which permits unrestricted noncommercial use, provided the original work is properly cited. Therapeutics and Clinical Risk Management 2010:6 143–152 Therapeutics and Clinical Risk Management
Journal of the American College of Cardiology, 2019
Background: Timely diagnosis and complete pericardial drainage is required to prevent fatal outco... more Background: Timely diagnosis and complete pericardial drainage is required to prevent fatal outcome in purulent pericarditis (PP). Case: A 53 yo man presented with chest pain and respiratory distress requiring intubation and vasopressors. He had no fever or leukocytosis. Myopericarditis was suspected based on diffuse ST elevation, elevated cTn I (14 ng/mL) and moderate-large pericardial effusion on ECHO. Antibiotics were added for right lower lobe pneumonia seen on chest imaging. No evidence of tamponade on ECHO or right heart cath. Decision-making: Despite absent evidence of tamponade, hemodynamic instability with rapidly accumulating effusion prompted pericardiocentesis yielding 600 mL of purulent fluid. Subxiphoid pericardiotomy was performed, yielding 500 mL of pus. Despite hemodynamics improvement, ECHO and chest CT revealed persistent loculated pericardial effusion. Patient declined further surgical options and intrapericardial tPA was administered for 5 days with complete resolution of effusion and full clinical recovery. Conclusion: Early suspicion for PP is required in cases of thoracic infection with rapid increase in pericardial effusion. Loculated effusion may mask classic signs of tamponade. Pericardiocentesis should be considered even in the absence of tamponade for timely diagnosis and treatment. Intrapericardial tPA can be attempted for loculated effusion when pericardial window does not provide a complete drainage and might help avoid extensive surgical procedure.
Giant Right Coronary Artery Aneurysm: Delineating Anatomy and Function with Multimodality Imaging
Journal of the American College of Cardiology, 2020
Coronary artery aneurysms (CAA) are rare and can be seen in patients with connective tissue disea... more Coronary artery aneurysms (CAA) are rare and can be seen in patients with connective tissue diseases, arteritis and atherosclerosis. Accurate diagnosis requires multimodality Imaging (MMI) for evaluation of physiological significance and surgical planning. 58 y/o female presented with dyspnea on
The lungs are affected in more than 90% of sarcoidosis patients with complications of chronic pul... more The lungs are affected in more than 90% of sarcoidosis patients with complications of chronic pulmonary sarcoidosis, such as pulmonary hypertension and progressive fibrosis. These diseases have been linked to mortality. Treating physicians first have to identify the subgroup of patients requiring therapy, and then recommend the best treatment with as little toxicity as possible. The current review aims to provide a guide to physicians for the diagnosis and treatment of patients with pulmonary sarcoidosis. The most frequent clinical symptoms are persistent cough, dyspnea and, more rarely, thoracic pain. The diagnosis of sarcoidosis is based on consensus criteria and, in essence, is a diagnosis of exclusion. Furthermore, there is no unique biomarker or imaging modality for sarcoidosis. Patients will often see various specialists until a diagnosis can be confirmed. When treatment is warranted, regimens are based on glucocorticosteroids as first-line treatment, but disease-modifying ant...
Ruptured Sinus of Valsalva Aneurysm: Use of Multimodality Imaging in Delineating Structure and Function
Journal of Investigative Medicine High Impact Case Reports
Sinus of Valsalva aneurysm is a rare defect that can present with fatal complications in case of ... more Sinus of Valsalva aneurysm is a rare defect that can present with fatal complications in case of rupture. Heart failure symptoms are common due to high fraction of the resultant shunt. Multimodality imaging and invasive hemodynamic assessment is essential for comprehensive evaluation of the defect and guiding surgical planning. We describe the case of a 40-year-old woman who presented with heart failure symptoms and was found to have ruptured sinus of Valsalva aneurysm on transthoracic echocardiogram. Cardiac computed tomography angiography further characterized the defect and the associated anomalies. Right heart catheterization assessed the hemodynamic significance of the left to right shunt. Intraoperative findings highlighted the associated congenital anomalies including supracristal ventricular septal defect. The use of intraoperative transesophageal echocardiography proved essential in detecting worsening of the right ventricular outflow track infundibular dynamic obstruction ...
Seminars in Respiratory and Critical Care Medicine, 2010
Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of g... more Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.
Seminars in Respiratory and Critical Care Medicine, 2010
Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of g... more Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.
An aberrant right subclavian artery can be used in a variety of ways in complex aortic arch recon... more An aberrant right subclavian artery can be used in a variety of ways in complex aortic arch reconstructions. Four patients (3 with interrupted aortic arch and 1 with coarctation) in whom this technique was used are presented. (Ann Thorac Surg 2007;83:1566 -8)
Patients with systemic sclerosis (SSc) can develop pulmonary hypertension (PH; mean pulmonary art... more Patients with systemic sclerosis (SSc) can develop pulmonary hypertension (PH; mean pulmonary artery pressure ≥ 25 mm Hg) caused by pulmonary arterial hypertension (PAH), left ventricular disease, or pulmonary fibrosis. PAH is a pulmonary vascular disease, the diagnosis of which requires pulmonary capillary wedge pressure less than 15 mm Hg, pulmonary vascular resistance greater than 3 Wood Units, and exclusion of thromboembolism and parenchymal lung disease. Molecular mechanisms underlying PAH-SSc include activation of inflammatory and fibrogenic pathways in the vasculature and right ventricle. Circulating autoantibodies trigger endothelial damage and
Prolonged ventilator support, pulmonary infections and the need for tracheostomies after cardiac ... more Prolonged ventilator support, pulmonary infections and the need for tracheostomies after cardiac operations are associated with increased hospital mortality, length of stay, cost of hospitalization and reduced long term survival. The objective of this study is to review the literature and develop and present an understanding of the potential role of specific pre-operatively or intra-operatively collected inflammatory biomarkers and their role as predictors of pulmonary outcomes in cardiac surgery.
Patients with systemic sclerosis (SSc) can develop pulmonary hypertension (PH; mean pulmonary art... more Patients with systemic sclerosis (SSc) can develop pulmonary hypertension (PH; mean pulmonary artery pressure ≥ 25 mm Hg) caused by pulmonary arterial hypertension (PAH), left ventricular disease, or pulmonary fibrosis. PAH is a pulmonary vascular disease, the diagnosis of which requires pulmonary capillary wedge pressure less than 15 mm Hg, pulmonary vascular resistance greater than 3 Wood Units, and exclusion of thromboembolism and parenchymal lung disease. Molecular mechanisms underlying PAH-SSc include activation of inflammatory and fibrogenic pathways in the vasculature and right ventricle. Circulating autoantibodies trigger endothelial damage and
The user has requested enhancement of the downloaded file. All in-text references underlined in b... more The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document and are linked to publications on ResearchGate, letting you access and read them immediately.
Seminars in Respiratory and Critical Care Medicine, 2010
Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of g... more Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.
... Pulmonary hypertension and sarcoidosis Linda Hushaw 1 , Ray Sawaqed 1 , Khader Mustafa 2 , Fa... more ... Pulmonary hypertension and sarcoidosis Linda Hushaw 1 , Ray Sawaqed 1 , Khader Mustafa 2 , Fariha Kauser 1 , Rafah Salloum 1 , D Kyle ... Sarcoidosis-associated pulmonary hypertension (SAPH) is now recognized as a common complication in sarcoidosis that can result in ...
which permits unrestricted noncommercial use, provided the original work is properly cited. Therapeutics and Clinical Risk Management 2010:6 143–152 Therapeutics and Clinical Risk Management
Journal of the American College of Cardiology, 2019
Background: Timely diagnosis and complete pericardial drainage is required to prevent fatal outco... more Background: Timely diagnosis and complete pericardial drainage is required to prevent fatal outcome in purulent pericarditis (PP). Case: A 53 yo man presented with chest pain and respiratory distress requiring intubation and vasopressors. He had no fever or leukocytosis. Myopericarditis was suspected based on diffuse ST elevation, elevated cTn I (14 ng/mL) and moderate-large pericardial effusion on ECHO. Antibiotics were added for right lower lobe pneumonia seen on chest imaging. No evidence of tamponade on ECHO or right heart cath. Decision-making: Despite absent evidence of tamponade, hemodynamic instability with rapidly accumulating effusion prompted pericardiocentesis yielding 600 mL of purulent fluid. Subxiphoid pericardiotomy was performed, yielding 500 mL of pus. Despite hemodynamics improvement, ECHO and chest CT revealed persistent loculated pericardial effusion. Patient declined further surgical options and intrapericardial tPA was administered for 5 days with complete resolution of effusion and full clinical recovery. Conclusion: Early suspicion for PP is required in cases of thoracic infection with rapid increase in pericardial effusion. Loculated effusion may mask classic signs of tamponade. Pericardiocentesis should be considered even in the absence of tamponade for timely diagnosis and treatment. Intrapericardial tPA can be attempted for loculated effusion when pericardial window does not provide a complete drainage and might help avoid extensive surgical procedure.
Giant Right Coronary Artery Aneurysm: Delineating Anatomy and Function with Multimodality Imaging
Journal of the American College of Cardiology, 2020
Coronary artery aneurysms (CAA) are rare and can be seen in patients with connective tissue disea... more Coronary artery aneurysms (CAA) are rare and can be seen in patients with connective tissue diseases, arteritis and atherosclerosis. Accurate diagnosis requires multimodality Imaging (MMI) for evaluation of physiological significance and surgical planning. 58 y/o female presented with dyspnea on
The lungs are affected in more than 90% of sarcoidosis patients with complications of chronic pul... more The lungs are affected in more than 90% of sarcoidosis patients with complications of chronic pulmonary sarcoidosis, such as pulmonary hypertension and progressive fibrosis. These diseases have been linked to mortality. Treating physicians first have to identify the subgroup of patients requiring therapy, and then recommend the best treatment with as little toxicity as possible. The current review aims to provide a guide to physicians for the diagnosis and treatment of patients with pulmonary sarcoidosis. The most frequent clinical symptoms are persistent cough, dyspnea and, more rarely, thoracic pain. The diagnosis of sarcoidosis is based on consensus criteria and, in essence, is a diagnosis of exclusion. Furthermore, there is no unique biomarker or imaging modality for sarcoidosis. Patients will often see various specialists until a diagnosis can be confirmed. When treatment is warranted, regimens are based on glucocorticosteroids as first-line treatment, but disease-modifying ant...
Ruptured Sinus of Valsalva Aneurysm: Use of Multimodality Imaging in Delineating Structure and Function
Journal of Investigative Medicine High Impact Case Reports
Sinus of Valsalva aneurysm is a rare defect that can present with fatal complications in case of ... more Sinus of Valsalva aneurysm is a rare defect that can present with fatal complications in case of rupture. Heart failure symptoms are common due to high fraction of the resultant shunt. Multimodality imaging and invasive hemodynamic assessment is essential for comprehensive evaluation of the defect and guiding surgical planning. We describe the case of a 40-year-old woman who presented with heart failure symptoms and was found to have ruptured sinus of Valsalva aneurysm on transthoracic echocardiogram. Cardiac computed tomography angiography further characterized the defect and the associated anomalies. Right heart catheterization assessed the hemodynamic significance of the left to right shunt. Intraoperative findings highlighted the associated congenital anomalies including supracristal ventricular septal defect. The use of intraoperative transesophageal echocardiography proved essential in detecting worsening of the right ventricular outflow track infundibular dynamic obstruction ...
Seminars in Respiratory and Critical Care Medicine, 2010
Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of g... more Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.
Seminars in Respiratory and Critical Care Medicine, 2010
Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of g... more Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.
An aberrant right subclavian artery can be used in a variety of ways in complex aortic arch recon... more An aberrant right subclavian artery can be used in a variety of ways in complex aortic arch reconstructions. Four patients (3 with interrupted aortic arch and 1 with coarctation) in whom this technique was used are presented. (Ann Thorac Surg 2007;83:1566 -8)
Patients with systemic sclerosis (SSc) can develop pulmonary hypertension (PH; mean pulmonary art... more Patients with systemic sclerosis (SSc) can develop pulmonary hypertension (PH; mean pulmonary artery pressure ≥ 25 mm Hg) caused by pulmonary arterial hypertension (PAH), left ventricular disease, or pulmonary fibrosis. PAH is a pulmonary vascular disease, the diagnosis of which requires pulmonary capillary wedge pressure less than 15 mm Hg, pulmonary vascular resistance greater than 3 Wood Units, and exclusion of thromboembolism and parenchymal lung disease. Molecular mechanisms underlying PAH-SSc include activation of inflammatory and fibrogenic pathways in the vasculature and right ventricle. Circulating autoantibodies trigger endothelial damage and
Prolonged ventilator support, pulmonary infections and the need for tracheostomies after cardiac ... more Prolonged ventilator support, pulmonary infections and the need for tracheostomies after cardiac operations are associated with increased hospital mortality, length of stay, cost of hospitalization and reduced long term survival. The objective of this study is to review the literature and develop and present an understanding of the potential role of specific pre-operatively or intra-operatively collected inflammatory biomarkers and their role as predictors of pulmonary outcomes in cardiac surgery.
Patients with systemic sclerosis (SSc) can develop pulmonary hypertension (PH; mean pulmonary art... more Patients with systemic sclerosis (SSc) can develop pulmonary hypertension (PH; mean pulmonary artery pressure ≥ 25 mm Hg) caused by pulmonary arterial hypertension (PAH), left ventricular disease, or pulmonary fibrosis. PAH is a pulmonary vascular disease, the diagnosis of which requires pulmonary capillary wedge pressure less than 15 mm Hg, pulmonary vascular resistance greater than 3 Wood Units, and exclusion of thromboembolism and parenchymal lung disease. Molecular mechanisms underlying PAH-SSc include activation of inflammatory and fibrogenic pathways in the vasculature and right ventricle. Circulating autoantibodies trigger endothelial damage and
The user has requested enhancement of the downloaded file. All in-text references underlined in b... more The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document and are linked to publications on ResearchGate, letting you access and read them immediately.
Seminars in Respiratory and Critical Care Medicine, 2010
Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of g... more Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.
... Pulmonary hypertension and sarcoidosis Linda Hushaw 1 , Ray Sawaqed 1 , Khader Mustafa 2 , Fa... more ... Pulmonary hypertension and sarcoidosis Linda Hushaw 1 , Ray Sawaqed 1 , Khader Mustafa 2 , Fariha Kauser 1 , Rafah Salloum 1 , D Kyle ... Sarcoidosis-associated pulmonary hypertension (SAPH) is now recognized as a common complication in sarcoidosis that can result in ...
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