Fernando Fleischman
University of Southern California
Network
Latest external collaboration on country level. Dive into details by clicking on the dots.
Publication
Featured researches published by Fernando Fleischman.
Fertility and Sterility | 2012
Koji Matsuo; Fernando Fleischman; Christian S. Ghattas; Anna S. Gabrielyan; Charles A. Ballard; Lynda D. Roman; C.Paul Morrow
OBJECTIVE To report a conservative surgical management of cardiac-extending intravenous (IV) leiomyomatosis. DESIGN Case report. SETTING Tertiary care center. PATIENT(S) A 40-year-old nulligravid with incidentally identified IV leiomyomatosis arising from the right gonadal vein and extending into the right atrium. INTERVENTION(S) First, intraoperative transesophageal echocardiogram was performed that demonstrated the IV leiomyomatosis stalk to be 1.1 cm in diameter without an enlarged tip or adherence to the vessel lumen. Next, the 20-week-size uterus was gently pulled caudally under live visualization of the IV leiomyomatosis tip with transesophageal echocardiogram. As the uterus was pulled caudally, the IV leiomyomatosis tip obviously protruded from the right atrium and down into inferior vena cava. Lastly, the gonadal vein was incised longitudinally and the stalk of the tumor was grasped and extracted through the incision. MAIN OUTCOME MEASURE(S) One-step abdominal surgery for complete tumor resection without sternotomy or cardiac bypass surgery. RESULT(S) To our knowledge, this is the first reported case of a cardiac-extending IV leiomyomatosis successfully extracted through the gonadal vein. CONCLUSION(S) In a selected case with logistic step-by-step approach, conservative surgical treatment via gonadal vein extraction could be a feasible option in the management of cardiac-extending IV leiomyomatosis. Systematic literature review highlights important clinical characteristics and management options for IV leiomyomatosis.
World Journal for Pediatric and Congenital Heart Surgery | 2013
Jerold S. Shinbane; Jabi E. Shriki; Fernando Fleischman; Antreas Hindoyan; James Withey; Christopher Lee; Alison Wilcox; Mark J. Cunningham; Craig J. Baker; Ray V. Matthews; Vaughn A. Starnes
Cardiovascular computed tomographic angiography (CCTA) provides an understanding of the three-dimensional (3D) coronary artery anatomy in relation to cardiovascular thoracic structures important to the surgical management of anomalous coronary arteries (ACAs). Although some ACA variants are not clinically significant, others can lead to ischemia/infarction, related acute ventricular dysfunction, ventricular arrhythmias, and sudden cardiac death. The CCTA is important to surgical decision making, as it provides noninvasive visualization of the coronary arteries with (1) assessment of origin, course, and termination of coronary artery anomalies in the context of 3D thoracic anatomy, (2) characterization of anatomy helpful for differentiation of benign versus hemodynamically significant variants, (3) identification of other cardiothoracic anomalies, and (4) detection of coronary artery disease. High-risk ACA anatomy in the appropriate clinical setting can require surgical intervention with decisions including minimally invasive versus open sternotomy approach, correction via reimplantation of a coronary artery, alteration of the ACA course without reimplantation, or bypass of an ACA. Given the rarity of ACA, there is limited data in the literature, and significant controversy related to the management issues. The management of ACA requires comprehensive clinical history, thorough assessment of cardiac function, and detailed anatomic imaging. Future studies will need to address the long-term outcome based on detailed assessment of original anatomy and surgical approach.
European Journal of Radiology | 2017
Farhood Saremi; Steven Cen; Nazila Tayari; Houman Alizadeh; Amir Emami; Leah Lin; Fernando Fleischman
OBJECTIVE Various degrees of aortic valve rotation may be seen in individuals with no history of congenital cardiovascular malformations, but its association with aortic sizes has not been studied. METHODS Gated computed tomographic (CT angiograms in 217 patients were studied (66.7±15; 22-97 years old)). Aortic diameters were determined at 5 anatomic locations. The length of the aorta from sinus to left subclavian artery was measured. The angle of valve rotation was recorded by measuring the angle between a line connecting the midpoint of the non-coronary sinus to the anterior commissure and another line along the interatrial septum. Rotation angles were correlated with aortic measurements. Patients were separated into two groups based on aortic sizes and into three groups based on age. The threshold for aortic dilatation was set at maximum ascending aorta diameter ≥40mm (≥21mm body surface area [BSA] indexed). RESULTS No significant difference in rotation angles was seen between the three age groups or between genders. Rotation angles were significantly correlated with maximal, average, and BSA adjustment of the aortic root and ascending aortic measurements. The aortic root angles were significantly different between the dilated versus nondilated aortas. There was no significant association between the rotation angles and age, length of ascending aorta, or diameters of descending aorta. Multivariate adaptive regression splines showed 25° of aortic root rotation as the diagnostic cut off for ascending aorta dilation. Above the 25° rotation, every 10° of increasing rotation was associated with a 3.78±0.87mm increase in aortic diameter (p<0.01) and a 1.73±0.25 times increased risk for having a dilated aorta (p<0.01). CONCLUSION Rotation angles of the aortic valve may be an independent non-invasive imaging marker for dilatation of the ascending aorta. Patients with increased rotation angle of the aortic valve may have higher risk for development or acceleration of an ascending aortic dilatation.
Journal of Vascular Surgery | 2017
Miguel Manzur; Sukgu M. Han; Joie Dunn; Ramsey S. Elsayed; Fernando Fleischman; Yolee Casagrande; Fred A. Weaver
Objective: The objective of this study was to describe the outcomes of patients with acute aortic syndrome (AAS) during and after transfer to a regional aortic center by a rapid transport system. Methods: Review of patients with AAS who were transferred by a rapid transport system to a regional aortic center was performed. Data regarding demographics, diagnosis, comorbidities, transportation, and hospital course were acquired. Severity of existing comorbidities was determined by the Society for Vascular Surgery Comorbidity Severity Score (SVSCSS). The Acute Physiology and Chronic Health Evaluation II (APACHE II) score assessed physiologic instability on admission. Risk factors associated with system‐related (transfer and hospital) mortality were identified by univariate and multivariate linear regression analysis. Results: During a recent 18‐month period (December 2013‐July 2015), 183 patients were transferred by a rapid transport system; 148 (81%) patients were transported by ground and 35 (19%) by air. Median distance traveled was 24 miles (range, 3.6‐316 miles); median transport time was 42 minutes (range, 10‐144 minutes). Two patients died during transport, one with a type A dissection, the other of a ruptured abdominal aortic aneurysm. There were 118 (66%) patients who received operative intervention. Median time to operation was 6 hours. Type B dissections had the longest median time to operation, 45 hours, with system‐related mortality of 1.9%; type A dissections had the shortest median time, 3 hours, and a system‐related mortality of 16%. Overall, system‐related mortality was 15%. On univariate analysis, factors associated with system‐related mortality were age ≥65 years (P = .026), coronary artery disease (P = .030), prior myocardial infarction (P = .049), prior coronary revascularization (P = .002), SVSCSS of >8 (P < .001), abdominal pain (P = .002), systolic blood pressure <90 mm Hg at sending hospital (P = .001), diagnosis of aortic aneurysm (P = .013), systolic blood pressure <90 mm Hg in the intensive care unit (P < .001), and APACHE II score >10 (P = .004). Distance traveled and transport mode and duration were not associated with increased risk of system‐related mortality. Only SVSCSS of >8 (odds ratio, 7.73; 95% confidence interval, 2.32‐25.8; P = .001) was independently associated with an increase in system‐related mortality on multivariate analysis. Conclusions: Implementation of a rapid transport system, regardless of mode or distance, can facilitate effective transfer of patients with AAS to a regional aortic center. An SVSCSS of >8 predicted an increased system‐related mortality and may be a useful metric to assess the appropriateness of patient transfer.
Cardiology Clinics | 2017
Ramsey S. Elsayed; Robbin G. Cohen; Fernando Fleischman; Michael E. Bowdish
Type A aortic dissection is a surgical emergency occurring when an intimal tear in the aorta creates a false lumen in the ascending aorta. Prompt diagnosis and surgical treatment are imperative to optimize outcomes. Surgical repair requires replacement of the ascending aorta with or without aortic root or aortic arch replacement. Surgical outcomes for this highly lethal diagnosis have improved, with contemporary survival to discharge at Centers of Excellence of 85% to 90%. Survival is related to prompt treatment, preexisting medical comorbidities, presence or absence of end organ malperfusion, extent of aortic repair required, and the development of postoperative complications.
Annals of Vascular Surgery | 2017
Sherwin Abdoli; Sung W. Ham; Alison Wilcox; Fernando Fleischman; Lydia Lam
Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian was struck by a vehicle resulting in polytrauma including BTAI with transection distal to the left subclavian artery origin. The patient underwent successful TEVAR. Nine months later, the patient developed transient paresthesia below the waist that progressed to bilateral lower extremity paralysis and malperfusion syndrome below the diaphragm including nonpalpable pulses in the lower extremities, acute renal failure, and ischemic colitis. Imaging demonstrated near occlusive thrombosis of the distal end of the thoracic endograft. An emergent axillobifemoral bypass resolved the organ malperfusion and acute limb ischemia. Patients who have undergone TEVAR for BTAI may develop asymptomatic or symptomatic intragraft thrombosis. In patients presenting with malperfusion syndrome below the diaphragm, extra-anatomic bypass can expeditiously resolve symptoms until definitive treatment can be performed. Oversizing of thoracic stents in trauma patient may lead to intragraft thrombosis.
The Annals of Thoracic Surgery | 2018
W. Hampton Gray; Fernando Fleischman; Mark J. Cunningham; Anthony W. Kim; Craig J. Baker; Vaughn A. Starnes; P. Michael McFadden
Left atrial-esophageal fistula after endovascular radiofrequency ablation for cardiac arrhythmias is a life-threatening complication. Immediate surgical repair offers the best chance for survival. The optimal surgical technique is unknown. We describe our recommended surgical approach.
Radiographics | 2018
Farhood Saremi; Cameron Hassani; Leah M. Lin; Christopher Lee; Alison Wilcox; Fernando Fleischman; Mark J. Cunningham
Treatment of thoracic aortic dissection remains highly challenging and is rapidly evolving. Common classifications of thoracic aortic dissection include the Stanford classification (types A and B) and the DeBakey classification (types I to III), as well as a new supplementary classification geared toward endovascular decision making. By using various imaging techniques, the extent of the dissection, the location of the primary intimal tear, the shape of the aortic arch, and the zonal involvement of the aortic arch-factors that affect the treatment strategy-can easily be identified. Thoracic endovascular aortic repair (TEVAR) is generally performed in two groups of patients: (a) those with a surgically repaired type A dissection, and (b) those with a complicated type B dissection. Several imaging findings can help predict the course of remodeling of the dissected aorta after a repaired type A dissection and TEVAR. A spectrum of imaging findings exist with regard to favorable (positive) or failing (negative) remodeling. A schematic model with imaging support allows the classification of important causes of failing remodeling into proximal and distal groups, on the basis of the origin of the refilling of the false lumen and the underlying pathophysiology of pressurization. Refilling of the false lumen of the aorta after repair of a type A dissection is usually secondary to a persistent intimal tear at the aortic arch, a leak of the distal graft anastomosis, or refilling from the false lumen of a dissected aortic arch vessel. After TEVAR, false lumen refilling is most commonly due to an incomplete seal of the proximal landing related to the aortic tortuosity, an arch branch stump, a supra-arch chimney stent, or the TEVAR technique. Online supplemental material is available for this article. ©RSNA, 2018.
Journal of Vascular Surgery | 2017
Eric C. Kuo; Narek Veranyan; Fred A. Weaver; Sung W. Ham; Vincent L. Rowe; Fernando Fleischman; Michael E. Bowdish; Sukgu M. Han
likely to have VWINGS in use at last follow-up (P < .007). No differences in use were found between clinic providers. A total of 77 (12%) patients had at least one device removed. Reasons for explantation were 28.6% infection, 26% cannulation difficulties, 11.7% device moved, 11.7% no longer needed, 6.5% excessive scarring, and 15.6% unknown. A total of 44 patients (6.7%) had a secondary procedure, not including catheter placement. There were no known fistula failures due to device placement or removal. Fistula survival was 87%. Failure of 84 fistulas (12.8%) occurred an average of 254 days after implantation. Conclusions: VWING devices facilitate cannulation in a difficult dialysis population. Use of the devices is safe and allows use of deep fistulas with smaller incisions than traditional superficialization.
Cardiology Clinics | 2017
Dawn S. Hui; Fernando Fleischman
Endovascular approaches to the aortic arch are challenged by unique anatomy and physiology of this area. Simple application of conventional endovascular technology and technique for abdominal or descending thoracic aortic disease to the aortic arch is insufficient to achieve effective and durable repairs. Appreciation of these challenges has led to developments in endovascular technology as well as complex strategies to deal with individual patient anatomy that hold the potential for continued improved outcomes in both the short and the long term.