Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality...Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality of life and a worse illness course.The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity.Moreover,the complex underlying mechanism that links these two conditions remains unclear.This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.展开更多
BACKGROUND The use of pre-closure suture-based devices represents a widely access-site hemostasis technique in percutaneous transfemoral transcatheter-aortic-valvereplacement(TF-TAVR);yet this technique is associated ...BACKGROUND The use of pre-closure suture-based devices represents a widely access-site hemostasis technique in percutaneous transfemoral transcatheter-aortic-valvereplacement(TF-TAVR);yet this technique is associated with the risk of a device failure that may result in clinically relevant residual bleeding.Thus,a bailout intervention is needed.So far,the best management of pre-closure device failure has not been recognized.AIM To report the first clinical results obtained using a novel bailout hemostasis technique for patients with double suture-based vascular closure device failure in the setting of TF-TAVR.METHODS We developed a“pledget-assisted hemostasis”technique to manage residual access-site bleeding.This consists of the insertion of a surgical,non-absorbable,polytetrafluoroethylene pledget over the sutures of the two ProGlide(Abbott Vascular,CA,United States).The ProGlide’s knot-pushers are used to push down the pledget and the hand-made slipknot to seal the femoral artery leak.This technique was used as a bailout strategy in patients undergoing TF-TAVR with a systematic double pre-closure technique.Post-procedural access-site angiography was systematically performed.In-hospital complications were systematically detected and classified according to Valve Academic Research Consortium-2 criteria.RESULTS Out of 136 consecutive patients who underwent TF-TAVR,15 patients(mean age 80.0±7.2 years,66.7%female)with access-site bleeding after double pre-closure technique failure were treated by pledget-assisted hemostasis.In the majority of patients,16F sheath was used(n=12;80%).In 2 cases(13%),a peripheral balloon was also inflated in the iliac artery to limit blood loss during pledget preparation.Angiography-confirmed hemostasis(primary efficacy endpoint)was achieved in all patients.After the procedure,1 patient required blood transfusion(2 units),and no other bleeding or major ischemic complication was noticed.CONCLUSION The“pledget assisted hemostasis”might be considered as a possible bailout technique to treat patients with residual access site bleeding.Further studies are needed to compare this approach with other bail-out techniques.展开更多
Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease,both shortly after the event and during follow-up,particularly in women.The coronavirus disease 2...Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease,both shortly after the event and during follow-up,particularly in women.The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women,possibly due to several contributing factors,ranging from lockdown,stay at home regulations,job losses,anxiety,and stress.Accordingly,it remains paramount to enforce proactive preventive strategies,at both the family and individual level,maintain a high level of attention to recognize all forms of violence or abuse,and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical,sexual,and emotional domains and offer a personalized care.展开更多
文摘Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity.The coexistence of a heart disease complicates the management of mental illness,can contribute to a reduced quality of life and a worse illness course.The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity.Moreover,the complex underlying mechanism that links these two conditions remains unclear.This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.
文摘BACKGROUND The use of pre-closure suture-based devices represents a widely access-site hemostasis technique in percutaneous transfemoral transcatheter-aortic-valvereplacement(TF-TAVR);yet this technique is associated with the risk of a device failure that may result in clinically relevant residual bleeding.Thus,a bailout intervention is needed.So far,the best management of pre-closure device failure has not been recognized.AIM To report the first clinical results obtained using a novel bailout hemostasis technique for patients with double suture-based vascular closure device failure in the setting of TF-TAVR.METHODS We developed a“pledget-assisted hemostasis”technique to manage residual access-site bleeding.This consists of the insertion of a surgical,non-absorbable,polytetrafluoroethylene pledget over the sutures of the two ProGlide(Abbott Vascular,CA,United States).The ProGlide’s knot-pushers are used to push down the pledget and the hand-made slipknot to seal the femoral artery leak.This technique was used as a bailout strategy in patients undergoing TF-TAVR with a systematic double pre-closure technique.Post-procedural access-site angiography was systematically performed.In-hospital complications were systematically detected and classified according to Valve Academic Research Consortium-2 criteria.RESULTS Out of 136 consecutive patients who underwent TF-TAVR,15 patients(mean age 80.0±7.2 years,66.7%female)with access-site bleeding after double pre-closure technique failure were treated by pledget-assisted hemostasis.In the majority of patients,16F sheath was used(n=12;80%).In 2 cases(13%),a peripheral balloon was also inflated in the iliac artery to limit blood loss during pledget preparation.Angiography-confirmed hemostasis(primary efficacy endpoint)was achieved in all patients.After the procedure,1 patient required blood transfusion(2 units),and no other bleeding or major ischemic complication was noticed.CONCLUSION The“pledget assisted hemostasis”might be considered as a possible bailout technique to treat patients with residual access site bleeding.Further studies are needed to compare this approach with other bail-out techniques.
文摘Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease,both shortly after the event and during follow-up,particularly in women.The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women,possibly due to several contributing factors,ranging from lockdown,stay at home regulations,job losses,anxiety,and stress.Accordingly,it remains paramount to enforce proactive preventive strategies,at both the family and individual level,maintain a high level of attention to recognize all forms of violence or abuse,and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical,sexual,and emotional domains and offer a personalized care.
