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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

In 24 cases of membranous subaortic stenosis, aortic valvular insufficiency was commonly associated and thickening of the aortic valves was frequent. Poststenotic dilatation was found in only 13 of the 24 patients. Other frequent lesions were ventricular septal defect, mitral insufficiency, and coarctation of the aorta. Radiographically, the membrane is best seen on the anteroposterior projections of the left ventriculogram.

Membranous Subaortic Stenosis and Its Associated Malformations

Operative mortality for 262 infants with interruption of the aortic arch repaired from 1982 to June 1993 has remained constant at about 35%. Major coexistent cardiac malformations, type B interruption, or staged repair are risk factors for mortality.

Operative mortality and frequency of coexistent anomalies in interruption of the aortic arch

Recent reports suggest that peak left ventricular systolic pressure can be estimated from the echocardiogram. This study compares the accuracy of echocardiographic measurements with clinical estimates of severity of aortic stenosis derived from information of the Joint Natural History Study. Twenty-seven children with isolated aortic valve stensosis were evaluated clinically and with echocardiography and cardiac catheterization. From the echocardiograms, the ratio of systolic left ventricular wall thickness to internal dimension ( W s D s ) showed a better correlation (r = 0.82) with peak left ventricular systolic pressure than did the diastolic ratio. However, there was significant variation so that a precise estimate of peak left ventricular systolic pressure could not be made from the echocardiogram. Eight of the 27 patients had a normal W s D s ratio (0.55 or less), and their cardiac catheterization data revealed mild aortic stenosis not requiring operation. In contrast, clinical criteria based on the Natural History Study identified only three of the patients with mild aortic stenosis. Prospective studies are needed to confirm the usefulness of echocardiography in noninvasive evaluation of children with aortic valve stenosis.

Echocardiographic screening to assess the severity of congenital aortic valve stenosis in children.

The electrocardiograms and vectorcardiograms of 29 patients with single ventricle are described and analyzed. The electrocardiographic and vectorcardiographic findings of these cases in relation to the anatomic position of the great vessels and the presence or absence of pulmonary stenosis were correlated. In the 10 cases of single ventricle with transposition of the great vessels with inversion, the electrocardiogram and vectorcardiogram exhibited an abnormal initial QRS vector in the horizontal plane directed posteriorly and to the left forming abnormal Q waves in the right precordial leads. The Q wave was absent in the left precordial leads of the scalar electrocardiogram. Right axis deviation was frequently observed. These features are commonly seen in congenital corrected transposition of the great vessels and indicate the importance of the position of the great vessels regardless of the presence of one or two ventricles. Among the 12 cases of single ventricle with transposition of the great vessels with the aorta anterior and to the right of the pulmonary artery, an abnormal direction of the initial QRS vector anteriorly and to the left was commonly observed. This was represented by absence of Q waves in the precordial electrocardiographic leads V 1 through V 6 . Left axis deviation or an axis beyond −90 ° was frequently seen. On the other hand, in cases of single ventricle and normally related great vessels the QRS axis was commonly normal or slightly to the left, and there were stereotype Rs or rS patterns across the precordial leads. Although in our series the presence of pulmonary stenosis in single ventricle had no effect on the QRS pattern, it commonly altered atrial depolarization. Cases of single ventricle and pulmonary stenosis or pulmonary hypertension showed right atrial enlargement, but cases without pulmonary stenosis and with a large left to right shunt showed left atrial enlargement. The abnormal initial QRS vector on the vectorcardiogram observed in most cases of single ventricle as well as lack of a normal transitional zone of the precordial QRS complexes on the scalar electrocardiogram are perhaps the result of an abnormal ventricular conduction pathway.

The electrocardiogram and vectorcardiogram in single ventricle: Anatomic correlations

Left ventricular haemodynamics were studied both at rest and during supine exercise in 33 children with isolated aortic valvular disease, either aortic stenosis or aortic insufficiency. In each child cardiac index and stroke index were normal at rest. Exercise response was characterized in 32 patients by an increase in cardiac index without a major increase in left ventricular end-diastolic pressure. Only one patient showed an abnormal exercise response. In each patient with aortic stenosis an increase in peak left ventricular systolic pressure occurred on exercise, while no predictable change occurred among patients with aortic insufficiency. Left ventricular end-diastolic pressure was greater in patients with more severe stenosis or with significant aortic insufficiency.

https://heart.bmj.com/content/heartjnl/35/1/93.full.pdf

James H. Moller

Papers

Membranous Subaortic Stenosis and Its Associated Malformations

Operative mortality and frequency of coexistent anomalies in interruption of the aortic arch

Echocardiographic screening to assess the severity of congenital aortic valve stenosis in children.

The electrocardiogram and vectorcardiogram in single ventricle: Anatomic correlations

Haemodynamics of exercise in children with isolated aortic valvular disease.