Journal of cardiothoracic and vascular anesthesia
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Despite considerable advances in medicine, cardiovascular disease is still rising, with ischemic heart disease being the leading cause of death and disability worldwide. Thus extensive efforts are continuing to establish effective therapeutic modalities that would improve both quality of life and survival in this patient population. Novel therapies are being investigated not only to protect the myocardium against ischemia-reperfusion injury but also to regenerate the heart. ⋯ Similar to other new technologies, early failures are not unusual and they may be followed by impressive success. Nevertheless, there has been considerable attention to safety by the clinical investigators because the adverse events of stem cell therapy have been impressively rare. In summary, although regenerative biology might not help the cardiovascular patient in the near term, it is destined to do so over the next several decades.
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Patients with pericardial disease often require interventional therapies or surgery, making it essential for anesthesiologists to understand the altered physiology of these disease states and the resultant impact on perioperative management. The broad spectrum of syndromes involving the pericardium present with varying degrees of clinical significance, from asymptomatic presentations to life-threatening emergencies. Impaired diastolic filling of the heart represents a common theme of pericardial disease, with the rate of onset of pericardial pathology largely determining the extent of this impairment and subsequent severity of presentation. This review highlights recent updates in the literature regarding the diagnostic evaluation, medical therapy, and invasive therapeutic procedures for common pericardial syndromes from the perspective of a perioperative physician.
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J. Cardiothorac. Vasc. Anesth. · Jan 2019
Review Case ReportsLate Clinical Presentation of Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement.
Prosthesis-patient mismatch (PPM) is relatively common after aortic valve replacement (AVR) and generally is associated with reduced regression of left ventricular (LV) mass. PPM after valve-in-valve transcatheter aortic valve replacement (TAVR) was reported to be 38%. PPM generally is manifested clinically by dyspnea and echocardiographically by high transvalvular gradients. In this E-Challenge, the authors will review a case of a late clinical presentation of PPM 1-year following a valve-in-valve TAVR.
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J. Cardiothorac. Vasc. Anesth. · Jan 2019
EditorialPlus Les Choses Changent Plus Elles Restent Les Mêmes.
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