简介：Amongallcongenitalheartdisease,Ebsteinanomalyisthelesionwiththewidestspectrumofpresentation.Itcanpresentasearlyastheneonatalperiodwhereimmediateinterventionisoftenneededtotheadultwithnodiscernablesymptoms.Itisalsoonewhereoveralloutcomegreatlyrelatestoageatpresentation.Generally,presentationintheneonatalperiodisassociatedwithpooroutcomeswhilepresentationbeyondtheneonatalperiodhasexcellentoutcomeswithlowoperativemortality.ItisthusapparentthatunderstandingeveryaspectoftheanatomyandphysiologyofEbsteinanomalyandhowitmanifestsclinicallyisparamounttosuccessfultreatment.ThepurposeofthisreviewistooutlinethecurrentconceptsandstrategiesinthesurgicalmanagementofEbsteinanomaly,andtodiscussthecurrentexpertconsensusonhowbesttotacklethiscongenitalheartdiseaseatdifferentagesofdiagnosis.

简介：Hypertensionisaleadingriskfactorforcardiovasculardisease,theleadingcauseofdeathandmorbidityinoursocietyandonaglobalscale.Majorcomponentsofcardiovasculardiseaseincludestroke,coronaryarterydisease,heartfailure,andchronickidneydisease,inallofwhichhypertensionplaysamajorrole.Theriskofthesecomplicationsincreasesdirectlyandlinearlywithsystolicbloodpressurestartingat115mmHg.Althoughusuallyasymptomatic,hypertensionisreadilydetectableonphysicalexaminationandisamenabletobothlifestylemodificationandpharmacologictreatmentinmostpatients.However,largeproportionsofthehypertensivepopulationremainundetectedandundertreated.Numerousguidelineshavebeenissuedduringthepastfewdecadestopromotedetectionandoptimaltherapy.Despitetheincreaseinriskwithsystolicbloodpressuregreaterthan115mmHg,thegenerallyacceptedthresholdfordiagnosisandtreatmenthasbeensystolicbloodpressuregreaterthan139mmHganddiastolicbloodpressuregreaterthan80mmHgbecauseuntilrecentlytreatmenttolowerlevelshasbeenassociatedwithanunfavorablerelationbetweenclinicalbenefitandharm.Inthepastseveralyears,newguidelines,advisories,commentaries,andclinicaltrialshaveprovidedevidenceforapotentialchangeincurrentrecommendationsforthemanagementofhypertension.Inthisregard,thelong-awaitedeighthreportoftheJointNationalCommitteeonthePrevention,Detection,Evaluation,andTreatmentofHighBloodPressurerecommendedpatientsolderthan60yearsbetreatedtoasystolicbloodpressureoflessthan150mmHg,whichhasgeneratedconsiderablecontroversyandcaution.ThestrikingfindingsoftheSystolicBloodPressureInterventionTrial(SPRINT)havereceivedconsiderableattentionbecauseofthedemonstrationthatintensivetherapytoatargetsystolicbloodpressurebelow120mmHgdecreasescardiovascularmortalityandmorbiditymorethanlessintensivetreatmenttoatargetsystolicbloodpressurebelow140mmHg

简介：Thispaperreviewscurrentrecommendationsontheappropriateevaluationandmanagementofcardiacarrhythmiasinthepregnantpatient.Mostarrhythmiasduringpregnancyarebenignandrequirenointervention.Whenrequired,thedecisiontotreatshouldbebasedonsymptomseverityandtheassociatedrisktomotherandfetusposedbypotentiallyrecurringarrhythmiaepisodesthroughoutthepregnancy.Anytreatmentstrategyinthispatientpopulationhasinherentrisktobothmotherandunbornchild.Beforetheinitiationofanyintervention,documentationofaclinicalarrhythmiaandcorrelationwithclinicalsymptomsshouldbeobtained.Thereisnoroleforempirictherapy.

简介：Heartfailureposesanincreasingproblemforglobalhealthcaresystems.Theepidemiologicaldatawhichhavebeenaccruedoverthelast30yearshavepredominantlybeenaccumulatedfromexperiencewithinNorthAmericaandEurope.TheEuropeanexperienceinheartfailure,althoughsimilartothatinNorthAmerica,hasrecentlydemonstrateddifferencesinhospitalizationwhichmayunderliethedifferencesbetweenhealthcaresystemconfigurations.Despitethepredictedincreaseinthenumberofpatientsaffectedbyheartfailure,overthelast30yearsaclearmanagementalgorithmhasevolvedfortheuseofpharmacotherapies,device-basedtherapies,andmechanicaltherapies,includingleftventricularassistdevicesandcardiactransplantation.Althoughthetreatmentofsuchpatientshasbeenclearlydelineatedinnationalandinternationalguidelines,theunderuseofallavailableandappropriatetherapiesremainsasignificantproblem.ThepurposeofthisreviewistoprovideaEuropeanperspectiveonmanagementofheartfailure.

简介：Iatrogenicaortocoronarydissection(IACD)isararebutpotentiallylife-threateningcomplicationduringcoronarycatheterizations.Althoughtheincidencewasrelativelylow,thedissectionoftenleadstoprocedurefailurewithincreasedriskofmyocardialinfarctionanddeath.IACDismainlycausedbydisruptionofintimaattheostiaofleftorrightcoronaryarteryduringinterventionalprocedures,andappearsasluminalfillingdefectsorpersistenceofcontrast(“extraluminalcap”)orintimaltearoutsidethecoronarylumen.Dissectioncoulddisseminateantegradelyandleadtosubtotalortotalocclusionofthecoronarylumen.Similarly,itcouldextendretrogradelyintothesinusofValsalvaandcusp,oreventheascendingaorta,aorticarch,ordescendingaorta,leadingtohemodynamiccollapse.EarlyidentificationandpromptmanagementiscrucialtotheprognosisofpatientswithIACD.Immediatebail-outstentingshouldbeperformedasrapidlyaspossibleinmostcasesofseveredissection,evenwhensignificantpropagationhasalreadyoccurred.Surgeryshouldonlybeconsideredwhenstentingfailedtosealthedissectionandthepatientshadhemodynamiccompromise.

简介：Managementofrheumaticmitralregurgitationinawomancontemplatingpregnancypresentsuniquechallengesfortheclinician.Whentaskedwithtakingcareofthistypeofpatient,attentionneedstobepaidtothepatient’sfunctionalstatustodetermineifsymptomsarepresent.Inadditiontothisclinicalassessment,transthoracicechocardiographyisalsocritical.Itprovidesinsightintotheetiologyofthemitralregurgitation,assessesforthepresenceofconcomitantmitralstenosisorothervalvularabnormalities,characterizestheseverityofmitralregurgitationthroughanintegrativeapproachandidentifieshighriskfindingsincludingprogressiveleftventricular(LV)dilationandLVdysfunction.SurgicalinterventionisrecommendedforsymptomaticpatientsandinasymptomaticpatientswithevidenceofprogressiveLVdilationandaLVejectionfractionoflessthan60%.Whilethepresenceofpulmonaryhypertensionandatrialfibrillationhavebeenshowntoberiskfactorsindegenerativemitralregurgitation,thesamehasnotbeendemonstratedinrheumaticmitralvalvedisease.Whilemitralregurgitationmaybereasonablywelltoleratedduringpregnancy,symptomaticpatientsareathigherriskforadversematernalandfetaloutcomes,andtherefore,itisrecommendedthatmitralvalvesurgerybeperformedpriortopregnancy.Oncethedecisionhasbeenmadetoproceedtosurgery,mitralrepair,performedataHeartValveCenterofExcellenceisrecommendedifpossibleduetoimprovedoutcomes.Mitralvalverepairispossiblein>80%casesofrheumaticmitralregurgitation.Ifrepairisnotpossible,replacementwitheitherabioprostheticormechanicalvalvearereasonableoptions.Thereareadvantagesanddisadvantagestoeachapproachandthechoiceofprosthesisshouldbeashareddecisionbetweenthepatientandhertreatmentteam.

简介：Ventriculartachycardia(VT)inthepresenceofstructuralheartdiseaseisassociatedwithsuddencardiacdeathandwarrantspromptattention.Implantablecardioverterdefibrillators(ICDs)whilehighlyeffectiveinterminatingsustainedventriculararrhythmiasandreducingmortality,havenoeffectonthearrhythmiasubstrateandrecurrentshocksforVTterminationoccurinapproximately20%ofpatients.Shocksworsenqualityoflifeandareassociatedwithprogressionofheartfailureandincreasedmortality.Antiarrhythmicdrugs,mainlyintheformofbeta-blockersoramiodarone,aremoderatelyeffectiveinreducingICDtherapiesbutdrugintoleranceandserioustoxicitiesofamiodaronenecessitatedrugcessationinaquarterofpatients.CatheterablationhasemergedasaneffectivetreatmentforcontroloffrequentVTepisodesandcanbelifesavingincasesofincessantVTorVTstorm.Asexperienceincreases,itisbeingusedincreasinglyearlier,ratherthanalastresorttherapy.Efficacyvarieswiththenatureoftheunderlyingheartdisease.Intramuralarrhythmiasubstrateandfailuretocreatepermanentablationlesionsremainchallengesandrepeatproceduresarenecessaryinathirdtoahalfofpatients.ForidiopathicVTsorPVCsthataresymptomaticorworsenLVfunction,catheterablationisoftenaneffectivetherapy.

简介：Accordingtothemostrecentepidemiologicaldata,theprevalenceofhypertensionrangedfromabout25%inChineselivingeitherinthemainlandorinTaiwanandKoreans,toapproximately40%inMongolians.Thecontrolrateofhypertensionwasabout35%inKoreansandJapanese,24%inMongolians,andlessthan10%inChinese.Fourplacebo-controlledtrialsinChinaunequivocallyprovedthatantihypertensivetherapymaypreventstrokeandothercardiovascularcomplicationsinhypertensionorpatientswithahistoryofstrokeortransientischemicattack.Fouractively-controlledtrialsinJapandidnotshowsignificantdifferencebetweenvariousclassesorcombinationsofantihypertensivedrugs.TwotrialsthatcomparedintensivewithlessintensivebloodpressurecontrolinelderlyJapanesehypertensivepatientsdidnotshowfurtherbenefitofcontrollingsystolicbloodpressuretoalevelbelow140mmHgincomparisonwithbloodpressurecontroltoalevelof140mmHgorabove.Thesetrialsthatcomparedvariousclassesofantihypertensivedrugsorintensivewithlessintensivebloodpressurecontroloftenhadsmallsamplesizeandhenceinadequatepowertodetectmodestormoderatebenefit.ThereisstillaneedforhighqualityoutcometrialdatainEastAsians.

简介：Sinceitsoriginaldescription,theFontanoperationhasbeenwidelyusedforthepalliationofchildrenwithsingleventriclephysiologyandhasresultedinanincreasingnumberofthesepatientssurvivingtoadulthood.TheFontanoperationisauniqueapproachtocreateacirculationinserieswithouttwodistinctpumpingchambers.AlthoughtheFontanoperationincreasedthesurvivalratesofpatientswithsingleventriclephysiology,itcarriesaninevitableriskoflong-termmorbiditiesthatimpactstheoutcomesandqualityoflifeinthesepatients.Inthisreview,wediscussthechallengesresultingfromtheuniquepathophysiologyofFontancirculationandproposemanagementstrategies.

简介：Congenitalheartdisease(CHD)-associatedpulmonaryarterialhypertension(PAH)includesaheterogeneouspatientpopulationthatcanbecharacterizedbytheunderlyingcardiacmalformation.CHD-associatedPAHhasanestimatedprevalenceof5–10%inadultpatients,withanincreasingnumberofpatientssurvivingtoadulthoodbecauseofadvancesinthesurgicalmanagementandthedevelopmentofpulmonaryarterialhypertension(PAH)-targetedpharmacotherapy.Althoughlimiteddataexist,targetedPAHpharmacotherapyhasproventobebeneficialinpatientswithCHD-associatedPAH,withobservedimprovementinfunctionalclass,increaseinexercisecapacity,andimprovementinqualityoflifeandcardiopulmonaryhemodynamics.Additionally,therehasbeenincreasinginterestinthe“treat-to-close”strategy.PAH-targetedpharmacotherapymaybeusedtooptimizecardiopulmonaryhemodynamicssoastoimprovepatients’operabilityinrepairingthecardiacdefect.Althoughtherehavebeensignificantadvancesinthemanagementofthisdiseasestateinthepast2decades,mortalityremainshigh,andongoingclinicaltrialsareneededtobetterunderstandthetreat-to-closestrategy.

简介：Despitethedevelopmentofnoninvasivetoolsasechocardiography,right-sidedheartcatheterizationremainsanintegralpartofthecardiovascularevaluation.Inthelastdecade,betterunderstandingofthehemodynamicprocessbeforeheartfailuredecompensationledtoimprovementofoutpatientstrategiestopreventit.Advancesinimplantablewirelesstechnologynowallowfrequentanddirectmeasurementofintracardiacfillingpressures,whichcanbemonitoredbyhealthcareproviderstohelptailortherapytoreducefillingpressuresandhospitalreadmissionrates.

简介：INTRODUCTIONWiththedevelopmentofeconomyandimprovementoflifequality,theincidencesofhypertension,hyper-cholesterolemia,diabetes,obesityandsmokinghavebeenincreasedinChina,whichhasledtoasignificantincreaseinthemorbidityandmortalityofcoronaryarterydisease(CAD)~1.SinceitwasintroducedintoChinain1984,coronaryintervention(PCI)hasdevelopedrapidlyandhasbecomethemajortreatmentofCADbecauseofitsuniquecharacteristicsofminimalinvasiveand

简介：The2016revisionofthe“ChineseGuidelinesonPreventionandTreatmentofDyslipidemiainAdults”istheoutcomeofthejointeffortsofthemembersofanexpertpanelformorethan1year,andisbasedonthe2007guidelines.Thereisnodoubtthatthereleaseofthe2007guidelinesgreatlyfacilitatedthemanagementofdyslipidemiaandthepreventionandtreatmentofatheroscleroticcardiovasculardiseases(ASCVDs)inChina.However,anupdateoftheguidelinesforthemanagementofdyslipidemiainChineseadultsisurgentlyneededsincehugechangeshaveoccurredintheconceptsofdyslipidemiaresearchandcontrolduringthelastdecade.

简介：Amlodipine/valsartan(Aml/Val)single-pillcombination(SPC)therapyhasbeenwidelyusedandstudiedinclinicalpracticeinrecentyears.ThisarticlereviewstheChineseandEnglishliteratureontheclinicaluseofAml/ValSPCtherapyinChinesehypertensivepatients.Accordingtofivestudiesconcerningtheefficacyandsafetyofthistreatment,Aml/ValSPCtherapywasmoreefficaciousthanmonotherapywithvalsartan,amlodipine,orthenifedipinegastrointestinaltherapeuticsystem.Thistreatmentshowedgreaterbloodpressure-loweringeffects,ahigherbloodpressurecontrolrate,andahigherresponserate.Aml/ValSPCtreatmentwaswelltolerated,withadverseeventratessimilartothoseofmonotherapywithvalsartanoramlodipineandsignificantlyrareradverseeventscomparedwiththenifedipinegastrointestinaltherapeuticsystem.Aml/ValSPCisahighlyefficaciousandwell-toleratedantihypertensivetreatmentinChinesehypertensivepatients.

简介：Themanagementofpatientswithseveresymptomaticaorticstenosisandahightransvalvulargradientisstraightforward.Itrequiresaorticvalvereplacement.Managementofaorticstenosispatientswithlowflow,lowejectionfractionandlowgradientisfraught.Suchpatientsrarelyfulfillallthetenetsof“severity”andalsohavesevereleftventriculardysfunction.Bothcircumstancesmaketheoutcomeofaorticvalvereplacementuncertain.Thusthemanagementofthisgroupofpatientsrequiresintegrationofalldiagnosticmodalitiesavailable.Thephysicalexamination,degreeofvalvecalcification,theappearanceofthevalveduringsonographicexaminationandthepresenceofinotropicreserveallcontributeimportantlyinjudgingstenosisseverityandthelikelihoodofsuccessfulvalvereplacement.

简介：In2014theAmericanCollegeofCardiology/AmericanHeartAssociationissuedfournewguidelinesforcardiovasculardiseasepreventionthatfocusedoncardiovascularriskassessment,lifestylemanagement,obesitymanagement,andbloodcholesterolmanagement.Thedevelopmentofanatheroscleroticcardiovasculardiseaseriskcalculatorformedthebasisoftheriskassessmentguideline,andthelifestylemanagementguidelinefocusedonrecommendinganevidence-baseddietarypattern.Thebloodcholesterolmanagementguidelinespecificallyidentifiedfourgroupsofpatientsshowntobenefitfrommoderate-intensityorhigh-intensitystatintherapyfrompreviousclinicaltrialsandabandonedtheuseofspecificlow-densitylipoprotein(LDL)cholesterol(LDL-C)goallevelsonthebasisofthelackofclinicaltrialevidence.Therecommendationsfortreatmentwithmoderate-intensityorhigh-intensitystatintherapyarebasedonrigorousevidencefromrandomizedclinicaltrials.Guidancehassincebeenprovidedfortheuseofnonstatintherapies,includingcholesterolabsorptioninhibitorandproproteinconvertasesubtilisin/kexintype9monoclonalantibodytherapywhenadequatereductionofLDL-Clevelsisnotachievedwithmaximallytoleratedstatintherapy.TherecentdevelopmentandapplicationofthesetherapieshaveresultedinremarkablereductionsinLDL-Clevelsthatarewelltolerated,andpreliminaryoutcomedataarepromisinginshowingsubstantialatheroscleroticcardiovasculardiseaseeventreductionsbeyondstatintherapy.

简介：APeruviannative,Dr.VelardeearnedhermedicaldegreefromtheNewYorkUniversitySchoolofMedicineinNewYorkandwentontocompleteherresidencytraininginInternalMedicineatColumbiaPresbyterianMedicalCenterandCardiovascularDiseasefellowshiptrainingatMountSinaiHospitalinNewYorkandBostonUniversity.Dr.GladysP.VelardeisAssociateProfessorofMedicine/CardiologyatTheUniversityofFlorida,JacksonvillewhereshedirectstheWomen’sCardiovascularHealthProgramandisDirectoroftheCardiovascularDiseaseFellowshiptrainingprogram.

简介：波士顿科学国际有限公司是一家全球性的医疗技术产品研发、生产、营销公司，现有17，500名雇员，2005年的销售收入为63亿美金。在过去的二十五年中，公司为广泛的医疗技术领域提供了具有深度和广度的众多创新产品，从而推动了微创介入产品的实践和发展。通过提供传统外科手术的替代产品，波士顿科学公司致力于帮助医生和其它医疗行业工作者改善病人的生命质量。

简介：StandardTherapyforHeartFailureUntilnowtheprincipalfocusofheartfailuretherapyhasbeenonthesympatheticnervoussystemandtherenin-angiotensinsystem.Betablockadecounterstheunwantedeffectsofcatecholaminesonthemyocardiumaswellasmoderatelyreducingafterload.Sinceangiotensinisavasoconstrictorandhassometoxiceffectonthemyocardium,bothcontributingtoheartfailure,inhibitionoftherenin–angiotensinsystemhasbeenlogicaltherapyforheartfailure.However,useofangiotensinconvertingenzyme(ACE)inhibitorsmayincreasebradykininlevels,whichareresponsibleforthecoughthatmaybeassociatedwiththeiruseaswellasangioedemathatmayresultfromthesamemedications.

简介：BackgroundAcuterespiratorydistresssyndrome(ARDS)causedbyH7N9influenzainpregnantwomanisalife-threateningeventwithanincreasedriskformaternalandbaby'sdeath.Theaimofthisstudywastoevaluatetheimpactofpoint-of-careultrasonography(POCUS)onthemanagementandprognosisofthesepatients.MethodsAcaseof31-yr-oldpregnantwomaninourhospital,whowasunderwentPOCUSforevaluatingcardiopulmonaryfunctions,volumestate,fluidresponsivenessandultrasound-guidedprocedureswasadmittedtoIntensiveCareUnit(ICU).Weperformedultrasonographydailyformonitoringorganfunctions.Reviewofrelatedliteratureswasalsoconducted.ResultsWiththehelpofPOCUS,wemadequicklydiagnosisofseverepneumoniaandARDScausedbyH7N9influenza.ThetherapieshadalsobeenchangedafterPOCUSexaminations,suchasrestrictfluidadministrationrelyingontheassessmentsoftheinferiorvenacava(IVC)toestimatepreloadandlungultrasoundmonitoringtoidentifytheearlypresenceofextravascularlungwater(EVLW)andavoidfluidoverresuscitation,ultrasound-guidedrecruitmentmaneuvertoimprovedrespiratorydistresssyndrome,andsoon.ConclusionsPOCUShasasignificantimpactondecision-makingandtherapeuticmanagementandshouldbecomeaclinicalroutineinthemanagementofARDSpatientscausedbyH7N9influenzainpregnancy.