2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation

/pdf/2016-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-z18hg30pp1.pdf

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

/pdf/2016-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-53v7yllhiz.pdf

ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 : The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC

https://anmco.it/uploads/u_cms/media/2014/12/798e9298d77b7b8c9aa0514e43fe95a2.pdf

ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.

2018 ESC/ESH Guidelines for the management of arterial hypertension.

OBJECTIVES: Due to progression of rheumatic disease, percutaneous mitral commissurotomy (PMC) is a palliative procedure. We aimed at evaluating the outcomes of patients requiring surgery for failure of PMC, focusing on the fate of the mitral valve (MV) (repair versus replacement). METHODS: From January 1993 through December 2012, 61 patients with previous PMC were submitted to MV surgery. Detailed operative findings were collected from all patients and an intraoperative anatomical score was introduced to predict reparability. Time to surgery, overall survival and freedom from reoperation were analysed. RESULTS: The mean time to surgery after PMC was 6.9 ± 5.9 years and indications were restenosis in 25 patients (41%) and mitral regurgitation or mixed lesion in 36 (59%). Nine patients (14.8%) had more than one previous intervention. Intraoperative inspection of the valve revealed leaflet laceration outside the commissural area in 27 patients (44.3%). Valve repair was accomplished in 38 patients (62.3%). Pulmonary hypertension, calcification and intraoperative anatomical score were independently associated with the probability of valve replacement (OR 1.12, OR 7.03 and OR 4.49, respectively, P< 0.05). There was no hospital mortality. MV area increased on average 1.6 cm 2 after surgery to 2.7 cm 2 ; 5-, 10- and 20-year survival rates were 98.1 ± 1.9, 91 ± 5.2 and 82.7 ± 9.2%, respectively. The rate of freedom from mitral reoperation (for repaired cases) at 5, 10 and 15 years was 100, 95.8 ± 4.1 and 87.8 ± 8.5%, respectively. There was no difference in survival between repaired or replaced MVs, but the former had less valve-related events during follow-up. CONCLUSION: The MV can be repaired after failed PMC, with very low complication rates and excellent long-term results. Hence, whenever possible, these patients should be sent to reference centres where repair can be successfully achieved.

/pdf/mitral-valve-surgery-after-percutaneous-mitral-2mospq48tl.pdf

Mitral valve surgery after percutaneous mitral commissurotomy: is repair still feasible?

This paper proposes a methodology for ECG (electrocardiograms) data compression based on R-R segmentation. An ECG can be seen as a quasi-periodic signal, where it is possible to find many similarities between heart beats. These similarities are explored by the proposed compression scheme through the use of a segment dictionary combined with an efficient form of progressive error codification. The dictionary is able to incorporate new patterns, in order to assure the algorithm adapts to changes in signal morphology. Experimental results reveal that high compression ratios are possible for highly regular signals, with irregular signals still achieving acceptable results.

An ECG compression approach based on a segment dictionary and bezier approximations

Heart sound is a valuable biosignal for early detection of a large set of cardiac diseases Ambient and physiological noise interference is one of the most usual and high probable incidents during heart sound acquisition It tends to change the prominent and crucial characteristics of heart sound which may possess important information for heart disease diagnosis In this paper, we propose a new method to detect ambient and internal body noises combined with heart sound The algorithm is based upon the periodic nature of heart sounds and physiologically inspired criteria A small segment of clean heart sound exhibiting periodicity in time as well as in the frequency domain is first detected and applied as a reference signal in sorting noise from the sound The achieved average sensitivity and specificity are 94% and 97%, respectively

Near real time noise detection during heart sound acquisition

Objectives The reported superiority of mitral valve (MV) repair for isolated MV regurgitation has not been confirmed in mitroaortic valve surgery. Our goals were to evaluate the feasibility of repair in patients undergoing mitral and aortic valve surgery and to identify factors predisposing to MV replacement, to compare long-term outcomes (survival and MV reoperation) of repair and replacement and to perform a subgroup analysis in patients with rheumatic MV disease. Methods From January 1992 through December 2016, 1122 consecutive patients were submitted to concomitant aortic and MV surgery in 2 different centres (Coimbra and Santiago). Of these, 837 patients underwent MV repair (74.6%) and 285 patients had MV replacement (25.4%). Rheumatic aetiology was predominant (666 patients; 59.4%). Cumulative follow-up was 9522.6 patient-years (25th-75th percentile 2.6-13.2 years) and was complete for 95.6% of patients. Propensity score matching (1:1) was performed in 232 patients for comparing each treatment option (MV repair and MV replacement). Results Previous MV intervention, rheumatic aetiology, chronic obstructive pulmonary disease, higher degrees of tricuspid and mitral regurgitation and pulmonary hypertension were independently correlated with MV replacement. The 30-day mortality rate was higher in patients with MV replacement (4.2% vs 1.8%, P = 0.021) and was confirmed in the propensity score matching (4.7% vs 1.7%, P = 0.06). Late survival was lower in the MV replacement group (53.3 ± 4.5% vs 61.7 ± 2.0% at 12 years; P = 0.026) and was confirmed in the propensity score matching (54.6 ± 4.9% vs 63.2 ± 3.8%, P = 0.062) and rheumatic subgroup (57.9 ± 4.8% vs 68.0 ± 2.5%, P = 0.018). Freedom from MV reoperation at 12 years was higher in the MV repair group (94.7 ± 1.1% vs 89.0 ± 3.1%, P = 0.004) but similar in patients with rheumatic MV disease. Conclusions MV repair can be performed in most patients undergoing aortic valve replacement. It should be the procedure of choice whenever feasible, because it is associated with lower early and late mortality rates and with freedom from reoperation in non-rheumatic patients.

Long-term results after concomitant mitral and aortic valve surgery: repair or replacement?

OBJECTIVES: A very high percentage of patients submitted to coronary artery bypass grafting (CABG) develop symptomatic aortic disease requiring surgery upon ageing. The surgical risk of the redo procedure is controversial. We describe our recent experience with patients submitted to this surgery under such conditions. METHODS: From July 1999 to July 2010, 51 patients (mean age, 70.3 ± 7.0 years, 86.3% male) submitted to CABG previously required aortic valve surgery (AVS). The mean interval between the surgeries was 7.1 ± 3.9 years. Twenty-one patients (41.2%) had also undergone AVS during the first surgery [12 patients (57.7%) had valve replacement and 9 patients (42.8%) had valvuloplasty]. At presentation, 51.0% were in New York Heart Association Class III/IV and the standard and logistic EuroSCOREs were 10.1 ± 2.5 and 20.9 ± 16.5%, respectively. RESULTS: Aortic valve replacement was performed in 48 patients (94.1%). Two patients had undergone a surgery for the closure of a peri-prosthetic leak and one patient a valvuloplasty. Thirteen patients (25.5%) needed to undergo additional cardiac procedures, including root enlargement (three patients, 5.9%). Valve surgery was performed with non-dissection of the internal thoracic artery graft, when patented, and antegrade cardioplegic arrest of other territories. Hospital and 30-day mortality rate was 2% (n= 1). The mean duration of hospital stay was 13.0 ± 11.1 days. The most frequent complication was arrhythmias – in 25.5% of the patients, and mostly due to atrial fibrillation (19.6%). Permanent pacemaker for A-V block was required in 5.9% of the cases, stroke was documented in two cases (3.9%) and early re-intervention was observed in two cases. CONCLUSIONS: Redo AVS performed in patients submitted to CABG previously results in mortality and morbidity rates that are much lower than what is expected, bringing clear benefits to the patients.

https://rihuc.huc.min-saude.pt/bitstream/10400.4/1568/1/Eur%20J%20Cardiot%20Surg.pdf

Manuel J. Antunes

Papers

Mitral valve surgery after percutaneous mitral commissurotomy: is repair still feasible?

An ECG compression approach based on a segment dictionary and bezier approximations

Near real time noise detection during heart sound acquisition

Long-term results after concomitant mitral and aortic valve surgery: repair or replacement?

Aortic valve surgery in patients who had undergone surgical myocardial revascularization previously.