New Heart Failure modalities: HIS Bundle Pacing & Cardiac Contractility Modul...NAJEEB ULLAH SOFI
His bundle pacing activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising alternate site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block
CCM signals do not elicit a new contraction; rather, they influence the biology of the failing myocardium
1. Shock is a systemic state of low tissue perfusion that is inadequate for normal cellular respiration. It can be caused by various factors like blood loss, heart problems, or sepsis.
2. In trauma patients, shock is a common cause of death second only to traumatic brain injury. The Advanced Trauma Life Support (ATLS) protocol is used to assess and treat patients in shock.
3. Shock is classified into stages from initial to irreversible based on the body's attempts at compensation. Fluid resuscitation is used to treat hypovolemic shock, with blood transfusion as needed to replace lost volume. Dynamic fluid monitoring helps determine fluid responsiveness.
This document discusses flail mitral leaflet, which is a cause of mitral regurgitation requiring surgical correction. It occurs when the chordae tendineae connecting the mitral leaflet to the papillary muscles rupture. This causes the mitral leaflet to flail or balloon into the left atrium during systole. If left untreated, it can lead to complications like congestive heart failure, atrial fibrillation, thromboembolism and death. Surgical repair or replacement of the mitral valve is usually required to treat significant flail mitral leaflet.
The document discusses different techniques for aortic valve-sparing operations, including the remodeling technique and the reimplantation technique. It provides details on how each technique is performed surgically and discusses findings from studies comparing the techniques. The main points are:
1) The remodeling technique preserves some aortic root distensibility but the reimplantation technique causes higher pressure gradients due to a more rigid fixation of the valve.
2) Bending deformation of the valve leaflets is higher for both techniques compared to native aortic roots, due to the use of synthetic graft material.
3) Aortic root distensibility decreases for both techniques compared to native roots, with less distensibility observed with
The document provides guidelines for the surgical management of valvular heart disease from the 2020 ACC/AHA guidelines. It discusses evaluation and staging of valvular heart disease from initial diagnosis using tools like echocardiography and cardiac catheterization. It provides recommendations for treatment and follow-up of different valvular lesions based on severity and symptoms, including frequency of echocardiograms and antibiotic prophylaxis. It also reviews management and imaging follow-up for patients after valve interventions.
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
The aortic root consists of the aortic annulus, leaflets, sinuses, and sinotubular junction. It extends from the left ventricle outflow tract to the ascending aorta. Conditions requiring aortic root replacement include aneurysm, dissection, and connective tissue disorders. The Bentall procedure involves replacing the root with a composite graft. The Ross procedure uses the patient's pulmonary valve as an autograft. The reimplantation and remodeling techniques aim to spare the native valve. Long-term outcomes of root replacement are generally good with low rates of reoperation and structural valve deterioration.
New Heart Failure modalities: HIS Bundle Pacing & Cardiac Contractility Modul...NAJEEB ULLAH SOFI
His bundle pacing activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising alternate site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block
CCM signals do not elicit a new contraction; rather, they influence the biology of the failing myocardium
1. Shock is a systemic state of low tissue perfusion that is inadequate for normal cellular respiration. It can be caused by various factors like blood loss, heart problems, or sepsis.
2. In trauma patients, shock is a common cause of death second only to traumatic brain injury. The Advanced Trauma Life Support (ATLS) protocol is used to assess and treat patients in shock.
3. Shock is classified into stages from initial to irreversible based on the body's attempts at compensation. Fluid resuscitation is used to treat hypovolemic shock, with blood transfusion as needed to replace lost volume. Dynamic fluid monitoring helps determine fluid responsiveness.
This document discusses flail mitral leaflet, which is a cause of mitral regurgitation requiring surgical correction. It occurs when the chordae tendineae connecting the mitral leaflet to the papillary muscles rupture. This causes the mitral leaflet to flail or balloon into the left atrium during systole. If left untreated, it can lead to complications like congestive heart failure, atrial fibrillation, thromboembolism and death. Surgical repair or replacement of the mitral valve is usually required to treat significant flail mitral leaflet.
The document discusses different techniques for aortic valve-sparing operations, including the remodeling technique and the reimplantation technique. It provides details on how each technique is performed surgically and discusses findings from studies comparing the techniques. The main points are:
1) The remodeling technique preserves some aortic root distensibility but the reimplantation technique causes higher pressure gradients due to a more rigid fixation of the valve.
2) Bending deformation of the valve leaflets is higher for both techniques compared to native aortic roots, due to the use of synthetic graft material.
3) Aortic root distensibility decreases for both techniques compared to native roots, with less distensibility observed with
The document provides guidelines for the surgical management of valvular heart disease from the 2020 ACC/AHA guidelines. It discusses evaluation and staging of valvular heart disease from initial diagnosis using tools like echocardiography and cardiac catheterization. It provides recommendations for treatment and follow-up of different valvular lesions based on severity and symptoms, including frequency of echocardiograms and antibiotic prophylaxis. It also reviews management and imaging follow-up for patients after valve interventions.
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
The aortic root consists of the aortic annulus, leaflets, sinuses, and sinotubular junction. It extends from the left ventricle outflow tract to the ascending aorta. Conditions requiring aortic root replacement include aneurysm, dissection, and connective tissue disorders. The Bentall procedure involves replacing the root with a composite graft. The Ross procedure uses the patient's pulmonary valve as an autograft. The reimplantation and remodeling techniques aim to spare the native valve. Long-term outcomes of root replacement are generally good with low rates of reoperation and structural valve deterioration.
Echocardiography plays an essential role in diagnosing hypertrophic cardiomyopathy (HCM) by demonstrating left ventricular hypertrophy of 15mm or greater that is asymmetric and cannot be attributed to another cause. Echocardiography can also identify the characteristic patterns of hypertrophy such as sigmoid septum, reverse curvature of the septum, and apical hypertrophy. It is used to detect complications of HCM such as left ventricular outflow tract obstruction, mitral regurgitation, and apical aneurysms. Risk stratification for sudden cardiac death utilizes echocardiography to identify features such as massive hypertrophy, abnormal blood pressure response to exercise, and nonsustained ventricular tachycard
This document discusses intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for assessing coronary artery disease.
IVUS uses sound waves to image vessel walls with good penetration but lower resolution compared to OCT. Virtual histology IVUS can characterize plaque morphology. Studies show IVUS guidance for percutaneous coronary intervention reduces major adverse cardiac events. OCT uses near-infrared light for very high resolution imaging of plaque, thrombus, dissections and stent apposition. It guides lesion preparation and detects post-PCI complications. Both modalities provide detailed vessel and plaque assessment to optimize revascularization.
This document discusses techniques for recanalizing chronic total occlusions (CTOs). It defines a CTO and explains their etiology. Successful recanalization is associated with improved angina and reduced ischemia. Key steps include careful pre-procedure planning, selecting appropriate guidewires and microcatheters, and using techniques like parallel wiring or penetration when standard wiring fails. Expertise is important for high success rates. Proper wire shaping and handling can help avoid subintimal tracking.
Spinal cord protection in aortic surgeriesthanigai arasu
Spinal cord protection is important during aortic surgeries to prevent neurological deficits. The risk is highest with open thoracoabdominal aortic aneurysm (TAAA) repair. Techniques to protect the spinal cord include minimizing ischemia time, increasing cord tolerance through hypothermia, augmenting perfusion, and monitoring for ischemia. Early detection of ischemia allows interventions like reattachment of segmental arteries or modifying perfusion to salvage the cord. While endovascular repair reduces risk compared to open surgery, open repair requires strategies like distal aortic perfusion, cerebrospinal fluid drainage and evoked potential monitoring to optimize spinal cord protection.
The document summarizes the Year Review of Bifurcation PCI by Ahmed Kamel. It discusses various techniques for bifurcation stenting including provisional side branch stenting, two stent techniques like T-stenting and culotte, and the DK crush technique. It provides guidance on assessing bifurcation anatomy and recommendations for treating different types of bifurcations including left main bifurcations. The consensus is that provisional stenting is generally the preferred approach, but planned two stent techniques like DK crush may be better for complex anatomies with long side branches.
Coronary bifurcation lesions are challenging to treat percutaneously and account for approximately 15% of PCIs. Interventions on bifurcations have lower success rates and higher complication rates than other lesions. The optimal strategy for treating bifurcations, whether provisional stenting of the main vessel with treatment of the side branch only if needed versus systematic two-stent techniques, is still debated. Several randomized trials have compared different approaches but longer-term data is still needed. Dedicated bifurcation stents may improve outcomes but need low profiles, ease of use, and cost effectiveness.
This document discusses troubleshooting of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT). It describes evaluating patients who receive shocks from their ICD and assessing ineffective or absent treatment. The document outlines different causes of oversensing that can lead to inappropriate shocks, such as P-wave oversensing, R-wave double counting, and T-wave oversensing. It provides guidance on approaches to reduce oversensing, including adjusting sensitivity thresholds and blanking periods. The document emphasizes that identifying and addressing lead failures is important for preventing repetitive inappropriate shocks.
1. Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing CAG and is treated medically has a 3-year mortality rate of 50%.
2. Studies have shown PCI with drug-eluting stents for ULMCA disease can achieve low rates of death, MI, and TLR at 12 months compared to bare-metal stents which had high rates of restenosis and mortality.
3. While CABG remains the standard of care for many patients, randomized trials found PCI with DES to have non-inferior outcomes to CABG at 1-2 years for death, MI, and stroke in selected patients with low complexity lesions. Rates
This document discusses guide catheter selection for transradial coronary procedures. It provides guidance on the most commonly used guide catheters for accessing the left and right coronary arteries from the radial approach. Specific catheter shapes like the Judkins left and extra backup are recommended for the left coronary while the Judkins right is suitable for the right coronary. Newer catheter technologies including hydrophilic sheathless catheters are also reviewed. The conclusion emphasizes that knowledge of guide catheter selection and engagement technique enables successful transradial PCI.
Saphenous vein grafts used in coronary artery bypass grafting are prone to occlusion over time. Percutaneous interventions on occluded saphenous vein grafts carry risks of distal embolization. Techniques to reduce this risk include use of embolic protection devices, which filter out debris, and proximal occlusion devices, which block blood flow during the intervention. Drug-eluting stents may reduce restenosis compared to bare-metal stents in saphenous vein grafts, but dual antiplatelet therapy is required. While percutaneous interventions on saphenous vein grafts can relieve symptoms, the underlying disease progression remains an issue.
SAN FRANCISCO—Results from ORBIT II, a clinical trial designed to evaluate the safety and efficacy of the Diamondback 360° Orbital Atherectomy System to treat de novo severely calcified coronary lesions, were presented March 9 at the American College of Cardiology (ACC) scientific session.
This document discusses the differences between CABG (coronary artery bypass grafting) and PCI (percutaneous coronary intervention) for treating multivessel coronary artery disease. It notes that both procedures are established treatments, but that factors like mortality benefit, quality of life improvements, costs, and long-term effects need to be considered. The concept of "functional angioplasty" and using FFR (fractional flow reserve) to accurately evaluate clinical ischemia in the catheterization lab are introduced as ways to optimize outcomes from PCI. Several studies comparing outcomes of FFR-guided versus angiography-guided PCI are summarized. The document also discusses unfavorable aspects of CABG like invasiveness and long-term graft failure
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Based on the size of the defect, perimembranous VSDs between 4-18 mm in diameter would be suitable for closure with the Amplatzer VSD occluder. The device size would need to be selected based on the actual defect size as assessed by echocardiography. Adequate rims around the defect are required but specifics on rim measurements are not provided in this document. Other factors such as indications for closure and no contraindications to the percutaneous approach would also need to be evaluated for a particular patient.
Surgical management of ventricular septal defects (VSDs) involves evaluation using echocardiography and cardiac catheterization to determine the size, location, and hemodynamics of the defect. Indications for surgical intervention include symptoms, large defect size, and pulmonary vascular disease. Approaches include transatrial, transventricular, and transarterial depending on defect location. Complications include heart block, residual defects, and pulmonary hypertensive crisis. Long-term outcomes are generally good with surgical cure, though late complications like endocarditis can occur. Device closure is now an option for certain midmuscular and anterior muscular VSDs.
This document discusses coarctation of the aorta, including its embryology, nomenclature, pathophysiology, natural history, and clinical features. Some key points include:
- Coarctation of the aorta is a congenital narrowing of the aorta near the ductus arteriosus. Left untreated, 50% of patients will die within 10 years primarily due to heart failure.
- Associated anomalies include ventricular septal defects (40% of cases) and bicuspid aortic valves (46% of cases).
- Long-term complications include hypertension, aneurysm formation, dissection, and rupture.
- Natural history studies show mortality rates increase significantly from 25% at age
Tous les radiologues (et même de très nombreux cliniciens) connaissent et utilisent Osirix : il s’agit d’une logiciel de visualisation DICOM gratuit très avancé, robuste, rapide et simple à utiliser. Il permet de réaliser quasiment tous les types de post-traitement, jusqu’aux MPR curvilignes et reconstructions 3D en rendu volumique, le tout avec une vitesse impressionnante, y compris sur un ordinateur de puissance moyenne. Une version 64bits payante permet d’améliorer la vitesse de chargement et de reconstruction. A noter que la licence 64bits est valable par établissement, donc si votre service en a fait l’acquisition, vous pouvez tout à fait y avoir droit,dans le cadre d’une utilisation professionnelle. Demandez donc à votre chef de service ou à votre cadre de santé de vous fournir la clé 64bits, ça en vaut largement la peine !
Seuls résistent encore à Osirix des post-traitements complexes tels que le suivi automatique de vaisseaux, la suppression de l’os ou les séquences IRMfonctionnelles (cardiaque, spectroscopie,…). Et encore, même pour ces tâches complexes, des plugs-in permettent de pallier en partie ces insuffisances… Bref, Osirix est parfait mais… il ne fonctionne que sous Mac (logiciel OSX uniquement) ! Pourtant, son créateur le Dr Antoine Rosset nous avait confié lors de la session « Success Story » des JFR 2012 qu’une version Windows n’était pas impossible techniquement, mais coûterait cher à développer et que son équipe n’avait tout simplement pas les moyens financiers et humains pour s’y atteler. Tout espoir n’est donc pas perdu de voir débarquer Osirix sur nos PC, mais probablement pas dans une version gratuite.
Alors comment faire quand on n’a qu’un PC (car c’est bien le PC, c’est bien moins cher que les Mac et on y fait plus de choses… sans compter que Powerpoint y est nettement meilleur !) ?
Radioactif a enquêté, écumé les tréfonds du web médical, pour vous livrer les meilleures (ou les moins pires) alternatives à Osirix. Alternatives si possible gratuites bien évidemment, car il existe des logiciels professionnels (comme par exemple Myrian) de très bon niveau, mais hors de prix (plusieurs milliers d’euros pour les licences).
This document discusses coronary stent thrombosis, a serious complication of percutaneous coronary intervention (PCI). It outlines risk factors and prevention strategies. Key points include:
- Stent thrombosis is a nightmare for cardiologists and can have various causes, including patient factors, lesion characteristics, technical issues, and non-adherence to dual antiplatelet therapy.
- Prevention through optimal stent deployment, complete coverage of the lesion, and adherence to prolonged dual antiplatelet therapy are critical to minimizing the risk of stent thrombosis.
- Intravascular imaging can help identify issues like incomplete stent expansion or apposition that may lead to thrombosis.
- Large clinical trials have demonstrated the efficacy of newer antiplatelet regimens like
Echocardiography plays an essential role in diagnosing hypertrophic cardiomyopathy (HCM) by demonstrating left ventricular hypertrophy of 15mm or greater that is asymmetric and cannot be attributed to another cause. Echocardiography can also identify the characteristic patterns of hypertrophy such as sigmoid septum, reverse curvature of the septum, and apical hypertrophy. It is used to detect complications of HCM such as left ventricular outflow tract obstruction, mitral regurgitation, and apical aneurysms. Risk stratification for sudden cardiac death utilizes echocardiography to identify features such as massive hypertrophy, abnormal blood pressure response to exercise, and nonsustained ventricular tachycard
This document discusses intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for assessing coronary artery disease.
IVUS uses sound waves to image vessel walls with good penetration but lower resolution compared to OCT. Virtual histology IVUS can characterize plaque morphology. Studies show IVUS guidance for percutaneous coronary intervention reduces major adverse cardiac events. OCT uses near-infrared light for very high resolution imaging of plaque, thrombus, dissections and stent apposition. It guides lesion preparation and detects post-PCI complications. Both modalities provide detailed vessel and plaque assessment to optimize revascularization.
This document discusses techniques for recanalizing chronic total occlusions (CTOs). It defines a CTO and explains their etiology. Successful recanalization is associated with improved angina and reduced ischemia. Key steps include careful pre-procedure planning, selecting appropriate guidewires and microcatheters, and using techniques like parallel wiring or penetration when standard wiring fails. Expertise is important for high success rates. Proper wire shaping and handling can help avoid subintimal tracking.
Spinal cord protection in aortic surgeriesthanigai arasu
Spinal cord protection is important during aortic surgeries to prevent neurological deficits. The risk is highest with open thoracoabdominal aortic aneurysm (TAAA) repair. Techniques to protect the spinal cord include minimizing ischemia time, increasing cord tolerance through hypothermia, augmenting perfusion, and monitoring for ischemia. Early detection of ischemia allows interventions like reattachment of segmental arteries or modifying perfusion to salvage the cord. While endovascular repair reduces risk compared to open surgery, open repair requires strategies like distal aortic perfusion, cerebrospinal fluid drainage and evoked potential monitoring to optimize spinal cord protection.
The document summarizes the Year Review of Bifurcation PCI by Ahmed Kamel. It discusses various techniques for bifurcation stenting including provisional side branch stenting, two stent techniques like T-stenting and culotte, and the DK crush technique. It provides guidance on assessing bifurcation anatomy and recommendations for treating different types of bifurcations including left main bifurcations. The consensus is that provisional stenting is generally the preferred approach, but planned two stent techniques like DK crush may be better for complex anatomies with long side branches.
Coronary bifurcation lesions are challenging to treat percutaneously and account for approximately 15% of PCIs. Interventions on bifurcations have lower success rates and higher complication rates than other lesions. The optimal strategy for treating bifurcations, whether provisional stenting of the main vessel with treatment of the side branch only if needed versus systematic two-stent techniques, is still debated. Several randomized trials have compared different approaches but longer-term data is still needed. Dedicated bifurcation stents may improve outcomes but need low profiles, ease of use, and cost effectiveness.
This document discusses troubleshooting of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT). It describes evaluating patients who receive shocks from their ICD and assessing ineffective or absent treatment. The document outlines different causes of oversensing that can lead to inappropriate shocks, such as P-wave oversensing, R-wave double counting, and T-wave oversensing. It provides guidance on approaches to reduce oversensing, including adjusting sensitivity thresholds and blanking periods. The document emphasizes that identifying and addressing lead failures is important for preventing repetitive inappropriate shocks.
1. Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing CAG and is treated medically has a 3-year mortality rate of 50%.
2. Studies have shown PCI with drug-eluting stents for ULMCA disease can achieve low rates of death, MI, and TLR at 12 months compared to bare-metal stents which had high rates of restenosis and mortality.
3. While CABG remains the standard of care for many patients, randomized trials found PCI with DES to have non-inferior outcomes to CABG at 1-2 years for death, MI, and stroke in selected patients with low complexity lesions. Rates
This document discusses guide catheter selection for transradial coronary procedures. It provides guidance on the most commonly used guide catheters for accessing the left and right coronary arteries from the radial approach. Specific catheter shapes like the Judkins left and extra backup are recommended for the left coronary while the Judkins right is suitable for the right coronary. Newer catheter technologies including hydrophilic sheathless catheters are also reviewed. The conclusion emphasizes that knowledge of guide catheter selection and engagement technique enables successful transradial PCI.
Saphenous vein grafts used in coronary artery bypass grafting are prone to occlusion over time. Percutaneous interventions on occluded saphenous vein grafts carry risks of distal embolization. Techniques to reduce this risk include use of embolic protection devices, which filter out debris, and proximal occlusion devices, which block blood flow during the intervention. Drug-eluting stents may reduce restenosis compared to bare-metal stents in saphenous vein grafts, but dual antiplatelet therapy is required. While percutaneous interventions on saphenous vein grafts can relieve symptoms, the underlying disease progression remains an issue.
SAN FRANCISCO—Results from ORBIT II, a clinical trial designed to evaluate the safety and efficacy of the Diamondback 360° Orbital Atherectomy System to treat de novo severely calcified coronary lesions, were presented March 9 at the American College of Cardiology (ACC) scientific session.
This document discusses the differences between CABG (coronary artery bypass grafting) and PCI (percutaneous coronary intervention) for treating multivessel coronary artery disease. It notes that both procedures are established treatments, but that factors like mortality benefit, quality of life improvements, costs, and long-term effects need to be considered. The concept of "functional angioplasty" and using FFR (fractional flow reserve) to accurately evaluate clinical ischemia in the catheterization lab are introduced as ways to optimize outcomes from PCI. Several studies comparing outcomes of FFR-guided versus angiography-guided PCI are summarized. The document also discusses unfavorable aspects of CABG like invasiveness and long-term graft failure
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Based on the size of the defect, perimembranous VSDs between 4-18 mm in diameter would be suitable for closure with the Amplatzer VSD occluder. The device size would need to be selected based on the actual defect size as assessed by echocardiography. Adequate rims around the defect are required but specifics on rim measurements are not provided in this document. Other factors such as indications for closure and no contraindications to the percutaneous approach would also need to be evaluated for a particular patient.
Surgical management of ventricular septal defects (VSDs) involves evaluation using echocardiography and cardiac catheterization to determine the size, location, and hemodynamics of the defect. Indications for surgical intervention include symptoms, large defect size, and pulmonary vascular disease. Approaches include transatrial, transventricular, and transarterial depending on defect location. Complications include heart block, residual defects, and pulmonary hypertensive crisis. Long-term outcomes are generally good with surgical cure, though late complications like endocarditis can occur. Device closure is now an option for certain midmuscular and anterior muscular VSDs.
This document discusses coarctation of the aorta, including its embryology, nomenclature, pathophysiology, natural history, and clinical features. Some key points include:
- Coarctation of the aorta is a congenital narrowing of the aorta near the ductus arteriosus. Left untreated, 50% of patients will die within 10 years primarily due to heart failure.
- Associated anomalies include ventricular septal defects (40% of cases) and bicuspid aortic valves (46% of cases).
- Long-term complications include hypertension, aneurysm formation, dissection, and rupture.
- Natural history studies show mortality rates increase significantly from 25% at age
Tous les radiologues (et même de très nombreux cliniciens) connaissent et utilisent Osirix : il s’agit d’une logiciel de visualisation DICOM gratuit très avancé, robuste, rapide et simple à utiliser. Il permet de réaliser quasiment tous les types de post-traitement, jusqu’aux MPR curvilignes et reconstructions 3D en rendu volumique, le tout avec une vitesse impressionnante, y compris sur un ordinateur de puissance moyenne. Une version 64bits payante permet d’améliorer la vitesse de chargement et de reconstruction. A noter que la licence 64bits est valable par établissement, donc si votre service en a fait l’acquisition, vous pouvez tout à fait y avoir droit,dans le cadre d’une utilisation professionnelle. Demandez donc à votre chef de service ou à votre cadre de santé de vous fournir la clé 64bits, ça en vaut largement la peine !
Seuls résistent encore à Osirix des post-traitements complexes tels que le suivi automatique de vaisseaux, la suppression de l’os ou les séquences IRMfonctionnelles (cardiaque, spectroscopie,…). Et encore, même pour ces tâches complexes, des plugs-in permettent de pallier en partie ces insuffisances… Bref, Osirix est parfait mais… il ne fonctionne que sous Mac (logiciel OSX uniquement) ! Pourtant, son créateur le Dr Antoine Rosset nous avait confié lors de la session « Success Story » des JFR 2012 qu’une version Windows n’était pas impossible techniquement, mais coûterait cher à développer et que son équipe n’avait tout simplement pas les moyens financiers et humains pour s’y atteler. Tout espoir n’est donc pas perdu de voir débarquer Osirix sur nos PC, mais probablement pas dans une version gratuite.
Alors comment faire quand on n’a qu’un PC (car c’est bien le PC, c’est bien moins cher que les Mac et on y fait plus de choses… sans compter que Powerpoint y est nettement meilleur !) ?
Radioactif a enquêté, écumé les tréfonds du web médical, pour vous livrer les meilleures (ou les moins pires) alternatives à Osirix. Alternatives si possible gratuites bien évidemment, car il existe des logiciels professionnels (comme par exemple Myrian) de très bon niveau, mais hors de prix (plusieurs milliers d’euros pour les licences).
This document discusses coronary stent thrombosis, a serious complication of percutaneous coronary intervention (PCI). It outlines risk factors and prevention strategies. Key points include:
- Stent thrombosis is a nightmare for cardiologists and can have various causes, including patient factors, lesion characteristics, technical issues, and non-adherence to dual antiplatelet therapy.
- Prevention through optimal stent deployment, complete coverage of the lesion, and adherence to prolonged dual antiplatelet therapy are critical to minimizing the risk of stent thrombosis.
- Intravascular imaging can help identify issues like incomplete stent expansion or apposition that may lead to thrombosis.
- Large clinical trials have demonstrated the efficacy of newer antiplatelet regimens like
This document discusses the management of weaning patients from cardiopulmonary bypass after cardiac surgery. It describes the process of transitioning patients from full mechanical circulatory support to spontaneous heart function. During weaning, hemodynamic monitoring and echocardiography are used to assess the patient's status and guide therapeutic decisions. Difficult weaning situations can involve structural issues, dynamic abnormalities, ventricular dysfunction, or vasoplegia. Inotropes, vasopressors, pulmonary vasodilators and mechanical support may be needed to treat low blood pressure or cardiac issues identified during weaning from bypass.
Casi Clinici 1 - del Prof. Sasso. 27 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
Casi Clinici 2 - Prof. Sasso. 27 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
This document discusses various dental indices used for recording oral diseases in children. It begins by defining what a dental index is and providing examples of common indices. It then categorizes indices based on how their scores can change, the areas of the mouth they measure, and the conditions they assess. Key indices discussed include the Oral Hygiene Index, Simplified Oral Hygiene Index, Plaque Index, Gingival Index, and CPITN. The document outlines the methodology, scoring, and uses of these important indices for assessing conditions like dental caries, periodontal disease, fluorosis, and malocclusion.
Valutazione ecocardiografica del meccanismo e della severità dell'insufficienza valvolare aortica. Dr.ssa Rita Conti - Villa Maria Cecilia Hospital - Maggio 2009
Congress presentation in Milan SICVE 2009: ENDOLEAK TYPE II PREVENTION
Presentazione al congresso di MIlano SICVE 2009: PREVENZIONE ENDOLEAK DI TIPO II
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
A view of prevention: congress presentation at Società Italiana di Chirurgia Vascolare Milano 2009
Uno sguardo alla prevenzione: presentazione al congresso della Società Italiana di Chirurgia Vascolare Milano nel 2009
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
Colonscopia virtuale come alternativa a quella classica, più invasiva. Prevenzione del tumore al colon tramite due prodotti di lifeplus: paraclenase e colon formula
1. LA NUOVA CHIRURGIALA NUOVA CHIRURGIA
CONSERVATIVA DELLA VALVOLACONSERVATIVA DELLA VALVOLA
MITRALEMITRALE
Prof. Carlo Santi
Direttore Scientifico: Dipartimento di Chirurgia Cardio-toraco-vascolare “Policlinico di Monza”
2. EMBRIOLOGIAEMBRIOLOGIA
Valvola mitraleValvola mitrale
O R I G I N E L E M B O A N T E R I O R E
D a lla f o r m a z i o n e d e i c u s c i n e t t i e n d o c a r d i c i
a lla s i n i s t r a d e l s e t t o p r i m a r io
d u e a n te r io r i
p o c o t e s s u to m u s c o a r e
V A L V O L A Q U A D R IC U S P ID E
T a r d iv a m e n te
s o tt i li e fi b r o s i
I n iz i a lm e n te
s p e s s i e c a r n o s i
D u e p o s t e r i o r i
t e s s u t o m u s c o la r e
A b b o z z o v a lv o la r e
d i v i s o i n q u a t t r o
c o m p a r t im e n ti
O R IG IN E D E L L E M B O P O S T E R I O R E
M u s c o la t u r a v e n tr i c o la r e d i ff e r e n z i a ta s i
d a lla p a r e t e v e n t r i c o la r e
O R IG IN E
T r a b e c o le v e n t r ic o la r i e m b r io n a li
e m b r io n e d i 1 0 - 1 2 m m . d i lu n g h e z z a
3. CRITERI DI SCELTACRITERI DI SCELTA
PROCEDURA TERAPEUTICAPROCEDURA TERAPEUTICA
0 20 35 50 70 Anni
AutograftAutograft
HomograftHomograft
MeccanicaMeccanica
StentlessStentless
BioprotesiBioprotesiConservativa
P.T.A.interventistica
4. VALVULOPLASTICA MITRALICA PERCUTANEAVALVULOPLASTICA MITRALICA PERCUTANEA
CRITERI DI SELEZIONE
ORIFIZIO VALVOLARE STRETTO
STORIA DI EMBOLIE
INSUFFICIENZA MITRALICA LIEVE
PRESENZA DI ALTRE PATOLOGIE VALVOLARI NON CHIRURGICHE
MALATTIE ASSOCIATE
CONTROINDICAZIONI
TROMBO FRESCO IN ATRIO SINISTRO – SETTO INTERATRIALE
TROMBO MOBILE
INSUFFICIENZA MITRALICA MEDIO – SEVERA
VALUTAZIONE DEI 4 PARAMETRI ECOGRAFICI
MOBILITA’ DEI LEMBI VALVOLARI
ISPESSIMENTO DELL’APPARATO SOTTOVALVOLARE
ISPESSIMENTO DEI LEMBI VALVOLARI
CALCIFICAZIONE DEI LEMBI VALVOLARI
OBBIETTIVO
SUPERFICIE VALVOLARE > 1,5 cmq
INSUFFICIENZA MITRALICA LIEVE – MEDIA
FOLLOW – UP
RESTENOSI ELEVATA
5. FILOSOFIA DELLAFILOSOFIA DELLA
CHIRURGIACHIRURGIA
CONSERVATIVACONSERVATIVA
Secondo i molteplici lavori pubblicati in letteratura, con le
attuali tecniche di plastica della valvola mitrale circa il 70-80%
dei pazienti che presentano un quadro di insufficienza o di
stenosi mitralica può beneficiare di un intervento ricostruttivo.
Sono state proposte alcune opzioni chirurgiche interessanti,
alcune, per correggere l’incontinenza della valvola, come la
resezione quadrangolare del lembo posteriore associata a
l’interposizione di corde tendinee artificiali, che non concedono
però errori sull’esatta determinazione della lunghezza e del
punto di impianto, la resezione triangolare dei lembi prolassanti
con accorciamento delle corde tendinee ed altre per aumentarne
la superficie come in tutte le varianti di commissurotomia. Le
lesioni più difficili da trattare sono il prolasso del lembo
anteriore, associato o meno a quello posteriore, le insufficienze
con concomitante calcificazione anulare, la malattia di Barlow
e l’insufficienza secondaria a disfunzione di parete o a lesioni
multiple. In presenza di queste lesioni sono state proposte due
tecniche, una definita “edge-to-edge”, con risultati
estremamente interessanti ma con il rischio che possa generare
stenosi residue della valvola a doppio orifizio e un’altra di
doppia plastica dei due lembi, che si prefigge di correggere la
coaptazione, caratteristica questa che fornisce alla procedura
elevata predicibilità del risultato con esclusione del rischio di
SAM post-operatorio.
19. CRITERI DI SCELTA DELLA PROTESICRITERI DI SCELTA DELLA PROTESI
versusversus
CONSERVATIVACONSERVATIVA
0 20 50 70 Anni
AutograftAutograft
HomograftHomograft
MeccanicaMeccanica
StentlessStentless
BioprotesiBioprotesi
Conservativa
20. SOSTITUZIONE VALVOLARE :SOSTITUZIONE VALVOLARE :
LIMITI , PROSPETTIVELIMITI , PROSPETTIVE
Protesi valvolare idealeProtesi valvolare ideale
LIMITILIMITI
Tessuti biologiciTessuti biologici
DurataDurata
Rapido deterioramentoRapido deterioramento
Rottura dei lembiRottura dei lembi
calcificazionecalcificazione
Protesi meccanicheProtesi meccaniche
Biocampatibilià
Rischi dell’anticoagulazione
Emolisi, Rigidità
Emodinamica inversamente proporzionale alla
misura della protesi
Rigurgito transprotesico nella frazione statica e
dinamica
21. SOSTITUZIONE VALVOLARE :SOSTITUZIONE VALVOLARE :
LIMITI , PROSPETTIVELIMITI , PROSPETTIVE
Protesi valvolare idealeProtesi valvolare ideale
PROSPETTIVEPROSPETTIVE
Tessuti biologiciTessuti biologici
Durata (Trattamento , design dello stent)(Trattamento , design dello stent)
Emodinamica (stentless)Emodinamica (stentless)
Assenza di tromboembolismo senzaAssenza di tromboembolismo senza
anticoagulazioneanticoagulazione
Conservazione a bassa pressione o a pressioneConservazione a bassa pressione o a pressione
libera con gluteraldeidelibera con gluteraldeide
Protesi meccanicheProtesi meccaniche
BiocompatibilitàBiocompatibilità (Materiali , design)(Materiali , design)
Integrità strutturaleIntegrità strutturale
Rotazione all’interno dell’anelloRotazione all’interno dell’anello
