The American journal of cardiology
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In patients with acute ST-elevation myocardial infarction (STEMI), a strategy of prehospital reduced dose fibrinolytic administration coupled with urgent percutaneous coronary intervention (PCI), termed FAST-PCI strategy, has been found to be superior to primary PCI (PPCI) alone. A coordinated STEMI system of care that includes FAST-PCI should offer better outcomes than a system in which prehospital diagnosis of STEMI is followed by PPCI alone. The aim of this study was to compare the in-hospital outcomes for patients treated with the FAST-PCI approach with outcomes for patients treated with the PPCI approach in a common system. ⋯ There was a lower frequency of pre-PCI Thrombolysis In Myocardial Infarction 0 flow (no patency) seen in patients treated with FAST-PCI compared with the PPCI patients (26.7% vs 62.7%, p <0.0001). Earlier infarct artery patency in the FAST-PCI group had a favorable impact on the incidence of cardiogenic shock on hospital arrival (3.1% vs 20.9%, p <0.0001). In conclusion, compared with a PPCI strategy in a common STEMI system of care, the FAST-PCI strategy was associated with earlier infarct artery patency and lower incidence of cardiogenic shock, as well as with reduced in-hospital mortality.
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Comparative Study
Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of fallot or pulmonary atresia associated with ventricular septal defect.
The short lifespan of right ventricle-to-pulmonary artery (RV-PA) conduits used in repairs of complex congenital heart defects makes future surgical replacement inevitable. Percutaneous pulmonary valve implantation (PPVI) now offers an attractive alternative to surgery in some patients. The objectives of this study were to examine the pattern of conduit reoperations, the factors affecting conduit longevity, and to discuss the role of PPVI in these patients. ⋯ There were 37 adults whose current existing conduits had not yet failed, with 73% (27 of 37) potentially suitable in the future for PPVI on the basis of conduit size of 16 to 27 mm. In conclusion, multiple RV-PA conduit revisions were required in patients who survived to adulthood, with many replacements taking place during adolescence. Most conduits in this adult cohort met size criteria for PPVI, thereby offering these patients a potential alternative to surgical intervention for conduit failure.
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This case presents an uncommon but important mechanism of muscular left ventricular outflow obstruction in hypertrophic cardiomyopathy due to anomalous and direct papillary muscle insertion into the anterior mitral leaflet, a finding reliably identified clinically by cardiac magnetic resonance imaging. The identification of this left ventricular outflow tract morphology is important before invasive ventricular septal reduction therapy because it dictates a specific surgical strategy. These findings further support the role of cardiac magnetic resonance imaging in the early evaluation of hypertrophic cardiomyopathy patients.