Cardiology Commons^™

Fontan Circulation And Transplantation: Considerations For The Complex Candidate., Drishti Tolani, Sharon Chen, Edo Bedzra, Kurt R. Schumacher, Shahnawaz Amdani

Manuscripts, Articles, Book Chapters and Other Papers

The Fontan operation has transformed survival for patients with single ventricle congenital heart disease, but the long-term durability of this physiology remains limited. Fontan circulatory failure (FCF) is a progressive, heterogeneous condition associated with multiorgan dysfunction, lymphatic failure, and elevated post-transplant risk when not recognized early. With increasing survival into adulthood, heart transplantation has emerged as the definitive "fourth stage" of palliation. However, referrals for advanced therapies are often delayed, with many patients presenting in advanced stages of decline. This review synthesizes current evidence on the pathophysiology of Fontan failure, outlines consensus indications for transplant evaluation, and highlights pre-transplant strategies …

Beyond The Norm: Decoding Spontaneous Coronary Artery Dissection As An Unusual Cause Of Acute Coronary Syndrome, Holden Zimmerman, Himanshi Banker, Inder P. Kaur, Jaskaran Munjal, Vasu Gupta, Ayushi Garg, Nikita Garg, Meet Patel, Rohit Jain

HCA Healthcare Journal of Medicine

Spontaneous coronary artery dissection (SCAD) is a rare nonatherosclerotic cause of myocardial infarction among young women, particularly during pregnancy. As the name suggests, SCAD is caused by the spontaneous formation of the false lumen within the coronary artery wall, thus compromising the blood flow to the myocardium. Unlike atherosclerotic acute coronary syndromes, SCAD is not directly associated with diabetes or hypertension; moreover, underlying connective tissue defects and inflammation are considered more contributory towards its etiology. Although its pathophysiology is not well understood, multiple theories have been proposed. Clinically, SCAD has a similar presentation to acute coronary syndromes, including substernal chest …

Managing Anticoagulation In A Patient With Calciphylaxis And Mechanical Valve: A Therapeutic Dilemma, Qutaiba Qafisheh, Abdalhakim Shubietah, Mohanad Qwaider, Muath A. Baniowda, Abdalrahman Assaassa, Roaa Aljunaidi, Abubakar Nazir

Division of Cardiology Faculty Papers

BACKGROUND: Calciphylaxis is a rare, life-threatening vasculopathic syndrome most commonly seen in end-stage renal disease (ESRD) and associated with high mortality. Vitamin K antagonists complicate management in patients with mechanical valves by potentially exacerbating vascular calcification while remaining essential for thromboprophylaxis.

CASE PRESENTATION: A 50-year-old woman with ESRD on hemodialysis and a mechanical mitral valve on warfarin presented with severe abdominal pain and rapidly progressive necrotic ulcers. Despite broad-spectrum antibiotics and sodium thiosulfate, lesions worsened. Biopsies were nondiagnostic; however, the clinical phenotype was consistent with calciphylaxis. A multidisciplinary team transitioned anticoagulation from warfarin to subcutaneous unfractionated heparin (UFH) (333 U/kg …

A Structured, Competency-Based Framework For Aspiring Cardiothoracic Surgeons, Adham Ahmed, Samantha Colon, Gianna J. Dafflisio, Purab Kothari, Nina Uzoigwe, Alice Zhou, Juli Buchwald, Betemariam Sharew, Carter Glenn, Steven Medvedovsky, Justin Olivera, Ryan Kramer, Gabrielle Colon, Jonathan M. Tomasko, Sara J. Pereira, Mara Antonoff, Marc Pelletier, Irbaz Hameed

Student Papers, Posters & Projects

OBJECTIVE: Cardiothoracic surgery requires mastery of a broad knowledge base and advanced skillset to manage critically ill patients. Although competency-based assessment frameworks have been developed in several specialties, there remains a paucity of resources to guide practical progression for early cardiothoracic surgical trainees.

METHODS: Members of the Thoracic Surgery Residents Association, Thoracic Surgery Medical Student Association, and attending cardiothoracic surgeons with a strong track record of surgical education were invited to share their insights and experiences. A structured, milestone-driven roadmap was developed on the basis of their contributions.

RESULTS: We developed a structured, competency-based framework for early surgical trainees, with …

Physical Exercise Intervention Improves Cardiac Function And Reduce Recurrences In Non-Permanent Atrial Fibrillation: A Systematic Review And Meta-Analysis, Editya Fukata, Rivaldo Hardani, Nabilah Mukti, Ferrisaga Pranawa, Fahmy Rusnanta, Ardian Rizal

Journal of the Saudi Heart Association

Objectives: Evidences indicate positive effect of physical exercise on exercise capacity and quality of life in patients with AF. However, whether it improves cardiac function and reverse cardiac remodeling in AF patients was unknown. We aim to evaluate the effects of exercise intervention on cardiac function and structure, and the risk of AF recurrence in patients with non-permanent AF. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in PubMed, ProQuest, Google Scholar, ScienceDirect, and Scopus to identify randomized controlled trials (RCTs) comparing exercise interventions combined with standard AF treatment versus standard treatment alone in …

Utilization Of Critical Care U/S Imaging Tools For Assessment Of Cardio-Pulmonary Complications In Extracorporeal Circulatory Support In Patients Post Cardiac Surgery And Ecmo, Mohamed Abdelghany Mohamed Ragab, Suzi Fawazy Mikhael, Amr Elsayed Elhadidy, Ihab Ahmed Abdelmoneim, Khalid Abdulraheem Alfariady, Abdulrahman Ibrahim Alhusil, Mohsen Salah Abdelazeem Mahmoud, Abdelraouf Fahmy, Sarah Hassan Yacoub, Fathia Adel Samter

Journal of the Saudi Heart Association

Background

Extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO), is increasingly used in patients post-cardiac surgery. However, cardiopulmonary complications and delayed weaning remain common.

Objectives

This study aims to investigate the clinical course of post-cardiac surgery and extracorporeal membrane oxygenation patients using lung ultrasound and echocardiography.

Patient and methods:

This prospective multicenter observational study was conducted in the intensive care units of King Fahd Military Medical Complex, Saudi Arabia, and Cairo University, Egypt. A total of 103 adult patients requiring ECMO or post-cardiac surgery with cardiopulmonary bypass were enrolled.

Result

Postoperative echocardiographic assessment showed significant reductions in EF, TAPSE, …

Nutritional Management Of The Complex Fontan Physiology Patient In The Pre-Transplant Phase, Mona Kasik, Jill Rockwell

2025

No abstract provided.

Clinical Course And Treatment Outcomes In Solid-Basaloid Adenoid Cystic Carcinoma Of The Breast: A Systematic Review And Case Report, Stephanie Kim, Kyle Sheth, Xiaoying Yu, Laura Porterfield, Elizabeth M Vaughan

Faculty, Staff and Students Publications

Background: Adenoid Cystic Carcinoma (ACC) is a rare, indolent subtype of triple-negative breast cancer, accounting for < 0.1 % of cases. The solid-basaloid subtype (SBACC), comprising approximately one-quarter of breast ACCs, has a poorer prognosis. While ACC is typically managed with surgery and is chemo-resistant, SBACC is more aggressive and often treated with chemotherapy and, more recently, immunotherapy-though supporting evidence remains limited.

Aim: To assess clinical characteristics and treatment outcomes of SBACC of the breast.

Methods: This study presents a case of breast SBACC and a systematic review of five databases (inception-September 10, 2024). Eligible studies reported clinical course, treatment, and outcomes. Exclusions included duplicates, non-SBACC focus, animal studies, and those lacking clinical or with only pathological data. Descriptive statistics were used for binary and categorical variables. Risk of bias was assessed using JBI tools, following PRISMA 2020 guidelines. The review is registered in PROSPERO.

Results: …

Genetic Determinants And Genomic Consequences Of Non-Leukemogenic Somatic Point Mutations, Joshua S Weinstock, Sharjeel A Chaudhry, Maria Ioannou, Maria Viskadourou, Paula Reventun, Yasminka A Jakubek, L Alexander Liggett, Cecelia Laurie, Jai G Broome, Alyna Khan, Kent D Taylor, Xiuqing Guo, Patricia A Peyser, Eric Boerwinkle, Nathalie Chami, Eimear E Kenny, Ruth J Loos, Bruce M Psaty, Russell P Tracy, Jennifer A Brody, Jeong H Yun, Michael H Cho, Ramachandran S Vasan, Sharon L Kardia, Jennifer A Smith, Laura M Raffield, Aurelian Bidulescu, Emily C O'Brien, Mariza De Andrade, Jerome I Rotter, Stephen S Rich, Russell P Tracy, Yii Der Ida Chen, C Charles Gu, Chao A Hsiung, Charles Kooperberg, Bernhard Haring, Rami Nassir, Rasika Mathias, Alex Reiner, Vijay G Sankaran, Charles J Lowenstein, Thomas W Blackwell, Goncalo R Abecasis, Albert V Smith, Hyun M Kang, Pradeep Natarajan, Siddhartha Jaiswal, Alexander Bick, Wendy S Post, Paul Scheet, Paul Auer, Theodoros Karantanos, Alexis Battle, Marios Arvanitis

Faculty, Staff and Students Publications

Clonal hematopoiesis (CH) is defined by the expansion of a lineage of genetically identical cells in blood. Genetic lesions that confer a fitness advantage, such as leukemogenic point mutations or mosaic chromosomal alterations (mCAs), are frequent mediators of CH. However, recent analyses of both single cell-derived colonies of hematopoietic cells and population sequencing cohorts have revealed CH frequently occurs in the absence of known driver genetic lesions. To characterize CH without known driver genetic lesions, we use 51,399 deeply sequenced whole genomes from the NHLBI TOPMed sequencing initiative to perform simultaneous germline and somatic mutation analyses among individuals without leukemogenic …

Percutaneous Thromboaspiration Of Left Main Coronary Artery Vegetation In A Patient With Aortic Valve Infective Endocarditis And Acute Coronary Syndrome, Matthew B Morton, Jeremy Russo, Malanka Lankaputhra, Christopher Merry, Dion Stub

Journal of the Saudi Heart Association

Acute myocardial infarction from a vegetation is a rare complication of infective endocarditis. Thrombolysis, percutaneous coronary intervention with balloon angioplasty, stenting, and thromboaspiration, and surgery have all been described in this challenging clinical scenario. A woman with staphylococcal bioprosthetic aortic valve infective endocarditis developed acute myocardial infarction due to a vegetation invading the left main coronary artery, which was successfully managed with percutaneous thromboaspiration.

Ultrasound Evaluation Of Left Ventricular Function In Coronary Artery Ectasia: The Added Value Of 2d Speckle-Tracking Echocardiography, Osama Abouelfetouh Elshaer, Mahmoud Gomaa, Ramy Magdy Elgamal, Mohamed Shokry Fahmy, Reda Nabil Dawoud, Reda Biomy, Ahmed Mostafa Ahmed, Mohamed Kamal Salama

Journal of the Saudi Heart Association

Introduction: Coronary artery ectasia (CAE) is defined as abnormal dilatation of coronary arteries and may be linked to subclinical myocardial dysfunction. Conventional echocardiographic parameters may not adequately detect early left ventricular (LV) dysfunction. Two-dimensional speckle-tracking echocardiography (2D STE) has shown promise in identifying subtle myocardial changes.

Methods: In this single-center observational study, 90 participants with available coronary angiography were divided into three groups: Group A (controls, n=30), Group B (single-vessel CAE, n=30), and Group C (multi-vessel CAE, n=30). Standard echocardiographic indices including LV ejection fraction (LVEF), volumes, and diastolic function were assessed. Global radial, longitudinal, circumferential, and area strains were …

Drug-Eluting Resorbable Scaffold Versus Balloon Angioplasty For Below-The-Knee Peripheral Artery Disease: 2-Year Results From The Life-Btk Trial., Brian G Derubertis, Ramon L Varcoe, Prakash Krishnan, Marc P Bonaca, David J O'Connor, Richard Pin, David C Metzger, Andrew Holden, Jen-Kuang Lee, Osamu Iida, Ehrin J Armstrong, Steven W C Kum, Raghu Kolluri, Danielle R Bajakian, Lawrence A Garcia, Mehdi H Shishehbor, Shawn Yu, Karine Ruster, Brad J Martinsen, Zsuzsanna Igyarto, Sahil A Parikh

Heart and Vascular Articles

BACKGROUND: Limited treatment options exist for infrapopliteal disease in patients with chronic limb-threatening ischemia (CLTI), a condition associated with a high risk of limb loss. Interventional management of diseased infrapopliteal vessels with percutaneous transluminal angioplasty (PTA) is associated with high rates of restenosis and reintervention. In the LIFE-BTK randomized controlled trial (Pivotal Investigation of Safety and Efficacy of BRS Treatment-Below the Knee), the drug-eluting resorbable scaffold (DRS) demonstrated superior 12-month efficacy compared with PTA in a selected CLTI population with predominantly noncomplex, mildly to moderately calcified lesions. This report presents the 2-year safety and efficacy outcomes of the Esprit BTK …

Coronary Stent Infection: A Rare Complication Of Percutaneous Coronary Intervention, Harini Anandan Ms, Balaji Pakshirajan Dr

Journal Of Indian Physician Associates

Background Since the introduction of coronary stents, less than 40 cases of coronary stent infection have been reported worldwide. Although coronary stent infection is rare, the mortality rate is high. We report the first case of coronary stent infection from our institute, presented as pyrexia of unknown origin.

Case Presentation A 48-year-old male was presented with low-grade fever associated with cough and malaise on the 8th day of the PCI procedure. He priorly underwent a multivessel percutaneous coronary intervention (PCI) at another hospital. He was evaluated elsewhere and treated with antipyretics, but he continued to be symptomatic and failed to …

Discriminative Accuracy Of Cha2ds2-Vasc Score, And Development Of Predictive Accuracy Model Using Machine Learning For Ischemic Stroke Risk In Cardiac Amyloidosis And Atrial Fibrillation, Waqas Ullah, Abhinav Nair, Eric Warner, Salman Zahid, Mansoor Rahman, Palwasha Khan, Indranee Rajapreyar, Sridhara S. Yaddanapudi, M. Chadi Alraies, Said Ashraf, Jeffery Van Hook, Yegeny Brailovsky

Department of Medicine Faculty Papers

BACKGROUND: CHA2DS2-VASc score in cardiac amyloidosis (CA) with atrial fibrillation (AF) is believed to underestimate ischemic stroke risk, necessitating a better predictive model.

METHODS: Data were obtained from the National Readmission Database (NRD). Outcomes between CA-AF and no-CA-AF were compared using multivariate regression analysis to calculate adjusted odds ratios (aORs). AutoScore, an interpretable machine learning framework, was used to develop a stroke risk prediction model, and its predictive accuracy was evaluated with an area under the curve (AUC) using the receiver operating characteristic analysis.

RESULTS: A total of 11,860,804 (CA-AF 22,687 (0.19%) and no-CA-AF 11,838,117) patients were identified from 2015 …

Beyond Racial Categorization In Sports Cardiology: A Systematic Review Of Cardiac Adaptations In Athletes, Douglas Corsi, Rafael Hernandez, Jasmine Yimeng Bao, Stephen Garrova, David Shipon

Division of Cardiology Faculty Papers

Background/Objectives: Race-based cardiac screening criteria in sports cardiology, including the “Black athlete’s heart” concept, assume biological distinctions that may not reflect physiological reality. This systematic review evaluates whether geographic ancestry provides more clinically relevant predictors of cardiac adaptation than racial categorization. Methods: PubMed was searched (January 2005–July 2025) for studies examining cardiac adaptations in athletes by ethnicity. Data extraction captured demographics, geographic origin, cardiac assessments, and outcomes. Narrative synthesis was employed due to methodological heterogeneity. Results: Forty-seven studies (n = 66,130) revealed substantial within-race heterogeneity. The “Black athlete repolarization variant” prevalence ranged from 1.8% (Brazilian) to 30% (Ghanaian) Black athletes. …

Corrigendum To “Saudi Heart Association Position Statement On Troponin Use For Cardiovascular Risk Screening In Asymptomatic Populations.” [Journal Of The Saudi Heart Association, 2025;37:32–39. Https://Doi.Org/10.37616/2212-5043.1444]

Journal of the Saudi Heart Association

No abstract provided.

Orthostatic Hypotension In Older Adults And Its Economic Impact On The Healthcare System: A Systematic Literature Review, Olushola E. Ilogho, Jennifer Broyles, Viet Le, Denise Rizzolo

Lynchburg Journal of Medical Science

ABSTRACT

Orthostatic Hypotension (OH) has been shown to lead to poor quality of life, falls, and death. Literature suggests that falls from OH may be preventable, therefore opportunities to reduce its associated cost to the healthcare system exist. This literature review aims to evaluate the importance of diagnosing and treating OH in older adult patients. OH is the drop in blood pressure upon changing to an upright position. This acute hemodynamic drop in blood pressure causes hypoperfusion in the brain, leading to dizziness, syncope, and falls. An extensive literature search for publications in PubMed and Cumulative Index in Nursing and …

The Colchicine-Sodium-Glucose Cotransporter Two Inhibitors Conundrum: Promise, Pitfalls, And Next Steps, Ali Bin Jabbar, Asma Ahmed, Salim S. Virani

Population Health, East Africa

No abstract provided.

Unexpected Diagnosis Of Arrhythmogenic Right Ventricular Cardiomyopathy After Routine Preoperative Evaluation Leads To Life-Saving Intervention, Parth Desai, Alexandra Maloof, Linda Vong, Savitri Fedson, Dhaval Parekh, Wilson W Lam

Faculty, Staff and Students Publications

Background: A healthy 44-year-old woman presented for preoperative evaluation of planned bunionectomy. Electrocardiogram showed T-wave inversions in leads V1 to V5 and epsilon waves in precordium prompting further evaluation.

Case summary: Imaging studies and genetic testing revealed diagnosis of arrhythmogenic right ventricular cardiomyopathy. Patient met Class IIb indication for primary prevention with implantable cardioverter-defibrillator (ICD). Despite weak guideline indication, shared decision-making with the patient led to ICD implantation. Six months later, she had a ventricular tachycardia arrest resulting in ICD shock and return to sinus rhythm.

Discussion: Routine preoperative evaluation led to the diagnosis of a rare pathology. Prompt evaluation …

Kidney Function Trajectories With Mechanical Circulatory Support, Carl P Walther, Harveen K Lamba, Ajith P Nair, Andrew B Civitello, Nandan K Mondal, Kenneth K Liao, Sankar D Navaneethan

Faculty, Staff and Students Publications

Introduction: Adverse long-term kidney outcomes with left ventricular assist devices (LVADs) are common but little understood. Creatinine-based estimated glomerular filtration rate (eGFR) is used clinically in this setting; however, it is of uncertain validity and tends to change nonlinearly after LVAD implantation with an early peak followed by decline. We investigated nonlinear eGFR trajectories over 90 days following LVAD implantation and the relationships with patient factors and outcomes.

Methods: We used 2 complementary cohorts of LVAD recipients, a single-center cohort (n = 190) and a US national cohort (n = 10794). Segmented linear regression with 2 segments was …