bluuebunny/crossref_metadata_2025_split huggingface dataset:
State of the art: Using natriuretic peptide levels in clinical practice
Authors: Maisel Alan , Mueller Christian , Adams Kirkwood , Anker Stefan D. , Aspromonte Nadia , Cleland John G.F. , Cohen‐Solal Alain , Dahlstrom Ulf , DeMaria Anthony , Di Somma Salvatore , Filippatos Gerasimos S. , Fonarow Gregg C. , Jourdain Patrick , Komajda Michel , Liu Peter P. , McDonagh Theresa , McDonald Kenneth , Mebazaa Alexandre , Nieminen Markku S. , Peacock W. Frank , Tubaro Marco , Valle Roberto , Vanderhyden Marc , Yancy Clyde W. , Zannad Faiez , Braunwald Eugene 
Published: August 2008

AbstractNatriuretic peptide (NP) levels (B‐type natriuretic peptide (BNP) and N‐terminal proBNP) are now widely used in clinical practice and cardiovascular research throughout the world and have been incorporated into most national and international cardiovascular guidelines for heart failure. The role of NP levels in state‐of‐the‐art clinical practice is evolving rapidly. This paper reviews and highlights ten key messages to clinicians:
NP levels are quantitative plasma biomarkers of heart failure (HF).
NP levels are accurate in the diagnosis of HF.
NP levels may help risk stratify emergency department (ED) patients with regard to the need for hospital admission or direct ED discharge.
NP levels help improve patient management and reduce total treatment costs in patients with acute dyspnoea.
NP levels at the time of admission are powerful predictors of outcome in predicting death and re‐hospitalisation in HF patients.
NP levels at discharge aid in risk stratification of the HF patient.
NP‐guided therapy may improve morbidity and/or mortality in chronic HF.
The combination of NP levels together with symptoms, signs and weight gain assists in the assessment of clinical decompensation in HF.
NP levels can accelerate accurate diagnosis of heart failure presenting in primary care.
NP levels may be helpful to screen for asymptomatic left ventricular dysfunction in high‐risk patients.
Published by Elsevier B.V. on behalf of European Society of Cardiology.
Altered glial cell line-derived neurotrophic factor (GDNF) concentrations in the brain of patients with depressive disorder: A comparative post-mortem study
Authors: Michel Tanja M. , Frangou Sophia , Camara Sibylle , Thiemeyer Dorothea , Jecel Julia , Tatschner Thomas , Zoechling Robert , Grünblatt Edna 
Published: August 2008

AbstractIntroductionA growing body of evidence suggests that the glial cell line-derived neurotrophic factor (GDNF) is involved in the aetiopathology of mood disorders. GDNF is a neurotrophic factor from the transforming growth factor-β-family, playing a role in cell development and function in the limbic system. This is the first study to examine GDNF concentration in different brain regions of patients with depressive disorder (DD).Material and MethodsWe used sandwich-ELISA-technique to ascertain GDNF concentration and Lowry assay for overall protein levels in post-mortem brain tissue of 7 patients with recurrent depressive disorder and 14 individuals without any neurological or psychiatric diagnoses. We included cortical regions as well as limbic area's (hippocampus, entorhinal cortex) basal ganglia (putamen, caudate nucleus), thalamus and cingulated gyrus.ResultsWe found a significant increase in GDNF concentration in the parietal cortex of patients with DD compared to the control group. In other regions the trend of an increased GDNF concentration did not reach statistical difference.DiscussionThis proof of concept study supports previous findings of an alteration of the GDNF in patients with depressive disorder. However, for the first time a significant increase of GDNF in a cortical brain area was found in DD.
The surgical repair for complete transposition
Authors: Kirklin John W. 
Published: August 2008

SummaryAlthough uncertainty exists, in some situations, as to the optimal type of operation and a true cure may not always be possible, the outlook for patients with all types of complete transposition is poor without surgical treatment. With surgery, and in spite of current uncertainties as to the optimal type of repair, most patients can be greatly benefited, and many given a long and happy life. Even more should be possible in the future.
The diagnostic evaluation of patients with complete transposition
Authors: Rigby Michael L. , Chan Kit-Yee 
Published: August 2008

SummaryThe vast majority of patients with complete transposition present during either the neonatal period or early infancy. Almost always the diagnosis and the categorization of associated lesions can be established by cross-sectional echocardiography. Doppler techniques usually provide enough information about flows to allow palliative or radical surgery to be undertaken without formal cardiac catheterization, because balloon atrial septostomy is carried out with echocardiographic imaging, often on the intensive care unit. Angiography is occasionally performed to visualize the pulmonary arteries or the aorta, and, if there is suspicion of a significant elevation of the pulmonary vascular resistance, it must be measured at cardiac catheterization. Neither cross-sectional echocardiography nor aortography is entirely reliable in identifying those patterns of the coronary arteries which are a contraindication to the arterial switch operation. There is, as yet, no evidence that either magnetic resonance imaging or transesophageal echocardiography are superior to more conventional methods of preoperative diagnosis in complete transposition and it seems unlikely that they will be required.
Morphologic aspects of complete transposition
Authors: Anderson Robert H. , Henry G. William , Becker Anton E. 
Published: August 2008

SummaryComplete transposition is a morphologic entity which exists by virtue of a concordant atrioventricular connection co-existing with a discordant connection at the ventriculoarterial level. If diagnosed in this manner, all variants can be described simply and unambiguously in terms of associated malformations along with variations in relationships and infundibular morphology.
Coronary arterial anatomy in regard to the arterial switch procedure
Authors: Kurosawa Hiromi , Imai Yasuharu , Kawada Masaaki 
Published: August 2008

SummarySince the success of the arterial switch procedure is dependent on the successful translocation of the coronary arteries, a thorough understanding of the anatomic variations of the coronary arteries is essential. We reviewed the anatomy of the coronary arteries encountered in 140 consecutive cases undergoing the arterial switch procedure for complete transposition at the Heart Institute of Japan. The anatomic variations, described using the Shaher and Puddu classification, varied significantly, requiring alteration in the surgical technique.
Réparation à l'Etage Ventriculaire — The REV procedure: Technique and clinical results
Authors: Lecompte Yves 
Published: August 2008

SummaryFrom November 1982 to July 1989, fifty patients were treated by the REV procedure for complete transposition associated with ventricular septal defect and obstruction of the pulmonary outflow tract. The age at operation ranged from 4 months to 15 years (mean 3.8 years). The technique, based on the resection of the outlet (infundibular) septum, is described in detail. Operative mortality was 18%, essentially related to technical errors or faulty indications at the beginning of our experience. There was no late death. Six patients needed reoperation for pulmonary stenosis (2 cases) or a residual defect, in some cases associated with tricuspid regurgitation. All survivors were in excellent clinical condition. The REV procedure has fewer limitations and better results than the classical approach using Rastelli's procedure.
Modification of the Mustard operation for surgical treatment of complete transposition by creating a confluence of the caval veins
Authors: Oelert Hellmut 
Published: August 2008

SummaryIn this review, I describe our modification of the Mustard operation for hemodynamic correction of complete transposition which, in principle, consists of intraatrial construction of a caval venous confluence. A new design of the intraatrial baffle has been developed using Gore-Tex. Fewer complications have been encountered with this method when compared to other techniques of atrial redirection. The Mustard procedure, therefore, will retain a future role when anatomic abnormalities, or other circumstances, preclude anatomic correction at the arterial level.
The Senning operation for complete transposition: mid-term physiologic, electrophysiologic, and functional results
Authors: Merrill Walter H. , Stewart James R. , Hammon John W. , Johns James A. , Bender Harvey W. 
Published: August 2008

SummaryWe report analysis of surgical results in 110 consecutive infants and children who underwent atrial repair of simple complete transposition using the Senning operation between February 1978 and May 1990. Mean age at operation was 5.4 months ± 6.1 (range 1 week to 4 years); 75 were less than 6 months old. There were 72 males and 38 females. Operative mortality rate was 5.5%, with one late death. Average follow-up is 48.1 months with 44 followed greater than 3 years, and 27 greater than 5 years. Postoperative cardiac catheterization was performed in 48 patients. Right ventricular ejection fraction averaged 0.52 ± 0.08 and was normal in 28 patients. Response of right ventricular ejection fraction to afrerload stress was abnormal in 12 of 14 patients tested. Right ventricular ejection fraction increased normally during exercise in 6 patients, but was abnormal in 15. Mild tricuspid regurgitation was noted in 12 patients. Mild obstruction of the superior caval vein was noted in 4 patients. Baffle leak requiring reoperation occurred in one patient. Fifty-seven of 90 patients are in sinus rhythm by latest electrocardiogram. Postoperative electrophysiologic studies were performed in 34 patients, and Holter monitoring in 25. Significant arrhythmia occurred in 26 patients: 6 patients required pacemakers for slow junctional rhythm or complete heart block; 20 additional patients have a junctional rhythm. Six patients have delayed sinus nodal recovery time. At last follow-up, 88 children (98%) are in New York Heart Association functional Class I, and 2 (2%) are in Class II. The Senning operation for compete transposition can be accomplished with a low operative and late mortality. Serious baffle complications requiring reoperation are rare. Surviving patients are clinically well, but arrhythmias and depressed right ventricular function may limit their long-term functional status.
Functional assessment of the heart after corrective surgery for complete transposition
Authors: Redington Andrew N. 
Published: August 2008

SummaryThe justification for the introduction of the arterial switch procedure was based, primarily, on concern regarding the long-term ability of the right ventricle to perform as the systemic pumping chamber. In this article, the functional performance of both the systemic and pulmonary ventricles after atrial redirection procedures and the arterial switch operation will be discussed.
Arrhythmias after surgery for complete transposition: Do they matter?
Authors: Deanfield John E. , Cullen Seamus , Gewillig Marc 
Published: August 2008

SummaryConcern about long-term complications after intraatrial repair of complete transposition has been used as an argument in favor of “anatomic” repair by the arterial switch operation. Late arrhythmias, including loss of sinus rhythm and the development of supraventricular tachycardias, particularly atrial flutter, are widely reported after intraatrial repair. Despite modifications of technique, the electrophysiologic substrate for arrhythmia results from the extensive atrial surgery required. Arrhythmias occur, even in the “modern surgical era” after both Mustard and Senning operations, are progressive, and appear to be inevitable. The circulation after an intraatrial repair is more vulnerable to the effects of excessive tachycardia, and this may place the patient at risk from sudden cardiac death. Current attempts at individual stratification of risk are disappointing using even aggressive electrophysiologic approaches, and a combined assessment involving hemodynamics is likely to be necessary. The electrophysiologic and arrhythmic consequences of the arterial switch operation have been less extensively researched but, as might be expected, are quite different from those seen after intraatrial repair. The atrial activation sequence is relatively undisturbed, and sinus nodal dysfunction and supraventricular arrhythmia are uncommon. Ventricular extrasystoles are the arrhythmia most consistently found during the short follow-up currently available. In the longer term, myocardial ischemia, hemodynamic disturbances and autonomic imbalance may predispose to late arrhythmia. Current evidence would suggest that the lack of clinically significant arrhythmia and the restoration of the left ventricle to the systemic circulation are significant advantages of the arterial switch operation over intraatrial repair procedures.
Further morphologic studies on hearts with pulmonary atresia and intact ventricular septum
Authors: Anderson Robert H. , Anderson Christine , Zuberbuhler James R. 
Published: August 2008

SummaryAtresia of the outflow tract of the right ventricle in the presence of an intact ventricular septum poses major problems for surgical management. In the light of known problems, 43 autopsied hearts with this congenital abnormality were evaluated to note the arrangement of the myocardium and the cavity of the right ventricle, the state of the tricuspid valve, the precise substrate for pulmonary atresia, and the presence offistulous communications between the ventricular cavity and the coronary arteries. The specimens could be divided into two groups. The first group (38 hearts) had hypoplasia of the cavity of the right ventricle with mural hypertrophy while the second group (5 hearts) had a dilated right ventricular cavity with thinning of the wall. The larger group could be divided into two subgroups on the basis of the substrate for pulmonary atresia. Twenty hearts had muscular atresia of the right ventricular outflow tract and 18 had a potentially patent outflow tract blocked by an imperforate pulmonary valve. A comparison of these two subgroups revealed that mural hypertrophy and cavitary hypoplasia were more severe in hearts with muscular atresia. The tricuspid valve was hypoplastic and its leaflets were not dysplastic in this group but the leaflets were dysplastic in hearts with valvar pulmonary atresia. Fistulous communications between the ventricular cavity and the coronary arteries were only seen in the cases with muscular atresia. In this series, recognition of muscular pulmonary atresia would have identified those patients with the worst surgical prognosis.
The changes in right ventricular diastolic indices in babies with pulmonary atresia and intact ventricular septum undergoing corrective surgery: a pulsed Doppler echocardiographic study
Authors: Leung Maurice P. , Lo Peter T. S. , Lo Roxy N. S. , Cheung Henry , Mok Che-Keung 
Published: August 2008

SummaryWe used pulsed Doppler echocardiography to study the right ventricular diastolic function of29 normal babies and 12 neonates with pulmonary atresia and intact ventricular septum. Eleven patients underwent staged operations of closed pulmonaryvalvotomy followed by either rightventricular outflow reconstruction (n=5) or balloon angioplasty of the pulmonary valve (n=3). In normal babies, the Doppler wave form showed dominant early (E) and separate late active (A) waves of activity, when the heart rate was slow (<100/min). The two waves gradually merged with increasing heart rate, to form a monophasic active wave. Prior to any intervention, all except one of our patients had only a monophasic active right ventricular filling wave over the entire range of heart rates recorded. To quantitate these differences in ventricular filling, we derived 4 diastolic indices from the ratio of: the peak velocity of the early versus the late active wave (EIA); the integral with time of these waves (E/Aarea); the time of diastolic filling relative to the cardiac cycle (TIRR); and the peak diastolic filling velocity relative to the mean filling velocity over the cardiac cycle (Velocity Index). Profiles of the indices against heart rate for both normal controls and patients indicated that only the index of the time of diastolic filling (T/RR) and the Velocity Index were appropriate for our serial comparisons. Thus, for neonates with pulmonary atresia, the index of the time (TIRR) was significantly lower (0.29±0.03 vs 0.43±0.04, p<0.01) and the Velocity Index higher (5.98±0.79 vs 3.98 ±0.31, p<0.001) than those of normal. After valvotomy, but with a poor surgical result, babies continued to have a predominantly monophasic right ventricular filling pattern without significant improvement (p>0.05) of the index of time (T/RR=0.29±0.05) or velocity (5.88±1.17). Babies who underwent a second stage procedure and achieved a final good result had predominantly biphasic right ventricular diastolic filling waves with significant progression (p<0.001) in the index of time (T/RR=0.42±0.03) and velocity (4.09±0.49).
Exercise in congenital heart disease
Authors: Cullen Seamus , Celermajer David S. , Deanfield John E. 
Published: August 2008

SummaryExercise is of both physical and psychological benefit in children with congenital heart disease, leading to improved cardiovascular fitness and better quality of life. In such children, however, capacity for exercise is often impaired, and there is a risk of exercise-induced mortality or morbidity. We have reviewed the abnormal cardiovascular response to exercise in children with congenital heart defects and postoperative residua, and the role of exercise testing and training in their diagnosis and treatment. Some patients should be excluded absolutely from all but mild regular exercise because of known high risk; for example, those with severe aortic or subaortic stenosis. Other patients should be encouraged to participate in sports without any limitation; for example, those with small left-to-right shunts or mild valvar regurgitation. In many patients strict recommendations cannot be made, and one must consider the individual, the lesion and its hemodynamic implications, and the type and level of exercise contemplated. Children with congenital heart disease should be encouraged to participate in exercise and recreational sport within the limits provided by their cardiovascular defect. Understanding the pathophysiology of these defects, and knowledge of the risk of exercise in certain conditions, will allow the physician to make sensible recommendations for participation in exercise by individual patients.
Hypercyanotic spells caused by antegrade catheterization of the pulmonary arteries in tetralogy of Fallot: fact or fiction?
Authors: Murdoch Ian A. , Qureshi Shakeel A. , Anjos Rue Dos , Parsons Jonathan M. , Baker Edward J. , Tynan Michael J. 
Published: August 2008

SummaryBetween January 1985 and March 1990, 66 children with the tetralogy of Fallot underwent 85 cardiac catheterization procedures. The mean age at first procedure was 2.5 years (range 0.1–;14.4 years) and the mean weight was 10.4 kg ( range 2.4–36.0 kg). Diagnostic cardiac catheterization was performed in 60 procedures and balloon dilatation in 25. Hypercyanotic spells had occurred prior to 24 (28%) of the procedures (all the patients being on propranolol) and a systemic-to-pulmonary arterial shunt had been constructed before 28 (33%) procedures. Of the procedures, 54 (64%) were performed under local and 31(36%) under general anesthesia. The pulmonary trunk was entered antegradely in 52 procedures, retrogradely through a shunt in 6 and not entered in 27. Balloon dilatation was performed under general anesthesia on 25 occasions. No procedure was abandoned because of a cyanotic spell. Nine (11%) spells occurred during 86 procedures, one of the procedures being postponed because ofa spell occurring after premedication, the procedure and not, therefore, continuing to catheterization. Five spells occurred before the catheter was positioned in the heart, 2 spells occurred during catheterization. Of the spells, eight occurred during procedures in children who had not had previous shunts. Antegrade entry into the pulmonary trunk in the group with shunts was associated with no spells compared with 6/38 (18%) in the group not having undergone surgery (p<0.l). In the group not undergoing surgery, when the pulmonary trunk was not entered, 1 (5%) spell occurred during 19 procedures compared with 6/38 (18%) when the pulmonary trunk was entered (p<0.4). The only clinically important factor which significantly influenced the incidence of spells was the use of general anesthesia, which was associated with 6/31 (19%) spells compared with local anesthesia which was associated with 2/54 (4%) spells (p<0.026).
The technique of fetal echocardiography, with its indications and results in a selected population
Authors: Azcárate Maria J. Maitre , Jiménez Manuel Quero 
Published: August 2008

SummaryOne of the most important contributions of echocardiography to the diagnosis of congenital cardiac malformations is represented by its use in prenatal evaluation. In the present work we discuss the analysis of echocardiographic findings in a preliminary study of the hearts of fetuses in 273 pregnant women. The cases have been divided into three groups. The first group of 169 women was made up of those without a known factor conferring high risk on the pregnancy. The second group of 18 women was comprised of those of suspicions of either arrhythmias or congenitally malformed hearts. The final group of 86 women, consisted of those having had previous children with congenital heart disease. The incidence of pathology in those without risk was 0.5%. In those referred because of suspicion of disease, the incidence was 16.6%, while in those with previous history of children with heart disease, the incidence was 5.8%. Our findings proved the utility of the echocardiogram for the diagnosis of heart malformations prior to birth and confirmed the increased incidence of malformations in fetuses in mothers who had previously produced children with congenital heart disease. The high incidence of cardiac abnormalities in the group referred on the basis of an earlier scan is due to the filter represented by routine echocardiography performed by the obstetricians.
Cyanosis following a modified Fontan procedure secondary to anomalous inferior systemic venous return
Authors: Day Ronald W. , Harake Bilal , Laks Hillel 
Published: August 2008

SummaryA persistent subcardinal anastomosis was identified as a source of right-to-left shunting in a patient with excessive cyanosis following a modified Fontan procedure. Anomalies of inferior systemic venous return must be defined when a Fontan procedure is performed by direct caval venous anastomosis to the pulmonary arteries, and hepatic venous drainage is left to mix with pulmonary venous return.
Double outlet left atrium with co-existing double inlet left ventricle and discordant atrioventricular connections
Authors: Gnanapragasam James P. , Houston Allan B. , Anderson Robert H. 
Published: August 2008

SummaryWe describe an unusual heart in which double outlet from the left atrium resulted in atrioventricular connections to a dominant left ventricle and to a left-sided rudimentary right ventricle, while the right atrium also connected to the left ventricle. This produced, in effect, double inlet left ventricle in association with discordant atrioventricular connections. The diagnosis was made by echocardiography and confirmed at post mortem examination.