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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
PMCID:8370868
PMID: 34430775
ISSN: 2468-6441
CID: 5148322

Two cases of acute endocarditis misdiagnosed as COVID-19 infection

Hayes, Dena E; Rhee, David W; Hisamoto, Kazuhiro; Smith, Deane; Ro, Richard; Vainrib, Alan F; Bamira, Daniel; Zhou, Fang; Saric, Muhamed
The COVID-19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID-19 infection from other diseases. COVID-19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life-threatening acute endocarditis was initially misdiagnosed as COVID-19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.
PMID: 33715241
ISSN: 1540-8175
CID: 4817282

Characterization of Myocardial Injury in Patients With COVID-19

Giustino, Gennaro; Croft, Lori B; Stefanini, Giulio G; Bragato, Renato; Silbiger, Jeffrey J; Vicenzi, Marco; Danilov, Tatyana; Kukar, Nina; Shaban, Nada; Kini, Annapoorna; Camaj, Anton; Bienstock, Solomon W; Rashed, Eman R; Rahman, Karishma; Oates, Connor P; Buckley, Samantha; Elbaum, Lindsay S; Arkonac, Derya; Fiter, Ryan; Singh, Ranbir; Li, Emily; Razuk, Victor; Robinson, Sam E; Miller, Michael; Bier, Benjamin; Donghi, Valeria; Pisaniello, Marco; Mantovani, Riccardo; Pinto, Giuseppe; Rota, Irene; Baggio, Sara; Chiarito, Mauro; Fazzari, Fabio; Cusmano, Ignazio; Curzi, Mirko; Ro, Richard; Malick, Waqas; Kamran, Mazullah; Kohli-Seth, Roopa; Bassily-Marcus, Adel M; Neibart, Eric; Serrao, Gregory; Perk, Gila; Mancini, Donna; Reddy, Vivek Y; Pinney, Sean P; Dangas, George; Blasi, Francesco; Sharma, Samin K; Mehran, Roxana; Condorelli, Gianluigi; Stone, Gregg W; Fuster, Valentin; Lerakis, Stamatios; Goldman, Martin E
BACKGROUND:Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. OBJECTIVES/OBJECTIVE:This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. METHODS:We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. RESULTS:A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. CONCLUSIONS:Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.
PMID: 33121710
ISSN: 1558-3597
CID: 4646832

Recent clinical trials in valvular heart diseases

Goel, Sunny; Ro, Richard; Lerakis, Stamatios; Khera, Sahil
PURPOSE OF REVIEW/OBJECTIVE:In recent years, no other field of cardiology has experienced a greater influx of transformational therapeutic options as valvular heart disease. The present review discusses the landmark trials published in the last 18 months that have shaped the modern day management of valvular heart diseases. RECENT FINDINGS/RESULTS:There have been several landmark trials in recent years, which have expanded the indications for transcatheter aortic valve replacement to low-risk surgical patients and the use of MitraClip for patients with functional mitral regurgitation. Options for transcatheter management of right-sided valvular disease also continue to evolve, including promising results from early feasibility studies. SUMMARY/CONCLUSIONS:The development of novel transcatheter therapies for valvular heart disease has expanded the armamentarium of physicians treating patients with valvular heart disease. The present review will focus on the recent (within 2 years) trials in this field of interest.
PMID: 32398605
ISSN: 1531-7080
CID: 4482282

A Novel Method to Quantify Leaflet Insertion During Transcatheter Mitral Valve Repair With the MitraClip [Letter]

Tang, Gilbert H L; Ro, Richard J; Sengupta, Aditya; Khera, Sahil; Sharma, Samin K; Kini, Annapoorna; Lerakis, Stamatios
PMID: 32222438
ISSN: 1876-7605
CID: 4482272

Murphy's Law or Domino Effect: Severe Aortic Annular Calcification in Transcatheter Aortic Valve Replacement

Ro, Richard; Tang, Gilbert H L; Khera, Sahil; Krishnamoorthy, Parasuram; Sharma, Samin K; Kini, Annapoorna; Lerakis, Stamatios
PMID: 32208736
ISSN: 1942-0080
CID: 4482262

Echocardiographic Imaging for Transcatheter Tricuspid Edge-to-Edge Repair

Ro, Richard; Tang, Gilbert H L; Seetharam, Karthik; Khera, Sahil; Sharma, Samin K; Kini, Annapoorna S; Lerakis, Stamatios
PMID: 32089056
ISSN: 2047-9980
CID: 4482252

Stress Cardiomyopathy in a Patient with Hypertrophic Cardiomyopathy: Case Presentation and Review of the Literature [Case Report]

Vinardell, Juan M; Mihos, Christos G; Nader, Adam; Ro, Richard; Escolar, Esteban; Santana, Orlando
Stress cardiomyopathy and hypertrophic cardiomyopathy are two distinct entities with different pathophysiologic causes. In the recent medical literature their concurrency has been described. During the acute phase of a stress cardiomyopathy making the diagnosis of a concomitant hypertrophic cardiomyopathy may be challenging, and has important implications in both the acute and longterm clinical management. Herein, we present a case of a stress cardiomyopathy occurring in a patient with hypertrophic cardiomyopathy, along with a review of the literature.
PMID: 31032604
ISSN: 1530-6550
CID: 4482242

Mitral valve coaptation and its relationship to late diastolic flow: A color Doppler and vector flow map echocardiographic study in normal subjects

Sherrid, Mark V; Kushner, Josef; Yang, Georgiana; Ro, Richard
BACKGROUND: Three competing theories about the mechanism of mitral coaptation in normal subjects were evaluated by color Doppler and vector flow mapping (VFM): (1) beginning of ventricular (LV) ejection, (2) "breaking of the jet" of diastolic LV inflow, and (3) returning diastolic vortices impacting the leaflets on their LV surfaces. METHODS AND RESULTS: We analyzed 80 color Doppler frames and 320 VFM measurements. In all 20 normal subjects, coaptation occurred before LV ejection, 78+/-16 ms before onset. On color Doppler frames the larger anterior, and smaller posterior vortices circle back and, in all cases, strike the ventricular surfaces of the leaflets. On the first closing-begins frame, for the first time, vortex velocity normal to the ventricular surface of the anterior leaflet (AML) is greater than that in the mitral orifice, and the angle of attack of LV vortical flow onto the AML is twice as high as the angle of flow onto the valve in orifice. Thus, at the moment coaptation begins, vortical flow strikes the mitral leaflet with higher velocity, and higher angle of attack than orifice flow, and thus with greater force. According to the "breaking of the jet" theory, one would expect to see de novo LV flow perpendicular to the leaflets beginning after transmitral flow terminates. Instead, the returning continuous LV vortical flow that impacts the valve builds continuously after the P-wave. CONCLUSIONS: Late diastolic vortices strike the ventricular surfaces of the mitral leaflets and contribute to valve coaptation, permitted by concomitant decline in transmitral flow.
PMID: 28247433
ISSN: 1540-8175
CID: 2471272