Frequency of Severe Valvular Disease Caused by Mediastinal Radiation Among Patients Undergoing Valve Surgery in a Community-Based Academic Medical Center
Our goal was to define the prevalence of radiation-induced valvular heart (RIVD) disease among patients undergoing cardiac valve surgery in a community-based, regional academic medical center. Mediastinal radiation is a treatment modality for various hematologic and solid malignancies; however, long-term cardiac complications, including radiation-induced valvular heart disease, can occur years after the radiation treatments.
Mediastinal radiation exposure is an independent risk factor for valvular heart disease often necessitating valve replacement in patients without other risk factors for valve disease.
Between January 1, 1998 and September 1, 2007, we retrospectively analyzed our institution’s cardiac surgical database over a 10 year period and identified 189 consecutive patients ≤ 50 years of age who underwent valve surgery. Using case-control matching, we assessed the prevalence of mediastinal radiation among these young patients with valve disease necessitating surgery and to their matched controls from all patients admitted to the hospital.
Nine individuals (4.8%) were identified as having received previous mediastinal radiation, significantly increased from controls (p<0.0001), and 8 of whom had surgical or pathologic findings consistent with radiation damage. Compared with a matched case-control population, individuals who had severe valve disease and underwent valve replacement had a markedly increased prevalence of prior mediastinal radiation therapy.
In conclusion, cardiologists must remain aware of the potential long term valvular complications in patients treated with mediastinal radiation. Increased surveillance for RIVD may be considered in the decades following radiation therapy.
A 70-year-old patient presented with melena, dyspnea, and generalized weakness. An endoscopy revealed a deep ulcer with a pulsatile clot in the intrathoracic gastric tube that had been previously constructed for esophageal replacement. Shortly thereafter, the patient died of exsanguination secondary to a fistula between the stomach and the right ventricle. This complication presents a unique but deadly cause of gastrointestinal bleeding that mandates swift diagnosis and immediate surgical correction.
Survival and Neurologic Recovery in Patients With ST-Elevation Myocardial Infarction Resuscitated From Cardiac Arrest”
We examined outcomes of patients resuscitated from cardiac arrest owing to ST-segment elevation myocardial infarction (STEMI) and predictors of survival and neurologic recovery.
Immediately after resuscitation from cardiac arrest owing to STEMI, many patients show signs of neurologic impairment, and benefits of percutaneous coronary intervention and subsequent prognosis are not well defined.
Between January 1, 2002, and December 31, 2006, we retrospectively identified consecutive patients resuscitated from cardiac arrest, regardless of time to return of spontaneous circulation (ROSC) and neurologic status, and reviewed the outcomes of those who had STEMI. Mortality and neurologic recovery at discharge and long-term mortality were assessed by individual chart review for those who underwent emergent angiography.
Our study population consisted of 98 patients; 64% survived to discharge, and 92% had a full neurologic recovery. Predictors of survival were shorter time to ROSC, younger age, neurologic status post-resuscitation (alert or minimally responsive), and male sex. Predictors of neurologic recovery included shorter time to ROSC, neurologic status post-resuscitation (alert or minimally responsive), and younger age. Ninety-six percent of patients who were alert post-resuscitation survived. Ninety-three percent of patients who were minimally responsive post-resuscitation survived. Fifty-nine patients were unresponsive post-resuscitation, with 44% survival, of whom 88% had full neurologic recovery. In the unresponsive group, unwitnessed arrest, prolonged ROSC, and older age were associated with increased risk of death, and older age and prolonged ROSC predicted poor neurologic recovery.
When resuscitated patients with STEMI are being evaluated in the emergency department, serious consideration should be given to emergent angiography and revascularization, regardless of neurologic status.
Ehsanur Rahman, Vivek K Reddy, Subba R. Vanga, Amratash Malodiya, Farzad Moussavi, George D Moutsatsos, Andrew J Doorey, Vinay R Hosmane, William S. Weintraub. “Survival of Suspected Acute Coronary Syndrome Patients Resuscitated by CPR Is Dependent on the Arrest Rhythm but Not on the Presence of ST Elevation on the Post Resuscitation ECG” European Society of Cardiology Conference, ESC 2013
Reddy V, Malodiya A, Moussavi F, Vanga SR, Doorey A, Hosmane V, Moutsatsos G, Weintraub WS, Rahman E. “Survival of Suspected Acute Coronary Syndrome Patients Resuscitated from Cardiac Arrest Depends on Initial Rhythm but not on the Presence of ST Elevation on Pre-cath ECG. Abstract presented at American Heart Association Conference, 2012.
Vivek K. Reddy, Vinay R. Hosmane, Andrew Doorey, William S. Weintraub, Ehsanur Rahman. “It Appropriate To Take All Post-Resuscitation Patients Suspected of Having an Acute MI For Urgent Angiography?” J Am Coll Cardiol, 2011; 58:131. Abstract presented at Transcatheter Cardiovascular Therapeutics (TCT) 2011
Kevin Copeland, Vinay Hosmane, Michael Banbury, Andrew Doorey, William S. Weintraub. “Frequency of Severe Valvular Disease Caused by Mediastinal Radiation Among Patients Undergoing Valve Surgery in a Community Hospital,” J. Am. Coll. Cardiol. 2011;57;E1362 doi:10.1016/S0735-1097(11)61362.Abstract presented by K. Copeland at ACC Scientific Sessions April 2011, New Orleans.
Lionel Malebranche, Vivek K Reddy, Vinay R Hosmane, Zagui Zhang, William S Weintraub, Ehsanur Rahman, “Survival and Neurologic Recovery in Patients with ST-Elevation After Resuscitation from Cardiac Arrest Found to Have Non-Obstructive Disease on Angiography”, Circulation 2010. 2010;122:A19239. Abstract presented by L. Malebranche at AHA Scientific Sessions, Chicago 2010.
Hisham M.F. Sherif, Ehsanur Rahman, Nowwar Mustafa, Vinay R. Hosmane, Vivek Reddy, William Weintraub, Angela DiSabatino. Recovery after Resuscitation from Cardiac Arrest in ST-Elevation Myocardial Infarction: A Computer-Based Medical Decision-Support Tool. Abstract presented at Medicine Meets Virtual Reality Conference, Long Beach, California, January 2009.
Kevin Copeland, Vinay Hosmane, Michael Banbury, Andrew Doorey,“Frequency of Severe Valvular Disease Caused by Mediastinal Radiation Among Patients Undergoing Valve Surgery in a Community Hospital”; Journal of Clinical Lipidology (October 2008) Supplement, Volume 2, Issue 5, Pages S45-S46.Abstract presented by K. Copeland at the7th International Symposium on “MULTIPLE RISK FACTORS IN CARDIOVASCULAR DISEASES – Prevention and Intervention – Heath Policy”, Venice, Italy, October 22-25, 2008
Vivek Reddy, Vinay R. Hosmane, Nowwar Mustafa, Charles Reese IV, Angela DiSabatino, William S. Weintraub, Ehsanur Rahman, “A Comparison of Survival And Neurologic Recovery In Patients With ST-Elevation Myocardial Infarction Resuscitated From Cardiac Arrest Outside the Hospital Versus the Emergency Department”; Circulation 2008 Volume 177, No. 121;Page e439.Abstract presented at AHA Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference, by V. Reddy, Baltimore, M.D., 2008.
Vivek Reddy, Vinay R. Hosmane, Nowwar Mustafa, Charles Reese IV, Angela DiSabatino, Paul Kolm, William S. Weintraub, Ehsanur Rahman. Survival And Neurologic Recovery In Patients With ST-Elevation Myocardial Infarction Resuscitated From Cardiac
Arrest; Circulation 2007,Vol 116, No. 16;Page II-385.Abstract presented by V. Hosmane at AHA Scientific Sessions, Orlando, 2007.
Zeshan Rana, Divya Tiwari, Paul Kolm, Nowwar Mustafa, Vinay Hosmane, Michael Metzger, Donna Mahoney, Angela Disabatino, Maria Albert, William Weintraub, Ehsanur Rahman; The Risk of Carotid Endarterectomy Preceding Coronary Artery Bypass Grafting in Patients with Concomitant Significant Coronary Artery Disease and Critical Carotid Stenosis; Circulation 2007,Vol 116, No. 16;Page II-417. Abstract presented by Z. Rana at AHA Scientific Sessions, 2007.
Vinay R. Hosmane, Vivek K. Reddy, Nowwar Mustafa, William S. Weintraub, Ehsanur Rahman, Christiana Care Health System, Newark, DE. Angiographic Findings And Outcomes In Unresponsive Patients With ST-Elevation Myocardial Infarction Resuscitated From Cardiac Arrest; Am J Cardiol 2007 (supplement), Vol 100(8);9L.
Abstract presented by V.Hosmane at Transcatheter Cardiovascular Therapeutics, 2007.
Mustafa N, Hosmane V, Bittner L, DiSabatino A, O’Connor R, Reese C, Hopkins J, Weintraub W, Rahman E; Analysis of Door to Balloon Timeline to Identify Where Delays Occurred In ST-Elevation Myocardial Infarction Patients who Presented After Versus During Regular Working Hours; Circulation 2007, Vol 115, No. 21; Page 2.Abstract presented at AHA Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference, by N. Mustafa, Washington, D.C., May 2007
Mustafa N, Hosmane V, DiSabatino A, Bittner L, O’Connor R, Reese C, Hopkins J, Weintraub W, Rahman E; Utilization of Emergency Medical Services for Hospital Transport in Patients with ST-Elevation Myocardial Infarction results in a Shorter Door to Balloon Time; JACC 2007, Vol 49, No. 9 (Supplement A); Page 227A. Abstract presented at ACC Scientific Sessions by N. Mustafa, March 2007, New Orleans.
Hosmane V, Buck, J Vandover J, Reese C, DiSabatino A, Kolm P, Weintraub W, Rahman E; Prognosis of Patients Receiving Primary Percutaneous Coronary Intervention who Remain Comatose after Resuscitation from Cardiac Arrest in the Setting of ST Elevation Myocardial Infarction; Circulation 2006, Vol 114, No. 18; Page II-1210.
Abstract presented by V. Hosmane at AHA Scientific Sessions, Resuscitation Science Symposium, Chicago, IL, November 2006.
Hosmane V, Case Report of A Latino Male Presenting with Thyrotoxic Periodic Paralysis
First Prize, Delaware Chapter, ACP Abstract Competition, 1/05. Presented at Delaware Chapter, ACP Conference, 2/05. Presented at the National, ACP Conference in San Francisco, CA, 4/05
Dr. Hosmane is a cardiologist based in Delaware whose number one goal is to improve your heart health. His strength lies in the fact that he truly enjoys his daily interactions with patients.