• Trial of Oral Diuretics Prior to Discharge Is Not Associated With Improved Outcomes in Decompensated Heart Failure Adeba Mohammad 1Shuktika Nandkeolyar 2Dennis Grewal 2Antoine Sakr 2Ahmed Seliem 2Liset Stoletniy 2Dmitry Abramov 2 Cardiol Res.2021 Aug;12(4):244-250 (08/2021) (link)
  • Inpatient Diuretic Management of Acute Heart Failure: A Practical Review The inpatient treatment of acute heart failure (AHF) is aimed at achieving euvolemia, relieving symptoms, and reducing rehospitalization. Adequate treatment of AHF is rooted in understanding the pharmacokinetics and pharmacodynamics of select diuretic agents used to achieve decongestion. While loop diuretics remain the primary treatment of AHF, the dosing strategies of loop diuretics and the use of adjunct diuretic classes to augment clinical response can be complex. This review examines the latest strategies for diuretic management in patients with AHF, including dosing and monitoring strategies, interaction of diuretics with other medication classes, use adjunctive therapies, and assessing endpoints for diuretic. The goal of the review is to guide the reader through commonly encountered clinical scenarios and pitfalls in the diuretic management of patients with AHF. (03/2021) (link)
  • Increased sensitivity to ischemic interval of donor hearts with diminished left ventricular function Background: Previous studies have demonstrated that carefully selected donor hearts (DHs) with poor left ventricular ejection fraction (EF) may be transplanted with long-term survival equivalent to hearts with normal function. The purpose of this study is to facilitate their selection. Methods: Using the United Network for Organ Sharing database, we reviewed all adult heart transplants between January 2000 and March 2016. Regression models were developed to estimate hazard ratios with 95% confidence intervals of post-transplant 1-year mortality and failure of EF to recover at 1 year for DHs with EF ≥50%, EF 40%-49.9%, and EF 30%-30.9%. Results: During the study period, 31,979 DHs were transplanted. Compared with DHs with left ventricular ejection fraction ≥50%, DHs with reduced EF were younger and had slightly lower body mass index. There were no differences in the mechanism of death between groups and no differences in recipient characteristics, except for a higher incidence of African American recipients of hearts with an EF of 40%-49.9%. Of the variables analyzed, only a 1-hour increase in ischemia time had different hazard ratios for 1-year mortality between groups, with increasing hazard as EF diminished. It was also the only variable that predicted failure of recovery of normal EF and that was in the lowest EF group. Conclusions: The impact of DH traits associated with adverse outcomes after heart transplantation that we studied are similar between DHs with EF <50% and those with EF ≥50%. However, limiting ischemic time may be even more important for DHs with diminished left ventricular function, particularly at the low end of the EF spectrum. (03/2020) (link)
  • Aortobronchial Fistula Causing Recurrent Hemoptysis 21 Years Post-Heart Transplant Aortobronchial fistulae (ABF) are uncommon but potentially fatal anomalies. Patients may initially present with small volume hemoptysis, which can rapidly lead to massive hemoptysis and death if not diagnosed and intervened upon early. Diagnosis by imaging and bronchoscopy is not always conclusive; thus, a high index of suspicion is necessary to diagnose this life-threatening condition. Herein, we describe a case of a young man who had a late presentation of ABF 21 years following heart transplantation. This case illustrates the diagnostic and clinical challenge of ABF as a late sequela of cardiac transplantation and highlights the rarity of this anomaly. (12/2019) (link)
  • Predictors of Systolic Heart Failure and Mortality Following Orthotopic Liver Transplantation: a Single-Center Cohort Antoine E Sakr 1Gary E Fraser 2Tanya P Doctorian 2Hyungjin B Kim 2Deepika Narasimha 2Islam Abudayyeh 2Anthony D Hilliard 2Wendy Shih 3Michael E de Vera 4Pedro W Baron 4Michael L Volk 4Liset N Stoletniy 2 Transplant Proc.Jul-Aug 2019;51(6):1950-1955  (08/2019) (link)
  • A case report of heart transplant for ischaemic cardiomyopathy from lupus coronary vasculitis Background: Coronary vasculitis is a rare, life-threatening complication of systemic lupus erythematosus (SLE). Case summary: A 23-year-old woman with SLE presented with typical angina and worsening dyspnoea on exertion. Coronary angiography revealed severe triple vessel disease with a 'string of beads' appearance classic for coronary vasculitis. Transthoracic echocardiogram revealed ejection fraction of 25-30% with a severely hypokinetic distal septum and distal anterior wall and an akinetic apical wall. Despite vasculitis treatment with cyclophosphamide and pulse-dose steroids, her coronary vasculitis did not improve. She was refractory to anti-anginal and guideline-directed medical therapy for heart failure and successfully underwent orthotopic heart transplant (OHT). Discussion: This is the first reported case of OHT in the case of SLE coronary vasculitis. Chronic SLE coronary vasculitis is caused by lymphocyic infiltration leading to inflammation and fibrosis of the major epicardial coronary arteries but can be successfully managed with OHT when refractory to medical SLE and heart failure therapies. It can affect patients of all ages with SLE, emphasizing the importance of thorough history taking and clinical evaluation in young patients presenting with cardiac symptoms to establish an appropriate diagnosis and treatment plan. (10/2018) (link)
  • 91-Year-Old Allograft: Oldest Surviving Donor Heart Still Going: A Case Report For patients with end-stage heart failure, heart transplantation remains one of the most successful therapies with excellent long-term survival rates. However, over the past few decades, there has been a worsening supply/demand mismatch given the rising epidemic of heart failure and the relatively fixed availability of donor hearts. In this case report, we describe the case of a 30-year-old woman who underwent transplantation with a 68-year-old donor heart and who has survived for 23 years without any major cardiac problems. To our knowledge, this patient has one of the oldest surviving donor hearts (91-year-old heart). Review of the latest guidelines and recent studies have demonstrated a gradual expansion of donor criteria to meet this critical shortage of donor organs. (09/2017) (link)
  • The advent of more advanced 3D image processing, reconstruction, and a variety of three-dimensional (3D) printing technologies using different materials has made rapid and fairly affordable anatomically accurate models much more achievable. These models show great promise in facilitating procedural and surgical planning for complex congenital and structural heart disease. Refinements in 3D printing technology lend itself to advanced applications in the fields of bio-printing, hemodynamic modeling, and implantable devices. As a novel technology with a large variability in software, processing tools and printing techniques, there is not a standardized method by which a clinician can go from an imaging data-set to a complete model. Furthermore, anatomy of interest and how the model is used can determine the most appropriate technology. In this over-view we discuss, from the standpoint of a clinical professional, image acquisition, processing, and segmentation by which a printable file is created. We then review the various printing technologies, advantages and disadvantages when printing the completed model file, and describe clinical scenarios where 3D printing can be utilized to address therapeutic challenges. (02/2017) (link)

Scholarly Journals--Published