International journal of cardiology
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Comparative Study
Can we use the end systolic volume index to monitor intrinsic right ventricular function after repair of tetralogy of Fallot?
After tetralogy of Fallot (ToF) repair the right ventricle (RV) is commonly exposed to abnormal volume load resulting from pulmonary regurgitation (PR) leading to progressive RV dilatation. The objective of this study was to assess the relationship between RV volumes, especially the end systolic volume index (ESVi), and RV contractility in patients after ToF repair and significant PR and to determine whether RV dilatation reflects intrinsic RV dysfunction in these patients. ⋯ ESVi is a valid estimate of intrinsic RV function in repaired ToF patients with residual PR and in this respect seems superior to EF. These data underscore the importance of serial ventricular volume assessment in the follow-up of these patients.
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Most patients with severe pulmonary arterial hypertension (PAH) demonstrate persistent structural alterations in small pulmonary arterioles at the time of diagnosis, including marked proliferation of pulmonary artery endothelial cells (ECs), smooth muscle cells (SMCs) and fibroblasts. Rai et al. have recently proposed a paradigm shift to explain the pathobiology of small vessel disease in severe PAH patients as a quasi-neoplastic process. Indeed, the vascular lesions of patients with severe PAH exhibit some cancer-like characteristics: decreased population of apoptotic cells and overexpression of antiapoptotic proteins. ⋯ PDGF has been identified as a novel potential therapeutic target and the successful treatment of experimental PAH with a PDGF receptor tyrosine kinase inhibitor has been demonstrated recently. These findings justify further clinical trials concerning thyrosine kinase inhibitors as future PAH therapies. However, the drugs currently developed for malignant neoplasms to target neoplastic proliferation should be tested carefully in PAH patients due to their cardiac and pulmonary toxicity.
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Letter Case Reports
Thigh pain preceding myocardial infarction--is this merely coincidence?
The association between myocardial infarction and lower limb symptoms is rare and poorly recognised. To our knowledge, we present the third reported case in the English literature of a patient presenting with isolated lower limb pain as the initial symptom of a myocardial infarction. We describe the clinical case and discuss the potential pathophysiology behind this atypical presentation.