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202


Outcomes after transcatheter aortic valve replacement in patients with low versus high gradient severe aortic stenosis in the setting of preserved left ventricular ejection fraction

Shah, Binita; McDonald, Daniel; Paone, Darien; Redel-Traub, Gabriel; Jangda, Umair; Guo, Yu; Saric, Muhamed; Donnino, Robert; Staniloae, Cezar; Robin, Tonya; Benenstein, Ricardo; Vainrib, Alan; Williams, Mathew R
BACKGROUND:Transcatheter aortic valve replacement (TAVR) for low gradient (LG) severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) remains an area of clinical uncertainty. METHODS:Retrospective review identified 422 patients who underwent TAVR between September 4, 2014 and July 1, 2016. Procedural indication other than severe AS (n = 22) or LVEF <50% (n = 98) were excluded. Outcomes were defined by valve academic research consortium two criteria when applicable and compared between LG (peak velocity <4.0 m/s and mean gradient <40 mmHg; n = 73) and high gradient (HG) (n = 229) groups. The LG group was further categorized as low stroke volume index (SVI) (n = 41) or normal SVI (n = 32). Median follow-up was 747 days [interquartile range 220-1013]. RESULTS: = 0.39). CONCLUSION/CONCLUSIONS:Patients with preserved LVEF undergoing TAVR for severe AS with LG, including LG with low SVI, have no significant difference in adverse outcomes when compared to patients with HG.
PMID: 30203608
ISSN: 1540-8183
CID: 3278212

Advanced Imaging Techniques for Mitral Regurgitation

Quien, Mary M; Vainrib, Andrew F; Freedberg, Robin S; Bamira, Daniel G; Benenstein, Ricardo J; Williams, Matthew R; Saric, Muhamed
Mitral regurgitation (MR) is one of the most commonly encountered valvular lesions in clinical practice. MR can be either primary (degenerative) or secondary (functional) depending on the etiology of MR and the pathology of the mitral valve (MV). Echocardiography is the primary diagnostic tool for MR and is key in determining this etiology as well as MR severity. While clinicians usually turn to 2 Dimensional echocardiography as first-line imaging, 3 Dimensional echocardiography (3DE) has continually shown to be superior in terms of describing MV anatomy and pathology. This review article elaborates on 3DE techniques, modalities, and advances in software. Furthermore, the article demonstrates how 3DE has reformed MR evaluation and has played a vital role in determining patient management.
PMID: 30321560
ISSN: 1873-1740
CID: 3368072

Multimodality imaging of scimitar syndrome in adults: A report of four cases [Case Report]

Ngai, Calvin; Freedberg, Robin S; Latson, Larry; Argilla, Michael; Benenstein, Ricardo J; Vainrib, Alan F; Donnino, Robert; Saric, Muhamed
Partial anomalous pulmonary venous return (PAPVR) comprises a group of congenital cardiovascular anomalies associated with pulmonary venous flow directly or indirectly into the right atrium. Scimitar syndrome is a variant of PAPVR in which the right lung is drained by right pulmonary veins connected anomalously to the inferior vena cava. Surgery is the definitive treatment for scimitar syndrome. However, it is not always necessary as many patients are asymptomatic, have small left-to-right shunts, and enjoy a normal life expectancy without surgery. We report multimodality imaging in four adults with scimitar syndrome and the implications for management of this rare syndrome.
PMID: 30136740
ISSN: 1540-8175
CID: 3246482

Ultrasound imaging artifacts: How to recognize them and how to avoid them

Quien, Mary M; Saric, Muhamed
Echocardiography has become a critical tool in clinical cardiology in evaluating cardiac physiology and diagnosing cardiac disease states. However, imaging artifacts are commonly encountered and often lead to misdiagnoses of life-threatening diseases, such as aortic dissection and ventricular thrombus. It is, thus, critical for clinicians to understand these artifacts to avoid these misdiagnoses and protect patients from undue intervention. Artifacts can be broken down into two categories: those from violation of ultrasound system assumptions and those from interference by external equipment and devices. This review article discusses the most commonly encountered artifacts by category, explains their physical mechanisms, elaborates on their most common presentations, and instructs clinicians on how to avoid their misinterpretation.
PMID: 30079966
ISSN: 1540-8175
CID: 3226472

Left Atrial Appendage Occlusion/Exclusion: Procedural Image Guidance with Transesophageal Echocardiography

Vainrib, Alan F; Harb, Serge C; Jaber, Wael; Benenstein, Ricardo J; Aizer, Anthony; Chinitz, Larry A; Saric, Muhamed
Atrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. In this article, the authors describe the crucial role of two- and three-dimensional transesophageal echocardiography in the pre- and postprocedural assessment and intraprocedural guidance of percutaneous left atrial appendage (LAA) occlusion procedures. Although recent advances have been made in the field of systemic anticoagulation with the novel oral anticoagulants, these medications come with a significant risk for bleeding and are contraindicated in many patients. Because thromboembolism in atrial fibrillation typically arises from thrombi originating in the LAA, surgical and percutaneous LAA exclusion/occlusion techniques have been devised as alternatives to systemic anticoagulation. Currently, surgical LAA exclusion is typically performed as an adjunct to other cardiac surgical procedures, which limits the number of eligible patients. Recently, several percutaneously delivered devices for LAA exclusion from the systemic circulation have been developed, some of which have been shown in clinical trials to reduce the risk for thromboembolism. These devices use an either purely endocardial LAA occlusion approach, such as the Watchman and Amulet procedures, or both an endocardial and a pericardial (epicardial) approach, such as the Lariat procedure. In the Watchman and Amulet procedures, a transseptally delivered structure composed of nitinol is placed in the LAA orifice, thereby excluding the LAA from the systemic circulation. In the Lariat procedure, a magnet link is created between a transseptally delivered endocardial wire and epicardially delivered pericardial wire, followed by epicardial suture ligation of the LAA.
PMID: 29158017
ISSN: 1097-6795
CID: 2792412

OUTCOMES AFTER TRANSCATHETER MITRAL VALVE REPAIR IN PATIENTS WITH CHRONIC KIDNEY DISEASE: AN ANALYSIS OF 5,241 PATIENTS IN THE UNITED STATES [Meeting Abstract]

Shah, Binita; Vemulapalli, Sreekanth; Manandhar, Pratik; Amoroso, Nicholas; Ruiz-Maya, Tania; Staniloae, Cezar; Saric, Muhamed; Williams, Mathew
ISI:000429659704030
ISSN: 0735-1097
CID: 3055232

Intraoperative Two- and Three-Dimensional Transesophageal Echocardiography in Combined Myectomy-Mitral Operations for Hypertrophic Cardiomyopathy

Nampiaparampil, Robert G; Swistel, Daniel G; Schlame, Michael; Saric, Muhamed; Sherrid, Mark V
Transesophageal echocardiography is essential in guiding the surgical approach for patients with obstructive hypertrophic cardiomyopathy. Septal hypertrophy, elongated mitral valve leaflets, and abnormalities of the subvalvular apparatus are prominent features, all of which may contribute to left ventricular outflow tract obstruction. Surgery aims to alleviate the obstruction via an extended myectomy, often with an intervention on the mitral valve and subvalvular apparatus. The goal of intraoperative echocardiography is to assess the anatomic pathology and pathophysiology in order to achieve a safe intraoperative course and a successful repair. This guide summarizes the systematic evaluation of these patients to determine the best surgical plan.
PMID: 29502589
ISSN: 1097-6795
CID: 2974652

Echocardiography in a patient with a new murmur

Chapter by: Friedman, J; Saric, M
in: Echocardiography in the CCU by
pp. 93-112
ISBN: 9783319902784
CID: 3330102

Mediastinal Hematoma and Tracheal Compression following Transradial Percutaneous Coronary Intervention

Smilowitz, Nathaniel R; Saric, Muhamed; Attubato, Michael J; Slater, James N
Vascular complications from transradial percutaneous coronary intervention (PCI) are rare. We report an unusual case of stridor after PCI due to brachiocephalic artery perforation, pseudoaneurysm formation, and development of a large mediastinal hematoma with tracheal compression. Endovascular repair of the brachiocephalic artery was achieved with covered stent placement at the neck of the pseudoaneurysm. This case highlights the importance of careful guide catheter placement from the right radial approach. Ultimately, rapid diagnosis of vascular perforation, appropriate airway management, and prompt endovascular repair of the injured vessel is critical to the successful management of this life-threatening condition.
PMCID:5842741
PMID: 29682356
ISSN: 2090-6404
CID: 3052312

Echocardiography in acute neurologic syndrome

Chapter by: Katz, G; Saric, M
in: Echocardiography in the CCU by
pp. 113-132
ISBN: 9783319902784
CID: 3330112