Journal of cardiovascular medicine
-
J Cardiovasc Med (Hagerstown) · May 2009
Case ReportsA rare case of mitro-aortic intervalvular fibrosa aneurysm evolving in the para-aortic cavity.
The mitro-aortic intervalvular fibrosa (MAIF) connects the anterior mitral leaflet to the posterior portion of the aortic annulus. The aneurysms of MAIF represent a complication of aortic valve endocarditis, but blunt chest trauma, aortic valve replacement and congenital heart disease have also been reported as a cause. We describe a case of an aneurysm of MAIF, whose progression was documented by serial echocardiographic observations. To the best of our knowledge, this very rare occurrence has not been reported previously.
-
J Cardiovasc Med (Hagerstown) · May 2009
Transcatheter aortic valve implantation in the operating room: early experience.
Aortic stenosis is the most common valvular heart disease in the Western world and the proportion of patients unsuitable for conventional surgery is increasing as a result of aging and comorbidities. We report our early experience with transcatheter aortic valve implantation in high-risk patients with severe symptomatic aortic stenosis. ⋯ The present study confirms the excellent hemodynamic performances of the transcatheter-implanted aortic prosthesis, with both transarterial and transapical approaches, in inoperable candidates with end-stage aortic stenosis. With progressive improvement in patient selection, techniques, equipment, and operator endovascular skills, vascular complications can decline further.
-
J Cardiovasc Med (Hagerstown) · May 2009
Is it too early to recommend patent foramen ovale closure for all patients who suffer from migraine? A single-centre study.
To evaluate the course of migraine in migraine headache patients undergoing patent foramen ovale (PFO) transcatheter closure. ⋯ The consistent observations of this and other studies are provocative and worthy of evaluation with a prospective randomized trial using objective measures of migraine frequency and severity. However, it seems too early to recommend PFO closure for all patients who suffer from migraine until the results of ongoing large randomized trials are available.
-
J Cardiovasc Med (Hagerstown) · Apr 2009
Randomized Controlled Trial Comparative StudyRationale and design of a trial evaluating the effects of losartan vs. nebivolol vs. the association of both on the progression of aortic root dilation in Marfan syndrome with FBN1 gene mutations.
The major clinical problem of Marfan syndrome (MFS) is the aortic root aneurysm, with risk of dissection when the root diameter approximates 5 cm. In MFS, a key molecule, transforming growth factor-beta (TGF-beta), normally bound to the extracellular matrix, is free and activated. In an experimental setting, TGF-beta blockade prevents the aortic root structural damage and dilatation. The angiotensin receptor 1 blockers (sartanics) exert an anti-TGF-beta effect; trials are now ongoing for evaluating the effect of losartan compared with atenolol in MFS. beta-Adrenergic blockers are the drugs most commonly used in MFS. The third-generation beta-adrenergic blocker nebivolol retains the beta-adrenergic blocker effects on heart rate and further exerts antistiffness effects, typically increased in MFS. ⋯ The present study will add information about pharmacological therapy in MFS, supporting the new application of angiotensin receptor 1 blockers and finding beta-adrenergic blockers that may give more specific effects. Moreover, the study will further deepen understanding of the pathogenetic mechanisms that are active in Marfan syndrome through the pharmacogenomic and transcriptomic mechanisms that may explain MFS phenotype variability.
-
J Cardiovasc Med (Hagerstown) · Apr 2009
Multicenter Study Comparative StudyCost-effectiveness of the real-world use of drug-eluting stents at 9-month follow-up: results from the Sicilian DES Registry.
With the aim of reducing restenosis after percutaneous coronary intervention with bare-metal stents (BMSs) for the treatment of ischemic heart disease, drug-eluting stents (DESs) were introduced in the field of percutaneous coronary intervention in 2002. However, the higher cost of DES in comparison with BMS made it necessary to determine whether their use brings a real economic advantage. ⋯ The medium-term results of the proposed models, tested with sensitivity analysis, demonstrate the use of DES to be justified; moreover, these results could positively influence the attitude of the SSR toward these new therapeutic strategies, which are an improvement on standard therapies, both from a clinical and a financial standpoint.