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  1. Article: Noisy Breathing in an Infant: A Case Report.

    Sang, Charlie J / Hebson, Camden

    Cureus

    2021  Volume 13, Issue 1, Page(s) e13015

    Abstract: The diagnosis of vascular rings is challenging and may be delayed as symptoms overlap with more common conditions associated with childhood. Underlying genetic associations of this condition remain largely undiscovered. In this report, we present a ... ...

    Abstract The diagnosis of vascular rings is challenging and may be delayed as symptoms overlap with more common conditions associated with childhood. Underlying genetic associations of this condition remain largely undiscovered. In this report, we present a patient with a double aortic arch and highlight the importance of diagnostic imaging. We also engage in a review of the important genetic considerations.
    Language English
    Publishing date 2021-01-30
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.13015
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  2. Article ; Online: To flip or not: Case series of coronary angioplasty in patients with right-sided heart.

    Kelley, Brian P / Glasco, Shanice / Sang, Charlie J / Yoo, Bianca / Yeung, Michael / Zhang, Jiandong

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

    2024  Volume 103, Issue 4, Page(s) 565–569

    Abstract: Coronary angioplasty in patients with a right-sided heart may be difficult due to challenges in engaging the coronary arteries, interpreting angiogram, and further delivering intracoronary therapies. We present our experience of percutaneous coronary ... ...

    Abstract Coronary angioplasty in patients with a right-sided heart may be difficult due to challenges in engaging the coronary arteries, interpreting angiogram, and further delivering intracoronary therapies. We present our experience of percutaneous coronary intervention in two cases and propose a practical algorithm to approach cardiac catheterization in these patients.
    MeSH term(s) Humans ; Treatment Outcome ; Dextrocardia ; Angioplasty, Balloon, Coronary ; Percutaneous Coronary Intervention/adverse effects ; Coronary Angiography
    Language English
    Publishing date 2024-02-12
    Publishing country United States
    Document type Case Reports
    ZDB-ID 1459995-8
    ISSN 1522-726X ; 1522-1946
    ISSN (online) 1522-726X
    ISSN 1522-1946
    DOI 10.1002/ccd.30973
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    Zs.A 1226: Show issues Location:
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  3. Article ; Online: Coronary artery aneurysm in Loeys-Dietz syndrome: a case report.

    Jost, Zachary T / Sang, Charlie J / Lertwilaiwittaya, Pongtawat / Chapman, Gregory D

    European heart journal. Case reports

    2022  Volume 6, Issue 6, Page(s) ytac204

    Abstract: Background: Loeys-Dietz syndrome (LDS) is a connective tissue disorder that commonly presents with vascular abnormalities. Owing to the rarity and severity of the condition, consensus guidelines for aortic surgery thresholds vary. In addition, ... ...

    Abstract Background: Loeys-Dietz syndrome (LDS) is a connective tissue disorder that commonly presents with vascular abnormalities. Owing to the rarity and severity of the condition, consensus guidelines for aortic surgery thresholds vary. In addition, evaluation of coronary arteries in patients with LDS (either routinely or before aortic root surgery) remain undefined. In this case report, we discuss a patient with LDS who found to have an ectatic aortic root and a coronary artery aneurysm and discuss guidelines for evaluation and management in this patient population.
    Case summary: A 48-year-old woman was incidentally found to have a 45 mm ectatic aortic root during evaluation for a neck mass. As part of pre-operative evaluation for aortic root replacement, left heart catheterization revealed a left main coronary artery aneurysm. Family history revealed aortic aneurysms, sudden cardiac death, and tall height. Physical examination was notable for pectus excavatum and elongated limbs. Workup for inflammatory aetiologies of aortic root dilation was negative. Genetic testing revealed a heterozygous pathogenic
    Discussion: In this case, we describe a patient with LDS who was noted to have a coronary artery aneurysm, a rare finding in the initial presentation of disease. In addition, we examine guidelines regarding evaluation of management of aortic root disease and coronary aneurysms.
    Language English
    Publishing date 2022-05-13
    Publishing country England
    Document type Case Reports
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytac204
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  4. Article ; Online: Massive pulmonary embolism in a COVID-19 patient: a case report.

    Sang, Charlie J / Heindl, Brittain / Von Mering, Gregory / Rajapreyar, Indranee

    European heart journal. Case reports

    2020  Volume 4, Issue FI1, Page(s) 1–5

    Abstract: Background: Myocardial injury is associated with excess mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, and the mechanisms of injury are diverse. Coagulopathy associated with this infection may have unique ... ...

    Abstract Background: Myocardial injury is associated with excess mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, and the mechanisms of injury are diverse. Coagulopathy associated with this infection may have unique cardiovascular implications.
    Case summary: We present a case of 62-year-old male who presented after experiencing syncope and cardiac arrest. Given the clinical presentation and electrocardiographic findings, there was concern for acute coronary syndrome. However, coronary angiogram did not reveal significant coronary obstruction. Due to the unclear nature of his presentation, a bedside echocardiogram was rapidly performed and was indicative of right ventricular strain. Due to these findings, a pulmonary angiogram was performed that revealed massive pulmonary embolism. He successfully underwent catheter-directed thrombolysis and, after a prolonged hospital stay, was discharged home on lifelong anticoagulation.
    Discussion: The impact of coronavirus disease-2019 (COVID-19) on the cardiovascular system has been prominent and multifaceted. COVID-19 can have wide-ranging effects on the cardiovascular system due to coagulopathy with resultant venous and arterial thrombo-embolism. Due to the critical condition of many patients affected by COVID-19, imaging for thrombo-embolic events is often delayed. With the use of bedside echocardiogram, observation of right ventricular strain may be critical in raising suspicion for pulmonary embolism, especially when atypical features are noted on electrocardiogram.
    Keywords covid19
    Language English
    Publishing date 2020-07-21
    Publishing country England
    Document type Case Reports
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytaa223
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  5. Article ; Online: Heart failure in an elderly man: where is that coronary?

    Sang, Charlie J / Clarkson, Stephen A / Jackson, Elizabeth A / Al Solaiman, Firas / Cribbs, Marc G

    Cardiology in the young

    2021  Volume 31, Issue 6, Page(s) 1030–1033

    Abstract: Anomalous coronary arteries from the pulmonary artery are uncommon causes of heart failure in the adult population. This case demonstrates the unusual presentation in a patient with anomalous right coronary artery from the pulmonary artery and discusses ... ...

    Abstract Anomalous coronary arteries from the pulmonary artery are uncommon causes of heart failure in the adult population. This case demonstrates the unusual presentation in a patient with anomalous right coronary artery from the pulmonary artery and discusses the complex pathophysiology of this lesion and the role of guideline-directed medical therapy in the management of these patients.
    MeSH term(s) Adult ; Aged ; Coronary Angiography ; Coronary Vessel Anomalies/diagnosis ; Coronary Vessel Anomalies/diagnostic imaging ; Heart Failure/diagnosis ; Heart Failure/etiology ; Humans ; Male ; Pulmonary Artery
    Language English
    Publishing date 2021-01-28
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1078466-4
    ISSN 1467-1107 ; 1047-9511
    ISSN (online) 1467-1107
    ISSN 1047-9511
    DOI 10.1017/S104795112100007X
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    Zs.A 4050: Show issues Location:
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  6. Article ; Online: Energy- and protein-enriched formula improves weight gain in infants with malnutrition due to cardiac and noncardiac etiologies.

    Goday, Praveen S / Lewis, Jeffery D / Sang, Charlie J / George, Donald E / McGoogan, Katherine E / Safta, Anca M / Seth, Anand / Krekel, Caitlin

    JPEN. Journal of parenteral and enteral nutrition

    2022  Volume 46, Issue 6, Page(s) 1270–1282

    Abstract: Background: We aimed to assess safety, tolerability, and improvement in weight gain with an energy- and protein-enriched formula (EPEF) in infants with poor growth.: Methods: Infants aged 1-8 months with poor growth received EPEF for 16 weeks. Our ... ...

    Abstract Background: We aimed to assess safety, tolerability, and improvement in weight gain with an energy- and protein-enriched formula (EPEF) in infants with poor growth.
    Methods: Infants aged 1-8 months with poor growth received EPEF for 16 weeks. Our primary objective was improvement in weight as measured by change in weight-for-age z-score (WAZ) and weight gain velocity (grams per day) ≥ median for age. Secondary objectives included improvement in other anthropometric z-scores, formula tolerance, and safety.
    Results: Twenty-six patients with poor growth due to congenital heart disease (n = 15), other organic causes (n = 9), and nonorganic causes (n = 2) completed the study per protocol. Mean daily energy intake was 123 ± 32 kilocalories per kilogram of body weight, with >90% of energy coming from EPEF. Weight gain velocity exceeded the median for 83% (20 of 24) and 67% (16 of 24) of infants at ≥1 time point and for the overall study period, respectively. Mean ± SD WAZ improved from -2.92 ± 1.04 at baseline to -2.01 ± 1.12 at 16 weeks (P = 0.0001). Z-scores for weight-for-length and head circumference (P = 0.0001) and for length-for-age (P = 0.003) improved significantly at 16 weeks. Compared with baseline, stool consistency was different at 2, 4, and 16 weeks (P < 0.05). There were no significant differences in vomiting, fussiness, or daily number of stools while there was a decrease or no change in spit-up, flatulence, crying, or gassiness.
    Conclusion: EPEF is safe, well tolerated, and improves weight gain in infants with poor growth.
    MeSH term(s) Anthropometry ; Humans ; Infant ; Infant Formula ; Malnutrition ; Weight Gain
    Language English
    Publishing date 2022-01-05
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 800861-9
    ISSN 1941-2444 ; 0148-6071
    ISSN (online) 1941-2444
    ISSN 0148-6071
    DOI 10.1002/jpen.2308
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    Zs.A 1524: Show issues Location:
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  7. Article ; Online: Risk Factors and Outcomes Associated with Gaps in Care in Children with Congenital Heart Disease.

    Rosamilia, Michael B / Williams, Jason / Bair, Courtney A / Mulder, Hillary / Chiswell, Karen E / D'Ottavio, Alfred A / Hartman, Robert J / Sang, Charlie J / Welke, Karl F / Walsh, Michael J / Hoffman, Timothy M / Landstrom, Andrew P / Li, Jennifer S / Sarno, Lauren A

    Pediatric cardiology

    2024  Volume 45, Issue 5, Page(s) 976–985

    Abstract: Adults with congenital heart disease (CHD) benefit from cardiology follow-up at recommended intervals of ≤ 2 years. However, benefit for children is less clear given limited studies and unclear current guidelines. We hypothesize there are identifiable ... ...

    Abstract Adults with congenital heart disease (CHD) benefit from cardiology follow-up at recommended intervals of ≤ 2 years. However, benefit for children is less clear given limited studies and unclear current guidelines. We hypothesize there are identifiable risks for gaps in cardiology follow-up in children with CHD and that gaps in follow-up are associated with differences in healthcare utilization. Our cohort included children < 10 years old with CHD and a healthcare encounter from 2008 to 2013 at one of four North Carolina (NC) hospitals. We assessed associations between cardiology follow-up and demographics, lesion severity, healthcare access, and educational isolation (EI). We compared healthcare utilization based on follow-up. Overall, 60.4% of 6,969 children received cardiology follow-up within 2 years of initial encounter, including 53.1%, 58.1%, and 79.0% of those with valve, shunt, and severe lesions, respectively. Factors associated with gaps in care included increased drive time to a cardiology clinic (Hazard Ratio (HR) 0.92/15-min increase), EI (HR 0.94/0.2-unit increase), lesion severity (HR 0.48 for shunt/valve vs severe), and older age (HR 0.95/month if < 1 year old and 0.94/year if > 1 year old; p < 0.05). Children with a care gap subsequently had more emergency department (ED) visits (Rate Ratio (RR) 1.59) and fewer inpatient encounters and procedures (RR 0.51, 0.35; p < 0.05). We found novel factors associated with gaps in care for cardiology follow-up in children with CHD and altered health care utilization with a gap. Our findings demonstrate a need to mitigate healthcare barriers and generate clear cardiology follow-up guidelines for children with CHD.
    MeSH term(s) Humans ; Heart Defects, Congenital/therapy ; Male ; Female ; Child, Preschool ; Risk Factors ; Infant ; Child ; North Carolina/epidemiology ; Health Services Accessibility ; Retrospective Studies ; Patient Acceptance of Health Care/statistics & numerical data ; Infant, Newborn ; Follow-Up Studies
    Language English
    Publishing date 2024-03-14
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 800857-7
    ISSN 1432-1971 ; 0172-0643
    ISSN (online) 1432-1971
    ISSN 0172-0643
    DOI 10.1007/s00246-024-03414-y
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    Zs.A 1528: Show issues Location:
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  8. Article ; Online: Clinical and socio-economic predictors of work participation in adult CHD patients.

    Sarno, Lauren A / Cortright, Lindsay / Stanley, Tiara / Tumin, Dmitry / Li, Jennifer S / Sang, Charlie J

    Cardiology in the young

    2020  Volume 30, Issue 8, Page(s) 1081–1085

    Abstract: Background: Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work ... ...

    Abstract Background: Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work participation.
    Methods: We retrospectively identified adults with employment information in the North Carolina Congenital Heart Defects Surveillance Network. Employment was defined as any paid work in a given year. Logistic regression was used to examine patients' employment status during each year.
    Results: The registry included 1,208 adult CHD patients with a health care encounter between 2009 and 2013, of whom 1,078 had ≥1 year of data with known employment status. Overall, 401 patients (37%) were employed in their most recent registry year. On multivariable analysis, the odds of employment decreased with older age and were lower for Black as compared to White patients (odds ratio = 0.78; 95% confidence interval: 0.62, 0.98; p = 0.030), and single as compared to married patients (odds ratio = 0.50; 95% confidence interval: 0.39, 0.63; p < 0.001).
    Conclusion: In a registry where employment status was routinely captured, only 37% of adult CHD patients aged 18-64 years were employed, with older patients, Black patients, and single patients being less likely to be employed. Further work is needed to consider how enhancing cardiology follow-up for adults with CHD can integrate support for employment.
    MeSH term(s) Adult ; Aged ; Employment ; Heart Defects, Congenital/epidemiology ; Humans ; North Carolina/epidemiology ; Registries ; Retrospective Studies
    Language English
    Publishing date 2020-07-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 1078466-4
    ISSN 1467-1107 ; 1047-9511
    ISSN (online) 1467-1107
    ISSN 1047-9511
    DOI 10.1017/S1047951120001572
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  9. Article ; Online: Massive pulmonary embolism in a COVID-19 patient

    Sang, Charlie J / Heindl, Brittain / Von Mering, Gregory / Rajapreyar, Indranee

    European Heart Journal - Case Reports

    a case report

    2020  Volume 4, Issue FI1, Page(s) 1–5

    Abstract: Abstract Background Myocardial injury is associated with excess mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, and the mechanisms of injury are diverse. Coagulopathy associated with this infection may have unique ... ...

    Abstract Abstract Background Myocardial injury is associated with excess mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, and the mechanisms of injury are diverse. Coagulopathy associated with this infection may have unique cardiovascular implications. Case summary We present a case of 62-year-old male who presented after experiencing syncope and cardiac arrest. Given the clinical presentation and electrocardiographic findings, there was concern for acute coronary syndrome. However, coronary angiogram did not reveal significant coronary obstruction. Due to the unclear nature of his presentation, a bedside echocardiogram was rapidly performed and was indicative of right ventricular strain. Due to these findings, a pulmonary angiogram was performed that revealed massive pulmonary embolism. He successfully underwent catheter-directed thrombolysis and, after a prolonged hospital stay, was discharged home on lifelong anticoagulation. Discussion The impact of coronavirus disease-2019 (COVID-19) on the cardiovascular system has been prominent and multifaceted. COVID-19 can have wide-ranging effects on the cardiovascular system due to coagulopathy with resultant venous and arterial thrombo-embolism. Due to the critical condition of many patients affected by COVID-19, imaging for thrombo-embolic events is often delayed. With the use of bedside echocardiogram, observation of right ventricular strain may be critical in raising suspicion for pulmonary embolism, especially when atypical features are noted on electrocardiogram.
    Keywords covid19
    Language English
    Publisher Oxford University Press (OUP)
    Publishing country uk
    Document type Article ; Online
    ISSN 2514-2119
    DOI 10.1093/ehjcr/ytaa223
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Cardiac pathology in COVID-19: a single center autopsy experience.

    Sang, Charlie J / Burkett, Alison / Heindl, Brittain / Litovsky, Silvio H / Prabhu, Sumanth D / Benson, Paul V / Rajapreyar, Indranee

    Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology

    2021  Volume 54, Page(s) 107370

    Abstract: Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is commonly associated with myocardial injury and heart failure. The pathophysiology behind this phenomenon remains unclear, with many diverse and multifaceted hypotheses. To ... ...

    Abstract Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is commonly associated with myocardial injury and heart failure. The pathophysiology behind this phenomenon remains unclear, with many diverse and multifaceted hypotheses. To contribute to this understanding, we describe the underlying cardiac findings in fifty patients who died with coronavirus disease 2019 (COVID-19).
    Methods: Included were autopsies performed on patients with a positive SARS-CoV-2 reverse-transcriptase-polymerase-chain reaction test from the index hospitalization. In the case of out-of-hospital death, patients were included if post-mortem testing was positive. Complete autopsies were performed according to a COVID-19 safety protocol, and all patients underwent both macroscopic and microscopic examination. If available, laboratory findings and echocardiograms were reported.
    Results: The median age of the decedents was 63.5 years. The most common comorbidities included hypertension (90.0%), diabetes (56.0%) and obesity (50.0%). Lymphocytic inflammatory infiltrates in the heart were present in eight (16.0%) patients, with focal myocarditis present in two (4.0%) patients. Acute myocardial ischemia was observed in eight (16.0%) patients. The most common findings were myocardial fibrosis (80.0%), hypertrophy (72.0%), and microthrombi (66.0%). The most common causes of death were COVID-19 pneumonia in 18 (36.0%), COVID-19 pneumonia with bacterial superinfection in 12 (24.0%), and COVID-19 pneumonia with pulmonary embolism in 10 (20.0%) patients.
    Conclusions: Cardiovascular comorbidities were prevalent, and pathologic changes associated with hypertensive and atherosclerotic cardiovascular disease were the most common findings. Despite markedly elevated inflammatory markers and cardiac enzymes, few patients exhibited inflammatory infiltrates or necrosis within cardiac myocytes. A unifying pathophysiologic mechanism behind myocardial injury in COVID-19 remains elusive, and additional autopsy studies are needed.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Atherosclerosis/mortality ; Atherosclerosis/pathology ; Autopsy ; COVID-19/immunology ; COVID-19/mortality ; COVID-19/pathology ; COVID-19/virology ; Comorbidity ; Female ; Heart Diseases/immunology ; Heart Diseases/mortality ; Heart Diseases/pathology ; Heart Diseases/virology ; Host-Pathogen Interactions ; Humans ; Hypertension/mortality ; Hypertension/pathology ; Inflammation Mediators/analysis ; Male ; Middle Aged ; Myocardium/immunology ; Myocardium/pathology ; Necrosis ; SARS-CoV-2/immunology ; SARS-CoV-2/pathogenicity ; Up-Regulation
    Chemical Substances Inflammation Mediators
    Language English
    Publishing date 2021-07-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1134600-0
    ISSN 1879-1336 ; 1054-8807
    ISSN (online) 1879-1336
    ISSN 1054-8807
    DOI 10.1016/j.carpath.2021.107370
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