T. Kalish; Edgar Jaeggi; Michael Puchalski; Anita Szwast; Shaine A. Morris; Stephanie Levasseur; James C. Huhta; Ann Kavanaugh-McHugh; Anita J. Moon-Grady; Mary Donofrio; Erik C. Michelfelder; Jay Pruetz; Lisa Howley; Mary E. van der Velde; Bettina F. Cuneo; Margaret Vernon; Catherine Ikemba; John Kovalchin; Cyrus Samai; Gary Satou; Elif Seda Selamet Tierney; Colin Phoon; Wayne Tworetzky
Ebstein anomaly and tricuspid valve dysplasia (EA/TVD) are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature to date consists of small, single center case series often spanning several decades. We performed a multi-center study to assess perinatal
Circulation | 2015
Lindsay R. Freud; Maria C. Escobar-Diaz; Brian T. Kalish; Rukmini Komarlu; Michael D. Puchalski; Edgar Jaeggi; Anita Szwast; Grace Freire; Stéphanie M. Levasseur; Ann Kavanaugh-McHugh; Erik Michelfelder; Anita J. Moon-Grady; Mary T. Donofrio; Lisa W. Howley; Elif Seda Selamet Tierney; Bettina F. Cuneo; Shaine A. Morris; Jay D. Pruetz; Mary E. van der Velde; John P. Kovalchin; Catherine Ikemba; Margaret M. Vernon; Cyrus Samai; Gary Satou; Nina L. Gotteiner; Colin K.L. Phoon; Norman H. Silverman; Doff B. McElhinney; Wayne Tworetzky
Background— Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature consists of small, single-center case series spanning several decades. We performed a multicenter study to assess the outcomes and factors associated with mortality after fetal diagnosis in the current era. Methods and Results— Fetuses diagnosed with Ebstein anomaly and tricuspid valve dysplasia from 2005 to 2011 were included from 23 centers. The primary outcome was perinatal mortality, defined as fetal demise or death before neonatal discharge. Of 243 fetuses diagnosed at a mean gestational age of 27±6 weeks, there were 11 lost to follow-up (5%), 15 terminations (6%), and 41 demises (17%). In the live-born cohort of 176 live-born patients, 56 (32%) died before discharge, yielding an overall perinatal mortality of 45%. Independent predictors of mortality at the time of diagnosis were gestational age <32 weeks (odds ratio, 8.6; 95% confidence interval, 3.5–21.0; P<0.001), tricuspid valve annulus diameter z-score (odds ratio, 1.3; 95% confidence interval, 1.1–1.5; P<0.001), pulmonary regurgitation (odds ratio, 2.9; 95% confidence interval, 1.4–6.2; P<0.001), and a pericardial effusion (odds ratio, 2.5; 95% confidence interval, 1.1–6.0; P=0.04). Nonsurvivors were more likely to have pulmonary regurgitation at any gestational age (61% versus 34%; P<0.001), and lower gestational age and weight at birth (35 versus 37 weeks; 2.5 versus 3.0 kg; both P<0.001). Conclusion— In this large, contemporary series of fetuses with Ebstein anomaly and tricuspid valve dysplasia, perinatal mortality remained high. Fetuses with pulmonary regurgitation, indicating circular shunt physiology, are a high-risk cohort and may benefit from more innovative therapeutic approaches to improve survival.
Circulation | 2015
Lindsay R. Freud; Maria C. Escobar-Diaz; Brian T. Kalish; Rukmini Komarlu; Michael D. Puchalski; Edgar Jaeggi; Anita Szwast; Grace Freire; Stéphanie M. Levasseur; Ann Kavanaugh-McHugh; Erik Michelfelder; Anita J. Moon-Grady; Mary T. Donofrio; Lisa W. Howley; Elif Seda Selamet Tierney; Bettina F. Cuneo; Shaine A. Morris; Jay D. Pruetz; Mary E. van der Velde; John P. Kovalchin; Catherine Ikemba; Margaret M. Vernon; Cyrus Samai; Gary Satou; Nina L. Gotteiner; Colin K.L. Phoon; Norman H. Silverman; Doff B. McElhinney; Wayne Tworetzky
Background— Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature consists of small, single-center case series spanning several decades. We performed a multicenter study to assess the outcomes and factors associated with mortality after fetal diagnosis in the current era. Methods and Results— Fetuses diagnosed with Ebstein anomaly and tricuspid valve dysplasia from 2005 to 2011 were included from 23 centers. The primary outcome was perinatal mortality, defined as fetal demise or death before neonatal discharge. Of 243 fetuses diagnosed at a mean gestational age of 27±6 weeks, there were 11 lost to follow-up (5%), 15 terminations (6%), and 41 demises (17%). In the live-born cohort of 176 live-born patients, 56 (32%) died before discharge, yielding an overall perinatal mortality of 45%. Independent predictors of mortality at the time of diagnosis were gestational age <32 weeks (odds ratio, 8.6; 95% confidence interval, 3.5–21.0; P<0.001), tricuspid valve annulus diameter z-score (odds ratio, 1.3; 95% confidence interval, 1.1–1.5; P<0.001), pulmonary regurgitation (odds ratio, 2.9; 95% confidence interval, 1.4–6.2; P<0.001), and a pericardial effusion (odds ratio, 2.5; 95% confidence interval, 1.1–6.0; P=0.04). Nonsurvivors were more likely to have pulmonary regurgitation at any gestational age (61% versus 34%; P<0.001), and lower gestational age and weight at birth (35 versus 37 weeks; 2.5 versus 3.0 kg; both P<0.001). Conclusion— In this large, contemporary series of fetuses with Ebstein anomaly and tricuspid valve dysplasia, perinatal mortality remained high. Fetuses with pulmonary regurgitation, indicating circular shunt physiology, are a high-risk cohort and may benefit from more innovative therapeutic approaches to improve survival.
Circulation | 2015
Lindsay R. Freud; Maria C. Escobar-Diaz; Brian T. Kalish; Rukmini Komarlu; Michael D. Puchalski; Edgar Jaeggi; Anita Szwast; Grace Freire; Stéphanie M. Levasseur; Ann Kavanaugh-McHugh; Erik Michelfelder; Anita J. Moon-Grady; Mary T. Donofrio; Lisa W. Howley; Elif Seda Selamet Tierney; Bettina F. Cuneo; Shaine A. Morris; Jay D. Pruetz; Mary E. van der Velde; John P. Kovalchin; Catherine Ikemba; Margaret M. Vernon; Cyrus Samai; Gary Satou; Nina L. Gotteiner; Colin K.L. Phoon; Norman H. Silverman; Doff B. McElhinney; Wayne Tworetzky
Background— Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature consists of small, single-center case series spanning several decades. We performed a multicenter study to assess the outcomes and factors associated with mortality after fetal diagnosis in the current era. Methods and Results— Fetuses diagnosed with Ebstein anomaly and tricuspid valve dysplasia from 2005 to 2011 were included from 23 centers. The primary outcome was perinatal mortality, defined as fetal demise or death before neonatal discharge. Of 243 fetuses diagnosed at a mean gestational age of 27±6 weeks, there were 11 lost to follow-up (5%), 15 terminations (6%), and 41 demises (17%). In the live-born cohort of 176 live-born patients, 56 (32%) died before discharge, yielding an overall perinatal mortality of 45%. Independent predictors of mortality at the time of diagnosis were gestational age <32 weeks (odds ratio, 8.6; 95% confidence interval, 3.5–21.0; P<0.001), tricuspid valve annulus diameter z-score (odds ratio, 1.3; 95% confidence interval, 1.1–1.5; P<0.001), pulmonary regurgitation (odds ratio, 2.9; 95% confidence interval, 1.4–6.2; P<0.001), and a pericardial effusion (odds ratio, 2.5; 95% confidence interval, 1.1–6.0; P=0.04). Nonsurvivors were more likely to have pulmonary regurgitation at any gestational age (61% versus 34%; P<0.001), and lower gestational age and weight at birth (35 versus 37 weeks; 2.5 versus 3.0 kg; both P<0.001). Conclusion— In this large, contemporary series of fetuses with Ebstein anomaly and tricuspid valve dysplasia, perinatal mortality remained high. Fetuses with pulmonary regurgitation, indicating circular shunt physiology, are a high-risk cohort and may benefit from more innovative therapeutic approaches to improve survival.
American Journal of Cardiology | 2014
Kevin G. Friedman; David N. Schidlow; Lindsay R. Freud; Maria C. Escobar-Diaz; Wayne Tworetzky
Pediatric Cardiology | 2015
Kevin G. Friedman; Lindsay R. Freud; Maria C. Escobar-Diaz; Puja Banka; Sitaram M. Emani; Wayne Tworetzky