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Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Pure aortic regurgitation is less common than aortic valve stenosis. The aetiology of aortic regurgitation can be subgrouped into those conditions primarily affecting the aortic valve cusps and those primarily affecting the aortic root (Table 3.5). In the normal aortic valve, total cusp area exceeds root area and disturbance of this relationship, either by decreasing cusp area by fibrosis or increasing root area by dilatation or distortion, leads to regurgitation. The cusps also need to be structurally intact, i.e. without tears or perforations. The causes of regurgitation are multiple and vary between surgical series due to selection bias (Table 3.6). The most common aetiologies are aortic root dilatation followed by rheumatic disease followed by endocarditis.
Endoscopic Biopsy Demonstrating High-Grade Dysplasia in Barrett’s Esophagus
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
There are no specific clinical signs or symptoms that are pathognomonic of Barrett’s esophagus or high-grade dysplasia. Clinical trials are underway evaluating an alternative diagnostic strategy that can be applied in the community setting, namely, the Cytosponge. At the present time, Barrett’s esophagus is identified incidentally in patients who undergo endoscopy, usually in the context of investigation of symptoms of gastroesophageal reflux disease (heartburn and/or regurgitation). Barrett’s esophagus is usually present at the first endoscopy, and in most individuals its length is relatively stable over time, suggesting that the metaplastic change occurs early in susceptible individuals.
Digestive and Metabolic Actions of Dopamine
Published in Nira Ben-Jonathan, Dopamine, 2020
Gastroesophageal reflux disease (GERD), or acid reflux disease, is a recurrent condition where acidic gastric juices leak upward into the esophagus [8]. The most common symptoms are an acidic taste in the mouth, regurgitation, and heartburn. The pathogenesis of GERD is multifactorial, involving lower esophageal sphincter relaxation or pressure abnormalities. As a result, reflux of acid, bile, pepsin, and pancreatic enzymes occurs, leading to esophageal mucosal injury. Other factors contributing to the pathophysiology of this disease include hiatal hernia, impaired esophageal clearance, delayed gastric emptying, and impaired mucosal defensive factors. Treatments for GERD include changes in food choices, medications, and surgery in extreme cases. Initial treatment is commonly done with proton-pump inhibitors such as omeprazole to neutralize the acid. Metoclopramide, a peripheral D2R antagonist, has been used alone or in combination with antacids to treat GERD for some years. However, use of metoclopramide has declined in recent years because of concerns with adverse effects such as PD-like movement disorders.
The clinical role of invasive hemodynamics in the evaluation and treatment of structural heart disease
Published in Expert Review of Cardiovascular Therapy, 2023
Joshua Rezkalla, Mackram F. Eleid
Transcatheter aortic valve implantation (TAVI) has greatly expanded our ability to treat AS however long-term durability of TAVI durability remains an area of study and continual reassessment of valve function and prosthetic gradients will be required [27]. Echocardiography remains the cornerstone of postoperative assessment of prosthetic valves with the index study performed within the first several weeks [2,28]. Transaortic velocity is accepted as an easily reproducible measure of prosthetic hemodynamics and is used for prosthetic valve surveillance [28–31]. Causes of elevated gradients includes (i) structural valve dysfunction such as thrombosis, degeneration, or leaflet disruption and nonstructural causes, (ii) increased flow states such as paravalvular regurgitation, (iii) patient-prosthesis mismatch (PPM), or iv) pressure recovery [28,30]. Acquisition and confirmation of elevated gradients is essential as it informs clinical decision-making and has prognostic implications as higher gradients (regardless of etiology) after aortic valve replacement (AVR) are associated with increased rates of valve deterioration [27,30,32].
Peripartum anesthetic management in patients with Ebstein anomaly: a case series
Published in Baylor University Medical Center Proceedings, 2023
Carmelina Gurrieri, Emily E. Sharpe, Heidi M. Connolly, Carl H. Rose, Katherine W. Arendt
Ebstein anomaly (EA) is a rare congenital cardiac malformation that affects 1 in 10,000 to 1 in 50,000 live births1 and is characterized by abnormalities of both the tricuspid valve leaflets and the right ventricle (RV)1(Figure 1). Typically, the valve is displaced and presents various degrees of regurgitation. The RV is divided into two portions: the more proximal, referred to as the “atrialized” RV, and the more distal, functional RV, which is typically small, and it can be affected by an inherent myopathy with declining function over time.2 Patients with EA may have other associated cardiac abnormalities, including atrial septal defect or patent foramen ovale, with a right-to-left shunt and an RV outflow tract obstruction. Arrhythmias are also common, including atrial fibrillation, atrial flutter, and Wolff-Parkinson-White syndrome.2 Pregnant women affected by EA are at increased risk of adverse outcomes, such as fetal loss, premature birth, cesarean delivery (CD), postpartum hemorrhage, congenital heart disease in offspring, and major adverse cardiac events, including congestive heart failure and arrhythmias requiring intervention.3–5 We retrospectively assessed the peripartum anesthetic management and outcomes of patients with EA who delivered at our institution.
Safety considerations when managing gastro-esophageal reflux disease in infants
Published in Expert Opinion on Drug Safety, 2021
Melina Simon, Elvira Ingrid Levy, Yvan Vandenplas
The scientific evidence-based approach for GER (D) management would be that no intervention is necessary as the natural evolution suggests a disappearance of troublesome regurgitation, the major presenting symptom, in the majority of the infants. As a consequence, reassurance and anticipatory guidance is recommended (Figure 1). Acid-related GERD in infants does exist, but only in a small subgroup of all infants presenting with troublesome regurgitation. Therefore, the consulted health-care provider should know the alarm or warning symptoms, in order to reassure appropriate referral of these patients (Table 1). Prokinetic medication seems a logic choice, but data on efficacy are disappointing and all drugs have a risk of inducing severe adverse effects. Worldwide, there is an erroneous belief among health-care providers that acid-blocking medication will decrease distress, resulting in an overuse. Moreover, acid-blocking medication is also associated with a high prevalence of adverse effects. According to the available evidence included in the most frequently applied guidelines, nutritional management is effective in reducing regurgitation and distress and is safe. The challenge is to spread this information to primary health-care providers in combination with knowledge of the alarm signs to reassure appropriate referral for the subgroup of infants needing investigations and drug treatment.