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Cardiovascular Medicine is published by MDPI from Volume 28 Issue 1 (2025). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Editores Medicorum Helveticorum (EMH).

Cardiovasc. Med., Volume 11, Issue 6 (06 2008) – 7 articles

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2 pages, 286 KB  
Interesting Images
Thrombolysis of a Tricuspid Prosthetic Valve
by Yvan Fournier and Alain Delabays
Cardiovasc. Med. 2008, 11(6), 219; https://doi.org/10.4414/cvm.2008.01335 - 27 Jun 2008
Viewed by 58
Abstract
A 25-year-old Caucasian woman presented to our hospital in April 2005, complaining of exertional dyspnoea, palpitations and fatigue since three weeks.[...] Full article
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2 pages, 461 KB  
Interesting Images
Sinus Arrest in a Patient with a History of Syncope
by Marcello Di Valentino and Beat Schaer
Cardiovasc. Med. 2008, 11(6), 217; https://doi.org/10.4414/cvm.2008.01334 - 27 Jun 2008
Viewed by 64
Abstract
A67-year-old patient with complete right bundle block in the 12-lead ECG underwent an ambulatory electrocardiographic monitoring (AEM) in order to exclude relevant arrhythmias after a syncope.[...] Full article
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8 pages, 419 KB  
Editorial
Traitement Percutané de L’insuffisance Mitrale: Tour D’horizon en 2008
by Stéphane Noble and Luc Bilodeau
Cardiovasc. Med. 2008, 11(6), 209; https://doi.org/10.4414/cvm.2008.01333 - 27 Jun 2008
Viewed by 60
Abstract
Over the past several years, developmental efforts to achieve percutaneous catheter-based therapies for valvular heart disease have allowed the first pulmonic and aortic transcatheter valve replacement respectively in year 2000 and 2002. Regarding mitral regurgitation, a variety of catheter-based percutaneous approaches have been [...] Read more.
Over the past several years, developmental efforts to achieve percutaneous catheter-based therapies for valvular heart disease have allowed the first pulmonic and aortic transcatheter valve replacement respectively in year 2000 and 2002. Regarding mitral regurgitation, a variety of catheter-based percutaneous approaches have been developed. The most studied device is the MitraClip® (Evalve, Inc., Menlo Park, CA, USA) which is used to realise a percutaneous edge-to-edge mitral repair, resulting in a double-orifice mitral valve. The first prospective registry results in over 100 patients are encouraging. EVEREST II is currently randomising patients to either percutaneous approach or standard surgical repair with clinical and echographic safety and efficacy endpoints. Devices dedicated to coronary sinus annuloplasty such as the Edwards MONARC system™ (Edwards Lifesciences, Irvine, CA, USA), the Carillon™ (Cardiac Dimensions, Inc., Kirkland, WA, USA) and the Viacor PTMA™ (Viacor, Inc., Wilmington, MA, USA) are investigated in ongoing safety and efficacy trials. To address some of the potential limitations of indirect annuloplasty via the coronary sinus, direct approaches to the mitral annulus are being developed such as the Mitralign device (Mitralign, Inc., Tewksbury, MA, USA). All these transcatheter approaches may offer treatment options for high surgical risk patients. Treatment modalities for mitral regurgitation remain complex due to a wide disease spectrum and appropriate patient selection is the cornerstone for success. Percutaneous treatment of mitral regurgitation seems to be a promising approach, but is still at an early stage of development. Full article
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7 pages, 635 KB  
Review
Coronary CT Angiography: Overuse, Underuse or Adequate Use?
by Osman Ratib
Cardiovasc. Med. 2008, 11(6), 202; https://doi.org/10.4414/cvm.2008.01339 - 27 Jun 2008
Viewed by 55
Abstract
Coronary CT angiography (CTA) is emerging as a highly effective alternative imaging technique for the assessment of coronary artery disease (CAD). The rapid evolution of multidetector CT scanners has lead to major improvement in temporal resolution of image acquisition allowing high-resolution images of [...] Read more.
Coronary CT angiography (CTA) is emerging as a highly effective alternative imaging technique for the assessment of coronary artery disease (CAD). The rapid evolution of multidetector CT scanners has lead to major improvement in temporal resolution of image acquisition allowing high-resolution images of coronary arteries to be acquired even in patients with fast and irregular heart rate. So far the clinical value of coronary CTA was mainly enforced by its high negative predictive value allowing to exclude coronary disease with high degree of accuracy in patients with low probability for CAD. With the ability of CTA to provide anatomical and functional information of the heart and great vessels, there are numerous additional applications of CTAfor evaluating cardiac function, valvular disease, calcifications, and characterisation of vascular plaques. With the advent of dual energy imaging and hybrid scanners, combining PET and CT imaging modalities, additional potential applications of CTA in cardiology are predictable. The main limiting factor for broader adoption of CTA in clinical practice is the lag between conclusive clinical trials and the rapid advancement of technology that render clinical trials performed with earlier generation of machines obsolete even before the trials are completed. Full article
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6 pages, 401 KB  
Review
Coronary CT Is Overused, Angiography Remains the Standard
by Bernhard Meier
Cardiovasc. Med. 2008, 11(6), 196; https://doi.org/10.4414/cvm.2008.01337 - 27 Jun 2008
Viewed by 57
Abstract
Computerised tomography (CT) was first used to screen for coronary artery disease (CAD) by using a calcium score produced by electron beam computerised tomography (EBCT). After an initial boom, the interest waned until CT angiography became available with 16- and more recently 64-slice [...] Read more.
Computerised tomography (CT) was first used to screen for coronary artery disease (CAD) by using a calcium score produced by electron beam computerised tomography (EBCT). After an initial boom, the interest waned until CT angiography became available with 16- and more recently 64-slice technology. Stunning pictures of the major epicardial coronary arteries can be produced and luminal narrowings can be reconstructed. However, the enthusiasm of those running such equipment is not justified for a number of banes of the technique. First, the coronary arteries can be seen at best down to the second-degree vessels. Smaller vessels do simply not appear on the pictures. Second, there are plenty of artefacts. Even if they are recognised as such, each of them renders a segment of the coronary tree non-assessable. Third, calcium (virtually omnipresent in people beyond 50 years of age) forfeits analysis of the vessel adjacent to it. Forth, the heart rate needs to be regular and in the physiological range for any gating process. Fifth, the patients have to be able to hold their breaths for 15–30 seconds while constrained in an uncomfortable position and surrounding. And last but not least the radiation dose applied is prohibitive for a screening method. Irradiation is higher than for a conventional coronary angiogram including multivessel angioplasty. There is hope, that radiation can be reduced by dual source CT apparatus or prospective ECG gating. Yet, even if the x-ray hazard can be significantly curbed, the method remains invalidated by oversensitivity. Most people in the typical screening ages will have irregularities in CT coronary angiography. Hence, they will all be sent on to conventional coronary angiography so that the intermediate step of CT angiography should be skipped. In young people, where normal coronary arteries prevail, CT angiography screening for CAD will produce a malignant tumor in about 1 out of 200 cases. This being conveyed to people asking for it will likely stop them asking for it. Full article
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9 pages, 481 KB  
Article
Interventional Cardiology in Switzerland 2006
by Micha T. Maeder, Jean-Christoph Stauffer, Stephan Windecker, Giovanni Pedrazzini, Christoph A. Kaiser, Marco Roffi, Hans Rickli and on behalf of the Working Group “Interventional Cardiology and Acute Coronary Syndrome”
Cardiovasc. Med. 2008, 11(6), 187; https://doi.org/10.4414/cvm.2008.01338 - 27 Jun 2008
Cited by 2 | Viewed by 70
Abstract
Background: Since 1987, a nationwide survey of percutaneous cardiac interventions is performed annually in Switzerland, which allows recognition of contemporary trends and comparison with other countries. Methods: Volume and type of procedures performed during the year 2006 were collected by means [...] Read more.
Background: Since 1987, a nationwide survey of percutaneous cardiac interventions is performed annually in Switzerland, which allows recognition of contemporary trends and comparison with other countries. Methods: Volume and type of procedures performed during the year 2006 were collected by means of a standardised questionnaire from all adult percutaneous cardiac intervention centres in Switzerland. Results: During the year 2006, 36817 coronary angiographies (CA; 2005: 36436; +1.0%) and 17061 percutaneous coronary interventions (PCI; 2005: 16624; +2.6%) were performed in 27 centres (5 university hospitals, 9 public, nonuniversity hospitals, and 13 private hospitals) by 193 operators (64 of them performing only diagnostic studies). Ninety-three percent of PCI procedures were performed ad hoc, and 78% of them were single-vessel interventions. Stents were used in 89% of all PCI (2005: 91%) procedures with drug-eluting stents (DES) being responsible for the largest share (82% of all stents) (2005: 78%). Emergency procedures (primary PCI or rescue PCI after failed thrombolysis) accounted for 20% of interventions (2005: 19%). Glycoprotein IIb/IIIa inhibitors were used in 19% of PCI (2005: 23%) procedures. In addition, valvuloplasties of mitral, aortic, and pulmonary valves were performed in 42, 21, and 5 cases, respectively. Finally, percutaneous closure of a patent foramen ovale and an atrial deptal defect were performed in 515 (2005: 510) and in 88 (2005: 94) cases, respectively. Conclusions: The increase in the number of CA and PCI has flattened during 2006. The use of DES remained high, though the previously rapidly growing utilisation of these devices reached a plateau. The number of procedures for the percutaneous closure of patent foramen ovale and atrial septal defect has stabilised. Full article
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4 pages, 237 KB  
Editorial
Krankenversicherungsgesetz, die Versicherungen und die ärztliche Ethik—Jenseits Evidenzbasierter Medizin?
by Thomas F. Lüscher
Cardiovasc. Med. 2008, 11(6), 183; https://doi.org/10.4414/cvm.2008.01336 - 27 Jun 2008
Viewed by 56
Abstract
Die ärztliche Ethik hat sich seit Hippokrates erheblich verändert: Es geht nicht mehr nur darum, nicht zu schaden (primum nil nocere), sondern dem Patienten die bestmögliche, das heisst evidenzbasierte Medizin zuteil werden zu lassen.[...] Full article
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