Cardiovascular Medicine

6 pages, 480 KB

Open AccessInteresting Images

Eine Seltene Ursache der Idiopathischen Ventrikulären Extrasystolie

by Ardan M. Saguner, Shibu Mathew, Andreas Metzner, Christine Lemes, Francesco Santoro, Christian Sohns, Kentaro Hayashi, Johannes Riedl, Tilman Maurer, Christian H. Heeger, Karl-Heinz Kuck and Feifan Ouyang

Cardiovasc. Med. 2016, 19(2), 60; https://doi.org/10.4414/cvm.2016.00384 - 17 Feb 2016

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Abstract

Ein 73-jähriger Mann stellte sich aufgrund von Palpitationen (Pulsaussetzern) und unspezifischem Schwindel in unserer Ambulanz vor [...] Full article

5 pages, 262 KB

Open AccessCase Report

How to Do It? Rotational Atherectomy of In-Stent Restenosis

by Ganiga Srinivasaiah Sridhar, Chee Kok Han and Timothy Watson

Cardiovasc. Med. 2016, 19(2), 55; https://doi.org/10.4414/cvm.2016.00392 - 17 Feb 2016

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Abstract

A 69-year-old man with previous bypass surgery and multiple coronary stents presented with refractory angina. At angiography, the only suitable target was the left anterior descending artery (LAD), which had severe disease extending through an old stent into a large diagonal. Because of eccentric in-stent restenosis, it was only possible to access the diagonal after rotational atherectomy of the LAD through the previous stent. Subsequently separate angioplasty wires were passed into the LAD and diagonal. After sequential predilatation, T-stenting was performed using two drug-eluting stents, finalised with kissing inflations and proximal optimisation using noncompliant balloons. He remains symptom-free at follow-up. Full article

4 pages, 331 KB

Open AccessCase Report

Simplified, One-Stage Repair of Combined Ascending-Descending Aortic Disease

by Luca Koechlin, Oliver Reuthebuch, Martin Grapow, Friedrich Eckstein and Peter Matt

Cardiovasc. Med. 2016, 19(2), 52; https://doi.org/10.4414/cvm.2016.00385 - 17 Feb 2016

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Abstract

We present a simplified, one-stage procedure to address combined ascending- descending aortic disease. This procedure consists of a hemiarch repair in hypothermic circulatory arrest and the antegrade delivery plus fixation of a stent graft in the descending aorta. This technique, known as “modified frozen elephant trunk” repair, has recently become popular for treating acute DeBakey type 1 dissections. We demonstrate, in a patient with a covered but complicated rupture of the descending aorta combined with an ascending aneurysm, that the indication for the procedure can be expanded and has technical advantages compared with the classical twostage approach. Full article

10 pages, 266 KB

Open AccessReview

Prevention of Sudden Death in Apparently Healthy Athletes, Where Do We Stand in Switzerland?

by Bruno Capelli and François Regoli

Cardiovasc. Med. 2016, 19(2), 44; https://doi.org/10.4414/cvm.2016.00391 - 17 Feb 2016

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Abstract

Sudden cardiac death (SCD) during sport is frequently the first and the last manifestation of an unrecognised, underlying, often asymptomatic heart disease. Athletes are seen as one of the healthiest segments of the population. SCD in an athlete is always shocking and profoundly affects the communities where it occurs. As a result of the considerable media attention that often accompanies SCD in an athlete, it has been suggested that its prevalence is overestimated. However, in reality the incidence may still be higher than we think as SCD events occurring during recreational-leisure sports may be underreported. An overall incidence of 1:50 000 athletes per year is a reasonable estimate based on available retrospective cohort studies and prospective observational or cross-sectional studies with male black basketball athletes being at higher risk (1:11 000 athletes per year). Overall the health benefits of regular exercise heavily outweigh the risks of SCD in young and in older athletes, especially in those who train appropriately. This is “the paradox of sports”: physicians are faced with the challenge of providing a sensible strategy for the prevention of SCD while simultaneously reaffirming that the benefits of regular exercise far outweigh potential risks. Considering the potentially increased, albeit small, risk of cardiac events and SCD during physical activity (PA), it is prudent to establish practical and pragmatic algorithms for the cardiovascular evaluation of young and of middle-aged / senior individuals before engaging in regular PA. However, there is disagreement on how to implement an effective pre-participation screening strategy of SCD prevention in athletes, which is, at the same time, cost-effective. At present there is a broad range of screening recommendations, which vary from country to country. In this brief review, we summarise the current state of knowledge in this area with respect to epidemiology, mechanisms, approaches to risk stratification based on existing scientific evidence and on expert documents. Screening for SCD prevention in athletes by cardiology/sport physicians in Switzerland will then be discussed. Full article

6 pages, 202 KB

Open AccessReview

Extracorporeal Membrane Oxygenation for Acute Cardiogenic Shock

by Markus J. Wilhelm

Cardiovasc. Med. 2016, 19(2), 39; https://doi.org/10.4414/cvm.2016.00393 - 17 Feb 2016

Cited by 2 | Viewed by 9

Abstract

Veno-arterial extracorporeal membrane oxygenation (ECMO) is utilised as a short-term mechanical circulatory assist device for treatment of refractory acute cardiogenic shock. After a period of support, called “bridge to decision”, the options for ensuing therapy include weaning from ECMO, switch to a long-term ventricular assist device, or heart transplantation, depending on the occurrence of myocardial recovery and the presence of comorbidities. The femoral vessels are the standard access for implantation. The subclavian artery or central cannulation are the alternatives in peripheral artery disease. Early survival rates amount to approximately 40%. Patients who survived the early period have a good long-term survival. The poor outcome of ECMO therapy results from the high frequency of complications, including vascular, bleeding, neurological, infectious and renal adverse events, as well as from the particular circumstances of cardiogenic shock. The condition triggers a cascade of systemic inflammation, which is aggravated depending on the duration of the hypotensive period. The extent of the subsequent multiorgan dysfunction syndrome substantially affects outcome. As a consequence, early ECMO implantation is advocated. In unclear neurological conditions and severely compromised end-organ function, the anticipated poor outcome has to be weighed very carefully against ethical and economical aspects before ECMO is initiated. Full article

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Cardiovasc. Med., Volume 19, Issue 2 (02 2016) – 5 articles

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