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Moady G, Rubinstein G, Mobarki L, Shturman A, Or T, Atar S. The Risk of Left Atrial Appendage Thrombus in Patients With Atrial Flutter Versus Atrial Fibrillation. Clin Med Insights Cardiol 2024; 18:11795468231221404. [PMID: 38192356 PMCID: PMC10771748 DOI: 10.1177/11795468231221404] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/18/2023] [Indexed: 01/10/2024]
Abstract
Objective Patients with atrial fibrillation (AF) are at increased risk of thromboembolic events originating mainly from left atrial appendage thrombus (LAAT). Patients with atrial flutter (AFL) are treated with anticoagulation based on the same criteria as patients with AF. However, whether patients with AFL have similar thromboembolic risk as AF is unclear. In the current study we aimed to estimate the prevalence of LAAT in patients with AFL undergoing trans-esophageal echocardiography (TEE). Methods/results We included 438 patients (404 with AF and 34 with AFL) scheduled for TEE to rule out LAAT before cardioversion (patients who reported no or inadequate anticoagulation before cardioversion). Demographic and echocardiographic data were compared between patients with and without LAAT. Despite a similar CHA2DS2-VASC score (3.8 ± 1.3 vs 3.4 ± 1.5 in the AF and AFL groups, respectively, P = .09), LAAT was documented in 12 (2.8%) in the AF group and in no patient in the AFL group (P < .0001). Conclusion Based on our results and previous studies, it seems reasonable to re-evaluate the need for oral anticoagulation in specific populations with AFL such as those with solitary AFL (without a history of AF episodes) undergoing successful ablation and in those with low CHA2DS2-VASC score.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Gal Rubinstein
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | - Loai Mobarki
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | | | - Tsafrir Or
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Moady G, Serhan M, Atar S, Shturman A. Complete Transesophageal Assessment of the Aortic Valve Using the Continuity Equation in Equivocal Cases of Aortic Stenosis. Isr Med Assoc J 2023; 25:747-751. [PMID: 37980620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND The continuity equation (CE) used for evaluating aortic stenosis (AS) is based on values obtained from transthoracic echocardiography (TTE) with the assumption that the left ventricular outflow tract (LVOT) has a circular shape. Transesophageal echocardiography (TEE) may be used for accurate measurement of the LVOT cross-sectional area (CSA). Previous studies have focused on fusion from TEE for LVOT-CSA measurement and TTE for velocity time integrals (VTI) calculations. OBJECTIVES To assess aortic valve area (AVA) using parameters obtained exclusively from TEE as an alternative approach. METHODS Thirty patients with equivocal AS based on TTE were evaluated using TEE for further assessment. RESULTS The mean pressure gradient across the aortic valve (AV) was 38 ± 5.9 and 37.9 ± 7.6 mmHg in TTE and TEE, respectively, P = 0.42. LVOT-CSA was larger in TEE (3.6 ± 0.3 vs. 3.4 ± 0.3 cm2, P = 0.049). VTI over the AVA was similar (98.54 ± 22.8 and 99.52 ± 24.52 cm in TTE and TEE, respectively, P = 0.608), while VTI across the LVOT was higher when measured by TTE (24.06 ± 5.8 vs. 22.03 ± 4.3 cm, P < 0.009). Using the CE, AVA was 0.82 ± 0.3 vs. 0.83 ± 0.17 cm2 in TEE vs. TTE, respectively, P = 0.608. Definitive grading was achieved in all patients (26 patients defined with severe AS and 4 with moderate). CONCLUSIONS In equivocal cases of AS, full assessment using TEE may be a reliable modality for decision making.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Moanis Serhan
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Alexander Shturman
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Moady G, Shturman A, Daud E, Rubinstein G, Levinar D, Atar S. Late Onset Takotsubo Following Surgery of Tricuspid Valve Fibroelastoma. Isr Med Assoc J 2023; 25:154-155. [PMID: 36841988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Alexander Shturman
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Elias Daud
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Gal Rubinstein
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Dror Levinar
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Braester A, Shturman A, Raviv B, Dorosinsky L, Rosental E, Atar S. What a Family Doctor Should Know about Incidental Finding of High Mean Platelet Volume, Metabolic Syndrome, and Pre-diabetes. Isr Med Assoc J 2021; 23:699-702. [PMID: 34811984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Mean platelet volume (MPV), an essential component of the complete blood count (CBC) indices, is underutilized in common practice. In recent years, MPV has drawn strong interest, especially in clinical research. During inflammation, the MPV has a higher value because of platelet activation. OBJECTIVES To verify whether high MPV values discovered incidentally in healthy naïve patients indicates the development or the presence of cardiovascular risk factors, particularly metabolic syndrome and pre-diabetes. METHODS A cohort study was used to assess the diagnostic value of high MPV discovered incidentally, in naïve patients (without any known cause of an abnormal high MPV, greater than upper limit of the normal range, such as active cardiovascular diseases and metabolic syndrome). RESULTS The mean MPV value in the patient group was 12.3 femtoliter. There was a higher incidence of metabolic syndrome in our research group than in the general population and a non-significant tendency of pre-diabetes. Family doctors more frequently meet naïve patients with high MPV than a hospital doctor. The results of our study are more relevant for him, who should know the relevance of such a finding and search for a hidden pre-diabetes or metabolic syndrome. CONCLUSIONS High MPV values discovered incidentally in healthy naïve subjects suggest the development or the presence of cardiovascular risk factors, particularly metabolic syndrome and pre-diabetes. No statistically significant association was found between MPV and the presence of cardiovascular disease.
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Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Alexander Shturman
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Bennidor Raviv
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Lev Dorosinsky
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eyal Rosental
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Shaul Atar
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Hamud A, Brezins M, Shturman A, Abramovich A, Dragu R. Right coronary artery diastolic perfusion pressure on outcome of patients with left heart failure and pulmonary hypertension. ESC Heart Fail 2021; 8:4086-4092. [PMID: 34296540 PMCID: PMC8497380 DOI: 10.1002/ehf2.13469] [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: 03/03/2021] [Revised: 05/17/2021] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Aims Right ventricle adaptation to prolonged exposure against pulmonary hypertension (PH) includes structural and functional abnormalities, translated into modifications of blood flow pattern through the right coronary artery. Given these changes, we investigate the relationship between right coronary artery diastolic perfusion pressure (RCDPP) and clinical outcome, in patients with PH secondary to left‐sided heart failure (HF). Methods and results We studied 108 HF patients who underwent right heart catheterization. PH was present in 75 (69.4%). Mean RCDPP was lower in patients with PH (59.4 ± 14.0 mmHg) as compared with no PH patients (65.5 ± 11.6 mmHg) (P = 0.03). Aortic diastolic pressure accounted for 79% of RCDPP variability explained by the model (P < 0.0001). During a median follow‐up of 26 months, the RCDPP 1st tertile (<55 mmHg) [hazard ration (HR) 5.19, 95% confidence interval (CI) 1.08–25.12, P = 0.04] and left ventricular ejection fraction <45% [HR 7.26, 95% CI 1.77–29.73, P = 0.006] were independent predictors of mortality. Conclusions Right coronary artery diastolic perfusion pressure is a strong independent haemodynamic maker of mortality in left‐sided HF and PH. Excessive reduction of aortic diastolic pressure may be detrimental. Future research is necessary to determine the therapeutic approach to blood pressure in this population.
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Affiliation(s)
- Amir Hamud
- Department of Internal Medicine C, Galilee Medical Center, Nahariya, Israel
| | - Marc Brezins
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | | | - Adrian Abramovich
- Department of Internal Medicine C, Galilee Medical Center, Nahariya, Israel
| | - Robert Dragu
- Department of Internal Medicine C, Galilee Medical Center, Nahariya, Israel.,Pulmonary Vascular Diseases Service, Galilee Medical Center, PO Box 21, Nahariya, 22100, Israel
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Daud E, Or T, Adler Z, Shturman A. The value of three-dimensional echocardiography in the diagnosis and management of ruptured sinus of Valsalva aneurysm: a case report. Eur Heart J Case Rep 2019; 3:ytz111. [PMID: 31660486 PMCID: PMC6764532 DOI: 10.1093/ehjcr/ytz111] [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] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/27/2019] [Indexed: 11/12/2022]
Abstract
Background A sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly. Most SVA's rupture into right heart chambers and can be classified using the modified Sakakibara classification according to the site of rupture. Transoesophageal echocardiography (TOE) is a useful diagnostic tool and aides in treatment planning in patients with congenital anomalies in emergency situations. Three-dimensional TOE (3D-TOE) provides additional value over standard TOE. Case summary A 38-year-old man with a reported history of ventricular septal defect (VSD) presented to the emergency department complaining of chest pain and epigastric pain lasting several days. Physical examination revealed a continuous heart murmur and signs of acute heart failure. A 3D-TOE revealed an SVA rupture into the right ventricle (Type IIIv) but no evidence of a VSD. Urgent aortic valve replacement with correction of the ruptured SVA was performed. Neither a VSD nor signs of endocarditis were found during surgical exploration. The patient was discharged on post-operative Day 5 in good condition. Discussion A sinus of Valsalva aneurysm is a rare cardiac condition. Ventricular septal defect, bicuspid aortic valve, or aortic valve regurgitation may coexist with SVA. Xin-Jin et al. classified a ruptured SVA into five types according to the site of rupture. Transoesophageal echocardiography is an important tool for diagnosis, anatomical description, and typing of the ruptured SVA. Sinus of Valsalva aneurysm may be misdiagnosed as a VSD, as was the case in our patient, and 3D-TOE can be instrumental for providing both correct diagnosis and critical surgical planning.
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Affiliation(s)
- Elias Daud
- Cardiology Department, Galilee Medical Center, PO Box 21, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Henrietta Szold 8, Safed, Israel
| | - Tsafrir Or
- Cardiology Department, Galilee Medical Center, PO Box 21, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Henrietta Szold 8, Safed, Israel
| | - Zvi Adler
- Cardiac Surgery Department, Rambam Healthcare Campus, HaAliya HaShniya 8, PO Box 9602, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Efron 1, Haifa, Israel
| | - Alexander Shturman
- Cardiology Department, Galilee Medical Center, PO Box 21, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Henrietta Szold 8, Safed, Israel
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Moady G, Bickel A, Shturman A, Khader M, Atar S. The Safety and Hemodynamic Effects of Pneumatic Sleeves in Patients with Severe Left Ventricular Dysfunction. Isr Med Assoc J 2019; 21:649-652. [PMID: 31599504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Pneumatic sleeves (PS) are often used during laparoscopic surgery and for prevention of deep vein thrombosis in patients who cannot receive anticoagulation treatment. There is very little information on the hemodynamic changes induced by PS and their effect on brain natriuretic peptide (BNP) in patients with severely reduced left ventricular ejection function (LVEF). OBJECTIVES To determine the safety and hemodynamic changes induced by PS and their effects on brain natriuretic peptide (BNP). METHODS This study comprised 14 patients classified as New York Heart Association (NYHA) II-III with severely reduced LVEF (< 40%). We activated the PS using two inflation pressures (50 or 80 mmHg, 7 patients in each group) at two cycles per minute for one hour. We measured echocardiography, hemodynamic parameters, and BNP levels in each patient prior to, during, and after the PS operation. RESULTS The baseline LVEF did not change throughout the activation of PS (31 ± 10% vs. 33 ± 9%, P = 0.673). Following PS activation there was no significant difference in systolic or diastolic blood pressure, the pulse measurements, or central venous pressure. BNP levels did not change after PS activation (P = 0.074). CONCLUSIONS The use of PS, with either low or high inflation pressures, is safe and has no detrimental effects on hemodynamic parameters or BNP levels in patients with severely reduced LVEF following clinical stabilization and optimal medical therapy.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | - Amitai Bickel
- Department of Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University of the Galilee, Safed, Israel
| | - Alexander Shturman
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University of the Galilee, Safed, Israel
| | - Muhammad Khader
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University of the Galilee, Safed, Israel
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Arsanjani R, Flint N, Beigel R, Khachatryan T, Shalev A, Shturman A, Lee C, Rader F, Berman DS, Heo R, Siegel RJ. Comparison of Accuracy of Left Atrial Area and Volume by Two-dimensional Trans-thoracic Echocardiography Versus Computed Tomography. Am J Cardiol 2019; 123:1180-1184. [PMID: 30660353 DOI: 10.1016/j.amjcard.2018.12.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022]
Abstract
Left atrial (LA) size is prognostic of cardiovascular events and can be quantified as diameter, area, or volume. While LA area measurement by 2-dimensional (2D) echocardiography is performed by tracing LA borders in the apical 4-chamber view, LA volume is derived from a formula that is based on geometrical assumptions. We compared LA area and volume measurements obtained by trans-thoracic echocardiography (TTE) to those obtained using multi-detector computed tomography (MDCT). Sixty-four patients with MDCT and TTE performed within a 1-week period were included in the study. End-systolic LA area was planimetered from the 4-chamber view by TTE and MDCT. LA end-systolic volume was calculated using the biplane area-length (AL) method in both TTE and MDCT. Mean LA volume measurement using MDCT was significantly larger than TTE measurement (92 ± 31 mL vs 68 ± 27 mL, p <0.001). There was moderate correlation between MDCT and TTE in both LA area (0.74, p <0.0001), and volumetric measurements (0.77, p <0.0001). Bland-Altman agreement plots demonstrated a significantly lower bias and narrower 95% confidence intervals (CI) for the 2D area (bias: -5.5; 95% CI: -14.3 to 3.3) as compared with volumetric measurements (bias: -23.7; 95% CI: -64.9 to 17.5, p <0.0001). Contrary to current guidelines for chamber quantification, 2D TTE LA area has better agreement with MDCT than volumetric measurements by TTE. LA volumetric measurements are desirable; however, they are currently less reliable than the direct LA area tracing by 2D TTE and therefore represent a suboptimal and less reproducible method to determine LA size.
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Shturman A, Vardi S, Bickel A, Atar S. Ventricular Late Potentials Immediately Post ST-Elevation Myocardial Infarction, and Very Long-Term Mortality. Isr Med Assoc J 2017; 19:246-250. [PMID: 28480680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The very long-term prognostic significance of ventricular late potentials (VLP) in patients post ST-elevation myocardial infarction (STEMI) is unclear. OBJECTIVES To evaluate the long-term predictive value of VLP for mortality post-STEMI. METHODS We conducted serial signal-averaged electrocardiography (SAECG) measurements in 63 patients on the 1st, 2nd and 3rd day pre-discharge, and 30 days after STEMI in patients admitted in 2001. We followed the patients for 10 years and correlated the presence of VLP with all-cause and cardiovascular mortality. RESULTS The mean age was 59.9 ± 12.3 years. Thrombolysis was performed in 41 patients (65%). Percutaneous coronary intervention was performed pre-discharge in 40 patients (63%) and coronary artery bypass grafting in 7 (11%). Five consecutive measurements to define the presence of VLP were obtained in 52 patients (21 with VLP and 31 without). We found a higher prevalence of VLP in males compared to females (QRS segment > 114 msec, 51% vs. 12%, P = 0.02, duration of the low amplitude signal < 40 mV) in the terminal portion of the averaged QRS complex > 38 msec, 47% vs. 25%, P = 0.05). Over 10 years of follow-up, 14 (22%) patients died, 10 (70%) due to cardiovascular non-arrhythmic complications, 6 with VLP compared to only 3 without (28.6% vs. 9.7%, P = 0.125, hazard ratio = 2.96, confidence intervals = 0.74-11.84) (are these numbers meant to total 10?). CONCLUSIONS Over 10 years of follow-up, the presence of VLP in early post-STEMI is not predictive of arrhythmic or non-arrhythmic cardiovascular mortality.
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Affiliation(s)
- Alexander Shturman
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Shira Vardi
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | - Amitai Bickel
- Department of Surgery, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Abstract
INTRODUCTION The optimal method for creation of a pericardial window (PW) is still controversial and it remains a surgical challenge, mainly in obese patients. The aim of this study was to evaluate the efficacy and safety of a novel approach that has not been described previously, for creation of a PW in patients with symptomatic, chronic, large pericardial effusion. METHODS We retrospectively analysed the records of 30 patients (14 men, 16 women) who underwent a PW procedure between 2001 and 2011. The mean age was 63 years (standard deviation [SD]: 17 years, median: 60 years, range: 27-90 years) and the mean body mass index was 34 kg/m(2) (SD: 2 kg/m(2)). The operation was performed through a curvilinear parasternal approach, 6-8 cm in length, followed by a mini-thoracotomy between ribs 4 and 5. Discharged patients were followed up clinically. RESULTS The mean operative time was 73 minutes (SD: 21 minutes) and a median of 658 ml (range: 300-1,500 ml) of fluid was evacuated. The main aetiologies were idiopathic in 17 patients (57%) and malignant in 9 (30%). Seven patients (23%) died in hospital owing to underlying malignancy. Postoperative complications included mild renal failure (20%), respiratory failure (20%), pneumonia (13%), atrial fibrillation (10%) and atelectasis (6%). There were no wound infections. The median length of stay following the procedure was 8 days. In a median follow-up period of 3.8 years, 16 patients with non-malignant effusion were free of recurrence of pericardial effusion. CONCLUSIONS The anterior parasternal approach for creation of a PW is simple, safe and efficacious, and results in long-term symptomatic improvement, specifically in patients with non-malignant effusions. This approach may be more appealing in obese patients.
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Affiliation(s)
- E Altman
- Galilee Medical Centre, Nahariya, Israel
| | - O Rutsky
- Galilee Medical Centre, Nahariya, Israel
| | - A Shturman
- Galilee Medical Centre, Nahariya, Israel
| | | | - S Atar
- Galilee Medical Centre, Nahariya, Israel
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Hassan K, Hassan D, Shturman A, Rubinchik I, Fadi H, Shadi H, Atar S. The impact of sub-clinical over-hydration on left ventricular mass in peritoneal dialysis patients. Int J Clin Exp Med 2015; 8:5890-5896. [PMID: 26131181 PMCID: PMC4483851] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Left ventricular hypertrophy (LVH) represents a major predictor of the development of cardiovascular (CV) complications. Over-hydration (OH) is an important uremic risk factor associated with LVH and increased CV morbidity and mortality in peritoneal dialysis (PD) patients. In the present study we evaluated the prevalence of sub-clinical OH (SCOH) among PD patients and its effects on left ventricular mass (LVM). METHODS In this cross sectional study hydration status, blood pressure, glucose load, systemic inflammation and LVM were evaluated in 43 clinically stable patients on maintenance PD for 24-76 months. The hydration status was assessed by whole-body bio-impedance spectroscopy (BIS). Peripheral edema and any evidence of pulmonary congestion were considered clinical signs of OH. RESULTS OH ≥ 1.5 L was detected in 26 (60.5%) of the study participants; the OH in 19 (73.1%) of them was sub-clinical. Only 23.5% (4/17) of patients with OH < 1.5 L had LVH compared to 68.4% (13/19) of those with SCOH ≥ 1.5 L (P = 0.007). Compared to patients with OH < 1.5 L, patients with SCOH ≥ 1.5 L had higher levels of blood pressure, peritoneal glucose load, plasma brain natriuretic peptide, high sensitive C-reactive protein, interleukin-6 and LVMI; and lower levels of serum albumin (P < 0.001). No significant differences were found between patients with clinical OH or SCOH with OH ≥ 1.5 L. CONCLUSIONS SCOH is highly prevalent among PD patients and may contribute to the development of LVH. Considering the poor prognosis associated with over-hydrated PD patients, periodic assessment of hydration status using accurate BIS is suggested.
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Affiliation(s)
- Kamal Hassan
- Faculty of Medicine in The Galilee, Bar-Ilan UniversitySafed, Israel
- Peritoneal Dialysis Unit-Western Galilee HospitalNahariya, Israel
| | - Dunia Hassan
- Women’s Health Wing-Western Galilee HospitalNahariya, Israel
| | | | - Irina Rubinchik
- Peritoneal Dialysis Unit-Western Galilee HospitalNahariya, Israel
| | - Hassan Fadi
- Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel
| | - Hassan Shadi
- Internal Medicine Department-Carmel Medical CenterHaifa, Israel
| | - Shaul Atar
- Faculty of Medicine in The Galilee, Bar-Ilan UniversitySafed, Israel
- Department of Cardiology-Western Galilee HospitalNahariya, Israel
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Bickel A, Shturman A, Sergeiev M, Ivry S, Eitan A, Atar S. Hemodynamic effect and safety of intermittent sequential pneumatic compression leg sleeves in patients with congestive heart failure. J Card Fail 2014; 20:739-746. [PMID: 25038262 DOI: 10.1016/j.cardfail.2014.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 10/26/2013] [Revised: 05/10/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pneumatic leg sleeves are widely used after prolonged operations for prevention of venous stasis. In healthy volunteers they increase cardiac function. We evaluated the hemodynamic effects and safety of intermittent sequential pneumatic compression (ISPC) leg sleeves in patients with chronic congestive heart failure (CHF). METHODS AND RESULTS We studied 19 patients with systolic left ventricular dysfunction and CHF. ISPC leg sleeves, each with 10 air cells, were operated by a computerized compressor, exerting 2 cycles/min. Hemodynamic and echocardiographic parameters were measured before, during, and after ISPC activation. The baseline mean left ventricular ejection fraction was 29 ± 9.2%, median 32%, range 10%-40%. Cardiac output (from 4.26 to 4.83 L/min; P = .008) and stroke volume (from 56.1 to 63.5 mL; P = .029) increased significantly after ISPC activation, without a reciprocal increase in heart rate, and declined after sleeve deactivation. Systemic vascular resistance (SVR) decreased significantly (from 1,520 to 1,216 dyne-s/cm5; P = .0005), and remained lower than the baseline level throughout the study. There was no detrimental effect on diastolic function and no adverse clinical events, despite increased pulmonary venous return. CONCLUSIONS ISPC leg sleeves in patients with chronic CHF do not exacerbate symptoms and transiently improve cardiac output through an increase in stroke volume and a reduction in SVR.
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Affiliation(s)
- Amitai Bickel
- Department of Surgery, Western Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar Ilan University, Israel
| | - Alexander Shturman
- Department of Cardiology, Western Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar Ilan University, Israel
| | - Michael Sergeiev
- Department of Anesthesiology, Western Galilee Medical Center, Nahariya, Israel
| | - Shimon Ivry
- Department of Anesthesiology, Western Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar Ilan University, Israel
| | - Arieh Eitan
- Department of Surgery, Western Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar Ilan University, Israel
| | - Shaul Atar
- Department of Cardiology, Western Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar Ilan University, Israel.
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Fotheringham J, Campbell MJ, Wilkie M, Lopes Barreto D, Sampimon DE, Struijk DG, Krediet RT, Portoles J, Janeiro D, Tato AM, Lopez P, Castellano I, Del Peso G, Rivera M, Fernandez-Reyes MJ, Ortega M, Martinez De Miguel P, Caparros G, Selgas R, Sarmento-Dias M, Santos-Araujo C, Poinhos R, Soares Silva I, Simoes Silva L, Sousa MJ, Correia F, Pestana M, Kang SH, Cho KH, Park JW, Yoon KW, Do JY, Ponce D, Banin V, Bueloni T, Caramori J, Balbi A, Barretti P, Virzi GM, Na HY, Kim YB, Jo YI, Griva K, Yu Z, Foo M, Chang KY, Kim YK, Kim YO, Song HC, Yang CW, Kim SH, Kim YL, Kim YS, Kang SW, Kim NH, Kim HW, Waniewski J, Poleszczuk J, Antosiewicz S, Baczy ski D, Pietribiasi M, Wankowicz Z, Alhwiesh A, Nasreldin MA, Saeed I, Braide M, Milan Manani S, I{middle dot}Nal S, Okyay GU, Ulu MS, Kidir V, Altuntas A, Ahsen A, Unverdi S, Yuksel S, Duranay M, Sezer MT, Mushahar L, Lim WM, Mohd Yusuf WS, Sivathasan S, Ancarani P, Parodi D, Terrile O, Scofferi S, Lenzora G, Martins AR, Vizinho R, Branco PQ, Gaspar MA, Barata JD, Dimkovic N, Lazarevic T, Zdenka M, Pljesa S, Marinkovic J, Djukanovic L, Ahbap E, Kara E, Sahutoglu T, Basturk T, Koc Y, Sakaci T, Sevinc M, Akgol C, Unsal A, Vlahu CA, De Graaff M, Vink H, Struijk DG, Krediet RT, Zeiler M, Marani M, Agostinelli RM, Monteburini T, Marinelli R, Di Luca M, Santarelli S, Moreiras-Plaza M, Blanco-Garcia R, Martin-Baez I, Fernandez-Fleming F, Beato-Coo L, Chang JH, Ro H, Jung JY, Lee HH, Moon SJ, Chung W, Hassan K, Hassan D, Shturman A, Hassan F, Rubinchik I, Hassan S, Atar S, Witoon R, Matsuda A, Tayama Y, Ogawa T, Kogure Y, Okazaki S, Hatano M, Kiba T, Iwashita T, Shimizu T, Hasegawa H, Mitarai T, Rroji ( Molla) M, Seferi S, Burazeri G, Thereska N, Theodoridis M, Gioka T, Bounta T, Kriki P, Mourvati E, Thodis E, Roumeliotis A, Passadakis P, Vargemezis V, Bek S, Eren N, Eraldemir FC, Batman A, Derviso lu E. PERITONEAL DIALYSIS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Atar S, Wishniak A, Shturman A, Shtiwi S, Brezins M. Fatal association of mechanical valve thrombosis with dabigatran: a report of two cases. Chest 2013; 144:327-328. [PMID: 23880682 DOI: 10.1378/chest.12-2486] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Several new oral anticoagulants have been approved for thromboembolism prevention in patients with nonvalvular atrial fibrillation. However, they are not yet approved for anticoagulation use in patients with prosthetic mechanical valves, and no randomized data have been published so far on their safety of use in these patients. We present two cases of patients with prosthetic mechanical mitral valves who were switched from warfarin and acenocoumarol to dabigatran and within 1 month experienced severe valve complications resulting in death. One patient experienced stroke and later cardiogenic shock and death, and the other experienced pulmonary edema, cardiogenic shock, and subsequent death.
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Affiliation(s)
- Shaul Atar
- Department of Cardiovascular Medicine, The Western Galilee Hospital in Nahariya, Nahariya; Faculty of Medicine of the Galilee, Bar Ilan University, Safed.
| | - Alice Wishniak
- Department of Cardiovascular Medicine, The Western Galilee Hospital in Nahariya, Nahariya
| | - Alexander Shturman
- Department of Cardiovascular Medicine, The Western Galilee Hospital in Nahariya, Nahariya; Faculty of Medicine of the Galilee, Bar Ilan University, Safed
| | - Sewaed Shtiwi
- Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Marc Brezins
- Department of Cardiovascular Medicine, The Western Galilee Hospital in Nahariya, Nahariya; Faculty of Medicine of the Galilee, Bar Ilan University, Safed
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Shturman A, Gellerman M, Atar S. Isolated right ventricular myocardial infarction from occlusion of a dominant right coronary artery mimicking anterior myocardial infarction. Isr Med Assoc J 2013; 15:252-253. [PMID: 23841249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Shturman A, Bickel A, Atar S. The predictive value of P-wave duration by signal-averaged electrocardiogram in acute ST elevation myocardial infarction. Isr Med Assoc J 2012; 14:493-497. [PMID: 22977969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The prognostic value of P-wave duration has been previously evaluated by signal-averaged ECG (SAECG) in patients with various arrhythmias not associated with acute myocardial infarction (AMI). OBJECTIVES To investigate the clinical correlates and prognostic value of P-wave duration in patients with ST elevation AMI (STEMI). METHODS The patients (n = 89) were evaluated on the first, second and third day after admission, as well as one week and one month post-AMI. Survival was determined 2 years after the index STEMI. RESULTS In comparison with the upper normal range of P-wave duration (<120 msec), the P-wave duration in STEMI patients was significantly increased on the first day (135.31 +/- 29.29 msec, P < 0.001), up to day 7 (127.17 +/- 30.02 msec, P = 0.0455). The most prominent differences were observed in patients with left ventricular ejection fraction (LVEF) < or = 40% (155.47 +/- 33.8 msec), compared to LVEF > 40% (128.79 +/- 28 msec) (P = 0.001). P-wave duration above 120 msec was significantly correlated with increased complication rate; namely, sustained ventricular tachyarrhythmia (36%), congestive heart failure (41%), atrial fibrillation (11%), recurrent angina (14%), and re-infarction (8%) (P = 0.012, odds ratio 4.267, 95% confidence interval 1.37-13.32). P-wave duration of 126 msec on the day of admission was found to have the highest predictive value for in-hospital complications including LVEF 40% (area under the curve 0.741, P < 0.001). However, we did not find a significant correlation between P-wave duration and mortality after multivariate analysis. CONCLUSIONS P-wave duration as evaluated by SAECG correlates negatively with LVEF post-STEMI, and P-wave duration above 126 msec can be utilized as a non-invasive predictor of in-hospital complications and low LVEF following STEMI.
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Bickel A, Shturman A, Grevtzev I, Roguin N, Eitan A. The physiological impact of intermittent sequential pneumatic compression (ISPC) leg sleeves on cardiac activity. Am J Surg 2011; 202:16-22. [PMID: 21440888 DOI: 10.1016/j.amjsurg.2010.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pneumatic sleeves are widely used in surgery to prevent venous stasis and to improve cardiac function. The aim of this study was to assess the underlying cardiovascular mechanism induced by the activation of intermittent sequential pneumatic compression (ISPC) in healthy volunteers. METHODS Twenty male subjects underwent transthoracic echocardiographic and tissue Doppler imaging evaluation before and during the activation ISPC devices. Each patient served as his own control. RESULTS Following ISPC activation, there were significant increases in cardiac output (from 5.1 to 5.5 L/min, P < .05) and stroke volume (from 72 to 78 mL, P < .002), as well as ejection fraction, the velocity-time integral of aortic flow, and fractional shortening of the left ventricle. There was no increase in heart rate. Tissue Doppler imaging was compatible with normal cardiac responses. Total peripheral resistance was significantly reduced during ISPC activation. CONCLUSIONS The activation of ISPC devices in normal volunteers augmented cardiac output because of increased preload as well as decreased afterload.
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Affiliation(s)
- Amitai Bickel
- Department of Surgery, Western Galilee Hospital, Nahariya, Israel.
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Shturman A, Chernihovski A, Goldfeld M, Furer A, Wishniak A, Roguin N. Usefulness of 64 multi-slice computed tomography in acute myopericarditis. Isr Med Assoc J 2007; 9:333-4. [PMID: 17491234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Shturman A, Singer-Jordan J, Krivilevich A, Roguin N. Usefulness of 64 multislice spiral computed tomography for preoperative assessment of severe coarctation of aorta in an adult. Isr Med Assoc J 2006; 8:713. [PMID: 17125122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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