Degenerative Aortic Valve Disease Its Mechanism On Progression Its Effect On The Left Ventricle And The Postoperative Results
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Degenerative Aortic Valve Disease, its Mechanism on Progression, its Effect on the Left Ventricle and the Postoperative Results by Wilhelm Peter Mistiaen Pdf
"Degenerative aortic valve disease is the most prominent cardiac valve disease in Western societies. This volume describes some of the more important issues and problems for this condition: its progressive character and the underlying mechanisms of this progression diagnostic difficulties 1) ascertainment of valvular origin of symptoms in elderly; 2) the challenge of the low output – low gradient syndrome; 3) moderate aortic valve calcification during CABG; 4) prediction of the rate of progression (who will need surgery on short term and who not). the burden on the left ventricle and its consequences (danger of postponement of surgery) the effect and the modalities (access, types of valves) of surgical treatment on survival (and QoL) the mode of registering postoperative complications determining predictors for valve related, non-valve related cardiac and non-cardiac postoperative complications. The e-book is a unique presentation, specific to degenerative aortic valve disease and its treatment including information about ways to deal with the progressive character of the disease (autophagy as a mode of cell death). Cardiologists still avoid or delay referring patients to the surgeon for the sake of age, left ventricular function or co-morbidity. Therefore, the e-book benefits readers by addressing the above issue and providing critical information for changing referral policy, which would ultimately enhance postoperative survival of patients suffering from heart valve disease."
Implications of myocardial dysfunction before and after aortic valve intervention by Henrik Hultkvist Pdf
BACKGROUND Postoperative heart failure in the setting of aortic valve surgery results in poor long-term survival. We hypothesized that there could be a myocardial factor that is not addressed by risk scores currently available. We speculated that this myocardial factor could be diastolic dysfunction. By evaluating postoperative heart failure, the EuroSCORE, the NT-proBNP level, and diastolic function, we might achieve a deeper understanding of the outcome for individuals with postoperative heart failure. METHODS This research project was built upon four cohort studies. The first two studies (I and II) were retrospective in nature, and studies III and IV were prospective, observational, and longitudinal. All work was based on data from clinical and national databases. In Study I, we compared the outcome of patients with or without postoperative heart failure, evaluated according to the preoperative risk score. In Study II, we explored the effect of underlying heart disease on the preoperative level of NT-proBNP and the relationships between NT-proBNP and severe postoperative heart failure and short-term mortality. In Study III, we described the dynamics of NT-proBNP, from a preoperative evaluation to a six-month follow-up, in patients that underwent one of two different procedures: a surgical aortic valve replacement and a transcatheter implantation. We related both pre- and postprocedural NT-proBNP levels to one-year mortality. In Study IV, we evaluated diastolic function in patients that underwent surgical aortic valve replacement and its influence on outcome. We also evaluated NT-proBNP levels and postoperative heart failure as predictors of long-term mortality. RESULTS Study I This study included 397 patients that underwent isolated surgical aortic valve replacements. Of these, 45 patients (11%) were treated for postoperative heart failure. With an average follow-up of 8.1 years (range 5.2-11.2), among patients at low risk (EuroSCORE≤7), the crude five-year survival rates were 58% in patients with postoperative heart failure and 89% in those without postoperative heart failure (p<0.001). Among patients with postoperative heart failure, those classified as low risk had the same poor long-term prognosis as those classified as high risk (EuroSCORE>7). In the high risk group, survival rates were similar between patients with or without postoperative heart failure (57% vs. 64%; p=0.60). Study II This study included a cohort of 2978 patients with coronary artery disease, aortic stenosis, and mitral regurgitation. Preoperative NTproBNP levels were found to be 1.7-fold higher in patients with aortic stenosis than in patients with coronary artery disease and 1.4-fold higher in patients with mitral regurgitation than in patients with coronary disease. The power of preoperative NT-proBNP for predicting severe postoperative heart conditions was good among patients with coronary heart disease and patients with mitral regurgitation, but not as good among patients with aortic stenosis. NT-proBNP also showed good discriminating power for short-term mortality among patients with coronary artery disease. Moreover, NT-proBNP was found to be an independent predictor for both severe postoperative heart failure and short-term mortality in patients with coronary artery disease. Study III This study included 462 patients that underwent preoperative evaluations for aortic valve disease. Aortic valve interventions elicited a rise in NT-proBNP that was more pronounced in patients undergoing surgical aortic valve replacement compared to patients undergoing transcatheter valve implantation. No deterioration in NT-proBNP was observed during the waiting time before the intervention, despite a median duration of four months. At six months after the intervention, NT-proBNP levels had decreased to or below the preoperative levels in all groups. Among patients that received surgical aortic valve replacements, pre-and early postoperative NT-proBNP levels showed good discriminatory power for oneyear mortality. This discriminatory power was not observed among patients that had undergone a transcatheter procedure; those patients had higher levels of both pre- and postoperative NT-proBNP compared to patients that had undergone surgery. Study IV We evaluated 273 patients that underwent aortic valve surgery. High left ventricular filling pressure was present in 22% (n=54) of patients at the time of surgery. At six months after surgery, diastolic function deteriorated in 24/193 (12%) patients and improved in 27/54 (50%) patients. Diastolic dysfunction was not found to be associated with long-term mortality. However, both postoperative heart failure and preoperative NTproBNP levels were associated with increases in long-term mortality. In a multivariable Cox analysis, NT-proBNP remained predictive of long-term mortality. CONCLUSION Postoperative heart failure contributed to long-term mortality, even in patients considered to be at low risk preoperatively. Our results suggested that pressure overload, followed by a volume overload led to a NTproBNP response that was more pronounced than the ischemia response. Elevated levels of NT-proBNP were associated with both short- and long-term mortality. In these studies, we could not corroborate the notion that high left ventricular filling pressure was associated with long-term mortality.
Drug-induced Valvular Heart Disease by Steven Droogmans Pdf
The notion that drugs can induce valvular heart disease (VHD) has occurred since the sixties and has received a lot of attention in recent years. Overstimulation of the serotonin 2B receptor (5-HT2B) leads to valvular fibroblast proliferation and thickening of the valvular leaflets with reduced mobility and regurgitation as a consequence. This new book focuses on different aspects of this distinct kind of valvulopathy including pathophysiology of drug-induced VHD, histopathological and echocardiographic characteristics, drugs associated with VHD, the influence of cumulative drug dose and risk factors and others.
This is the first textbook to focus on Aortopathy, a new clinical concept for a form of vasculopathy. The first section of the book starts from discussing general concept and history of Aortopathy, and then deals with its pathophysiology, manifestation, intrinsic factor, clinical implication, management and prevention. The second part closely looks at various disorders of the Aortopathy such as bicuspid aortic valve and coarctation of aorta. The book editors have published a lot of works on the topic and have been collecting relating data in the field of congenital heart disease for the past 20 years, thus present the book with confidence. The topic - an association of aortic pathophysiological abnormality, aortic dilation and aorto-left ventricular interaction - is getting more and more attention among cardiovascular physicians. This is the first book to refer for cardiologists, pediatric cardiologists, surgeons, ACHD specialists, etc. to acquire thorough knowledge on Aortopathy.
Due to population aging, calcific aortic valve disease (CAVD) has become the most common heart valve disease in Western countries. No therapies exist to slow this disease progression, and surgical valve replacement is the only effective treatment. Calcific Aortic Valve Disease covers the contemporary understanding of basic valve biology and the mechanisms of CAVD, provides novel insights into the genetics, proteomics, and metabolomics of CAVD, depicts new strategies in heart valve tissue engineering and regenerative medicine, and explores current treatment approaches. As we are on the verge of understanding the mechanisms of CAVD, we hope that this book will enable readers to comprehend our current knowledge and focus on the possibility of preventing disease progression in the future.
As the most common cardiac valve disease, aortic stenosis is frequently encountered by healthcare providers in clinical practice. It may be suspected from a cardiac murmur found at a routine clinical exam, signs on ECG, heart failure, or an episode of syncope or arrhythmia. Echocardiography as well as other imaging tools provide information about the degree of severity of the stenosis. Nevertheless, careful judgement of potential symptoms is crucial. When it comes to treatment, a catheter-based approach has emerged as the preferred option in many cases, even though open-chest surgery is still standard treatment. Regardless of treatment modality, a multidisciplinary team is needed to provide optimal management of patients with aortic stenosis. This book provides all the necessary information on aortic stenosis, including etiology, diagnosis, treatment, and follow-up.
Acute Rheumatic Fever and Rheumatic Heart Disease by Dr. Scott Dougherty,Jonathan Carapetis,Liesl Zuhlke,Nigel Wilson Pdf
Acute Rheumatic Fever and Rheumatic Heart Disease is a concise, yet comprehensive, clinical resource highlighting must-know information on rheumatic heart disease and acute rheumatic fever from a global perspective. Covering the major issues dominating the field, this practical resource presents sufficient detail for a deep and thorough understanding of the latest treatment options, potential complications, and disease management strategies to improve patient outcomes. Divided into four distinct sections for ease of navigation: Acute Rheumatic Fever, Rheumatic Heart Disease, Population-Based Strategies for Disease Control, and Acute and Emergency Presentations. International editors and chapter authors ensure a truly global perspective. Covers all clinical aspects, including epidemiology, pathophysiology, clinical features, diagnosis, management, and treatment. Includes key topics on population-based measures for disease control for effective primary, secondary, and tertiary prevention. Consolidates today’s available information and guidance into a single, convenient resource.
Author : Michael M. Henry,Jeremy N. Thompson Publisher : Elsevier Health Sciences Page : 768 pages File Size : 47,7 Mb Release : 2012-02-13 Category : Medical ISBN : 9780702051210
Clinical Surgery E-Book by Michael M. Henry,Jeremy N. Thompson Pdf
The previous edition won first Prize (Surgery category) at the BMA Awards 2005. The judges' comment: 'A comprehensive and attractively presented 4-colour textbook of surgery aimed primarily at medical students but also of use to junior doctors and surgical technicians. The book has two key features: firstly, it provides students with coverage of every aspect of surgery; secondly, it has been designed and written to be the 'surgical companion' to Kumar & Clark's Clinical Medicine. This new edition will also offer an online version to all purchasers of the book - the first surgical textbook in the UK to make an electronic version available.' A comprehensive account of surgery - students only need to buy one text Covers general issues such as wound healing and pain control in the first section. By grouping these issues into one section at the beginning, students are immediately given an overview of what makes surgery different A regional approach is adopted for the largest section - section 2 - this reflects the way in which surgeons talk about surgery to each other The third section covers surgical specialities - paediatrics, endocrinology, urology - and also includes specialities such as ophthalmology, ENT and orthopaedics. These are often omitted from competing books to save space The logical arrangement of the three sections makes the book easy to use and refer to in clinical practice The arrangement of contents is straightforward and easily understood Text boxes are used throughout to highlight and isolate important information Includes over 350 four-colour images and line drawings original to this book and greatly praised by students Also includes over 100 black and white and approximately 50 full-colour clinical photographs, X-rays and scans Designed to complement Kumar and Clark's highly successful Clinical Medicine textbook so that students can have 'matching' texts in these complementary areas Written by an expert team of contributors Your purchase of this book entitles you to online access to the text at no extra charge. This innovative web site offers you... Access to the complete text and illustrations of this book. Integration links to bonus content in other Elsevier online titles. Content clipping for your handheld. An interactive community center with a wealth of additional resources. The more Elsevier titles you buy, the more resources you can access online! New edition of a prize-winning textbook. Completely revised throughout to reflect recent changes in surgical practice. New chapter on bariatric surgery for the treatment of morbidly obese patients. Covers the increasing use of minimally invasive surgical techniques, including robotic surgery. Emphasises the increasing impact of multimodality therapy, in particular for the treatment of cancer. Covers improvements in imaging technology and impact on surgical decision making.
Dilated Cardiomyopathy by Gianfranco Sinagra,Marco Merlo,Bruno Pinamonti Pdf
This open access book presents a comprehensive overview of dilated cardiomyopathy, providing readers with practical guidelines for its clinical management. The first part of the book analyzes in detail the disease’s pathophysiology, its diagnostic work up as well as the prognostic stratification, and illustrates the role of genetics and gene-environment interaction. The second part presents current and future treatment options, highlighting the importance of long-term and individualized treatments and follow-up. Furthermore, it discusses open issues, such as the apparent healing phenomenon, the early prognosis of arrhythmic events or the use of genetic testing in clinical practice. Offering a multidisciplinary approach for optimizing the clinical management of DCM, this book is an invaluable aid not only for the clinical cardiologists, but for all physicians involved in the care of this challenging disease.
The Practice of Clinical Echocardiography by Catherine M. Otto Pdf
Dr. Otto's best-selling text not only explains how to qualitatively and quantitatively interpret echocardiographic images and Doppler flow data, but also outlines how this information affects your clinical decision making. This edition features new chapters on tissue doppler, intracardiac echocardiography, hand-held echocardiography, and echocardiography in inherited connective tissue disorders. A companion DVD offers case-based multiple-choice questions to help you assess your understanding. Whether you are attempting to choose a course of therapy, ascertain the optimal timing for intervention, arrive at a prognosis, or determine the possible need for periodic diagnostic evaluation, this is an essential resource you'll consult time and time again. Delivers clear and concise coverage of the basics of image acquisition that explains the how and why of echocardiography. Reflects the latest technology and standards of practice. Provides a clinically based approach to echocardiography, with an in-depth discussion of the main cardiac events seen in practice, including adult congenital heart disease. Devotes extensive detail to training, education, and quality assurance-making it the most comprehensive text on echocardiography. Includes a practical outline called The Echo Exam at the end of each chapter that presents necessary calculations, diagnoses, and examples along with guidance on how to interpret outcomes. Includes a bonus DVD containing 3 cases and 5 multiple-choice questions for each chapter that test your knowledge of the material. Perfect resource for Residents preparing for the boards. Offers an expanded section on echocardiography techniques that explains the latest applications for all types of practices. Discusses new echocardiography modalities, including contrast and 3-D echocardiography, so you can utilize the most promising new approaches for your patients. Includes new chapters on tissue doppler, intracardiac echocardiography, hand-held echocardiography, and echocardiography in inherited connective tissue disorders. Uses new, full-color line drawings and new color Doppler images to help you easily visualize cardiac problems.
Since the publication of the second edition of this volume, 3D echocardiography has penetrated the clinical arena and become an indispensable tool for patient care. The previous edition, which was highly commended at the British Medical Book Awards, has been updated with recent publications and improved images. This third edition has added important new topics such as 3D Printing, Surgical and Transcatheter Management, Artificial Valves, and Infective Endocarditis. The book begins by describing the principles of 3D echocardiography, then proceeds to discuss its application to the imaging of • Left and Right Ventricle, Stress Echocardiography • Left Atrium, Hypertrophic Cardiomyopathy • Mitral Regurgitation with Surgical and Nonsurgical Procedures • Mitral Stenosis and Percutaneous Mitral Valvuloplasty • Aortic Stenosis with TAVI / TAVR • Aortic and Tricuspid Regurgitation • Adult Congenital Heart Disease, Aorta • Speckle Tracking, Cardiac Masses, Atrial Fibrillation KEY FEATURES In-depth clinical experiences of the use of 3D/2D echo by world experts Latest findings to demonstrate clinical values of 3D over 2D echo One-click view of 263 innovative videos and 352 high-resolution 3D/2D color images in a supplemental eBook.
