Medical Specialties Commons^™

Can The Bicuspid Aortic Valve Be Spared? The Con Position, With Caveats And Nuances, Joseph E Bavaria, Caroline M Komlo, Tyler Rhode, Prashanth Vallabhajosyula

The Texas Heart Institute Journal

No abstract provided.

Perventricular Device Closure Of Residual Muscular Ventricular Septal Defects After Repair Of Complex Congenital Heart Defects In Pediatric Patients, Da Zhu, Kaiyu Tao, Qi An, Shuhua Luo, Changping Gan, Ke Lin

The Texas Heart Institute Journal

Residual muscular ventricular septal defects are surgical challenges, especially after the repair of complex congenital heart defects. We investigated perventricular device closure as a salvage technique in pediatric patients who had postoperative residual muscular ventricular septal defects.

From February 2009 through June 2011, 14 pediatric patients at our hospital had residual muscular ventricular septal defects after undergoing surgical repair of complex congenital heart defects. Ten patients met our criteria for perventricular device closure of the residual defects: significant left-to-right shunting (Qp/Qs >1.5) or substantial hemodynamic instability (a defect ≥2 mm in size). The patients' mean age was 20.4 ± 13.5 …

Two Cases Of Bezold-Jarisch Reflex Induced By Intra-Arterial Nitroglycerin In Critical Left Main Coronary Artery Stenosis, Sachin P Shah, Sergio Waxman

The Texas Heart Institute Journal

The Bezold-Jarisch reflex, a well-described phenomenon, occurs upon the stimulation of intracardiac mechanoreceptors and is mediated by vagal afferent nerve fibers. Several factors can sensitize the cardiovascular system to develop this reflex, including acute myocardial ischemia, natriuretic peptides, and, rarely, nitroglycerin administration in the setting of acute myocardial infarction. The development of the Bezold-Jarisch reflex in the presence of severe coronary artery stenosis, specifically left main coronary artery stenosis, has not been described. We report 2 cases of patients who underwent elective coronary angiography and were given intra-arterial nitroglycerin during radial sheath insertion to reduce radial artery spasm. In both …

Feasibility Of Temporary Biventricular Pacing After Off-Pump Coronary Artery Bypass Grafting In Patients With Reduced Left Ventricular Function, Daniel Y Wang, Lauren A Kelly, Marc E Richmond, T Alexander Quinn, Bin Cheng, Michelle D Spotnitz, Santos E Cabreriza, Yoshifumi Naka, Allan S Stewart, Craig R Smith, Henry M Spotnitz

The Texas Heart Institute Journal

In selected patients undergoing cardiac surgery, our research group previously showed that optimized temporary biventricular pacing can increase cardiac output one hour after weaning from cardiopulmonary bypass. Whether pacing is effective after beating-heart surgery is unknown. Accordingly, in this study we examined the feasibility of temporary biventricular pacing after off-pump coronary artery bypass grafting.

The effects of optimized pacing on cardiac output were measured with an electromagnetic aortic flow probe at the conclusion of surgery in 5 patients with a preoperative mean left ventricular ejection fraction of 0.26 (range, 0.15–0.35). Atrioventricular (7) and interventricular (9) delay settings were optimized in …

Open Versus Laparoscopic Hiatal Hernia Repair., Terrence M. Fullum, Tolulope A. Oyetunji, Gezzer Ortega, Daniel D. Tran, Ian M. Woods, Olusola Obayomi-Davies, Orighomisan Pessu, Stephanie R. Downing, Edward E. Cornwell

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The literature reports the efficacy of the laparoscopic approach to paraesophageal hiatal hernia repair. However, its adoption as the preferred surgical approach and the risks associated with paraesophageal hiatal hernia repair have not been reviewed in a large database.

METHOD: The Nationwide Inpatient Sample dataset was queried from 1998 to 2005 for patients who underwent repair of a complicated (the entire stomach moves into the chest cavity) versus uncomplicated (only the upper part of the stomach protrudes into the chest) paraesophageal hiatal hernia via the laparoscopic, open abdominal, or open thoracic approach. A multivariate analysis was performed controlling for …

Incomplete Polyp Resection During Colonoscopy—Results Of The Complete Adenoma Resection (Care) Study, Heiko Pohl, Amitabh Srivastava, Steve P. Bensen, Peter Anderson, Richard I. Rothstein, Stuart R. Gordon, L Campbell Levy, Arifa Toor, Todd A. Mackenzie, Thomas Rosch, Douglas J. Robertson

Dartmouth Scholarship

Although the adenoma detection rate is used as a measure of colonoscopy quality, there are limited data on the quality of endoscopic resection of detected adenomas. We determined the rate of incompletely resected neoplastic polyps in clinical practice.We performed a prospective study on 1427 patients who underwent colonoscopy at 2 medical centers and had at least 1 nonpedunculated polyp (5-20 mm). After polyp removal was considered complete macroscopically, biopsies were obtained from the resection margin. The main outcome was the percentage of incompletely resected neoplastic polyps (incomplete resection rate [IRR]) determined by the presence of neoplastic tissue in post-polypectomy biopsies. …

The Complex Transcriptional Landscape Of The Anucleate Human Platelet., Paul F. Bray, Steven E. Mckenzie, Leonard Edelstein, Srikanth Nagalla, Kathleen Delgrosso, Adam Ertel, Joan Kupper, Yi Jing, Eric R. Londin, Phillipe Loher, Huang-Wen Chen, Paolo Fortina, Isidore Rigoutsos

Cardeza Foundation for Hematologic Research

BACKGROUND: Human blood platelets are essential to maintaining normal hemostasis, and platelet dysfunction often causes bleeding or thrombosis. Estimates of genome-wide platelet RNA expression using microarrays have provided insights to the platelet transcriptome but were limited by the number of known transcripts. The goal of this effort was to deep-sequence RNA from leukocyte-depleted platelets to capture the complex profile of all expressed transcripts.

RESULTS: From each of four healthy individuals we generated long RNA (≥40 nucleotides) profiles from total and ribosomal-RNA depleted RNA preparations, as well as short RNA (<40 >nucleotides) profiles. Analysis of ~1 billion reads revealed that coding …

Preoperative Statin Therapy In Cardiac Surgery Is More Effective In Patients Who Display Preoperative Activation Of The Inflammatory System, José Martínez-Comendador, José Rubio Alvarez, Juan Sierra, Elvis Teijeira, Belén Adrio

The Texas Heart Institute Journal

We sought to determine whether preoperative statin treatment is more effective in reducing, after cardiac surgery with cardiopulmonary bypass, systemic inflammatory response and myocardial damage markers in patients who have elevated preoperative interleukin-6 levels than in patients who have normal preoperative interleukin-6 levels.

The study involved a prospective cohort of 164 patients who underwent coronary and valvular surgery with cardiopulmonary bypass. There were 2 study groups: group A (n = 60), patients with elevated preoperative interleukin-6 levels; and group B (n = 104), patients with normal preoperative interleukin-6 levels. Each group was subdivided according to whether patients were (group 1) …

Components Of The Complete Blood Count As Risk Predictors For Coronary Heart Disease: In-Depth Review And Update, Mohammad Madjid, Omid Fatemi

The Texas Heart Institute Journal

Atherosclerosis is an inflammatory disease, and several inflammatory biomarkers, such as C-reactive protein, have been used to predict the risk of coronary heart disease. High white blood cell count is a strong and independent predictor of coronary risk in patients of both sexes, with and without coronary heart disease. A high number of white blood cells and their subtypes (for example, neutrophils, monocytes, lymphocytes, and eosinophils) are associated with the presence of coronary heart disease, peripheral arterial disease, and stroke. The coronary heart disease risk ratios associated with a high white blood cell count are comparable to those of other …

Surgical Pulmonary Embolectomy: The Resurrection Of An Almost Discarded Operation, Samuel Z Goldhaber

The Texas Heart Institute Journal

No abstract provided.

Inverted Takotsubo Cardiomyopathy And The Fundamental Diagnostic Role Of Echocardiography, Arantza Manzanal, Lara Ruiz, Jose Madrazo, Majesh Makan, Julio Perez

The Texas Heart Institute Journal

Takotsubo cardiomyopathy is characterized by the development of transient focal wall-motion abnormalities that involve the apical and midventricular segments, in the absence of obstructive coronary artery disease. A variant, inverted takotsubo cardiomyopathy, was described in 2010. We report 3 cases in which each patient's transthoracic echocardiogram revealed the characteristic basal and midventricular segmental akinesis of this variant. This pattern is not associated with coronary artery distribution, and it therefore can be differentiated from coronary artery disease with the use of echocardiography, by evaluating the distribution and temporal changes of akinetic areas.

Osteosarcoma Tumor Thrombus: A Case Report With A Review Of The Literature, Pournima Navalkele, Sarah M Jones, Jason K Jones, Jorge D Salazar, Patrick C Toy, Rathi V Iyer, Betty Herrington

The Texas Heart Institute Journal

Tumor thrombus arising from osteosarcoma is rare. We report the case of a 20-year-old man with proximal humerus osteosarcoma, accompanied by an extensive intravascular tumor thrombus extending into the heart. Our review of the literature found 14 previous reports on osteosarcoma with tumor thrombus. The combination of positron emission tomography and computed tomography is very useful in differentiating tumor thrombus from vascular thrombus, thereby avoiding unnecessary anticoagulation therapy. This same imaging combination can also be used to evaluate the response to treatment. Surgical resection of the tumor thrombus is highly recommended. The effect of tumor thrombus on survival is still …

Predicting Early Death After Cardiovascular Surgery By Using The Texas Heart Institute Risk Scoring Technique (Thirst), Saurabh Sanon, Vei-Vei Lee, Macarthur A Elayda, Sreedevi Gondi, James J Livesay, George J Reul, James M Wilson

The Texas Heart Institute Journal

Preoperative risk-prediction models are an important tool in contemporary surgical practice. We developed a risk-scoring technique for predicting in-hospital death for cardiovascular surgery patients. From our institutional database, we obtained data on 21,120 patients admitted from 1995 through 2007. The outcome of interest was early death (in-hospital or within 30 days of surgery). To identify mortality predictors, multivariate logistic regression was performed on data from 14,030 patients from 1995 through 2002 and risk scores were computed to stratify patients (low-, medium-, and high-risk). A recalibrated model was then created from the original risk scores and validated on data from 7,090 …

Endovascular Treatment Of Acute Type B Dissection Complicating Aortic Coarctation, Seyed Ebrahim Kassaian, Kyomars Abbasi, Mehdi Mousavi, Mohammad Sahebjam

The Texas Heart Institute Journal

Surgical treatment poses a high risk to patients with concomitant aortic coarctation and dissection, and an interventional approach could be an alternative. We describe the case of a 52-year-old man with a long history of untreated hypertension and aortic coarctation who emergently presented at our institution with an acute Stanford type B dissection. The patient's elevated serum creatinine level, perfusion deficit in the right lower limb, and hypertension did not respond to medical therapy, and he did not consent to surgery. By endovascular means, we used a self-expandable stent-graft to cover the entry point of the dissection; then, we deployed …

Preventing Sudden Cardiac Death In Athletes: In Search Of Evidence-Based, Cost-Effective Screening, Paolo Angelini, Mladen I Vidovich, Christine E Lawless, Macarthur A Elayda, J Alberto Lopez, Dwayne Wolf, James T Willerson

The Texas Heart Institute Journal

Sudden cardiac death in athletes is a recurrent phenomenon at sporting events and during training. Recent studies have associated sudden cardiac death with such cardiovascular conditions as coronary artery anomalies, cardiomyopathies, and electrocardiographic abnormalities, most of which are screenable with modern imaging techniques. We recently inaugurated the Center for Coronary Artery Anomalies at the Texas Heart Institute, which is dedicated to preventing sudden cardiac death in the young and investigating coronary artery anomalies. There, we are conducting 2 cross-sectional studies intended to firmly establish and quantify, in a large group of individuals from a general population, risk factors for sudden …

Preventing Deep Wound Infection After Coronary Artery Bypass Grafting: A Review, Charles S Bryan, William M Yarbrough

The Texas Heart Institute Journal

The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include …

Some Thoughts About The Historic Events That Led To The First Clinical Implantation Of A Total Artificial Heart, Denton A Cooley

The Texas Heart Institute Journal

No abstract provided.

Stab Wound Of The Heart With Unusual Sequelae, Peter I Praeger, Jonathan Praeger, Ahmed M Abdel-Razek, Elie M Elmann

The Texas Heart Institute Journal

A 31-year-old woman was admitted to the emergency department with a stab wound to the heart. She was initially stable but rapidly developed hypotension. While the operating room and staff were in preparation, she underwent pericardiocentesis. She was then rushed to the operating room by the general surgical trauma team, who performed a bilateral anterior thoracotomy to control the bleeding. In the recovery room, the patient was still hypotensive, so cardiothoracic surgery was consulted.

An echocardiogram revealed severe hypokinesis of both ventricles. The cardiothoracic surgeons returned her to the operating room and discovered that the anterior pericardium had been completely …

The Pathobiology Of Acute Coronary Syndromes: Clinical Implications And Central Role Of The Mitochondria, L Maximilian Buja

The Texas Heart Institute Journal

Ongoing investigation has provided new insights into the pathobiology of myocardial ischemic injury. These include an improved understanding of the roles of the major modes of cell injury and death, including oncosis, apoptosis, and unregulated autophagy, as well as the central role of the mitochondria in the progression of myocardial ischemic injury, reperfusion injury, and myocardial conditioning. This understanding is providing insights for developing new pathophysiologic, pharmacologic, and cell-based therapies, alone or in combination with percutaneous coronary interventions, for better preservation of myocardium and reduction of morbidity and mortality rates from ischemic heart disease.

Cardiovascular Disease In Late Survivors Of Tetralogy Of Fallot: A Tertiary Care Center Experience, Elisa Bradley, Jeff Parker, Eric Novak, Philip Ludbrook, Joseph Billadello, Ari Cedars

The Texas Heart Institute Journal

Patients with tetralogy of Fallot can survive to late adulthood; however, there are few data on cardiovascular outcomes in this population. We conducted a single-center retrospective analysis of cardiovascular outcomes and risk factors in 208 patients with tetralogy of Fallot to better evaluate the burden of cardiovascular disease in this group. Descriptive statistics were used to determine the prevalence of relevant cardiovascular risk factors and outcomes, including a composite analysis of cardiovascular disease. Rates and mean values from the American Heart Association 2011 Heart Disease and Stroke Statistics Update were used as population estimates for comparison.

In tetralogy of Fallot …

The Diagnosis Of Exclusion: An Ongoing Uncertainty, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Cor Triatriatum Sinister In A 43-Year-Old Man With Syncope, Janet L Eichholz, Samer S Hodroge, Jerry J Crook, John W Mack, Dale C Wortham

The Texas Heart Institute Journal

Cor triatriatum sinister, a congenital cardiac anomaly involving a fibromuscular membrane that partitions the left atrium into 2 chambers, has been reported in only 0.1% to 0.4% of patients with congenital heart disease. The posterosuperior chamber receives blood from the pulmonary veins, and the anteroinferior chamber contains the left atrial appendage and mitral valve orifice. Most patients are diagnosed with the condition in infancy or childhood; adult cases are rare. We describe a case of cor triatriatum sinister in a 43-year-old man whose only presenting symptom was recurrent syncope. He underwent corrective resection of the membrane and was asymptomatic thereafter. …

Low Serum Triglyceride Levels As Predictors Of Cardiac Death In Heart Failure Patients, Guliz Kozdag, Gokhan Ertas, Ender Emre, Yasar Akay, Umut Celikyurt, Tayfun Sahin, Gozde Gorur, Kurtulus Karauzum, Irem Yilmaz, Dilek Ural, Mira Sarsekeyeva

The Texas Heart Institute Journal

Understanding the influence of sex differences on predictors of cardiac mortality rates in chronic heart failure might enable us to lengthen lifetimes and to improve lives. This study describes the influence of sex on cardiovascular mortality rates among chronic heart failure patients.

From January 2003 through December 2009, we evaluated 637 consecutive patients (409 men and 228 women) with chronic heart failure, who ranged in age from 18 through 94 years (mean age, 64 ± 13 yr) and ranged in New York Heart Association (NYHA) functional class from II through IV. The mean follow-up period was 38 ± 15 months, …

Cervical Assessment By Ultrasound For Preventing Preterm Delivery., Vincenzo Berghella, Jason K. Baxter Md, Mscp, Nancy W Hendrix

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Measurement of cervical length (CL) by transvaginal ultrasound (TVU) is predictive of preterm birth (PTB). It is unclear if this screening test is effective for prevention of PTB.

OBJECTIVES: To assess the effectiveness of antenatal management based on transvaginal ultrasound of cervical length (TVU CL) screening for preventing PTB.

SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2012), reviewed the reference lists of all articles and contacted experts in the field for additional and ongoing trials.

SELECTION CRITERIA: Published and unpublished randomized controlled trials including pregnant women between the gestational ages of 14 …

Identification Of Phosphorylation Sites In The Cooh-Terminal Tail Of The Μ-Opioid Receptor., Ying-Ju Chen, Sue Oldfield, Adrian J. Butcher, Andrew B. Tobin, Kunal Saxena, Vsevolod V. Gurevich, Jeffrey L. Benovic, Graeme Henderson, Eamonn Kelly

Department of Biochemistry and Molecular Biology Faculty Papers

Phosphorylation is considered a key event in the signalling and regulation of the μ opioid receptor (MOPr). Here, we used mass spectroscopy to determine the phosphorylation status of the C-terminal tail of the rat MOPr expressed in human embryonic kidney 293 (HEK-293) cells. Under basal conditions, MOPr is phosphorylated on Ser(363) and Thr(370), while in the presence of morphine or [D-Ala2, NMe-Phe4, Gly-ol5]-enkephalin (DAMGO), the COOH terminus is phosphorylated at three additional residues, Ser(356) , Thr(357) and Ser(375). Using N-terminal glutathione S transferase (GST) fusion proteins of the cytoplasmic, C-terminal tail of MOPr and point mutations of the same, we …

Characteristics And Quality Of Life Of Patients Presenting To Cancer Support Centres: Patient Rated Outcomes And Use Of Complementary Therapies, Bonnie J. Furzer, Kemi E. Wright, Anna S. Petterson, Karen E. Wallman, Timothy R. Ackland, David Jl Joske

Research outputs 2013

Background: In order to effectively target and provide individualised patient support strategies it is crucial to have a comprehensive picture of those presenting for services. The purpose of this study was to determine the characteristics and patient rated outcomes of individuals presenting to SolarisCare cancer support centres and their choices regarding complementary and integrated therapies (CIT).Methods: A cohort with a current or previous cancer diagnosis aged 18 - 87 years presenting to a SolarisCare centre during a 5-day period completed a questionnaire. Four SolarisCare centres participated in the trial including regional and metropolitan locations. Outcomes included medical and demographic characteristics, …

Potentials And Limitations Of Real-Time Elastography For Prostate Cancer Detection: A Whole-Mount Step Section Analysis., Daniel Junker, Georg Schäfer, Friedrich Aigner, Peter Schullian, Leo Pallwein-Prettner, Jasmin Bektic, Wolfgang Horninger, Ethan J Halpern, Ferdinand Frauscher

Department of Radiology Faculty Papers

OBJECTIVES: To evaluate prostate cancer (PCa) detection rates of real-time elastography (RTE) in dependence of tumor size, tumor volume, localization and histological type.

MATERIALS AND METHODS: Thirdy-nine patients with biopsy proven PCa underwent RTE before radical prostatectomy (RPE) to assess prostate tissue elasticity, and hard lesions were considered suspicious for PCa. After RPE, the prostates were prepared as whole-mount step sections and were compared with imaging findings for analyzing PCa detection rates.

RESULTS: RTE detected 6/62 cancer lesions with a maximum diameter of 0-5 mm (9.7%), 10/37 with a maximum diameter of 6-10 mm (27%), 24/34 with a maximum diameter …

Hyperosmolar Therapy For Raised Intracranial Pressure., Ethan A Benardete

Department of Neurosurgery Faculty Papers

No abstract provided.

Evaluating Changes In Radiation Treatment Volumes From Post-Operative To Same-Day Planning Mri In High-Grade Gliomas., Colin E Champ, Joshua Siglin, Mark V Mishra, Xinglei Shen, Maria Werner-Wasik, David W Andrews, Sonal U Mayekar, Haisong Liu, Wenyin Shi

Department of Radiation Oncology Faculty Papers

BACKGROUND: Adjuvant radiation therapy (RT) with temozolomide (TMZ) is standard of care for high grade gliomas (HGG) patients. RT is commonly started 3 to 5 weeks after surgery. The deformation of the tumor bed and brain from surgery to RT is poorly studied. This study examined the magnitude of volume change in the postoperative tumor bed and the potential impact of RT planning.

METHOD AND MATERIALS: This study includes 24 patients with HGG who underwent craniotomy and adjuvant RT with TMZ at our institution. All patients had immediate postoperative MRI and repeat MRI during the day of RT simulation. Gross …

Successful Identification Of Pathogens By Polymerase Chain Reaction (Pcr)-Based Electron Spray Ionization Time-Of-Flight Mass Spectrometry (Esi-Tof-Ms) In Culture-Negative Periprosthetic Joint Infection., Christina L Jacovides, Rachael Kreft, Bahar Adeli, Bryan Hozack, Garth D Ehrlich, Javad Parvizi

Rothman Institute Papers

BACKGROUND: The diagnosis of periprosthetic joint infection poses many challenges, one of which is the difficulty of isolating the infecting organism. Recently, a sophisticated modality (the Ibis Biosciences T5000 biosensor system) has been introduced that uses pan-domain primers in a series of polymerase chain reactions (PCRs) to identify and speciate essentially all bacteria and fungi as well as to identify key antibiotic resistance genes. We investigated the role of the Ibis in identifying infecting organisms in cases of known and suspected periprosthetic joint infection.

METHODS: Synovial fluid specimens were collected prospectively from eighty-two patients undergoing eighty-seven arthroplasty procedures (sixty-five knee …