99 results on '"Larry E. Jacobs"'
Search Results
2. The day of the week and acute heart failure admissions: Relationship with acute myocardial infarction, 30-day readmission rate and in-hospital mortality
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Larry E Jacobs Md, Matthew W. Martinez, Mahek Shah, Vincent M. Figueredo, Nilay Patel, Sopan Lahewala, Brijesh Patel, Shilpkumar Arora, and Soumya Patnaik
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Names of the days of the week ,education ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Logistic regression ,Patient Readmission ,Coronary artery disease ,Young Adult ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,After-Hours Care ,Risk Factors ,Diabetes mellitus ,Severity of illness ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Myocardial infarction ,Intensive care medicine ,Aged ,Aged, 80 and over ,Heart Failure ,business.industry ,Incidence (epidemiology) ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Heart failure ,Acute Disease ,Emergency medicine ,Female ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
In-hospital care may be constrained during the weekend due to lesser resources. Impact on outcomes of weekend versus weekday care in congestive heart failure (HF) needs further study.Admissions with a primary diagnosis of HF using ICD-9CM codes were studied. 22,287 HF-admissions from Einstein Medical Center (2003-2013) and 2,248,482 HF-admissions from the 2002-2012 Nationwide Inpatient Sample (NIS) were analyzed separately. Primary outcomes were 30-day HF-readmission and in-hospital mortality. Logistic regression models were used to evaluate outcomes.Weekends experienced lower rates of admission and discharge. Mondays experienced the highest admission rate and Fridays experienced the highest discharge rate. Friday was independently associated with highest 30-day HF-readmission rates (Adjusted OR 1.12, CI 1.01-1.23; p=0.02) in addition to risk factors such as African-American race, hypertension, diabetes, hyperlipidemia, end-stage renal disease and coronary artery disease. Within the NIS sample, 85,479 in-hospital deaths (3.8%) were recorded. Compared to weekdays, patients admitted over the weekend had greater comorbidities, higher incidence of acute myocardial infarction (AMI) (15.8% vs. 16.8%; p0.01), higher Charlson-comorbidity index and underwent less procedures such as echocardiography, right heart catheterization, coronary angiography, coronary revascularization or mechanical circulatory support. Weekend HF admission predicted higher in-hospital mortality (aOR 1.07, 95%CI 1.05-1.08; p0.01) on multivariate analysis. This relationship was applicable for teaching and non-teaching hospitals.Friday was associated with the highest discharge and 30-day HF-readmission rate. Weekend HF admissions experienced more AMI, had greater comorbidities, received less cardiac procedures and predicted higher in-hospital mortality. Higher weekend mortality may be related to the greater degree of severity of illness among admitted patients.
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- 2017
3. Trends in Hospitalization for Hypertensive Emergency, and Relationship of End-Organ Damage With In-Hospital Mortality
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Shilpkumar Arora, Matthew W. Martinez, Nilay Patel, Larry E Jacobs Md, Sahil Agrawal, Mahek Shah, Brijesh Patel, Susan Steigerwalt, Shantanu Patil, and Lohit Garg
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Male ,Time Factors ,Databases, Factual ,Comorbidity ,030204 cardiovascular system & hematology ,Chest pain ,Patient Admission ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Medicine ,Hypertensive emergency ,Hospital Mortality ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Aged, 80 and over ,Aortic dissection ,Incidence ,Incidence (epidemiology) ,Age Factors ,Middle Aged ,Aortic Aneurysm ,Ischemic Attack, Transient ,Hypertension ,Cardiology ,Female ,medicine.symptom ,Respiratory Insufficiency ,Adult ,Chest Pain ,medicine.medical_specialty ,03 medical and health sciences ,Internal medicine ,Internal Medicine ,Humans ,Aged ,Heart Failure ,Chi-Square Distribution ,business.industry ,Odds ratio ,Length of Stay ,medicine.disease ,United States ,Aortic Dissection ,Logistic Models ,Multivariate Analysis ,Emergencies ,business - Abstract
BACKGROUND There are no comprehensive guidelines on management of hypertensive emergency (HTNE) and complications. Despite advances in antihypertensive medications HTNE is accompanied with significant morbidity and mortality. METHODS We queried the 2002–2012 nationwide inpatient sample database to identify patients with HTNE. Trends in incidence of HTNE and in-hospital mortality were analyzed. Logistic regression analysis was used to assess the relationship between end-organ complications and in-hospital mortality. RESULTS Between 2002 and 2012, 129,914 admissions were included. Six hundred and thirty (0.48%) patients died during their hospital stay. There was an increase in the number of HTNE admissions (9,511–15,479; Ptrend < 0.001) with concurrent reduction of in-hospital mortality (0.8–0.3%; Ptrend < 0.001) by the year 2012 compared to 2002. Patients who died during hospitalization were older, had longer length of stay, higher cost of stay, more comorbidities, and higher risk scores. Presence of acute cardiorespiratory failure [adjusted odds ratio (OR), 15.8; 95% confidence interval (CI), 13.2–18.9], stroke or transient ischemia attack (TIA) (adjusted OR, 7.9; 95% CI, 6.3–9.9), chest pain (adjusted OR, 5.9; 95% CI, 4.4–7.7), stroke/TIA (adjusted OR, 5.9; 95% CI, 4.5–7.7), and aortic dissection (adjusted OR, 5.9; 95% CI, 2.8–12.4) were most predictive of higher in-hospital mortality in addition to factors such as age, aortic dissection, acute myocardial infarction, acute renal failure, and presence of neurological symptoms. CONCLUSION A rising trend in hospitalization for HTNE, with an overall decrease in in-hospital mortality was observed from 2002 to 2012, possibly related to changes in coding practices and improved management. Presence of acute cardiorespiratory failure, stroke/TIA, chest pain, and aortic dissection were most predictive of higher hospital mortality.
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- 2017
4. Therapeutic Hypothermia and Stent Thrombosis
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Rahul Chaudhary, Larry E Jacobs Md, Nainesh Patel, Neeraj Shah, Ronald S. Freudenberger, Jalaj Garg, Kathan Mehta, Karl B. Kern, Vratika Agarwal, and David A. Cox
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Percutaneous coronary intervention ,030208 emergency & critical care medicine ,Odds ratio ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Coronary thrombosis ,Internal medicine ,Conventional PCI ,Propensity score matching ,Cardiology ,Medicine ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Chi-squared distribution - Abstract
Objectives This study sought to determine whether “real-world” data supported the hypothesis that therapeutic hypothermia (TH) led to increased rates of stent thrombosis. Background TH, which is often instituted after cardiac arrest (CA) to improve neurologic outcomes, alters pharmacokinetics of antiplatelet medications, leading to a theoretical risk of stent thrombosis after percutaneous coronary intervention (PCI). Methods CA patients with acute myocardial infarction undergoing PCI were identified from the Nationwide Inpatient Sample from 2006 to 2011, with a defined primary outcome of stent thrombosis. The incidence of stent thrombosis in patients undergoing TH versus those not undergoing TH was compared using both logistic regression and propensity score matching. Results In this dataset, 49,109 CA patients underwent PCI for acute myocardial infarction from 2006 to 2011, of whom 1,193 (2.4%) underwent TH. The incidence of stent thrombosis in the TH group was 3.9% (43 of 1,193), compared to 4.7% (2,271 of 47,916) in the no TH group (p = 0.61). Logistic regression showed that TH was not a significant predictor of stent thrombosis with an adjusted odds ratio of 0.71 (95% confidence interval: 0.28 to 1.76; p = 0.46). Propensity matching was performed to adjust for baseline differences between the TH and no TH groups, matching 1,155 patients in the TH group with 3,399 patients in the no TH group. No difference was observed in the incidence of stent thrombosis in the TH and the no TH groups after propensity matching (3.5% vs. 6.1%; p = 0.17). Conclusions TH does not increase the incidence of stent thrombosis after primary PCI in patients with acute myocardial infarction presenting as CA.
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- 2016
5. TOO MUCH CALCIUM: PRIMARY HYPERPARATHYROIDISM PRECIPITATING OBSTRUCTION IN HYPERTROPHIC CARDIOMYOPATHY
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Soorya Aggarwal, Preysi Patel, Sagar Vadhar, Tarick Sheikh, John DallaRosa, Larry E. Jacobs, Lekha Racharla, Kailyn Mann, and Tyler Boozel
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medicine.medical_specialty ,chemistry ,business.industry ,Internal medicine ,medicine ,Hypertrophic cardiomyopathy ,Cardiology ,chemistry.chemical_element ,Calcium ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Primary hyperparathyroidism - Published
- 2020
6. PULMONARY VEIN TUMOR THROMBUS IN A PATIENT WITH WITH METASTASIS TO THE BRAIN
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Syed Rafay Ali Sabzwari, Nikhil Mehta, Sara Godil, and Larry E Jacobs Md
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medicine.medical_specialty ,business.industry ,Central nervous system ,Emergency department ,medicine.disease ,Pulmonary vein ,Metastasis ,Tumor thrombus ,medicine.anatomical_structure ,medicine ,In patient ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Tumor and thrombotic involvement of the pulmonary vein (PV) is a rare finding. In patients with central nervous system (CNS) metastasis in the setting of a suspected PV source, use of anti-thrombotic therapy is unknown. A 65 year old female presented to the emergency department with headache, lower
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- 2020
7. Incidental Finding of the Anomalous Origin of Left Main Coronary Artery from Pulmonary Artery in an Adult Presenting with Arrhythmia-Induced Myocardial Ischemia
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Lohit Garg Md, Mahek Shah, Nauman Islam Md, Brijesh Patel Md, Matthew W Martinez Md, Larry E Jacobs Md, and Shantanu Patil
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medicine.medical_specialty ,Mitral regurgitation ,lcsh:Diseases of the circulatory (Cardiovascular) system ,business.industry ,Atrial fibrillation ,Case Report ,030204 cardiovascular system & hematology ,medicine.disease ,Pulmonary hypertension ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,lcsh:RC666-701 ,Internal medicine ,medicine.artery ,Heart failure ,Pulmonary artery ,medicine ,Cardiology ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly with high mortality. It is associated with cardiovascular complications and is usually diagnosed soon after birth. Those who survive into adulthood can present with signs of myocardial infarction, heart failure, mitral regurgitation, severe pulmonary hypertension, or sudden cardiac death. We present a 53-year-old female presenting with atrial fibrillation and found to have an incidental diagnosis of ALCAPA who refused surgical correction. We also review the epidemiology, diagnosis, age-based clinical presentations, and treatment options for ALCAPA.
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- 2018
8. Transcatheter Aortic Valve Replacement (TAVR) in Low Flow-Low Gradient Severe Aortic Stenosis without Cardiac Reserve
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Anuraj Sudhakaran, Larry E. Jacobs, Brijesh Patel, Ronald S. Freudenberger, Patrick Kleaveland, Matthew W. Martinez, Naumann Islam, Bruce Feldman, Mahek Shah, and Aparna Baburaj
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medicine.medical_specialty ,Cardiac output ,Ejection fraction ,business.industry ,medicine.medical_treatment ,Cardiac reserve ,medicine.disease ,Stenosis ,Valve replacement ,Aortic valve replacement ,Internal medicine ,Aortic valve stenosis ,medicine ,Cardiology ,Dobutamine ,business ,medicine.drug - Abstract
With accumulating positive evidence in favour of transcatheter aortic valve replacement (TAVR) over a surgical approach, it has replaced surgical AVR to become the mainstay of treatment for severe symptomatic aortic stenosis in patients with prohibitive and high surgical risk. There is significant surgical mortality and morbidity associated with surgical aortic valve replacement in patients with low flow-low gradient (LFLG) true severe aortic valve stenosis (AS) and severely reduced left ventricular ejection fraction (rEF) without contractile reserve (CR). CR is measured following use of dobutamine in an attempt to increase cardiac output by more than 20% while differentiating severe from pseudostenosis in some cases. The value of transcatheter aortic valve replacement (TAVR) over a surgical approach for these patients with rEF LFLG true severe AS and no CR is uncertain. We present a patient with LFLG severe AS and low left ventricular EF without contractile reserve who underwent TAVR and experienced significant improvement in their clinical status without complications.
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- 2017
9. ISOLATED BICUSPID PULMONIC VALVE: 'FORGOTTEN VALVE' AND A RARE ANOMALY
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Fnu Vikram, Larry E Jacobs Md, Ghulam Akbar, Lohit Garg, and Matthew W. Martinez
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Isolated finding ,Pulmonary valve ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Pulmonary valve is called “the forgotten valve” due to very uncommon clinical involvement. Bicuspid pulmonic valve is usually associated with other congenital heart defects. Isolated finding of bicuspid pulmonic valve is extremely rare. 46 year old healthy female was found to have systolic
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- 2019
10. Reply
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Rahul Chaudhary, Karl B. Kern, Vratika Agarwal, Nainesh Patel, Kathan Mehta, Ronald S. Freudenberger, David A. Cox, Jalaj Garg, Larry E Jacobs Md, and Neeraj Shah
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Potential impact ,medicine.medical_specialty ,High risk patients ,business.industry ,030204 cardiovascular system & hematology ,Hypothermia ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
We thank Dr. Jellinghaus and colleagues for their interest in our article [(1)][1]. We have read their commentary with great interest and would like to respond to the points raised by them. Dr. Jellinghaus and colleagues mention the potential impact of use of newer P2Y12 inhibitors such as
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- 2017
11. CARDIAC THROMBOSIS IN ACUTE ANTERIOR MYOCARDIAL INFARCTION: EVALUATION OF HOSPITAL MORTALITY, THROMBOEMBOLISM AND BLEEDING
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Sahil Agrawal, Pradhum Ram, Mahek Shah, Shilpkumar Arora, Nilay Patel, Larry E. Jacobs, Shantanu Patil, Brijesh Patel, Natee Sirinvaravong, Lohit Garg, and Vincent M. Figueredo
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medicine.medical_specialty ,business.industry ,Anterior wall ,Hospital mortality ,Acute anterior myocardial infarction ,Left ventricular thrombus ,medicine.disease ,Cardiac thrombosis ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Left ventricular thrombus (LVT) is a well-known complication of acute myocardial infarction, most commonly seen in anterior wall ST-segment elevation myocardial infarction (STEMI). It is associated with systemic thromboembolism. The aim of this study is to evaluate the impact of LVT on in-hospital
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- 2018
12. Periprocedural Management of New Oral Anticoagulants in Atrial Fibrillation Ablation
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Chandrasekar Palaniswamy, Larry E Jacobs Md, Martin Zak, Jalaj Garg, and Saramaria Afanador Castiblanco
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medicine.medical_specialty ,Cardiac Catheterization ,medicine.medical_treatment ,Administration, Oral ,Catheter ablation ,Dabigatran ,Meta-Analysis as Topic ,Rivaroxaban ,Internal medicine ,Thromboembolism ,Atrial Fibrillation ,medicine ,Humans ,Pharmacology (medical) ,Pharmacology ,business.industry ,Warfarin ,Anticoagulants ,Atrial fibrillation ,Ablation ,medicine.disease ,Surgery ,Clinical trial ,Treatment Outcome ,Cardiology ,Catheter Ablation ,Apixaban ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Factor Xa Inhibitors - Abstract
Background: Patients who undergo catheter ablation for atrial fibrillation (AF) are at increased risk of developing thromboembolic and bleeding complications periprocedurally. Many patients are now on newer oral anticoagulants (NOACs), but data regarding their safety and efficacy during AF ablation are limited. Methods and Results: This article reviews the literature in PubMed from 1998 to 2014 and includes clinical trials and meta-analysis that analyzed the safety and efficacy of NOACs during AF catheter ablation. Dabigatran seems to be as effective and safe as warfarin, although most data are from single-center studies, with small samples and very low overall bleeding and thromboembolic complications. Periprocedural anticoagulation protocols also vary greatly between studies. Some recent meta-analysis has shown that warfarin could still be a safer and more effective alternative. There are fewer studies with rivaroxaban in AF ablation, and there have been no meta-analysis yet comparing rivaroxaban to warfarin or dabigatran. There seems to be no significant differences in safety or efficacy of rivaroxaban compared to warfarin. Interestingly, there are no available data for apixaban in AF ablation yet. Discussion: There are no consensus guidelines regarding the use of NOACs during AF ablation. Dabigatran and rivaroxaban seem as safe and effective as warfarin, although larger studies with standardized protocols are needed, as available studies may be underpowered to detect small differences in bleeding and thromboembolic rates.
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- 2014
13. Inducible Left Ventricular Outflow Tract Gradient During Dobutamine Stress Echocardiography: An Association with Intraoperative Hypotension But Not a Contraindication to Liver Transplantation
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Kenneth Rothstein, Larry E. Jacobs, Taseem A. Malik, Rajiv Maraj, Morris N. Kotler, Pairoj Rerkpattanapipat, Suraj Maraj, Cosme Manzarbeitia, Santiago Munoz, and Rafael Contreras
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medicine.medical_specialty ,education.field_of_study ,Cirrhosis ,business.industry ,medicine.medical_treatment ,Population ,Renal function ,Hemodynamics ,Liver transplantation ,medicine.disease ,Internal medicine ,medicine ,Cardiology ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,Clinical significance ,Cardiology and Cardiovascular Medicine ,business ,education ,Contraindication - Abstract
Background: Dobutamine stress echocardiography (DSE) is frequently used in the evaluation of cardiac risk prior to orthotopic liver transplantation (OLT). In the general cardiac population, an inducible left ventricular outflow tract gradient (LVOT Δ) during DSE has variable prognostic importance. The purpose of this study was to determine the prevalence and clinical significance of LVOT Δ in patients undergoing OLT during DSE. Methods: Consecutive medical records of 106 patients who had undergone OLT at our institution from January 1997 until January 2002 were retrospectively analyzed and divided into two groups based on the presence (Group I, LVOT Δ > 36 mmHg) or absence (Group II, LVOT Δ≤ 36 mmHg) of a significant LVOT Δ measured during DSE. We determined any outcome differences between these two groups with regard to intraoperative hypotension, cardiac mortality, length of hospital stay, graft function, and renal function post-OLT. Results: Forty-six patients had an LVOT Δ > 36 mmHg (Group I) and 60 patients had LVOT Δ≤ 36 mmHg (Group II). Baseline demographics were similar in both groups. There was no significant overall difference in cardiac mortality between Group I versus Group II patients (0 versus 1 patient, respectively, P = 0.57). Intraoperative hypotension occurred in 4 patients in Group I versus 0 patient in Group II (P = 0.03). Length of stay, graft function, and postoperative renal function were similar in both groups. Conclusion: A significant LVOT Δ > 36 mmHg is a frequent finding occurring in 46/106 (43%) of patients who have DSE pre-OLT. Intraoperative hypotension is associated with patients having an LVOT Δ. However, post-OLT patients with significant LVOT Δ have a similar in-hospital outcome compared to patients without significant LVOT Δ.
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- 2004
14. Epidemiology and Outcome of Infective Endocarditis in Hemodialysis Patients
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Prakash Krishnasamy, Morris N. Kotler, Leonard E. Braitman, Shiang-Cheng Kung, Larry E. Jacobs, Rasib M. Raja, Suraj Maraj, and Rajiv Maraj
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Bacteremia ,Comorbidity ,Renal Dialysis ,Risk Factors ,Mitral valve ,Drug Resistance, Bacterial ,Prevalence ,medicine ,Humans ,Endocarditis ,Hypoalbuminemia ,Survival rate ,Demography ,Retrospective Studies ,Mitral regurgitation ,business.industry ,Incidence ,Endocarditis, Bacterial ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,Infective endocarditis ,Acute Disease ,Female ,Hemodialysis ,business ,Echocardiography, Transesophageal - Abstract
Background Survival in patients with infective endocarditis (IE) ranges from 4 to 50% depending on the type of organism, the type of valve involvement and the type of treatment. Methods We conducted a retrospective analysis of data in hemodialysis (HD) patients at our center from 1990 to 2000. Demographics, risk factors, and outcome data were extracted in the subgroup of patients with first-episode IE diagnosed primarily by echocardiography. Results A total of 2239 patients underwent HD at our center. Thirty-two (1.4%) had IE defined using the Duke Criteria. Permanent and temporary venous dialysis catheters, arteriovenous (AV) grafts, and AV fistulae were used in 19 (59%), 12 (38%), and 1 (3%) patient respectively. Mean access duration was 7.6 ± 7.9 months. Thirty (94%) patients had positive blood cultures, with the majority having Staphylococcus aureus bacteremia. Two (7%) patients had positive echocardiographic findings but negative blood cultures due to the commencement of empiric antibiotic therapy prior to blood cultures. The mitral valve was mainly affected. Transesophageal echocardiography was performed in 23 (72%) patients and detected an intracardiac mass in all 23 patients. One-year mortality was 56.3%. A poor 1-year prognosis was associated with presenting features of low hemoglobin, elevated leukocyte count, hypoalbuminemia, severe aortic and mitral regurgitation, and annular calcification in mitral valve IE. Conclusion The prevalence of IE in HD patients is 1.4%. One-year mortality was 56.3%. Close observation is required during the first year when patients with severe valvular regurgitation and hematological abnormalities have a high mortality.
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- 2002
15. IVC filters—Trends in placement and indications, a study of 2 populations
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Glenn Eiger, Apostholos Perelas, Mahek Shah, Nilay Patel, Shilpa N. Reddy, Talal Alnabelsi, Shilpkumar Arora, Shantanu Patil, Larry E Jacobs Md, Aditya Chandorkar, Marvin Lu, and Brijesh Patel
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Male ,IVC filter ,Vena Cava Filters ,indication ,Comorbidity ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Medicine ,030212 general & internal medicine ,retrieval ,Aged, 80 and over ,education.field_of_study ,Age Factors ,Venous Thromboembolism ,General Medicine ,Middle Aged ,Community hospital ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Major bleeding ,Research Article ,inappropriate ,trends ,medicine.medical_specialty ,Population ,Observational Study ,Inferior vena cava filter ,Hemorrhage ,03 medical and health sciences ,Sex Factors ,Humans ,education ,Contraindication ,Device Removal ,Aged ,Retrospective Studies ,appropriate ,business.industry ,Retrospective cohort study ,medicine.disease ,Surgery ,Nationwide Inpatient Sample ,Socioeconomic Factors ,Observational study ,Pulmonary Embolism ,business ,contraindication - Abstract
Supplemental Digital Content is available in the text, Inferior vena cava filter (IVCF) placement appears to be expanding over time despite absence of clear directing evidence. Two populations were studied. The first population included patients who received an IVCF between January 2005 and August 2013 at our community hospital center. Demographic information, indications for placement, and retrieval rate was recorded among other variables. The second population comprised of patients receiving an IVCF from 2005 to 2012 according to the Nationwide Inpatient Sample (NIS) using ICD-9CM coding. Patients were divided into 2 groups based on the year of admission for comparison, that is, first group from 2005 to 2008 and the second from 2009 to 2012. In addition, we analyzed annual trends in filter placement, acute venothromboembolic events (VTE) and several underlying comorbidities within this population. At our center, 802 IVCFs were placed (55.2% retrievable); 34% for absolute, 61% for relative, and 5% for prophylactic indications. Major bleeding (27.5%), minor self-limited bleeding (13.7%), and fall history (11.2%) were the commonest indications. Periprocedural complication rate was 0.7%, and filter retrieval rate was 7%. The NIS population (811,487 filters) saw a decline in IVCF placement after year 2009, following an initial uptrend (Ptrend
- Published
- 2017
16. An unusual cause for syncope: Pericardial paraganglioma causing right ventricular outflow obstruction
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Matthew W. Martinez, Mahek Shah, Naumann Islam, Larry E. Jacobs, Ronald S. Freudenberger, and Kailyn Mann
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medicine.medical_specialty ,biology ,business.industry ,Electronic journal ,Syncope (genus) ,Free access ,Ventricular Outflow Obstruction ,medicine.disease ,biology.organism_classification ,Paraganglioma ,Internal medicine ,Cardiology ,Medicine ,business ,Cardiac Tumors - Published
- 2017
17. Iatrogenic Cardiovascular Complications: Part IV: Interventional Procedures
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RAJIV MARAJ, PAIROJ RERKPATTANAPIPAT, NATTAWUT WONGPRAPARUT, MOISES FRAIFELD, GARY S. LEDLEY, LARRY E. JACOBS, SHAHRIAR YAZDANFAR, and MORRIS N. KOTLER
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2000
18. Clinical predictors of pulmonary hypertension in patients undergoing liver transplant evaluation
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Alyson N. Owen, Cosme Manzarbeitia, Santiago J. Munoz, Morris N. Kotler, Kenneth D. Rothstein, Nektarios D. Pilatis, David Reich, Pairoj Rerkpattanapipat, and Larry E. Jacobs
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Male ,medicine.medical_specialty ,Cirrhosis ,Hypertension, Pulmonary ,medicine.medical_treatment ,Liver transplantation ,Sensitivity and Specificity ,Preoperative care ,Group B ,Predictive Value of Tests ,Internal medicine ,medicine.artery ,Hypertension, Portal ,Preoperative Care ,Humans ,Medicine ,Pulmonary Wedge Pressure ,cardiovascular diseases ,Pulmonary wedge pressure ,Retrospective Studies ,Transplantation ,Portopulmonary hypertension ,Hypertrophy, Right Ventricular ,Hepatology ,business.industry ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Liver Transplantation ,medicine.anatomical_structure ,Echocardiography ,Case-Control Studies ,Hypertension ,Pulmonary artery ,Cardiology ,Vascular resistance ,Female ,Surgery ,business - Abstract
Clinical prediction of portopulmonary hypertension(PPHTN) is critical in the preoperative evaluation of candidates for orthotopic liver transplantation (OLT) because of its association with significant morbidity and mortality. To determine the clinical, laboratory, and echocardiographic predictors of PPHTN, we retrospectively evaluated 55 candidates before OLT From those, 8 candidates had pulmonary hypertension ([HTN] group A) and 47 candidates did not (group B). Pulmonary HTN was defined as a mean pulmonary artery pressure (PAP) of 25 mm Hg or greater and either elevated pulmonary vascular resistance or normal pulmonary artery wedge pressure. The significant predictors of PPHTN were (1) systemic arterial HTN (63% in group A v 9% in group B; P < .001), (2) loud pulmonary component of the second heart sound (38% v 2%; P = .001), (3) right ventricular (RV) heave (38% v 4%; P = .002), (4) RV dilatation by echocardiogram (63% v 0%; P < .001), (5) RV hypertrophy by echocardiogram (38% v 0%; P = .001), and (6) echocardiogram-estimated systolic PAP (SPAP) greater than 40 mm Hg (63% v 2%; P < .001). The sensitivity of these variables for the detection of pulmonary HTN ranges from 37% to 63%, and their specificity from 91% to 100%. We conclude that several clinical and echocardiographic features are significantly associated with pulmonary HTN in patients with cirrhosis. In particular, echocardiogram-estimated SPAP greater than 40 mm Hg is strongly associated with pulmonary HTN and is specific. These predictors, however, are not sensitive enough to identify all the patients with PPHTN. Therefore, the evaluation of a combination of these variables may be useful for the preoperative identification of pulmonary HTN in liver transplant candidates.
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- 2000
19. Iatrogenic Cardiovascular Complications: Part III. Interventional Procedures
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Nattawut Wongpraparut, Larry E. Jacobs, Morris N. Kotler, Gary S. Ledley, Pairoj Rerkpattanapipat, Moises Fraifeld, Rajiv Maraj, and Shahriar Yazdanfar
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Part iii ,medicine.medical_specialty ,Pediatrics ,business.industry ,General surgery ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Published
- 1999
20. Iatrogenic Cardiovascular Complications: Part II. Monitoring Devices
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Nattawut Wongpraparut, Gary S. Ledley, Morris N. Kotler, Shahriar Yazdanfar, Moises Fraifeld, Rajiv Maraj, Pairoj Rerkpattanapipat, and Larry E. Jacobs
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medicine.medical_specialty ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 1999
21. Iatrogenic Cardiovascular Complications: Part I. Semi-Noninvasive Procedures and Diagnostic Invasive Procedures
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Morris N. Kotler, Gary S. Ledley, Rajiv Maraj, Shahriar Yazdanfar, Larry E. Jacobs, Pairoj Rerkpattanapipat, Nattawut Wongpraparut, and Moises Fraifeld
- Subjects
medicine.medical_specialty ,business.industry ,Pulmonary Infarction ,medicine.medical_treatment ,Ischemia ,medicine.disease ,Myocardial rupture ,Air embolism ,Thrombosis ,Venous thrombosis ,Internal medicine ,Anesthesia ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Cardiac catheterization - Abstract
This article reviews cardiac and noncardiac complications encountered with various procedures used in cardiology practice. Some of the common complications associated with transesophageal echocardiography are hypoxia, laryngospasm, bronchospasm, and brady- or tachyarrhythmias. Death is a rare complication. The overall prevalence of complications associated with external cardioversion is low. Major complications include death, cardiac arrhythmias, pulmonary edema, systemic embolism, and cerebral embolism. The main indication for endomyocardial biopsy at present is to assess cardiac transplant rejection. Complications occurring most frequently are carotid artery puncture, arrhythmias, and conduction abnormalities. The most commonly occurring complications of electrophysiological studies are pneumothorax, venous thrombosis, and hypotension. Cardiac catheterization is an invaluable procedure in the assessment of patients with ischemic heart disease. Major complications include vascular complications, arrhythmias, complications due to contrast agents, and death. Central venous catheterization is used to deliver medication and parenteral nutrition and also in the hemodynamic monitoring of patients. Local infection, sepsis, noninfectious phlebitis, and catheter dislodgment are some of the more commonly occurring associated complications. Swan-Ganz catheters are indicated for the hemodynamic monitoring of critically ill patients. Major associated complications include pneumothorax, arterial puncture, air embolism, tracheal and esophageal puncture, arrhythmias, valvular damage, infection, thrombosis, and pulmonary infarction. The use of intra-aortic balloon pumps can be complicated by ischemia, bleeding, intraaortic balloon pump rupture, vascular complications (mainly limb ischemia), and death. Some of the common underlying mechanisms responsible for complications during interventional procedures are abrupt closure, noreflow phenomenon, coronary artery spasm, distal embolization, and side branch occlusion. The use of abciximab may be associated with an increased risk of major bleeding. Acute profound thrombocytopenia is another potential complication associated with abciximab use. Heparin usage may be associated with bleeding, thrombocytopenia, skin necrosis, osteoporosis and hypersensitivity reactions. Some of the more common complications of thrombolytic therapy are bleeding, myocardial rupture, hypotension, allergic reactions, anaphylaxis, thromboembolic complications, reperfusion arrhythmias, and splenic rupture.
- Published
- 1999
22. Experimental and Computational Investigation of Flow and Thermal Behavior of a Mechanical Seal
- Author
-
Larry E. Jacobs, Nori Aki Okita, Parviz Merati, and Robert L. Phillips
- Subjects
Engineering ,business.industry ,Rotor (electric) ,Stator ,Mechanical Engineering ,Flow (psychology) ,Thermodynamics ,Surfaces and Interfaces ,Mechanics ,Nusselt number ,Seal (mechanical) ,Surfaces, Coatings and Films ,law.invention ,Flow velocity ,Heat flux ,Mechanics of Materials ,law ,Thermal ,business - Abstract
A comparison of a computational model for flow and thermal analysis of a mechanical seal with experimental results is presented. The computational model adequately predicts the flow field in the seal chamber and temperature distribution within the stator of a mechanical seal. This model is used to determine Nusselt numbers on the wetted surfaces of the seal components. The Nusselt numbers can be used to calculate the temperature distribution on the seal face. Flow velocity and pressure, and temperature fields within the seal chamber fluid, stator and rotor are presented. The largest magnitude of the heat flux occurs on the rotor surface near the interface between the rotor and stator. Presented at the 54th Annual Meeting Las Vegas, Nevada May 23–27, 1999
- Published
- 1999
23. Evaluation of hemolysis in patients with prosthetic heart valves
- Author
-
Morris N. Kotler, Alfred W. Ioli, Rajiv Maraj, and Larry E. Jacobs
- Subjects
Hemolytic anemia ,Anemia, Hemolytic ,medicine.medical_specialty ,Anemia ,Reviews ,Regurgitation (circulation) ,Hemolysis ,Diagnosis, Differential ,Internal medicine ,medicine ,Humans ,Heart valve ,business.industry ,General Medicine ,Jaundice ,medicine.disease ,Echocardiography, Doppler ,Surgery ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Heart failure ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Echocardiography, Transesophageal - Abstract
The primary mechanism and most common cause of hemolytic disease in patients with prosthetic heart valves are mechanical trauma to red blood cells and paraprosthetic valvular regurgitation, respectively. Presenting features in patients with this condition include anemia, congestive heart failure, fatigue, jaundice, dark urine, and a regurgitant murmur. Various laboratory studies can be utilized to diagnose hemolytic anemia and to assess the severity of hemolysis. Transthoracic echocardiography, transesophageal echocardiography, and Doppler studies including color Doppler are useful imaging methods to assess valve function. Treatment is usually medical (oral iron); however, in patients with paravalvular regurgitation, surgery is often required to correct the anemia.
- Published
- 1998
24. Experimental Determination of the Thermal Characteristics of a Mechanical Seal and Its Operating Environment
- Author
-
Larry E. Jacobs, Parviz Merati, and Robert L. Phillips
- Subjects
Engineering ,business.industry ,Mechanical Engineering ,Thermodynamics ,Fluid mechanics ,Surfaces and Interfaces ,Mechanics ,Nusselt number ,Seal (mechanical) ,Surfaces, Coatings and Films ,law.invention ,Temperature gradient ,Mechanics of Materials ,law ,Thermal ,Heat transfer ,Fluid dynamics ,O-ring ,business - Abstract
The thermal distortion of mechanical seal faces has a critical impact on the performance of the seal. Experimental work is discussed which quantifies the thermal characteristics of a mechanical seal and its operating environment. Experimental techniques are employed which measure the seal face torque, thermal gradients, and fluid flow patterns under the normal operating conditions of the seal. The experimental data is used to calculate the heat that is generated at the seal faces and the Nusselt number on the wetted surfaces on the stationary element. The experimentally determined Nusselt numbers are compared to experimental and empirical values that have been presented by other researchers. The effect of the seal geometry on the experimental Nusselt numbers is evaluated. Presented at the 52nd Annual Meeting in Kansas City, Missouri May 18–22, 1997
- Published
- 1997
25. Cardiac sarcoidosis masquerading as a metastatic tumor: The role of transthoracic and transesophageal echocardiography
- Author
-
Larry E. Jacobs, Morris N. Kotler, Ian I. Joffe, Alfred Ioli, Craig Lampert, and Alyson N. Owen
- Subjects
Adult ,medicine.medical_specialty ,Pathology ,Sarcoidosis ,Cardiac sarcoidosis ,Metastatic tumor ,Diagnosis, Differential ,Heart Neoplasms ,medicine ,Humans ,Pericardium ,Radiology, Nuclear Medicine and imaging ,Unusual case ,business.industry ,medicine.disease ,medicine.anatomical_structure ,Echocardiography ,cardiovascular system ,Female ,Radiology ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
We present an unusual case of biopsy-proven myocardial sarcoidosis in which the transthoracic and transesophageal echocardiographic findings suggested metastatic tumor involvement of the myocardium and pericardium. The pathologic, clinical, and echocardiographic features of cardiac sarcoidosis are reviewed, with emphasis on the role of echocardiography.
- Published
- 1995
26. The utility of transesophageal echocardiography in the management of renal cell carcinoma with intracardiac extension
- Author
-
Alfred Ioli, Larry E. Jacobs, Iqbal Singh, and Morris N. Kotler
- Subjects
medicine.medical_specialty ,Vena Cava, Inferior ,Inferior vena cava ,Intracardiac injection ,Vena caval ,Diagnostic modalities ,Heart Neoplasms ,Renal cell carcinoma ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Heart Atria ,cardiovascular diseases ,Carcinoma, Renal Cell ,Aged ,business.industry ,Middle Aged ,Neoplastic Cells, Circulating ,medicine.disease ,Kidney Neoplasms ,medicine.anatomical_structure ,medicine.vein ,Hepatic veins ,cardiovascular system ,Right atrium ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Renal carcinoma ,Echocardiography, Transesophageal - Abstract
The accurate assessment of the distal extent of vena caval invasion of renal cell carcinoma into the hepatic veins, inferior vena cava, and right atrium is critical before surgical resection. We present two cases of renal carcinoma with vena caval extension in which preoperative transesophageal echocardiography accurately assessed tumor extent and guided surgical therapy. The role of transesophageal echocardiography in comparison to other diagnostic modalities is discussed.
- Published
- 1995
27. Angina caused by systolic compression of the left coronary artery as a result of pseudoaneurysm of the mitral-aortic intervalvular fibrosa
- Author
-
Morris N. Kotler, Scott R. Spielman, Deepak Parashara, Sean F. Janzer, Charles E. Bemis, Shahriar Yazdanfar, and Larry E. Jacobs
- Subjects
Male ,Aortic valve ,medicine.medical_specialty ,Heart disease ,Systole ,Heart Valve Diseases ,Coronary Disease ,Angina Pectoris ,Angina ,Pseudoaneurysm ,Postoperative Complications ,Left coronary artery ,Streptococcal Infections ,Internal medicine ,medicine.artery ,medicine ,Humans ,Endocarditis ,business.industry ,Middle Aged ,medicine.disease ,Compression (physics) ,Surgery ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Aneurysm, False - Published
- 1995
28. Penetrating atherosclerotic aortic ulcers
- Author
-
Craig Lampert, Morris N. Kotler, Larry E. Jacobs, and Herman D. Movsowitz
- Subjects
Male ,medicine.medical_specialty ,Arteriosclerosis ,Aortic Rupture ,Aortic Diseases ,Aorta, Thoracic ,Disease ,Dissection (medical) ,Thoracic aortic aneurysm ,medicine.artery ,Back pain ,Humans ,Medicine ,Thoracic aorta ,Ulcer ,Aged ,Aortic dissection ,Aorta ,business.industry ,Vascular disease ,Middle Aged ,medicine.disease ,cardiovascular system ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Penetrating atherosclerotic aortic ulceration is a unique disease with distinct management and prognostic implications. It is an important clinical entity that must be distinguished from classic aortic dissection and rapid expansion or contained rupture of a thoracic aortic aneurysm. Although symptoms of penetrating aortic ulceration may mimic dissection, the characteristic signs of dissection are absent. New imaging modalities have made it possible to establish the diagnosis of penetrating aortic ulceration with a high degree of accuracy and to tailor management according to the presence of complications. Physicians should be aware of the possibility of atherosclerotic aortic ulceration, particularly in elderly patients with systemic atherosclerosis and hypertension who have sudden onset of chest or back pain.
- Published
- 1994
29. DEEPAK K. PARASHARA, M.D
- Author
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Oline J, Parashara Dk, Morris N. Kotler, Gary S. Ledley, Shahriar Yazdanfar, and Larry E. Jacobs
- Subjects
Coronary angiography ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Percent stenosis ,medicine.anatomical_structure ,Internal medicine ,Intravascular ultrasound ,medicine ,Cardiology ,Cineangiography ,Radiology, Nuclear Medicine and imaging ,Intravascular ultrasonography ,Left main coronary artery disease ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography. intravascular ultrasound, left main coronary artery, coronary cineangiography
- Published
- 1994
30. Atrial fibrillation following cardiac surgery: established and emerging strategies of prevention
- Author
-
Christopher Cutitta, Larry E Jacobs Md, Abdul Aleem, Matthew W. Martinez, Ronald S. Freudenberger, Martin E. Matsumura, Sultan M. Siddique, and Nasir Shariff
- Subjects
medicine.medical_specialty ,business.industry ,Cardiac arrhythmia ,Atrial fibrillation ,medicine.disease ,Cardiac surgery ,Patents as Topic ,Internal medicine ,Drug Discovery ,Atrial Fibrillation ,cardiovascular system ,medicine ,Cardiology ,Animals ,Humans ,Pharmacology (medical) ,cardiovascular diseases ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Anti-Arrhythmia Agents - Abstract
More than 250,000 patients undergo cardiac surgery every year. Although advances in surgical techniques have reduced the peri-operative morbidity and mortality in these patients, atrial fibrillation persists to commonly occur following these surgeries. Traditional therapies have reduced their occurrence; however there are still a significant number of patients who develop this complication. Newer and non-conventional medications are being studied to reduce this cardiac arrhythmia. This review will elaborate on the patho-physiology, and prevention of this arrhythmia. We also aim to summarize recent investigated and patented medications which may result in more effective strategies for prophylaxis against this cardiac arrhythmia.
- Published
- 2011
31. Assessment of Aortic Regurgitation by Transesophageal Echocardiography: Correlation with Angiographic Determination
- Author
-
Morris N. Kotler, Alfred Ioli, Colin B. Meyerowitz, Sean Janzer, John H. Wertheimer, Krishnaswamy Chandrasekaran, and Larry E. Jacobs
- Subjects
Male ,Cardiac Catheterization ,medicine.medical_specialty ,Aortography ,medicine.medical_treatment ,Aortic Valve Insufficiency ,Hemodynamics ,Regurgitation (circulation) ,Coronary Angiography ,Sensitivity and Specificity ,Correlation ,Esophagus ,Internal medicine ,Left ventricular diastolic area ,medicine ,Humans ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,Aged ,Cardiac catheterization ,Observer Variation ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Echocardiography, Doppler ,Evaluation Studies as Topic ,Angiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
Transthoracic echocardiographic studies have shown that color Doppler mapping of the aortic regurgitation (AR) jet correlated well with the severity of regurgitation as assessed by contrast aortography. The present study was performed to assess whether these parameters could be similarly applied to measurements determined by transesophageal echocardiography (TEE). In order to determine and validate criteria for the assessment of AR severity, 39 clinically stable patients with a TEE color Doppler study and contrast aortography within a 2-week period were identified. The ratio of the jet area (JA) to left ventricular diastolic area (LVDA) had the best correlation to AR severity as determined by contrast aortography (r = 0.89). Jet length, JA, the ratio of jet width to the width of the left ventricular outflow tract and jet width had r values of 0.88, 0.88, 0.83, and 0.84, respectively. The best sensitivity and specificity for the assessment of AR by TEE were obtained as follows: JA/LVDA ratio of 0%-7% predicts 0-1 + AR; 8%-20% 2-3 + AR, and greater than 20% 4 + AR. Of the three patients miscategorized, none was misgraded by more than one angiographic grade of AR. Jets that measure more than 6 cm in length or have an area of greater than 10 cm 2 have a 100% sensitivity and specificity for diagnosing 4 + AR. In the present study the ratio of JA to LVDA area correlates best with AR severity as determined by angiography.
- Published
- 1993
32. Pitfalls in the Echo-Doppler Diagnosis of Hypertrophic Cardiomyopathy
- Author
-
Larry E. Jacobs, Morris N. Kotler, Colin Movsowitz, and Herman D. Movsowitz
- Subjects
medicine.medical_specialty ,Diastole ,Ventricular outflow tract obstruction ,Doppler echocardiography ,Diagnosis, Differential ,Ventricular hypertrophy ,Internal medicine ,Mitral valve ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Mitral regurgitation ,medicine.diagnostic_test ,business.industry ,Hypertrophic cardiomyopathy ,Equipment Design ,Gold standard (test) ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Echocardiography, Doppler ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
While Doppler echocardiography has become the gold standard for the diagnosis of hypertrophic cardiomyopathy, there are many pitfalls in its use. Some of these pitfalls are technical in nature resulting from inadequate image quality, incorrect transducer angulation, and improper equipment settings. Other pitfalls relate to the diversity and heterogeneity in defining hypertrophic cardiomyopathy and to the host of disorders that may mimic it by echocardiography. The pattern and extent of ventricular hypertrophy, systolic anterior motion of the mitral valve, and Doppler determination of left ventricular outflow tract obstruction, diastolic dysfunction, and mitral regurgitation are discussed, as are wall-motion abnormalities and myocardial echo reflectivity. While these echocardiographic features of hypertrophic cardiomyopathy are nonspecific when seen in isolation, their combined presence in the appropriate clinical setting makes the diagnosis likely.
- Published
- 1993
33. Aortic dissection following intraaortic balloon insertion: Recognition by transesophageal echocardiography
- Author
-
Morris N. Kotler, Alfred W. Ioli, Moises Fraifeld, and Larry E. Jacobs
- Subjects
Aortic dissection ,medicine.medical_specialty ,Aorta ,Intra-Aortic Balloon Pumping ,Intraaortic balloon ,Vascular disease ,business.industry ,Aorta, Thoracic ,Autopsy ,medicine.disease ,Aortic disease ,Aortic Aneurysm ,Surgery ,Aortic Dissection ,Echocardiography ,medicine.artery ,Cuff ,medicine ,Humans ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Aged - Published
- 1992
34. Systolic Indentation of the Left Ventricular Outflow Tract in Eisenmenger Syndrome
- Author
-
Larry E. Jacobs, Deepak Parashara, Colin B. Meyerowitz, Morris N. Kotler, Gary S. Ledley, and Alfred W. Ioli
- Subjects
Adult ,medicine.medical_specialty ,Systole ,Systolic hypertension ,Cardiac Volume ,Volume overload ,Blood Pressure ,Ventricular Function, Left ,Ventricular Outflow Obstruction ,Internal medicine ,medicine ,Humans ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Interventricular septum ,business.industry ,Hemodynamics ,Eisenmenger Complex ,medicine.disease ,Myocardial Contraction ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Eisenmenger syndrome ,Anesthesia ,cardiovascular system ,Ventricular pressure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Marked bulging of the interventricular septum toward the left ventricle has been described as a reliable index of right ventricular systolic hypertension. We report a patient with Eisenmenger syndrome who has systolic aneurysmal protrusion of the interventricular septum into the left ventricular outflow tract. To our knowledge, this is the first report of systolic indentation of the left ventricular outflow tract in a patient with right ventricular pressure/volume overload.
- Published
- 1992
35. Quantification of Mitral Regurgitation: A Comparison of Transesophageal Echocardiography and Contrast Ventriculography
- Author
-
Robert Fanning, Larry E. Jacobs, Morris N. Kotler, Alfred W. Ioli, Colin B. Meyerowitz, John H. Wertheimer, and Clifford S. Strauss
- Subjects
Male ,medicine.medical_specialty ,Heart Ventricles ,Left atrium ,Sensitivity and Specificity ,Esophagus ,Left atrial ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Observer Variation ,Mitral regurgitation ,business.industry ,Mitral Valve Insufficiency ,Color doppler ,Middle Aged ,Contrast ventriculography ,Echocardiography, Doppler ,Radiography ,medicine.anatomical_structure ,Cardiology ,Area ratio ,Female ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
Transesophageal echocardiography (TEE) allows an unobscured view of the left atrium for the assessment of mitral regurgitation (MR). However, criteria for assessing MR by TEE have not been carefully validated. In order to determine and validate criteria for the assessment of MR severity, 65 clinically stable patients with a TEE color Doppler study and contrast ventriculography within a 2-week period were identified. Maximal or peak mitral regurgitation jet area to left atrial area ratio (MR/LA) derived solely from TEE imaging had the best correlation to MR severity by contrast ventriculography (r = 0.89). Utilizing MR jet area without correction for LA size resulted in r = 0.72 to 0.75. Utilizing LA area data from transthoracic echocardiograms in a subset of 29 patients resulted in r = 0.77. Best sensitivity and specificity for the assessment of MR by TEE were obtained using the following criteria: Peak MR/LA of 0%-9% predicts 0 + MR; 10%-28% 1 + MR; 29%-54% 2 + to 3 + MR; and greater than 55% 4 + MR. Best sensitivity and specificity occurs for assessment of 0 + and 4 + MR. Considerable overlap in data occurs in the 1 + and 3 + MR range utilizing the above stated criteria. Peak MR/LA ratio derived from a single TEE view in which the MR jet is maximally imaged is the best determinant of MR severity.
- Published
- 1992
36. Innocent Bystander or Marker of Pathology!
- Author
-
Gurpreet Kochar, Morris N. Kotler, David S. Blondheim, and Larry E. Jacobs
- Subjects
Mitral annular calcification ,medicine.medical_specialty ,Mitral regurgitation ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Population ,Atrial fibrillation ,equipment and supplies ,Left ventricular hypertrophy ,medicine.disease ,Stenosis ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Endocarditis ,Radiology, Nuclear Medicine and imaging ,sense organs ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,education - Abstract
Mitral annular calcification is known to be associated with conduction abnormalities, embolic phenomena, endocarditis, mitral regurgitation, and thromboembolic cerebrovascular events in the younger population. The size of our elderly population is growing dramatically with the fastest growth in those aged greater than 85 years. The incidence of mitral annular calcification increases sharply in these “very elderly group of patients.” To determine if mitral annular calcification in the elderly patients has the same implications as in the younger population, electrocardiographic and echocardiography (M-mode, two-dimensional, Doppler) data from 553 octogenarian patients who were referred for a variety of clinical indications were analyzed. Patients with mitral annular calcification were quantified into mild, moderate, and severe, and the association of each was determined with various cardiac abnormalities. Mitral annular calcification was found in 59% of the octogenarian patients. Out of these, mild mitral annular calcification was present in 38%, moderate in 40%, and severe mitral annular calcification in 22% of the patients. Mild mitral annular calcification was not associated with an increased incidence of any cardiac abnormalities. Moderate mitral annular calcification was also not associated with any increased incidence of significant aortic stenosis, conduction abnormalities, and enlarged left ventricular size. However, severe mitral annular calcification was associated with all these findings. Moderate and severe mitral annular calcification were associated with significant mitral regurgitation and left ventricular hypertrophy. Thus, in the majority of elderly patients with mild and moderate mitral annular calcification (78%), its presence merely represents an aging process and an innocent bystander as compared to elderly patients without mitral annular calcification. However, only severe mitral annular calcification is strongly associated with cardiac abnormalities. Therefore, quantification of mitral annular calcification in the elderly is important before associating it with various cardiac abnormalities. (ECHOCARDIOGRAPHY, Volume 8, May 1991)
- Published
- 1991
37. Mechanism of Mitral Regurgitation in Dilated Cardiomyopathy
- Author
-
Morris N. Kotler, Larry E. Jacobs, and Jeffrey Bruss
- Subjects
medicine.medical_specialty ,Mitral regurgitation ,business.industry ,Dilated cardiomyopathy ,medicine.disease ,Surgery ,Contractility ,medicine.anatomical_structure ,Ventricle ,Heart failure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Left atrial enlargement ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Chordae tendineae ,Cardiology and Cardiovascular Medicine ,business ,Papillary muscle - Abstract
Dilated cardiomyopathy is a condition characterized by chamber dilatation and impaired systolic function, resulting in the clinical manifestations of congestive heart failure. Mitral regurgitation occurs with varying frequency in dilated cardiomyopathy, and its detection depends on the diagnostic modality utilized. The presence of mitral regurgitation imposes an additional burden on the failing ventricle, and appears to be an independent prognostic indicator of mortality. The mechanism of mitral regurgitation in dilated cardiomyopathy is complex, controversial, and incompletely understood. The mitral apparatus consists of the left atrial wall, mitral annulus, mitral leaflets, chordae tendineae, papillary muscles, and left ventricular wall, and each of these components and the intimate interrelationship between these structures may contribute to the development of mitral regurgitation. Left atrial enlargement, reduced left atrial contractility, mitral leaflet retraction, abnormal vector of chordal tendineae pull, papillary muscle dysfunction (either asynergic contraction or malalignment), mitral annular dilatation, and changes in the size, shape, and function of the left ventricle have been suggested as possible mechanisms for the development of mitral regurgitation in dilated cardiomyopathy. The primary event in the development of mitral regurgitation appears to be left ventricular dilatation and dysfunction. Controversy persists as to whether the associated mechanism is annular dilatation, papillary muscle or free left ventricular wall dysfunction, or a combination of all, but recent echo-Doppler studies reviewed in this article support the notion that annular dilatation is the predominant mechanism. Improved understanding of the mechanism of mitral regurgitation in dilated cardiomyopathy may lead to a more aggressive approach with regard to pharmacological therapy, thus impacting on survival in this group of patients. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
- Published
- 1991
38. Transesophageal atrial pacing or pharmacologic stress testing in detection of coronary artery disease in patients who are unable to undergo exercise stress testing
- Author
-
Morris N. Kotler and Larry E. Jacobs
- Subjects
Coronary artery disease ,Exercise stress testing ,medicine.medical_specialty ,Atrial pacing ,business.industry ,Internal medicine ,Stress testing ,medicine ,Cardiology ,In patient ,medicine.disease ,business ,Cardiology and Cardiovascular Medicine - Published
- 1990
- Full Text
- View/download PDF
39. Flow Patterns in Dilated Cardiomyopathy: A Pulsed-wave and Color Flow Doppler Study
- Author
-
Morris N. Kotler, Wayne R. Parry, and Larry E. Jacobs
- Subjects
Adult ,Cardiomyopathy, Dilated ,medicine.medical_specialty ,Cardiomyopathy ,Inflow ,Coronary Circulation ,Internal medicine ,Mitral valve ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Aged ,business.industry ,Color flow doppler ,Dilated cardiomyopathy ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,Apex (geometry) ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,cardiovascular system ,Cardiology ,Outflow ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity - Abstract
In 48 patients with dilated cardiomyopathy, pulsed-wave and color Doppler examination were performed. In addition, 14 normal patients served as control subjects. Peak inflow velocity at the level of the mitral valve, middle left ventricle, and apex and outflow velocity at the level of the apex, middle left ventricle, and subaortic area were measured. In normal patients there was brisk propagation of inflow velocity to the apex. Patients with dilated cardiomyopathy demonstrated delayed propagation and prolongation of the duration of inflow compared with control subjects (p less than 0.04). Continuous apical flow was visualized in 25% of dilated cardiomyopathies and in no normal patients. Apical velocities were significantly increased in cardiomyopathies with significant mitral regurgitation. Outflow velocities were decreased in dilated cardiomyopathy. In patients with dilated cardiomyopathy and apical dyskinesis, flow directed toward the base was measured in the middle left ventricle during isovolumic relaxation secondary to dyskinetic rebound. Patterns of abnormal flow in dilated cardiomyopathies are readily apparent by color M-mode and two-dimensional color Doppler.
- Published
- 1990
40. Left Ventricular Outflow Tract Obstruction Following Mitral Valve Replacement with Carpentier-Edwards Prosthesis
- Author
-
Alfred W. Ioli, Morris N. Kotler, and Larry E. Jacobs
- Subjects
medicine.medical_specialty ,Mitral regurgitation ,Systolic Murmurs ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,Ventricular outflow tract obstruction ,Doppler echocardiography ,medicine.disease ,Surgery ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Ventricular outflow tract ,Mitral valve prolapse ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiac catheterization - Abstract
Left ventricular outflow tract (LVOT) obstruction is a rare complication of mitral valve replacement. In this article, we describe three patients in whom left ventricular outflow tract obstruction occurred following Carpentier-Edwards porcine mitral valve replacement. All three patients presented with symptomatic mitral regurgitation (angiographic grade 3–4) requiring mitral valve replacement. Preoperatively there was no evidence of hypertrophic obstructive cardiomyopathy by physical exam, echocardiography, or by cardiac catheterization. At the time of surgery all three were shown to have severe mitral valve prolapse. The native anterior mitral leaflet was left intact and pledgeted to the mitral annulus. Following surgery a new systolic murmur was appreciated. Echocardiographic exam visualized obstruction of the left ventricular outflow tract by the prosthetic strut in two cases and by a flail anterior leaflet in one case. Continuous-wave Doppler measured a calculated peak gradient of 72 to 81 mmHg across the left ventricular outflow tract. In one case simultaneous Doppler and cardiac catheterization confirmed the diagnosis and severity of left ventricular outflow tract obstruction. Mechanisms of left ventricular outflow tract obstruction following Carpentier-Edwards porcine mitral valve replacement are discussed. These three cases highlight the importance of echo-Doppler techniques in understanding the mechanism of newly detected systolic murmurs following mitral valve replacement.
- Published
- 1990
41. Perioperative surface and transesophageal color-flow doppler evaluation of post-traumatic intracardiac shunt
- Author
-
Larry E. Jacobs, Morris N. Kotler, Gary A. Lindenbaum, Michael Morris, and John Bell-Thomson
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Fistula ,Heart Diseases ,Thoracic Injuries ,Heart Ventricles ,medicine.medical_treatment ,Coarctation of the aorta ,Wounds, Stab ,Intracardiac injection ,Internal medicine ,Angioplasty ,Preoperative Care ,Humans ,Medicine ,Heart Atria ,Thoracotomy ,business.industry ,Color flow doppler ,Balloon catheter ,Perioperative ,medicine.disease ,Echocardiography, Doppler ,Surgery ,Cardiology ,Balloon dilation ,Cardiology and Cardiovascular Medicine ,business - Abstract
angioplasty for coarctation of the aorta. Am J Cardiol 1986;57:828-32. 6. Morrow WR, Vick GW, Nihill MR, Rokey R, Johnston DL, Hedrick TD, Mullins CE. Balloon dilation of unoperated coarctation of the aorta: shortand intermediate-term results. J Am Coll Cardiol 1988;11:133-8. 7. Marvin WJ, Mahoney LT, Rose EF. Pathologic sequelae of balloon dilation angioplasty for unoperated coarctation of the aorta [Abstract]. J Am Coil Cardiol 1986;7:117A. 8. Boxer RA, LaCorte MA, Singh S, Cooper R, Fishman MC, Goldman M, Stein HL. Nuclear magnetic resonance imaging in evaluation and follow-up of children treated for coarctation of the aorta. J Am Coll Cardiol 1986;7:1095-8. 9. Finley JP, BeauUeu RG, Nanton MA, Roy DL. Balloon catheter dilatation of coarctation of the aorta in young infants. Br Heart J 1983;50:411-15. 10. Lock JE, Niemi T, Burke BA, Einzig S, Castaneda-Zuniga WK. Transcutaneous angioplasty of experimental aortic coarctation. Circulation 1982;66:1280-6.
- Published
- 1990
42. Implicit Modeling of Flexible Break Assignments in Optimal Shift Scheduling
- Author
-
Larry E. Jacobs and Stephen E. Bechtold
- Subjects
Flexibility (engineering) ,Service system ,Schedule ,Mathematical optimization ,Computer science ,Strategy and Management ,Scheduling (production processes) ,Staffing ,Management Science and Operations Research ,service operations, labor scheduling, integer programming ,Scheduling (computing) ,Heuristics ,Integer programming ,Integer (computer science) - Abstract
The labor scheduling literature has demonstrated that the use of flexibility in designing employee schedules can result in a substantial improvement in labor utilization. This paper presents a new implicit integer linear programming formulation for the inclusion of meal/rest-break flexibility. Although the use of flexible break assignments in labor staffing decisions has been of research interest since an early article by Segal (1974), due to problem size, the majority of related research has involved the use of heuristics. An experimental analysis using four different labor requirements patterns and ten shift-length combinations demonstrated that, when flexible break assignments were modeled, the implicit formulation was superior to the traditional set-covering formulation with respect to 1) execution time, 2) computer memory requirements, and 3) the ability to produce optimal integer solutions to larger problems incorporating greater flexibility. Finally, a number of possible extensions of the implicit modeling approach for use in other labor scheduling environments are identified.
- Published
- 1990
- Full Text
- View/download PDF
43. STENT THROMBOSIS IS NOT INCREASED IN CARDIAC ARREST PATIENTS UNDERGOING THERAPEUTIC HYPOTHERMIA: AN ANALYSIS OF 15,079 PROCEDURES
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Jalaj Garg, Larry E Jacobs Md, Vratika Agarwal, Nainesh Patel, Kathan Mehta, Neeraj Shah, and Ronald S. Freudenberger
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Hypothermia ,medicine.disease ,surgical procedures, operative ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,cardiovascular diseases ,Myocardial infarction ,Stent thrombosis ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
There is little and conflicting data in the literature regarding stent thrombosis rates in cardiac arrest patients following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Therapeutic hypothermia (TH), which is often instituted in these patients for better
- Published
- 2015
44. The correlation of left ventricular hypertrophy with the severity of atherosclerosis and embolic events
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Nattawut, Wongpraparut, Sirin, Apiyasawat, Suraj, Maraj, Larry E, Jacobs, and Morris N, Kotler
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Male ,Arteriosclerosis ,Embolism ,Aortic Diseases ,Humans ,Female ,Hypertrophy, Left Ventricular ,Middle Aged ,Echocardiography, Transesophageal ,Aged - Abstract
The study was undertaken to assess the correlation between the presence and degree of aortic atheroma with degree of Left ventricular (LV) mass index and subsequent clinical outcomes.The authors studied the clinical profiles of 87 patients with aortic atherosclerosis and controls, who had undergone TEE between 1995 and 2000.Mean LV mass index was 116 gram/m2 in atherosclerosis group compared to 81 gram/m2 in the control group (p0.009). In the atherosclerotic group, there was a close correlation between LV mass index score and severity of the plaque in the aortic arch and descending aorta (p0.001, 0.001). The presence of large ulcerated plaque had a significant correlation with stroke (p0.002).1) LV mass index correlates with the severity of aortic atheroma. 2) Smoking, elevated mean arterial blood pressure and a high LV mass index score are significantly correlated with large ulcerated plaque and stroke. 3) These findings may in part explain the higher cardiovascular risk in patients with increased left ventricular mass.
- Published
- 2005
45. Inducible left ventricular outflow tract gradient during dobutamine stress echocardiography: an association with intraoperative hypotension but not a contraindication to liver transplantation
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Suraj, Maraj, Larry E, Jacobs, Rajiv, Maraj, Rafael, Contreras, Pairoj, Rerkpattanapipat, Taseem A, Malik, Cosme, Manzarbeitia, Santiago, Munoz, Kenneth, Rothstein, and Morris N, Kotler
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Male ,Ventricular Dysfunction, Left ,Risk Factors ,Contraindications ,Liver Diseases ,Humans ,Female ,Middle Aged ,Echocardiography, Stress ,Liver Transplantation - Abstract
Dobutamine stress echocardiography (DSE) is frequently used in the evaluation of cardiac risk prior to orthotopic liver transplantation (OLT). In the general cardiac population, an inducible left ventricular outflow tract gradient (LVOT Delta) during DSE has variable prognostic importance. The purpose of this study was to determine the prevalence and clinical significance of LVOT Delta in patients undergoing OLT during DSE.Consecutive medical records of 106 patients who had undergone OLT at our institution from January 1997 until January 2002 were retrospectively analyzed and divided into two groups based on the presence (Group I, LVOT Delta36 mmHg) or absence (Group II, LVOT Deltaor = 36 mmHg) of a significant LVOT Delta measured during DSE. We determined any outcome differences between these two groups with regard to intraoperative hypotension, cardiac mortality, length of hospital stay, graft function, and renal function post-OLT.Forty-six patients had an LVOT Delta36 mmHg (Group I) and 60 patients had LVOT Deltaor = 36 mmHg (Group II). Baseline demographics were similar in both groups. There was no significant overall difference in cardiac mortality between Group I versus Group II patients (0 versus 1 patient, respectively, P=0.57). Intraoperative hypotension occurred in 4 patients in Group I versus 0 patient in Group II (P=0.03). Length of stay, graft function, and postoperative renal function were similar in both groups.A significant LVOT Delta36 mmHg is a frequent finding occurring in 46/106 (43%) of patients who have DSE pre-OLT. Intraoperative hypotension is associated with patients having an LVOT Delta. However, post-OLT patients with significant LVOT Delta have a similar in-hospital outcome compared to patients without significant LVOT Delta.
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- 2004
46. Bacteremia and infective endocarditis in patients on hemodialysis
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Larry E. Jacobs, Suraj Maraj, Rajiv Maraj, and Morris N. Kotler
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Bacteremia ,General Medicine ,Endocarditis, Bacterial ,Neutropenia ,medicine.disease ,Prognosis ,End stage renal disease ,Surgery ,Echocardiography ,Renal Dialysis ,Risk Factors ,Internal medicine ,Infective endocarditis ,medicine ,Endocarditis ,Humans ,Kidney Failure, Chronic ,Hemodialysis ,business ,Kidney disease - Abstract
The number of patients with end-stage renal disease (ESRD) has risen dramatically over the last decade. There are 300,000 patients in the United States with ESRD who are receiving hemodialysis (HD), and the incidence is increasing at a rate of 6% to 8% per year. Bacteremia, a prerequisite for infective endocarditis (IE), occurs at a rate of 0.7 to 1.4 episodes per 100 patient-care months. Few other medical conditions, except for chemotherapy-induced neutropenia, immunosuppression, and intravenous drug abuse, are associated with higher rates of bacteremia. IE occurs in approximately 2% to 6% of patients receiving HD. The aim of this article is to review the pathogenesis, diagnosis, current therapeutic options, and determinants of prognosis of IE in patients receiving HD.
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- 2004
47. Aortoventricular fistula and abscess caused by vancomycin-resistant enterococcus in a hemodialysis patient
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Enakshi Bajpai, Suraj Maraj, Guillermo Crespo, Morris N. Kotler, and Larry E. Jacobs
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Adult ,medicine.medical_specialty ,Heart Diseases ,medicine.medical_treatment ,Fistula ,Microbial Sensitivity Tests ,medicine.disease_cause ,Risk Assessment ,Fatal Outcome ,Renal Dialysis ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Vancomycin-resistant Enterococcus ,Abscess ,Vascular Fistula ,business.industry ,Vancomycin Resistance ,medicine.disease ,Surgery ,Disease Progression ,Kidney Failure, Chronic ,Female ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Enterococcus - Published
- 2003
48. Resolution of a primary intracardiac lymphoma
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Suraj Maraj, Richard G. To, Larry E. Jacobs, Guillermo Crespo, and Morris N. Kotler
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Aged, 80 and over ,Male ,medicine.medical_specialty ,Lymphoma, B-Cell ,business.industry ,Resolution (electron density) ,medicine.disease ,Intracardiac injection ,Lymphoma ,Heart Neoplasms ,Doxorubicin ,Vincristine ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Humans ,Prednisone ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Cyclophosphamide ,Echocardiography, Transesophageal ,Aged - Published
- 2003
49. Undefined hypercoaguable state associated with massive right ventricular thrombus and embolism in a previously healthy 17-year-old male
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Larry E. Jacobs, Enakshi Bajpai, Guillermo Crespo, Suraj Maraj, Kokila Doshi, Morris N. Kotler, and Nicholas Langan
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Male ,medicine.medical_specialty ,Adolescent ,Heart Diseases ,Heart Ventricles ,Thrombophilia ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Young male ,business.industry ,Thrombosis ,Right ventricular thrombus ,medicine.disease ,Pulmonary embolism ,Embolism ,Echocardiography ,cardiovascular system ,Etiology ,Cardiology ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism - Abstract
A right ventricular thrombus (RVT) is an unusual finding on echocardiography. We describe a healthy young male patient who developed RVT with subsequent pulmonary embolism (PE), the etiology of which remains uncertain.
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- 2003
50. Penetrating aortic atherosclerotic ulcer complicated by periesophageal hematoma
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Morris N. Kotler, Nayere Zaeri, Guillermo Crespo, Suraj Maraj, Fermin Garcia, and Larry E. Jacobs
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medicine.medical_specialty ,Fatal outcome ,Arteriosclerosis ,Aortic Diseases ,Aorta, Thoracic ,Chest pain ,Esophageal Diseases ,Hematoma ,Fatal Outcome ,Penetrating atherosclerotic ulcer ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Esophagus ,Ulcer ,Aged ,Ultrasonography ,Aorta ,business.industry ,Stomach ,medicine.disease ,digestive system diseases ,Surgery ,medicine.anatomical_structure ,cardiovascular system ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Penetrating aortic atherosclerotic ulcers have been recently recognized as an entity among the acute aortic syndromes with a potentially fatal outcome. We describe the case of a patient presenting with severe chest pain who died as a result of a thoracic-aorta penetrating atherosclerotic ulcer complicated by a intramural hematoma of the esophagus and stomach, leading to exsanguination. To our knowledge this is the first case reported in the literature of such a complication from penetrating aortic atherosclerotic ulcers.
- Published
- 2003
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