Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches

AbstractPurpose of ReviewWith increasing use of prosthetic valves to treat degenerative valvular heart disease (VHD) in an aging population, the incidence and adverse consequences of paravalvular leaks (PVL) are better recognized. The present work aims to provide a cohesive review of the available literature in order to better guide the evaluation and management of PVL.Recent FindingsDespite gains in operator experience and design innovation, significant PVL remains a significant complication that may present with congestive heart failure and/or hemolytic anemia. To date, clear consensus or guidelines on the evaluation and management of PVL remain lacking.SummaryAlthough the evolution of transcatheter valve therapies has had a tremendous impact on the management of patients with VHD, the limitations and complications of such techniques, including PVL, present further challenges. Incidence of PVL, graded as moderate or greater, ranges from 4 to 7.4% in surgical and transcatheter valve replacements, respectively. Improved imaging modalities and the advent of novel surgical and percutaneous therapies have undoubtedly yielded a better understanding of PVL including its anatomical location, mechanism, severity, and treatment options. Echocardiography, used in conjunction with cardiac computed tomography and cardiac magnetic resonance, provides essential details for diagnosis and management of PVL. Transcatheter intervention has become a favored approach in lieu of surgical interve...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research

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RARITAN, NJ, May 13, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today results from the final analysis of the pivotal Phase 3 SPARTAN study demonstrating ERLEADA® (apalutamide) in combination with androgen deprivation therapy (ADT) significantly improved overall survival (OS), compared to ADT alone, in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) who were at high risk of developing metastases.[i] Results will be presented at the American Society of Clinical Oncology (ASCO) Virtual Scientific Program (Abstract #5516) beginning May 29th. ERLEADA® i...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
RARITAN, N.J., February 3, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today multiple data presentations from a robust solid tumor portfolio that will be featured at the American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, taking place February 13-15 in San Francisco. Company-sponsored data presentations will include clinical results for ERLEADA® (apalutamide) and niraparib in prostate cancer; and BALVERSA™ (erdafitinib) in bladder cancer. “We are committed to improving outcomes in patients with prostate and bladder cancer where high unmet ...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
This study investigated if statins would similarly reduce postoperative arrhythmias in patients undergoing THA. METHODS:: We queried a large Medicare and private-payer database from 2005 to 2012 and identified 12,075 patients who were on a statin prior to THA. We then age and sex matched 34,446 non-statin users who underwent THA. Baseline comorbidities and postoperative complications were obtained and assessed via standard descriptive statistics. RESULTS:: The statin users had more preoperative comorbidities including congestive heart failure, valvular heart disease, pulmonary and renal disease, diabetes, hyperte...
Source: Hip International - Category: Orthopaedics Authors: Tags: Hip Int Source Type: research
​BY GREGORY TAYLOR, DO, &SHERIF G. EL-ALAYLI, DOA 30-year-old G5P3 presented to the ED with bilateral lower-extremity edema and headache for three days. She presented one week after an uncomplicated full-term vaginal delivery with an unremarkable pregnancy course and no prior requirement for antihypertensive therapy. The headache was described as achy to sharp, with associated photophobia. She also noted occasional vaginal spotting, which was common a few weeks after delivery. She denied any chest pain, shortness of breath, nausea or vomiting, abdominal pain, or any other symptoms. She admitted to occasional mild cra...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
ConclusionAn explicit emulation of a target trial using electronic health records, combined with the parametric g‐formula, allowed comparison of real‐world dynamic strategies that have not been compared in randomized trials.
Source: Health Services Research - Category: Health Management Authors: Tags: Methods Article Source Type: research
Publication date: September 2016 Source:Canadian Journal of Cardiology, Volume 32, Issue 9 Author(s): Nahid A. Azad, Lisa Mielniczuk With the population aging, there is an exponential increase in the prevalence of cardiovascular disease (CVD). Congestive heart failure (CHF) is considered the “poster child” of the blend of CVD, multimorbidity, and frailty in the aging population. Traditionally, from the cardiologist's point of view, the top multimorbidities in CHF are hypertension, ischemic heart disease, hyperlipidemia, anemia, and diabetes. However, the care of these patients is confounded by common geriatric...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Publication date: Available online 8 August 2016 Source:Respiratory Investigation Author(s): Alexandru Corlateanu, Serghei Covantev, Alexander G. Mathioudakis, Victor Botnaru, Nikolaos Siafakas The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, mus...
Source: Respiratory Investigation - Category: Respiratory Medicine Source Type: research
In a previous blog post, I highlighted general principles for implementing and scaling systems to support remote monitoring of chronic conditions, namely congestive heart failure (CHF), Diabetes Mellitus (Type II Diabetes) and chronic obstructive pulmonary disease (COPD).  In this blog post I will focus on COPD as a case study for the development, implementation and scaling of a remote monitoring system. Definition of COPD The World Health Organization (WHO) defines COPD as a “…lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversib...
Source: Medical Connectivity Consulting - Category: Information Technology Authors: Tags: Mobile Health Source Type: blogs
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 10. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Conclusions Perioperative stroke carries a significant clinical burden. The incidence of perioperative stroke may be higher than previously recognized, and there are diverse pathophysiologic mechanisms. There are many opportunities for further investigation of the pathophysiology, prevention, and management of perioperative stroke.
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research
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