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151. Musculoskeletal Trauma, Pelvic Angioembolization

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012
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152. Multi-casualty Triage

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012
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153. Mitochondrial Therapy in Critical Illness

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012
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154. Mechanical Circulatory Assist

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012
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155. Mechanical Ventilation, Principles of

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012
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156. Mycobacterial Tuberculosis Complex

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012
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157. Metabolic Acidosis, Renal Causes

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012
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158. Cardiac angiogenic imbalance leads to peripartum cardiomyopathy

Author

Sarosh Rana, Eliyahu V. Khankin, Glenn C. Rowe, S. Ananth Karumanchi, Caitlin Farrell, Federica del Monte, John D. Mitchell, I. Tudorache, Philip E. Hess, Laura Liu, Michele R. Hacker, Johann Bauersachs, Cholsoon Jang, Nicole Koulisis, Suzanne D. Burke, Denise Hilfiker-Kleiner, Zoltan Arany, Sajid Shahul, Ian S. Patten, Julie S. Rhee, and Feroze Mahmood

Subjects
Male, Vascular Endothelial Growth Factor A, medicine.medical_specialty, Peripartum cardiomyopathy, Pregnancy Complications, Cardiovascular, Diastole, Neovascularization, Physiologic, Kaplan-Meier Estimate, Article, Multiple Gestation, Preeclampsia, Mice, Pre-Eclampsia, Pregnancy, Internal medicine, medicine, Animals, Humans, Myocytes, Cardiac, Peripartum Period, reproductive and urinary physiology, Bromocriptine, Subclinical infection, Mice, Knockout, Multidisciplinary, Vascular Endothelial Growth Factor Receptor-1, Neovascularization, Pathologic, business.industry, Vascular disease, Heart, medicine.disease, Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1-alpha, female genital diseases and pregnancy complications, Disease Models, Animal, Endocrinology, Cardiology, Trans-Activators, Female, business, Cardiomyopathies, Transcription Factors
Abstract

Peripartum cardiomyopathy (PPCM) is an often fatal disease that affects pregnant women who are near delivery, and it occurs more frequently in women with pre-eclampsia and/or multiple gestation. The aetiology of PPCM, and why it is associated with pre-eclampsia, remain unknown. Here we show that PPCM is associated with a systemic angiogenic imbalance, accentuated by pre-eclampsia. Mice that lack cardiac PGC-1α, a powerful regulator of angiogenesis, develop profound PPCM. Importantly, the PPCM is entirely rescued by pro-angiogenic therapies. In humans, the placenta in late gestation secretes VEGF inhibitors like soluble FLT1 (sFLT1), and this is accentuated by multiple gestation and pre-eclampsia. This anti-angiogenic environment is accompanied by subclinical cardiac dysfunction, the extent of which correlates with circulating levels of sFLT1. Exogenous sFLT1 alone caused diastolic dysfunction in wild-type mice, and profound systolic dysfunction in mice lacking cardiac PGC-1α. Finally, plasma samples from women with PPCM contained abnormally high levels of sFLT1. These data indicate that PPCM is mainly a vascular disease, caused by excess anti-angiogenic signalling in the peripartum period. The data also explain how late pregnancy poses a threat to cardiac homeostasis, and why pre-eclampsia and multiple gestation are important risk factors for the development of PPCM.

Published
2011

159. Bench to bedside: dynamic mitral valve assessment

Author

Haider J. Warraich, Sajid Shahul, Robina Matyal, and Feroze Mahmood

Subjects
medicine.medical_specialty, Geometric analysis, Systole, Point-of-Care Systems, Echocardiography, Three-Dimensional, 3 dimensional transesophageal echocardiography, User-Computer Interface, Software, PROSTHETIC MITRAL VALVE, Internal medicine, Mitral valve, medicine, Image Processing, Computer-Assisted, Humans, Computer Simulation, Cardiac Surgical Procedures, Simulation, ComputingMethodologies_COMPUTERGRAPHICS, business.industry, Mitral Valve Insufficiency, Software package, Bench to bedside, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Cardiology, Mitral Valve, Cardiology and Cardiovascular Medicine, business
Abstract

Purpose The authors analyze a commercially available software package capable of geometrically reconstructing the mitral valve (MV) dynamically throughout systole. Description Three-dimensional echocardiography has revolutionized the understanding of MV geometry. Advanced quantification software can be used to assess geometric changes in the MV, which have been shown to have important implications for MV surgery. Evaluation The authors performed geometric analysis on 24 patients, with both anatomically normal and abnormal MVs to assess the feasibility of this new software. The application of this new software is briefly reviewed. Conclusion This new software, despite its limitations, allows an improved perspective on MV geometry with implications for MV repair and surgical decision making.

Published
2011

160. Contributors

Author

Edward Abraham, Peter Abrams, Kareem Abu-Elmagd, Yasir Abu-Omar, Carlos Agustí, William C. Aird, Philip Alapat, Ali H. Al-Khafaji, Gustavo G. Angaramo, Derek C. Angus, Anastasia Antoniadou, Anupam Anupam, Andrew C. Argent, John H. Arnold, Anna Arroyo, Stephen Ashwal, Mark E. Astiz, Elie Azoulay, Omer A. Bajwa, Anthony Baldea, Marie R. Baldisseri, Zsolt J. Balogh, Rasheed Abiodun Balogun, Arna Banerjee, Philip S. Barie, Brendan Barrett, Robert Bartlett, John G. Bartlett, Gianluigi Li Bassi, Sarice L. Bassin, Julie A. Bastarache, Colin Bauer, Daniel G. Bausch, Hülya Bayýr, David T. Bearden, Gregory J. Beilman, Rinaldo Bellomo, E. David Bennett, Gordon R. Bernard, Jay K. Bhama, Joost J.L.M. Bierens, Walter L. Biffl, Thomas P. Bleck, Thomas A. Bledsoe, Karen C. Bloch, Frank Bloos, Desmond Bohn, Nicole C. Bouchard, Arthur J. Boujoukos, William J. Brady, Serge Brimioulle, Daniel E. Brooks, Richard C. Brundage, Jeffrey P. Burns, Belén Cabello, Karen H. Calhoun, Clifton W. Callaway, Peter M.A. Calverley, John Camm, Diane M. Cappelletty, Joseph A. Carcillo, Anthony J. Carlese, Juan Carlos-Puyana, Franco A. Carnevale, Edward D. Chan, Sanjay Chawla, Lakshmipathi Chelluri, David C. Chen, Annie S. Chevrier, Su Min Cho, Robert S.B. Clark, Michael A. Coady, Stephen M. Cohn, Alan D. Cook, Deborah J. Cook, Robert N. Cooney, Susan J. Corbridge, Thomas C. Corbridge, Howard L. Corwin, Mark A. Crowther, Burke A. Cunha, Cheston B. Cunha, J. Randall Curtis, Vincenzo D’Intini, Pirouz Daeihagh, Joseph M. Darby, James M. Dargin, Michaël Darmon, Joseph F. Dasta, John D. Davies, Robert W. Derlet, Mark Dershwitz, Anne Marie G.A. de Smet, Monica Dhand, Anahat Dhillon, Rajeev Dhupar, Michael N. Diringer, Peter Doelken, Michael Donahoe, Timothy R. Donahue, David J. Dries, Thomas D. DuBose, Susan Duthie, Randy Edwards, Philippe Eggimann, Waleed A. Elhassan, E. Wesley Ely, Guillaume Emeriaud, Gregory A. Eschenauer, Joel H. Ettinger, Joshua H. Ettinger, David Clay Evans, Gregory T. Everson, Derek V. Exner, Ronald J. Falk, Jeremy Farrar, Alan P. Farwell, Kathryn Felmet, Niall D. Ferguson, Miguel Ferrer, Mitchell P. Fink, Ericka L. Fink, Douglas N. Fish, Diana F. Florescu, Brett E. Fortune, Bradley D. Freeman, Blake Froberg, John J. Fung, Brent Furbee, Richard L. Gamelli, Raúl J. Gazmuri, Robert H. Geelkerken, Todd W.B. Gehr, Michael A. Gentile, M. Patricia George, Herwig Gerlach, R. Mark Ghobrial, Helen Giamarellou, Fredric Ginsberg, Thomas G. Gleason, Jacques P. Goldstein, Hernando Gomez, Sherilyn Gordon Burroughs, Jeremy David Gradon, Cornelia R. Graves, Cesare Gregoretti, Jeffrey S. Groeger, R. Michael Grounds, Paul O. Gubbins, Kyle J. Gunnerson, Fahim A. Habib, Mitchell L. Halperin, Mary E. Hartman, Maurene A. Harvey, Moustafa A. Hassan, Yoshiro Hayashi, Jan A. Hazelzet, Stephen O. Heard, Paul C. Hébert, Elizabeth D. Hermsen, Daren K. Heyland, Jonathan R. Hiatt, Robert W. Hickey, Tran Tinh Hien, Thomas L. Higgins, Nicholas S. Hill, Horacio Hojman, Steven M. Hollenberg, J. Terrill Huggins, David T. Huang, Christopher G. Hughes, Russell D. Hull, Margaret Isaac, James P. Isbister, Connie Jastremski, Larry Jenkins, Paul Jodka, Robert G. Johnson, Philippe G. Jorens, Vern C. Juel, Rose Jung, Christina R. Kahl, Andre C. Kalil, Edo Kaluski, Kamel S. Kamel, Sandra Kane-Gill, Jeffrey P. Kanne, Lionel Karlin, Marinka Kartalija, James Kasiewicz, Kenneth D. Katz, David Kaufman, John A. Kellum, Rick Kingston, Orlando C. Kirton, Kurt Kleinschmidt, Jason Knight, Patrick M. Kochanek, W. Andrew Kofke, Jeroen J. Kolkman, Robert L. Kormos, Rosemary A. Kozar, David J. Kramer, John W. Kreit, James A. Kruse, Anand Kumar, Vladimir Kvetan, Jacques Lacroix, Gilles Lebuffe, Virginie Lemiale, Angela M. Leung, Sharon Leung, Allan D. Levi, Phillip D. Levin, Mitchell M. Levy, Mah Chou Liang, Scott Liebman, Stuart L. Linas, Gregory Y.H. Lip, Pamela A. Lipsett, Alan Lisbon, Carmen Lucena, Andrew I.R. Maas, Neil R. MacIntyre, Duncan Macrae, Bernhard Maisch, Amer M. Malik, Jordi Mancebo, Henry J. Mann, Sanjay Manocha, Stéphane Manzo-Silberman, Paul E. Marik, John J. Marini, Donald W. Marion, Steven J. Martin, Alvaro Martinez-Camacho, Anne Marie Mattingly, Gary R. Matzke, Adeline Max, George V. Mazariegos, Joanne Mazzarelli, Stephen A. McClave, Ryan M. McEnaney, John K. McIllwaine, Michelle K. McNutt, Sangeeta Mehta, Dieter Mesotten, Kimberly S. Meyer, David J. Michelson, Saar Minha, Marek A. Mirski, Rima A. Mohammad, Xavier Monnet, Frederick A. Moore, Laura J. Moore, Anne-Sophie Moreau, Delphine Moreau, Alison Morris, Amy E. Morris, Bruno Mourvillier, Mark A. Munger, Raghavan Murugan, Claus-Martin Muth, Kurt G. Naber, Lena M. Napolitano, Stanley A. Nasraway, Jovany Cruz Navarro, Lewis S. Nelson, Michael S. Niederman, Jessica C. Njoku, Scott Norwood, Juan B. Ochoa, Mark D. Okusa, Keith M. Olsen, Steven M. Opal, James P. Orlowski, Catherine M. Otto, Heleen M. Oudemans-van Straaten, Pratik P. Pandharipande, Joseph E. Parrillo, David L. Paterson, Frédéric L. Paulin, Andrew B. Peitzman, Daleen Aragon Penoyer, Bradley Peterson, Graham F. Pineo, Michael R. Pinsky, Greta Piper, Didier Pittet, Fred Plum, Murray M. Pollack, Lucido L. Ponce, Robert Pousman, Peter J. Pronovost, Przemyslaw B. Radwański, Thomas G. Rainey, Thomas Rajan, Vito Marco Ranieri, Konrad Reinhart, Jorge Reyes, Andrew Rhodes, Zaccaria Ricci, Christian Richard, John R. Richards, John Riordan, Arsen D. Ristic, Sandro Rizoli, Claudia S. Robertson, Emmanuel Robin, Ferran Roche-Campo, Paul Rogers, Claudio Ronco, John C. Rotschafer, Gordon D. Rubenfeld, Randall A. Ruppel, Laura T. Russo, Daniel E. Rusyniak, Steven A. Sahn, Juan C. Salgado, Cristina Santonocito, Penny Lynn Sappington, John Sarko, Richard H. Savel, Irina Savelieva, Benoit Schlemmer, Minka Schofield, Kristine S. Schonder, Anton C. Schoolwerth, Robert W. Schrier, Carl Schulman, Evan Schwarz, Aaron M. Scifres, Donna L. Seger, Amelie Seguin, Frank W. Sellke, Sajid Shahul, M. Khaled Shamseddin, Erik S. Shank, Eduard Shantsila, Kapil Sharma, Robert L. Sheridan, Ariel L. Shiloh, Debra J. Skaar, Anthony D. Slonim, Teresa L. Smith Jacobs, Pablo Solís-Muñoz, Michael D. Sosin, Charles L. Sprung, Vincenzo Squadrone, Thomas E. Starzl, Steven M. Steinberg, David M. Steinhorn, Eric J. Stern, Thomas E. Stewart, Nino Stocchetti, Joerg-Patrick Stübgen, Sanjay Subramanian, Justin Szawlewicz, David Szpilman, David P. Taggart, Daniel Talmor, Jean-Louis Teboul, Isaac Teitelbaum, Stephen R. Thom, C. Louise Thwaites, Jean-François Timsit, Alan Tinmouth, Samuel A. Tisherman, S. Rob Todd, Antoni Torres, Robert D. Truog, Krista Turner, Edith Tzeng, Nir Uriel, Benoit Vallet, Greet Van den Berghe, P. Vernon van Heerden, Benjamin W. Van Tassell, Frédéric Vanden Eynden, Olivier Varenne, Ramesh Venkataraman, Kathleen M. Ventre, Zvi Vered, Jean-Louis Vincent, Elizabeth A. Vitarbo, Louis Voigt, Florian M.E. Wagenlehner, Christina J. Wai, Keith R. Walley, Nicholas S. Ward, Lorraine B. Ware, Robert J. Weber, Lawrence R. Wechsler, David Weill, Craig R. Weinert, Julia Wendon, Michel Wolff, Benjamin Wrigley, Richard G. Wunderink, Lam M. Yen, Sergio L. Zanotti-Cavazzoni, Allyson R. Zazulia, Janice Zimmerman, and Walter Zingg

Published
2011
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162. Transthoracic echocardiographic simulator: normal and the abnormal

Author

Haider J. Warraich, Sajid Shahul, Stephen Ratcliff, Robina Matyal, Ruma Bose, Peter Panzica, and Feroze Mahmood

Subjects
medicine.medical_specialty, Heart Diseases, Preoperative risk, MEDLINE, Routine practice, User-Computer Interface, Anesthesiology, Computer Graphics, Image Processing, Computer-Assisted, Medicine, Image acquisition, Humans, Computer Simulation, Supervised training, Modality (human–computer interaction), business.industry, Heart, Training methods, medicine.disease, Anesthesiology and Pain Medicine, Echocardiography, Radiology, Medical emergency, Clinical Competence, Cardiology and Cardiovascular Medicine, business, Clinical skills, Echocardiography, Transesophageal, Software
Abstract

Despite anesthesiologists’ use of transesophageal echocardio-graphy (TEE) and familiarity with cardiovascular imaging,TTE has not been as widely used perioperatively. With therecent availability of relatively inexpensive and portable ultra-sound systems, there has been a resurgence of interest in usingthis modality to its full potential. Another possible reason for itsunderutilization could be the lack of structured training programsfor anesthesiologists. The National Board of Echocardiographymandates a minimum of 150 TTE examinations to be per-formed by operators, with 300 interpretations under appropriatesupervision, as requirements for certification. However, a short-age of trained personnel and staffing-related issues are two ofthe reasons for a comprehensive TTE examination either notbeing performed routinely or not in a timely fashion, particu-larly for preoperative risk stratification.TTE is a modality that requires considerable skill in imageacquisition and supervised training for interpretation. Tradi-tionally, cardiologists have employed the services of trainedechocardiography technicians for image acquisition, whereasemergency room and critical care physicians have to acquireand interpret transthoracic images themselves. Major nationalprofessional societies (eg, the American Society of Anesthesi-ologists, the Society of Cardiovascular Anesthesiologists, andthe Society of Critical Care Medicine) have taken the initiativeto educate their members about the benefits and applications ofechocardiography in routine practice. However, currently thereare no formal TTE image-acquisition training opportunitiesavailable for anesthesiologists.As a result, an increasing demand for this clinical skill isfurther exacerbated by a paucity of training opportunities, ne-cessitating the employment of alternate training methods totrain physicians in TTE. Therefore, the use of simulation tech-nology provides a unique opportunity to create a virtual train-ing environment to offset the initial learning curve and shortenthe eventual training duration.

Published
2010

163. Echocardiographically derived parameters of fluid responsiveness

Author

Feroze Mahmood, Jennifer Gerstle, and Sajid Shahul

Subjects
business.industry, Fluid responsiveness, Computational biology, Water-Electrolyte Balance, Respiration, Artificial, Anesthesiology and Pain Medicine, Text mining, Echocardiography, Predictive Value of Tests, Respiratory Mechanics, Medicine, Humans, business, Monitoring, Physiologic
Published
2010

164. Moderate-to-Severe Aortic Stenosis and Three-Dimensional Echocardiography

Author

Sajid Shahul and Jayant S. Jainandunsing

Subjects
Aortic valve, Moderate to severe, Male, medicine.medical_specialty, Echocardiography, Three-Dimensional, 3-dimensional echocardiography, Severity of Illness Index, Internal medicine, Preoperative Care, medicine, Humans, aortic valve classification, Aged, 3 dimensional echocardiography, business.industry, transesophageal echocardiography, Three dimensional echocardiography, Aortic Valve Stenosis, medicine.disease, aortic valve, Stenosis, Anesthesiology and Pain Medicine, Aortic valve area, medicine.anatomical_structure, Ventricular pressure, Cardiology, transesophageal, Cardiology and Cardiovascular Medicine, business, left ventricular outflow tract, aortic valve area
Published
2013
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165. OS094. Subclinical left ventricular dysfunction in preeclamptic women with preserved left ventricular ejection fraction: A 2D speckle tracking imaging study

Author

John D. Mitchell, Michele R. Hacker, Phil Hess, Sajid Shahul, Julie S. Rhee, Sarosh Rana, Daniel Talmor, and Feroze Mahmood

Subjects
Cardiac function curve, medicine.medical_specialty, Ejection fraction, business.industry, Obstetrics and Gynecology, Imaging study, Speckle tracking echocardiography, medicine.disease, Preeclampsia, Speckle pattern, Interquartile range, Internal medicine, Internal Medicine, medicine, Cardiology, business, Subclinical infection
Abstract

Introduction Patients with preeclampsia are at risk for cardiovascular disease [1,2]. Changes in cardiac function are subtle in preeclampsia and are quantitatively difficult with conventional imaging. Strain measurements using speckle-tracking echocardiography have been used to sensitively quantifyabnormalities in other disease settings [3]. Objectives The objective of this study was to evaluate changes in myocardial strain using speckle tracking echocardiography in women with and without preeclampsia. We hypothesized that global left systolic strain measures would prove more sensitive than conventional left ventricular ejection fraction in detecting early changes in systolic LV function manifesting as subclinical disease prior to overt progression. Methods We evaluated the feasibility and sensitivity of strain imaging using speckle tracking echocardiography. Thirty-six women were enrolled in this pilot study; 28 were analyzed: 11 with preeclampsia and 17 without preeclampsia. Echocardiographic Ejection fraction and global peak longitudinal ,radial and circumferential strain were measured. Results Global Median longitudinal strain was significantly worsened in women with preeclampsia compared to women without preeclampsia ( P P =0.006) and circumferential strain ( P =0.03). There was no significant difference in ejection fraction between the groups ( P =0.52) (Table 1). Data are presented as median (interquartile range). Conclusion Myocardial strain imaging using speckle tracking is more sensitive than left ventricular ejection fraction to detect differences in left ventricular systolic function in women with and without preeclampsia.

Published
2012
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166. Unilateral Pulmonary Edema Secondary to Mitral Valve Perforation

Author

Duane S. Pinto, David C. Liu, Sajid Shahul, Robina Matyal, Feroze Mahmood, Umer Aziz Bhatti, and Haider J. Warraich

Subjects
Male, medicine.medical_specialty, Perforation (oil well), Pulmonary Edema, Lung biopsy, Physiology (medical), Mitral valve, medicine, Humans, Heart Valve Prosthesis Implantation, Mitral regurgitation, Rupture, Spontaneous, medicine.diagnostic_test, business.industry, Mitral Valve Insufficiency, Auscultation, Middle Aged, Pulmonary edema, medicine.disease, Systolic murmur, respiratory tract diseases, Surgery, Pneumonia, medicine.anatomical_structure, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
Abstract

A 52-year-old hypertensive man, with a 40–pack-a-year smoking history, presented to an outside hospital with dyspnea, fever, and cough. Chest x-ray demonstrated right-sided infiltrates. He was treated with antibiotics for presumed pneumonia. However, the patient presented the following morning with worsening dyspnea and hemoptysis. Bronchioalveolar lavage and right lung biopsy under general anesthesia were nondiagnostic. The patient was transferred to our institution for further management. At our hospital, chest auscultation revealed a systolic murmur consistent with mitral regurgitation (MR). Chest x-ray and …

Published
2011
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167. Fate of Mitral Regurgitation After Aortic Valve Replacement for Aortic Stenosis

Author

Balachundar Subramaniam, Sajid Shahul, Robina Matyal, Geoffery Hayward, and Haider J. Warraich

Subjects
Male, medicine.medical_specialty, Anesthesia, General, Catheterization, law.invention, Coronary artery disease, Aortic valve replacement, law, Internal medicine, Diabetes mellitus, Cardiopulmonary bypass, Humans, Medicine, Aged, Heart Valve Prosthesis Implantation, Mitral regurgitation, business.industry, Mitral Valve Insufficiency, Aortic Valve Stenosis, medicine.disease, Stenosis, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Aortic Valve, Heart failure, Cardiology, Mitral Valve, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal, Artery
Abstract

A75-YEAR-OLD MAN with dizziness and shortness of breath underwent a balloon valvuloplasty performed for critcal aortic stenosis. After experiencing minimal symptomatic reief, the patient presented to the authors’ tertiary care center with orsening symptoms 2 weeks after the procedure. The patient’s istory was significant for congestive heart failure, type-2 diabetes ellitus, coronary artery disease, chronic atrial fibrillation, and ypertension, and he had undergone a coronary artery bypass graft rocedure in 1992. Because of a lack of symptomatic improveent after balloon valvuloplasty and persistence of decompenated congestive heart failure, despite his high risk, it was decided o perform aortic valve replacement (AVR). After an uneventful induction of general anesthesia, a re– cardiopulmonary bypass (CPB) transesophageal echoardiographic (TEE) examination was performed; an AV rea of 0.5 cm2 (critical 0.8 cm2) was calculated with the

Published
2011
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168. Anterior Myocardial Infarction With Dynamic Left Ventricular Outflow Tract Obstruction

Author

Haider J. Warraich, Peter Panzica, Kamal R. Khabbaz, Sajid Shahul, Feroze Mahmood, Robina Matyal, and Swaminathan Karthik

Subjects
Pulmonary and Respiratory Medicine, Cardiac Catheterization, medicine.medical_specialty, Myocardial Infarction, Ventricular outflow tract obstruction, Anterior myocardial infarction, Transesophageal echocardiogram, Hyperkinesis, Ventricular Outflow Obstruction, law.invention, Diagnosis, Differential, Electrocardiography, law, Internal medicine, Mitral valve, Cardiopulmonary bypass, medicine, Humans, Aged, medicine.diagnostic_test, business.industry, Surgery, medicine.anatomical_structure, Echocardiography, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Complication
Abstract

We present the case of a 78-year-old woman who presented with acute anterior myocardial infraction. An intraoperative transesophageal echocardiogram revealed an akinetic apex with hyperkinesis of the basal segments causing systolic anterior motion of the mitral valve. The patient was immediately placed on cardiopulmonary bypass. Her postoperative course was uneventful. We present transesophageal and transthoracic echocardiographic videos showing this unique complication and describing the challenge of managing a patient who required opposing therapies.

Published
2011
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169. [Untitled]

Author

Daniel Talmor, Brett A. Simon, Sajid Shahul, Robert Canelli, Feroze Mahmood, Gaurav Gulati, Victor Novack, and Michele R. Hacker

Subjects
medicine.medical_specialty, Ejection fraction, business.industry, Septic shock, Internal medicine, Cardiology, Medicine, Critical Care and Intensive Care Medicine, business, medicine.disease
Published
2014
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170. Role of breast-feeding in transmission of hepatitis C virus to infants of HCV-infected mothers

Author

Rachana M. Kumar and Sajid Shahul

Subjects
Adult, Pediatrics, medicine.medical_specialty, Hepatitis C virus, Hepacivirus, medicine.disease_cause, Liver disease, Risk Factors, medicine, Humans, Hepatology, Milk, Human, business.industry, Reverse Transcriptase Polymerase Chain Reaction, Colostrum, Infant, Newborn, Infant, Hepatitis C, Hepatitis C Antibodies, medicine.disease, Fetal Blood, Infectious Disease Transmission, Vertical, Breast Feeding, Immunology, Carrier State, RNA, Viral, Female, Viral disease, Viral hepatitis, business, Breast feeding, Viral load, Asymptomatic carrier, Follow-Up Studies
Abstract

The aim of this study was to explore the role of breast-feeding in transmission of hepatitis C virus (HCV) to infants of HCV-infected mothers.Sixty-five parturient asymptomatic carrier mothers with anti-HCV antibody (index patients) and 42 healthy parturient anti-HCV negative mothers (control subjects) were studied from September 1994 to June 1996. Maternal blood and colostrum were taken from each subject within 5 days post-partum and tested for anti-HCV and HCV RNA. Blood samples were collected from all infants at birth (cord blood) and at 1, 3, 6, 9 and 12 months of age. All infants were breast-fed. By 3 months post-partum, five of 65 index patients developed symptomatic liver disease and three of their infants developed acute viral hepatitis. Genotyping and subsequent nucleotide sequencing of the hepatitis C genome was done on these three symptomatic mother-baby pairs.Within 5 days post-partum, the 65 carrier mothers had anti-HCV ranging from 1:40 to 1:30,000 and HCV-RNA ranging from 10(2) to 2.5x10(6) copies/ml. Both anti-HCV antibody and HCV-RNA were present in colostral samples but in significantly lower levels (p0.0001). The five symptomatic mothers had anti-HCV titers ranging from 1:45,000 to 1:90,000 and HCV-RNA ranging from 2.5x10(8) to 4.5x10(9) copies/ml; three of their infants were symptomatic by 3 months of age. Hepatitis C virus genotype (3a) was concordant within each of the three mother-baby pairs, and all three pairs demonstrated greater than 97% homologies between pairs. These three infants were delivered by elective cesarean section at term, breast-fed regularly and there was no apparent maternal breast nipple trauma. None of the remaining infants had evidence of HCV infection up to 1 year of age. All 42 mother-infant pairs from the control group remained anti-HCV negative throughout this study.Among asymptomatic mothers breast-feeding seems safe. Symptomatic women, especially with high viral loads, should not breast-feed to avoid the risk of viral transmission through breast-feeding.

Published
1998

171. Anomalous Right Coronary Artery Arising From the Pulmonary Artery

Author

Robina Matyal, Venkatachalam Senthilnathan, Sajid Shahul, Haider J. Warraich, and Feroze Mahmood

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Coronary Vessel Anomalies, medicine.medical_treatment, Ischemia, Pulmonary Artery, Coronary artery disease, medicine.artery, Internal medicine, Ascending aorta, medicine, Humans, Abnormalities, Multiple, Cardiac catheterization, biology, business.industry, medicine.disease, Troponin, medicine.anatomical_structure, Right coronary artery, Pulmonary artery, Cardiology, biology.protein, Surgery, Cardiology and Cardiovascular Medicine, business, Artery
Abstract

A42-year-old man with a history of cocaine abuse presented to the emergency department with severe acute exertional chest pain. Electrocardiographic findings were consistent with ischemia. However troponin levels were normal. A 64-slice coronary computed tomography angiogram was performed, which revealed an anomalous dominant right coronary artery originating from the pulmonary artery (ARCAPA) (Fig 1 [LAD left anterior descending; PA pulmonary artery and Fig 2 [Ao aortic artery; PA pulmonary artery; RCA right coronary artery]). There were extensive collaterals from the left anterior descending artery to the ARCAPA in the absence of coronary artery disease. After confirmation of these findings by cardiac catheterization, the patient was scheduled for immediate surgical repair to prevent further ischemic episodes. Intraoperative transesophageal echocardiography revealed the ARCAPA, which was implanted into the ascending aorta (Fig 2, Videos 1 and 2; accompanying videos for this article can be viewed at http://ats.ctsnetjournals.org/content/vol93/issue3/ images/data/e75/DC1/warraich1.avi and http://ats. ctsnetjournals.org/content/vol93/issue3/images/data/e75/ DC1/warraich2.avi.). ARCAPA is a rare but potentially fatal congenital abnormality, with surgical repair recommended even in asymptomatic patients [1]. The extent of collateralization

Published
2012
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172. 389: Myocardial performance index in preeclampsia

Author

Sarosh Rana, Benjamin Hamar, Feroze Mahmood, Sajid Shahul, Philip E. Hess, John D. Mitchell, Julie Rhee, and Camille E. Powe

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Cardiology, Obstetrics and Gynecology, Medicine, Myocardial Performance Index, business, medicine.disease, Preeclampsia
Published
2011
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175. Dissection of the thoracic aorta following cardiopulmonary resuscitation

Author

Achikam Oren-Grinberg, Todd Sarge, and Sajid Shahul

Subjects
Aortic dissection, medicine.medical_specialty, Resuscitation, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Dissection (medical), Transesophageal echocardiogram, medicine.disease, Stenosis, Anesthesia, Internal medicine, medicine.artery, Pulseless electrical activity, Cardiology, cardiovascular system, Medicine, Thoracic aorta, Cardiopulmonary resuscitation, cardiovascular diseases, business
Abstract

An 86-year-old patient was admitted to the ICU with multiple trauma injury following a fall down ten stairs. Shortly after ICU admission the patient went into cardiac arrest and resuscitation efforts, including cardiopulmonary resuscitation (CPR), were initiated. Transesophageal echocardiogram was performed to guide therapy and, after regaining heart rhythm and blood pressure, the echocardiogram exam demonstrated critical aortic stenosis and type-B aortic dissection. The aortic dissection was not present on initial chest computerized tomography done on admission to the hospital. The aortic dissection appears to have resulted from the CPR performed to revive the patient.

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176. Multi-complexity measures of heart rate variability and the effect of vasopressor titration: a prospective cohort study of patients with septic shock

Author

Matthew T. Rondina, Samuel M. Brown, Colin K. Grissom, Michael J. Lanspa, Sajid Shahul, Jeff Sorensen, and V.J. Mathews

Subjects
Adult, Male, Mean arterial pressure, medicine.medical_specialty, Adolescent, Heart Rate Variability, Blood Pressure, law.invention, Sepsis, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, law, Physiological Variability, Internal medicine, Heart rate, medicine, Humans, Vasoconstrictor Agents, Heart rate variability, Prospective Studies, 030212 general & internal medicine, APACHE, Aged, Aged, 80 and over, APACHE II, Septic shock, business.industry, Shock, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Shock, Septic, Intensive care unit, 3. Good health, Surgery, Treatment Outcome, Infectious Diseases, Shock (circulatory), Cardiology, Female, medicine.symptom, business, Research Article
Abstract

Background Septic shock is a common and often devastating syndrome marked by severe cardiovascular dysfunction commonly managed with vasopressors. Whether markers of heart rate complexity before vasopressor up-titration could be used to predict success of the up-titration is not known. Methods We studied patients with septic shock requiring vasopressor, newly admitted to the intensive care unit. We measured the complexity of heart rate variability (using the ratio of fractal exponents from detrended fluctuation analysis) in the 5 min before all vasopressor up-titrations in the first 24 h of an intensive care unit (ICU) admission. A successful up-titration was defined as one that did not require further up-titration (or decrease in mean arterial pressure) for 60 min. Results We studied 95 patients with septic shock, with a median APACHE II of 27 (IQR: 20–37). The median number of up-titrations, normalized to 24 h, was 12.2 (IQR: 8–17) with a maximum of 49. Of the up-titrations, the median proportion of successful interventions was 0.28 (IQR: 0.12–0.42). The median of mean arterial pressure (MAP) at the time of a vasopressor up-titration was 66 mmHg; the average infusion rate of norepinephrine at the time of an up-titration was 0.11 mcg/kg/min. The ratio of fractal exponents was not associated with successful up-titration on univariate or multivariate regression. On exploratory secondary analyses, however, the long-term fractal exponent was associated (p = 0.003) with success of up-titration. Independent of heart rate variability, MAP was associated (p

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