Medical Specialties Commons^™

Transient Tricuspid Valvulitis: Another Brief Casualty Of Covid-19 In Children, Amulya Buddhavarapu, Girish S. Shirali, Stephen Kaine, Doaa Aly

Posters

Clinical Presentation:

We discuss 3 patients, 8-10 years old, with significant tricuspid valve dysfunction during initial days of admission for multi-system inflammatory syndrome in children (MIS-C) associated with coronavirus 2019 (COVID-19) infection.

All 3 patients had COVID antibodies and presented in uncompensated shock needing aggressive fluid resuscitation and vasoactive support. Elevated acute inflammatory markers, acute kidney injury (2/3 patients), troponin leak and repolarization abnormality on ECG were present on admission and resolved by discharge. All were treated with intravenous immunoglobulin (IVIG) infusion, high-dose steroids and prophylactic low molecular weight heparin. They were discharged home on aspirin and steroid taper.

All …

Challenges In Echocardiographic Diagnosis Of Corrected Malposition Of Great Arteries: The Segmental Approach Coming Handy, Amulya Buddhavarapu, Anmol Goyal, Sanket Shah, Nitin Madan, Hayley S. Hancock, Maria Kiaffas

Posters

Clinical Presentation

Two cases of {S,D,L} anatomically corrected malposition of great arteries (ACMGA) are presented with differences in conal anatomy. Case 1: A fetal echocardiogram (echo) performed at 28 weeks gestation due to multiple anomalies revealed atrial situs solitus, D-loop ventricles, a large conoventricular septal defect (VSD) and an overriding, anterior and leftward aorta. The diagnosis of double outlet right ventricle (DORV) vs ACGMA was entertained. Postnatal echo revealed {S,D,L} segmental anatomy with ventriculoarterial concordance consistent with ACGMA and a muscular VSD. Case 2: A 3-week-old boy presented to clinic for a murmur evaluation with no associated cardiac symptoms. Transthoracic …

Development Of Stress-Induced Cardiomyopathy After Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy, Saad Ahmed Naved, Sadiq Shoukat Parpia, Huma Shoukat Ali

Medical College Documents

Pseudomyxoma Peritonei, a massive mucinous peritoneal collection due to a rare epithelial neoplasm, can be effectively treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). A 43-year-old female, previously treated for mucinous ovarian carcinoma with CRS-HIPEC, and total abdominal hysterectomy and bilateral salpingo-oophorectomy, presented with new-onset abdominal distension and early satiety. She was diagnosed with Pseudomyxoma Peritonei. After 48 hours of treatment with CRS-HIPEC, she presented haemodynamically unstable with acute chest pain. Electrocardiogram showed broad complex tachycardia with ST depression in leads V3-6. Severe systolic dysfunction with Ejection Fraction (EF) of 20% along with severe pulmonary hypertension, visualized on Echocardiography. …

Correlation Between Strain And Weight Status In Infants With A Univentricular Hear, Amulya Buddhavarapu, Mathew Warren, Lori Erickson, Christopher Mathis, Whitney Haas, Daniel Forsha

Posters

Background

Infants with univentricular physiology are at risk of poor weight gain and reduced ventricular function, both of which have been independently associated with worse outcomes. Since nutritional status has been correlated to ventricular function in other populations, we evaluated the relationship between nutritional status and ventricular function including speckle-tracking strain during this period.

Methods

Thirty term infants (median age 55 days, 13 females) with univentricular physiology prior to stage II palliation were included with data obtained at the time of their initial hospital discharge. Ventricular function was quantified using 2D global longitudinal strain (GLS) and strain rate, analyzed from …

Speckle-Tracking Echocardiography For Detecting Subclinical Left Ventricular Dysfunction In Patients With Familial Hypercholesterolemia, Rongjuan Li, Jinjie Xie, Bo Jiang, Zhonghua Sun, Lvya Wang, Zhaoting Leng, Yueli Wang, Ya Yang

The Texas Heart Institute Journal

Myocardial ischemia and left ventricular dysfunction have been documented in young adults with familial hypercholesterolemia. We investigated whether speckle-tracking echocardiography can be used to detect subclinically impaired global and regional myocardial function in patients with this lipid disorder. This single-center study included 47 patients with familial hypercholesterolemia and 37 healthy control subjects who underwent transthoracic Doppler echocardiography and speckle-tracking echocardiography from January 2003 through December 2016. Conventional echocardiographic and strain parameters in the 2 groups were analyzed and compared. Left ventricular dimensions were significantly larger at end-diastole (P=0.02) and end-systole (P=0.013), left ventricular walls were significantly thicker (P

Active Implantable Cardioverter-Defibrillators In Continuous-Flow Left Ventricular Assist Device Recipients, Kuldeep Shah, Rahul Chaudhary, Mohit K. Turagam, Mahek Shah, Brijesh Patel, Gregg Lanier, Dhanunjaya Lakkireddy, Jalaj Garg

Division of Cardiology Faculty Papers

Introduction

Implantable cardioverter-defibrillator (ICD) in patients with heart failure with reduced ejection fraction reduces mortality secondary to malignant arrhythmias. Whether end-stage heart failure (HF) with continuous-flow left ventricular assist device (cf-LVAD) derive similar benefits remains controversial.

Methods

We performed a systematic literature review and meta-analysis of all published studies that examined the association between active ICDs and survival in advanced HF patients with cfLVAD. We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting the association between ICD and all-cause mortality in advanced HF patients with cfLVAD. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data.

Results …

Patient Perceptions And Use Of Non-Statin Lipid Lowering Therapy Among Patients With Or At Risk For Atherosclerotic Cardiovascular Disease: Insights From The Palm Registry, Angela Lowenstern, Shuang Li, Ann Marie Navar, Salim S Virani, Veronique L Roger, Jennifer G Robinson, Anne C Goldberg, Wendy Kampman, Eric D Peterson, Tracy Y Wang

Faculty, Staff and Students Publications

BACKGROUND: Non-statin lipid lowering therapies (LLTs) provide additional treatment options for patients. Use patterns and patient perceptions of non-statin LLT remain incompletely described.

HYPOTHESIS: The guideline-recommended statin intensity remains underutilized in patients treated with and without non-statin LLT.

METHODS: The PALM Registry collected LLT information on patients with or at risk of ASCVD treated at 125 US clinics in 2015. We compared patient perceptions, lipid levels and statin use among patients treated with and without non-statin LLT.

RESULTS: Among 7720 patients, 1930 (25.0%) were treated with a non-statin LLT (1249 fish oil, 417 fibrates, 329 ezetimibe, 196 niacin). Concurrent statin …

Young Athletes: Preventing Sudden Death By Adopting A Modern Screening Approach? A Critical Review And The Opening Of A Debate, Paolo Angelini, Raja Muthupillai, Alberto Lopez, Benjamin Cheong, Carlo Uribe, Eduardo Hernandez, Stephanie Coulter, Emerson Perin, Silvana Molossi, Federico Gentile, Scott Flamm, Giovanni Lorenz, Flavio D'Ascenzi, Jonathan Tobis, Roberto Sarnari, Antonio Corno, James Furgerson, Amedeo Chiribiri, Adriana D M Villa, Fulvio Orzan, Pedro Brugada, John Jefferies, Pierre Aubry, Jeffrey Towbin, Gaetano Thiene, Robert Tomanek

Faculty, Staff and Students Publications

Preventing sudden cardiac death (SCD) in athletes is a primary duty of sports cardiologists. Current recommendations for detecting high-risk cardiovascular conditions (hr-CVCs) are history and physical examination (H&P)-based. We discuss the effectiveness of H&P-based screening versus more-modern and accurate methods. In this position paper, we review current authoritative statements and suggest a novel alternative: screening MRI (s-MRI), supported by evidence from a preliminary population-based study (completed in 2018), and a prospective, controlled study in military recruits (in development).

We present: 1. Literature-Based Comparisons (for diagnosing hr-CVCs): Two recent studies using traditional methods to identify hr-CVCs in >3,000 young athletes are …

Dexrazoxane Decreases The Cardiotoxic Effects Of Doxorubicin In Osteosarcoma Patients Without Increasing Mortality From Secondary Malignant Neoplasms, Thomas S. Przybycien

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Schwartz CL, Wexler LH, Krailo MD, et al. Intensified chemotherapy with dexrazoxane cardioprotection in newly diagnosed nonmetastatic osteosarcoma: A report from the Children’s Oncology Group. Pediatr Blood Cancer. 2016;63(1):54-615. https://doi.org/10.1002/pbc.25753

for a patient with osteosarcoma and concerns about the risk of secondary malignant neoplasms that attend use of dexarazoxane.

Outpatient Mineralocorticoid Receptor Antagonist Prescription Rate For Heart Failure, Svenja Schneider, Md, Sairamya Bodempudi, Md, Joshua Bernard, Md, Ryan D'Angelo, Pharmd, Eitan Frankel, Md, Sara Collins, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement:

Improve MRA prescription rate in the outpatient cardiology clinic by 25%

Mind The Gap: A Call For Attention At The Telemetry Station, N. Haroian, Md, T. Zivan, D. Frisch, A. Greenspon, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

"Gaps" in telemetry recordings are a risk factor for patient identification errors and have led to near misses and adverse events in our hospital.

Goal: Completely eliminate wrongful telemetry data display by the end of the academic year.

Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel

Doctor of Nursing Practice Final Manuscripts

Abstract

Background

Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.

Methods:

Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …

Identifying Opportunities For Implementing Home Blood Pressure Monitoring In Newly Diagnosed Or Worsening Hypertension At A Family Health Clinic, Catherine Liikala

Doctor of Nursing Practice Final Manuscripts

Abstract

The literature is clear that the diagnosis, treatment, and plan of care for hypertension in adults should rely, at least in part, on ambulatory blood pressure. Using in-office blood pressures alone risks inaccurate measurements and can result in inappropriate treatments. Many clinics, however, do not adhere to this recommendation and will fall back on clinic readings which puts the patient at risk of mismanaged hypertension and polypharmacy. This project was formulated to identify the extent to which hypertensive patients were diagnosed and managed without the use of home blood pressure monitoring in a small local community clinic. This …

Providing High Reliability Care For Picu Patients With Pulmonary Hypertension: A Quality Improvement Project, Anjali Subbaswamy, Nicholas Tan, Iric Guthrie, Kelsey Fath, Cole Linzmeyer, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project

Anjali Subbaswamy, MD; Nicholas Tan, DO; Iric Guthrie, MD; Kelsey Fath, MD; Cole Linzmeyer, DO; Elizabeth Yakes Jimenez, PhD, RDN, LD

Purpose: Pediatric patients with pulmonary hypertension (PHTN) are a high acuity, low frequency population, and are often admitted to the pediatric intensive care unit (PICU). To mitigate the risk of precipitating a potentially life-threatening pulmonary hypertensive crisis, health care staff need to take specific precautions. This quality improvement (QI) project aims to increase the number of inpatient PHTN patients for whom PHTN precautions are applied …

Biomarkers Of Thrombo-Inflammatory Responses In Pulmonary Embolism Patients With Pre-Existing Versus New-Onset Atrial Fibrillation., Dimpi Patel, Amir Darki, Debra Hoppensteadt, Iman Darwish, Mushabbar Syed, Yevgeniy Brailovsky, Jawed Fareed

Division of Cardiology Faculty Papers

Pulmonary embolism (PE) patients have an increased prevalence and incidence of atrial fibrillation (AF). Because comorbid AF increases risk of morbidity and mortality, we sought to investigate the role of thrombo-inflammatory biomarkers in risk stratifying patients who experience an acute PE episode. Study participants were enrolled from a Pulmonary Embolism Response Team (PERT) registry between March 2016 and March 2019 at Loyola University Medical Center and Gottlieb Memorial Hospital. This cohort was divided into 3 groups: PE patients with a prior diagnosis of AF (n = 8), PE patients with a subsequent diagnosis of AF (n = 11), and PE …

Calculation Of The Correct Angle Of Bifurcation Predicts The Atherosclerotic Lesion Severity More Accurately, Mehmet Ozgeyik, Onur Kaypakli, Mufide Okay Ozgeyik

Journal of the Saudi Heart Association

No abstract provided.

Rota Burr-Induced Aortic Cusp Laceration Necessitating Valve Replacement, Vinayak Vadgaonkar, Nooraldaem Yousif, Husam A. Noor, Sadananda Shivappa

Journal of the Saudi Heart Association

No abstract provided.

Differences In Nt-Probnp Response And Prognosis In Men And Women With Heart Failure With Reduced Ejection Fraction., Melissa A Daubert, Eric Yow, Huiman X Barnhart, Ileana L Piña, Tariq Ahmad, Eric Leifer, Lawton Cooper, Patrice Desvigne-Nickens, Mona Fiuzat, Kirkwood Adams, Justin Ezekowitz, David J Whellan, James L Januzzi, Christopher M O'Connor, G Michael Felker

Division of Cardiology Faculty Papers

Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a prognostic biomarker in heart failure (HF) with reduced ejection fraction. However, it is unclear whether there is a sex difference in NT-proBNP response and whether the therapeutic goal of NT-proBNP ≤1000 pg/mL has equivalent prognostic value in men and women with HF with reduced ejection fraction. Methods and Results In a secondary analysis of the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial we analyzed trends in NT-proBNP and goal attainment by sex. Differences in clinical characteristics, HF treatment, and time to all-cause death or HF hospitalization were compared. Landmark …

Left Ventricular Assist Device Thrombosis Treated With Intravenous Tissue Plasminogen Activator In A Patient With Covid-19 Infection, Simone A. Jarrett, Jafar Alzubi, Savalan Babapoor-Farrokhran, Zaid Ammari, Mohammad Al-Sarie, Zachary Port, Farhan Hasni, Behnam Bozorgnia, Raphael Bonita

The VAD Journal

Left ventricular assist device (LVAD) implantation is an established treatment for patients with end-stage, systolic heart failure as a bridge to heart transplantation or destination therapy. LVAD pump thrombosis is a life-threatening complication than can be triggered by prothrombotic conditions such as infection. Management of pump thrombosis presents as both a diagnostic and therapeutic challenge that is associated with a high morbidity and mortality. We report a case of pump thrombosis in a patient with a HeartMate II (Abbott Laboratories, Chicago, IL) and coronavirus (COVID-19) infection that was treated successfully with an intravenous thrombolytic, tissue plasminogen activator.

Transcatheter Mitral Valve Replacement And Repair Technology, Joel Thomas

Senior Honors Theses

The mitral valve is a two-cusp valve that is located between the left atrium and left ventricle of the heart. As blood flows from the lungs and enters the atrium, it must pass through this valve in one direction to enter the ventricle and be pumped out to the systemic circuit.

Mitral valve disease occurs when normal mitral valve function is impaired. Many different repair and replacement options exist. These options are contingent upon age and risk factors for patients. This paper focuses on the four main transcatheter mitral valve replacement devices that have limited human trials. It concludes that …

What’S In The Lv? A Story Of Scad Leading To Anterior Apical Aneurysm With Left Ventricular Thrombus, Lekha Racharla Do, Zeel Patel Do, Tyler Boozel Do, Rahul Gupta Md, Sagar Vadhar Do, Akhil Kher Md, Ellina C. Feiner Md, Yasotha Rajeswaran Md, Daniel J. Makowski Do

Department of Medicine

No abstract provided.

Durability Of Left Bundle Branch Area Pacing – Long-Term Follow Up On A New Technique, Nikhil A. Mehta Md, Syed Rafay A. Sabzwari Md, Bilal Saqi Md, Rahul Gupta Md, Apurva Vyas Md, Jeffrey Gordon Md, Talha Nazir Md, Sergio Cossu Md, Ronald S. Freudenberger Md, Babak Bozorgnia Md

Department of Medicine

No abstract provided.

Neonatal Arch Obstruction: Not Always A Coarctation, Karoline Krzywda

Research Days

Background: Spontaneous neonatal arch thrombosis is a rare, highly lethal cause of aortic arch obstruction.

Case: A 1-day-old male infant presented failing CCHD screen, on prostaglandin infusion for echocardiographic concerns of aortic coarctation. Repeat echocardiogram revealed severe arch obstruction due to a large, 7.5x5mm echogenic mass, at the aortic isthmus (Fig1A) with right to left systolic PDA flow. CT angiography confirmed presence of a large aortic arch thrombus (Fig1B). Bivalirudin infusion was initiated without change in thrombus size after 2 days. Tissue plasminogen activator (tPA) was subsequently administered with significant reduction in thrombus size to 3x4mm (Fig1C) on day 1 …

Atrial Standstill In A Pediatric Patient With Scn5a Mutation Following Procainamide Challenge, Anmol Goyal

Research Days

Background: Atrial standstill (AS) is a rare arrhythmia characterized by absence of electrical and mechanical atrial activity associated with SCN5A channelopathy.

Case: An 18 year old male with structurally normal heart, frequent sinus pauses, nonsustained atrial tachycardia and high-grade block was found to have SCN5A mutation c.3823G>A (p.Asp1275Asn). An electrophysiology study (EPS) with high density voltage mapping of the right atrium was done (Fig 1a). Nonsustained multifocal atrial tachycardia was induced without ablative targets (Fib 1b). Procainamide challenge was negative for Brugada, however induced AS (Fig 1c-d). No atrial capture could be achieved at maximal output. Empiric atrial lead …

Pediatric Pulmonary Artery Aneurysms Causing Pulmonary Hemorrhage: A Case Of Transcatheter Intervention While On Va Ecmo Support, Igor Areinamo

Research Days

Background: The incidence of pulmonary artery aneurysm (PAA) in children remains unknown. There are few reports of a transcutaneous interventional approach to address this type of pathology. Management of PAAs while on VA ECMO has not been described in pediatrics.

Objectives/Goal:

Methods/Design:

Case: 9-year-old previously healthy male presented with MRSA associated ARDS and sepsis requiring urgent VA ECMO cannulation. Chest CT done on ECMO day 22 showed development of right sided PAAs. Patient had an episode of significant pulmonary hemorrhage. Angiogram demonstrated two fusiform right PAAs, one of which had ruptured and was bleeding into the lung parenchyma. Patient had …

Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Tyler Johnson, Laura Kuzava, Alison Samrany, Nitin Madan, Sanket Shah

Research Days

Background: Adequate echocardiographic (echo) education is integral to successful cardiology training. Online education is proven to be effective in other specialties, but pediatric echo training data are lacking.

Objectives/Goal: Our aim was to design and assess the role of a novel online module-based curriculum to enhance pediatric cardiology fellows’ echo education.

Methods/Design: Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. Content included high quality 2D and 3D echo clips as well as interactive quizzes and could be accessed from a phone, tablet, or computer. All fellows completed pre- and post-tests, validated by …

Constrictive Pericarditis After Repair Of A Ruptured Sinus Of Valsalva, Sarah Studyvin, Laura Kuzava

Research Days

Background: Constrictive pericarditis is an uncommon complication of cardiac surgery. We report a patient who developed constrictive pericarditis after ruptured sinus of Valsalva (RSOV) repair.

Methods: A 23-year-old male presented with exertional dyspnea one year after RSOV repair. TTE showed a small, circumferential effusion with thickened pericardium, ventricular septal bounce, left atrial enlargement, diastolic hepatic flow reversal, and trivial mitral regurgitation without stenosis. He underwent cardiac catheterization, which revealed elevated filling pressures (RVEDP 16 mmHg, LVEDP 18 mmHg), RVEDP/RVSP ratio < 0.5, and a low cardiac index (1.65 L/min/m2). Cardiac MRI confirmed pericardial thickening with paradoxic septal motion, dilated pulmonary veins and retrograde flow in the SVC.

Results: Pericardiectomy of thickened and adherent pericardium was performed. The central venous pressure decreased from 23 to 7 mmHg and …

Prenatal Diagnosis Of An Uncommon Form Of A Hypoplastic Left Heart Syndrome Variant., Anmol Goyal

Research Days

Background: Mitral valve dysplasia syndrome (MVDS) is a rare form of congenital heart disease, similar to hypoplastic left heart syndrome (HLHS). Prenatal identification is important for counseling, delivery planning and postnatal management.

Case: A 39 year-old woman underwent fetal echocardiography at ~34 weeks gestation for evaluation of fetal cardiomegaly and hydrops revealing: biatrial enlargement, mild-to-moderate mitral and tricuspid valve insufficiency, echobright mitral valve apparatus, biventricular dilation, severe LV fibroelastosis (EFE) and systolic dysfunction, mild hypoplasia of aortic valve annulus and aortic arch, and a thick restrictive atrial septum (RAS) with left to right flow (Fig 1a-c).

Decision‐making: Although critical aortic …

Two-Dimensional Speckle -Tracking Echocardiography Derived Longitudinal Strain In Patients With Unstable Angina And Normal Left Ventricular Ejection Fraction, Srinivasan Giridharan, Arumugam Aashish, Palamalai Arun Prasath, Selvaraj Karthikeyan, Sasinthar Rangasamy, Balasubramaniyan Amirthaganesh, Pazhanivel Vijayalakshmi

Journal of the Saudi Heart Association

Longitudinal strain (LS) measurements by Speckle Tracking Echocardiography (STE) is a point of care imaging modality that had been documented to have a role in NSTEMI/STEMI and stable Coronary artery disease (CAD). This study aims to determine the accuracy of LS parameters in diagnosis and predicting severity of CAD in unstable angina patients with no regional wall motion abnormalities. It was a prospective analytical study in which 143 low-risk Unstable angina patients underwent STE. Based on Coronary angiogram results, the study participants were divided into obstructive CAD and control group. Patients with obstructive CAD (n ¼ 79) had significantly higher …

Partial Vena Cava Occlusion (Vco) To Counteract Refractory Heart Failure: A New Era In Interventional Heart Failure Strategy., Yasar Sattar, Monil Majmundar, Talal Almas, David Song, Waqas Ullah, Homam Moussa Pacha, Mohamed Zghouzi, Islam Y Elgendy, Fatir Murtaza, M Chadi Alraies

Abington Jefferson Health Papers

Background: Patients with acute decompensated heart failure are prone to recurrent exacerbation leading to poor quality of life when they do not respond to an optimal medical regimen. Due to the lack of linear positive inotropy response to increasing preload in heart failure patients, increasing preload is associated with poor outcomes. Partial occlusion of either IVC or SVC is a proposed novel treatment that can improve cardiac function or quality of life by altering preload/pressure in heart failure (HF) patients unresponsive to diuretics.

Methods: PubMed, Ovid (MEDLINE), and Cochrane database we searched using the MeSH terms including "Superior vena cava …