Cost Perception of Cardiological Procedures Among -Medical Students and Doctors in Switzerland.

INTRODUCTION: Aims: The aim of the present study was to analyze the cost awareness of cardiological tests and procedures among medical students, residents and doctors in Switzerland and discuss trends in cost perception in health expenditures. Methods: Using an online questionnaire, participants (randomly recruited by mailing lists, messaging app or via direct contact) had to estimate the costs of the 13 predefined cardiological procedures services, diagnostic tests and procedures in Swiss Francs (CHF). Short technical descriptions of the procedures and tests were provided. Estimated costs were considered accurate if they were within ±25 % of the reimbursement rate. Participant groups were defined: medical students, residents, hospital-based physicians and cardiologists in private practice (practitioners). Results: A total of 939 participants (172 physicians and 767 medical students) were enrolled. The overall proportion of medical gestures estimated correctly within ±25% of the reimbursement rate ranged from 10 % (students) to 55 % in practitioners. Residents (26 %) and hospital-based physicians (38 %) performed intermediately. In general, the costs were overestimated. Conclusions: The level of cost knowledge of cardiological tests and procedures among medical students, residents and doctors in Switzerland is modest. In general, the costs were overestimated. Increasing experience seems to sharpen the accuracy of cost estimation. Overestimation of costs is potentially problematic: Either in systems of governmental defined global budget or systems with substantial out-of-pocket costs for patients, overestimated costs will result in more restrictive ordering than it would be appropriate and affordable for the individual patient.

Multimodality imaging of eosinophilic myocarditis (loeffler's endocarditis) in a patient with idiopathic hypereosinophilic syndrome.

Eosinophilic myocarditis can result in endomyocardial fibrosis affecting both ventricles, leading to restrictive cardiomyopathy. Multimodality imaging is crucial for diagnosis, as demonstrated in this case of a patient presenting with symptoms of heart failure.

Postoperative Myocardial Infarction Due to Coronary Embolization of Valve Tissue After Surgical Mitral Valve Replacement.

We present the case of a 61-year-old man with known Morbus Barlow disease, who presented with postoperative myocardial infarction and cardiac arrest within 1 hour after minimally invasive mitral valve surgery owing to coronary artery occlusion by native mitral valve tissue.

Transcatheter Aortic Valve Implantation With Balloon-Expandable Valve Prostheses in Patients With Pure Native Non- or Mildly Calcified Aortic Regurgitation: A Case-Series and Literature Review.

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) is an off-label procedure for selected patients at high surgical risk with native non- or mildly calcified aortic regurgitation (AR). Traditionally, self-expanding transcatheter heart valves (THV) have been favored over balloon-expandable THV's probably due to assumed better device fixation. We report a series of patients with native severe AR successfully treated with a balloon-expandable THV. METHODS: Between 2019 and 2022, 8 consecutive patients (5 male, 82 (interquartile range 80-85) years old, STS PROM 4.0 % (interquartile range 2.9-6.0), EuroSCORE II 5.5% (IQR 4.1-7.0) with non- or mildly calcified pure AR were treated with a balloon-expandable THV. All procedures were performed after heart team discussion and standardized diagnostic workup. Clinical endpoints were collected prospectively and included device success, procedural complications (according to VARC-2 definitions) and 1-month survival. RESULTS: Device success was 100% with no device embolization or migration. Two preprocedural nonfatal complications were reported (one access site complication that required stent implantation and one pericardial tamponade). Two patients required permanent pacemaker implantation for complete AV block. At discharge and at 30-day follow-up all patients were alive and no patient showed more than minimal AR. CONCLUSION: This series documents that treatment of native non- or mildly calcified AR with balloon-expandable THV is feasible, safe and offers favorable short-term clinical outcomes. Hence, TAVI with balloon-expandable THVs may offer a valuable treatment option in patients with native AR at high surgical risk.

[Transcatheter Aortic Valve Implantation in Multivalvular Heart Disease]. / Transkatheter-Aortenklappenimplantation (TAVI) bei multivalvulären Herzerkrankungen.

Transcatheter Aortic Valve Implantation in Multivalvular Heart Disease Abstract. The prevalence of multivaluvular heart disease is high in patients undergoing transcatheter aortic valve implantation (TAVI). The most common combination is aortic valve stenosis (AS) and mitral regurgitation, followed by the combination of AS with a tricuspid regurgitation or mitral stenosis. Grading of multivalvular disease is challenging and can quickly lead to underestimation of the disease stage. Therefore, a profound knowledge of pathophysiologic interactions is essential, and the patient should always undergo multimodal evaluation. After a successful TAVI intervention, secondary heart valve defects may improve, deteriorate, or remain unchanged. Due to the still sparse scientific data in this field, the role of the heart team remains central to provide the patient with an individually adapted therapy plan.

[CME/Answers: Mechanical Assist Devices in Cardiopulmonary Resuscitation]. / CME/Antworten: Mechanische Reanimationshilfe bei Herz-Kreislauf-Stillstand.

CME/Answers: Mechanical Assist Devices in Cardiopulmonary Resuscitation Abstract. Early high-quality cardiopulmonary resuscitation in the event of a cardiac arrest is the most effective measure to improve the outcome. With the aim of improving the quality of resuscitation and replacing the need of manual compression, various mechanical assist devices have been developed and are used in the clinical practice. When should they be used, whether do they lead to better outcomes and what injuries are they associated with? These questions have been examined in several studies and the following review will provide an overview.

Heart rate profiles and heart rate variability during scuba diving.

AIMS: The aim of the present study was to describe heart rate profiles and heart rate variability patterns in non-selected scuba divers of different ages under non-experimental real-world conditions. METHODS: We used specially designed silver-loaded polydimethylsiloxane dry electrodes for underwater ECG recordings. With a custom-built setup, heart rate profiles and heart rate variability patterns were documented before submersion, during diving and after resurfacing in 18 separate dives. RESULTS: Heart rates of the divers just before descent were remarkably high (median 114 bpm, interquartile range [IQR] 83-154) with a statistically significant rapid decrease after submersion (median 90 bpm, IQR 70-116; p = 0.008). The percentage heart rate reduction by submersion was individually very variable (median 21%, range 5-39%). We noted a general increase in autonomic nervous system (ANS) activity without predominance of parasympathetic parameters, suggesting a concomitant sympatheticadrenergic activation. CONCLUSIONS: Scuba diving under real-world conditions by non-selected divers is characterised by relatively high heart rates just before submersion, an individually variable but significant bradycardic dive response, and induces an immediate and sustained parallel increase of parasympathetic and sympathetic-adrenergic autonomic nervous system activity. These observations could explain several specific pathophysiological mechanisms of diving incidents (haemodynamic decompensation, arrhythmias, acute coronary syndromes) and underlines the importance of cardiovascular risk stratification in diving eligibility assessment.

[CME: Mechanical Assist Devices in Cardiopulmonary Resuscitation]. / CME: Mechanische Reanimationshilfe bei Herz-Kreislauf-Stillstand CME-Fragen.

CME: Mechanical Assist Devices in Cardiopulmonary Resuscitation Abstract. Early high-quality cardiopulmonary resuscitation in the event of a cardiac arrest is the most effective measure to improve the outcome. With the aim of improving the quality of resuscitation and replacing the need of manual compression, various mechanical assist devices have been developed and are used in the clinical practice. When should they be used, whether do they lead to better outcomes and what injuries are they associated with? These questions have been examined in several studies and the following review will provide an overview.

[CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome]. / CME/Antworten: Das Linksschenkelblockbild und die Ausschlussdiagnose «Painful Left Bundle Branch Block¼.

CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.

[CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome]. / CME: Das Linksschenkelblockbild und die Ausschlussdiagnose «Painful Left Bundle Branch Block¼.

CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.

Percutaneous pulmonary valve implantation in grown-up congenital heart disease patients: Insights from the Zurich experience.

OBJECTIVES: The aim of the study was to assess indications, procedural success, complications, echocardiographic, and clinical outcomes of percutaneous pulmonary valve implantation (PPVI) in adult patients with congenital heart disease (CHD). BACKGROUND: PPVI offers a non-surgical treatment option for failing prosthetic conduits in pulmonary position. However, efficacy and clinical outcomes after PPVI are still underreported. METHODS: From January 2008 to March 2016, 25 adult CHD patients with right ventricular outflow tract (RVOT) stenosis and/or pulmonary regurgitation underwent PPVI in our institution. Clinical and echocardiographic data was collected at baseline, at 12 months of follow-up and yearly afterwards. RESULTS: Tetralogy of Fallot and repaired pulmonary atresia were among the most prevalent underlying congenital defects. Twenty-one (84%) received a Medtronic Melody® and four (16%) patients an Edwards Sapien valve prosthesis. The PPVI procedure was successful in all 25 patients. Pre-stenting was performed in all but two (8%) patients. PPVI reduced peak-to-peak pulmonary valve gradient from 43 (IQR 28-60) mmHg to 16 (IQR 14-22) mmHg (P < 0.001). Periprocedural complications occurred in two (8%) patients (tricuspid valve damage, pulmonary artery perforation). Over a median follow-up of 43 (IQR 18-58) months all patients were alive. Only two (8%) required re-operation and two (8%) developed stent fractures (one of them had not undergone pre-stenting). NYHA functional class improved significantly, with 20 (80%) patients in NYHA class I on follow-up. CONCLUSIONS: PPVI with Medtronic Melody or Edwards Sapien valve conduits is safe and provides effective relief from right ventricular outflow tract obstruction or pulmonary regurgitation.