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CardioNerds Dr. Josh Saef and Dr. Tommy Das join Dr. Omkar Betageri, Dr. Andrew Geissler, Dr. Philip Lacombe, and Dr. Cashel O'Brien from the Maine Medical Center in Portland, Maine to enjoy an afternoon by the famous Portland headlight. They discuss a case of a patient who presents with obstructive cardiogenic shock. Dr. Bram Geller and Dr. Jon Donnelly provide the Expert CardioNerd Perspectives & Review segment for this episode. Dr. Maxwell Afari, the Maine Medical Center cardiology fellowship program director highlights the fellowship program. Audio editing by CardioNerds Academy Intern, student doctor Tina Reddy. This is the case of a 42 year-old woman born with complicated Tetralogy of Fallot repair culminating in a 29mm Edwards Sapiens (ES) S3 valve placement within a pulmonary homograft for graft failure who was admitted to the cardiac ICU for progressive cardiogenic shock requiring vasopressors and inotropic support. Initial workup showed lactic acidosis, acute kidney injury, elevated NT-proBNP, and negative blood cultures. TTE showed at least moderate biventricular systolic dysfunction. She was placed on furosemide infusion, blood cultures were drawn and empiric antibiotics initiated. Right heart catheterization demonstrated elevated right sided filling pressures, blunted PA pressures with low PCWP, low cardiac index, and low pulmonary artery pulsatility index. Intracardiac echocardiography (ICE) showed a large mass within the ES valve apparatus causing restrictive valve motion with a low gradient across the pulmonic valve in the setting of poor RV function. Angiography revealed a large filling defect and balloon valvuloplasty was performed with immediate hemodynamic improvement. Blood cultures remained negative, she was gradually weaned off of inotropic and vasopressor support, and discharged. Despite empiric treatment for culture negative endocarditis and ongoing anticoagulation, she was readmitted for recurrent shock one month later at which time the pulmonic mass was revisualized on ICE. A valve-in-valve transcatheter pulmonary valve (29mm ES S3) was placed to compress what was likely pannus, with an excellent hemodynamic result and no visible mass on ICE. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media Pearls - Obstructive Cardiogenic ShocK Tetralogy of Fallot is the most common cyanotic defect and can lead to long term complications after surgical repair including chronic pulmonary insufficiency, RV dysfunction, residual RVOT obstruction and branch pulmonary artery stenoses. Chronic RV failure may be more indicative of a structural defect and therefore require interventional or surgical management. Valve thrombosis, infective endocarditis and obstructive pannus formation should be considered in the differential of a patient with obstructive shock with a prosthetic valve. Bioprosthetic pulmonic valve obstruction may be effectively managed with balloon valvuloplasty in patients who present in acute extremis but TCPV will likely provide a more lasting result. While valvular gradients are typically assessed via echocardiography, invasive hemodynamics can serve as a critical adjunctive tool in its characterization. Show Notes - Obstructive Cardiogenic ShocK Notes were drafted by Drs. Omkar Betageri, Philip Lacombe, Cashel O'Brien, and Andrew Geissler. What are the common therapies and management for Tetralogy of Fallot? Tetralogy of Fallot is the most common cyanotic defect in children beyond the age of one year Anatomic Abnormalities: Anterior and Superior deviation of the conal septum creating a SubAo VSD and encroachment on the RVOT.
It's the 400th Episode of RVOT! Shawn and Colm recap the Underdog Big Board Draft from the 4th slot. Did their plan become a reality? Subscribe to the RotoViz YouTube Channel here! HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code "rvradio2022" at checkout. Underdog Fantasy - Sign up via this link or use Promo Code ROTOVIZ at Underdogfantasy.com and get a 100% deposit match on their first deposit up to $100. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
It's the 400th Episode of RVOT! Shawn and Colm recap the Underdog Big Board Draft from the 4th slot. Did their plan become a reality? Subscribe to the RotoViz YouTube Channel here! HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code "rvradio2022" at checkout. Underdog Fantasy - Sign up via this link or use Promo Code ROTOVIZ at Underdogfantasy.com and get a 100% deposit match on their first deposit up to $100. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
It's the 400th Episode of RVOT! Shawn and Colm recap the Underdog Big Board Draft from the 4th slot. Did their plan become a reality? Subscribe to the RotoViz YouTube Channel here! HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code "rvradio2022" at checkout. Underdog Fantasy - Sign up via this link or use Promo Code ROTOVIZ at Underdogfantasy.com and get a 100% deposit match on their first deposit up to $100. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
CardioNerds (Daniel Ambinder), ACHD series co-chair, Dr. Josh Saef (ACHD fellow at University of Pennsylvania), and ACHD FIT lead Dr. Charlie Jain (Mayo Clinic) join ACHD expert Dr. George Lui (Medical Director of The Adult Congenital Heart Program at Stanford and Program Director for the ACGMEadult congenital heart disease fellowship at Stanford. ), to discuss Tetrology of Fallot. Audio editing by CardioNerds Academy Intern, Dr. Leticia Helms. Tetralogy of Fallot (ToF) is the most common cyanotic heart disease and one of the most common congenital heart diseases that we see in adults overall. The anatomy includes a ventricular septal defect (VSD), an overriding aorta, and infundibular hypertrophy with subpulmonic +/- pulmonic valvular +/- supravalvular stenosis, which causes severe RV outflow obstruction and subsequent RV hypertrophy. Patients require surgery during childhood, which includes patching the VSD and relieving RV outflow obstruction. This results in pulmonic regurgitation (usually severe) and patients can live with this for decades. Adults with ToF commonly will require pulmonic valve replacement, potential relief of subvalvular or supravalvular stenoses, and tricuspid valve repair (for functional tricuspid regurgitation caused by RV dilation). These patients are at increased risk of atrial and ventricular arrhythmias and may warrant prophylactic ICDs. The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Tetralogy of Fallot Tetralogy of Fallot is the most common cyanotic heart disease and the 4 anatomic features are: VSD, infundibular hypertrophy (with RVOT obstruction), overriding aorta, and RV hypertrophy. The most common lesion you will see in adults with repaired Tetralogy of Fallot is pulmonic regurgitation.Pulmonic regurgitation (PR) can be easy to miss on exam as the murmur is brief and even shorter when the PR is severe. In patients with PR and aortic regurgitation, remember PR is clearest when laying supine, in comparison to aortic regurgitation which is loudest while leaning forward.Patients with ToF may also have coronary anomalies (e.g. LAD off RCA), right-sided aortic arches, and also left-sided heart disease (LV diastolic or systolic dysfunction).Patients with ToF are at risk for atrial and ventricular arrhythmias, and clinicians should consider prophylactic ICD for those with multiple risk factors for sudden death (e.g. QRS >180ms, scar on MRI).In all patients with congenital heart disease, inspection is a key part of the physical exam (e.g. right thoracotomy could clue you into a prior BTT shunt) and in patients with prior BTT shunts and/or prior brachial cut-downs (look in the antecubital fossa for scars), radial arterial access is discouraged. Show notes - Tetralogy of Fallot 1. What is the embryologic origin of Tetrology of Fallot (i.e. anterocephalad deviation of spiral septum)? With Tetralogy of Fallot, the most important considerations are in the embryology of the primitive outflow trac...
RotoViz Overtime is powered by RotoViz Radio. IT'S OVERTIME Shawn and Colm discuss how the 2021 listeners leagues went and what the roster construction of the top teams was. How did the guys fair? Players discussed include Deebo Samuel and Ceedee Lamb. Subscribe to the RotoViz YouTube Channel here! HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2022' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. IT'S OVERTIME Shawn and Colm discuss how the 2021 listeners leagues went and what the roster construction of the top teams was. How did the guys fair? Players discussed include Deebo Samuel and Ceedee Lamb. Subscribe to the RotoViz YouTube Channel here! HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2022' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. IT'S OVERTIME In this edition, Shawn and Colm review Week10 and discuss some of the key takeaways from a fun and successful week for the RVOT rosters. Players discussed include A.J. Dillon and Russell Wilson. Article: The Juggernauts Strike Back, Plus Rhamondre Stevenson And A.J. Dillon Take Their Star Turns HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. TickPick - Visit TickPick.com/RotoViz today and use the promo code ROTOVIZ to save $10 on your first order of NFL tickets! SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. IT'S OVERTIME In this edition, Shawn and Colm review Week10 and discuss some of the key takeaways from a fun and successful week for the RVOT rosters. Players discussed include A.J. Dillon and Russell Wilson. Article: The Juggernauts Strike Back, Plus Rhamondre Stevenson And A.J. Dillon Take Their Star Turns HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. TickPick - Visit TickPick.com/RotoViz today and use the promo code ROTOVIZ to save $10 on your first order of NFL tickets! SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. IT'S OVERTIME In this edition, Shawn and Colm review various rosters and draft boards submitted by the RVOT listeners. Players discussed include Kyler Murray and Ezekiel Elliot. HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. IT'S OVERTIME In this edition, Shawn and Colm review various rosters and draft boards submitted by the RVOT listeners. Players discussed include Kyler Murray and Ezekiel Elliot. HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. ON THE CLOCK! In this episode, Shawn and Colm are co-owning a team in the FFPC Best Ball Tournament but this time it is an exclusive RVOT Listerner league! That's right, either RVOT or one of the podcast listeners will be heading to the playoffs for a shot at the grand prize! Listen in as they discuss strategy and pick selection while on the clock from the 3rd spot in the draft. HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. TIME TO REVIEW In this episode, Shawn and Colm review the draft, what they would do if given a chance to change they picks and which team looks best after the draft is complete. The guys are co-owning a team in the FFPC Best Ball Tournament but this time it is an exclusive RVOT Listerner league! That's right, either RVOT or one of the podcast listeners will be heading to the playoffs for a shot at the grand prize! HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. TIME TO REVIEW In this episode, Shawn and Colm review the draft, what they would do if given a chance to change they picks and which team looks best after the draft is complete. The guys are co-owning a team in the FFPC Best Ball Tournament but this time it is an exclusive RVOT Listerner league! That's right, either RVOT or one of the podcast listeners will be heading to the playoffs for a shot at the grand prize! HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. ON THE CLOCK! In this episode, Shawn and Colm are co-owning a team in the FFPC Best Ball Tournament but this time it is an exclusive RVOT Listerner league! That's right, either RVOT or one of the podcast listeners will be heading to the playoffs for a shot at the grand prize! Listen in as they discuss strategy and pick selection while on the clock from the 3rd spot in the draft. HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. ON THE CLOCK! In this episode, Shawn and Colm are co-owning a team in the FFPC Best Ball Tournament but this time it is an exclusive RVOT Listerner league! That's right, either RVOT or one of the podcast listeners will be heading to the playoffs for a shot at the grand prize! Listen in as they discuss strategy and pick selection while on the clock from the 3rd spot in the draft. HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. ON THE CLOCK! In this episode, Shawn and Colm are co-owning a team in the FFPC Best Ball Tournament but this time it is an exclusive RVOT Listerner league! That's right, either RVOT or one of the podcast listeners will be heading to the playoffs for a shot at the grand prize! Listen in as they discuss strategy and pick selection while on the clock from the 3rd spot in the draft. HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. ON THE CLOCK! In this episode, Shawn and Colm are co-owning a team in the FFPC Best Ball Tournament but this time it is an exclusive RVOT Listerner league! That's right, either RVOT or one of the podcast listeners will be heading to the playoffs for a shot at the grand prize! Listen in as they discuss strategy and pick selection while on the clock from the 3rd spot in the draft. HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio Learn more about your ad choices. Visit podcastchoices.com/adchoices
RotoViz Overtime is powered by RotoViz Radio. ON THE CLOCK! In this episode, Shawn and Colm are co-owning a team in the FFPC Best Ball Tournament but this time it is an exclusive RVOT Listerner league! That's right, either RVOT or one of the podcast listeners will be heading to the playoffs for a shot at the grand prize! Listen in as they discuss strategy and pick selection while on the clock from the 3rd spot in the draft. HOSTS Colm Kelly (@OvertimeIreland) – Executive Producer of RotoViz Radio Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner SPONSORS RotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio Learn more about your ad choices. Visit podcastchoices.com/adchoices
Yakın dönemde olgu olarak Cevabı Görselinde serisinde paylaştığımız, pulmoner embolide (PE) erken sistolik çentik (ESN) bulgusunun acil servis hastalarında tanısal duyarlılığı ile ilgili çok merkezli çalışmasını da yayımladık.1 Bu yazımızda, bu bulgunun acil servis hastalarında ne kadar güvenilir olduğu ile ilgili sonuçları paylaşacağız. İyi okumalar. Giriş Afonso ve ark., 2019 yılında, masif ve submasif PE hastalarında ESN bulgusunun %92 duyarlılık ve %99 özgüllük ile çok yüksek tanısal doğruluğa sahip olduğunu bildirdi.2 Bu sonuçlar, akademik dünyada büyük bir yankı yaptı. Fakat çalışmanın retrospektif olması ayrıca bilinen pulmoner hipertansiyon, orta-ileri kapak patolojisi ve PE tanısı olan hastaların dışlanmış olması çalışmadaki büyük sınırlamalardı. Dahası, çalışma sadece masif ve submasif hastalarda yüksek tanısal doğruluk bildiriyordu. Bu nedenle bu bulgunun acil servis hastalarında belirgin bir dışlama kriteri olmadan tüm hastaları kapsayacak şekilde ele alınması önem arz etmekteydi. Yöntem Dizayn: Prospektif kohort Hasta Alımı: Örneklem Merkezler: Dört akademik acil servis Kabul Kriterleri: Acil servise başvuran ve PE öntanısıyla toraks CTA çekilen 18 yaş ve üzeri hastalar. Dışlama Kriterleri: Gebeler, görüntüleme öncesi trombolit tedavi alan ve yetersiz görüntüye sahip hastalar. Görüntüleme: Odaklanmış kardiyak US (FOCUS), 4 acil tıp uzmanı ve 4 acil tıp asistanı tarafından kaydedildi. Görüntüler içerisinde sadece sağ ventrikül çıkış yolu (RVOT) görüntüleri cihaza kaydedildi. Triküspit kaçak akımı, sağ/sol ventrikül oranı ve vena cava inferior ölçümleri formlara not edildi. Cihaza kaydedilen RVOT görüntüleri çalışmada yer alan kardiyolog tarafından ESN varlığı açısından yorumlandı. Ayrıca bu görüntüler, hasta alımına katılmayan ve FOCUS konusunda deneyimli başka bir acil tıp uzmanına kişiler arası uyum açısından yorumlatıldı. Çalışma akış şeması ise tüm araştırmacılara önceden bildirildi ve yorumları alındı. RVOT görüntülemesi ve ESN bulgusu ile sonografik değerlendirme yöntemine önceki yazımızdan ulaşabilirsiniz. Bulgular Altı aylık sürede toplam 183 hasta çalışmaya dahil edildi. Bu hastaların 96'sında PE ve 36'sında ESN bulgusu mevcuttu. Ayrıntılı demografik veriler Tablo 1'de sunulmaktadır. PE hastaların içerisinde sadece 33 hastada ESN bulgusu mevcuttu. Geriye kalan ve ESN bulgusu olan 3 hastada PE saptanmadı. PE yönelik ayrıntılı veriler Tablo 2'se sunulmaktadır. ESN'nin tüm acil servis hastalarındaki tanısal duyarlılığı %34, özgüllüğü %97 ve doğruluğu %64 saptandı. Bu oran, yüksek ve orta-yüksek risk PE grubunda (eski tanımlama ile masif ve submasif) %69 duyarlılık, %90 özgüllük ve %86 doğruluk olarak bulundu. Fakat orta-düşük ve düşük risk PE grubunda, tanısal değerliliğe sahip değildi. FOCUS deneyimli acil tıp uzmanı ve kardiyolog arasındaki uyum yüksek olarak saptandı (Kappa 0,87). Sonuç ESN bulgusu tüm PE hastalarında yüksek-orta özgüllük ve düşük duyarlılık değerlerine sahiptir. Yüksek ve orta-yüksek risk PE hastalarında ise orta özgül ve düşük duyarlıdır. Bununla beraber, ESN bulgusunun PE'de tek başına kullanımını destekleyen halen yeterli veri yoktur, bu nedenle bir süre daha diğer kardiyak US bulguları ile birlikte değerlendirilmesi uygun olacaktır. Ayrıca, bu görüntüleme temel US seviyesinin üstünde bir deneyim gerektirdiği için şüpheli olgularda ileri görüntüleme ve konsultasyon istemi gerekmektedir. Kaynaklar 1. Aslaner MA, Karbek Akarca F, Aksu ŞH, et al. Diagnostic Accuracy of Early Systolic Notching in Pulmonary Embolism. J Ultrasound Med. Published online May 14, 2021. doi:10.1002/jum.15744 2. Afonso L, Sood A, Akintoye E, et al. A Doppler Echocardiographic Pulmonary Flow Marker of Massive or Submassive Acute Pulmonary Embolus. Journal of the American Society of Echocardiography. Published online July 2019:799-806. doi:10.1016/j.echo.2019.03.004
RotoViz Overtime is powered by RotoViz Radio.HOSTSColm Kelly (@OvertimeIreland) – Executive Producer of RotoViz RadioShawn Siegele (@FF_Contrarian) – RotoViz Co-OwnerIT’S OVERTIMEIn this edition, Shawn and Colm are joined by the RVOT 200 contest winner. Alex joins the guys in a fun question-and-answer session. He asks the guys about the MFL10 of death, Rookie Drafts, Best Ball, Zero RB, and more. Players discussed include Ja'marr Chase, Rondale Moore, and Deshaun Watson.SPONSORSRotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout.SHOW NOTESEmail: RotoVizRadio@gmail.comTwitter: @RotoVizOvertime
RotoViz Overtime is powered by RotoViz Radio.HOSTSColm Kelly (@OvertimeIreland) – Executive Producer of RotoViz RadioShawn Siegele (@FF_Contrarian) – RotoViz Co-OwnerIT’S OVERTIMEIn this edition, Shawn and Colm are joined by the RVOT 200 contest winner. Alex joins the guys in a fun question-and-answer session. He asks the guys about the MFL10 of death, Rookie Drafts, Best Ball, Zero RB, and more. Players discussed include Ja'marr Chase, Rondale Moore, and Deshaun Watson.SPONSORSRotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout.SHOW NOTESEmail: RotoVizRadio@gmail.comTwitter: @RotoVizOvertime
RotoViz Overtime is powered by RotoViz Radio.HOSTSColm Kelly (@OvertimeIreland) – Executive Producer of RotoViz RadioShawn Siegele (@FF_Contrarian) – RotoViz Co-OwnerIT’S OVERTIMEIt is the 200th edition of the podcast. Shawn and Colm discuss the Running Back Class and evaluate their values based on their landing spots. They also answer some listener questions regarding Draft Strategy. Players discussed include Travis Etienne, Javonte Williams, and Chubba Hubbard.SPONSORSRotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout.SHOW NOTESEmail: RotoVizRadio@gmail.comTwitter: @RotoVizOvertime
RotoViz Overtime is powered by RotoViz Radio.HOSTSColm Kelly (@OvertimeIreland) – Executive Producer of RotoViz RadioShawn Siegele (@FF_Contrarian) – RotoViz Co-OwnerIT’S OVERTIMEIt is the 200th edition of the podcast. Shawn and Colm discuss the Running Back Class and evaluate their values based on their landing spots. They also answer some listener questions regarding Draft Strategy. Players discussed include Travis Etienne, Javonte Williams, and Chubba Hubbard.SPONSORSRotoViz - RotoViz Radio listeners can save 10% off of a 1-year RotoViz subscription at RotoViz.com/podcast or by applying the discount code 'rvradio2021' at checkout.SHOW NOTESEmail: RotoVizRadio@gmail.comTwitter: @RotoVizOvertime
Cardiac Consult: A Cleveland Clinic Podcast for Healthcare Professionals
Dr. Thomas Fagan, interventional cardiologist in the Department of Pediatric Cardiology at Cleveland Clinic, discusses interventional options, such as PDA and RVOT shunt placements, as alternatives to surgery. The talk was presented at the Cleveland Clinic’s 4th Annual Advances in Pediatric and Congenital Heart Summit focused on Congenitally Corrected Transposition of the Great Arteries. We look forward to the 5th Annual Advances in Congenital Heart Disease at Cleveland Clinic in October of 2020.
This week we review a recent report on transcatheter pulmonary valve replacement with the Sapien S3 prosthesis. What are the circumstances in which this valve might be preferable versus other valve types? What are the disadvantages of this device? How can patients be effectively screened as candidates for different valves? How can decisions be made between self expanding systems like Harmony or Venus P versus this sort of device for large RVOT's? We review all of these issues and more with Dr. Daniel Levi of UCLA who offers a wonderful overview of transcatheter PVR in 2019. You will not want to miss his many insights. doi: 10.1002/ccd.27973
Dr Paul Wang: Welcome to the monthly podcast On the Beat, for Circulation: Arrhythmia, and Electrophysiology. I'm Dr Paul Wang, editor-in-chief, with some of the key highlights from this month's issue. In our first paper, Elizabeth Saarel and associates describe the analysis of athletes in the ICD sports registry. The authors found that over a median follow-up of 42 months of 129 young athletes, and a mean age of 16 years, there were 35 athletes, or 27%, that received a total of 38 shocks. Long QT syndrome and hypertrophic cardiomyopathy were the most common diagnoses. While shocks related to competition and practice were not uncommon, there were no serious adverse sequelae. Lead malfunction rates were similar to previously reported in an unselected pediatric ICD populations. There were no occurrences of death, arrest, injury related to arrhythmia during sports. There was one ventricular tachycardia ventricular fibrillation storm during competition. In our next paper, Kedar K. Aras and associates theorize that the tissue volume to wavelength volume ratio is important in determining ventricular fibrillation sustainability. They perform panoramic optical mapping of coronary perfused human left ventricular wedge preparations, which were subjected to acts of potential duration changes produced by IK,ATP agonist pinacidil and antagonist glybenclamide. They found that pinacidil and escalating concentrations progressively decreased the volume wavelength in ventricular fibrillation became sustained when the tissue volume to wavelength ratio was above the safety factor, K equals 4.4. In addition, ventricular fibrillation was only sustained when the ventricular volume exceeded the critical wavelength volume defined by the product of pacing cycle wave length in the longitudinal transverse and transmural directions. In our next paper Thomas Deneke and associates examine the ability of a novel infrared thermal probe to predict endoscopically detected thermal esophageal lesions post atrial fibrillation ablation. They studied six patients undergoing their first pulmonary vein isolation, using radio frequency point by point catheter ablation in the HEAT-AF study; 12 or 19% of patients had endoscopically detected thermal esophageal lesions. The peak esophageal temperature Tpeak was significantly higher, 56.3 degrees Celsius versus 45.7 degrees Celsius. P less than 0.0001 in patients with endoscopically detected thermal esophageal lesions compared to those without lesions. Logistical regression analysis demonstrated Tpeak was a statistically significant predictor, P equals 0.0008 pf endoscopically detected thermal esophageal lesions with an odds ratio of 1.52. In our next paper Dian Cheng and associates examine a novel algorithm incorporating right precordial and posterior leads to discriminate between left ventricular outflow tract and right ventricular outflow tract foci. The V3R to V7 index was prospectively tested in consecutive patients at four centers. In 94 patients of the validation cohort with 79% RVOT foci, a QS pattern in lead V3R exclusively recorded in right ventricular outflow tract foci, while an S wave in V3 was exclusively recorded in left ventricular outflow tract foci. The V3R to V7 index of LVOT origin was significantly great than that of RVOT 1.05 versus 0.28 P, less than 0.001 with a V3R to V7 index of greater than equal to 0.85 predicting an LVOT origin with 87% sensitivity and 96% specificity. With the V3R to V7 index of 0.85 or greater RVOT origin could be excluded with 98.6% accuracy. In the next paper Jim Cheung and associates examine the in-hospital outcomes, cause, and thirty-day readmissions following catheter ablation of MI associated ventricular tachycardia. The authors use a nationwide readmissions database to evaluate 4109 admissions for catheter ablation of MI associated ventricular tachycardia occurring between 2010 and 2015. The index admission in-hospital mortality rate was 2.7% and the procedural complication rate after ventricular tachycardiablation was 11.5%. Pulmonary hypertension, lung disease, obesity and coagulopathy were independent predictors of mortality. Following discharge after VT ablation the thirty-day readmission rate was 19.2%. With the median time to readmission of 10.0 days, in an in-hospital mortality of 2.9%. Cardiac causes accounted for 74% of readmissions. With ventricular tachycardia accounting for 41% of admissions and congestive heart failure accounting for 14% of readmissions. Pulmonary hypertension, congestive heart failure, smoking, chronic pulmonary disease, and prolonged index hospitalization were significant independent predictors of thirty-day readmission. After adjustment thirty-day readmissions were associated with a 38.9% increase in cumulative hospitalization costs. In the next paper Tomofumi Nakamura and associates examine the relation of hemorrhagic and thromboembolic events with anticoagulations strategy in the setting of epicardial axis procedures for ventricular arrhythmia mapping and ablation. In 355 patients oral anticoagulants were stopped perioperatively in heparin administered prior to the procedure. The patients were divided to three groups per the anticoagulations strategy. Group 1, no heparin was administered before pericardial access, Group 2, heparin was administered in reverse before pericardial access, and Group 3 heparin was administered and not reversed. Significant pericardial bleeding defined is greater than 80 milliliter occurred in 46 cases or 13% and did not differ among the three groups. Unintentional cardiac puncture in left ventricular chest infraction less than [inaudible 00:07:32] 35% were independently associated with pericardial bleeding with an odd ratio of 16.4 or 2.28. Of 38 procedures with unintentional cardiac puncture there were no differences in pericardial bleeding for different anti-coagulant strategies. Thromboembolic events occur in 5 patients, 1 coronary embolism, 1 stroke, 2 deep vein thrombosis, and 1 fatal pulmonary embolism and 1 thrombus on a temporary ventricular assist device. In the next paper, Elisabeth Mouws and associates examine whether the combination of lines of conduction block with multiple wave fronts at the pulmonary vein area may result in increased arrhythmogenicity and susceptibility to atrial fibrillation. The author performed intra-operative high-density epicardial mapping of pulmonary vein area and is 450 sites with an intra-electrical distance of 2 milliliters which performed during sinus rhythm in 327 patients. With and without preoperative intra-fibrillation. Excitation of the pulmonary vein area occurred via multiple consecutive wave fronts in the vast majority, 81% of patients. In total 561 wave fronts were observed which propagated through the septal or paraseptal regions tore the pulmonary vein area in 82%. Substantial dissociation of consecutive wave fronts was observed with delta activation times of 10.6 milliseconds. No difference was observed in delta activation times of consecutive wave fronts during sinus rhythm between patients with and without atrial fibrillation. In excitation-based risk factor model including conduction delay of greater equal to 6 millimeters conduction block of greater than or equal to 6 millimeters and conduction delay conduction block of 16 millimeters or greater, wave fronts vie the posterior inferior and posterior superior in multiple opposing wave fronts demonstrated a 5-fold risk of atrial fibrillation when multiple risk factors were present. In our final paper Yoshitaka Kimura and associates examine the prognostics significance of PR interval prolongation on adverse cardiac events. They studied 176 patients with repaired tetralogy of flow with a median age of 17.4 years then they evaluated their correlation with right ventricular volume and function measured by cardiac magnetic resonance and the significance as a risk factor of adverse cardiac events were ventricular arrhythmias, atrial arrhythmias, heart failure, hospitalization, complete AV block, and all cause death. First degree AV block was noted 25 patients or 14% during a median follow-up of 10 years there was a progressive prolongation of PR interval 2.0 milliseconds per year. Importantly there were significant correlations between PR interval prolongation and right ventricular enlargement or right ventricular disfunction. In contrast, patients who underwent pulmonary valve replacement, N equal 23, significant shortening of PR interval was noted, 204 versus 176 milliseconds, P equals 0.007. Cox regression analysis showed that the first degree AV block was an independent risk factor for ventricular arrhythmias hazard ratio 5.479, in complete heart block, hazard ratio 27.67, and it had a tendency for heart failure hospitalization, hazard ratio 3.3. In addition PR interval prolongation greater than 2 millisecond per year was also a significant risk factor for ventricular arrhythmias regardless of the presence or absence of first degree AV block in enrollment. That's it for this month. We hope that you will find the journal to be the go to place for everyone interested in the field. See you next time.
Interventional cardiology is on tap this week as we explore the world of transcatheter management of the dysfunctional RVOT with 2 papers on this topic. In the first, Dr. Mary Hunt Martin, Assistant Professor of Pediatrics - University of Utah is the first author on a recent PHN paper on outcomes of Melody implantation in the native RVOT. Dr. Martin joins us to answer a number of questions about this important work. The second work is a recent multi center French study on use of the Sapien valve in the RVOT/conduit. How do the acute results with this valve compare with the Melody? What are the indications for Melody vs. Sapien? These are amongst the questions we tackle this week on the podcast. DOI: 10.1016/j.jcin.2018.05.051 and DOI: 10.1016/j.jcin.2018.05.050
Interventional cardiology is on tap this week as we explore the world of transcatheter management of the dysfunctional RVOT with 2 papers on this topic. In the first, Dr. Mary Hunt Martin, Assistant Professor of Pediatrics - University of Utah is the first author on a recent PHN paper on outcomes of Melody implantation in the native RVOT. Dr. Martin joins us to answer a number of questions about this important work. The second work is a recent multi center French study on use of the Sapien valve in the RVOT/conduit. How do the acute results with this valve compare with the Melody? What are the indications for Melody vs. Sapien? These are amongst the questions we tackle this week on the podcast. DOI: 10.1016/j.jcin.2018.05.051 and DOI: 10.1016/j.jcin.2018.05.050
If you’re a listener of the show who isn’t subscribing yet to RotoViz, you can get a special 30% discount through the podcast. HOSTS Colm Kelly (@OvertimeIreland) – Assistant Executive Producer of the RotoViz Radio. Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner Colm and Shawn bring you the RotoViz Overtime podcast on RotoViz Radio. Each week the guys bring you a show covering topics from around the Fantasy Football landscape through a RotoViz lens. IT’S OVERTIME On this edition they discuss: Zero RB Targets - 2018 Zero RB Targets: No. 15 to No. 11Fifth-year breakouts - The 3 Fifth-Year WR Breakout Candidates You Need to Add Late on Every TeamBoom/Bust Candidates - Using the Advanced Stats to Find 2018’s Best Boom/Bust Candidates SPONSOR Fantasy Football Players Championship – The home of season-long high-stakes fantasy football. To register for a premium league starting at just $35, go to MyFFPC.com. RotoViz Patreon - Support the RotoViz Radio team on Patreon and gain access to the RotoViz LIVE video show every Sunday from 26th August. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime / #RVOT
RotoViz Overtime is powered by RotoViz Radio and hosted by Colm Kelly (@OvertimeIreland) – Assistant Executive Producer of the RotoViz Radio and Shawn Siegele (@FF_Contrarian) – RotoViz Co-Owner. If you’re a listener of the show who isn’t subscribing yet to RotoViz, you can get a special 30% discount through the podcast. Colm and Shawn bring you the RotoViz Overtime podcast on RotoViz Radio. Each week the guys bring you a show covering topics from around the Fantasy Football landscape through a RotoViz lens. IT’S OVERTIME On this edition they discuss: The Apex Experts Draft- View Draftboard HereThe RotoViz Draft Apps - FF Draft Prep ToolsAnd a wide variety of players from the first 4 rounds of the draft. SPONSOR Fantasy Football Players Championship – The home of season-long high-stakes fantasy football. To register for a premium league starting at just $35, go to MyFFPC.com. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizOvertime / #RVOT
If you’re a listener of the show who isn’t subscribing yet to RotoViz, you can get a special 30% discount through the podcast. Hosted by: Colm Kelly (@OvertimeIreland) - Assistant Executive Producer of the RotoViz Radio. Shawn Siegele (@FF_Contrarian) - RotoViz Co-Owner. Colm and Shawn bring you the debut edition of the all-new RotoViz Overtime podcast on RotoViz Radio. Each week the guys bring you a show covering topics from around the Fantasy Football landscape through a RotoViz lens. It's Overtime On this edition they discuss: Camp Battles - Jets, Cardinals, Browns.RB Game flow - Game Flow: How Every Running Back Was Used In 2017And some Deep Sleepers with one standing out in particular. SPONSOR Fantasy Football Players Championship – The home of season-long high-stakes fantasy football. To register for a premium league starting at just $35, go to MyFFPC.com. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio / #RVOT
RotoViz Overtime is powered by RotoViz Radio. If you’re a listener of the show who isn’t subscribing yet to RotoViz, you can get a special 30% discount through the podcast. Hosted by: Colm Kelly (@OvertimeIreland) - Assistant Executive Producer of the RotoViz Radio. Shawn Siegele (@FF_Contrarian) - RotoViz Co-Owner. Colm and Shawn bring you the debut edition of the all-new RotoViz Overtime podcast on RotoViz Radio. Each week the guys bring you a show covering topics from around the Fantasy Football landscape through a RotoViz lens. It's Overtime On this edition they discuss: Camp Battles - Jets, Cardinals, Browns.RB Game flow - Game Flow: How Every Running Back Was Used In 2017And some Deep Sleepers with one standing out in particular. SPONSOR Fantasy Football Players Championship – The home of season-long high-stakes fantasy football. To register for a premium league starting at just $35, go to MyFFPC.com. SHOW NOTES Email: RotoVizRadio@gmail.com Twitter: @RotoVizRadio / #RVOT
This week we delve into the exciting world of congenital interventional cardiology with 2 very different types of interventional cardiology research. In the first highly technical work from the group at Children's Hospital of Michigan in Detroit, we review an innovative approach to transcatheter management of pulmonary regurgitation in tetralogy when the RVOT is just too large for a valved stent. Dr. Tom Forbes, director of the cardiac catheterization laboratory and co-author of this work, discusses the challenges to and indications for bilateral branch pulmonary artery valve implantation in such cases. In the second work, the concept of practice variation and its impact on outcomes is explored by Dr. Andy Glatz and the team from Children's Hospital of Philadelphia reporting data from the IMPACT registry on compliance of interventionalists with established and published guidelines for proceeding with aortic or pulmonary valvuloplasty. Dr. Glatz will join us to discuss some of the interesting aspects of his work as well as trying to answer the question of whether 'homogenizing' our approach to a somewhat 'heterogeneous' group of patients makes good sense.
This week we delve into the exciting world of congenital interventional cardiology with 2 very different types of interventional cardiology research. In the first highly technical work from the group at Children's Hospital of Michigan in Detroit, we review an innovative approach to transcatheter management of pulmonary regurgitation in tetralogy when the RVOT is just too large for a valved stent. Dr. Tom Forbes, director of the cardiac catheterization laboratory and co-author of this work, discusses the challenges to and indications for bilateral branch pulmonary artery valve implantation in such cases. In the second work, the concept of practice variation and its impact on outcomes is explored by Dr. Andy Glatz and the team from Children's Hospital of Philadelphia reporting data from the IMPACT registry on compliance of interventionalists with established and published guidelines for proceeding with aortic or pulmonary valvuloplasty. Dr. Glatz will join us to discuss some of the interesting aspects of his work as well as trying to answer the question of whether 'homogenizing' our approach to a somewhat 'heterogeneous' group of patients makes good sense.
Commentary by Dr. Valentin Fuster
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