Cardiology Commons^™

Case Report: Diagnosis Of Dual-Biopsy Negative Severe Cardiac Amyloidosis, Kristin Lohr, Md, Eric Kasprowicz, Md

The Medicine Forum

INTRODUCTION

Amyloidosis is a rare disorder that involves the deposition of misfolded protein in extracellular tissue. Disease manifestations vary depending on the affected organs. Areas most often involved include the kidneys, gastrointestinal tract, heart, nervous system, and musculoskeletal system. The most common type is AL amyloidosis, in which plasma cells produce an abundance of a monoclonal proteins that affect numerous organ systems. A second variety, AA amyloidosis, is associated with inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease. Finally, a heritable version of amyloidosis mediated by mutations in the transthyretin protein (TTR) has a predilection for deposition in …

Coronary Subclavian Steal Syndrome, Rady Ho, Md, Jonathan A. Dunn, Md

The Medicine Forum

INTRODUCTION

Coronary subclavian steal (CSS) syndrome is a rare complication of coronary artery bypass graft surgery (CABG) involving the left internal mammary artery (LIMA) graft to the left anterior descending (LAD) artery. It results from stenosis of the left subclavian artery proximal to the LIMA, which compromises myocardial blood flow. The incidence of CSS syndrome is between 0.1-3.4% in the United States.1 Most cases occur as a result of long-standing subclavian stenosis due to progres-sion of the stenosis following CABG. We report a case of CSS syndrome, which presented as a non-ST elevation myocardial infarction (NSTEMI).

Allergic Inflammatory Mediated Coronary Artery Vasospasm: A Case Report Of Kounis Syndrome, Jonathan Hullman, Ms4, Jaehee Kim, Md, Gregary D. Marhefka, Md, Facc, Facp

The Medicine Forum

INTRODUCTION

Kounis syndrome is an acute coronary syndrome occurring secondary to an anaphylactic reaction. A wide variety of triggers such as drugs and environmental exposures have been described for the so-called allergic myocardial infarction. The pathophysiology of Kounis syndrome is thought to be due to the release of inflammatory mediators such as histamine and cytokines by mast cells and eosinophils resulting in either coronary vasospasm, myocardial infarction or stent thrombosis.

Squamous Cell Carcinoma Metastatic To The Heart Mimicking St-Elevation Myocardial Infarction, Jason Chen, Md, Colin Craft, Md, Andrew W. Panakos, Md, Gregary D. Marhefka, Md, Facc, Facp

The Medicine Forum

INTRODUCTION

Heart disease remains the leading cause of mortality in the United States, accounting for about one quarter of all deaths in 20131. Acute ischemic heart disease is a major subpopulation of this group, and typically presents with characteristic electrocardiographic (EKG) changes. The most concerning of these findings are ST-elevations, as ST Elevation Myocardial Infarction (STEMI) typically indicates the need for emergent reperfusion therapy because 30-day mortality of untreated STEMI is approximately 10-15% versus 5% in treated cases2. As a result, clinicians are taught to recognize the symptoms and signs of myocardial ischemia and STEMI in order to achieve timely …

Incidence Of Pump Thrombosis In Heartmate Ii During Destination Therapy, Rohan Samson, Abhishek Jaiswal, Frank Smart, Thierry H. Lejemtel

The VAD Journal

Pump thrombosis (PT) occurs during destination therapy (DT) with HeartMate II, a continuous blood flow left ventricular assist device (St Jude, Pleasanton, CA, USA). With adherence to stringent post-operative and long-term anticoagulation a low incidence of PT was initially reported during DT. The increased PT incidence during DT that was reported in early 2013 was attributed to lenient anticoagulation. A wide range of PT incidence during DT is being reported since the return to stringent post-operative and long-term anticoagulation. We searched PubMed from January 2008 to February 2016 for reports of PT during mechanical circulatory support with HeartMate II and …

Normal Lactate Dehydrogenase Does Not Exclude Pump Thrombosis In Left Ventricular Assist Devices, Julie Shelton Do, Bennet George Md, Amanda Hart Bsn, Rn, Maya Guglin Md

The VAD Journal

Left ventricular assist device (LVAD) pump thrombosis is a well-known complication of LVAD placement. Elevated lactate dehydrogenase (LDH) has classically been the first objective marker of pump thrombosis. In this case, we present a patient found to have normal serum LDH values but was ultimately found to have significant pump thrombosis.

Outcomes Of External Repair Of Heartmate Ii™ Lvad Percutaneous Leads, Jay D. Pal, Claudius Mahr, Jason W. Smith, Todd F. Dardas, Jay Pinette, David J. Farrar, Nahush A. Mokadam

The VAD Journal

Background: The HeartMate II Left Ventricular Assist Device (LVAD) receives power via a percutaneous lead connected to an external controller and batteries. At times, this lead can be damaged during normal wear, as well as by traumatic fracture, which may jeopardize the functionality of the LVAD. If there is significant internal damage, surgical replacement of the LVAD is required. However it is possible to repair externally damaged leads by replacing the distal portion of the lead to avoid pump replacement. We report the overall experience and outcomes in patients with external lead repairs.

Methods: A procedure for full …

Exploring Body Mass Index Changes In Left Ventricular Assist Device Patients, Raquel E. Thomas, Corrine Hanson, Glenda Woscyna, Brian D. Lowes

The VAD Journal

Background: Current treatment options for end-stage heart failure, such as transplantation, can be limited by obesity guidelines. Mechanical devices such as Left Ventricular Assistive Devices (LVAD) can bridge heart failure patients to transplantation, however, after implantation; some patients may experience weight gain that precludes them from transplantation. Therefore, the objective of this study was to evaluate weight changes after the implantation of an LVAD.

Methods: A retrospective review of 130 patients receiving an LVAD were divided into two groups based on BMI at the time of implantation: obese (>30 kg/m²) and non-obese (/m²). Patients were …

A Protocol For Collecting Human Cardiac Tissue For Research, Cheavar A. Blair, Premi Haynes, Stuart G. Campbell, Charles Chung, Mihail I. Mitov, Donna Dennis, Mark R. Bonnell, Charles W. Hoopes, Maya Guglin, Kenneth S. Campbell

The VAD Journal

This manuscript describes a protocol at the University of Kentucky that allows a translational research team to collect human myocardium that can be used for biological research. We have gained a great deal of practical experience since we started this protocol in 2008, and we hope that other groups might be able to learn from our endeavors. To date, we have procured ~4000 samples from ~230 patients. The tissue that we collect comes from organ donors and from patients who are receiving a heart transplant or a ventricular assist device because they have heart failure. We begin our manuscript by …

The Utility Of Remote Hemodynamic Monitoring Devices In Patients With A Ventricular Assist Device, Bennet George, Amanda Hart, Sarah Branam, Maya Guglin

The VAD Journal

Remote intracardiac hemodynamic monitoring is a growing area of interest to help aid in the management of patients with chronic congestive heart failure. The utility of remote hemodynamic monitoring has not previously been investigated with a ventricular assist device population. We present two cases of patients with ventricular assist devices in which we employed remote hemodynamic monitoring data to aid in patient management.

Speech At The Reception For Dr. Frazier At The Ishlt 2016. Remarks For O.H. Frazier, M.D., Edwin C. Mcgee Jr

The VAD Journal

No abstract provided.

Orthotopic Heart Transplant Following Implantation Of A Systemic Ventricular Assist Device In A Patient With Congenitally Corrected Transposition Of The Great Arteries And Dextrocardia Situs Inversus Totalis, Bree Ann C. Young, Zachariah B. Nealy, Michael F. Mcgrath, John M. Herre

The VAD Journal

Congenitally corrected transposition of the great arteries (CCTGA) is a rare congenital heart disease that commonly results in congestive heart failure due to exposure of the anatomic right ventricle to systemic pressures. Additional anatomic abnormalities, such as situs inversus, in which the viscera are mirror images of normal anatomy, or dextrocardia in which the heart apex is located on the patient’s right, once were contraindications to transplant in the treatment of advanced heart failure. However, recent advancements now allow for the management of heart failure through mechanical circulatory support and subsequent transplant. This case presents a 52 year-old man with …

Va-Ecmo In Cardiogenic Shock In Adults: Indications And Outcomes, Maya Guglin, Andrew Burchett

The VAD Journal

Background

Use of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) has become increasingly common as a means of providing hemodynamic support for patients in cardiogenic shock. Data regarding the efficacy of VA-ECMO are provided almost exclusively by single-center, retrospective analyses. These retrospective analyses vary significantly with regards to documentation of the underlying pathophysiologic process resulting in cardiogenic shock.

Methods

Relevant published studies were identified by using a comprehensive search of English-language MEDLINE from 1966 to November 2015. Relevant references found cited in these studies were also analyzed. These studies were analyzed with regard to the indications the authors used for initiation of …

Bleeding And Thromboembolic Events In Patients With Heartmate Ii Mechanical Circulatory Support, Salman Allana, Carrie Chapman, Nancy Sweitzer, Maryl Johnson, Takushi Kohmoto, Margaret Murray, David Murray, Zhanhai Li, Peter S. Rahko

The VAD Journal

Background: Bleeding and thromboembolic events (TE) are common complications following HeartMate II (HMII) implantation. The aim of the study was to review our experience related to bleeding and TE events in patients with a HMII and identify factors associated with increased risk of these events.

Methods: We retrospectively reviewed 70 consecutive patients who received a HMII between May 2006 and December 2011. The patients were followed for 12 months or until cardiac transplantation, device explantation or death. Major bleeding was defined by INTERMACS criteria with intracranial bleeding events added.

Results: There were 48 bleeding events in 28 (40%) patients with …

An Unusual Migration Of A Stent: A Case Report, Fikadu G. Tekleyes Md, Melissa D. Lester Md, Mark A. Studeny Md, Ellen A. Thompson Md, Steven Craig Md

Marshall Journal of Medicine

Stent dislodgment and embolization is a rare complication of coronary stenting.

There are reports of intra-coronary stent entrapment, stripping, and dislodgement

during percutaneous coronary interventions causing potentially life threatening

complications, including intra-coronary or systemic embolization. Reports of

dislodgment and migration of previously placed drug eluting intra-coronary stent

several months after deployment are very limited in the literature. We describe a

drug eluting stent dislodgment and migration in an 88 year-old male 10 months after

its deployment.

Lung Edema On Va Ecmo, Christof Schmid Md

The VAD Journal

No abstract provided.

Temporary And Durable Mechanical Circulatory Support For Single Ventricular Failure In An Adult, Joshua L. Hermsen, Jason W. Smith, Jay D. Pal, Agustin Rubio, S. Carolina Masri, Nahush A. Mokadam, Richard K. Cheng, Claudius Mahr

The VAD Journal

Patients palliated with Fontan circulation requiring mechanical circulatory support pose anatomic and physiologic challenges. We treated a Fontan patient with acute ventricular failure with sequential temporary and durable support devices. Aspects of treatment with each device required modification based on the patient’s anatomy and physiology.

Decrease In Driveline Infections With Change In Driveline Management Protocol, Saima Aslam, Jennifer Dan, Amanda Topik, Michael Belyk, Francesca Torriani, Randy Taplitz, Jorge Silva-Enciso, Denise Barnard, Barry Greenberg, Jack Copeland, Victor Pretorius, Eric Adler

The VAD Journal

Background: Driveline infections (DLI) are a significant cause of morbidity and mortality in ventricular assist device (VAD) recipients. We compared driveline infection (DLI) rate after an institutional change in driveline management protocol.

Methods: We retrospectively reviewed records of left VAD recipients at our institution, based on driveline management. Group 1: daily driveline dressing change consisting of chlorhexidine cleansing, sterile 4x4 gauze, and use of an abdominal binder. Group 2: Dressing change every 3 days consisting of chlorhexidine cleansing, non-sterile silver-impregnated foam with overlying clear dressing, and use of a driveline anchor. Follow-up was censored at first DLI, device removal, transplant …

Pulmonary Congestion (White Lungs) On Va Ecmo, Maya Guglin, Andrew Burchett, Thomas Tribble, Richard Charnigo

The VAD Journal

Veno-arterial extracorporeal membrane oxygenation therapy (VA ECMO) is used for short-term circulatory support in the setting of cardiogenic shock or cardiac arrest. While VA-ECMO improves hemodynamics and gas exchange, it may result in left ventricular distention and pulmonary congestion.

Methods

The records of all patients supported with VA ECMO for at least three consecutive days at our institution from 2012-2014 were retrospectively analyzed. All chest radiographs taken during VA ECMO support were graded on a scale of 1 to 4. A score of 1 was used when no pulmonary congestion was present. A score of 2 was used for congestion …

Development And Pilot-Testing Of A Patient Decision Aid For Left Ventricular Assist Device Placement, Kristin Kostick, Estevan D. Delgado, Lidija A. Wilhelms, Courtenay R. Bruce, Jerry D. Estep, Matthias Loebe, Charles Minard, Jennifer S. Blumenthal-Barby

The VAD Journal

Objectives: This paper describes the development methodology and pilot-testing of a decision aid for Left Ventricular Assist Device (LVAD) placement, combining traditional needs-assessment with a novel user-centered approach.

Background: Studies indicate suboptimal patient understanding of the capabilities, lifestyle implications, and risks of LVAD therapy.

Methods and Results: We developed the decision aid in line with the Ottawa Decision Support Framework (ODSF) and the International Patient Decision Aids Standards (IPDAS) for ensuring quality, patient-centered content. Structured interviews were conducted with patients, caregivers, candidates for LVAD treatment, and expert clinicians (n=71) to generate content based on patient values and …

What Did We Learn About Vads In 2015?, Maya Guglin

The VAD Journal

No abstract provided.

Development And Validation Of A Preprocedural Risk Score To Predict Access Site Complications After Peripheral Vascular Interventions Based On The Vascular Quality Initiative Database, Daniel Ortiz, Maharaj Singh, Arshad Jahangir, Suhail Allaqaband, Anjan Gupta, Tanvir Bajwa, Mark W. Mewissen

Journal of Patient-Centered Research and Reviews

Purpose

Access site complications following peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Prediction of access site complication risk may optimize PVI care; however, there is no tool designed for this. We aimed to create a clinical scoring tool to stratify patients according to their risk of developing access site complications after PVI.

Methods

The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 27,997 patients who had undergone PVI at 131 North American centers. Clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI access site complications were included in a multivariate logistic regression …