International journal of cardiology
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A severely dysfunctioning congenitally bicuspid aortic valve may require surgical treatment within the fourth decade of life. Among conventional options, the pulmonary autograft (PA) offers many theoretical advantages particularly for young patients, including potential for growth, hemodynamic performance, no need for anticoagulants and freedom from endocarditis. However the operation is more complex and longer, may interfere with coronary and right ventricular anatomy and function and may expose the patient to the downside of two valves at risk. ⋯ In conclusion, PA root implantation can be offered as a low-risk alternative to conventional prosthetic aortic valve replacement to adolescents and young adults with a bicuspid aortic valve. The routine achievement of blood loss containment has minimized the risk of transfusion thus contributing to expand the indication in young patients. Continued patients evaluation particularly with regard to evidence of neo-aortic valve degeneration, root dilatation and homograft dysfunction in the long term is warranted.
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Letter Case Reports
Pseudoaneurysm of the descending aorta caused by Candida albicans.
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We report two cases of ventricular fibrillation during noncardiac surgery. Although an emergency coronary angiogram showed no significant coronary stenosis, coronary artery spasm was induced by the intracoronary injection of acetylcholine. It is possible that ventricular fibrillation is caused by coronary artery spasm during noncardiac surgery in patients without overt coronary artery disease.
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Comparative Study
Regression of ventricular repolarisation inhomogeneity after aortic bileaflet valve replacement in patients with aortic stenosis.
Aortic valve replacement relieves mechanical outflow obstruction in patients with aortic stenosis. However, there is limited information on whether aortic valve replacement can provide regression of ventricular repolarisation inhomogeneity. ⋯ Our study demonstrated a favorable consequence of aortic valve replacement distinct from hemodynamic improvement. Patients with aortic stenosis before valve replacement have abnormal prolonged QT or QTc intervals and increased QT or QTc dispersions. After successful valve replacement left ventricular mass index regressed and QT or QTc intervals and QT or QTc dispersions were normalized. These findings warrant further investigation in a large trial and long-term follow-up for clinical implications.
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Intra-aortic balloon counterpulsation (IABP) related complications in a heterogeneous group of patients who received an IABP before or after thrombolytic therapy and mechanical revascularization or in the management of refractory unstable angina and myocardial infarction related mechanical complications were evaluated prospectively. Ninety-one patients were enrolled to the study. Mean IABP duration was 4.3+/-2.4 days. ⋯ A chi-squared analysis showed that nadroparine use was more often complicated with emboli (P = 0.00005) and ischemic events (emboli and/or lower extremity ischemia) (three patients; 30% of nadroparine group vs. four patients; 4.9% of heparin group, P = 0.005) and hypercholesterolemia (>200 mg/dl) was more often complicated with lower extremity ischemia (P = 0.017). Forward conditional logistic regression analysis did not show any relation between the risk factors identified and emboli, lower extremity ischemia, ischemic events and groin hematoma (P>0.05), but an inverse relation was found between IABP duration and total complications (P = 0.0198). In conclusion, IABP related complications were found to remain unchanged but were not life-threatening and were inversely related to IABP duration and this suggests shorter periods of IABP use whenever possible and one must be cautious to use low molecular weight heparin in patients with an IABP in place.