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Jorde UP, Arfaras-Melainis A, Wan N, Uehara M, Castagna F, Vukelic S, Rochlani YM, Madan SA, Murthy S, Patel SR, Sims DB, Borgi J, Goldstein DJ, Forest SJ, Jakobleff WA, Saeed O. Use of Extracorporeal Membrane Oxygenation for Primary Graft Dysfunction After Cardiac Transplantation: Results of an A Priori Ventless Approach. ASAIO J 2024; 70:31-37. [PMID: 37797341 DOI: 10.1097/mat.0000000000002051] [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: 10/07/2023] Open
Abstract
Primary graft dysfunction (PGD) after cardiac transplantation is a devastating complication with increasing frequency lately in the setting of donation after circulatory death (DCD). Severe PGD is commonly treated with extracorporeal membrane oxygenation (ECMO) using central or peripheral cannulation. We retrospectively reviewed the outcomes of PGD after cardiac transplantation requiring ECMO support at our center from 2015 to 2020, focused on our now preferential approach using peripheral cannulation without a priori venting. During the study period, 255 patients underwent heart transplantation at our center and 26 (10.2%) of them required ECMO for PGD. Of 24 patients cannulated peripherally 19 (79%) were alive at 30 days and 17 (71%) 1 year after transplant; two additional patients underwent central ECMO cannulation due to unfavorable size of femoral vessels and concern for limb ischemia. Successful decannulation with full graft function recovery occurred in 22 of 24 (92%) patients cannulated peripherally. Six of them had an indwelling intra-aortic balloon pump placed before the transplantation. None of the other 18 patients received a ventricular vent. In conclusion, the use of an a priori peripheral and ventless ECMO approach in patients with PGD after heart transplant is an effective strategy associated with high rates of graft recovery and survival.
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Affiliation(s)
- Ulrich P Jorde
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Angelos Arfaras-Melainis
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ningxin Wan
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Mayuko Uehara
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Francesco Castagna
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sasa Vukelic
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Yogita M Rochlani
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Shivank A Madan
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sandhya Murthy
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Snehal R Patel
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel B Sims
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jamil Borgi
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Stephen J Forest
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - William A Jakobleff
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Omar Saeed
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Chen M, Larson I, Singh J, Patel SR, Jorde UP, Sims D, Rochlani YM. EPIDEMIOLOGY, CHARACTERISTICS, AND OUTCOMES OF CARDIAC SARCOIDOSIS IN A LARGE SOCIOECONOMICALLY DIVERSE HEALTHCARE SYSTEM. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01243-8] [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: 10/18/2022]
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Vlismas PP, Rochlani YM, Romero J, Scheinin S, Shin JJ, Goldstein D, Jorde UP. Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmia in Continuous-Flow Left Ventricular Assist Device. JACC Case Rep 2021; 3:443-446. [PMID: 34317554 PMCID: PMC8311031 DOI: 10.1016/j.jaccas.2020.12.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/12/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
Cardiac sympathetic denervation has been shown to reduce sustained ventricular arrhythmias and implantable cardioverter-defibrillator shocks by inhibiting sympathetic outflow to the heart. We describe the first case to our knowledge of cardiac sympathetic denervation in the left ventricular assist device population. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Peter P Vlismas
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Yogita M Rochlani
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Jorge Romero
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Scott Scheinin
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Jooyoung J Shin
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Daniel Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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Goldberg J, Spevack D, Ahsan SA, Rochlani YM, Dutta T, Ohira S, Kai M, Spielvogel D, Lansman S, Malekan R. SURGICAL MANAGEMENT OF MASSIVE AND HIGH-RISK SUBMASSIVE PULMONARY EMBOLISMS RESULTS IN RIGHT VENTRICULAR RECOVERY WITH LOW MORTALITY: INSIGHTS FROM THE LARGEST CASE SERIES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31716-2] [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: 11/25/2022]
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Rochlani YM, Bhinder J, Pashkovetsky E, Yandrapalli S, Jolly G, Kai M, Cooper HA, Panza JA, Gass AL, Lanier GL. Primary Graft Dysfunction and Early Mortality in Heart Transplants from Drug Overdose Donors. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.534] [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: 11/30/2022]
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Chatterjee K, Rochlani YM, Kuriakose K, Khasawneh K, Paydak H. Amiodarone Induced Interstitial and Organizing Pneumonia Reversed with Steroids. J Ark Med Soc 2017; 113:294-296. [PMID: 29649357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Amiodarone is a widely used antiarrhythmic agent for supraventricular and ventricular tachyarrhythmias. It is known to cause pulmonary toxicity, which can manifest in a variety of presentations, ranging from asymptomatic to fatal. We present a case of chronic interstitial pneumonia with organizing pneumonia induced by amiodarone that was successfully treated with drug cessation and use of corticosteroids. The patient experienced complete resolution of symptoms and full recovery of lung function after the course of steroids.
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Kattoor AJ, Rochlani YM, Kuriakose K, Meena NK. Mitral valve vegetation diagnosed with oesophageal ultrasound with bronchoscope (EUS-B). BMJ Case Rep 2017; 2017:bcr-2016-218849. [PMID: 28512099 DOI: 10.1136/bcr-2016-218849] [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] [Indexed: 11/03/2022] Open
Abstract
Oesophageal ultrasound with bronchoscope (EUS-B) is designed to evaluate mediastinal structures. We describe a case of a 78-year-old woman who presented with altered mental status for 2 weeks. CT head revealed a subacute infarct in the right middle cerebral artery distribution. She was also found to have a lung mass on chest imaging. EUS-B-guided fine needle aspiration demonstrated the presence of adenocarcinoma in station 7 lymph node and in the mass. Immunohistochemistry confirmed it to be a lung primary as the Thyroid Transcription Factor-1 (TTF-1) was strongly positive. During the procedure, the cardiac valves were evaluated, and a mitral valve vegetation was noted. Formal echocardiography confirmed the presence of the vegetation. During hospital stay, the patient developed fever. Her blood cultures grew oxacillin-resistant Staphylococcus aureus. She was subsequently treated for infective endocarditis. We suggest that the use of EUS-B to routinely scan adjacent structures during a procedure may help obtain additional clinical information that may be critical to patient management.
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Affiliation(s)
- Ajoe John Kattoor
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yogita M Rochlani
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kevin Kuriakose
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nikhil K Meena
- Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Rochlani YM, Pai VB, Lataifeh ARM, Bartter T. Thinking outside the box: a middle-aged man with new-onset dyspnoea on exertion and pedal oedema. BMJ Case Rep 2015; 2015:bcr-2015-209724. [PMID: 25953584 DOI: 10.1136/bcr-2015-209724] [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: 11/03/2022] Open
Abstract
We describe a diagnostic dilemma in a middle-aged man presenting with dyspnoea and bilateral pedal oedema who had been diagnosed with right heart failure based on clinical evidence. The evaluation for aetiology eventually led to discovery of an unusual extrathoracic cause, a left-to-right communication in the renal vasculature. Renal arteriovenous fistulae are rare and can be congenital, acquired or idiopathic. A left-to-right shunt typically presents with high-output cardiac failure involving the left and right sides of the heart. An atypical feature of this case was the finding of overt right heart failure in the setting of a normal left heart. Such a presentation has only been described in a few isolated case reports. Diagnostic approaches include CT angiography and cardiac catheterisation for haemodynamic measurements. The primary treatment options for arteriovenous fistulae are medical management, arterial embolisation and surgical repair.
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Affiliation(s)
- Yogita M Rochlani
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Vidya B Pai
- Department of Medicine-Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Abdel Rahman M Lataifeh
- Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Thaddeus Bartter
- Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Kaur A, Klair JS, Rochlani YM, Kuriakose K, Khan NA. A rare case of multiple digital infarcts in a patient with Mycobacterium avium-intracellulare (MAI) infection. BMJ Case Rep 2015; 2015:bcr-2015-209582. [PMID: 25883260 DOI: 10.1136/bcr-2015-209582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Aneet Kaur
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jagpal Singh Klair
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yogita M Rochlani
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kevin Kuriakose
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nasim A Khan
- Department of Rheumatology and Immunology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Rochlani YM, Shah N, Pothineni NV, Paydak H. UTILIZATION AND PREDICTORS OF ELECTRICAL CARDIOVERSION FOR ATRIAL FIBRILLATION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60463-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rochlani YM, Kakkera K, Vallurupalli S, Hakeem A, Bhatti S. ACCURACY OF TRADITIONAL AND NOVEL RISK FACTORS FOR PREDICTING THE EXTENT AND SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61608-4] [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: 12/01/2022]
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Abstract
Myasthenia gravis (MG) is a neuromuscular disorder that typically affects the ocular, bulbar, neck, proximal limbs and respiratory muscles. Dysphagia can occasionally be the only presenting symptom leading to extensive but ultimately futile gastrointestinal workup. Delay in diagnosis and use of certain pharmacological agents in the interim can lead to a myasthenic crisis, which though diagnostic is life threatening. We document a case of dysphagia as the only symptom of myasthenia, diagnosed after a magnesium infusion precipitated myasthenic crisis. A 70-year-old Caucasian woman who had had progressive dysphagia for 2 years, for which multiple oesophageal dilations were performed. During a hosptalisation for further gastrointestinal workup, she went into myasthenic crisis (respiratory failure) after receiving magnesium replacement. She required ventilatory support and received five plasma exchange (PLEX) treatments after myasthenia was confirmed by the detection of high antiacetylcholine receptor antibody. Though her symptoms improved, she had a prolonged hospital stay (25 days) and required 18 days of mechanical ventilation. This underscores the morbidity associated with a delay in diagnosis of this condition. This case report suggests that neuromuscular causes should be considered early in elderly patients presenting with dysphagia. Timely diagnosis, initiation of management and avoidance of drugs that affect neuromuscular transmission may help reduce the morbidity and mortality associated with myasthenic crisis.
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Affiliation(s)
- Jagpal Singh Klair
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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