Try a new search

Format these results:

Searched for:

person:appler01

Total Results:

60


Left Atrial Appendage Thrombus Formation after Perioperative Cardioversion in the Setting of Severe Rheumatic Mitral Stenosis

Gorbaty, Benjamin J; Perelman, Seth; Applebaum, Robert M
PMID: 32482503
ISSN: 1532-8422
CID: 4468722

Klippel-Feil syndrome: A very unusual cause of severe aortic regurgitation visualized by multimodality imaging [Case Report]

Ahluwalia, Monica; Sehgal, Sankalp; Vainrib, Alan F; Applebaum, Robert; Latson, Larry; Williams, Mathew R; Saric, Muhamed
A 51-year-old man with Klippel-Feil syndrome (KFS) and immunodeficiency syndrome, status postintravenous immunoglobulin therapy, presented with shortness of breath. He was found to have severe aortic regurgitation in the setting of a trileaflet aortic valve with thickened leaflets and mild prolapse of the right coronary cusp with left ventricular dilation and borderline left ventricular ejection fraction. Although various cardiac anomalies have been described in KPS, otherwise unexplained severe aortic regurgitation has not been previously reported to the best of our knowledge. The patient underwent an uncomplicated surgical aortic valve replacement with a 25-mm Medtronic Avalus pericardial tissue valve resulting in symptomatic improvement. Intra-operative management and transesophageal echocardiography can be particularly challenging in KFS patients. We describe the first reported case of severe aortic regurgitation in KPS, review the cardiac anomalies associated with the syndrome, and highlight the clinical challenges in intra-operative management of these patients.
PMID: 31246314
ISSN: 1540-8175
CID: 3954352

Totally Endoscopic Robotic Left Atrial Appendage Closure Demonstrates High Success Rate

Ward, Alison F; Applebaum, Robert M; Toyoda, Nana; Fakiha, Ans; Neuburger, Peter J; Ngai, Jennie; Nampiaparampil, Robert G; Yaffee, David W; Loulmet, Didier F; Grossi, Eugene A
OBJECTIVE: In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates. METHODS: Before robotic mitral repair, patients underwent RLAAC; the base of the LAA was oversewn using a running 4-0 polytetrafluoroethylene suture in two layers. Postoperatively, the LAA was interrogated in multiple TEE views. Incomplete closure was defined as any flow across the LAA suture line or a residual stump of greater than 1 cm. RESULTS: Seventy-nine consecutive patients underwent RLAAC; no injuries occurred. On postrepair TEE, 73 of 79 patients had LAAs visualized well enough to thoroughly evaluate. Successful ligation was confirmed in 64 (87.7%) of 73 patients. Seven patients (9.6%) had small jet flow into the LAA; no residual stumps were noted. Two patients (2.7%) had undetermined flow. CONCLUSIONS: We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7%) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5%) and staple closure (72.7%). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients.
PMID: 28129320
ISSN: 1559-0879
CID: 2418792

Left Atrial Appendage Velocity as a Predictor of Atrial Fibrillation After Cardiac Surgery

Ngai, Jennie; Leonard, James; Echevarria, Ghislaine; Neuburger, Peter; Applebaum, Robert
OBJECTIVE: To determine if there is an association between left atrial appendage velocity and the development of postoperative atrial fibrillation (POAF). DESIGN: Single institution retrospective study performed between January 2013 and December 2013. SETTING: Single-institution, university hospital. PARTICIPANTS: Five hundred sixty-two adult patients undergoing cardiac surgery utilizing cardiopulmonary bypass. INTERVENTIONS: No interventions for the purpose of this study. MEASUREMENTS AND MAIN RESULTS: Left atrial appendage velocity, measured by transesophageal echocardiogram, ranged from 8 cm/sec to 126 cm/sec. The development of POAF within the first 3 days after cardiac surgery was 38.3%. The authors found that patients with a lower left atrial appendage velocity had a higher risk of developing POAF. In the adjusted logistic regression model, there was an 11% decrease in the odds of POAF for each 10-unit (cm/sec) increase in the left atrial appendage velocity (p = 0.044). CONCLUSIONS: Decreasing left atrial appendage velocity is an independent predictor of risk for the development of POAF following cardiac surgery with cardiopulmonary bypass.
PMID: 26706710
ISSN: 1532-8422
CID: 1884402

TEE 101 for the Mitral Repair Surgeon

Ward, Alison F; Ursomanno, Patricia; Grossi, Eugene A; Loulmet, Didier F; Applebaum, Robert
[New York] : NYUSOM Digital Press (Institute for Innovations in Medical Education), 2015
Extent: 45 p.
ISBN:
CID: 2169852

Systolic anterior motion of the mitral valve: A 30-year perspective

Loulmet, Didier F; Yaffee, David W; Ursomanno, Patricia A; Rabinovich, Annette E; Applebaum, Robert M; Galloway, Aubrey C; Grossi, Eugene A
OBJECTIVE: Systolic anterior motion (SAM) can occur after mitral valve repair (MVr), most frequently in patients with degenerative valve disease. Our initial observations (1981-1990) revealed that most patients with SAM can be successfully treated medically. Here the authors review the last 16 years of their experience with SAM after MVr. METHODS: Between January 1996 and October 2011, 1918 patients with degenerative mitral valve disease underwent MVr at our institution. We performed a retrospective analysis of SAM in this patient population. RESULTS: The incidence of SAM was 4.6% (89 of 1918) overall, 4.0% (77 of 1906) in patients who did not have SAM preoperatively (de novo). Compared with our previously published report, the incidence of SAM decreased from 6.4% to 4.0% (P = .03). Hospital mortality was 2.0% (38 of 1918) overall, 1.3% (14 of 1078) for isolated MVr. One patient with de novo SAM (1 of 77; 1.3%) died after emergency MVr. All patients with de novo SAM were successfully managed conservatively with intravenous fluids, alpha agonists, and/or beta blockers. A higher incidence of SAM was associated with a left ventricular ejection fraction greater than 60% (P = .01), posterior leaflet resection (P = .048), and hypertrophic obstructive cardiomyopathy (P < .01). The incidence of SAM was lower in patients who underwent device mitral annuloplasty with a semirigid posterior band compared with a complete ring (P = .03). CONCLUSIONS: In the more recent era, SAM occurs one-third less frequently after repair of degenerative mitral valve disease. Use of an incomplete annuloplasty band rather than a complete ring is associated with a lower incidence of SAM. The mainstay treatment of SAM continues to be medical management.
PMID: 25212050
ISSN: 0022-5223
CID: 1258352

Intimal sarcoma in the aortic arch partially obstructing the aorta with metastasis to the brain

Mecklai, Alicia; Rosenzweig, Barry; Applebaum, Robert; Axel, Leon; Grossi, Eugene; Chan, Alexander; Saric, Muhamed
Primary tumors of the aorta are rare entities. We report the unusual manifestation of an aortic intimal sarcoma that presented as a brain metastasis in a 56-year-old, otherwise healthy woman. After the brain mass had been resected, multiple imaging methods revealed pseudocoarctation and the primary tumor in the aortic arch. To our knowledge, this is the first report of the diagnosis of an aortic intimal sarcoma with use of real-time, 3-dimensional transesophageal echocardiography.
PMCID:4120511
PMID: 25120401
ISSN: 0730-2347
CID: 1131972

The windsock syndrome: subpulmonic obstruction by membranous ventricular septal aneurysm in congenitally corrected transposition of great arteries

Razzouk, Louai; Applebaum, Robert M; Okamura, Charles; Saric, Muhamed
Anomalies of the membranous portion of the interventricular septum include perimembranous ventricular septal defect and/or membranous septal aneurysm (MSA). In congenitally corrected transposition of the great arteries (L-TGA in sinus solitus), the combination of ventricular inversion and arterial transposition creates a unique anatomic substrate that fosters subpulmonic left ventricular outflow tract obstruction by an MSA. The combination of an L-TGA with subpulmonic obstruction by an MSA is referred to as the windsock syndrome. We report a case of windsock syndrome in a 25-year-old man which is to our knowledge the first three-dimensional echocardiographic description of this congenital entity.
PMID: 23808930
ISSN: 0742-2822
CID: 541722

Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization

Grossi, Eugene A; Crooke, Gregory A; DiGiorgi, Paul L; Schwartz, Charles F; Jorde, Ulrich; Applebaum, Robert M; Ribakove, Greg H; Galloway, Aubrey C; Grau, Juan B; Colvin, Stephen B
BACKGROUND: Mild and moderate functional ischemic mitral insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic mitral insufficiency at the time of isolated coronary artery bypass grafting (CABG). METHODS AND RESULTS: From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5%) with no MR, 1137 (50.7%) with mild MR, and 264 (11.8%) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expbeta = 1.49; P=0.007) and mild MR (expbeta = 1.34; P=0.033). CONCLUSIONS: Independent of ventricular function, mild and moderate functional mitral insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined
PMID: 16820640
ISSN: 1524-4539
CID: 67535

Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization [Meeting Abstract]

Grossi, EA; DiGiorgi, PL; Schwartz, CF; Ulrich, J; Applebaum, RM; Ribakove, GH; Galloway, AC; Grau, JB; Colvin, SB
ISI:000232956403300
ISSN: 0009-7322
CID: 60207