다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

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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,

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

https://www.zora.uzh.ch/id/eprint/150846/1/ehx391.pdf

2017 ESC/EACTS Guidelines for the management of valvular heart disease

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

https://www.medpagetoday.com/upload/2014/3/3/02536-1.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

We attempted percutaneous transcatheter-balloon mitral commissurotomy in eight children and young adults (9 to 23 years of age) with rheumatic mitral stenosis. The atrial septum was traversed by needle puncture, and an 8-mm angioplasty balloon was advanced over a guide wire. The atrial septal perforation was then dilated to allow passage of the valvuloplasty balloon catheter (18 to 25 mm) across the mitral annulus. Inflation of the transmitral balloon decreased the end-diastolic transmitral gradient temporarily in all patients (from 21.2 +/- 4.0 mm Hg [mean +/- S.D.] to 10.1 +/- 5.5 mm Hg; P less than 0.001). The immediate decrease in the gradient was associated with increases in cardiac output (from 3.8 +/- 1.0 to 4.9 +/- 1.3 liters per minute per square meter of body-surface area; P less than 0.01) and in the calculated mitral-valve-area index (from 0.73 +/- 0.29 to 1.34 +/- 0.32 cm2 per square meter; P less than 0.001). Murmur intensity diminished immediately after commissurotomy in all patients. The greatest reduction in pressure gradient (76 to 95 per cent) occurred when the largest balloon (inflated diameter, 25 mm) was used in the smallest patients (0.9 to 1.2 m2). The balloon commissurotomy produced minimal mitral regurgitation in only one child. Follow-up catheterization (at two to eight weeks) demonstrated persistence of hemodynamic improvement with evidence of partial restenosis in one patient. These early results indicate that balloon mitral commissurotomy can be a safe and effective treatment for children and young adults with rheumatic mitral stenosis.

Percutaneous catheter commissurotomy in rheumatic mitral stenosis

https://www.internationaljournalofcardiology.com/article/S0167-5273(98)00008-4/pdf

Cardiac involvement in Dengue Haemorrhagic Fever.

Cardiac myxomas: Clinical and echocardiographic profile

Thrombolytic therapy for prosthetic valve thrombosis: short- and long-term results.

We analysed coronary arteriographic profile in 125 young patients (below 40 years, mean age 373 years) with clinical evidence of ischaemic heart disease (IHD) (Group I) and compared it with 125 older patients with IHD (more than 40 years, mean age 528 years) (Group II) studied during the same period Left anterior descending coronary artery was the most frequently involved vessel in both the groups, 102/125 (816%) in Group I and 120/125 (96%) in Group II (P less than 0001) The incidence of left main coronary artery involvement was 5/125 (4%) in Group I and 15/125 (12%) in Group II (P less than 005) and coronary artery calcification was 17/125 (137%) in Group I and 72/125 (576%) in Group II (P less than 0001) Triple vessel disease was the most common form of involvement, 56/125 (448%) in Group I and 65/125 (528%) in Group II (P = NS) The incidence of diffuse disease was 35/125 (28%) in Group I vs 39/125 (312%) in Group II (P = NS), ectasia was observed in 13/125 (101%) in Group I vs 15/125 (12%) in Group II (P = NS) and coronary collaterals were found in 42/125 (336%) in Group I and 56/125 (448%) in Group II (P = NS) Thus left main and left anterior descending coronary artery disease and coronary calcification were more common in the older age group Our findings suggest that in young Indian patients with IHD, multivessel and extensive coronary artery involvement in frequently seen This pattern of involvement has many features resembling the disease pattern in their older counterparts

Vinay K. Bahl

Papers

Percutaneous catheter commissurotomy in rheumatic mitral stenosis

Cardiac involvement in Dengue Haemorrhagic Fever.

Cardiac myxomas: Clinical and echocardiographic profile

Thrombolytic therapy for prosthetic valve thrombosis: short- and long-term results.

Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study.