Gosta Pettersson

Metropolitan Heart and Vascular Institute, Minneapolis, Minnesota, United States

Are you Gosta Pettersson?

Claim your profile

Publications (126)609.25 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Two cases of Shone syndrome with severe mitral and aortic valve problems and pulmonary hypertension were referred for heart–lung transplantation. Severely elevated pulmonary vascular resistance (PVR) was confirmed as was severe periprosthetic mitral and aortic regurgitation. Based on the severity of the valve lesions in both patients, surgery was decided upon and undertaken. Both experienced early pulmonary hypertensive crises, one more than the other, that gradually subsided, followed by excellent recovery and reversal of pulmonary hypertension and PVR. These cases illustrate Braunwald’s concept that pulmonary hypertension secondary to left-sided valve disease is reversible.
    Full-text · Article · Jan 2016 · World Journal for Pediatric and Congenital Hearth Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Unicuspid aortic valve is an important subset of bicuspid aortic valve, and knowledge regarding its aortopathy pattern and surgical outcomes is limited. Our objectives were to characterize unicuspid aortic valve patients, associated aortopathy, and surgical outcomes. Methods: From January 1990 to May 2013, 149 adult unicuspid aortic valve patients underwent aortic valve replacement or repair for aortic stenosis (n = 13), regurgitation (n = 13), or both (n = 123), and in 91 (61%) the aortic valve operation was combined with aortic repair. Data were obtained from the Cardiovascular Information Registry and medical record review. Three-dimensional imaging analysis was performed from preoperative computed tomography and magnetic resonance imaging scans. The Kaplan-Meier method was used for survival analysis. Results: Patients had a mean maximum aortic diameter of 44 ± 8 mm and variably involved the aortic root, ascending, or arch, or both. Patients with valve operations alone were more likely to be hypertensive (p = 0.01) and to have severe aortic stenosis (p = 0.07) than those who underwent concurrent aortic operations. There were no operative deaths, strokes, or myocardial infarctions. Patients undergoing aortic repair had better long-term survival. Estimated survival at 1, 5, and 10 years was 100%, 100%, and 100% after combined operations and was 100%, 88%, and 88% after valve operations alone (p = 0.01). Conclusions: Patients with a dysfunctional unicuspid aortic valve frequently present with an ascending aneurysm that requires repair. Combined aortic valve operations and aortic repair was associated with significantly better long-term survival than a valve operation alone. Further study of this association may direct decisions about timing of surgical intervention.
    Full-text · Article · Oct 2015 · The Annals of thoracic surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic Q fever caused by Coxiella burnetii is uncommon in the United States and is most often associated with infective endocarditis. We present a 52-year-old woman with a history of aortic valve replacement and rheumatoid arthritis treated with Etanercept with chronic Q fever manifesting as prosthetic valve infective endocarditis. Explanted valve tissue showed organisms confirmed to be Coxiella burnetii by PCR (Polymerase chain reaction) sequencing. She subsequently reported consumption of unpasteurized cow milk which was the likely source of C. burnetii. She continues to do well 6 months after valve replacement on oral doxycycline and hydroxychloroquine.
    Preview · Article · Sep 2015 · IDCases
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bioprosthetic valves are increasingly implanted, with generally consistent and durable results. Early bioprosthetic valve failure is uncommon, and most clinicians are unfamiliar with the spectrum of early structural complications involving bioprostheses. In this review, the authors organize causes of early bioprosthetic valve failure according to possible pathogenesis, demonstrate the correlation between echocardiographic and anatomic findings, and discuss potential treatments. First, they address early bioprosthetic valve stenosis secondary to thrombosis. Next, they discuss excessive pannus formation, a hitherto rarely described cause of early bioprosthetic valve failure. Finally, the authors address early structural valve deterioration mediated by calcification or primary tears. Illustrative examples with relevant echocardiographic and operative findings are provided. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
  • [Show abstract] [Hide abstract]
    ABSTRACT: Infective endocarditis (IE) requiring surgical intervention in patients who actively inject drugs poses treatment challenges. Decisions regarding the need for operation are affected by concern for relapse of IE from ongoing injection drug use (IDU). The purpose of this study was to evaluate the effect of active IDU on outcomes after operation for IE. All patients with IE surgically treated at Cleveland Clinic from July 1, 2007 to July 1, 2012 were identified from the Cleveland Clinic Infective Endocarditis Registry and the Cardiovascular Information Registry. Of 536 patients operated on for IE during the study period, 41 (8%) actively injected drugs. The primary outcome of the study was death or reoperation for IE. Patients who injected drugs had poorer survival free of reoperation, and the risk of events varied with time. In a multivariable Cox proportional hazards model, using time-dependent covariates, IDU was associated with a higher hazard of death or reoperation between 90 and 180 days (hazard ratio [HR], 9.8; 95% confidence interval [CI], 2.7-35.3) but not before 90 days (HR, 0.38; 95% CI, 0.05-3.1) or after 180 days (HR, 1.8; 95% CI, 0.8-3.8). Among patients who injected drugs, reoperation and death contributed equally to the outcome, whereas among patients who did not inject drugs, reoperation for IE was far less common. Between 3 and 6 months after operation for IE, patients who inject drugs have a hazard of death or reoperation that is about 10 times that of patients who do not inject drugs. Before and after, the HRs are much smaller and not statistically significant. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · The Annals of thoracic surgery

  • No preview · Article · Jun 2015 · JACC. Cardiovascular imaging
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Large Vessel Vasculitides (LVV) are a group of autoimmune diseases characterized by injury and anatomic modifications of large vessels including aorta and its branch vessels. Disease etiology is unknown. Using samples from aorta root, ascending aorta and aorta arch surgical specimens, we sought to identify antigen targets within affected vessel walls in patients with LVV, including giant cell arteritis, Takayasu's arteritis and isolated focal aortitis. Methods Thoracic aorta aneurysm specimens and autologous blood were acquired from consenting patients in whom aorta reconstruction procedures were performed. Aorta proteins were extracted from patients with both LVV and age-, race- and gender-matched disease controls with non-inflammatory aneurysms. A total of 108 sera samples including LVV, matched controls, controls with antinuclear antibodies, different forms of vasculitis and sepsis were tested. Results Investigating 108 sera samples and 22 aortic tissues we found that 78% patients with LVV produce antibodies to 14-3-3 proteins in the aortic wall, whereas controls are less likely (6.7%) to do so. LVV patient sera contained autoantibody sufficient to immunoprecipitate 14-3-3 protein(s) from aortic lysates. Three out of seven isoforms of 14-3-3 were found to be upregulated in LVV aortas, and two isoforms (epsilon and zeta) found to be antigenic in LVV. Conclusion In this study, which is the first to utilize sterile, snap frozen thoracic aorta biopsies to identify autoantigens in LVV, we discovered that 78% patients with LVV had antibody reactivity to 14-3-3 protein(s). The precise role of these antibodies and 14-3-3 proteins in LVV pathogenesis deserves further study. This article is protected by copyright. All rights reserved. © 2015 American College of Rheumatology.
    Full-text · Article · Apr 2015 · Arthritis and Rheumatology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Lack of invasiveness of surgically treated right-sided (RS) Infective Endocarditis (IE) compared with left-sided IE is not well recognized.
    Full-text · Conference Paper · Apr 2015
  • Kisha Beg · Larry A Latson · Gosta Pettersson · Lee Wallace · Athar M Qureshi
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac erosions may occur in a small percentage of patients after device closure of atrial septal defects. These devices have to be explanted. We report an aorta-to-left atrial fistula after surgical explantation of the device eight years after implant for access to mitral valve repair. The importance of realizing the risk of subclinical cardiac erosion and subsequent fistula development after device removal is discussed. © The Author(s) 2014.
    No preview · Article · Apr 2015 · World Journal for Pediatric and Congenital Hearth Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Quadricuspid aortic valve (QAV) morphology is rare (0.008%) but often dysfunctional, manifesting early or late in life. No large series have been evaluated. Current objectives are to characterize these patients, and assess repair possibilities and outcomes. Methods: From 1989 to 2010, a total of 19,722 patients underwent aortic valve surgery at Cleveland Clinic. Thirty-one (0.0016%) patients had dysfunctional QAV and underwent repair or replacement for moderate to severe aortic regurgitation (n = 21), stenosis (n = 5), or both (n = 4). One additional patient with functional QAV required excision of fibroelastoma. The mean age was 58 ± 18 years. Ascending aortic diameter was ≥4 cm in 13 (42%) patients, and 7 required ascending repair (mean diameter: 4.8 ± 0.4 cm). Three patients had anomalous origin of coronary artery, and 1 required repair. Results: The aortic valve was repaired in 7 (23%) patients and replaced in 23 (73%). The decision of which procedure to use was based on intraoperative findings. The Ross procedure was performed in 1 patient who had endocarditis. Most patients in the repair group had leaflet prolapse that was repaired with accessory cusp excision and commisuroplasty. The mean gradient after repair was 14 ± 5 mm Hg. Bioprostheses were used in all replacements; median valve size was 25 mm (range: 21-27 mm). No operative mortality occurred. One patient suffered nonpermanent stroke after aortic valve replacement. There was no myocardial infarction, renal failure, respiratory failure, or reoperation for bleeding. The median follow-up time was 38 months; 1 patient required replacement 13 years after previous repair for recurrent regurgitation and stenosis. Conclusions: Quadricuspid aortic valve dysfunction includes both regurgitation and stenosis; repair may be feasible in some patients with regurgitation, but most require replacement. Aortic root and ascending dilatation are frequent, and further studies are needed.
    Full-text · Article · Mar 2015 · The Journal of thoracic and cardiovascular surgery
  • Michael Z Tong · Douglas R Johnston · Gosta B Pettersson
    [Show abstract] [Hide abstract]
    ABSTRACT: Long-term survival of lung-transplant patients is 53% at 5 years and 31% at 10 years, lagging behind the survival of other solid organs recipients. Modern lung transplantation has seen a shift from early mortality and complications related to the bronchial anastomosis to late mortality secondary to progressive organ dysfunction; the complex disease process may include elements of bronchiolitis obliterans syndrome, obliterative bronchiolitis, chronic rejection, or chronic lung allograft dysfunction. Initial goals of bronchial artery revascularization include reducing the incidence of airway ischemia and improving bronchial healing. Benefits of restored bronchial artery circulation may extend beyond bronchial healing alone.
    No preview · Article · Feb 2015 · Thoracic Surgery Clinics
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: -Prior transcriptional studies of atrial fibrillation (AF) have been limited to specific transcripts, animal models, chronic AF, right atria, or small samples. We sought to characterize the left atrial transcriptome in human AF to distinguish changes related to AF susceptibility and persistence. -Left atrial appendages from 239 patients stratified by coronary artery disease, valve disease and AF history (No AF history, AF history in sinus rhythm at surgery, AF history in AF at surgery) were selected for genome-wide mRNA microarray profiling. Transcripts were examined for differential expression with AF phenotype group. Enrichment in differentially expressed genes was examined in 3 gene set collections: A transcription factor (TF) collection, defined by shared conserved cis-regulatory motifs; a miRNA collection, defined by shared 3'UTR motifs; and a molecular function collection, defined by shared Gene-Ontology molecular function. AF susceptibility was associated with decreased expression of the targets of CREB/ATF family, HSF1, ATF6, SRF, and E2F1 TFs. Persistent AF activity was associated with decreased expression in genes and gene sets related to ion channel function consistent with reported functional changes. -AF susceptibility was associated with decreased expression of targets of several transcription factors related to inflammation, oxidation, and cellular stress responses. In contrast, changes in ion channel expression were associated with AF activity, but were limited in AF susceptibility. Our results suggest that significant transcriptional remodeling marks susceptibility to AF, while remodeling of ion channel expression occurs later in the progression or as a consequence of AF.
    Full-text · Article · Dec 2014 · Circulation Arrhythmia and Electrophysiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Despite increasing efforts to prevent infection, the prevalence of hospital-associated Clostridium difficile infections (CDI) is increasing. Heightened awareness prompted this study of the prevalence and morbidity associated with CDI after cardiac surgery. Methods: A total of 22,952 patients underwent cardiac surgery at Cleveland Clinic from January 2005 to January 2011. CDI was diagnosed by enzyme immunoassay for toxins and, more recently, polymerase chain reaction (PCR) testing. Hospital outcomes and long-term survival were compared with those of the remaining population in propensity-matched groups. Results: One hundred forty-five patients (0.63%) tested positive for CDI at a median of 9 days postoperatively, 135 by enzyme immunoassay and 11 by PCR. Its prevalence more than doubled over the study period. Seventyseven patients (48%) were transfers from outside hospitals. Seventy-three patients (50%) were exposed preoperatively to antibiotics and 79 (56%) to proton-pump inhibitors. Patients with CDI had more baseline comorbidities, more reoperations, and received more blood products than patients who did not have CDI. Presenting symptoms included diarrhea (107; 75%), distended abdomen (48; 34%), and abdominal pain (27; 19%). All were treated with metronidazole or vancomycin. Sixteen patients (11%) died in hospital, including 5 of 10 who developed toxic colitis; 3 of 4 undergoing total colectomy survived. Among matched patients, those with CDI had more septicemia (P<.0001), renal failure (P ¼ .0002), reoperations (P<.0001), prolonged postoperative ventilation (P<.0001), longer hospital stay (P<.0001), and lower 3-year survival, 52% versus 64% (P ¼ .03), than patients who did not have CDI. Conclusions: Although rare, the prevalence of CDI is increasing, contributing importantly to morbidity and mortality after cardiac surgery. If toxic colitis develops, mortality is high, but colectomy may be lifesaving. (J Thorac Cardiovasc Surg 2014;148:3157-65)
    Full-text · Article · Dec 2014 · Journal of Thoracic and Cardiovascular Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cerebral angiography is an invasive procedure utilized without supporting guidelines in preoperative evaluations of infective endocarditis (IE). It is used to identify mycotic intracranial aneurysm, which is suspected to increase the risk of intracranial bleeding during cardiac surgery. Our objectives were to: (1) assess the utility of cerebral angiography by determining which subset of IE patients benefit from its performance; and (2) identify clinical and noninvasive screening tests that can preclude the need for invasive cerebral angiography. Retrospective analysis was performed of all patients treated surgically for IE from 7/2007 to 1/2012 and discharged with medical treatment for IE from 7/2007 to 7/2009 presenting to a large academic center. Of the 151 patients who underwent cerebral angiography, mycotic aneurysm was identified in seven (prevalence=4.6%; 95% CI 2.3-9.3%). Five had viridans group streptococci as the causative IE microorganism (p=0.0017). Noninvasive imaging and particularly absence of intracranial bleed on magnetic resonance imaging conveys a negative predictive value (NPV) of 0.977 (95% CI 0.879-0.996). Absence of a focal neurologic deficit or altered mental status convey a NPV of 0.990 (95% CI 0.945-0.998) and 0.944 (95% CI 0.883-0.974), respectively. Clinical suspicion for mycotic aneurysm and thus utilization of cerebral angiography is likely necessary only in the setting of acute neurologic deficits and when noninvasive imaging demonstrates acute intracranial bleed. A novel association between viridans group streptococci and intracranial mycotic aneurysm is demonstrated.
    No preview · Article · Oct 2014 · Vascular Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Testing excised valves in surgically treated infective endocarditis (IE) patients provides an opportunity to identify the microbial etiology of IE. Microbial sequencing (universal bacterial, mycobacterial, or fungal polymerase chain reaction followed by DNA sequencing) of valves can identify microorganisms accurately, but the value it adds beyond information provided by blood and valve cultures has not been adequately explored. Three hundred fifty-six patients who underwent surgery for active IE from January 1, 2010, to January 1, 2013, were identified from our cardiovascular information registry and outpatient parenteral antibiotic therapy registry. Their records were reviewed to identify 174 patients whose valves were sent for sequencing. The microbial etiology of IE was defined using comprehensive clinical, pathologic, and microbiological criteria. Blood culture, valve culture, and valve sequencing were examined to determine how frequently they identified the definitive cause of IE. Of the 174 patients, 162 (93%) had acute inflammation on histopathologic examination of their valves. Valve sequencing was significantly more sensitive than valve culture in identifying the causative pathogen (90% versus 31%, p < 0.001), and yielded fewer false positive results (3% versus 33%, p <0.001). The pathogen would not have been identified in 25 patients (15%) had it not been for valve sequencing. All the value provided by sequencing was attributable to bacterial DNA sequencing; mycobacterial and fungal sequencing provided no additional information beyond that provided by blood culture, histopathology, and valve culture. Valve sequencing, not valve culture, should be considered the primary test for identifying bacteria in excised cardiac valves. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Oct 2014 · The Annals of Thoracic Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Rifampin is recommended in the treatment regimen for staphylococcal prosthetic valve endocarditis (PVE), and for staphylococcal native valve endocarditis (NVE) treated with placement of prosthetic material at surgery. The evidence base for this is scant, and some clinicians opt to forgo rifampin. The purpose of this study was to examine if treatment with rifampin in patients with surgically-treated staphylococcal infective endocarditis (IE) results in better outcomes. Methods: Patients operated for staphylococcal IE from April 1, 2008 to July 1, 2012 were identified from our institution’s IE registry. Treatment was defined as at least 3 days of rifampin post-op. The propensity to receive rifampin was calculated in a model that included NVE vs PVE, Staphylococcus species, left side involvement, invasive disease (extending beyond annulus), positive valve culture, past history of IE, presence of a pacemaker/defibrillator, end-stage renal disease, hepatitis C, and concomitant medications that could interact with rifampin. Cox proportional hazards regression was used to compare a composite outcome of death or reoperation for IE, between patients treated and not treated with rifampin, adjusted for age, sex and propensity to receive rifampin. Results: 189 patients were identified. Mean age was 56 yrs, 66% were male, 50% had PVE, 60% had S. aureus or lugdunensis infection, 89% had left side involvement, and 57% had invasive disease. 51 (27%) received at least 3 days of rifampin post-op. The median time to event was 979 days (IQR 191 - 1918). Rifampin treatment was associated with PVE (OR 2.93, p 0.001), left side involvement (OR 3.91, p 0.04), invasive disease (OR 2.26, p 0.02), and concomitant potentially interacting medications (OR 2.13, p 0.04). Patients treated with rifampin had a similar hazard of death or reoperation for IE as those not treated (HR 1.09, 95% CI 0.63 – 1.83), after adjusting for age, sex and propensity to receive rifampin. Results were similar when treatment was defined as at least one dose of rifampin, any pre-op rifampin, or rifampin at hospital discharge. Conclusion: Among patients with surgically treated staphylococcal IE there was insufficient evidence to claim a reoperation-free survival benefit from treatment with rifampin.
    No preview · Conference Paper · Oct 2014

  • No preview · Article · Oct 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Surgical aortic valve replacement is challenging in patients with severe aortic calcification. Some patients undergo sternotomy and have the operation aborted because of intraoperative discovery of severe calcification. Hypothermic circulatory arrest and transcatheter aortic valve replacement offer clampless treatment options for aortic stenosis. The study objectives are to characterize patients who are referred after sternotomy was aborted for porcelain aorta and to describe the treatment outcomes. From 2001 to 2013, 19 patients presented after attempt at surgical aortic valve replacement was aborted because of porcelain aorta. Patients presented with aortic stenosis (n = 16), regurgitation (n = 1), or both (n = 2). Off-pump coronary bypass was performed in 10 patients. At the Cleveland Clinic, patients underwent surgical aortic valve replacement (n = 7) or transcatheter aortic valvve replacement (n = 12). The median interval between aborted aortic valve replacement and definitive treatment was 9.6 months. The mean age was 74 ± 11 years. The mean transvalvular gradient was 51 ± 18 mm Hg, and area was 0.6 cm(2). Axillary cannulation was used in all patients undergoing surgical aortic valve replacement, but only 4 required circulatory arrest. The transcatheter aortic valve replacement approach was transfemoral (n = 5), transapical (n = 6), or transaortic (n = 1). The mean postoperative gradient was 13 ± 4 mm Hg. There was no mortality, stroke, renal failure, or reoperation for bleeding. One patient required a second valve implantation for paravalvular leak. The median hospital length of stay was 8 days. Five late noncardiac deaths occurred at a median follow-up of 16 months. Both surgical aortic valve replacement and transcatheter aortic valve replacement are safe and effective options after aborted sternotomy in patients with porcelain aorta who are referred to a high-risk valve center. Procedure selection may be tailored to individual patients on the basis of aortic morphology and comorbidities. Patients with aortic stenosis at risk for calcific aortic disease should be screened with cross-sectional imaging preoperatively. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Sep 2014 · Journal of Thoracic and Cardiovascular Surgery
  • Michael Z Tong · Douglas R Johnston · Gosta B Pettersson
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of review: Current results of lung transplantation still lag behind those of other solid-organ transplants. Although bronchial dehiscence was the main cause of early mortality in the past, modern-day operative techniques and immunosuppression regiments have decreased, but not eliminated, this complication. Current barriers to long-term survival are chronic lung allograft dysfunction and infection. Bronchial artery revascularization was effective in decreasing bronchial anastomotic complications, but it was largely abandoned because of technical challenges. Recent findings: Long-term follow-up in patients with bronchial artery revascularization has shown a survival advantage compared with the standard lung transplant technique. Recent data also show decreased infection, decreased early rejection and decreased bronchiolitis obliterans syndrome, in addition to confirming the known advantages in bronchial healing. Modifications of the technique have also made bronchial artery revascularization feasible in the pediatric population. Summary: Bronchial artery revascularization, although initially designed for bronchial healing, has clinical advantages that extend long term, including survival, infection and decreased graft dysfunction. Its usage in lung transplantation needs to be revisited.
    No preview · Article · Aug 2014 · Current Opinion in Organ Transplantation
  • Source

    Full-text · Conference Paper · Aug 2014

Publication Stats

2k Citations
609.25 Total Impact Points

Institutions

  • 2010-2014
    • Metropolitan Heart and Vascular Institute
      Minneapolis, Minnesota, United States
  • 2007-2014
    • Cleveland Clinic Laboratories
      Cleveland, Ohio, United States
  • 2004-2014
    • Cleveland Clinic
      • • Department of Cardiovascular Medicine
      • • Department of Thoracic and Cardiovascular Surgery
      Cleveland, Ohio, United States
  • 2013
    • Lerner Research Institute
      • Department of Cellular and Molecular Medicine
      Cleveland, Ohio, United States