26
|
Basman C, Seetharam K, Johnson J, Hemli JM, Brinster DR, Patel NC, Jacob Scheinerman S, Kliger CA, Pirelli L. Preoperative multidetector computed tomography for isolated surgical aortic valve replacement: Planning for future transcatheter options. J Card Surg 2020; 35:3354-3361. [PMID: 32996186 DOI: 10.1111/jocs.15080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/22/2020] [Accepted: 09/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become a valuable option in patients with bioprosthetic failure. However, potential issues with ViV TAVR may occur in patients with high-risk anatomy for coronary obstruction and patients with baseline smaller bioprosthetic valves at risk for patient prosthesis mismatch. The purpose of this study was, therefore, to use preoperative electrocardiography-gated, multidetector computed tomography (MDCT) in patients undergoing isolated surgical aortic valve replacement (SAVR) to (1) identify which would be high risk for coronary occlusion with ViV TAVR, and (2) predict intraoperative SAVR sizing. METHODS Among 223 patients from our institutions' database that underwent SAVR for aortic insufficiency (AI) or aortic stenosis (AS) between January 2012 and January 2020, 48 patients had MDCT imaging before surgery (AI; n = 31, AS; n = 17). Of all patients, 67% (n = 32) were bicuspid morphology. RESULTS With the use of virtual valve implantation, all patients with AI and bicuspid AS had feasible anatomy for ViV TAVR, while 38% of patients with tricuspid AS were high risk for coronary obstruction. There was a strong correlation between actual valve size implanted and preoperative MDCT measurements using annulus average diameter, area, and/or perimeter. CONCLUSION Preoperative MDCT in patients undergoing SAVR is a useful tool for lifetime management, particularly in patients with tricuspid AS. Decisions for surgical management may change based on MDCT's ability to predict intraoperative SAVR size and determine which patients may be high-risk candidates for future ViV TAVR due to coronary artery obstruction.
Collapse
|
27
|
Alexis SL, Malik AH, George I, Hahn RT, Khalique OK, Seetharam K, Bhatt DL, Tang GHL. Infective Endocarditis After Surgical and Transcatheter Aortic Valve Replacement: A State of the Art Review. J Am Heart Assoc 2020; 9:e017347. [PMID: 32772772 PMCID: PMC7660802 DOI: 10.1161/jaha.120.017347] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Prosthetic valve endocarditis (PVE) after surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) carries significant morbidity/mortality. Our review aims to compare incidence, predisposing factors, microbiology, diagnosis, management, and outcomes of PVE in surgical aortic valve replacement/TAVR patients. We searched PubMed and Embase to identify published studies from January 1, 2015 to March 13, 2020. Key words were indexed for original reports, clinical studies, and reviews. Reports were evaluated by 2 authors against a priori inclusion/exclusion criteria. Studies were included if they reported incidence and outcomes related to surgical aortic valve replacement/TAVR PVE and excluded if they were published pre-2015 or included a small population. We followed the Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for all stages of the design and implementation. Study quality was based on the Newcastle-Ottawa Scale. Thirty-three studies with 311 to 41 025 patients contained relevant information. The majority found no significant difference in incidence of surgical aortic valve replacement/TAVR PVE (reported as 0.3%-1.2% per patient-year versus 0.6%-3.4%), but there were key differences in pathogenesis. TAVR has a specific set of infection risks related to entry site, procedure, and device, including nonstandardized protocols for infection control, valve crimping injury, paravalvular leak, neo-leaflet stress, intact/calcified native leaflets, and intracardiac hardware. With the expansion of TAVR to lower risk and younger patients, a better understanding of pathogenesis, patient presentation, and guideline-directed treatment is paramount. When operative intervention is necessary, mortality remains high at 20% to 30%. Unique TAVR infection risks present opportunities for PVE prevention, therefore, further investigation is imperative.
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW Echocardiography is an indispensable tool in diagnostic cardiology and is fundamental to clinical care. Significant advances in cardiovascular imaging technology paralleled by rapid growth in electronic medical records, miniaturized devices, real-time monitoring, and wearable devices using body sensor network technology have led to the development of complex data. RECENT FINDINGS The intricate nature of these data can be overwhelming and exceed the capabilities of current statistical software. Machine learning (ML), a branch of artificial intelligence (AI), can help health care providers navigate through this complex labyrinth of information and unravel hidden discoveries. Furthermore, ML algorithms can help automate several tasks in echocardiography and clinical care. ML can serve as a valuable diagnostic tool for physicians in the field of echocardiography. In addition, it can help expand the capabilities of research and discover alternative pathways in medical management. In this review article, we describe the role of AI and ML in echocardiography.
Collapse
|
29
|
Basman C, Hemli JM, Kim MC, Seetharam K, Brinster DR, Pirelli L, Kliger CA, Scheinerman SJ, Singh VP, Patel NC. Long‐term survival in triple‐vessel disease: Hybrid coronary revascularization compared to contemporary revascularization methods. J Card Surg 2020; 35:2710-2718. [DOI: 10.1111/jocs.14891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
30
|
Seetharam K, Sengupta PP, Bianco CM. Cardiac mechanics in heart failure with preserved ejection fraction. Echocardiography 2020; 37:1936-1943. [PMID: 32594605 DOI: 10.1111/echo.14764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 12/30/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical entity associated with significant morbidity and mortality. Common comorbidities including hypertension, coronary artery disease, diabetes, chronic kidney disease, obesity, and increasing age predispose to preclinical diastolic dysfunction that often progresses to frank HFpEF. Clinical HFpEF is typically associated with some degree of diastolic dysfunction, but can occur in the absence of many conventional diastolic dysfunction indices. The exact biologic links between risk factors, structural changes, and clinical manifestations are not clearly apparent. Innovative approaches including deformation imaging have enabled deeper understanding of HFpEF cardiac mechanics beyond conventional metrics. Furthermore, predictive analytics through data-driven platforms have allowed for a deeper understanding of HFpEF phenotypes. This review focuses on the changes in cardiac mechanics that occur through preclinical myocardial dysfunction to clinically apparent HFpEF.
Collapse
|
31
|
Basman C, Seetharam K, Pirelli L, Kliger CA. Transcatheter aortic valve-in-valve-in-valve implantation with three-dimensional printing guidance: A case report. J Card Surg 2020; 35:1676-1680. [PMID: 32369868 DOI: 10.1111/jocs.14614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/15/2020] [Accepted: 04/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Valve-in-valve implantation (ViV) has become a valid option for the treatment of bioprosthetic valve failure. We describe the first in-man transfemoral transcatheter aortic valve replacement (TAVR) or "turducken" in a patient with previous TAVR within surgical aortic valve replacement with preprocedural guidance utilizing three-dimensional (3D) printing and intraprocedural guidance with fusion imaging. CASE SUMMARY A 65-year-old male with a previous valve-in-valve with a transcatheter Melody valve presented with symptomatic severe valvular and paravalvular aortic incompetence. Using 3D printing for preprocedural guidance and computed tomography angiography-fluoroscopy fusion imaging for intraprocedural guidance we successfully placed a 29 mm self-expanding valve with minimal residual gradients. The patient continued to be asymptomatic at 1- and 5-year follow-up. DISCUSSION We describe the first in man aortic valve-in-valve-in-valve using preprocedural guidance with 3D printing and intraprocedural guidance with fusion imaging. The valve has continued to demonstrate good function up to 5 years postprocedure suggesting that transcatheter aortic valve-in-valve-in-valve may be feasible with the proper pre- and intraprocedural guidance.
Collapse
|
32
|
Patel NC, Hemli JM, Seetharam K, Singh VP, Scheinerman SJ, Pirelli L, Brinster DR, Kim MC. Minimally invasive coronary bypass versus percutaneous coronary intervention for isolated complex stenosis of the left anterior descending coronary artery. J Thorac Cardiovasc Surg 2020; 163:1839-1846.e1. [DOI: 10.1016/j.jtcvs.2020.04.171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022]
|
33
|
Hemli JM, Uppal SK, Seetharam K, Delianides J, Pirelli L, Scheinerman SJ, Patel NC. Galactorrhea Following Minimally Invasive Reoperative Mitral Valve Replacement: An Unexpected Complication. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:177-179. [PMID: 32352899 DOI: 10.1177/1556984520909800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Galactorrhea, or nonpuerperal lactation, is a rare complication that can occur after trauma to the chest wall. Although galactorrhea has been reported after thoracic surgery, it has not been previously noted as a potential outcome following cardiac surgery. We present a unique case of hyperprolactinemic galactorrhea experienced by a 39-year-old nongravid female patient after having undergone reoperative mitral valve replacement via a right minithoracotomy. To the best of our knowledge, this is the first reported case of spontaneous lactation occurring after cardiac surgery.
Collapse
|
34
|
Pupovac SS, Hemli JM, Seetharam K, Giammarino AT, Scheinerman SJ, Hartman AR, Brinster DR. Acute Type A Aortic Dissection Repair After Hours: Does It Influence Outcomes? Ann Thorac Surg 2020; 110:1622-1628. [PMID: 32234321 DOI: 10.1016/j.athoracsur.2020.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/19/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Time of day has been associated with adverse outcomes in certain surgical pathologies. Because acute type A aortic dissection typically mandates immediate repair, relatively little attention has been paid to the potential impact of the day-night timing of the operation itself. We sought to determine whether patients with acute dissection treated during typical working hours demonstrated a difference in outcomes compared with those who required surgery after hours. METHODS We undertook a comprehensive review of our prospectively collected database from July 2014 to October 2018. A total of 164 consecutive patients underwent primary repair of an acute type A dissection. Based on the procedure start time, patients were divided into 2 groups: working hours (7 am to 4 pm, Monday to Friday; n = 60), and after hours (all other times, including weekends and holidays; n = 104). We propensity-matched 58 pairs of patients and analyzed perioperative data and short-term clinical outcomes. RESULTS Thirty-day mortality for all 164 patients was 10.4% (17 deaths), which was not significantly different between the matched groups (working-hours: 8 deaths [13.8%] versus after hours: 4 deaths [6.9%]; P = .36). Perfusion, cross-clamp, and circulatory arrest times did not differ between groups, nor did the types of aortic repairs performed. Postoperative complications were also comparable, including stroke, reoperation for bleeding, and new-onset renal failure requiring dialysis. CONCLUSIONS Thirty-day mortality and major morbidity after acute type A dissection repair are independent of when the operation is performed. Expeditious surgical intervention is recommended for all primary acute type A dissection, irrespective of time of day.
Collapse
|
35
|
Ro R, Tang GHL, Seetharam K, Khera S, Sharma SK, Kini AS, Lerakis S. Echocardiographic Imaging for Transcatheter Tricuspid Edge-to-Edge Repair. J Am Heart Assoc 2020; 9:e015682. [PMID: 32089056 PMCID: PMC7335573 DOI: 10.1161/jaha.119.015682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
36
|
Lerakis S, Ro R, Zhao W, Seetharam K, Krishnamoorthy P, Senguttuvan NB, Tang G, Stone G, Sharma SK, Kini AS. ACUTE CHANGES IN LEFT VENTRICULAR CARDIAC MECHANICS AFTER MITRACLIP TREATMENT OF MITRAL REGURGITATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
37
|
Ro R, Lerakis S, Seetharam K, Khera S, Sharma SK, Kini AS, Tang G. ACUTE CHANGES IN MITRAL ANNULAR DIMENSIONS ON 3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY AFTER MITRACLIP TREATMENT OF MITRAL REGURGITATION: A PILOT STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Seetharam K, Shrestha S, Sengupta PP. Artificial Intelligence in Cardiac Imaging. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2019.19.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Machine learning (ML), a subset of artificial intelligence, is showing promising results in cardiology, especially in cardiac imaging. ML algorithms are allowing cardiologists to explore new opportunities and make discoveries not seen with conventional approaches. This offers new opportunities to enhance patient care and open new gateways in medical decision-making. This review highlights the role of ML in cardiac imaging for precision phenotyping and prognostication of cardiac disorders.
Collapse
|
39
|
Chen J, Seetharam K, Reginauld S, Lerakis S. Higher Walk Score is associated with higher rates of bystander automated external defibrillator use in street-level cardiac arrest from Cardiac Arrest Registry to Enhance Survival registry. J Cardiovasc Med (Hagerstown) 2019; 20:859-860. [DOI: 10.2459/jcm.0000000000000870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
40
|
Baber U, Mehran R, Seetharam K, Kovacic J, Khan A, Sweeny J, Melarcode-Krishnamoorthy P, Vengrenyuk Y, Dangas G, Sharma S, Kini A. TCT-635 Combined and Independent Impact of Diabetes Mellitus and Elevated C-Reactive Protein Levels on Risk for Death and MI Following PCI: Insights From a Large Single-Center Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
41
|
Abstract
Over the last 15 years, cardiovascular magnetic resonance (CMR) imaging has progressively evolved to become an indispensable tool in cardiology. It is a non-invasive technique that enables objective and functional assessment of myocardial tissue. Recent innovations in magnetic resonance imaging scanner technology and parallel imaging techniques have facilitated the generation of T1 and T2 parametric mapping to explore tissue characteristics. The emergence of strain imaging has enabled cardiologists to evaluate cardiac function beyond conventional metrics. Significant progress in computer processing capabilities and cloud infrastructure has supported the growth of artificial intelligence in CMR imaging. In this review article, we describe recent advances in T1/T2 mapping, myocardial strain, and artificial intelligence in CMR imaging.
Collapse
|
42
|
Patel NC, Hemli JM, Seetharam K, Graver LM, Brinster DR, Pirelli L, Scheinerman SJ, Hartman AR. Reoperative mitral valve surgery via sternotomy or right thoracotomy: A propensity‐matched analysis. J Card Surg 2019; 34:976-982. [DOI: 10.1111/jocs.14170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/28/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
|
43
|
Seetharam K, Kagiyama N, Sengupta PP. Application of mobile health, telemedicine and artificial intelligence to echocardiography. Echo Res Pract 2019; 6:R41-R52. [PMID: 30844756 PMCID: PMC6432977 DOI: 10.1530/erp-18-0081] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/20/2019] [Indexed: 01/20/2023] Open
Abstract
The intersection of global broadband technology and miniaturized high-capability computing devices has led to a revolution in the delivery of healthcare and the birth of telemedicine and mobile health (mHealth). Rapid advances in handheld imaging devices with other mHealth devices such as smartphone apps and wearable devices are making great strides in the field of cardiovascular imaging like never before. Although these technologies offer a bright promise in cardiovascular imaging, it is far from straightforward. The massive data influx from telemedicine and mHealth including cardiovascular imaging supersedes the existing capabilities of current healthcare system and statistical software. Artificial intelligence with machine learning is the one and only way to navigate through this complex maze of the data influx through various approaches. Deep learning techniques are further expanding their role by image recognition and automated measurements. Artificial intelligence provides limitless opportunity to rigorously analyze data. As we move forward, the futures of mHealth, telemedicine and artificial intelligence are increasingly becoming intertwined to give rise to precision medicine.
Collapse
|
44
|
Seetharam K, Shrestha S, Sengupta PP. Artificial Intelligence in Cardiovascular Medicine. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:25. [PMID: 31089906 PMCID: PMC7561035 DOI: 10.1007/s11936-019-0728-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The ripples of artificial intelligence are being felt in various sectors of human life. Machine learning, a subset of artificial intelligence, extracts information from large databases of information and is gaining traction in various fields of cardiology. In this review, we highlight noteworthy examples of machine learning utilization in echocardiography, nuclear cardiology, computed tomography, and magnetic resonance imaging over the past year. RECENT FINDINGS In the past year, machine learning (ML) has expanded its boundaries in cardiology with several positive results. Some studies have integrated clinical and imaging information to further augment the accuracy of these ML algorithms. All the studies mentioned in this review have clearly demonstrated superior results of ML in relation to conventional approaches for identifying obstructions or predicting major adverse events in reference to conventional approaches. As the influx of data arriving from gradually evolving technologies in health care and wearable devices continues to be more complex, ML may serve as the bridge to transcend the gap between health care and patients in the future. In order to facilitate a seamless transition between both, a few issues must be resolved for a successful implementation of ML in health care.
Collapse
|
45
|
Patel NC, Hemli JM, Kim MC, Seetharam K, Pirelli L, Brinster DR, Scheinerman SJ, Singh VP. Short- and intermediate-term outcomes of hybrid coronary revascularization for double-vessel disease. J Thorac Cardiovasc Surg 2018; 156:1799-1807.e3. [DOI: 10.1016/j.jtcvs.2018.04.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 11/16/2022]
|
46
|
Basman C, Hemli J, Kim M, Seetharam K, Brinster D, Pirelli L, Scheinerman J, Singh V, Patel NC. TCT-108 Long-term Survival After Hybrid Coronary Revascularization for Triple-Vessel Disease: How Does it Compare to Coronary Artery Bypass Surgery or Multi-Vessel Percutaneous Intervention? J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
47
|
Kulina R, Seetharam K, Agarwal S, Wiley BM, Narula J, Chaudhry FA, Sengupta PP. Beamforming algorithms for endocardial border detection. Echocardiography 2018; 35:1499-1506. [PMID: 29943870 DOI: 10.1111/echo.14059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Software-based beamforming which utilizes delay and standard beamforming is a signal processing technique that temporarily stores data from each probe element to improve specular reflections to improve the image resolution. We compared a software algorithm which uses delay and standard beamforming with delay and sum beamforming in standard, hardware to evaluate endocardial borders and need for echo contrast. METHODS In this prospective study, eligible participants were ≥18 years of age referred clinically for transthoracic echocardiograms. A limited study consisting of three views (apical 4, apical 3, and apical 2 chamber) was performed with the software-based beamforming and standard platform. Number and quality of segments visualized were evaluated using a 17-segment model. Quality of segments was graded as 0 = not visualized, 1 = incompletely visualized, or 2 = completely visualized. Overall quality score for each study (0 = poor, 1 = adequate, 2 = good) was reported. The need for contrast was determined by ASE guidelines. RESULTS A total of 101 patients (mean age 61 ± 16 years, males 52%) were enrolled. Mean number of segments visualized in apical 4- (6.28 vs 5.65, P < .001), apical 3- (6.27 vs 5.54, P < .001), and apical 2-chamber views (6.26 vs 5.72 P < .001) was higher with the software vs standard platform. The average overall score for image quality was significantly better for the software platform vs standard (1.4 vs 0.9, P =< .001). With the software platform, 23% were judged as requiring contrast as compared with 45% for the standard platform (P < .001). CONCLUSIONS Delay and standard beamforming in software platform identified more segments with better image quality when compared to the standard high-end platform, decreasing the need for contrast usage.
Collapse
|
48
|
Pawale A, Takahashi M, Seetharam K, Reddy RC. Minimally Invasive Direct Coronary Artery Bypass for the management of Anomalous Left Coronary Artery from the Right Coronary Sinus. Heart Surg Forum 2018; 21:E239-E241. [PMID: 30084770 DOI: 10.1532/hsf.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/26/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Anomalous left coronary artery from the right coronary sinus (ALCA) is a known cause of sudden death. Surgical correction is recommended for all patients with interarterial course. We describe two patients who underwent surgical correction through an off pump- minimally invasive direct coronary artery bypass (MIDCAB) approach with good short- and mid-term results.
Collapse
|
49
|
Supariwala A, Sanchez-Ross M, Suma V, Seetharam K, Marrero D, Swistel D, Balaram S, Chaudhry FA. Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature. Echocardiography 2018; 35:611-620. [PMID: 29605969 DOI: 10.1111/echo.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Midwall fibrosis and low stroke volume are independent predictors of mortality in severe aortic stenosis (AS) with preserved LV ejection fraction (LVEF). The role of speckle tracking echocardiography (STE) to identify latent myopathy pre- and post- aortic valve replacement (AVR) in high risk AS patients with normal LVEF is limited. METHODS Demographic, 2D echocardiographic, and STE data were analyzed in patients with severe AS and preserved LVEF who underwent tissue AVR. Velocity vector imaging (VVI) was used to assess regional and global peak systolic longitudinal strain (GLS). Low flow (LF) was defined as an indexed LV stroke volume <35 mL/m2 . RESULTS Between December 2008 and May 2011, 37 patients (75 ± 9 years, 51% male) had both pre- and post-AVR echos within 6.6 ± 6.5 months (median = 4 months; range = 2.5-9.5) of surgery. Compared with pre-AVR, GLS (-6.9 ± 4.9% vs -11.1 ± 4.1%; P < .001) and strain rate (-0.72 ± 0.3s-1 vs -0.87 ± 0.3s-1 ; P = .01) improved post-AVR. Pre-AVR mid-segments showed a similar myopathy as the basal segments (-9.5 ± 4.3% vs -9.0 ± 4.2%;P = .3). The 16 (43%) LF patients in this study had lower pre- and post-AVR strain compared to NF patients (GLS Pre-AVR:LF vs NF: -5.1 ± 4.1% vs -8.4 ± 4.9% (P = .04) and GLS Post-AVR:LF vs NF: -9.2 ± 3.7% vs -12.5 ± 3.9% (P = .01)). However, there was no difference in absolute and %change improvement in GLS post-AVR (LF vs NF:∆ -4.2 ± 3.5% vs ∆-4.1 ± 5.3% (P = .90) and 193 ± 214% vs 143 ± 230% change (P = .5)). The lowest GLS was seen in LF/HG AS followed by LF/LG, NF/LG and NF/HG AS; P = .03. CONCLUSIONS Latent myopathy is more pronounced in LF AS both pre- and post-AVR. Our study provides evidence of improvement in myopathy in LF AS despite a persistent worse myopathy compared to NF patients post-AVR.
Collapse
|
50
|
Patel NC, Singh VP, Seetharam K, Hemli JM, Scheinerman SJ, Pirelli L, Brinster DR, Grines CL, Kliger CA, Mihelis EA, Kim MC. DOES MINIMALLY-INVASIVE BYPASS SURGERY AFFORD A LONG-TERM SURVIVAL ADVANTAGE COMPARED WITH DRUG-ELUTING STENT FOR ISOLATED COMPLEX DISEASE OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY? J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|