Cardiology Commons^™

Double-Port Totally Endoscopic Mitral Valve Replacement Through A Prosthesis-Sized Working Incision With Posterior Subvalvular Preservation, Cao Dang Khang, Tran Duc Quang, Phan Quang Thuan, Vuong Ngoc Minh, Pham Tran Viet Chuong, Nguyen Hoang Dinh

Journal of the Saudi Heart Association

Objective: To evaluate the feasibility and early outcomes of totally endoscopic non-robotic mitral valve replacement using a double-port DCT approach with posterior subvalvular preservation.

Methods: In this single-center retrospective observational study, 76 consecutive patients underwent totally endoscopic non-robotic mitral valve replacement between November 2023 and December 2025. The DCT approach was defined by exclusive endoscopic visualization, no rib spreading, a camera port and prosthesis-sized working incision placed in the same intercostal space, and thoracoscopic intracardiac instrumentation. Posterior ventricular-annular continuity was preserved whenever feasible by posterior leaflet preservation, native chordal preservation, or artificial chordal reimplantation after leaflet resection. Outcomes were reported …

Premature Ventricular Contractions As A Result Of Subacute Myocarditis In A Professional Football Player, Charlotte Pirquet, Daniel Underberg, Brian Osler, Derek Schwabe-Warf, David Shipon

Department of Medicine Faculty Papers

BACKGROUND: Return-to-play (RTP) decisions for professional athletes with arrhythmias are challenging, particularly when the diagnosis is uncertain.

CASE SUMMARY: A 33-year-old professional football player presented for RTP evaluation of premature ventricular contractions (PVCs) and atypical chest pain. Work-up was significant for fragmented R waves and PVCs on electrocardiogram as well as late gadolinium enhancement on cardiac magnetic resonance imaging. Positron emission tomography scan was normal. These findings suggested possible subacute myocarditis. He elected to rest for 2 to 3 months and was treated with guideline-directed medical therapy. Risk stratification highlighted increased risks associated with late gadolinium enhancement and incomplete genetic …

Isolated Giant Aneurysm Of The Acute Marginal Branch Of Right Coronaryartery Presenting As Nstemi: Successful Direct Surgical Repair Preserving The Native Flow, Sai Kumari Ms., Anbarasu Mohanraj Dr, Saranya Damodaran Ms

Journal Of Indian Physician Associates

Abstract

Background: A “giant” coronary artery aneurysm is variably defined in the literature—commonly as a dilatation of a coronary vessel exceeding four times the diameter of the adjacent normal segment, or exceeding a fixed threshold such as > 8 mm or > 20 mm in diameter^1.

Case presentation: We report the case of a 61-year-old woman with type II diabetes mellitus and systemic hypertension, who presented with breathlessness and chest pain radiating to the back. She had recently suffered a non-ST elevation myocardial infarction (NSTEMI) and was found on coronary angiography to have a large aneurysm of the acute marginal branch …

Evaluation Of The Effectiveness Of Antihypertensive Therapy Chosen Through Maternal Hemodynamic Profile Analysis, Margaret Weimer

Poster Presentations

In treatment of emergent hypertension, the American College of Obstetricians and Gynecologists (ACOG) recommends both oral labetalol and nifedipine, with no preference shown between the two. These medications have different mechanisms of action. Studies have suggested that consideration of hemodynamic profile may be an effective way to determine medication, but have not considered the Rule of 55, a simple calculation to predict hemodynamic profile.

Goals: 1. Determine if tailoring the antihypertensive to patient’s hemodynamic profile is associated with better control of blood pressure. 2. Determine if the Rule of 55 is an accurate method to determine hemodynamic profile.

Free Versus In Situ Right Internal Mammary Artery As A Conduit In Coronary Artery Bypass Surgery: A Meta-Analysis, Yuta Kikuchi, Tomoki Sakata, Tomonari Shimoda, Shinichi Fukuhara, Junichi Shimamura, Makoto Hibino, Tsuyoshi Kaneko, Hiroo Takayama, Hisato Takagi, Michel Pompeu Sa, Toshiki Kuno

Department of Medicine Faculty Papers

OBJECTIVES: There is debate regarding the optimal choice for a second conduit in coronary artery bypass grafting. The right internal mammary artery (RIMA) is commonly employed as a second conduit; however, it is unclear whether the free (fRIMA) or in situ (isRIMA) configuration yields superior outcomes. We performed a systematic review and meta-analysis to compare clinical outcomes between fRIMA and isRIMA as the second conduit.

METHODS: A comprehensive search of PubMed (MEDLINE), EMBASE, and CENTRAL was performed through May 2025 to identify studies comparing outcomes in patients undergoing coronary artery bypass grafting with either fRIMA or isRIMA as a second …

Artificial Intelligence-Enhanced Cardiac Point-Of-Care Ultrasound: A Prospective Single-Arm Study, Lior Fisher, Michael Fiman, Yuval Yarkoni, Ella Segal, Boris Fishman, Kobi Faierstein, Noa Rubin, Adiel Am-Shalom, Howard Amital, Qiong Zhao, Smadar Kort, Praveen Mehrotra, Ehud Schwammenthal, Robert Klempfner, Eyal Zimlichman, Ehud Raanani, Elad Maor

Division of Cardiology Faculty Papers

OBJECTIVE: To evaluate the clinical utility of combining artificial intelligence (AI) with handheld focused cardiac ultrasound (FoCUS) performed by noncardiologist physicians in clinical care settings.

PATIENTS AND METHODS: In this prospective, single-arm study conducted from July 1, 2022, through December 31, 2023 (ClinicalTrials.gov NCT05455541), 660 adult patients presenting to the emergency department or internal medicine wards were assessed with handheld ultrasound devices enhanced by AI algorithms. These algorithms provided automated analysis of ventricular function, valvular disease, pericardial effusion, and inferior vena cava size. Participating physicians received focused training and performed examinations either in response to clinical suspicion or as part …

Whole-Blood, Concentrated, And Micro–Dose Del Nido Cardioplegia In Adult Cardiac Surgery: A Scoping Review, Christian Iulianelli

Student Works

1. A.     Background/Introduction: Del Nido cardioplegia was originally developed for pediatric cardiac surgery to provide prolonged myocardial protection with a single-dose strategy. Its adoption in adult cardiac surgery has led to multiple modified formulations, including whole-blood, concentrated, and bloodless strategies. Given expanding clinical use and variation in technique, a structured mapping of the adult evidence base is warranted.
2. B.     Methodology: This scoping review followed PRISMA-ScR guidance. PubMed and CINAHL were searched, yielding 88 records. After duplicate removal and screening, 18 studies met inclusion criteria. Data were charted on study design, cardioplegia formulation, patient population, myocardial biomarkers, arrhythmias, renal outcomes, transfusion requirements, …

Plasma Ca125 Levels As A Predictor Of Major Adverse Cardiac Events In Patients With Acute Coronary Syndrome: A Six-Month Follow-Up Study, Nazlı Dilek Çolak, Turgut Karabağ, Onuralp Çalışkan, Songül Tezcan

Journal of the Saudi Heart Association

Objectives: Carbohydrate antigen 125 (CA125) is associated with different cardiovascular conditions. This study aimed to determine CA125 levels in patients with acute coronary syndrome (ACS) and the potential relationship between major adverse cardiac events (MACE) in the short-term following.

Methods: This prospective cohort study was conducted in a coronary care unit between May and November 2022. Plasma CA125 levels were measured only once upon hospital admission. Patients were followed for six months. All-cause mortality, recurrent acute coronary syndrome, requirement for revascularization, decompensated heart failure, cardiogenic pulmonary edema, atrial fibrillation, and stroke were recorded as MACE.

Results: A total of 127 …

Use Of Electrocardiograms To Identify Coronary Artery Disease: Cross-Validation Of An Artificial Intelligence Model, Michael Leasure, Indu Poornima, Adam Butchy, Utkars Jain, Devin Vasoya, Michael Warnick, Brent Williams, John Rehder, Prahlad Menon, Veronica A. Covalesky, Gary S. Mintz

Department of Medicine Faculty Papers

BACKGROUND: The current gold standard for the diagnosis of coronary artery disease (CAD) is invasive angiography; however, it is an invasive procedure. Therefore, we developed an artificial intelligence model designed to predict significant CAD from a resting digital 12-lead electrocardiogram (ECG).

OBJECTIVES: This retrospective study assessed the model's ability to predict clinically significant CAD in a patient population presenting for coronary angiography.

METHODS: From 2019 to 2021, 16,476 patients had a resting 12-lead digital ECG recorded within 90 days prior to coronary angiography. The artificial intelligence model was developed using 10-fold cross-validation methodology. Clinically significant disease was defined as angiographic …

Prognostic Value Of Baseline Qfr In Single-Vessel Intermediate Coronary Stenosis, Yanfeng Lu, Abdulrahman Alqazzaz, Jasmine Bao, Gary S. Mintz, Jiahao Feng, Yong Zhang, Shanshan Gao, Qiang Song, Feifei Ning, Xin Huang, Ning Guo

Student Papers, Posters & Projects

BACKGROUND AND OBJECTIVES: The prognostic value of baseline Quantitative Flow Ratio (QFR) in real-world patients remains unclear. This study aimed to evaluate the prognostic value of baseline QFR and its three-tier model-low, grey-zone, and high QFR-in patients with single-vessel intermediate stenosis.

METHODS: This retrospective study included 478 patients with QFR between 0.70 and 0.90 who underwent coronary angiography between May and June 2023. Patients were stratified into Low (0.70-0.74), Grey-Zone (0.75-0.85), and High (0.86-0.90) QFR groups. The primary endpoint was major adverse cardiac events (MACE); the key secondary endpoint was target vessel failure (TVF). Kaplan-Meier and Cox proportional hazards models …

Predictors Of Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation: Systematic Review And Random-Effects Meta-Analysis, Yves Najm Mrad, Snehalkumar Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Predictors Of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Contemporary Systematic Review And Meta-Analysis Of Adjusted Risk Factors, Yves Najm Mrad, Snehalkumar Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Emergent Tandemheart-Extracorporal Membrane Oxygenation For Refractory Ischemic Ventricular Arrhythmia, Mukhtar Al-Saadi, Aswin Srinivasan, Mohammed Rajab, Alexander Rhodes, Negar Niknam, Pranav Loyalka

Gulf Coast Division GME Research Day 2026

No abstract provided.

Redo-Tavr Vs Tavr Explant Vs Redo-Savr: Comparative Outcomes In Failed Transcatheter Bioprostheses, Yves Najm Mrad, Ahmad Al-Taweel, Bahaeddin Shabaneh

Gulf Coast Division GME Research Day 2026

No abstract provided.

Acute Stemi Hours After Cabg From Distal Lima–Lad Graft Occlusion Complicated By Ellis Iii Perforation During Pci Successfully Treated With A Covered Stent, Eboselumen Aigbe, Brett Sasseen `

South Atlantic Division GME Research Days 2026

No abstract provided.

Mechanical-Medical Convergence In Heart Failure: Artificial Intelligence, Finite-Element Modeling, And 3d Printing For Diagnosis And Prognosis, Quazi Noor E. Sabrina, Quazi Md Zobaer Shah, Quazi Noor E. Sohela, Md Mahabub Hasan Mousum, Md. Moyeen Uddin Chisty, Quazi Md. Akbar Shah

Mechanical & Aerospace Engineering Faculty Publications

Heart failure remains a leading cause of global morbidity and mortality, yet routine clinical indices often miss the regional biomechanical disturbances that drive progression and shape treatment response. This State-of-the-Art review examines how finite-element (FE) modeling, additive manufacturing, and artificial intelligence (AI) are converging to improve the diagnosis, phenotyping, procedural planning, and prognostic assessment of heart failure (HF). Although these technologies have matured in structural heart disease and transcatheter intervention research, their greatest translational potential may lie in HF, where patient-specific ventricular remodeling, myocardial stress–strain heterogeneity, valve-ventricular coupling, and device-tissue interaction are incompletely captured by conventional clinical indices. We synthesize …

Neurologic Complications In Adult Va-Ecmo: Incidence, Phenotypes, And Mortality From Contemporary Elso Registry Analyses And Meta-Analytic Evidence, Yves Najm Mrad, Snehalkumar Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Antibody-Mediated Allograft Rejection 23 Years After Heart Transplant, Jorim Parmar, Boney Lapsiwala, Devika Adusumilli, Sienna Luk, Nguyen Dung, Song Li, Kamala Tamirisa

North Texas GME Research Forum 2026

INTRODUCTION: Orthotopic heart transplantation (OHT) remains the gold standard treatment for patients with advanced heart failure refractory to optimal medical and device-based therapies. Despite advances in perioperative management, immunosuppressive regimens, and long-term surveillance protocols, graft rejection remains a major determinant of post-transplant morbidity and mortality [1]. We report a case, representing one of the longest documented intervals in literature, of suspected antibody-mediated rejection (AMR) occurring 23 years after heart transplantation in which conventional endomyocardial biopsy (EMB) could not be successfully performed. This case highlights the diagnostic uncertainty associated with very late AMR and underscores the potential role of clinical presentation, …

A Rare Case Of Successful Resolution Of Bifurcation Stenosis Using Double Kissing Crush Stenting Technique, Greeshma Molugu, Tony Alacron, Karthik Anand, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Bifurcation lesions are associated with greater procedural complexity and consequently are at higher risk for stent restenosis. Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in the main vesseI and side branch Iimits the Iong-term prognosis. We present a rare case of successful resolution of bifurcation stenosis in a patient by using the double kissing (DK) crush stenting technique.

Case Description: A 52-year-old male patient with a past medical history of hypertension presented to the hospital for elective left heart catheterization as a part of an evaluation for a …

Prophylactic Distal Perfusion Catheters In Femoral Va-Ecmo: Association With Lower Limb Ischemia And Major Limb Outcomes (Systematic Review & Meta-Analysis), Yves Najm Mrad, Snehalkumar Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Relationship Between Exception Request For Higher Listing Urgency And Aggressiveness In Accepting Heart Offers, Jorim Parmar, Yingxian Liu, Devika Adusumilli, Luke Taylor, Shakir Al-Ezzi, Usman Khan, Claudio Bravo, Claudius Mahr, Song Li

North Texas GME Research Forum 2026

BACKGROUND: Transplant programs may submit exception requests to upgrade a listed patient’s priority, often anticipating a higher likelihood of accepting marginal or high-risk donor organs. This study explores whether exception request status is associated with increased risk tolerance in organ acceptance.

METHODS: We conducted a retrospective analysis using data from the Scientific Registry of Transplant Recipients (SRTR), focusing on adult patients (≥18 years) listed for heart transplantation. Statistical analyses were performed using SAS/STAT 14.1. Descriptive statistics summarized demographic and clinical variables. Baseline characteristics were compared between recipients with and without exception requests. Primary analysis: Mixed-effects linear regression was used to …

Cardiac Step-Down Unit (Csu), Two Failures Drive Suboptimal Vte Prevention: Quality Improvement, Jorim Parmar, Shakir Al-Ezzi, Anvi Manduva, Muhammad Suleman, Fahed Alsayed, Debra Medsker

North Texas GME Research Forum 2026

BACKGROUND: In the Cardiac Step-down Unit (CSU), two failures drive suboptimal VTE prevention: (1). over-ordering of SCDs in patients unlikely to benefit and (2). < 10% documented application when SCDs are truly indicated. Baseline data indicates that curbing over-ordering alone would reduce recorded non-compliance by >50%, revealing a clear opportunity for system redesign.

METHODS: To integrate the updated “3 Bucket” Risk Model assessment into the computerized physician order entry (CPOE) in order to delineate the prophylaxis for a given patient population. Once the manual risk assessment proves to be viable in increasing compliance, we can propose having the tool adopted into the CPOE system. Root Cause Analysis revealed that lack of standardized VTE risk stratification leads to inconsistent ordering practices – …

Prognostic Value Of Systemic Inflammatory Indices For Predicting Mace In Nstemi Patients Undergoing Pci, Boney Lapsiwala, Aditya Sharma, Usman Khan, Jorim Parmar, Justin Soloman, Veeranna Vibhuti, Mehdi Khalafi

North Texas GME Research Forum 2026

Background: Cardiovascular diseases (CVD) account for nearly one-third of global mortality, with ischemic heart disease caused by a mismatch between myocardial oxygen supply and demand. Despite advances in percutaneous coronary intervention (PCI) and contemporary pharmacotherapy, patients with non–ST-segment elevation myocardial infarction (NSTEMI) continue to experience substantial residual risk for major adverse cardiovascular events (MACE). As traditional risk stratification tools have limited ability to identify high-risk individuals, interest has shifted toward biomarkers reflecting inflammatory pathways central to atherosclerosis and plaque instability. Hematologic inflammatory markers including pan inflammatory value (PIV), systemic immune inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) initially …

Atrial Fibrillation Detection From At-Rest Ppg Signals Using An Sdof-Tf Method, Mamun Hasan, Zhili Hao

Mechanical & Aerospace Engineering Faculty Publications

At-rest PPG signals have been explored for detecting atrial fibrillation (AF), yet current signal-processing techniques do not achieve perfect accuracy even under low-motion artifact (MA) conditions. This study evaluates the effectiveness of a single-degree-of-freedom time–frequency (SDOF-TF) method in analyzing at-rest PPG signals for AF detection. The method leverages the influence of MA on the instant parameters of each harmonic, which is identified using an SDOF model in which the tissue–contact–sensor (TCS) stack is treated as an SDOF system. In this model, MA induces baseline drift and time-varying system parameters. The SDOF-TF method enables the quantification and removal of MA and …

Concomitant Transcatheter Edge-To-Edge Repair For Mitral And Tricuspid Regurgitation For Polyvalvular Disease, Omar Khan, Matthew Summers

Department of Medicine Faculty Publications

This patient is a 77-year-old male with non-ischemic cardiomyopathy, severe tricuspid regurgitation, and moderate mitral regurgitation who underwent simultaneous transcatheter edge-to-edge repair of both mitral and tricuspid valves. Post-procedure, the patient exhibited significant symptomatic improvement and reduced regurgitation severity, highlighting the feasibility of dual-valve TEER in high-risk patients.

Percutaneous Closure Of Ventricular Septal Rupture After Myocardial Infarction:, Thomas A. Cook, Simone K. Schumaecker, Anjani Patibandla, Nicholas J. Valle, Matthew R. Summers

Department of Medicine Faculty Publications

BACKGROUND: Ventricular septal rupture (VSR) following acute myocardial infarction is a rare but deadly complication with mortality rates exceeding 90% when left untreated. Coronary ischaemia leads to myocardial necrosis and friability resulting in septal rupture, most commonly 3-5 days post-infarction. The sudden development of a left-to-right shunt causes volume overload in the right ventricle, pulmonary vasculature, and left atrium, precipitating biventricular failure, and cardiogenic shock. Management requires careful consideration of timing and modality of closure along with stabilization with mechanical circulatory support in severe cases.

CASE SUMMARY: A 65-year-old female presented with anterior ST-segment elevation myocardial infarction complicated by VSR …

Discriminative Accuracy Of Cha2ds2-Vasc Score, And Development Of Predictive Accuracy Model Using Machine Learning For Ischemic Stroke Risk In Cardiac Amyloidosis And Atrial Fibrillation, Waqas Ullah, Abhinav Nair, Eric Warner, Salman Zahid, Mansoor Rahman, Palwasha Khan, Indranee Rajapreyar, Sridhara S. Yaddanapudi, M. Chadi Alraies, Said Ashraf, Jeffery Van Hook, Yegeny Brailovsky

Department of Medicine Faculty Papers

BACKGROUND: CHA2DS2-VASc score in cardiac amyloidosis (CA) with atrial fibrillation (AF) is believed to underestimate ischemic stroke risk, necessitating a better predictive model.

METHODS: Data were obtained from the National Readmission Database (NRD). Outcomes between CA-AF and no-CA-AF were compared using multivariate regression analysis to calculate adjusted odds ratios (aORs). AutoScore, an interpretable machine learning framework, was used to develop a stroke risk prediction model, and its predictive accuracy was evaluated with an area under the curve (AUC) using the receiver operating characteristic analysis.

RESULTS: A total of 11,860,804 (CA-AF 22,687 (0.19%) and no-CA-AF 11,838,117) patients were identified from 2015 …

Association Of Estimated Plasma Volume Status With Invasive Hemodynamics And Adverse Clinical Outcomes In Patients With Pulmonary Hypertension And Chronic Kidney Disease, Andrew Geller, Jose Manuel Martinez Manzano, Esteban Kosak Lopez, Phuuwadith Wattanachayakul, John Malin, Raul Leguizamon, Tara John, Rasha Khan, Ian Mclaren, Alexander Prendergast, Simone Jarrett, Kevin Bryan Lo, Christian Witzke

Einstein Health Papers

Identifying noninvasive measures to assess intravascular volume status and risk stratify patients with pulmonary hypertension (PH) and chronic kidney disease (CKD) is needed. We assessed the predictive value of estimated plasma volume status (ePVS) using the Strauss-derived Duarte formula in PH-CKD patients. This single-center retrospective cohort analysis included patients with PH and CKD Stage 3b (CKD3b), Stage 4 (CKD4), or Stage 5 (CKD5) who underwent right heart catheterization from 2018 to 2023. Patients were categorized into low ePVS (< 6.2) and high ePVS (≥ 6.2) using Youden's J statistics. We used the Cox-proportional hazards model, adjusting for age, sex, and body mass index, to investigate the association between …

Retrieval Of An Embolized Left Atrial Appendage Occluder From The Aortic Arch Using A Transcatheter Retrieval Device, Juan Siordia, Hussam Al Hennawi, Muhammad Sabri, Daniel Ice, Ronald Ross, Sheena Rastogi, Chunguang Chen, Richard Kovach, Muhammad Raza

Abington Jefferson Health Papers

BACKGROUND: Device embolization is a recognized complication of left atrial appendage occlusion (LAAO) procedures, with outcomes depending on the location of the embolized device and patient management.

CASE SUMMARY: A 70-year-old male with atrial fibrillation underwent LAAO due to high bleeding risk. Postoperative surveillance revealed an Amplatzer Amulet device embolized in the transverse arch of the aorta. The patient remained asymptomatic, and transcatheter retrieval was planned. A percutaneous approach was used with the ONOCOR system and snare devices with successful retrieval. The patient recovered without complications and remained stable at follow-up.

DISCUSSION: Device embolization often presents challenges, with clinical outcomes …

Silent Misplacement: Leadless Pacemaker In The Left Ventricle Discovered Over A Year Later-How Did It End Up There? Could It Explain The Stroke?, Abdalhakim Shubietah, Amir Singh, Qutaiba Qafisheh, Pouyan Razminia, Muath Baniowda, Abdalrahman Assaassa, Hosam I. Taha, Roaa Aljunaidi

Division of Cardiology Faculty Papers

Introduction: Leadless intracardiac pacemakers (LICPs) reduce lead-related complications but may be malpositioned in patients with unrecognized structural defects. We report a 69-year-old man with high-grade AV block whose LICP, intended for right ventricular placement, was found in the left ventricle via an undiagnosed ostium secundum ASD after presenting with multifocal embolic strokes 16 months later. Case Presentation: Stroke workup for acute right-sided symptoms revealed the LICP in the LV and a large, previously undiagnosed ASD with bidirectional shunting and severe pulmonary hypertension. Embolic infarcts were attributed to either paradoxical embolism or device-related thromboembolism. Due to high surgical risk, …