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Article ; Online: Asymptomatic Severe Aortic Valve Stenosis-When to Intervene: a Review of the Literature, Current Trials, and Guidelines.

Pineda, Andrés M / Kiefer, Todd L

2018 Volume 20, Issue 12, Page(s) 129

Abstract: Purpose of review: The optimal treatment for asymptomatic patients with severe aortic valve stenosis (AS) is not clearly known. Here, we review the available data on the management of such patients.: Recent findings: Half of patients with severe AS ... ...

Abstract	Purpose of review: The optimal treatment for asymptomatic patients with severe aortic valve stenosis (AS) is not clearly known. Here, we review the available data on the management of such patients. Recent findings: Half of patients with severe AS are asymptomatic at the time of diagnosis, and are at risk for adverse events, including sudden cardiac death. A significant proportion of these patients develop AS-related symptoms within 1 or 2 years. Clinical and echocardiographic characteristics are predictors of poor outcomes and can guide treatment decisions. Several non-randomized studies and meta-analyses have suggested benefit from early AVR for asymptomatic severe AS, including improved all-cause, cardiovascular, and valve-related mortality. Based on the available information, current guidelines suggest aortic valve replacement in the presence of specific characteristic, including left ventricular dysfunction and very severe AS with significantly elevated gradients. Although the available data suggests early AVR improves the clinical outcomes of these patients, most patients in current practice are managed conservatively. Six randomized trials are ongoing to better elucidate the ideal management of asymptomatic severe AS patients.
MeSH term(s)	Aortic Valve/surgery ; Aortic Valve Stenosis/surgery ; Death, Sudden, Cardiac/etiology ; Echocardiography/adverse effects ; Heart Valve Prosthesis/adverse effects ; Humans ; Practice Guidelines as Topic ; Randomized Controlled Trials as Topic ; Risk Factors ; Transcatheter Aortic Valve Replacement/adverse effects ; Ventricular Dysfunction, Left/physiopathology
Language	English
Publishing date	2018-10-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2055373-0
ISSN	1534-3170 ; 1523-3782
ISSN (online)	1534-3170
ISSN	1523-3782
DOI	10.1007/s11886-018-1072-x
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Zs.A 5524: Show issues

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Article ; Online: Challenges in Aortic Valve Stenosis: Low-Flow States Diagnosis, Management, and a Review of the Current Literature.

Sherwood, Matthew W / Kiefer, Todd L

Current cardiology reports

2017 Volume 19, Issue 12, Page(s) 130

Abstract: Purpose of review: We will describe and define the current diagnosis, management, and potential therapy for low-flow aortic stenosis (AS) states, as well as summarize the available evidence underlying these recommendations.: Recent findings: Low-flow ...

Abstract	Purpose of review: We will describe and define the current diagnosis, management, and potential therapy for low-flow aortic stenosis (AS) states, as well as summarize the available evidence underlying these recommendations. Recent findings: Low-flow aortic stenosis syndromes have worse prognoses than traditionally defined normal flow severe aortic stenosis. In this setting, aortic valve replacement is the only therapy that improves outcomes. Transcatheter aortic valve replacement has an ever-expanding role in the treatment of aortic stenosis, and there is growing evidence that TAVR may be a preferred therapy for low-flow AS states. Aortic stenosis remains one of the most common valvular diseases requiring therapy. Low-flow AS represents up to 40% of all patients with AS and is associated with significant mortality. This condition requires further testing for appropriate diagnosis and treatment. Low-flow AS states have poor prognoses, thus AVR and especially TAVR have a growing role in treatment of this challenging subset of AS patients.
MeSH term(s)	Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/mortality ; Aortic Valve Stenosis/physiopathology ; Aortic Valve Stenosis/surgery ; Cardiac Catheterization/methods ; Cardiac Catheterization/mortality ; Evidence-Based Medicine ; Heart Valve Prosthesis Implantation/mortality ; Humans ; Prognosis ; Transcatheter Aortic Valve Replacement/mortality ; Treatment Outcome
Language	English
Publishing date	2017-10-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2055373-0
ISSN	1534-3170 ; 1523-3782
ISSN (online)	1534-3170
ISSN	1523-3782
DOI	10.1007/s11886-017-0941-z
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Article ; Online: Correction to

Craig D. Byron / Adam M. Kiefer / Joanna Thomas / Sagar Patel / Amy Jenkins / Anthony L. Fratino / Todd Anderson

Heritage Science, Vol 9, Iss 1, Pp 1-

The authentication and repatriation of a ceremonial tsantsa to its country of origin (Ecuador)

2021 Volume 1

Abstract: An amendment to this paper has been published and can be accessed via the original article. ...

Abstract	An amendment to this paper has been published and can be accessed via the original article.
Keywords	Fine Arts ; N ; Analytical chemistry ; QD71-142
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	SpringerOpen
Document type	Article ; Online
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Article ; Online: Platypnea-Orthodeoxia Syndrome: To Shunt or Not to Shunt, That is the Question.

Klein, Michael R / Kiefer, Todd L / Velazquez, Eric J

Texas Heart Institute journal

2016 Volume 43, Issue 3, Page(s) 264–266

Abstract: ... at another hospital. In the emergency department, she was hypoxic, needing 6 L/min of oxygen. Her chest radiograph ...

Abstract	Platypnea-orthodeoxia syndrome is a rare disease defined by dyspnea and deoxygenation, induced by an upright position, and relieved by recumbency. Causes include shunting through a patent foramen ovale and pulmonary arteriovenous malformations. A 79-year-old woman experienced 2 syncopal episodes at rest and presented at another hospital. In the emergency department, she was hypoxic, needing 6 L/min of oxygen. Her chest radiograph showed nothing unusual. Transthoracic echocardiograms with saline microcavitation evaluation were mildly positive early after agitated-saline administration, suggesting intracardiac shunting. She was then transferred to our center. Right-sided heart catheterization revealed no oximetric evidence of intracardiac shunting while the patient was supine and had a low right atrial pressure. However, her oxygen saturation dropped to 78% when she sat up. Repeat transthoracic echocardiography while sitting revealed a dramatically positive early saline microcavitation-uptake into the left side of the heart. Transesophageal echocardiograms showed a patent foramen ovale, with right-to-left shunting highly dependent upon body position. The patient underwent successful percutaneous patent foramen ovale closure, and her oxygen supplementation was suspended. In patients with unexplained or transient hypoxemia in which a cardiac cause is suspected, it is important to evaluate shunting in both the recumbent and upright positions. In this syndrome, elevated right atrial pressure is not necessary for significant right-to-left shunting. Percutaneous closure, if feasible, is first-line therapy in these patients.
MeSH term(s)	Aged ; Cardiac Catheterization ; Cardiac Surgical Procedures/methods ; Decision Making ; Dextrocardia/complications ; Dextrocardia/diagnosis ; Dextrocardia/surgery ; Dyspnea/diagnosis ; Dyspnea/etiology ; Dyspnea/surgery ; Female ; Foramen Ovale, Patent/complications ; Foramen Ovale, Patent/diagnosis ; Foramen Ovale, Patent/surgery ; Heart Septal Defects, Atrial/complications ; Humans ; Hypoxia/diagnosis ; Hypoxia/etiology ; Hypoxia/surgery ; Syndrome
Language	English
Publishing date	2016-06
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	604761-0
ISSN	1526-6702 ; 0730-2347
ISSN (online)	1526-6702
ISSN	0730-2347
DOI	10.14503/THIJ-15-5280
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Zs.A 1452: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The authentication and repatriation of a ceremonial tsantsa to its country of origin (Ecuador)

Craig D. Byron / Adam M. Kiefer / Joanna Thomas / Sagar Patel / Amy Jenkins / Anthony L. Fratino / Todd Anderson

Heritage Science, Vol 9, Iss 1, Pp 1-

2021 Volume 13

Abstract: Abstract Tsantsas, commonly referred to as “shrunken heads”, are unique and valuable antiquities that were produced by the Shuar, Achuar, Awajún/Aguaruna, Wampís/Huambisa, and Candoshi-Shampra (SAAWC) peoples until the mid twentieth century. Originally ... ...

Abstract	Abstract Tsantsas, commonly referred to as “shrunken heads”, are unique and valuable antiquities that were produced by the Shuar, Achuar, Awajún/Aguaruna, Wampís/Huambisa, and Candoshi-Shampra (SAAWC) peoples until the mid twentieth century. Originally used with ceremonial purpose during important social group functions, tsantsas became monetarily valuable as keepsakes and curios during the nineteenth century as a result of Western/European cultural encroachment. Unmet demand resulted in the production of convincing forgeries that created confusion about the authenticity of existing collections. Ceremonial tsantsas are both human remains and valuable cultural items. Their production and purpose were negatively influenced by colonialism and the outside curio market; as such many institutions may choose to repatriate them to their places of origin. Herein, we report on the authentication and repatriation of a ceremonial tsantsa recently rediscovered in a university’s natural history collection. The personal memoirs of the original collector describe that it originated in the Ecuadorean Amazon. In consultation with the government of Ecuador, it was determined that authentication was required prior to repatriation. The tsantsa was compared to a list of thirty-three distinct characteristics shared by ceremonial tsantsas. These criteria were taken from those provided by Ecuador’s National Cultural Heritage Institute and those found in prior studies from the academic literature; they include notable skin and hair features, structure and facial anatomy, and evidence of traditional fabrication and modification. We were able to affirm 30 of the 33 authenticating indicators. As part of our protocol the tsantsa was scanned with a CT-imaging system. The resulting 3D images were invaluable in discerning subtle and difficult-to-visualize characteristics regarding the skin and patterns of modification, although there are limitations related to the small size of filamentous structures. The results of the authentication were ...
Keywords	Tsantsa ; Jivaro ; SAAWC peoples ; Ecuador ; Repatriation ; Computed tomography ; Fine Arts ; N ; Analytical chemistry ; QD71-142
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	SpringerOpen
Document type	Article ; Online
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Article: Infective endocarditis: a comprehensive overview.

Kiefer, Todd L / Bashore, Thomas M

Reviews in cardiovascular medicine

2012 Volume 13, Issue 2-3, Page(s) e105–20

Abstract: Infective endocarditis (IE) is an infection of a heart valve or other cardiac structure at a site of endothelial damage. The definition has been also expanded to include infected cardiac devices. A variety of organ systems may be ... ...

Abstract	Infective endocarditis (IE) is an infection of a heart valve or other cardiac structure at a site of endothelial damage. The definition has been also expanded to include infected cardiac devices. A variety of organ systems may be adversely affected in patients with IE. Although advances have improved the diagnostic accuracy for IE, morbidity and mortality remain remarkably high. This article reviews the pathophysiology, complications, diagnosis, and management of IE with recent updates to the literature and the major cardiovascular society guidelines. The increasingly prevalent clinical problem of intracardiac device-related IE is addressed, along with the recent changes to the IE prophylaxis guidelines.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Cardiac Surgical Procedures ; Endocarditis/diagnosis ; Endocarditis/microbiology ; Endocarditis/mortality ; Endocarditis/physiopathology ; Endocarditis/prevention & control ; Endocarditis/therapy ; Humans ; Practice Guidelines as Topic ; Prognosis ; Risk Factors
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2012-10-17
Publishing country	Singapore
Document type	Journal Article ; Review
ZDB-ID	2108910-3
ISSN	1530-6550
ISSN	1530-6550
DOI	10.3909/ricm0633
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Zs.A 6410: Show issues

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Article ; Online: Invasive hemodynamic evaluation in patients with mechanical aortic valves. Catheterization and cardiovascular interventions: official journal of the society for cardiac angiography & interventions 2013.

Kiefer, Todd L / Wang, Andrew / Harrison, J Kevin

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

2014 Volume 84, Issue 5, Page(s) 853–854

MeSH term(s)	Angiography/standards ; Angiography/trends ; Aortic Valve Stenosis/surgery ; Cardiac Catheterization/standards ; Cardiac Catheterization/trends ; Cardiac Surgical Procedures/standards ; Cardiac Surgical Procedures/trends ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/methods ; Hemodynamics/physiology ; Humans ; Periodicals as Topic ; Quality Improvement ; Societies, Medical
Language	English
Publishing date	2014-11-01
Publishing country	United States
Document type	Letter
ZDB-ID	1459995-8
ISSN	1522-726X ; 1522-1946
ISSN (online)	1522-726X
ISSN	1522-1946
DOI	10.1002/ccd.25067
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Article ; Online: Pulmonary hypertension related to left-sided cardiac pathology.

Kiefer, Todd L / Bashore, Thomas M

Pulmonary medicine

2011 Volume 2011, Page(s) 381787

Abstract: Pulmonary hypertension (PH) is the end result of a variety of diverse pathologic processes. The chronic elevation in pulmonary artery pressure often leads to right ventricular pressure overload and subsequent right ventricular failure. In patients with ... ...

Abstract	Pulmonary hypertension (PH) is the end result of a variety of diverse pathologic processes. The chronic elevation in pulmonary artery pressure often leads to right ventricular pressure overload and subsequent right ventricular failure. In patients with left-sided cardiac disease, PH is quite common and associated with increased morbidity and mortality. This article will review the literature as it pertains to the epidemiology, pathogenesis, and diagnosis of PH related to aortic valve disease, mitral valve disease, left ventricular systolic and diastolic dysfunction, and pulmonary veno-occlusive disease. Moreover, therapeutic strategies, which focus on treating the underlying cardiac pathology will be discussed.
Language	English
Publishing date	2011-05-29
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2603580-7
ISSN	2090-1844 ; 2090-1836
ISSN (online)	2090-1844
ISSN	2090-1836
DOI	10.1155/2011/381787
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Article ; Online: Left atrial appendage to great cardiac vein fistula complicating watchman left atrial appendage closure.

Vemulapalli, Sreekanth / Hurwitz Koweek, Lynne M / Kiefer, Todd L / Jackson, Kevin P / Piccini, Jonathan P

European heart journal

2016 Volume 37, Issue 20, Page(s) 1602

Language	English
Publishing date	2016-05-21
Publishing country	England
Document type	Journal Article
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehv609
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Article ; Online: Valve-in-Ring Transcatheter Aortic Valve Replacement After Left Ventricular Assist Device Therapy.

Chung, Matthew J / Ganapathi, Asvin M / Vora, Amit N / Schroder, Jacob N / Kiefer, Todd L / Hughes, G Chad

The Annals of thoracic surgery

2019 Volume 109, Issue 3, Page(s) e163–e165

Abstract: Aortic regurgitation after left ventricular assist device (LVAD) implantation is a well-described problem that decreases the clinical effectiveness of LVAD therapy and may eventually prompt consideration of aortic valve replacement once the regurgitation ...

Abstract	Aortic regurgitation after left ventricular assist device (LVAD) implantation is a well-described problem that decreases the clinical effectiveness of LVAD therapy and may eventually prompt consideration of aortic valve replacement once the regurgitation becomes severe. Transcatheter aortic valve replacement is an attractive, less invasive option compared with surgical aortic valve replacement in these patients. We report a valve-in-ring transcatheter aortic valve replacement for a patient with severe aortic regurgitation associated with LVAD destination therapy. Our case demonstrates that this approach is feasible in humans and can yield excellent clinical results.
MeSH term(s)	Aortic Valve/surgery ; Aortic Valve Insufficiency/surgery ; Heart-Assist Devices ; Humans ; Male ; Middle Aged ; Postoperative Complications/surgery ; Severity of Illness Index ; Transcatheter Aortic Valve Replacement/methods
Language	English
Publishing date	2019-08-22
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2019.06.094
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