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Barry L Karon

Publications and source records attributed to Barry L Karon.

5 recordsLinked to original sources
PubMed2006

Giant coronary artery aneurysm causing superior vena cava syndrome and congestive heart failure.

Coronary artery aneurysms are defined as localized coronary artery dilations >1.5 times the diameter of the adjacent segments. In adults, they are commonly of atherosclerotic origin and are usually asymptomatic. This is the first case report of a coronary artery aneurysm causing superior vena cava syndrome and heart failure. Chest x-ray showed cardiomegaly, and transthoracic echocardiography showed a mass that was confirmed by transesophageal echocardiography, computed tomography, and coronary angiography. In conclusion, giant coronary artery aneurysms can cause superior vena cava syndrome.

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PubMed2006

Use of a novel ultrafiltration device as a treatment strategy for diuretic resistant, refractory heart failure: initial clinical experience in a single center.

BACKGROUND: The System 100 UF device allows ultrafiltration (UF) via peripheral access and is approved for use in heart failure (HF), although clinical trials defining optimal target population and clinical utility are lacking. We report our initial experience with clinical use of this system in very advanced, diuretic resistant HF patients. METHODS AND RESULTS: Eleven HF patients (mean age 70 years) underwent 1 to 5 UF treatments each (total 32 UF). The goal was to remove 4 liters of fluid per 8-hour UF. Baseline creatinine averaged 2.2 mg/dL (range .9-3.2) while estimated glomerular filtration rates (GFRs) averaged 38 mL/min (range 20-87). Nine patients (82%) had moderate (GFR 30-59; n = 3) or severe (GFR <30; n = 6) renal dysfunction. Nine patients (82%) had documented right ventricular dysfunction, 6 with severe tricuspid regurgitation. Average daily intravenous furosemide dose prior to UF was 258 mg (range 80-480). Patients had received nesiritide (n = 4), dopamine (n = 4), and zaroxylyn (n = 7) prior to UF. Of the 32 UF treatments, 13 (41%) removed >3500 mL, 11 (34%) removed 2500-3500 mL, and 8 (25%) removed <2500 mL. Only one UF treatment (3%) was aborted due to hypotension. There were no significant complications related to UF. Five patients (45%) experienced an increase in creatinine of >.3 mg/dl. Five patients required dialysis for persistent diuretic resistant volume overload or uremic symptoms. Six-month mortality was 55%. CONCLUSIONS: Peripheral UF safely but variably removed fluid. In this very high-risk, advanced HF population, 45% of patients developed worsening renal function during UF therapy. Controlled studies are needed to determine the impact of UF on renal function and outcomes in high-risk populations such as this.

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PubMed2005

Diastolic dysfunction and left atrial volume: a population-based study.

OBJECTIVES: We examined the association between diastolic function and left atrial volume indexed to body surface area (LAVi) in a population-based study. BACKGROUND: Atrial enlargement has been suggested as a marker of the severity and duration of diastolic dysfunction (DD). However, the association between DD and atrial enlargement and their individual prognostic implications in the population is poorly defined. METHODS: A cross-sectional sample of Olmsted County, Minnesota, residents > or =45 years of age (n=2,042) underwent comprehensive Doppler echocardiography and medical record review. RESULTS: The LAVi increased with worsening DD: 23 +/- 6 ml/m2 (normal), 25 +/- 8 ml/m2 (grade I DD), 31 +/- 8 ml/m2 (grade II DD), 48 +/- 12 ml/m2 (grades III to IV DD). In bivariate analyses, age, left ventricular mass index, and DD grade were positively associated, whereas female gender and ejection fraction (EF) were inversely associated with LAVi (p <0.001 for all). When controlling for age, gender, cardiovascular (CV) disease, EF, and left ventricular mass, grade II DD was associated with a 24%, and grade III to IV DD was associated with a 62% larger LA volume (p <0.0001 for both). The area under the receiver-operator characteristic curve for LAVi to detect grade I, grade II, or grade III to IV DD was 0.57, 0.81, and 0.98, respectively. Both DD and LAVi were predictive of all-cause mortality, but when controlling for DD, LAVi was not an independent predictor of mortality. CONCLUSIONS: These data suggest that DD contributes to LA remodeling. Indeed, DD is a stronger predictor of mortality; presumably it better reflects the impact of CV disease within the general population.

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