Vera H Rigolin

Northwestern University, Evanston, Illinois, United States

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Publications (48)

  • [Show abstract] [Hide abstract] ABSTRACT: Background: Elimination of the left atrial appendage (LAA) attempts to reduce stroke in patients with atrial fibrillation (AF). A retrospective review suggests that various surgical techniques are often unsuccessful and may leave a stump or gap. In a pilot study, we prospectively evaluated 3 surgical techniques with long-term follow up to define effectiveness. Methods: At a single institution, 28 patients undergoing concomitant AF surgery were randomized prospectively into 1 of 3 techniques of LAA elimination: internal suture ligation (IL), external stapled excision (StEx), and surgical excision (SxEx). The success of LAA elimination was assessed by transesophageal echocardiography (TEE) in all patients at the time of surgery. Failure of LAA closure consisted of either a stump (residual appendage tissue >1 cm in maximum length) or a gap (persistent flow between the left atrium [LA] and the LAA). Failure was treated intraoperatively when recognized. Late follow-up was obtained using a TEE at a mean of 0.4 years in 21/28 (75%) of patients. Results: Early failure was recognized and treated in 1 patient in the IL group (13%), 6 patients in the StEx group (60%), and 2 patients in the SxEx group (20%) (P = .06). On follow-up TEE, 4 of 7 patients in the IL group (57%) had developed gaps, 3 of whom (43%) with greater than mild flow. No patients in the StEx or SxEx groups had a gap (P = .03). In late follow-up, 1 of 7 patients in the IL group (14%) had a stump, compared with 2 of 8 (25%) in the StEx group and 3 of 6 (50%) in the SxEx group (P = .35). The overall failure rate was 57%: 5 of 8 (63%) in the IL group, 6 of 10 (60%) in the StEx group, and 5 of 10 (50%) in the SxEx group (P = .85). No patient had a stroke at any time during follow-up. Conclusions: LAA elimination is often incomplete and goes undetected. If the LAA is eliminated at the time of surgery, then TEE should be used intraoperatively to assess effectiveness and reintervention performed if warranted. Late assessment for completeness of closure should be considered before cessation of anticoagulation until more effective LAA techniques can be developed.
    Article · Jun 2016 · The Journal of thoracic and cardiovascular surgery
  • Vera H. Rigolin
    Article · Jun 2016 · JACC. Cardiovascular imaging
  • Nicholas M. Furiasse · Todd Kiefer · Sanjiv Shah · [...] · Vera Rigolin
    Article · Apr 2016 · Journal of the American College of Cardiology
  • Article · Mar 2016 · JACC Cardiovascular Imaging
  • [Show abstract] [Hide abstract] ABSTRACT: Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a “coronary risk equivalent,” implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data.
    Article · Feb 2016 · JACC Cardiovascular Imaging
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    [Show abstract] [Hide abstract] ABSTRACT: Paravalvular regurgitation is a known complication after transcatheter and sutureless aortic valve replacement. Paravalvular regurgitation also may develop in patients undergoing percutaneous mitral valve replacement. There are few studies on contemporary surgical valve replacement for comparison. We sought to determine the contemporary occurrence of paravalvular regurgitation after conventional surgical valve replacement. We performed a single-center retrospective database review involving 1774 patients who underwent valve replacement surgery from April 2004 to December 2012: aortic in 1244, mitral in 386, and combined aortic and mitral in 144. Follow-up echocardiography was performed in 73% of patients. Patients with endocarditis were analyzed separately from noninfectious paravalvular leaks. Statistical comparisons were performed to determine differences in paravalvular regurgitation incidence and survival. During follow-up, 1+ or greater (mild or more) paravalvular regurgitation occurred in 2.2% of aortic cases and 2.9% of mitral cases. There was 2+ or greater (moderate or more) paravalvular regurgitation in 0.9% of aortic and 2.2% of mitral cases (P = .10). After excluding endocarditis, late noninfectious regurgitation 2+ or greater was detected in 0.5% of aortic and 0.4% of mitral cases (P = .93); there were no reoperations or percutaneous closures for noninfectious paravalvular regurgitation. In an academic medical center, the overall rate of paravalvular regurgitation is low, and late clinically significant noninfectious paravalvular regurgitation is rare. The benchmark for paravalvular regurgitation after conventional valve replacement is high and should be considered when evaluating patients for transcatheter or sutureless valve replacement. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
    Full-text Article · Jun 2015 · The Journal of thoracic and cardiovascular surgery
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    [Show abstract] [Hide abstract] ABSTRACT: Gender disparities in short- and long-term outcomes have been documented in cardiac and valvular heart surgery. However, there is a paucity of data regarding these differences in the bicuspid aortic valve (BAV) population. The aim of this study was to examine gender-specific differences in short- and long-term outcomes after surgical aortic valve (AV) replacement in patients with BAV. A retrospective analysis was performed in 628 consecutive patients with BAV who underwent AV surgery from April 2004 to December 2013. To reduce bias when comparing outcomes by gender, propensity score matching obtained on the basis of potential confounders was used. Women with BAV who underwent AV surgery presented with more advanced age (mean 60.7 ± 13.8 vs 56.3 ± 13.6 years, p <0.001) and less aortic regurgitation (29% vs 44%, p <0.001) and had a higher risk for in-hospital mortality (mean Ambler score 3.4 ± 4.4 vs 2.5 ± 4.0, p = 0.015). After propensity score matching, women received more blood products postoperatively (48% vs 34%, p = 0.028) and had more prolonged postoperative lengths of stay (median 5 days [interquartile range 5 to 7] vs 5 days [interquartile range 4 to 6], p = 0.027). Operative, discharge, and 30-day mortality and overall survival were not significantly different. In conclusion, women with BAV who underwent AV surgery were older, presented with less aortic regurgitation, and had increased co-morbidities, lending higher operative risk. Although women received more blood products and had significantly longer lengths of stay, short- and long-term outcomes were similar. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text Article · Apr 2015 · The American journal of cardiology
  • Nishath Quader · Charles J Davidson · Vera H Rigolin
    [Show abstract] [Hide abstract] ABSTRACT: There is considerable interest in percutaneous closure of perivalvular leaks without the need for repeat surgery. Successful percutaneous closure of these defects requires extensive planning and coordination before and during the procedure. However, there is no standardized description of valve pathology in the presence of a prosthetic valve, which adds to the challenge of communication. Transesophageal echocardiography is ideally suited to guide percutaneous mitral valve procedures, because of the proximity of the mitral valve to the esophagus. Successful percutaneous procedures of the mitral valve require teamwork. Both the interventionalist and the echocardiographer must have great familiarity with mitral valve anatomy, structure, and function, and they must know how to effectively communicate with each other. The authors review the relevant periprocedural mapping of the mitral valve and provide guidance to echocardiographers and interventionalists on effective ways to communicate during percutaneous perivalvular mitral leak closures to accomplish a successful outcome. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
    Article · Mar 2015 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    Nishath Quader · Vera H Rigolin
    [Show abstract] [Hide abstract] ABSTRACT: Mitral regurgitation may develop when the leaflets or any other portion of the apparatus becomes abnormal. As the repair techniques for mitral valve disease evolved, so has the need for detailed and accurate imaging of the mitral valve prior to surgery in order to better define the mechanism of valve dysfunction and the severity of regurgitation. In patients with significant mitral valve disease who require surgical intervention, multiplane transesophageal echocardiogram (TEE) is invaluable for surgical planning. However, a comprehensive TEE in a patient with complex mitral valve disease requires great experience and skill. There is evidence to suggest that 3D echocardiography can overcome some of the limitations of 2D multiplane TEE and thus is crucial in evaluation of patients undergoing mitral valve surgery. In the following sections, we review some of the crucial 2D and 3D echo images necessary for evaluation of MR based on the Carpentier classification.
    Full-text Article · Oct 2014 · Cardiovascular Ultrasound
  • [Show abstract] [Hide abstract] ABSTRACT: Ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HC) has been shown to reduce left ventricular (LV) outflow tract (LVOT) gradient and improve symptoms, although little data exist regarding changes in left atrial (LA) volume and LV diastolic function after myectomy. We investigated changes in LA size and LV diastolic function in patients with HC after septal myectomy from 2004 to 2011. We studied 25 patients (age 49.2 ± 13.1 years, 48% women) followed for a mean of 527 days after surgery who had serial echocardiography at baseline and at most recent follow-up, at least 6 months after myectomy. In addition to myectomy, 3 patients (12%) underwent Maze surgery and 13 (52%) underwent mitral valve surgery, of whom 5 had a mitral valve replacement or mitral annuloplasty. Patients with mitral valve replacement or mitral annuloplasty were excluded from LV diastolic function analysis. LA volume index decreased (from 47.2 ± 17.6 to 35.9 ± 17.0 ml/m(2), p = 0.001) and LV diastolic function improved with an increase in lateral e' velocity (from 7.3 ± 2.9 to 9.8 ± 3.1 cm/sec, p = 0.01) and a decrease in E/e' (from 14.8 ± 6.3 to 11.7 ± 5.5, p = 0.051). Ventricular septal thickness and LVOT gradient decreased, and symptoms of dyspnea and heart failure improved, with reduction in the New York Heart Association functional class III/IV symptoms from 21 (84%) to 1 (4%). In conclusion, relief of LVOT obstruction in HC by septal myectomy results in improved LV diastolic function and reduction in LA volume with improved symptoms.
    Article · Aug 2014 · The American Journal of Cardiology
  • Nausheen Akhter · Qiong Zhao · Adin‐Cristian Andrei · [...] · Vera H. Rigolin
    [Show abstract] [Hide abstract] ABSTRACT: Background The objectives of this study were twofold: to assess the diagnostic utility of three-dimensional (3D) multiplanar reconstruction (MPR) in identifying prolapsing mitral valve (MV) scallops, and (2) to compare two-dimensional (2D) transthoracic echocardiography (TTE) and 3DMPR to (2D) transesophageal echocardiography (TEE) approaches among patients with mitral valve prolapse (MVP).Methods Fifty-five patients with MVP who underwent MV repair or replacement were retrospectively analyzed using 3 types of echocardiographic studies (2DTEE, 2DTTE, 3DMPR). The operative (OR) findings were considered the gold standard.ResultsWhen 3DMPR was combined with 2DTTE, the agreement with the OR findings was moderately strong for the A2 scallop (P < 0.001) and strong for the A3 scallop (P = 0.001), entire anterior leaflet (P < 0.001), P2 scallop (P < 0.001) and the entire posterior leaflet (P < 0.001). In comparison to the OR findings, 2DTEE demonstrated moderately strong agreement for the A2 scallop (P = 0.010) and the entire anterior leaflet (P < 0.001), and strong agreement for the P2 scallop (P < 0.001) and entire posterior leaflet (P < 0.001).Conclusions Three-dimensional MPR should be added to the armamentarium of complementary echo techniques in the evaluation of MVP. There is increased benefit in combining 3DMPR with 2DTTE findings as part of the preoperative evaluation of patients with MVP.
    Article · Apr 2014 · Echocardiography
  • Article · Jan 2014 · Cardiology
  • Article · Jun 2013 · The Journal of thoracic and cardiovascular surgery
  • Laila A Payvandi · Vera H Rigolin
    [Show abstract] [Hide abstract] ABSTRACT: The mitral valve annulus is a complex structure that is an integral part of the mitral valve apparatus. The annulus plays an active role in mitral valve leaflet coaptation and in left atrial and ventricular function. The annulus is susceptible to disease processes that are distinct from those that affect the mitral valve leaflets. Advanced annular calcification may extend onto the mitral valve leaflets, thereby causing increased diastolic gradients across the mitral valve. This review highlights risk factors for mitral annular calcification, features of calcific mitral stenosis, differentiation from rheumatic mitral valve disease, and the echocardiographic approach to this disorder.
    Article · May 2013 · Cardiology clinics
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    Priya Kohli · Vera Rigolin · Andrew Kott · [...] · Jyothy Puthumana
    Full-text Article · Mar 2012 · Journal of the American College of Cardiology
  • [Show abstract] [Hide abstract] ABSTRACT: This study compares 2-dimensional, transthoracic echocardiography with cardiac magnetic resonance imaging in the preoperative identification of bicuspid aortic valve before aortic valve surgery. Of 1203 patients who underwent an aortic valve operation, 218 had both preoperative transthoracic echocardiography and cardiac magnetic resonance imaging. Patients in the study group were aged 56 years and had an ejection fraction of 56%, 76% were male, and 29% had associated coronary artery disease. The results of transthoracic echocardiography and cardiac magnetic resonance imaging were classified as bicuspid aortic valve, trileaflet aortic valve, or nondiagnostic. Of the 218 patients, 123 (56%) had bicuspid aortic valve as determined at the time of surgery and 116 (53%) had an ascending aortic aneurysm. Of the 123 patients with bicuspid aortic valve confirmed at surgery, by transthoracic echocardiography 76 (62%) were identified preoperatively with bicuspid aortic valve, 12 (10%) were misidentified with trileaflet aortic valve, and 35 (28%) were nondiagnostic for valve morphology. In the same patients with bicuspid aortic valve, by cardiac magnetic resonance imaging 115 (93%) were identified with bicuspid aortic valve, 5 (4%) were misidentified with trileaflet aortic valve, and 3 (2%) were nondiagnostic. The difference between transthoracic echocardiography and cardiac magnetic resonance imaging to determine the presence of bicuspid aortic valve was statistically significant (P<.001). In the entire cohort of patients, transthoracic echocardiography was diagnostic for valve morphology in 155 patients (71%) compared with cardiac magnetic resonance imaging, which was diagnostic in 212 patients (97%) (P<.001). Cardiac magnetic resonance imaging is more diagnostic than transthoracic echocardiography in determining the presence of bicuspid aortic valve. A significant factor is the rate of nondiagnostic transthoracic echocardiography for aortic valve morphology. Cardiac magnetic resonance imaging can be performed as a complementary test when transthoracic echocardiography is nondiagnostic for aortic valve morphology.
    Article · Dec 2011 · The Journal of thoracic and cardiovascular surgery
  • Article · Apr 2011 · Journal of the American College of Cardiology
  • [Show abstract] [Hide abstract] ABSTRACT: Patients with obstructive hypertrophic cardiomyopathy who undergo septal myectomy are at risk for developing postoperative atrial fibrillation. Amiodarone is effective in treating this arrhythmia but is associated with multiple adverse effects, often with delayed onset. A novel case is described of a patient who developed type 2 amiodarone-induced hyperthyroidism that presented as recurrence of outflow obstruction after septal myectomy. The patient's symptoms and echocardiographic findings of outflow obstruction resolved substantially with the treatment of the amiodarone-induced hyperthyroidism. Amiodarone-induced hyperthyroidism of delayed onset can be a subtle diagnosis, requiring a high index of suspicion. In conclusion, recognition of this diagnosis in patients with recurrence of outflow obstruction by symptoms and cardiac imaging after septal myectomy may avoid unnecessary repeat surgical intervention.
    Article · Dec 2010 · The American journal of cardiology
  • Asimul Ansari · Vera H Rigolin
    [Show abstract] [Hide abstract] ABSTRACT: The evaluation of valvular and nonvalvular structures is of central importance in the diagnosis, management, and treatment of infective endocarditis (IE). The incidence of IE has remained constant due to changing substrate, with notably higher prevalence observed in the elderly. Mortality and morbidity continue to remain high, despite advances in medical and surgical treatment. This article reviews the technical and practical aspects of the use of echocardiography to evaluate patients with suspected IE.
    Article · May 2010 · Current Cardiology Reports
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    [Show abstract] [Hide abstract] ABSTRACT: Valvular heart disease (VHD) encompasses a number of common cardiovascular conditions that account for 10% to 20% of all cardiac surgical procedures in the United States. A better understanding of the natural history coupled with the major advances in diagnostic imaging, interventional cardiology, and surgical approaches have resulted in accurate diagnosis and appropriate selection of patients for therapeutic interventions. A thorough understanding of the various valvular disorders is important to aid in the management of patients with VHD. Appropriate work-up for patients with VHD includes a thorough history for evaluation of causes and symptoms, accurate assessment of the severity of the valvular abnormality by examination, appropriate diagnostic testing, and accurate quantification of the severity of valve dysfunction and therapeutic interventions, if necessary. It is also important to understand the role of the therapeutic interventions vs the natural history of the disease in the assessment of outcomes. Prophylaxis for infective endocarditis is no longer recommended unless the patient has a history of endocarditis or a prosthetic valve.
    Full-text Article · May 2010 · Mayo Clinic Proceedings