Biological solutions to aortic root replacement: valve-sparing versus bioprosthetic conduit‡

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COMPORTAMIENTO DEL INTERVALO QT CORREGIDO EN ARTRITIS TEMPRANA

Introducción: La  dispersión del  intervalo QT  ha sido descripta en  pacientes con artritis reumatoidea (AR) y  puede ser un marcador útil de morbi-mortalidad cardiovascular.Objetivos: Conocer el comportamiento del intervalo QT corregido (iQTc) en pacientes con AT y evaluar la asociación con  actividad de la enfermedad (AE).Material y Métodos:  Se realizó un estudio comparativo de corte transversal que incluyó pacientes mayores de 16 años, con diagnóstico de artritis temprana (AT) , atendidos en la  Unidad de Reumatología del Hospital Córdoba, desde enero de 2010 a diciembre de 2013. El grupo control se apareó por edad, sexo y antecedentes patológicos.  Los criterios de exclusión fueron evidencias  de IAM,  arritmia, potasemia&gt;5mEq/L,  ingesta de fármacos que afecten el QT. Se recolectaron datos demográficos, la actividad de la enfermedad se midió por DiseaseActivity Score (DAS 28), clasificando la actividad de la enfermedad en Baja AE, DAS 28 menor a 3,2,  Moderada/ Alta mayor de 3.2;   y se realizó ECG con técnica  estándar. El  intervalo QT fue medido desde el comienzo del complejo QRS hasta el final de la onda T. Para obtener el valor del iQTc, se utilizó la fórmula de Bazett.Resultados: El número de pacientes fue de 31, 83.9 % de sexo femenino y con edad media de 41.9 años, el DAS 28 promedio de 5.09. El grupo control incluyo 31 individuos con  una edad media de 42.2. El intervalo QT fue de 0.376 mm/s y el iQTc de 0.408 en AT y el QT fue de 0.381 mm/s y el iQTc de 0.415mm/s en el grupo control (p NS, p NS). El QT y el iQTc fueron de 0.39 y 0.38mm/s en los pacientes con baja  AE; 0.37mm/s y 0.411en Moderada / Alta AE (p=NS).Conclusión: El iQTc no demostró alteraciones ni se relacionó con actividad de la enfermedad en  AT   Background: The QT interval modification has been described in patients with Rheumatoid Arthritis (RA) and it could be a useful marker of cardiovascular morbidity and mortality.Aims: To evaluate the QT interval modifications in patients with early arthritis (EA) and its association with disease activity (DA).METHODS: We studied patients with diagnosis of EA attended to Rheumatology Unit at Córdoba Hospital from January 2010 to December 2013. Control group was population age, gender and cardiovascular risk factors matched. Exclusion criteria were: myocardial infarction, arrhythmia, K level &gt;5, or anti-arrhythmia treatment. ECG was performed by standard technique and QT interval was measured from the beginning of QRS to the end of T wave. QTC value was calculated by Bazzet formula.  The activity disease was measured by Disease Activity Score (DAS 28), and was considered low disease activity below 3.2, and moderate / high disease activity more than 3,2.RESULTS: 31 patients were included with 83.9 % of females and the mean age was  41.9 years old and DAS 28 was 5.09.  31 persons were included as a control group with a mean age of 42.2 years old.  QT interval was  0.376 mm/s  and l QTC  0.408  in EA and  QT was  0.381 mm/s and  QTC  0.415 mm/s  in the control group ( p= NS, p= NS).  QT interval and  QTC were  0.39 and 0.38 in low DA patients; 0.37 and  0.411 in Moderate / High DA ( p=NS)CONCLUSIONS: The QT interval  was not modified and it was not related with DA in EA. </p

Lipid profile in early arthritis and its relation with inflammatory activity

Cardiovascular risk is increased in Rheumatoid Arthritis and it is associated with higher morbility and mortality. Few studies have evaluated the lipid profile in early arthritis (EA). Aims: To study the lipid profile in patients with EA and its association with disease activity (DA). Methods: We studied 31 patients with diagnosis of EA and a control group, with age, gender and cardiovascular risk factors matched, who were attended to Rheumatology Unit at Córdoba Hospital from January 2011 to May 2013. We evaluated demographic data, lipid profile and DA by DAS28. Results: 31 patients were included with mean age of 42.3 years old, 87% female , the cholesterol level was 191.9 mg/dl, HDL 54, LDL 115.8, Triglycerides 117,6; and 31 patients were included in the control group with average age of 42.7 years old, and cholesterol level of 198.7 mg / dl, HDL 56.9 LDL 122.6, Triglycerides 99.6 (p NS). Regards disease activity, in the low DA group the Cholesterol level was 196.3 , LDL 115.8, HDL 62 y triglycerides 95.17, and in the Moderate and High DA the Cholesterol level was 190 mg/ dl, LDL 115, HDL 52 y triglycerides 122,9 (p NS) CONCLUSIONS : The lipid profile was normal and it was not associated with DA in EA patients

Enseñar en educación secundaria, un compromiso con la construcción de aprendizajes relevantes y duraderos: secuencias didácticas implementadas en los distintos ciclos y años de la educación secundaria y modalidades : ciencias naturales, matemáticas y tecnologías

Fil: Ferreyra, Horacio Ademar. Universidad Católica de Córdoba. Facultad de Educación; Argentin

Latest Advances in Annuloplasty Protheses for Valvular Reconstructive Surgery

This is the third and final part of our update on the latest advances in cardiac valvular replacement. Part 1 was dedicated to cardiac valvular replacement, and Part 2 focused on transcatheter cardiac valvular treatment. This part concerns annuloplasty prostheses for valvular reconstructive surgery. The number of patients undergoing surgical heart valve repair has been increasing, particularly in high-volume centers. Annuloplasty is now considered the gold standard in mitral valve regurgitation repair secondary to degenerative, ischemic and idiopathic dilated cardiomyopathy disease. The techniques of mitral valve reconstruction have been well established, but controversies remain regarding the type of annuloplasty ring to be used. The available annuloplasty rings include rigid, flexible, complete, partial, and semi-rigid/flexible. The choice of annuloplasty ring has been the focus of extensive investigation and debate, but to date it still largely remains a matter of "surgeon's preference" rather than an evidence-based selection. Functional tricuspid regurgitation was traditionally treated by the classic De Vega annuloplasty, but has since evolved after the development of prosthetic tricuspid annuloplasty. Head-to-head comparisons have demonstrated superior long-term outcomes with device-based annuloplasty compared to suture-based surgery, but the type of ring to be used (flexible versus rigid) has recently been questioned, without reaching definitive conclusions. In contrast to mitral and tricuspid valve repair, aortic repair is more difficult with respect to specific valve features. Annuloplasty is considered to play a key role in controlling aortic regurgitation and preventing recurrence after valve repair. Various modifications of annuloplasty have been advocated (internal/external, with/without ring (suture), rigid/flexible ring). but none of them has become a de facto standard. This paper describes the various rings that are available to help orient surgeons and to serve as a reference for students

Latest Advances in Annuloplasty Protheses for Valvular Reconstructive Surgery

This is the third and final part of our update on the latest advances in cardiac valvular replacement. Part 1 was dedicated to cardiac valvular replacement, and Part 2 focused on transcatheter cardiac valvular treatment. This part concerns annuloplasty prostheses for valvular reconstructive surgery. The number of patients undergoing surgical heart valve repair has been increasing, particularly in high-volume centers. Annuloplasty is now considered the gold standard in mitral valve regurgitation repair secondary to degenerative, ischemic and idiopathic dilated cardiomyopathy disease. The techniques of mitral valve reconstruction have been well established, but controversies remain regarding the type of annuloplasty ring to be used. The available annuloplasty rings include rigid, flexible, complete, partial, and semi-rigid/flexible. The choice of annuloplasty ring has been the focus of extensive investigation and debate, but to date it still largely remains a matter of "surgeon's preference" rather than an evidence-based selection. Functional tricuspid regurgitation was traditionally treated by the classic De Vega annuloplasty, but has since evolved after the development of prosthetic tricuspid annuloplasty. Head-to-head comparisons have demonstrated superior long-term outcomes with device-based annuloplasty compared to suture-based surgery, but the type of ring to be used (flexible versus rigid) has recently been questioned, without reaching definitive conclusions. In contrast to mitral and tricuspid valve repair, aortic repair is more difficult with respect to specific valve features. Annuloplasty is considered to play a key role in controlling aortic regurgitation and preventing recurrence after valve repair. Various modifications of annuloplasty have been advocated (internal/external, with/without ring (suture), rigid/flexible ring). but none of them has become a de facto standard. This paper describes the various rings that are available to help orient surgeons and to serve as a reference for students

Is postoperative calcium channel blocker therapy needed in patients with radial artery grafts?

BackgroundChronic calcium channel blocker therapy has traditionally been considered necessary in patients carrying a radial artery graft, even in the absence of objective data to support it. This report was conceived to evaluate the angiographic and clinical effects of calcium channel blocker therapy during the first postoperative year.Patients and resultsA total of 100 consecutive patients who received a radial artery graft at our institution were randomly assigned to receive (n = 53) or not receive (n = 47) calcium channel blocker therapy with oral diltiazem 120 mg/daily started in the early postoperative period. At 1-year follow-up, all patients were reassessed clinically and by Tl201 myocardial scintigraphy, and 83 of them underwent control angiography. In 12 cases we also evaluated the response of the radial artery to the endovascular infusion of serotonin. No difference in terms of clinical outcome, scintigraphic results, and patency rate was found between patients who received or did not receive calcium channel blocker therapy. Endovascular serotonin infusion evoked an evident spastic reaction of radial artery grafts, not attenuated by calcium channel blocker therapy.ConclusionCalcium channel blocker therapy started immediately after surgery and continued for the first postoperative year does not affect radial artery graft patency and clinical and scintigraphic outcomes. On the basis of these data, the prophylactic use of calcium channel blocker therapy in patients with radial artery grafts seems unsubstantiated

Root Reimplantation and Aortic Annuloplasty With External Ring in Bicuspid Aortic Valve: An Anatomical Comparison

Aortic annuloplasty has demonstrated to be a protective factor in valve-sparing root replacement and aortic valve repair. Both reimplantation for aortic root aneurysms and external ring annuloplasty for isolated aortic regurgitation have demonstrated good long-term results. The aim of this anatomical study is to compare aortic reimplantation with Valsalva graft with aortic external ring annuloplasty in bicuspid aortic valves, analyzing their morphological features with CT scan. We selected 56 patients with bicuspid aortic valve who underwent reimplantation procedure with Valsalva graft or external ring annuloplasty; after propensity-matching, 2 homogeneous groups of 10 patients each were obtained. Through multiplanar ECG-gated CT-Scan reconstructions, pre- and postoperative, aortic annular, and valve geometrical characteristics were compared (diameters, perimeter, area and ellipticity index for the annulus; effective height, coaptation length and commissural height for the valve). Aortic root volume was also analyzed. Postoperative comparison of the two groups showed similar geometric features of the aortic annulus in terms of major and minor diameters, perimeter, area and ellipticity index. Analysis of valve's parameters showed similar results in terms of effective height and coaptation length (respectively 10.9 ± 2.1 mm and 7.5 ± 1.9 mm in External Ring group and 10.1 ± 2.0 mm and 7.6 ± 1.6 mm in the Reimplantation group). Both techniques achieve an efficient annuloplasty with similar anatomical results on bicuspid the aortic valves. The stability of these results needs to be confirmed by long-term clinical and echocardiographic follow-up

Morphological modification of the aortic annulus in tricuspid and bicuspid valves after aortic valve reimplantation: an electrocardiography-gated computed tomography study

Aortic valve-sparing operations have been shown to produce fewer valve-related complications than valve replacement. The aortic root is a morphological and functional unit in which the annulus plays an important role on dynamism, shape and geometry of the valve with different results in bicuspid aortic valves (BAVs) or tricuspid aortic valves (TAVs). The aim is to evaluate the differences in the size and shape of the aortic annulus between native BAVs and TAVs using ECG-gated computed tomography (CT) after a reimplantation procedure

Optimized use of the "skirt" of the Valsalva graft for the completion Bentall

We report the case of a patient with an aortic root aneurysm who had previously undergone aortic valve replacement with a large mechanical prosthesis which proved to be normally functioning at the time of reoperation. We describe a new technique of replacing the aortic root while retaining the existing aortic valve similar to the "completion Bentall" procedure using a 32 mm Valsalva graft by suturing the skirted portion of the graft to the sewing ring of the mechanical valve. The ability of the skirt to increase its diameter was the key of this approach