Minerva cardioangiologica
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Minerva cardioangiologica · Aug 2013
ReviewEchocardiography in transcatheter aortic valve implantation.
Transcatheter aortic valve implantation (TAVI) has become a feasible and effective therapeutic option for patients with severe aortic stenosis and high operative risk or relative contraindications for surgical aortic valve replacement (SAVR). Patient selection plays a crucial role in the success of TAVI. Echocardiography is a mainstay during the whole process starting with the very important morphological evaluation and accurate measurement of the aortic root, followed by guiding the procedure and detecting possible complications, and ending with serial assessment of the patient's heart and the implanted prosthesis. This present article reviews the role of echocardiography before, during, and after transcatheter aortic valve implantation.
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Minerva cardioangiologica · Aug 2013
ReviewTranscatheter aortic valve implantation: alternative access options.
Calcific aortic valve stenosis represents the most common acquired valvular heart disease in adults. Transcatheter aortic valve implantation (TAVI) has been established as a widely accepted therapeutic option in elderly and multimorbid patients with severe aortic stenosis not amenable to conventional surgery. ⋯ Recently, different alternative access route options have been proposed and described. These alternative access routes include approaches via the subclavian/axillary artery, the ascending aorta, the carotid artery, and the brachiocephalic artery.
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Minerva cardioangiologica · Aug 2013
ReviewMultidetector computed tomography in transcatheter aortic valve implantation. Where we stand.
Degenerative calcific aortic stenosis represents the most common valve abnormality with increasing incidence in the elderly. Studies have shown that aortic stenosis is a fatal disease with a high cardiovascular death rate if untreated. However, many patients are encumbered with multiple comorbidities making them high-risk candidates for surgical aortic valve replacement, which is the hitorical treatment of choice. ⋯ Among different imaging modalities that have been employed, multidetector computed tomography (MDCT) is increasingly used because of its capability of 3-dimentional (3D) determination of the non-circular nature of the aortic annulus as well as the complex aortic root anatomy. Additionally, MDCT provides a deep understanding of the structural integrity of the transcatheter aortic valve and enables the evaluation of the prosthesis location after TAVI and identification of post procedure complications. In this article, we discuss the current role of MDCT in pre-TAVI evaluation but also in the guidance of the procedure and in post-procedure follow-up.
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Minerva cardioangiologica · Aug 2013
ReviewLong-term results after transcatheter aortic valve implantation: positive and side effects.
The scientific and technological progress in the field of medicine has allowed to treat patients with severe aortic valve stenosis and with a high perioperative risk. Before the introduction of transcatheter aortic valve implantation (TAVI), patients considered at high risk for surgical treatment were managed with medical therapy or with balloon aortic valvuloplasty. With more than 50000 transcatheter aortic valves implanted in patients around the world, TAVI has demonstrated to be a valid alternative to surgical aortic valve replacement in inoperable and high-risk patients. ⋯ In this review, we will present the immediate results and distinct TAVI-related drawbacks and relative impact on the long-term outcome. New technology advances promise to simplify TAVI and to improve the results by reducing the rate of TAVI-specific issues such as paravalvular aortic regurgitation, annular rupture, and conduction disturbances which may impact on the clinical outcome. Therefore, we believe that when some of these weaknesses will be overcome, even patients at lower risk might benefit from TAVI in the near future.
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Minerva cardioangiologica · Aug 2013
Comparative StudyB-type natriuretic peptide. Guided vs. conventional care in outpatients with chronic heart failure: a retrospective study.
It is not known whether therapy assisted by determinations of serum B-type natriuretic peptide (BNP) may improve the outcome for outpatients with chronic heart failure (CHF). ⋯ A fall in BNP ≥60% from baseline on the fifth day after admission was found to be associated with a favorable clinical outcome in outpatients with CHF after four months of follow-up, irrespective whether this finding had been detected in patients treated according to the BNP-guided therapy or in patients treated with conventional clinical criteria. However, among the outpatients with previous ADHF, a substantial improvement in cardiovascular event rates could not be demonstrated in those treated with BNP-guided therapy compared with those undergoing usual, symptom-guided treatment.