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Overview of Impella and mechanical devices in cardiogenic shock

Chera, Hymie Habib; Nagar, Menachem; Chang, Nai-Lun; Morales-Mangual, Carlos; Dous, George; Marmur, Jonathan D; Ihsan, Muhammad; Madaj, Paul; Rosen, Yitzhak
INTRODUCTION:Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. The Impella (Abiomed Inc.) is an axial flow pump on a pigtail catheter that is placed across the aortic valve to unload the left ventricle by delivering non-pulsatile blood flow to the ascending aorta. It is used for high-risk percutaneous coronary intervention and CS. AREAS COVERED:Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance. We review Impella and other percutaneous devices such as intra-aortic balloon pump, TandemHeart, and extracorporeal membrane oxygenation (ECMO) and the evidence supporting their use in the setting of CS. EXPERT COMMENTARY:Impella has been proven to be safe and may be superior to other mechanical support devices in CS.
PMID: 29600725
ISSN: 1745-2422
CID: 4110962

Complications of myocardial infarction and cardiovascular emergencies

Chapter by: Chang, Nai-lun; Budzikowski, Adam S
in: Cardiology consult manual by Mieszczanska, Hanna Z; Budzikowski, Adam S (Eds)
Cham, Switzerland : Springer, [2018]
pp. ?-?
ISBN: 9783319897257
CID: 4168982

Clarithromycin-Induced Torsades de Pointes [Case Report]

Chang, Nai-Lun; Shah, Priyank; Bikkina, Mahesh; Shamoon, Fayez
Acquired QT prolongation can be caused by cardiac and noncardiac medications. Macrolides are known to prolong QT interval. Rarely, it can be fatal. We report a case of torsades de pointes in a patient taking clarithromycin as a part of Helicobacter pylori eradication regimen.
PMID: 25057773
ISSN: 1536-3686
CID: 4168942

Diagnostic Yield of Echocardiography in Syncope Patients with Normal ECG

Chang, Nai-Lun; Shah, Priyank; Bajaj, Sharad; Virk, Hartaj; Bikkina, Mahesh; Shamoon, Fayez
Aim. This study aimed to assess the role of echocardiography as a diagnostic tool in evaluating syncope patients with normal versus abnormal electrocardiogram. Methods. We conducted a retrospective study of 468 patients who were admitted with syncope in 2011 at St. Joseph's Regional Medical Center, Paterson, NJ. Hospital records and patient charts, including initial emergency room history and physical, were carefully reviewed. Patients were separated into normal versus abnormal electrocardiogram groups and then further divided as normal versus abnormal echocardiogram groups. Causes of syncope were extrapolated after reviewing all test results and records of consultations. Results. Three hundred twelve of the total patients (68.6%) had normal ECG. Two-thirds of those patients had echocardiograms; 11 patients (5.7%) had abnormal echo results. Of the aforementioned patients, three patients had previous documented history of severe aortic stenosis on prior echocardiograms. The remaining eight had abnormal but nondiagnostic echocardiographic findings. Echocardiography was done in 93 of 147 patients with abnormal ECG (63.2%). Echo was abnormal in 27 patients (29%), and the findings were diagnostic in 6.5% patients. Conclusions. This study demonstrates that echocardiogram was not helpful in establishing a diagnosis of syncope in patients with normal ECG and normal physical examination.
PMID: 26881172
ISSN: 2090-8016
CID: 4110952

Severe hemophagocytic lymphohistiocytosis as a complication of drug-induced hypersensitivity syndrome

Gauchan, Dron; Shaaban, Hamid; Parikh, Neil; Chang, Nai-Lun; Altheeb, Zaid; Maroules, Michael
PMID: 25810969
ISSN: 2229-5151
CID: 4168952

Small Bowel Obstruction Mimicking Acute ST-Elevation Myocardial Infarction

Patel, Kunal; Chang, Nai-Lun; Shulik, Oleg; DePasquale, Joseph; Shamoon, Fayez
We present a case of a 42-year-old female who presented to our institution with a small bowel obstruction and had emergent surgical decompression. Thirteen days postoperatively, the patient became tachycardic and had worsening epigastric pain. Electrocardiogram showed significant ST-segment elevations in leads II, III, aVF, and V3-V6, suggesting the possibility of acute inferolateral myocardial infarction. Subsequent workup revealed the cause of the ST-elevations to be due to recurrent small bowel obstruction. Although intra-abdominal causes of ST-elevation have been reported, our case may be the first to be associated with small bowel obstruction.
PMID: 25838963
ISSN: 2090-6900
CID: 4110942


Teli, Kunal J.; Gupta, Nishant; Parikh, Neil; Chang, Nai-Lun; Kumar, Abhishek; Bajaj, Sharad; Shamoon, Fayez; Bikkina, Mahesh
ISSN: 0735-1097
CID: 4168962

The effects of the Cox maze procedure on atrial function

Voeller, Rochus K; Zierer, Andreas; Lall, Shelly C; Sakamoto, Shun-ichiro; Chang, Nai-Lun; Schuessler, Richard B; Moon, Marc R; Damiano, Ralph J
OBJECTIVE:The effects of the Cox maze procedure on atrial function remain poorly defined. The purpose of this study was to investigate the effects of a modified Cox maze procedure on left and right atrial function in a porcine model. METHODS:After cardiac magnetic resonance imaging, 6 pigs underwent pericardiotomy (sham group), and 6 pigs underwent a modified Cox maze procedure (maze group) with bipolar radiofrequency ablation. The maze group had preablation and immediate postablation left and right atrial pressure-volume relations measured with conductance catheters. All pigs survived for 30 days. Magnetic resonance imaging was then repeated for both groups, and conductance catheter measurements were repeated for the right atrium in the maze group. RESULTS:Both groups had significantly higher left atrial volumes postoperatively. Magnetic resonance imaging-derived reservoir and booster pump functional parameters were reduced postoperatively for both groups, but there was no difference in these parameters between the groups. The maze group had significantly higher reduction in the medial and lateral left atrial wall contraction postoperatively. There was no change in immediate left atrial elastance or in the early and 30-day right atrial elastance after the Cox maze procedure. Although the initial left atrial stiffness increased after ablation, right atrial diastolic stiffness did not change initially or at 30 days. CONCLUSIONS:Performing a pericardiotomy alone had a significant effect on atrial function that can be quantified by means of magnetic resonance imaging. The effects of the Cox maze procedure on left atrial function could only be detected by analyzing segmental wall motion. Understanding the precise physiologic effects of the Cox maze procedure on atrial function will help in developing less-damaging lesion sets for the surgical treatment of atrial fibrillation.
PMID: 19026812
ISSN: 1097-685x
CID: 4110922

Surgical ablation for atrial fibrillation: the efficacy of a novel bipolar pen device in the cardioplegically arrested and beating heart

Sakamoto, Shun-ichiro; Voeller, Rochus K; Melby, Spencer J; Lall, Shelly C; Chang, Nai-lun; Schuessler, Richard B; Damiano, Ralph J
OBJECTIVE:The introduction of ablation technology has simplified surgical intervention for atrial fibrillation. However, most ablation devices cannot create focal transmural lesions on the beating heart and have difficulty ablating specific regions of the atria, such as the atrioventricular isthmus, coronary sinus, and ganglionated plexus. The purpose of this study was to examine the efficacy of a pen-type bipolar radiofrequency ablation device on both arrested and beating hearts. METHODS:Endocardial and epicardial atrial tissues in the free wall, left atrial roof, atrioventricular annuli, and coronary sinus were ablated for varying time intervals (2.5-15 seconds) in porcine cardioplegically arrested (n = 6) and beating (n = 9) hearts. The hearts were stained with 1% 2,3,5-triphenyl-tetrazolium chloride solution and sectioned to determine lesion depth and width. In 5 animals epicardial fat pads containing ganglionated plexus were stimulated and ablated. RESULTS:Lesion depth increased with ablation time similarly in both arrested and beating hearts. Transmurality was fully achieved in the thin atrial tissue (<4 mm) at 10 seconds in the beating and arrested hearts. The device had a maximal penetration depth of 6.1 mm. Epicardial ablation of the coronary sinus showed complete penetration through the left posterior atrium only in the arrested heart. Seven of 17 fat pads demonstrated a vagal response. All vagal responses were eliminated after ablation. CONCLUSION/CONCLUSIONS:The bipolar pen effectively ablated atrial tissue in both arrested and beating hearts. This device might allow the surgeon to ablate tissue in regions not accessible to other devices during atrial fibrillation surgery.
PMID: 19026819
ISSN: 1097-685x
CID: 4110932

Syncope Evaluation Unit: Safe and Cost Effective

Shah, Priyank; Bajaj, Sharad; Chang, Nai-Lun; Ng, Hanyann; Kurtz, Georgina; Johnson, Cynthia; Virk, Hartaj; Bikkina, Mahesh; Shamoon, Fayez
ISSN: 2330-4596
CID: 4168972