Cardiovascular Disease
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
Cardiac surgery is an effective treatment for ischaemic heart disease and valve disease, relieving symptomatic angina and prolonging survival in selected patient groups. Standard indications for coronary artery bypass surgery include left main stem or triple vessel coronary artery disease, particularly in patients with diabetes and/or LV dysfunction where there is prognostic benefit. Surgery is offered for severe heart valve disease providing specific criteria are met, with either repair or replacement with bioprosthetic or mechanical valves. Surgical treatments for severe HF include cardiac transplantation or LV assist device implantation for eligible patients. Patients with complex congenital heart disease frequently require surgical correction.
Democratic, divine and heroic: the history and historiography of surgery
Christopher Lawrence in Medical Theory, Surgical Practice, 2018
As the whole history of surgery demonstrates, making a part of the body into a surgical object was a long, piecemeal process. The twentieth century has witnessed a continuation, and to some extent an acceleration of this process. The rise of cardiovascular surgery is often described as though the only obstacles to operating on the heart were technical.188 I have argued elsewhere, however, that during the first decades of this century a generation of self-styled ‘new cardiologists’ created an account of the heart in which its mechanical deformities were usually considered relatively unimportant and not the proper object of therapy.189 The cardiologists themselves recognised that this made the heart an inappropriate object of surgical intervention.190
Cardiac CT and MRI: State of the Art
Phillip M. Boiselle, Charles S. White in New Techniques in Cardiothoracic Imaging, 2007
Cardiac MRI remains an important part of the imaging armamentarium because of its versatility and lack of ionizing radiation and iodinated contrast material (53). However, an adequate study requires that the patient remain in the magnet for some length of time. Acquisition of a diagnostic examination may be challenging in patients who are uncooperative or disoriented. However, if the patient is only mildly uncooperative, it is possible to obtain much useful information with fast imaging techniques, depending on the indication. Similar to MRI studies of other parts of the body, cardiac MRI is contraindicated in patients with a variety of foreign devices, including certain aneurysm clips, cochlear implants, and penile prostheses. MRI is also contraindicated in patients who have pacemakers or implantable cardioverter defibrillator (ICD) devices, although this limitation is being reconsidered. In general, MRI can be performed in patients who have prosthetic cardiac valves. Patients who have undergone recent cardiac surgery (coronary artery bypass graft or valve surgery) can probably be studied 1–2 weeks after the procedure, although this has not been documented conclusively.
Preoperative circadian physical activity rhythm and postoperative delirium in cardiovascular surgery patients
Published in Chronobiology International, 2020
Chieko Tan, Nao Saito, Ikuko Miyawaki, Hideyuki Shiotani
Delirium is defined as an acute and variable impairment of consciousness and cognitive impairment (American Psychiatric Association 2013). Postoperative delirium (POD), a form of delirium, manifests in patients who have undergone surgical procedures and anesthesia, usually peaking in intensity between 1 and 3 days after the operation (Whitlock et al. 2011). POD is associated with an increased intensive care unit (ICU) length of stay and hospital length of stay, as well as functional decline in patients. Furthermore, POD has been found to be related to an increase in mortality rate, risk of dementia, and medical costs (Whitlock et al. 2011). Cardiovascular surgery requires the use of temporary aortic blockage, heart-lung machine, and extracorporeal circulation to prevent vital organ damage, depending on the surgical procedure; and it is extremely invasive. Recent studies have reported that the incidence of delirium after cardiovascular surgery is at least 3% and is great as 55% (Aitken et al. 2017; Djaiani et al. 2016; Gosselt et al. 2015; Lei et al. 2017; Liu et al. 2017). Therefore, patients who undergo cardiovascular surgery can have a high risk of delirium. In order to enhance the quality of life of such patients, it is essential to develop interventions for the prevention, symptoms reduction, and period shortening of delirium.
Effects of remote ischemic preconditioning on platelet activation and reactivity in patients undergoing cardiac surgery using cardiopulmonary bypass: a randomized controlled trial
Published in Platelets, 2022
Youn Joung Cho, Karam Nam, Sol Ji Yoo, Seohee Lee, Jinyoung Bae, Ji-Young Park, Hang-Rae Kim, Tae Kyong Kim, Yunseok Jeon
Eligible patients were adult patients (age >18 years) who were scheduled for cardiac surgery using CPB at Seoul National University Hospital. Cardiac surgery included cardiac valve surgery, aorta replacement, intracardiac mass excision, and combined surgical procedures, using CPB. Patients were excluded if they met any of the following criteria: preoperative left ventricular ejection fraction <30% or receipt of mechanical ventricular support; presence of peripheral vascular disease or poorly controlled diabetes; use of non-steroidal anti-inflammatory drugs within 3 days, intravenous heparin within 6 h, low-molecular-weight heparin within 24 h, or platelet inhibitors within 24 h prior to surgery; known thrombocytopenia or platelet dysfunction; end-stage renal disease or requirement for hemodialysis; active infectious disease; pregnancy; or refusal to participate (Figure 1).
Safety and feasibility of same-day discharge after elective percutaneous balloon mitral valvotomy: a prospective, single-center registry in India
Published in Acta Cardiologica, 2021
Sharad Chandra, Abhishek Gupta, Gaurav Chaudhary, VS Narain, SK Dwivedi, Rishi Sethi, Akshyaya Pradhan, Pravesh Vishwakarma, Akhil Sharma, Monika Bhandari, Salvatore Cassese
This is a single-centre registry performed at the Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India. Between January 2018 and November 2018 all patients admitted at our institution with severe MV stenosis were screened for possible enrolment in the registry. Patients above the age of 12 years were included in the registry if they had: (a) severe symptomatic (New York Heart Association – NYHA class II–IV) MV stenosis; (b) MV stenosis suitable for elective PBMV; or (c) history of restenosis after previous PBMV (pending anatomical suitability for repeat elective PBMV). Patients were excluded if they had: (a) mild MV stenosis; (b) pre-procedural more than mild MV regurgitation; (c) other significant concomitant valvular disease (except secondary tricuspid regurgitation); (d) decompensated congestive heart failure; (e) atrial flutter/fibrillation; (f) indication to oral anticoagulants due to other comorbid conditions; (g) clot in left atrium or left atrial appendage; (h) need for cardiac surgery due to other cardiac disease; or (i) pregnancy (supposed or planned).
Related Knowledge Centers
- Congenital Heart Defect
- Coronary Artery Bypass Surgery
- Coronary Artery Disease
- Endocarditis
- Rheumatic Fever
- Surgery
- Heart
- Great Vessels
- Surgeon
- Valvular Heart Disease