Sindrome de Marfan ; Por: Ricardo Mora Moreno MAECO (medico en adiestramiento ecocardiografico), IMSS CMN SS XXI, Hospital de Cardiología, CDMX, 29 de Agosto del 2019
Utilidad strain en cardiopatia isquemica; Por: Dr. Ricardo Mora Moreno MAECO (medico en adiestramiento ecocardiografico); IMSS CMN SS XXI Hospital de Cardiologia Servicio de Gabinetes; CDMX, 11 de Octubre del 2019
Recomendaciones Cuantificacion para medicion de camaras cardiacas por ecocard...Ricardo Mora MD
"Recomendaciones para la cuantificacion de las cavidades cardiacas por ecocardiografia en adultos: Actualizacion de la Sociedad Americana de Ecocardiografia y de la Asociacion Europea de Imagen Cardiovascular"; Guidelines ASE 2015; Por Dr. Ricardo Mora Moreno MAECO; 12 de Abril 2019; Ciudad de México; IMSS Hospital de Cardiologia CMN SS XXI
This document discusses athlete's heart and the use of echocardiography in evaluating it. It notes that intense dynamic training can cause eccentric hypertrophy while intense isometric training causes concentric hypertrophy. It references several studies on using new echocardiography techniques to differentiate physiological cardiac remodeling in athletes from pathology. One study found 4D strain imaging useful to identify subtle abnormalities. Other studies examined global longitudinal strain for assessing athlete's heart and the role of cardiac biomarkers to improve diagnosis. The document provides an overview of research on evaluating cardiac changes in athletes using echocardiography.
Insuficiencia Mitral y Ecocardiograma; Por: Dr. Ricardo Mora Moreno MAECO (Fellow Ecocardiografia Adultos); 17 Enero 2020; Ciudad de Mexico; IMSS CMN Hospital de Cardiologia SS XXI
Whom to refer for mitral valve repair and whom notdrucsamal
This document discusses the treatment of mitral regurgitation in patients with heart failure. It describes the mechanisms of functional and ischemic mitral regurgitation. While medical therapy can improve symptoms and survival, cardiac resynchronization therapy may also help reduce mitral regurgitation severity and improve outcomes. Surgery to repair the mitral valve is an option but the risk of recurrence of mitral regurgitation is high, especially with more advanced left ventricular remodeling. Randomized trials are still needed to determine whether surgical correction provides clear benefits over medical therapy alone in high-risk patients. Percutaneous mitral valve repair may be a lower risk option for inoperable patients to reduce symptoms.
This document discusses the conundrum of managing mitral regurgitation (MR) in patients with heart failure. It highlights the importance of using multimodality imaging to:
1) Assess the severity of MR at rest and with exercise to determine risk and need for intervention.
2) Evaluate left ventricular function, dyssynchrony, viability and ischemia to determine indications for cardiac resynchronization therapy or revascularization.
3) Assess left ventricular remodeling and mitral valve deformation to predict risk of recurrent MR after repair and determine the best repair/replacement option.
Imaging provides essential information to optimize treatment strategies for MR in heart failure.
Cabg is superior to pci in heart failure patients with multivessel disease prodrucsamal
1. CABG has been the standard of care for over 50 years in treating multivessel coronary artery disease based on clinical trials showing superior outcomes compared to medical management alone.
2. The SYNTAX trial demonstrated superior survival rates for CABG compared to first-generation drug-eluting stents for patients with 3-vessel disease.
3. Incomplete revascularization during PCI is associated with worse outcomes, with differences between PCI and CABG being most significant for patients who are incompletely revascularized.
Utilidad strain en cardiopatia isquemica; Por: Dr. Ricardo Mora Moreno MAECO (medico en adiestramiento ecocardiografico); IMSS CMN SS XXI Hospital de Cardiologia Servicio de Gabinetes; CDMX, 11 de Octubre del 2019
Recomendaciones Cuantificacion para medicion de camaras cardiacas por ecocard...Ricardo Mora MD
"Recomendaciones para la cuantificacion de las cavidades cardiacas por ecocardiografia en adultos: Actualizacion de la Sociedad Americana de Ecocardiografia y de la Asociacion Europea de Imagen Cardiovascular"; Guidelines ASE 2015; Por Dr. Ricardo Mora Moreno MAECO; 12 de Abril 2019; Ciudad de México; IMSS Hospital de Cardiologia CMN SS XXI
This document discusses athlete's heart and the use of echocardiography in evaluating it. It notes that intense dynamic training can cause eccentric hypertrophy while intense isometric training causes concentric hypertrophy. It references several studies on using new echocardiography techniques to differentiate physiological cardiac remodeling in athletes from pathology. One study found 4D strain imaging useful to identify subtle abnormalities. Other studies examined global longitudinal strain for assessing athlete's heart and the role of cardiac biomarkers to improve diagnosis. The document provides an overview of research on evaluating cardiac changes in athletes using echocardiography.
Insuficiencia Mitral y Ecocardiograma; Por: Dr. Ricardo Mora Moreno MAECO (Fellow Ecocardiografia Adultos); 17 Enero 2020; Ciudad de Mexico; IMSS CMN Hospital de Cardiologia SS XXI
Whom to refer for mitral valve repair and whom notdrucsamal
This document discusses the treatment of mitral regurgitation in patients with heart failure. It describes the mechanisms of functional and ischemic mitral regurgitation. While medical therapy can improve symptoms and survival, cardiac resynchronization therapy may also help reduce mitral regurgitation severity and improve outcomes. Surgery to repair the mitral valve is an option but the risk of recurrence of mitral regurgitation is high, especially with more advanced left ventricular remodeling. Randomized trials are still needed to determine whether surgical correction provides clear benefits over medical therapy alone in high-risk patients. Percutaneous mitral valve repair may be a lower risk option for inoperable patients to reduce symptoms.
This document discusses the conundrum of managing mitral regurgitation (MR) in patients with heart failure. It highlights the importance of using multimodality imaging to:
1) Assess the severity of MR at rest and with exercise to determine risk and need for intervention.
2) Evaluate left ventricular function, dyssynchrony, viability and ischemia to determine indications for cardiac resynchronization therapy or revascularization.
3) Assess left ventricular remodeling and mitral valve deformation to predict risk of recurrent MR after repair and determine the best repair/replacement option.
Imaging provides essential information to optimize treatment strategies for MR in heart failure.
Cabg is superior to pci in heart failure patients with multivessel disease prodrucsamal
1. CABG has been the standard of care for over 50 years in treating multivessel coronary artery disease based on clinical trials showing superior outcomes compared to medical management alone.
2. The SYNTAX trial demonstrated superior survival rates for CABG compared to first-generation drug-eluting stents for patients with 3-vessel disease.
3. Incomplete revascularization during PCI is associated with worse outcomes, with differences between PCI and CABG being most significant for patients who are incompletely revascularized.
This document discusses PCI (percutaneous coronary intervention) versus CABG (coronary artery bypass grafting) for treating stable coronary artery disease. It provides historical context on the evolution of both procedures and summarizes key randomized controlled trials comparing outcomes of PCI versus CABG. The trials show that CABG provided better long-term outcomes than balloon angioplasty or bare metal stents in multivessel disease. Later trials with drug-eluting stents still found CABG superior for left main or multivessel disease, though the differences were smaller. CABG remains the standard of care for more complex anatomies while PCI is preferred for simpler cases.
Left Main Coronary Artery Disease- Management StrategyApollo Hospitals
1) Left main coronary artery disease has traditionally been treated with coronary artery bypass grafting (CABG), which is considered the gold standard.
2) Recent studies comparing percutaneous coronary intervention (PCI) using drug-eluting stents to CABG have shown no significant differences in mortality or major adverse cardiac events between the two treatments.
3) PCI may be preferable to CABG for patients with isolated left main or left main plus single vessel disease, while CABG remains the standard treatment for more complex multi-vessel disease.
Should functional mr be fixed in heart failuredrucsamal
This document discusses functional mitral regurgitation (FMR) in heart failure patients. It presents evidence that even mild FMR results in poor survival outcomes, and that FMR is not just a late marker but also a cause of worse prognosis. Surgical mitral repair using a small, complete, rigid ring to reduce the mitral annulus has been shown to improve survival, ventricular remodeling, and functional status compared to no repair or incomplete repairs that do not fully correct FMR. Ongoing studies are exploring newer percutaneous approaches to treating FMR, but surgical repair remains the standard treatment when anatomically feasible to fully correct FMR.
Endo vascular treatment of infected aa as is surgıcal draınage and debrıdemen...uvcd
1) Endovascular treatment of infected abdominal aortic aneurysms (AAAs) is an alternative to open surgery that provides less invasive and rapid aneurysm exclusion with prompt bleeding control.
2) Successful endovascular repair requires broad-spectrum antibiotics, adjunct procedures like surgical debridement for eliminating infection sources, and prolonged antibiotic therapy.
3) Endovascular repair alone may be sufficient for well-controlled infections, while unstable patients may require additional drainage; long-term antibiotic therapy is always needed.
This document summarizes the career and research of Dr. Eulogio García focusing on primary angioplasty for acute myocardial infarction. It details his early work in the 1990s establishing primary angioplasty programs in Spain and conducting randomized trials comparing it to thrombolysis. It describes his later involvement in large international multicenter trials that helped establish best practices in primary angioplasty and demonstrated benefits in subgroups. The document outlines over 150 publications and highlights his role in increasing acceptance of primary angioplasty in clinical guidelines.
This document discusses the case of an 83-year-old man with ischemic and valvular cardiomyopathy who presented with acute decompensated heart failure. He underwent transcatheter aortic valve replacement (TAVR) with improvement in symptoms initially. However, follow-up echocardiography showed persistence of severe mitral regurgitation. The patient's options for treatment of residual mitral regurgitation are discussed, including intensifying medical management, surgical mitral valve replacement, or percutaneous mitral valve repair with a MitraClip procedure.
Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....Brussels Heart Center
This document summarizes a presentation given by Dr. Remes on the surgical treatment of atrial fibrillation. It discusses the pathophysiology of AF and reviews studies on the Cox Maze procedure. Dr. Remes presents data on success rates of different Cox Maze variations and predictors of recurrence. Minimally invasive surgical approaches for AF ablation including pulmonary vein isolation are discussed. Energy sources for ablation like bipolar radiofrequency are highlighted. Guidelines for lone AF surgery are reviewed. In conclusion, the document provides an overview of the state of the art in surgical treatment of AF.
- Biomarkers such as troponins, copeptin, and natriuretic peptides have become indispensable diagnostic tools in cardiology over the past 60 years.
- Troponins are the gold standard for diagnosing myocardial infarction, while copeptin allows for very early rule-out of MI.
- New biomarkers continue to be discovered through advances in genomics, epigenetics, and other 'omics' fields, with microRNAs showing promise to improve risk stratification and precision medicine for cardiovascular disease.
- Biomarkers have transformed cardiology practice and decision-making, with troponins in particular demonstrating their ability to guide therapies and intervention timing for conditions like ACS.
Ascending aortic dilatation associated with bav copyFereidoon Ashnaei
bicuspid aortic valve have heterogeneous presentation of phenotypes due to more complex matter related to congenital,genetic or connective tissue abnormality
Guidelines in the management of carotid stenosisuvcd
This document provides an overview of guidelines for the management of carotid stenosis. It discusses:
1) Stroke is a major cause of death, with many caused by carotid artery disease. The risk of stroke is directly related to the degree of stenosis.
2) Natural history studies show that the risk of stroke is highest in the first year after symptoms and then declines over time. The risk is higher for more severe stenosis.
3) Early trials demonstrated the benefits of carotid endarterectomy (CEA) in reducing stroke risks compared to medical management alone for symptomatic and some asymptomatic patients.
4) Later trials evaluated carotid angioplasty and stenting (CAS) as an alternative to CEA but
Left main disease pci vs cabg excel trial 2016Kunal Mahajan
This randomized controlled trial compared percutaneous coronary intervention (PCI) using everolimus-eluting stents to coronary artery bypass grafting (CABG) for the treatment of left main coronary artery disease. The primary outcome was a composite of death, stroke, or myocardial infarction at 3 years. PCI was found to be non-inferior to CABG for the primary outcome. At 30 days, PCI had fewer adverse events like infections and bleeding, but more deaths, strokes and MIs. Between 30 days and 3 years, ischemia-driven revascularization was more common with PCI. Longer follow-up is still needed given differences in long-term medication use and revascularization between the treatments.
1) A study examined 103 heart attack patients treated with high-dose statins and found plaque volume decreased slightly (0.9%) in the arteries not responsible for the heart attack.
2) A randomized study of 296 heart attack patients found that performing revascularization of additional blocked arteries beyond the heart attack artery led to fewer total cardiac events (10% vs 21%) over 12 months compared to only treating the heart attack artery.
3) A study of 738 patients with chronic total blockages and good collateral blood flow found that revascularizing the blockages reduced cardiac death and total cardiac events compared to medical treatment alone, showing benefit of revascularization even in patients with established collateral circulation.
The document discusses options for difficult forearm arteriovenous fistula (AVF) access for hemodialysis. It describes using basilic or cephalic vein transposition in the forearm when wrist AVF is not available or has failed. The author presents case studies and results from 82 patients who underwent basilic or cephalic vein transposition, finding 96% primary patency and 87% secondary patency after a mean follow up of 32.5 months. Complications occurred in 17% of cases and were mostly treated conservatively without loss of the fistula. The conclusions emphasize that autogenous AVF using transposed forearm veins can provide good patency and should be emphasized for long-term hemod
Upper extremity thrombosis in traditional cvc vjamekobrien
This document discusses upper extremity deep vein thrombosis (UEDVT) and compares the risks of thrombosis and infection for peripherally inserted central catheters (PICCs) versus central venous catheters (CVCs). Several studies found higher rates of asymptomatic UEDVT in patients with PICCs compared to CVCs, though PICCs may have lower risks of catheter-related bloodstream infections. The risks of pulmonary embolism and post-phlebitic syndrome from UEDVT alone seem clinically less significant than from lower extremity DVT. Treatment guidelines for UEDVT are limited and based on low-quality evidence. Further research is needed to guide management and compare the costs and benefits of PICC placement versus C
How should recently symptomatic patients be treated urgent cea or casuvcd
Recent symptomatic patients with carotid artery stenosis can be treated with either urgent carotid endarterectomy (CEA) or carotid artery stenting (CAS). While early studies found CEA to have better outcomes, more recent trials like CREST showed comparable rates of stroke and death between CEA and CAS. For recently symptomatic patients specifically, CEA may still be preferred to CAS due to concerns about stabilizing carotid plaque after stenting. Operator experience also impacts outcomes, so treatment should be individualized based on each patient's clinical situation.
1) There is a lack of evidence around the optimal management of both symptomatic and asymptomatic carotid stenosis.
2) For symptomatic stenosis, we are uncertain about the optimal timing of intervention after an ischemic stroke.
3) For asymptomatic stenosis, the results of landmark trials like ACAS and ACST are being questioned given improvements in medical management and declining stroke risks over time.
4) It is likely that there are asymptomatic patients at very low risk of stroke as well as those at high risk, but we currently lack standardized methods to reliably identify these subgroups.
This document summarizes the EXCEL trial, which compared everolimus-eluting stents to bypass surgery for treating left main coronary artery disease. The trial included over 2900 patients across 17 countries. At 3 years, the primary endpoint of death, stroke, or heart attack was similar between the stent and surgery groups, but the stent group had fewer adverse events in the first 30 days. However, at 5 years stent patients had higher rates of non-procedural heart attacks and required more repeat procedures, though mortality remained similar. The conclusion is that stents may be preferable to surgery for selected left main disease patients after discussion, though surgery provided better long-term outcomes.
This study evaluated outcomes of 1095 patients who underwent off-pump coronary artery bypass surgery at Bangkok Heart Hospital between 2003-2008. 170 patients (15.5%) developed atrial fibrillation post-operatively. The study found no significant differences in pre-operative characteristics or operative details between those who did and did not develop atrial fibrillation. However, patients who developed atrial fibrillation tended to be older, have a higher rate of congestive heart failure and prior percutaneous coronary intervention, and a longer hospital stay. Developing atrial fibrillation also increased risks of post-operative pneumonia, renal failure, and dialysis requirement.
Hypertrophic cardiomyopathy (HCM) is characterized by thickening of the left ventricle in the absence of other cardiac causes. It has diverse morphological presentations and is the most common genetic cardiovascular disease. Symptoms include heart failure, chest pain, and syncope. Treatment involves managing symptoms through medications, surgery such as septal myectomy for obstruction, and implantable cardioverter-defibrillators for high-risk patients. Screening of family members is recommended due to its genetic basis. HCM has variable clinical outcomes ranging from few symptoms to sudden cardiac death.
This document discusses PCI (percutaneous coronary intervention) versus CABG (coronary artery bypass grafting) for treating stable coronary artery disease. It provides historical context on the evolution of both procedures and summarizes key randomized controlled trials comparing outcomes of PCI versus CABG. The trials show that CABG provided better long-term outcomes than balloon angioplasty or bare metal stents in multivessel disease. Later trials with drug-eluting stents still found CABG superior for left main or multivessel disease, though the differences were smaller. CABG remains the standard of care for more complex anatomies while PCI is preferred for simpler cases.
Left Main Coronary Artery Disease- Management StrategyApollo Hospitals
1) Left main coronary artery disease has traditionally been treated with coronary artery bypass grafting (CABG), which is considered the gold standard.
2) Recent studies comparing percutaneous coronary intervention (PCI) using drug-eluting stents to CABG have shown no significant differences in mortality or major adverse cardiac events between the two treatments.
3) PCI may be preferable to CABG for patients with isolated left main or left main plus single vessel disease, while CABG remains the standard treatment for more complex multi-vessel disease.
Should functional mr be fixed in heart failuredrucsamal
This document discusses functional mitral regurgitation (FMR) in heart failure patients. It presents evidence that even mild FMR results in poor survival outcomes, and that FMR is not just a late marker but also a cause of worse prognosis. Surgical mitral repair using a small, complete, rigid ring to reduce the mitral annulus has been shown to improve survival, ventricular remodeling, and functional status compared to no repair or incomplete repairs that do not fully correct FMR. Ongoing studies are exploring newer percutaneous approaches to treating FMR, but surgical repair remains the standard treatment when anatomically feasible to fully correct FMR.
Endo vascular treatment of infected aa as is surgıcal draınage and debrıdemen...uvcd
1) Endovascular treatment of infected abdominal aortic aneurysms (AAAs) is an alternative to open surgery that provides less invasive and rapid aneurysm exclusion with prompt bleeding control.
2) Successful endovascular repair requires broad-spectrum antibiotics, adjunct procedures like surgical debridement for eliminating infection sources, and prolonged antibiotic therapy.
3) Endovascular repair alone may be sufficient for well-controlled infections, while unstable patients may require additional drainage; long-term antibiotic therapy is always needed.
This document summarizes the career and research of Dr. Eulogio García focusing on primary angioplasty for acute myocardial infarction. It details his early work in the 1990s establishing primary angioplasty programs in Spain and conducting randomized trials comparing it to thrombolysis. It describes his later involvement in large international multicenter trials that helped establish best practices in primary angioplasty and demonstrated benefits in subgroups. The document outlines over 150 publications and highlights his role in increasing acceptance of primary angioplasty in clinical guidelines.
This document discusses the case of an 83-year-old man with ischemic and valvular cardiomyopathy who presented with acute decompensated heart failure. He underwent transcatheter aortic valve replacement (TAVR) with improvement in symptoms initially. However, follow-up echocardiography showed persistence of severe mitral regurgitation. The patient's options for treatment of residual mitral regurgitation are discussed, including intensifying medical management, surgical mitral valve replacement, or percutaneous mitral valve repair with a MitraClip procedure.
Traitement de la FA vu par le chirurgien cardiaque : state of the art. (Dr J....Brussels Heart Center
This document summarizes a presentation given by Dr. Remes on the surgical treatment of atrial fibrillation. It discusses the pathophysiology of AF and reviews studies on the Cox Maze procedure. Dr. Remes presents data on success rates of different Cox Maze variations and predictors of recurrence. Minimally invasive surgical approaches for AF ablation including pulmonary vein isolation are discussed. Energy sources for ablation like bipolar radiofrequency are highlighted. Guidelines for lone AF surgery are reviewed. In conclusion, the document provides an overview of the state of the art in surgical treatment of AF.
- Biomarkers such as troponins, copeptin, and natriuretic peptides have become indispensable diagnostic tools in cardiology over the past 60 years.
- Troponins are the gold standard for diagnosing myocardial infarction, while copeptin allows for very early rule-out of MI.
- New biomarkers continue to be discovered through advances in genomics, epigenetics, and other 'omics' fields, with microRNAs showing promise to improve risk stratification and precision medicine for cardiovascular disease.
- Biomarkers have transformed cardiology practice and decision-making, with troponins in particular demonstrating their ability to guide therapies and intervention timing for conditions like ACS.
Ascending aortic dilatation associated with bav copyFereidoon Ashnaei
bicuspid aortic valve have heterogeneous presentation of phenotypes due to more complex matter related to congenital,genetic or connective tissue abnormality
Guidelines in the management of carotid stenosisuvcd
This document provides an overview of guidelines for the management of carotid stenosis. It discusses:
1) Stroke is a major cause of death, with many caused by carotid artery disease. The risk of stroke is directly related to the degree of stenosis.
2) Natural history studies show that the risk of stroke is highest in the first year after symptoms and then declines over time. The risk is higher for more severe stenosis.
3) Early trials demonstrated the benefits of carotid endarterectomy (CEA) in reducing stroke risks compared to medical management alone for symptomatic and some asymptomatic patients.
4) Later trials evaluated carotid angioplasty and stenting (CAS) as an alternative to CEA but
Left main disease pci vs cabg excel trial 2016Kunal Mahajan
This randomized controlled trial compared percutaneous coronary intervention (PCI) using everolimus-eluting stents to coronary artery bypass grafting (CABG) for the treatment of left main coronary artery disease. The primary outcome was a composite of death, stroke, or myocardial infarction at 3 years. PCI was found to be non-inferior to CABG for the primary outcome. At 30 days, PCI had fewer adverse events like infections and bleeding, but more deaths, strokes and MIs. Between 30 days and 3 years, ischemia-driven revascularization was more common with PCI. Longer follow-up is still needed given differences in long-term medication use and revascularization between the treatments.
1) A study examined 103 heart attack patients treated with high-dose statins and found plaque volume decreased slightly (0.9%) in the arteries not responsible for the heart attack.
2) A randomized study of 296 heart attack patients found that performing revascularization of additional blocked arteries beyond the heart attack artery led to fewer total cardiac events (10% vs 21%) over 12 months compared to only treating the heart attack artery.
3) A study of 738 patients with chronic total blockages and good collateral blood flow found that revascularizing the blockages reduced cardiac death and total cardiac events compared to medical treatment alone, showing benefit of revascularization even in patients with established collateral circulation.
The document discusses options for difficult forearm arteriovenous fistula (AVF) access for hemodialysis. It describes using basilic or cephalic vein transposition in the forearm when wrist AVF is not available or has failed. The author presents case studies and results from 82 patients who underwent basilic or cephalic vein transposition, finding 96% primary patency and 87% secondary patency after a mean follow up of 32.5 months. Complications occurred in 17% of cases and were mostly treated conservatively without loss of the fistula. The conclusions emphasize that autogenous AVF using transposed forearm veins can provide good patency and should be emphasized for long-term hemod
Upper extremity thrombosis in traditional cvc vjamekobrien
This document discusses upper extremity deep vein thrombosis (UEDVT) and compares the risks of thrombosis and infection for peripherally inserted central catheters (PICCs) versus central venous catheters (CVCs). Several studies found higher rates of asymptomatic UEDVT in patients with PICCs compared to CVCs, though PICCs may have lower risks of catheter-related bloodstream infections. The risks of pulmonary embolism and post-phlebitic syndrome from UEDVT alone seem clinically less significant than from lower extremity DVT. Treatment guidelines for UEDVT are limited and based on low-quality evidence. Further research is needed to guide management and compare the costs and benefits of PICC placement versus C
How should recently symptomatic patients be treated urgent cea or casuvcd
Recent symptomatic patients with carotid artery stenosis can be treated with either urgent carotid endarterectomy (CEA) or carotid artery stenting (CAS). While early studies found CEA to have better outcomes, more recent trials like CREST showed comparable rates of stroke and death between CEA and CAS. For recently symptomatic patients specifically, CEA may still be preferred to CAS due to concerns about stabilizing carotid plaque after stenting. Operator experience also impacts outcomes, so treatment should be individualized based on each patient's clinical situation.
1) There is a lack of evidence around the optimal management of both symptomatic and asymptomatic carotid stenosis.
2) For symptomatic stenosis, we are uncertain about the optimal timing of intervention after an ischemic stroke.
3) For asymptomatic stenosis, the results of landmark trials like ACAS and ACST are being questioned given improvements in medical management and declining stroke risks over time.
4) It is likely that there are asymptomatic patients at very low risk of stroke as well as those at high risk, but we currently lack standardized methods to reliably identify these subgroups.
This document summarizes the EXCEL trial, which compared everolimus-eluting stents to bypass surgery for treating left main coronary artery disease. The trial included over 2900 patients across 17 countries. At 3 years, the primary endpoint of death, stroke, or heart attack was similar between the stent and surgery groups, but the stent group had fewer adverse events in the first 30 days. However, at 5 years stent patients had higher rates of non-procedural heart attacks and required more repeat procedures, though mortality remained similar. The conclusion is that stents may be preferable to surgery for selected left main disease patients after discussion, though surgery provided better long-term outcomes.
This study evaluated outcomes of 1095 patients who underwent off-pump coronary artery bypass surgery at Bangkok Heart Hospital between 2003-2008. 170 patients (15.5%) developed atrial fibrillation post-operatively. The study found no significant differences in pre-operative characteristics or operative details between those who did and did not develop atrial fibrillation. However, patients who developed atrial fibrillation tended to be older, have a higher rate of congestive heart failure and prior percutaneous coronary intervention, and a longer hospital stay. Developing atrial fibrillation also increased risks of post-operative pneumonia, renal failure, and dialysis requirement.
Hypertrophic cardiomyopathy (HCM) is characterized by thickening of the left ventricle in the absence of other cardiac causes. It has diverse morphological presentations and is the most common genetic cardiovascular disease. Symptoms include heart failure, chest pain, and syncope. Treatment involves managing symptoms through medications, surgery such as septal myectomy for obstruction, and implantable cardioverter-defibrillators for high-risk patients. Screening of family members is recommended due to its genetic basis. HCM has variable clinical outcomes ranging from few symptoms to sudden cardiac death.
This document discusses thromboembolic prevention in elderly patients with atrial fibrillation. It provides information on the role of aspirin versus anticoagulants like warfarin in this population. It summarizes a clinical trial that found warfarin to be superior to aspirin for stroke prevention in elderly patients with atrial fibrillation. The document also discusses factors like age, comorbidities, polypharmacy, adherence, cognitive impairment, mobility and nutritional status that influence the risk-benefit assessment of anticoagulation for thromboembolic prevention in frail elderly patients.
Marfan syndrome is an autosomal dominant genetic disorder of connective tissue that affects many parts of the body including the heart, blood vessels, bones, lungs and eyes. It is caused by mutations in the FBN1 gene which results in abnormal production of fibrillin-1, an important component of connective tissue. Common features include tall stature, long limbs, curved spine and eye problems. Treatment focuses on managing cardiovascular complications through beta blockers and surgery as well as correcting skeletal abnormalities. Current research aims to better understand the genetic basis of Marfan syndrome and related disorders to improve diagnosis and treatment.
1. Marfan syndrome is an inherited disorder of connective tissue that affects many parts of the body, including the skeletal, ocular, cardiovascular and pulmonary systems.
2. It is caused by mutations in the FBN1 gene which results in abnormal fibrillin protein and connective tissue abnormalities.
3. Diagnosis is based on assessments of the skeletal, ocular, cardiovascular and other body systems compared to established diagnostic criteria such as the Ghent nosology, with a focus on assessments of the aorta and lenses.
1) Most patients with asymptomatic severe aortic stenosis will develop symptoms within 5 years if not operated on, and the risk of sudden cardiac death is 1% per year.
2) Independent predictors of reduced survival in non-operated patients include advanced age, low left ventricular ejection fraction, heart failure, renal failure, and hypertension.
3) Aortic valve replacement dramatically improves survival outcomes, with 5-year survival rates of 90% for operated patients compared to 38% for non-operated patients.
This document discusses how tissue biomarker data can help tailor treatment pathways for colorectal cancer. It defines biomarkers and describes different types including diagnostic, prognostic, predictive, and surveillance. It outlines several molecular markers analyzed in CRC like extended RAS testing, BRAF mutations, microsatellite instability, tumor location, circulating tumor DNA, HER2 amplification, fusions, consensus molecular subtypes, and circulating tumor DNA for minimal residual disease. Several molecular markers are associated with prognosis and predictive of treatment response including anti-EGFR therapies. Analyzing these tissue and blood-based biomarkers is important for precision oncology in colorectal cancer.
Gene polymorphisms in the renin-angiotensin-aldosterone system (RAAS) have been associated with differences in myocardial perfusion as measured by myocardial perfusion imaging (MPI). Specifically, the ACE I/D, REN C5312T, AGT M235T, AGT T174M, AT1R A1166C, and AT2R C3123A polymorphisms have been investigated for their relationship to MPI results. Studies have found that certain alleles or combinations of alleles of these RAAS gene polymorphisms are independent predictors of summed stress scores and summed difference scores on MPI and can influence myocardial blood flow.
This document presents a study plan to investigate molecular markers and toll-like receptor expression in myelodysplastic syndrome (MDS) patients in Assam, India. The study aims to measure mutation levels of genes like TET2, SAXL1, RUNX1, RAS, and TP53 in MDS patients and determine expression of toll-like receptors TLR1-10 at mRNA and protein levels. The methodology involves collecting blood samples from MDS patients, extracting RNA and protein, and using techniques like qRT-PCR, ELISA, western blotting, and flow cytometry for analysis. The expected significance is that the study may help explore gene expression and mutation patterns in MDS patients in Assam and support approaches for treating
This study evaluated D-dimer levels in 80 patients with chronic atrial fibrillation to determine if D-dimer could diagnose left atrial appendage thrombus. The patients underwent transesophageal echocardiography and were divided into two groups: those with thrombus and those without. All patients in the thrombus group had elevated D-dimer levels, while only 28.5% of patients without thrombus had elevated levels. After 3 months of anticoagulation therapy, D-dimer levels decreased significantly in the thrombus group and thrombus resolved in 77.8% of patients. The study concludes that D-dimer has 100% sensitivity and 71.4% specificity for diagnosing left
This document summarizes key points from a task force report on identifying and treating asymptomatic patients vulnerable to heart attack. It introduces a new paradigm focused on outcomes studies, measuring disease activity, and identifying the vulnerable plaque and patient. The report was chaired by Morteza Naghavi and had writing contributions from experts in cardiovascular imaging, risk assessment, and prevention. It aims to advance the field beyond traditional risk factor assessment alone.
Renal disease in diabetes from prediabetes to late vasculopathy complication...nephro mih
This document provides information about Prof Basset El Essawy's qualifications and a lecture on renal disease in diabetes. It discusses epidemiological data on diabetic kidney disease prevalence in the US, summarizes findings from large diabetes treatment trials, and defines insulin resistance and prediabetes. It also covers prediabetes and nephropathy, presents case studies, and examines insulin resistance and vascular calcification.
Should C2 Disease Classification Be Broken Down Further? Who Progresses to C4?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
The document discusses various types of thyroid tumors including cancer. It describes the normal anatomy and microscopic picture of the thyroid gland. The primary types of thyroid cancer are papillary, follicular, medullary, and anaplastic originating from the follicular epithelium or parafollicular cells. Risk factors include radiation exposure, family history, iodine deficiency, and thyroiditis. Evaluation involves history, examination, FNAC, ultrasound, and radiological investigations. Treatment depends on cancer type and involves surgery, radioactive iodine, and thyroxine therapy. Prognosis depends on age, tumor size and spread.
Atrial fibrillation and increased mortality: causation or association? Mexico...Antonio Raviele
AF is associated with increased mortality, but it is unclear if this is directly caused by AF or associated conditions. Studies show AF patients have 1.5-2x higher risk of death than controls (1). While some evidence suggests AF directly increases mortality risk through stroke and heart failure worsening, randomized trials found rhythm control did not reduce mortality compared to rate control (2). It is likely AF directly increases mortality in some patients and is also a marker for worsening of linked conditions. Understanding the AF-mortality relationship could guide new treatments to lower premature death risk.
This document summarizes the risk of thrombosis/deep vein thrombosis (DVT) associated with multiple myeloma and its treatments. It finds that the risk of DVT is increased by certain drugs like thalidomide, lenalidomide, and dexamethasone, especially when combined with chemotherapy. Studies show aspirin, low molecular weight heparin, and warfarin can effectively prevent DVT when used as prophylaxis, with aspirin and heparin posing a lower bleeding risk than warfarin. A phase III trial compared aspirin, low dose warfarin, and low molecular weight heparin for DVT prevention in newly diagnosed multiple myeloma patients on thalidomide-containing regimens
This document discusses mitral valve disease and treatment options. It provides information on:
- Mitral regurgitation (MR), the most common type of heart valve disease, which occurs when the mitral valve does not close properly.
- Treatment options for MR including open-heart surgery, minimally invasive surgery, robotic surgery, and the MitraClip procedure. MitraClip offers a less invasive alternative for high-risk surgical patients.
- Guidelines for referral for mitral valve repair/replacement, focusing on patients with moderate-severe or severe MR who are at high-risk for open-heart surgery.
- The large population of MR patients who are not surgical candidates, representing an unmet
Ecocardiografia en la sala de hemodinamia (Cierre CIA, Mitraclip, cierre orejuela izquierda); Por: Dr. Ricardo Mora Moreno MAECO (Fellow Ecocardiografia Adultos); 02 Diciembre 2019; CDMX; IMSS CMN SS XXI Hospital de Cardiologia
Strain adecuada realizacion e interpretacion por fellows ecocardiografia en adultos (MAECO); Dr. Jesus Angel Sanchez Carranza, Dr. Ulises Uriel Aparicio Sanchez, Dra. Marlene Solis Cancino, Dra. Ariana Acevedo Melendez, Dr. Ricardo Mora Moreno; IMSS Hospital de Cardiologia CMN SS XXI, CD MX, 17 de Octubre del 2019
Aorta Bivalva; Por: Dr. Ricardo Mora Moreno MAECO (Medico en adiestramiento ecocardiografico); IMSS CMN SS XXI Hospital de Cardiología, servicio de Ecocardiografia, CDMX, 29 Agosto 2019
Mismatch protesis aortica (PPM) ; por Dr. Ricardo Mora Moreno MAECO (Medico en adiestramiento ecocardiografico); 04 de septiembre del 2019; IMSS CMN SS XXI Hospital de Cardiologia, CDMX
Generalidades de cardiopatia isquemica en ecocardiogramaRicardo Mora MD
Generalidades de cardiopatia isquemica en ecocardiograma; por Dr. Ricardo Mora Moreno MAECO; Fellow Ecocardiografía adultos Hospital de Cardiología IMSS CMN SS XXI; CDMX, 12 de Agosto del 2019
Miocardiopatia No Compacta, caso clinico interesante y revision del tema; Dr. Ricardo Mora Moreno MAECO, Fellow ecocardiografía CMN SS XXI, CDMX, 01 de Agosto del 2019
Caso clinico Fibroelastoma 3er cumbre interinstitucional SONECOMRicardo Mora MD
Caso clinico Fibroelastoma 3er cumbre interinstitucional SONECOM; Dr. Ricardo Mora Moreno MAECO; CDMX, 23 de Marzo del 2019; Servicio de Ecocardiografia CMN Siglo XXI
Guias para manejo de dislipidemia y prevencion de enfermedad cardiovascularRicardo Mora MD
Guidelines for management of dyslipidemia and prevention of cardiovascular disease (ATP III, ATP IV, AACE 2017, AHA/ACC 2018) por Dr. Ricardo Mora Moreno R3C; IMSS UMAET1 León, Guanajuato, México; 15 de Enero del 2019
Arritmias en post operatorio; Por: Dr. Ricardo Mora Moreno (R3C Residente 3er año Cardiología) IMSS UMAET T1 Bajio, León, Guanajuato, México; 15 de Noviembre del 2018
- The document discusses mitral stenosis and echocardiography. It describes the anatomy, etiology, pathophysiology and grading of severity of mitral stenosis.
- Echocardiography is outlined as the primary method for evaluating mitral stenosis, including 2D, Doppler and 3D imaging. Methods for measuring mitral valve area such as planimetry, pressure half-time and continuity equation are covered. Stress echocardiography is also discussed.
- Scoring systems for predicting outcomes of percutaneous mitral balloon valvuloplasty are presented, including the Wilkins, Padial and Cormier scores. Treatment options for mitral stenosis are mentioned.
Cuarta definicion universal de infarto del miocardio 2018Ricardo Mora MD
Este documento presenta varios conceptos relacionados con el infarto agudo del miocardio (IAM), incluyendo: 1) La primera definición de IAM data de 1949; 2) Se describen 5 tipos de IAM dependiendo de la causa subyacente; 3) Se proveen criterios actualizados para el diagnóstico de cada tipo de IAM basados en niveles anormales de biomarcadores cardiacos y evidencia clínica o por imagen de isquemia miocárdica aguda. El documento provee información relevante sobre la definición, clasific
Este documento resume los síndromes de preexcitación, en particular el síndrome de Wolf-Parkinson-White. Describe la epidemiología, características electrocardiográficas, clasificación, tratamiento y complicaciones de la ablación por radiofrecuencia de las vías accesorias en estos síndromes.
Telmisartan, ramipril, or both in patients at high risk for vascular events; ...Ricardo Mora MD
Telmisartan, ramipril, or both in patients at high risk for vascular events; “The ONTARGET Investigators”; NEJM 2008; Dr. Ricardo Mora Moreno R3C; IMSS UMAET1 León, Guanajuato, México; 04-Junio-2018
Taquicardia supraventricular parte I (TSV); REIN, SX pre-excitacion, Taquicardia de la union, vías accesorias; Dr. Ricardo Mora Moreno R3C; UMAET1 IMSS, León, Guanajuato, México
SPRINT Trial, revisión de articulo; A Randomized Trial of Intensive versus Standard Blood-Pressure Control; The SPRINT Research Group; N Engl J Med 2015;373:2103-16; Dr. Ricardo Mora Moreno R3C; IMSS UMAE T1; León, Guanajuato, México; 02-Marzo-2018
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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
1. Instituto Mexicano del Seguro Social
Centro Médico Nacional Siglo XXI
Hospital de Cardiología
Servicio de Ecocardiografía CMN Siglo XXI
“Síndrome de Marfan”
Dr. Ricardo Mora Moreno (MAECO)
Ciudad de México
29/ Agosto / 2019
2. Sx Marfan: Epidemiología
• Trastorno del tejido conectivo
• Condición Autosómica dominante
• Incidencia 1 en 3,000-5,000 habitantes
•Ramirez F, Godfrey M, Lee B, et al.. Marfan syndrome and related disorders. In: The Metabolic and Molecular Basis of Inherited Disease, Scriver CR, Beaudet AL, Sly WS, et
al. (Eds), McGraw Hill, New York 1995. p.4079.
•Judge DP, Dietz HC. Marfan's syndrome. Lancet 2005; 366:1965.
Dr.RicardoMoraMoreno(MAECO)
SíndromedeMarfan
3. Sx Marfan: Genética
• Condición Autosómica dominante
• Afección Gen FBN-1 (15q-21.1) encargado de la proteína fibrilina-1
• 10% de los casos sin mutación del FBN-1
• Smallridge RS, Whiteman P, Doering K, et al. EGF-like domain calcium affinity modulated by N-terminal domain linkage in human fibrillin-1. J Mol Biol 1999;
286:661.
• Sinha S, Nevett C, Shuttleworth CA, Kielty CM. Cellular and extracellular biology of the latent transforming growth factor-beta binding proteins. Matrix Biol
1998; 17:529.
Dr.RicardoMoraMoreno(MAECO)
SíndromedeMarfan
4. Sx Marfan: Histopatología
• Afección de la capa media de la raíz aortica:
Fragmentación de la lamina elástica
Necrosis quística de la capa media
Fibrosis
Perdida de células musculares lisas
• Schlatmann TJ, Becker AE. Pathogenesis of dissecting aneurysm of aorta. Comparative histopathologic study of significance of medial changes. Am J Cardiol
1977; 39:21.
• Hirst AE, Gore I. Editorial: Is cystic medionecrosis the cause of dissecting aortic aneurysm? Circulation 1976; 53:915.
• Trotter SE, Olsen EG. Marfan's disease and Erdheim's cystic medionecrosis. A study of their pathology. Eur Heart J 1991; 12:83.
• Collins MJ, Dev V, Strauss BH, et al. Variation in the histopathological features of patients with ascending aortic aneurysms: a study of 111 surgically excised
cases. J Clin Pathol 2008; 61:519.
Dr.RicardoMoraMoreno(MAECO)
SíndromedeMarfan
5. 2010 Revised Ghent Nosology for Marfan syndrome
Loeys BL, Dietz HC, Braverman AC, et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet 2010; 47:476.
Dr.RicardoMoraMoreno(MAECO)
SíndromedeMarfan
6. 2010 Revised Ghent Nosology for Marfan syndrome
Loeys BL, Dietz HC, Braverman AC, et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet 2010; 47:476.
Dr.RicardoMoraMoreno(MAECO)
SíndromedeMarfan
13. Sx Marfan: Aorta
Enfermedad
Raíz Aortica
Dilatación
aneurismática
Regurgitación
Aortica
Disección
Aortica
Jeremy RW, Huang H, Hwa J, et al. Relation between age, arterial distensibility, and aortic dilatation in the Marfan syndrome. Am J Cardiol 1994; 74:369.
Adams JN, Brooks M, Redpath TW, et al. Aortic distensibility and stiffness index measured by magnetic resonance imaging in patients with Marfan's syndrome. Br Heart J 1995;
73:265.
Groenink M, de Roos A, Mulder BJ, et al. Biophysical properties of the normal-sized aorta in patients with Marfan syndrome: evaluation with MR flow mapping. Radiology 2001;
219:535.
Jondeau G, Boutouyrie P, Lacolley P, et al. Central pulse pressure is a major determinant of ascending aorta dilation in Marfan syndrome. Circulation 1999; 99:2677.
Dr.RicardoMoraMoreno(MAECO)
SíndromedeMarfan
15. Sx Marfan: Aorta
• Dilatación aortica aproximadamente en 50% en niños con Marfan y avanza
progresivamente
• Dilatación raíz aortica 60-80% de adultos con Marfan, acompañado de
regurgitación aortica
• Ecocardiograma de control cada 6 meses para confirmar estabilidad de la
dimensiones aorticas
• Control anual con estudios de imagen para valorar aorta ascendente
(TAC/RM)
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic
Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American
College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional
Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121:e266.
Dr.RicardoMoraMoreno(MAECO)
SíndromedeMarfan
16. Sx Marfan: afección cardiaca
• Prolapso valva mitral, presente en Sx Marfan 40-54%
• Incidencia aumenta con la edad del paciente
• Incidencia: Mujer > Hombre
• Valvas elongadas y apariencia redundante
• Insuficiencia mitral leve o minima
• Deterioro de IM secundaria a ruptura de cuerda tendinosa o
endocarditis
• Prolapso de valva tricúspidea también puede estar presente
• Rybczynski M, Mir TS, Sheikhzadeh S, et al. Frequency and age-related course of mitral valve dysfunction in the Marfan syndrome. Am J Cardiol 2010; 106:1048.
• Faivre L, Collod-Beroud G, Loeys BL, et al. Effect of mutation type and location on clinical outcome in 1,013 probands with Marfan syndrome or related phenotypes and
FBN1 mutations: an international study. Am J Hum Genet 2007; 81:454.
Dr.RicardoMoraMoreno(MAECO)
SíndromedeMarfan