TAG: "Heart"

New approach to remove blood clots


Catheter-based system removes clots without open heart surgery.

Victor Pretorius (left) and Mitul Patel, UC San Diego

When a large blood clot was discovered attached to the end of a catheter inside the right atrial chamber of a patient’s heart, doctors faced a daunting challenge. If the clot came loose, the consequences would likely be catastrophic for the patient, who suffered from pulmonary hypertension – a dangerous narrowing of blood vessels connecting the heart and lungs.

But experts at the UC San Diego Sulpizio Cardiovascular Center (SCVC) are now able to save patients like this one from potentially fatal outcomes by using a new technology capable of removing blood clots, infected masses or foreign bodies from major cardiac blood vessels without performing open-heart surgery.

The SCVC is the first in San Diego County to use the AngioVac system developed by AngioDynamics. The AngioVac is a catheter-based device in which thin tubes are inserted into two major veins in the body through the neck or groin area. Under X-ray guidance, the flexible tubes are advanced to the proximal veins, right-sided heart chambers and/or lung arteries. Each is equipped with an expandable, balloon-shaped funnel tip that, when attached to a bypass circuit, vacuums the targeted material, such as a blood, clot out of the body.

“In some cases, medications can be used to dissolve blood clots, but this treatment option does not work for all patients, especially those who are in a life-threatening situation,” said Mitul Patel, M.D., FACC, interventional cardiologist at UC San Diego Health System. “This new device allows our team to safely extract material, preventing the patient from having to undergo invasive, high-risk surgery.”

Open-heart surgery takes much longer to perform and often requires the surgeon to divide the breastbone lengthwise down the middle and spread the halves apart to access the heart. After the heart is repaired, surgeons use wires to hold the breastbone and ribs in place as they heal.

“Removing a blood clot through open-heart surgery results in longer hospitalization, recovery and rehabilitation times compared to the minimally invasive approach provided by this new device,” said Victor Pretorius, M.B.Ch.B., cardiothoracic surgeon at UC San Diego Health System.

The AngioDynamics device does not eliminate the need for a surgery called pulmonary thromboendarterectomy (PTE) to remove chronic blood clots in the lung arteries, a surgery that cardiothoracic surgeons at UC San Diego Health System have special expertise in performing.

Nearly 100,000 Americans die each year when a clot breaks away from a blood vessel wall and lodges in the lungs or heart. Several factors can cause a blood clot, including certain medications (oral contraceptives and hormone therapy drugs), deep vein thrombosis, family history, heart arrhythmias, obesity, surgery, prolonged sitting or bed rest, and smoking.

The new procedure is performed by a multidisciplinary team comprised of anesthesiologists, cardiothoracic surgeons and interventional cardiologists. Six patients at UC San Diego Health System have undergone the procedure so far, which can be completed in as little as one hour with patients typically able to walk and leave the hospital the following day.

“The success of this new device would not be possible without the collaboration of our colleagues dedicated to helping patients with a vast array of cardiovascular issues,” said Patel. “As the only academic hospital in San Diego County, we are excited about this new technology and what it offers as a new treatment option for our patients at SCVC.”

To learn more about treatment options at UC San Diego Sulpizio Cardiovascular Center, click here.

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Minimally invasive heart stents prove safer


The safety of the procedure also appears to be improving over time.

Researchers at the UC San Diego School of Medicine have documented the safety benefits of aortic stent grafts inserted during minimally invasive surgery to repair abdominal aortic aneurysms – weaknesses in the body’s largest artery that can rupture, causing potentially lethal internal bleeding.

The study, published today (July 9) in JAMA Surgery, shows that patients who received the minimally invasive aortic repair procedure had a 42 percent reduction in preventable post-operative complications and a 72 percent reduction in mortality, compared with those who had undergone open repair surgery.

The safety of the endovascular “inside blood vessel” procedure also appears to be improving over time, as researchers documented a 37 percent reduction in the likelihood of an avoidable complication between 2003 and 2010.

The statistics are based on an analysis of 70,946 cases of abdominal aortic aneurysm repair performed over the seven-year period, culled from a nationwide hospital database maintained by the Healthcare Cost and Utilization Project.

“All this is good news for patients because endovascular repair has become the most common treatment for abdominal aortic aneurysms,” said senior author John Lane, M.D., director of endovascular surgery at UC San Diego Health System and associate professor at the UC San Diego School of Medicine.

The lead author is John Rose, M.D., a resident physician at UC San Diego School of Medicine.

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Catheter ablation a first-line treatment for atrial flutter


UCSF researchers find procedure also reduces hospital visits, lowers atrial fibrillation risk.

Use of catheter ablation is not only beneficial for treating atrial flutter but also can significantly reduce hospital visits – both inpatient and emergency – and lower the risk for atrial fibrillation, according to research by UC San Francisco.

The study is in the July issue of PLOS ONE and available online.

“We’ve seen firsthand in our clinical experience that atrial flutter is difficult to control with drugs, even more than atrial fibrillation,” said senior author Gregory Marcus, M.D., director of clinical research in the UCSF Division of Cardiology. “Based on our study findings, physicians and patients need to be educated that atrial flutter can be readily cured through catheter ablation, and the procedure may reduce the risk for atrial fibrillation.”

Atrial flutter (AFL) is a common abnormal heart rhythm similar to atrial fibrillation (AF). In AF, electrical impulses are triggered from many areas in and around the upper chambers (atria) of the heart instead of just one area. This activity is chaotic, and the atrial walls quiver rather than contract normally in moving blood to the lower chambers (ventricles). In AFL, the electrical activity is more coordinated into one rapid circuit, but the atria contract very rapidly.

“The use of catheter ablation for AFL is very effective and can significantly reduce hospital visits and demand on health care services,” Marcus said. “It’s a safe procedure we frequently perform, even on people in their 90s.”

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Forbes, Buffett honor UCSF donor


Chuck Feeney recognized after decades of stealth philanthropy.

Chuck Feeney, after decades of anonymous and stealth philanthropy, has been caught in the spotlight by earning a Forbes 400 Lifetime Achievement Award.

In presenting the award, billionaire Warren Buffett referred to Feeney as his hero, and Bill Gates’ hero as well. “He should be everybody’s hero,” Buffett remarked.

Feeney, through his philanthropic arm The Atlantic Philanthropies, is UC San Francisco’s single greatest benefactor, giving more than a quarter of a billion dollars over the years. Proof of his epic generosity is visible most prominently at Mission Bay, where he has provided indispensable support to state-of-the-art buildings and created the environment for the remarkable science that goes on within them.

“Chuck’s approach to giving is based on backing great people in achieving demonstrable outcomes. As he has noted, ‘you should think of your philanthropic efforts as a business – out to achieve a demonstrable result,’” said Feeney’s business partner, Steve Denning, who accepted the honor on his behalf.

Feeney’s deep and wide investment in UCSF is evidence of his confidence in UCSF’s ability to deliver on its promise as a world-class bioscience center.

His most recent gift to UCSF has been to Global Health Sciences, enabling UCSF to build Mission Hall, which will house its global health researchers, scientists, and students under the same roof for the first time. The building opens this fall.

Feeney also has given generously to the building of the Smith Cardiovascular Research Building, Helen Diller Family Cancer Research Building, and the UCSF Medical Center at Mission Bay, which opens its doors in 2015.

“Chuck Feeney is an extraordinary human being – a visionary, a humanitarian, and a pragmatist,” said Interim Chancellor Sam Hawgood, M.B.B.S. “These traits have made him an indispensable partner in our evolution as a global health science hub. We are thrilled that he is being recognized for the magnitude of his remarkable generosity around the world.”

Committed to “giving while living,” Feeney transferred nearly all his and his family’s assets to The Atlantic Philanthropies with the intent to give it all away during his lifetime. For the first 15 years, Feeney swore The Atlantic Philanthropies staff to secrecy and gave anonymously, until he was outed by Forbes Magazine. By 2016, Atlantic Philanthropies will close its books, having emptied its $7.5 billion coffers into the promising causes Feeney has carefully chosen over the years.

“Chuck Feeney has changed the face of philanthropy,” said Hawgood. “Giving while living substantially increases the value of a gift both emotionally and financially. The working relationship we have with Chuck has been a source of inspiration for us all, personally and professionally.”

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Heart muscle can regenerate itself in very limited amounts


UCLA researchers are first to directly measure division of cardiomyocytes.

Reza Ardehali, UCLA

Researchers from UCLA’s Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research are the first to directly measure the division of heart muscle cells, proving that while such division is very rare, it does occur.

The study, conducted by assistant professor of cardiology Dr. Reza Ardehali and colleagues, resolves a recent controversy over whether the heart muscle has the power to regenerate itself. The findings are also important for future research that could lead to the regeneration of heart tissue to repair damage caused by disease or heart attack.

The findings were published May 29 in Proceedings of the National Academy of Sciences.

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UC Davis Medical Center receives echocardiography accreditation


Accreditation a ‘seal of approval’ for patients.

UC Davis Medical Center has been granted a three-year term of accreditation in echocardiography in three areas by the Intersocietal Accreditation Commission (IAC).

The three areas for which the IAC granted accreditation are adult stress, adult transesophageal and adult transthoracic.

Accreditation by the IAC signifies that the medical center has undergone a thorough review of its operational and technical components by a panel of experts. The IAC grants accreditation only to those facilities that are found to be providing quality patient care, in compliance with national standards through a comprehensive application process including detailed case study review.

IAC accreditation is a “seal of approval” that patients can rely on as an indication that the facility has been carefully critiqued on all aspects of its operations considered relevant by medical experts in the field of echocardiography. When scheduled for an echocardiography procedure, patients are encouraged to ask about the accreditation status of the facility where their examination will be performed, and can learn more by visiting www.intersocietal.org/echo/main/patients.htm.

IAC accreditation is widely respected within the medical community, as illustrated by the support of the national medical societies related to echocardiography, which include physicians and sonographers. Echocardiography accreditation is required in some states and regions by the Centers for Medicare and Medicaid Services (CMS) and by some private insurers. However, patients should remain vigilant in making sure that their echocardiography procedures are performed within accredited facilities, because for many facilities accreditation remains a voluntary process.

Cardiovascular diseases are the No. 1 cause of death in the United States. On average, one American dies every 39 seconds of cardiovascular disease — disorders of the heart and blood vessels. The American Heart Association estimates that the direct and indirect cost for cardiovascular disease in the U.S. for 2010 was $503.2 billion.

Early detection of life threatening heart disorders and other diseases is possible through the use of echocardiography procedures performed within hospitals, outpatient centers and physicians’ offices. While these tests are helpful, there are many facets that contribute to an accurate diagnosis based on echocardiography testing. The skill of the echocardiography sonographer performing the examination, the type of equipment used, the background and knowledge of the interpreting physician and quality assurance measures are each critical to quality patient testing.

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Possible source of Kawasaki disease found


Deadly childhood condition may be triggered by aerosols from northeast China.

Jane Burns, UC San Diego

An international team of scientists, including researchers at the UC San Diego School of Medicine and Scripps Institution of Oceanography, report that the likely cause of Kawasaki disease in Japan is a windborne agent originating from northeast China, a region characterized by dense cereal croplands.

Kawasaki disease (KD) is the most common cause of acquired heart disease in children, most notably in Japan, though incidence rates are also rising in the United States and Western Europe. For decades, it has stubbornly resisted scientific explanation. The disease is difficult to diagnose and, without treatment, 25 percent of children with the condition develop coronary artery aneurysms – balloon-like bulges of heart vessels – that may eventually result in heart attacks, congestive heart failure or sudden death. Prevalence rates of KD are rising among children in Asia, the United States and Western Europe. Predictive models estimate that by 2020 one in every 1,600 adults in the U.S. will be affected by the disease.

First described in Japan in 1967 and named after its discoverer, Dr. Tomisaku Kawasaki, the cause of KD has eluded two generations of researchers. Dr. Jane C. Burns, professor and director of the Kawasaki Disease Research Center at the UC San Diego School of Medicine and Rady Children’s Hospital-San Diego, assembled an international team to help decipher the distinct seasonality of this devastating childhood illness.

Noting that the timing of KD outbreaks in Japan coincides with certain wind patterns from Asia, climate scientist Xavier Rodó and colleagues at the Catalan Institution for Research and Advanced Studies and the Catalan Institute of Climate Sciences, both in Barcelona, used computer models to simulate air currents and airborne particle transport for all days since 1977 with high numbers of KD cases in Japan, based on data compiled by Dr. Yoshikazu Nakamura and colleagues at Jichi Medical University in Japan. The modeling indicated that KD cases in many Japanese locations, both in and out of epidemic years, peaked only when winds originated from a densely-cultivated region in northeastern China characterized by vast cereal croplands.

In 2011, the Barcelona researchers equipped an aircraft based in Japan with a newly designed large-volume air-filtering device to collect aerosol samples. With help from Hiroshi Tanimoto and colleagues at the National Institute of Environmental Science in Tsukuba, Japan, the plane sampled at altitudes between two and three kilometers above Japan to avoid surface contaminants, and on days during the KD season when air currents originated only from northeastern China. Detailed microbiome analyses of the samples by Brent Williams and Dr. Ian Lipkinat Columbia University in New York City identified Candida species as the dominant airborne fungus, a finding not previously reported from other aerosol sampling campaigns in other regions of the globe. Candida is a genus of yeasts and the most common cause of diverse human fungal infections worldwide.

In their new PNAS paper, the multidisciplinary team of Rodó; Burns; Dan Cayan, a climate researcher at UC San Diego’s Scripps Institution of Oceanography; and co-authors in New York, Barcelona and Japan, say the new evidence suggests that the most likely cause of KD is a “preformed toxin or molecule” originating from northeastern China, possibly related to Candida, which has been linked to Kawasaki-like coronary artery vasculitis in mouse models.

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Different approaches needed to control cardiovascular risks for those with HIV


Study authors recommend greater emphasis on cardiology in HIV treatment, research.

Heejung Bang, UC Davis

Even if treated, hypertension and high cholesterol are common for people with human immunodeficiency virus (HIV), according to a new study from researchers at Mount Sinai St. Luke’s and Mount Sinai Roosevelt hospitals in New York and UC Davis.

The finding — published online in the Journal of Acquired Immune Deficiency Syndromes — persuaded the study authors to recommend greater emphasis on cardiology in HIV treatment and research.

“It is clearly important to add cardiology specialists to the care teams for patients with HIV,” said Heejung Bang, professor of public health sciences at UC Davis and senior author of the study. “We also need more research focused on identifying treatments that work in controlling heart disease and stroke risks for this patient population.”

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Children with Down syndrome have better heart surgery outcomes


Mortality rates for congenital heart disease repairs are lower in kids with Down syndrome.

Jacqueline Evans, UC Davis

Researchers at UC Davis Children’s Hospital have shown that children with Down syndrome have significantly better in-hospital survival rates after surgeries for congenital heart disease (CHD) than their genetically typical peers.

While post-surgical mortality rates for children with Down syndrome have been studied before, this is by far the most comprehensive effort to date. Using the Kids’ Inpatient Database (KID), the researchers looked at results from almost 80 different procedures, performed on more than 50,000 children across the United States during 2000, 2003, 2006 and 2009.

The overall in-hospital mortality rate for children with Down children was 1.9 percent as compared with 4.3 percent for children without Down syndrome. The paper was published in the journal Circulation: Cardiovascular Quality and Outcomes.

“We’ve known for some time that children with Down syndrome do better after certain procedures,” said lead author Jacqueline Evans, assistant professor at UC Davis Children’s Hospital. “But even when you correct for surgical risk, prematurity, the presence of a major non-cardiac structural abnormality and age at the time of surgery, children with Down syndrome have lower in-hospital mortality rates across a wide spectrum of repairs.”

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Researchers discover how high blood pressure damages the heart


Biological trigger found that makes heart beat stronger in response to higher blood pressure.

Ye Chen-Izu, UC Davis

The heart’s ability to adjust its contraction strength in response to increases in blood pressure can, when the condition becomes excessive, lead to arrhythmias and other serious heart conditions.

Now, a multidisciplinary research team at UC Davis has found a key biological trigger — a protein known as nitric oxide synthase, or NOS — that makes the heart beat stronger in response to higher blood pressure, along with a way to turn that trigger off when it becomes overactive.

“The heart is a robust pump that can compensate for short-term increases in blood pressure due to changes in physical and emotional conditions — like exercise or joy,” said study senior author Ye Chen-Izu, assistant professor of pharmacology and biomedical engineering at UC Davis. “But there is a darker side to that compensating system that could lead to life-threatening heart diseases. Our work opens up new avenues for preventing that outcome.”

Chen-Izu pulled together an interdisciplinary team of biophysicists, chemists, engineers, physiologists and cardiologists for a study of the biological system that controls contractility of the heart under mechanical stress such as that caused by high blood pressure. They put heart muscle cells from mice into a “cell-in-gel” system that simulates mechanical stress on cells. The system, which was developed by Chen-Izu and Kit Lam, chair of the UC Davis Department of Biochemistry and Molecular Medicine, is transparent, allowing changes at the molecular level to be observed as they occur in living cells through high-power microscopes.

A series of experiments showed that as mechanical stress increases, the release of calcium increases and strengthens heart contractions so it can pump harder against higher blood pressure. They identified NOS as the molecule that initially senses mechanical stress and creates nitric oxide, which activates ryanodine receptors that increase the calcium release.

The researchers also discovered that an isoform of NOS — neuronal nitric oxide synthase, or nNOS — was responsible for spontaneous calcium sparks that occurred when cells were supposed to rest, likely due to the buildup of nitric oxide from ongoing mechanical stress.

“Under conditions of heavy, persistent mechanical load, the heart’s fine-tuned calcium control system becomes unstable, causing irregular heartbeats,” said Chen-Izu, whose research focuses on the biomechanics and bioelectricity of heart disease. “This could explain why high blood pressure can increase arrhythmias, which may lead to sudden cardiac death, heart failure and stroke.”

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Injectable hydrogel for treating heart attacks licensed to startup


UC San Diego project will be among those presented at Research Expo on April 17.

UC San Diego bioengineer Karen Christman’s new injectable hydrogel, which is designed to repair damaged cardiac tissue following a heart attack, has been licensed to San Diego-based startup Ventrix Inc, which is planning the first human clinical trials of the technology. Christman is a co-founder of Ventrix.

In a 2013 study published in Science Translational Medicine, Christman reported the semi-solid, porous gel encourages cells to repopulate areas of damaged cardiac tissue and to preserve heart function. The hydrogel forms a scaffold to repair the tissue and increases cardiac muscle.

You can learn more about this technology at Research Expo on April 17, where Christman is one of six faculty speakers at the UC San Diego Jacobs School of Engineering event. Wang, an M.D./Ph.D. student in bioengineering, will present a poster explaining her research on how the hydrogel works to rebuild tissue in damaged hearts.

More than 200 forward-looking research projects will be presented. The annual event features cutting-edge research posters by engineering graduate students and their faculty advisors; ten-minute faculty talks; and a networking reception with faculty, students, industry partners and alumni.

Research Expo will be held on Thursday, April 17, from 2-6p.m. Register today.

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Early cardiac risks linked to worse cognitive function in middle age


Blood pressure, glucose, cholesterol in 18- to 30-year-olds predicts decline.

Kristine Yaffe, UC San Francisco

Young adults with such cardiac risk factors as high blood pressure and elevated glucose levels have significantly worse cognitive function in middle age, according to a new study by dementia researchers at UC San Francisco.

The findings bolster the view that diseases like Alzheimer’s develop over an individual’s lifespan and may be set in motion early in life. And they offer hope that young adults may be able to lower their risk of developing dementia through diet and exercise, or even by taking medications.

“These cardiovascular risk factors are all quite modifiable,” said senior author Kristine Yaffe, M.D., a professor in the departments of psychiatry, neurology, and epidemiology and niostatistics at UCSF, who holds the Roy and Marie Scola Endowed Chair in Psychiatry.

“We already know that reducing these risk factors in midlife can decrease the risk of dementia in old age,” continued Yaffe, who is also chief of geriatric psychiatry and director of the Memory Disorders Clinic at the San Francisco VA Medical Center. “If it turns out that the damage begins before middle age, we may need to expand our focus and work on reducing heart disease risks in earlier stages of life.”

The study, published today (March 31) in Circulation, examines data from more than 3,300 18- to 30-year-olds in the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began enrolling thousands of participants nationwide in 1985 to understand how heart disease develops in black and white adults.

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