Medicine and Health Sciences Commons^™

To Balloon Or Not To Balloon, The Current State Of Management Of Eustachian Tube Dysfunction., David J. Lafferty, Brian J Mckinnon

Otolaryngology (ENT) Resident Research

While otologic complaints are a common reason for patients to present to an otolaryngologist, Eustachian tube dysfunction (ETD) remains a poorly understood disease whose management is unclear. Among the general population in the United States, ETD has a prevalence of 4.6% among adults and 6.1% among children. Eustachian tube dysfunction is not just a common diagnosis for otolaryngologists, ETD accounted for 2 million visits for patients less than 20 years old to primary care providers and over 2 million visits for patients older than 20 years old between 2005 and 2012. Despite the commonality of ETD, opinions differ wildly among …

Combined Effects Of Gender Affirmation And Economic Hardship On Vulnerability To Hiv: A Qualitative Analysis Among U.S. Adult Transgender Women., Larissa Jennings Mayo-Wilson, Eric G. Benotsch, Sheila R. Grigsby, Sarah Wagner, Fatmata Timbo, Tonia Poteat, Lauretta Cathers, Ashlee N. Sawyer, Shelby A. Smout, Rick S. Zimmerman

School of Nursing Faculty Publications

Background: Transgender women ("trans women"), particularly African-American and Latina trans women, have disproportionately high prevalence of HIV in the United States (U.S.). In order to decrease gender dysphoria and overcome discrimination, trans women affirm their gender through social and medical transition, often in contexts of economic hardship and sexual risk. This study qualitatively examined how gender-affirming behaviors enhance or diminish vulnerability to HIV in light of structural and economic barriers to gender transition.Methods: We conducted individual interviews with 19 adult trans women in two U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors …

Managing Acute Pain In Hiv+/Aids Patients: Knowledge And Practice Trends Among Emergency Physicians Of Major Tertiary Care Centers Of A Developing Country, Aliya Ahmed, Gauhar Afshan, Robyna Irshad Khan, Badar Afzal Khan, Seemin Jamali, Nighat Farooq, Sarosh Saleem, Rubaba Naeem, Uzma R. Khan

Department of Anaesthesia

Objective: To assess knowledge and practice trends in managing acute pain in patients infected with human immunodeficiency virus (HIV+) or having acquired immunodeficiency syndrome (AIDS) among emergency physicians of four tertiary care hospitals. Acute pain management in such patients is complex because of multiple concomitant painful conditions related to their disease. After obtaining ethical approval and written informed consent, emergency physicians were requested to fill out a questionnaire.
Results: Out of 84 physicians who participated, 49 had managed HIV+/AIDS patients during the preceding year. Out of the 49, 30 (61.2%) physicians stated that they used a combination of analgesics for …

Laws Restricting Access To Abortion Services And Infant Mortality Risk In The United States, Roman Pabayo, Amy Ehntholt, Daniel M. Cook, Megan Reynolds, Peter Muennig, Sze Yan Liu

Department of Public Health Scholarship and Creative Works

Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and …

A Rare Clinical Presentation Of Metastatic Crohn's Disease, Kaitlyn L Streight, Tara L Braun, Nicholas Lowe, Soo Jung Kim

Faculty, Staff and Students Publications

A 31-year-old female with a history of systemic lupus erythematous, IgA nephropathy, and psoriasis presented with a one-month history of a painful, pruritic rash under the bilateral breasts and in the genital region. Cutaneous examination revealed a large, tender ulcer under the left breast with a shiny erythematous base and peripheral hypertrophic changes. Small ulcers were present on the bilateral inguinal folds, and the labia majora were edematous with multiple erythematous papules. Histological examination of the left breast revealed ulceration with granulomatous dermatitis, consistent with a diagnosis of metastatic Crohn's disease. Metastatic Crohn's disease is a rare cutaneous manifestation of …

Myeloma Cells Shift Osteoblastogenesis To Adipogenesis By Inhibiting The Ubiquitin Ligase Murf1 In Mesenchymal Stem Cells, Zhiqiang Liu, Huan Liu, Jin He, Pei Lin, Qiang Tong, Jing Yang

Faculty, Staff and Students Publications

The suppression of bone formation is a hallmark of multiple myeloma. Myeloma cells inhibit osteoblastogenesis from mesenchymal stem cells (MSCs), which can also differentiate into adipocytes. We investigated myeloma-MSC interactions and the effects of such interactions on the differentiation of MSCs into adipocytes or osteoblasts using single-cell RNA sequencing, in vitro co-culture, and subcutaneous injection of MSCs and myeloma cells into mice. Our results revealed that the α4 subunit of integrin on myeloma cells stimulated vascular cell adhesion molecule 1 (VCAM1) on MSCs, leading to the activation of protein kinase C β1 (PKCβ1) signaling and repression of the muscle ring-finger …

Association Between Chronic Kidney Disease-Mineral Bone Disease (Ckd-Mbd) And Cognition In Children: Chronic Kidney Disease In Children (Ckid) Study., Jennifer S. Yokoyama, Mina Matsuda-Abedini, Michelle R. Denburg, Juhi Kumar, Bradley A. Warady, Susan L. Furth, Stephen R. Hooper, Anthony A. Portale, Farzana Perwad

Manuscripts, Articles, Book Chapters and Other Papers

Rationale & objective: Chronic kidney disease (CKD) in children is associated with cognitive dysfunction that affects school performance and quality of life. The relationship between CKD-mineral and bone disorder and cognitive function in children is unknown.

Study design: Observational study.

Participants: 702 children enrolled in the Chronic Kidney Disease in Children (CKiD) Study.

Predictors: Plasma fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), calcium, phosphorus, 25 hydroxyvitamin D (25[OH]D), and 1,25 dihydroxyvitamin D (1,25[OH]2D).

Outcomes: Neurocognitive tests of intelligence, academic achievement, and executive functions.

Analytical approach: Linear regression models to analyze the cross-sectional associations between log2FGF-23, 25(OH)D, 1,25(OH)2D, PTH, calcium, …

2020-05-25_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …

Ocular Hypertension Suppresses Homeostatic Gene Expression In Optic Nerve Head Microglia Of Dba/2 J Mice., James R Tribble, Jeffrey M. Harder, Pete A Williams, Simon W M John

Faculty Research 2020

Glaucoma is the leading cause of irreversible vision loss. Ocular hypertension is a major risk factor for glaucoma and recent work has demonstrated critical early neuroinflammatory insults occur in the optic nerve head following ocular hypertension. Microglia and infiltrating monocytes are likely candidates to drive these neuroinflammatory insults. However, the exact molecular identity / transcriptomic profile of microglia following ocular hypertensive insults is unknown. To elucidate the molecular identity of microglia after long-term exposure to ocular hypertension, we used a mouse model of glaucoma (DBA/2 J). We performed RNA-sequencing of microglia mRNA from the optic nerve head at a time …

2020-05-25_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …

2020-05-25_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., with COVID-19 results included as of 10 a.m.

Note on cumulative counts: This report is provisional and subject to change. As public health investigations of individual cases continue, there will be corrections to the status and details of referred cases that result in changes to this report. City of Detroit and Wayne County are reported separately.
Note on the deaths: Deaths must be reported by health care …

Characteristics Of Nontuberculous Mycobacterial Infections At A Midwestern Tertiary Hospital: A Retrospective Study Of 365 Patients., Claire E Hannah, Bradley A Ford, Jina Chung, Dilek Ince, Karolyn A Wanat

Department of Dermatology and Cutaneous Biology Faculty Papers

Background: The prevalence of infections due to nontuberculous mycobacteria (NTM) is increasing worldwide, yet little is known about the epidemiology and pathophysiology of these ubiquitous environmental organisms. Pulmonary disease due to Mycobacterium avium complex is most prevalent, but many other NTM species can cause disease in virtually any organ system. As NTM becomes an increasingly common cause of morbidity and mortality, more information is needed about the epidemiology of NTM disease.

Methods: We conducted a retrospective chart review of all patients with cultures that grew NTM at a Midwestern tertiary hospital from 1996 to 2017. Information on demographics, medical history, …

Progress In The Seasonal Variations Of Blood Lipids: A Mini-Review., Xiaochun Ma, Haichen Yan, Haizhou Zhang, Mansen Wang, Qunye Zhang, Xiaoming Zhou

Articles, Abstracts, and Reports

The seasonal variations of blood lipids have recently gained increasing interest in this field of lipid metabolism. Elucidating the seasonal patterns of blood lipids is particularly helpful for the prevention and treatment of cardiovascular and cerebrovascular diseases. However, the previous results remain controversial and the underlying mechanisms are still unclear. This mini-review is focused on summarizing the literature relevant to the seasonal variability of blood lipid parameters, as well as on discussing its significance in clinical diagnoses and management decisions.

2020-05-25_Michiganoverview_Covidcounts, Michigan Department Of Health & Human Services

Michigan COVID-19 Confirmed Cases by Date of Onset Data

Data was captured from the Cumulative Data link of Michigan's Coronavirus webpage, under the url https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173_99207---,00.html.

The website contained the table Count of Confirmed COVID-19 Cases by Date of Onset , sorted by Michigan Preparedness Region. It also contained 18 charts, including the count of confirmed Covid-19 cases by date of onset in the state overall as well as in each preparedness region,and the normalized rate of Covid-19 cases per 1,000,000 residents in both the state and in each preparedness region.

Mild Acute Inflammation Does Not Impair Maintenance Of Blood Pressure During A Hypotensive Stimulus, Elizabeth C. Schroeder, Thessa I.M. Hilgenkamp, Wesley K. Lefferts, Bo Fernhall

Physical Therapy Faculty Research

Severe acute inflammation, such as sepsis, disrupts autonomic nervous system function and jeopardizes blood pressure regulation [1]. Acute hypotension under normal conditions stimulates baroreceptors to restore blood pressure by activating the sympathetic nervous system to increase heart rate and vasoconstrict peripheral vasculature. Severe acute experimental inflammation (endotoxin) blunts baroreflex-mediated increases in muscle sympathetic nerve activity during reductions in blood pressure and uncouples baroreflex control of heart rate [2]. Whether mild acute inflammation alters the ability to maintain blood pressure during a hypotensive challenge is less clear.

Regulation Of Myofilament Contractile Function In Human Donor And Failing Hearts, Kerry S. Mcdonald, Laurin M. Hanft, Joel C. Robinett, Maya Guglin, Kenneth S. Campbell

Internal Medicine Faculty Publications

Heart failure (HF) often includes changes in myocardial contractile function. This study addressed the myofibrillar basis for contractile dysfunction in failing human myocardium. Regulation of contractile properties was measured in cardiac myocyte preparations isolated from frozen, left ventricular mid-wall biopsies of donor (n = 7) and failing human hearts (n = 8). Permeabilized cardiac myocyte preparations were attached between a force transducer and a position motor, and both the Ca²⁺ dependence and sarcomere length (SL) dependence of force, rate of force, loaded shortening, and power output were measured at 15 ± 1°C. The myocyte preparation size was …

Determining The Genetic Control Of Neural Tube Malformation Through Genetic Interactions With Idgf3, Elli N. Fox

Honors Projects

Genetic mutations disrupting human neural tube formation can lead to birth defects such as spina bifida and anencephaly. Defects can result in lack of neural tube closure in either the caudal (spina bifida) or cranial (anencephaly) regions. Little is known about the genes that cause these malformations. Researchers have been using the model organism Drosophila melanogaster in an attempt to determine genes responsible for neural tube malformations. Recently, an ortholog of human chitin-like protein, imaginal disc growth factor 3 (Idgf3), has been identified as important in the proper formation of Drosophila egg dorsal appendages. However, the molecular mechanism responsible for …

Genetic Biocontrol For Invasive Species, John L. Teem, Luke Alphey, Sarah Descamps, Matt P. Edgington, Owain Edwards, Neil Gemmell, Tim Harvey-Samuel, Rachel L. Melnick, Kevin P. Oh, Antoinette J. Piaggio, J. Royden Saah, Dan Schill, Paul Thomas, Trevor Smith, Andrew Roberts

United States Department of Agriculture Wildlife Services: Staff Publications

Invasive species are increasingly affecting agriculture, food, fisheries, and forestry resources throughout the world. As a result of global trade, invasive species are often introduced into new environments where they become established and cause harm to human health, agriculture, and the environment. Prevention of new introductions is a high priority for addressing the harm caused by invasive species, but unfortunately efforts to prevent new introductions do not address the economic harm that is presently manifested where invasive species have already become established. Genetic biocontrol can be defined as the release of organisms with genetic methods designed to disrupt the reproduction …

Engagement Of Community Stakeholders To Develop A Framework To Guide Research Dissemination To Communities, Jennifer Cunningham-Erves, Tilicia Mayo-Gamble, Yolanda Vaughn, Jim Hawk, Mike Helms, Claudia Barajas, Yvonne Joosten

Health Policy & Community Health: Faculty Publications

Background: Dissemination of research findings to past study participants and the community-at-large is important. Yet, a standardized process for research dissemination is needed to report results to the community. Objective: We developed a framework and strategies to guide community-academic partnerships in community-targeted, dissemination efforts.

Methods: From 2017 to 2019, a community-academic partnership was formed in Nashville, Tennessee, and iteratively developed a framework and strategies for research dissemination using cognitive interviews. A deductive, constant comparative analysis was conducted on interview responses to examine framework and strategy content. Feedback was used to finalize the framework and strategies for the evaluation. …

Cardiac Screening To Mitigate The Risk Of Sudden Cardiac Death In Middle Eastern And African Competitive Athletes. A Systematic Review, Yusuf Hallak, Umberto Battistin, Ahmad Mustafa Al-Masaeed

Journal of the Saudi Heart Association

Objective: The study aims to review the literature regarding abnormalities predisposing to Sudden Cardiac Death (SCD) in young Middle Eastern and African competitive athletes between the years 2009e2019 and aims to assess cardiac pre-participation screening methods.

Methods: A PubMed search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search targeted articles that reported the prevalence of cardiac abnormalities found in Middle Eastern and African athletes, and it also focused on comparing cardiac screening methods for assessment of athletes. Results: our studies fell within the inclusion criteria and were included in the …

The Carpentier-Edwards Classic And Physio Annuloplasty Rings In Repair Of Degenerative Mitral Valve Disease: A Retrospective Study, Abubakari I. Sidiki Md, Alexandr G. Faybushevich Md, Phd, Alexandr N. Lishchuk Md, Phd, Alexandr N. Koltunov Md, Phd, Ekaterina A. Roshchina, Jonas Atulebire Akambase

Journal of the Saudi Heart Association

Objectives. Physio ring (SR) is considered an improved version of the Classic rigid ring (RR). Today, SR is more widely used in mitral valve (MV) repair. We sought to compare the long-term outcomes of repair with RR and SR in degenerative mitral valve disease.

Methods. In a computerized registry of our institution, 306 patients had MV repair with either RR (139 patients) or SR (167 patients) ring between 2005 and 2015. Fifteen of them had concomitant tricuspid valve repair. Ninety-two (30.1%) had Barlow’s disease and 214 (69.9%) had fibroelastic deficiency. The patients had similar demographic and echocardiographic characteristics. …

Tricuspid Valve Regurgitation After Heart Transplantation: A Single-Center 10-Year Experience, Khaled D. Algarni, Amr A. Arafat, Claudio Pragliola, Yahya S. Alhebaishi, Latifa A. Alfayez, Khaled Alotaibi, Abeer M. Bakhsh, Ahmed A. Amro, Adam I. Adam

Journal of the Saudi Heart Association

Background: Tricuspid valve regurgitation may affect the outcomes after heart transplantation. There is a paucity of data reporting the outcomes of heart transplants in our region. The objectives of this study were to report the occurrence of tricuspid regurgitation after heart transplantation, its course, and its effect on survival.

Methods: From 2009 to 2019, 30 patients had heart transplantation at our cardiac center. Their age was 36.73± 13.5 years, and 25 (83.33%) were males. Indications for transplantation were dilated cardiomyopathy (n= 21; 72.41%), ischemic cardiomyopathy (n= 8; 26.67%) and hypertrophic cardiomyopathy (n=1; 3.45%). Cardiopulmonary bypass time was 157.24± 34.6 minutes, …

The Trans-Septal Approach In Transcatheter Mitral Valve-In-Valve Implantation For Degenerative Bioprosthesis, Mohammed Al Otaiby, Turki A. Al Garni, Abdullah Alkhushail, Abdulrahman Almoghairi, Sondos Samargandy, Monirah Albabtain, Amr A. Arafat, Hussein Alamri

Journal of the Saudi Heart Association

Background: Transcatheter Mitral Valve-in-Valve Implantation (TMViVI) has recently emerged as a novel therapy for degenerated mitral valve bioprosthesis. Re-operative mitral valve surgery is associated with a substantial risk of mortality and morbidity. The objective of this study was to describe the outcomes of transcatheter mitral valve-in-valve implantations in our cardiac center.

Methods: Twenty-two patients underwent the valve-in-valve procedure because of bioprosthesis degeneration from March 2017 to October 2018. Clinical, echocardiographic, procedural details and survival at follow up were assessed.

Results: Eight patients refused re-operative cardiac surgery while others were deemed a high risk for conventional re-operative sternotomy. All patients had …

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, Ali Jelly, Abdulrahman Almesned, Abdullah Alqwaiee, Mansour Almutairi, Sherif Salah, Mahmoud Hasan, Mustafa Almuhaya, Abdulhamid Alnajjar, Mohammed Mofeed, Bana Nasser

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, BAS, balloon pulmonary …

A New Scoring System Detecting The Supraventricular Tachycardia Inducibility And Radiofrequency Ablation With High Specificity In Electrophysiological Study, Savas Ozer, Mustafa Çetin, Ali Gokhan Ozyildiz, Ramazan Gengorü, Oguzhan Ekrem Turan, Meltem Pusuroglu, Bülent Bahçeci, Turan Erdogan

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 of …

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

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, Maziar Mireskandari, Nicholas J. Cheshire, Ulrich P. Rosendahl

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 (TTE) …