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Related Concept Videos

Cardiac Catheterization IV: Nursing Management01:26

Cardiac Catheterization IV: Nursing Management

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Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
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Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Mitral Stenosis IV: Nursing Management01:27

Mitral Stenosis IV: Nursing Management

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A comprehensive nursing assessment is essential for patients with valvular heart disease, which involves any dysfunction of the heart valves that could impact blood flow and overall heart function.Subjective Data Collection:Chief Complaint and Present Illness: Start with the patient's primary concerns, focusing on the onset, duration, and progression of cardiac symptoms such as dyspnea, fatigue, chest pain, and palpitations.Past Medical History: Collect detailed information on any previous...
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Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Neo-Sinus Washout Time Following Transcatheter Aortic Valve Replacement and Hemodynamic Outcomes.

Shivabalan Kathavarayan Ramu1, Toshiaki Isogai1, Saksham Beotra1

  • 1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA.

Structural Heart : the Journal of the Heart Team
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Summary

Prolonged neo-sinus washout time (NWT) after transcatheter aortic valve replacement (TAVR) is linked to higher valve gradients and hypoattenuated leaflet thickening (HALT). NWT may predict TAVR dysfunction, guiding early treatment.

Keywords:
Bioprosthetic valve dysfunctionNeo-sinus washout timeTranscatheter aortic valve replacement

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Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Transcatheter aortic valve replacement (TAVR) carries risks of leaflet thrombosis and valve dysfunction.
  • Prolonged neo-sinus washout time (NWT) is implicated in hypoattenuated leaflet thickening (HALT) and valve degeneration.

Purpose of the Study:

  • To evaluate the association between in vivo NWT, derived from aortograms using computer vision, and hemodynamic outcomes post-TAVR.
  • To determine if NWT predicts adverse valve events at 30 days and 1 year.

Main Methods:

  • Retrospective analysis of 2254 patients undergoing TAVR with balloon-expandable valves (2016-2020).
  • Patients stratified into tertiles based on NWT (T1: 1.444-1.870s, T2: 1.870-1.939s, T3: 1.939-2.110s).
  • Computer vision analysis of aortograms to derive NWT; assessment of hemodynamic parameters and HALT.

Main Results:

  • The highest NWT tertile (T3) showed significantly higher transvalvular aortic valve mean gradient at 30 days compared to T1 (p=0.03).
  • In multivariate analysis, T3 was independently associated with increased aortic valve mean gradient (p=0.02).
  • NWT was significantly higher in patients with HALT at 30 days (p=0.001), with each 0.1s increase in NWT tripling HALT odds.

Conclusions:

  • Prolonged NWT is associated with higher transvalvular gradients and independently predicts HALT following TAVR.
  • NWT serves as a potential novel marker for identifying patients at risk of TAVR dysfunction.
  • NWT measurement may guide early pharmacotherapy to mitigate valve degeneration.