Cardiovascular Medicine

4 pages, 150 KB

Open AccessReview

Left Atrial Appendage Device Closure as Non-Pharmacological Prevention of Thromboembolism in Atrial Fibrillation

by Bernhard Meier

Cardiovasc. Med. 2014, 17(9), 277; https://doi.org/10.4414/cvm.2014.00277 (registering DOI) - 24 Sep 2014

Viewed by 12

The fact that non-valvular (non-rheumatic) atrial fibrillation creates detectable thrombi in 17% of patients without oral anticoagulation and that 16% of the 17% (over 90% relatively) reside in the left atrial appendage (LAA), suggest that patients without an LAA or with an occluded [...] Read more.

The fact that non-valvular (non-rheumatic) atrial fibrillation creates detectable thrombi in 17% of patients without oral anticoagulation and that 16% of the 17% (over 90% relatively) reside in the left atrial appendage (LAA), suggest that patients without an LAA or with an occluded LAA do not need oral anticoagulation. This has already led to surgical LAA exclusion for decades and to catheter-based LAA occlusion for the past 13 years. Currently 5 different technical approaches are approved in European countries, but only 2 are widely used, the Amplatzer and the Watchman devices. With the latter, randomised data showed superiority in terms of embolism protection, bleeding, and survival compared to vitamin K antagonists (VKA) after 4 years in a randomised trial. The clinical results in thousands of patients with Watchman and Amplatzer occluders suggest, moreover, that they are at least competitive with non-VKA oral anticoagulants. Non-pharmacological prevention of thromboembolism with device implantation or, in case of another indication for heart surgery during that intervention, may be discussed with every patient with atrial fibrillation as an alternative to oral anticoagulation. Full article

2 pages, 390 KB

Open AccessInteresting Images

Supracardiac Total Anomalous Pulmonary Venous Connection with Right Ascending Vertical Vein

by Himanshu Mahla, Kavya Mallikarjun, Usha Mandikal Kodanda Rama Sastry, Jayarangnath Mahimarangaiah and Cholenahally Nanjappa Manjunath

Cardiovasc. Med. 2014, 17(9), 273; https://doi.org/10.4414/cvm.2014.00265 - 24 Sep 2014

Cited by 1 | Viewed by 9

Abstract

Case report A 20-day-old neonate was referred to our tertiary care institute for evaluation of increased precordial activity and feeding difficulty [...] Full article

3 pages, 233 KB

Open AccessCase Report

Percutaneous Closure of Ventricular Septal Defect Following Aortic Valve Replacement

by Jean-Jacques Goy, Patrick Ruchat, Valérie Stoltc, Léopold Schlueter and Alexandre Berger

Cardiovasc. Med. 2014, 17(9), 266; https://doi.org/10.4414/cvm.2014.00270 - 24 Sep 2014

Viewed by 13

Abstract

Membranous ventricular septal defect (VSD) is a rare complication of surgical aortic valve replacement. We describe a complex case of iatrogenic VSD following surgical aortic valve replacement with a bioprosthetic aortic valve. VSD could be successfully closed using a retrograde approach. Full article

10 pages, 539 KB

Open AccessReview

The Early Development of Cardiology in Zurich–A Personal Account Part I

by Wilhelm Rutishauser

Cardiovasc. Med. 2014, 17(9), 256; https://doi.org/10.4414/cvm.2014.00175 - 24 Sep 2014

Viewed by 10

Abstract

Thanks to the outstanding surgical talent and competence of Åke Senning, since 1961 head of cardiovascular and visceral surgery at the University Hospital of Zurich, the indications for operative corrections were gradually extended to most congenital and acquired heart diseases. His influence considerably [...] Read more.

Thanks to the outstanding surgical talent and competence of Åke Senning, since 1961 head of cardiovascular and visceral surgery at the University Hospital of Zurich, the indications for operative corrections were gradually extended to most congenital and acquired heart diseases. His influence considerably stimulated and challenged all those working in the field of heart disease in the Medical Clinic (Paul Lichtlen) and in the Policlinic (Ernst Lüthy) and led ultimately to the development of an official Cardiology Division (Wilhelm Rutishauser) in 1970. Children and adults with acquired and congenital diseases of the heart underwent catheterisation and angiography for a more accurate and quantitative diagnosis. Echocardiographic and Doppler methods only came later. Pressure measurements with fluid-filled and catheter-tip manometers allowed for a precise evaluation of gradients at stenosed valves and dye-dilution and thermodilution permitted flow measurements necessary for the calculation of valve areas. The dye-dilution method allowed for the measurement of right to left and left to right shunts on all levels of the circulation and was superior to the estimation of shunts by oxygen saturation of blood samples. The upstream sampling by dye and thermodilution made the assessment of the severity of valvular regurgitations more accurate before echocardiographic and nuclear methods became available. The characterisation of ventricular function by measurement of dP/dt with tip-manometers during pacing, handgrip and ergometric exercise allowed the study of the performance of the heart. Of considerable interest was the alteration of ventricular function during ischaemia induced with the above-mentioned stress tests in the catheterisation laboratory. A big step forward was the use of angiography in a quantitative way. Densitometry made possible the appreciation of stenoses in vessels more precisely than the measurement of diameter reduction. Cine- and videodensitometry allowed the measurement of blood flow by angiography in individual vessels in conscious men, which was impossible before without the introduction of these devices. The perspective that utilisation of catheters would one day lead to therapeutic interventions on vessels and the heart–reserved until then for surgery–was fascinating and a major impetus. Initiating dilatation of narrowed coronary arteries needed vision and courage. Grüntzig’s previous successes with percutaneous treatment of iliac and femoral stenoses gave us confidence. After careful experiments in dogs with artificial coronary stenoses and intraoperative dilatation Andreas Grüntzig performed the first successful coronary angioplasty on 16 September 1977 on a 36-year-old patient, who is still alive today. Bernhard Meier, responsible for the medical ward of this patient, carefully described the circumstances, later followed Grüntzig to Atlanta and has devoted his life to interventional cardiology. Full article

7 pages, 250 KB

Open AccessReview

Pregnancy-Associated Cardiomyopathies

by Denise Hilfiker-Kleiner and Johann Bauersachs

Cardiovasc. Med. 2014, 17(9), 245; https://doi.org/10.4414/cvm.2014.00262 - 24 Sep 2014

Cited by 1 | Viewed by 9

Abstract

Cardiovascular disease is a major cause of complications in pregnancy worldwide and the number of patients who develop cardiac problems during pregnancy is increasing. The physiological changes occurring during pregnancy and in the peripartum period provide a challenge to the cardiovascular system of [...] Read more.

Cardiovascular disease is a major cause of complications in pregnancy worldwide and the number of patients who develop cardiac problems during pregnancy is increasing. The physiological changes occurring during pregnancy and in the peripartum period provide a challenge to the cardiovascular system of all women. Understanding the morphological and functional changes in normal pregnancy is therefore important for the timely recognition of cardiovascular pathology during this vulnerable period. However, evidence-based clinical data in this field are scarce and there is a deficit in understanding general physiological and pathophysiological processes operating in the maternal heart around pregnancy. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system with a special focus laid on hypertensive complications in pregnancy, i.e., pre-eclampsia. A second focus is set on peripartum heart failure, especially peripartum cardiomyopathy (PPCM) which is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. We present clinical and basic science data on the current state of knowledge of normal pregnancy, pre-eclampsia and PPCM and bring them into context thereby highlighting promising novel diagnostic tools and therapeutic approaches. Full article

6 pages, 409 KB

Open AccessEditorial

The Infamous Coronary Stent Saga

by Bernhard Meier

Cardiovasc. Med. 2014, 17(9), 239; https://doi.org/10.4414/cvm.2014.00274 (registering DOI) - 24 Sep 2014

Viewed by 13

Abstract

Against all odds, as a foreign body in a coronary artery was considered too thrombogenic, coronary artery stents have become a standard feature of percutaneous coronary intervention (PCI). After initial reluctance to employ coronary stents based on misinterpretation of thrombosis rates when stents [...] Read more.

Against all odds, as a foreign body in a coronary artery was considered too thrombogenic, coronary artery stents have become a standard feature of percutaneous coronary intervention (PCI). After initial reluctance to employ coronary stents based on misinterpretation of thrombosis rates when stents were exclusively used for bail-out procedures, stent overuse took over quickly. Balloon angioplasty results indicated that only 25% of lesions can possibly benefit from a stent. A stent implanted in the remaining 75% of lesions is without any chance to help but carries some risk to harm. However, the risk of harm has become so small with ever improving stents that default stenting has become acceptable. Avid stent implanters argue that only 100% stenting assures that the 25% of lesions needing a stent indeed get a stent. Shortly after drug-eluting stents (DES) had been introduced, they were falsely accused of being dangerous on the ground of their higher propensity for stent thrombosis after the first year compared to bare metal stents (BMS). In fact, they had significantly fewer early stent thromboses during the first year irrespective of the extent of antiplatelet therapy. This advantage was admittedly progressively lost over the years. Subsequent generations of DES enhanced this early reduction of stent thrombosis but no longer showed that late catch-up phenomenon. These facts are ignored or misinterpreted to the present date by most physicians and all guidelines and textbooks. It was always preferable to implant a DES rather than a BMS when there was concern about stent thrombosis, be it because of need of early surgery or another impossibility to maintain double antiplatelet therapy. The respective advantage of current generation DES is overwhelming so that using a BMS is close to unethical. The most recent misconception, i.e., the need to have an absorbable stent, is also principally based on the myth of DES to be overly thrombogenic. The current absorbable stents disappear at best after a few years when the risk of a late stent thrombosis with a modern DES is virtually nil. Other reasons for absorbable stents, such as restitution of normal histology and vasomotion, easy accessibility of the stented segment for later bypass graft insertion, less stent malapposition to the vessel wall, and reduced need for antiplatelet therapy are either wrong or clinically trivial. Full article

4 pages, 129 KB

Open AccessCase Report

Recurrent Spontaneous Coronary Artery Dissection in a 46-Year-Old Woman

by Marco Amoruso, Tiziano Moccetti and Giovanni Pedrazzini

Cardiovasc. Med. 2014, 17(9), 1; https://doi.org/10.4414/cvm.2014.00273 (registering DOI) - 24 Sep 2014

Viewed by 11

Abstract

Spontaneous coronary artery dissection is a rather rare cause of chest pain. Recurrent spontaneous dissection is even more uncommon and the extant literature reports very few cases. We describe the case of a 46-year-old woman, who presented two spontaneous coronary dissections in different [...] Read more.

Spontaneous coronary artery dissection is a rather rare cause of chest pain. Recurrent spontaneous dissection is even more uncommon and the extant literature reports very few cases. We describe the case of a 46-year-old woman, who presented two spontaneous coronary dissections in different coronary territories with a three-year lapse. An invasive treatment at first and a conservative one the second time were performed successfully. Epidemiology, pathogenesis, clinical features and diagnosis are also discussed. Full article

Journal Menu

Journal Browser

Cardiovasc. Med., Volume 17, Issue 9 (09 2014) – 7 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI