Publications by authors named "Adrian daSilva-deAbreu"

29 Publications

  • Page 1 of 1

Erratum to 'Understanding Heart Failure Risk in a Diverse Cohort with Human Immunodeficiency Virus': [Mayo Clinic Proceedings 97 (2022) 433-435].

Mayo Clin Proc 2022 Apr 27. Epub 2022 Apr 27.

John Ochsner Heart and Vascular Institute Ochsner Medical Center New Orleans, LA.

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http://dx.doi.org/10.1016/j.mayocp.2022.04.002DOI Listing
April 2022

Understanding Heart Failure Risk in a Diverse Cohort With Human Immunodeficiency Virus Infection.

Mayo Clin Proc 2022 03;97(3):433-435

John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA. Electronic address:

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http://dx.doi.org/10.1016/j.mayocp.2022.01.021DOI Listing
March 2022

Diagnostic Tools for Cardiac Amyloidosis: A Pragmatic Comparison of Pathology, Imaging and Laboratories.

Curr Probl Cardiol 2022 Jan 7:101106. Epub 2022 Jan 7.

Department of Transplantation, Mayo Clinic, Jacksonville, FL.

Cardiac amyloidosis (CA) is a complex disease considered to be the most common underdiagnosed form of restrictive cardiomyopathy. Accumulation of misfolded proteins called amyloid fibrils in the extracellular space results in clinical deterioration and late diagnosis is associated with morbidity and mortality. Both types of this disease, light chain CA and transthyretin-related CA share many cardiac and extracardiac features that compromise multiple organs such as kidneys, musculoskeletal system, autonomic nervous system, and gastrointestinal tract. Early diagnosis and detection of CA are imperative. Clinicians should maintain a high degree of suspicion among patients with unexplained diastolic heart failure to implement different disease-altering therapies at the early stages of the disease. In this article, we provided a comprehensive review of multiple invasive and non-invasive cardiac imaging modalities with their respective degrees of sensitivities and specificity.
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http://dx.doi.org/10.1016/j.cpcardiol.2022.101106DOI Listing
January 2022

The sodium-glucose co-transporter 2 inhibitor dapagliflozin improves prognosis in systolic heart failure independent of the obesity paradox.

Eur J Heart Fail 2021 10 9;23(10):1673-1676. Epub 2021 Sep 9.

Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA.

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http://dx.doi.org/10.1002/ejhf.2336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628197PMC
October 2021

Feasibility and Safety of Coronary Angiography via Radial Approach in Cardiac Transplant Recipients: A Single Center Experience.

Curr Probl Cardiol 2021 Jul 24:100935. Epub 2021 Jul 24.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA. Electronic address:

Coronary angiography remains the gold standard post-transplant screening test for cardiac allograft vasculopathy. This procedure has traditionally been performed via femoral approach. Data on safety and efficacy of radial approach in cardiac transplant patients remains scarce. Single center retrospective study including all cardiac transplant patients who underwent coronary angiography via transradial approach (TRA) or transfemoral approach (TFA). Safety and efficacy outcomes were compared between the 2 groups. Primary end points included major bleeding, vascular complications, crossover to femoral approach, contrast use and radiation exposure. A total of 201 patients were included. 96 patients (47.8%) underwent angiography via TRA. At baseline, no significant differences with regards to age, gender, or traditional risk factors such as HTN, DM, hyperlipidemia were noted between the 2 groups. Most patients underwent intravascular ultrasound (n = 179, 89%) with no statistically significant differences between the 2 groups (TRA: 90.6% vs TFA: 87.6%, P = 0.5). Additionally, there were no statistically significant differences in radiation exposure, amount of contrast use and fluoroscopy time between the 2 groups. Although there were trends toward increased bleeding among TFA group, these were not statistically significant and were mostly driven by access site hematomas. Use of TRA increased over time and Conversion from TRA to TFA was low (n = 4, 4.2%). Coronary angiography via the radial approach in cardiac transplant recipients is feasible, safe and is associated with low a risk of bleeding with no significant increase in radiation exposure when compared to the traditional femoral approach.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100935DOI Listing
July 2021

FGF23 predicts outcomes in heart failure but questions remain unanswered.

Int J Cardiol 2021 09 19;338:145-146. Epub 2021 Jun 19.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.; The University of Queensland, Ochsner Clinical School, Faculty of Medicine, New Orleans, LA, USA.

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http://dx.doi.org/10.1016/j.ijcard.2021.06.036DOI Listing
September 2021

Bridging the palliative care chasm in advanced heart failure.

Int J Cardiol 2021 09 16;338:147-149. Epub 2021 Jun 16.

Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1016/j.ijcard.2021.06.010DOI Listing
September 2021

Elusive Diagnosis of Eosinophilic Myocarditis: A Case Series.

Curr Probl Cardiol 2021 Oct 27;46(10):100849. Epub 2021 Mar 27.

John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA.

We present 2 relevant cases of eosinophilic myocarditis (EM) in patients that presented with cardiogenic shock, one of whom received a durable ventricular assist device followed by heart transplantation, with the diagnosis of EM being made based on analysis of the excisional biopsy obtained during implantation of the ventricular assist device. The second patient was initially misdiagnosed with peripartum cardiomyopathy and underwent abortion, to later being diagnosed with EM through endomyocardial biopsy. These two cases highlight the importance of high clinical suspicion for EM based on eosinophilia, comorbidities, and presentation, as well as the value of early diagnosis and therapeutic interventions, including corticosteroids, and advanced heart failure therapies, such as mechanical circulatory support and heart transplantation.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100849DOI Listing
October 2021

Interactions of hypertension, obesity, left ventricular hypertrophy, and heart failure.

Curr Opin Cardiol 2021 07;36(4):453-460

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation.

Purpose Of Review: Hypertension (HTN) and obesity are major risk factors for cardiac remodeling and dysfunction, leading to left ventricular hypertrophy (LVH) and heart failure (HF). In this review, we discuss the complex mechanisms and effects of HTN and obesity, and their treatments in LVH, ventricular function, and HF.

Recent Findings: Obesity and HTN impact the heart through overlapping neurohormonal pathways. However, the relationship between obesity and cardiomyopathy is more complex, and additional metabolic and hemodynamic pathways seem to contribute to cardiac dysfunction in these patients. Weight loss and blood pressure (BP) control help to prevent and reverse at least some of the damage caused by obesity and HTN even beyond what would be expected from solely the hemodynamic changes.

Summary: Obesity and HTN cause maladaptive changes in the heart that can lead to LVH and HF. Weight loss and BP control help to, at least partially, reverse some of these changes and improve clinical outcomes in patients with HF.
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http://dx.doi.org/10.1097/HCO.0000000000000868DOI Listing
July 2021

Ruptured hemorrhagic bulla in a patient with a HeartMate 3 treated with an Amplatzer device.

Arch Cardiol Mex 2021 Mar 24. Epub 2021 Mar 24.

Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA; Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA.

A 60-year-old female with underlying emphysema and left ventricular assist device (LVAD) HeartMate 3 presented with progressive hemoptysis, dyspnea, and right chest pain. Baseline hemoglobin was 11.1 g/dL and INR 2.9.
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http://dx.doi.org/10.24875/ACM.20000331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351646PMC
March 2021

Obesity Is a Heavy Load in Cardiogenic Shock and Mechanical Circulation.

Circ Heart Fail 2021 03 12;14(3):e008300. Epub 2021 Mar 12.

John Ochsner Heart and Vascular Institute and The University of Queensland Ochsner Clinical School, New Orleans, LA.

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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.121.008300DOI Listing
March 2021

Bariatric Surgery in Patients with Obesity and Ventricular Assist Devices Considered for Heart Transplantation: Systematic Review and Individual Participant Data Meta-analysis.

J Card Fail 2021 03 25;27(3):338-348. Epub 2020 Dec 25.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana.

Background: Class II obesity (body mass index BMI ≥35 kg/m) is a contraindication to heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices, low sample sizes have made their analysis and interpretation challenging.

Methods And Results: We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every ventricular assist device patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured. Fourteen references with 29 patients were included. The mean age was 41.9 ± 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. The mean pre-BS BMI was 45.5 ± 6.6 kg/m and decreased significantly during follow-up (rho -0.671; P< .00001). Among 23 patients with documented listing status, 78.3% were listed for HT. Thirteen of 28 patients (46.4%) underwent HT at 14.4 ± 7.0 months. There were no reported deaths for the HT-free 1-year period. Median follow-up was 24 months (interquartile range, 12-30 months). Twenty-two of 28 patients (78.6%) achieved the composite outcome (BMI of<35 kg/m/HT/listing for HT/myocardial recovery) at 11 months (interquartile range, 3-17 months). Patients with a BMI<45 kg/m had a higher chance of achieving the composite outcome (P< .003).

Conclusions: BS may help patients with obesity and ventricular assist devices to lose a significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.
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http://dx.doi.org/10.1016/j.cardfail.2020.12.011DOI Listing
March 2021

Subtotal Airway Occlusion Due to Sublingual Hematoma in a Patient with Mechanical Aortic Valve on Warfarin.

Methodist Debakey Cardiovasc J 2020 Jul-Sep;16(3):249

MCGOVERN MEDICAL SCHOOL, THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON, HOUSTON, TEXAS.

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http://dx.doi.org/10.14797/mdcj-16-3-249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587325PMC
February 2021

Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note.

BMC Res Notes 2020 Sep 17;13(1):439. Epub 2020 Sep 17.

The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.

Objectives: Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight after implantation, which is associated with higher complication rates and is a contraindication for heart transplantation (HT). The objective was to analyze the outcomes of obese patients with ESHF and VADs who underwent laparoscopic sleeve gastrectomy (LSG) at Ochsner Medical Center in New Orleans, which is the only program performing VADs and HT in the State of Louisiana, and also one of the largest VAD centers in the USA.

Data Description: This dataset contains detailed baseline, perioperative, and long-term data of patients with VADs undergoing LSG. These variables were collected retrospectively from electronic medical records. Patients who achieved ≥ 50% excess BMI loss, BMI ≤ 35 kg/m, listing for HT, HT, or myocardial recovery were identified and the timing to each of these milestones was documented. These data can be used alone or in combination with other datasets to achieve a larger sample size with more power for further analysis of these variables, which include the most important, standard, and objective bariatric and ESHF outcomes of patients with VADs undergoing LSG. Elaboration of composite outcomes is feasible.
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http://dx.doi.org/10.1186/s13104-020-05272-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496210PMC
September 2020

Laparoscopic Sleeve Gastrectomy in Patients with Ventricular Assist Devices, Beyond Just Bridging to Heart Transplantation.

Obes Surg 2020 12 8;30(12):5123-5124. Epub 2020 Sep 8.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.

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http://dx.doi.org/10.1007/s11695-020-04966-7DOI Listing
December 2020

Laparoscopic Sleeve Gastrectomy in Patients with Obesity and Ventricular Assist Devices: a Comprehensive Outcome Analysis.

Obes Surg 2021 02 25;31(2):884-890. Epub 2020 Aug 25.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.

We analyzed in detail the outcomes of eight patients with ventricular assist devices (VADs) and obesity who underwent laparoscopic sleeve gastrectomy (LSG) at a single heart transplant (HT) center. This comprehensive analysis included body mass index (BMI) trends from VAD implantation to the time of LSG; BMI and percentage of excess BMI lost during follow-up; adverse outcomes; and changes in echocardiographic parameters, fasting lipids, unplanned hospitalizations, and functional status. We also identified the patients who achieved the following outcomes: listing for HT, HT, 50% excess BMI loss, and BMI < 35 kg/m. Laparoscopic sleeve gastrectomy seems to be a reasonable and effective intervention to help patients with VADs and obesity to decrease excess BMI and become candidates for HT.
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http://dx.doi.org/10.1007/s11695-020-04948-9DOI Listing
February 2021

Bariatric surgery in obese patients with ventricular assist devices.

BMC Res Notes 2020 Aug 14;13(1):382. Epub 2020 Aug 14.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.

Objectives: Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight, which may prevent them from receiving heart transplantation (HT) if their body mass index (BMI) reaches ≥ 35 kg/m. The objective was to synthesize all cases available in the literature and describe the most important outcomes of bariatric surgery (BS) in VAD patients, including BMI trends, reaching a BMI < 35 kg/m, listing for HT, achieving HT, myocardial recovery, and mortality. These data were obtained for an individual participant data (IPD) meta-analysis and include available IPD for every case in the scientific literature describing VAD patients undergoing BS during VAD support with documented postoperative BMI (and time of measurement) during follow-up.

Data Description: These data include baseline, periprocedural, and long-term outcomes for the 29 patients meeting selection criteria. The composite outcome includes reaching a BMI < 35 kg/m, listing for HT, receiving HT, and myocardial recovery, indicating significant BMI loss associated with major ESHF outcomes. As multiple centers are becoming more experienced in this field, the present data can be merged with their databases to form larger samples that will allow to perform further statistical analysis to identify outcome predictors and improve clinical protocols and outcomes.
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http://dx.doi.org/10.1186/s13104-020-05221-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427728PMC
August 2020

Characteristics and Outcomes of Pulmonary Angioplasty With or Without Stenting for Sarcoidosis-Associated Pulmonary Hypertension: Systematic Review and Individual Participant Data Meta-Analysis.

Curr Probl Cardiol 2021 Mar 19;46(3):100616. Epub 2020 May 19.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA.

Background: Pulmonary angioplasty has been performed in patients with sarcoidosis-associated pulmonary hypertension (SAPH) but most evidence comes from case reports and small case series. Overall outcomes remain unclear. We conducted an individual participant data (IPD) meta-analysis of baseline, procedural, and outcome data of pulmonary angioplasty in patients with SAPH.

Methods: We performed searches and systematically reviewed references from PubMed, Embase, Cochrane, ClinicalTrials.gov, and grey literature. We included IPD of patients who underwent pulmonary angioplasty for SAPH. Those without definitive diagnosis of sarcoidosis or with other causes of pulmonary vascular stenosis or compression were excluded.

Results: Of 1293 screened references, 7 were included. IPD was obtained for 17 patients (mean age 58.6 (±9.1) years; 82.4% female); most of whom were Scadding stages III or IV and had NYHA FC III or IV. All patients with documented changes in 6-minute-walk distance (6MWD) had a significant improvement that ranged from 12.6 to 102.4% (P < 0.01). There were no deaths during a median follow-up of 6 (3-18) months.

Conclusions: Pulmonary angioplasty with or without stenting of focal stenosis or compressions of pulmonary vessels may lead to significant improvement in 6MWD in patients with SAPH. However, this study had a small sample and some methodological limitations, such as analysis mostly of case reports and series. Randomized controlled clinical trials and/or large multicenter registry studies are needed to provide higher evidence in this topic.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100616DOI Listing
March 2021

Sarcoidosis-Associated Pulmonary Hypertension: An Updated Review and Discussion of the Clinical Conundrum.

Curr Probl Cardiol 2021 Mar 30;46(3):100506. Epub 2019 Nov 30.

Pulmonary hypertension (PH) is a life-threatening disease with complex pathophysiology. The World Health Organization has classified PH in 5 groups according to etiology, the fifth of which corresponds to PH due to unknown or multiple mechanisms; including sarcoidosis-associated PH (SAPH). Although this system has been used to guide treatment recommendations according to each group, it does not provide much insight into the heterogeneous group 5. Furthermore, pulmonary vasodilators have been contraindicated for patients in this cluster which represents a challenge for the management of SAPH which can sometimes improve with these PH-directed drugs. In this review, we discuss the classification of SAPH; as well as the evidence behind the use of pulmonary vasodilator, invasive procedures, and lung transplantation for treating SAPH; and the little that is known about his disease in the setting of cardiac sarcoidosis.
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http://dx.doi.org/10.1016/j.cpcardiol.2019.100506DOI Listing
March 2021

Predictors and Prognostic Impact of In-hospital Bleeding after Transcatheter Aortic Valve Replacement According to BARC and VARC-2 Definitions.

Braz J Cardiovasc Surg 2019 12 1;34(6):788-790. Epub 2019 Dec 1.

The University of Texas Health Science Center at Houston McGovern Medical School Texas United States of America Division of Cardiovascular Disease, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas, United States of America.

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http://dx.doi.org/10.21470/1678-9741-2019-0275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894019PMC
December 2019

One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression.

J Interv Cardiol 2019 2;2019:8947204. Epub 2019 Jan 2.

Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA.

Objective: To assess 1-year mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS).

Background: Clinical trials have proven the beneficial effect of TAVR on mortality in patients with tricuspid AS. Individuals with bicuspid AS were excluded from these trials.

Methods: A meta-analysis using literature search from the Cochrane, PubMed, ClinicalTrials, SCOPUS, and EMBASE databases was conducted to determine the effect of TAVR on 1-year mortality in patients with bicuspid AS. Short-term outcomes that could potentially impact one-year mortality were analyzed.

Results: After evaluating 380 potential articles, 5 observational studies were selected. A total of 3890 patients treated with TAVR were included: 721 had bicuspid and 3,169 had tricuspid AS. No statistically significant difference between the baseline characteristics of the two groups of patients was seen outside of mean aortic gradient. Our primary endpoint of one-year all-cause mortality revealed 85 deaths in 719 patients (11.82%) with bicuspid AS compared to 467 deaths in 3100 patients (15.06%) with tricuspid AS, with no difference between both groups [relative risk (RR) 1.03; 95% CI 0.70-1.51]. Patients with bicuspid AS were associated with a decrease in device success (RR 0.62; 95% CI 0.45-0.84) and an increase in moderate-to-severe prosthetic valve regurgitation (RR 1.55; 95% CI 1.07-2.22) after TAVR compared to patients with tricuspid AS. The effect of meta-regression coefficients on one-year all-cause mortality was not statistically significant for any patient baseline characteristics.

Conclusion: When comparing TAVR procedure in tricuspid AS versus bicuspid AS, there was no difference noted in one-year all-cause mortality.
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http://dx.doi.org/10.1155/2019/8947204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739767PMC
February 2020

A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery.

Methodist Debakey Cardiovasc J 2019 Jul-Sep;15(3):220-222

THE JOHN OCHSNER HEART & VASCULAR INSTITUTE, OCHSNER CLINIC FOUNDATION, NEW ORLEANS, LOUISIANA.

It is estimated that there are more than 210,000 hospital admissions for acute pancreatitis and more than 56,000 admissions for chronic pancreatitis each year in the United States. Pancreatitis comes with numerous complications that can increase morbidity, mortality, and length of hospital stay. Local and systemic complications include pseudocysts, necrosis, sepsis, multiorgan failure, and vascular complications. Thrombosis of the splanchnic venous system occurs in approximately 2% of patients with pancreatitis, but thrombosis is rarely seen in the arterial system. In this report, we describe a case of thrombosis of the abdominal aorta and superior mesenteric artery in a female patient who presented with acute pancreatitis.
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http://dx.doi.org/10.14797/mdcj-15-3-220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822660PMC
January 2020

Decreasing Rates of Acute Kidney Injury After Percutaneous Coronary Interventions Through Education and Standardized Order Sets in a Large Tertiary Teaching Center.

Curr Probl Cardiol 2021 Mar 22;46(3):100453. Epub 2019 Aug 22.

Acute kidney injury (AKI) is a common complication of percutaneous coronary interventions (PCI), and it is associated with increased morbidity, mortality, and healthcare costs. Post-PCI AKI is a major quality outcome measured by the National Cardiovascular Data Registry for hospitals that perform PCI. We report the experience of a large, tertiary center with high standardized, post-PCI AKI rates in which we implemented multilevel interventions that included: (1) a multidisciplinary education module for all personnel involved in care of patients undergoing cardiac angiography, (2) a standardized electronic medical record based preprocedure hydration protocol order set for patients undergoing cardiac angiography, and (3) a hydration task list to be completed by the care team the evening before the procedure or prior to admission. All this resulted in a constant decrease of the post-PCI AKI rates in remarkable magnitude, significantly stronger than the national tendency, demonstrating a center-specific behavior.
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http://dx.doi.org/10.1016/j.cpcardiol.2019.100453DOI Listing
March 2021

Acute myocardial infarction and renal dysfunction due to chronic extreme anemia (hemoglobin 2.5 g/dL) in immune thrombocytopenia.

Proc (Bayl Univ Med Cent) 2018 Oct 23;31(4):508-510. Epub 2018 Oct 23.

Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at HoustonHoustonTexas.

Immune thrombocytopenic purpura (ITP) is an acquired thrombocytopenia where autoantibodies are generated against platelet antigens. Primary ITP is often idiopathic, whereas secondary ITP has many potential causes, including drug induced, infection related (human immunodeficiency virus, hepatitis C), leukemias, or autoimmune such as systemic lupus erythematosus. ITP is a common cause of thrombocytopenia in asymptomatic individuals, where evidence of bleeding may be minor or absent. Chronic silent bleeding leading to extreme anemia in patients with ITP is rare, and evidence of multiorgan damage is even rarer; hence the relevance of this case report. Here we describe a case of primary ITP with severe chronic blood loss leading to profound anemia causing renal failure and a type II non-ST elevation myocardial infarction. Our patient underwent extensive workup for the etiology of both thrombocytopenia and anemia and was eventually treated with packed red blood cell and platelet transfusions, along with intravenous steroids and immunoglobulin therapy.
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http://dx.doi.org/10.1080/08998280.2018.1499317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413974PMC
October 2018

Incision and Drainage of a Forgotten Vascular Graft.

Methodist Debakey Cardiovasc J 2018 Jul-Sep;14(3):236

UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON, HOUSTON, TEXAS.

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http://dx.doi.org/10.14797/mdcj-14-3-236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217572PMC
May 2019

Ruptured Aortic Pseudoaneurysm: An Unusual Cause of Recurrent Lightheadedness and Cough.

Methodist Debakey Cardiovasc J 2018 Jan-Mar;14(1):66-67

MCGOVERN MEDICAL SCHOOL, THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON, HOUSTON, TEXAS.

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http://dx.doi.org/10.14797/mdcj-14-1-66DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880564PMC
March 2019

An Unusual Endovascular Therapeutic Approach for a Rare Case of May-Thurner Syndrome.

Am J Case Rep 2017 Mar 6;18:226-229. Epub 2017 Mar 6.

Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.

BACKGROUND The etiology of deep venous thrombosis (DVT) may pose a significant diagnostic challenge because truly reversible causes of DVT are rare. In this regard, known pelvic anatomic abnormalities such as aortic and iliac aneurysms should be seriously considered as a complicating factor in patients presenting with acute DVT so as not to miss a potentially curable etiology of May-Thurner syndrome (MTS). CASE REPORT We report the case of a 69-year-old man with a known abdominal aortic aneurysm and bilateral iliac artery aneurysms who presented with an acute DVT. A computed tomography scan of the abdomen and pelvis showed increased dilation of his aneurysmal disease with new resultant compression of the left iliac vein representing acquired MTS. The patient underwent endovascular aneurysm repair of the infra-renal abdominal aortic aneurysm and right common iliac artery aneurysm with a Gore Excluder endoprosthesis in lieu of venous stenting, with resolution of symptoms. CONCLUSIONS Infra-renal aortic and iliac aneurysms causing MTS are extremely rare, and patients at risk for MTS through these mechanisms do not fit the classical demographics associated with this syndrome. Furthermore, this is the first case described in which MTS was treated by addressing the aneurysm through an endoprosthetic approach instead of venous stenting, which is the conventional intervention for MTS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358844PMC
http://dx.doi.org/10.12659/ajcr.902776DOI Listing
March 2017

Hyperkalemia masked by pseudo-stemi infarct pattern and cardiac arrest.

Int J Emerg Med 2017 Dec 26;10(1). Epub 2017 Jan 26.

Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, 77030, TX, USA.

Background: Hyperkalemia is a common electrolyte abnormality and has well-recognized early electrocardiographic manifestations including PR prolongation and symmetric T wave peaking. With severe increase in serum potassium, dysrhythmias and atrioventricular and bundle branch blocks can be seen on electrocardiogram. Although cardiac arrest is a worrisome consequence of untreated hyperkalemia, rarely does hyperkalemia electrocardiographically manifest as acute ischemia.

Case Presentation: We present a case of acute renal failure complicated by malignant hyperkalemia and eventual ventricular fibrillation cardiac arrest. Recognition of this disorder was delayed secondary to an initial ECG pattern suggesting an acute ST segment elevation myocardial infarction (STEMI). Emergent coronary angiography performed showed no evidence of coronary artery disease.

Conclusions: Pseudo-STEMI patterns are rarely seen in association with acute hyperkalemia and are most commonly described with patient without acute cardiac symptomatology. This is the first such case presenting concurrently with cardiac arrest. A brief review of this rare pseudo-infarct pattern is also given.
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http://dx.doi.org/10.1186/s12245-017-0132-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5267584PMC
December 2017

Differences on Primary Care Labor Perceptions in Medical Students from 11 Latin American Countries.

PLoS One 2016 14;11(7):e0159147. Epub 2016 Jul 14.

Facultad de Medicina, Universidad Juárez, Durango, México.

Background: The shortage in Latin-American Primary Care (PC) workforce may be due to negative perceptions about it. These perceptions might be probably influenced by particular features of health systems and academic environments, thus varying between countries.

Methods: Observational, analytic and cross-sectional multicountry study that evaluated 9,561 first and fifth-year medical students from 63 medical schools of 11 Latin American countries through a survey. Perceptions on PC work was evaluated through a previously validated scale. Tertiles of the scores were created in order to compare the different countries. Crude and adjusted prevalence ratios were calculated using simple and multiple Poisson regression with robust variance.

Results: Approximately 53% of subjects were female; mean age was 20.4±2.9 years; 35.5% were fifth-year students. Statistically significant differences were found between the study subjects' country, using Peru as reference. Students from Chile, Colombia, Mexico and Paraguay perceived PC work more positively, while those from Ecuador showed a less favorable position. No differences were found among perceptions of Bolivian, Salvadoran, Honduran and Venezuelan students when compared to their Peruvian peers.

Conclusions: Perceptions of PC among medical students from Latin America vary according to country. Considering such differences can be of major importance for potential local specific interventions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159147PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945076PMC
July 2017
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