Structural heart disease: one valve does not fit all

This article highlights the work that has been done to facilitate decision-making in this challenging patient population. Recent findings Patient selection is of paramount importance as TAVR remains a costly intervention. Currently, our gold standards for preprocedural patient evaluation are inadequate. Apropos, several objective tools are being developed to help clinicians evaluate frailty. Giving patients a more accurate postprocedure prognosis allows them to make informed decisions on whether this intervention is appropriate for their respective goals. Summary In order for us to fully embrace shared decision-making and cost-effectiveness, we must continue to work on our prognostic tools and have honest conversations with patients and their families to formulate individualized treatment plans. This becomes even more important when factors like economic impact of intervention are considered. In an era where cost-effective care has garnered more attention than ever before, we must do our best to make sure our interventions are in line with patient goals and offer the maximum amount of benefit, given the current cost of TAVR.
Source: Current Opinion in Supportive and Palliative Care - Category: Palliative Care Tags: CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. Beattie Source Type: research

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AbstractPurpose of ReviewAging is associated with an increased prevalence of both cancer and heart disease. The progression of aortic valve calcification to aortic stenosis may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy with mediastinal involvement. Symptomatic aortic stenosis is occasionally diagnosed in cancer patients undergoing cardiovascular evaluation; likewise, cancer is often recognized during assessment preceding aortic valve interventions. In these complex cases, physicians face difficult treatment decisions. Due to a myriad of clinical presentations of cancer a...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
AbstractOutcomes for patients with single ventricle congenital heart disease (SV-CHD) continue to improve over time. However, the prognosis for patients who develop heart failure immediately after surgery is poorly understood. We conducted a single-center, retrospective cohort study of patients with SV-CHD, who suffered postoperative heart failure. Of 1038 cardiac surgeries performed on 621 SV-CHD patients between 2004 and 2010, 125 patients met inclusion criteria, including non-septatable anatomy, stage 1 surgery, and verified low cardiac output or heart failure state per STS definition. Overall survival was 73.2% at 2 &n...
Source: Mammalian Genome - Category: Genetics & Stem Cells Source Type: research
Publication date: Available online 17 January 2019Source: Best Practice &Research Clinical Obstetrics &GynaecologyAuthor(s): Helena M. GardinerAbstractThe aim of foetal cardiac therapy is to treat an abnormality at the developmental stage so that the process of cardiac growth, which is complex and relies on the volume and direction of circulating blood as well as genetic determinants, can continue. In reality, most cardiac interventions are palliative; hence, major abnormalities are still present at birth. Nevertheless, tangible benefits following successful foetal intervention include improved haemodynamics and re...
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research
Publication date: Available online 17 January 2019Source: Best Practice &Research Clinical Obstetrics &GynaecologyAuthor(s): Helena M. GardinerAbstractThe aim of fetal cardiac therapy is to treat an abnormality at the developmental stage so that the complex process of cardiac growth, which relies on volume and direction of circulating blood as well as genetic determinants, can continue. In reality, most cardiac interventions are palliative, so that important abnormality is still present at birth, nevertheless tangible benefits following successful fetal intervention include improved haemodynamics and reduction in s...
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research
Publication date: Available online 29 September 2018Source: American Heart JournalAuthor(s): Alexander C. Egbe, William R. Miranda, Sameh M. Said, Heidi M. ConnollyAbstractBackgroundTo determine if RV volume was predictive of survival and cardiovascular adverse event (CAE) after pulmonary valve replacement (PVR).MethodsWe reviewed the MACHD (Mayo Adult Congenital Heart Disease) database for patients with tetralogy of Fallot (TOF) undergoing PVR, 2000–2015. The patients were divided into quartiles based on RV end-diastolic volume index (RVEDVI); those in the lowest quartile (Group A, n = 46) and the top quar...
Source: American Heart Journal - Category: Cardiology Source Type: research
This study developed the first procedure for the removal of epithelium from the lung airway with the full preservation of vascular epithelium, which could be applied in vivo to treat diseases of lung epithelium. Whole lung scaffolds with an intact vascular network may also allow for recellularization using patient-specific cells and bioengineering of chimeric lungs for transplantation. In addition to the clinical potential, lung scaffolds lacking an intact epithelial layer but with functional vascular and interstitial compartments may also serve as a valuable physiological model for investigating (i) lung development, (ii)...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Three-year-old Finn stands in front of the full-length mirror in his parents’ room, with his shirt off. “Mommy, look how cool!” he shouts, placing his finger along the long scar running down the middle of his chest. “That’s where I had my heart surgeries!” “That’s right, buddy,” Jenna replies, surprised because they’d never talked about his scars. “We always tell him he has a special heart. We don’t ever want him to feel different.” Finn runs off to play. It makes Jenna smile and sometimes cry to see her son so happy and full of life. Now 5 years...
Source: Thrive, Children's Hospital Boston - Category: Pediatrics Authors: Tags: Diseases & Conditions Our Patients’ Stories Christopher Baird complex congenital heart defect Heart Center hypoplastic left heart syndrome Wayne Tworetzky Source Type: news
ConclusionThe aortic perfusion score can be used to predict a composite endpoint of death or transplant and may be helpful in selecting patients that should be listed for transplant.
Source: Congenital Heart Disease - Category: Cardiology Authors: Tags: ORIGINAL ARTICLE Source Type: research
Purpose of review: Grading of aortic stenosis is essential in aortic stenosis management patients. However, despite clear thresholds provided in the guidelines, up to 30% of patients have discordant grading of aortic stenosis. The management of patients with low gradients/velocity despite tight aortic valve area is challenging. Recent findings: Recent studies demonstrated that patients with or without low flow may have a severe aortic stenosis despite a low gradient. Moreover, aortic valve replacement has been shown to improve outcome in low-gradient aortic stenosis patients with or without low flow. Finally, measurement ...
Source: Current Opinion in Cardiology - Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma Source Type: research
Balloon aortic valvotomy is usually done as a palliative procedure for those at high risk for open aortic valvotomy or aortic valve replacement. A guide wire is introduced through the femoral artery into the aorta. The stenotic aortic valve is crossed, often requiring multiple attempts and a long time. A long sheath is introduced over the guidewire and through the sheath a Mansfield balloon is introduced and positioned across the aortic valve. The balloon is manually inflated using a large syringe filled with dilute contrast. Care is taken to avoid melon seeding of the balloon into the aorta during inflation. If there is ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Angiography and Interventions Structural Heart Disease Interventions Balloon aortic valvotomy BAV guide wire Mansfield balloon melon seeding melon seeding of the balloon risk of development of aortic regurgitation trans valvar gradient Source Type: blogs
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