Morris Salem

Predictors of left ventricular outflow obstruction following single-stage repair of interrupted aortic arch and ventricular septal defect

This study looked at echocardiographic predictors of left ventricular outflow obstruction after primary neonatal repair of interrupted aortic arch and ventricular septal defect. Results of this study indicate that the only significant independent predictor of left ventricular outflow obstruction is aortic valve diameter; all patients with an aortic valve diameter <4.5 mm (Z score <-5) subsequently developed obstruction, whereas patients with annuli >4.5 mm (Z score >-5) remained free from obstruction.

Transcatheter native pulmonary valve and tricuspid valve replacement with the sapien XT: Initial experience and development of a new delivery platform

While the Melody valve is unable to be used for replacement of large pulmonary outflow tracts, the 29 mm Sapien XT transcatheter valve, designed specifically for aortic valve replacement, can potentially be used in these large native outflow tracts. Techniques to enable off‐label use of the Sapien XT valve for large‐diameter pulmonary and tricuspid valve replacement are described.

Aortic root compression during transcatheter pulmonary valve replacement

To describe the incidence of aortic root compression (ARC) during transcatheter pulmonary valve replacement (TPVR).

Transcatheter melody valve placement in large diameter bioprostheses and conduits: What is the optimal "Landing zone"?

This study sought to elucidate the optimal bioprosthetic valve (BPV) size prior to Melody valve implantation. Background: BPVs provide an ideal “landing zone” for future Melody valve insertion. To guide surgical choice of BPV size, it is important to understand which BPV size can serve consistently as substrates for Melody valve placements.

Transcatheter closure of an iatrogenic ventricular septal defect after SAPIEN valve implantation.

A 57‐year‐old woman developed progressive calcific mitral and aortic valve disease with a porcelain aorta secondary to a history of radiation therapy. She was considered a very poor operative candidate and referred for transcatheter aortic valve replacement (TAVR). Four weeks after extensive coronary artery stenting, a TAVR was performed with a 23 mm Edwards SAPIEN valve (Edwards Life Sciences, Irvine, CA) through a transapical approach. Post‐operatively, her symptoms of dyspnea persisted and worsened. She was found to have an acquired ventricular septal defect (VSD) measuring 8 mm by 5 mm by transesophageal echocardiogram and by a CT angiogram. Percutaneous VSD closure was accomplished with an 8 mm Muscular VSD Occluder (St. Jude Medical, St. Paul, MN) with elimination of her shunt, improvement of her dyspnea, and marked improvement in exercise tolerance.

Echocardiography for patent ductus arteriosus including closure in adults.

Patent ductus arteriosus (PDA) represents at least 5–10% of all congenital heart defects (CHDs) making it a very important commonly diagnosed lesion. Although spontaneous closure of the PDA occurs within 24 to 48 hours after birth in the majority, those children who do not have natural or surgical closure may have a persistent PDA into adulthood. The diagnosis is most often confirmed by echocardiography that also guides catheter‐based interventions and surgeries. Echocardiography continues to be the most important tool in long‐term follow‐up of residua and sequelae.

Incidence and outcome of infective endocarditis following percutaneous versus surgical pulmonary valve replacement

To provide a comparison of the outcome of infective endocarditis (IE) in patients undergoing transcatheter pulmonary valve replacement (TPVR) versus surgical pulmonary valve replacement (SPVR).

Transcatheter closure of a giant communication between the right pulmonary artery and left atrium in a neonate

Direct communication between the right pulmonary artery and the left atrium is an extremely rare congenital pathologic entity characterized by right to left shunt and a rare cause of cyanosis in newborn. The value of echocardiography is emphasized in making the diagnosis as well as never before reported successful treatment with the Amplatzer vascular plug in a neonate.

Chest pain during stenting of a native aortic coarctation: A case for acute intercostal muscle ischemia and rhabdomyolysis

An adult male experienced severe chest pain during stenting of a native aortic coarctation. He also developed the postcoarctectomy syndrome with paradoxical hypertension and abdominal pain. Our hypothesis suggests that sudden interruption of large collateral blood flow caused acute chest wall muscle ischemia, rhabdomyolysis, and severe chest pain. Cathet Cardiovasc Intervent 2002;57:217–220.

Ventricular arrhythmia burden after transcatheter versus surgical pulmonary valve replacement

Objective Comparative ventricular arrhythmia (VA) outcomes following transcatheter (TC-PVR) or surgical pulmonary valve replacement (S-PVR) have not been evaluated. We sought to compare differences in VAs among patients with congenital heart disease (CHD) following TC-PVR or S-PVR. Methods Patients with repaired CHD who underwent TC-PVR or S-PVR at the UCLA Medical Center from 2010 to 2016 were analysed retrospectively. Patients who underwent hybrid TC-PVR or had a diagnosis of congenitally corrected transposition of the great arteries were excluded. Patients were screened for a composite of non-intraoperative VA (the primary outcome variable), defined as symptomatic/recurrent non-sustained ventricular tachycardia (VT) requiring therapy, sustained VT or ventricular fibrillation. VA epochs were classified as 0–1 month (short-term), 1–12 months (mid-term) and ≥1 year (late-term). Results Three hundred and two patients (TC-PVR, n=172 and S-PVR, n=130) were included. TC-PVR relative to S-PVR was associated with fewer clinically significant VAs in the first 30 days after valve implant (adjusted HR 0.20, p=0.002), but similar mid-term and late-term risks (adjusted HR 0.72, p=0.62 and adjusted HR 0.47, p=0.26, respectively). In propensity-adjusted models, S-PVR, patient age at PVR and native right ventricular outflow tract (RVOT) (vs bioprosthetic/conduit outflow tract) were independent predictors of early VA after pulmonary valve implantation (p<0.05 for all). Conclusion Compared with S-PVR, TC-PVR was associated with reduced short-term but comparable mid-term and late-term VA burdens. Risk factors for VA after PVR included a surgical approach, valve implantation into a native RVOT and older age at PVR.