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Bali AD, Malik A, Naidu SS. Treatment Strategies for Hypertrophic Cardiomyopathy: Alcohol Septal Ablation and Procedural Step-by-Step Technique. Am J Cardiol 2024; 212S:S42-S52. [PMID: 38368036 DOI: 10.1016/j.amjcard.2023.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 02/19/2024]
Abstract
Alcohol septal ablation (ASA) is a well-established procedure for septal reduction therapy in patients with obstructive hypertrophic cardiomyopathy, significant at rest or provocable outflow tract gradients, and medically refractory symptoms. This percutaneous approach to relief of obstruction and eventual cardiac remodeling involves the infusion of a small quantity of ethanol into an appropriately targeted septal artery that is feeding the basal septum to create an iatrogenic and controlled focal infarction. Early akinesia is followed by subsequent thinning and remodeling, which widens the outflow tract, reducing or eliminating the obstruction. Historically, the use of ASA was reserved primarily for high-risk surgical candidates; however, more contemporary data suggest similar outcomes in the short-term and long-term safety of the procedure and overall effectiveness in relieving obstructive symptoms when it is performed in broader populations at experienced centers. Therefore, the current guidelines published in 2020 support ASA as a class 1 indication, similar to its open-heart surgical counterpart, surgical myectomy, when no concomitant significant coronary or valve surgical indication exists. This article summarizes contemporary management of patients with hypertrophic cardiomyopathy who were selected for ASA and details procedural methods and outcomes.
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Affiliation(s)
- Atul D Bali
- Westchester Medical Center, New York Medical College, Valhalla, New York.
| | - Aaqib Malik
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Srihari S Naidu
- Westchester Medical Center, New York Medical College, Valhalla, New York
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Gregory V, Isath A, Bali AD, Al-Mufti F, Levine A, Kai M, Ohira S. Catheter thrombectomy for basilar artery stroke immediately after insertion of durable left ventricular assist device. Perfusion 2023:2676591231216793. [PMID: 37967279 DOI: 10.1177/02676591231216793] [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] [Indexed: 11/17/2023]
Abstract
Background: Acute ischemic stroke (AIS) following left ventricular assist device (LVAD) implantation is a serious complication associated with device morbidity. AIS development following LVAD placement typically presents between 6- and 24-months post implantation.Case/Results: We report a case of a 67-year-old male who initially presented with reduced ejection fraction and severe coronary vessel disease. Following coronary artery bypass graft surgery, the patient remained in a low output state necessitating placement of an LVAD device. Approximately 4.5 hours following LVAD implantation, a severe acute decrease in mental status revealed new development of ischemic stroke of the basilar artery, which was successfully treated in one pass with catheter endovascular thrombectomy.Conclusion: While embolic stroke management in these cases remains difficult as patients are usually anticoagulated, our case demonstrates the utilization of endovascular thrombectomy as a viable therapeutic option in the setting of an uncommon occurrence of embolic stroke in the hours following LVAD implantation.
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Affiliation(s)
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Atul D Bali
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Avi Levine
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Masashi Kai
- Beth Israel Deaconess Medical Center, Cardiac Surgery, Boston, MA, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
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Gregory V, Grunfeld M, Kanwal A, Bali AD, Pan S, Spielvogel D, Kai M, Ohira S. Escalation from impella 5.5 to ECPELLA support as a bridge to mitral valve surgery in a patient with degenerative mitral regurgitation. Perfusion 2023:2676591231186725. [PMID: 37354131 DOI: 10.1177/02676591231186725] [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] [Indexed: 06/26/2023]
Abstract
Severe mitral regurgitation (MR) is an important cause of acute heart failure and significant contributor to morbidity and mortality. Mechanical circulatory support (MCS) devices such as Impella are readily used to hemodynamically stabilize patients with cardiogenic shock (CS) secondary to this valvular pathology. Impella can also be combined with VA-ECMO to an "ECPELLA" configuration if further escalation of hemodynamic support is needed. We report a case of a 57-year-old female who presented with CS secondary to a perforated anterior mitral valve leaflet and non-ischemic cardiomyopathy that did not stabilize with initial choice of Impella 5.5. She required further escalation from axillary Impella 5.5 to the combined ECPELLA configuration, which allowed hemodynamic stabilization and ultimately a successful high-risk isolated mitral valve replacement. Despite adequate Impella flow, escalation to a combined MCS configuration, such as ECPELLA, may need to be considered upfront for acute valvular insufficiency in the setting of pre-existing cardiomyopathy.
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Affiliation(s)
| | - Matan Grunfeld
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Arjun Kanwal
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Atul D Bali
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Stephen Pan
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
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Kim JK, Bali AD, Smith SC, Ohira S, Cooper HA. Acute occlusion of the left main coronary ostium by an endocarditis vegetation. Echocardiography 2023; 40:447-451. [PMID: 37010977 DOI: 10.1111/echo.15557] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Affiliation(s)
- John K Kim
- Westchester Medical Center, Valhalla, New York, USA
| | - Atul D Bali
- Westchester Medical Center, Valhalla, New York, USA
| | | | - Suguru Ohira
- Westchester Medical Center, Valhalla, New York, USA
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Bahl S, Dheendsa A, Ramlal N, Hashim HD, Bali AD, Khalid N, Chhabra L. TRANS-RADIAL BAND COMPRESSION DEVICE RELATED COMPLICATIONS: FOOD AND DRUG ADMINISTRATION DATABASE ANALYSIS INVOLVING MANUFACTURER AND USER FACILITY DEVICE EXPERIENCE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01447-x] [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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Bali AD, Rosenzveig A, Frishman WH, Aronow WS. Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: Causation or Association. Cardiol Rev 2023; Publish Ahead of Print:e000537. [PMID: 36825899 DOI: 10.1097/crd.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a disease process that is gaining increasing recognition. The global prevalence of NAFLD is increasing in parallel with growing rates of risk factors for NAFLD such as hypertension, obesity, diabetes, and metabolic syndrome. NAFLD has been referred to as a risk factor for cardiovascular disease (CVD). As CVD is the leading cause of morbidity and mortality worldwide, there are constant efforts to describe and alleviate its risk factors. Although there is conflicting data supporting NAFLD as a causative or associative factor for CVD, NAFLD has been shown to be associated with structural, electrical, and atherosclerotic disease processes of the heart. Shared risk factors and pathophysiologic mechanisms between NAFLD and CVD warrant further explication. Pathologic mechanisms such as endothelial dysfunction, oxidative stress, insulin resistance, genetic underpinnings, and gut microbiota dysregulation have been described in both CVD and NAFLD. The mainstay of treatment for NAFLD is lifestyle intervention including physical exercise and hypocaloric intake in addition to bariatric surgery. Investigations into various therapeutic targets to alleviate hepatic steatosis and fibrosis by way of maintaining the balance between lipid synthesis and breakdown. A major obstacle preventing the success of many pharmacologic approaches has been the effects of these medications on CVD risk. The future of pharmacologic treatment of NAFLD is promising as effective medications with limited CVD harm are being investigated.
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Affiliation(s)
- Atul D Bali
- From the Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | | | - William H Frishman
- From the Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- From the Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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Patail H, Sharma T, Bali AD, Isath A, Aronow WS, Haidry SA. Dual antiplatelet therapy with concomitant anticoagulation: current perspectives on triple therapy. Arch Med Sci Atheroscler Dis 2023; 8:e13-e18. [PMID: 37153377 PMCID: PMC10161787 DOI: 10.5114/amsad/161172] [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: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 05/09/2023] Open
Abstract
Anticoagulation and antiplatelet therapy are individually mainstays of treatment for multiple cardiovascular conditions. Antiplatelet therapy, most commonly with dual agents, is vital in the setting of coronary artery disease with acute coronary syndrome requiring percutaneous coronary intervention to prevent in-stent complications. A multitude of cardiovascular conditions with increased thromboembolic risk also require anticoagulation, including atrial fibrillation, venous or arterial thrombosis, and prosthetic heart valves to name a few. There is often an overlap in comorbidities as our patient population ages and becomes more complex, frequently necessitating a combination of both anticoagulation and antiplatelet agents, known as "triple therapy". To reduce or treat thromboembolic disease states as well as reduce platelet aggregation for coronary stent protection, many patients are placed at an increased bleeding risk without compelling evidence of reduction in major adverse cardiac events. With this comprehensive review of the existing literature, we aim to analyse different strategies and durations of triple therapy medication regimens.
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Affiliation(s)
- Haris Patail
- Department of Internal Medicine, University of Connecticut School of Medicine, Storrs, United States
| | - Tanya Sharma
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, United States
| | - Atul D. Bali
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, United States
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, United States
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, United States
| | - Syed Abbas Haidry
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, United States
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Bali AD, Haidry S, Timmermans R, Kai M, Ohira S. Migration of Left Axillary Intra-Aortic Balloon Pump to the Right Common Carotid Artery. JACC Cardiovasc Interv 2021; 14:e199-e200. [PMID: 34274301 DOI: 10.1016/j.jcin.2021.05.017] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Atul D Bali
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA.
| | - Syed Haidry
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Robert Timmermans
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York, USA
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