Percutaneous Transcatheter Mitral Valve ReplacementShadab Ahmad
Symptomatic mitral regurgitation (MR) conveys significant morbidity and mortality. However, many patients with severe MR are not treated with surgery due to advanced age, left ventricular (LV) dysfunction, or other comorbidities. This unmet clinical need has driven the development of safer, catheter-based treatments for mitral valve disease.
Transcatheter mitral valve repair can be safe and effective in patients with suitable anatomy.
Percutaneous Transcatheter Mitral Valve ReplacementShadab Ahmad
Symptomatic mitral regurgitation (MR) conveys significant morbidity and mortality. However, many patients with severe MR are not treated with surgery due to advanced age, left ventricular (LV) dysfunction, or other comorbidities. This unmet clinical need has driven the development of safer, catheter-based treatments for mitral valve disease.
Transcatheter mitral valve repair can be safe and effective in patients with suitable anatomy.
http://www.theheart.org/web_slides/1225341.do
The first randomized trial on Endovascular Valve Edge-to-Edge Repair (EVEREST) to compare outcomes with MitraClip vs surgery
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
http://www.theheart.org/web_slides/1225341.do
The first randomized trial on Endovascular Valve Edge-to-Edge Repair (EVEREST) to compare outcomes with MitraClip vs surgery
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
XIII Reunión anual de la sección de Insuficiencia Cardiaca de la SEC
OVIEDO, 16-18 JUNIO 2016 HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS (HUCA)
http://secardiologia.es/insuficiencia/cientifico/ic-oviedo-2016
Simposio: Abordaje integral y multidisciplinar de la Insuficiencia Mitral
VIERNES, 17 DE JUNIO 12:45-14:00 SALA A
Posibilidades del tratamiento percutáneo
Xavi Freixa Rofastes, Barcelona
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
DETAILS OF EVIDENCE TAVI FROM ITS EXISTENCE IN INTERVENTIONAL CARDIOLOGY TO THE SURTAVI REGISTRY ..AS AN OPTION FROM HIGH RISK UNOPERABLE PATIENTS TO INTERMEDIATE AND LOW RISK PATIENTS
Surgery of Rectal Cancer : Potentials and Limitations - Dimitris P. KorkolisDimitris P. Korkolis
EPIDEMOLOGY
2015 Estimates
New cases: 96,830 (colon); 40,000 (rectal)
Deaths: 50,310 (colon and rectal combined)
Death rate over last 20 years declining
Screening and improvements in treatment
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
History and Future of Transcatheter Mitral Valve Interventions
1.
2.
3. Euro Heart Survey surgery is often denied in the older patients Isolated MR (n=877) Severe MR (n=546) No Severe MR (n=331) No Symptoms (n=144) Symptoms (n=396) No Intervention (n=193) 49% Intervention (n=203) 51% Mirabel et al, European Heart J 2007;28:1358-1365 2/3 of symptomatic MR patients >70 are denied surgery
4. Prevalence of valve disease in the population: MR is epidemic in the elderly Nkomo et al , Lancet 2006
11. Clip repair in porcine heart (6 mos post repair) Fann JI; St. Goar FG; Komtebedde J; Oz MC; Block PC; Foster E; Feldman T; Burdon TA Circulation 2003, 108:(Supp IV) 493. 2002-2003 Off-pump Edge-to-Edge Mitral Valve Technique Using a Mechanical Clip in a Chronic Model – Initial clinical experience FIM (2003)
17. Percutaneous Mitral Valve Repair Prosthetic Ring Coronary Sinus Annuloplasty Safety at 30 Days Monarch Carillon Viacor n 69 43 26 Success implantation % 80 70 42 Death % 3 2 0 MI % 3 4 0 Tamponade % 3 4 4 Dissection CS % 0 2 8
18. Percutaneous Mitral Valve Repair Prosthetic Ring Coronary Sinus Annuloplasty Efficacy Monarc Carillon Viacor Pre 6 Mos Pre Post (TEE no core lab) n 21 Reduction MR>/=1+ 57% 63% NA ERO Cm² 0.31 0.20 0.33 0.19 NA Rvol ml 42 27 40 24 NA
34. EVEREST Preliminary Cohort Efficacy Results through Discharge N = 107 * Acute Procedural Success (APS): Defined as placement of one or more Clips resulting in discharge MR severity of 2+ or less , as determined by Core Lab. 70% of procedures are 1 st , 2 nd or 3 rd at Site
35.
36.
37.
38.
39.
40.
41.
42.
43.
44. HRR FMR: Mitral Regurgitation (ITT) MitraClip therapy results in sustained MR reduction Mild-Moderate MR (Grade 1+/2+) Moderate-Severe or Severe MR (Grade 3+/4+) 52% of patients had MR grade 0 or 1+ at 12 months n=34, Matched Data 97% 3% 26% 18% 82% 74%
55. Treating valve disease in the future today Tailored approach – the best option for the patient
Editor's Notes
Ross J Jr, Braunwald E, Morrow AG AJC 3:653-655,1959 In 1958, while working at National Institutes of Health, Eugene Braunwald was director of a cath lab, and 1st Yr Fellow was John Ross. Ross was using sizing balloons to measure atrial septal defects in the cath lab. A visiting physician from Argentina observed this procedure and asked whether Ross had considered using a needle to puncture the intact septum. Ross discussed at doiner with EB, then requested time off from the cath lab, and developed a needle device in the dog lab. This was introduced into patients via femoral cutdown. A couple of years later when the Seldinger technique was introduced, a surgical resident working with Breaunwald designed a catheter, the Brockenbrough, through which the Ross needle could be placed. Related by EB March 09, 2004
JAMA 196:991-992, 1966
Here is a schematic movie the progressive shortening of the annulus and the theoretical changes of the geometry of the heart
The third step is the implantation, the distal anchor is first deployed , than the proximal At the end of the procedure a coronary angiography is again performed to insure that there is no immediate coronary artery complication
Removed “Remained Improved by 12 months” and put “improved by 12-months”. Remained improved implies the patients who improved at 30-days that were still improved at 12-months. 85% of the 82% 30-day successes were improved at 12-months. – this is 70% of the 30-day success patients. 79% of the total pop improved at 12months
![History and Future of Transcatheter Mitral Valve Repair ,[object Object],[object Object],[object Object],[object Object]](https://image.slidesharecdn.com/m-091124154752-phpapp02/85/History-and-Future-of-Transcatheter-Mitral-Valve-Interventions-1-320.jpg)
![TAVI is moving rapidly into a clinical procedure widely available ,[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)