2,708 research outputs found
Indications for treatment in adults with tricuspid valve dysfunction due to a congential cardiac anomaly
No full textThe tricuspid valve is frequently affected in adults with congenital heart disease (CHD). Disease of this valve can occur primarily or develop secondary to changes in the right ventricle caused by other defects. Quantitative echocardiographic assessment of tricuspid regurgitation is essential to assess its cause and prognosis. Treatment options vary depending on the underlying defect and right ventricular function. Surgical management of tricuspid valve disease is complex and evolving
Impact of percutaneous patent foramen ovale closure on migraine course
No full textMigraine is a neurological disorder characterized by an increased individual susceptibility to respond to certain triggers by a propagating wave of neuronal depolarization that culminates in typical migraine headaches. Patients with a patent foramen ovale or any kind of right-to-left shunt are more likely to have migraine; and patients with migraine with aura are more likely to have a patent foramen ovale than patients without migraine. Nonrandomized reports of patent foramen ovale closure in divers, in patients with paradoxical embolism and in migraine patients with ischemic brain lesions have shown an impressive reduction in migraine headaches during follow-up. To date, the only double-blind, randomized controlled trial with a sham procedure in the control arm failed to show any benefit, probably owing to inadequate patient selection and maybe because of a high residual shunt rate. Two other randomized trials continue to enroll patients with migraine with aura and drug-refractory headaches and their results are awaited
Transition bei angeborenen Herzfehlern in der Schweiz
No full textDie Chance, mit einem angeborenen Herzfehler erwachsen zu werden, liegt mittlerweile bei über 90 %. Trotz aller Erfolge der Medizin können Herzfehler auch nach erfolgreicher Korrektur nicht als geheilt betrachtet werden. Langzeitkomplikationen im Sinn von Herzrhythmusstörungen, Herzinsuffizienz, embolischen Ereignissen, Endokarditis, oder Reoperationen aufgrund residualer Befunde oder Klappendegenerationen sind häufig. Aus diesem Grund wird für eine Vielzahl angeborener Herzfehler eine lebenslange spezialisierte Betreuung empfohlen. Jugendliche mit Herzfehlern müssen darauf vorbereitet werden, im Erwachsenenalter Eigenverantwortung zu übernehmen. Dazu ist eine strukturierte Transition ein entscheidender Vorteil. Dadurch werden einerseits Jugendliche selbst auf ihre Erwachsenenrolle vorbereitet und andererseits kann ein adäquater Transfer der Betreuung vom Kinder- zum Erwachsenenmediziner gewährleistet werden. Jugendliche ohne Transfer und ohne spezialisierte Betreuung im Erwachsenenalter haben ein erhöhtes Risiko, kardiovaskuläre Komplikationen zu erleiden. Es wurde gezeigt, dass die Mortalität bei angeborenen Herzfehlern bei Erwachsenen mit spezialisierter Betreuung geringer ist als bei Patienten ohne entsprechende Betreuung. Am Beispiel des Zentrums für angeborene Herzfehler in Bern wird aufgezeigt, wie eine pflegegeleitete Transitionssprechstunde aufgebaut und erfolgreich umgesetzt werden kann.The chance of growing up to adulthood with a congenital heart defect is currently more than 90 %. However, in spite of all medical advances in the past, heart defects cannot be considered to be cured, even after successful repair. Long-term complications such as cardiac arrhythmias, heart failure, embolic events, endocarditis, or reoperation for residual findings or valve degeneration are frequent. For this reason, life-long specialized care is recommended for a variety of congenital heart defects, and adolescents with heart defects should be timely prepared to take on personal responsibility for their health. Thus, a structured transition is of crucial benefit. With a structured transition process, adolescents are on the one hand prepared for their adult role, and on the other, the appropriate transfer of care from the pediatric to the adult physicians can be guaranteed. Adolescents who are not transfered and do not have specialist care in adulthood are at a higher risk of suffering from cardiovascular complications in later life. It has been shown that mortality in adults with congenital heart defects with specialized care is lower than in patients who do not have the appropriate care. Using the example of the Center for Congenital Heart Defects in Bern, it is demonstrated how a nurse-led transition clinic can be established and successfully implemented
Pulmonal-arterielle Hypertonie - neue Medikamente reduzieren die Mortalität
No full textDie Behandlung der pulmonal-arterielle Hypertonie (PAH) umfasst
unspezifische Massnahmen (Basistherapie) und spezifische Medikamente
(selektive pulmonale Vasodilatatoren). Eine ausgebaute Basistherapie, u.a. orale Antikoagulation, Rhythmuskontrolle, Rehabilitationsmassnahmen und psychosoziale Unterstützung bei depressiver Symptomatik, ist essenziell. Spezifische Vasodilatatoren reduzieren Morbidität und Mortalität der PAH. Aktuell stehen verschiedene Substanzen zu Verfügung, die einen der drei PAH-Signalwege beeinflussen: Endothelin-, NO- oder Prostazyklin- Kaskade. Substanzen, die den gleichen Signalweg beeinflussen (z.B. Riociguat und Sildenafil oder Macitentan und Bosentan), dürfen nicht miteinander kombiniert werden
Approaching atrial septal defects in pulmonary hypertension
No full textAtrial septal defects (ASDs) are one of the most frequent congenital cardiac malformations, accounting for about 8-10% of all congenital heart defects. The prevalence of pulmonary arterial hypertension (PAH) in adults with an ASD is 8-10%. Different clinical PAH scenarios can be encountered. At one end of the spectrum are adults with no or only mild pulmonary vascular disease and a large shunt. These are patients who can safely undergo shunt closure. In the elderly, mild residual pulmonary hypertension after shunt closure is the rule. At the other end of the spectrum are adults with severe, irreversible pulmonary vascular disease, shunt reversal and chronic cyanosis, that is, Eisenmenger syndrome. These are patients who need to be managed medically. The challenge is to properly classify ASD patients with PAH falling in between the two ends of the spectrum as the ones with advanced, but reversible pulmonary vascular disease amenable to repair, versus the ones with progressive pulmonary vascular disease not responding to shunt closure. There are concerns that adults with progressive pulmonary vascular disease have worse outcomes after shunt closure than patients not undergoing shunt closure. Due to the correlation of pulmonary vascular changes and pulmonary hemodynamics, cardiac catheterization is used in the decision-making process. It is important to consider the hemodynamic data in the context of the clinical picture, the defect anatomy and further noninvasive tests when evaluating the option of shunt closure in these patients
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