Cardiology clinics
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Triage of patients with acute, potentially life-threatening chest pain is one of the most daunting challenges currently facing emergency department physicians. Acute aortic syndrome and pulmonary embolism are two potentially underlying causes. For both, computed tomography has become the de facto clinical reference standard for diagnosis. This article discusses state-of-the-art computed tomography for the detection of these disorders, including recent advances and future perspectives.
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The recent, widespread success of mechanical circulatory support has prompted the development of numerous implantable devices to treat advanced heart failure. It is important to raise awareness of novel device systems, the mechanisms by which they function, and implications for patient management. ⋯ Implantation strategy, mechanism of action, durability, efficacy, hemocompatibility, and human factors are considered. The feasibility of novel strategies for unloading the failing heart is examined.
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Nonreversible failure of the right ventricle is seen in 0.04% to 0.1% of postcardiotomy cases. The incidence of right ventricular dysfunction after left ventricular assist device (LVAD) implantation that fails to resolve in the operating room is reported to be as frequent as 20% to 50% and imposes a considerable burden in terms of postoperative morbidity and mortality. Should this syndrome supervene, the mortality of an LVAD operation increases from 19% to 43%. Although most patients can be maintained with prolonged inotropic support, 10% to 15% may require implantation of a separate right ventricular support device.
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Review
Contemporary application of cardiovascular hemodynamics: transcatheter aortic valve interventions.
Over the past two decades, echocardiography has replaced cardiac catheterization for aortic valvular hemodynamic assessment. In recent years, however, there has been a rapid evolution of transcatheter aortic valve technology and, with its refinement, there has been the increasing recognition of the value of transcatheter hemodynamic assessment in complementing the information provided by contemporary echocardiography. With an emphasis on transcatheter hemodynamics, this article reviews the symbiotic application of these assessment modalities pertaining to contemporary transcatheter aortic valve implantation.