A Description of Data Handling Practices and Software Tools Developed by the Boston Children’s Hospital Echo Core Laboratory

Ultrasound ‘Echocardiogram (echo)’ images generated by commercial scanners are non-invasive, economical, and have therefore become an important clinical and research tool for cardiovascular disease. The Boston Children’s Hospital (BCH, USA) cardiology department has developed echo image handling processes and software tools to simplify and manage the flow of echo data from sites participating in multi-center research studies. With frequent needs to correlate echocardiographic findings with surgical outcomes and more recently, better understand the acute and long-term effects of the SARS-CoV-2 pandemic on the heart in a multi- institutional collaborative 1, the need for a central corelab for image review and reporting has spurred the development of new software tools that seamlessly prepare, transmit and measure echocardiographic images and generate reports formatted to merge easily with clinical databases. In this paper we provide a descriptive guide to these software tools, and offer suggested approaches to data preparations that can simplify corelab processing

Early repair of hemitruncus: Excellent early and late outcomes

ObjectiveAnomalous origin of 1 of the branch pulmonary arteries from the aorta with 2 normal semilunar valves (hemitruncus) is a rare entity. There have been several small case series reported. We report here our single-institution surgical experience with hemitruncus from 1982 to 2006.MethodsA retrospective case review of all cases of conotruncal anomalies at Children’s Hospital Boston revealed 16 patients with hemitruncus. Ten patients had surgery in the neonatal period (<30 days), 4 at 1 to 6 months, 1 at 8 months, and 1 at 2 years. Diagnosis of hemitruncus was the indication for operation in all but 1. Fourteen of the 16 had anomalous right pulmonary artery from aorta, and 2 had left pulmonary artery from aorta. Common associated anomalies included patent foramen ovale in 14, patent ductus arteriosus in 11, and ventricular septal defect in 4. All patients had elevated right ventricular pressures with systemic pressures in 5 and suprasystemic pressures in 9.ResultsThere was 1 operative death in this series in an infant who died from sepsis following ligation of a tracheoesophageal fistula. One patient required reoperation for supravalvar aortic stenosis and right pulmonary artery stenosis 1 year postoperatively. Three patients required 4 catheter-based interventions postoperatively. At 20 years, survival by Kaplan–Meier was 93%; freedom from reoperation, 93%; and freedom from catheter reintervention, 79%.ConclusionsEarly repair of hemitruncus results in excellent hemodynamic and anatomic results. Survival is excellent, with a low incidence of reoperation or reintervention

Association between Technical Performance Scores and neurodevelopmental outcomes after congenital cardiac surgery

ObjectivesTechnical Performance Score (TPS) has been shown to have a strong association with early and late outcomes after congenital cardiac surgery, with greater morbidity and reintervention in children with major residual lesions (TPS class 3). We sought to explore the effect of TPS on the neurodevelopmental outcomes.MethodsAll infants undergoing cardiac surgery, excluding those with trisomy 21, were offered neurodevelopmental testing at 1 year of age using the Bayley Scales of Infant Development, 3rd edition. TPSs from the discharge echocardiograms were graded as class 1 (optimal), class 2 (minor residual), or class 3 (major residual). Multivariate regression analysis was performed using patient characteristics and preoperative variables.ResultsNeurodevelopmental testing was performed in 140 patients at a median age of 16 months. Of these, 28 (20%) had single ventricle palliation; 39 (28%) were in Risk Adjustment for Congenital Heart Surgery category 4 to 6. Significant differences between the groups were found in the cognitive (P = .01) and motor (P = .05) domains, with subjects in TPS class 3 having significantly lower cognitive and motor composite scores. The scores did not vary significantly according to single ventricle versus biventricular repair or Risk Adjustment for Congenital Heart Surgery categorization. In multivariate modeling, class 3 TPS remained significantly associated with a lower Bayley cognitive score (P = .02), with a trend toward a lower Bayley motor score (P = .08).ConclusionsWe found that TPS is an independent predictor of neurodevelopmental outcomes after infant heart surgery. Future research should explore whether a structured program of intraoperative recognition and intervention on residual lesions can improve the TPS and neurodevelopmental outcomes

Mechanical Mitral Valve Replacement:A Multicenter Study of Outcomes With Use of 15-to 17-mm Prostheses

Background. The aim of this study was to evaluate early and mid-term outcomes (mortality and prosthetic valve reintervention) after mitral valve replacement with 15- to 17-mm mechanical prostheses. Methods. A multicenter, retrospective cohort study was performed among patients who underwent mitral valve replacement with a 15- to 17-mm mechanical prosthesis at 6 congenital cardiac centers: 5 in The Netherlands and 1 in the United States. Baseline, operative, and follow-up data were evaluated. Results. Mitral valve replacement was performed in 61 infants (15 mm, n = 17 [28%]; 16 mm, n = 18 [29%]; 17 mm, n = 26 [43%]), of whom 27 (47%) were admitted to the intensive care unit before surgery and 22 (39%) required ventilator support. Median age at surgery was 5.9 months (interquartile range [IQR] 3.2-17.4), and median weight was 5.7 kg (IQR, 4.5-8.8). There were 13 in-hospital deaths (21%) and 8 late deaths (17%, among 48 hospital survivors). Major adverse events occurred in 34 (56%). Median follow-up was 4.0 years (IQR, 0.4-12.5) First prosthetic valve replacement (n = 27 [44%]) occurred at a median of 3.7 years (IQR, 1.9-6.8). Prosthetic valve endocarditis was not reported, and there was no mortality related to prosthesis replacement. Other reinterventions included permanent pacemaker implantation (n = 9 [15%]), subaortic stenosis resection (n = 4 [7%]), aortic valve repair (n = 3 [5%], and aortic valve replacement (n = 6 [10%]). Conclusions. Mitral valve replacement with 15- to 17-mm mechanical prostheses is an important alternative to save critically ill neonates and infants in whom the mitral valve cannot be repaired. Prosthesis replacement for outgrowth can be carried out with low risk. (C) 2020 by The Society of Thoracic Surgeons. Published by Elsevier Inc

Mechanical Mitral Valve Replacement: A Multicenter Study of Outcomes with Use of 15- to 17-mm Prostheses

Background: The aim of this study was to evaluate early and mid-term outcomes (mortality and prosthetic valve reintervention) after mitral valve replacement with 15- to 17-mm mechanical pr

Unscrambling the lensed galaxies in JWST images behind SMACS0723

The first deep field images from the James Webb Space Telescope (JWST) of the galaxy cluster SMACS~J0723.3-7327 reveal a wealth of new lensed images at uncharted infrared wavelengths, with unprecedented depth and resolution. Here we securely identify 14 new sets of multiply imaged galaxies totalling 42 images, adding to the five sets of bright and multiply-imaged galaxies already known from Hubble Space Telescope data. We find examples of arcs crossing critical curves, allowing detailed community follow-up, such as JWST spectroscopy for precise redshift determinations, and measurements of the chemical abundances and of the detailed internal gas dynamics of very distant, young galaxies. One such arc contains compact knots of magnification $\mu\sim$750, and features a microlensed transient. We also detect an Einstein cross candidate only visible thanks to JWST's superb resolution. Our parametric lens model is available at https://www.dropbox.com/sh/gwup2lvks0jsqe5/AAC2RRSKce0aX-lIFCc9vhBXa?dl=0 , and will be regularly updated using additional spectroscopic redshifts. The model reproduces the multiple images to better than an rms of $0.5^{\prime \prime}$, and allows for accurate magnification estimates of high-redshift galaxies. The intracluster light extends beyond the cluster members, exhibiting large-scale features that suggest a significant past dynamical disturbance. This work represents a first taste of the enhanced power JWST will have for lensing-related science.Comment: Submitted to ApJ. 13 pages, 6 figure

Flashlights: More than A Dozen High-Significance Microlensing Events of Extremely Magnified Stars in Galaxies at Redshifts z=0.7-1.5

Once only accessible in nearby galaxies, we can now study individual stars across much of the observable universe aided by galaxy-cluster gravitational lenses. When a star, compact object, or multiple such objects in the foreground galaxy-cluster lens become aligned, they can magnify a background individual star, and the timescale of a magnification peak can limit its size to tens of AU. The number and frequency of microlensing events therefore opens a window into the population of stars and compact objects, as well as high-redshift stars. To assemble the first statistical sample of stars in order to constrain the initial mass function (IMF) of massive stars at redshift z=0.7-1.5, the abundance of primordial black holes in galaxy-cluster dark matter, and the IMF of the stars making up the intracluster light, we are carrying out a 192-orbit program with the Hubble Space Telescope called "Flashlights," which is now two-thirds complete owing to scheduling challenges. We use the ultrawide F200LP and F350LP long-pass WFC3 UVIS filters and conduct two 16-orbit visits separated by one year. Having an identical roll angle during both visits, while difficult to schedule, yields extremely clean subtraction. Here we report the discovery of more than a dozen bright microlensing events, including multiple examples in the famous "Dragon Arc" discovered in the 1980s, as well as the "Spocks" and "Warhol" arcs that have hosted already known supergiants. The ultradeep observer-frame ultraviolet-through-optical imaging is sensitive to hot stars, which will complement deep James Webb Space Telescope infrared imaging. We are also acquiring Large Binocular Telescope LUCI and Keck-I MOSFIRE near-infrared spectra of the highly magnified arcs to constrain their recent star-formation histories

Flashlights: an off-caustic lensed star at redshift z = 1.26 in Abell 370

We report the discovery of a transient seen in a strongly lensed arc at redshift zs = 1.2567 in Hubble Space Telescope imaging of the Abell 370 galaxy cluster. The transient is detected at 29.51 ± 0.14 AB mag in a WFC3/UVIS F200LP difference image made using observations from two different epochs, obtained in the framework of the Flashlights programme, and is also visible in the F350LP band (mF350LP ≈ 30.53 ± 0.76 AB mag). The transient is observed on the negative-parity side of the critical curve at a distance of ∼0.6 arcsec from it, greater than previous examples of lensed stars. The large distance from the critical curve yields a significantly smaller macromagnification, but our simulations show that bright, O/B-type supergiants can reach sufficiently high magnifications to be seen at the observed position and magnitude. In addition, the observed transient image is a trailing image with an observer-frame time delay of ∼+0.8 d from its expected counterpart, so that any transient lasting for longer than that should have also been seen on the minima side and is thus excluded. This, together with the blue colour we measure for the transient (mF200LP − mF350LP ≈ [−0.3, −1.6] AB), rules out most other transient candidates such as (kilo)novae, for example, and makes a lensed star the prime candidate. Assuming that the transient is indeed a lensed star as suggested, many more such events should be detected in the near future in cluster surveys with the Hubble Space Telescope and JWST.This research was supported by NASA/HST grants GO-15936 and GO-16278 from the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS5-26555. AKM, AZ, and MG acknowledge support by grant 2020750 from the United States-Israel Binational Science Foundation (BSF) and grant 2109066 from the United States National Science Foundation (NSF), and by the Ministry of Science & Technology, Israel. This work was supported by JSPS KAKENHI grants JP22H01260, JP20H05856, and JP20H00181. AKM would like to thank Lukas Furtak for useful discussions. JMD acknowledges the support of projects PGC2018-101814-B-100 and MDM-2017-0765. AVF is grateful for additional financial support from the Christopher R. Redlich Fund and numerous individual donors.Peer reviewe

JWST's PEARLS: a new lens model for ACT-CL J0102−-4915, "EL Gordo'', and the first red supergiant star at cosmological distances discovered by JWST

The first JWST data on the massive colliding cluster El Gordo confirm 23 known families of multiply lensed images and identify 8 new members of these families. Based on these families, which have been confirmed spectroscopically by MUSE, we derived an initial lens model. This model guided the identification of 37 additional families of multiply lensed galaxies, among which 28 are entirely new systems, and 9 were previously known. The initial lens model determined geometric redshifts for the 37 new systems. The geometric redshifts agree reasonably well with spectroscopic or photometric redshifts when those are available. The geometric redshifts enable two additional models that include all 60 families of multiply lensed galaxies spanning a redshift range $2<z<6$. The derived dark-matter distribution confirms the double-peak configuration of mass found by earlier work with the southern and northern clumps having similar masses. We confirm that El Gordo is the most massive known cluster at $z>0.8$ and has an estimated virial mass close the maximum mass allowed by standard cosmological models. The JWST images also reveal the presence of small-mass perturbers that produce small lensing distortions. The smallest of these is consistent with being a dwarf galaxy at $z=0.87$ and has an estimated mass of $3.8\times10^9$~\Msol, making it the smallest substructure found at $z>0.5$. The JWST images also show several candidate caustic-crossing events. One of them is detected at high significance at the expected position of the critical curve and is likely a red supergiant star at $z=2.1878$. This would be the first red supergiant found at cosmological distances. The cluster lensing should magnify background objects at $z>6$, making more of them visible than in blank fields of similar size, but there appears to be a deficiency of such objects.Comment: 27 pages, 21 figure

JWST's PEARLS: Mothra, a new kaiju star at z=2.091 extremely magnified by MACS0416, and implications for dark matter models

We report the discovery of Mothra, an extremely magnified monster star, likely a binary system of two supergiant stars, in one of the strongly lensed galaxies behind the galaxy cluster MACS0416. The star is in a galaxy with spectroscopic redshift $z=2.091$ in a portion of the galaxy that is parsecs away from the cluster caustic. The binary star is observed only on the side of the critical curve with negative parity but has been detectable for at least eight years, implying the presence of a small lensing perturber. Microlenses alone cannot explain the earlier observations of this object made with the Hubble Space Telescope. A larger perturber with a mass of at least $10^4$\,\Msun\ offers a more satisfactory explanation. Based on the lack of perturbation on other nearby sources in the same arc, the maximum mass of the perturber is $M< 2.5\times10^6$\,\Msun, making it the smallest substructure constrained by lensing above redshift 0.3. The existence of this millilens is fully consistent with the expectations from the standard cold dark matter model. On the other hand, the existence of such small substructure in a cluster environment has implications for other dark matter models. In particular, warm dark matter models with particle masses below 8.7\,keV are excluded by our observations. Similarly, axion dark matter models are consistent with the observations only if the axion mass is in the range $0.5\times10^{-22}\, {\rm eV} < m_a < 5\times10^{-22}\, {\rm eV}$.Comment: 26 pages and 27 figure