Clinical research in cardiology : official journal of the German Cardiac Society
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A prolongation of the corrected QT interval (QTc) in the routine ECG of otherwise healthy neonates has been suspected to be a risk factor for sudden infant death. None of the studies published so far differentiated between awake and sleeping neonates. ⋯ Changes of the corrected QT interval in neonates seems to be dependent on the lead position of ambulatory ECGs, and could be found only in one lead. Guide values for the sleeping and awake neonate are provided.
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Case Reports
Restrictive ventricular septal defect and critical subaortic stenosis in tetralogy of Fallot.
Tetralogy of Fallot is characterized by a non-restrictive malalignment ventricular septal defect (VSD), an overriding aorta and right ventricular outflow tract obstruction resulting from anterior deviation of the infundibular septum. Due to the large VSD, systolic pressures are equal in both ventricles. In rare cases, redundant tricuspid valve tissue may prolapse into the VSD resulting in restriction of the defect size and causing suprasystemic pressure in the right ventricle. Subaortic obstruction by prolapse of the redundant tricuspid tissue into the left ventricular outflow tract, although theoretically possible in this situation, has not been described yet in the literature. ⋯ In tetralogy of Fallot, accessory tricuspid valve tissue may obstruct the VSD as well as the left ventricular outflow tract resulting in a life threatening condition in newborns shortly after birth.
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Chest pain units (CPUs) have been established to optimize treatment of patients with acute coronary syndrome (ACS) and to early and accurately discharge patients with non-coronary chest pain. The aim of this analysis was to elucidate whether treatment of ACS patients in the CPU versus emergency department (ED) has prognostic implications. ⋯ These results demonstrate a better 1-year prognosis for ACS patients treated in the CPU instead of the ED, therefore, supporting the idea to establish CPUs in Europe.
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Severe symptomatic aortic stenosis in a 90-year-old man was treated with percutaneous aortic valve implantation (TAVI) with a 29-mm CoreValve Revalving system. Following implantation, severe aortic regurgitation occurred. Echocardiography showed a small paravalvular and a huge valvular leakage, probably due to one malfunctioning valve leaflet. Concerning this pathophysiology, a further TAVI was performed using a second 29-mm CoreValve Revalving system, as a "valve-in-valve" implantation.
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Review Meta Analysis
ST-segment resolution and prognosis after facilitated versus primary percutaneous coronary intervention in acute myocardial infarction: a meta-analysis.
Complete ST-segment resolution (STR) is associated with favorable prognosis in ST-elevation myocardial infarction (STEMI). The optimal reperfusion strategy in patients with STEMI presenting early after symptom-onset is still a matter of debate. So far, there are only a few studies comparing the effect of facilitated and primary percutaneous coronary intervention (PCI) on early myocardial reperfusion assessed by STR. The objective of this meta-analysis was, therefore, to evaluate the extent of early STR and subsequent prognosis in facilitated versus primary PCI. ⋯ Prehospital initiated facilitated PCI results in a higher percentage of complete STR before and after PCI when compared with primary PCI. However, this enhanced early reperfusion did not significantly improve the outcome after facilitated PCI. Therefore, the current data suggest that facilitated PCI does not offer an advantage over primary PCI. The results from ongoing clinical trials in STEMI patients presenting early (<3 h) after symptom-onset with more effective antithrombotic co-therapy will provide guidance regarding the utility of a facilitated PCI strategy.