Cardiology Commons^™

The Utility Of Perioperative Transesophageal Echocardiography After Left Ventricular Assist Device Implant: A Case Report, Andrew Parks, Bennet George, Alexis Shafii, Mikel Smith, Maya Guglin

The VAD Journal

Immediate post-operative evaluation of patients who have received a left ventricular assist device (LVAD) can be a daunting task. We present a case of a 51-year-old female who developed ventricular tachycardia soon after returning from the operating theatre and describe the role transesophageal echocardiogram played in helping prompt urgent and definitive treatment.

Adverse Events In Continuous-Flow Lvad Recipients: Gastrointestinal Bleeding Is Still Notable?, Marija Petrovic, Sriram Nathan, Rajko Radovancevic, Indranee Rajapreyar, Kevin J. Dasher, Mehmet H. Akay, Bindu Akkanti, Pranav Loyalka, Biswajit Kar, Igor D. Gregoric

The VAD Journal

Background: The etiology and risk factors associated with gastrointestinal bleeding (GIB) in patients with continuous-flow left ventricular assist devices (CF-LVADs) are currently unknown. Therefore, we sought to assess the risk factors for GIB in these patients.

Design and Methods: This was a retrospective, non-randomized, non-controlled study at a single center. Between 2012 and 2014, 65 men and 6 women (mean age = 55 ± 12 years) underwent CF-LVAD implantation at our institution. Overall, 23.9% of patients (17/71) had at least one GIB episode. Endoscopy confirmed GIB in 13/17. Arteriovenous malformation was the major GIB source in 8/13 (61%). …

Fever Of Unknown Origin In Patient After Left Ventricular Assist Device Implantation, Eugenia Raichlin, Sara Varnado, John Y. Um, Michael J. Moulton, Ronald Zolty Dr

The VAD Journal

Mechanical circulatory support (MCS) is a lifesaving procedure in patients with refractory cardiogenic shock. Despite improvement in surgical techniques, ICU care and restored hemodynamics, some patients on MCS remain severely debilitated due to multiple medical problems, including infections, respiratory failure, de-conditioning and nutritional deficits.

Here we present a case of a patient with persistent high degree fever, devastating muscle weakness, and elevated lactate dehydrogenase (LDH) level, who dramatically responded to treatment with vitamin B 12.

Epigenetics Of Lipid Phenotypes, Sergi Sayols-Baixeras, Marguerite R. Irvin, Donna K. Arnett, Roberto Elosua, Stella W. Aslibekyan

Epidemiology and Environmental Health Faculty Publications

Dyslipidemia is a well-established risk factor for cardiovascular disease, the main cause of death worldwide. Blood lipid profiles are patterned by both genetic and environmental factors. In recent years, epigenetics has emerged as a paradigm that unifies these influences. In this review, we have summarized the latest evidence implicating epigenetic mechanisms—DNA methylation, histone modification, and regulation by RNAs—in lipid homeostasis. Key findings have emerged in a number of novel epigenetic loci located in biologically plausible genes (eg, CPT1A, ABCG1, SREBF1, and others), as well as microRNA-33a/b. Evidence from animal and cell culture models suggests a complex interplay …

Delayed Presentation Of Forgotten Thyroid Goiter - 25 Years After Thyroidectomy, Fazal Wahab Khan, Ayesha Muhammad, Mohsin Abbas, Syed Usman Bin Mahmood, Benish Fatima, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Forgotten goiter is a rare occurrence (2 - 16% of retrosternal thyroid cases) that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy …

Increased Level Of Morning Surge In Blood Pressure In Normotensives: A Cross-Sectional Study From Pakistan, Aysha Almas, Fatehali Tipoo Sultan, Khawar Kazmi

Department of Medicine

Objective: To determine the mean morning surge (MS) in blood pressure, the frequency of increased morning surge in normotensive subjects, and to compare those with morning surge with those without MS.
Study Design: A cross-sectional, comparative study.
Place and Duration of Study: The Department of Medicine, The Aga Khan University Hospital, Karachi, from April 2011 to March 2012.
Methodology: Adult normotensive healthy volunteers aged 35 to 65 years were inducted. Their ambulatory blood pressure (ABP) was measured over a 24-hour period, using digital ambulatory blood pressure monitors. Morning surge was calculated as the average of four readings after waking …

Analysis Of The Final Denali Trial Data: A Prospective, Multicenter Study Of The Denali Inferior Vena Cava Filter., S William Stavropoulos, James X Chen, Ronald F Sing, Fakhir Elmasri, Mitchell J Silver, Alex Powell, Frank C Lynch, Ahmed Kamel Abdel Aal, Alexandra Lansky, Bart E Muhs

Heart and Vascular Articles

PURPOSE: To report the final 2-year data on the efficacy and safety of a nitinol retrievable inferior vena cava (IVC) filter for protection against pulmonary embolism (PE).

MATERIALS AND METHODS: This was a prospective multicenter trial of 200 patients with temporary indications for caval filtration who underwent implantation of the Denali IVC filter. After filter placement, all patients were followed for 2 years after placement or 30 days after filter retrieval. The primary endpoints were technical success of filter implantation in the intended location and clinical success of filter placement and retrieval. Secondary endpoints were incidence of clinically symptomatic recurrent …

Thirty-Three Years Of Dizzy Medical Writing And Editing: A Meta-Analysis And The Hall Of Shame, Herbert L Fred, Mark S Scheid

The Texas Heart Institute Journal

No abstract provided.

Venous Myocardial Infarction In An Infant With Obstructed Totally Anomalous Pulmonary Venous Drainage And Coronary Sinus Ostial Atresia, Deepa Prasad, James P Strainic, Khyati Pandya, Peter C Kouretas, Ravi C Ashwath

The Texas Heart Institute Journal

We report a rare causal association between obstructed supracardiac totally anomalous pulmonary venous drainage and coronary sinus ostial atresia. Our 12-week-old patient developed venous myocardial infarction secondary to coronary venous hypertension because her sole route of coronary venous drainage was obstructed. She recovered after the obstruction was relieved by balloon dilation. Surgical repair then included anastomosis of the pulmonary venous confluence to the left atrium, ligation of the vertical vein, and unroofing of the coronary sinus. Coronary sinus ostial atresia is rarely diagnosed before autopsy.

Long-Term Follow-Up Study Of Temporary Tricuspid Valve Detachment As Approach To Vsd Repair Without Consequent Tricuspid Dysfunction, Gianluca Lucchese, Lucia Rossetti, Giuseppe Faggian, Giovanni B Luciani

The Texas Heart Institute Journal

Temporary tricuspid valve detachment improves the operative view of certain congenital ventricular septal defects (VSDs), but its long-term effects on tricuspid valve function are still debated.

From 2002 through 2012, we performed a prospective study of 68 children (mean age, 1.28 ± 1.01 yr) who underwent transatrial closure of VSDs following temporary tricuspid valve detachment. Sixty patients had conoventricular and 8 had mid-muscular VSDs. All were in sinus rhythm. Seventeen patients had systemic pulmonary artery pressures. Preoperative echocardiograms showed trivial-to-mild tricuspid regurgitation in 62 patients and tricuspid dysplasia with severe regurgitation in 6 patients. Patients were clinically and echocardiographically monitored …

Catheter Ablation Of Ventricular Tachycardia: Moving Beyond Palliation, Nilesh Mathuria

The Texas Heart Institute Journal

No abstract provided.

Pacemaker Troubleshooting: Common Clinical Scenarios, Payam Safavi-Naeini, Mohammad Saeed

The Texas Heart Institute Journal

No abstract provided.

Cardiomems™ In Lvad Patients: A Case Series, Maya Guglin, Bennet George, Sarah Branam, Amanda Hart

The VAD Journal

Patients with a left ventricular assist device (LVAD) commonly encounter issues with volume status post-implant. Volume overload can result from incomplete compensation of left ventricular failure or from right ventricular failure. The CardioMEMS™ intracardiac hemodynamic monitoring device is an area of growing interest regarding the management of chronic congestive heart failure, however, its utility has not been serially investigated in patients with an LVAD. We present a case series of patients with ventricular assist devices care for at our institution in which the CardioMEMS™ device aided in the management of volume status and pump performance.

Ligation Of The Outflow Graft Of The Left Ventricular Assist Device For Management Of Hemolysis Due To Pump Thrombosis, Jean Touchan, Alexis Shafii, Maya Guglin

The VAD Journal

Pump thrombosis is a serious complication of continuous-flow left ventricular assist devices (LVAD). Treatment options include medical thrombolysis, surgical pump exchange or urgent heart transplantation. We are reporting a case of pump thrombosis with active hemolysis and acute renal failure managed surgically by isolating the LVAD while awaiting renal recovery and donor heart availability.

Economic Impact Of Moderate-Vigorous Physical Activity Among Those With And Without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey, Javier Valero-Elizondo, Joseph A. Salami, Chukwuemeka U. Osondu, Oluseye Ogunmoroti, Alejandro Arrieta, Erica S. Spatz, Adnan Younus, Jamal S. Rana, Salim S. Virani, Ron Blankstein

Office of the Provost

Background: Physical activity (PA) has an established favorable impact on cardiovascular disease (CVD) outcomes and quality of life. In this study, we aimed to estimate the economic effect of moderate-vigorous PA on medical expenditures and utilization from a nationally representative cohort with and without CVD.
Methods and results: The 2012 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥18 years of age. Variables of interest included CVD (coronary artery disease, stroke, heart failure, dysrhythmias, or peripheral artery disease) and cardiovascular modifiable risk factors (CRFs; hypertension, diabetes mellitus, hypercholesterolemia, smoking, and/or obesity). Two-part …

An Interactive Videogame Designed To Improve Respiratory Navigator Efficiency In Children Undergoing Cardiovascular Magnetic Resonance, Sean M. Hamlet, Christopher M. Haggerty, Jonathan D. Suever, Gregory J. Wehner, Jonathan D. Grabau, Kristin N. Andres, Moriel H. Vandsburger, David K. Powell, Vincent L. Sorrell, Brandon K. Fornwalt

Saha Cardiovascular Research Center Faculty Publications

Background: Advanced cardiovascular magnetic resonance (CMR) acquisitions often require long scan durations that necessitate respiratory navigator gating. The tradeoff of navigator gating is reduced scan efficiency, particularly when the patient’s breathing patterns are inconsistent, as is commonly seen in children. We hypothesized that engaging pediatric participants with a navigator-controlled videogame to help control breathing patterns would improve navigator efficiency and maintain image quality.

Methods: We developed custom software that processed the Siemens respiratory navigator image in real-time during CMR and represented diaphragm position using a cartoon avatar, which was projected to the participant in the scanner as visual feedback. The …

Caregiver Burden Is Low Nine To Twelve Months After Ventricular Assist Device Implantation, Roxana Ghashghaei, Hao Tran, Jorge Silva, Barry H. Greenberg, Denise Barnard, Eric Adler

The VAD Journal

Background:

Prior studies have found that caregivers of chronically ill patients, including those with heart failure, have significant stress and burden. Ventricular Assist Devices (VADs) are a promising therapeutic modality for end stage heart failure. However, caregiver burden has not previously been studied in the caregivers of VAD patients.

Methods:

We studied 31 caregivers of VAD patients receiving care at University of California, San Diego. Validated instruments tools, such as the Bakas Caregiving Outcomes scale and Oberst Caregiving Demand and Difficulty sub-scales, were used to measure the caregivers’ psychological burden.

Results:

Nearly half of the caregivers were the patient’s spouse …

Imaging Right Ventricular Function To Predict Outcome In Pulmonary Arterial Hypertension, Alessandro Bellofiore, Melanie Brewis, Rebecca Vanderpool, Naomi Chesler, Martin Johnson, Robert Naeije, Andrew Peacock

Faculty Publications

Right ventricular (RV) function is a major determinant of outcome in pulmonary arterial hypertension (PAH). However, uncertainty persists about the optimal method of evaluation.MethodsWe measured RV end-systolic and end-diastolic volumes (ESV and EDV) using cardiac magnetic resonance imaging and RV pressures during right heart catheterization in 140 incident PAH patients and 22 controls. A maximum RV pressure (Pmax) was calculated from the nonlinear extrapolations of early and late systolic portions of the RV pressure curve. The gold standard measure of RV function adaptation to afterload, or RV–arterial coupling (Ees/Ea) was estimated by the stroke volume (SV)/ESV ratio (volume method) or …

Irisin Lowers Blood Pressure By Improvement Of Endothelial Dysfunction Via Ampk‐Akt‐Enos‐No Pathway In The Spontaneously Hypertensive Rat, Jinjuan Fu, Yu Han, Jialiang Wang, Yukai Liu, Shuo Zeng, Lin Zhou, Pedro A. Jose, Chunyu Zeng

Medicine Faculty Publications

Background Exercise is a major nonpharmacological treatment for hypertension, but its underlying mechanisms are still not completely elucidated. Irisin, a polypeptide containing 112 amino acids, which is secreted mainly by skeletal muscle cells during exercise, exerts a protective role in metabolic diseases, such as diabetes mellitus and obesity. Because of the close relationship between irisin and metabolic diseases, we hypothesized that irisin may play a role in the regulation of blood pressure.

Methods and Results Blood pressures of male Wistar‐Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs) were monitored through the carotid artery. Our study found that acute intravenous injection …

Can A Point-Of-Care Troponin I Assay Be As Good As A Central Laboratory Assay? A Midas Investigation., W. Frank Peacock, Deborah Diercks, Robert Birkhahn, Adam J. Singer, Judd Hollander, Richard Nowak, Basmah Safdar, Chadwick D. Miller, Mary Peberdy, Francis Counselman, Abhinav Chandra, Joshua Kosowsky, James Neuenschwander, Jon Schrock, Elizabeth Lee-Lewandrowski, William Arnold, John Nagurney

Department of Emergency Medicine Faculty Papers

BACKGROUND: We aimed to compare the diagnostic accuracy of the Alere Triage Cardio3 Tropinin I (TnI) assay (Alere, Inc., USA) and the PathFast cTnI-II (Mitsubishi Chemical Medience Corporation, Japan) against the central laboratory assay Singulex Erenna TnI assay (Singulex, USA).

METHODS: Using the Markers in the Diagnosis of Acute Coronary Syndromes (MIDAS) study population, we evaluated the ability of three different assays to identify patients with acute myocardial infarction (AMI). The MIDAS dataset, described elsewhere, is a prospective multicenter dataset of emergency department (ED) patients with suspected acute coronary syndrome (ACS) and a planned objective myocardial perfusion evaluation. Myocardial infarction …