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Panama G, Martinez A, Alattal S, Banga P, Banga S, Quintar M. A Patent Foramen Ovale With an Atrial Septal Aneurysm in a Patient Presenting With Deep Vein Thrombosis and Pulmonary Embolism. Cureus 2024; 16:e53714. [PMID: 38455830 PMCID: PMC10919323 DOI: 10.7759/cureus.53714] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Patent foramen ovale (PFO) is an embryogenic remnant that can be found in healthy adults with no repercussions. However, it poses a risk of paradoxical embolism. In patients with known embolic stroke, the risk of recurrence is greater. A PFO can be accompanied by morphological variants such as atrial septal aneurysms (ASA). These have been shown to further increase the risk of stroke and embolism. This is a case of a patient who presented to the emergency department with deep vein thrombosis and sub-massive pulmonary embolism. An echocardiogram showed a PFO with an ASA as an incidental finding. The defect was closed with a transcatheter PFO closure device due to a high risk of paradoxical embolism.
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Affiliation(s)
- Gabriel Panama
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Adolfo Martinez
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Saif Alattal
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Preeti Banga
- Radiology, Michigan State University, East Lansing, USA
| | - Sandeep Banga
- Cardiology, Michigan State University, East Lansing, USA
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2
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Sabanci R, Saeed Al-Asad K, Saaed M, Geunwon Kim A, Martinez A, Banga S, Abela G. A Rare Case of Streptococcus pneumoniae Complicated With Pericardial Abscess. Cureus 2023; 15:e47780. [PMID: 38021773 PMCID: PMC10676517 DOI: 10.7759/cureus.47780] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
This abstract presents the case of a 37-year-old female with no significant past medical history who presented to the emergency department with a unique and challenging clinical scenario. The patient complained of chest pain, dyspnea, and a productive cough associated with stabbing chest pain that improved with leaning forward for the past week. Despite an initial diagnosis of community-acquired pneumonia, the patient's condition deteriorated rapidly, leading to septic shock. Blood cultures ultimately revealed Streptococcus pneumoniae as the causative organism. Subsequent imaging and diagnostic procedures demonstrated a complex clinical course, including loculated pleural and pericardial effusions. The patient's condition necessitated multiple interventions, including pericardiocentesis, chest tube placement, and intracavitary lytic therapies, in addition to intubation for acute respiratory failure. The case further evolved with the development of a pericardial abscess, successfully managed with surgical drainage and a partial pericardiectomy. The patient eventually showed significant clinical improvement and was discharged on a targeted antibiotic regimen. This case highlights the importance of vigilance in identifying rare complications of pneumonia and the need for prompt, multidisciplinary management to ensure the best possible outcome for the patient. Long-term follow-up was recommended to assess the patient's recovery. This case underscores the complexities and challenges of managing uncommon presentations of infectious diseases and emphasizes the value of a comprehensive, multidisciplinary approach in such cases.
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Affiliation(s)
- Rand Sabanci
- Internal Medicine, Michigan State University, East Lansing, USA
| | | | - Moiz Saaed
- Internal Medicine, Michigan State University, East Lansing, USA
| | | | - Adolfo Martinez
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Sandeep Banga
- Cardiology, Michigan State University, Lansing, USA
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
| | - George Abela
- Cardiology, Michigan State University, East Lansing, USA
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3
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Faisaluddin M, Sattar Y, Manasrah N, Banga S, Ahmed A, Goel M, Taha A, Alamzaib SM, Virk HUH, Alam M, Alraies MC, Dani SS, Kadavath S, Kawsara A, Elgendy IY, Daggubati R. Outcomes of Transcatheter Aortic Valve Replacement With and Without Index Chronic Total Occlusion of Coronary Artery: A Propensity Matched Analysis. Am J Cardiol 2023; 204:405-412. [PMID: 37598538 DOI: 10.1016/j.amjcard.2023.07.069] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) utilization is increasing, along with procedural success. Coronary angiography is frequently performed before the TAVR procedure for coronary artery disease workup. Chronic total occlusion (CTO) of the coronary artery shares common risk factors with aortic stenosis and could be challenging, especially in terms of procedural safety. The outcomes of TAVR among patients with concomitant CTO are not extensively studied. We analyzed the National Inpatient Sample database between October 2015 and December 2020 to evaluate the clinical characteristics, procedural safety, and outcomes among patients who underwent TAVR who had concomitant CTO lesions. A total of 304,330 TAVRs were performed between 2015 and 2020, 5,235 of which (1.72%) were in patients with TAVR-CTO and 299,095 (98.28%) in those with TAVR-no CTO. After propensity matching, there was no difference in the odds of in-hospital mortality (adjusted odds ratio [aOR] 1.28, 95% confidence interval [CI] 0.94 to 1.75, p = 0.11). However, TAVR-CTO was associated with an increased incidence of acute myocardial infarction (aOR 1.27, 95% CI 1.05 to 1.53, p = 0.01), cardiac arrest (aOR, 2.60, 95% CI 1.64 to 4.11, p <0.0001), and need for mechanical circulatory support (aOR 2.6, 95% CI 1.88 to 3.59, p <0.0001). There was no difference in the incidence of stroke, major bleeding, complete heart block, or requirement for permanent pacemaker between the 2 groups. However, the TAVR-CTO cohort had a slightly greater length of stay and total hospitalization cost. TAVR is a relatively safe procedure among those with concomitant CTO lesions; however, it is associated with a greater incidence of acute myocardial infarction, cardiac arrest, and requirement for mechanical circulatory support.
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Affiliation(s)
- Mohammed Faisaluddin
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, West Virginia.
| | - Nouraldeen Manasrah
- Department of Internal Medicine, Wayne State University, Detroit Medical Center, Sinai Grace Hospital, Detroit, Michigan
| | - Sandeep Banga
- Division of Cardiology, Michigan State University/Sparrow Hospital, Lansing, Michigan
| | - Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Mishita Goel
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Amro Taha
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois
| | | | | | - Mahboob Alam
- Department of Cardiology, Baylor College of Medicine, Houston, Texas
| | - M Chadi Alraies
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Sourbha S Dani
- Department of Cardiology, Lahey Clinic, Boston, Massachusetts
| | | | - Akram Kawsara
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Ramesh Daggubati
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
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Ukponmwan EU, Banga S, Kim AG, Qintar M, Abela G. Cryptogenic Stroke Caused by a Newly Diagnosed Patent Foramen Ovale in a Healthy Young Adult. Cureus 2023; 15:e46895. [PMID: 37954786 PMCID: PMC10636518 DOI: 10.7759/cureus.46895] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
The foramen ovale serves as an opening between the right and left atria at the site of the fossa ovalis in the fetus during uterine life. During fetal life, it makes it possible for venous blood from the maternal placenta with oxygen and nutrients to bypass the immature fetal lung and get transported to the left side of the heart and onto the systemic circulation. This hole from the right to the left atrium is usually occluded at the time of birth or shortly after birth, due to increased pressures in the left-sided cardiac cavities associated with normal breathing during delivery or shortly afterwards. If the foramen ovale remains open and fails to fuse beyond the first year of life, it is known as a patent foramen ovale (PFO). PFO occurs when, during fetal life, the septum primum and secundum, which develop and overlap normally, fail to fuse at birth. This results in the persistence of communication between the right and left atria. Paradoxical embolism from the right to the left side of the heart can occur through a PFO, causing a cryptogenic stroke or embolic stroke of an undetermined source in an otherwise healthy adult. There was a debate on the long-term benefits of closure. However, data from the randomized evaluation of the recurrent stroke comparing PFO closure to established current standard of care treatment (RESPECT) trial and two randomized trials (patent foramen ovale closure or anticoagulants versus antiplatelet therapy to prevent stroke recurrence (CLOSE) and reduction by dutasteride of prostate cancer events (REDUCE)) have clarified that there is a benefit to closure. In this case report, we describe a patient who presented with cryptogenic stroke, the investigations, imaging modalities for diagnosis of PFO, and procedure for closure. We also describe long-term outcomes and management following closure.
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Affiliation(s)
| | - Sandeep Banga
- Cardiology, Michigan State University, East Lansing, USA
| | - Andrew G Kim
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Mohammed Qintar
- Cardiology, Human Medicine, Michigan State University, East Lansing, USA
| | - George Abela
- Cardiology, Michigan State University, East Lansing, USA
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Salazar AM, Al-Asad KS, Prasad RM, Panama G, Banga S, Wilcox M. Pulmonary Artery Denervation as a New Therapeutic Option for Pulmonary Hypertension: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101776. [PMID: 37121454 DOI: 10.1016/j.cpcardiol.2023.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/02/2023]
Abstract
Pulmonary hypertension (PH) is a progressive disease with a high morbidity and mortality. The treatment is based on the type of PH. Prognosis still remains poor despite the use of different medications. Pulmonary artery denervation (PADN) has been studied as a novel therapeutic option in these patients. PUBMED, EMBASE and COCHRANE databases were searched by 2 investigators until January 2023. Information was analyzed for the following outcomes: 6-minute walk distance (6MWD), mean pulmonary artery pressure, pulmonary vascular resistance and cardiac output. Subgroup analysis comparing pre and post PADN in different PH groups was done. Statistical analysis was performed with the Review Manager version 5.4. This meta- analysis included 6 controlled trials and 6 single-arm prospective studies with a total of 616 patients. Our pooled analysis showed a significant reduction in mean pulmonary artery pressure [WMD -6.51, 95% CI (-9.87, -3.15), p = 0.0001], pulmonary vascular resistance [WMD -3.69, 95% CI (-6.74, -0.64), p = 0.02] and increased cardiac output [WMD -0.37, 95% CI (0.08, 0.65), p = 0.01]. Subgroup analysis pre and post PADN demonstrated a significant improvement in 6MWD in the WHO group 1 [WMD 99.53, 95% CI (19.60, 179.47), p = 0.01], group 2 [WMD: 69.96, 95% CI (36.40, 103.51), p = < 0.0001] and group 4 [WMD: 99.54, 95% CI (21.80, 177.28), p = 0.01]. This meta-analysis supports PADN as a therapeutic option for patients with PH, regardless of group class. Further randomized trials are still needed to evaluate safety and efficacy.
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Affiliation(s)
- Adolfo Martinez Salazar
- Division of Internal Medicine, Department of Medicine, Michigan State University, East Lansing, Michigan.
| | - Khalid Saeed Al-Asad
- Division of Internal Medicine, Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Rohan M Prasad
- Department of Cardiology, Michigan State University, East Lansing, Michigan
| | - Gabriel Panama
- Division of Internal Medicine, Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Sandeep Banga
- Department of Cardiology, Michigan State University, East Lansing, Michigan
| | - Matthew Wilcox
- Department of Cardiology, Thoracic Cardiovascular Institute, Sparrow Hospital, Lansing, Michigan
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Banga S, Abela GS, Saltiel F, Fischell T, Kalavakunta JK, Sood A, Jolly G, Najib K, Al-Ali H, Qintar M, Bazil J, Singh Y, Gupta V. Management of Atrial Fibrillation Post Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 200:171-177. [PMID: 37329837 DOI: 10.1016/j.amjcard.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 06/19/2023]
Abstract
Atrial fibrillation (AF) is a common complication in patients who underwent transcatheter aortic valve implantation. Some of these patients have preexisting AF as well. The management of these patients is complex, especially after the procedure, when there is a sudden change in hemodynamics. There are no established guidelines about the management of the patients who underwent transcatheter aortic valve replacement with preexisting or new-onset AF. This review article discusses the management of these patients with rate and rhythm control strategies with medications. This article also highlights the role of newer oral anticoagulation medications and left atrial occlusion devices to prevent stroke after the procedure. We will also discuss new advances in the care of this patient population to prevent the occurrence of AF after transcatheter aortic valve implantation. In conclusion, this article is a synopsis of both pharmacologic and device interventions for the management of AF in patients who underwent transcatheter aortic valve replacement.
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Affiliation(s)
- Sandeep Banga
- Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan.
| | - George S Abela
- Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan
| | - Frank Saltiel
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Tim Fischell
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Jagadeesh K Kalavakunta
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Abhinav Sood
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - George Jolly
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Khalid Najib
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Haya Al-Ali
- Department of Physiology, Michigan State University, Lansing, Michigan
| | - Mohammed Qintar
- Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan
| | - Jason Bazil
- Department of Physiology, Michigan State University, Lansing, Michigan
| | - Yashbir Singh
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Vishal Gupta
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
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Tokavanich N, Machado C, Banga S, Smiles K, Dhar A, Ali A, Ali M, Qutrio Baloch Z, Ip J. Implant efficiency and clinical performance of Aveir™ VR and Micra™ VR leadless pacemaker: A multicenter comparative analysis of 67 patients. Pacing Clin Electrophysiol 2023; 46:827-832. [PMID: 37382396 DOI: 10.1111/pace.14766] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/08/2023] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Leadless pacemaker (LP) is a novel pacemaker that has been proven to be effective and safe; however, the majority of LPs in previous reports were the Medtronic Micra™ VR LP. We aim to evaluate the implant efficiency and clinical performance of the Aveir™ VR LP compared to the Micra™ VR LP. METHOD We performed a retrospective analysis in two healthcare systems (Sparrow Hospital and Ascension Health System, Michigan) in patients implanted with LPs between January 1, 2018, and April 1, 2022. The parameters were collected at implantation, 3 months and 6 months. RESULTS A total of 67 patients were included in the study. The Micra™ VR group had shorter time in the electrophysiology lab (41 ± 12 vs. 55 ± 11.5 min, p = .008) and shorter fluoroscopic time (6.5 ± 2.2 vs. 11.5 ± 4.5 min, p < .001) compared to the Aveir™ VR group. The Aveir™ VR group had a significantly higher implant pacing threshold compared to the Micra™ VR group (0.74 ± 0.34 mA vs. 0.5 ± 0.18 mA at pulse width 0.4 ms, p < .001), but no difference was found at 3 months and 6 months. There was no significant difference in the R-wave sensing and impedance and pacing percentage at implantation, 3 months, and 6 months. Complications of the procedure were rare. The mean projected longevity of the Aveir™ VR group was longer than the Micra™ VR group (18.8 ± 4.3 vs. 7.7 ± 0.75 years, p < .001). CONCLUSION Implantation of the Aveir™ VR required longer laboratory and fluoroscopic time, but showed longer longevity at 6 months follow-up, compare to the Micra™ VR. Complications and lead dislodgement are rare.
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Affiliation(s)
- Nithi Tokavanich
- Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, Michigan, USA
- Sparrow Clinical Research Institute, Lansing, Michigan, USA
| | - Christian Machado
- Department of Cardiology, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Sandeep Banga
- Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, Michigan, USA
- Sparrow Clinical Research Institute, Lansing, Michigan, USA
| | - Katelyn Smiles
- Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, Michigan, USA
- Sparrow Clinical Research Institute, Lansing, Michigan, USA
| | - Anya Dhar
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Abbas Ali
- Heart and Vascular Institute, West Virginia University Medicine, Morgantown, West Virginia, USA
| | - Mohammed Ali
- Heart and Vascular Institute, West Virginia University Medicine, Morgantown, West Virginia, USA
| | - Zulfiqar Qutrio Baloch
- Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, Michigan, USA
- Sparrow Clinical Research Institute, Lansing, Michigan, USA
| | - John Ip
- Thoracic and Cardiovascular Institute, Sparrow Hospital, Lansing, Michigan, USA
- Sparrow Clinical Research Institute, Lansing, Michigan, USA
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Banga S, Cardoso R, Castellani C, Srivastava S, Watkins J, Lima J. Cardiac MRI as an Imaging Tool in Titin Variant-Related Dilated Cardiomyopathy. Cardiovasc Revasc Med 2023; 52:86-93. [PMID: 36934006 DOI: 10.1016/j.carrev.2023.03.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
Dilated Cardiomyopathy is a common myocardial disease characterized by dilation and loss of function of one or both ventricles. A variety of etiologies have been implicated including genetic variation. Advancement in genetic sequencing, and diagnostic imaging allows for detection of genetic mutations in sarcomere protein titin (TTN) and high resolution assessment of cardiac function. This review article discusses the role of cardiac MRI in diagnosing dilated cardiomyopathy in patients with TTN variant related cardiomyopathy.
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Affiliation(s)
- Sandeep Banga
- Division of Cardiology, Michigan State University, Sparrow Hospital, Lansing, MI, USA.
| | | | - Carson Castellani
- Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shaurya Srivastava
- Division of Internal Medicine, Michigan State University, Lansing, MI, USA
| | - Jennifer Watkins
- Division of Cardiology, Michigan State University, Sparrow Hospital, Lansing, MI, USA
| | - Joao Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
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Muacevic A, Adler JR, Kim A, Watat K, Banga S. Beta-Blocker and Calcium Channel Blocker Toxicity With BRASH Syndrome: A Case Report. Cureus 2023; 15:e33544. [PMID: 36779105 PMCID: PMC9907465 DOI: 10.7759/cureus.33544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Atrioventricular (AV) nodal blockers have a wide variety of medical uses, including the management of hypertension and cardiac arrhythmias. Like any other drug, they can carry side effects and toxicity. We present a case of a patient with a constellation of findings consistent with bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia (BRASH) syndrome. A 75-year-old female with a history of paroxysmal atrial fibrillation and heart failure with preserved ejection fraction presented to the hospital with shortness of breath. She was discharged two weeks prior to the presentation from another hospital after being treated for atrial fibrillation with a rapid ventricular response. She was discharged on metoprolol and diltiazem. Upon presentation to the hospital, the patient was noted to be bradycardic and hypotensive with blood work notable for acute kidney injury and hyperkalemia, consistent with BRASH syndrome. She received a dose of intravenous (IV) glucagon followed by infusion and received epinephrine infusion. Once clinically stable, she was discharged with her home dose of metoprolol and a reduced dose of diltiazem with a close follow-up with cardiology. Early recognition of BRASH syndrome as a unique clinical entity rather than different pathologic conditions is important to improve morbidity and mortality in these patients.
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Osman AF, Jamal SM, Banga S, Baloch Z, Sheikh A. Abstract P027: Yamaguchi Syndrome Presenting With Atrial Fibrillation And Heart Failure Diagnosed With Contrast Echocardiography. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p027] [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
Yamaguchi syndrome or apical hypertrophic cardiomyopathy (ApHCM), is a rare variant of hypertrophic cardiomyopathy (HCM), prevalence of about 3% among HCM population in the United States. Generally considered a benign condition but can be potentially life-threatening.
A 84 year old female with history of mitral regurgitation with mitra-clip, paroxysmal atrial fibrillation (pAF) presented to ED with dyspnea and leg swelling. She was tachypneic with bibasilar rales, jugular venous distention. BNP 1,086 pg/l with cardiomegaly and pulmonary edema on chest x-ray.
She was managed for acute decompensated cardiac failure (NYHA class III) using IV furosemide with symptom improvement. EKG revealed AF with abnormal deep T-wave inversion most prominent in precordial leads (V4-V6). Contrast echocardiogram revealed ApHCM, missed on prior echocardiograms. Patient’s dose of metoprolol was doubled, and outpatient follow-up was scheduled.
Conclusion:
ApHCM commonly presents with heart failure symptoms, chest pain, palpitation, or syncope. Undiagnosed/untreated ApHCM can lead to complications including diastolic dysfunction, left atrial enlargement causing atrial fibrillation, apical clots formation with subsequent thromboembolism, ventricular wall aneurysm, arrhythmias, and myocardial infarction. In our case, contrast echocardiogram was able to diagnose ApHCM. A presentation of heart failure symptoms at NYHA class II or higher is a known predictor of poor prognosis in patients with ApHCM. Missing diagnosis on normal echocardiogram without use of ultrasound contrast is very common. Diagnosing with proper use of modality can help to improve outcomes in these patients.
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Affiliation(s)
| | | | | | | | - Ali Sheikh
- Michigan State Univ - Sparrow Hosp, Lansing, MI
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11
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Saeed Al-Asad K, Martinez Salazar A, Banga S, Yavari M, Al-Abcha A, Saleh Y, Abela G. Meta-analysis Comparing Transradial With Transfemoral Access in the Treatment of Coronary Chronic Total Occlusion. Am J Cardiol 2022; 179:114-116. [PMID: 35851470 DOI: 10.1016/j.amjcard.2022.06.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Khalid Saeed Al-Asad
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | | | - Sandeep Banga
- Department of Cardiology, Michigan State University, East Lansing, Michigan
| | - Majid Yavari
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Abdullah Al-Abcha
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Yehia Saleh
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Department of Cardiology, Alexandria University, Alexandria, Egypt
| | - George Abela
- Department of Cardiology, Michigan State University, East Lansing, Michigan
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12
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Khor SY, Osman AF, Agarwal P, Banga S. Streptococcus anginosus purulent pericarditis with cardiac tamponade presenting as a complication of postobstructive pneumonia. BMJ Case Rep 2022; 15:15/6/e249871. [DOI: 10.1136/bcr-2022-249871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in his 60s with stage 3 squamous cell carcinoma of the left lung status postchemotherapy and radiation therapy presented with mixed septic and obstructive shock with multiorgan dysfunction. Initial electrocardiogram showed sinus tachycardia and diffuse concaved ST elevation. Transthoracic echocardiogram revealed pericardial effusion with tamponade physiology. CT thorax was notable for dense left lung consolidation with pleural effusion. Emergent pericardiocentesis and percutaneous balloon pericardiotomy were performed which successfully drained 500 mL of purulent pericardial fluid. A left chest tube was placed and revealed a large volume of empyema. Both pericardial and pleural fluid cultures yielded similar strains of Streptococcus anginosus. The patient was initially treated with empiric broad-spectrum intravenous antibiotics which were eventually de-escalated to intravenous ceftriaxone based on microbiology culture and sensitivity. Unfortunately, the patient developed pulseless electrical activity arrest on day 10 of intensive care unit stay and expired despite cardiopulmonary resuscitation.
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Kagiyama N, Yanamala N, Banga S, Shrestha S, Verzosa GC, Sengupta PP. IDENTIFICATION OF VALVULAR HEART DISEASE FROM BODY SURFACE ELECTROCARDIOGRAM: A PROSPECTIVE MULTICENTER STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01021-x] [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: 11/25/2022]
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14
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Jamal S, Ijaz SH, Minhas AMK, Kichloo A, Khan MZ, Albosta M, Aljadah M, Banga S, Baloch ZQ, Aboud H, Haji AQ, Sheikh A, Kanjwal K. Outcomes of Hospitalizations with Acute Respiratory Distress Syndrome with and without Atrial Fibrillation - Analyses from the National Inpatient Sample (2004-2014). Am J Med Sci 2022; 364:289-295. [DOI: 10.1016/j.amjms.2022.01.020] [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] [Received: 06/19/2021] [Revised: 10/17/2021] [Accepted: 01/31/2022] [Indexed: 11/01/2022]
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15
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Prasad R, Al-Abcha A, Banga S, Sheth R, Ali S, Baloch Z. Effect of Roux-en-Y gastric bypass versus medical therapy on type 2 diabetes mellitus and cardiovascular risk factors. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.770] [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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16
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Prasad R, Al-Abcha A, Banga S, Sheth R, Ali S, Baloch Z. Fractional flow reserve: Comparing intravenous regadenoson and intravenous adenodsine. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.888] [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: 10/20/2022]
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17
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Abstract
Left ventricular non-compaction cardiomyopathy (LVNC) is a rare and unclassified cardiomyopathy that carries the potential to cause heart failure, arrhythmias, and embolic events within adults. The diagnosis of this cardiomyopathy can be based off a variety of echocardiographic, cardiac magnetic resonance (CMR), and computed tomography (CT) imaging criteria; none of which have been standardized to establish a firm diagnosis. This is further complicated by the observation from prior studies that LVNC may present as different forms of cardiomyopathy, each with its own subset of nuances that may change treatment strategies. Management of such cardiomyopathy has been debated in terms of anticoagulation, electrophysiologic studies to prevent arrhythmia, as well as heart failure prevention. Not enough data exists in regard to establishing firm guidelines for management. The following article aims to provide a comprehensive review in regard to the etiologies, pathogenesis, diagnostic criteria, management, and treatment of LVNC.
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Affiliation(s)
- Shaurya Srivastava
- Department of Internal Medicine, Michigan State University, East Lansing, USA.
| | - Majid Yavari
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | - Abdullah Al-Abcha
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | - Sandeep Banga
- Sparrow Hospital, Transthoracic Cardiovascular Institute, Lansing, USA
| | - George Abela
- Department of Internal Medicine, Michigan State University, East Lansing, USA
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Kadiyala M, Hui K, Banga S, Loomba RS, Pandian NG, Kutty S. Persistent Right Venous Valve: Insights From Multimodality Imaging. Circ Cardiovasc Imaging 2021; 14:e010977. [PMID: 33993704 DOI: 10.1161/circimaging.120.010977] [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] [Indexed: 11/16/2022]
Abstract
Anatomic variants in the right atrium are under-recognized and under-reported phenomena in cardiac imaging. In the fetus, right atrium serves as a conduit for oxygenated blood to be delivered to the left heart bypassing the right ventricle and the nonfunctional lungs. The anatomy in the fetal right atrium is designed for such purposeful circulation. The right and left venous valves are prominent structures in the fetal heart that direct inferior vena caval flow towards the foramen ovale. These anatomic structures typically regress and the foramen ovale closes after birth. However, the venous valves can persist leading to a range of anatomic, physiological, and pathological consequences in the adult. We describe various presentations of persistent venous valves, focusing on the right venous valve in this illustrated multimodality imaging article.
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Affiliation(s)
- Madhavi Kadiyala
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, WV (M.K., S.B.)
| | - Kevin Hui
- New York Medical College, Valhalla, NY (K.H.)
| | - Sandeep Banga
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, WV (M.K., S.B.)
| | - Rohit Seth Loomba
- Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL (R.S.L.)
| | - Natesa G Pandian
- Division of Cardiology, Hoag Hospital, Newport Beach, CA (N.G.P.).,Tufts University School of Medicine, Boston, MA (N.G.P.)
| | - Shelby Kutty
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
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Banga S, Baloch ZQ, Ali A, Al-abcha A, Ip J. INCIDENCE OF ACTIONABLE EVENTS ON IMPLANTABLE CARDIAC MONITORS: A PROSPECTIVE STUDY COMPARING REVEAL LINQTM OR CONFIRM RXTMIMPLANTABLE CARDIAC MONITORS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01792-7] [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: 11/26/2022]
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20
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Al-Abcha A, Saleh Y, Elsayed M, Elshafie A, Herzallah K, Baloch ZQ, Banga S, Rayamajhi S, Abela GS. Left atrial appendage closure versus oral anticoagulation in non-valvular atrial fibrillation; a systemic review and meta-analysis. Cardiovasc Revasc Med 2021; 36:18-24. [PMID: 33903038 DOI: 10.1016/j.carrev.2021.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) devices are an alternative therapy in non-valvular atrial fibrillation (NVAF) patients with contraindications to oral anticoagulation (OAC). However, there are limited data about the clinical outcomes of LAAC devices compared to medical treatment. METHODS A comprehensive research for studies comparing LAAC devices and OAC for patients with NVAF was performed from inception to January 1, 2021. A meta-analysis was performed using a random effect model to calculate odds ratios (OR) with 95% confidence intervals (CIs). RESULTS Five studies were eligible that included a total of 4778 patients with a median-weighted follow-up period was 2.6 years. Compared to OAC, the LAAC device arm was associated with a lower risk of the composite of stroke, systematic embolism, and cardiovascular death (OR 0.71; 95% CI 0.51-1.00; p = 0.05). LAAC device arm was also associated with a lower risk of all-cause mortality (OR of 0.60, 95% CI 0.46-0.77; p < 0.0001), cardiovascular mortality (OR of 0.57, 95% CI 0.46-0.70; p < 0.00001), hemorrhagic stroke (OR of 0.19, 95% CI 0.07-0.50; p= 0.0006), all major bleeding (OR of 0.61, 95% CI 0.43-0.88; p = 0.007) and non-procedural major bleeding (OR of 0.46, 95% CI 0.32-0.65; p < 0.0001). There was no significant difference in all stroke, ischemic stroke, and systematic embolization between the two groups. CONCLUSIONS Our meta-analysis showed lower all-cause mortality, cardiovascular mortality, hemorrhagic stroke, major bleeding, non-procedural major bleeding and the composite of stroke, systematic embolism, and cardiovascular death in the LAAC device arm when compared to OAC. However, the risk of all stroke, ischemic stroke, and systematic embolism were similar between the two arms.
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Affiliation(s)
- Abdullah Al-Abcha
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA.
| | - Yehia Saleh
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mahmoud Elsayed
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ahmed Elshafie
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | | | | | - Sandeep Banga
- Department of Cardiology, Michigan State University, East Lansing, MI, USA
| | - Supratik Rayamajhi
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | - George S Abela
- Department of Cardiology, Michigan State University, East Lansing, MI, USA
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Banga S, Osman M, Sengupta PP, Benjamin MM, Shrestha S, Challa A, Zeb I, Kadiyala M, Mills J, Balla S, Raybuck B, Seetharam K, Hamirani YS. CT assessment of the left atrial appendage post-transcatheter occlusion - A systematic review and meta analysis. J Cardiovasc Comput Tomogr 2020; 15:348-355. [PMID: 33384253 DOI: 10.1016/j.jcct.2020.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/16/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transesophageal echocardiography (TEE) is the standard imaging modality used to assess the left atrial appendage (LAA) after transcatheter device occlusion. Cardiac computed tomography angiography (CCTA) offers an alternative non-invasive modality in these patients. We aimed to conduct a comparison of the two modalities. METHODS We performed a comprehensive systematic review of the current literature pertaining to CCTA to establish its usefulness during follow-up for patients undergoing LAA device closure. Studies that reported the prevalence of inadequate LAA closure on both CCTA and TEE were further evaluated in a meta-analysis. 19 studies were used in the systematic review, and six studies were used in the meta-analysis. RESULTS The use of CCTA was associated with a higher likelihood of detecting LAA patency than the use of TEE (OR, 2.79, 95% CI 1.34-5.80, p = 0.006, I2 = 70.4%). There was no significant difference in the prevalence of peridevice gap ≥5 mm (OR, 3.04, 95% CI 0.70-13.17, p = 0.13, I2 = 0%) between the two modalities. Studies that reported LAA assessment in early and delayed phase techniques detected a 25%-50% higher prevalence of LAA patency on the delayed imaging. CONCLUSION CCTA can be used as an alternative to TEE for LAA assessment post occlusion. Standardized CCTA acquisition and interpretation protocols should be developed for clinical practice.
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Affiliation(s)
- Sandeep Banga
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Mohammed Osman
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Mina M Benjamin
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sirish Shrestha
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Abhiram Challa
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Irfan Zeb
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Madhavi Kadiyala
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - James Mills
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sudarshan Balla
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Bryan Raybuck
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Karthik Seetharam
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Yasmin S Hamirani
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA.
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22
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Benjamin M, Banga S, Kim C, Hamirani Y, Zeb I, Kadiyala M. Concordance Of CT-FFR With Invasive Angiography Is Affected By Image Quality And Coronary Vessel Volume/Mass Ratio. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.085] [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: 10/23/2022]
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23
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Banga S, Hafiz AM, Chami Y, Gumm DC, Banga P, Howard C, Kim M, Sengupta PP. Comparing sedation vs. general anaesthesia in transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair: a meta-analysis. Eur Heart J Cardiovasc Imaging 2020; 21:511-521. [PMID: 32101610 DOI: 10.1093/ehjci/jeaa019] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/15/2020] [Accepted: 01/24/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair (TOE-guided PMVR) using edge-to-edge leaflet plication is typically performed under general anaesthesia (GA). Increasing evidence supports the efficacy and safety of PMVR performed under conscious sedation (CS) or deep sedation (DS). We performed a meta-analysis comparing safety and efficacy of CS/DS vs. GA in PMVR. METHODS AND RESULTS A comprehensive search was performed using PubMed, CINAHL, Ovid MEDLINE, Embase, and the Cochrane Library. Study characteristics, participant demographics, and procedural outcomes with both types of anaesthesia were analysed. Out of 73 articles, five met inclusion criteria. Overall, there was no significant difference in the primary outcome of procedural success rate [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.30-1.88, I2= 0.0%, P = 0.538] or post-procedure in-hospital mortality (OR 1.02; 95% CI 0.38-2.71, I2= 0.0%, P = 0.970) in the patients undergoing PMVR under CS/DS vs. GA. The secondary endpoint of intensive care unit (ICU) length of stay (LOS) was significantly shorter in patients under CS/DS vs. GA (standardized mean difference, SMD = -0.97; 95% CI -1.75 to -0.20; P = 0.014), but the hospital LOS (SMD = 0.36; 95% CI -0.77 to 0.04, P = 0.078) did not show a statistically significant difference between the groups, although it was shorter in the CS/DS group. No difference was observed between CS/DS and GA in fluoroscopy time, procedure time, or complications, including pneumonia, stroke/transient ischaemic attack, and major bleeding. CONCLUSION CS or DS has lower ICU LOS, but comparable procedural success rate and in-hospital mortality, making it a potential alternative to GA for TOE-guided PMVR.
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Affiliation(s)
- Sandeep Banga
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, USA
| | - Abdul Moiz Hafiz
- Division of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Youssef Chami
- Division of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Darrel C Gumm
- Division of Cardiology, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Preeti Banga
- University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Carmen Howard
- Library of the Health Sciences at Peoria, University of Illinois at Chicago, Peoria, IL, USA
| | - Minchul Kim
- Center of Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Partho P Sengupta
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, USA
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Banga S, Osman M, Shrestha S, Challa A, Mehanni M, Zeb I, Sengupta P, Balla S, Kadiyala M, Mills J, Agrawal P, Hamirani YS. META-ANALYSIS ON EFFICACY OF CARDIAC CT ANGIOGRAPHY VERSUS TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR FOLLOW UP IN PATIENTS POST LEFT ATRIAL APPENDAGE CLOSURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32430-x] [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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25
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Benjamin MM, Banga S, Ghaffar YA, Patel J, Sengupta P, Hamirani YS. FUSED ACCESSORY MITRAL SCALLOP CAUSING ASYMMETRIC DOUBLE ORIFICE VALVE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33498-7] [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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26
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Patel JN, Ahmad M, Kim M, Banga S, Asche C, Barzallo M, Mungee S. Relation of Frailty to Cost for Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:469-474. [PMID: 31806209 DOI: 10.1016/j.amjcard.2019.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 01/08/2023]
Abstract
Frailty is associated with significant morbidity and mortality for patients undergoing transcatheter aortic valve implantation (TAVI). In addition to clinical outcomes, cost is an important factor to inform clinical decision-making around TAVI. However, the association of frailty with cost is unknown. This study tested whether frailty was associated with cost for adult patients who underwent TAVI at a moderate-volume single center between December 2012 and April 2018 (n = 431). Frailty was determined from pre-TAVI clinical visits as a composite of 2 markers: 5-meter walk time (abnormal: >6 seconds or unable to perform) and serum albumin (abnormal: <3.5 g/dl). Patients were excluded if missing frailty assessment or covariate data (24). Cost data were derived from financial statements, and assigned at the department-level by charge code. Multivariable regression models were adjusted for age, gender, and procedural co-morbidities. Of 407 patients in the analytical sample (mean age 81 years, 49% female), 74 (18%) were determined to be frail. Adjusted mean total costs were $6,397 higher for frail patients ($78,823 vs $72,425, p = 0.042) compared with nonfrail. Higher total costs were driven by department-level charges associated with longer in-hospital length of stay (7.6 vs 3.3 days, p <0.001): room, physical therapy, pharmacy, laboratory, supply, and imaging services. Providers must address frailty proactively to salvage the benefit associated with TAVI.
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Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) plays a crucial role in the management of patients with refractory cardiac and pulmonary dysfunction by providing temporary mechanical hemodynamic and respiratory support. However, the paucity of guidelines on indications for administering it and the failure to timely initiate VA-ECMO often result in a high in-hospital mortality rate and poor six-month outcomes after VA-ECMO deployment. Due to ethical issues, randomized controlled studies with VA-ECMO have not been conducted so that no recommended evidence-based guidelines exist for VA-ECMO patient-selection criteria. Therefore, the indication for administering the device depends solely on expert opinion after reviewing the literature. We conducted a review of the current literature to better understand and classify the need for proper patient selection, including proven indications for VA-ECMO.
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Banga S, Mungee S, Patel AR, Singh S, Kizhakekuttu TJ. Management of Resistant Hypertension Based on Recommendations from Different Guidelines and the Systolic Blood Pressure Intervention Trial. Cureus 2019; 11:e5371. [PMID: 31612099 PMCID: PMC6784919 DOI: 10.7759/cureus.5371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The long-term management of patients with resistant hypertension has been made even more difficult by a “moving target” goal blood pressure (BP). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines defined resistant hypertension as the failure to achieve goal BP in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) guidelines laid out more lenient target BP goals, without addressing the definition of resistant hypertension directly. The present scenario is a state of confusion, with providers selectively adopting recommendations from different guidelines. The Systolic Blood Pressure Intervention Trial (SPRINT) trial contributed to the confusion with further evidence supporting the strict control of hypertension. In addition, the failure of another trial on renal denervation in the US has essentially put an end to six long years of experimentation with catheter ablation in patients with resistant hypertension. Other therapies are still experimental. Adding a new dimension of medical management, spironolactone has made a comeback in resistant hypertension, with reports of better responsiveness when added to existing anti-hypertensive therapy. The present review discusses the current state and management options for patients with resistant hypertension considering the new evidence. Newer advances in pharmacological and device therapy are also discussed to improve understanding and quality in the management of resistant hypertension.
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Banga S, Gumm DC, Kizhakekuttu TJ, Emani VK, Singh S, Singh S, Kaur H, Wang Y, Mungee S. Left Ventricular Ejection Fraction along with Zwolle Risk Score for Risk Stratification to Enhance Safe and Early Discharge in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Retrospective Observational Study. Cureus 2019; 11:e5272. [PMID: 31583196 PMCID: PMC6768833 DOI: 10.7759/cureus.5272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/22/2022] Open
Abstract
Introduction Zwolle risk score (ZRS) is a validated scoring system to determine the time of discharge in ST-segment elevation myocardial infarction (STEMI) patients. Left ventricular ejection fraction (LVEF) also provides prognostic information after ST-elevation myocardial infarction (STEMI). We studied that the addition of LVEF to ZRS variable can improve decision making in safe and early discharge in STEMI patients post-primary coronary intervention. Methods Overall, 249 STEMI patients were studied retrospectively. LVEF was considered as an independent variable. The patients having LVEF <50% were under Group A and LVEF ≥50% were under Group B. Groups were analyzed by model comparison for overall hospital length of stay (LOS) and Intensive care unit (ICU) LOS post-primary percutaneous coronary intervention (PCI). Results There were 123 patients in Group A and 126 patients in Group B. Comparison for primary outcomes showed significant difference with hospital length of stay (LOS) being 3.1 ± 2.3 days in Group A versus 2.1 ± 0.8 days in Group B (p < 0.001). Similarly, ICU stay was also significantly higher in Group A with 36.5 ± 31.4 hours versus 24.0 ± 11.8 hours for Group B, which led to prolonged hospitalization for patients with LVEF <50%. Model 1 that considers ZRS individually is nested within Model 2 where ZRS and LVEF are considered together. The profile log-likelihood ratio test favors model 2 over model 1 (p < 0.0001). Similarly for ICU LOS, R2 = 0.12 (Model 1) < R2 = 0.20 (Model 2). The F test favors model 2 over model 1 (p < 0.0001). Conclusion We concluded that adding LVEF to Zwolle risk score gives a better model for risk stratification in STEMI patients to decide early and safe discharge post-primary PCI.
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Affiliation(s)
- Sandeep Banga
- Cardiology, West Virginia University School of Medicine, Morgantown, USA
| | - Darrel C Gumm
- Cardiology, University of Illinois College of Medicine at Peoria, Order of St. Francis Medical Centre, Peoria, USA
| | - Tinoy J Kizhakekuttu
- Cardiology, University of Illinois College of Medicine at Peoria, Order of St. Francis Medical Centre, Peoria, USA
| | - Vamsi K Emani
- Internal Medicine, University of Illinois College of Medicine at Peoria, Order of St. Francis Medical Centre, Peoria, USA
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Harleen Kaur
- Neurology, Univeristy of Missouri, Columbia, USA
| | - Yanzhi Wang
- Epidemiology and Public Health, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Sudhir Mungee
- Cardiology, University of Illinois College of Medicine, Order of St. Francis Medical Centre, Peoria, USA
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Yerasi C, Jonnalagadda AK, Tripathi B, Banga S, Miryala V, Al-Qaisi S, Nafisi S, Kalya A. ETIOLOGIES, TRENDS AND PREDICTORS OF EARLY READMISSION AFTER VENTRICULAR TACHYCARDIA ABLATION: AN ANALYSIS OF 4,614 PATIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31018-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Potu K, Patel J, Banga S, Avula S, Roy A, Clemson B, Bhardwaj C, Mungee S. PALLIATIVE CARE CONSULTATION REDUCES 30-DAY READMISSION RATES FOR HOSPITALIZED PATIENTS WITH HEART FAILURE: A SINGLE-CENTER EXPERIENCE. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31320-2] [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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Banga S, Barzallo MA, Nighswonger CL, Mungee S. Transcatheter aortic valve replacement in membranous interventricular septum aneurysm with left ventricular outflow tract extension. World J Cardiol 2018; 10:1-5. [PMID: 29391929 PMCID: PMC5785698 DOI: 10.4330/wjc.v10.i1.1] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/25/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
We report a challenging case of a 81-year-old male with history of severe calcific aortic valve stenosis and aneurysmal membranous interventricular septum. The presence of anomalies in the sub-annular area can lead to valve malpositioning and its consequences. Transcatheter aortic valve implantation (TAVR) in patients with aneurysm of the perimembranous interventricular septum extending into the left ventricular outflow tract has not been previously reported. This case describes a successful transfemoral TAVR with an Edwards SAPIEN XT valve (Edwards Lifesciences, Irvine, CA, United States) with such anomaly.
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Affiliation(s)
- Sandeep Banga
- Division of Cardiology, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
- Osf St. Francis Medical Center, Peoria, IL 61637, United States
| | - Marco A Barzallo
- Division of Cardiology, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
- Osf St. Francis Medical Center, Peoria, IL 61637, United States
| | | | - Sudhir Mungee
- Division of Cardiology, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
- Osf St. Francis Medical Center, Peoria, IL 61637, United States
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Graziano FD, Banga S, Busman DK, Muthusamy P, Wohns DH. Barriers to Early Discharge after Elective Percutaneous Coronary Intervention (BED PCI): A Single-Center Study. Indian Heart J 2016; 69:217-222. [PMID: 28460770 PMCID: PMC5414966 DOI: 10.1016/j.ihj.2016.11.323] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/23/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To identify patient characteristics and procedural factors that may play a role in hindering same-day discharge (SDD) practices. Background Multiple studies have shown the safety and cost effectiveness of SDD following elective percutaneous coronary intervention (PCI), but factors that hinder SDD practices have not been thoroughly studied. Material and Methods A retrospective comparative analysis of elective PCI patients who had an overnight stay (OS) (n = 345) vs. SDD patients (n = 222) was conducted to identify significant differences between the two groups in baseline patient characteristics, procedural, and postprocedural factors. Results Comparing OS to SDD patients, OS patients had a lower prevalence of radial access (20.29% vs. 39.64%, P < 0.0001); a higher incidence of suboptimal angiographic results (14.49% vs. 1.80%, P = 0.0027); CRCL values lower than 60 mL/min (26.38% vs. 15.32%, P = 0.0019); and greater femoral vascular site hemostasis with manual compression (69.09% vs. 36.57%, P = 0.0027). OS patients received larger sheath sizes (P = 0.0209), more bivalirudin (45.80% vs. 36.70%) and glycoprotein IIb/IIIa inhibitors (5.51% vs. 2.25%), but less heparin (51.30% vs. 53.21%). Chest pain (8.12% vs. 0.92%, P = 0.0042) and vascular access site concerns (20.58% vs. 0%, P = 0.0027) were more common among OS patients. Conclusions Pre-, peri-, and post-procedural factors play a role in SDD eligibility. Understanding factors that limit as well as those that facilitate SDD may enable institutions to establish or enhance a SDD program.
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Affiliation(s)
| | - Sandeep Banga
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
| | - Denise K Busman
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; Spectrum Health, Grand Rapids, MI, USA
| | | | - David H Wohns
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; Spectrum Health, Grand Rapids, MI, USA
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Patel J, Banga S, Kim MC, Wattanakit K, Barzallo MA, Mungee S. TCT-684 Frailty Profile is Independently Associated with Higher Cost for Patients undergoing Transcatheter Aortic Valve Replacement for Symptomatic Severe Aortic Stenosis: a Single Center Experience. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.097] [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: 11/29/2022]
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Kalvakuri K, Banga S, Upalakalin N, Shaw C, Davila WF, Mungee S. Metastatic right ventricular mass with intracavitary obliteration. J Community Hosp Intern Med Perspect 2016; 6:31679. [PMID: 27406457 PMCID: PMC4942513 DOI: 10.3402/jchimp.v6.31679] [Citation(s) in RCA: 4] [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] [Received: 03/21/2016] [Accepted: 04/22/2016] [Indexed: 12/17/2022] Open
Abstract
Metastatic cardiac tumors are more common than the primary cardiac tumors. Cervical cancer metastasizing outside of the pelvis is commonly spread to the lungs, liver, bones and lymph nodes than to the heart. Right-sided metastasis to the heart is more common than to the left side. Intramural spread is more common than intracavitary growth of metastatic cardiac tumors leading to delayed clinical presentation. Intracavitary mass can be confused with intracavitary thrombus which can be seen in the setting of pulmonary embolism. Transthoracic echocardiography plays a major role in the decision making and management of pulmonary embolism, and this modality can also be used to diagnose cardiac masses. Other modalities like TEE, cardiac CT, cardiac MRI and PET-CT scan have further utility in delineating these masses. This may help to plan appropriate management of the right ventricular mass particularly in cases where the patient history and CT pulmonary angiography results favor the diagnosis of pulmonary embolism. We present the case of a 49-year-old woman with a history of supracervical hysterectomy and salpingo-oophorectomy on oral estrogen therapy who was admitted with complaints of pleuritic chest pain and respiratory insufficiency after a long flight. Initial work-up showed sub-segmental pulmonary embolus in the right posterior lower lobe pulmonary artery, and the patient was managed on intravenous heparin. Lack of appropriate response to standard therapy led to further evaluation. Multimodality imaging and biopsies revealed a large right intracavitary ventricular metastatic squamous cell tumor, with the cervix as the primary source.
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Affiliation(s)
- Kavitha Kalvakuri
- Division of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA.,Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Sandeep Banga
- Division of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA.,Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA;
| | - Nalinee Upalakalin
- Department of Pathology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Crystal Shaw
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Wilmer Fernando Davila
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Sudhir Mungee
- Division of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA.,Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Narala K, Banga S, Gayam S, Mungee S. Cutaneo-Pericardial Fistula After Transapical Approach for Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:747-9. [DOI: 10.1016/j.jcin.2015.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/07/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022]
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Aggarwal A, Banga S, McRae R, Mungee S, Kizhakekuttu T. TCT-459 Effect of bleeding complications as assessed by the National Cardiovascular Data Registry (NCDR) bleeding risk calculator in patients undergoing Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.475] [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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Abdelsalam M, Krishnan M, Banga S, Bachinsky WB. High-risk percutaneous coronary intervention in a patient with a single coronary artery presenting as STEMI and cardiogenic shock. BMJ Case Rep 2015; 2015:bcr-2015-210345. [PMID: 26275407 DOI: 10.1136/bcr-2015-210345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cardiogenic shock due to ST elevation myocardial infarction in a patient with a single coronary artery involving the sole vessel is a rare presentation. This can be clinically and angiographically challenging. Proper recognition of the topography of diseased vessels and a systematic guarded approach can lead to procedural success. We report a case of an 81-year-old woman who presented with chest pain followed by a near syncope associated with an acute myocardial infarction. Coronary angiography revealed a single proximally occluded right coronary artery and an anomalous left main coronary artery (originating from the proximal right coronary artery) and occluded distal left circumflex artery. The right coronary artery was successfully stented following predilation without compromising the anomalous left main origin. The flow in the chronically occluded left circumflex artery (originating from the anomalous left main) which was depended on the retrograde supply from right coronary artery through collaterals, was also re-established.
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Affiliation(s)
- Murad Abdelsalam
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | | | - Sandeep Banga
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA Division of Cardiology, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, Illinois, USA
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Heslop JJ, Narala K, Banga S, Mungee S. ANTEROSEPTAL ST ELEVATION MYOCARDIAL INFARCTION AND NON-DOMINANT RIGHT CORONARY ARTERY LESION INVOLVING ACUTE MARGINAL BRANCH: A DILEMMA IN DECISION MAKING. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60665-9] [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: 11/15/2022]
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41
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Narala KR, Banga S, Hsu M, Barzallo M, Venkatapuram S, Mungee S. PARADOXICAL LOW-FLOW SEVERE AORTIC STENOSIS IN THE SETTING OF APICAL VARIANT HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60724-0] [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: 11/24/2022]
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Ibrahim M, Banga S, Venkatapuram S, Mungee S. Transient cardiogenic shock during a crisis of pheochromocytoma triggered by high-dose exogenous corticosteroids. BMJ Case Rep 2015; 2015:bcr-2014-208683. [PMID: 25694646 DOI: 10.1136/bcr-2014-208683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 39-year-old woman who presented to the emergency department (ED) with symptoms of pharyngitis and fever. Diagnosed with streptococcal pharyngitis, she received antibiotics and dexamethasone, and was discharged. Within 24 h she returned to the ED with signs and symptoms of an acute coronary syndrome; she was thus given β-blockers. Her coronary angiogram was normal. She developed cardiogenic shock with an ejection fraction (EF) of 10% and apical ballooning on echocardiography. Her condition improved with optimal medical therapy. Subsequent testing weeks later confirmed the presence of a pheochromocytoma. Following prazosin and an adrenalectomy, all her antihypertensive medications were weaned and her EF normalised. We believe the high-dose exogenous corticosteroids triggered a pheochromocytoma crisis. The concomitant use of β-blockers without preceding α blockade resulted in cardiovascular collapse. Pheochromocytoma crisis must be included in the differential diagnosis of any dramatic haemodynamic collapse after administration of exogenous corticosteroid or β-blockers.
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Affiliation(s)
- Majd Ibrahim
- Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | - Sandeep Banga
- Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | - Suneetha Venkatapuram
- Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | - Sudhir Mungee
- Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center, Peoria, Illinois, USA
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Abstract
A 72-year-old man with a history of hypertension, hiatal hernia, prostate cancer and lung cancer was admitted with complaints of abdominal pain, sweating and rigors. An electrocardiogram showed ST elevation in multiple leads. Noninvasive and invasive cardiovascular work-up was performed that was negative for occlusive coronary artery disease. Further studies demonstrated a large hiatal hernia; this was found to be the culprit causing his symptoms. Hiatal hernia is a very rare cause of ST segment elevation and should be considered in the differential diagnosis of disorders that can cause ST elevation.
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Affiliation(s)
- Karthiek Narala
- Department of Cardiology, University of Illinois College of Medicine, Peoria, Ill., USA
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44
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Madder R, Busman M, Banga S. Plaque characterization to identify patients at high risk of acute complications during PCI. Interv Cardiol 2013. [DOI: 10.2217/ica.13.76] [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] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Banga S, Chalfoun N, Finta B, Elmouchi D, Dahu M, Woelfel A, McNamara RF, Fritz T, Schuitema JI, Judson CA, Gauri A. Syncope and recurrent ventricular tachycardia with a newly-identified desmosomal gene mutation. Glob Cardiol Sci Pract 2013; 2013:261-8. [PMID: 24689027 PMCID: PMC3963755 DOI: 10.5339/gcsp.2013.33] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/28/2013] [Indexed: 11/08/2022] Open
Abstract
Ventricular arrhythmias in young people most commonly occur due to the presence of hypertrophic cardiomyopathy, long QT syndrome or Wolff-Parkinson-White syndrome. We present a case in which the patient had exercise induced syncopal spells and was found to have ventricular tachycardia (VT) during both exercise stress testing and an electrophysiology study. Further genetic studies showed a previously unseen desmosomal gene mutation confirming the presence of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).
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Bhaskar B, Ahuja I, Janeja S, Banga S. Intergeneric hybridization between Erucastrum canariense and Brassica rapa. Genetic relatedness between E(C) and A genomes. Theor Appl Genet 2002; 105:754-758. [PMID: 12582489 DOI: 10.1007/s00122-002-0915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2001] [Accepted: 01/07/2002] [Indexed: 05/24/2023]
Abstract
An intergeneric hybrid between a wild species, Erucastrum canariense (2n = 18; E(C)E(C)), and a cultivated oilseed brassica species, Brassica rapa (2n = 20; AA), was synthesized through ovary culture in White's basal medium supplemented with casein hydrolysate. Morphological, cytological and DNA-based analysis helped to establish the hybrid nature of the derived plants. Hybrid plants were morphologically intermediate between the two parents and were completely male, as well as female sterile. Cytological analysis revealed the occurrence of 19 I in about 38% of the PMCs investigated. However 1-8 bivalents/PMC were also observed, indicating a significant level of homology between the two genomes. Normal chromosome pairing and pollen fertility was restored following colchiploidy. The intergeneric amphiploid developed during the investigation can be used as a bridging species for the transfer of desirable genes from E(C) to cultivated genomes (especially A and C), and for resistance to Alternaria blight and mustard aphid. Under field conditions, the E. canariense intergeneric hybrid and the amphiploid appeared to be moderately resistant to Alternaria blight and also harboured a significantly lower population of mustard aphid than the cultivated B. rapa.
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Affiliation(s)
- B. Bhaskar
- Department of Plant Breeding, Punjab Agricultural University, Ludhiana - 141 004, India
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Banga S, Patil GP, Taillie C. Likelihood contour method for the calculation of asymptotic upper confidence limits on the risk function for quantitative responses. Risk Anal 2001; 21:613-623. [PMID: 11726016 DOI: 10.1111/0272-4332.214139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article develops a computationally and analytically convenient form of the profile likelihood method for obtaining one-sided confidence limits on scalar-valued functions phi = phi(psi) of the parameters psi in a multiparameter statistical model. We refer to this formulation as the likelihood contour method (LCM). In general, the LCM procedure requires iterative solution of a system of nonlinear equations, and good starting values are critical because the equations have at least two solutions corresponding to the upper and lower confidence limits. We replace the LCM equations by the lowest order terms in their asymptotic expansions. The resulting equations can be solved explicitly and have exactly two solutions that are used as starting values for obtaining the respective confidence limits from the LCM equations. This article also addresses the problem of obtaining upper confidence limits for the risk function in a dose-response model in which responses are normally distributed. Because of normality, considerable analytic simplification is possible and solution of the LCM equations reduces to an easy one-dimensional root-finding problem. Simulation is used to study the small-sample coverage of the resulting confidence limits.
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Affiliation(s)
- S Banga
- Center for Statistical Ecology and Environmental Statistics, Department of Statistics, The Pennsylvania State University, University Park 16802, USA
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Bash J, Zong WX, Banga S, Rivera A, Ballard DW, Ron Y, Gélinas C. Rel/NF-kappaB can trigger the Notch signaling pathway by inducing the expression of Jagged1, a ligand for Notch receptors. EMBO J 1999; 18:2803-11. [PMID: 10329626 PMCID: PMC1171361 DOI: 10.1093/emboj/18.10.2803] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.4] [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] [Indexed: 12/23/2022] Open
Abstract
Jagged1 belongs to the DSL family of ligands for Notch receptors that control the proliferation and differentiation of various cell lineages. However, little is known about the transcription factors that regulate its expression. Here, we show that Jagged1 is a Rel/NF-kappaB-responsive gene. Both c-Rel and RelA induced jagged1 gene expression, whereas a mutant defective for transactivation did not. Importantly, jagged1 transcripts were also upregulated by endogenous NF-kappaB activation and this effect was inhibited by a dominant mutant of IkappaBalpha, a physiological inhibitor of NF-kappaB. Cell surface expression of Jagged1 in c-Rel-expressing cell monolayers led to a functional interaction with lymphocytes expressing the Notch1/TAN-1 receptor. This correlated with the initiation of signaling downstream of Notch, as evidenced by increased levels of HES-1 transcripts in co-cultivated T cells and of CD23 transcripts in co-cultivated B cells. Consistent with its Rel/NF-kappaB-dependent induction, Jagged1 was found to be highly expressed in splenic B cells where c-Rel is expressed constitutively. These results demonstrate that c-Rel can trigger the Notch signaling pathway in neighboring cells by inducing jagged1 gene expression, and suggest a role for Jagged1 in B-cell activation, differentiation or function. These findings also highlight the potential for an interplay between the Notch and NF-kappaB signaling pathways in the immune system.
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Affiliation(s)
- J Bash
- Center for Advanced Biotechnology and Medicine, 679 Hoes Lane, Piscataway, NJ 08854-5638, USA
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Abstract
Human diploid cells have a limited life span, ending in replicative senescence, in contrast to cell lines derived from tumors, which show an indefinite life span and are immortal, suggesting that replicative senescence is a tumor suppression mechanism. We have utilized introduction of SV40 sequences to develop matched sets of nonimmortal and immortal cell lines to help dissect the mechanism of immortalization and have found that it has multiple facets, involving both SV40-dependent and -independent aspects. These studies have led to the identification of a novel growth suppressor gene (SEN6) as well as providing a model system for the study of cellular aging, apoptosis, and telomere stabilization among other things. It is anticipated that SV40-transformed cells will continue to provide a very useful experimental system leading to insights into the behavior of cells with altered expression of oncogenes and growth suppressor gene products.
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Affiliation(s)
- K K Jha
- Department of Microbiology and Molecular Genetics, UMDNJ-New Jersey Medical School, Newark, New Jersey, 07103-2714, USA
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Kim SH, Banga S, Jha KK, Ozer HL. SV40-mediated transformation and immortalization of human cells. Dev Biol Stand 1998; 94:297-302. [PMID: 9776250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
SV40 infection of human cells results in both transformation and lytic infection. We have used origin-defective viral mutants which are unable to replicate in permissive cells to help analysis of transformation. Expression of large T antigen (T ag) and small t antigen results in the altered growth phenotypes characteristic of transformation in other species. Human diploid fibroblasts (HF) have a limited lifespan and undergo senescence; T ag results in extension of lifespan but only in rare cases are the cells capable of continuous growth and are immortal. We have developed matched sets of non-immortal and immortal transformed HF for assessment of the steps required for immortalization. Results are summarized to characterize both T-dependent and T-independent functions. A novel growth suppressor gene SEN6 has been identified, the inactivation of which is required for immortalization; it may also serve as a marker to distinguish cells in which SV40 is replicating from those in which it is responsible for tumorigenesis.
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Affiliation(s)
- S H Kim
- Department of Microbiology and Molecular Genetics UMD-New Jersey Medical School, Newark 07103-2714, USA
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