1) The study evaluated the utility of the balloon-assisted technique (BAT) versus conventional techniques (CT) for trans catheter closure of very large atrial septal defects (ASDs) ≥35 mm.
2) BAT had a higher success rate of 90.3% compared to 16.6% for CT. Posterior malalignment of the septum was associated with failure of CT.
3) BAT helps facilitate controlled delivery and alignment of the closure device in very large ASDs with challenging anatomical features like posterior malalignment and is often useful when CT fails.
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.
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.
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.
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
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.
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
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...Ramachandra Barik
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Introduction: Radiofrequency Ablation (RF) of Nodal Reentry Tachycardia (AVNRT) requires precision to avoid AV block. 3D Electro-Anatomic Mapping (EAM) systems allowed to reduce radiological exposure. We sought to evaluate safety and effi cacy of AVNRT ablation, analyzing tip stability with a EAM
system aiming a Minimal Fluoroscopic Approac (MFA).
Ann Vasc Surg 2012; 26: 141-148-Selected technique- Funnel Technique for EVAR: ‘‘A Way Out’’ for Abdominal Aortic Aneurisms With Ectatic Proximal Necks
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
At SciArt Center, we think artists and scientists seek answers to the same fundamental questions: who are we, why are we here, and where are we going? Both art and science build models of human experience in order to extend the boundaries of human capacity. Despite this common ground, artists and scientists are too often separate in their endeavors. As a community-based arts organization, we provide support and promote cross-disciplinary approaches and interactions.
SciArt Center offers a variety of online resources for our members and also hosts an assortment of pop-up events around New York City open to the public. In creating a virtual space for our members to interact and share their work, we seek to connect scientists and artists online and explore the potentials of those connections. Paired with our partner publication SciArt in America, we publish the fruits of these cross-disciplinary interactions, bolstering the science-art community at large. Our science and art themed pop-up events including film screenings, book club meetings, art shows, panel talks, and social mixers, serve to physically bring together scientists and artists for a common creative and intellectual cause.
With the pursuit of scientific and artistic understanding within the larger paradigm of intellectual unity, SciArt Center encourages the connectivity and transdisciplinary approaches needed for the 21st century.
For more information, please visit: http://www.sciartcenter.org.
Aims: Post-mortem pathological studies have shown that a “vulnerable” plaque is the dominant patho-physiological mechanism responsible for acute coronary syndromes (ACS). One way to improve our understanding of these plaques in vivo is by using histological “surrogates” created by intravascular ultrasound derived virtual histology (IVUS-VH). Our aim in this analysis was to determine the relationship between site-specific differences in individual plaque areas between ACS plaques and stable plaques (SP), with a focus on remodelling index and the pattern of calcifying necrosis.
Methods and results: IVUS-VH was performed before percutaneous intervention in both ACS culprit plaques (CP) n=70 and stable disease (SP) n=35. A total of 210 plaque sites were examined in 105 lesions at the minimum lumen area (MLA) and the maximum necrotic core site (MAX NC). Each plaque site had multiple measurements made including some novel calculations to ascertain the plaque calcification equipoise (PCE) and the calcified interface area (CIA). CP has greater amounts of positive remodelling at the MLA (RI@MLA): 1.1 (±0.17) vs. 0.95 (±0.14) (P<0.001);><0.001)>1.12; RI @ MAX NC >1.22; PCE @ MLA <47.1%;><47.3%;>2.6; CIA @ MAX NC >3.1.
Conclusions: Determining the stage of calcifying necrosis, along with the remodelling index can discriminate between stable and ACS related plaques. These findings could be applied in the future to help detect plaques that have a vulnerable phenotype.
Prosthetic paravalvular leaks (PVL) is an uncommon but serious complication after surgical valve replacement. Although surgery has been the traditional treatment of choice in hemodinamically significant PVL, percutaneous transcatheter closure is emerging as a novel and less invasive option for patients with high operative risk. Cardiac imaging, especially two- and three-dimensional transoesophageal echocardiography, plays an essential role in the diagnosis, guidance of intervention and subsequently in the evaluation of the outcomes of the procedure. The aim of this manuscript is to review the role of cardiac imaging techniques in the interventional management of patients with symptomatic PVL.
Background: Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan.
Methods: Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or implantable cardiac defibrillator (ICD). A descriptive statistical analysis was performed.
Results: Thirty-two patients with myocarditis were included in the study. The mean age was 42.6±21.2 years and 81.2% were male. In a mean follow up of 30.4±17.8 months, the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or ICD was 15.6% (n=5). Two patients had heart failure (one of them underwent heart transplant), one patient needed ICD because of ventricular tachycardia and two other patients were re-hospitalized, for recurrent chest pain and for recurrent myocarditis respectively.
Conclusions: In our series of acute myocarditis diagnosed by CMR we found a low rate of cardiovascular events without mortality. These findings might oppose data from recently published myocarditis trials.
Abstract
Objective: The objective of this study is to determine the normal value of 3D left ventricular (LV) twist in subendocardial, mid-wall and subepicardial layers, as well as to study the effects of aging on 3D LV twist by tagged MR motion tracking techniques. Three dimensional motion detection based on 3D tagged MR images is robust to out-of-plane motion error; while 2D motion detection is inherently unable to analyze the 3D cardiac motion and may lead to inaccurate results.
Methods: The 3D LV volumetric images were acquired in 52 normal adult subjects (aged 21-82) and were analyzed by using 3D HARmonic phase (HARP) technique. HARP technique provided the 3D displacement fields and the displacements were utilized to compute the rotational values. LV twist was defined as apical rotation relative to the basal rotation, in the 3D coordinates. The LV twist values of subendocardial, midwall and subepicardial layers were analyzed separately. The measured parameters in this study were: peak apical rotation, peak basal rotation, and peak LV twist.
Result: Looking at the apex, the normal LV maintains a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal rotation values increase during the aging process, leading to an increased value of LV twist. Peak epicardial LV twist is (10.4±2.6 degrees) which is lower than the mid-wall LV twist (11.3±2.2 degrees) and endocardial LV twist (12.1±2.6 degrees) in the young group (21-35 years old). Also, peak epicardial LV twist is (12.2±2.6 degrees) which is lower than the mid-wall LV twist (14.4±2.8 degrees) and endocardial LV twist (14.7±2.5 degrees) in the middle aged group (21-35 years old). In a similar way, peak epicardial LV twist is (14.8±2.9 degrees) which is lower than the mid-wall LV twist (15.7±3.6 degrees) and endocardial LV twist (16.7±3.0 degrees) in the old group (50-65 years old). Regarding the older group (more than 65 years old), peak epicardial LV twist is (15.9±3.1 degrees) which is lower than the mid-wall LV twist (16.2±3.4 degrees) and endocardial LV twist (18.3±3.0 degrees).
Conclusions: It is feasible to measure the subepicardial, mid-wall and subendocardial twist in tagged MR images. The twist value gradually increases in the aging process. Outside layers have greater twist values compared to the inside layers.
Abstract
This issue of ‘Cardiovascular Diagnosis and Therapy (CDT)’ has a special focus on application and development of magnetic resonance imaging (MRI) in cardiovascular diseases. The challenges associated with imaging of the heart and the huge disease burden associated with cardiovascular diseases has been one of the major motivations in the last few years for the development of new MRI techniques. A realm of new pulse sequences, either focusing on ‘freezing’ motion or on providing improved endogenous contrast mechanisms were developed in this context and are now being evaluated in clinical and preclinical research efforts focusing on the heart and vascular circulation.
Exercise stress echocardiography in patients with aortic stenosis: impact of baseline diastolic dysfunction and functional capacity on mortality and aortic valve replacement
Authors: Andrew N. Rassi, Wael AlJaroudi, Sahar Naderi, M Chadi Alraies, Venu Menon, Leonardo Rodriguez, Richard Grimm, Brian Griffin, Wael A. Jaber
http://www.thecdt.org/article/view/2855
Improved diagnosis and prognosis using Decisions Informed by Combining Entities (DICE): results from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE)
Authors: Mark Doyle, Gerald M. Pohost, C. Noel Bairey Merz, Leslee J. Shaw, George Sopko, William J. Rogers, Barry L. Sharaf, Carl J. Pepine, Diane A. Vido-Thompson, Geetha Rayarao, Lindsey Tauxe, Sheryl F. Kelsey, Douglas Mc Nair, Robert W. Biederman
http://www.ncbi.nlm.nih.gov/pubmed/24400205
http://www.thecdt.org/article/view/3004
More from Cardiovascular Diagnosis and Therapy (CDT) (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.