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1. Risk of Paradoxical Embolism (RoPE)–Estimated Attributable Fraction Correlates With the Benefit of Patent Foramen Ovale Closure

Author

Kent, David M, Saver, Jeffrey L, Ruthazer, Robin, Furlan, Anthony J, Reisman, Mark, Carroll, John D, Smalling, Richard W, Jüni, Peter, Mattle, Heinrich P, Meier, Bernhard, and Thaler, David E

Subjects
Epidemiology, Biomedical and Clinical Sciences, Health Sciences, Brain Disorders, Stroke, Clinical Research, Cardiovascular, Hematology, Neurosciences, Cardiac Catheterization, Embolism, Paradoxical, Foramen Ovale, Patent, Humans, Risk Factors, Secondary Prevention, Treatment Outcome, embolism, paradoxical, foramen ovale, patent, patients, prediction, risk, embolism, paradoxical, foramen ovale, patent, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

Background and purposeIn patients with cryptogenic stroke and patent foramen ovale (PFO), the Risk of Paradoxical Embolism (RoPE) Score has been proposed as a method to estimate a patient-specific "PFO-attributable fraction"-the probability that a documented PFO is causally-related to the stroke, rather than an incidental finding. The objective of this research is to examine the relationship between this RoPE-estimated PFO-attributable fraction and the effect of closure in 3 randomized trials.MethodsWe pooled data from the CLOSURE-I (Evaluation of the STARFlex Septal Closure System in Patients With a Stroke and/or Transient Ischemic Attack due to Presumed Paradoxical Embolism through a Patent Foramen Ovale), RESPECT (Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment), and PC (Clinical Trial Comparing Percutaneous Closure of Patent Foramen Ovale [PFO] Using the Amplatzer PFO Occluder With Medical Treatment in Patients With Cryptogenic Embolism) trials. We examine the treatment effect of closure in high RoPE score (≥7) versus low RoPE score (

Published
2020

4. Heart Brain Clinic

Author

Tariq, Muhammad Bilal, primary, Qadri, Syed Kalimullah S., additional, Sharrief, Anjail, additional, Tulod, Kathleen, additional, Dhoble, Abhijeet, additional, Gurung, Sidhanta, additional, Jamilla Lacap, Maria, additional, Okpala, Munachi, additional, Manwani, Bharti, additional, Smalling, Richard W., additional, and Gonzales, Nicole, additional

Published
2023
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6. Anticoagulation After Surgical or Transcatheter Bioprosthetic Aortic Valve Replacement

Author

Chakravarty, Tarun, Patel, Akshar, Kapadia, Samir, Raschpichler, Matthias, Smalling, Richard W., Szeto, Wilson Y., Abramowitz, Yigal, Cheng, Wen, Douglas, Pamela S., Hahn, Rebecca T., Herrmann, Howard C., Kereiakes, Dean, Svensson, Lars, Yoon, Sung-Han, Babaliaros, Vasilis C., Kodali, Susheel, Thourani, Vinod H., Alu, Maria C., Liu, Yangbo, McAndrew, Thomas, Mack, Michael, Leon, Martin B., and Makkar, Raj R.

Published
2019
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8. Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement

Author

Yoon, Sung-Han, Bleiziffer, Sabine, Latib, Azeem, Eschenbach, Lena, Ancona, Marco, Vincent, Flavien, Kim, Won-Keun, Unbehaum, Axel, Asami, Masahiko, Dhoble, Abhijeet, Silaschi, Miriam, Frangieh, Antonio H., Veulemans, Verena, Tang, Gilbert H.L., Kuwata, Shingo, Rampat, Rajiv, Schmidt, Tobias, Patel, Amisha J., Nicz, Pedro Felipe Gomez, Nombela-Franco, Luis, Kini, Annapoorna, Kitamura, Mitsunobu, Sharma, Rahul, Chakravarty, Tarun, Hildick-Smith, David, Arnold, Martin, de Brito, Fabio Sandoli, Jr., Jensen, Christoph, Jung, Christian, Jilaihawi, Hasan, Smalling, Richard W., Maisano, Francesco, Kasel, Albert Markus, Treede, Hendrik, Kempfert, Joerg, Pilgrim, Thomas, Kar, Saibal, Bapat, Vinayak, Whisenant, Brian K., Van Belle, Eric, Delgado, Victoria, Modine, Thomas, Bax, Jeroen J., and Makkar, Raj R.

Published
2019
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11. Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

Author

Aertker, Robert A, Barker, Colin M, Anderson, H Vernon, Denktas, Ali E, Giesler, Gregory M, Julapalli, Vinay R, Ledoux, John F, Persse, David E, Sdringola, Stefano, Vooletich, Mary T, McCarthy, James J, and Smalling, Richard W

Subjects
electrocardiogram, ST elevation, myocardial infarction, proximal LAD, Cardiology, Emergency Medicine
Abstract

Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD) artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG) could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI). Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI) capability for the treatment of acute myocardial infarctions. Given the paucity ofhospitals capable of PCI, early identification of more severe myocardial infarction may promptemergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions.Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings ofproximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset.Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35), the mean sum of ST elevation (STE) in leads V1 through V6 plus ST depression (STD) in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007). A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37), there was no significant difference in ST-segment deviation between the 2 groups.Conclusion: The sum STE (V1-V6) and STD (II, III, aVF) on a 12-lead ECG can be used to predict proximal LAD occlusions if performed within the first hour of symptom onset. This should be considered a high-risk finding and may prompt prehospital direction of such patients to PCI-capable hospitals. [West J Emerg Med. 2011;12(4):408–413.]

Published
2011

14. COVID-19 COMPLICATED BY RESPIRATORY FAILURE INCREASES INPATIENT STEMI MORTALITY: MACHINE LEARNING-AUGMENTED MODIFIED PROPENSITY SCORE ADJUSTED LONGITUDINAL COHORT STUDY

Author

Ynalvez, Leslie Ammabel, primary, Monlezun, Dominique, additional, Hust, Michael, additional, Madjid, Mohammad, additional, Alexandrescu, Sofia, additional, Koutroumpakis, Efstratios, additional, Palaskas, Nicolas L., additional, Honan, Kevin, additional, Liu, Victor Y., additional, Cilingiroglu, Mehmet, additional, Marmagkiolis, Konstantinos, additional, Deswal, Anita, additional, Smalling, Richard W., additional, and Iliescu, Cezar, additional

Published
2023
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15. The safety of intracoronary ultrasound. A multicenter survey of 2207 examinations.

Author

Hausmann, Dirk, Erbel, Raimund, Alibelli-Chemarin, Marie-J, Boksch, Wolfgang, Caracciolo, Eugene, Cohn, Joel M, Culp, Stephen C, Daniel, Werner G, De Scheerder, Ivan, DiMario, Carlo, Ferguson, James J, Fitzgerald, Peter J, Friedrich, Guy, Ge, Junbo, Görge, Günther, Hanrath, Peter, McB. Hodgson, John, Isner, Jeffrey M, Jain, Suresh, Maier-Rudolph, Willibald, Mooney, Michael, Moses, Jeffrey W, Mudra, Harald, Pinto, Fausto J, Smalling, Richard W, Talley, J David, Tobis, Jonathan M, Walter, Paul D, Weidinger, Franz, Werner, Gerald S, Yeung, Alan C, and Yock, Paul G

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Atherosclerosis, Biomedical Imaging, Patient Safety, Cardiovascular, Clinical Research, Heart Disease - Coronary Heart Disease, Adult, Aged, Aged, 80 and over, Coronary Vessels, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Ultrasonography, ULTRASONICS, CORONARY DISEASE, RISK FACTORS, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences, Sports science and exercise
Abstract

BackgroundIntracoronary ultrasound (ICUS) is increasingly used in clinical practice to study the natural history of coronary artery disease and to assess the effects of intracoronary, catheter-based interventions. However, the risk associated with the procedure is not well documented.Methods and resultsICUS studies performed in 28 centers were retrospectively included; these centers agreed to contribute to the study among a total of 60 centers initially invited. Among the 2207 ICUS studies, 505 (23%) were performed in heart transplant recipients and 1702 (77%) in nontransplant patients. Indication for ICUS was diagnostic imaging in 915 (41%), drug testing in 244 (11%), and guidance for intracoronary interventions in 1048 patients (47%). There were no complications in 2034 patients (92.2%). In 87 patients (3.9%), complications occurred but were judged to be "not related" to ICUS by the operator. In 63 patients (2.9%), spasm occurred during ICUS imaging. In 9 patients (0.4%), complications other than spasm were judged to have a "certain relation" to ICUS, including acute procedural events in 6 (3 acute occlusion, 1 embolism, 1 dissection, and 1 thrombus) and major events in 3 patients (2 occlusion and 1 dissection; all resulting in myocardial infarction). In 14 patients (0.6%), complications with "uncertain relation" to ICUS were recorded, including acute procedural events in 9 (5 acute occlusion, 3 dissection, and 1 arrhythmia) and major events in 5 patients (2 myocardial infarction and 3 emergency coronary artery bypass surgery). The incidence of acute procedural or major complications judged to be associated with ICUS (uncertain relation or certain relation to ICUS) was compared in different patient groups. The complication rate was higher in patients with unstable angina or acute myocardial infarction (2.1% events) as compared with patients with stable angina pectoris and asymptomatic patients (0.8% and 0.4%, respectively; chi 2 = 10.9, P < .01). These complications were also more frequent in patients undergoing interventions (1.9%) as compared with transplant and nontransplant patients undergoing diagnostic ICUS imaging (0% and 0.6%, respectively; chi 2 = 13.5, P < .001). Adverse events were few, and no association was detected between these events and the size or type of ICUS catheter used.ConclusionsICUS is associated with (but not necessarily the direct cause of) a minor acute clinical risk. Vessel spasm is the most frequent event occurring during ICUS. Other complications predominantly occur in patients with acute coronary syndromes and during guidance for intervention.

Published
1995

16. Association of Atrial Septal Aneurysm and Shunt Size With Stroke Recurrence and Benefit From Patent Foramen Ovale Closure

Author

Mas, Jean-Louis, primary, Saver, Jeffrey L., additional, Kasner, Scott E., additional, Nelson, Jason, additional, Carroll, John D., additional, Chatellier, Gilles, additional, Derumeaux, Geneviève, additional, Furlan, Anthony J., additional, Herrmann, Howard C., additional, Jüni, Peter, additional, Kim, Jong S., additional, Koethe, Benjamin, additional, Lee, Pil Hyung, additional, Lefebvre, Benedicte, additional, Mattle, Heinrich P., additional, Meier, Bernhard, additional, Reisman, Mark, additional, Smalling, Richard W., additional, Sondergaard, Lars, additional, Song, Jae-Kwan, additional, Thaler, David E., additional, and Kent, David M., additional

Published
2022
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17. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Author

Amsterdam, Ezra A., Wenger, Nanette K., Brindis, Ralph G., Casey, Donald E., Jr., Ganiats, Theodore G., Holmes, David R., Jr., Jaffe, Allan S., Jneid, Hani, Kelly, Rosemary F., Kontos, Michael C., Levine, Glenn N., Liebson, Philip R., Mukherjee, Debabrata, Peterson, Eric D., Sabatine, Marc S., Smalling, Richard W., and Zieman, Susan J.

Published
2014
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18. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Author

Amsterdam, Ezra A., Wenger, Nanette K., Brindis, Ralph G., Casey, Donald E., Jr., Ganiats, Theodore G., Holmes, David R., Jr., Jaffe, Allan S., Jneid, Hani, Kelly, Rosemary F., Kontos, Michael C., Levine, Glenn N., Liebson, Philip R., Mukherjee, Debabrata, Peterson, Eric D., Sabatine, Marc S., Smalling, Richard W., and Zieman, Susan J.

Published
2014
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27. Association of Atrial Septal Aneurysm and Shunt Size With Stroke Recurrence and Benefit From Patent Foramen Ovale Closure

Author

Mas, Jean-Louis, Saver, Jeffrey L., Kasner, Scott E., Nelson, Jason, Carroll, John D., Chatellier, Gilles, Derumeaux, Geneviève, Furlan, Anthony J., Herrmann, Howard C, Jüni, Peter, Kim, Jong S., Koethe, Benjamin, Lee, Pil Hyung, Lefebvre, Benedicte, Mattle, Heinrich P, Meier, Bernhard, Reisman, Mark, Smalling, Richard W., Sondergaard, Lars, Song, Jae Kwan, Thaler, David E., Kent, David M., Mas, Jean-Louis, Saver, Jeffrey L., Kasner, Scott E., Nelson, Jason, Carroll, John D., Chatellier, Gilles, Derumeaux, Geneviève, Furlan, Anthony J., Herrmann, Howard C, Jüni, Peter, Kim, Jong S., Koethe, Benjamin, Lee, Pil Hyung, Lefebvre, Benedicte, Mattle, Heinrich P, Meier, Bernhard, Reisman, Mark, Smalling, Richard W., Sondergaard, Lars, Song, Jae Kwan, Thaler, David E., and Kent, David M.

Abstract

Importance: The Patent Foramen Ovale (PFO)-Associated Stroke Causal Likelihood classification system combines information regarding noncardiac patient features (vascular risk factors, infarct topography) and PFO features (shunt size and presence of atrial septal aneurysm [ASA]) to classify patients into 3 validated categories of responsiveness to treatment with PFO closure. However, the distinctive associations of shunt size and ASA, alone and in combination, have not been completely delineated. Objective: To evaluate the association of PFO closure with stroke recurrence according to shunt size and/or the presence of an ASA. Design, Setting, and Participants: Pooled individual patient data from 6 randomized clinical trials conducted from February 2000 to October 2017 that compared PFO closure with medical therapy. Patients in North America, Europe, Australia, Brazil, and South Korea with PFO-associated stroke were included. Analysis was completed in January 2022. Exposures: Transcatheter PFO closure plus antithrombotic therapy vs antithrombotic therapy alone, stratified into 4 groups based on the combination of 2 features: small vs large PFO shunt size and the presence or absence of an ASA. Main Outcomes and Measures: Recurrent ischemic stroke. Results: A total of 121 recurrent ischemic strokes occurred in the pooled 3740 patients (mean [SD] age, 45 [10] years; 1682 [45%] female) during a median (IQR) follow-up of 57 (23.7-63.8) months. Treatment with PFO closure was associated with reduced risk for recurrent ischemic stroke (adjusted hazard ratio [aHR], 0.41 [95% CI, 0.28-0.60]; P <.001). The reduction in hazard for recurrent stroke was greater for patients with both a large shunt and an ASA (aHR, 0.15 [95% CI, 0.06-0.35]) than for large shunt without ASA (aHR, 0.27 [95% CI, 0.14-0.56]), small shunt with ASA (aHR, 0.36 [95% CI, 0.17-0.78]), and small shunt without ASA (aHR, 0.68 [95% CI, 0.41-1.13]) (interaction P =.02). At 2 years, the absolute risk reductio

Published
2022

32. Abstract TMP106: Pooled Analysis Of Five Randomized Trials Comparing Device Closure Of Patent Foramen Ovale After Stroke To Medical Treatment: Impact Of Residual Shunt On Stroke Outcomes

Author

Thaler, David E, primary, Saver, Jeffrey L, additional, Kasner, Scott, additional, Carroll, John, additional, Furlan, Anthony J, additional, Herrmann, Howard C, additional, Juni, Peter, additional, Kim, Jong S, additional, Koethe, Benjamin, additional, Lee, Pil Hyung, additional, Lefebvre, Bénédicte, additional, Mas, Jean-Louis, additional, Mattle, Heinrich P, additional, Meier, Bernhard, additional, Nelson, Jason, additional, Reisman, Mark, additional, Smalling, Richard W, additional, Soendergaard, Lars, additional, Song, Jae-kwan, additional, and Kent, David M, additional

Published
2022
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36. Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke

Author

Kent, David M., primary, Saver, Jeffrey L., additional, Kasner, Scott E., additional, Nelson, Jason, additional, Carroll, John D., additional, Chatellier, Gilles, additional, Derumeaux, Geneviève, additional, Furlan, Anthony J., additional, Herrmann, Howard C., additional, Jüni, Peter, additional, Kim, Jong S., additional, Koethe, Benjamin, additional, Lee, Pil Hyung, additional, Lefebvre, Benedicte, additional, Mattle, Heinrich P., additional, Meier, Bernhard, additional, Reisman, Mark, additional, Smalling, Richard W., additional, Soendergaard, Lars, additional, Song, Jae-Kwan, additional, Mas, Jean-Louis, additional, and Thaler, David E., additional

Published
2021
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38. Abstract 11058: Pooled Analysis of Six Randomized Trials Comparing Device Closure of Patent Foramen Ovale After Stroke to Medical Treatment: Overall Effects and Patient Selection Using a Causal Classification System

Author

Kent, David M, primary, Saver, Jeffrey L, additional, Kasner, Scott E, additional, Nelson, Jason, additional, Carroll, John D, additional, CHATELLIER, Gilles, additional, Derumeaux, Geneviéve, additional, Furlan, Anthony J, additional, Herrmann, Howard C, additional, Juni, Peter, additional, Kim, Jong S, additional, Koethe, Benjamin, additional, Lee, Pil Hyung, additional, Lefebvre, Bénédicte, additional, Mattle, Heinrich P, additional, Meier, Bernhard, additional, Reisman, Mark, additional, Smalling, Richard W, additional, Soendergaard, Lars, additional, Song, Jae-kwan, additional, Mas, Jean-Louis, additional, and Thaler, David E, additional

Published
2021
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39. Abstract 13212: Chronic Total Occlusion Racial and Income Inequities by Mortality and Cost: Propensity Score and Machine Learning Augmented Nationally Representative Case-Control Study of 30 Million Hospitalizations

Author

Agrawal, Nikhil, primary, Monlezun, Dominique, additional, Grable, Cullen, additional, Graham, Jordan, additional, Marmagkiolis, Konstantinos, additional, Chauhan, Siddharth, additional, Hostetter, Logan, additional, Cilingiroglu, Mehmet, additional, Dhoble, Abhijeet, additional, Charitakis, Konstantinos, additional, Smalling, Richard W, additional, Palaskas, Nicolas L, additional, Arain, Salman A, additional, and Iliescu, Cezar, additional

Published
2021
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40. Abstract 10501: Clinical Outcomes After Transcatheter Edge-to-Edge Repair of the Mitral Valve with the Mitraclip TM System in Cancer Survivors

Author

Agrawal, Nikhil, primary, Lin, Kevin, additional, Battel, Lucas, additional, Garcia-Sayan, Enrique, additional, Lopez-Mattei, Juan, additional, Arain, Salman A, additional, Charitakis, Konstantinos, additional, Iliescu, Cezar, additional, Smalling, Richard W, additional, and Dhoble, Abhijeet, additional

Published
2021
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41. Clinical characteristics and outcomes after unplanned intraaortic balloon counterpulsation in the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction trial

Author

Kohl, Louis P., Leimberger, Jeffrey D., Chiswell, Karen, Jones, Schuyler W., Thiele, Holger, Smalling, Richard W., Chandra, Praveen, Cohen, Marc, Perera, Divaka, Chew, Derek P., French, John K., Blaxil, Jonathan, Kumar, Sreenivas A., Ohman, Magnus E., and Patel, Manesh R.

Published
2016
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42. Reduced-Dose Fibrinolytic Acceleration of ST-Segment Elevation Myocardial Infarction Treatment Coupled With Urgent Percutaneous Coronary Intervention Compared to Primary Percutaneous Coronary Intervention Alone: Results of the AMICO (Alliance for Myocardial Infarction Care Optimization) Registry

Author

Denktas, Ali E., Athar, Haris, Henry, Timothy D., Larson, David M., Simons, Michael, Chan, Roger S., Niles, Nathaniel W., Thiele, Holger, Schuler, Gerhard, Ahn, Chul, Sdringola, Stefano, Anderson, H. Vernon, McKay, Raymond G., and Smalling, Richard W.

Published
2008
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48. The RoPE-Estimated Attributable Fraction Correlates with the Benefit of PFO Closure: An analysis of 3 trials

Author

Kent, David M., Saver, Jeffrey L., Ruthazer, Robin, Furlan, Anthony J., Reisman, Mark, Carroll, John D., Smalling, Richard W., Jüni, Peter, Mattle, Heinrich P., Meier, Bernhard, and Thaler, David E.

Subjects
Stroke, Cardiac Catheterization, Treatment Outcome, Risk Factors, Secondary Prevention, Foramen Ovale, Patent, Humans, Article, Embolism, Paradoxical
Abstract

In patients with cryptogenic stroke and patent foramen ovale (PFO), the Risk of Paradoxical Embolism (RoPE) Score has been proposed as a method to estimate a patient-specific "PFO-attributable fraction"-the probability that a documented PFO is causally-related to the stroke, rather than an incidental finding. The objective of this research is to examine the relationship between this RoPE-estimated PFO-attributable fraction and the effect of closure in 3 randomized trials.We pooled data from the CLOSURE-I (Evaluation of the STARFlex Septal Closure System in Patients With a Stroke and/or Transient Ischemic Attack due to Presumed Paradoxical Embolism through a Patent Foramen Ovale), RESPECT (Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment), and PC (Clinical Trial Comparing Percutaneous Closure of Patent Foramen Ovale [PFO] Using the Amplatzer PFO Occluder With Medical Treatment in Patients With Cryptogenic Embolism) trials. We examine the treatment effect of closure in high RoPE score (≥7) versus low RoPE score (7) patients. We also estimated the relative risk reduction associated with PFO closure across each level of the RoPE score using Cox proportional hazard analysis. We estimated a patient-specific attributable fraction using a PC trial-compatible (9-point) RoPE equation (omitting the neuroradiology variable), as well as a 2-trial analysis using the original (10-point) RoPE equation. We examined the Pearson correlation between the estimated attributable fraction and the relative risk reduction across RoPE strata.In the low RoPE score group (7, n=912), the rate of recurrent strokes per 100 person-years was 1.37 in the device arm versus 1.68 in the medical arm (hazard ratio, 0.82 [0.42-1.59]The RoPE score estimated attributable fraction is highly correlated to the relative risk reduction of device versus medical therapy. This observation suggests the RoPE score identifies patients with cryptogenic stroke who are likely to have a PFO that is pathogenic rather than incidental.

Published
2020

49. An Unusual Cause of Hypoxia: Ventricular Septal Defect, Pulmonary Artery Atresia, and Major Aortopulmonary Collaterals Diagnosed in the Adult Cardiac Catheterization Lab

Author

Bravo-Jaimes, Katia, Walton, Brian, Tung, Poyee, and Smalling, Richard W.

Subjects
congenital, hereditary, and neonatal diseases and abnormalities, Article Subject, cardiovascular diseases
Abstract

The association of pulmonary atresia, ventricular septal defect (VSD) and major aortopulmonary collaterals (MAPCA) is an extreme form of tetralogy of Fallot (TOF). It carries a high mortality risk if not intervened on during infancy with only 20% of unoperated patients surviving into adulthood. We present the case of a 40-year-old man who presented for evaluation prior to retinal surgery and was found to have hypoxia and a loud murmur. Cardiac catheterization was performed in the general catheterization laboratory, demonstrating a membranous VSD, pulmonary atresia, and MAPCA. We highlight the challenges and limitations that an adult interventional cardiologist may have when encountering these patients.

Published
2020
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