Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Nov 2008
Case ReportsAtrial septal defect combined with partial anomalous pulmonary venous return: complete anatomic and functional characterization by cardiac magnetic resonance.
The presented case regards a 17-year-old male with new-onset right bundle branch block and significantly enlarged right-heart sections as the only pathologic finding on transthoracic echocardiography. Cardiac magnetic resonance (CMR) revealed the presence of a superior sinus venosus atrial septal defect associated with a partial anomalous pulmonary venous return, with the right upper lobe pulmonary vein draining into the superior vena cava. ⋯ With echocardiography, sinus venosus defects and anomalous pulmonary vein drainage may be more easily detected by a transoesophageal approach because of the proximity of the transducer to the atrial septum. CMR may be specifically recommended as an alternative to transoesophageal echocardiography in any patient with an unexplained dilatation of the right ventricle.
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J Cardiovasc Med (Hagerstown) · Nov 2008
Primary percutaneous coronary intervention in comatose survivors of cardiac arrest with ST-elevation acute myocardial infarction: a single-center experience in Florence.
Primary percutaneous coronary intervention is currently known as the most effective reperfusion strategy in patients with ST-elevation myocardial infarction. There are no formal recommendations from the American Heart Association/American College of Cardiology and European Society of Cardiology guidelines regarding the treatment of comatose patients with signs of ST-elevation myocardial infarction after reestablishment of spontaneous circulation. ⋯ According to our data, comatose survivors undoubtedly present a high-risk subgroup of ST-elevation myocardial infarction population in which percutaneous coronary intervention shows a procedural efficacy similar to conscious ST-elevation myocardial infarction patients and whose prognosis seems to be related both to infarct size and to neurological status. Further studies need to be performed in this high-risk subgroup investigating the effects of mild hypothermia (mainly on the neurological outcome) as well as the feasibility, safety and outcome of assistance device.
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J Cardiovasc Med (Hagerstown) · Nov 2008
Physical and emotional symptom burden of patients with end-stage heart failure: what to measure, how and why.
Much of our understanding about symptom burden near the end of life is based on studies of cancer patients. The aim of this study was to explore physical and emotional symptom experience among end-stage chronic heart failure patients, looking for those symptoms mostly related to their global health status. ⋯ General discomfort together with depression and anxiety were the symptoms that were mostly related with the physical limitation domain of global health status, but did not influence the social functioning and the self-efficacy domains. When ESAS is used together with KCCQ, comprehensive and quantitative information on a patient's physical, emotional and social distress is provided.
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J Cardiovasc Med (Hagerstown) · Nov 2008
Preoperative angiotensin-converting enzyme inhibitors protect myocardium from ischemia during coronary artery bypass graft surgery.
Coronary artery bypass graft surgery may result in perioperative myocardial injury during cardioplegic arrest. Angiotensin-converting enzyme (ACE) inhibitors protect the myocardium from ischemia in several clinical conditions, but no previous study has attempted to evaluate the impact of preoperative ACE inhibitor therapy on myocardial protection in patients undergoing coronary artery bypass graft surgery. ⋯ ACE inhibitors prior to surgery confer added myocardial protection during surgical revascularization. Prospective, randomized clinical trials will be necessary to better define the role of ACE inhibitors in improving outcomes when they are prescribed prior to coronary artery bypass graft surgery.
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J Cardiovasc Med (Hagerstown) · Oct 2008
ReviewRole of intraoperative transesophageal echocardiography in patients undergoing noncardiac surgery.
Major perioperative cardiac complications, including cardiac death, nonfatal myocardial infarction and nonfatal cardiac arrest, can occur in patients undergoing noncardiac surgery. To reduce the risk of these complications, some authors have reported on the utility of intraoperative transesophageal echocardiography as a complementary monitoring tool in noncardiac surgery. ⋯ In this review, we discuss published information about the use of intraoperative transesophageal echocardiography during noncardiac surgery with an attempt to clarify whether this approach may offer potential benefits compared with conventional intraoperative monitoring systems. In addition, perioperative risk determinants in noncardiac surgery are briefly summarized and information derived from intraoperative transesophageal echocardiography for evaluation of cardiac morphology and function is schematically presented.