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Hai T, Amador Y, Mahmood F, Jeganathan J, Khamooshian A, Knio ZO, Matyal R, Nicoara A, Liu DC, Senthilnathan V, Khabbaz KR. Changes in Tricuspid Annular Geometry in Patients with Functional Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2017; 31:2106-2114. [PMID: 29100836 DOI: 10.1053/j.jvca.2017.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether the indices of tricuspid annular dynamics that signify irreversible tricuspid valvular remodeling can improve surgical decision making by helping to better identify patients with functional tricuspid regurgitation who could benefit from annuloplasty. DESIGN Retrospective analysis study. SETTING Tertiary hospital. PARTICIPANTS A total number of 55 patients were selected, 18 with functional tricuspid valve (TV) regurgitation and 37 normal nonregurgitant TVs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS When comparing the basal, mid, and longitudinal diameters of the right ventricle between the nonregurgitant valve (NTR) group and the functional tricuspid regurgitation (FTR) group, tricuspid annulus was more dilated (p < 0.001, p = 0.001, and p = 0.006, respectively) and less nonplanar (p < 0.001) in the FTR group. At end-systole (ES), the posterolateral-anteroseptal axis was significantly greater in the FTR group than in the NTR group (mean difference = 7.15 mm; p < 0.001). The right ventricle in the FTR group was also significantly dilated with greater leaflet restriction (p = 0.015). CONCLUSIONS As compared to NTR TVs, FTR is associated with identifiable indices of tricuspid annular structural changes that are indicative of irreversible remodeling.
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O'Donnell TFX, Shean KE, Deery SE, Bodewes TC, Wyers MC, O'Brien KL, Matyal R, Schermerhorn ML. IP027. A Preoperative Risk Score for Transfusion in Infrarenal Endovascular Aneurysm Repair to Avoid Type and Cross. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bortman J, Knio Z, Amir R, Hamid K, Mahmood F, Matyal R. Perioperative Surface Ultrasound for Placement and Confirmation of Central Venous Access: A Case Report. ACTA ACUST UNITED AC 2017; 8:197-199. [PMID: 28118211 DOI: 10.1213/xaa.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a case highlighting that the real-time visualization of the guidewire in the internal jugular vein with ultrasound, and confirmation of correct position of the guidewire tip at the superior vena cava to right atrial junction with surface ultrasound, is possibly the safest method of central venous catheter insertion.
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Woltersom A, Matyal R, Mahmood F. Tracing and animating to help define the dynamics of the tricuspid - and mitral valve annulus. J Cardiothorac Vasc Anesth 2017. [DOI: 10.1053/j.jvca.2017.02.122] [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: 11/11/2022]
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80
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Knio ZO, Montealegre-Gallegos M, Yeh L, Chaudary B, Jeganathan J, Matyal R, Khabbaz KR, Liu DC, Senthilnathan V, Mahmood F. Tricuspid annulus: A spatial and temporal analysis. Ann Card Anaesth 2017; 19:599-605. [PMID: 27716689 PMCID: PMC5070318 DOI: 10.4103/0971-9784.191569] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Traditional two-dimensional (2D) echocardiographic evaluation of tricuspid annulus (TA) dilation is based on single-frame measurements of the septolateral (S-L) dimension. This may not represent either the axis or the extent of dynamism through the entire cardiac cycle. In this study, we used real-time 3D transesophageal echocardiography (TEE) to analyze geometric changes in multiple axes of the TA throughout the cardiac cycle in patients without right ventricular abnormalities. Materials and Methods: R-wave-gated 3D TEE images of the TA were acquired in 39 patients undergoing cardiovascular surgery. The patients with abnormal right ventricular/tricuspid structure or function were excluded from the study. For each patient, eight points along the TA were traced in the 3D dataset and used to reconstruct the TA at four stages of the cardiac cycle (end- and mid-systole, end- and mid-diastole). Statistical analyses were applied to determine whether TA area, perimeter, axes, and planarity changed significantly over each stage of the cardiac cycle. Results: TA area (P = 0.012) and perimeter (P = 0.024) both changed significantly over the cardiac cycle. Of all the axes, only the posterolateral-anteroseptal demonstrated significant dynamism (P < 0.001). There was also a significant displacement in the vertical axis between the points and the regression plane in end-systole (P < 0.001), mid-diastole (P = 0.014), and mid-systole (P < 0.001). Conclusions: The TA demonstrates selective dynamism over the cardiac cycle, and its axis of maximal dynamism is different from the axis (S-L) that is routinely measured with 2D TEE.
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Eshun D, Saraf R, Bae S, Jeganathan J, Mahmood F, Dilmen S, Ke Q, Lee D, Kang PM, Matyal R. Neuropeptide Y 3-36 incorporated into PVAX nanoparticle improves functional blood flow in a murine model of hind limb ischemia. J Appl Physiol (1985) 2017; 122:1388-1397. [PMID: 28302707 DOI: 10.1152/japplphysiol.00467.2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 02/21/2017] [Accepted: 03/12/2017] [Indexed: 02/07/2023] Open
Abstract
We generated a novel nanoparticle called PVAX, which has intrinsic antiapoptotic and anti-inflammatory properties. This nanoparticle was loaded with neuropeptide Y3-36 (NPY3-36), an angiogenic neurohormone that plays a central role in angiogenesis. Subsequently, we investigated whether PVAX-NPY3-36 could act as a therapeutic agent and induce angiogenesis and vascular remodeling in a murine model of hind limb ischemia. Adult C57BL/J6 mice (n = 40) were assigned to treatment groups: control, ischemia PBS, ischemia PVAX, ischemia NPY3-36, and Ischemia PVAX-NPY3-36 Ischemia was induced by ligation of the femoral artery in all groups except control and given relevant treatments (PBS, PVAX, NPY3-36, and PVAX-NPY3-36). Blood flow was quantified using laser Doppler imaging. On days 3 and 14 posttreatment, mice were euthanized to harvest gastrocnemius muscle for immunohistochemistry and immunoblotting. Blood flow was significantly improved in the PVAX-NPY3-36 group after 14 days. Western blot showed an increase in angiogenic factors VEGF-R2 and PDGF-β (P = 0.0035 and P = 0.031, respectively) and antiapoptotic marker Bcl-2 in the PVAX-NPY3-36 group compared with ischemia PBS group (P = 0.023). Proapoptotic marker Smad5 was significantly decreased in the PVAX-NPY3-36 group as compared with the ischemia PBS group (P = 0.028). Furthermore, Y2 receptors were visualized in endothelial cells of newly formed arteries in the PVAX-NPY3-36 group. In conclusion, we were able to show that PVAX-NPY3-36 can induce angiogenesis and arteriogenesis as well as improve functional blood flow in a murine model of hind limb ischemia.NEW & NOTEWORTHY Our research project proposes a novel method for drug delivery. Our patented PVAX nanoparticle can detect areas of ischemia and oxidative stress. Although there have been studies about delivering angiogenic molecules to areas of ischemic injury, there are drawbacks of nonspecific delivery as well as short half-lives. Our study is unique because it can specifically deliver NPY3-36 to ischemic tissue and appears to extend the amount of time therapy is available, despite NPY3-36's short half-life.
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Mahmood F, Knio ZO, Yeh L, Amir R, Matyal R, Mashari A, Gorman RC, Gorman JH, Khabbaz KR. Regional Heterogeneity in the Mitral Valve Apparatus in Patients With Ischemic Mitral Regurgitation. Ann Thorac Surg 2017; 103:1171-1177. [PMID: 28274519 DOI: 10.1016/j.athoracsur.2016.11.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/17/2016] [Accepted: 11/28/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Apical displacement of the coaptation point of the mitral valve (MV) in response to ischemic mitral regurgitation (IMR) represents remodeling of the MV apparatus. Whereas it implies chronicity, it lacks specificity in discriminating normal from a significantly remodeled MV apparatus. Regional aspects of MV remodeling have shown superior value over global remodeling in predicting recurrence after MV repair for IMR. Quite possibly, presence of specific regional changes in MV geometry that are unique to chronic IMR patients could also be used to diagnose the presence and track progression of remodeling. Knowledge of these changes in MV apparatus in patients with IMR can possibly be used to identify patients for surgical intervention before irreversible remodeling occurs. METHODS Three-dimensional transesophageal echocardiographic data were collected from patients who underwent MV surgery for IMR (IMR group, n = 66), and from patients with normal valvular and biventricular function (control group, n = 10). The acquired data of the MV were geometrically analyzed to make regional comparisons between the IMR and the control group to identify measurements that reliably differentiate normal from remodeled MVs. RESULTS Lengthening of the middle potion of the anterior annulus (A2 regional perimeter: 11.149 mm versus 9.798 mm, p = 0.0041), larger nonplanarity angle (147.985 versus 140.720 degrees, p = 0.0459), and increased tenting angle of the posteromedial scallop of the posterior leaflet (P3 tenting angle: 44.354 versus 40.461 degrees, p = 0.0435) were sufficient in differentiating between IMR and the control group. CONCLUSIONS Specific three-dimensional changes in MV geometry can be used to reliably identify a significantly remodeled valve apparatus.
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Khamooshian A, Amador Y, Hai T, Jeganathan J, Saraf M, Mahmood E, Matyal R, Khabbaz KR, Mariani M, Mahmood F. Dynamic Three-Dimensional Geometry of the Aortic Valve Apparatus-A Feasibility Study. J Cardiothorac Vasc Anesth 2017; 31:1290-1300. [PMID: 28800987 DOI: 10.1053/j.jvca.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide (1) an overview of the aortic valve (AV) apparatus anatomy and nomenclature, and (2) data regarding the normal AV apparatus geometry and dynamism during the cardiac cycle obtained from three-dimensional transesophageal echocardiography (3D TEE). DESIGN Retrospective feasibility study. SETTING A single-center university teaching hospital. PARTICIPANTS The study was performed on data of 10 patients with a nonregurgitant, nonstenotic aortic valve undergoing cardiac surgery. INTERVENTIONS Intraoperative 3D TEE was performed on all the participants using the Siemens ACUSON SC2000 ultrasound system and Z6Ms transducer (Siemens Medical Systems, Mountainview, CA). MEASUREMENTS AND MAIN RESULTS Dynamic offline analyses were performed with Siemens eSie valve analytical software in a semiautomated fashion. Forty-five parameters were exported of which 13 were selected and analyzed. The cardiac cycle was divided into 4 quartiles to account for frame-rate variations. The annulus, sinus of Valsalva (SoV) and sinotubular junction (STJ) areas, diameter, perimeter and height, aortic leaflet height, leaflet coaptation height, and aortic valve-mitral valve angle changed significantly during the cardiac cycle (p < 0.001). STJ expanded more than both the annulus and the SoV (p < 0.001). The maximum aortic valve leaflet height change was greater in the left and right versus noncoronary leaflet (p < 0.001). CONCLUSIONS The semiautomated AV apparatus dynamic assessment using eSie valve software is a clinically feasible technique and can be performed readily in the operating room. It has the potential to significantly impact intraoperative decision-making in cases suitable for AV repair. The AV apparatus is a dynamic structure and demonstrates significant changes during the cardiac cycle.
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Baribeau Y, Amir R, Matyal R, Mahmood F. A Second Look at Dilation of the Ascending Aorta. J Cardiothorac Vasc Anesth 2017; 31:1535-1537. [PMID: 28389186 DOI: 10.1053/j.jvca.2017.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Indexed: 11/11/2022]
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85
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Yeh L, Montealegre-Gallegos M, Mahmood F, Hess PE, Shnider M, Mitchell JD, Jones SB, Mashari A, Wong V, Matyal R. Assessment of Perioperative Ultrasound Workflow Understanding: A Consensus. J Cardiothorac Vasc Anesth 2017; 31:197-202. [DOI: 10.1053/j.jvca.2016.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 11/11/2022]
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86
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Montealegre-Gallegos M, Mahmood F, Kim H, Bergman R, Mitchell JD, Bose R, Hawthorne KM, O'Halloran TD, Wong V, Hess PE, Matyal R. Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics. Ann Card Anaesth 2017; 19:245-50. [PMID: 27052064 PMCID: PMC4900337 DOI: 10.4103/0971-9784.179595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training. METHODS AND RESULTS During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions). The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations) were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance. CONCLUSION Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE.
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Mashari A, Montealegre-Gallegos M, Knio Z, Yeh L, Jeganathan J, Matyal R, Khabbaz KR, Mahmood F. Making three-dimensional echocardiography more tangible: a workflow for three-dimensional printing with echocardiographic data. Echo Res Pract 2016; 3:R57-R64. [PMID: 27974356 PMCID: PMC5302065 DOI: 10.1530/erp-16-0036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/14/2016] [Indexed: 11/08/2022] Open
Abstract
Three-dimensional (3D) printing is a rapidly evolving technology with several potential applications in the diagnosis and management of cardiac disease. Recently, 3D printing (i.e. rapid prototyping) derived from 3D transesophageal echocardiography (TEE) has become possible. Due to the multiple steps involved and the specific equipment required for each step, it might be difficult to start implementing echocardiography-derived 3D printing in a clinical setting. In this review, we provide an overview of this process, including its logistics and organization of tools and materials, 3D TEE image acquisition strategies, data export, format conversion, segmentation, and printing. Generation of patient-specific models of cardiac anatomy from echocardiographic data is a feasible, practical application of 3D printing technology.
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Khamooshian A, Hai T, Amador Y, Jeganathan J, Mahmood F, Matyal R. Intraoperative Challenges in the Management of Biventricular Failure in Takotsubo Cardiomyopathy. J Cardiothorac Vasc Anesth 2016; 31:1318-1321. [PMID: 28262450 DOI: 10.1053/j.jvca.2016.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Indexed: 11/11/2022]
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89
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Bardia A, Sood A, Mahmood F, Orhurhu V, Mueller A, Montealegre-Gallegos M, Shnider MR, Ultee KHJ, Schermerhorn ML, Matyal R. Combined Epidural-General Anesthesia vs General Anesthesia Alone for Elective Abdominal Aortic Aneurysm Repair. JAMA Surg 2016; 151:1116-1123. [DOI: 10.1001/jamasurg.2016.2733] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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90
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Owais K, Mahmood F, Khabbaz KR, Matyal R. Systolic Anterior Motion after Myocardial Revascularization-The Unusual Suspect. J Cardiothorac Vasc Anesth 2016; 32:1825-1827. [PMID: 27842948 DOI: 10.1053/j.jvca.2016.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 11/11/2022]
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91
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Khamooshian A, Hai T, Amador Y, Jeganathan J, Matyal R. Recurrent Pulmonary Vein Stenosis After Pulmonary Vein Isolation. J Cardiothorac Vasc Anesth 2016; 31:1007-1009. [PMID: 28041807 DOI: 10.1053/j.jvca.2016.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Indexed: 11/11/2022]
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Owais K, Montealegre-Gallegos M, Jeganathan J, Matyal R, Khabbaz KR, Mahmood F. Dynamic changes in the ischemic mitral annulus: Implications for ring sizing. Ann Card Anaesth 2016; 19:15-9. [PMID: 26750668 PMCID: PMC4900374 DOI: 10.4103/0971-9784.173014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Contrary to the rest of the mitral annulus, inter-trigonal distance is known to be relatively less dynamic during the cardiac cycle. Therefore, intertrigonal distance is considered a suitable benchmark for annuloplasty ring sizing during mitral valve (MV) surgery. The entire mitral annulus dilates and flattens in patients with ischemic mitral regurgitation (IMR). It is assumed that the fibrous trigone of the heart and the intertrigonal distance does not dilate. In this study, we sought to demonstrate the changes in mitral annular geometry in patients with IMR and specifically analyze the changes in intertrigonal distance during the cardiac cycle. METHODS Intraoperative three-dimensional transesophageal echocardiographic data obtained from 26 patients with normal MVs undergoing nonvalvular cardiac surgery and 36 patients with IMR undergoing valve repair were dynamically analyzed using Philips Qlab ® software. RESULTS Overall, regurgitant valves were larger in area and less dynamic than normal valves. Both normal and regurgitant groups displayed a significant change in annular area (AA) during the cardiac cycle (P < 0.01 and P < 0.05, respectively). Anteroposterior and anterolateral-posteromedial diameters and inter-trigonal distance increased through systole (P < 0.05 for all) in accordance with the AAs in both groups. However, inter-trigonal distance showed the least percentage change across the cardiac cycle and its reduced dynamism was validated in both cohorts (P > 0.05). CONCLUSIONS Annular dimensions in regurgitant valves are dynamic and can be measured feasibly and accurately using echocardiography. The echocardiographically identified inter-trigonal distance does not change significantly during the cardiac cycle.
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Mashari A, Knio Z, Jeganathan J, Montealegre-Gallegos M, Yeh L, Amador Y, Matyal R, Saraf R, Khabbaz K, Mahmood F. Hemodynamic Testing of Patient-Specific Mitral Valves Using a Pulse Duplicator: A Clinical Application of Three-Dimensional Printing. J Cardiothorac Vasc Anesth 2016; 30:1278-85. [DOI: 10.1053/j.jvca.2016.01.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Indexed: 11/11/2022]
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Belani K, Montealegre-Gallegos M, Ferla B, Matyal R. Intrapleural placement of a thoracic epidural catheter in a patient with spinal stenosis. J Clin Anesth 2016; 35:195-197. [PMID: 27871519 DOI: 10.1016/j.jclinane.2016.07.023] [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] [Received: 03/09/2016] [Revised: 05/31/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
Due to the close proximity of the thoracic epidural space and parietal pleura, pleural puncture with intrapleural catheter placement is a potential complication of thoracic epidural anesthesia. The authors present a case of an obese patient with a history of spinal stenosis that underwent thoracotomy. Repeated failed attempts at epidural anesthesia were complicated by intrapleural placement of the catheter. The patient subsequently developed clinical signs of pneumothorax and required urgent thoracostomy.
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Mahmood F, Matyal R, Skubas N, Montealegre-Gallegos M, Swaminathan M, Denault A, Sniecinski R, Mitchell JD, Taylor M, Haskins S, Shahul S, Oren-Grinberg A, Wouters P, Shook D, Reeves ST. Perioperative Ultrasound Training in Anesthesiology. Anesth Analg 2016; 122:1794-804. [DOI: 10.1213/ane.0000000000001134] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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96
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Amir R, Yeh L, Montealegre-Gallegos M, Saraf R, Matyal R, Mahmood F. A Tight Spot After Pulmonary Vein Catheter Ablation. J Cardiothorac Vasc Anesth 2016; 30:1748-1749. [PMID: 27542905 DOI: 10.1053/j.jvca.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 11/11/2022]
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97
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Mahmood F, Jeganathan J, Saraf R, Shahul S, Swaminathan M, Burkhard Mackensen G, Knio Z, Matyal R. A Practical Approach to an Intraoperative Three-Dimensional Transesophageal Echocardiography Examination. J Cardiothorac Vasc Anesth 2016; 30:470-90. [DOI: 10.1053/j.jvca.2015.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Indexed: 12/15/2022]
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98
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Montealegre-Gallegos M, Pal A, Matyal R. Pro: Simulation training in transesophageal echocardiography. J Cardiothorac Vasc Anesth 2016; 28:1410-1. [PMID: 25281051 DOI: 10.1053/j.jvca.2014.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Indexed: 11/11/2022]
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99
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Amir R, Yeh L, Matyal R, Mahmood F. An Echodensity in the Sinus of Valsalva. J Cardiothorac Vasc Anesth 2016; 30:1742-1743. [PMID: 27461797 DOI: 10.1053/j.jvca.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Indexed: 11/11/2022]
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100
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Saraf R, Mahmood F, Amir R, Matyal R. Neuropeptide Y is an angiogenic factor in cardiovascular regeneration. Eur J Pharmacol 2016; 776:64-70. [PMID: 26875634 DOI: 10.1016/j.ejphar.2016.02.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/27/2016] [Accepted: 02/09/2016] [Indexed: 12/13/2022]
Abstract
In diabetic cardiomyopathy, there is altered angiogenic signaling and increased oxidative stress. As a result, anti-angiogenic and pro-inflammatory pathways are activated. These disrupt cellular metabolism and cause fibrosis and apoptosis, leading to pathological remodeling. The autonomic nervous system and neurotransmitters play an important role in angiogenesis. Therapies that promote angiogenesis may be able to relieve the pathology in these disease states. Neuropeptide Y (NPY) is the most abundantly produced and expressed neuropeptide in the central and peripheral nervous systems in mammals and plays an important role in promoting angiogenesis and cardiomyocyte remodeling. It produces effects through G-protein-coupled Y receptors that are widely distributed and also present on the myocardium. Some of these receptors are also involved in diseased states of the heart. NPY has been implicated as a potent growth factor, causing cell proliferation in multiple systems while the NPY3-36 fragment is selective in stimulating angiogenesis and cardiomyocyte remodeling. Current research is focusing on developing a drug delivery mechanism for NPY to prolong therapy without having significant systemic consequences. This could be a promising innovation in the treatment of diabetic cardiomyopathy and ischemic heart disease.
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