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  • ISSN: 2333-6676
    Volume 2, Issue 1
    January-March 2014
    Editorial
    Beili Zhu*
    Transcatheter aortic valve replacement (TAVR) is a treatment for aortic stenosis in patients who are inoperable or have high risk for surgery [1,2]. Since the first in-man TAVR was performed in France in 2002, this procedure has been practiced for 10 years, and over 50,000 patients received valve implantation in more than 40 countries [2,3]. The PARTNER Trial showed the survival rate of patients after TAVR and Surgery was similar at 1 year, and TAVR resulted in a significantly lower mortality rate than standard medical therapy [4,5].
    Perspective
    Jie Liu*
    Cardiovascular disease is a leading cause of morbidity and mortality in the world. Cardiovascular imaging technique is a key for cardiovascular disease diagnosis and treatment. In coronary imaging, the cardiac CT is of high spatial and temporal resolution. Compared with other medical imaging modality, the cardiac CT has a unique advantage in coronary stenosis detection, plaque assessment and stent visualization [1]. Currently, cardiac CT has been widely applied clinically and play important role in cardiovascular disease diagnosis and treatment.
    Short Communication
    Mikhael F. El-Chami*
    Atrial Fibrillation (AF) occurs in 20%- 30% of patients after coronary artery bypass (CABG) [1,2] and in 40%-50% of patients after valve surgery and in 60% of patients after combined CABG and valve surgery [3]. AF after cardiac surgery (POAF) is associated with prolonged hospital stay and increased morbidity and mortality [4,5].
    Review Article
    Raman S. Dusaj1,2*, Monica Mukherjee1, Lena Furmark1, Richard J. Katz1, Brian G. Choi1 and Jannet F. Lewis1
    Abstract: Background: Elevation in PA pressures has been observed by 2D echo in some but not all hypertensive patients. The mechanism and hemodynamic impact of pulmonary hypertension in these patients remains unclear.
    Methods: We reviewed echoes of all patients referred with systemic hypertension between 9/2006 to 5/2009 to identify those patients with left ventricular hypertrophy, normal systolic function, and evidence of PH (i.e., systolic PA pressure (sPAP) >35 mmHg by echo). Patients with primary pulmonary disease, renal disease requiring dialysis, systolic dysfunction, valvular heart disease, and infiltrative cardiac disease were excluded from analysis. Quantitative measures of cardiac chamber size, and right and left ventricular hemodynamics were assessed in these patients (n=185) using standard methods, including calculation of diastolic PA pressure (dPAP) and mean PA pressure ([mPAP). LV remodeling was assessed with relative wall thickness (RWT), and diastolic function using mitral annular tissue Doppler (E/E).
    Results: Interestingly, sPAP correlated with left atrial area (R=0.18, p=0.03), while dPAP showed significant correlation to tissue Doppler septal E/E'(R=0.23, p<0.04). Right atrial area was associated with increases in mPAP (R=0.47, p<0.001), sPAP (R=0.19, p=0.02), and dPAP (R=0.25, p=004). In addition, mPAP was higher in patients with RWT ≥0.45 (37.37 mmHg vs 14.42, p=0.0013). Furthermore, a highly significant correlation was also observed between RWT and septal E/E' (R=0.33, p<0.0001).
    Conclusions: In patients with systemic hypertension and evidence of PH, pulmonary pressure appears to be related to LV diastolic function as evidenced by both left atrial dilation and elevated diastolic filling pressure. This may be a consequence of the abnormal LV remodeling observed. These findings support a mechanism for development of PH in systemic hypertension. Moreover, the observed relation between pulmonary pressure and right atrial enlargement suggests important anatomic repercussions in this subset of patients.
    Endale Tefera*
    Abstract: The surgical or percutaneous treatment of children with congenital or acquired heart diseases remains a challenge in most developing countries. Different charity and non-governmental organizations have provided sporadic care to children with congenital or acquired heart diseases through transfer of patients to sophisticated centers in Europe or North America. In recent decades, the model of cooperation has shifted towards sending short-term surgical and catheter missions with their equipment to treat patients in the local countries, or in some cases, establishing cardiovascular centers. This review aims to analyze the strengths of short-term cardiac surgery missions and the challenges that are associated with this strategy, particularly in the care of children with rheumatic heart disease.
    Treatment of patients with rheumatic heart disease in sub-Saharan Africa by overseas medical missions is an effective model of care for patients with rheumatic heart disease. However, there are still important challenges. Timely and proper postoperative care, issues related to anticoagulant treatment, adherence to secondary prophylaxis and need for timely re-intervention when needed, are few of the many challenges that this model does not effectively address. The collaboration has to focus on strengthening the local capacity and training system if these patients are to get the care they need at the appropriate time and accessible location. While it might be difficult for a single foreign charity to send missions and cover all-year round to contribute to a meaningful training program, this may be feasible if voluntary missions in different western countries collaborate and set a time-table for sequential visits. The volunteers need to work with the local governments in sub-Saharan Africa so that they will have input into the medical education and health care system of the nations.
    Dimitri Laurent and John G. Edwards*
    Abstract: Alcoholism is the third leading cause of preventable death in the United States. Aside from promoting cardiomyopathies, chronic alcohol consumption is associated with an increased risk of dementia, the development of liver or pancreas failure, and cancers of the oral cavity and pharynx. Although a J-shaped curve for all cause mortality has been identified for average alcohol consumption, irregular heavy drinking also carries significantly greater risks for cardiovascular disease.
    Alcohol induced cardiovascular disease has a complex multigenic etiology. There is significant variation in the initial presentation of alcoholic cardiomyopathy with diastolic dysfunction possibly being the first indication. Ethanol exposure generates toxic metabolites, primarily acetaldehyde and ROS, which activate several cell signaling systems to alter cell function across many levels. Sudden cardiac death is a known occurrence of alcoholism that may be linked to an arrhythmogenic effect of alcohol.
    Microscopic and molecular examination of diseased hearts has demonstrated abnormal alterations to various cellular components, including the mitochondria and myofibrils.
    These studies have shown not only the direct impact on myocardial contractility but also disrupted metabolism that determines the long-term survival of the myocardium.
    Significant variations in the response to chronic alcohol consumption may be related to unique genotypes that modify the metabolic response to ethanol. Future studies to further characterize the role of different genotypes will help indentify those genotypes are more susceptible to chronic alcohol consumption.
    Case Report
    Jonathan R. Sarik, Harrison Pitcher, Hitoshi Hirose*, and Nicholas C. Cavarocchi
    Abstract:
    Introduction: Antithrombin or antithrombin III is a vitamin K-independent, natural anticoagulant that is the major inhibitor of thrombin. With the binding of heparin, a conformational change in antithrombin occurs that increases the inactivation of thrombin by antithrombin by 4000-fold. Antithrombin deficiency can be hereditary or acquired; the acquired form is frequently encountered in patients requiring mechanical circulatory support.
    Cases: A retrospective chart review was performed of patients requiring mechanical circulatory support, 2 patients were identified as being antithrombin deficiency and received antithrombin replacement therapy. Patient 1 required extracorporeal membrane oxygenation (ECMO) for cardiogenic shock secondary to myocardial infarction. The ECMO oxygenator repeatedly clotted, which triggered an investigation into the failure of anticoagulation. The clots dissolved after replacement of the antithrombin III. Patient 2 required biventricular assist device placement for cardiogenic shock secondary to myocardial infarction. On day 5 both the right and left ventricle devices developed clot and the hematologic work-up diagnosed antithrombin III deficiency. After replacement of the antithrombin III the clot in the device chamber resolved.
    Conclusions: Routine monitoring of antithrombin levels in patients requiring mechanical circulatory support is advisable and cost efficient. Institutions that routinely care for patients requiring mechanical circulatory support should have protocols for triggering the monitoring of antithrombin levels as well as triggers for therapeutic intervention when patients are found to be antithrombin deficient.
    Hiromichi Suzuki1*, Hitosi Hoshi1, Tsutomu Inoue1, Tomohiro Kikuta1, Hiroshi Takane1, Tsuneo Takenaka1 and Yumi Kimura2
    Abstract:
    Background: In patients receiving dialysis therapy, cardiovascular diseases is the leading cause of death and there are a close association between mortality and blood pressure. However, there have been few reports discussing the effects of dialysis therapy on central aortic pressure (CAP).
    Aim: The purpose of the present study was to examine CAP of patients receiving peritoneal dialysis (PD) and hemodialysis (HD).
    Methods: There were 53 PD patients and 52 HD patients in this study. These two groups were comparable in age, and gender. All individuals were examined after resting in the supine position and radial artery pulse waveform was obtained by an automated tonometric system HEM-9000AI (Omeron Healthcare, Kyoto, Japan). SBP2, an index of CAP, is well correlated with CAP when measured simultaneously by a direct catheter method, as well as simultaneous measurement of pulse wave velocity (PWV). Clinical data and lab tests were collected from the electronic medical records.
    Results: Systolic (S) BPs were positively correlated with CAP in both groups. The levels of SBP (mm Hg) were similar in both groups (140 ± 23 in PD and 137 ± 21 in HD). However, the levels of CAP in patients with PD (126 ± 27) were lower than in HD patients (137 ± 25 mm Hg) (p<0.01). In contrast, there were no differences in PWV between PD and HD patients.
    Conclusion: This study supports the recent call for a prospective examination of CAP as a treatment target in future trials in dialysis patients.
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