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Zhang RS, Ro R, Bamira D, Vainrib A, Zhang L, Nayar AC, Saric M, Bernard S. Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction. Curr Cardiol Rep 2024:10.1007/s11886-024-02042-5. [PMID: 38526749 DOI: 10.1007/s11886-024-02042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
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Affiliation(s)
- Robert S Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Richard Ro
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Daniel Bamira
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Alan Vainrib
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Lily Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ambika C Nayar
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Muhamed Saric
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Samuel Bernard
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
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2
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Hayes DE, Bamira D, Vainrib AF, Freedberg RS, Aizer A, Chinitz LA, Saric M. Left Atrial Appendage Tilt-Up-and-Turn-Left Maneuver: A Novel Three-Dimensional Transesophageal Echocardiography Imaging Maneuver to Characterize the Left Atrial Appendage and to Improve Transcatheter Closure Guidance. CASE (Phila) 2023; 7:391-395. [PMID: 37970485 PMCID: PMC10635893 DOI: 10.1016/j.case.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
•Precise LAA anatomy must be established for LAA occlusion device selection. •We have developed the TUPLE maneuver, an acronym for “tilt up and turn left”. •The TUPLE maneuver facilitates LAA device selection and intraprocedural guidance.
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Affiliation(s)
- Dena E. Hayes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Robin S. Freedberg
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Larry A. Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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3
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Maidman SD, Bamira D, Vainrib AF, Ro R, Saric M. Cysts Around the Heart: Differential Diagnosis and Multimodality Imaging Strategies for Paracardiac Cysts. CASE (Phila) 2023; 7:365-376. [PMID: 37791128 PMCID: PMC10543172 DOI: 10.1016/j.case.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
•Paracardiac cysts (located adjacent to or inside the heart) are rarely detected. •There is a broad differential diagnosis for cysts encountered with echocardiography. •Multimodality imaging is crucial for comprehensively evaluating paracardiac cysts.
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Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Richard Ro
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
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4
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Moazami N, Stern JM, Khalil K, Kim JI, Narula N, Mangiola M, Weldon EP, Kagermazova L, James L, Lawson N, Piper GL, Sommer PM, Reyentovich A, Bamira D, Saraon T, Kadosh BS, DiVita M, Goldberg RI, Hussain ST, Chan J, Ngai J, Jan T, Ali NM, Tatapudi VS, Segev DL, Bisen S, Jaffe IS, Piegari B, Kowalski H, Kokkinaki M, Monahan J, Sorrells L, Burdorf L, Boeke JD, Pass H, Goparaju C, Keating B, Ayares D, Lorber M, Griesemer A, Mehta SA, Smith DE, Montgomery RA. Pig-to-human heart xenotransplantation in two recently deceased human recipients. Nat Med 2023; 29:1989-1997. [PMID: 37488288 DOI: 10.1038/s41591-023-02471-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023]
Abstract
Genetically modified xenografts are one of the most promising solutions to the discrepancy between the numbers of available human organs for transplantation and potential recipients. To date, a porcine heart has been implanted into only one human recipient. Here, using 10-gene-edited pigs, we transplanted porcine hearts into two brain-dead human recipients and monitored xenograft function, hemodynamics and systemic responses over the course of 66 hours. Although both xenografts demonstrated excellent cardiac function immediately after transplantation and continued to function for the duration of the study, cardiac function declined postoperatively in one case, attributed to a size mismatch between the donor pig and the recipient. For both hearts, we confirmed transgene expression and found no evidence of cellular or antibody-mediated rejection, as assessed using histology, flow cytometry and a cytotoxic crossmatch assay. Moreover, we found no evidence of zoonotic transmission from the donor pigs to the human recipients. While substantial additional work will be needed to advance this technology to human trials, these results indicate that pig-to-human heart xenotransplantation can be performed successfully without hyperacute rejection or zoonosis.
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Affiliation(s)
- Nader Moazami
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA.
| | - Jeffrey M Stern
- New York University Langone Transplant Institute, New York, NY, USA
| | - Karen Khalil
- New York University Langone Transplant Institute, New York, NY, USA
| | - Jacqueline I Kim
- New York University Langone Transplant Institute, New York, NY, USA
| | - Navneet Narula
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Massimo Mangiola
- New York University Langone Transplant Institute, New York, NY, USA
| | - Elaina P Weldon
- New York University Langone Transplant Institute, New York, NY, USA
| | - Larisa Kagermazova
- Department of Biochemistry and Molecular Pharmacology, New York University Grossman School of Medicine, New York, NY, USA
| | - Les James
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Nikki Lawson
- New York University Langone Transplant Institute, New York, NY, USA
| | - Greta L Piper
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Philip M Sommer
- Department of Anesthesiology, New York University Langone Health, New York, NY, USA
| | - Alex Reyentovich
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Daniel Bamira
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Tajinderpal Saraon
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Bernard S Kadosh
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Michael DiVita
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Randal I Goldberg
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Syed T Hussain
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Justin Chan
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Jennie Ngai
- Department of Anesthesiology, New York University Langone Health, New York, NY, USA
| | - Thomas Jan
- Department of Anesthesiology, New York University Langone Health, New York, NY, USA
| | - Nicole M Ali
- New York University Langone Transplant Institute, New York, NY, USA
| | | | - Dorry L Segev
- Department of Surgery, New York University Langone Health, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Shivani Bisen
- New York University Grossman School of Medicine, New York University, New York, NY, USA
| | - Ian S Jaffe
- New York University Grossman School of Medicine, New York University, New York, NY, USA
| | - Benjamin Piegari
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Haley Kowalski
- New York University Grossman School of Medicine, New York University, New York, NY, USA
| | | | | | | | | | - Jef D Boeke
- Department of Biochemistry and Molecular Pharmacology, New York University Grossman School of Medicine, New York, NY, USA
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA
| | - Harvey Pass
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Chandra Goparaju
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Brendan Keating
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marc Lorber
- United Therapeutics Corporation, Silver Spring, MD, USA
| | - Adam Griesemer
- New York University Langone Transplant Institute, New York, NY, USA
| | - Sapna A Mehta
- New York University Langone Transplant Institute, New York, NY, USA
| | - Deane E Smith
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
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Dhaduk N, Vainrib AF, Bamira D, Ro R, Aizer A, Chinitz L, Saric M. Device-Associated Thrombus with Watchman FLX Left Atrial Appendage Closure Device: A Report of Two Cases. CASE (Phila) 2023; 7:226-232. [PMID: 37396475 PMCID: PMC10307589 DOI: 10.1016/j.case.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Individual cases of Watchman FLX DAT are scare in literature. The Watchman FLX has shown lower rates of DAT than the Watchman 2.0. Thrombus formation is still possible in rare instances with the Watchman FLX.
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Affiliation(s)
- Nehal Dhaduk
- Correspondence: Nehal Dhaduk, MD, NYU Langone Health, Department of Internal Medicine, 225 E 34th Street, New York, NY 10016.
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6
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Moazami N, Smith D, Stern J, Kim J, Khalil K, James L, Kowalski H, Bisen S, Bamira D, Saraon T, Reyentovich A, Piper G, Sommer P, Ngai J, Mangiola M, Mehta S, Griesemer A, Ayares D, Narula N, Weldon E, Montgomery R. Two 10-Gene Modified Xenoheart Transplants into Brain Dead Decedents. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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7
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Bamira D, Vainrib A, Saric M, Saraon T, Reyentovich A, Jaffe I, James L, Stern J, Khalil K, Weldon E, Ayares D, Griesemer A, Smith D, Montgomery R, Moazami N. Echocardiographic Evaluation of Two 10-Gene Modified Xenoheart Transplants into Brain Dead Decedents. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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8
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Maidman SD, Bamira D, Ro R, Vainrib AF, Saric M. Taking Command of Three-Dimensional Stitching Artifacts: From an Annoyance to an Easy Tool for Navigating Three-Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr 2023; 36:105-110. [PMID: 36174809 DOI: 10.1016/j.echo.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 01/10/2023]
Abstract
Despite many recent advances in three-dimensional (3D) transesophageal echocardiography (TEE) imagining, the process of orienting 3D TEE images is nonintuitive and uses assumptions based on idealized anatomy. Correlating two-dimensional TEE cross-sectional images to 3D reconstructions remains an additional challenge. In this article, we suggest the repurposing of the stitching artifact generated in 2-beat electrocardiogram-gated 3D TEE as a means of exactly orienting 3D images within a patient's unique anatomy. We demonstrate the application of this strategy to assess a normal mitral valve to localize scallops of mitral valve prolapse and to visualize typical left atrial appendage two-dimensional cuts in a 3D space. By taking command of stitching artifacts, cardiac imagers can successfully navigate the complex structures of the heart for optimal, individualized echocardiographic views.
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Affiliation(s)
- Samuel D Maidman
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Richard Ro
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York.
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9
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Kuohn LR, Ro R, Bamira D, Vainrib A, Freedberg R, Galloway A, Williams MR, Saric M. Bacterial endocarditis with AACEK (HACEK) organisms. Echocardiography 2022; 39:1348-1358. [PMID: 36198094 DOI: 10.1111/echo.15440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/07/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gram-negative organisms of the AACEK group, formerly known as HACEK, rarely cause endocarditis. CASE SERIES We present three cases of bacterial endocarditis, involving native and prosthetic valves, caused by AACEK organisms. In two patients, Cardiobacterium hominis was the responsible organism, and in a third, Aggregatibacter aphrophilus was implicated. A dental source of infection was identified in two patients, and in all three patients, the presentation of endocarditis was subacute. DISCUSSION This case series highlights the indolent nature of infection with the AACEK organisms. It also demonstrates the crucial role of multimodality imaging, especially transesophageal echocardiography, in the diagnosis of AACEk endocarditis of both native and prosthetic valves, and in delineating the extent of abscess in those with prosthetic valve infection.
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Affiliation(s)
- Lindsey R Kuohn
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Richard Ro
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Daniel Bamira
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Alan Vainrib
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Robin Freedberg
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Aubrey Galloway
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Mathew R Williams
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Muhamed Saric
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
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10
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Liebman J, Bamira D, Ro R, Vainrib AF, Small AJ, Donnino R, Saric M. Multimodality Imaging of Caval and Coronary Sinus Venous Anomalies. CASE 2022; 6:366-376. [PMID: 36247374 PMCID: PMC9556923 DOI: 10.1016/j.case.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abnormal fetal development can produce several anomalies of the caval venous system. We present multimodality imaging of the most common caval venous anomalies. Each imaging modality provides incremental value when identifying these anomalies. Even normal variants may impact pacing lead or central venous catheter placement. Pathologic variants may lead to intracardiac shunting.
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11
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Qiu JK, Bamira D, Vainrib AF, Latson LA, Halpern DG, Chun A, Saric M. Response to Letter to the Editor: Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults. CASE 2022; 6:147. [PMID: 35602979 PMCID: PMC9120830 DOI: 10.1016/j.case.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica K Qiu
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Larry A Latson
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Dan G Halpern
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Anne Chun
- Department of Pediatrics, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
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12
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Qiu JK, Bamira D, Vainrib AF, Latson LA, Halpern DG, Chun A, Saric M. Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults. CASE 2022; 6:107-113. [PMID: 35602989 PMCID: PMC9120852 DOI: 10.1016/j.case.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
SVASD should be suspected in cases of unexplained RV volume overload. Direct visualization of SVASD with TTE is difficult in adults compared with children. TEE is helpful for diagnosing SVASD and associated pulmonary venous abnormalities. Multimodal imaging techniques offer incremental value in the workup of SVASD.
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13
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Kuohn L, Staniloae C, Jilaihawi H, Ibrahim H, Bamira D, Pushkar I, Vainrib A, Ro R, Williams M, Saric M. BIOPROSTHETIC LEAFLET THROMBOSIS AFTER TRANSCATHETER MITRAL VALVE-IN-VALVE IMPLANTATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Maidman SD, Kiefer NJ, Bernard S, Freedberg RS, Rosenzweig BP, Bamira D, Vainrib AF, Ro R, Neuburger PJ, Basu A, Moreira AL, Latson LA, Loulmet DF, Saric M. Native mitral valve staphylococcus endocarditis with a very unusual complication: Ruptured posterior mitral valve leaflet aneurysm. Echocardiography 2021; 39:112-117. [DOI: 10.1111/echo.15254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Nicholas J. Kiefer
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Samuel Bernard
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Robin S. Freedberg
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Barry P. Rosenzweig
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Richard Ro
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Peter J. Neuburger
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Atreyee Basu
- Department of Pathology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Andre L. Moreira
- Department of Pathology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Larry A. Latson
- Department of Radiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Didier F. Loulmet
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
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15
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Maidman SD, Sulica R, Freedberg RS, Bamira D, Vainrib AF, Ro R, Latson LA, Saric M. Cor Pulmonale from Concomitant Human Immunodeficiency Virus Infection and Methamphetamine Use. CASE 2021; 5:239-242. [PMID: 34430775 PMCID: PMC8370868 DOI: 10.1016/j.case.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
HIV and frequent methamphetamine use are two known risk factors for PAH development. HIV and methamphetamine are both associated with higher rates of mortality in PAH. Echocardiography is an effective noninvasive modality for assessing PAH severity.
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16
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Hayes DE, Rhee DW, Hisamoto K, Smith D, Ro R, Vainrib AF, Bamira D, Zhou F, Saric M. Two cases of acute endocarditis misdiagnosed as COVID-19 infection. Echocardiography 2021; 38:798-804. [PMID: 33715241 PMCID: PMC8251260 DOI: 10.1111/echo.15021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 12/26/2022] Open
Abstract
The COVID‐19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID‐19 infection from other diseases. COVID‐19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life‐threatening acute endocarditis was initially misdiagnosed as COVID‐19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real‐time reverse transcription‐polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.
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Affiliation(s)
- Dena E Hayes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - David W Rhee
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Kazuhiro Hisamoto
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Deane Smith
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Richard Ro
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
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17
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Rzucidlo J, Jaspan V, Paone D, Jilaihawi H, Xia Y, Kapitman A, Nakashima M, He Y, Ibrahim H, Pushkar I, Neuburger PJ, Saric M, Bamira D, Paschke S, Kalish C, Staniloae C, Shah B, Williams M. Long-term outcomes after transcatheter aortic valve replacement with minimal contrast in chronic kidney disease. Catheter Cardiovasc Interv 2020; 98:319-327. [PMID: 33180381 DOI: 10.1002/ccd.29378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with renal insufficiency have poor short-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS Retrospective chart review identified 575 consecutive patients not on hemodialysis who underwent TAVR between September 2014 and January 2017. Outcomes were defined by VARC-2 criteria. Primary outcome of all-cause mortality was evaluated at a median follow-up of 811 days (interquartile range 125-1,151). RESULTS Preprocedural glomerular filtration rate (GFR) was ≥60 ml/min in 51.7%, 30-60 ml/min in 42.1%, and < 30 ml/min in 6.3%. Use of transfemoral access (98.8%) and achieved device success (91.0%) did not differ among groups, but less contrast was used with lower GFR (23 ml [15-33], 24 ml [14-33], 13 ml [8-20]; p < .001). Peri-procedural stroke (0.7%, 2.1%, 11.1%; p < .001) was higher with lower GFR. Core lab analysis of preprocedural computed tomography scans of patients who developed a peri-procedural stroke identified potential anatomic substrate for stroke in three out of four patients with GFR 30-60 ml/min and all three with GFR <30 ml/min (severe atheroma was the most common subtype of anatomical substrate present). Compared to GFR ≥60 ml/min, all-cause mortality was higher with GFR 30-60 ml/min (HR 1.61 [1.00-2.59]; aHR 1.61 [0.91-2.83]) and GFR <30 ml/min (HR 2.41 [1.06-5.48]; aHR 2.34 [0.90-6.09]) but not significant after multivariable adjustment. Follow-up echocardiographic data, available in 63%, demonstrated no difference in structural heart valve deterioration over time among groups. CONCLUSIONS Patients with baseline renal insufficiency remain a challenging population with poor long-term outcomes despite procedural optimization with a transfemoral-first and an extremely low-contrast approach.
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Affiliation(s)
- Justyna Rzucidlo
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Vita Jaspan
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Darien Paone
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Hasan Jilaihawi
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Yuhe Xia
- Department of Biostatistics, NYU Langone Health, New York, New York
| | - Anna Kapitman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Makoto Nakashima
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Yuxin He
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Homam Ibrahim
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Illya Pushkar
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Sonja Paschke
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Chloe Kalish
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Cezar Staniloae
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York
| | - Binita Shah
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, New York.,Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System: Manhattan Campus, New York, New York
| | - Mathew Williams
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
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18
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Rzucidlo J, Jaspan V, Shah B, Paone D, Pushkar I, Kapitman A, Ibrahim H, Hisamoto K, Neuburger P, Saric M, Staniloae C, Vainrib A, Bamira D, Jilaihawi H, Querijero M, Williams M. LONG TERM MORTALITY AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATINTS WITH CHRONIC KIDNEY DISEASE NOT ON HEMODIALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Jilaihawi H, Zhao Z, Du R, Staniloae C, Saric M, Neuburger PJ, Querijero M, Vainrib A, Hisamoto K, Ibrahim H, Collins T, Clark E, Pushkar I, Bamira D, Benenstein R, Tariq A, Williams M. Minimizing Permanent Pacemaker Following Repositionable Self-Expanding Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:1796-1807. [DOI: 10.1016/j.jcin.2019.05.056] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/06/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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20
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Vainrib AF, Bamira D, Aizer A, Chinitz LA, Loulmet D, Benenstein RJ, Saric M. Photorealistic imaging of left atrial appendage occlusion/exclusion. Echocardiography 2019; 36:1601-1604. [PMID: 31385344 DOI: 10.1111/echo.14438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022] Open
Abstract
Recent improvements in 3D TEE post processing rendering techniques referred to as TrueVue (Philips Medical Systems, Andover, MA, USA). It allows for novel photorealistic imaging of cardiac structures including left atrial appendage (LAA) and its closure devices. Here we present TrueVue images of the LAA prior to and after LAA exclusion/occlusion using various percutaneous and surgical techniques. TrueVue may improve delineation of LAA anatomy prior to occlusion as well as visualization of occluder device position within the LAA.
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Affiliation(s)
- Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Didier Loulmet
- Division of Cardiothoracic Surgery, New York University Langone Health, New York City, New York
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
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21
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Vainrib AF, Bamira D, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Echocardiographic Guidance of the Novel WaveCrest Left Atrial Appendage Occlusion Device. ACTA ACUST UNITED AC 2018; 2:297-300. [PMID: 30582095 PMCID: PMC6302034 DOI: 10.1016/j.case.2018.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The WaveCrest device is a novel LAA occluder with unique features. Two-dimensional and 3D TEE and fluoroscopy are essential for successful implantation. Air between layers of WaveCrest ePTFE fabric may obscure visualization on TEE.
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Affiliation(s)
- Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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22
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Du R, Jilaihawi H, Staniloae C, Vapheas E, Zhao ZG, Wang M, Saric M, Neuburger P, Querijero M, Vainrib A, Hisamoto K, Amoroso N, Collins T, Clark E, Pushkar I, Robin T, Sin D, Shah B, Taylor Z, Lee H, Bamira D, Vidal S, Benenstein R, Williams M. TCT-497 Predictors of Post-Dilatation after Self-Expanding Transcatheter Aortic Valve Replacement: Large Single Center Experience. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Zhao ZG, Williams M, Staniloae C, Vapheas E, Du R, Wang M, Saric M, Neuburger P, Querijero M, Vainrib A, Hisamoto K, Amoroso N, Collins T, Clark E, Pushkar I, Sin D, Shah B, Taylor Z, Lee H, Vidal S, Robin T, Bamira D, Benenstein R, Jilaihawi H. TCT-121 A Highly Predictive Model for New Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement with Contemporary Self-Expanding Valves: Importance of the Membranous Septum Length. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Zhao ZG, Jilaihawi H, Staniloae C, Vapheas E, Du R, Wang M, Saric M, Neuburger P, Querijero M, Vainrib A, Hisamoto K, Amoroso N, Collins T, Clark E, Pushkar I, Robin T, Sin D, Shah B, Taylor Z, Lee H, Vidal S, Bamira D, Benenstein R, Williams M. TCT-494 Influence of High Device Positioning on Outcomes after Transcatheter Aortic Valve Replacement with Contemporary Self-Expanding Valves. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Vidal S, Williams M, Lee H, Staniloae C, Vapheas E, Zhao ZG, Du R, Wang M, Saric M, Neuburger P, Querijero M, Vainrib A, Hisamoto K, Amoroso N, Collins T, Clark E, Pushkar I, Robin T, Sin D, Taylor Z, Shah B, Bamira D, Benenstein R, Jilaihawi H. TCT-172 Aortic Valvar Complex and Cardiac Anatomy: Gender-Related Differences in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Thibodeau-Jarry N, Bamira D, Picard M. USING SIMULATION TO TEACH TRANSTHORACIC ECHOCARDIOGRAPHY TO CARDIOLOGY FELLOWS: A STUDY USING THE MASTERY LEARNING CONCEPT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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27
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Dalia AA, Bamira D, Albaghdadi M, Essandoh M, Rosenfield K, Dudzinski D. Four-Dimensional Transesophageal Echocardiography-Guided AngioVac Debulking of a Tricuspid Valve Vegetation. J Cardiothorac Vasc Anesth 2016; 31:1713-1716. [PMID: 28215497 DOI: 10.1053/j.jvca.2016.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Adam A Dalia
- Department of Anesthesiology, Pain Medicine, and Critical Care, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Daniel Bamira
- Department of Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mazen Albaghdadi
- Department of Interventional Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Kenneth Rosenfield
- Department of Interventional Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Dudzinski
- Department of Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
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28
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Sinclair K, Bamira D, Girard E, Szucs M, Spilker R, Elmariah S, Passeri J, Inglessis I. TCT-505 Feasibility of a Novel Echo/X-Ray Fusion Software to Determine Implant Angulation during Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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El-Hayek G, Benjo A, Uretsky S, Al-Mallah M, Cohen R, Bamira D, Chavez P, Nascimento F, Santana O, Patel R, Cavalcante JL. Meta-analysis of coronary computed tomography angiography versus standard of care strategy for the evaluation of low risk chest pain: Are randomized controlled trials and cohort studies showing the same evidence? Int J Cardiol 2014; 177:238-45. [DOI: 10.1016/j.ijcard.2014.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/24/2014] [Accepted: 09/15/2014] [Indexed: 11/30/2022]
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Medina-Ramirez CM, Goswami S, Smirnova T, Bamira D, Benson B, Ferrick N, Segall J, Pollard JW, Kitsis RN. Apoptosis inhibitor ARC promotes breast tumorigenesis, metastasis, and chemoresistance. Cancer Res 2011; 71:7705-15. [PMID: 22037876 DOI: 10.1158/0008-5472.can-11-2192] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Apoptosis repressor with caspase recruitment domain (ARC) inhibits both death receptor- and mitochondrial/ER-mediated pathways of apoptosis. Although expressed mainly in terminally differentiated cells, ARC is markedly upregulated in a variety of human cancers, where its potential contributions have not yet been defined. In this study, we provide evidence of multiple critical pathophysiologic functions for ARC in breast carcinogenesis. In the polyoma middle T-antigen (PyMT) transgenic mouse model of breast cancer, in which endogenous ARC is strongly upregulated, deletion of the ARC-encoding gene nol3 decreased primary tumor burden without affecting tumor onset or multiplicity. More notably, ARC deficiency also limited tumor cell invasion and the number of circulating cancer cells, markedly reducing the number of lung metastases. Conversely, ectopic overexpression of ARC in a PyMT-derived metastatic breast cancer cell line increased invasion in vitro and lung metastasis in vivo. We confirmed these results in a humanized orthotopic model based on MDA-MB-231-derived LM2 metastatic breast cancer cells, in which RNAi-mediated knockdown of ARC levels was shown to reduce tumor volume, local invasion, and lung metastases. Lastly, we found that endogenous levels of ARC conferred chemoresistance in primary tumors and invading cell populations. Our results establish that ARC promotes breast carcinogenesis by driving primary tumor growth, invasion, and metastasis as well as by promoting chemoresistance in invasive cells.
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31
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Medina-Ramirez CM, Gowasmi S, Smirnova T, Bamira D, Condeelis J, Segall J, Pollard JW, Kitsis RN. Abstract 4695: Apoptosis inhibitor ARC as a novel mediator of breast tumorigenesis, metastasis and chemoresistance. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-4695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Apoptosis is critical for normal development and post-natal tissue homeostasis. ARC (Apoptosis Repressor with CARD), is an inhibitor of apoptosis with the unusual property of antagonizing both death receptor and mitochondrial apoptosis pathways. Under normal conditions, ARC is expressed in cardiac and skeletal myocytes and neurons. Suppression of cell death is critical for carcinogenesis and chemoresistance and we previously reported that ARC expression is induced in a wide variety of primary human epithelial cancers, including breast. Herein we present the first data demonstrating critical roles for ARC in several aspects of breast carcinogenesis. To test the hypothesis that ARC plays an important role in the pathogenesis of breast cancer in vivo, ARC-/- mice were bred onto the polyoma middle T-antigen (PyMT) transgenic mouse model of breast cancer. PyMT expression activates many oncogenic pathways common to human breast cancer including the induction of ARC in early and late-stage tumors and invading and metastatic cells. PyMT mice lacking ARC exhibit a 34% decrease in primary tumor burden compared to PyMT mice with ARC, although tumor onset and multiplicity remains unchanged. Unexpectedly, the reduced tumor burden can be accounted for by a novel function of ARC to promote proliferation, while baseline apoptosis remained comparable. The absence of ARC also results in a 44% reduction in the number of lung metastases independent of primary tumor burden. In vivo invasion assays and blood burden intravasation assays demonstrate that PyMT mice lacking ARC have a significant reduction in invading and circulating tumor cells when compared to those with ARC. Conversely, overexpression of ARC in a PyMT-derived metastatic cell line caused a significant increase in basement membrane invasion in vitro and lung metastases when injected into tail veins of mice. To test the function of ARC in a humanized model of breast cancer, ARC was knocked-down in the MDA-MB-231-derived LM2 human metastatic breast cancer cell line which was subsequently transplanted into mammary glands of SCID mice. Diminished ARC expression resulted in a 50% reduction in xenograft tumor volume and a drastic decline in stromal invasion in vivo. We also examined if the presence of ARC in invasive and metastatic cells contributes to chemoresistance. Xenograft LM2 mammary tumors deficient in ARC were sensitized to apoptosis induced by doxorubicin while the control tumors remained resistant. Moreover, deletion of ARC sensitized the invading cell population collected from primary PyMT breast tumors to tamoxifen-induced killing. This study demonstrates that ARC promotes primary tumor growth, improves the efficiency of metastasis at several stages and renders invasive breast cancer cells resistant to chemotherapies. These data implicate ARC as a novel mediator in the pathogenesis of breast cancer.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4695. doi:10.1158/1538-7445.AM2011-4695
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