Cardiology Commons^™

Atrial Pacing In Wide-Complex Rhythm, Yang Yang, John Allison, Mark Pollet, Yochai Birnbaum

The Texas Heart Institute Journal

No abstract provided.

Infective Endocarditis Caused By Klebsiella Oxytoca In A Patient With Hemodialysis: A Care-Compliant Case Report And Review Of The Literature, Hanane Aissaoui, Youssef Hdidou, Ramia Bougrine, Nabila Ismaili, Noha Elouafi

Journal of the Saudi Heart Association

The rarity of endocarditis due to Klebsiella species limits its recognition. We report the case of a 63-year-old man, known to have a tight calcified aortic stenosis presenting with acute heart failure associated with high fever. Klebsiella oxytoca endocarditis was diagnosed based on three sets of positive blood cultures together with fluttering vegetation (11 mm x 14 mm) on the middle segment of the anterior leaflet of the mitral valve. After 6 weeks of intravenous ceftriaxone and gentamicin bi-therapy, the patient had completely recovered. This case illustrates how sporadic this condition is, for which early assessment and proper treatment are …

Bad Heart Luck: Myocardial Infarction Related To Iatrogenic Coronary Cameral Fistula In A Heart Transplant Patient, Badre El Boussaadani, Zakaria Raiss, Amine Qat, Pascal Goube

Journal of the Saudi Heart Association

Endomyocardial biopsy (EMB) remains the gold standard method for diagnosis of cardiac allograft rejection. Complications following EMB rarely occur, however, it can lead to coronary cameral fistulae (CCF). We describe the case of a 65-year-old patient admitted for lateral STEMI related to a fistula communicating the distal part of the left anterior descending artery (LAD) with the right ventricle after EMB biopsy, which was incompletely closed with a covered stent.

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Assessment Of Left Ventricular Mechanics In Patients With Severe Aortic Stenosis After Transcatheter Aortic Valve Implantation: 2-D Speckle Tracking Imaging Study, Hesham A. Naeim, Reda Abuelatta, Faisal O. Alatawi, Lamiaa Khedr

Journal of the Saudi Heart Association

Background: Chronic pressure overload secondary to severe aortic stenosis causes impairment of left ventricular myocardial deformation and associated with adverse outcome. The present study aimed to assess the response of myocardial mechanics after transcatheter aortic valve implantation (TAVI).

Methods: Assessment of myocardial mechanics by quantification of LV longitudinal, circumferential strain and rotational deformation (apical, basal rotation and twist) by 2-D Speckle-tracking echocardiography at baseline and at midterm follow-up post-TAVI. The patients were divided into 2 groups based on baseline left ventricular ejection fraction. 46 patients had preserved LV EF ≥50% preserved ejection fraction (PEF) and 34 patients had reduced left …

Impact Of Ramadan Fasting On Biochemical And Exercise Parameters Among Patients Undergoing Exercise-Based Cardiac Rehabilitation, Hazem Khorshid, Adel Shabana, Osama Rifaie, Yasser Abdellatif

Journal of the Saudi Heart Association

Background: Ramadan fasting is an important worship activity for Muslims. It is not known if fasting could have deleterious effect on cardiac patients joining cardiac rehabilitation (CR) program, especially during summer season.

Aim: To assess the effect of Ramadan fasting on biochemical and exercise parameters among patients undergoing 12- week exercise-based CR program. Patients and methods: 53 patients joining CR program in university hospital were included in the study. The patients were divided into two groups according to their Ramadan fasting status. Fasting group included 32 patients, while nonfasting group included 21 patients. All patients underwent supervised exercise-based CR during …

Percutaneous Coronary Interventions In Chronic Total Occlusion - Profile, Technique And Outcome -The Malabar Experience, Desabandhu Vinayakumar, Madhusudan Pramod Raikar, Kurukkanparampil Sreedharan Mohanan

Journal of the Saudi Heart Association

Introduction: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) remains a challenge. The reasons being that these procedures may be lengthy and complex, with elevated radiation exposure, increased contrast load, lower procedural success rate, and a higher risk of complication when compared with non-CTO elective PCI. Clarifying the long-term clinical outcomes of CTO-PCI is very important to justify potential investments in training and technology. However, there is a paucity of data from Indian subcontinent. Hence we decided to report the outcomes from a real-life cohort of consecutive patients undergoing elective PCI for CTO at our institution.

Materials and methods: …

Characterizing Recurrence Following Hybrid Ablation In Patients With Persistent Atrial Fibrillation, David C. Kress, Lynn Erickson, Tadele W. Mengesha, David Krum, Jasbir Sra

Journal of Patient-Centered Research and Reviews

Purpose: It is It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF.

Methods: Patients with persistent AF (N = 108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of …

Percutaneous Intervention Or Bypass Graft For Left Main Coronary Artery Disease? A Systematic Review And Meta-Analysis, Waqas Ullah, Yasar Sattar, Irfan Ullah, Ammu Susheela, Maryam Mukhtar, M Chadi Alraies, Mamas A Mamas, D L Fischman

Abington Jefferson Health Papers

Background: The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial.

Methods: Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR).

Results: A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42-0.76;

Conclusion: PCI might offer early safety advantages, while CABG provides greater …

Efficacy Of Manual Hemostasis For Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal, Rajiv Tayal, Michael Divita, Christoph W. Sossou, Alexis K. Okoh, Kelly Stelling, James M. Mccabe, Amir Kaki, Najam Wasty, David A. Baran

School of Medicine Faculty Research

Background. The prevalence of peripheral vascular disease has led to the re-emergence of percutaneous axillary vascular access as a suitable alternative access site to femoral artery. We sought to investigate the efficacy and safety of manual hemostasis in the axillary artery. Methods. Data were collected from a prospective internal registry of patients who had a Maquet® (Rastatt, Germany) Mega 50 cc intra-aortic balloon pumps (IABP) placed in the axillary artery position. They were anticoagulated with weight-based intravenous heparin to maintain an activated partial thromboplastin time (aPTT) of 50-80 seconds. Anticoagulation was discontinued 2 hours prior to the device explantation. Manual …

Coronary Artery Ectasia With Acute Myocardial Infarction, A Case Report, Maysan Mohammed Almegbel, Fawaz Qabel Almutairi

Journal of the Saudi Heart Association

Coronary artery ectasia (CAE), also known as aneurysmal coronary artery disease, is defined as an abnormal diffuse (ectasia) or segmental (aneurysmal) dilatation of any branch of the coronary arteries. It is a well-recognized entity with 1.2-4.9% prevalence. Our case is a 46year old male with no prior medical problem who presented to the ER with inferior ST elevation myocardial infarction (STEMI). The Coronary angiogram revealed multiple ectatic segments in the right coronary artery (RCA) with 100% stenosis in the middle segment. Upon wiring the RCA a big clot burden was noted on the ectatic segment. We planned to keep him …

Post Myocardial Infarction Papillary Muscle Rupture In The Context Of Coronavirus Disease-2019 Pandemic, Nooraldaem Yousif, Vinayak Vadgaonkar, Helen Saunders, Mohammad Amin, Habib Tareif, Fuad Abdulqader

Journal of the Saudi Heart Association

Papillary muscle rupture is a very rare but often catastrophic complication of acute myocardial infarction. In this case we are sharing our experience in the context of the current COVID-19 pandemic, which rendered the management extremely challenging.

Giant Ascending Aortic Aneurysm With Painless Dissection In A Patient With Marfan Syndrome, Khaled D. Algarni, Amr A. Arafat, Adam I. Adam, Claudio Pragliola

Journal of the Saudi Heart Association

A female patient aged 17 years old presented with dyspnea grade III with no chest pain. The patient has Marfan Syndrome, and there was a history of mitral valve repair six years ago. Echocardiography showed an ejection fraction of 55%, severe aortic regurgitation, dilatation of the ascending aorta, and moderate tricuspid regurgitation. CT scan showed an ascending aortic aneurysm (92 mm in its maximum diameter) with dissection flap (Figure 1A and B). We performed a Bentall operation with an axillary cannulation (Figure 1C). The postoperative course was complicated with bleeding requiring re-exploration, and the patient was discharged with stable hemodynamics …

The Echocardiography Society Of Saudi Heart Association Recommendation On Quality And Laboratory Accreditation Guideline And Standards, Abdulhalim Jamal Kinsara, Sami Ghazal, Ahmad S. Omran, Esra Aleid

Journal of the Saudi Heart Association

Objective: To create the Saudi Arabian Society of Echocardiography Accreditation Commission Guidelines and Standards.

Method: A review of available the North American and European accreditation guidelines was conducted and a model, locally appropriate for Saudi echocardiography laboratories and applicable in the current settings, was developed.

Results: The document specifies the organizational setting as well as the following categories of personnel: medical director, technical director, medical staff, and technical staff. The guideline team also examined aspects related to the facility and the facility safety policies and protocols. Examination and procedural issues for Adult transthoracic echocardiography including instrumentation, archiving media, examination interpretation …

Atrial High-Rate Episodes, Subclinical Atrial Fibrillation And Short-Duration Clinical Atrial Fibrillation: Different Names For The Same Arrhythmia Or A New Player On The Pitch?, Juan Benezet-Mazuecos, Alvaro Lozano Rosado, Julian Crosa, Jose Antonio Iglesias

Journal of the Saudi Heart Association

No abstract provided.

Infected Coronary Artery Aneurysm - A Rare But Fatal Complication Of Percutaneous Coronary Intervention, Ajit Pal Singh, Harnoor Singh Pruthi

Journal of the Saudi Heart Association

A 43 year old male underwent successful Percutaneous Coronary Intervention (PCI) to LCX. 3 months after the procedure, he presented with NYHA class III-IV angina associated with low grade fever and reduced appetite. Biochemical parameters including complete blood count and renal function tests were normal. ECG showed ST segment depression in lateral leads. Echocardiography showed lateral wall hypokinesia with moderate Mitral valve regurgitation. Coronary angiogram revealed large mycotic aneurysms in LAD and LCX coronary arteries (Image 1). Blood culture showed growth of Pseudomonas aeruginosa. Infected coronary aneurysms are a rare and potentially fatal complication after drug eluting stent implantationand …

Disseminated Varicella-Zoster Virus Infection Complicated By Encephalitis And Ramsay Hunt Syndrome In An Hiv Patient, Amro Elshereye, Burak Erdinc, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Varicella-zoster virus (VZV) is a human α-herpesvirus which cause primary varicella infection (chicken pox) or herpes zoster infection (shingles) after reactivation of the dormant virus. VZV infection is usually self-limited but disseminated infection can be seen in immunocompromised individuals. It can also get complicated by central nervous system (CNS) involvement. We describe a case of a 51-year-old male with human immunodeficiency virus (HIV) who presented with altered mental status and deficits in his right-sided cranial nerves of VI, VII, and VIII. The patient also had disseminated vesicular-pustular rash all over his body at different stages of healing. A diagnosis of …

Wet Labs: A Useful Tool In Training Surgical Residents In A Third World Country, Hina Inam, Narmeen Asif, Abdul Ahad Sohail, Saulat Fatimi

Section of Cardiothoracic Surgery

•Wet labs are a useful, cost-effective and safe tool in teaching of Cardiothoracic Surgery residents.•In a third world country where advance real life simulators are not available.•It improves resident's tissue handling and surgical skills.•Allows faculty members to give continuous feedback to their residents.

A Rare Case Of Constrictive Pericarditis As Initial Manifestation Of Paediatric Anaplastic Large Cell Lymphoma Requiring Urgent Pericardiectomy, Sara Iqbal, Abdul Ahad Sohail, Narmeen Asif, Muhammad Rahil Khan, Sabeehuddin Siddique, Saulat Fatimi

Section of Cardiothoracic Surgery

Constrictive pericarditis (CP) is a rare end stage inflammatory disorder affecting both parietal and visceral pericardium leading to a right heart failure. Malignancy is the least common cause of CP. Anaplastic large cell lymphoma (ALCL) accounts for 10-15% of all Non-Hodgkin lymphomas in children. Very few case reports have reported ALCL that is involving the heart and only two have been published involving pericardium but all were managed medically. We present an interesting case of an 11 year old child who presented with an effusive CP that required urgent Pericardiectomy for managing right heart failure. His histopathology was positive for …

Perioperative Management Of Pheochromocytoma Resection In A Patient With A Continuous Flow Left Ventricular Assist Device, Arif Albulushi Md, Ronald Zolty Md Phd, Brian Lowes Md, Phd, Amy L. Duhacheck-Stapleman Md, Tal Sandler Md, James N. Sullivan Md, Douglas Stoller Md Phd

Journal of the Saudi Heart Association

Current generation LVADs provide continuous blood flow which has been shown to increase sympathetic tone. Pheochromocytoma is a rare neuroendocrine tumor which classically presents with episodic hypertension, palpitations and headaches. Careful perioperative management with alpha blockade is required to prevent cardiovascular complications, specifically hypertensive crisis. Here we present a description of perioperative management of pheochromocytoma in a patient with a continuous flow LVAD. Traditional assessment of sympathetic tone is challenging in LVAD patients due to the presence of continuous circulatory flow. Invasive management via an arterial line was useful in perioperative management, allowing for accurate circulatory monitoring and hemodynamic control. …

Association Of Cardiovascular Risk Factor Profile And Financial Hardship From Medical Bills Among Non-Elderly Adults In The United States, Gowtham R. Grandhi, Javier Valero-Elizondo, Reed Mszar Reed Mszar, Eric J. Brandt, Amarnath Annapureddy, Rohan Khera, Anshul Saxena, Salim S. Virani, Ron Blankstein, Nihar R. Desai

Office of the Provost

Background: While optimal cardiovascular risk factor (CRF) profile is associated with lower mortality, morbidity, and healthcare expenditures among individuals with atherosclerotic cardiovascular disease (ASCVD), less is known regarding its impact on financial hardship from medical bills. Therefore, we assessed whether an optimal CRF profile is associated with a lower burden of financial hardship from medical bills and a reduction in cost-related barriers to health.
Methods: We used a nationally representative sample of adults between 18 and 64 years from the National Health Interview Survey between 2013 and 2017. We assessed ASCVD status and the number of risk factors to categorize …