Publications

Scholarly Journals--Published

  • Shinozaki RM, Johnson MC, Gazit AZ. Native aortic root thrombus leading to myocardial infarction in a single ventricle patient. Cardiology in the Young. Published online 2024:1-4. doi:10.1017/S1047951124025150 Abstract We report a 14-month-old male with hypoplastic left heart syndrome, mitral stenosis, and aortic stenosis with native aortic root thrombus. He developed a wide complex ventricular tachycardia and ST-segment elevation myocardial infarction with troponin I levels peaking at 388 ng/mL. He was treated safely with systemic alteplase with a resolution of his regional wall motion abnormality 18 hours later. (05/2024) (link)
  • Hernandez BS, Shinozaki RM, Grady RM, Drussa A, Jamro-Comer E, Wang J, Aggarwal M. Improvement in Echocardiographic and Diagnostic Biomarkers after Systemic Glucocorticoid Therapy in Infants with Pulmonary Hypertension. J Pediatr. 2024 May 28:114116. doi: 10.1016/j.jpeds.2024.114116. Epub ahead of print. PMID: 38815741. Abstract: Objective:  To assess the effect of treating pulmonary hypertension (PH) in infants less than 1 year of age with systemic glucocorticoids using echocardiographic and diagnostic biomarkers as measures of efficacy.  Study Design: A retrospective chart review was performed on 17 hospitalized infants less than one year of age at St. Louis Children’s Hospital who received a five to seven-day course of systemic glucocorticoid treatment followed by a three-week taper with no significant intracardiac shunts from January 1, 2017 to December 31, 2021. Quantitative echocardiographic indices for PH, N-terminal pro b-type natriuretic peptide (NT-proBNP) and/or b-type natriuretic peptide (BNP) levels were collected pre-glucocorticoid treatment, after the glucocorticoid burst, and after the 21-day taper.  Results: There were eight (47%) males, a mean (+/- SD) gestational age of 32.1 (+/-5.8) weeks, and five (29%) concomitantly treated with sildenafil. Twelve were classified as World Health Organization (WHO) group 3 PH (71%), and 29% WHO group 1 PH. There were significant improvements 30 days post-glucocorticoid initiation in BNP levels (p=0.008), partial pressure of carbon dioxide (p=0.03), eccentricity index (p=0.005), RV ejection time (p=0.04), pulmonary artery acceleration time (PAAT) (p=0.002), and PAAT to right ventricular ejection time ratio (PAAT/RVET) (p=0.02). Tricuspid regurgitation velocity was not able to be assessed. There were no mortalities during the study timeline. Conclusions: In our retrospective study, systemic glucocorticoid therapy was well tolerated and may be associated with significant improvement in cardio-pulmonary function in infants with PH.   (05/2024) (link)
  • Shinozaki R, Balzer D, Nageotte SJ. Pediatric Use of a Novel Thrombectomy System Designed to Minimize Blood Loss. JACC Cardiovasc Interv. 2021 Aug 9;14(15):e195-e196. doi: 10.1016/j.jcin.2021.04.042. Epub 2021 Jul 14. PMID: 34274298. (08/2021) (link)
  • Shinozaki RM, Schwingshackl A, Srivastava N, Grogan T, Kelly RB. Pediatric interfacility transport effects on mortality and length of stay. World J Pediatr. 2021 Aug;17(4):400-408. doi: 10.1007/s12519-021-00445-w. Epub 2021 Jul 28. PMID: 34319538; PMCID: PMC8363522. Abstract Background: We aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS. Methods: Retrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission. Results: Four hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4-2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59-5.90) than ambulance transports (P = 0.017). Conclusions: These results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs. Keywords: Helicopter; Hospital length of stay; Pediatric critical care; Pediatric intensive care unit; Transport medicine. (07/2021) (link)