ORCID Profile
0000-0003-2638-2775
Current Organisation
University of Alberta
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-11-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
Publisher: Springer Science and Business Media LLC
Date: 23-10-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-11-2020
Publisher: Elsevier BV
Date: 2013
Publisher: Springer Science and Business Media LLC
Date: 10-10-2020
Publisher: Wiley
Date: 11-2016
DOI: 10.1002/BDRA.23572
Abstract: Australian Aboriginal children have increased infant and childhood mortality compared with Caucasian children, but their mortality related to congenital heart defects (CHDs) throughout life is unknown. We conducted a retrospective cohort study using data on 8,110 live born, singleton infants with CHDs born January 1980 to December 2010 from the Western Australian Register of Developmental Anomalies. Vital status was determined from death and medical records. Data for infants with chromosomal anomalies (except Down syndrome) were excluded. Kaplan-Meier Product-Limit estimates and 95% confidence intervals (CIs) were computed by Aboriginality. Hazard ratios (HRs) and 95% CIs were calculated from multivariable Cox-Proportional Hazard Regression models. Aboriginal children had lower survival than Caucasians for all CHDs combined but most notably during the neonatal period for functional single ventricle (50.0% vs. 86.1% p = 0.015) and during the postneonatal period for tetralogy of Fallot (87.0% vs. 97.4% p = 0.021) and atrioventricular septal defect (60.0% vs. 94.6% p = 0.010). After adjusting for covariates except remoteness and socioeconomic status (SES), Aboriginal children with all CHDs combined (HR = 1.4 95% CI, 1.0-1.9), with transposition of the great arteries (HR = 4.3 95% CI, 1.0-18.9) or functional single ventricle (HR = 8.6 95% CI, 1.3-57.9) had increased risk of mortality compared with Caucasian children. When remoteness and SES were included, the risks were not statistically significant. Long-term survival was lower for Aboriginal children with CHDs, and Aboriginal children with specific CHD phenotypes had increased risk of mortality throughout life. Increased risk may be due to SES and environmental factors. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:1016-1031, 2016. © 2016 Wiley Periodicals, Inc.
Publisher: Wiley
Date: 27-08-2022
DOI: 10.1111/ECHO.15427
Publisher: Cambridge University Press (CUP)
Date: 23-05-2017
Publisher: Elsevier BV
Date: 07-2022
Publisher: Portland Press Ltd.
Date: 08-2023
DOI: 10.1042/CS20230594
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-11-2018
Publisher: Springer Science and Business Media LLC
Date: 02-03-2014
DOI: 10.1007/S00246-014-0880-Z
Abstract: This study identified tracheobronchial cartilage calcification in children with congenital heart disease. Calcification of the tracheobronchial airways has been found previously in adults receiving warfarin and in children receiving warfarin after mitral valve replacement. A 9-year-old girl who had received a Fontan repair 6 years previously underwent a cardiac computed tomography (CT) scan to evaluate pulmonary artery size. The result was an incidental finding of extensive tracheobronchial cartilage calcification. A retrospective review of all pediatric Fontan patients who had undergone cardiac CT was conducted to search for calcification of the tracheobronchial cartilage. The study investigated ten pediatric Fontan patients who had undergone cardiac CT scanning. Two patients with extensive calcification of the tracheobronchial airways were identified. The index case had hypoplastic left heart syndrome, and the patient had undergone a staged repair with the Fontan at the age of 3 years. A 16-year-old boy with tricuspid atresia had undergone staged repair and Fontan at the age of 3.5 years. These two patients had received continuous warfarin therapy for 6 and 13 years, respectively. Other common causes of airway calcification were excluded from the study. This report describes warfarin-induced tracheobronchial calcification in patients after the Fontan procedure. This finding has possible implications for airway growth and vascular calcification.
Publisher: Wiley
Date: 12-2017
DOI: 10.1111/ECHO.13654
Abstract: Evaluation of fetal cardiac function is one of the most important components of fetal echocardiography. Fetal cardiac dysfunction is closely linked to risk of intrauterine fetal demise, in many, but not all cases is indicative of worse postnatal prognosis and may prompt the use of medications or interventions to optimize outcomes. There may be implications for termination versus continuation of pregnancy, an indication for early delivery, a change in location and even mode of delivery. In extreme cases, fetal cardiac dysfunction may prompt prenatal or early neonatal listing for cardiac transplantation. There are several important differences between the fetal and postnatal circulatory physiology which affect echocardiographic assessment of cardiac dysfunction. In this review, we examine the echocardiographic findings according to their underlying pathophysiology with reference to common causes.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 08-2022
Publisher: Wiley
Date: 27-06-2021
DOI: 10.1002/PD.5979
Publisher: Springer Science and Business Media LLC
Date: 14-05-2021
Publisher: Cambridge University Press (CUP)
Date: 30-09-2015
DOI: 10.1017/S1047951115001870
Abstract: A 14-year-old boy presented to us with a diagnosis of severe asthma and oxygen desaturation of 76% on a 6-minute-walk test. A contrast echocardiogram revealed echocontrast in the left and right atria simultaneously. A secundum atrial septal defect and partial cor triatriatum dexter were diagnosed, and the atrial defect was closed by cardiac catheterisation.
Publisher: Elsevier BV
Date: 08-2001
DOI: 10.1016/S0169-328X(01)00163-2
Abstract: A reduced ability to regenerate peripheral axons may be partly responsible for diabetic neuropathy. The source of the impairment has not been narrowed down to axonal or Schwann cell failure. We used nerve grafts from control or diabetic donor rats transplanted into control or diabetic hosts to pursue this differential diagnosis. An isograft between the left sciatic nerves of inbred Lewis rats was performed 8 weeks after STZ treatment and on age-matched controls. The nerve exchanges were control-control, control-diabetic, diabetic-control and diabetic-diabetic. At postsurgical day 14, nerves were excised and analysed for levels of axonal markers, total and phosphorylated neurofilament, and Schwann cell receptors, ErbB2 and p75(NTR), using immunohistochemistry and Western blotting. The aim was to measure ingress of axonal markers into the graft and judge the appropriateness of Schwann cell phenotype changes. Transfer of nerve from diabetic to control rats resulted in a doubling in neurofilament, both phosphorylated and nonphosphorylated (both P<0.05). ErbB2 was decreased in grafts from diabetic rats (53% of control, P<0.05) and p75(NTR) levels were increased in both types of graft in diabetic rats (to 300-400% of controls, P<0.05). Schwann cells in diabetic nerve grafts showed receptor levels more similar to controls when placed into a normal environment and the converse also appeared to hold. TUNEL staining revealed increased apoptosis in diabetic nerve distal to the graft. The data show that alterations in Schwann cell phenotype in diabetes are reversed by transfer to control rats and develop in normal nerve after transfer to a diabetic host.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-09-2022
Publisher: Wiley
Date: 09-2021
DOI: 10.1002/UOG.23558
Publisher: Elsevier BV
Date: 02-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2021
Publisher: Wiley
Date: 18-08-2023
DOI: 10.1002/UOG.27456
Abstract: The association between pre‐gestational maternal diabetes (MD) and risk of congenital heart disease (CHD) is well‐recognized however, the importance of glycemic control and other coexisting risk factors during pregnancy is less clear. We sought to determine the relative risk of major CHD (mCHD) among offspring in pregnancies complicated by pre‐gestational maternal diabetes (MD), and the effect of first trimester glycemic control on mCHD risk. We determined the incidence of mCHD, (requiring an operation at year or resulting in pregnancy termination or fetal demise), among registered births in Alberta. Linkage of diabetes status, maximum hemoglobin A 1c (HbA 1c ) at weeks gestation and other covariates was performed using the Alberta Perinatal Health Program registry. Risk of mCHD according to HbA 1c was estimated as an adjusted risk ratio (aRR) calculated using log‐binomial modelling (StataIC14.2). Of 1412 cases of mCHD in 594,755 Alberta births in the study period (2.37/1000), mCHD was present in 48/7449 births with MD (6.4/1000, RR 2.8 (95%CI 2.1, 3.7, p .001). In the entire cohort, increased maternal age (aRR 1.03, 95%CI 1.02, 1.04, p .0001) and multiple gestations (aRR 1.37 (95%CI 1.3, 2.1, p .001) were also associated with mCHD risk, whereas maternal pre‐pregnancy weight kg was not. The stratified risks for mCHD associated with A1c ≤6.1%, 6.1%‐8.0% and ≥8.0% were 4.2/1000, 6.8/1000, 17/1000 births, respectively the aRR of mCHD associated with MD and an A 1c .0% was 8.5 (95%CI 5.0, 14.4) compared to no diabetes, and 4.4 (95%CI 2.3, 8.8, p .001) compared to MD with a normal HbA 1c ( .1%). MD is associated with a 2.8 risk ratio for mCHD, increasing to 7.3 in those with HbA 1c %. This data should facilitate refinement of referral indications for high‐risk pregnancy screening. This article is protected by copyright. All rights reserved.
Publisher: Elsevier
Date: 2002
DOI: 10.1016/S0074-7742(02)50081-7
Abstract: The relationships among Schwann cells, axons, and the perineurial barrier emphasize the key role Schwann cells play in normal functions of the nerve. Schwann cells are responsible for action potential velocity through insulation of axons, maintenance of axonal caliber, and correct localization of Na+ channels immunological and funcitonal integrity of the nerve through the perineurial blood-nerve-barrier and effective nerve regeneration. In diabetic neuropathy, many of these facets of nerve function are defective. Hypoxia, hyerglycemia, and increased oxidative stress contribute directly and indirectly to Schwann cell dysfunction. The results include impaired paranodal barrier function, damaged myelin, reduced antioxidative capacity, and decreased neurotrophic support for axons. This chapter discusses the role of the Schwann cell in the normal or regenerating nerve nad in the altered metabolic conditons of diabetes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-11-2020
Publisher: Wiley
Date: 27-01-2022
DOI: 10.1002/PD.6102
Publisher: Wiley
Date: 09-2022
DOI: 10.1002/UOG.26030
Abstract: Socioeconomic status (SES) and distance of residence from tertiary care may impact fetal detection of congenital heart disease (CHD), partly through reduced access to and quality of obstetric ultrasound screening. It is unknown whether SES and remoteness of residence (RoR) affect prenatal detection of CHD in jurisdictions with universal health coverage. We examined the impact of SES and RoR on the rate and timing of prenatal diagnosis of major CHD within the province of Alberta in Canada. In this retrospective study, we identified all fetuses and infants diagnosed with major CHD in Alberta, from 2008 to 2018, that underwent cardiac surgical intervention within the first year after birth, died preoperatively, were stillborn or underwent termination. Using maternal residence postal code and geocoding, Chan SES index quintile, geographic distance from a tertiary-care fetal cardiology center and the Canadian Index of Remoteness (IoR) were calculated. Outcome measures included rates of prenatal diagnosis and diagnosis after 22 weeks' gestation. Risk ratios (RR) were calculated using log-binomial regression and stratified by rural (≥ 100 km from tertiary care) or metropolitan (< 100 km from tertiary care) residence, adjusting for year of birth and the obstetric ultrasound screening view in which CHD would most likely be detected (four-chamber view outflow-tract view three-vessel or three-vessels-and-trachea or non-standard view septal view). Of 1405 fetuses/infants with major CHD, prenatal diagnosis occurred in 814 (57.9%). Residence ≥ 100 km from tertiary care (adjusted RR, 1.19 95% CI, 1.05-1.34) and higher IoR (adjusted RR, 1.9 95% CI, 1.1-3.3) were associated with missed prenatal diagnosis of major CHD. Similarly, residence ≥ 100 km from tertiary care (adjusted RR, 1.41 95% CI, 1.22-1.62) and higher IoR (adjusted RR, 3.6 95% CI, 2.2-8.2) were associated with prenatal diagnosis after 22 weeks. Although adjusted and unadjusted analyses showed no association between Chan SES index quintile and prenatal-diagnosis rate overall nor for residence in rural areas, in metropolitan regions, lower SES quintiles were associated with missed prenatal diagnosis (quintile 1: RR, 1.24 95% CI, 1.02-1.50) and higher risk of diagnosis after 22 weeks' gestation (quintile 1: RR, 1.46 95% CI, 1.10-1.93 quintile 2: RR, 1.66 95% CI, 1.24-2.23). Despite universal healthcare, rural residence in Alberta is associated with lower rate of prenatal diagnosis of major CHD and higher risk of late prenatal diagnosis (≥ 22 weeks). Within metropolitan regions, lower SES impacts negatively prenatal-diagnosis rate and timing. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Publisher: Wiley
Date: 09-2021
DOI: 10.1111/ECHO.15178
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-11-2022
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.ECHO.2018.08.009
Abstract: Accurate fetal arrhythmia (FA) diagnosis is key for effective management. Currently, FA assessment relies on standard echocardiography-based techniques (M mode and spectral Doppler), which require adequate fetal position and cursor alignment to define temporal relationships of mechanical events. Few data exist on the application of color Doppler tissue imaging (c-DTI) in FA assessment. The aim of this study was to examine the feasibility and clinical applicability of c-DTI in FA assessment in comparison with standard techniques. Pregnancies with diagnosed FA were prospectively recruited to undergo c-DTI following fetal echocardiography. Multiple-cycle four-chamber clips in any orientation were recorded (mean frame rate, 180 ± 16 frames/sec). With offline analysis, s le volumes were placed on atrial (A) and ventricular (V) free walls for simultaneous recordings. Atrial and ventricular rates, intervals (for atrial-ventricular conduction and tachyarrhythmia mechanism), and relationships were assessed to decipher FA mechanism. FA diagnosis by c-DTI, conventional echocardiographic techniques, and postnatal electrocardiography and/or Holter monitoring were compared. FA was assessed by c-DTI in 45 pregnancies at 15 to 39 weeks, including 16 with atrial and/or ventricular ectopic beats 18 with supraventricular tachyarrhythmias, including ectopic atrial tachycardia in 11, atrioventricular reentrant tachycardia in four, atrial flutter in two, and intermittent atrial flutter and junctional ectopic rhythm in one three with ventricular tachycardias and eight with bradycardias or atrioventricular conduction pathology, including five with complete atrioventricular block (AVB), one with first-degree AVB evolving into complete AVB, one with second-degree AVB, and one with sinus bradycardia. After training, FA diagnosis by c-DTI could be made irrespective of fetal orientation within 10 to 15 min. FA diagnosis by c-DTI concurred with standard techniques in 41 cases (91%), with additional findings identified by c-DTI in 10. c-DTI led to new FA diagnoses in four cases (9%) not definable by standard techniques. FA diagnosis by c-DTI was confirmed in all 20 with persistent arrhythmias after birth, including three with new diagnoses defined by c-DTI. c-DTI was particularly helpful in deciphering SVT mechanism (long vs short ventricular-atrial interval) in all 18 cases, whereas standard techniques permitted definition in only half. c-DTI with offline analysis permits rapid and accurate definition of FA mechanism, providing new information in nearly one-third of affected pregnancies.
Publisher: Elsevier BV
Date: 08-2016
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.ATHORACSUR.2017.08.032
Abstract: An increasing proportion of those living with single ventricle physiology have hypoplastic left heart syndrome (HLHS). Our objective was to assess the association between HLHS and outcomes post Fontan operation. All pediatric patients who underwent a Fontan procedure at the University of Alberta between 1996 and 2016 were included. Follow-up clinical data collected included early and late surgical or catheter reintervention, echocardiography, and long-term transplant-free survival. Characteristics were compared between those with and without HLHS, and the association between outcomes and HLHS were assessed. A total of 320 children (median age 3.3 years, interquartile range 2.8 to 3.9 years 121 [43.4%] female) underwent a Fontan procedure over the course of the study. Nearly one third of subjects had HLHS (107, 33.4%). Patients with HLHS were more likely to have abnormal ventricular function (19.6% versus 7.0%, p = 0.003) and worse than mild atrioventricular valve (AVV) regurgitation (23.4 versus 9.2%, p = 0.001) preoperatively. HLHS was not predictive of in-hospital Fontan failure (odds ratio 0.82, 95% CI 0.28, 2.39), late reintervention (hazard ratio [HR] 1.08, 95% CI 0.66, 1.76), or transplant-free survival (HR 1.58, 95% CI 0.72, 3.44). Subjects with HLHS were more likely to have more than mild AVV regurgitation (31.6% versus 13.3%, p = 0.028) and abnormal ventricular function (29.8% versus 10.7%, p < 0.0001) at late follow-up. Patients with HLHS who survive to the Fontan procedure do no worse with the operation than those with other anatomy. Given worse late ventricular function and AVV regurgitation, equivalent survival may not persist throughout a patient's life course.
Publisher: Research Square Platform LLC
Date: 22-08-2022
Publisher: Elsevier BV
Date: 12-2021
Publisher: Cold Spring Harbor Laboratory
Date: 21-03-2023
Publisher: Elsevier BV
Date: 12-2022
Publisher: Elsevier BV
Date: 06-2021
Publisher: BMJ
Date: 30-06-2015
DOI: 10.1136/ARCHDISCHILD-2014-307691
Abstract: Screening for critical congenital heart disease (CHD) with prenatal ultrasound or postnatal pulse oximetry has the potential to improve outcome. To guide screening recommendations, this study aimed to identify the proportion and outcome of major CHD diagnosed before (early) or after (late) postnatal discharge prior to the introduction of postnatal oximetry screening. A retrospective, population-based review of all major CHD in New Zealand from 2006 to 2010. The timing of diagnosis relative to discharge and to intervention in critical and non-critical cases with intention to treat was determined, as was the relationship of diagnostic timing to mortality at 1 year of age. Late diagnosis occurred in 20% of critical and 51% of non-critical cases. Mortality occurred in 18% of critical vs 8% of non-critical cases. Mortality was lower with an early diagnosis of critical CHD (early diagnosis 16% vs late diagnosis 27%, p=0.04). Isolated critical CHD benefited most from early diagnosis (mortality, early diagnosis 12% vs late diagnosis 29%, p=0.002). Early diagnosis occurred in % critical complex CHD and hypoplastic left heart syndrome, 85% d-transposition of the great arteries (d-TGA) and 53% critical left ventricular outflow tract obstruction (LVOTO). Deaths in d-TGA and LVOTO primarily occurred prior to intervention and for d-TGA most often when birth was distant from the cardiac centre. Excess mortality occurs following late diagnosis of critical CHD, and for d-TGA even with early diagnosis if intervention is not immediately available. Antenatal detection retains an important role in reducing mortality related to critical CHD.
Publisher: Elsevier BV
Date: 12-2019
Publisher: Elsevier BV
Date: 05-2022
Publisher: BMJ
Date: 12-04-2014
Location: Australia
No related grants have been discovered for Luke Eckersley.