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Janerot Sjöberg, Birgitta
Alternative names
Publications (10 of 70) Show all publications
Hildebrand, E., Abrandt Dahlgren, M., Sved, C., Gottvall, T., Blomberg, M. & Janerot Sjöberg, B. (2014). Impact of a standardized training program on midwive’s ability to assess fetal heart anatomy by ultrasound. BMC Medical Imaging, 14(20)
Open this publication in new window or tab >>Impact of a standardized training program on midwive’s ability to assess fetal heart anatomy by ultrasound
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2014 (English)In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 14, no 20Article in journal (Refereed) Published
Abstract [en]

Background: Studies of prenatal detection of congenital heart disease (CDH) in the UK, Italy, and Norway indicate that it should be possible to improve the prenatal detection rate of CDH in Sweden. These studies have shown that training programs, visualization of the outflow tracts and color-Doppler all can help to speed up and improve the detection rate and accuracy. We aimed to introduce a more accurate standardized fetal cardiac ultrasound screening protocol in Sweden.

Methods: A novel pedagogical model for training midwives in standardized cardiac imaging was developed, a model using a think-aloud analysis during a pre- and post-course test and a subsequent group reflection. The self-estimated difficulties and knowledge gaps of four midwives were identified. A two-day course with mixed lectures, demonstrations and handson sessions was followed by a feedback session one month later consisting of an interview and check-up. The long-term effects were tested two years later.

Results: At the post-course test the self-assessed uncertainty was lower than at the pre-course test. The qualitative evaluation showed that the color Doppler images were difficult to interpret, but the training seems to have enhanced the familiarity with the new technique. The ability to perform the method remained at the new level at follow-up both three months and two years later.

Conclusions: Our results indicate that by implementing new imaging modalities and providing hands-on training, uncertainty can be reduced and time decreased, but they also show that continuous on-site training with clinical and technical back-up is important.

Keyword
Color Doppler, Congenital heart disease, Detection of congenital heart defects, Fetal heart scanning, Learning program, Prenatal cardiology, Second trimester screening, Standardized training program, Ultrasound screening
National Category
Other Clinical Medicine Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-104181 (URN)10.1186/1471-2342-14-20 (DOI)000336853200001 ()
Available from: 2014-02-10 Created: 2014-02-10 Last updated: 2017-12-06Bibliographically approved
Richter, A., Cederholm, I., Fredrikson, M., Mucchiano, C., Träff, S. & Janerot Sjöberg, B. (2012). Effect of Long-Term Thoracic Epidural Analgesia on Refractory Angina Pectoris: A 10-Year Experience. Journal of Cardiothoracic and Vascular Anesthesia, 26(5), 822-828
Open this publication in new window or tab >>Effect of Long-Term Thoracic Epidural Analgesia on Refractory Angina Pectoris: A 10-Year Experience
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2012 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 26, no 5, p. 822-828Article in journal (Refereed) Published
Abstract [en]

Objectives

In patients with refractory angina, the adjuvant effects of long-term home self-treatment with thoracic epidural analgesia on angina, quality of life, and safety were evaluated.

Design

A prospective, consecutive study.

Setting

A university hospital.

Participants and Intervention

Between January 1998 and August 2007, 152 consecutive patients with refractory angina began treatment with thoracic epidural analgesia by intermittent injections of bupivacaine (139 home treatment and 13 palliative). Data were collected until August 2008; therefore, the follow-up for each patient was between 1 and 9 years.

Measurements and Main Results

All but 7 of the patients improved symptomatically, and the improvement was maintained throughout the period of treatment (median = 19 months; range, 1 month-8.9 years). After 1 to 2 weeks, the median (interquartile range [IQR]) Canadian Cardiovascular Society angina class decreased from 4.0 (3.0-4.0) to 2.0 (1.0-2.0), the mean ± standard deviation frequency of anginal attacks decreased from 36 ± 19 to 4.4 ± 6.8 a week, the nitroglycerin intake decreased from 27.7 ± 15.7 to 2.7 ± 4.9 a week, and the median (IQR) overall self-rated quality of life assessed by the visual analog scale increased from 25 (20-30) to 70 (50-75) (all p < 0.001). About one-third of the patients had a dislodgement of the epidural catheter. Apart from 1 epidural hematoma that appeared in 1 patient with a previously undiagnosed bleeding defect, no other serious catheter-related complications occurred.

Conclusions

Long-term self-administered home treatment with thoracic epidural analgesia is a safe, widely available adjuvant treatment for patients with severe refractory angina. It produces symptomatic relief of angina and improves quality of life. The technical development of the method to protect the catheter against dislodgement is needed.

Place, publisher, year, edition, pages
Saunders Elsevier, 2012
Keyword
coronary artery disease, refractory angina pectoris, horacic epidural analgesia, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84740 (URN)10.1053/j.jvca.2012.01.047 (DOI)000309020900012 ()
Note

Funding Agencies|Research Board of the County Council of Ostergotland, Ostergotland, Sweden||

Available from: 2012-10-19 Created: 2012-10-19 Last updated: 2017-12-07
Baranowski, J., Ahn, H., Freter, W., Nielsen, N.-E., Nylander, E., Janerot-Sjöberg, B., . . . Wallby, L. (2011). Echo-guided presentation of the aortic valve minimises contrast exposure in transcatheter valve recipients. Catheterization and cardiovascular interventions, 77(2), 272-275
Open this publication in new window or tab >>Echo-guided presentation of the aortic valve minimises contrast exposure in transcatheter valve recipients
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2011 (English)In: Catheterization and cardiovascular interventions, ISSN 1522-1946, E-ISSN 1522-726X, Vol. 77, no 2, p. 272-275Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

We have developed a method using transthoracic echocardiography in establishing optimal visualization of the aortic root, to reduce the amount of contrast medium used in each patient.

BACKGROUND:

During transcatheter aortic valve implantation, it is necessary to obtain an optimal fluoroscopic projection for deployment of the valve showing the aortic ostium with the three cusps aligned in the beam direction. This may require repeat aortic root angiograms at this stage of the procedure with a high amount of contrast medium with a risk of detrimental influence on renal function.

METHODS:

We studied the conventional way and an echo guided way to optimize visualisation of the aortic root. Echocardiography was used initially allowing easier alignment of the image intensifier with the transducer's direction.

RESULTS:

Contrast volumes, radiation/fluoroscopy exposure times, and postoperative creatinine levels were significantly less in patients having the echo-guided orientation of the optimal fluoroscopic angles compared with patients treated with the conventional approach.

CONCLUSION:

We present a user-friendly echo-guided method to facilitate fluoroscopy adjustment during transcatheter aortic valve implantation. In our series, the amounts of contrast medium and radiation have been significantly reduced, with a concomitant reduction in detrimental effects on renal function in the early postoperative phase.

Keyword
aortic valve stenosis;heart valve prosthesis;transthoracic echocardiography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-74503 (URN)10.1002/ccd.22747 (DOI)20824753 (PubMedID)
Available from: 2012-01-30 Created: 2012-01-30 Last updated: 2017-12-08
Hübbert, L., Peterzén, B., Ahn, H. & Janerot Sjöberg, B. (2010). Second Harmonic Echocardiography and Spontaneous Contrast during Implantation of a left Ventricular Assist Device. ASAIO journal (1992), 56(5), 417-421
Open this publication in new window or tab >>Second Harmonic Echocardiography and Spontaneous Contrast during Implantation of a left Ventricular Assist Device
2010 (English)In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 56, no 5, p. 417-421Article in journal (Refereed) Published
Abstract [en]

Implantable mechanical left ventricular assist devices (LVADs) are used as a bridge or alternative to heart transplantation. Peroperative transesophageal echocardiography is commonly applied during implantation. Significant air embolism may occur as a result of air leakage at connections and anastomoses when LV filling becomes inadequate, and this must be prevented. Early suspicion and detection of air is mandatory to avoid negative circulatory effects. We hypothesized that monitoring of heart chamber size and occurrence of single air bubbles using second harmonic imaging (SHI) echocardiography may prevent risk for significant air embolism. After implantation of the LVAD in 10 calves, invasive hemodynamic monitoring and epicardial SHI were performed while increasing pump speed. Air bubbles in the ascending aorta were monitored and the left heart visualized for off-line dimensional analysis. Detection of air bubbles in the ascending aorta preceded their appearance in the left ventricle. They occurred exclusively but not always after a decrease in left atrial (LA) size. Decrease in LA pressure did not predict bubble detection or reduction in LA size. We conclude that SHI detects spontaneous ultrasound contrast during implantation of a LVAD and that a decrease in LA size is a warning that air embolism is imminent.

Place, publisher, year, edition, pages
Wolters Kluwer, 2010
National Category
Mathematics
Identifiers
urn:nbn:se:liu:diva-61517 (URN)10.1097/MAT.0b013e3181e9261d (DOI)
Available from: 2010-11-16 Created: 2010-11-16 Last updated: 2017-12-12
Ressner, M., Jansson, T., Cedefamn, J., Ask, P. & Janerot Sjöberg, B. (2009). Contrast Biases the Autocorrelation Phase Shift Estimation in Doppler Tissue Imaging. Ultrasound in Medicine and Biology, 35(3), 447-457
Open this publication in new window or tab >>Contrast Biases the Autocorrelation Phase Shift Estimation in Doppler Tissue Imaging
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2009 (English)In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 35, no 3, p. 447-457Article in journal (Refereed) Published
Abstract [en]

Quantitative assessment of regional myocardial function at rest and during stress with Doppler tissue imaging (DTI) plays an important role in daily routine echocardiography. However, reliable visual analysis is largely dependent on image quality and adequate border delineation, which still remains a challenge in a significant number of patients. In this respect, an ultrasound contrast agent (UCA) is often used to improve visualization in patients with suboptimal image quality. The knowledge of how DTI measurements will be affected by UCA present in the tissue is therefore of significant importance for an accurate interpretation of local myocardial motion. The aim of this paper was to investigate how signal contribution from UCA and nonlinear wave propagation influence the performance of the autocorrelation phase shift estimator used for DTI applications. Our results are based on model experiments with a clinical 2-D grayscale scanner and computational simulations or the DTI velocity estimator for synthetically-derived pulses, simulated bubble echoes and experimentally-sampled RF data of transmitted pulses and backscattered contrast echoes. The results show that destruction of UCA present in the tissue will give rise to an apparent bidirectional velocity bias of individual velocity estimates, but that spatial averaging of individual velocity measurements within a region-of-interest will result in a negative bias (away from the transducer) of the estimated mean or mean peak velocity. The UCA destruction will also have a significant impact on the measured integrated mean velocity over time, i.e., displacement. To achieve improved visualization with UCA during DTI-examinations, we either recommend that it is performed at low acoustic powers, mechanical index <= 0.3, thereby minimizing the effects from bubble rupture, or that each Doppler pulse package is preceded by a destruction burst similar to "Flash imaging" to clear the target area of contrast microbubbles.

Keyword
Ultrasound, Tissue Doppler, Contrast, Microbubbles, Velocity estimation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17277 (URN)10.1016/j.ultrasmedbio.2008.09.012 (DOI)
Available from: 2009-03-16 Created: 2009-03-16 Last updated: 2017-12-13
Bak, Z., Sjöberg, F., Eriksson, O., Steinvall, I. & Janerot Sjöberg, B. (2009). Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula. Journal of Trauma, 66(2), 329-336
Open this publication in new window or tab >>Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula
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2009 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 66, no 2, p. 329-336Article in journal (Refereed) Published
Abstract [en]

Background: The Parkland formula (2-4 mL/kg/burned area of total body surface area %) with urine output and mean arterial pressure (MAP) as endpoints; for the fluid resuscitation in burns is recommended all over the world. There has recently been a discussion on whether central circulatory endpoints should be used instead, and also whether volumes of fluid should be larger. Despite this, there are few central hemodynamic data available in the literature about the results when the formula is used correctly.

Methods: Ten burned patients, admitted to our unit early, and with a burned area of >20% of total body sur-face area were investigated at 12, 24, and 36 hours after injury. Using transesophageal echocardiography, pulmonary artery catheterization, and transpulmonary thermodilution to monitor them, we evaluated the cardiovascular coupling when urinary output and MAP were used as endpoints.

Results: Oxygen transport variables, heart rate, MAP, and left ventricular fractional area, did not change significantly during fluid resuscitation. Left ventricular end-systolic and end-diastolic area and global end-diastolic volume index increased from subnormal values at 12 hours to normal ranges at 24 hours after the burn. Extravascular lung intrathoracal blood volume ratio was increased 12 hours after the burn.

Conclusions: Preload variables, global systolic function, and oxygen transport recorded simultaneously by three separate methods showed no need to increase the total fluid volume within 36 hours of a major burn. Early (12 hours) signs of central circulatory hypovolemia, however, support more rapid infusion of fluid at the beginning of treatment.

Keyword
Cardiovascular coupling, Echocardiography, Hemodynamic monitoring, Fractional area change, Global end-diastolic volume
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17146 (URN)10.1097/TA.0b013e318165c822 (DOI)
Available from: 2009-03-07 Created: 2009-03-07 Last updated: 2017-12-13
Hübbert, L., Peterzén, B., Träff, S., Janerot Sjöberg, B. & Ahn, H. C. (2008). Axial flow pump treatment during myocardial depression in calves: an invasive hemodynamic and echocardiographic tissue Doppler study.. ASAIO journal (1992), 54(4), 367-371
Open this publication in new window or tab >>Axial flow pump treatment during myocardial depression in calves: an invasive hemodynamic and echocardiographic tissue Doppler study.
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2008 (English)In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 54, no 4, p. 367-371Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate flow characteristics and myocardial function after implantation of an axial pump left ventricular assist device while varying afterload and during progressive myocardial depression. Ten calves were included, seven of which fulfilled the protocol. Invasive hemodynamic monitoring and echocardiography with color-coded systolic tissue Doppler velocity (TD velocity) were used during prepump conditions, at three different pump speeds, during modification of the systemic vascular resistance (SVR), and during increasing degrees of beta-blockade. The TD velocity decreased with the myocardial function whereas left ventricular size, fractional shortening, and pump speed did not correlate significantly with the TD velocity. The TD velocity correlated significantly with native stroke volume, heart rate, SVR and cardiac output but none of these alone could explain more than 20% of the changes in TD velocity. The axial flow pump studied is effective in unloading the severely depressed heart and has a high capacity for maintaining an adequate cardiac output, regardless of differing hemodynamic conditions, pump speed or decreasing LV function. Echocardiography with volumetric rendering and TD velocity imaging are valuable tools for monitoring and quantifying residual myocardial function during pump treatment.

Place, publisher, year, edition, pages
Philadelphia, PA USA: Lippincott Williams & Wilkins, 2008
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-44738 (URN)10.1097/MAT.0b013e31817fd8de (DOI)000257861700006 ()77509 (Local ID)77509 (Archive number)77509 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Bak, Z., Sjöberg, F., Eriksson, O., Steinvall, I. & Janerot Sjöberg, B. (2008). Cardiac dysfunction after burns. Burns, 34(5), 603-609
Open this publication in new window or tab >>Cardiac dysfunction after burns
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2008 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 5, p. 603-609Article in journal (Refereed) Published
Abstract [en]

Objectives

Using transoesophageal echocardiography (TEE) we investigated the occurrence, and the association of possible abnormalities of motion of the regional wall of the heart (WMA) or diastolic dysfunction with raised troponin concentrations, or both during fluid resuscitation in patients with severe burns.

Patients and methods

Ten consecutive adults (aged 36–89 years, two women) with burns exceeding 20% total burned body surface area who needed mechanical ventilation were studied. Their mean Baux index was 92.7, and they were resuscitated according to the Parkland formula. Thirty series of TEE examinations and simultaneous laboratory tests for myocyte damage were done 12, 24, and 36 h after the burn.

Results

Half (n = 5) the patients had varying grades of leakage of the marker that correlated with changeable WMA at 12, 24 and 36 h after the burn (p ≤ 0.001, 0.044 and 0.02, respectively). No patient had WMA and normal concentrations of biomarkers or vice versa. The mitral deceleration time was short, but left ventricular filling velocity increased together with stroke volume.

Conclusion

Acute myocardial damage recorded by both echocardiography and leakage of troponin was common, and there was a close correlation between them. This is true also when global systolic function is not deteriorated. The mitral flow Doppler pattern suggested restrictive left ventricular diastolic function.

Keyword
Diastolic and regional systolic dysfunction; Echocardiography; Myocardial injury; Fluid resuscitation in burns; Myocardial infarction; Troponin
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12901 (URN)10.1016/j.burns.2007.11.013 (DOI)
Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-13
Chew, M., Brandberg, J., Janerot Sjöberg, B., Sloth, E., Hasenkam, J. M. & Ask, P. (2008). Colour Doppler flow measurements using surface integration of velocity vectors (SIVV): Effect of colour flow gain, pulse repetition frequency and number of imaging planes. Open medical imaging journal, 2, 56-61
Open this publication in new window or tab >>Colour Doppler flow measurements using surface integration of velocity vectors (SIVV): Effect of colour flow gain, pulse repetition frequency and number of imaging planes
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2008 (English)In: Open medical imaging journal, ISSN 1874-3471, Vol. 2, p. 56-61Article in journal (Refereed) Published
Keyword
flow, doppler, echocardiography, cardiac output
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-42610 (URN)66879 (Local ID)66879 (Archive number)66879 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2011-01-10
Wallby, L., Janerot Sjöberg, B., Jonasson, L., Locht, H. & Broqvist, M. (2008). History and signs of rheumatic disease in patients with significant heart valve disease.
Open this publication in new window or tab >>History and signs of rheumatic disease in patients with significant heart valve disease
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2008 (English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13049 (URN)
Available from: 2008-03-18 Created: 2008-03-18
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