Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...Crimsonpublisherssmoaj
Acute type A aortic dissection is a catastrophic event in which blood exits the vascular lumen and dissects the media, creating a false lumen. Surgery is the best possible treatment but it is complex. The surgical team needs to understand the anatomy and physiopathology before dealing with the repair. While there are just a few surgical solutions for the repair of the dissected ascending aorta, debate is still ongoing about the best surgical option for the disease involving the arch and the descending aorta. Late reoperations are relatively common on the aortic valve and/or the distal aorta after primary repair. Results are excellent in specialized centers with high volume and complexity. Lifelong follow-up is required in survivors.
The main hemodynamic interactions that may impact on the diagnosis of multiple and mixed Multiple and Mixed Valvular Heart Diseases:HOW TO USE IMAGINGThe interplay of multiple valve pathology.The clinical challenge of concomitant aortic and mitral valve stenosis
.
.
Study of 89 Cases of Peripheral Vascular Disease by CT AngiographyM A Hasnat
The purpose of this study was to observe the morphological pattern by CT angiography
and risk factors for development of peripheral vascular disease in Bangladeshi patient suffering
from peripheral vascular disease using a multidetector scanner in the evaluation of patients with
peripheral vascular disease.
Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...Crimsonpublisherssmoaj
Acute type A aortic dissection is a catastrophic event in which blood exits the vascular lumen and dissects the media, creating a false lumen. Surgery is the best possible treatment but it is complex. The surgical team needs to understand the anatomy and physiopathology before dealing with the repair. While there are just a few surgical solutions for the repair of the dissected ascending aorta, debate is still ongoing about the best surgical option for the disease involving the arch and the descending aorta. Late reoperations are relatively common on the aortic valve and/or the distal aorta after primary repair. Results are excellent in specialized centers with high volume and complexity. Lifelong follow-up is required in survivors.
The main hemodynamic interactions that may impact on the diagnosis of multiple and mixed Multiple and Mixed Valvular Heart Diseases:HOW TO USE IMAGINGThe interplay of multiple valve pathology.The clinical challenge of concomitant aortic and mitral valve stenosis
.
.
Study of 89 Cases of Peripheral Vascular Disease by CT AngiographyM A Hasnat
The purpose of this study was to observe the morphological pattern by CT angiography
and risk factors for development of peripheral vascular disease in Bangladeshi patient suffering
from peripheral vascular disease using a multidetector scanner in the evaluation of patients with
peripheral vascular disease.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
2. EPIDEMIOLOGY
1-2 % aged 65 or older
12 % aged 75 or older
3.4% aged older than 75 had severe AS.
Rate of progression from aortic sclerosis to stenosis –
1.8% to 1.9% per year.
Braunwald 12th edition pg 1399
3. Valvular AS – 3 principal causes:
A congenital bicuspid valve with superimposed
calcification,
calcification of a normal trileaflet valve,
and rheumatic disease.
AS – severe atherosclerosis of the aorta and aortic valve
(rare – homozygous type II hyperlipoproteinemia, severe
hypercholesterolemia)
4. Fixed obstruction to left ventricular (LV)
outflow
Above the valve (supravalvular stenosis)
Below the valve (discrete subvalvular stenosis)
Dynamic subaortic obstruction - caused by
hypertrophic cardiomyopathy
5. Unicuspid, bicuspid, tricuspid, & quadricuspid.
Unicuspid valves usually are severely narrowed at birth and
produce symptoms in infancy.
7. Rheumatic aortic stenosis. The
commissures are fused with a fixed
central orifice.
Calcific aortic stenosis
8.
9. Generally, repeat imaging is performed every 6 to 12
months for severe AS, every 1 to 2 years for moderate AS,
and every 3 to 5 years for mild AS,
ESC 2021 GUIDELINES ON VALVULAR HEART DISEASE
10. Severity depends upon measurement of mean pressure
gradient (the most robust parameter), peak transvalvular
velocity (Vmax), and valve area.
Discordant cases should take account of additional parameters:
functional status, stroke volume, Doppler velocity index,156
degree of valve calcification, LV function, the presence or
absence of LV hypertrophy, flow conditions, and the adequacy
of BP control.
11.
12.
13.
14.
15.
16.
17. Natriuretic peptides –predict
free survival and outcome in
normal and low-flow severe
aortic stenosis
Exercise testing may
unmask symptoms and is
recommended for
risk stratification of
asymptomatic patients with
severe aortic stenosis.
Exercise echocardiography
provides additional
prognostic
information by assessing the
increase in mean pressure
gradient and change in LV
function.
18. Diagnostic workup
CCT is the preferred imaging tool to assess:
(i) aortic valve anatomy,
(ii) annular size and shape,
(iii) extent and distribution
of valve and vascular calcification,
(iv) risk of coronary ostial obstruction,
(v) aortic root dimensions, (vi) optimal fluoroscopic projections
for valve deployment, and (vii) feasibility of vascular access (femoral,
subclavian, axillary, carotid, transcaval or transapical).
19.
20. Myocardial fibrosis is a major driver of LV decompensation in
aortic stenosis (regardless of the presence or absence of CAD),
which can be detected and quantified using CMR.
Amyloidosis is also frequently associated with aortic stenosis in elderly patients
(incidence 9 - 15%).
When cardiac amyloidosis is clinically suspected, based on symptoms
(neuropathy and hematologic data), diphosphonate scintigraphy and/or CMR
should be considered
21.
22.
23. Clinical, anatomical and procedural factors that
influence the choice of treatment modality for an individual
24.
25.
26. The prognosis of patients with normal-flow, low-gradient
aortic
stenosis and preserved ejection fraction is similar to that of
moderate aortic stenosis—regular clinical and
echocardiographic surveillance is recommended
27.
28.
29.
30.
31.
32.
33. Special patient populations
CAD and aortic stenosis frequently coexist.
Both simultaneous SAVR and CABG, and SAVR late after CABG, carry a
higher procedural risk than isolated SAVR.
Patients aged <70 years with mean gradient progression >5 mmHg/year
benefit from SAVR at the time of CABG once baseline peak gradient
exceeds 30 mmHg. ESC 2021 VALVULAR HEART DISEASE GUIDELINES
34. PCI and TAVI - Combined or staged
SURTAVI trial, there was no significant difference in the
primary endpoint (all-cause mortality or stroke at 2-year
follow-up) in intermediate-risk patients with severe aortic
stenosis and noncomplex CAD (SYNTAX score <22)
undergoing either TAVI and
PCI or SAVR and CABG [16.0% (95% CI, 11.122.9) vs.
14% (95% CI, 9.221.1); P= 0.62].
37. CASE #1 : ASYMPTOMATIC PATIENT WITH SEVERE AS
(STAGE C 1)
75 YEAR old women with calcific AS
Asymptomatic (confirmed by ETT)
BNP :190pg/ml
LVEF:60%
Grading of AS severity on ECHO:
Severely calcified valve
Peak jet velocity :5.1m/s (1 year ago:4.8m/s)
Peak/mean gradient : 104/64 mmHg
AVA:0.65 cm² Indexed AVA:0.35cm²/m²
38. Clinical dilemma in true asymptomatic severe AS
( C1 stage)
Early << Prophylactic >> AVR?
Or
Watchful waiting?
39.
40. CASE 2#
82 year woman,
HTN – ACEI
No CAD
NYHA III, HF hospitalization
LVEF – 65%
Global longitudinal strain : 13%
Grade 2 diastolic dysfunction
Echo: AVA :0.64 cm2, iAVA:0.36cm2/m2
Doppler velocity index :0.19
Peak/mean gradient : 44/26mmHg
SVI: 29 ml/m2
42. CASE 3:
AC01.0005011140
74 YEAR OLD,
DM
ANEMIA
EF-60%
Asymptomatic
Exercise testing: normal
Next year came with symptoms
Echo:
AVA : 0.9cm2,
Peak/mean gradient : 107/67mmHg
43. CASE 4
AC01.0003681487
Name: ABC
Age: 84 years, female
Asymptomatic severely calcified AS
ACS-NSTEMI
NSVT, Paroxysmal AF
HFpEF
NTproBNP: 9620 pg/ml
ECHO: E/e: 22.5
PG: 123 mmHG, MG : 73 mmHG
AVA : 0.5 cm2
