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Left Atrial Appendage Tilt-Up-and-Turn-Left Maneuver: A Novel Three-Dimensional Transesophageal Echocardiography Imaging Maneuver to Characterize the Left Atrial Appendage and to Improve Transcatheter Closure Guidance [Case Report]

Hayes, Dena E; Bamira, Daniel; Vainrib, Alan F; Freedberg, Robin S; Aizer, Anthony; Chinitz, Larry A; Saric, Muhamed
• Precise LAA anatomy must be established for LAA occlusion device selection. • We have developed the TUPLE maneuver, an acronym for “tilt up and turn left”. • The TUPLE maneuver facilitates LAA device selection and intraprocedural guidance.
PMID: 37970485
ISSN: 2468-6441
CID: 5610832

Bacterial endocarditis with AACEK (HACEK) organisms [Case Report]

Kuohn, Lindsey R; Ro, Richard; Bamira, Daniel; Vainrib, Alan; Freedberg, Robin; Galloway, Aubrey; Williams, Mathew R; Saric, Muhamed
INTRODUCTION/BACKGROUND:Gram-negative organisms of the AACEK group, formerly known as HACEK, rarely cause endocarditis. CASE SERIES/METHODS:We present three cases of bacterial endocarditis, involving native and prosthetic valves, caused by AACEK organisms. In two patients, Cardiobacterium hominis was the responsible organism, and in a third, Aggregatibacter aphrophilus was implicated. A dental source of infection was identified in two patients, and in all three patients, the presentation of endocarditis was subacute. DISCUSSION/CONCLUSIONS:This case series highlights the indolent nature of infection with the AACEK organisms. It also demonstrates the crucial role of multimodality imaging, especially transesophageal echocardiography, in the diagnosis of AACEk endocarditis of both native and prosthetic valves, and in delineating the extent of abscess in those with prosthetic valve infection.
PMID: 36198094
ISSN: 1540-8175
CID: 5356642

Native mitral valve staphylococcus endocarditis with a very unusual complication: Ruptured posterior mitral valve leaflet aneurysm [Case Report]

Maidman, Samuel D; Kiefer, Nicholas J; Bernard, Samuel; Freedberg, Robin S; Rosenzweig, Barry P; Bamira, Daniel; Vainrib, Alan F; Ro, Richard; Neuburger, Peter J; Basu, Atreyee; Moreira, Andre L; Latson, Larry A; Loulmet, Didier F; Saric, Muhamed
Infective endocarditis (IE) is a life-threatening disease associated with in-hospital mortality of nearly one in five cases. IE can destroy valvular tissue, which may rarely progress to aneurysm formation, most commonly at the anterior leaflet in instances of mitral valve involvement. We present a remarkable case of a patient with IE and a rare complication of a ruptured aneurysm of the posterior leaflet of the mitral valve. Two- and Three-dimensional transesophageal echocardiography, intra-operative videography, and histopathologic analysis revealed disruption at this unusual location-at the junction of the P2 and P3 scallops, surrounded by an annular abscess.
PMID: 34923683
ISSN: 1540-8175
CID: 5108652

Cor Pulmonale from Concomitant Human Immunodeficiency Virus Infection and Methamphetamine Use [Case Report]

Maidman, Samuel D; Sulica, Roxana; Freedberg, Robin S; Bamira, Daniel; Vainrib, Alan F; Ro, Richard; Latson, Larry A; Saric, Muhamed
PMID: 34430775
ISSN: 2468-6441
CID: 5148322

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

Geriatric Presentation of Idiopathic Left Ventricular Aneurysm

Dwivedi, Aeshita; Freedberg, Robin; Donnino, Robert; Vainrib, Alan; Dodson, John A; Saric, Muhamed
PMID: 30062251
ISSN: 2468-6441
CID: 3217042

Lipomatous Atrial Septal Hypertrophy: A Review of Its Anatomy, Pathophysiology, Multimodality Imaging, and Relevance to Percutaneous Interventions

Laura, Diana M; Donnino, Robert; Kim, Eugene E; Benenstein, Ricardo; Freedberg, Robin S; Saric, Muhamed
Lipomatous atrial septal hypertrophy (LASH) is a histologically benign cardiac lesion characterized by excessive fat deposition in the region of the interatrial septum that spares the fossa ovalis. The etiology of LASH remains unclear, though it may be associated with advanced age and obesity. Because of the sparing of the fossa ovalis, LASH has a pathognomonic dumbbell shape. LASH may be mistaken for various tumors of the interatrial septum. Histologically, LASH is composed of both mature and brown (fetal) adipose tissue, but the role of brown adipose tissue remains unclear. In interventional procedures requiring access to the left atrium, LASH may interfere with transseptal puncture, as traversing the thickened area can reduce the maneuverability of catheters and devices. This may cause the needle to enter the epicardial space, causing dangerous pericardial effusions. LASH was once considered a contraindication to percutaneous device closure of atrial septal defects because of an associated increased risk for incorrect device deployment. However, careful attention to preprocedural imaging and procedural intracardiac echocardiography enable interventional cardiologists to perform procedures in patients with LASH without serious complications. In this review article, the authors describe anatomic and functional aspects of LASH, with emphasis on their roles in percutaneous interventions.
PMID: 27288088
ISSN: 1097-6795
CID: 2136702

Extrinsic Esophageal Compression by Cervical Osteophytes in Diffuse Idiopathic Skeletal Hyperostosis: A Contraindication to Transesophageal Echocardiography?

Chang, Kevin; Barghash, Maya; Donnino, Robert; Freedberg, Robin S; Hagiwara, Mari; Bennett, Genevieve; Benenstein, Ricardo; Saric, Muhamed
Contraindications to transesophageal echocardiography (TEE) include various esophageal pathologies, but compression of the esophagus by vertebral osteophytes is not listed in the current American Society of Echocardiography guidelines. We report a case of diffuse idiopathic skeletal hyperostosis (DISH) in an 81-year-old man who had incidentally been found to have extrinsic esophageal compression by cervical osteophytes prior to a proposed TEE. The incidence of esophageal perforation in patients with DISH and vertebral osteophytes is not well documented. We believe these patients are at increased risk of esophageal perforation during TEE, and thus, TEE may be relatively contraindicated in patients with DISH.
PMID: 26603685
ISSN: 1540-8175
CID: 1856922

The Role of Multimodality Imaging in Percutaneous Left Atrial Appendage Suture Ligation with the LARIAT Device

Laura, Diana M; Chinitz, Larry A; Aizer, Anthony; Holmes, Douglas S; Benenstein, Ricardo; Freedberg, Robin S; Kim, Eugene E; Saric, Muhamed
Atrial fibrillation (AF), the most common cardiac arrhythmia, is a significant cause of embolic stroke. Although systemic anticoagulation is the primary strategy for preventing the thromboembolic complications of AF, anticoagulants carry major bleeding risks, and many patients have contraindications to their use. Because thromboembolism typically arises from a clot in the left atrial appendage (LAA), local therapeutic alternatives to systemic anticoagulation involving surgical or percutaneous exclusion of the LAA have been developed. Surgical exclusion of the LAA is typically performed only as an adjunct to other cardiac surgeries, thus limiting the number of eligible patients. Furthermore, surgical exclusion of the LAA is frequently incomplete, and thromboembolism may still occur. Percutaneous LAA exclusion includes two approaches: transseptal delivery of an occlusion device to the LAA and epicardial suture ligation of the LAA, the LARIAT procedure. In the LARIAT procedure, a pretied snare is placed around the epicardial surface of the LAA orifice via pericardial access. Proper snare placement is achieved with epicardial and endocardial magnet-tipped guidewires. The endocardial wire is advanced transvenously to the LAA apex after transseptal puncture. The epicardial wire, introduced into the pericardial space, achieves end-to-end union with the endocardial wire at the LAA apex. The snare is then placed over the LAA, tightened, and sutured. On the basis of early clinical experience, the LARIAT procedure has a high success rate of LAA exclusion with low risk for complications. The authors describe the indispensable role of real-time transesophageal echocardiography in the guidance of LAA epicardial suture ligation with the LARIAT device.
PMID: 24874974
ISSN: 0894-7317
CID: 1018862