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Tahlawi ME, Ismail SM, Eldamanhory A, Khorshed A, Salem SM. In emergency hypertension, could biomarkers change the guidelines? BMC Cardiovasc Disord 2024; 24:152. [PMID: 38481132 PMCID: PMC10935803 DOI: 10.1186/s12872-024-03785-3] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Hypertension may cause target organ damage (TOD). Target blood pressure (BP) management may not be appropriate in some conditions. AIM We aim to assess the impact of targeted BP management in severe hypertension on renal TOD. PATIENTS & METHODS This is a prospective cohort study involving patients admitted due to severe hypertension (BP > 180/120) associated with any symptoms. The study involved patients referred to the ICU in our tertiary center during the period between August 2017 and February 2018. All patients underwent target BP treatment according to recent guidelines. Hs-Troponin T (hs-TNT) and serum creatinine (s.creat) were measured in all patients on admission and 24 h later. Patients were divided into Group A (with initial normal hs-TNT) and Group B (with initial high hs-TNT). The main outcome was in-hospital renal-related morbidity (including renal failure). RESULTS Four hundred seventy consecutive patients with hypertensive crises were involved in the study. Group B had a significantly higher incidence of in-hospital mortality (4 patients) and renal TOD (acute renal dysfunction) than Group A (P value = 0.001 and 0.000 respectively). There was a significant difference between initial s.creat on admission and follow-up s.creat values in Group B with significant elevation of their s.creat on the following 24 h (P = 0.002), while this difference is insignificant in Group A (P = 0.34). There was a significant positive correlation between hs-TNT and the follow-up s.creat (P = 0.004). CONCLUSION In severe HTN, hs-TNT may be elevated due to marked afterload. Patients with severe HTN and high hs-TNT have higher s.creat values, which are associated with an increased risk of renal failure and in-hospital mortality if their BP decreases acutely to the guideline-target BP. Using biomarkers during the management of emergency HTN should be considered before following clinical guidelines. However, our findings do underscore the potential utility of hs-TNT as an indicator for risk stratification in patients with severe or emergency HTN.
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Affiliation(s)
| | - Scopus Mohamed Ismail
- Zagazig University Hospitals, Zagazig, Egypt
- University of Central Florida College of Medicine, Graduate Medical Education, Florida, USA
| | | | | | - Salem M Salem
- Zagazig University Hospitals, Zagazig, Egypt
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Jajcay N, Bezak B, Segev A, Matetzky S, Jankova J, Spartalis M, El Tahlawi M, Guerra F, Friebel J, Thevathasan T, Berta I, Pölzl L, Nägele F, Pogran E, Cader FA, Jarakovic M, Gollmann-Tepeköylü C, Kollarova M, Petrikova K, Tica O, Krychtiuk KA, Tavazzi G, Skurk C, Huber K, Böhm A. Data processing pipeline for cardiogenic shock prediction using machine learning. Front Cardiovasc Med 2023; 10:1132680. [PMID: 37034352 PMCID: PMC10077147 DOI: 10.3389/fcvm.2023.1132680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Recent advances in machine learning provide new possibilities to process and analyse observational patient data to predict patient outcomes. In this paper, we introduce a data processing pipeline for cardiogenic shock (CS) prediction from the MIMIC III database of intensive cardiac care unit patients with acute coronary syndrome. The ability to identify high-risk patients could possibly allow taking pre-emptive measures and thus prevent the development of CS. Methods We mainly focus on techniques for the imputation of missing data by generating a pipeline for imputation and comparing the performance of various multivariate imputation algorithms, including k-nearest neighbours, two singular value decomposition (SVD)-based methods, and Multiple Imputation by Chained Equations. After imputation, we select the final subjects and variables from the imputed dataset and showcase the performance of the gradient-boosted framework that uses a tree-based classifier for cardiogenic shock prediction. Results We achieved good classification performance thanks to data cleaning and imputation (cross-validated mean area under the curve 0.805) without hyperparameter optimization. Conclusion We believe our pre-processing pipeline would prove helpful also for other classification and regression experiments.
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Affiliation(s)
- Nikola Jajcay
- Premedix Academy, Bratislava, Slovakia
- Department of Complex Systems, Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
| | - Branislav Bezak
- Premedix Academy, Bratislava, Slovakia
- Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
- Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
- Correspondence: Branislav Bezak
| | - Amitai Segev
- The Leviev Cardiothoracic & Vascular Center, Chaim Sheba Medical Center, Ramat Gan, Israel
- Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- The Leviev Cardiothoracic & Vascular Center, Chaim Sheba Medical Center, Ramat Gan, Israel
- Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Michael Spartalis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
- Global Clinical Scholars Research Training (GCSRT) Program, Harvard Medical School, Boston, MA, United States
| | - Mohammad El Tahlawi
- Department of Cardiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Umberto I - Lancisi - Salesi”, Ancona, Italy
| | - Julian Friebel
- Department of Cardiology Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tharusan Thevathasan
- Department of Cardiology Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Berlin, Germany
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Leo Pölzl
- Department for Cardiac Surgery, Cardiac Regeneration Research, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Nägele
- Department for Cardiac Surgery, Cardiac Regeneration Research, Medical University of Innsbruck, Innsbruck, Austria
| | - Edita Pogran
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
| | - F. Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - Milana Jarakovic
- Cardiac Intensive Care Unit, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Can Gollmann-Tepeköylü
- Department for Cardiac Surgery, Cardiac Regeneration Research, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Otilia Tica
- Cardiology Department, Emergency County Clinical Hospital of Oradea, Oradea, Romania
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, United Kingdom
| | - Konstantin A. Krychtiuk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
- Duke Clinical Research Institute Durham, NC, United States
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Carsten Skurk
- Department of Cardiology Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Berlin, Germany
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
| | - Allan Böhm
- Premedix Academy, Bratislava, Slovakia
- Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
- Department of Acute Cardiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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Basha MAA, Shemais DS, Abdelwahed ES, Elfwakhry RM, Zeid AF, Abdalla AAEHM, Aly SA, Abdelrahman DS, Elshenawy AA, Mansour W, Elbanna KAA, El Tahlawi M, Elnahal N. Computed Tomography Imaging Assessment of the Effect of Vancomycin Paste on Poststernotomy Healing. Int J Gen Med 2021; 14:9287-9296. [PMID: 34880667 PMCID: PMC8648099 DOI: 10.2147/ijgm.s343124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/07/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess vancomycin paste effect on poststernotomy healing in high-risk coronary artery bypass grafting (CABG) patients compared to bone wax using the 6-point computed tomography (CT) score. Additionally assessed the reliability of this score and its relationship to the occurrence of infection. Patients and Methods A prospective comparative analysis included 126 high-risk CABG patients. The patients were randomly assigned into bone wax or vancomycin paste for sternal haemostasis. All patients were submitted to CT examinations 6-months postoperative. Two radiologists independently reviewed all CT scans to assess sternal healing using the 6-point CT score. The CT healing score of the two groups was compared. The kappa statistics were used to calculate the inter-reader agreement (IRA) of the 6-point CT score. Results The final analysis included 61 patients in each group. The main CT score for sternal healing was 3.9±0.4 in the vancomycin group and 3.3±0.8 in the bone wax group. Patients in the vancomycin group had a higher statistically significant improvement in CT healing score than those in the bone wax group (p<0.001). There was no statistically significant relationship (p = 0.79) between the occurrence of infection and the 6-point CT score in the vancomycin group. The overall IRA of the 6-point CT score was good in two groups (κ = 0.79 in the vancomycin group and = 0.78 in the bone wax group). Conclusion Vancomycin paste had a better CT healing score and can be used as a sternal haemostatic material instead of bone wax. The 6-point CT healing score is a reliable diagnostic tool for evaluating sternal healing.
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Affiliation(s)
| | - Dina Said Shemais
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Essam Saad Abdelwahed
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ayman Fathy Zeid
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Sameh Abdelaziz Aly
- Department of Radiodiagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Anwar A Elshenawy
- Department of Surgical Oncology, Faculty of Human Medicine, Aswan University, Aswan, Egypt
| | - Waleed Mansour
- Department of Chest Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohammad El Tahlawi
- Department of Cardiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nezar Elnahal
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Pazdernik M, Gramegna M, Bohm A, Trepa M, Vandenbriele C, De Rosa S, Uzokov J, Aleksic M, Jarakovic M, El Tahlawi M, Mostafa M, Stratinaki M, Araiza-Garaygordobil D, Gubareva E, Duplyakova P, Chacon-Diaz M, Refaat H, Guerra F, Cappelletti AM, Berka V, Westermann D, Schrage B. Regional differences in presentation characteristics, use of treatments and outcome of patients with cardiogenic shock: Results from multicenter, international registry. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:291-297. [PMID: 34421120 DOI: 10.5507/bp.2021.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/03/2020] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Concurrent evidence about cardiogenic shock (CS) characteristics, treatment and outcome does not represent a global spectrum of patients and is therefore limited. The aim of this study was to investigate these regional differences. METHODS To investigate regional differences in presentation characteristics, treatments and outcomes of patients treated with all types of cardiogenic shock (CS) in a single calendar year on a multi-national level. Consecutive patients from 19 tertiary care hospitals in 13 countries with CS who were treated between January 1, 2018 and December 31, 2018 were enrolled in this study. RESULTS In total, 699 cardiogenic shock patients were included in this study. Of these patients, 440 patients (63%) were treated in European hospitals and 259 (37%) were treated in Non-European hospitals. Female patients (P<0.01) and patients with a previous myocardial infarction (P=0.02) were more likely to present at Non-European hospitals; whereas older patients (P=0.01) and patients with cardiogenic shock due to acute heart failure (P<0.01) were more likely to present at European hospitals. Vasopressor use was more likely in Non-European hospitals (P=0.04), whereas use of mechanical circulatory support (MCS) was more likely in European hospitals (P<0.01). Despite adjustment for relevant confounders, 30-day in-hospital mortality risk was comparably high in CS patients treated in European vs. Non-European hospitals (hazard ratio 1.08, 95% CI 0.84-1.39, P=0.56). CONCLUSION Despite marked heterogeneity in characteristics and treatment of CS patients, including fewer use of MCS but more frequent use of vasopressors in Non-European hospitals, 30-day in-hospital mortality did not differ between regions.
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Affiliation(s)
- Michal Pazdernik
- Department of Cardiology, IKEM, Prague, Czech Republic.,Department of Cardiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Mario Gramegna
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Allan Bohm
- National Cardiovascular Institute, Bratislava, Slovak Republic.,3rd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Maria Trepa
- Centro Hospitalar Universitario do Porto, Porto, Portugal
| | | | | | - Jamol Uzokov
- Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Milica Aleksic
- Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | - Milana Jarakovic
- Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | | | | | | | | | | | | | | | - Hesham Refaat
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.,Al Jahra Hospital, Al Jahra, Kuwait
| | - Federico Guerra
- Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy
| | | | - Vojtech Berka
- Department of Cardiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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El Tahlawi M, Morsy M, Elawady M, Abdelaziz M, Eldamanhory A. Is there any relationship between biomarkers and echocardiographic markers in patients with pulmonary stenosis underwent balloon valvuloplasty? Echocardiography 2021; 38:924-931. [PMID: 33998046 DOI: 10.1111/echo.15077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/21/2021] [Revised: 04/09/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Congenital pulmonary stenosis (PS) is a progressive disease. Balloon pulmonary valvuloplasty (BPV) is the treatment of choice in valvular PS. AIM We aim to study the relationship between biomarkers and echocardiographic markers in valvular PS and to assess the impact of BPV on these markers. PATIENTS AND METHODS Patients with moderate and severe valvular PS amenable for BPV were recruited. Serum troponin I was measured. Echocardiographic assessment of PS and right ventricular (RV) function was done. All patients underwent BPV. Troponin level and echocardiographic data were re-assessed 2 weeks and 6 months after BPV. RESULTS Fifty patients with valvular PS were recruited. There was significant correlation between peak SPG and troponin (P < .001). Troponin was significantly decreased 2 weeks after BPV. Similarly, there was an initial improvement in RV function. After 6 months of follow-up, we divided patients into two groups: Group A: 36 patients with no restenosis. Group B: 14 patients with restenosis. There were high significant differences between both groups regarding troponin level and RV functions with re-elevated troponin in Group B that correlated with peak PG (r = .9, P < .001). RV function parameters in Group B became significantly worse 6 months after BPV than those after the initial 2 weeks. CONCLUSION Troponin correlates with the severity of PS and associates with RV dysfunction. Both troponin and RV functions improved with BPV. Recurrent elevation of troponin and impairment of RV function is associated with PV restenosis and could be set as an indication for repeated balloon dilatation of PV.
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Affiliation(s)
| | - Mohammad Morsy
- Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Nasr AY, El Tahlawi M. Anatomical and radiological angiographic study of the coronary ostia in the adult human hearts and their clinical significance. Anat Cell Biol 2018; 51:164-173. [PMID: 30310708 PMCID: PMC6172585 DOI: 10.5115/acb.2018.51.3.164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 04/23/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 11/27/2022] Open
Abstract
This study was carried out to investigate the morphometric parameters and variations of coronary ostia in the hearts of adult human cadavers and coronary angiographs. The hearts of 60 adult human cadavers and 400 coronary angiographs were used in this study. The root of the aorta was carefully dissected to clear aortic sinuses, coronary ostia, and sinutubular junction (STJ). Number, locations, internal diameter distance between coronary ostia and their corresponding STJ, sinus bottom, and valve commissures were investigated. The anterior aortic sinus (AAS) revealed a single ostium for right coronary artery (RCA) in 77.5% of male and 80% of female hearts. This ostium gave a common origin for RCA and third coronary artery (TCA) in 15% of male and 20% of female hearts. However, two separate ostia for RCA and TCA origin were seen in 20% of male and 15% of female hearts. Moreover, three ostia were seen in one male and one female hearts within AAS. Meanwhile, the left posterior aortic sinus showed a single ostium for left coronary artery (LCA) in 97.5% of male and 95% of female hearts and two ostia in one male and one female hearts. The ostia were commonly seen below STJ and less commonly were observed above STJ. The distance between the bottom of aortic sinus and LCA ostium was longer than that of RCA. The internal diameter of RCA ostium was significantly (P<0.05) narrower than that of LCA but with no significant sex difference. Moreover, anomalous of coronary ostia was observed in seven out 400 angiographs and in two cadaveric hearts. Knowledge the morphometric parameters and anatomical variations of coronary ostia helps the cardiac surgeons to overcome the possible difficulties that could occur during surgical and radiological coronary interventions.
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Affiliation(s)
- Ashraf Youssef Nasr
- Department of Anatomy, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Department of Anatomy, Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Mohammad El Tahlawi
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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El Sammak DAEA, Basha MAA, Tahlawi ME. Role of MDCT renal angiography in determining the anatomical eligibility for renal sympathetic denervation in resistant hypertensive patients. The Egyptian Journal of Radiology and Nuclear Medicine 2018. [DOI: 10.1016/j.ejrnm.2017.11.003] [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: 10/17/2022] Open
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El Tahlawi M, Sakrana A, Elmurr A, Gouda M, Tharwat M. The relation between coronary tortuosity and calcium score in patients with chronic stable angina and normal coronaries by CT angiography. Atherosclerosis 2016; 246:334-7. [DOI: 10.1016/j.atherosclerosis.2016.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 12/17/2022]
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El Tahlawi M, Abdalla M, Gouda M, Gad M, Elawady M. 55. Can we assess the success of balloon pulmonary valvuloplasty by ECG. J Saudi Heart Assoc 2015. [DOI: 10.1016/j.jsha.2015.05.236] [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: 10/23/2022] Open
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Tahlawi ME, Kammache I, Fraisse A. Ventricular septal defect closure in a small children with the Amplatzer Duct Occluder II. Catheter Cardiovasc Interv 2011; 77:268-71. [DOI: 10.1002/ccd.22723] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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El Tahlawi M, Jop B, Bonello B, Dragulescu A, Rouault F, Habib G, Fraisse A. Should we close hypoxaemic patent foramen ovale and interatrial shunts on a systematic basis? Arch Cardiovasc Dis 2009; 102:755-9. [PMID: 19944391 DOI: 10.1016/j.acvd.2009.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 09/09/2009] [Accepted: 09/10/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rarely, hypoxaemia is associated with shunt reversal at the atrial level. Closure by interventional catheterization is the treatment of choice but indications and results have been studied insufficiently. PURPOSE To describe our experience with interventional closure of atrial right-to-left shunts described as hypoxaemic and the impact on patient oxygenation and clinical status. METHOD Retrospective study in two referral centres, including all patients undergoing closure of interatrial right-to-left shunt associated with hypoxaemia. RESULTS Since 2001, 21 consecutive patients underwent interventional shunt closure using the "Amplatzer((R)) device"; two patients had atrial septal defect and 19 had patent foramen ovale. Three patients had minor adverse events; two patients have a tiny residual shunt. Transcutaneous oxygen saturation and partial oxygen pressure increased significantly from 86+/-5 to 95+/-3% (p<0.001) and from 49.8+/-6.8 to 82.9+/-30.4mmHg (p=0.001), respectively. Seventeen (80%) patients reported clinical improvement. However, patients with chronic respiratory insufficiency remained more symptomatic, with three deaths after a median follow-up of 35 (6-97) months and 89% remaining in New York Heart Association class III/IV (vs 29% of patients without chronic respiratory insufficiency; p=0.035). CONCLUSION Hypoxaemic shunts are treated effectively by transcatheter closure, resulting in functional improvement in patients without respiratory insufficiency. When associated with chronic respiratory insufficiency, hypoxaemia often persists after shunt closure. In such cases, the right-to-left atrial shunt does not seem to be the main cause of hypoxaemia and the indication for closure is questionable.
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Affiliation(s)
- Mohammad El Tahlawi
- Service de cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, rue Saint-Pierre, Marseille, France
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El Tahlawi M, Bonello B, Fraisse A. Radiofrequency recanalization of an occluded long segment left pulmonary artery in bidirectional cavopulmonary anastomosis. Catheter Cardiovasc Interv 2009; 75:773-7. [DOI: 10.1002/ccd.22225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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