Panminerva medica
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Optimal management of multivessel disease (MVD) is a complex medical decision with significant prognostic implications. Despite the advent of clinical and angiographic scores to aid with treatment delineation, therapy for MVD must be individualized for each patient and his/her clinical presentation. ⋯ Several patient factors including clinical presentation, severity of coronary artery disease, presence of left ventricular dysfunction and other comorbidities, and the patient's personal preferences should guide the decision making process. In this review, we discuss the management of MVD with regards to decisions of revascularization versus GDMT alone, mode of revascularization, extent of revascularization (i.e., complete versus incomplete), the strategy of angiography- versus ischemia-guided revascularization, and MVD management in the setting of an acute coronary syndrome.
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Mitral valve regurgitation (MR) is a frequent condition usually associated with heart failure and reduced survival. Surgery remains the gold standard treatment but a significant number of patients are not optimal candidates due to age, comorbidities or poor left ventricular function. ⋯ However, mitral apparatus is a complex scenario and there are several potential targets for improving mitral regurgitation. The aim of this paper was to review the current trnascatheter technology developed to treat MR.