Amr Mohsen

Cardiac Sarcoidosis: Electrophysiological Outcomes on Long‐Term Follow‐Up and the Role of the Implantable Cardioverter‐Defibrillator

The objectives of this study were to identify the predictors of life‐threatening ventricular arrhythmias in patients with cardiac sarcoidosis (CS) and to evaluate the role of the implantable cardioverter‐defibrillator (ICD) in this patient population.

Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement

Data are limited regarding transcatheter aortic valve replacement (TAVR)‐related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR.

The cost of outpatient venous thromboembolism prophylaxis following lower limb injuries

This paper reports the cost of outpatient venous thromboembolism (VTE) prophylaxis following 388 injuries of the lower limb requiring immobilisation in our institution, from a total of 7408 new patients presenting between May and November 2011. Prophylaxis was by either self-administered subcutaneous dalteparin (n = 128) or oral dabigatran (n = 260). The mean duration of prophylaxis per patient was 46 days (6 to 168). The total cost (pay and non-pay) for prophylaxis with dalteparin was £107.54 and with dabigatran was £143.99. However, five patients in the dalteparin group required nurse administration (£23 per home visit), increasing the cost of dalteparin to £1142.54 per patient. The annual cost of VTE prophylaxis in a busy trauma clinic treating 12 700 new patients (2010/11), would be £92 526.33 in the context of an income for trauma of £1.82 million, which represents 5.3% of the outpatient tariff. Outpatient prophylaxis in a busy trauma clinic is achievable and affordable in the context of the clinical and financial risks involved.

Variable ECG findings associated with pulmonary embolism

An elderly man with a recent diagnosis of invasive rectal adenocarcinoma was admitted to the hospital because of a lower gastrointestinal bleeding and low haemoglobin. During the hospitalisation he complained of chest pain. ECG showed new onset ST-segment elevation in leads III, aVF and in the precordial leads V1–V4. Shortly thereafter, he became hypotensive and coded. Despite resuscitation he passed away. Autopsy revealed massive pulmonary emboli with near complete obstruction of the involved branches of the pulmonary arteries. Coronary arteries were free of significant coronary artery disease and multiple sections of the myocardium showed the absence of myocardial infarction.

Femoral arterial closure using ProGlide® is more efficacious and cost-effective when ambulating early following cardiac catheterization

Objective This was a prospective, single-center study evaluating the efficacy and cost-effectiveness of early ambulation (within 30 min) following femoral artery closure with the ProGlide® suture-mediated vascular closure device (PD) in patients undergoing diagnostic cardiac catheterization compared with manual compression. Background It is unclear whether early ambulation with ProGlide is safe or is associated with patient satisfaction and cost savings as compared with manual compression (MC). Methods and results Inclusion criteria were met in 170 patients (85 PD and 85 MC patients). Patients ambulated 20 ft. within 30 min (PD) or after the requisite 4 h recumbent time (MC) if feasible. Primary endpoint was time-to-ambulation (TTA) following device closure. We also directly compared the safety of closure, times-to-hemostasis (TTH), -ambulation (TTA) and -discharge (TTD) with MC and, using a fully allocated cost model, performed cost analysis for both strategies. Multivariate analysis was used to determine predictors of patient satisfaction. The primary endpoint of safe, early ambulation was achieved following closure (mean of 27.1 ± 14.9 min; 95% confidence interval [CI] 25.2–30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD; the latter contributed indirectly to significant cost savings in the PD group (1250.3 ± 146.4 vs. 2248.1 ± 910.2 dollars, respectively; P < 0.001) and incremental cost savings by strategy also favored closure over MC (

Acute lymphoblastic leukaemia in a Jehovah’s Witness: a management dilemma

84,807). Conclusions ProGlide is safe and effective for femoral artery closure in patients who ambulate within 30 min after cardiac catheterization; translating into improved patient satisfaction and substantial cost savings.

Massive, rapidly growing cardiac lymphoma with rare valvular involvement showing excellent response to chemotherapy

Abstract Jehovah’s witnesses represent a unique group of patients whose religious beliefs prohibit receiving transfusion of all blood products. Since most chemotherapeutic regimens used to treat acute leukemia are myelosuppressive and often resulting in potentially life threatening pancytopenia, their refusal of blood products poses a challenge to clinicians. We report a case of a Jehovah’s Witness patient with acute lymphoblastic leukemia (ALL) who was successfully treated with non-myelosuppressive chemotherapy for both first and second remission and achieved complete remissions both times without transfusion of blood products.

Angina caused by a giant coronary artery fistula

Massive, Rapidly Growing Cardiac Lymphoma With Rare Valvular Involvement Showing Excellent Response to Chemotherapy Amr Mohsen, MD, Amir H. Najafi, MD, Louise Zhou, MD, Dalia A. Mobarek, MD, Anita Aggarwal, DO, PhD, Jehan El-Bayoumi, MD, Michael D. Greenberg, MD, and Federico E. Mordini, MD Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA Veterans Affairs Medical Center, Washington, District of Columbia, USA University of Florida, Jacksonville, Florida, USA George Washington University, Washington, District of Columbia, USA

Anomalous muscle bundles causing double-chambered right ventricle in adults.

A 49-year-old woman presented with 3 weeks of exertional chest pain. A trans-esophageal echocardiogram with color Doppler was suggestive of a large coronary artery fistula ∼3.1 × 2.4 cm in size, originating from the left main coronary artery and emptying into the superior …