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Minimizing cardiac surgery risks in a Hepatitis C patient: Changing surgical strategy after evaluation by modern imaging technologies
Felix Kur, Andres Beiras-Fernandez, Martin Oberhoffer, Konstantin Nikolaou, et al.
Therapeutics and Clinical Risk Management , 2009, DOI: http://dx.doi.org/10.2147/TCRM.S5496
Abstract: imizing cardiac surgery risks in a Hepatitis C patient: Changing surgical strategy after evaluation by modern imaging technologies Case report (2961) Total Article Views Authors: Felix Kur, Andres Beiras-Fernandez, Martin Oberhoffer, Konstantin Nikolaou, et al. Published Date May 2009 Volume 2009:5 Pages 409 - 412 DOI: http://dx.doi.org/10.2147/TCRM.S5496 Felix Kur1, Andres Beiras-Fernandez1, Martin Oberhoffer1, Konstantin Nikolaou2, Calin Vicol1, Bruno Reichart1 1Department of Cardiac Surgery, 2Department of Radiology, University Hospital Grosshadern, Munich, Germany Abstract: Minimizing operative risks for the surgical team in infectious patients is crucial. We report on a patient suffering from Hepatitis C undergoing re-operative aortic valve and ascending aorta replacement for aortic aneurysm and paravalvular leakage due to recurrent endocarditis of a Smeloff–Cutter aortic ball prosthesis. Preoperative multi-slice computed tomography and real-time three-dimensional echocardiography proved helpful in changing operative strategy by detecting a previously unknown aortic aneurysm, assessing its extent, and demonstrating the close proximity of the right coronary artery, right ventricle, and the aortic aneurysm to the sternum. Thus, cardiopulmonary bypass was instituted via the femoral vessels, instead of conventionally. Location, morphology, and extent of the paravalvular defect could also be assessed.
Minimizing cardiac surgery risks in a Hepatitis C patient: Changing surgical strategy after evaluation by modern imaging technologies
Felix Kur,Andres Beiras-Fernandez,Martin Oberhoffer,Konstantin Nikolaou
Therapeutics and Clinical Risk Management , 2009,
Abstract: Felix Kur1, Andres Beiras-Fernandez1, Martin Oberhoffer1, Konstantin Nikolaou2, Calin Vicol1, Bruno Reichart11Department of Cardiac Surgery, 2Department of Radiology, University Hospital Grosshadern, Munich, GermanyAbstract: Minimizing operative risks for the surgical team in infectious patients is crucial. We report on a patient suffering from Hepatitis C undergoing re-operative aortic valve and ascending aorta replacement for aortic aneurysm and paravalvular leakage due to recurrent endocarditis of a Smeloff–Cutter aortic ball prosthesis. Preoperative multi-slice computed tomography and real-time three-dimensional echocardiography proved helpful in changing operative strategy by detecting a previously unknown aortic aneurysm, assessing its extent, and demonstrating the close proximity of the right coronary artery, right ventricle, and the aortic aneurysm to the sternum. Thus, cardiopulmonary bypass was instituted via the femoral vessels, instead of conventionally. Location, morphology, and extent of the paravalvular defect could also be assessed.Keywords: aortic valve replacement, aorta, surgery, risk analysis
Inappropriateness of Cardiovascular Radiological Imaging Testing; A Tertiary Care Referral Center Study  [PDF]
Clara Carpeggiani, Paolo Marraccini, Maria Aurora Morales, Renato Prediletto, Patrizia Landi, Eugenio Picano
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081161
Abstract: Aims Radiological inappropriateness in medical imaging leads to loss of resources and accumulation of avoidable population cancer risk. Aim of the study was to audit the appropriateness rate of different cardiac radiological examinations. Methods and Principal Findings With a retrospective, observational study we reviewed clinical records of 818 consecutive patients (67±12 years, 75% males) admitted from January 1-May 31, 2010 to the National Research Council – Tuscany Region Gabriele Monasterio Foundation cardiology division. A total of 940 procedures were audited: 250 chest x-rays (CXR); 240 coronary computed tomographies (CCT); 250 coronary angiographies (CA); 200 percutaneous coronary interventions (PCI). For each test, indications were rated on the basis of guidelines class of recommendation and level of evidence: definitely appropriate (A, including class I, appropriate, and class IIa, probably appropriate), uncertain (U, class IIb, probably inappropriate), or inappropriate (I, class III, definitely inappropriate). Appropriateness was suboptimal for all tests: CXR (A = 48%, U = 10%, I = 42%); CCT (A = 58%, U = 24%, I = 18%); CA (A = 45%, U = 25%, I = 30%); PCI (A = 63%, U = 15%, I = 22%). Top reasons for inappropriateness were: routine on hospital admission (70% of inappropriate CXR); first line application in asymptomatic low-risk patients (42% of CCT) or in patients with unchanged clinical status post-revascularization (20% of CA); PCI in patients either asymptomatic or with miscellaneous symptoms and without inducible ischemia on non-invasive testing (36% of inappropriate PCI). Conclusion and Significance Public healthcare system – with universal access paid for with public money – is haemorrhaging significant resources and accumulating avoidable long-term cancer risk with inappropriate cardiovascular imaging prevention.
Noninvasive Imaging of Cardiac Electrophysiology  [cached]
Thomas Berger,Florian Hintringer,Gerald Fischer
Indian Pacing and Electrophysiology Journal , 2007,
Abstract: Noninvasive imaging of cardiac electrophysiology is still a major goal despite all recent technical innovations. This review gives an overview about the historical background, recent developments and possible future applications of noninvasive imaging of cardiac electrophysiology.
Economic and biological costs of cardiac imaging
Eugenio Picano
Cardiovascular Ultrasound , 2005, DOI: 10.1186/1476-7120-3-13
Abstract: A Renaissance of cardiac imaging occurred in the 1980s [1]. New technologies allowed the non-invasive description of cardiac function, perfusion, and metabolism in a polychrome, three-dimensional, overwhelming fashion. Almost unlimited resources were devoted to patient care in the economic framework of the affluent society. At the beginning of the 1990s, The Renaissance made its transition into the splendid decadence of the Baroque. The increasing technological burden in clinical cardiology paradoxically did not bring a parallel increase in the quality of care but rather an increase in cost. The economic climate had changed; the illusion of unlimited economic resources had come to an end [2]. Keeping in mind that each test represents a cost, often a risk, and always a diagnostic hypothesis, we can agree that every unnecessary and unjustifiable test is one test too many. Small individual costs, risks, and wastes multiplied by billions of examinations per year represent an important population [3], society [4] and environmental [5] burden. Unfortunately, the appropriateness of cardiac imaging is usually extra-ordinarily low and there is little awareness among patients and physicians of the elementary physical basis, differential costs, radiological doses, and long term risks of different imaging modalities [6]. It is also well known that – in the words of Bernard Lown – "technology in medicine is frequently untested scientifically, often applied without data relating to cost benefit, and driven by market forces rather than by patient needs." Bernard Lown, 2004 [7]."Ten years ago, medical imaging wasn't even in the radar screen for most health insurers. In 2004, it' s one of the highest cost items in a health plan's medical budget, and also one of the fastest growing". (Atlantic info service newsletter, 2004) [8]. As an example, in U.S. during the year 2002, 7.8 million cardiac perfusion scans were performed, with a growth of 40% in the last 3 years [9]. Still in U.S.,
Cardiac magnetic resonance imaging of a patient with an magnetic resonance imaging conditional permanent pacemaker
Andrew J. Hogarth,Nigel J. Artis,Mohan Sivananthan,Chris B. Pepper
Heart International , 2011, DOI: 10.4081/hi.2011.e19
Abstract: Cardiac Magnetic Resonance Imaging (MRI) is increasingly used as the optimum modality for cardiac imaging. An aging population and rising numbers of patients with permanent pacemakers means many such individuals may require cardiac MRI scanning in the future. Whilst the presence of a permanent pacemaker is historically regarded as a contra-indication to MRI scanning, pacemaker systems have been developed to limit any associated risks. No reports have been published regarding the use of such devices with cardiac MRI in a clinical setting. We present the safe, successful cardiac MRI scan of a patient with an MRI-conditional permanent pacing system.
The American College of Radiology white paper on radiation dose in medicine:deep impact on the practice of cardiovascular imaging
Eugenio Picano, Eliseo Vano, Richard Semelka, Dieter Regulla
Cardiovascular Ultrasound , 2007, DOI: 10.1186/1476-7120-5-37
Abstract: The medical use of radiation is the largest man-made source of radiation exposure. About 5 billion imaging examinations are performed worldwide each year, and 2 out of 3 employ ionizing radiations with radiology or nuclear medicine [1]. In the developed countries, exposure from medical ionizing test results in a mean effective dose per year per head in the range of 100 (Germany, radiological year 1997) [2] to 160 chest x-rays (USA, radiological year 2006) [3] – an amount higher than that originating from one year of natural background radiation: Fig. 1. With now obsolete radiological dose estimates, referred to 1991–1996 and excluding nuclear medicine exposures, Berrington and Darby estimated in 2004 that 0.6 (for UK) to 3.2% (for Japan) of cancers could be caused by diagnostic x-rays. The attributable cancer risk from diagnostic x-rays was 0.9% for USA and 1.5% for Germany [4]. In 1991–96, the mean exposure for the US citizen was 0.5 mSv per head per year from x-rays. In 2006, the estimated exposure (from radiology and nuclear medicine) reaches an unprecedented 3.2 mSv per head per year (more than 6-fold higher) than the estimate used by Berrington. The attributable cancer risk will rise accordingly – at least around 5% risk of cancers from diagnostic radiation [5]. The inappropriateness of imaging techniques with high doses and high long-term risks is economically and socially unsustainable, but it also opens a unique opportunity to abate healthcare costs, reduce long-term risks, and improve health care standard simply targeting inappropriate examinations.Cardiologists prescribe and/or directly perform >50% of all imaging examinations, accounting for about two thirds of the total effective dose to patients [3,6]. Mettler et al recently reported data referred to the radiological year 2006 in USA. There were almost 20 million studies of nuclear medicine. Cardiac studies account for 57% of all nuclear medicine studies and 85% of the dose [3]. Bedetti et al reported d
Health Risk and Biological Effects of Cardiac Ionising Imaging: From Epidemiology to Genes  [PDF]
Ilenia Foffa,Monica Cresci,Maria Grazia Andreassi
International Journal of Environmental Research and Public Health , 2009, DOI: 10.3390/ijerph6061882
Abstract: Cardiac diagnostic or therapeutic testing is an essential tool for diagnosis and treatment of cardiovascular disease, but it also involves considerable exposure to ionizing radiation. Every exposure produces a corresponding increase in cancer risk, and risks are highest for radiation exposure during infancy and adolescence. Recent studies on chromosomal biomarkers corroborate the current radioprotection assumption showing that even modest radiation load due to cardiac catheter-based fluoroscopic procedures can damage the DNA of the cell. In this article, we review the biological and clinical risks of cardiac imaging employing ionizing radiation. We also discuss the perspectives offered by the use of molecular biomarkers in order to better assess the long-term development of health effects.
Principles and Pitfalls in Cardiac Imaging
B. Raissi
Iranian Journal of Radiology , 2007,
Abstract: Multidetector row computed tomography (MDCT) is becoming one of the most rapidly growing radiologi-cal techniques since the introduction of computed tomography. The advantages of faster gantry rotation speed and sophisticated algorithms allow for data re-construction from various cardiac phases. Most pit-falls can be overcome through appropriate image data reconstruction. Multidetector CT scanners with >4 detector rows will result in improved temporal and spatial resolution and fewer motion artifacts. This new technology allows for cardiac imaging. The focus of this article will be on the basic principles and techniques as well as some of the common pitfalls of MDCT coronary angiography.
Cardiac imaging: Current and emerging applications  [cached]
Jankharia B,Raut A
Journal of Postgraduate Medicine , 2010,
Abstract: Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) scan have made big inroads as modalities used for evaluation of various pathologies of the heart. Cardiac MRI is typically used for perfusion and viability studies as well as to study various cardiomyopathies, valvular diseases and the pericardium. It has been used in the evaluation of congenital heart diseases over the last two decades. Cardiac CT is used mainly for the evaluation of the coronary arteries, typically in the setting of "to rule out coronary artery disease".
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