Minerva cardioangiologica
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Minerva cardioangiologica · Feb 2012
ReviewMy rules of a perfect SAPIEN™ transcatheter aortic valve implantation.
Transcatheter aortic valve implantation has been established as an alternative treatment option for those patients with aortic stenosis (AO), who are high risk or unsuitable for surgical aortic valve replacement. Since its introduction, transcatheter aortic valve implantation has been mainly performed either by a percutaneous approach through the femoral arteries or by using a transapical approach via a left-sided mini-thoracotomy. More recently, experience on alternative access routes such as the subclavian artery and the ascending aorta has been reported in a small number of patients. ⋯ Their mixture of skills will enable the team to build patient care pathways in which patients are assessed regarding cardiac and non-cardiac comorbidities, the most appropriate type of treatment is jointly agreed, and finally various treatment options are delivered. In this review we highlight the cornerstones of a successful transcatheter aortic valve program using the Edwards SAPIENTM valve. We focus in particular on preoperative diagnostics, patient selection and potential strengths and weaknesses of the various access routes to offer a guideline for future experience.
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Minerva cardioangiologica · Feb 2012
Indications, techniques and results of percutaneous patent foramen ovale closure.
Patent foramen ovale (PFO) has been shown to be more prevalent in certain disease states, suggesting a potentially causative role in some patients with cryptogenic stroke, migraine headache or a number of other conditions. Percutaneous PFO closure has become a reasonable treatment option in a subset of those patients. Our objective is to review the possible indications of PFO closure. We further elucidate the technical aspects of PFO closure, provide an overview of the available devices and summarize results of PFO closure procedures.
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Minerva cardioangiologica · Dec 2011
In chronic heart failure with marked fluid retention, the i.v. high doses of loop diuretic are a predictor of aggravated renal dysfunction, especially in the set of heart failure with normal or only mildly impaired left ventricular systolic function.
In the presence of resistance to oral diuretics in chronic heart failure (CHF) patients with extreme hydrosaline retention, among the proposed therapeutic options the administration of high doses of loop diuretics - either intravenous (i.v.) boluses or i.v. continuous infusion - should first of all be considered. Nevertheless, the use of this therapy may lead to the risk of further aggravation of frequently coexisting renal dysfunction, especially when loop diuretics such as furosemide (FUR), torasemide etc. are administered at excessive doses leading to hypotension, hypoperfusion and/or relative dehydration in patients with decompensated CHF who could have benefit from intensive unloading therapy. The aim of this study was to identify the clinical and hematochemical markers which are able to predict a possible decline or rapid deterioration of renal function implying a rise in serum creatinine (Cr) >25% of its basal value, i.e. the so-called aggravated renal dysfunction (ARD), typically occurring during intensive unloading therapy with i.v. FUR or other loop diuretics, administered to CHF pts with extreme fluid retention. ⋯ In CHF patients with widespread edema refractory to oral diuretic, ARD can be propitiated by high dosages of i.v. FUR, when not associated with other treatments to preserve the effective circulating volume and renal flow. The HFNEF patients appear to be more prone to ARD related to i.v. high dosages of FUR, perhaps because their hemodynamics is more seriously harmed by the drop, FUR-related, in venous return and cardiac preload, as compared to CHF patients with reduced (45-30%) LVEF.
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Minerva cardioangiologica · Aug 2011
ReviewEchocardiography: future developments. What is diastole and how to assess it? Impaired left ventricular systolic function.
Epidemiologic data show that diastolic heart failure is responsible for 38% to 54% of all heart failure cases. Left ventricular diastolic function can be characterized invasively in the catheter laboratory and non-invasively by echocardiography. Although echocardiography does not directly measure hemodynamic parameters, it is the most practical routine clinical approach for the evaluation of left ventricular diastolic function with given clinical and experimental evidence supporting its use as well as its safety, versatility, and portability. ⋯ Furthermore, calculated parameters, e.g. like E/E´, E/Vp, AR-A, for a more accurate determination of diastolic dysfunction have been evaluated. With respect to recent guidelines and recommendations, this review summarizes the physiology and pathophysiology of diastole, current echocardiographic methods and calculated echocardiographic parameters for the assessment of left ventricular diastolic function and dysfunction. In addition, an overview of the current state of research with regard to the echocardiographic assessment of left ventricular diastolic function will be given.
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Despite the passage of 50 years since the introduction of closed chest compression and mouth-to-mouth rescue breathing as the techniques of modern cardiopulmonary resuscitation (CPR), the simple techniques remain the backbone of successful resuscitation of victims of cardiac arrest. In particular, the importance of high quality chest compressions is increasingly clear. Current evidence demonstrates chest compressions should be provided at a rate of 100 compressions a minute to a depth of 4 to 5 cm (1.5 to 2 inches) with full chest recoil between compressions. ⋯ Early defibrillation is a key component to successful resuscitation of ventricular tachycardia and ventricular fibrillation arrest; however, implementation of defibrillation should be coordinated with CPR to minimize interruptions in chest compressions. Aside from early defibrillation, there are no clear adjuncts to CPR that improve survival. However, postresuscitation therapies such as therapeutic hypothermia may become an important part of early resuscitation management as tools to provide hypothermia become increasingly portable and capable of rapid cooling.