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Masson R, Vuyisile NT, Holmes DR, Pislaru SV, Arsanjani R, Chao CJ, Klanderman M, Abraham B, Morsy M, Fortuin FD, Sweeney JP, Sell-Dotten K, Alsidawi S. Disproportionately High Aortic Valve Calcium Scores in Atrial Fibrillation: Implications for Transcatheter Aortic Valve Replacement. Eur Heart J Cardiovasc Imaging 2024:jeae113. [PMID: 38669204 DOI: 10.1093/ehjci/jeae113] [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] [Received: 01/30/2024] [Revised: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
AIMS Doppler mean gradient (MG) can underestimate aortic stenosis (AS) severity in patients with atrial fibrillation (AF) compared to patients in sinus rhythm (SR), potentially delaying intervention in AF. This study compared outcomes in patients with AF and SR following transcatheter aortic valve replacement (TAVR) and investigated delay in TAVR based on computed tomography aortic valve calcium score (AVCS). METHODS AND RESULTS Patients who underwent TAVR from 2013 to 2017 for native valve severe AS were identified from an institutional database. Baseline characteristics and overall survival were compared between those in SR and AF. There were 820 patients (mean age 81 years; 41.6% female) included. AF was present in 356 patients. Patients in AF were older (82.2 vs. 80.5, p = 0.003), had lower MG compared to SR patients (42.0 vs. 44.9, p = 0.002) with similar indexed aortic valve area (0.4 vs. 0.4, p = 0.17). Median AVCS was higher in AF (males: AF 2850.0 vs. SR 2561.0, p = 0.044; females: AF 1942.0 vs. SR 1610.5, p = 0.025). Projected AVCS assuming same age of diagnosis was similar between AF and SR. Median survival post-TAVR was worse in AF compared to SR (3.2 vs 5.4 years, log rank p < 0.001). AF, lower MG, higher RVSP, dialysis, diabetes, and significant TR were associated with higher mortality (p < 0.05 for all). CONCLUSION Older age and higher AVCS in patients with AF compared to SR suggests that AS was both underestimated and more advanced at TAVR referral.
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Affiliation(s)
- Rajeev Masson
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Nkomo T Vuyisile
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Molly Klanderman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mahmoud Morsy
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - F David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Kristen Sell-Dotten
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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2
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Tan MC, Yeo YH, San BJ, Suleiman A, Lee JZ, Chatterjee A, Sell-Dottin KA, Sweeney JP, Fortuin FD, Lee KS. Trends and Disparities in Valvular Heart Disease Mortality in the United States From 1999 to 2020. J Am Heart Assoc 2024; 13:e030895. [PMID: 38587138 DOI: 10.1161/jaha.123.030895] [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: 05/06/2023] [Accepted: 10/19/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND Percutaneous heart valve procedures have been increasingly performed over the past decade, yet real-world mortality data on valvular heart disease (VHD) in the United States remain limited. METHODS AND RESULTS We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients ≥15 years old from 1999 to 2020. VHD and its subtypes were listed as the underlying cause of death. We calculated age-adjusted mortality rate (AAMR) per 100 000 individuals and determined overall trends by estimating the average annual percent change using the Joinpoint regression program. Subgroup analyses were performed based on demographic and geographic factors. In the 22-year study, there were 446 096 VHD deaths, accounting for 0.80% of all-cause mortality (56 014 102 people) and 2.38% of the total cardiovascular mortality (18 759 451 people). Aortic stenosis recorded the highest mortality of VHD-related death in both male (109 529, 61.74%) and female (166 930, 62.13%) populations. The AAMR of VHD has declined from 8.4 (95% CI, 8.2-8.5) to 6.6 (95% CI, 6.5-6.7) per 100 000 population. Similar decreasing AAMR trends were also seen for the VHD subtypes. Men recorded higher AAMR for aortic stenosis and aortic regurgitation, whereas women had higher AAMR for mitral stenosis and mitral regurgitation. Mitral regurgitation had the highest change in average annual percent change in AAMR. CONCLUSIONS The mortality rate of VHD among the US population has declined over the past 2 decades. This highlights the likely efficacy of increasing surveillance and advancement in the management of VHD, resulting in improved outcomes.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
- Department of Internal Medicine New York Medical College at Saint Michael's Medical Center Newark NJ USA
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics Beaumont Health Royal Oak MI USA
| | | | - Addi Suleiman
- Department of Cardiovascular Medicine New York Medical College at Saint Michael's Medical Center Newark NJ USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH USA
| | - Arka Chatterjee
- Department of Cardiovascular Medicine University of Arizona Sarver Heart Center/Banner University Medical Center Tucson AZ USA
| | | | - John P Sweeney
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
| | - F David Fortuin
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
| | - Kwan S Lee
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USA
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Baqal O, Habib EA, Hasabo EA, Galasso F, Barry T, Arsanjani R, Sweeney JP, Noseworthy P, David Fortuin F. Artificial intelligence-enabled electrocardiogram (AI-ECG) does not predict atrial fibrillation following patent foramen ovale closure. Int J Cardiol Heart Vasc 2024; 51:101361. [PMID: 38379633 PMCID: PMC10877678 DOI: 10.1016/j.ijcha.2024.101361] [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: 01/07/2024] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024]
Abstract
Background Atrial fibrillation (AF) is a known complication following patent foramen ovale (PFO) closure. AI-enabled ECG (AI-ECG) acquired during normal sinus rhythm has been shown to identify individuals with AF by noting high-risk ECG features invisible to the human eye. We sought to characterize the value of AI-ECG in predicting AF development following PFO closure and investigate key clinical and procedural characteristics possibly associated with post-procedural AF. Methods We performed a retrospective analysis of patients who underwent PFO closure at our hospital from January 2011 to December 2022. We recorded the probability (%) of AF using the Mayo Clinic AI-ECG dashboard from pre- and post-procedure ECGs. The cut-off point of ≥ 11 %, which was found to optimally balance sensitivity and specificity in the original derivation paper (the Youden index) was used to label an AI-ECG "positive" for AF. Pre-procedural transesophageal echocardiography (TEE) and pre- and post-procedure transcranial doppler (TCD) data was also recorded. Results Out of 93 patients, 49 (53 %) were male, mean age was 55 ± 15 years with mean post-procedure follow up of 29 ± 3 months. Indication for PFO closure in 69 (74 %) patients was for secondary prevention of transient ischemic attack (TIA) and/or stroke. Twenty patients (22 %) developed paroxysmal AF post-procedure, with the majority within the first month post-procedure (15 patients, 75 %). Patients who developed AF were not significantly more likely to have a positive post-procedure AI-ECG than those who did not develop AF (30 % AF vs 27 % no AF, p = 0.8).Based on the PFO-Associated Stroke Causal Likelihood (PASCAL) classification, patients who had PFO closure for secondary prevention of TIA and/or stroke in the "possible" group were significantly more likely to develop AF than patients in "probable" and "unlikely" groups (p = 0.034). AF-developing patients were more likely to have post-procedure implantable loop recorder (ILR) (55 % vs 9.6 %, p < 0.001), and longer duration of ILR monitoring (121 vs 92.5 weeks, p = 0.035). There were no significant differences in TCD and TEE characteristics, device type, or device size between those who developed AF vs those who did not. Conclusions In this small, retrospective study, AI-ECG did not accurately distinguish patients who developed AF post-PFO closure from those who did not. Although AI-ECG has emerged as a valuable tool for risk prediction of AF, extrapolation of its performance to procedural settings such as PFO closure requires further investigation.
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Affiliation(s)
- Omar Baqal
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Eiad A. Habib
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Elfatih A. Hasabo
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
| | - Francesca Galasso
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - John P. Sweeney
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Peter Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - F. David Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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4
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Farina JM, Chao CJ, Pereyra M, Roarke M, Said EF, Barry T, Alsidawi S, Sell-Dottin K, Sweeney JP, Fortuin DF, Ayoub C, Lester SJ, Oh JK, Arsanjani R, Marcotte F. Role of lipoprotein(a) concentrations in bioprosthetic aortic valve degeneration. Heart 2024; 110:299-305. [PMID: 37643771 DOI: 10.1136/heartjnl-2023-322987] [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: 05/18/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Lipoprotein(a) (Lp(a)) is associated with an increased incidence of native aortic stenosis, which shares similar pathological mechanisms with bioprosthetic aortic valve (bAV) degeneration. However, evidence regarding the role of Lp(a) concentrations in bAV degeneration is lacking. This study aims to evaluate the association between Lp(a) concentrations and bAV degeneration. METHODS In this retrospective multicentre study, patients who underwent a bAV replacement between 1 January 2010 and 31 December 2020 and had a Lp(a) measurement were included. Echocardiography follow-up was performed to determine the presence of bioprosthetic valve degeneration, which was defined as an increase >10 mm Hg in mean gradient from baseline with concomitant decrease in effective orifice area and Doppler Velocity Index, or new moderate/severe prosthetic regurgitation. Levels of Lp(a) were compared between patients with and without degeneration and Cox regression analysis was performed to investigate the association between Lp(a) levels and bioprosthetic valve degeneration. RESULTS In total, 210 cases were included (mean age 74.1±9.4 years, 72.4% males). Median time between baseline and follow-up echocardiography was 4.4 (IQR 3.7) years. Bioprostheses degeneration was observed in 33 (15.7%) patients at follow-up. Median serum levels of Lp(a) were significantly higher in patients affected by degeneration versus non-affected cases: 50.0 (IQR 72.0) vs 15.6 (IQR 48.6) mg/dL, p=0.002. In the regression analysis, high Lp(a) levels (≥30 mg/dL) were associated with degeneration both in a univariable analysis (HR 3.6, 95% CI 1.7 to 7.6, p=0.001) and multivariable analysis adjusted by other risk factors for bioprostheses degeneration (HR 4.4, 95% CI 1.9 to 10.4, p=0.001). CONCLUSIONS High serum Lp(a) is associated with bAV degeneration. Prospective studies are needed to confirm these findings and to investigate whether lowering Lp(a) levels could slow bioprostheses degradation.
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Affiliation(s)
- Juan M Farina
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Michael Roarke
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ebram F Said
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Said Alsidawi
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Kristen Sell-Dottin
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - David F Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Steven J Lester
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Francois Marcotte
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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5
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Chao CJ, Agasthi P, Seri AR, Barry T, Shanbhag A, Wang Y, Eleid MF, Fortuin D, Sweeney JP, Pollak P, El Sabbagh A, Lester SJ, Freeman WK, Naqvi TZ, Holmes DR, Appleton CP, Arsanjani R. Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure. J Cardiovasc Dev Dis 2023; 10:jcdd10050192. [PMID: 37233159 DOI: 10.3390/jcdd10050192] [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] [Received: 03/29/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients. METHODS Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data. AugSBP, AugMAP and valvulo-arterial impedance (Zva) (Zva) were evaluated using Cox regression. Receiver operating characteristic curve analysis and the c-index were used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score. RESULTS The final cohort contained 974 patients with a mean age of 81.4 ± 8.3 years old, and 56.6% were male. The mean STS risk score was 8.2 ± 5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that AugSBP and AugMAP parameters were independent predictors for intermediate-term post-TAVR mortality (all p < 0.0001). AugMAP1 < 102.5 mmHg was associated with a 3-fold-increased risk of all-cause mortality 1-year post-TAVR (hazard ratio 3.0, 95%confidence interval 2.0-4.5, p < 0.0001). A univariate model of AugMAP1 surpassed the STS score model in predicting intermediate-term post-TAVR mortality (area under the curve: 0.700 vs. 0.587, p = 0.005; c-index: 0.681 vs. 0.585, p = 0.001). CONCLUSIONS Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Amith R Seri
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Yuxiang Wang
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - William K Freeman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
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6
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Chao CJ, Seri A, Abraham B, Farina JM, Fennelly E, Campany M, Pereyra M, Said EF, Kenyon C, Fath AR, Smith S, Buckner-Petty S, Rayfield CA, Fortuin D, Sweeney JP, Yang EH, Ayoub C, Eleid MF, Alkhouli M, Rihal CS, Holmes DR, Pollak PM, El Sabbagh A, Oh JK, Arsanjani R. Impact of Persistent Iatrogenic Atrial Septal Defect following MitraClip. J Cardiovasc Dev Dis 2022; 10:jcdd10010001. [PMID: 36661896 PMCID: PMC9864604 DOI: 10.3390/jcdd10010001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Prior studies have reported conflicting results of persistent iatrogenic atrial septal defect (iASD) and its impact following a transcatheter edge-to-edge repair (TEER) procedure. This study aims to evaluate the incidence of iASD and its clinical and hemodynamic impact after a TEER. METHODS Consecutive patients who underwent a TEER procedure from June 2014 to September 2020 at the Mayo Clinic were identified. The presence of iASD was retrospectively identified on post-procedure transthoracic echocardiography (TTE) to group patients into an iASD+ group and an iASD- group for comparison of prognosis and cardiac function. RESULTS A total of 316 patients were included; the mean age was 79.1 ± 9.1 years, and 67.7% were male. Persistent iASD was diagnosed in 108 (34.2%) patients. There was no difference concerning all-cause mortality, heart failure hospitalization, and stroke/TIA between groups at follow-up (median follow-up of 9 months). Post-procedure TTE demonstrated no differences regarding right ventricle (RV) and left ventricle (LV) dimensions and function, including TAPSE (15.2 ± 4.6 vs. 15.4 ± 5.5 mm, p = 0.875), and LV ejection fraction (51.1 ± 14.0% vs. 51.3 ± 13.9%, p = 0.933). However, patients with iASD had higher RV systolic pressure (48.7 ± 14.4 vs. 45.5 ± 14.5 mmHg, p = 0.042) compared with patients without iASD. CONCLUSION Notwithstanding higher RV pressures, patients with persistent iASD had no hemodynamic compromise and an equal prognosis compared with those without a residual atrial defect after a TEER procedure. These findings support the mid-term safety of procedures in which an interatrial defect needs to be created and would argue against the need for interventional closure.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Amith Seri
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Juan M Farina
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Evelyn Fennelly
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Megan Campany
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Milagros Pereyra
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Ebram F Said
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Courtney Kenyon
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Ayman R Fath
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Sean Smith
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Skye Buckner-Petty
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Corbin A Rayfield
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Eric H Yang
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Peter M Pollak
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
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7
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Chao C, Seri A, Fortuin FD, Sweeney JP, Thaden JJ, Eleid M, Alkhouli M, Rihal CR, Holmes DR, Pollak PM, Elsabbagh A, Lester SJ, Oh JK, Banerjee I, Arsanjani R. Topological data analysis identified prognostically-distinct phenotypes in MitraClip patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1578] [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: 11/13/2022] Open
Abstract
Abstract
Background
Topological data analysis (TDA) is the state-of-the-art unsupervised machine learning framework that can provide insight into the dataset and visualize condensed information via the topological network graph. This robust approach was never used to assess the heterogeneous MitraClip population.
Purpose
We aim to develop a TDA model that will identify prognostically-distinct phenogroups in MitraClip patients without a priori knowledge of the population and their outcomes.
Method
Patients who underwent MitraClip (June 2014-September 2020) at Mayo Clinic sites were identified from the institutional database for baseline and follow-up data. Thirteen variables were used for TDA. The topological network graph was created using the Python Scikit-TDA Kepler-Mapper package (v. 2.0.1), and clustering was performed at the graph level with Louvain's modularity method. Kaplan-Meier survival analysis was used to assess the all-cause mortality endpoint of each cluster identified in an unsupervised manner. The dataset with cluster labels was also used to train a Light Gradient Boosted Machine model, and SHapley Additive exPlanations (SHAP) analysis was applied to determine the feature importance.
Results
A total of 389 consecutive patients were included in the final analysis and two major clusters consisting of 384 patients were identified. The mean age was 80.3±8.7 years; 256 (65.8%) were male. The mean Society of Thoracic Surgeons Mitral Valve Replacement risk score was 9.6±6.9%. Fifty-five (14.5%) patients died during the mean follow duration (185 days). Kaplan-Meier analysis showed significant survival differences among the two clusters (HR: 2.38; 95% CI: 1.39–4.06, p=0.001; Figure 1). Clusters 1 (n=195) was associated with > mild residual mitral regurgitation and worse survival performance and was characterized with worse tricuspid regurgitation severity, a higher proportion of patients with atrial fibrillation/flutter, anterior leaflet prolapse, and mitral annular/leaflet calcification, as summarized in Table 1.
Conclusion
TDA can identify distinct phenotype clusters with prognostic significance in MitraClip patients based on mitral valve morphology and clinical risk factors. This simple model can facilitate clinical risk stratification for MitraClip patients regarding procedural success and survival performance.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Chao
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - A Seri
- Mayo Clinic Arizona , Scottsdale , United States of America
| | - F D Fortuin
- Mayo Clinic Arizona , Scottsdale , United States of America
| | - J P Sweeney
- Mayo Clinic Arizona , Scottsdale , United States of America
| | - J J Thaden
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - M Eleid
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - M Alkhouli
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - C R Rihal
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - D R Holmes
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - P M Pollak
- Mayo Clinic , Jacksonville , United States of America
| | - A Elsabbagh
- Mayo Clinic , Jacksonville , United States of America
| | - S J Lester
- Mayo Clinic Arizona , Scottsdale , United States of America
| | - J K Oh
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - I Banerjee
- Mayo Clinic Arizona , Scottsdale , United States of America
| | - R Arsanjani
- Mayo Clinic Arizona , Scottsdale , United States of America
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8
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Ashraf H, Fortuin FD, Sweeney JP, Rosenthal JL, Arsanjani R. Percutaneous mitral valve repair with MitraClip as an effective bridge to transplant. Eur Heart J Cardiovasc Imaging 2021; 22:e13. [PMID: 32810199 DOI: 10.1093/ehjci/jeaa213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hasan Ashraf
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - F David Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - John P Sweeney
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Julie L Rosenthal
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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9
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Abstract
Abstract
A high pressure liquid chromatographic method has been developed for separation of provitamin A carotene stereoisomers in vegetables. A column designed to withstand high pressures is packed tightly with a mixture of calcium and magnesium hydroxides. An elution mixture of 1.5%p-methylanisole in petroleum ether is forced through by nitrogen pressure. Resolution of as many as 7 isomers is obtained in less than 1 hr. The principal stereoisomer of all-trans-β-carotene in green vegetables was found to be neo-β-carotene U. In red and yellow vegetables, it was neo-β- carotene B.
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Affiliation(s)
- J P Sweeney
- Human Nutrition Research Division, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Md. 20705
| | - A C Marsh
- Human Nutrition Research Division, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Md. 20705
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10
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Katayama M, Panse PM, Kendall CB, Daniels JR, Cha SS, Fortuin FD, Sweeney JP, DeValeria PA, Lanza LA, Belohlavek M, Chaliki HP. Left Ventricular Septal Hypertrophy in Elderly Patients With Aortic Stenosis. J Ultrasound Med 2018; 37:217-224. [PMID: 28741721 DOI: 10.1002/jum.14320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Left ventricular (LV) septal hypertrophy in aortic stenosis raises diagnostic and therapeutic questions. However, the etiology and clinical consequences of this finding have not been well studied. The aim of this study was to perform a morphologic evaluation of the LV in aortic stenosis and to investigate the contributing factors and consequences of septal hypertrophy. METHODS Patients with moderate or severe aortic stenosis were prospectively enrolled. Patients with previous myocardial infarction, wall motion abnormalities, at least moderate valvular regurgitation, known cardiomyopathy, an LV ejection fraction of less than 50%, and age younger than 65 years were excluded. RESULTS Forty-one patients underwent a final analysis. Septal hypertrophy (LV septal wall thickness ≥15 mm) was confirmed in 21 of 41 patients. The septal hypertrophy group had higher peak aortic valve velocity, a higher diabetes mellitus rate, and a higher rate and longer duration of hypertension than those without septal hypertrophy. The peak aortic valve velocity (odds ratio, 7.1; 95% confidence interval, 1.4-37.1) and diabetes mellitus (odds ratio, 7.4; 95% confidence interval, 1.2-46.2) were the significant factors associated with septal hypertrophy by multivariate analysis. Intraventricular conduction disturbance on electrocardiography was more frequent in the septal hypertrophy group (P = .021). CONCLUSIONS Left ventricular septal hypertrophy was commonly observed in elderly patients with aortic stenosis, and a higher aortic valve velocity, hypertension, and diabetes mellitus were associated factors. Intraventricular conduction disturbance occurred more often in patients with septal hypertrophy than those without, which implies the pathophysiologic consequence. Further studies are needed to determine the impact of septal hypertrophy and intraventricular conduction disturbance on the prognosis of patients after aortic valve interventions.
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Affiliation(s)
- Minako Katayama
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Prasad M Panse
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Christopher B Kendall
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
- Department of Radiology, Mayo Clinic, Scottsdale, Arizona, USA
| | - John R Daniels
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
- Department of Radiology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Stephen S Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - F David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Patrick A DeValeria
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Louis A Lanza
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Marek Belohlavek
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Hari P Chaliki
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
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11
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Seamans DP, Louka BF, Fortuin FD, Patel BM, Sweeney JP, Lanza LA, DeValeria PA, Ezrre KM, Ramakrishna H. The utility of live video capture to enhance debriefing following transcatheter aortic valve replacement. Ann Card Anaesth 2017; 19:S6-S11. [PMID: 27762242 PMCID: PMC5100244 DOI: 10.4103/0971-9784.192576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The surgical and procedural specialties are continually evolving their methods to include more complex and technically difficult cases. These cases can be longer and incorporate multiple teams in a different model of operating room synergy. Patients are frequently older, with comorbidities adding to the complexity of these cases. Recording of this environment has become more feasible recently with advancement in video and audio capture systems often used in the simulation realm. Aims: We began using live capture to record a new procedure shortly after starting these cases in our institution. This has provided continued assessment and evaluation of live procedures. The goal of this was to improve human factors and situational challenges by review and debriefing. Setting and Design: B-Line Medical's LiveCapture video system was used to record successive transcatheter aortic valve replacement (TAVR) procedures in our cardiac catheterization/laboratory. An illustrative case is used to discuss analysis and debriefing of the case using this system. Results and Conclusions: An illustrative case is presented that resulted in long-term changes to our approach of these cases. The video capture documented rare events during one of our TAVR procedures. Analysis and debriefing led to definitive changes in our practice. While there are hurdles to the use of this technology in every institution, the role for the ongoing use of video capture, analysis, and debriefing may play an important role in the future of patient safety and human factors analysis in the operating environment.
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Affiliation(s)
- David P Seamans
- Department of Anesthesiology, Mayo Clinic Arizona, AZ 85054, USA
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - F David Fortuin
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - Bhavesh M Patel
- Department of Critical Care, Mayo Clinic Arizona, AZ 85054, USA
| | - John P Sweeney
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - Louis A Lanza
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, AZ 85054, USA
| | - Patrick A DeValeria
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, AZ 85054, USA
| | - Kim M Ezrre
- Department of Catheterization Laboratory, Mayo Clinic Arizona, AZ 85054, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Arizona, AZ 85054, USA
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12
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Kransdorf EP, Kransdorf LN, Fortuin FD, Sweeney JP, Wilansky S. Stepwise Progression of Right-to-Left Atrial Shunting through a Combination of Patent Foramen Ovale and Tricuspid Regurgitation. Tex Heart Inst J 2016; 43:171-4. [PMID: 27127438 DOI: 10.14503/thij-14-4913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patent foramen ovale is a common clinical finding that generally becomes a concern in the presence of transient ischemic attack or stroke. Rarely, patent foramen ovale is associated with hypoxemia in the presence of substantial right-to-left atrial shunting. We present the case of an 86-year-old woman with a pacemaker, who was initially asymptomatic notwithstanding a patent foramen ovale. Over 1.5 years, her symptoms progressed in a stepwise fashion, in the setting of progressive pacemaker-associated tricuspid regurgitation. Ultimately, the patient's symptoms and her hypoxemia resolved after percutaneous closure of her patent foramen ovale with use of a 25-mm "Cribriform" occluder device. This case highlights the fact that clinically significant right-to-left shunting requires an anatomic lesion, such as patent foramen ovale, together with elevated right atrial pressure, which in this case was contributed by severe tricuspid regurgitation.
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13
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Ramakrishna H, DeValeria PA, Sweeney JP, Mookaram F. Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses. Ann Card Anaesth 2016; 18:246-51. [PMID: 25849702 PMCID: PMC4881642 DOI: 10.4103/0971-9784.154493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves.
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Affiliation(s)
- Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, 5777 East Mayo Blvd., Phoenix, Arizona, 85054, USA
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14
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Abstract
Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence.
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Affiliation(s)
- Fayaz A Hakim
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Evan P Kransdorf
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Muaz M Abudiab
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
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15
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O'Reilly A, O'Keeffe M, Aherne P, Mayer NJ, Sweeney JP, Power DG. Treatment of metastatic penile cancer in the adjuvant setting with ifosfamide, paclitaxel, and cisplatin: A single institution experience. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
340 Background: Surgery alone rarely results in long-term disease-free control in patients with N2 or N3 (stage III or IV) metastatic penile cancer. Five-year overall survival rarely exceeds 40% in this group of patients. Ifosfamide, paclitaxel, and cisplatin chemotherapy (ITP) has been reported in the neoadjuvant setting in a phase II trial. The evidence supporting adjuvant chemotherapy after inguinal lymph node dissection (LND) is poor. We report our experience of ITP chemotherapy given in the adjuvant setting after bilateral inguinal LND for stage III and IV penile cancer Methods: In our regional cancer center we performed a retrospective analysis of a prospectively maintained database of all patients between May 2008 and February 2012 who received adjuvant chemotherapy for regional metastatic penile cancer. Results: Four patients received chemotherapy in the adjuvant setting. One patient completed 4 cycles of cisplatin and 5-Fluorouracil after bilateral inguinal LND (pT1N2). There is no evidence of disease recurrence at 20 months post completion of chemotherapy. Three patients received adjuvant chemotherapy with paclitaxel 175 mg/m2 on day 1; ifosfamide 1,200 mg/m2 on days 1-3; and cisplatin 20 mg/m2on days 1-3 (ITP). All pts received 4 X 3 weekly cycles with no significant toxicity. The first two patients underwent inguinal LND for pT3N2 (stage IIIB) disease followed by 4 cycles of ITP. In both patients surveillance imaging showed no evidence of disease recurrence 28 and 50 months, respectively, post completion of chemotherapy. The third patient underwent inguinal LND for pT1bN3 (stage IV) disease followed by 4 cycles of ITP. Surveillance imaging at 6 months post completion of chemotherapy showed no evidence of local or distant recurrence. Conclusions: Multimodality treatment of regional metastatic penile cancer offers the best chance of long-term disease-free and overall survival. The ITP regimen is relatively nontoxic and well-tolerated. We propose that this regimen should be further investigated in the adjuvant or peri-operative settings.
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Affiliation(s)
| | - Margaret O'Keeffe
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | | | - Nicholas J. Mayer
- Department of Histopathology, Mercy University Hospital, Cork, Ireland
| | - John P. Sweeney
- Department of Urology, Mercy University Hospital, Cork, Ireland
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16
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Power DG, Battley JE, McCarthy A, Brady C, Sweeney JP, Fleming S, Mayer NJ, Bambury RM. Translocation renal cell carcinomas: An evolving entity. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15078] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15078 Background: Translocation renal cell carcinomas (tRCCs) are a novel, rare and distinct clinicopathological entity. The term refers to RCCs with overexpression of transcription factor E3 (TFE3) due to translocation involving the Xp11 locus or less commonly with overexpression of transcription factor EB (TFEB) due to a t(6:11) translocation. In children it is estimated that these tumours account for 40% of RCCs but in adults this proportion is estimated to be 1-4%. These neoplasms are only recently recognised and outcome data are premature. We report 2 cases of tRCC in an Irish regional cancer centre and describe clinicopathological characteristics and early outcome. Methods: : Approximately 70 new cases of RCC are referred to our centre annually. Recently, 2 renal cell carcinomas were suspected to be tRCCs on morphology and immunohistochemical(IHC) features (RCC+/CK7-/EMA-). Using IHC we tested for expression of TFE3 and TFEB. Results: : Both tumours were tRCCs. The first case was a 74 year old lady who presented with right upper quadrant pain and had a 9cm right renal mass with no metastatic disease on CT imaging. Radical nephrectomy was performed and histology revealed a pT3aN2, Fuhrman grade 4 RCC with mixed clear cell and papillary architecture. IHC for TFE3 showed focal nuclear positivity consistent with an Xp11 translocation RCC. She relapsed 9 months later with local recurrence, retroperitoneal adenopathy and lung metastases. She commenced sunitinib and response assessment is pending. The 2nd case was a 46 year old man with an incidental finding of a right renal mass on ultrasound abdomen. Staging CT revealed no metastatic disease and he underwent laparoscopic nephrectomy. Histology revealed a pT1aNx, Fuhrman grade 3 renal cell carcinoma with predominantly alveolar architecture and focal papillary and microcystic areas. IHC for TFEB was positive consistent with a t6:11 translocation RCC. He remains disease free 9 months post surgery. Conclusions: We report 2 new cases of this rare subset of RCC. The therapeutic implications for patients with these mutations are as yet unclear. We plan to update with ongoing follow-up and will also report 3 further cases suspected to be tRCCs based on morphology and IHC. Confirmatory TFE3/TFEB IHC is awaited.
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Affiliation(s)
- Derek Gerard Power
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - Jodie E Battley
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - Aoife McCarthy
- Department of Histopathology, Mercy University Hospital, Cork, Ireland
| | - Claire Brady
- Department of Medical Oncology, Mercy University Hospitals, Cork, Ireland
| | - John P. Sweeney
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Stewart Fleming
- Department of Histopathology, Ninewells Hospital, Dundee, Scotland
| | - Nicholas J. Mayer
- Department of Histopathology, Mercy University Hospital, Cork, Ireland
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17
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Naidu SG, Stone WM, Sweeney JP, Money SR. Endovascular Retrieval of a Permanent IVC Filter placed within the Aorta. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.10.013] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Chism BS, Lee RW, Sweeney JP, Fortuin FD. The crooked buddy technique: use of a Wiggle wire alongside an extra support wire to improve device deliverability. J Invasive Cardiol 2010; 22:377-381. [PMID: 20679675] [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: 05/29/2023]
Abstract
The buddy wire is a useful technique for difficult-to-cross lesions that are typically identified by poor guide support, vessel tortuosity, calcification and/or prior stent placement. We present 5 cases of percutaneous coronary interventional success involving difficult-to-cross lesions using the "crooked buddy" technique, a unique combination of the Wiggle guidewire as the rail and an extra support guidewire as the buddy wire. From our experience, we recommend that when difficult-to-cross lesions are identified, moving quickly to the crooked buddy technique may avoid unnecessary equipment, contrast and procedure time.
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19
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Kronsteiner E, Lee RW, Sweeney JP, Metallo JR, Stoehr JD, Fortuin FD. Outcomes of overlapping bare-metal stents with sirolimus-eluting stents for long lesions in small coronary vessels. J Invasive Cardiol 2010; 22:76-79. [PMID: 20124593] [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: 05/28/2023]
Abstract
OBJECTIVES Compare outcomes of hybrid bare-metal stent (BMS)/sirolimus-eluting stent (SES) to BMS alone for the treatment of stenoses in small coronary arteries. BACKGROUND One approach to potentially reduce the risk of restenosis in long lesions with smaller distal reference diameters is to use a small (2.0-2.5 mm) "BMS cap" (BMC) distally, telescoped in tandem with a SES(s) proximally, matched to a proximal segment where the diameter is > or = 2.5 mm (creating a BMC/SES hybrid stent). Results from previous reports using "hybrid" drug-eluting stents and BMS are mixed. METHODS We performed a retrospective analysis of BMC/SES cases in small vessels at our institution and compared the outcomes with a control group (BMS) consisting of patients treated with at least one 2.0-2.5 mm BMS. RESULTS During the years 2003-2006, 41 BMC/SES and 62 BMS cases were identified and follow up was available in 33 and 49 patients, respectively. Baseline demographics, procedure indications and pertinent discharge medications for the two groups were similar. Despite the use of more stents and longer total stent length in the BMC/SES group compared to the BMS group (2.9 +/- 0.79 vs. 1.4 +/- 0.69 and 64 +/- 21 mm vs. 26 +/- 18 mm; p < 0.0001 for both comparisons), there was a significant decrease in the composite of restenosis, myocardial infarction and cardiac death (9% vs. 29%; p = 0.033). CONCLUSIONS The use of a "BMS cap" distally, telescoped in tandem with SES more proximally, may be a reasonable approach in treating long lesions in coronary arteries with distal reference diameters < or = 2.5 mm.
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20
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Bush JB, Sweeney JP, Robison JE, DeMoss B, Meyer MS. Chondromyxoid fibroma of the radial shaft treated with nonvascularized fibular autograft. Am J Orthop (Belle Mead NJ) 2010; 39:30-34. [PMID: 20305838] [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: 05/29/2023]
Abstract
Chondromyxoid fibroma is a benign yet highly recurrent neoplasm of bone, usually found in the metaphyseal segments of long bones. We present the case of an unusual diaphyseal chondromyxoid fibroma of the radius and review the literature regarding these rare chondroid neoplasms.
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Affiliation(s)
- J Bernard Bush
- Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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21
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Yang HS, Shah SB, Sweeney JP, Khandheria BK, Chandrasekaran K. Subepicardial aneurysm evaluated by multiplane 2D and real-time 3D volumetric transesophageal echocardiography. Circ Cardiovasc Imaging 2009; 1:171-2. [PMID: 19808535 DOI: 10.1161/circimaging.108.780833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hyun Suk Yang
- Division of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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22
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Money SR, Sweeney JP, Chong BW. Turf wars and silos--the effect of disruptive technologic innovation in the treatment of cerebral and peripheral vascular disease. Catheter Cardiovasc Interv 2007; 70:769-70; author reply 771. [PMID: 17932904 DOI: 10.1002/ccd.21295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Abbas AE, Appleton CP, Liu PT, Sweeney JP. Congenital absence of the pericardium: case presentation and review of literature. Int J Cardiol 2006; 98:21-5. [PMID: 15676161 DOI: 10.1016/j.ijcard.2003.10.021] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [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] [Received: 04/04/2003] [Revised: 07/26/2003] [Accepted: 10/23/2003] [Indexed: 12/11/2022]
Abstract
Congenital absence of the pericardium is an uncommon finding that may or may not be symptomatic. Asymptomatic patients are discovered incidentally during cardiac surgery for an unrelated condition or postmortem. However, symptomatic patients may experience non-exertional paroxysmal stabbing chest pain. It may occur with other cardiac or extracardiac abnormalities and a variety of imaging modalities may identify the condition. Complete cases are more rare than partial effects. However, complications are more common with partial absence due to strangulation of the heart into the defect thus requiring surgical intervention.
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Affiliation(s)
- Amr E Abbas
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA.
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24
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Hurst RT, Askew JW, Reuss CS, Lee RW, Sweeney JP, Fortuin FD, Oh JK, Tajik AJ. Transient midventricular ballooning syndrome: a new variant. J Am Coll Cardiol 2006; 48:579-83. [PMID: 16875987 DOI: 10.1016/j.jacc.2006.06.015] [Citation(s) in RCA: 222] [Impact Index Per Article: 12.3] [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] [Received: 03/08/2006] [Revised: 04/21/2006] [Accepted: 04/24/2006] [Indexed: 12/16/2022]
Abstract
We describe a new variant of transient left ventricular (LV) ballooning in North American Caucasian patients in which only the midventricle is affected. The patients described in this case series initially presented with emotional or physical stress and had similarities to transient apical ballooning syndrome; however, this variant is unique in that the transient ballooning involves the midventricle with hypercontractility of the apical and basal segments. The presentation, clinical features, and transient nature of the reported cases in this series are similar to transient LV apical ballooning and suggest a shared pathophysiologic etiology. Sparing of the apical segment with involvement of midventricle only supports etiologies not related to an epicardial coronary artery distribution. Although the pathophysiologic mechanism of the transient ventricular ballooning syndromes and other cases of catecholamine-associated transient ventricular dysfunction are not well understood, the emergence of this new variant raises further questions in the understanding of the "brain-heart" relationship.
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Affiliation(s)
- R Todd Hurst
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona 85260, USA.
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25
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Abstract
Pseudostenosis is a generally benign complication of percutaneous coronary intervention that is caused by the mechanical deformation of a tortuous artery by the guidewire. We describe two cases of a tortuous right coronary artery in which pseudostenosis was relieved by placing a Transit exchange catheter (Cordis) distally and subsequently removing the guidewire. This technique safely confirmed the diagnosis of pseudostenosis without losing guidewire position or requiring additional wires and balloons.
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Affiliation(s)
- F David Fortuin
- Division of Cardiology, Mayo Clinic Scottsdale, Clinic Hospital 1st Floor, 5777 E. Mayo Boulevard, Phoenix, AZ 85054, USA.
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26
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Khositseth A, Cabalka AK, Sweeney JP, Fortuin FD, Reeder GS, Connolly HM, Hagler DJ. Transcatheter Amplatzer device closure of atrial septal defect and patent foramen ovale in patients with presumed paradoxical embolism. Mayo Clin Proc 2004; 79:35-41. [PMID: 14708946 DOI: 10.4065/79.1.35] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [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: 11/23/2022]
Abstract
OBJECTIVE To review our experience with, and profile the safety and efficacy of, the Amplatzer PFO (patent foramen ovale) occluder (APO) and Amplatzer septal occluder (ASO) used to close PFO and/or atrial septal defect (ASD) in patients with paradoxical embolism (PE). PATIENTS AND METHODS Between April 1998 and November 2002, 103 patients at the Mayo Clinic in Rochester, Minn, and Scottsdale, Ariz, mean age 52.4 years, with presumed PE (transient ischemic attack [n=22], stroke [n=77], or peripheral emboli [n=4]) underwent transcatheter device closure of PFO (n=81), ASD (n=12), and ASD/PFO (n=10) with 106 devices (APO [n=22] or ASO [n=84]). RESULTS All devices deployed successfully, and no patients died. Procedural complications included atrial fibrillation (n=2), vessel injury (n=3), profound sinus node dysfunction (n=1), and device embolization with successful retrieval (n=1). At 3 months, 7 of 95 monitored patients had trivial residual shunt; at 12 months, 2 of 28 monitored patients had trivial residual shunt. Three patients had recurrent events--2 transient ischemic attacks and 1 retinal artery occlusion--at a mean +/- SD follow-up of 8.3 +/- 8.1 months (range, 1-34 months). None of these 3 patients had residual shunt or evidence of intracardiac thrombus. The average annual recurrence of all events was 3.6% at 23 months. The overall mean +/- SD freedom from recurrence of all events was 98.9% +/- 1.2% and 83.8% +/- 10.2% at 12 and 29 months of follow-up, respectively. CONCLUSIONS Transcatheter device closure of PFO and/or ASD with use of APO/ASO in patients with presumed PE is effective and safe. Recurrent events may occur in the absence of a residual shunt.
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Affiliation(s)
- Anant Khositseth
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Ernster JA, Franquemont DW, Sweeney JP. Initial report of a case of carcinosarcoma of the supraglottis. Ear Nose Throat J 2000; 79:384-7. [PMID: 10832205] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Minor salivary gland carcinosarcoma is a rare malignancy with an ominous prognosis. This report recounts a single case of supraglottic minor salivary gland carcinosarcoma that was treated aggressively. We discuss the peculiarities of the histology, with special mention of the distinction that must be made between mucosal-origin and salivary-gland-origin carcinosarcoma. Carcinosarcomas are aggressive regardless of their origin, but differentiating their origin is important because the prognosis is worse for those that arise in salivary glands than for those that originate in the surface epithelium. This report adds to the literature a new case of minor salivary-gland-origin carcinosarcoma involving the upper airway. It is the first case we could identify in which the supraglottis was involved.
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Affiliation(s)
- J A Ernster
- Department of Otolaryngology-Head and Neck Surgery, Penrose-St. Francis Healthcare System, Colorado Springs, USA.
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Sweeney JP, Fan CW, Keogh JA, Thornhill JA. Upper renal tract deterioration after cyclophosphamide-induced cystitis: the case for monitoring after cyclophosphamide therapy. Br J Urol 1998; 81:639-40. [PMID: 9598647 DOI: 10.1046/j.1464-410x.1998.00400.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J P Sweeney
- Department of Urology, Meath Hospital, Dublin, Ireland
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Lee M, Gaffney EF, Sweeney JP, McDermott TE, Butler MR, Thornhill JA. Mesothelioma of the tunica vaginalis--beware of the malignant hydrocoele. Ir Med J 1998; 91:64-5. [PMID: 9617036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Balloon rupture during coronary angioplasty is a well-recognized complication of PTCA. Coronary angiography commonly fails to elicit the cause of balloon perforation. We present a case with multiple balloon rupture during additional high-pressure inflations of a Palmaz-Schatz stent where intravascular ultrasound was useful in revealing a calcified lesion protruding through the struts of the stent.
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Affiliation(s)
- C Zellner
- Adult Cardiac Catheterization Laboratories, University of California, San Francisco 94143-0124, USA
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31
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Hilborn MD, Bennett JD, Davies ET, Sweeney JP. Pseudoaneurysm of the gastroduodenal artery: an unusual cause of painless jaundice. Can Assoc Radiol J 1996; 47:413-6. [PMID: 8943911] [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: 02/03/2023] Open
Affiliation(s)
- M D Hilborn
- Department of Diagnostic Radiology, St. Joseph's Health Centre, London, Ont
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32
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Sweeney JP, Thornhill JA, Graiger R, McDermott TE, Butler MR. Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment. Br J Urol 1996; 78:351-3. [PMID: 8881940 DOI: 10.1046/j.1464-410x.1996.00140.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare treatment outcomes in symptomatic and incidental renal cell carcinoma (RCC) with specific interest in the role of radical nephrectomy. PATIENTS AND METHODS The records of 189 patients with a clinical diagnosis of RCC were reviewed. The mode of presentation, tumour size, grade and stage at presentation were correlated with final outcome, as measured by the disease-free and overall survival of the patients. RESULTS The rate of incidental detection was 15%; incidental tumours were of a lower stage and patients with incidentally detected tumours had a significantly longer disease-free and overall survival than had those with symptomatic tumours (P < 0.05). CONCLUSIONS The increased detection of incidental tumours should further improve survival in RCC. We continue to advocate radical nephrectomy for incidentally detected tumours, as it offers the best outcome and simplifies the follow-up.
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Affiliation(s)
- J P Sweeney
- Department of Urology, Meath Hospital, Dublin, Ireland
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33
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Sweeney JP, Schwartz GG. Applying the results of large clinical trials in the management of acute myocardial infarction. West J Med 1996; 164:238-48. [PMID: 8775936 PMCID: PMC1303418] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mortality from acute myocardial infarction has declined in recent years, largely due to the widespread application of new pharmacologic and mechanical interventions that have been tested in large, prospective, randomized clinical trials. For practicing generalists, we review the key data from such trials that have shaped the current management of patients with acute myocardial infarction. We discuss the roles of thrombolytic therapy, coronary angioplasty, nitrates, beta- and calcium channel blockers, angiotensin-converting-enzyme inhibitors, magnesium, and antiarrhythmic and antithrombotic agents. In addition, we highlight critical unanswered questions in the management of this disorder.
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Affiliation(s)
- J P Sweeney
- Cardiology Section, Department of Veterans Affairs (VA) Medical Center, San Francisco, CA 94121, USA
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34
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Heidenreich PA, Chou TM, Smedira NG, Sweeney JP, Schiller NB, Schwartz DE, Merrick SH, Ports TA. Catheter fragmentation of massive pulmonary embolus: guidance with transesophageal echocardiography. Am Heart J 1995; 130:1306-8. [PMID: 7484792 DOI: 10.1016/0002-8703(95)90165-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- P A Heidenreich
- Department of Medicine, University of California, San Francisco, USA
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35
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Harris KA, Carroll SE, Derose G, Jamieson WG, Kozak R, Meads GE, Sweeney JP. Intraoperative thrombolytic therapy as a treatment of small vessel thrombosis: an experimental study. INT ANGIOL 1994; 13:331-5. [PMID: 7790755] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This paper studies the effect of three doses of Streptokinase infused intra-operatively into an animal model of small vessel thrombosis. EXPERIMENTAL DESIGN This is a controlled trial of intraoperative infusion of thrombolytic agent into a thrombosed arterial segment compared to no infusion into the contralateral limb. EXPERIMENTAL SUBJECTS 19 New Zealand White rabbits were stratified into 3 groups. INTERVENTIONS Thrombosis was achieved by infusing a mixture of topical thrombin and autologous blood into individual iliac arteries of the New Zealand white rabbit. A randomly selected hind limb had an infusion of one of three doses of streptokinase (A = 2,500u; B = 5,000u; C = 10,000u) in saline over 20 minute period. Preinfusion and post infusion angiography was performed. MEASUREMENTS Angiograms were ranked by a radiologist blinded to the side of infusion and clotting parameters were assessed. RESULTS All limbs at all doses of streptokinase infusion (SK) showed significant clot lysis when compared to the non-infused limb(C). The percentage of improved segments is as follows: iliac: SK = 100%, C = 79%; femoral SK = 79%, C = 32%; tibial SK = 52%, C = 5%. Although there was an elevation in clotting time and a reduction in fibrinogen, levels remained within normal limits. CONCLUSIONS Streptokinase infused directly into thrombus in arteries even in low doses significantly enhances thrombolysis of vessels which are too small to be cleared by mechanical means. No significant systemic complications were encountered.
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Affiliation(s)
- K A Harris
- Department of Surgery, University of Western Ontario, London
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Abstract
Intraabdominal abscess formation is a well-recognized complication of perforated appendicitis. Extraabdominal complications, however, are rare. The authors present the case of an 8-year-old boy who had an acute painful right-sided scrotal mass 2 days after an operation for perforated appendicitis. During exploration, an abscess within a previously undiagnosed patent processus vaginalis was found and successfully managed by drainage. This case demonstrates that a persistent patent processus vaginalis may predispose to scrotal pathology secondary to intraabdominal sepsis and represents a unique complication of perforated appendicitis.
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Affiliation(s)
- B S Gan
- Department of Surgery, St Joseph's Health Centre, University of Western Ontario, London, Canada
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37
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Affiliation(s)
- T M Chou
- Coronary Care Unit, San Francisco Veterans Affairs Medical Center, CA
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Abstract
Ductal carcinoma in situ (DCIS) of the breast is thought to represent a number of biologically different processes, ranging in clinical presentation from a palpable mass to a mammographically-detected abnormality. The optimal management of DCIS is controversial. We reviewed our experience in 40 patients with DCIS, 26 with gross disease and 14 with microscopic disease. Treatment was by total mastectomy (n = 21), complete local excision (n = 16), and local excision followed by radiotherapy (n = 3). At a mean follow-up of 34 months (range 3-120), 35 patients (88%) are disease-free. All patients treated by mastectomy remained disease-free, but 3 patients (16%) treated by breast conservation surgery have had local recurrences. All local recurrences were in the same area as the original lesion, two manifesting the same subtype of DCIS and one an invasive carcinoma. The margins of excision were close to the resection margin in all cases that recurred. All four recurrences were successfully managed by mastectomy. Mastectomy is still the most secure and reliable management for DCIS, but pathologically verified wide local excision may be appropriate.
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Affiliation(s)
- J V Reynolds
- Department of Surgery, St. Vincent's Hospital, Dublin
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39
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Sweeney JP. Assessing the patient undergoing GI endoscopy. Gastroenterol Nurs 1992; 14:266-9. [PMID: 1581382 DOI: 10.1097/00001610-199204000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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40
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Harris KA, van Schie L, Carroll SE, Deathe A, Maryniak O, Meads GE, Sweeney JP. Rehabilitation potential of elderly patients with major amputations. J Cardiovasc Surg (Torino) 1991; 32:463-7. [PMID: 1864873] [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: 12/29/2022]
Abstract
This study was undertaken to determine the rehabilitation potential of patients undergoing amputation for vascular disease. A total of 101 patients were studied with a mean age of 69 +/- 14 years, 26 of whom were over age 80. Operative indications were gangrene or ulceration in 80% with rest pain in 20%. Eighteen patients were bilateral amputees. Fifty per cent of the patient population had previous vascular operations. The operative mortality was 13% and was not affected by the age of the patients or the presence of diabetes. Most operative deaths were due to cardiac or septic respiratory complications. Twenty-four of 88 surviving patients were not considered candidates for rehabilitation and the major determining factor was the occurrence of a remote or perioperative stroke. None of these 24 patients was discharged from institutional care. Sixty-four patients were considered rehabilitation candidates with equal distribution in all age groups. Ninety-five per cent of these patients were discharged home with 80% of those patients over 80 being discharged. Eighty-seven per cent of the elderly rehabilitation candidates were fitted with prostheses which compares favourably to other age groups. Seventy-three per cent of the elderly reached their rehabilitation goals (most frequently ambulation with the aid of a walker) which is only slightly less than the younger amputation group. From this study we conclude that amputations which are done for ease of nursing care and patient comfort in debilitated patients have a high mortality rate and rehabilitation goals are unlikely to be met. We have demonstrated high success rates with rehabilitation including patients over age 80. The majority of these patients may be discharged home after a period of aggressive rehabilitation.
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Affiliation(s)
- K A Harris
- Department of Surgery and Rehabilitation Medicine, St. Joseph's Health Centre, London, Ontario, Canada
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41
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Sweeney JP, Pollokoff AM. Outsourcing revisited. New ways to develop your information asset. Healthc Exec 1991; 6:16-7. [PMID: 10110669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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42
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Sweeney JP, Turner K, Harris KA. Aneurysms of the inferior vena cava. J Vasc Surg 1990; 12:25-7. [PMID: 2374250] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aneurysms of the inferior vena cava are very rare. We describe a case of a saccular aneurysm of the inferior vena cava that thrombosed after vigorous exercise. This presented as deep venous thrombosis associated with a retroperitoneal mass. Laparotomy with biopsy confirmed the benign nature of this lesion, and symptoms gradually resolved. It is hypothesized that the increased intraabdominal pressure during exercise led to the thrombosis of what is presumed to be a congenital aneurysm of the inferior vena cava.
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Affiliation(s)
- J P Sweeney
- Department of Surgery, St. Joseph's Health Centre, London, Ontario, Canada
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Sim KT, Picone S, Crade M, Sweeney JP. Ultrasound with graded compression in the evaluation of acute appendicitis. J Natl Med Assoc 1989; 81:954-7. [PMID: 2674464 PMCID: PMC2626073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Acute appendicitis is the most common diagnosis made (in the Western world) in patients with an "acute abdomen." Although the mortality rate has been vastly reduced, the diagnostic inaccuracy rate of 15% to 20% has remained unchanged in the past 100 years. In this article, the authors report the ultrasonographic findings in 80 patients examined using a small linear-array transducer, which enables direct visualization of the inflamed appendix. During 22 months, 80 patients (28 males and 52 females; age range, 3 to 81 years; mean, 32.3 years) with equivocal clinical signs and symptoms of acute appendicitis were examined sonographically. Of the 29 patients whose appendicitis was verified at surgery, ultrasonography was positive in 26, with an overall sensitivity of 90%. Of the 51 patients who did not have appendicitis, ultrasonography was negative in all, with a specificity of 100%. The authors concur with reports in the literature that ultrasonography is helpful in diagnosing appendicitis.
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Harris KA, Niesobska V, Carroll SE, De Rose G, Jamieson WG, Meads GE, Sweeney JP. Extra-anatomic bypass grafting: a rational approach. Can J Surg 1989; 32:113-6. [PMID: 2920313] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
To determine predictors of long-term patency in extra-anatomic bypass grafting, the authors studied retrospectively the charts of 134 patients who underwent bypass grafting (axillofemoral in 17, axillobifemoral in 32 and femorofemoral in 85). Of the study group, 64% were men; the mean age was 65 +/- 12 years (+/- SEM). The indications for grafting were limb salvage (102), claudication (27) and replacement of septic grafts (5), and for using the extra-anatomic route included high risk (83), sepsis (8) and unilateral disease (34). Operative mortality was 6% and the early graft occlusion rate 7.4%. The late death rate was 44%. At 3 years, the life-table patency rates for the various procedures were axillofemoral 52.5%, axillobifemoral 67.7% and crossfemoral 86.9%. Smoking significantly (p less than 0.05) decreased the patency rate, but diabetes did not. However, amputation was more frequent in diabetics. Indications for operation did not alter patency rates, but did affect operative mortality. The authors conclude that extra-anatomic bypass grafting is highly successful, but not as successful as anatomic bypass. When appropriate, the axillobifemoral graft is preferred to the axillounifemoral graft because of its increased patency. Crossfemoral grafts must be carefully monitored to ensure that no donor limb stenosis occurs and this procedure should not be attempted unless the disease is truly unilateral.
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Affiliation(s)
- K A Harris
- Department of Surgery, St. Joseph's Hospital, London, Ont
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46
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Harris KA, Kozak R, Carroll SE, Meads GE, Sweeney JP. Confirmation of infection of an aortic graft. J Cardiovasc Surg (Torino) 1989; 30:230-2. [PMID: 2708440] [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: 01/02/2023]
Abstract
The presentation of an aortic graft infection may be dramatic in the form of an aortoenteric fistula or drainage of pus from the wound. Some cases may be more subtle with presentations of fever of unknown origin. Prior to embarking upon major operative repair for these suspected lesions, it is essential to confirm the presence of infection. Under CT control, a fine needle may be inserted into the peri-graft space, and cultures may be obtained. Further confirmation may be achieved by an injection of a small amount of contrast material which will demonstrate lack of incorporation of the graft into surrounding tissues. Prior confirmation of graft infection permits a staged procedure to repair this technique is illustrated with a case history.
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Affiliation(s)
- K A Harris
- Department of Surgery, St. Joseph's Health Centre, London, Ontario, Canada
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47
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Laschuk B, Harris KA, Carroll SE, Meads GE, Sweeney JP. Simple method of intraoperative blood collection and reinfusion during aortic surgery. Can J Surg 1988; 31:337-40. [PMID: 3416246] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The increasing fear of acquired immune deficiency syndrome and other blood-transmissible diseases and increasing blood-bank shortages prompted a study of the safety and feasibility of a commercially available hand-held unit for collecting and reinfusing blood. The device was used on nine patients undergoing aortic surgery and permitted a mean saving of 2.6 units of banked blood. The reinfusion of collected blood did not result in any coagulation disturbances or changes in renal function. The hemoglobin and platelet levels were comparable to those in a group of patients receiving only banked blood. The unit does not require additional personnel or technical training for its use. The authors conclude that this autotransfusion device is a safe and feasible method of reducing the requirement for banked blood during aortic surgery.
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Affiliation(s)
- B Laschuk
- Department of Surgery, St. Joseph's Health Centre, University of Western Ontario, London, Ont
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48
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Sweeney JP, Helms CA, Minagi H, Louie KW. The widened teardrop distance: a plain film indicator of hip joint effusion in adults. AJR Am J Roentgenol 1987; 149:117-9. [PMID: 3495970 DOI: 10.2214/ajr.149.1.117] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The teardrop distance is defined as the distance from the lateral margin of the pelvic teardrop to the most medial aspect of the femoral head as seen on anteroposterior pelvic radiographs. The structure responsible for the teardrop is the anteroinferior portion of the acetabular fossa with contributions from the ischium and from the superior pubic ramus. Anteroposterior pelvic radiographs of 10 patients with documented cases of unilateral hip effusion were retrospectively evaluated for teardrop distance widening on the affected side. Proof of the presence of hip effusion was based on the results of percutaneous hip joint aspirations as described in the patient's medical records. A teardrop distance widening of 1 mm or more was always consistent with hip joint fluid. In addition, radiographs from 20 patients with no known hip abnormalities were reviewed as a control population. These showed side-to-side symmetry in 16 cases (80%) and widening of less than 1 mm in the remaining four cases (20%). Thus, hip joint effusion in adults can be accurately diagnosed from plain radiographs in the presence of a teardrop asymmetry of 1 mm or more and in the absence of degenerative joint disease.
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49
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Bershof JF, Sweeney JP, Jafek BW. Diagnostic imaging of Waldeyer's ring. Otolaryngol Clin North Am 1987; 20:229-34. [PMID: 3601386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Diagnostic imaging of Waldeyer's ring can be obtained by plain films, CT scans, and MRI. In most instances, physical examination and plain films are sufficient for diagnosis and therapy. In addition, plain films are inexpensive and readily available. Although more expensive and less available, CT and MRI allow further evaluation of deep tissues not seen by physical examinations and plain film and permit more complete evaluations of more complex pathologic processes in Waldeyer's ring. Although both CT and MRI are often complementary, the indications for each modality are still evolving.
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50
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Sweeney JP, Mason A. Integrated hospital information systems. J R Coll Physicians Lond 1987; 21:102-4. [PMID: 3585829 PMCID: PMC5379451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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