ABSTRACT
A 56-year old male was evaluated for exertional dyspnea. He had previously undergone mechanical aortic valve replacement and aortic coarctation repair. Following uncomplicated coronary angiography using Judkins left and right catheters, aortography revealed that the loud murmur was related to an unusual, extra-anatomic surgical repair: transverse aorta to descending aorta bypass. Recognition of an extra-anatomic surgical bypass of coarctation is important, as this repair would leave a continuous murmur on exam.
Subject(s)
Aorta, Thoracic , Aortic Coarctation , Blood Vessel Prosthesis Implantation , Endovascular Procedures/methods , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortic Coarctation/diagnosis , Aortic Coarctation/physiopathology , Aortic Coarctation/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/methods , Catheterization, Peripheral/methods , Heart Auscultation/methods , Humans , Male , Middle Aged , Outcome Assessment, Health CareABSTRACT
BACKGROUND: The purpose of this study is to comparatively analyze outcomes of heart transplant patients bridged to transplantation with HeartWare (HW-VAD) versus HeartMate II (HMII-VAD) left ventricular assist devices. METHODS: The United Network for Organ Sharing Database was reviewed to identify first-time heart transplant recipients who were bridged to transplantation with either HW-VAD (n=141) or HMII-VAD (n=1824) from January 2009 through July 2012. RESULTS: Recipients of HW-VAD had a higher proportion of female patients (27.0% versus 18.9%; p=0.019), a lower body surface area (2.01±0.25 m2 versus 2.06±0.25 m2; p=0.035), and a trend toward a higher peak percentage of panel reactive antibody against human leukocyte class I antigens (40.4%±32.8% versus 33.0%±30.4%; p=0.070). Pretransplantation recipient cardiac index (2.33±0.66 Lâ min(-1)â m(-2) versus 2.33±0.68 Lâ min(-1)â m(-2)), serum creatinine (1.21±0.43 mg/dL versus 1.26±0.57 mg/dL), and total bilirubin (1.34±3.45 mg/dL versus 1.06±1.84 mg/dL) were comparable between the two groups (p>0.05 for all comparisons). After transplantation, there were no significant differences in freedom from rejection or freedom from cardiac allograft vasculopathy. Posttransplant graft survival rates were similar between the HW-VAD group and the HMII-VAD group at 1, 2, and 3 years (88.4% versus 87.8%, 79.9% versus 83.8%, and 77.4% versus 79.9%, respectively; p=0.843). CONCLUSIONS: These findings suggest similar hemodynamic unloading, pretransplant end-organ function, and posttransplant outcomes in patients bridged to transplantation with both the HW-VAD and HMII-VAD.
Subject(s)
Heart Failure/surgery , Heart Transplantation , Heart-Assist Devices , Adolescent , Adult , Female , Humans , Male , Middle Aged , Preoperative Care , Prosthesis Design , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Portion-size estimation is an important component of weight management. Literacy and numeracy skills may be important for accurate portion-size estimation. It was hypothesized that low literacy and numeracy would be associated with decreased accuracy in portion estimation. METHODS: A cross-sectional study of primary care patients was performed from July 2006 to August 2007; analyses were performed from January 2008 to October 2008. Literacy and numeracy were assessed with validated measures (the Rapid Estimate of Adult Literacy in Medicine and the Wide Range Achievement Test, third edition). For three solid-food items and one liquid item, participants were asked to serve both a single serving and a specified weight or volume amount representing a single serving. Portion-size estimation was considered accurate if it fell within +/-25% of a single standard serving. RESULTS: Of 164 participants, 71% were women, 64% were white, and mean (SD) BMI was 30.6 (8.3) kg/m(2). While 91% reported completing high school, 24% had <9th-grade literacy skills and 67% had <9th-grade numeracy skills. When all items were combined, 65% of participants were accurate when asked to serve a single serving, and 62% were accurate when asked to serve a specified amount. In unadjusted analyses, both literacy and numeracy were associated with inaccurate estimation. In multivariate analyses, only lower literacy was associated with inaccuracy in serving a single serving (OR=2.54; 95% CI=1.11, 5.81). CONCLUSIONS: In this study, many participants had poor portion-size estimation skills. Lower literacy skills were associated with less accuracy when participants were asked to serve a single serving. Opportunities may exist to improve portion-size estimation by addressing literacy.
