Methodist DeBakey cardiovascular journal最新文献

{"title":"Surfacer Inside-Out Central Venous Catheterization Through an Occluded Inferior Vena Cava.","authors":"Rishik Puppala, Pallavi Gorantla, Bright Benfor, Eric Peden","doi":"10.14797/mdcvj.1602","DOIUrl":"https://doi.org/10.14797/mdcvj.1602","url":null,"abstract":"<p><p>This case describes the use of the Surfacer® Inside-Out Access Catheter System (SIO) from Merit Medical in an occluded inferior vena cava. The procedure typically utilizes right femoral vein access with contraindications of acute iliocaval thrombosis due to possible embolization. After history and imaging studies, the occlusion was determined to be chronic in this case, and a decision was made to employ the SIO procedure using an indwelling catheter. This case demonstrates the use of the SIO procedure in certain settings in patients with central venous occlusions who have exhausted all other options.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 1","pages":"63-67"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250121","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}

{"title":"Hypercoagulability and the A1298C MTHFR Mutation: Case Series of Unexplained Pulmonary Embolism.","authors":"Akshat Sahai, Vaibhav Sharma, Prapti Mishra, Avinash Siddanoor, Abhishek Bhatia, Deepak Gargi Pande","doi":"10.14797/mdcvj.1565","DOIUrl":"10.14797/mdcvj.1565","url":null,"abstract":"<p><p>Methylenetetrahydrofolate reductase gene (<i>MTHFR</i>) mutations can lead to hyperhomocysteinemia, a known risk factor for venous thromboembolism. In some studies, the A1298C and C677T polymorphisms of the <i>MTHFR</i> gene have been linked to thrombosis, though their clinical significance remains debated. This case presents a detailed analysis of two premenopausal females who presented with pulmonary embolism and were subsequently diagnosed with the A1298C mutation, indicating a potential relation between the A1298C mutation of the <i>MTHFR</i> gene and the subsequent triggering events of thrombotic manifestations associated with raised levels of homocysteine. The varying clinical presentations and biochemical profiles underscore the complex relationship between genotype and phenotype in <i>MTHFR</i>-associated thrombophilias.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 1","pages":"57-62"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200270","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}

{"title":"Allogeneic, Xenogeneic, and Exogenic Hearts for Transplantation.","authors":"Daniel J Garry, Mary G Garry, Hiromitsu Nakauchi, Hideki Masaki, David H Sachs, Joshua I Weiner, Daniel Reichart, Eckhard Wolf","doi":"10.14797/mdcvj.1590","DOIUrl":"10.14797/mdcvj.1590","url":null,"abstract":"<p><p>The only curative therapy for end-stage heart failure is orthotopic allogeneic heart transplantation. This therapy has extended the survival of patients worldwide but is limited due to the scarcity of donor organs. Potential alternative donor sources of organs for transplantation include genetically-modified (GM) large animal donors (ie, xenografts) and human organs developed in large animal hosts. These strategies utilize gene editing and somatic cell nuclear transfer technologies to engineer partially or completely humanized organs. Preclinical xenotransplantation studies of GM pig hearts into baboons have already provided an important clinical foundation, as two patients have received cardiac xenografts from GM pigs and have survived for up to 2 months. Additional issues need to be addressed in order for patients to survive more than 1 year, which would make these strategies clinically applicable. Thus, in combination with immunosuppression agents, xenogeneic and exogenic organ sources hold tremendous promise for an unlimited and transformative supply of organs for transplantation.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 3","pages":"92-99"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094249","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}

{"title":"Rejection Surveillance: Integrating Cell-Free DNA and Gene Expression Panels to Decrease Invasiveness in Routine Monitoring of Heart Transplant Recipients.","authors":"Hatem Alansari, Janardhana R Gorthi","doi":"10.14797/mdcvj.1578","DOIUrl":"10.14797/mdcvj.1578","url":null,"abstract":"<p><p>Post-transplant rejection surveillance remains a cornerstone of heart transplant care. Although endomyocardial biopsy has long been the gold standard for monitoring rejection, its invasiveness and limitations have driven innovations in noninvasive techniques. Molecular diagnostics, including gene expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA), have emerged as promising alternatives with demonstrated utility. GEP excels in identifying immune activation with high negative predictive value, while dd-cfDNA provides insights into allograft injury, with sensitivity up to 81% and specificity of 85%. Complementary cardiac imaging such as echocardiography and cardiac magnetic resonance enhance graft assessment by providing structural and functional data. Together, these investigations offer a multimodal approach to rejection surveillance, reducing the frequency of endomyocardial biopsy and improving overall care for transplant recipients.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 3","pages":"51-57"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095140","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}

{"title":"Cardiac Transplantation: The Second Epoch of a Sacred Adventure.","authors":"James B Young","doi":"10.14797/mdcvj.1610","DOIUrl":"10.14797/mdcvj.1610","url":null,"abstract":"<p><p>Cardiac transplantation is one of the most dramatic, esoteric, and sacred procedures available to cardiologists and cardiac surgeons as treatment for a limited number of patients with advanced, end-stage heart failure at imminent risk of death. Since the first \"successful\" allographic heart transplant in Cape Town, South Africa-in which the patient survived only 18 days-the procedure has become sine qua non for dramatic cardiovascular surgical adventures. The sacred aspect of cardiac transplantation relates to its intimate link to circulatory death, brain death, organ donation-and the miraculous gift that follows the decision to donate. It has indeed been called the \"Gift of Life,\" where remarkable donor organ reanimation is seen in recovered hearts removed from a deceased donor. While this issue of the <i>Methodist DeBakey Cardiovascular Journal</i> focuses mainly on the current state of cardiac transplantation, Houston Methodist Hospital recently celebrated the 40th anniversary of its reenergized and remodeled cardiac transplant program. The program was led initially by Michael E. DeBakey, MD, with surgeons George P. Noon, H. David Short, and Hartwell H. Whisennand, and received substantial support from the Methodist Hospital cardiology section for what was to become the Multi-organ Transplant Team. This second epoch of the heart transplant program began on February 21, 1984, following commercial availability of the immunosuppressive agent cyclosporin, and it has operated continuously since then. The following highlights several aspects of cardiac transplantation that have led to its success as a lifesaving last resort for the most severe cases, which ultimately helps explain why the procedure is, in fact, sacred.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 3","pages":"100-105"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095090","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}

{"title":"Expanding the Donor Pool.","authors":"Saleem Toro, Kelly H Schlendorf","doi":"10.14797/mdcvj.1577","DOIUrl":"10.14797/mdcvj.1577","url":null,"abstract":"<p><p>Given the aging population and despite advances in heart failure therapies, the number of patients with advanced heart failure in need of heart transplantation continues to increase, and the longstanding mismatch between organ demand and organ supply persists. In an effort to address this mismatch and expand the donor pool, a number of strategies are being pursued. This article reviews several of those strategies, including transplantation from hepatitis C virus-infected donors, transplantation from donors after circulatory death, the role of organ preservation technologies in facilitating transplantation of hearts that might otherwise be discarded, and the impact of public education and national donation policies.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 3","pages":"33-39"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095094","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}

{"title":"The Stethoscope Song: A Professional Ballad by One of America's Earliest Physician-Writers.","authors":"Justin C Cordova, James B Young","doi":"10.14797/mdcvj.1571","DOIUrl":"10.14797/mdcvj.1571","url":null,"abstract":"<p><p>Oliver Wendell Holmes Sr. (1809-1894) was a poet, essayist, educator, and physician who played an important role in the formation of the American medical establishment. After studying medicine in Paris, Holmes penned what may be his most memorable satirical poem, \"The Stethoscope Song,\" which was first published around 1848. He was a master of stethoscopy and used this ballad to reflect upon the initial resistance to its widespread adoption as well as to give a cautionary tale that auscultation should not replace a thorough medical examination. Holmes was a prominent clinician with important contributions to both medical literature and pedagogy, but he also became a notable author who set a precedent upon which future generations of physician-writers could build.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 3","pages":"109-113"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095153","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}

{"title":"Who is the Candidate? The Heart Transplant Evaluation Process.","authors":"Michelle M Kittleson","doi":"10.14797/mdcvj.1512","DOIUrl":"10.14797/mdcvj.1512","url":null,"abstract":"<p><p>The evaluation for heart transplantation is a comprehensive endeavor requiring multidisciplinary collaboration. The goal of a heart transplant evaluation is to determine if (1) the patient's cardiac status is limited enough, despite optimal medical therapy, to benefit from heart transplantation; (2) the patient does not have comorbidities that would preclude heart transplantation; and (3) the patient demonstrates compliance and possesses adequate social support. The most common indications for heart transplant are highly symptomatic heart failure with reduced ejection fraction, uncontrolled ventricular arrhythmias, or intractable angina. Extracardiac contraindications require specific considerations regarding whether they will (1) confer mortality risk that will negate the expected improvement in survival after transplantation; (2) affect post-transplant quality of life and hamper rehabilitation efforts; and (3) progress with immunosuppression. With careful and appropriate selection, heart transplant recipients are best positioned to experience the improved quality of life and survival expected after transplantation.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 3","pages":"13-24"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095073","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}

{"title":"Uncovering a Windsock Aneurysm of the Interventricular Septum: An Incidental Structural Abnormality.","authors":"Saliha Erdem, Kazim Baser","doi":"10.14797/mdcvj.1592","DOIUrl":"10.14797/mdcvj.1592","url":null,"abstract":"<p><p>We present a case of a 75-year-old female with a history of idiopathic small fiber neuropathy, essential hypertension, and heterozygous familial hypercholesterolemia who was evaluated for exertional dyspnea and fatigue. Coronary computed tomography angiography demonstrated a 16-mm wide-neck windsock aneurysm of the interventricular septum along with a patent foramen ovale and left-to-right shunting. This case underscores the role of advanced cardiac imaging in detecting rare structural abnormalities.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 3","pages":"106-108"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095158","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}

{"title":"Multi-Organ Transplantation in Adult Congenital Heart Disease: Navigating the Unique Challenges of a Distinct Patient Population.","authors":"Valeria E Duarte, Marcus A Urey, Eric D Adler, Brenda Merkelz, Mark J Hobeika, Erik E Suarez, Andrea G Quarti, Rayan Yousefzai","doi":"10.14797/mdcvj.1576","DOIUrl":"10.14797/mdcvj.1576","url":null,"abstract":"<p><p>The prevalence of adult congenital heart disease (ACHD) is increasing, with heart failure being the leading cause of death. For many ACHD patients, heart transplantation is the only treatment option for advanced heart failure, though significant extracardiac involvement may require multi-organ transplantation. Despite the rising number of ACHD transplants, multi-organ transplants in this population remain challenging, and a substantial gap remains between those in need and those who receive a transplant. While short-term outcomes may be worse for ACHD patients, long-term outcomes are comparable and even superior to other cardiomyopathies. Extracardiac organ dysfunction is common in ACHD patients, often precluding heart-alone transplantation. Fontan-associated liver disease, pulmonary vascular and restrictive lung disease, and renal dysfunction frequently necessitate multi-organ transplantation. ACHD patients have a unique immunological and sensitization profile, increasing their risk for infection, rejection, and malignancies, requiring specialized pretransplant desensitization and post-transplant immunosuppression strategies. ACHD transplantation presents unique surgical challenges, including chest reentry, vascular access issues, bleeding risks, extensive anatomical reconstruction, the need for longer vascular segments from donors, and prolonged ischemic times. Decisions regarding heart-alone versus heart-liver, heart-lung, or heart-kidney transplantation demand careful evaluation. These complex surgical plans require extensive multimodal imaging and collaboration with ACHD cardiac imaging specialists and abdominal transplant teams. Comprehensive coordination and psychosocial support are crucial for ACHD patients throughout the transplant process. A dedicated multidisciplinary team and an established and separate pathway for pre-, peri-, and postoperative care in centers with ACHD and multi-organ transplant expertise are essential. There is need for a revised organ allocation system to ensure timely access to transplantation for ACHD patients.</p>","PeriodicalId":39207,"journal":{"name":"Methodist DeBakey cardiovascular journal","volume":"21 3","pages":"72-82"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095131","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}