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Sauter R, Lin C, Magunia H, Schreieck J, Dürschmied D, Gawaz M, Patzelt J, Langer HF. Improved mid-term stability of MR reduction with an increased number of clips after percutaneous mitral valve repair in functional MR. Int J Cardiol Heart Vasc 2023; 45:101190. [PMID: 36941997 PMCID: PMC10024191 DOI: 10.1016/j.ijcha.2023.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Background Percutaneous mitral valve repair (PMVR) has evolved to be a standard procedure in suitable patients with mitral regurgitation (MR) not accessible for open surgery. Here, we analyzed the influence of the number and positioning of the clips implanted during the procedure on MR reduction analyzing also sub-collectives of functional and degenerative MR (DMR). Results We included 410 patients with severe MR undergoing PMVR using the MitraClip® System. MR and reduction of MR were analyzed by TEE at the beginning and at the end of the PMVR procedure. To specify the clip localization, we sub-divided segment 2 into 3 sub-segments using the segmental classification of the mitral valve. Results We found an enhanced reduction of MR predominantly in DMR patients who received more than one clip. Implantation of only one clip led to a higher MR reduction in patients with functional MR (FMR) in comparison to patients with DMR. No significant differences concerning pressure gradients could be observed in degenerative MR patients regardless of the number of clips implanted. A deterioration of half a grade of the achieved MR reduction was observed 6 months post-PMVR independent of the number of implanted clips with a better stability in FMR patients, who got 3 clips compared to patients with only one clip. Conclusions In patients with FMR, after 6 months the reduction of MR was more stable with an increased number of implanted clips, which suggests that this specific patient collective may benefit from a higher number of clips.
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Key Words
- CO, cardiac output
- COe, cardiac output echocardiographically determinded by combination of TTE and TEE parameters
- COi, invasively determined cardiac output
- Clips
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FMR, functional mitral regurgitation
- Heart failure
- Heart geometry
- Hemodynamics
- ICE, intracardiac echocardiography
- IVUS, intravascular ultrasound
- Interventional cardiology
- Interventional therapy
- LA, left atrium
- LV, left ventricle
- LVEDD, left ventricular end diastolic diameter
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association
- PA, pulmonary artery
- PAP, pulmonary artery pressure
- PASP, pulmonary artery systolic pressure
- PCW, pulmonary capillary wedge
- PCWP, pulmonary capillary wedge pressure
- PHT, pulmonary hypertension
- PMVR
- PMVR, percutaneous mitral valve repair
- RV, right ventricle
- SD, standard deviation
- Structural heart disease
- Surgery
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard Sauter
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Chaolan Lin
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Dürschmied
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F. Langer
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
- Corresponding author at: Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, 68167 Mannheim, Germany.
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Hama-Karim DS, Othman YN, Majeed ZS, Ali RK, Mohammed A, Muhamad HN. Intracardiac amorphous tumor presenting in a patient with homocystinuria; a case report with literature review. Radiol Case Rep 2023; 18:1337-1341. [PMID: 36704364 PMCID: PMC9870922 DOI: 10.1016/j.radcr.2022.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
Homocystinuria is a rare genetic disease with autosomal recessive pattern. It is reported to be highest in Arabian descend and could cause thrombosis, but mainly peripherally. Cardiac amorphous tumor has been recognized in the past 20 years and it is also a very rare cause primary benign tumor of the heart. Most of the cases reported to be associated with end-stage renal disease. Homocystinuria associated with Cardiac Amorphous tumor is extremely rare. Up to our knowledge, there has been only one other case has been reported. Our patient is a 14-year-old female known case of homocystinuria presented with dyspnea and leg edema. On workup was found to have a mass in the right atrium extending to superior vena cava and inferior cava. Surgery undertaken on cardiopulmonary bypass partial resection of the mass was done and result came back as cardiac amorphous tumor. We assume the cause of this sinister complication of her primary illness is calcification of thrombus as stated in literature. And also recommend further studies regarding issue on hand.
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Affiliation(s)
- Diar S. Hama-Karim
- Open Heart Center, Cardiac Care Unit, Sulaimaniyah Teaching Hospital, As-Sulaimaniyah, Kurdistan, Iraq
| | - Yad N. Othman
- Department of Thoracic and Cardiovascular, Shar Teaching Hospital, Malik Mahmood Circle, As-Sulaimaniyah 46001, Kurdistan, Iraq,Corresponding author.
| | - Zryan Salar Majeed
- Department of Thoracic and Cardiovascular, Shar Teaching Hospital, Malik Mahmood Circle, As-Sulaimaniyah 46001, Kurdistan, Iraq
| | - Razhan K. Ali
- Department of Thoracic and Cardiovascular, Shar Teaching Hospital, Malik Mahmood Circle, As-Sulaimaniyah 46001, Kurdistan, Iraq
| | - Arian Mohammed
- Open Heart Center, Cardiac Care Unit, Sulaimaniyah Teaching Hospital, As-Sulaimaniyah, Kurdistan, Iraq
| | - Han Nihad Muhamad
- College of Dentistiry, University of Sulaimany, As-Sulaimaniyah, Kurdistan, Iraq
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3
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Goldar G, Chaisson N, Ghobrial J. Transcatheter Valve Implantation in Reversed Potts Shunt in Pulmonary Arterial Hypertension: Keeping the Shunt Reversed. JACC Case Rep 2022; 4:101678. [PMID: 36458180 PMCID: PMC9706157 DOI: 10.1016/j.jaccas.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 06/17/2023]
Abstract
The reversed Potts shunt is designed to offload the right ventricle in severe pulmonary arterial hypertension. We present a case of bidirectional flow across a reversed Potts shunt leading to pulmonary edema, with clinical improvement after implantation of a transcatheter valve in the shunt to maintain unidirectional flow. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Ghazaleh Goldar
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, Ohio, USA
| | - Neal Chaisson
- Cleveland Clinic Foundation, Respiratory Institute, Cleveland, Ohio, USA
| | - Joanna Ghobrial
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, Ohio, USA
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4
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Yadav S, Shah S, Gajurel RM, Poudel CM, Ghimire R, Shah N. A study of Clinical Profile and in Hospital Outcomes of patients undergoing Percutaneous Transvenous Mitral Commissurotomy at a Tertiary Care Center of Nepal. Ann Med Surg (Lond) 2022; 84:104867. [PMID: 36536708 PMCID: PMC9758362 DOI: 10.1016/j.amsu.2022.104867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Rheumatic heart disease (RHD), is a common cause of mitral stenosis (MS) in developing nations. As per current recommendation, Percutaneous Transvenous Mitral Commissurotomy (PTMC) is advised as a Class IA (I-Class Of Recommendation, COR; A-Level Of Evidence, LOE) indication in patients with symptomatic severe mitral stenosis. We aim to examine the clinical profile and in-hospital results of PTMC for mitral stenosis. Methods A cross-sectional retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center from April 2020 to May 2022. A structured questionnaire was used to collect the data and ethical approval for conducting the study was taken from the Institutional Review Committee (IRC) of Institute of Medicine (IOM). The data was collected in Microsoft Excel (Ver. 2013). For statistical analysis, SPSS 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) Association was measured using a parametric and non-parametric test (depending upon the distribution of data) and p value < 0.05 was considered significant. Results A total of 104 patients who met the inclusion criteria underwent PTMC during the study period. The mean age group of the patient was 41.7 ± 12.5 years, of which 23 (22.1%) were males and 81 (78.9%) were females. Mean mitral valve area prior to PTMC was 0.98 ± 0.19 mm2 that increased to 1.69 ± 0.19 mm2 after the procedure and it was statistically significant (p=<0.001). The post PTMC MVA varied with PTMC Wilkin's score with less than or equal to 8 having favorable outcomes. Conclusion Successful PTMC is highly influenced by the patients' increasing age, valve morphology (calcification, thickness, mobility), Left atrial dimensions, Pre PTMC mitral valve area, Degree of Baseline mitral regurgitation. Post procedure development of MR is usually well tolerated but rarely be severe enough requiring surgical valve replacement.
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Key Words
- AF, atrial fibrillation
- BMV, balloon mitral valvotomy
- CMC, closed mitral commissurotomy
- LA, left atrium
- LAP, left atrial pressure
- LVEF, Left ventricular ejection fraction
- LVSD, Left ventricle systolic dysfunction
- MI, Myocardial Infarction
- MS, mitral stenosis
- MVA, mitral valve area
- MVR, mitral valve replacement
- Mitral regurgitation
- Mitral stenosis
- Mitral valve area
- NSR, normal sinus rhythm
- NYHA, New York Heart Association
- Nepal
- OMC, open mitral commissurotomy
- Outcomes
- PA, pulmonary artery
- PASP, pulmonary artery systolic pressure
- PTMC
- PTMC, percutaneous transvenous mitral commissurotomy
- RHD, rheumatic heart disease
- TTE TEE, Transthoracic Echocardiography Transesophageal Echo
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Affiliation(s)
- Sutap Yadav
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Sangam Shah
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Ratna Mani Gajurel
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Chandra Mani Poudel
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Roshan Ghimire
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Nischal Shah
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
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5
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Ponchant K, Nguyen DA, Prsa M, Beghetti M, Sologashvili T, Vallée JP. Three-dimensional printing and virtual reconstruction in surgical planning of double-outlet right ventricle repair. JTCVS Tech 2022; 17:138-150. [PMID: 36820361 PMCID: PMC9938382 DOI: 10.1016/j.xjtc.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives For more than a decade, 3-dimensional (3D) printing has been identified as an innovative tool for the surgical planning of double-outlet right ventricle (DORV). Nevertheless, lack of evidence concerning its benefits encourages us to identify valuable criteria for future prospective trials. Methods We conducted a retrospective study involving 10 patients with DORV operated between 2015 and 2019 in our center. During a preoperative multidisciplinary heart team meeting, we harvested surgical decisions following a 3-increment step process: (1) multimodal imaging; (2) 3D virtual valvular reconstruction (3DVVR); and (3) 3D-printed heart model (3DPHM). The primary outcome was the proportion of predicted surgical strategy following each of the 3 steps, compared with the institutional retrospective surgical strategy. The secondary outcome was the change of surgical strategy through 3D modalities compared with multimodal imaging. The incremental benefit of the 3DVVR and 3DPHM over multimodal imaging was then assessed. Results The operative strategy was predicted in 5 cases after multimodal imaging, in 9 cases after 3DVVR, and the 10 cases after 3DPHM. Compared with multimodal imaging, 3DVVR modified the strategy for 4 cases. One case was correctly predicted only after 3DPHM inspection. Conclusions 3DVVR and 3DPHM improved multimodal imaging in the surgical planning of patients with DORV. 3DVVR allowed a better appreciation of the relationships between great vessels, valves, and ventricular septal defects. 3DPHM offers a realistic preoperative view at patient scale and enhances the evaluation of outflow tract obstruction. Our retrospective study demonstrates benefits of preoperative 3D modalities and supports future prospective trials to assess their impact on postoperative outcomes.
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Key Words
- 3D modality in surgical planning
- 3D printed heart model
- 3D printing
- 3D virtual valvular reconstruction
- 3D, 3-dimensional
- 3DPHM, 3D-printed heart model
- 3DVVR, 3D virtual valvular annulus reconstruction
- CTA, computed tomography angiogram
- DORV, double-outlet right ventricle
- LV, left ventricle
- PA, pulmonary artery
- PV, pulmonary valve
- TGA, transposition of the great arteries
- TTE, transthoracic echocardiography
- VSD, ventricular septal defect
- double-outlet right ventricle
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Affiliation(s)
- Kevin Ponchant
- Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland,Address for reprints: Kevin Ponchant, Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Duy-Anh Nguyen
- Pediatric Cardiology Unit, Children's University Hospital, Geneva, Switzerland
| | - Milan Prsa
- Division of Pediatric Cardiology, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Children's University Hospital, Geneva, Switzerland,Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland
| | - Tornike Sologashvili
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland,Division of Cardiac Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Vallée
- Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Feldman HA, Zhou N, Deboever N, Hofstetter W, Mehran R, Rajaram R, Rice D, Roth JA, Sepesi B, Swisher S, Vaporciyan A, Walsh G, Godoy M, Strange C, Antonoff MB. Intraoperative challenges after induction therapy for non-small cell lung cancer: Effect of nodal disease on technical complexity. JTCVS Open 2022; 12:372-84. [PMID: 36590745 DOI: 10.1016/j.xjon.2022.09.012] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
Objectives Neoadjuvant therapy has been theorized to increase complexity of non-small cell lung cancer resections; however, specific factors that contribute to intraoperative challenges after induction therapy have not been well described. We aimed to characterize the effect of nodal involvement and nodal treatment response on surgical complexity after neoadjuvant therapy. Methods We identified patients treated with neoadjuvant therapy followed by anatomic lung resection for cN + non-small cell lung cancer between 2010 and 2020. Patients were categorized according to clinical N1 versus N2 disease. To evaluate the effect of nodal response to therapy, thoracic radiologists measured clinically suspected and pathologically involved lymph nodes before and after induction therapy. Operative reports were reviewed to identify technical challenges specifically related to nodal disease. Categorical outcomes were compared using Fisher exact test. Results One hundred twenty-four patients met inclusion criteria, among whom 107 (86.3%) were treated with neoadjuvant chemotherapy, whereas chemoradiation (n = 8) and targeted therapy (n = 9) were less common. In cases with N1 disease, 8/38 (21.0%) required proximal pulmonary arterial control, whereas this was necessary in only 2/88 (2.3%) of N2 cases (P = .001). Likewise, sleeve resection and arterioplasty were needed more frequently during resection of N1 disease (7/38, 18.4%) versus N2 disease (0/88, P < .001). Increased nodal response to therapy was associated with greater likelihood of requiring change in vascular approach (P = .011). Conclusions After induction therapy, N1 disease was associated with greater need for complex surgical maneuvers than N2 disease. Likewise, substantial treatment response was associated with increased intraoperative technical challenges. Recognizing such factors enables surgical teams to engage in appropriate operative planning to ensure patient safety.
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7
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Hribernik I, Jaber O, Bentham JR. Alternative Hybrid Approach to Promote Native Pulmonary Artery Growth in Pulmonary Atresia VSD MAPCAs. JACC Case Rep 2022; 4:1366-9. [PMID: 36299658 DOI: 10.1016/j.jaccas.2022.07.022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
We present a case of right ventricle to pulmonary artery hybrid perforation and stenting in a patient with pulmonary atresia with ventricular septal defect major aortopulmonary collaterals and diminutive native pulmonary arteries, then discuss how it compares with established approaches. (Level of Difficulty: Advanced.).
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8
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Ravipati H, Sabouni MA, Kodavaluru T, Alkhawam H, Ahmed MI. Venous-Left Atrial Extracorporeal Membrane Oxygenation Configuration Use in Right Ventricular Failure and Tricuspid Ring. JACC Case Rep 2022; 4:1263-1266. [PMID: 36406909 PMCID: PMC9666754 DOI: 10.1016/j.jaccas.2022.07.020] [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] [Received: 06/17/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
Mechanical circulatory support devices are used to support the heart in cardiogenic shock. We present a case of demonstrating the feasible use of left ventricular assistive device with reverse configuration to support severe right ventricular failure in a patient with recent tricuspid annuloplasty ring.
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Key Words
- AS, aortic stenosis
- LVEF, left ventricular ejection fraction
- MR, mitral regurgitation
- PA, pulmonary artery
- RA, right atrial
- RV, right ventricular
- RVAD, right ventricular assistive device
- TEE, transesophageal echocardiogram
- TH, tandem heart
- TR, tricuspid regurgitation
- TV, tricuspid valve
- VA ECMO, veno-arterial extracorporeal membrane oxygenation
- cardiac assist devices
- right ventricle
- tricuspid valve
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Affiliation(s)
- Harish Ravipati
- Section of Advanced Heart Failure, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mouhamed Amr Sabouni
- Division of Interventional and Structural Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Hassan Alkhawam
- Division of Interventional and Structural Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mustafa I. Ahmed
- Division of Interventional and Structural Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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9
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Shibata K, Maeda S, Kawamura M, Nakatsuji H, Ryugo M, Tsutsumi Y, Monta O. Successful Surgical Treatment for Ruptured Aneurysm of Coronary-Pulmonary Artery Fistula Complicated With Cardiac Tamponade. JACC Case Rep 2022; 4:1283-1287. [PMID: 36406920 PMCID: PMC9666919 DOI: 10.1016/j.jaccas.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 06/16/2023]
Abstract
A 74-year-old woman with no past medical history showed cardiac tamponade caused by rupture of a coronary-pulmonary artery fistula-related aneurysm. Preoperative pericardial puncture and multidetector computed tomography imaging enabled patient condition optimization and accurate morphologic evaluation of fistula and aneurysm, leading to complete surgical resection of the aneurysm. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | - Shusaku Maeda
- Address for correspondence: Dr Shusaku Maeda, Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinbo, Fukui 9100833, Japan.
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10
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Swartz MF, Yoshitake S, Cholette JM, Atallah-Yunes N, Wang H, Alfieris GM. A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperation. JTCVS Tech 2022; 16:196-211. [PMID: 36510535 PMCID: PMC9735427 DOI: 10.1016/j.xjtc.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/16/2022] Open
Abstract
Objective Maintaining adequate branch pulmonary arterial growth is critical in preventing early (<3 years) right ventricular outflow tract reoperation after the repair of truncus arteriosus. We hypothesized that a modified truncus arteriosus repair keeping the branch pulmonary arteries in situ would promote branch pulmonary arterial growth and limit early right ventricular outflow tract reoperation. Methods For infants requiring repair for type I and II truncus arteriosus, the truncal root was septated through a hockey stick incision keeping the branch pulmonary arteries in situ, the ventricular septal defect was closed, and a short aortic homograft was used to reconstruct the right ventricular outflow tract. Echocardiograms measured preoperative and follow-up branch pulmonary artery diameter. Results Between 1998 and 2020, 41 infants were repaired using the modified approach (type I, 28; type II, 13). With a median follow-up of 11.6 (interquartile range, 3.1-15.5) years, there was no significant change between preoperative left pulmonary artery and right pulmonary artery Z-scores and their corresponding follow-up measurement (left pulmonary artery: 0.97, interquartile range, 0.6-1.6 vs left pulmonary artery: 1.4, interquartile range, -0.3 to 1.9) (right pulmonary artery: 0.6, interquartile range, -0.4 to 1.7 vs right pulmonary artery: 0.3 interquartile range, 0.5-0.9). Only 7.3% (n = 2) of follow-up right pulmonary artery Z-scores were less than 2.5 Z-scores below preoperative measurements. Four children (9.8%) required early right ventricular outflow tract reoperation. On multivariable analysis, larger conduit Z-scores were associated with greater time to right ventricular outflow tract reoperation (hazard ratio, 0.55, confidence interval, 0.307-0.984; P = .043). Conclusions Maintaining the branch pulmonary arteries in situ at initial truncus arteriosus repair allows for branch pulmonary arterial growth, limiting early right ventricular outflow tract reoperation.
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Affiliation(s)
- Michael F. Swartz
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Address for reprints: Michael F. Swartz, PhD, Strong Memorial Hospital, Box Surg/Cardiac, 601 Elmwood Ave, Rochester, NY 14642.
| | - Shuichi Yoshitake
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY
| | - Jill M. Cholette
- Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Nader Atallah-Yunes
- Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY
| | - George M. Alfieris
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
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11
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Zhou AL, Etchill EW, Shou BL, Whitbread JJ, Barbur I, Giuliano KA, Kilic A. Outcomes after heart transplantation in patients who have undergone a bridge-to-bridge strategy. JTCVS Open 2022; 12:255-268. [PMID: 36590736 PMCID: PMC9801290 DOI: 10.1016/j.xjon.2022.08.011] [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] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/04/2023]
Abstract
Objectives We compared posttransplant outcomes between patients bridged from temporary mechanical circulatory support to durable left ventricular assist device before transplant (bridge-to-bridge [BTB] strategy) and patients bridged from temporary mechanical circulatory support directly to transplant (bridge-to-transplant [BTT] strategy). Methods We identified adult heart transplant recipients in the Organ Procurement and Transplantation Network database between 2005 and 2020 who were supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device as a BTB or BTT strategy. Kaplan-Meier survival analysis and Cox regressions were used to assess 1-year, 5-year, and 10-year survival. Posttransplant length of stay and complications were compared as secondary outcomes. Results In total, 201 extracorporeal membrane oxygenation (61 BTB, 140 BTT), 1385 intra-aortic balloon pump (460 BTB, 925 BTT), and 234 temporary ventricular assist device (75 BTB, 159 BTT) patients were identified. For patients supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device, there were no differences in survival between BTB and BTT at 1 and 5 years posttransplant, as well as 10 years posttransplant even after adjusting for baseline characteristics. The extracorporeal membrane oxygenation BTB group had greater rates of acute rejection (32.8% vs 13.6%; P = .002) and lower rates of dialysis (1.6% vs 21.4%; P < .001). For intra-aortic balloon pump and temporary ventricular assist device patients, there were no differences in posttransplant length of stay, acute rejection, airway compromise, stroke, dialysis, or pacemaker insertion between BTB and BTT recipients. Conclusions BTB patients have similar short- and midterm posttransplant survival as BTT patients. Future studies should continue to investigate the tradeoff between prolonged temporary mechanical circulatory support versus transitioning to durable mechanical circulatory support.
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Key Words
- BTB, bridge-to-bridge
- BTT, bridge-to-transplant
- CO, cardiac output
- ECMO, extracorporeal membrane oxygenation
- IABP, intra-aortic balloon pump
- LVAD, left ventricular assist device
- MCS, mechanical circulatory support
- OPTN, Organ Procurement and Transplantation Network
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge pressure
- TAH, total artificial heart
- UNOS, United Network for Organ Sharing
- extracorporeal membrane oxygenation
- heart transplant
- intra-aortic balloon pump
- mPAP, mean pulmonary arterial pressure
- mechanical circulatory support
- tVAD, temporary ventricular assist device
- transplant outcomes
- ventricular assist devices
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Affiliation(s)
- Alice L. Zhou
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Eric W. Etchill
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | - Iulia Barbur
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Katherine A. Giuliano
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Address for reprints: Ahmet Kilic, MD, Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7107, 1800 Orleans St, Baltimore, MD 21287.
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12
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Contento J, Mass P, Cleveland V, Aslan S, Matsushita H, Hayashi H, Nguyen V, Kawaji K, Loke YH, Nelson K, Johnson J, Krieger A, Olivieri L, Hibino N. Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine models. JTCVS Open 2022; 12:355-363. [PMID: 36590712 PMCID: PMC9801286 DOI: 10.1016/j.xjon.2022.08.006] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 01/04/2023]
Abstract
Objective Although surgical simulation using computational fluid dynamics has advanced, little is known about the accuracy of cardiac surgical procedures after patient-specific design. We evaluated the effects of discrepancies in location for patient-specific simulation and actual implantation on hemodynamic performance of patient-specific tissue-engineered vascular grafts (TEVGs) in porcine models. Methods Magnetic resonance angiography and 4-dimensional (4D) flow data were acquired in porcine models (n = 11) to create individualized TEVGs. Graft shapes were optimized and manufactured by electrospinning bioresorbable material onto a metal mandrel. TEVGs were implanted 1 or 3 months postimaging, and postoperative magnetic resonance angiography and 4D flow data were obtained and segmented. Displacement between intended and observed TEVG position was determined through center of mass analysis. Hemodynamic data were obtained from 4D flow analysis. Displacement and hemodynamic data were compared using linear regression. Results Patient-specific TEVGs were displaced between 1 and 8 mm during implantation compared with their surgically simulated, intended locations. Greater offset between intended and observed position correlated with greater wall shear stress (WSS) in postoperative vasculature (P < .01). Grafts that were implanted closer to their intended locations showed decreased WSS. Conclusions Patient-specific TEVGs are designed for precise locations to help optimize hemodynamic performance. However, if TEVGs were implanted far from their intended location, worse WSS was observed. This underscores the importance of not only patient-specific design but also precision-guided implantation to optimize hemodynamics in cardiac surgery and increase reproducibility of surgical simulation.
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Key Words
- 4D, four-dimensional
- AR, augmented reality
- CFD, computational fluid dynamics
- CHD, congenital heart disease
- LPA, left pulmonary artery
- MPA, main pulmonary artery
- MRA, magnetic resonance angiography
- MRI, magnetic resonance imaging
- PA, pulmonary artery
- RPA, right pulmonary artery
- SCA, subclavian artery
- STL, stereolithography
- TEVG, tissue-engineered vascular graft
- WSS, wall shear stress
- center of gravity
- computational fluid dynamics
- displacement
- hemodynamics
- surgical planning
- tissue-engineered vascular grafts
- wall shear stress
- αSMA, α-smooth muscle actin
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Affiliation(s)
| | - Paige Mass
- Department of Cardiology, Children's National Hospital, Washington, DC
| | - Vincent Cleveland
- Department of Cardiology, Children's National Hospital, Washington, DC
| | - Seda Aslan
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Md
| | - Hiroshi Matsushita
- Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
| | - Hidenori Hayashi
- Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
| | - Vivian Nguyen
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Ill
| | - Keigo Kawaji
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Ill
| | - Yue-Hin Loke
- Department of Cardiology, Children's National Hospital, Washington, DC
| | | | | | - Axel Krieger
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Md
| | - Laura Olivieri
- Department of Cardiology, Children's National Hospital, Washington, DC
| | - Narutoshi Hibino
- Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill,Department of Cardiovascular Surgery, Advocate Children's Hospital, Oak Lawn, Ill,Address for reprints: Narutoshi Hibino, MD, PhD, Section of Cardiac Surgery, Department of Surgery, The University of Chicago, Advocate Children's Hospital, 5841 S Maryland Ave, Room E500B, MC5040, Chicago, IL 60637.
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13
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Brailovsky Y, Masoumi A, Bijou R, Oliveros E, Sayer G, Takeda K, Uriel N. Fulminant Giant Cell Myocarditis Requiring Bridge With Mechanical Circulatory Support to Heart Transplantation. JACC Case Rep 2022; 4:265-270. [PMID: 35257100 PMCID: PMC8897036 DOI: 10.1016/j.jaccas.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
Giant cell myocarditis is a rare cause of cardiogenic shock requiring a high index of suspicion, rapid immunosuppressive therapy, and mechanical circulatory support. We present the case of a patient with giant cell myocarditis who underwent a successful bridge with four different types of mechanical circulatory support devices to heart transplantation. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Yevgeniy Brailovsky
- Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amirali Masoumi
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Rachel Bijou
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Estefania Oliveros
- Division of Cardiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Gabriel Sayer
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiovascular Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
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14
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Almakadma AH, Simard T, Sarma D, Akkawi AR, Challa AB, Taggart N, Misra S, Holmes DR Jr. Retrograde Transseptal Pulmonary Vein Transcatheter Plug Closure for Pulmonary Arteriovenous Malformation. JACC Case Rep 2022; 4:150-3. [PMID: 35199006 DOI: 10.1016/j.jaccas.2021.12.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
Pulmonary arteriovenous malformations (PAVMs) may manifest with bleeding or embolic events necessitating intervention. Transcatheter coil embolization through the pulmonary artery (PA) is an established approach. We present a case of recurrent PAVMs despite numerous PA coil embolizations. PAVM occlusion was achieved through plug placement by a transseptal and pulmonary venous approach. (Level of Difficulty: Advanced.)
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15
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Shirakawa K, Kobayashi E, Ichihara G, Kitakata H, Katsumata Y, Sugai K, Hakamata Y, Sano M. H 2 Inhibits the Formation of Neutrophil Extracellular Traps. JACC Basic Transl Sci 2022; 7:146-161. [PMID: 35257042 PMCID: PMC8897170 DOI: 10.1016/j.jacbts.2021.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 01/08/2023]
Abstract
NETs have been implicated as therapeutic targets to address inflammation and thrombotic tissue damage in conditions such as sepsis, acute respiratory disease syndrome, COVID-19, and CVDs. H2 has been clinically and experimentally proven to ameliorate inflammation; however, the underlying molecular mechanisms remain elusive. Compared with control neutrophils, PMA-stimulated human neutrophils exposed to H2 exhibited reduced citrullination of histones and release of NET components; mechanistically, H2-mediated neutralization of HOCl produced during oxidative bursts suppresses DNA damage. Inhalation of H2 inhibited the formation and release of NET components in the blood and BAL of the LPS-induced sepsis in mice and aged mini pigs. H2 therapy is potentially a new therapeutic strategy for inflammatory diseases involving NETs associated with excessive neutrophil activation.
Neutrophil extracellular traps (NETs) contribute to inflammatory pathogenesis in numerous conditions, including infectious and cardiovascular diseases, and have attracted attention as potential therapeutic targets. H2 acts as an antioxidant and has been clinically and experimentally proven to ameliorate inflammation. This study was performed to investigate whether H2 could inhibit NET formation and excessive neutrophil activation. Neutrophils isolated from the blood of healthy volunteers were stimulated with phorbol-12-myristate-13-acetate (PMA) or the calcium ionophore A23187 in H2-exposed or control media. Compared with control neutrophils, PMA- or A23187-stimulated human neutrophils exposed to H2 exhibited reduced neutrophil aggregation, citrullination of histones, membrane disruption by chromatin complexes, and release of NET components. CXCR4high neutrophils are highly prone to NETs, and H2 suppressed Ser-139 phosphorylation in H2AX, a marker of DNA damage, thereby suppressing the induction of CXCR4 expression. H2 suppressed both myeloperoxidase chlorination activity and production of reactive oxygen species to the same degree as N-acetylcysteine and ascorbic acid, while showing a more potent ability to inhibit NET formation than these antioxidants do in PMA-stimulated neutrophils. Although A23187 formed NETs in a reactive oxygen species–independent manner, H2 inhibited A23187-induced NET formation, probably via direct inhibition of peptidyl arginine deiminase 4-mediated histone citrullination. Inhalation of H2 inhibited the formation and release of NET components in the blood and bronchoalveolar lavage fluid in animal models of lipopolysaccharide-induced sepsis (mice and aged mini pigs). Thus, H2 therapy can be a novel therapeutic strategy for NETs associated with excessive neutrophil activation.
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Key Words
- BAL, bronchoalveolar lavage
- CVD, cardiovascular disease
- CitH3, citrullinated histone H3
- H2
- HOCl, hypochlorous acid
- LPS, lipopolysaccharide
- MI, myocardial infarction
- MPO, myeloperoxidase
- NAC, N-acetyl-L-cysteine
- NET, neutrophil extracellular trap
- PA, pulmonary artery
- PADI4, peptidyl arginine deiminase 4
- PMA, phorbol-12-myristate-13-acetate
- ROS, reactive oxygen species
- dsDNA, double-stranded DNA
- neutrophil extracellular traps
- phorbol-12-myristate-13-acetate
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Affiliation(s)
- Kohsuke Shirakawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Center for Molecular Hydrogen Medicine, Keio University, Tokyo, Japan.,Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Eiji Kobayashi
- Center for Molecular Hydrogen Medicine, Keio University, Tokyo, Japan.,Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.,Department of Organ Fabrication, School of Medicine, Keio University, Tokyo, Japan
| | - Genki Ichihara
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroki Kitakata
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshinori Katsumata
- Center for Molecular Hydrogen Medicine, Keio University, Tokyo, Japan.,Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Kazuhisa Sugai
- Department of Basic Sciences, Faculty of Veterinary Sciences, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Yoji Hakamata
- Department of Basic Sciences, Faculty of Veterinary Sciences, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Motoaki Sano
- Center for Molecular Hydrogen Medicine, Keio University, Tokyo, Japan.,Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
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16
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Steinhorn R, Dalia AA, Bittner EA, Chang MG. Surgical pulmonary embolectomy on VA-ECMO. Respir Med Case Rep 2021; 34:101551. [PMID: 34868870 PMCID: PMC8626575 DOI: 10.1016/j.rmcr.2021.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022] Open
Abstract
Surgical pulmonary embolectomy is a procedure that is often used to rescue patients with massive pulmonary embolism (PE) and circulatory collapse that have failed or may not be ideal candidates for other systemic and endovascular treatment modalities. This procedure typically involves a sternotomy and the use of cardiopulmonary bypass (CPB), which requires full systemic anticoagulation. Here, we report the case of a surgical pulmonary embolectomy performed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) rather than CPB to minimize systemic anticoagulation. The patient had suffered a cardiac arrest due to a saddle PE and required VA-ECMO which was complicated by a concomitant intracranial hemorrhage. The patient tolerated the surgical pulmonary embolectomy performed on VA-ECMO without procedure-related complications, and the ECMO support did not substantially complicate the technical performance of the procedure. In contrast to surgical pulmonary embolectomy performed on CPB, greater attention must be paid to volume status when performing the procedure on VA-ECMO since there is no blood reservoir. This case suggests cardiopulmonary support on ECMO as a viable strategy for surgical embolectomy in patients with unstable PEs in whom thrombolysis or full systemic anticoagulation are contraindicated.
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Key Words
- ACT, activated clotting time
- ASD, atrial septal defect
- CI, cardiac index
- CPB, cardiopulmonary bypass
- CT, computed tomography
- Cardiopulmonary bypass
- Case report
- EEG, electroencephalogram
- Extracorporeal membrane oxygenation
- ICU, intensive care unit
- LPA, left pulmonary artery
- MPA, main pulmonary artery
- MPAP, mean pulmonary artery pressure
- MRI, magnetic resonance imaging
- PA, pulmonary artery
- PE, pulmonary embolism
- PERT, pulmonary embolism response team
- PFO, patent foramen ovale
- PTT, partial thromboplastin time
- Pulmonary embolectomy
- Pulmonary embolism
- RPA, right pulmonary artery
- SDH, subdural hemorrhage
- TEE, transesophageal echocardiography
- TPA, tissue plasminogen activator
- VA-ECMO
- VA-ECMO, venoarterial extracorporeal membrane oxygenation
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Affiliation(s)
- Rachel Steinhorn
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, United States
| | - Adam A Dalia
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, United States
| | - Edward A Bittner
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, United States
| | - Marvin G Chang
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, United States
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17
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Ranard LS, Kaple R, Khalique OK, Agarwal V, Bellumkonda L, Bonde P, George I, Uriel N, Leon MB, Vahl TP. First Transfemoral Implantation of a Novel Transcatheter Valve in an LVAD Patient With Aortic Insufficiency. JACC Case Rep 2021; 3:1806-1810. [PMID: 34917959 PMCID: PMC8642726 DOI: 10.1016/j.jaccas.2021.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 06/14/2023]
Abstract
An 80-year-old man with a destination left ventricular assist device (LVAD) presented with decompensated heart failure. Evaluation demonstrated numerous LVAD high power spike events, significant aortic regurgitation, and hemolysis. He underwent successful aortic valve replacement with a novel transcatheter valve and LVAD pump exchange that resulted in an improvement in his clinical status. (Level of Difficulty: Advanced.).
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Key Words
- AR, aortic regurgitation
- CO, cardiac output
- CTA, computed tomography angiography
- LVAD, left ventricular assist device
- LVEDD, left ventricular end diastolic dimension
- NYHA, New York Heart Association
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge pressure
- RA, right atrial
- RV, right ventricular
- TAVR
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiogram
- THV, transcatheter heart valve
- TTE, transthoracic echocardiogram
- aortic regurgitation
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Affiliation(s)
- Lauren S. Ranard
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Ryan Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Omar K. Khalique
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Vratika Agarwal
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lavanya Bellumkonda
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Pramod Bonde
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isaac George
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Nir Uriel
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Martin B. Leon
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | - Torsten P. Vahl
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
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18
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Karuru UD, Relan J, Verma M, Kumar S, Tripathi M, Gupta SK, Ramakrishnan S, Saxena A, Kothari SS. Heart Failure in a Child: Multimodality Approach Leading to an Unusual Cause. JACC Case Rep 2021; 3:1869-1876. [PMID: 34917970 PMCID: PMC8642737 DOI: 10.1016/j.jaccas.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/05/2022]
Abstract
Heart failure secondary to isolated pulmonary artery vasculitis is rarely described in children. We describe a 10-year-old child who presented with right heart failure symptoms, severe pulmonary hypertension, and bilateral branch pulmonary artery stenosis secondary to isolated pulmonary artery vasculitis. (Level of Difficulty: Advanced.)
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Key Words
- ESR, erythrocyte sedimentation rate
- FDG-PET, fluorodeoxyglucose-positron emission tomography
- LPA, left pulmonary artery
- MPA, main pulmonary artery
- PA, pulmonary artery
- PPS, peripheral pulmonary artery stenosis
- RA, right atrium
- RPA, right pulmonary artery
- RV, right ventricle
- TA, Takayasu arteritis
- Takayasu arteritis
- congestive heart failure
- peripheral pulmonary artery stenosis
- pulmonary artery intervention
- pulmonary artery vasculitis
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Affiliation(s)
- Uma Devi Karuru
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Yagishita A, Yamauchi Y, Hirao K, Aonuma K, Nogami A. Pulmonary Artery Isolation for Polymorphic Outflow Tract Ventricular Tachycardia. JACC Case Rep 2021; 3:1738-1742. [PMID: 34825200 PMCID: PMC8603021 DOI: 10.1016/j.jaccas.2021.08.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/16/2021] [Accepted: 08/04/2021] [Indexed: 11/02/2022]
Abstract
Malignant ventricular arrhythmias arising from the pulmonary artery rarely occur in patients without structural heart disease. We highlight the feasibility and efficacy of a circular catheter-guided pulmonary artery isolation procedure for frequent premature ventricular contractions and polymorphic ventricular tachycardia causing syncope. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | - Yasuteru Yamauchi
- Department of Cardiology, Japan Redcross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Kenzo Hirao
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kanagawa, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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20
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Planek MIC, Ruge M, Du Fay de Lavallaz JM, Kyung SB, Gomez JMD, Suboc TM, Williams KA, Volgman AS, Simmons JA, Rao AK. Cardiovascular findings on chest computed tomography associated with COVID-19 adverse clinical outcomes. Am Heart J Plus 2021; 11:100052. [PMID: 34667971 PMCID: PMC8511552 DOI: 10.1016/j.ahjo.2021.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE Chest computed tomography (chest CT) is routinely obtained to assess disease severity in COVID-19. While pulmonary findings are well-described in COVID-19, the implications of cardiovascular findings are less well understood. We evaluated the impact of cardiovascular findings on chest CT on the adverse composite outcome (ACO) of hospitalized COVID-19 patients. SETTING/PARTICIPANTS 245 COVID-19 patients who underwent chest CT at Rush University Health System were included. DESIGN Cardiovascular findings, including coronary artery calcification (CAC), aortic calcification, signs of right ventricular strain [right ventricular to left ventricular diameter ratio, pulmonary artery to aorta diameter ratio, interventricular septal position, and inferior vena cava (IVC) reflux], were measured by trained physicians. INTERVENTIONS/MAIN OUTCOME MEASURES These findings, along with pulmonary findings, were analyzed using univariable logistic analysis to determine the risk of ACO defined as intensive care admission, need for non-invasive positive pressure ventilation, intubation, in-hospital and 60-day mortality. Secondary endpoints included individual components of the ACO. RESULTS Aortic calcification was independently associated with an increased risk of the ACO (odds ratio 1.86, 95% confidence interval (1.11-3.17) p < 0.05). Aortic calcification, CAC, abnormal septal position, or IVC reflux of contrast were all significantly associated with 60-day mortality and major adverse cardiovascular events. IVC reflux was associated with in-hospital mortality (p = 0.005). CONCLUSION Incidental cardiovascular findings on chest CT are clinically important imaging markers in COVID-19. It is important to ascertain and routinely report cardiovascular findings on CT imaging of COVID-19 patients as they have potential to identify high risk patients.
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Key Words
- Ao, aorta
- Aortic calcification
- CAC, coronary artery calcification
- CAD, coronary artery disease
- CI, confidence intervals
- COVID-19
- CT, computed tomography
- CVD, cardiovascular disease
- Chest computed tomography
- Coronary artery calcification
- ECMO, extracorporeal membrane oxygenation
- ICU, intensive care unit
- IVC, inferior vena cava
- LV, left ventricular
- MACE, major adverse cardiovascular events
- PA, pulmonary artery
- RV, right ventricular
- Right ventricular strain
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Affiliation(s)
| | - Max Ruge
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | | | - Stella B. Kyung
- Division of Cardiology, Loyola University Medical Center, Chicago, IL, United States of America
| | | | - Tisha M. Suboc
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Kim A. Williams
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | | | - J. Alan Simmons
- Department of Research Core, Rush University Medical Center, Chicago, IL, United States of America
| | - Anupama K. Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
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21
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Murakami T, Kainuma S, Toda K, Miyagawa S, Yoshioka D, Kawamura T, Kawamura A, Kashiyama N, Sawa Y. Acute Coronary Syndrome Requiring Coronary Artery Bypass Grafting in a Patient With Sotos Syndrome. JACC Case Rep 2021; 3:1630-1634. [PMID: 34729517 PMCID: PMC8543145 DOI: 10.1016/j.jaccas.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022]
Abstract
Sotos syndrome, characterized by cerebral gigantism with neurologic disorders, is an overgrowth syndrome caused by mutations of the NSD1 gene, with an estimated prevalence of 1:10,000-1:50,000. We herein describe the first case of Sotos syndrome complicated by acute coronary syndrome, for which emergency coronary artery bypass grafting was performed. (Level of Difficulty: Intermediate.)
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Key Words
- AV, atrioventricular
- CT, computed tomography
- LAD, left anterior descending artery
- LITA, left internal thoracic artery
- LMT, left main trunk
- OM, obtuse marginal branch
- PA, pulmonary artery
- PDA, posterior descending artery
- RCA, right coronary artery
- RITA, right internal thoracic artery
- Sotos syndrome
- acute coronary syndrome
- coronary aneurysm
- coronary artery bypass grafting
- coronary artery disease
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Affiliation(s)
- Takashi Murakami
- Address for correspondence: Dr Takashi Murakami, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita, Osaka 565-0871, Japan.
| | | | | | | | | | | | | | | | - Yoshiki Sawa
- Dr Yoshiki Sawa, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita, Osaka 565-0871, Japan.
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22
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Salve GG, Cole AD, Nicholson IA, Winlaw DS, Chard RB, Orr Y. Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteries. JTCVS Tech 2021; 9:111-20. [PMID: 34647077 DOI: 10.1016/j.xjtc.2021.05.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To study the outcomes of a novel modified pulmonary artery banding (mPAB) technique used for staged repair of a subset of patients with complex transposition physiology. Methods A total of 13 patients who underwent mPAB during their staged repair (biventricular repair [BVR], n = 6) or palliation (1-1/2 repair, n = 1; univentricular repair [UVR], n = 6) from 2004 to 2020 were studied retrospectively. A restrictive interposition graft was used to reconstruct the main PA between the pulmonary root and the distal pulmonary confluence, functioning as a mPAB. Twelve of the 13 patients (92.3%) underwent a concurrent arterial switch operation (ASO), of which 6 were palliative ASOs for 1-1/2 repair (n = 1) or UVR (n = 5). Patient weight and cardiac anatomy determined the size of interposition graft. Results The disease spectrum included dextro transposition of the great arteries (d-TGA) with multiple ventricular septal defects (VSDs) (n = 4), Taussig–Bing anomaly (n = 3), d-TGA with VSD and hypoplastic right ventricle (RV) (n = 3), double-inlet left ventricle with l-TGA (n = 2), and congenitally corrected TGA with double-outlet RV (n = 1). The Lecompte procedure was performed in 10 patients. Predischarge echocardiography revealed a band gradient of 61 mm Hg (interquartile range [IQR], 40-90 mm Hg) for BVR/1-1/2 ventricular repair (n = 7) and 49 mm Hg (IQR, 37-61 mm Hg) for UVR (n = 6). Survival was 100% at a median follow-up of 3.7 years (IQR, 2.6-4.0 years). Conclusions The mPAB technique is effective and reproducible for staged BVR or UVR for patients with TGA. It effectively regulates pulmonary blood flow, may reduce neopulmonary root distortion, and eliminates complications associated with band migration in standard PAB.
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Key Words
- ASO, arterial switch operation
- BDGS, bidirectional Glenn shunt
- BVR, biventricular repair
- Cx, circumflex artery
- IQR, interquartile range
- LPA, left pulmonary artery
- PA, pulmonary artery
- PAB, pulmonary artery banding
- PTFE, polytetrafluoroethylene
- RPA, right pulmonary artery
- RV, right ventricle/ventricular
- UVR, univentricular repair
- VSD, ventricular septal defect
- arterial switch operation
- biventricular repair
- d-TGA, dextro transposition of the great arteries
- l-TGA, levo transposition of the great arteries
- mPAB, modified pulmonary artery banding
- modified pulmonary artery banding
- transposition of the great arteries
- univentricular repair
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23
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Yadav S, Phadke M, Mahajan A, Nathani P. A Rare Case of Transposition of Great Arteries Uncovered With Progressive Rheumatic Aortic Stenosis. JACC Case Rep 2021; 3:1291-1293. [PMID: 34471880 PMCID: PMC8387841 DOI: 10.1016/j.jaccas.2021.07.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022]
Abstract
The authors describe a case of transposition of great arteries with a large atrial septal defect with fusion of tricuspid valve leaflets and severe aortic stenosis. The latter two were likely rheumatic in etiology. The patient’s condition improved after atrial switch and aortic valve replacement surgery. (Level of Difficulty: Intermediate.)
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Key Words
- AS, aortic stenosis
- IVC, inferior vena cava
- LV, left ventricle
- MV, mitral valve
- PA, pulmonary artery
- RA, right atrium
- RHD, rheumatic heart disease
- RV, right ventricle
- TGA, transposition of great arteries
- TV, tricuspid valve
- aortic valve stenosis
- congenital heart disease
- rheumatic heart disease
- transposition of the great arteries
- tricuspid valve
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Affiliation(s)
- Siddhant Yadav
- Department of Cardiology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Milind Phadke
- Department of Cardiology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Ajay Mahajan
- Department of Cardiology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Pratap Nathani
- Department of Cardiology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
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24
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Ingraham BS, Chareonthaitawee P, Reddy YNV. Exercise-Induced Left Bundle Branch Block Resulting in Severe Mitral Regurgitation. JACC Case Rep 2021; 3:1287-90. [PMID: 34471879 DOI: 10.1016/j.jaccas.2021.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022]
Abstract
Exercise hemodynamic catheterization is helpful to evaluate exertional symptoms when noninvasive investigations fail to provide an explanation in non-ischemic cardiomyopathy. In this case, a rate-related left bundle branch block resulted in severe dynamic mitral regurgitation and acute increase in pulmonary capillary wedge pressure. Cardiac resynchronization therapy resolved her symptoms. (Level of Difficulty: Intermediate.).
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Key Words
- AO, aorta
- BMI, body mass index
- CRT, cardiac resynchronization therapy
- LA, left atrium
- LBBB, left bundle branch block
- MR, mitral regurgitation
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge
- TTE, transthoracic echocardiogram
- Vo2, oxygen consumption
- cardiac resynchronization therapy
- exercise
- hemodynamics
- mitral valve
- right-sided catheterization
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25
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Shibbani K, Thattaliyath B, Bunker M, Anwar S, Ashwath R. Double-Outlet Right Ventricle, Pulmonary Atresia, and Discontinuous Branch Pulmonary Arteries Supplied by Bilateral Ducti. JACC Case Rep 2021; 3:1236-1240. [PMID: 34401767 PMCID: PMC8353570 DOI: 10.1016/j.jaccas.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/05/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
We present a rare case of double-outlet right ventricle with pulmonary atresia and discontinuous branch pulmonary arteries supplied by bilateral ducti from a right aortic arch. To our knowledge, this is only the second documented case of double-outlet right ventricle with bilateral ducti. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Kamel Shibbani
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Bijoy Thattaliyath
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Michael Bunker
- University of California-San Francisco, Center for Advanced 3D+ Technologies, San Francisco, California, USA
| | - Shafkat Anwar
- University of California-San Francisco, Center for Advanced 3D+ Technologies, San Francisco, California, USA.,Division of Cardiology, Department of Pediatrics, University of California-San Francisco, School of Medicine, San Francisco, California, USA
| | - Ravi Ashwath
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
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26
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Mejia E, George RS, Lozier JS, Bocks ML. Perventricular Transcatheter Pulmonary Valve Implantation in a Symptomatic 3-Year-Old Child With Repaired Tetralogy of Fallot. JACC Case Rep 2021; 3:712-714. [PMID: 34317611 PMCID: PMC8311154 DOI: 10.1016/j.jaccas.2020.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/24/2020] [Indexed: 11/04/2022]
Abstract
In select patients, transcatheter pulmonary valve replacement through a percutaneous approach can be challenging because of complicated anatomy or small patient size. In these patients, especially those weighing <20 kg, hybrid perventricular valve delivery may provide a preferred alternative approach. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Ernesto Mejia
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Renelle S George
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - John S Lozier
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Martin L Bocks
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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27
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Petit CJ, Ligon RA. Direct Percutaneous Transthoracic Cardiac Access for Recanalization of Longstanding Branch Pulmonary Artery Atresia. JACC Case Rep 2021; 3:180-186. [PMID: 34317499 PMCID: PMC8310936 DOI: 10.1016/j.jaccas.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022]
Abstract
We describe the use of direct percutaneous cardiac access to recanalize an atretic right pulmonary artery in an adolescent with complex congenital heart disease and right heart failure. This case highlights the problems associated with loss of central venous access and potential advantages of a direct cardiac approach to catheterization. (Level of Difficulty: Intermediate.)
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Key Words
- CHD, congenital heart disease
- CMR, cardiac magnetic resonance
- CTA, computed tomographic angiography
- CTO, chronic total occlusion
- CV, central venous
- DCA, direct cardiac access
- IJ, internal jugular
- LIMA, left internal mammary artery
- PA, pulmonary artery
- PA-VSD, pulmonary atresia with ventricular septal defect
- PAH, pulmonary arterial hypertension
- RHF, right heart failure
- RPA, right pulmonary artery
- RV, right ventricle
- RV-PA, right ventricle to pulmonary artery
- RVOT, right ventricular outflow tract
- congenital heart disease
- pulmonary artery
- recanalization
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Affiliation(s)
- Christopher J Petit
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - R Allen Ligon
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
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28
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Shibbani K, Nagpal P, Ashwath R. Anomalous Left Anterior Descending Coronary Artery With Retroaortic Left Circumflex Artery: A Novel Coronary Pattern. JACC Case Rep 2021; 3:546-549. [PMID: 34317579 PMCID: PMC8302782 DOI: 10.1016/j.jaccas.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 06/13/2023]
Abstract
A novel coronary anatomy in the form of anomalous left anterior descending coronary artery from pulmonary artery with a retroaortic left circumflex arising from the right coronary artery is presented. This unreported anatomy was discovered in a 7-month-old girl with failure to thrive. (Level of Difficulty: Intermediate.).
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Key Words
- ALADCAPA, anomalous left anterior descending coronary artery from pulmonary artery
- ALCAPA, anomalous left coronary artery arising from pulmonary artery
- CT, computed tomography
- FTT, failure to thrive
- LAD, left anterior descending
- LCA, left coronary artery
- LCx, left circumflex
- MPA, main pulmonary artery
- PA, pulmonary artery
- RCA, right coronary artery
- congenital heart defect
- coronary vessel anomaly
- pediatric surgery
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Affiliation(s)
- Kamel Shibbani
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Ravi Ashwath
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
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29
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Bartoli CR, Hennessy-Strahs S, Dowling RD, Gaynor JW, Glatz AC. Abnormalities in the Von Willebrand-Angiopoietin Axis Contribute to Dysregulated Angiogenesis and Angiodysplasia in Children With a Glenn Circulation. JACC Basic Transl Sci 2021; 6:222-35. [PMID: 33778210 DOI: 10.1016/j.jacbts.2020.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 02/08/2023]
Abstract
Children with a bidirectional superior cavopulmonary connection (Glenn circulation) develop dysregulated angiogenesis and pulmonary angiodysplasia in the form of arteriovenous malformations (AVMs). No targeted therapy exists. The von Willebrand factor (vWF)–angiopoietin axis plays a major role in normal angiogenesis, angiodysplasia, and AVM formation in multiple diseases. vWF and angiopoietin-2 (which destabilizes vessel formation) were abnormal in children with a Glenn circulation versus control children. Within Glenn patients, angiopoietin-1 (which stabilizes vessel formation) and angiogenesis were different in the systemic versus pulmonary circulation. Plasma angiopoietin-1 was lower in the pulmonary circulation of Glenn patients with pulmonary AVMs than Glenn patients without AVMs. In parallel, differences in multiple angiogenic and inflammatory signaling peptides were observed between Glenn patients and controls, which indicated derangements in multiple angiogenic pathways in Glenn patients. These findings support the novel hypothesis that abnormal vWF metabolism and angiopoietin signaling dysregulate angiogenesis and contribute to pulmonary AVM formation in children with a Glenn circulation. The vWF-angiopoietin axis may be a target to correct angiogenic imbalance and reduce pulmonary angiodysplasia in Glenn patients.
Children with a bidirectional superior cavopulmonary (Glenn) circulation develop angiodysplasia and pulmonary arteriovenous malformations (AVMs). The von Willebrand factor (vWF)–angiopoietin axis plays a major role in AVM formation in multiple diseases. We observed derangements in global angiogenic signaling, vWF metabolism, angiopoietins, and in vitro angiogenesis in children with a Glenn circulation versus controls and within Glenn pulmonary versus systemic circulations. These findings support the novel hypothesis that abnormalities in the vWF-angiopoietin axis may dysregulate angiogenesis and contribute to Glenn pulmonary AVMs. The vWF-angiopoietin axis may be a target to correct angiogenic imbalance in Glenn patients, for whom no targeted therapy exists.
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Key Words
- ADAMTS-13, a disintegrin and metalloproteinase thrombospondin (motif) #13
- AVM, arteriovenous malformation
- EBM, endothelial basal media
- EGM, endothelial growth media
- Glenn
- HUVEC, human umbilical vein endothelial cell
- IVC, inferior vena cava
- LVAD, left ventricular assist device
- PA, pulmonary artery
- SVC, superior vena cava
- angiogenesis
- angiopoietin
- arteriovenous malformation
- vWF, von Willebrand factor
- von Willebrand factor
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30
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Kaiser DW, Platzer P, Miyashiro K, Canfield J, Patel R, Liu D, St. Goar F, Kaiser CA. First-in-Human Experience of Mechanical Preload Control in Patients With HFpEF During Exercise. JACC Basic Transl Sci 2021; 6:189-198. [PMID: 33778208 PMCID: PMC7987536 DOI: 10.1016/j.jacbts.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
Heart failure patients demonstrate pulmonary hypertension during exertion that correlates with limitations in exercise capacity. Titrated partial occlusion of the IVC through balloon inflation (mechanical preload control) during exercise significantly reduced PA pressure by 25% (from 68 ± 7 mm Hg to 51 ± 7 mm Hg) with no significant reduction in peak VO2 (from 16.4 ± 5.8 ml/kg/min to 16.2 ± 4.0 ml/kg/min) or cardiac output (14.4 ± 5.9 l/min to 12.8 ± 2.9 l/min). Mechanical preload control trended toward longer exercise times and significantly reduced respiratory rate at matched exercise, suggesting that pulmonary pressures directly contribute to exercise limitations and hyperventilation in heart failure patients. Mechanical preload control may serve as a novel research and treatment strategy for heart failure patients.
Exercise intolerance remains one of the major factors determining quality of life in heart failure patients. In 6 patients with heart failure with preserved ejection fraction (HFpEF) undergoing invasive cardiopulmonary exercise testing, balloon inflation within the inferior vena cava (IVC) was performed during exercise to reduce and maintain pulmonary arterial (PA) pressures. Partial IVC occlusion significantly reduced PA pressures without reducing cardiac output. Partial IVC occlusion significantly reduced respiratory rate at matched levels of exercise. These findings highlight the importance of pulmonary pressures in the pathophysiology of HFpEF and suggest that therapies targeting hemodynamics may improve symptoms and exercise capacity in these patients.
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Affiliation(s)
- Daniel W. Kaiser
- Department of Respiratory Therapy, El Camino Hospital, Mountain View, California
- Department of Cardiovascular Medicine, Saint Thomas Hospital, Nashville, Tennessee, USA
- CardioFlow Technologies, Nashville, Tennessee, USA
- Address for correspondence: Dr. Daniel W Kaiser, Saint Thomas Hospital, 301 21st Avenue, N #100, Nashville, Tennessee 37203, USA.
| | - Patrick Platzer
- Department of Cardiovascular Medicine, Saint Thomas Hospital, Nashville, Tennessee, USA
| | | | - James Canfield
- Department of Respiratory Therapy, El Camino Hospital, Mountain View, California
| | - Rupal Patel
- Department of Respiratory Therapy, El Camino Hospital, Mountain View, California
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Frederick St. Goar
- Department of Respiratory Therapy, El Camino Hospital, Mountain View, California
| | - Clayton A. Kaiser
- Department of Cardiovascular Medicine, Saint Thomas Hospital, Nashville, Tennessee, USA
- CardioFlow Technologies, Nashville, Tennessee, USA
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31
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Cohen SS, Nageshwaran SK, Murthy R, Chan A, Cohen J, Jhaveri S, Love B, Zaidi AN. To Be or Not to Be Eisenmenger: The Different Shades of Blue. JACC Case Rep 2021; 3:230-235. [PMID: 34317508 PMCID: PMC8310966 DOI: 10.1016/j.jaccas.2020.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 10/26/2022]
Abstract
Eisenmenger syndrome refers to any untreated congenital cardiac defect with an intracardiac communication that leads to pulmonary arterial hypertension, reversal of intracardiac shunting, and cyanosis. We describe a 40-year-old cyanotic patient with congenital heart disease with presumed Eisenmenger syndrome who was considered inoperable. Testing revealed a partial atrioventricular septal defect with no evidence of pulmonary arterial hypertension, and the patient underwent successful cardiac repair. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Sarit S Cohen
- Department of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Bronx, New York, USA
| | | | - Raghav Murthy
- Pediatric Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alice Chan
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Cohen
- Children's Heart Center, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Simone Jhaveri
- Children's Heart Center, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barry Love
- Children's Heart Center, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ali N Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Children's Heart Center, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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32
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Blossom J, Lowe C, Ashley KE, Kogon BE, Lee SB, Long RC, Moore CK, Lennep BW, Papadimitriou L, Hernandez GA. Torrential Mitral Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair. JACC Case Rep 2021; 3:69-73. [PMID: 34317471 DOI: 10.1016/j.jaccas.2020.11.039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/03/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022]
Abstract
A patient with severe mitral regurgitation and chronic systolic heart failure taking inotropic support at home presents for transcatheter edge-to-edge mitral valve repair, complicated by torrential mitral regurgitation from damaged mitral leaflets requiring escalating mechanical circulatory support and ultimately expedited orthotopic heart transplantation. (Level of Difficulty: Intermediate.).
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33
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Hutt E, Santos-Martins C, Aguilera J, Wierup P, Kalahasti V, Tan C. A 27-Year-Old Woman With Postpartum Papillary Muscle Rupture. JACC Case Rep 2020; 2:2191-2195. [PMID: 34317136 PMCID: PMC8299862 DOI: 10.1016/j.jaccas.2020.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022]
Abstract
Postpartum papillary muscle rupture (PMR) is extremely uncommon and tolerated poorly with limited management options other than emergency surgical intervention. This case demonstrates the challenges of postpartum PMR in a young woman with unrecognized vascular Ehlers-Danlos syndrome and highlights the importance of preconception screening of cardiovascular disease. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Erika Hutt
- Cardiovascular Medicine Department, Cleveland Clinic, Cleveland, Ohio
| | | | - Jose Aguilera
- Cardiovascular Medicine Department, Cleveland Clinic, Cleveland, Ohio
| | - Per Wierup
- Thoracic and Cardiovascular Surgery Department, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela Tan
- Anatomic Pathology Department, Cleveland Clinic, Cleveland, Ohio
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34
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Mehta NA, Sabzwari SRA, Godil S, Akbar G, Dusaj R, Shah N. Ventricular Septal Aneurysm Mimicking Right Ventricular Outflow Tract Mass in a Patient With Ventricular Septal Defect. JACC Case Rep 2020; 2:2111-2114. [PMID: 34317118 PMCID: PMC8299768 DOI: 10.1016/j.jaccas.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022]
Abstract
A 50-year-old man presented with an episode of chest pain. Cardiac magnetic resonance revealed the presence of a large ventricular septal aneurysm partially closing a perimembranous ventricular septal defect, prolapsing into the right ventricular outflow tract, and mimicking a mass. We illustrate the diagnostic approach and management of such ventricular septal aneurysms. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Nikhil A. Mehta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania
- Address for correspondence; Dr. Nikhil A Mehta, Department of Cardiology, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Suite 300, Allentown, Pennsylvania 18103.
| | | | - Sara Godil
- Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Ghulam Akbar
- Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Raman Dusaj
- Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Neeraj Shah
- Department of Cardiology, East Carolina University, Greenville, North Carolina
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35
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Leiva O, Hollingsworth P, Singh V, Qian X, Blankstein R, Vaduganathan M. What Looks Like a Clot But Is Not a Clot?: Cardiac Leiomyosarcoma Mimicking Pulmonary Embolism. JACC Case Rep 2020; 2:1966-1968. [PMID: 34317090 PMCID: PMC8299237 DOI: 10.1016/j.jaccas.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/21/2020] [Indexed: 11/02/2022]
Abstract
Primary cardiac tumors in the right ventricular outflow tract are often misdiagnosed as pulmonary embolism due to rarity and inadequate imaging characterization. Multimodality imaging offers advantages and facilitates subsequent diagnostics and management. We present a case of a woman with suspected submassive pulmonary embolism who was found to have pleomorphic leiomyosarcoma. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Orly Leiva
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Parker Hollingsworth
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vasvi Singh
- Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Xiaohua Qian
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Muthiah Vaduganathan
- Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Address for correspondence: Dr. Muthiah Vaduganathan, Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, 75 Francis Street., Boston, Massachusetts 02115.
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36
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Compadre AJ, Kohi M, Lokken RP, Blissett S, Harris IS, Lucero J, Rosenstein MG, Sobhani NC. Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism in the Third Trimester of Pregnancy. JACC Case Rep 2020; 2:1899-1904. [PMID: 34317077 PMCID: PMC8299248 DOI: 10.1016/j.jaccas.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/16/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022]
Abstract
A 37-year-old woman presented with chest pain and shortness of breath in the third trimester of pregnancy. Diagnostic imaging demonstrated a saddle pulmonary embolism, severe impairment of right ventricular function, and an extensive deep venous thrombus. She underwent catheter-directed thrombolysis with tissue plasminogen activator and delivered a healthy infant at term. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Amanda J. Compadre
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, School of Medicine, San Francisco, California
| | - Maureen Kohi
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California-San Francisco, School of Medicine, San Francisco, California
| | - R. Peter Lokken
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California-San Francisco, School of Medicine, San Francisco, California
| | - Sarah Blissett
- Division of Cardiology, Department of Internal Medicine, University of California-San Francisco, School of Medicine, San Francisco, California
| | - Ian S. Harris
- Division of Cardiology, Department of Internal Medicine, University of California-San Francisco, School of Medicine, San Francisco, California
| | - Jennifer Lucero
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, School of Medicine, San Francisco, California
- Department of Anesthesia and Perioperative Care, University of California-San Francisco, School of Medicine, San Francisco, California
| | - Melissa G. Rosenstein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, School of Medicine, San Francisco, California
| | - Nasim C. Sobhani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, School of Medicine, San Francisco, California
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37
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Ahmed T, Nautiyal A, Kapadia S, Nissen SE. Delayed Presentation of STEMI Complicated by Ventricular Septal Rupture in the Era of COVID-19 Pandemic. JACC Case Rep 2020; 2:1599-1602. [PMID: 32839758 PMCID: PMC7438051 DOI: 10.1016/j.jaccas.2020.05.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 12/21/2022]
Abstract
A significant concern in current coronavirus disease-2019 (COVID-19) pandemic era is delay in first medical contact in patients with ST-segment elevation myocardial infarction (STEMI), due to reluctance to visit the hospital. We report a case of delayed presentation of STEMI as ventricular septal rupture during the COVID-19 pandemic, a rare presentation in the current age of primary percutaneous coronary intervention. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Taha Ahmed
- Department of Internal Medicine, Cleveland Clinic Foundation (Fairview), Cleveland, Ohio
| | - Ashoka Nautiyal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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38
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Shea NJ, Rosner G, Takayama H, Takeda K. A Boulder in the Chest: Case of Massive Pulmonary Artery Sarcoma. JACC Case Rep 2020; 2:1532-1535. [PMID: 34317011 PMCID: PMC8302178 DOI: 10.1016/j.jaccas.2020.05.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
A 79-year-old woman presented with dyspnea and cough. Workup revealed a pulmonary artery mass. After undergoing surgery, she was treated with adjuvant immunotherapy for an undifferentiated pulmonary artery sarcoma. Fifteen months after surgery, there was no evidence of recurrence. The case is discussed, imaging presented, and the published reports reviewed. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Nicholas J Shea
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York
| | - Gregg Rosner
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York
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39
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Jayanna MB, Ahmad TA, Maalouf M, Omondi A, Bobby R, Caroline M, Gnall EM. Catheter-Directed Mechanical Thrombectomy in Massive Pulmonary Embolism With Cardiogenic Shock. JACC Case Rep 2020; 2:1036-41. [PMID: 34317410 DOI: 10.1016/j.jaccas.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/04/2022]
Abstract
We discuss a patient who presented with cardiogenic shock secondary to massive pulmonary embolism and right ventricular failure. She was managed by a multidisciplinary heart team and treated with catheter-directed thrombectomy, followed by ProtekDuo (Tandem [Liva Nova], London, United Kingdom) heart percutaneous right ventricular support leading to complete recovery from this often fatal condition. (Level of Difficulty: Intermediate.)
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40
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Kubota S, Hara H, Yamamoto M, Hiroi Y. Percutaneous Coil Embolization of Confluent Bilateral Coronary Artery Fistulas. JACC Case Rep 2020; 2:991-995. [PMID: 34317400 PMCID: PMC8302086 DOI: 10.1016/j.jaccas.2020.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 10/29/2022]
Abstract
A 52-year-old woman presented with a continuous heart murmur at an annual health examination. Coronary computed tomography angiography showed confluent coronary artery fistulas meeting to form a large aneurysm fistulizing to the pulmonary artery. Percutaneous coil embolization was performed, resulting in the disappearance of the coronary artery fistulas and aneurysms. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Shuji Kubota
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masaya Yamamoto
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
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41
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Mantha Y, Feldman M, Assaf A, Harada R, Musselman D, Hieda M, Kawalsky D. Anomalous Origin of a Right Coronary Artery from the Pulmonary Artery in a Middle-Aged Woman. JACC Case Rep 2020; 2:464-467. [PMID: 34317265 PMCID: PMC8311615 DOI: 10.1016/j.jaccas.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/05/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
A 53-year-old female patient presented for evaluation of a murmur. The examination revealed a 2/6 systolic ejection murmur in the left upper sternal border. Transthoracic echocardiography with color Doppler showed increased blood flow around the apex of the right ventricle. Further imaging revealed the right coronary artery emerging from the pulmonary artery. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Yogamaya Mantha
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Mark Feldman
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Andrew Assaf
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Rakushumimarika Harada
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - David Musselman
- Cardiovascular Department, North Texas Heart Center, Dallas, Texas
| | - Michinari Hieda
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas.,Division of Cardiology, Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Darryl Kawalsky
- Cardiovascular Department, North Texas Heart Center, Dallas, Texas
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42
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Haleem SM, Ahmad S, Patel B. A Rare Cause of Chest Pain. JACC Case Rep 2020; 2:314-5. [PMID: 34317231 DOI: 10.1016/j.jaccas.2019.09.025] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/20/2022]
Abstract
A patient presenting with typical chest pain with a background of ischemic heart disease often alarms one of an acute coronary syndrome but differentials should always be ruled out. We report a case of typical chest pain which was referred from a district general hospital as an acute coronary syndrome but turned out to be a pulmonary artery sarcoma. (Level of Difficulty: Intermediate.)
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43
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Verma AK, Williams D, Nelson DM, Rathor R, Benhardt A, Chakinala M, Moon M, Kotkar K, Pepine CJ, Lindley KJ. A Cardio-Obstetric Approach to Management of the Complex Pregnant Cardiac Patient. JACC Case Rep 2020; 2:86-90. [PMID: 34316971 PMCID: PMC8301680 DOI: 10.1016/j.jaccas.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 11/19/2022]
Abstract
A 23-year-old female presented at 28.5 weeks gestation with symptomatic heart failure due to severe mitral stenosis and severe pulmonary arterial hypertension. After multidisciplinary planning, she underwent caesarean delivery with mitral valve replacement 48 h postpartum. Cardio-obstetric teams provide expert coordinated care for complex cardiovascular disease in pregnancy. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Amanda K. Verma
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Address for correspondence: Dr. Amanda K. Verma, Washington University School of Medicine in St. Louis, Department of Medicine, Cardiovascular Division, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110. @AmandaKVerma
| | - Dominique Williams
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - D. Michael Nelson
- Division of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Rashmi Rathor
- Division of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Amber Benhardt
- Division of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Murali Chakinala
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Marc Moon
- Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kunal Kotkar
- Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Kathryn J. Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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44
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Anand V, Frantz RP, DuBrock H, Kane GC, Krowka M, Yanagisawa R, Sandhu GS. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Initial Single-Center Experience. Mayo Clin Proc Innov Qual Outcomes 2019; 3:311-318. [PMID: 31485569 PMCID: PMC6713895 DOI: 10.1016/j.mayocpiqo.2019.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/14/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the safety and efficacy of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) seen at a US medical center. Patients and Methods Patients with inoperable or residual postendarterectomy CTEPH who underwent BPA at Mayo Clinic in Rochester, Minnesota, between August 11, 2014, and May 17, 2018, were included. Invasive hemodynamic, clinical, laboratory, and echocardiographic data were collected and analyzed retrospectively. Results We identified 31 patients (26 with inoperable CTEPH and 5 with residual postendarterectomy CTEPH) who underwent 75 BPA procedures performed in a staged manner to reduce complications. The median number of sessions was 2 (interquartile range [IQR], 1-3) per patient, and the number of vessels treated per session was 3 (IQR, 2-3). Of the 31 patients, 24 (77.4%) were taking pulmonary vasodilators and 22 (71.0%) were taking riociguat. The mean pulmonary arterial pressure decreased from 40 mm Hg (IQR, 29-48 mm Hg) to 29 mm Hg (IQR, 25-37 mm Hg; P<.001); pulmonary vascular resistance decreased from 5.5 Wood units (WU) (IQR, 3.0-7.6 WU) to 3.3 WU (2.2-5.2 WU; P<.001). The follow-up 6-minute walk test was performed in 13 patients and improved from 402 m (IQR, 311-439 m) to 439 m (366-510 m; P=.001). Of the 31 patients, 19 (61.3%) had improvement in New York Heart Association functional class. The mean ± SD nadir of minute ventilation/carbon dioxide production decreased by 3.4±5.5 (P=.03), reflecting improved ventilatory efficiency. Complications included hemoptysis requiring overnight intensive care unit observation (n=1) and cardiac tamponade requiring pericardiocentesis (n=1). One patient had reperfusion injury requiring intubation, recovered, and was dismissed to home but died unexpectedly within less than 30 days of the procedure. Serious complications occurred in 3 of the 75 BPA procedures (4.0%). Conclusion Our experience with BPA revealed that this procedure has acceptable risk and improves hemodynamics, functional class, and exercise tolerance in patients with inoperable or residual CTEPH.
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Key Words
- 6MWD, 6-minute walk distance
- BPA, balloon pulmonary angioplasty
- CTEPH, chronic thromboembolic pulmonary hypertension
- ICU, intensive care unit
- IQR, interquartile range
- NT-proBNP, N-terminal pro-B-type natriuretic peptide
- NYHA, New York Heart Association
- PA, pulmonary artery
- PH, pulmonary hypertension
- RAP, right atrial pressure
- RHC, right-sided heart catheterization
- RV, right ventricular
- RVSP, right ventricular systolic pressure
- TAPSE, tricuspid annular plane systolic excursion
- WU, Wood units
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Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Hilary DuBrock
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Michael Krowka
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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45
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Tang H, Wu K, Wang J, Vinjamuri S, Gu Y, Song S, Wang Z, Zhang Q, Balistrieri A, Ayon RJ, Rischard F, Vanderpool R, Chen J, Zhou G, Desai AA, Black SM, Garcia JGN, Yuan JXJ, Makino A. Pathogenic Role of mTORC1 and mTORC2 in Pulmonary Hypertension. JACC Basic Transl Sci 2018; 3:744-762. [PMID: 30623134 PMCID: PMC6314964 DOI: 10.1016/j.jacbts.2018.08.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/23/2018] [Accepted: 08/16/2018] [Indexed: 01/07/2023]
Abstract
G protein-coupled receptors and tyrosine kinase receptors signal through the phosphoinositide 3-kinase/Akt/mTOR pathway to induce cell proliferation, survival, and growth. mTOR is a kinase present in 2 functionally distinct complexes, mTORC1 and mTORC2. Functional disruption of mTORC1 by knockout of Raptor (regulatory associated protein of mammalian target of rapamycin) in smooth muscle cells ameliorated the development of experimental PH. Functional disruption of mTORC2 by knockout of Rictor (rapamycin insensitive companion of mammalian target of rapamycin) caused spontaneous PH by up-regulating platelet-derived growth factor receptors. Use of mTOR inhibitors (e.g., rapamycin) to treat PH should be accompanied by inhibitors of platelet-derived growth factor receptors (e.g., imatinib).
Concentric lung vascular wall thickening due to enhanced proliferation of pulmonary arterial smooth muscle cells is an important pathological cause for the elevated pulmonary vascular resistance reported in patients with pulmonary arterial hypertension. We identified a differential role of mammalian target of rapamycin (mTOR) complex 1 and complex 2, two functionally distinct mTOR complexes, in the development of pulmonary hypertension (PH). Inhibition of mTOR complex 1 attenuated the development of PH; however, inhibition of mTOR complex 2 caused spontaneous PH, potentially due to up-regulation of platelet-derived growth factor receptors in pulmonary arterial smooth muscle cells, and compromised the therapeutic effect of the mTOR inhibitors on PH. In addition, we describe a promising therapeutic strategy using combination treatment with the mTOR inhibitors and the platelet-derived growth factor receptor inhibitors on PH and right ventricular hypertrophy. The data from this study provide an important mechanism-based perspective for developing novel therapies for patients with pulmonary arterial hypertension and right heart failure.
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Key Words
- EC, endothelial cell
- FOXO3a, Forkhead box O3a
- GPCR, G protein-coupled receptor
- HPH, hypoxia-induced pulmonary hypertension
- PA, pulmonary artery
- PAEC, pulmonary arterial endothelial cell
- PAH, pulmonary arterial hypertension
- PASMC, pulmonary arterial smooth muscle cell
- PDGF, platelet-derived growth factor
- PDGFR, platelet-derived growth factor receptor
- PH, pulmonary hypertension
- PI3K, phosphoinositide 3-kinase
- PTEN, phosphatase and tensin homolog
- PVR, pulmonary vascular resistance
- RVH, right ventricular hypertrophy
- RVSP, right ventricular systolic pressure
- Raptor
- Raptor, regulatory associated protein of mammalian target of rapamycin
- Rictor
- Rictor, rapamycin insensitive companion of mammalian target of rapamycin
- SM, smooth muscle
- TKR, tyrosine kinase receptor
- WT, wild-type
- mTOR
- mTORC1, mammalian target of rapamycin complex 1
- mTORC2, mammalian target of rapamycin complex 2
- pAKT, phosphorylated AKT
- pulmonary hypertension
- right ventricle
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Affiliation(s)
- Haiyang Tang
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kang Wu
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Wang
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sujana Vinjamuri
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Yali Gu
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Shanshan Song
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Ziyi Wang
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qian Zhang
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Physiology, The University of Arizona College of Medicine, Tucson, Arizona
| | - Angela Balistrieri
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Ramon J Ayon
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Franz Rischard
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Rebecca Vanderpool
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Jiwang Chen
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois
| | - Guofei Zhou
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois
| | - Ankit A Desai
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,Division of Cardiology, Department of Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Stephen M Black
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,Department of Physiology, The University of Arizona College of Medicine, Tucson, Arizona
| | - Joe G N Garcia
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,Department of Physiology, The University of Arizona College of Medicine, Tucson, Arizona.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Jason X-J Yuan
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Physiology, The University of Arizona College of Medicine, Tucson, Arizona
| | - Ayako Makino
- Division of Translational and Regenerative Medicine, The University of Arizona College of Medicine, Tucson, Arizona.,Department of Physiology, The University of Arizona College of Medicine, Tucson, Arizona
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Yoshida K, Saku K, Kamada K, Abe K, Tanaka-Ishikawa M, Tohyama T, Nishikawa T, Kishi T, Sunagawa K, Tsutsui H. Electrical Vagal Nerve Stimulation Ameliorates Pulmonary Vascular Remodeling and Improves Survival in Rats With Severe Pulmonary Arterial Hypertension. ACTA ACUST UNITED AC 2018; 3:657-671. [PMID: 30456337 PMCID: PMC6234524 DOI: 10.1016/j.jacbts.2018.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 05/14/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
Abstract
Autonomic imbalance has been documented in patients with PAH. Electrical VNS is known to restore autonomic balance and improve heart failure. This study aimed to elucidate the therapeutic effects of VNS on severe PAH in a rat model. VNS significantly restored autonomic balance, decreased mean pulmonary arterial pressure, attenuated pulmonary vascular remodeling, and preserved right ventricular function. In addition, VNS markedly improved the survival of rats with PAH. Our findings may contribute greatly to the development of device therapy for PAH and widen the clinical applicability of VNS.
This study aimed to elucidate the therapeutic effects of electrical vagal nerve stimulation (VNS) on severe pulmonary arterial hypertension in a rat model. In a pathophysiological study, VNS significantly restored autonomic balance, decreased mean pulmonary arterial pressure, attenuated pulmonary vascular remodeling, and preserved right ventricular function. In a survival study, VNS significantly improved the survival rate in both the prevention (VNS from 0 to 5 weeks after a SU5416 injection) and treatment (VNS from 5 to 10 weeks) protocols. Thus, VNS may serve as a novel therapeutic strategy for pulmonary arterial hypertension.
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Key Words
- BNP, brain natriuretic peptide
- HF, high-frequency
- HRV, heart rate variability
- IL, interleukin
- MCP, monocyte chemotactic protein
- NE, norepinephrine
- NO, nitric oxide
- PA, pulmonary artery
- PAH, pulmonary arterial hypertension
- PAP, pulmonary arterial pressure
- PVR, pulmonary vascular resistance
- RV, right ventricular
- RVEDP, right ventricular end-diastolic pressure
- SS, sham-stimulated
- VNS, vagal nerve stimulation
- autonomic imbalance
- eNOS, endothelial nitric oxide synthase
- mRNA, messenger ribonucleic acid
- pulmonary arterial hypertension
- pulmonary vascular remodeling
- vagal nerve stimulation
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Affiliation(s)
- Keimei Yoshida
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Keita Saku
- Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
- Address for correspondence: Dr. Keita Saku, Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kazuhiro Kamada
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mariko Tanaka-Ishikawa
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takuya Nishikawa
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takuya Kishi
- Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Kenji Sunagawa
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Oka S, Shinohara S, Kuwata T, Takenaka M, Chikaishi Y, Hirai A, Ichiki Y, Shimajiri S, Aoki T, Tanaka F. The major thoracic vascular invasion of lung cancer. Ann Med Surg (Lond) 2017; 20:13-18. [PMID: 28702181 PMCID: PMC5484982 DOI: 10.1016/j.amsu.2017.06.025] [Citation(s) in RCA: 3] [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] [Received: 04/12/2017] [Revised: 06/17/2017] [Accepted: 06/18/2017] [Indexed: 01/25/2023] Open
Abstract
Background We actually investigated the surgical and pathological findings in cases which tumor invasion of the major thoracic vessels was suspected based on the preoperative Computed tomography (CT) findings. Materials and methods We retrospectively reviewed our prospective database of all patients, who underwent lung resection for lung cancer from 2012 to 2014. 387 patients underwent lung cancer surgery. Among these patients, we analyzed 30 patients in whom pulmonary artery (PA) invasion was suspected and 11 patients in whom pulmonary vein (PV) or left atrium (LA) invasion was suspected based on the preoperative CT findings. Results Among the 30 patients with suspected PA invasion, there were 9 patients in whom the tumor could be peeled off the PA in actual thoracotomy. Pathological invasion of the PA was observed in 6 of these patients. The positive predictive value of the preoperative CT findings was 20%. Among the 11 patients with suspected PV or LA invasion, there were 2 patients in whom the tumor could be peeled off the PV or LA in actual thoracotomy. Pathological tumor invasion of the PV or LA was observed in 4 of these patients. The positive predictive value of the preoperative CT findings was 36%. Conclusion The positive predictive value of the preoperative CT findings for tumor invasion of the thoracic vessels was low. Therefore, surgical opportunities that offer the chance of a cure shouldn't be missed in advanced lung cancer patients because the tumor is located near the major thoracic vessels on preoperative CT. We actually investigated tumor invasion of the major thoracic vessels. We analyzed 30 patients in whom pulmonary artery (PA) invasion was suspected. We analyzed 11 patients in whom pulmonary vein (PV) or left atrium (LA) invasion was suspected. The positive predictive value of CT findings was low.
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Affiliation(s)
- Soichi Oka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
- Corresponding author. Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.Second Department of SurgerySchool of MedicineUniversity of Occupational and Environmental Health1-1 IseigaokaYahatanishi-kuKitakyushu807-8555Japan
| | - Shuichi Shinohara
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Taiji Kuwata
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Takenaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasuhiro Chikaishi
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ayako Hirai
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshinobu Ichiki
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shohei Shimajiri
- Department of Pathology and Cell Biology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Roushdy AM, Ragab I, Abd El Raouf W. Noninvasive assessment of elevated pulmonary vascular resistance in children with pulmonary hypertension secondary to congenital heart disease: A comparative study between five different Doppler indices. J Saudi Heart Assoc 2012; 24:233-41. [PMID: 24174831 DOI: 10.1016/j.jsha.2012.05.004] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 02/22/2012] [Accepted: 05/20/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Pulmonary vascular resistance (PVR) is an important hemodynamic parameter in patients with congenital heart disease (CHD). Noninvasive estimation of PVR represents an attractive alternative to invasive measurements. METHODS The study included 175 patients with pulmonary hypertension (PH) secondary to CHD. All patients underwent full echocardiographic study and invasive hemodynamic measurements. The study population was then subdivided into four subgroups. Each of the following Doppler indices was measured in one of these four subgroups: peak tricuspid regurgitant velocity (TRV), the ratio of the TRV to the velocity time integral of the right ventricular outflow tract (TRV/TVIRVOT), peak velocity of tricuspid annular systolic motion (TSm), heart rate corrected acceleration time and infliction time of the proximal left pulmonary artery (ATc, InTc). The data obtained was correlated with invasive PVR measurement. An ROC curve analysis was done to generate cutoff points with the highest balanced sensitivity and specificity to predict PVR > 6WU/m(2). The receiver operating characteristics (ROC) curves were compared with each other to determine the most reliable cutoff point in predicting elevated PVR > 6WU/m(2). RESULTS There was a significant correlation between both the TRV and TSm and invasive measurement of PVR (r = -0.511, 0.387 and P value = 0.0002, 0.006 respectively). The TSm and TRV cutoff values were the most reliable to predict elevated PVR > 6 WU/m(2). A TSm cutoff value of ⩽16.16 cm/s provided the best balanced sensitivity (85.7%) and specificity (66.7%) to determine PVRCATH > 6 WU/m(2). A cutoff value less than 7.62 cm/s had 100% specificity to predict PVRCATH > 6 WU/m(2). A TRV cutoff value of >3.96 m/s provided the best balanced sensitivity (66.7%) and specificity (100%) to determine PVRCATH > 6 WU/m(2). Both TRV and TSm had the highest area under the ROC curve among the 5 DOPPLER indices studied. CONCLUSION Prediction of elevated PVR in children with PH secondary to CHD could be achieved noninvasively using a number of Doppler indices. Among the five Doppler indices examined in the current study, the peak TRV and the TSm of the lateral tricuspid annulus had the highest balanced sensitivity and specificity to predict PVRI > 6 WU/m(2).
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Key Words
- AcT, acceleration time
- AcTc, acceleration time corrected to heart rate
- BSA, body surface area
- CHD, congenital heart disease
- Congenital heart disease
- DTI, Doppler tissue imaging
- Doppler
- InT, inflection time
- InTc, inflection time corrected to heart rate
- MPAP, mean pulmonary artery pressure
- Noninvasive
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge pressure
- PH, pulmonary hypertension
- PVR, pulmonary vascular resistance
- Pulmonary vascular resistance
- Qp, pulmonary blood flow
- ROC, receiver operating characteristics curves
- RVSP, right ventricular systolic pressure
- TRV, peak tricuspid regurgitant velocity
- TSm, peak velocity of tricuspid annular systolic motion
- TVIRVOT, right ventricular outflow tract time–velocity integral
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Abstract
Embolization of central catheter fragments is a rare but well-documented complication of indwelling vascular devices. We describe a unique case of a catheter fragment migrating through the pulmonary vasculature after indwelling reservoir catheter removal in a 42 year-old female with metastatic breast cancer. The catheter fragment was initially visualized in the right upper lobe pulmonary artery two years after removal. One year later, it was seen in the right middle lobe PA. Two years later, it had migrated to the right lower lobe PA, where it remained for at least three months before the patient was lost to follow-up. The patient remained clinically asymptomatic from the catheter fragment throughout this time. Although there have been numerous case reports published regarding catheter embolization, to our knowledge, migration within the pulmonary vasculature has not been described. This is an interesting illustration of the hemodynamics of pulmonary blood flow and transient retrograde flow in the lungs.
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