This document discusses cardiac imaging techniques used in the diagnosis and treatment of prosthetic paravalvular leaks (PVLs). Echocardiography, especially 3D transoesophageal echocardiography (TEE), plays a key role in initially diagnosing PVLs, guiding percutaneous closure procedures, and evaluating outcomes. While transthoracic echocardiography is often first used, TEE is needed to confirm clinically significant leaks. Additional techniques like CT, MRI, and angiography can provide further detail. Intraprocedural imaging with TEE and fluoroscopy helps interventional cardiologists properly position closure devices and confirm adequate sealing of leaks.
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
Carotid artery disease is a major cause of stroke. Left untreated, carotid stenosis over 75% carries a risk of stroke of 2-5% per year. Carotid endarterectomy has been shown in clinical trials such as NASCET and ACAS to significantly reduce stroke risk compared to medical management alone, with perioperative stroke or death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Carotid artery stenting is an alternative treatment that utilizes embolic protection devices and stent placement to treat carotid stenosis, but requires technical expertise to achieve outcomes comparable to surgery.
The document discusses carotid artery disease and treatment options such as carotid angioplasty and stenting. It notes that stroke is a major cause of death and disability in the US. Carotid artery stenosis over 75% poses a high risk of stroke without treatment. Newer techniques like carotid stenting aim to achieve low stroke/death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Success requires choosing the right tools, techniques, and protection devices tailored to each patient's anatomy and plaque characteristics. Ongoing studies evaluate newer neuroprotection systems to further reduce embolic risks of carotid stenting.
An Overview of Filter-Protected Carotid Artery Stentinggailms
This document provides an overview of filter-protected carotid artery stenting. It discusses carotid artery disease and treatment options like carotid endarterectomy and carotid artery stenting. Embolic protection filters are used during carotid artery stenting to prevent plaque and debris from entering the bloodstream and causing strokes. The document summarizes various embolic protection devices and filter designs. It also reviews several in vitro studies that evaluate the capture efficiency and performance of different filter devices using particle models and benchtop flow loops. Overall, the document presents background information on carotid artery disease and stenting and evaluates the performance of embolic protection filters through in vitro testing.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
This document discusses carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) for treatment of carotid artery stenosis. It provides details on patient selection criteria and describes the CAS procedure, including diagnostic arteriography, embolic protection device placement, stent placement, and post-procedure care. Several major clinical trials are summarized that demonstrated CAS to be non-inferior to CEA for reducing risk of stroke in both symptomatic and asymptomatic patients.
Acs0609 Surgical Treatment Of Carotid Artery Diseasemedbookonline
1) Surgical treatment of carotid artery disease aims to prevent stroke by operating on patients with carotid stenosis.
2) Carotid endarterectomy has been shown to reduce stroke risk in patients with symptomatic stenosis >50% or asymptomatic stenosis >60%.
3) Preoperative evaluation assesses patient health and imaging identifies carotid lesions. Proper positioning and anesthesia are also important.
4) The operative technique involves incising along the carotid sheath and carefully exposing and mobilizing the carotid artery and bifurcation while protecting surrounding nerves.
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
Carotid artery disease is a major cause of stroke. Left untreated, carotid stenosis over 75% carries a risk of stroke of 2-5% per year. Carotid endarterectomy has been shown in clinical trials such as NASCET and ACAS to significantly reduce stroke risk compared to medical management alone, with perioperative stroke or death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Carotid artery stenting is an alternative treatment that utilizes embolic protection devices and stent placement to treat carotid stenosis, but requires technical expertise to achieve outcomes comparable to surgery.
The document discusses carotid artery disease and treatment options such as carotid angioplasty and stenting. It notes that stroke is a major cause of death and disability in the US. Carotid artery stenosis over 75% poses a high risk of stroke without treatment. Newer techniques like carotid stenting aim to achieve low stroke/death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Success requires choosing the right tools, techniques, and protection devices tailored to each patient's anatomy and plaque characteristics. Ongoing studies evaluate newer neuroprotection systems to further reduce embolic risks of carotid stenting.
An Overview of Filter-Protected Carotid Artery Stentinggailms
This document provides an overview of filter-protected carotid artery stenting. It discusses carotid artery disease and treatment options like carotid endarterectomy and carotid artery stenting. Embolic protection filters are used during carotid artery stenting to prevent plaque and debris from entering the bloodstream and causing strokes. The document summarizes various embolic protection devices and filter designs. It also reviews several in vitro studies that evaluate the capture efficiency and performance of different filter devices using particle models and benchtop flow loops. Overall, the document presents background information on carotid artery disease and stenting and evaluates the performance of embolic protection filters through in vitro testing.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
This document discusses carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) for treatment of carotid artery stenosis. It provides details on patient selection criteria and describes the CAS procedure, including diagnostic arteriography, embolic protection device placement, stent placement, and post-procedure care. Several major clinical trials are summarized that demonstrated CAS to be non-inferior to CEA for reducing risk of stroke in both symptomatic and asymptomatic patients.
Acs0609 Surgical Treatment Of Carotid Artery Diseasemedbookonline
1) Surgical treatment of carotid artery disease aims to prevent stroke by operating on patients with carotid stenosis.
2) Carotid endarterectomy has been shown to reduce stroke risk in patients with symptomatic stenosis >50% or asymptomatic stenosis >60%.
3) Preoperative evaluation assesses patient health and imaging identifies carotid lesions. Proper positioning and anesthesia are also important.
4) The operative technique involves incising along the carotid sheath and carefully exposing and mobilizing the carotid artery and bifurcation while protecting surrounding nerves.
Catheter ablation of Idiopatic ventricular tachycardiaMarina Mercurio
1. The study assessed the feasibility, success rate, and safety of catheter ablation for idiopathic ventricular tachycardia without the use of fluoroscopy.
2. Nineteen patients underwent ablation guided by electroanatomical mapping and intracardiac echocardiography without fluoroscopy.
3. The procedure was successful in all patients with no complications. At 18-month follow up, recurrences occurred in two patients. The study demonstrates catheter ablation for idiopathic VT can be performed safely and effectively without fluoroscopy.
This review article discusses aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI). It notes that AR is more common after TAVI than surgical aortic valve replacement, with mild AR observed in about 70% of TAVI patients. Even mild AR has been linked to decreased survival up to two years after the procedure. The review aims to provide an overview of the three types of AR that can occur after TAVI - transvalvular, paravalvular, and supraskirtal - focusing on their different pathophysiological mechanisms. Accurate evaluation and classification of AR is important for understanding its implications, but challenging due to limitations of echocardiography for assessing transcatheter
This document discusses infrainguinal arterial procedures, focusing on femoropopliteal bypass surgery. It begins with an overview of preoperative testing and imaging, including duplex scanning, MRI angiography, CT angiography, and conventional angiography. The key steps of an above-the-knee femoropopliteal bypass are then described in detail, including harvesting the great saphenous vein, exposing the femoral artery, and exposing the popliteal artery distally. The bypass is performed by anastomosing the vein graft proximally to the femoral artery and distally to the popliteal artery above the knee. Precise surgical technique is important for successful bypass outcomes.
This document provides guidance on percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs). It notes that PCI of native coronary arteries is preferred when feasible. For SVG PCI, it recommends the liberal use of embolic protection devices to reduce the risk of atheroembolism. It also provides tips for technical considerations like guide catheter selection and balloon inflation pressures. It discusses the indications for and results of SVG intervention in different time periods after CABG, noting higher risks for early reintervention but short-term benefits of PCI over reoperation.
This document discusses carotid artery disease and carotid stenting procedures. It provides background on carotid artery atherosclerosis and how vulnerable plaques can lead to strokes. It then summarizes guidelines for diagnosing and treating symptomatic and asymptomatic carotid stenosis, including the risks and benefits of medical therapy, carotid endarterectomy, and carotid artery stenting. The document concludes by outlining the key steps for performing carotid artery stenting, including patient selection, imaging, vascular access, stent placement, and complications to consider.
The field of transcatheter mitral valve repair (TMVr) for
mitral regurgitation (MR) is rapidly evolving. Besides the
well-established transcatheter mitral edge-to-edge repair
approach, there is also growing evidence for therapeutic
strategies targeting the mitral annulus and mitral valve
chordae. A patient-tailored approach, careful patient
selection and an experienced interventional team is crucial
in order to optimise procedural and clinical outcomes. With
further data from ongoing clinical trials to be expected,
consensus in the Heart Team is needed to address these
complexities and determine the most appropriate TMVr
therapy, either single or combined, for patients with severe
MR
The document discusses complications and limitations of the elephant trunk procedure for treating complex aortic aneurysms. Some key points:
- The elephant trunk procedure has acceptable short and long-term outcomes but carries risks of left recurrent nerve injury, aortic rupture early after surgery, and rupture before the second stage.
- Only 61% of patients underwent the planned second-stage repair, and some refused the second procedure.
- Alternatives like a single-stage approach or performing the distal anastomosis more distally can reduce risks but were not always favored in the past.
- Emerging techniques like using the elephant trunk graft to enable endovascular stent grafting of the descending aorta may address some limitations
11:35 CASE 3 Lefevre - impossible to crossEuro CTO Club
A 70-year-old male presented with pulmonary edema and was found to have an anterior myocardial infarction with total occlusion of the mid-LAD and intermediate lesion in the distal RCA. Angiography showed collaterals from the RCA to the LAD via a septal channel. Attempts to cross the CTO in the LAD with a balloon and wire were unsuccessful. The next steps considered were either using antegrade laser ablation or a retrograde approach through the septal collaterals. Ultimately, antegrade laser ablation was successful after 3 hours and 42 minutes, improving the patient's ejection fraction from 30% to 47% at 6-month follow up.
Georgios Sianos - RETROGRADE STEP BY STEP APPROACHEuro CTO Club
This document provides an overview of retrograde techniques for recanalizing chronic total occlusions (CTOs). It discusses the history and evolution of retrograde techniques, including septal collateral crossing and dilatation. Key steps in the retrograde approach like wire escalation, dissection and re-entry are outlined. Case examples demonstrate the retrograde procedure in detail. Consensus recommendations emphasize the importance of operator experience before performing retrograde CTO PCI independently. Required lab set-up and equipment are also reviewed.
Retrograde access to seal a large coronary perforationRamachandra Barik
The sealing of a large vessel coronary perforation during percutaneous coronary intervention typically requires the
deployment of 1 or more covered stents. A novel approach to seal a life-threatening perforation caused by unnoticed
wire-exit and balloon dilation, utilizing retrograde techniques, without a covered-stent is described.
This document discusses saphenous vein graft interventions. It covers the natural progression of saphenous vein graft disease over time, techniques for intervening on saphenous vein grafts such as thrombectomy and aspiration thrombectomy, potential complications, and the role of stents and supportive medications. Distal protection devices are mentioned as a way to prevent distal embolization during saphenous vein graft interventions. Clinical trials demonstrate reductions in adverse events when using distal protection compared to routine stenting without protection.
This document discusses novel techniques for recanalizing the radial artery after late occlusion. In 95 cases of radial artery occlusion out of over 2000 repeat transradial interventions, recanalization was successful in 82 cases using techniques similar to those used for coronary chronic total occlusions or tibial arteries, including wire strategies, penetration techniques, and balloon angioplasty. A new distal entry point via the deep palmar arch was used successfully in 13 of 14 cases. Hydrodynamic recanalization, where liquid is injected under high pressure, also helped in 4 cases. A new study is proposed to compare the traditional entry point to the new distal puncture technique to assess radial artery occlusion rates and safety.
This document discusses endovascular interventions for infrapopliteal peripheral vascular disease. Infrapopliteal disease is rising due to an aging population and increased rates of diabetes and kidney disease. Surgical and early endovascular interventions historically had high failure rates in this region. Endovascular procedures now provide an alternative to bypass surgery for treating critical limb ischemia in the infrapopliteal arteries, with the goal of establishing straight line blood flow to the foot. Success depends on factors like number of vessels opened, inflow status, and addressing more proximal disease first when needed. Complications can include access issues, vessel spasm or perforation, embolism, and contrast nephropathy.
Coronary endarterectomy and patch angioplasty for diffuse coronary artery dis...Abdulsalam Taha
CABG may not be sufficient to treat the diffusely diseased coronary arteries. New techniques such as coronary endarterectomy with patch angioplasty may provide a solution.
This document discusses the use of multi-modal CT scanning in evaluating patients with cerebrovascular disease. It begins by introducing ischemic stroke as a leading cause of disability and mortality. It then discusses how CT has evolved as a non-invasive imaging tool to evaluate carotid artery pathology and intracranial vessels. In particular, it describes the use of CT angiography (CTA) to assess vessel lumen and plaque characteristics, and CT perfusion (CTP) to provide information on brain vascular physiology and identify ischemic penumbra. The document provides details on CT protocols for CTA and CTP, and discusses how findings from these techniques can predict stroke risk and guide treatment decisions. It focuses on how CTA allows evaluation of
The document discusses interventions for recurrent ischemia after coronary artery bypass grafting, describing the typical causes of early and late ischemia, techniques for intervening on saphenous vein grafts including thrombectomy and aspiration devices to remove thrombus, and the use of distal protection devices during stenting to prevent embolization. It compares rheolytic thrombectomy, aspiration thrombectomy, and various distal protection devices. The role of glycoprotein IIb/IIIa inhibitors during saphenous vein graft interventions is also discussed.
Valsalva manoeuvre in drug refractory ventricular tachycardiaRamachandra Barik
Ventricular tachycardia (VT) is a cardiac emergency exerting significant morbidity and mortality. Differentiation between VT and supraventricular tachycardia with aberrancy (SVT-A) can be challenging,necessitating awareness of the salient lectrocardiogram (ECG)criteria1 and at times, proven refractoriness to adenosine. Despite well-established guidelines and evidence-based anti-arrhythmic medications for VT management, the role of Valsalva manoeuvre (VM) as
an effective treatment for VT remains controversial.2,3 In this case report, we describe a patient who presented with multiple
drug-refractory VTs, one of which repeatedly terminated by VM.
This document discusses the role of MRI in assessing the thoracic aorta. It provides details on various MRI techniques used including CE-MRA, bSSFP, phase contrast, and black-blood sequences. It reviews clinical applications of MRI for thoracic aortic aneurysm, acute aortic syndromes, and large vessel vasculitis. MRI is presented as a good non-invasive alternative to CT for evaluation and serial imaging of thoracic aortic pathology due to lack of ionizing radiation and ability to characterize soft tissues and evaluate flow.
Echocardiographic guidance is critical for procedural success of paravalvular leak closure. Transesophageal echocardiography (TEE) and particularly three-dimensional echocardiography represent the gold standards. Fusion imaging provides real-time integration of three-dimensional echocardiography and X-ray fluoroscopy and can further facilitate spatial orientation, wire placement and device deployment. Intracardiac echocardiography (ICE) is a secondary approach possibly beneficial in selected cases.
Catheter ablation of Idiopatic ventricular tachycardiaMarina Mercurio
1. The study assessed the feasibility, success rate, and safety of catheter ablation for idiopathic ventricular tachycardia without the use of fluoroscopy.
2. Nineteen patients underwent ablation guided by electroanatomical mapping and intracardiac echocardiography without fluoroscopy.
3. The procedure was successful in all patients with no complications. At 18-month follow up, recurrences occurred in two patients. The study demonstrates catheter ablation for idiopathic VT can be performed safely and effectively without fluoroscopy.
This review article discusses aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI). It notes that AR is more common after TAVI than surgical aortic valve replacement, with mild AR observed in about 70% of TAVI patients. Even mild AR has been linked to decreased survival up to two years after the procedure. The review aims to provide an overview of the three types of AR that can occur after TAVI - transvalvular, paravalvular, and supraskirtal - focusing on their different pathophysiological mechanisms. Accurate evaluation and classification of AR is important for understanding its implications, but challenging due to limitations of echocardiography for assessing transcatheter
This document discusses infrainguinal arterial procedures, focusing on femoropopliteal bypass surgery. It begins with an overview of preoperative testing and imaging, including duplex scanning, MRI angiography, CT angiography, and conventional angiography. The key steps of an above-the-knee femoropopliteal bypass are then described in detail, including harvesting the great saphenous vein, exposing the femoral artery, and exposing the popliteal artery distally. The bypass is performed by anastomosing the vein graft proximally to the femoral artery and distally to the popliteal artery above the knee. Precise surgical technique is important for successful bypass outcomes.
This document provides guidance on percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs). It notes that PCI of native coronary arteries is preferred when feasible. For SVG PCI, it recommends the liberal use of embolic protection devices to reduce the risk of atheroembolism. It also provides tips for technical considerations like guide catheter selection and balloon inflation pressures. It discusses the indications for and results of SVG intervention in different time periods after CABG, noting higher risks for early reintervention but short-term benefits of PCI over reoperation.
This document discusses carotid artery disease and carotid stenting procedures. It provides background on carotid artery atherosclerosis and how vulnerable plaques can lead to strokes. It then summarizes guidelines for diagnosing and treating symptomatic and asymptomatic carotid stenosis, including the risks and benefits of medical therapy, carotid endarterectomy, and carotid artery stenting. The document concludes by outlining the key steps for performing carotid artery stenting, including patient selection, imaging, vascular access, stent placement, and complications to consider.
The field of transcatheter mitral valve repair (TMVr) for
mitral regurgitation (MR) is rapidly evolving. Besides the
well-established transcatheter mitral edge-to-edge repair
approach, there is also growing evidence for therapeutic
strategies targeting the mitral annulus and mitral valve
chordae. A patient-tailored approach, careful patient
selection and an experienced interventional team is crucial
in order to optimise procedural and clinical outcomes. With
further data from ongoing clinical trials to be expected,
consensus in the Heart Team is needed to address these
complexities and determine the most appropriate TMVr
therapy, either single or combined, for patients with severe
MR
The document discusses complications and limitations of the elephant trunk procedure for treating complex aortic aneurysms. Some key points:
- The elephant trunk procedure has acceptable short and long-term outcomes but carries risks of left recurrent nerve injury, aortic rupture early after surgery, and rupture before the second stage.
- Only 61% of patients underwent the planned second-stage repair, and some refused the second procedure.
- Alternatives like a single-stage approach or performing the distal anastomosis more distally can reduce risks but were not always favored in the past.
- Emerging techniques like using the elephant trunk graft to enable endovascular stent grafting of the descending aorta may address some limitations
11:35 CASE 3 Lefevre - impossible to crossEuro CTO Club
A 70-year-old male presented with pulmonary edema and was found to have an anterior myocardial infarction with total occlusion of the mid-LAD and intermediate lesion in the distal RCA. Angiography showed collaterals from the RCA to the LAD via a septal channel. Attempts to cross the CTO in the LAD with a balloon and wire were unsuccessful. The next steps considered were either using antegrade laser ablation or a retrograde approach through the septal collaterals. Ultimately, antegrade laser ablation was successful after 3 hours and 42 minutes, improving the patient's ejection fraction from 30% to 47% at 6-month follow up.
Georgios Sianos - RETROGRADE STEP BY STEP APPROACHEuro CTO Club
This document provides an overview of retrograde techniques for recanalizing chronic total occlusions (CTOs). It discusses the history and evolution of retrograde techniques, including septal collateral crossing and dilatation. Key steps in the retrograde approach like wire escalation, dissection and re-entry are outlined. Case examples demonstrate the retrograde procedure in detail. Consensus recommendations emphasize the importance of operator experience before performing retrograde CTO PCI independently. Required lab set-up and equipment are also reviewed.
Retrograde access to seal a large coronary perforationRamachandra Barik
The sealing of a large vessel coronary perforation during percutaneous coronary intervention typically requires the
deployment of 1 or more covered stents. A novel approach to seal a life-threatening perforation caused by unnoticed
wire-exit and balloon dilation, utilizing retrograde techniques, without a covered-stent is described.
This document discusses saphenous vein graft interventions. It covers the natural progression of saphenous vein graft disease over time, techniques for intervening on saphenous vein grafts such as thrombectomy and aspiration thrombectomy, potential complications, and the role of stents and supportive medications. Distal protection devices are mentioned as a way to prevent distal embolization during saphenous vein graft interventions. Clinical trials demonstrate reductions in adverse events when using distal protection compared to routine stenting without protection.
This document discusses novel techniques for recanalizing the radial artery after late occlusion. In 95 cases of radial artery occlusion out of over 2000 repeat transradial interventions, recanalization was successful in 82 cases using techniques similar to those used for coronary chronic total occlusions or tibial arteries, including wire strategies, penetration techniques, and balloon angioplasty. A new distal entry point via the deep palmar arch was used successfully in 13 of 14 cases. Hydrodynamic recanalization, where liquid is injected under high pressure, also helped in 4 cases. A new study is proposed to compare the traditional entry point to the new distal puncture technique to assess radial artery occlusion rates and safety.
This document discusses endovascular interventions for infrapopliteal peripheral vascular disease. Infrapopliteal disease is rising due to an aging population and increased rates of diabetes and kidney disease. Surgical and early endovascular interventions historically had high failure rates in this region. Endovascular procedures now provide an alternative to bypass surgery for treating critical limb ischemia in the infrapopliteal arteries, with the goal of establishing straight line blood flow to the foot. Success depends on factors like number of vessels opened, inflow status, and addressing more proximal disease first when needed. Complications can include access issues, vessel spasm or perforation, embolism, and contrast nephropathy.
Coronary endarterectomy and patch angioplasty for diffuse coronary artery dis...Abdulsalam Taha
CABG may not be sufficient to treat the diffusely diseased coronary arteries. New techniques such as coronary endarterectomy with patch angioplasty may provide a solution.
This document discusses the use of multi-modal CT scanning in evaluating patients with cerebrovascular disease. It begins by introducing ischemic stroke as a leading cause of disability and mortality. It then discusses how CT has evolved as a non-invasive imaging tool to evaluate carotid artery pathology and intracranial vessels. In particular, it describes the use of CT angiography (CTA) to assess vessel lumen and plaque characteristics, and CT perfusion (CTP) to provide information on brain vascular physiology and identify ischemic penumbra. The document provides details on CT protocols for CTA and CTP, and discusses how findings from these techniques can predict stroke risk and guide treatment decisions. It focuses on how CTA allows evaluation of
The document discusses interventions for recurrent ischemia after coronary artery bypass grafting, describing the typical causes of early and late ischemia, techniques for intervening on saphenous vein grafts including thrombectomy and aspiration devices to remove thrombus, and the use of distal protection devices during stenting to prevent embolization. It compares rheolytic thrombectomy, aspiration thrombectomy, and various distal protection devices. The role of glycoprotein IIb/IIIa inhibitors during saphenous vein graft interventions is also discussed.
Valsalva manoeuvre in drug refractory ventricular tachycardiaRamachandra Barik
Ventricular tachycardia (VT) is a cardiac emergency exerting significant morbidity and mortality. Differentiation between VT and supraventricular tachycardia with aberrancy (SVT-A) can be challenging,necessitating awareness of the salient lectrocardiogram (ECG)criteria1 and at times, proven refractoriness to adenosine. Despite well-established guidelines and evidence-based anti-arrhythmic medications for VT management, the role of Valsalva manoeuvre (VM) as
an effective treatment for VT remains controversial.2,3 In this case report, we describe a patient who presented with multiple
drug-refractory VTs, one of which repeatedly terminated by VM.
This document discusses the role of MRI in assessing the thoracic aorta. It provides details on various MRI techniques used including CE-MRA, bSSFP, phase contrast, and black-blood sequences. It reviews clinical applications of MRI for thoracic aortic aneurysm, acute aortic syndromes, and large vessel vasculitis. MRI is presented as a good non-invasive alternative to CT for evaluation and serial imaging of thoracic aortic pathology due to lack of ionizing radiation and ability to characterize soft tissues and evaluate flow.
Echocardiographic guidance is critical for procedural success of paravalvular leak closure. Transesophageal echocardiography (TEE) and particularly three-dimensional echocardiography represent the gold standards. Fusion imaging provides real-time integration of three-dimensional echocardiography and X-ray fluoroscopy and can further facilitate spatial orientation, wire placement and device deployment. Intracardiac echocardiography (ICE) is a secondary approach possibly beneficial in selected cases.
This document discusses sonographic evaluation for diagnosing upper extremity deep venous thrombosis (UEDVT). It provides an overview of the risk factors and complications of UEDVT. Color Doppler sonography is outlined as the preferred noninvasive screening technique, with sensitivity of 78-100% and specificity of 82-100% for diagnosing UEDVT. The normal venous anatomy of the upper extremity is described and techniques for performing the sonographic examination are explained. Examples of sonographic appearances of acute and chronic UEDVT are illustrated and described.
This document discusses updates in venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It describes the risk factors, signs, symptoms, and diagnostic testing for VTE including ultrasonography, CT pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scanning, and magnetic resonance imaging (MRI). It also discusses specific considerations for diagnosing PE during pregnancy.
This document summarizes a study that evaluated the use of 256 slice MDCT pulmonary angiography (MDCT-PA) to diagnose pulmonary embolism (PE) in 100 unselected patients with clinically suspected PE. The study found that 35% of patients had thromboembolic disease, with 32% having acute PE and 8% having acute deep vein thrombosis (DVT). MDCT-PA allowed direct visualization of thrombi in the pulmonary arteries and veins. The study concludes that MDCT-PA is an effective first-line imaging method for evaluating patients suspected of having a PE due to its non-invasive nature and ability to directly identify thrombotic material.
This document summarizes a study of 89 cases of peripheral vascular disease examined using CT angiography. The study found that hypertension was the most common risk factor, affecting 46.1% of patients. The predominant lesion observed was stenosis (5.61%), followed by hematoma and arteriovenous malformation. The abdominal aorta was the most commonly affected artery (58.43%), followed by the lower limbs. CT angiography provided a noninvasive means to image peripheral vascular disease and obtain data on morphological patterns and risk factors in Bangladeshi patients, which previously lacked disease-specific research.
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.
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
This document discusses prosthetic heart valve thrombosis (PVT), including its diagnosis, treatment, and management. Some key points:
- PVT is more common for mechanical heart valves than bioprosthetic valves. It occurs more frequently on the right side of the heart and for mitral valves.
- Transoesophageal echocardiography (TOE) is the primary diagnostic tool and can identify thrombi, reduced valve mobility, and other signs. It helps determine if PVT is obstructive or non-obstructive.
- Treatment depends on factors like thrombus size, location, and the patient's symptoms/health. Surgery is typically recommended for large or mobile left-sided thrombi and
The document discusses the radiological pathology of various cerebral conditions. It focuses on cerebral infarction, providing details on the pathophysiology and timeline of ischemic changes. Key CT findings of acute infarction include the hyperdense middle cerebral artery sign indicating vessel occlusion, and subtle early parenchymal edema visible as hypoattenuation. The significance of accurate early detection by CT for determining treatment eligibility for thrombolysis is emphasized.
Usefulness of Non-Enhanced 3-Dementional CT with Partial Maximum Intensity Pr...science journals
Computed Tomography (CT) with contrast material is often used for preoperative assessment and planning of embolotherapy in the treatment of Pulmonary Arteriovenous Malformations (PAVMs).
This document discusses chronic total occlusion (CTO) of coronary arteries. It defines CTO and differentiates it from functional occlusions and pseudo-occlusions. The prevalence of CTO is estimated to be around 15% based on registry data. CTOs present technical challenges for percutaneous coronary intervention (PCI) due to factors like lesion length, calcification, and tortuosity. Proper preparation is important for CTO PCI, including adequate guide support and anticoagulation. Scoring systems can help predict the difficulty of crossing a CTO. Special guidewires and techniques may be needed depending on the lesion characteristics and collateral pathways.
Echocardiography is commonly used to evaluate patients receiving continuous-flow left ventricular assist devices (LVADs), but evidence for its applications is limited and guidelines do not exist. The document reviews the evidence for using echocardiography in pre-operative planning, predicting post-operative right ventricular failure, assessing hemodynamics noninvasively, and optimizing device settings. However, most evidence is from axial-flow LVADs and applications to newer centrifugal devices require validation. Standardization of echocardiography for LVAD patients is needed.
This document summarizes venous thromboembolism (VTE), specifically deep vein thrombosis (DVT). It discusses how DVT is typically treated with anticoagulation to prevent further clotting, but this does not restore vein function. The document then focuses on how thrombolysis can restore flow and improve outcomes by reducing postthrombotic syndrome and recurrent DVT. For patients with iliofemoral DVT, thrombolysis often reveals underlying venous outflow obstructions that require treatment, such as with stents, to prevent reclotting and improve patency. The document provides guidance on indications for venous stenting after thrombolysis and the technique for performing stent placement.
This document summarizes information about tumours of the heart. It begins by stating that while heart tumours are rare, comprising 0.0017-0.33% of tumours, they can cause a variety of cardiac and systemic symptoms depending on their size and location. Small benign tumours in critical locations can have devastating effects, while advances in imaging and surgery have improved prognosis for many patients. However, cardiac sarcomas remain life-threatening. The document goes on to discuss the classification, epidemiology, clinical features, imaging and treatment of different heart tumours.
Trans catheter intervention is emerging field in cardiac intervention. due to complex anatomy of mitral valve understanding of anatomy and three dimensional imaging is most important aspect of successful intervention and could be life saving in high risk surgical candidate
This document provides guidelines for using multimodality imaging to evaluate patients with repaired tetralogy of Fallot (TOF). It describes the role of echocardiography, cardiovascular magnetic resonance (CMR), computed tomography (CT), nuclear scintigraphy, and angiography. Echocardiography and CMR are well-suited for longitudinal follow-up due to lack of radiation. CMR is considered the reference standard for assessing right ventricular size and function and pulmonary regurgitation. A multimodality approach is recommended to comprehensively evaluate the complex anatomy and physiology while considering each patient's needs and institutional resources.
This document provides an overview of chronic lower limb ischemia and the role of angioplasty in treating it. It begins with definitions and descriptions of chronic lower limb ischemia and its causes. It then discusses the diagnosis of chronic lower limb ischemia through tests like ankle-brachial index measurements and contrast angiography. The document reviews endovascular procedures like percutaneous transluminal angioplasty and stenting as options for revascularization, compared to surgical options. It provides details on how to perform angioplasty and discusses factors that determine the success of endovascular interventions. The document concludes by discussing potential complications of these procedures.
[123doc] - bai-giang-sieu-am-tim-3d-trong-danh-gia-va-can-thiep-cac-benh-ly-v...Thọ Văn
3D echocardiography plays an important role in assessing and intervening in valve diseases. It can evaluate valve anatomy in detail, guide interventional procedures such as MitraClip and balloon valvuloplasty, and monitor outcomes. Real-time 3D TEE is especially useful for quantifying mitral regurgitation and measuring the mitral valve area during balloon valvuloplasty. 3D imaging also helps with patient selection and guidance for transcatheter aortic valve implantation.
Similar to Cardiac imaging in prosthetic paravalvular leaks (20)
The World Hypertension League: where now and where to in salt reductionPaul Schoenhagen
Abstract: High dietary salt is a leading risk for death and disability largely by causing increased blood pressure. Other associated health risks include gastric and renal cell cancers, osteoporosis, renal stones, and increased disease activity in multiple sclerosis, headache, increased body fat and Meniere’s disease. The World Hypertension League (WHL) has prioritized advocacy for salt reduction. WHL resources and actions include a non-governmental organization policy statement, dietary salt fact sheet, development of standardized nomenclature, call for quality research, collaboration in a weekly salt science update, development of a process to set recommended dietary salt research standards and regular literature reviews, development of adoptable power point slide sets to support WHL positions and resources, and critic of weak research studies on dietary salt. The WHL plans to continue to work with multiple governmental and non-governmental organizations to promote dietary salt reduction towards the World Health Organization (WHO) recommendations.
Developing a national salt reduction strategy for MongoliaPaul Schoenhagen
Background: The increase in prevalence of risk factors such as hypertension has contributed to an incremental rise in non-communicable diseases (NCDs) in Mongolia over recent decades, such that they now account for 80% of all deaths in the country. Salt reduction is one of the most cost-effective interventions to reduce the burden of NCDs.
Methods: In 2011, the Ministry of Health (MOH) instigated the development of a national salt reduction strategy for Mongolia. As part of a 2-week national consultation and training program on salt reduction, it established an inter-sectoral working party and organized a series of bilateral meetings and visits to factories. Actions arising included a baseline survey of population salt consumption patterns and the implementation of a series of pilot salt reduction initiatives.
Results: The results of the baseline assessment revealed that average daily intake of salt, based on 24 hour urine samples from a representative national sample (n=1,027), was 11.06±5.99 g in 2011, more than double the World Health Organization (WHO) five grams recommendation. Moreover, while most participants knew that salt was bad for health, few were taking efforts to reduce intake, and many were consuming highly salty meals and tea; salt in tea alone was estimated to contribute 30% of daily salt intake. A pilot Pinch Salt intervention to reduce salt consumption of factory workers was undertaken in Ulaanbaatar (UB) city between 2012 and 2013, and was associated with a reduction of 2.8 g of salt intake. Ongoing food industry initiatives have led to significant reductions in salt levels in bread, and companies producing processed meat have indicated a willingness to reduce salt. Relevant stakeholders have also supported the campaign by participating in annual World Salt Awareness Week events. The activities to date have demonstrated the potential for action and there is now a need scale these up to a national level to ensure that Mongolia is in a strong position to achieve a 30% reduction in population salt intake by 2025. The main goal of the Mongolian national salt reduction strategy is to create a social, economic and legal environment that supports salt reduction, including by influencing food supply, increasing partnerships between government and relevant stakeholders, and creating an enabling environment to support improved consumer choices. The strategy will be implemented from 2015 to 2025, with an interim review of progress in 2020.
Conclusions: Given that Mongolia has one of the highest rates of stroke in the world, which is strongly associated with population-wide blood pressure (BP) levels, the addition of a population-based stroke surveillance program would provide a reliable direct assessment of the impact of these salt reduction initiatives on the health of the Mongolian people. The results from this research would likely be widely generalizable to other populations experiencing similar lifestyle transitional changes.
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Sodium content in processed foods in Argentina: compliance with the national lawPaul Schoenhagen
Background: Despite the body of evidence that documents the unfavorable effects of excessive sodium
consumption on blood pressure and cardiovascular health, public health efforts to decrease sodium consumption
have been limited to a few countries. Argentina is the first country in Latin America to regulate sodium content of
processed foods by means of a national law. The objective of this cross-sectional quantitative study is to provide a
baseline comparison against the reduction targets set by the national law before its entry into force.
Methods: Data were collected in February 2014 in a leading supermarket chain located in Buenos Aires.
Nutrient data from package labels were analysed for 1,320 products within 14 food groups during the study
period. To compare sodium concentration levels with the established maximum levels we matched the
collected food groups with the food groups included in the law resulting in a total of 292 products. Data
analysis was conducted using SPSS version 20 software.
Results: Food groups with the highest median sodium content were sauces and spreads (866.7 mg/100 g),
meat and meat products (750 mg/100 g) and snack foods (644 mg/100 g). Categories with the highest sodium
content were appetizers (1,415 mg/100 g), sausages (1,050 mg/100 g) and ready-made meals (940.7 mg/100 g).
We also found large variability within products from the same food categories. Products included in the
national law correspond to 22.1% (n=292) of the surveyed foods. From the 18 food groups, 15 showed
median sodium values below the established targets. Products exceeding the established maximum levels
correspond to 15.1% (n=44) of the products included in the analysis.
Conclusions: This study is the first analysis of food labels to determine sodium concentrations of processed
foods in Argentina and to provide a baseline against the national law standards. Upon the completion of
this analysis, maximum levels have been achieved by most of the food groups included in the law. Thus, the
introduction of further reductions for the existing maximum levels and the establishment of sodium targets for
all relevant product categories not included in the law should be considered as the next steps in the process.
Salt reduction and hypertension in China: a concise state-of-the-art reviewPaul Schoenhagen
Abstract: Hypertension (HTN) and its cardiovascular complications such as stroke and heart failure are a serious public health problem around the world. A growing number of studies confirm that salt plays an important role in the development of HTN. Increasing intake of salt leads to abnormal transport of sodium ions at the cellular level with activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Studies have shown that salt restriction can reduce blood pressure (BP) in patients with HTN, especially salt-sensitive HTN. Public health interventions to reduce salt intake, with the goal of decreasing adverse outcomes have been launched in numerous countries. In this review we will summarize the epidemiology of cardiovascular diseases and their risk factors, the relationship between salt and HTN, the effect of salt restriction on HTN and the current situation of prevention and treatment of HTN by salt reduction in China.
WHO’s supported interventions on salt intake reduction in the sub-Saharan Afr...Paul Schoenhagen
Abstract: Reduction of salt intake is an important and cost-effective way for reducing hypertension and the risk of cardiovascular diseases (CVDs). Current global salt intakes are estimated at around 10 g/day, well above the World Health Organization (WHO) recommended level of <5 g/day. The sub-Saharan Africa (SSA) region has a prevalence of hypertension of 46% among adults aged 25 and over and therefore strategies to reduce salt intake are necessary. This requires an understanding of salt intake behaviors in the population along with government commitment to increase awareness and take actions that would create an enabling environment. It is also important to have the food industry and other key stakeholders on board. A review of the developed WHO’s norms and guidelines, technical support provided to countries by WHO as well as country initiatives shows that countries in the African region are at different stages in the implementation of salt reduction interventions. For example, South Africa has enacted legislation to make the food industry reduce the salt content of a number of its products while Mauritius is requesting bakery owners to reduce salt in bread. A number of countries are currently undertaking studies to measure salt intake in the populations. Overall progress is slow as the region experiences a double burden of communicable and noncommunicable diseases, competing health priorities and limited resources for health.
Keywords: Africa; salt intake; sodium; non-communicable diseases (NCDs); cardiovascular
An overview of salt intake reduction efforts in the Gulf Cooperation Council ...Paul Schoenhagen
Globally, morbidity and mortality from non-communicable diseases (NCDs) are increasing steadily and at an alarming rate. High blood pressure is a major risk factor for cardiovascular disease (CVD) and salt reduction is an effective measure to decrease mortality rates. In the Eastern Mediterranean region, current salt intake is high, with an average intake of >12 g per person per day. Reducing the intake of salt has been identified as a priority intervention to reduce NCDs. Countries of the Gulf Cooperation Council (GCC) are showing a willingness to comply with the World Health Organization (WHO) recommendations and an eagerness to reduce the burden of NCDs. However, they face some challenges, including lack of political commitment, lack of experience, and shortage of qualified human resources. Salt intake reduction efforts
Salt intake reduction efforts: advances and challengesPaul Schoenhagen
The articles in this special issue of Cardiovascular Diagnosis and Therapy describe the efforts to reduce salt intake in different parts of the world, including South America, Africa, the Middle East, the Far East (China and Mongolia) and Australia, in addition to an overview of the work of the World Hypertension League in this domain. Sharing experiences from diverse regions and countries, these data will contribute to better understanding the challenges and opportunities encountered by the groups working in the field.
A new polymer-free drug-eluting stent with nanocarriers eluting sirolimus fro...Paul Schoenhagen
Background: Permanent polymers in first generation drug-eluting stent (DES) have been imputed to be a possible cause of persistent inflammation, remodeling, malapposition and late stent thrombosis. We aim to describe the in vivo experimental result of a new polymer-free DES eluting sirolimus from stent-plus-balloon (Focus np stent, Envision Scientific) compared with a bare-metal stent (BMS) (Amazonia CroCo, Minvasys) and with a biolimus A9 eluting stent (Biomatrix, Biosensors).
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
Improved non-calcified plaque delineation on coronary CT angiography by sonog...Paul Schoenhagen
Purpose: To prospectively compare non-calcified plaque delineation and image quality of coronary computed tomography angiography (CCTA) obtained with sinogram-affirmed iterative reconstruction (IR) with different filter strengths and filtered back projection (FBP).
Hemodynamic assessment of partial mechanical circulatory support: data derive...Paul Schoenhagen
Partial mechanical circulatory support represents a new concept for the treatment of advanced heart failure. The Circulite Synergy Micro Pump®, where the inflow cannula is connected to the left atrium and the outflow cannula to the right subclavian artery, was one of the first devices to introduce this concept to the clinic. Using computational fluid dynamics (CFD) simulations, hemodynamics in the aortic tree was visualized and quantified from computed tomography angiographic (CTA) images in two patients. A realistic computational model was created by integrating flow information from the native heart and from the Circulite device. Diastolic flow augmentation in the descending aorta but competing/antagonizing flow patterns in the proximal innominate artery was observed. Velocity time curves in the ascending aorta correlated well with those in the left common carotid, the left subclavian and the descending aorta but poorly with the one in the innominate. Our results demonstrate that CFD may be useful in providing a better understanding of the main flow patterns in mechanical circulatory support devices.
Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD.
microRNA-based diagnostics and therapy in cardiovascular disease—Summing up t...Paul Schoenhagen
This document discusses microRNAs (miRNAs) as potential biomarkers for cardiovascular disease diagnosis and therapy. It summarizes that miRNAs have been found to be specifically up or downregulated in different cardiovascular diseases and animal models. Circulating miRNAs have shown promise as biomarkers for conditions like myocardial infarction and coronary artery disease due to their stability and disease-specific expression patterns. Several miRNAs have been identified as biomarkers for acute myocardial infarction that may complement or improve upon existing protein biomarkers. Research is also exploring the potential of miRNA-based therapies for cardiovascular diseases.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Carotid intima-media thickness (CIMT) and carotid plaques in young Nepalese p...Paul Schoenhagen
Abstract
Background: Carotid intima-media thickness (CIMT) and carotid plaques are non-invasive surrogate markers of early evaluation of coronary artery disease (CAD) and sub clinical atherosclerosis. The objective of the study was to evaluate CIMT and carotid plaques in less than 45 years old Nepalese patients with angiographically proven CAD.
Methods: A total of 54 patients with angiographically documented CAD at less than 45 years of age were enrolled. CAD was confirmed by coronary angiography. Demographic profile was obtained. High resolution B-mode ultrasound was used to detect the CIMT and carotid plaques.
Results: The study population included 44 males and 10 females, with a mean ± SD age of 38.4±4.3 years (range, 25-44 years). Cardiovascular risks factors included smoking in 81%, Hypertension in 52%, diabetes in 19% and alcohol consumption in 78% of patients. Lipid profile (mean ± SD) was normal except for elevated triglyceride (TG) levels of 204±130.8 mg/dL. By angiography, 64.8% had single vessel disease, 26% had double vessel disease and 9.2% had triple vessel disease. Ultrasound detected either thickened CIMT or presence of plaques in 46 (85.2%) cases (group-A) and 8 (14.8%) had negative (normal) carotid study (group-B). Among the 46 patients with positive findings 63% had carotid plaques and 37% had thickened CIMT only. The majority (69%) of the carotid plaques were detected at the carotid bulbs. In total population, carotid plaque was detected in 53.7% of cases. There was no statistical significant difference of age, body mass index (BMI) and lipid level between group-A and group-B.
Conclusions: Increased CIMT and carotid plaques are detected in majority of the young Nepalese patients with angiographically documented CAD. The majority of carotid plaques are detected at the carotid bulbs. Routine carotid ultrasound study in young individuals with CAD risk factors appears worthwhile.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
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DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
Can Allopathy and Homeopathy Be Used Together in India.pdfDharma Homoeopathy
This article explores the potential for combining allopathy and homeopathy in India, examining the benefits, challenges, and the emerging field of integrative medicine.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
Key Areas Covered:
Texting and Email Communication: Understand the compliance requirements for electronic communication.
Encryption Standards: Learn what is necessary and what is overhyped.
Medical Messaging and Voice Data: Ensure secure handling of sensitive information.
IT Risk Factors: Identify and mitigate risks related to your IT infrastructure.
Why Attend:
Expert Instructor: Brian Tuttle, with over 20 years in Health IT and Compliance Consulting, brings invaluable experience and knowledge, including insights from over 1000 risk assessments and direct dealings with Office of Civil Rights HIPAA auditors.
Actionable Insights: Receive practical advice on preparing for audits and avoiding common mistakes.
Clarity on Compliance: Clear up misconceptions and understand the reality of HIPAA regulations.
Ensure your compliance strategy is up-to-date and effective. Enroll now and be prepared for the 2024 HIPAA audits.
Enroll Now to secure your spot in this crucial training session and ensure your HIPAA compliance is robust and audit-ready.
https://conferencepanel.com/conference/hipaa-training-for-the-compliance-officer-2024-updates
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version