Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Feb 2007
ReviewAcute type A aortic dissection: an update on a still challenging disease.
The aim of this report is to offer a concise review of the current knowledge of type A aortic dissection aetiology and pathogenesis, to propose an updated diagnostic algorithm, to provide descriptions of current surgical and endovascular techniques for treatment, and to emphasise criteria for patient follow-up. Additional information regarding the institutional experience developed in a tertiary university hospital with a 25-year exposure to aortic dissection is also included to provide a comprehensive view of a clinical entity that still challenges physicians and surgeons.
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J Cardiovasc Med (Hagerstown) · Feb 2007
ReviewAutografts, homografts, and xenografts: overview on stentless aortic valve surgery.
Stentless valves, either human (autografts, homografts) or animal (porcine xenografts), were historically among the first substitutes to be used to replace the diseased aortic valve. Forty years after those pioneering days and 15 years after revival of such valves, stentless grafts have become a mainstay in aortic surgery. Although limitations associated with the use of autografts, homografts and xenografts remain, stentless valves have profoundly improved quality of life after aortic valve/root replacement. In addition, stentless surgery has greatly advanced the understanding of aortic root anatomy, physiology and pathology among surgeons.
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J Cardiovasc Med (Hagerstown) · Jan 2007
ReviewThe impact of prenatal diagnosis of congenital heart disease on pediatric cardiology and cardiac surgery.
Since the early 1980s prenatal diagnosis of congenital heart disease (CHD) has progressively impacted on the practice of pediatric cardiology and cardiac surgery. Fetal cardiology today raises special needs in screening programs, training of the involved staff, and allocations of services. Due to the increased detection rate and to the substantial number of terminations, the reduced incidence of CHD at birth can affect the workload of centers of pediatric cardiology and surgery. ⋯ Prenatal diagnosis allows counselling of families which are better prepared for the foreseeable management and outcome of the fetus. These benefits can reduce the risks of litigation for missed ultrasound diagnosis. As increased costs can be expected in institutions dealing with a large number of fetal CHD, the administrators of these institutions should receive protected funds, proportional to their needs.
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J Cardiovasc Med (Hagerstown) · Jan 2007
ReviewPatent foramen ovale and cryptogenic stroke. A critical review.
The underlying causes of ischemic stroke in young patients are often difficult to find, despite systematic investigations concerning heart, coagulation system or any other type of vascular disease, thus the definition of 'cryptogenic'. In patients with cryptogenic stroke, the prevalence of a patent foramen ovale is about 45%, versus 25% of the general healthy population, leading to many speculations about a potential role of intracardiac right-to-left shunts in determining ischemic cerebral disease. Since a possible mechanism has been thought to be paradoxical embolism, percutaneous closure of the foramen ovale is currently discussed, at least until the appearance of data from the ongoing randomized trials. ⋯ Professional divers may benefit from the procedure as well, whereas migraine is still not considered an indication. In the pediatric population, closure of the patent foramen ovale seems to be safe and effective to prevent recurrent stroke. As the complication rate for device implantation decreases, the threshold for percutaneous closure is likely to decline.
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J Cardiovasc Med (Hagerstown) · Nov 2006
Comparative Study Clinical TrialMetabolic syndrome in obstructive sleep apnea and related cardiovascular risk.
There is little evidence available about the relationship between metabolic syndrome as a comprehensive clinical entity and obstructive sleep apnea (OSA) with respect to the cardiovascular risk of patients with coexisting metabolic syndrome and OSA. ⋯ Metabolic syndrome was a frequent comorbidity in OSA patients, reflecting higher degrees of sleep-disordered breathing, and did not increase the risk of cardiovascular events after adoption of CPAP therapy.