Cardiology in review
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Cardiology in review · Nov 2000
Mitral valve surgery with concomitant treatment of atrial fibrillation.
Recovery of sinus rhythm after mitral valve surgery in patients with chronic atrial fibrillation lowers thromboembolic risk and improves survival and quality of life. This article reviews the principal surgical procedures devised in the 1980s and 1990s to treat atrial fibrillation during mitral valve operations. Advantages and drawbacks of the different techniques are discussed. ⋯ Intraoperative radiofrequency ablation has recently proven extremely effective in atrial fibrillation surgery, allowing a further simplification of the procedures. We report the results of an original technique for atrial fibrillation treatment during mitral valve surgery through epicardial radiofrequency ablation. Based on recently reported results of atrial fibrillation surgery and on prognostic considerations, specific treatment of both chronic and paroxysmal atrial fibrillation is indicated in virtually all affected patients undergoing mitral valve surgery.
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Cardiology in review · Sep 2000
ReviewTransesophageal echocardiography in pediatric congenital heart disease.
The uses of transesophageal echocardiography have expanded dramatically over the last decade. With advances in technology, this imaging modality has become readily available for evaluation of the complex pediatric population with congenital heart disease. This article discusses the many uses of transesophageal echocardiography in this population, in the outpatient setting, in the peri-operative period, and in the cardiac catheterization laboratory.
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Cardiology in review · Jul 2000
ReviewTreatment options for acute myocardial infarction complicated by cardiogenic shock.
Hospital survival of patients with acute myocardial infarction complicated by cardiogenic shock has improved during recent years. Before the 1990s, emphasis on a medical and supportive approach to treatment of these high-risk patients (including thrombolytic therapy) was not clearly associated with improving outcomes. However, in the past decade, the interventional approach to treatment of acute myocardial infarction complicated by cardiogenic shock (mainly acute infarct angioplasty) has led to an improving prognosis across a broad spectrum of patients with cardiogenic shock.
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Although thought to be rare, sudden deaths caused by nonpenetrating chest wall impact in the absence of structural injury to the ribs, sternum, and heart (commotio cordis) are reported with increasing frequency. This phenomenon is described in individuals when they are struck by relatively innocent blows to the chest wall. Young male athletes aged 5 to 18 years are particularly at risk for this catastrophe. ⋯ Death is usually instantaneous, and successful resuscitation is uncommon. A recently reported experimental model provides clues to the mechanisms and inferences for the prevention and treatment of this devastating condition. This swine model shows that a) ventricular fibrillation results from low-energy chest wall impacts during a vulnerable period of repolarization, b) the risk of this event can be decreased with softer-than-standard baseballs, and c) prompt defibrillation is crucial for resuscitation to be successful.
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Cardiology in review · May 1999
Reperfusion therapy for acute myocardial infarction: observations from the National Registry of Myocardial Infarction 2.
The National Registry of Myocardial Infarction 2 (NRMI-2) provides a unique opportunity to evaluate the practice patterns among participating cardiology and emergency medicine departments involved in the care of patients with acute myocardial infarction. The data from NRMI-2 suggest that almost 1/3 of all non-transfer-in and non-transfer-out patients are eligible for reperfusion therapy. Furthermore, of those patients who are clearly eligible for reperfusion therapy, 24% are not given this proven therapy. ⋯ The data from NRMI-2 also suggest that patients with contraindications to thrombolysis may be very appropriate for primary angioplasty. Realizing the full potential benefits of reperfusion therapy in terms of reduced cardiovascular morbidity and mortality will require that clinical practice patterns be aligned more closely with the recommended national guidelines, which are based on extensive clinical trial data that show the benefit of reperfusion therapy in a wide range of patients with acute myocardial infarction. By using observational databases, such as the NRMI-2, which describe how clinical care is administered in nonclinical trial settings, we can continually monitor our progress and initiate changes to ensure that patients are given access to the many therapies that have been shown to improve their quality of life and survival.