Cardiology Commons^™

Contemporary Outcomes Of Isolated Bioprothestic Mitral Valve Replacement For Mitral Regurgitation, Chalak Berzingi, Vinay Badhwar, Fahad Alqahtani, Sami Aljohani, Zakeih Chaker, Mohamad Alkhouli

Faculty & Staff Scholarship

Background Early experience with transcatheter mitral valve replacement (TMVR) highlighted several investigational challenges related to this novel therapy. Conclusive randomised clinical trials in the field may, therefore, be years ahead. In the interim, contemporary outcomes of isolated surgical bioprosthetic mitral valve replacement (MVR) can be used as a benchmark for the emerging TMVR therapies. Methods We used the nationwide inpatient sample to examine recent trends and outcomes of surgical bioprosthetic MVR for mitral regurgitation (isolated and combined). Results 21 007 patients who had bioprosthetic MVR between 2003 and 2014 were included. Of those, 30% had isolated MVR and 70% had …

The Effect Of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors On Nonfasting Remnant Cholesterol In A Real World Population, Anthony P. Morise, Jennifer Tennant, Sari D. Holmes, Danyel H. Tacker

Faculty & Staff Scholarship

Background. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have demonstrated significant effects on low-density lipoprotein (LDL) cholesterol and nonhigh density lipoprotein (HDL) cholesterol. To date, there have been limited reports on the effect of PCSK9 inhibitors on remnant cholesterol. Objectives. Assess the effect of PCSK9 inhibitors on nonfasting remnant cholesterol in a real world population. Identify whether pretreatment triglyceride levels are associated with PCSK9 inhibition success as indicated by changes in remnant cholesterol levels. Methods. Patients in our adult lipid clinic (n = 109) receiving PCSK9 inhibition for atherosclerotic cardiovascular disease or familial hypercholesterolemia who had available pre- and post- …

Anomalous Origin Of A Right Coronary Artery From Pulmonary Artery, Muhammad Shabbir Rawala, S. Tahira Shah Naqvi, Kinaan Farhan, Muhammad Yasin, Syed Bilal Rizvi

Faculty & Staff Scholarship

Congenital defects of the coronary arteries are noted in 0.2–1.4% of the general population. The first case of an anomalous origin of right coronary artery from pulmonary artery (ARCAPA) was described by Brooks in 1885. ARCAPA has an overall incidence of 0.002% in the general population. Most of the cases are asymptomatic; however, it can lead to serious complications such as heart failure, ischemia, and sudden death. A 57-year-old man presented to the cardiologist’s office with complaints of shortness of breath and fatigue. The patient also had a previous history of coronary stents and heart failure. Initially, he was evaluated …

First Uses Of Haart 300 Rings For Aortic Valve Repair In Poland – 4 Case Studies, Jacek H. Juscinski, Andrzej Koprowski, Magdalena Kotackowska, Maciej M. Kowalik, Jan A. Rogowski, James S. Rankin

Faculty & Staff Scholarship

Introduction: Aortic valve reconstructions using geometric an- nuloplasty rings HAART 300/200 open new era in aortic valve surgery. The HAART technology resizes, reshapes, stabilizes and simplifies aortic valve repair. The HAART aortic repair rings are designed to be implanted directly into aortic annulus (un- der aortic valve leaflets).

Aim: We present first in Poland 4 cases of aortic valve recon- structions using geometric annuloplasty rings HAART 300. Material and methods: Two patients had type IA aortic insuf- ficiency (due to El-Khoury classification) – they were treated by HAART 300 ring insertion and ascending aorta prosthesis implantation. Third patient, Marfan with …

Optimal Scene Time To Achieve Favorable Outcomes In Out-Of-Hospital Cardiac Arrest: How Long Is Too Long?, Glenn Goodwin, Dyana Picache, Brian J. Louie, Nicholas Gaeto, Tarik Zeid, Paxton P. Aung, Sonu Sahni

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

Despite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) cases have an average survival rate of only 12% nationwide, compared to 24.8% of cases occurring in hospital. Many factors, including resuscitation interventions, contribute to positive patient outcomes and have, therefore, been studied in attempts to optimize emergency medical services (EMS) protocols to achieve higher rates of return of spontaneous circulation (ROSC) in the field. However, no consensus has been met regarding the appropriate amount of time for EMS to spend on scene.

Total Sulfane Sulfur Bioavailability Reflects Ethnic And Gender Disparities In Cardiovascular Disease, Saurabh Rajpal, Pavan Katikaneni, Matthew Deshotels, Sibile Pardue, John Glawe, Xinggui Shen, Nuri Akkus, Kalgi Modi, Ruchi Bhandari, Paari Dominic, Pratap Reddy, Gopi K. Kolluru, Christopher G. Kevil

Faculty & Staff Scholarship

Hydrogen sulfide (H2S) has emerged as an important physiological and pathophysiological signaling molecule in the cardiovascular system influencing vascular tone, cytoprotective responses, redox reactions, vascular adap- tation, and mitochondrial respiration. However, bioavailable levels of H2S in its various biochemical metabolite forms during clinical cardiovascular disease remain poorly understood. We performed a case-controlled study to quantify and compare the bioavailability of various biochemical forms of H2S in patients with and without cardiovascular disease (CVD). In our study, we used the reverse-phase high performance liquid chromatography monobromobimane assay to analytically measure bioavailable pools of H2S. Single nucleotide polymorphisms (SNPs) were also identified …

Determinants And Outcomes Of Vasoplegia Following Left Ventricular Assist Device Implantation, K. M. Tecson, B. Lima, A. Y. Lee, F. S. Raza, G. Ching, C. Lee, J. Felius, R. D. Baxter, S. Still, S. M. Joseph, +2 Additional Authors

Journal Articles

No abstract provided.

High-Frequency Percussive Ventilation Facilitates Weaning From Extracorporeal Membrane Oxygenation In Adults, I. Gulkarov, J. Schiffenhaus, I. Wong, A. Afzal, F. Khusid, B. Worku

Journal Articles

© 2018 American Society of Extra-Corporeal Technology. All Rights Reserved. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an invaluable rescue therapy for patients suffering from cardiopulmonary arrest, but it is not without its drawbacks. There are cases where patients recover their cardiac function, yet they fail to wean to mechanical conventional ventilation (MCV). The use of high-frequency percussive ventilation (HFPV) has been described in patients with acute respiratory failure (RF) who fail MCV. We describe our experience with five patients who underwent VA-ECMO for cardiopulmonary arrest who were successfully weaned from VA-ECMO with HFPV after failure to wean with MCV. Weaning …

Sternotomy Closure Using Rigid Plate Fixation: A Paradigm Shift From Wire Cerclage, K. B. Allen, K. J. Icke, V. H. Thourani, Y. Naka, K. J. Grubb, J. Grehan, N. Patel, T. S. Guy, K. Landolfo, M. Bonnell, +1 Additional Author

Journal Articles

No abstract provided.

Digital Stethoscope: Technology Update, S. Swarup, A. N. Makaryus

Journal Articles

© 2018 Swarup and Makaryus. Cardiovascular disease (CVD) is recognized as the leading cause of mortality throughout the world. About one-third of global mortality is attributable to CVD. In addition to clinical presentation, specific clinical exam findings can assist in treating and preventing CVD. CVD may initially manifest as pulmonary pathology, and thus, accurate cardiopulmonary auscultation is paramount to establishing accurate diagnosis. One of the most powerful tools available to physicians is the stethoscope. The stethoscope first emerged in the year 1818, invented by a French physician, René Laennec. Since then, the initial modest monaural wooden tube has evolved into …

Spontaneous Coronary Artery Dissection: Current State Of The Science: A Scientific Statement From The American Heart Association, S. N. Hayes, C. E. S. H. Kim, J. Saw, D. Adlam, C. Arslanian-Engoren, K. E. Economy, S. K. Ganesh, R. Gulati, J. H. Mieres, M. J. Wood, +5 Additional Authors

Journal Articles

© 2018 American Heart Association, Inc. Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with …

Real-World Clinical Utility And Impact On Clinical Decision-Making Of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve: Lessons From The Advance Registry., T. A. Fairbairn, K. Nieman, T. Akasaka, B. L. Nørgaard, D. S. Berman, G. Raff, L. M. Hurwitz-Koweek, G. Pontone, M. Poon, M. R. Patel, +13 Additional Authors

Journal Articles

Aims:Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography (CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE). Methods and results:A total of 5083 patients with symptoms concerning for coronary artery disease (CAD) and atherosclerosis on CCTA were enrolled at 38 international …

Effects Of Endovascular Cooling On Infarct Size In St-Segment Elevation Myocardial Infarction: A Patient-Level Pooled Analysis From Randomized Trials., M. Dae, W. O'Neill, C. L. Grines, S. Dixon, D. Erlinge, M. Noc, M. Holzer, A. Dee

Journal Articles

OBJECTIVES: This study sought to examine the relationship between temperature at reperfusion and infarct size.

BACKGROUND: Hypothermia consistently reduces infarct size when administered prior to reperfusion in animal studies, however, clinical results have been inconsistent.

METHODS: We performed a patient-level pooled analysis from six randomized control trials of endovascular cooling during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in 629 patients in which infarct size was assessed within 1 month after randomization by either single-photon emission computed tomography (SPECT) or cardiac magnetic resonance imaging (cMR).

RESULTS: In anterior infarct patients, after controlling for variability between studies, …

Acute Effects Of Diets Rich In Almonds And Walnuts On Endothelial Function, Ravindra Bhardwaj, Harvinder Dod, Manjinder S. Sandhu, Rohil Bedi, Sachin Dod, Gregory Konat, H.K. Chopra, Rakesh Sharma, Abnash C. Jain, Navin Nanda

Faculty & Staff Scholarship

Objective: Omega-3 fatty acids, especially alpha-linolenic acid (ALA), which are present in nuts may reduce cardiovascular disease (CVD) risk, by changing vascular inflammation and improving endothelial dysfunction. The objective of the study was to evaluate the acute effects of two different diets, one containing walnuts and the other almonds on endothelial function.

Methods: Twenty-seven overweight volunteers underwent a randomized 2-period, crossover, controlled intervention study. The subjects were given either walnut or almond diets which varied in monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) content. The walnut diet provided 23.1% energy from PUFA and the almond diet provided 7.6% …

Patient-Specific Quantification Of The Relationship Between The Left Atrium Pressure And The Ostial Diameter Of The Left Atrial Appendage, Sky Tianqi Gao

Electronic Theses and Dissertations

The left atrial appendage has been a historically understudied region of the heart until fairly recently with the new understanding of its role in the stroke pathway of patients with atrial fibrillation. The goal of this study is to take a look at the biomechanical behavior of the left atrium and left atrial appendage under normal physiological loading conditions using material properties taken from biaxial stretch tests. Several different options for material properties models were tested and biaxial stretch test data of cadaveric human tissue samples for the left atrium and appendage were fit to a Fung-type strain-energy function for …

Impact Of Reducing Transcatheter Aortic Valve Replacement (Tavr) Turnover Time, Diane Rydzy Rn, Victor Mejia, Umer M. Darr

Posters

With increasing financial constraints hospitals must find ways to increase efficiency while maintaining patient safety. Operating rooms function with substantial resources and can be essential in affecting revenue. Turnover time can cause delays, prevent maximum use of resources, and affect patient satisfaction. With increasing TAVR volume, efficient use of the hybrid OR is key to maximizing resources.

Percutaneous Management Of Ostial Stenosis Of The Left Internal Mammary Artery Graft, Tanuka Datta, Mohammed Gibreal, Ramesh Mazhari, Allen J. Solomon

Medicine Faculty Publications

A 61-year-old man, who had undergone coronary artery bypass surgery 10 years earlier, presented with a non-ST segment elevation myocardial infarction. He was treated with medical therapy and taken to the Cardiac Catheterization Laboratory. A left heart catheterization demonstrated an ostial stenosis in the left internal mammary artery graft, which was felt to be the culprit lesion. This was successfully repaired with a drug eluting stent. This case is presented as an unusual location for a de novo coronary stenosis. The pathophysiology of these lesions is not well understood.

Comparison Between Different Strategies Of Rheumatic Heart Disease Echocardiographic Screening In Brazil: Data From The Provar (Rheumatic Valve Disease Screening Program) Study, B Nascimento, Craig A. Sable, M Nunes, A Diamantino, K Oliveira, Andrea Z. Beaton, +Several Additional Authors

Pediatrics Faculty Publications

Background-—Considering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease (RHD), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent RHD in schoolchildren (aged 5–18 years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil.

Methods and Results-—The PROVAR (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for RHD echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart …

Drug Therapy Vs. Ablation Therapy For Patients With Atrial Fibrillation, Jessica Ansara

Theses and Graduate Projects

The prevalence of atrial fibrillation is 6.5 percent in the adult population in the United States, in an attempt to treat this patient population, there are numerous options and this study attempts to find the optimal treatment plan that has the least Atrial fibrillation(AF) reoccurrence, best quality of life and is the most effective. This is a Systematic Review comparing catheter ablation therapy vs. drug therapy in treating patients with atrial fibrillation. The search engines used in this analysis include PubMed, UpToDate, Google Scholar and Academic Search Premier. A total of 19 articles were analyzed and data was extracted, and …

In Developing Countries, Does The Implementation Of Basic Cardio-Pulmonary Resuscitation Education In The Community Improve Patient Outcomes?, Ashley Gross

Theses and Graduate Projects

Circulatory shock and cardiovascular diseases contribute to significant mortality globally, with an increased burden in developing countries. The compilation of these studies and anecdotal support gathered while in Nicaragua supports the impact education on high-quality CPR among the community can have on out-of- hospital cardiac arrest patient outcomes. Even though some studies showed guideline-compliant CPR does not improve all patient outcomes, we cannot estimate the time it will take a patient to achieve ROSC. Therefore, educating the public and refining the skills of health care professionals can have a significant positive impact on out-of-hospital cardiac arrest patient outcomes if there …