Hemodynamic and clinical impact of prosthesis–patient mismatch in the aortic valve position and its prevention

Chronic imbalance of the autonomic nervous system is a prevalent and potent risk factor for adverse cardiovascular events, including mortality. Although not widely recognized by clinicians, this risk factor is easily assessed by measures such as resting and peak exercise heart rate, heart rate recovery after exercise, and heart rate variability. Any factor that leads to inappropriate activation of the sympathetic nervous system can be expected to have an adverse effect on these measures and thus on patient outcomes, while any factor that augments vagal tone tends to improve outcomes. Insulin resistance, sympathomimetic medications, and negative psychosocial factors all have the potential to affect autonomic function adversely and thus cardiovascular prognosis. Congestive heart failure and hypertension also provide important lessons about the adverse effects of sympathetic predominance, as well as illustrate the benefits of β-blockers and angiotensin-converting enzyme inhibitors, 2 classes of drugs that reduce adrenergic tone. Other interventions, such as exercise, improve cardiovascular outcomes partially by increasing vagal activity and attenuating sympathetic hyperactivity.

Autonomic tone as a cardiovascular risk factor: The dangers of chronic fight or flight. Editorial

NHS Blood and Transplant, Imperial College Healthcare NHS Trust, London, University College Hospitals NHS Trust, London, Serious Hazards of Transfusion, NHS Blood and Transplant, Manchester, Royal Hospital for Sick Children, Glasgow, NHS Blood and Transplant, St. Mary’s Hospital, Manchester/University of Manchester, Manchester, Royal Brompton Hospital, London, UK, Mater Research Institute, University of Queensland, Brisbane, Australia, Addenbrookes Hospital/NHS Blood and Transplant, Cambridge, and Oxford University Hospitals NHS Trust/NHS Blood and Transplant, Oxford, UK

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjh.14233

Guidelines on transfusion for fetuses, neonates and older children

Background: Repair of neonatal tetralogy of Fallot (TOF) has low mortality. Debate continues regarding the initial management of cyanotic or duct-dependent infants with TOF and adverse risk factors. While repair can and has been performed in these patients, it is associated with increased morbidity. Objective: We review the effectiveness of right ventricular outflow tract (RVOT) stenting in the symptomatic young infant with TOF. Methods: Clinical, echocardiographic, angiographic and haemodynamic data were reviewed for nine patients who underwent 11 RVOT stenting procedures from October 1994 to August 2007. Results: The pulmonary valve was deemed unsalvageable in all patients (median valve diameter 3.7 mm (range 2.7–4.2), Z-score −6.7 (range −9.7 to −5.4). RVOT stenting improved arterial oxygen saturation from a median of 73% (60–85%) to 94% (90–98%) (p = 0.008). Median Z-score for the left pulmonary artery increased from −4.9 (−7.8 to −2.4) before stent implantation to −1.5 (−4.2 to −0.2) (p = 0.02) before surgical repair. Median Z-score for the right pulmonary artery increased from −3.7 (−6.8 to −1.9) to −0.8 (−2.5 to 0.1) (p = 0.008). Median Nakata index increased from 56 mm 2 /m 2 (21–77) to 150 mm 2 /m 2 (123–231) (p = 0.008). There were no procedural complications. Six patients have undergone successful repair. There were no deaths. Conclusions: In the symptomatic young infant with TOF, stenting of the RVOT provides a safe and effective management strategy, improving arterial oxygen saturation and encouraging pulmonary artery growth.

https://heart.bmj.com/content/heartjnl/95/2/142.full.pdf

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Papers

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흉선종의 술후 예후판정요인의 분석

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개심술시 체외순환이 혈소판에 미치는 영향