Try a new search

Format these results:

Searched for:

in-biosketch:true

person:swistd01

Total Results:

93


The Mitral Valve in Obstructive Hypertrophic Cardiomyopathy: A Test in Context

Sherrid, Mark V; Balaram, Sandhya; Kim, Bette; Axel, Leon; Swistel, Daniel G
Mitral valve abnormalities were not part of modern pathological and clinical descriptions of hypertrophic cardiomyopathy in the 1950s, which focused on left ventricular (LV) hypertrophy and myocyte fiber disarray. Although systolic anterior motion (SAM) of the mitral valve was discovered as the cause of LV outflow tract obstruction in the M-mode echocardiography era, in the 1990s structural abnormalities of the mitral valve became appreciated as contributing to SAM pathophysiology. Hypertrophic cardiomyopathy mitral malformations have been identified at all levels. They occur in the leaflets, usually elongating them, and also in the submitral apparatus, with a wide array of malformations of the papillary muscles and chordae, that can be detected by transthoracic and transesophageal echocardiography and by cardiac magnetic resonance. Because they participate fundamentally in the predisposition to SAM, they have increasingly been repaired surgically. This review critically assesses imaging and measurement of mitral abnormalities and discusses their surgical relief.
PMID: 27081025
ISSN: 1558-3597
CID: 2078502

Echocardiography before and after Resect-Plicate-Release Surgical Myectomy for Obstructive Hypertrophic Cardiomyopathy

Halpern, Dan G; Swistel, Daniel G; Po, Jose Ricardo; Joshi, Rajeev; Winson, Glenda; Arabadjian, Milla; Lopresto, Charles; Kushner, Josef; Kim, Bette; Balaram, Sandhya K; Sherrid, Mark V
BACKGROUND: Anatomic features of obstructive hypertrophic cardiomyopathy are septal hypertrophy, elongated mitral leaflets, and anterior displacement of the papillary muscles. In addition to extended myectomy, the resect-plicate-release operation adds horizontal plication of the anterior mitral leaflet (AML) and release of the anterolateral papillary muscle (APM) in selected patients. The aim of this study was to test the hypotheses that (1) preoperative findings would be associated with procedures applied, (2) anatomic corrections would be observable postoperatively, and (3) there would be consistently good physiologic outcomes. METHODS: A retrospective study was conducted of patients with obstructive hypertrophic cardiomyopathy who had adequate echocardiograms before and 9.5 +/- 12 months after the resect-plicate-release operation was performed from 2006 to 2012. RESULTS: Seventy-seven patients underwent myectomy, 50 AML plication, and 50 APM release. Patients who underwent plication had longer AMLs (32 +/- 4 vs 28 +/- 4 mm; P < .004). Anterior extension of the APM was more common with papillary muscle release (86% vs 62%, P < .04). Twenty-seven (35%) had septal thickness
PMID: 26272699
ISSN: 1097-6795
CID: 1745022

Low Operative Mortality Achieved With Surgical Septal Myectomy: Role of Dedicated Hypertrophic Cardiomyopathy Centers in the Management of Dynamic Subaortic Obstruction [Letter]

Maron, Barry J; Dearani, Joseph A; Ommen, Steve R; Maron, Martin S; Schaff, Hartzell V; Nishimura, Rick A; Ralph-Edwards, Anthony; Rakowski, Harry; Sherrid, Mark V; Swistel, Daniel G; Balaram, Sandhya; Rastegar, Hassan; Rowin, Ethan J; Smedira, Nicholas G; Lytle, Bruce W; Desai, Milind Y; Lever, Harry M
PMID: 26361164
ISSN: 1558-3597
CID: 1795302

Optimal conduit for diabetic patients: propensity analysis of radial and right internal thoracic arteries

Hoffman, Darryl M; Dimitrova, Kamellia R; Lucido, David J; Dincheva, Gabriela R; Geller, Charles M; Balaram, Sandhya K; Ko, Wilson; Swistel, Daniel G; Tranbaugh, Robert F
BACKGROUND: Multiple arterial grafts, in addition to the left internal thoracic artery, improve long-term survival after coronary artery bypass grafting (CABG); yet, the use of this procedure remains low for both the right internal thoracic artery (RITA) and the radial artery (RA). To identify the optimal arterial conduit to deploy for revascularization of diabetic patients, we compared the outcomes for RA and RITA grafts to the circumflex coronary. METHODS: From January 1, 1995, to December 31, 2011, 908 consecutive diabetic patients underwent first-time, isolated CABG (99% on-pump), 659 with the RA and 502 with the RITA, respectively, in two affiliated hospitals. Data were prospectively collected, and late mortality was determined from the Social Security Death Index. Propensity matching, based on preoperative and operative variables, identified 202 matched pairs from each group. RESULTS: Long-term survival was similar for matched patients. Mortality, myocardial infarction, reoperation for bleeding, stroke, sepsis, and renal failure were not significantly different between groups. However, deep sternal wound infection (p<0.035) and respiratory failure (p<0.048) favored the RA group, in which the total major adverse events were significantly fewer (p=0.002). CONCLUSIONS: In diabetic patients undergoing multivessel revascularization with either RA or RITA grafts to the circumflex coronary, long-term survival is similar. However, RA patients experienced significantly fewer respiratory or sternal wound adverse events. The RA is the preferred conduit to extend to more diabetic patients the recognized survival benefit of a multiple arterial graft strategy.
PMID: 24878172
ISSN: 1552-6259
CID: 1562692

The second best arterial graft: a propensity analysis of the radial artery versus the free right internal thoracic artery to bypass the circumflex coronary artery

Tranbaugh, Robert F; Dimitrova, Kamellia R; Lucido, David J; Hoffman, Darryl M; Dincheva, Gabriela R; Geller, Charles M; Balaram, Sandhya K; Ko, Wilson; Swistel, Daniel G
OBJECTIVE: We sought to determine if the radial artery (RA) or the free right internal thoracic artery (RITA) is the better conduit to bypass the circumflex coronary artery during coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA). METHODS: Propensity matching was performed on 2488 CABG-LITA patients from 2 affiliated centers, resulting in 528 pairs who received either a RA at one center or a free RITA at the other center to bypass the circumflex coronary artery from 1995 to 2009. RESULTS: Kaplan Meier estimated 1-, 5-, 10-, and 15-year survival rates were 99%, 95%, 85%, and 76% for RA patients, respectively, and 97%, 92%, 80%, and 71% for RITA patients, respectively (P = .060). Major adverse events (MAEs) were fewer in the RA group (7.6% vs 14.0%; P = .001) and use of the RA was a significant predictor of reduced MAEs (odds ratio [OR], 0.48; P = .002) in all patients and especially in diabetic (OR, 0.32; P = .003), older (OR, 0.40; P = .009), obese (OR, 0.15; P < .001), and chronic obstructive pulmonary disease (COPD) (OR, 0.05; P = .016) patients. However, survival was better with RA only in COPD (hazard ratio, 0.49; P = .045) and older (hazard ratio, 0.71; P = .050) patients. Overall RA patency (83.9%) was similar to RITA patency (87.4%) at a mean of 5.1 +/- 3.8 years (P = .155). CONCLUSIONS: Long-term survival is similar in CABG-LITA patients using either a RA or free RITA graft to bypass the circumflex coronary artery. RA grafting has fewer MAEs, a similar patency to RITA, and improves survival in older and COPD patients. The choice of the second arterial conduit should be guided by patient profiles and surgeon preferences.
PMID: 24100104
ISSN: 1097-685x
CID: 1562702

Echocardiography After Resect-Plicate-Release for Obstructive Hypertrophic Cardiomyopathy [Meeting Abstract]

Halpern, Dan G; Po, Jose Ricardo; Joshi, Rajiv; Winson, Glenda; Kim, Bette; Balaram, Sandhya K; Swistel, Dan G; Sherrid, Mark V
ISI:000332162901300
ISSN: 1524-4539
CID: 1571772

Wretched excess: stool-softener abuse and cardiogenic shock [Case Report]

Frisoli, Tiberio M; Swistel, Daniel G; Makani, Harikrishna; Sherrid, Mark V
PMID: 23968901
ISSN: 1555-7162
CID: 1562712

Treatment of obstructive hypertrophic cardiomyopathy symptoms and gradient resistant to first-line therapy with β-blockade or verapamil

Sherrid, Mark V; Shetty, Aneesha; Winson, Glenda; Kim, Bette; Musat, Dan; Alviar, Carlos L; Homel, Peter; Balaram, Sandhya K; Swistel, Daniel G
BACKGROUND:There is controversy about preferred methods to relieve obstruction in hypertrophic cardiomyopathy patients still symptomatic after β-blockade or verapamil. METHODS AND RESULTS/RESULTS:Of 737 patients prospectively registered at our institution, 299 (41%) required further therapy for obstruction for limiting symptoms, rest gradient 61 ± 45, provoked gradient 115 ± 49 mm Hg, and followed up for 4.8 years. Disopyramide was added in 221 (74%) patients and pharmacological control of symptoms was achieved in 141 (64%) patients. Overall, 138 (46%) patients had surgical relief of obstruction (91% myectomy) and 6 (2%) alcohol septal ablation. At follow-up, resting gradients in the 299 patients had decreased from 61 ± 44 to 10 ± 25 mm Hg (P<0.0001); New York Heart Association class decreased from 2.7 ± 0.7 to 1.8 ± 0.5 (P<0.0001). Kaplan-Meier survival at 10 years in the 299 advanced-care patients was 88% and did not differ from nonobstructed patients (P=0.28). Only 1 patient had sudden death, a low annual rate of 0.06%/y. Kaplan-Meier survival at 10 years in the advanced-care patients did not differ from that expected in a matched cohort of the US population (P=0.90). CONCLUSIONS:Patients with obstruction and symptoms resistant to initial pharmacological therapy with β-blockade or verapamil may realize meaningful symptom relief and low mortality through stepped management, adding disopyramide in appropriately selected patients, and when needed, by surgical myectomy.
PMID: 23704138
ISSN: 1941-3297
CID: 3123022

Vascular stent fracture and migration to pulmonary artery during arteriovenous shunt thrombectomy [Case Report]

Ho, Jessica M; Kahan, Jonathan; Supariwala, Azhar; Silberzweig, James; Kornberg, Robert; Swistel, Daniel; Dreifuss, Ronald
PURPOSE: Endovascular stent fracture and migration is an extremely rare complication of arteriovenous shunt thrombectomy. TECHNIQUE: We report a case of endovascular stent fracture following repeat arteriovenous graft thrombectomy, which was complicated by migration of a 26 millimeter stent fragment to the left main pulmonary artery. Attempts at percutaneous transvenous retrieval were unsuccessful, and an open thoracotomy to extract the stent fragment was performed. CONCLUSIONS: Although there is no consensus for the management of endovascular stents that have migrated to the pulmonary arteries, stent retrieval may be necessary in cases where arterial flow is compromised or heavy clot burden is a concern. Moreover, steps toward prevention of stent fracture and migration should be considered in order to preclude such occurrences--avoidance of puncturing the stent for hemodialysis access, discontinuation of use of the Arrow-Trerotola device through or near stents, and consideration of short segment angioplasty for regional intrastent stenosis rather than typical long segment venous angioplasty.
PMID: 23032954
ISSN: 1724-6032
CID: 1562732

OPTIMAL GRAFTING STRATEGY FOR MULTIVESSEL CORONARY ARTERY BYPASS SURGERY [Meeting Abstract]

Tranbaugh, Robert; Schwann, Thomas; Swistel, Daniel; Dimitrova, Kamellia; Al-Shaar, Laila; Hoffman, Darryl; Geller, Charles; Balaram, Sandhya; Ko, Wilson; Engoren, Milo; Habib, Robert
ISI:000316555201235
ISSN: 0735-1097
CID: 2362602