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A Review Of Pain Control In Pediatric Cardiac Bypass Surgery, Pranathi Ari, Andrew T. Waberski, Nina Deutsch 2017 George Washington University

A Review Of Pain Control In Pediatric Cardiac Bypass Surgery, Pranathi Ari, Andrew T. Waberski, Nina Deutsch

GW Research Days 2016 - Present

Background: Children undergoing cardiac surgery with cardiopulmonary bypass receive high dose opioids for analgesia and to reduce the neurohormonal stress response. While opioids have excellent pharmacodynamics profiles adverse effects include: respiratory depression, bradycardia, nausea, vomiting, and tolerance. Additionally, opioids with short half-lives like fentanyl require several boluses to be administered during surgery causing fluctuating levels analgesia. Several strategies to advance pain control incorporate regional and neuraxial anesthetic techniques, however anticoagulation preclude its routine use. Alternatively using opioids with longer half-lives for analgesia may improve pain control and reduce adverse effects.

Objective: The objective of this study is to quantify postoperative ...


Secondary Prevention At The Aswan Heart Centre, Amira Athanasios 2017 George Washington University

Secondary Prevention At The Aswan Heart Centre, Amira Athanasios

GW Research Days 2016 - Present

Cardiovascular disease remains the leading cause of death globally, taking the lives of almost 18 million patients around the world each year. The overwhelming majority of cardiovascular deaths take place in low- to mid-income counties, suggesting that most cardiovascular deaths are preventable. In this study, current literature on secondary prevention of coronary artery disease was analyzed. Specific emphasis was given to preventative measures and successes in low income countries. Based on a literature review, a patient questionnaire to better understand patient adherence to preventative measures was created. This questionnaire focuses on patients receiving dual antiplatelet therapy post acute myocardial infarct ...


Messenger Rna And Microrna Transcriptomic Signatures Of Cardiometabolic Risk Factors, David D. McManus, Jian Rong, Tianxiao Huan, Sean Lacey, Kahraman Tanriverdi, Peter J. Munson, Martin G. Larson, Roby Joehanes, Venkatesh Murthy, Ravi Shah, Jane Freedman, Daniel Levy 2017 University of Massachusetts Medical School

Messenger Rna And Microrna Transcriptomic Signatures Of Cardiometabolic Risk Factors, David D. Mcmanus, Jian Rong, Tianxiao Huan, Sean Lacey, Kahraman Tanriverdi, Peter J. Munson, Martin G. Larson, Roby Joehanes, Venkatesh Murthy, Ravi Shah, Jane Freedman, Daniel Levy

David D. McManus

BACKGROUND: Cardiometabolic (CM) risk factors are heritable and cluster in individuals. We hypothesized that CM risk factors are associated with multiple shared and unique mRNA and microRNA (miRNA) signatures. We examined associations of mRNA and miRNA levels with 6 CM traits: body mass index, HDL-cholesterol and triglycerides, fasting glucose, and systolic and diastolic blood pressures through cross-sectional analysis of 2812 Framingham Heart Study who had whole blood collection for RNA isolation for mRNA and miRNA expression studies and who consented to genetic research. We excluded participants taking medication for hypertension, dyslipidemia, or diabetes. We measured mRNA (n = 17,318; using ...


Does Left Ventricular Assist Device Implantation Affect Driving Patterns In Patients With End-Stage Heart Failure?, Mamatha Pinninti, Christina Sauld, Vinay Thohan, Omar Cheema, T. Edward Hastings, John Crouch, Frank Downey, Nasir Z. Sulemanjee 2017 Aurora Cardiovascular Services, Aurora Health Care

Does Left Ventricular Assist Device Implantation Affect Driving Patterns In Patients With End-Stage Heart Failure?, Mamatha Pinninti, Christina Sauld, Vinay Thohan, Omar Cheema, T. Edward Hastings, John Crouch, Frank Downey, Nasir Z. Sulemanjee

The VAD Journal

Background

In 2012, the Canadian Society of Cardiology indicated that patients supported with left ventricular assist device (LVAD) may drive a private vehicle 2 months after implantation, provided they are deemed clinically stable. Objective evidence supporting this recommendation is limited. We sought to compare data regarding driving habits in our patients following LVAD implantation.

Methods

A standard questionnaire addressing driving patterns before and after LVAD implantation was sent to all living patients who had received an LVAD between January 2010 and January 2014. Ninety-four of 124 patients responded (average age 58 years, 69.2% men, 77.7% bridge to transplant ...


Venoarterial Extracorporeal Membrane Oxygenation For Cardiogenic Shock: A Retrospective Analysis Based On The Etiology Of Shock, Andrew Burchett, Thomas Tribble, Richard Charnigo, Susan Smyth, Maya Guglin 2017 University of Kentucky

Venoarterial Extracorporeal Membrane Oxygenation For Cardiogenic Shock: A Retrospective Analysis Based On The Etiology Of Shock, Andrew Burchett, Thomas Tribble, Richard Charnigo, Susan Smyth, Maya Guglin

The VAD Journal

Abstract:

Background: We performed a retrospective analysis to evaluate the efficacy of VA-ECMO support in cardiogenic shock based on various etiologies.

Methods: We retrospectively analyzed 99 patients supported with VA-ECMO from January 1, 2012 to January 1, 2015. Outcomes included survival to discontinuation of VA-ECMO support and survival to hospital discharge. The etiologies of cardiogenic shock included cardiac arrest (CPR), acute myocardial infarction (AMI), decompensated congestive heart failure (CHF), pulmonary embolism (PE), right ventricular failure (RVF) not secondary to an acute pulmonary embolism, and post-cardiotomy syndrome (PCS). The PCS group was used as a reference group; odds ratios were estimated ...


Reversible Mitral Regurgitation As A Complication Of Impella® 5.0, Katrina A. Bidwell, Andrew R. Kolodziej, Maya E. Guglin 2017 University of Kentucky, Department of Internal Medicine

Reversible Mitral Regurgitation As A Complication Of Impella® 5.0, Katrina A. Bidwell, Andrew R. Kolodziej, Maya E. Guglin

The VAD Journal

The Impella® is a ventricular assist device used for temporary left ventricular support and has been approved for use since 2008. In this report we present a case of a patient who experienced mitral regurgitation as a complication shortly after placement of an Impella® as well as a brief literature review. To our knowledge this is the first such case demonstrating resolution of iatrogenic mitral regurgitation with removal of the device as opposed to permanent damage.


Usage Of 3d Models Of Tetralogy Of Fallot For Medical Education: Impact On Learning Congenital Heart Disease., Yue-Hin Loke, Ashraf S Harahsheh, Axel Krieger, Laura J Olivieri 2017 George Washington University

Usage Of 3d Models Of Tetralogy Of Fallot For Medical Education: Impact On Learning Congenital Heart Disease., Yue-Hin Loke, Ashraf S Harahsheh, Axel Krieger, Laura J Olivieri

Pediatrics Faculty Publications

BACKGROUND: Congenital heart disease (CHD) is the most common human birth defect, and clinicians need to understand the anatomy to effectively care for patients with CHD. However, standard two-dimensional (2D) display methods do not adequately carry the critical spatial information to reflect CHD anatomy. Three-dimensional (3D) models may be useful in improving the understanding of CHD, without requiring a mastery of cardiac imaging. The study aimed to evaluate the impact of 3D models on how pediatric residents understand and learn about tetralogy of Fallot following a teaching session.

METHODS: Pediatric residents rotating through an inpatient Cardiology rotation were recruited. The ...


A Mendelian Randomization Study Of The Effect Of Calcium On Coronary Artery Disease, Myocardial Infarction And Their Risk Factors, Lin Xu, Shi Lin Lin, C. Mary Schooling 2017 University of Hong Kong

A Mendelian Randomization Study Of The Effect Of Calcium On Coronary Artery Disease, Myocardial Infarction And Their Risk Factors, Lin Xu, Shi Lin Lin, C. Mary Schooling

Publications and Research

Meta-analyses of randomized controlled trials (RCTs) suggest calcium could have adverse effects on cardiovascular disease, although these findings are controversial. To clarify, we assessed whether people with genetically higher calcium had a higher risk of coronary artery disease (CAD), myocardial infarction (MI) and their risk factors. We used a two-sample Mendelian randomization study. We identified genetic variants (single nucleotide polymorphisms (SNPs)) that independently contributed to serum calcium at genome-wide significance which we applied to large extensively genotyped studies of CAD, MI, diabetes, lipids, glycaemic traits and adiposity to obtain unconfounded estimates, with body mass index (BMI) as a control outcome ...


Messenger Rna And Microrna Transcriptomic Signatures Of Cardiometabolic Risk Factors, David D. McManus, Jian Rong, Tianxiao Huan, Sean Lacey, Kahraman Tanriverdi, Peter J. Munson, Martin G. Larson, Roby Joehanes, Venkatesh Murthy, Ravi Shah, Jane Freedman, Daniel Levy 2017 University of Massachusetts Medical School

Messenger Rna And Microrna Transcriptomic Signatures Of Cardiometabolic Risk Factors, David D. Mcmanus, Jian Rong, Tianxiao Huan, Sean Lacey, Kahraman Tanriverdi, Peter J. Munson, Martin G. Larson, Roby Joehanes, Venkatesh Murthy, Ravi Shah, Jane Freedman, Daniel Levy

UMass Center for Clinical and Translational Science Supported Publications

BACKGROUND: Cardiometabolic (CM) risk factors are heritable and cluster in individuals. We hypothesized that CM risk factors are associated with multiple shared and unique mRNA and microRNA (miRNA) signatures. We examined associations of mRNA and miRNA levels with 6 CM traits: body mass index, HDL-cholesterol and triglycerides, fasting glucose, and systolic and diastolic blood pressures through cross-sectional analysis of 2812 Framingham Heart Study who had whole blood collection for RNA isolation for mRNA and miRNA expression studies and who consented to genetic research. We excluded participants taking medication for hypertension, dyslipidemia, or diabetes. We measured mRNA (n = 17,318; using ...


Heart Pump Modelling: Design Of Pulsatile Flow Phantoms, Olivia Coiado, Kevin Jones, Parker Schibel, Nicolas de Almeida 2017 University of Portland

Heart Pump Modelling: Design Of Pulsatile Flow Phantoms, Olivia Coiado, Kevin Jones, Parker Schibel, Nicolas De Almeida

Biomedical Engineering Western Regional Conference

The purpose of this project is to build a model, which mimics physiological conditions of the human cardiovascular system in order to simulate the parameters of the human heart in vivo. For this project, it was developed a flow phantom with vessel mimicking material, as well as blood-mimicking and tissue-mimicking fluid. Phantoms in general are specifically designed objects involving dedicated biomaterials to simulate special realistic circuits of human beings. To develop the flow phantom, low-priced biomaterials for blood mimicking fluid, tissue mimicking, and vessel mimicking material was researched.

Keywords: Cardiovascular system, heart pump, modelling, pulsatile.


Alcohol Consumption, Left Atrial Diameter, And Atrial Fibrillation, David D. McManus, Xiaoyan Yin, Rachel Gladstone, Eric Vittinghoff, Ramachandran S. Vasan, Martin G. Larson, Emelia J. Benjamin, Gregory M. Marcus 2017 University of Massachusetts Medical School

Alcohol Consumption, Left Atrial Diameter, And Atrial Fibrillation, David D. Mcmanus, Xiaoyan Yin, Rachel Gladstone, Eric Vittinghoff, Ramachandran S. Vasan, Martin G. Larson, Emelia J. Benjamin, Gregory M. Marcus

David D. McManus

BACKGROUND: Alcohol consumption has been associated with atrial fibrillation (AF) in several epidemiologic studies, but the underlying mechanisms remain unknown. We sought to test the hypothesis that an atrial myopathy, manifested by echocardiographic left atrial enlargement, explains the association between chronic alcohol use and AF. METHODS AND RESULTS: We evaluated the relationship between cumulative alcohol consumption and risk of incident AF in 5220 Offspring and Original Framingham Heart Study participants (mean age 56.3 years, 54% women) with echocardiographic left atrial size measurements. The incidence of AF was 8.4 per 1000 person-years, with 1088 incident AF cases occurring over ...


Common Clinical Dilemmas In Left Ventricular Assist Device Therapy: A Glimpse Into Current Trends, Ahmet Kilic, Michael S. Kiernan, Meredith A. Brisco-Bacik, Sangjin Lee, Behzad Soleimani, Aditya Bansal, Igor Gosev, Peter Eckman, Brian Lima, Brian Bethea, Chetan B. Patel, Jason N. Katz, Jonathan D. Rich, Susan M. Joseph 2017 The Ohio State University

Common Clinical Dilemmas In Left Ventricular Assist Device Therapy: A Glimpse Into Current Trends, Ahmet Kilic, Michael S. Kiernan, Meredith A. Brisco-Bacik, Sangjin Lee, Behzad Soleimani, Aditya Bansal, Igor Gosev, Peter Eckman, Brian Lima, Brian Bethea, Chetan B. Patel, Jason N. Katz, Jonathan D. Rich, Susan M. Joseph

The VAD Journal

Background

Left ventricular assist device (LVAD) therapy has been thrust into the forefront of surgical treatment for advanced heart failure (HF). Despite advancements in survival and quality of life with these devices, the multi-disciplinary care for these patients remains far from standardized across institutions.

Methods

A survey of current practices in LVAD was carried out at the St. Jude Medical User’s meeting representing a variety of caregivers including cardiac surgeons, HF cardiologists, non-HF cardiologists, advanced practice providers and ventricular assist device coordinators, with representation from several continents. Utilizing an audience response system, eleven questions were asked related to the ...


A Rare Case Of Paradoxical Left Sided Endocarditis Through Patent Foramen Ovale., George M. Yousef, Paul I. Okhumale, Haytham Aljoudi, Silvestre Cansino 2017 Marshall University

A Rare Case Of Paradoxical Left Sided Endocarditis Through Patent Foramen Ovale., George M. Yousef, Paul I. Okhumale, Haytham Aljoudi, Silvestre Cansino

Marshall Journal of Medicine

A 36 -year old woman IV drug abuser admitted with Right-Sided Infective Endocarditis (RSIE) as demonstrated by transthoracic echocardiogram. Patient was admitted 8 weeks later with recurrence of symptoms, moreover signs of systemic embolization were noted. Transthoracic and Transesophageal Echocardiograms revealed tricuspid valve vegetation, severe tricuspid regurgitation, left atrial mass, Patent Foramen Ovale (PFO), severely dilated right atrium and prominent Chiari's network. Systemic embolization included brain and Left iliacus abscesses. Patent Foramen ovale is the proposed mechanism leading to extensive systemic embolization in the present case.


Inferior Stemi Complicated By Retroperitoneal Hemorrhage Due To Ruptured Aaa, Farley B. Neasman III, Melissa D. Lester, Nepal C. Chowdhury 2017 Marshall University

Inferior Stemi Complicated By Retroperitoneal Hemorrhage Due To Ruptured Aaa, Farley B. Neasman Iii, Melissa D. Lester, Nepal C. Chowdhury

Marshall Journal of Medicine

When patients present with life threatening conditions, a rapid cost-benefit analysis prioritizes care and commits treatment to a certain course that, in the case of ST Elevation Myocardial Infarction (STEMI) treated with drug-eluting stents (DES), could be fatal if there is any deviation. Antiplatelet therapy is vital and secondary concerns (i.e. bleeding diatheses) may accept suboptimal outcomes – in rare cases, another life-threatening condition may be unmasked, the treatment for which runs directly counter to the first. We present a case of STEMI with high clot burden treated with multiple DES, complicated by retroperitoneal hemorrhage due to a ruptured abdominal ...


Zero-Fluoroscopy Cavotricuspid Isthmus Ablation Using Carto Mapping System As Sole Guiding Method, Wassim Ballany, Indrajit Choudhuri, Mohamed Djelmami-Hani, Ryan L. Cooley 2017 Aurora Health Care

Zero-Fluoroscopy Cavotricuspid Isthmus Ablation Using Carto Mapping System As Sole Guiding Method, Wassim Ballany, Indrajit Choudhuri, Mohamed Djelmami-Hani, Ryan L. Cooley

Aurora Electrophysiology Fellows

Background: Catheter ablation of the cavotricuspid isthmus (CTI) is traditionally performed using fluoroscopy and electroanatomical mapping systems. Zero-fluoroscopy approaches have recently been studied, mostly using the EnSite® mapping system (St. Jude Medical Inc., St. Paul, MN). We studied the feasibility and efficacy of zero-fluoroscopic mapping and ablation of the CTI using the Carto® 3 system (Biosense Webster Inc., South Diamond Bar, CA).

Purpose: To evaluate the efficacy and safety of a zero-fluoroscopic approach to CTI ablation.

Methods: We included 9 patients with typical atrial flutter for whom mapping and ablation of the CTI was done using Carto mapping as the ...


High Burden Of Unrecognized Atrial Fibrillation In Rural India: An Innovative Community-Based Cross-Sectional Screening Program, Apurv Soni, Allison Earon, Anna Handorf, Nisha Fahey, Kandarp Talati, John Bostrom, Ki Chon, Craig Napolitano, Michael S. Chin, John Stephen Sullivan, Shyamsundar Raithatha, Robert J. Goldberg, Somashekhar Nimbalkar, Jeroan J. Allison, Sunil Thanvi, David D. McManus 2017 University of Massachusetts Medical School

High Burden Of Unrecognized Atrial Fibrillation In Rural India: An Innovative Community-Based Cross-Sectional Screening Program, Apurv Soni, Allison Earon, Anna Handorf, Nisha Fahey, Kandarp Talati, John Bostrom, Ki Chon, Craig Napolitano, Michael S. Chin, John Stephen Sullivan, Shyamsundar Raithatha, Robert J. Goldberg, Somashekhar Nimbalkar, Jeroan J. Allison, Sunil Thanvi, David D. Mcmanus

David D. McManus

BACKGROUND: Atrial fibrillation, the world's most common arrhythmia, is a leading risk factor for stroke, a disease striking nearly 1.6 million Indians annually. Early detection and management of atrial fibrillation is a promising opportunity to prevent stroke but widespread screening programs in limited resource settings using conventional methods is difficult and costly. OBJECTIVE: The objective of this study is to screen people for atrial fibrillation in rural western India using a US Food and Drug Administration-approved single-lead electrocardiography device, Alivecor. METHODS: Residents from 6 villages in Anand District, Gujarat, India, comprised the base population. After obtaining informed consent ...


Use Of Grounded Theory In Cardiovascular Research, Patrick J. Dunn, Vasileios Margaritis, Cheryl Anderson 2017 American Heart Association

Use Of Grounded Theory In Cardiovascular Research, Patrick J. Dunn, Vasileios Margaritis, Cheryl Anderson

The Qualitative Report

While grounded theory is often cited in the qualitative literature as the methodology, there are few good examples of publications that follow the principles of grounded theory and result in an actual theory. The purpose of this paper is to demonstrate how the Corbin and Strauss (2015) method of grounded theory was used in a study looking at how patients with cardiovascular disease and diabetes develop health literacy skills that are used to manage their condition. The key principles of grounded theory include theoretical sampling, constant comparison, open, axial, and selective coding, the use of memoing, and theoretical saturation. Data ...


The Crux Of The Heart –– The Closest Approach Of The Right Atrium To The Left Ventricle, Lynn Erickson, David Krum, Hannah Samuel, Anwer Dhala, Jasbir Sra 2017 Aurora Research Institute

The Crux Of The Heart –– The Closest Approach Of The Right Atrium To The Left Ventricle, Lynn Erickson, David Krum, Hannah Samuel, Anwer Dhala, Jasbir Sra

Jasbir Sra, MD, FACC, Program Director

Background: Accessory pathways, the source of atrioventricular reentry tachycardia, occasionally connect the left ventricle to the right atrium. This is possible because, in some patients, a portion of the right atrium abuts the left ventricle on the posterior wall of the heart, near the mid-coronary sinus. This anatomic region is known as the “crux” of the heart. These accessory pathways can be difficult to ablate because of the unusual and unexpected substrate. While the presence of these accessory pathways is described in the literature, the prevalence of the underlying anatomic substrate is not currently known.

Purpose: To measure the closest ...


Predicting Outcomes In Patients With Atrial Fibrillation And Acute Mesenteric Ischemia, Sanjay Bhandari, Geetanjali Dang, Muhammad Shahreyar, Ahmad Hanif, Vijayadershan Muppidi, Atul Bhatia, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir 2017 Medical College of Wisconsin

Predicting Outcomes In Patients With Atrial Fibrillation And Acute Mesenteric Ischemia, Sanjay Bhandari, Geetanjali Dang, Muhammad Shahreyar, Ahmad Hanif, Vijayadershan Muppidi, Atul Bhatia, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir

Jasbir Sra, MD, FACC, Program Director

Purpose Outcomes in patients with atrial fibrillation who develop acute mesenteric ischemia, and the impact of anticoagulation on complications, are not defined. Methods Patients admitted with acute mesenteric ischemia in the National Inpatient Sample from 2007, with and without atrial fibrillation, were compared for in-hospital outcomes using multivariate regression, and the impact of prior anticoagulation determined. Results Of 48,872 patients with acute mesenteric ischemia, 8,306 had atrial fibrillation, with 680 patients also on anticoagulation. Atrial fibrillation patients were more likely to be older and have hypertension, heart failure, or chronic lung or renal disease. After adjusting for potential ...


Predictors Of Mortality In Patients With Transient Severe Left Ventricular Systolic Dysfunction, Kanwar Y. Singh, Firas Zahwe, Bilal Omery, Crystal Platz, Wassim Ballany, Robyn Shearer, Tadele Mengesha, M. Eyman Mortada, Jasbir Sra, Indrajit Choudhuri 2017 Aurora Health Care

Predictors Of Mortality In Patients With Transient Severe Left Ventricular Systolic Dysfunction, Kanwar Y. Singh, Firas Zahwe, Bilal Omery, Crystal Platz, Wassim Ballany, Robyn Shearer, Tadele Mengesha, M. Eyman Mortada, Jasbir Sra, Indrajit Choudhuri

Jasbir Sra, MD, FACC, Program Director

Background: About 20% of patients who develop left ventricular (LV) systolic dysfunction will have improvement in ejection fraction (LVEF) over time. This patient cohort is generally excluded from large sudden death trials and, hence, understudied.

Purpose: To evaluate the predictors of mortality in patients with severe LV systolic dysfunction who have improvement in LVEF during follow-up.

Methods: Patients who had transient LV systolic dysfunction from 2010 to 2014 within the Aurora Health Care system and who had LVEF improve to ≥ 40%, irrespective of implantable cardioverter-defibrillator (ICD) implant, were studied. Predictors of mortality were identified using Cox proportional hazards model. Patients ...


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