Saint Luke's Health System’s Post

Essential Pathologies to Identify in Ultrasound Examinations Here are some vital pathologies that sonographers and radiologists should vigilantly assess for across various ultrasound examinations: 1. Deep Vein Thrombosis (DVT): In vascular studies, identifying DVT is crucial to prevent life-threatening complications like pulmonary embolism. Ultrasound helps in visualizing thrombi in deep veins, aiding in prompt management. 2. Ectopic Pregnancy: In obstetric ultrasound, early detection of ectopic pregnancy can be life-saving, preventing complications and guiding immediate intervention. 3. Appendicitis: In abdominal ultrasound, diagnosing acute appendicitis is critical to avoid rupture and subsequent peritonitis. Ultrasound can reveal an enlarged appendix and signs of inflammation. 4. Cholelithiasis and Cholecystitis: Gallbladder pathologies, including stones and inflammation, are key findings in abdominal ultrasounds, often leading to surgical intervention. 5. Aortic Aneurysm: Identifying aneurysms, particularly in the abdominal aorta, is vital to prevent rupture. Ultrasound is instrumental in measuring the aorta’s diameter and monitoring for changes. 6. Cardiac Abnormalities: Echocardiography can reveal a range of pathologies, from valvular diseases to cardiac effusions, which are critical for directing cardiac care and interventions. 7. Liver Cirrhosis and Masses: Liver assessment can uncover cirrhosis, tumors, or other hepatic conditions that significantly impact patient management and prognosis. 8. Renal Pathologies: Kidney examinations should focus on detecting stones, cysts, tumors, or signs of acute kidney injury, influencing treatment approaches. 9. Thyroid Nodules: In neck ultrasounds, distinguishing between benign and potentially malignant thyroid nodules is essential for determining the need for biopsy or surgery. #ultrasound #diagnosticimaging

Fighting for Life: TEVAR Intervention in an 80-Year-Old with Ruptured Thoracic Aortic Dissection Case: An 80-year-old female with a history of hypertension presented with a sudden onset of severe chest and back pain, accompanied by pain and pallor in the left leg. Initial evaluation at another facility suspected a Type 3 aortic dissection. The initial CT imaging revealed a Type 3 aortic dissection with the true lumen exit for the visceral arteries, except the left renal artery, and dissection extending into both the left and right iliac arteries. Additionally, there was a left hemothorax with aortic rupture. Transferred to our center 18 hours after the initial presentation, the patient was in moderate general condition, complaining of shortness of breath, pallor, and cooling in the left leg, which she was unable to move. The blood pressure was 80/50 mmHg, and lung sounds were absent on the left side. The chest X-ray showed a closed left hemithorax. Emergency TEVAR was decided upon for the ruptured Type 3 dissection. A 36x200 mm Valiant (#medtronic) endovascular stent was placed just distal to the left carotid artery, and a 16x12 Vascular plug (#abbott) was applied to the left subclavian artery ostium. Despite these interventions, an ongoing Type 1 endoleak into the false lumen with flow out of the aorta was observed. Subsequently, aortic balloon dilation was performed within the endovascular stent, but the endoleak persisted, causing the initial stent to displace distally. To address this, a 36x150 mm Valiant stent was added proximally to the first endovascular stent. The procedure was successful, with no Type 1 endoleak. After the procedure, CSF drainage was applied, and a chest tube was inserted for the left hemothorax. The following day, due to incomplete resolution of hemothorax, Thoracic Surgery (Prof. Dr. Celalettin Kocatürk and Ass. Prof. Dr. Tuğba Coşkun) performed VATS for decortication of pleural adhesions, likely saving the patient's life, and hematoma drainage. A follow-up CT scan revealed thrombosis in the false lumen with open peripheral arteries. After a 12-day hospital stay, the patient was discharged. Following one month of rehabilitation, the patient began walking, and three months later, she returned to her normal daily activities. #cardiology, #interventionalcardiology, #cardiologist, #aortic, #aorticdissection, #tevar, #aortaed, #endovascular, #endoleak, #vascularplug, #rupture

Long-Term Outcome and Prognosis of Noninfectious Thoracic Aortitis This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis. The key findings are: 🦎 Aortic arch involvement in aortitis increases the risk of vascular complications by two times. 🦑 The use of statins after aortitis diagnosis is associated with a reduced likelihood of requiring a second vascular procedure. 🦂 Descending thoracic aortitis and aortic dissection at the time of aortitis diagnosis are independent risk factors for needing a second vascular procedure. 🦅 A substantial number of patients with aortitis experience vascular complications during follow-up, including new aortic aneurysms, dissections, and peripheral artery issues. 🦋 Recurrence of aortitis-related events tends to occur at the same site, suggesting ongoing inflammation. 🐞 Statin use may have a protective effect against vascular complications in patients with aortitis. This study highlights the importance of monitoring and managing aortitis patients to reduce the risk of vascular complications and the need for additional surgical procedures. Congratulations to: Olivier ESPITIA, BRUNEVAL Patrick, Lucie Biard, Saadoun David and team on behalf of the French Study Group for Large Vessel Vasculitides (GEFA) Published in the Journal of American College of Cardiology: https://lnkd.in/enQZeXr5 #aortitis #GEFA #immunology #vascularmedicine #aortaed

🔬 Delighted to share insights from a recent study titled "Effectiveness of Non-Invasive Ventilation in Mitigating Postoperative Respiratory Complications among Patients Undergoing Bariatric Surgery," published in Medicina. Conducted by Francesco Imperatore et al., this research explores the impact of non-invasive ventilation (NIV) on post-extubation acute respiratory failure (ARF) in obese patients following biliointestinal bypass (BIBP) procedures. The correlation between increased body mass index (BMI) and the diminishment of perioperative functional residual capacity, expiratory reserve volume, and total lung capacity was a pivotal consideration. 📚 Conducting a retrospective analysis spanning from January 2019 to December 2020, the researchers compared incidences of acute respiratory failure during the initial 72 hours post-surgery and measured oximetry values among obese patients who underwent BIBP, comparing those subjected to postoperative NIV protocols against individuals who received conventional Venturi mask ventilation. The study cohort encompassed 50 patients following the postoperative NIV protocol and 57 patients treated with conventional Venturi mask ventilation. The findings at 120 minutes within the PACU demonstrated superior pH, pCO2, pO2, and SpO2 levels in the NIV group compared to the control group (p < 0.001). Within the 72-hour postoperative period, acute respiratory failure was observed in one patient (2%) in the NIV group versus seven patients (12.2%) in the control group. 🩺 The study concluded that the implementation of short-term NIV during PACU observation following bariatric surgery facilitated a swifter recuperation of postoperative lung function and oxygenation among obese patients, consequently diminishing the necessity for critical care in the subsequent days post-surgery. Hence, conventional Venturi mask ventilation exhibited a significant association (p < 0.05) with postoperative ARF, with a relative risk (RR) of 0.51 (CI 0.27–0.96). Source: https://lnkd.in/d9TR5qHG #MedicalResearch #RespiratoryHealth #BariatricSurgery #NonInvasiveVentilation #MedicinaJournal #Obesity

This retrospective study investigates the risk factors influencing prolonged stays in the intensive care unit (ICU) after coronary artery bypass grafting (CABG) surgery. It analyzed 1070 patients, identifying several univariate predictors for extended ICU stays, such as larger left atrial diameter, chronic obstructive pulmonary disease, hypertension, diabetes, pre-surgery beta-blocker use, #CABGSurgery #Pneumonia #ProlongedICUStay #VentilatorSupport

#828 A 68-year-old man with a history of myocardial infarction is scheduled for elective hernia repair. Which of the following statements regarding perioperative medication use in coronary disease patients undergoing noncardiac surgery is TRUE? A. Cardiac adverse event rates are reduced when high-dose beta-blocker therapy is initiated immediately before surgery B. Nitrates decrease intraoperative myocardial ischemia and reduce rates of adverse cardiac outcomes C. Most cardiac medications should be discontinued 2 to 3 days before surgery and resumed as soon as the patient can tolerate oral intake. D. Statin therapy has been associated with reduced perioperative cardiovascular event rates in high-risk patients. Answer =D It is generally safe and appropriate to continue most chronically administered cardiac medications up to the day of surgery and to resume them as soon as possible after the operation. This is true of beta-blockers in patients with underlying coronary artery disease (or other indications for chronic beta-blocker use) .However, there has been controversy about the role of initiating preoperative beta-blocker therapy for the purpose of risk reduction, as summarized in a recent systemic review. The evidence to date suggests that beta-blockers reduce the perioperative risk of cardiac events (ischemia, atrial fibrillation, need for coronary interventions), but can be associated with bradycardia, hypotension, and stroke, particularly if high doses or long- acting preparations are initiated shortly before surgery.If initiation of preoperative beta-blocker therapy is planned, it should be started at least 2-7 days before surgery, to assess tolerability and safety, and to allow titration of the dosage if appropriate. Although nitrates reduce intraoperative ischemia, cardiac outcomes are not affected. Statins have anti-inflammatory and plaque-stabilizing properties, and studies in patients undergoing vascular surgery have demonstrated reduced cardiac event rates in patients on such therapy perioperatively. #cardiology

New case report! "Fungal Endocarditis: A Rare Cause of Left Ventricular Outflow Obstruction" by Elia El Hajj, PhD; Alexander Glaser, MD; David Yancey; Allen Byl, DO; Mehnaz Rahman, MD. A 53-year-old male presented with worsening fever, chest pain, and dyspnea during the past 2 weeks. He was hypoxic, tachycardic, and hypotensive on admission. Labs were notable for high-sensitivity troponin of 657 pg/mL and B-type natriuretic peptide of 1,648 pg/mL. Chest imaging was consistent with acute respiratory distress syndrome. Transthoracic echocardiography revealed an ejection fraction of 30% to 35% and a mobile 1.5 cm x 1.6 cm hyperechoic mass on the ventricular surface of the aortic valve (AV) with left ventricular outflow obstruction and mean pressure gradient of 38.7 mm Hg and maximum velocity of 3.64 m/s. The patient was initiated on empiric antibiotic and antifungal therapy. Cardiothoracic surgery was consulted for urgent AV repair. Blood cultures were positive for Candida metapsilosis, and intravenous fluconazole and micafungin were initiated. See video and more images at Methodist DeBakey Cardiovascular Journal https://lnkd.in/gpEyvnqz

Can atrial fibrillation patients avoid lifelong anticoagulation after surgical closure of the left atrial appendage?   This urgent question will be answered soon! We are exited to announce the launch of the ATLAAC trial (Anticoagulant Therapy after Left Atrial Appendage Closure) at Aarhus University Hospital today! Initiated and led by Professor Lars Riber and PhD student Kristina Gosvig from Odense University Hospital's Department of Cardiothoracic Surgery, this pivotal non-inferiority RCT aims to assess the safety of discontinuing oral anticoagulation in atrial fibrillation (AFib) patients following sufficient surgical closure of the left atrial appendage. Inceasing evidence suggests that thrombus formation in the left atrial appendage increases stroke risk in Afib patients. A recent RCT has shown that surgical closure of the left atrial appendage along with oral anticoagulation can significantly reduce the risk of thromboembolic events in these patients (Whitlock 2021). However, a trial without oral anticoagulation is pending. Hence, current guidelines recommend long-term oral anticoagulation for most AFib patients, despite its substantial bleeding and management challenges, to reduce the risk of ischemic stroke. The primary outcome of the ATLAAC trial is a composite endpoint, focusing on cerebrovascular events and systemic embolisms, with additional measures including mortality and major hemorrhage. We look forward to join forces with other Danish Heart Centers to learn more about preventing stroke in AFib patients. The results of ATLAAC are expected to make a big difference for our patients. For more information, check out the comment below.

The average age was 69.6±11.2 years, with 79% being male. The mean European System for Cardiac Operative Risk Evaluation score I additive (EuroSCORE I) additive was 7.6±10.2 and the mean SYNergy between PCI with TAXUS and Cardiac Surgery (SYNTAX) Score I was 22.9±9.4. A total of 97 MIDCAB surgeries and 41 MICS-CABG procedures were performed without any instances of conversion to sternotomy or cardiopulmonary bypass (CPB). A total of 70 patients, or 50.7% of the sample, received the planned PCI treatment. This percentage was substantially lower in the subgroup with chronic CAD, with just 27, equivalent to 39.1%. The observed 30-day death rate was 2.1% (3/138). During follow-up, 3 myocardial infarctions, 18 PCI repeats, no CABG, and 4 strokes occurred. From 128 followed-up patients, 28 died (21.9%), 7 of which were heart deaths (5.5%). Total MACCE was 36.7%. The survival rates at 3 and 5 years were 92% and 85% respectively. Patients who didn't get the planned PCI had a mean survival rate of 6.8-9.1 years, while those with completed hybrid treatment had a higher mean survival rate of 8.4-10.2 years. In selected individuals with MVCAD, current evidence suggests that HCR is a safe and effective coronary artery revascularization approach. After coronary bypass surgery, the attention going forward needs to be devoted toward the organization of the PCI step in the treatment process.

Breakthrough valve with every feature scientifically improved: new Rhenium superalloy = 2x strength, much less recoil = best in class hemodynamics. No foreshortening + commissural alignment = precise positioning. Only THV in the world that is Nickel free. Protective Nitride oxide coating on frame. Valve mounted directly on frame and still lowest profile (8 Fr sheath) = increased safety and lower complications.