Cardiology Commons^™

Delayed Sternal Closure Does Not Reduce Complications Associated With Coagulopathy And Right Ventricular Failure After Left Ventricular Assist Device Implantation, Roh Yanagida, Navin Rajagopalan, Daniel L. Davenport, Thomas A. Tribble, Mark A. Bradley, Charles W. Hoopes

Internal Medicine Faculty Publications

Delayed sternal closure (DSC) is occasionally adopted after implantation of left ventricular assist device (LVAD). Recent studies suggest that DSC be used for high risk group of patients with coagulopathy, hemodynamic instability or right ventricular failure. However, whether DSC is efficacious for bleeding complication or right ventricular failure is not known. This study is single center analysis of 52 patients, who underwent LVAD implantation. Of those 52 patients, 40 consecutive patients underwent DSC routinely. The sternum was left open with vacuum assist device after implantation of LVAD. Perioperative outcome of the patients who underwent routine DSC were compared with 12 …

Echocardiographic Detection Of Increased Ventricular Diastolic Stiffness In Pediatric Heart Transplant Recipients: A Pilot Study., Shahryar M. Chowdhury, Ryan J. Butts, Anthony M. Hlavacek, Carolyn L. Taylor, Karen S. Chessa, Varsha M. Bandisode, Girish S. Shirali, Arni Nutting, G Hamilton Baker

Manuscripts, Articles, Book Chapters and Other Papers

Background: Pediatric heart transplant recipients are at risk for increased left ventricular (LV) diastolic stiffness. However, the noninvasive evaluation of LV stiffness has remained elusive in this population. The objective of this study was to compare novel echocardiographic measures of LV diastolic stiffness versus gold-standard measures derived from pressure-volume loop (PVL) analysis in pediatric heart transplant recipients.

Methods: Patients undergoing left heart catheterization were prospectively enrolled. PVLs were obtained via conductance. The end-diastolic pressure-volume relationship was obtained via balloon occlusion. The stiffness constant, β, was calculated. Echocardiographic measures of diastolic function were derived from spectral and tissue Doppler and two-dimensional …

Treatment Options For Primary Cns Lymphoma, Abid Laghari, Syed Ijlal Ahmed, Adnan Jabbar, Muhammad Shahzad Shamim

Section of Haematology/Oncology

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL.

Cardiac Amyloidosis Masquerading As Hypertrophic Obstructive Cardiomyopathy, Lohit Garg Md, Naveen Sablani, Amy Ahnert, Bruce Feldman Do

Department of Medicine

Background: Cardiac amyloidosis (CA) remains a diagnostic challenge and is associated with significant morbidity and mortality.

Case: A 67-year old male was referred for septal myomectomy for hypertrophic obstructive cardiomyopathy (HOCM) due to worsening symptoms despite medical therapy. His medical history included chronic diastolic heart failure, and atrial fibrillation post pulmonary vein isolation. His examination revealed mid peaking crescendo-decrescendo systolic murmur, worse on Valsalva. An electrocardiogram revealed normal sinus rhythm and normal voltage. Transthoracic and transesophageal echocardiogram revealed asymmetric septal hypertrophy, chordal systolic anterior motion (SAM), and left ventricular (LV) obstruction with a peak gradient of 40 mmHg at rest. …

Type Ii Brugada Syndrome Syncopal Seizure: A Diagnostic Dilemma, Syed Rafay Ali Sabzwari, Nghia Hoang

Department of Medicine

Background: Type II Brugada syndrome is a rare entity that can present as syncope, sudden cardiac death, palpitations and nocturnal agonal respiration as a manifestation of ventricular tachyarrythmia. Although patients can experience a syncopal seizure, the dilemma between epileptic seizure and syncopal seizure due to type II Brugada syndrome is rarely encountered and reported in literature.

Case: 45 years old caucasian male with history of bicuspid aortic valve and no family history of sudden cardiac death or arrhythmia presented with generalized body shaking, unresponsiveness, mouth frothing and rolling of eyes for 4 minutes during sleep followed by 30 minutes of …

Outcomes Of Catheter Ablation For Supraventricular Tachycardia In Adult Patients With Congenital Heart Disease, Lohit Garg Md, Sahil Agrawal Md, Manyoo Agarwal Md, Brijesh Patel Md, Mahek Shah Md, Aakash Garg Md, Sudip Nanda Md, Facp, Talha Nazir Md, Raman Dusaj Md

Department of Medicine

Background: Supraventricular tachyarrhythmias (SVT) are common in adult patients with congenital heart disease (CHD). There is paucity of data regarding the safety and outcomes associated with catheter ablation in these patients.

Methods: We queried the National Inpatient Sample (NIS) to identify all adults patients > 18 years with CHD undergoing catheter ablation for SVT.

Results: Between 2003-2013, 5,966 patients with CHD underwent catheter ablation for SVT. Of these 4,769 were performed for atrial fibrillation or atrial flutter and rest for other SVTs. The mean age of these patient was 47+/- 15 years, 59.9% were males. 18% of patients experienced procedure related …

Obesity Is Not Associated With A Differential Outcome Following Coronary Artery Bypass Surgery, Lohit Garg Md, Sahil Agrawal Md, Amitoj Singh, Raman Dusaj, Jamshid Shirani

Department of Medicine

Background: Conflicting data exists regarding the impact of obesity on mortality and morbidity following coronary artery bypass graft (CABG) surgery with some suggesting a paradoxical reduction in adverse outcomes. We aimed to compare the in-hospital outcomes of CABG in obese and non-obese subjects.

Methods: The Nationwide Inpatient Sample for years 2003- 2014 was used to identify adults (age ≥18 years) who underwent isolated CABG.

Results: A total of 2,297,932 patients underwent CABG of which 554,857 (28.2%) surgeries were for acute coronary syndrome (ACS) and 1,743075 (74.2%) were elective. Obese patients in either group were younger, were more likely to be …

Risk Factors For Major Early Adverse Events Related To Cardiac Catheterization In Children And Young Adults With Pulmonary Hypertension: An Analysis Of Data From The Impact (Improving Adult And Congenital Treatment) Registry., Michael L O'Byrne, Kevin F Kennedy, Joshua P Kanter, John T Berger, Andrew C Glatz

Pediatrics Faculty Publications

BACKGROUND: Cardiac catheterization is the gold standard for assessment and follow-up of patients with pulmonary hypertension (PH). To date, there are limited data about the factors that influence the risk of catastrophic adverse events after catheterization in this population.

METHODS AND RESULTS: A retrospective multicenter cohort study was performed to measure risk of catastrophic adverse outcomes after catheterization in children and young adults with PH and identify risk factors for these outcomes. All catheterizations in children and young adults, aged 0 to 21 years, with PH at hospitals submitting data to the IMPACT (Improving Adult and Congenital Treatment) registry between …

Acute Pressor Response To Psychosocial Stress Is Dependent On Endothelium‐Derived Endothelin‐1, Brandon M. Fox, Bryan K. Becker, Analia S. Loria, Kelly A. Hyndman, Chunhua Jin, Hannah Clark, Robin Johns, Masashi Yanagisawa, David M. Pollock, Jennifer S. Pollock

Pharmacology and Nutritional Sciences Faculty Publications

Background

Acute psychosocial stress provokes increases in circulating endothelin‐1 (ET‐1) levels in humans and animal models. However, key questions about the physiological function and cellular source of stress‐induced ET‐1 remain unanswered. We hypothesized that endothelium‐derived ET‐1 contributes to the acute pressor response to stress via activation of the endothelin A receptor.

Methods and Results

Adult male vascular endothelium‐specific ET‐1 knockout mice and control mice that were homozygous for the floxed allele were exposed to acute psychosocial stress in the form of cage switch stress (CSS), with blood pressure measured by telemetry. An acute pressor response was elicited by CSS in …

Risk Scores-Medical Derivatives., Ronald S. Freudenberger Md

Department of Medicine

No abstract provided.

Premature Ventricular Contraction-Induced Polymorphic Ventricular Tachycardia After Leadless Pacemaker Implantation: A Unique Adverse Effect Of Leadless Pacing., Anish K Amin, Sreedhar R Billakanty, Nagesh Chopra, Eugene Y Fu, Allan J Nichols, James M Kleman, Gregory A Kidwell

Heart and Vascular Articles

No abstract provided.

Rad Gtpase Deletion Atenuates Post-Ischemic Cardiac Dysfunction And Remodeling, Janet R. Manning, Lakshman Chelvarajan, Bryana R. Levitan, Catherine Nicole Kaminski Withers, Prabhakara R. Nagareddy, Christopher M. Haggerty, Brandon K. Fornwalt, Erhe Gao, Himi Tripathi, Ahmed Abdel-Latif, Douglas A. Andres, Jonathan Satin

Physiology Faculty Publications

The protein Rad interacts with the L-type calcium channel complex to modulate trigger Ca²⁺ and hence to govern contractility. Reducing Rad levels increases cardiac output. Ablation of Rad also attenuated the inflammatory response following acute myocardial infarction. Future studies to target deletion of Rad in the heart could be conducted to establish a novel treatment paradigm whereby pathologically stressed hearts would be given safe, stable positive inotropic support without arrhythmias and without pathological structural remodeling. Future investigations will also focus on establishing inhibitors of Rad and testing the efficacy of Rad deletion in cardioprotection relative to the time of …

The World Database For Pediatric And Congenital Heart Surgery: Use Of An International Congenital Database In South Korea., James D. St Louis, Cheul Lee, Hiromi Kurosawa, Richard A. Jonas, Sakamoto Kisaburo, Christo I. Tchervenkov, Jeffery P. Jacobs, James K. Kirklin

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Very Late Occurrence Of Complete Heart Block Without Preexisting Atrioventricular Conduction Abnormalities: A Rare Complication After Transaortic Valvular Replacement., Nagesh Chopra, Matthew S Tong, Steven J Yakubov

Heart and Vascular Articles

No abstract provided.

A Great Speech From A Great Man, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Symptomatic Celiomesenteric Trunk: Variable Presentations And Outcomes In 2 Patients, Michael L Kueht, Darrel L Wu, Joseph L Mills, Ramyar Gilani

The Texas Heart Institute Journal

Mesenteric ischemia can be difficult to diagnose without a high degree of suspicion because it presents in a variety of ways. Visceral vascular collaterals between the fore- and midgut often provide protection against ischemia; however, the presence of anatomic variations, such as celiomesenteric trunk, can undermine the expected redundancy. Misdiagnosis can result in prolonged suffering or death, as evidenced in 2 of our patients with celiomesenteric trunk. The first patient with chronic mesenteric ischemia was diagnosed in the clinic and underwent successful surgical correction; the other had overwhelming, acute mesenteric ischemia, which resulted in death. Our cases show that successful …

Cardiac Rehabilitation Improves Cardiometabolic Health In Young Patients With Nonischemic Dilated Cardiomyopathy, Samuel G Wittekind, Yvette Gerdes, Wayne Mays, Clifford Chin, John L Jefferies

The Texas Heart Institute Journal

Nonischemic dilated cardiomyopathy is deadly and costly, and treatment options are limited. Cardiac rehabilitation has proved safe and beneficial for adults with various types of heart failure. Therefore, we retrospectively evaluated the hypothesis that rehabilitation is safe and improves cardiometabolic health in young patients with nonischemic dilated cardiomypathy. From 2011 through 2015, 8 patients (4 males) (mean age, 20.6 ± 6.6 yr; range, 10-31 yr) underwent rehabilitation at our institution. They were in American Heart Association class C or D heart failure and were on maximal medical therapy. Their mean left ventricular ejection fraction at baseline was 0.26 ± 0.15. …

Novel Scoring System For Prediction Of Cardiac Syndrome X In Women With Typical Angina And A Positive Exercise Tolerance Test, Farzad Masoudkabir, Ali Vasheghani-Farahani, Elham Hakki, Hamidreza Poorhosseini, Saeed Sadeghian, Seyed Hesameddin Abbasi, Shahram Bahmanyar, Seyed Ebrahim Kassaian

The Texas Heart Institute Journal

A major diagnostic challenge for cardiologists is to distinguish cardiac syndrome X (CSX) from obstructive coronary artery disease in women with typical angina and a positive exercise tolerance test (ETT). We performed this study to develop a scoring system that more accurately predicts CSX in this patient population.

Data on 976 women with typical angina and a positive ETT who underwent coronary angiography at our center were randomly divided into derivation and validation datasets. We developed a backward stepwise logistic regression model that predicted the presence of CSX, and a scoring system was derived from it.

The derivation dataset (809 …

Effects Of Older Donor Age And Cold Ischemic Time On Long-Term Outcomes Of Heart Transplantation, Heidi J Reich, Jon A Kobashigawa, Tamar Aintablian, Danny Ramzy, Michelle M Kittleson, Fardad Esmailian

The Texas Heart Institute Journal

Using older donor hearts in cardiac transplantation may lead to inferior outcomes: older donors have more comorbidities that reduce graft quality, including coronary artery disease, hypertension, diabetes mellitus, and dyslipidemia. Shorter cold ischemic times might overcome the detrimental effect of older donor age. We examined the relationship between donor allograft age and cold ischemic time on the long-term outcomes of heart transplant recipients. rom 1994 through 2010, surgeons at our hospital performed 745 heart transplantations. We retrospectively classified these cases by donor ages of(younger) and ≥50 years (older), then by cold ischemic times of(short), 120 to 240 min (intermediate), and …

Disconnect Between Genes Associated With Ischemic Heart Disease And Targets Of Ischemic Heart Disease Treatments, C Mary Schooling, J. V. Huang, J. V. Zhao, M.K. Kwok, S. L. Au Yeung, S. L. Lin

Publications and Research

Background: Development of pharmacological treatments to mitigate ischemic heart disease (IHD) has encompassed disappointing results and expensive failures, which has discouraged investment in new approaches to prevention and control.Newtreatments aremost likely to be successful if they act on genetically validated targets. We assessed whether existing pharmacological treatments for IHD reduction are acting on genetically validated targets and whether all such targets for IHD are currently being exploited. Methods: Genes associatedwith IHDwere obtained fromthe loci of single nucleotide polymorphisms reported in either of two recent genome wide association studies supplemented by a gene-based analysis (accounting for linkage disequilibrium) of CARDIoGRAMplusC4D 1000 …