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Chakraborty A, Beasley G, Martinez H, Jesudas R, Anton-Martin P, Christakopoulos G, Kramer J. Selumetinib for Refractory Pulmonary and Gastrointestinal Bleeding in Noonan Syndrome. Pediatrics 2022; 150:189468. [PMID: 36082608 DOI: 10.1542/peds.2022-056336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
A 15-year-old-boy with Noonan syndrome and status post orthoptic heart transplant developed mixed mitral valve disease and underwent mechanical mitral valve replacement 6 months before presentation with acute respiratory distress. He developed massive pulmonary hemorrhage that required veno-venous extracorporeal membrane oxygenation (ECMO) support. He had a prolonged anticoagulation free ECMO course of 4 weeks, with ongoing recurrent pulmonary hemorrhage and underwent several rounds of coil embolization of aortopulmonary collaterals. ECMO course was complicated by significant nasopharyngeal bleeding that required embolization of the sphenopalatine artery. Shortly after decannulation, he developed massive gastrointestinal and peritoneal hemorrhage that was treated by embolization of the left gastric artery and a branch of the internal iliac artery. His bleeding was attributed to neo-angiogenesis. Initial treatment with propranolol was unsuccessful. Subsequent treatment with interferon α 2b demonstrated efficacy, but severe neutropenia required cessation of therapy. Because functional alterations of the rat sarcoma virus-mitogen activated protein kinase signaling pathway and protein tyrosine phosphatase nonreceptor type (PTPN11) mutations in Noonan syndrome are known to be associated with neo-angiogenesis, we used the mitogen-activated protein kinase inhibitor selumetinib as a gene-targeted therapy with the hope of controlling bleeding and inhibiting neo-angiogenesis. After initiation of selumetinib, bleeding stopped and allowed the patient to be discharged from the hospital on dipyridamole as antiplatelet prophylaxis for his mechanical mitral valve. He had no further bleeding episodes through 1 year after hospital discharge.
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Affiliation(s)
- Abhishek Chakraborty
- Division of Pediatric Cardiology, University of Tennessee, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Gary Beasley
- Division of Pediatric Cardiology, University of Tennessee, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Hugo Martinez
- Division of Pediatric Cardiology, University of Tennessee, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Rohith Jesudas
- Department of Clinical Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Pilar Anton-Martin
- Division of Pediatric Cardiology, University of Tennessee, Le Bonheur Children's Hospital, Memphis, Tennessee
| | | | - Jennifer Kramer
- Division of Pediatric Cardiology, University of Tennessee, Le Bonheur Children's Hospital, Memphis, Tennessee
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Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, Alaswad K, Lombardi W, Grantham JA, Moses J, Christakopoulos G, Tarar MNJ, Rangan BV, Lembo N, Garcia S, Cipher D, Thompson CA, Banerjee S, Brilakis ES. Development and Validation of a Novel Scoring System for Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score. JACC Cardiovasc Interv 2016; 9:1-9. [PMID: 26762904 DOI: 10.1016/j.jcin.2015.09.022] [Citation(s) in RCA: 240] [Impact Index Per Article: 30.0] [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] [Received: 05/27/2015] [Revised: 08/10/2015] [Accepted: 09/10/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study sought to develop a novel parsimonious score for predicting technical success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) performed using the hybrid approach. BACKGROUND Predicting technical success of CTO PCI can facilitate clinical decision making and procedural planning. METHODS We analyzed clinical and angiographic parameters from 781 CTO PCIs included in PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) using a derivation and validation cohort (2:1 sampling ratio). Variables with strong association with technical success in multivariable analysis were assigned 1 point, and a 4-point score was developed from summing all points. The PROGRESS CTO score was subsequently compared with the J-CTO (Multicenter Chronic Total Occlusion Registry in Japan) score in the validation cohort. RESULTS Technical success was 92.9%. On multivariable analysis, factors associated with technical success included proximal cap ambiguity (beta coefficient [b] = 0.88), moderate/severe tortuosity (b = 1.18), circumflex artery CTO (b = 0.99), and absence of "interventional" collaterals (b = 0.88). The resulting score demonstrated good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow chi-square = 2.633; p = 0.268, and receiver-operator characteristic [ROC] area = 0.778) and validation (Hosmer-Lemeshow chi-square = 5.333; p = 0.070, and ROC area = 0.720) subset. In the validation cohort, the PROGRESS CTO and J-CTO scores performed similarly in predicting technical success (ROC area 0.720 vs. 0.746, area under the curve difference = 0.026, 95% confidence interval = -0.093 to 0.144). CONCLUSIONS The PROGRESS CTO score is a novel useful tool for estimating technical success in CTO PCI performed using the hybrid approach.
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Affiliation(s)
- Georgios Christopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Robert W Yeh
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Georgios Christakopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Muhammad Nauman J Tarar
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bavana V Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Daisha Cipher
- College of Health Innovation, University of Texas at Arlington, Arlington, Texas
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
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Patel K, Christakopoulos G, Karatasakis A, Danek BA, Nguyen-Trong PK, Amsavelu S, Stetler J, Rangan B, Roesle M, Abdullah S, Addo T, Banerjee S, Brilakis E. PROSPECTIVE EVALUATION OF THE IMPACT OF SIDE-HOLES AND GUIDE CATHETER DISENGAGEMENT FROM THE CORONARY OSTIUM ON FRACTIONAL FLOW RESERVE MEASUREMENTS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30232-7] [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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Christakopoulos G, Christopoulos G, Karmpaliotis D, Alaswad K, Yeh R, Jaffer F, Wyman RM, Lombardi W, Tarar MN, Grantham A, Kandzari D, Lembo N, Moses J, Kirtane A, Parikh M, Green P, Finn M, Garcia S, Doing A, Thompson CA, Banerjee S, Brilakis E. FACTORS ASSOCIATED WITH HIGH PATIENT RADIATION DOSE DURING CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM A CONTEMPORARY MULTICENTER REGISTRY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30143-7] [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: 10/22/2022]
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Christopoulos G, Makke L, Christakopoulos G, Kotsia A, Rangan BV, Roesle M, Haagen D, Kumbhani DJ, Chambers CE, Kapadia S, Mahmud E, Banerjee S, Brilakis ES. Optimizing Radiation Safety in the Cardiac Catheterization Laboratory. Catheter Cardiovasc Interv 2015; 87:291-301. [DOI: 10.1002/ccd.25959] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Georgios Christopoulos
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Lorenza Makke
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Georgios Christakopoulos
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Anna Kotsia
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Michele Roesle
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Donald Haagen
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Dharam J. Kumbhani
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic; Cleveland Ohio
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine; Sulpizio Cardiovascular Center, University of California; San Diego California
| | - Subhash Banerjee
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
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Christakopoulos G, Christopoulos G, Carlino M, Jeroudi O, Roesle M, Rangan B, Abdullah S, Grodin J, Kumbhani D, Vo M, Luna M, Alaswad K, Karmpaliotis D, Rinfret S, Garcia S, Banerjee S, Brilakis E. CLINICAL OUTCOMES OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY CHRONIC TOTAL OCCLUSION INTERVENTIONS: A WEIGHTED META-ANALYSIS OF 28,486 PATIENTS FROM 25 STUDIES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61691-6] [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: 10/23/2022]
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Christopoulos G, Wyman RM, Alaswad K, Karmpaliotis D, Lombardi W, Grantham JA, Yeh R, Jaffer F, Rangan B, Christakopoulos G, Kypreos MA, Lembo N, Kandzari D, Garcia S, Thompson CA, Banerjee S, Brilakis E. CLINICAL UTILITY OF THE J-CTO SCORE IN CORONARY CHRONIC TOTAL OCCLUSION INTERVENTIONS: RESULTS FROM A MULTICENTER REGISTRY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61807-1] [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: 10/23/2022]
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