Dr. Thomas  Wisenbaugh  Md image

Dr. Thomas Wisenbaugh Md

1 Jarrett White Rd Tripler Army Medical Center Cardiology Section
Tripler Amc HI 96859
808 331-1225
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 12589
NPI: 1528049533
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Transcatheter closure of secundum-type atrial septal defect after failed surgical intervention. - Military medicine
Atrial septal defect (ASD) closure is routinely performed using transcatheter closure under echocardiographic guidance.A 24-year-old male was evaluated for a newly detected heart murmur. This was the first time a murmur or any other cardiac abnormalities were detected. He reported no symptoms of chest pain, dyspnea, palpitations, and reported being able to run without limitations. Physical examination revealed a short-grade systolic murmur consistent with high pulmonary flow in the left sternal border. A transesophageal echocardiogram revealed a 28-mm secundum ASD with right ventricular and right atrial enlargement. Percutaneous closure device was initially contemplated but was deferred secondary to the size of ASD and the lack of inferior rim. He then underwent open surgical closure, which was complicated by reoperation for bleeding and incomplete ASD closure. However, the surgery provided a new generous inferoposterior rim from scar tissue to perform percutaneous closure.This case illustrates an example of a patient with a significant ASD with an initially inadequate rim to perform a successful percutaneous closure. Following a failed surgical closure, the patient had developed enough scar tissue in the previously inadequate rim to undergo a successful percutaneous closure that resolved his defect.Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.
Ten years of percutaneous coronary intervention in a low-volume military treatment facility: a quality improvement project. - Military medicine
The quality assurance of a percutaneous coronary intervention (PCI) program is particularly important when the volume of procedures is low in the center.Determine predictors of the 30-day and long-term incidence of stent thrombosis, myocardial infarction, and death from any cause for all PCIs performed at Tripler Army Medical Center from January 2002 to June 2012.929 PCIs were performed in 795 patients, resulting in an average PCI volume of 88 per year. Follow-up data were obtained for 99.8% of the patients at 30 days and for 83% at 3 years.18 deaths occurred during the first 30 days after PCI, with an observed morality rate of 2.26%. Multivariate logistic regression identified independent predictors of death at 30 days: stent thrombosis (OR 96), acute myocardial infarction, hemodynamic instability (OR 47), emergent (OR 17) or salvage (OR 28) PCI, and the need for preprocedural balloon pumping (OR 27). The long-term survival Kaplan-Meier estimates were 94% at 1 year and 90.4% at 3 years.The 30-day mortality was similar to the expected mortality based on the risk factors in the New York State Registry model, and long-term survival was comparable with that reported in large registries.Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.
Percutaneous coronary intervention outcomes in a low-volume center: survival, stent thrombosis, and repeat revascularization. - Circulation. Cardiovascular quality and outcomes
American College of Cardiology (ACC) guidelines state that percutaneous coronary interventions (PCI) be performed at centers and by operators with high-volume (>400 yearly/center) whose historical and current risk-adjusted outcomes statistics are comparable to those reported in large registries. Tripler Army Medical Center is a low-volume treatment facility but has a geographic need and special mission requirement for providing this service.We computed 30-day incidence of stent thrombosis, need for repeat revascularization, and all-cause mortality for all PCIs performed at Tripler from January 2002 through June 2008. The New York State Registry regression model was selected among 3 risk-adjustment models that we assessed in our patients. This model was used to compute expected mortality rate based on patient risk factors. The 30-day incidence of stent thrombosis and repeat revascularization was also determined, and the long-term incidence of these events was estimated with the Kaplan-Meier method as was survival. For all 546 PCI procedures, 30-day mortality was 1.47%, the incidence of stent thrombosis 2.1%, the incidence of any repeat revascularization 5.1%, and the combined event rate 5.9%. Based on risk factors used in the New York State Registry, our expected mortality was 1.93% and not significantly different from the observed rate. Although survival at 1 and 3 years appeared comparable with benchmarks at 94.6% and 89.3%, as did repeat revascularization rates at 13.0% and 21.4%, the incidence of stent thrombosis was regarded as high whether the definition included possible cases (3.2% and 3.9%) or only those regarded as definite or probable (2.7% and 3.1%). We did not identify any remediable risk factors for stent thrombosis, nor were we able to identify significant differences by year or by operator. However, visual inspection of a plot of deciles of New York State risk of death demonstrated 2 outlier cases among the 8 who died, who could have been considered candidates for thorough peer review.We recommend other low-volume interventional programs enter all patients undergoing PCI into a database, their own local registry even if not a national one such as the American College of Cardiology National Cardiovascular Data Registry, obtain information about survival and cardiac events during follow-up, compute and risk-adjust in-hospital or 30-day mortality, and use the objective assessment of risk in individual patients to identify outliers when outcome is adverse, and possibly as a means of triaging patients to appropriate therapy before choosing PCI.
Prosthetic mitral valvuloplasty. - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
A 78-year-old man underwent mitral valve replacement with a no. 33 Hancock porcine bioprosthesis for severe mitral regurgitation. Postoperatively, a transthoracic echocardiogram (TTE) revealed a mean mitral valve gradient (MVG) of 4 mm Hg, a calculated mitral valve area (MVA) of 2.8 cm(2), and no mitral regurgitation. Eighteen months later, he presented to the emergency room with progressive dyspnea. Repeat TTE demonstrated severe mitral stenosis (MVG, 16 mm Hg; MVA, 0.9 cm(2)). The patient was deemed high risk for a repeat valve replacement, and percutaneous valvuloplasty was performed with an Inoue balloon catheter inflated to 26 mm. The patient's symptoms dramatically improved, as did his hemodynamics (MVG, 5 mm Hg; MVA, 1.6 cm(2)). There was no evidence of mitral regurgitation and the successful results were maintained after 10 months of follow-up. Since its introduction in 1987, there have been only nine cases reporting successful balloon valvulotomy in prosthetic mitral valves. While percutaneous valvulotomy is the intervention of choice for native mitral stenosis, it is rarely performed in prosthetic valves, with surgical valve replacement being the treatment of choice. Our case was successful and may suggest a niche to reconsider using the procedure in certain clinical circumstances.(c) 2004 Wiley-Liss, Inc.

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1 Jarrett White Rd Tripler Army Medical Center Cardiology Section Tripler Amc, HI 96859
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