摘要:

In 1990, echocardiography continued to develop rapidly, with new applications in the operating room and new solutions to common problems in the management of valvular heart disease. The newly published experiences with transesophageal and epicardial intraoperative echocardiography from Duke and the Cleveland Clinic illustrate the utility of these methods. Refinement of our concepts of mitral valve prolapse has occurred, along with echo Doppler support for awaiting symptoms prior to valve replacement in aortic stenosis.

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The search for the basic pathophysiologic mechanisms responsible for the development of myocardial dysfunction in valvular heart disease has been quite extensive; nonetheless, no single answer has been forthcoming. Such information is of obvious clinical importance because it ultimately may influence the timing of surgery in valvular heart disease, as well as the management of patients with pump dysfunction resulting from longstanding valvular heart disease. In this review, we discuss a number of recent articles on basic mechanisms responsible for the contractile dysfunction in hypertrophied myocardial tissue. We also review recent literature concerned with the factors responsible for regulating myocardial growth (hypertrophy) in the adult heart. Although much of the literature to be reviewed is decidedly in the domain of cellular and molecular biology, our primary intent is to interpret this experimental material in light of its clinical relevance.

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This paper will discuss the contribution of nonultrasonic methods to the diagnosis and the hemodynamic assessment of valvular heart disease as it has been discussed in the literature since the end of 1989. From recently published papers, several topics can be developed: the continuing importance of evaluating symptoms, the possible end of the epidemic of mitral valve prolapse, the persisting value of invasive assessment in case of inadequate Doppler echocardiographic examination, the need for coronary angiogram before surgery, the assessment of the left ventricular function, and the relation between fluid mechanics and new diagnostic modalities.

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Despite recent advances in operative and percutaneous surgical techniques for valvular heart disease, medical management of complications of valvular disease, such as atrial fibrillation and infection, and prevention of thromboembolism remain important clinical problems. This review discusses recent data that address the role of vasodilator therapy in valvular regurgitation, the management of severe, asymptomatic aortic stenosis, and studies pertinent to the treatment of complications of valvular heart disease. Although vasodilators are promising agents, their efficacy in delaying the need for valve replacement remains unproven.

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

After 5 years' experience with percutaneous balloon aortic valvuloplasty and more than 550 patients dilated for calcific aortic stenosis in our series, the limits of the method are well recognized, and the indications have been reviewed. To date, the two main indications are very old patients with increased surgical risks and critically ill patients in whom the procedure is most often used as a bridge to surgery. From our series of 180 octogenarians and nonagenarians with several factors increasing the predicted perioperative mortality, we showed that the technique is able to efficiently palliate the symptoms and improve survival. Valve replacement remains, however, recommended in otherwise healthy and active elderly patients. Balloon aortic valvuloplasty is also clearly useful in critically ill patients with major left ventricular dysfunction and severe heart failure, especially in patients with cardiogenic shock in whom it may be life saving. A dramatic improvement of left ventricular function is most generally obtained, allowing valve replacement to be performed later with an acceptable lowered risk. Balloon aortic valvuloplasty, a low-cost and low-risk procedure in experienced hands, requiring only local anesthesia and a short hospitalization stay, partially reduces aortic stenosis but may in many cases be the only valuable therapeutic option for patient improvement.

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The decision to perform valve surgery requires knowledge of the natural history of valvular heart disease and of the results of surgical therapy. Recent reports have shed light on these important factors. Long-term results of valvular surgery are multifactorial, and data relating to age, type of prosthetic valve, and anticoagulation are presented.

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

There has been a recent renewed interest in certain aspects of cardiopulmonary bypass employing extracorporeal circulation. Several areas have received special attention. Among these is the institution of extracorporeal circulation using a percutaneous technique for circulatory assistance during high-risk percutaneous transluminal coronary angioplasty. A national registry has been established to review and monitor results using this percutaneous technique. Several recent developments in the delivery of cardioplegia during ischemic arrest have stimulated investigative efforts. In particular, the delivery of cardioplegia in a retrograde manner through the coronary sinus has proved an effective and useful adjunct to myocardial protection during cardiopulmonary bypass with extracorporeal circulation. A newer investigative technique employing only warm cardioplegia delivered primarily through the retrograde coronary sinus route seems to offer some promise in providing optimal myocardial protection while minimizing hemorrhagic complications and other cold-induced myocardial injury. Because of concerns regarding blood transfusion-related communicable disease (eg, acquired immune deficiency syndrome and non-A, non-B hepatitis), there has been increasing research effort into postoperative hemorrhage related to cardiopulmonary bypass with extracorporeal circulation. Specifically, various drugs that may serve as hemostatic adjuncts have been investigated extensively. These drugs include aprotinin and desmopressin acetate. Likewise, several studies have evaluated other drugs (mainly aspirin) that have a negative influence on postoperative hemostasis. Additionally, there has been continued research interest in the activation of the inflammatory system during cardiopulmonary bypass. Since activation of the various inflammatory mediators seems to be related to postoperative organ system dysfunction following extracorporeal circulation, it is possible that modification of the inflammatory response may be associated with decreased organ dysfunction following cardiac procedures that employ extracorporeal circulation. This review attempts to focus on recent developments related to extracorporeal circulation, with emphasis placed not only on advances in clinical practice that may have an immediate influence on operative outcome but also on newer laboratory studies that will have an impact in the future.

ISSN:0268-4705    

出版商:OVID    

年代:1991

数据来源: OVID