Cardiology Commons^™

Identification Of Critical Illness-Related Corticosteroid Insufficiency After Congenital Heart Surgery With Next Generation Sequencing, Juan S. Farias, Nicholas Diehl, Lori A. Erickson, Jenny Marshall, Nataliya Kibiryeva, Kelly S. Tieves, Jorge Cross-Bu, Jaime Silva-Gburek

Posters

Introduction: Critical illness-related corticosteroid insufficiency (CIRCI) which is characterized by relative inadequate cortisol levels in relation to increased demand during periods of severe stress is common after cardiac surgery and is a cause of hemodynamic instability. The purpose of this study was to identify possible genetic abnormalities related to CIRCI in pediatric patients after congenital heart surgery. Methods: Single-center retrospective study of neonates who underwent cardiac surgery between August 2018 to July 2020. We included patients who had obtained postoperative cortisol levels and next gen DNA-sequencing (NGS) as previous standard of care. Analysis methods are displayed in Figure 1. Results: …

An Unusual Cardiomegaly Culprit: Case Report Of A Hemodynamically Significant Portosystemic Shunt, Zoetta L. Mcloughlin Md, Melanie Kathol, Amanda Mcintosh

Posters

Background: Cardiomegaly discovered in the fetal or neonatal period may be the first sign of cardiac disease. However, the differential diagnosis for cardiomegaly with a structurally and functionally normal heart includes cardiomyopathies as well as non-cardiac etiologies, including extracardiac shunt lesions and vascular malformations, among others. Thus, unexplained cardiomegaly requires further investigation for extracardiac anomalies. In this case, we focus on an unusual etiology of diffuse cardiac dilatation – intrahepatic portosystemic shunt – that was initially misdiagnosed as dilated cardiomyopathy. Case Description: A 9-year-old male with history of learning difficulty and tall stature was seen for follow-up of diffuse cardiomegaly …

Multi-Disciplinary Collaboration And The Use Of Technology In The Reduction Of Cardiac Surgical Site Infections, Kelly Fehlhafer, Tiffany Mullen, Elizabeth Chang, Stacy Reynolds, Shannon Lysaught, Stephanie Doughty, Jessica Nichols

Posters

No abstract provided.

Predictive Value Of Syntax Ii Score In Patient With Acute Myocardial Infarction Complicated By Cardiogenic Shock: A Healthcare Network Based Study, Md Mashiul Alam, Sun-Joo Jang, Mohamed A. Badheeb, Mary Quien, Ju Young Bae, Ashraf Ahmed, Mark Samsky Md, Michael Nanna Md, Elliot Miller Md, Carlos D. Davila

Posters

The SYNTAX II score was designed to improve decision making between CABG and PCI.

Clinical correlation of SYNTAX II score in patients with AMI complicated by cardiogenic shock (AMI-CS) is investigated

Changes In Electrocardiographic And Cardiac Implantable Electronic Device Parameters Following Transcatheter Aortic Valve Replacement, Elizabeth Seeley, Luai Madanat, Nishaki Mehta

Posters

Transcatheter aortic valve replacement (TAVR) is known to cause conduction abnormalities leading to the need for permanent pacemaker implantation. However, the impact of TAVR-related conduction abnormalities on cardiac implantable electronic device (CIED) parameters in patients with preexisting devices is not known. We sought to investigate and describe changes in EKG and CIED parameters following TAVR in patients with preexisting CIEDs.

A Retrospective Review Of Catheter-Directed Therapy For Patients With Intermediate Risk Pulmonary Embolisms, Austin Lehew, Michael Tucciarone

Posters

Each year, hundreds of patients present to the William Beaumont hospital system with intermediate risk pulmonary embolisms (IRPE) with common symptoms of chest pain, shortness of breath, and hypoxia. Conventional treatments include anticoagulants alone, or a more aggressive approach with systemic thrombolytics which come with a higher risk of major bleeding and death. However, in the last few years, catheter-directed therapies (CDT) have been developed to mechanically remove clots in a minimally invasive fashion. The goal of this study is to determine the safety and efficacy of novel CDT at Beaumont Troy and Royal Oak.

Changes In Electrocardiographic And Cardiac Implantable Electronic Device Parameters Following Transcatheter Aortic Valve Replacement, Elizabeth Seeley, Luai Madanat, Nishaki Mehta

Posters

Transcatheter aortic valve replacement (TAVR) is known to cause conduction abnormalities leading to the need for permanent pacemaker implantation. However, the impact of TAVR-related conduction abnormalities on cardiac implantable electronic device (CIED) parameters in patients with preexisting devices is not known. We sought to investigate and describe changes in EKG and CIED parameters following TAVR in patients with preexisting CIEDs.

Pillow Cpr: Using A Low Resource Method To Teach Hands-Only Cpr To Hispanic Adolescents In A Community Setting, Benjamin Goldstein, Ekaterina Clark, Alan Silverman, Virginia Uhley

Posters

Hands-only Cardiopulmonary resuscitation (CPR) training for adolescents in community settings is often limited by training device availability. This pilot study’s objective was to investigate the feasibility, participant knowledge gains, and attitude changes through hands-only CPR training using a pillow for skill development.

A Metabolic, Mechanical, Multi-Organ Masterpiece: Dural Device Support Bridge To En-Bloc Heart-Liver Transplantation In Propionic Acidemia, Rebecca Juhl, Brian Birnbaum, Aliessa P. Barnes, William Gibson, Bhargava Mullapudi, Beth Lang, Megan Faseler, Daniel E. Heble, Victoria Urban, Ryan T. Fischer, Jennifer L. Gannon, David Sutcliffe

Posters

Introduction: Propionic Acidemia (PA) is a disorder related to abnormal protein and lipid metabolism resulting in progressive neurological injury and dilated cardiomyopathy (DCM). Interventions for PA and secondary disease manifestations can require multi-organ transplantation. Herein we report the case of a child with PA and end-stage DCM requiring left ventricular assist device (LVAD) support with eventual heart-liver transplant. Case Report: A 17 year old male diagnosed in childhood with PA developed chronically progressive DCM culminating in end stage heart failure with acute decompensations. In a recurrent admission, he progressed to require dual inotropic support and systemic anticoagulation for new LV …

An Unusual Cause Of Epicardial Coronary Artery Compression, Md Mashiul Alam, Michael Azrin, Muhammad Adeel

Posters

Atherosclerotic plaque rupture, embolization or dissection are the common causes of acute coronary artery occlusion. We present a case of iatrogenic external compression of right sided posterior descending artery (rPDA) by a chest tube.

Safety Profile Of Ultrasound Enhancing Agents In Echocardiography Across Yale New Haven Health System (Ynhhs), Md Mashiul Alam, Gini P. Jeyashanmugaraja, Robert L. Mcnamara Md, Evgeny Shkolnik

Posters

Ultrasound Enhancing Agents (UEAs) are increasingly used in echocardiography for delineation of endocardial border and detection of left ventricular (LV) thrombus with reported rate of serious adverse reactions from 0 to 0.029%. Contemporary utilization and safety data of UEA in echocardiography is scarce.

Cardiac Biomarkers In Differentiating Kawasaki Disease And Multisystem Inflammatory Syndrome In Children Associated With Covid-19, Mollie Walton, Geetha Raghuveer, K Kamakoti, N Dahdah, L Garrido, S Tierney, T Harris, M Khoury, M Hicar, E Braunlin, D Thacker, M Khare, F Dallaire, R Lowndes, I Glassmeyer, J Ballweg, G Goldenberg, S Merves, C Manlhiot, P Farid, Bw Mccrindle

Posters

Introduction – Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show considerable clinical overlap making differentiation challenging, particularly in the absence of evidence of evidence of prior COVID-19. Hypothesis – Cardiac biomarkers can differentiate KD from MIS-C. Methods – The International KD Registry enrolled n=2903 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 42 sites in 8 countries from January 2020 through July 2022. The study population was confined to 1489 MIS-C patients meeting CDC criteria with confirmed evidence of prior COVID-19 infection and 387 KD patients meeting AHA guideline criteria with confirmed evidence …

Impact Of Remote Monitoring During The Interstage Period On Outcomes In Single Ventricle Patients Across Socioeconomic Groups, Bianca Cherestal, Lori Erickson, Janelle R. Noel-Macdonnell, Girish S. Shirali, Hayley S. Hancock, Doaa Aly, Natalie Jayaram

Posters

Background: Despite improvements in outcomes over time, morbidity and mortality for infants with single ventricle (SV) heart disease remains high. Among other risk factors for mortality, infants of low socioeconomic status (SES) are known to be particularly vulnerable following stage 1 palliation. We sought to determine whether use of a novel remote monitoring program, CHAMP (Cardiac High Acuity Monitoring Program), mitigates differences in outcomes by SES for infants with SV during the interstage period. Methods: Using the CHAMP database, we identified 607infants across 11 institutions enrolled in the program between 2014–2021. All enrolled patients’ families were provided with a Windows-based …

Safety, Timing, And Outcomes Of Early Postoperative Cardiac Catheterization Following Congenital Heart Surgery, Karoline Krzywda, Jeremy Affolter, Darcie Al-Hassan, William Gibson, Ryan Romans, Kelly S. Tieves

Posters

Intro: Historically, early postoperative (<6weeks) cardiac catheterization (EPOCC) was considered high risk and often delayed. Recently, the safety of early postoperative cardiac catheterization has been demonstrated. The timing of catheterization in the struggling postoperative patient remains variable and optimal timing remains uncertain. There is limited data on the impact of EPOCC on outcomes such as length of stay, duration of mechanical ventilatory or extracorporeal support, and surgical or catheter- based interventions. The aim of this study was to describe our experience with EPOCC and its impact on management, length of stay, and duration of mechanical ventilatory support. Methods: This is a descriptive retrospective cohort study of patients who underwent cardiac surgery between 01/01/2010 and 12/31/2019 and cardiac catheterization within 30 days after surgery. Patients with catheterization for LA decompression on ECMO, endomyocardial biopsy, or BAS post hybrid procedure were excluded. We collected information surrounding timing, indication, and complications of catheterization, duration of mechanical ventilation/ECMO, and ICU/hospital LOS and compared these differences in patients who underwent EPOCC < 72hours (earlier) versus >72hours (later). Data was analyzed using IBM SPSS, version 28. Chi-square and Student’s t-test, or appropriate nonparametric tests were used to compare categorical and continuous variables, respectively. Results: There were 2542 surgeries performed during the study period with 167 patients undergoing cardiac catheterization within the defined 30 days. Twenty-six patients met exclusion criteria, leaving 141 patients for analyses. Median time from surgery to EPOCC was 10 days (1-30), with 26 patients(18.4%) having an earlier EPOCC. Interventions were performed in 70 patients (49.6%), not statistically different in those with earlier vs later EPOCC [n=9 (12.9%) vs …

Myocardial Work By Strain Echocardiography: A Predictor Of Exercise Capacity In The Fontan Population, Amulya Buddhavarapu, Suma Goudar, David A. White, Daniel Forsha, Doaa Aly

Posters

INTRODUCTION: Global myocardial work index (GWI) obtained by non-invasive pressure-strain loops is a fast-emerging tool to assess myocardial contractility, independent of loading conditions. Data about the feasibility and utility of this modality in single ventricles are still lacking. AIM: We aimed to explore the relationship between the non-invasive myocardial work indices and exercise parameters in the Fontan population. METHOD: Fontan patients were prospectively evaluated by exercise testing and echocardiography. The systemic ventricle was tracked in 3 orthogonal apical planes for global longitudinal strain (GLS). Pressure-strain loops were generated against brachial blood pressure (surrogate for ventricular systolic pressure in the absence …

Cardiorespiratory, Hemodynamic, And Perceived Exertion Responses To Seated Chair Exercise, Ryan Khemraj, Cristian Solano, Neesirg Patel, Roger Sacks

Posters

INTRODUCTION
The increasing prevalence of cardiovascular disease (CVD) and its sequelae in the United States population has led to escalating health care expenditures. To favorably modify cardiovascular outcomes, exercise physiologists have developed varied exercise programs that are associated with mortality reduction, symptom relief, improved exercise tolerance, favorable risk factor modification and improved psychosocial well-being. For patients with significant disability and deconditioning, chair-based exercise may provide an alternative method of achieving the relative cardioprotective benefits of traditional exercise.

Transcatheter Aortic Valve Replacement: Volume Impact On Length Of Stay And Readmissions, Alexander M. Balinksi, Patrick Karabon, Girish Pathangey, Amr E. Abbas

Posters

INTRODUCTION
TAVR is an alternative to surgery in patients with severe aortic stenosis. Procedural volume impacts mortality but little is known of its effect on length of stay (LOS) and readmissions. We sought to examine the impact of transcatheter aortic valve replacement (TAVR) procedural volume on trends in LOS and hospital readmission rates from 2012 to 2016.

Late Outcomes For Patients With Acute Chest Pain And Positive Fractional Flow Reserve By Computed Tomography, Zach Rollins, Jason Schott, Robert Safian

Posters

INTRODUCTION
Testing with fractional flow reserve derived from computed tomography (FFRCT) can be used to stratify otherwise indeterminate grade stenoses on cardiac computed tomography angiography (CCTA). Long-term clinical outcomes using FFRCT have been reported in stable heart disease but not for acute chest pain (ACP). This study analyzes clinical outcomes in patients with ACP who underwent FFRCT, including the risk of mortality, myocardial infarction (MI), invasive coronary angiography (ICA), and revascularization.

Does Aspirin Reduce Risk For Future Cardiovascular Events In Women With Diabetes?, Olivia Hillier, Amna Zeb, Pamela Marcovitz

Posters

INTRODUCTION
The use of low dose aspirin (LDA) in primary prevention of cardiovascular events (CVE) is no longer recommended due to lack of benefit in prevention of primary outcome and increased bleeding risks. It’s postulated that LDA could still be of benefit in those with very high vascular risk including diabetes mellitus (DM) as it confers a higher risk for future CVE in women as compared to men. We conducted a meta-analysis to determine if use of low dose ASA is beneficial to lower CVE in women with multiple risk factors.

Longitudinal Analysis Of Myocardial Function Using Strain In Patients Receiving Cardiotoxic Chemotherapy, Anmol Goyal, Amulya Buddhavarapu, Kayla Simpson, Nataliya Kibiryeva, Wendy Hein, Joy M. Fulbright, Sanket Shah

Posters

Background:

Chemotherapy-related cardiotoxicity (CTRC) is associated with significant morbidity and mortality in long-term cancer survivors. Left ventricular [LV] Global longitudinal strain (GLS) is a sensitive parameter that can be used for earlier detection of contractile function changes in these patients. Recent literature suggested certain genotypes may influence CTRC. Our goal was to assess longitudinal myocardial function and identify any correlation between certain genetic variations and LV function regarding CTRC in our pediatric population.

Methods:

50 subjects ≥10 years of age who have survived >2 years after completion of cancer treatment were enrolled out of which 29 subjects agreed for genetic …

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

Posters

Clinical Presentation:

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

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

All …

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

Posters

Clinical Presentation

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

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

Posters

Background

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

Methods

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

Congenital Mitral Valve Regurgitation, The Dilemma Of Repair Versus Replacement, Bianca Cherestal, Doaa Aly

Posters

Background: Congenital mitral regurgitation is a rare condition and can be challenging to manage when presenting in the neonatal period.

Case: Two week old male presented with poor weight gain, murmur and cardiomegaly on chest X-ray. Echocardiogram showed moderate to severe mitral regurgitation (MR) and suprasystemic pulmonary hypertension (PHN) (fig 1 a, b). The mitral valve (MV) leaflets were thickened and tethered with failure of central coaptation. PHN was classified as WHO I and II (due to persistent PHN of newborn and MR respectively). Inhaled nitric oxide, Enalapril and Furosemide were initiated. Cardiac catheterization revealed PVRi of 8.9 WU x …

Atrial Standstill In A Pediatric Patient With Scn5a Mutation Following Procainamide Challenge, Anmol Goyal, Lindsey Malloy-Walton, Christopher Follansbee

Posters

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

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

Constrictive Pericarditis After Repair Of A Ruptured Sinus Of Valsalva, Sarah Studyvin, Sanket Shah

Posters

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

Case: A 23-year-old male presented with severe exertional dyspnea one year after RSOV repair. Echocardiogram showed thickened pericardium, ventricular septal bounce (Fig 1A), left atrial enlargement, diastolic hepatic flow reversal (Fig 1B), and trivial mitral regurgitation without stenosis. He underwent cardiac catheterization, which revealed elevated filling pressures (RVEDP 16 mmHg, LVEDP 18 mmHg), RVEDP/RVSP ratio < 0.5, and a low cardiac index (1.65 L/min/m2). Cardiac MRI on the same day confirmed pericardial thickening (Fig D) with paradoxic septal motion, dilated pulmonary veins (Fig 1F) and retrograde flow in the SVC.

Decision‐making: Pericardiectomy of thickened and adherent pericardium was performed without the use of cardiopulmonary bypass. The central venous pressure decreased …

Not-So-Apparent Mixing Lesions: Late Presentation Of Cardioembolic Stroke, Amulya Buddhavarapu, Christopher Mathis, William Gibson, Sanket Shah

Posters

Background: Multiple levels of inter-atrial shunting can rarely present late in life with dyspnea and embolic stroke from effects of bidirectional shunting.

Case: A 55-year-old male with history of a patent foramen ovale, atrial fibrillation and embolic stroke presented with worsening fatigue and dyspnea at rest. Echocardiogram showed mildly reduced ventricular function with severe right heart dilation. On transesophageal echo, the coronary sinus (CS) was severely dilated with a persistent left superior vena cava (LSVC). A stress test showed no perfusion defects. CT angiography showed an absence of right SVC and a single LSVC connecting to the CS. There was …

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

Posters

Background: Adequate echocardiographic (echo) education is integral to successful cardiology training. Online education is proven to be effective in other specialties, but pediatric echo training data are lacking. Our aim was to design and assess the role of a novel online module-based curriculum to enhance pediatric cardiology fellows’ echo education.

Methods: Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. Content included high quality 2D and 3D echo clips (Fig 1A) as well as interactive quizzes (Fig 1B) and could be accessed from a phone, tablet, or computer. All fellows completed pre- and …

Prenatal Diagnosis Of An Uncommon Form Of A Hypoplastic Left Heart Syndrome Variant., Anmol Goyal, Kelsey Pinnick, Rita France, Maria Kiaffas

Posters

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

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

Decision‐making: Although critical aortic …

Subacute Thromboembolic Pulmonary Hypertension With Acute Clinical Worsening But Improving Ct Findings - A Case Reporrt, Doaa Aly, Alvin Singh, Pamela Finn, Kate Carp, Brian Birnbaum

Posters

ackground: • Subacute massive pulmonary embolism (PE) is associated with high mortality. • The subacute presentation makes it difficult to diagnose and older clots are less amenable to systemic thrombolysis. • This can result into increased likelihood of recurrence and thromboembolic pulmonary hypertension Case description: • 17-year-old, previously healthy male presented with a month of exertional dyspnea, initially misdiagnosed with asthma. • CT demonstrated diffuse PE on repeat presentation (Fig1). • Echocardiography demonstrated moderate to severe RV dilation and systolic dysfunction and suggested an RV systolic pressure of 73mmHg + RAP. • He was subsequently admitted to the ICU and …