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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

IMPROVING ACCESS TO ADVANCED CARDIORESPIRATORY THERAPIES FOR UNDERSERVED PATIENTS AND MINORITIES WITH A MULTIDISCIPLINARY EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) PROGRAM IN A LARGE PUBLIC HOSPITAL NETWORK [Meeting Abstract]

Alviar, Carlos L.; Postelnicu, Radu; Pradhan, Deepak R.; Hena, Kerry M.; Chitkara, Nishay; Milland, Thor; Mukherjee, Vikramjit; Uppal, Amit; Goldberg, Randal I.; Divita, Michael; Asef, Fariha; Wan, Kah Loon; Vlahakis, Susan; Patel, Mansi; Mertola, Ma-Rosario; Stasolla, Vito; Bianco, Lauren; Nunemacher, Kayla M.; Yunaev, Victoria; Howe, William B.; Cruz, Jennifer; Bernard, Samuel; Bangalore, Sripal; Keller, Norma M.
ISI:000895468901089
ISSN: 0012-3692
CID: 5523002

Cardiogenic shock complicating multisystem inflammatory syndrome following COVID-19 infection: a case report

Gurin, Michael I; Lin, Yue J; Bernard, Samuel; Goldberg, Randal I; Narula, Navneet; Faillace, Robert T; Alviar, Carlos L; Bangalore, Sripal; Keller, Norma M
BACKGROUND:With the high prevalence of COVID-19 infections worldwide, the multisystem inflammatory syndrome in adults (MIS-A) is becoming an increasingly recognized entity. This syndrome presents in patients several weeks after infection with COVID-19 and is associated with thrombosis, elevated inflammatory markers, hemodynamic compromise and cardiac dysfunction. Treatment is often with steroids and intravenous immunoglobulin (IVIg). The pathologic basis of myocardial injury in MIS-A, however, is not well characterized. In our case report, we obtained endomyocardial biopsy that revealed a pattern of myocardial injury similar to that found in COVID-19 cardiac specimens. CASE PRESENTATION:A 26-year-old male presented with fevers, chills, headache, nausea, vomiting, and diarrhea 5 weeks after his COVID-19 infection. His SARS-CoV-2 PCR was negative and IgG was positive, consistent with prior infection. He was found to be in cardiogenic shock with biventricular failure, requiring inotropes and diuretics. Given concern for acute fulminant myocarditis, an endomyocardial biopsy (EMB) was performed, showing an inflammatory infiltrate consisting predominantly of interstitial macrophages with scant T lymphocytes. The histologic pattern was similar to that of cardiac specimens from COVID-19 patients, helping rule out myocarditis as the prevailing diagnosis. His case was complicated by persistent hypoxemia, and a computed tomography scan revealed pulmonary emboli. He received IVIg, steroids, and anticoagulation with rapid recovery of biventricular function. CONCLUSIONS:MIS-A should be considered as the diagnosis in patients presenting several weeks after COVID-19 infection with severe inflammation and multi-organ involvement. In our case, EMB facilitated identification of MIS-A and guided therapy. The patient's biventricular function recovered with IVIg and steroids.
PMCID:8555861
PMID: 34715788
ISSN: 1471-2261
CID: 5042902

Echocardiographic Features of COVID-19 Illness and Association with Cardiac Biomarkers [Letter]

Churchill, Timothy W; Bertrand, Philippe B; Bernard, Samuel; Namasivayam, Mayooran; Churchill, Jessica; Crousillat, Daniela; Davis, Esther F; Hung, Judy; Picard, Michael H
PMCID:7253994
PMID: 32580898
ISSN: 1097-6795
CID: 4502332

Managing tricuspid valve regurgitation: a long and winding road [Comment]

Bernard, Samuel; Hung, Judy
PMID: 31492702
ISSN: 1468-201x
CID: 4502312

Paravalvular Leaks-From Diagnosis to Management

Bernard, Samuel; Yucel, Evin
PURPOSE OF REVIEW/OBJECTIVE:As the number of surgical and transcatheter valve replacements continue to increase in the aging population, so does the incidence of paravalvular leak (PVL). Given its impact on morbidity and mortality, this article will focus on the epidemiology, clinical presentation, diagnostic assessment, and available treatments for PVL. RECENT FINDINGS/RESULTS:Despite being performed on inoperable and typically higher risk patients, short-term complication rates of transcatheter PVL closure appear relatively low (< 10%). When indirectly compared with surgical PVL closure, long-term mortality, reoperation rates and degree of symptom improvement are similar. Nonetheless, current transcatheter closure devices are off-label and repurposed from other indications. Further development of percutaneous closure devices is an essential next step in order to improve and optimize outcomes. In patients with surgical and especially transcatheter-replaced heart valves, clinicians need to maintain vigilance for the presence of PVL, particularly in those with new-onset heart failure or hemolysis. Multimodality imaging is essential to detect and quantify PVL. Echocardiography (both transthoracic and transesophageal) is the backbone of diagnosis and quantification, and cardiac computed tomography and cardiac magnetic resonance imaging play an important role in defect characterization and in periprocedural planning. For those patients who are unable to undergo surgery, transcatheter PVL closure is an appropriate next step in management as it has similar outcomes to surgical intervention when performed in a center of expertise.
PMID: 31728667
ISSN: 1092-8464
CID: 4502322

Reflections on Echocardiography in Pulmonary Embolism-Literally and Figuratively [Comment]

Bernard, Samuel; Namasivayam, Mayooran; Dudzinski, David M
PMID: 31272591
ISSN: 1097-6795
CID: 4502302

Familial Anomalous Origin of Right Coronary Artery from the Left Coronary Sinus [Case Report]

Youniss, Mohamed A; Ghoshhajra, Brian; Bernard, Samuel; Bhatt, Ami B; Aranki, Sary F; MacGillivray, Thomas E; Defaria Yeh, Doreen
Anomalous origin of a coronary artery from the opposite sinus of Valsalva is a rare congenital anomaly. The prevalence of familial clustering of coronary artery anomalies is unknown. Here we describe the case of a father and son, both of whom presented with major adverse cardiac events due to Anomalous origin of a coronary artery from the opposite sinus of Valsalva and both had right coronary artery arising from the left coronary cusp with an interarterial course.
PMID: 30227962
ISSN: 1879-1913
CID: 4502292

Intravenous heparin dosing strategy in hospitalized patients with atrial dysrhythmias

Roswell, Robert O; Greet, Brian; Shah, Sunny; Bernard, Samuel; Milin, Alexandra; Lobach, Iryna; Guo, Yu; Radford, Martha J; Berger, Jeffrey S
Patients with non-valvular atrial fibrillation (AF) have an elevated stroke risk that is 2-7 times greater than in those without AF. Intravenous unfractionated heparin (UFH) is commonly used for hospitalized patients with atrial fibrillation and atrial flutter (AFL) to prevent stroke. Dosing strategies exist for intravenous anticoagulation in patients with acute coronary syndromes and venous thromboembolic diseases, but there are no data to guide providers on a dosing strategy for intravenous anticoagulation in patients with AF/AFL. 996 hospitalized patients with AF/AFL on UFH were evaluated. Bolus dosing and initial infusion rates of UFH were recorded along with rates of stroke, thromboemobolic events, and bleeding events as defined by the International Society on Thrombosis and Haemostasis criteria. Among 226 patients included in the analysis, 76 bleeding events occurred. Using linear regression analysis, initial rates of heparin infusion ranging from 9.7 to 11.8 units/kilogram/hour (U/kg/h) resulted in activated partial thromboplastin times that were within therapeutic range. The median initial infusion rate in patients with bleeding was 13.3 U/kg/h, while in those without bleeding it was 11.4 U/kg/h; p = 0.012. An initial infusion rate >11.0 U/kg/h yielded an OR 1.95 (1.06-3.59); p = 0.03 for any bleeding event. Using IV heparin boluses neither increased the probability of attaining a therapeutic aPTT (56.1 vs 56.3 %; p = 0.99) nor did it significantly increase bleeding events in the study (35.7 vs 31.3 %; p = 0.48). The results suggest that higher initial rates of heparin are associated with increased bleeding risk. From this dataset, initial heparin infusion rates of 9.7-11.0 U/kg/h without a bolus can result in therapeutic levels of anticoagulation in hospitalized patients with AF/AFL without increasing the risk of bleeding.
PMID: 26951166
ISSN: 1573-742x
CID: 2024222

Incidence, predictors, and impact of neurological events in non-ST-segment elevation acute coronary syndromes: the ACUITY trial

Genereux, Philippe; Bernard, Samuel; Palmerini, Tullio; Caixeta, Adriano; Rosner, Gregg; Reiss, George R; Xu, Ke; Mehran, Roxana; Stone, Gregg W
Aims: We sought to describe the incidence, predictors, and impact of adverse neurological events (NE) in a non-ST-segment elevation acute coronary syndromes (NSTEACS) population undergoing percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy (MT). Methods and results: 13,819 patients with moderate and high-risk NSTEACS were enrolled in the prospective ACUITY trial. Angiography was performed within 72 hours of presentation, after which 7,789 patients (56.4%) underwent PCI, 1,539 (11.1%) underwent CABG, and 4,491 (32.5%) received MT. The rate of NE (stroke or transient ischaemic attack) at 30 days and one year and its relationship to adverse ischaemic events, including death, were assessed. Thirty-day rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.5% with MT (p<0.001). One-year rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.6% with MT (p<0.001). Independent predictors of NE at 30 days and one year included age, renal insufficiency, baseline troponin elevation, and initial treatment with CABG. The occurrence of NE was a strong independent predictor of death at 30 days and one year (HR 4.07, 95% CI [1.49, 11.11], p=0.006, and HR 4.25, 95% CI [2.37, 7.62], p<0.001, respectively). Conclusions: In the large-scale ACUITY trial, CABG was associated with a higher risk of NE at 30 days and one year compared to PCI and MT. The occurrence of NE in patients with NSTEACS was strongly associated with increased early and late mortality. Clinical Trials.gov Identifier NCT00093158.
PMID: 25022226
ISSN: 1774-024x
CID: 1075052