Minerva cardioangiologica
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Minerva cardioangiologica · Apr 2007
ReviewThe role of echocardiography in mitral valve dysfunction after repair.
The echocardiographer responsible for the intraoperative evaluation should be familiar with the transesophageal echocardiography (TEE) views of mitral valve morphology as well as the the repair procedure(s) in order to assess postoperative results. The most frequent immediate mitral valve repair failures are a result of extensive valve disease, calcification, suture dehiscence, ischemia, technical misadventures, stenosis, or systolic anterior motion. ⋯ Intraoperative TEE is extremely valuable in evaluating the competency of the mitral valve following repair. In fact the results of this modality have a predictive valve in determining long-term outcomes in these patients.
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Minerva cardioangiologica · Apr 2007
ReviewIntraoperative transesophageal echocardiography during valve replacement surgery. A review.
Intraoperative transesophageal echocardiography (IOTEE) has become an important diagnostic and monitoring tool in the operating theatre during cardiac and noncardiac operations. However, its routine application during valve replacement operations has not received universal recognition. The cumulative experience, brought up in this review, shows that IOTEE is invaluable during valve replacement operations. ⋯ Important data influencing the operative plan has been reported in 3-29% of operations in various studies. The postpump IOTEE is also essential for numerous reasons: it can rule out important misfortunes, such as leaflet immobilization or perivalvular leak, leaky bioprosthesis or coronary obstruction due to valve struts, and is responsible for second pump-run in 3-6% of cases; it is essential in monitoring the deairing process; it provides the surgeon and the anesthesiologist data on biventricular function and volume and exclusion of dynamic left ventricular outflow tract obstruction, and, therefore, guides pharmacotherapy, volume handling and mechanical assistance, including intra-aortic balloon pump indication and location. In conclusion, IOTEE is an essential tool in patients undergoing valve replacement operations, and should be used on a standard basis.
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Minerva cardioangiologica · Apr 2007
Comparative StudyUsefulness of N-terminal pro-B-type natriuretic peptide levels in predicting residual myocardial ischemia in patients with ST elevation acute myocardial infarction.
N-terminal pro-b-type natriuretic peptide (NT pro-BNP) is a neurohormone synthesized predominantly in ventricular myocardium. In patients with symptoms of heart failure, elevation in NT pro-BNP accurately identifies ventricular dysfunction. However, NT pro-BNP levels are not specific for ventricular dysfunction in patients who do not have overt symptoms of heart failure, suggesting that other cardiac processes such as myocardial ischemia may also cause elevation in NT pro-BNP. The study was aimed to determine whether NT pro-BNP elevations are associated with myocardial ischemia. ⋯ Elevated levels of NT pro-BNP are associated with residual myocardial ischemia among patients with STEMI and preserved left ventricular ejection fraction, as demonstrated by perfusion defect on SPECT imaging, suggesting that these patients may need further evaluation for stratification of the future risk of fatal events. The observed association between NT pro-BNP levels and ischemia may explain because tests for NT pro-BNP are not specific for ventricular dysfunction among patients with coronary artery disease.