Nicola Johnston's research while affiliated with Belfast Health and Social Care Trust and other places
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Publications (15)
Background
European guidelines advise that patients suffering ST-segment elevation myocardial infarction (STEMI) should be revascularized within 120 minutes of diagnosis. The preferred method of revascularization is primary percutaneous coronary intervention (pPCI). We analysed the Northern Irish STEMI database to establish the proportion of pPCI d...
Background
Thrombolysis is an established recommended therapy for patients presenting with acute pulmonary embolism (PE) and shock. The management of “intermediate-high” risk patients is not as clear and the use of thrombolysis splits opinion and as such it remains a “consideration” for these patients in both the ESC and BTS guidelines. Both effica...
With a rise in the aging population, mitral annular calcification is increasingly encountered with an incidence of 10% in over 70 years old. This with increasing patient comorbidities presents a technical challenge due to the risk of atrioventricular disruption which is associated with high operative mortality of up to 75%. We describe two cases of...
Learning Points Identified During Our First Transapical Transcatheter Valve-in-ring Implantation.
IntroductionThere is considerable variability within the population of patients treated with transcatheter aortic valve implantation (TAVI), the procedural approach and time to discharge. In Belfast, from the commencement of our program, our approach has been to perform TAVI by the least invasive approach, where feasible, utilizing a percutaneous t...
A fit 69-year-old bus driver presented acutely to hospital following an episode of nocturnal dyspnoea. Co-morbidities included a history of stage I renal cell carcinoma treated by simple left nephrectomy 17 years previously.
On admission, ECG demonstrated anterior T-wave inversion (leads V1–V4) and chest X-ray revealed cardiomegaly. Troponin-T was...
Background:
Cardiac magnetic resonance (CMR) is used in the diagnosis and risk stratification of hypertrophic cardiomyopathy (HCM) and can detect myocardial replacement fibrosis (anindependent predictor of adverse cardiac outcomes) using late gadolinium enhancement (LGE).
Methods:
We retrospectively analysed CMR studies carried out over a 2 year...
Idiopathic mediastinal fibrosis is a rare, histologically benign condition which often presents with symptoms attributable to compression of vital mediastinal structures. Diagnosis can be difficult and individualised treatments are required for patients, with possible intervention including pharmacotherapy, surgery and percutaneous stenting. We pre...
A 36-year-old woman presented following 6 months of intermittent palpitation and dizziness. Twelve-lead electrocardiogram showed sinus rhythm with a prolonged QRS duration ( Panel A ). Ambulatory monitoring detected non-sustained broad-complex tachycardia during symptomatic episodes. Two-dimensional echocardiography revealed asymmetric hypertrophy...
Citations
... It is however not known whether the performance of the valves will be the same in a rheumatic landing zone with commissural fusion and potentially different patterns of calcification. Published case series included older patients with mean ages between 79 and 83, when calcification is likely extensive (61,63,64) and the dominant lesion is AS. The predominant aortic valve lesion in low-and middle-income countries is however AR (6) and most current prostheses are either not approved or have shown inferior results in AR patients as compared to AS (66,67). ...
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... Figure 2a and b demonstrate the augmented prosthesis crimped and deployed respectively. Due to the limited LA access, we could only secure the valve in 3 positions, (3, 6 and 9 o'clock) rather than run a continuous 4.0 Prolene between the wall of the left atrium and skirt of the prosthesis to prevent valve migration and paravalvular leak (PVL), as previously published [1]. ...
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... Acortar las estancias hospitalarias significa tratar a más pacientes en el mismo hospital, algo importante en un ya de por sí colapsado sistema sanitario y con largas listas de espera. Estas eficiencias del TAVI también reducen el riesgo de infección y contaminación 33 , algo apreciado durante la reciente pandemia de la COVID-19. Por último, el TAVI reduce el periodo de recuperación y la vuelta a las actividades diarias normales, aspectos que no se incluyeron en este análisis. ...
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... Late gadolinium enhancement is frequent in patients with HCM (around 65% of cases) [25], while it is rare among young athletes (3-13%) [26] (Fig. 2). ...
... Procedure-related complications associated with endovascular intervention for central vascular obstructions due to FM have been reported to occur in 24% of the cases according to a retrospective review of 40 interventions. The most common complications are hemoptysis, catheterization site bleeding and reperfusion lung injury; however, major complications and/or death following percutaneous intervention are rare [17][18][19]. The survival of patients with FM depends on the underlying etiology, the severity of its complications and possibly due to the therapeutic approach. ...
... The mass showed low signal on T 1 -and T 2 -weighted images, no increase in signal during first-pass perfusion, but diffuse delayed hyperenhancement after gadolinium injection ( Fig. 1K and L), a feature typical of cardiac fibroma. 1,4,5 This feature reflects contrast accumulation within an expanded extracellular compartment by deposition of collagen and elastin fibers. 1 On MRI, fibroma is the only intramural tumor to have a combination of an intermediatelow signal on T 1 -weighted images plus a low signal on T 2 -weighted images, which reflects small intracellular and vascular space and low water content. 1,4 MRI can help to make this differential diagnosis between other cardiac masses based on the presented characteristics. ...
