ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The renin angiotensin system is implicated in the development of vein graft disease after coronary artery bypass surgery. Components of this system have been shown to play important roles in determining the short-term and long-term performance of coronary artery bypass grafts. Significant differences exist in the commonly used arterial and venous grafts in angiotensin converting enzyme activity and angiotensin responses. The existence of a dual enzyme pathway in angiotensin II formation has also been demonstrated. Such findings have implications for the use of AT1-receptor antagonists over enzyme inhibitors to improve graft performance and prevent the development of coronary artery bypass graft disease.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

A new generation of surgical telemanipulation systems has helped to overcome the limitations of conventional endoscopic tools. These computer-enhanced instrumentation systems provide tremor filtering and motion scaling and allow dexterous manipulations in confined spaces through ports or trocars. Using these systems, total endoscopic coronary artery bypass grafting both on the arrested and on the beating heart has been performed successfully. Repair of mitral valves as well as atrial septal defects has also been performed remotely through 1 centimeter incisions. Despite some early procedural success, operating times are prolonged and a number of conversions have been reported. Currently, the use of telemanipulation systems is restricted to selected patients and limited to very few indications. Further refinements in telemanipulator technology as well as integration of image-based navigation systems may expand the use of computer-enhanced instrumentation systems in the near future.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

With marked improvements in stent technology as adjunct to balloon angioplasty for multivessel coronary disease, several newer trials are currently in progress reviewing the optimal revascularization strategy. This review provides background from older studies and addresses the current progress and design of these newer trials.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

This article reviews the rationale for lipid lowering in patients who have coronary heart disease, and specifically for post-bypass patients. It has been well demonstrated that after coronary artery bypass graft surgery, atherosclerosis continues to progress in the native circulation and develops at an accelerated rate in saphenous vein bypass grafts. During the last decade, numerous clinical trials based on angiographic or clinical outcomes have clearly shown the beneficial effect of lipid lowering in coronary heart disease. Three trials (CLAS, post-CABG, and CARE) have demonstrated delayed progression of atherosclerosis in SVGs and/or a reduction of cardiac deaths, nonfatal MI, and the need for revascularization after lowering LDL-cholesterol. The recommended target of LDL cholesterol level of more than 100 mg/dl can be safely reached with diet and monotherapy using one of the statin drugs (HMG-CoA reductase inhibitors). Despite this widely-circulated information, there appears to be inadequate public and professional awareness of the importance of properly managing hyperlipidemia after coronary artery bypass graft surgery.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

When operations become safer, attention inevitably shifts from mortality to morbidity. Unfortunately, morbidity is more difficult to measure than death, but it is arguably of greater interest to the patient and to those from public or private institutions that have the responsibility for balancing a health care budget. Studies that focus on morbidity are currently few, and specific risk models are being developed. It is already evident that risk factors associated with hospital death are qualitatively different from risk factors associated with prolonged hospital stay. The study of morbidity after coronary artery surgery is important to surgeons and physicians, to assess quality of care and the impact of new treatments and procedures.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Endothelial dysfunction is an early and persistent vascular abnormality in the evolution of atherothrombotic disease. Risk factors for atherosclerosis promote an inflammatory oxidative environment in the vasculature that induces pathologic changes in endothelial function, including the support of enhanced smooth muscle tone, thrombosis, and smooth muscle proliferation. This article provides an overview of the molecular basis of endothelial dysfunction and of its diagnosis and treatment.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

To an increasing degree, cardiology and endocrinology are finding a broadening interface. There is little doubt that atherosclerosis is in many ways a metabolic disorder, just as it is becoming increasingly clear that diabetes is a vascular disease. Framing such notions is evidence of diabetes as a risk equivalent for coronary disease, and clinical cardiovascular trials demonstrate the impact of altering lipid metabolism. Although the focus has been on statins and LDL, data continues to emerge for other therapies for triglycerides and HDL. These issues are discussed, as are future directions for metabolic therapeutic interventions for vascular disease.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Cardiac transplantation has emerged as a valuable therapy for various end-stage cardiac disorders. Cardiac allograft vasculopathy (CAV), an unusually accelerated and diffuse form of obliterative coronary arteriosclerosis, determines long-term function of the transplanted heart. Cardiac allograft vasculopathy is a complicated interplay between immunologic and nonimmunologic factors resulting in repetitive vascular injury and a localized sustained inflammatory response. Dyslipidemia, oxidant stress, immunosuppressive drugs, and viral infection appear to be important contributors to disease development. Endothelial dysfunction is an early feature of CAV and progresses over time after transplantation. Early identification of CAV is essential if long-term prognosis is to be improved. Annual coronary angiography is performed for diagnostic and surveillance purposes. Intravascular ultrasound is a more sensitive diagnostic tool for early disease stages and has revealed that progressive luminal narrowing in CAV is in part due to negative vascular remodeling. Because of the diffuse nature of CAV, percutaneous and surgical revascularization procedures have a limited role. Prevention of CAV progression is a primary therapeutic goal.

ISSN:0268-4705    

出版商:OVID    

年代:2000

数据来源: OVID