Current cardiology reports
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Overweight or obese adults have demonstrated a survival advantage compared with leaner adults in several population-based samples. This counterintuitive association has been termed the obesity paradox. Evidence for an obesity paradox among persons with diabetes has been less consistent. ⋯ The majority of these studies reported that mortality was lowest in overweight and obese persons, and that leaner adults had the highest relative total and cardiovascular mortality. Some of these studies observed the patterns most strongly in older (age > 65 years) adults. To date, little research has been conducted to identify mechanisms that could explain elevated mortality in leaner adults with diabetes, or to identify strategies for diabetes management or mitigation of elevated mortality risk.
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Obesity and diabetes are chronic diseases frequently linked together. Durable weight loss is uncommon with medical/behavioral approaches. For severe obesity, bariatric surgery is the only treatment resulting in sustained weight loss. ⋯ Bariatric surgery reduces the incidence of diabetes in overweight insulin-resistant subjects and is associated with remission of diabetes in a large proportion of patients. In considering the usefulness of bariatric surgery, it is also important to recognize that long-term follow-up is required before assigning a beneficial therapeutic effect in patients with diabetes because of the potential for weight regain that has been observed. As diabetes is a lifelong disease, it is important to emphasize that a certain percentage of patients will suffer from relapse of their diabetes.
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Most secundum atrial septal defects (ASD) are amenable to device closure. Three- dimensional transesophageal echocardiography (3DTEE) can be used to obtain an en face view of the ASD and important surrounding structures which provides for analysis of the type, size, shape, orientation, number and position of orifices, ASD rims and important surrounding structures in a single live 3D echo view. ⋯ The respective 3D TEE modalities, imaging protocols, advantages and limitations will be discussed. Because it is useful, accurate and fairly simple to use, we have adopted 3D TEE for routine clinical use during ASD device closure.