12 results on '"Kiddy L Ume"'
Search Results
2. Abstract WMP95: External Validation Of Acute Atherosclerotic Ischemic Stroke Radiological Markers
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Vincent A Barnes, Alayna N Henry, Kiddy L Ume, Gary Rajah, Sudeepta Dandapat, Santiago Ortega-Gutierrez, and Fazeel M Siddiqui
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Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Intracranial atherosclerosis-related acute large vessel occlusion (ICAS-LVO) is the dominant cause of acute middle cerebral artery (MCA) occlusions that can be passed with wire or microcatheter but cannot be completely opened (5-15% of all middle cerebral artery (MCA) infarcts). The major challenge of ICAS-LVO is the tendency of reocclusion or cause a residual, fixed severe stenosis rendering the vessel with suboptimal revascularization. These patients carry a poor functional outcome and high mortality despite mechanical thrombectomy (MT). We aimed to externally validate three preidentified markers of ICAS-LVO on early non-contrast computed tomography (NCCT) and CT Angiogram (absent hyperdense MCA sign (HMCAS), Hounsfield measurements (HU ratio≤1.1 and Delta HU Methods: We conducted a retrospective analysis of 77 consecutive patients presenting with acute M1 occlusions undergoing MT. Based on our previous observational experiences, NCCT and CTA patterns that had been associated with ICAS-LVO included the absent HMCAS, HU ratio and Delta HU between site of occlusion and contralateral MCA and CTA truncal occlusion. ICAS-LVO was identified if an occlusion was difficult to cross, had tendency to reocclude after successful recanalization or demonstrated residual fixed severe stenosis. These markers were also compared with reperfusion rates and functional outcomes at 3 months. Results: Out of 77 patients, 13 (16%) had suspected ICAS-LVO. Absent HMCAS had a sensitivity of 91% and specificity of 90% (AUC 0.91), HU ratio ≤1.1 and delta HU 2) at 3 months. Conclusion: Initial non-contrast CT and CTA markers are highly sensitive and specific in predicting atherosclerotic M1 occlusions and significantly associated with failed reperfusion, and poor functional outcomes after mechanical thrombectomy.
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- 2023
3. E-050 Utility of hounsfield unit in predicting failed mechanical thrombectomy
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Mudassir Farooqui, Cynthia Zevallos, Kiddy L Ume, Fazeel M. Siddiqui, Matthew W. Weber, Sameer A. Ansari, Andres Dajles, S Ortega Gutierrez, D Quispe, and Sudeepta Dandapat
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Univariate analysis ,medicine.diagnostic_test ,business.industry ,Cerebral infarction ,medicine.medical_treatment ,Thrombolysis ,Digital subtraction angiography ,medicine.disease ,Hounsfield scale ,Angiography ,Occlusion ,medicine ,Nuclear medicine ,business ,Stroke - Abstract
Background and Purpose Despite advancement in technique, around 30% of mechanical thrombectomies (MT) for acute large vessel occlusion (LVO) are unsuccessful. Current prediction models fail to address the association between patient’s specific factors and post-procedural reperfusion. In the present study, we aim to evaluate pre-thrombectomy clinical and radiological features and their association with failed MT. Methods We retrospectively analyzed consecutive, adult, MT patients with anterior circulation LVO (2012–2017) treated at two large comprehensive stroke centers. We collected clinical and procedural data and reviewed imaging features from non-contrast enhanced head computed tomography (CT), CT angiography (CTA) and digital subtraction angiography (DSA). We performed a quantitative assessment of hyperdense vessel on CT, measuring Hounsfield unit (HU) in the occluded side and its counterpart. The primary outcome was unsuccessful recanalization measured by the Thrombolysis in Cerebral Infarction (TICI) score (0-2A). We utilized univariate and multivariate logistic regression to examine these associations. Results Out of 348 anterior LVO patients, 87 had failed MT. In univariate analysis, smoking, difficult arch, vessel tortuosity, vessel calcification specifically matching the LVO location, diminutive vessels, truncal M1 occlusion and quantitative measures for hyperdense MCA (delta HU and HU ratio) were significantly associated with failed MT. When we fitted 2 separate multivariate models delta HU or HU ratio; both delta HU Conclusions Quantitative assessment of HU utilizing delta HU and HU ratio may help identify patients refractory to standard thrombectomy strategies. Disclosures S. Ortega Gutierrez: 2; C; MEDTRONIC, STRYKER. C. Zevallos: None. F. Siddiqui: None. S. Dandapat: None. A. Dajles: None. K. Ume: None. M. Weber: None. D. Quispe: None. M. Farooqui: None. S. Ansari: None.
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- 2020
4. Abstract WP60: Absence of Hyperdense Middle Cerebral Artery Sign, as Measured on the Hounsfield Scale, Predicts Poor Functional Outcome and May Indicate Atherosclerotic Disease in Patients Undergoing Mechanical Thrombectomy for M1 Occlusion
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Cynthia Zevallos, Kiddy L Ume, Abigail Levy, Matthew W. Weber, Fazeel M. Siddiqui, Sudeepta Dandapat, and Santiago Ortega-Gutierrez
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Advanced and Specialized Nursing ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Atherosclerotic disease ,Computed tomography ,Mechanical thrombectomy ,medicine.artery ,Hounsfield scale ,Internal medicine ,Occlusion ,Middle cerebral artery ,Cardiology ,Medicine ,In patient ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Sign (mathematics) - Abstract
Introduction: The hyper-dense middle cerebral artery sign (HMCAS) on computed tomography (CT) is associated with ischemic stroke involving the middle cerebral artery (MCA) territory. While its presence is indicative of acute thromboembolic disease, the clinical implications of its absence in patients presenting with M1 occlusions have not been widely studied. Methods: We retrospectively analyzed104 consecutive patients presenting with acute M1 occlusions undergoing mechanical thrombectomy. Pertinent clinical/radiological variables were obtained from the electronic medical records and review of angiographic images. Presence of HMCAS was defined as a difference of >5 Hounsfield units (HU) between the occlusion site and the corresponding contralateral MCA segment. Patients were stratified based on the presence (HD group) vs. absence (nHD group) of HMCAS. Primary outcomes included mortality, reperfusion status (TICI), and 3-month Modified Rankin Scale (mRS). Other relevant clinical variables were statistically analyzed and compared. Statistical analyses were two-tailed and considered significant if p Results: Out of the 104 patients with M1 occlusions, 78 had a measurable HMCAS (HD group), while 22 patients did not (nHD group). 4 patients were excluded due to CT artifacts. Age (69.2 ± 16.0), presenting NIHSS (15.8 ± 5.1), and time to groin (347.0 ± 282.6 min) were similar in the two groups. Mortality and 3-month mRS were 50% and 4.4 (±1.9) in the nHD group versus 27% and 3.1 (±2.2) in the HD group, both significant, with p=0.0201. and p=0.0152, respectively. The nHD patients had significantly higher incidence of diabetes (40.9% vs. 19.2%, p=0.0178). TICI score was unfavorable (2A, 1, or 0) in 31.8% of the nHD- and 24.4% of the HD patients, although not statistically significant. Lesions were presumed to be atherosclerotic (based on cerebral angiography) in 40.9% of nHD- and 7.7% of HD cases (p=0.00006). Conclusion: Absent HMCAS - defined as a
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- 2020
5. Abstract TP59: Atherosclerosis and Unsuccessful Recanalization in Acute Stroke Patients
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Cynthia Zevallos, Fazeel M. Siddiqui, Sameer A. Ansari, Matthew Weber, Andrea Holcombe, Gloria V Lopez, Kiddy L Ume, Sudeepta Dandapat, Andres Dajles, Abigail Levy, Darko Quispe-Orozco, and Santiago Ortega-Gutierrez
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Acute stroke - Abstract
Unsuccessful recanalization rates in acute ischemic stroke patients range between 8-18%. Currently, there are no models to predict thrombectomy reperfusion success with current thrombectomy techniques. We aimed to describe the clinical and radiological features of patients with unsuccessful thrombectomy (UT) and its association with intracranial atherosclerosis (ICAD). A cohort of 413 consecutive, adult, thrombectomy patients admitted to two comprehensive stroke centers were reviewed from 2014 to 2017. Patients with anterior circulation large vessel occlusions (LVOs) and a thrombolysis in cerebral infarction (TICI) score of ≤2a were selected. Demographics, clinical and imaging data were obtained from electronic medical records. Head CT, CT angiography and digital subtraction angiography (DSA) images were reviewed by one independent investigator to evaluate ASPECTS score, vessel calcifications, clot burden score and CTA and DSA collateral score. Proposed causes of UT were categorized based on angiography evaluation by two independent neurointerventionalists. Analysis was performed using descriptive frequency analysis and univariate logistic regression models. A total of 87 low TICI score (≤2a) patients from 413 procedures were included. The median age was 74 years (IQR 58.5-84) and 58% were female. The most common comorbidity was hypertension (73.5%), followed by hyperlipidemia (46%). TICI score of 0 was found in 23% (N=20), 1 in 9.2% (N=8), and 2a in 67.8% (N=59). The inpatient mortality rate was 19.5% (17/87). Out of the remaining 70 patients, 78.5% (N=55) had a 3-month follow up modified Rankin Scale (mRS) of 3-6. The most common proposed cause of poor revascularization in our study was presence of ICAD [29.9% (n=32) of patients]. In our cohort of UT patients with ICAD, 68.8% (N=22) had TICI 2a score with majority (96.8%) having a 3 months mRS of 3-6. Patients with ICAD had 7.3% increased odds of having angiographic collateral score of 5 (p=0.035) and 15.2% increased odds of having an absence of hyperdense MCA in noncontrast CT scan (p=0.003). ICAD is frequently found in patients that undergo UT. Identification of radiological predictors of ICAD may be helpful to consider alternative revascularization strategies for LVOs.
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- 2020
6. Abstract TP58: Initial Non-Contrast Computed Tomography Predicts Atherosclerotic M1 Occlusions and Poor Functional Outcomes After Mechanical Thrombectomy
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Santiago Ortega-Gutierrez, Cynthia Zevallos, Sudeepta Dandapat, Abigail Levy, Fazeel M. Siddiqui, Matthew Weber, and Kiddy L Ume
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Advanced and Specialized Nursing ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,media_common.quotation_subject ,Computed tomography ,Mechanical thrombectomy ,medicine ,Contrast (vision) ,Neurology (clinical) ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,media_common - Abstract
Introduction: Intracranial atherosclerosis related occlusions (ICAS-O), occurring in 5-15% of all middle cerebral artery (MCA) infarcts, carry a poor functional outcome and high mortality despite mechanical thrombectomy (MT). We aimed to identify early non-contrast computed tomography (NCCT) predictors for ICAS-O and unfavorable outcomes in patients with M1 occlusions. Methods: We conducted a retrospective analysis of 104 consecutive patients presenting with acute M1 occlusions undergoing MT. Based on our previous observational experience, NCCT patterns that had been associated with atherosclerosis included the absence of visible hyperdense MCA sign, the presence of anterior temporal/insular hypodensity and the presence M1/M2 caliber asymmetry (diminutive vessels). These were used as predictors and were scored (1 for each) to build a 0-3 CT atherosclerosis score (CTAS) which was correlated with findings on cerebral angiogram, reperfusion status (TICI), 3-month Modified Rankin Scale (mRS), mortality, and other clinical variables. Results: CTAS was 3 in 16, 2 in 15, 1 in 41, and 0 in 30 patients. Two patients were excluded for poor quality NCCT. Age (69.1 ± 16.1), presenting NIHSS (15.7 ± 5.1), and time to groin (347.2 ± 281.4 min) were similar across all CTAS scores. Mortality and 3-month mRS both showed significant correlation with increasing CTAS (p=0.0198 and p=0.0111, respectively). CTAS 3 patients did poorly, carrying a mortality of 62.5%, and having a mean 3-month mRS of 5.1. The probability of unfavorable reperfusion (TICI 0, 1, and 2A) also increased with CTAS (p=0.0207). There was a significant correlation between CTAS and the presence of ICAS-O (p Conclusion: Initial non-contrast CT can be used to predict atherosclerotic M1 occlusions, failed reperfusions, and poor functional outcomes after mechanical thrombectomy. Co-existence of the above 3 predictors (CTAS 3) is more than 95% specific for atherosclerotic M1 occlusions and may identify an at-risk population that may be considered for alternative treatment approaches in the future.
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- 2020
7. Ventricular Tachycardia (VT) Substrate Characteristics: Insights from Multimodality Structural and Functional Imaging of the VT Substrate Using Cardiac MRI Scar, 123I-Metaiodobenzylguanidine SPECT Innervation, and Bipolar Voltage
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Mark F. Smith, Mohammed Abdulghani, Timm Dickfeld, Tamunoinemi Bob-Manuel, Alejandro Jimenez Restrepo, Yousra Ghzally, Kiddy L Ume, Vasken Dilsizian, Hasan Imanli, Stephen R. Shorofsky, Vincent See, Refael Itah, Wengen Chen, Jean Jeudy, and Jagat Bandhu Mahat
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medicine.medical_specialty ,Ischemic cardiomyopathy ,business.industry ,123i mibg ,030204 cardiovascular system & hematology ,medicine.disease ,Ventricular tachycardia ,030218 nuclear medicine & medical imaging ,Functional imaging ,03 medical and health sciences ,0302 clinical medicine ,Fibrosis ,Internal medicine ,Cardiology ,Medicine ,Late gadolinium enhancement ,Radiology, Nuclear Medicine and imaging ,Bipolar voltage ,business ,Cardiac imaging - Abstract
Postischemic adaptation results in characteristic myocardial structural and functional changes in the ventricular tachycardia (VT) substrate. The aim of this study was to compare myocardial structural and functional adaptations (late gadolinium enhancement/abnormal innervation) with detailed VT mapping data to identify regional heterogeneities in postischemic changes. Methods: Fifteen patients with ischemic cardiomyopathy and drug-refractory VT underwent late gadolinium enhancement cardiac MRI (CMR), 123I-metaiodobenzylguanidine SPECT, and high-resolution bipolar voltage mapping to assess fibrosis (>3 SDs), abnormal innervation ( 0.05). However, any single modality underestimated the total VT substrate area defined as abnormal in at least 1 of the 3 modalities (76.0 cm2 [57.9-143.2 cm2]; P < 0.001). Within the total VT substrate area, regions abnormal in all 3 modalities were most common (25.2%). However, significant parts of the VT substrate had undergone heterogeneous adaptation (abnormal in
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- 2018
8. Abstract WP277: Clinical Utility and Cost-Effectiveness of Transthoracic Echocardiogram in Lacunar Strokes
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Fazeel M. Siddiqui, Vismay Thakkar, Widad Abou Chaar, Gary Hendricks, Riley Kraus, David Forgas, Aaron Fleming, and Kiddy L Ume
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Cost effectiveness ,Stroke care ,medicine.disease ,body regions ,Emergency medicine ,Medicine ,cardiovascular diseases ,Neurology (clinical) ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Background: The average annual cost of inpatient stroke care in the United States exceeds $35 billion. The lack of clear recommendations for the use of transthoracic echocardiography (TTE) in patients with Acute ischemic stroke (AIS) has made this test a universal component of every stroke work-up. We evaluated the clinical utility and cost-effectiveness of TTE performed in patients with lacunar strokes. Methods: This is a single-center retrospective analysis of AIS patients from October 2015 through December 2017 (27 months). Brain MRI was used to select patients with a single acute/subacute lacunar infarct and no T2FLAIR evidence of previous cortical embolic strokes. Patients with cardiac symptoms (chest pain, shortness of breath, pedal edema) or an abnormal ECG (Atrial fibrillation, other arrhythmias, ST-T changes) on admission were excluded. Results of TTE were reviewed and their utility in decision making was evaluated. TTE associated costs were calculated. Results: Out of the 442 patients diagnosed with AIS in the given timeframe , 98 met the above criteria for inclusion. Mean age was 55 and 40 patients were female.TTE revealed no patients with an ejection fraction below 40%. Incidence of cardiac thrombus was 0%. Small patent foramen ovale was found in 5 (5.1%) patients, out of which none had right to left shunting or associated atrial septal aneurysm. Obtaining TTE did not change the management in any of the cases. Average cost of inpatient TTE was $2616, totaling $266,832 in all patients. Based on the current incidence of lacunar strokes (15-25%), this corresponds to approximately $500 million of nationwide spending annually. Conclusion: In AIS patients with no cardiac symptoms and normal ECG, it may be safe and clinically reasonable to obtain MRI brain before deciding about the need for TTE. If MRI shows a lacunar stroke, inpatient TTE done routinely may not change the management but adds up unnecessary cost to the healthcare system. Large multi-center studies are warranted.
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- 2019
9. Ventricular Tachycardia (VT) Substrate Characteristics: Insights from Multimodality Structural and Functional Imaging of the VT Substrate Using Cardiac MRI Scar
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Hasan, Imanli, Kiddy L, Ume, Jean, Jeudy, Tamunoinemi, Bob-Manuel, Mark F, Smith, Wengen, Chen, Mohammed, Abdulghani, Yousra, Ghzally, Jagat Bandhu, Mahat, Refael, Itah, Alejandro, Restrepo, Vincent Y, See, Stephen, Shorofsky, Vasken, Dilsizian, and Timm, Dickfeld
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Male ,Tomography, Emission-Computed, Single-Photon ,3-Iodobenzylguanidine ,Tachycardia, Ventricular ,Feasibility Studies ,Humans ,Female ,Heart ,Magnetic Resonance Imaging ,Multimodal Imaging ,Aged - Abstract
Postischemic adaptation results in characteristic myocardial structural and functional changes in the ventricular tachycardia (VT) substrate. The aim of this study was to compare myocardial structural and functional adaptations (late gadolinium enhancement/abnormal innervation) with detailed VT mapping data to identify regional heterogeneities in postischemic changes.
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- 2018
10. Is cold blood cardioplegia absolutely superior to cold crystalloid cardioplegia in aortic valve surgery?
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Daniel Alejandro Lerman, Bruno Péault, Nasri Alotti, Pablo A Salgado, Kevin Lim, Kiddy L Ume, Sai Prasad, and Matilde Otero-Losada
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Male ,medicine.medical_treatment ,Medicina Clínica ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,Postoperative Complications ,Aortic valve replacement ,law ,purl.org/becyt/ford/3.2 [https] ,Hospital Mortality ,Stroke ,Cardioplegic Solutions ,Cold Blood Cardioplegia ,Heart Valve Prosthesis Implantation ,Cardiopulmonary Bypass ,General Medicine ,Treatment Outcome ,Anesthesia ,Aortic Valve ,Cardiology ,Heart Arrest, Induced ,Female ,purl.org/becyt/ford/3 [https] ,Medicina Critica y de Emergencia ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,CIENCIAS MÉDICAS Y DE LA SALUD ,Aortic Valve Surgery ,Blood Component Transfusion ,Myocardial Reperfusion Injury ,Crystalloid Cardioplegia ,Patient Readmission ,Article ,Sepsis ,03 medical and health sciences ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Humans ,Aged ,Retrospective Studies ,Mechanical ventilation ,business.industry ,Crystalloid Solutions ,medicine.disease ,Aortic cross-clamp ,Platelet transfusion ,030228 respiratory system ,Respiratory failure ,Surgery ,Isotonic Solutions ,business - Abstract
BACKGROUND:Experimental evidence suggests that blood cardioplegia (BCP) may be superior to cold crystalloid cardioplegia (CCP) for myocardial protection. However, robust clinical data are lacking. We compared post-operative outcome of patients undergoing aortic valve replacement (AVR) using cold anterograde-retrograde intermittent BCP versus anterograde (CCP).METHODS:Adult consecutive isolated AVR performed between April 2006 and February 2011 at the Royal Infirmary Hospital of Edinburgh were retrospectively analyzed. The use of anterograde CCP was compared with that of intermittent anterograde-retrograde cold BCP. End points were intra-operative mortality, 30-day hospital re-admission, need for RBC or platelet transfusion, mechanical ventilation time and renal failure.RESULTS:Of total 774 cases analyzed, 592 cases of BCP and 182 cases of CCP were identified. Demographics did not differ between groups (mean patient age in years): 67±12 CCP and 69±12 BCP. Groups (BCP vs CCP) were indistinguishable (p > 0.05, NS) based on: average aortic cross clamp time (min) 77.01±14.47 vs 75.78±18.78, cardiopulmonary bypass time (min) 104.07±43.70 vs 100.34±25.90, surgery time (min) 190.53±61.80 vs 204.04±51.09 and post-operative total blood consumption (units) 1.38±2.11 vs 1.61±2.4. The percentage of patients who required platelets´ transfusion was similar: 12.8% BCP and 18.7% CCP (Fisher exact test, p=0.053). Prevalence of respiratory failure was lower in BCP than in CCP: 2.6% vs 6.3% (p=0.028). Admission time (days) at ICU was 3.63± 21.90 in BCP and 3.07 ± 8.04 in CCP (NS). Intra-hospital mortality, 30-day hospital re-admission, renal failure, sepsis, wound healing and stroke did not differ between groups.CONCLUSIONS:BCP was strictly not superior to CCP in every aspect. In particular it was definitely not superior in terms of post-operative ventricular function. Our results question the absolute superiority of BCP over CCP in terms of hard outcomes. Likelihood of serious complications should be considered to improve risk profile of patients before choosing a cardioplegic solution. Fil: Lerman, Daniel A.. University of Edinburgh; Reino Unido Fil: Otero-Losada, Matilde Estela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina Fil: Ume, Kiddy. Southern Illinois University; Estados Unidos Fil: Salgado, Pablo A.. Universidad de Buenos Aires. Facultad de Odontología; Argentina. Ministerio de Salud de la Nación; Argentina Fil: Prasad, Sai. University of Edinburgh; Reino Unido Fil: Lim, Kevin. University of Edinburgh; Reino Unido Fil: Péault, Bruno. University of Edinburgh; Reino Unido Fil: Alotti, Nasri. Pécs University; Hungría
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- 2017
11. Cardiac Repair and Regeneration: The Value of Cell Therapies
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Kiddy L Ume, Daniel Alejandro Lerman, Bruno Péault, and Nasri Alotti
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,Heart disease ,business.industry ,Mesenchymal stem cell ,Bioinformatics ,medicine.disease ,Embryonic stem cell ,Article ,03 medical and health sciences ,030104 developmental biology ,Heart failure ,medicine ,Myocardial infarction ,Progenitor cell ,Stem cell ,Cardiology and Cardiovascular Medicine ,business ,Induced pluripotent stem cell - Abstract
Ischaemic heart disease is the predominant contributor to cardiovascular morbidity and mortality; one million myocardial infarctions occur per year in the USA, while more than five million patients suffer from chronic heart failure. Recently, heart failure has been singled out as an epidemic and is a staggering clinical and public health problem associated with significant mortality, morbidity and healthcare expenditures, particularly among those aged ≥ 65 years. Death rates have improved dramatically over the last four decades, but new approaches are nevertheless urgently needed for those patients who go on to develop ventricular dysfunction and chronic heart failure. Over the past decade, stem cell transplantation has emerged as a promising therapeutic strategy for acute or chronic ischaemic cardiomyopathy. Multiple candidate cell types have been used in preclinical animal models and in humans to repair or regenerate the injured heart, either directly or indirectly (through paracrine effects), including: embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), neonatal cardiomyocytes, skeletal myoblasts (SKMs), endothelial progenitor cells, bone marrow mononuclear cells (BMMNCs), mesenchymal stem cells (MSCs) and, most recently, cardiac stem cells (CSCs). Although no consensus has emerged yet, the ideal cell type for the treatment of heart disease should: (a) improve heart function; (b) create healthy and functional cardiac muscle and vasculature, integrated into the host tissue; (c) be amenable to delivery by minimally invasive clinical methods; (d) be available ‘off the shelf’ as a standardised reagent; (e) be tolerated by the immune system; (f) be safe oncologically, i.e. not create tumours; and (g) circumvent societal ethical concerns. At present, it is not clear whether such a ‘perfect’ stem cell exists; what is apparent, however, is that some cell types are more promising than others. In this brief review, we provide ongoing data on agreement and controversy arising from clinical trials and touch upon the future directions of cell therapy for heart disease.
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- 2016
12. Early Results of a Novel Mitral Valve Repair Procedure: The Interpapillary Polytetrafluoroethylene Bridge Formation
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Daniel Alejandro Lerman, Kiddy L Ume, Károly Gombocz, Aref Rashed, Nasri Alotti, and Amer Sayour
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Surgical repair ,Neochordae ,medicine.medical_specialty ,Mitral regurgitation ,Mitral valve repair ,Ischemic cardiomyopathy ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Transesophageal echocardiogram ,medicine.disease ,Article ,Surgery ,medicine.anatomical_structure ,Internal medicine ,Papillary muscle ,medicine ,Cardiology ,business ,Mitral valve regurgitation ,Artery - Abstract
Early Results of a Novel Mitral Valve Repair Procedure: The Interpapillary Polytetrafluoroethylene Bridge Formation Objective: Background: Surgical repair of ischemic mitral regurgitation (IMR) associated with chordal rupture in patients with ischemic cardiomyopathy is challenging as it aims to correct several structural pathologies at once. There are ongoing studies evaluating multiple approaches, however long term results are still scarce. Methods and Results: 19 patients with IMR underwent mitral valve repair with interpapillary polytetrafluoroethylene (PTFE) bridge and neochordae formation at the Zala County Teaching Hospital. Concomitant coronary artery bypass grafting was performed in all patients. Post-procedural Transesophageal Echocardiogram (TEE) showed no mitral regurgitation (MR) in eighteen (94.7%) patients, with a leaflet coaptation mean height of 8 ± 3 mm. No operative mortality was observed. At the follow up (mean 17.7 ± 4.6 months; range 9 to 24 months), 17 (89%) patients showed no leakage and 2 had regurgitation grade ≤1, with documented NYHA functional class I or II in all patients. Conclusion: This retrospective study presents the first results of a novel surgical approach to treating ischemic mitral regurgitation. The interpapillary PTFE bridge formation is a safe and feasible surgical procedure that is reproducible, time sparing and effectively eliminates mitral valve regurgitation with promising long-term results.
- Published
- 2016
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