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Isolated Anomalous Right Superior Pulmonary Venous Return to the Inferior Vena Cava [Case Report]

Tinsay, Maria Andrea Francesca M; Halpern, Dan G; Small, Adam J
Partial anomalous pulmonary venous connection is a rare congenital abnormality. We present images from an atypical case of isolated anomalous right superior pulmonary venous return to the inferior vena cava without other cardiac abnormalities.
PMID: 35757945
ISSN: 2150-136x
CID: 5278682

Emotions, Perceptions and Health Behaviors of Adult Congenital Heart Disease Patients during COVID-19 in New York City

Feinberg, Jodi L.; Sheng, Peter; Pena, Stephanie; Small, Adam J.; Wendelboe, Susanna; Nemani, Katlyn; Agrawal, Vikram; Halpern, Dan G.
Background: Adults with congenital heart disease (ACHD) have increased prevalence of mood and anxiety dis-orders. There are limited data regarding the influence of the COVID-19 pandemic on the mental health and health behaviors of these patients. Objective: The purpose is to evaluate the perceptions, emotions, and health behaviors of ACHD patients during the COVID-19 pandemic. Methods: In this cross-sectional study of ACHD patients, we administered surveys evaluating self-reported emotions, perceptions and health behaviors. Logistic regressions were performed to determine the adjusted odds of displaying each perception, emotion and health behavior based on predictor variables. Results: Ninety-seven patients (mean age 38.3 years, 46.4% female, 85.6% moderate or complex lesion) completed the survey. The majority of patients reported feeling moderately or very sad (63.1%), and 48.4% of patients identified themselves as feeling moderately or very anxious. The majority of patients perceived their risk of COVID-19 as moderate or high. Females were more likely to report feeling sad and anxious (95% CI 1.06"“10.96, p-value 0.039, and 95% CI 1.44"“15.30, p-value = 0.012, respectively), and were associated with higher odds of having a perceived increased risk of COVID-19 (95% CI 1.33"“10.59, p-value 0.012). There was no association between ACHD anatomic or physiologic classification and perceptions, emotions and health behaviors. Conclusions: Females were more likely to report feeling sad, anxious and an increased risk of COVID-19 in comparison to males. These findings indicate the need for mental health support and promotion of health behaviors during the pandemic amongst all ACHD patients, regardless of underlying condition.
SCOPUS:85137421722
ISSN: 1747-079x
CID: 5330302

ANATOMICAL AND PHYSIOLOGICAL CORRELATES DURING EXERCISE-INDUCED HYPERTENSION IN COARCTATION OF THE AORTA [Meeting Abstract]

Ramachandran, Abhinay; Talmor, Nina; Small, Adam; Feinberg, Jodi; Halpern, Dan Gil
ISI:000781026601504
ISSN: 0735-1097
CID: 5532322

Short-Segment Type B Interrupted Aortic Arch Presenting With Subarachnoid Hemorrhage With Subsequent Primary Percutaneous Repair

Ramachandran, Abhinay; Argilla, Michael; Saharan, Sunil; Halpern, Dan; Small, Adam
This report describes a young adult man presenting with subarachnoid hemorrhage secondary to an intracranial aneurysm who was found to have a short-segment type B interrupted aortic arch. We describe the clinical presentation, evaluation, and management of this patient and highlight imaging findings and percutaneous repair of the aneurysm and interrupted aortic arch. (Level of Difficulty: Intermediate.).
PMCID:8543161
PMID: 34729511
ISSN: 2666-0849
CID: 5038122

Acquired pulmonary vein stenosis resulting in haemoptysis: a case series [Case Report]

Talmor, Nina; Massera, Daniele; Small, Adam; Ramachandran, Abhinay; Argilla, Michael; Staniloae, Cezar S; Latson, Larry A; Halpern, Dan G
Background/UNASSIGNED:Acquired pulmonary vein stenosis (PVS) is an infrequent complication of atrial fibrillation ablation that is often misdiagnosed due to predominant respiratory symptoms. It can result in pulmonary venous hypertension, with varying presentations, ranging from shortness of breath to haemoptysis. Case summary/UNASSIGNED:We report two patients with a history of paroxysmal atrial fibrillation treated with radiofrequency ablation and pulmonary vein (PV) isolation, who subsequently developed PVS. Case 1 initially presented with indolent symptoms of shortness of breath and cough. He was initially diagnosed with and treated for pneumonia. In contrast, Case 2 presented with massive haemoptysis, requiring intubation and intensive care unit admission. Both patients were eventually diagnosed with PVS by computed tomography. They were treated with PV angioplasty and stenting. Discussion/UNASSIGNED:While previously limited to the congenital heart disease population, PVS is occurring more frequently now in adult patients as a complication of ablation procedures. It is most effectively treated with angioplasty and stent implantation but has a high rate of recurrence.
PMCID:8243221
PMID: 34222784
ISSN: 2514-2119
CID: 4932892

Peripheral venous pressure accurately predicts central venous pressure in the adult Fontan circulation

Tan, Weiyi; Small, Adam; Gallotti, Roberto; Moore, Jeremy; Aboulhosn, Jamil
BACKGROUND:Patients with the Fontan circulation lack a subpulmonary ventricular pump and thus the main driver for pulmonary blood flow is a high central venous pressure. Peripheral venous pressure (PVP) measurement has been shown to be a reproducible and fairly accurate surrogate for central venous pressure (CVP), but not specifically for the adult Fontan circulation. This study aims to determine the relationship of PVP to CVP in adult Fontan patients. METHODS:All adult patients (≥18 yo) with a Fontan circulation undergoing cardiac catheterization were included. Both CVP and PVP were measured during the catheterization. The relationship between the peripheral venous and central venous pressures was assessed using simple linear regression and the Bland-Altman plot analysis for differences. RESULTS:value of 0.83 (p < 0.001). The CVP can be estimated with PVP measurements using the formula CVP = (0.86 * PVP) + 1.3. A Bland-Altman plot for PVP and CVP demonstrated that the PVP overestimated CVP by a mean of 1.2 mmHg, with a 95% limit of agreement of -5.2 mmHg to 2.8 mmHg. CONCLUSIONS:In adult Fontan patients, measuring PVP is a reliable, less-invasive, and accurate method of estimating the CVP during cardiac catheterization procedures. These findings may enable outpatient monitoring of Fontan hemodynamics.
PMID: 33189798
ISSN: 1874-1754
CID: 4734632

High-Output Heart Failure From Growth of Vascular Malformations in Multiple Gestation Pregnancy [Case Report]

Srivastava, Pratyaksh K; Vyas, Nina; Jones, Jesse; Wong, Thalia C; Holliman, Kerry; Small, Adam J; Rao, Rashmi R; Dowling, Erin P; Finn, J Paul; Duckwiler, Gary R; Reardon, Leigh C; Aboulhosn, Jamil A; Ascher, Simon B; Hogeling, Marcia; Lluri, Gentian; Yang, Eric H
PMID: 31658832
ISSN: 1941-3297
CID: 4502212

Left Atrial Wall Trauma Causing Intracardiac Thrombus After Device Closure of Patent Foramen Ovale [Case Report]

Small, Adam J; Denton, Kevin L; Aboulhosn, Jamil A
PMID: 30813771
ISSN: 1942-0080
CID: 4502202

Thromboprophylaxis in Adults With Atrio-Pulmonary Fontan

Small, Adam J; Aboulhosn, Jamil A; Lluri, Gentian
BACKGROUND:Although aspirin has been compared to warfarin for thromboembolic prophylaxis in the general Fontan population, little is known about the optimal preventative strategy for the atriopulmonary right atrium-pulmonary artery [RA-PA]) Fontan particularly. METHODS:A retrospective cohort study was performed including adult patients identified in the Ahmanson/UCLA Adult Congenital Heart Disease Center database with a history of RA-PA Fontan and use of either aspirin or warfarin as most recent primary prophylaxis against thromboembolism. Primary outcome was incident thromboembolism, defined as space-occupying lesion on imaging consistent with thrombus within the Fontan or pulmonary arterial circuit. Secondary outcomes were death, transplantation, Fontan conversion, and bleeding requiring either transfusion or invasive intervention. Follow-up was terminated upon achievement of a primary outcome or achievement of a secondary outcome other than bleeding. Kaplan-Meier analysis of freedom from thrombosis was performed. RESULTS:Twenty-six patients met inclusion criteria. Thirteen (50%) received aspirin as most recent primary prophylaxis and 13 (50%) received warfarin. Tricuspid atresia was the most common underlying diagnosis (42%), followed by double-inlet left ventricle (38%). Median age at Fontan operation was 8.2 years; median age at prophylaxis initiation was 25.9 years. After six years, the aspirin group had 50% ± 35% freedom from thrombosis and the warfarin group 92% ± 8% ( P = .15). Incidences of secondary outcomes were not significantly different between the groups. CONCLUSION:In this cohort of long-term Fontan survivors with RA-PA Fontan, the risk of thromboembolic complications is high, especially in those taking aspirin rather than warfarin. Larger studies are needed to confirm these findings.
PMID: 30157726
ISSN: 2150-136x
CID: 4502192

Cryoballoon pulmonary vein isolation after extracardiac Fontan operation [Case Report]

Small, Adam J; Buch, Eric F; Sanchez, Daniel R; Moore, Jeremy P
PMCID:6092570
PMID: 30112282
ISSN: 2214-0271
CID: 4502182