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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
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A z score (or standardized value) is measured in units of the standard deviation. It tells you how many standard deviations the value x is above (to the right of) or below (to the left of) the mean, μ. Values of x that are larger than the mean have positive z scores, and values of x that are smaller than the mean have negative z scores. If x equals the mean, then x has a zero z score. It is important to note that the mean of the z scores is zero, and the standard deviation is one.
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Preoperative Venoarterial Extracorporeal Membrane Oxygenation Slashes Risk Score in Advanced Structural Heart

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Venoarterial extracorporeal membrane oxygenation (ECMO) supports patients with severe heart failure and cardiogenic shock, enabling them to undergo high-risk cardiac surgery. This approach improves end-organ function, making complex procedures feasible and improving survival rates.

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Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • Cardiac surgery for structural heart disease carries poor outcomes in patients with cardiogenic shock or advanced heart failure.
  • Venoarterial extracorporeal membrane oxygenation (ECMO) can be applied to restore end-organ function and resuscitate patients prior to high-risk cardiac operations.

Purpose of the Study:

  • To evaluate the efficacy of ECMO as a bridge to high-risk cardiac surgery in patients with cardiogenic shock and end-organ failure.
  • To assess the impact of ECMO support on patient outcomes and surgical risk scores.

Main Methods:

  • Twelve patients with cardiogenic shock and end-organ failure underwent peripheral ECMO cannulation for an average of 7 days before cardiac surgery.
  • Surgical procedures included repair of prosthetic mitral stenosis, ruptured papillary muscle, ischemic ventricular septal defect, and severe aortic stenosis.
  • Patient data on comorbidities, physiological parameters, and mortality risk scores were collected and analyzed.

Main Results:

  • Patients presented with significant comorbidities including acute renal failure, inotrope dependence, and cardiac arrest.
  • ECMO support led to significant improvements in vasopressor requirements, central venous pressure, creatinine, lactate, pH, and pulmonary hypertension.
  • All operative patients survived to hospital discharge, with a mean follow-up of 420 days; 6 patients survived over 1 year.

Conclusions:

  • ECMO serves as a viable bridge to cardiac valve or septal defect surgery for severely decompensated patients.
  • By enabling end-organ function recovery, ECMO can facilitate surgical correction of structural heart disease in previously inoperable patients.