Monvadi Barbara Srichai, M.D.

A Case of Berry Syndrome Type 2B
Mannelli, Lorenzo; Mosca, Ralph; Henry, Gillian; Srichai-Parsia, Monvadi Barbara
2011 Jul;6(4):389-392, Congenital heart disease
We present a case of a 34-day-old baby boy with congestive heart failure and differential cyanosis. Based on echocardiography and confirmed with computed tomography angiography, the following abnormalities were detected: aortopulmonary window, aortic origin of the right pulmonary artery, patent ductus arteriosus, and hypoplasia/coarctation of the aorta. No other congenital abnormalities were detected, and a diagnosis of Berry Syndrome type 2B was made. No preoperative cardiac catheterization or angiocardiography was needed. The patient underwent complete surgical repair of the aortopulmonary window and reconstruction of the hypoplastic aortic arch. This case highlights the value of cross-sectional imaging with computed tomography angiography in the evaluation of complex congenital heart disease
— id: 135569, year: 2011, vol: 6, page: 389, stat: Journal Article,

CORONARY COMPUTED TOMOGRAPHY ANGIOGRAP
Srichai-Parsia, Monvadi Barbara; Lim, Ruth P.; Mannelli, Lorenzo; Donnino, Robert; Hiralal, Rajesh; Ho, Corey K.; Babb, James S.; Jacobs, Jill E.
2011 APR 5 ;57(14):E672-E672, Journal of the American College of Cardiology
— id: 134896, year: 2011, vol: 57, page: E672, stat: Journal Article,

Evaluation of myocardial abnormalities and ischemia
Chandarana, Hersh; Srichai, Monvadi B
2010 Jul;48(4):771-782, Radiologic clinics of North America
Cardiac computed tomography angiography (CCTA) has emerged as a powerful noninvasive technique for anatomic evaluation of the coronary arteries. Multiple studies have demonstrated very good diagnostic accuracy for detection of coronary artery disease, particularly with 64-slice systems. CCTA allows for accurate assessment of myocardial structure, perfusion, and function comparable to established techniques. CCTA has the potential to be a ''one-stop shop'' because it can be used to assess coronary artery anatomy and myocardial structure, perfusion, and function. In this article, established and emerging CCTA techniques for the evaluation of myocardial structure, perfusion, and function are reviewed
— id: 111968, year: 2010, vol: 48, page: 771, stat: Journal Article,

Evaluation of the Mitral and Aortic Valves With Cardiac CT Angiography
Chheda, Samir V; Srichai, Monvadi B; Donnino, Robert; Kim, Danny C; Lim, Ruth P; Jacobs, Jill E
2010 Feb;25(1):76-85, Journal of thoracic imaging
Cardiac computed tomographic angiography (CTA) using multidetector computed tomographic scanners has proven to be a reliable technique to image the coronary vessels. CTA also provides excellent visualization of the mitral and aortic valves, and yields useful information regarding valve anatomy and function. Accordingly, an assessment of the valves should be performed whenever possible during CTA interpretation. In this paper, we highlight the imaging features of common functional and structural left-sided valvular disorders that can be seen on CTA examinations
— id: 107290, year: 2010, vol: 25, page: 76, stat: Journal Article,

Noninvasive imaging of congenital heart defects
Phoon CKL; Chun AJL; Srichai-Parsia MB
Congenital heart defects : from origin to treatment New York : Oxford University Press, 2010,
— id: 5301, year: 2010, vol: , page: ?, stat: Chapter,

Carney's complex
Pursnani, Amit K; Levy, Natalie K; Benito, Maryellen; Hong, Susie N; Srichai, Monvadi B; Yee, Herman; Kronzon, Itzhak
2010 Mar 30;55(13):1395-1395, Journal of the American College of Cardiology
— id: 114156, year: 2010, vol: 55, page: 1395, stat: Journal Article,

Non-gadolinium-enhanced 3-dimensional magnetic resonance angiography for the evaluation of thoracic aortic disease: a preliminary experience
Srichai, Monvadi B; Kim, Sooah; Axel, Leon; Babb, James; Hecht, Elizabeth M
2010 ;37(1):58-65, Texas Heart Institute journal
We compared image quality and diagnostic accuracy of a noncontrast 3-dimensional magnetic resonance angiography (NC-MRA) technique (balanced steady-state free-precession sequence) to contrast-enhanced MRA (CE-MRA) for evaluation of thoracic aortic disease.The CE-MRA provides 3-dimensional high-resolution images of the thoracic aorta that are important in the evaluation of patients with aortic disease. However, recent concerns with the potential nephrotoxic effects of gadolinium contrast medium limit the application of CE-MRA for patients who have significant renal insufficiency.Twenty-one patients (mean age, 51 yr; 18 men) who underwent NC-MRA and CE-MRA for evaluation of thoracic aortic disease were retrospectively identified. Data sets were reviewed by 2 readers who were blinded to the patients' information. The thoracic aorta was divided into 5 segments. Image quality and reader confidence for diagnosis of aortic pathology were rated on 5-point scales. The Wilcoxon matched-pairs signed rank test and the Student t test were used for comparisons.The NC-MRA identified all pathologic findings with 100% diagnostic accuracy and similar reader confidence, when compared with CE-MRA. Although overall image quality was not significantly different, superior image quality was observed at the aortic root (4.4 +/- 0.8 vs 3.2 +/- 0.9, P <0.0005) and ascending aorta (4.1 +/- 1 vs 3.7 +/- 0.9, P=0.05) respectively.In conclusion, NC-MRA is a useful alternative for evaluation and follow-up of thoracic aortic disease, especially for patients with poor intravenous access or contraindications to gadolinium use
— id: 107791, year: 2010, vol: 37, page: 58, stat: Journal Article,

Cardiac Events Predicted by Computed Tomography Coronary Angiography
Donnino, R; Jacobs, JE; Doshi, JV; Pursnani, S; Babb, JS; Kim, DC; Sedlis, SP; Srichai, MB
2009 MAR 10 ;53(10):A272-A272, Journal of the American College of Cardiology
— id: 97556, year: 2009, vol: 53, page: A272, stat: Journal Article,

Dual-source versus single-source cardiac CT angiography: comparison of diagnostic image quality
Donnino, Robert; Jacobs, Jill E; Doshi, Jay V; Hecht, Elizabeth M; Kim, Danny C; Babb, James S; Srichai, Monvadi B
2009 Apr;192(4):1051-1056, American journal of roentgenology
OBJECTIVE: Dual-source CT improves temporal resolution, and theoretically improves the diagnostic image quality of coronary artery examinations without requiring preexamination beta-blockade. The purpose of our study was to show the improved diagnostic image quality of dual-source CT compared with single-source CT despite the absence of preexamination beta-blockade in the dual-source CT group. MATERIALS AND METHODS: We performed a retrospective analysis of consecutive patients who underwent coronary artery evaluation with either single-source CT or dual-source CT at our institution between February 2005 and October 2006. Examination reports were analyzed for the presence of image artifacts, and image quality was graded on a 3-point scale (no, mild, or severe artifact). Type of artifact (motion, calcium, quantum mottle) was also noted. RESULTS: Examinations (339 single-source CT and 126 dual-source CT) of 465 patients were analyzed. Artifact was reported in 39.8% of examinations using single-source CT and in 29.4% of examinations using dual-source CT (p < 0.05). The number of examinations with motion artifact was significantly higher with single-source CT than with dual-source CT (15.9% vs 4.8%; p < 0.001) despite significantly higher heart rates in the dual-source CT group (59.4 +/- 8.4 vs 68.6 +/- 14.6 beats per minute; p < 0.001). No patients in the dual-source CT group received preexamination beta-blockade compared with 81% of patients in the single-source CT group. The presence of severe (nondiagnostic) calcium artifact was also significantly reduced in the dual-source CT group (13.0% vs 3.2%; p < 0.001). CONCLUSION: Dual-source CT provides significantly better diagnostic image quality than single-source CT despite higher heart rates in the dual-source CT group. These findings support the use of dual-source CT for coronary artery imaging without the need for preexamination beta-blockade
— id: 97842, year: 2009, vol: 192, page: 1051, stat: Journal Article,

The Value of Clinical Risk Strati. cation by the Morise Score in Assessing the Presence of Obstructive and Nonobstructive Coronary Artery Disease in Symptomatic Women
Hong, SN; Mieres, JH; Jacobs, JE; Patel, P; Pearte, CA; Srichai, MB
2009 MAR 10 ;53(10):A269-A269, Journal of the American College of Cardiology
— id: 97555, year: 2009, vol: 53, page: A269, stat: Journal Article,

Gender Normalized Reference Values of Heart and Great Vessel Dimensions in Cardiac CT (CME Credit Available)
Nevsky, G; Jacobs, J; Kim, D; Chandarana, H; Donnino, R; Lim, R; Srichai, M
2009 MAY ;192(5):646-651, American journal of roentgenology
— id: 99181, year: 2009, vol: 192, page: 646, stat: Journal Article,

CT and MR Appearances of Cardiac Pseudomasses: Imaging Pearls and Pitfalls (CME Credit Available)
Rueff, L; Srichai, M; Jacobs, J; Chandarana, H; Axel, L; Kim, D; Lim, R
2009 MAY ;192(5):646-651, American journal of roentgenology
— id: 99182, year: 2009, vol: 192, page: 646, stat: Journal Article,

Ductal arteriosus aneurysm, right aortic arch, and isolated left subclavian artery in a neonate
Scott, Claudeen K F; Meyer, David; Phoon, Colin K L; Srichai, Monvadi B
2009 May;4(3):187-189, Congenital heart disease
Ductal arteriosus aneurysm (DAA) is a well-recognized condition, especially in infancy, and is usually asymptomatic. We report the first case of a newborn who presented with significant inspiratory stridor and, using multiple imaging investigations, was subsequently diagnosed with the rare constellation of a congenital DAA, a right aortic arch and an isolated left subclavian artery with normal intra-cardiac anatomy. The patient underwent surgical resection of the DAA with significant improvement in symptoms
— id: 99247, year: 2009, vol: 4, page: 187, stat: Journal Article,

Aberrant crossed left circumflex and left anterior descending arteries: diagnosis with multidetector cardiac CT angiography
Shepard, Timothy F; Srichai, Monvadi B; Kim, Danny; Lim, Ruth; Jacobs, Jill E
2009 Mar-Apr;33(2):211-214, Journal of computer assisted tomography
The multidetector coronary computed tomography angiogram findings of a rare variant crossed left circumflex and left anterior descending artery are presented. In this patient, multidetector coronary computed tomography angiogram enabled clear delineation of the aberrant coronary artery anatomy, including an estimation of patency during systole and diastole. To our knowledge, this is only the second reported case of this particular coronary artery anomaly in the world literature
— id: 97866, year: 2009, vol: 33, page: 211, stat: Journal Article,

Dual-source computed tomography angiography image quality in patients with fast heart rates
Srichai, Monvadi B; Hecht, Elizabeth M; Kim, Danny; Babb, James; Bod, Jessica; Jacobs, Jill E
2009 Sep-Oct;3(5):300-309, Journal of Cardiovascular Computed Tomography
BACKGROUND: Dual-source computed tomography (DSCT) provides diagnostic quality images of the coronary arteries over a wide range of heart rates (HRs). Current dose reduction techniques, including electrocardiographic (ECG) dose modulation and prospective triggering, are optimized for use in patients with relatively slow (<70 beats/min) HRs by limiting radiation dose to the ideal phases of image acquisition. OBJECTIVE: We evaluated coronary vessel image quality (IQ) at different reconstruction phases in patients with fast HRs (>80 beats/min) to assess potential feasibility of prospective triggering techniques on DSCT. METHODS: Patients (n=101) underwent 64-slice DSCT with retrospective ECG-gating without beta-blocker premedication. Image reconstructions were performed at 10% R-R wave phase intervals (0%-90%). Patients were grouped by mean HR: group A, <60 beats/min (n=22); group B, 60-80 beats/min (n=57); group C, >80 beats/min (n=22). Coronary artery IQ was assessed by 2 readers in consensus on a 5-point scale. RESULTS: Optimal IQ occurred at 70% phase for all arteries in groups A and B. In group C, optimal IQ occurred at 30% and 40% phases. The 70% phase achieved diagnostic IQ in 97% of group A and 86% of group B. A widened reconstruction window (30%-50%) was necessary for diagnostic IQ in a similar high proportion (84%) of group C. CONCLUSION: Optimal IQ occurs during late-systolic phases for patients with fast HRs (>80 beats/min). Late-systolic phase prospective triggering is potentially feasible in these patients; however, given the widened reconstruction windows required, a higher radiation dose may be required compared with patients with slower HRs (<80 beats/min)
— id: 104344, year: 2009, vol: 3, page: 300, stat: Journal Article,

Cardiovascular applications of phase-contrast MRI
Srichai, Monvadi B; Lim, Ruth P; Wong, Samson; Lee, Vivian S
2009 Mar;192(3):662-675, American journal of roentgenology
OBJECTIVE: The purpose of this study was to review and illustrate various clinical applications of phase-contrast MRI. CONCLUSION: Cardiac MRI has emerged as a valuable noninvasive clinical tool for evaluation of the cardiovascular system. Phase-contrast MRI has a variety of established applications in quantifying blood flow and velocity and several emerging applications, such as evaluation of diastolic function and myocardial dyssynchrony
— id: 97755, year: 2009, vol: 192, page: 662, stat: Journal Article,

Total anomalous pulmonary venous connection in an adult: comprehensive multimodality evaluation
Vavas, Eleni; Rosenzweig, Barry P; Meyer, David B; Srichai, Monvadi B
2009 Sep;4(5):384-386, Congenital heart disease
An unusual case of total anomalous pulmonary venous connection surviving to adulthood without surgical correction is presented. Transthoracic echocardiography first led to this diagnosis and magnetic resonance imaging refined the anatomic diagnosis leading to successful surgical correction
— id: 102163, year: 2009, vol: 4, page: 384, stat: Journal Article,

Delayed enhancement cardiac magnetic resonance imaging in a patient with Duchenne muscular dystrophy
Guillaume, Melissa D; Phoon, Colin K L; Chun, Anne J L; Srichai, Monvadi B
2008 ;35(3):367-368, Texas Heart Institute journal
— id: 97023, year: 2008, vol: 35, page: 367, stat: Journal Article,

Myocardial bridging: evaluation using single- and dual-source multidetector cardiac computed tomographic angiography
Jacobs, Jill E; Bod, Jessica; Kim, Danny C; Hecht, Elizabeth M; Srichai, Monvadi B
2008 Mar-Apr;32(2):242-246, Journal of computer assisted tomography
OBJECTIVE: To evaluate the prevalence and characteristics of myocardial bridging in patients who underwent single- or dual-source multidetector cardiac computed tomographic angiography (MDCTA). METHODS: Retrospective review of the imaging characteristics of 57 myocardial bridges in 53 patients who underwent cardiac MDCTA examinations was performed. RESULTS: The prevalence of myocardial bridges was 10.4%, most of which were located in the mid-left anterior descending coronary artery. The average myocardial bridge length was 23.4 mm, and the average tunneled artery depth was 2.6 mm. CONCLUSIONS: Myocardial bridges are commonly found in patients who undergo cardiac multidetector computed tomographic angiograms on both single- and dual-source computed tomographic scanners and are most frequently located in the mid-left anterior descending coronary artery. Increasing utilization of cardiac MDCTA for noninvasive evaluation of coronary artery disease permits recognition, characterization, and functional assessment of this entity in a single examination
— id: 78740, year: 2008, vol: 32, page: 242, stat: Journal Article,

Images in cardiovascular medicine. Lyme carditis
Naik, Mohit; Kim, Danny; O'Brien, Francis; Axel, Leon; Srichai, Monvadi B
2008 Oct 28;118(18):1881-1884, Circulation
— id: 91481, year: 2008, vol: 118, page: 1881, stat: Journal Article,

Ectopic origin of left coronary ostium from left ventricle, with occlusive membrane: a previously unreported anomaly, with an embryologic interpretation
Pirelli, Luigi; Yu, Pey-Jen; Srichai, Monvadi B; Khvilivitzky, Katherine; Angelini, Paolo; Grau, Juan B
2008 ;35(2):162-165, Texas Heart Institute journal
Congenital atresia of the left main coronary artery, a condition in which the left main trunk is developed but has been occluded since birth, is a rare coronary anomaly. Herein, we describe this anomaly's association with a subannular location of an obliterated left main ostium in a patient with a bicuspid aortic valve and severe aortic stenosis. The patient underwent successful surgery. We discuss the embryologic implications of congenital atresia of the left main coronary artery, in view of the exceptional anatomic features of this condition. To our knowledge, this is the 1st report of a left coronary artery that was found to arise from the left ventricle
— id: 93334, year: 2008, vol: 35, page: 162, stat: Journal Article,

Is it ventricular diverticulum or closed muscular ventricular septal defect? - Reply
Srichai, MB; Phoon, CKL; Jacobs, JE
2008 JUN ;190(6):W375-W375, American journal of roentgenology
— id: 86982, year: 2008, vol: 190, page: W375, stat: Journal Article,

Anomalous right coronary artery from the pulmonary artery
Barker, Colin M; Srichai, Monvadi B; Meyer, David B; Sedlis, Steven P
2007 Dec;1(3):166-167, Journal of Cardiovascular Computed Tomography
— id: 94657, year: 2007, vol: 1, page: 166, stat: Journal Article,

Improved visualization of non-transmural scar using slice-selective inversion-recovery delayed contrast-enhanced MRI: a preliminary report
Kim, Daniel; Lee, Vivian S; Srichai, Monvadi B
2007 Apr;20(2):121-127, NMR in biomedicine
Delayed contrast-enhanced MRI (ce-MRI) pulse sequence is a promising modality for the assessment of myocardial viability. However, conventional ce-MRI using a non-selective inversion recovery (IR) pulse can often yield poor edge definition or contrast-to-noise ratio (CNR) between the non-transmural scar and blood (i.e. the blood and scar appear isointense). Subtraction and multicontrast ce-MRI methods can be used to improve the CNR between the non-transmural scar and blood, but they require two image acquisitions. The authors have developed a single-acquisition ce-MRI pulse sequence that utilizes a slice-selective IR pulse to generate bright-blood contrast using inflow effects for an improved edge definition between the non-transmural scar and blood. Six patients with myocardial infarction were imaged at 1.5 T using both non-selective and slice-selective IR ce-MRI acquisitions with identical imaging parameters. The CNR between the non-transmural scar and normal myocardium was not different between the two acquisitions. The CNR between the blood and non-transmural scar (16.9 +/- 12.3 versus 3.2 +/- 7.9; p < 0.001) was significantly higher for the slice-selective IR acquisition than for the non-selective IR acquisition. This study demonstrates the feasibility of using a slice-selective IR pulse to improve the visualization of a non-transmural scar in ce-MRI, without increasing the acquisition time.
— id: 69405, year: 2007, vol: 20, page: 121, stat: Journal Article,

Non-ischemic causes of delayed myocardial hyperenhancement on MRI
Lim, Ruth P; Srichai, Monvadi B; Lee, Vivian S
2007 Jun;188(6):1675-1681, American journal of roentgenology
OBJECTIVE: Delayed contrast-enhanced cardiac MRI has been used to evaluate myocardial viability in ischemic heart disease (IHD). However, it can also be used in the assessment of non-ischemic cardiac diseases. CONCLUSION: We illustrate a number of non-ischemic cardiac conditions and describe how they can be differentiated from IHD
— id: 72500, year: 2007, vol: 188, page: 1675, stat: Journal Article,

Computed tomography and magnetic resonance of the thorax
Naidich, David P; Srichai, Monvadi B
Philadelphia : Lippincott Williams & Wilkins, 2007,
— id: 1398, year: 2007, vol: , page: , stat: ,

Anatomy of the heart at multidetector CT: what the radiologist needs to know
O'Brien, James P; Srichai, Monvadi B; Hecht, Elizabeth M; Kim, Daniel C; Jacobs, Jill E
2007 Nov-Dec;27(6):1569-1582, Radiographics
Continued improvements in multidetector computed tomographic (CT) scanners have made cardiac CT an important clinical tool that is revolutionizing cardiac imaging. Multidetector CT with submillimeter collimation and gantry rotation times under 0.5 seconds allows the acquisition of studies with high temporal resolution and isotropic voxels. The volumetric data set that is generated can be analyzed with a depth previously not possible, requiring a solid understanding of the cardiac anatomy and its appearance on CT scans and postprocessed images
— id: 75160, year: 2007, vol: 27, page: 1569, stat: Journal Article,

Ventricular diverticula on cardiac CT: more common than previously thought
Srichai, Monvadi B; Hecht, Elizabeth M; Kim, Danny C; Jacobs, Jill E
2007 Jul;189(1):204-208, American journal of roentgenology
OBJECTIVE: We describe the findings of contrast-enhanced gated cardiac CT in 15 patients with 23 incidentally noted cardiac ventricular diverticula. CONCLUSION: Cardiac diverticula most commonly occur in the left ventricle but have been reported to occur in all chambers of the heart. Despite reports of their rare occurrence, cardiac ventricular diverticula are fairly common findings in patients undergoing cardiac MDCT angiography.
— id: 72986, year: 2007, vol: 189, page: 204, stat: Journal Article,

Giant right atrial wall vegetation mimicking cardiac tumor
Yu, Pey-Jen; Fordyce, Marshall; Srichai, Monvadi B; Zinn, Andrew; Losada, Mariela; El-ftesi, Samyra; Vittorio, Timothy J; Grau, Juan B
2007 Nov;20(11):1315.e9-1315.11, Journal of the American Society of Echocardiography
We report the use of cardiac magnetic resonance imaging in the diagnosis of a large right atrial vegetation. A 44-year-old woman admitted with septic shock was found to have a giant mass attached to the lateral free wall of the right atrium that was consistent with tumor on transesophageal echocardiography. Interestingly, diagnosis of vegetation was later made by cardiac magnetic resonance imaging and confirmed by surgical pathology. The case highlights not only an atypical presentation for intracardiac vegetation, but also the use of cardiac magnetic resonance imaging as an adjunct to transesophageal echocardiography in the evaluation of cardiac masses
— id: 75189, year: 2007, vol: 20, page: 1315.e9, stat: Journal Article,

Quadricuspid aortic valve: Imaging findings on multidetector helical CT with echocardiographic correlation
Jacobs, Jill E; Srichai, Monvadi; Kim, Danny; Hecht, Elizabeth; Kronzon, Itzhak
2006 Jul-Aug;30(4):569-571, Journal of computer assisted tomography
Cardiac multidetector helical computed tomography angiogram (MDCTA) findings of a quadricuspid aortic valve are presented. MDCTA enabled evaluation of the aortic valve and its function, the coronary arteries, and left ventricular function. This case is, to our knowledge, the first description of the MDCTA imaging appearance of quadricuspid aortic valve
— id: 66760, year: 2006, vol: 30, page: 569, stat: Journal Article,

Clinical application of a semiautomatic 3D fusion tool where automatic fusion techniques are difflicult to use
Noz, ME; Maguire, GQ; Zeleznik, MP; Olivecrona, L; Olivecrona, H; Axel, L; Srichai, MB; Moy, L; Murphy-Walcott, A
2006 ;4057:195-205, Lecture notes in computer science
The purpose of this paper is to demonstrate the clinical advantages of using semiautomatic volume registration where automatic registration is problematic due to large deformations, small bone anatomy, or extraneous structures. Examples are drawn from clinical cases of MRI/PET breast studies, CT angiography/SPECT cardiac studies, and total wrist arthroplasty. These types of studies should be contrasted with those involving the head, thorax, and pelvis where there is much less deformation and the existence of (some) large bones facilitates automatic matching
— id: 69353, year: 2006, vol: 4057, page: 195, stat: Journal Article,

Comparison of left atrial volume and left atrial appendage contribution in patients with and without persistent atrial fibrillation
Srichai, MB; Jacobs, JE; Bernstein, N; Chinitz, L; Axel, L
2006 FEB 21 ;47(4):125A-125A, Journal of the American College of Cardiology
— id: 63302, year: 2006, vol: 47, page: 125A, stat: Journal Article,

Magnetic resonance imaging in the management of pericardial disease
Srichai, Monvadi B; Axel, Leon
2005 Dec;7(6):449-457, Current treatment options in cardiovascular medicine
The pericardium, although seldom the primary cause of systemic illness, can be involved in almost every type of disease. Pericardial involvement may be subtle and escape detection unless specifically sought, or it can overshadow features of the underlying systemic disease. Suspected pericardial disease is usually initially evaluated with echocardiography. However, magnetic resonance imaging can offer additional valuable information. In addition to the excellent resolution and unlimited imaging planes available for visualization of the entire pericardial sac, the wide field of view allows for evaluation of involvement of adjacent cardiac structures. Dynamic functional imaging and tissue characterization with and without contrast can further characterize disease and provide information regarding concomitant myocardial disease and effects on cardiac motion. The treatment of specific pericardial conditions ultimately depends on the underlying disease process. Magnetic resonance imaging can provide useful information to aid in diagnosis, management, and guidance of therapy for pericardial disease
— id: 133569, year: 2005, vol: 7, page: 449, stat: Journal Article,

Isolated left ventricular apical hypoplasia: a new congenital anomaly described with cardiac tomography
Fernandez-Valls, M; Srichai, M B; Stillman, A E; White, R D
2004 May;90(5):552-555, Heart (British Cardiac Society)
OBJECTIVE: To describe cardiac tomography findings of an apparently new, presumably congenital, left ventricular (LV) abnormality noted consistently in three patients. PATIENTS: Three patients presenting with non-specific symptoms including fatigue, shortness of breath, or chest discomfort were evaluated with cardiac tomography for cardiac structure and function. RESULTS: Findings from the three patients were very similar: a truncated and spherical LV with abnormal diastolic and systolic function, invagination of fatty material into the myocardium of the defective LV apex, origin of a complex papillary network in the anteroapical LV, and an elongated right ventricle wrapping around the deficient apex. CONCLUSIONS: Isolated LV apical hypoplasia is a unique, presumably congenital, cardiac anomaly that is an important condition to recognise
— id: 45265, year: 2004, vol: 90, page: 552, stat: Journal Article,

Evaluating the benefits of glycoprotein IIb/IIIa inhibitors in heart failure at baseline in acute coronary syndromes
Srichai, Monvadi B; Jaber, Wael A; Prior, David L; Marso, Steven P; Houghtaling, Penny L; Menon, Venu; Simoons, Maarten L; Harrington, Robert A; Hochman, Judith S
2004 Jan;147(1):84-90, American heart journal
BACKGROUND: We evaluated whether the use of glycoprotein IIb/IIIa receptor inhibitors, in addition to heparin and aspirin, imparts an incremental benefit in a subgroup of patients with acute coronary syndromes (ACS) who had congestive heart failure (CHF) symptoms at presentation. METHODS: We analyzed patients enrolled in the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, a randomized, double-blind, placebo-controlled study evaluating the use of eptifibatide versus placebo for patients with ACS without persistent ST-elevation. We compared the clinical characteristics and 30-day outcomes for 861 patients who had Killip class II or III CHF symptoms with those of 8558 patients who had no CHF symptoms. RESULTS: Odds ratios for the primary end point, 30-day death or non-fatal myocardial infarction, in the placebo group versus the eptifibatide group were similar for patients with and without CHF (odds ratio, 1.11; 95% CI, 0.8-1.5; odds ratio, 1.13; 95% CI, 1.0-1.3). However, adverse events were almost twice as frequent for patients with CHF compared with patients with no CHF (24.5% vs 14%). CONCLUSIONS: Although patients with non-ST-segment elevation ACS who have CHF have markedly worse outcomes than patients without CHF symptoms, we did not find an incremental benefit from the use of eptifibatide in this seriously ill subgroup
— id: 43526, year: 2004, vol: 147, page: 84, stat: Journal Article,

Acute dissection of the descending aorta: noncommunicating versus communicating forms
Srichai, Monvadi B; Lieber, Michael L; Lytle, Bruce W; Kasper, Jane M; White, Richard D
2004 Jun;77(6):2012-2020, Annals of thoracic surgery
BACKGROUND: Noncommunicating dissecting intramural hematoma is an aortic dissection variant, characterized by absent flow within the false lumen. Noncommunicating dissecting intramural hematoma is thought to be more stable than communicating dissection when beginning in the descending aorta. This study assessed clinical characteristics, anatomic characteristics, and 1-year outcomes in acute descending noncommunicating dissecting intramural hematoma versus communicating dissection. METHODS: Retrospective database review identified patients who underwent magnetic resonance or computed tomography imaging revealing acute descending noncommunicating dissecting intramural hematoma or communicating dissection. Comparisons of clinical and anatomic characteristics and 1-year outcomes were performed. RESULTS: Twenty-four noncommunicating dissecting intramural hematoma and 36 communicating dissection cases were identified. Patients with noncommunicating dissecting intramural hematoma were older (68.5 +/- 8.8 versus 61.8 +/- 11.6 years; p < 0.05). Although noncommunicating dissecting intramural hematoma often showed abdominal aorta extension (50%), the infrarenal level was spared. Communicating dissection characteristically extended beyond the diaphragm (89%), including into the infrarenal aorta (28%). There was no significant difference in rates of adverse clinical events for noncommunicating dissecting intramural hematoma versus communicating dissection (13% versus 30%; 0.10 > p > 0.05). By follow-up imaging (87% of population), aortic deterioration was more frequent in noncommunicating dissecting intramural hematoma versus communicating dissection cases (60% versus 15%; p < 0.005). CONCLUSIONS: Acute descending noncommunicating dissecting intramural hematoma and communicating dissection represent two variants, with differing clinical and anatomic characteristics, but comparable levels of 1-year morbidity
— id: 45264, year: 2004, vol: 77, page: 2012, stat: Journal Article,

Extent of myocardial scarring on nonstress delayed-contrast-enhancement cardiac magnetic resonance imaging correlates directly with degrees of resting regional dysfunction in chronic ischemic heart disease
Srichai, Monvadi B; Schvartzman, Paulo R; Sturm, Bernhard; Kasper, Jane M; Lieber, Michael L; White, Richard D
2004 Aug;148(2):342-348, American heart journal
BACKGROUND: Hyper-enhancement on delayed-enhancement magnetic resonance imaging (DE-MRI) is a marker of irreversible myocardial injury. Both reversible and irreversible ischemically injured regions of myocardium develop reductions in systolic function compared with unaffected regions. This study evaluated whether there is a relationship between myocardial hyper-enhancement from remote scarring on DE-MRI and the degree of myocardial circumferential shortening (%CS) as determined with dynamic MRI tissue tagging (TAG-MRI) in the setting of chronic ischemic heart disease (CIHD). METHODS: Thirty-five patients with CIHD and 8 control patients underwent nonstress, resting DE-MRI and TAG-MRI. A total of 168 CIHD and 96 control segments from the basal- and middle-thirds of the left ventricle (LV) were selected to achieve a balanced test set. With a 16-segment model, segmental myocardial scarring was graded on the basis of the amount of hyper-enhancement on DE-MRI. With TAG-MRI images, segmental %CS was calculated. RESULTS: Patients with CIHD had lower LV ejection fraction compared with the control patients (28% vs 67%). The %CS of normal segments was notably different from %CS of CIHD segments, regardless of the presence or absence of myocardial hyper-enhancement on DE-MRI. Among the CIHD segments, however, %CS correlated inversely with the amount of myocardial hyper-enhancement from scarring (P <.0001, r = -0.38). CONCLUSIONS: On cardiac MRI for CIHD, myocardial hyper-enhancement correlates inversely with %CS, supporting the direct relationship between the amount of remote myocardial scarring determined with nonstress DE-MRI and baseline resting functional impairment
— id: 45263, year: 2004, vol: 148, page: 342, stat: Journal Article,

Nonstress delayed-enhancement magnetic resonance imaging of the myocardium predicts improvement of function after revascularization for chronic ischemic heart disease with left ventricular dysfunction
Schvartzman, Paulo R; Srichai, Monvadi B; Grimm, Richard A; Obuchowski, Nancy A; Hammer, Donald F; McCarthy, Patrick M; Kasper, Jane M; White, Richard D
2003 Sep;146(3):535-541, American heart journal
BACKGROUND: The extent of myocardial scarring of the left ventricle (LV) is important in patients with chronic ischemic heart disease (CIHD). With delayed-enhancement magnetic resonance imaging (DE-MRI), scarred myocardium (hyper-enhanced) is easily distinguishable from viable (dark) myocardium. This investigation assessed the use of DE-MRI for predicting functional improvement after coronary artery bypass grafting (CABG) in patients with CIHD and significant LV dysfunction. METHODS: The patient population (n = 29) with CIHD and LV dysfunction (ejection fraction 28% +/- 10%) underwent both DE-MRI, to delineate scarred regions before revascularization, and echocardiography (Echo), to assess segmental function before and after CABG (interval 188 +/- 57 days). Using a 16-segment model, LV myocardium was semiquantitatively analyzed for scarring based on DE-MRI and for improvements in resting function by pre- and post-CABG Echo. RESULTS: Before CABG, 82% of targeted myocardial segments had abnormal contraction; 78% showed scarring, including 38% with greater than mild amounts (25%-100%). Normal contraction was found in 18% of segments before revascularization; scarred areas were identified in 42%, 84% of which had, at most, minimal amounts (0%-24%). Of segments with pre-CABG dysfunction, 82% with no evidence of scar recovered, compared to only 18% with > or =50% scarring. Amount of hyper-enhancement was a very good indicator of improvement of function, especially at the > or =50%/segment threshold; overall accuracy was 0.74 (95% CI 0.66-0.82, P <.001). CONCLUSIONS: In patients with CIHD and significant LV dysfunction, DE-MRI can predict likelihood of functional improvement after revascularization
— id: 45266, year: 2003, vol: 146, page: 535, stat: Journal Article,

Cardiac tamponade masking clinical presentation and hemodynamic effects of papillary muscle rupture after acute myocardial infarction
Srichai, Monvadi B; Casserly, Ivan P; Lever, Harry M
2002 Sep;15(9):1000-1003, Journal of the American Society of Echocardiography
A 67-year-old woman sustained an acute lateral-wall myocardial infarction and was treated with thrombolytic therapy. Postinfarction hypotension developed 3 days later. Clinical findings at that time were consistent with cardiac tamponade, and an echocardiographic study revealed a moderate-sized pericardial effusion. She underwent urgent pericardiocentesis with transient improvement in hemodynamics, followed by deterioration associated with the development of acute pulmonary edema. Follow-up transesophageal echocardiographic imaging revealed papillary muscle rupture with severe mitral regurgitation. The patient underwent urgent surgical intervention consisting of coronary artery bypass grafting and mitral valve replacement. The presence of cardiac tamponade in this patient masked the clinical manifestations of papillary muscle rupture through the hemodynamic effect of tamponade physiology on mitral regurgitation
— id: 45267, year: 2002, vol: 15, page: 1000, stat: Journal Article,

Effects of structural modifications on the photosensitizing properties of dialkylcarbocyanine dyes in homogeneous and heterogeneous solutions
Krieg M; Bilitz JM; Srichai MB; Redmond RW
1994 Mar 2;1199(2):149-156, Biochimica & biophysica acta
The photophysical characterization of structurally modified symmetric dialkylthiacarbocyanine dyes in homogeneous and biomimetic media is reported. The aim of the two specific structural modifications was to increase singlet oxygen production, hence enhancing the photosensitizing properties of these cyanine dyes. Specifically, (1) the sulfur was exchanged with selenium in order to enhance intersystem crossing via an internal heavy atom effect and (2) substituents of differing size were introduced into the meso-position of the polymethine chain to reduce photoisomerization. The result of incorporation of an internal heavy atom (selenium) into the structure of the dye yields the expected effect: this modification results in a 22-fold increase in the rate of intersystem crossing, but does not change the remaining competing deactivation rates of the first excited singlet state. As a consequence, singlet oxygen quantum yields increase from 0.001 to 0.014 in ethanol and from 0.006 to 0.08 in unilamellar liposomes. In the case of the meso-substituted thiacarbocyanine dyes, a significant reduction in photoisomerization is indeed observed. However, this modification drastically enhances internal conversion which then becomes the main deactivation pathway of the first excited singlet state. As a result, very small fluorescence and singlet oxygen quantum yields are obtained, e.g. 0.006 and 0.001, respectively, in ethanol
— id: 45269, year: 1994, vol: 1199, page: 149, stat: Journal Article,

Merocyanine dyes: effect of structural modifications on photophysical properties and biological activity
Redmond RW; Srichai MB; Bilitz JM; Schlomer DD; Krieg M
1994 Oct;60(4):348-355, Photochemistry & photobiology
Merocyanine derivatives were prepared by structural alterations at the barbituric acid or chalcogenazole moieties. The photophysical properties of the dyes were markedly influenced by the presence of selenium rather than sulfur as a substituent at position 2 of the barbiturate. In methanol, quantum yields of both triplet state (phi T) and singlet oxygen sensitization (phi delta) were increased by over an order of magnitude, with a concomitant decrease in fluorescence, when selenium was present in the molecule. Photoisomerization, one of the dominant deactivation pathways in the sulfur- or oxygen-containing analogues, was completely absent in the selenium-containing derivatives. Efficient triplet state formation was observed for selenium-containing derivatives incorporated into L1210 cells by diffuse reflectance laser flash photolysis. Cytotoxicity studies, carried out using clonogenic assays on L1210 leukemia cells, showed a good correlation with phi T and phi delta, measured in solution. Experimental evidence provided by this paper supports a triplet state-, and probably singlet oxygen-, mediated phototoxic mechanism. Photoisomerization or singlet state mechanisms can be discounted
— id: 45268, year: 1994, vol: 60, page: 348, stat: Journal Article,

Photophysical properties of 3,3'-dialkylthiacarbocyanine dyes in organized media: unilamellar liposomes and thin polymer films
Krieg M; Srichai MB; Redmond RW
1993 Sep 19;1151(2):168-174, Biochimica & biophysica acta
All symmetrical dialkylthiacarbocyanine dyes, with the exception of the diethyl derivatives, are incorporated into liposomes. Absorption and fluorescence data indicate a solubilization site close to the bilayer surface with the alkyl chains penetrating into the lipid bilayer. Incorporation into organized assemblies affects the photophysical parameters of these dyes. Photoisomerization occurring from the first excited state becomes more difficult as the restrictive effect of the solubilization site increases. As a consequence, competing deactivation processes, such as fluorescence and triplet formation, become more efficient with the result that fluorescence quantum yields, triplet yields and singlet oxygen quantum yields are larger in liposomes than in homogeneous solution. Dihexylthiacarbocyanine iodide has a fluorescence quantum yield of 0.27 and 0.10 (25 degrees C) in dimyristoylphosphatidyl-choline liposomes and ethanol, respectively, and the singlet oxygen yield increases by a factor three to 0.006 on going from ethanol to liposomes. The effect of a highly organized environment is even more pronounced in thin polymer films. In these systems, photoisomerization is completely inhibited and only triplet formation is observed in the transient absorption spectrum
— id: 45270, year: 1993, vol: 1151, page: 168, stat: Journal Article,