Advanced treatment options for the failing left ventricle:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1995
|
| Schriftenreihe: | Cardiology clinics
13,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV, 147 S. Ill., graph. Darst. |
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Datensatz im Suchindex
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| adam_text | ADVANCED TREATMENT OPTIONS FOR THE FAILING LEFT VENTRICLE
CONTENTS
Foreword xi
Michael H. Crawford
Preface xiii
John A. Elefteriades, Forrester A. Lee, and George V. Letsou
Introduction 1
John A. Elefteriades, Forrester A. Lee, and George V. Letsou
This issue of Cardiology Clinics focuses on patients with left ventricular
ejection fraction of 30% or less. Multiple advanced treatment modalities are
becoming available for severe left ventricular dysfunction. The traditional
modalities—medical management and heart transplantation—have made
significant strides in recent years. Clinical studies reviewed in this issue
indicate that in addition to traditional modalities, coronary bypass surgery,
valve replacement, left ventricular aneurysmectomy, automatic defibrilla
tor implantation, placement of the mechanical left ventricle, and cardiomy
oplasty are beneficial in specific patient groups.
Medical Therapy and Prognosis in Chronic Heart Failure:
Lessons from Clinical Trials 5
Tarik M. Ramahi and Forrester A. Lee
Medical therapy remains the first and, for the majority of patients, only
option for the treatment of chronic heart failure and left ventricular dys¬
function. This article reviews the clinical evidence on which current ap¬
proaches to therapy are predicated, discusses the pathophysiologic con¬
cepts learned from these studies, and introduces some of the most
promising therapeutic agents currently under investigation for the treat¬
ment of chronic heart failure.
New Medical Therapies for Advanced Left Ventricular Dysfunction 27
Kenneth Baughman
The incidence and prevalence of congestive heart failure and dilated
cardiomyopathy are increasing. As one looks to new medical therapies for
advanced left ventricular dysfunction, one must first review the targets of
current treatment, decipher what has been learned, and apply this analysis
to new therapies.
CABG in Advanced Left Ventricular Dysfunction 35
John A. Elefteriades and Irving L. Kron
Concurrent, independent clinical series at Yale University and the Univer¬
sity of Virginia demonstrate an important role for CABG in patients
with advanced ischemic cardiomyopathy. It is found that CABG can be
performed safely in these patients, both angina and congestive heart
failure states improve, ejection fraction increases substantially, and good
long term longevity is achieved. Despite prior concerns, the internal mam¬
mary conduit can be used safely in these patients. It appears that CABG
serves to protect viable noninfarcted muscle and to recruit hibernating
ischemic muscle. CABG is suggested as an alternative to heart transplanta¬
tion in this patient group.
Nuclear Imaging Techniques for the Assessment of Myocardial Viability 43
Diwakar Jain and Barry L. Zaret
Regional and global left ventricular dysfunction caused by coronary artery
disease may be reversible in a significant proportion of cases. This fact has
important clinical implications. The choice of the optimal nuclear imaging
technique for the detection of myocardial viability is a matter of ongoing
debate. Currently the choice of technique depends on the clinical question
to be answered, the local availability of the technique, and local expertise.
Cost considerations may also play an important role in choice of technique.
Left Ventricular Aneurysmectomy in Advanced Left Ventricular Dysfunction 59
John A. Elefteriades, Lawrence W. Solomon, Lynda L. Mickleborough, and
Denton A. Cooley
Despite widespread application in clinical practice and extensive labora¬
tory investigations, many basic issues regarding left ventricular aneurys¬
mectomy remain to be resolved. Analysis of clinical data from the authors
three centers and application of powerful modern imaging techniques
provide important information to resolve these issues.
Valve Replacement for Regurgitant Lesions of the Aortic or Mitral Valve in
Advanced Left Ventricular Dysfunction 73
Robert O. Bonow, Dimitri Nikas, and John A. Elefteriades
Patients with aortic regurgitation and severe left ventricular dysfunction
are candidates for aortic valve replacement, as long as the risks of late
left ventricular dysfunction and congestive heart failure have been fully
discussed with the patient, family, and referring physician. Patients with
mitral regurgitation and severe systolic dysfunction are at considerable
risk of more severe left ventricular dysfunction after operation, especially
if mitral valve repair or chordal sparing procedure cannot be performed.
Ventricular Arrhythmias in Heart Failure 87
William P. Batsford, Lynda L. Mickleborough, and John A. Elefteriades
Therapy of ventricular arrhythmias in patients with heart failure is under¬
taken with the goal of preventing unexpected and avoidable sudden
cardiac death. This article focuses on the identification of patients at
highest risk for sudden death and reviews some of the therapeutic options
for such patients.
Viii CONTENTS
Candidate Selection for Heart Transplantation 93
Leslie W. Miller
The number of patients referred for heart transplantation continues to
increase at a rate well beyond the number of available donors. Further
attempts to expand the donor pool may be difficult and certainly cannot
keep pace with the increased demand. Uniform criteria for candidate
selection are critically needed. Application of simple but definitive guide¬
lines should help significantly reduce the number of patients on the
transplant waiting list and allow patients with the greatest survival benefit
to receive a graft in a much shorter period of time.
New Frontiers in Heart Transplantation: Clinical Applications of
Basic Research and New Surgical Approaches 101
Maria Rosa Costanzo and Kenneth L. Franco
Heart transplantation remains one of the most remarkable achievements
in modern medicine. Initially considered experimental, heart transplanta¬
tion is now an established therapy for a variety of end stage cardiac
diseases. Over the last 10 years, the results of heart transplantation have
continued to improve because of better patient selection, surgical tech¬
niques, immunosuppression, and postoperative care. Further advances
will occur because of better management of right sided heart dysfunction
and newer immunosuppressive modalities. In addition, xenografts will
address the critical donor shortage that exists in the United States, and in
the future, mechanical assist devices will become available as an alterna¬
tive to heart transplantation.
Permanent Mechanical Replacement of the Left Ventricle 111
Michael P. Macris
Patients with congestive heart failure have a poor prognosis and their care
is expensive. Treatment with the HeartMate left ventricular assist device
(Thermo Cardiosystems Inc, Woburn, MA) has indicated that life for such
patients can be prolonged, quality of life increased, and cost of care
decreased. Although currently approved only as a bridge to transplanta¬
tion, the HeartMate and other such devices may one day offer permanent
support of the left ventricle as an alternative to cardiac transplantation.
Dynamic Cardiomyoplasty 121
George V. Letsou, Lori Austin, Pierre A. Grandjean, John H. Braxton, and
John A. Elefteriades
Dynamic cardiomyoplasty is a promising new technique that appears
to effect symptomatic improvement in patients with New York Heart
Association class III heart failure. Randomized clinical trials currently in
progress will provide definitive answers within the next few years to
important questions.
Skeletal Muscle for Cardiac Assist 125
George V. Letsou, John H. Braxton, John A. Elefteriades, and Stephan Ariyan
Although current efforts at cardiomyoplasty have not produced the antici¬
pated clear cut benefits in cardiac function, replicable improvements in
subjective function have resulted. Efforts at optimizing conditioning proto¬
cols, skeletal muscle strength, and timing of skeletal muscle assist devices
should provide further improvements in cardiomyoplasty. Further work
with alternative ways of configuring skeletal muscle for cardiac assist is
extremely promising.
CONTENTS ix
Synthesis: Guidelines for Selection Among Treatment Options 137
John A. Elefteriades, George V. Letsou, and Forrester A. Lee
In this concluding article, the authors review the take home messages
from each of the preceding articles and integrate the information on each
of the advanced treatment options into a set of overall guidelines for
treatment selection.
Index 145
Subscription Information Inside back cover
X CONTENTS
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| spelling | Advanced treatment options for the failing left ventricle John A. Elefteriades, ... guest ed. Philadelphia [u.a.] Saunders 1995 XIV, 147 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Cardiology clinics 13,1 Linke Herzkammer (DE-588)4126506-3 gnd rswk-swf Herzkrankheit (DE-588)4024663-2 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Linke Herzkammer (DE-588)4126506-3 s Herzkrankheit (DE-588)4024663-2 s DE-604 Elefteriades, John A. Sonstige (DE-588)132127520 oth Cardiology clinics 13,1 (DE-604)BV000008602 13,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=006830754&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | Advanced treatment options for the failing left ventricle |
| title_auth | Advanced treatment options for the failing left ventricle |
| title_exact_search | Advanced treatment options for the failing left ventricle |
| title_full | Advanced treatment options for the failing left ventricle John A. Elefteriades, ... guest ed. |
| title_fullStr | Advanced treatment options for the failing left ventricle John A. Elefteriades, ... guest ed. |
| title_full_unstemmed | Advanced treatment options for the failing left ventricle John A. Elefteriades, ... guest ed. |
| title_short | Advanced treatment options for the failing left ventricle |
| title_sort | advanced treatment options for the failing left ventricle |
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| topic_facet | Linke Herzkammer Herzkrankheit Aufsatzsammlung |
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