Naser Ammash - Academia.edu (original) (raw)
Papers by Naser Ammash
Because congenital ventricular septal defects are of different sizes and locations, their clinica... more Because congenital ventricular septal defects are of different sizes and locations, their clinical presentation, natural history, and treatment vary greatly. This review discusses the different types of ventricular septal defects commonly seen in adults in the authors' experience and in published literature. Ventricular septal defects are either isolated small defects or larger defects associated with pulmonary stenosis, pulmonary hypertension, or aortic regurgitation. These associations play an important role in the pathophysiologic consequences of the defect, its long-term complications, and treatment options. Knowledge of the different clinical presentations in adulthood and the specific features pertinent to these defects will help in the assessment and the care of adult patients with one of the most common congenital cardiac malformations.
Journal of The American College of Cardiology, 1997
Objectives. This study sought to demonstrate that with proper technique, identification of the no... more Objectives. This study sought to demonstrate that with proper technique, identification of the normal and abnormal pulmonary venous connection can be made with confidence using transesophageal echocardiography (TEE).Background. Partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital anomaly whose diagnosis has classically been made using angiography.Methods. We performed a retrospective review of all patients of all ages with PAPVC
The Annals of thoracic surgery, Jan 27, 2015
Ebstein anomaly (EA) is commonly associated with atrial flutter or fibrillation (AFl/F), which ad... more Ebstein anomaly (EA) is commonly associated with atrial flutter or fibrillation (AFl/F), which adversely affects outcome. Surgical ablation of AFl/F during surgery for EA has been shown to be effective, but the optimal lesion set remains unknown. Between 1995 and 2010, 86 patients had corrective surgery for EA and concomitant maze procedure for associated AFl/F. Median age at operation was 40 years (range, 1 to 72 years), and 49 patients (60%) were male. Preoperative AFl/F was paroxysmal in 43 patients (50%). All patients who had diagnosis of or treatment for accessory pathways and reentrant tachycardia were excluded from this analysis. All patients underwent tricuspid valve surgery for EA and concomitant maze procedure, including right-sided maze (RSM) in 62 patients (72%) and biatrial maze (BAM) in 24 patients (28%). Early mortality occurred in 3 patients (3.5%). During median follow-up of 52 months (range, 3 months to 17 years), overall freedom from AFl/F without antiarrhythmic m...
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2012
Reversible causes of miscarriage are many, but they affect only 1% of women who are trying to con... more Reversible causes of miscarriage are many, but they affect only 1% of women who are trying to conceive. Herein, we describe the case of a 23-year-old woman who presented for evaluation of repeated miscarriages and was found to have hypoxemia and erythrocytosis. Further evaluation revealed hypoplastic right-heart syndrome with an intracardiac shunt. She underwent hybrid repair with pulmonary valve balloon valvuloplasty, followed by surgery to perform atrial septal defect closure and a Glenn anastomosis. The erythrocytosis and hypoxemia resolved, and she was able to conceive and deliver a healthy baby at term 2 years later. This is a unique case of a rare congenital heart defect that went unnoticed until adulthood, when attempts at pregnancy failed because of the associated hypoxemia. Timely and appropriate treatment led to a successful pregnancy after repeated miscarriages. This case exemplifies the need for a comprehensive medical evaluation of every woman with a history of multiple...
Circulation. Arrhythmia and electrophysiology, 2015
Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but th... more Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8%) and 37 (16%) had left ventricular dysfunction, defined as left ventricular ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95%, 90%, an...
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 12, 2015
Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-rela... more Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE). We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥48 h, and 59% had been ...
Heart (British Cardiac Society), 2014
The Annals of thoracic surgery, 2014
Patients with atriopulmonary Fontan tend to undergo conversion to total cavopulmonary connections... more Patients with atriopulmonary Fontan tend to undergo conversion to total cavopulmonary connections secondary to arrhythmias or poor flow dynamics. However, the ideal candidate is unknown. Between December 1994 and May 2011, 70 patients (40 males [57%]) underwent Fontan conversion. Median age was 23 years (range, 4 to 46 years). Excluded were 1.5 ventricle conversions. The most common diagnoses included tricuspid atresia in 34 patients (49%) and double-inlet left ventricle in 16 (23%). Atrial tachyarrhythmia was present in 62 patients (89%), 41 (59%) had atrioventricular valve (AVV) regurgitation, and 32 (46%) were in New York Heart Association class III or IV. Atriopulmonary Fontan was the original connection in 58 patients (83%), whereas the Björk modification was performed in 8 (11%). Fontan was performed with an intraatrial conduit in 41 patients, an extracardiac conduit in 18, and a lateral tunnel in 11. Forty-nine patients (70%) underwent concomitant arrhythmia operations. Early...
The Annals of thoracic surgery, 2014
Transesophageal echocardiography (TEE) is often performed during cardiac operations. The need to ... more Transesophageal echocardiography (TEE) is often performed during cardiac operations. The need to repeat TEE to exclude left atrial or left atrial appendage thrombus before direct current cardioversion (DCCV) in patients with a recent intraoperative TEE showing no thrombus is unclear. We sought to determine the incidence of and risk factors for new thrombus in patients undergoing TEE-guided DCCV after cardiac operations. We reviewed 817 patients referred for TEE-guided DCCV within 30 days of a cardiac operation and an intraoperative TEE. Patients were excluded if the intraoperative TEE showed thrombus or a surgical left atrial appendage intervention was performed. Univariate logistic regression identified risk factors for thrombus. The study included 362 patients (71% male) with a mean age of 69 years. Median time from the operation to DCCV was 6 days. Thrombus was present in 13 patients (3.6%) on TEE before cardioversion; DCCV was cancelled in these patients. Heart failure was assoc...
The Annals of Thoracic Surgery, 2014
Patients with Ebstein malformation (EM) and severe RV dilatation and dysfunction have increased o... more Patients with Ebstein malformation (EM) and severe RV dilatation and dysfunction have increased operative risk. Early results with right ventricular unloading utilizing the bidirectional cavopulmonary shunt (BCPS) during repair of EM have been encouraging. We report our experience of the 1.5-ventricle repair strategy for this difficult group of patients. Between July 1999 and January 2013, 62 patients with severe EM underwent BCPS at the time of tricuspid repair. Median age was 21.5 years (range, 9 months to 57 years), 51.6% were male, and 72.5% were children. Severe RV dilatation was present in all patients; severe RV dysfunction was present in 72.5% (n=45) and moderate to severe RV dysfunction in 22.5% (n=14). Mean RV systolic pressure was 32.7±0.7 mm Hg and mean PA pressure was 15.6±2.1 mm Hg. Mean preoperative left ventricular ejection fraction (LVEF) was 0.536±0.071; it was less than 40% in 10 patients (16.1%). New York Heart Association class III/IV heart failure was present in 43 patients (69.3%) preoperatively and 20 patients (32.2%) were initially referred for heart transplant evaluation. Prior EM surgery occurred in 35.4% (n=22; 8 prior valve repair, 8 prior valve replacement, Blalock-Taussig shunt in 4, atrial septal defect (ASD) closure in 2). Tricuspid repair was performed in 51.6% (n=32, 5 had re-repair). Bioprosthetic valve replacement was performed in 48.4% (n=30, 8 had rereplacement). The BCPS was a planned procedure in 53 patients (85.5%) because of RV dysfunction; BCPS was added after unsuccessful weaning from bypass in 7 (11.2%), and in the early postoperative period due to hemodynamic instability in 2. Concomitant procedures included ASD closure in 48.3%, maze in 38.7%, and mitral valve repair in 6.4%. Postoperative extracorporeal membrane oxygenation support was needed in 8 patients. Delayed chest closure was performed in 25.8%. Early mortality was 1.6% (n=1). Mean mechanical ventilation time was 69.7 hours. Mean intensive care unit and hospital stays were 5.4±3.5 and 10.7±3.5 days, respectively. Mean follow-up was 3.6±2.6 years (maximum, 12.8 years). Patients (n=10) with low preoperative LVEF (0.362±0.035) improved to 0.517±0.042 postoperatively (p=0.001). There was 1 late death in a patient with cystic fibrosis. Late reintervention was needed in 5 patients (8%). Late follow-up was available in 95% (n=59); all were acyanotic and 88% were in New York Heart Association functional class I/II. Concomitant BCPS is a useful adjunct in repair of advanced EM with severe RV dilatation and dysfunction. Operation can be performed with low early mortality. Intermediate-term survival and quality of life is good to excellent, and transplantation can be delayed or avoided in the majority.
International Journal of Cardiology, 2015
Obesity is a risk factor for non-valvular atrial fibrillation (NVAF), diabetes mellitus, and hype... more Obesity is a risk factor for non-valvular atrial fibrillation (NVAF), diabetes mellitus, and hypertension. Adiponectin, a unique biomarker of adipose tissue, has antiinflammatory, insulin-sensitizing, and antiatherogenic properties and is known to be higher in women. The relationship between adiponectin, gender, and thromboembolic risk in atrial fibrillation however is unknown. The relationship between gender, adiponectin levels, and echocardiographic measures of blood stagnation and left atrial appendage thrombus (LAAT) was assessed in 209 patients with NVAF (55 women and 154 men; mean age 63±14years) compared to 70 normal sinus rhythm controls (29 women and 41 men; mean age 64±14years). Total adiponectin was measured by solid-phase ELISA. Demographic and clinical variables of CHADS2 and CHA2DS2-VASc were collected, and spontaneous echocardiographic contrast (SEC), left atrial appendage emptying velocity (LAAEV) and left atrium volume index (LAVI) were measured prospectively. Elevated adiponectin was associated with advanced cardiovascular pathology and permanent arrhythmia but only in men with NVAF. In NVAF men, a step-wise increase in adiponectin levels was noted relative to increasing intensity of SEC and decreasing LAAEV. Adiponectin level &amp;amp;amp;amp;amp;amp;amp;gt;16657ng/ml predicted LAAT (OR: 3.66; 95% Cl: 1.21-11.48; p=0.022) after adjustment for CHADS2 score in men but not in women with NVAF. There is a direct correlation between elevated adiponectin level and the degree of left atrial blood stasis in men but not in women with NVAF. High adiponectin levels can be used as an important variable in the prediction of LAAT.
Mayo Clinic Proceedings, 2015
To determine whether blood type affects the risk of thromboembolic complications in patients with... more To determine whether blood type affects the risk of thromboembolic complications in patients with atrial fibrillation (AF). The Mayo Clinic electronic medical record was searched (between January 1, 2004, and December 31, 2010) to identify all patients with AF with blood group assessment. Records were analyzed for stroke, transient ischemic attack, left atrium appendage thrombus, cerebral or peripheral embolism, and hemorrhagic stroke. All events were adjusted for Congestive heart failure, Hypertension, Age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;75 Years, Diabetes mellitus, and Stroke/transient ischemic attack score. Of the 47,816 patients with AF, 14,462 had blood group type available (40% women; mean age, 73±12 years). These included 12,363 patients with nonvalvular atrial fibrillation (NVAF) (40% women; mean age, 73±12 years) and 2099 patients with valvular AF (41% women, mean age, 73±12 years). Within patients with NVAF, the rate of peripheral embolization was significantly lower in those with blood type O (2.0%) than in those with other blood types (3.0%; odds ratio, 0.66; 95% CI, 0.52-0.84; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Neither cerebral thromboembolic (8.1% for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;O&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; vs 8.2% for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;non-O&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; blood group for NVAF and 7.29% vs 7.76% for valvular AF) nor cerebral hemorrhage (2.0% each group) events rates differed by blood group. Blood group O may be protective against peripheral cardioembolic complications of NVAF, which may relate, in part, to reduced circulating von Willebrand factor levels. Cerebral thromboembolic event rates did not differ by blood group.
Pacing and Clinical Electrophysiology, 2005
Atrial remodeling secondary to atrial fibrillation (AF) may be important in the arrhythmogenic pr... more Atrial remodeling secondary to atrial fibrillation (AF) may be important in the arrhythmogenic process. Unfortunately, the study of electrophysiologic remodeling in humans has been limited by the invasive nature of most tests of electrophysiologic characteristics. We sought to determine whether changes in atrial electrophysiology occur acutely (within the first hour) after cardioversion and whether these changes could be detected noninvasively by measuring the signal-averaged P-wave. The filtered P-wave duration (FPD) was measured by signal-averaged electrocardiography (ECG) at 20 and 60 minutes after cardioversion in 46 patients with AF, and the difference between the two values was calculated. The root-mean-square voltage of the terminal 40 ms of the signal-averaged P-wave at 20 and 60 minutes and the difference between them were also determined. The FPD at 20 minutes was significantly different from that at 60 minutes (153.0 +/- 19.1 vs 159.7 +/- 24.8 ms; P = 0.02). In a univariate linear regression model, none of the clinical variables studied was significantly associated with the change in FPD. The root-mean-square voltage at 20 minutes was not significantly different from that at 60 minutes (5.8 +/- 3.0 vs 5.5 +/- 2.7; P = 0.14). We conclude that significant changes in atrial electrophysiology occur within the first hour after cardioversion of AF. These changes can be detected by measuring the FPD.
Pacing and Clinical Electrophysiology, 2011
Patients with congenital heart disease and prosthetic valves frequently present management dilemm... more Patients with congenital heart disease and prosthetic valves frequently present management dilemmas related to cardiac pacing and lead placement. Permanent pacing of the right ventricle across a bioprosthetic tricuspid valve presents discreet issues related to its potential for traumatic injury and subsequent prosthetic valve dysfunction. Coronary sinus (CS) lead placement is being used more frequently to avoid valvular dysfunction. We report an unusual case in which the CS ostium was located ventricular to the tricuspid prosthesis. Intracardiac echocardiography was used to position a CS lead between the commissures of the tricuspid prosthesis resulting in trivial regurgitation acutely and at 1-year follow-up.
Mayo Clinic Proceedings, 2005
ASD = atrial septal defect; CI = confidence interval; NYHA = New York Heart Association; PVR = pu... more ASD = atrial septal defect; CI = confidence interval; NYHA = New York Heart Association; PVR = pulmonary valve replacement; PVS = pulmonary valve stenosis; RV = right ventricular
Mayo Clinic Proceedings, 2003
A lthough the association between coarctation of the aorta (CoA) and intracranial aneurysm (IA) h... more A lthough the association between coarctation of the aorta (CoA) and intracranial aneurysm (IA) has been reported, 1-7 the exact frequency of an IA in association with CoA is unknown and has not been evaluated systematically. A frequency of detection ranging from 2.5% 8 to 50% 9 has been reported, underscoring the need to determine the exact frequency of this potentially serious condition.
Journal of the American Society of Echocardiography, 1997
Partial anomalous pulmonary venous connection, a rare congenital anomaly, most commonly involves ... more Partial anomalous pulmonary venous connection, a rare congenital anomaly, most commonly involves the right lung, with one or more pulmonary veins anomalously connecting most frequently to the superior vena cava and less commonly to the right atrium or inferior vena cava. This article describes an unusual case of anomalous pulmonary venous connection of the right lung to the azygos vein in an adult. This anomaly was dearly delineated with angiography, computed tomography of the chest, and transesophageal echocardiography. The transesophageal echocardiographic features of the anomaly are described as a means to prevent further diagnostic misinterpretation. (J Am Soc Echocardiogr 1997;10:738-44.) Partial anomalous pulmonary venous connection (PAPVC), first described by Winslow in 1739, ~ is a rare congenital anomaly typified by persistence of an embryonic anastomosis between systemic veins and the pulmonary venous plexuses) -'~ The right lung is most commonly involved (80% to 90% of cases), with one or more pulmonary veins connecting most frequently to the superior vena cava and less commonly to the right atrium or inferior vena cava. 2,4,s Rarely, pulmonaly veins connect to the brachioccphalic veins, 4,6 portal vein, 7 azygos vein, s and coronary sinus. We present an unusual case of PAPVC of the right lung to the azygos vein in an adult. This anomaly was ininally missed on transesophageal echocardiography (TEE) but later was clearly delineated after angiographic diagnosis. This report highlights the TEE features of PAPVC as a means to prevent future diagnostic misinterpretation.
Journal of the American Society of Echocardiography, 2008
Background: Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonl... more Background: Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonly causes post-DCCV left atrial (LA) stunning (LAS), which may potentiate thromboembolic complications. Data on LAS determinants are inconclusive.
Journal of the American College of Cardiology, 2003
Connolly HM, Huston J., Brown RD, Warnes CA, Ammash NM, Emerson JA, Rosales AG, Jamil Tajik A.//J... more Connolly HM, Huston J., Brown RD, Warnes CA, Ammash NM, Emerson JA, Rosales AG, Jamil Tajik A.//Journal of the American College of Cardiology, 2003. Поиск в библиотеке, Расширенный поиск. ...
Journal of the American College of Cardiology, 2003
e~,, ,~a, aldws e Gu!rulo,md hq 's,ua!,ed asaq, u! uo!,~n,Shp ,ua,e, sy,, aso,xyp cl, pay, =M 'OS... more e~,, ,~a, aldws e Gu!rulo,md hq 's,ua!,ed asaq, u! uo!,~n,Shp ,ua,e, sy,, aso,xyp cl, pay, =M 'OS .a,=,s hp=a,s e ,= a,"(!=, 3!,O,s=!p ,"a,=, aq, ,3=,ap 0,,,"3g,,!p S! ,! ',anaMoH +m11e4 w,s=!p) uo!,wn,shp o!\o,shs ,"w,,!M am,!=, ,~=a!, sasnez h,(euo!s=mo s,ua!,=d D!,=qe!p p"e msuauadhq u! uogwn,shp o!,o,s=!p (/\I) ,=,">!,,"=A ,,a, :puno~iiyzeg ueder 'e,!ns '%,~a~ 1 f f sa)aqe!fJ ,,&!A SlUa!lad SA!SUSlJSdhH u! uo!43unpAa a!lolse!a syseluun Jamaueyy 6u!44!16al Aq uJa44ed MO~)U~ JejnolrluaA I4al Jalddoa u( a6Uar(3 EC-990 1 .y=daJ (ea!f%ns 40 !%!lu!, ,ew!,do au!wm,ap dlaq he!i~ xapu! sg, 'waged o!,e -um,duihs= UI 'jg lewm pue !j!,y =J=nas LMM s,ua!,=d u! otw as!3J=xa Guunp uo!,wn, -shp =~!,~=~,uo~ ~1 wa,=l leaw 04 dlaq Aelusag 40 uo!,elu!,sa an!s=fwuo~ :uo,=n,xm~ .(pOuO = d !Qp'O = J) 4%~ ,= "3 pue (~0'0 = d !Q8'0 = J) ss=J,s yead pue (LOX = d :gp'O = J) ,S=J ,e j3 L,,!M suo!,=(=m3 =,empour hluo L,,!M (~00'0 > d !L'O = 1) asp~axa yead ,= 9 L,,!M ,Saq pa,e~=Mx j!edal 4SOd 33 '(10'0 = d) IW/6HWrU 8.0 -,+ ZQ'Z 04 (rU/fjH(lurU 90 y+ QZZ um, paseam"! ~~)x~s!m~xa
Because congenital ventricular septal defects are of different sizes and locations, their clinica... more Because congenital ventricular septal defects are of different sizes and locations, their clinical presentation, natural history, and treatment vary greatly. This review discusses the different types of ventricular septal defects commonly seen in adults in the authors' experience and in published literature. Ventricular septal defects are either isolated small defects or larger defects associated with pulmonary stenosis, pulmonary hypertension, or aortic regurgitation. These associations play an important role in the pathophysiologic consequences of the defect, its long-term complications, and treatment options. Knowledge of the different clinical presentations in adulthood and the specific features pertinent to these defects will help in the assessment and the care of adult patients with one of the most common congenital cardiac malformations.
Journal of The American College of Cardiology, 1997
Objectives. This study sought to demonstrate that with proper technique, identification of the no... more Objectives. This study sought to demonstrate that with proper technique, identification of the normal and abnormal pulmonary venous connection can be made with confidence using transesophageal echocardiography (TEE).Background. Partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital anomaly whose diagnosis has classically been made using angiography.Methods. We performed a retrospective review of all patients of all ages with PAPVC
The Annals of thoracic surgery, Jan 27, 2015
Ebstein anomaly (EA) is commonly associated with atrial flutter or fibrillation (AFl/F), which ad... more Ebstein anomaly (EA) is commonly associated with atrial flutter or fibrillation (AFl/F), which adversely affects outcome. Surgical ablation of AFl/F during surgery for EA has been shown to be effective, but the optimal lesion set remains unknown. Between 1995 and 2010, 86 patients had corrective surgery for EA and concomitant maze procedure for associated AFl/F. Median age at operation was 40 years (range, 1 to 72 years), and 49 patients (60%) were male. Preoperative AFl/F was paroxysmal in 43 patients (50%). All patients who had diagnosis of or treatment for accessory pathways and reentrant tachycardia were excluded from this analysis. All patients underwent tricuspid valve surgery for EA and concomitant maze procedure, including right-sided maze (RSM) in 62 patients (72%) and biatrial maze (BAM) in 24 patients (28%). Early mortality occurred in 3 patients (3.5%). During median follow-up of 52 months (range, 3 months to 17 years), overall freedom from AFl/F without antiarrhythmic m...
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2012
Reversible causes of miscarriage are many, but they affect only 1% of women who are trying to con... more Reversible causes of miscarriage are many, but they affect only 1% of women who are trying to conceive. Herein, we describe the case of a 23-year-old woman who presented for evaluation of repeated miscarriages and was found to have hypoxemia and erythrocytosis. Further evaluation revealed hypoplastic right-heart syndrome with an intracardiac shunt. She underwent hybrid repair with pulmonary valve balloon valvuloplasty, followed by surgery to perform atrial septal defect closure and a Glenn anastomosis. The erythrocytosis and hypoxemia resolved, and she was able to conceive and deliver a healthy baby at term 2 years later. This is a unique case of a rare congenital heart defect that went unnoticed until adulthood, when attempts at pregnancy failed because of the associated hypoxemia. Timely and appropriate treatment led to a successful pregnancy after repeated miscarriages. This case exemplifies the need for a comprehensive medical evaluation of every woman with a history of multiple...
Circulation. Arrhythmia and electrophysiology, 2015
Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but th... more Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8%) and 37 (16%) had left ventricular dysfunction, defined as left ventricular ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95%, 90%, an...
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 12, 2015
Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-rela... more Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE). We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥48 h, and 59% had been ...
Heart (British Cardiac Society), 2014
The Annals of thoracic surgery, 2014
Patients with atriopulmonary Fontan tend to undergo conversion to total cavopulmonary connections... more Patients with atriopulmonary Fontan tend to undergo conversion to total cavopulmonary connections secondary to arrhythmias or poor flow dynamics. However, the ideal candidate is unknown. Between December 1994 and May 2011, 70 patients (40 males [57%]) underwent Fontan conversion. Median age was 23 years (range, 4 to 46 years). Excluded were 1.5 ventricle conversions. The most common diagnoses included tricuspid atresia in 34 patients (49%) and double-inlet left ventricle in 16 (23%). Atrial tachyarrhythmia was present in 62 patients (89%), 41 (59%) had atrioventricular valve (AVV) regurgitation, and 32 (46%) were in New York Heart Association class III or IV. Atriopulmonary Fontan was the original connection in 58 patients (83%), whereas the Björk modification was performed in 8 (11%). Fontan was performed with an intraatrial conduit in 41 patients, an extracardiac conduit in 18, and a lateral tunnel in 11. Forty-nine patients (70%) underwent concomitant arrhythmia operations. Early...
The Annals of thoracic surgery, 2014
Transesophageal echocardiography (TEE) is often performed during cardiac operations. The need to ... more Transesophageal echocardiography (TEE) is often performed during cardiac operations. The need to repeat TEE to exclude left atrial or left atrial appendage thrombus before direct current cardioversion (DCCV) in patients with a recent intraoperative TEE showing no thrombus is unclear. We sought to determine the incidence of and risk factors for new thrombus in patients undergoing TEE-guided DCCV after cardiac operations. We reviewed 817 patients referred for TEE-guided DCCV within 30 days of a cardiac operation and an intraoperative TEE. Patients were excluded if the intraoperative TEE showed thrombus or a surgical left atrial appendage intervention was performed. Univariate logistic regression identified risk factors for thrombus. The study included 362 patients (71% male) with a mean age of 69 years. Median time from the operation to DCCV was 6 days. Thrombus was present in 13 patients (3.6%) on TEE before cardioversion; DCCV was cancelled in these patients. Heart failure was assoc...
The Annals of Thoracic Surgery, 2014
Patients with Ebstein malformation (EM) and severe RV dilatation and dysfunction have increased o... more Patients with Ebstein malformation (EM) and severe RV dilatation and dysfunction have increased operative risk. Early results with right ventricular unloading utilizing the bidirectional cavopulmonary shunt (BCPS) during repair of EM have been encouraging. We report our experience of the 1.5-ventricle repair strategy for this difficult group of patients. Between July 1999 and January 2013, 62 patients with severe EM underwent BCPS at the time of tricuspid repair. Median age was 21.5 years (range, 9 months to 57 years), 51.6% were male, and 72.5% were children. Severe RV dilatation was present in all patients; severe RV dysfunction was present in 72.5% (n=45) and moderate to severe RV dysfunction in 22.5% (n=14). Mean RV systolic pressure was 32.7±0.7 mm Hg and mean PA pressure was 15.6±2.1 mm Hg. Mean preoperative left ventricular ejection fraction (LVEF) was 0.536±0.071; it was less than 40% in 10 patients (16.1%). New York Heart Association class III/IV heart failure was present in 43 patients (69.3%) preoperatively and 20 patients (32.2%) were initially referred for heart transplant evaluation. Prior EM surgery occurred in 35.4% (n=22; 8 prior valve repair, 8 prior valve replacement, Blalock-Taussig shunt in 4, atrial septal defect (ASD) closure in 2). Tricuspid repair was performed in 51.6% (n=32, 5 had re-repair). Bioprosthetic valve replacement was performed in 48.4% (n=30, 8 had rereplacement). The BCPS was a planned procedure in 53 patients (85.5%) because of RV dysfunction; BCPS was added after unsuccessful weaning from bypass in 7 (11.2%), and in the early postoperative period due to hemodynamic instability in 2. Concomitant procedures included ASD closure in 48.3%, maze in 38.7%, and mitral valve repair in 6.4%. Postoperative extracorporeal membrane oxygenation support was needed in 8 patients. Delayed chest closure was performed in 25.8%. Early mortality was 1.6% (n=1). Mean mechanical ventilation time was 69.7 hours. Mean intensive care unit and hospital stays were 5.4±3.5 and 10.7±3.5 days, respectively. Mean follow-up was 3.6±2.6 years (maximum, 12.8 years). Patients (n=10) with low preoperative LVEF (0.362±0.035) improved to 0.517±0.042 postoperatively (p=0.001). There was 1 late death in a patient with cystic fibrosis. Late reintervention was needed in 5 patients (8%). Late follow-up was available in 95% (n=59); all were acyanotic and 88% were in New York Heart Association functional class I/II. Concomitant BCPS is a useful adjunct in repair of advanced EM with severe RV dilatation and dysfunction. Operation can be performed with low early mortality. Intermediate-term survival and quality of life is good to excellent, and transplantation can be delayed or avoided in the majority.
International Journal of Cardiology, 2015
Obesity is a risk factor for non-valvular atrial fibrillation (NVAF), diabetes mellitus, and hype... more Obesity is a risk factor for non-valvular atrial fibrillation (NVAF), diabetes mellitus, and hypertension. Adiponectin, a unique biomarker of adipose tissue, has antiinflammatory, insulin-sensitizing, and antiatherogenic properties and is known to be higher in women. The relationship between adiponectin, gender, and thromboembolic risk in atrial fibrillation however is unknown. The relationship between gender, adiponectin levels, and echocardiographic measures of blood stagnation and left atrial appendage thrombus (LAAT) was assessed in 209 patients with NVAF (55 women and 154 men; mean age 63±14years) compared to 70 normal sinus rhythm controls (29 women and 41 men; mean age 64±14years). Total adiponectin was measured by solid-phase ELISA. Demographic and clinical variables of CHADS2 and CHA2DS2-VASc were collected, and spontaneous echocardiographic contrast (SEC), left atrial appendage emptying velocity (LAAEV) and left atrium volume index (LAVI) were measured prospectively. Elevated adiponectin was associated with advanced cardiovascular pathology and permanent arrhythmia but only in men with NVAF. In NVAF men, a step-wise increase in adiponectin levels was noted relative to increasing intensity of SEC and decreasing LAAEV. Adiponectin level &amp;amp;amp;amp;amp;amp;amp;gt;16657ng/ml predicted LAAT (OR: 3.66; 95% Cl: 1.21-11.48; p=0.022) after adjustment for CHADS2 score in men but not in women with NVAF. There is a direct correlation between elevated adiponectin level and the degree of left atrial blood stasis in men but not in women with NVAF. High adiponectin levels can be used as an important variable in the prediction of LAAT.
Mayo Clinic Proceedings, 2015
To determine whether blood type affects the risk of thromboembolic complications in patients with... more To determine whether blood type affects the risk of thromboembolic complications in patients with atrial fibrillation (AF). The Mayo Clinic electronic medical record was searched (between January 1, 2004, and December 31, 2010) to identify all patients with AF with blood group assessment. Records were analyzed for stroke, transient ischemic attack, left atrium appendage thrombus, cerebral or peripheral embolism, and hemorrhagic stroke. All events were adjusted for Congestive heart failure, Hypertension, Age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;75 Years, Diabetes mellitus, and Stroke/transient ischemic attack score. Of the 47,816 patients with AF, 14,462 had blood group type available (40% women; mean age, 73±12 years). These included 12,363 patients with nonvalvular atrial fibrillation (NVAF) (40% women; mean age, 73±12 years) and 2099 patients with valvular AF (41% women, mean age, 73±12 years). Within patients with NVAF, the rate of peripheral embolization was significantly lower in those with blood type O (2.0%) than in those with other blood types (3.0%; odds ratio, 0.66; 95% CI, 0.52-0.84; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Neither cerebral thromboembolic (8.1% for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;O&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; vs 8.2% for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;non-O&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; blood group for NVAF and 7.29% vs 7.76% for valvular AF) nor cerebral hemorrhage (2.0% each group) events rates differed by blood group. Blood group O may be protective against peripheral cardioembolic complications of NVAF, which may relate, in part, to reduced circulating von Willebrand factor levels. Cerebral thromboembolic event rates did not differ by blood group.
Pacing and Clinical Electrophysiology, 2005
Atrial remodeling secondary to atrial fibrillation (AF) may be important in the arrhythmogenic pr... more Atrial remodeling secondary to atrial fibrillation (AF) may be important in the arrhythmogenic process. Unfortunately, the study of electrophysiologic remodeling in humans has been limited by the invasive nature of most tests of electrophysiologic characteristics. We sought to determine whether changes in atrial electrophysiology occur acutely (within the first hour) after cardioversion and whether these changes could be detected noninvasively by measuring the signal-averaged P-wave. The filtered P-wave duration (FPD) was measured by signal-averaged electrocardiography (ECG) at 20 and 60 minutes after cardioversion in 46 patients with AF, and the difference between the two values was calculated. The root-mean-square voltage of the terminal 40 ms of the signal-averaged P-wave at 20 and 60 minutes and the difference between them were also determined. The FPD at 20 minutes was significantly different from that at 60 minutes (153.0 +/- 19.1 vs 159.7 +/- 24.8 ms; P = 0.02). In a univariate linear regression model, none of the clinical variables studied was significantly associated with the change in FPD. The root-mean-square voltage at 20 minutes was not significantly different from that at 60 minutes (5.8 +/- 3.0 vs 5.5 +/- 2.7; P = 0.14). We conclude that significant changes in atrial electrophysiology occur within the first hour after cardioversion of AF. These changes can be detected by measuring the FPD.
Pacing and Clinical Electrophysiology, 2011
Patients with congenital heart disease and prosthetic valves frequently present management dilemm... more Patients with congenital heart disease and prosthetic valves frequently present management dilemmas related to cardiac pacing and lead placement. Permanent pacing of the right ventricle across a bioprosthetic tricuspid valve presents discreet issues related to its potential for traumatic injury and subsequent prosthetic valve dysfunction. Coronary sinus (CS) lead placement is being used more frequently to avoid valvular dysfunction. We report an unusual case in which the CS ostium was located ventricular to the tricuspid prosthesis. Intracardiac echocardiography was used to position a CS lead between the commissures of the tricuspid prosthesis resulting in trivial regurgitation acutely and at 1-year follow-up.
Mayo Clinic Proceedings, 2005
ASD = atrial septal defect; CI = confidence interval; NYHA = New York Heart Association; PVR = pu... more ASD = atrial septal defect; CI = confidence interval; NYHA = New York Heart Association; PVR = pulmonary valve replacement; PVS = pulmonary valve stenosis; RV = right ventricular
Mayo Clinic Proceedings, 2003
A lthough the association between coarctation of the aorta (CoA) and intracranial aneurysm (IA) h... more A lthough the association between coarctation of the aorta (CoA) and intracranial aneurysm (IA) has been reported, 1-7 the exact frequency of an IA in association with CoA is unknown and has not been evaluated systematically. A frequency of detection ranging from 2.5% 8 to 50% 9 has been reported, underscoring the need to determine the exact frequency of this potentially serious condition.
Journal of the American Society of Echocardiography, 1997
Partial anomalous pulmonary venous connection, a rare congenital anomaly, most commonly involves ... more Partial anomalous pulmonary venous connection, a rare congenital anomaly, most commonly involves the right lung, with one or more pulmonary veins anomalously connecting most frequently to the superior vena cava and less commonly to the right atrium or inferior vena cava. This article describes an unusual case of anomalous pulmonary venous connection of the right lung to the azygos vein in an adult. This anomaly was dearly delineated with angiography, computed tomography of the chest, and transesophageal echocardiography. The transesophageal echocardiographic features of the anomaly are described as a means to prevent further diagnostic misinterpretation. (J Am Soc Echocardiogr 1997;10:738-44.) Partial anomalous pulmonary venous connection (PAPVC), first described by Winslow in 1739, ~ is a rare congenital anomaly typified by persistence of an embryonic anastomosis between systemic veins and the pulmonary venous plexuses) -'~ The right lung is most commonly involved (80% to 90% of cases), with one or more pulmonary veins connecting most frequently to the superior vena cava and less commonly to the right atrium or inferior vena cava. 2,4,s Rarely, pulmonaly veins connect to the brachioccphalic veins, 4,6 portal vein, 7 azygos vein, s and coronary sinus. We present an unusual case of PAPVC of the right lung to the azygos vein in an adult. This anomaly was ininally missed on transesophageal echocardiography (TEE) but later was clearly delineated after angiographic diagnosis. This report highlights the TEE features of PAPVC as a means to prevent future diagnostic misinterpretation.
Journal of the American Society of Echocardiography, 2008
Background: Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonl... more Background: Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonly causes post-DCCV left atrial (LA) stunning (LAS), which may potentiate thromboembolic complications. Data on LAS determinants are inconclusive.
Journal of the American College of Cardiology, 2003
Connolly HM, Huston J., Brown RD, Warnes CA, Ammash NM, Emerson JA, Rosales AG, Jamil Tajik A.//J... more Connolly HM, Huston J., Brown RD, Warnes CA, Ammash NM, Emerson JA, Rosales AG, Jamil Tajik A.//Journal of the American College of Cardiology, 2003. Поиск в библиотеке, Расширенный поиск. ...
Journal of the American College of Cardiology, 2003
e~,, ,~a, aldws e Gu!rulo,md hq 's,ua!,ed asaq, u! uo!,~n,Shp ,ua,e, sy,, aso,xyp cl, pay, =M 'OS... more e~,, ,~a, aldws e Gu!rulo,md hq 's,ua!,ed asaq, u! uo!,~n,Shp ,ua,e, sy,, aso,xyp cl, pay, =M 'OS .a,=,s hp=a,s e ,= a,"(!=, 3!,O,s=!p ,"a,=, aq, ,3=,ap 0,,,"3g,,!p S! ,! ',anaMoH +m11e4 w,s=!p) uo!,wn,shp o!\o,shs ,"w,,!M am,!=, ,~=a!, sasnez h,(euo!s=mo s,ua!,=d D!,=qe!p p"e msuauadhq u! uogwn,shp o!,o,s=!p (/\I) ,=,">!,,"=A ,,a, :puno~iiyzeg ueder 'e,!ns '%,~a~ 1 f f sa)aqe!fJ ,,&!A SlUa!lad SA!SUSlJSdhH u! uo!43unpAa a!lolse!a syseluun Jamaueyy 6u!44!16al Aq uJa44ed MO~)U~ JejnolrluaA I4al Jalddoa u( a6Uar(3 EC-990 1 .y=daJ (ea!f%ns 40 !%!lu!, ,ew!,do au!wm,ap dlaq he!i~ xapu! sg, 'waged o!,e -um,duihs= UI 'jg lewm pue !j!,y =J=nas LMM s,ua!,=d u! otw as!3J=xa Guunp uo!,wn, -shp =~!,~=~,uo~ ~1 wa,=l leaw 04 dlaq Aelusag 40 uo!,elu!,sa an!s=fwuo~ :uo,=n,xm~ .(pOuO = d !Qp'O = J) 4%~ ,= "3 pue (~0'0 = d !Q8'0 = J) ss=J,s yead pue (LOX = d :gp'O = J) ,S=J ,e j3 L,,!M suo!,=(=m3 =,empour hluo L,,!M (~00'0 > d !L'O = 1) asp~axa yead ,= 9 L,,!M ,Saq pa,e~=Mx j!edal 4SOd 33 '(10'0 = d) IW/6HWrU 8.0 -,+ ZQ'Z 04 (rU/fjH(lurU 90 y+ QZZ um, paseam"! ~~)x~s!m~xa