A Randomised Trial of Nurse-led Intervention at the Time of Catheter Ablation of Atrial Fibrillation—Effects on Quality of Life, Symptom Severity and Rehospitalisation

Abstract

S Heart, Lung and CirculationAbstracts S229 2011;20S:S156-S251 or missed, and most of these occur peripartum. Literature shows that women present later than men and with more atypical symptoms and signs. Since the mortality increases by about 1% per hour when a patient remains untreated, time plays a crucial factor in outcome.Case series: We report a series of five women with peripartum acute aortic dissection, treated from 2002 to 2010. The average age at presentation was 33 years. Four patients were in their first pregnancy, and one in her third. Two women had Marfan's syndrome and one had Turner's syndrome. The median time to diagnosis was 18 hours (range 5-150 hours). Provisional diagnoses for four patients were stroke, pulmonary embolus, indigestion and pericarditis. Diagnosis in four patients was by transthoracic echocardiography and in the other patient via computed tomography.All five patients underwent emergency surgical repair. Two patients underwent a Bentall procedure with prosthetic AVR, the remaining three patients had ascending aortic replacement with one requiring resuspension of the aortic valve. One mother died from catastrophic nonsurvivable brain damage. The other four women are alive and well. One foetus died.Conclusion: Delayed diagnosis of acute aortic dissection in pregnant women is not rare. A high degree of suspicion and appropriate investigations are critical in optimising management and outcome.Tissue engineered valve scaffolds have been pursued as a way of overcoming the limitations of currently available mechanical and xenogeneic valve prostheses. This study investigates the previously untested detergent taurodeoxycholate as a potential agent for decellularisation in the field of heart valve tissue engineering, providing comprehensive investigation of structure, morphology and hydrodynamic performance of the resultant scaffolds.Porcine aortic roots were decellularised using a two detergent method including Triton X 100 and taurodeoxycholate, followed by nucleic acid digestion with a non-specific endonuclease (Benzonase). Quality of decellularisation and valve structure were assessed by histology and immunostaining, while the following gross morphological characteristics were measured: mass, area, thickness, density and water content. Alteration of haemodynamic behaviour was investigated by testing the same valves pre and post decellularisation in a Sheffield Pulse duplicator.Efficient decellularisation was achieved and normal valve structure was largely maintained, while morphology was mildly altered. An apparent swelling of collagen fibers in the fibrosa, and a reduction in laminin immunodetection were noted, while GAGs and elastin distribution were well maintained. Fibronectin immunofluorescence was enhanced potentially due to unmasking following treatment. Basement membrane components Collagen IV and Fibronectin were largely intact. Hydrodynamic performance demonstrated significantly increased transvalvular gradients and regurgitant volumes.Taurodeoxycholate is a promising...