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Cueto-Robledo G, González-Hermosillo LM, Porres-Aguilar M, Navarro-Vergara DI, Garcia-Cesar M, Torres-Rojas MB, Martinez-Carrillo AD, Cajigas HR. Complications of Right Heart Catheterization in Patients ≥70 Years of Age With Suspected Pulmonary Hypertension: Experience From a Tertiary Care Center. Curr Probl Cardiol 2024; 49:102136. [PMID: 37858849 DOI: 10.1016/j.cpcardiol.2023.102136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
Right heart catheterization (RHC) represents the gold standard diagnostic approach for pulmonary hypertension (PH). Historically, the complication rates of RHC are known to be low. The study aimed to evaluate the indications for performing RHC and the occurrence of adverse events related to the procedure in patients > over 70 years of age in a Mexican Tertiary Care Center. We conducted a retrospective single-center registry from July 2017 to July 2022. A total of 517 patients with suspected PH underwent RHC. The cohort included patients <70 (n = 427) and ≥70 years of age (n = 90). Adverse events were classified as major (eg, death, pneumothorax, and carotid artery puncture) and minor (eg, atrial arrhythmia, superior vena cava dissection, incidental arterial puncture, and local hematoma). Appropriate hemodynamic parameters were recorded. No report of major adverse events in the entire cohort. In the <70 years age group, 9 minor events, and 3 minor events were in the ≥70-year-old patients (P < 0.0001). There was a significant difference in the measurement of mean pulmonary artery pressure (mPAP) between the <70 years old vs ≥70 years old (P < 0.001); there was a significant difference in right atrial pressures: 4.71 ± 3.14 mmHg in the <70-year-old vs 4.07 ± 1.94 mmHg for the ≥ 70-year-old group (P = 0.014). Our findings suggest that RHC can be safely performed in patients aged ≥70 years using different vascular access routes without significant major complications.
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Affiliation(s)
- Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Leslie-Marisol González-Hermosillo
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Doctorate Program in Biomedical Sciences, Postgraduate Unit. National Autonomous University of Mexico, Mexico City, Mexico
| | - Mateo Porres-Aguilar
- Divisions of Hospital and Adult Thrombosis Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center and Paul L. Foster School of Medicine, El Paso, TX
| | - Dulce-Iliana Navarro-Vergara
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Marisol Garcia-Cesar
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | - Maria-Berenice Torres-Rojas
- Cardiorespiratory Emergencies, Hospital General de México 'Dr Eduardo Liceaga', Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico
| | | | - Hector R Cajigas
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Grinstein J, Sinha SS, Goswami RM, Patel PA, Cyrille-Superville N, Neyestanak ME, Feliberti JP, Snipelisky DF, Devore AD, Najjar SS, Jeng EI, Rao SD. Variation in Hemodynamic Assessment and Interpretation: A Call to Standardize the Right Heart Catheterization. J Card Fail 2023; 29:1507-1518. [PMID: 37352965 DOI: 10.1016/j.cardfail.2023.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Invasive hemodynamic measurement via right heart catheterization has shown divergent data in its role in the treatment of patients with heart failure (HF) and cardiogenic shock. We hypothesized that variation in data acquisition technique and interpretation might contribute to these observations. We sought to assess differences in hemodynamic acquisition and interpretation by operator subspecialty as well as level of experience. METHODS AND RESULTS Individual-level responses to how physicians both collect and interpret hemodynamic data at the time of right heart catheterization was solicited via a survey distributed to international professional societies in HF and interventional cardiology. Data were stratified both by operator subspecialty (HF specialists or interventional cardiologists [IC]) and operator experience (early career [≤10 years from training] or late career [>10 years from training]) to determine variations in clinical practice. For the sensitivity analysis, we also look at differences in each subgroup. A total of 261 responses were received. There were 141 clinicians (52%) who self-identified as HF specialists, 99 (38%) identified as IC, and 20 (8%) identified as other. There were 142 early career providers (54%) and late career providers (119 [46%]). When recording hemodynamic values, there was considerable variation in practice patterns, regardless of subspecialty or level of experience for the majority of the intracardiac variables. There was no agreement or mild agreement among HF and IC as to when to record right atrial pressures or pulmonary capillary wedge pressures. HF cardiologists were more likely to routinely measure both Fick and thermodilution cardiac output compared with IC (51% vs 29%, P < .001), something mirrored in early career vs later career cardiologists. CONCLUSIONS Significant variation exists between the acquisition and interpretation of right heart catheterization measurements between HF and IC, as well as those early and late in their careers. With the growth of the heart team approach to management of patients in cardiogenic shock, standardization of both assessment and management practices is needed.
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Affiliation(s)
- Jonathan Grinstein
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
| | - Shashank S Sinha
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax Virginia
| | - Rohan M Goswami
- Division of Transplant, Research and Innovation, Mayo Clinic in Florida, Jacksonville Florida
| | - Priyesh A Patel
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | | | - Maryam E Neyestanak
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Jason P Feliberti
- University of South Florida Heart and Vascular Institute, Transplant Cardiology, Tampa, Florida
| | - David F Snipelisky
- Section of Heart Failure & Cardiac Transplant Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Adam D Devore
- Division of Cardiology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Samer S Najjar
- Medstar Heart and Vascular Institute, Baltimore Maryland
| | - Eric I Jeng
- Department of surgery, Division of cardiovascular surgery, University of Florida, Gainesville, Florida
| | - Sriram D Rao
- Medstar Washington Hospital Center, Division of Cardiology, Georgetown University, Department of Medicine, Washington DC
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Sunder T, Ramesh Thangaraj P, Kumar Kuppusamy M, Balasubramanian Sriraman K, Selvi and
Srinivasan Yaswanth Kumar C. Lung Transplantation for Pulmonary Artery Hypertension. NEW INSIGHTS ON PULMONARY HYPERTENSION [WORKING TITLE] 2023. [DOI: 10.5772/intechopen.1002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This manuscript discusses the role of lung transplantation in patients with pulmonary hypertension. The indications and timing for referral to a transplant unit and timing for wait-listing for lung transplantation are discussed. The type of transplantation—isolated (single or double) lung transplantation and situations when combined heart and double lung transplantation is indicated—will be elaborated. Escalation of medical therapy with the need and timing for bridging therapies such as extracorporeal membrane oxygenation until an appropriate organ becomes available will be discussed. Challenges in the postoperative period, specific to lung transplantation for pulmonary artery hypertension, will be reviewed. The outcomes following lung transplantation will also be considered in greater detail.
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Lauzier DC, Huguenard AL, Srienc AI, Cler SJ, Osbun JW, Chatterjee AR, Vellimana AK, Kansagra AP, Derdeyn CP, Cross DT, Moran CJ. A review of technological innovations leading to modern endovascular brain aneurysm treatment. Front Neurol 2023; 14:1156887. [PMID: 37114225 PMCID: PMC10126349 DOI: 10.3389/fneur.2023.1156887] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Tools and techniques utilized in endovascular brain aneurysm treatment have undergone rapid evolution in recent decades. These technique and device-level innovations have allowed for treatment of highly complex intracranial aneurysms and improved patient outcomes. We review the major innovations within neurointervention that have led to the current state of brain aneurysm treatment.
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Affiliation(s)
- David C. Lauzier
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- *Correspondence: David C. Lauzier ;
| | - Anna L. Huguenard
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Anja I. Srienc
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Samuel J. Cler
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Joshua W. Osbun
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Arindam R. Chatterjee
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ananth K. Vellimana
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Akash P. Kansagra
- Department of Neurointerventional Surgery, California Center of Neurointerventional Surgery, San Diego, CA, United States
| | - Colin P. Derdeyn
- Department of Radiology, University of Iowa School of Medicine, Iowa City, IA, United States
| | - Dewitte T. Cross
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Christopher J. Moran
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Right Heart Catheterization (RHC): A comprehensive review of provocation tests and hepatic hemodynamics in patients with pulmonary hypertension (PH). Curr Probl Cardiol 2022; 47:101351. [DOI: 10.1016/j.cpcardiol.2022.101351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 12/26/2022]
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Yan F, Wang P, Xiong Z, Yang F, Cai W, Wang GX, Tan YH, Zhang J, Yang L. Pulmonary Artery Catheter in Patients with Severe Acute Pancreatitis: A Single-Center Retrospective Study. Dig Dis Sci 2022; 67:667-675. [PMID: 33570682 DOI: 10.1007/s10620-021-06881-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE It is still uncertain what effects pulmonary artery catheter (PAC)-guided resuscitation has on outcomes for patients with severe acute pancreatitis (SAP). Therefore, we aimed to investigate the effect of PAC on hospital mortality in patients with SAP. METHODS We collected the data of patients with a diagnosis of SAP from January 10, 2017, to July 30, 2019. Patients were divided into a PAC group and a control group. The primary outcome measured was the day-28 mortality. Secondary outcomes included day-90 mortality, duration of ICU and hospital stay, ventilation days, usage of renal support and vasoactive agents, incidences of acute abdominal compartment syndrome, infusion volumes, and fluid balance and hemodynamic characteristics measured by the PAC. Kaplan-Meier analysis was applied to estimate survival outcomes. Complications related to PAC were also analyzed. RESULTS There was no significant difference between the PAC group and the control group for day-28 mortality (22.7% vs. 30%, odds ratio, 0.69; 95% CI 0.31-1.52; P = 0.35). The duration of ICU stay in the PAC group was shorter (P = 0.00), and the rate of dependence on renal support treatment was lower in the PAC group than in the control group (P = 0.03). There was no difference in other secondary outcomes and no significant difference in the survival curve between the two groups (log-rank P = 0.72, X2 = 0.13). However, SAP patients inserted PAC within 24 h ICU admission showed that duration of renal support therapy in PAC patients within 24 h ICU admission (mean days, 1.60; standard deviation, 0.14) was shorter than those with 24-72 h ICU admission (mean days, 2.94; standard deviation, 0.73; P = 0.03). The organ failure rates (1 organ, 2 organs and 3 organs) were all lower in PAC patients within 24 h ICU admission than with 24-72 h ICU admission (P = 0.02, P = 0.02, P = 0.048, respectively). CONCLUSION In patients with severe acute pancreatitis, PAC-guided fluid resuscitation shortened the duration of ICU stay, and patients in the PAC group had a lower rate of dependence on renal support, while no benefit in terms of mortality was observed. However, SAP patients inserted PAC within 24 h ICU admission showed shorter duration of renal support therapy and lower organ failure rates than those with 24-72 h ICU admission, indicating that early use of PAC, especially within 24 h, might be better for SAP patients.
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Affiliation(s)
- Fang Yan
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.,Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Ping Wang
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Zhen Xiong
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Fang Yang
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Wei Cai
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Guo-Xiang Wang
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Yun-Hui Tan
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Jing Zhang
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Li Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
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8
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Laird CT, Cox S, Nakayama DK. Vascular access: Centuries of progress. Semin Pediatr Surg 2021; 30:151118. [PMID: 34930588 DOI: 10.1016/j.sempedsurg.2021.151118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chris T Laird
- Division of Pediatric General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO, United States.
| | - Sharon Cox
- Division of Paediatric Surgery, University of Cape Town, Cape Town, South Africa
| | - Don K Nakayama
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, United States
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Ghafari C, Carlier S. Stent visualization methods to guide percutaneous coronary interventions and assess long-term patency. World J Cardiol 2021; 13:416-437. [PMID: 34621487 PMCID: PMC8462039 DOI: 10.4330/wjc.v13.i9.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
Evaluation of acute percutaneous coronary intervention (PCI) results and long-term follow-up remains challenging with ongoing stent designs. Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion, improving overall PCI results and reducing adverse cardiac events. Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results. Digital stent enhancement methods have been well validated and improved stent strut visualization. Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure. With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results. We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.
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Affiliation(s)
| | - Stéphane Carlier
- Department of Cardiology, UMONS, Mons 7000, Belgium
- Department of Cardiology, CHU Ambroise Paré, Mons 7000, Belgium
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Costello JS, Soldozy S, Norat P, Sokolowski JD, Yağmurlu K, Sharifi K, Tvrdik P, Park MS, Kalani MYS. Endovascular Approach to Cerebral Revascularization: Historical Vignette. World Neurosurg 2020; 136:258-262. [PMID: 31954910 DOI: 10.1016/j.wneu.2020.01.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
From their origins as cardiovascular research tools, endovascular techniques have evolved to provide a minimally invasive means of diagnosis and therapy for individuals suffering from occlusive artery disease. The techniques were pioneered by William Harvey, whose work set the stage for all subsequent endovascular experiments. These included the bold self-catheterization procedure performed by Werner Forssmann in 1929, which would lead to his dismissal by his superiors, only to regain respect within the medical community in 1956 on receiving the Nobel Prize. Charles Dotter was the first to understand the true potential of endovascular approaches after a chance recanalization that would catapult arterial catheterization first into the cardiovascular surgical arena, then into neurosurgery for intracranial stenoses. Having been meticulously evaluated and compared with open vascular procedures, endovascular neurosurgery has continued to be refined and optimized. Understanding the history and development of these techniques and their applications in neurosurgery is necessary to appreciate the current clinical utility of these procedures, serving to provide the vascular neurosurgeon a greater array of treatment options for patients. Here we explore the major scientific and technological advancements that facilitated the development of the endovascular approach to cerebral revascularization, as well as current indications and ongoing clinical trials.
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Affiliation(s)
- John S Costello
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sauson Soldozy
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
| | - Pedro Norat
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kaan Yağmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Khadijeh Sharifi
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - M Yashar S Kalani
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Arita Y, Okada M, Ogasawara N, Hasegawa S. Patients With Obesity Exhibit a Plateau Pattern of the Right Ventricular Waveform. Cardiol Res 2019; 10:165-171. [PMID: 31236179 PMCID: PMC6575107 DOI: 10.14740/cr865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/29/2019] [Indexed: 02/05/2023] Open
Abstract
Background Ventricular waveforms are characterized by a dip-and-plateau pattern during diastole owing to an abrupt termination of ventricular filling because of pericardial constraint under conditions such as constrictive pericarditis (CP). However, constrictive hemodynamics is not specifically caused by CP. Therefore, this study aimed to evaluate whether patients with obesity exhibited constrictive hemodynamics. Methods Overall, 60 consecutive Japanese patients (mean age, 69.5 years; 45% women) who underwent right heart catheterization at the Japan Community Healthcare Organization Osaka Hospital from July 2016 to September 2018 were examined. Two-dimensional echocardiography was used to measure the epicardial adipose tissue (EAT) in the standard parasternal long-axis view during end-diastole. Because patients who underwent open-heart surgery were highly likely to have CP, they were excluded. Results Among the 60 patients, 11 (18%) exhibited a plateau pattern of the right ventricular waveform and had a mean EAT value of 4.2 mm, which was significantly higher than that of patients without such a pattern (2.1 mm, P < 0.001). Similarly, the mean body mass index (BMI) values were significantly higher in patients with a plateau pattern than in those without it (27.2 vs. 21.8 kg/m2, P < 0.001). EAT was significantly correlated with the BMI (r = 0.72, P < 0.001). In patients with a plateau pattern, the triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher (TG: 150 vs. 100 mg/dL, LDL-C: 121 vs. 95 mg/dL, P < 0.05) and the left atrial diameter (52.8 vs. 44.7 mm, P < 0.01) and left atrial volume index (58.7 vs. 47.6 mL/m2, P < 0.05) were significantly greater than those in the patients without it. The EAT was also significantly correlated with the TG level (r = 0.37, P < 0.01). Conclusions Obese patients may present with constrictive hemodynamics, suggesting left ventricular diastolic dysfunction. EAT was significantly correlated with metabolic syndrome components, namely obesity and TG levels.
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Affiliation(s)
- Yoh Arita
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka 553-0003, Japan
| | - Masako Okada
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka 553-0003, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka 553-0003, Japan
| | - Shinji Hasegawa
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka 553-0003, Japan
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Cronin B, O'Brien EO, Gu W, Banks D, Maus T. Intraoperative 3-Dimensional Echocardiography–Derived Right Ventricular Volumetric Analysis in Chronic Thromboembolic Pulmonary Hypertension Patients Before and After Pulmonary Thromboendarterectomy. J Cardiothorac Vasc Anesth 2019; 33:1498-1503. [DOI: 10.1053/j.jvca.2018.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Indexed: 11/11/2022]
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Abstract
Introduction Sclerotherapy in all its current forms is based on experience going back to the 1850s. Methods To trace the evolution of sclerotherapy over the past 250 years, using the internet for past documentation and the literature. Conclusion Sclerotherapy principles were established long ago, although current modifications have been made possible by the introduction of detergent sclerosants and ultrasound guidance.
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Hanley BP, Bains W, Church G. Review of Scientific Self-Experimentation: Ethics History, Regulation, Scenarios, and Views Among Ethics Committees and Prominent Scientists. Rejuvenation Res 2018; 22:31-42. [PMID: 29926769 DOI: 10.1089/rej.2018.2059] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We examine self-experimentation ethics history and practice, related law, use scenarios in universities and industry, and attitudes. We show through analysis of the historical development of medical ethics and regulation, from Hippocrates through Good Clinical Practice that there are no ethical barriers to self-experimentation. When the self-experimenter is a true investigator, there is no other party to be protected from unethical behavior. We discuss the n-of-1 issue in self-experiments, and make suggestions for improving experiment design. We discuss real-world scenarios of self-experimentation: at universities, for independent single-subject investigators, investigator/employees at pharmaceutical firms, and nonscientist self-experimenters. Our survey of ethics committees regarding policy and review for self-experimenting investigators show that approximately one-third of ethics committee respondents had a policy regarding self-experimentation, and one-third did not require ethical committee review of proposed experiments. There was no relationship between having a policy and asking for review. We also surveyed member attitudes to, and experiences of, self-experimentation among members of the National Academy of Sciences, Royal Society, and European Academy of Sciences. To our knowledge, this survey is the first breakdown of self-experiments into impact-relevant type classifications, and represents an advance in the field. Half of our scientist respondents performed self-experiments, and roughly one-fifth had conducted serious self-experiments. Most responders thought self-experiments were valuable, however, biologics injections, radiation exposure, and surgical implants had negative ratings greater than positive. We conclude that self-experimenters should not have attempts made to terminate them, bar them from use of facilities, nor be barred from using themselves or their tissues except in exceptional circumstances. Organizational uncertainty over the ethical and regulatory status of self-experimentation, and resulting fear of consequences is unjustified and may be blocking a route to human experiments that practicing scientists widely consider appropriate, and which historical precedent has shown is valuable.
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Affiliation(s)
| | - William Bains
- 2 Rufus Scientific Ltd., Hertsfordshire, United Kingdom
| | - George Church
- 3 Department of Genetics, Harvard Medical School, Boston, Massachusetts
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Marshall EL, Borrego D, Fudge JC, Rajderkar D, Bolch WE. Organ doses in pediatric patients undergoing cardiac-centered fluoroscopically guided interventions: Comparison of three methods for computational phantom alignment. Med Phys 2018; 45:10.1002/mp.13044. [PMID: 29896882 PMCID: PMC6292782 DOI: 10.1002/mp.13044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/15/2018] [Accepted: 06/07/2018] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To assess various computational phantom alignment techniques within Monte Carlo radiation transport models of pediatric fluoroscopically guided cardiac interventional studies. METHODS Logfiles, including all procedure radiation and machine data, were extracted from a Toshiba infinix-I unit in the University of Florida Pediatric Catheterization Laboratory for a cohort of 10 patients. Two different alignment methods were then tested against a ground truth standard based upon identification of a unique anatomic reference point within images co-registered to specific irradiation events within each procedure. The first alignment method required measurement of the distance from the edge of the exam table to the top of the patient's head (table alignment method). The second alignment method fixed the anatomic reference point to be the geometric center of the heart muscle, as all 10 studies were cardiac in nature. Monte Carlo radiation transport simulations were performed for each patient and intervention using morphometry-matched hybrid computational phantoms for the reference and two tested alignment methods. For each combination, absorbed doses were computed for 28 organs and root mean square organ doses were assessed and compared across the alignment methods. RESULTS The percent error in root mean square organ dose ranged from -57% to +41% for the table alignment method, and from -27% to +22% for the heart geometric centroid alignment method. Absorbed doses to specific organs, such as the heart and lungs, demonstrated higher accuracy in the heart geometric centroid alignment method, with average percent errors of 10% and 1.4%, respectively, compared to average percent errors of -32% and 24%, respectively, using the table alignment method. CONCLUSIONS Of the two phantom alignment methods investigated in this study, the use of an anatomical reference point - in this case the geometric centroid of the heart - provided a reliable method for radiation transport simulations of organ dose in pediatric interventional cardiac studies. This alignment method provides the added benefit of requiring no physician input, making retrospective calculations possible. Moving forward, additional anatomical reference methods can be tested to assess the reliability of anatomical reference points beyond cardiac centered procedures.
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Affiliation(s)
- Emily L Marshall
- J. Crayton Pruitt Family, Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - David Borrego
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James C Fudge
- Div. of Pediatric Cardiology, UF Health Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Dhanashree Rajderkar
- Department of Radiology, Chief of Pediatric Radiology, University of Florida, Gainesville, FL, USA
| | - Wesley E Bolch
- J. Crayton Pruitt Family, Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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Marshall JD, Bazan I, Zhang Y, Fares WH, Lee PJ. Mitochondrial dysfunction and pulmonary hypertension: cause, effect, or both. Am J Physiol Lung Cell Mol Physiol 2018; 314:L782-L796. [PMID: 29345195 DOI: 10.1152/ajplung.00331.2017] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pulmonary hypertension describes a heterogeneous disease defined by increased pulmonary artery pressures, and progressive increase in pulmonary vascular resistance due to pathologic remodeling of the pulmonary vasculature involving pulmonary endothelial cells, pericytes, and smooth muscle cells. This process occurs under various conditions, and although these populations vary, the clinical manifestations are the same: progressive dyspnea, increases in right ventricular (RV) afterload and dysfunction, RV-pulmonary artery uncoupling, and right-sided heart failure with systemic circulatory collapse. The overall estimated 5-yr survival rate is 72% in highly functioning patients, and as low as 28% for those presenting with advanced symptoms. Metabolic theories have been suggested as underlying the pathogenesis of pulmonary hypertension with growing evidence of the role of mitochondrial dysfunction involving the major proteins of the electron transport chain, redox-related enzymes, regulators of the proton gradient and calcium homeostasis, regulators of apoptosis, and mitophagy. There remain more studies needed to characterize mitochondrial dysfunction leading to impaired vascular relaxation, increase proliferation, and failure of regulatory mechanisms. The effects on endothelial cells and resulting interactions with their microenvironment remain uncharted territory for future discovery. Additionally, on the basis of observations that the "plexigenic lesions" of pulmonary hypertension resemble the unregulated proliferation of tumor cells, similarities between cancer pathobiology and pulmonary hypertension have been drawn, suggesting interactions between mitochondria and angiogenesis. Recently, mitochondria targeting has become feasible, which may yield new therapeutic strategies. We present a state-of-the-art review of the role of mitochondria in both the pathobiology of pulmonary hypertension and potential therapeutic targets in pulmonary vascular processes.
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Affiliation(s)
- Jeffrey D Marshall
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Isabel Bazan
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Yi Zhang
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Wassim H Fares
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Patty J Lee
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine , New Haven, Connecticut
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Invasive Hemodynamic Assessment of Patients with Heart Failure and Pulmonary Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:40. [PMID: 28466117 DOI: 10.1007/s11936-017-0544-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OPINION STATEMENT Right heart catheterization (RHC) with a pulmonary artery (PA) catheter is a minimally invasive method of obtaining hemodynamic data (e.g., right atrial and pulmonary pressures, cardiac output, pulmonary vascular resistance), which are used to diagnose and manage patients with advanced heart failure (HF), HF with preserved ejection fraction, and pulmonary hypertension (PH). Invasive hemodynamic data obtained from RHC can aid in the prognostication of HF and PH patients and are important in guiding decisions of implanting mechanical circulatory support devices and listing patients for heart and/or lung transplantation. The basis of RHC has also paved the way for implantable hemodynamic devices to monitor pulmonary artery pressures in the outpatient setting, which can reduce rates of HF-related hospitalizations. We will discuss the utility of PA catheters in the diagnosis and management of the aforementioned disease states, the role of implantable hemodynamic monitors, and the complications associated with RHC procedures.
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Gow KW, Tapper D, Hickman RO. Between the lines: The 50th anniversary of long-term central venous catheters. Am J Surg 2017; 213:837-848. [PMID: 28364951 DOI: 10.1016/j.amjsurg.2017.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/26/2017] [Accepted: 03/15/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor. Many have wondered who the inventors were of each catheter, and what specifically inspired their inventions. Many of these compelling stories have yet to be told. DATA SOURCE A literature review of common catheters and personal communication with inventors. Only first person accounts from inventors or those close to the invention were used. CONCLUSIONS CVCs are now essential devices that have saved countless lives. Though the inventors have earned the honor of naming their catheters, it may be reasonable to consider more consistent terminology to describe these catheters to avoid confusion.
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Affiliation(s)
- Kenneth W Gow
- Division of General and Thoracic Surgery, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA.
| | - David Tapper
- Division of General and Thoracic Surgery, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
| | - Robert O Hickman
- Division of Nephrology, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
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Outpatient follow-up during the first year after heart transplantation, is it feasible? Int J Cardiol 2017; 228:1-3. [PMID: 27863348 DOI: 10.1016/j.ijcard.2016.11.188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/06/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION First year follow-up after heart transplantation requires invasive tests. Although patients used to be hospitalized for this purpose, ambulatory invasive procedures now offer the possibility of outpatient follow-up. The feasibility and security of this strategy is unknown. METHODS From 2007 we transitioned to outpatient follow-up. We have retrospectively reviewed the clinical course of the outpatient group (2007 to 2014) and an inpatient group (2000-2006). Basal characteristics, hospital stay, infections, rejection episodes and vascular complications were evaluated. RESULTS 87 patients had Inpatient Follow-up (IF) and 98 Outpatient Follow-up (OF). Basal characteristics were similar, with significant differences in immunosuppression (tacrolimus IF 44.8% vs. OF 90.8%, and mycophenolate IF 86.2% vs OF 100%, both p values <0.001) and age (IF 52±11.5years vs. OF 56.1±11years, p=0.016). In the OF group more clinical visits were performed (IF 10 vs. OF 13, p<0.001) while hospital stay was lower (IF 23days vs. OF 3days, p<0.001). The rate of infection, rejection, and vascular complications was similar. No difference was found in 1-year mortality (IF 2.3% vs. 1.0%, p=0.60). CONCLUSION First year post-cardiac transplantation outpatient follow-up seems to be feasible and safe in terms of infection, rejection, vascular complications and mortality.
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Rosenkranz S, Preston IR. Right heart catheterisation: best practice and pitfalls in pulmonary hypertension. Eur Respir Rev 2016; 24:642-52. [PMID: 26621978 DOI: 10.1183/16000617.0062-2015] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Right heart catheterisation (RHC) plays a central role in identifying pulmonary hypertension (PH) disorders, and is required to definitively diagnose pulmonary arterial hypertension (PAH). Despite widespread acceptance, there is a lack of guidance regarding the best practice for performing RHC in clinical practice. In order to ensure the correct evaluation of haemodynamic parameters directly measured or calculated from RHC, attention should be drawn to standardising procedures such as the position of the pressure transducer and catheter balloon inflation volume. Measurement of pulmonary arterial wedge pressure, in particular, is vulnerable to over- or under-wedging, which can give rise to false readings. In turn, errors in RHC measurement and data interpretation can complicate the differentiation of PAH from other PH disorders and lead to misdiagnosis. In addition to diagnosis, the role of RHC in conjunction with noninvasive tests is widening rapidly to encompass monitoring of treatment response and establishing prognosis of patients diagnosed with PAH. However, further standardisation of RHC is warranted to ensure optimal use in routine clinical practice.
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Affiliation(s)
- Stephan Rosenkranz
- Dept III of Internal Medicine and Cologne Cardiovascular Research Center (CCRC), Cologne University Heart Center, Cologne, Germany
| | - Ioana R Preston
- Pulmonary, Critical Care, and Sleep Division, Tufts Medical Center, Boston, MA, USA
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Wong DJ, Sampat U, Gibson MA, Auger WR, Madani MM, Daniels LB, Raisinghani AB, DeMaria AN, Blanchard DG. Tricuspid annular plane systolic excursion in chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy. Echocardiography 2016; 33:1805-1809. [DOI: 10.1111/echo.13364] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Darrin J. Wong
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
| | - Unnati Sampat
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
| | - Michael A. Gibson
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
| | - William R. Auger
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
| | - Michael M. Madani
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
| | - Lori B. Daniels
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
| | - Ajit B. Raisinghani
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
| | - Anthony N. DeMaria
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
| | - Daniel G. Blanchard
- UCSD School of Medicine; University of California San Diego Cardiovascular Center; La Jolla California
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Physick-Sheard PW. Equine electrocardiography revisited. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P. W. Physick-Sheard
- Department of Population Medicine; Ontario Veterinary College; University of Guelph; Canada
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Hernandez GA, Navas V, Chaparro S. Noninvasive Hemodynamic Monitoring for Heart Failure: A New Era of Heart Failure Management. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2015. [DOI: 10.15212/cvia.2015.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Harwani N, Chukwu E, Alvarez M, Thohan V. Comparison of Brachial Vein Versus Internal Jugular Vein Approach for Access to the Right Side of the Heart With or Without Myocardial Biopsy. Am J Cardiol 2015; 116:740-3. [PMID: 26150174 DOI: 10.1016/j.amjcard.2015.05.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/17/2022]
Abstract
Right heart catheterization (RHC) and endomyocardial biopsy are mainstay procedures for patients with heart failure and heart transplantation. Approaches are predominantly neck (internal jugular) or leg (femoral vein). We describe a novel arm (brachial/basilica vein) approach. Over 5.5 years, 1,130 right-sided cardiac procedures in 276 patients were analyzed retrospectively and divided into either neck or arm approach. Comparative analyses of procedural success, time, safety, efficacy, and cost were performed. Patient preference was assessed for those who had both neck and arm approaches. In patients receiving RHC (174 neck and 121 arm cases) and in those receiving RHC + biopsy (594 neck and 141 arm cases), mean elapsed and fluoroscopic times (minutes), respectively, were 60 ± 20 versus 62 ± 19 and 3.43 ± 3.8 versus 4.99 ± 5.2 (RHC neck vs arm, respectively), and 55 ± 19 versus 63 ± 17 and 4.14 ± 3.4 versus 5.22 ± 2.6 (RHC + biopsy neck vs arm, respectively). Procedural complications were low (n = 7, 0.6%) and restricted to the neck approach. Patients surveyed preferred the arm approach. In conclusion, RHC and endomyocardial biopsy through the brachial vein can be performed safely, timely, effectively, and at equivalent cost compared with a neck approach. We advocate that an arm approach be the preferred method for these procedures.
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Affiliation(s)
- Neha Harwani
- Department of Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Ebere Chukwu
- Department of Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Manrique Alvarez
- Department of Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Vinay Thohan
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
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20 Things You Didn’t Know About Measurement of Cardiac Output. J Cardiovasc Nurs 2014; 29:155-7. [DOI: 10.1097/jcn.0000000000000099] [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: 11/26/2022]
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Nelson H. Surgical innovation. Br J Surg 2013; 100 Suppl 6:S28-30. [PMID: 23804052 DOI: 10.1002/bjs.9093_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- H Nelson
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
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Nelson H. Surgical innovation. Br J Surg 2013; 100:721-3. [PMID: 23436716 DOI: 10.1002/bjs.9093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 11/08/2022]
Abstract
A Nobel pursuit
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Affiliation(s)
- H Nelson
- Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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