Acute aortic dissection type A discloses Corpus alienum

We report an unusual case of an aortic type A dissection with a corpus alienum which compresses the right ventricle. The patient successfully underwent an aortic root replacement in deep hypothermia with re-implantation of the coronary arteries using a modified Bentall procedure and the resection of the corpus alienum. Intraoperative finding reveals 3 greatly adhered gauze compresses, which were most likely forgotten in the operation 34 years ago

Surgery for Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HOCM) is an inherited disorder with variable expressivity, resulting in asymmetric septal hypertrophy and left ventricular outflow tract obstruction (LVOTO). Symptoms are similar to those of aortic stenosis and are due to LV diastolic dysfunction and myocardial ischemia in the absence of epicardial coronary narrowing. Goals of treatment include symptomatic control, resolution of hemodynamic abnormalities and their sequelae, reduction of sudden cardiac death risk and screening of family members. Left ventricular outflow tract obstruction at rest is a predictor of severe symptoms, heart failure, and death. The majority of patients are managed medically, predominantly with b-blockers and calcium channel blockade.Disopyramide, a negative inotrope, can be used in cases with persistently high resting gradients. To prevent sudden cardiac death, implantable cardioverterdefibrillators are used aggressively

Surgery for Hypertrophic Obstructive Cardiomyopathy

Surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM) comprises septal myectomy which though has been limited to patients with refractory symptoms and high resting gradients. Results of surgical intervention are well documented with dramatic reduction in left ventricular outflow tract gradient and resultant relief of symptoms in about 95% of patients. Transcoronary ablation of septal hypertrophy with alcohol is a newer percutaneous technique, designed to ablate hypertrophied cardiac septal muscle through localized infarction, but its efficacy compared with that of surgical myectomy is uncertain. In the present article we briefly review the technique of septal myectomy and compare it with septal ablation, concluding that the standard septal myectomy still remains the preferred and proven therapy. &nbsp

Patient-reported outcomes in patients with heart failure

The key challenge in heart failure care research is to explore new directions for optimizing care on an individual and population level. This thesis aimed to investigate the use of different patient-reported outcomes in patients with heart failure and the perception of these outcomes by the patients themselves. We assessed the preferences of outpatients and showed that the majority awards more weight to quality of life over longevity. The prevalence of impairments due to heart failure and the degree of perceived harshness was also investigated. Highly prevalent impairments are not by definition perceived as severely harsh. With a qualitative study we analysed which treatment goal patients perceived as important. ‘Not getting worse’ was perceived as the treatment goal that matters most. We have also studied possibilities to improve health-related quality of life in these patients and found an association between optimism and health-related quality of life and between anemia and health-related quality of life. These associations may serve as emerging targets for improving health-related quality of life. We also studied the effect of using telemonitoring in patients with heart failure, and found that the use of telemonitoring is safe and can reduce heart failure related visits to the outpatient clinic. However we did not find differences in rehospitalisation-, mortality rates and health-related quality of life measurements between patients who used telemonitoring or not. Finally, with a literature review we investigated the satisfaction of patients with using telemedicine. We showed that patient satisfaction is still underexposed in the literature about non-invasive telemedicine research