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JACC Cardiovasc Imaging ; 12(7 Pt 1): 1254-1278, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31272608


There has been a tremendous growth quantity of high-quality imaging evidence in the area of acute and stable ischemic heart disease (SIHD). A number of recent comparative effectiveness trials have spurned significant controversies in the field of cardiovascular imaging. The result of this evidence is that many health care policies and national guidelines have undergone significant revisions. With all of this evidence, many challenges remain and the optimal evaluation strategy for evaluation of patients presenting with chest pain remains ill-defined. This paper enlisted the guidance of numerous experts in the field of cardiovascular imaging to garner their perspective on available imaging research in chest pain syndromes. Each of these vignettes represent editorial perspectives and diverse opinions as to which, if any, should be the primary test in the evaluation of stable chest pain. These perspectives are not meant to be all inclusive but to highlight many of the commonly discussed controversies in the evaluation of chest pain symptoms. These perspectives are presented as a pre-amble to an upcoming American College of Cardiology/American Heart Association clinical practice guideline that is undergoing revision from the previous report published in 2012. The evidence has changed considerably since the 2012 SIHD guideline, and the current perspectives represent the diversity of available evidence as to the optimal imaging strategy for evaluation of the symptomatic patient.

Clin Med (Lond) ; 19(1): 1, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30651236
Future Healthc J ; 5(1): 1, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31098520
Eur J Cardiothorac Surg ; 53(3): 505-511, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29040454


Aircrew are responsible for safe and reliable aircraft operations. Cardiovascular disease accounts for 50% of all pilot licences declined or withdrawn for medical reasons in Western Europe and is the most common cases of sudden incapacitation in flight. Aircrew retirement age is increasing (up to age 65) in a growing number of airlines and the burden of subclinical, but potentially significant, coronary atherosclerosis is unknown in qualified pilots above age 40. Safety considerations are paramount in aviation medicine, and the most dreaded cardiovascular complications are thromboembolic events and rhythm disturbances due to their potential for sudden incapacitation. In aviation, the current consensus risk threshold for an acceptable level of controlled risk of acute incapacitation is 1% (for dual pilot commercial operations), a percentage calculated using engineering principles to ensure the incidence of a fatal air accident is no greater than 1 per 107 h of flying. This is known as the '1% safety rule'. To fly as a pilot after cardiac surgery is possible; however, special attention to perioperative planning is mandatory. Choice of procedure is crucial for license renewal. Licensing restrictions are likely to apply and the postoperative follow-up requires a tight scheduling. The cardiac surgeon should always liaise and communicate with the pilot's aviation medicine examiner prior to and following cardiac surgery.

Medicina Aeroespacial , Procedimentos Cirúrgicos Cardíacos , Pilotos/normas , Adulto , Animais , Pesquisa Biomédica , Doenças Cardiovasculares/cirurgia , Gravitação , Haplorrinos , Humanos , Masculino , Literatura de Revisão como Assunto
Pacing Clin Electrophysiol ; 40(11): 1218-1226, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28940449


BACKGROUND: Tissue thickness at the site of ablation is a determinant of lesion transmurality. We reported the feasibility, safety, and efficacy of longstanding persistent atrial fibrillation ablation, incorporating deliberate left atrial appendage (LAA) isolation and occlusion, and identified systematic differences in ostial LAA tissue thickness in a matched cohort of cadaveric specimens. METHODS: Preprocedural cardiac computed tomography (CCT) scans were acquired from 22 patients undergoing LAA isolation and subsequent occlusion. Using a novel CCT wall thickness algorithm, LAA ostial wall thickness was assessed in vivo, compared with measurements from the cadaveric specimens, and analyzed for differences between regions that demonstrated acute electrical reconnection and those that did not. RESULTS: Mean tissue thickness calculated for each LAA ostial quadrant was 2.1 (±0.6) mm (anterior quadrant), 1.9 (±0.4) mm (superior quadrant), 1.5 (±0.4) mm (posterior quadrant), and 1.8 (±0.7) mm (inferior quadrant). Tissue was significantly thicker in the anterior (P  =  0.004) and superior quadrants (P  =  0.014) than the posterior quadrant. Higher thickness measurements were recorded from quadrants demonstrated to be thicker from histology. Tissue was significantly thicker in regions that demonstrated acute electrical reconnection (1.9 (±0.6) mm) when compared with those that did not (1.6 (±0.5) mm) (P  =  0.008). CONCLUSIONS: CCT imaging may be used to detect differences in wall thickness at different atrial locations and success of LAA ablation may be affected by local tissue thickness. Atrial wall thickness may need to be considered as a metric to guide titration of radiofrequency energy for safe and successful ablation.

Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Tomografia Computadorizada por Raios X , Algoritmos , Apêndice Atrial/patologia , Fibrilação Atrial/patologia , Cadáver , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Resultado do Tratamento