Transcatheter approaches to non-valvar structural heart disease

With advancement in transcatheter technology, numerous non-congenital structural heart lesions previously untreated, or treated with surgery are now amenable to transcatheter therapy. These therapies have centered on transcatheter valve replacement, however, other lesions are increasingly treated via the percutaneous approach. These procedures include patent foramen ovale closure, left atrial appendage occlusion, closure of post-infarct ventricular septal defects, occlusion of ruptured sinus of Valsalva aneurysm and treatment of paravalvar leaks. This review will outline indications for and approach to each of these procedures in the context of the current literature base with emphasis on pre- and intra-procedural imaging modalities.     

Hospital policies and practices concerning normal childbirth in Jordan

We investigated reported policies and practices of normal delivery in Jordanian hospitals to assess whether these practices are evidence-based and whether women are given choices in delivery. Staff at a nationally representative sample of 30 hospitals were interviewed using a semistructured questionnaire. The surveyed hospitals were found to be well equipped to deal with obstetric emergencies, and many follow evidence-based procedures. The internal evaluation system, however, typically is based on team feedback, and 20 percent of hospitals reported having no internal evaluation procedure. Some unnecessary procedures, including pubic shaving and enemas, are frequently practiced. Women are restricted in their movement during labor, and the lithotomy position is usually adopted for delivery; the majority of hospitals report strapping women in the delivery position. Most hospitals do not allow social support during labor and delivery. Measures are needed to encourage the best evidence-based practices regarding normal childbirth, including better evaluation. Jordanian women need much more information about their delivery options so that they can exercise their preferences wherever possible.     

Transcatheter closure of unroofed coronary sinus using covered stents in an adult with drainage of the coronary sinus to the right ventricle after supra‐annular tricuspid valve replacement

We present a rare case of unroofed coronary sinus in a patient who underwent supra‐annular tricuspid valve replacement with consequent drainage of the coronary sinus to the right ventricle. It is unclear whether the coronary sinus was unroofed congenitally or iatrogenically. This rare setup resulted in significant cyanosis. The abnormal drainage was successfully closed via trans‐catheter delivery of covered stents with resolution of the cyanosis. © 2017 Wiley Periodicals, Inc.     

Nanomedicine in cardiovascular therapy: recent advancements

Cardiovascular disease (CVD) is comprised of a group of disorders affecting the heart and blood vessels of the human body and is one of the leading causes of death worldwide. Current therapy for CVD is limited to the treatment of already established disease, and it includes pharmacological and/or surgical procedures, such as percutaneous coronary intervention with stenting and coronary artery bypass grafting. However, lots of complications have been raised with these modalities of treatment, including systemic toxicity with medication, stent thrombosis with percutaneous coronary intervention and nonsurgical candidate patients for coronary artery bypass grafting. Nanomedicine has emerged as a potential strategy in dealing with these obstacles. Applications of nanotechnology in medicine are already underway and offer tremendous promise. This review explores the recent developments of nanotechnology in the field of CVD and gives an insight into its potential for diagnostics and therapeutics applications. The authors also explore the characteristics of the widely used biocompatible nanomaterials for this purpose and evaluate their opportunities and challenges for developing novel nanobiotechnological tools with high efficacy for biomedical applications, such as radiological imaging, vascular implants, gene therapy, myocardial infarction and targeted delivery systems.     

Double jeopardy: assessing the association between internal displacement,housing quality and chronic illness in a low-income neighborhood

Purpose  

This study analyzed associations between war-related internal displacement, housing quality and the prevalence of chronic illness in Nabaa, a low-income neighborhood on the outskirts of Beirut, Lebanon.     

用Amplatzer房间隔封堵器堵闭边缘不足的房间隔缺损效果观察

目的　探讨用Amplatzer房间隔缺损封堵器经导管堵闭部分边缘缺乏或不足(<5mm)的房间隔缺损的可行性。方法　1999年7月至2 0 0 1年9月对芝加哥大学儿童医院的2 3例边缘<5mm的房间隔缺损患儿试用Amplatzer封堵器进行堵闭,其中男10例,女13例,平均年龄10 7岁。2 0例经食管超声心动图或心内超声心动图测量的房间隔缺损前缘0～4mm ,2例下缘为2mm ,1例后缘为2mm。同期,4 8例房间隔缺损边缘>5mm的患儿作对照。结果　全部2 3例边缘<5mm的房间隔缺损患儿和4 8例对照儿均成功安装了封堵器。两组间年龄、缺损大小和所用封堵器大小差异无显著性意义(P >0 . 0 5 )。2 3例边缘<5mm的患儿中17例(73. 9% )即刻完全堵闭,对照组4 4例(91 .7% )即刻完全堵闭(P <0 .0 5 ) ;2 4h复查边缘<5mm患儿及对照组的完全堵闭率分别是91 3%和93 8% (P >0. 0 5 ) ;6个月复查两组完全堵闭率分别是95 7%和95 8% (P >0 . 0 5 )。缺损边缘<5mm患儿及对照组手术时间分别为(72 . 5±2 6 .5 )min和(6 1. 4±2 1 .9)min ;X线暴光时间分别为(12 .6±7 .0 )min和(9. 8±4 . 2 )min ,与对照组比较手术时间稍长。两组患儿术中和术后均未出现并发症。结论　前、后或下缘<5mm的房间隔缺损仍可以用Amplatzer房间隔缺损封堵器经导管堵闭,但长期手术