Clinical Focus

  • Fellow
  • Interventional Cardiology

Professional Education

  • BMed MD, University of New South Wales, Sydney, Australia (2013)
  • FRACP, Royal Australian College of Physicians (2021)
  • MClinTRes, The University of Sydney, Australia, Clinical trials research (2022)
  • PhD, University of New South Wales, Sydney, Australia, Cardiac remodelling, aortic valve disease, machine learning, valve motion (2025)

All Publications

  • State-of-the-Art in Echocardiographic Strain Imaging of Arrhythmogenic Cardiomyopathy. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Meredith, T., Picard, M. H., Churchill, T. W., Bernard, S., Bertrand, P. B., Sanborn, D. M., Namasivayam, M. 2025

    Abstract

    BACKGROUND: Arrhythmogenic cardiomyopathy (ACM) is a genetic disorder marked by fibrofatty myocardial replacement, leading to ventricular dysfunction and life-threatening arrhythmias. Historically identified as a right ventricular disease, advances in cardiac magnetic resonance imaging (CMR) have revealed left ventricular involvement in some cases, underscoring the need for refined diagnostic criteria. Conventional echocardiographic methods lack sensitivity, particularly for early disease detection, while strain imaging holds promise for identifying subclinical dysfunction.OBJECTIVE: This review explores the advancements in echocardiographic strain imaging techniques for ACM diagnosis and prognosis, focusing on recent developments in right and left ventricular assessment, differentiation from athletic remodeling, and integration with CMR findings.METHODS: An extensive review of contemporary literature was conducted, analyzing diagnostic thresholds, prognostic significance, and the utility of echocardiographic strain imaging compared to standard measures.FINDINGS: Echocardiographic right ventricular strain assessment offers enhanced diagnostic sensitivity, identifying ACM in cases that fail to meet traditional echocardiographic criteria. Strain provides superior prognostic discrimination, correlating with risk of ventricular arrhythmias and disease progression. Left ventricular strain, particularly global longitudinal strain (GLS), detects subclinical dysfunction and predicts adverse outcomes, emphasizing its importance in left-dominant ACM phenotypes. Strain-based mechanical dispersion metrics also facilitate early disease detection and risk stratification.CONCLUSION: Echocardiographic strain imaging is a valuable, non-invasive tool for ACM, addressing gaps in traditional echocardiographic diagnostic criteria. Standardization of thresholds and broader integration into clinical practice are required to maximize its utility. Future directions include leveraging machine learning and multimodal imaging for comprehensive ACM characterization.

    View details for DOI 10.1016/j.echo.2025.11.007

    View details for PubMedID 41242619

  • Aortic valve leaflet motion for diagnosis and classification of aortic stenosis using single view echocardiography. Journal of cardiovascular imaging Meredith, T., Mohammed, F., Pomeroy, A., Barbieri, S., Meijering, E., Jorm, L., Roy, D., Hayward, C., Kovacic, J. C., Muller, D. W., Feneley, M. P., Namasivayam, M. 2025; 33 (1): 8

    Abstract

    BACKGROUND: Accurate classification of aortic stenosis (AS) severity remains challenging despite detailed echocardiographic assessment. Adjudication of severity is informed by subjective interpretation of aortic leaflet motion from the first image parasternal long axis (PLAX) view, but quantitative metrics of leaflet motion currently do not exist. The objectives of the study were to echocardiographically quantify aortic leaflet motion using the PLAX view and correlate motion data with Doppler-derived hemodynamic indices of disease severity, and predict significant AS using these isolated motion data.METHODS: PLAX loops from 200 patients with and without significant AS were analyzed. Linear and angular motion of the anterior (right coronary) leaflet were quantified and compared between severity grades. Three simple supervised machine learning classifiers were then trained to distinguish significant (moderate or worse) from nonsignificant AS and individual severity grades.RESULTS: Linear and angular displacement demonstrated strong correlation with aortic valve area (r=0.81 and r=0.74, respectively). Severe AS cases demonstrated global leaflet motion of 2.1mm, compared with 3.6 mm for moderate cases (P<0.01) and 9.2 mm for control cases (P<0.01). Severe cases demonstrated mean global angular rotation of 11°, significantly less than moderate (18°, P<0.01) and normal cases (47°, P<0.01). Using these novel metrics, a simple supervised machine learning model predicted significant AS with an accuracy of 90% and area under the receiver operator characteristics curve (AUC) of 0.96. Prediction of individual severity class was achieved with an accuracy of 72.5% and AUC of 0.88.CONCLUSIONS: Advancing severity of AS is associated with significantly reduced linear and angular leaflet displacement. Leaflet motion data can accurately classify AS using a single parasternal long axis view, without the need for hemodynamic or Doppler assessment. Our model, grounded in biological plausibility, simple linear algebra, and supervised machine learning, provides a highly explainable approach to disease identification and may hold significant clinical utility for the diagnosis and classification of AS.

    View details for DOI 10.1186/s44348-025-00051-8

    View details for PubMedID 40629469

  • Right Ventricular Function and Afterload Following Novel Transcatheter Tricuspid Valve Replacement. JACC. Case reports Kempton, H., Namasivayam, M., Meredith, T., Shaw, M., Jansz, P., Muller, D. W. 2025; 30 (11): 103312

    Abstract

    Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension and valvular heart disease. The accurate assessment of RV function is however limited by the presence of concomitant tricuspid regurgitation (TR). Implantation of a novel transcatheter tricuspid valve device in this case highlights the importance of recognizing these limitations, and the need to define alternative ways to measure RV systolic function, contextualized to pulmonary pressure in patients with severe TR. It also demonstrates the clinical potential of perforation of the pop-off zone in this prosthesis, to create mild residual TR, thereby reducing the increase in RV afterload of this intervention, and its impact on RV systolic function.

    View details for DOI 10.1016/j.jaccas.2025.103312

    View details for PubMedID 40409857

  • Low-flow Low-gradient Aortic Stenosis: Foundations, Challenges, and Solutions CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE Weir, L., Meredith, T., Hayward, C., Muller, D., Feneley, M., Namasivayam, M. 2025; 27 (1)

    View details for DOI 10.1007/s11936-025-01082-6

    View details for Web of Science ID 001443231700001

  • Machine learning cluster analysis identifies increased 12-month mortality risk in transcatheter aortic valve replacement recipients FRONTIERS IN CARDIOVASCULAR MEDICINE Meredith, T., Mohammed, F., Pomeroy, A., Barbieri, S., Meijering, E., Jorm, L., Roy, D., Kovacic, J., Feneley, M., Hayward, C., Muller, D., Namasivayam, M. 2025; 12: 1444658

    Abstract

    Long-term mortality risk is seldom re-assessed in contemporary clinical practice following successful transcatheter aortic valve implantation (TAVR). Unsupervised machine learning permits pattern discovery within complex multidimensional patient data and may facilitate recognition of groups requiring closer post-TAVR surveillance.We analysed and differentiated routinely collected demographic, biochemical, and cardiac imaging data into distinct clusters using unsupervised machine learning. k-means clustering was performed on data from 200 patients who underwent TAVR for severe aortic stenosis (AS). Input features were ranked according to their influence on cluster assignment. Survival analyses were performed with Kaplan-Meier and Cox proportional hazards models. Nested cox models were used to identify any incremental prognostic benefit cluster assignment achieved beyond conventional risk scores.Analysis identified two distinct clusters. Compared to Cluster 1, Cluster 2 demonstrated significantly worse all-cause mortality at 12 months (HR 6.3, p < 0.01), and was characterised by more advanced cardiac remodelling with worse indices of multi-chamber cardiac function, as quantified by strain imaging. Cluster assignment demonstrated greater predictive power for 12-month mortality as compared with conventional risk and frailty calculators.k-means clustering identified two prognostically distinct phenogroups of patients who had undergone TAVR with better discriminatory power than conventional risk and frailty calculators. Our results highlight the utility of machine learning applications for clinical risk prediction and scope to improve patient surveillance.

    View details for DOI 10.3389/fcvm.2025.1444658

    View details for Web of Science ID 001425326300001

    View details for PubMedID 39974597

    View details for PubMedCentralID PMC11836646

  • Machine Learning Cluster Analysis Identifies Increased 12-Month Mortality Risk in Transcatheter Aortic Valve Replacement Recipients Meredith, T., Mohammed, F., Pomeroy, A., Barbieri, S., Meijering, E., Jorm, L., Feneley, M., Muller, D. ELSEVIER SCIENCE INC. 2024: B20

    View details for Web of Science ID 001345355600046

  • The influence of transcatheter aortic valve replacement on left atrial mechanics: a systematic review and meta-analysis. European heart journal. Imaging methods and practice Meredith, T., Brown, L., Mohammed, F., Pomeroy, A., Roy, D., Muller, D. W., Hayward, C., Feneley, M., Namasivayam, M. 2024; 2 (2): qyae026

    Abstract

    Aims: The morphology and function of the left atrium (LA) are intimately tied to left ventricular loading conditions. Data pertaining to the effect of transcatheter aortic valve replacement (TAVR) on LA function and geometry are scarce. The aim of the study was to quantify associations between TAVR and LA remodelling by pooling available data from published observational studies.Methods and results: A systematic review and meta-analysis were performed. Studies reporting serial LA speckle-tracking echocardiographic (STE) data, before and after TAVR, were included. Other outcome data included LA area and indexed volume (LAVi) and standard chamber measurements. Outcomes were stratified by timing of follow-up echocardiography: early (<6 months) or late (≥6 months). Twelve studies were included, comprising 1066 patients. The mean reduction in LAVi was 2.72 mL/m2 [95% confidence interval (CI) 1.37-4.06, P < 0.01]. LA reservoir function improved overall by a mean difference (MD) of 3.71% (95% CI 1.82-5.6, P < 0.01), although there was significant heterogeneity within the pooled studies (I 2 = 87.3%). Significant improvement in reservoir strain was seen in both early follow-up (MD 3.1%, P < 0.01) and late follow-up studies (MD 4.48%, P = 0.03), but heterogeneity remained high (I 2 = 65.23 and 94.4%, respectively). Six studies reported a change in LA contractile function, which recovered in the early follow-up studies (MD 2.26, P < 0.01), but not in the late group (MD 1.41, P = 0.05). Pooled improvement in LA booster function was 1.96% (95% CI 1.11-2.8, P < 0.01).Conclusion: TAVR is associated with significant negative LA remodelling, and an improvement in LA mechanics, quantified by STE. The prognostic implications of these findings require further study.

    View details for DOI 10.1093/ehjimp/qyae026

    View details for PubMedID 39045464

  • Strain Assessment in Aortic Stenosis: Pathophysiology and Clinical Utility JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY Meredith, T., Roy, D., Hayward, C., Feneley, M., Kovacic, J., Muller, D., Namasivayam, M. 2024; 37 (1): 64-76

    Abstract

    Contemporary echocardiographic criteria for grading aortic stenosis severity have remained relatively unchanged, despite significant advances in noninvasive imaging techniques over the last 2 decades. More recently, attention has shifted to the ventricular response to aortic stenosis and how this might be quantified. Global longitudinal strain, semiautomatically calculated from standard two-dimensional echocardiographic images, has been the focus of extensive research. Global longitudinal strain is a sensitive marker of subtle hypertrophy-related impairment in left ventricular function and has shown promise as a relatively robust prognostic marker, both independently and when added to severity classification systems. Herein we review the pathophysiological basis underpinning the potential utility of global longitudinal strain in the assessment of aortic stenosis, as well as its potential role in quantifying myocardial recovery and prognostic discrimination following aortic valve replacement.

    View details for DOI 10.1016/j.echo.2023.10.001

    View details for Web of Science ID 001152334500001

    View details for PubMedID 37805144

  • A Clinician's Guide to the Changing Aortic Stenosis Landscape: Updates in Aortic Stenosis Diagnosis, Surveillance and Management CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE Meredith, T., Roy, D., Muller, D., Namasivayam, M. 2023; 25 (11): 675-688

    View details for DOI 10.1007/s11936-023-01020-4

    View details for Web of Science ID 001098737900001

  • Machine learning prediction of progressive subclinical myocardial dysfunction in moderate aortic stenosis FRONTIERS IN CARDIOVASCULAR MEDICINE Namasivayam, M., Meredith, T., Muller, D. W. M., Roy, D. A., Roy, A. K., Kovacic, J. C., Hayward, C. S., Feneley, M. P. 2023; 10: 1153814

    Abstract

    Moderate severity aortic stenosis (AS) is poorly understood, is associated with subclinical myocardial dysfunction, and can lead to adverse outcome rates that are comparable to severe AS. Factors associated with progressive myocardial dysfunction in moderate AS are not well described. Artificial neural networks (ANNs) can identify patterns, inform clinical risk, and identify features of importance in clinical datasets.We conducted ANN analyses on longitudinal echocardiographic data collected from 66 individuals with moderate AS who underwent serial echocardiography at our institution. Image phenotyping involved left ventricular global longitudinal strain (GLS) and valve stenosis severity (including energetics) analysis. ANNs were constructed using two multilayer perceptron models. The first model was developed to predict change in GLS from baseline echocardiography alone and the second to predict change in GLS using data from baseline and serial echocardiography. ANNs used a single hidden layer architecture and a 70%:30% training/testing split.Over a median follow-up interval of 1.3 years, change in GLS (≤ or >median change) could be predicted with accuracy rates of 95% in training and 93% in testing using ANN with inputs from baseline echocardiogram data alone (AUC: 0.997). The four most important predictive baseline features (reported as normalized % importance relative to most important feature) were peak gradient (100%), energy loss (93%), GLS (80%), and DI < 0.25 (50%). When a further model was run including inputs from both baseline and serial echocardiography (AUC 0.844), the top four features of importance were change in dimensionless index between index and follow-up studies (100%), baseline peak gradient (79%), baseline energy loss (72%), and baseline GLS (63%).Artificial neural networks can predict progressive subclinical myocardial dysfunction with high accuracy in moderate AS and identify features of importance. Key features associated with classifying progression in subclinical myocardial dysfunction included peak gradient, dimensionless index, GLS, and hydraulic load (energy loss), suggesting that these features should be closely evaluated and monitored in AS.

    View details for DOI 10.3389/fcvm.2023.1153814

    View details for Web of Science ID 001006836300001

    View details for PubMedID 37324638

    View details for PubMedCentralID PMC10266266

  • MACHINE LEARNING PREDICTION OF PROGRESSIVE SUBCLINICAL MYOCARDIAL DYSFUNCTION IN MODERATE AORTIC STENOSIS Namasivayam, M., Meredith, T., Muller, D. W. M., Roy, D., Roy, A. K., Kovacic, J., Hayward, C. S., Feneley, M. P. ELSEVIER SCIENCE INC. 2023: 1398

    View details for Web of Science ID 000990866101410

  • Coronary angiography of the ex-situ beating donor heart in a portable organ care system CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Meredith, T., Scheuer, S., Hoffman, M., Joshi, Y., Kathir, K., Gunalingam, B., Roy, D., Wilson, S., Jansz, P., Macdonald, P., Muller, D. 2022; 100 (7): 1252-1260

    Abstract

    To determine safety and feasibility of ex-situ coronary angiography.To cater for the perpetually growing demand for heart donors, interest in donation following circulatory death (DCD) has been rekindled. Further pursuit of donor pool expansion has led to eligibility extension to "marginal" donors who are at higher risk of coronary artery disease (CAD). Excluding CAD in potentially eligible DCD donors, for whom ante-mortem angiography is commonly not permitted, is therefore challenging. Ex-situ coronary angiography serves as an ethical and feasible diagnostic tool to assess for preclusive CAD.We undertook a systematic review of the published literature and institutional retrospective review of case experience with ex-situ coronary angiography of donor hearts, supported by a portable organ care system.Combined literature and institutional case review yielded nine total cases of ex-situ coronary angiography of donor human hearts plus one experimental porcine model. Of the eight cases of ex-situ coronary angiography performed at our institute, all were conducted without complication or injury to the allograft. Two thirds of reported human cases have proceeded to successful transplantation.Diagnostic coronary angiography of the ex-situ beating donor heart is safe, feasible, and demonstrates novel clinical utility in mitigating subsequent transplantation of unsuitable allografts. In the setting of suspected coronary atherosclerosis of the donor heart, which may preclude favorable transplantation outcomes, ex-situ coronary angiography should be considered at eligible transplant centers.

    View details for DOI 10.1002/ccd.30455

    View details for Web of Science ID 000877533000001

    View details for PubMedID 36321629

    View details for PubMedCentralID PMC10091975

  • Extracorporeal Membrane Oxygenation-Supported Transcatheter Mitral Valve-in-Valve Replacement and Paravalvular Plugging for Critical Prosthetic Mitral Stenosis. JACC. Case reports Meredith, T., Gorrie, N., Roy, D., Muller, D. W. 2022; 4 (8): 491-496

    Abstract

    We present the case of a patient with rapidly progressive bioprosthetic mitral valve stenosis in the setting of end-stage renal failure. Critical valve stenosis led to cardiogenic shock requiring full hemodynamic support. Emergent extracorporeal membrane oxygenation-supported transcatheter mitral valve-in-valve implantation was successfully undertaken as a life-saving measure with an excellent final result. (Level of Difficulty: Advanced.).

    View details for DOI 10.1016/j.jaccas.2022.02.017

    View details for PubMedID 35493798

  • Importance of electromagnetic interactions between ICD and VAD devices-Mechanistic assessment ARTIFICIAL ORGANS Schnegg, B., Robson, D., Furholz, M., Meredith, T., Kessler, C., Baldinger, S. H., Hayward, C. 2022; 46 (6): 1132-1141

    Abstract

    Implanted cardioverter defibrillators (ICDs) and left ventricular assist devices (LVADs) are established interventions that prolong life in advanced heart failure, but their combination has not been demonstrated as beneficial. Electromagnetic interference (EMI) produced by a LVAD can preclude ICD interrogation with external programmers. We undertook a systematic evaluation of the LVAD-ICD interaction "in-vitro" to clarify the extent of this interaction.Using explanted ICDs and VADs in a mock physiological rig, we assessed interrogation and reprogramming of ICD devices in the presence of a running LVAD. When connectivity between the ICD programmer and the ICD failed, we attempted three different techniques to re-establish connectivity: (1) Electromagnetic shielding of the ICD with a pseudo-faraday cage; (2) altering the LVAD speed; and (3) increasing the distance between the VAD and the ICD.We tested a total of 24 ICDs from different manufacturers in the presence of the Heartware (HW) and HeartMate 3 (HM3) LVADs. With HW, we only observed interaction with Biotronik ICD devices at very close range (0-6 cm). With HM3, only Medtronic ICD devices showed no interaction. Interactions could be mitigated by increasing the VAD-ICD distance.LVADs, notably the HM3, produce EMI that interferes with the communication between an ICD and its respective programmer. This may need to be considered when choosing the type of VAD to implant in patients with a previously implanted left-sided ICD. The only safe way to regain connectivity is to increase the distance between the VAD and the ICD, with patients raising their arm above their head.

    View details for DOI 10.1111/aor.14167

    View details for Web of Science ID 000742819300001

    View details for PubMedID 34978729

  • Heart failure therapies for the prevention of HER2-monoclonal antibody-mediated cardiotoxicity: A systematic review and meta-analysis Brown, L. J., Meredith, T., Yu, J., Patel, A., Neal, B., Arnott, C., Lim, E. WILEY. 2021: 119

    View details for Web of Science ID 000717281500164

  • Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials CANCERS Brown, L. J., Meredith, T., Yu, J., Patel, A., Neal, B., Arnott, C., Lim, E. 2021; 13 (21)

    Abstract

    Monoclonal antibodies including trastuzumab, pertuzumab, and antibody-drug conjugates, form the backbone of HER2-positive breast cancer therapy. Unfortunately, an important adverse effect of these agents is cardiotoxicity, occurring in approximately 10% of patients. There is increasing published data regarding prevention strategies for cardiotoxicity, though seldom used in clinical practice. We performed a systematic review and meta-analysis of randomized-controlled trials to evaluate pharmacotherapy for the prevention of monoclonal HER2-directed antibody-induced cardiotoxicity in patients with breast cancer. Online databases were queried from their inception until October 2021. Effects were determined by calculating risk ratios (RRs) and 95% confidence intervals (CI) or mean differences (MD) using random-effects models. We identified five eligible trials. In the three trials (n = 952) reporting data on the primary outcome of cardiotoxicity, there was no clear effect for patients assigned active treatment compared to control (RR = 0.90, 95% CI 0.63 to 1.29, p = 0.57). Effects were similar for ACE-I/ARB and beta-blockers (p homogeneity = 0.50). Active treatment reduced the risk of HER2 therapy interruptions (RR = 0.57, 95% CI 0.43 to 0.77, p < 0.001) with similar findings for ACE-I/ARB and beta-blockers (p homogeneity = 0.97). Prophylactic treatment with ACE-I/ARB or beta-blocker therapy may be of value for cardio-protection in patients with breast cancer prescribed monoclonal antibodies. Further, adequately powered randomized trials are required to define the role of routine prophylactic treatment in this patient group.

    View details for DOI 10.3390/cancers13215527

    View details for Web of Science ID 000726209100001

    View details for PubMedID 34771689

    View details for PubMedCentralID PMC8583665

  • The use of direct oral anticoagulants in patients with ventricular assist devices: Is there hope for Factor Xa inhibition? ARTIFICIAL ORGANS Meredith, T., Schnegg, B., Hayward, C. 2021; 45 (5): E123-E129

    Abstract

    The use of continuous-flow ventricular assist devices (cf-VAD) necessitates systemic anticoagulation, routinely with vitamin K antagonists (VKA). Newer direct oral anticoagulants (DOACs) have significant advantages over VKA in providing a predictable level of systemic anticoagulation without frequent monitoring or strict dietary surveillance. Despite randomized evidence demonstrating their usefulness in several conditions including atrial fibrillation, there is limited data pertaining to their use in cf-VAD patients. Early reports of adverse outcomes has resulted in a Class III recommendation, advising against DOACs generally in cf-VAD patients. Recent reports suggest there may be a role for certain DOACs; as such we present a systematic review identifying studies reporting DOAC uses in patients with a cf-VAD. We identified eight pertinent studies, including a single randomized controlled trial and seven case reports/series. Limited numbers and significant study heterogeneity limits interpretation; however, Factor Xa inhibitors appear to be feasible alternatives, favorable to direct thrombin inhibitors, although further research is required.

    View details for DOI 10.1111/aor.13848

    View details for Web of Science ID 000626135300001

    View details for PubMedID 33084087

  • Spontaneous Oscillatory Left Ventricular-Aortic Uncoupling Under Continuous-Flow Left Ventricular Assist Device Support CIRCULATION-HEART FAILURE Jain, P., Meredith, T., Adji, A., Schnegg, B., Hayward, C. S. 2021; 14 (2): e007658

    View details for DOI 10.1161/CIRCHEARTFAILURE.120.007658

    View details for Web of Science ID 000639306500011

    View details for PubMedID 33504157

  • Colonic malakoplakia in a dual stem cell and cardiac transplant recipient: A case report and literature review TRANSPLANT INFECTIOUS DISEASE Meredith, T., Dharan, N., Killen, L., Anandabaskaran, S., Kim, A., Yang, T., Marriott, D., Hayward, C., Macdonald, P. 2021; 23 (2): e13488

    Abstract

    We describe the first published case of malakoplakia in a dual stem cell and cardiac transplant recipient. In the 2 months following cardiac transplantation, our patient developed persistent diarrhea and recurrent E coli bacteremia. Biopsies obtained from areas of colonic thickening revealed malakoplakia. Despite improvement in symptoms with prolonged antimicrobial therapy and reduction of his immunosuppression, he eventually died from sepsis. Our case highlights not only the importance of the timely diagnosis of this rare disorder, but also the difficulty in determining optimal treatment duration, particularly where excision of involved areas is not possible, as data on this disease are lacking. Here we describe our case and review the available literature published on malakoplakia in the cardiac transplant population.

    View details for DOI 10.1111/tid.13488

    View details for Web of Science ID 000580607400001

    View details for PubMedID 33034139

  • The Challenge of Researching Pre-Treatment Omission With Invasive Strategy Timing in NSTEACS JACC-CARDIOVASCULAR INTERVENTIONS Meredith, T., Nadel, J., Jain, P., Roy, D. 2020; 13 (14): 1726

    View details for DOI 10.1016/j.jcin.2020.05.019

    View details for Web of Science ID 000550286800021

    View details for PubMedID 32703600

  • Recanalization of an atretic left internal mammary graft after bypass surgery for an anomalous left main coronary artery origin: a case report EUROPEAN HEART JOURNAL-CASE REPORTS Meredith, T., Jansz, P., Sesel, K., Kathir, K. 2019; 3 (1): yty152

    Abstract

    The inter-arterial anomalous course of the left main coronary artery (LMCA) originating from the right coronary sinus of Valsalva is a rare, though potentially lethal pathology. Coronary artery bypass grafting is a potential surgical therapy with previously reported success, however, there is concern for the possibility of graft occlusion in the setting of competitive native vessel flow.A 48-year-old gentleman presented to our facility with a non-ST elevation acute coronary syndrome. A malignant anomalous course of the LMCA was confirmed using invasive coronary angiography and computed tomography (CT). The patient underwent surgical revascularization of the left anterior descending artery with a left internal mammary artery (LIMA) graft, which was found to be atretic on follow-up CT. Seven years later the patient underwent repeat CT imaging, which confirmed recanalization of the previously atretic LIMA.We present the first documented case of a patient with spontaneous recanalization of an occluded LIMA following bypass surgery for an inter-arterial anomalous course of the LMCA. We postulate that the dynamic obstruction of the anomalous LMCA led to variable flow dependence on the bypass graft and subsequent atresia of the LIMA, due to the favourable native flow conditions in the absence of significant obstructive coronary disease. The exact mechanism of LIMA recanalization remains unclear, but in our case may have been partly mediated by a small increase in left main plaque.

    View details for DOI 10.1093/ehjcr/yty152

    View details for Web of Science ID 000645605500005

    View details for PubMedID 31020228

    View details for PubMedCentralID PMC6439389

  • Isolated myocardial relapse of Philadelphia-positive acute lymphoblastic leukaemia causing myocarditis: a case report EUROPEAN HEART JOURNAL-CASE REPORTS Nadel, J., Meredith, T., Anthony, C., Sivasubramaniam, V., Jabbour, A. 2018; 2 (4): yty104

    Abstract

    Relapse of acute lymphoblastic leukaemia (ALL) causes significant morbidity. Extramedullary relapse is seldom isolated to one site and almost always coexists with extensive marrow disease. Leukaemic infiltration of the myocardium is a well described entity, evident in up to 44% of patients at post-mortem examination; however, ante-mortem diagnosis remains difficult and rare. As a result, myocardial involvement in the absence of any other foci of relapse has only seldom been reported.Here, we present an unusual case of isolated gross intracardiac relapse of ALL in a patient presenting with chest pain and fevers. Both cardiac magnetic resonance imaging and endomyocardial biopsy were utilized in the diagnosis and identified leukaemic infiltrate in the absence of peripheral lymphoblasts.Despite evidence supporting a positive correlation between peripheral lymphocyte count and myocardial infiltration, our case highlights the rare and hypothesis-driving occurrence of myocardial infiltration with a complete absence of a peripheral lymphoblastosis. The report highlights the utility of modern histopathological and imaging modalities in the diagnosis of isolated myocardial relapse of ALL and provides insight into the aetiologies driving this process.

    View details for DOI 10.1093/ehjcr/yty104

    View details for Web of Science ID 000645588900004

    View details for PubMedID 31020180

    View details for PubMedCentralID PMC6426045

  • Pushing beyond the limit: a novel clinical sign of thoracic aortic dissection. BMJ case reports Meredith, T., Jain, P., Feneley, M. 2017; 2017

    Abstract

    The timely diagnosis of aortic dissection is notoriously confounded by unreliable symptomatology. We present a previously unreported clinical sign: thoracic pain reproduced by abdominal palpation. Our case illustrates the dependence of traditional clinical features on the anatomical location of an aortic dissection and lends weight to the concept of aortic pain as being a dynamic product of inter-related changes in intraluminal pressure, volume, wall stress and diameter. The clinical sign we describe may be very specific of acute aortic pathology.

    View details for DOI 10.1136/bcr-2017-221653

    View details for PubMedID 29167214