Proctorbarry5953

The Italian scientific societies of cardiology (SIC and ANMCO), cardiothoracic surgery, endodontics, and periodontology realized that a specific protocol addressing preoperative dental/peri-dental screening in patients undergoing elective cardiothoracic surgery was lacking in the literature. As a consequence, they projected and then realized in 2019 a consensus document to establish the modalities for such a diagnostic and therapeutic screening, whose related options and timing depend on the patient's physical conditions as well as the time available before surgery. A high level of agreement was reached by the experts involved in the release of the consensus document and each clinical issue was addressed adequately. Three tables were released, with the aim of sharing a standardized protocol for the perioperative dental/peri-dental screening of patients who are waiting for elective cardiothoracic procedures. The authors of the consensus document, which has been widely diffused by all the involved scientific societies, hope that it can be largely accepted and applied, during the multidisciplinary phase preceding cardiovascular surgery the most.The European Society of Cardiology guidelines on non-ST-elevation acute coronary syndromes suggest different temporal strategies for the angiographic study depending on the risk profile. The scientific evidence underlying the guideline recommendations and the critical issues currently existing in Italy that often do not allow either an extended strategy of revascularization within 24 h or the application of the principle of the same day transfer from a spoke to a hub center are analyzed. The position paper focuses, in particular, on the subgroup of patients with a defined diagnosis of non-ST-elevation myocardial infarction by proposing a timing of coronary angiography/revascularization that takes into account the available scientific evidence and the organizational possibilities of a considerable part of national cardiology services.Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare but serious congenital heart defect. We report two cases of ALCAPA diagnosed in infancy, presenting with low body weight and severe symptoms of congestive heart failure. Both were repaired surgically using Takeuchi technique. Both cases have developed supravalvular pulmonary stenosis at long-term follow-up.Mechanisms leading to mitral regurgitation can be multiple and have different etiologies. We present the case of severe mitral insufficiency due to posterior papillary muscle rupture in a young man, with exertional dyspnea, but permanently asymptomatic for chest pain and without clinical and laboratory signs of myocardial ischemia at the time of our evaluation.

Cardiac rehabilitation (CR) is a model of care proven to reduce recurrent cardiovascular events, new hospitalizations and mortality in patients with coronary artery disease. The aim of this study was to describe ambulatory CR in Gualdo-Tadino, ASL1 of Perugia (Italy), analyzing the outcomes of this population at 1 year and in the medium-long term.

The clinical instrumental characteristics and the outcome of patients referred to CR after ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), angina, coronary artery bypass graft (CABG), ischemic heart disease have been analyzed. Follow-up interval 2005-2018. Average follow-up 4.9 ± 4.4 years/patient. Comorbidity, new events, and mortality have been analyzed.

From a population of 1552, 1384 were selected with a history of coronary artery disease age 64.6 ± 9.8 years; 17% female (mean age 67.6 ± 8.8 years); 13.2% elderly >75 years; 57.2% were referred for CR after STEMI, 17.1% after non-STEMI, 19.9% after angina or ifactors and comorbidities. The increase of comorbidities, particularly peripheral vascular disease, diabetes mellitus and chronic renal failure - along with the non-reduction of smoking - have significantly affected the outcome, despite the effective control of the other coronary risk factors.

The study highlights the efficacy of ambulatory CR programs and subsequent follow-up in the treatment of a population with coronary heart disease, risk factors and comorbidities. The increase of comorbidities, particularly peripheral vascular disease, diabetes mellitus and chronic renal failure - along with the non-reduction of smoking - have significantly affected the outcome, despite the effective control of the other coronary risk factors.Valvular heart diseases (VHD) are common in the elderly population and several therapeutic options are available to treat them. When selecting the management strategy for VHD patients, to evaluate the operatory risk, using special scores like STS score, EuroSCORE II and other more specific ones is pivotal. However, the risk scores do not consider some aspects, such as the clinical needs of the single patients, the management of local resources and the expertise of the center. The Heart Team, combining the experience of various specialists, can optimize the decision-making process through a better evaluation of the risk/benefit ratio of the therapeutic choices. The multidisciplinary discussion of the most complex cases is recommended by the international guidelines for the management of VHD and it is part of the clinical practice of many centers. selleck products So far, both trials and large clinical studies supporting such multidisciplinary management are lacking. Despite these important limitations, the Heart Team can be actually regarded as a promising tool to locally promote best practices for the treatment of VHD patients.The best treatment for patients with asymptomatic carotid stenosis is a rather debated topic and there is significant discrepancy in the indication for surgical revascularization therapy either across different centers and countries or between guidelines. The purpose of this narrative review is to try to provide the tools for a multidisciplinary approach in order to best stratify the patient. Current evidence supports the hypothesis that only a small proportion of patients can benefit from surgical treatment, but they should be identified and managed in the optimal way to ensure the best option for preventing ischemic stroke. Current evidence regarding optimal medical therapy, which should be guaranteed to all patients with carotid stenosis, will also be briefly discussed.