Ovid’s Metamorphoses tells the story of Icarus – his tragic flight with man-made wings, the melting of the wax that bound them, and the ensuing fall to his death. This moment has been immortalized across the arts and through several mediums, but none are more notable than Bruegel’s Landscape with the Fall of Icarus. Described as a “painter for poets,” Bruegel’s work served as inspiration for several writers, with this piece in particular providing the basis for ekphrastic poems by W.H. Auden and William Carlos Williams. Though each of these works has a different focus, the unifying theme is that human tragedy is too often placed on the periphery of notice. They are effective reminders to physicians and other healthcare providers about the human aspect of suffering and pain in medicine.
奥维德的《变形记》讲述了伊卡洛斯的故事--他带着人造翅膀悲惨地飞行，束缚翅膀的蜡融化，随后坠落身亡。这一时刻通过多种艺术媒介被永恒铭记，但最著名的莫过于勃鲁盖尔的《伊卡洛斯坠落的风景》。勃鲁盖尔被誉为 "诗人的画家"，他的作品为多位作家带来了灵感，尤其是这幅作品为奥登（W.H. Auden）和威廉-卡洛斯-威廉姆斯（William Carlos Williams）创作咏物诗提供了基础。虽然这些作品各有侧重，但统一的主题是人类的悲剧往往被忽视。它们有效地提醒了医生和其他医疗服务提供者，医学中的痛苦和疼痛是人性的一面。
{"title":"Bruegel’s Landscape with the Fall of Icarus","authors":"J. C. Cordova, James B. Young","doi":"10.14797/mdcvj.1377","DOIUrl":"https://doi.org/10.14797/mdcvj.1377","url":null,"abstract":"Ovid’s Metamorphoses tells the story of Icarus – his tragic flight with man-made wings, the melting of the wax that bound them, and the ensuing fall to his death. This moment has been immortalized across the arts and through several mediums, but none are more notable than Bruegel’s Landscape with the Fall of Icarus. Described as a “painter for poets,” Bruegel’s work served as inspiration for several writers, with this piece in particular providing the basis for ekphrastic poems by W.H. Auden and William Carlos Williams. Though each of these works has a different focus, the unifying theme is that human tragedy is too often placed on the periphery of notice. They are effective reminders to physicians and other healthcare providers about the human aspect of suffering and pain in medicine.","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"45 21","pages":"68 - 71"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140970505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul Haddad, Jasmine Peng, Madeline Drake, Maham Rahimi
For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.
{"title":"Inferior Vena Cava Filters: An Overview","authors":"Paul Haddad, Jasmine Peng, Madeline Drake, Maham Rahimi","doi":"10.14797/mdcvj.1346","DOIUrl":"https://doi.org/10.14797/mdcvj.1346","url":null,"abstract":"For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"6 9","pages":"49 - 56"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140970042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulmonary embolism is a debilitating and potentially life-threatening disease characterized by high mortality and long-term adverse outcomes. Traditional treatment options are fraught with serious bleeding risks and incomplete thrombus removal, necessitating the development of innovative treatment strategies. While new interventional approaches offer promising potential for improved outcomes with fewer serious complications, their rapid development and need for more comparative clinical evidence makes it challenging for physicians to select the optimal treatment for each patient among the many options. This review summarizes the current published clinical data for both traditional treatments and more recent interventional approaches indicated for pulmonary embolism. While published studies thus far suggest that these newer interventional devices offer safe and effective options, more data is needed to understand their impact relative to the standard of care. The studies in progress that are anticipated to provide needed evidence are reviewed here since they will be critical for helping physicians make informed treatment choices and potentially driving necessary guideline changes.
{"title":"Catheter Interventions for Pulmonary Embolism: Mechanical Thrombectomy Versus Thrombolytics","authors":"Nicolas J. Mouawad","doi":"10.14797/mdcvj.1344","DOIUrl":"https://doi.org/10.14797/mdcvj.1344","url":null,"abstract":"Pulmonary embolism is a debilitating and potentially life-threatening disease characterized by high mortality and long-term adverse outcomes. Traditional treatment options are fraught with serious bleeding risks and incomplete thrombus removal, necessitating the development of innovative treatment strategies. While new interventional approaches offer promising potential for improved outcomes with fewer serious complications, their rapid development and need for more comparative clinical evidence makes it challenging for physicians to select the optimal treatment for each patient among the many options. This review summarizes the current published clinical data for both traditional treatments and more recent interventional approaches indicated for pulmonary embolism. While published studies thus far suggest that these newer interventional devices offer safe and effective options, more data is needed to understand their impact relative to the standard of care. The studies in progress that are anticipated to provide needed evidence are reviewed here since they will be critical for helping physicians make informed treatment choices and potentially driving necessary guideline changes.","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"5 11","pages":"36 - 48"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140967075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Massive pulmonary embolism (MPE) is a serious condition affecting the pulmonary arteries and is difficult to diagnose, triage, and treat. The American College of Chest Physicians (AHA) and the European Society of Cardiology (ESC) have different classification approaches for PE, with the AHA defining three subtypes and the ESC four. Misdiagnosis is common, leading to delayed or inadequate treatment. The incidence of PE-related death rates has been increasing over the years, and mortality rates vary depending on the subtype of PE, with MPE having the highest mortality rate. The current definition of MPE originated from early surgical embolectomy cases and discussions among experts. However, this definition fails to capture patients at the point of maximal benefit because it is based on late findings of MPE. Pulmonary Embolism Response Teams (PERTs) have emerged as a fundamental shift in the management of MPE, with a focus on high-risk and MPE cases and a goal of rapidly connecting patients with appropriate therapies based on up-to-date evidence. This review highlights the challenges in diagnosing and managing MPE and emphasizes the importance of PERTs and risk stratification scores in improving outcomes for patients with PE.
大面积肺栓塞（MPE）是一种影响肺动脉的严重疾病，难以诊断、分流和治疗。美国胸科医师学会（AHA）和欧洲心脏病学会（ESC）对肺栓塞有不同的分类方法，AHA 定义了三种亚型，ESC 定义了四种亚型。误诊很常见，导致治疗延误或治疗不当。与 PE 相关的死亡率逐年上升，不同亚型的 PE 死亡率也不同，其中 MPE 死亡率最高。目前，MPE 的定义源于早期外科栓子切除术病例和专家之间的讨论。然而，由于该定义基于 MPE 的晚期发现，因此无法捕捉到处于最大获益点的患者。肺栓塞反应小组（PERTs）的出现是 MPE 管理的根本性转变，其重点是高风险和 MPE 病例，目标是根据最新证据将患者与适当的疗法迅速联系起来。本综述强调了诊断和管理 MPE 所面临的挑战，并强调了 PERTs 和风险分层评分在改善 PE 患者预后方面的重要性。
{"title":"From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary Embolism","authors":"Pavan Thangudu","doi":"10.14797/mdcvj.1345","DOIUrl":"https://doi.org/10.14797/mdcvj.1345","url":null,"abstract":"Massive pulmonary embolism (MPE) is a serious condition affecting the pulmonary arteries and is difficult to diagnose, triage, and treat. The American College of Chest Physicians (AHA) and the European Society of Cardiology (ESC) have different classification approaches for PE, with the AHA defining three subtypes and the ESC four. Misdiagnosis is common, leading to delayed or inadequate treatment. The incidence of PE-related death rates has been increasing over the years, and mortality rates vary depending on the subtype of PE, with MPE having the highest mortality rate. The current definition of MPE originated from early surgical embolectomy cases and discussions among experts. However, this definition fails to capture patients at the point of maximal benefit because it is based on late findings of MPE. Pulmonary Embolism Response Teams (PERTs) have emerged as a fundamental shift in the management of MPE, with a focus on high-risk and MPE cases and a goal of rapidly connecting patients with appropriate therapies based on up-to-date evidence. This review highlights the challenges in diagnosing and managing MPE and emphasizes the importance of PERTs and risk stratification scores in improving outcomes for patients with PE.","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"34 8","pages":"19 - 26"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140969759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD Zachary L. Steinberg, MD LAUREN N. CARLOZZI, M. P. C. HUIE LIN
Chronic thromboembolic pulmonary hypertension is a rare form of pulmonary hypertension in patients who have evidence of chronic thromboembolic occlusion of the pulmonary vasculature. Historically, surgical pulmonary thromboendarterectomy has been the treatment of choice. However, with up to 40% of patients deemed inoperable, balloon pulmonary angioplasty has emerged as an additional treatment strategy. Balloon pulmonary angioplasty is a complementary strategy alongside surgical pulmonary thromboendarterectomy and offers the opportunity for pulmonary revascularization in patients who have more distal disease, higher comorbidities, or residual obstruction following operative intervention. This review examines the history of balloon pulmonary angioplasty, highlights its effectiveness, discusses important complications and risk reduction strategies, and emphasizes the importance of centers forming a multidisciplinary team of providers to manage the complexity of patients with chronic thromboembolic pulmonary hypertension.
{"title":"Balloon Pulmonary Angioplasty for the Treatment of Chronic Thromboembolic Pulmonary Hypertension","authors":"MD Zachary L. Steinberg, MD LAUREN N. CARLOZZI, M. P. C. HUIE LIN","doi":"10.14797/mdcvj.1347","DOIUrl":"https://doi.org/10.14797/mdcvj.1347","url":null,"abstract":"Chronic thromboembolic pulmonary hypertension is a rare form of pulmonary hypertension in patients who have evidence of chronic thromboembolic occlusion of the pulmonary vasculature. Historically, surgical pulmonary thromboendarterectomy has been the treatment of choice. However, with up to 40% of patients deemed inoperable, balloon pulmonary angioplasty has emerged as an additional treatment strategy. Balloon pulmonary angioplasty is a complementary strategy alongside surgical pulmonary thromboendarterectomy and offers the opportunity for pulmonary revascularization in patients who have more distal disease, higher comorbidities, or residual obstruction following operative intervention. This review examines the history of balloon pulmonary angioplasty, highlights its effectiveness, discusses important complications and risk reduction strategies, and emphasizes the importance of centers forming a multidisciplinary team of providers to manage the complexity of patients with chronic thromboembolic pulmonary hypertension.","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"23 18","pages":"57 - 64"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140968444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aakash D. Rana, S. Vallurupalli, Mark A. Mitchell, David A. Duncan, Jack Xu
A 51-year-old male with a complicated medical history presented with shortness of breath. Preoperative workup confirmed the presence of a large atrial mass. However, delayed gadolinium enhancement CMR with long inversion time (TI 600) showed lack of enhancement, which was suggestive of a thrombus. During cardiac magnetic resonance imaging, delayed gadolinium enhancement sequences with long inversion time (TI 600) are commonly used to distinguish between an avascular thrombus versus a vascular tumor.
{"title":"All that Doesn’t Enhance Isn’t a Thrombus: Pitfalls Using Cardiac MRI TI 600 Sequence to Distinguish Between Cardiac Thrombus Versus Myxoma","authors":"Aakash D. Rana, S. Vallurupalli, Mark A. Mitchell, David A. Duncan, Jack Xu","doi":"10.14797/mdcvj.1322","DOIUrl":"https://doi.org/10.14797/mdcvj.1322","url":null,"abstract":"A 51-year-old male with a complicated medical history presented with shortness of breath. Preoperative workup confirmed the presence of a large atrial mass. However, delayed gadolinium enhancement CMR with long inversion time (TI 600) showed lack of enhancement, which was suggestive of a thrombus. During cardiac magnetic resonance imaging, delayed gadolinium enhancement sequences with long inversion time (TI 600) are commonly used to distinguish between an avascular thrombus versus a vascular tumor.","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"38 1","pages":"23 - 25"},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Alfawara, Vivek Modi, Min-Fang Chao, Malek Nayfeh, F. Alahdab, Mahmoud Alrifai, M. Al-Mallah
Giant coronary artery aneurysm (GCA) is a rare disease afflicting 0.2% of the population. It is primarily attributed to atherosclerosis in adults and Kawasaki disease in children. Other uncommon etiologies include Takayasu arteritis and post-percutaneous coronary intervention.1,2 GCA lacks a universally accepted definition, with proposed criteria including a diameter exceeding 2 cm, 5 cm, or four times the normal vessel size.3 While the majority of GCAs are asymptomatic, a subset of patients present with angina, myocardial infarction from embolization or compression, heart failure due to fistula formation, or even sudden death.1 We report a case of an adult harboring a GCA involving the right coronary artery.
{"title":"Left Upper Extremity Pain, Right Coronary Artery Culprit: A Puzzling Path to Aneurysm Discovery","authors":"M. Alfawara, Vivek Modi, Min-Fang Chao, Malek Nayfeh, F. Alahdab, Mahmoud Alrifai, M. Al-Mallah","doi":"10.14797/mdcvj.1287","DOIUrl":"https://doi.org/10.14797/mdcvj.1287","url":null,"abstract":"Giant coronary artery aneurysm (GCA) is a rare disease afflicting 0.2% of the population. It is primarily attributed to atherosclerosis in adults and Kawasaki disease in children. Other uncommon etiologies include Takayasu arteritis and post-percutaneous coronary intervention.1,2 GCA lacks a universally accepted definition, with proposed criteria including a diameter exceeding 2 cm, 5 cm, or four times the normal vessel size.3 While the majority of GCAs are asymptomatic, a subset of patients present with angina, myocardial infarction from embolization or compression, heart failure due to fistula formation, or even sudden death.1 We report a case of an adult harboring a GCA involving the right coronary artery.","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"46 10","pages":"14 - 17"},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140736668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05eCollection Date: 2024-01-01DOI: 10.14797/mdcvj.1341
Hussam Al Hennawi, Shayan Iqbal Khan, Aamna Khan, Usama Sadiq, Sung-Hae Cho
Gerbode defect, an anomalous connection between the left ventricle and right atrium, is often congenital but can be acquired or iatrogenically formed. We present an exceedingly rare case of this defect associated with multiple valve perforation in an otherwise healthy patient with bicuspid aortic valve and endocarditis.
{"title":"Swiss Cheese Heart: A Tale of Multiple Valve Perforations.","authors":"Hussam Al Hennawi, Shayan Iqbal Khan, Aamna Khan, Usama Sadiq, Sung-Hae Cho","doi":"10.14797/mdcvj.1341","DOIUrl":"https://doi.org/10.14797/mdcvj.1341","url":null,"abstract":"<p><p>Gerbode defect, an anomalous connection between the left ventricle and right atrium, is often congenital but can be acquired or iatrogenically formed. We present an exceedingly rare case of this defect associated with multiple valve perforation in an otherwise healthy patient with bicuspid aortic valve and endocarditis.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"20 1","pages":"18-22"},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11011950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/s0735-1097(24)04993-3
H. Al Hennawi, S. Khan, Aamna Khan, Usama Sadiq, Sung-Hae Cho
{"title":"Swiss Cheese Heart: A Tale of Multiple Valve Perforations","authors":"H. Al Hennawi, S. Khan, Aamna Khan, Usama Sadiq, Sung-Hae Cho","doi":"10.1016/s0735-1097(24)04993-3","DOIUrl":"https://doi.org/10.1016/s0735-1097(24)04993-3","url":null,"abstract":"","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"40 11","pages":"18 - 22"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew Takla, Fahad Eid, Mostafa Elbanna, M. Eid, Akshay Joshi, Abdallah Bitar, Ryan Lydon, Scott Feitell
Left ventricular assist devices serve as a salvage therapy for patients with advanced heart failure. Complications such as thrombosis and obstruction can lead to acute device malfunction, posing significant clinical risks. A multidisciplinary approach is crucial for management. Few cases in the literature have demonstrated the safety and efficacy of percutaneous intervention, which holds significant value due to its less invasive nature and minimal risk of morbidity, especially in high-risk surgical patients.
{"title":"Percutaneous Intervention of LVAD Outflow Graft Obstruction and Thrombosis","authors":"Andrew Takla, Fahad Eid, Mostafa Elbanna, M. Eid, Akshay Joshi, Abdallah Bitar, Ryan Lydon, Scott Feitell","doi":"10.14797/mdcvj.1360","DOIUrl":"https://doi.org/10.14797/mdcvj.1360","url":null,"abstract":"Left ventricular assist devices serve as a salvage therapy for patients with advanced heart failure. Complications such as thrombosis and obstruction can lead to acute device malfunction, posing significant clinical risks. A multidisciplinary approach is crucial for management. Few cases in the literature have demonstrated the safety and efficacy of percutaneous intervention, which holds significant value due to its less invasive nature and minimal risk of morbidity, especially in high-risk surgical patients.","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"82 3","pages":"9 - 13"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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