Cardiology Commons^™

Endovascular Repair Of Aortoesophageal And Aortobronchial Fistulae, Roberto Chiesa, Andrea Kahlberg, Yamume Tshomba, Enrico M Marone, Massimiliano M Marrocco-Trischitta, Germano Melissano

The Texas Heart Institute Journal

Aortoesophageal fistulae (AEF) and aortobronchial fistulae (ABF) are uncommon, but are in general fatal if left untreated. Conventional treatment requires surgical replacement of the thoracic aorta, along with several adjunctive procedures to repair the esophageal or tracheobronchial lesion.The mortality rates associated with open surgery reach 61% in cases of primary fistula and 78% in secondary fistula.

Thoracic endovascular aortic repair (TEVAR) has been proposed as an alternative strategy to surgical management.Although less invasive, this technique has important limitations in treating AEF and ABF, the chief of which is the high risk of graft contamination. Moreover, we still lack sufficient data …

Reflections On A Heart Surgery Career With Insights For Western-Trained Medical Specialists In Developing Countries, Sami S Kabbani

The Texas Heart Institute Journal

Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. After our independent surgical center was established in early 1976, we performed 1 open-heart and 1 closed-heart procedure per day. Open-heart procedures evolved from the few and simple to the multiple and complex, and we solved difficulties as they arose. Today, our cardiac surgical center occupies an entire 6-floor building. We have 12 …

Internal Medicine Problems As They Present To The Cardiologist, Ira Martin Grais

The Texas Heart Institute Journal

No abstract provided.

Heterogeneity Of Left Ventricular Signal Characteristics In Response To Acute Vagal Stimulation During Ventricular Fibrillation In Dogs, Alireza Nazeri, Macarthur A Elayda, Lubomir Dragnev, Christopher M Frank, Jihong Qu, Valtino X Afonso, Abdi Rasekh, Mohammad Saeed, Jie Cheng, Mossaab Shuraih, Ali Massumi, Mehdi Razavi

The Texas Heart Institute Journal

Studies have shown that long-term vagal stimulation is protective against ventricular fibrillation; however, the effects of acute vagal stimulation during ventricular fibrillation in the normal heart have not been investigated. We examined the effects of acute vagal stimulation on ventricular fibrillation in a canine model. In 4 dogs, we induced 30-second periods of ventricular fibrillation by means of intraventricular pacing. During 2 of the 4 periods of fibrillation that we analyzed, vagal stimulation was delivered through electrodes in the caudal ends of the vagus nerves. Noncontact unipolar electrograms were recorded from 3 ventricular regions: the basal septum, apical septum, and …

Robotic Cardiac Surgery By 2031, W Randolph Chitwood

The Texas Heart Institute Journal

No abstract provided.

Troubleshooting Implantable Cardioverter-Defibrillators: An Overview For Physicians Who Are Not Electrophysiologists, Mohammad Saeed

The Texas Heart Institute Journal

No abstract provided.

Central Venous Pressure And Pulmonary Capillary Wedge Pressure, Tony S Ma, Biykem Bozkurt, David Paniagua, Biswajit Kar, Kumudha Ramasubbu, Carl F Rothe

The Texas Heart Institute Journal

Heart-failure phenotypes include pulmonary and systemic venous congestion. Traditional heart-failure classification systems include the Forrester hemodynamic subsets, which use 2 indices: pulmonary capillary wedge pressure (PCWP) and cardiac index. We hypothesized that changes in PCWP and central venous pressure (CVP), and in the phenotypes of heart failure, might be better evaluated by cardiovascular modeling. Therefore, we developed a lumped-parameter cardiovascular model and analyzed forms of heart failure in which the right and left ventricles failed disproportionately (discordant ventricular failure) versus equally (concordant failure). At least 10 modeling analyses were carried out to the equilibrium state. Acute discordant pump failure was …

Sirolimus-Eluting Stents Versus Bare-Metal Stents In Routine Clinical Use, Muhammad Munir, Jonathan Aliota, Amany Ahmed, Anwarullah Mohammed, Vei Vei Lee, Macarthur A Elayda, James M Wilson

The Texas Heart Institute Journal

Conflicting patient outcomes have been reported after the use of sirolimus-eluting stents or bare-metal stents. In this nonrandomized study, we examine the outcomes after placement of sirolimus-eluting versus bare-metal stents in an unselected population of patients who underwent percutaneous coronary revascularization.

We used THIRD-base, a longitudinal data registry of patients who underwent revascularization at our institution, to compare demographics and outcomes in patients treated with a sirolimus-eluting or bare-metal stent from January 2001 through June 2006. Outcome measures included major acute coronary and cerebral events at 30 days, target-vessel failure at 9 months and at 3 years, and stent thrombosis. …

A Dosing Study Of Bone Marrow Mononuclear Cells For Transendocardial Injection In A Pig Model Of Chronic Ischemic Heart Disease, Guilherme V Silva, Marlos R Fernandes, Cristiano O Cardoso, Ricardo R Sanz, Edie M Oliveira, Pilar Jimenez-Quevedo, Javier Lopez, Franca S Angeli, Yi Zheng, James T Willerson, Emerson C Perin

The Texas Heart Institute Journal

We studied the effect of the dose of bone marrow mononuclear cells, delivered via transendocardial injection, upon capillary density and fibrosis in pigs with chronic ischemic heart disease.

Pigs (n = 16) that had undergone ameroid constrictor placement (left circumflex coronary artery) to induce chronic ischemia were divided equally into 4 groups on the basis of bone marrow mononuclear cell dose: control (saline injection) and 50, 100, or 200 × 106 bone marrow mononuclear cells. Thirty days after ameroid placement, each pig received 13 transendocardial NOGA-guided injections. An implantable loop recorder monitored possible arrhythmias caused by cell transplantation. Thirty days …

Qrs Duration And Echocardiographic Evidence Of Left Ventricular Dyssynchrony In Patients With Left Ventricular Systolic Dysfunction, Hafeez Ahmed, Javed Tai, Sohail Abrar Khan, Muniza Yousuf

Department of Medicine

Objective: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.
Study Design: A cross-sectional study.
Place and Duration of Study: The Aga Khan University, Karachi, from June to September 2007.
Methodology: All patients with LVEF < 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer’s exact test was used to determine the association between QRS duration and left ventricular dyssynchrony.
Results: A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference …

Reducing Late Charges In Cardiovascular Services, Diane Rydzy Rn

Posters

• Late charges are charges that are “added” to a patient’s bill after the bill has been sent
• Late charges strain the system by making it necessary to “re-bill” the account
• In order to reduce late charges, it is necessary to understand how late charges occur

Inflammatory Biomarkers And Subclinical Atherosclerosis In African-American Women With Systemic Lupus Erythematosus (Sle), Edith M. Williams, Carlos J. Crespo, Joan Dorn

Community Health Faculty Publications and Presentations

Women with lupus are at increased risk for developing cardiovascular disease (CVD). Previous studies of atherosclerosis in SLE have not been representative of the minority groups most affected by lupus and its complications. Therefore, a study of 41 lupus cases and 83 controls was conducted to investigate the relationship between carotid atherosclerosis and inflammation in African-American women. Participation consisted of a questionnaire, physical examination, fasting blood draw, and ultrasound of the carotid arteries. There were observed differences between cases and controls with regard to carotid intima media thickness (IMT) and traditional cardiovascular risk factors, although few reached statistical significance. Tumor …

Associated Symptoms In The Ten Days Before Diagnosis Of Kawasaki Disease., Annette L. Baker, Minmin Lu, L Luann Minich, Andrew M. Atz, Gloria L. Klein, Rosalind Korsin, Linda Lambert, Jennifer S. Li, Wilbert Mason, Elizabeth Radojewski, Victoria L. Vetter, Jane W. Newburger, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To describe common associated symptoms within the 10 days before diagnosis in subjects enrolled in the Pediatric Heart Network's trial of steroid therapy in Kawasaki disease (KD).

STUDY DESIGN: Patients with acute KD were enrolled between days 4 and 10 of illness at 8 centers between 2002 and 2004. We defined common associated symptoms as those occurring in >or=10% of patients. Principal clinical criteria for KD were not included in this analysis.

RESULTS: Among 198 patients, irritability was reported in 98 (50%), vomiting in 88 (44%), decreased food/fluid intake in 73 (37%), cough in 55 (28%), diarrhea in 52 …

Rhabdomyosarcoma Embryonal Type: In A Three And A Half Year Old Girl, Ameer A Khowaja, Saqib Ali Gowani, Asmatullah Khan, Saulat H. Fatimi

Department of Biological & Biomedical Sciences

Rhadomyosarcoma is the most common tumour of the soft tissues in infants and children. We report a case of a 3 1/2 year old girl who presented with a swelling over the neck. Swelling was diagnosed as Rhabdomyosarcoma (embryonal type). Tumour mass was found to be unresectable initially. The patient was subjected to multiple courses of checmotherapy, which shrunk the tumour significantly. There was simultaneous development of cystic lesions in upper lobe of right lung. Excision of the remnant rhabdomyosarcoma mass and biopsy of right lung with cystectomy of right upper lobe cystic lesion was performed. The patient fully recovered …

Left Ventricular Noncompaction Mimicking Peripartum Cardiomyopathy., Chetan Patel, Girish S. Shirali, Naveen Pereira

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Ischemic Stroke Subtypes In Pakistan: The Aga Khan University Stroke Data Bank, N. A. Syed, B. A. Khealani, S. Ali, A. Hasan, H. Brohi, T. Mozaffar, N. Ahmed, A. Hameed, S. M. Baig, M. Wasay

Department of Medicine

Objective: Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital.

Methods: We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi.

Results: A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 …

Risk Factors For Cardiovascular Disease In School Children--A Pilot Study., A. K. Khuwaja, Zafar Fatmi, W. B. Soomro, N. K. Khuwaja

Community Health Sciences

OBJECTIVE:

To assess the frequencies of risk factors for cardiovascular disease in school children. The information may help in designing interventions aimed at modifying unhealthy lifestyle in children, which may reduce the later incidence of cardiovascular disease in adults.

METHODS:

A cross-sectional study was conducted on 206 students (ages 14-18 years), enrolled in higher secondary school. Students were interviewed about their lifestyles, family history of cardiovascular disease and its risk factors. Moreover, they were assessed for height, weight and blood pressure.

RESULTS:

Twenty nine percent of the children were physically inactive, 31% were taking unhealthy diet daily, 21% were overweight …

Probucol Prevents Early Coronary Heart Disease And Death In The High-Density Lipoprotein Receptor Sr-Bi/Apolipoprotein E Double Knockout Mouse, Anne Braun, Songwen Zhang, Helena E. Miettinen, Shamsah Ebrahim, Teresa M. Holm, Eliza Vasile, Mark J. Post

Dartmouth Scholarship

Mice with homozygous null mutations in the high-density lipoprotein receptor SR-BI (scavenger receptor class B, type I) and apolipoprotein E genes fed a low-fat diet exhibit a constellation of pathologies shared with human atherosclerotic coronary heart disease (CHD): hypercholesterolemia, occlusive coronary atherosclerosis, myocardial infarctions, cardiac dysfunction (heart enlargement, reduced systolic function and ejection fraction, and ECG abnormalities), and premature death (mean age 6 weeks). They also exhibit a block in RBC maturation and abnormally high plasma unesterified-to-total cholesterol ratio (0.8) with associated abnormal lipoprotein morphology (lamellar/vesicular and stacked discoidal particles reminiscent of those in lecithin/cholesterol acyltransferase deficiency and cholestasis). Treatment …

Drug Eluting Stent: A Major Advance In Fighting Coronary Artery Restenosis, Yuk-Kong Lau

Journal of the Hong Kong College of Cardiology

Since the first use of coronary angioplasty in 1977, there have been major growth and development in percutaneous coronary intervention (PCI). Due to the advances in techniques, experiences, devices, and newer potent antiplatelet and antithrombotic medications, PCI is increasingly performed in highly complex and high risk patients with a reasonably low complication rate. Coupled with reduced discomfort, shorter hospital stay and recovery time, it has far outnumbered the volume of coronary artery bypass surgery. Currently, 1.7 million PCI procedures are performed annually worldwide with increases by 15-20% per year the last decade.

Is Dynamic Atrial Overdrive Pacing Anti-Arrhythmic Or Proarrhythmic: A Case Report, Ngai-Yin Chan, Miu-Fong Kwok, Chi-Chung Choy

Journal of the Hong Kong College of Cardiology

No abstract provided.

The Post-Madit Ii Era: Icd For All Post-Infarct Patients With Moderate To Severe Left Ventricular Dysfunction?, Kathy Lai-Fun Lee, Chu-Pak Lau

Journal of the Hong Kong College of Cardiology

Device therapy has become the preferred treatment for patients who have survived sudden cardiac death. Throughout the last decade, large-scale randomized clinical trials have provided consistent evidence on the clinical efficacy of device therapy. ICD is proven to be superior to anti-arrhythmic drugs in patients with structural heart diseases who suffer from haemodynamically significant ventricular arrhythmias. The role of ICD in primary prevention of sudden death in selected patients with coronary artery disease and left ventricular dysfunction is also widely established after the Multicenter Automatic Defibrillator Implant Trial (MADIT) and the Multicenter Unsustained Tachycardia Trial (MUSTT).

Role Of Signal-Averaged Ecg In Predicting Results Of Flecainide Provocation Test Used In Family Screening For Brugada Syndrome, Ngai-Shing Mok, Chi-Chung Choy, Ngai-Yin Chan, Amy Ho

Journal of the Hong Kong College of Cardiology

Brugada syndrome (BS) is an inherited arrhythmogenic disease with an autosomal dominant mode of inheritance. Flecainide provocation test (FPT) has been shown to be highly sensitive and specific in unmasking the Brugada ECG pattern in affected subjects. We sought to test if late potential (LP) in signal averaged electrocardiogram (SAECG) is helpful in predicting the results of FPT used in family screening for BS. The study included 17 asymptomatic Chinese subjects from 8 families (M:F 10:7, mean age 24.8±11.4 years) who have undergone family screening for BS. All screened subjects had a normal 12-lead ECG at baseline. None had structural …

Percutaneous Revascularisation In Diabetic Patients With Coronary Artery Disease, Wai-Hong Chen, Chu-Pak Lau

Journal of the Hong Kong College of Cardiology

Diabetic patients with coronary artery disease are associated with an unfavourable long-term outcome. Surgical revascularisation on top of medical therapy has been shown to confer survival benefit in patients with mutivessel and left main disease. With the emergence of the percutaneous approach of revascularisation, several clinical trials have been conducted to compare these two modalities of treatment. Consistent results were demonstrated in the diabetic subgroup that coronary artery bypass grafting is superior to balloon angioplasty in preventing late adverse cardiac event. With the advancement of percutaneous technique using coronary stenting as the predominant mode of catheter based revascularisation, the latest …

The Long-Term Clinical Prognosis In Patients With Anterior Wall And Non-Anterior Wall Acute Myocardial Infarction Referred To Primary Percutaneous Transluminal Coronary Angioplasty, Mingzhong Zhao, Dayi Hu, Tianchang Li, Sanqing Jia

Journal of the Hong Kong College of Cardiology

Objective: To investigate the long-term clinical prognosis in patients with anterior wall acute myocardial infarction (AW-AMI) and non AW-AMI (NAW-AMI) referred to primary percutaneous transluminal coronary angioplasty (P-PTCA). Methods: 287 patients with AMI who underwent P-PTCA were divided into AW-AMI group (142 cases) and NAW AMI group (145 cases) according to different sites of AMI. The baseline characteristics and coronary artery lesions of patients were analysed. The primary end points were in-hospital mortality and the major cardiovascular events (MACE) during a mean 17.3±9.8 months follow-up including the occurrences of non-fatal myocardial infarction, non-fatal congestive heart failure, revascularization of target vessels …

Appropriate Use Of Clopidogrel, Cyrus R Kumana, Bernard Man-Yung Cheung, Ij Lauder

Journal of the Hong Kong College of Cardiology

Clopidogrel (Plavix®) is an orally administered pro-drug, whose pharmacology and therapeutic role has been extensively reviewed in recent publications.1-5 In essence, it results in selective and irreversible antagonism of ADP-induced platelet aggregation. Such aggregation normally results in the surface expression of platelet glycoprotein (GP) IIb/IIIa receptors, which facilitate fibrinogen binding as well as consequential further platelet aggregation – the final common pathway of vascular occlusion. Specific cytochrome P450 enzymes are thought to generate the responsible active metabolite (believed to persist transiently). However, dosage adjustment is not recommended in hepatic impairment (unless severe) and drug-drug interactions and co-administration with meals are …

Mapping And Ablation Of Complex Cardiac Arrhythmia Guided By A Novel Three Dimensional Non-Contact Endocardial Activation Mapping System, Wing-Hong Fung, Chi-Kin Chan, Kam-Sang Woo, Wilson Wai-Man Chan

Journal of the Hong Kong College of Cardiology

Conventional cardiac activation mapping requires a sequentially-based method of positioning a catheter in contact with the endocardium to generate intracardiac electrograms at single points during sustained arrhythmia. Significant limitation of such point by point mapping may be encountered when applying to complex arrhythmia e.g. non-sustained arrhythmia or haemodynamically unstable arrhythmia. A novel non-contact mapping system (Ensite 3000 system) providing a three-dimensional simultaneous display of arrhythmia activation may offer a solution. The non-contact mapping system consists of a specially designed balloon catheter (Ensite EP catheter) with 64 insulated wires over the surface of the balloon for sensing electrical potentials on the …

The Use Of Wallstent And Smart Stents Incarotid Stent-Supported Angioplasty, Steven Siu-Lung Li

Journal of the Hong Kong College of Cardiology

In the endovascular approach of carotid stenosis treatment, stent-supported angioplasty is current state-of-the-art technique. Self-expandable stents are preferable to balloon-expandable stents due to the potential risk of deformation of the latter by external pressure. Wallstents and SMART stents are the more commonly used self-expandable stents. They appear to be of similar efficacy and safety but due to their different characteristics, their applications may be different according to different lesion characteristics.

Arrhythmogenic Right Ventricular Cardiomyopathy, Wing-Hong Fung, Chi-Kin Chan, John E. Sanderson

Journal of the Hong Kong College of Cardiology

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a familial form of cardiomyopathy predominantly affecting the right ventricle but may progress to involve the left ventricle as well. At the late stage of the disease, it is sometimes difficult to differentiate with other forms of dilated cardiomyopathy. In most affected families, the mode of inheritance of the disease is autosomal dominant. Lately, the gene accounting for the autosomal recessive form of ARVC, which was associated with palmoplantar keratosis, was identified. ARVC can present with sudden cardiac death without any preceding symptoms in the young population. Therefore, ARVC must be included in the …

Thrombolytic Therapy For Acute Myocardial Infarction In The Elderly, Bernard Bun-Lap Wong, Wai-Hong Chen

Journal of the Hong Kong College of Cardiology

Acute myocardial infarction (MI) is a leading cause of morbidity and mortality in developed countries. Patients ≥75 years constitute up to 30% of the acute MI population and are associated with a 50% in-hospital mortality. Thrombolytic therapy was shown in a metaanalysis of 9 largest randomized controlled trials to reduce 35-day mortality. However, the benefit was observed mainly among patients < 75 years old. For patients ≥ 75 years, the 35-day mortality was 24.3% in those treated with thrombolytic therapy and 25.3% in the placebo group, a difference not reaching statistical significance.

Brachytherapy In The New Millennium Abstracts, Jilin Chen, Runlin Gao, Qiangjun Cai, Yuejin Yang

Journal of the Hong Kong College of Cardiology

In order to examine long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA), coronary stenting and to assess the factors affecting its efficacy, 790 patients who underwent successful PTCA and PTCS+Stent in this Hospital were followed by direct interview or letter.