Heart, lung & circulation
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Heart, lung & circulation · Apr 2019
ReviewAdult Congenital Heart Disease in Australia and New Zealand: A Call for Optimal Care.
Adult congenital heart disease (ACHD) is a relatively new subspecialty in the cardiology field. The prevalence of ACHD is estimated at ∼ 3,000 per million adult population. The ACHD patient group is estimated to grow at ∼ 5% per year and in the next decade it is forecast that 1 in 150 young adults will carry some form of ACHD diagnosis. These estimates translate to ∼ 72,000 ACHD patients in Australia and ∼ 14,000 in New Zealand, although no current numbers are available. The Cardiac Society of Australia and New Zealand (CSANZ) has recently published Recommendations for Standards of Care for Adult Congenital Heart Disease (ACHD) in 2016. There is currently no long-term plan or proposal to address this huge health care burden within the federal government. This document details the size of the problem insofar as it is known and recommends solutions to be implemented. ⋯ The authorship group comprised participants in the CSANZ adult CHD standards of care recommendations from 2013 with the inclusion of some newly trained ACHD cardiologists, who represented most states and territories across ANZ. None of the authors has any academic or professional conflict of interest.
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Right heart catheterisation (RHC) is a minimally invasive procedure that provides direct haemodynamic measurement of intracardiac and pulmonary pressures. It is the gold standard investigation for the diagnosis and management of pulmonary hypertension. This article will describe how to perform right heart catheterisation, indications and contraindications.
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Heart, lung & circulation · Apr 2019
ReviewThe Australian and New Zealand Cardiac Implantable Electronic Device Survey: Calendar Year 2017.
A cardiac implantable electronic device (CIED) survey was undertaken in Australia and New Zealand for calendar year 2017 and involved pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). ⋯ For 2017, there were 17,971 (15,203 in 2013) new PMs sold in Australia and 1,811 (1,641 in 2013) implanted in New Zealand. The number of new PM implants per million population was 745 for Australia (652 in 2013) and 384 for New Zealand (367 in 2013). In both Australia and New Zealand, the number of PM replacements fell as a result of improved power source service life. Pulse generator types implanted were predominantly dual chamber; Australia 73% (74% in 2013) and New Zealand 68% (59% in 2013). There were 1,247 biventricular PMs implanted in Australia (661 in 2013) and 118 in New Zealand (83 in 2013). Transvenous pacing leads were overwhelmingly active fixation in both the atrium and ventricle. In Australia there was an increase in ICD usage with 4,212 new implants (3,904 in 2013), but a small fall in New Zealand to 396 (423 in 2013). The new ICD implants per million population were 175 for Australia (167 in 2013) and 90 for New Zealand (95 in 2013). There was a small reduction in biventricular ICDs in both Australia (2,195) and New Zealand (111).
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Heart, lung & circulation · Apr 2019
Direct Innominate Artery Cannulation as a Sole Systemic and Cerebral Perfusion Technique in Aortic Surgery.
Arterial cannulation is often challenging in thoracic aortic surgery due to the location of the surgery and need for cerebral protection during periods of circulatory arrest. Cannulation sites including the ascending and descending aorta, axillary, carotid and femoral arteries have limitations and are associated with complications due to their proximity to surrounding structures. Therefore, the innominate artery can be used by either direct cannulation or indirect cannulation via a graft as an alternative site. We present a technique of sole direct innominate artery cannulation that is able to provide both systemic and selective antegrade cerebral perfusion during aortic surgery.
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Heart, lung & circulation · Apr 2019
Angioscopic Evaluation During Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disorder with a poor prognosis. Recently, balloon pulmonary angioplasty (BPA) has been reported to be an effective treatment for inoperable patients with CTEPH. However, this catheter-based treatment has potentially life-threatening vascular complications. To improve the efficacy and safety of BPA, we assessed the morphological evaluation of organised thrombus and the vascular injury by BPA procedure. ⋯ Assessment of organised thrombus and vascular injury by angioscopy might contribute to improving the treatment of the patients with CTEPH.