Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
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G Ital Cardiol (Rome) · Mar 2015
Review[Vagus nerve stimulation for the treatment of heart failure].
In the last two decades, the autonomic imbalance characterized by vagal withdrawal and sympathetic increase has been shown to play a major role in the progression and prognosis of heart failure. Therefore, modulation of the autonomic nervous system (neuromodulation) with the aim to restore autonomic balance is gaining increasing interest as a potential therapy for patients with heart failure. ⋯ This technique showed excellent results in preclinical studies, but at present the clinical experience is limited to a few studies, the results of which are apparently conflicting. This review discusses the preclinical and clinical experience of vagal stimulation in heart failure, in order to help understand the complexity of the methodology and our still limited knowledge of the dose-response relationship, which make difficult to interpret and compare the results of studies conducted with different designs and evaluating different devices and stimulation protocols.
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Dextro-transposition of the great arteries with intact ventricular septum (d-TGA) is the most frequent cyanotic congenital heart disease in neonates. In newborns affected by d-TGA, the pulmonary and systemic circulations are in parallel instead of being in series. ⋯ The current surgical approach is the anatomical correction with the arterial switch operation, which has excellent early and medium-term results. In this review, we discuss treatment of d-TGA and the arterial switch operation, the medium- and long-term results following surgery, and the reasons that have led the arterial switch operation to its popularity compared to the former physiological correction of d-TGA, i.e. the Senning and Mustard procedures.