Archives of cardiovascular diseases
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Arch Cardiovasc Dis · Apr 2011
ReviewPatent foramen ovale and obstructive sleep apnoea: from pathophysiology to diagnosis of a potentially dangerous association.
Patent foramen ovale and obstructive sleep apnoea are frequently encountered in the general population. Owing to their prevalence, they may coexist fortuitously; however, the prevalence of patent foramen ovale seems to be higher in patients with obstructive sleep apnoea. We have reviewed the epidemiological data, pathophysiology, and the diagnostic and therapeutic options for both patent foramen ovale and obstructive sleep apnoea. We focus on the interesting pathophysiological links that could explain a potential association between both pathologies and their implications, especially on the risk of stroke.
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Arch Cardiovasc Dis · Oct 2010
ReviewPaediatric cardiac intensive care unit: current setting and organization in 2010.
Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. ⋯ An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.
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Deficient neurological disorders after heart surgery are destructive and affect vital prognosis. They concern between 3% to 9% of patients and are related mainly to embolic episodes or brain perfusion defects. The causes of these mechanisms are numerous, but surgical procedures and cardiopulmonary bypass optimization reduce their occurrence significantly.
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Arch Cardiovasc Dis · Oct 2008
ReviewSurgical or medical treatment for thrombus straddling the patent foramen ovale: impending paradoxical embolism? Report of four clinical cases and literature review.
Thrombus straddling the patent foramen ovale (TSFO) is a rare event. It occurs in the presence of pulmonary embolism and can be responsible for paradoxical embolism. The aim of this report is to guide the optimal choice of treatment for TSFO in different clinical contexts. ⋯ Medical treatment with heparin tends to be used as a second option in patients with more frequent comorbidities and strokes but the mortality rate is similar to that in the surgical group. Surgery seems to be justified in the prevention of paradoxical embolism. Thrombolysis is more frequently chosen in the higher risk group and is associated with the greatest mortality.