Cardiology Commons^™

Acute Mitral Valve Regurgitation Caused By Left Ventricular Pacing Wire During Transcatheter Aortic Valve Replacement, Byeng-Ju Son, Ung Kim, Jong-Ho Nam, Kang-Un Choi, Jong-Il Park, Jang-Won Son

The Texas Heart Institute Journal

Transcatheter aortic valve replacement is quickly becoming the standard of care for patients with severe aortic stenosis thanks to its minimally invasive nature and favorable outcomes. Recently, left ventricular pacing has been proposed as a safer alternative to traditional right heart pacing, which could simplify the transcatheter aortic valve replacement procedure overall, although procedural complications may still occur. This report describes a rare case of left ventricular pacing wire-induced acute severe mitral valve regurgitation during transcatheter aortic valve replacement.

Ischemic Evaluation And Revascularization In Patients Presenting With Advanced Atrioventricular Block Without Concomitant Acute Myocardial Infarction, Jasmeet Kalsi, John Suffredini, June K Pickett, Mahboob Alam, Waleed Kayani, Xiaoming Jia

The Texas Heart Institute Journal

No abstract provided.

An Unusual Case Of Cardiogenic Shock: Coronary Artery Vasospasms, Amanda Bergeron, Maks Mihalj

Journal of Shock and Hemodynamics

Coronary artery vasospasms may occur in one or multiple coronary arteries, typically causing transient chest pain or angina. Although rare, it can lead to lethal cardiac arrhythmias, cardiac arrest, or cardiogenic shock and is often misdiagnosed. We report a case of a young man with an atypical presentation of generalized coronary vasospasm leading to cardiac arrest and subsequent cardiogenic shock. The patient required support with veno-arterial extracorporeal membrane oxygenation and Impella. We discuss the risk factors, diagnosis, and treatment of this rare condition.

Endocarditis: A Review Of Recent Literature, Scott Dale, Zaid Tayyem, Steven Maceyko

Jefferson Hospital Staff Papers and Presentations

Purpose of Review

Endocarditis remains a challenging diagnosis, with significant implications for early identification and initiation of therapy. In this review, we examine the evolution in the epidemiology and presentation of infectious endocarditis (IE), the role of new diagnostic tools, and the approach to therapy.

Recent Findings

Staphylococcus and Streptococcus species remain the most common causative organisms, but the prevalence of IE caused by enterococcus and non-HACEK organisms is increasing. While newer antibiotics such as dalbavancin have shown promise, treatment must still be tailored on an individual basis. Evidence suggests that antibiotic prophylaxis to prevent IE be limited to high-risk …

Real-World Outcomes For The Fifth-Generation Balloon Expandable Transcatheter Heart Valve In The United States., Curtiss T Stinis, Amr E Abbas, Paul Teirstein, Raj R Makkar, Christine J Chung, Vijay Iyer, Philippe Généreux, Robert M Kipperman, John K Harrison, G Chad Hughes, Jefferson M Lyons, Ayaz Rahman, Nikolaos Kakouros, Jennifer Walker, David K Roberts, Pei-Hsiu Huang, Biswajit Kar, Abhijeet Dhoble, Daniel P Logsdon, Puneet K Khanna, Joseph Aragon, James M Mccabe

Heart and Vascular Articles

BACKGROUND: The fifth-generation SAPIEN 3 Ultra Resilia valve (S3UR) incorporates several design changes as compared with its predecessors, the SAPIEN 3 (S3) and SAPIEN 3 Ultra (S3U) valves, including bovine leaflets treated with a novel process intended to reduce structural valve deterioration via calcification, as well as a taller external skirt on the 29-mm valve size to reduce paravalvular leak (PVL). The clinical performance of S3UR compared with S3 and S3U in a large patient population has not been previously reported.

OBJECTIVES: The aim of this study was to compare S3UR to S3/S3U for procedural, in-hospital, and 30-day clinical and …

How We Heal Little Hearts: The Piccolo Procedure Explained, Rania Habib, Toby A. Rockefeller

Transformational Pediatrics Podcast

The Piccolo device is an innovative and minimally invasive way to close the Patent ductus arteriosus (PDA) in pediatrics. Dr. Rockefeller talks about how the Piccolo came to fruition, the benefits, and what else is on the horizon for the PDA closure world.

Successful Percutaneous Thoracic Duct Embolization For Chylothorax After Total Arch Replacement, Fumihiro Kitashima, Naohiro Shimada, Yojiro Machii, Masashi Tanaka

The Texas Heart Institute Journal

Chylothorax after cardiac surgery is a rare complication associated with severe morbidity and mortality. This report documents successful treatment with percutaneous thoracic duct embolization for chylothorax after total arch replacement. A 69-year-old man underwent replacement of the aortic arch to treat a ruptured aortic aneurysm. After surgery, the left thoracic drain discharged 2,000 to 3,000 mL serosanguineous fluid per day, even though the patient took nothing orally and was administered subcutaneous octreotide therapy. On postoperative day 9, percutaneous thoracic duct embolization was performed, and the drain could be removed. The chylothorax did not recur, and the patient was discharged on …

Restoring Effective Sleep Time In Post Cardiac Surgery Patients: A Quality Improvement Project, Brooke Watts Bsn, Rn

Epsilon Sigma at-Large Research Conference

Purpose: Restoring Effective Sleep Time in Post Cardiac Surgery Patients: A Quality Improvement Project

Brooke Watts, BSN, RN, DNP Student, Murray State University

Dr. Kristin Reid, DNP, APRN, ACNS-BC, DNP Program Director/Assistant Professor Murray State University

Aims: This quality improvement project was developed using DNP project guidelines provided through Murray State University and was designed to improve sleep in hospitalized cardiac surgery patients.

Processes: IRB approval was obtained from the healthcare institution and academic institution. This two-phase quality improvement project was designed to analyze the effects of a change in normalized hospital routines on self-reported sleep in post-cardiac surgery patients. …

Electromechanical Dissociation Of Atria After Cardioversion- Clinical Case And Management Considerations., Devi Parvathy Jyothi Ramachandran Nair, Muhammad Umer Riaz Gondal, Muhammad Asad Hanif, Raesham Bukhari, Nayab Mirza, Rajesh Reddy

Tower Health Research Day

No abstract provided.

A Case Of Rare Primary Cardiac Tumor - Left Atrial Hemangioma, Nimesh Khanal Md, Prem Parajuli Md, Bharosha Bhattarai Mbbs, Nensi Shah Mbbs, Bidhya Timilsina Md, Robert Dendall Do

Tower Health Research Day

No abstract provided.

Swiss Cheese Heart: A Tale Of Multiple Valve Perforations, Hussam Al Hennawi, Shayan I. Khan, Aamna Khan, Usama Sadiq, Sung-Hae Cho

Abington Jefferson Health Papers

Gerbode defect, an anomalous connection between the left ventricle and right atrium, is often congenital but can be acquired or iatrogenically formed. We present an exceedingly rare case of this defect associated with multiple valve perforation in an otherwise healthy patient with bicuspid aortic valve and endocarditis.

Pulmonary Vein Isolation With Or Without Left Atrial Appendage Ligation In Atrial Fibrillation: The Amaze Randomized Clinical Trial., Dhanunjaya R Lakkireddy, David J Wilber, Suneet Mittal, David Tschopp, Christopher R Ellis, Abdi Rasekh, Troy Hounshell, Rudy Evonich, Sheetal Chandhok, Ronald D Berger, Rodney Horton, Michael H Hoskins, Hugh Calkins, Steven J Yakubov, Pamela Simons, Benjamin R Saville, Randall J Lee

Heart and Vascular Articles

IMPORTANCE: Left atrial appendage elimination may improve catheter ablation outcomes for atrial fibrillation.

OBJECTIVE: To assess the safety and effectiveness of percutaneous left atrial appendage ligation adjunctive to catheter pulmonary vein isolation for nonparoxysmal atrial fibrillation.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective, open-label, randomized clinical trial evaluated the safety and effectiveness of percutaneous left atrial appendage ligation adjunctive to planned pulmonary vein isolation for nonparoxysmal atrial fibrillation present for less than 3 years. Eligible patients were randomized in a 2:1 ratio to undergo left atrial appendage ligation and pulmonary vein isolation or pulmonary vein isolation alone. Use of a …

Association Of Multiple Metabolic And Cardiovascular Markers With The Risk Of Cognitive Decline And Mortality In Adults With Alzheimer’S Disease And Ad-Related Dementia Or Cognitive Decline: A Prospective Cohort Study, Longjian Liu, Edward Gracely, Xiaopeng Zhao, Gediminas Gliebus, Nathalie May, Stella Volpe, Jingyi Shi, Rose Ann Dimaria-Ghalili, Howard Eisen

Division of Cardiology Faculty Papers

BACKGROUND AND OBJECTIVES: There is a scarcity of data stemming from large-scale epidemiological longitudinal studies focusing on potentially preventable and controllable risk factors for Alzheimer's disease (AD) and AD-related dementia (ADRD). This study aimed to examine the effect of multiple metabolic factors and cardiovascular disorders on the risk of cognitive decline and AD/ADRD.

METHODS: We analyzed a cohort of 6,440 participants aged 45-84 years at baseline. Multiple metabolic and cardiovascular disorder factors included the five components of the metabolic syndrome [waist circumference, high blood pressure (HBP), elevated glucose and triglyceride (TG) concentrations, and reduced high-density lipoprotein cholesterol (HDL-C) concentrations], C-reactive …

Cardiogpt: An Ecg Interpretation Generation Model, Guohua Fu, Jianwei Zheng, Islam Abudayyeh, Chizobam Ani, Cyril Rakovski, Louis Ehwerhemuepha, Hongxia Lu, Yongjuan Guo, Shenglin Liu, Huimin Chu, Bing Yang

Mathematics, Physics, and Computer Science Faculty Articles and Research

Numerous supervised learning models aimed at classifying 12-lead electrocardiograms into different groups have shown impressive performance by utilizing deep learning algorithms. However, few studies are dedicated to applying the Generative Pre-trained Transformer (GPT) model in interpreting electrocardiogram (ECG) using natural language. Thus, we are pioneering the exploration of this uncharted territory by employing the CardioGPT model to tackle this challenge. We used a dataset of ECGs (standard 10s, 12-channel format) from adult patients, with 60 distinct rhythms or conduction abnormalities annotated by board-certified, actively practicing cardiologists. The ECGs were collected from The First Affiliated Hospital of Ningbo University and Shanghai …

Antisense Oligonucleotide Targeting Hepatic Serum Amyloid A Limits The Progression Of Angiotensin Ii-Induced Abdominal Aortic Aneurysm Formation, Preetha Shridas, Ailing Ji, Andrea C. Trumbauer, Victoria P. Noffsinger, Luke W. Meredith, Frederick C. De Beer, Adam E. Mullick, Nancy R. Webb, Dennis G. Karounos, Lisa R. Tannock

Saha Cardiovascular Research Center Faculty Publications

Background and aims: Obesity increases the risk for abdominal aortic aneurysms (AAA) in humans and enhances angiotensin II (AngII)-induced AAA formation in C57BL/6 mice. We reported that deficiency of Serum Amyloid A (SAA) significantly reduces AngII-induced inflammation and AAA in both hyperlipidemic apoE-deficient and obese C57BL/6 mice. The aim of this study is to investigate whether SAA plays a role in the progression of early AAA in obese C57BL/6 mice.

Methods: Male C57BL/6J mice were fed a high-fat diet (60% kcal as fat) throughout the study. After 4 months of diet, the mice were infused with AngII until the end …

Innominate Artery Pseudoaneurysm From A Salter-Harris Fracture Of The Sternoclavicular Joint, Emily Y Fan, Santiago Abrill Zegarra, Jennifer Walker, Errol Mortimer, Jessica P Simons

Faculty, Staff and Student Publications

Fractures and dislocations of the sternoclavicular joint (SCJ) are uncommon, accounting for <5% of all shoulder girdle injuries. They are relatively more common in the pediatric population than in the adult population and can often present concurrently as a posteriorly displaced medial clavicular dislocation with a fracture through the unfused physis. It is especially important to recognize this injury, because its management and potential sequelae are very different from those for fractures of the clavicle shaft. This type of injury frequently requires closed or open operative management because fracture-dislocation of the SCJ can be associated with potentially serious complications such as pneumothorax, brachial plexus injury, vagus nerve injury, tracheal injury, and vascular compromise. Few case reports describe fracture-dislocation of the SCJ resulting in vascular injuries. We describe the case of a 17-year-old boy who sustained a blunt hockey injury resulting in a right physeal fracture-dislocation of the SCJ causing an innominate artery pseudoaneurysm. This was treated with excision of the pseudoaneurysm, bovine pericardial patch angioplasty repair of the innominate artery, and open reduction and internal fixation of the medial clavicular physeal fracture.

Prediction Of Cardiovascular Risk Factors From Retinal Fundus Photographs: Validation Of A Deep Learning Algorithm In A Prospective Non-Interventional Study In Kenya, Tom White, Viknesh Selvarajah, Fredrik Wolfhagen, Nils Svangård, Gayathri Mohankumar, Peter Fenici, Kathryn Rough, Nelson Onyango, Mansoor Saleh, Innocent Abayo

Haematology and Oncology, East Africa

Aim: Hypertension and diabetes mellitus (DM) are major causes of morbidity andmortality, with growing burdens in low-income countries where they are underdiag-nosed and undertreated. Advances in machine learning may provide opportunities toenhance diagnostics in settings with limited medical infrastructure.

Materials and Methods: A non-interventional study was conducted to develop andvalidate a machine learning algorithm to estimate cardiovascular clinical and labora-tory parameters. At two sites in Kenya, digital retinal fundus photographs were col-lected alongside blood pressure (BP), laboratory measures and medical history. Theperformance of machine learning models, originally trained using data from the UKBiobank, were evaluated for their ability to estimate …

Simplifying Transcatheter Tricuspid Valve Replacement With 3-Dimensional Intracardiac Echocardiography., Carlos E Sanchez, Steven J Yakubov

Heart and Vascular Articles

Transcatheter tricuspid valve replacement (TTVR) offers the potential for improved outcomes for the significant number of patients with severe tricuspid valve regurgitation relative to current treatment options. Imaging is a critical component of the success of this procedure. Here we describe strategies and techniques for the use of 3-dimensional intracardiac echocardiography as an adjunct to standard transesophageal echocardiography during TTVR procedure.

The Time Is Now For Vascular Medicine, Heather L Gornik, Raghu Kolluri, Herbert Aronow, Bruce Gray, Geno Merli, Ido Weinberg, Joshua A Beckman

Heart and Vascular Articles

No abstract provided.

Clinical Care For Life's Essential 8 By Medical Specialty In The United States, An Observational Cohort Study., Michael E Johansen, Madeline R Sterling, Jeremy B Sussman

Heart and Vascular Articles

No abstract provided.

Effect Of Perioperative Stroke On Survival After Carotid Intervention, Tommaso Cambiaghi, Alexander Mills, Samuel Leonard, Regina Husman, Syed T Zaidi, Ezra Y Koh, Kourosh Keyhani, S Keisin Wang

Faculty, Staff and Student Publications

OBJECTIVES: Perioperative stroke is the most dreaded complication of carotid artery interventions and can severely affect patients' quality of life. This study evaluated the impact of this event on mortality for patients undergoing interventional treatment of carotid artery stenosis with three different modalities.

METHODS: Patients undergoing carotid revascularization at participating Memorial Hermann Health System facilities were captured from 2003-2022. These patients were treated with either carotid endarterectomy (CEA), transfemoral carotid stenting (TF-CAS), or transcarotid artery revascularization (TCAR). Perioperative outcomes, including stroke and mortality, as well as follow-up survival data at 6-month intervals, were analyzed and stratified per treatment modality.

RESULTS: …

Transcatheter Electrosurgical Septotomy Technique For Chronic Postdissection Aortic Aneurysms, Aidin Baghbani-Oskouei, Safa Savadi, Thomas Mesnard, Titia Sulzer, Aleem K Mirza, Shadman Baig, Carlos H Timaran, Gustavo S Oderich

Faculty, Staff and Student Publications

Aortic dissection often results in chronic aneurysmal degeneration due to progressive false lumen expansion. Thoracic endovascular aortic repair and other techniques of vessel incorporation such as fenestrated-branched or parallel grafts have been increasingly used to treat chronic postdissection aneurysms. True lumen compression or a vessel origin from the false lumen can present considerable technical challenges. In these cases, the limited true lumen space can result in inadequate stent graft expansion or restrict the ability to reposition the device or manipulate catheters. Reentrance techniques can be used selectively to assist with target vessel catheterization. Transcatheter electrosurgical septotomy is a novel technique …

Open Repair With Latissimus Muscle Flap Coverage For Treatment Of Infected Thoracic Endovascular Aneurysm Repair, Lucas Ribé Bernal, Rana O Afifi, Anthony L Estrera

Faculty, Staff and Student Publications

A male patient, 70 years of age, was evaluated for an infected thoracic endovascular aneurysm repair (TEVAR). After presenting with persistent fever, a positron emission tomography scan found an infected aortic stent graft. The patient underwent open repair with explantation of the infected TEVAR, extensive periaortic debridement, graft replacement with a Dacron graft, and complete coverage with a latissimus dorsi muscle flap. Tissue culture revealed

Congenital Disseminated Malignant Rhabdoid Tumor Mimicking A Vascular Lesion, Scott K Wang, Prabhath Mannam, Katerina Dukleska, Fabiola Balarezo

Faculty, Staff and Student Publications

A congenital disseminated malignant rhabdoid tumor (MRT) is an exceedingly rare and aggressive pediatric cancer marked by the presence of malignant rhabdoid cells in various organs, including the brain, kidneys, and soft tissues, at birth. It is often detected prenatally or shortly post-birth. The malignancy's aggressiveness results in a bleak prognosis, offering limited treatment options and low survival rates. Early diagnosis and comprehensive medical intervention are crucial, but managing this condition is complicated by its rarity. We herein presented a case of a 37 and 1/7 week gestation male infant with a rapidly growing arm soft tissue mass within two …

Definition Of Polypharmacy In Heart Failure: A Scoping Review Of The Literature, Keshav Patel, Jorge A Irizarry-Caro, Adil Khan, Travis Holder, Darrell Salako, Parag Goyal, Min Ji Kwak

Faculty, Staff and Student Publications

Patients with heart failure (HF) have a high prevalence of polypharmacy, which can lead to drug interactions, cognitive impairment, and medication non-compliance. However, the definition of polypharmacy in these patients is still inconsistent. The aim of this scoping review was to find the most common definition of polypharmacy in HF patients. We conducted a scoping review searching Medline, Embase, CINAHL, and Cochrane using terms including polypharmacy, HF and deprescribing, which resulted in 7,949 articles. Articles without a definition of polypharmacy in HF patients and articles which included patients < 18 years of age were excluded; only 59 articles were included. Of the 59 articles, 49% (n = 29) were retrospective, 20% (n = 12) were prospective, 10% (n = 6) were cross-sectional, and 27% (n = 16) were review articles. Twenty percent (n = 12) of the articles focused on HF with reduced ejection fraction, 10% (n = 6) focused on HF with preserved ejection fraction and 69% (n = 41) articles either focused on both diagnoses or did not clarify the specific type of HF. The most common cutoff for polypharmacy in HF was five medications (59%, n = 35). There was no consensus regarding the inclusion or exclusion of over-the-counter medications, supplements, or vitamins. Some newer studies used a cutoff of 10 medications (14%, n = 8), and this may be a more practical and meaningful definition for HF patients.

Successful Extravascular Implantable Cardioverter-Defibrillator Implantation In A Patient With Recurrent Transvenous Implantable Cardioverter-Defibrillator Erosion., Andrea Robinson, Sreedhar Billakanty, Eugene Fu, Anish Amin

Heart and Vascular Articles

No abstract provided.

Atrial Fibrillation Symptom Reduction And Improved Quality Of Life Following The Hybrid Convergent Procedure: A Converge Trial Subanalysis., Jaswinder Gill, Karl J Crossen, Christopher Blauth, Faraz Kerendi, Saumil R Oza, Anthony R Magnano, Mark A Mostovych, Michael E Halkos, David Tschopp, Jose Osorio, Paul Tabereaux, William Boedefeld, Kenneth Civello, Syed Ahsan, John Yap, Sreedhar Billakanty, Steve Duff, Otto Costantini, Eric Espinal, Andy Kiser, Christian Shults, David Pederson, James Garrison, David M Gilligan, Michael G Link, Marcin Kowalski, Christopher Stees, Jason S Sperling, Israel Jacobowitz, Felix Yang, Yisachar J Greenberg, David B De Lurgio

Heart and Vascular Articles

BACKGROUND: CONVERGE was a prospective, multicenter, randomized controlled trial that evaluated the safety of Hybrid Atrial Fibrillation Convergent (HC) and compared its effectiveness to endocardial catheter ablation (CA) for the treatment of persistent atrial fibrillation (PersAF) and longstanding PersAF (LSPAF). In 2020, we reported that CONVERGE met its primary safety and effectiveness endpoints. The primary objective of the present study is to report CONVERGE trial results for quality of life (QOL) and Class I/III anti-arrhythmic drug (AAD) utilization following HC.

METHODS: Eligible patients had drug-refractory symptomatic PersAF or LSPAF and a left atrium diameter ≤6.0 cm. Enrolled patients were randomized …

Evaluation Of Vascular Aging On Measures Of Cardiac Function And Mechanical Efficiency: Insights From, Lawrence J Mulligan, Julian Thrash, Ludmil Mitrev, Douglas Folk, Alyssa Exarchakis, Daniel Ewert, Jeffrey C Hill

Cooper Medical School of Rowan University Departmental Research

INTRODUCTION: This study evaluated the hypothesis that vascular aging (VA) reduces ventricular contractile function and mechanical efficiency (ME) using the left ventricular pressure-volume (PV) construct.

METHODS: A previously published in-silico computational model (CM) was modified to evaluate the hypothesis in two phases. In phase I, the CM included five settings of aortic compliance (CA) from normal to stiff, studied at a heart rate of 80 bpm, and phase II included the normal to stiff CA settings evaluated at 60, 100, and 140 bpm. The PV construct provided steady-state and transient data through a simulated vena caval occlusion (VCO). …

Nonpharmacologic Rate Control Of Postoperative Atrial Fibrillation In The Canine Sterile Pericarditis Model, Seungyup Lee, Don Wallick, Celeen Khrestian, Dragan Juzbasich, Daniel Laurita, Gregory Rushing, Jayakumar Sahadevan

Faculty Scholarship

Introduction: Postoperative atrial fibrillation (POAF) is common following open heart surgery, and is associated with significant morbidity. Medications used for ventricular rate control of POAF may not be effective in controlling rapid ventricular rates during the postoperative period because of increased sympathetic tone. The purpose of this study was to develop nonpharmacologic rate control of POAF by atrioventricular node (AVN) fat pad stimulation using clinically available temporary pacing wires in the canine sterile pericarditis model. Methods: We studied 10 sterile pericarditis dogs in the closed-chest state on postoperative days 1−3. The AVN fat pad stimulation (amplitude 2–15 mA; frequency 20 …

“This Ekg Is Concerning For Ischemia!”, Muhammad M. Zafar

Transformative Medicine

No abstract provided.