11 results on '"Lee, Lawrence S."'
Search Results
2. Enhanced recovery after cardiac surgery protocol reduces perioperative opioid use
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Loria, Chelsea M., Zborek, Kirsten, Millward, James B., Anderson, Matthew P., Richardson, Cynthia M., Namburi, Niharika, Faiza, Zainab, Timsina, Lava R., and Lee, Lawrence S.
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- 2022
- Full Text
- View/download PDF
3. Hypertrophic Cardiomyopathy With Elongated Mitral Valve Leaflets: Clinical Characteristics and Surgical Results: HCM With Elongated MVL.
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Liu, Xianying, McGrath, Daniel, Ohlrich, Kelly, Chen, Frederick Y., Lee, Lawrence S., Robich, Michael, and Mazur, Piotr
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MITRAL valve ,MITRAL valve surgery ,MITRAL valve insufficiency ,HYPERTROPHIC cardiomyopathy ,MYOMECTOMY - Abstract
Background: Hypertrophic cardiomyopathy (HCM) is commonly associated with mitral valve pathology. A large majority of patients with HCM have elongated anterior and posterior mitral leaflets. There remains debate regarding the necessity and role of concomitant mitral valve surgery at the time of septal myectomy. We aimed to describe the characteristics and share our surgical experiences with this specific group of patients. Methods: This retrospective single‐center study investigates adult patients with HCM, with or without elongated mitral valve leaflets (MVLs), who underwent elective septal myectomy with or without concomitant mitral valve intervention, between January 1, 2016, and June 30, 2020. Clinical data were obtained from institutional medical records as well as the Society of Thoracic Surgeons data registry. The clinical characteristics and in‐hospital surgical outcomes were compared between patients with an elongated MVL and those without. Results: In total, 379 patients underwent septal myectomy, and 22 patients with intrinsic mitral valve disease were excluded. In addition, 23 patients were excluded due to missing data. Of the remaining 334 patients, 131 (39.2%) had elongated MVL and concomitant MVL plication. Patients with elongated MVL had higher rates of preoperative mitral valve systolic anterior motion (SAM) (94.7% vs. 86.7%, p = 0.019) and higher preoperative provoked left ventricular outflow tract gradient (LVOTG) (134.5 mmHg versus 125.3 mmHg, p = 0.046). Post septal myectomy and mitral valve plication, they had lower rates of postoperative residual mitral regurgitation (3.8% vs. 12.8%, p = 0.006), comparable rates of residual SAM (28.2% vs. 31.5%, p = 0.524), postoperative provoked LVOTG (15.4 mmHg vs. 14.0 mmHg, p = 0.317), 30‐day major adverse cardiopulmonary events (2.3% vs. 3.9%, p = 0.409), and mortality (0% vs. 1.0%, p = 0.255). Conclusions: Elongated MVLs contribute more significantly to dynamic LVOT obstruction, as evidenced during provocative testing. Concomitant mitral valve intervention during septal myectomy can be performed safely and may provide an effective strategy to resolve SAM and stress‐induced LVOTG. [ABSTRACT FROM AUTHOR]
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- 2024
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4. An Emergent Nexus between Striae and Thoracic Aortic Dissection.
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Landis, Benjamin J., Vujakovich, Courtney E., Elmore, Lindsey R., Pillai, Saila T., Lee, Lawrence S., Everett, Jeffrey E., Markham, Larry W., Brown, John W., Hess, Phillip J., and Corvera, Joel S.
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AORTIC dissection ,THORACIC aneurysms ,HERNIA ,AORTIC valve ,DISEASE progression ,THORACIC aorta - Abstract
Current approaches to stratify the risk for disease progression in thoracic aortic aneurysm (TAA) lack precision, which hinders clinical decision making. Connective tissue phenotyping of children with TAA previously identified the association between skin striae and increased rate of aortic dilation. The objective of this study was to analyze associations between connective tissue abnormalities and clinical endpoints in adults with aortopathy. Participants with TAA or aortic dissection (TAD) and trileaflet aortic valve were enrolled from 2016 to 2019 in the setting of cardiothoracic surgical care. Data were ascertained by structured interviews with participants. The mean age among 241 cases was 61 ± 13 years. Eighty (33%) had history of TAD. While most participants lacked a formal syndromic diagnosis clinically, connective tissue abnormalities were identified in 113 (47%). This included 20% with abdominal hernia and 13% with skin striae in atypical location. In multivariate analysis, striae and hypertension were significantly associated with TAD. Striae were associated with younger age of TAD or prophylactic aortic surgery. Striae were more frequent in TAD cases than age- and sex-matched controls. Thus, systemic features of connective tissue dysfunction were prevalent in adults with aortopathy. The emerging nexus between striae and aortopathy severity creates opportunities for clinical stratification and basic research. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
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5. Atrial Septal Defect
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Menillo AM, Lee LS, and Pearson-Shaver AL
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Atrial septal defect (ASD) is one of the most common types of congenital heart defects, occurring in about 25% of children. An atrial septal defect occurs when there is a failure to close the communication between the right and left atria. It encompasses defects involving both the true septal membrane and other defects that allow for communication between both atria. There are five types of atrial septal defects ranging from most frequent to least: patent foramen ovale, ostium secundum defect, ostium primum defect, sinus venosus defect, and coronary sinus defect. Small atrial septal defects usually spontaneously close in childhood. Large defects that do not close spontaneously may require percutaneous or surgical intervention to prevent further complications such as stroke, dysrhythmias, and pulmonary hypertension., (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
6. National Quality Forum
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Namburi N and Lee LS
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The National Quality Forum (NQF) is an independent, nonpartisan organization tasked with devising a national strategy to set standards for quality improvement and reporting in the United States healthcare industry. It is the first-ever public service organization explicitly focused on addressing the quality of healthcare. The NQF consists of more than 400 member bodies, including consumer organizations, private and public purchasers, hospitals, physicians, certifying and accreditation agencies, and other healthcare stakeholders., (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
7. Left Ventricular False Aneurysm
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Faiza Z and Lee LS
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Left ventricular false aneurysm, also known as pseudoaneurysm, is a rare and highly morbid pathology. It most commonly presents as a complication of myocardial infarction (MI). It occurs when an ischemic left ventricular free wall rupture (due to acute infarction) is contained as a hematoma communicating with the ventricular cavity. The rupture could become sealed by an adherent pericardium, organizing hematoma, thrombus, or scar tissue and gives the appearance of an aneurysm.[1][2] The wall of the false aneurysm consists only of fibrous tissue or pericardium and lacks the true layers of the ventricle (endocardium and myocardium).[3] False aneurysms tend to appear on the posterior and lateral wall segments and demonstrate a tightened neck compared to the aneurysm sac diameter.[4] These aneurysms have a higher propensity to rupture and necessitate timely diagnosis and management.[2], (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
8. Catheter Directed Thrombolysis Of Pulmonary Embolism
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Brown KN, Devarapally SR, Lee LS, and Gupta N
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Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States of America. It is one of the most common causes of death worldwide. Many patients die within the first few hours of presentation, making an early diagnosis and treatment paramount to survival. Pulmonary embolisms are categorized into three main risk categories: low risk, intermediate (sub-massive), and high risk (massive). Submassive PEs are further sub-divided into intermediate-high and intermediate-low risk PEs. Catheter-directed thrombolysis (CDT) is one of the newest treatment options for massive and submassive pulmonary embolisms with hemodynamic instability. CDT involves the infusion of a thrombolytic agent intravascularly adjacent to the clot burden through a percutaneous transcatheter. This article will review the anatomy involved in the pathology of pulmonary embolisms, indications for CDT, contraindications for CDT, an overview of the CDT procedural technique, possible complications of CDT, and the clinical significance of CDT for PE., (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
9. Papillary Fibroelastoma
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Devanabanda AR and Lee LS
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Primary cardiac tumors are rare entities, and the majority of these are benign. In adults, papillary fibroelastomas (PFEs) and cardiac myxomas are the most common types of primary cardiac tumors. Papillary fibroelastoma is a benign neoplasm. A single large series of 511 patients at Mayo Clinic by Tamin et al. reported PFEs as the most common cardiac tumor [1]. Increasing utilization of advanced imaging techniques such as transesophageal echocardiography (TEE) has led to more frequent identification of intracardiac tumors.[1] The first reported case of PFE was in 1975 as an embolic complication of PFE, leading to myocardial infarction.[2] Since then, papillary fibroelastomas have been identified as possible etiology of vascular embolism, stroke, and cardiac arrest. Much controversy still exists in the surgical versus medical management of these “benign” tumors as they are known to lead to downstream embolic complications. This activity will focus on providing the latest literature update on PFEs., (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
10. Mitral Valve Repair
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Salik I, Lee LS, and Widrich J
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Although the standard of care for mitral valve (MV) pathology due to degenerative changes is surgical repair, patient outcomes depend on multiple factors including pre-operative status, the severity of mitral regurgitation (MR), the technique of repair and surgeon and center experience. If MV repair is carried out in a timely fashion, the operative risk is low, and life expectancy is close to that of similar sex-aged matched controls. In high-risk patients, the choice amongst surgical, percutaneous, and conservative approaches can be challenging but should have as its basis patient comorbidities and surgical expertise. Mitral valve repair (MVr) surgery has some advantages over mitral valve replacement (MVR), although patient-specific factors must be taken into consideration. Of note, close to 50% of patients with severe mitral valve pathology are not candidates for surgical intervention due to age or other comorbidities.[1] Up to 2 to 3% of adults in the United States are afflicted with degenerative mitral valve disease.[2] Patients with degenerative MV pathology who develop symptoms of MR have a poor prognosis, with annual mortality rates of up to 34%.[3] Mitral stenosis (MS), primarily caused by rheumatic heart disease (RHD), is commonly treated by percutaneous balloon mitral valvuloplasty or MVR. Repair is usually not feasible in these patients with rheumatic mitral disease. MR is classified as primary or secondary, depending on whether the lesion is located at the mitral valve apparatus or due to left ventricular changes, respectively. While severe primary MR still receives treatment with surgical intervention, percutaneous techniques for repair and replacement are also gaining traction. MVR may be considered in patients with MR caused by papillary muscle rupture, degenerative and ischemic MR, or in patients with a failed repair undergoing reoperation.[4], (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
11. Catheter Management Of Aortic Valve Disorders
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Brown KN, Lee LS, and Kanmanthareddy A
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Aortic valve disease, specifically aortic valve stenosis, is one of the most common valvular disorders in the United States and worldwide. While traditional aortic valve replacement via open heart surgery was historically the preferred--and only--definitive treatment option, transcatheter therapy now plays a significant role. Since the first reported case of transcather aortic valve replacement (TAVR) in a human in 2002, TAVR has evolved rapidly and now has become the preferred first-line treatment option for many patients with aortic stenosis.[1] While the earliest TAVR patients were those deemed either prohibitive or very high risk for surgical aortic valve replacement (SAVR), the use of TAVR has expanded to include those who are intermediate and low risk. The evolution has TAVR has encountered numerous pitfalls and technical modifications that have improved safety and efficacy.[2] Landmark trials including the PARTNER 1 and PARTNER 2 studies have demonstrated the benefits of TAVR compared to medical management and SAVR. We describe here an overview of TAVR for aortic valve stenosis., (Copyright © 2022, StatPearls Publishing LLC.)
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- 2022
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