Italian heart journal : official journal of the Italian Federation of Cardiology最新文献

{"title":"Sudden heart failure due to a ruptured posterior Valsalva sinus aneurysm into the right atrium: feasibility of catheter closure using the Amplatzer duct occluder.","authors":"Eustaquio Onorato,&nbsp;Francesco Casilli,&nbsp;Marcel Mbala-Mukendi,&nbsp;Elena Perlasca,&nbsp;Franco Santoro,&nbsp;Franco Bortone,&nbsp;Vincenzo Arena","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Valsalva sinus aneurysms are usually congenital and relatively rare and tend to be more frequent in adults. Rupture of these aneurysms can result in sudden death or in an abrupt and rapid progressive heart failure. Surgical repair is the traditional treatment of choice. We report the case of a 48-year-old female with a ruptured posterior non-coronary Valsalva sinus aneurysm, resulting in an anomalous aorto-right atrial fistula. Successful percutaneous catheter closure of the massive left-to-right shunt by using the Amplatzer duct occluder is presented.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 7","pages":"603-7"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25689825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revascularization of diabetic patients: are drug-eluting stents the solution?","authors":"Giulio Guagliumi,&nbsp;Giuseppe Musumeci","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Restenosis and need of repeat revascularization as well as major adverse cardiac events (MACE) are all significantly increased after coronary stenting in patients with diabetes compared to non-diabetic patients. The potential clinical benefit of drug-eluting stents (DES) in this cohort is currently under definition. Both Cypher and Taxus stents in randomized clinical trials and real world post-approval registries appear to be effective with a substantial reduction in MACE and target lesion revascularization compared to control patients. However, despite stability of target lesion revascularization obtained with DES, diabetes continues to be associated with a significant increase in MACE at mid- and long-term follow-up. These data emphasize the role of a fully integrated medical, glycemic and device treatment for optimal outcome in diabetes. In order to develop new guidelines for diabetic treatment, prospective and randomized studies comparing DES with surgical revascularization in three-vessel and/or left main disease are ongoing. Despite significant amelioration obtained with DES the diabetic population remains an unmet need, requiring further basic and clinical research.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"507-13"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25180035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Zwolle global experience on primary percutaneous coronary intervention.","authors":"Giuseppe De Luca,&nbsp;Harry Suryapranata,&nbsp;Menko-Jan de Boer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Timely restoration of antegrade blood flow in the infarct-related artery of patients with ST-segment elevation myocardial infarction (STEMI) results in myocardial salvage and improved survival. We describe the Zwolle approach with regard to prehospital phase, the first 15 min in hospital, initial pharmacological therapy, angiography, angioplasty, risk stratification, rehabilitation and secondary prevention. Confirmation of the diagnosis by 12-lead electrocardiography by either general practitioners or ambulance paramedics allows substantial reduction in the time-delay to first balloon inflation, as the hospital and the catheterization laboratory can be prepared in advance, and the emergency room and the coronary care unit with their unavoidable delays can be skipped on the way to acute angiography. In our setting all patients with STEMI are treated at the time of diagnosis (before or during transportation) with heparin (5000 IU) and aspirin (500 mg) intravenously, with additional oral bolus (300 mg) of clopidogrel and additional 5000 IU heparin at the time of angiography. Our attitude is that an optimal balloon angioplasty result should never be jeopardized just for somewhat lower rate of target vessel revascularization during the first year after the acute event. In particular, attention should be paid to side branches, which may be of more clinical relevance in this setting than with elective angioplasty. Additional mechanical devices, such as distal protection devices and/or thrombosuction, should be mostly used when relevant thrombotic material is visible, with concomitant higher risk of distal embolization, particularly in high-risk patients. Finally, the use of the Zwolle risk score may help to identify low-risk patients who could be safely discharged within 36-48 hours after primary angioplasty, with a significant reduction in the costs of hospitalization.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"453-8"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25181864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The present and future of drug-eluting stents.","authors":"Ciro Indolfi,&nbsp;Annalisa Mongiardo,&nbsp;Carmen Spaccarotella,&nbsp;Alessandro Ferraro,&nbsp;Daniele Torella","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The only widely accepted way to reduce restenosis rate after percutaneous balloon angioplasty has been the use of coronary bare metal stents, and the last decade has witnessed a prompt and widespread adoption of bare metal stents that has revolutionized the field of interventional cardiology. The new millennium has seen the recent development of drug-eluting stents (DES), allowing controlled release of a drug directly to the injured artery, which seem to have prevented by large the problem of in-stent restenosis. The goal of this review was to summarize recent laboratory and clinical investigations concerning the effects of DES in various settings relevant to coronary heart disease. In the experimental setting, we examine the intracellular signaling and the role of smooth muscle cells after vascular injury. We also discuss recent observations from our laboratory showing the effects of coating per se on cell apoptosis and proliferation. In the clinical setting, the effects of DES in patients with stable or unstable angina pectoris is examined in detail for the relevant implications both in the treatment and prognosis. The results of a meta-analysis on the effects that have been overlooked in individual studies are reported which show a striking reduction in bypass surgery after DES implantation. Finally, we discuss the potential role of new materials and technologies (i.e., nanotechnology) that will improve DES performance allowing other future clinical applications in patients with ST-elevation myocardial infarction, vulnerable plaques, insulin-dependent diabetes mellitus, etc.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"498-506"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25180034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of creatine kinase release after percutaneous coronary intervention.","authors":"Claudio Cavallini,&nbsp;Matteo Rugolotto,&nbsp;Stefano Savonitto","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the last 10 years a large number of studies have clearly shown that mild-to-moderate elevations of biochemical markers of myocardial damage are frequently detected after percutaneous coronary revascularization, but the clinical significance of these findings is still debated. Side branch occlusion, abrupt vessel closure and major dissection are the factors most frequently responsible for myocardial damage after stent implantation. However even in the case of a successful and uncomplicated procedure, enzyme leak may occur as a result of coronary microembolization. Post-procedural creatine kinase (CK)-MB rise is detected in 10 to 20% of the cases and is associated with a higher risk of death; the level of risk seems to increase linearly with any elevation of the marker, with no obvious threshold effect or cut-off value. Post-procedural elevations of cardiac troponins, occurring in almost 50% of the cases, do not seem to predict long-term mortality and do not add any prognostic information to that offered by CK-MB. Potential mechanisms responsible for adverse prognosis after CK-MB elevation include increased susceptibility to ventricular arrhythmias via microreentrant circuits, compromise of coronary collaterals, and microvascular circulation dysfunction. Although a cause-and-effect relationship between CK-MB elevation and adverse outcome has not been clearly demonstrated, post-procedural myonecrosis should be prevented, systematically sought for and, if detected, always reported in order to define the patient's risk profile more precisely.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"522-9"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25180037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-tech primary percutaneous coronary intervention.","authors":"Luca Favero,&nbsp;Giampaolo Pasquetto,&nbsp;Carlo Cernetti,&nbsp;Salvatore Saccà,&nbsp;Bernhard Reimers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Coronary recanalization by means of primary percutaneous coronary intervention is actually the treatment of choice in patients with ST-elevation myocardial infarction. However, conventional primary percutaneous coronary intervention still presents several limitations. In recent years sophisticated new devices and techniques have been developed to further improve the results of primary percutaneous coronary intervention: it seems to be appropriate to refer to their utilization using the definition \"high-tech primary percutaneous coronary intervention\". Although the study data available are controversial and clinical benefits have not clearly been shown, adjunctive devices have been used in many procedures. Patient and lesion selection appears to be crucial and the health economics as well as the safety of high-tech devices should be carefully evaluated.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"465-74"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25181867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bifurcation lesions.","authors":"Antonio Colombo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The introduction of drug-eluting stents has significantly improved the immediate and long-term results following treatment of bifurcation coronary lesions. Despite these improvements, few questions are still without a clear answer. Among them the most important one is the need to use two stents vs provisional side branch stenting in true bifurcations. At present time the approach most frequently applied is to stent the main branch stenting to the side branch only for suboptimal results. In situations when the operator needs two stents as intention to treat we suggest the usage of the \"Crush\" or \"V\" technique. These two approaches have been utilized with good immediate and long-term results with sirolimus-eluting stents and with polymer-based paclitaxel-eluting stents. The usage of the \"Crush\" technique followed by final dilation of the side branch and with kissing balloon inflation has decreased. We recently evaluated results with this technique in 70 patients treated with sirolimus-eluting stents. The 6-month angiographic follow-up was available in 83% of the lesions and restenosis rate was 33% (7% main and side branches and 26% only side branch). No difference was observed in the restenosis rate on the main branch between lesions treated with final kissing balloon inflation and lesions without final kissing inflation (4% in the final kissing group vs 8% in the no final kissing group, p = 1.00). The restenosis rate on the side branch was lower in the final kissing group (17%) in comparison to the no final kissing group (42%) (p = 0.046). Similar results are achieved with polymer-based paclitaxel-eluting stents. The introduction of drug-eluting stents with selective usage of stenting the main and side branches applying the \"Crush\" or \"V\" techniques has significantly improved the results compared to bare metal stents in bifurcation lesions.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"475-88"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25181868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial and microvascular reperfusion with primary percutaneous coronary intervention.","authors":"Leonardo Bolognese,&nbsp;Giovanni Falsini,&nbsp;Francesco Liistro,&nbsp;Paolo Angioli,&nbsp;Kenneth Ducci","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Restoration of normal flow and tissue-level perfusion are key factors in the reduction of mortality in acute myocardial infarction. The goal of reperfusion during primary percutaneous coronary intervention (PCI) should be to restore not only epicardial patency and flow, but also downstream myocardial tissue perfusion. This review will focus on the techniques able to evaluate and quantify epicardial and microvascular perfusion and on the available therapeutic tools that may be useful in primary PCI. After primary PCI, rates of TIMI flow grade 3 of 80 to 100% have been reported. Furthermore, after stenting during primary PCI more than one third of patients have persistently abnormal corrected TIMI frame counts related to increased downstream resistance. Achievement of TIMI flow grade 3 is no longer sufficient to define an optimal result of primary PCI and restoration of normal tissue-level perfusion is also required. Coronary no/slow reflow and myocardial hypoperfusion after otherwise successful recanalization of infarct-related arteries may involve more than just classical non-reperfusion of the myocardium that is already dead: distal embolization of debris or microparticulate atheromatous material, capillary edema, inflammation, and neurohormonal reflexes and vasoconstriction may play a crucial role. Evolving treatments of the no-reflow phenomenon are directed toward the restoration of microvascular flow abnormalities because these either directly or indirectly contribute to cell death. Promising adjunctive therapies that may reduce microemboli include intensive antiplatelet therapy with aspirin and ticlopidine, platelet glycoprotein IIb/IIIa inhibitors, coronary vasodilators, and embolization protection devices. Therapy targeting microvascular vasospasm also appears promising. Finally a variety of interventional new approaches have been focused on the setting of primary PCI, like atherectomy and thrombectomy devices, distal protection devices, hypothermia and hyperoxemic therapy, that are under investigation in numerous trials before they can be used routinarily.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"447-52"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24891426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restenosis treatment in the drug-eluting stent era.","authors":"Patrizia Presbitero,&nbsp;Giacomo Boccuzzi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite recent advances, the in-stent restenosis (ISR) remains a challenging problem in interventional cardiology with an estimated overall restenosis rate of 20%, 25-30% in bare metal stents and 12% in drug-eluting stents (DES). In this review, we provide an overview of therapeutic options which include balloon angioplasty, cutting balloon, debulking techniques, brachytherapy and DES. Intracoronary brachytherapy using beta or gamma radiation had been considered the standard of care for some years. However, the use of DES to treat ISR has been shown to be safe, effective and ease-of-use for the prevention of recurrent restenosis. ISR after DES when focal angiographic pattern is present can be often treated with balloon angioplasty whereas if a non-focal pattern is recognized a new DES implantation is indicated. Waiting for a definitive answer regarding the optimal treatment of ISR from ongoing trials, we present our current approach to ISR.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"514-21"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25180036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital networks for the treatment of acute myocardial infarction.","authors":"Zoran Olivari","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients with ST-elevation myocardial infarction (STEMI) may have a survival benefit, as well as a reduced occurrence of reinfarction and stroke, if treated with primary percutaneous coronary intervention (PCI) instead of fibrinolysis. Furthermore, there are no other reperfusion options for patients with absolute contraindications to fibrinolysis or after failed fibrinolysis or in shock. Unfortunately, primary PCI programs require a relatively high number of experienced interventional cardiologists as well as other specialized personnel to guarantee a 24-hour call schedule together with a high level of skill. Since these conditions may be achieved only in a minority of hospitals with high volumes of interventional procedures, most of the patients with STEMI will be admitted to hospitals without a primary PCI program. The implementation of hospital networks based on a Hub-and-Spoke model is the only way to allow the choice of a reperfusion treatment on the basis of clinical needs and not only on the basis of the hospital characteristics. In Italy this process should be driven by regional authorities that have to establish the distribution of Hub centers, in close cooperation with cardiologists and physicians involved in emergency departments and 118 Service. Several key points, such as the collaboration between cardiologists and emergency physicians, common diagnostic and therapeutic protocols, prehospital diagnosis and treatment, transportation difficulties, overflow of the patients in the Hub centers, public campaigns for the use of the 118 Service and registries for all patients with STEMI, should be adequately addressed and implemented. In hospitals with well established primary PCI programs, all patients with STEMI should receive a mechanical reperfusion. The selection of patients with STEMI who might benefit most from mechanical reperfusion even after transfer, should be made considering the patient's risk profile, the time interval from symptom onset and the time interval to a primary PCI: in late comers (> 3 hours of symptom onset) and in the elderly, primary PCI should be the treatment of choice, but in early comers and younger patients, if an excessive time delay is necessary to perform a primary PCI, fibrinolysis might be a good initial option. In the latter, a systematic immediate transfer of high-risk patients to a primary PCI center for facilitated or rescue PCI should be considered.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 6","pages":"459-64"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25181865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}