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Zhang RS, Ro R, Bamira D, Vainrib A, Zhang L, Nayar AC, Saric M, Bernard S. Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction. Curr Cardiol Rep 2024:10.1007/s11886-024-02042-5. [PMID: 38526749 DOI: 10.1007/s11886-024-02042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
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Affiliation(s)
- Robert S Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Richard Ro
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Daniel Bamira
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Alan Vainrib
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Lily Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ambika C Nayar
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Muhamed Saric
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Samuel Bernard
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
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Zhang RS, Harari R, Kelly SM, Talmor N, Rhee AJ, Panhwar MS, Yee-Chang M, Nayar AC, Keller NM, Alviar CL, Bangalore S. Percutaneous Debulking of a Tricuspid Valve Papillary Fibroelastoma: A Rare Presentation and Management Approach. Circ Cardiovasc Imaging 2023; 16:e015970. [PMID: 38047386 DOI: 10.1161/circimaging.123.015970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Robert S Zhang
- Department of Medicine, Leon H. Charney Division of Cardiology (R.S.Z., R.H., N.T., M.S.P., A.C.N., N.M.K., C.L.A., S.B.), New York University Grossman School of Medicine
| | - Rafael Harari
- Department of Medicine, Leon H. Charney Division of Cardiology (R.S.Z., R.H., N.T., M.S.P., A.C.N., N.M.K., C.L.A., S.B.), New York University Grossman School of Medicine
| | - Sean M Kelly
- Department of Neurology (S.M.K.), New York University Grossman School of Medicine
| | - Nina Talmor
- Department of Medicine, Leon H. Charney Division of Cardiology (R.S.Z., R.H., N.T., M.S.P., A.C.N., N.M.K., C.L.A., S.B.), New York University Grossman School of Medicine
| | - Aaron J Rhee
- Department of Medicine (A.J.R.), New York University Grossman School of Medicine
| | - Muhammad S Panhwar
- Department of Medicine, Leon H. Charney Division of Cardiology (R.S.Z., R.H., N.T., M.S.P., A.C.N., N.M.K., C.L.A., S.B.), New York University Grossman School of Medicine
| | - Melissa Yee-Chang
- Department of Pathology (M.Y.-C.), New York University Grossman School of Medicine
| | - Ambika C Nayar
- Department of Medicine, Leon H. Charney Division of Cardiology (R.S.Z., R.H., N.T., M.S.P., A.C.N., N.M.K., C.L.A., S.B.), New York University Grossman School of Medicine
| | - Norma M Keller
- Department of Medicine, Leon H. Charney Division of Cardiology (R.S.Z., R.H., N.T., M.S.P., A.C.N., N.M.K., C.L.A., S.B.), New York University Grossman School of Medicine
| | - Carlos L Alviar
- Department of Medicine, Leon H. Charney Division of Cardiology (R.S.Z., R.H., N.T., M.S.P., A.C.N., N.M.K., C.L.A., S.B.), New York University Grossman School of Medicine
| | - Sripal Bangalore
- Department of Medicine, Leon H. Charney Division of Cardiology (R.S.Z., R.H., N.T., M.S.P., A.C.N., N.M.K., C.L.A., S.B.), New York University Grossman School of Medicine
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Siddiqui E, Alviar CL, Flattery E, Bernard S, Nayar AC, Keller N, Bangalore S. READMISSIONS AFTER SURGICAL VERSUS MEDICAL MANAGEMENT OF DRUG USE-ASSOCIATED INFECTIVE ENDOCARDITIS COMPLICATED BY SEPTIC PULMONARY EMBOLI. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Rhee DW, Nayar AC, Yan JL, Gausman V, Park DS, Vareedayah AA. Endoscopy-guided transesophageal echocardiography for large esophageal varices: Use of the "Double Barrel" technique. Echocardiography 2021; 38:1970-1972. [PMID: 34713478 DOI: 10.1111/echo.15227] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 01/23/2023] Open
Abstract
Rhythm control strategies in patients with esophageal varices and atrial arrhythmias pose a unique challenge. The left atrium should be imaged for a thrombus prior to attempting cardioversion or ablation, but the presence of varices is a relative contraindication for transesophageal echocardiography. We present a safe, novel technique of evaluating for left atrial thrombus with simultaneous transesophageal echocardiography and esophagogastroduodenoscopy using slim probes in a patient with large, high-risk esophageal varices, and symptomatic atrial flutter with rapid ventricular rates despite medical therapy.
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Affiliation(s)
- David W Rhee
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Ambika C Nayar
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Joe L Yan
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Valerie Gausman
- Division of Gastroenterology and Hepatology, New York University Langone Health, New York, New York, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Ashley A Vareedayah
- Division of Gastroenterology and Hepatology, New York University Langone Health, New York, New York, USA
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Vaughn J, Nayar AC, Srichai MB. Right coronary artery aneurysm with aneurysmal dilation and thrombosis of the sinoatrial nodal branch mimicking a right atrial mass. J Cardiovasc Comput Tomogr 2014; 8:85-7. [DOI: 10.1016/j.jcct.2013.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/12/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Ascunce RR, Nayar AC, Phoon CKL, Srichai MB. Cardiac magnetic resonance findings in a case of carnitine deficiency. Tex Heart Inst J 2013; 40:104-105. [PMID: 23468586 PMCID: PMC3568278] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Rebecca Rudominer Ascunce
- Departments of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York 10016, USA
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Ramanathan K, Harkness SM, Nayar AC, Cosmi JE, Sleeper LS, White HD, Davidoff R, Hochman JS. 887-2 Cardiogenic shock in patients with preserved left ventricular systolic function: Characteristics and insight into mechanisms. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91027-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reynolds HR, Nayar AC, McAleer EP, Schwartz JD, Tunick PA, Applebaum RM, Colvin SB, Culliford AT, Galloway AC, Grossi EA, Ribakove GH, Kronzon I. Substernal epicardial echocardiography: review of a new technique. J Am Soc Echocardiogr 2003; 16:1204-10. [PMID: 14608297 DOI: 10.1067/s0894-7317(03)00513-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients after cardiac operation pose a challenge to the treating physician-these patients may become critically ill and are among the most difficult to image using transthoracic echocardiography. Several factors contribute to this, including difficulties in positioning the patient, inability of the patient to cooperate with instructions, surgical dressings, and hyperinflated lungs. Transesophageal echocardiography may be performed when transthoracic echocardiography is not diagnostic; however, transesophageal echocardiography is semi-invasive and does not lend itself to prolonged or repeated monitoring. METHODS Recently, a new approach to echocardiography for use in the patient after operation has been introduced with the modification of the standard mediastinal drainage tube to allow for substernal epicardial echocardiography (SEE). The SEE tube has 2 lumens. The first allows for routine mediastinal drainage and the second has a blind end that permits the insertion of a standard transesophageal echocardiographic probe for high-resolution imaging as often as is desired over the period during which the mediastinal tube is in place. CONCLUSION This article reviews the technique of SEE including a description of the method of performance of SEE (with representative images), a review of the published literature on this new modality, examples of clinical use, and a discussion of the advantages, indications, and limitations of SEE with an eye toward future directions for research.
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Affiliation(s)
- Harmony R Reynolds
- Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
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Reynolds HR, Applebaum RM, Spevack DM, Shah A, McAleer EP, Nayar AC, Tunick PA, LaPietra A, Patel S, Bizekis CS, Wood MG, Grossi EA, Ribakove GH, Colvin SB, Kronzon I. Substernal epicardial echocardiography may be a critical diagnostic tool in the postoperative cardiac surgery patient. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Benenstein R, Nayar AC, Rosen R, Schlossberg P, Katz ES, Tunick PA, Kronzon I. Doppler diagnosis of acute occlusion of the superior vena cava. Echocardiography 2003; 20:97-8. [PMID: 12848706 DOI: 10.1046/j.1540-8175.2003.00015.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ricardo Benenstein
- Department of Medicine, New York University School of Medicine, New York, New York 10016, USA
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Tunick PA, Nayar AC, Goodkin GM, Mirchandani S, Francescone S, Rosenzweig BP, Freedberg RS, Katz ES, Applebaum RM, Kronzon I. Effect of treatment on the incidence of stroke and other emboli in 519 patients with severe thoracic aortic plaque. Am J Cardiol 2002; 90:1320-5. [PMID: 12480041 DOI: 10.1016/s0002-9149(02)02870-9] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Severe aortic plaques seen on transesophageal echocardiography (TEE) are a high-risk cause of stroke and peripheral embolization. Evidence to guide therapy is lacking. Retrospective information was obtained regarding the occurrence of embolic events (stroke, transient ischemic attacks, or peripheral emboli) in 519 patients with severe thoracic aortic plaque seen on TEE since 1988. Treatment with statins, warfarin, or antiplatelet medications was noted. Treatment was not randomized. In a matched-paired analysis, each patient taking each class of therapy was matched for age, gender, previous embolic event, hypertension, diabetes, congestive failure, and atrial fibrillation to someone not taking that medication. Multivariate analysis was also performed. An embolic event occurred in 111 patients (21%). Multivariate analysis showed that statin use was independently protective against recurrent events (p = 0.0001). Matched analysis also showed a protective effect of statins (p = 0.0004; absolute risk reduction 17%, relative risk reduction 59%, number needed to treat [n = 6]). No protective effect was found for warfarin or antiplatelet drugs. The odds ratio for embolic events was 0.3 (95% confidence interval [CI] 0.2 to 0.6) for statin therapy, 0.7 (95% CI 0.4 to 1.2) for warfarin, and 1.4 (95% CI 0.8 to 2.4) for antiplatelet agents. Thus, there is a protective effect of statin therapy, and no significant benefit of warfarin or antiplatelet drugs on the incidence of stroke and other embolic events in patients with severe thoracic aortic plaque on TEE.
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Affiliation(s)
- Paul A Tunick
- Noninvasive Cardiology Laboratory, Cardiology Division, Department of Medicine, New York University School of Medicine, New York, New York 10016, USA.
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Affiliation(s)
- Ambika C Nayar
- The Noninvasive Cardiology Laboratory, New York University School of Medicine, New York, NY 10016, USA
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Abstract
Pulsed wave, continuous wave, and color flow Doppler imaging as well as intravenously administered agitated saline solution can detect intracardiac shunts during transthoracic echocardiography. Ultrasonographic contrast agents have greatly improved the visualization of left heart chambers and can enhance signals from blood flow within chambers and across valves, increasing the sensitivity of Doppler techniques. We describe a patient in whom the use of echo contrast media during transthoracic echocardiography allowed the detection of a previously unseen atrial septal defect. Combining such modalities may help to increase the sensitivity of transthoracic echocardiography and may eliminate the need for transesophageal echocardiography in selected patients.
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Affiliation(s)
- B P Rosenzweig
- Non-Invasive Cardiology Laboratories, New York University Medical Center, New York, New York 10016, USA
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