Medical Specialties Commons^™

The World Database For Pediatric And Congenital Heart Surgery: Use Of An International Congenital Database In South Korea., James D. St Louis, Cheul Lee, Hiromi Kurosawa, Richard A. Jonas, Sakamoto Kisaburo, Christo I. Tchervenkov, Jeffery P. Jacobs, James K. Kirklin

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Novel Scoring System For Prediction Of Cardiac Syndrome X In Women With Typical Angina And A Positive Exercise Tolerance Test, Farzad Masoudkabir, Ali Vasheghani-Farahani, Elham Hakki, Hamidreza Poorhosseini, Saeed Sadeghian, Seyed Hesameddin Abbasi, Shahram Bahmanyar, Seyed Ebrahim Kassaian

The Texas Heart Institute Journal

A major diagnostic challenge for cardiologists is to distinguish cardiac syndrome X (CSX) from obstructive coronary artery disease in women with typical angina and a positive exercise tolerance test (ETT). We performed this study to develop a scoring system that more accurately predicts CSX in this patient population.

Data on 976 women with typical angina and a positive ETT who underwent coronary angiography at our center were randomly divided into derivation and validation datasets. We developed a backward stepwise logistic regression model that predicted the presence of CSX, and a scoring system was derived from it.

The derivation dataset (809 …

A Great Speech From A Great Man, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Symptomatic Celiomesenteric Trunk: Variable Presentations And Outcomes In 2 Patients, Michael L Kueht, Darrel L Wu, Joseph L Mills, Ramyar Gilani

The Texas Heart Institute Journal

Mesenteric ischemia can be difficult to diagnose without a high degree of suspicion because it presents in a variety of ways. Visceral vascular collaterals between the fore- and midgut often provide protection against ischemia; however, the presence of anatomic variations, such as celiomesenteric trunk, can undermine the expected redundancy. Misdiagnosis can result in prolonged suffering or death, as evidenced in 2 of our patients with celiomesenteric trunk. The first patient with chronic mesenteric ischemia was diagnosed in the clinic and underwent successful surgical correction; the other had overwhelming, acute mesenteric ischemia, which resulted in death. Our cases show that successful …

Cardiac Rehabilitation Improves Cardiometabolic Health In Young Patients With Nonischemic Dilated Cardiomyopathy, Samuel G Wittekind, Yvette Gerdes, Wayne Mays, Clifford Chin, John L Jefferies

The Texas Heart Institute Journal

Nonischemic dilated cardiomyopathy is deadly and costly, and treatment options are limited. Cardiac rehabilitation has proved safe and beneficial for adults with various types of heart failure. Therefore, we retrospectively evaluated the hypothesis that rehabilitation is safe and improves cardiometabolic health in young patients with nonischemic dilated cardiomypathy. From 2011 through 2015, 8 patients (4 males) (mean age, 20.6 ± 6.6 yr; range, 10-31 yr) underwent rehabilitation at our institution. They were in American Heart Association class C or D heart failure and were on maximal medical therapy. Their mean left ventricular ejection fraction at baseline was 0.26 ± 0.15. …

Effects Of Older Donor Age And Cold Ischemic Time On Long-Term Outcomes Of Heart Transplantation, Heidi J Reich, Jon A Kobashigawa, Tamar Aintablian, Danny Ramzy, Michelle M Kittleson, Fardad Esmailian

The Texas Heart Institute Journal

Using older donor hearts in cardiac transplantation may lead to inferior outcomes: older donors have more comorbidities that reduce graft quality, including coronary artery disease, hypertension, diabetes mellitus, and dyslipidemia. Shorter cold ischemic times might overcome the detrimental effect of older donor age. We examined the relationship between donor allograft age and cold ischemic time on the long-term outcomes of heart transplant recipients. rom 1994 through 2010, surgeons at our hospital performed 745 heart transplantations. We retrospectively classified these cases by donor ages of(younger) and ≥50 years (older), then by cold ischemic times of(short), 120 to 240 min (intermediate), and …

Very Late Occurrence Of Complete Heart Block Without Preexisting Atrioventricular Conduction Abnormalities: A Rare Complication After Transaortic Valvular Replacement., Nagesh Chopra, Matthew S Tong, Steven J Yakubov

Heart and Vascular Articles

No abstract provided.

Disconnect Between Genes Associated With Ischemic Heart Disease And Targets Of Ischemic Heart Disease Treatments, C Mary Schooling, J. V. Huang, J. V. Zhao, M.K. Kwok, S. L. Au Yeung, S. L. Lin

Publications and Research

Background: Development of pharmacological treatments to mitigate ischemic heart disease (IHD) has encompassed disappointing results and expensive failures, which has discouraged investment in new approaches to prevention and control.Newtreatments aremost likely to be successful if they act on genetically validated targets. We assessed whether existing pharmacological treatments for IHD reduction are acting on genetically validated targets and whether all such targets for IHD are currently being exploited. Methods: Genes associatedwith IHDwere obtained fromthe loci of single nucleotide polymorphisms reported in either of two recent genome wide association studies supplemented by a gene-based analysis (accounting for linkage disequilibrium) of CARDIoGRAMplusC4D 1000 …

What Did We Learn About Vads In 2017?, Maya Guglin

The VAD Journal

No abstract provided.

A Rare Case Of Asystole During A Laparoscopic Appendectomy In A Young Patient, Rachit Gupta, George Yousef, Melissa Lester

Marshall Journal of Medicine

Laparoscopic surgery has become the mainstay of treatment for uncomplicated appendicitis cases. We describe a case of a 29 year old male with a pertinent past medical history of poorly controlled hypertension who was undergoing a routine laparoscopic appendectomy for confirmed appendicitis and developed bradycardia and subsequent asystolic cardiac arrest approximately one hour into the operation. Urgent cardiopulmonary resuscitation and intravenous (IV) atropine were required to reinitiate sinus cardiac rhythm. While the patient was admitted to the intensive care unit for close monitoring following his operation, he ultimately had an uncomplicated postoperative period and an unremarkable cardiac work up and …

Infection Of A Ventricular Septal Defect Patch With Acremonium Species, Nosheen Nasir, Kauser Jabeen, Joveria Farooqi, Binish Arif Sultan, Afia Zafar, Aamir Hameed Khan, Muneer Amanullah, Farheen Ali

Section of Internal Medicine

A ventricular septal defect (VSD) patch infection with Acremonium species isolated from vegetation and blood culture is described. Antifungal treatment was discontinued after 3 months and patient developed relapse. Surgery with prolonged oral voriconazole was instituted with recovery. We emphasize importance of surgery and prolonged therapy to treat such infections.

Management Of Aortic Insufficiency In Patients With Left Ventricular Assist Device ̶ A Retrospective Analysis, Hartmuth B. Bittner

The VAD Journal

Background: Aortic insufficiency is increasingly recognized as a complication of left ventricular assist device (LVAD) support and may lead to clinical decompensation requiring correction. This article describes experiences in managing patients presenting with concomitant aortic insufficiency and with de novo aortic insufficiency following left ventricular assist device implantations.

Methods: All patients undergoing LVAD implantation between 2012 and 2014 were included in this retrospective analysis if aortic valve insufficiency was present on implantation or newly developed (de novo) after implantation. Moderate to severe aortic valve insufficiency was corrected at implantation.

Results: The data of 39 patients were included. At the time …

Guidewire Method For Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation., Seth J Rials, Michele Pershing, Christy Collins

OhioHealth Research Institute Articles

The timing of local activation at left ventricular (LV) pacing leads is measured from the onset of the QRS complex to the peak of the LV electrogram (QLV). Pacing from the sites of late activation is associated with higher response rates to cardiac resynchronization therapy (CRT). Prior studies have measured QLV from permanent pacing leads, or have used electroanatomic mapping systems. The current study compares QLV measurements made with a guidewire to those collected from permanent LV pacing leads positioned at the same venous site without the use of electroanatomic mapping systems. In this study, 20 patients undergoing CRT implantation …

Approach To Unresponsive Patient With Lvad, Maya Guglin

The VAD Journal

No abstract provided.

Deciphering A Case Of Pulmonary Hypertension In A Young Female: Partial Anomalous Pulmonary Venous Drainage The Culprit, Hiten R. Patel, Suchit Bhutani, Fayez Shamoon, Hartaj Virk

Abington Jefferson Health Papers

Partial anomalous pulmonary venous drainage (PAPVD) is a rare congenital cardiac defect and is associated with sinus venosus atrial septal defect. While most cases are asymptomatic, a patient can present with pulmonary hypertension (PHTN) and it can be difficult to diagnose. Here, we discuss the case of a young female with PHTN who was found to have two right-sided PAPVD. Through this case, authors try to emphasize the importance of meticulous and thorough investigation when evaluating PHTN, which allows for correct diagnosis and a timely intervention before PHTN becomes irreversible.

Unresponsive Patient With Lvad: A Case Series, Ameer Z. Musa, Julia Akhtarekhavari

The VAD Journal

Mechanical circulatory support (MCS) for patients with advanced heart failure (HF) is becoming more commonplace as technology has progressed and reliability of these systems has improved. We report our experience with three patients with cardiopulmonary arrest in the hospital and propose a protocol for the prompt assessment and treatment of an unresponsive patient with a LVAD in place. We presented three cases of unresponsive patients on LVAD support with low flow or no flow through the LVAD. Although all three of them were alive after resuscitation, none survived to discharge. In all three cases, there were no flaws in LVAD …

Demographics And Cardiovascular Risk Factors In A Bi-Ethnic Church-Based Intervention: Baseline Results Of The Stroke Health And Risk Education (Share) Project, Lesli Skolarus

Journal of Health Disparities Research and Practice

Objectives: Hispanics have a higher incidence of cardiovascular disease (CVD) than non-Hispanic whites (NHWs). Despite proven benefits in other minority populations, few interventions have been conducted in partnership with Churches with substantial Hispanic membership. In this context, we describe the baseline demographics and CVD risk factors among participants of a bi-ethnic Catholic Church-based CVD prevention trial.

Methods: The Stroke Health and Risk Education (SHARE) project was a cluster-randomized, multi-component, faith-based, behavioral intervention that enrolled Mexican Americans (MAs) and NHWs from Catholic Churches in Corpus Christi, Texas. Strategies to ensure MA recruitment included bilingual staff and materials and partnership with Catholic …

Heart Failure Follow Up Phone Calls, Melissa Lampert, Anne Major

Nursing Posters

Increase the number of 72-hour post-discharge follow-up phone calls for patients hospitalized with a primary diagnosis of heart failure.

This is a quality measure required for Joint Commission Heart Failure Certification and also to maintain American Heart Association Gold Plus Status.

Decreasing Unnecessary Pharmacy Cost In The Cath Lab, Scott M. Scepaniak, Kristi Patterson

Nursing Posters

AngioMax is a single dose heparin alternative introduced in 2002 that is used in cardiac patients undergoing percutaneous intervention (PCI). Bivalirudin costs $377 per dose; heparin is less than $15 per dose. Noting practice variations, the Cath Lab set out to eliminate unnecessary pharmacy cost for PCI patients by:

• Using current literature to inform clinical care
• Standardizing practice
• Using data to track and guide implementation

The Impact Of Schizophrenia On Copd Readmission Rate Among Hospitalized South Carolinians, Emilienne Y. Watonsi

DNP Research Projects

Due to elevated readmission costs, the Affordable Care Act established the Hospital Readmission Reduction Program in 2012 to curb the 30-day readmission rates. COPD and schizophrenia are two very expensive diseases, COPD national medical costs is projected to be $49.0 billion in 2020; the cost of schizophrenia was 155.7 billion in 2013. The main objective of this study was to determine if schizophrenia is a significant predictor of 30-day readmission following hospitalization for acute exacerbation of COPD after adjusting for age, gender, anxiety, smoking status, T2DM, chronic ischemic heart disease, and GERD. Methods: A retrospective cohort design was used to …

Association Of Coronary Vessel Characteristics With Outcome In Patients With Percutaneous Coronary Interventions With Incomplete Revascularization, E. L. Hannan, Y. Zhong, P. B. Berger, A. K. Jacobs, G. Walford, F. S. K. Ling, F. J. Venditti, S. B. King

Journal Articles

© 2017 American Medical Association. All rights reserved. IMPORTANCE Many studies have compared outcomes for incomplete revascularization (IR) among patients undergoing percutaneous coronary interventions (PCI), but little is known about whether outcomes are related to the nature of the IR. OBJECTIVE To determine whether some coronary vessel characteristics are associated with worse outcomes in patients with PCI with IR. DESIGN, SETTING, AND PARTICIPANTS New York's PCI registrywas used to examine mortality (median follow-up, 3.4 years) as a function of the number of vessels that were incompletely revascularized, the stenosis in those vessels, and whether the proximal left anterior descending artery …

Confronting System Barriers For St- Elevation Mi In Low And Middle Income Countries With A Focus On India, S. Mehta, C. Granger, C. L. Grines, A. Jacobs, T. D. Henry, I. Rokos, A. Lansky, A. Baumbach, R. Botelho, S. Hiremath, +8 Additional Authors

Journal Articles

© 2017 Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays. In doing so, we incorporated a unique strategy of global STEMI expertise. With this methodology, the recommendations were provided by expert Indian cardiologist and final guidelines were drafted after comprehensive discussions by …

Is Transcatheter Aortic Valve Replacement Better Than Surgical Aortic Valve Replacement In Patients With Chronic Obstructive Pulmonary Disease? A Nationwide Inpatient Sample Analysis, T. Ando, O. Adegbala, E. Akintoye, S. Ashraf, M. Pahuja, A. Briasoulis, H. Takagi, C. L. Grines, L. Afonso, T. Schreiber

Journal Articles

No abstract provided.

Reduction Of Vascular Inflammation, Ldl-C, Or Both For The Protection From Cardiovascular Events?, Andromachi Reklou, Michael Doumas, Konstantinos Imprialos, Konstantinos Stavropoulos, Dimitris Patoulias, Vasilios Athyros

Medicine Faculty Publications

Background:

Low density lipoprotein cholesterol (LDL-C) and low grade arterial inflammation are key pathogenic factors for atherosclerosis and its manifestation, cardiovascular disease (CVD).

Objective:

In this narrative review we assessed if decreasing LDL-C levels or inflammation or both is more effective in reducing CVD events.

Results:

In the Scandinavian Simvastatin Survival Study (4S), all statin trials of the 90s’ and the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) the benefit came from the LDL-C reduction. In the GREak and Atorvastatin Coronary heart disease Evaluation (GREACE), the Treating to New Targets (TNT), and the Justification …

Relationship Of Transmural Variations In Myofiber Contractility To Left Ventricular Ejection Fraction: Implications For Modeling Heart Failure Phenotype With Preserved Ejection Fraction, Yanghoub Dabiri, Kevin L. Sack, Semion Shaul, Partho P. Sengupta, Julius M. Guccione

Faculty & Staff Scholarship

The pathophysiological mechanisms underlying preserved left ventricular (LV) ejection fraction (EF) in patients with heart failure and preserved ejection fraction (HFpEF) remain incompletely understood. We hypothesized that transmural variations in myofiber contractility with existence of subendocardial dysfunction and compensatory increased subepicardial contractility may underlie preservation of LVEF in patients with HFpEF. We quantified alterations in myocardial function in a mathematical model of the human LV that is based on the finite element method. The fiber-reinforced material formulation of the myocardium included passive and active properties. The passive material properties were determined such that the diastolic pressure-volume behavior of the LV …

Quantum Confined Peptide Assemblies With Tunable Visible To Near-Infrared Spectral Range, Kai Tao, Zhen Fan, Leming Sun, Pandeeswar Makam, Zhen Tian, Mark Ruegsegger, Shira Shaham-Niv, Derek Hansford, Ruth Aizen, Zui Pan, Scott Galster, Jianjie Ma, Fan Yuan, Mingsu Si, Songnan Qu, Mingjun Zhang, Ehud Gazit, Junbai Li

Faculty & Staff Scholarship

Quantum confined materials have been extensively studied for photoluminescent applica- tions. Due to intrinsic limitations of low biocompatibility and challenging modulation, the utilization of conventional inorganic quantum confined photoluminescent materials in bio- imaging and bio-machine interface faces critical restrictions. Here, we present aromatic cyclo-dipeptides that dimerize into quantum dots, which serve as building blocks to further self-assemble into quantum confined supramolecular structures with diverse morphologies and photoluminescence properties. Especially, the emission can be tuned from the visible region to the near-infrared region (420 nm to 820 nm) by modulating the self-assembly process. Moreover, no obvious cytotoxic effect is observed for …

Experimental Intravascular Hemolysis Induces Hemodynamic And Pathological Pulmonary Hypertension: Association With Accelerated Purine Metabolism, Victor P. Bilan, Frank Schneider, Enrico M. Novelli, Eric E. Kelley, Sruti Shiva, Mark T. Gladwin, Edwin K. Jackson, Stevan P. Tofovic

Faculty & Staff Scholarship

Pulmonary hypertension (PH) is emerging as a serious complication associated with hemolytic disorders, and plexiform lesions (PXL) have been reported in patients with sickle cell disease (SCD). We hypothesized that repetitive hemolysis per se induces PH and angioproliferative vasculopathy and evaluated a new mechanism for hemolysis-associated PH (HA-PH) that involves the release of adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) from erythrocytes. In healthy rats, repetitive admin- istration of hemolyzed autologous blood (HAB) for 10 days produced reversible pulmonary parenchymal injury and vascular remodeling and PH. Moreover, the combination of a single dose of Sugen-5416 (SU, 200mg/kg) and 10-day …

Impact Of Acute Diabetes Decompensation On Outcomes Of Diabetic Patients Admitted With St-Elevation Myocardial Infarction, Mayada Issa, Fahad Alqahtani, Chalak Berzingi, Mohammad Al-Hajji, Tatiana Busu, Mohamad Alkhouli

Faculty & Staff Scholarship

Background: Acute hyperglycemia is associated with worse outcomes in diabetic patients admitted with ST‐eleva‐ tion myocardial infarction (STEMI). However, the impact of full‐scale decompensated diabetes on STEMI outcomes has not been investigated.

Methods: We utilized the national inpatient sample (2003–2014) to identify adult diabetic patients admitted with STEMI. We defined decompensated diabetes as the presence of diabetic ketoacidosis (DKA) or hyperglycemic hyper‐ osmolar state (HHS). We compared in‐hospital morbidity and mortality and cost between patients with and without diabetes decompensation before and after propensity‐score matching.

Results: A total of 73,722 diabetic patients admitted with STEMI were included in the study. …

Comparative Early Outcomes Of Tricuspid Valve Repair Versus Replacement For Secondary Tricuspid Regurgitation, Mohammad Alkhouli, Chalak Berzingi, Amer Kowatti, Fahad Alqahtani, Vinay Badhawr

Faculty & Staff Scholarship

Background Comparative outcome data on tricuspid valve repair (TVr) versus tricuspid valve replacement (TVR) for severe secondary tricuspid regurgitation (TR) are limited.

Methods We used a national inpatient sample to assess in-hospital morbidity and mortality, length of stay and cost in patients with severe secondary TR undergoing isolated TVr versus TVR.

Results A total of 1364 patients (national estimate=6757) underwent isolated tricuspid valve surgery during the study period, of whom 569 (41.7%) had TVr and 795 (58.3%) had TVR. There was no difference in the prevalence of major morbidities between the two groups, except for liver disease and hepatic cirrhosis, …

Contemporary Outcomes Of Isolated Bioprothestic Mitral Valve Replacement For Mitral Regurgitation, Chalak Berzingi, Vinay Badhwar, Fahad Alqahtani, Sami Aljohani, Zakeih Chaker, Mohamad Alkhouli

Faculty & Staff Scholarship

Background Early experience with transcatheter mitral valve replacement (TMVR) highlighted several investigational challenges related to this novel therapy. Conclusive randomised clinical trials in the field may, therefore, be years ahead. In the interim, contemporary outcomes of isolated surgical bioprosthetic mitral valve replacement (MVR) can be used as a benchmark for the emerging TMVR therapies. Methods We used the nationwide inpatient sample to examine recent trends and outcomes of surgical bioprosthetic MVR for mitral regurgitation (isolated and combined). Results 21 007 patients who had bioprosthetic MVR between 2003 and 2014 were included. Of those, 30% had isolated MVR and 70% had …