Current Treatment Options in Cardiovascular Medicine最新文献

Purpose of review: Paradigms surrounding congenital heart disease (CHD) etiology represent an evolving area of study. Traditionally, genetic causes of CHD have been classified into chromosomal abnormalities, copy number variation, and single-gene disorders, while environmental contributors include external and intrinsic maternal factors that impair cardiac development. Here, we summarize established causes of CHD and highlight emerging insights into CHD pathogenesis that may inform future treatment options.

Recent findings: Recent advancements in next-generation sequencing technologies have uncovered novel genetic etiologies underlying CHD including oligogenic inheritance and pathogenic noncoding variation. In addition, industrialization and transformation of society has introduced new environmental risk factors that may contribute to CHD. Further, mechanistic insight into both genetic and environmental factors underlying CHD has led to discovery of novel therapeutic strategies.

Summary: New methodologies have greatly improved our comprehension of the heterogeneous mechanisms underlying CHD, catalyzing the discovery of effective therapeutic strategies to reduce CHD incidence.

Purpose of review: Patent ductus arteriosus (PDA) treatment strategies in the neonatal period differ widely. Variations in what constitutes hemodynamic significance (hsPDA) and scarcity of high-quality data on long-term outcomes has contributed to lack of standardization. Filling these knowledge gaps would impact clinical decision making.

Recent findings: Recent trials have not shown improvement in outcomes with early compared to expectant management. Targeted neonatal echocardiography (TnECHO) has facilitated timely intervention with encouraging outcomes. Acetaminophen use is increasing even in infants < 24 weeks. Advancements in percutaneous transcatheter occlusion, characterization of the unique expression of genes and ion channels of the ductus arteriosus, and attention to nonpharmacologic strategies are essential advances in PDA management.

Summary: With increased utilization of TnECHO, clarification of the scope of transcatheter-based closures, further understanding of the genetic and molecular factors involved in ductal tone, and the appreciation of the off-target effects that medications and fluid balance can have on the DA, providing targeted, individualized PDA treatment is achievable. However, the development of innovative therapies to promote ductal closure is a necessity.

Purpose of review: 3D printing (3DP) technology has emerged as a valuable tool for surgeons and cardiovascular interventionalists in developing and tailoring patient-specific treatment strategies, especially in complex and rare cases. This short review covers advances, primarily in the last three years, in the use of 3DP in the diagnosis and management of heart failure and related cardiovascular conditions.

Recent findings: Latest studies include utilization of 3DP in ventricular assist device placement, congenital heart disease identification and treatment, pre-operative planning and management in hypertrophic cardiomyopathy, clinician as well as patient education, and benchtop mock circulatory loops.

Summary: Studies reported benefits for patients including significantly reduced operation time, potential for lower radiation exposure, shorter mechanical ventilation times, lower intraoperative blood loss, and less total hospitalization time, as a result of the use of 3DP. As 3DP technology continues to evolve, clinicians, basic science researchers, engineers, and regulatory authorities must collaborate closely to optimize the utilization of 3D printing technology in the diagnosis and management of heart failure.

Purpose of review: The main objective of this review article is to discuss the prevalence, utilization, and outcomes associated with advanced heart failure therapies among patients with neuromuscular disorders.

Recent findings: Neuromuscular disorders often have multisystem involvement with a high prevalence of cardiovascular pathology. With the improvement in management of respiratory related complications, heart failure is now the leading cause of mortality in this patient population. Advanced heart failure therapies with durable left ventricular assist devices and heart transplantation have proven to be feasible and safe treatment options in selected patients.

Summary: Management of neuromuscular disease involves multidisciplinary team involvement given the systemic nature of the disease. Early recognition and close monitoring of these patients will allow for timely initiation of advanced heart failure therapies that can lead to successful outcomes.