Heparin induced thrombocytopenia presents as an underdiagnosed condition with life threatening thrombotic complications. The incidence in cardiac surgery patients is dependent on several factors and appeared to be greater in procedures that involve the use of intraaortic balloon pump. Clinical diagnosis is particularly challenging in cardiac surgery patients due to the natural occurrence of post-operative thrombocytopenia. High index of suspicion is key factor to establish adequate treatment and prevent the occurrence of thrombotic complications, such as saphenous vein graft occlusion, pulmonary embolism and myocardial infarction, which lead to substantially increased mortality rates. The 4T's assessment point system was designed in order to evaluate the likelihood of occurrence of the condition based on clinical presentation; however, serotonin release assay represents the gold standard to reach diagnosis. Treatment of heparin induced thrombocytopenia involves cessation of unfractionated and fractionated heparin, and the instauration of therapy with direct thrombin inhibitors. Among all direct thrombin inhibitors agents, Bivaluridin is emerging as a potential first line of treatment based on its benefits of a short half-life and enzymatic elimination.
Purpose of review
Significant improvements in the diagnosis and management of patients with congenital heart disease (CHD) have led to improved survival. These patients require life-long noninvasive evaluation. The use of advanced imaging such as cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT) has increased to support this need. The purpose of this review is to discuss the basics of advanced cardiac imaging, indications and review the recent innovations.
Recent findings
Recent literature has demonstrated the increasing reliance of advanced imaging for CHD patients. In addition, research is focusing on CMR techniques to shorten scan time and address previous limitations that made imaging younger and sicker patients more challenging. CCT research has involved demonstrating high-quality images with low radiation exposure. Advances in digital technology have impacted the interactivity of 3D imaging through the use of virtual and augmented reality platforms. With the increased reliance of advanced imaging, appropriate use criteria have been developed to address possible under or over utilization.
Summary
The utilization of advanced cardiac imaging continues to increase. As CMR and CCT continue to grow, increased knowledge of these modalities and their usage will be necessary for clinicians caring for CHD patients.
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