76
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Jafar N, Moses MJ, Benenstein RJ, Vainrib AF, Slater JN, Tran HA, Donnino R, Williams MR, Saric M. 3D transesophageal echocardiography and radiography of mitral valve prostheses and repairs. Echocardiography 2017; 34:1687-1701. [DOI: 10.1111/echo.13656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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77
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Dwivedi A, Freedberg R, Donnino R, Vainrib A, Dodson JA, Saric M. Geriatric Presentation of Idiopathic Left Ventricular Aneurysm. CASE 2017; 1:84-87. [PMID: 30062251 PMCID: PMC6058218 DOI: 10.1016/j.case.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Idiopathic left ventricular aneurysm is a rare diagnosis. Management and prognosis of idiopathic left ventricular aneurysms remain unknown. We describe a conservative management of an idiopathic left ventricular aneurysm in a geriatric patient.
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78
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Underwood K, Vorsanger M, Saric M, Skolnick AH. Positional Right Ventricular Obstruction in Pectus Excavatum. Am J Cardiol 2017; 119:1288-1289. [PMID: 28214505 DOI: 10.1016/j.amjcard.2016.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022]
Abstract
Pectus excavatum is one of the most common congenital chest wall deformities. The degree of sternal depression, which may result in compression of the right heart by the chest wall, is variable. While typically asymptomatic, there are various symptoms that can result from severe pectus excavatum. We report on a patient with severe pectus excavatum leading to dynamic obstruction of the right ventricular outflow tract in the seated position.
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79
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Garshick MS, Mulliken J, Schoenfeld M, Riedy K, Guo Y, Zhong J, Dodson JA, Saric M, Skolnick A. USE OF DIASTOLIC PARAMETERS ON TRANSTHORACIC ECHOCARDIOGRAM TO PREDICT LEFT ATRIAL APPENDAGE THROMBUS IN PATIENTS WITH ATRIAL FIBRILLATION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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80
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Paone D, Shah B, McDonald D, Thakker R, Houanche P, Neuburger P, Saric M, Staniloae C, Jilaihawi H, Querijero M, Williams M. SHORT- AND MID-TERM OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH RENAL INSUFFICIENCY NOT ON HEMODIALYSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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81
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Tanna MS, Reyentovich A, Balsam LB, Dodson JA, Vainrib AF, Benenstein RJ, Rosenzweig BP, Saric M. Aortic root thrombus complicated by left main coronary artery occlusion visualized by 3D echocardiography in a patient with continuous-flow left ventricular assist device. Echocardiography 2017; 34:306-310. [PMID: 28191682 DOI: 10.1111/echo.13425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aortic root thrombus is an uncommon complication of continuous-flow left ventricular assist devices (LVAD). We present the case of a 71-year-old man with ischemic cardiomyopathy who underwent destination therapy HeartMate II LVAD placement. Eighteen months later, he presented with a cerebrovascular accident followed by myocardial infarction. Transesophageal echocardiography revealed an aortic root thrombus spanning the left and noncoronary cusps and obliterating the left main coronary artery. We discuss the incidence, risk factors, and management of aortic root thrombus in LVAD patients. To our knowledge, this is the first report of three-dimensional echocardiography used to characterize an LVAD-associated aortic root thrombus.
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82
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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83
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Chikkabyrappa S, McElhinney DB, Saric M. Subacute left ventricular outflow tract obstruction after transapical closure of a mitral paravalvular leak in the region of the aortomitral curtain. Echocardiography 2016; 33:1771-1776. [PMID: 27576330 DOI: 10.1111/echo.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a rare case of progressive left ventricular outflow tract (LVOT) obstruction after percutaneous device closure of a mechanical prosthetic mitral valve (MV) paravalvular leak (PVL) in the region of aortomitral curtain in a patient who also had small mechanical aortic valve prosthesis with patient-prosthesis mismatch.
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84
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Laura DM, Donnino R, Kim EE, Benenstein R, Freedberg RS, Saric M. Lipomatous Atrial Septal Hypertrophy: A Review of Its Anatomy, Pathophysiology, Multimodality Imaging, and Relevance to Percutaneous Interventions. J Am Soc Echocardiogr 2016; 29:717-723. [PMID: 27288088 DOI: 10.1016/j.echo.2016.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Indexed: 11/19/2022]
Abstract
Lipomatous atrial septal hypertrophy (LASH) is a histologically benign cardiac lesion characterized by excessive fat deposition in the region of the interatrial septum that spares the fossa ovalis. The etiology of LASH remains unclear, though it may be associated with advanced age and obesity. Because of the sparing of the fossa ovalis, LASH has a pathognomonic dumbbell shape. LASH may be mistaken for various tumors of the interatrial septum. Histologically, LASH is composed of both mature and brown (fetal) adipose tissue, but the role of brown adipose tissue remains unclear. In interventional procedures requiring access to the left atrium, LASH may interfere with transseptal puncture, as traversing the thickened area can reduce the maneuverability of catheters and devices. This may cause the needle to enter the epicardial space, causing dangerous pericardial effusions. LASH was once considered a contraindication to percutaneous device closure of atrial septal defects because of an associated increased risk for incorrect device deployment. However, careful attention to preprocedural imaging and procedural intracardiac echocardiography enable interventional cardiologists to perform procedures in patients with LASH without serious complications. In this review article, the authors describe anatomic and functional aspects of LASH, with emphasis on their roles in percutaneous interventions.
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85
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Kataoka A, Scherrer-Crosbie M, Senior R, Garceau P, Valbuena S, Čelutkienė J, Hastings JL, Cheema AN, Lara A, Srbinovska-Kostovska E, Hessian R, Poggio D, Goldweit R, Saric M, Dajani KA, Kohn JA, Shaw LJ, Reynolds HR, Picard MH. Transient Ischemic Dilatation during Stress Echocardiography: An Additional Marker of Significant Myocardial Ischemia. Echocardiography 2016; 33:1202-8. [PMID: 27040889 DOI: 10.1111/echo.13222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIM Left ventricular (LV) transient ischemic dilatation (TID) is not clear how it relates to inducible myocardial ischemia during stress echocardiography (SE). METHODS AND RESULTS Eighty-eight SEs were examined from the site certification phase of the ISCHEMIA Trial. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were measured at rest and peak stages and the percent change calculated. Moderate or greater ischemia was defined as ≥3 segments with stress-induced severe hypokinesis or akinesis. Optimum cut points in stress-induced percent EDV and ESV change that identified moderate or greater myocardial ischemia were analyzed. Analysis from percentage distribution identified a > 13% LV volume increase in EDV or a > 9% LV volume increase in ESV as the optimum cutoff points for moderate or greater ischemia. Using these definitions for TID, there were 27 (31%) with TIDESV and 12 (14%) with TIDEDV . By logistic regression analysis and receiver operating characteristic curves, the percent change in ESV had a stronger association with moderate or greater myocardial ischemia than that of EDV change. Compared to those without TIDESV , cases with TIDESV had larger extent of inducible wall-motion abnormalities, lower peak stress LVEF, and higher likelihood of moderate or grater ischemia. For moderate or greater myocardial ischemia detection, TIDESV had a sensitivity of 46%, specificity of 83%, positive predictive value of 70%, and negative predictive value of 64%. CONCLUSION Transient ischemic dilatation by SE is a marker of extensive myocardial ischemia and can be used as an additional marker of higher risk.
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86
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Williams M, Slater J, Saric M, Hughes C, Harrison K, Kodali S, Kipperman R, Brown J, Deeb GM, Chetcuti S, Popma J. EARLY OUTCOMES WITH THE EVOLUT R REPOSITIONABLE SELF-EXPANDING TRANSCATHETER AORTIC VALVE IN THE UNITED STATES. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32173-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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87
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Vainrib AF, Moses MJ, Benenstein RJ, Reyentovich A, Williams MR, Slater JN, Saric M. Multimodality Imaging of Bioprosthetic Percutaneous Balloon Valvuloplasty Followed by Valve-in-Valve Implantation for Mitral Stenosis Due to Commissural Leaflet Fusion. JACC Cardiovasc Interv 2016; 9:e43-5. [DOI: 10.1016/j.jcin.2015.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/19/2015] [Indexed: 11/25/2022]
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88
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Neuburger PJ, Saric M, Huang C, Williams MR. A Practical Approach to Managing Transcatheter Aortic Valve Replacement With Sedation. Semin Cardiothorac Vasc Anesth 2016; 20:147-57. [DOI: 10.1177/1089253215625111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcatheter aortic valve replacement is increasingly performed as a minimally invasive treatment option for aortic valve disease. The typical anesthetic management for this procedure was traditionally similar to surgical aortic valve replacement and involved general anesthesia and transesophageal echocardiography. In this review, we discuss the technological advances in transcatheter valve systems that have improved outcomes and allow for use of sedation instead of general anesthesia. We describe an anesthetic protocol that avoids general anesthesia and utilizes transthoracic echocardiography for procedural guidance.
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89
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Patel R, Lim RP, Saric M, Nayar A, Babb J, Ettel M, Axel L, Srichai MB. Diagnostic Performance of Cardiac Magnetic Resonance Imaging and Echocardiography in Evaluation of Cardiac and Paracardiac Masses. Am J Cardiol 2016; 117:135-40. [PMID: 26552505 DOI: 10.1016/j.amjcard.2015.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
Echocardiography is the preferred initial imaging method for assessment of cardiac masses. Cardiac magnetic resonance (CMR) imaging, with its excellent tissue characterization and wide field of view, may provide additional unique information. We evaluated the predictive value of echocardiography and CMR imaging parameters to identify tumors and malignancy and to provide histopathologic diagnosis of cardiac masses. Fifty patients who underwent CMR evaluation of a cardiac mass with subsequent histopathologic diagnosis were identified. Echocardiography was available in 44 of 50 cases (88%). Echocardiographic and CMR characteristics were evaluated for predictive value in distinguishing tumor versus nontumor and malignant versus nonmalignant lesions using histopathology as the gold standard. The Wilcoxon rank-sum test was used to compare the 2 imaging methods' ability to provide the correct histopathologic diagnosis. Parameters associated with tumor included location outside the right atrium, T2 hyperintensity, and contrast enhancement. Parameters associated with malignancy included location outside the cardiac chambers, nonmobility, pericardial effusion, myocardial invasion, and contrast enhancement. CMR identified 6 masses missed on transthoracic echocardiography (4 of which were outside the heart) and provided significantly more correct histopathologic diagnoses compared to echocardiography (77% vs 43%, p <0.0001). In conclusion, CMR offers the advantage of identifying paracardiac masses and providing crucial information on histopathology of cardiac masses.
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90
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Narula A, Benenstein RJ, Duan D, Zagha D, Li L, Choy-Shan A, Konigsberg MW, Lau G, Phillips LM, Saric M, Vreeland L, Reynolds HR. Ankle-Brachial Index Testing at the Time of Stress Testing in Patients Without Known Atherosclerosis. Clin Cardiol 2015; 39:24-9. [PMID: 26694882 DOI: 10.1002/clc.22487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/18/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Individuals referred for stress testing to identify coronary artery disease may have nonobstructive atherosclerosis, which is not detected by stress tests. Identification of increased risk despite a negative stress test could inform prevention efforts. Abnormal ankle-brachial index (ABI) is associated with increased cardiovascular risk. HYPOTHESIS Routine ABI testing in the stress laboratory will identify unrecognized peripheral arterial disease in some patients. METHODS Participants referred for stress testing without known history of atherosclerotic disease underwent ABI testing (n = 451). Ankle-brachial index was assessed via simultaneous arm and leg pressure using standard measurement, automated blood-pressure cuffs at rest. Ankle-brachial index was measured after exercise in 296 patients and 30 healthy controls. Abnormal postexercise ABI was defined as a >20% drop in ABI or fall in ankle pressure by >30 mm Hg. RESULTS Overall, 2.0% of participants had resting ABI ≤0.90, 3.1% had ABI ≥1.40, and 5.5% had borderline ABI. No patient with abnormal or borderline ABI had an abnormal stress test. Participants who met peripheral arterial disease screening criteria (age ≥65 or 50-64 with diabetes or smoking) tended toward greater frequency of low ABI (2.9% vs 1.0%; P = 0.06) and were more likely to have borderline ABI (0.91 to 0.99; 7.8% vs 2.9%; P = 0.006). Postexercise ABI was abnormal in 29.4% of patients and 30.0% of controls (P not significant). CONCLUSIONS Ankle-brachial index screening at rest just before stress testing detected low ABI in 2.0% of participants, all of whom had negative stress tests.
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91
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Chang K, Barghash M, Donnino R, Freedberg RS, Hagiwara M, Bennett G, Benenstein R, Saric M. Extrinsic Esophageal Compression by Cervical Osteophytes in Diffuse Idiopathic Skeletal Hyperostosis: A Contraindication to Transesophageal Echocardiography? Echocardiography 2015; 33:314-6. [PMID: 26603685 DOI: 10.1111/echo.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Contraindications to transesophageal echocardiography (TEE) include various esophageal pathologies, but compression of the esophagus by vertebral osteophytes is not listed in the current American Society of Echocardiography guidelines. We report a case of diffuse idiopathic skeletal hyperostosis (DISH) in an 81-year-old man who had incidentally been found to have extrinsic esophageal compression by cervical osteophytes prior to a proposed TEE. The incidence of esophageal perforation in patients with DISH and vertebral osteophytes is not well documented. We believe these patients are at increased risk of esophageal perforation during TEE, and thus, TEE may be relatively contraindicated in patients with DISH.
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92
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Neuburger P, Potosky R, Ursomanno P, Abdallah R, Saric M, Benenstein RJ, Staniloae CS, Slater J, Querijero M, Williams M. TCT-632 Implementation of a Moderate Sedation Protocol for Transfemoral Transcatheter Aortic Valve Replacement: A Review at 6 Months. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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93
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Aizer A, Young W, Saric M, Holmes D, Fowler S, Chinitz L. Three-dimensional transesophageal echocardiography to facilitate transseptal puncture and left atrial appendage occlusion via upper extremity venous access. Circ Arrhythm Electrophysiol 2015; 8:988-90. [PMID: 26286309 DOI: 10.1161/circep.115.002780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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94
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Kronzon I, Jelnin V, Ruiz CE, Saric M, Williams MR, Kasel AM, Shivaraju A, Colombo A, Kastrati A. Optimal Imaging for Guiding TAVR: Transesophageal or Transthoracic Echocardiography, or Just Fluoroscopy? JACC Cardiovasc Imaging 2015; 8:361-370. [DOI: 10.1016/j.jcmg.2015.01.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
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95
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Saleh M, Balakrishnan R, Castillo Kontak L, Benenstein R, Chinitz LA, Donnino R, Saric M. Congenital Absence of the Left Atrial Appendage Visualized by 3D Echocardiography in Two Adult Patients. Echocardiography 2015; 32:1206-10. [DOI: 10.1111/echo.12882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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96
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Hussain A, Saric M, Bernstein S, Holmes D, Chinitz L. Hemostasis of left atrial appendage bleed with lariat device. Indian Pacing Electrophysiol J 2014; 14:273-7. [PMID: 25408569 PMCID: PMC4217304 DOI: 10.1016/s0972-6292(16)30800-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
New devices designed for minimally invasive closure of the left atrial appendage (LAA) may be a viable alternative for patients in whom anticoagulation is considered high risk. The Lariat (Sentreheart, Redwood City, CA), which is currently FDA-approved for percutaneous closure of tissue, requires both trans-septal puncture and epicardial access. However it requires no anticoagulation after the procedure. Here we describe a case of effusion and tamponade during a Lariat procedure with successful completion of the case and resolution of the effusion.
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97
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Hastings RS, McElhinney DB, Saric M, Ngai C, Skolnick AH. Embolic myocardial infarction in a patient with a Fontan circulation. World J Pediatr Congenit Heart Surg 2014; 5:631-4. [PMID: 25324270 DOI: 10.1177/2150135114540180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coronary artery embolism is an uncommon cause of acute myocardial infarction (MI). We present a patient with pulmonary atresia and severe right heart hypoplasia who underwent a lateral tunnel Fontan procedure in childhood and presented with an acute ST-segment elevation MI at 19 years of age. In addition to the known risk of thrombotic complications associated with a Fontan circulation, potential predisposing factors to thromboembolism in this patient included a right ventricle to left anterior descending coronary connection and a Fontan baffle leak. The patient was treated with device closure of the baffle leak and anticoagulation. This is one of the first reports of an embolic MI in a patient with a Fontan circulation. The optimal method of reducing thromboembolic risk in this patient, and those with a Fontan circulation in general, is complicated and no consensus exists.
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98
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Mecklai A, Rosenzweig B, Applebaum R, Axel L, Grossi E, Chan A, Saric M. Intimal sarcoma in the aortic arch partially obstructing the aorta with metastasis to the brain. Tex Heart Inst J 2014; 41:433-6. [PMID: 25120401 DOI: 10.14503/thij-13-3448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary tumors of the aorta are rare entities. We report the unusual manifestation of an aortic intimal sarcoma that presented as a brain metastasis in a 56-year-old, otherwise healthy woman. After the brain mass had been resected, multiple imaging methods revealed pseudocoarctation and the primary tumor in the aortic arch. To our knowledge, this is the first report of the diagnosis of an aortic intimal sarcoma with use of real-time, 3-dimensional transesophageal echocardiography.
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99
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Lader JM, Lam G, Donnino R, Katz ES, DeAnda A, Ettel M, Saric M. Lone aortic insufficiency and conduction disease: a marker of reactive arthritis. Echocardiography 2014; 31:E271-4. [PMID: 25059534 DOI: 10.1111/echo.12691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 48-year-old male with history of chronic arthritis and uveitis presented with 1 year of progressively reduced exercise capacity and nonexertional chest pain. Physical examination was consistent with severe aortic insufficiency. An electrocardiogram demonstrated sinus rhythm with first degree atrioventricular block. Transthoracic and transesophageal echocardiography demonstrated severe lone central aortic insufficiency of a trileaflet valve due to leaflet thickening, retraction of leaflet margins and mild aortic root dilation in the setting of left ventricular dilatation. In addition, computed tomographic angiography revealed a small focal aneurysm of the distal transverse arch. He was found to be positive for the immunogenetic marker HLA-B27. The patient subsequently underwent uncomplicated mechanical aortic valve replacement. The diagnosis of HLA-B27 associated cardiac disease should be entertained in any individual with lone aortic insufficiency, especially if accompanied by conduction disease.
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100
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Laura DM, Chinitz LA, Aizer A, Holmes DS, Benenstein R, Freedberg RS, Kim EE, Saric M. The Role of Multimodality Imaging in Percutaneous Left Atrial Appendage Suture Ligation with the LARIAT Device. J Am Soc Echocardiogr 2014; 27:699-708. [DOI: 10.1016/j.echo.2014.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Indexed: 10/25/2022]
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