Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Nov 2007
Case ReportsSevere hypoxaemia after weaning from cardiopulmonary bypass: a case report.
Persistence of patent foramen ovale is frequent in adults and usually asymptomatic. We report the case of a patient in whom a patent foramen ovale was diagnosed after weaning from cardiopulmonary bypass and was not recognised preoperatively. Intraoperative transoesophageal echocardiography is pivotal for surgical decision-making and should be performed in all patients undergoing cardiac surgery.
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J Cardiovasc Med (Hagerstown) · Nov 2007
American College of Cardiology/American Heart Association perioperative assessment guidelines for noncardiac surgery reduces cardiologic resource utilization preserving a favourable clinical outcome.
The American College of Cardiology (ACC) and the American Heart Association (AHA) provided perioperative evaluation and management guidelines for assessing cardiac risk in noncardiac surgery. Even if previously validated as safe and effective in risk stratification, there is often a gap between clinical practice and the recommendations of the ACC/AHA guidelines. We evaluated the impact of strict application of ACC/AHA guidelines for cardiac risk assessment of patients undergoing elective noncardiac vascular surgery in a consultant anaesthesiologist-led preoperative clinic. ⋯ Implementation of the ACC/AHA guidelines for cardiac risk assessment prior to noncardiac surgery in a consultant anaesthesiologist-led preoperative clinic reduced preoperative resources utilization, improved medical treatment and preserved a low rate of perioperative cardiac complications.
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J Cardiovasc Med (Hagerstown) · Oct 2007
Contrast-enhanced cardiovascular magnetic resonance in primary and ischemic dilated cardiomyopathy.
Differentiation between primary dilated cardiomyopathy and ischemic cardiomyopathy has an important clinical significance. Contrast-enhanced cardiovascular magnetic resonance can play a role in this task, identifying myocardial scarring or fibrosis as presence of delayed enhancement. The aim of the present study was to evaluate the diagnostic potential of contrast-enhanced cardiovascular magnetic resonance in differentiating dilated cardiomyopathy from ischemic cardiomyopathy. ⋯ Patterns of delayed enhancement are different in dilated cardiomyopathy and ischemic cardiomyopathy, reflecting the presence of scarring or various degrees of fibrosis in left ventricular myocardium. The presence of subendocardial or transmural delayed enhancement at contrast-enhanced cardiovascular magnetic resonance allowed distinction between dilated cardiomyopathy and ischemic cardiomyopathy with high sensitivity (88%) and specificity (100%). Integration of cardiovascular magnetic resonance results with angiographic information can be useful in the identification of pathogenic mechanisms underlying left ventricular dysfunction.
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J Cardiovasc Med (Hagerstown) · Sep 2007
Case ReportsRelative adrenal insufficiency in severe congestive heart failure with preserved systolic function: a case report.
Relative adrenal insufficiency in critically ill patients is an important syndrome in septic shock. The insufficient stress response of the hypothalamic-pituitary-adrenal axis in acute illness contributes to hemodynamic instability. ⋯ In this report, we describe the case of a patient with severe diastolic dysfunction who presented in cardiogenic shock associated with relative adrenal insufficiency and had a complete recovery with corticosteroid replacement. Alteration of the hypothalamic-pituitary-adrenal axis may be more prevalent than suspected in end-stage heart failure, and the diagnosis and treatment of this syndrome may ultimately improve outcomes in a subgroup of heart failure patients.
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J Cardiovasc Med (Hagerstown) · Aug 2007
Acquired pulmonary vein stenosis after radiofrequency ablation treated by angioplasty and stent implantation.
Pulmonary vein (PV) stenosis is a late complication of radiofrequency ablation for atrial fibrillation. Although frequently asymptomatic, it can be associated with severe respiratory symptoms that cause significant morbidity. This study evaluated the role of angioplasty and stent implantation in patients affected by acquired PV stenosis. ⋯ The treatment of PV stenosis by angioplasty with stent implantation is feasible and safe. The majority of patients undergoing this procedure showed symptomatic improvement and patency of the PV.