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3.
Tex Heart Inst J ; 46(3): 189-194, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708701

RESUMO

Patients with anomalous origin of a coronary artery during aortic valve replacement (AVR) are at risk of coronary compromise. Large case series are lacking. In this retrospective study, we review our experience with this condition. From August 2014 through June 2016, 8 adult patients (mean age, 74 ± 17.5 yr; age range, 33-86 yr; 5 men) with anomalous aortic origin of a coronary artery underwent surgical or transcatheter AVR at our institution. Six patients had aortic stenosis; 2 had aortic insufficiency, one of whom had an associated aortic root aneurysm. In 7 patients, the left anomalous coronary artery originated from the right aortic sinus, and in one, the right coronary artery arose from the left cusp. The anatomic course was revealed by means of 3-dimensional computed tomographic angiography. No patient underwent primary aortic reimplantation of the anomalous artery. Two had the artery mobilized from encircling the annulus too closely and then underwent coronary artery bypass grafting. Two high-risk patients underwent transcatheter AVR. After surgical AVR, 2 patients had perioperative myocardial infarction caused by coronary compression, so percutaneous coronary intervention was performed. One patient died of sepsis 3 months after discharge from the hospital. In our patients, AVR sometimes led to severe perioperative complications. Successful AVR depended on 3-dimensional computed tomographic angiographic findings, individual anatomic variations, and appropriate treatment choices.


Assuntos
Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia Doppler em Cores , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Resultado do Tratamento
4.
Methodist Debakey Cardiovasc J ; 15(3): 223-225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687103

RESUMO

Anomalous origin of the right coronary artery (ARCA) is an extremely rare cardiac pathology. The coronary artery can potentially course between the aorta and the pulmonary artery, putting the patient at risk for sudden cardiac death. Even rarer is an ARCA that arises from the left main coronary artery (LMCA). To our knowledge, this is the first case where an ARCA arising entirely from the LMCA is associated with critical bicuspid aortic valve stenosis.


Assuntos
Estenose da Valva Aórtica/etiologia , Valva Aórtica/anormalidades , Anomalias dos Vasos Coronários/complicações , Doenças das Valvas Cardíacas/complicações , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
Rev Port Cir Cardiotorac Vasc ; 26(3): 223-224, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734976

RESUMO

Cold agglutinins (CA) are autoantibodies whose clinical significance depends upon titer and thermal amplitude. Patients, which undergo cardio-pulmonary bypass and especially hypothermic cardioplegia myocardial protection, represent a challenge regarding operative management, as tissue temperature should be maintained above the threshold of agglutination. We report on a case in which the presence of CA was discovered during elective aortic valve replacement surgery, and managed with normothermic cardiopulmonary bypass and continuous retrograde warm blood cardioplegia administration.


Assuntos
Anemia Hemolítica Autoimune/complicações , Ponte Cardiopulmonar/métodos , Parada Cardíaca Induzida/métodos , Doenças das Valvas Cardíacas/cirurgia , Hipotermia Induzida/efeitos adversos , Anemia Hemolítica Autoimune/imunologia , Valva Aórtica/cirurgia , Autoanticorpos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Crioglobulinas/efeitos adversos , Procedimentos Cirúrgicos Eletivos , Parada Cardíaca Induzida/efeitos adversos , Doenças das Valvas Cardíacas/complicações , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos
6.
Braz J Cardiovasc Surg ; 34(5): 535-541, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719007

RESUMO

INTRODUCTION: Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. METHODS: The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. RESULTS: Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). CONCLUSION: We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.


Assuntos
Calcinose/complicações , Doenças das Valvas Cardíacas/complicações , Síndrome Metabólica/complicações , Valva Mitral , Tromboembolia/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Calcinose/fisiopatologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Tromboembolia/fisiopatologia
7.
Braz J Cardiovasc Surg ; 34(5): 615-617, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719013

RESUMO

We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.


Assuntos
Endocardite Bacteriana/cirurgia , Infecções por Bactérias Gram-Negativas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Stenotrophomonas maltophilia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Pessoa de Meia-Idade , Choque Séptico/etiologia
8.
Expert Rev Cardiovasc Ther ; 17(10): 753-761, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31591904

RESUMO

Introduction: Dilatation of the proximal aorta is often associated with an aortic valve disease (e.g. bicuspid aortic valve, aortic stenosis), so-called 'valve-related aortopathy.' The definition of optimal timing for surgical intervention in valve-related aortopathy remains incompletely clarified. The limited value of traditional diameter-based intervention criteria has been recognized and more sophisticated diagnostic tools are necessary.Areas covered: This article aims to give an overview on the most recent literature addressing the different forms of valve-related aortopathies and the optimal timing of surgical intervention. It highlights the valve morphotype-dependent (BAV vs TAV) and the valve lesion-dependent aortopathies (stenosis vs regurgitation) and outlines the current treatment options of those pathologies. Further, this review discusses novel serological and rheological markers, potentially helping in the decision-making process in valve-related aortopathy. Systematic literature searches were performed using PubMed and Embase up to July 2019.Expert opinion: The combination of serological biomarkers and quantitative rheological markers for transvalvular flow eccentricity might be an additional useful tool. A possible solution for the future could be a risk score which considers body-surface-adjusted aortic diameters, activity of certain circulating biomarkers, transvalvular flow patterns, possible connective tissue disorders, and the valve morphology to define an individualized treatment strategy.


Assuntos
Aorta/patologia , Valva Aórtica/patologia , Doenças das Valvas Cardíacas/complicações , Aorta/cirurgia , Valva Aórtica/anormalidades , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Biomarcadores/metabolismo , Doenças das Valvas Cardíacas/cirurgia , Humanos
9.
J Cardiothorac Surg ; 14(1): 180, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31647015

RESUMO

BACKGROUND: The traditional approach for adult congenital heart disease combined with valvular disease is surgical treatment under cardiopulmonary bypass (CPB). This approach has a high incidence of postoperative complications, especially in patients with pulmonary hypertension and old age. We present two patients in whom the hybrid procedure was used to treat congenital malformations, followed by valve formation and replacement surgery. CASE PRESENTATION: A 63-year-old man had a muscular ventricular septal defect complicated by mitral regurgitation and a 57-year-old man had patent ductus arteriosus complicated by aortic stenosis. In both of the patients, the congenital malformation was successfully treated by the hybrid procedure, followed by valve repair or replacement. Both patients had no complications. A post-procedure echocardiogram showed no residual shunt across the duct. CONCLUSIONS: Our findings suggest that the hybrid procedure is a useful alternative for treating adult congenital heart disease with valvular heart disease. This procedure reduces the surgical incision and difficulty of surgery, shortens the CPB time, avoids residual leakage after surgery, and reduces recovery and hospitalization times.


Assuntos
Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Estenose da Valva Aórtica/complicações , Ponte Cardiopulmonar , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia , Cardiopatias Congênitas/complicações , Comunicação Interventricular/cirurgia , Doenças das Valvas Cardíacas/complicações , Hospitalização , Humanos , Hipertensão Pulmonar/complicações , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Complicações Pós-Operatórias
10.
Arkh Patol ; 81(5): 70-73, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626207

RESUMO

Lambl's excrescences are a rare disease that is characterized by a lesion of the heart valves as filamentous growths on their surface mainly along the coaptation lines and that is mostly asymptomatic. Due to traumatic injuries during heart contractions, fibrin masses can be deposited on the surface of the growths, contributing to thromboembolic events or infection. The paper provides the data available in the literature and demonstrates a postmortem observation of Lambl's excrescences on the ventricular surface of the mitral valve concurrent with myocardial infarction.


Assuntos
Doenças das Valvas Cardíacas/complicações , Valva Mitral/patologia , Infarto do Miocárdio/complicações , Autopsia , Doenças das Valvas Cardíacas/patologia , Humanos , Infarto do Miocárdio/patologia
11.
Indian Heart J ; 71(3): 284-287, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543203

RESUMO

OBJECTIVE: This study was conducted to evaluate the prevalence of significant coronary artery disease (CAD) in patients with severe valvular heart disease (VHD) and the association between these two cardiac entities. Our research aims to introduce the theory of a possible causal relationship. METHODS: A retrospective study was conducted on 1308 consecutive patients who underwent surgery for severe VHD in the cardiovascular department of Notre-Dame de Secours University Hospital (NDSUH) between December 2000 and December 2016. According to transthoracic echocardiography, patients were divided into 4 groups: patients with severe aortic stenosis (AS), patients with severe aortic regurgitation (AR), patients with severe mitral stenosis (MS), and patients with severe mitral regurgitation (MR). Preoperative coronary angiographies were reviewed for the presence or the absence of significant CAD (≥50% luminal stenosis). Chi-square test and 2 × 2 tables were used. RESULTS: Of the 1308 patients with severe VHD, 1002 patients had isolated aortic valve disease, 240 patients had isolated mitral valve disease, and 66 patients had combined aortomitral valve disease. CAD was detected in 27.75% of all patients with severe VHD, in 32% of patients with isolated aortic valve disease, and in 15% of patients with isolated mitral valve disease. Statistical analysis showed a higher prevalence in patients with severe aortic valve stenosis and a significant relationship between CAD and aortic valve disease, mainly severe AS (p < 0.0001). CONCLUSION: The prevalence of CAD in patients with VHD is 27.75%, and it correlates significantly with aortic valve disease, in particular with severe AS. Future large studies are needed to evaluate the possible causal relationship.


Assuntos
Doença da Artéria Coronariana/complicações , Doenças das Valvas Cardíacas/complicações , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Angiografia Coronária , Feminino , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia , Prevalência , Estudos Retrospectivos
13.
Rev Port Cir Cardiotorac Vasc ; 26(2): 139-141, 2019.
Artigo em Português | MEDLINE | ID: mdl-31476815

RESUMO

Persistant left superior vena cava is a rare systemic venous anomaly that can be associated with agenesis of the right superior vena cava. It is usually assymptomatic and discovered incidentally during surgery or other procedures. The authors present the case of a 72-year-old male submitted to an aortic valve replacement surgery. After sternotomy, persistant left superior vena cava and absence of the right superior vena cava were identified. The patient developed complete atrioventricular block after surgery, requiring the implantation of a definitive cardiac pacemaker through the brachiocephalic vein and coronary sinus. This case highlights and ilustrates the clinical implications of the described systemic venous anomalies, discussing the necessary management both in the perioperative and intraoperative periods.


Assuntos
Valva Aórtica/cirurgia , Bloqueio Atrioventricular/terapia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Malformações Vasculares/complicações , Veia Cava Superior/anormalidades , Idoso , Bloqueio Atrioventricular/etiologia , Estimulação Cardíaca Artificial , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino
14.
Medicine (Baltimore) ; 98(31): e16568, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374023

RESUMO

INTRODUCTION: Valvular vegetation is often due to rheumatic heart disease and infective endocarditis. However, multi-arterial embolism can happen in older patients with no history of infection, fever, and cardiac symptoms. We describe a case of multi-organ embolism caused by oscillating aortal valve vegetation. PATIENT CONCERNS: An 80-year-old woman without a history of infection, fever, and heart symptoms showed sudden loss of consciousness and symptoms of a multi-vessel embolism. Magnetic resonance imaging revealed multiple patchy ischemic foci in both cerebral hemispheres in the same time-phase, and echocardiography showed regurgitation in the aortic valve due to an abnormally hypo-hyperechoic mass measuring about 7.7 × 17.2 mm and oscillating aortic valve vegetation, which was induced by cardiac contraction. DIAGNOSIS: Multiple organ cardiac embolisms caused by oscillating aortic valve vegetation. INTERVENTIONS: Anti-platelet, fluid-supplement, and vascular-dilating therapies as well as intravenous diazepam were given to the patient. OUTCOME: The patient died of epileptic attack secondary to the cerebral embolism. CONCLUSIONS: The patient's whole-body multi-vessel ischemic events in nearly the same time-phase should have encouraged us to consider the possibility of cardiogenic embolism and thus early examination and treatment, although she was old with a relatively poor response due to early infection and physical discomfort. Clinicians should be aware that aortic valve vegetation induces generalized multi-organ embolism in the setting of infective endocarditis in order to ensure prompt recognition and treatment of this fatal complication.


Assuntos
Valva Aórtica , Embolia/etiologia , Doenças das Valvas Cardíacas/complicações , Idoso de 80 Anos ou mais , Embolia/terapia , Feminino , Hidratação , Humanos , Imagem por Ressonância Magnética , Inibidores da Agregação de Plaquetas/uso terapêutico , Vasodilatadores/uso terapêutico
15.
Cardiol Young ; 29(8): 1099-1100, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280738

RESUMO

We present a case of infective endocarditis caused by Streptococcus gordonii in an 11-year-old girl with Barlow's mitral valve disease. The differential diagnosis of rheumatic carditis and infective endocarditis was difficult as the patient fulfilled the Jones criteria. Vegetation on the mitral valve which became evident later in course of the disease and positive blood culture allowed diagnosing "definite" infective endocarditis.


Assuntos
Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Streptococcus gordonii/isolamento & purificação , Criança , Diagnóstico Diferencial , Ecocardiografia , Endocardite Bacteriana/cirurgia , Feminino , Doenças das Valvas Cardíacas/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Resultado do Tratamento
16.
Herz ; 44(6): 491-501, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312873

RESUMO

Pulmonary hypertension (PH) is an important contributor to morbidity and mortality in patients with left-sided heart disease, including valvular heart disease. In this context, elevated left atrial pressure primarily leads to the development of post-capillary PH. Despite the fact that repair of left-sided valvular heart disease by surgical or interventional approaches will improve PH, recent studies have highlighted that PH (pre- or post-interventional) remains an important predictor of long-term outcome. Here, we review the current knowledge on PH in valvular heart disease taking into account new hemodynamic PH definitions, and the distinction between post- and pre-capillary components of PH. A specific focus is on the precise characterization of hemodynamics and cardiopulmonary interaction, and on potential strategies for the management of residual PH after mitral or aortic valve interventions. In addition, we highlight the clinical significance of tricuspid regurgitation, which may occur as a primary condition or as a consequence of PH and right heart dilatation (functional). In this context, proper patient selection for potential tricuspid valve interventions is crucial. Finally, the article highlights gaps in evidence, and points toward future perspectives.


Assuntos
Doenças das Valvas Cardíacas , Hipertensão Pulmonar , Insuficiência da Valva Tricúspide , Doenças das Valvas Cardíacas/complicações , Hemodinâmica , Humanos , Hipertensão Pulmonar/complicações , Valva Tricúspide , Insuficiência da Valva Tricúspide/complicações
17.
Lakartidningen ; 1162019 May 15.
Artigo em Sueco | MEDLINE | ID: mdl-31192394

RESUMO

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, affecting 1-2% of the general population. BAV is associated with an increased morbidity and mortality related to diseases of the aortic valve (aortic stenosis and aortic regurgitation) and the thoracic aorta (aortic aneurysm and aortic dissection). These conditions can often be treated surgically to prevent adverse events and reduce mortality. However, optimal management of BAV patients requires knowledge about the natural history of common clinical complications and involved pathological mechanisms. The aim of this article is to present common complications associated with BAV and to summarize the recently published evidence-based guidelines focusing solely on BAV patients.


Assuntos
Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas , Valva Aórtica/cirurgia , Consenso , Ecocardiografia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Guias de Prática Clínica como Assunto , Estados Unidos
19.
Int Heart J ; 60(3): 637-642, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105146

RESUMO

Bicuspid aortic valve (BAV) is the most common congenital heart disease. Different distribution of valve dysfunction was found in patients with BAV in different age and sex groups, but related difference was not well established. The aim of our study is to investigate age- and sex-related clinical characteristics differences in patients with BAV.Six hundred twenty patients with BAV who had moderate or severe aortic valve dysfunction were included in the study. Basic clinical data and image data were recorded. Patients were classified into four different age groups: (A: ≤ 50 years old; B: 50-60 years old; C: 60-70 years old; D: > 70 years old). The sex-related clinical difference in different age groups was compared. Association between incidence of aortic valve dysfunction and age was evaluated.Male patients had more frequent aortic regurgitation (AR) in patients younger than 70 years old (A: 52.3% versus 20.0%, P = 0.012; B: 43.2% versus 17.8%, P < 0.001; C: 17.0 versus 2.6%, P = 0.002), whereas female patients were more likely to have aortic stenosis (AS) (A: 75.0% versus 34.1%, P = 0.001; B: 77.8% versus 37.0%, P < 0.001; C: 93.6% versus 69.8%, P < 0.001). Frequency of AR in male patients decreased with age, whereas frequency of AS increased. Trend test showed a significant difference in incidence of aortic valve dysfunction as age increased in male patients (AR, P < 0.001; AS, P < 0.001). No trend was found in female patients.Male patients with BAV present more often with moderate/severe AR at a young age, and the frequency of AR decreases with age. Female patients with BAV had more frequent AS at first presentation regardless of age.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/etiologia , Ecocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
20.
Monaldi Arch Chest Dis ; 89(2)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31107036

RESUMO

We do not always accomplish what is best for our patients. Is "more procedures, more drugs" a real synonym of good and always useful medicine? Probably not. Indeed, it has been highlighted that many tests and treatments, widely used in medical practice, do not bring benefits to patients, but they can be harmful. So, why do we keep performing them? Many reasons, surely one of the main is the constant fear of malpractice legal-medical consequences; this led to the development of a defensive medicine, no longer focused on the health of the patient. For this reason, the Italian Association of Cardiac Prevention and Rehabilitation (GICR-IACPR) joined an international project "Choosing Wisely", supported by the Slow Medicine Initiative, a network which states that "Less is more". The purpose of "Choosing Wisely " project is to improve the quality and safety of health services through the reduction of practices that, according to available scientific knowledge, do not bring significant benefits to the patients, but can, on the contrary, expose them to risks. This GICR-IACPR paper proposes to avoid five widespread practices in cardiology, at risk for inappropriateness and lacking of clinical evidence of benefit: • Do not perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery • Do not perform Computed Tomography for coronary calcium score in patients at high cardiovascular risk • Do not perform Holter electrocardiographic monitoring in patients suffering from syncope, near syncope or dizziness, in whom a non-arrhythmic origin has been documented • Do not routinely prescribe proton pump inhibitors (PPI) for gastrointestinal bleeding prophylaxis in patient with single drug antiplatelet therapy in absence of additional risk factors. • Avoid routine use of infective endocarditis prophylaxis in mild to moderate native valve disease.


Assuntos
Cardiologia/métodos , Cardiologia/normas , Endocardite/prevenção & controle , Hemorragia Gastrointestinal/prevenção & controle , Melhoria de Qualidade , Procedimentos Desnecessários , Anti-Infecciosos/uso terapêutico , Reabilitação Cardíaca , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia Ambulatorial , Endocardite/etiologia , Hemorragia Gastrointestinal/induzido quimicamente , Doenças das Valvas Cardíacas/complicações , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Radiografia Torácica , Fatores de Risco , Síncope/etiologia , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagem
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