Mount Sinai Morningside’s Post

A 39 YO man with prior Hx of AVR following endocarditis due to his history of IVDU. The patient presented to the hospital with main compaint of left arm pain and swelling --> arm abscess. No cardiac complaints. Troponin was found to be elevated. Echo showed some thickening of the aortic root so TEE was done. TEE showed thickening of the aortic root posteriorly, an area of heterogenous echodensity and starnding--> interpreted as a peri-aortic abscess. Blood cultures were negative. Cardiac CT was done showing fluid attenuation around the aortic valve surrounded by inflammatory tissue. The patient underwent surgery redo AVR - large annular abscess that involves 1/3 of the annular circumference disrupting the mitral leaflet. Two interesting points from the imaging perspective: 1. On TEE, abscess did not show the more common echolucent appearance 2. On CT, there was no peripheral enhancement as it would be expected with an abscess. TEE and CT images included. #echofirst #yescct American Society of EchocardiographySociety of Cardiovascular Computed Tomography

#snsinstitution #snsdesignthinking #snsdesignthinkers I am glad to share my article About Off pump CABG... 1. **Definition:** Off-pump coronary artery bypass grafting (OPCABG) is a surgical technique used in cardiac surgery where the heart is not stopped during the procedure. Instead of using a heart-lung machine, the surgeon performs the grafts on the beating heart. 2. **Advantages:** One major advantage is the avoidance of cardiopulmonary bypass-related complications, such as systemic inflammatory response syndrome. OPCABG may reduce the risk of neurological complications and bleeding. Additionally, it can be beneficial for patients with certain coexisting conditions. 3. **Procedure:** During OPCABG, the surgeon stabilizes the area of the heart where the graft is needed using specialized devices. This allows the surgeon to perform the grafts while the heart continues to beat. Multiple grafts can be done without stopping the heart, potentially reducing the overall duration of the surgery. 4. **Patient Selection:** Not all patients are suitable candidates for OPCABG. Patient selection is crucial, and factors such as the complexity of coronary artery disease, patient age, and overall health need to be considered. High-risk patients may benefit more from traditional on-pump CABG. 5. **Outcomes:** While OPCABG offers certain advantages, studies have shown comparable long-term outcomes between OPCABG and on-pump CABG in terms of mortality and major adverse cardiac events. The choice between the two techniques often depends on individual patient characteristics and surgeon expertise

ON SEPTEMBER 16, 1977, DR. ANDREAS GRUENTZIG used a balloon to dilate a severe stenosis in the coronary artery of a conscious patient. Relief of angina was afforded by a procedure using a catheter that had been inserted into the patient’s leg artery and advanced to the heart. At that time, the only procedure available to treat medically refractory angina was open-heart, coronary artery bypass graft surgery, also known as bypass. The Swiss postman who was the first patient to receive coronary artery balloon angioplasty (plasty), had been scheduled for bypass. His cardiac surgeon was standing by in case the prediction “inflating a balloon within the diseased arteries of a human heart would be like throwing a hand grenade into a dumpster” occurred. It did not. That fateful day, the surgeon’s services were not required. Fast forward 40 years - Wherever it is available within ninety minutes, plasty with stents is the preferred emergency reperfusion method for patients suffering acute myocardial infarction or other medically refractory, acute coronary syndromes. from Chapter 2 'The Balloon Inflation Heard 'round the World and the Revolution in the Care for Patients with Acute Coronary Syndromes' Different Drummer A cardiologist's memoir of imperfect heroes and care for the heart #heart #care #angioplastyrevolution #acutecoronarysyndromes #coronaryarterydisease #ACC #AHA #plasty #bypass #standby

Intravascular Ultrasound (IVUS) IVUS is a diagnostic procedure using sound waves to visualize the inside of blood vessels, particularly coronary arteries. A catheter with a tiny ultrasound wand is inserted through the groin, providing an inside-out view of artery walls. This helps evaluate the need for heart surgery, treat certain heart conditions, and assess stent placement during angioplasty. IVUS reveals cholesterol deposits and helps understand stent restenosis. Risks include general anesthesia complications and potential damage to heart structures. After the procedure, a brief hospital stay may be required, depending on whether it was done during cardiac catheterization or angioplasty. Alternative names include Endovascular Ultrasound and Intravascular Echocardiography. #cardiovasculardisease #cardiology #medicaleducation #medicaldevices #newtechnology #healthandwellness

Introducing the Coronary Balloon Catheter: Revolutionizing Coronary Artery Treatment 🩺 The Coronary Balloon Catheter is a pioneering tool in percutaneous transluminal coronary angioplasty (PTCA), transforming the management of coronary artery disease (CAD) without resorting to open-heart surgery. 📍 This specialized catheter, equipped with a tiny balloon at its tip, is precisely guided to the narrowed area of the coronary artery. Upon inflation, the balloon compresses fatty tissue, expanding the artery and enhancing blood flow to the heart tissue. After the balloon is deflated and removed, a stent is often inserted to maintain the expanded artery. 👊🏻 In essence, the Coronary Balloon Catheter offers a minimally invasive approach to restore arterial blood flow, marking a significant advancement in cardiovascular care. 🩺 #TTHealthConnect #PTCA #CoronaryAngioplasty #Cardiology #BalloonCatheter #Healthcare #CardiacCare #MedicalProcedure #InterventionalCardiology

In our latest blog, we dive deep into the essential roles of stents and catheters in modern cardiovascular procedures. Did you know that over 𝟕 𝐦𝐢𝐥𝐥𝐢𝐨𝐧 stents are implanted worldwide each year? These tiny devices are critical in treating conditions like coronary artery disease, where they help keep arteries open and restore blood flow.  Additionally, catheters are used in over 𝟖𝟎% of all cardiac interventions, with advancements leading to more than 𝟗𝟎% success rates in procedures like angioplasty. With the development of drug-eluting stents, patients experience a 𝟓𝟎% reduction in the risk of re-narrowing compared to bare-metal stents.  Discover how these medical devices are transforming the landscape of heart health and improving patient outcomes. Read more to understand why these tools are the backbone of modern cardiovascular surgery: https://lnkd.in/guk67yC6 #CardiovascularHealth #MedicalInnovation #HeartSurgery #HealthcareTechnology #Stents #Catheters #MedivationBio

Board certified interventional radiologist, Dr. Davis performing endovascular surgery to treat PAD and restore healthy blood circulation in this patient's leg. This patient was suffering from an arterial blockage in the femoral artery that was blocking blood circulation to his leg and putting him at risk of a leg amputation if left untreated. Arterial blockage in the legs is a vascular disorder known as peripheral arterial disease (PAD). PAD is a condition where plaque builds up in the walls of the arteries, narrowing them and restricting blood circulation through the legs. So, if you are experiencing leg pain or leg cramps while walking, it is recommended to have a vascular consultation as soon as possible to help determine if your symptoms may be due to PAD. To treat PAD and restore blood flow through their patients' legs our vascular specialists perform the latest endovascular surgery methods such as stenting, atherectomy, and balloon angioplasty. These treatments are performed on an outpatient basis in our office-based lab, allowing for quick recovery and no downtime. To learn more about how the diagnosis and treatment of PAD can save you from leg amputation, visit: https://lnkd.in/eV5Dkfks #PADDoctorsNewHavenCT #PADTreatmentNewHavenCT #PADSpecialistMilfordCT #PADSpecialistNewHavenCT #PADVascularSurgeryNewHavenCT #ArteryBlockageTreatmentNewHavenCT #VascularDiseaseTreatmentMilfordCT #PeripheralVascularDoctorNewHavenCT #PeripheralVascularSurgeonsBridgeportCT #PeripheralArteryDiseaseTreatmentNewHavenCT

The intra aortic balloon pump (IABP) 101 is a temporary device that is used for mechanical circulatory support. It is filled with helium opposed to oxygen. Insertion: typically into the femoral artery Confirmation 🩻: X-ray Indications ✅ 1️⃣ Cardiogenic shock 2️⃣ Post MI/bypass surgery 3️⃣ Cardiomyopathies 4️⃣ High risk PCI The main purpose of the IABP is to increase coronary perfusion (which occurs during diastole) and decrease left ventricular afterload Diastole- balloon inflates which displaces blood to the proximal aorta. This increases the augmented diastolic pressure which increases coronary perfusion pressure. Systole- balloon deflates which acts like a vacuum to decrease afterload and reduce LV workload. Tip 💡 An arterial line should be placed in the left radial artery to help detect if the balloon migrated too far into the arch. #meded #foamed #nursing #flightparamedic #criticalcare #emergencymedicine #cvicu #iabp #intraaorticballoonpump #cardiology #paramedic #criticalcaretransport

Board certified interventional radiologist, Dr. Davis performing endovascular surgery to treat PAD and restore healthy blood circulation in this patient's leg. This patient was suffering from an arterial blockage in the femoral artery that was blocking blood circulation to his leg and putting him at risk of a leg amputation if left untreated. Arterial blockage in the legs is a vascular disorder known as peripheral arterial disease (PAD). PAD is a condition where plaque builds up in the walls of the arteries, narrowing them and restricting blood circulation through the legs. So, if you are experiencing leg pain or leg cramps while walking, it is recommended to have a vascular consultation as soon as possible to help determine if your symptoms may be due to PAD. To treat PAD and restore blood flow through their patients' legs our vascular specialists perform the latest endovascular surgery methods such as stenting, atherectomy, and balloon angioplasty. These treatments are performed on an outpatient basis in our office-based lab, allowing for quick recovery and no downtime. To learn more about how the diagnosis and treatment of PAD can save you from leg amputation, visit: https://lnkd.in/e7JnzyeS #PADDoctorsNewHavenCT #PADTreatmentNewHavenCT #PADSpecialistMilfordCT #PADSpecialistNewHavenCT #PADVascularSurgeryNewHavenCT #ArteryBlockageTreatmentNewHavenCT #VascularDiseaseTreatmentMilfordCT #PeripheralVascularDoctorNewHavenCT #PeripheralVascularSurgeonsBridgeportCT #PeripheralArteryDiseaseTreatmentNewHavenCT

Ophthopedia Update:PRESENTATIONS AND FACTORS AFFECTING OUTCOME OF RHEGMATOGENOUS RETINAL DETACHMENT WITH CHOROIDAL DETACHMENT: An Indo-Taiwanese Study: Purpose: To report the clinical settings, management, and factors associated with outcomes of rhegmatogenous retinal detachment with concurrent choroidal detachment. Methods: Retrospective, consecutive, multicenter case series from January 2014 to January 2021 were included. Cases were from a tertiary eye care center in India and Taiwan. Results: Overall 303 eyes were included. Mean age was 43.72 ± 20.64 years (median 46). Best-corrected presenting visual acuity was 1.79 ± 0.92 logMAR (median 2.10) (Snellen 20/1,233). Forty-four patients (17.91%) received preoperative steroids. Final visual acuity was 1.33 ± 0.94 logMAR (median 1.10) (Snellen 20/427). Favorable anatomic outcome was seen in 200/303 (66%), whereas favorable functional outcome was seen in 128/303 (42.20%). Factors predicting favorable anatomic outcome were absence of phakic lens status (odds ratio [OR] 2.76), absence of proliferative vitreoretinopathy worse than Grade A (OR 7.69), use of preoperative steroids (OR 4.50), and use of an encircling band (3.85). Factors predicting favorable functional outcome were better presenting visual acuity (OR 3.03), absence of phakic lens status (OR 4.93), absence of proliferative vitreoretinopathy worse than Grade A (OR 10.41), and use of preoperative steroids (OR 7.24). Conclusion: Administration of preoperative steroids, use of an encircling band during surgery, and pseudophakic status of the eye were found to have better outcomes in rhegmatogenous retinal detachment with concurrent choroidal detachment. #Ophthotwitter #Ophthalmology #Retina