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It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

/pdf/acc-aha-2006-guidelines-for-the-management-of-patients-with-27qfh9fc7i.pdf

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

because observed behavior is the result of interactions between environmental factors and genes during the extended period of development. Therefore, to better understand expert and exceptional performance, we must require that the account specify the different environmental factors that could selectively promote and facilitate the achievement of such performance. In addition, recent research on expert performance and expertise (Chi, Glaser, & Farr, 1988; Ericsson & Smith, 1991a) has shown that important characteristics of experts' superior performance are acquired through experience and that the effect of practice on performance is larger than earlier believed possible. For this reason, an account of exceptional performance must specify the environmental circumstances, such as the duration and structure of activities, and necessary minimal biological attributes that lead to the acquisition of such characteristics and a corresponding level of performance. An account that explains how a majority of individuals can attain a given level of expert performance might seem inherently unable to explain the exceptional performance of only a small number of individuals. However, if such an empirical account could be empirically supported, then the extreme characteristics of experts could be viewed as having been acquired through learning and adaptation, and studies of expert performance could provide unique insights into the possibilities and limits of change in cognitive capacities and bodily functions. In this article we propose a theoretical framework that explains expert performance in terms of acquired characteristics resulting from extended deliberate practice and that limits the role of innate (inherited) characteristics to general levels of activity and emotionality. We provide empirical support from two new studies and from already published evidence on expert performance in many different domains.

/pdf/the-role-of-deliberate-practice-in-the-acquisition-of-expert-3j9768t5su.pdf

The role of deliberate practice in the acquisition of expert performance.

March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

ALAT
: alanine aminotransferase
ASAT
: aspartate aminotransferase
APAH
: associated pulmonary arterial hypertension
BAS
: balloon atrial septostomy
BMPR2
: bone morphogenetic protein receptor 2
BNP
: brain natriuretic peptide
BPA
: balloon pulmonary angioplasty
BREATHE
: Bosentan

/pdf/2015-esc-ers-guidelines-for-the-diagnosis-and-treatment-of-y26yabnnom.pdf

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovas...

Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association

Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study

Late cardiovascular complications after operative repair of coarctation of the aorta include systemic hypertension, premature coronary artery disease, aortic valve abnormalities, aortic aneurysm, and recoarctation. We report the outcome in 274 subjects ≥50 years after coarctation repair. Operative repair of simple coarctation was performed on 274 patients at the University of Minnesota Hospital between 1948 and 1976. Twenty patients (7%) died in the immediate postoperative period. Of the 254 survivors, 2 were lost to follow-up, 45 (18%) died at a mean age of 34 years, and 207 (81%) were alive ≥50 years after the original operation. Coronary artery disease and perioperative deaths at the time of a second cardiac operation accounted for 17 of the 45 late deaths. Predictors of survival were age at operation and blood pressure at the first postoperative visit. Of the 207 long-term survivors, 92 (48%) participated in a clinical cardiovascular evaluation. Thirty-two of the 92 subjects had systemic hypertension that was predicted by age at operation, blood pressure at the first postoperative visit, and paradoxic hypertension at operative repair. New cardiovascular abnormalities detected at follow-up evaluation included evidence of a previous myocardial infarction, cardiomyopathy, atrial fibrillation, moderate to severe left ventricular outflow tract obstruction, moderate aortic valve regurgitation, recoarctation, and ascending aortic dilation. Thus, long-term survival is significantly affected by age at operation, with the lowest mortality rates observed in patients who underwent surgery between 1 and 5 years of age. More than 1/3 of the survivors developed significant late cardiovascular abnormalities.

Long-term follow-up of patients after coarctation of the aorta repair.

The types of cardiac and visceral anomalies of 146 autopsied cases of polysplenia are described. One hundred and five of these cases were from the literature and the other 41 cases were specimens we personally reviewed. The anomalies found support the previous description of this condition as bilateral leftsidedness. Each lung had 2 lobes in 55% of patients, and abdominal heterotaxia was present in 56%. Cardiac anomalies occurring in at least half of the patients include bilateral superior vena cava, interruption of the inferior vena cava with azygos continuation, ventricular septal defect, ostium primum defect, and morphologic left ventricular outflow obstruction. Not all patients with polysplenia have cardiac anomalies, and in many patients the cardiac anomalies are not complex. Fifty percent of the 146 patients died by 4 months of age and 75% before 5 years of age.

Polysplenia: a review of 146 cases.

The well-recognized association of congenital cardiac disease with asplenia has been termed "bilateral right-sidedness" or dextro-isomerism, since the spleen is absent, the liver is symmetrical, and each lung has three lobes and an epiarterial bronchus. In a study of pathological material from 12 patients with congenital cardiac disease associated with multiple spleens (as contrasted to accessory spleen), we found a definite tendency for the symmetrical development of organs but with a tendency for bilateral left-sidedness or levo-isomerism. The abnormalities assumed one of three forms as follows: (1) absence of a normal right-sided structure, (2) bilateral organs, each with the structure of a left-sided organ, or (3) excessive tissue of a left-sided organ. Thus, in polysplenia we observed a tendency for (1) absence of the hepatic segment of the inferior vena cava and absence of the gallbladder, (2) two lobes in each lung with hyparterial bronchi, and (3) multiple spleens. Other noncardiac abnormalities w...

Congenital cardiac disease associated with polysplenia. A developmental complex of bilateral "left-sidedness".

Successful nonsurgical treatment of gastrointestinal bleeding and arteriovenous malformations by embolization techniques has been previously documented. 1) Compressed Ivalon sponge was found to be a suitable embolic material in animals and in four patients. 2) The material has been extensively used in surgery, and its biocompatibility has been proved. 3) Expansion of the compressed sponge to its original size after embolization makes this material extremely effective. Recanalization did not occur in animals and humans. 4) For the occlusion of larger arteries, Ivalon can be wrapped around the guidewire. Ivalon sponge absorbs blood and serum, unwraps itself allowing withdrawal of the guidewire. 5) Embolization procedures are not without risk since reflux of embolic material may occur. Therefore, these procedures have to be carried out under fluoroscopic control.

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.125.3.609

James H. Moller

Papers

Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study

Long-term follow-up of patients after coarctation of the aorta repair.

Polysplenia: a review of 146 cases.

Congenital cardiac disease associated with polysplenia. A developmental complex of bilateral "left-sidedness".

Polyvinyl alcohol (ivalon)—a new embolic material