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Article ; Online: The Emerging Role of Intracardiac Echocardiography (ICE) in Left Atrial Appendage Closure (LAAC).

Jhand, Aravdeep / Goldsweig, Andrew M

2023 Volume 25, Issue 10, Page(s) 1223–1232

Abstract: Purpose of review: Intracardiac echocardiography (ICE) has emerged as a powerful imaging tool to guide percutaneous left atrial appendage closure (LAAC). Herein, we review an imaging protocol for ICE-guided LAAC and discuss the evidence for its use.: ... ...

Abstract	Purpose of review: Intracardiac echocardiography (ICE) has emerged as a powerful imaging tool to guide percutaneous left atrial appendage closure (LAAC). Herein, we review an imaging protocol for ICE-guided LAAC and discuss the evidence for its use. Recent findings: Standardized imaging protocols have been proposed but have not been fully validated. ICE imaging yields similar procedural and clinical outcomes when compared to transesophageal echocardiography (TEE) to guide LAAC. Despite benefits of avoiding general anesthesia, TEE, and multiple physicians for LAAC procedures, ICE imaging remains under-utilized. Novel ICE catheters with 3D imaging capabilities may improve accuracy and efficiency of LAAC device implantation. ICE guidance is feasible, safe, and effective for LAAC. As the field evolves, further studies will be necessary to assess this technological advancement in imaging guidance.
MeSH term(s)	Humans ; Atrial Appendage/diagnostic imaging ; Atrial Appendage/surgery ; Treatment Outcome ; Cardiac Catheterization/methods ; Echocardiography, Transesophageal ; Cardiac Surgical Procedures ; Atrial Fibrillation/diagnostic imaging ; Atrial Fibrillation/surgery
Language	English
Publishing date	2023-08-23
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/s11886-023-01940-4
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Article ; Online: A case report of non-dominant right coronary artery occlusion: not always benign!

Shabbir, Muhammad Asim / Jhand, Aravdeep / Velagapudi, Poonam

European heart journal. Case reports

2023 Volume 7, Issue 7, Page(s) ytad303

Abstract: Background: Non-dominant right coronary artery (RCA) occlusion is uncommon and usually affects a small area of the myocardium. Rarely, it can complicate fatal outcomes such as shock, cardiac arrest, bradyarrhythmia, or tachyarrhythmia.: Case summary: ...

Abstract	Background: Non-dominant right coronary artery (RCA) occlusion is uncommon and usually affects a small area of the myocardium. Rarely, it can complicate fatal outcomes such as shock, cardiac arrest, bradyarrhythmia, or tachyarrhythmia. Case summary: A 50-year-old man with no significant medical history presented with ventricular fibrillation (VF) cardiac arrest. He required prolonged cardiopulmonary resuscitation and multiple defibrillation shocks to achieve return of spontaneous circulation. ST elevation was noted on inferior leads. Due to refractory VF, extracorporeal membrane oxygenation (ECMO) was initiated followed by coronary angiography which demonstrated 100% acute occlusion of proximal RCA (small non-dominant), 90% stenosis of ramus intermedius (RI), and 80% stenosis of obtuse marginal (OM) arteries. Left ventricular ejection fraction was 35%. Percutaneous coronary intervention (PCI) of the RCA was performed with drug eluting stent. He had excellent clinical recovery without any neurological deficits. The ECMO was weaned off and decannulated within three days. Guideline directed medical therapy was administered. He remained hemodynamically stable and underwent staged PCI of RI and OM to achieve complete revascularization. Discussion: Non-dominant RCA lesions are usually considered benign. However, when acute RCA occlusion results in cardiac arrest as seen in our patient, prompt revascularization is necessary. Treatment of cardiogenic shock with appropriate pharmacological and mechanical therapies is important, such as ECMO in our patient.
Language	English
Publishing date	2023-07-26
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytad303
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Article ; Online: A penny saved: cost reduction in transcatheter aortic valve replacement.

Jhand, Aravdeep S / Goldsweig, Andrew M

European heart journal. Quality of care & clinical outcomes

2021 Volume 7, Issue 3, Page(s) 219–221

MeSH term(s)	Aortic Valve Stenosis/surgery ; Heart Valve Prosthesis Implantation ; Humans ; Transcatheter Aortic Valve Replacement
Language	English
Publishing date	2021-01-23
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	2823451-0
ISSN	2058-1742 ; 2058-5225
ISSN (online)	2058-1742
ISSN	2058-5225
DOI	10.1093/ehjqcco/qcab003
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Article ; Online: Rotational atherectomy for calcified lesions during ST-segment elevation myocardial infarction: a case series and literature review.

Brown, Kristen N / Jhand, Aravdeep S / Chatzizisis, Yiannis / Goldsweig, Andrew M

European heart journal. Case reports

2023 Volume 7, Issue 5, Page(s) ytad207

Abstract: Background: ST elevation myocardial infarction (STEMI) has traditionally been a relative contraindication for the utilization of rotational atherectomy (RA). However, in severely calcified lesions, RA may be necessary to facilitate stent delivery.: ... ...

Abstract	Background: ST elevation myocardial infarction (STEMI) has traditionally been a relative contraindication for the utilization of rotational atherectomy (RA). However, in severely calcified lesions, RA may be necessary to facilitate stent delivery. Case summary: Three patients who present with STEMI are found to have severely calcified lesions on intravascular ultrasound. Equipment was unable to pass the lesions in all three cases. Rotational atherectomy was therefore performed to allow for stent passage. All three cases had achieved successful revascularization with no intraoperative or post-operative complications. The patients remained angina-free the rest of their hospitalization and at the 4 month follow-up. Discussion: Rotational atherectomy for calcific plaque modification during STEMI when equipment will not pass is a feasible and safe therapeutic option.
Language	English
Publishing date	2023-05-09
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytad207
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Article ; Online: Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock.

Jhand, Aravdeep / Shabbir, Muhammad Asim / Um, John / Velagapudi, Poonam

Journal of visualized experiments : JoVE

2023 , Issue 199

Abstract: Cardiogenic shock (CS) is a clinical condition characterized by inadequate tissue perfusion in the setting of low cardiac output. CS is the leading cause of death following acute myocardial infarction (AMI). Several temporary mechanical support devices ... ...

Abstract	Cardiogenic shock (CS) is a clinical condition characterized by inadequate tissue perfusion in the setting of low cardiac output. CS is the leading cause of death following acute myocardial infarction (AMI). Several temporary mechanical support devices are available for hemodynamic support in CS until clinical recovery ensues or until more definitive surgical procedures have been performed. Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has evolved as a powerful treatment option for short-term circulatory support in refractory CS. In the absence of randomized clinical trials, the utilization of ECMO has been guided by clinical experience and based on data from registries and observational studies. Survival to hospital discharge with the use of VA-ECMO ranges from 28-67%. The initiation of ECMO requires venous and arterial cannulation, which can be performed either percutaneously or by surgical cutdown. Components of an ECMO circuit include an inflow cannula that draws blood from the venous system, a pump, an oxygenator, and an outflow cannula that returns blood to the arterial system. Management considerations post ECMO initiation include systemic anticoagulation to prevent thrombosis, left ventricle unloading strategies to augment myocardial recovery, prevention of limb ischemia with a distal perfusion catheter in cases of femoral arterial cannulation, and prevention of other complications such as hemolysis, air embolism, and Harlequin syndrome. ECMO is contraindicated in patients with uncontrolled bleeding, unrepaired aortic dissection, severe aortic insufficiency, and in futile cases such as severe neurological injury or metastatic malignancies. A multi-disciplinary shock team approach is recommended while considering patients for ECMO. Ongoing studies will evaluate whether the addition of routine ECMO improves survival in AMI patients with CS who undergo revascularization.
MeSH term(s)	Humans ; Extracorporeal Membrane Oxygenation ; Shock, Cardiogenic/therapy ; Perfusion ; Myocardial Infarction/therapy ; Autonomic Nervous System Diseases
Language	English
Publishing date	2023-09-01
Publishing country	United States
Document type	Journal Article ; Video-Audio Media
ZDB-ID	2259946-0
ISSN	1940-087X ; 1940-087X
ISSN (online)	1940-087X
ISSN	1940-087X
DOI	10.3791/62052
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Article ; Online: Think Left and Think Right: Left Internal Mammary Artery Graft Unexpectedly Originating From Arteria Lusoria.

Mawer, Scott M / Jhand, Aravdeep S / Goldsweig, Andrew M

JACC. Cardiovascular interventions

2020 Volume 13, Issue 24, Page(s) e217–e218

MeSH term(s)	Cardiovascular Abnormalities ; Humans ; Internal Mammary-Coronary Artery Anastomosis ; Mammary Arteries ; Subclavian Artery ; Treatment Outcome
Language	English
Publishing date	2020-11-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2020.09.037
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Zs.A 6669: Show issues

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Article ; Online: Transcatheter Aortic Valve Implantation in Mixed Aortic Valve Disease: A Multicenter Study.

Guddeti, Raviteja R / Gill, Gauravpal S / Parekh, Jai D / Jhand, Aravdeep S / Walters, Ryan W / Panaich, Sidakpal S / Goldsweig, Andrew M / Alla, Venkata Mahesh

The American journal of cardiology

2023 Volume 203, Page(s) 394–402

Abstract: Mixed aortic valve disease (MAVD), defined by the concurrent presence of aortic stenosis (AS) and insufficiency is frequently seen in patients who have undergone transcatheter aortic valve implantation (TAVI). However, studies comparing the outcomes of ... ...

Abstract	Mixed aortic valve disease (MAVD), defined by the concurrent presence of aortic stenosis (AS) and insufficiency is frequently seen in patients who have undergone transcatheter aortic valve implantation (TAVI). However, studies comparing the outcomes of TAVI in MAVD versus isolated AS have demonstrated conflicting results. Therefore, we aim to assess the outcomes of TAVI in patients with MAVD in comparison with those with isolated severe AS. Patients who underwent native valve TAVI for severe AS at 3 tertiary care academic centers between January 2012 and December 2020 were included and categorized into 3 groups based on concomitant aortic insufficiency (AI) as follows: group 1, no AI; group 2, mild AI; and group 3, moderate to severe AI. Outcomes of interest included all-cause mortality and all-cause readmission rates at 30 days and 1 year. Other outcomes include bleeding, stroke, vascular complications, and the incidence of paravalvular leak at 30 days after the procedure. Of the 1,588 patients who underwent TAVI during the study period, 775 patients (49%) had isolated AS, 606 (38%) had mild AI, and 207 (13%) had moderate to severe AI. Society of Thoracic Surgeons risk scores were significantly different among the 3 groups (5% in group 1, 5.5% in group 2, and 6% in group 3, p = 0.003). Balloon-expandable valves were used in about 2/3 of the population. No statistically significant differences in 30-day or 1-year all-cause mortality and all-cause readmission rates were noted among the 3 groups. Post-TAVI paravalvular leak at follow-up was significantly lower in group 1 (2.3%) and group 2 (2%) compared with group 3 (5.6%) (p = 0.01). In summary, TAVI in MAVD is associated with comparable outcomes at 1 year compared with patients with isolated severe AS.
MeSH term(s)	Humans ; Transcatheter Aortic Valve Replacement/methods ; Aortic Valve/surgery ; Heart Valve Prosthesis/adverse effects ; Treatment Outcome ; Aortic Valve Stenosis ; Aortic Valve Insufficiency/epidemiology ; Aortic Valve Insufficiency/surgery ; Aortic Valve Insufficiency/etiology ; Postoperative Complications/etiology
Language	English
Publishing date	2023-07-29
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.07.064
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Article ; Online: Two Limitations of Subcutaneous Implantable Cardioverter Defibrillator in the Same Patient Warranting Its Explant.

Dhawan, Rahul / Ahmad, Mansoor / Jhand, Aravdeep / Kanwal, Sumera / Jamil, Adeel / Khan, Faris

The American journal of case reports

2021 Volume 22, Page(s) e928983

Abstract: BACKGROUND A subcutaneous implantable cardioverter defibrillator (S-ICD) is preferred over a transvenous implantable cardioverter defibrillator (TV-ICD) in selected cases owing to a lower rate of lead-related complications such as infections and venous ... ...

Abstract	BACKGROUND A subcutaneous implantable cardioverter defibrillator (S-ICD) is preferred over a transvenous implantable cardioverter defibrillator (TV-ICD) in selected cases owing to a lower rate of lead-related complications such as infections and venous thrombosis. However, the S-ICD has its own limitations, including inappropriate shocks due to oversensed events, and the inability to treat ventricular tachycardia (VT) below a heart rate of 170 beats per minutes (bpm). We present a patient case which showed manifestations of both of these limitations, warranting explant of the device. CASE REPORT A 50-year-old man with a history of nonischemic cardiomyopathy and VT had a S-ICD placed at an outside facility. However, he continued to have VT despite on anti-arrhythmic drugs and required recurrent S-ICD shocks. Device interrogation showed that he was intermittently receiving appropriate shocks for slower VT (with a heart rate ranging from 150 bpm to 160 bpm) due to oversensing of T waves. However, treatment was delayed for other VT episodes owing to appropriate sensing and the patient's heart rate being below the lowest detection zone for S-ICD. Due to slower VT cycle length and frequent oversensed events, the S-ICD was ultimately replaced by a TV-ICD system. CONCLUSIONS This case report emphasizes the importance of S-ICD pre-implant vector screening and the need for paying attention to VT cycle length to prevent inappropriate device shocks and/or delayed therapies.
MeSH term(s)	Arrhythmias, Cardiac ; Defibrillators, Implantable/adverse effects ; Electric Countershock ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular/therapy ; Treatment Outcome
Language	English
Publishing date	2021-04-29
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.928983
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Article: Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.

Machanahalli Balakrishna, Akshay / Dilsaver, Danielle B / Aboeata, Ahmed / Gowda, Ramesh M / Goldsweig, Andrew M / Vallabhajosyula, Saraschandra / Anderson, Jason H / Simard, Trevor / Jhand, Aravdeep

Journal of clinical medicine

2023 Volume 12, Issue 15

Abstract: Background: Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in ... ...

Abstract	Background: Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves. Methods: A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves. Results: A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, Conclusions: The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.
Language	English
Publishing date	2023-07-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12154886
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Article ; Online: Pathogenesis, Evaluation, and Management of Pulmonary Vein Stenosis: JACC Review Topic of the Week.

Simard, Trevor / Sarma, Dhruv / Miranda, William R / Jain, C Charles / Anderson, Jason H / Collins, Jeremy D / El Sabbagh, Abdallah / Jhand, Aravdeep / Peikert, Tobias / Reeder, Guy S / Munger, Thomas M / Packer, Douglas L / Holmes, David R

Journal of the American College of Cardiology

2023 Volume 81, Issue 24, Page(s) 2361–2373

Abstract: Pulmonary vein stenosis (PVS) can arise from several etiologies, including congenital, acquired, and iatrogenic sources. PVS presents insidiously, leading to significant delays in diagnosis. A high index of suspicion and dedicated noninvasive evaluation ... ...

Abstract	Pulmonary vein stenosis (PVS) can arise from several etiologies, including congenital, acquired, and iatrogenic sources. PVS presents insidiously, leading to significant delays in diagnosis. A high index of suspicion and dedicated noninvasive evaluation are key to diagnosis. Once diagnosed, both noninvasive and invasive evaluation may afford further insights into the relative contribution of PVS to symptoms. Treatment of underlying reversible pathologies coupled with transcatheter balloon angioplasty and stenting for persistent severe stenoses are established approaches. Ongoing refinements in diagnostic modalities, interventional approaches, postintervention monitoring, and medical therapies hold promise to further improve patient outcomes.
MeSH term(s)	Humans ; Stenosis, Pulmonary Vein/diagnosis ; Stenosis, Pulmonary Vein/etiology ; Stenosis, Pulmonary Vein/therapy ; Constriction, Pathologic/diagnosis ; Constriction, Pathologic/etiology ; Constriction, Pathologic/therapy ; Angioplasty, Balloon ; Stents
Language	English
Publishing date	2023-03-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2023.04.016
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