Medicine and Health Sciences Commons^™

Aortopulmonary Window: Types, Associated Cardiovascular Anomalies, And Surgical Outcome. Retrospective Analysis Of A Single Center Experience, Mohammed Bin-Moallim, Hussam K. Hamadah, Fahad Alhabshan, Abdullah A. Alghamdi, Mohamed S. Kabbani

Journal of the Saudi Heart Association

Objective: Aortopulmonary window (APW) is a rare congenital heart defect. It occurs as an isolated cardiac lesion or in association with other cardiac anomalies and rarely with abnormal coronary arteries. The spectrum of cardiovascular anomalies associated with APW and overall management and outcome in the current era were reviewed.

Methods: Between 2001 and 2018, all patients diagnosed with APW were included. Based on associated cardiovascular anomalies, those patients were divided into 2 groups: simple APW group and complex APW group (APW with asso- ciated other cardiovascular anomalies). All cases were followed longitudinally. The outcomes are described.

Result: Twenty patients underwent ...

Cardiac Catheterisation Interventions In Neonates And Infants Less Than Three Months, Ali A. Alakhfash

Journal of the Saudi Heart Association

Introduction: Pediatric cardiac catheterization interventions become an established way of care for selected patients with congenital heart diseases. Cardiac catheterization for neonates and small infants can be challenging. The indications for diagnostic cardiac catheterization have decreased with the advent of advanced non-invasive imaging modalities.

Patients and method: Between June 2012 and July 2017 patients less than three months who had cardiac catheterization in two centers were reviewed

Results: During the study period, 174 patients underwent interventional cardiac catheterization,83.3% of them had CHD with two-ventricle circulation and 29 patients (16.7%) had single ventricle pathophysiology. Procedures include diagnostic cath ...

A New Scoring System Detecting The Supraventricular Tachycardia Inducibility And Radiofrequency Ablation With High Specificity In Electrophysiological Study, Ali Gokhan Ozyildiz

Journal of the Saudi Heart Association

Aim: The relationship between arrhythmia induction and ablation with palpitation characteristics has been demonstrated in electrophysiological study (EPS) patients. However, there is insufficient data on palpitation characteristics and their sensitivity and specificity. We aimed to identify the relationship between scoring composed of palpitation characteristics with the supraventricular tachycardia (SVT) induction and the success rate of the procedure.

Method: A total of 119 patients, diagnosed as paroxysmal supraventricular tachycardia (PSVT) by electrocardiography, rhythm Holter or symptoms, and underwent EPS, were enrolled in the study. A psychiatrist administered the Hospital Anxiety and Depression Score (HADS) questionnaire.

Results: In SVT induced group, palpitation ...

Pacemaker Detected Prolonged Atrial High Rate Episodes – Incidence, Predictors And Implications; A Retrospective Observational Study, Pratheesh George Mathen, David Chase

Journal of the Saudi Heart Association

Introduction: Atrial tachyarrhythmias especially atrial fibrillation are the most commonly encountered arrhythmias in clinical practice. Most atrial tachyarrhythmia episodes are subclinical. Cardiac implantable electronic devices with atrial sensing function enable detection of atrial tachyarrhythmias through means of atrial high rate event algorithms. Prolonged atrial high rate episodes(AHRE) above a defined rate and duration threshold represent episodes of atrial fibrillation, atrial flutter, and longer atrial tachycardias that correlate strongly with risk for thromboembolic events.

Objective: 1. To examine the occurrence of prolonged AHRE in dual-chamber pacemaker recipients over the study period. 2. To examine the factors which influence the occurrence ...

Comparison Of The Effects Of Ticagrelor And Clopidogrel On Heart Rate Variability And Heart Rate Turbulence In Patients With Percutaneous Coronary Interventions, Hasan Ari

Journal of the Saudi Heart Association

Introduction: Clopidogrel and ticagrelor are commonly used, antiplatelet agents. Ticagrelor has an effect of enhancing the plasma level of adenosine that may alter the autonomic function. The aim of this study is to compare the effects of ticagrelor and clopidogrel on heart rate variability (HRV) and heart rate turbulence (HRT).

Methods: Thirty subjects who performed percutaneous coronary intervention (PCI) were included in the randomized, crossover study. These patients were divided into two groups. Clopidogrel or ticagrelor was administered in two different testing sessions (1-month treatment for each session). In group 1, clopidogrel and ticagrelor treatment were used while in group ...

Delayed Repair Of Aortic Dissection In Sickle Cell Anaemia As A Combined Cardiac And Vascular Surgical Approach, Massimo Capoccia

Journal of the Saudi Heart Association

We discuss a patient who presented with a type B aortic dissection with a retrograde progression in the context of sickle cell anaemia. Given the involvement of the superior mesenteric artery and concern for bowel ischaemia, a delayed approach was considered. Subsequently, a frozen elephant trunk was performed in the hybrid theatre with the back-up of the vascular surgeon for mesenteric protection. A technically demanding procedure followed by a prolonged and challenging postoperative course finally led to a successful outcome. We argue that the case presented is an example of how a close cooperation between professionals can offer additional options ...

Ultraslow Thrombolytic Therapy In Stuck Mechanical Aortic Valve, Case Report, And Review Of The Literature, Hesham Abdo Naeim, Osama Amoudi, Amjad Karam, Abeer Mahmood, Ahmed Albagi, Ibraheem Alharbi, Reda Abuelatta

Journal of the Saudi Heart Association

Background: Stuck mechanical heart valves had a debate about the management plan. There is debate regarding the type, dose, and rate of administration of various thrombolytic agents. We report a case with successful thrombolysis using an ultraslow regimen.

Case summary: A 43-year-old female with a history of aortic valve (AV) and mitral valve replacement (bi-leaflet metallic valves), and tricuspid valve repair (MINI band) at 10/2017. Physical examination showed normal metallic first heart sound and weak metallic second heart sound. Laboratory investigations were normal except low INR, hematocrit, and hemoglobin level ( 9gm/L due to iron deficiency anemia). Transthoracic echocardiogram ...

Chylothorax After Coronary Artery Bypass Surgery. Report Of A Case And Review Of The Literature, Imran Khan, Zahid M. Khan, Abdelbasset El Refy, Ahmad Mahmood El Badry, Tarig Faisal Babiker

Journal of the Saudi Heart Association

Chylothorax after coronary artery bypass grafting is a rare complication and leads to increased mortality and morbidity. Because of the rarity of this complication, its management is debatable. We present the case of a 41 years old male patient who had a left sided chylothorax after coronary artery bypass grafting. The patient was managed conservatively with low fat diet and drainage of the chylothorax. A thorough search of the literature published on the subject was done and treatment strategies employed by various authors were studied. Various treatment options are conservative management with chest tube drainage, octreotide and low-fat diet or ...

Removal Of Unusual Multiple Aortic Valve Fibroelastoma Using Right Mini-Thoracotomy, Muhammed Tamim Tamim, Marwan Sadek, Khaled Al-Faraidy, Donya Al-Hassan

Journal of the Saudi Heart Association

Papillary Fibroelastomas are rare, primary cardiac tumors. They are typically diagnosed as an incidental finding but can also present as thrombo-embolic events. We present the case of 78-years- old man who presented to emergency room with a cerebrovascular event (CVE). Transesophageal echocardiography (TEE) revealed e presence of a mass on the aortic valve. Intra-operatively, two masses where found: one was highly mobile attached to left ventricular (LV) side of the left coronary cusp, another small size mass attached to the non-coronary cusp, and there was suspicion of a mass attached to the mitral valve. The two masses were surgically excised ...

Myocardial Infarction Caused By An Enclosed Thrombus In A Patent Foramen Ovale, Meriem Boumaaz

Journal of the Saudi Heart Association

Paradoxical embolism in coronary artery is a rarely diagnosed clinical entity. In the majority of reported cases; the diagnostic of this pathology is « presumptive » based on certain criteria. It can be considered “proven” when the embolus is found lodged in the abnormal communication between the venous and arterial circulation; which is very rare. We herein report a case of myocardial infarction caused by a proven paradoxical coronary embolism through a patent foramen ovale. The authors highlight through this paper the contribution of echocardiography and particularly transesophageal echocardiography, especially if performed soon after presentation, for early diagnosis.

Massive Hemoptysis And Recurrent Infective Endocarditis In Intravenous Drug User: A Case Report, Mutlaq Almutairi

Journal of the Saudi Heart Association

Intravenous drug use (IDU) poses a high risk of serious complications such as infective endocarditis (IE), which carries high morbidity and mortality rates. Mycotic pulmonary artery aneurysms (MPAA) are rarely associated with right-sided IE, especially in the setting of IDU. It is a potentially fatal complication as it can lead to severe hemorrhage if the aneurysm ruptures. We report the case of a young male with a history of current IDU and tricuspid valve replacement post complicated IE 2 years ago. The patient initially presented with massive hemoptysis and fever. Chest computed tomography (CT) showed a lobulated lesion in the ...

Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Mental Health Screening For Low-Income Adolescents

BACKGROUND: Nearly 80% of adolescents in the United States will suffer from a mental illness and not receive evaluation or services. Children from low socio-economic backgrounds have an increased risk of mental health disorders which permeate into adulthood, leading to additional negative sequel and lower quality of life. Among adolescent mental health conditions, depression and anxiety are the most common. Literature has suggested provider intuition alone has low sensitivity and specificity for detecting mental illness and that screening tools are indicated.

PURPOSE: The aim of this project is to implement standardized routine ...

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and ...

Bridging The Gap: Improving Hospital Discharge Through Utilization Of A Priority Care Clinic, Kristian Jamerson

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Poorly coordinated care often results in poor health outcomes. Best practices in academic literature recommend effective programs that consist of comprehensive discharge planning, complete and timely communication of information, medication reconciliation, patient and caregiver education using the teach-back method, open communication among providers, and prompt follow-up visits with an outpatient provider after discharge. Using a priority care clinic (PCC) for follow-up is one approach to decrease hospital readmissions.

Purpose: To implement an evidence-based program utilizing a PCC to facilitate post-discharge transition-in-care and reduce hospital readmissions.

Evidence-based Intervention: A PCC assists patients in their transition of care from the ...

Implementing A Basal-Bolus Insulin Regimen Via A Manual Insulin Pump Device, Helen Stearns

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose:The purpose of this evidence-based practice project is to decrease glycated hemoglobin (HgbA1C) levelsby initiating use of a manual insulin pump in patients with Type II Diabetes Mellitus (T2DM) with poor glycemic control who are on multiple daily insulin injections (MDII).

Background: Uncontrolled hyperglycemia is associated with a myriad of complications and co-morbidities that are generally associated with vascular changes that include nephropathy, neuropathy, blindness, stroke, and heart disease (Winter et al., 2015). Coronary artery disease and cerebrovascular disease alone accounts for approximately 65% of the deaths in diabetic patients (Molinaro & Dauscher, 2017). Achieving and maintaining therapeutic glycemic ...

It's More Than Just "Baby Blues" - Screening For Postpartum Depression In A Pediatric Setting, Breanna M. Lazar, Martha G. Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Postpartum depression (PPD) is estimated to affect up to 1 out of 7 women. Evidence and American Academy of Pediatrics (AAP) guidelines support maternal screening for PPD in a pediatric setting during well-child visits. The pediatric office is frequently visited during the first year of life and is a suitable setting to perform screening.

Aims of Service Change: Implement AAP recommended PPD screening at a busy primary care practice in Southern California using the Patient Health Questionnaire (PHQ-9).

Details of Innovation: In this pilot project, mothers (who were not patients of the pediatric practice) consented to be screened ...

Eating For Two Without Eating Too Much: Optimizing Gestational Weight Gain, Sandra Pope

Doctor of Nursing Practice Final Manuscripts

This evidence-based pilot project was implemented to optimize gestational weight gain (GWG) among women enrolled for prenatal care at a private practice. Evidence from meta-analyses and large studies show: 1) an association between excess GWG and increased risk of fetal macrosomia and increased cesarean delivery; 2) 66% of women do not know their healthy GWG target; 3) a 20% reduction in excess GWG in women receiving diet or exercise interventions or both. In addition, visual plotting of weight gain has helped overweight adults reduce and maintain weight loss over a one-year period. Nutrition assessment using a validated nutritional screening questionnaire ...

Assessing The Need For Standardized Pre-Chemotherapy Education: An Outpatient Oncology Clinic Initiative, Spana Patel

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: In a diverse southern California outpatient oncology clinic, assess the need for standardized pre-chemotherapy education for newly diagnosed cancer patients to aid in the improvement of health literacy, self-management of side effects, satisfaction, and reduction of anxiety.

Background: Cancer patients often feel anxious, overwhelmed, and confused by the abundance of information and medical jargon that they must digest. One southern California outpatient oncology clinic identified the need for consistent, standardized procedure in providing chemotherapy education and assessing treatment knowledge in newly-diagnosed cancer patients as evidenced by: inconsistent attendance in educational classes and or appointments, inability to articulate treatment ...

Audiocommunicator Reminder Phone Calls To Increase Attendance Of Well Child Visits, Taylor L. Wisner Barojas, Martha G. Fuller, Alison M. Schurman

Doctor of Nursing Practice Final Manuscripts

Background: The American Academy of Pediatrics recommends six well child checks (WCC) between 2 to 15 months. A large pediatric clinic in Southern California has an attendance rate of 86% and a very mobile population. Reminder phone calls have been shown to improve WCC attendance.

Aims of Service Change: Improve WCC attendance to >90%. As an interim step, we implemented a pilot project and measured responses to AudioCOMMUNICATOR™ reminder calls.

Outcome: In two months 148 calls were made, the majority,74%, went unanswered. 26% were able to schedule an appointment or discharge from the clinic.

Discussion: Reminder calls provide a ...

Screening For Iron-Deficiency Anemia In The Pediatric Population (Ages 1-17) In Gonaïves, Haiti, Cara Rose Fratianni

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this pilot project is to screen for iron-deficiency anemia in pediatric patients (ages 1-17) in a primary school in Gonaïves, Haiti. Patients with anemia will be treated with oral supplemental iron for a period of four weeks according to WHO guidelines (WHO, 2011). All students will be treated empirically for helminths per WHO guidelines, unless treated elsewhere in the last six months (WHO, 2017). Nutritional status will also be assessed using MUAC according to WHO guidelines (2017).

Background Summary: Malnutrition contributes significantly to the problem of iron-deficiency anemia, with one in four children exhibiting stunting ...