BMN Blog

The Alabama Pediatric and Congenital Heart Center at Children’s of Alabama continues to achieve unsurpassed results and bring the latest technology and procedures to children and adults with congenital heart disease in Alabama and throughout the Southeast. Despite the challenges of the COVID pandemic, the volume of patients has remained steady, demanding adaptability among the 300 members of the Heart Center.

As a cardiologist, I have become accustomed to diagnosing and treating patients with congestive heart failure (CHF), seeing their leg edema, prescribing lasix, doing an evaluation en route to hopefully watching their recovery. 

It took a trip to a textile store… yes, a textile store. It was late 1940s, and Michael DeBakey (who would later become the most innovative and most distinguished cardiovascular surgeon in the world) was thinking how to address a major clinical need for a deadly disease – ruptured aortic aneurysm.

Albert Einstein just died of one, with echoes of his sudden death reverberating in the world and in the medical community. Einstein consulted doctors, including DeBakey, but no treatment options existed at that time.

It is the most complex cardiothoracic surgery performed in newborns, one in which surgeons literally construct a new, larger aorta for babies born with hypoplastic left heart syndrome (HLHS). Called the Norwood procedure, it must be done within the infant’s first week of life, followed by a second surgery when the baby is three to six months, and a third at age four or five.

September is Atrial Fibrillation (AF) Awareness Month, which reminds us that even in the midst of the pandemic, cardiovascular and other diseases progress unabated. As a result, we welcome this opportunity to review some of the important approved developments in AF therapeutics and assess their validity when subjected to scientific scrutiny.

The Brookwood Baptist system recently incorporated state-of-the art Cardiac Magnetic Resonance (CMR) imaging for diagnosis patients with complex cardiovascular conditions. The technique allows for the acquisition of three-dimensional multi-planar moving images of the heart, blood vessels and associated organs without the need for ionizing radiation in about one 15-minute session.

Transcatheter aortic valve replacement, or TAVR, is a minimally invasive alternative to open heart surgery for patients who require replacement of their aortic valve due to severe aortic stenosis. Although previously available only to patients at high or intermediate surgical risk, in August the Food and Drug Administration approved both of the latest-generation TAVR valves for use in patients at low surgical risk. This is a large group of patients who are typically younger and/or more active than those at higher risk. Until now these patients' only option was open heart surgery.

Atrial fibrillation (AFIB), a condition in which the heart fires so rapidly that the upper chambers quiver instead of beating in a normal rhythmic pattern, is the now most common arrhythmia condition worldwide and is recognized as a global health problem with its burden of morbidity and mortality resulting from embolic stroke. AFIB is expected to double by 2030.

Peripheral arterial disease, or PAD, is a disease process in which plaque buildup causes the arteries to narrow, resulting in reduced blood flow to the limbs. This can lead to a variety of medical emergencies: Claudication, stroke, uncontrolled hypertension, and possibly amputation.

In 2012, Transcatheter Aortic Valve Replacement (TAVR) became commercially available in the US to treat high-risk patients with severe aortic stenosis. It offered effective, minimally invasive, and often lifesaving treatment to tens of thousands of patients who previously had no option for aortic valve replacement surgery.

It’s been more than twenty years since the 1997 revisions to Evaluation and Management guidelines, which focus mainly on physical examination. The 2019 proposed changes provide practitioners a choice in the basis of documenting E/M visits; alleviate the burdens, and focus attention on alternatives that better reflect the current practice of medicine.  The implementation of electronic medical records has allowed providers to document more information, yet repetitive templates, cloning, and other workflows have pushed the envelope on compliance in documenting the traditional elements of the visit.

Over 10 million people in the Unites States and over 200 million worldwide have peripheral arterial disease (PAD).¹ Critical limb ischemia (CLI), defined as ischemic rest pain or tissue loss resulting from arterial insufficiency, affects approximately 1% of the adult population, or 10% of patients with PAD.² Further increasing the impact of CLI is the poor prognosis it carries. Major amputation occurs in 33-67% of patients with ischemic tissue loss at 4 years.^3,4 Mortality at 2 years in CLI patients is as high as 40%, and appears to be even higher in those with tissue loss. The vast majority of these deaths are due to cardiac events, cardiovascular disease, and cancer, rather than PAD.^4,5

Where are the old (and not so good) days when a patient with myocardial infarction was staying in hospital bed for a week?