The Canadian journal of cardiology
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There is an ongoing debate whether the tricuspid valve (TV) should be repaired with a suture annuloplasty or a prosthetic ring. ⋯ A modified De Vega suture annuloplasty was effective at eliminating TR and producing right ventricular (RV) reverse remodelling at 5-year follow-up, although TR tends to increase with time.
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The junction between the left brachiocephalic vein and the superior vena cava is a high-risk region during lead extraction. Venous laceration with hemodynamic collapse is the most feared complication arising in this region, but arteriovenous fistula formation after excimer laser extraction also has been reported. ⋯ A continuous murmur was heard near the extraction site and invasive angiography demonstrated a left internal mammary artery to the brachiocephalic vein fistula, which was coiled. A new continuous murmur after lead extraction is the hallmark of this rare complication.
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Review Practice Guideline
Focused 2012 update of the Canadian Cardiovascular Society guidelines for the use of antiplatelet therapy.
The initial 2010 Canadian Cardiovascular Society (CCS) Guidelines for the Use of Antiplatelet Therapy in the Outpatient Setting were published in May 2011. As part of a planned re-evaluation within 2 years, we conducted an extensive literature search encompassing all topics included in the 2010 CCS Guidelines, and concluded that there were sufficient new data to merit revisiting the guidance on antiplatelet therapy for secondary prevention in the first year after acute coronary syndrome (ACS), percutaneous coronary intervention, or coronary artery bypass grafting, and the interaction between clopidogrel and proton pump inhibitors. ⋯ For non-ACS stented patients, we recommend acetylsalicylic acid/clopidogrel for 1 year, with at least 1 month of therapy for bare-metal stent patients and 3 months for drug-eluting stent patients unable to tolerate year-long double therapy. We also consider therapy for patients with a history of stent thrombosis, the indications for longer-term treatment, discontinuation timing preoperatively, indications for changing agents, the management of antiplatelet therapy before and after bypass surgery, and use/selection of proton pump inhibitors along with antiplatelet agents.
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Surveillance for stroke/transient ischemic attack (TIA) using administrative data has traditionally been limited to reporting patients who had an acute event and were hospitalized. This underestimates the true prevalence because many events do not result in hospitalization. We examined whether the accuracy of administrative data for identifying prevalent stroke/TIA could be improved by using data from both inpatient and outpatient visits. ⋯ The use of outpatient physician claims data in addition to hospitalization data improves the sensitivity of administrative data for the identification of prevalent stroke/TIA and may be used to estimate the prevalence of cerebrovascular events in large populations and over time.
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The Canadian Heart Health Strategy and Action Plan recommended that the Canadian Cardiovascular Society (CCS) lead the development of pan-Canadian data definitions and quality indicators (QIs) for evaluating cardiovascular care in Canada. In response to this recommendation, the CCS developed and adopted a standardized QI development methodology. This report provides a brief overview of the CCS "Best Practices" for developing pan-Canadian cardiovascular QIs. ⋯ It also describes the CCS QI approval process and addresses knowledge translation. Adoption of a standardized methodology for QI development will improve the quality, completeness, acceptability, and usability of pan-Canadian cardiovascular QIs developed by the CCS. Public release of the QI definitions and related performance data might help improve patient care quality and outcomes.