Research Spotlight

Posted February 15th 2020

Severe Eosinophilic Myocarditis in the Portion of Left Ventricular Wall Excised to Insert a Left Ventricular Assist Device for Severe Heart Failure.

William C. Roberts M.D.
William C. Roberts M.D.

Roberts, W. C. and A. T. Kietzman (2020). “Severe Eosinophilic Myocarditis in the Portion of Left Ventricular Wall Excised to Insert a Left Ventricular Assist Device for Severe Heart Failure.” Am J Cardiol 125(2): 264-269.

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Described herein are 3 adults in whom histologic study of the left ventricular myocardium excised (“LV core”) to insert a left ventricular assist device (LVAD) disclosed severe acute myocarditis and the inflammatory cells included numerous eosinophils (eosinophilic myocarditis). Examination of the clinical records disclosed elevated absolute eosinophil counts at the time of insertion of the LVAD and the counts rapidly (<30 days) returned to normal after the operation. Because of the numerous medications that each patient was taking at the time of LVAD insertion, identification of a specific initiating medication as its cause was not possible. Of the 3 patients, 2 had idiopathic-dilated cardiomyopathy and 1 had ischemic cardiomyopathy and each had had heart failure for years. The eosinophilic myocarditis in these 3 patients appears to have been transient and superimposed on the earlier cardiomyopathy.


Posted February 15th 2020

Massive Cardiomegaly (>1000 g Heart) and Obesity.

William C. Roberts M.D.
William C. Roberts M.D.

Roberts, W. C. and O. S. Khan (2020). “Massive Cardiomegaly (>1000 g Heart) and Obesity.” Am J Cardiol 125(2): 277-281.

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Described herein are certain clinical and morphologic findings in 9 patients who at necropsy had hearts weighing >1000 g, a weight approximately 3 times normal. With the exception of 2 patients with hypertrophic cardiomyopathy, the common finding in the remaining 7 patients was obesity. None had valvular heart disease, the previously described major cause of massive cardiomegaly. Thus, obesity needs to be added to the causes of massive cardiomegaly, a cause not previously recognized. Electrocardiograms in 4 patients disclosed high total 12-lead QRS voltage on the electrocardiogram in only one despite the massive cardiomegaly.


Posted February 15th 2020

Perforation of a Stenotic Congenitally Bicuspid Aortic Valve Cusp by Heavy Calcium in the Other Cusp.

William C. Roberts M.D.
William C. Roberts M.D.

Roberts, W. C., I. Kale and C. S. Roberts (2020). “Perforation of a Stenotic Congenitally Bicuspid Aortic Valve Cusp by Heavy Calcium in the Other Cusp.” Am J Cardiol 125(2): 299-301.

Full text of this article.

On occasion in patients with stenotic congenitally bicuspid aortic valves (BAVs), the quantity of calcium in one of the cusps is considerably greater than in the other cusp. We examined operatively excised stenotic congenitally BAVs in 630 patients having isolated aortic valve replacement (No other cardiac valve was replaced, and none had had infective endocarditis.) Of the 630 valves, 3 contained a perforation in the mildly calcified cusp due to a large calcific “spur” extending across the orifice from a heavily calcified cusp. In conclusion, heavy calcific deposits in 1 of 2 BAVs may extend across the orifice causing a perforation in the noncalcified portion of the opposing cusp.


Posted February 15th 2020

Examining Hearts Containing Left Ventricular Assist Devices at Necropsy.

William C. Roberts M.D.
William C. Roberts M.D.

Roberts, W. C., N. Ather and J. M. Guileyardo (2020). “Examining Hearts Containing Left Ventricular Assist Devices at Necropsy.” Am J Cardiol 125(2): 244-250.

Full text of this article.

There are no publications describing hearts at necropsy containing left ventricular assist devices (LVADs). The purpose was to study the relation of the LVAD cannula to the left ventricular (LV) cavity and wall. We studied the hearts at necropsy of 15 adults who had an LVAD inserted from 4 to 1,423 days (median 60) earlier. In 13 patients, the cannula had been inserted at an angle to the major longitudinal axis of the LV chamber, and in 11 patients, the orifice margin of the cannulas contacted the LV mural endocardium. In 3 patients, the LVAD cannula was inserted into the posterior wall, and, in another into the anterior wall. In the remaining 11 patients, the cannula had been inserted into the LV apex. Despite the insertion of the cannulas into the LV apex, the direction of the insertion was not into the longitudinal axis of the LV cavity in 9 patients. These unusual insertions in some patients may have altered flow into the orifice of the cannula; in others, based on their long postoperative survival, physiologic consequences were almost certainly absent. The presence of considerable quantities of subepicardial adipose tissue and pericardial adhesions from previous cardiac procedures (mainly coronary bypass) potentially interfered with achieving proper alignment of the LVAD cannula during its insertion. Misalignment of the cannulas of the LVAD in the LV cavity appears to be rather frequent.


Posted February 15th 2020

Non-invasive monitoring is coming the full circle, making our patients safer!

Michael A.E. Ramsay M.D.
Michael A.E. Ramsay M.D.

Ramsay, M. A. (2020). “Non-invasive monitoring is coming the full circle, making our patients safer!” J Clin Monit Comput Jan 18. [Epub ahead of print].

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Non-invasive monitoring is becoming more accurate, more available and mobile. The clinical advantage that this developing technology provides is that the data may be monitored continuously; relatively unobtrusively, and transmitted directly to the caregiver. The downside of being non-invasive has been the potential loss of accuracy in the data displayed. This has been overcome in the measurement of oxygen saturation of hemoglobin by pulse oximetry, in that treatment will be instigated by a decline in oxygen saturation without necessarily an arterial blood gas analysis being performed. The development of pulse oximetry to measure hemoglobin levels (SpHb) has relied on “trend accuracy” to indicate the need for a confirmatory laboratory analysis of hemoglobin level. The study by Applegate et al. [1] confirms the trend accuracy of SpHb as an indication to perform a laboratory confirmation of hemoglobin level. This will lead to earlier laboratory screening, so that developing adverse conditions, such as postoperative bleeding, may be identified at a time that major events, such as failure to rescue can be avoided. This increased availability of non-invasive technology will make patients safer both in our hospitals and at home.