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.

Images in cardio-thoracic surgery Endocarditis of the mitral valve with left ventricular atrial fistula

The aim of the study in this issue of the Journal by Amado et al. of the Cardiology Department of Faro Hospital was to compare their experience of patient referrals for cardiac surgery between January 1, 2008 and September 30, 2014, divided into two groups: those referred between January 1, 2008 and August 1, 2011 (43 months; 557 patients) and those referred between August 1, 2011 and September 30, 2014 (37 months; 307 patients). The division into two time periods was prompted by changes to referral protocols issued by the Regional Health Authorities. Although it is not specifically stated in the article, it appears that patients were preferentially referred to a particular hospital in Lisbon during the first period and to a different one during the second period. For reasons that are not explained, the number of patients referred in each period is not proportional to the length of the period, but this may be due to a broadening of the referral network in the more recent period. The demographic and clinical characteristics of the two patient groups were similar but the mean waiting time increased from 10.6±18.5 days in the first period to 55.7±79.9 days in the second, which led to a significant difference in morbidity, as reflected in hospitalizations (0.4% and 9.1%, respectively) and mortality (0% and 2.3%) while

The economics and costs of patient referral protocols for cardiac surgery.

The authors report the case of a 53-year-old man, with a long-standing history of mild mitral stenosis, admitted for worsening fatigue. Transthoracic echocardiography (limited by poor image quality) showed mitral annular calcification, leaflets that were difficult to visualize and an estimated mitral valve area of 1.8 cm(2) by the pressure half-time method. However, elevated mean transmitral and right ventricle/right atrium gradients were identified (39 and 117 mmHg, respectively). This puzzling discrepancy in the echocardiographic findings prompted investigation by transesophageal echocardiography, which revealed an echogenic structure adjacent to the mitral annulus, causing severe obstruction (effective orifice area 0.7 cm(2)). The suspicion of supravalvular mitral ring was confirmed during surgery. Following ring resection and mitral valve replacement there was significant improvement in the patient's clinical condition and normalization of the left atrium/left ventricle gradient. Supravalvular mitral ring is an unusual cause of congenital mitral stenosis, characterized by an abnormal ridge of connective tissue on the atrial side of the mitral valve, which often obstructs mitral valve inflow. Few cases have been reported, most of them in children with concomitant congenital abnormalities. Diagnosis of a supravalvular mitral ring is challenging, since it is very difficult to visualize in most diagnostic tests. It was the combination of clinical and various echocardiographic findings that led us to suspect this very rare condition, enabling appropriate treatment, with excellent long-term results.

When what appears to be mitral stenosis is not: diagnostic and therapeutic implications.

In this issue of the Journal, Park and colleagues from Grand Rapids, Michigan, describe a case of extremely early structural failure of a self-expanding transcatheter aortic valve secondary to leaflet dehiscence. The original implantation was followed by a postdeployment balloon dilatation for residual moderate paravalvular insufficiency. Immediately after the procedure, the valve appeared to be in good condition; 10 months later, however, there was severe aortic regurgitation requiring surgery, during which the prosthesis was shown to have a left cusp avulsion. In their conclusion, Park and colleagues state that ‘‘this case should bring to light the potential complications of balloon dilatation on the integrity of transcatheter valve leaflets. Long-term follow up may eventually reveal the effect of balloon valvuloplasty nuances with respect to size, type, and methods on valve durability.’’ I assume that the failure of the prosthesis may have been due to off-label manipulation by the balloon. The conclusion of Park and colleagues thus may be appropriate, and this would be a good reason for no further comments; however that assumption may not be certain. But before I get along with this invited commentary, I wish to make a declaration of conflict of interest. With regard to the percutaneous valves, I am still in a ‘‘wait and see’’ mood. Nonetheless, when my mother required treatment for aortic valve stenosis some 5 years ago, I took her to the best transcatheter aortic valve implantation specialist in my country. But then, she was 90 years old!

Manuel J. Antunes

Papers

Images in cardio-thoracic surgery Endocarditis of the mitral valve with left ventricular atrial fistula

The economics and costs of patient referral protocols for cardiac surgery.

When what appears to be mitral stenosis is not: diagnostic and therapeutic implications.

Commentary: Extremely early failure of transcatheter aortic valves-Another warning!

Commentary: Mitral valvuloplasty rings: Do they make the difference?