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Ann Frances Bolger, M.D.

Ann Frances Bolger, M.D.
William Watt Kerr Professor of Clinical Medicine

mail: San Francisco General Hospital
1001 Potrero Ave., 5G1
UCSF Box 0846
San Francisco, CA 94110
phone:(415) 206-8315
fax:(415) 206-5100
email:abolger@medsfgh.ucsf.edu

Education

University of California, Los Angeles, MD, 1977-1981, Medicine

University of California, Riverside, BS, 1974-1977, Biomedical Science

Professional Experience

University of California San Francisco, School of Medicine, 1998 - Present

  • Director of Echocardiography, San Francisco General Hospital, 1998 - Present
  • Professor of Clinical Medicine, July 2004 - Present
  • Associate Professor of Clinical Medicine, 2002 - 2004
  • Associate Clinical Professor of Medicine, 1998 - 2002

Stanford University School of Medicine, 1987-1997

  • Associate Professor of Medicine 1996 - 1997
  • Assistant Professor of Medicine 1987 - 1996

Palo Alto VA Medical Center, 1987- 1997

  • Director of Echocardiography

Linköping University, Linköping, Sweden, 1992 - Present

  • Co-Investigator, Cardiovascular Flow Dynamics Research Group

University of California, Riverside, Division of Biomedical Sciences, 1995 - Present

  • Associate Clinical Professor, 1997- Present
  • Assistant Clinical Professor, 1995 - 1997

Cedars Sinai Medical Center, Los Angeles, CA, , 1981-1987

  • Clinical Fellowship, Division of Cardiology, 1984-1987
  • Internship and Residency, Department of Internal Medicine, 1981-1984

Honors

5/2004 Clinical Teaching Award, UCSF School of Medicine
6/2002 Honorary Member, Alpha Omega Alpha Honor Medical Society (elected by the UCSF senior medical students)
6/2002 Clinical Teaching Award, UCSF School of Medicine
5/2002 Doctor of medicine honoris causa, M.D. h.c. Linköping, Faculty of Health Sciences, Linköping University, Linköping, Sweden
6/2001 UCSF Cardiology Faculty Teaching Award
6/2000 Imaging Solution of the Year. Advanced Imaging, Cygnus Publishing, Melville, NY.
1998 - Present Board Member, American Heart Association, San Francisco Affiliate
1998 - 2000 President, Bay Area Society of Echocardiography
1995-1997 Vice-President, Bay Area Society of Echocardiography
1996 Kaiser Award for Excellence in Clinical Teaching, Stanford University
1992 Fellow, Andrew W. Mellon Foundation
1992 Fellow, Council on Clinical Cardiology, American Heart Association
1990 Fellow, Mellon Foundation
1989 Fellow, American College of Cardiology

Research Interests

My current research is heavily focused on the study of three-dimensional (3D) cardiac flow using phase contrast magnetic resonance imaging. This basic aspect of cardiovascular physiology has been poorly studied until the present, due to the lack of high quality tools for visualization and measurement of dynamic in vivo blood flow. Earlier attempts to apply quantitative ultrasound-based methods to the definition of 3D flow in the atria and ventricles of the heart were unsuccessful due to the limitations of 2D echocardiography. It is increasingly recognized that the success or failure of common cardiovascular surgeries may be heavily influenced by the ways in which we succeed or fail to correct abnormal flow patterns; another method for studying the perturbations in 3D cardiac flow had to be sought in order to study these issues.

Cardiac MRI is able to provide data regarding heart structures and flows with an accuracy that current ultrasound methods cannot. The tremendous density of the MRI data required aggressive methods for visualization and quantification. With the assistance of Lars Wigstrom, PhD, at University of Linköping, Sweden, we developed a method for putting in vivo MRI data into a formal computational fluid dynamics software package initially designed for aeronautical engineering. Using those engineering tools, we were able for the first time to create intuitive 3D visualizations of blood flowing through the beating heart.

That research has progressed to its current form, which is a multinational and multidisciplinary group comprising physicists, engineers, physiologists and cardiologists and graduate trainees at multiple levels. The group is presently studying the role and quantifiers of vortical flow structures within the cardiovascular system, including the thoracic aorta as well as the cardiac chambers. The flow information is also the basis for novel three-dimensional maps of fluid pressure within the heart, and for preliminary work on the correlation of flow, pressure and myocardial strain. An extraordinarily satisfying, and challenging, aspect of our research is the fact that many of the flow characteristics that we are documenting have not been described before, and therefore we are making basic contributions to the fundamental understanding of cardiovascular function.

Of interest, performing this heavily collaborative science has required us to develop a robust model for conducting our work internationally. Our group has a highly organized structure of laboratory meetings, with agendas, pre-posted data and demonstrations, and assigned presentations. These meetings occur over the phone, with common data and images available on the group web site. This format allows us to discuss in a dynamic and interactive fashion the results of the various projects, and allows the faculty involved in the group to serve as accessible and involved mentors and supervisors for the medical and engineering students, and doctoral and postdoctoral trainees. I participate actively in the dissertation development and writing for our group; PhD defenses by three members of our group will occur in December 2004 and January 2005. Recent publications specifically related to this work include:

Kvitting J-P E, Ebbers T, Wigström L, Engvall J, Olin CL, Bolger AF. Flow patterns in the aortic root and the aorta studied by time-resolved 3D phase contrast magnetic resonance imaging: Implications for aortic valve-sparing surgery. In press, JTCVS, October, 2003.

Identified the need for analysis tools to evaluate three-dimensional images of in vivo human aortic flow in normal subjects and patients after root replacement, formed the scientific team, assisted in development and validation of methods, assisted in data collection and analysis, co-wrote the paper with Dr. Kvitting.

Ebbers T, Wigström L, Bolger AF, Wranne B, Karlsson M. Noninvasive measurement of time-varying three-dimensional relative pressure fields within the human heart. J Biomech Eng 124(3):288-93, 2002.

Identified the clinical issues creating the need for a time resolved multidimensional description of intracardiac pressure distribution. Assisted in study design and method development, assisted in data analysis and manuscript preparation.

Ebbers T, Wigström L, Bolger AF, Engvall J, Karlsson M. Estimation of relative cardiovascular pressures using time-resolved three-dimensional phase contrast MRI. Magn Reson Med May;45(5):872-9, 2001.

Identified the clinical issues creating the need for a time resolved multidimensional description of intracardiac pressure distribution. Assisted in study design and method development, assisted in data analysis and manuscript preparation.

Fyrenius A, Wigström L, Ebbers T, Karlsson M, Engvall J, and Bolger A. Three-dimensional flow in the human left atrium. Heart 86:448-455, 2001.

Conceived the concept of the study, designed the analysis tools, assisted in data collection and analysis, wrote 50% of the paper.

Wigström L, Ebbers T, Fyrenius A, Karlsson M, Engvall J, Wranne B, and Bolger A: Particle trace visualization of intracardiac flow using time-resolved 3D phase contrast MRI. Magnetic Resonance in Medicine 41:793-799, 1999.

Identified the need for analysis tools to evaluated three-dimensional images of in vivo human cardiac flow, formed the scientific team, assisted in development and validation of methods, assisted in data collection and analysis, wrote 50% of the paper.

Clinical Research Program

I am participating in a study of atherosclerosis in patients with HIV disease receiving HAART (highly active antiretroviral therapy) in collaboration with Principle Investigator Dr. Priscilla Hsue. Cutting edge methods for assessing the thickness of the carotid artery intima with ultrasound are being used to identify and track atherosclerosis in those patients, and correlated to lipid status and clinical course. I provide the technical advice regarding the imaging ultrasound methods, assist in design of data acquisition and analysis methods, manuscript preparation and review.

I am also a participant in the Daptomycin study, evaluating the efficacy of this novel antimicrobial against staphylococcus aureus in bactermic patients. I provide transeophageal imaging which is required by this protocol, and assist in data acquisition and interpretation.

Publications

Book Chapters

  1. Ryan E, Bolger A. Aortic Dissection. In: The Practice of Clinical Echocardiography, Otto ed., W.B. Saunders, Philadelphia, Pennsylvania, 2001.
  2. Ryan E, Bolger A. Transesophageal echocardiography (TEE) in the evaluation of endocarditis. In: Cardiology Clinics, Foster ed., W.B. Saunders, Philadelphia, Pennsylvania. Cardiol Clin 2000 Nov;18(4):773-87.
  3. Bolger A. Aortic Dissection. In: The Practice of Clinical Echocardiography, Otto ed., W.B. Saunders, Philadelphia, Pennsylvania, 1997.
  4. Bolger A, Miller DC. Intraoperative Doppler color flow mapping for assessment of ischemic mitral regurgitation. In: Ischemic Mitral Incompetence, Vetter-Hetzer Schmutzler, eds., Steinkopf-Verlag, Darmstadt, GDR, 1989.

Recent Published Articles

  1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA; Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease; Council on Cardiovascular Disease in the Young; American Heart Association; American Academy of Pediatrics.Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004 Oct 26;110(17):2747-71.
  2. Carlhäll C, Wigström L, Heiberg E, Karlsson M, Bolger A, Nylander E. The contribution of mitral annular excursion and shape dynamics to total left ventricular volume change. In Press, Am J Physiol, 2004.
  3. Hsue PY, Lo JC, Franklin A, Bolger AF, Martin JN, Deeks SG, Waters DD. Progression of Atherosclerosis as Assessed by Carotid Intima-Media Thickness in Patients With HIV Infection. Circulation 2004 Mar 15.
  4. Baddour LM, Bettmann MA, Bolger AF, Epstein AE, Ferrieri P, Gerber MA, Gewitz MH, Jacobs AK, Levison ME, Newburger JW, Pallasch TJ, Wilson WR, Baltimore RS, Falace DA, Shulman ST, Tani LY, Taubert KA Nonvalvular cardiovascular device-related infections. Circulation. 2003 Oct 21;108(16):2015-31.
  5. Kvitting J-P E, Ebbers T, Wigström L, Engvall J, Olin CL, Bolger AF. Flow patterns in the aortic root and the aorta studied by time-resolved 3D phase contrast magnetic resonance imaging: Implications for aortic valve-sparing surgery. In press, JTCVS, 10/2003.
  6. Nielsen SL, Timek TA, Green GR, Dagum P, Daughters GT, Hasenkam JM, Bolger AF, Ingels NB, Miller DC. Influence of anterior mitral leaflet second-order chordae tendinae on left ventricular systolic function. Circulation. 2003 Jul 29;108(4):486-91.
  7. Bolger AF. Endocarditis beyond the annulus: eat your heart out. J Am Coll Cardiol 39(7):1212-3, 2002.
  8. Ebbers T, Wigstrom L, Bolger AF, Wranne B, Karlsson M. Noninvasive measurement of time-varying three-dimensional relative pressure fields within the human heart. J Biomech Eng 124(3):288-93, 2002.
  9. Webb CL, Jenkins KJ, Karpawich PP, Bolger AF, Donner RM, Allen HD, Barst RJ; Congenital Cardiac Defects Committee of the American Heart Association Section on Cardiovascular Disease in the Young. Collaborative care for adults with congenital heart disease. Circulation May 14;105(19):2318-23, 2002.
  10. Hsue PY, Salinas CL, Bolger AF, Benowitz NL, Waters DD. Acute aortic dissection related to crack cocaine. Circulation 105(13):1592-5, 2002.
  11. Ferrieri P, Gewitz MH, Gerber MA, Newburger JW, Dajani AS, Shulman ST, Wilson W, Bolger AF, Bayer A, Levison ME, Pallasch TJ, Gage TW, Taubert KA; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the American Heart Association Council on Cardiovascular Disease in the Young. Unique features of infective endocarditis in childhood. Circulation105(17):2115-26, 2002; Pediatrics 109(5):931-43, 2002.
  12. Fyrenius A, Wigström L, Ebbers T, Karlsson M, Engvall J, and Bolger A. Three-dimensional flow in the human left atrium. Heart 86:448-455, 2001.
  13. Timek TA, Nielsen SL, Green GR, Dagum P, Bolger AF, Daughters GT, Hasenkam JM, Ingels NB Jr, Miller DC. Influence of anterior mitral leaflet second-order chordae on leaflet dynamics and valve competence. Ann Thorac Surg Aug;72(2):535-40; discussion 541, 2001.
  14. Ebbers T, Wigstrom L, Bolger AF, Engvall J, Karlsson M. Estimation of relative cardiovascular pressures using time-resolved three-dimensional phase contrast MRI. Magn Reson Med May;45(5):872-9, 2001.
  15. Timek T, Glasson JR, Dagum P, Green GR, Nistal JF, Komeda M, Daughters GT, Bolger AF, Foppiano LE, Ingels NB Jr, Miller DC. Ring annuloplasty prevents delayed leaflet coaptation and mitral regurgitation during acute left ventricular ischemia. J Thorac Cardiovasc Surg, 119(4 Pt 1):774-83, 2000.
  16. Fyrenius A, Wigström L, Bolger A, Ebbers T, Öhman P, Karlsson M, Wranne B and Engvall J. Pitfalls in Doppler evaluation of diastolic function: insights from three-dimensional magnetic resonance imaging. J Am Soc Echocardiogr, 12(10):817-26, 1999.
  17. Wigström L, Ebbers T, Fyrenius A, Karlsson M, Engvall J, Wranne B, and Bolger A: Particle trace visualization of intracardiac flow using time-resolved 3D phase contrast MRI. Magnetic Resonance in Medicine, 41:793-799, 1999.
  18. Green GR, Dagum P, Glasson JR, Daughters GT, Bolger AF, Foppiano LE, Berry GJ, Ingels NB Jr, Miller DC. Mitral annular dilatation and papillary muscle dislocation without mitral regurgitation in sheep. Circulation,100(19 Suppl):II95-102, 1999.
  19. Dagum P, Green GR, Timek TA, Daughters GT, Foppiano LE, Tye TL, Bolger AF, Ingels NB Jr, Miller DC. Functional evaluation of the Medtronic stentless porcine xenograft mitral valve in sheep. Circulation, 100(19 Suppl):II70-7, 1999.
  20. Dagum P, Green GR, Nistal FJ, Daughters GT, Timek TA, Foppiano LE, Bolger AF, Ingels NB Jr, Miller DC. Deformational dynamics of the aortic root: modes and physiologic determinants. Circulation, 100(19 Suppl):II54-62, 1999.
  21. Dagum P, Green GR, Glasson JR, Daughters GT, Bolger AF, Foppiano LE, Ingels NB Jr, Miller DC. Potential mechanism of left ventricular outflow tract obstruction after mitral ring annuloplasty. J Thorac Cardiovasc Surg, 117(3):472-80, 1999.
  22. Glasson JR, Green GR, Nistal JF, Dagum P, Komeda M, Daughters GT, Bolger AF, Foppiano LE, Ingels NB Jr, Miller DC. Mitral annular size and shape in sheep with annuloplasty rings. J Thorac Cardiovasc Surg, 117(2):302-9, 1999.
  23. Green GR, Dagum P, Glasson JR, Daughters GT, Bolger AF, Foppiano LE, Ingels NB Jr, Miller DC. Semirigid or flexible mitral annuloplasty rings do not affect global or basal regional left ventricular systolic function. Circulation, 98(19 Suppl):II128-35; discussion II135-6, 1998.
  24. DeAnda A Jr, Komeda M, Moon MR, Green GR, Bolger AF, Nikolic SD, Daughters GT 2nd, Miller DC. Estimation of regional left ventricular wall stresses in intact canine hearts. Am J Physiol, 275(5 Pt 2):H1879-85, 1998.
  25. Bayer AS, Bolger AF, Taubert KA, Wilson W, Steckelberg J, Karchmer AW, Levison M, Chambers HF, Dajani AS, Gewitz MH, Newburger JW, Gerber MA, Shulman ST, Pallasch TJ, Gage TW, Ferrieri P. Diagnosis and management of infective endocarditis and its complications. Circulation, 98(25):2936-48, 1998.
  26. DeAnda A, Komeda M, Moon MR, Bolger AF, Nikolic SD, Daughters GT, Ingels NB, Miller DC: Determination of simultaneous regional left ventricular wall stresses in intact canine hearts. Am J Physiol, 275(5Pt2):H1879-85, 1998.
  27. Glasson JR, Komeda M, Daughters GT, Bolger AF, Foppiano LE, Hiyase M, Oesterle SN, Ingels NB, and Miller DC: Early systolic mitral leaflet "loitering" during acute ischemic mitral regurgitation. J Thorac Cardiovasc Surg, 116(2):193-205, 1998.
  28. Karlsson MO, Glasson JR, Bolger AF, Daughters GT, Komeda M, Foppiano LE, Miller DC, Ingels NB: Mitral valve opening in the ovine heart. Am J Physiol, 274(2 Pt 2):H552-H563, 1998.
  29. Glasson JR, Komeda M, Daughters GT, Foppiano LE, Bolger AF, Tye TL, Ingels NB, Miller DC: Most mitral 3-D annular size reduction occurs before systole in sheep and is abolished with ventricular pacing. Circulation, 96 (9 Suppl): II-II11522, 1997.
  30. Komeda M, Glasson JR, Bolger AF, Daughters GT, MacIsaac A, Osterle SN, Ingels NB, Miller DC: Geometric determinants of ischemic mitral regurgitation. Circulation, 96(9 Suppl):II-II128-33, 1997.
  31. Komeda M, DeAnda A, Glasson JR, Bolger AF, Daughters GT, Ingels NB, Miller DC: Complete unloading alone may not protect the left ventricle. Ann Thorac Surg, 64:1250-5, 1997.
  32. Komeda M, Glasson JR, Bolger AF, Daughters GT, Ingels NB, Miller DC. Papillary muscle-LV wall "complex". J Thorac Cardiovasc Surg, 113:292-301, 1997.
  33. Dajani AS, et al. Rheumatic Fever, Endocarditis, and Kawasaki's Disease Committee of the Council on Cardiovascular Disease in the Young, American Heart Association: Prevention of Bacterial Endocarditis: Recommendations by the American Heart Association. JAMA 277:1794-1801, 1997; Circulation 96:358-366, 1997; Clin Infect Dis, 25(6):1448-1458, 1997; J Am Dent Assoc., 128(8):1142 .1151, 1997.
  34. Bolger AF, Eidenvall L, Ask P, Loyd D, Wranne B: Understanding continuous wave Doppler signal intensity as a measure of regurgitant severity. J Am Soc Echocardiogr, 7:613-622, 1997.

 
     
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