109 research outputs found
Percutaneous PFO closure with Amplatzer PFO occluder: predictors of residual shunts at 6 months follow-up
No full textOBJECTIVE: The objective of this study was to assess predictors of residual shunts after percutaneous patent foramen ovale (PFO) closure with Amplatzer PFO occluder (AGA Medical Corporation, Golden Valley, MN, USA). METHODS: All percutaneous PFO closures, using Amplatzer PFO occluder performed at a tertiary center between May 2002 and August 2006, were reviewed. Follow-up, including saline contrast transesophageal echocardiography, was performed in all patients 6 months after the intervention. PATIENTS: A total of 135 procedures were performed. Mean age of the patients was 51 years. The indication for PFO closure was an ischemic cerebrovascular event in 92%, paradoxical systemic embolism in 4%, and a diving accident in 4%. Recurrent events prior to PFO closure were noted in 34%. A concomitant atrial septal aneurysm was present in 61%. RESULTS: At 6 months follow-up, a residual shunt was detected in 26 patients (19%). Residual shunts were more common in patients with an atrial septal aneurysm (27 vs. 8%, P= .01) and in patients treated with a 35-mm compared with a 25-mm device (39 vs. 15%, P= .01). A concomitant atrial septal aneurysm remained independently associated with residual shunts when controlled for body mass index, gender, age, atrial dimensions, and presence of a Chiari network (odds ratio 4.1, 95% confidence intervals 1.1-15.0). CONCLUSION: The presence of atrial septal aneurysms in patients undergoing percutaneous PFO closure with an Amplatzer PFO occluder significantly increases the rate of residual shunts at 6 months follow-up, even if 35-mm devices are used
Risk stratification of adults with congenital heart disease during the COVID-19 pandemic: Insights from a multinational survey among European experts
No full textObjective Adults with congenital heart disease (ACHD) may be at a higher risk of a fatal outcome in case of COVID-19. Current risk stratification among these patients relies on personal experience and extrapolation from patients with acquired heart disease. We aimed to provide an expert view on risk stratification while awaiting results from observational studies. Methods This study was an initiative of the EPOCH (European Collaboration for Prospective Outcome Research in Congenital Heart disease). Among nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain and Switzerland), 24 experts from 23 tertiary ACHD centres participated in the survey. ACHD experts were asked to identify ACHD-specific COVID-19 risk factors from a list of potential outcome predictors and to estimate the risk of adverse COVID-19 outcomes in seven commonly seen patient scenarios. Results 82% of participants did not consider all ACHD patients at risk of COVID-19 related complications. There was a consensus on pulmonary arterial hypertension, Fontan physiology and cyanotic heart disease as risk factors for adverse outcomes. Among different ACHD scenarios, a patient with Eisenmenger syndrome was considered to be at the highest risk. There was a marked variability in risk estimation among the other potential outcome predictors and ACHD scenarios. Conclusions Pulmonary arterial hypertension, Fontan palliation and cyanotic heart disease were widely considered as risk factors for poor outcome in COVID-19. However, there was a marked disparity in risk estimation for other clinical scenarios. We are in urgent need of outcome studies in ACHD suffering from COVID-19
Marfan-Syndrom: Wissenswertes zu Diagnose und Therapie für die Praxis
No full text• Das M arfan-Syndrom ist die häufigste h ereditäre Bindegewebskrankheit
mit einer Häufigkeit (Prävalenz) von etwa 1:5000.
• Die Ursache ist eine Mutation im FBN1-Gen. Die Vererbung erfolgt autosomal-
dominant, bei etwa 30% der Fälle handelt es sich um de novo
FBN1-Mutationen.
• Die Hauptmanifestationen des Marfan-Syndroms sind: Aortendilatation,
Mitralklappenprolaps, Augenveränderungen (Linsensubluxation) und
Skelettveränderungen ( Skoliose, Thoraxasymmetrie, Platt- u nd/oder
Senkfüsse, Arachnodaktylie).
• Ziel einer frühzeitigen Diagnose ist die Verminderung des Risikos katastrophaler
Aortendissektionen. Dies wird erreicht durch eine frühzeitige
korrekte Diagnose sowie darauf basierend durch einen entsprechenden
Lebensstil zur Vermeidung von hohen Blutdruckbelastungen, eine prophylaktische
Behandlung mit Betablockern/Angiotensin-II-Antagonisten
und den frühzeitigen prothetischen Ersatz dilatierter Aortenabschnitte
Dental Medicine and Infective Endocarditis: Current guidelines for antibiotic prophylaxis and recommendations for daily clinical practice.
No full textSurgical interventions in the dental practice as well as interventions in the ear, nose and throat area, the skin, the respiratory, gastrointestinal or urogenital tract can lead to transient bacteremia. As a result, an infectious endocarditis (IE) may occur. Overall, this is a rare occurrence, but it is associated with high morbidity and mortality. Individuals with a history of IE, implanted valve prostheses and certain congenital heart defects are at the highest risk for IE. In dental medicine, there is a controversial debate as to whether bacteremia can occur already by chewing or brushing the teeth. Antibiotic prophylaxis for prevention of endocarditis should only be given to those patients who are at the highest risk for IE. This article discusses novelties and Swiss recommendations for antibiotic prophylaxis for highrisk patients for IE in the dental practice. In this context, antibiotic prophylaxis has gained importance for dentists, which is also reflected by the fact that the recommendations on the new endocarditis card are limited solely to dental interventions
Play the Map: Ablation of a Macro Reentrant Atrial Tachycardia in a Patient After Senning Repair for Transposition of the Great Arteries
No full textA 50-year-old male patient who had undergone Senning repair for transposition of the great arteries at the age of 7 years was referred to our electrophysiology lab with recurrent supraventricular tachycardias. Fast anatomical mapping of the systemic venous atrium was performed with the CARTO electroanatomical mapping system. Propagation mapping with animated dynamic maps facilitates the understanding of the underlying mechanism and provides visualization of reentrant circuits of tachycardias in cardiac chambers with native barriers and surgical scars
- …
