Papers by Bryan Rene Toledano
Catheterization and cardiovascular interventions, Mar 12, 2024
Journal of the American College of Cardiology, Apr 1, 2022
Journal of Asian Pacific Society of Cardiology
Background: The goal in the treatment of ST-elevation MI (STEMI) is prompt revascularisation. Thi... more Background: The goal in the treatment of ST-elevation MI (STEMI) is prompt revascularisation. This study aims to assess system delays and identify optimal target points within each step of the response program. Methods: This study included adults aged >19 years enrolled in the acute MI (AMI) registry due to STEMI and treated with emergency percutaneous coronary intervention (PCI) between January 2019 and June 2021. Door-to-balloon times and STEMI diagnosis-to-wire cross times were divided into Met and Unmet groups, and time frames were compared using the Mann–Whitney U-test. For time frames with no significant difference, the median of the Met group was adopted, whereas, for significantly different time frames, the optimal target points were chosen from the highest percentages of Met if the value was less than or equal to the target point and Unmet if the value was greater than the target point. ORs with 95% CIs from binary logistic regression were calculated to predict the Met s...
Journal of Asian Pacific Society of Cardiology
Background: Defining geographic areas of responsibility sheds light on the current status of the ... more Background: Defining geographic areas of responsibility sheds light on the current status of the acute coronary syndrome healthcare system and the unmet needs that will help plan for improvement. Methods: The list of registered percutaneous coronary intervention (PCI)-capable hospitals and the total members of adult interventional cardiologists per island from the Philippine Society of Cardiovascular Catheterization and Interventions as of January 2022 was used. A map was created by establishing a 120 km radius around each PCI-capable hospital, which was then employed to classify provinces as either covered, partially covered or not covered. Results: The analysis included 244 adult interventional cardiologists and 54 PCI-capable hospitals. Luzon registered the highest percentage of interventional cardiologists (85.7%) and PCI-capable hospitals (78.9%), followed by Visayas (8.6%) and (11.5%), and Mindanao (5.7%) and (9.6%), respectively. Most PCI-capable hospitals were privately owne...
European Heart Journal - Case Reports
Background Transcatheter treatment in post-infarction ventricular septal defects can be unique an... more Background Transcatheter treatment in post-infarction ventricular septal defects can be unique and complex; hence, the development of a new technique is needed to improve outcomes. Summary We describe two cases in which large and complex apical post-infarction ventricular septal defects were treated with a novel transcatheter approach as salvage and the other due to refusal for open surgical repair. By direct externalization and enmeshment of a device to the right ventricular moderator band, the defect was blocked and immediate improvement of haemodynamics was achieved. Conclusion In large, complex, apical post-infarction ventricular septal defects with no apical rims, the DEXTER technique allows for exclusion of the defect and vestigialization of the right ventricular apex. An immediate and dramatic haemodynamic improvement can therefore be achieved.
Journal of Asian Pacific Society of Cardiology
A mycotic aortic aneurysm is a rare and life-threatening condition, with the most common culprit ... more A mycotic aortic aneurysm is a rare and life-threatening condition, with the most common culprit being Staphylococcus aureus. The incidence varies widely from 0.6% to 13%. It usually affects immunocompromised patients, such as those undergoing haemodialysis who are subjected to repeated skin punctures. The insidiousness of the presentation of this high-risk condition makes diagnosis and management challenging. The authors document the case of a 75-year-old woman with multiple comorbidities on maintenance haemodialysis, who also recently underwent central line reinsertions, presenting with progressive leukocytosis and persistent anaemia. Diagnostic work-ups initially showed pneumonia and methicillin-resistant S aureus bacteraemia, later revealing infective endocarditis and a mycotic aortic aneurysm in the descending aorta with contained rupture. A hybrid two-step procedure with debranching and anastomoses of aortic branches was employed, followed by transthoracic endovascular aortic ...
Journal of the American College of Cardiology
Journal of Asian Pacific Society of Cardiology
In most epidemiological studies underweight and normal weight central obesity groups are either u... more In most epidemiological studies underweight and normal weight central obesity groups are either underrepresented, excluded, or merged to the normal weight category. This study aims to compare underweight and normal weight central obesity groups and possible age and gender differences in association with cardiovascular risk and diseases using a previous local study. Methods: Participants were Filipinos aged 20 years or older who had participated in and completed the desired data in the National Nutrition and Health Survey 2008. Participants were categorised into two groups: underweight and normal weight central obesity. The profiles of the groups were compared and their association with cardiovascular risks and diseases determined, using adjustment models for age and sex. Results: A total of 3,009 participants were included in this study: 684 (22.7%) underweight and 2,325 (77.3%) normal weight central obesity. The mean age for underweight participants was 47.8 years versus 43.2 years...
European Heart Journal, 2022
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): ... more Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Philippine Lipid Atherosclerotic Society Background Normal weight central obesity reflects an increased visceral fat and low lean mass hence its association with cardiovascular diseases Purpose The study aims to measure the prevalence of normal weight central obesity, to measure its association with cardiovascular diseases and to compare it across the different types of obesity among Filipinos. Methods The participants were Filipinos aged 20 years old and above who had participated and completed the desired data in the National Nutrition Survey II which employed a stratified multistage sampling that covered the entire Philippine population. The participants were categorized into the following groups: normal weight (NW) (BMI 18.5-24/9 kg/m²) and no central obesity; normal weight with central obesity (NWCO) (WC ≥80cm or WHR ≥ 0.85 for females, WC≥ 90cm or WHR ≥ 0.90 for males); overweight ...
European Heart Journal, 2022
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): ... more Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Philippine Lipid Atherosclerotic Society Background Normal weight central obesity reflects an increased visceral fat and low lean mass hence its association with cardiovascular diseases Purpose The study aims to measure the prevalence of normal weight central obesity, to measure its association with cardiovascular diseases and to compare it across the different types of obesity among Filipinos. Methods The participants were Filipinos aged 20 years old and above who had participated and completed the desired data in the National Nutrition Survey II which employed a stratified multistage sampling that covered the entire Philippine population. The participants were categorized into the following groups: normal weight (NW) (BMI 18.5-24/9 kg/m²) and no central obesity; normal weight with central obesity (NWCO) (WC ≥80cm or WHR ≥ 0.85 for females, WC≥ 90cm or WHR ≥ 0.90 for males); overweight ...
Journal of the American College of Cardiology, 2022
position the occluder device safely and securely without the need for contrast injection and risk... more position the occluder device safely and securely without the need for contrast injection and risk of embolism. After the opening of the device, a TEE check was performed (Figure 6). Contrast injection was done by hand. A pull-and-push maneuver was performed to check occluder stability and the device was successfully deployed. Patient was discharged home on the second postoperative day without any complication. At 2-month follow up the patient remained symptom free and 2D transthoracic echocardiography confirmed stable position of the LAA occluder with no residual leaks.
Journal of the American College of Cardiology, 2022
Background: Carcinoid heart disease is a rare but notable cause of valve pathology that leads to ... more Background: Carcinoid heart disease is a rare but notable cause of valve pathology that leads to heart failure without proper intervention. Depending on the extent of valve disease, therapeutic options often require invasive measures. Case: This is a case of a 52-year-old female with stage IV carcinoid tumor and tricuspid valvopathy s/p bioprosthetic tricuspid valve replacement 3 years ago presenting with dyspnea, a new systolic murmur, and Doppler parameters consistent with severe pulmonic stenosis. She underwent a novel approach that required advancing a balloon catheter through the bioprosthetic tricuspid valve to dilate the stenosed area. Decision-making: Echocardiographic assessment of the right heart proved vital in the diagnosis and perioperative appraisal of the patient's procedural success. What made the interpretation of the echocardiogram for this case more challenging was the bioprosthetic tricuspid valve that restricted movement of the right ventricular free wall and consequently confound the obtained results. This likely explains the inconsistency with the preoperative findings of normal RV FAC (43%) obtained by measuring total area change versus the abnormal TAPSE (1.5) and DTI-derived S' (5.97) which measure lateral annular movement towards the apex.
ASEAN Heart Journal, 2021
PURPOSE The gap in evidence in the management of multivalvular lesions can be addressed by provid... more PURPOSE The gap in evidence in the management of multivalvular lesions can be addressed by providing more data on clinical and echocardiographic outcomes after Percutaneous Mitral commissurotomy (PMC). METHODS Participants were Filipinos aged >/= 19 years old, admitted due to severe mitral stenosis with moderate to severe tricuspid regurgitation (TR). The outcome of PMC was divided into 2 groups: Significant TR which included the progression of moderate to severe TR or persistence of severe TR and Insignificant TR group which included those with mild TR, regression to moderate to mild TR, severe to moderate, or persistence of moderate TR. These groups were compared from baseline, 24th hour, 1st month, and 6th month using the same echocardiographic parameters. The numerical data between significant and nonsignificant tricuspid regurgitation were compared using non-parametric Mann Whitney U test and categorical data using the Chi-Square test. RESULTS A total of 38 participants were...
Journal of the American College of Cardiology, 2022
ASEAN Heart Journal, 2020
PURPOSE This is a local study conducted that describes the clinical profile and cost incurred of ... more PURPOSE This is a local study conducted that describes the clinical profile and cost incurred of patients with lymphedema among Filipinos seen in our institution. METHODS A descriptive study using the data from the Philippine Heart Center Lymphedema clinic from 2018-2020. It consists of the patient's name, age, sex, lymphedema onset, classification, type, stage, affected site, treatment modality, and the number of sessions. The cost incurred was based on the clinic's costing list, treatment modality, and the number of sessions rendered. RESULTS The analysis included a total of 97 patients. The mean age was 60.3 (± 14.3) years old, with female predominance (74.2% versus 25.8%). The majority is classified as secondary (91.8%) versus primary (8.2%). The classification of primary lymphedema are praecox (62.5%), congenital (25%) and tarda (12.5%) while for secondary it is cancer related (53.9%), phlebolymphedema (34.8%), lipolymphedema (3.4%), obesity induced 3.4%, traumarelated, infection (3.4%) and iatrogenic (1.1). The stage of severity is stage IIA (60.8%), III (17.6%), IIB (13.4%), and I (8.2%). The most affected site is bilateral lower extremities (30%), followed by left (18.5%) and right (17.5%) lower extremities. The right and left upper extremities showed equal (16.5%) with no bilateral upper extremities affectation. The majority of treatment is unilateral (68.8%) versus bilateral (31.2%) decompressive lymphatic therapy. The total cost incurred was an average of P17,753 per patient and mostly came from the private section (89.7%) versus (10.3%). CONCLUSION Lymphedema is a chronic and recurrent disease that carries a substantial cost to patients. Its exact incidence, treatment outcomes, and quality of life among Filipinos are yet to be explored. A clinical profile will be the first step to raise awareness and to identify the different subset of populations for prevention, support, and treatment.
ASEAN Heart Journal, 2020
BACKGROUND Aortobronchial fistula (ABF) is a rare complication of a chronic thoracic aneurysm. An... more BACKGROUND Aortobronchial fistula (ABF) is a rare complication of a chronic thoracic aneurysm. An ABF secondary to Disseminated Tuberculous (TB) Aortitis and Takayasu Arteritis (TA) may present with extensive combinations of aneurysms and stenoses in different parts of the arterial system with involvement of other organs. CASE PRESENTATION A 29-year-old Filipino female, married, who was admitted to our institution due to sudden massive hemoptysis. A Computed Tomography of the chest showed pulmonary tuberculosis with lymph node involvement and pseudoaneurysm of the descending aorta. The pertinent physical examinations are blood pressure (BP) differential of 20mmhg of upper extremities, painless multiple nodular tongue, multiple cervical, and supraclavicular lymphadenopathies, grade 3/6 holosystolic murmur. On Computed Tomography of the aorta, there are combinations of aneurysms of the mid to distal descending thoracic aorta, distal abdominal aorta, superior mesenteric artery with ste...
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Papers by Bryan Rene Toledano