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Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults [Case Report]

Qiu, Jessica K; Bamira, Daniel; Vainrib, Alan F; Latson, Larry A; Halpern, Dan G; Chun, Anne; Saric, Muhamed
PMID: 35602989
ISSN: 2468-6441
CID: 5232842

Response to Letter to the Editor: Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults

Qiu, Jessica K; Bamira, Daniel; Vainrib, Alan F; Latson, Larry A; Halpern, Dan G; Chun, Anne; Saric, Muhamed
PMID: 35602979
ISSN: 2468-6441
CID: 5283782

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

Mitral Valve-in-Ring Leaflet Thrombosis: A Multimodality Imaging Primer

Hayes, D E; Bamira, D; Vainrib, A F; Staniloae, C; Jilaihawi, H; Williams, M; Saric, M
ISSN: 2468-6441
CID: 5292982

Multiphase Assessment of Mitral Annular Dynamics in Consecutive Patients With Significant Mitral Valve Disease

Nakashima, Makoto; Williams, Mathew; He, Yuxin; Latson, Larry; Saric, Muhamed; Vainrib, Alan; Staniloae, Cezar; Hisamoto, Kazuhiro; Ibrahim, Homam; Querijero, Michael; Tovar, Joseph; Kalish, Chloe; Pushkar, Illya; Jilaihawi, Hasan
OBJECTIVES/OBJECTIVE:The aim of this study was to clarify the dynamics of the mitral annulus throughout the cardiac cycle and its relevance to transcatheter mitral valve replacement (TMVR) sizing and case selection. BACKGROUND:Limited data are available regarding the relevance of mitral annular (MA) and neo-left ventricular outflow tract (LVOT) dynamics in the overall population presenting with significant mitral valve disease. METHODS:Patients attending a combined surgical-transcatheter heart valve clinic for severe symptomatic mitral valve disease were assessed using multiphase computed tomography. The relative influence of MA and neo-LVOT dynamics to TMVR case selection was studied. RESULTS:A total of 476 patients with significant mitral valve disease were evaluated. In 99 consecutive patients with severe mitral regurgitation, a 10-phase assessment showed that the mitral annulus was on average largest in late systole. On comparing maximal MA dimension with late systolic dimension, TMVR size assignment changed in 24.2% of patients. If the average MA perimeter was used to determine sizing, 48.5% were excluded because of MA dimension being too large; in a multiphase assessment of the neo-LVOT, an additional 16.2% were excluded on the basis of neo-LVOT dimension. In an expanded series of 312 consecutive patients, selection protocol influenced anatomical exclusion: a manufacturer-proposed early systolic approach excluded 69.2% of patients, whereas a late systolic approach excluded 82.7% of patients, the vast majority because of large mitral annuli. CONCLUSIONS:Contemporary TMVR can treat only a minority of patients with severe mitral regurgitation, principally because of limitations of large MA dimension.
PMID: 34600871
ISSN: 1876-7605
CID: 5026992

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

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

Three-Dimensional Imaging and Dynamic Modeling of Systolic Anterior Motion of the Mitral Valve

Vainrib, Alan; Massera, Daniele; Sherrid, Mark V; Swistel, Daniel G; Bamira, Daniel; Ibrahim, Homam; Staniloae, Cezar; Williams, Mathew R; Saric, Muhamed
Left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM) is often caused by systolic anterior motion (SAM) of the mitral valve caused by the interplay between increased left ventricular (LV) wall thickness and an abnormal mitral valve anatomy and geometry. Three-dimensional (3D) echocardiographic imaging of the mitral valve has revolutionized the practice of cardiology, paving the way for new methods to see and treat valvular heart disease. Here we present the novel and incremental value of 3D transesophageal echocardiography (TEE) of SAM visualization. This review first provides step-by-step instructions on acquiring and optimizing 3D TEE imaging of SAM. It then describes the unique and novel findings using standard 3D TEE rendering as well as dynamic mitral valve modeling of SAM from 3D data sets, which can provide a more detailed visualization of SAM features. The findings include double-orifice LVOT caused by the residual leaflet, the dolphin smile phenomenon, and delineation of SAM width. Finally, the review discusses the essential role of 3D TEE imaging for preprocedural assessment and intraprocedural guidance of surgical and novel percutaneous treatments of SAM.
PMID: 33059963
ISSN: 1097-6795
CID: 4641632

Unusual Cause of Severe Tricuspid Regurgitation: Tricuspid Leaflet Annular Tear Following Remote Motor Vehicle Accident [Case Report]

Bamira, Daniel G; Dwivedi, Aeshita; Bhatla, Puneet; Halpern, Dan; Vainrib, Alan F; Kim, Eugene; Zias, Elias; Saric, Muhamed
Tricuspid regurgitation (TR) is an uncommon and underdiagnosed complication of blunt chest trauma. Typical mechanisms include torn chordae, papillary muscle rupture, and radial leaflet tear. We describe an unusual case of traumatic TR due to circumferential avulsion of the anterior tricuspid leaflet from the tricuspid annulus and the crucial role of multimodality imaging in its diagnosis and treatment. (Level of Difficulty: Intermediate.).
PMID: 34317128
ISSN: 2666-0849
CID: 4949442


Pushkar, I; Nakashima, M; Tovar, J; Kalish, C; Vainrib, A; Ibrahim, H; Hisamoto, K; Peter, N; Latson, L; Querijero, M; Saric, M; Williams, M; Jilaihawi, H
Background Computed tomography (CT) has become the standard of care for assessment for the suitability for transcatheter mitral valve replacement (TMVR); however, variation in mitral annular measurements across the cardiac cycle has thus far been poorly studied. Because of this, currently TMVR assessment is cumbersome and involves the assessment of multiple phases. We sought to further understand variation in mitral annular dimensions with the cardiac cycle and assess its potential implications for Methods A total of 118 patients presented to the heart valve clinic and underwent CT for possible TMVR assessment and were consecutively studied with multiphase CT. The mitral annulus was measured in 10 phases using 3mensio mitral planning software and several parameters collected including perimeter, area, anterior-posterior (AP) dimension and commissure-commissure (CC) dimension. Results Of the 118 patients screened, 83.9% had predominant MR, 10.2% mixed MS/MR and 5.9% predominant MS. Changes in perimeter, Area, AP and CC dimensions are shown (figure). Comparison of largest and smallest mean measurements for each phase for perimeter, Area, AP and CC dimensions showed a 2.02%, 4.36%, 8.09% and 2.86% variation respectively. Conclusion In contrast to the dynamism of the aortic annulus and neo-LVOT, the mitral annulus does not vary significantly. This may allow limitation of radiation restricting CT acquisitions to mid-systole where the neo-LVOT is smallest. [Figure presented]
ISSN: 1558-3597
CID: 4381172