Focus Issue: Advanced Venous Imaging and Image-guided Venous Interventions

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https://www.medizin.uni-tuebingen.de/uktmedia/Studierende/PDF_Archiv/PhD_Experimental_Medicine_T%C3%BCbingen.pdf

https://www.medizin.uni-tuebingen.de/uktmedia/Studierende/PDF_Archiv/PhD_Experimental_Medicine_T%C3%BCbingen.pdf

The Faculty of Medicine Tübingen is one of the top medical schools in Germany and is characterized by interdisciplinary, international and innovative research and teaching. We can look back at major advances in clinical and basic biomedical research, particularly in our primary research fields – neuroscience, immunology, oncology, infection biology, imaging science, biomedical engineering, diabetology and vascular medicine.

Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial.

Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial.

 

Eur Radiol. 2016 Nov 18. [Epub ahead of print]

Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial.

Abstract

OBJECTIVES:

More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266).

METHODS:

In this trial, patients with a low-to-intermediate pretest probability (10-60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines.

RESULTS:

Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences.

CONCLUSIONS:

The DISCHARGE trial will assess the comparative effectiveness of CT and ICA.

KEY POINTS:

• Coronary artery disease (CAD) is a major cause of morbidity and mortality. • Invasive coronary angiography (ICA) is the reference standard for detection of CAD. • Noninvasive computed tomography angiography excludes CAD with high sensitivity. • CT may effectively reduce the approximately 2 million negative ICAs in Europe. • DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

KEYWORDS:

Adverse events; Angiography; Comparative effectiveness; Computed tomography; Invasive coronary angiography

PMID:
27864607
DOI:
10.1007/s00330-016-4620-z

Seeking medical care abroad: A challenge to empathy.

Seeking medical care abroad: A challenge to empathy. Zein NN. Cleve Clin J Med. 2016 Nov;83(11):801-803. doi: 10.3949/ccjm.83a.16097.

Outcomes of Endovascular Repair of Ascending Aortic Dissection in Patients Unsuitable for Direct Surgical Repair.

Outcomes of Endovascular Repair of Ascending Aortic Dissection in Patients Unsuitable for Direct Surgical Repair.

 

J Am Coll Cardiol. 2016 Nov 1;68(18):1944-1954. doi: 10.1016/j.jacc.2016.08.031.

Outcomes of Endovascular Repair of Ascending Aortic Dissection in Patients Unsuitable for Direct Surgical Repair.

Abstract

BACKGROUND:

Stent grafting is a therapeutic option for patients who are unable to undergo urgent surgical repair of ascending aortic dissections. However, follow-up regarding outcomes is limited.

OBJECTIVES:

This study reports mid-term outcomes with endovascular repair for ascending aortic dissections in patients deemed high risk for open repair.

METHODS:

Between May 1, 2009 and January 31, 2011, 15 ascending aortic dissection patients (ages 45 to 78 years) ineligible for direct surgical repair underwent endovascular repair (1 acute dissection, 7 subacute dissections, and 7 chronic dissections) and were closely followed up for a median of 72 months (range 61 to 81 months).

RESULTS:

The mean interval between aortic dissection onset and treatment was 25.5 (range 6 to 353) days. Technical success was achieved in all patients. No major morbidity or deaths occurred perioperatively. During the follow-up period, there were no deaths, 8 complications occurred, and there were 4 reinterventions. A new dissection in the aortic arch was treated with a branched endograft. One patient developed retrograde aortic dissection and a left ventricular pseudoaneurysm was successfully treated with open surgery. One cardiovascular ischemia was treated with stenting and 1 supraventricular tachycardia was treated with radiofrequency ablation. Other morbidities included perigraft endoleak, a bird-beak sign, a temporary pericardial effusion, and a left kidney atrophy. Significant enlargements of true lumens and shrinkage of false lumens and overall thoracic aorta were observed at 12 months. No significant changes were detected subsequently. Minimal impact on aortic valve function was recorded over time.

CONCLUSIONS:

Our results with the novel endovascular procedure appear acceptable. Additional evidence and studies with larger sample size and longer follow-up are needed to support the durability of this new technique.

A case of asymptomatic patient with right ventricular dilatation

 

A case of asymptomatic patient with right ventricular dilatation

Wael AlJaroudi1, Firas El Bitar2, Ghida Mouharram3, Jihad Daher3, Gebrine El-Khoury4

1Division of Cardiovascular Medicine, 2Division of Cardiothoracic Surgery, 3Department of Radiology, Clemenceau Medical Center, Beirut, Lebanon; 4Division of Cardiothoracic Surgery, St-Luc hospital, Bruxelles, Belgium

Correspondence to: Wael AlJaroudi, MD, FESC, FACC, FAHA. Associate Professor of Medicine, Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon. Email: wael.jaroudi@cmc.com.lb.

Abstract: Sinus venous defect is an uncommon type of atrial septal defect (ASD), often associated with anomalous pulmonary vein drainage and left to right shunting. If undetected, it leads to right atrial and ventricular volume overload. The current case describes an asymptomatic athlete with missed large sinus venosus defect since birth, and the different types of cardiac imaging modalities that lead to the detection of the defect and guiding the appropriate surgical intervention.

Keywords: Sinus venosus defect; anomalous pulmonary vein drainage; shunt; right ventricular dilatation

http://xym.amegroups.com/article/view/3633/4336

 

3633-pb5-r1

Our Focus Issue about cardiothoracic surgery in sub-saharan Africa is online!

Our Focus Issue about cardiothoracic surgery in sub-saharan Africa is online. http://cdt.amegroups.com/issue/view/489

suppl-oct-cdt