EPICORE Embase Updates: September 2024

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<1>
Accession Number
2034661315
Title
Drones reduce the time to defibrillation in a highly visited non-urban
area: A randomized simulation-based trial.
Source
American Journal of Emergency Medicine. 86 (pp 5-10), 2024. Date of
Publication: December 2024.
Author
van Veelen M.J.; Vinetti G.; Cappello T.D.; Eisendle F.; Mejia-Aguilar A.;
Parin R.; Oberhammer R.; Falla M.; Strapazzon G.
Institution
(van Veelen, Vinetti, Cappello, Eisendle, Falla, Strapazzon) Institute of
Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
(van Veelen) Department of Sport Science, Medical Section, University of
Innsbruck, Innsbruck, Austria
(Eisendle) Department of Anaesthesiology and Intensive Care Medicine,
Medical University of Innsbruck, Innsbruck, Austria
(Mejia-Aguilar) Center for Sensing Solutions, Eurac Research, Bolzano,
Italy
(Parin) terraXcube, Eurac Research, Bolzano, Italy
(Oberhammer) HELI Helicopter Emergency Medical Services South Tyrol,
Bolzano, Italy
(Oberhammer) Department of Anaesthesia and Intensive Care, Emergency
Medicine and Pain Therapy, Hospital of Brunico (SABES-ASDAA), Teaching
Hospital of Paracelsus Medical University, Brunico, Italy
(Falla) Department of Neurology/Stroke Unit, Hospital of Bolzano
(SABES-ASDAA), Teaching Hospital of Paracelsus Medical University,
Bolzano, Italy
(Strapazzon) Corpo Nazionale Soccorso Alpino e Speleologico, National
Medical School (CNSAS SNaMed), Milano, Italy
Publisher
W.B. Saunders
Abstract
Introduction: Out-of-hospital cardiac arrest (OHCA) has a high global
incidence and mortality rate, with early defibrillation significantly
improving survival. Our aim was to assess the feasibility of autonomous
drone delivery of automated external defibrillators (AED) in a non-urban
area with physical barriers and compare the time to defibrillate (TTD)
with bystander retrieval from a public access defibrillator (PAD) point
and helicopter emergency medical services (HEMS) physician performed
defibrillation. Method(s): This randomized simulation-based trial
with a cross-over design included bystanders performing AED retrievals
either delivered by automated drone flight or on foot from a PAD point,
and simulated HEMS interventions. The primary outcome was the time to
defibrillation, with secondary outcomes comparing workload, perceived
physical effort, and ease of use. Result(s): Thirty-six simulations
were performed. Drone-delivered AED intervention had a significantly
shorter TTD [2.2 (95 % CI 2.0-2.3) min] compared to PAD retrieval [12.4
(95 % CI 10.4-14.4) min] and HEMS [18.2 (95 % CI 17.1-19.2) min]. The
self-reported physical effort on a visual analogue scale for
drone-delivered AED was significantly lower versus PAD [2.5 (1 - 22) mm
vs. 81 (65-99) mm, p = 0.02]. The overall mean workload measured by
NASA-TLX was also significantly lower for drone delivery compared to PAD
[4.3 (1.2-11.7) vs. 11.9 (5.5-14.5), p = 0.018]. Conclusion(s): The
use of drones for automated AED delivery in a non-urban area with physical
barriers is feasible and leads to a shorter time to defibrillation.
Drone-delivered AEDs also involve a lower workload and perceived physical
effort than AED retrieval on foot. Copyright © 2024

<2>
Accession Number
2034666397
Title
Letter to the editor regarding "Efficacy of bilateral catheter superficial
parasternal intercostal plane blocks using programmed intermittent bolus
for opioid-sparing postoperative analgesia in cardiac surgery with
sternotomy: A randomized, double-blind, placebo-controlled trial".
Source
Journal of Clinical Anesthesia. 99 (no pagination), 2024. Article Number:
111630. Date of Publication: December 2024.
Author
Xue F.-S.; Lin D.-Y.; Zheng X.-C.
Institution
(Xue, Lin, Zheng) Department of Anesthesiology, Shengli Clinical Medical
College of Fujian Medical University, Fuzhou University Affiliated
Provincial Hospital, Fujian Provincial Hospital, Fuzhou, China
Publisher
Elsevier Inc.

<3>
Accession Number
2034677700
Title
The effects of exercise-based prehabilitation in patients undergoing
coronary artery bypass grafting surgery: A systematic review of randomized
controlled trials.
Source
Heart and Lung. 69 (pp 41-50), 2025. Date of Publication: 01 Jan 2025.
Author
Yamikan H.; Ahiskali G.N.; Demirel A.; Kutukcu E.C.
Institution
(Yamikan, Ahiskali, Demirel, Kutukcu) Hacettepe University, Faculty
Physical Therapy and Rehabilitation, Ankara, Samanpazari 06100, Turkey
Publisher
Elsevier Inc.
Abstract
Background: Postoperative exercise-based rehabilitation improves the
physical performance and health-related outcomes of patients undergoing
coronary artery bypass grafting (CABG). However, the effectiveness of
exercise-based prehabilitation in patients undergoing CABG remains
unknown. Objective(s): The purpose of this systematic review was to
investigate the effects of exercise-based prehabilitation on functional
exercise capacity, postoperative complications, anxiety, depression,
self-efficacy, quality of life, length of hospital and intensive care unit
stay, frailty, and endothelial function in patients undergoing CABG
surgery. Method(s): This systematic review followed the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. The study protocol is recorded in the PROSPERO database
(registration number CRD42023488530). PubMed, the Physiotherapy Evidence
Database (PEDro), Google Scholar, Web of Science, Scopus, and the Cochrane
Library were searched from inception to December 2023. The titles and
abstracts of the studies were screened using Rayyan Ai software. After
full-text screening, randomized controlled trials that met the inclusion
criteria were included. Result(s): Five randomized controlled trials
involving 616 participants were included. The systematic review suggests
strong evidence that exercise-based prehabilitation improved functional
capacity and moderate evidence that it reduced postoperative complications
and length of hospital stay. Although there was conflicting evidence
regarding the effects of exercise-based prehabilitation on quality of
life, there was limited evidence of its effects on physical activity,
anxiety, depression, self-efficacy, frailty, and endothelial function.
 Conclusion(s): Exercise-based prehabilitation can be recommended for
improvements in functional capacity, postoperative complications, and
length of hospital stay in patients undergoing CABG. Copyright ©
2024 Elsevier Inc.

<4>
Accession Number
2034708107
Title
Effects of psychological interventions on clinical outcomes in patients
with cardiovascular diseases: A systematic review and meta-analysis.
Source
Journal of Psychosomatic Research. 187 (no pagination), 2024. Article
Number: 111938. Date of Publication: December 2024.
Author
Nie Y.; Wang N.; Chi M.; Li A.; Ji S.; Zhu Z.; Li S.; Hou Y.
Institution
(Nie, Wang, Hou) The First Affiliated Hospital of Soochow University,
Suzhou, China
(Nie, Wang, Chi, Li, Ji, Zhu, Li, Hou) School of Nursing, Suzhou Medical
College of Soochow University, Suzhou, China
Publisher
Elsevier Inc.
Abstract
Objective: To perform a systematic review and meta-analysis to evaluate
the effects of psychological interventions on the clinical outcomes of
patients with cardiovascular diseases (CVDs). Method(s): We searched
PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL from the
establishment of each database to August 1, 2023. Randomized controlled
trials (RCTs) on psychological interventions in patients with CVDs were
included. Statistical analyses were performed using Review Manager 5.3 and
Stata 17.0, and pooled measures were presented as the relative risk (RR)
and 95 % confidence interval (CI). Result(s): A total of 32 studies
were included, involving 15,814 patients. Our results showed that
psychological interventions could reduce cardiac mortality (RR = 0.81, 95
% CI = 0.68 to 0.96) and the occurrence of myocardial infarction (MI) (RR
= 0.79, 95 % CI = 0.69 to 0.89), arrhythmia (RR = 0.61, 95 % CI = 0.42 to
0.89) and angina (RR = 0.92, 95 % CI = 0.87 to 0.97). However, no
statistically significant differences were detected in the risk of
all-cause mortality, all-cause rehospitalization rates, cardiac
rehospitalization rates, revascularization, heart failure (HF), or stroke
between the psychological intervention and control groups.
 Conclusion(s): Psychological interventions can reduce cardiac
mortality and the occurrence of MI, arrhythmia, and angina in patients
with CVDs. It is crucial to incorporate psychological interventions into
the existing treatment and management of patients with CVDs. High-quality
RCTs should be conducted to explore the optimal psychological intervention
methods and the maximum beneficiaries. Copyright © 2024 Elsevier
Inc.

<5>
Accession Number
2034707801
Title
Effect of impaired kidney function on outcomes and treatment effects of
oral anticoagulant regimes in patients with atrial fibrillation in a
real-world registry.
Source
PLoS ONE. 19(9) (no pagination), 2024. Article Number: e0310838. Date of
Publication: September 2024.
Author
Salbach C.; Milles B.R.; Hund H.; Biener M.; Mueller-Hennessen M.; Frey
N.; Katus H.; Giannitsis E.; Yildirim M.
Institution
(Salbach, Milles, Hund, Biener, Mueller-Hennessen, Frey, Katus,
Giannitsis, Yildirim) Department of Internal Medicine III, Cardiology,
University Hospital of Heidelberg, Heidelberg, Germany
Publisher
Public Library of Science
Abstract
Background The impact of impaired kidney function on outcomes and
treatment benefits of vitamin-K antagonists (VKA) versus direct oral
anticoagulants (DOAC) in patients with atrial fibrillation (AF) has
insufficiently been investigated in randomized controlled studies (RCTs).
Most studies and registries are either biased due to incomplete enrolment
of consecutive patients in large pharma industry sponsored registries, or
due to short recruitment periods or incomplete assessment of important
variables in national registries. Methods This study uses data from the
Heidelberg Registry of Atrial Fibrillation (HERA-FIB), a retrospective
single-center registry of 10,222 consecutive patients with AF presenting
to the emergency department of University Hospital of Heidelberg from June
2009 until March 2020. Rates of all-cause mortality, stroke, major
bleeding and myocardial infarction (MI) were related to the presence and
severity of impaired presenting kidney function, as well as to assigned
treatment with VKA vs. DOAC. Results The risks for all-cause mortality
(HR: 3.26, p<0.001), stroke (HR: 1.58, p<0.001), major bleeding (HR: 2.28,
p<0.001) and MI (HR: 2.48, p<0.001) were significantly higher in patients
with an eGFR<60 ml/min at admission and increased with decreasing eGFR.
After adjustment for variables of CHA<inf>2</inf>DS<inf>2</inf>VASc-score,
presence of eGFR <60 ml/min remained as an independent predictor for
all-cause mortality, major bleeding and MI. The hazard ratio (HR) for
all-cause mortality, major bleedings and MI was significantly lower in
patients receiving DOAC compared to VKA. Conclusion Findings from our
large real-life registry confirm the data from RCTs and extend our
knowledge on the effectiveness and safety of DOACs to subjects that were
underrepresented in RCTs. Copyright © 2024 Salbach et al. This is
an open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<6>
Accession Number
2034623612
Title
The prognostic difference study on the individualized clopidogrel
administration in Hmong and Dong patients based on the CYP2C19 gene
polymorphism after percutaneous coronary intervention.
Source
Cellular and Molecular Biology. 70(8) (pp 110-115), 2024. Date of
Publication: 2024.
Author
Xiangyi Y.; Yang L.; Teng Z.; Jie X.; Xue L.; Qinxiang P.; Minzhen H.
Institution
(Xiangyi, Minzhen) School of Pharmacy, Guizhou Medical University, Guiyang
550025, China
(Yang, Jie, Xue, Qinxiang) Department of Pharmacy, The Second Affiliated
Hospital of Guizhou Medical University, Kaili 556000, China
(Teng) Department of Cardiovascular Medicine, The Second Affiliated
Hospital of Guizhou Medical University, Kaili 556000, China
(Minzhen) The Second Affiliated Hospital of Guizhou Medical University,
Kaili 556000, China
Publisher
Cellular and Molecular Biology Association
Abstract
This study explored the distribution characteristics of CYP2C19 gene
polymorphism among Hmong and Dong patients in the Qiandongnan region of
Guizhou province after percutaneous coronary intervention (PCI). The aim
was to assess the clinical impact of individualized clopidogrel
administration based on CYP2C19 genotypes. A total of 208 patients were
classified into ultra-fast, fast, intermediate, and slow metabolic groups.
They were randomly assigned to clopidogrel individualized administration
(IA) or conventional treatment (CA) groups. Patients were followed for 6
months to evaluate major adverse cardiovascular events (MACE) and adverse
reactions. The CYP2C19 genotype distribution was in Hardy-Weinberg
equilibrium, showing consistency in the population. While no significant
ethnic differences were found in genotype and metabolic distribution,
allele distribution varied, with Hmong patients exhibiting a higher
proportion of CYP2C19*1 alleles than Dong patients. Following
individualized administration, the IA group demonstrated lower incidences
of non-fatal myocardial infarction and emergency revascularization
compared to the CA group. Bleeding events were higher in the IA group, but
the total MACE incidence was lower. No statistical difference in MACE and
adverse drug reactions (ADR) was observed in the CA group across metabolic
types, but MACE incidence was higher in intermediate and slow metabolic
groups. In the IA group, no significant difference in MACE was noted among
metabolic types, but ADR incidence varied significantly, particularly in
dyspnea. The study highlighted significant CYP2C19 allele distribution
differences between Hmong and Dong patients post-PCI in Qiandongnan.
Patients with slow metabolic profiles demonstrated higher MACE incidence
with conventional clopidogrel dosage, whereas CYP2C19-guided therapy
reduced MACE without increasing bleeding risk. These findings supported
clinical individualized clopidogrel administration in post-PCI patients in
the Qiandongnan region, contributing to rational clopidogrel
use. Copyright © 2024 Cellular and Molecular Biology Association.
All rights reserved.

<7>
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Accession Number
2034618189
Title
Efficacy of Single-Bolus Administration of Remimazolam During Induction of
Anesthesia in Patients Undergoing Cardiac Surgery: A Prospective,
Single-Center, Randomized Controlled Study.
Source
Anesthesia and Analgesia. 139(4) (pp 770-780), 2024. Date of Publication:
01 Oct 2024.
Author
Lee S.-H.; Nam J.-S.; Choi D.-K.; Chin J.-H.; Choi I.-C.; Kim K.
Institution
(Lee) Department of Anesthesiology and Pain Medicine, Dongsan Medical
Center, Keimyung University School of Medicine, Daegu, South Korea
(Nam, Choi, Chin, Choi, Kim) Department of Anesthesiology and Pain
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Remimazolam is a recently marketed ultrashort-acting
benzodiazepine. This drug is considered safe and effective during general
anesthesia; however, limited information is available about its effects on
patients undergoing cardiac surgery. Therefore, the present study was
conducted to evaluate the efficacy and hemodynamic stability of a bolus
administration of remimazolam during anesthesia induction in patients
undergoing cardiac surgery. METHOD(S): Patients undergoing elective
cardiac surgery were randomly assigned to any 1 of the following 3 groups:
anesthesia induction with a continuous infusion of remimazolam 6 mg/ kg/h
(continuous group), a single-bolus injection of remimazolam 0.1 mg/kg
(bolus 0.1 group), or a single-bolus injection of remimazolam 0.2 mg/kg
(bolus 0.2 group). Time to loss of responsiveness, defined as modified
Observer's Assessment of Alertness/Sedation Scale <3, and changes in
hemodynamic status during anesthetic induction were measured.
 RESULT(S): Times to loss of responsiveness were 137 +/- 20, 71 +/-
35, and 48 +/- 9 seconds in the continuous, bolus 0.1, and bolus 0.2
groups, respectively. The greatest mean difference was observed between
the continuous and bolus 0.2 groups (89.0, 95% confidence interval [CI],
79.1-98.9), followed by the continuous and bolus 0.1 groups (65.8, 95% CI,
46.9-84.7), and lastly between the bolus 0.2 and bolus 0.1 groups (23.2,
95% CI, 6.6-39.8). No significant differences were found in terms of
arterial blood pressures and heart rates of the patients.
 CONCLUSION(S): A single-bolus injection of remimazolam provided
efficient anesthetic induction in patients undergoing cardiac surgery. A
0.2 mg/kg bolus injection of remimazolam resulted in the shortest time to
loss of responsiveness among the 3 groups, without significantly altering
the hemodynamic parameters. Therefore, this dosing can be considered a
favorable anesthetic induction method for patients undergoing cardiac
surgery. Copyright © 2024 International Anesthesia Research
Society.

<8>
Accession Number
2031407623
Title
Effect of optimizing cerebral oxygen saturation on postoperative delirium
in older patients undergoing one-lung ventilation for thoracoscopic
surgery.
Source
Journal of International Medical Research. 52(9) (no pagination), 2024.
Date of Publication: September 2024.
Author
Teng P.; Liu H.; Xu D.; Feng X.; Liu M.; Wang Q.
Institution
(Teng, Liu, Xu) Department of Anesthesiology, Ganyu Hospital Affiliated to
Kangda College of Nanjing Medical University, Lianyungang, China
(Teng) Department of Anesthesiology, the Affiliated Clinical College of
Yangzhou Medical College, Jiangsu, China
(Feng, Liu) Department of Anesthesiology, Xuanwu Hospital, Capital Medical
University, Beijing, China
(Wang) Department of Anesthesiology, Shanghai East Clinical Medical
College, Nanjing Medical University, Nanjing, China
(Wang) Department of Anesthesiology, Shanghai East Hospital, Tongji
University School of Medicine, Shanghai, China
Publisher
SAGE Publications Ltd
Abstract
Objectives: This randomized controlled trial investigated whether the
regional cerebral oxygenation saturation (rScO<inf>2</inf>)-guided
lung-protective ventilation strategy could improve brain oxygen and reduce
the incidence of postoperative delirium (POD) in patients older than 65
years. Method(s): This randomized controlled trial enrolled 120
patients undergoing thoracic surgery who received one-lung ventilation
(OLV). Patients were randomly assigned to the lung-protective ventilation
group (PV group) or rScO<inf>2</inf>-oriented lung-protective ventilation
group (TPV group). rScO<inf>2</inf> was recorded during the surgery, and
the occurrence of POD was assessed. Result(s): The incidence of POD 3
days after surgery-the primary outcome-was significantly lower in the TPV
group (23.3% versus 8.5%). Meanwhile, the levels of POD-related biological
indicators (S100beta, neuron-specific enolase, tumor necrosis
factor-alpha) were lower in the TPV group. Considering the secondary
outcomes, both groups exhibited a lower oxygenation index after OLV,
whereas partial pressure of carbon dioxide and mean arterial pressure were
significantly increased in the TPV group. In addition, minimum
rScO<inf>2</inf> during surgery and mean rScO<inf>2</inf> were higher in
the TPV group than in the PV group. Conclusion(s): Continuous
intraoperative monitoring of brain tissue oxygenation and active
intervention measures guided by cerebral oxygen saturation are critical
for improving brain metabolism and reducing the risk of POD. Copyright
© The Author(s) 2024.

<9>
Accession Number
645296990
Title
Erythropoiesis-stimulating agents for preventing acute kidney injury.
Source
Cochrane Database of Systematic Reviews. 2024(9) (no pagination), 2024.
Article Number: CD014820. Date of Publication: 20 Sep 2024.
Author
Nishiwaki H.; Abe Y.; Suzuki T.; Hasegawa T.; Levack W.M.M.; Noma H.; Ota
E.
Institution
(Nishiwaki) Division of Nephrology, Department of Internal Medicine, Showa
University Fujigaoka Hospital, Yokohama, Japan
(Nishiwaki, Hasegawa) Institute of Clinical Epidemiology (iCE), Showa
University, Tokyo, Japan
(Nishiwaki, Hasegawa) Showa University Research Administration Center
(SURAC), Showa University, Tokyo, Japan
(Abe) Children's Medical Center, Showa University Koto Toyosu Hospital,
Tokyo, Japan
(Suzuki, Hasegawa) Department of Nephrology, Showa University Graduate
School of Medicine, Tokyo, Japan
(Hasegawa) Department of Hygiene, Public Health, and Preventive Medicine,
Graduate School of Medicine, Showa University, Tokyo, Japan
(Levack) Rehabilitation Teaching and Research Unit, Department of
Medicine, University of Otago, Wellington, New Zealand
(Noma) Department of Interdisciplinary Statistical Mathematics, The
Institute of Statistical Mathematics, Tokyo, Japan
(Ota) Global Health Nursing, Graduate School of Nursing Science, St.
Luke's International University, Tokyo, Japan
(Ota) Tokyo Foundation for Policy Research, Tokyo, Japan
Publisher
John Wiley and Sons Ltd
Abstract
Background: Acute kidney injury (AKI) is characterised by a rapid decline
in kidney function and is caused by a variety of clinical conditions. The
incidence of AKI in hospitalised adults is high. In animal studies,
erythropoiesis-stimulating agents (ESA) have been shown to act as a novel
nephroprotective agent against ischaemic, toxic, and septic AKI by
inhibiting apoptosis, promoting cell proliferation, and inducing
antioxidant and anti-inflammatory responses. As a result, ESAs may reduce
the incidence of AKI in humans. Randomised controlled trials (RCTs) have
been conducted on the efficacy and safety of ESAs, but no prior systematic
reviews exist that comprehensively examine ESAs with respect to AKI
prevention, although the effectiveness of these agents has been examined
for a range of other diseases and clinical situations. Objective(s):
This review aimed to look at the benefits and harms of ESAs for preventing
AKI in the context of any health condition. Search Method(s): We
searched the Cochrane Kidney and Transplant Register of Studies up to 30
August 2024 through contact with the Information Specialist using search
terms relevant to this review. Studies in the Register are identified
through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings,
the International Clinical Trials Registry Platform (ICTRP) Search Portal
and ClinicalTrials.gov. Selection Criteria: We included RCTs and
quasi-RCTs (in which allocation to treatment was based on alternate
assignment or order of medical records, admission dates, date of birth or
other non-random methods) that compared ESAs with placebo or standard care
in people at risk of AKI. Data Collection and Analysis: Three authors
independently extracted data and assessed the risk of bias for included
studies. We used random-effects model meta-analyses to perform
quantitative synthesis of the data. We used the I2 statistic to
measure heterogeneity amongst the studies in each analysis. We indicated
summary estimates as a risk ratio (RR) for dichotomous outcomes and mean
difference (MD) for continuous outcomes with their 95% confidence interval
(CI). We assessed the certainty of the evidence for each main outcome
using the Grades of Recommendation, Assessment, Development, and
Evaluation (GRADE) approach. Main Result(s): A total of 20 studies
(36 records, 5348 participants) were included. The number of participants
ranged from 10 to 1302, and most studies were carried out in single
centres (13/20). All the included studies compared ESAs to placebo or
usual care. Many of the studies were judged to have unclear or high risk
of reporting bias, but were at low risk for other types of bias. ESAs,
when compared to control interventions, may make little or no difference
to the risk of AKI (18 studies, 5314 participants: RR 0.97, 95% CI 0.85 to
1.10; I2 = 19%; moderate-certainty evidence), death (18 studies, 5263
participants: RR 0.92, 95% CI 0.80 to 1.06; I2 = 0%; moderate-certainty
evidence), or the initiation of dialysis (14 studies, 2059 participants:
RR 1.16, 95% CI 0.90 to 1.51; I2 = 0%; low-certainty evidence). Even with
standardised measurement of AKI, the studies showed no difference in
results between different routes of administration (subcutaneous or
intravenous), background diseases (cardiac surgeries, children or
neonates, other adults at risk of AKI), or duration or dose of ESA. ESAs
may make little or no difference to the risk of thrombosis when compared
to control interventions (8 studies, 3484 participants: RR 0.92, 95% CI
0.68 to 1.24; I2 = 0%). Similarly, there were probably no differences in
kidney function measures and adverse events such as myocardial infarction,
stroke or hypertension. However, this may be due to the low incidence of
these adverse events. Authors' conclusions: In patients at risk of AKI,
ESAs probably do not reduce the risk of AKI or death and may not reduce
the need for starting dialysis. Similarly, there were probably no
differences in kidney function measures and adverse events such as
thrombosis, myocardial infarction, stroke or hypertension. There are
currently two ongoing studies that have either not been completed or
published, and it is unclear whether they will change the results. Caution
should be exercised when using ESAs to prevent AKI. Copyright ©
2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<10>
Accession Number
2034694939
Title
Exploring the Historical Context of American Indian/Alaska Native
Intensive Care Inequities: A Narrative Review.
Source
Journal of Pediatric Health Care. (no pagination), 2024. Date of
Publication: 2024.
Author
Burns J.; Penny D.J.; Angelino A.C.; Tjoeng Y.L.; Deen J.F.
Publisher
Elsevier Inc.
Abstract
Introduction: This narrative review aims to frame the historical context
of American Indian/Alaska Native (AI/AN) pediatric intensive care and
offers suggestions for mitigating the impact of unique social drivers.
 Method(s): Recent literature was surveyed to determine pertinent
studies describing intensive care outcomes in AI/AN children and was
summarized in a narrative review. Result(s): American Indian/Alaska
Native people experience disproportionate health inequites due to unique
social drivers of health, including settler colonialism, historical
trauma, and systemic racism. These factors contribute to inequities in the
pediatric intensive care experience, including rates of admission for
injury and infectious diseases and mortality due to injuries and following
cardiac surgery. Discussion(s): These inequities are understudied and
require dedicated evaluation. Institutions and providers are responsible
for educating, modeling, and providing culturally competent care and
aiming to achieve workforce equity to improve outcomes for AI/AN children
receiving intensive care. Copyright © 2024 National Association
of Pediatric Nurse Practitioners

<11>
Accession Number
2031490850
Title
The use of extracorporeal photopheresis in solid organ
transplantation-current status and future directions.
Source
American Journal of Transplantation. 24(10) (pp 1731-1741), 2024. Date of
Publication: October 2024.
Author
Barten M.J.; Fisher A.J.; Hertig A.
Institution
(Barten) Department of Cardiovascular Surgery, University Heart and
Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany
(Fisher) Transplant and Regnerative Medicine Group, Translational and
Clinical Research Institute, Newcastle University, Newcastle upon Tyne,
United Kingdom
(Hertig) Department of Nephrology, University Versailles Saint Quentin,
Foch Hospital, Suresnes, France
Publisher
Elsevier B.V.
Abstract
Prevention and management of allograft rejection urgently require more
effective therapeutic solutions. Current immunosuppressive therapies used
in solid organ transplantation, while effective in reducing the risk of
acute rejection, are associated with substantial adverse effects. There
is, therefore, a need for agents that can provide immunomodulation,
supporting graft tolerance, while minimizing the need for
immunosuppression. Extracorporeal photopheresis (ECP) is an
immunomodulatory therapy currently recommended in international guidelines
as an adjunctive treatment for the prevention and management of organ
rejection in heart and lung transplantations. This article reviews
clinical experience and ongoing research with ECP for organ rejection in
heart and lung transplantations, as well as emerging findings in kidney
and liver transplantation. ECP, due to its immunomodulatory and
immunosuppressive-sparing effects, offers a potential therapeutic option
in these settings, particularly in high-risk patients with comorbidities,
infectious complications, or malignancies. Copyright © 2024 The
Authors

<12>
Accession Number
2034730218
Title
Safety and Effectiveness of a Kaolin-Impregnated Hemostatic Device in
Anticoagulated Patients: Real-World and Controlled Trial Outcomes.
Source
Annals of Emergency Medicine. Conference: ACEP24. Mondalay Bay Convention
Center, Las Vegas United States. 84(4 Supplement 1) (pp S69), 2024. Date
of Publication: October 2024.
Author
Ryan C.; Edwards C.; Scott A.; Moon M.; Reece T.B.; Keeling W.; Ross C.
Institution
(Ryan, Edwards, Scott, Moon, Reece, Keeling, Ross) Teleflex Medical,
Westmeath, Athlone, Ireland
Publisher
Elsevier Inc.
Abstract
Background: Increased bleeding risk with the use of anticoagulants is a
challenge, particularly after traumatic tissue injuries or surgical
interventions. Few studies have examined hemostatic device use in patients
at high risk for internal bleeding, such as those on anticoagulant and/or
antiplatelet therapy. We sought to determine whether the QuikClot Control+
(QCC+) Hemostatic Device, a kaolin-impregnated, non-resorbable hemostatic
dressing, is effective and safe in this patient population.
 Method(s): Analysis of real-world data (RWD) of 404 patient uses of
QCC+ from a retrospective medical record review, including 64 emergency
physician and trauma surgeon responses, was conducted. Successful control
of bleeding and adverse events (AEs) were assessed in cases of mild,
moderate, severe and traumatic internal bleeding. Successful control of
bleeding was also assessed at each anatomical site of use. A separate
secondary analysis of Randomized Controlled Trial (RCT) data of QCC+ use
in 152 cardiac surgery patients assessed hemostasis at 5 and 10 minutes
and AEs. Both analyses evaluated the impact of anticoagulant medication on
the effectiveness of QCC+ to control bleeding. Result(s): In the 404
RWD cases, bleeding was successfully controlled in 98.2% (110/112) of
anticoagulated cases compared to 97.9% (286/292) non-anticoagulated
(P=1.000). Bleeding was successfully controlled for all bleeding grades
and at all anatomical sites with no significant difference in the
effectiveness of QCC+ to control internal bleeding between anticoagulated
and non-anticoagulated patients. There was no significant difference in
safety outcomes between the two populations (P=1.000). Of the 152 RCT
patients receiving QCC+, there was no significant difference in the
proportion of anticoagulated patients (111/152) achieving hemostasis at 5
minutes (79.3% vs. 80.5%; P=0.87) or at 10 minutes (89.2% vs. 92.7%;
P=0.52) compared to non-anticoagulated patients (41/152) and no
statistically significant difference in safety outcomes (P=0.47).
 Conclusion(s): There was no statistically significant difference in
the effectiveness of QCC+ to control internal bleeding or in the safety of
QCC+ use in anticoagulated patients compared to non-anticoagulated
patients. This study is the first report to demonstrate that internal use
of the QCC+ hemostatic device is as effective and safe for control of
internal bleeding in anticoagulated patients, regardless of clinical
setting, internal bleeding grade or internal anatomical site of use.
[Formula presented] Yes, authors have interests to disclose Disclosure:
Teleflex Medical Employee Teleflex Medical Disclosure: Teleflex Medical
Employee Teleflex Medical Disclosure: Teleflex Medical Employee Teleflex
Medical Copyright © 2024 American College of Emergency Physicians

<13>
Accession Number
2034723846
Title
Effectiveness and safety of emergency transcatheter aortic valve
replacement in patients with severe aortic stenosis complicated by
cardiogenic shock: A systematic review and meta-analysis.
Source
Heart and Lung. 69 (pp 62-70), 2025. Date of Publication: 01 Jan 2025.
Author
Deng Y.; Wei S.; Zhu L.; Tao L.
Institution
(Deng, Tao) Northern Jiangsu People's Hospital Affiliated to Yangzhou
University, Yangzhou 225001, China
(Deng, Zhu) Medical College of Yangzhou University, Yang zhou 225001,
China
(Deng, Tao) Northern Jiangsu People's Hospital, Yang zhou 225001, China
(Wei, Zhu) Taizhou People's Hospital affiliated towith Nanjing Medical
University, Taizhou 225300, China
Publisher
Elsevier Inc.
Abstract
Background: The application of transcatheter aortic valve replacement
(TAVR) has been developed on different populations in many clinical
studies. However, research dedicated to the application of emergency TAVR
in patients with aortic stenosis (AS) experiencing cardiogenic shock is
limited. Objective(s): To investigate the safety and effectiveness of
emergency TAVR in AS patients with circulatory collapse. Method(s):
Studies on the application of emergency TAVR in AS patients with
cardiogenic shock were screened from PubMed, Web of Science, and Embase
databases. Two researchers independently screened the literature-extracted
data and conducted a meta-analysis was conducted using STATA 16.0
software. Result(s): 17 studies comprising 36,886 patients undergoing
emergency TAVR and 8,530 patients undergoing emergency SAVR or BAV.
Emergency TAVR showed no difference in valve implantation success rate
compared to elective TAVR. At 30-day endpoints comparison, emergency TAVR
exhibited significantly higher all-cause mortality and readmission rates
than elective TAVR (RR=2.73 95 %CI 2.04-3.65, P < 0.01; RR=1.2 95 %CI
0.9-1.6, P < 0.01), but reduced mortality risk compared to emergency
SAVR/BAV (RD=-0.15 95 %CI -0.25 to -0.04, P = 0.005). At one year
post-operation, people with emergency TAVR continued to have higher
all-cause mortality than elective TAVR (RR=1.55 95 %CI 1.37-1.74, P <
0.01) but similar with emergency SAVR/BAV (RD=-0.04 95 %CI -0.33 to 0.25,
P = 0.796). Rates of severe bleeding and new-onset renal dialysis were
higher after emergency TAVR, compared to elective TAVR, while the
incidences of permanent pacemaker implantation, severe paravalvular
leakage and stroke were similar. Conclusion(s): Despite emergency
TAVR having higher readmission and mortality rates compared to elective
TAVR, it is a relatively safe and effective treatment in cases of
cardiogenic shock compared to emergency BAV/SAVR. Copyright ©
2024 Elsevier Inc.

<14>
[Use Link to view the full text]
Accession Number
2034645637
Title
CCTA-Guided Invasive Coronary Angiography in Patients With CABG: A
Multicenter, Randomized Study.
Source
Circulation: Cardiovascular Interventions. 17(9) (pp e014045), 2024. Date
of Publication: 01 Sep 2024.
Author
Tsigkas G.; Toulgaridis F.; Apostolos A.; Kalogeropoulos A.; Karamasis
G.V.; Vasilagkos G.; Pappas L.; Toutouzas K.; Tsioufis K.; Korkonikitas
P.; Tsiafoutis I.; Hamilos M.; Ziakas A.; Kanakakis I.; Moulias A.;
Zampakis P.; Davlouros P.; Papanikolaou A.; Spyropoulou P.; Chlorogiannis
D.D.; Chamakioti M.; Spanou E.; Kartas N.; Vithoulkas N.; Sideris A.;
Zacharoulis A.; Lampropoulos K.; Georgopoulos S.; Synetos A.; Latsios G.;
Alexopoulos D.; Argentos S.; Xenogiannis I.; Triantafyllou K.;
Patsilinakos S.; Fagkrezos D.; Mantis C.; Pappa A.; Koutouzis M.;
Sakellaropoulou A.; Kochiadakis G.; Kladou E.; Sianos G.; Kouparanis A.;
Karagiannidis E.; Daios S.; Papoutsis D.; Sertedaki E.
Institution
(Tsigkas, Vasilagkos, Moulias, Davlouros) Department of Cardiology,
University Hospital of Patras, Greece
(Zampakis) Department of Radiology, University Hospital of Patras, Greece
(Toulgaridis) Second Department of Cardiology, 'Evangelismos' General
Hospital of Athens, Greece
(Pappas) First Department of Cardiology, 'Evangelismos' General Hospital
of Athens, Greece
(Apostolos, Toutouzas, Tsioufis) First Department of Cardiology,
'Hippocration' University Hospital of Athens, Greece
(Kalogeropoulos) Division of Cardiology, Department of Medicine, Stony
Brook University, New York, United States
(Karamasis) Second Department of Cardiology, 'Attikon' University Hospital
of Athens, Greece
(Korkonikitas) Department of Cardiology, 'Agia Olga' General Hospital of
Nea Ionia, Athens, Greece
(Tsiafoutis) First Department of Cardiology, 'Red Cross' General Hospital
of Athens, Greece
(Hamilos) Department of Cardiology, 'PAGNI' University Hospital of
Heraklion Creta, Greece
(Ziakas) First Department of Cardiology, 'AHEPA' University Hospital of
Thessaloniki, Greece
(Kanakakis) Department of Cardiology, 'Alexandra' General Hospital of
Athens, Greece
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Coronary computed tomography angiography (CCTA) in patients
with post-coronary artery bypass graft (CABG) has a high diagnostic
accuracy for visualization of grafts. Invasive coronary angiography (ICA)
in patients with CABG is associated with increased procedural time,
contrast agent administration, radiation exposure, and complications,
compared with non-CABG patients. The aim of this multicenter, randomized
controlled trial was to compare the strategy of CCTA-guided ICA versus
classic ICA in patients with prior CABG. METHOD(S): Patients with
prior CABG were randomly assigned (1:1 ratio) to have a CCTA before ICA
(CCTA-ICA, group A) or not (ICA-only, group B). The primary end point of
the study was the total volume (milliliters) of the contrast agent
administered. RESULT(S): A total of 251 patients were randomized, and
225 were included in analysis; 110 in group A and 115 in group B. The
total contrast volume was higher in group A (184.5 [143-255] versus 154
[102-240] mL; P = 0.001). The contrast volume administered during the
invasive procedure was lower in group A (101.5 [60-151] versus 154
[102-240]; P<0.001). Total fluoroscopy time was decreased in group A (480
[259-873] versus 594 [360-1080] seconds; P = 0.027), but total effective
dose was increased (24.1 [17.7-32] versus 10.8 [5.6-18] mSv; P<0.001). The
rate of contrast-induced nephropathy, periprocedural complications, and
major adverse cardiac events during 3 to 5 and 30 days did not differ
significantly between the 2 groups. CONCLUSION(S): A CCTA-directed
ICA strategy for patients with CABG is associated with expedition of the
invasive procedure, and less fluoroscopy time, at the cost of higher total
contrast volume and effective radiation dose, compared with the classic
ICA approach. Copyright © 2024 American Heart Association, Inc.

<15>
Accession Number
2031527069
Title
Intraoperative end-tidal carbon dioxide levels are not associated with
recurrence-free survival after elective pancreatic cancer surgery: a
retrospective cohort study.
Source
Frontiers in Medicine. 11 (no pagination), 2024. Article Number: 1442283.
Date of Publication: 2024.
Author
Dehne S.; Kirschner L.; Klotz R.; Kilian S.; Michalski C.W.; Hackert T.;
Buchler M.W.; Weigand M.A.; Larmann J.
Institution
(Dehne, Kirschner, Weigand, Larmann) Heidelberg University, Medical
Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
(Klotz, Michalski, Hackert, Buchler) Heidelberg University, Medical
Faculty Heidelberg, Department of General, Visceral, and Transplantation
Surgery, Heidelberg, Germany
(Kilian) Heidelberg University, Medical Faculty Heidelberg, Institute of
Medical Biometry, Heidelberg, Germany
Publisher
Frontiers Media SA
Abstract
Background: Intraoperative end-tidal carbon dioxide concentrations
(EtCO<inf>2</inf>) values are associated with recurrence-free survival
after colorectal cancer surgery. However, it is unknown if similar effects
can be observed after other surgical procedures. There is now evidence
available for target EtCO<inf>2</inf> and its relation to surgical
outcomes following pancreatic cancer surgery. Method(s): In this
single-center, retrospective cohort study, we analyzed 652 patients
undergoing elective resection of pancreatic cancer at Heidelberg
University Hospital between 2009 and 2016. The entire patient cohort was
sorted in ascending order based on mean intraoperative EtCO<inf>2</inf>
values and then divided into two groups: the high-EtCO<inf>2</inf> group
and the low-EtCO2 group. The pre-specified primary endpoint was the
assessment of recurrence-free survival up to the last known follow-up.
Cardiovascular events, surgical site infections, sepsis, and reoperations
during the hospital stay, as well as overall survival were pre-specified
secondary outcomes. Result(s): Mean EtCO<inf>2</inf> was 33.8 mmHg
+/-1.1 in the low-EtCO<inf>2</inf> group vs. 36.8 mmHg +/-1.9 in the
high-EtCO<inf>2</inf> group. Median follow-up was 2.6 (Q1:1.4; Q3:4.4)
years. Recurrence-free survival did not differ among the high and
low-EtCO<inf>2</inf> groups [HR = 1.043 (95% CI: 0.875-1.243), log rank
test: p = 0.909]. Factors affecting the primary endpoint were studied via
Cox analysis, which indicated no correlation between mean EtCO<inf>2</inf>
levels and recurrence-free survival [Coefficient -0.004, HR = 0.996 (95%
CI:0.95-1.04); p = 0.871]. We did not identify any differences in the
secondary endpoints, either. Conclusion(s): During elective
pancreatic cancer surgery, anesthesiologists should set EtCO<inf>2</inf>
targets for reasons other than oncological outcome until conclusive
evidence from prospective, multicenter randomized controlled trials is
available. Copyright © 2024 Dehne, Kirschner, Klotz, Kilian,
Michalski, Hackert, Buchler, Weigand and Larmann.

<16>
Accession Number
2034725729
Title
Colchicine in Patients With Coronary Disease Who Underwent Coronary Artery
Bypass Surgery: A Meta-Analysis of Randomized Controlled Trials.
Source
American Journal of Cardiology. 231 (pp 48-54), 2024. Date of Publication:
15 Nov 2024.
Author
Kirov H.; Caldonazo T.; Runkel A.; Medin D.; Fischer J.; Dallan L.R.;
Mukharyamov M.; Mejia O.A.; Jatene F.B.; Doenst T.
Institution
(Kirov, Caldonazo, Runkel, Medin, Fischer, Mukharyamov, Doenst) Department
of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena,
Germany
(Dallan, Mejia, Jatene) Department of Cardiovascular Surgery, Heart
Institute - University of Sao Paulo Medical School, Sao Paulo, Brazil
Publisher
Elsevier Inc.
Abstract
Recent randomized evidence has shown that low-dose colchicine lowers the
risk of cardiovascular events in patients with chronic coronary artery
disease. Colchicine has also been used in coronary artery bypass grafting
(CABG), with individual studies suggesting protective effects for
postoperative atrial fibrillation (POAF). We performed a meta-analysis of
studies assessing the effect of colchicine on outcomes in CABG surgery. We
systematically searched 3 libraries (MEDLINE, Web of Science, and the
Cochrane Library), selecting all randomized control trials including
patients who underwent CABG and were randomized for perioperative
administration of colchicine versus standard of care. The primary outcome
was incidence of POAF. The inverse variance method (DerSimonian&Laird) and
random-effects model were performed. The leave-one-out analysis was
carried out as a sensitivity analysis to address possible outliers. From
205 screened studies, 5 met the inclusion criteria and were selected. The
data from 839 patients were included in the final analysis. The included
studies were published between 2014 and 2022. The perioperative
administration of colchicine was associated with the reduction of POAF
rates after CABG compared with standard of care (relative risk 0.54, 95%
confidence interval 0.40 to 0.73, p <0.01). The leave-one-out analysis
confirmed the robustness of the analysis, with minimal variations of the
confidence interval. This meta-analysis of randomized studies suggests
that the perioperative administration of colchicine is associated with
significant reduction of POAF after CABG. Copyright © 2024 The
Author(s)

<17>
Accession Number
2034725138
Title
Low-dose colchicine for the prevention of cardiovascular events after
percutaneous coronary intervention: Rationale and design of the COL BE PCI
trial.
Source
American Heart Journal. 278 (pp 61-71), 2024. Date of Publication:
December 2024.
Author
De Cock E.; Kautbally S.; Timmermans F.; Bogaerts K.; Hanet C.; Desmet W.;
Gurne O.; Vranckx P.; Hiltrop N.; Dujardin K.; Vanduynhoven P.; Vermeersch
P.; Pirlet C.; Hermans K.; Van Reet B.; Ferdinande B.; Aminian A.; Dewilde
W.; Guedes A.; Simon F.; De Roeck F.; De Vroey F.; Jukema J.W.; Sinnaeve
P.; Buysschaert I.
Institution
(De Cock, Buysschaert) Department of Cardiology, AZ Sint-Jan Brugge AV,
Bruges, Belgium
(De Cock, Timmermans) Department of Cardiology, Ghent University Hospital,
Ghent, Belgium
(Kautbally, Gurne) Department of Cardiology, Cliniques Universitaires
St-Luc, Universite Catholique de Louvain, Brussels, Belgium
(Bogaerts) Department of Public Health and Primary Care, KU Leuven,
I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Diepenbeek, Belgium
(Hanet, Guedes) Department of Cardiology, Universite Catholique de
Louvain, Mont Godinne, Yvoir, Belgium
(Desmet, Sinnaeve) Department of Cardiovascular Sciences, University of
Leuven, Leuven, Belgium
(Desmet, Sinnaeve) Belgium & Department of Cardiovascular Medicine,
University Hospitals Leuven, Leuven, Belgium
(Vranckx) Department of Cardiology and Intensive Care Medicine, Jessa
Ziekenhuis, Hasselt, Belgium
(Hiltrop) Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
(Dujardin) Department of Cardiology, AZ Delta, Roeselare, Belgium
(Vanduynhoven) Department of Cardiology, Arrhythmia Clinic, ASZ Aalst,
Aalst, Belgium
(Vermeersch) Department of Cardiology, ZNA (Ziekenhuis Netwerk Antwerpen)
Middelheim, Antwerp, Belgium
(Pirlet) Department of Cardiology, Citadelle Liege, Liege, Belgium
(Hermans) Department of Cardiology, AZ Sint-Lucas Ghent, Ghent, Belgium
(Van Reet) Department of Cardiology, AZ Turnhout, Turnhout, Belgium
(Ferdinande) Department of Cardiology, Hospital Oost-Limburg, Genk,
Belgium
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
(Dewilde) Department of Cardiology, Imelda Hospital Bonheiden, Bonheiden,
Belgium
(Simon) Department of Cardiology, Clinique Saint-Luc Bouge, Namur, Belgium
(De Roeck) Department of Cardiology, University Hospital Antwerp, Edegem,
Belgium
(De Vroey) Department of Cardiology, Grand Hopital de Charleroi,
Charleroi, Belgium
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Jukema) Netherlands Heart Institute, Utrecht, Netherlands
Publisher
Elsevier Inc.
Abstract
Introduction: Patients with coronary artery disease (CAD) remain
vulnerable to future major atherosclerotic events after revascularization,
despite effective secondary prevention strategies. Inflammation plays a
central role in the pathogenesis of CAD and recurrent events. To date,
there is no specific anti-inflammatory medicine available with proven
effective, cost-efficient, and favorable benefit-risk profile, except for
colchicine. Initial studies with colchicine have sparked major interest in
targeting atherosclerotic events with anti-inflammatory agents, but
further studies are warranted to enforce the role of colchicine role as a
major treatment pillar in CAD. Given colchicine's low cost and established
acceptable long-term safety profile, confirming its efficacy through a
pragmatic trial holds the potential to significantly impact the global
burden of cardiovascular disease. Method(s): The COL BE PCI trial is
an investigator-initiated, multicenter, double-blind, event-driven trial.
It will enroll 2,770 patients with chronic or acute CAD treated with
percutaneous coronary intervention (PCI) at 19 sites in Belgium, applying
lenient in- and exclusion criteria and including at least 30% female
participants. Patients will be randomized between 2 hours and 5 days
post-PCI to receive either colchicine 0.5 mg daily or placebo on top of
contemporary optimal medical therapy and without run-in period. All
patients will have baseline hsCRP measurements and a Second Manifestations
of Arterial Disease (SMART) risk score calculation. The primary endpoint
is the time from randomization to the first occurrence of a composite
endpoint consisting of all-cause death, spontaneous non-fatal myocardial
infarction, non-fatal stroke, or coronary revascularization. The trial is
event-driven and will continue until 566 events have been reached,
providing 80% power to detect a 21 % reduction in the primary endpoint
taking a premature discontinuation of 15% into account. We expect a trial
duration of approximately 44 months. Conclusion(s): The COL BE PCI
Trial aims to assess the effectiveness and safety of administering
low-dose colchicine for the secondary prevention in patients with both
chronic and acute coronary artery disease undergoing PCI. Trial
registration: ClinicalTrials.gov: NCT06095765. Copyright © 2024
Elsevier Inc.

<18>
Accession Number
2034712601
Title
The emerging role of cardiopulmonary exercise testing and cardiac
rehabilitation in dilated cardiomyopathy: A mini review.
Source
Journal of the Pakistan Medical Association. 74(10) (pp 1894-1896), 2024.
Date of Publication: October 2024.
Author
Murad S.; Azim M.E.; Siddiqi F.A.; Rathore F.A.
Institution
(Murad, Azim, Siddiqi) Foundation University Islamabad, Rawalpindi,
Pakistan
(Rathore) Armed Forces Institute of Rehabilitation Medicine (AFIRM),
Rawalpindi, Pakistan
Publisher
Pakistan Medical Association
Abstract
Cardiovascular mortality is a major health burden worldwide and the number
of patients with cardiac diseases is increasing. Dilated cardiomyopathy
(DCM) is the most frequent cause for patient visits in cardiac care units
and emergency departments. It is commonly misdiagnosed as ischaemic
cardiac disease. Middle- and low-income countries rely on pharmacological
management as the only treatment option. Most of the patients cannot
afford heart transplants or advanced treatment strategies. Most health
professionals also do not prescribe cardiac rehabilitation for DCM
patients in their routine clinical practice. There is evidence that
supervised cardiac rehabilitation is safe and beneficial for DCM patients.
In addition to medications, cardiopulmonary exercise testing (CPET) and
supervised cardiac rehabilitation, can provide more benefits to the
affected population of cardiomyopathies. CPET and cardiac rehabilitation
are still novel concepts in countries like Pakistan. The present review
aims to provide clinicians with an overview of an evidence-based and
innovative perspective. This perspective emphasizes the utilization of the
additional benefits of cardiac rehabilitation in the holistic management
of DCM patients and the prevention of chronic heart failure. Copyright
© 2024 Pakistan Medical Association. All rights reserved.

<19>
Accession Number
2031523178
Title
Assessing the cost-effectiveness of replacing antimetabolites with mTOR
inhibitors in heart transplant immunosuppression in China: a network
meta-analysis-based economic evaluation.
Source
International Journal of Clinical Pharmacy. (no pagination), 2024. Date
of Publication: 2024.
Author
Gu Y.; Liu B.; Lin X.; Chen J.; Chen X.; Jiang Y.; Zhu Y.; Li X.; Lou S.;
Zhu J.
Institution
(Gu, Liu, Lin, Chen, Lou, Zhu) Department of Pharmacy, Nanjing First
Hospital, China Pharmaceutical University, Nanjing 210006, China
(Gu, Liu, Lin, Chen, Lou, Zhu) Department of Pharmacy, Nanjing First
Hospital, Nanjing Hospital Afiliated to Nanjing Medical University,
Nanjing 210006, China
(Chen, Jiang, Zhu) Department of Cardiothoracic Surgery, Nanjing First
Hospital, Nanjing Hospital Affiliated to Nanjing Medical University,
Nanjing 210006, China
(Li) School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
(Li) Center for Global Health, School of Public Health, Nanjing Medical
University, Nanjing, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Although several pharmacoeconomic studies have assessed the
cost-effectiveness of maintenance immunosuppressive regimens for heart
transplant recipients, economic comparisons between various combination
drug therapies remain sparse. Aim(s): This study used an economic
evaluation based on network meta-analysis to assess the cost-effectiveness
of four immunosuppressive regimens for adult heart transplant recipients
in China. Method(s): We conducted a systematic search for clinical
trials in PubMed, Embase, Cochrane Library, Web of Science, China National
Knowledge Infrastructure (CNKI), Wanfang Data, and VIP database. A
validated Markov model was adapted to reflect the Chinese medical
landscape. Four maintenance immunosuppression regimens were considered:
tacrolimus/mycophenolate mofetil (TAC/MMF), cyclosporine/mycophenolate
mofetil (CSA/MMF), everolimus/cyclosporine (EVL/CSA), and
sirolimus/tacrolimus (SRL/TAC). The probabilities of health events were
derived from a comprehensive literature review. Direct medical costs,
adjusted for 2022 values, were from public documents and websites, while
utilities for quality-adjusted life-years (QALYs) were taken from previous
studies. Primary outcomes were mean lifetime cost, QALYs, and
cost-effectiveness, with a willingness-to-pay (WTP) threshold set at three
times China's GDP per capita in 2022. Sensitivity analyses were conducted
to test the robustness of the results. Result(s): The base case
analysis identified TAC/MMF as the most cost-effective regimen, producing
a mean of 6.31 QALYs per patient at a cost of Chinese Yuan (CNY)
534,182.89. Sensitivity analyses consistently reinforced TAC/MMF as the
most cost-effective and robust choice. Conclusion(s): TAC/MMF is the
most cost-effective maintenance immunosuppressive regimen for heart
transplant recipients within the Chinese health system. The study findings
are reinforced by sensitivity analyses, affirming their robustness amid
various uncertainties. Copyright © The Author(s), under exclusive
licence to Springer Nature Switzerland AG 2024.

<20>
Accession Number
2031396383
Title
Impact of staged goal-directed fluid therapy on postoperative pulmonary
complications in patients undergoing McKeown esophagectomy: a randomized
controlled trial.
Source
BMC Anesthesiology. 24(1) (no pagination), 2024. Article Number: 330. Date
of Publication: December 2024.
Author
Yang C.; Shi Y.; Zhang M.; Yang Y.; Xie Y.
Institution
(Yang, Shi, Xie) Graduate School of Bengbu Medical College, Anhui, Bengbu
233004, China
(Yang, Shi, Zhang, Yang, Xie) Department of Anesthesiology, The First
Affiliated Hospital of the University of Science and Technology of China,
South District, No. 1 Tian'ehu Street, Hefei 236001, China
Publisher
BioMed Central Ltd
Abstract
Background: Our aim was to evaluate the influence of staged goal directed
therapy (GDT) on postoperative pulmonary complications (PPCs),
intraoperative hemodynamics and oxygenation in patients undergoing Mckeown
esophagectomy. Method(s): Patients were randomly divided into three
groups, staged GDT group (group A, n = 56): stroke volume variation (SVV)
was set at 8-10% during the one lung ventilation (OLV) stage and 8-12%
during the two lung ventilation (TLV) stage, GDT group (group B, n = 56):
received GDT with a target SVV of 8-12% During the entire surgical
procedure, and control group (group C, n = 56): conventional fluid therapy
was administered by mean arterial pressure (MAP), central venous pressure
(CVP), and urine volume. The primary outcome was the incidence of
postoperative pulmonary complications within Postoperative days (POD) 7.
The secondary outcomes were postoperative lung ultrasound (LUS) B-lines
artefacts (BLA) scoring, incidence of other complications, the length of
hospital stay, intraoperative hemodynamic and oxygenation indicators
included mean arterial pressure (MAP), heart rate (HR), cardiac index
(CI), cardiac output (CO), oxygenation index (OI), respiratory indices
(RI), alveolar-arterial oxygen difference (Aa-DO<inf>2</inf>).
 Result(s): Patients in group A and group B had a lower incidence of
PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines
score on postoperative ultrasound (4.61 +/- 0.51 vs. 6.15 +/- 0.74 and
4.75 +/- 0.62 vs. 6.15 +/- 0.74, p < 0.05) compared to group C. The CI,
CO, MAP, and OI were higher in group A compared to group B and group C in
the stage of thoracic operation. During the abdominal operation stage,
patients in group A and group B had a better hemodynamic and oxygenation
indicators than group C. Conclusion(s): In comparison to conventional
fluid therapy, intraoperative staged GDT can significantly reduce the
incidence of postoperative pulmonary complications in patients undergoing
McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it
can improve intraoperative oxygenation and stabilize intraoperative
hemodynamics in patients. Trial registration: This study was registered in
the Chinese Clinical Trial Registry on 24/11/2021
(ChiCTR2100053598). Copyright © The Author(s) 2024.

<21>
Accession Number
2031396382
Title
The effect of perioperative dexmedetomidine on postoperative delirium in
adult patients undergoing cardiac surgery with cardiopulmonary bypass: a
systematic review and meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 24(1) (no pagination), 2024. Article Number: 332. Date
of Publication: December 2024.
Author
Zhuang X.; Fu L.; Luo L.; Dong Z.; Jiang Y.; Zhao J.; Yang X.; Hei F.
Institution
(Zhuang, Fu, Luo, Dong, Jiang, Zhao, Yang, Hei) Department of
Cardiopulmonary Bypass, Beijing Anzhen Hospital, Capital Medical
University, Beijing 100029, China
Publisher
BioMed Central Ltd
Abstract
Background: Dexmedetomidine is considered to have neuroprotective effects
and may reduce postoperative delirium in both cardiac and major
non-cardiac surgeries. Compared with non-cardiac surgery, the delirium
incidence is extremely high after cardiac surgery, which could be caused
by neuroinflammation induced by surgical stress and CPB. Thus, it is
essential to explore the potential benefits of dexmedetomidine on the
incidence of delirium in cardiac surgery under CPB. Method(s):
Randomized controlled trials studying the effect of perioperative
dexmedetomidine on the delirium incidence in adult patients undergoing
cardiac surgery with CPB were considered to be eligible. Data collection
was conducted by two reviewers independently. The pre-specified outcome of
interest is delirium incidence. RoB 2 was used to perform risk of bias
assessment by two reviewers independently. The random effects model and
Mantel-Haenszel statistical method were selected to pool effect sizes for
each study. Result(s): PubMed, Embase, Cochrane Library, and Web of
Science were systematically searched from inception to June 28, 2023.
Sixteen studies including 3381 participants were included in our
systematic review and meta-analysis. Perioperative dexmedetomidine reduced
the incidence of postoperative delirium in patients undergoing cardiac
surgery with CPB compared with the other sedatives, placebo, or normal
saline (RR 0.57; 95% CI 0.41-0.79; P = 0.0009; I2 = 61%).
 Conclusion(s): Perioperative administration of dexmedetomidine could
reduce the postoperative delirium occurrence in adult patients undergoing
cardiac surgery with CPB. However, there is relatively significant
heterogeneity among the studies. And the included studies comprise many
early-stage small sample trials, which may lead to an overestimation of
the beneficial effects. It is necessary to design the large-scale RCTs to
further confirm the potential benefits of dexmedetomidine in cardiac
surgery with CPB. Registration number: CRD42023452410. Copyright
© The Author(s) 2024.

<22>
Accession Number
2018962374
Title
Effect of ventilation mode on postoperative pulmonary complications
following lung resection surgery: a randomised controlled trial.
Source
Anaesthesia. 77(11) (pp 1219-1227), 2022. Date of Publication: November
2022.
Author
Li X.-F.; Jin L.; Yang J.-M.; Luo Q.-S.; Liu H.-M.; Yu H.
Institution
(Li, Liu, Yu) Department of Anaesthesiology, West China Hospital of
Sichuan University, Chengdu, China
(Jin, Yang, Luo) Department of Anaesthesiology, Leshan People's Hospital,
Leshan, China
Publisher
John Wiley and Sons Inc
Abstract
The effect of intra-operative mechanical ventilation modes on pulmonary
outcomes after thoracic surgery with one-lung ventilation has not been
well established. We evaluated the impact of three common ventilation
modes on postoperative pulmonary complications in patients undergoing lung
resection surgery. In this two-centre randomised controlled trial, 1224
adults scheduled for lung resection surgery with one-lung ventilation were
randomised to one of three groups: volume-controlled ventilation;
pressure-controlled ventilation; and pressure-control with volume
guaranteed ventilation. Enhanced recovery after surgery pathways and
lung-protective ventilation protocols were implemented in all groups. The
primary outcome was a composite of postoperative pulmonary complications
within the first seven postoperative days. The outcome occurred in 270
(22%), with 87 (21%) in the volume control group, 89 (22%) in the pressure
control group and 94 (23%) in the pressure-control with volume guaranteed
group (p = 0.831). The secondary outcomes also did not differ across study
groups. In patients undergoing lung resection surgery with one-lung
ventilation, the choice of ventilation mode did not influence the risk of
developing postoperative pulmonary complications. This is the first
randomised controlled trial examining the effect of three ventilation
modes on pulmonary outcomes in patients undergoing lung resection
surgery. Copyright © 2022 Association of Anaesthetists.

<23>
Accession Number
2034639413
Title
Risk factor-targeted abdominal aortic aneurysm screening: systematic
review of risk prediction for abdominal aortic aneurysm.
Source
British Journal of Surgery. 111(9) (no pagination), 2024. Article Number:
znae239. Date of Publication: 01 Sep 2024.
Author
Musto L.; Smith A.; Pepper C.; Bujkiewicz S.; Bown M.
Institution
(Musto, Bown) Department of Cardiovascular Sciences, University of
Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital,
Leicester, United Kingdom
(Smith, Bujkiewicz) Department of Population Health Sciences,
Biostatistics Research Group, University of Leicester, University Road,
Leicester, United Kingdom
(Pepper) Library and Information Services, University Hospitals of
Leicester NHS Trust, Leicester Royal Infirmary, Leicester, United Kingdom
Publisher
Oxford University Press
Abstract
Background: This systematic review aimed to investigate the current state
of risk prediction for abdominal aortic aneurysm in the literature,
identifying and comparing published models and describing their
performance and applicability to a population-based targeted screening
strategy. Method(s): Electronic databases MEDLINE (via Ovid), Embase
(via Ovid), MedRxiv, Web of Science, and the Cochrane Library were
searched for papers reporting or validating risk prediction models for
abdominal aortic aneurysm. Studies were included only if they were
developed on a cohort or study group derived from the general population
and used multiple variables with at least one modifiable risk factor. Risk
of bias was assessed using the Prediction model Risk Of Bias ASsessment
Tool. A synthesis and comparison of the identified models was undertaken.
 Result(s): The search identified 4813 articles. After full-text
review, 37 prediction models were identified, of which 4 were unique
predictive models that were reported in full. Applicability was poor when
considering targeted screening strategies using electronic health
record-based populations. Common risk factors used for the predictive
models were explored across all 37 models; the most common risk factors in
predictive models for abdominal aortic aneurysm were: age, sex, biometrics
(such as height, weight, or BMI), smoking, hypertension,
hypercholesterolaemia, and history of heart disease. Few models had
undergone standardized model development, adequate external validation, or
impact evaluation. Conclusion(s): This study identified four risk
models that can be replicated and used to predict abdominal aortic
aneurysm with acceptable levels of discrimination. None of the models have
been validated externally. Copyright © 2024 The Author(s).
Published by Oxford University Press on behalf of BJS Foundation Ltd.

<24>
Accession Number
2034637735
Title
Comparison of intravascular ultrasound-guided with optical coherence
tomography-guided percutaneous coronary intervention for left main distal
bifurcation lesions: Rationale and design of the ISOLEDS trial.
Source
Contemporary Clinical Trials. 146 (no pagination), 2024. Article Number:
107691. Date of Publication: November 2024.
Author
Hao Y.; Zhao X.; Zhang H.; Wang X.; Li F.; Zhang W.; Yang M.; Chen H.; Zhu
Z.; Tang Y.; Miao L.; Li W.; Yang Q.; Guo N.; Chen B.; He Y.; Ye Y.; Zeng
Y.
Institution
(Zhao, Ye, Zeng) Center for Coronary Artery Disease, Division of
Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing,
China
(Hao) Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart, Lung and Blood Vessel Diseases,
Beijing, China
(Zhao, Zhang, Wang) Department of Cardiology, Handan First Hospital,
Handan, China
(Li) Department of Cardiology, The First Affiliated Hospital of Hebei
North University, Zhangjiakou, China
(Zhang) Department of Cardiology, Beijing Hospital, Chinese Academy of
Medical Sciences, Beijing, China
(Yang) Department of Cardiology, Peking Union Medical College Hospital,
Peking Union Medical College & Chinese Academy of Medical Sciences,
Beijing 100730, China
(Chen) Department of Cardiology, Cardiovascular Center, Beijing Friendship
Hospital, Capital Medical University, Beijing, China
(Zhu) Department of Cardiology, Central China Fuwai Hospital of Zhengzhou
University, Henan Provincial People's Hospital Heart Center, Zhengzhou,
China
(Tang) Department of Cardiology and Institute of Vascular Medicine, Peking
University Third Hospital, and Key Laboratory of Molecular Cardiovascular
Science, Ministry of Education, Beijing, China
(Miao) Heart Center, The First Hospital of Tsinghua University, Beijing,
China
(Li) Heart Center and Beijing Key Laboratory of Hypertension, Beijing
Chaoyang Hospital, Capital Medical University, Beijing, China
(Yang) Department of Cardiology, General Hospital, Tianjin Medical
University, Tianjin, China
(Guo) Department of Cardiovascular Medicine, First Affiliated Hospital of
Xi'an Jiaotong University, Xi'an, China
(Chen) Department of Cardiology, Qinghai Province Cardiovascular and
Cerebrovascular Disease Specialist Hospital, Xining, China
(He) Department of Cardiology, West China Hospital of Sichuan University,
Chengdu, China
Publisher
Elsevier Inc.
Abstract
Background: Percutaneous coronary intervention (PCI) can provide benefits
for anatomically suitable left main coronary artery (LMCA) lesions. When
compared to traditional coronary angiography (CAG) -guided PCI, the use of
intravascular ultrasound (IVUS) guidance has shown significant long-term
prognostic improvements in LMCA PCI. Optical coherence tomography (OCT)
offers a higher axial resolution than IVUS. However, there is currently a
lack of relevant randomized controlled trials investigating the use of OCT
specifically for left main distal bifurcation lesions. Method(s): The
ISOLEDS trial is an ongoing multicenter study that aims to compare
IVUS-guided PCI with OCT-guided PCI for patients with true LMCA distal
bifurcation lesions. This prospective, randomized, controlled,
non-inferiority trial will enroll a total of 664 patients with
visually-defined Medina 1,1,1 or 0,1,1 classification of left main distal
bifurcation lesions. The patients will be randomly assigned in a 1:1 ratio
to either IVUS-guided or OCT-guided PCI. The primary endpoint is to assess
the occurrence of target lesion failure (TLF) within 12 months after the
procedure. After undergoing PCI, patients are required to visit the
hospital for a 12-month clinical follow-up. During this clinical
assessment, CAG can be performed to evaluate the status of target lesions.
 Discussion(s): The ISOLEDS trial represents the first attempt to
compare two distinct intracoronary imaging techniques for guiding PCI in
patients with true LMCA distal bifurcation lesions. By evaluating and
comparing the outcomes of these two imaging techniques, the trial results
will aid operators in selection of the most effective approach for guiding
PCI in these patients. Copyright © 2024

<25>
[Use Link to view the full text]
Accession Number
2034616865
Title
Effect of Esketamine on Postoperative Delirium in Patients Undergoing
Cardiac Valve Replacement with Cardiopulmonary Bypass: A Randomized
Controlled Trial.
Source
Anesthesia and Analgesia. 139(4) (pp 743-753), 2024. Date of Publication:
01 Oct 2024.
Author
Xiong X.; Shao Y.; Chen D.; Chen B.; Lan X.; Shi J.
Institution
(Xiong, Shao, Chen, Lan, Shi) Department of Anesthesiology, The Affiliated
Hospital of Guizhou Medical University, Guiyang, China
(Chen) Department of Anesthesiology, West China Second Hospital, Sichuan
University, Chengdu, China
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The aim of this study was to investigate the effects of
esketamine on the risk of postoperative delirium (POD) in adults
undergoing on-pump cardiac valve surgery. METHOD(S): In this
randomized, triple-blind, controlled trial, 116 adult patients with an
American Society of Anesthesiologists (ASA) grade or and a New York Heart
Association (NYHA) grade or who underwent cardiac valve surgery with
cardiopulmonary bypass were included. Esketamine (0.25 mg/kg) or normal
saline was administered intravenously before anesthesia induction. The
primary outcome was POD, defined as a positive delirium assessment
according to the 3-minute confusion assessment method (CAM) or the
confusion assessment method for the intensive care unit (CAM-ICU) on a
twice-daily basis for 7 days after surgery. Delirium duration and the
delirium subtype were also recorded. The cognitive status of patients was
measured according to the Mini-Mental State Examination at baseline,
discharge, 30 days postoperatively and 3 months postoperatively.
 RESULT(S): A total of 112 patients (mean age, 52 years; 53.6% female)
were enrolled; 56 were assigned to receive esketamine, and 56 were
assigned to receive placebo. POD occurred in 13 (23.2%) patients in the
esketamine group and in 25 (44.6%) patients in the placebo group (relative
risk [RR], 0.52, 95% confidence interval [CI], 0.28-0.91; P =.018).
Thirteen patients (23.2%) in the esketamine group and 24 (42.9%) patients
in the placebo group had multiple episodes of delirium (RR, 0.54, 95% CI,
0.28-0.92), and 13 (23.2%) vs 22 (39.3%) patients exhibited the
hyperactive subtype. CONCLUSION(S): A single dose of esketamine (0.25
mg/kg) injected intravenously before anesthesia induction reduced the
incidence of delirium in relatively young patients with ASA grade or who
underwent on-pump cardiac surgery. Copyright © 2024 International
Anesthesia Research Society.

<26>
Accession Number
2033100488
Title
Personalised perioperative dosing of ivabradine in noncardiac surgery: a
single-centre, randomised, placebo-controlled, double-blind feasibility
pilot trial.
Source
British Journal of Anaesthesia. 133(4) (pp 738-747), 2024. Date of
Publication: October 2024.
Author
White M.J.; Zaccaria I.; Ennahdi-Elidrissi F.; Putzu A.; Dimassi S.; Luise
S.; Diaper J.; Mulin S.; Baudat A.D.; Gil-Wey B.; Elia N.; Walder B.;
Bollen Pinto B.
Institution
(White, Zaccaria, Ennahdi-Elidrissi, Putzu, Dimassi, Luise, Diaper, Mulin,
Baudat, Gil-Wey, Elia, Walder, Bollen Pinto) Division of Anaesthesiology,
Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency
Medicine, Geneva University Hospitals, Geneva, Switzerland
(Elia, Walder, Bollen Pinto) Department of Anaesthesiology, Pharmacology,
Intensive Care and Emergency Medicine, Faculty of Medicine, University of
Geneva, Geneva, Switzerland
Publisher
Elsevier Ltd
Abstract
Background: Perioperative myocardial injury after noncardiac surgery is
associated with postoperative mortality. Heart rate (HR) is an independent
risk factor for perioperative myocardial injury. In this pilot trial we
tested the feasibility of a randomised, placebo-controlled trial of
personalised HR-targeted perioperative ivabradine. Method(s): This
was a single-centre, randomised, placebo-controlled, double-blind,
parallel group, feasibility pilot trial conducted at Geneva University
Hospitals. We included patients >=75 yr old or >=45 yr old with
cardiovascular risk factors planned for intermediate- or high-risk
surgery. Patients were randomised to receive ivabradine (2.5, 5.0, or 7.5
mg) or placebo according to their HR, twice daily, from the morning of
surgery until postoperative day 2. Primary outcomes were appropriate
dosage and blinding success rates. Result(s): Between October 2020
and January 2022, we randomised 78 patients (recruitment rate of 1.3
patients week-1). Some 439 of 444 study drug administrations
were adequate (99% appropriate dosage rate). The blinding success rate was
100%. There were 137 (31%) administrations of Pill A (placebo in both
groups for HR <=70 beats min-1). Nine (11.5%) patients had a
high-sensitive cardiac troponin T elevation >=14 ng L-1 between
any two measurements. The number of bradycardia episodes was eight in the
placebo group and nine in the ivabradine group. Conclusion(s): This
pilot study demonstrates the feasibility of, and provides guidance for, a
future trial testing the efficacy of personalised perioperative
ivabradine. Future studies should include patients at higher risk of
cardiac complications. Clinical trial registration:
NCT04436016. Copyright © 2024 The Authors

<27>
Accession Number
2031407465
Title
Preoperative frailty and postoperative complications after non-cardiac
surgery: a systematic review.
Source
Journal of International Medical Research. 52(9) (no pagination), 2024.
Date of Publication: September 2024.
Author
Becerra-Bolanos A.; Hernandez-Aguiar Y.; Rodriguez-Perez A.
Institution
(Becerra-Bolanos, Hernandez-Aguiar, Rodriguez-Perez) Department of
Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario
de Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
(Becerra-Bolanos, Hernandez-Aguiar, Rodriguez-Perez) Department of Medical
and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las
Palmas de Gran Canaria, Spain
Publisher
SAGE Publications Ltd
Abstract
Objective: Many tools have been used to assess frailty in the
perioperative setting. However, no single scale has been shown to be the
most effective in predicting postoperative complications. We evaluated the
relationship between several frailty scales and the occurrence of
complications following different non-cardiac surgeries. Method(s):
This systematic review was registered in PROSPERO (CRD42023473401). The
search strategy included PubMed, Google Scholar, and Embase, covering
manuscripts published from January 2000 to July 2023. We included
prospective and retrospective studies that evaluated frailty using
specific scales and tracked patients postoperatively. Studies on cardiac,
neurosurgical, and thoracic surgery were excluded because of the impact of
underlying diseases on patients' functional status. Narrative reviews,
conference abstracts, and articles lacking a comprehensive definition of
frailty were excluded. Result(s): Of the 2204 articles identified,
145 were included in the review: 7 on non-cardiac surgery, 36 on general
and digestive surgery, 19 on urology, 22 on vascular surgery, 36 on spinal
surgery, and 25 on orthopedic/trauma surgery. The reviewed manuscripts
confirmed that various frailty scales had been used to predict
postoperative complications, mortality, and hospital stay across these
surgical disciplines. Conclusion(s): Despite differences among
surgical populations, preoperative frailty assessment consistently
predicts postoperative outcomes in non-cardiac surgeries. Copyright
© The Author(s) 2024.

<28>
Accession Number
2021801395
Title
Outcomes of Transcatheter Aortic Valve Implantation Comparing Medtronic's
Evolut PRO and Evolut R: A Systematic Review and Meta-Analysis of
Observational Studies.
Source
International Journal of Environmental Research and Public Health. 20(4)
(no pagination), 2023. Article Number: 3439. Date of Publication: February
2023.
Author
Gozdek M.; Kuzma L.; Dabrowski E.J.; Janiak M.; Pietrzak M.; Skonieczna
K.; Woznica M.; Wydeheft L.; Makhoul M.; Matteucci M.; Litwinowicz R.;
Kowalowka A.; Wanha W.; Pasierski M.; Ronco D.; Massimi G.; Jiritano F.;
Fina D.; Martucci G.; Raffa G.M.; Suwalski P.; Lorusso R.; Meani P.;
Kowalewski M.
Institution
(Gozdek) Department of Cardiology, Hospital of the Ministry of Interior,
Bydgoszcz 72-122, Poland
(Kuzma, Dabrowski) Department of Invasive Cardiology, Medical University
of Bialystok, Bialystok 15-540, Poland
(Makhoul) Department of Cardiac Surgery, Harefield Hospital, London UB9
6JH, United Kingdom
(Matteucci) Cardiac Surgery Unit, ASST dei Sette Laghi, Department of
Medicine and Surgery, University of Insubria, Varese 21100, Italy
(Litwinowicz) Department of Cardiac Surgery, Regional Specialist Hospital,
Grudziadz 86-300, Poland
(Kowalowka) Department of Cardiac Surgery, Upper-Silesian Heart Center,
Katowice 40-752, Poland
(Kowalowka) Department of Cardiac Surgery, Faculty of Medical Sciences,
Medical University of Silesia, Katowice 40-752, Poland
(Wanha) Department of Cardiac Surgery, School of Medicine in Katowice,
Medical University of Silesia, Katowice 40-752, Poland
(Jiritano) Department of Experimental and Clinical Medicine, Magna Graecia
University, Catanzaro 88100, Italy
(Fina, Meani) Department of Cardiothoracic, Vascular Anesthesia and
Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico
(IRCCS) Policlinico, Milan, San Donato Milanese 20097, Italy
(Martucci) Department of Anesthesia and Intensive Care, Istituto
Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
(IRCCS-ISMETT), Palermo 90100, Italy
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, Istituto di Ricovero e Cura a
Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad
Alta Specializzazione (IRCCS-ISMETT), Palermo 90100, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become a
broadly acceptable alternative to AV surgery in patients with aortic
stenosis (AS). New valve designs are becoming available to address the
shortcomings of their predecessors and improve clinical outcomes.
 Method(s): A systematic review and meta-analysis was carried out to
compare Medtronic's Evolut PRO, a new valve, with the previous Evolut R
design. Procedural, functional and clinical endpoints according to the
VARC-2 criteria were assessed. Result(s): Eleven observational
studies involving N = 12,363 patients were included. Evolut PRO patients
differed regarding age (p < 0.001), sex (p < 0.001) and STS-PROM estimated
risk. There was no difference between the two devices in terms of
TAVI-related early complications and clinical endpoints. A 35% reduction
of the risk of moderate-to-severe paravalvular leak (PVL) favoring the
Evolut PRO was observed (RR 0.66, 95%CI, [0.52, 0.86] p = 0.002;
I2 = 0%). Similarly, Evolut PRO-treated patients demonstrated a
reduction of over 35% in the risk of serious bleeding as compared with the
Evolut R (RR 0.63, 95%CI, [0.41, 0.96]; p = 0.03; I2 = 39%),
without differences in major vascular complications. Conclusion(s):
The evidence shows good short-term outcomes of both the Evolut PRO and
Evolut R prostheses, with no differences in clinical and procedural
endpoints. The Evolut PRO was associated with a lower rate of
moderate-to-severe PVL and major bleeding. Copyright © 2023 by
the authors.

<29>
Accession Number
2034698245
Title
The Impact of Preoperative Combined Pectoserratus and/or Interpectoral
Plane (Pectoralis Type II) Blocks on Opioid Consumption, Pain, and Overall
Benefit of Analgesia in Patients Undergoing Minimally Invasive Cardiac
Surgery: A Prospective, Randomized, Controlled, and Triple-blinded Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Gasteiger L.; Fiala A.; Naegele F.; Gasteiger E.; Seisl A.; Bonaros N.;
Mair P.; Velik-Salchner C.; Holfeld J.; Hofer D.; Stundner O.
Institution
(Gasteiger, Fiala, Gasteiger, Seisl, Mair, Velik-Salchner, Stundner)
Department of Anaesthesiology and Intensive Care Medicine, Medical
University of Innsbruck, Innsbruck, Austria
(Naegele, Bonaros, Holfeld, Hofer) Department of Cardiac Surgery, Medical
University of Innsbruck, Innsbruck, Austria
Publisher
W.B. Saunders
Abstract
Objective: Acute postoperative pain remains a major obstacle in minimally
invasive cardiac surgery (MICS). Evidence of the analgesic benefit of
chest wall blocks is limited. This study was designed to assess the
influence of combined pectoserratus plane block plus interpectoral plane
block (PSPB + IPPB) on postoperative pain and the overall benefit of
analgesia compared with placebo. Design(s): A prospective,
randomized, triple-blinded study was conducted. Setting(s): The
setting was the operating room and intensive care unit of a university
hospital. Participant(s): A total of 60 patients undergoing elective
right-lateral MICS were enrolled. Intervention(s): Patients were
randomly assigned to preoperative PSPB + IPPB with 30 mL of ropivacaine
0.5% or saline. Measurements and Main Results: The primary endpoint
was total intravenous morphine milligram equivalents administered in the
first 24 hours after extubation. Secondary endpoints included the Overall
Benefit of Analgesia Score (OBAS) at 24 hours after extubation and
repeated Visual Analogue Scale (VAS). Values for intravenous morphine
milligram equivalents administered in the first 24 hours after extubation
were significantly lower (median [interquartile range]: 4.2 mg [2.1 - 7.9]
v 8.3 mg [4.2 - 15.7], p = 0.025; mean difference: 6.7 mg [0.94 - 12 mg],
p = 0.024, Cohen's d: 0.64 [0.09 - 1.2]). Moreover, OBAS at 24 hours and
VAS after extubation were significantly lower (4.0 [3.0 - 6.0] v 7.0 [3.0
- 9.0], p = 0.043; 0.0 cm [0.0 - 2.0] v 1.5 cm [0.3 - 3.0], p = 0.030).
VAS did not differ between groups at later points. Conclusion(s):
Preoperative PSPB + IPPB reduced 24-hour postextubation opioid
consumption, pain at extubation, and OBAS. Given its low risk and
expedient placement, it could be a helpful addition to MICS protocols.
Future studies should evaluate these findings in multicenter settings and
further elucidate the optimal timing of block placement. Copyright
© 2024

<30>
Accession Number
2031513622
Title
Unlocking the potential of deferoxamine: a systematic review on its
efficacy and safety in alleviating myocardial ischemia-reperfusion injury
in adult patients following cardiopulmonary bypass compared to standard
care.
Source
Therapeutic Advances in Cardiovascular Disease. 18 (no pagination), 2024.
Date of Publication: January-December 2024.
Author
Lamichhane A.; Sharma S.; Bastola B.; Chhusyabaga B.; Shrestha N.; Poudel
P.
Institution
(Lamichhane) College of Medical Sciences, Bharatpur 44200, Nepal
(Sharma, Bastola, Chhusyabaga, Shrestha, Poudel) College of Medical
Sciences, Bharatpur, Nepal
Publisher
SAGE Publications Ltd
Abstract
Background: Reperfusion injury, characterized by oxidative stress and
inflammation, poses a significant challenge in cardiac surgery with
cardiopulmonary bypass (CPB). Deferoxamine, an iron-chelating compound,
has shown promise in mitigating reperfusion injury by inhibiting
iron-dependent lipid peroxidation and reactive oxygen species (ROS)
production. Objective(s): The objective of our study was to analyze
and evaluate both the efficacy and safety of a new and promising
intervention, that is, deferoxamine for ischemia-reperfusion injury (I/R).
 Design(s): Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines are used to perform the study. Data
sources and methods: We conducted a systematic review following PRISMA
guidelines to assess the efficacy and safety of deferoxamine in reducing
I/R injury following CPB. A comprehensive search of electronic databases,
namely, PubMed, Scopus, and Embase, yielded relevant studies published
until August 18, 2023. Included studies evaluated ROS production, lipid
peroxidation, cardiac performance, and morbidity outcomes. Result(s):
(a) ROS production: Multiple studies demonstrated a statistically
significant decrease in ROS production in patients treated with
deferoxamine, highlighting its potential to reduce oxidative stress. (b)
Lipid peroxidation: Deferoxamine was associated with decreased lipid
peroxidation levels, indicating its ability to protect cardiac tissue from
oxidative damage during CPB. (c) Cardiac performance: Some studies
reported improvements in left ventricular ejection fraction and wall
motion score index with deferoxamine. Conclusion(s): Our review shows
that deferoxamine is an efficacious and safe drug that can be used to
prevent myocardial I/R injury following CPB. It also highlights the need
for trials on a larger scale to develop potential strategies and
guidelines on the use of deferoxamine for I/R injury. Copyright ©
The Author(s), 2024.

<31>
Accession Number
2031423383
Title
Nebulized Budesonide Prevents Airway Inflammation in Children with High
Total IgE Levels After Open Heart Surgery with Cardiopulmonary Bypass: A
Prospective Randomized Controlled Trial.
Source
Pediatric Cardiology. (no pagination), 2024. Date of Publication: 2024.
Author
Zhu L.; Li C.; Gong X.; Xu Z.; Zhang H.
Institution
(Zhu, Li, Gong, Xu) Cardiac Intensive Care Unit, Department of
Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center,
Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
(Zhang) Department of Cardiovascular and Thoracic Surgery, Shanghai
Children's Medical Center, Shanghai Jiao Tong University School of
Medicine, Shanghai 200127, China
Publisher
Springer
Abstract
Cardiopulmonary bypass (CPB) is a crucial technique used to repair
congenital heart defects (CHD); however, it may induce inflammatory
response, leading to airway inflammation and need for prolonged mechanical
ventilation. In this study, we aimed to evaluate the effect of budesonide
nebulization in children with high serum total immunoglobulin E (tIgE)
levels undergoing surgical repair of CHD via CPB. We conducted a
randomized, single-center, controlled trial at a tertiary teaching
hospital. One-hundred and one children with high tIgE were enrolled and
randomized into the budesonide nebulization group (BUD group, n = 50) or
the normal saline nebulization group (NS group, n = 51) between January
2020 and December 2020. Budesonide or normal saline was administered
through a vibrating mesh nebulizer during mechanical ventilation every 8
h. Blood and bronchoalveolar lavage fluid (BALF) samples were examined and
data on airway mechanics and clinical outcomes were recorded. IL-6 and
IL-8 levels in the blood and BALF samples significantly increased after
CPB in both groups. Budesonide inhalation reduced IL-6 and IL-8 levels in
the blood and BALF samples in children with high tIgE (P < 0.05). The mean
airway pressure, PCO<inf>2</inf>, and oxygen index in the BUD group were
significantly lower than those in the NS group after the first inhalation
dose and persisted until almost 24 h after surgery. The peak inspiratory
pressure and drive pressure were lower in the BUD group than in the NS
group at nearly 24 h after surgery, with no significant difference at
other time points. Additionally, the duration of mechanical ventilation,
number of noninvasive ventilations after extubation, and number of
patients using aerosol-inhaled bronchodilators after CICU in the BUD group
were significantly lower than those in the NS group (P < 0.05). Children
with high preoperative tIgE levels are at risk of airway inflammation
after cardiopulmonary bypass. Inhaling budesonide during postoperative
mechanical ventilation can reduce the intensity of inflammatory reactions,
shorten the duration of mechanical ventilation, reduce airway pressure and
the utilization of NIV after extubation. Copyright © The
Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature 2024.

<32>
Accession Number
645330078
Title
Comparison of routine del Nido cardioplegia vs two types of modified del
Nido cardioplegias for myocardial protection among patients undergoing
coronary artery bypass grafting (CABG) surgeries: A randomized
double-blind clinical trial.
Source
The journal of extra-corporeal technology. 56(3) (pp 84-93), 2024. Date of
Publication: 01 Sep 2024.
Author
Ali B.; Butt S.P.; Nour M.G.; Khosravi M.B.; Asmarian N.; Shoul A.R.;
Kumar A.; Darr U.; Bhatnagar G.
Institution
(Ali) Student Research Committee of Shiraz University of Medical Sciences,
PO BOX 71348-14336, Shiraz, Iran, Islamic Republic of
(Butt, Kumar, Darr, Bhatnagar) Heart Vascular and Thoracic Institute,
Cleveland Clinic Abu Dhabi, PO BOX 112412, United Arab Emirates
(Nour) Department of Surgery, Section of Cardiac Surgery, Shiraz
University of Medical Sciences, PO BOX 71348-14336, Shiraz, Iran, Islamic
Republic of
(Khosravi, Asmarian) Anesthesiology and Critical Care Research Center,
Shiraz University of Medical Sciences, PO BOX 71348-14336, Shiraz, Iran,
Islamic Republic of
(Shoul) Department of Perfusion, Division of Anesthesiology and Critical
Care Research Center, Shiraz University of Medical Sciences, PO BOX
71348-14336, Shiraz, Iran, Islamic Republic of
Abstract
BACKGROUND: The del Nido cardioplegia solution is a widely used method for
myocardial protection in various settings. However, there is limited
evidence of its effectiveness in adult cardiac surgery, and the baseline
solution, Plasma Lyte A, is not readily available, leading to the use of
alternative baseline solutions. This study aims to investigate the
effectiveness of routine del Nido cardioplegia in adult cardiac surgery
and the impact of different baseline solutions on myocardial protection
and other perioperative outcomes. METHOD(S): This study was a
prospective, double-blind randomized parallel group clinical trial
conducted at a single tertiary care hospital in Iran. A total of 187 adult
patients were evaluated for eligibility, of which 120 met the inclusion
criteria for elective isolated CABG surgery. The patients were randomly
assigned to three groups, with each group consisting of 40 patients. The
control group received a normal saline-based routine del Nido
cardioplegia, Intervention Group A received Ringer lactate-based del Nido
cardioplegia, and Intervention Group B received plain Ringer-based del
Nido cardioplegia. The levels of Creatine Kinase-MB (CK-MB), Troponin T,
Troponin I, and lactate were primarily assessed at four different times:
after anesthesia induction (Baseline), 2 h, 12 h, and 24 h.
 RESULT(S): Preoperative demographic and clinical characteristics were
the same among groups with insignificant differences (p > 0.05). There was
no significant difference among groups based on CK-MB, Troponin T,
Troponin I, and lactate levels (p = 0.078, 0.143, 0.311, and 0.129
respectively). However, there was a significant difference in the time
effect of Troponin T and Lactate (p = 0.034, p = <0.001).
 CONCLUSION(S): Normal saline, Ringer lactate, and plain Ringer
provide comparable myocardial protection in adult-isolated CABG surgery
with modified del Nido cardioplegia. Larger studies are needed to identify
the best alternative to Plasma Lyte A while maintaining del Nido
cardioplegia as the control. Copyright © The Author(s), published
by EDP Sciences, 2024.

<33>
Accession Number
2031504556
Title
Evaluation and Management of Metabolic Alkalosis in Children.
Source
Current Treatment Options in Pediatrics. (no pagination), 2024. Date of
Publication: 2024.
Author
Fulchiero R.; Boe D.M.; Seo-Mayer P.
Institution
(Fulchiero, Seo-Mayer) Inova Children's Hospital, 8280 Willow Oaks
Corporate Drive, Suite 250, Fairfax, VA 22031, United States
(Fulchiero, Boe, Seo-Mayer) Georgetown University School of Medicine,
MedStar Georgetown Hospital, Washington, DC, United States
(Seo-Mayer) University of Virginia School of Medicine, Charlottesville,
VA, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose of Review: This paper reviews the pathophysiology, diagnostic
evaluation, and treatment strategies for pediatric patients with metabolic
alkalosis. The goal is to provide pediatric clinicians a framework to
understand the underlying reasons for metabolic alkalosis, and to grasp
the need to identify and treat the primary problem as well as the barriers
that prevent adequate renal compensation to correct this acid-base
disorder. Recent Findings: The strategy for metabolic alkalosis management
lies in understanding of basic pathophysiology. With innovations in
genetic testing and drug development, more precise diagnoses with targeted
intervention are possible. Understanding which children are at high risk
for this disorder gives clinicians the ability to prevent and intervene
early to reduce morbidity. Summary: Metabolic alkalosis is one of the
most common acid-base disturbances in hospitalized children. Pediatric
cardiothoracic surgery patients are at high risk for development of
metabolic alkalosis. The importance of careful history and physical
examination, and measurement of urinary chloride to help identify primary
renal and non-renal drivers of alkalosis, is essential. Understanding the
pathophysiology of metabolic alkalosis directs treatment and management of
the condition. Copyright © The Author(s), under exclusive licence
to Springer Nature Switzerland AG 2024.

<34>
Accession Number
645328511
Title
Early diagnosis to avoid invasive treatment in cardiac migration of a
ventriculoperitoneal catheter: a qualitative systematic review and Weibull
analysis of case reports.
Source
Journal of neurosurgery. (pp 1-10), 2024. Date of Publication: 20 Sep
2024.
Author
Nakae T.; Hojo M.; Arakawa Y.
Institution
(Nakae, Arakawa) 1Department of Neurosurgery, Kyoto University Graduate
School of Medicine, Kyoto City, Kyoto; and
(Nakae, Hojo) Department of Neurosurgery, Shiga General Hospital, Shiga,
Japan
Abstract
OBJECTIVE: The migration of distal catheter after ventriculoperitoneal
shunt placement is a rare but significant complication. Especially in a
case of cardiac migration, open-heart surgery or catheter intervention may
be required. The authors encountered a case of cardiac migration that
fortunately could be treated by withdrawal. A systematic review of cardiac
migration was performed to clarify when and how migration was diagnosed
and why invasive treatments were required. Based on the collected cases, a
Weibull analysis of the latency until diagnosis was performed to examine
whether cardiac migration is caused by an initial factor and to compare
the result with the other migration sites such as gastrointestinal tract
or urinary tract. METHOD(S): A qualitative systematic review was
performed according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analysis (PRISMA) guidelines. A database of case reports
was created by searching PubMed and Scopus with the keywords
"ventriculoperitoneal AND shunt AND migration" (last search date: April
2022). Whether the occurrence rate of migration is constant over time was
examined by fitting a Weibull distribution. RESULT(S): A total of 339
articles of all migration sites were identified. Among them, 36 articles
reporting 38 cases of cardiac migration were considered eligible. A total
of 39 cases including the authors' case were reviewed qualitatively. When
classifying the cases by their latency to diagnosis, the rates of
pulmonary thrombosis and of cardiac adhesion were higher in the delayed
group (>= 1 year) than in the early group (<= 1 month). The rate of open
chest surgery was higher in the delayed, intermediate, and early groups,
in that order. In the Weibull analysis, the shape parameter (beta) was
less than 1, indicating that the occurrence rate of cardiac migration was
initially high, followed by a decline. The finding supports the hypothesis
that migration results from an intraoperative vascular injury. Note that
these findings are subject to bias given that they are derived from case
reports. CONCLUSION(S): In light of the previous reports, the latency
until diagnosis of cardiac migration was associated with the rate of
thrombosis and adhesion, which resulted in escalation to invasive
treatment. Early diagnosis will prevent invasive treatment because most
cases are caused by initial factors, as the Weibull analysis showed.

<35>
Accession Number
645324692
Title
Ramipril After Transcatheter Aortic Valve Implantation in Patients Without
Reduced Ejection Fraction: The RASTAVI Randomized Clinical Trial.
Source
Journal of the American Heart Association. (pp e035460), 2024. Date of
Publication: 18 Sep 2024.
Author
Amat-Santos I.J.; Lopez-Otero D.; Nombela-Franco L.; Peral-Disdier V.;
Gutierrez-Ibanes E.; Jimenez-Diaz V.; Munoz-Garcia A.; Del Valle R.;
Regueiro A.; Ibanez B.; Romaguera R.; Cuellas Ramon C.; Garcia B.; Sanchez
P.L.; Gomez-Herrero J.; Gonzalez-Juanatey J.R.; Tirado-Conte G.;
Fernandez-Aviles F.; Raposeiras S.; Revilla-Orodea A.; Lopez-Diaz J.;
Gomez I.; Carrasco-Moraleja M.; San Roman J.A.
Institution
(Amat-Santos, Gomez-Herrero, Revilla-Orodea, Lopez-Diaz, San Roman)
Cardiology Department Hospital Clinico Universitario de Valladolid Spain,
Spain
(Amat-Santos, Lopez-Otero, Peral-Disdier, Gutierrez-Ibanes, Munoz-Garcia,
Del Valle, Regueiro, Ibanez, Cuellas Ramon, Garcia, Sanchez,
Gonzalez-Juanatey, Fernandez-Aviles, Revilla-Orodea, Lopez-Diaz, Gomez,
Carrasco-Moraleja, San Roman) CIBERCV (Centro de Investigacion biomedica
en red-Enfermedades Cardiovasculares) Instituto de Salud Carlos III Madrid
Spain, Spain
(Lopez-Otero, Gonzalez-Juanatey) Cardiology Department, IDIS Complejo
Hospitalario Universitario de Santiago de Compostela Spain, Spain
(Nombela-Franco, Tirado-Conte) Cardiovascular Institute, Hospital Clinico
San Carlos Instituto de Investigacion Sanitaria Hospital Clinico San
Carlos (IdISSC) Madrid Spain, Spain
(Peral-Disdier) Cardiology Department, Hospital Universitari Son Espases
(HUSE) Institut d'Investigacio Sanitaria Illes Balears (IdISBa) Palma
Balearic Islands Spain, Spain
(Gutierrez-Ibanes, Fernandez-Aviles) Cardiology Department Hospital
Gregorio Maranon Madrid Spain, Spain
(Jimenez-Diaz, Raposeiras) Cardiology Department, Hospital Alvaro
Cunqueiro University Hospital of Vigo Pontevedra Spain, Spain
(Munoz-Garcia) Cardiology Department Hospital Virgen de la Victoria Malaga
Spain, Spain
(Del Valle) Cardiology Department Hospital U. Central de Asturias Oviedo
Spain, Spain
(Regueiro) Cardiology Department, Instituto Clinic Cardiovascular,
Hospital Clinic Institut d'Investigacions Biomediques August Pi i Sunyer
(IDIBAPS) Barcelona Spain, Spain
(Ibanez) Cardiology Department Fundacion Jimenez Diaz Madrid Spain, Spain
(Ibanez) Centro Nacional de Investigaciones Cardiovasculares (CNIC) Madrid
Spain, Spain
(Romaguera) Cardiology Department Hospital Bellvitge Barcelona Spain,
Spain
(Cuellas Ramon) Cardiology Department Hospital Clinico de Leon Spain,
Spain
(Garcia) Cardiology Department Hospital Vall d'Hebron Barcelona Spain,
Spain
(Sanchez) Cardiology Department Hospital Clinico de Salamanca Spain, Spain
Abstract
BACKGROUND: Patients with aortic stenosis may continue to have an
increased risk of heart failure, arrhythmias, and death after successful
transcatheter aortic valve implantation. Renin-angiotensin system
inhibitors may be beneficial in this setting. We aimed to explore whether
ramipril improves the outcomes of patients with aortic stenosis after
transcatheter aortic valve implantation. METHODS AND RESULTS: PROBE
(Prospective Randomized Open, Blinded Endpoint) was a multicenter trial
comparing ramipril with standard care (control) following successful
transcatheter aortic valve implantation in patients with left ventricular
ejection fraction >40%. The primary end point was the composite of cardiac
mortality, heart failure readmission, and stroke at 1-year follow-up.
Secondary end points included left ventricular remodeling and fibrosis. A
total of 186 patients with median age 83years (range 79-86), 58.1% women,
and EuroSCORE-II 3.75% (range 3.08-4.97) were randomized to receive either
ramipril (n=94) or standard treatment (n=92). There were no significant
baseline, procedural, or in-hospital differences. The primary end point
occurred in 10.6% in the ramipril group versus 12% in the control group
(P=0.776), with no differences in cardiac mortality (ramipril 1.1% versus
control group 2.2%, P=0.619) but lower rate of heart failure readmissions
in the ramipril group (3.2% versus 10.9%, P=0.040). Cardiac magnetic
resonance analysis demonstrated better remodeling in the ramipril compared
with the control group, with greater reduction in end-systolic and
end-diastolic left ventricular volumes, but nonsignificant differences
were found in the percentage of myocardial fibrosis. CONCLUSION(S):
Ramipril administration after transcatheter aortic valve implantation in
patients with preserved left ventricular function did not meet the primary
end point but was associated with a reduction in heart failure
re-admissions at 1-year follow-up. REGISTRATION: URL:
https://www.clinicaltrials.gov; Unique Identifier: NCT03201185.

<36>
Accession Number
645324602
Title
Surgery Versus Thrombolytic Therapy for the Management of Left-Sided
Prosthetic Valve Thrombosis Without Hemodynamic Compromise: A Systematic
Review and Meta-Analysis.
Source
Journal of the American Heart Association. (pp e035143), 2024. Date of
Publication: 18 Sep 2024.
Author
Chopard R.; Vidoni C.; Besutti M.; Ismail M.; Ecarnot F.; Favoulet B.;
Badoz M.; Schiele F.; Perrotti A.; Meneveau N.
Institution
(Chopard, Vidoni, Besutti, Ecarnot, Favoulet, Badoz, Schiele, Meneveau)
Department of Cardiology University Hospital Besancon France, France
(Chopard, Ecarnot, Badoz, Schiele, Meneveau) SINERGIES University of
Franche-Comte Besancon France, France
(Ismail, Perrotti) Department of Thoracic and Cardio-Vascular Surgery
University Hospital Besancon France, France
Abstract
BACKGROUND: The optimal strategy in prosthetic heart valve thrombosis
(PVT) remains controversial, with no randomized trials and conflicting
observational data. We performed a systematic review and meta-analysis of
evidence comparing systemic thrombolysis and cardiac surgery in PVT.
METHODS AND RESULTS: We searched PubMed, the Cochrane Library, and Embase
for studies on treatment strategies in patients with left-sided PVT since
2000. The primary outcome was death, and the secondary outcomes were major
bleeding and thromboembolism during follow-up (International Prospective
Register of Systematic Reviews No. CRD42022384092). We identified 2298
studies, of which 16 were included, comprising 1389 patients with PVT
(mean age, 50.4+/-9.3years; 60.0% women). Among them, 67.2% were New York
Heart Association stage III/IV at admission. Overall, 48.1% were treated
with systemic thrombolysis and 51.9% with cardiac surgery. The mortality
rate was 10.8% in the thrombolysis group and 15.3% in the surgery group.
The pooled risk difference for death with systemic thrombolysis was 1.13
(exact CI, 0.74-1.79; zeta2=0.89; P<0.001) versus cardiac surgery. Rates
of both transient ischemic attack and non-central nervous system embolism
were higher in the thrombolysis group (P=0.002 and P=0.02, respectively).
Treatment success, major bleeding, and stroke were similar between groups.
Sensitivity analysis including studies that used low-dose or slow-infusion
thrombolysis showed that the mortality rate was lower, and treatment
success was higher, in patients referred to systemic thrombolysis, with
similar rates of other secondary outcomes. CONCLUSION(S): There is
evidence to suggest that thrombolysis might be the preferred option for
the management of PVT without cardiogenic shock, pending future randomized
controlled trials or larger observational studies.

<37>
Accession Number
645323070
Title
Incidence of Infective Endocarditis Post-TPVR with MELODY Valve in
Pediatric Patients: A Systematic Review and Meta-Analysis.
Source
Current cardiology reviews. (no pagination), 2024. Date of Publication:
16 Sep 2024.
Author
Veldurthy S.; Shrivastava D.; Majeed F.; Ayaz T.; Munir A.; Haider A.;
Mylavarapu M.
Institution
(Veldurthy) Department of Pediatrics, Mediciti Institute of Medical
Sciences, Telangana, India
(Shrivastava) Department of Anesthesia, University of Minnesota,
Minneapolis, United States
(Majeed) Department of Medicine, Pakistan Medical and Dental Council,
Islamabad, Pakistan
(Ayaz) Department of Medicine, Baqai Medical University, Karachi, Pakistan
(Munir) Department of Anesthesia, Mayo Hospital, Lahore, Pakistan
(Haider) Department of Allied Health Sciences, University of Lahore,
Gujrat, Pakistan
(Mylavarapu) Department of Public Health, Adelphi University, NY, United
States
Abstract
INTRODUCTION: Infective Endocarditis (IE) has emerged to be one of the
most impactful adverse complications post-transcatheter procedures,
especially Transcatheter Pulmonary Valve Replacement (TPVR). We conducted
a systematic review and meta-analysis with the aim of identifying the
incidence of IE post-TPVR with the MELODY valve in the pediatric
population. METHOD(S): A comprehensive literature search was
performed across several prominent databases, including PubMed/MEDLINE,
SCOPUS, and Science Direct. Studies compared the clinical outcomes of
pediatric patients who received TPVR using the MELODY valve. Data
extraction was done for variables like the total pediatric patient
population that underwent TPVR with MELODY valve, mean age, the sex of the
patients, the incidence rate of IE following the procedure, and the
duration between the procedure and the occurrence of IE. Inverse Variance
was used to estimate the incidence of IE in patients who underwent TPVR
with respective 95% confidence interval (CI). RESULT(S): In total, 4
studies with 414 pediatric patients who underwent TPVR using the MELODY
valve were included in the study. The mean age of the study population was
12.7 +/- 3.11 years. The pooled incidence of IE following TPVR with MELODY
valve in the pediatric population was 17.70% (95% Cl 3.84-31.55;
p<0.00001). Additionally, the mean length of duration to develop IE
following TPVR with MELODY valve in the pediatric population was 2.18
years (95% Cl 0.35-4.01; p<0.00001). CONCLUSION(S): Our meta-analysis
reveals that IE post-TPVR with MELODY valve in pediatric patients is a
significant complication, clinically and statistically. Further research
needs to be done to understand the risk factors and develop better
management strategies. Copyright© Bentham Science Publishers; For
any queries, please email at epub@benthamscience.net.

<38>
Accession Number
2031407358
Title
Comparison of liberal versus restrictive transfusion strategies after hip
surgery in patients with coronary artery disease: a post hoc analysis of
the FOCUS trial.
Source
BMC Cardiovascular Disorders. 24(1) (no pagination), 2024. Article Number:
498. Date of Publication: December 2024.
Author
Zhang J.; Chen Z.; He Y.
Institution
(Zhang, Chen, He) Department of Cardiology, West China Hospital of Sichuan
University, 37 Guo Xue Xiang, Sichuan, Chengdu 610041, China
Publisher
BioMed Central Ltd
Abstract
Background: There are no clear recommendations for optimal transfusion
thresholds for patients with coronary artery disease who undergo
noncardiac surgery. By comparing restrictive and liberal transfusion
strategies for coronary artery disease combined with hip surgery, this
study hopes to provide recommendations for transfusion strategies in this
special population. Method(s): A total of 805 patients from the FOCUS
trial (Transfusion Trigger Trial for Functional Outcomes in Cardiovascular
Patients Undergoing Surgical Hip Fracture Repair) with coronary artery
disease combined with hip surgery were divided into two groups based on
transfusion thresholds: restricted transfusion (a hemoglobin level of 8
g/deciliter) and liberal transfusion (a hemoglobin threshold of 10
g/deciliter). The primary outcome of this study was a composite endpoint
including in-hospital death, myocardial infarction, unstable angina, and
acute heart failure. The secondary endpoints included other in-hospital
adverse events and 30- and 60-day follow-up events. Analyses were
performed by intention to treat. Result(s): Except for the proportion
of congestive heart failure patients, the baseline levels of the two
groups were comparable. The median number of transfusion units in the
liberal transfusion group was 2 units, and the median transfusion volume
in the restricted transfusion group was 0 units. The primary outcome was
not significantly different between the two groups (9.2% vs. 9.4%, p =
0.91). The incidence of in-hospital myocardial infarction events was lower
in the liberal transfusion group than in the restricted transfusion group
(3.2% vs. 6.2%) (OR = 0.51, P = 0.048). The remaining in-hospital endpoint
events, except for myocardial infarction, were not significantly different
between the two groups. The 30-day and 60-day endpoints of death and
inability to walk independently were not significantly different between
the two groups, with ORs (95% CI) of 1.00 (0.75-1.31) and 1.06
(0.80-1.41), respectively. We also found no interaction between
transfusion strategies and factors such as age, sex, or multiple
underlying comorbidities at the 60-day follow-up. Conclusion(s):
There was no significant difference in the in-hospital, 30-day or 60-day
outcome endpoints between the two groups. However, this study demonstrated
that a liberal transfusion strategy tends to reduce the incidence of
in-hospital myocardial infarction events in patients with coronary artery
disease combined with hip surgery compared to a restrictive transfusion
strategy. More high-quality studies should be designed to investigate the
optimal transfusion threshold in patients with coronary artery disease
treated without cardiac surgery. Copyright © The Author(s) 2024.

<39>
Accession Number
2031392105
Title
Effect of non-steroidal anti-inflammatory drugs on the management of
postoperative pain after cardiac surgery: a multicenter, randomized,
controlled, double-blind trial (KETOPAIN Study).
Source
Trials. 25(1) (no pagination), 2024. Article Number: 613. Date of
Publication: December 2024.
Author
Huette P.; Moussa M.; Diouf M.; Lefebvre T.; Bayart G.; Guilbart M.; Viart
C.; Haye G.; Bar S.; Caus T.; Soriot-Thomas S.; Boddaert S.; Alshatri
H.Y.; Tarpin P.; Fumery O.; Beyls C.; Dupont H.; Mahjoub Y.; Besnier E.;
Abou-Arab O.
Institution
(Huette, Lefebvre, Bayart, Guilbart, Viart, Haye, Bar, Tarpin, Fumery,
Beyls, Dupont, Mahjoub, Abou-Arab) Department of Anesthesia and Critical
Care, Amiens Hospital University, 1 Rue du Professeur Christian Cabrol,
Amiens 80054, France
(Moussa) Department of Anesthesia and Critical Care, Lille Hospital
University, Lille 59037, France
(Diouf) Department of Statistic, Amiens Hospital University, Amiens 80054,
France
(Caus) Department of Cardiac Surgery, Amiens Hospital University, Amiens
80054, France
(Soriot-Thomas) Clinical Research Centre, Amiens Hospital University,
Amiens 80054, France
(Boddaert) Department of Pharmacology, Amiens Hospital University, Amiens
80054, France
(Alshatri) Faculty of Medicine, Department of Anesthesia and Critical
Care, University of Jeddah, Jeddah, Saudi Arabia
(Beyls, Mahjoub) UR UPJV 758 SSPC (Simplification of Care of Complex
Surgical Patients) Research Unit, University of Picardie Jules Verne,
Amiens 80054, France
(Besnier) Department of Anesthesia and Critical Care, Rouen Hospital
University, Rouen 76031, France
(Abou-Arab) MP3CV, EA7517, CURS, Jules Verne University of Picardie,
Amiens, France
Publisher
BioMed Central Ltd
Abstract
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended
for the management of acute postoperative pain as part of a multimodal
strategy to reduce opioid use, relieve pain, and reduce chronic pain in
non-cardiac surgery. However, significant concerns arise in cardiac
surgery due to the potential adverse effects of NSAID including increased
bleeding and acute kidney injury (AKI). We hypothesized that NSAIDs are
effective against pain and safe in the early postoperative period
following cardiac surgery, taking contraindications into account.
 Method(s): The KETOPAIN trial is a prospective, double blind, 1:1
ratio, versus placebo multicentric trial, randomizing 238 patients
scheduled for cardiac surgery. Written consent will be obtained for all
participants. The inclusion criterion is patients more than 18 years old
undergoing for elective cardiac surgery under cardiopulmonary bypass
(CPB). Patients will be allocated to the intervention (ketoprofen) group
(n = 119) or the control (placebo) group (n = 119). In the intervention
group, in addition to the standard treatment, patients will receive NSAIDs
(ketoprofen) at a dose of 100 mg each 12 h 48 h after. The control group,
in addition to the standard treatment, will receive a placebo of NSAIDs
every 12 h for 48 h after surgery. An intention-to-treat analysis will be
performed. The primary endpoint will be the intensity of acute
postoperative pain at rest at 24 h from the end of surgery. Pain will be
assessed using the numerous rating scale. The secondary endpoints will be
postoperative pain on coughing during chest physiotherapy, postoperative
pain until day 7, the pain trajectory between day 3 and day 7, cumulative
opioid consumption within 48 h after surgery, nausea and vomiting, the
occurrence of postoperative pulmonary complications within the first 7
days after surgery, neuropathic pain at 3 months, and quality of life at 3
months. Discussion(s): NSAIDs function as non-selective, reversible
inhibitors of the cyclooxygenase enzyme and play a role in a multimodal
pain management approach. While there are recommendations supporting the
use of NSAIDs in major non-cardiac surgery, recent guidelines do not favor
their use in cardiac surgery. However, this is based on low-quality
evidence. Major concerns regarding NSAID use in cardiac surgery patients
are potential increase in postoperative bleeding or AKI. However, few
studies support the possible use of NSAIDs without the risk of bleeding
and/or AKI. Also, in a recent French survey, many anesthesiologists
reported using NSAIDs in cardiac surgery. To date, no large randomized
study has been conducted to evaluate the efficacy of NSAIDs in the
management of postoperative pain in cardiac surgery. The expected outcome
of this study is an improvement in the management of acute postoperative
pain in cardiac surgery with a multimodal strategy including the use of
NSAIDs. Trial registration: ClinicalTrials.gov NCT06381063. Registered on
April 24, 2024. Copyright © The Author(s) 2024.

<40>
Accession Number
2029866483
Title
Simultaneous Transcatheter Aortic Valve Implantation and Endovascular
Aneurysm Repair for Severe Aortic Stenosis and Symptomatic Abdominal
Aortic Aneurysm: Mini Review.
Source
Vascular and Endovascular Surgery. 58(7) (pp 762-768), 2024. Date of
Publication: October 2024.
Author
Conde Vela C.N.; Gamarra-Valverde N.N.; Inga K.; Vargas Machuca L.A.M.
Institution
(Conde Vela, Vargas Machuca) Department of Cardiology, Peruvian Society of
Cardiology, Lima, Peru
(Gamarra-Valverde, Inga) Faculty of Medicine, Peruvian University Cayetano
Heredia, Lima, Peru
Publisher
SAGE Publications Inc.
Abstract
Background: The treatment of patients with severe aortic stenosis (SAS)
who concomitantly present with abdominal aortic aneurysm (AAA) is not
defined. Aortic valve replacement surgery, performed alone, increases the
risk of AAA rupture. Transcatheter aortic valve replacement (TAVR) and
endovascular abdominal aortic aneurysm repair (EVAR) in the same
intervention, especially in high-risk patients, is a safe alternative.
 Purpose(s): We report a case of simultaneous endovascular treatment
of SAS and AAA and a mini literature review of nineteen cases with similar
characteristics. Research design: Case report and literature review. Data
Collection: An electronic search of PubMed and Scopus was performed from
inception to December 2023. Result(s): Nineteen case reports of
simultaneous transcatheter aortic valve repair and endovascular aneurysm
repair for SAS and symptomatic AAA were identified published in the
literature. Conclusion(s): We regard the simultaneous endovascular
approach to both pathologies as a promising treatment alternative for
selected patients with severe aortic stenosis and abdominal aortic
aneurysm. We highlight the need to conduct randomized clinical trials in
this patient population. Copyright © The Author(s) 2024.

<41>
Accession Number
2022334482
Title
Early Results of the Newly-Designed Flowdynamics Dense Mesh Stent for
Residual Dissection After Proximal Repair of Stanford Type A or Type B
Aortic Dissection: A Preliminary Single-Center Report From a Multicenter,
Prospective, and Randomized Study.
Source
Journal of Endovascular Therapy. 31(5) (pp 984-994), 2024. Date of
Publication: October 2024.
Author
Lu C.; Wang H.; Yang P.; Liu Y.; Zhang Y.; Xu Z.; Xie Y.; Hu J.
Institution
(Lu, Wang, Yang, Liu, Zhang, Xu, Xie, Hu) Department of Cardiovascular
Surgery, West China Hospital, Sichuan University, Chengdu, China
(Hu) Department of Cardiothoracic Surgery, Guang'an Hospital, West China
Hospital, Sichuan University, Guang'an, China
Publisher
SAGE Publications Inc.
Abstract
Background: Negative remodeling of the distal aorta due to residual
dissection significantly impacts the long-term outcomes of dissection
patients after proximal repair of acute aortic dissection.
Branched/fenestrated aortic stents are technically demanding, and studies
of the first generation of multilayer flow modulators for tackling this
clinical scenario are few and limited. The single-center results from a
multicenter, prospective, and randomized controlled study aimed to verify
the safety and effectiveness of a newly-designed flowdynamics dense mesh
stent for treating residual dissection after proximal repair.
 Method(s): Patients with nonchronic residual dissection involving
visceral branches were prospectively enrolled in 3 centers
(ChiCTR1900023638). Eligible patients were randomly assigned to the
flowdynamics dense mesh stent (FDMS) group and control group. Follow-up
visits were arranged at 1, 3, 6, and 12 months after recruitment. The
primary endpoints were all-cause and aortic-related mortality. The
secondary endpoints included visceral branch occlusion, reintervention,
and severe adverse events. Morphological changes were analyzed to exhibit
the therapeutic effect. Our center participated in the multicenter
prospective randomized controlled trial, and the preliminary single-center
experience was reported. Result(s): Thirty-six patients were enrolled
in our center, and the baseline characteristics of the 2 groups were
comparable. Thirty-four patients completed the 12 month follow-up. Freedom
from all-cause and aortic-related death were 94.4% and 100%. All visceral
branches remained patent in the FDMS group. Increased area of the true
lumen (1.03+/-0.38 vs 0.48+/-0.63 cm2 at the plane below renal
arteries, p=0.006; 1.27+/-0.80 vs 0.32+/-0.50 cm2 at the plane
5 cm below renal arteries, p<0.001) and decreased area of the false lumen
at the plane below renal arteries (-1.03+/-0.84 vs -0.15+/-1.21
cm2, p=0.023) were observed in the FDMS group compared with
those parameters in the control group. The FDMS group showed a significant
increase in true lumen volume (p<0.001) and a significant decrease in
false lumen volume (p=0.018). Conclusion(s): This newly-designed FDMS
for endovascular repair of residual dissection after the proximal repair
is safe and effective at 12 months. Clinical Impact: One-year results of
the randomized controlled clinical trial indicated the short-term safety
and promising effect of FDMS on treating non-chronic residual dissection
after proximal repair. At the 12th-month follow-up, the true lumen
expanded, the false lumen shrunk and all visceral arteries kept patent. As
far as I'm concerned, this is the first randomized controlled study
concerning utilizing multilayer flow mesh stent treating aortic
dissection. Despite a preliminary single-center report, our results are
supposed to provide high-quality evidence to guide clinical practice and
fill the gap in the application of FDMS. Copyright © The
Author(s) 2023.

<42>
Accession Number
2021000579
Title
Outcomes and Patency of Endovascular Infrapopliteal Reinterventions in
Patients With Chronic Limb-Threatening Ischemia.
Source
Journal of Endovascular Therapy. 31(5) (pp 831-839), 2024. Date of
Publication: October 2024.
Author
Kleiss S.F.; van Mierlo-van den Broek P.A.H.; Vos C.G.; Fioole B.;
Bloemsma G.C.; de Vries-Werson D.A.B.; Bokkers R.P.H.; de Vries J.-P.P.M.
Institution
(Kleiss, de Vries-Werson, de Vries) Division of Vascular Surgery,
Department of Surgery, University Medical Center Groningen, University of
Groningen, Groningen, Netherlands
(van Mierlo-van den Broek, Fioole) Department of Vascular Surgery,
Maasstad Hospital, Rotterdam, Netherlands
(Vos) Department of Surgery, Martini Hospital, Groningen, Netherlands
(Bloemsma, Bokkers) Medical Imaging Center, Department of Radiology,
University Medical Center Groningen, University of Groningen, Groningen,
Netherlands
Publisher
SAGE Publications Inc.
Abstract
Purpose: Endovascular revascularization is the preferred treatment to
improve perfusion of the lower extremity in patients with chronic
limb-threatening ischemia (CLTI). Patients with CLTI often present with
stenotic-occlusive lesions involving the infrapopliteal arteries. Although
the frequency of treating infrapopliteal lesions is increasing, the
reintervention rates remain high. This study aimed to determine the
outcomes and patency of infrapopliteal endovascular reinterventions.
 Method(s): This retrospective, multicenter cohort study of 3 Dutch
hospitals included patients who underwent an endovascular infrapopliteal
reintervention in 2015 up to 2021 after a primary infrapopliteal
intervention for CLTI. The outcome measures after the reintervention
procedures included technical success rate, the mortality rate and
complication rate (any deviation from the normal postinterventional
course) at 30 days, overall survival, amputation-free survival (AFS),
freedom from major amputation, major adverse limb event (MALE), and
recurrent reinterventions (a reintervention following the infrapopliteal
reintervention). Cox proportional hazard models were used to determine
risk factors for AFS and freedom from major amputation or recurrent
reintervention. Result(s): Eighty-one patients with CLTI were
included. A total of 87 limbs underwent an infrapopliteal reintervention
in which 122 lesions were treated. Technical success was achieved in 99
lesions (81%). The 30-day mortality rate was 1%, and the complication rate
was 13%. Overall survival and AFS at 1 year were 69% (95% confidence
interval [CI], 55%-79%) and 54% (95% CI, 37%-67%), respectively, and those
at 2.5 years were 45% (95% CI, 33%-56%) and 21% (95% CI, 11%-33%),
respectively. Freedom from major amputation, MALE, and recurrent
reinterventions at 1 year and 2.5 years were 59% (95% CI, 46%-70%) and 41%
(95% CI, 25%-56%); 54% (95% CI, 41%-65%) and 36% (95% CI, 21%-51%); and
68% (95% CI, 55%-78%) and 51% (95% CI, 33%-66%), respectively. A Global
Limb Anatomic Staging System score of III showed an increased hazard ratio
of 2.559 (95% CI, 1.078-6.072; p=0.033) for freedom of major amputation or
recurrent reintervention. Conclusion(s): The results of this study
indicate that endovascular infrapopliteal reinterventions can be performed
with acceptable 30-day mortality and complication rates. However, outcomes
and patency were moderate to poor, with low AFS, high rates of major
amputations, and recurrent reinterventions. Clinical Impact: This
multicenter retrospective study evaluating outcome and patency of
endovascular infrapopliteal reinterventions for CLTI, shows that
endovascular infrapopliteal reinterventions can be performed with
acceptable 30-day mortality and complication rates. However, the short-
and mid-term outcomes of the infrapopliteal reinterventions were moderate
to poor, with low rates of AFS and a high need for recurrent
reinterventions. While the frequency of performing infrapopliteal
reinterventions is increasing with additional growing complexity of the
disease, alternative treatment options such as venous bypass grafting or
deep venous arterialization may be considered and should be studied in
randomized controlled trials. Copyright © The Author(s) 2023.

<43>
Accession Number
2034673798
Title
Prevention of Heart Failure in Hypertension-the Role of Coronary Heart
Disease Events Treated With Versus Without Revascularization: The ALLHAT
Study.
Source
American Journal of Cardiology. 231 (pp 1-10), 2024. Date of Publication:
15 Nov 2024.
Author
Chen V.; Davis B.R.; Kapadia S.R.; Kattan M.W.; Tereshchenko L.G.
Institution
(Chen, Kapadia, Tereshchenko) Heart, Vascular & Thoracic Institute,
Cleveland Clinic, Cleveland, Ohio, United States
(Davis) University of Texas School of Public Health, Houston, Texas,
United States
(Kattan, Tereshchenko) Quantitative Health Sciences, Lerner Research
Institute, Cleveland Clinic, Cleveland, Ohio, United States
Publisher
Elsevier Inc.
Abstract
In modern clinical practice, less than half of patients with new-onset
heart failure (HF) undergo ischemic evaluation and only a minority undergo
revascularization. We aimed to assess the proportion of the effect of
hypertension (antihypertensive treatment) on incident HF to be eliminated
by prevention of coronary heart disease (CHD) event treated with or
without revascularization, considering possible treatment-mediator
interaction. The causal mediation analysis of Antihypertensive and
Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) included
42,418 participants (age 66.9 +/- 7.7, 35.6% black, 53.2% men). A new CHD
event (myocardial infarction or angina) that occurred after randomization
but before the incident HF outcome was the mediator. Incident symptomatic
congestive HF (CHF) and hospitalized/fatal HF (HHF) were the primary and
secondary outcomes, respectively. Logistic regression (for mediator) and
Cox proportional hazards regression (for outcome) were adjusted for
demographics, cardiovascular disease history, and risk factors. During a
median 4.5-year follow-up, 2,785 patients developed CHF, including 2,216
HHF events. Participants who developed CHD events had twice the higher
incidence rate of CHF than CHD-free (28.5 vs 13.9 events/1,000
person-years). The proportion of reference interaction indicating direct
harm because of a CHD event for lisinopril (234% for CHF, 355% for HHF)
and amlodipine (244% for CHF, 468% for HHF) was greater than for
chlortalidone (143% for CHF, 269% for HHF). In patients with
revascularized CHD events, chlortalidone and amlodipine eliminated 21% to
24% and lisinopril eliminated -45% of HHF. Antihypertensive treatment
could not eliminate harm from CHD events treated without
revascularization. In conclusion, the antihypertensive drugs
(chlortalidone, lisinopril, and amlodipine) prevent HF not principally by
preventing CHD events but by way of other pathways. HF is moderated but
not mediated by CHD events. Revascularization of CHD events is paramount
for HF prevention. Copyright © 2024 Elsevier Inc.

<44>
Accession Number
2034582468
Title
The effects of selenium supplementation on lipid profile in adults: A
systematic review and meta-analysis of randomized controlled trials.
Source
Prostaglandins and Other Lipid Mediators. 175 (no pagination), 2024.
Article Number: 106901. Date of Publication: December 2024.
Author
Saadh M.J.; Khaleel A.Q.; Merza M.S.; Hassan H.; Tomar B.S.; Singh M.;
Kumar A.V.; Hasaanzadeh S.
Institution
(Saadh) Faculty of Pharmacy, Middle East University, Amman 11831, Jordan
(Khaleel) Department of Medical Instruments Engineering, College of
Engineering, University of Al Maarif, AlAnbar 31001, Iraq
(Merza) Prosthetic Dental Techniques Department, Al-Mustaqbal University
College, Babylon 51001, Iraq
(Hassan) Management and Science University, Selangor, Shah Alam, Malaysia
(Tomar) Institute of Pediatric Gastroenterology and Hepatology, National
Institute of Medical Sciences, NIMS University Rajasthan, Jaipur, India
(Singh) Department of Applied Sciences, Chandigarh Engineering College,
Chandigarh Group of Colleges-Jhanjeri, Punjab, Mohali 140307, India
(Kumar) Department of Allied Healthcare and Sciences, Vivekananda Global
University, Rajasthan-, Jaipur 303012, India
(Hasaanzadeh) Department of Nutrition, School of Public Health, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Introduction: Dyslipidemia with a considerable progression rate is a
primary risk factor for CVDs if left untreated. Dietary interventions have
explored the health influences of selenium on lipid profiles in adults,
yet the findings remain contentious. This study seeks to determine if
selenium supplementation can positively modify the lipid profile (total
cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol
(LDL-C), very-low-density lipoprotein cholesterol (VLDL), and high-density
lipoprotein cholesterol (HDL-C) in adults. Method(s): Using
predefined keywords, we searched online databases, including Scopus,
PubMed, Web of Science Core Collection, and Google Scholar, for relevant
studies published from inception through July 2024. A random-effects
meta-analysis was then employed to pool the weighted mean differences
(WMD) and 95 % CI for outcomes assessed by a minimum of three studies.
 Result(s): Initially 1205 studies were obtained out of which 25 RCTs
were decided to be included for further analyses. Selenium supplementation
reduced VLDL (WMD: -1.53; 95 % CI: -2.86, -0.20), but did not change TG
(WMD: 1.12; 95 % CI: -4.51, 6.74), TC (WMD: -2.25; 95 % CI: -6.80, 2.29),
LDL-C (WMD: 1.60; 95 % CI: -4.26, 7.46), and HDL-C levels (WMD: 0.98; 95 %
CI: - 0.02, 1.98). Conclusion(s): Our study showed significantly
reduced VLDL but limited effects were observed in other lipid indexes.
More extensive RCTs are required globally to achieve a holistic
comprehension of the connection between selenium and lipid
profile. Copyright © 2024 Elsevier Inc.

<45>
[Use Link to view the full text]
Accession Number
2033992005
Title
Changes in the Term Neonatal Electroencephalogram with General Anesthesia:
A Systematic Review with Narrative Synthesis.
Source
Anesthesiology. 141(4) (pp 670-680), 2024. Date of Publication: 01 Oct
2024.
Author
Corlette S.J.; Walker S.M.; Cornelissen L.; Brasher C.; Bower J.; Davidson
A.J.
Institution
(Corlette, Brasher, Davidson) Department of Anaesthesia and Pain
Management, Royal Children's Hospital, Melbourne, VIC, Australia
(Corlette, Davidson) Department of Paediatrics, Melbourne Medical School,
University of Melbourne, Melbourne, VIC, Australia
(Corlette) Murdoch Children's Research Institute, Melbourne, VIC,
Australia
(Walker) Paediatric Pain Research Group, Developmental Neurosciences,
University College London Great Ormond Street Institute of Child Health,
London, United Kingdom
(Cornelissen) Department of Anesthesiology, Critical Care and Pain
Medicine, Boston Children's Hospital, Boston, MA, United States
(Cornelissen) Harvard Medical School, Boston, MA, United States
(Brasher) Department of Critical Care, Melbourne Medical School,
University of Melbourne, Melbourne, VIC, Australia
(Bower) Royal Children's Hospital, Melbourne, VIC, Australia
(Bower) Faculty of Fine Arts and Music, University of Melbourne,
Melbourne, VIC, Australia
(Davidson) Melbourne Children's Trial Centre, Murdoch Children's Research
Institute, Melbourne, VIC, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Although effects of general anesthesia on neuronal activity in
the human neonatal brain are incompletely understood,
electroencephalography provides some insight and may identify
age-dependent differences. Method(s): A systematic search (MEDLINE,
Embase, PubMed, and Cochrane Library to November 2023) retrieved English
language publications reporting electroencephalography during general
anesthesia for cardiac or noncardiac surgery in term neonates (37 to 44
weeks postmenstrual age). Data were extracted, and risk of bias (ROBINS-I
Cochrane tool) and quality of evidence (Grading of Recommendations
Assessment, Development, and Evaluation [GRADE] checklist) were assessed.
 Result(s): From 1,155 abstracts, 9 publications (140 neonates; 55%
male) fulfilled eligibility criteria. Data were limited, and study quality
was very low. The occurrence of discontinuity, a characteristic pattern of
alternating higher and lower amplitude electroencephalography segments,
was reported with general anesthesia (94 of 119 neonates, 6 publications)
and with hypothermia (23 of 23 neonates, 2 publications). Decreased power
in the delta (0.5 to 4 Hz) frequency range was also reported with
increasing anesthetic dose (22 neonates; 3 publications).
 Conclusion(s): Although evidence gaps were identified, both
increasing sevoflurane concentration and decreasing temperature are
associated with increasing discontinuity. Copyright © 2024 The
Author(s).

<46>
Accession Number
2033680138
Title
Non-pulmonary complications of intrathecal morphine administration: a
systematic review and meta-analysis with meta-regression.
Source
British Journal of Anaesthesia. 133(4) (pp 823-838), 2024. Date of
Publication: October 2024.
Author
Renard Y.; El-Boghdadly K.; Rossel J.-B.; Nguyen A.; Jaques C.; Albrecht
E.
Institution
(Renard, Nguyen, Albrecht) Department of Anaesthesia, University Hospital
of Lausanne and University of Lausanne, Lausanne, Switzerland
(El-Boghdadly) Department of Anaesthesia, Guy's and St Thomas' NHS
Foundation Trust, London, United Kingdom
(El-Boghdadly) King's College London, London, United Kingdom
(Rossel) Centre for Primary Care and Public Health (Unisante), Lausanne,
Switzerland
(Jaques) Medical Library, Lausanne University Hospital and University of
Lausanne, Lausanne, Switzerland
Publisher
Elsevier Ltd
Abstract
Background: Intrathecal morphine provides effective analgesia for a range
of operations. However, widespread implementation into clinical practice
is hampered by concerns for potential side-effects. We undertook a
systematic review, meta-analysis, and meta-regression with the primary
objective of determining whether a threshold dose for non-pulmonary
complications could be defined and whether an association could be
established between dose and complication rates when intrathecal morphine
is administered for perioperative or obstetric analgesia. Method(s):
We systematically searched the literature for randomised controlled trials
comparing intrathecal morphine vs control in patients undergoing any type
of surgery under general or spinal anaesthesia, or women in labour.
Primary outcomes were rates of postoperative nausea and vomiting,
pruritus, and urinary retention within the first 24 postoperative hours,
analysed according to doses (1-100 mug; 101-200 mug; 201-500 mug; >500
mug), type of surgery, and anaesthetic strategy. Trials were excluded if
doses were not specified. Result(s): Our analysis included 168 trials
with 9917 patients. The rates of postoperative nausea and vomiting,
pruritus, and urinary retention were significantly increased in the
intrathecal morphine group, with an odds ratio (95% confidence interval)
of 1.52 (1.29-1.79), P<0.0001; 6.11 (5.25-7.10), P<0.0001; and 1.73
(1.17-2.56), P=0.005, respectively. Meta-regression could not establish an
association between dose and rates of non-pulmonary complications. There
was no subgroup difference according to surgery for any outcome. The
quality of evidence was low (Grading of Recommendations Assessment,
Development, and Evaluation [GRADE] system). Conclusion(s):
Intrathecal morphine significantly increased postoperative nausea and
vomiting, pruritus, and urinary retention after surgery or labour in a
dose-independent manner. Systematic review protocol: PROSPERO
(CRD42023387838). Copyright © 2024 The Authors

<47>
[Use Link to view the full text]
Accession Number
2033675580
Title
Postoperative pain management after thoracic transplantations.
Source
Current Opinion in Anaesthesiology. 37(5) (pp 493-503), 2024. Date of
Publication: 01 Oct 2024.
Author
Lobo C.; Tufegdzic B.
Institution
(Lobo, Tufegdzic) Anesthesiology Institute, Cleveland Clinic Abu Dhabi,
Abu Dhabi, United Arab Emirates
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of reviewHeart and lung transplantation evolution marked
significant milestones. Pioneering efforts of Dr Christiaan Barnard with
the first successful heart transplant in 1967, followed by advancements in
heart-lung and single-lung transplants by Drs Bruce Reitz, Norman Shumway,
and Joel Cooper laid the groundwork for contemporary organ
transplantation, offering hope for patients with end-stage heart and
pulmonary diseases.Recent findingsPretransplant opioid use in heart
transplant recipients is linked to higher mortality and opioid dependence
posttransplant. Effective pain control is crucial to reduce opioid-related
adverse effects and enhance recovery. However, research on specific pain
management protocols for heart transplant recipients is limited. In lung
transplantation effective pain management is crucial. Studies emphasize
the benefits of multimodal strategies, including thoracic epidural
analgesia and thoracic paravertebral blocks, to enhance recovery and
reduce opioid use. Perioperative pain control challenges in lung
transplantation are unique and necessitate careful consideration to
prevent complications and improve outcomes.SummaryThis review emphasizes
the importance of tailored pain management in heart and lung transplant
recipients. It advocates for extended follow-up and alternative analgesics
to minimize opioid dependency and enhance quality of life. Further
high-quality research is needed to optimize postoperative analgesia and
improve patient outcomes. Copyright © 2024 Wolters Kluwer Health,
Inc. All rights reserved.

<48>
Accession Number
2026342242
Title
Impact of early versus class I-triggered surgery on postoperative survival
in severe aortic regurgitation: An observational study from the Aortic
Valve Insufficiency and Ascending Aorta Aneurysm International Registry.
Source
Journal of Thoracic and Cardiovascular Surgery. 168(4) (pp 1011-1022.e3),
2024. Date of Publication: October 2024.
Author
Hanet V.; Schafers H.-J.; Lansac E.; de Kerchove L.; El Hamansy I.;
Vojacek J.; Contino M.; Pouleur A.-C.; Beauloye C.; Pasquet A.;
Vanoverschelde J.-L.; Vancraeynest D.; Gerber B.L.
Institution
(Hanet, de Kerchove, Pouleur, Beauloye, Pasquet, Vanoverschelde,
Vancraeynest, Gerber) Department of Cardiovascular Diseases, Cliniques
Universitaires St Luc, Pole de Recherche Cardiovasculaire (CARD), Institut
de Recherche Experimentale et Clinique IREC UCLouvain, Brussels, Belgium
(Schafers) Surgery Department, Homburg-Saarland University Medical Center,
Homburg, Germany
(Lansac) Surgery Department, Institut Mutualiste Montsouris, Paris, France
(El Hamansy) Surgery Department, Montreal Heart Institute, Montreal,
Canada
(Vojacek) Surgery Department, Charles University Hospital, Hradec Kralove,
Czechia
(Contino) Surgery Department, Socio Sanitaria Territoriale Universita
degli Studi di Milano, Milano, Italy
Publisher
Elsevier Inc.
Abstract
Objectives: Class I triggers for severe and chronic aortic regurgitation
surgery mainly rely on symptoms or systolic dysfunction, resulting in a
negative outcome despite surgical correction. Therefore, US and European
guidelines now advocate for earlier surgery. We sought to determine
whether earlier surgery leads to improved postoperative survival.
 Method(s): We evaluated the postoperative survival of patients who
underwent surgery for severe aortic regurgitation in the international
multicenter registry for aortic valve surgery, Aortic Valve Insufficiency
and Ascending Aorta Aneurysm International Registry, over a median
follow-up of 37 months. Result(s): Among 1899 patients (aged 49 +/-
15 years, 85% were male), 83% and 84% had class I indication according to
the American Heart Association and European Society of Cardiology,
respectively, and most were offered repair surgery (92%). Twelve patients
(0.6%) died after surgery, and 68 patients died within 10 years after the
procedure. Heart failure symptoms (hazard ratio, 2.60 [1.20-5.66], P =
.016) and either left ventricular end-systolic diameter greater than 50 mm
or left ventricular end-systolic diameter index greater than 25
mm/m2 (hazard ratio, 1.64 [1.05-2.55], P = .030) predicted
survival independently over and above age, gender, and bicuspid phenotype.
Therefore, patients who underwent surgery based on any class I trigger had
worse adjusted survival. However, patients who underwent surgery while
meeting early imaging triggers (left ventricular end-systolic diameter
index 20-25 mm/m2 or left ventricular ejection fraction 50% to
55%) had no significant outcome penalty. Conclusion(s): In this
international registry of severe aortic regurgitation, surgery when
meeting class I triggers led to postoperative outcome penalty compared
with earlier triggers (left ventricular end-systolic diameter index 20-25
mm/m2 or ventricular ejection fraction 50%-55%). This
observation, which applies to expert centers where aortic valve repair is
feasible, should encourage the global use of repair techniques and the
conduction of randomized trials. Copyright © 2023 The American
Association for Thoracic Surgery

<49>
Accession Number
2031411326
Title
Cardiac metastasis in uterine cervical cancer: A systematic review and
case study.
Source
Strahlentherapie und Onkologie. (no pagination), 2024. Date of
Publication: 2024.
Author
Simek I.-M.; Sturdza A.; Knoth J.; Spannbauer A.; Bergler-Klein J.;
Vogele-Kadletz M.; Widder J.; Schmid M.P.
Institution
(Simek, Sturdza, Knoth, Widder, Schmid) Department of Radiation Oncology,
Comprehensive Cancer Center, Medical University of Vienna, General
Hospital of Vienna, Wahringer Gurtel 18-20, Vienna 1090, Austria
(Spannbauer, Bergler-Klein) Department of Cardiology, Medical University
of Vienna, General Hospital of Vienna, Vienna, Austria
(Vogele-Kadletz) Department of Cardiac Surgery, Medical University of
Vienna, General Hospital of Vienna, Vienna, Austria
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Cardiac metastasis from cervical cancer is rare and only scarcely
documented. We aim to present a new case and systematically summarize the
available literature. Material(s) and Method(s): PubMed, Scopus, Web
of Science, Central, and ClinicalTrials.gov were systematically searched
following the PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) criteria. Results were screened via title, abstract, and
full text. Additionally, the reference lists of all papers chosen for the
review were screened. Result(s): Eighty-one papers were identified,
describing 86 cases in total. Cardiac metastasis occurred at all stages of
cervical cancer and in all age groups. Median time from initial diagnosis
to diagnosis of cardiac metastasis was 12 months. Patients mainly
complained of dyspnea and chest pain, 60.8% had pathologic ECG
(electrocardiographic) findings. The cardiac mass was most frequently
detected by transthoracic echography. The most common tumor histology was
squamous cell carcinoma. Chemotherapy and surgical interventions were the
main treatment modalities. Median survival after diagnosis of cardiac
metastasis was 3 months. Conclusion(s): This largest review on
cardiac metastases from cervical cancer confirmed the heart as a very
infrequent site of metastasis. There are <100 cases described in the
literature, with very poor prognosis and undefined clinical
management. Copyright © The Author(s) 2024.

<50>
Accession Number
2030104186
Title
Ultrasound-guided erector spinae plane block versus thoracic epidural
block for postoperative analgesia in pediatric Nuss surgery: a randomized
noninferiority trial.
Source
Journal of Anesthesia. 38(5) (pp 600-608), 2024. Date of Publication:
October 2024.
Author
Ren Y.; Nie X.; Zhang F.; Ma Y.; Hua L.; Zheng T.; Xu Z.; Gao J.; Zhang J.
Institution
(Ren, Zhang, Ma, Hua, Zheng, Xu, Gao, Zhang) Department of Anesthesiology,
Beijing Children's Hospital, National Center for Children's Health,
Capital Medical University, No. 56, South Lishi Road, Beijing 100045,
China
(Nie) Center for Clinical Epidemiology and Evidence-Based Medicine,
Beijing Children's Hospital, National Center for Children's Health,
Capital Medical University, Beijing 100045, China
Publisher
Springer
Abstract
Purpose: Thoracic epidural anesthesia (TEA) is often used for analgesia
after thoracic surgery. Erector spinae plane block (ESPB) has been
proposed to provide adequate analgesia. We hypothesized that ESPB would be
noninferior to TEA as a part of multimodal analgesia in pediatric patients
undergoing the Nuss procedure. Method(s): Patients aged 7-18 years
and scheduled for the Nuss procedure were randomly allocated to receive
bilateral single-shot ESPB or TEA and a multimodal analgesic regimen
including parent-controlled intravenous analgesia (PCIA). At 6 h, 12 h, 18
h, and 24 h postoperatively, pain was evaluated using the numeric rating
scale (NRS) and opioid consumption was assessed by counting the number of
PCIA boluses. The joint primary outcomes were the average pain score and
opioid consumption at 24 h after surgery. The secondary outcomes were the
NRS scores and the number of opioid boluses administered at different
postoperative time points, adverse events, and recovery quality.
 Result(s): Three hundred patients underwent randomization, and 286
received ESPB (147 patients) or TEA (139 patients). At 24 h
postoperatively, ESPB was noninferior to TEA in terms of the average NRS
score (mean difference, - 0.1, 95% confidence interval [CI], - 0.3-0.1,
margin = 1, P for noninferiority < 0.001) and the number of opioid boluses
administered (mean difference, - 1.1, 95% CI, - 2.8-0.6, margin = 7, P for
noninferiority < 0.001). Adverse events and patient recovery were
comparable between groups. Conclusion(s): The results demonstrate
that combined with a multimodal analgesia, ESPB provides noninferior
analgesia compared to TEA with respect to pain score and opioid
consumption among pediatric patients undergoing the Nuss
procedure. Copyright © The Author(s) under exclusive licence to
Japanese Society of Anesthesiologists 2024.

<51>
Accession Number
645298816
Title
Comparison of prewarming plus intraoperative warming with intraoperative
warming alone in patients undergoing minimally invasive thoracic or
abdominal surgery: A systematic review and meta-analysis.
Source
PloS one. 19(9) (pp e0310096), 2024. Date of Publication: 2024.
Author
Ding N.; Yang J.; Wu C.
Institution
(Ding, Wu) Operating Room, Ningbo Medical Center LiHuiLi Hospital, Ningbo,
Zhejiang, China
(Yang) Department of Cardiac Vascular Surgery, Ningbo Medical Center
LiHuiLi Hospital, Ningbo, Zhejiang, China
Abstract
OBJECTIVE: Prewarming has been recommended to reduce intraoperative
hypothermia. However, the evidence is unclear. This review examined if
prewarming can prevent intraoperative hypothermia in patients undergoing
thoracoscopic and laparoscopic surgeries. METHOD(S): PubMed, CENTRAL,
Web of Science, and Embase databases were searched for randomized
controlled trials (RCTs) up to 15th January 2024. The primary outcome of
interest was the difference in intraoperative core temperature. The
secondary outcomes were intraoperative hypothermia (<36degree) and
postoperative shivering. RESULT(S): Seven RCTs were eligible.
Meta-analysis showed that intraoperative core temperature was
significantly higher at the start or within 30mins of the start of the
surgery (MD: 0.32 95% CI: 0.15, 0.50 I2 = 94% p = 0.0003), 60 mins after
the start of the surgery (MD: 0.37 95% CI: 0.24, 0.50 I2 = 81% p<0.00001),
120 mins after the start of the surgery (MD: 0.34 95% CI: 0.12, 0.56 I2 =
88% p = 0.003), and at the end of the surgery (MD: 0.35 95% CI: 0.25, 0.45
I2 = 61% p<0.00001). The incidence of shivering was also significantly
lower in the prewarming group (OR: 0.18 95% CI: 0.08, 0.43 I2 = 0%).
Prewarming was also associated with a significant reduction in the risk of
hypothermia (OR: 0.20 95% CI: 0.10, 0.41 I2 = 0% p<0.0001). The certainty
of the evidence assessed by GRADE was "moderate" for intraoperative core
temperatures at all time points and "low" for minimal intraoperative core
temperature, shivering, and hypothermia. CONCLUSION(S): Moderate to
low-quality evidence shows that prewarming combined with intraoperative
warming, as compared to intraoperative warming alone, can improve
intraoperative temperature control and reduce the risk of hypothermia and
shivering in patients undergoing thoracoscopic and laparoscopic
procedures. Copyright: © 2024 Ding et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<52>
Accession Number
2034641870
Title
Effects of Serratus Anterior Plane Block on Early Recovery from
Thoracoscopic Lung Resection: A Randomized, Blinded, Placebo-Controlled
Trial.
Source
Anesthesiology. (no pagination), 2024. Date of Publication: 2024.
Author
Jackson J.C.; Tan K.S.; Pedoto A.; Park B.J.; Rusch V.W.; Jones D.R.;
Zhang H.; Desiderio D.; Fischer G.W.; Amar D.
Institution
(Jackson, Tan, Pedoto, Zhang, Desiderio, Fischer, Amar) Department of
Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer
Center, New York, NY, United States
(Jackson, Pedoto, Park, Rusch, Jones, Desiderio, Fischer, Amar) Weill
Cornell Medical College, New York, NY, United States
(Park, Rusch, Jones) Thoracic Service, Department of Surgery, Memorial
Sloan Kettering Cancer Center, New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The efficacy of serratus anterior plane block (SAPB) for
treatment of pain after minimally invasive thoracic surgery remains
unclear. This trial assesses the impact of SAPB on postoperative opioid
consumption and on measures of early recovery after thoracoscopic lung
resection. Method(s): Patients undergoing minimally invasive anatomic
lung resection at a single center were randomized to undergo SAPB with 40
mL of injectate containing bupivacaine 0.25%, clonidine 100 mcg, and
dexamethasone 4 mg (SAPB group) or sham block with 40 mL of normal saline
(placebo group) at the conclusion of surgery. The primary outcome was
cumulative intravenous morphine equivalents during the first 24 h
postoperatively. Secondary outcomes were intravenous morphine equivalents,
pain scores at rest and with cough, inspiratory volume on incentive
spirometry, and incidence of nausea/vomiting during the first 48 h
postoperatively; Quality of Recovery-15 score on postoperative day 7; and
length of stay. Result(s): Using the protocol-specified
intention-To-Treat analysis, the median (interquartile range, IQR)
intravenous morphine equivalents was 10.6 (5.0 to 27.1) mg in SAPB
patients (n=46) versus 18.8 (9.9 to 29.6) mg in placebo patients (n=46)
(32% reduction; ratio=0.68 [95% CI, 0.44 to 1.06]; P=0.085). Of the
secondary outcomes, only the composite pain with cough scores differed
significantly in the SAPB group by a coefficient of-0.41 (95% CI,-0.81
to-0.01; P=0.044). A sensitivity as-Treated analysis reported median (IQR)
intravenous morphine equivalents of 10.0 (5.0 to 27.2) mg in SAPB patients
(n=44) versus 19.9 (10.4 to 29.0) mg in placebo patients (n=48) (36%
reduction; ratio=0.64 [95% CI, 0.41 to 1.00]; P=0.048).
 Conclusion(s): The protocol-specified intention-To-Treat analysis
demonstrated that SAPB did not result in a significant reduction in opioid
consumption when added to a multimodal analgesic regimen after
thoracoscopic anatomic lung resection. The sensitivity as-Treated analysis
showed a significant and modest clinical reduction in the primary outcome
that warrants further investigation. Copyright © 2024 Lippincott
Williams and Wilkins. All rights reserved.

<53>
Accession Number
645306979
Title
Efficacy of Sternum Guard vs. bone wax in post-cardiac surgery patients: a
randomized controlled trial.
Source
The Journal of cardiovascular surgery. (no pagination), 2024. Date of
Publication: 18 Sep 2024.
Author
Hanafy D.A.; Muroso K.K.; Sugisman S.; Soetisna T.W.; Tjubandi A.; Wartono
D.A.; Herlambang B.; Busro P.W.
Institution
(Hanafy, Soetisna, Tjubandi, Wartono, Herlambang, Busro) Division of
Cardiac, Thoracic and Vascular Surgery, Faculty of Medicine, University of
Indonesia, Jakarta, Indonesia
(Hanafy, Sugisman, Soetisna, Tjubandi, Wartono, Herlambang) Division of
Adult Cardiac Surgery, National Cardiovascular Center Harapan Kita, West
Jakarta, Indonesia
(Muroso) Division of Cardiac, Thoracic and Vascular Surgery, Faculty of
Medicine, University of Indonesia, Jakarta, Indonesia
(Busro) Division of Pediatric and Congenital Heart Surgery, National
Cardiovascular Center, Jakarta, Indonesia
Abstract
BACKGROUND: Median sternotomy offers the main access during cardiac
surgery. However, a surgical site infection (SSI) of the sternum is a
distressing complication following this procedure. The incidence of
postoperative superficial and deep SSI in cardiac surgery varies from 1.3%
to 12.8%. Bone wax, a nonabsorbable substance applied as a mechanical
barrier following a median sternotomy, can increase the risk of
postoperative sternal dehiscence. Sternum Guard (Vygon, Ecouen, France), a
sternal protection device used to cover the sternum after a median
sternotomy, offers mechanical protection to prevent lesions on the
sternum. The aim of this study was to compare the effectiveness of Sternum
Guard (Vygon) and bone wax in reducing SSI and facilitating hemostasis in
post-cardiac surgery patients. METHOD(S): This single-blinded, single
center randomized controlled trial comprised 414 adult patients who
underwent cardiac surgery. The postoperative outcomes assessed were SSI
and the quantity of blood lost from the sternal edges in the Sternum Guard
(Vygon; treatment) and bone wax (control) groups. RESULT(S): The
superficial SSI prevalence in the Sternum Guard group was lower than that
in the bone wax group (2.9% vs. 8.2%, respectively; P=0.018). The
incidence of deep SSI was also lower in the Sternum Guard group (1%)
compared to the control group (2.9%) although this was not statistically
significant (P=0.284). In terms of intraoperative sternal bleeding,
Sternum Guard (Vygon) absorbed more than the sterile drapes used in the
control group (84.97+/-115.99 vs. 81.18+/-14.62, respectively; P=0.012).
 CONCLUSION(S): Sternum Guard (Vygon) had a significantly lower
incidence of postoperative infection and bleeding from the sternum
compared to bone wax.

<54>
Accession Number
645306202
Title
Antegrade Approach versus Retrograde Approach Percutaneous Coronary
Intervention for Chronic Total Occlusion: An updated Meta-Analysis.
Source
Current problems in cardiology. (pp 102832), 2024. Date of Publication:
16 Sep 2024.
Author
Abdelaziz A.; Hafez A.; Atta K.; Elsayed H.; Elaraby A.; Ibrahim A.A.;
Gadelmawla A.F.; Helmi A.; Abdelazeem B.; Lavie C.J.; Tafur-Soto J.
Institution
(Abdelaziz, Hafez, Elaraby) Medical Research Group of Egypt (MRGE), Negida
Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University,
Cairo, Egypt
(Atta) Medical Research Group of Egypt (MRGE), Negida Academy, Arlington,
MA, USA; Institute of Medicine, National Research Mordovia State
University, Saransk, Russia
(Elsayed) Medical Research Group of Egypt (MRGE), Negida Academy,
Arlington, MA, USA; Faculty of Medicine, Zagazig University, Zagazig,
Egypt
(Ibrahim, Gadelmawla) Medical Research Group of Egypt (MRGE), Negida
Academy, Arlington, MA, USA; Faculty of Medicine, Menoufia University,
Menoufia, Egypt
(Helmi) Medical Research Group of Egypt (MRGE), Negida Academy, Arlington,
MA, USA; Faculty of Medicine, Alexandria University, Alexandria, Egypt
(Abdelazeem) Medical Research Group of Egypt (MRGE), Negida Academy,
Arlington, MA, USA; Department of Cardiology, West Virginia University,
Morgantown, West Virginia, USA
(Lavie) John Ochsner Heart and Vascular Institute, Department of
Cardiovascular Diseases, Ochsner Clinical School, University of Queensland
School of Medicine, New Orleans, LA, United States
(Tafur-Soto) John Ochsner Heart and Vascular Institute, Department of
Cardiovascular Diseases, Ochsner Clinical School, University of Queensland
School of Medicine, New Orleans, LA, United States
Abstract
BACKGROUND: Retrograde approach has notably improved success rates of
chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
However, longer procedural time, increase use of fluoroscopy and contrast
dye have been reported in retrograde techniques in CTO PCI. We aimed to
study in-hospital and long-term outcomes of retrograde approach versus
antegrade approach in CTO PCI. METHOD(S): We searched PubMed, Scopus,
WOS, and Cochrane Central until June, 2023 to include all relevant studies
that compared retrograde approach versus antegrade approach in patients
with CTO PCI. We synthesized the outcome data using a random-effects
model, expressing the effect estimates as odds ratios (OR) or mean
difference (MD) with corresponding 95% confidence intervals (CI).
 RESULT(S): A total of 18 studies comprising 18,830 patients were
included in the analysis. Regarding in-hospital outcomes, antegrade
approach was associated with lower odds of MACE (OR= 0.34, 95% CI: 0.23 to
0.51), all-cause mortality (OR= 0.35, 95% CI: 0.19 to 0.64), MI (OR= 0.36,
95% CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95% CI: 0.16
to 0.46), CIN (OR= 0.46, 95% CI: 0.33 to 0.65), procedural complications
(OR= 0.52, 95% CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95%
CI: 0.32 to 0.64). while antegrade was associated with higher success
rates (OR= 1.16, 95% CI: 1.1 to 1.22). CONCLUSION(S): Compared to
antegrade technique, retrograde was associated with higher risk for
in-hospital and long-term adverse events, and preferably should be
performed in more complex CTO lesions. Copyright © 2024.
Published by Elsevier Inc.

<55>
Accession Number
645299542
Title
The effect of eye mask on sleep quality and pain in patients undergoing
coronary artery bypass graft surgery: A double-blind randomized controlled
trial.
Source
Nursing in critical care. (no pagination), 2024. Date of Publication: 16
Sep 2024.
Author
Dagcan Sahin N.; Nal B.; Gurol Arslan G.; Astarcioglu M.A.; Parlar A.I.
Institution
(Dagcan Sahin, Nal) Faculty of Health Sciences, Kutahya Health Sciences
University, Kutahya, Turkey
(Gurol Arslan) Fundamentals of Nursing Department, Nursing Faculty, Dokuz
Eylul University, Izmir, Turkey
(Astarcioglu) Department of Cardiology, Kutahya Health Science University,
Kutahya, Turkey
(Parlar) Department of Cardiovascular Surgery, Kutahya Health Science
University, Kutahya, Turkey
Abstract
BACKGROUND: Pain is one of the common postoperative issues that impair
recovery and quality of life in patients undergoing coronary artery bypass
graft (CABG) surgery. It leads to prolonged recovery and sleep
disturbances in patients. AIM: This study was conducted to examine the
effect of eye mask use on sleep quality and pain in patients undergoing
CABG surgery. STUDY DESIGN: A double-blind randomized trial design was
employed. The study included 60 patients undergoing CABG surgery. They
were divided into intervention and control groups through block
randomization. Data were collected using a 'Demographic Characteristics
Form', the 'Richards-Campbell Sleep Questionnaire (RCSQ)' and a 'Visual
Analogue Scale' (VAS) through face-to-face interviews. While patients in
the control group received standard care throughout the night, patients in
the intervention group received standard care and used eye mask. All
patients were followed up for three nights. The CONSORT was used to report
the study. RESULT(S): The main outcome of the study, the RCSQ score,
was higher in the intervention group at baseline. The intervention group
had higher RCSQ scores than the control group at time 1 and time 2. There
were no differences between the groups in the secondary outcome, pain
levels. The control group had higher pain scores at time 1 and time 2 than
the intervention group. CONCLUSION(S): The use of an eye mask after
CABG surgery is an effective, safe and simple nursing intervention to
improve sleep quality and control pain. RELEVANCE TO CLINICAL PRACTICE:
Because the use of an eye mask is an independent and unique nursing
intervention, nurses should be supported and allowed to practise
it. Copyright © 2024 The Author(s). Nursing in Critical Care
published by John Wiley & Sons Ltd on behalf of British Association of
Critical Care Nurses.

<56>
Accession Number
2025567479
Title
Long-term major adverse cardiovascular events following myocardial injury
after non-cardiac surgery: meta-analysis.
Source
BJS Open. 7(2) (no pagination), 2023. Article Number: zrad021. Date of
Publication: 01 Apr 2023.
Author
Strickland S.S.; Quintela E.M.; Wilson M.J.; Lee M.J.
Institution
(Strickland, Lee) Academic Directorate of General Surgery, Sheffield
Teaching Hospitals, Sheffield, United Kingdom
(Quintela, Wilson) Department of Anaesthesia, Sheffield Teaching
Hospitals, Sheffield, United Kingdom
(Quintela, Wilson) Centre for Urgent and Emergency Care Research, School
of Health and Related Research, University of Sheffield, Sheffield, United
Kingdom
(Lee) Department of Oncology and Metabolism, The Medical School,
University of Sheffield, Sheffield, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Myocardial injury after non-cardiac surgery is diagnosed
following asymptomatic troponin elevation in the perioperative interval.
Myocardial injury after non-cardiac surgery is associated with high
mortality rates and significant rates of major adverse cardiac events
within the first 30 days following surgery. However, less is known
regarding its impact on mortality and morbidity beyond this time. This
systematic review and meta-analysis aimed to establish the rates of
long-term morbidity and mortality associated with myocardial injury after
non-cardiac surgery. Method(s): MEDLINE, Embase and Cochrane CENTRAL
were searched, and abstracts screened by two reviewers. Observational
studies and control arms of trials, reporting mortality and cardiovascular
outcomes beyond 30 days in adult patients diagnosed with myocardial injury
after non-cardiac surgery, were included. Risk of bias was assessed using
the Quality in Prognostic Studies tool. A random-effects model was used
for the meta-analysis of outcome subgroups. Result(s): Searches
identified 40 studies. The meta-analysis of 37 cohort studies found a rate
of major adverse cardiac events-associated myocardial injury after
non-cardiac surgery of 21 per cent and mortality following myocardial
injury after non-cardiac surgery was 25 per cent at 1-year follow-up. A
non-linear increase in mortality rate was observed up to 1 year after
surgery. Major adverse cardiac event rates were also lower in elective
surgery compared with a subgroup including emergency cases. The analysis
demonstrated a wide variety of accepted myocardial injury after
non-cardiac surgery and major adverse cardiac events diagnostic criteria
within the included studies. Conclusion(s): A diagnosis of myocardial
injury after non-cardiac surgery is associated with high rates of poor
cardiovascular outcomes up to 1 year after surgery. Work is needed to
standardize diagnostic criteria and reporting of myocardial injury after
non-cardiac surgery-related outcomes. Registration: This review was
prospectively registered with PROSPERO in October 2021
(CRD42021283995). Copyright © 2023 The Author(s). Published by
Oxford University Press on behalf of BJS Society Ltd.

<57>
Accession Number
2034549428
Title
Incidence of High-Grade AV Block Requiring Permanent Pacemaker
Implantation After TTVR: A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 17(18) (pp 2195-2196), 2024. Date of
Publication: 23 Sep 2024.
Author
Gupta K.; Jain V.; Kakar T.S.; Nguyen F.; Rangavajla G.; Merchant F.M.;
Lahiri M.
Publisher
Elsevier Inc.

<58>
Accession Number
2034537774
Title
Treatment of sleep apnoea early after myocardial infarction with adaptive
servo-ventilation: a proof-of-concept randomised controlled trial.
Source
European Respiratory Journal. 64(3) (no pagination), 2024. Article Number:
2302338. Date of Publication: September 2024.
Author
Arzt M.; Fox H.; Stadler S.; Hetzenecker A.; Oldenburg O.; Hamer O.W.;
Poschenrieder F.; Wiest C.; Tanacli R.; Kelle S.; Bruch L.; Seidel M.;
Koller M.; Zeman F.; Buchner S.
Institution
(Arzt, Stadler, Hetzenecker, Wiest, Buchner) Department of Internal
Medicine II, University Hospital Regensburg, Regensburg, Germany
(Fox) Clinic for General and Interventional Cardiology, Angiology Heart
and Diabetes Center, NRW Ruhr University Bochum, Bad Oeynhausen, Germany
(Hetzenecker, Hamer, Poschenrieder) Center for Pneumology, Donaustauf
Hospital, Donaustauf, Germany
(Oldenburg) Center for Cardiology, Ludgerus-Kliniken, Munster, Germany
(Hamer, Poschenrieder) Department of Radiology, University Hospital
Regensburg, Regensburg, Germany
(Tanacli, Kelle) Department of Internal Medicine/Cardiology, German Heart
Center Berlin, Berlin, Germany
(Tanacli, Kelle) Department of Internal Medicine/Cardiology, Charite
Campus Virchow Klinikum, Berlin, Germany
(Kelle) DZHK (German Center for Cardiovascular Research), Partner Site
Berlin, Berlin, Germany
(Bruch, Seidel) Department of Internal Medicine, Unfallkrankenhaus Berlin,
Berlin, Germany
(Koller, Zeman) Center for Clinical Studies, University Hospital
Regensburg, Regensburg, Germany
(Buchner) Internal Medicine II - Cardiology, Sana Clinics of the District
of Cham, Cham, Germany
Publisher
European Respiratory Society
Abstract
Background Sleep disordered breathing (SDB) has been associated with less
myocardial salvage and smaller infarct size reduction after acute
myocardial infarction (AMI). The Treatment of sleep apnoea Early After
Myocardial infarction with Adaptive Servo-Ventilation (TEAM-ASV I) trial
investigated the effects of adding adaptive servo-ventilation (ASV) for
SDB to standard therapy on the myocardial salvage index (MSI) and change
in infarct size within 12 weeks after AMI. Methods In this multicentre,
randomised, open-label trial, patients with AMI and successful
percutaneous coronary intervention within 24 h after symptom onset plus
SDB (apnoea-hypopnoea index >=15 events.h-1) were randomised to
standard medical therapy alone (control) or plus ASV (starting 3.6+/-1.4
days post-AMI). The primary outcome was the MSI at 12 weeks post-AMI.
Cardiac magnetic resonance (CMR) imaging was performed at <=5 days and 12
weeks after AMI. Results 76 individuals were enrolled from February 2014
to August 2020; 39 had complete CMR data for analysis of the primary
end-point. The MSI was significantly higher in the ASV versus control
group (difference 14.6% (95% CI 0.14-29.1%); p=0.048). At 12 weeks,
absolute (6.6 (95% CI 4.8-8.5) versus 2.8 (95% CI 0.9-4.8) % of left
ventricular mass; p=0.003) and relative (44 (95% CI 30-57) versus 21 (95%
CI 6-35) % of baseline; p=0.013) reductions in infarct size were greater
in the ASV versus control group. No serious treatment-related adverse
events occurred. Conclusions Early treatment of SDB with ASV improved the
MSI and decreased infarct size at 12 weeks after AMI. Larger randomised
trials are required to confirm these findings. Copyright ©The
authors 2024.

<59>
Accession Number
2034620812
Title
Evaluating the precision of ultrasound versus computed tomography-guided
measurement of cricoid cartilage diameter for double-lumen tube selection
in thoracic surgery: A randomised comparative study.
Source
Indian Journal of Anaesthesia. 68(10) (pp 896-901), 2024. Date of
Publication: October 2024.
Author
Mathew R.M.; Gautam S.; Raman R.; Rai A.; Srivastava V.K.; Singh M.K.
Institution
(Mathew, Gautam, Raman, Srivastava, Singh) Department of Anaesthesiology,
King George's Medical University, Uttar Pradesh, Lucknow, India
(Rai) Department of Thoracic Surgery, King George's Medical University,
Uttar Pradesh, Lucknow, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Precise airway management is vital in thoracic
surgeries to ensure patient safety and optimal outcomes. Choosing the
correct double-lumen tube (DLT) size is challenging, as it typically
relies on height, gender and subjective experience. This study
investigates using ultrasonography (USG) and computed tomography (CT) to
measure cricoid cartilage diameter for objective DLT sizing.
 Method(s): In a randomised study, 120 adult patients undergoing
elective thoracic surgery were randomised to three groups: Group A (DLT
size determined by USG), Group B (DLT size determined by CT) and Group C
(DLT size determined by conventional methods based on height and gender).
The primary outcome variable was the appropriateness of DLT size.
Secondary outcome variables were the degree of lung collapse and sore
throat. Student's t-test and 2 test were used to analyse continuous and
dichotomous variables, respectively. Result(s): DLT sizing based on
cricoid cartilage diameter improved the accuracy, with inappropriate sizes
found in 25% in the conventional group, 5% in the USG group and 2.5% in
the CT group (P < 0.05). Lung collapse was better in the USG (excellent in
92.5%) and CT (95%) groups compared to the conventional group (70%) (P <
0.05). Moderate sore throat was higher in the conventional group (37.5%)
compared to the USG (5%) and CT groups (7.5%). Conclusion(s): The
study demonstrates that USG- and CT-guided measurements of cricoid
cartilage diameter are reliable and effective methods for determining DLT
size in thoracic surgery compared to conventional methods. Copyright
© 2024 Indian Journal of Anaesthesia.

<60>
Accession Number
2031267171
Title
Normothermic Regional Perfusion in Controlled Donation After Circulatory
Death Liver Transplantation: A Systematic Review and Meta-Analysis.
Source
Transplant International. 37 (no pagination), 2024. Article Number: 13263.
Date of Publication: 2024.
Author
Mastrovangelis C.; Frost C.; Hort A.; Laurence J.; Pang T.; Pleass H.
Institution
(Mastrovangelis, Frost, Hort, Laurence, Pang, Pleass) Westmead Clinical
School, Faculty of Medicine and Health, The University of Sydney, Sydney,
NSW, Australia
(Hort, Laurence, Pang, Pleass) Department of Surgery, Westmead Hospital,
Westmead, NSW, Australia
(Laurence, Pleass) Department of Surgery, Royal Prince Alfred Hospital,
Sydney, NSW, Australia
(Pang) Surgical Innovations Unit, Westmead Hospital, Westmead, NSW,
Australia
Publisher
Frontiers Media SA
Abstract
Liver grafts from controlled donation after circulatory death (cDCD)
donors have lower utilization rates due to inferior graft and patient
survival rates, largely attributable to the increased incidence of
ischemic cholangiopathy, when compared with grafts from brain dead donors
(DBD). Normothermic regional perfusion (NRP) may improve the quality of
cDCD livers to allow for expansion of the donor pool, helping to alleviate
the shortage of transplantable grafts. A systematic review and metanalysis
was conducted comparing NRP cDCD livers with both non-NRP cDCD livers and
DBD livers. In comparison to non-NRP cDCD outcomes, NRP cDCD grafts had
lower rates of ischemic cholangiopathy [RR = 0.23, 95% CI (0.11, 0.49), p
= 0.0002], primary non-function [RR = 0.51, 95% CI (0.27, 0.97), p =
0.04], and recipient death [HR = 0.5, 95% CI (0.36, 0.69), p < 0.0001].
There was no difference in outcomes between NRP cDCD donation compared to
DBD liver donation. In conclusion, NRP improved the quality of cDCD livers
compared to their non-NRP counterparts. NRP cDCD livers had similar
outcomes to DBD grafts. This provides further evidence supporting the
continued use of NRP in cDCD liver transplantation and offers weight to
proposals for its more widespread adoption. Copyright © 2024
Mastrovangelis, Frost, Hort, Laurence, Pang and Pleass.

<61>
Accession Number
2031067744
Title
Non-steroidal anti-inflammatory drugs and postoperative atrial
fibrillation in patients having non-cardiac surgery: a systematic review.
Source
Signa Vitae. 20(9) (pp 16-23), 2024. Date of Publication: September 2024.
Author
Ntalarizou N.; Papagiannakis N.; Laou E.; Ekmektzoglou K.; Iacovidou N.;
Xanthos T.; Chalkias A.
Institution
(Ntalarizou, Ekmektzoglou, Iacovidou) "Resuscitation", School of Medicine,
National and Kapodistrian University of Athens, Athens 11527, Greece
(Papagiannakis) First Department of Neurology, Eginition University
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens 11528, Greece
(Laou) Department of Anesthesiology, Agia Sophia Children's Hospital,
Athens 11527, Greece
(Ekmektzoglou) School of Medicine, European University Cyprus, Nicosia
2404, Cyprus
(Iacovidou) Department of Neonatology, "Aretaieio" Hospital, School of
Medicine, National and Kapodistrian University of Athens, Athens 11528,
Greece
(Xanthos) School of Health Sciences, University of West Attica, Athens
12243, Greece
(Chalkias) Institute for Translational Medicine and Therapeutics,
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
19104-5158, United States
(Chalkias) Outcomes Research Consortium, Cleveland, OH 44195, United
States
Publisher
Pharmamed Mado Ltd
Abstract
Increasing evidence suggests an association between non-steroidal
anti-inflammatory drugs (NSAIDs) and atrial fibrillation in the general
population. A systematic review was conducted to characterize the
association of perioperative NSAIDs with atrial fibrillation after
non-cardiac surgery (POAF). PubMed and Scopus were searched for relevant
studies. We excluded review articles, case studies, articles not published
in English, and animal studies. The primary objective was to investigate
the relationship between the perioperative use of NSAIDs and POAF during
the first 30 postoperative days (from the day of surgery), at hospital
discharge, and at 30 and 90 days after hospital discharge. Four studies
were identified, a pooled analysis of two randomized double-blind clinical
trials and three observational studies. A post-hoc sensitivity analysis
for acetylsalicylic acid (aspirin) vs. other NSAIDs revealed that the
former seems to decrease the incidence of POAF although non-significantly
(Relative Risk (RR) (95% Confidence Interval (CI)): 0.92 (0.81, 1.04) p =
0.165). After excluding acetylsalicylic acid from the analysis, NSAIDs
were associated with an increased risk of POAF development (RR (95% CI):
1.15 (1.07, 1.23) p < 0.001). In conclusion, perioperative administration
of non-aspirin NSAIDs may be associated with an increased risk of POAF
development. Further studies investigating the role of NSAIDs and the
potential protective role of aspirin in POAF are justified. Copyright
© 2024 The Author(s).

<62>
Accession Number
2030827301
Title
Clinical presentation and surgical outcomes in patients with Shone's
complex: a systematic review.
Source
General Thoracic and Cardiovascular Surgery. 72(10) (pp 621-640), 2024.
Date of Publication: October 2024.
Author
Ahmed H.S.; Jayaram P.R.; Gupta D.
Institution
(Ahmed, Jayaram, Gupta) Department of Medicine, Bangalore Medical College
and Research Institute, K.R Road, Karnataka, Bangalore 560002, India
Publisher
Springer
Abstract
Objective: Shone's complex comprises of a combination of congenital
cardiac anomalies causing obstructions in the left ventricle's inflow and
outflow tracts. This systematic review aims to evaluate the clinical
features and surgical outcomes of Shone's complex. Method(s): An
electronic literature search of PubMed and Scopus was performed to
identify relevant studies related to the presentation, management, and
outcomes of Shone's complex. Two reviewers independently performed
selection. Data on study characteristics, participant demographics,
interventions, outcomes, and follow-up durations were extracted and
analyzed. Result(s): A total of 691 papers were identified, with 18
studies included in the final analysis. The majority of the studies (n =
12) focused on the pediatric age group. The most common clinical
presentations were coarctation of the aorta (n = 17) and mitral stenosis
(n = 12). Surgical interventions often involved staged approaches,
prioritizing outflow before inflow obstructions. Mitral valve repair was
preferred over replacement due to better long-term outcomes (n = 8).
Biventricular repair was recommended due to improved postoperative
outcomes, but often needed reoperations. Reoperations were common,
primarily due to recurrent coarctation (n = 10), subaortic stenosis (n =
8), and mitral valve dysfunction (n = 7). Pulmonary hypertension (n = 10)
and arrhythmias (n = 11) were significant complications. Most patients
were in modified Ross/NYHA functional class 1 on follow-up. Mortality
rates ranged from 4 to 28%, with better outcomes associated with early and
strategic surgical interventions. Conclusion(s): Early diagnosis and
biventricular repair were associated with better outcomes while
transplantation was often an eventuality. Standardized diagnostic
criteria, long-term follow-up, and consensus guidelines are needed to
improve the management of this congenital heart disease. Copyright
© The Author(s), under exclusive licence to The Japanese Association
for Thoracic Surgery 2024.

<63>
Accession Number
2028991774
Title
Effect of preoperative vitamin D on postoperative atrial fibrillation
incidence after coronary artery bypass grafting.
Source
General Thoracic and Cardiovascular Surgery. 72(10) (pp 649-655), 2024.
Date of Publication: October 2024.
Author
Alirezaei T.; Ansari Aval Z.; Karamian A.; Hayati A.
Institution
(Alirezaei) Cardiology Department of Shohaday-e-Tajrish Hospital, Shahid
Behesti University of Medical Science, Tehran, Iran, Islamic Republic of
(Ansari Aval) Cardiovascular Research Center, Shahid Beheshti University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Karamian) School of Medicine, Lorestan University of Medical Sciences,
Khorramabad, Iran, Islamic Republic of
(Hayati) School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Springer
Abstract
Background: Post-operative atrial fibrillation (POAF) is associated with
adverse long-term cardiovascular events. Objective(s): This study
investigated the effects of a high-dose vitamin D administered
preoperatively on the postoperative atrial fibrillation (POAF) incidence
in patients with vitamin D deficiency following coronary artery bypass
grafting (CABG) surgery. Method(s): This randomized controlled
clinical trial was conducted on 246 CABG patients with vitamin D
deficiency. All patients were randomly divided into intervention and
control groups including 123 cases for each group. In the intervention
group, from 3 days before surgery, they received a daily dose of 150,000
units of vitamin D orally (50,000 units of Vit D tablet three times a day)
and the patients in the control group received placebo tablets before
surgery. All patients in the intervention group were assessed continuously
for the occurrence of POAF during the recovery period. Result(s): In
terms of gender, age, and BMI there were no significant differences
between intervention and control groups. Our findings showed that the use
of vitamin D supplements did not cause a significant change in the
duration of intubation and hospitalization. The ratio of POAF following
CABG surgery in the control and treatment groups was 26% and 11.4%,
respectively (odds ratio = 0.36; 95% CI = 0.18-0.72; P = 0.003).
 Conclusion(s): Our findings revealed that high-dose vitamin D
supplementation before CABG surgery significantly reduced the incidence of
POAF. Further multicenter randomized trials with larger sample sizes are
certainly warranted to confirm our results. Copyright © The
Author(s), under exclusive licence to The Japanese Association for
Thoracic Surgery 2024.

<64>
[Use Link to view the full text]
Accession Number
2034521847
Title
Cost and cost-effectiveness of treatments for rheumatic heart disease in
low-and middle-income countries: A systematic review protocol.
Source
JBI Evidence Synthesis. 22(9) (pp 1886-1897), 2024. Date of Publication:
27 Jun 2024.
Author
Thangamma Ag M.A.; Vidyadharan B.; Daniel R.P.; Sirur A.; Kumar P.; Thunga
P.G.; Gopal Poojari P.; Rashid M.; Mukherjee N.; Bhattacharya P.; John D.
Institution
(Thangamma Ag, Vidyadharan, Daniel, Sirur, Kumar, Thunga) Department of
Commerce, Manipal Academy of Higher Education, Karnataka, Manipal, India
(Gopal Poojari, Rashid, Mukherjee) Department of Pharmacy Practice,
Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher
Education, Karnataka, Manipal, India
(Bhattacharya, John) Evidence Synthesis and Implementation for Indigenous
Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum
Ananda, Ashram Nityananda Trust (MANT), West Bengal, Kolkata, India
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: This review will synthesize studies on costs, the impact of
these costs, and the cost-effectiveness of treatments for rheumatic heart
disease (RHD) in low-and middle-income countries. Introduction: RHD incurs
high costs owing to its clinical complexity, surgical treatments, and
prolonged hospital stays. Thus, the disease has a substantial economic
impact on the health system, patients, and their families. No systematic
review on economic evidence of treatments for RHD has been published to
date. Inclusion criteria: This review will consider all cost and
cost-effectiveness studies on RHD treatments for children and young adults
(5-30 years) residing in low-and middle-income countries. Method(s):
The review will follow the JBI methodology for systematic reviews of
economic evaluation evidence. The search strategy will locate published
and unpublished studies in English. Systematic searches will be conducted
in MEDLINE (PubMed), MEDLINE (Ovid), Embase (Ovid), Scopus, CINAHL
(EBSCOhost), National Health Service Economic Evaluation Databases,
Pediatric Economic Database Evaluation, and Cost-Effectiveness Analysis
Registry. Two independent reviewers will screen titles and abstracts,
followed by a full-Text review based on the inclusion criteria. Data will
be extracted using a modified JBI data extraction form for economic
evaluations. JBI's Dominance Ranking Matrix for economic evaluations will
be used to summarize and compare the results of cost and
cost-effectiveness studies. The Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) approach will be used to assess the
certainty of economic evidence for outcomes related to resource use.
Review registration: PROSPERO CRD42023425850. Copyright © 2024
JBI.

<65>
Accession Number
2034254213
Title
Percutaneous Versus Surgical Cutdown Access for Transfemoral Transcatheter
Aortic Valve Implantation: A Systematic Review and Meta-Analysis Focusing
on Propensity-Score Matched Studies.
Source
Heart Lung and Circulation. 33(10) (pp 1393-1403), 2024. Date of
Publication: October 2024.
Author
Riaz S.; Kasam Shiva P.K.; Manimekalai Krishnamurthi J.S.; Shah R.S.;
Cherukuri A.M.K.; Bhatia P.; Arul S.; Multani M.; Singh A.; Suyambu J.;
Asif K.; Al-Tawil M.
Institution
(Riaz) Department of Medicine, Allama Iqbal Medical College, Lahore,
Pakistan
(Kasam Shiva) Bangalore Medical College and Research Institute, Bangalore,
India
(Manimekalai Krishnamurthi) Department of Medicine, Madras Medical
College, Chennai, India
(Shah) Department of Medicine, G.M.E.R.S. Medical College, Gandhinagar,
India
(Cherukuri) Department of Medicine, Guntur Medical College, Guntur, India
(Bhatia) Seth GS Medical College and KEM Hospital, Mumbai, India
(Arul, Suyambu) University of Perpetual Help System DALTA Jonelta
Foundation School of Medicine, Manila, Philippines
(Multani) Adesh Institute of Medical Sciences and Research, Punjab, India
(Singh) Government Medical College and Hospital, Chandigarh, India
(Asif) Department of Medicine, Dr. Ruth K. M. Pfau Civil Hospital Karachi,
Karachi, Pakistan
(Al-Tawil) Faculty of Medicine, Al-Quds University Jerusalem, Palestine,
Palestine
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
a potential alternative for aortic valve surgery to treat aortic valve
stenosis. There is limited evidence on the comparative outcomes of TAVI
access approaches, specifically the percutaneous (PC) vs surgical cutdown
(SC) approach. This study aimed to assess the short-term outcomes in
patients undergoing PC vs SC access for transfemoral transcatheter aortic
valve replacement. Method(s): PubMed, SCOPUS, and EMBASE were
searched to identify relevant studies. The primary outcomes were
short-term all-cause mortality, bleeding, vascular complications, and
length of in-hospital stay for patients who underwent transfemoral TAVI.
Both matched and unmatched observational studies were included and
subgroup analyses were performed. This systematic review and meta-analysis
was performed in line with the PRISMA guidelines. Result(s): Fifteen
observational studies involving 7,545 patients (3,033 underwent the PC
approach and 2,466 underwent the SC approach) were included. There were no
clinically significant between-group differences in short-term mortality,
bleeding, length of in-hospital stay, or major vascular complications.
However, minor vascular complications were significantly higher in
patients who underwent PC-TAVI (p=0.007). In the matched subgroup, all
outcomes were comparable between both groups, with the largest difference
being observed in minor vascular complications more frequently occurring
in the PC group (p=0.08). Conclusion(s): The evidence shows that
outcomes were comparable between the two methods of access, rendering both
the PC and SC approaches equally effective for transfemoral TAVI. However,
it is worth noting that minor vascular complications were more pronounced
in the PC group. Copyright © 2024 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<66>
Accession Number
2031493530
Title
Outcomes of mitral valve transcatheter edge-to-edge repair for patients
with hemodynamic instability: A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 67 (pp 19-28), 2024. Date of
Publication: October 2024.
Author
Yokoyama H.; Kokawa T.; Shigekiyo S.; Seno A.; Izumi T.; Ogura R.; Mahara
K.; Hosokawa S.
Institution
(Yokoyama, Kokawa, Shigekiyo, Seno, Izumi, Ogura, Mahara, Hosokawa)
Tokushima Red Cross Hospital, Tokushima, Japan
Publisher
Elsevier Inc.
Abstract
Background: The outcomes after mitral valve transcatheter edge-to-edge
repair (M-TEER) for the patients with severe mitral regurgitation (MR) in
hemodynamically unstable conditions, such as cardiogenic shock, still
remain unclear. We aimed to integrate previous publications regarding
M-TEER indicated for life-threatening conditions and indirectly
particularly compared the short-term outcomes thereof, with that of other
treatments. Method(s): We systematically searched the PubMed,
Cochrane, and MEDLINE databases for studies from inception to June 2023,
regarding M-TEER in patients with hemodynamic instability and severe MR.
The primary outcomes analyzed included the in-hospital and 30-day
mortality rates, and peri-procedural complications. Result(s): Of the
initial 820 publications, we conducted a meta-analysis of a total of 25
studies. The relative risk of moderate-to-severe or severe MR was 0.13 (95
% confidence interval [CI]: 0.10-0.18, I2 = 45.2 %). The pooled
in-hospital and 30-day mortality rates were 11.8 % (95 % CI: 8.7-15.9,
I2 = 96.4 %) and 14.1 % (95 % CI: 10.9-18.3, I2 =
35.5 %), respectively. The 30-day mortality rate was statistically
significantly correlated with the residual moderate-to-severe or severe
MR, as per the meta-regression analysis (coefficient beta = 3.48 [95 % CI:
0.99-5.97], p = 0.006). Regarding peri-procedural complications, the
pooled rates of a stroke or transient ischemic attack, life-threatening or
major bleeding, acute kidney injury, and peri-procedural mitral valve
surgery were 2.3 % (95 % CI: 1.9-2.6), 7.6 % (95 % CI: 6.8-8.5), 32.9 %
(95 % CI: 31.6-34.3), and 1.0 % (95 % CI: 0.8-1.3), respectively.
 Conclusion(s): This meta-analysis demonstrates that the relatively
higher rates of procedural complications were observed, nevertheless,
M-TEER can potentially provide favorable short-term outcomes even in
hemodynamically unstable patients. PROSPERO registration number:
CRD42023468946. Copyright © 2024 The Authors

<67>
Accession Number
2031418487
Title
Remifentanil vs. dexmedetomidine for cardiac surgery patients with
noninvasive ventilation intolerance: a multicenter randomized controlled
trial.
Source
Journal of Intensive Care. 12(1) (no pagination), 2024. Article Number:
35. Date of Publication: December 2024.
Author
Hao G.-W.; Wu J.-Q.; Yu S.-J.; Liu K.; Xue Y.; Gong Q.; Xie R.-C.; Ma
G.-G.; Su Y.; Hou J.-Y.; zhang Y.-J.; Liu W.-J.; Li W.; Tu G.-W.; Luo Z.
Institution
(Hao, Ma, Su, Hou, zhang, Liu, Tu, Luo) Department of Cardiac Intensive
Care Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
(Wu, Xue) Department of Nursing, Zhongshan Hospital, Fudan University,
Shanghai 200032, China
(Yu, Liu) Department of Critical Care Medicine, Zhongshan Hospital, Fudan
University, Shanghai 200032, China
(Gong) Department of Cardiovascular Surgery, The First Affiliated Hospital
of Anhui Medical University, Anhui, Hefei 230032, China
(Xie) Department of Critical Care Medicine, Xiamen Branch, Zhongshan
Hospital, Fudan University, Fujian, Xiamen 361015, China
(Li) Department of Intensive Care Unit, The People's Hospital of Fujian
Traditional Medical University, Fujian, Fuzhou 350004, China
(Luo) Department of Critical Care Medicine, Shanghai Xuhui Central
Hospital, Zhongshan Xuhui Hospital, Fudan University, Shanghai 200020,
China
(Luo) Shanghai Key Lab of Pulmonary Inflammation and Injury, Zhongshan
Hospital, Fudan University, Shanghai 200032, China
Publisher
BioMed Central Ltd
Abstract
Background: The optimal sedative regime for noninvasive ventilation (NIV)
intolerance remains uncertain. The present study aimed to assess the
efficacy and safety of remifentanil (REM) compared to dexmedetomidine
(DEX) in cardiac surgery patients with moderate-to-severe intolerance to
NIV. Method(s): In this multicenter, prospective, single-blind,
randomized controlled study, adult cardiac surgery patients with
moderate-to-severe intolerance to NIV were enrolled and randomly assigned
to be treated with either REM or DEX for sedation. The status of NIV
intolerance was evaluated using a four-point NIV intolerance score at
different timepoints within a 72-h period. The primary outcome was the
mitigation rate of NIV intolerance following sedation. Result(s): A
total of 179 patients were enrolled, with 89 assigned to the REM group and
90 to the DEX group. Baseline characteristics were comparable between the
two groups, including NIV intolerance score [3, interquartile range (IQR)
3-3 vs. 3, IQR 3-4, p = 0.180]. The chi-squared test showed that
mitigation rate, defined as the proportion of patients who were relieved
from their initial intolerance status, was not significant at most
timepoints, except for the 15-min timepoint (42% vs. 20%, p = 0.002).
However, after considering the time factor, generalized estimating
equations showed that the difference was statistically significant, and
REM outperformed DEX (odds ratio = 3.31, 95% confidence interval:
1.35-8.12, p = 0.009). Adverse effects, which were not reported in the REM
group, were encountered by nine patients in the DEX group, with three
instances of bradycardia and six cases of severe hypotension. Secondary
outcomes, including NIV failure (5.6% vs. 7.8%, p = 0.564), tracheostomy
(1.12% vs. 0%, p = 0.313), ICU LOS (7.7 days, IQR 5.8-12 days vs. 7.0
days, IQR 5-10.6 days, p = 0.219), and in-hospital mortality (1.12% vs.
2.22%, p = 0.567), demonstrated comparability between the two groups.
 Conclusion(s): In summary, our study demonstrated no significant
difference between REM and DEX in the percentage of patients who achieved
mitigation among cardiac surgery patients with moderate-to-severe NIV
intolerance. However, after considering the time factor, REM was
significantly superior to DEX. Trial registration ClinicalTrials.gov
(NCT04734418), registered on January 22, 2021. URL of the trial registry
record:
https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000
AM4S&selectaction=Edit&uid=U00038YX&ts=3&cx=eqn1z0. Copyright ©
The Author(s) 2024.

<68>
Accession Number
2031389965
Title
Effect of Perioperative Active Warming on Postoperative Pain and Shivering
in Preschool Pediatric Patients: A Randomized Controlled Trial.
Source
Indian Pediatrics. 61(9) (pp 829-834), 2024. Date of Publication:
September 2024.
Author
Ciftci C.; Kara I.; Buyukcavlak M.; Aslanlar E.
Institution
(Ciftci, Buyukcavlak) Department of Anesthesiology and Reanimation, Konya
City Hospital, University of Health Sciences, Akabe mah. Adana Cevre Yolu
Cd. 135/1, Karatay, Konya 42020, Turkey
(Ciftci, Kara, Aslanlar) Department of Anesthesiology and Reanimation,
Faculty of Medicine, Selcuk University, Selcuklu, Konya, Turkey
Publisher
Springer
Abstract
Objective: To evaluate the effects of perioperative active warming on the
core body temperature, postoperative pain, shivering and agitation in
pediatric patients. Method(s): Children aged 2-6 years undergoing
elective surgery, including orthopedic soft tissue surgeries, ear nose
throat surgical procedures and general surgical interventions, all
performed under general anesthesia, were randomized to receive either
active warming (using the forced-air warming gowns, Bair Hugger, in the
pre- and postoperative period, and a carbon fiber blanket in
intraoperative period; Group A), or conventional warming using green
blankets pre-and post-operatively and a carbon fiber blanket
intraoperatively (Group B). Children undergoing emergency surgery,
surgeries involving major body cavities (abdominal, thoracic, cranial
surgery), or those with endocrinological pathologies, or baseline fever,
were excluded. Core body temperature (t-core), postoperative pain,
shivering and agitation scores were compared between the two groups.
 Result(s): Seventy children were included, with 35 in each group. No
significant difference was observed between the groups in t-core values at
0 and 15 minutes preoperatively (P > 0.05). However, the value at 30
minutes preoperatively and all subsequent t-core values were higher in
Group A (P < 0.001). Postoperative pain and shivering scores at 0 minutes,
30 minutes and 6 hours were significantly lower in Group A compared to
Group B. No significant difference was observed in agitation scores in the
immediate postoperative period, although, Group A showed reduced agitation
at 30 minutes (P = 0.03). Conclusion(s): Active warming in the pre-
and post-operative period significantly maintained higher core
temperatures and reduced postoperative pain and shivering in children
undergoing surgery compared to those receiving conventional passive
warming measures in the pre- and post-operative period. Copyright
© Indian Academy of Pediatrics 2024.

<69>
Accession Number
2031355327
Title
A multicomponent personalized prevention program in the primary care
setting: a randomized clinical trial in older people with noncommunicable
chronic diseases (Primacare_P3 study).
Source
Trials. 25(1) (no pagination), 2024. Article Number: 611. Date of
Publication: December 2024.
Author
Pilotto A.; Barbagelata M.; Lacorte E.; Custodero C.; Veronese N.; Maione
V.; Morganti W.; Seminerio E.; Piscopo P.; Fabrizi E.; Lorenzini P.;
Carbone E.; Lora Aprile P.; Solfrizzi V.; Barbagallo M.; Vanacore N.;
Della Gatta F.; Conti L.; Fortini P.; Crestini A.; Rivabene R.; Di Vendra
S.; Nikolic D.; Paparella R.R.; Mazzocca A.; Berutti-Bergotto C.; De
Benedetto M.; Gresonti M.; Canepa S.; Argusti A.; Massone C.; Ferri A.;
Pettenati M.
Institution
(Pilotto, Barbagelata, Maione, Morganti, Seminerio) Geriatrics Unit,
Department of Geriatric Care, Neurology and Rehabilitation, E.O. Galliera
Hospital, Genoa, Italy
(Lacorte, Fabrizi, Lorenzini, Vanacore) National Center for Disease
Prevention and Health Promotion, Italian National Institute of Health,
Rome 00161, Italy
(Pilotto, Custodero, Carbone, Solfrizzi) Department of Interdisciplinary
Medicine, University of Bari "Aldo Moro", Bari, Italy
(Veronese, Barbagallo) Geriatrics Unit, Department of Internal Medicine
and Geriatrics, University of Palermo, Palermo, Italy
(Piscopo, Carbone) Department of Neuroscience, Italian National Institute
of Health, Rome 00161, Italy
(Lora Aprile) Italian College of General Practitioners and Primary Care,
Florence, Italy
Publisher
BioMed Central Ltd
Abstract
Background: Multicomponent interventions based on a comprehensive
geriatric assessment (CGA) could promote active aging and improve health
status in older people with Noncommunicable Chronic Diseases (NCDs), but
conflicting evidences are available. Aim(s): To evaluate the efficacy
of a CGA-based multicomponent personalized preventive program (PPP) in
reducing unplanned hospitalization rates during 12-month follow-up in
community-dwelling older people with NCDs. Material(s) and Method(s):
In this randomized clinical trial (RCT), 1216 older adults recruited by 33
general practitioners (GPs) will be randomly allocated to intervention
group (IG) or usual care control group (CG). The IG will receive a
multicomponent PPP developed on the findings of the CGA-based
Multidimensional Prognostic Index short-form (Brief-MPI), including
structured interventions to improve functional, physical, cognitive, and
nutritional status, to monitor NCDs and vaccinations, and to prevent
social isolation. Participants in the CG will receive usual care.
Brief-MPI, resilience, and health-related quality of life will be assessed
after 6 and 12 months. Moreover, saliva samples will be collected at
baseline in IG to measure biomarkers of oxidative stress, inflammatory
cytokines, and oral microbiome. Expected results: The CGA-based PPP might
reduce unplanned hospitalization rates and potentially
institutionalization rates, emergency department (ED) and unplanned GP
visits, and mortality. Further outcomes explored in the IG will be the
adherence to PPP, resilience, health-related quality of life, and
multidimensional frailty as assessed by the Brief-MPI. Conclusion(s):
Results will suggest whether the CGA-based multicomponent PPP is able to
improve specific outcomes in a primary care setting. Trial registration:
ClinicalTrials.gov; identifier: NCT06224556; Registered January 25,
2024. Copyright © The Author(s) 2024.

<70>
Accession Number
2031344160
Title
A Comparison of Conventional Rotating Method and Non-Rotating Method for
Double-Lumen Tube Insertion Using a Customized Rigid J-Shaped Stylet for
One-Lung Ventilation: A Randomized Controlled Trial.
Source
Journal of Clinical Medicine. 13(17) (no pagination), 2024. Article
Number: 5302. Date of Publication: September 2024.
Author
Lee S.; Han S.J.; Park J.; Kim Y.-H.; Hong B.; Oh C.; Yoon S.-H.
Institution
(Lee, Kim, Hong, Oh, Yoon) Department of Anesthesiology and Pain Medicine,
Chungnam National University Hospital, Daejeon 35015, South Korea
(Lee, Park, Kim, Hong, Oh, Yoon) Department of Anesthesiology and Pain
Medicine, College of Medicine, Chungnam National University, Daejeon
35015, South Korea
(Han) Department of Thoracic and Cardiovascular Surgery, College of
Medicine, Chungnam National University Hospital, Daejeon 35015, South
Korea
(Park) Department of Anesthesiology and Pain Medicine, Sejong Chungnam
National University Hospital, Sejong 30099, South Korea
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: The conventional double-lumen tube (DLT) insertion method
requires a rotatory maneuver that was developed using direct laryngoscopy
and may not be optimal for video laryngoscopy. This study compared a new
non-rotatory maneuver with the conventional method for DLT insertion using
video laryngoscopy. Method(s): Patients scheduled for thoracic
surgery requiring one-lung ventilation were randomly assigned to either
the rotating (R) or non-rotating (NR) method groups. All patients were
intubated using a customized rigid J-shaped stylet, a video laryngoscope,
and a left-sided silicone DLT. The conventional rotatory maneuver was
performed in the R group. In the NR group, the stylet was inserted with
its tip oriented anteriorly (12 o'clock direction) while maintaining the
bronchial lumen towards the left (9 o'clock direction). After reaching the
glottic opening, the tube was inserted using a non-rotatory maneuver,
maintaining the initial orientation. The primary endpoint was the
intubation time. Secondary endpoints included first-trial success rate,
sore throat, hoarseness, and airway injury. Result(s): Ninety
patients (forty-five in each group) were included. The intubation time was
significantly shorter in the NR group compared to the R group (22.0 [17.0,
30.0] s vs. 28.0 [22.0, 34.0] s, respectively), with a median difference
of 6 s (95% confidence interval [CI], 3-11 s; p = 0.017). The NR group had
a higher first-attempt success rate and a lower incidence of sore throats.
 Conclusion(s): The non-rotatory technique with video laryngoscopy
significantly reduced intubation time and improved first-attempt success
rate, offering a viable and potentially superior alternative to the
conventional rotatory technique. Copyright © 2024 by the authors.

<71>
Accession Number
2031340517
Title
Radial Artery Spasm-A Review on Incidence, Prevention and Treatment.
Source
Diagnostics. 14(17) (no pagination), 2024. Article Number: 1897. Date of
Publication: September 2024.
Author
Zus A.S.; Crisan S.; Luca S.; Nisulescu D.; Valcovici M.; Patru O.; Lazar
M.-A.; Vacarescu C.; Gaita D.; Luca C.-T.
Institution
(Zus, Crisan, Luca, Valcovici, Patru, Lazar, Vacarescu, Gaita, Luca)
Cardiology Department, "Victor Babes" University of Medicine and Pharmacy,
2 Eftimie Murgu Sq., Timisoara 300041, Romania
(Zus, Crisan, Luca, Nisulescu, Valcovici, Lazar, Vacarescu, Gaita, Luca)
Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street,
Timisoara 300310, Romania
(Zus, Crisan, Luca, Nisulescu, Valcovici, Patru, Lazar, Vacarescu, Gaita,
Luca) Research Center of the Institute of Cardiovascular Diseases
Timisoara, 13A Gheorghe Adam Street, Timisoara 300310, Romania
(Nisulescu) Department of Histology, Faculty of Medicine, Vasile Goldis
Western University of Arad, Arad 310025, Romania
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Radial artery spasm (RAS) is a common complication associated with
transradial access (TRA) for coronary interventions, particularly
affecting elderly patients in whom radial access is preferred due to its
benefits in reducing bleeding complications, improving clinical outcomes,
and lowering long-term costs. This review examines the incidence,
prevention, and treatment of RAS. Methods included an online search of
PubMed and other databases in early 2024, analyzing meta-analyses,
reviews, studies, and case reports. RAS is characterized by a sudden
narrowing of the radial artery due to psychological and mechanical factors
with incidence reports varying up to 51.3%. Key risk factors include
patient characteristics like female sex, age, and small body size as well
as procedural factors such as emergency procedures and the use of multiple
catheters. Preventive measures include using distal radial access,
hydrophilic sheaths, and appropriate catheter sizes. Treatments involve
the intraarterial administration of nitroglycerine and verapamil as well
as mechanical methods like balloon-assisted tracking. This review
underscores the need for standardizing RAS definitions and emphasizes the
importance of operator experience and patient management in reducing RAS
incidence and improving procedural success. Copyright © 2024 by
the authors.

<72>
Accession Number
2031340265
Title
Influence of Anesthetic Regimes on Extracellular Vesicles following Remote
Ischemic Preconditioning in Coronary Artery Disease.
Source
International Journal of Molecular Sciences. 25(17) (no pagination), 2024.
Article Number: 9304. Date of Publication: September 2024.
Author
Pham P.N.V.; Yahsaly L.; Ochsenfarth C.; Giebel B.; Schnitzler R.; Zahn
P.; Frey U.H.
Institution
(Pham, Ochsenfarth, Frey) Department of Anesthesiology, Intensive Care,
Pain and Palliative Care, Marien Hospital Herne, Ruhr-University Bochum,
Bochum 44801, Germany
(Yahsaly) Department of Cardiology, University Hospital Essen, University
of Duisburg-Essen, Essen 45147, Germany
(Giebel) Institute for Transfusion Medicine, University Hospital Essen,
University of Duisburg-Essen, Essen 45147, Germany
(Schnitzler, Zahn) Department of Anesthesiology, Intensive Care and Pain
Medicine, BG University Hospital Bergmannsheil, Ruhr-University Bochum,
Bochum 44789, Germany
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Remote ischemic preconditioning (RIPC) reduces ischemia-reperfusion injury
in aortocoronary bypass surgery, potentially via extracellular vesicles
(EVs) and their micro-RNA content. Clinical data implicate that propofol
might inhibit the cardioprotective RIPC effect. This prospective,
randomized study investigated the influence of different anesthetic
regimes on RIPC efficacy and EV micro-RNA signatures. We also assessed the
impact of propofol on cell protection after hypoxic conditioning and
EV-mediated RIPC in vitro. H9c2 rat cardiomyoblasts were subjected to
hypoxia, with or without propofol, and subsequent simulated
ischemia-reperfusion injury. Apoptosis was measured by flow cytometry.
Blood samples of 64 patients receiving anesthetic maintenance with
propofol or isoflurane, along with RIPC or sham procedures, were analyzed,
and EVs were enriched using a polymer-based method. Propofol
administration corresponded with increased Troponin T levels (4669 +/-
435.6 pg/mL), suggesting an inhibition of the cardioprotective RIPC
effect. RIPC leads to a notable rise in miR-21 concentrations in the group
receiving propofol anesthesia (fold change 7.22 +/- 6.6). In vitro
experiments showed that apoptosis reduction was compromised with propofol
and only occurred in an EV-enriched preconditioning medium, not in an
EV-depleted medium. Our study could clinically and experimentally confirm
propofol inhibition of RIPC protection. Increased miR-21 expression could
provide evidence for a possible inhibitory mechanism. Copyright ©
2024 by the authors.

<73>
Accession Number
2031329517
Title
Outcomes of Valve-in-Valve (VIV) Transcatheter Aortic Valve Replacement
(TAVR) after Surgical Aortic Valve Replacement with Sutureless Surgical
Aortic Valve Prostheses PercevalTM: A Systematic Review of Published
Cases.
Source
Journal of Clinical Medicine. 13(17) (no pagination), 2024. Article
Number: 5164. Date of Publication: September 2024.
Author
Owais T.; Bisht O.; El Din Moawad M.H.; El-Garhy M.; Stock S.; Girdauskas
E.; Kuntze T.; Amer M.; Lauten P.
Institution
(Owais, Stock, Girdauskas) Department of Cardiac Surgery, University
Hospital Augsburg, Augsburg 86156, Germany
(Owais) Department of Cardiothoracic Surgery, Cairo University, Giza
12163, Egypt
(Bisht) Department of Cardiology and Angiology, Regiomed Klinikum Coburg,
Coburg 96450, Germany
(El Din Moawad) Department of Clinical Pharmacy, Faculty of Pharmacy,
Alexandria 21513, Egypt
(El-Garhy) Department of Cardiology, Heart Vascular Center, Rotenburg an
der Fulda 36199, Germany
(Kuntze, Lauten) Heart Center, Zentralklinik Bad Berka, Bad Berka 99437,
Germany
(Amer) Department of Cardiac Surgery, Heart Centre Siegburg-Wuppertal,
University Witten-Herdecke, Wuppertal 42103, Germany
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Valve-in-Valve (VIV) transcatheter aortic valve replacement
(TAVR) is a potential solution for malfunctioning surgical aortic valve
prostheses, though limited data exist for its use in Perceval valves.
 Method(s): searches were performed on PubMed and Scopus up to 31 July
2023, focusing on case reports and series addressing VIV replacement for
degenerated Perceval bioprostheses. Result(s): Our analysis included
57 patients from 27 case reports and 6 case series. Most patients (68.4%)
were women, with a mean age of 76 +/- 4.4 years and a mean STS score of
6.1 +/- 4.3%. Follow-up averaged 9.8 +/- 8.9 months, the mean gradient
reduction was 15 +/- 5.9 mmHg at discharge and 13 +/- 4.2 mmHg at
follow-up. Complications occurred in 15.7% of patients, including
atrioventricular block III in four patients (7%), major bleeding or
vascular complications in two patients (3.5%), an annular rupture in two
patients (3.5%), and mortality in two patients (3.5%). No coronary
obstruction was reported. Balloon-expanding valves were used in 61.4% of
patients, predominantly the Sapien model. In the self-expanding group
(38.6%), no valve migration occurred, with a permanent pacemaker
implantation rate of 9%, compared to 5.7% for balloon-expanding valves.
 Conclusion(s): VIV-TAVR using both balloon-expanding and
self-expanding technologies is feasible after the implantation of Perceval
valves; however, it should be performed by experienced operators with
experience both in TAVR and VIV procedures. Copyright © 2024 by
the authors.

<74>
[Use Link to view the full text]
Accession Number
645291498
Title
NT-PRO-BNP LEVELS ARE NOT SIGNIFICANTLY AFFECTED BY LEFT ATRIAL APPENDAGE
OCCLUSION (LAAO), A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of Hypertension. Conference: 18th Indonesian Society of
Hypertension Scientific Meeting, InaSH 2024. Jakarta Indonesia.
42(Supplement 2) (pp e11), 2024. Date of Publication: May 2024.
Author
Sebastian M.; Deantri F.; Sianipar L.M.; Krisna A.I.
Institution
(Sebastian, Deantri, Sianipar, Krisna) Faculty of Medicine, Udayana
University, Denpasar, Indonesia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Left atrial appendage occlusion (LAAO) is a procedure used to
occlude or close the left atrial appendage (LAA), a part of the left
atrium that is associated with thrombus formation in patients with atrial
fibrillation. However, LAA is involved in the neurohumoral homeostasis
that may be affected by this procedure. Objective(s): This study aims
to evaluate the changes of NT-pro-BNP to see the neurohormonal effects
caused by LAAO. Method(s): We searched the online databases PubMed
(Search conducted on December 2023), ScienceDirect (Search conducted on
December 2023), and Cochrane Library (Search conducted on December 2023)
for studies of atrial fibrillation patients that underwent left atrial
appendage occlusion which measures NT-Pro-BNP levels as an outcome. All
samples that were included are patients with a prior diagnosis of atrial
fibrillation indicated for LAAO due to contraindications to standard
anticoagulation regimens. Baseline demographic data, as well as NT-pro-BNP
concentration pre and post-LAAO, are extracted for this study. The primary
outcome of this study is the absolute mean difference across NT-Pro-BNP
levels obtained before the procedure and during the initial follow-up
visit for each of the studies included in this analysis with a 95%
confidence interval. Result(s): To compare NT-Pro-BNP changes after
LAAO, we analyzed 7 studies comparing the changes of NT-Pro-BNP during
follow-up from established baseline levels. Using a random-effects model,
and Hedges's method, the pooled NT-Pro-BNP changes in this study are
statistically not significant, with an absolute mean difference in
NT-Pro-BNP concentration of -27.486 pg/dl (95%CI -81.723;26.750, p=0.32).
Begg's test for publication bias was conducted and showed this study had a
low risk of publication bias (z=-0.90, p=0.548). Conclusion(s): This
study is among one of the first to quantitatively pool studies of
NT-Pro-BNP changes after LAAO. In this study, NT-Pro-BNP changes are not
statistically significant. Further high-quality studies are required to
validate this result. Keywords atrial fibrillation, left atrial appendage
occlusion, NT-Pro-BNP.

<75>
Accession Number
2034606331
Title
Systematic Review and Meta-Analysis of Interventional Emergency Treatment
of Decompensated Severe Aortic Stenosis.
Source
Journal of Invasive Cardiology. 32(1) (pp 30-36), 2020. Date of
Publication: January 2020.
Author
Wernly B.; Jirak P.; Lichtenauer M.; Veulemans V.; Zeus T.; Piayda K.;
Hoppe U.C.; Lauten A.; Frerker C.; Jung C.
Institution
(Wernly, Jirak, Lichtenauer, Hoppe) Clinic of Internal Medicine II,
Department of Cardiology, Paracelsus Medical University of Salzburg,
Salzburg, Austria
(Veulemans, Zeus, Piayda, Jung) Division of Cardiology, Pulmonology, and
Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf,
Germany
(Lauten) Department of Cardiology, Charite - Universitaetsmedizin Berlin,
Berlin, Germany
(Frerker) Department of Cardiology, Asklepios Klinik St. Georg, Hamburg,
Germany
Publisher
Cliggott Publishing Co.
Abstract
Aims. Patients in cardiogenic shock (CS) due to decompensated aortic
stenosis (AS) evidence poor prognosis. Both emergency transcatheter aortic
valve replacement (eTAVR) and emergency balloon aortic valvuloplasty
(eBAV) have been reported in CS patients. We aimed to summarize and
compare available studies on eBAV and eTAVR in patients suffering from CS
due to decompensated AS with regard to safety and efficacy. Methods and
Results. Study-level data were analyzed. Heterogeneity was assessed using
the I2 statistic. Pooled proportions, ie, event rates, were
calculated and obtained using a random-effects model (DerSimonian and
Laird). Eight studies were found suitable for the final analysis,
including 311 patients. Primary endpoint was mortality at 30 days. For
eBAV (n = 238), 30-day mortality rate was 46.2% (95% confidence interval
[CI], 30.3%-62.5%; I2=74%), major bleeding rate was 10% (95%
CI, 5.4%-15.7%; I2=13%), and stroke rate was 0.7% (95% CI,
0.0%-2.7%; I2=0%). Aortic regurgitation (AR) >=II was present
in 8.6% (95% CI, 0.4%-23.5%; I2=86%). For eTAVR (n = 73),
30-day mortality rate was 22.6% (95% CI, 12.0%-35.2%; I2=26%),
major bleeding rate was 5.8% (95% CI, 0.5%-14.7%; I2=0%), and
stroke rate was 5.8% (95% CI, 0.5%-14.7%; I2=0%). AR >=II was
present in 4% (95% CI, 0.0%-12.1%; I2=0%). Conclusion.
Mortality in CS patients due to decompensated severe AS is high,
regardless of interventional treatment strategy. Both eBAV and eTAVR seem
feasible. As eTAVR is associated with better initial improvements in
hemodynamics and simultaneously avoids sequential interventions, it might
be favorable to eBAV in select patients. If eTAVR is not available, eBAV
might serve as a "bridge" to elective TAVR. Copyright © 2020
Cliggott Publishing Co.. All rights reserved.

<76>
Accession Number
2034656160
Title
Intracardiac vs transesophageal echocardiography for left atrial appendage
occlusion: An updated systematic review and meta-analysis.
Source
Heart Rhythm. (no pagination), 2024. Date of Publication: 2024.
Author
Serpa F.; Rivera A.; Fernandes J.M.; Braga M.A.P.; Araujo B.; Ferreira
Felix I.; Ferro E.G.; Zimetbaum P.J.; d'Avila A.; Kramer D.B.
Institution
(Serpa, Ferro, Zimetbaum, Kramer) Richard A. and Susan F. Smith Center for
Outcomes Research, Beth Israel Deaconess Medical Center and Harvard
Medical School, Boston, Massachusetts, United States
(Serpa) Division of Internal Medicine, University of Texas Southwestern
Medical Center, Dallas, Texas, United States
(Rivera, Araujo) Department of Medicine, Nove de Julho University, Sao
Bernardo do Campo, Brazil
(Fernandes) Department of Medicine, Albert Einstein University, Sao Paulo,
Brazil
(Braga) Department of Medicine, Federal University of Rio de Janeiro, Rio
de Janeiro, Brazil
(Ferreira Felix) Department of Internal Medicine, Mayo Clinic, Rochester,
Minnesota, United States
(Ferro, Zimetbaum, d'Avila, Kramer) Division of Cardiology, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,
United States
Publisher
Elsevier B.V.
Abstract
Background: Multiple studies continue to evaluate the use of intracardiac
echocardiography (ICE) and transesophageal echocardiography (TEE) for
guiding left atrial appendage occlusion (LAAO). Objective(s): The
purpose of this study was to conduct an updated meta-analysis comparing
the effectiveness and safety outcomes of both imaging modalities.
 Method(s): PubMed, Cochrane, and Embase were searched for studies
comparing ICE vs TEE to guide LAAO. Odds ratios (ORs) with 95% confidence
intervals (CIs) were pooled using a random-effects model. The primary
effectiveness endpoint was procedural success. The primary safety endpoint
included the overall complications rate. Additional safety outcomes were
assessed as secondary endpoints. Subgroup analysis of primary endpoints
was conducted according to device type (Amulet, LAmbre, Watchman, Watchman
FLX) and study region (American, Asia, Europe). R Version 4.3.1 was used
for all statistical analyses. Result(s): Our meta-analysis included
19 observational studies encompassing 42,474 patients, of whom 4415
(10.4%) underwent ICE-guided LAAO. Compared with TEE, ICE was associated
with a marginally higher procedural success (OR 1.33; 95% CI 1.01-1.76; P
= .04; I2 = 0%). There was no significant difference in the
overall complications rate (OR 1.02; 95% CI 0.77-1.36; P = .89;
I2 = 5%). However, ICE showed higher rates of pericardial
effusion (OR 2.11; 95% CI 1.47-3.03; P <.001; I2 = 0%) and
residual iatrogenic atrial septal defect (iASD) (OR 1.52; 95% CI
1.15-2.03; P <.004; I2 = 0%). Subgroup analysis revealed
variations in procedural success within the ICE group across study regions
(P = .02). Conclusion(s): In this updated meta-analysis, the
increasing adoption of ICE-guided LAAO demonstrated higher procedural
success rates compared to TEE, although with limited statistical
significance. Overall complication rates were similar; however, ICE showed
higher rates of pericardial effusion and residual iASD. Copyright
© 2024 Heart Rhythm Society

<77>
Accession Number
2031415424
Title
Inclusion body myositis coexisting with severe aortic stenosis due to
bicuspid aortic valve: A case report and literature review of cardiac
involvement in inclusion body myositis.
Source
Neurology and Clinical Neuroscience. (no pagination), 2024. Date of
Publication: 2024.
Author
Ono R.; Iwahana T.; Aoki K.; Kato H.; Suichi T.; Hirano Y.; Ogaya E.;
Yoshizaki S.; Kuwabara S.; Ito C.; Matsumiya G.; Nishino I.; Kobayashi Y.
Institution
(Ono, Iwahana, Aoki, Kato, Kobayashi) Department of Cardiovascular
Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
(Suichi, Hirano, Ogaya, Yoshizaki, Kuwabara) Department of Neurology,
Chiba University Graduate School of Medicine, Chiba, Japan
(Ito, Matsumiya) Department of Cardiovascular Surgery, Chiba University
Graduate School of Medicine, Chiba, Japan
(Nishino) Department of Neuromuscular Research, National Institute of
Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
Publisher
John Wiley and Sons Inc
Abstract
Inclusion body myositis (IBM) is an idiopathic inflammatory myopathy, but
cardiac involvement has rarely been reported. Although bicuspid aortic
valve (BAV) is one of the most common congenital heart diseases, the
relationship between IBM and valvular heart disease remains unknown. We
herein report the first case of a 68-year-old male patient with IBM
coexisting with severe aortic stenosis due to BAV that was successfully
treated with aortic valve replacement. To date, only 10 cases of IBM with
cardiac manifestation, including our case, have been reported, and we
review the current literature on cardiac involvement in patients with
IBM. Copyright © 2024 Japanese Society of Neurology and John
Wiley & Sons Australia, Ltd.

<78>
Accession Number
645287683
Title
SciScribe: Automating & Contextualizing Literature Reviews in Cardiac
Surgery.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination),
2024. Date of Publication: 13 Sep 2024.
Author
Mahboubi R.; Dinkla K.; Weiss A.; Acierto A.; Staar P.; Robinson J.; Salim
Hammoud M.; Karamlou T.
Institution
(Mahboubi, Weiss, Robinson, Salim Hammoud) Department of Thoracic and
Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic,
Cleveland, OH, United States
(Dinkla, Staar) IBM Research, Zurich, Switzerland
(Acierto) Syracuse University, Syracuse, NY, United States
(Karamlou) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
Abstract
OBJECTIVES: The task of writing structured content reviews and guidelines
has grown stronger and more complex. We propose to go beyond search tools,
toward curation tools, by automating time-consuming and repetitive steps
of extracting and organizing information. METHOD(S): SciScribe is
built as an extension of IBM's Deep Search platform, which provides
document processing and search capabilities. This platform was used to
ingest and search full-content publications from PubMed Central (PMC) and
official, structured records from the ClinicalTrials and OpenPayments
databases. Author names and NCT numbers, mentioned within the
publications, were used to link publications to these official records as
context. Search strategies involve traditional keyword-based search as
well as natural language question and answering via large language models
(LLMs). RESULT(S): SciScribe is a web-based tool that helps
accelerate literature reviews through key features: 1. Accumulate a
personal collection from publication sources, such as PMC or other
sources; 2. Incorporate contextual information from external databases
into the presented papers, promoting a more informed assessment by
readers. 3. Semantic question and answering of a document to quickly
assess relevance and hierarchical organization. 4. Semantic question
answering for each document within a collection, collated into tables.
 CONCLUSION(S): Emergent language processing techniques open new
avenues to accelerate and enhance the literature review process, for which
we have demonstrated a use case implementation within cardiac surgery.
SciScribe automates and accelerates this process, mitigates errors
associated with repetition and fatigue, as well as contextualizes results
by linking relevant external data sources, instantaneously. Copyright
© 2024. Published by Elsevier Inc.

<79>
Accession Number
2034552264
Title
Assessing mortality and safety of IV thrombolysis in ischemic stroke
patients on direct oral anticoagulants (DOACs): A systematic review and
meta-analysis.
Source
Clinical Neurology and Neurosurgery. 246 (no pagination), 2024. Article
Number: 108523. Date of Publication: November 2024.
Author
Alam K.; Khan A.N.; Fatima A.; Haseeb A.; Jaffar D.; Mussarat A.; Amir M.;
Rana M.O.; Saeed H.; Asmar A.
Institution
(Alam) Liaquat National Hospital and Medical College, Karachi, Pakistan
(Khan) Karachi Medical and Dental College, Karachi, Pakistan
(Fatima, Haseeb, Mussarat, Amir) Jinnah Sindh Medical university, Karachi,
Pakistan
(Jaffar, Saeed) Dow University of Health Sciences, Karachi, Pakistan
(Rana) Dow Medical College, Karachi, Pakistan
(Asmar) Department of Neurology, Houston Methodist Hospital, Houston, TX,
United States
Publisher
Elsevier B.V.
Abstract
Background: Intravenous thrombolysis (IVT) is considered a standard
reperfusion therapy for acute ischemic stroke (AIS) patients presenting
within 4.5 hours of the last known well (LKW). Current guidelines
contraindicate the use of IVT in patients within the window who are on
Direct Oral Anticoagulants (DOACs) and took their last dose within 48
hours of presentation, due to a risk of symptomatic intracranial
hemorrhage (sICH). Objective(s): To assess the safety of IVT as
management of AIS in patients who take DOACs. Method(s): A thorough
literature search of four databases (PubMed, Scopus, Medline, Google
Scholar, Web of science and ScienceDirect) was done from inception until
May 2023. Double-arm studies that reported outcomes of mortality, sICH,
and mRS scores were selected. Results from these studies were presented as
odds ratios (ORs) with 95 % confidence intervals (CIs) and were pooled
using a random-effects model. Result(s): Four eligible studies were
included with a total of 238,425 stroke patients who underwent IVT (3330
in the DOAC arm and 235,217 in the placebo arm). The group with prior DOAC
intake showed a significant decrease in sICH development and an increase
in functional independence at 90 days compared to the control group. No
significant association was seen between prior DOAC use and any serious
alteplase-related complication within 36 hours, serious systemic or
life-threatening hemorrhage within 36 hours, mortality within 3 months, or
mRS score at 3 months. Conclusion(s): The pooled analysis suggests
that IVT is a safe management option for acute ischemic stroke in patients
with DOAC intake before symptom onset without an increased risk of serious
adverse events. Copyright © 2024

<80>
Accession Number
2034549315
Title
Effect of different priming fluids on extravascular lung water, cell
integrity and oxidative stress in cardiopulmonary bypass surgery.
Source
Cardiovascular Journal of Africa. 35(2) (pp 70-74), 2024. Date of
Publication: September 2024.
Author
Ulugol H.; Can M.G.; Aksu U.; Vardar K.; Okten M.; Toraman F.
Institution
(Ulugol, Can, Toraman) Department of Anesthesiology and Reanimation,
Acibadem Mehmet Ali Aydinlar University, Altunizade Hospital, Istanbul,
Turkey
(Aksu, Vardar) Department of Biology, Faculty of Science, University of
Istanbul, Istanbul, Turkey
(Okten) Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydinlar
University, Altunizade Hospital, Istanbul, Turkey
Publisher
Clinics Cardive Publishing (PTY)Ltd
Abstract
Background: Discussions continue on the ideal priming fluid in adult
cardiac surgery. The purpose of this prospective study was to evaluate the
effects of different types of priming fluids on extravascular lung water,
cell integrity and oxidative stress status. Method(s): Thirty
elective coronary artery bypass surgery patients were randomised
prospectively into two groups. The first group received colloid priming
fluid, while the second group received crystalloid priming fluid.
Extravascular lung water index, advanced oxidative protein products, total
thiol, free haemoglobin, ischaemic modified albumin and sialic acid levels
were measured. Moreover, intra-operative and postoperative outcomes were
reviewed. Result(s): There were no significant differences between
the groups with regard to extravascular lung water index, oxidative stress
parameters or cell integrity (p > 0.05). Similarly, no significant
differences were observed between the patients with regard to
intra-operative and postoperative outcomes (p > 0.05). Conclusion(s):
The presumed superiority of colloidal priming for cardiopulmonary bypass
could not be confirmed in our study. Copyright © 2024 Clinics
Cardive Publishing (PTY)Ltd. All rights reserved.

<81>
Accession Number
2034599741
Title
Cardiac Hemangioma Located in the Interatrial Septum: A Case Report and
Literature Review.
Source
Heart Surgery Forum. 27(9) (pp E990-E997), 2024. Date of Publication:
September 2024.
Author
Shen C.; Yang S.; Cai C.; Liu G.; Diao W.; Zhang S.
Institution
(Shen, Yang, Cai, Liu, Diao, Zhang) Department of Cardiac Surgery, The
First Affiliated Hospital of Bengbu Medical University, Anhui, Bengbu
233004, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Cardiac hemangiomas are extremely rare benign tumors that can occur in any
part of the heart. We report the case of an adult female with no history
of structural heart disease or symptoms of discomfort. Cardiac ultrasound
showed a mass on the right atrial surface of the atrial septum.
Intraoperatively, the mass was identified within the atrial septum, at the
junction of the inferior vena cava and the ostium of the coronary sinus.
The mass did not enter the left or right atrial cavities. The mass was
successfully removed, and cardiac hemangioma was confirmed by
postoperative pathology. This report discusses the clinical
manifestations, diagnostic approaches, and treatment options for cardiac
hemangiomas based on an analysis of previously reported cases. Owing to
the risk of arrhythmia in patients with hemangiomas in the atrial or
ventricular septum, surgical resection is recommended. Copyright:
© 2024 The Author(s). Published by Forum Multimedia Publishing, LLC.

<82>
Accession Number
2028504812
Title
The impact of sex differences on 3-year outcomes of patients with
non-ST-segment elevation myocardial infarction after successful stent
implantation according to symptom-to-balloon time.
Source
Hellenic Journal of Cardiology. 79 (pp 35-48), 2024. Date of Publication:
01 Sep 2024.
Author
Kim Y.H.; Her A.-Y.; Rha S.-W.; Choi C.U.; Choi B.G.; Park S.; Kang D.O.;
Cho J.R.; Park J.Y.; Park S.-H.; Jeong M.H.
Institution
(Kim, Her) Division of Cardiology, Department of Internal Medicine,
Kangwon National University College of Medicine, Kangwon National
University School of Medicine, Chuncheon 24289, South Korea
(Rha, Choi, Park, Kang) Cardiovascular Center, Korea University Guro
Hospital, Seoul 08308, South Korea
(Choi) Cardiovascular Research Institute, Korea University College of
Medicine, Seoul 02841, South Korea
(Cho) Cardiology Division, Department of Internal Medicine, Kangnam Sacred
Heart Hospital, Hallym University College of Medicine, Seoul 07441, South
Korea
(Park) Division of Cardiology, Department of Internal Medicine,
Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul
01830, South Korea
(Park) Cardiology Department, Soonchunhyang University Cheonan Hospital,
Cheonan 31151, South Korea
(Jeong) Department of Cardiology, Cardiovascular Center, Chonnam National
University Hospital, Gwangju 61469, South Korea
Publisher
Hellenic Cardiological Society
Abstract
Background: Because no data are available, we compared the 3-year outcomes
of patients with non-ST-elevation myocardial infarction (NSTEMI) based on
sex and symptom-to-balloon time (SBT). Method(s): This study included
4910 patients who were divided into two groups based on SBT: SBT <48 h (n
= 3,293, 67.1%) and SBT >=48 h (n = 1,617, 32.9%). The primary outcome was
all-cause death during the 3-year follow-up period. The secondary outcome
was major adverse cardiac events (MACE), defined as all-cause death,
recurrent myocardial infarction, or repeat coronary revascularization.
 Result(s): After adjustment, the in-hospital mortality rates for
males and females in the SBT <48 h and SBT >=48 h groups were similar.
During a 3-year follow-up period, females in the SBT <48 h group had
significantly higher rates of all-cause death (adjusted hazard ratio
[aHR], 1.482; P = 0.006), cardiac death (CD, aHR, 1.617; P = 0.009), and
MACE (aHR, 1.268; P = 0.024) than those males in the same groups. Females
and males in the SBT >=48 h group did not differ significantly in the
primary and secondary outcomes. In males, the rates of all-cause death (P
= 0.008) and CD (P = 0.024) were significantly higher in the SBT >=48 h
group than in the SBT <48 h group. Conclusion(s): This study has
identified a higher 3-year mortality rate in female patients with NSTEMI
and SBT <48 h compared to their male counterparts. As such, a more
preventive approach may be required to reduce mortality in these female
patients. Copyright © 2023 Hellenic Society of Cardiology

<83>
[Use Link to view the full text]
Accession Number
2034479576
Title
The effect of dexmedetomidine on emergence delirium of postanesthesia
events in pediatric department: A systematic review and meta-analysis of
randomized controlled trials.
Source
Medicine (United States). 103(36) (no pagination), 2024. Article Number:
e39337. Date of Publication: 06 Sep 2024.
Author
Tang S.; Liu J.; Ding Z.; Shan T.
Institution
(Tang, Ding) Wuxi Medical College, Jiangnan University, Wuxi, China
(Liu) Department of Anesthesiology, Jiangnan University Medical Center,
Wuxi, China
(Shan) General Surgery Department, Jiangnan University Medical Center,
Wuxi, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Emergence delirium (ED) is a common occurrence in pediatric
postanesthesia events, leading to negative outcomes. Dexmedetomidine
(DEX), as an anesthesia adjuvant, has shown promise in preventing ED in
adult surgeries, and it has been increasingly used in pediatric surgical
settings. However, its effectiveness in other postanesthesia events, such
as MRI examinations and ambulatory surgery centers, remains unclear. This
meta-analysis aims to assess the safety and efficacy of DEX in preventing
ED in various pediatric postanesthesia events beyond surgery.
 Method(s): Prospective randomized controlled trials were searched in
Pubmed, Web of Science, and EBSCO until October 13, 2023. Comparisons were
made between DEX and other sedatives or analgesics in different
postanesthesia events (including surgery operations, the examination of
MRI, day surgery, and invasive action). Subgroup analyses were conducted
based on drug delivery methods, medication timing, DEX dosages, use of
analgesics, event types, and recovery time. Result(s): A total of 33
trials involving 3395 patients were included. DEX significantly reduced
the incidence of ED (odds ratios [OR] = 0.23, 95% confidence interval
[CI]: 0.19-0.27, I2 = 37%, P < .00001). Intranasal delivery of
DEX was the most effective (OR 0.18, 95% CI: 0.10-0.32, P < .00001,
I2 = 0%). DEX also showed benefits in day surgery and mask
insertion events (OR 0.30, 95% CI: 0.14-0.26, P = .001, I2 =
0%). Conclusion(s): DEX demonstrates superior efficacy in preventing
ED in pediatric postanesthesia events compared to other sedatives and
analgesics. Its use is recommended in various settings for its safety and
effectiveness in managing ED. Copyright © 2024 Lippincott
Williams and Wilkins. All rights reserved.

<84>
Accession Number
2033192060
Title
Concomitant Tricuspid Valve Ring Annuloplasty During Mitral Valve Surgery
Versus Mitral Valve Surgery Alone: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 33(10) (pp 1383-1392), 2024. Date of
Publication: October 2024.
Author
Poon S.S.; Chan J.; Ahmed Y.; Aslam U.; Cianci V.; Sharma S.; Kumar P.
Institution
(Poon, Ahmed, Aslam, Cianci, Sharma, Kumar) Department of Cardiothoracic
Surgery, Morriston Hospital, Wales, Swansea, United Kingdom
(Chan) Department of Cardiothoracic Surgery, Bristol Royal Infirmary,
Bristol, United Kingdom
Publisher
Elsevier Ltd
Abstract
Aim: Although current guidelines recommend concomitant tricuspid
annuloplasty for moderate or greater tricuspid regurgitation (TR) and/or
dilated annulus, there remains significant variation in undertaking
concomitant tricuspid valve surgery (TVA) across different centres. This
meta-analysis aimed to compare the clinical outcomes of concomitant
tricuspid valve surgery for patients with moderate or greater TR and/or
dilated annulus at the time of mitral valve (MV) surgery. Method(s):
A systematic review of the literature using six databases. Eligible
studies include comparative studies on TVA concomitant with MV surgery
versus MV surgery alone. A meta-analysis was performed on studies
reporting outcomes of interest to quantify the effects of concomitant
tricuspid ring annuloplasty. Result(s): Two randomised controlled
trials and six cohort studies were included in the analysis. 1,941
patients were included in the analysis, of whom, 1,090 underwent
concomitant TVA and 851 underwent MV surgery alone. Pooled analysis
demonstrated that there was less progression of moderate/severe TR in the
concomitant group (3.0% vs 9.6%; odds ratio [OR] 0.29; 95% confidence
interval [CI] 0.13-0.55; p=0.0001). There was no significant difference in
in-hospital mortality (3.0% vs 3.8%; OR 0.79; 95% CI 0.47-1.34; p=0.38).
The rate of permanent pacemaker implantation was higher in the concomitant
group although this did not reach statistical significance (7.6% vs 5.3%;
OR 1.30; 95% CI 0.85-1.98; p=0.23). Cardiopulmonary bypass was longer in
the concomitant TVA group by 20 minutes (mean difference 13.9-26.0;
p<0.00001). Conclusion(s): Our study demonstrated that concomitant
tricuspid ring annuloplasty at the time of MV surgery is associated with a
significantly lower rate of TR progression without increasing the
operative mortality. There is a trend towards a higher permanent pacemaker
implantation rate although this did not reach statistical
significance. Copyright © 2024

<85>
Accession Number
2032776885
Title
Ultrasound Guidance for Transradial Access in the Cardiac Catheterisation
Laboratory: A Systematic Review of the Literature and Meta-Analysis.
Source
Heart Lung and Circulation. 33(10) (pp 1404-1413), 2024. Date of
Publication: October 2024.
Author
Hamilton G.W.; Sharma V.; Yeoh J.; Yudi M.B.; Raman J.; Clark D.J.;
Farouque O.
Institution
(Hamilton, Yeoh, Yudi, Clark, Farouque) Department of Cardiology, Austin
Health, Melbourne, VIC, Australia
(Hamilton, Sharma, Yeoh, Yudi, Raman, Clark, Farouque) Faculty of
Medicine, Dentistry and Health Sciences, University of Melbourne,
Melbourne, VIC, Australia
(Sharma, Raman) Brian F. Buxton Cardiac Surgical Unit, Austin Health,
Melbourne, VIC, Australia
(Raman) Department of Cardiac Surgery, St Vincent's Hospital, Melbourne,
VIC, Australia
Publisher
Elsevier Ltd
Abstract
Background: Although ultrasound (US) guidance for vascular access has been
widely adopted, its use for transradial access (TRA) in the cardiac
catheterisation laboratory is rare. There is a perception that US guidance
does not offer a clinically relevant benefit over traditional
palpation-guided TRA, amplified by inconsistent findings of individual
studies. Method(s): A systematic review of MEDLINE, EMBASE and the
Cochrane Library identified studies comparing US to palpation-guided TRA
for cardiac catheterisation. Studies evaluating radial artery (RA)
cannulation for any other reason were excluded. Event rates and risk
ratios (RRs) were pooled for meta-analysis. Access failure was the primary
outcome. A random-effects model was used for analysis. Result(s): Of
the 977 records screened, four studies with a total of 1,718 patients (861
US-guided and 864 palpation-guided procedures) were included in the
meta-analysis. Most procedures were elective. The pooled analysis showed
US guidance significantly lowered the risk of access failure (RR 0.45; 95%
confidence interval [CI] 0.21-0.97; p=0.04). Heterogeneity was moderate
(I2=51.2%; p=0.105). There was a strong trend to improved
first-pass success with US (RR 1.29; 95% CI 1.00-1.66; p=0.05;
I2=83.8%), although no differences were found in rates of
difficult access (RR 0.29; 95% CI 0.07-1.18; p=0.09; I2=88.3%).
Salvage US guidance was successful in 30/41 (73.2%) patients following
failed palpation-guided TRA. No differences were found in already low
complication rates including RA spasm (RR 1.18; 95% CI 0.70-1.99; p=0.53;
I2=0.0%) and bleeding (RR 1.32; 95% CI 0.46-3.80; p=0.60;
I2=0.0%). Conclusion(s): US guidance was found to improve
TRA success in the cardiac catheterisation laboratory. Further
investigation is necessary to determine whether routine, selective, or
salvage use of US confers the most RA protection, patient satisfaction,
and overall clinical benefit. (PROSPERO registration:
CRD42022332238). Copyright © 2024 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<86>
Accession Number
2031344177
Title
Constrictive Pericarditis and Protein-Losing Enteropathies: Exploring the
Heart-Gut Axis.
Source
Journal of Clinical Medicine. 13(17) (no pagination), 2024. Article
Number: 5150. Date of Publication: September 2024.
Author
Birtolo L.I.; Shahini E.
Institution
(Birtolo) Cardiology Unit, National Institute of Gastroenterology-IRCCS
"Saverio de Bellis", Castellana Grotte 70013, Italy
(Birtolo) Department of Clinical, Internal, Anesthesiology and
Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome,
Rome 00185, Italy
(Shahini) Gastroenterology Unit, National Institute of
Gastroenterology-IRCCS "Saverio de Bellis", Castellana Grotte 70013, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Constrictive pericarditis very rarely causes
protein-losing enteropathy (PLE) induced by secondary intestinal
lymphangiectasia. This study thoroughly reviewed the literature to shed
light on the clinical management of PLE provoked by intestinal
lymphangiectasia following constrictive pericarditis. Method(s): We
performed a PubMed search using the keywords enteropathy, protein-losing
enteropathy, pericarditis, acute pericarditis, pericardial effusion,
recurrent pericarditis, constrictive pericarditis, noninfectious
pericarditis, idiopathic pericarditis, and infective pericarditis, with
only English-language publications included. Result(s): Although
constrictive pericarditis is primarily idiopathic, less common causes
include infectious etiologies, connective/autoimmune tissue disorders,
previous cardiac surgery, congenital syndromes, and cancer. On the one
hand, PLE secondary to intestinal lymphangiectasia may cause a severe
cellular immune deficiency that could raise infection hazards due to
lymphocytopenia and hypogammaglobulinemia. On the other hand,
lymphocytopenia may cause anergy and mask an underlying tuberculous
etiology of constrictive pericarditis. Cardiac catheterization is the most
useful diagnostic tool for constrictive pericarditis, though it may be
misdiagnosed in rare cases. The videocapsule endoscopy and double-balloon
enteroscopy techniques can detect small bowel lymphangiectasias distal to
the Treitz ligament. MRI or a CT scan helps confirm constrictive
pericarditis, visualize lymphangiectasias, and reveal features specific to
the underlying etiology of PLE. Radioisotopic techniques may ensure PLE
diagnosis in challenging cases, whereas fecal alpha1-antitrypsin can
estimate gastrointestinal protein loss. Conclusion(s): Constrictive
pericarditis is rarely associated with PLE. The cardio-intestinal
abnormalities of PLE caused by constrictive pericarditis are frequently
reversed following a complete pericardiectomy, though its ability to
invert severe hypoalbuminemia is currently unknown. Copyright ©
2024 by the authors.

<87>
Accession Number
2031267320
Title
Effects of sodium-glucose cotransporter 2 inhibitors on cardiovascular and
cerebrovascular diseases: a meta-analysis of controlled clinical trials.
Source
Frontiers in Endocrinology. 15 (no pagination), 2024. Article Number:
1436217. Date of Publication: 2024.
Author
Wang F.; Li C.; Cui L.; Gu S.; Zhao J.; Wang H.
Institution
(Wang, Li, Cui) Department of Endocrinology and Metabology, The First
Affiliated Hospital of Shandong First Medical University & Shandong
Provincial Qianfoshan Hospital, Shandong First Medical University,
Shandong Key Laboratory of Rheumatic Disease and Translational medicine,
Shandong Institute of Nephrology, Jinan, China
(Gu) School of Clinical Medicine, Jining Medical University, Jining, China
(Zhao) Institute for Literature and Culture of Chinese Medicine, Shandong
University of Traditional Chinese Medicine, Jinan, China
(Wang) Department of Radiology, Shandong Provincial Hospital Affiliated to
Shandong First Medical University, Jinan, China
Publisher
Frontiers Media SA
Abstract
Objective: Evaluate the effects of sodium-glucose cotransporter 2
inhibitor (SGLT2i) on cardiovascular and cerebrovascular diseases.
 Method(s): Articles of SGLT2i on cardiovascular and cerebrovascular
diseases were searched. Two authors independently screened the literature,
extracted the data, assessed the quality of the study and performed
statistical analyses using Review Manager 5.4. Result(s):
Random-effect model was used to merge the OR values, and the pooled effect
showed that SGLT2i had significant preventive effects on cardiovascular
death (OR=0.76, 95%CI 0.64 to 0.89), myocardial infarction (OR=0.90, 95%CI
0.84 to 0.96), heart failure (OR=0.69, 95%CI 0.64 to 0.74) and all-cause
mortality (OR=0.65, 95%CI 0.58 to 0.73). Empagliflozin, dapagliflozin and
canagliflozin all reduced the incidence of heart failure (OR=0.72, 95%CI
0.64 to 0.82; OR=0.56, 95%CI 0.39 to 0.80; OR=0.62, 95%CI 0.53 to 0.73),
but only dapagliflozin displayed a favorable effect on inhibiting stroke
(OR=0.78, 95%CI 0.63 to 0.98). SGLT2i could prevent stroke (OR=0.86, 95%CI
0.75 to 0.99), heart failure (OR=0.63, 95%CI 0.56 to 0.70) and all-cause
mortality (OR=0.64, 95%CI 0.57 to 0.72) compared to DPP-4i. Furthermore,
SGLT2i could reduce the incidence of heart failure (OR=0.72, 95%CI 0.67 to
0.77) and cardiovascular death (OR=0.72, 95%CI 0.54 to 0.95) in patients
with high-risk factors. Conclusion(s): SGLT2i affects cardiovascular
death, myocardial infarction, heart failure and all-cause mortality. Only
dapagliflozin displayed a favorable effect on inhibiting stroke. SGLT2i
could prevent stroke, heart failure and all-cause mortality compared to
DPP-4i. In addition, SGLT2i significantly reduced the development of heart
failure and cardiovascular death in patients with high-risk factors.
Systematic review registration: https://www.crd.york.ac.uk/prospero,
identifier CRD42024532783. Copyright © 2024 Wang, Li, Cui, Gu,
Zhao and Wang.

<88>
Accession Number
2034580994
Title
Liraglutide effects on epicardial adipose tissue micro-RNAs and
intra-operative glucose control.
Source
Nutrition, Metabolism and Cardiovascular Diseases. (no pagination), 2024.
Date of Publication: 2024.
Author
Iacobellis G.; Goldberger J.J.; Lamelas J.; Martinez C.A.; Sterling C.M.;
Bodenstab M.; Frasca D.
Institution
(Iacobellis, Bodenstab) Division of Endocrinology, Diabetes and
Metabolism, Department of Medicine, University of Miami Miller School of
Medicine, Miami, FL, United States
(Goldberger, Martinez, Sterling) Division of Cardiology, Department of
Medicine, University of Miami Miller School of Medicine, Miami, FL, United
States
(Lamelas) Division of Cardiothoracic Surgery, DeWitt Daughtry Department
of Surgery, University of Miami Miller School of Medicine, Miami, FL,
United States
(Frasca) Department of Microbiology and Immunology, University of Miami
Miller School of Medicine, Miami, FL, United States
(Frasca) Sylvester Comprehensive Cancer Center, University of Miami Miller
School of Medicine, Miami, FL, United States
Publisher
Elsevier B.V.
Abstract
Background and aim: Epicardial adipose tissue (EAT) plays a role in
coronary artery disease (CAD). EAT has regional distribution throughout
the heart and each location may have a different genetic profile and
function. Glucagon like peptide-1 receptor analogs (GLP-1RAs) reduce
cardiovascular risk. However, the short-term effects of GLP-1RA on
microRNA (miRNA) profile of each EAT location is unknown. Objective was to
evaluate if EAT miRNAs were different between coronary (CORO-EAT), left
atrial EAT (LA-EAT) and subcutaneous fat (SAT), and liraglutide can
modulate EAT miRNAs expression. Methods and Results: This was a
12-week randomized, double-blind, placebo-controlled study in 38 patients
with type 2 diabetes (T2DM) and coronary artery disease (CAD) who were
started on either liraglutide or placebo for a minimum of 4 up to 12 weeks
prior to coronary artery by-pass grafting (CABG). Fat samples were
collected during CABG. miR16, miR155 and miR181a were significantly higher
in CORO-EAT and in LA-EAT than SAT (p < 0.01 and p < 0.05) in overall
patients. miR16 and miR181-a were significantly higher in CORO-EAT than
SAT (p < 0.01), and miR155 and miR181a were higher in LA-EAT than SAT (p <
0.05) in the liraglutide group. Liraglutide-treated patients had better
intra-op glucose control than placebo (146 +/- 21 vs 160 +/- 21 mg/dl, p <
0.01). Conclusion(s): Our study shows that CORO- and LA-miRNAs
profiles were significantly different than SAT miRNAs in overall patients
and miRNAs were significantly higher in CORO-EAT and LA-EAT than SAT in
the liraglutide group. Pre-op liraglutide was also associated with better
intra operative glucose control than placebo independently of weight
loss. Copyright © 2024 The Italian Diabetes Society, the Italian
Society for the Study of Atherosclerosis, the Italian Society of Human
Nutrition and the Department of Clinical Medicine and Surgery, Federico II
University

<89>
Accession Number
2031369465
Title
Minimally Invasive Coronary Artery Bypass Grafting for Multivessel
Coronary Artery Disease: A Systematic Review.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2024. Date of Publication: 2024.
Author
Sef D.; Thet M.S.; Hashim S.A.; Kikuchi K.
Institution
(Sef) Department of Cardiac Surgery, University Hospitals of Leicester,
United Kingdom
(Thet) Department of Surgery and Cancer, Faculty of Medicine, Imperial
College London & Imperial College Healthcare NHS Trust, United Kingdom
(Hashim) Department of Cardiothoracic Surgery, University of Malaya
Medical Centre, Kuala Lumpur, Malaysia
(Kikuchi) Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa
Medical Center, Japan
Publisher
SAGE Publications Ltd
Abstract
Objective: We conducted a systematic review of all available evidence on
the feasibility and safety of minimally invasive coronary artery bypass
grafting (MICS CABG) in patients with multivessel coronary artery disease
(CAD). Method(s): A systematic literature search in PubMed, MEDLINE
via Ovid, Embase, Scopus, and Web of Science was performed to identify all
relevant studies evaluating outcomes of MICS CABG among patients with
multivessel CAD and including at least 15 patients with no restriction on
the publication date. Result(s): A total of 881 studies were
identified, of which 26 studies met the eligibility criteria. The studies
included a total of 7,556 patients. The average patient age was 63.3 years
(range 49.5 to 69.0 years), male patients were an average of 77.8% (54.0%
to 89.8%), and body mass index was 29.8 kg/m2 (24.5 to 30.1
kg/m2). Early mortality and stroke were on average 0.6% (range
0% to 2.0%) and 0.4% (range 0% to 1.3%), respectively. The average number
of grafts was 2.8 (range 2.1 to 3.7). The average length of hospital stay
was 5.6 days (range 3.1 to 9.3 days). Conclusion(s): MICS CABG
appears to be a safe method in well-selected patients with multivessel
CAD. This approach is concentrated at dedicated centers, and there is no
widespread application, although it has potential to be widely applicable
as an alternative for surgical revascularization. However, large
randomized controlled studies with longer follow-up are still required to
compare the outcomes with conventional CABG and other revascularization
strategies. Copyright © The Author(s) 2024.

<90>
[Use Link to view the full text]
Accession Number
644458128
Title
Re-exploration for bleeding and long-term survival after adult cardiac
surgery: a meta-analysis of reconstructed time-to-event data.
Source
International journal of surgery (London, England). 110(9) (pp 5795-5801),
2024. Date of Publication: 01 Sep 2024.
Author
Jr Soletti G.; Cancelli G.; Dell'Aquila M.; Caldonazo T.; Harik L.; Rossi
C.; Tasoudis P.; Leith J.; An K.R.; Dimagli A.; Demetres M.; Gaudino M.
Institution
(Jr Soletti, Cancelli, Dell'Aquila, Caldonazo, Harik, Rossi, Leith, An,
Dimagli, Gaudino) Department of Cardiothoracic Surgery at New York
Presbyterian, Weill Cornell Medicine, NY, United States
(Caldonazo) Division of Cardiothoracic Surgery, University of North
Carolina, Chapel Hill, United States
(Tasoudis) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University Jena, Germany
(Demetres) Samuel J. Wood Library & CV Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY
Abstract
BACKGROUND: Postoperative bleeding requiring re-exploration is a serious
complication that occurs in 2.8-4.6% of patients undergoing cardiac
surgery. Re-exploration has previously been associated with a higher risk
of short-term mortality. However, a comprehensive analysis of long-term
outcomes after re-exploration for bleeding has not been published.
MATERIALS AND METHODS: The authors performed a systematic, three databases
search to identify studies reporting long-term outcomes in patients who
required re-exploration for bleeding after cardiac surgery compared to
patients who did not, with at least 1-year of follow-up. Long-term
survival was the primary outcome. Secondary outcomes were operative
mortality, myocardial infarction, stroke, renal and respiratory
complications, and hospital length of stay. Random-effects models was
used. Individual patient survival data was extracted from available
survival curves and reconstructed using restricted mean survival time.
 RESULT(S): Six studies totaling 135 456 patients were included. The
average follow-up was 5.5 years. In the individual patient data, patients
who required re-exploration had a significantly higher risk of death
compared with patients who did not [hazard ratio (HR): 1.21; 95% CI:
1.14-1.27; P <0.001], which was confirmed by the study-level survival
analysis (HR: 1.32; 95% CI: 1.12-1.56; P <0.01). Re-exploration was also
associated with a higher risk of operative mortality [odds ratio (OR):
5.25, 95% CI: 4.74-5.82, P <0.0001], stroke (OR: 2.05, 95% CI: 1.72-2.43,
P <0.0001), renal (OR: 4.13, 95% CI: 3.43-4.39 P <0.0001) respiratory
complications (OR: 3.91, 95% CI: 2.96-5.17, P <0.0001), longer hospital
length of stay (mean difference: 2.69, 95% CI: 1.68-3.69, P <0.0001), and
myocardial infarction (OR: 1.85, 95% CI: 1.30-2.65, P =0.0007).
 CONCLUSION(S): Postoperative bleeding requiring re-exploration is
associated with lower long-term survival and increased risk of short-term
adverse events including operative mortality, stroke, renal and
respiratory complications, and longer hospital length of stay. To improve
both short-term and long-term outcomes, strategies to prevent the need for
re-exploration are necessary. Copyright © 2024 The Author(s).
Published by Wolters Kluwer Health, Inc.

<91>
Accession Number
643841475
Title
Post-operative Pain Control: A Comparison between Bupivacaine and Tramadol
Local Wound Infiltration in Children Undergoing Herniotomy and
Orchidopexy.
Source
African journal of paediatric surgery : AJPS. 21(4) (pp 217-222), 2024.
Date of Publication: 01 Oct 2024.
Author
Aisien E.; Chibuzom C.N.; Osifo D.O.; Evbuomwan I.
Institution
(Aisien, Osifo, Evbuomwan) Department of Surgery, University of Benin
Teaching Hospital, Benin City, Nigeria
(Chibuzom) Department of Surgery, Nnamdi Azikiwe University Teaching
Hospital, Nnewi, Anambra State, Nigeria
Abstract
BACKGROUND: Post-operative pain control improves patient's satisfaction
and affects the period of admission. Local wound infiltration following
hernia surgery using xylocaine or bupivacaine has been a common practice.
The use of tramadol for such infiltration is relatively new and has not
been studied in our environment. This study compared the efficacy of
post-operative pain control between Bupivacaine and Tramadol wound
infiltration in children who underwent herniotomy and orchidopexy.
MATERIALS AND METHODS: This was a prospective randomised study involving
104 patients. A simple random method was used to allocate the study group
into two equal groups (A, n = 52 and B, n = 52) using sealed envelopes
with contents labelled A or B. Pre- and post-operative respiratory rate,
heart rate, and C-reactive protein (CRP) were all recorded. Time to first
and subsequent analgesia was determined using face, legs, activity, cry,
consolability (FLACC) pain score. RESULT(S): Fifteen patients in
Group A and 18 patients in Group B received each two doses of supplemental
analgesia within the first 24 h, ( P = 0.527). Time to first analgesia was
significantly different between the two groups, (6.93 +/- 0.80 h and 6.11
+/- 1.08 h, P = 0.020). The mean FLACC pain score at the time of first
analgesia in hours was 4.93 +/- 0.59 and 4.72 +/- 0.67 for Group A and B,
respectively, P = 0.350. The changes in CRP were not different in the two
groups, ( P = 0.665). Four patients in Group A, but none in Group B had an
episode each of post-operative vomiting. CONCLUSION(S): Tramadol
showed comparable efficacy with bupivacaine in post-operative pain control
by wound infiltration in children who had unilateral herniotomy or
orchidopexy. Tramadol, however, achieves a longer duration of action
before rescue analgesic is required. Caution is necessary to avoid
post-operative vomiting. Copyright © 2024 Copyright: © 2024
African Journal of Paediatric Surgery.

<92>
Accession Number
2034607828
Title
1334P PET/CT-guided immune checkpoint blocker treatment discontinuation vs
treatment continuation in lung cancer long-term responders: A National
Network Genomic Medicine Lung Cancer Germany (nNGM) analysis.
Source
Annals of Oncology. Conference: ESMO Congress 2024. Barcelona Spain.
35(Supplement 2) (pp S846-S847), 2024. Date of Publication: September
2024.
Author
Frost N.; Wiesweg M.; Rasokat A.; Kulhavy J.; Kollmeier J.; Reinmuth N.;
Luders H.; Roeper J.; Rittmeyer A.; Heinzen S.; Saalfeld F.C.; Wesseler
C.; Kauffmann-Guerrero D.; Christopoulos P.; Kemper M.; Collienne M.;
Berezucki E.; Overbeck T.R.; Kropf C.; Reck M.
Institution
(Frost) Department of Infectious Diseases and Pulmonary Medicine,
Charite-Universitatsmedizin Berlin (Corporate Member of Freie Universitat
Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health),
Berlin, Germany
(Wiesweg) Department of Medical Oncology, University Hospital Essen
Westdeutsches Tumorzentrum, Essen, Germany
(Rasokat) University Hospital Cologne, Cologne, Germany
(Kulhavy) Comprehensive Cancer Center Mainfranken, UKW - University
Hospital Wurzburg, Wurzburg, Germany
(Kollmeier) Pneumonology, HELIOS Klinikum Emil von Behring
Berlin-Zehlendor, Berlin, Germany
(Reinmuth) Thoracic Oncology, Asklepios-Fachklinikum, Gauting, Germany
(Luders) Pneumonology, Evangelische Lungenklinik Berlin, Berlin, Germany
(Roeper) Department of Internal Medicine-Oncology, Pius Hospital,
Oldenburg, Germany
(Rittmeyer) Thoracic Oncology Department, LKI - Lungenfachklinik
Immenhausen, Immenhausen, Germany
(Heinzen) Medical Oncology, Universitatsklinikum Frankfurt
(Johannes-Wolfgang Goethe-Universitat), Frankfurt am Main, Germany
(Saalfeld) Clinic for Medicine I, Technische Universitat Dresden - Carl
Gustav Carus Faculty of Medicine, Dresden, Germany
(Wesseler) Pulmonary Medicine/Thoracic Oncology, Asklepios Klinik Harburg,
Hamburg, Germany
(Kauffmann-Guerrero) Department of Internal Medicine V, LMU Klinikum der
Universitat Munchen, Munich, Germany
(Christopoulos) Department of Oncology of Thoracic Tumors, Thoraxklinik
Heidelberg gGmbH, Heidelberg, Germany
(Kemper) Medical Oncology, UKM - University Hospital Muenster, Muenster,
Germany
(Collienne) Oncology and Hematology Department, University Medical Center
Mannheim, Mannheim, Germany
(Berezucki) Pneumonology, University of Regensburg - Faculty of Medicine,
Regensburg, Germany
(Overbeck) Hematology and Medical Oncology Department, Universitatsmedizin
Gottingen, Goettingen, Germany
(Kropf) Pulmonology Department, University Hospital Ulm, Ulm, Germany
(Reck) Thoracic Oncology Department, LungenClinic Grosshansdorf,
Grosshansdorf, Germany
Publisher
Elsevier Ltd
Abstract
Background: Optimal duration of immune checkpoint blocker (ICB)-treatment
in lung cancer has not been determined yet. One in five patients treated
with first-line ICB achieves durable responses for >=2 years. Treatment
continuation beyond 2 years impacts on economic burden and might cause
avoidable toxicities. Thus, safe discontinuation strategies represent an
urgent medical need. Method(s): For this retrospective cohort
analysis, 430 nNGM-patients from 20 centers and stable on first-line
ICB-based treatment for >=2 years were enrolled into 2 cohorts, either
with a PET/CT after >=2 years and offer to discontinue treatment (A,
n=101) or with continued ICB administration without PET/CT (B, n=329).
Treatment outcome was assessed with PET/CT as a time-depending covariate.
 Result(s): Frequencies of (non-) squamous NSCLC and SCLC were 72%,
21% and 7%. In cohort A, median time to PET/CT was 26 months [25-27] with
a complete metabolic response (CMR) observed in 59 (58%) cases. In non-CMR
patients (n=42, 42%), 28 rebiopsies were performed (67%), confirming
residual vital cancer in 13 patients (46%). Of these, 10 patients (77%)
underwent subsequent local ablative treatments. Median duration of
ICB-treatment was 28 (A) vs. 44 months (B) (p<0.001), with the main
reasons for treatment discontinuation being the PET/CT (A: 89%) and
subsequent irAE (B: 31%). After a median FU of 46 months [44-49], HR for
PFS and OS (A vs. B) were 0.55 [0.31-0.96; p=0.03] and 0.45 [0.20-1.05; p=
0.06], respectively. Conclusion(s): Shorter treatment duration in
group A was not associated with inferior PFS or OS, and patients
benefitted from a lower incidence of treatment-limiting irAE.
PET/CT-guided treatment seems reasonable, might identify high-risk
patients and should be evaluated prospectively. [Formula presented] Legal
entity responsible for the study: The authors. Funding(s): German
Cancer Aid (Deutsche Krebshilfe). Disclosure: N. Frost: Financial
Interests, Personal, Advisory Board: AbbVie, Amgen, AstraZeneca, BeiGene,
BMS, Boehringer Ingelheim, Daiichi Sankyo, Janssen Oncology, Merck Serono,
MSD, Novartis, Pfizer, Roche, Takeda; Financial Interests, Personal,
Invited Speaker: Berlinchemie, Boehringer Ingelheim, Eli Lilly, MSD,
Roche, Sanofi, Regeneron; Financial Interests, Personal and Institutional,
Research Grant, ANTELOPE trial (NCT05689671): Roche; Non-Financial
Interests, Leadership Role, Member of the steering board, section thoracic
oncology: Working Group Medical Oncology within German Cancer Society
(AIO). M. Wiesweg: Financial Interests, Personal, Invited Speaker: Amgen,
Roche, Takeda, GSK, AstraZeneca, Daiichi Sankyo; Financial Interests,
Personal, Advisory Board: GSK, Novartis, Pfizer, Roche, Janssen, Daiichi
Sankyo, Bristol Myers Squibb; Financial Interests, Institutional, Local
PI: Takeda; Financial Interests, Institutional, Funding: Bristol Myers
Squibb. J. Kollmeier: Financial Interests, Institutional, Advisory Board:
Boehringer Ingelheim, MSD, Roche Pharma AG, Bristol Myers Squibb,
Janssen-Cilag GmbH; Financial Interests, Institutional, Local PI: MSD
Sharp & Dohme GmbH, Takeda, Roche Pharma AG, Novartis; Non-Financial
Interests, Member: Deutsche Gesellschaft fur Hamatologie und Onkologie,
Deutsche Krebsgesellschaft. N. Reinmuth: Financial Interests, Personal,
Invited Speaker, including Ad-Boards: AstraZeneca; Financial Interests,
Personal, Invited Speaker: Amgen, Daiichi Sankyo, F. Hoffmann-La Roche,
Lilly, Pfizer, Takeda, Merck, GSK; Financial Interests, Personal, Invited
Speaker, including Advisory Boards: Bristol Myers Squibb,
Boehringer-Ingelheim, MSD; Financial Interests, Institutional, Invited
Speaker: Sanofi. J. Roeper: Financial Interests, Personal, Invited
Speaker: AstraZeneca. A. Rittmeyer: Financial Interests, Personal,
Advisory Board: AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Daichi
Sankyo, Gilead, GSK, MSD, Eli Lilly, Novartis, Pfizer, Roche. S. Heinzen:
Financial Interests, Personal, Advisory Board: BeiGene; Financial
Interests, Personal, Invited Speaker: AstraZeneca GmbH; Financial
Interests, Institutional, Other, Congress and Travelling Support: BeiGene;
Financial Interests, Institutional, Research Grant, Research Award:
Novartis. F.C. Saalfeld: Financial Interests, Personal, Advisory Board:
Janssen, Takeda, AstraZeneca, Janssen, BMS; Financial Interests, Personal,
Invited Speaker: Pfizer, GWT TUD GmBH, AstraZeneca, Novartis, German
Society for Thoracic Surgery; Financial Interests, Personal, Writing
Engagement: Thieme; Financial Interests, Institutional, Research Grant:
Roche; Non-Financial Interests, Personal, Training: Lilly; Non-Financial
Interests, Member: German Cancer Society - AIO. C. Wesseler: Financial
Interests, Personal, Advisory Board: MSD, Boehringer Ingelheim, BMS,
Novocure; Financial Interests, Personal, Invited Speaker: Roche,
Boehringer Ingelheim, MSD, BMS, AstraZeneca, Lilly, Takeda, Novartis,
Pfizer, GSK, Chugai, Amgen, Novocure, Janssen; Financial Interests,
Institutional, Local PI: Gilead, Roche, MSD, Novartis, BMS, Takeda,
AstraZeneca, Novocure, Lilly, Janssen, Merus, Helsinn Healthcare. D.
Kauffmann-Guerrero: Financial Interests, Personal, Advisory Board: MSD,
Boehringer Ingelheim, Janssen, Pfizer, BMS; Financial Interests, Personal,
Invited Speaker: Roche. P. Christopoulos: Financial Interests, Personal,
Advisory Board: AstraZeneca, Boehringer Ingelheim, Chugai, Pfizer,
Novartis, MSD, Takeda, Roche, Daiichi Sankyo; Financial Interests,
Personal, Writing Engagement: Gilead; Financial Interests, Personal,
Invited Speaker: Thermo Fisher; Financial Interests, Institutional,
Funding: AstraZeneca, Boehringer Ingelheim, Amgen, Novartis, Roche;
Financial Interests, Personal, Funding: Takeda. M. Kemper: Financial
Interests, Personal and Institutional, Research Grant, InCa (Inflammation
and Lung Cancer) Award 2021: Novartis; Financial Interests, Personal,
Other, AIO Travel Grant ESMO 2023: Amgen, AstraZeneca, Daiichi Sankyo,
Janssen-Cilag, Roche Pharma, Takeda Pharma. M. Collienne: Financial
Interests, Personal, Invited Speaker: RG Gesellschaft fur Information und
Organisation mbH; Financial Interests, Institutional, Other, local
subinvestigator: AbbVie, MSD Sharp & Dohme GmbH, Pharma Mar, Roche,
IOVANCE biotherapeutics; Financial Interests, Institutional, Local PI:
Servier, Roche. T.R. Overbeck: Financial Interests, Personal, Advisory
Board: AstraZeneca, BMS, Boehringer Ingelheim, Eli Lilly, Merck, MSD,
Novartis, Roche, Takeda; Financial Interests, Personal, Other, travel
support: AstraZeneca, Boehringer-Ingelheim, Janssen-Cilag, Amgen, Daiichi
Sankyo. C. Kropf: Financial Interests, Personal, Advisory Board: Amgen,
AstraZeneca, AstraZeneca, Boehringer Ingelheim, BMS, Daiichi Sankyo,
Lilly, Novartis, MSD, Pfizer, Roche, Sanofi, Takeda; Financial Interests,
Personal, Invited Speaker: Amgen, Art Tempi, Boehringer Ingelheim, BMS,
Daiichi Sankyo, Lilly, Novartis, MSD, Pfizer, Regeneron, Roche, Sanofi,
Streamed up, Takeda; Financial Interests, Personal, Other, Reporting from
conferences as an expert: Onkowissen; Financial Interests, Institutional,
Local PI: AstraZeneca, Novartis. M. Reck: Financial Interests, Personal,
Invited Speaker: Amgen, AstraZeneca, BMS, Boehringer-Ingelheim, Lilly,
MSD, Merck, Novartis, Regeneron, Roche, Sanofi, GSK, Pfizer; Financial
Interests, Personal, Advisory Board: Amgen, AstraZeneca, BMS, BioNTech,
Boehringer-Ingelheim, Daiichi Sankyo, Gilead, MSD, Mirati, Pfizer,
Regeneron, Roche, Sanofi, GSK, Lilly; Financial Interests, Personal,
Other, Member of DMSB: Daiichi Sankyo; Financial Interests, Personal,
Coordinating PI: AstraZeneca; Financial Interests, Institutional, Steering
Committee Member: Amgen, Boehringer-Ingelheim, BeiGene, Daiichi Sankyo,
GSK, BMS, Lilly, MSD, Regeneron, Roche; Financial Interests,
Institutional, Local PI: Pfizer Seagen. All other authors have declared no
conflicts of interest. Copyright © 2024

<93>
Accession Number
2034600562
Title
THE UNCOMMON SEQUELAE OF MRSA SEPTIC EMBOLI: COMMON ILIAC MYCOTIC ANEURYSM
AND RENAL VEIN PSEUDOANEURYSM.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A949-A950),
2024. Date of Publication: October 2024.
Author
MCKINNEY D.A.; WEINSTOCK A.; KOSNIK N.R.; GHAFFAR M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Reports Posters (R) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: S. aureus bacteremia carries a significant risk of systemic
complication as nearly every tissue is susceptible. Infective endocarditis
(IE) from methicillin-resistant Staphylococcus aureus (MRSA-IE) has been
documented to cause between 26-43% of cases of IE in which a causative
pathogen is identified [Williams]. Risk factors for MRSA-IE include:
intravenous drug use, prolonged hospitalization, MRSA colonization,
invasive procedures, HIV infection, and long-term central venous access.
This report describes a case of MRSA-IE and the complications of this
process, including: septic embolism, multi-organ infarction, mycotic
aneurysm and critical limb ischemia. CASE PRESENTATION: A 20 year-old
female presented for evaluation of malaise and fever. Her medical history
was significant for intravenous drug use (amphetamines and heroin),
hepatitis C infection and infective endocarditis from MRSA infection
requiring mitral and tricuspid valvuloplasty. Initial evaluation noted
hypotension, tachycardia and fever. A sepsis alert resulted in intravenous
fluid (IVF) resuscitation, blood and urine collection for culture, and
initiation of broad-spectrum antibiotics (vancomycin and
piperacillin-tazobactam). Transthoracic echocardiogram (TTE) revealed the
presence of a 2.4 by 2.3 cm mobile vegetation on the anterior mitral valve
leaflet.Despite appropriate treatment, the patient developed severe,
acute-onset pain in her right lower extremity. Physical evaluation
revealed pulselessness by palpation and doppler ultrasonography in
addition to pallor and poikilothermia. Computed tomography angiogram (CTA)
with runoff confirmed acute arterial occlusion of the right common iliac
artery [Figure 1]. Additional findings included partial thrombosis of the
left femoral artery and left posterior tibial artery, as well as multiple
renal and splenic infarcts [Figure 2]. Immediate embolectomy and 4C
fasciotomy was performed, during which 5.4 by 5.7 cm mycotic aneurysm of
the right internal iliac artery was discovered, necessitating VBX stent
graft placement. DISCUSSION: S. aureus is a leading cause of bacteremia,
infective endocarditis (IE), device-related and osteoarticular infections.
20 -30 percent of bacteremia cases are directly attributable to S. aureus,
and 20 percent of those will result in mortality. While the incidence of
MRSA has decreased over the past several decades, that rate of decline has
slowed significantly. Additionally, cases involving methicillin-sensitive
species have become more frequent, especially as community-acquired
infections have increased [Kourtis]. MRSA Infective endocarditis (MRSA-IE)
is a feared complication, as the consequences of cardiac seeding have
far-reaching implications. The case is clearly demonstrative of the
potential for multi-organ involvement and infarction in the setting of
MRSA-IE. Septic embolization resulted in splenic infarction, renal vein
infarction and pseudoaneurysm, and embolization to the right common iliac
artery progressing to mycotic aneurysm and critical limb ischemia.
Vancomycin remains the recommended initial antibiotic choice, with
daptomycin as a reasonable alternative. Escalation of antibiotic therapy
will be required in cases involving resistant organisms, and if no single
agent option is appropriate, combination therapy is necessary. Commonly
recommended combinations include: daptomycin with ceftaroline or a
beta-lactam, or vancomycin with a hydrophilic beta-lactam or rifampin
[Rose]. CONCLUSION(S): The frequency of MRSA bacteremia, associated
complications and risk mortality remain an important topic. Prompt
initiation of management is critical, and close monitoring is imperative
for detection of complications. REFERENCE #1: Williams ML, Doyle MP,
McNamara N, Tardo D, Mathew M, Robinson B. Epidemiology of infective
endocarditis before versus after change of international guidelines: a
systematic review. Ther Adv Cardiovasc Dis. 2021
Jan-Dec;15:17539447211002687. doi: 10.1177/17539447211002687. PMID:
33784909; PMCID: PMC8020745. REFERENCE #2: Kourtis AP, Hatfield K, Baggs
J, Mu Y, See I, Epson E, Nadle J, Kainer MA, Dumyati G, Petit S, Ray SM;
Emerging Infections Program MRSA author group; Ham D, Capers C, Ewing H,
Coffin N, McDonald LC, Jernigan J, Cardo D. Vital Signs: Epidemiology and
Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible
Staphylococcus aureus Bloodstream Infections - United States. MMWR Morb
Mortal Wkly Rep. 2019 Mar 8;68(9):214-219. doi: 10.15585/mmwr.mm6809e1.
PMID: 30845118; PMCID: PMC6421967. REFERENCE #3: Rose W, Fantl M, Geriak
M, Nizet V, Sakoulas G. Current Paradigms of Combination Therapy in
Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia: Does it
Work, Which Combination, and For Which Patients? Clin Infect Dis. 2021 Dec
16;73(12):2353-2360. doi: 10.1093/cid/ciab452. PMID: 33993226; PMCID:
PMC8826002. DISCLOSURES: No relevant relationships by Muhammad Ghaffar No
relevant relationships by Noah Kosnik No relevant relationships by Duncan
McKinney No relevant relationships by Anthony Weinstock Copyright
© 2024 American College of Chest Physicians

<94>
Accession Number
2034599998
Title
IDENTIFICATION OF WHOLE LUNG TORSION ON CT SCAN IMAGING FOLLOWING
LINGULA-SPARING LEFT UPPER LOBECTOMY.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3993-A3994), 2024. Date of Publication: October 2024.
Author
ZAMAN S.A.I.F.; MONTANO M.; DIXE DE OLIVEIRA SANTO I.; TRAUBE L.E.A.H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Intriguing Imaging SESSION TYPE: Case Reports PRESENTED ON:
10/07/2024 01:30 pm - 02:30 pm INTRODUCTION: Lobar torsion was first
described in 1930 upon autopsy by Epplen and Jacobson.[1] Etiologies of
lung torsion can vary from spontaneous to traumatic to any intrathoracic
intervention.[2] Torsion is characterized by the rotation of the whole
lung at hilum, which can result in impaired blood flow with subsequent
ischemia. The true incidence is to difficult deduce, but there are
estimates between 0.089- 0.3%, with overall mortality of torsion
associated with lobectomy approximating at 8.3%.[3-6] Clinical
manifestation can be non-specific and include dyspnea, fever, and chest
pain with primary diagnostic evaluation being computed tomography
(CT).[7,8] While lung torsion is a rare diagnosis, its recognition and
intervention is critical to prevent mortality. Dr. Benjamin Felson
described characteristic radiographic findings such as hilar displacement
in an inappropriate direction, alterations in pulmonary vasculature, and
rapid opacification of an ipsilateral lobe.[9] Additional characteristic
CT imaging findings include rotation of the lung around its vascular
pedicle, resulting "swirling" appearance of the related vasculature.[7]
Management includes surgical detorsion, lobectomy, or monitoring with the
severity being considered. When surgical intervention is necessary,
segment-preserving surgery is preferred unless infarction is present for
which lobectomy is warranted.[10] In this report, we present a case of
whole lung torsion and lingular infarction post lingula-sparing left upper
lobectomy (LUL) in a patient with squamous cell carcinoma with the aim to
highlight early detection/treatment in a condition that carries a high
mortality should there be delays in treatment.[11] CASE PRESENTATION: A
67-year-old woman with history of anti-phospholipid syndrome (APLS), deep
vein thrombosis, and gastrointestinal (GI) arteriovenous malformations who
presented with a left upper lobe nodule on a routine CT scan. Squamous
cell carcinoma was confirmed with biopsy and further staging scans to
reveal a PT1aNO lesion for which a lingula-sparing LUL was planned.
Immediately post-operative the patient developed a left-sided pneumothorax
requiring a left thoracostomy tube. A chest x-ray at that time revealed
subcutaneous emphysema with expected postsurgical changes including chain
sutures adjacent to the left hilum. On postoperative day 1 (POD#1), the
chest radiograph revealed re-expansion of the left lung. Retrospectively,
there is displacement of the sutures, suggesting this could be when the
torsion occurred (Figure 1). The patient was discharged on POD#6 and
returned on POD#10 with cough and dyspnea, unremarkable vital signs, and a
mild leukocytosis with persistent anemia. Given history of APLS/DVT - CT
angiography was obtained to evaluate for embolism, but was remarkable for
left lung torsion with twisting of the bronchovascular structures at the
hilum (Figure 2). Subsequently, the patient underwent an uneventful
video-assisted thoracoscopic surgery with lingulectomy and was discharged
home without incident. DISCUSSION: This case highlights lung torsion
following LUL, likely precipitated by anatomical alterations during
surgery and a postoperative pneumothorax. Prompt recognition via CT
imaging and intervention are crucial to prevent further ischemic injury
and mortality. CONCLUSION(S): Early recognition and treatment of lung
torsion is critical in preventing progressive morbidity and mortality. CT
imaging plays a pivotal role in diagnosis and decision-making, emphasizing
the importance of understanding potential precipitating factors for this
rare phenomenon. REFERENCE #1: 1. Epplen, F. & Jacobson, A. L. TWISTED
PEDICLE OF ACCESSORY LOBE OF THE LUNG. J. Am. Med. Assoc. 94, 1135 (1930).
2. Jalota Sahota, R. & Anjum, F. Lung Torsion. in StatPearls (StatPearls
Publishing, 2023). 3. Larsson, S., Lepore, V., Dernevik, L., Nilsson, F. &
Selin, K. Torsion of a lung lobe: diagnosis and treatment. Thorac.
Cardiovasc. Surg. 36, 281-283 (1988). 4. Keagy, B. A. et al. Elective
pulmonary lobectomy: factors associated with morbidity and operative
mortality. Ann. Thorac. Surg. 40, 349-352 (1985). 5. Cable, D. G. et al.
Lobar torsion after pulmonary resection: Presentation and outcome. J.
Thorac. Cardiovasc. Surg. 122, 1091-1093 (2001). 6. Dai, J. et al.
Predictors of survival in lung torsion: A systematic review and pooled
analysis. J. Thorac. Cardiovasc. Surg. 152, 737-745.e3 (2016). 7. Hammer,
M. M. & Madan, R. Clinical and imaging features in lung torsion and
description of a novel imaging sign. Emerg. Radiol. 25, 121-127 (2018). 8.
Jhala, K., Madan, R. & Hammer, M. A pictorial review of lung torsion using
3D CT cinematic rendering. Emerg. Radiol. 28, 171-176 (2021). 9. Felson,
B. Lung torsion: radiographic findings in nine cases. Radiology 162,
631-638 (1987).10. Taira, N. et al. Postoperative Lung Torsion With
Retained Viability: The Presentation and Surgical Indications. Heart Lung
Circ. 27, 849-852 (2018). 11. Purohit, M. & Zacharias, J. A simple
reproducible method of preventing lobar torsion. J. Cardiothorac. Surg. 3,
22 (2008). DISCLOSURES: No relevant relationships by Irene Dixe de
Oliveira Santo No relevant relationships by Mason Montano No relevant
relationships by Leah Traube No relevant relationships by Saif
Zaman Copyright © 2024 American College of Chest Physicians

<95>
Accession Number
2034598298
Title
IMPACT OF THE SPO2 TARGET AND DIFFERENT OXIMETERS ON THE OXYGEN FLOW RATES
USED IN PATIENTS HOSPITALIZED FOR ACUTE RESPIRATORY DISTRESS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3010-A3011), 2024. Date of Publication: October 2024.
Author
LELLOUCHE F.; BOUCHARD P.I.E.; MALTAIS F.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Influential Factors Shaping Critical Care Management
Practices SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/08/2024
01:45 pm - 02:30 pm PURPOSE: The choice of the SpO<inf>2</inf> target and
the brand of oximeter significantly influence the oxygen flow rates
administered to post-operative cardiac surgery patients (1). The study
objectives were to evaluate the impact of combining multiple SpO2 targets
and multiple brands of oximeters on oxygen flow rates and oxygen weaning
in different populations with acute respiratory failure hospitalized in
the ward. METHOD(S): We are conducting a randomized crossover study
in 40 patients requiring oxygen therapy administered via nasal cannula: 20
with an acute exacerbation of COPD and 20 with other causes of acute
respiratory failure (ARF). In patients with COPD, 3 SpO2 targets were
assessed (88, 90 and 92%), in other patients, four targets were assessed
(90, 92, 94 and 96%). Three oximeters were evaluated (Nonin, Nellcor and
Philips) each time. The randomized periods were carried out in all
patients and after 2 minutes of stability, the oxygen flow was noted. We
compared oxygen flow rates (primary endpoint), partial oxygen weaning
(O2<0.5L/min) or complete and the frequency of high oxygen requirements
(O2>5L/min). RESULT(S): We present preliminary data based on the
first 32 patients (including 19 with COPD), mean age 75 +/- 7 years, 33%
were women, all had light skin pigmentation, none had shock. At baseline,
mean SpO2 was 90.6+/-2.5% and mean oxygen flow was 1.9+/-1.0L/min. The
main results regarding oxygen flow during different periods for patients
with ARF are shown in the figure. In this same population, the rate of
partial or complete oxygen weaning was 69% in the Philips90 period and 8%
in the Nonin96 period (P<0.001). The frequency of high oxygen flow rates
was 0% in the Philips90 period and 38% in the Nonin96 period (P<0.001).
The oxygen ratio (oxygen flow with one condition/oxygen flow with other
condition) are the following: Nonin96/Philips90=7.4;
Nonin96/Nellcor90=4.3; Nonin94/Nonin90=1.8; Nonin96/Nonin92=1.7;
Nellcor94/Nellcor90=3.1; Nellcor96/Nellcor92=2.0; Philips
94/Philips90=3.2; Philips96/Philips92=2.7; Nonin90/Nellcor92=0.9;
Nonin90/Philips94=0.9; Nonin92/Nellcor94=0.8; Nonin92/Philips96=0.9).
 CONCLUSION(S): In patients requiring conventional oxygen therapy,
SpO2 target, oximeter brand, and the combination of the two have a
significant impact on oxygen flow rates, oxygen weaning, or use of high
flow rates which may require other respiratory support. CLINICAL
IMPLICATIONS: These data highlight the need to take into account the
confounding factors of oxygen therapy in clinic and research (2). The same
patient may require significantly more oxygen with two different SpO2
targets as expected, but also with two different pulse oximeters.
DISCLOSURES: No relevant relationships by Pie Bouchard No relevant
relationships by Francois Lellouche Speaker/Speaker's Bureau relationship
with Grifols Please note: $1001 - $5000 by Francois Maltais,
value=Honoraria Removed 03/23/2024 by Francois Maltais, source=Web
Response Grant relationship with GSK Please note: $20001 - $100000 by
Francois Maltais, value=Grant/Research Support Grant relationship with
Novaris Please note: >$100000 by Francois Maltais, value=Grant/Research
Support Removed 03/23/2024 by Francois Maltais, source=Web Response Grant
relationship with AstraZeneca Please note: >$100000 by Francois Maltais,
value=Grant/Research Support Speaker/Speaker's relationship with GSK
Please note: 2020-2022 by Francois Maltais, value=Honoraria
Speaker/Speaker's Bureau relationship with AstraZeneca Please note:
2021-2024 Added 03/23/2024 by Francois Maltais, source=Web Response,
value=Honoraria Copyright © 2024 American College of Chest
Physicians

<96>
Accession Number
2034597929
Title
DON'T DELAY, DIALYZE TODAY: INITIATION OF HEMODIALYSIS IN A PATIENT WITH
SUSPECTED TOXIN INGESTION AND HYPEROSMOLARITY.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A2075-A2076), 2024. Date of Publication: October 2024.
Author
PERHAM Z.O.E.Y.; PALUMBO S.A.; YERRAMREDDY A.; SINGH D.; PALUMBO R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Reports Posters (AR) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am INTRODUCTION:
Hyperosmolarity and acidosis are frequently identified as the initial
laboratory findings in ethylene glycol toxicity[1]. Unfortunately, at many
facilities ethylene glycol levels are not readily available acutely, so
management may depend on other lab tests including osmolarity. Ultimately,
hemodialysis has been cited as effective for management of multiple toxin
ingestions, including ethylene glycol[2-3]. CASE PRESENTATION: This
patient is a 61-year-old male with past medical history of non-insulin
dependent diabetes, hypertension, hyperlipidemia, paroxysmal atrial
fibrillation with left atrial appendage closure device, nonischemic
cardiomyopathy with CRT-D, aortic stenosis with bioprosthetic valve
replacement, and unspecified psychiatric disorder with history of suicidal
ideation, who presented with chest discomfort. He denied other symptoms at
the time of presentation, however he was exhibiting slurred speech and
stroke workup was initiated. Initial head CT was negative; however, the
patient continued to have slurred speech. He became confused but was able
to follow simple commands. After admission, he experienced a fall, and
subsequent repeat head CT was negative as well; however, his mental status
continued to worsen and he developed respiratory distress. At this time,
12 hours after his initial evaluation, he was transferred to the ICU and
laboratory studies revealed anion gap metabolic acidosis, high osmolar
gap, elevated acetaminophen level, and acute renal failure. The patient
was intubated due to worsening respiratory distress and hypoxia. At this
time, toxic ingestion was suspected, despite patient denying ingestion of
any substances prior to his clinical deterioration. He was treated with
N-acetylcysteine protocol for acetaminophen toxicity and emergent
hemodialysis due to hyperosmolarity and profound acidosis, which indicated
the possibility of a toxic alcohol ingestion. After two rounds of dialysis
his acidosis and hyperosmolarity resolved, mental status improved, and he
was successfully extubated. Ethylene glycol level resulted as elevated
after been extubated and his metabolic derangements resolved. He denied
ingestion of substances including acetaminophen, despite laboratory
evidence of toxin ingestion; however, the patient's family confirmed
finding at least one empty bottle of acetaminophen in the patient's car.
His renal function subsequently improved, and he was eventually discharged
to a psychiatric facility and is not hemodialysis dependent following his
hospitalization. DISCUSSION: This case demonstrates hyperosmolarity
secondary to suspected toxin ingestion as an indication for hemodialysis.
It was suspected that this patient had ingested a volatile alcohol, though
there was no laboratory evidence to support it at time of hemodialysis
initiation, and though hyperosmolarity alone is not considered an
indication for hemodialysis[4], in cases of toxin ingestion dialysis
should be considered especially in such cases when the ability to obtain
levels of the toxin in question will be delayed[5]. In this case, the
combination of ethylene glycol and acetaminophen causing severe metabolic
derangement was considered an indication for hemodialysis[2]. Prompt
initiation of treatment in these patients has been shown to decrease
morbidity and mortality4, and dialysis should be considered in addition to
or without antidotes. CONCLUSION(S): In patients presenting with
unknown and possibly multiple toxin ingestions who are critically ill with
hyperosmolarity, hemodialysis should be strongly considered for acute
clearance of toxins with or without antidotes. REFERENCE #1: 1. Y. Ahmad,
S. Kissling, C. Torrent, J.-D. Chiche, L. Liaudet, Z. Ltaief. The three
biological gaps and hyperoxaluria in ethylene glycol poisoning: case
presentation and review. 2. Aibek E. Mirrakhimov, Aram Barbaryan, Adam
Gray, Taha Ayach, "The Role of Renal Replacement Therapy in the Management
of Pharmacologic Poisonings", International Journal of Nephrology, vol.
2016, Article ID 3047329, 12 pages, 2016.
https://doi.org/10.1155/2016/3047329 REFERENCE #2: 3. Ghannoum, M.,
Gosselin, S., Hoffman, R.S. et al. Extracorporeal treatment for ethylene
glycol poisoning: systematic review and recommendations from the EXTRIP
workgroup. Crit Care 27, 56 (2023).
https://doi.org/10.1186/s13054-022-04227-2. 4. Scalley RD, Ferguson DR,
Piccaro JC, Smart ML, Archie TE. Treatment of ethylene glycol poisoning.
Am Fam Physician. 2002 Sep 1;66(5):807-12. PMID: 12322772. REFERENCE #3:
5. Pizon AF, Brooks DE. Hyperosmolality: another indication for
hemodialysis following acute ethylene glycol poisoning. Clin Toxicol
(Phila). 2006;44(2):181-3. doi: 10.1080/15563650500514582. PMID: 16615677.
DISCLOSURES: No relevant relationships by Sarah Palumbo No relevant
relationships by Ralph Palumbo No relevant relationships by Zoey Perham No
relevant relationships by Devanshi Singh No relevant relationships by
Ananya Yerramreddy Copyright © 2024 American College of Chest
Physicians

<97>
Accession Number
2034597764
Title
A TUMULTUOUS JOURNEY WITH ACUTE RESPIRATORY DISTRESS SYNDROME REQUIRING
EXTRACORPOREAL MEMBRANE OXYGENATON COMPLICATED BY RIGHT ATRIAL
PERFORATION.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A1905-A1906), 2024. Date of Publication: October 2024.
Author
VO R.; BESAS J.; PURI I.S.H.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Reports Posters (BJ) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm INTRODUCTION:
Acute respiratory distress syndrome (ARDS) is a life-threatening lung
injury characterized by diffuse inflammation resulting in non-compliant
lungs, which can lead to hypoxemia and multi-organ failure. Conventional
management includes treatment of the underlying cause, lung protective
ventilation, prone positioning, and prevention of ventilator induced lung
injury (VILI). Extracorporeal membrane oxygenation (ECMO) is a means for
lung protective ventilation associated with a decreased mortality of
eligible patients with ARDS compared to mechanical ventilation. CASE
PRESENTATION: 54-year-old male presented with cough and fever of 6 days'
duration. Initial work-up revealed bilateral interstitial opacities on
chest radiography and positive influenza A PCR. Over the next 24 hours, he
experienced worsening hypoxemia and was emergently intubated. Work-up was
negative for thromboembolism and cardiac etiology for this ongoing
hypoxemia. The clinical picture was consistent with ARDS secondary to
influenza A infection. Despite low tidal volume ventilation, prone
positioning, and paralytics, he remained severely hypoxemic, and the
decision was made to initiate VV-ECMO on day five. Cannulation was
complicated by hemorrhagic cardiac tamponade leading to cardiac arrest.
Resuscitation included ACLS and a bedside pericardial window. Emergent
mediastinal exploration revealed 1-cm perforation of the right atrium,
which was repaired, and he was centrally cannulated for VA-ECMO. He
developed renal failure requiring dialysis and ECMO-associated
complications including hemolysis, intracerebral hemorrhage, and
thrombosis. He remained on VA-ECMO for eight days followed by VV-ECMO for
five days. Ultimately, he was discharged to LTAC with tracheostomy and
PEG. To date, he is on tracheostomy collar, uses a speaking valve, and can
follow commands. DISCUSSION: ECMO provides an alternative means for lung
protective ventilation and reduction of VILI in severe cases of ARDS that
fail conventional management. Meta-analyses by Munshi et al. and Combes et
al. found a reduction in both 60-day and 90-day mortality compared to
mechanical ventilation, respectively. The decision to initiate ECMO is
patient-specific; however, prognostic factors include age, disease
severity and reversibility, organ dysfunction, and days on mechanical
ventilation prior to ECMO initiation. Common complications include
bleeding, thromboembolism, intracerebral hemorrhage or infarct, hemolysis,
heparin-induced thrombocytopenia, and sepsis. The extracorporeal life
support organization (ELSO) registry indicates that incidence of
cannulation-related complications is less than 5% and that the historical
rate of hemorrhagic pericardial effusion was 0.53% from 1985 to 2010. It
has been proposed that the lack of rigidity with guidewires used in ECMO
cannulation carries an increased risk of perforation due to risk of
intracardiac looping. The overall 5-year survival rate in those who
received ECMO versus mechanical ventilation and survived to 30-days range
from 60-80%. Long-term follow-up of ARDS patients post-mechanical
ventilation vs. post-ECMO showed normal or near-normal PFTs, though there
are findings of interstitial fibrosis on high-resolution CT, seen by
Herridge et al. and Linden et al. respectively. CONCLUSION(S): As
compared to mechanical ventilation, ECMO is another means for lung
protective ventilation and reduction of VILI in those with severe ARDS. A
multidisciplinary team involving intensivists, cardiologists,
cardiothoracic surgeons, and nurses is crucial for handling the complex
care needs of ECMO patients and early recognition of its associated
complications. REFERENCE #1: Charlesworth, M., & Ashworth, A. D. (2018).
Reducing the Risk of Cardiac Perforation During Placement of Bicaval
Veno-Venous Extracorporeal Membrane Oxygenation Cannulae. Journal of
Cardiothoracic and Vascular Anesthesia, 32(1), e19-e20.
https://doi.org/10.1053/j.jvca.2017.09.003 REFERENCE #2: Palakshappa, J.
A., Krall, J. T. W., Belfield, L. T., & Files, D. C. (2021). Long-Term
Outcomes in Acute Respiratory Distress Syndrome. Critical Care Clinics,
37(4), 895-911. https://doi.org/10.1016/j.ccc.2021.05.010 REFERENCE #3:
Rossong, H., Debreuil, S., Yan, W., Hiebert, B. M., Singal, R. K., Arora,
R. C., & Yamashita, M. H. (2022). Long-term survival and quality of life
after extracorporeal membrane oxygenation. The Journal of Thoracic and
Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2021.10.077
DISCLOSURES: No relevant relationships by Jonathan Besas No relevant
relationships by Isha Puri No relevant relationships by Russell
Vo Copyright © 2024 American College of Chest Physicians

<98>
Accession Number
2034597630
Title
AN UNUSUAL CASE OF LUNG CANCER PRESENTING AS TAMPONADE.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A4102-A4103), 2024. Date of Publication: October 2024.
Author
NANCE B.K.; CHOUBDAR P.; SINGH K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Diagnostic Dilemmas in Malignancy SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/07/2024 12:30 pm - 01:15 pm INTRODUCTION:
Non-small cell lung cancer has been found to be the most common cause of
malignant pericardial effusion, per systematic review. Recurrence rate has
been shown to be as high as 40% leading to the need for more definitive
treatment. We present a case of non-small cell lung cancer presenting as
cardiac tamponade and discuss the various treatment options for
recurrence. CASE PRESENTATION: Patient is a 62-year-old male with a past
medical history significant for hypertension and a 20 pack year smoker
(quit 20 years prior to presentation) who initially presented to our
facility as a transfer from an outside hospital due to evaluation of a
pericardial effusion. Three days prior to presentation he developed
bilateral lower extremity edema and exertional dyspnea. He denied
receiving age appropriate cancer screening. Labs were remarkable only for
some mildly elevated liver enzymes. CT abdomen/pelvis demonstrated
bilateral pleural effusions and a large pericardial effusion. EKG
demonstrated electrical alternans. Point of care ultrasound demonstrated
RV diastolic collapse. His presentation was consistent with cardiac
tamponade for which he had a pericardiocentesis with removal of 750 cc
hemorrhagic fluid. Cytology studies resulted in metastatic adenocarcinoma
with suspicion of lung as primary. He had a PET/CT scan which demonstrated
consolidation in the lingula with central cavitation, SUV 8.5, and
mediastinal lymphadenopathy. He was referred to an oncologist who felt
this presentation was consistent with stage IV non-small cell lung cancer.
DISCUSSION: It's reported that 15 to 35% of lung cancer patients have
cardiac metastasis per autopsy results. Non-small cell lung cancer is the
most frequent cause of malignant pericardial effusion which occurs mainly
by retrograde lymphatic migration of tumor cells. In the setting of
tamponade, pericardiocentesis provides symptomatic relief and hemodynamic
stability but there is a fivefold greater need for reintervention in this
cohort of patients compared to non-neoplastic effusions. There is an
estimated 40% recurrence rate after an isolated pericardiocentesis.
Studies have evaluated more definitive therapy with recurrence rates for
extended catheter drainage, pericardial sclerosis, and percutaneous
balloon pericardiotomy of 12.1, 10.8 and 10.3% respectively. One study
evaluated the use of Bleomycin as a sclerosing agent and demonstrated a
one-year pericardial effusion free survival rate of 74.0%. The 6-, 12- and
24-months overall survival rates were 38.8, 33.9 and 14.5% respectively.
It was found that the worst prognosis was in those not suitable for
systemic treatments and it's reasonable to consider only
pericardiocentesis for such patients. It's currently a class IIa
recommendation to consider instillation of intrapericardial Cisplatin for
malignant pericardial effusion in the setting of lung cancer per the
European Society of Cardiology. CONCLUSION(S): Cardiac tamponade can
be the first presentation of underlying malignancy. While the immediate
treatment includes pericardiocentesis, it's important to consider the high
recurrence rate especially in the setting of non-small cell lung cancer.
We hope this paper sheds light on the need for more definitive therapy in
the setting of preventing recurrence for malignant pericardial effusion.
More studies directly comparing the various treatment options to prevent
recurrence and side effect profile are warranted. REFERENCE #1: Numico,
G., Cristofano, A., Occelli, M., Sicuro, M., Mozzicafreddo, A., Fea, E.,
Colantonio, I., Merlano, M., Piovano, P., & Silvestris, N. (2016).
Prolonged Drainage and Intrapericardial Bleomycin Administration for
Cardiac Tamponade Secondary to Cancer-Related Pericardial Effusion.
Medicine (Baltimore), 95(15), e3273-.
https://doi.org/10.1097/MD.0000000000003273 REFERENCE #2: Lee, L. N.,
Yang, P. C., Chang, D. B., Yu, C. J., Ko, J. C., Liaw, Y. S., Wu, R. G., &
Luh, K. T. (1994). Ultrasound guided pericardial drainage and
intrapericardial instillation of mitomycin C for malignant pericardial
effusion. Thorax, 49(6), 594-595. https://doi.org/10.1136/thx.49.6.594
REFERENCE #3: Adler, Y., Charron, P., Imazio, M., Badano, L.,
Baron-Esquivias, G., Bogaert, J., Brucato, A., Gueret, P., Klingel, K.,
Lionis, C., Maisch, B., Mayosi, B., Pavie, A., Ristic, A. D., Sabate
Tenas, M., Seferovic, P., Swedberg, K., & Tomkowski, W. (2015). 2015 ESC
Guidelines for the diagnosis and management of pericardial diseases: The
Task Force for the Diagnosis and Management of Pericardial Diseases of the
European Society of Cardiology (ESC)Endorsed by: The European Association
for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 36(42),
2921-2964. https://doi.org/10.1093/eurheartj/ehv318 DISCLOSURES: No
relevant relationships by Parnia Choubdar No relevant relationships by
Brandon Nance No relevant relationships by Karan Singh Copyright
© 2024 American College of Chest Physicians

<99>
Accession Number
2034597287
Title
LEFT ATRIAL APPENDAGE OCCLUSION DURING CARDIAC SURGERY TO PREVENT STROKE:
A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A316),
2024. Date of Publication: October 2024.
Author
SAYED A.L.A.A.; KAMAL A.; KAMAL I.; FATHALLAH A.H.; NOURELDEN A.Z.I.Z.;
ZAIDI S.A.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Mechanical Devices Cardiac Support and Beyond SESSION TYPE:
Rapid Fire Original Inv PRESENTED ON: 10/08/2024 01:45 pm - 02:30 pm
PURPOSE: Introduction: Atrial fibrillation accounts for one-sixth of all
strokes, potentially leading to significant disability and death. The left
atrial appendage (LAA) is the most common location for thrombus formation
that can cause ischemic strokes. Excluding the LAA has been hypothesized
to decrease the risk of ischemic strokes. This study examines LAA
occlusion (LAAO) with otherwise indicated cardiac surgery and its effect
on surgical outcomes. METHOD(S): Methods: We followed the standards
recommended by the Cochrane Collaborative Group and PRISMA checklist to
prepare this systematic review and meta-analysis. Studies were retrieved
through an online bibliographic search, studies were screened, and data
were extracted. We compared the two study arms (LAAO and cardiac surgery
without LAAO). Ten studies were included in this study. RESULT(S):
Results: LAAO is associated with significantly higher operative time
(p<0.0001). There was no significant difference in all-cause mortality
(p=0.98) and systemic embolism (p=0.31). There was a significantly lower
risk of strokes (p< 0.0001) and, particularly, ischemic strokes (p
=0.0007) in patients who underwent LAAO during their cardiac surgery.
 CONCLUSION(S): Current evidence supports LAAO during cardiac surgery.
It significantly attenuates the risk for stroke events without significant
change in operative time. CLINICAL IMPLICATIONS: LAAO can be done safely
with other cardiac surgeries when performed concurrently. LAAO can
complement the chemical anticoagulation regimen. Even with the limitations
reported, LAAO is associated with a lower risk of stroke (and particularly
ischemic strokes). Further studies are needed to shape guidance on the
continuation versus discontinuation of chemical anticoagulation after
LAAO, especially in the patients with a higher risk of bleeding.
DISCLOSURES: No relevant relationships by Ahmed Hashem Fathallah No
relevant relationships by Abdallah Kamal No relevant relationships by
Ibrahim Kamal No relevant relationships by Anas Zakarya Ibrahim Zaky
Nourelden No relevant relationships by Alaa Sayed No relevant
relationships by Syed Arsalan Zaidi Copyright © 2024 American
College of Chest Physicians

<100>
Accession Number
2034596866
Title
ALL THAT AND A BAG OF B12: FIVE PRESSOR REFRACTORY VASOPLEGIC SHOCK
TREATED WITH HIGH-DOSE HYDROXOCOBALAMIN.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A2662-A2663), 2024. Date of Publication: October 2024.
Author
MEHTA M.; FOSTER R.; GREER M.K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Shocking Shock Cases SESSION TYPE: Rapid Fire Case Reports
PRESENTED ON: 10/09/2024 10:20 am - 11:05 am INTRODUCTION:
Hydroxocobalamin has been historically effective in vasoplegia during
cardiac surgery. More recently, it has been used for septic shock. We
present a case of successful hydroxocobalamin use for refractory
distributive shock after toxic ingestion. CASE PRESENTATION: A 26-year-old
man with paranoid schizophrenia was admitted to the medical intensive care
unit with emesis, abdominal pain, and shock after a reported ingestion of
aripiprazole and amlodipine. He rapidly developed multi-organ dysfunction
including electrolyte derangements, acute tubular necrosis requiring renal
replacement therapy, and respiratory failure requiring intubation. His
shock was determined to be distributive as bedside echocardiogram showed
adequate volume status and cardiac function and CT was negative for PE. CT
chest/abdomen/pelvis showed bibasilar ground glass opacities consistent
with aspiration and findings concerning for pancreatitis. Given the
severity of his illness he was started on broad-spectrum antibiotics with
subsequent addition of antifungals. He continued to have severe
hypotension despite 5 liters of IV fluids, high dose norepinephrine,
vasopressin, and stress dose steroids. Over the first 48 hours of
admission, his metabolic acidosis worsened, and his mean arterial pressure
(MAP) remained below 50 mmHg despite addition of epinephrine,
phenylephrine, and angiotensin II. Given concern for amlodipine ingestion
and significant hypocalcemia, IV calcium was administered with only
temporary improvement despite repeated dosing. He received 2 doses of
methylene blue, also with only transient improvement in his MAP. Given
persistent vasoplegia 60 hours after admission, he was given 5 g IV
hydroxocobalamin (vitamin B12a) and during the subsequent 48 hours was
able to be weaned off all vasopressors. DISCUSSION: A high dose of
hydroxocobalamin (vitamin B12), or a Cyanokit, was initially approved for
cyanide poisoning, but recent evidence shows its efficacy in treating
vasoplegic shock. Vasoplegia is refractory hypotension that is associated
with increased production of the vasodilators nitric oxide (NO) and
hydrogen sulfide (H2S). Hydroxocobalamin directly inhibits NO and NO
synthase and increases the elimination of sulfide preventing H2S
formation. This results in a vasopressor effect that catecholamines cannot
achieve. Several case reports, a case series, and a randomized,
double-blind, placebo-controlled clinical trial support hydroxocobalamin's
efficacy in improving MAP and reducing vasopressor requirements in
refractory septic shock. As patients with septic shock are known to have
high levels of H2S, hydroxocobalamin's inhibition of further H2S formation
leads to reduced vasodilation with improvements in MAP lasting up to 24
hours. Hydroxocobalamin has also been successfully used in two cases of
calcium channel blocker (nimodipine) induced vasoplegia. Importantly, the
adverse effects of hydroxocobalamin are minimal-chromaturia, rash, and
headaches-compared to other vasopressors including methylene blue which
can cause serotonin syndrome and hemolysis. Our patient had distributive
shock refractory to catecholaminergic vasopressors, two doses of methylene
blue, and calcium repletion. Hydroxocobalamin is the only medication that
stabilized his blood pressure allowing time for calcium channel blocker
excretion and potential sepsis to resolve. CONCLUSION(S): High dose
hydroxocobalamin (Cyanokit) is a minimal risk, effective salvage agent for
vasoplegia in distributive shock, including in sepsis and calcium channel
blocker overdose. It should be considered in patients with catecholamine
resistant shock. REFERENCE #1: Busse, L. W., Barker, N., & Petersen, C.
(2020). Vasoplegic syndrome following cardiothoracic surgery-review of
pathophysiology and update of treatment options. Critical Care, 24, 1-11.
Cooper, T. M., Shewmaker, J. W., & Blunck, J. R. (2021). Hydroxocobalamin
rescue from nimodipine-induced refractory vasoplegia. Clinical Neurology
and Neurosurgery, 211, 107026. REFERENCE #2: Lin, Y., & Vu, T. Q. (2019).
Use of High-Dose Hydroxocobalamin for Septic Shock: A Case Report. A&A
practice, 12(9), 332-335. https://doi.org/10.1213/XAA.0000000000000928
Patel, J. J., Willoughby, R., Peterson, J., Carver, T., Zelten, J.,
Markiewicz, A., Spiegelhoff, K., Hipp, L. A., Canales, B., Szabo, A.,
Heyland, D. K., Stoppe, C., Zielonka, J., & Freed, J. K. (2023). High-Dose
IV Hydroxocobalamin (Vitamin B12) in Septic Shock: A Double-Blind,
Allocation-Concealed, Placebo-Controlled Single-Center Pilot Randomized
Controlled Trial (The Intravenous Hydroxocobalamin in Septic Shock Trial).
Chest, 163(2), 303-312. https://doi.org/10.1016/j.chest.2022.09.021
REFERENCE #3: Rosen, P. J., Johnson, C., McGehee, W. G., & Beutler, E.
(1971). Failure of methylene blue treatment in toxic methemoglobinemia.
Association with glucose-6-phosphate dehydrogenase deficiency. Annals of
internal medicine, 75(1), 83-86. https://doi.org/10.7326/0003-4819-75-1-83
Sacco, A. J., Cunningham, C. A., Kosiorek, H. E., & Sen, A. (2021).
Hydroxocobalamin in Refractory Septic Shock: A Retrospective Case Series.
Critical care explorations, 3(4), e0408.
https://doi.org/10.1097/CCE.0000000000000408 Shapeton, A. D., Mahmood, F.,
& Ortoleva, J. P. (2019). Hydroxocobalamin for the treatment of
vasoplegia: a review of current literature and considerations for use.
Journal of Cardiothoracic and Vascular Anesthesia, 33(4), 894-901.
DISCLOSURES: No relevant relationships by Robert Foster No relevant
relationships by Meredith Greer No relevant relationships by Monica
Mehta Copyright © 2024 American College of Chest Physicians

<101>
Accession Number
2034596528
Title
UNVEILING HEYDE SYNDROME: A CASE OF SEVERE AORTIC STENOSIS AND
GASTROINTESTINAL BLEEDING WITHOUT VON WILLEBRAND SYNDROME.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A556-A557),
2024. Date of Publication: October 2024.
Author
SEKULITS A.; ALCOCER F.; NABI S.; SANTIAGO ZAYAS L.U.I.S.; DEVINE
A.D.A.M.; RODRIGUEZ CASTRO J.L.; DANCKERS M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Reports Posters (V) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Heyde Syndrome (HS) is a complex condition characterized by
the triad of aortic stenosis (AS), gastrointestinal bleeding, and acquired
von Willebrand syndrome (AVWS). First identified in 1958, it poses
significant challenges due to late diagnosis, leading to prolonged
hospital stays and increased mortality rates among the elderly. Aortic
valve repair has shown promising outcomes in alleviating symptoms
associated with HS. Here, we present a case highlighting the overlooked
diagnosis of Heyde Syndrome in a patient during two previous admissions.
CASE PRESENTATION: Our 67-year-old male patient, with a medical history
including erosive gastritis, diverticulosis, and aortic stenosis,
presented to the hospital with chest pain a week after a previous
discharge. On admission, he exhibited hypotension (96/60), a heart rate of
92 bpm, and a respiratory rate of 22. Laboratory findings showed a
hemoglobin level of 6.5, elevated troponin at 0.092, and a BNP of 1790.
Chest X-ray revealed interstitial edema, prompting BIPAP therapy for
respiratory distress. EKG showed Normal Sinus Rhythm with LVH and ST
depression in lead II and V6, raising concerns for NSTEMI, but
anticoagulation was withheld due to acute blood loss anemia.During a prior
admission, the patient underwent gastroenterology Capsule Endoscopy,
revealing erosive gastritis and solitary angiodysplasia in the upper third
of the small bowel. EGD was deferred due to cardiovascular risk.
Echocardiogram indicated an EF of 45-50% with severe aortic valve stenosis
(AS), suggesting Heyde Syndrome, though VWF and platelet function tests
were normal. During this admission, Percutaneous Coronary Vessel
Intervention (PCI) was performed on the proximal right coronary artery.
The patient was initiated on guideline-directed medical therapy (GDMT) and
discharged with instructions to follow up with cardiology for scheduling a
Transcatheter Aortic Valve Replacement (TAVR). DISCUSSION: Heyde syndrome,
characterized by aortic stenosis, acquired von Willebrand disease, and
angiodysplasias, is a significant consideration in cases of
gastrointestinal bleeding. The prevailing hypothesis regarding its
pathophysiology involves acquired von Willebrand syndrome (AVWS). This
theory suggests that shearing forces from a stenotic aortic valve lead to
the destruction of high molecular weight von Willebrand factor (vWF),
resulting in AVWS and subsequent bleeding. However, there are cases where
this hypothesis is not supported by evidence or where vWF assessment is
lacking, leading to controversy. Our case, like others in the literature,
suggests that there may be patients with Heyde syndrome whose
pathophysiology cannot be solely attributed to AVWS. Therefore,
alternative explanations should be considered, such as connective tissue
abnormalities predisposing to both aortic stenosis and angiodysplasia, or
mucosal hypoxia from cholesterol emboli causing angiodysplasia. Studies
have shown promising outcomes, with gastrointestinal bleeding ceasing in
62% of patients following transcatheter aortic valve implantation.
 CONCLUSION(S): Despite being initially diagnosed in 1958, the present
lacks significant data regarding HS and its management. Further research
is imperative to foster a deeper understanding and enhance awareness among
physicians regarding HS, potentially leading to expedited diagnoses and
improved management strategies. REFERENCE #1: Theis SR, Turner SD. Heyde
syndrome [Internet]. [cited 2024 Mar 2]; Available from:
https://europepmc.org/article/nbk/nbk551625. 2. Baliga RR. From clinical
observation to mechanism--Heyde's syndrome. N. Engl. J. Med.
2013;368(6):579. 3. Saha B, Wien E, Fancher N, Kahili-Heede M, Enriquez N,
Velasco-Hughes A. Heyde's syndrome: a systematic review of case reports.
BMJ Open Gastroenterology 2022;9(1):e000866. 4. Goltstein LCMJ,
Rooijakkers MJP, Gortjes NCC, et al. Reduction of Gastrointestinal
Bleeding in Patients With Heyde Syndrome Undergoing Transcatheter Aortic
Valve Implantation. Circ Cardiovasc Interv 2022;15(7):e011848.
DISCLOSURES: No relevant relationships by Francini Alcocer No relevant
relationships by Mauricio Danckers No relevant relationships by Adam
Devine No relevant relationships by Saadia Nabi No relevant relationships
by Jose Luis Rodriguez Castro No relevant relationships by Luis Santiago
Zayas No relevant relationships by Ambar Sekulits Copyright ©
2024 American College of Chest Physicians

<102>
Accession Number
2034596499
Title
THE SNEAKY LEAK: A CASE OF AN OCCULT, SEVERE PARAVALVULAR LEAK AFTER TAVR.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A524-A525),
2024. Date of Publication: October 2024.
Author
MCAULIFFE J.D.; AMIN H.; SUMMERS M.R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Reports Posters (O) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Paravalvular leaks (PVL) are a well-known complication after
transcatheter aortic valve replacement (TAVR), however the clinical
significance of mild-to-moderate PVLs remains poorly defined in the
current literature. Trace-to-mild PVLs are common and often managed with
surveillance alone. Severe PVLs, while relatively rare, are known to
increase mortality and require clinical intervention. Determining the
severity of PVLs can be challenging and often requires an array of
invasive diagnostic modalities to accurately detect and characterize
occult PVLs. CASE PRESENTATION: This case presents a 78-year-old female
who underwent elective transfemoral TAVR (29mm Evolut Pro+) for severe
symptomatic aortic stenosis (AVAi 0.4 cm2/m2, mean gradient 40 mmHg). Her
cardiopulmonary history is also significant for non-obstructive CAD, HF
with recovered EF (45% pre-TAVR; 55% after), and LLL segmentectomy
(performed six months post-TAVR) for primary adenocarcinoma. After her
TAVR, the patient achieved near total symptomatic resolution and had
echocardiographic evidence showing a well-seated valve with a mild
posterior PVL. Nine months later, she required her first admission for
decompensated CHF. TTE showed new combined systolic (EF 39%) and diastolic
(grade 3) dysfunction with the PVL now graded mild-to-moderate. She
achieved symptom resolution with IV diuresis and was initiated on
maintenance diuretics and a GDMT regimen on discharge. Over the next few
months, she required increasing doses of furosemide but serial TTE's
showed recovery of cardiac function and a stable PVL. At sixteen months
post-TAVR, she was again admitted for decompensated CHF. Repeat CTA (TAVR
protocol) showed a well seated prosthetic valve and corroborated the
presence of a moderate PVL. On TEE, however, the posterior PVL was clearly
severe and highly eccentric. After considering interventional options, the
patient elected to undergo balloon valvuloplasty, which reduced the PVL to
trivial flow and led to significant symptom improvement. This again proved
transient. She was readmitted for a severe CHF exacerbation ten months
later (two years post-TAVR). TTE now judged the PVL as mild-moderate.
Given her historic discrepancy, repeat TEE was obtained and again
demonstrated the PVL to truly be severe. The patient elected for
percutaneous transcatheter closure, with a vascular plug (8mm AVP4)
successfully occluding the PVL. Peri-procedural aortography was positive
for diastolic flow reversal that completely resolved after PVL occlusion.
DISCUSSION: The assessment and management of a PVL in TAVR patients can be
challenging. Based on guidelines from the American Society of
Echocardiography, PVL severity is determined via a composite of 14
quantitative and qualitative factors. While often the default modality for
detecting and monitoring PVLs, TTE can significantly underestimate the
severity of a PVL. Further research is needed regarding guidelines for
management of mild-to-moderate PVLs, but severe PVLs are known to require
intervention. CONCLUSION(S): This case highlights the need for high
clinical suspicion when PVL severity seems disproportionate to a patient's
clinical status or longitudinal trajectory. In such cases, more invasive
modalities of PVL characterization (i.e., TEE, coronary angiography,
aortography, etc.) should be pursued, with some evidence suggesting 3D
modalities may offer superior characterization. REFERENCE #1: Conte, S.,
Kearney, K., Jain, P., Watson, A., Muller, D., & Roy, D. (2019). Plugging
paravalvular leak in transcatheter aortic valves. JACC: Case Reports,
1(5), 696-702. https://doi.org/10.1016/j.jaccas.2019.10.013 REFERENCE #2:
Bhushan, S., Huang, X., Li, Y., He, S., Mao, L., Hong, W., & Xiao, Z.
(2022). Paravalvular leak after Transcatheter Aortic valve Implantation
Its Incidence, diagnosis, clinical implications, Prevention, management,
and Future Perspectives: A review article. Current Problems in Cardiology,
47(10), 100957. https://doi.org/10.1016/j.cpcardiol.2021.100957 REFERENCE
#3: Sa, M. P., Jacquemyn, X., Van Den Eynde, J., Tasoudis, P., Erten, O.,
Sicouri, S., Macedo, F., Pasala, T., Kaple, R., Weymann, A., Ruhparwar,
A., Clavel, M., Pibarot, P., & Ramlawi, B. (2023). Impact of paravalvular
leak on outcomes after transcatheter aortic valve implantation:
Meta-Analysis of Kaplan-Meier-derived individual patient data. Structural
Heart, 7(2), 100118. https://doi.org/10.1016/j.shj.2022.100118
DISCLOSURES: No relevant relationships by Harsh Amin No relevant
relationships by Jacob McAuliffe No relevant relationships by Matthew
Summers Copyright © 2024 American College of Chest Physicians

<103>
Accession Number
2034596062
Title
YOU CAN TEACH AN OLD DOG (MEDICATION) NEW TRICKS: UTILITY OF TRANEXAMIC
ACID (TXA) FOR A HEMORRHAGIC MALIGNANT PLEURAL EFFUSION.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3676-A3677), 2024. Date of Publication: October 2024.
Author
KABIR J.; YE J.; HAWK C.; SINHA T.; GHATTAS C.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Pleural Potpourri SESSION TYPE: Rapid Fire Case Reports
PRESENTED ON: 10/08/2024 12:30 pm - 01:15 pm INTRODUCTION: Renal
transplant patients are at an increased risk of cancer with an incidence
nearly three times that of the general population. Transplant patients
also carry an increased risk of disseminated fungal infections due to
immunosuppression. Herein, we present a case of a renal transplant patient
with a rare malignancy, disseminated fungal infection, and a hemorrhagic
malignant pleural effusion. CASE PRESENTATION: A 42-year-old male with
history of renal transplant was admitted with worsening cough and dyspnea.
CT chest showed bilateral pulmonary nodules and small bilateral pleural
effusions. He underwent bronchoscopy and results were non-diagnostic;
however, urine Blastomyces antigen was positive and he was started on
antifungal therapy. Despite treatment, his symptoms progressed and he was
readmitted with hypoxemia and enlarging left pleural effusion. The
effusion was drained and he underwent navigational and EBUS bronchoscopy.
Biopsy of a right lower lobe lung nodule and 11R lymph node demonstrated
epithelioid angiosarcoma. The pleural effusion was serosanguinous and
exudative. Cytology was also consistent with epithelioid angiosarcoma and
a left tunneled pleural catheter was placed. He continued antifungal
treatment and started chemotherapy. He presented again one month later
with dizziness, anemia, and worsening dyspnea with an enlarging right
pleural effusion. A right tunneled pleural catheter was placed and the
effusion was consistent with a hemothorax. He had significant blood loss
and high output from his hemothorax, requiring daily transfusion of blood
products for multiple weeks. Given concern that the hemothorax was related
to the angiosarcoma he was continued on chemotherapy and also treated with
radiation therapy to his right pleura. Despite these interventions, he had
ongoing blood loss so decision was made to treat with intrapleural
tranexamic acid (TXA). This briefly slowed the output from his hemothorax
so he was treated with a second dose of intrapleural TXA as well as
intravenous TXA which led to resolution of his hemothorax and no further
need for transfusions. DISCUSSION: Primary pleural angiosarcoma is a very
rare malignancy affecting the endothelial cells of small blood vessels and
can present with spontaneous hemothorax. Chemotherapy and radiation
therapy have minimal efficacy and most patients have a very poor
prognosis. In this case, the patient had a spontaneous right hemothorax
which led to significant blood loss despite starting treatment for his
angiosarcoma. Tranexamic acid has been used to manage hemothorax secondary
to malignant mesothelioma during thoracic surgery. This case is unique in
that we describe the first report of using intrapleural and intravenous
TXA for hemothorax secondary to angiosarcoma. This case is also unique in
the patient presenting with both a rare malignancy as well as a
concomitant disseminated fungal infection. This highlights the importance
of maintaining a broad differential when evaluating immunosuppressed
patients who present with pulmonary nodules, lymphadenopathy, and pleural
effusions. CONCLUSION(S): Hemorrhagic malignant pleural effusions are
rare but can be difficult to manage and lead to significant morbidity and
mortality. Multiple modalities of therapy are needed for systemic control
of the bleeding and tranexamic acid maybe a useful adjunctive treatment
that warrants further study for refractory hemothorax. REFERENCE #1: Wang
Y, Lan GB, Peng FH, Xie XB. Cancer risks in recipients of renal
transplants: a meta-analysis of cohort studies. Oncotarget.
2017;9(20):15375-15385. Published 2017 Dec 16.
doi:10.18632/oncotarget.23841. Mehta TI, Kurman J, Dolan S, Gill H, Thapa
B. Blastomycosis in solid organ transplant recipients-A retrospective
series from southeastern Wisconsin. Transpl Infect Dis. 2021;23(4):e13671.
doi:10.1111/tid.13671 REFERENCE #2: Wang X, Lu Z, Luo Y, et al.
Characteristics and outcomes of primary pleural angiosarcoma: A
retrospective study of 43 published cases. Medicine (Baltimore).
2022;101(6):e28785. doi:10.1097/MD.0000000000028785. De Boer WA, Koolen
MG, Roos CM, Ten Cate JW. Tranexamic acid treatment of hemothorax in two
patients with malignant mesothelioma. Chest. 1991;100(3):847-848.
doi:10.1378/chest.100.3.847 REFERENCE #3: Pappas PG, Threlkeld MG, Bedsole
GD, Cleveland KO, Gelfand MS, Dismukes WE. Blastomycosis in
immunocompromised patients. Medicine (Baltimore). 1993;72(5):311-325.
doi:10.1097/00005792-199309000-00003. Torres HA, Rivero GA, Kontoyiannis
DP. Endemic mycoses in a cancer hospital. Medicine (Baltimore).
2002;81(3):201-212. doi:10.1097/00005792-200205000-00004 DISCLOSURES: No
relevant relationships by Christian Ghattas No relevant relationships by
Charles Hawk No relevant relationships by Jason Kabir No relevant
relationships by Tejas Sinha No relevant relationships by Joshua
Ye Copyright © 2024 American College of Chest Physicians

<104>
Accession Number
2034595940
Title
A CASE OF SEVERE SEPTIC SHOCK DUE TO PASTEURELLA BACTEREMIA TREATED WITH
METHYLENE BLUE AS AN ADJUNCT THERAPY: BREAKING THE TABOO FOR NONRESPONDER
PATIENTS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A2269-A2270), 2024. Date of Publication: October 2024.
Author
GAVILANES D.; ESENBEKOVA M.; CALDERON-MARTINEZ E.; KHAMAR D.; MOSHER Z.;
NESTOITER K.; FRANZ C.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Reports Posters (R) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am INTRODUCTION:
Methylene blue (MB) is a phenothiazine-related heterocyclic aromatic
molecule used in the medical field for over a century due to its diverse
range of applications (1). Recently, MB has been used as an adjunct
therapy for patients with refractory septic shock who do not respond to
first line treatment. MB has shown reduction of time to vasopressor
discontinuation and length of stay in the intensive care unit (ICU) (2).
Despite available data and reported cases, its use is still under debate
(2). We present a case of refractory septic shock due to Pasteurella
bacteremia successfully treated with adjunct methylene blue. CASE
PRESENTATION: A 60-year-old man with a past medical history of HIV with a
CD4 count of 536 presented to the emergency department with headache,
generalized muscle pain, and acute encephalopathy. He was noted to have
persistent hypotension, which was unresponsive to initial fluid
resuscitation. On physical examination, the patient was lethargic,
oliguric, and had warm extremities. Initial laboratory analysis revealed
WBC 3,000, pH 7.2, bicarbonate level 9 mmol/L, anion gap 28 mmol/L, and
lactic acid >12 mmol/l. A norepinephrine drip was started, and he was
admitted to the ICU for septic shock. The patient's hemodynamic status
remained refractory, requiring the addition of vasopressin,
hydrocortisone, phenylephrine, and epinephrine. CT (Computed Tomography)
scans of the head and chest were normal, while CT of the abdomen and
pelvis revealed mild colitis. We initiated a bicarbonate drip for profound
acidemia, followed by one push of methylene blue. The MB intervention
allowed de-escalation of vasopressor support; however, the effect lasted 3
hours. Bedside ultrasound demonstrated normal LV function with a left
ventricular outflow tract velocity time interval 20.5 cm and cardiac
output of 8.2 liters per minute. Given persistent oliguria and lactic
acidosis, continuous renal replacement therapy was initiated. Due to
persistent refractory shock, a MB infusion was initiated at 0.5 mg/kg/hr.
After 3 hours of MB initiation, the doses of vasopressors decreased. The
patient's blood cultures revealed Pasteurella Multicocida. After inquiry,
the patient's family member admitted their dog licked a wound on the
patient's leg days prior to admission. After 12 days of intensive care
management, the patient was successfully transferred to the medical floor
for further care. DISCUSSION: Methylene blue inhibits nitric oxide
production and halts vasodilation. MB is useful for vasoplegia in
refractory shock and has been studied after cardiac surgeries (3) Multiple
studies have shown its efficacy as an adjunct therapy, particularly for
non-responders to initial treatments. (1,2). The routine use of MB is not
well studied and not recommended by itself, but adding the medication can
have a catecholamine-sparing effect, decreasing vasodilation (1). In this
case, MB was given as an adjunctive therapy with a significant therapeutic
response in a patient with a rare source of bacteremia.
 CONCLUSION(S): MB should be considered in cases of refractory shock.
However, additional clinical trials are needed. Our case aims to report a
successful use of MB in a patient with refractory shock resulted in less
time on vasopressor therapy and discharge from the ICU. REFERENCE #1:
Jang, D. H., Nelson, L. S., & Hoffman, R. S. (2013, April 12). Methylene
Blue for Distributive Shock: A Potential New Use of an Old Antidote.
Journal of Medical Toxicology. https://doi.org/10.1007/s13181-013-0298-7
REFERENCE #2: Ibarra-Estrada, M., Kattan, E., Aguilera-Gonzalez, P. E.,
Sandoval-Plascencia, L., Rico-Jauregui, U., Gomez-Partida, C. A.,
Ortiz-Macias, I. X., Lopez-Pulgarin, J. A., Chavez-Pena, Q.,
Mijangos-Mendez, J., Aguirre-Avalos, G., & Hernandez, G. (2023, March 13).
Early adjunctive methylene blue in patients with septic shock: a
randomized controlled trial. Critical Care.
https://doi.org/10.1186/s13054-023-04397-7 REFERENCE #3: Jentzer, J.C.,
Vallabhajosyula, S., Khanna, A. K., Chawla, L. S., Busse, L. W. & Kashani,
K. B. (2018). Management of Refractory Vasodilatory Shock. CHEST, 154(2):
416-426. DISCLOSURES: No relevant relationships by Evelyn
Calderon-Martinez No relevant relationships by Medina Esenbekova No
relevant relationships by Christopher Franz No relevant relationships by
Diana Gavilanes No relevant relationships by Dhaval Khamar No relevant
relationships by Zachary Mosher No relevant relationships by Konstantin
Nestoiter Copyright © 2024 American College of Chest Physicians

<105>
Accession Number
2034595659
Title
COVID-19 WITH SPONTANEOUS PNEUMOTHORAX AND PERSISTENT AIR LEAK IN
UNDERLYING BULLOUS EMPHYSEMA.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A4935-A4936), 2024. Date of Publication: October 2024.
Author
ESCUDERO G.; EMBRY E.; XIONG J.A.Y.; KUNADHARAJU R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Obstructive Lung Diseases Case Reports Posters (B) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Spontaneous pneumothorax (PTX) is defined as air within the
pleural cavity occurring without an obvious precipitating factor, such as
trauma or iatrogenic causes. A persistent air leak (PAL) is arbitrarily
defined as the bubbling of air through a chest drain after 48 hours, or an
air leak lasting longer than 5-7 days. Overall incidence of PTX is
approximately 1% in patients hospitalized with COVID-19, and is also
associated with increased mortality. However, current literature is
lacking regarding the relationship between COVID-19 and spontaneous PTX,
especially in underlying bullous emphysema. We report a case with
previously undiagnosed bullous emphysema presenting with COVID-19,
complicated by spontaneous PTX with PAL. CASE PRESENTATION: A 91-year-old
male with a history of hypertension presented to our emergency department
with flu-like symptoms for 2 weeks, with shortness of breath and cough
over 2 days. Physical exam was significant for diminished breath sounds
throughout his left lung fields. Vitals showed mild tachycardia and
tachypnea, and oxygen saturation of 95% on room air. Significant lab
findings revealed a positive COVID-19 test. He eventually required
supplemental oxygen with 2 L/minute of nasal cannula. He received
intravenous (IV) sepsis bolus of 30 cc/kg, empirical antibiotics, and 6 mg
of IV decadron. Chest x-ray showed a large left pneumothorax. Chest tube
with a pigtail catheter was inserted. Pulmonology was consulted for
management of chest tube, who recommended evaluation of lung parenchyma
with computed tomography (CT) of the chest. Further history revealed the
patient smoked an unspecified amount of cigarettes for approximately 63
years. CT chest revealed diffuse bilateral bullous emphysema. His hospital
course was complicated by extensive subcutaneous emphysema along his
bilateral chest, left neck, and left arm. Despite the chest tube set to
suction, he exhibited PAL. Oxygen supplementation requirement increased to
4 L/minute of nasal cannula. Cardiothoracic surgery emergently replaced
the initial chest tube for a large bore chest tube, yet the PAL did not
resolve. Pulmonology recommended transfer to a tertiary care facility for
potential endobronchial valve (EBV) placement. Despite undergoing EBV
placement, the PAL failed to resolve. Patient ultimately underwent a
thoracoscopic pulmonary adhesiolysis and pleurodesis, with video-assisted
thoracic surgery (VATS) of left upper lobe bleb resection. He eventually
was discharged with home health 22 days after initial presentation.
DISCUSSION: Early identification of underlying bullous emphysema in our
patient prompted timely management. Given his extensive and complicated
course, it is possible that an association exists between COVID-19 and
spontaneous PTX in the setting of underlying bullous emphysema.
 CONCLUSION(S): The relationship between COVID-19 and spontaneous PTX
is not well understood. There are some case reports that do highlight
successful EBV placement for PAL in COVID-19. Our case, however, suggests
that underlying bullous emphysema may have contributed to unsuccessful EBV
placement. Clinical suspicion of underlying bullous emphysema should
therefore not be underestimated in spontaneous PTX with COVID-19. Prompt
identification can avoid delay of care, especially in those with decreased
lung reserve, such as bullous emphysema. Higher quality studies can
potentially help decrease the associated mortality in spontaneous PTX with
COVID-19. REFERENCE #1: Ding M, Gao Y, Zeng XT, Guo Y, Yang J.
Endobronchial one-way valves for treatment of persistent air leaks: a
systematic review. Respiratory Research. 2017;18(1).
doi:https://doi.org/10.1186/s12931-017-0666-y REFERENCE #2: Lazarus DR,
Casal RF. Persistent air leaks: a review with an emphasis on bronchoscopic
management. Journal of Thoracic Disease. 2017;9(11):4660-4670.
doi:https://doi.org/10.21037/jtd.2017.10.122 REFERENCE #3: MacDuff A,
Arnold A, Harvey J. Management of spontaneous pneumothorax: British
Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl
2):ii18-ii31. doi:https://doi.org/10.1136/thx.2010.136986. Marciniak SJ,
Farrell J, Rostron A, et al. COVID-19 Pneumothorax in the United Kingdom:
a prospective observational study using the ISARIC WHO clinical
characterisation protocol. European Respiratory Journal. Published online
June 3, 2021:2100929. doi:https://doi.org/10.1183/13993003.00929-2021.
Martinelli AW, Ingle T, Newman J, et al. COVID-19 and Pneumothorax: A
Multicentre Retrospective Case Series. European Respiratory Journal.
Published online January 1, 2020.
doi:https://doi.org/10.1183/13993003.02697-2020. Noppen M, De Keukeleire
T. Pneumothorax. Respiration; international review of thoracic diseases.
2008;76(2):121-127. doi:https://doi.org/10.1159/000135932. Saha BK,
Bonnier A, Chong WH, Chenna P. Successful use of endobronchial valve for
persistent air leak in a patient with COVID-19 and bullous emphysema. BMJ
Case Reports CP. 2021;14(11):e246671.
doi:https://doi.org/10.1136/bcr-2021-246671 DISCLOSURES: No relevant
relationships by Edsel Embry No relevant relationships by Gabriel Escudero
No relevant relationships by Rajesh Kunadharaju No relevant relationships
by Jay Xiong Copyright © 2024 American College of Chest
Physicians

<106>
Accession Number
2034595649
Title
TREATMENT OF MALIGNANT CENTRAL AIRWAY OBSTRUCTION IN A VENTILATED PATIENT
USING MULTIMODAL THERAPIES.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A5150-A5151), 2024. Date of Publication: October 2024.
Author
NASUTI D.; KAINTH K.; RIPA R.; VON GIZYCKI C.; PATEL B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Interventions for Airway Obstruction SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/07/2024 12:30 pm - 01:15 pm
INTRODUCTION: Endobronchial stent placements have been shown to be a safe
and effective intervention to manage patients with malignant central
airway obstruction, offering significant improvement in symptoms and
clinical outcomes. Here, we present a case of a male in his 80s with newly
diagnosed non-operable stage IIIb pulmonary adenocarcinoma and worsening
respiratory failure who underwent endobronchial tumor debulking using
cryotherapy, argon plasma coagulation, and subsequent bilateral stent
placement with success. CASE PRESENTATION: An 82-year-old man with an
extensive smoking history who presented for shortness of breath, wheezing,
and hemoptysis for 3 months. Computed tomography (CT) angiogram showed a
spiculated mass in the right upper lobe (RUL) with large mediastinal and
hilar adenopathy and collapse of the right middle and lower lobe, highly
suspicious for malignancy. He required intubation for hypoxemic
respiratory failure. Initial bronchoscopy showed bilateral mainstem
obstruction with complete occlusion of the right distal bronchi extending
into the bronchus intermedius without active bleeding. Cryotherapy and
argon plasma coagulation (APC) were used in the left mainstem bronchus
which improved lumen size to 90% patency. Endobronchial biopsy pathology
was consistent with pulmonary adenocarcinoma with 65% PD-L1 expression. He
was successfully extubated to nasal cannula. He underwent one session of
radiation therapy to the mediastinum, and 4 days later he required
reintubation for worsening hypoxemia. Chest imaging showed further volume
loss on the right with a pleural effusion. Repeat bronchoscopy in the ICU
was performed which continued to demonstrate a large endobronchial tumor
within the bronchus intermedius for which cryotherapy and APC were used,
achieving patency of 90% on the right. The left mainstem was again 90%
occluded in the context of recent radiation, and this was debulked until
approximately 50% patent. Self-expandable nitinol bronchial stents were
placed into the left mainstem and bronchus intermedius with success. The
patient was extubated, with plan to start immunotherapy as an outpatient.
Chest x-ray showed improved aeration on the right side. He was discharged
without an oxygen requirement and seen for follow-up outpatient saturating
well on room air. DISCUSSION: Approximately 30% of lung cancer patients
develop central airway obstruction (CAO), which is a poor prognostic
indicator due to high rates of respiratory failure, post-obstructive
pneumonia, and atelectasis was the case with our patient. With
intervention, survival improves from 2-3 months to 6-8 months (1).
Interventions that may be performed via bronchoscopy for malignant CAO
include dilation, laser therapy, photocoagulation, electrocautery, and
bronchial stenting, with stenting recommended for extrinsic compression
causing collapse of portions of the lungs to improve symptom-free survival
rates (1-3). Airway stenting has also been shown to facilitate weaning
from mechanical ventilation (4). Radiotherapy alone does not improve
symptoms immediately, and without prompt intervention, patients with CAO
causing severe hypoxia have poor outcomes. Bronchial stenting, however,
provides rapid results and has been shown to have high success rates with
low complication rates, providing an effective means of both clinical and
symptomatic improvement. CONCLUSION(S): Bronchial stenting can be an
essential minimally invasive procedure to be considered as a palliative
treatment option for cases of malignant central airway obstruction.
REFERENCE #1: Umar Z, Haseeb Ul Rasool M, Hosna AU, Parikh A, Ariyaratnam
J, Sandhu JK, Ashfaq S, Ahmed N, Khan J, Trandafirescu T. Malignant Airway
Obstruction and Endobronchial Stent Placement: A Systematic Review on the
Efficacy and Safety. Cureus. 2023 Jun 24;15(6):e40912. doi:
10.7759/cureus.409123. Endoscopic management of central airway
obstruction. Gorden JA, Ernst A. Semin Thorac Cardiovasc Surg.
2009;21:263-273. REFERENCE #2: Wilson, G E, et al. "Treatment of large
airway obstruction in lung cancer using expandable metal stents inserted
under direct vision via the fibreoptic bronchoscope." Thorax, vol. 51, no.
3, 1 Mar. 1996, pp. 248-252. REFERENCE #3: Saji, Hisashi, et al. "Outcomes
of airway stenting for advanced lung cancer with central airway
obstruction." Interactive CardioVascular and Thoracic Surgery, vol. 11,
no. 4, 1 Oct. 2010, pp. 425-428. Oltmanns, Ute, and Mark Slade.
"Tracheobronchial stenting." British Journal of Hospital Medicine, vol.
72, no. 6, June 2011, pp. 318-324. DISCLOSURES: No relevant relationships
by Kashish Kainth No relevant relationships by Danielle Nasuti No relevant
relationships by Bhavi Patel No relevant relationships by Rashelle Ripa No
relevant relationships by Christian von Gizycki Copyright © 2024
American College of Chest Physicians

<107>
Accession Number
2034595048
Title
USE OF EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) IN TRAUMA PATIENT WITH
TRACHEAL INJURY.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A299-A300),
2024. Date of Publication: October 2024.
Author
RENBARGER T.; WARNER M.A.R.K.; RIZVI G.; PATEL M.; FAIZ S.A.; SALAS DE
ARMAS I.; AKKANTI B.; GREGORIC I.D.; JANI P.; DINH K.H.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Reports Posters (A) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is an advanced
therapy known for its use in cardiac and respiratory failure. Tracheal
injuries and utilization of ECMO is very rare, and we present here a
successful case of recovery from tracheal injury in a patient bridged on
Veno-Venous (VV) ECMO to recovery. CASE PRESENTATION: A 19-year-old man
presented after a crush injury to the chest while operating heavy
machinery. Imaging revealed traumatic vascular injury to the proximal
subclavian, and extensive lung contusions were present bilaterally with
air leak (image 1). Despite maximal medical and ventilatory strategies,
the patient had persistent hypoxemic respiratory failure and was supported
on V-V ECMO. Flexible bronchoscopy revealed an anterior tracheal injury
with involvement of the left mainstem bronchus. After two days of support
on Veno-Venous ECMO, a tracheal Y-stent was successfully deployed. The
patient recovered from respiratory failure after a week of initiation on
VV-ECMO, and he was decannulated from VV ECMO after nine days of VV-ECMO
support. After rehabilitation and 2 months following his injury, the
tracheal Y-stent was removed, and repeat imaging confirmed the absence of
a tracheal tear (image 2). DISCUSSION: Although the first reported use of
ECMO was in traumatic respiratory failure, use of VV ECMO for refractory
hypoxemic respiratory failure has not gained popularity until the last
fifteen years. Despite several case reports highlighting it's uses,
consensus for the use of ECMO in trauma patients is lacking. Most
frequently, the implementation of VV-ECMO in acute trauma patients was
used in the setting of acute respiratory distress syndrome induced by
traumatic lung injury. Early involvement of VV-ECMO allows for improved
oxygenation while limiting barotrauma, ultimately improving tissue
perfusion and reducing the risk of the trauma triad of death: acidosis,
hypothermia and coagulopathy. Use of VV-CMO to facilitate tracheobronchial
interventions for central airway obstructions related to malignant disease
has been described. Our case is unique in that oxygenation was difficult
due to presence of the tracheobronchial injury, and bridging therapy with
VV-ECMO was needed allowing subsequent deployment of Y-stent. Our case
emphasizes that VV ECMO may be a viable options in the trauma population
in cases of tracheal injury especially with multi-disciplinary approach
and support. CONCLUSION(S): This case adds to the growing population
of patients with tracheal-bronchial injuries that have been successfully
treated with VV-ECMO. In our case, use of VV-ECMO facilitated
stabilization of oxygenation and allowed for facilitating tracheal injury
with a tracheobronchial Y stent. This case helps provide support for use
of VV-ECMO in the trauma population, and it highlights the need for
patient selection and a multi-disciplinary approach. REFERENCE #1: Amos,
T., Bannon-Murphy, H., Yeung, M., Gooi, J., Marasco, S., Udy, A., &
Fitzgerald, M. (2021). ECMO (extra corporeal membrane oxygenation) in
major trauma: A 10 year single centre experience. Injury, 52(9),
2515-2521. https://doi.org/10.1016/j.injury.2021.03.058. Grant, A. A.,
Lineen, E. B., Villamizar, N. R., Galbut, D., Brozzi, N., Loebe, M., &
Ghodsizad, A. (2021). Traumatic Tracheal Injury and Pulmonary Contusions:
Buying Time With ECMO. The American Surgeon, 87(12), 2006-2008.
https://doi.org/10.1177/0003134820940262. Grant, A. A., Hart, V. J.,
Lineen, E. B., Lai, C., Ginzburg, E., Houghton, D., Schulman, C. I.,
Vianna, R., Patel, A. N., Casalenuovo, A., Loebe, M., & Ghodsizad, A.
(2018). The Impact of an Advanced ECMO Program on Traumatically Injured
Patients. Artificial Organs, 42(11), 1043-1051.
https://doi.org/10.1111/aor.13152. Hussein, E., Shepherd, R., Debesa, O.,
& Shojaee, S. (2014). Management of Membranous Tracheal Laceration With
Polyurethane Covered Nitinol Tracheal Stent on ECMO. Chest, 146(4),
764A-764A. https://doi.org/10.1378/chest.1994966. Kim, S. H., Huh, U.,
Song, S., Kim, M. S., Wang, I. J., & Tak, Y. J. (2023). Outcomes in trauma
patients undergoing veno-venous extracorporeal membrane oxygenation for
acute respiratory distress syndrome. Perfusion, 38(5), 1037-1044.
https://doi.org/10.1177/02676591221093880. Okochi, S., Schad, C., Shakoor,
A., Middlesworth, W., Sonett, J., Zitsman, J., & Duron, V. (2017).
Tracheal injury during extraction of an esophageal foreign body: Repair
utilizing venovenous ECMO. Journal of Pediatric Surgery Case Reports,
20(C), 21-23. https://doi.org/10.1016/j.epsc.2017.02.017. Wang, C., Zhang,
L., Qin, T., Xi, Z., Sun, L., Wu, H., & Li, D. (2020). Extracorporeal
membrane oxygenation in trauma patients: a systematic review. World
Journal of Emergency Surgery, 15(1), 51-51.
https://doi.org/10.1186/s13017-020-00331-2 DISCLOSURES: Research Grant
relationship with Alung Please note: $1001 - $5000 by Bindu Akkanti,
value=Grant/Research Support Speaker/Speaker's Bureau relationship with
Jansen Please note: 2021-2023 by Bindu Akkanti, value=Honoraria
Speaker/Speaker's Bureau relationship with Abiomed Please note: 2022 by
Bindu Akkanti, value=Honoraria Speaker/Speaker's Bureau relationship with
Abiomed Please note: 2022 by Bindu Akkanti, value=Honoraria
Speaker/Speaker's Bureau relationship with Abiomed Please note: 2023 Added
11/20/2023 by Bindu Akkanti, source=Web Response, value=Travel
Speaker/Speaker's Bureau relationship with Janssen Please note: 2023 Added
11/20/2023 by Bindu Akkanti, source=Web Response, value=Honoraria
Scientific Medical Advisor relationship with Alung/Livanova Please note:
2023 Added 11/20/2023 by Bindu Akkanti, source=Web Response,
value=Honoraria No relevant relationships by Kha Dinh No relevant
relationships by Saadia Faiz No disclosure on file for Igor Gregoric No
relevant relationships by Pushan Jani No relevant relationships by Maulin
Patel No relevant relationships by Taylor Renbarger No relevant
relationships by Ghazi Rizvi No disclosure submitted for Ismael Salas De
Armas No relevant relationships by Mark Warner Copyright © 2024
American College of Chest Physicians

<108>
Accession Number
2034595018
Title
DANGER! THORACIC ANEURYSM RUPTURE PRESENTS AS HEMATEMESIS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A272-A273),
2024. Date of Publication: October 2024.
Author
DAVALATH D.; CHINTAM N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Reports Posters (A) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Thoracic aneurysms are characterized by the dilation of the
aortic wall and are often asymptomatic. However, complications can
escalate, particularly if certain risk factors are present, such as
smoking, hypertension, hypercholesterolemia, and a history of aortic
dissections. For asymptomatic individuals, the treatment approach
typically focuses on symptom management and reduction of cardiovascular
risks. Despite comprehensive conservative management, open or endovascular
surgical repair may be considered as secondary options. Both techniques
carry potential complications, and in some instances, the risks may
outweigh the benefits of surgical intervention. CASE PRESENTATION: A
67-year-old woman with a multifaceted medical history, including a prior
small bowel perforation managed with small bowel resection and right
hemicolectomy, thoracic aortic aneurysm handled with an endovascular stent
graft, chronic obstructive pulmonary disease (COPD), high blood pressure
(HTN), multidrug-resistant organism urinary tract infection (MDRO UTI), a
complex cyst/mass in the right adnexal region and severe protein caloric
malnutrition. Her hospitalization consisted of complications such as
hydronephrosis, which required a percutaneous nephrostomy (PCN) tube
placement, an extended-spectrum beta-lactamase (ESBL) E. coli UTI, a
bloodstream infection caused by methicillin-resistant Staphylococcus
aureus (MRSA), and acute kidney injury (AKI). Due to severe pain,
tachycardia, hypotension, and hypoxia, a rapid response was called.
Initial examination suggested she was vomiting blood, with bright red
blood observed at the back of her throat. She expelled between 100 to 200
cc of blood, which necessitated the infusion of blood products and
intravenous fluids. Her history of gastritis and recent MRSA bloodstream
infection led to suspicion of gastrointestinal bleeding, but immediate CT
Abdominal imaging showed endovascular leak from a thoracic abdominal
aneurysm stent which led to massive thoracic abdominal aneurysmal rupture.
It is hypothesized that the thoracic endovascular stent eroded into the
esophagus, which led to massive hematemesis. Critical care intensivists
and the cardiothoracic team were consulted which recommended invasive
mechanical ventilation to protect the airway. Despite these interventions,
her prognosis remained grim due to the extravasation and rapid hemodynamic
instability. After multidisciplinary discussions with family and the
respective care team the patient unfortunately passed away. DISCUSSION:
Understanding the pivotal role invasive surgical techniques play in
managing end-stage aneurysms is a topic which is yet to be delved into. It
is crucial to highlight the frightening complications of endovascular
stent placement as it is progressively becoming a common procedure
performed. CONCLUSION(S): This case highlights the complexities and
risks of endovascular stent placements for aortic aneurysms, a procedure
used in about 60% of eligible patients. Over time, these stents can erode
the arterial wall, potentially leading to fistulous tracts to
theesophagus. As stent placement becomes more common, understanding its
alarming complications becomes crucial. Notably, women face a 96% higher
risk of complications, including endovascular leaks and arterial rupture,
and have a significantly higher 30-day mortality rate. This underscores
the need for a more nuanced approach to these procedures. REFERENCE #1:
Mehta M, Byrne WJ, Robinson H, Roddy SP, Paty PS, Kreienberg PB, Feustel
P, Darling RC 3rd. Women derive less benefit from elective endovascular
aneurysm repair than men. J Vasc Surg. 2012 Apr;55(4):906-13. doi:
10.1016/j.jvs.2011.11.047. Epub 2012 Feb 8. PMID: 22322123. REFERENCE #2:
EVAR trial participants. Endovascular aneurysm repair versus open repair
in patients with abdominal aortic aneurysm (EVAR trial 1): randomized
controlled trial. Lancet. 2005 Jun 25-Jul 1;365(9478):2179-86. doi:
10.1016/S0140-6736(05)66627-5. PMID: 15978925. REFERENCE #3: Findeiss LK,
Cody ME. Endovascular repair of thoracic aortic aneurysms. Semin Intervent
Radiol. 2011 Mar;28(1):107-17. doi: 10.1055/s-0031-1273945. PMID:
22379281; PMCID: PMC3140248. DISCLOSURES: No relevant relationships by
Nikita Chintam No relevant relationships by Deepika Davalath Copyright
© 2024 American College of Chest Physicians

<109>
Accession Number
2034594957
Title
EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON 6-MINUTE WALK TEST
OUTCOMES IN PATIENTS WITH EXCESSIVE CENTRAL AIRWAY COLLAPSE.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A260-A261),
2024. Date of Publication: October 2024.
Author
BURBANO A.V.; ROSENBERG B.; PARRISH R.; OSPINA-DELGADO D.; PARIKH M.S.;
SWENSON K.E.; BEATTIE J.; WILSON J.L.; GANGADHARAN S.P.; MAJID A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Abstracts Posters SESSION TYPE:
Original Investigation Posters PRESENTED ON: 10/08/2024 01:45 pm - 02:30
pm PURPOSE: The use of non-invasive positive pressure ventilation has been
proposed to improve exercise capacity in patients with Excessive Central
Airway Collapse (ECAC). Our aim is to determine if the use of a portable
Continuous Positive Airway Pressure (CPAP) device will allow patients to
achieve a significant difference on 6-minute walk test (6MWT) distance and
decrease dyspnea. METHOD(S): In this prospective, randomized,
placebo-controlled clinical trial, patients with clinical suspicion of
ECAC and well-controlled respiratory comorbidities underwent initial
dynamic bronchoscopy. Severe ECAC defined as collapse >90% was confirmed
and intraoperative CPAP titration was performed, to a setting where
collapse was < 90%. On a subsequent clinic visit, patients were randomized
to sham-CPAP using a modified exhalation valve or CPAP. Peak flow meter
was performed before and after 6MWT as well as dyspnea assessment using
the Borg scale and Multidisciplinary Dyspnea Scale (MDS). Paired t-test
was used to compare change in 6MWT, two sample t-test was used to compare
group means. RESULT(S): 14 patients with severe ECAC completed
initial dynamic bronchoscopy with CPAP titration. Median age was 67 years,
10 were female, 10 had asthma, 10 OSA, mean BMI was 31.9+/-5.4, the most
common presenting symptoms were severe cough and dyspnea on exertion. On
titration, median pressure at which severe collapse was relieved was 14
(IQR 12-14) cmH20. Nine patients were randomized, five to sham-CPAP, four
to CPAP, and all completed the 6MWT. In the sham-CPAP group, mean 6MWT
distance decreased by -45.65 meters (95% CI -96.1 to 4.8; p=0.06). In the
CPAP group mean 6MWT distance decreased by -2.85 (-94.8 to 89.1; p=0.9).
Between group difference was -44.5 (-135.5 to 46.4; p=0.2). One patient,
randomized to the CPAP group, achieved an increase in 6MWT distance >24m.
Mean peak flow before 6MWT in the sham-CPAP group was 248 L/min and 214
after with a difference of -34. Mean peak flow in the CPAP group was 247.5
and 270 after with an increase of 22.5. Mean Borg before 6MWT in the
sham-CPAP group was 3.4 and 3.4 after; in the CPAP group mean Borg was
3.75 and 5 after with an absolute increase of 1.25 in dyspnea assessment.
One patient in the CPAP group improved their Borg dyspnea assessment by
-1, the remaining patients in both groups experienced equal or increased
dyspnea. Mean MDS in the sham-CPAP group at baseline was 43.6 and 26.4
after with a difference of -17.2. In the CPAP group mean MDS was 34.5 at
baseline and 35 after, with an increase of 0.5. CONCLUSION(S): In
this interim analysis, the use of CPAP increased peak flow measurements
but failed to improve exercise capacity or dyspnea in patients with severe
excessive central airway collapse. Full data will determine the effect of
CPAP on exercise capacity, respiratory symptoms, and airflow measurements
in patients with ECAC. CLINICAL IMPLICATIONS: Results from our preliminary
analysis do not support the routine use of CPAP in ambulatory patients
with ECAC who do not exhibit acute respiratory distress or respiratory
failure. DISCLOSURES: Speaker/Speaker's Bureau relationship with Intuitive
Surgical Please note: 05/2023 to present Added 06/03/2024 by Jason
Beattie, source=Web Response, value=Educational speaker fees Consultant
relationship with Impact Biotech Please note: 06/2023-08/2023 Added
06/03/2024 by Jason Beattie, source=Web Response, value=Consulting fee No
relevant relationships by Alma Burbano No relevant relationships by Sidhu
Gangadharan Consultant relationship with praxis medical Please note:
1/2023 Added 11/30/2023 by Adnan Majid, source=Web Response,
value=Consulting fee Consultant relationship with praxis medical Please
note: 1/2023 Added 11/30/2023 by Adnan Majid, source=Web Response,
value=Consulting fee Consultant relationship with Boston Scientific Please
note: 1/2022 Added 11/30/2023 by Adnan Majid, value=Consulting fee
Consultant relationship with olympus Please note: 1/2016 Added 11/30/2023
by Adnan Majid, value=Consulting fee Consultant relationship with pinacle
biologics Please note: 1/2022 Added 11/30/2023 by Adnan Majid,
value=Consulting fee Speaker/Speaker's Bureau relationship with cook
medical Please note: 9/2023 Added 11/30/2023 by Adnan Majid, source=Web
Response, value=Honoraria Speaker/Speaker's Bureau relationship with
pulmon-x Please note: 11/2023 Added 11/30/2023 by Adnan Majid, source=Web
Response, value=Honoraria No relevant relationships by Daniel
Ospina-Delgado No relevant relationships by Mihir Parikh Consultant
relationship with Chorus, LLC Please note: 2/2024-present Added 03/25/2024
by Raymond Parrish, source=Web Response, value=Consulting fee No relevant
relationships by Brian Rosenberg No relevant relationships by Kai Swenson
No relevant relationships by Jennifer Wilson Copyright © 2024
American College of Chest Physicians

<110>
Accession Number
2034600923
Title
INVASIVE PULMONARY ASPERGILLOSIS LEADING TO ACUTE HYPOXIC RESPIRATORY
FAILURE AND POLYMORPHIC VENTRICULAR TACHYCARDIA IN A HEART TRANSPLANT
PATIENT.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A6322-A6323), 2024. Date of Publication: October 2024.
Author
ARMIJO-ALBA J.; RADAELLI M.; HOLLEY A.B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Transplantation Case Reports Posters (A) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am INTRODUCTION:
Invasive Aspergillosis (IA) is a relatively uncommon complication after
heart transplantation, with associated mortality up to 66% [1-3]. Despite
being uncommon, IA in solid organ transplant (SOT) recipients poses
significant diagnostic and therapeutic challenges. While the
pathophysiology of IA and the impact of immunosuppression is better
understood now, risk stratification remains challenging [4] and
broad-spectrum antifungal prophylaxis controversial [5]. Identified risk
factors include re-operation, CMV infection, organ rejection, and
post-transplant HD [1,2,4]. Moreover, diagnostic tools perform
suboptimally in the SOT populations compared to neutropenic patients,
often hindering a prompt definitive diagnosis [6-8]. Treatment is often
complicated by underlying conditions and drug interactions, necessitating
individualized approaches. CASE PRESENTATION: A 62-year-old female with a
history of orthotopic heart transplant (OHT), rheumatoid arthritis, COPD,
and CKD presented to a follow-up visit at the Heart Transplant clinic in
March of 2024 complaining of progressive dyspnea on exertion.She underwent
heart transplantation in December of 2023, complicated by acute organ
rejection treated with plasmapheresis and pulse-dose steroids. She was
discharged to acute rehabilitation (AR) on mycophenolate, prednisone, and
tacrolimus with plans to initiate bortezomib as an outpatient. During her
prolonged stay at AR, she developed hypoxia. CT (image 1) was concerning
for pneumonia, for which she completed a course of cefepime. At her
follow-up visit, she reported that she had been weaned off oxygen but now
required it again. Her donor-specific antibodies (DSA) were elevated,
leading to admission for repeat plasmapheresis and workup of hypoxia.
DISCUSSION: She was given empiric antibiotics, treatment of suspected
underlying COPD was initiated, and sputum studies were pursued.
Thoracentesis revealed an exudative effusion, though the patient became
acutely hypoxic and altered leading to ICU uptriage before further workup
could be done. The patient was placed on BiPAP and started on
voriconazole; CRRT was initiated to address metabolic derangements.
Interval CT (image 2) showed worsening of the RUL infiltrate. Clinical
status improved briefly before experiencing two episodes of unstable VT
requiring electric cardioversion, without recurrence after voriconazole
was switched to isavuconazonium. Around this time, a BAL sample returned
positive for mold, subsequently speciated to Aspergillus fumigatus.
Aspergillus antigens were positive; Fungitell testing was above the upper
limit of the assay. Repeat CT showed extensive cavitation throughout the
entire RUL and portions of the middle and lower lobes (image 3). Thoracic
Surgery determined that the only surgical option would be pneumonectomy,
which the patient cannot tolerate in her current condition. She remains
intubated after one failed extubation attempt and is being considered for
tracheostomy. CONCLUSION(S): As the number, diversity, and
immunosuppressant regimen complexity of transplant patients all increase
[9], it is of vital importance for clinicians to be aware of possible
atypical presentations of infection to enhance early recognition and
treatment. This is especially important in the case of invasive
aspergillosis, as it can mimic other pulmonary pathology in early stages
and carries an elevated mortality. Persistent systemic symptoms in
transplant patients should warrant a comprehensive re-evaluation of the
patient and consideration of unusual etiologies. REFERENCE #1: 1. Singh
NM, Husain S. Aspergillosis in Solid Organ Transplantation. American
Journal of Transplantation. 2013;13:228-241. doi:10.1111/ajt.12115. 2.
Lamoth F, Chung SJ, Damonti L, Alexander BD. Changing Epidemiology of
Invasive Mold Infections in Patients Receiving Azole Prophylaxis. Clinical
Infectious Diseases. 2017;64(11):1619-1621. doi:10.1093/cid/cix130. 3.
Pfeiffer CD, Fine JP, Safdar N. Diagnosis of Invasive Aspergillosis Using
a Galactomannan Assay: A Meta-Analysis. Clinical Infectious Diseases.
2006;42(10):1417-1727. doi:10.1086/503427. 4. Farmakiotis D, Kontoyiannis
DP. Emerging Issues With Diagnosis and Management of Fungal Infections in
Solid Organ Transplant Recipients. American Journal of Transplantation.
2015;15(5):1141-1147. doi:10.1111/ajt.13186. 5. Neofytos D, Chatzis O,
Nasioudis D, et al. Epidemiology, risk factors and outcomes of invasive
aspergillosis in solid organ transplant recipients in the Swiss Transplant
Cohort Study. Transplant Infectious Dis. 2018;20(4):e12898.
doi:10.1111/tid.12898. 6. Munoz P, Ceron I, Valerio M, et al. Invasive
aspergillosis among heart transplant recipients: A 24-year perspective.
The Journal of Heart and Lung Transplantation. 2014;33(3):278-288.
doi:10.1016/j.healun.2013.11.003. 7. Neofytos D, Garcia-Vidal C, Lamoth F,
Lichtenstern C, Perrella A, Vehreschild JJ. Invasive aspergillosis in
solid organ transplant patients: diagnosis, prophylaxis, treatment, and
assessment of response. BMC Infect Dis. 2021;21(1):296.
doi:10.1186/s12879-021-05958-3. 8. Flores-Umanzor E, Ivey-Miranda JB,
Pujol-Lopez M, et al. Invasive pulmonary aspergillosis in heart transplant
recipients: Is mortality decreasing? Revista Portuguesa de Cardiologia
(English Edition). 2021;40(1):57-61. doi:10.1016/j.repce.2019.02.018. 9.
Colvin MM, Smith JM, Ahn YS, et al. OPTN/SRTR 2022 Annual Data Report:
Heart. American Journal of Transplantation. 2024;24(2):S305-S393.
doi:10.1016/j.ajt.2024.01.016 DISCLOSURES: No relevant relationships by
Julian Armijo-Alba My spouse/partner as a Employee<br relationship with
United Health Group Please note: $20001 - $100000 by Aaron Holley,
value=stock options Removed 03/24/2024 by Aaron Holley, source=Web
Response Write pieces on journal articles to be published online
relationship with WebMD Please note: 5 years by Aaron Holley,
value=Consulting fee Designed educational material relationship with CHEST
Please note: 2014-current Added 03/24/2024 by Aaron Holley,
value=Honoraria Consultant relationship with Metapharm Please note: 2022
by Aaron Holley, value=Consulting fee No relevant relationships by Marco
Radaelli Copyright © 2024 American College of Chest Physicians

<111>
Accession Number
2034600767
Title
ATRIAL FIBRILLATION, AMIODARONE, AND PULMONARY HEMORRHAGES: THE PERFECT
STORM.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A236-A237),
2024. Date of Publication: October 2024.
Author
JAMAL U.; DIAMOND T.; MORILES K.; ROHRIG S.; SCHROCK I.A.N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Reports Posters (B) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Amiodarone is one of North America's most commonly
prescribed antiarrhythmic medications due to its well-described
biochemical and electrophysiological properties. Amiodarone is also the
drug of choice in cardiac surgery to reduce the incidence of postoperative
tachyarrhythmias which reduces mortality, hospital stay, and
cardiovascular morbidity. Despite its proven benefits, adverse effects of
amiodarone therapy can be as high as 15% in the initial year of use and
may reach as high as 50% with long-term use. Pulmonary toxicity can
manifest within the first year of use and carries a mortality of 10%.
Pulmonary toxicity can often present as organizing pneumonia, pleural
effusion, acute respiratory distress syndrome, or even more rarely diffuse
alveolar hemorrhage. This case report reviews a patient who underwent
major cardiac surgery secondary to failing medical management of new-onset
atrial fibrillation. Within two months of amiodarone use pre and
post-surgery, the patient was found to have diffuse alveolar hemorrhage
without any preexisting lung disease. The case highlights the risks of
diffuse alveolar hemorrhage in the setting of amiodarone use that may
outweigh clinical benefits in the setting of cardiac surgery. CASE
PRESENTATION: The patient is a 75-year-old male with a past medical
history of coronary artery disease, aortic stenosis, and paroxysmal atrial
fibrillation presenting with shortness of breath. Two weeks before
admission, the patient underwent a four-vessel coronary artery bypass,
aortic valve replacement, and left atrial appendage clip placement due to
worsening dyspnea and was later discharged to inpatient rehab. During
rehab, the patient became rapidly short of breath with new onset
hemoptysis. Physical exam was significant for diffuse crackles on
bilateral lungs and the patient was placed on Airvo 40L at 70% Fio2.
Aggressive diuresis did not improve his symptoms. An echocardiogram showed
a patent aortic valve, no signs of pericardial effusion, constrictive
pericarditis, or changes to ejection fraction. A CT of the chest showed
new extensive bilateral lower lobe predominant ground glass opacities with
consolidations. The patient was empirically started on vancomycin and
Zosyn, but this was later discontinued due to a lack of clinical
improvement. The patient was then started on steroids but continued to
have worsening shortness of breath and hemoptysis. The patient was then
intubated for airway protection and a bronchoscopy with BAL was performed
that revealed diffuse alveolar hemorrhage. Despite multiple paralytics and
adequate sedation, the patient had worsening difficulty in achieving
oxygenation and ventilation. The patient was transferred to a tertiary
care center for ECMO where ultimately he decided comfort measures only.
DISCUSSION: Amiodarone-induced alveolar hemorrhage is very rare, with only
a few case reports in the literature detailing its devastating
presentation. A review of the literature reveals the incidence of
pulmonary toxicity associated with amiodarone ranges from 1% to 10%.
 CONCLUSION(S): Patients may benefit from rate control versus rhythm
control with amiodarone if the patient has atrial fibrillation and is
undergoing cardiac surgery. While it has been shown that amiodarone
reduces cardiovascular morbidity/mortality, physicians should be aware of
this major complication and have a high index of suspicion when initiating
treatment with amiodarone. REFERENCE #1: Vassallo, P., & Trohman, R. G.
(2007). Prescribing Amiodarone. JAMA, 298(11), 1312.
https://doi.org/10.1001/jama.298.11.1312. Wolkove, N., & Baltzan, M.
(2009). Amiodarone Pulmonary Toxicity. Canadian Respiratory Journal,
16(2), 43-48. https://doi.org/10.1155/2009/282540 REFERENCE #2: Aasbo, J.
D., Lawrence, A., Rama, R., Kim, M., & Trohman, R. G. (2005). Amiodarone
Prophylaxis Reduces Major Cardiovascular Morbidity and Length of Stay
after Cardiac Surgery: A Meta-Analysis. Annals of Internal Medicine,
143(5), 327-327. https://doi.org/10.7326/0003-4819-143-5-200509060-00008.
Florek, J. B., & Girzadas, D. (2023, November 12). Amiodarone. National
Library of Medicine; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK482154/ REFERENCE #3: Saeed, J.,
Waqas, Q. A., Khan, U. I., & Abdullah, H. M. A. (2019). Amiodarone-induced
diffuse alveolar haemorrhage: a rare but potentially life-threatening
complication of a commonly prescribed medication. BMJ Case Reports,
12(10), e232149. https://doi.org/10.1136/bcr-2019-232149 DISCLOSURES: No
relevant relationships by Thomas Diamond No relevant relationships by
Ummar Jamal No relevant relationships by Kevin Moriles No relevant
relationships by Sarah Rohrig No relevant relationships by Ian
Schrock Copyright © 2024 American College of Chest Physicians

<112>
Accession Number
2034600563
Title
WHEN IT RAINS IT POURS: A CASE OF FUNGAL CARDIAC TAMPONADE AND MILIARY
TUBERCULOSIS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A1275-A1276), 2024. Date of Publication: October 2024.
Author
FARRELL B.P.; MOYER R.; KINNIRY P.A.U.L.; WADE A.; LEISER A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Reports Posters (G) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/07/2024 12:30 pm - 01:15 pm
INTRODUCTION: Pericarditis is an inflammatory condition of the pericardium
which in severe cases can cause cardiac restriction or tamponade. Purulent
pericarditis is hallmarked by pus accumulation within the pericardial sac
and is commonly due to bacterial and in rarer cases fungal infection.
Miliary Tuberculosis is a severe disseminated infection of pulmonary
tuberculosis (TB) which appears like millet seeds throughout the infected
tissue. Immunosuppression whether iatrogenically or acquired such as from
Human immunodeficiency Virus (HIV) increases the risk of infection of
opportunistic pathogens such as both TB and fungal infections. Given their
similar risk factors, approximately 25% of patients who present with
pulmonary TB have fungal coinfection, primarily from candida species. We
present a case of candidal pericarditis and resulting cardiac tamponade in
a patient with concomitant miliary TB and immunosuppression from
uncontrolled HIV infection. CASE PRESENTATION: A thirty-four-year-old
Indonesian male with a history of uncontrolled HIV presented to the
hospital after being found down and minimally responsive by his roommate
who reported a preceding two-week history of cough and fevers with limited
PO intake. On presentation he was hypothermic, leukopenic, and hypotensive
with multi-system end organ damage. Chest imaging was notable for diffuse
randomly distributed pulmonary nodules, mediastinal lymphadenopathy and
hilar lymphadenopathy. Quantiferon gold testing came back positive for TB1
and TB2. Trans-thoracic echocardiogram (TTE) shortly after admission was
notable for a trivial pericardial effusion. Bronchoalveolar lavage was
performed and notable for acid fast bacilli (AFB) on gram stain. Patient
was started on RIPE therapy with levofloxacin, isoniazaid, ethambutol,
pyrazinamide, and vitamin B6 for pulmonary miliary TB. Several days after
initiation of treatment hemodynamics started to worsen, electrical
alternans and pulsus parodoxus were noted on telemetry. Repeat TTE was
notable for a large pericardial effusion with impending tamponade
physiology. Pericardiocentesis was performed with removal of 420mL of
bloody-purulent fluid. Fluid analysis of this fluid was notable for the
absence of AFB but growth of candida lusitaniae. Blood Cultures drawn at
this time also grew candida lusitaniae which was absent from prior
cultures. Systemic antifungal therapy with caspofungin was initiated
without re-accumulation of the pericardial fluid and resolution of the
fungemia. DISCUSSION: Miliary tuberculosis represents a severe and deadly
disease process which is further complicated by high degrees of fungal
co-infection greatly increasing mortality. It is imperative to assess for
these concomitant infections to expedite treatment and minimize
complications when Miliary TB is suspected. Candida pericarditis and
tamponade, while rare, have significant associated mortality and may be
difficult to diagnose quickly in seriously ill patients. Continuous
telemetry and vigilant hemodynamic monitoring can help catch this syndrome
as it develops. CONCLUSION(S): Candidal pericarditis is a rare
disease but those with immunosuppression and pulmonary TB infection are at
increased risk so warrant close monitoring and prompt intervention.
REFERENCE #1: Reuven Rabinovici, Damian Szewczyk, Philip Ovadia, Jeffrey R
Greenspan, Jocelyn J Sivalingam, Candida Pericarditis: Clinical Profile
and Treatment, The Annals of Thoracic Surgery, Volume 63, Issue 4,1997,
Pages 1200-1204, ISSN 0003-4975,
https://doi.org/10.1016/S0003-4975(97)00086-6.Salimi M, Davoodi L,
Jalalian R, et al. A fatal Candida albicans pericarditis presenting with
cardiac tamponade after COVID-19 infection and cardiothoracic surgery. J
Clin Lab Anal. 2023; 37:e24968. doi:10.1002/jcla.24968 REFERENCE #2: Sung
J, Perez IE, Feinstein A, Stein DK. A case report of purulent pericarditis
caused by Candida albicans: Delayed complication forty-years after
esophageal surgery. Medicine (Baltimore). 2018 Jul;97(28):e11286. doi:
10.1097/MD.0000000000011286. PMID: 29995762; PMCID: PMC6076085. Chang SA.
Tuberculous and infectious pericarditis. Cardiology Clinics.
2017;35(4):615-622. REFERENCE #3: Rabinovici R, Szewczyk D, Ovadia P,
Greenspan JR, Sivalingam JJ. Candida pericarditis: clinical profile and
treatment. Ann Thorac Surg. 1997 Apr;63(4):1200-4. doi:
10.1016/s0003-4975(97)00086-6. PMID: 9124944. Mehdi Hadadi-Fishani, Ali
Shakerimoghaddam, Azad Khaledi. Candida coinfection among patients with
pulmonary tuberculosis in Asia and Africa; A systematic review and
meta-analysis of cross-sectional studies, Microbial Pathogenesis, Volume
139, 2020,103898, ISSN 0882-4010,
https://doi.org/10.1016/j.micpath.2019.103898. DISCLOSURES: No relevant
relationships by Brendon Farrell No relevant relationships by Paul Kinniry
No relevant relationships by Abraham Leiser No disclosure on file for
Ronald Moyer No relevant relationships by Andrew Wade Copyright ©
2024 American College of Chest Physicians

<113>
Accession Number
2034600304
Title
FROM TRADITIONAL TO TRANSCATHETER: VALVE-IN-VALVE TAVR AS A PARADIGM SHIFT
IN AORTIC VALVE INTERVENTIONS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A478-A479),
2024. Date of Publication: October 2024.
Author
SAEED M.O.I.Z.; SABANCI R.A.N.D.; SHABAN D.I.N.A.; GHNAIMA H.; NADER G.;
ALATTAL S.A.-D.; WATAT K.; MARTINEZ SALAZAR A.; KHALEEQ G.; SHAH N.; PAHWA
R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Reports Posters (U) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Valve-in-valve transcatheter aortic valve replacement
(ViV-TAVR) has emerged as a useful alternative procedure to redo-surgical
aortic valve replacement (Redo-SAVR) in managing degenerated bioprosthetic
valves (1). Prior research has indicated that transcatheter aortic valve
replacement (TAVR) is a viable and effective treatment approach for
individuals with severe aortic stenosis (AS) (2-5). However, degeneration
of bioprosthetic valves often requires re-intervention due to restenosis
or regurgitation. Redo-SAVR has been the traditional approach for these
cases but carries higher surgical risks (6,7). With the advancements in
TAVR techniques and outcomes, ViV-TAVR has emerged as an alternative,
particularly for high-risk patients (8). While still evolving, ViV-TAVR
shows promise as a viable alternative to Redo-SAVR for managing
degenerated bioprosthetic aortic valves. CASE PRESENTATION: A 74-year-old
female with a history of paroxysmal atrial fibrillation, surgical aortic
valve replacement with bioprosthesis for aortic insufficiency 13 years
prior to presentation, moderate mitral regurgitation, and congestive heart
failure presented to the emergency department with shortness of breath and
lower extremity swelling. She was hypotensive requiring vasopressor
support. Evaluation with echocardiogram revealed left ventricular ejection
fraction of 40% and a degenerative bioprosthetic aortic valve with severe
regurgitation. Despite appropriate pressor support, she remained
hemodynamically unstable prompting urgent consideration for ViV-TAVR. To
stabilize her condition, a 5.5 Impella was inserted into the left
ventricle for hemodynamic support. Following this, ViV-TAVR was performed
using a 26 mm Edwards Sapien valve, resulting in significant improvement
in her hemodynamics and symptoms. Upon discharge, follow-up
echocardiography showed a stable ejection fraction of 40% and normal
functioning of her bioprosthetic valve, with no signs of regurgitation or
abnormal gradients. DISCUSSION: Over time, TAVR procedures have been
performed in younger populations, and their longer life expectancy raises
concerns about the durability of transcatheter heart valves (THVs). This
may lead to an increasing incidence of THV failure during extended
follow-up. Treatment options for failed THVs include redo-SAVR or
ViV-TAVR. The choice between these therapies should consider factors like
the cause of THV dysfunction, aortic root anatomy, initial THV type,
patient's clinical condition, and procedural/surgical risk. Recent
multicenter studies conducted by Deharo et al., Malik et al., Hirji et
al., and Tam et al. compared ViV-TAVR and redo-SAVR using propensity score
matching and national databases. They found that ViV-TAVR demonstrated
improvements in short-term mortality rates and reductions in major
bleeding events compared to redo-SAVR. However, for mid to long-term
follow-up, outcomes were similar between the two groups. Overall, ViV-TAVR
was consistently associated with lower in-hospital adverse events and
significantly reduced short-term mortality (9-13). Despite the associated
numerous benefits, a significant drawback of ViV-TAVR is the elevated risk
of prosthesis-patient mismatch and heightened transvalvular gradients.
Randomized controlled trials with longer follow-ups and extensive
multicenter registries are crucial for a more comprehensive analysis and
definition of the disparities in survival between these two procedures.
 CONCLUSION(S): ViV-TAVR shows promise as an effective alternative to
redo-SAVR for managing degenerated bioprosthetic valves, although further
research is needed to fully assess its long-term efficacy and risks.
REFERENCE #1: 1. Yousef S, Serna-Gallegos D, Iyanna N, et al.
Valve-in-valve transcatheter aortic valve replacement versus isolated redo
surgical aortic valve replacement. J Thorac Cardiovasc Surg. Published
online July 1, 2023. doi:10.1016/j.jtcvs.2023.06.014. 2. Kolte D, Khera S,
Vemulapalli S, et al. Outcomes Following Urgent/Emergent Transcatheter
Aortic Valve Replacement: Insights From the STS/ACC TVT Registry. JACC
Cardiovasc Interv. 2018;11(12):1175-1185. doi:10.1016/j.jcin.2018.03.002.
3. Frerker C, Schewel J, Schluter M, et al. Emergency transcatheter aortic
valve replacement in patients with cardiogenic shock due to acutely
decompensated aortic stenosis. EuroIntervention. 2016;11(13):1530-1536.
doi:10.4244/EIJY15M03_03. 4. Bongiovanni D, Kuhl C, Bleiziffer S, et al.
Emergency treatment of decompensated aortic stenosis. Heart.
2018;104(1):23-29. doi:10.1136/heartjnl-2016-311037. 5. Landes U, Orvin K,
Codner P, et al. Urgent Transcatheter Aortic Valve Implantation in
Patients With Severe Aortic Stenosis and Acute Heart Failure: Procedural
and 30-Day Outcomes. Can J Cardiol. 2016;32(6):726-731.
doi:10.1016/j.cjca.2015.08.022 REFERENCE #2: 6. Baumgartner H, Falk V, Bax
JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart
disease. Eur Heart J. 2017;38(36):2739-2791. doi:10.1093/eurheartj/ehx391.
7. Maganti M, Rao V, Armstrong S, Feindel CM, Scully HE, David TE. Redo
valvular surgery in elderly patients. Ann Thorac Surg. 2009;87(2):521-525.
doi:10.1016/j.athoracsur.2008.09.030. 8. Carabello BA. Transcatheter
aortic-valve implantation for aortic stenosis in patients who cannot
undergo surgery. Curr Cardiol Rep. 2011;13(3):173-174.
doi:10.1007/s11886-011-0173-6. 9. Saleem S, Ullah W, Syed MA, et al.
Meta-analysis comparing valve-in-valve TAVR and redo-SAVR in patients with
degenerated bioprosthetic aortic valve. Catheter Cardiovasc Interv.
2021;98(5):940-947. doi:10.1002/ccd.29789. 10. Deharo P, Bisson A, Herbert
J, et al. Transcatheter Valve-in-Valve Aortic Valve Replacement as an
Alternative to Surgical Re-Replacement. J Am Coll Cardiol.
2020;76(5):489-499. doi:10.1016/j.jacc.2020.06.010 REFERENCE #3: 11. Tam
DY, Dharma C, Rocha RV, et al. Transcatheter ViV Versus Redo Surgical AVR
for the Management of Failed Biological Prosthesis: Early and Late
Outcomes in a Propensity-Matched Cohort. JACC Cardiovasc Interv.
2020;13(6):765-774. doi:10.1016/j.jcin.2019.10.030. 12. Malik AH,
Yandrapalli S, Zaid S, et al. Valve-in-Valve Transcatheter Implantation
Versus Redo Surgical Aortic Valve Replacement. Am J Cardiol.
2020;125(9):1378-1384. doi:10.1016/j.amjcard.2020.02.005. 13. Hirji SA,
Percy ED, Zogg CK, et al. Comparison of in-hospital outcomes and
readmissions for valve-in-valve transcatheter aortic valve replacement vs.
reoperative surgical aortic valve replacement: a contemporary assessment
of real-world outcomes. Eur Heart J. 2020;41(29):2747-2755.
doi:10.1093/eurheartj/ehaa252 DISCLOSURES: No relevant relationships by
Saif Al-Deen Alattal No relevant relationships by Harith Ghnaima No
relevant relationships by Ghulam Khaleeq No relevant relationships by
Adolfo Martinez Salazar No relevant relationships by Georgette Nader No
relevant relationships by Rajit Pahwa No relevant relationships by Rand
Sabanci No relevant relationships by Moiz Saeed No relevant relationships
by Dina Shaban No relevant relationships by Niket Shah No relevant
relationships by Kevin Watat Copyright © 2024 American College of
Chest Physicians

<114>
Accession Number
2034600221
Title
VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION IN PATIENTS WITH NONACUTE
MYOCARDIAL INFARCTION-RELATED CARDIOGENIC SHOCK.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A635-A636),
2024. Date of Publication: October 2024.
Author
UMEH C.; DARJI P.U.J.A.; FELIX R.; BANZON J.O.S.E.; RANDHAWA S.; PATEL
S.M.I.T.; WAGNER C.O.R.Y.; DAKORIA R.; NWOKO P.; HOTWANI P.; KAUR P.;
PENAHERRERA J.O.S.E.; GUPTA R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Hot Topics in Coronary Ischemia SESSION TYPE: Rapid Fire
Original Inv PRESENTED ON: 10/08/2024 10:20 am - 11:05 am PURPOSE:
Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) has been used
in patients with refractory cardiogenic shock. A recent meta-analysis of
patients with acute myocardial infarction (AMI) related cardiogenic shock
showed no 30-day mortality benefit and increased rate of major bleeding in
those that received VA-ECMO compared to medical care alone. Following this
study, the benefit of VA-ECMO in non-AMI-related cardiogenic shock remains
uncertain. We aim to study the benefit of VA-ECMO in patients with
non-AMI-related cardiogenic shock using a large nationwide data set.
 METHOD(S): We analyzed the 2020 United States National Inpatient
Sample, a 20-percent stratified sample of discharges from United States
hospitals. We included patients with non-AMI-related cardiogenic shock who
received medical care alone. We excluded patients managed with circulatory
support devices such as intra-aortic balloon pumps, and Impella left
ventricular support systems. RESULT(S): There were 24,385 patients
with non-AMI-related cardiogenic shock, of which 61.3% were males. The
overall mortality was 32.6%. 375 patients (1.5%) were treated with
VA-ECMO. The patients treated with VA-ECMO compared to those that received
medical care alone were younger (44.50 years vs. 64.43 years, p<0.001),
had longer length of hospital stay (22.76 days vs. 11.90 days, p<0.001),
and had higher in-hospital mortality (48.5% vs. 32.4%, p<0.001). In the
multivariate analysis, the use of VA-ECMO was associated with younger
patients (OR 0.0.96, 95% CI 0.95-0.96, p<0.001) and an increased odds of
intracranial bleeding (OR 2.58, 95% CI 1.53-4.33, p<0.001), acute kidney
injury (OR 1.87, 95% CI 1.44-2.41, p<0.001), increased length of hospital
stay (OR 1.014, 95% CI 1.011-1.018, p<0.001) and increased inpatient
mortality (OR 2.73, 95% CI 2.19-3.40, p<0.001). CONCLUSION(S): The
mortality rate in non-AMI-related cardiogenic shock is high, irrespective
of whether VA-ECMO was used or not. Our study found an increased risk of
intracranial hemorrhage and no mortality benefit with the routine use of
VA-ECMO in non-AMI-related cardiogenic shock. The patients with VA-ECMO
are more likely to have an advanced cardiogenic shock (SCAI stage D and
E), which could have contributed to the increased in-hospital mortality.
CLINICAL IMPLICATIONS: Our study suggests no mortality benefits from the
routine use of VA-ECMO in non-AMI-related cardiogenic shock. However, this
does not preclude its benefits in selected patients who might be
candidates for other procedures, such as heart transplants. DISCLOSURES:
No relevant relationships by Jose Banzon No relevant relationships by
Ruchi Dakoria No relevant relationships by Puja Darji No relevant
relationships by Roman Felix No relevant relationships by Rakesh Gupta No
relevant relationships by Priya Hotwani No relevant relationships by
Parvinder Kaur No relevant relationships by Precious Nwoko No relevant
relationships by Smit Patel No relevant relationships by Jose Penaherrera
No relevant relationships by Simranjit Randhawa No relevant relationships
by Chukwuemeka Umeh No relevant relationships by Cory Wagner Copyright
© 2024 American College of Chest Physicians

<115>
Accession Number
2034600145
Title
THE SHOCKING CASE OF A BLEEDING HEART: OBSTRUCTIVE SHOCK IN SPONTANEOUS
HEMORRHAGIC PERICARDIAL EFFUSION WITH APIXABAN THERAPY.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3040-A3041), 2024. Date of Publication: October 2024.
Author
SUDADI S.; WU H.; HOSKOTE A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Reports Posters (BE) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm INTRODUCTION:
Apixaban is a Factor Xa inhibitor commonly used for stroke prevention in
non-valvular atrial fibrillation and venous thromboembolism. Apixaban
therapy is associated with the risk of major bleeding events, most
commonly gastrointestinal and those from trivial or major trauma.
Spontaneous hemopericardium is rare but can be life-threatening. CASE
PRESENTATION: A 78-year-old male with a past medical history of end-stage
renal disease on hemodialysis, COPD, hypertension, and previous
cerebrovascular accident initially presented to the emergency department
for a syncopal episode. MRI brain showed new small areas of infarct in the
left parietotemporal white matter. With the identification of atrial
fibrillation, a cardioembolic etiology was considered and he was initiated
on Apixaban 5mg twice daily. Initial transthoracic echocardiogram showed
no thrombus or wall motion abnormalities. On day 6 of Apixaban therapy he
developed lethargy, hypotension, and respiratory distress. Initial
intravenous crystalloid resuscitation resulted in no improvement and
vasopressors were initiated. He was subsequently intubated for respiratory
distress. A repeat echocardiogram demonstrated a new large pericardial
effusion with right ventricular compression in both systole and diastole
suggesting tamponade physiology. An emergent pericardiocentesis revealed
dark red bloody fluid consistent with hemopericardium. He was transferred
to the Cardiac Intensive Care Unit for further care. A follow-up
Echocardiogram the next day showed no recurrence of the pericardial
effusion. Unfortunately, despite resolution of his hemopericardium, he
continued to progress towards multiorgan failure likely secondary to his
significant shock state. He was transitioned to comfort measures and
palliatively extubated. DISCUSSION: While rare, spontaneous hemorrhagic
pericardial effusion is a potentially life-threatening complication seen
in patients on Apixaban therapy. Risk factors such as age, male gender,
elevated creatinine, elevated INR, and drug interactions should be taken
into consideration. This case meets three of those five risk factors.
Patients on hemodialysis are more prone to bleeding due to uremic platelet
dysfunction among other effects on the coagulation cascade. DOACs are
primarily excreted through the liver, but there is also a significant
amount of excretion through the renal system. The increased bleeding risk
in ESRD combined with poor clearance of DOACs in renal dysfunction can
further increase the risk of this rare outcome. CONCLUSION(S): As
with all anticoagulation, major complications of Apixaban therapy are
major bleeding events. In situations where the patient has several risk
factors, it is important to maintain a high suspicion for hemopericardium
and tamponade, especially in the event of circulatory shock, for timely
identification of this potentially life-threatening event. REFERENCE #1:
Ifeanyi J, See S. A Review of the Safety and Efficacy of Apixaban in
Patients With Severe Renal Impairment. Sr Care Pharm. 2023 Mar
1;38(3):86-94. doi: 10.4140/TCP.n.2023.86. PMID: 36803700. Nasir SA, Babu
Pokhrel N, Baig A. Hemorrhagic Pericardial Effusion From Apixaban Use:
Case Report and Literature Review. Cureus. 2022 Oct 7;14(10):e30021. doi:
10.7759/cureus.30021. PMID: 36381894; PMCID: PMC9637442. Cinelli M, Uddin
A, Duka I, Soomro A, Tamburrino F, Ghavami F, Lafferty J. Spontaneous
Hemorrhagic Pericardial and Pleural Effusion in a Patient Receiving
Apixaban. Cardiol Res. 2019 Aug;10(4):249-252. doi: 10.14740/cr902. Epub
2019 Jul 31. PMID: 31413784; PMCID: PMC6681851. REFERENCE #2: Sigawy C,
Apter S, Vine J, Grossman E. Spontaneous Hemopericardium in a Patient
Receiving Apixaban Therapy: First Case Report. Pharmacotherapy. 2015
Jul;35(7):e115-7. doi: 10.1002/phar.1602. Epub 2015 Jun 10. PMID:
26095120. Abideen Asad, Z. U., Ijaz, S. H., Din Chaudhary, A. M., Khan, S.
U., & Pakala, A. (2019). Hemorrhagic Cardiac Tamponade Associated with
Apixaban: A Case Report and Systematic Review of Literature.
Cardiovascular Revascularization Medicine : Including Molecular
Interventions, 20(11 Suppl), 15.
https://doi.org/10.1016/j.carrev.2019.04.002 Ertas, F., Polat, N., Yildiz,
A., Oylumlu, M., & Ulgen, M. S. (2013). Anticoagulant-induced
hemopericardium with tamponade: A case report and review of the
literature. Journal of Clinical and Experimental Investigations, 4(2),
229-233. https://doi.org/10.5799/ahinjs.01.2013.02.0273 REFERENCE #3:
Basnet S, Tachamo N, Tharu B, Dhital R, Ghimire S, Poudel DR.
Life-Threatening Hemopericardium Associated with Rivaroxaban. Case Rep
Cardiol. 2017;2017:4691325. doi: 10.1155/2017/4691325. Epub 2017 Apr 5.
PMID: 28480082; PMCID: PMC5396431. Rogula S, Gasecka A, Mazurek T,
Navarese EP, Szarpak L, Filipiak KJ. Safety and Efficacy of DOACs in
Patients with Advanced and End-Stage Renal Disease. Int J Environ Res
Public Health. 2022 Jan 27;19(3):1436. doi: 10.3390/ijerph19031436. PMID:
35162472; PMCID: PMC8835601. DISCLOSURES: No relevant relationships by
Abhinav Hoskote No relevant relationships by Shreya Sudadi No relevant
relationships by Henry Wu Copyright © 2024 American College of
Chest Physicians

<116>
Accession Number
2034600066
Title
BILEAFLET MITRAL VALVE PROLAPSE RISK PROFILE AND CLINICAL COURSE: A
COMPREHENSIVE LITERATURE REVIEW.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A383),
2024. Date of Publication: October 2024.
Author
KUMANAYAKA D.D.; MEMAR MONTAZERIN S.; YAR KHAN N.; SULEIMAN A.D.D.I.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Abstracts Posters (E) SESSION TYPE:
Original Investigation Posters PRESENTED ON: 10/09/2024 10:20 am - 11:05
am PURPOSE: The mitral valve apparatus includes the mitral annulus, mitral
valve leaflets, chordae tendineae and the left ventricular wall with
attached papillary muscles. Any imbalance in the interplay/integrity of
these components can result in regurgitation, stenosis or combined
regurgitant/stenotic valve dysfunction. Mitral valve prolapse (MVP) is
defined as single or bileaflet prolapse into the left atrium, with or
without leaflet thickening, which affects ~2.4% of the general population.
MVP can involve Single leaflet (SiMVP) or both leaflets (BiMVP). After
managing a male patient in 30s with severe mitral regurgitation, resulting
from BiMVP, we conducted a systematic review to better understand the risk
profile METHODS: A comprehensive search of three major online databases
(PubMed, Google Scholar, and Embase) was done from inception through
December 2023. The search also included screening of the references of
relevant articles. Articles with available full text in English were
included. Letters to editor and short communications including a case
presentation were also included. Abstracts with no available full text and
articles with full text in other languages were excluded. Data on
patients' demographics (age and gender), study characteristics (first
author and year of publication), presence of arrhythmia, EKG at baseline,
Holter monitoring, echocardiography findings, other comorbidities
(presence of concomitant structural heart disease), ICD placement,
management (surgical repair or mitral clip) and patients' outcome were
extracted and collected in predefined forms of Microsoft Office Excel. The
Case Report (CARE) guidelines were used to report the case. Our systematic
review included a descriptive study of previously reported cases and our
case report. We used mean and standard deviation for continuous variables
and frequencies and percentages for dichotomous variables. RESULT(S):
The search of the included online databases yielded 798 articles which
resulted in the final inclusion of 41 cases. The mean age of our patients
was 48.70 years old ranging from 11 to 85 years old. A total of 64.86% of
the participants were female. One patient received a mitral clip for
mitral valve repair. The remaining patient underwent mitral valve surgery
or not depending on the severity of concomitant mitral regurgitation.
Fifteen individuals experienced ventricular fibrillation during their
lifetime. Mitral annular disjunction was the most common comorbidity among
the patients. Genetic mutation of undetermined significance was described
in seven cases. Three cases reported the presence of bileaflet mitral
valve in other family members of the patient. CONCLUSION(S): Based on
our comprehensive literature review, BiMVP is most prevalent in middle
aged women and can be arrhythmogenic not rarely causing malignant
ventricular arrhythmias. There might be a genetic component associated
with the presence of BiMVP. Although BiMVP was associated with higher
incidence of ventricular arrhythmias, it still has better survival
compared to SiMVP or other controls. First line treatment option for BiMVP
causing severe mitral regurgitations is surgical repair or replacement,
but extremely rarely mitral clip or transcatheter mitral valve repair
procedure can be considered for poor surgical candidates. CLINICAL
IMPLICATIONS: To better understand patient risk factors, clinical
compications and possible treatment option with transcatheter
interventions associated with BiMVP. DISCLOSURES: No relevant
relationships by Dilesha Kumanayaka No relevant relationships by Sahar
Memar Montazerin No relevant relationships by Addi Suleiman No relevant
relationships by Nibras Yar Khan Copyright © 2024 American
College of Chest Physicians

<117>
Accession Number
2034599978
Title
INSPIRATORY MUSCLE TRAINING DEVICES: AN UNUSUAL CAUSE OF RECURRENT
SPONTANEOUS PNEUMOTHORAX.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3748-A3749), 2024. Date of Publication: October 2024.
Author
KIM M.; KASSABO W.; BROWN III S.; SERJI S.A.R.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Pleura Case Reports Posters (C) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Spontaneous pneumothorax is a life-threatening condition
presenting with gas accumulation in the pleural space without an
identifiable external cause. Here we present a case of recurrent
spontaneous pneumothorax in a patient who lacks typical risk factors but
utilizes commercial inspiratory muscle training devices (IMTDs) for
strength training. CASE PRESENTATION: A 44-year-old man with a medical
history of left spontaneous pneumothorax one year prior presented with a
cough, difficulty breathing, and chest pain for five days. He was
hemodynamically stable with decreased breath sounds in the left lung
fields without signs of tension pneumothorax. Radiography confirmed a
recurrent large left pneumothorax. A chest tube was inserted. CT imaging
of the chest didn't reveal evidence of blebs or structural abnormalities.
A thorough history revealed the patient's use of an IMTD for weight
training, with close temporal relationship between device use during
exercise and symptom onset. Subsequent chest X-rays indicated no air leak
after chest tube insertion, but a left apical pneumothorax was observed
after clamping. Following a thorough discussion of the risks and benefits,
the patient underwent left video-assisted thoracoscopic surgery (VATS)
with mechanical pleurodesis. The patient was discharged after a successful
removal of the chest tube. DISCUSSION: IMTDs have gained attention in the
fields of respiratory therapy and athletic performance enhancement. IMTDs
function by providing resistance during inhalation, thereby challenging
the inspiratory muscles to work harder and resulting in enhancements in
muscle hypertrophy, endurance, and overall respiratory function. Athletes
who incorporate IMTDs into their training routines have reported increased
respiratory muscle strength, enhanced endurance, reduced breathlessness,
improved athletic performance, and better adaptation to hypoxic conditions
during high-altitude training. While IMTDs are generally considered safe
with minimal risk of adverse effects when used correctly, proper
instruction and supervision are essential to prevent potential misuse or
overexertion. During our patient's recovery phase, we recommended
incentive spirometry to aid in his recuperation. However, it's important
to note that commercially available IMTDs may not always conform to this
safety profile. Upon further investigation, our patient's IMTD provides
resistance during both inhalation and exhalation. We hypothesize that the
increased need for CO2 removal during forceful exhalation during exercise
may have been obstructed by this commercial IMTD, potentially contributing
to the pneumothorax. Furthermore, the manufacturer's webpage advised
against using it with history of prior spontaneous pneumothorax, although
no data is provided for the reasoning behind this warning. While IMTDs are
marketed to improve respiratory function and enhance exercise capacity
with typically low risk of adverse effects, we propose that in our
patient's case, there may be potential adverse effects associated with the
use of commercial IMTDs that could contribute to pneumothorax.
 CONCLUSION(S): This case underscores the importance of conducting a
detailed patient history to identify potential triggers for pneumothorax
and emphasizes the need for patient education regarding the appropriate
use of IMTDs. Further research is warranted to fully elucidate the optimal
protocols and long-term effects of IMTDs in various populations and
applications, particularly to mitigate the risk of serious adverse events
such as pneumothorax. REFERENCE #1: 1. Gupta D, Hansell A, Nichols T, et
al. Epidemiology of pneumothorax in England. Thorax 2000; 55: 666-71. 2.
Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting
spontaneous pneumothorax. Chest 1987; 92: 1009-12. 3. Khoj L, Zaga V,
Amram DL, et al. Effects of cannabis smoking on the respiratory system: A
state-of-the-art review. Respir Med. 2024 Jan:221:107494 4. Bense L,
Lewander R, Eklund G, et al. Nonsmoking, non-alpha 1-antitrypsin defi
ciency-induced emphysema in nonsmokers with healed spontaneous
pneumothorax, identifi ed by computed tomography of the lungs. Chest 1993;
103: 433-38. 5. Chen JS, Chan WK, Tsai KT, et al. Simple aspiration and
drainage and intrapleural minocycline pleurodesis versus simple aspiration
and drainage for the initial treatment of primary spontaneous
pneumothorax: an open-label, parallel-group, prospective, randomised,
controlled trial. Lancet 2013; 381: 1277-82. 6. Light RW, O'Hara VS,
Moritz TE, et al. Intrapleural tetracycline for the prevention of
recurrent spontaneous pneumothorax. Results of a Department of Veterans
Aff airs cooperative study. JAMA 1990; 264: 2224-30. 7. Bintcliffe OJ,
Hallifax RJ, Edey A, et al. Spontaneous pneumothorax: time to rethink
management. Lancet Respir Med 2015; 3: 578-88 8. Casha AR, Manche A, Gatt
R, et al. Is there a biomechanical cause for spontaneous pneumothorax?
European Journal of Cardio-Thoracic Surgery, Vol. 45, no. 6, 2014, pp
1011-16 9. Noppen M. Do blebs cause primary spontaneous pneumothorax? Con:
Blebs do not cause primary spontaneous pneumothorax. J Bronchol 2002; 9:
319-23 REFERENCE #2: 10. Smith, A. et al. (2020). The therapeutic
potential of inspiratory muscle training devices in respiratory
conditions. Journal of Pulmonary Rehabilitation, 25(2), 123-135. 11.
Johnson, B. et al. (2019). Mechanisms underlying the effectiveness of
inspiratory muscle training devices. Journal of Applied Physiology,
125(3), 567-578. 12. Thompson, C. et al. (2018). Inspiratory muscle
training for improving sports performance: A systematic review. Sports
Medicine, 48(6), 1311-1323. 13. Rodriguez, D. et al. (2017). Enhancing
altitude training with inspiratory muscle training devices: A randomized
controlled trial. High Altitude Medicine & Biology, 18(3), 256-263. 14.
Jones, G. et al. (2016). Safety and feasibility of inspiratory muscle
training devices: A systematic review. Respiratory Medicine, 115, 118-124.
DISCLOSURES: No relevant relationships by Stafford Brown III No relevant
relationships by Waleed Kassabo No relevant relationships by Minju Kim No
relevant relationships by Sara Serji Copyright © 2024 American
College of Chest Physicians

<118>
Accession Number
2034599808
Title
UNDIAGNOSED MILIARY TUBERCULOSIS IN A PATIENT WITH A HISTORY OF METASTATIC
PROSTATE CANCER.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A1479-A1480), 2024. Date of Publication: October 2024.
Author
LEFEBVRE D.; NEDUNCHEZHIAN S.; MILOJEVIC I.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Reports Posters (O) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Miliary tuberculosis (TB) is a treatable yet potentially
fatal disease. Prompt diagnosis and treatment are critical for reducing
mortality and can be increasingly challenging in patients with a complex
medical history given its nonspecific presentation and large differential
diagnosis. Herein is described a case of undiagnosed miliary TB in a
patient with a history of metastatic prostate cancer. CASE PRESENTATION: A
63-year-old man with a past medical history significant for metastatic
prostate cancer (completed hormonal and radiation therapy with subsequent
prostate-specific antigen (PSA) normalization), presumed osseous
metastatic process with recent posterior spinal fusion, and childhood TB
exposure presented with dyspnea, altered mental status, leukocytosis,
lactic acidosis, and purulence at the thoracic surgical site. He was found
to have progressive nodular lung infiltrates despite extensive antibiotic
coverage on a background of old granulomatous disease. Chest radiographs
and CT scans demonstrated a progressively nodular pattern described as
miliary which had progressed from normal lung parenchyma on CT one year
prior. The patient underwent multiple bronchoscopies with negative
acid-fast bacilli (AFB) smears and MTB PCR. Transbronchial lung biopsy
initially did not reveal granulomas. Despite clinical suspicion for TB,
empiric treatment was not begun as metastatic prostate cancer or
pseudo-miliary sarcoidosis were considered more likely. He eventually was
transferred to the ICU for worsening respiratory status where he died two
days after transbronchial cryobiopsy for the first time revealed poorly
formed non-caseating granulomas with negative AFB stains. Posthumously,
AFB cultures revealed the presence of acid-fast bacilli, later identified
as Mycobacterium tuberculosis. DISCUSSION: Miliary TB, more common in
immunocompromised individuals like those with human immunodeficiency virus
(HIV), poses diagnostic challenges in immunocompetent patients. Our
patient's diagnosis was particularly challenging since bronchoalveolar
lavage samples showed no growth, and his history of prostate cancer
increased the likelihood of a neoplastic process. There have been
documented case reports describing PSA-negative metastatic prostate cancer
and miliary patterns of metastatic prostate cancer which fit the patient's
presentation. However, bone biopsy was negative for malignant cells. It is
not known if starting empiric anti-tuberculosis therapy would have
improved this patient's outcome. Empiric miliary TB treatment's impact on
survival in immunocompetent patients remains poorly understood due to
limited data. CONCLUSION(S): Empiric treatment for miliary TB is
underexplored despite known diagnostic delays. Initiating empiric
treatment may reduce complications and improve survival during diagnostic
uncertainty. Further research is warranted to optimize treatment
strategies for miliary TB cases. REFERENCE #1: Shindo K, Ohuchida K,
Moriyama T, et al. A rare case of PSA-negative metastasized prostate
cancer to the stomach with serum CEA and CA19-9 elevation: a case report.
Surgical Case Reports. 2020/12/02 2020;6(1):303.
doi:10.1186/s40792-020-01074-7 REFERENCE #2: Miliary Pattern Of Lung
Metastases From Prostate Cancer. D43 INTERESTING CASES OF TUMORS AND MORE.
A5885-A5885. REFERENCE #3: Rajagopala S, Sankari S, Kancherla R,
Ramanathan RP, Balalakshmoji D. Miliary Sarcoidosis: does it exist? A case
series and systematic review of literature. Sarcoidosis Vasc Diffuse Lung
Dis. 2020;37(1):53-65. doi:10.36141/svdld.v37i1.7837 DISCLOSURES: No
relevant relationships by Danielle Lefebvre No relevant relationships by
Ivana Milojevic No relevant relationships by Saihariharan
Nedunchezhian Copyright © 2024 American College of Chest
Physicians

<119>
Accession Number
2034598544
Title
ANTI-MDA5 DERMATOMYOSITIS: ECMO AS A BRIDGE TO LUNG TRANSPLANT IN
REFRACTORY RAPIDLY PROGRESSIVE ILD.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3259-A3260), 2024. Date of Publication: October 2024.
Author
RODRIGUEZ CASTRO J.L.; DEVINE A.D.A.M.; GONZALEZ GARCIA G.; DANCKERS M.;
DIAZ R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Diffuse Lung Disease Case Reports Posters (J) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Anti-melanoma differentiation-associated gene 5 (MDA5) is a
rare subtype of dermatomyositis associated with a high prevalence of
rapidly progressive interstitial lung disease (RP-ILD). The diagnosis is
often delayed leading to a high mortality rate and poor prognosis.
Currently, there is no established standard treatment. Anti-MDA5 with
RP-ILD is managed with corticosteroids and immunosuppressive agents.
Extracorporeal membrane oxygenation (ECMO) is a bridge therapy to lung
transplant in patients with refractory RP-ILD. We present a case of
Anti-MDA5 with RP-ILD refractory to medical management. CASE PRESENTATION:
Our patient is a 55-year-old male with a history of anti-MDA5
dermatomyositis and a recent diagnosis of ILD. The patient was diagnosed
with dermatomyositis with clinical manifestations of arthritis and skin
ulcerations. His symptoms quickly progressed to shortness of breath and a
diagnosis of ILD. Outpatient management of three months of corticosteroids
and methotrexate did not alleviate his disease. The patient was admitted
to a community hospital with worsening hypoxia requiring max high flow
nasal cannula and non-rebreather to maintain oxygen saturations of 90%.
The computerized tomography of the chest was consistent with the patient's
previously diagnosed ILD. Immunosuppressive therapy was initiated with
Rituximab and pulse dose steroids. Empiric therapy for pneumocystis
jirovecii, fungal and community-acquired pneumonia was started. Despite
medical management, the patient's respiratory status continued to decline
and he was subsequently intubated. Before intubation, lung transplant
centers were contacted and the patient was accepted for further
evaluation. Cardiothoracic surgery was consulted for persistent hypoxia on
the ventilator and the patient was cannulated for VV ECMO as bridge
therapy for lung transplantation. The patient was transferred to a
tertiary center where a lung transplant was completed 4 weeks after the
initial presentation. DISCUSSION: The anti-MDA-5 dermatomyositis subtype
presents a worse prognosis and a higher likelihood of progressing to
RP-ILD. Early diagnosis and treatment is essential. These patients have
higher mortality and a tendency to be refractory to medical management of
corticosteroids and immunosuppressive drugs such as cyclophosphamide and
rituximab. A definitive treatment in refractory patients with advanced
RP-ILD is lung transplantation. Our patient's condition continued to
decline and required mechanical ventilation and subsequent VV ECMO
cannulation as a bridge to lung transplantation. Prior studies have
supported improved outcomes with the early initiation of VV ECMO and
evaluation by primary lung transplant centers in patients with RP-ILD.
 CONCLUSION(S): Properly recognizing refractory RP-ILD in a community
hospital can effectively improve the prognosis and identify lung
transplant candidates. Early initiation of VV ECMO should be considered as
a bridge therapy in patients with refractory RP-ILD. REFERENCE #1: 1.
Bobirca A, Alexandru C, Musetescu AE, Bobirca F, Florescu AT, Constantin
M, Tebeica T, Florescu A, Isac S, Bojinca M, Ancuta I. Anti-MDA5
Amyopathic Dermatomyositis-A Diagnostic and Therapeutic Challenge. Life
(Basel). 2022 Jul 23;12(8):1108. doi: 10.3390/life12081108. PMID:
35892910; PMCID: PMC9329888. 2. Trudzinski FC, Kaestner F, Schafers HJ,
Fahndrich S, Seiler F, Bohmer P, Linn O, Kaiser R, Haake H, Langer F, Bals
R, Wilkens H, Lepper PM. Outcome of Patients with Interstitial Lung
Disease Treated with Extracorporeal Membrane Oxygenation for Acute
Respiratory Failure. Am J Respir Crit Care Med. 2016 Mar 1;193(5):527-33.
doi: 10.1164/rccm.201508-1701OC. PMID: 26492547. 3. Faverio, P., De
Giacomi, F., Sardella, L. et al. Management of acute respiratory failure
in interstitial lung diseases: overview and clinical insights. BMC Pulm
Med 18, 70 (2018). https://doi.org/10.1186/s12890-018-0643-3 REFERENCE #2:
4. Chen Z, Cao M, Plana MN, Liang J, Cai H, Kuwana M, Sun L. Utility of
anti-melanoma differentiation-associated gene 5 antibody measurement in
identifying patients with dermatomyositis and a high risk for developing
rapidly progressive interstitial lung disease: a review of the literature
and a meta-analysis. Arthritis Care Res (Hoboken). 2013 Aug;65(8):1316-24.
doi: 10.1002/acr.21985. PMID: 23908005. 5. Marasco SF, Lukas G, McDonald
M, McMillan J, Ihle B. Review of ECMO (extra corporeal membrane
oxygenation) support in critically ill adult patients. Heart Lung Circ.
2008;17 Suppl 4:S41-7. doi: 10.1016/j.hlc.2008.08.009. Epub 2008 Oct 29.
PMID: 18964254. 6. Gu Q, Diao M, Hu W, Huang M, Zhu Y. Case Report:
Extracorporeal Membrane Oxgenation for Rapidly Progressive Interstitial
Lung Disease Associated With Clinically Amyopathic Dermatomyositis in a
Post-partum Woman. Front Med (Lausanne). 2021 Oct 1;8:742823. doi:
10.3389/fmed.2021.742823. PMID: 34660647; PMCID: PMC8517250. DISCLOSURES:
No relevant relationships by Mauricio Danckers No relevant relationships
by Adam Devine No relevant relationships by Raiko Diaz No relevant
relationships by Grettel Gonzalez Garcia No relevant relationships by Jose
Luis Rodriguez Castro Copyright © 2024 American College of Chest
Physicians

<120>
Accession Number
2034598479
Title
CARDIOGENIC SHOCK INDUCED BY ACUTE MITRAL REGURGITATION MISDIAGNOSED AS
PNEUMONIA.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A389-A390),
2024. Date of Publication: October 2024.
Author
KARKI M.; BHATTARAI P.; MOHAN R.I.Y.A.; REYNA Y.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Reports Posters (C) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/07/2024 12:30 pm - 01:15 pm
INTRODUCTION: Acute mitral regurgitation (MR) leading to cardiogenic shock
is a medical emergency. Diagnosis is frequently overlooked as it is
commonly misinterpreted as an acute respiratory condition, given that
patients often present with overlapping symptoms such as acute shortness
of breath. We present a case of acute MR-induced cardiogenic shock in a
patient with mitral valve prolapse (MVP), initially misdiagnosed as
multi-lobar pneumonia, emphasizing the importance of early recognition of
cardiac etiologies in patients presenting with respiratory distress. CASE
PRESENTATION: A 61-year-old female with a history of MVP presented with
shortness of breath at rest for two days. Initial evaluation was
significant for tachycardia (125 bpm), hypotension (98/78 mm Hg), and
hypoxia (80% on room air). Physical exam was remarkable for bibasilar
crackles and a faint systolic murmur in the left sternal border. Labs
showed leukocytosis (18,000/uL), elevated BNP (1540 pg/ml), troponin (0.35
ng/ml), and lactic acidosis (3.1 mmol/L). EKG showed sinus tachycardia and
premature ventricular complex. CXR and CT chest revealed bilateral
pulmonary infiltrates with pulmonary edema and bilateral pleural effusion.
She was initiated on antibiotics and diuretic therapy. Echocardiography
showed acute severe MR with an anteriorly directed jet due to chord
rupture in the setting of posterior MVP. Cardiac catheterization ruled out
coronary artery disease but confirmed cardiogenic shock, necessitating
intra-aortic balloon (IABP) placement as a bridge to her emergent mitral
valve surgery. Intraoperative TEE identified a complete flail P2 segment
of the mitral valve and moderate tricuspid regurgitation with a dilated
annulus. Radical mitral valvuloplasty and tricuspid valve repair were
done, but post-operatively she required venoarterial extracorporeal
membrane oxygenation (VA ECMO) along with IABP support and inotropes.
Post-surgery, she had biventricular dysfunction that improved to normal
ventricular function by postoperative day 7. She was decannulated from VA
ECMO, IABP was removed, and subsequently she was extubated. She was
discharged home on postoperative day 14 after making significant recovery.
DISCUSSION: Cardiogenic shock is a clinical diagnosis characterized by
inadequate organ and tissue perfusion secondary to cardiac dysfunction. It
is often overlooked but must be considered in patients presenting with
respiratory distress, especially those with cardiovascular risk factors.
Early utilization of bedside echocardiography is crucial for quick and
early detection of cardiac dysfunction, particularly in hemodynamically
unstable patients. Managing acute MR-induced cardiogenic shock in patients
with underlying valvular pathology, such as MVP, is a significant
challenge. However, this case demonstrates that accurate diagnosis,
emergent surgical intervention, and utilization of mechanical support with
VA ECMO and an IABP are essential in achieving remarkable recovery.
 CONCLUSION(S): This case highlights the diagnostic challenges of
distinguishing cardiogenic shock from respiratory conditions and stresses
the importance of early consideration of cardiac etiologies in patients
presenting with acute respiratory distress. Thorough clinical assessment,
timely echocardiographic evaluation, and multidisciplinary collaboration
are essential for improving patient outcomes in the management of
cardiogenic shock. REFERENCE #1: Gabbay U, Yosefy C. The underlying causes
of chordae tendinae rupture: a systematic review. Int J Cardiol. 2010 Aug
20;143(2):113-8. doi: 10.1016/j.ijcard.2010.02.011. Epub 2010 Mar 7. PMID:
20207434. REFERENCE #2: Akodad M, Schurtz G, Adda J, Leclercq F, Roubille
F. Management of valvulopathies with acute severe heart failure and
cardiogenic shock. Arch Cardiovasc Dis. 2019 Dec;112(12):773-780. doi:
10.1016/j.acvd.2019.06.009. Epub 2019 Sep 3. PMID: 31492536. REFERENCE #3:
Bizzarri F, Mattia C, Ricci M, Coluzzi F, Petrozza V, Frati G, Pugliese G,
Muzzi L. Cardiogenic shock as a complication of acute mitral valve
regurgitation following posteromedial papillary muscle infarction in the
absence of coronary artery disease. J Cardiothorac Surg. 2008 Nov 4;3:61.
doi: 10.1186/1749-8090-3-61. PMID: 18983645; PMCID: PMC2586022.
DISCLOSURES: No relevant relationships by Pramod Bhattarai No relevant
relationships by Monika Karki No relevant relationships by Riya Mohan
Speaker/Speaker's Bureau relationship with AstraZeneca Please note:
1/2022-07/2023 Added 03/15/2024 by Yordanka Reyna, source=Web Response,
value=Honoraria Copyright © 2024 American College of Chest
Physicians

<121>
Accession Number
2034598206
Title
INTERSTITIAL LUNG ABNORMALITIES AND CORONARY HEART DISEASE IN COPD GENE.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3262-A3263), 2024. Date of Publication: October 2024.
Author
CUTTING C.; ROSE J.; TUKPAH A.; WADA N.; NISHINO M.; MOLL M.; CHO M.;
SILVERMAN E.; WASHKO G.; KINNEY G.L.; HOKANSON J.O.H.N.; ROSSITER H.B.;
BUDOFF M.; HATABU H.; HUNNINGHAKE G.M.; PUTMAN R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Diffuse Lung Disease Abstracts Posters (A) SESSION TYPE:
Original Investigation Posters PRESENTED ON: 10/08/2024 01:45 pm - 02:30
pm PURPOSE: Interstitial lung abnormalities (ILA) and coronary heart
disease (CHD) share common risk factors including advanced age and
cigarette smoking. We sought to evaluate the association between ILA and
CHD in participants from COPDGene. METHOD(S): We included
participants with available ILA and coronary artery calcium (CAC) data. We
defined CHD as participant reported history at enrollment of the
following: angina, coronary artery disease, myocardial infarction,
coronary artery bypass grafting, or angioplasty, and additionally as
CAC>100, denoting at least moderate coronary calcifications. Multivariable
logistic regression was used to assess the relationship between ILA and
CHD; multivariable logistic regression and Cox proportional hazards models
were used to assess mortality associated with ILA (and ILA subtypes) and
CHD, all models were adjusted for age, race, sex, BMI, current smoking
status, pack-years smoking, and GOLD spirometry grade. RESULT(S):
CHD, as both the composite measure and CAC > 100 was more common in
participants with ILA compared to those without ILA (20% vs 10%, and 45%
vs 28%, both p<0.001). In multivariable models, subjects with ILA had
increased odds of CHD defined by both composite score (OR 1.6, 95% CI:
1.2, 2.0, p=0.0004) and CAC>100 (OR 1.4, 95% CI: 1.1, 1.8, p=0.003).
Subjects with fibrotic ILA had increased odds of CHD by composite (OR 1.8,
95% CI: 1.2, 2.8, p-value=0.006) and CAC>100 (OR 1.6, 95% CI: 1.0, 2.6,
p-value=0.04) when compared to those without ILA, there was no increase in
the odds of CHD in those with fibrotic ILA compared to ILA without
fibrosis. Over a median follow up time of 10.9 years, the presence of ILA
resulted in greater odds of death (OR 3.0, 95% CI: 1.9, 4.8, p<0.001) and
risk of death (HR 1.9, 95% CI: 1.5-2.8, p<0.001) among patients with CHD
defined by composite. The presence of ILA also resulted in greater odds of
death (OR 2.4, 95% CI: 1.7, 3.4, P<0.001) and risk of death (HR 1.6, 95%
CI: 1.3-2.0, p<0.001) in subjects with CAC>100. The risk of death was
highest among participants with fibrotic ILA and underlying CHD (when
compared to no ILA) by the composite definition (HR 3.8, 95% CI 2.6-5.7,
p<0.001) and CAC>100 (HR 2.5, 95% CI 1.8-3.5, p<0.001).
 CONCLUSION(S): Participants with ILA are more likely to have
cardiovascular disease, and ILA confers greater risk of death in subjects
with underlying CHD. CLINICAL IMPLICATIONS: These results suggest that ILA
screening should be considered in patients with CHD. DISCLOSURES: No
relevant relationships by Matthew Budoff Researcher relationship with
Bayer Please note: 9/1/2020-9/1/2023 Added 03/23/2024 by Michael Cho,
source=Web Response, value=Grant/Research Support Grant funding
relationship with Bayer Please note: 9/1/2019 by Michael Cho,
value=Grant/Research Support No relevant relationships by claire cutting
No disclosure on file for Hiroto Hatabu No relevant relationships by John
Hokanson Consultant relationship with Boehringer-Ingelheim Please note:
10/16/2023 Added 11/30/2023 by Gary Hunninghake, source=Web Response,
value=Consulting fee Consultant relationship with Chugai Pharma Please
note: 06/2022 by Gary Hunninghake, value=Consulting fee Consultant
relationship with Gerson Lehrman Group Please note: 2021 by Gary
Hunninghake, value=Consulting fee Removed 11/30/2023 by Gary Hunninghake,
source=Web Response Consultant relationship with Boehringer-Ingelheim
Please note: 03/2021 by Gary Hunninghake, value=Consulting fee Removed
11/30/2023 by Gary Hunninghake, source=Web Response No disclosure on file
for Gregory Kinney No relevant relationships by Matthew Moll No relevant
relationships by Mizuki Nishino No relevant relationships by Rachel Putman
No relevant relationships by Jonathan Rose No relevant relationships by
Harry Rossiter Investigator relationship with Bayer Please note:
2019-present by Edwin Silverman, value=Grant/Research Support ECLIPSE DCC
Director relationship with GlaxoSmithKline Please note: 2015-2018 by Edwin
Silverman, value=Grant/Research Support Removed 04/02/2024 by Edwin
Silverman, source=Web Response Institutional Grant Support relationship
with Northpond Laboratories Please note: 2020-present Added 04/02/2024 by
Edwin Silverman, source=Web Response, value=Grant/Research Support No
relevant relationships by AnnMarcia Tukpah No relevant relationships by
Noriaki Wada Consultant relationship with Vertex Please note: $5001 -
$20000 by George Washko, value=Consulting fee Removed 11/30/2023 by George
Washko, source=Web Response My spouse/partner as a Employee relationship
with biogen Please note: 2014-present Added 11/30/2023 by George Washko,
value=Salary Owner/Founder relationship with Quantitative Imaging
Solutions Please note: 2015 - present Added 11/30/2023 by George Washko,
value=Ownership interest Advisory Committee Member relationship with
Boehringer Ingelheim Please note: $1001 - $5000 by George Washko,
value=Consulting fee Removed 11/30/2023 by George Washko, source=Web
Response Advisory Committee Member relationship with PulmonX Please note:
$1001 - $5000 by George Washko, value=Consulting fee Removed 11/30/2023 by
George Washko, source=Web Response Scientific Advisory Board relationship
with Quantitative Imaging Solutions Please note: 1/2015 to present Added
04/12/2024 by George Washko, source=Web Response, value=Ownership interest
Advisory Committee Member relationship with Pieris Therapeutics Please
note: 5/2023 Added 04/12/2024 by George Washko, source=Web Response,
value=Consulting fee Consultant relationship with Intellia Therapeutics
Please note: 1/2023 to present Added 04/12/2024 by George Washko,
source=Web Response, value=Consulting fee Consultant relationship with
Sanofi Please note: 6/2023 to present Added 04/12/2024 by George Washko,
source=Web Response, value=Travel Consultant relationship with Intellia
Therapeutics Please note: 2021-present Added 11/30/2023 by George Washko,
source=Web Response, value=Consulting fee Consultant relationship with
Sanofi Please note: 1/1/2022 - Present Added 11/30/2023 by George Washko,
source=Web Response, value=Travel Consultant relationship with Johnson and
Johnson Please note: 2016-present Added 11/30/2023 by George Washko,
value=Consulting fee Advisory Committee Member relationship with CSL
Behring Please note: $1001 - $5000 by George Washko, value=Consulting fee
Removed 11/30/2023 by George Washko, source=Web Response Copyright
© 2024 American College of Chest Physicians

<122>
Accession Number
2034597951
Title
VENOVENOUS ECMO AS SALVAGE THERAPY FOR PULMONARY HEMORRHAGE.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3507-A3508), 2024. Date of Publication: October 2024.
Author
WINSKI A.; GILBERT P.A.U.L.; JAO G.; GUPTA A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Diffuse Lung Disease Case Reports Posters (N) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a form of
temporary mechanical circulatory support [MCS] used for emergent
management of pulmonary and cardiac failure when patients are
decompensating on conventional treatment.[1] Veno-arterial ECMO (VA-ECMO)
and veno-venous ECMO (VV-ECMO) are primarily used for cardiac/circulatory
failure and respiratory failure, respectively. Use of ECMO in patients
where anticoagulation cannot be used is a relative contraindication
requiring consideration of risks and benefits.[2,6] We report the
successful use of VV-ECMO as salvage therapy for pulmonary hemorrhage with
brief anticoagulation use, discussing patient specific risk factors and
current literature. CASE PRESENTATION: A 48-year-old male with history of
hypertension, type 2 diabetes mellitus (T2DM), morbid obesity (BMI 34.35
kg/m2), severe obstructive sleep apnea (OSA), asthma, GERD and anxiety
presented for three hours of unrelenting chest pain. Vitals upon
presentation revealed temperature of 97.9 F, tachycardic to 120s,
hypertensive to 139/92 mm Hg and SpO2 of 86%. EKG showed ST elevation in
avR and globally diffuse ST segment depressions with new onset LBBB.
Initial chest radiograph showed cardiomegaly and bilateral infiltrates
consistent with pulmonary edema. Initial troponin was 0.89 ng/mL (normal
<0.04 ng/mL), BNP 157 pg/mL (normal <100 pg/mL), and blood lactate of 5.90
mmol/L (normal 0.4-1.2 mmol/L). Bedside echocardiogram showed global
hypokinesis and ejection fraction <10%. He was intubated for acute
respiratory failure secondary to cardiogenic shock with blood pressure of
71/58 mmHg at time of intubation. Left heart catheterization demonstrated
severe multivessel disease involving the left main. Vasopressors,
inotropic support, and mechanical circulatory support with Impella 5.5
were initiated. Two days after presentation, continuous renal replacement
therapy (CRRT) for acute kidney failure was started. On day three, patient
underwent multi-vessel percutaneous intervention with drug-eluting stents
in LAD and RCA with dual antiplatelet therapy (DAPT). The patient
underwent bedside tracheostomy placement ten days after intubation,
complicated by tracheostomy obstruction from blood clots causing
cardiopulmonary arrest. Bronchoscopy performed showed pulmonary hemorrhage
with diffuse bloody secretions noted at carina, bilateral bronchi with no
active bleeding around tracheostomy site. Nebulized tranexamic acid (TXA)
was administered without resolution of hemoptysis. The patient was placed
on VV-ECMO for 11 days for salvage therapy. During ECMO therapy,
therapeutic anticoagulation was withheld for 10 days and only trialed for
24 hours in addition to DDAVP. The hospital course was otherwise
uneventful. After being weaned from ECMO, he was discharged to an acute
rehab facility requiring hemodialysis. DISCUSSION: Systemic
anticoagulation is required for patients undergoing ECMO to maintain
circuit patency, making ongoing hemorrhage a relative
contraindication.[1,2] Our patient's relevant risk factors for pulmonary
hemorrhage were severe acute respiratory distress syndrome (ARDS) from
cardiogenic shock, DAPT use, pulmonary hypertension, and T2DM.5 His
elevated BMI is a potential protective factor; BMI >30 kg/m2 has been
associated with lower ICU mortality when undergoing ECMO therapy.[3] While
continuous anticoagulation is standard of care, limited retrospective
study has shown DVT prophylaxis dosages to have statistically similar
survival rates, in addition to lower rates of oxygenator dysfunction.[4]
 CONCLUSION(S): Further study of ECMO use for treatment of pulmonary
hemorrhage is necessary for assessment of clinical utility. REFERENCE #1:
1. Reddy HG, Maynes EJ, Saxena A, et al. Utilization of extracorporeal
life support for diffuse alveolar damage and diffuse alveolar hemorrhage:
A systematic review. Artificial Organs. 2021;45(6):559-568.
doi:10.1111/aor.13861 2. Helms J, Frere C, Thiele T, et al.
Anticoagulation in adult patients supported with extracorporeal membrane
oxygenation: guidance from the Scientific and Standardization Committees
on Perioperative and Critical Care Haemostasis and Thrombosis of the
International Society on Thrombosis and Haemostasis. J Thromb Haemost.
2023;21(2):373-396. doi:10.1016/j.jtha.2022.11.014 REFERENCE #2: 3. Rudym
D, Pham T, Rackley CR, et al. Mortality in Patients with Obesity and Acute
Respiratory Distress Syndrome Receiving Extracorporeal Membrane
Oxygenation: The Multicenter ECMObesity Study. Am J Respir Crit Care Med.
2023;208(6):685-694. doi:10.1164/rccm.202212-2293OC 4. Kurihara C, Walter
JM, Karim A, et al. Feasibility of Venovenous Extracorporeal Membrane
Oxygenation Without Systemic Anticoagulation. Ann Thorac Surg.
2020;110(4):1209-1215. doi:10.1016/j.athoracsur.2020.02.011 REFERENCE #3:
5. Cardinal-Fernandez P, Lorente JA, Ballen-Barragan A, Matute-Bello G.
Acute respiratory distress syndrome and diffuse alveolar damage. new
insights on a complex relationship. Annals of the American Thoracic
Society. 2017;14(6):844-850. doi:10.1513/annalsats.201609-728ps6.
Pretorius V, Alayadhi W, Modry D. Extracorporeal life support for the
control of life-threatening pulmonary hemorrhage. The Annals of Thoracic
Surgery. 2009;88(2):649-650. doi:10.1016/j.athoracsur.2008.12.066
DISCLOSURES: No relevant relationships by Paul Gilbert No relevant
relationships by Aditya Gupta No relevant relationships by Geoffrey Jao No
relevant relationships by Alexandra Winski Copyright © 2024
American College of Chest Physicians

<123>
Accession Number
2034597949
Title
AORTIC INSUFFICIENCY: A GRAVE PRESENTATION OF EGPA.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3268-A3269), 2024. Date of Publication: October 2024.
Author
DHUNGEL S.; KUMAR S.; FAKHRAN S.S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: All About Eosinophilic Lung Diseases SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/07/2024 12:30 pm - 01:15 pm
INTRODUCTION: Eosinophilic granulomatosis with polyangiitis (EGPA) is a
rare multi-systemic vasculitis, with cardiac involvement being one of its
most serious manifestations. Due to the rarity and heterogeneous clinical
phenotype of EGPA, the diagnosis is not always straightforward. We present
a case of EGPA with one of the grave manifestations. CASE PRESENTATION: A
57-year-old male with asthma on Mepolizumab presented to the Emergency
Room with worsening dyspnea on exertion ongoing for 1 month, which was
different from his usual asthma symptoms. He had mild expiratory wheezing
with bibasilar crackles on exam. Electrocardiogram showed sinus
tachycardia with a new left bundle branch block and chest Xray showed new
right upper and lower/mid-lung airspace opacities. The troponin was
elevated to 0.269ng/ml and BNP was 1600 pg/ml. Echocardiogram showed new
reduced ejection fraction of 20-25%, severe Aortic Insufficiency secondary
to possible valvular rupture and moderate-to-severe mitral regurgitation
with pulmonary artery pressures of 60 mm Hg. He underwent an urgent aortic
valve replacement. He had a history of eosinophilia with absolute
eosinophil count reaching 1.8k/ul but had resolved after starting
Mepolizumab. His ANCA resulted with high MPO titer of >8AI and PR3
negative results. HRCT of the chest showed patchy areas of nodularity and
ground glass opacities in left upper lobe as well as right upper and lower
lobes with mediastinal lymphadenopathy. Urinalysis showed microscopic
hematuria and UPCR elevated to 1.23 g/dl with dysmorphic cells on urine
microscopy, concerning for renal involvement. He underwent renal biopsy
for concern of EGPA vasculitis and sub nephrotic proteinuria which
resulted as pauci-immune necrotizing glomerulonephritis with necrosis and
crescents. He was started on rituximab for EGPA vasculitis. DISCUSSION:
EGPA is rare with incidence between 0.5 and 4.2 cases per million people
per year and the mean age at diagnosis is ~50 years [1]. It evolves
through three different phases: a prodromic 'allergic' phase, which can
last for several years and is marked by asthma and chronic rhinosinusitis;
an eosinophilic phase, during which eosinophilia and end-organ involvement
appear; and a vasculitic phase, with clinical manifestations due to
small-vessel vasculitis (like mononeuritis multiplex and
glomerulonephritis). These phases may overlap and not occur sequentially.
Eosinophilia is usually associated with asthma alone and the treatment for
asthma can mask EGPA presentation. Cardiac involvement in EGPA varies
between 16.0% and 29.0% in different studies [2]. It is important because
fifty percent of deaths in patients suffering from EGPA are related to
cardiac diseases [2]. Cardiac manifestations include but are not limited
to pericardial effusion, pericarditis, myocarditis, cardiomyopathy, acute
or chronic heart failure, arrhythmias, valvular regurgitation or rupture,
intracardiac thrombus formation and acute coronary syndromes. The
treatment options for EGPA are still limited and there are growing options
for biologics and anti-IL-5 therapy. Recent study by Wechsler et al.
showed benralizumab was noninferior to mepolizumab for the induction of
remission in patients with relapsing or refractory EGPA [3].
 CONCLUSION(S): The learning point from the case is that EGPA should
be considered early on in patients with refractory asthma. If recognized
early, it prevents significant morbidity and mortality. REFERENCE #1:
Emmi, G., Bettiol, A., Gelain, E. et al. Evidence-Based Guideline for the
diagnosis and management of eosinophilic granulomatosis with polyangiitis.
Nat Rev Rheumatol 19, 378-393 (2023).
https://doi.org/10.1038/s41584-023-00958-w REFERENCE #2: Pakbaz M, Pakbaz
M. Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis: A
Meta-Analysis of 62 Case Reports. J Tehran Heart Cent. 2020
Jan;15(1):18-26. PMID: 32742288; PMCID: PMC7360870. REFERENCE #3: N Engl J
Med 2024; 390:911-92, DOI: 10.1056/NEJMoa2311155 DISCLOSURES: No relevant
relationships by Swati Dhungel No relevant relationships by Sherene
Fakhran No relevant relationships by Shruthi Kumar Copyright ©
2024 American College of Chest Physicians

<124>
Accession Number
2034597744
Title
ANGIOVAC DEBULKING OF TRICUSPID AND PULMONIC VALVE VEGETATIONS IN THE
SETTING OF LIBMAN-SACKS ENDOCARDITIS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A1439-A1440), 2024. Date of Publication: October 2024.
Author
PALATNIC L.; ARRIETA J.-C.; ZLOTNICK MD D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Salvage Therapies for Infections SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm INTRODUCTION:
Libman-Sacks endocarditis (LSE) is a rare form of noninfectious
endocarditis characterized by the deposition of sterile platelet thrombi
on heart valves. The current literature has commonly described the
Angiovac mechanical aspiration system being used to percutaneously debulk
native valve, prosthetic valve and prosthetic device-associated
thromboses, commonly in the setting of infective endocarditis. Herein, we
present a unique case of Angiovac debulking of Tricuspid Valve (TV) and
Pulmonic Valve (PV) vegetations in the setting of LSE. CASE PRESENTATION:
A 55-year-old male with past medical history of pulmonary embolism on
anticoagulation, membranous nephropathy, chronic kidney disease was
initially admitted due to anasarca, dyspnea on exertion and worsening
renal function. In the setting of symptomatic volume overload, a
transthoracic echocardiogram was obtained, revealing LVEF 45-55% and a 2.1
x 1.4cm mass on the TV septal leaflet. Broad spectrum antibiotics were
started. A trans-esophageal echocardiogram (TEE) was then obtained, which
demonstrated LVEF 60-65%, a trileaflet TV vegetation with largest segment
measuring 2.5 x 1.4cm, moderate-severe tricuspid regurgitation, and a
medium sized vegetation on the PV with moderate regurgitation. At this
time, antinuclear and antiphospholipid antibodies were obtained and came
back negative. A multi-disciplinary heart team was consulted given the
risk of embolization and the need for biopsy, and the patient was deemed
too high risk for cardiac surgery. The decision was then made to proceed
with Angiovac Debulking. Venous access was obtained, and after
anticoagulation with heparin, the Angiovac catheter was advanced and
debulking of both the PV and TV was performed under TEE guidance. TEE
demonstrated a significant reduction (~70%) in the size of the vegetations
on both valves, with only a small residual vegetation identified. The
degree of TR remained mild which was similar to the pre-operative TEE. The
patient tolerated the procedure without any complications. Two sets of
blood cultures remained negative. Cardiac tissue culture obtained during
Angiovac debulking was also negative, but the pathology report of the
collected specimen revealed portions of fibrin with entrapped blood cells
and histiocytes and foci of organization compatible with LSE. Patient's
antibiotic regimen was stopped per Infectious Disease, and the patient was
subsequently discharged with close outpatient follow-up with Nephrology.
DISCUSSION: Libman-Sacks endocarditis remains a rare clinical diagnosis,
and one that requires rapid evaluation given its elevated risk for
recurrent and extensive embolization. Our case illustrates the successful
use of Angiovac debulking of both TV and PV vegetations in the setting of
Libman-Sacks endocarditis. While the use of Angiovac debulking has been
increasingly described in recent literature, particularly in the setting
of infective endocarditis, description of its use in noninfectious
endocarditis has been sparse. Although larger, randomized studies are
necessary to better evaluate its true benefit, Angiovac debulking may
offer as a useful alternative to patients who are deemed too high-risk for
cardiac surgery. CONCLUSION(S): We present a unique case of Angiovac
debulking of Tricuspid Valve (TV) and Pulmonic Valve (PV) vegetations in
the setting of LSE. This catheter-based treatment modality may offer
high-risk patients a safe and efficacious alternative to cardiac surgery.
REFERENCE #1: Mhanna M, Beran A, Al-Abdouh A, Jabri A, Sajdeya O, Al-Aaraj
A, Alharbi A, Khuder SA, Eltahawy EA. AngioVac for Vegetation Debulking in
Right-sided Infective Endocarditis: A Systematic Review and Meta-Analysis.
Curr Probl Cardiol. 2022 Nov;47(11):101353. doi:
10.1016/j.cpcardiol.2022.101353. Epub 2022 Aug 10. PMID: 35961428.
DISCLOSURES: No disclosure on file for Juan-Carlos Arrieta No relevant
relationships by Leonard Palatnic No disclosure submitted for David
Zlotnick MD Copyright © 2024 American College of Chest Physicians

<125>
Accession Number
2034597589
Title
REFRACTORY PERICARDIAL EFFUSION WITH TAMPONADE AFTER A SINGLE DOSE OF
DOCETAXEL.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A1687-A1688), 2024. Date of Publication: October 2024.
Author
BAZHENOV A.; MENENDEZ A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Toxicology in the ICU SESSION TYPE: Rapid Fire Case Reports
PRESENTED ON: 10/09/2024 10:20 am - 11:05 am INTRODUCTION: Docetaxel (D)
is used to treat several oncological diseases, including all breast cancer
(BC) subtypes. Commonly reported side effects are hypersensitivity
reaction[1], cumulative fluid retention.[2] Pericardial tamponade (PC)
related to D has been reported exclusively in a dose-dependent fashion[3].
We present a case of refractory PC after a single dose of D hypothesizing
this may be an intrinsic D side effect. CASE PRESENTATION: 61 year old AA
woman with PMH of hypertension, HFpEF, congenital hypertrophic
cardiomyopathy, CKD stage 3A, acquired hypothyroidism secondary to thyroid
cancer and a diagnosis of stage I right BC (pT1c, pN0, MX) ER borderline
positive (30%), PR negative, HER2 negative (1+) BC, medullary subtype,
nuclear grade 3, histologic grade 3. At time of surgery found to have
19mm, grade 3 with 0/1 lymph nodes positive. Repeat receptor status
demonstrated ER negativity, PR (-), HER2 (-). Patient was started on
adjuvant D at a dose of 75mg/m2 and cyclophosphamide at a dose of 600mg/m2
30 days after surgery. Patient's course was complicated by significant
shortness of breath starting on day +6. Severity of this prompted
self-initiated visit to ED. On arrival patient was hypotensive (77/44
mmHg), tachycardic (102 bpm), SpO2 90% requiring 4 L nasal cannula oxygen
therapy. CTA/PE demonstrated low volume pulmonary embolism (PE) in RUL as
well as moderate (500 cc) bilateral pleural effusions and pericardial
fluid (pic 1). Echocardiography confirmed large pericardial effusion with
tamponade physiology and RA diastolic collapse (pic 2). Patient was
started on heparin infusion for PE, as well as phenylephrine and
vasopressin for hypotension. On day 1 of hospitalization, patient
underwent pericardiocentesis with 450cc of red-colored fluid removed and
pericardial drain placement. Cytology was negative for malignancy, LDH
ratio = 1, 1300 nucleated cells and 61% lymphocytes. Systemic inflammatory
diseases were ruled out. (ANA, ANCA, cardiolipin antibody, La (SSB), Ro
(SSA) were negative, complement C3 and C4 124 and 28 mg/dL respectively
within normal range, RF and CCP negative). Patient underwent bilateral
thoracentesis with 500cc drained also negative for malignancy. On day 4 of
hospitalization pericardial drain was removed however
echocardiogram-proven recurrent PC led to thoracoscopy with pericardial
windows creation on day 8 of hospitalization. Repeat cytology was negative
for malignancy and demonstrated mixed inflammatory cells. Patient was
discharged on day 14 of hospitalization without evidence of
re-accumulation of pericardial fluid. D was permanently discontinued and
patient was treated with appropriate alternative regimen with curative
intent. There was no PC recurrence following discontinuation of D.
DISCUSSION: D has been reported to cause PC exclusively a in dose-depended
fashion[3-7]. Our patient developed it after single dose (112mg).
Considering lack of PMH of PC and negative polyserositis work-up, we
believe this was D-related despite patient's comorbidities. To our
knowledge, this is first documented case of PC after single dose of D and
its use should be balanced with this potential risk especially when
comorbidities exists. CONCLUSION(S): D may induce pericardial
effusion after a single dose REFERENCE #1: Genestreti G, Di Battista M,
Trisolini R, et al. A commentary on interstitial pneumonitis induced by
docetaxel: clinical cases and systematic review of the literature. Tumori.
2015;101(3):e92-e95. doi:10.5301/TJ.5000275 REFERENCE #2: Park SI, Jeon
WH, Jeung HJ, Kim GC, Kim DK, Sim YJ. Clinical features of docetaxel
chemotherapy-related lymphedema. Lymphat Res Biol. 2014;12(3):197-202.
doi:10.1089/LRB.2013.0037 REFERENCE #3: Chevallier B, Fumoleau P, Kerbrat
P, et al. Docetaxel is a major cytotoxic drug for the treatment of
advanced breast cancer: a phase II trial of the Clinical Screening
Cooperative Group of the European Organization for Research and Treatment
of Cancer. J Clin Oncol. 1995;13(2):314-322. doi:10.1200/JCO.1995.13.2.314
DISCLOSURES: No relevant relationships by Aleksei Bazhenov No relevant
relationships by Alvaro Menendez Copyright © 2024 American
College of Chest Physicians

<126>
Accession Number
2034597322
Title
SEEDING A BIOPROSTHETIC VALVE 8 YEARS LATER - A UNIQUE CASE OF PROTEUS
VULGARIS ENDOCARDITIS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A311-A312),
2024. Date of Publication: October 2024.
Author
PAREDES FLORES M.; GONZALEZ VAZQUEZ C.; HUSSAIN S.; SINGH S.; TURBAY
CABALLERO V.; JABR D.; DIA M.; BOLY F.; RAGHUVIR R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Unusual Cardiac Infections II SESSION TYPE: Rapid Fire Case
Reports PRESENTED ON: 10/07/2024 02:35 pm - 03:05 pm INTRODUCTION:
Infectious endocarditis caused by Proteus species is a rare condition with
a high mortality rate. We present a case of Proteus vulgaris endocarditis
after a urinary tract infection in a patient with an 8-year-old
bioprosthetic valve complicated by an aortic root abscess. CASE
PRESENTATION: A 55-year-old male with a history of bioprosthetic aortic
valve replacement eight years ago presented with lower back pain, malaise,
and fatigue. He was hypotensive to 86/64 mmHg and tachycardic to 103 bpm.
Laboratory evaluation showed a WBC of 20.6 K/mcL. The urinalysis showed
bacteriuria, and the CT of the abdomen/pelvis suggested pyelonephritis. He
was admitted to the ICU for septic shock. Two sets of blood cultures were
positive for Proteus vulgaris. A transthoracic echocardiogram revealed a
mobile echogenicity on the aortic valve surrounded by an echolucent space.
A transesophageal echocardiogram showed a perivalvular aortic root abscess
measuring 6.0 x 4.5 cm, extending anteriorly towards the subvalvular area
and into the left atrium. He was evaluated by cardiothoracic surgery and
underwent a successful bioprosthetic aortic valve and root replacement.
The postoperative course was complicated by cardiogenic shock and complete
AV block. Intraoperative blood cultures confirmed an aortic valve
infection with Proteus vulgaris. A leadless single-chamber pacemaker was
implanted, and the patient was discharged home with a 6-week course of
ceftriaxone. DISCUSSION: An extensive systematic review of 2761 infective
endocarditis cases found that only 0.1% were caused by Proteus spp., of
which only one case was caused by Proteus vulgaris and involved a native
valve. In our case, the prosthetic valve was infected with an
exceptionally rare microorganism eight years post valve implantation,
making this a unique presentation. CONCLUSION(S): Proteus vulgaris is
a very rare causal agent of infective endocarditis. To our knowledge, this
is the first reported case of Proteus vulgaris endocarditis in a
prosthetic valve. REFERENCE #1: Bux, A., Mustafa, A., Niazi, M.,
Manchandani, U., Mobarakai, N., Lafferty, J., & DeChavez, V. (2022).
Multivalvular infective endocarditis with Proteus mirabilis. IDCases, 27.
https://doi.org/10.1016/j.idcr.2022.e01429 REFERENCE #2: Claassen. Proteus
mirabilis. A rare cause of infectious endocarditis. (n.d.). Goel, R.,
Sekar, B., & Payne, M. N. (2015). Proteus endocarditis in an intravenous
drug user. https://doi.org/10.1136/bcr-2015 REFERENCE #3: Grossman, L. G.,
Sharkey, J. M., Grossman, D. S., Hartman, A., Makaryus, M., & Shah, K. B.
(2021). Rare case of Proteus mirabilis native mitral valve endocarditis in
an immunocompromised patient. BMC Infectious Diseases, 21(1).
https://doi.org/10.1186/s12879-021-06931-w DISCLOSURES: No relevant
relationships by Frances Boly No relevant relationships by Muhyaldeen Dia
No relevant relationships by Carolina Gonzalez Vazquez No relevant
relationships by Sheraz Hussain No relevant relationships by Daniel Jabr
No relevant relationships by Manuel Paredes Flores No relevant
relationships by Rashmi Raghuvir No relevant relationships by Suyashi
Singh No relevant relationships by Valentina Turbay
Caballero Copyright © 2024 American College of Chest Physicians

<127>
Accession Number
2034596935
Title
TRIPLE COVERAGE FOR REFRACTORY MRSA PNEUMONIA WITH VV-ECMO RESCUE.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A1028-A1029), 2024. Date of Publication: October 2024.
Author
SELCH G.; GOETZ R.L.; NELLORE A.; SCULLIN D.; MCELWEE S.K.; CAWASJI Z.F.;
KOTECHA A.; RUSANOV V.; BELLOT S.C.; OROZCO-HERNANDEZ E.R.I.K.; GONGORA
E.; WILLE K.M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Reports Posters (Y) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Pneumonia is the leading cause of death due to infection
worldwide (1). Secondary bacterial pneumonia is a common complication of
influenza, and in severe cases is associated with a mortality of >50%
(2,3). Additionally, methicillin resistant staph aureus (MRSA) can produce
Panton-Valentine leukocidin (PVL), an exotoxin which contributes to
necrotizing infection (4). Veno-venous extracorporeal membrane oxygenation
(VV-ECMO) is an option for patients with refractory hypoxemia or
hypercapnia (5-7). CASE PRESENTATION: A 29-year-old female with a history
of asthma presented with respiratory failure despite outpatient antibiotic
therapy. She tested positive for Influenza B prompting treatment with
oseltamivir. Sputum and blood cultures were positive for MRSA. Imaging was
notable for bilateral diffuse consolidations with cavitary lesions in
addition to bilateral cystic bronchiectasis and right-sided pneumothorax
(for which a chest tube was placed). The patient's hypoxemia worsened,
requiring intubation. Despite treatment with ceftaroline, refractory
hypoxemia ensued and high flow VV-ECMO was commenced. Blood cultures
initially cleared, however the patient subsequently developed refractory
MRSA bacteremia with worsening shock and respiratory failure requiring the
addition of vancomycin, then linezolid. Despite a course complicated by
renal failure requiring renal replacement therapy, persistent air-leak
requiring video assisted thoracic surgery, refractory hypoxemia requiring
an additional drainage cannula w/ dual oxygenator in parallel,
biventricular dysfunction, polymicrobial pneumonia with growth of
aspergillus fumigatus and herpes simplex virus, and mixed shock requiring
multiple vasopressors, ultimately her cultures cleared and
shock/respiratory failure slowly resolved. She was decannulated from ECMO
after 45 days and discharged to a rehab facility. She was recently seen in
post-ECMO clinic and off oxygen therapy. DISCUSSION: This young and
otherwise healthy patient experienced a common infection resulting in
prolonged and profound critical illness. Despite the mixed evidence
regarding mortality benefit of ECMO in severe ARDS, carefully selected
patients likely experience benefit (5-7). Considering the severity of this
patient's hypoxemia with extensive pulmonary necrosis, she would have
likely died without ECMO intervention. For patients with persistent
impairments in gas exchange despite high flow VV-ECMO, additional drainage
or return limbs and / or dual oxygenator placement in parallel may be
considered. Vancomycin and Linezolid are first line treatments for MRSA
pneumonia with no difference in mortality or adverse events, though there
is some data to suggest higher rates of clinical cure with Linezolid (8).
Data from a retrospective cohort study suggests addition of ceftaroline to
vancomycin for refractory MRSA bacteremia is safe and effective at
attaining microbiological cure (9). Our patient continued to decompensate
despite vancomycin and ceftaroline. Linezolid has several pharmacologic
benefits including inhibition of toxin production and superior tissue
penetration (10). By targeting three separate mechanisms of action, we
were able to clear this patient's MRSA infection and achieve clinical
improvement. CONCLUSION(S): Patients with post-influenza MRSA
pneumonia have a high mortality and aggressive antimicrobial strategies
may be necessary in the setting of refractory necrotizing disease.
Additionally, select ARDS patients may benefit from VV-ECMO rescue with a
favorable outcome once the underlying pathological process is reversed.
REFERENCE #1: 1. The top 10 causes of death. 2014; fact sheet. Available
at: http://www.who.int/mediacentre/factsheets/fs310/en/. Accessed
1/25/2024. 2. Prasso JE, Deng JC. Postviral Complications: Bacterial
Pneumonia. Clin Chest Med. 2017 Mar;38(1):127-138. doi:
10.1016/j.ccm.2016.11.006. Epub 2016 Dec 13. PMID: 28159155; PMCID:
PMC5324726. 3. Jacquot A, Luyt CE, Kimmoun A, Levy B, Baux E; Fluvalentine
Study group. Epidemiology of post-influenza bacterial pneumonia due to
Panton-Valentine leucocidin positive Staphylococcus aureus in intensive
care units: a retrospective nationwide study. REFERENCE #2: 4. Loffler B,
Niemann S, Ehrhardt C, Horn D, Lanckohr C, Lina G, Ludwig S, Peters G.
Pathogenesis of Staphylococcus aureus necrotizing pneumonia: the role of
PVL and an influenza coinfection. Expert Rev Anti Infect Ther. 2013
Oct;11(10):1041-51. doi: 10.1586/14787210.2013.827891. Epub 2013 Sep 27.
PMID: 24073746. 5. Combes A, Hajage D, Capellier G, Demoule A, Lavoue S,
Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B,
Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton
G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A; EOLIA
Trial Group, REVA, and ECMONet. Extracorporeal Membrane Oxygenation for
Severe Acute Respiratory Distress Syndrome. N Engl J Med. 2018 May
24;378(21):1965-1975. doi: 10.1056/NEJMoa1800385. PMID: 29791822. 6.
Gattinoni L, Vasques F, Quintel M. Use of ECMO in ARDS: does the EOLIA
trial really help? Crit Care. 2018 Jul 5;22(1):171. doi:
10.1186/s13054-018-2098-6. PMID: 29976250; PMCID: PMC6034241. REFERENCE
#3: 7. Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E.
Venovenous extracorporeal membrane oxygenation for acute respiratory
distress syndrome: a systematic review and meta-analysis. Lancet Respir
Med. 2019 Feb;7(2):163-172. doi: 10.1016/S2213-2600(18)30452-1. Epub 2019
Jan 11. PMID: 30642776. 8. Kato H, Hagihara M, Asai N, Shibata Y, Koizumi
Y, Yamagishi Y, Mikamo H. Meta-analysis of vancomycin versus linezolid in
pneumonia with proven methicillin-resistant Staphylococcus aureus. J Glob
Antimicrob Resist. 2021 Mar;24:98-105. doi: 10.1016/j.jgar.2020.12.009.
Epub 2021 Jan 2. PMID: 33401013. 9. Kufel WD, Parsels KA, Blaine BE,
Steele JM, Mahapatra R, Paolino KM, Thomas SJ. Vancomycin plus ceftaroline
for persistent methicillin-resistant Staphylococcus aureus bacteremia.
Pharmacotherapy. 2023 Jan;43(1):15-23. doi: 10.1002/phar.2741. Epub 2022
Nov 21. PMID: 36371648. 10. Catherine Liu, Arnold Bayer, Sara E. Cosgrove,
Robert S. Daum, Scott K. Fridkin, Rachel J. Gorwitz, Sheldon L. Kaplan,
Adolf W. Karchmer, Donald P. Levine, Barbara E. Murray, Michael J. Rybak,
David A. Talan, Henry F. Chambers, Clinical Practice Guidelines by the
Infectious Diseases Society of America for the Treatment of
Methicillin-Resistant Staphylococcus aureus Infections in Adults and
Children: Executive Summary, Clinical Infectious Diseases, Volume 52,
Issue 3, 1 February 2011, Pages 285-292,
https://doi.org/10.1093/cid/cir034 DISCLOSURES: No disclosure on file for
Scott Bellot No relevant relationships by Zain Cawasji No relevant
relationships by Ryan Goetz No disclosure on file for Enrique Gongora No
disclosure on file for Aditya Kotecha No relevant relationships by Samuel
McElwee No disclosure on file for Anoma Nellore No disclosure on file for
Erik Orozco-Hernandez No relevant relationships by Victoria Rusanov No
relevant relationships by Daniel Scullin No relevant relationships by
Griffin Selch No relevant relationships by Keith Wille Copyright
© 2024 American College of Chest Physicians

<128>
Accession Number
2034596803
Title
INTRALOBAR PULMONARY SEQUESTRATION WITH CONGENITAL PULMONARY AIRWAY
MALFORMATION PRESENTING AS CHRONIC COUGH AND HEMOPTYSIS: A CASE REPORT.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A4570-A4571), 2024. Date of Publication: October 2024.
Author
SASING G.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Lung Pathology Case Reports Posters (H) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am INTRODUCTION:
Pulmonary sequestration is rare and comprises 0.5 to 6.4% of all
congenital pulmonary malformations [1]. Congenital pulmonary airway
malformation (CPAM) is an extremely rare congenital anomaly of the lower
pulmonary tract with incidence of 1 in 10,000 to 1 in 35,000 births [8].
Few cases are described in literatures on their association, especially
those presenting in adulthood. Here we describe a case of a Filipino male
who presented with chronic cough and hemoptysis, underwent video-assisted
thoracic surgery (VATS), revealing the coexistence of two rare congenital
anomalies. CASE PRESENTATION: This is a case of an 18 year old, Filipino
male, presenting with chronic cough, exertional dyspnea and hemoptysis. A
chest radiography showed air fluid filled round, tubular, cystic
structures in the left lower lung. A closed tube thoracotomy was done,
draining 200 milliliter of bloody pleural fluid. The pleural fluid
analysis was unrevealing. A chest CT scan revealed a 11.2x 9.5x11.9 cm
well-circumscribed, heterogeneous soft-tissue mass at the left lower
thorax. The mediastinal structures were contralaterally displaced,
compressing the left lower lung parenchyma and left lower lobe bronchus
anteriorly. A feeding artery to the mass arising directly from the
descending thoracic aorta and venous drainage via the enlarged azygous
vein were demonstrated. Lacking was a tracheobronchial tree communication.
The patient underwent VATS with left lower lobectomy, resecting an
intralobar pulmonary sequestration (ILS) with a 1.2 cm feeding artery from
the descending thoracic aorta. Histopathologic findings were compatible
with CPAM. While the histopathological findings point to CPAM, the chest
CT scan and intraoperative findings also confirmed the presence of ILS.
DISCUSSION: Pulmonary sequestration is a condition in which a segment or
lobe of a lung tissue has no communication with the tracheobronchial tree
and receives anomalous systemic vascular supply [1]. In ILS, the lesion
lies within the pleural layer surrounding the lobar lung. Pulmonary
sequestrations receive blood supply from the thoracic or abdominal aorta
and drain into the pulmonary veins [1, 2, 3]. The pathogenesis is poorly
understood, although the widely accepted is the congenital
bronchopulmonary foregut malformation theory by Gerle et.al. CPAM is
characterized by the development of a nonfunctioning cystic tissue arising
anywhere along the bronchial tree or pulmonary acini and replaces normal
lung tissues [6, 8]. Few patients are asymptomatic and go into adulthood
are incidentally discovered during chest radiography, although some
develop complications such as recurrent pneumonia, hemoptysis or
malignancy [7, 8]. Chest CT confirms the diagnosis, identifies the
anomalous arterial supply and venous drainage and assists surgical plan.
Surgical approach is curative for both and is often sought when
complications such as pneumonia and hemoptysis arise [1, 8]. Pulmonary
lobectomy, the treatment of choice, is recommended even in asymptomatic
patients, to prevent recurrent infection and progressive lung parenchymal
inflammation [1]. CONCLUSION(S): The occurrence of both CPAM and ILS
in the same patient, known as "hybrid lesion", suggests that both have
similar embryological origin [20]. The former is rare, but the coexistence
of the two is rare still. The existence of further congenital anomalies
only happens in 15% of ILS cases. REFERENCE #1: 1. Chakraborty RK, Modi P,
Sharma S. Pulmonary Sequestration. [Updated 2023 Jul 24]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK532314/. 2. Petty,
L., Joseph, A., & Sanchez, J. (2017). Case report: Pulmonary sequestration
in an adult. Radiology case reports, 13(1), 21-23.
https://doi.org/10.1016/j.radcr.2017.09.029. 3. Alsumrain, M., Ryu, J.H.
Pulmonary sequestration in adults: a retrospective review of resected and
unresected cases. BMC Pulm Med 18, 97 (2018).
https://doi.org/10.1186/s12890-018-0663-z. 4. Yang, G., Chen, L., Xu, C.,
Yuan, M., & Li, Y. (2019). Congenital bronchopulmonary foregut
malformation: systematic review of the literature. BMC pediatrics, 19(1),
305. https://doi.org/10.1186/s12887-019-1686-1. 5. Chaudhry IA, Khan MN,
Alqahtani YA, Alghamdi A, AlFraih OM, et al. Pulmonary congenital cystic
adenomatoid malformation: a rare congenital abnormality in adults and
review of literature. J Pulmonol Respir Res. 2022; 6: 016-019. 6. Lonsane,
A. R., Wankhede, V. V., Tirpude, S., Rout, A., & Kekre, G. (2023).
Congenital pulmonary airway malformation (CPAM) presenting as spontaneous
pneumothorax in young boy. Lung India : official organ of Indian Chest
Society, 40(4), 349-352.
https://doi.org/10.4103/lungindia.lungindia_437_22. 7. Mehta PA, Sharma G.
Congenital Pulmonary Airway Malformation. [Updated 2023 Aug 7]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551664/. 8.
Valentin, M., Sharma, R., Trabanco, J., & Ashby, T. (2022). Congenital
Pulmonary Airway Malformation in an Adult Male Presenting With Hemoptysis.
Cureus, 14(1), e20862. https://doi.org/10.7759/cureus.20862 REFERENCE #2:
9. Dehner, L. P., Schultz, K. A. P., & Hill, D. A. (2023). Congenital
Pulmonary Airway Malformations With a Reconsideration and Current
Perspective on the Stocker Classification. Pediatric and developmental
pathology : the official journal of the Society for Pediatric Pathology
and the Paediatric Pathology Society, 26(3), 241-249.
https://doi.org/10.1177/10935266221146823. 10. Sadasivan Nair, P., Merry,
C. & White, A. Intralobar pulmonary sequestration in an adult: a case
report. J Cardiothorac Surg 18, 5 (2023).
https://doi.org/10.1186/s13019-023-02127-2. 11. Gaillard F, Yap J, Yu Jin
T, et al. Congenital pulmonary airway malformation. Reference article,
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https://doi.org/10.53347/rID-1156. 12. Norichika Iga, Hideyuki Nishi,
Shinichiro Miyoshi. Video-assisted thoracoscopic surgery for bilateral
intralobar pulmonary sequestration. International Journal of Surgery Case
Reports. Volume 53, 2018. Pages 333-336. ISSN 2210-2612.
https://doi.org/10.1016/j.ijscr.2018.10.060. 13. N. Halkic, P.F. Cuenoud,
M.E. Corthesy, R. Ksontini, M. Boumghar, Pulmonary sequestration: a review
of 26 cases, European Journal of Cardio-Thoracic Surgery, Volume 14, Issue
2, August 1998, Pages 127-133,
https://doi.org/10.1016/S1010-7940(98)00154-7. 14. Sakala, E. P., Perrott,
W. S., & Grube, G. L. (1994). Sonographic characteristics of antenatally
diagnosed extralobar pulmonary sequestration and congenital cystic
adenomatoid malformation. Obstetrical & gynecological survey, 49(9),
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J., Eyler, W. R., Spizarny, D. L., & Stone, C. H. (2002). Developmental
lung anomalies in the adult: radiologic-pathologic correlation.
Radiographics : a review publication of the Radiological Society of North
America, Inc, 22 Spec No, S25-S43.
https://doi.org/10.1148/radiographics.22.suppl_1.g02oc26s25. 16. Trabalza
Marinucci, B., Maurizi, G., Vanni, C., Cardillo, G., Poggi, C., Pardi, V.,
Inserra, A., & Rendina, E. A. (2020). Surgical treatment of pulmonary
sequestration in adults and children: long-term results. Interactive
cardiovascular and thoracic surgery, 31(1), 71-77.
https://doi.org/10.1093/icvts/ivaa054 REFERENCE #3: 17. Kirschner, H. J.,
& Fuchs, J. (2017). Angeborene pulmonale Malformationen [Congenital Lung
Malformations]. Zentralblatt fur Chirurgie, 142(1), 127-139.
https://doi.org/10.1055/s-0042-112683. 18. Chen, Y., Li, L. Q., Ge, Y. L.,
Li, W. Q., Zhang, Q., Zhang, H. F., Zhang, S., Zhu, X. Y., Zhang, J. B.,
Chen, Q. C., Jing, Q., Lu, Y., Liu, Y., Sun, Y., Min, P., & Hou, L. L.
(2020). Elevated Leukocytes Combined with Left Lung Consolidation on Chest
Computed Tomography (CT) Scan in an Adult Patient Firstly Misdiagnosed as
Pneumonia and Finally Diagnosed as Pulmonary Sequestration by Enhanced CT
Scan and CT Angiography: a Case Report and Literature Review. Clinical
laboratory, 66(4), 10.7754/Clin.Lab.2019.190828.
https://doi.org/10.7754/Clin.Lab.2019.190828. 19. Wang, D., & Wheeler, W.
B. (2022). A hybrid lesion of intralobar sequestration with mixed features
of CPAM type I and type II unmasked following SARS-CoV-2 infection: Case
report and literature review. International journal of surgery case
reports, 96, 107336. https://doi.org/10.1016/j.ijscr.2022.107336. 20. Cass
D.L., Crombleholme T.M., Howell L.J., Stafford P.W., Ruchelli E.D., Adzick
N.S. Cystic lung lesions with systemic arterial blood supply: a hybrid of
congenital cystic adenomatoid malformation and bronchopulmonary
sequestration. J. Pediatr. Surg. 1997;32:986-990. 21. Pogoriler J., Swarr
D., Kreiger P., Adzick N.S., Peranteau W. Congenital cystic lung lesions:
redefining the natural distribution of subtypes and assessing the risk of
malignancy. Am. J. Surg. Pathol. 2019;43(1):47-55. 22. Feijo CA, Ferreira
H, Fischer G. Congenital lung malformations. J Bras Pneumol.
2011;37(2):259---71. 23. A. Sanchez Abuin, I. Somoza, J. Liras, R. Mendez,
M. Tellado, J. Rios, et al. Malformacion adenomatoidea quistica congenita
asociada a secuestro pulmonar. Presentacion de dos casos clinicos. Cir
Pediatr, 18 (2005), pp. 39-41 DISCLOSURES: No relevant relationships by
Georgitha Sasing Copyright © 2024 American College of Chest
Physicians

<129>
Accession Number
2034596710
Title
IN-HOSPITAL OUTCOMES OF TRANSCATHETER AORTIC VALVE REPLACEMENT VS SURGICAL
AORTIC VALVE REPLACEMENT FOR AORTIC STENOSIS IN PATIENTS WITH PRIOR CHEST
RADIATION.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A805-A806),
2024. Date of Publication: October 2024.
Author
YOUSAF H.; SHARMA A.; SHAHID R.I.J.A.; HANIFF S.; HASNAIN H.; ISLAM S.;
KHAN A.; KATIB H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Mechanical Devices Cardiac Support and Beyond SESSION TYPE:
Rapid Fire Original Inv PRESENTED ON: 10/08/2024 01:45 pm - 02:30 pm
PURPOSE: Radiation therapy has been used to treat different malignancies
associated with the thoracic wall and cavity. Cardiac complications are
significant side effects of chest radiotherapy. Radiation-induced aortic
stenosis (AS) is one of the most common valvular complications of
radiation therapy. Treatment of radiation-induced AS is more challenging
because of other relevant complications associated with radiation
exposure. Surgical aortic valve replacement (SAVR) has shown increased
morbidity and mortality in patients with prior chest radiation as compared
to patients with no exposure. Transcatheter aortic valve replacement
(TAVR) can be a better therapeutic strategy for aortic stenosis with prior
chest radiation as compared to SAVR. However, there is a lack of data
comparing the safety and efficacy of TAVR vs SAVR in this population. We
conducted a systematic review and meta-analysis comparing In-Hospital
outcomes of TAVR vs. SAVR for aortic stenosis in patients with prior chest
radiation therapy history. METHOD(S): We electronically searched
studies on In-Hospital outcomes of TAVR versus (vs) SAVR for aortic
stenosis in patients with prior chest radiation therapy using PubMed,
Embase, Cochrane, and Scopus databases. All studies were screened,
comparing In-Hospital therapeutic effects and clinical adverse events of
TAVR vs. SAVR in patients with chest radiation history. Outcomes included
in-hospital mortality, stroke, atrial fibrillation, renal failure,
bleeding, and pacemaker placement. Outcomes were pooled using a
random-effects model with Hartung-Knapp-Sidik-Jonkman (HSKJ) adjustment
using R software and reported as odd ratios (OR) and 95% confidence
intervals (CI). RESULT(S): A total of 4 studies with 7015 patients
were screened and analyzed. Our study showed patients with prior chest
radiation undergoing TAVR as compared to SAVR were associated with
significantly better In-Hospital outcomes, including mortality [OR 0.55,
CI 0.39-0.77, p-value (P) = 0.01], atrial fibrillation [OR 0.22, CI
0.06-0.82, P = 0.04] and bleeding [OR 0.30, CI 0.25-0.35, P < 0.01]. No
significant difference was noted for TAVR vs. SAVR in stroke [OR 1.32, CI
0.33-5.30, P = 0.57], renal failure [OR 0.62, CI 0.34-1.13, P = 0.08], and
pacemaker placement [OR 1.74, CI 0.74-4.07, P = 0.13]. CONCLUSION(S):
TAVR has shown better In-Hospital outcomes in terms of mortality, atrial
fibrillation, and bleeding in patients with a prior chest radiation
history. No significant difference was observed for TAVR vs. SAVR
regarding stroke, renal failure, and pacemaker placement. Our findings
further need to be validated by more prospective RCTs to identify the
optimal strategy for aortic valve replacement in chest radiotherapy
patients with AS. More studies showing long-term outcomes are also needed.
CLINICAL IMPLICATIONS: TAVR can be a better alternative therapy regarding
in-hospital outcomes than SAVR for aortic stenosis in patients with prior
chest radiation therapy. DISCLOSURES: No relevant relationships by Shaniza
Haniff No relevant relationships by Haider Hasnain No relevant
relationships by Sabeeh Islam No relevant relationships by Husam Katib No
relevant relationships by Arshan Khan No relevant relationships by Rija
Shahid No relevant relationships by Akash Sharma No relevant relationships
by Hamza Yousaf Copyright © 2024 American College of Chest
Physicians

<130>
Accession Number
2034596617
Title
FATAL COMPLICATIONS OF ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL
NEEDLE ASPIRATION (EBUS-TBNA)-MEDIASTINITIS AND PERICARDITIS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A5285-A5286), 2024. Date of Publication: October 2024.
Author
ABBAGONI V.; KAMBAM G.; INGAWALE S.; KALEJAIYE A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedures Case Reports Posters (A) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am INTRODUCTION:
Endobronchial ultrasound-guided transbronchial needle aspiration
(EBUS-TBNA) is a minimally invasive and safe procedure performed to
investigate mediastinal lesions(1). The diagnostic sensitivity of EBUS is
around 85% to 100% compared to mediastinoscopy. As per the literature, the
reported complications are around 1.4% to 1.23% and the incidence of
pericarditis and mediastinitis are around 0.01%(2) Here we discuss a case
of infectious mediastinitis and pericarditis after EBUS-TBNA procedure.
CASE PRESENTATION: This is a case of a 58-year-old female with a medical
history of pulmonary hypertension, chronic dyspnea, and recently diagnosed
primary neuroendocrine neoplasm of the lung (stage III). The patient was
an active smoker with 40 pack years, underwent a routine scan of the chest
for chronic dyspnea, and incidentally reported lymphadenopathy in the
paratracheal, right pulmonary hilum, and para-aortic region. A PET-CT scan
of the chest revealed hypermetabolic partially necrotic right paratracheal
and hilar lymphadenopathy consistent with malignancy. For further
evaluation, the patient underwent an EBUS procedure for right mediastinal
mass revealed non-small cell lung cancer with neuroendocrine features-
synaptophysin and CK7 positive. She presented to the hospital 15 days
after the EBUS-TBNA procedure, with worsening pleuritic chest pain,
shortness of breath, difficulty swallowing, altered mental status,
tachycardia, and hypotension. Findings on admission revealed leukocytosis
and lactic acidosis. EKG revealed diffuse PR depression and ST-segment
elevation which is indicative of pericardial inflammation. The
echocardiogram demonstrated moderate pericardial effusion, with no
evidence of cardiac tamponade. The patient was admitted for sepsis
secondary to pericardial effusion and underwent pericardiocentesis. The
cytology reported inflammation without malignant cells. Chest x-ray and CT
thorax revealed, bilateral pleural effusions, pericardial effusion, and
widened mediastinum concerning for mediastinitis. She underwent
thoracotomy with purulent drainage and was started on cefepime and
vancomycin. However, remained in severe sepsis requiring pressors, acute
kidney failure requiring dialysis, and developed disseminated
intravascular coagulation (DIC). DISCUSSION: Though EBUS TBNA is
considered one of the safest procedures with few complications,
mediastinitis is fatal with a mortality rate of 50% (3). As discussed in
our case, our patient's procedure was complicated by mediastinitis and
purulent pericarditis and progressed to DIC and multiorgan dysfunction.
Multiple randomized controlled trials have been conducted to use
prophylactic antibiotics before the procedure to prevent the dreadful
complication but the incidence of infectious events has remained
unchanged. There are no clinical trials yet to determine the risk factors
for the development of this infectious process after EBUS-TBNA however
from the information from some of the case reports, biopsy of a necrotic
lesion, site of the lesion, and number of punctures during the procedure
could be served as a potential source of infection. (2)
 CONCLUSION(S): The complications like mediastinitis and pericarditis
after EBUS-TBNA are associated with high morbidity and mortality. The use
of prophylactic antibiotics before the procedure is yet to be explored but
the earlier diagnosis of mediastinitis and identification of the pathogen
can decrease the rate of morbidity and mortality in these patients.
REFERENCE #1: Kurokawa K, Asao T, Ko R, Nagaoka T, Suzuki K, Takahashi K.
Severe mediastinitis over a month after endobronchial ultrasound-guided
transbronchial needle aspiration. Respirology case reports. 2019;7(5).
doi:https://doi.org/10.1002/rcr2.426 REFERENCE #2: Alfaiate J, Brito A,
Ana Luisa Matos. EBUS-TBNA-INDUCED PURULENT PERICARDITIS: A RARE
COMPLICATION OF A COMMON PROCEDURE. PubMed. 2023;10(3):003738-003738.
doi:https://doi.org/10.12890/2023_003738 REFERENCE #3: Koh JS, Kim YJ,
Kang DH, Lee JE, Lee SI. Severe mediastinitis and pericarditis after
endobronchial ultrasound-guided transbronchial needle aspiration: A case
report. World Journal of Clinical Cases. 2021;9(34):10723-10727.
doi:https://doi.org/10.12998/wjcc.v9.i34.10723 DISCLOSURES: No relevant
relationships by Vaidarshi Abbagoni No relevant relationships by Sushrut
Ingawale No relevant relationships by Ayoola Kalejaiye No relevant
relationships by Greeshmasree Kambam Copyright © 2024 American
College of Chest Physicians

<131>
Accession Number
2034596599
Title
CLOSING THE CONDUIT: A CASE OF SUCCESSFUL PERCUTANEOUS TRANSCATHETER
EMBOLIZATION OF A LARGE PLEXIFORM CORONARY ARTERY FISTULA.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A624-A625),
2024. Date of Publication: October 2024.
Author
AMIN H.; MCAULIFFE J.D.; SUMMERS M.R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Reports Posters (A) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/07/2024 12:30 pm - 01:15 pm
INTRODUCTION: Coronary artery fistulas (CAF) are rare anatomic anomalies
with a 0.5-0.9% prevalence in the general population. Congenital CAFs can
be present at any age, even in elderly patients, with clinical features
ranging from asymptomatic cases to severe heart failure or acute coronary
syndrome. Given their rarity and variance, CAFs are managed on a
case-by-case basis directed by expert consensus. CASE PRESENTATION: A
63-year-old male with past cardiac history significant for paroxysmal
atrial fibrillation was admitted for evaluation of a several days history
of worsening palpitations associated with new chest discomfort. Serial
troponins and ECGs were inconsistent with ACS. A nuclear stress test
revealed apical lateral wall ischemia. Transthoracic echocardiography
demonstrated preserved systolic function (LVEF 58%) with no wall motion
abnormalities or significant valvular pathology. The patient was taken for
non-emergent left heart catheterization that showed no obstructive CAD,
but did reveal a complex AV fistula, arising from the proximal LAD artery
and terminating in the left pulmonary artery. The patient was discharged
with structural heart and cardiothoracic surgery referrals for
consideration of percutaneous transcatheter embolization (PTE) or surgical
ligation. After further characterization via Coronary CTA and
multidisciplinary considerations, the patient elected to pursue PTE.
Pre-intervention right heart catheterization confirmed left-to-right
shunting (Qp:Qs 1.36) with preserved cardiac index (Fick 2.53). The
fistula was engaged via the proximal LAD with deployment of two
endovascular coils. Two additional antegrade entries into the plexiform
fistula were then noted; the more proximal was occluded with a single coil
but the distal entry was unable to be engaged. The fistula was then
engaged in a retrograde fashion via the pulmonary artery, where seven
additional coils were deployed. The patient tolerated the procedure
without complication and post-PTE angiography demonstrated near total
occlusion of the plexiform fistula and improved LAD and LCx flow.
DISCUSSION: The management of a CAF depends on many aspects but often
involves eliminating the presence of anomalous shunting through either
surgical ligation or PTE. Characterizing a CAF's anatomy is highly
important because a range of factors can dictate the severity and limit
management options. These decisions can be influenced by the number and
location of origin and terminus sites, the fistula's diameter and length,
whether the fistula creates an arteriovenous or cameral circuit, and
whether anatomic lesions are present. For management of a plexiform
lesion, the current expert consensus supports surgical ligation in most
cases, especially when PTE cannot sufficiently address all origin and
terminus sites. While coiling does present disadvantages like embolization
or requiring multiple coils for complex CAFs, some case series suggest PTE
entails a lower risk of postprocedural MI, as well as mitigate other risks
associated with surgical closure. CONCLUSION(S): This case presents
the discovery and management of a large, plexiform CAF in an elderly man
with angina. PTE was utilized to eliminate the anomalous left-to-right
shunt, resolving the patient's exertional symptoms, and helping to
mitigate long term complications. Given a lack of randomized clinical
trials comparing PTE and surgical ligation, future considerations are
needed to better define guidelines for management of plexiform CAFs.
REFERENCE #1: Cai R, Ma X, Zhao X, Xu J, Zhu L, Ku L. CTA analysis of 482
cases of coronary artery fistula: A large-scale imaging study. J Card
Surg. 2022 Jul;37(7):2172-2181. doi: 10.1111/jocs.16500. Epub 2022 May 4.
PMID: 35508600. REFERENCE #2: Rao SS, Agasthi P. Coronary Artery Fistula.
[Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK559191/ REFERENCE #3: Al-Hijji M, El
Sabbagh A, El Hajj S, AlKhouli M, El Sabawi B, Cabalka A, Miranda WR,
Holmes DR, Rihal CS. Coronary Artery Fistulas: Indications, Techniques,
Outcomes, and Complications of Transcatheter Fistula Closure. JACC
Cardiovasc Interv. 2021 Jul 12;14(13):1393-1406. doi:
10.1016/j.jcin.2021.02.044. PMID: 34238550. DISCLOSURES: No relevant
relationships by Harsh Amin No relevant relationships by Jacob McAuliffe
No relevant relationships by Matthew Summers Copyright © 2024
American College of Chest Physicians

<132>
Accession Number
2034596509
Title
A BLEEDING HEART: HEMORRHAGIC TAMPONADE AND RECURRENT IDIOPATHIC
PERICARDITIS TREATED WITH ANAKINRA.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A526-A527),
2024. Date of Publication: October 2024.
Author
COCHRAN K.; MELLGARD G.; MIN S.U.G.I.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiac Toxicities: Old Foes and New Enemies SESSION TYPE:
Rapid Fire Case Reports PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Recurrent idiopathic pericarditis is the repeat presentation
of pericarditis symptoms after six weeks symptom-free, occurring in the
absence of a clear etiology. The United States has less than 40,000 cases
annually. Diagnosis requires pleuritic chest pain and signs of pericardial
inflammation: fever, electrocardiogram (ECG) changes, pericardial
effusion, or elevated inflammatory markers. The rarity of this disease
complicates attempts to identify predictive markers and select a treatment
course. CASE PRESENTATION: A 25-year-old female presented with acute,
positional chest pain. Given her ECG showing diffuse ST-segment
elevations, C-reactive protein (CRP) of 197.4 mg/L, and erythrocyte
sedimentation rate (ESR) of 92 mm/hr, she was diagnosed with pericarditis.
Transthoracic echocardiogram (TTE) noted a small pericardial effusion. She
was initiated on colchicine and ibuprofen, her chest pain resolved, and
she was discharged. Despite continuing her prescribed treatment, the
patient's chest pain worsened, and she returned five days post-discharge.
Exam was notable for a new fever (39.5degreeC) and tachycardia (136 beats
per minute). Lab findings included anemia (hemoglobin 6.9 g/dL),
leukocytosis (white blood cell count 13.6x103/uL), and elevated
inflammatory markers (CRP 213 mg/L, ESR 63 mm/hr). Repeat TTE revealed
worsening pericardial effusion (measuring 3 cm) and right ventricular
compression, consistent with echocardiographic tamponade. An emergent
pericardiocentesis drained 45 mL of bloody fluid. The effusion persisted,
and a subsequent pericardial window drained an additional 300 mL.
Diagnostic workup showed slightly elevated C anti-neutrophil cytoplasmic
antibody (ANCA) (35 AU/mL) and a positive P-ANCA (titer 1:80), with
otherwise negative infectious and rheumatologic markers. Following
surgical intervention, the patient's chest pain resolved, and she was
discharged on hospital day twelve on colchicine and a steroid taper.At the
completion of her taper six weeks later, her chest pain recurred. TTE
showed re-accumulation of a pericardial effusion. The patient's symptoms
and titers were insufficient to diagnose either a rheumatologic or an
infectious etiology of her pericarditis. Given these exclusions and the
reoccurrence of her symptoms six weeks following the cessation of her
prior episode, she was diagnosed with recurrent idiopathic pericarditis.
Once her acute symptoms had resolved with steroids and colchicine, she was
trialed on subcutaneous anakinra 100 mg daily. Since starting anakinra,
the patient has not experienced a recurrent pericarditis episode.
DISCUSSION: Diagnostic exclusion of non-idiopathic etiologies of recurrent
pericarditis simultaneously rules out clear treatment options that would
target underlying rheumatologic, cardiac, or infectious causes. Although
the mechanism of recurrent idiopathic pericarditis is unknown, studies
have linked the disease to elevated cytokines. Anakinra works by
antagonizing the interleukin (IL)-1 receptor, thereby blocking IL-1
mediated sterile inflammation and inflammasome assembly. A few recent
studies have demonstrated the efficacy of anakinra in reducing recurrence
of pericarditis, but sample sizes are limited due to the disease's rare
nature. The full resolution of this patient's case following treatment
provides further evidence for the nascent but compelling narrative of
selecting anakinra to treat recurrent pericarditis. CONCLUSION(S): In
this case of recurrent idiopathic pericarditis complicated by hemorrhagic
cardiac tamponade and refractory to steroids, positive response to
anakinra, an IL-1 inhibitor, supports a cytokine mediated etiology of
disease. REFERENCE #1: Adler, Y., Charron, P., Imazio, M., Badano, L.,
Baron-Esquivias, G., Bogaert, J., Brucato, A., Gueret, P., Klingel, K.,
Lionis, C., Maisch, B., Mayosi, B., Pavie, A., Ristic, A. D., Sabate
Tenas, M., Seferovic, P., Swedberg, K., Tomkowski, W., & ESC Scientific
Document Group (2015). 2015 ESC Guidelines for the diagnosis and
management of pericardial diseases: The Task Force for the Diagnosis and
Management of Pericardial Diseases of the European Society of Cardiology
(ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery
(EACTS). European heart journal, 36(42), 2921-2964.
https://doi.org/10.1093/eurheartj/ehv318Andreis, A., Imazio, M., Casula,
M., Avondo, S., & Brucato, A. (2021). Recurrent pericarditis: an update on
diagnosis and management. Internal and emergency medicine, 16(3), 551-558.
https://doi.org/10.1007/s11739-021-02639-6Baskar, S., Klein, A. L., &
Zeft, A. (2016). The Use of IL-1 Receptor Antagonist (Anakinra) in
Idiopathic Recurrent Pericarditis: A Narrative Review. Cardiology research
and practice, 2016, 7840724. https://doi.org/10.1155/2016/7840724
REFERENCE #2: Brucato, A., Imazio, M., Gattorno, M., Lazaros, G.,
Maestroni, S., Carraro, M., Finetti, M., Cumetti, D., Carobbio, A.,
Ruperto, N., Marcolongo, R., Lorini, M., Rimini, A., Valenti, A., Erre, G.
L., Sormani, M. P., Belli, R., Gaita, F., & Martini, A. (2016). Effect of
Anakinra on Recurrent Pericarditis Among Patients With Colchicine
Resistance and Corticosteroid Dependence: The AIRTRIP Randomized Clinical
Trial. JAMA, 316(18), 1906-1912.
https://doi.org/10.1001/jama.2016.15826Cantarini, L., Lucherini, O. M.,
Brucato, A., Barone, L., Cumetti, D., Iacoponi, F., Rigante, D.,
Brambilla, G., Penco, S., Brizi, M. G., Patrosso, M. C., Valesini, G.,
Frediani, B., Galeazzi, M., Cimaz, R., Paolazzi, G., Vitale, A., & Imazio,
M. (2012). Clues to detect tumor necrosis factor receptor-associated
periodic syndrome (TRAPS) among patients with idiopathic recurrent acute
pericarditis: results of a multicentre study. Clinical research in
cardiology : official journal of the German Cardiac Society, 101(7),
525-531. https://doi.org/10.1007/s00392-012-0422-8Imazio, M., Bobbio, M.,
Cecchi, E., Demarie, D., Pomari, F., Moratti, M., Ghisio, A., Belli, R., &
Trinchero, R. (2005). Colchicine as first-choice therapy for recurrent
pericarditis: results of the CORE (COlchicine for REcurrent pericarditis)
trial. Archives of internal medicine, 165(17), 1987-1991.
https://doi.org/10.1001/archinte.165.17.1987Imazio, M., Bobbio, M.,
Cecchi, E., Demarie, D., Demichelis, B., Pomari, F., Moratti, M.,
Gaschino, G., Giammaria, M., Ghisio, A., Belli, R., & Trinchero, R.
(2005). Colchicine in addition to conventional therapy for acute
pericarditis: results of the COlchicine for acute PEricarditis (COPE)
trial. Circulation, 112(13), 2012-2016.
https://doi.org/10.1161/CIRCULATIONAHA.105.542738 REFERENCE #3: Jain, S.,
Thongprayoon, C., Espinosa, R. E., Hayes, S. N., Klarich, K. W., Cooper,
L. T., Moder, K. G., Anavekar, N. S., Oh, J. K., & Matteson, E. L. (2015).
Effectiveness and Safety of Anakinra for Management of Refractory
Pericarditis. The American journal of cardiology, 116(8), 1277-1279.
https://doi.org/10.1016/j.amjcard.2015.07.047. Peet, C. J., Rowczenio, D.,
Omoyinmi, E., Papadopoulou, C., Mapalo, B. R. R., Wood, M. R., Capon, F.,
& Lachmann, H. J. (2022). Pericarditis and Autoinflammation: A Clinical
and Genetic Analysis of Patients With Idiopathic Recurrent Pericarditis
and Monogenic Autoinflammatory Diseases at a National Referral Center.
Journal of the American Heart Association, 11(11), e024931.
https://doi.org/10.1161/JAHA.121.024931. Tombetti, E., Mule, A., Tamanini,
S., Matteucci, L., Negro, E., Brucato, A., & Carnovale, C. (2020). Novel
Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020.
Current cardiology reports, 22(8), 59.
https://doi.org/10.1007/s11886-020-01308-y. Picco P., Brisca G., Traverso
F., Loy A., Gattorno M., Martini A. Successful treatment of idiopathic
recurrent pericarditis in children with interleukin-1beta receptor
antagonist (anakinra): an unrecognized autoinflammatory disease? Arthritis
& Rheumatism. 2009;60(1):264-268. doi: 10.1002/art.24174. Vassilopoulos,
D., Lazaros, G., Tsioufis, C., Vasileiou, P., Stefanadis, C., &
Pectasides, D. (2012). Successful treatment of adult patients with
idiopathic recurrent pericarditis with an interleukin-1 receptor
antagonist (anakinra). International journal of cardiology, 160(1), 66-68.
https://doi.org/10.1016/j.ijcard.2012.05.086 DISCLOSURES: No relevant
relationships by Kensington Cochran No relevant relationships by George
Mellgard No relevant relationships by Sugi Min Copyright © 2024
American College of Chest Physicians

<133>
Accession Number
2034596411
Title
INCIDENTAL FINDINGS FROM A LUNG CANCER SCREENING COHORT OF U.S. VETERANS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A4068-A4069), 2024. Date of Publication: October 2024.
Author
WAN E.; LECLAIRE R.; WHITE J.; JOHNSTON D.; LACERDA K.; O'LEARY J.; BLAKE
L.A.; JACOB S.M.; MORREALE-KARL M.; JATI A.; WILDER F.; WIENER D.;
GARSHICK E.R.I.C.; GOLDSTEIN R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Imaging Abstracts Posters (B) SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/09/2024 10:20 am - 11:05 am
PURPOSE: Incidental findings (IFs) are frequently encountered in lung
cancer screening (LCS) programs. The prevalence, types, and subsequent
management of IFs vary substantially across populations and programs.
Balancing return of information with "alert fatigue" for primary
healthcare providers represents a unique challenge. VA Boston supports a
high-volume, multidisciplinary LCS program based within the Pulmonary
Section; in conjunction with the primary care service, potentially
actionable IFs were identified for which alerts (requiring acknowledgement
or intervention) were to be generated for the patient's provider team. The
aim of the current work is to characterize the prevalence and types of IFs
encountered within a Veteran LCS cohort. METHOD(S): Systematic review
of randomly-sampled radiology reports from low-dose computed tomography
(LDCT) scans performed from 8/17/23-11/20/23 at VA Boston was performed.
Lung Imaging Reporting and Data System (LungRADS) scores and the presence
(yes/no) of significant IFs, defined as aneurysms (>4.5cm aortic, >4cm
thoracic), bronchial wall thickening, bronchiectasis, coronary artery
calcifications (CACs, severe or worsening), cirrhosis, emphysema,
gynecomastia (asymmetric), enlarging lymph nodes, pericardial or pleural
effusion, pneumonia, pulmonary fibrosis, pleural plaques. Alerts were also
required for new/enlarging lung nodules or a LungRADS score >=3. Urgent
IFs, defined as findings requiring additional testing or treatment within
1 month were adjudicated separately. Significant and urgent findings were
not mutually exclusive. All study activities were conducted under an
IRB-approved protocol (IRBNet 1629925). RESULT(S): During the
observation period, 938 LDCTs were performed, of which 200 records were
systematically reviewed. Subjects were predominantly male (95%), with mean
age 69.0+/-6.8 and 49.0+/-22.4 pack-years of smoking with 50% (n=100)
current smokers. Significant IFs were reported in 62 (31%) patients, of
which, the most common findings were emphysema (n=40, 64.5%) and severe or
worsening CACs (n=24, 38.7%). 29 individuals had urgent IFs, of which the
most common finding was non-specific parenchymal infiltrates (n=14,
46.7%), followed by new or enlarging nodules (n=11, 36.7%), with the
remainder comprised of airway abnormalities. The majority of individuals
with urgent IFs had concurrent significant IFs (n=27, 90%) and all (100%)
of the urgent IFs were managed by the Pulmonary Section with Thoracic
Surgery and Radiology review as needed. CONCLUSION(S): Approximately
a third of patients undergoing LDCT for LCS have significant or urgent
IFs, with most IFs related to pulmonary processes. CLINICAL IMPLICATIONS:
Incidental findings are common in LCS cohorts. Although developed for the
detection of pulmonary malignancy, LCSs are resource-intensive and require
algorithms for the prioritization, notification, and subsequent
co-management of IF's. DISCLOSURES: No relevant relationships by Lisa
Blake No relevant relationships by Eric Garshick No relevant relationships
by Ronald Goldstein No relevant relationships by Samantha Jacob No
relevant relationships by Anupma Jati No relevant relationships by
Demerise Johnston No relevant relationships by Kathleen LaCerda No
relevant relationships by Renee LeClaire No relevant relationships by
Michelle Morreale-Karl No relevant relationships by Julianne O'Leary No
relevant relationships by Emily Wan No relevant relationships by Julie
White No relevant relationships by Daniel Wiener No relevant relationships
by Fatima Wilder Copyright © 2024 American College of Chest
Physicians

<134>
Accession Number
2034596375
Title
EPSTEIN-BARR VIRUS AS A RARE CAUSE OF ACUTE PERICARDITIS AND CARDIAC
TAMPONADE.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A1326),
2024. Date of Publication: October 2024.
Author
PATEL J.; LAU C.; O'HEA J.A.; SHER N.; KHAN A.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Reports Posters (T) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Pericarditis is the inflammation of the sac surrounding the
heart that can lead to cardiac tamponade, compression of the heart
chambers by excess fluid. The etiology of pericarditis is varied including
infections, autoimmune conditions, post-myocardial infarction, or
medications. While Coxsackie B virus is a well-established culprit, less
common pathogens like Epstein-Barr virus (EBV) can also incite pericardial
inflammation. We report a unique case of a young female presenting with
acute pericarditis progressing to cardiac tamponade due to EBV infection.
CASE PRESENTATION: A 33-year-old female, previously healthy, exhibited
altered mental status and syncope mid-flight. She complained of pleuritic
chest pain, nausea, dizziness, and diaphoresis, followed by post-ictal
confusion and posturing. The patient had experienced fever and a viral
prodrome the preceding week. Despite fluid resuscitation, her blood
pressure remained low at 80/60 mmHg, with a heart rate of 120 beats/min.
Laboratory investigations revealed elevated high-sensitivity troponin (16
ng/l), B-type natriuretic peptide (3464 pg/ml), lactic acid (4.3mmol/l),
and D-dimer (683 ng/ml). Lower extremity venous doppler ultrasound was
unremarkable. Physical examination revealed jugular venous distention with
Kussmaul's sign and bilateral lower extremity edema. An echocardiogram
displayed moderate pericardial effusion with tamponade physiology. CT
angiogram confirmed pericarditis, bilateral pleural effusions, and
atelectasis. Oxygen supplementation reached 4L/min. Thyroid-stimulating
hormone (TSH) was normal. Tests for respiratory viral panel, HIV, and
antinuclear antibodies (ANA) were negative, except for an elevated EBV
nuclear antigen (>600 U/mL). Treatment included NSAIDs, colchicine, and
pericardiocentesis, draining 200 mL of serosanguinous fluid. Cultures from
pericardial fluid and blood were negative. Oxygen therapy was discontinued
upon discharge. DISCUSSION: Epstein-Barr virus is a member of the
herpesvirus family and one of the most common viruses worldwide. It is
primarily transmitted through saliva and infects most people at some point
in their lives, often during childhood or adolescence. While often
asymptomatic or causing mild illness, EBV is linked to various diseases,
including infectious mononucleosis and certain cancers. Limited evidence
suggests EBV can induce severe cardiac complications, as seen in this
case, underscoring the importance of considering EBV in pericarditis and
cardiac tamponade presentations among adolescents and young adults.
 CONCLUSION(S): Pericarditis is most associated with viral infection,
particularly Coxsackie B virus. Treatment is largely supportive and
revolves around NSAIDs, aspirin, or colchicine. While pericarditis is
often self-limiting, it can progress to cardiac tamponade and often
requires further, more intensive, management. Our case highlights the need
to consider EBV as a potential cause of pericarditis. REFERENCE #1: Imazio
M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A
Systematic Review [published correction appears in JAMA. 2015 Nov
10;314(18):1978] [published correction appears in JAMA. 2016 Jan
5;315(1):90. Dosage error in article text]. JAMA. 2015;314(14):1498-1506.
doi:10.1001/jama.2015.12763 DISCLOSURES: No relevant relationships by
Abdul Ahad Khan No relevant relationships by Christopher Lau No relevant
relationships by Jennifer O'Hea No relevant relationships by Jason Patel
No relevant relationships by Nehan Sher Copyright © 2024 American
College of Chest Physicians

<135>
Accession Number
2034596298
Title
TRIPLE THREAT: A LIFE-THREATENING CONVERGENCE OF HYPERTENSIVE EMERGENCY,
CARDIAC TAMPONADE, AND LUPUS NEPHRITIS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A2262-A2263), 2024. Date of Publication: October 2024.
Author
BOMMU V.; QAISER S.; RAJENDRAN J.; KHAN W.H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Reports Posters (G) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/07/2024 12:30 pm - 01:15 pm INTRODUCTION:
Systemic Lupus Erythematosus (SLE) can present with varying systemic
features. It can affect just about any organ system. Cardiac and renal
involvement are frequently reported, however, features such as tamponade
and hypertensive emergency are less common. Cardiac tamponade has been
reported in 5.9% of cases; and hypertensive emergency in 1-2% of cases.
Furthermore, the presentation of concomitant tamponade, hypertensive
emergency, and lupus nephritis is very rare. We report a combination of
all three life-threatening emergencies in an 18-year-old female. CASE
PRESENTATION: An 18-year-old African American female with no significant
past medical history presented to the emergency department (ED) for
persistent nausea, vomiting, fatigue, and headache for a week. She was
found to be severely hypertensive with a blood pressure of 205/155 mm Hg
and in acute renal failure with creatinine 5.0 mg/dL. Her hospital course
was complicated by cardiac tamponade (figure 1) for which she underwent a
pericardial window draining 1600 cc. An autoimmune evaluation revealed
positive antinuclear antibodies 1:1300, negative anti-double-stranded DNA,
and negative anti-GBM. Renal biopsy revealed chronic sclerosing
glomerulonephritis with multiple fibrous crescents, arteriosclerosis,
tubular atrophy, and interstitial inflammation. Immunofluorescence
revealed granular global mesangial, and capillary wall deposits 3+ for IgG
and 1+ for IgM, 1-2+ for C3 and C1, and 3+ for kappa and lambda -
consistent with class IV Lupus nephritis. She was treated with high-dose
intravenous steroids and rituximab. She was ultimately discharged home in
stable condition, with plans for outpatient hemodialysis. Figure 1A: Chest
radiograph revealing enlarged cardiac silhouette due to cardiac tamponade
B: Status post pericardial window DISCUSSION: The classic presentation of
cardiac tamponade is traditionally described as Beck's triad with
hypotension, elevated jugular venous pressure, and muffled heart sounds.
However, hypertension can be an exceptional presentation especially if it
is associated with other causes such as lupus, such as in our patient.
Patients with tamponade who were hypertensive have a higher probability of
pre-existing hypertension (88% vs. 46, p <0.05) and advanced renal illness
(63% vs. 14%, p <0.05)[4]. Brown et al. described six patients with
cardiac tamponade and hypertension. Peripheral vascular resistance (PVR)
and hypertension decreased in each patient after pericardiocentesis. When
pericardial limitation reduces cardiac output, PVR plays a crucial
compensating role in addition to enhanced myocardial contractility. By
improving cardiac output and causing an instant decrease in intracardiac
pressure, pericardiocentesis decreases PVR. Our patient presented with
known features of SLE, including lupus nephritis, pericarditis,
pericardial effusion, and hypertension. The presentation of all three
features at once though is very rare. First-line treatment includes
pericardial decompression and hemodynamic management. This is followed by
high-dose steroids and rituximab. Rituximab is now considered superior to
other agents. In a systematic review of five randomized controlled trials,
rituximab led to a higher rate of remission than other agents, including
cyclophosphamide. CONCLUSION(S): Although SLE can affect any organ
system, and present with varying signs and symptoms, the presentation of
tamponade, hypertensive emergency, and renal failure is rare. REFERENCE
#1: 1. Hoover PJ, Costenbader KH. Insights into the epidemiology and
management of lupus nephritis from the US rheumatologist's perspective.
Kidney Int. 2016 Sep;90(3):487-92. doi: 10.1016/j.kint.2016.03.042. Epub
2016 Jun 22. PMID: 27344205; PMCID: PMC5679458. 2. Goswami RP, Sircar G,
Ghosh A, Ghosh P. Cardiac tamponade in systemic lupus erythematosus. QJM.
2018 Feb 1;111(2):83-87. doi: 10.1093/qjmed/hcx195. PMID: 29048543.
REFERENCE #2: 3. Alley WD, Schick MA. Hypertensive Emergency. [Updated
2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2024 Jan. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470371/. 4. Argulian E, Herzog E,
Halpern DG, Messerli FH. Paradoxical hypertension with cardiac tamponade.
Am J Cardiol. 2012 Oct 1;110(7):1066-9. doi:
10.1016/j.amjcard.2012.05.042. Epub 2012 Jun 19. PMID: 22721572. REFERENCE
#3: 5. Handler J. Hypertensive emergency with cardiac tamponade associated
with hypothyroidism. J Clin Hypertens (Greenwich). 2007 Jan;9(1):67-72.
doi: 10.1111/j.1524-6175.2007.06343.x. PMID: 17215663; PMCID: PMC8109977.
6. Yuan Z, Xie Q, Wu X, Tan B, Zhang X. Rituximab treatment for lupus
nephritis: A systematic review. Clin Invest Med. 2020 Jun 28;43(2):E47-54.
doi: 10.25011/cim.v43i2.33864. PMID: 32593276. DISCLOSURES: No relevant
relationships by Veera Bommu No relevant relationships by Wajahat Khan No
relevant relationships by Saria Qaiser No relevant relationships by
Jackson Rajendran Copyright © 2024 American College of Chest
Physicians

<136>
Accession Number
2034596121
Title
NONTUBERCULOUS MYCOBACTERIUM EMPYEMA: UNIQUE COMPLICATION AFTER
ROBOTIC-ASSISTED BRONCHOSCOPY WITH LUNG BIOPSY.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A1123-A1124), 2024. Date of Publication: October 2024.
Author
WU S.S.; GOWDA N.R.; BERKOWITZ D.M.; SARDI A.H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Salvage Therapies for Infections SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm INTRODUCTION:
Non-tuberculous mycobacterium (NTM) is a commonly occurring organism with
rare manifestation in the forms of pleural effusions. NTM empyema is
rarely reported, thus with limited data on appropriate antibiotic
treatment. With the emergence of robotic-assisted bronchoscopy (RAB) for
pulmonary lesion sampling, various complications would expectedly surface
as prevalence of these procedures increases. We report a unique case of
iatrogenic NTM empyema post lung biopsy via RAB using shape-sensing
technology. CASE PRESENTATION: 80-year-old male non-smoker with bladder
cancer treated with radiation and chemotherapy 10 month ago, asbestos
exposure and related pleural plaques, presented initially for elective RAB
with biopsy and bronchoalveolar lavage (BAL) for a right lower lobe
cavitary lesion due to concern for possible metastatic malignancy. He
underwent RAB with shape-sensing technology (ION-platform) with 3D
Fluoroscopical tool-in-lesion confirmation. Transbronchial needle
aspirations, brush biopsies, forceps biopsies, cryobiopsies and BAL were
done sequentially. Eventual tissue biopsy grew mycobacterium avium (MAC).
Post procedural chest X-ray showed a minimally symptomatic 3.8 cm apical
pneumothorax that improved to 2.1 cm on serial X-ray at the time of
discharge. Chest X-ray the week after showed further improvement to 1.1
cm. CT scan of the chest 2 weeks after showed resolution of pneumothorax
and interval development of moderate pleural effusion containing multiple
locules of air. Thus, the patient underwent thoracentesis that showed
lymphocytic dominant exudative effusion, eventually culturing MAC. He was
admitted to the hospital for treatment of NTM empyema due to persistent
cough, exercise intolerance, and generalized malaise. Treatment with
Ethambutol, Azithromycin, and Rifabutin were initiated. He also received 3
days of parenteral Amikacin but was discontinued due to auditory side
effects. He underwent 14 French chest tube placement and completed with 3
days of intrapleural tissue plasminogen activator plus dornase alfa with
resolution of pleural effusion on CXR prior to discharge. 1-month and
3-month interval CT scan of the chest showed improving but residual
pleural effusion with thickened pleura. Thoracic surgery evaluated during
outpatient follow up and differed decortication due to increased
procedural risk and lack of long-term benefit. He is maintained on
surveillance CT scans to date. DISCUSSION: We highlight a unique case of
iatrogenic NTM empyema, which can be a diagnostic challenge with limited
prior medical history and imaging. A high index of suspicion and culture
positivity are needed for diagnosis. NTM can enter a pleural cavity
through transient bacteremia or by contiguous spread via recent
instrumentation. Other potential contributors include impaired cellular
immunity and disrupted anatomical integrity. Post procedural pneumothorax
can be managed conservatively especially those without clinical symptoms.
However, given the disruption of visceral pleura, rare pleural
complications including empyema, sympathetic effusion, hemorrhage could
occur and require medical attention. NTM Empyema has a poor prognosis
based on literature review and a high risk of complications requiring
surgical interventions in addition to anti-NTM therapy.
 CONCLUSION(S): NTM empyema is a unique iatrogenic complication
post-lung biopsy described to date. Translocation of primary parenchymal
lesion is the presumed etiology. Urgent source control combined with
propriate prolonged anti-microbial therapy is the mainstay treatment.
REFERENCE #1: Yu, F., Li, Y., Luo, J. et al. Thoracic empyema due to
nontuberculous mycobacteria in an immunocompetent patient without
pulmonary disease: a case report. BMC Pulm Med 23, 215 (2023).
https://doi.org/10.1186/s12890-023-02494- REFERENCE #2: Pooja Desa, Ketan
Buch, Mycobacterium avium complex Empyema: A Rare Entity, Chest, Volume
148, Issue 4, Supplement, 2015, page 454A, ISSN 0012-3692,
https://doi.org/10.1378/chest.2269004. REFERENCE #3: Keren Bachar, Tiberiu
Shulimzon, Michael J. Segel, Nontuberculous mycobacteria infections of the
pleura: A systematic review, Respiratory Medicine, Volume 205, 2022,
107036, ISSN 0954-6111, https://doi.org/10.1016/j.rmed.2022.107036.
DISCLOSURES: No relevant relationships by David Berkowitz No relevant
relationships by Niraj Gowda No relevant relationships by Alejandro Sardi
No relevant relationships by Steven Wu Copyright © 2024 American
College of Chest Physicians

<137>
Accession Number
2034596058
Title
ACUTE MEDIASTINITIS AND PERICARDIAL EFFUSION FOLLOWING ENDOBRONCHIAL
ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION: A RARE COMPLICATION.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A5156-A5157), 2024. Date of Publication: October 2024.
Author
ELENGICKAL J.; BAREFIELD J.; ROMANO C.; CARLYLE L.; YESSIN O.; AHUJA D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedural Complications SESSION TYPE: Rapid Fire Case
Reports PRESENTED ON: 10/08/2024 12:30 pm - 01:15 pm INTRODUCTION:
Endobronchial ultrasound-guided transbronchial needle aspiration
(EBUS-TBNA) is a minimally invasive approach to evaluating peribronchial,
mediastinal, and lung masses and lymph nodes. Adverse events including
infection, perforation, pneumothorax, hemorrhage, and respiratory
complications are exceedingly rare, with one study estimating a rate of
0.14% (1). Acute mediastinitis is a rare but serious complication and has
been reported in several case studies (2). There are even fewer cases of
post-EBUS acute mediastinitis spreading to the pericardium resulting in
pericardial effusion. Our case demonstrates a patient who developed acute
mediastinitis and a purulent pericarditis following EBUS-TBNA. CASE
PRESENTATION: A 70-year-old male patient in relatively good health was
found to have a subcarinal mediastinal mass on his first routine lung
cancer screening CT chest. Patient underwent outpatient bronchoscopy with
EBUS-TBNA of the mass without any immediate complications. He began
experiencing chest pain and fevers within 24 hours of the procedure and
presented to the hospital 1 week later. Chest CT showed interval
enlargement of the mediastinal mass from 4.7 cm x 5.1 cm to 5.8 cm x 6.9
cm. EKG showed global ST segment elevations concerning for pericarditis.
Follow up imaging 12 hours later showed a decrease in the mediastinal mass
with concurrent significant increase of a pericardial effusion, concerning
for communication between the mass and pericardial space. Empirical
treatment with IV Vancomycin, Cefepime, and Flagyl was initiated with
concerns for mediastinitis and presumed infective pericarditis. Patient
underwent pericardiocentesis with drain placement that produced copious
amounts of frank pus, however days later he required a pericardial window
due to reaccumulation of the pericardial effusion following clamping of
the drain. The pericardial fluid cultures grew Haemophilus influenzae.
After several days of antibiotics and source control, the patient had
improvements in chest pain with resolution of his fever. The results of
the initial EBUS-TBNA biopsy indicate the mediastinal mass was likely a
bronchogenic or esophageal duplication cyst. DISCUSSION: EBUS-TBNA is a
relatively safe and well tolerated procedure for biopsy of lymph nodes and
mediastinal lesions. Complications are rare and usually nonfatal, but
include infection, perforation, pneumothorax, hemorrhage, and respiratory
complications (3). Mediastinitis has been reported as one of the possible
forms of infection following EBUS-TBNA. Common pathogens causing post-op
mediastinitis include staphylococcus aureus, coagulase negative
staphylococcus and gram negative bacteria. While mediastinitis with
purulent pericarditis is an extremely rare complication, it is important
for physicians to be aware of the possibility, as prompt source control
and antimicrobial therapy can result in better patient outcomes.
 CONCLUSION(S): This case demonstrates a rare complication following
EBUS-TBNA, documents the clinical progression of the patient, and shares
the eventual recovery. Further studies into risk factors associated with
development of these infections are necessary. REFERENCE #1: M.B. von
Bartheld, A. van Breda, J.T. Annema; Complication Rate of Endosonography
(Endobronchial and Endoscopic Ultrasound): A Systematic Review.
Respiration 1 March 2014; 87 (4): 343-351.
https://doi.org/10.1159/000357066 REFERENCE #2: Fukunaga, K., Kawashima,
S., Seto, R., Nakagawa, H., Yamaguchi, M. and Nakano, Y. (2015),
Infectious complications of EBUS-TBNA. Respirology Case Reports, 3: 16-18.
https://doi.org/10.1002/rcr2.90 REFERENCE #3: Pere Serra Mitja, Filipe
Goncalves dos Santos Carvalho, Ignasi Garcia Olive, Jose Sanz Santos,
Jesus Jimenez Lopez, Ana Nunez Ares, Laura Tomas Lopez, Carmen Centeno
Clemente, Rachid Tazi, Eva Castella, Jorge Abad Capa, Antoni Rosell
Gratacos, Felipe Andreo Garcia,Incidence and Risk Factors for Infectious
Complications of EBUS-TBNA: Prospective Multicenter Study, Archivos de
Bronconeumologia, Volume 59, Issue 2, 2023, 84-89.
https://doi.org/10.1016/j.arbres.2022.10.007. DISCLOSURES: No relevant
relationships by Divya Ahuja No relevant relationships by James Barefield
No relevant relationships by Logan Carlyle No relevant relationships by
Joseph Elengickal No relevant relationships by Christina Romano No
disclosure on file for Olivia Yessin Copyright © 2024 American
College of Chest Physicians

<138>
Accession Number
2034595692
Title
FILLING A VOID: A RARE CASE OF POSTPNEUMONECTOMY SYNDROME IN A 79-YEAR-OLD
FEMALE.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A275-A276),
2024. Date of Publication: October 2024.
Author
BHIKHA M.; MOTATO J.; NEWMAN-CARO A.; DAWOODJEE Y.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Reports Posters (A) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Pneumonectomy is performed in patients with advanced lung
malignancy, infection, profound inflammation or trauma. Typical
post-pneumectomy changes include fluid accumulation in the voided space,
mediastinal shift towards the vacant pleural space and elevation of the
diaphragm. This case report highlights a rare case of post-pneumonectomy
syndrome, which involves herniation of the right lung and mediastinum into
the left pleural space. CASE PRESENTATION: We have found a rare case of a
79-year-old female with history of non-small cell bronchogenic carcinoma
post left pneumonectomy 18 years ago who was admitted for acute hypoxic
respiratory failure from pneumonia. Arterial blood gas showed acute on
chronic respiratory acidosis and maging showed herniation of the right
lung into the left hemithorax, marked deviation of upper thoracic
esophagus, and mediastinal shift to the left hemithorax periphery.
Esophagram study showed severe dysphagia with limited peristalsis.
Hospitalization was further complicated with aspiration pneumonia and
atrial fibrillation with rapid ventricular response. The patient was
started on empiric antibiotic coverage and bronchodilator therapy with
rate and rhythm-controlled medications. Her oxygen requirement had
increased over the course, requiring non-invasive positive pressure
ventilation. Given the malposition of her mediastinum, attempts to
intubate endotracheally would be complicated. Despite aggressive measures,
her hypercapnia and pneumonia continued to worsen and the patient and
family ultimately decided to transition to palliative measures.
DISCUSSION: Pneumonectomy is the invasive surgical procedure indicated in
those with advanced malignancy, infection, inflammatory lung disease or
trauma. Prior to the procedure, a series of evaluations such as pulmonary
function testing, imaging and smoking status is performed to assess
post-operative viability. After the procedure, the voided pleural space is
typically occupied by air with possible hyperinflation of the remaining
lung and mediastinal shift to the post-pneumonectomy space. After 24
hours, fluid begins to accumulate the space and with expected complete
opacification of the hemithorax within 7 months. Expected changes include
elevation of the diaphragm and mediastinal shift to voided space. Post
operative complications may include pulmonary edema, pneumothorax,
fistulas and empyema; rare cases of post-pneumectomy syndrome, where the
shifting of the mediastinum may cause large airway obstruction which is
reflected in this case presentation. Management revolves around
repositioning of the mediastinum by endobronchial stenting, prosthetic
implant, or surgical correction. The importance of this case is to
determine methods to prevent the herniation of the residual lung and
mediastinum and modalities of treatment if the presentation arises.
 CONCLUSION(S): Changes of post pneumectomy begin with air
infiltration which is replaced with fluid within months. Rare cases of
post-pneumonectomy syndrome, where there is a drastic shift of the
mediastinum and contralateral lung into the voided space, have emerged.
This phenomenon may cause obstruction of the airways, torsion or
malalignment of the great vessels from the heart. In this case report, we
have discovered post-pneumonectomy syndrome in a patient who suffered
acute hypoxic respiratory failure, dysphagia with subsequent aspiration
pneumonia, and atrial fibrillation with RVR. This case provides insight
into complications of post pneumonectomy syndrome and encourages further
investigation into the necessity of surveillance and pursuing preventative
treatment. REFERENCE #1: Beshara M, Bora V. Pneumonectomy. [Updated 2023
Mar 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK555969/ REFERENCE #2:
Christodoulides, N., Fitzmaurice, G.J., Bukowska, I. et al.
Post-pneumonectomy syndrome: a systematic review of the current evidence
and treatment options. J Cardiothorac Surg 18, 119 (2023).
https://doi.org/10.1186/s13019-023-02278-2 REFERENCE #3: Christodoulides
N, Fitzmaurice GJ, Bukowska I, O'Rhaillaigh E, Toale C, Griffin M, Redmond
KC. Post-pneumonectomy syndrome: a systematic review of the current
evidence and treatment options. J Cardiothorac Surg. 2023 Apr
10;18(1):119. doi: 10.1186/s13019-023-02278-2. PMID: 37038182; PMCID:
PMC10084598. DISCLOSURES: No relevant relationships by Mikul Bhikha No
relevant relationships by Yousuf Dawoodjee No relevant relationships by
Jefry Motato No relevant relationships by Alvin Newman-Caro Copyright
© 2024 American College of Chest Physicians

<139>
Accession Number
2034595665
Title
MAPPING TOP-CITED RESEARCH RELATED TO ROBOTIC SURGERY FOR LUNG CANCER: DO
GEOGRAPHIC DISPARITIES EXIST?.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A122-A123),
2024. Date of Publication: October 2024.
Author
MASOOD L.; MARTINS R.S.; HUMAYUN N.O.O.R.; WASIM M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Beyond Diseases Abstracts Posters (A) SESSION TYPE:
Original Investigation Posters PRESENTED ON: 10/08/2024 01:45 pm - 02:30
pm PURPOSE: The growing popularity of robotic surgery for lung cancer is
paralleled by a research boom, capturing media attention in the United
States (US) and worldwide. We investigated geographic origins, and
assessed academic impact and media attention, for top-cited articles
related to robotic surgery for lung cancer. METHOD(S): We used
Publish or Perish software to source the 100 most-cited articles related
to robotic-assisted operations for lung cancer, published between
2019-2021. Data was collected as of July 15, 2022. The study type was
dichotomized as primary (original studies) or secondary
(reviews/meta-analyses) research. Basic journal information included,
name, Journal Citation Reports impact factor (IF), and PubMed indexation.
Corresponding authors' countries were classified according to World Bank
classifications as high-income (HIC), upper-middle-income (UMIC),
lower-middle-income (LMIC) and low-income (LIC) countries to assess
geographic origin. US states (if applicable) were categorized as Midwest,
South, Northeast, or West. Altmetric Attention Score (AAS) was used which
measures non-academic attention (including mentions on news outlets and
Twitter) and is calculated with Altmetric plugin. Numeric variables were
described as median [range] and categorical variables as frequency
(percentage). Categorical variables were compared using
Chi-squared/Fischer Exact tests and numeric variables using the
Mann-Whitney U-test. Correlations were assessed using Pearson's
correlation (r). A p-value < 0.05 was considered significant.
 RESULT(S): The 100 articles were distributed across 47 journals, with
Journal of Thoracic Disease (n=11) and The Annals of Thoracic Surgery
(n=10) publishing most articles. Median number of citations was 7 [1-59]
and median journal IF was 4.19 [1.23-20.21]. Approximately half (48/100;
48%) of the articles were mentioned by Twitter and 7/100 (7%) by news
outlets. Article AAS correlated poorly with citations (r=0.347). Most
articles originated from the US (46/100), with the majority of remaining
published from high-income countries other than the US (non-US HIC:
50/100) such as China (n=16) and Italy (n=11). Three articles were
published from upper-middle-income countries (UMICs) and only one from a
lower-middle-income county (LMIC). Articles from the US had a
significantly higher AAS, more Tweet mentions, and were more likely to be
mentioned by a news outlet, compared to articles from non-US HICs. In the
US, most articles were published from states in the Northeast (20/46;
43.5%) and Midwest (14/46; 30.4%) regions, with only 3/46 (6.5%) from the
West. There were no significant differences across article
characteristics, article impact, or journal quality between US regions.
The states of New York (n=8) and Ohio (n=6) produced the most articles.
 CONCLUSION(S): We identified major geographic disparities in robotic
lung cancer surgery research, reflecting lower penetration of this
operative modality in UMICs/LMICs and the Southern and Western US. Non-US
HICs had lower mainstream and social media attention, though academic
quality and impact was comparable to those in the US. CLINICAL
IMPLICATIONS: With geographic disparities apparent in robotic surgery
research, western US and other HICs should be encouraged to collect data.
Studying different approaches to this minimally-invasive approach to lung
cancer is imperative to further improve its modalities. Use of social
media in non-US HICs can encourage discussions and disseminate valuable
information across borders. DISCLOSURES: No relevant relationships by Noor
Humayun No relevant relationships by Russell Seth Martins No relevant
relationships by Laiba Masood No relevant relationships by Minahil
Wasim Copyright © 2024 American College of Chest Physicians

<140>
Accession Number
2034595418
Title
PERSISTENT AIR LEAK IN ILD TREATED WITH ENDOBRONCHIAL VALVES.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A5228-A5229), 2024. Date of Publication: October 2024.
Author
HENN K.Y.L.E.; DAMANI J.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedures Case Reports Posters (B) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am INTRODUCTION:
Persistent air leaks provide a unique challenge in critically ill
patients, particularly in those who are poor surgical candidates due to
comorbidities like ILD/IPF and acute disease severity. Endobronchial
valves were initially used as an alternative for LVRS, but they also
provide an alternative, less invasive treatment option for patients with
persistent air leaks. We present a case of a patient with persistent air
leak for >2 weeks who underwent attempted palliative endobronchial valve
treatment. CASE PRESENTATION: 82yo male with PMHx of pulmonary fibrosis
and emphysema who presented for left chest pain and SOB for 2 days. He
used 3-4L O2 via NC at baseline, but SpO2 was in the 70s with EMS and
improved to 99% with NRB mask. CXR revealed a large left pneumothorax for
which a small bore chest tube was placed. Repeat CXR showed smaller but
persistent pneumothorax. Oxygenation worsened, so the patient was placed
on Vapotherm. Chest tube was placed to wall suction at 20cm H2O. Serial
CXRs showed a persistent pneumothorax, and a persistent air leak was
present both on water seal and on wall suction. Patient underwent
endobronchial valve placement by Interventional Pulmonology as an attempt
to resolve the air leak. Valves were placed in the LUL proper and superior
segments of the lingula with significant improvement in air leak
intraoperatively. He was extubated post-procedure, but re-intubated for
hypercapnia and transferred to ICU. Post valve placement, patient had
resolution of the pneumothorax on CXR. Patient eventually had resolution
of his hypercapnic respiratory failure on the ventilator. He did pass his
breathing trial and was extubated to BiPAP; however, patient wanted to
pursue comfort measures and refused all supplemental oxygen. Patient
unfortunately passed away. DISCUSSION: Management guidelines for
persistent air leaks recommend surgical evaluation if the leak is still
present more than four days after chest tube placement; additionally, for
patients who are not surgical candidates, the recommendations were for
prolonged chest tube drainage. Some small studies have evaluated the
efficacy of endobronchial valves as an alternative to surgery or other
non-surgical interventions such as pleurodesis or spigots. While these
studies are not RCTs, they are still encouraging that endobronchial valves
can be a viable treatment option for critically ill patients with
persistent air leaks as a humanitarian use device. CONCLUSION(S):
Patients with chronic lung diseases such as ILD may be poor surgical
candidates, limiting treatment options for persistent air leaks. While
this patient's endobronchial valves were unable to completely resolve his
air leak, studies on this procedure are promising. Further research on
their effectiveness would be beneficial and may allow for expanded use of
valves for patients that otherwise lack treatment options. REFERENCE #1:
Kurman J. S. (2021). Persistent air leak management in critically ill
patients. Journal of thoracic disease, 13(8), 5223-5231.
https://doi.org/10.21037/jtd-2021-32 REFERENCE #2: Dugan, K. C., Laxmanan,
B., Murgu, S., & Hogarth, D. K. (2017). Management of persistent air
leaks. Chest, 152(2), 417-423.Travaline, J. M., McKenna Jr, R. J., De
Giacomo, T., Venuta, F., Hazelrigg, S. R., Boomer, M., ... & Endobronchial
Valve for Persistent Air Leak Group. (2009). Treatment of persistent
pulmonary air leaks using endobronchial valves. Chest, 136(2), 355-360.
REFERENCE #3: Fiorelli, A., D'Andrilli, A., Cascone, R., Occhiati, L.,
Anile, M., Diso, D., Cassiano, F., Poggi, C., Ibrahim, M., Cusumano, G.,
Terminella, A., Failla, G., La Sala, A., Bezzi, M., Innocenti, M.,
Torricelli, E., Venuta, F., Rendina, E. A., Vicidomini, G., Santini, M.,
... Andreetti, C. (2018). Unidirectional endobronchial valves for
management of persistent air-leaks: results of a multicenter study.
Journal of thoracic disease, 10(11), 6158-6167.
https://doi.org/10.21037/jtd.2018.10.61. Dugom, P. M., Mayan, D., Peine,
B. S., Bethea, J. P., Karimian, B. H., Dayal, S., ... & Speicher, J. E.
(2024). Endobronchial Valves for Management of Persistent Air Leaks in
Patients With Chronic Lung Disease. Annals of Thoracic Surgery Short
Reports, 2(1), 78-81. DISCLOSURES: No relevant relationships by Jalal
Damani No relevant relationships by Kyle Henn Copyright © 2024
American College of Chest Physicians

<141>
Accession Number
2034595279
Title
A CASE OF RAPIDLY PROGRESSIVE INTERSTITIAL PULMONARY FIBROSIS COMPLICATED
BY PNEUMOTHORAX AND PNEUMOMEDIASTINUM.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3318-A3319), 2024. Date of Publication: October 2024.
Author
NADEEM B.; RAJA SAGER A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Diffuse Lung Disease Case Reports Posters (I) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: The Idiopathic Pulmonary Fibrosis network (IPFnet) defines
an acute exacerbation of IPF (AE-IPF) as an acute worsening/flare of known
IPF and the diagnosis of AE-IPF can be made with CT evidence of new
bilateral ground glass opacities in the background of usual interstitial
pneumonia (UIP) while UIP is characterized by subpleural and bibasilar
reticulations that may progress to anatomical changes like traction
bronchiectasis and honeycombing. Symptoms of AE-IPF should not be fully
explainable by volume overload (1-2). Severe 'flares' tend to portend very
poor prognosis (3). Here, we present a case of rapidly progressive ILD in
setting of previously undiagnosed IPF. CASE PRESENTATION: 64-year-old male
former smoker presented with NSTEMI, underwent CABG, he was recovering
well, and undergoing spot diuresis for volume optimization. He developed
atrial flutter and started on amiodarone. Around eight days later, he
developed worsening acute hypoxic respiratory failure, eventually
requiring positive pressure ventilation. Chest CT showed patchy, diffuse
ground glass opacities in both lungs with bilateral, moderate pleural
effusions. His symptoms were initially attributed to aspiration pneumonia
and volume overload. The patient started on antibiotics and underwent
aggressive diuresis. Infectious workup was unrevealing. Repeat chest CT
was significant for new, extensive subpleural fibrosis, traction
bronchiectasis, reticulations and mild honeycombing. Upon revisiting his
prior CT scans, evidence of mild fibrosis was noticed, which raised the
concern for interstitial lung disease flare. Amiodarone was discontinued
and high dose steroids were started. An extensive autoimmune,
rheumatologic and vasculitis workup was unremarkable. Repeat imaging
showed new bilateral apical pneumothraces, extensive pneumomediastinum and
subcutaneous emphysema over the chest. Esophageal rupture was ruled out. A
right heart catheterization at this time revealed normal wedge pressures.
The patient developed shock and acute encephalopathy. He was intubated for
airway protection and treated with broad spectrum antibiotics for the
concern of mediastinitis. However, his shock continued to deteriorate very
rapidly, and he progressed into multi-organ failure. He transitioned to
comfort care, deceased soon after. DISCUSSION: Our patient had prior
radiographic evidence of UIP, it is likely that he had IPF that went
undiagnosed. However, definitive diagnosis is difficult because high
resolution CT (HRCT), which is needed to define the specific UIP pattern,
was not done in this case given the patients acuity (1). Amiodarone
induced toxicity is less likely because this is typically associated with
an insidious course and cumulative exposure (4). Risk factors for AE-IPF
were recent thoracic surgery and probable aspiration given his history of
severe reflux disease (5-6). Our patient developed two known complications
of IPF, namely pneumothorax and group 3 pulmonary hypertension, the latter
being evidenced by depressed right ventricular function on
echocardiography (7). The mainstay of treatment in AE-IPF is
glucocorticoids, antibiotics are often also used (1). Prognosis is guarded
and mortality during an AE is high (3). CONCLUSION(S): Early
recognition of IPF can help reduce subsequent AE's if patients are
initiated on antifibrotic drugs (8). During an AE-IPF, integration of
palliative care early in the medical course is warranted (1). REFERENCE
#1: 1. Collard HR, Ryerson CJ, Corte TJ, et al. Acute Exacerbation of
Idiopathic Pulmonary Fibrosis. An International Working Group Report. Am J
Respir Crit Care Med. 2016;194(3):265-275. doi:10.1164/rccm.201604-0801CI.
2. Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of Idiopathic
Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice
Guideline. Am J Respir Crit Care Med. 2018;198(5):e44-e68.
doi:10.1164/rccm.201807-1255ST. 3. Natsuizaka M, Chiba H, Kuronuma K, et
al. Epidemiologic survey of Japanese patients with idiopathic pulmonary
fibrosis and investigation of ethnic differences. Am J Respir Crit Care
Med. 2014;190(7):773-779. doi:10.1164/rccm.201403-0566OC. 4. Ernawati DK,
Stafford L, Hughes JD. Amiodarone-induced pulmonary toxicity. Br J Clin
Pharmacol. 2008;66(1):82-87. doi:10.1111/j.1365-2125.2008.03177.x. 5.
Ghatol A, Ruhl AP, Danoff SK. Exacerbations in idiopathic pulmonary
fibrosis triggered by pulmonary and nonpulmonary surgery: a case series
and comprehensive review of the literature. Lung. 2012;190(4):373-380.
doi:10.1007/s00408-012-9389-5. 6. Lee JS, Collard HR, Anstrom KJ, et al.
Anti-acid treatment and disease progression in idiopathic pulmonary
fibrosis: an analysis of data from three randomised controlled trials.
Lancet Respir Med. 2013;1(5):369-376. doi:10.1016/S2213-2600(13)70105-X.
7. Shorr AF, Wainright JL, Cors CS, Lettieri CJ, Nathan SD. Pulmonary
hypertension in patients with pulmonary fibrosis awaiting lung transplant.
Eur Respir J. 2007;30(4):715-721. doi:10.1183/09031936.00107206. 8. Petnak
T, Lertjitbanjong P, Thongprayoon C, Moua T. Impact of Antifibrotic
Therapy on Mortality and Acute Exacerbation in Idiopathic Pulmonary
Fibrosis: A Systematic Review and Meta-Analysis. Chest.
2021;160(5):1751-1763. doi:10.1016/j.chest.2021.06.049 DISCLOSURES: No
relevant relationships by Bilawal Nadeem No relevant relationships by
Avinaash Raja Sager Copyright © 2024 American College of Chest
Physicians

<142>
Accession Number
2034595165
Title
NAVIGATING COMPLEX BIVENTRICULAR THROMBI IN HIGH-RISK HEART FAILURE
PATIENT: TREATMENT STRATEGIES AND COMPLICATIONS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A528-A529),
2024. Date of Publication: October 2024.
Author
GREWAL N.; YI J.I.N.; TAMRAT R.U.T.H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Reports Posters (I) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Ventricular thrombosis is a complication associated with
cardiomyopathy, along with associated embolic risks. Occurrence of
bi-ventricular thrombi is rare in literature review. We present an
intriguing case of biventricular thrombi in a patient with multiple risk
factors and a novel approach to treatment. CASE PRESENTATION: A
38-year-old male with human immunodeficiency virus (HIV) infection
presented with dyspnea, hemoptysis, and leg edema for 2 weeks. Social
history was pertinent for polysubstance use (nicotine, cocaine, heroin and
marijuana). Computed tomography angiography (CTA) chest was negative for
pulmonary embolism (PE). Echocardiogram (echo) showed severe left
ventricular (LV) systolic dysfunction (ejection fraction (EF) 10-15%) and
a large apical LV thrombus (2.1 x 3.1 cm). Patient refused ischemic
workup. The patient was treated with goal directed medical therapy for
heart failure (sodium glucose linked cotransporter-2 inhibitor,
angiotensin receptor/Neprilysin inhibitor, beta blocker) and warfarin. He
presented with similar complaints one month later. Repeat echocardiogram
showed a new large right ventricular (RV) apical thrombus (1.2 x 1.9 cm),
and persistent LV thrombus (2.8 x 2.6 cm). CTA was positive for left lower
lobe PE. Thrombophilia workup was normal. Cardiothoracic Surgery
recommended medical management. Thrombolytic therapy was not pursued given
hemoptysis. Warfarin was switched to apixaban due to patient nonadherence
with warfarin and new thrombus. Repeat echo one week later, showed reduced
size of LV thrombus; however, RV thrombus was no longer seen. Repeat CTA
showed new filling defect in the right pulmonary artery and main left
pulmonary artery. DISCUSSION: In comparison to LV thrombus, RV thrombus
and biventricular thrombi are rarer. In this case biventricular thrombi
were complicated by PE. The patient had multiple risk factors for
hypercoagulability, including HIV, low EF, and polysubstance use disorder.
Echocardiography is crucial for identifying, localizing, and assessing the
size and mobility of biventricular thrombi. Contrast echo helps identify
small or mural thrombi. While there are guidelines regarding LV thrombus
management, there are no specific guidelines for management of RV
thrombus/biventricular thrombi given lack of randomized controlled trials.
Management options for RV thrombus include anticoagulation, thrombolysis,
and surgical thrombectomy, with the decision guided by specific patient
factors and collaboration of a multi-disciplinary team. For our patient,
the decision was made to use anticoagulation. A direct oral anticoagulant
(DOAC) was used due to adherence concerns, aligning with the 2022 American
Heart Association statement supporting DOACs as reasonable alternatives to
vitamin K antagonists in LV thrombus cases. Treatment duration is 3 to 6
months. Closer monitoring for systemic complications with follow up
imaging and patient education is valuable in such cases.
 CONCLUSION(S): Bi-ventricular thrombi are a rare occurrence in
patients with cardiomyopathy, unlike LV thrombus alone. This case
highlights the novel approach to treatment of these patients, with
multidisciplinary approach to care. REFERENCE #1: Sonaglioni, A., Albini,
A., Nicolosi, G. L., Rigamonti, E., Noonan, D. M., & Lombardo, M. (2021).
Case Report: An Unusual Case of Biventricular Thrombosis in a COVID-19
Patient With Ischemic Dilated Cardiomyopathy: Assessment of Mass Mobility
and Embolic Risk by Tissue Doppler Imaging. Frontiers in cardiovascular
medicine, 8, 694542. https://doi.org/10.3389/fcvm.2021.694542 REFERENCE
#2: Levine, G. N., McEvoy, J. W., Fang, J. C., Ibeh, C., McCarthy, C. P.,
Misra, A., Shah, Z. I., Shenoy, C., Spinler, S. A., Vallurupalli, S., Lip,
G. Y. H., & American Heart Association Council on Clinical Cardiology;
Council on Cardiovascular and Stroke Nursing; and Stroke Council (2022).
Management of Patients at Risk for and With Left Ventricular Thrombus: A
Scientific Statement From the American Heart Association. Circulation,
146(15), e205-e223. https://doi.org/10.1161/CIR.0000000000001092 REFERENCE
#3: Iwano, T., Yunoki, K., Tokunaga, N., Shigetoshi, M., Sugiyama, H.,
Yamamoto, H., Kondo, J., Nakai, M., Okada, M., & Matsubara, H. (2016). A
case of biventricular thrombi in a patient with dilated cardiomyopathy:
Utility of multimodality imaging for diagnosis and management of treatment
strategy. Journal of cardiology cases, 15(3), 91-94.
https://doi.org/10.1016/j.jccase.2016.10.013. Kammari, C. B., Rallabandi,
S., Rallabandi, H., Daggubati, S. R., Adapa, S., Naramala, S., & Konala,
V. M. (2020). Case Report: Dilated cardiomyopathy with biventricular
thrombus secondary to impaired coagulation in a patient with HIV.
F1000Research, 9, 610. https://doi.org/10.12688/f1000research.24016.2
DISCLOSURES: No relevant relationships by Niyati Grewal No relevant
relationships by Ruth Tamrat No disclosure on file for Jin
Yi Copyright © 2024 American College of Chest Physicians

<143>
Accession Number
2034594907
Title
UNCOMMON COMPLICATION OF COMMON FLU: AUTOPNEUMECTOMY.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A4532-A4533), 2024. Date of Publication: October 2024.
Author
ADHIKARI N.; ACHARYA R.; SHAMSI W.E.; ASSAAD M.A.R.C.; WALSH K.;
CIRINO-MARCANO M.D.M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Congenital and Airway Pathology SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/07/2024 02:35 pm - 03:05 pm INTRODUCTION:
Functional destruction of one lung leading to compensatory hyperexpansion
of the other lung and shift of mediastinal structures towards the diseased
side is known as autopneumectomy. The condition is rare and has been
reported mostly in recurrent pulmonary infections and pulmonary
tuberculosis in endemic areas and rarely in granulomatosis with
polyangiitis [1,2,3]. CASE PRESENTATION: A 24 year old man was diagnosed
with Influenza A pneumonia and the course was complicated by severe ARDS,
multi organ failure and superimposed bacterial infection requiring ICU
admission. Patient was later intubated and despite lung protective
ventilation support, patient continued to hypoxic requiring ECMO for 24
days. During this course patient had bilateral pneumothoraces requiring
chest tube placement. There was also evidence of bleeding from the left
chest tube site for which the patient required left mini-thoracotomy.
Percutaneous tracheostomy and PEG tubes were placed. Patient completed a
course of antibiotics and with improvement in clinical condition,
tracheostomy was decannulated and PEG tube was eventually removed after 1
month. Patient was evaluated by lung transplant team who suggested against
lung transplant.Upon retrospective review of the imaging studies, there
was a gradual loss of left lung volume with compensatory hyper expansion
of the right lung and a shift of the mediastinum towards the left.
Bronchoscopic evaluation showed tracheal stenosis, patent right segmental
bronchi, and granulation tissues in the left segmental bronchi. The
patient is being closely followed up by cardiothoracic surgery and the
pulmonary team as an outpatient. Currently, he lives an active and quality
life. DISCUSSION: Literature about autopneumectomy is limited and lesser
is known about its course and long-term management. It has been reported
that patients with autopneumectomy present with signs, symptoms and
radiological features like postpneumectomy syndrome. More pronounced if
the right side is affected and there is counterclockwise rotation of the
mediastinal structure to right. [2] In a recently published systematic
review of postpneumectomy syndrome, most of the patients presented with
shortness of breath, recurrent respiratory tract infections, wheezing,
stridor, GERD and persistent cough. Chest pain, haemoptysis, dysphagia and
dysphonia were less common.[4] Untreated chronic mycobacterium
tuberculosis has been implicated as the most common cause of
autopneumectomy. [2,3] Klebsiella infection causing autopneumectomy due to
necrotising pneumonia has also been reported. Gangrenous lung caused by
other organisms like Streptococcus pneumoniae, Haemophilus influenza,
Staphylococcus aureus and Mycoplasma pneumoniae can also lead to
autopneumectomy. [5] Management is mainly supportive. Patients are
followed up with close monitoring for development of complications. Recent
advancements like mediastinal repositioning with prostheses and tissue
expanders and endobronchial stents to relieve obstructions aretested and
tried for post-pneumectomy syndrome with variable outcomes. However, no
such evidence for autopneumectomy was found in the literature. [4]
 CONCLUSION(S): Even though true incidence of autopneumectomy is
unknown and available literature is not enough to guide long term
management plan, early diagnosis of the condition helps bothpatients and
clinicians to be prepared for unforeseen complications and prevent future
morbidity. With only limited literatures available, management in mainly
focused on closemonitoring and supportive care. REFERENCE #1: 1. J.
Biberston, R.J. Miller, and S. Foley. Auto pneumectomy with compensatory
lobarhyper expansion and extreme mediastinal shift in granulomatosis with
polyangiitis. AUTOIMMUNE LUNG DISEASE CASE REPORTS. May 1, 2018,
A3081-A3081. 2. King J, Lau RW, Wan I, Yim A. Tuberculosis
tracheobronchial stricture causingpostpneumonectomy-like syndrome
corrected by insertion of a bespoke Dumonstent. Int Cardiovasc Thorac
Surg. 2008;7:267-8 REFERENCE #2: 3. Kashyap S, Mohapatra PR, Saini V.
Endobronchial tuberculosis Indian J Chest DisAllied Sci. 2003;45:247-564.
Christodoulides, N., Fitzmaurice, G.J., Bukowska, I. et al.
post-pneumonectomysyndrome: a systematic review of the current evidence
and treatment options. JCardiothoracic Surg 18, 119 (2023).
https://doi.org/10.1186/s13019-023-02278-2 REFERENCE #3: 5. Chen
Chih-HaoVitin Dr. Alexander Gangrenous Lung Disease,
Gangrene-CurrentConcepts and Management Options. 2011 ISBN:
978-953-307-386-6 DISCLOSURES: No relevant relationships by Roshan Acharya
No relevant relationships by Nirajan Adhikari No relevant relationships by
Marc Assaad No relevant relationships by Maria del Mar Cirino-Marcano No
relevant relationships by Wasif Elahi Shamsi No relevant relationships by
Kevin Walsh Copyright © 2024 American College of Chest Physicians

<144>
Accession Number
2034594852
Title
NAVIGATING DIAGNOSTIC CHALLENGES IN A COMPLEX CASE OF SQUAMOUS CELL
CARCINOMA PRESENTING AS AN UPPER RIGHT LOBE MASS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A4308-A4309), 2024. Date of Publication: October 2024.
Author
SINGH B.; SALAZAR LUNA L.U.I.S.; FREIHAT M.; DUDIKI N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Interesting Lung Neoplasms III SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/09/2024 10:20 am - 11:05 am INTRODUCTION:
Lung masses in patients with a history of smoking and chronic obstructive
pulmonary disease (COPD) often raise immediate concerns for primary lung
malignancy. The diagnostic pathway can be fraught with challenges,
especially when initial biopsies yield non-malignant or inconclusive
results. This case discusses the intricacies of diagnosing and managing a
patient presenting with a right upper lobe mass, emphasizing the
importance of comprehensive evaluation and multidisciplinary
collaboration. CASE PRESENTATION: A 72-year-old female with a history of
aortic valve replacement, COPD, and former smoker presented to the
pulmonary clinic due to right upper lobe mass, detected after the symptoms
of a productive cough, dyspnea, weight loss (11 pounds), and intermittent
fever that led to an ER visit. A CT chest revealed a 7.5 x 6 cm
thick-walled pleural based mass in the right upper lobe extending into the
anterior chest wall with a central hypodensity suggesting necrosis,
alongside perihilar and precarinal lymphadenopathy, not present in earlier
scans. At an outside hospital, the patient underwent a bronchoscopy which
revealed mucus plugging and narrowing of the right upper lobe airway.
Transbronchial biopsies of the mass were negative for malignant cells, and
cultures were also negative. However, pathology revealed acute fibrinous
organizing pneumonia (AFOP). Given the high pretest probability for
cancer, based on radiologic appearance and an extensive smoking history,
and concerns about sampling error, a CT-guided core biopsy was performed,
which also confirmed AFOP. A PET scan showed a mass in the right upper
lobe that was peripherally hyper-metabolic with a centrally
cystic/necrotic area, noting an increase in size.After having a
multidisciplinary discussion at our hospital, with radiology and
cardiothoracic surgery because of high suspicion of cancer and sampling
challenges due to necrotic tissue, the patient underwent a right upper
lobectomy, chest wall resection and removal of lymph nodes stations 7, 9,
10 and 11 through open thoracotomy. Biopsy confirmed squamous cell
carcinoma with chest wall invasion and a second parabronchial lymph node
extension. DISCUSSION: This case illustrates the diagnostic dilemma posed
by complex cases where clinical, radiological, and initial
histopathological findings may not align. The initial absence of
malignancy in multiple biopsies, juxtaposed with progressive radiological
findings and a high clinical suspicion of malignancy, underscores the
critical role of comprehensive diagnostic strategies, including advanced
imaging and repeat tissue sampling. Research indicates that biopsies
yielding non-specific or benign findings don't reliably exclude cancer,
necessitating further tissue sampling or vigilant follow-up. This is
supported by the negative predictive value (NPV) of CT-guided FNA biopsies
being around 60%. The initial biopsy's inability to detect cancer might
stem from a necrotic center within the tumor or a large lesion.
Ultimately, the definitive diagnosis required surgical intervention,
reflecting the necessity of maintaining a high degree of suspicion for
malignancy in patients with significant risk factors and atypical
presentations. CONCLUSION(S): This case emphasizes the importance of
a multidisciplinary approach in the management of pulmonary masses,
especially in the context of complex clinical backgrounds and when initial
diagnostic efforts fail to yield a definitive diagnosis. REFERENCE #1:
Chaudhary K, Kaur P, Poudel B, et al. (July 27, 2023) A Case Report of
Squamous Cell Carcinoma Misdiagnosed as Cryptogenic Organizing Pneumonia.
Cureus 15(7): e42574. doi:10.7759/cureus.42574 REFERENCE #2: Quint LE,
Kretschmer M, Chang A, Nan B. CT-guided thoracic core biopsies: value of a
negative result. Cancer Imaging. 2006 Nov 8;6(1):163-7. doi:
10.1102/1470-7330.2006.0027. PMID: 17098648; PMCID: PMC1693782. REFERENCE
#3: Chae KJ, Hong H, Yoon SH, Hahn S, Jin GY, Park CM, Goo JM.
Non-diagnostic Results of Percutaneous Transthoracic Needle Biopsy: A
Meta-analysis. Sci Rep. 2019 Aug 27;9(1):12428. doi:
10.1038/s41598-019-48805-x. PMID: 31455841; PMCID: PMC6711972.
DISCLOSURES: No relevant relationships by Natasha Dudiki No relevant
relationships by Mohammad Freihat No relevant relationships by Luis
Salazar Luna No relevant relationships by Bhavneet Singh Copyright
© 2024 American College of Chest Physicians

<145>
Accession Number
2034594807
Title
DYSPNEA WITH MENSTRUATION: THE UNUSUAL CASE OF CATAMENIAL PNEUMOTHORAX.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3784-A3785), 2024. Date of Publication: October 2024.
Author
WALGAMAGE M.; WALGAMAGE T.; DE LUNA D.; NATHANI Z.A.I.N.; NUNEZ CUELLO L.;
BALLARINO G.J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Pleura Case Reports Posters (F) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/08/2024 10:20 am - 11:05 am
INTRODUCTION: Catamenial pneumothorax (CP) is an interesting and rare
cause of recurrent spontaneous pneumothorax in women of reproductive age.
We present a rare case of CP that was treated with pleurodesis and
hormonal therapy. CASE PRESENTATION: A 45-year-old female with a past
medical history of endometriosis, right-sided spontaneous pneumothorax,
multiple miscarriages, Castleman's disease, and migraines with aura
presented to the emergency department with a chief complaint of
right-sided pleuritic chest pain, cough and dyspnea on exertion for 1
week. On presentation, she was afebrile, normotensive, SpO2 90% on room
air. Chest x-ray revealed a small right apical pneumothorax. CT chest
without contrast showed a small to moderate size right spontaneous
pneumothorax. There were no anatomical pulmonary abnormalities such as
blebs, bullous disease, or emphysema on imaging. She had a history of
previous right-sided spontaneous pneumothorax requiring chest tube
decompression. In addition, she described right-sided pleuritic chest pain
episodes for which she did not seek medical treatment that self-resolved
on days 10-12 of symptom onset. Moreover, the patient had noted that her
pleuritic right-sided chest pain presentations, including the current
presentation, were occurring around her menstruation. Serial chest x-rays
revealed mild interval increase in the size of the moderate right apical
pneumothorax and small bilateral pleural effusions. Thoracic surgery was
consulted and she underwent right-sided Video-assisted thoracoscopic
surgery (VATS), mechanical and chemical pleurodesis with doxycycline and
chest tube placement. During the procedure, she was found to have several
fibrous pleural benign nodules without any lung parenchymal bleb disease.
Serial chest x-rays showed improvement of the pneumothorax with successful
chest tube removal and she was discharged to outpatient follow-up.
Pathology reports showed chronic pleuritis with predominantly histiocytes,
lymphocytes, and eosinophils. Within a few weeks, she presented to the
outpatient pulmonology office with similar right-sided, focal pleuritic
chest pains that occurred right before the onset of her menstruation.
Repeat chest x-ray was negative for pneumothorax. She was referred to
gynecology for hormonal contraceptives and was started on progesterone
contraceptives with an improvement of her pleuritic chest pains that seem
to occur around her menstruation cycles. DISCUSSION: Catamenial
pneumothorax (CP) is a rare and unique presentation of recurrent
pneumothoraxes in young women that occurs within 72 hours before or after
the onset of menstruation.1 Despite its rarity, it is one of the most
common presentations of thoracic endometriosis. Typically presents with
pleuritic chest pain and spontaneous pneumothorax (SPT) occurring around
menstruation. The etiology of CP is still unclear though multiple theories
including physiologic theory, metastatic or lymphovascular
microembolization theory, trans-diaphragmatic passage of air, retrograde
menstruation, and pelvic seeding of endometrial tissue via
transdiaphragmatic passage have been hypothesized.2 Most commonly occur on
the right side. Biopsy can be negative for endometrial tissue. Other
criteria such as pleural nodules, history of endometriosis, and primary or
secondary infertility are insightful though not necessary.1 Surgical
treatment is recommended to prevent recurrence with adjunct hormonal
therapy. CONCLUSION(S): It is important to have catamenial
pneumothorax as an important differential in recurrent SPT in young women
with diverse clinical presentations for timely management. REFERENCE #1:
Nguyen K, Nudelman BG, Quiros J, Cortes M, Savu C. Catamenial
Pneumothorax: A Rare Diagnosis Among Menstruating Women. Cureus.
2023;15(9):e45769. Published 2023 Sep 22. doi:10.7759/cureus.45769
REFERENCE #2: Marjanski T, Sowa K, Czapla A, Rzyman W. Catamenial
pneumothorax - a review of the literature. Kardiochir Torakochirurgia Pol.
2016;13(2):117-121. doi:10.5114/kitp.2016.61044 REFERENCE #3: Korom S,
Canyurt H, Missbach A, et al. Catamenial pneumothorax revisited: clinical
approach and systematic review of the literature. J Thorac Cardiovasc
Surg. 2004;128(4):502-508. doi:10.1016/j.jtcvs.2004.04.039 DISCLOSURES: No
disclosure on file for Guillermo Ballarino No relevant relationships by
Deogracias De Luna No relevant relationships by Zain Nathani No relevant
relationships by Lisandra Nunez Cuello No relevant relationships by Malsha
Walgamage No relevant relationships by Thilini Walgamage Copyright
© 2024 American College of Chest Physicians

<146>
Accession Number
2034594800
Title
KEEPING UP WITH THE PACE: INCREASING CHRONOTROPY IN A PACEMAKER-DEPENDENT
PATIENT TO IMPROVE HEMODYNAMICS IN VASOPLEGIC SHOCK.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A2530-A2531), 2024. Date of Publication: October 2024.
Author
IZZO C.S.; PATEL H.; NAJJAR N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Reports Posters (Y) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm INTRODUCTION:
Vasoplegic (also called distributive) shock is a state of tissue
hypoperfusion accompanied by hemodynamic instability defined by
pathologically low systemic vascular resistance (SVR) in the presence of
normal or raised cardiac output (CO) [1]. In normal physiology, as the
mean arterial pressure (MAP) drops, carotid baroreceptors signal a
sympathetic response to increase vasoconstriction, increased heart rate
(HR) and contractility [2]. Patients who are 100% reliant upon permanent
pacemaker (PPM) to determine their HR are unable to mount this physiologic
response. This case presents the impact of increasing the set rate of a
ventricularly paced patient in vasoplegic shock to augment hemodynamics.
CASE PRESENTATION: A 90-year-old male with pertinent past medical history
of permanent atrial fibrillation, AV node ablation and PPM who presented
to the emergency department with altered mental status. He was found to be
hypotensive with initial MAP in the 40s, HR of 60, lactic acidosis
(10mmol/L), hyperkalemia (8.5 mmol/L) and acute kidney injury (AKI) with
serum creatinine of 8.55mg/dL (previous baseline 1.39). He was admitted to
the Intensive Care Unit (ICU) for continuous renal replacement therapy
(CRRT) and shock managed with norepinephrine, vasopressin and
methylprednisolone. He was treated with vancomycin and
piperacillin-tazobactam for 72 hours until cultures remained sterile. He
had a Medtronic Advisa dual chamber PPM in DDDR mode of pacing with an
underlying complete heart block. Electrophysiology was consulted to
increase the lower rate limit to 80 beats per minute. There was an
immediate improvement in the patient's MAP which further improved as his
underlying acidosis and electrolyte derangements resolved. The patient's
AKI was determined to likely be related to hypovolemia in conjunction with
contrast induced nephropathy after discovering the patient recently had CT
with IV contrast of the head and neck in an outside hospital's emergency
department following dental extraction. Following resolution of his shock,
the PPM was changed back to previous lower rate limit of 60 beats per
minute on hospital day 3. DISCUSSION: The most common conditions leading
to vasoplegia are sepsis, cardiac failure, and post cardiac surgery [3].
Additionally, severe acidosis and associated transmembrane electrolyte
shifts impact hemodynamics through vascular smooth muscle dysfunction
leading to impaired vascular smooth muscle tone and myocardial function
[4] as was seen in this patient. In vasoplegic shock, hemodynamics are
impacted with a pathologically decreased SVR, which in turn decreases the
cardiac preload and stroke volume; the HR then has a compensatory increase
in order to maintain or increase the cardiac output. Patients with a PPM
may not be able to mount this chronotropic response. Although there are
not any guidelines or randomized controlled trials in this regard, it is
sometimes practiced to temporarily increase the minimum set HR in an
attempt to improve hemodynamics, which was observed to be successful in
this patient. CONCLUSION(S): Increasing the lower rate limit in PPM
dependent patients who are in vasoplegic shock can improve hemodynamics
and has a physiologic feasibility. This topic requires further study to
characterize objective benefits as well as identify the ideal patient
population, rate limit, and duration. REFERENCE #1: 1. Lambden S,
Creagh-Brown BC, Hunt J, Summers C, Forni LG. Definitions and
pathophysiology of vasoplegic shock. Crit Care. 2018;22(1):174. Published
2018 Jul 6. doi:10.1186/s13054-018-2102-1 REFERENCE #2: 2. Chaudhry R,
Miao JH, Rehman A. Physiology, Cardiovascular. [Updated 2022 Oct 16]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024
Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493197/
REFERENCE #3: 3. Ratnani I, Ochani RK, Shaikh A, Jatoi HN. Vasoplegia: A
Review. Methodist Debakey Cardiovasc J. 2023;19(4):38-47. Published 2023
Aug 1. doi:10.14797/mdcvj.1245.4.Kimmoun, A., Novy, E., Auchet, T. et al.
Hemodynamic consequences of severe lactic acidosis in shock states: from
bench to bedside. Crit Care 19, 175 (2016).
https://doi.org/10.1186/s13054-015-0896-7 DISCLOSURES: No relevant
relationships by Christopher Izzo No relevant relationships by Nimeh
Najjar No relevant relationships by Hamel Patel Copyright © 2024
American College of Chest Physicians

<147>
Accession Number
2034594792
Title
ANTICOAGULATION DILEMMA OF ATRIAL FIBRILLATION MANAGEMENT IN A STROKE
PATIENT WITH HEMORRHAGIC CONVERSION: WHEN THE CURE IS ALSO THE CULPRIT.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A728-A729),
2024. Date of Publication: October 2024.
Author
VO P.U.; GAO D.; HEPBURN M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Reports Posters (Y) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Cardiogenic embolism, most preceded by atrial fibrillation
(Afib), accounts for one-fifth of ischemic stroke etiologies.
Anticoagulation protects patients with Afib and/or cardioembolic stroke
from recurrent strokes. However, management becomes challenged when stroke
is complicated by hemorrhagic transformation, making an Afib-indicated
therapy a huge contraindication. CASE PRESENTATION: 59-year-old male, with
a new diagnosis of Afib on apixaban (2 days ago), diabetes, hypertension,
and hyperlipidemia, presented with aphasia and right hemiparesis. Initial
NIH was 19. He was well seven hours ago. Vitals were significant for
irregular tachycardia with pulse of 112 beats/min, consistent with Afib on
ECG, but otherwise unremarkable. CT head/CTA head and neck/CT brain
perfusion revealed large ischemic stroke due to left MCA M1 segment
occlusion with penumbra. Patient was ineligible for Tenecteplase given
duration of onset and prior use of antithrombotic. He emergently underwent
a mechanical thrombectomy with successful TICI 2B recanalization of left
M1. Echocardiogram revealed LVEF 30% but no left heart thrombus. Bilateral
leg venous duplex ultrasound was negative. Patient was started on
metoprolol, aspirin, and rosuvastatin; anticoagulant was held due to high
intracranial bleeding risk. Within 48 hours, repeat CT head indeed showed
evolving left MCA infarct with frontal parenchymal hemorrhage, prompting a
pause on both aspirin and subcutaneous enoxaparin. The following day CT
head showed increased brain compression from cerebral edema and a mixture
of intraparenchymal and subarachnoid hemorrhage conversion. Subcutaneous
deep vein thrombosis (DVT) prophylaxis was not resumed until day 5 after
improved head imaging and deficits. Digoxin was added for tighter Afib
control. Unfortunately, repeat duplex ultrasound on day 9 demonstrated
extensive right leg DVT, prompting an IVC filter placement the next day.
Aspirin and enoxaparin were resumed on day 10. Throughout the entire stay,
he remained in Afib, indicating an early resumption of therapeutic
anticoagulation. A PEG tube was also placed on day 14. Heparin infusion
was then reinitiated day 15 with a smooth transition to apixaban ten days
later given stable imaging and symptoms. He was discharged after one month
to rehabilitation on apixaban. DISCUSSION: Extensive literature search for
a safe timeline to restart anticoagulation, for patients having
concomitant intracranial bleed and Afib, was nonproductive. Most
guidelines highlight discontinuing and rapid reversal of anticoagulation
along with delaying restart of antithrombotic therapy. They all end at
vaguely recommending a decision weighing both benefits and risks when left
atrial appendage occlusion is not possible. Our patient is at substantial
risk for recurrent embolic stroke due to persistent Afib, thus requiring
anticoagulation, but also for rebleeding or hematoma expansion if the same
therapy restarted too early. Though he did well with our management, the
result does not necessarily generalize to other patients with similar
conditions. CONCLUSION(S): Most anticoagulation dilemmas arise from
concomitant vascular thrombus, as in Afib or pulmonary embolism, and acute
brain injury. Standardized guidance on safe timeline for anticoagulation
is unavailable, prompting variability in expert opinions. Anecdotal
managements suggest a waiting period for anticoagulation and graded
introduction of therapy coupled with surveillance imaging. Further
large-scale study is needed to address this gap in guidelines. REFERENCE
#1: Joglar J, Chung M, Armbruster A, et al. 2023 ACC/AHA/ACCP/HRS
Guideline for the Diagnosis and Management of Atrial Fibrillation: A
Report of the American College of Cardiology/American Heart Association
Joint Committee on Clinical Practice Guidelines. Circulation.
2024;149:e1-e156. REFERENCE #2: Paciaroni M, Agnelli G, Micheli S, et al.
Efficacy and safety of anticoagulant treatment in acute cardioembolic
stroke: a meta-analysis of randomized controlled trials. Stroke 2007.
Feb;38(2):423-430. REFERENCE #3: Vasconcelos T, Caleca Emidio F, Silva F,
Nascimento J, Duarte M. Hemorrhagic Transformation in Patients With
Ischemic Stroke and Atrial Fibrillation: To Anticoagulate or Not, That Is
the Question. Cureus. 2024 Feb 4;16(2):e53548. DISCLOSURES: No relevant
relationships by Daniel Gao No relevant relationships by Madihah Hepburn
No relevant relationships by Phuong Uyen Vo Copyright © 2024
American College of Chest Physicians

<148>
Accession Number
2034594692
Title
HOLY COW! A FREE-FLOATING THROMBUS IN A PATIENT WITH A BOVINE ARCH.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A3625-A3626), 2024. Date of Publication: October 2024.
Author
CARSON M.I.; ALBERTO JR M.; PAUL S.; ISMAIL M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Mediastinum Case Reports Posters (B)
SESSION TYPE: Case Report Posters PRESENTED ON: 10/07/2024 12:30 pm -
01:15 pm INTRODUCTION: A bovine arch is a misnomer for an anatomical
variant that occurs in approximately 13.6 % of patients. The term
describes the origin of the left carotid off the brachiocephalic artery.
Two known variants exist depending on how distal the left carotid
originates on the artery [1]. We present a case of a free-floating
thrombus in a patient with a bovine arch. CASE PRESENTATION: A 70-year-old
female with past medical history of chronic obstructive pulmonary disease,
hyperlipidemia, and active tobacco use. She presented to the emergency
department for ongoing fatigue, swelling in her lower extremities and
petechial rash. She underwent computed tomography of chest, abdomen, and
pelvis with IV contrast. A right upper lobe mass, a bovine arch variant of
the aorta, and a free-floating thrombus at the common trunk of the arch
were diagnosed (figure 1, 2, 3). The patient was started on heparin. She
was diagnosed with stage IV squamous cell lung cancer after a lymph node
biopsy and imaging suggestive of metastasis to liver. The patient elected
to pursue hospice services and was sent home on apixaban. She died one
month later. DISCUSSION: Only two cases of bovine arch thrombus were found
in the literature. One diagnosed via transesophageal echocardiogram did
not comment on treatment of the thrombus [2]. The other case underwent
thrombectomy via the wrist and was discharged on acenocoumarol (vitamin K
antagonist) [3]. The location of the thrombus proposes a high-risk of
stroke as it is proximal both to the right carotid and left carotid artery
and has potential of causing a massive bilateral stroke. Due to the rarity
of the condition with our patient's anatomy, further readings were
discovered to treat free floating aortic thromboses. One case series had
three cases of floating aortic thrombosis, all of which underwent surgical
thrombectomy due to their high-risk embolization and were placed on a
vitamin K antagonist [4]. Vitamin K antagonists were avoided in our
patient due to their requirement that monitoring of International
Normalized Ratio did not coincide with patient's wish to go home with
hospice and minimize medical intervention. Surgery and endovascular
thrombectomy were also not implemented to match the patient's goals. If
our patient did not have a terminal illness, we would have recommended
surgical thrombectomy as the location of the thrombus has the potential to
embolize to either carotid artery, the right brachial artery, or occlude
all three due to its location and potential to cause devastating ischemia
to both the brain and the right upper extremity. CONCLUSION(S): Given
the rarity of aortic thrombi and their potential of devastating
consequences if left untreated we found merit in reporting a case in a
patient with abnormal anatomy. elected to be managed medically due to her
prognosis, it should be noted that this thrombus given its location should
be managed with thrombectomy and placed on lifelong anticoagulation as 33
% of cases reoccur after thrombectomy, which can lead to devastating brain
and/or limb ischemia [4]. REFERENCE #1: [1] Popieluszko, P., Henry, B. M.,
Sanna, B., Hsieh, W. C., Saganiak, K., Pekala, P. A., Walocha, J. A., &
Tomaszewski, K. A. (2018). A systematic review and meta-analysis of
variations in branching patterns of the adult aortic arch. Journal of
vascular surgery, 68(1), 298-306.e10.
https://doi.org/10.1016/j.jvs.2017.06.097 [2] Kosarek, L., Fischer, S., &
Sniecinski, R. (2014). Clot in bovine arch diagnosed by transesophageal
echocardiography. Anesthesia and analgesia, 118(1), 80-82.
https://doi.org/10.1213/ANE.0000000000000044 REFERENCE #2: [3] Suarez
Gonzalez, L. Angel, Busto Suarez, S., Fernandez-Samos Gutierrez, R., &
Ballesteros Pomar, M. (2022). Symptomatic Aortic Arch Floating Thrombus In
A Patient With "Bovine Arch". Portuguese Journal of Cardiac Thoracic and
Vascular Surgery, 29(3), 79-81. https://doi.org/10.48729/pjctvs.307
REFERENCE #3: [4] Oki, N., Inoue, Y., & Kotani, S. (2021). Free-floating
thrombus of the aorta: 3 case reports. Surgical Case Reports, 7(1).
https://doi.org/10.1186/s40792-021-01230-7 DISCLOSURES: No relevant
relationships by Marcos Alberto Jr No relevant relationships by Michael
Carson No relevant relationships by Muhammad Ismail No relevant
relationships by Sonali Paul Copyright © 2024 American College of
Chest Physicians

<149>
Accession Number
2034594608
Title
ROCK-SOLID HEARTS: CABG PREOPERATIVE EVALUATION IN UNDIAGNOSED SILICOSIS.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp A271),
2024. Date of Publication: October 2024.
Author
TATAPUDI S.V.; KESAVAN R.B.; SARVA S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Reports Posters (D) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Silica exposure increases the risk of coronary artery
disease and cardiovascular disease mortality. However, evidence-based
guidelines for the perioperative cardiac management of patients with
restrictive lung disease are limited. CASE PRESENTATION: A 73-year-old
male presented with worsening dyspnea for 6 months. A positive nuclear
stress test led to a cardiac catheterization, revealing significant
three-vessel disease and heart failure with reduced ejection fraction (EF
35-40%). Prompt CABG surgery was deemed necessary but notably, the patient
had an extensive 30-year history of silica exposure as a sandblasting
industrialized painter. DISCUSSION: A CT chest was performed, revealing
diffusely large calcified mediastinal and hilar lymph nodes. The patient's
newly diagnosed silicosis predisposed him to risks of fibrosing
mediastinitis, difficulty in tissue dissection, and other operative
complications. To mitigate these risks, PFTs, ABG, and a
6-minute-walking-test were conducted to quantify restriction, aid in
anesthetic planning, estimate baseline oxygenation and ventilation, and
evaluate exercise tolerance. The patient was informed of the risks and
elected to undergo surgery. The procedure was completed without any
intraoperative or postoperative complications. CONCLUSION(S): In
conclusion, this case highlights the importance of comprehensive
preoperative evaluation in patients with significant silica exposure and
restrictive lung disease undergoing CABG surgery. Moving forward,
continued research is needed to establish evidence-based guidelines for
perioperative cardiac management in this patient population. Furthermore,
this case demonstrates that CABG can be safely performed in patients with
significant mediastinal calcification, emphasizing the significance of
multidisciplinary collaboration and careful preoperative evaluation to
optimize surgical outcomes and mitigate potential risks associated with
silica-related lung pathology. REFERENCE #1: Diaz-Fuentes G, Hashmi HR,
Venkatram S. Perioperative Evaluation of Patients with Pulmonary
Conditions Undergoing Non-Cardiothoracic Surgery. Health Serv Insights.
2016 Nov 9;9(Suppl 1):9-23. doi: 10.4137/HSI.S40541. PMID: 27867301;
PMCID: PMC5104294. REFERENCE #2: Esfahani M, Bashirian S, Mehri F, Khazaei
S. Association between Silica Exposure and Cardiovascular Disease
Mortality: A Meta-Analysis. J Tehran Heart Cent. 2020 Oct;15(4):151-157.
doi: 10.18502/jthc.v15i4.5940. PMID: 34178083; PMCID: PMC8217190.
DISCLOSURES: No disclosure on file for Ramesh Kesavan No relevant
relationships by Sivatej Sarva No relevant relationships by Suhas
Tatapudi Copyright © 2024 American College of Chest Physicians

<150>
Accession Number
2034594523
Title
A CASE REPORT OF AORTIC VALVE ENDOCARDITIS AND MULTIFOCAL SEPTIC STROKES
DUE TO ROTHIA DENTOCARIOSA IN A PATIENT WITH ACUTE MYELOID LEUKEMIA.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A1521-A1522), 2024. Date of Publication: October 2024.
Author
PLANTE M.; RAVAL D.; VENUGOPAL A.; ORING J.; DURVASULA R.A.V.I.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Reports Posters (V) SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2024 12:30 pm - 01:15 pm
INTRODUCTION: Infective endocarditis (IE) is a rare infection with an
estimated incidence of approximately 11- 15 per 100,000 population in the
United States, IE is diagnosed by the Duke's criteria. Reported risk
factors for IE include age greater than 60 years old, male gender, damaged
endocardium, and prosthetic heart valves. The most common organisms of
infectious endocarditis are Viridans streptococci, Streptococcus bovis,
the HACEK group, Staphylococcus aureus, and community acquired
Enterococci. The sensitivity of transthoracic echocardiography for
detection of IE consistent valvular abnormalities ranges from 40% to 80%
compared with 93% to 100% for transesophageal echocardiography. Currently,
ten different Rothia species have been described with three pathogenic
human species as follows: R. aeria, R. dentocariosa, and R. mucilaginosa.
This bacterial species is commonly described as round to rod shaped to
filamentous, encapsulated, gram-positive, fermentative, catalase-positive,
aerobic or facultative anaerobic, belonging to the Micrococcaceae family
and colonizes the oropharynx and respiratory tract flora in approximately
30% of the general population CASE PRESENTATION: A 70-year-old man with a
complex medical history including diabetes, coronary artery disease,
bladder cancer, and leukemia presented with progressive gait and balance
issues. Imaging revealed brain lesions, prompting concern for infection,
ischemia, or malignancy. Despite no acute symptoms, he was admitted for
evaluation. Initial tests were inconclusive, but subsequent blood cultures
revealed Rothia dentocariosa, indicating IE. Further imaging confirmed
embolic strokes and vegetations on the aortic valve. The patient met
Duke's criteria for IE and was readmitted for intravenous antibiotics.
Complications included hyperglycemia, kidney injury, and neutropenia. He
completed antibiotic therapy but was lost to follow-up for dental care, a
potential source of infection. One year later, he was hospitalized for
unrelated issues, and blood cultures remained negative, suggesting
successful treatment of IE. DISCUSSION: We believe our case represents a
true incidence of Rothia dentocariosa native aortic valve infective
endocarditis as this patient never had suspicion of vegetations in the
past to warrant echocardiographic evaluation until he developed
multi-focal CNS septic emboli which then showed two aortic valve
vegetations. Additionally, subsequent blood cultures failed to produce
other more common endocarditis-associated organisms such as streptococcal
species in the setting of active periodontal disease. The initial source
was likely periodontal disease with resultant bacteremia compounded by
elevated risk with active periodontal disease, poorly controlled diabetes,
and most importantly immunocompromised state with severe neutropenia
secondary to AML. Surprisingly, our patient did not develop any signs or
symptoms of systemic bacterial infection despite latent initiation of IV
antibiotic therapy. CONCLUSION(S): In conclusion, Rothia dentocariosa
induced IE of the native aortic valve complicated by septic embolic
strokes which highlights predisposing risk factors and emphasizes the
importance of awareness of dental commensal bacteria such as R.
dentocariosa as opportunistic pathogens in immunocompromised patients.
High-risk patients should be carefully monitored for development of this
potentially life-threatening condition and should undergo optimization of
all modifiable risk factors such as practicing good dental hygiene.
Although rare, recognition of Rothia bacteremia, particularly in patients
with prolonged neutropenia and concomitant periodontal disease, requires
urgent evaluation and intervention to prevent delays and subsequent
complications. REFERENCE #1: 1. Pant, S., Patel, N., Deshmukh, A., et al.
(2015). Trends in infective endocarditis incidence, microbiology, and
valve replacement in the United States from 2000 to 2011. Journal of the
American College of Cardiology, 65(19), 2070-2076.
https://doi.org/10.1016/j.jacc.2015.03.5182. Elkattawy, S., Alyacoub, R.,
Younes, I., Mowafy, A., Noori, M., Mirza, M. (2021). A rare report of
Rothia dentocariosa endocarditis. Journal of community hospital internal
medicine perspectives, 11(3), 413-415.
https://doi.org/10.1080/20009666.2021.1880539, 63. Franconieri, F.,
Join-Lambert, O., Creveuil, C., et al. (2021). Rothia spp. infective
endocarditis: A systematic literature review. Infectious diseases now,
51(3), 228-235. https://doi.org/10.1016/j.medmal.2020.10.021, 44.
Boudewijns, M., Magerman, K., Verhaegen, J., et al. (2003). Rothia
dentocariosa, endocarditis and mycotic aneurysms: case report and review
of the literature. Clinical microbiology and infection : the official
publication of the European Society of Clinical Microbiology and
Infectious Diseases, 9(3), 222-229.
https://doi.org/10.1046/j.1469-0691.2003.00503.x, 85. Fridman, D.,
Chaudhry, A., Makaryus, J., Black, K., Makaryus, A. (2016). Rothia
dentocariosa Endocarditis: An Especially Rare Case in a Previously Healthy
Man. Texas Heart Institute journal, 43(3), 255-257.
https://doi.org/10.14503/THIJ-15-5068, 96. Willner, S., Imam, Z., Hader,
I. (2019). Rothia dentocariosa Endocarditis in an Unsuspecting Host: A
Case Report and Literature Review. Case reports in cardiology, 2019,
7464251. https://doi.org/10.1155/2019/74642517. Abidi M., Ledeboer N.,
Banerjee A., Hari P. (2016). Morbidity and mortality attributable to
Rothia bacteremia in neutropenic and nonneutropenic patients. Diagnostic
microbiology and infectious disease, 85(1), 116-120.
https://doi.org/10.1016/j.diagmicrobio.2016.01.0058. Sekar, P., Johnson,
J., Thurn, J., et al. (2017). Comparative Sensitivity of Transthoracic and
Transesophageal Echocardiography in Diagnosis of Infective Endocarditis
Among Veterans With Staphylococcus aureus Bacteremia. Open forum
infectious diseases, 4(2), ofx035. https://doi.org/10.1093/ofid/ofx035,
39. Otto, C., Nishimura, R., Bonow, R., et al. (2021). 2020 ACC/AHA
Guideline for the Management of Patients With Valvular Heart Disease:
Executive Summary: A Report of the American College of Cardiology/American
Heart Association Joint Committee on Clinical Practice Guidelines.
Circulation, 143(5), e35-e71. https://doi.org/10.1161/CIR.0000000000000932
210. Sadhu, A., Loewenstein, R., Klotz, S. (2005). Rothia dentocariosa
endocarditis complicated by multiple cerebellar hemorrhages. Diagnostic
microbiology and infectious disease, 53(3), 239-240.
https://doi.org/10.1016/j.diagmicrobio.2005.05.00911. Chowdhary, M.,
Farooqi, B., Ponce-Terashima, R. (2015). Rothia dentocariosa: A Rare Cause
of Left-Sided Endocarditis in an Intravenous Drug User. The American
journal of the medical sciences, 350(3), 239-240.
https://doi.org/10.1097/MAJ.000000000000053912. Ramanan, P., Barreto, J.,
Osmon, D., Tosh, P. (2014). Rothia bacteremia: a 10-year experience at
Mayo Clinic, Rochester, Minnesota. J Clin Microbiol. 52(9):3184-9. doi:
10.1128/JCM.01270-14., 713. Butera, A., Pascadopoli, M., Pellegrini, M.,
Gallo, S., Zampetti, P., Scribante, A. (2022). Oral Microbiota in Patients
with Peri-Implant Disease: A Narrative Review. Applied Sciences.
12(7):3250. https://doi.org/10.3390/app1207325014. Vale G., Mayer M.
(2021). Effect of probiotic Lactobacillus rhamnosus by-products on
gingival epithelial cells challenged with Porphyromonas gingivalis.
Archives of oral biology, 128, 105174.
https://doi.org/10.1016/j.archoralbio.2021.10517415. Butera, A.,
Pascadopoli, M., Pellegrini, M., et al. (2022). Domiciliary Use of
Chlorhexidine vs. Postbiotic Gels in Patients with Peri-Implant Mucositis:
A Split-Mouth Randomized Clinical Trial. Applied Sciences. 12(6):2800.
https://doi.org/10.3390/app12062800 DISCLOSURES: No disclosure on file for
Ravi Durvasula No relevant relationships by Justin Oring No relevant
relationships by Marie Plante No relevant relationships by Darshankumar
Raval No relevant relationships by Amoghavarsha Venugopal Copyright
© 2024 American College of Chest Physicians

<151>
Accession Number
2034592428
Title
UNDER PRESSURE: A CASE OF PULMONARY HYPERTENSION WITH "GIANT"
CONSEQUENCES.
Source
Chest. Conference: CHEST 2024 Annual Meeting. Boston Convention and
Exhibition Center, Boston United States. 166(4 Supplement) (pp
A5711-A5712), 2024. Date of Publication: October 2024.
Author
PAULSON M.; KUMAR A.; DUNITZ J.M.; KIEL S.; PATIL J.; LAMBERT C.; BILLINGS
J.L.; MAHAN K.; HUDDLESTON S.; WILSON M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Congenital Pulmonary Vascular Cases SESSION TYPE: Case
Reports PRESENTED ON: 10/08/2024 02:45 pm - 03:45 pm INTRODUCTION:
Pulmonary arterial hypertension (PAH) is characterized by pulmonary
arteriole changes, causing increased pulmonary arterial pressure (1).
Elevated pulmonary arterial load may lead to right ventricle remodeling
and affect other right-sided cardiac structures (2). Here, we present a
case of acute right-sided heart failure in a young woman due to previously
unknown PAH, resulting in a giant pulmonary artery aneurysm (PAA) and
pulmonary valve insufficiency. CASE PRESENTATION: HistoryA 33-year-old
woman with a medical history of asthma and attention deficit hyperactivity
disorder presented with acute bilateral lower extremity edema, facial
swelling, and shortness of breath for one day. Family history revealed
pulmonary hypertension in her mother. Physical exam showed 2+ bilateral
lower extremity pitting edema and jugular venous distention.Investigative
studies. Chest x-ray indicated mild cardiomegaly and a large abnormal
convexity. Transthoracic echocardiogram revealed a 6.9cm main pulmonary
artery aneurysm, severe right ventricular dilation, severely reduced right
ventricular (RV) function, and severe pulmonary valve (PV) insufficiency.
CTA chest showed pulmonary artery dissection flaps, severe main pulmonary
artery aneurysm, aneurysmal dilation of bilateral pulmonary branches, and
limited rupture with a small pericardial effusion. Right heart
catheterization showed peak pulmonary artery pressure of 102/63 mmHg,
pulmonary capillary wedge pressure 13 mmHg, pulmonary vascular resistance
19 Wood units, and cardiac index 1.5 L/min/m2. Additional evaluation ruled
out autoimmune, thromboembolic and infectious causes.Patient progressShe
was initially treated with macitentan and intravenous epoprostenol for
PAH. Cardiothoracic surgery recommended bilateral lung transplant over
isolated pulmonary artery repair due to severe pulmonary hypertension and
right ventricular failure. The patient underwent bilateral sequential lung
transplant, pulmonic valve repair, and pulmonary artery aneurysm repair 28
days after presentation. Her post operative stay was uneventful and she
was discharged home. Follow-up imaging showed a normal caliber main
pulmonary artery and normal heart size. DISCUSSION: Hereditary PAH
predominantly affects young, female patients, and symptoms often relate to
right heart failure (3). PAA can be a consequence of PAH, with the time
course of PAH being an independent risk factor for formation of PAA (4,5).
In a 2020 systematic review of 248 cases of PAA, 35 had PAH identified as
the etiology (6). No guidelines exist for PAA treatment due to its rarity,
but surgical repair is recommended with signs of RV or PV dysfunction (7).
Aggressive management is suggested for patients with PAA and PAH due to
dissection and rupture risks (7,8). Treatment has shifted towards
bilateral lung transplant, as studies show recovery of severely remodeled
right ventricles post-lung transplant alone, with improved survival
compared to heart-lung transplant for idiopathic PAH patients (9).
 CONCLUSION(S): Our patient, previously undiagnosed with PAH,
developed a giant PAA and pulmonary valvular disease. Successful treatment
involved bilateral lung transplant and pulmonary artery repair, resulting
in significant improvement in right heart size and function. REFERENCE #1:
1. Hassoun PM. Pulmonary Arterial Hypertension. New England Journal of
Medicine. 2021;385(25):2361-2376. doi:10.1056/NEJMra2000348; 2.
Noordegraaf AV, Chin KM, Haddad F, et al. Pathophysiology of the right
ventricle and of the pulmonary circulation in pulmonary hypertension: an
update. European Respiratory Journal. 2019;53(1):1801900.
doi:10.1183/13993003.01900-2018; 3. Humbert M, Kovacs G, Hoeper MM, et al.
2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary
hypertension. European Respiratory Journal. 2023;61(1):2200879.
doi:10.1183/13993003.00879-2022 REFERENCE #2: 4. Bartter T, Irwin RS, Nash
G. Aneurysms of the pulmonary arteries. Chest. 1988 Nov;94(5):1065-75.
doi: 10.1378/chest.94.5.1065; 5. Nuche J, Montero-Cabezas JM, Lareo A,
Huertas S, Jimenez Lopez-Guarch C, Velazquez Martin M, Alonso Charterina
S, Revilla Ostolaza Y, Delgado JF, Arribas Ynsaurriaga F, Escribano Subias
P. Influence of long-standing pulmonary arterial hypertension and its
severity on pulmonary artery aneurysm development. Heart Vessels. 2020
Sep;35(9):1290-1298. doi: 10.1007/s00380-020-01600-5; 6. Gupta, M.,
Agrawal, A., Iakovou, A., Cohen, S., Shah, R. and Talwar, A. (2020),
Pulmonary artery aneurysm: a review. Pulmonary Circulation, 10: 1-10
2045894020908780. https://doi.org/10.1177/2045894020908780 REFERENCE #3:
7. Jacob S, Pham AN, Sareyyupoglu B, Pham SM. Bilateral lung
transplantation for pulmonary artery aneurysm with severe pulmonary
hypertension: An evolution or a revolution? Journal of Cardiac Surgery.
2021;36(8):3000-3002. doi:https://doi.org/10.1111/jocs.15654; 8.
Senbaklavaci O, Kaneko Y, Bartunek A, Brunner C, Kurkciyan E,
Wunderbaldinger P, Klepetko W, Wolner E, Mohl W. Rupture and dissection in
pulmonary artery aneurysms: incidence, cause, and treatment--review and
case report. J Thorac Cardiovasc Surg. 2001 May;121(5):1006-8. doi:
10.1067/mtc.2001.112634; 9. Doi A, Gajera J, Niewodowski D, et al.
Surgical management of giant pulmonary artery aneurysms in patients with
severe pulmonary arterial hypertension. J Card Surg. 2022; 37: 1019-1025.
doi:10.1111/jocs.16235 DISCLOSURES: PI for clinical trials relationship
with Vertex Pharmaceuticals Please note: greater than 2 yrs Added
03/25/2024 by Joanne Billings, source=Web Response, value=Grant/Research
Support No relevant relationships by Jordan Dunitz No relevant
relationships by Stephen Huddleston No relevant relationships by Sarah
Kiel No disclosure on file for Anupam Kumar No relevant relationships by
Christine Lambert No relevant relationships by Kathleen Mahan No relevant
relationships by Jagadish Patil No relevant relationships by Marissa
Paulson No relevant relationships by Marie Wilson Copyright ©
2024 American College of Chest Physicians

<152>
Accession Number
2034640079
Title
Effect of Adding Integrated Core and Graduated Upper Limb Exercises to
Inpatient Cardiac Rehabilitation on Sternal Instability After Coronary
Artery Bypass Grafting: A Randomized Controlled Trial.
Source
Archives of Physical Medicine and Rehabilitation. (no pagination), 2024.
Date of Publication: 2024.
Author
Mehani S.H.M.; Helmy Z.M.; Ali H.M.; Mohamed Mahmoud M.I.
Institution
(Mehani, Ali, Mohamed Mahmoud) Physical Therapy Department for
Cardiovascular / Respiratory Disorders and Geriatrics, Faculty of Physical
Therapy, Beni-Suef University
(Helmy) Physical Therapy Department for Cardiovascular / Respiratory
Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University,
Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the effect of adding integrated core and graduated
resistance upper limb exercises to an inpatient cardiac rehabilitation
program in patients with acute sternal instability after coronary artery
bypass grafting (CABG). Design(s): This was a single-center,
randomized, controlled, parallel-group intervention study.
 Setting(s): This study was conducted at the National Heart Institute.
 Participant(s): Forty patients with post-CABG with sternal
instability aged 50-60 years completed this study and were randomized into
2 groups: an intervention group (n=20) and an active control group (n=20).
 Intervention(s): The intervention group (A) received a routine
inpatient rehabilitation program from the first postoperative day plus
integrated core and graduated resistance upper limb exercises, which
started from the seventh postoperative day for approximately 4 weeks,
whereas the control group (B) received only the routine inpatient
rehabilitation program. Main Outcome Measure(s): Sternal separation
measured by ultrasonography, visual analog scale for measuring pain, and
activities of daily living (ADL) index were main outcome measures.
 Result(s): Patients in the intervention group (A) showed a
significant reduction in sternal separation from the supine and long
sitting positions, whereas those in the control group (B) showed a
significant increase in sternal separation (P=.0001). Both groups showed a
reduction in pain, and an increase in the ADL score was observed in group
A. There was a significant interaction between the time and group effects
(P=.0001). Conclusion(s): Adding integrated core and graduated upper
limb exercises to inpatient cardiac rehabilitation for patients with
sternal instability after coronary artery bypass grafting significantly
improved sternal healing, pain, and ADL. Copyright © 2024
American Congress of Rehabilitation Medicine

<153>
Accession Number
2034606330
Title
Transcatheter Aortic Valve Replacement Influence on Coronary Hemodynamics:
A Quantitative Meta-Analysis and Proposed Decision-Making Algorithm.
Source
Journal of Invasive Cardiology. 32(1) (pp 37-40), 2020. Date of
Publication: January 2020.
Author
Kotronias R.A.; Scarsini R.; Rajasundaram S.; De Maria G.L.; Ciofani J.L.;
Ribichini F.; Kharbanda R.K.; Banning A.P.
Institution
(Kotronias, Scarsini, Rajasundaram, De Maria, Ciofani, Kharbanda, Banning)
Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford,
United Kingdom
(Kotronias) The Department of Cardiovascular Medicine, University of
Oxford, Oxford, United Kingdom
(Scarsini, Ribichini) The Department of Medicine, Division of Cardiology,
University of Verona, Verona, Italy
Publisher
Cliggott Publishing Co.
Abstract
Background. As transcatheter aortic valve replacement (TAVR) expands to
younger and lower-risk severe aortic stenosis patients, appropriate
coronary artery disease treatment is key to reducing long-term adverse
cardiovascular outcomes. Recently, studies have been exploring the role of
coronary-physiology guided revascularization strategies. Our aim was to
investigate whether TAVR influences coronary physiology measurements using
quantitative meta-analytic methods. Methods. We performed a Medline and
Embase search for studies evaluating coronary physiology indices before
and after TAVR. Double independent screening and extractions of baseline,
procedural, angiographic, and echocardiographic data were performed. Risk
of bias was assessed using the ACROBAT-NRSI tool. Pooled mean difference
estimates of coronary hemodynamic indices before and after TAVR were
derived using random-effects models with the inverse variance method
(RevMan, Review Manager, version 5.3.5; Nordic Cochrane Centre). Results.
Five studies evaluating 250 coronary vessels in 169 severe aortic stenosis
patients were quantitatively synthesized. Coronary flow reserve did not
change immediately after TAVR in non-diseased vessels (n = 3; mean
difference, 0.11; 95% confidence interval [CI], -0.10-0.32; P=.29;
I2=0%; P=.68). Importantly, fractional flow reserve also did
not vary significantly following TAVR in both non-diseased (n = 3; mean
difference, -0.01; 95% CI, -0.04-0.03; P=.75; I2=41; P=.19) and
diseased coronaries (n = 3; mean difference, -0.01; 95% CI, -0.03-0.01;
P=.49; I2=0%; P=.46). Similarly, instantaneous wave-free ratio
remained stable following TAVR (n = 2; mean difference, 0.00; 95% CI,
-0.02-0.02; P>.99; I2=0; P>.99. Conclusions. Pooled coronary
physiology measurements before and after TAVR are similar, but data on
variation within individual lesions are limited. Copyright © 2020
Cliggott Publishing Co.. All rights reserved.

<154>
Accession Number
2034613884
Title
Randomised study for the Optimal Treatment of symptomatic patients with
low-gradient severe Aortic valve Stenosis and preserved left ventricular
ejection fraction (ROTAS trial).
Source
Heart. (no pagination), 2024. Date of Publication: 2024.
Author
Galli E.; Le Ven F.; Coisne A.; Sportouch C.; Le Tourneau T.; Lavie-Badie
Y.; Bernard A.; Eicher J.-C.; Dreyfus J.; Ternacle J.; Baleynaud S.;
Auffret V.; Le Pabic E.; Pibarot P.; Oger E.; Donal E.
Institution
(Sportouch) Clinique du Millenaire, Montpellier, France
(Le Tourneau) Nantes Universite, CHU Nantes, CNRS, INSERM, Institut du
Thorax, Nantes, France
(Lavie-Badie) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Bernard) Service de Cardiologie, CHU Tours, Tours, France
(Eicher) Unite de Rythmologie et Insuffisance Cardiaque, Centre de
Competences des Cardiomyopathies, Service de Cardiologie, Hopital Francois
Mitterrand, CHU Dijon-Bourgogne, Dijon, France
(Dreyfus) Cardiology Department, Centre Cardiologique du Nord, Saint
Denis, France
(Ternacle) Bordeaux University Hospital, Bordeaux, France
(Baleynaud) Department of Cardiology, Centre Hospitalier Bretagne Sud,
Lorient, France
(Le Pabic, Oger) CHU Rennes, Inserm, CIC, Rennes 1414, France
(Pibarot) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec (Quebec Heart and Lung Institute), Laval University, Quebec, QC,
Canada
(Galli, Auffret, Donal) Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099,
Rennes, France
(Le Ven) Hopital Cavale Blanche, CHRU Brest, Brest, France
(Coisne) University of Lille, Inserm, CHU Lille, Institut Pasteur de
Lille, Lille, France
Publisher
BMJ Publishing Group
Abstract
Background The best management of symptomatic patients with low-gradient
(LG) severe aortic stenosis (AS) and preserved left ventricular ejection
fraction (LVEF) has not been established. The Randomised study for the
Optimal Treatment of symptomatic patients with low-gradient severe Aortic
valve Stenosis (ROTAS) trial aimed to assess the superiority of aortic
valve replacement (AVR) versus medical treatment (MT) in this specific
group of AS patients. Methods Patients with symptomatic LG severe AS and
preserved LVEF (>50%) underwent dobutamine stress echocardiography and/or
CT-aortic calcium score to confirm AS severity and were then randomised
1:1 to AVR or MT. The primary endpoint was a composite of overall death
and/or cardiovascular hospitalisation. Results The ROTAS study was stopped
early because of insufficient recruitment. In the end, only 52 patients
(age 79+/-7 years; women 54%; NYHA III-IV 27%; median STS score 3.3%) were
included in the study. During follow-up (mean: 14+/-7 months), the primary
endpoint occurred in 12 (23%) patients. Compared with MT, AVR was not
associated with a significant prognostic benefit (events: 5/26 (19%) vs
7/26 (27%) (HR 0.76, 95% CI 0.24 to 2.39, p=0.63). During follow-up, 11
(42%) patients in the MT group developed class I criteria for AVR or
severe symptoms justifying a cross-over to the AVR group. Conclusions
Because of the small number of included patients and short follow-up the
ROTAS trial was underpowered and unable to demonstrate a difference in the
study endpoint between treatment arms. In patients in the MT arm, a
regular echocardiographic and clinical assessment might be useful to
disclose those developing class I indications of AVR or severe AS-related
symptoms. Copyright © Author(s) (or their employer(s)) 2024.

<155>
Accession Number
645287354
Title
Application of indocyanine green in thoracic surgery: A review article.
Source
Asian journal of surgery. (no pagination), 2024. Date of Publication: 14
Sep 2024.
Author
Zhu X.; Zhou S.; Chen Z.; Xing F.-B.; Chen W.-B.; Zhang L.
Institution
(Zhu, Zhou, Chen, Xing, Chen, Zhang) Department of Thoracic Surgery, First
Affiliated Hospital of Bengbu Medical University, Bengbu 233000, China
Abstract
Indocyanine green has been used in clinical practice for a long time
because of its many advantages such as stable coloration, safety and
cheapness. With the widespread development of thoracoscopic technology,
thoracic surgeons have a higher demand for the identification of lesions
and tissue structures under the thoracoscope, and the traditional white
light imaging can no longer fully meet the needs of thoracic surgeons. In
this situation, indocyanine green combined with NIR imaging technology has
brought great help to thoracic surgeons. For example, indocyanine green
plays an important role in the localization of small pulmonary nodules,
the imaging of intersegmental lung planes, the imaging of thoracic ducts,
and the assessment of blood supply to the tubular stomach. In this paper,
we review the application of indocyanine green in thoracic surgery
according to the related research and application at home and
abroad. Copyright © 2024 Asian Surgical Association and Taiwan
Society of Coloproctology. Published by Elsevier B.V. All rights reserved.

<156>
Accession Number
645287299
Title
The effects of open and closed suctioning systems on neonatal pain and
vital signs in neonatal intensive care units.
Source
Journal of pediatric nursing. 79 (pp 181-185), 2024. Date of Publication:
13 Sep 2024.
Author
Alaca A.; Sari H.Y.; Karaoz H.; Bostan H.A.; Engur D.
Institution
(Alaca) Izmir City Hospital, Turkey Turkey
(Sari) Izmir Katip Celebi University, Faculty of Health Science, Pediatric
Nursing Department, Izmir, Turkey
(Karaoz) Izmir Provincal Health Directorate, Turkey
(Bostan, Engur) Izmir Tepecik Education and Research Hospital, Turkey
Abstract
BACKGROUND: Endotracheal suctioning is a procedure used by neonatal
intensive care unit nurses to maximize oxygenation and clear airways of
secretions, and is one of the most common painful procedures causing
stress in intubated newborns. AIM: This aim of this study is to compare
the effects of open and closed endotracheal suctioning on pain, peak heart
rate and oxygen saturation in neonates on mechanicalventilation. MATERIALS
AND METHODS: This experimental-design study was conducted on 30 newborns
who were mechanically ventilated in the tertiary neonatal intensive care
unit of a public hospital. First, closed suctioning and then open
suctioning was performed on patients during the day. Pain, peak heart rate
and oxygen saturation levels were evaluated before, during and 30 min
after each suctioning procedure. RESULT(S): Of the newborns included
in the study, 53.3 % were male and 36.6 % were admitted to intensive care
unit due to a heart defect. No statistically significant differences were
found in pain, peak heart rate, or oxygen saturation between the open and
closed suctioning methods. However, oxygen saturation levels during
suctioning were lower compared to levels before and 30 min after the
procedure. Additionally, peak heart rate was lower during suctioning
compared to 30 min afterward. CONCLUSION(S): The study concludes that
there is no significant difference between open and closed suctioning
techniques concerning pain, peak heart rate, and oxygen saturation.
IMPLICATIONS TO PRACTICE: Given its sterility and ease of use, the closed
suction method may be preferable in clinical settings. Copyright
© 2024. Published by Elsevier Inc.

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