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Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction

Zhang, Robert S; Ro, Richard; Bamira, Daniel; Vainrib, Alan; Zhang, Lily; Nayar, Ambika C; Saric, Muhamed; Bernard, Samuel
PURPOSE OF REVIEW/OBJECTIVE:Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS/RESULTS:The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
PMID: 38526749
ISSN: 1534-3170
CID: 5644472

Percutaneous Debulking of a Tricuspid Valve Papillary Fibroelastoma: A Rare Presentation and Management Approach

Zhang, Robert S; Harari, Rafael; Kelly, Sean M; Talmor, Nina; Rhee, Aaron J; Panhwar, Muhammad S; Yee-Chang, Melissa; Nayar, Ambika C; Keller, Norma M; Alviar, Carlos L; Bangalore, Sripal
PMID: 38047386
ISSN: 1942-0080
CID: 5597802

Outcomes After Tricuspid Valve Operations in Patients With Drug-Use Infective Endocarditis

Siddiqui, Emaad; Alviar, Carlos L; Ramachandran, Abhinay; Flattery, Erin; Bernard, Samuel; Xia, Yuhe; Nayar, Ambika; Keller, Norma; Bangalore, Sripal
The increase of intravenous drug use has led to an increase in right-sided infective endocarditis and its complications including septic pulmonary embolism. The objective of this study was to compare the outcomes of tricuspid valve (TV) operations in patients with drug-use infective endocarditis (DU-IE) complicated by septic pulmonary emboli (PE). Hospitalizations for DU-IE complicated by septic PE were identified from the National Inpatient Sample from 2002 to 2019. Outcomes of patients who underwent TV operations were compared with medical management. The primary outcome was the incidence of major adverse cardiovascular events (MACEs), defined as in-hospital mortality, myocardial infarction, stroke, cardiogenic shock, or cardiac arrest. An inverse probability of treatment weighted analysis was utilized to adjust for the differences between the cohorts. A total of 9,029 cases of DU-IE with septic PE were identified (mean age 33.6 years), of which 818 patients (9.1%) underwent TV operation. Surgery was associated with a higher rate of MACE (14.5% vs 10.8%, p <0.01), driven by a higher rate of cardiogenic shock (6.1% vs 1.2%, p <0.01) but a lower rate of mortality (2.7% vs 5.7%, p <0.01). Moreover, TV operation was associated with an increased need for permanent pacemakers, blood transfusions, and a higher risk of acute kidney injury. In the inverse probability treatment weighting analysis, TV operation was associated with an increased risk for MACE driven by a higher rate of cardiogenic shock and cardiac arrest, but a lower rate of mortality when compared with medical therapy alone. In conclusion, TV operations in patients with DU-IE complicated by septic PE are associated with an increased risk for MACE but a decreased risk of mortality. Although surgical management may be beneficial in some patients, alternative options such as percutaneous debulking should be considered given the higher risk.
PMID: 36280471
ISSN: 1879-1913
CID: 5365292

Endoscopy-guided transesophageal echocardiography for large esophageal varices: Use of the "Double Barrel" technique [Case Report]

Rhee, David W; Nayar, Ambika C; Yan, Joe L; Gausman, Valerie; Park, David S; Vareedayah, Ashley A
Rhythm control strategies in patients with esophageal varices and atrial arrhythmias pose a unique challenge. The left atrium should be imaged for a thrombus prior to attempting cardioversion or ablation, but the presence of varices is a relative contraindication for transesophageal echocardiography. We present a safe, novel technique of evaluating for left atrial thrombus with simultaneous transesophageal echocardiography and esophagogastroduodenoscopy using slim probes in a patient with large, high-risk esophageal varices, and symptomatic atrial flutter with rapid ventricular rates despite medical therapy.
PMID: 34713478
ISSN: 1540-8175
CID: 5042812

Diagnostic Performance of Cardiac Magnetic Resonance Imaging and Echocardiography in Evaluation of Cardiac and Paracardiac Masses

Patel, Rima; Lim, Ruth P; Saric, Muhamed; Nayar, Ambika; Babb, James; Ettel, Mark; Axel, Leon; Srichai, Monvadi B
Echocardiography is the preferred initial imaging method for assessment of cardiac masses. Cardiac magnetic resonance (CMR) imaging, with its excellent tissue characterization and wide field of view, may provide additional unique information. We evaluated the predictive value of echocardiography and CMR imaging parameters to identify tumors and malignancy and to provide histopathologic diagnosis of cardiac masses. Fifty patients who underwent CMR evaluation of a cardiac mass with subsequent histopathologic diagnosis were identified. Echocardiography was available in 44 of 50 cases (88%). Echocardiographic and CMR characteristics were evaluated for predictive value in distinguishing tumor versus nontumor and malignant versus nonmalignant lesions using histopathology as the gold standard. The Wilcoxon rank-sum test was used to compare the 2 imaging methods' ability to provide the correct histopathologic diagnosis. Parameters associated with tumor included location outside the right atrium, T2 hyperintensity, and contrast enhancement. Parameters associated with malignancy included location outside the cardiac chambers, nonmobility, pericardial effusion, myocardial invasion, and contrast enhancement. CMR identified 6 masses missed on transthoracic echocardiography (4 of which were outside the heart) and provided significantly more correct histopathologic diagnoses compared to echocardiography (77% vs 43%, p <0.0001). In conclusion, CMR offers the advantage of identifying paracardiac masses and providing crucial information on histopathology of cardiac masses.
PMID: 26552505
ISSN: 1879-1913
CID: 1834702

Right coronary artery aneurysm with aneurysmal dilation and thrombosis of the sinoatrial nodal branch mimicking a right atrial mass

Vaughn, Jennifer; Nayar, Ambika C; Srichai, Monvadi B
Aneurysms of the branches of the coronary arteries are rare. We report a case of a right coronary artery aneurysm with aneurysmal dilation and thrombosis of the sinoatrial nodal branch presenting as a right atrial mass. The patient underwent multiple imaging evaluations before coronary CT angiography diagnosed aneurysm and thrombosis of the sinoatrial nodal branch.
PMID: 24582048
ISSN: 1876-861x
CID: 829582

Cardiac Magnetic Resonance Findings in a Case of Carnitine Deficiency

Ascunce, Rebecca Rudominer; Nayar, Ambika C; Phoon, Colin K L Mphil; Srichai, Monvadi B
PMID: 23468586
ISSN: 0730-2347
CID: 240822

Loeffler's endocarditis in hypereosinophilic syndrome [Case Report]

Mannelli, Lorenzo; Cherian, Varghese; Nayar, Ambika; Srichai-Parsia, Monvadi
PMID: 22607934
ISSN: 0363-0188
CID: 980532

Metastatic cerebral malignant fibrous histiocytoma masquerading as neurocysticercosis

Graber, Jerome J; Nayar, Ambika; Zagzag, David
PMID: 21544703
ISSN: 1573-7373
CID: 139728

A Case of an Anomalous Superior Vena Cava with Anomalous Pulmonary Veins-When Two Wrongs Do not Make a Right

Hong, Susie N; Nayar, Ambika; Srichai, Monvadi B; Morgan, Jeffrey A; Meyer, David; Katz, Edward
Intravenous agitated saline injection is useful in identifying right-to-left shunting at the atrial or intrapulmonary level. Anomalous systemic venous drainage to the left atrium is a rare but easily correctable cause of right-to-left shunting which, if left undiagnosed, may have serious consequences, including meningitis and pyogenic brain abscesses. This case illustrates an unusual cause of right-to-left shunting and the utility of venous microbubble injection in its diagnosis. (Echocardiography 2011;28:E39-E41)
PMID: 20678126
ISSN: 1540-8175
CID: 122531