Abstract:
:When considering all the major series comparing the early and late results of mitral valve repair versus prosthetic or bioprosthetic mitral valve replacement, the operative mortality rate is slightly lower for patients undergoing valve reconstruction. Late survival is also superior after valve repair. Although these modest differences may be related to patient selection bias, a lower rate of thromboembolic and endocarditis-related complications and improved LV function remain as rather compelling factors favoring valve repair. The durability of valve repair is comparable to valve replacement in terms of reoperation rate, except in cases of rheumatic valve abnormality (in which reoperation rates are higher after valvuloplasty). Definitive, objective evidence favoring mitral valve repair is lacking given the short period of followup in all studies and absence of controlled, randomized clinical trials. The success of mitral valve reconstruction relies heavily on the experience and technical expertise of the surgeon. The wide variability in observed survival rates, however, is unlikely to be due to differences in surgical skill between experienced groups; it more likely represents the results of differing criteria for mitral valve repair, various followup intervals, and comparisons between distinctly different cohorts. Although a prospective randomized trial would be ideal to compare the results of mitral valve reconstruction versus mitral valve replacement for patients with mitral valve regurgitation, it is unlikely and unrealistic that such a study will ever be conducted. The universal applicability of the results of such a study would also be dubious, given the widely varying extent of surgical expertise with mitral valve repair. Furthermore, not all types of mitral regurgitation are amendable to reconstruction short of using patch techniques (usually autologous pericardium treated with glutaraldehyde) or resorting to artificial chordae (e.g., extensive leaflet destruction from rheumatic changes or infective endocarditis, and substantial anterior leaflet redundancy). In cases in which mitral valve replacement is necessary, preservation of the mitral subvalvular apparatus promises to be an important concept to preserve optimal systolic LV function postoperatively.
journal_name
Cardiol Clinjournal_title
Cardiology clinicsauthors
Yun KL,Miller DCsubject
Has Abstractpub_date
1991-05-01 00:00:00pages
315-27issue
2eissn
0733-8651issn
1558-2264journal_volume
9pub_type
杂志文章,评审abstract::Given the rapid evolution of cardiovascular medicine, clinicians must sift through an enormous array of information about new therapies in order to determine how best to treat patients with ischemic heart disease. They should first consider the evidence from randomized clinical trials, because these trials eliminate b...
journal_title:Cardiology clinics
pub_type: 杂志文章
doi:
更新日期:1995-08-01 00:00:00
abstract::A number of therapeutic agents, foods, chemicals, and poisons have been associated with the development or exacerbation of hypertension. This review discusses those identified in recent years. ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-11-01 00:00:00
abstract::The AbioCor is a revolutionary device. It is the only device of its kind in the clinical world. The role of the AbioCor is to provide permanent replacement of the failing heart for patients who are not transplant candidates. The clinical trial has been successful in the majority (four of seven) of patients implanted t...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(02)00141-8
更新日期:2003-02-01 00:00:00
abstract::Dilated cardiomyopathy is a heterogeneous disease, both clinically and genetically. Two genes responsible for X-linked DCM have been identified. Five genetic loci responsible for X-linked DCM have been identified. Five genetic loci responsible for autosomal dominant DCM have also been mapped but no genes identified so...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70037-0
更新日期:1998-11-01 00:00:00
abstract::The increasing number of patients with both cardiac and renal disease makes it important for the clinician to bear in mind the effect of both renal failure and peritoneal or hemodialysis on the handling of drugs. Guidelines are available for specific medications; however, they must be used in the light of the patient'...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-11-01 00:00:00
abstract::Venous thromboembolism (VTE) is a potentially fatal condition and includes deep vein thrombosis and pulmonary embolism. The novel oral anticoagulants, which include the direct thrombin and factor Xa inhibitors, have been shown to be safe and effective for the treatment of VTE. Additional interventions include thrombol...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2014.09.007
更新日期:2015-02-01 00:00:00
abstract::Carcinoid heart disease is the collective term for all cardiac manifestations that develop in patients with carcinoid. The cardiac manifestations of carcinoid tumors are attributed to the paraneoplastic effects of vasoactive substances released by the malignant cells. The clinical manifestations of carcinoid heart dis...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2019.07.014
更新日期:2019-11-01 00:00:00
abstract::In conclusion, the findings of most recent studies show that moderate-intensity aerobic exercise training can lower BP in patients with stage 1 and 2 essential hypertension. The average reduction in BP is 10.5 mm Hg for systolic and 7.6 mm Hg for diastolic BP. The reductions do not appear to be gender- or age-specific...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70232-0
更新日期:2001-08-01 00:00:00
abstract::Exercise therapy is a valid therapeutic modality in patients with hyperlipoproteinemia (HLP). In combination with appropriate dietary modification, it can be a powerful therapeutic tool and may allow a reduction in hyperlipidemic medication doses. Improved triglyceride values and lipoprotein profiles can be obtained. ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-05-01 00:00:00
abstract::As the incidence of valvular disease in the elderly is increasing, understanding of its pathogenesis and natural progression as well as surgical approaches and device technologies are improving. Future studies are needed to develop medical interventions that slow or halt the degenerative valvular processes associated ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70061-8
更新日期:1999-02-01 00:00:00
abstract::One hundred years ago, Augustus Desiré Waller recorded the human electrocardiogram for the first time, using a capillary electrometer. Electrocardiography only became clinically relevant in 1901 when Willem Einthoven devised his string galvanometer for this purpose. Sir Thomas Lewis was the key figure in showing the v...
journal_title:Cardiology clinics
pub_type: 传,历史文章,杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::The evaluation and management of volume status in patients with heart failure is a challenge for most clinicians. In addition, such an evaluation is possible only during a personal clinician-patient interface. The ability to acquire hemodynamic data continuously with the help of implanted devices with remote monitorin...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2011.03.002
更新日期:2011-05-01 00:00:00
abstract::Systemic hypertension is a major public health problem and is perhaps the most common chronic disorder in most societies. Most patients with vascular disease report hypertension in their medical history. Irrespective of the specialty that one practices, every physician will likely encounter patients with systemic hype...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(01)00008-x
更新日期:2002-05-01 00:00:00
abstract::The fundamental requirements for a meaningful biomarker have not been met in the prediction of the aneurysm trait, the progression of the aneurysm disease state, or the prevention of catastrophic aortic complications. Aortic aneurysm is a worthy opponent on all fronts, and clinicians should continue actively to evalua...
journal_title:Cardiology clinics
pub_type: 评论,杂志文章,评审
doi:10.1016/j.ccl.2010.01.018
更新日期:2010-05-01 00:00:00
abstract::Abnormal systolic ventricular function and persistent ischemia are sensitive indicators of poor prognosis following myocardial infarction. The use of exercise improves the utility of both radionuclide ventriculography and myocardial perfusion scintigraphy in the identification of postinfarction patients at high risk o...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1984-08-01 00:00:00
abstract::Atrial fibrillation (AF) is the most prevalent heart rhythm disorder. AF accounts for a great proportion of deaths because it independently increases all-cause mortality and cardiovascular mortality risks. Ischemic stroke is the most common cardiovascular adverse event in AF patients. Oral anticoagulation (OAC) therap...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.12.006
更新日期:2016-05-01 00:00:00
abstract::Significant advances have been made in understanding the pathogenesis and clinical physiology of primary hypertension. This article presents an overview of the physiology of normal blood pressure control and the pathophysiologic mechanisms that predispose individuals and populations to primary hypertension. The role o...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2010.07.001
更新日期:2010-11-01 00:00:00
abstract::The initial evaluation of patients with transient loss of consciousness (LOC) comprises a detailed medical history, physical examination, and 12-lead electrocardiogram. Because there are many causes of syncopal and nonsyncopal LOC, an adequate method of taking the clinical history, which is the cornerstone of diagnosi...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.04.002
更新日期:2015-08-01 00:00:00
abstract::Many of the transcatheter devices described in this article remain investigational in the United States. Currently, we consider the applications of these techniques as either (1) procedures of choice (for closures of patent ductus arteriosus, balloon dilation or stent implantation for peripheral pulmonary stenoses, ba...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00
abstract::The overall management and prognosis of patients with acute myocardial infarction must take into account not only infarct size but also the site and locus of involvement as determined by electrocardiography. Transmural versus nontransmural infarction is discussed in relation to therapy and prognosis. ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1984-02-01 00:00:00
abstract::This article discusses the epidemiology of cardiovascular (CV) events in end-stage and early renal disease, summarizes the profile of classic and nonclassic CV risk factors in renal patients, highlights recent evidence documenting accelerated atherogenesis in renal disease, and provides information on the central arte...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2005.03.002
更新日期:2005-08-01 00:00:00
abstract::Coronary computed tomographic angiography (CTA) is a promising noninvasive tool that allows the visualization of plaque morphology. Plaques characterized by positive remodeling, low attenuation, and napkin ring circular enhancement on contrast-enhanced coronary CTA have been regarded as rupture-prone vulnerable plaque...
journal_title:Cardiology clinics
pub_type: 杂志文章
doi:10.1016/j.ccl.2011.10.002
更新日期:2012-02-01 00:00:00
abstract::Except for the unique eccentricities of individual devices, most dual-chamber paced rhythms, both normal and abnormal, are readily understood and lend themselves to analysis if the programmed parameters are known. Although they may appear intimidating, this need not be the case if the physician is initially willing to...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1985-11-01 00:00:00
abstract::Catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction is associated with improvement in patient-centered outcomes, such as mortality, heart failure readmission, and atrial fibrillation recurrence, compared with standard medical therapy with or without device therapy. T...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2019.01.004
更新日期:2019-05-01 00:00:00
abstract::Anger is the affective state most commonly associated with myocardial ischemia and life-threatening arrhythmias. The scope of the problem is sizeable-at least 36,000 (2.4% of 1.5 million) heart attacks are precipitated annually in the United States by anger. The lethal cardiovascular consequences in ischemic heart dis...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70281-2
更新日期:1996-05-01 00:00:00
abstract::Surgical septal myectomy is the preferred method of septal reduction for most patients with obstructive hypertrophic cardiomyopathy whose symptoms do not respond to medical management. Transaortic extended septal myectomy has low operative mortality and provides durable relief of symptoms. Surgical treatment is possib...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2018.08.006
更新日期:2019-02-01 00:00:00
abstract::This article presents an approach to real-time three-dimensional imaging of the tricuspid valve from three different views. This is followed by some representative cases that illustrate these views and some unique tricuspid valve abnormalities, including one case of corrected transposition. ...
journal_title:Cardiology clinics
pub_type: 杂志文章
doi:10.1016/j.ccl.2007.06.001
更新日期:2007-05-01 00:00:00
abstract::Chest pain units are now established centers for assessment of low-risk patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome. Accelerated diagnostic protocols, of which treadmill testing is a key component, have been developed within these units for efficient evaluation o...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2005.08.016
更新日期:2005-11-01 00:00:00
abstract::Ebstein anomaly is a congenital malformation involving primarily the tricuspid valve, with failure of delamination from the underlying myocardium and right ventricular myopathy. Echocardiography is diagnostic in most patients and demonstrates apical displacement of the septal leaflet and variable tethering of leaflet ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2020.04.004
更新日期:2020-08-01 00:00:00
abstract::The majority of individuals with diabetes die from cardiovascular disease (CVD) and related complications. The risk of CVD is 2 to 4 fold greater in diabetes and largely magnified by co-morbidities that aggregate along with it. Sufficient evidence-based data now exist to support multifactorial risk intervention with s...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2010.11.004
更新日期:2011-02-01 00:00:00