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Article ; Online: Intracardiac bone cement embolism resulting in ventricular perforation: an unusual cause of sudden chest pain.

Schmiady, Martin O / Possner, Mathias / Horisberger, Thomas / Ouda, Ahmed

Interdisciplinary cardiovascular and thoracic surgery

2023 Volume 36, Issue 1

Abstract: Leakage of bone cement is a known complication after percutaneous kyphoplasty. In rare cases, bone cement can reach the venous system and cause life-threatening embolism. We present the case of a 73-year-old male, who was admitted to our hospital with ... ...

Abstract	Leakage of bone cement is a known complication after percutaneous kyphoplasty. In rare cases, bone cement can reach the venous system and cause life-threatening embolism. We present the case of a 73-year-old male, who was admitted to our hospital with new-onset chest pain and dyspnoea. He had a history of percutaneous kyphoplasty. Multimodal imaging showed intracardiac cement embolism in the right ventricle with penetration of the interventricular septum and perforation of the apex. The bone cement was successfully removed during open cardiac surgery.
Language	English
Publishing date	2023-02-20
Publishing country	England
Document type	Journal Article
ISSN	2753-670X
ISSN (online)	2753-670X
DOI	10.1093/icvts/ivac292
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Article ; Online: Abdominal Skeletal Muscle Index as a Potential Novel Biomarker in Adult Fontan Patients.

Possner, Mathias / Alsaied, Tarek / Siddiqui, Saira / Morales, David / Trout, Andrew T / Veldtman, Gruschen

CJC open

2020 Volume 2, Issue 2, Page(s) 55–61

Abstract: Background: Fontan palliation results in a chronic multisystem disorder with diminished exercise capacity and increased risk of muscle wasting. The aims of this study were to assess the feasibility of skeletal muscle mass measurements in Fontan patients ...

Abstract	Background: Fontan palliation results in a chronic multisystem disorder with diminished exercise capacity and increased risk of muscle wasting. The aims of this study were to assess the feasibility of skeletal muscle mass measurements in Fontan patients undergoing magnetic resonance imaging liver surveillance to compare muscle mass with a historic control and to assess its correlation with cardiorespiratory fitness. Methods: Skeletal muscle area (SMA) and skeletal muscle index (SMI) were measured at T12 and L3. A young, healthy historic cohort was used as a comparison group. Results: Forty patients with a Fontan circulation (mean age, 25.5 ± 7.9 years; 50% were men) were included. Measurements of SMA and SMI were feasible and highly reproducible. Mean SMA and SMI were significantly lower in women compared with men at both T12 (SMA: 25.1 ± 4.9 cm Conclusions: Abdominal skeletal muscle mass can be reproducibly determined on surveillance liver magnetic resonance imaging scans. Muscle wasting appears to occur commonly in Fontan patients. Further research is needed to better define the value of SMI as a biomarker in the Fontan population.
Language	English
Publishing date	2020-01-20
Publishing country	United States
Document type	Journal Article
ISSN	2589-790X
ISSN (online)	2589-790X
DOI	10.1016/j.cjco.2019.12.004
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Article ; Online: Timing of Repair in Tetralogy of Fallot: Effects on Outcomes and Myocardial Health.

Peck, Daniel / Tretter, Justin / Possner, Mathias / Yutzey, Katherine / Zafar, Farhan / Morales, David / Alsaied, Tarek

Cardiology in review

2020 Volume 29, Issue 2, Page(s) 62–67

Abstract: Early complete repair of tetralogy of Fallot (ToF) prior to 1 year of age has been demonstrated to be safe and has survival benefits over late repair. The age at repair of ToF affects long-term outcomes. This may largely be related to preserved, or ... ...

Abstract	Early complete repair of tetralogy of Fallot (ToF) prior to 1 year of age has been demonstrated to be safe and has survival benefits over late repair. The age at repair of ToF affects long-term outcomes. This may largely be related to preserved, or comparatively better, myocardial health. Most studies advocate for an age of repair between 3 and 6 months and certainly below the age of 1 year. Patients with severe right ventricular outflow tract obstruction represent an exception to this rule and may require neonatal repair or surgical and catheter-based palliation before surgery. Older age at repair beyond the first birthday leads to unfavorable right ventricular remodeling with increased right ventricular stiffness and hypertrophy and is associated with increased long-term ventricular tachycardia and all-cause mortality. In this article, we review the short- and long-term benefits of early repair, with a focus on long-term morbidity. In conclusion, we emphasize the importance of myocardial health and the relationship to early repair and advocate for the use of magnetic resonance imaging in adult patients with repaired ToF to detect myocardial fibrosis.
MeSH term(s)	Adult ; Aged ; Heart Ventricles ; Humans ; Infant ; Infant, Newborn ; Myocardium ; Tetralogy of Fallot/diagnostic imaging ; Tetralogy of Fallot/surgery ; Treatment Outcome ; Ventricular Remodeling
Language	English
Publishing date	2020-01-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1294965-6
ISSN	1538-4683 ; 1061-5377
ISSN (online)	1538-4683
ISSN	1061-5377
DOI	10.1097/CRD.0000000000000293
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Zs.A 4491: Show issues

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Article ; Online: Ebstein's Anomaly of the Tricuspid Valve: an Overview of Pathology and Management.

Possner, Mathias / Gensini, Francisco J / Mauchley, David C / Krieger, Eric V / Steinberg, Zachary L

Current cardiology reports

2020 Volume 22, Issue 12, Page(s) 157

Abstract: Purpose of review: Ebstein's anomaly (EA) is a rare, but complex form of congenital heart disease consisting of a right ventricular myopathy and morphologic tricuspid valve disease leading to a high incidence of right ventricular dysfunction and ... ...

Abstract	Purpose of review: Ebstein's anomaly (EA) is a rare, but complex form of congenital heart disease consisting of a right ventricular myopathy and morphologic tricuspid valve disease leading to a high incidence of right ventricular dysfunction and arrhythmias. This review offers an updated overview of the current understanding and management of patients with EA with a focus on the adult population. Recent findings: Increased understanding of anatomic accessory atrioventricular pathways in EA has resulted in an improvement in ablation techniques and long-term freedom of atrial arrhythmia recurrence. Despite an improvement in understanding and recognition of EA, significant disease heterogeneity and complex treatment options continue to challenge providers, with the best outcomes achieved at expert congenital heart disease centers.
MeSH term(s)	Adult ; Arrhythmias, Cardiac/etiology ; Ebstein Anomaly/diagnostic imaging ; Ebstein Anomaly/surgery ; Heart Defects, Congenital ; Humans ; Tricuspid Valve/diagnostic imaging ; Tricuspid Valve/surgery ; Tricuspid Valve Insufficiency
Language	English
Publishing date	2020-10-09
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/s11886-020-01412-z
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Zs.A 5524: Show issues

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Article ; Online: Thromboprophylaxis in Patients With Fontan Circulation.

Van den Eynde, Jef / Possner, Mathias / Alahdab, Fares / Veldtman, Gruschen / Goldstein, Bryan H / Rathod, Rahul H / Hoskoppal, Arvind K / Saraf, Anita / Feingold, Brian / Alsaied, Tarek

Journal of the American College of Cardiology

2023 Volume 81, Issue 4, Page(s) 374–389

Abstract: Background: The optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown.: Objectives: The aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in ... ...

Abstract	Background: The optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown. Objectives: The aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in a network meta-analysis. Methods: Relevant studies published by February 2022 were included. The primary efficacy outcome was thromboembolic events; major bleeding was a secondary safety outcome. Frequentist network meta-analyses were conducted to estimate the incidence rate ratios (IRRs) of both outcomes. Ranking of treatments was performed based on probability (P) score. Results: A total of 21 studies were included (26,546 patient-years). When compared with no thromboprophylaxis, NOAC (IRR: 0.11; 95% CI: 0.03-0.40), warfarin (IRR: 0.23; 95% CI: 0.14-0.37), and aspirin (IRR: 0.24; 95% CI: 0.15-0.39) were all associated with significantly lower rates of thromboembolic events. However, the network meta-analysis revealed no significant differences in the rates of major bleeding (NOAC: IRR: 1.45 [95% CI: 0.28-7.43]; warfarin: IRR: 1.38 [95% CI: 0.41-4.69]; and aspirin: IRR: 0.72 [95% CI: 0.20-2.58]). Rankings, which simultaneously analyze competing interventions, suggested that NOACs have the highest P score to prevent thromboembolic events (P score 0.921), followed by warfarin (P score 0.582), aspirin (P score 0.498), and no thromboprophylaxis (P score 0.001). Aspirin tended to have the most favorable overall profile. Conclusions: Aspirin, warfarin, and NOAC are associated with lower risk of thromboembolic events. Recognizing the limited number of patients and heterogeneity of studies using NOACs, the results support the safety and efficacy of NOACs in patients with a Fontan circulation.
MeSH term(s)	Humans ; Warfarin/adverse effects ; Anticoagulants/adverse effects ; Fontan Procedure/adverse effects ; Fontan Procedure/methods ; Administration, Oral ; Hemorrhage/epidemiology ; Thromboembolism/epidemiology ; Thromboembolism/etiology ; Thromboembolism/prevention & control ; Aspirin/adverse effects ; Atrial Fibrillation/complications ; Stroke/prevention & control ; Treatment Outcome
Chemical Substances	Warfarin (5Q7ZVV76EI) ; Anticoagulants ; Aspirin (R16CO5Y76E)
Language	English
Publishing date	2023-01-07
Publishing country	United States
Document type	Meta-Analysis ; Journal Article
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2022.10.037
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Zs.A 1846: 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)
Zs.MO 196: Show issues

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Article ; Online: Decreased clinical performance in TGA-ASO patients after RVOT interventions; a multicenter European collaboration.

International journal of cardiology

2024 , Page(s) 132027

Abstract: Background: In patients with transposition of the great arteries and an arterial switch operation (TGA-ASO) right ventricular outflow tract (RVOT) obstruction is a common complication requiring one or more RVOT interventions.: Objectives: We aimed to ...

Abstract	Background: In patients with transposition of the great arteries and an arterial switch operation (TGA-ASO) right ventricular outflow tract (RVOT) obstruction is a common complication requiring one or more RVOT interventions. Objectives: We aimed to assess cardiopulmonary exercise capacity and right ventricular function in patients stratified for type of RVOT intervention. Methods: TGA-ASO patients (≥16 years) were stratified by type of RVOT intervention. The following outcome parameters were included: predicted (%) peak oxygen uptake (peak VO2), tricuspid annular plane systolic excursion (TAPSE), tricuspid Lateral Annular Systolic Velocity (TV S'), right ventricle (RV)-arterial coupling (defined as TAPSE/RV systolic pressure ratio), and N-terminal proBNP (NT-proBNP). Results: 447 TGA patients with a mean age of 25.0 (interquartile range (IQR) 21-29) years were included. Patients without previous RVOT intervention (n = 338, 76%) had a significantly higher predicted peak VO2 (78.0 ± 17.4%) compared to patients with single approach catheter-based RVOT intervention (73.7 ± 12.7%), single approach surgical RVOT intervention (73.8 ± 28.1%), and patients with multiple approach RVOT intervention (66.2 ± 14.0%, p = 0.021). RV-arterial coupling was found to be significantly lower in patients with prior catheter-based and/or surgical RVOT intervention compared to patients without any RVOT intervention (p = 0.029). Conclusions: TGA patients after a successful arterial switch repair have a decreased exercise capacity. A considerable amount of TGA patients with either catheter or surgical RVOT intervention perform significantly worse compared to patients without RVOT interventions.
Language	English
Publishing date	2024-04-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2024.132027
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Zs.A 1673: Show issues

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Article ; Online: Dynamic exercise changes in venous pressure and liver stiffness in Fontan patients: effects of Treprostinil.

Possner, Mathias / Chaudhry, Anisa / Dillman, Jonathan R / Urbina, Elaine M / Gao, Zhiqian / McCoy, Connie / Faust, Michelle / Rossiter, Harry B / Powell, Adam W / Mays, Wayne / Veldtman, Gruschen

Cardiology in the young

2021 Volume 31, Issue 8, Page(s) 1283–1289

Abstract: Background: Systemic venous hypertension and low cardiac output are believed to be important mediators of liver injury after the Fontan procedure. Pulmonary vasodilators have the potential to improve such haemodynamics. The aim of this study was to ... ...

Abstract	Background: Systemic venous hypertension and low cardiac output are believed to be important mediators of liver injury after the Fontan procedure. Pulmonary vasodilators have the potential to improve such haemodynamics. The aim of this study was to assess the acute effects of exercise on liver stiffness and venous pressures and to assess the impact of inhaled Treprostinil on this response. Methods: In this prospective, double-blind, placebo-controlled, crossover trial, 14 patients with a Fontan circulation were randomised to inhalation of placebo and Treprostinil. Incremental and constant work rate exercise tests were performed to assess the effect of Treprostinil on exercise tolerance. Venous pressures were measured throughout and liver stiffness at rest and immediately after peak exercise. Results: Mean age was 27.8 ± 7.9 years and 66% were females. Exercise acutely increased liver stiffness by 30% (mean shear wave speed: 2.38 ± 0.71 versus 2.89 ± 0.51 ms, p = 0.02). Peripheral venous pressures increased acutely during both incremental (12.1 ± 2.4 versus 22.6 ± 8.0 mmHg, p < 0.001) and constant work rate exercise (12.5 ± 2.5 versus 23.4 ± 5.2 mmHg, p < 0.001). Overall, Treprostinil failed to attenuate exercise-induced increases in liver stiffness. Compared with placebo, Treprostinil did not significantly impact venous pressure responses, VO2peak, nor exercise endurance times. Conclusions: Peripheral venous pressure increased acutely during exercise by an average of 88% above baseline and was not altered by administration of inhaled Treprostinil. Liver stiffness measured immediately post-exercise increased acutely by an average of 30%, with no attenuation following Treprostinil inhalation.
MeSH term(s)	Adult ; Epoprostenol/analogs & derivatives ; Exercise Tolerance ; Female ; Humans ; Liver ; Prospective Studies ; Venous Pressure ; Young Adult
Chemical Substances	Epoprostenol (DCR9Z582X0) ; treprostinil (RUM6K67ESG)
Language	English
Publishing date	2021-01-28
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1078466-4
ISSN	1467-1107 ; 1047-9511
ISSN (online)	1467-1107
ISSN	1047-9511
DOI	10.1017/S1047951121000159
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Zs.A 4050: Show issues

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Article ; Online: Atrial function in the Fontan circulation: comparison with invasively assessed systemic ventricular filling pressure.

Veldtman, Gruschen / Possner, Mathias / Mohty, Dania / Issa, Ziyad / Alsaleh, Monerah / AlMarzoog, AlJuhara Thaar / Emmanual, Shisamma / Salam, Yezan / AlHabdan, Mohammed Saleh / Alsaied, Tarek / Rathod, Rahul H / Siblini, Ghassan / Vriz, Olga

The international journal of cardiovascular imaging

2021 Volume 37, Issue 9, Page(s) 2651–2660

Abstract: Abnormal atrial mechanics in biventricular circulations have been associated with elevated left heart filling pressures. Similar associations in the Fontan circulation are unknown. The aim of this study was to examine the relationship between atrial ... ...

Abstract	Abnormal atrial mechanics in biventricular circulations have been associated with elevated left heart filling pressures. Similar associations in the Fontan circulation are unknown. The aim of this study was to examine the relationship between atrial mechanics and invasively assessed hemodynamic parameters late after the Fontan operation. Thirty-nine Fontan patients with echocardiographic and invasive hemodynamic studies done within 48 h were included and were compared to 40 age-matched healthy controls. Atrial and ventricular strain measurements were measured offline using 2-dimensional speckle-tracking. Mean age was 10.2 ± 6.7 years and 24 (62%) were male. Atrial strain measures were lower in Fontan patients compared to healthy controls. There was no significant association between atrial strain measurements and Fontan systemic ventricular filling pressures (SVFP) as indicated by pulmonary artery occlusion pressures, direct left atrial pressure or systemic ventricular end-diastolic pressure. Global atrial strain was not correlated with segmental atrial strain in the pulmonary venous atrium. Global atrial reservoir strain was positively correlated with pulmonary vascular resistance (r = 0.508, p = 0.045). Global atrial conduit strain was positively correlated with E/A ratio of the AV valve inflow (r = 0.555, p = 0.002). Atrial and ventricular strain measurements were not significantly correlated. In patients with a Fontan, global atrial function is significantly depressed, and is uncoupled from segmental left lateral atrial function. Global as well as segmental atrial mechanics are not significantly associated with SVFPs in Fontan patients. Instead, global atrial reservoir function appears to parallel pulmonary vascular resistance.
MeSH term(s)	Atrial Function, Left ; Child ; Echocardiography ; Fontan Procedure/adverse effects ; Humans ; Male ; Predictive Value of Tests ; Ventricular Pressure
Language	English
Publishing date	2021-05-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2055311-0
ISSN	1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
ISSN (online)	1875-8312 ; 1573-0743
ISSN	1569-5794 ; 0167-9899
DOI	10.1007/s10554-021-02298-w
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Zs.A 2104: Show issues

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Article ; Online: Hepatic Steatosis in Patients With Single Ventricle and a Fontan Circulation.

Katz, David A / Peck, Daniel / Lubert, Adam M / Possner, Mathias / Zafar, Faizeen / Trout, Andrew T / Palermo, Joseph J / Anwar, Nadeem / Dillman, Jonathan R / Powell, Adam W / Xanthakos, Stavra A / Opotowsky, Alexander R / Veldtman, Gruschen / Alsaied, Tarek

Journal of the American Heart Association

2021 Volume 10, Issue 9, Page(s) e019942

Abstract: Background Hepatic steatosis, caused by nonalcoholic fatty liver disease, is a leading cause of chronic liver disease. The interplay between hepatic steatosis and the development of liver disease following the Fontan procedure is not well understood. ... ...

Abstract	Background Hepatic steatosis, caused by nonalcoholic fatty liver disease, is a leading cause of chronic liver disease. The interplay between hepatic steatosis and the development of liver disease following the Fontan procedure is not well understood. This study examined the prevalence and associations of hepatic steatosis in patients with a Fontan circulation. Methods and Results This was a single-center retrospective study of 95 patients with a Fontan circulation with liver magnetic resonance imaging performed between 2012 and 2019. The average age at magnetic resonance imaging was 21.5±8.5 years. The percent liver fat signal was determined using magnetic resonance chemical shift-encoded proton density fat fraction imaging. Hepatic steatosis was defined as liver fat ≥5% and was present in 10.5% of the cohort. The presence of hepatic steatosis was associated with higher body mass index (29±4 versus 24±6 kg/m
MeSH term(s)	Adolescent ; Adult ; Child ; Echocardiography ; Fatty Liver/diagnosis ; Fatty Liver/epidemiology ; Fatty Liver/etiology ; Female ; Follow-Up Studies ; Fontan Procedure/adverse effects ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/surgery ; Heart Ventricles/abnormalities ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/surgery ; Humans ; Liver/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ohio/epidemiology ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prevalence ; Prognosis ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2021-04-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.120.019942
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Article ; Online: Effect of phosphodiesterase-5 inhibition on SystEmic Right VEntricular size and function. A multicentre, double-blind, randomized, placebo-controlled trial: SERVE.

European journal of heart failure

2023 Volume 25, Issue 7, Page(s) 1105–1114

Abstract: Aims: In adults with congenital heart disease and systemic right ventricles, progressive right ventricular systolic dysfunction is common and is associated with adverse outcomes. Our aim was to assess the impact of the phosphodiesterase-5-inhibitor ... ...

Abstract	Aims: In adults with congenital heart disease and systemic right ventricles, progressive right ventricular systolic dysfunction is common and is associated with adverse outcomes. Our aim was to assess the impact of the phosphodiesterase-5-inhibitor tadalafil on right ventricular systolic function. Methods and results: This was a double-blind, randomized, placebo-controlled, multicentre superiority trial (NCT03049540) involving 100 adults with systemic right ventricles (33 women, mean age: 40.7 ± 10.7 years), comparing tadalafil 20 mg once daily versus placebo (1:1 ratio). The primary endpoint was the change in right ventricular end-systolic volume after 3 years of therapy. Secondary endpoints were changes in right ventricular ejection fraction, exercise capacity and N-terminal pro-B-type natriuretic peptide concentration. Primary endpoint assessment by intention to treat analysis at 3 years of follow-up was possible in 83 patients (42 patients in the tadalafil group and 41 patients in the placebo group). No significant changes over time in right ventricular end-systolic volumes were observed in the tadalafil and the placebo group, and no significant differences between treatment groups (3.4 ml, 95% confidence interval -4.3 to 11.0, p = 0.39). No significant changes over time were observed for the pre-specified secondary endpoints for the entire study population, without differences between the tadalafil and the placebo group. Conclusions: In this trial in adults with systemic right ventricles, right ventricular systolic function, exercise capacity and neuro-hormonal activation remained stable over a 3-year follow-up period. No significant treatment effect of tadalafil was observed. Further research is needed to find effective treatment for improvement of ventricular function in adults with systemic right ventricles.
MeSH term(s)	Adult ; Humans ; Female ; Middle Aged ; Heart Ventricles/diagnostic imaging ; Transposition of Great Vessels/complications ; Transposition of Great Vessels/drug therapy ; Tadalafil/therapeutic use ; Tadalafil/pharmacology ; Cyclic Nucleotide Phosphodiesterases, Type 5/pharmacology ; Cyclic Nucleotide Phosphodiesterases, Type 5/therapeutic use ; Stroke Volume ; Heart Failure ; Ventricular Function, Right/physiology ; Double-Blind Method
Chemical Substances	Tadalafil (742SXX0ICT) ; Cyclic Nucleotide Phosphodiesterases, Type 5 (EC 3.1.4.35)
Language	English
Publishing date	2023-06-13
Publishing country	England
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1483672-5
ISSN	1879-0844 ; 1388-9842
ISSN (online)	1879-0844
ISSN	1388-9842
DOI	10.1002/ejhf.2924
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Zs.A 5299: Show issues

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