The objective of this study was to assess the immediate and mid-term results of transcatheter closure of postinfarct muscular ventricular septal defects (VSDs) using the new Amplatzer postinfarct muscular VSD device (PIMVSD). Ventricular... more
The objective of this study was to assess the immediate and mid-term results of transcatheter closure of postinfarct muscular ventricular septal defects (VSDs) using the new Amplatzer postinfarct muscular VSD device (PIMVSD). Ventricular septal rupture occurs in 0.2% of myocardial infarcts and remains associated with very high morbidity and mortality. Data were prospectively collected for 18 patients who underwent attempted device closure of postinfarction VSDs between 2000 and 2003. Five patients underwent the closure in the acute phase (within 6 days from the infarct); the remaining patients underwent closure on day 14–95 after the diagnosis of the infarct. Outcome parameters included procedural success, evidence of residual shunts on echocardiography, and occurrence of procedure-related complications. The procedure was successful in deploying a device across the VSD in 16 of 18 patients. The 30-day mortality was 28%. Eleven patients are still alive and have been followed up for a median of 332 days. Two patients required a second procedure to close a residual VSD. At the most recent outpatient follow-up, the VSD was completely closed in two patients, six patients had a trivial or small residual shunt, and two patients had a moderate residual shunt. We conclude that percutaneous device closure of postinfarction VSDs using the Amplatzer PIMVSD occluder appears to be safe and effective. Further trials are required to assess long-term efficacy and compare the results with those of surgical closure. Catheter Cardiovasc Interv 2004;61:196–201. © 2004 Wiley-Liss, Inc.
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Cardiac compression in pectus excavatum (PE) deformity and effect of PE surgery on cardiac function in adults have been debated. We examined the effect of PE correction on right heart size and cardiac output. A retrospective evaluation... more
Cardiac compression in pectus excavatum (PE) deformity and effect of PE surgery on cardiac function in adults have been debated. We examined the effect of PE correction on right heart size and cardiac output. A retrospective evaluation was performed of 168 adult patients who underwent a modified Nuss PE repair with intraoperative transesophageal echocardiography from 2011 to 2014. Seventeen patients with prior PE repair undergoing bar removal acted as controls. Mean age was 33.0 years (range, 18 to 71 years). There was an increase in right atrium (15.1%), tricuspid annulus (10.9%), and right ventricular outflow tract (6.1%) size after surgery (all P < .0001). Right ventricular cardiac output measured in a subset of 42 patients improved by 38%. No change in chamber size or cardiac output occurred before and after bar removal surgery in the control group. Surgical correction of PE deformity caused a significant improvement in right heart chamber size and cardiac output.
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Trastuzumab has substantially improved overall survival and reduced the risk of disease recurrence in patients with human epidermal growth factor receptor type II (HER-II)-positive breast cancer. However, this benefit may be at the... more
Trastuzumab has substantially improved overall survival and reduced the risk of disease recurrence in patients with human epidermal growth factor receptor type II (HER-II)-positive breast cancer. However, this benefit may be at the increased risk of cardiotoxicity. We aimed to explore the early subclinical left and right ventricular as well as atrial dysfunction, in trastuzumab-treated patients with HER-II-positive breast cancer, using velocity vector imaging. Echocardiography images were acquired in 50 patients with HER-II-positive breast cancer undergoing trastuzumab therapy. All patients had baseline and 3-6 months and 12-15 months of follow-up echocardiograms after initiation of trastuzumab therapy. Subendocardial borders of all the cardiac chambers were traced from the apical views to obtain volumetric and deformation indices. Mean age was 60 ± 13 years. Left ventricular (LV) ejection fraction as well as conventional indices of right ventricular (RV) function did not change wit...
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Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current... more
Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and for the treatment and prevention of venous thromboembolism (HYPERLINK\l &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;1). Recent prospective randomized trials comparing the NOACs with warfarin have shown similar efficacy between the treatment strategies but fewer bleeding episodes with the NOACs. This paper presents an evidence-based review describing the efficacy and safety of the new anticoagulants compared to warfarin.
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Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is being recognized with increasing frequency. Diagnostic and treatment information is limited. A systematic review is presented, focusing on patient demographics,... more
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is being recognized with increasing frequency. Diagnostic and treatment information is limited. A systematic review is presented, focusing on patient demographics, clinical presentation, diagnosis, treatment options, and outcomes. A systematic electronic literature search was conducted for adult DIPNECH cases reported in the English literature during the past 6 years. Twenty-four DIPNECH cases were identified. Another case from our institution is contributed. Women represent 92% (23 of 25). Mean age at diagnosis was 58 years (range, 36-76 yr). Most were nonsmokers (16 of 24). Symptoms included cough (71%), dyspnea (63%), and wheezing (25%) occurring days to years before diagnosis. Pulmonary function testing showed obstructive ventilatory disease in 54%. Lung nodules were seen in 15 patients (63%), ground-glass attenuation in 7 patients (29%), and bronchiectasis in 5 patients (21%). Histological confirmation requi...
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Cardiovascular disease remains the leading cause of mortality in women despite advances in treatment strategies. Challenges currently exist when making the diagnosis of coronary artery disease. Equitable treatment of women once the... more
Cardiovascular disease remains the leading cause of mortality in women despite advances in treatment strategies. Challenges currently exist when making the diagnosis of coronary artery disease. Equitable treatment of women once the disease has been identified is a further conundrum. Observational data have helped to identify those women at a higher risk of mortality and morbidity attributable to coronary artery disease. Interpretation of individual risk factors differs between the genders. Treatment may also differ depending on appropriate proper risk stratification, using newer models that take into account gender differences. Outcomes can be improved with the proper use of existing risk stratification tools.
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Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias.The defective cardiac sodium channels result in usual electrocardiographic... more
Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias.The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions.
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Objective To demonstrate that a distinct group of patients with Grade Ia diastolic dysfunction who do not conform to present ASE/ESE diastolic grading exists.Method and ResultsEchocardiographic and demographic data of the Grade Ia... more
Objective To demonstrate that a distinct group of patients with Grade Ia diastolic dysfunction who do not conform to present ASE/ESE diastolic grading exists.Method and ResultsEchocardiographic and demographic data of the Grade Ia diastolic dysfunction were extracted and compared with that of Grades I and II in 515 patients. The mean of age of the cohort was 75 ± 9 years and body mass index did not differ significantly between the 3 groups (P = 0.45). Measurements of left atrial volume index (28.58 ± 7 mL/m2 in I, 33 ± 10 mL/m2 in Ia, and 39 ± 12 mL/m2 in II P < 0.001), isovolumic relaxation time (IVRT) (100 ± 17 msec in I, 103 ± 21 msec in Ia, and 79 ± 15 msec in II P < 0.001), deceleration time (248 ± 52 msec in I, 263 ± 58 msec in Ia, and 217 ± 57 msec in II P < 0.001), medial E/e′ (10 ± 3 in I, 18 ± 5.00 in Ia, and 22 ± 8 in II), and lateral E/e′ (8 ± 3 in I, 15 ± 6 in Ia, and 18 ± 9 in II P < 0.001) were significantly different in grade Ia compared with I and II. Th...
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Catheter ablation for the management of recurrent ventricular arrhythmias (VAs) is an emerging technology, with good efficacy in selected patients. It is an effective treatment for recurrent VA and can terminate VA during electrical... more
Catheter ablation for the management of recurrent ventricular arrhythmias (VAs) is an emerging technology, with good efficacy in selected patients. It is an effective treatment for recurrent VA and can terminate VA during electrical storm. Recent innovations enhance the accuracy of ventricular mapping, allowing for substrate modification while the patient remains in sinus rhythm, thus facilitating the treatment of different types of VA. Epicardial ablation is now a feasible option for treating VA and increases the likelihood of success in certain types of VA. Percutaneous hemodynamic support facilitates successful ablation during poorly tolerated VA. This article reviews recent advances in catheter ablation techniques for VA and approaches to the management of specific types of VA, with a view toward future developments.
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Valvular endocarditis due to Mycobacterium tuberculosis is a rare clinical entity. It is usually manifest in the context of disseminated tuberculosis in immunocompromised patients. This report describes a unique case of a 30-year-old... more
Valvular endocarditis due to Mycobacterium tuberculosis is a rare clinical entity. It is usually manifest in the context of disseminated tuberculosis in immunocompromised patients. This report describes a unique case of a 30-year-old immunocompetent man with an incidental finding of tuberculous valvular endocarditis. The patient had a large mass on the anterior mitral leaflet and severe mitral regurgitation. He underwent mitral valve replacement and Mycobacterium tuberculosis was cultured from the valve vegetation and the right atrial masses. Post-operative recovery has been uneventful without relapse for 24 months.
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The percutaneous closure of mitral paravalvular leak (PVL) is emerging as an alternative treatment for high-risk surgical candidates. Several cases have been reported, and a few small studies have been conducted to investigate the outcome... more
The percutaneous closure of mitral paravalvular leak (PVL) is emerging as an alternative treatment for high-risk surgical candidates. Several cases have been reported, and a few small studies have been conducted to investigate the outcome of the technique. A meta-analysis of the combined data would be considered helpful in deriving more powerful data; hence, the study aim was to conduct a meta-analysis of the percutaneous closure of mitral PVLs, as reported in the medical literature. Searches were conducted of the PubMed, Embase, and CINAHL databases for reports of mitral PVL percutaneous closure. The data were extracted by two reviewers, who aggregated the information by using a random-effects model. Eight studies were included in the meta-analysis, with a total of 100 patients. The percutaneous closure of mitral PVLs was associated with a 15% cardiovascular mortality during the first year of follow up. Clinical success was noted in 48% of patients, while 52% failed to show any cli...
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To determine the prevalence of right ventricular (RV) dysfunction in patients with preserved left ventricular (LV) ejection fraction (EF) heart failure (HF) and to compare RV function between patients with preserved EF HF and those with... more
To determine the prevalence of right ventricular (RV) dysfunction in patients with preserved left ventricular (LV) ejection fraction (EF) heart failure (HF) and to compare RV function between patients with preserved EF HF and those with reduced EF HF. Hundred patients (72 +/- 14 years, 59% male) with HF were prospectively enrolled. Fifty-one had preserved EF HF (LVEF > 50%). The prevalence of RV systolic dysfunction in patients with preserved EF HF was 33, 40, and 50%, by using RV fractional area change (FAC), tricuspid annular motion (TAM), and peak systolic tricuspid annular tissue velocity (S') criteria, respectively. Tricuspid S' and TAM correlated the best with LVEF (r = 0. 48, P < 0.01). Patients with preserved EF HF had higher RV FAC (54 +/- 18 vs. 36 +/- 20%, P < 0.01), TAM (17 +/- 1 vs.11 +/- 1 mm, P < 0.01), and tricuspid S' (14 +/- 6 vs. 9 +/- 4 cm/s, P < 0.01) compared with those with reduced EF HF. Of those 51 patients, 34% had tricuspid E/e&#...
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Hemolytic anemia related to intracardiac prosthetic materials has been described. We describe a case of a 74-year-old female with a history of hypertrophic obstructive cardiomyopathy that had a postoperative ventricular septal defect... more
Hemolytic anemia related to intracardiac prosthetic materials has been described. We describe a case of a 74-year-old female with a history of hypertrophic obstructive cardiomyopathy that had a postoperative ventricular septal defect closed with a muscular ventricular septal defect occluder. The device caused intractable hemolytic anemia that required surgical removal and repair. We describe a rare cause of hemolysis complicating transcatheter closure of a post-traumatic ventricular septal defect.
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... infarction. Circulation 1984;69:250–258. 3. Teo KK, Yusuf S, Furberg CD. Effects ... infarction. CEPR 1997;1:207–209. 5. Waldo AL, Camm AJ, de Ruyter H, Friedman PL, MacNeil DJ, Pauls JF, Pitt B, Pratt CM, Schwartz PJ, Veltri EP.... more
... infarction. Circulation 1984;69:250–258. 3. Teo KK, Yusuf S, Furberg CD. Effects ... infarction. CEPR 1997;1:207–209. 5. Waldo AL, Camm AJ, de Ruyter H, Friedman PL, MacNeil DJ, Pauls JF, Pitt B, Pratt CM, Schwartz PJ, Veltri EP. Effect ...
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This study tested the feasibility of velocity vector imaging (VVI) analysis to quantitatively assess right ventricular (RV) function during stress echocardiography (SE). We prospectively enrolled 73 patients (treadmill 38, dobutamine 35)... more
This study tested the feasibility of velocity vector imaging (VVI) analysis to quantitatively assess right ventricular (RV) function during stress echocardiography (SE). We prospectively enrolled 73 patients (treadmill 38, dobutamine 35) undergoing SE using an Acuson C512 ultrasound system. The RV ejection fraction was measured for global RV function. The radial velocity, circumferential strain, and strain rate (SR) of four segments from the mid-level RV short-axis view, and the longitudinal velocity, strain, and SR of six segments from the RV apical four-chamber view were used to evaluate regional RV function. The VVI analysis successfully in 70 of 73 cases (96%). Fifty (71%) of the 70 demonstrated a normal response to stress, showing an increased RV ejection fraction (P < 0.001), and longitudinal velocity and SR in the basal lateral walls at peak stress (7.7 +/- 2.0-10.3 +/- 2.9 cm/s, -1.9 +/- 0.7 to -3.2 +/- 1.4/s, P < 0.001); the longitudinal displacement and strain of the...
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Studies have shown an association between obesity and total mortality among people with and without coronary artery disease. This study reviews outcomes among obese survivors of ventricular fibrillation in out-of-hospital cardiac arrest.... more
Studies have shown an association between obesity and total mortality among people with and without coronary artery disease. This study reviews outcomes among obese survivors of ventricular fibrillation in out-of-hospital cardiac arrest. All survivors of ventricular fibrillation in out-of-hospital cardiac arrest who presented in Rochester, MN from November 1990 to September 2006 were included and classified by body weight. Implantable cardioverter defibrillator shocks administered were determined by review of subsequent device interrogations. Among a study population of 226, 99 (44%) survived to hospital discharge with neurological recovery. Data to calculate body mass index were available in 213 cases (95%). There was no significant difference in the relative distribution of body weight between hospital survivors and non-survivors, nor in cardioverter defibrillator implantation rates. Mean follow-up was 5.8+/-4.4 years; 5-year survival was 80+/-5%, lower among underweight and normal compared with heavier individuals. The 5-year survival free of implantable cardioverter defibrillator shocks was 61+/-7%, with no weight-based difference in shocks. There was no apparent weight-based influence on resuscitation survival after ventricular fibrillation in out-of-hospital cardiac arrest. People of normal or low weight had a lower long-term survival and represent at population high risk from primarily non-cardiac diseases.
Research Interests: Obesity, Automated External defibrillator, Humans, Survivors, Female, and 12 moreResuscitation, Male, Body Mass Index, Clinical Sciences, Aged, Middle Aged, Public health systems and services research, Survival Rate, Body Weight, Implantable defibrillators-cardioverters, Ventricular Fibrillation, and First Responder
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Research Interests: Physics, Risk assessment, Stratification, Comorbidity, Cardiovascular Risk, and 22 moreEchocardiography, Adipose tissue, Humans, Arizona, Female, Male, Risk factors, Aged, Prevalence, Middle Aged, Calcinosis, Adult, Reproducibility of Results, Risk Factors, Risk Assessment, The Carotid Artery Intima Media Thickness, Indexation, Coronary Artery Disease, Pericardium, Sensitivity and Specificity, The American, and Risk Score
Congenital anomalies of the coronary arteries occur in 0.2% to 1.2% of the general population. Most coronary artery anomalies are found incidentally during angiographic evaluation for other cardiac diseases. We describe the case of a... more
Congenital anomalies of the coronary arteries occur in 0.2% to 1.2% of the general population. Most coronary artery anomalies are found incidentally during angiographic evaluation for other cardiac diseases. We describe the case of a young woman presenting with chest discomfort and fatigue where echocardiography identified a coronary artery fistula. Successful embolization of the coronary artery fistula was performed. To our knowledge, this is a unique case of an anomalous coronary artery and a fistulous anomaly in the same patient. This report describes the echocardiographic diagnosis, and the feasibility of a transcatheter management decision to avoid cardiopulmonary bypass in a patient in whom blood products are contraindicated.
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Research Interests: Management, Cardiology, Magnetic Resonance Imaging, Survival Analysis, Risk assessment, and 21 moreHR, Electrocardiography, Humans, Outcome, Aortic stenosis, Female, Male, OR, Aged, Public health systems and services research, Prognosis, Risk Assessment, Ejection Fraction, Exercise Test, Aortic Valve, Predictive value of tests, The American, LVEF, Valve replacement, Postoperative Complications, and Severity of Illness Index
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Objective: Heart failure with preserved ejection fraction (HFpEF) is a major cause of morbidity and mortality. Exercise training is an established adjuvant therapy in heart failure; however the effects of high-intensity interval training... more
Objective: Heart failure with preserved ejection fraction (HFpEF) is a major cause of morbidity and mortality. Exercise training is an established adjuvant therapy in heart failure; however the effects of high-intensity interval training (HIIT) in HFpEF are unknown. We compared the effects of HIIT versus moderate-intensity aerobic continuous training (MI-ACT) on peak oxygen uptake (VO2peak), left ventricular diastolic dysfunction, and endothelial function in patients with HFpEF. Materials and Methods: Nineteen patients with HFpEF (Age=70±8.3 years) were randomized to either HIIT (4 x 4 min at 85-90% peak heart rate, with 3 min active recovery) or MI-ACT (30 min at 70% peak heart rate). Fifteen patients completed exercise training (HIIT: n=9; MI-ACT: n=6). Patients trained 3 days/week for 4 weeks. Before and after training patients underwent a treadmill test for VO2peak determination, 2D-echocardiography for assessment of left ventricular diastolic dysfunction, and brachial artery fl...