Objective The impact of COVID-19 on the post-operative course of patients after cardiac surgery is unknown. We experienced a major Sars-CoV-2 outbreak in our cardiac surgery unit, with several patients that tested positive early after surgery. Here we describe the characteristics, the post-operative course and laboratory findings of these patients, along with the fate of the health-care workers. We also discuss how we reorganize and reallocate hospital resources in order to resume the surgical activity without further positive patients. Methods After diagnosis of the first symptomatic patient, surgery was suspended. Nasopharyngeal swabs were carried out in all patients and health care workers. Sars-CoV-2 positive patients were isolated and monitored throughout the in-hospital stay and followed-up after discharged until death or clinical recovery. Results Twenty patients were found positive to Sars-CoV-2 sometimes after cardiac surgery (mean age 69±10.4 y/o; median EuroSCORE-II 3(IQR 5.1)); median time from surgery to diagnosis was 15 days (IQR 11). Among them eighteen had received cardiac surgery and two of them transcatheter aortic valve replacement. Overall mortality was 15%. Specific COVID-19 related symptoms were identified in 7 patients (35%). Among the twelve health-care workers infected, one developed a bilateral mild-grade interstitial pneumonia. Conclusion COVID-19 infection after cardiac surgery, regardless the time of the onset, is a serious condition. The systemic inflammatory state that follows the extracorporeal circulation may mask the typical COVID-19 laboratory findings, making the diagnosis more problematic. A capillary reorganization of the hospital resources is necessary in order to safely resume the cardiac surgical activity.
Background: Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is a consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism.Therefore, it is essential to identify and understand the pathophysiology of mitral valve regurgitation. Aim of the Study:The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with threedimensional echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy, and hemodynamic changes in the left ventricle.Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve.Conclusions: Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.
After the introduction of drug eluting stent (DES) the rate of in-stent restenosis (ISR) has decreased if compared to the BMS era; however, treatment of patients with ISR remained a major issue for the interventional cardiologist. DES has been largely used with good results also as second layer for the treatment of ISR, but the overall percentage of patients suffering from restenosis still remains high, especially in some subgroups of patients as ones with diabetes mellitus (DM). In this clinical scenario, drug coated balloon (DCB) has been gaining an important role for the treatment of ISR. In fact, it allows to release an antiproliferative drug, namely paclitaxel, without the addition of a second metallic strut, which can lead to a persistent inflammatory stimulus and further narrow the vessel. This could be an advantage in patients with an already increased systemic inflammatory burden and stiffer vessels as those with DM. Despite differences in terms of efficacy and safety between DES and DCB have already been evaluated in different clinical trials, just few of these focused on diabetic patients. The aim of this paper is to review the available data for treatment of ISR both with DES, DCB, and a comparison between these two devices, in patients affected by DM. © 2017 Wiley Periodicals, Inc.
Background: Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism. Therefore, it is essential to identify and understand the pathophysiology of the mitral valve regurgitation. Aim of the study: The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with 3D echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy and hemodynamic changes in the left ventricle. Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve. Conclusions: Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.