Publications by Year: 2011

2011
Matyal R, Warraich HJ, Karthik S, Panzica P, Shahul S, Khabbaz KR, Mahmood F. Anterior myocardial infarction with dynamic left ventricular outflow tract obstruction. Ann Thorac Surg. 2011;91 :e39-40.Abstract
We present the case of a 78-year-old woman who presented with acute anterior myocardial infraction. An intraoperative transesophageal echocardiogram revealed an akinetic apex with hyperkinesis of the basal segments causing systolic anterior motion of the mitral valve. The patient was immediately placed on cardiopulmonary bypass. Her postoperative course was uneventful. We present transesophageal and transthoracic echocardiographic videos showing this unique complication and describing the challenge of managing a patient who required opposing therapies.
Matyal R, Warraich HJ, Panzica P, Khabbaz KR, Mahmood F. Echo rounds: bifid atrial septal aneurysm: visualization with three-dimensional transesophageal echocardiography. Anesth Analg. 2011;112 :1300-2.
Warraich HJ, Hayward G, Matyal R, Shahul S, Subramaniam B. Fate of mitral regurgitation after aortic valve replacement for aortic stenosis. J Cardiothorac Vasc Anesth. 2011;25 :885-6.
Warraich H, Zaidi AK, Patel K. Floods in Pakistan: a public health crisis. Bull World Health Organ. 2011;89 :236-7.
Warraich H, Matyal R, Shahul S, Mitchell J, Panzica P, Khabbaz K, Mahmood F. Giant saphenous vein graft pseudoaneurysm causing tricuspid valve stenosis. J Card Surg. 2011;26 :177-80.Abstract
We present the case of a 72-year-old male who was diagnosed with a saphenous vein graft pseudoaneurysm, detected on routine chest echocardiogram 13 years after undergoing coronary artery bypass graft surgery. Intraoperative transesophageal echocardiography revealed the pseudoaneurysm to be causing functional tricuspid stenosis, which was relieved after surgical excision of the mass.
Mir F, Tikmani SS, Shakoor S, Warraich HJ, Sultana S, Ali SA, Zaidi AK. Incidence and etiology of omphalitis in Pakistan: a community-based cohort study. J Infect Dev Ctries. 2011;5 :828-33.Abstract
INTRODUCTION: Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. METHODOLOGY: Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. RESULTS: Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10 %); Pseudomonas spp., 52 (8.9 %); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%). CONCLUSIONS: A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented.
Warraich H. Pakistan: the final frontier for a polio-free world. Lancet. 2011;377 :207-8.
Matyal R, Bose R, Warraich H, Shahul S, Ratcliff S, Panzica P, Mahmood F. Transthoracic echocardiographic simulator: normal and the abnormal. J Cardiothorac Vasc Anesth. 2011;25 :177-81.
Bose RR, Matyal R, Warraich HJ, Summers J, Subramaniam B, Mitchell J, Panzica PJ, Shahul S, Mahmood F. Utility of a transesophageal echocardiographic simulator as a teaching tool. J Cardiothorac Vasc Anesth. 2011;25 :212-5.Abstract
OBJECTIVE: This study was designed to test the hypothesis that simulator-based transesophageal echocardiographic training was a more effective method of training anesthesia residents with no prior experience in echocardiography as compared with conventional methods of training (books, articles, and web-based resources). STUDY DESIGN: A prospective randomized study. SETTING: An academic medical center (teaching hospital). PARTICIPANTS: The participants consisted of first-year anesthesia residents. INTERVENTION: The study design was composed of 2 groups: a control group (group 1, conventional group) and a study group (group 2, simulator group). The residents belonging to group 2 (simulator group) received a 90-minute simulator-based teaching session moderated by a faculty experienced in transesophageal echocardiography. Residents belonging to group 1 (conventional group) were asked to review the guidelines of the comprehensive intraoperative transesophageal echocardiographic examination published by the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. They also were encouraged to use other learning resources (eg, textbooks, electronic media, and web-based resources) to understand the underlying concepts of echocardiography. Written pre- and post-test was administered to both groups. MEASUREMENTS AND MAIN RESULTS: The groups were compared for the pretest scores by the nonparametric Mann-Whitney U test. Pre- and post-test scores were compared with a Wilcoxon paired test in the individual groups. The results showed a statistically significant difference between the scores of the 2 groups with better scores in the simulation group in the post-training test. CONCLUSION: The simulator-based teaching model for transesophageal echocardiography is a better method of teaching the basic concepts of transesophageal echocardiography like anatomic correlation, structure identification, and image acquisition.
Warraich HJ, Shahul S, Matyal R, Mahmood F. Bench to bedside: dynamic mitral valve assessment. J Cardiothorac Vasc Anesth. 2011;25 :863-6.Abstract
PURPOSE: The authors analyze a commercially available software package capable of geometrically reconstructing the mitral valve (MV) dynamically throughout systole. DESCRIPTION: Three-dimensional echocardiography has revolutionized the understanding of MV geometry. Advanced quantification software can be used to assess geometric changes in the MV, which have been shown to have important implications for MV surgery. EVALUATION: The authors performed geometric analysis on 24 patients, with both anatomically normal and abnormal MVs to assess the feasibility of this new software. The application of this new software is briefly reviewed. CONCLUSION: This new software, despite its limitations, allows an improved perspective on MV geometry with implications for MV repair and surgical decision making.
Mir F, Tikmani SS, Shakoor S, Warraich HJ, Sultana S, Ali SA, Zaidi AK. Incidence and etiology of omphalitis in Pakistan: a community-based cohort study. J Infect Dev Ctries. 2011;5 :828-33.Abstract
INTRODUCTION: Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. METHODOLOGY: Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. RESULTS: Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10 %); Pseudomonas spp., 52 (8.9 %); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%). CONCLUSIONS: A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented.
Warraich HJ, Bhatti UA, Shahul S, Pinto D, Liu D, Matyal R, Mahmood F. Unilateral pulmonary edema secondary to mitral valve perforation. Circulation. 2011;124 :1994-5.
Matyal R, Bose R, Warraich H, et al. Transthoracic echocardiographic simulator: normal and the abnormal. Journal of Cardiothoracic and Vascular Anesthesia. 2011;25(1):177-81.
Bose R, Matyal R, Warraich H, et al. Utility of a transesophageal echocardiographic simulator as a teaching tool. Journal of Cardiothoracic and Vascular Anesthesia. 2011; 25(2):212-5.
Warraich H. Pakistan: the final frontier for a polio-free world. Lancet. 2011;15; 377(9761):207-8.
Warraich H, Matyal R, Shahul S. Giant saphenous vein graft pseudoaneurysm causing tricuspid valve stenosis. Journal of Cardiac Surgery. 2011;26(2):177-80.
Matyal R, Warraich H, Karthik S, et al. Anterior myocardial infarction with dynamic left ventricular outflow tract obstruction. Annals of Thoracic Surgery. 2011; 91(3):e39-40.
Warraich H, Zaidi A, Patel K. Floods in Pakistan: a public health crisis. Bulletin of the World Health Organization. 2011;89(3):236-7.