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2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.

Journal of the American College of Cardiology (Impact Factor: 15.34). 10/2008; 52(13):e1-142. DOI: 10.1016/j.jacc.2008.05.007
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    ABSTRACT: Aim Cardiovascular magnetic resonance (CMR) has been increasingly used as an alternative method to evaluate the severity of aortic stenosis. The aim of our study was to evaluate whether the indirect measurement of the aortic gradient (Calc-PG), derived from Gorlin's formula, is a reproducible parameter for gradient assessment. Then, we evaluated if this parameter is correlated with left ventricular hypertrophy, considered as a marker of severity of aortic stenosis, better than phase-contrast sequences-derived pressure gradient (PC-PG) and aortic valve area. Methods Forty-one patients with isolated aortic stenosis underwent CMR. Calc-PG was obtained from the formula (cardiac output/aortic valve area)2, and it was compared to PC-PG. Results We found that the Calc-PG has higher correlation with left ventricle mass than PC-PG (r2 0.44, p < 0.001 vs. r2 0.26, p < 0.01), also after multivariate analysis adjusting for age, gender and hypertension (p < 0.001). Furthermore, Calc-PG was more reproducible than PC-PG. The receiver operating characteristic comparison curve analysis showed that Calc-PG has a significantly higher ability to describe the presence of left ventricular hypertrophy than PC-PG (area under the curve 0.85, 95% CI 0.70–0.94, p < 0.0001 vs. 0.74, 95% CI 0.58–0.87, p = 0.03). Conclusions We propose that transaortic gradient indirectly calculated by using the simplified Gorlin's equation could be an alternative method to assess the severity of aortic stenosis.
    Journal of Cardiology 08/2014; 65(5). DOI:10.1016/j.jjcc.2014.07.015 · 2.57 Impact Factor
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    ABSTRACT: Cardiovascular disease (CVD) is one of the leading causes of death in the Western world. The replacement of damaged vessels and valves has been practiced since the 1950's. Synthetic grafts, usually made of bio-inert materials, are long-lasting and mechanically relevant, but fail when it comes to "biointegration". Decellularized matrices, instead, can be considered biological grafts capable of stimulating in vivo migration and proliferation of endothelial cells (ECs), recruitment and differentiation of mural cells, finally, culminating in the formation of a biointegrated tissue. Decellularization protocols employ osmotic shock, ionic and non-ionic detergents, proteolitic digestions and DNase/RNase treatments; most of them effectively eliminate the cellular component, but show limitations in preserving the native structure of the extracellular matrix (ECM). In this review, we examine the current state of the art relative to decellularization techniques and biological performance of decellularized heart, valves and big vessels. Furthermore, we focus on the relevance of ECM components, native and resulting from decellularization, in mediating in vivo host response and determining repair and regeneration, as opposed to graft corruption.
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    ABSTRACT: BACKGROUND: The utility of cardiac magnetic resonance imaging (CMR) for assessment of adults with Ebstein anomaly is not well-defined. We sought to evaluate CMR characteristics in this population and to relate these to exercise parameters. METHODS: We analyzed CMR studies in adults with unrepaired Ebstein anomaly for measures of severity of Ebstein disease, including atrialized, functional and total right ventricular (RV) volumes, ejection fraction (EF) and severity index (area of atrialized RV+right atrium/functional RV+left ventricle+left atrium). We related these CMR values to cardiopulmonary exercise test measurements. RESULTS: Twenty-seven adults (mean age 41±14years, 70% female) were included. Functional RV end-diastolic volume (EDV) was 150±68mL/m(2) and atrialized RVEDV was 25±24mL/m(2). In 17 patients (63%), the functional RVEDV was enlarged (>114mL/m(2)). Percent predicted peak VO(2) for the population was 65±20%. On univariable analysis, peak VO(2) was inversely related to atrialized RVEDV (p=0.011), total RVEDV (p=0.041), functional RVEDV/left ventricular EDV ratio (p=0.015) and magnitude of tricuspid valve displacement (p=0.031). In the multivariate model, the only CMR factor to relate to peak VO(2) was atrialized RVEDV (p=0.011, β=-0.48). No significant correlations were found between CMR measures and heart rate response or ventilatory response to exercise. CONCLUSION: In adults with unrepaired Ebstein anomaly, atrialized RV volume was independently related to aerobic capacity. The volume of the atrialized RV is a novel CMR measure which may express severity of disease. Further research is needed to evaluate the prognostic relevance of this exploratory work.
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