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1.
Hernández-Antolín RA García E Sandoval S Almería C Cuadrado A Serrano J de Obeso E Del Valle R Bañuelos C Alfonso F Guerrero F Heredia J Benítez JC García-Rubira JC Rodríguez E Macaya C 《Revista espa?ola de cardiología》2011,64(1):35-42
Introduction and objectives
Transfemoral implantation of an Edwards SAPIEN (ES) or Medtronic CoreValve (MCV) aortic valve prosthesis is an alternative to surgical replacement for patients with severe aortic stenosis and a high surgical risk. The study's aim was to compare results obtained with these two devices.Methods
Prospective observational study of transfemoral prosthesis implantation performed at our center.Results
Of the 76 patients (age 83 ± 6 years, 63% female, logistic EuroSCORE 18 ± 9) included, 50 were assigned the ES and 26 the MCV device. There was no difference between the groups in age, sex, functional class, valve area, associated conditions, or EuroSCORE. Implantation was successful in 84% of the ES group and 100% of the MCV group (P = .04). There were three cases of tamponade, two aortic dissections and one valve malposition in the ES group. The two groups had similar vascular access complication rates (26% vs. 23%; P = NS), but pacemaker need was greater with the MCV (10% vs. 39%; P = .003). Mortality rates at 30 days were 12% and 20% (P = NS) in the ES and MCV groups, respectively, and at 1 year, 24% and 20% (P = NS), respectively. After a follow-up of 367 ± 266 days in the ES group and 172 ± 159 days in the MCV group, three patients died. Clinical improvement was maintained in other patients and no echocardiographic changes were observed.Conclusions
In-hospital mortality, the complication rate and medium-term outcomes were similar with the two devices. The only difference observed was a higher implantation success rate with the MCV, although at the expense of a greater frequency of atrioventricular block.Full English text available from: www.revespcardiol.org 相似文献2.
Forteza A Centeno J Bellot R López Gude MJ Pérez de la Sota E Sánchez V Rufilanchas JJ Cortina J 《Revista espa?ola de cardiología》2011,64(6):470-475
Introduction and objectives
Several aortic valve sparing techniques have been described for the treatment of aortic root aneurysms. We report our experience using the reimplantation technique in 120 patients.Methods
Between March 2004 and October 2010, 120 patients with aortic root aneurysms underwent David operations. Of these, 51 were diagnosed with Marfan syndrome. Mean patient age was 31 ± 12 years. The mean diameter of the sinuses of Valsalva was 51 ± 5 mm and moderate/severe aortic regurgitation was present in 16% of these patients. In the other 69 patients mean age was 56 ± 14 years, the mean diameter of the sinuses of Valsalva was 53 ± 7 mm and moderate/severe aortic regurgitation was present in 66%. A bicuspid aortic valve was presented in 14 cases.Results
Hospital mortality was 1.7%. Mean follow-up was 37 ± 21 months; 94% of the patients survived and 96% had an aortic regurgitation below grade II during 5 years of follow-up. One patient required re-operation because of severe aortic regurgitation. No endocarditis or thromboembolic complications have been documented, and 96% of the patients did not receive any anticoagulation therapy.Conclusions
Short- and mid-term results with the reimplantation technique for aortic root aneurysms are excellent. This technique prevents the need for chronic anticoagulation treatment as well as the complications arising from mechanical prostheses, and it should be the treatment of choice for young patients.Full English text available from: www.revespcardiol.org 相似文献3.
Hernandez-Vaquero D Calvo D Garcia JM Lozano I Morales C Naya JL Moris C Llosa JC 《Revista espa?ola de cardiología》2011,64(9):774-779
Introduction and objectives
The clinical impact of patient-prosthesis mismatch on the outcome in octogenarians who undergo surgery for aortic valve replacement due to severe stenosis is unknown. Our objective was to quantify the frequency of some degree of patient-prosthesis mismatch and its impact on mortality and life quality.Methods
We analyzed all the octogenarian patients who underwent surgery for aortic valve replacement due to severe stenosis in our center from February 2004 to April 2009. Patient-prosthesis mismatch was considered to exist when the indexed effective orifice area was ≤0.85 cm2/m2. The influence of patient-prosthesis mismatch on in-hospital mortality, medium-term survival, and New York Heart Association functional class was studied using an analysis adjusted for propensity score.Results
Of 149 patients studied, 61.7% had some degree of patient-prosthesis mismatch (mean follow-up was 32.71±14.42 months). After adjusting for propensity score, there were no differences in in-hospital mortality (odds ratio=0.75; 95% confidence interval, 0.15-3.58; P=.72), medium-term survival (hazard ratio=1; 95% confidence interval, 0.36-2.78; P=.99) or functional class during follow-up (odds ratio=1.46; 95% confidence interval, 0.073-29.24; P=.8).Conclusions
Although moderate patient-prosthesis mismatch is a very common finding in octogenarian patients who undergo aortic valve replacement, its influence on mortality and quality of life does not seem to be relevant. The biological profile of elderly patients with lower metabolic requirements and limited physical activity could justify the results obtained.Full English text available from: www.revespcardiol.org 相似文献4.
Introduction and objectives
The Working Group on Cardiac Catheterization and Interventional Cardiology presents on a yearly basis a report on the data collected for the national registry. This information displays how procedures are distributed throughout Spain and makes comparisons with other countries feasible.Methods
Institutions render their data voluntarily (online) and they are analyzed by the Working Group's steering committee.Results
Data was sent by 113 hospitals (71 public and 41 private) that treat mainly adults, reporting 135 486 diagnostic procedures, 119 118 of them coronary angiograms, slightly less than the year before, and with a rate of 2945 coronary angiograms per million inhabitants. Percutaneous coronary interventions increased a bit, to 64 331 procedures and a rate of 1398 interventions per million. Of 100 371 stents implanted, 61.3% were drug-eluting stents. In the acute phase of myocardial infarction, 14 248 coronary interventions were carried out, 6% more than in 2009 and 22% of the total number of coronary interventions. The most frequent intervention for adult congenital heart disease was closure of an atrial septal defect (295 procedures). Percutaneous mitral valvuloplasty continues to decrease (326 procedures) and percutaneous aortic valve implantations are growing rapidly, with 655 units implanted in 2010.Conclusions
The greatest increase in activity has occurred in the field of myocardial infarction and percutaneous aortic valve implantation. The other procedures, both diagnostic and therapeutic, remain stable.Full English text available from:www.revespcardiol.org 相似文献5.
López-Otero D Teles R Gómez-Hospital JA Balestrini CS Romaguera R Saaibi-Solano JF Neves J Cid-Alvarez B Brito J Cequier-Fillat A Trillo-Nouche R 《Revista espa?ola de cardiología》2012,65(4):350-355
Introduction and objectives
Percutaneous aortic valve implantation for patients with severe symptomatic aortic stenosis and a high surgical risk is currently well established. We report our experience in terms of safety and effectiveness of transcatheter aortic valve implantation in other clinical context like the degenerated aortic homografts.Methods
We report our initial experience in four hospitals and five patients with degenerated aortic homograft and severe aortic regurgitation, refused for surgery for a heart team, that underwent percutaneous implantation of CoreValve® aortic prosthesis.Results
We included three males and two females. The mean age was 70 (3.5) years. All patients were symptomatic in New York Heart Association class III or IV. Procedures were performed through one of the femoral arteries in all patients and under sedation in three patients. The implant was successfully carried out in all cases. There were no major complications during the procedure or admission and the valvular defect was solved in all cases. In-hospital and 30-days mortality was 0. All patients had clinical improvement during follow-up with a reduction in at less two grades in the New York Heart Association functional scale.Conclusions
In our experience the treatment of degenerated aortic homografts and aortic insufficiency with transcatheter aortic valve implantation showed to be safe and effective. The current challenge is to convey the good results of transcatheter aortic valve implantation in symptomatic aortic stenosis and high surgical risk to others disorders of the aortic valve. In the future, it is possible that transcatheter aortic valve implantation will expand its indications to majority of aortic valve disorders and patients with less surgical risk.Full English text available from:www.revespcardiol.org 相似文献6.
León C Suárez de Lezo J Mesa D Pan M Ruiz M Delgado M Segura J Romero M 《Revista espa?ola de cardiología》2011,64(1):67-70
The study investigated echocardiographic findings after 1 month in 22 patients who received a CoreValve prostheses to treat aortic valve stenosis. Particular attention was paid to the evaluation of valvular leaks and the left ventricular wall thickness. Echocardiograms were obtained prior to implantation, at discharge and 1 month later. The patients’ mean age was 77 ± 4 years. At discharge, 16 patients (76%) had aortic regurgitation: 8 grade I and 8 grade II. At 1 month, only 13 (62%) presented with the condition: 10 grade I and 3 grade II, with 8 patients (38%) demonstrating a reduction of at least one grade (P < .005). The septal thickness decreased (from 14.2 ± 2 mm at baseline to 11 ± 2.4 mm at 1 month; P < .001), as did the posterior wall thickness (from 10.9 ± 2.4 mm at baseline to 8.3 ± 1.2 mm at 1 month; P < .001). In our patient series, the frequency and grade of residual aortic regurgitation after implantation of the CoreValve prosthesis decreased within 1 month, and favorable left ventricular remodeling was also observed.Full English text available from:www.revespcardiol.org 相似文献
7.
Introduction and objectives
The increasing incidence of abdominal aortic aneurysm (AAA), mainly due to the aging population, and its mortality of 85-90% in the event of rupture justify opting for early diagnosis and elective treatment to repair it. The main aim of this paper is to analyze the utility of transthoracic echocardiography (TTE) in the study of infrarenal aorta and AAA screening.Methods
The study included 512 patients (309 men and 203 women) consecutively assessed by TTE and, where possible, abdominal ultrasound for any reason in a cardiology department.Results
An AAA was detected in 25 patients (5.1%), the minimum age at diagnosis was 55 years, the ratio of men to women was 7.3:1 and the mean diameter of the aneurysms was 39.5 ± 12.2 mm. Risk factors associated with AAA were to current and former smoking, age, and presence of femoral murmur. The TTE results were equivalent to those of abdominal ultrasound. All patients with AAA studied by coronary angiography showed significant coronary lesions.Conclusions
It is feasible and useful to complement conventional TTE with the study of the infrarenal aorta for AAA screening in patients visited at the department of cardiology. This study should be performed mainly in patients ≥55 years old or with risk factors to develop an AAA.Full English text available from:www.revespcardiol.org 相似文献8.
Background
Aortic complications are more frequent after bicuspid aortic valve (BAV) replacement (AVR), than tricuspid aortic valve replacement. We studied the size of the proximal thoracic aorta in patients with BAV undergoing AVR for pure, severe aortic stenosis, looking for dilatation in comparison with patients with a matched tricuspid aortic valve (TAV) and normograms of aortic size.Methods
Aortic root and ascending aortic diameter measurements were taken at 3 levels, from electrocardiographic-gated multidetector row computed tomograms, in 28 patients with pure, severe aortic stenosis before AVR. The patients were divided in 2 groups (BAV, n = 10; TAV, n = 18). Patients with greater than mild aortic regurgitation or who were scheduled for aortic root replacement were excluded.Results
Although patients in the BAV group were younger (P <.0001) and less likely to have hypertension (P <.005), their aortic diameters were larger than those of patients in the TAV group at all levels measured (aortic sinus, 41.1 ± 8.1 mm vs 33.8 ± 3.3 mm; sino-tubular junction, 39.0 ± 7.8 mm vs 31.1 ± 3.8 mm; right pulmonary artery level, 42.8 ± 7.1 mm vs 33.7 ± 4.3 mm; P <.005 for all). Whereas 60% (6/10) of patients in the BAV group had ≥1 aortic diameter measurements greater than the 95th age-adjusted percentile, 0% (0/18) of patients in the TAV group did.Conclusions
Patients with BAV undergoing AVR with pure, severe aortic stenosis commonly have moderate dilatation of the thoracic aorta, whereas matched patients with a TAV do not. This finding may contribute to the increased frequency of aortic complications seen in follow up of patients with a BAV after AVR. 相似文献9.
Ruiz-Nodar JM Feliu E Sánchez-Quiñones J Valencia-Martín J García M Pineda J Martín P Mainar V Bordes P Heras S Quintanilla MA Sogorb F 《Revista espa?ola de cardiología》2011,64(11):965-971
Introduction and objectives
When fibrinolysis fails in patients with ST elevation myocardial infarction, they are referred for a rescue percutaneous coronary intervention (PCI). However, there is still no evidence of how much myocardium potentially at risk we can actually salvage after rescue PCI.Methods
Fifty consecutive patients. Cardiac magnetic resonance was performed within 6 days. Myocardial necrosis was defined by the extent of abnormal late enhancement, myocardium at risk by extent of edema, and the amount of salvaged myocardium by the difference between myocardium at risk and myocardial necrosis. Finally, myocardial salvage index (MSI) resulted from the fraction (area-at-risk minus infarct-size)/area-at-risk.Results
The mean time elapsed between pain onset and fibrinolitic agent administration was 176 ± 113 min; time lysis-rescue = PCI 209 ± 122 min; time pain onset-PCI = 390 ± 152 min. The area at risk was 37% ± 13% and infarct size 34.5% ± 13%. Salvaged myocardium was 3% ± 4% and MSI 9 ± 8. Salvaged myocardium and MSI were similar between patients with the artery open on arrival at the catheterization lab (Thrombolysis in Myocardial Infarction [TIMI] 3) and those with TIMI flow ≤2 (3.3% ± 3.6% and 8.2 ± 6.9 in TIMI 0-2 vs 3.0% ± 3.7% and 10.8 ± 10.9 in TIMI 3; P = .80 and 0.31, respectively). No significant difference was observed between patients who went through rescue PCI within a shorter time and those with longer delay times.Conclusions
The myocardial salvage after rescue PCI quantified by cardiac magnetic resonance is very small. The long delay times between pain onset and the opening of the infarct-related artery with PCI are most probably the reason for such a minimal effect of rescue PCI.Full English text available from: www.revespcardiol.org 相似文献10.
11.
Isaac Pascual Pablo Avanzas Antonio J. Muñoz-García Diego López-Otero Manuel F. Jimenez-Navarro Belén Cid-Alvarez Raquel del Valle Juan H. Alonso-Briales Raimundo Ocaranza-Sanchez Fernando Alfonso José M. Hernández Ramiro Trillo-Nouche César Morís 《Revista espa?ola de cardiología》2013
Introduction and objectives
There is little information on the use of transcatheter aortic valve implantation in patients with severe aortic stenosis and porcelain aorta. The primary aim of this study was to analyze death from any cause after CoreValve® implantation in patients with severe aortic stenosis, with and without porcelain aorta.Methods
In this multicenter, observational prospective study, carried out in 3 hospitals, percutaneous aortic valves were implanted in 449 patients with severely calcified aortic stenosis. Of these, 36 (8%) met the criteria for porcelain aorta. The primary end-point was death from any cause at 2 years.Results
Patients with porcelain aorta more frequently had extracardiac vascular disease (11 [30.6%] vs 49 [11.9%]; P=.002), prior coronary revascularization (15 [41.7%] vs 98 [23.7%]; P=.017), and dyslipidemia (26 [72.2%] vs 186 [45%]; P=.02). In these patients, there was greater use of general anesthesia (15 [41.7%] vs 111 [16.9%]; P=.058) and axillary access (9 [25%] vs 34 [8.2%]; P=.004). The success rate of the procedure (94.4 vs 97.3%; P=.28) and the incidence of complications (7 [19.4%] vs 48 [11.6%]; P=.20) were similar in both groups. There were no statistically significant differences in the primary end point at 24 months of follow-up (8 [22.2%] vs 66 [16%]; P=.33). The only predictive variable for the primary end point was the presence of complications during implantation (hazard ratio=2.6; 95% confidence interval, 1.5-4.5; P=.001).Conclusions
In patients with aortic stenosis and porcelain aorta unsuitable for surgery, percutaneous implantation of the CoreValve® self-expanding valve prosthesis is safe and feasible.Full English text available from: www.revespcardiol.org/en 相似文献12.
Robert M.A. van der Boon Nicolas M. Van Mieghem Dominic A. Theuns Rutger-Jan Nuis Sjoerd T. Nauta Patrick W. Serruys Luc Jordaens Ron T. van Domburg Peter P.T. de Jaegere 《International journal of cardiology》2013
Background/objectives
To determine pacemaker (PM) dependency at follow-up visit in patients who underwent new permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI).Methods
Single center prospective observational study including 167 patients without previous PM implantation who underwent TAVI with the self-expanding Medtronic CoreValve System (MCS) between November 2005 and February 2011. PM dependency was defined by the presence of a high degree atrioventricular block (HDAVB; second [AV2] and third degree [AV3B]), or a slow (< 30 bpm) or absent ventricular escape rhythm during follow-up PM interrogation.Results
A total of 36 patients (21.6%) received a new PM following TAVI. The indication for PM was AV2B (n = 2, 5.6%), AV3B (n = 28, 77.8%), postoperative symptomatic bradycardia (n = 3, 8.3%), brady–tachy syndrome (n = 1, 2.8%), atrial fibrilation with slow response (n = 1, 2.8%) and left bundle branch block (n = 1, 2.8%). Long term follow-up was complete for all patients and ranged from 1 to 40 months (median (IQR): 11.5 (5.0–18.0 months). Of those patients with a HDAVB, 16 out of the 30 patients (53.3%) were PM independent at follow-up visit (complete or partial resolution of the AV conduction abnormality). Overall, 20 out of the 36 patients (55.6%) who received a new PM following TAVI were PM independent at follow-up.Conclusion
Partial and even complete resolution of peri-operative AV conduction abnormalities after MCS valve implantation occurred in more than half of the patients. 相似文献13.
Baram S McCrindle BW Han RK Benson LN Freedom RM Nykanen DG 《American heart journal》2003,145(6):1063-1070
Background
The management of uncomplicated aortic valve stenosis presenting with critical obstruction in infants continues to be associated with significant morbidity and mortality. However, not all infants have critical obstruction, and outcomes spanning the broader spectrum of disease severity are less well defined.Methods
In a 12-year period, 55 infants (<3 months of age) were seen with aortic valve stenosis and with anatomy suitable for biventricular repair. Clinical, echocardiographic, angiographic, management, and outcome data were reviewed.Results
Status at presentation (median age 6 days) included signs of congestive heart failure in 20 patients, cardiovascular collapse in 5 patients, and an asymptomatic heart murmur in 30 patients. The initial echocardiogram showed reduced left ventricular function in 26% of patients, with a mean peak instantaneous gradient of 69 ± 30 mm Hg in patients with normal function. There were 5 deaths (9%), all in patients with poor ventricular function. The initial intervention was balloon valvotomy in 24 patients and surgical valvotomy in 20 patients, with 11 patients having no intervention to date. The freedom-from-intervention rate was 69% at age 1 week, 58% at 1 month, 36% at 3 months, and 28% at 1 year. Patients without cardiovascular collapse, normal left ventricular function, and gradients <60 mm Hg at presentation (n =1 9) had better survival and longer freedom from intervention than patients with poor ventricular function or gradients ≥60 mm Hg (n = 36, P = .0001).Conclusion
Most infants with aortic valve stenosis receive intervention, although this may be safely delayed in selected patients with lower initial gradients and good left ventricular function. 相似文献14.
Oliver Husser Andreas Holzamer Markus Resch Dierk H. Endemann Julio Nunez Vicente Bodi Christof Schmid Günter A.J. Riegger Holger Gössmann Okka Hamer Christian Stroszczynski Andreas Luchner Michael Hilker Christian Hengstenberg 《International journal of cardiology》2013
Background
The complex anatomy of the aortic annulus warrants the use of three dimensional (3D) modalities for prosthesis sizing in transcatheter aortic valve implantation (TAVI). Multislice computed tomography (MSCT) has been used for this purpose, but its use may be restricted because of contrast administration. 3D transesophageal echocardiography (3D-TEE) lacks this limitation and data on comparison with MSCT is scarce. We compared 3D-TEE with MSCT for prosthesis sizing in TAVI.Methods
Aortic annulus diameters in the sagittal and coronal plane and annulus areas in 3D-TEE and MSCT were compared in 57 patients undergoing TAVI. Final prosthesis size was left at the operator's discretion and the agreement with 3D-TEE and MSCT was calculated.Results
Sagittal diameters on 3D-TEE and MSCT correlated well (r = .754, p < .0001) and means were comparable (22.3 ± 2.1 vs. 22.5 ± 2.3 mm; p = 0.2; mean difference: − 0.3 mm [− 3.3–2.8]). On 3D-TEE, coronal diameter and annulus area were significantly smaller (p < .0001 for both) with moderate correlation (r = 0.454 and r = 0.592). Interobserver variability was comparable for both modalities. TAVI was successful in all patients with no severe post-procedural insufficiency. Final prosthesis size was best predicted by sagittal annulus diameters in 84% and 79% by 3D-TEE and MSCT, respectively. Agreement between both modalities was 77%.Conclusions
Annulus diameters and areas for pre-procedural TAVI assessment by 3D-TEE are significantly smaller than MSCT with exception of sagittal diameters. Using sagittal diameters, both modalities predicted well final prosthesis size and excellent procedural results were obtained. 3D-TEE can thus be a useful alternative in patients with contraindications to MSCT. 相似文献15.
Gallach M Pérez J Vergara M Olivé G Miquel M Casas M Gil M Dalmau B Sánchez J Dosal A Moreno L Alavedra E Gené E 《Gastroenterologia y hepatologia》2011,34(9):599-604
Introduction
Because of the current overload of emergency services, new units, such as day units, have had to be created. Liver cirrhosis (LC) is a chronic disease with frequent decompensations requiring medical attention. The aim of this study was to compare differences between emergency consultations in a hepatology day hospital (HDH) and in an emergency service (ES) among patients with LC.Methods and material
We performed an observational prospective study. All patients with LC attending the HDH or ES from September 2007 to August 2008 were asked to complete a questionnaire. Demographic, clinical, and radiological variables were collected.Results
There were 743 consultations, of which 62% involved the HDH. The mean age was 65 ± 12 years, and the male/female ratio was 2:3. The most frequent diagnosis in the ES was hepatic encephalopathy (26.2% ES versus 6% HDH, p < 0.001) followed by upper gastrointestinal hemorrhage (17.7% ES versus 0.6% HDH, p < 0.001), while the most frequent diagnosis in the HDH was ascites (66.2% HDH versus 22.7% ES, p < 0.001). The tests performed were as follows: blood analysis: 95% ES versus 60% HDH (p < 0.01); radiology: 71% ES versus 11% HDH (p < 0.01) and paracentesis: 51% ES versus 74% HDH (p < 0.01). The mean length of stay in the ES was 21.3 ± 121.5 hours compared with 3.3 ± 2.4 hours in the HDH (p < 0.001). A total of 53% of patients attended in the ES were hospitalized compared with 12% of those attended in the HDH (p < 0.05).Conclusion
Patients with LC preferentially attend the HDH, where fewer tests are performed and the length of stay is shorter. The care provided in the HDH is appropriate and efficient. 相似文献16.
The decrease in QRS amplitude after aortic valve replacement in patients with aortic valve stenosis 总被引:1,自引:1,他引:0
Satoshi Kurisu MD Ichiro Inoue MD Takuji Kawagoe MD Masaharu Ishihara MD Yuji Shimatani MD Yasuharu Nakama MD Tatsuya Maruhashi MD Eisuke Kagawa MD Kazuoki Dai MD Junichi Matsushita MD Hiroki Ikenaga MD 《Journal of electrocardiology》2009,42(5):410-413
Purpose
The purpose of this study was to evaluate the effect of aortic valve replacement on electrocardiogram (ECG) in patients with aortic valve stenosis.Methods
Serial 12-lead ECGs were obtained in 15 patients with aortic valve stenosis who underwent aortic valve replacement. Three ECG indexes for left ventricular hypertrophy were manually measured in each ECG: Sokolow-Lyon index (sum of S wave in V1 and R wave in V5), Cornell voltage index (sum of R wave in aVL and S wave in V3), and Gubner index (sum of R wave in I and S wave in III).Results
After aortic valve replacement, Sokolow-Lyon index gradually decreased during 2 years (51.1 ± 17.9 to 34.8 ± 12.5 mm, P < .01). Cornell voltage index (25.6 ± 7.0 to 15.0 ± 4.8 mm, P < .01) and Gubner index (15.8 ± 7.6 to 10.3 ± 5.5 mm, P < .01) also gradually decreased during 2 years. ST depression in V6 was found in 14 patients (93%) before aortic valve replacement. It resolved in 9 of 14 patients during 2 years.Conclusions
Electrocardiographic evidence of left ventricular hypertrophy gradually resolved after aortic valve replacement in patients with aortic valve stenosis. 相似文献17.
Forteza A Evangelista A Sánchez V Teixidó G García D Sanz P Gutiérrez L Centeno J Rodríguez-Palomares J Cortina J García-Dorado D 《Revista espa?ola de cardiología》2011,64(6):492-498
Introduction and objectives
Marfan syndrome is an inherited disease of the connective tissue. Recent trials have indicated the use of losartan (a transforming growth factor beta inhibitor) in these patients prevents aortic root enlargement. The aim of our clinical trial is to assess the efficacy and safety of losartan versus atenolol in the prevention of progressive dilation of the aorta in patients with Marfan syndrome.Methods
This is a phase III clinical trial conducted in two institutions. A total of 150 subjects diagnosed with Marfan syndrome, aged between 5 and 60 years, of both sexes, and who meet the Ghent diagnostic criteria will be included in the study, with 75 patients per treatment group. It will be a randomized, double blind trial with parallel assignment to atenolol versus losartan (50 mg per day in patients below 50 kg and 100 mg per day in patients over 50 kg). Both growth and distensibility of the aorta will be assessed with echocardiography and magnetic resonance. Follow-up will be 3 years.Conclusions
Efficacy of losartan versus atenolol in the prevention of progressive dilation of the aorta, improved aortic distensibility, and prevention of adverse events (aortic dissection or rupture, cardiovascular surgery, or death) will be assessed in this study. It will also show the possible treatment benefits at different age ranges and with relation to the initial level of aortic root dilation.Full English text available from: www.revespcardiol.org 相似文献18.
Dacal Rivas A Quintas Lorenzo P Francisco González M Cubiella Fernández J Alonso Docampo MN Fernández Seara J 《Gastroenterologia y hepatologia》2011,34(4):254-261
Introduction
Within a program to improve referrals by primary care (PC) in Ourense (Spain), we implemented practice guidelines on dyspepsia and rectal bleeding. Our aim was to evaluate the reasons for referral to endoscopy, the appropriateness of these referrals, and wait times.Material and methods
We performed a retrospective cohort study in the Ourense health area between February 2009 and January 2010. The endoscopies performed with the indications of dyspepsia and rectal bleeding requested directly from PC were compared with those referred initially to specialist care (SC). The reasons for the referral, the priority of the endoscopy, compliance with the protocol, endoscopic finding and the wait time from referral were gathered.Results
During the period analyzed, 158 upper gastrointestinal endoscopies (SC: 121; PC: 37) and 243 colonoscopies (SC: 193; PC: 50) were performed with the indications of dyspepsia and rectal bleeding. Among endoscopies, 34.5% and 77.7% were requested with high priority from PC and SC, respectively (p < 0.001). The criteria for referral were met in 86.5% of upper gastrointestinal endoscopies and in 82% of colonoscopies requested from PC. No differences were found in endoscopic findings. The median wait time from referral was lower in upper gastrointestinal endoscopy (PC: 105 ± 5.5 days, SC: 174 ± 17.8 days; p: 0.003) and colonoscopies (PC: 101 ± 11.8 days, SC: 187 ± 9.6 days; p < 0.001) referred from PC.Conclusions
The use of the program for improved referrals by PC reduces wait times. The examinations requested complied with the indications. 相似文献19.
García E Albarrán A Heredia-Mantrana J Guerrero-Pinedo F Rodríguez J Hernández-Antolín R Tascón J Macaya C 《Revista espa?ola de cardiología》2011,64(11):1052-1055
Many patients with severe aortic stenosis never undergo surgical treatment for various reasons. Apart from the standard risks, some patients face an additional problem: their carrying of a mechanical mitral valve. In these patients, transcatheter aortic valve implantation is a therapeutic option. The literature contains only few reports of this procedure being performed (usually transapically) in such patients. This paper reports the cases of 3 patients with severe aortic stenosis, all carrying a mechanical mitral valve and at high surgical risk, all of whom were implanted by transcatheter aortic valve implantation with an Edwards aortic valve prosthesis. All procedures were successful with no complications encountered.Full English text available from: www.revespcardiol.org 相似文献
20.
Trivi M Thierer J Kuschnir P Acosta A Marino J Guglielmone R Ronderos R 《Revista espa?ola de cardiología》2011,64(12):1096-1099