pulmonary-embolism-in-transit-crossing-the-mitral-and-aortic-valve

Pulmonary Embolism In-Transit Crossing the Mitral and Aortic Valve

Hemodynamically significant pulmonary embolisms (PE) in the pulmonary artery or those crossing a patent foramen ovale (PFO) can become life-threatening ...

University of Florida

The role of ACTA2 mutations in Familial Aortic Disease has been increasingly recognized. We describe a highly penetrant variant (R118Q) in a family with aortic disease.

A highly penetrant ACTA2 mutation of thoracic aortic disease.

 In October 2018, the United Network for Organ Sharing changed their heart allocation criteria to prioritize patients on temporary mechanical circulatory support. This study assesses outcomes of patients bridged to orthotopic heart transplantation (OHT) with venoarterial extracorporeal membrane oxygenation (VA ECMO) since this change.  We conducted a retrospective single-center study of adults (≥18 years) supported with VA ECMO at the time of OHT (October 1, 2018, to December 31, 2021). The primary outcome was midterm survival.  During the study period, 117 patients underwent OHT including 52 adults ≥18 years (44%) and 65 children <18 years (56%). Among adults, 8 (15%) were supported with VA ECMO at the time of OHT and are included in this study; 75% were male ( = 6), and the median age was 52.5 (interquartile range [IQR] = 23.5 to 57.25) years. Most patients were peripherally cannulated (75%,  = 6) and supported with an intra-aortic balloon pump during the pretransplant period (87.5%,  = 7). The median ECMO duration was 7 (IQR = 4.5 to 25.25) days. Three patients experienced complications on ECMO (37.5%), including thromboembolic bowel infarction (12.5%,  = 1) and bleeding requiring reintervention (25%,  = 2). All patients survived to discharge without posttransplantation complications and were alive at the latest follow-up. The median follow-up time was 24.8 (IQR = 19.5 to 28.2) months.  Patients can be successfully bridged with VA ECMO directly to OHT with excellent midterm results. Key contributors to our outcomes include early extubation, use of bivalirudin over heparin, ambulation, and rehabilitation while on ECMO.

Contemporary Bridge to Heart Transplantation With Venoarterial Extracorporeal Membrane Oxygenation.

Coronary vasospasm involves constriction of the coronary arteries and has been described after manipulation of the coronary arteries (ie, after stenting or bypass grafting). This report details the case of a 57-year-old man who presented with an endoleak after thoracic endovascular aortic repair. He underwent a frozen elephant trunk procedure and postoperatively had diffuse coronary vasospasm, demonstrated on pre- and post-vasospasm cardiac catheterization. He required venoarterial extracorporeal membrane oxygenation for hemodynamic support and experienced complete recovery of cardiac function over the subsequent week. This case highlights the rarity of diffuse coronary vasospasm, documents its possibility after aortic surgery, and characterizes its successful treatment.

Diffuse Coronary Vasospasm After Zone 2 Debranching and Antegrade TEVAR.

Transvenous cardiac implantable electronic device (CIED) lead extraction (TLE) is susceptible to superior vena cava (SVC) injury and can be performed in the operating room (OR) or electrophysiology lab via a mechanical device or laser-powered extraction. This study reflects a contemporary experience of mechanical right-left rotational extraction by cardiac surgeons in the OR.

Article	Year
A highly penetrant ACTA2 mutation of thoracic aortic disease. Journal of cardiothoracic surgery\| PubMed ID: 38044429	2023
Contemporary Bridge to Heart Transplantation With Venoarterial Extracorporeal Membrane Oxygenation. Innovations (Philadelphia, Pa.)\| PubMed ID: 39494492	2024
Diffuse Coronary Vasospasm After Zone 2 Debranching and Antegrade TEVAR. Annals of thoracic surgery short reports\| PubMed ID: 39790615	2024
Zero superior vena cava injury lead extraction with rotational system: A contemporary experience. JTCVS open\| PubMed ID: 40061545	2025

Ryan Azarrafiy

Biography

JoVE Journal Publications

Other Publications