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Current Treatment Options in Cardiovascular Medicine

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https://www.readbyqxmd.com/read/28197939/prenatal-counseling-of-fetal-congenital-heart-disease
#1
REVIEW
Caroline K Lee
The field of fetal cardiology has advanced greatly over the last two decades and congenital heart defects can now be identified in utero with a high level of accuracy. Prenatal counseling of parents given the news of a fetal cardiac defect is an important role of the fetal cardiologist. Prenatal counseling is a complex task that requires skill to perform and interpret fetal echocardiograms, an understanding of fetal and postnatal cardiovascular physiology, knowledge of therapeutic and surgical options, and of long-term outcomes including quality of life...
January 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28155117/update-on-the-management-of-adults-with-arterial-switch-procedure-for-transposition-of-the-great-arteries
#2
REVIEW
Lucy M Safi, Ami B Bhatt
The arterial switch operation (ASO) is now the most frequently performed surgical correction in individuals with dextro-transposition of the great arteries (D-TGA). Patients who undergo this procedure as neonates have overall good clinical outcomes yet continued clinical follow-up is important to evaluate for postoperative complications. In this group, the highest mortality is in the immediate postoperative period and is generally associated with reimplantation of the coronary arteries. As these patients live into adulthood, longitudinal follow-up for other ASO complications including neo-pulmonary stenosis, right ventricular outflow tract (RVOT) obstruction, or neo-aortic root dilation and resulting aortic insufficiency should be performed...
January 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28150064/role-of-imaging-in-evaluating-infiltrative-heart-disease
#3
REVIEW
Sanjay Divakaran, Avinainder Singh, Bradley Collins, Tomas Vita, Rodney H Falk, Marcelo F Di Carli, Ron Blankstein
Infiltrative heart disease is caused by the deposition of abnormal substances in the heart and can lead to abnormalities in cardiac function and electrical conduction. Advances in non-invasive cardiovascular imaging have allowed for improved diagnosis of infiltrative heart disease, as well as ways to track disease progression or regression, thus enabling a mechanism to follow response to therapy. In this review, we provide an overview of the role of imaging in the diagnosis and management of cardiac sarcoidosis (CS) and cardiac amyloidosis (CA), as well as outline a proposed algorithm for using non-invasive cardiovascular imaging for evaluating these conditions...
January 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28144782/update-on-the-role-of-cardiac-magnetic-resonance-imaging-in-congenital-heart-disease
#4
REVIEW
Prabhakar Rajiah, Animesh Tandon, Gerald F Greil, Suhny Abbara
Cardiac magnetic resonance imaging (CMR) is an important imaging modality in the evaluation of congenital heart diseases (CHD). CMR has several strengths including good spatial and temporal resolutions, wide field-of-view, and multi-planar imaging capabilities. CMR provides significant advantages for imaging in CHD through its ability to measure function, flow and vessel sizes, create three-dimensional reconstructions, and perform tissue characterization, all in a single imaging study. Thus, CMR is the most comprehensive imaging modality available today for the evaluation of CHD...
January 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28105600/approach-to-cto-intervention-overview-of-techniques
#5
REVIEW
Aris Karatasakis, Barbara Anna Danek, Dimitri Karmpaliotis, Khaldoon Alaswad, Minh Vo, Mauro Carlino, Mitul P Patel, Stéphane Rinfret, Emmanouil S Brilakis
Successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has been associated with significant clinical benefits, but remains technically demanding. Failure to cross the CTO with a guidewire is the most common cause of CTO PCI failure. CTO crossing can be achieved in the antegrade or retrograde direction and can be accomplished by maintaining true lumen position throughout or via subintimal dissection/reentry techniques. A procedural plan should be created prior to the procedure through careful angiographic review of four key parameters: (a) morphology of the proximal occlusion cap; (b) length of the occlusion; (c) quality of the distal vessel and presence of bifurcation at the distal cap; and (d) suitability of collateral circulation for retrograde crossing...
January 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27844411/fetal-situs-isomerism-heterotaxy-syndrome-diagnostic-evaluation-and-implication-for-postnatal-management
#6
REVIEW
Karl Degenhardt, Jack Rychik
A hallmark of vertebrate anatomy is asymmetry of structures, especially internal organs, on the left and right side of the body. Heterotaxy syndrome is the combination of correct-sided, and incorrect-sided organs. The establishment of the left-right axis is an early event in vertebrate embryogenesis. Failure to establish this axis has numerous consequences for later development and can result in a wide range of potential defects. Congenital heart disease is among the more frequent and serious problems. Heterotaxy syndrome is diagnosed prenatally with increasing frequency due to improved screening practices...
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27826911/imaging-high-risk-atherosclerotic-plaques-with-pet
#7
REVIEW
Shawnbir Gogia, Yannick Kaiser, Ahmed Tawakol
Atherosclerotic disease, a primary cause of stroke and myocardial infarction, is the most common underlying cause of death worldwide. While atherosclerosis was formerly considered to be a relatively inert structural abnormality, decades of research have since shown that it is a biologically active process, driven by active inflammation. In concert with this conceptual shift, newer strategies to image vascular lesions have evolved. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging has been validated as a non-invasive tool to characterize atherosclerotic inflammation...
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27807794/low-testosterone-in-men-with-cardiovascular-disease-or-risk-factors-to-treat-or-not-to-treat
#8
REVIEW
Dimitri C Cassimatis, Matthew T Crim, Nanette K Wenger
Current evidence supports the use of testosterone replacement in men with the clinical-biochemical syndrome of hypogonadism, defined as low testosterone serum levels and symptoms such as fatigue, exercise intolerance, erectile dysfunction, low libido, or depression. Although the evidence consistently shows that hypogonadism is associated with elevated cardiovascular risk, evidence is mixed regarding whether testosterone (T) replacement provides cardiovascular (CV) benefit or harm. For a man with symptomatic hypogonadism in the setting of CV disease, clinical heart failure, and/or traditional CV risk factors (hypertension, diabetes, and hyperlipidemia), a balanced approach would be to counsel him that overall, the evidence should not dissuade him from utilizing T replacement for non-cardiac symptom relief but that more data are needed before a definitive recommendation can be made about T replacement for CV benefit...
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27783337/the-new-frontier-of-cardiac-computed-tomography-angiography-fractional-flow-reserve-and-stress-myocardial-perfusion
#9
REVIEW
Gianluca Pontone, Giuseppe Muscogiuri, Daniele Andreini, Andrea I Guaricci, Marco Guglielmo, Saima Mushtaq, Andrea Baggiano, Edoardo Conte, Virginia Beltrama, Andrea Annoni, Alberto Formenti, Elisabetta Mancini, Mark G Rabbat, Mauro Pepi
The increased number of patients with coronary artery disease (CAD) in developed countries is of great clinical relevance and involves a large burden of the healthcare system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore the ideal test would provide the correct diagnosis and actionable information. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography (ICA), but their diagnostic yield remains low with limited accuracy when compared to obstructive CAD at the time of ICA or invasive fractional flow reserve (FFR)...
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27778259/how-do-we-treat-complex-calcified-coronary-artery-disease
#10
REVIEW
Paul N Fiorilli, Saif Anwaruddin
Despite significant advances in treatment of coronary artery disease and improvements in interventional devices and techniques, the subset of obstructive calcified coronary artery disease remains challenging to treat. Percutaneous treatment of these lesions results in increased rates of procedural complications, as well as a higher risk of stent underexpansion and malapposition. This is associated with higher rates of restenosis, target lesion revascularization (TLR), and major adverse cardiac events (MACE)...
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27778258/radiation-exposures-associated-with-radial-and-femoral-coronary-interventions
#11
Konstantinos V Voudris, Martha Habibi, Panagiotis Karyofillis, Mladen I Vidovich
The volume of cardiac diagnostic procedures involving the use of ionizing radiation has increased rapidly in recent years, and the radiation exposure experienced by patients undergoing any medical imaging procedure has recently obtained a growing attention. Transradial (TR) access is being increasingly used worldwide for diagnostic coronary angiography (CA), and percutaneous coronary interventions, since it offers several benefits as compared to transfemoral (TF) access, such as by reducing hemostasis time and vascular complications, increased patient comfort, reduced hospital stay, and lower cost...
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27771856/conditioning-the-heart-thirty-years-of-research-and-still-far-from-humans
#12
Raúl J Domenech, Pilar Macho, Victor Parra
No abstract text is available yet for this article.
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27761871/the-crucial-role-of-cardiac-imaging-in-transcatheter-aortic-valve-replacement-tavr-pre-and-post-procedural-assessment
#13
Saif Al-Najafi, Frank Sanchez, Stamatios Lerakis
Transcatheter valve interventions have emerged as one of the most important developments in structural heart disease over the past 20 years. Initially, these interventions were directed at patients with severe aortic stenosis and high surgical risk; however, their applications have extended to involve other native valves' pathologies, degenerated prosthetic valves, as well as patients of lower surgical risk. In this article, we discuss the importance of cardiac imaging in transcatheter aortic valve replacement (TAVR) by exploring the current practices, guidelines, and recommendations with the supporting data...
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27747477/omega-3-fatty-acids-and-cardiovascular-disease-are-there-benefits
#14
REVIEW
Kate J Bowen, William S Harris, Penny M Kris-Etherton
Early secondary prevention trials of fish and omega-3 polyunsaturated fatty acid (PUFA) capsules reported beneficial effects on cardiovascular disease (CVD) outcomes, including all-cause mortality and sudden cardiac death. These clinical findings, as well as observational and experimental data, demonstrated that omega-3 PUFAs reduced the risk of coronary outcomes and overall mortality and were the basis for recommendations made in the early 2000s to increase omega-3 PUFA intake. In the last 6 years, however, results from both primary and secondary prevention trials have generally failed to show a beneficial effect of omega-3 PUFA supplementation, bringing current recommendations into question...
November 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27714654/physical-activity-endurance-exercise-and-excess-can-one-overdose
#15
REVIEW
Jonathan H Kim, Aaron L Baggish
Although moderate levels of exercise reduce cardiovascular morbidity and mortality in the general population, recent data have questioned whether higher doses of physical activity are associated with diminished health benefits and adverse outcomes. This review focuses on several issues at the center of this controversy including epidemiologic data describing mortality trends in those who engage in high levels of physical activity and recent observational data suggesting adverse cardiovascular outcomes among long-term endurance athletes...
November 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27687067/prosthesis-patient-mismatch-after-aortic-valve-replacement
#16
REVIEW
Abdellaziz Dahou, Haïfa Mahjoub, Philippe Pibarot
Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of a normally functioning prosthesis is too small in relation to the patient's body size, resulting in abnormally high postoperative gradients. PPM is frequent following aortic valve replacement (AVR), and it is associated with increased risk of morbidity and mortality proportionally to its severity. Differential diagnosis between PPM and prosthetic valve stenosis is made by comparing the measured valve effective orifice area, by assessing the changes in valve area and gradient during follow-up and by evaluating leaflet morphology and mobility...
November 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27646314/applications-of-advanced-imaging-in-cardiac-electrophysiology
#17
REVIEW
Mrinal Yadava, Michael D Shapiro
Imaging modalities such as computed tomography, magnetic resonance, positron emission tomography, and single-photon emission computed tomography are an indispensable component of cardiac arrhythmia management. Over the last two decades, developments in imaging techniques have facilitated safer and more effective cardiac ablation and device implantation procedures. Pre-procedural assessment of arrhythmogenic substrate and integration with electroanatomic data has significantly impacted the management of atrial fibrillation and ventricular tachycardia...
November 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27637492/human-ips-cell-derived-cardiac-tissue-sheets-a-platform-for-cardiac-regeneration
#18
REVIEW
Hidetoshi Masumoto, Jun K Yamashita
Stem cell therapy is a promising therapeutic option for severe cardiac diseases that are resistant to conventional therapies. To overcome the unsatisfactory results of most clinical researches on stem cell injections to an injured heart, we are developing bioengineered cardiac tissue grafts using pluripotent stem cell-derived cardiomyocytes and vascular cells. We have validated the functional benefits of mouse embryonic stem cell-derived and human induced pluripotent stem cell-derived cardiac tissue sheets (CTSs) in a rat myocardial infarction model...
November 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27620638/novel-therapies-for-familial-hypercholesterolemia
#19
REVIEW
Justin Parizo, Ashish Sarraju, Joshua W Knowles
Both HeFH and HoFH require dietary and lifestyle modification. Pharmacotherapy of adult HeFH patients is largely driven by the American Heart Association (AHA) algorithm. A high-potency statin is started initially with a goal low-density lipoprotein cholesterol (LDL-C) reduction of >50 %. The LDL-C target is adjusted to <100 or <70 mg/dL in subjects with coronary artery disease (CAD) with ezetimibe being second line. If necessary, a third adjunctive therapy, such as a PSCK9 inhibitor (not yet approved in children) or bile acid-binding resin, can be added...
November 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27620637/timing-of-surgical-intervention-for-aortic-regurgitation
#20
REVIEW
Brett Hiendlmayr, Joseph Nakda, Ossama Elsaid, Xuan Wang, Aidan Flynn
Aortic regurgitation is a frequently encountered condition, in which traditional measurements of severity have proven to be of limited value in identifying those who would be best served by aortic valve replacement. Novel methods of assessing severity are vital, particularly as an entirely new paradigm of aortic regurgitation has surfaced, with the advent of transcatheter aortic valve replacement (TAVR), and the adverse events that are being observed with varying degrees of aortic regurgitation. With that in mind, a comprehensive assessment of aortic regurgitation should now include indexed left ventricular systolic volumes and a comprehensive assessment of right ventricular function, in addition to the quantitative measures that are currently recommended...
November 2016: Current Treatment Options in Cardiovascular Medicine
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