Methodist DeBakey cardiovascular journal
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Methodist Debakey Cardiovasc J · Apr 2014
ReviewHybrid interventional procedures in congenital heart disease.
The evolution of congenital cardiac surgery has seen significant innovative advances in collaborative efforts between congenital cardiac surgeons and interventionalists to provide the least invasive intervention with the greatest hemodynamic benefit for patients with congenital heart disease. This review looks at how this collaborative approach has evolved and is being applied to treat a number of congenital conditions across the age ranges.
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Methodist Debakey Cardiovasc J · Apr 2014
ReviewStem cell therapies in patients with single ventricle physiology.
Single ventricle physiology, especially hypoplastic left heart syndrome, is one of the most high-risk lesions in children with congenital heart disease, and the ensuing heart failure remains as a major problem related to adverse outcomes in these patients. The field of stem cell therapy for heart failure has shown striking advances during the past 10 years, and many clinical trials using stem cell technologies have been conducted in adults, which suggest that stem cell therapy is associated with long-term improvement in cardiac function. Cardiac progenitor cells have recently been discovered, and their strong regenerative ability has been demonstrated in several studies. Although no large clinical trials have been performed in the field of congenital heart disease, recent investigations indicate that stem cell therapy may hold great potential to treat children with cardiac defects.
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Methodist Debakey Cardiovasc J · Jul 2013
ReviewSafety of MRIs in patients with pacemakers and defibrillators.
With a burgeoning population, increases in life expectancy, and expanding indications, the number of patients with cardiac devices such as pacemakers and implantable cardioverter defibrillators continues to increase each year. A majority of these patients will develop an indication for magnetic resonance imaging (MRI) in their lifetime. ⋯ However, given the historic safety concerns, many physicians are reluctant to use MRIs in this patient population. In this paper, we discuss the potential adverse effects of MRIs in patients with cardiac devices, review key studies that have addressed strategies to limit adverse effects, and provide our cardiovascular MRI laboratory's protocol for imaging patients with implanted cardiac devices.
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The treatment of chronic limb ischemia involves the restoration of pulsatile blood flow to the distal extremity. Some patients cannot be treated with endovascular means or with open surgery; some may have medical comorbidities that render them unfit for surgery, while others may have persistent ischemia or pain even in the face of previous attempts at reperfusion. ⋯ SCS also suppresses sympathetic vasoconstriction and pain transmission. When patient selection is based on microcirculatory parameters, SCS therapy can significantly improve pain relief, halt the progression of ulcers, and potentially achieve limb salvage.
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Peripartum cardiomyopathy is a rare and potentially fatal disease. Though approximately half of the patients recover, the clinical course is highly variable and some patients develop refractory heart failure and persistent left ventricular systolic dysfunction. ⋯ Etiology remains unclear, and treatment is similar to other cardiomyopathies and includes evidence-based standard heart failure management strategies. Experimental strategies such as intravenous immunoglobulin and bromocriptine await further clinical validation.