Texas Heart Institute Journal Volume 44: Issue 1

Denton A. Cooley, MD
Citation: Texas Heart Institute Journal 44, 1; 10.14503/THIJ-17-6217

Strange is our situation here on Earth. Each of us comes for a short visit, not knowing why, yet sometimes seeming to divine a purpose. From the standpoint of daily life, however, there is one thing we do know, that man is here for the sake of other men—above all those upon whose smiles and well-being our own happiness depends.

— Albert Einstein

Einstein must have had Denton A. Cooley in mind when he wrote that.

We said goodbye to Dr. Cooley on 28 November 2016 in a beautiful ceremony at Trinity

Crucial to the management of staphylococcal bacteremia is an accurate evaluation of associated endocarditis, which has both therapeutic and prognostic implications. Because the clinical presentation of endocarditis can be nonspecific, the judicious use of echocardiography is important in distinguishing patients at high risk of developing endocarditis. In the presence of high-risk clinical features, an early transesophageal echocardiogram is warranted without prior transthoracic echocardiography.

The purpose of this study was to investigate the clinical risk factors for staphylococcal infective endocarditis that might warrant earlier transesophageal echocardiography and to describe the incidence of endocarditis in cases of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia.

A retrospective case-control study was conducted by means of chart review of 91 patients consecutively admitted to a community hospital from January 2009 through January 2013. Clinical risk factors of patients with staphylococcal bacteremia were compared with risk factors of patients who had definite diagnoses of infective endocarditis. There were 69 patients with bacteremia alone (76%) and 22 patients with endocarditis (24%), as verified by echocardiography. Univariate analysis showed that diabetes mellitus (P=0.024), the presence of an automatic implantable cardioverter-defibrillator/pacemaker (P=0.006) or a prosthetic heart valve (P=0.003), and recent hospitalization (P=0.048) were significantly associated with developing infective endocarditis in patients with S. aureus bacteremia. The incidence of methicillin-resistant and methicillin-sensitive S. aureus bacteremia was similar in the bacteremia and infective-endocarditis groups (P=0.437).

In conclusion, identified high-risk clinical factors in the presence of bacteremia can suggest infective endocarditis. Early evaluation with transesophageal echocardiography might well be warranted.

Adults who underwent complex atrial baffling as children via Mustard or Senning procedures are at heightened risk for atrial arrhythmias. Antiarrhythmic therapies are typically ineffective in this population. Accordingly, our team of pediatric and adult electrophysiologists investigated the effectiveness of early invasive transbaffle-access techniques to perform early radiofrequency ablation at the source of these clinically significant arrhythmias.

For this retrospective study, we selected 11 adult survivors of atrial baffling (mean age, 34 ± 9 yr) who underwent clinically indicated electrophysiologic study after no more than one trial of antiarrhythmic therapy. Using transbaffle-access techniques and 3-dimensional mapping of the venous atria, we found 12 inducible arrhythmias in 10 patients: intra-atrial reentrant tachycardia (n=6), atrioventricular nodal reentrant tachycardia (n=3), focal atrial tachycardia (n=2), and repetitive double firing of the atrioventricular node (n=1). Defining success as short- and midterm freedom from arrhythmia, we analyzed outcomes of radiofrequency ablation at 1 and 6 months.

At 1 month, ablation was 100% successful. At 6 months, after 11 ablations in 9 patients, 5 patients had no clinical recurrence, 2 had improved arrhythmia control from minimal medical therapy, and 2 were to undergo repeat study for recurrent tachycardia. In the recurrence-free patients, arrhythmias during electrophysiology study matched the types found clinically before the study.

To our knowledge, this is the largest one-year cohort of adult survivors of atrial baffling to have undergone study by a combined pediatric–adult electrophysiology team. We conclude that early invasive transbaffle access for ablating diverse atrial tachyarrhythmias was effective in these patients.

Length of stay is the primary driver of heart-failure hospitalization costs. Because cancer antigen 125 has been associated with poor morbidity and mortality rates in heart failure, we investigated the relationship between admission cancer antigen 125 levels and lengths of stay in heart-failure patients. A total of 267 consecutive patients (184 men, 83 women) with acute decompensated heart failure were evaluated prospectively. The median length of stay was 4 days, and the patients were classified into 2 groups: those with lengths of stay ≤4 days and those with lengths of stay >4 days. Patients with longer lengths of stay had a significantly higher cancer antigen 125 level of 114 U/mL (range, 9–298 U/mL) than did those with a shorter length of stay (19 U/mL; range; 3–68) (P <0.001). The optimal cutoff level of cancer antigen 125 in the prediction of length of stay was >48 U/mL, with a specificity of 95.8% and a sensitivity of 96% (area under the curve, 0.979; 95% confidence interval [CI], 0.953–0.992). In the multivariate logistic regression model, cancer antigen 125 >48 U/mL on admission (odds ratio=4.562; 95% CI, 1.826–11.398; P=0.001), sodium level (P<0.001), creatinine level (P=0.009), and atrial fibrillation (P=0.015) were also associated with a longer length of stay after adjustment for variables found to be statistically significant in univariate analysis and correlated with cancer antigen 125 level. In addition, it appears that in a cohort of patients with acute decompensated heart failure, cancer antigen 125 is independently associated with prolonged length of stay.

A 60-year-old man with paroxysmal atrial fibrillation, hypertension, seizure disorder, and alcohol abuse was unresponsive on presentation at the hospital. Laboratory tests revealed hypokalemia (2.5 mg/dL), hypomagnesemia (1.3 mg/dL), and no elevation in cardiac biomarkers. The patient's admission electrocardiogram (ECG) showed an undetermined rhythm, with further interpretation limited by motion artifact. He was admitted with a diagnosis of alcohol withdrawal and hypothermia. During his hospital stay, he was monitored on telemetry for cardiac manifestations of electrolyte abnormalities. The covering physician was urgently called for suspicious telemetry events that prompted the completion of the following ECG (Fig. 1).

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Risk Factors for Development of Stroke in Patients With Continuous-Flow Left Ventricular Assist Device Support as Destination Therapy

Ioana B. FloreaMD, MPHS,

Nadia H. BakirMD,

Meghan O. KellyMD,

Joel D. SchillingMD, PhD,

Gregory A. EwaldMD,

Akinobu ItohMD, PhD,

Marc R. MoonMD,

Spencer J. MelbyMD,

Ralph J. Damiano JrMD,

Kunal D. KotkarMD, and

Muhammad F. MasoodMD

In Memoriam: Denton A. Cooley, MD (1920–2016)

Fare Thee Well, Dr. Cooley

Egregious Plagiarism: More than Misconduct

Jim's Prostate Cancer

Clinical Risk Factors for Infective Endocarditis in Staphylococcus aureus Bacteremia

Effectiveness of Early Invasive Therapy for Atrial Tachycardia in Adult Atrial-Baffle Survivors

Cancer Antigen 125 is Associated with Length of Stay in Patients with Acute Heart Failure

Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status

Modified Cone Reconstruction of the Tricuspid Valve for Ebstein Anomaly as Performed in Siberia

Percutaneous Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis

Revascularization in a 17-Year-Old Girl with Neurofibromatosis and Severe Hypertension Caused by Renal Artery Stenosis

Endovascular Exclusion of Aortobronchial Fistula and Distal Anastomotic Aneurysm after Extra-Anatomic Bypass for Aortic Coarctation

Nonfluoroscopic Imaging as Guidance for Radiofrequency Ablation of Atrioventricular Nodal Reentrant Tachycardia after Mustard Repair

Right Thoracoabdominal Approach for Retrocardiac Paraganglioma Resection

Titanium Plug Closure after HeartWare Ventricular Assist Device Explantation in a 15-Year-Old Girl: First U.S. Experience

Minimally Invasive LVAD Deactivation in a 65-Year-Old Man with Recurrent Pump Thrombosis and Left Ventricular Recovery

Compartment Syndrome of the Hand: A Rare Sequela of Transradial Cardiac Catheterization

Resection of Celiac Artery Aneurysm with Bypass Grafting to the Splenic and Common Hepatic Arteries

Electrocardiogram Interpretation in a Man with Alcohol Withdrawal and Hypothermia

Surgical Lessons from the Repair of Recurrent Tricuspid Regurgitation after DeVega Annuloplasty

What Are the Predictors of Atrial Fibrillation in Coronary Artery Bypass Grafting?

Risk Factors for Development of Stroke in Patients With Continuous-Flow Left Ventricular Assist Device Support as Destination Therapy

Lyme Carditis and Inflammation-Driven Plaque Erosion Presenting as Sudden Cardiac Arrest

Midterm Outcomes of Pediatric Mitral Valvuloplasty for Moderate to Severe Mitral Valve Regurgitation and Associated Risk Factors for Postoperative Deterioration

Navigating the Complexities of Mitral Valve Clipping: Early Severe Mitral Valve Stenosis After Mitral Valve Clipping

The Department of Cardiovascular Anesthesia of The Texas Heart Institute: An Informal History

Ectopic Right Renal Artery Originating from Anomalous Common Celio-Mesenteric Trunk: Multifaceted Imaging Approach

Low-Velocity Nail-Gun Injuries to the Interventricular Septum: Report of Two Cases, One in a Child

Pulmonary Artery Sling Causing Tracheal Stenosis in a Neonate

Transcatheter Aortic Valve Replacement: A Physician-Patient's Story

Mother and the Bicycle