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Aswan Heart Centre: Fundamental values 阿斯旺心脏中心:基本价值观
Pub Date : 2023-12-07 DOI: 10.21542/gcsp.2024.1
Ingi Farid
To celebrate Aswan Heart Centre’s 15th Anniversary, which is an integral and core part of the Magdi Yacoub Foundation, it was decided to review the Values that have contributed significantly to the progress of AHC. To do this, we had a consensus meeting and the proceedings of the meeting represented our core values.
为了庆祝阿斯旺心脏中心成立15周年,该中心是Magdi Yacoub基金会不可或缺的核心部分,我们决定审查对AHC进步做出重大贡献的价值观。为此,我们召开了一次共识会议,会议记录代表了我们的核心价值观。
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引用次数: 0
Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: a clinical study 确定 LV 充盈时间是否对 LBBB 患者不同 QRS 宽度的房颤症状有影响:一项临床研究
Pub Date : 2023-12-07 DOI: 10.21542/gcsp.2024.8
Masoumeh Ahmadzadeh, Mehran Rahimi, Mehrnoush Toufan-Tabrizi, Kamran Mohammadi
Objectives: Accurate assessment of left ventricular (LV) function is essential for managing patients with left bundle branch block (LBBB). This study aimed to evaluate the relationship between LV systolic function, left ventricular diastolic filling time (LVFT), QRS duration, and heart failure symptoms in patients with LBBB.Methods: This study was conducted between June 2021 and June 2022. Patients with LBBB and sinus rhythm who were referred to the echocardiography department were included in the study. All the patients underwent electrocardiogram-gated echocardiography using the same machine. In this study, the LVFT value was measured in absolute terms and as a ratio to the R-R interval (LVFT/RR).Results: A total of sixty-five patients were included, forty-two (64.6%) were women, and the mean age was 60.71 ± 8.72. We performed three one-way ANOVA tests that showed that LV filling time/RR ratio, QRS duration, and ejection fraction were significantly different between heart failure classes (p=0.008, p=0.001, and p<0.001, respectively). A weak correlation was observed between LVEF and LVFT/RR (r= 0.349, p=0.004). Additionally, QRS duration was negatively correlated with LVEF (r = -0.395, p=0.004) and LVFT/RR (r = -0.350, p=0.004), although these correlations were weak.Conclusion: We showed that LVFT/RR ratio differed significantly between HF functional classes and was lower in patients with more severe HF symptoms. Additionally, QRS duration was negatively correlated with LVEF and LVFT/RR, and patients with more severe HF symptoms had longer QRS durations.
目的:准确评估左心室(LV)功能对治疗左束支传导阻滞(LBBB)患者至关重要。本研究旨在评价LBBB患者左室收缩功能、左室舒张充盈时间(LVFT)、QRS持续时间与心衰症状的关系。方法:本研究于2021年6月至2022年6月进行。在超声心动图科就诊的LBBB和窦性心律患者也被纳入研究。所有患者均使用同一台机器进行心电图门控超声心动图检查。在本研究中,LVFT值以绝对值和与R-R区间的比值(LVFT/RR)测量。结果:共纳入65例患者,其中女性42例(64.6%),平均年龄60.71±8.72岁。我们进行了三个单因素方差分析,结果显示左室充盈时间/RR比、QRS持续时间和射血分数在心力衰竭类别之间存在显著差异(分别为p=0.008、p=0.001和p<0.001)。LVEF与LVFT/RR呈弱相关(r= 0.349, p=0.004)。QRS持续时间与LVEF (r = -0.395, p=0.004)和LVFT/RR (r = -0.350, p=0.004)呈负相关,但相关性较弱。结论:我们发现,不同功能级别的心衰患者LVFT/RR差异显著,且心衰症状越严重,LVFT/RR越低。QRS持续时间与LVEF和LVFT/RR呈负相关,HF症状越严重的患者QRS持续时间越长。
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引用次数: 0
Structural aortic wall abnormalities following the Nikaidoh operation, which could be reversible and include a healing process 尼凯多手术后主动脉壁结构异常,这可能是可逆的,包括一个愈合过程
Pub Date : 2023-12-07 DOI: 10.21542/gcsp.2024.3
Magdi Yacoub, A. Afifi, Hatem Hosny, Ahmed Nahgoub, Mohamed Nagy, Sanida Vaz, P. Sarathchandra, N. Latif
The Nikaidoh operation continues to be used for patients with transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction. We recently reported structural and functional changes in the aortic root during the follow-up of a patient who underwent the Nikaidoh operation. These changes necessitated re-operation. The pathophysiology of these changes and their potential for reversibility have not yet been studied. In this communication, we describe the extensive structural changes in the aortic wall of the same patient.
Nikaidoh手术继续用于大动脉转位、室间隔缺损和左心室流出道梗阻的患者。我们最近报道了一位接受Nikaidoh手术的患者在随访期间主动脉根部的结构和功能变化。这些变化需要重新操作。这些变化的病理生理学及其潜在的可逆性尚未得到研究。在这篇文章中,我们描述了同一患者主动脉壁的广泛结构变化。
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引用次数: 0
Navigating the challenges of bicuspid aortic valve-aortopathy 导航二尖瓣主动脉瓣病变的挑战
Pub Date : 2023-09-10 DOI: 10.21542/gcsp.2023.27
Sai Gautham Kanagala, Aanchal Sawhney, Kinna Parikh, Vasu Gupta, Talha Mahmood, FNU Anamika, Rohit Jain, Nikita Garg
Bicuspid aortic valve (BAV) is a congenital heart defect that affects 0.5-2% of the general population with familial predominance. The modifications in hemodynamics and structure change at cellular level contribute to the dilation of aorta, resulting in bicuspid aortopathy, which can result in catastrophic aortic events. The American Heart Association recommends screening first-degree relatives of patients with bicuspid aortic valve and aortic root disease. BAV may or may not be associated with a syndrome, with the non-syndromic variety having a higher chance of predisposition to congenital and vascular abnormalities. Many genes have been implicated in the etiology of non-syndromic aortic aneurysm such as ACTA2, MYH11, FLNA, and SMAD3. Common diagnostic modalities include transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), multi system computer tomography (MSCT), and cardiac MRI. Medical management reduces the rate of disease progression and surgical management is indicated based on the diameter of the ascending aorta, which differs in American and European guidelines. Our article aims to explore the current understanding of the pathophysiology, clinical aspects, and surgical management of bicuspid aortic valve disease. Additionally, we have included a discussion on the management of this condition in special populations, such as athletes and pregnant women, who require distinct treatment recommendations.
双尖瓣主动脉瓣(BAV)是一种先天性心脏缺陷,影响0.5-2%的普通人群,具有家族优势。血流动力学的改变和细胞水平上的结构改变导致主动脉扩张,导致双尖动脉病变,可导致主动脉灾难性事件。美国心脏协会建议筛查患有二尖瓣主动脉瓣和主动脉根部疾病的患者的一级亲属。BAV可能与综合征有关,也可能与综合征无关,而非综合征型的BAV更易发生先天性和血管异常。许多基因与非综合征性主动脉瘤的病因有关,如ACTA2、MYH11、FLNA和SMAD3。常见的诊断方式包括经胸超声心动图(TTE)、经食管超声心动图(TEE)、多系统计算机断层扫描(MSCT)和心脏MRI。内科治疗可降低疾病进展率,根据升主动脉直径进行手术治疗,这在美国和欧洲的指南中有所不同。我们的文章旨在探讨目前对二尖瓣主动脉瓣疾病的病理生理,临床方面和手术治疗的理解。此外,我们还讨论了特殊人群(如运动员和孕妇)对这种疾病的管理,这些人群需要不同的治疗建议。
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引用次数: 0
Myocarditis and COVID-19 related issues 心肌炎和COVID-19相关问题
Pub Date : 2023-09-10 DOI: 10.21542/gcsp.2023.28
Michele Ciabatti, Chiara Zocchi, Iacopo Olivotto, Leonardo Bolognese, Maurizio Pieroni
The recent COVID-19 (Coronavirus Disease 2019) pandemic by SARS-CoV2 infection has caused millions of deaths and hospitalizations across the globe. In the early pandemic phases, the infection had been initially considered a primary pulmonary disease. However, increasing evidence has demonstrated a wide range of possible cardiac involvement. Most of systemic and cardiac damage is likely sustained by a complex interplay between inflammatory, immune-related and thrombotic mechanisms. Biventricular failure and myocardial damage with elevation of cardiac biomarkers have been reported in COVID-19 patients, although histological demonstration of acute myocarditis has been rarely documented. Indeed while cardiac magnetic resonance findings include different patterns of myocardial involvement in terms of late gadolinium enhancement, histological data from necropsy and endomyocardial biopsy showed peculiar inflammatory patterns, mostly composed by macrophages. On the other hand COVID-19 vaccines based on mRN technology have been also associated with increased risk of myocarditis. COVID-19 and mRNA vaccine-related myocarditis present different clinical and imaging presentations and recent data suggest the presence of distinctive immunological mechanisms involved.
& # x0D;& # x0D;& # x0D;最近由SARS-CoV2感染引起的COVID-19(冠状病毒病2019)大流行已在全球造成数百万人死亡和住院。在大流行的早期阶段,这种感染最初被认为是一种原发性肺部疾病。然而,越来越多的证据表明,心脏可能受到广泛的影响。大多数全身和心脏损伤可能是由炎症、免疫相关和血栓形成机制之间的复杂相互作用维持的。尽管急性心肌炎的组织学表现很少有文献记载,但在COVID-19患者中已报道双心室衰竭和心肌损伤伴心脏生物标志物升高。的确,虽然心脏磁共振结果包括不同类型的晚期钆增强心肌受累,但尸检和心内膜活检的组织学数据显示了特殊的炎症模式,主要由巨噬细胞组成。另一方面,基于mRN技术的COVID-19疫苗也与心肌炎风险增加有关。COVID-19和mRNA疫苗相关心肌炎表现出不同的临床和影像学表现,最近的数据表明存在不同的免疫机制。 & # x0D;& # x0D;
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引用次数: 0
The catastrophic association of prosthetic mitral valve thrombosis and hemorrhagic stroke 假体二尖瓣血栓形成与出血性中风的灾难性关联
Pub Date : 2023-09-10 DOI: 10.21542/gcsp.2023.31
Humberto Morais, Mauer Gonçalves
Prosthetic valve thrombosis is a serious complication of valve replacement associated with a high mortality rate. Stroke may be the first symptom of prosthetic valve thrombosis. We present the case of a patient who visited the emergency department with symptoms of dysarthria and left hemiparesis. An examination revealed an ischemic stroke with hemorrhagic transformation, stemming from a thrombosis of their mitral valve prosthesis, which progressed to the patient’s death. We emphasize the difficulty in the therapeutic and diagnostic management of these patients.
人工瓣膜血栓形成是瓣膜置换术的严重并发症,死亡率高。卒中可能是人工瓣膜血栓形成的第一症状。我们提出的情况下,病人访问了急诊科的症状构音障碍和左偏瘫。检查显示缺血性中风并出血转化,源于他们的二尖瓣假体的血栓形成,并发展到病人的死亡。我们强调在这些病人的治疗和诊断管理的困难。
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引用次数: 0
Reoperative CABG in a patient with prior concomitant lung transplantation and two-vessel CABG 既往合并肺移植和双血管冠脉搭桥患者的再手术
Pub Date : 2023-09-10 DOI: 10.21542/gcsp.2023.25
Emily Larson, Anson Lee, Jennifer Lawton, Hamza Aziz
Background: Lung transplants (LTx) are being offered to increasingly older patients, and as a result, more concomitant coronary artery disease is being encountered in LTx candidates. While concurrent coronary artery bypass grafting (CABG) and LTx have become more common, the long-term considerations of reoperative CABG in patients following CABG with concomitant LTx are not fully understood. Case presentation: A 75-year-old man with a history of bilateral LTx and concomitant CABG X 2 15 years prior presented to the emergency room with tachycardia and chest discomfort radiating to the left upper extremity. Emergent coronary angiography revealed severe three- vessel coronary artery disease with two occluded saphenous vein grafts, severe distal obtuse marginal (OM) and left circumflex disease, a collateralized chronic total occlusion of the mid LAD, and tortuosity of the proximal right innominate artery. The patient underwent a complex redo sternotomy and CABG X 2 due to dense adhesions in the mediastinum and pleura bilaterally. The postoperative course was complicated by left leg SVG harvest site cellulitis treated with IV antibiotics and hypervolemia treated with diuresis. The patient was discharged postoperatively on day 13. Discussion: To our knowledge, this is the first reported successful reoperative CABG in a patient with a history of concomitant LTx and CABG. This case demonstrates feasibility, though additional caution is required due to the technical complexity and risk of immunosuppression in such complex patients.
背景:肺移植(LTx)正被越来越多的老年患者所接受,因此,在LTx候选者中,更多的合并冠状动脉疾病正在被遇到。虽然同时进行冠状动脉旁路移植术(CABG)和LTx已经变得越来越普遍,但对于CABG合并LTx患者再行CABG手术的长期考虑尚不完全清楚。病例介绍:一名75岁男性,15年前有双侧LTx病史并伴有冠脉搭桥,因左上肢心动过速和胸部不适就诊于急诊室。急诊冠状动脉造影显示严重的三支冠状动脉疾病,伴两条隐静脉移植物闭塞,严重的远端钝缘(OM)和左旋疾病,侧枝性LAD中部慢性全闭塞,右近端无名氏动脉扭曲。由于双侧纵隔和胸膜致密粘连,患者接受了复杂的重做胸骨切开术和CABG x2。术后并发左腿SVG采集部位蜂窝组织炎,静脉注射抗生素治疗,利尿治疗高血容量。患者于术后第13天出院。讨论:据我们所知,这是首例有LTx和CABG合并病史的患者成功再手术CABG的报道。该病例证明了可行性,但由于技术复杂性和这种复杂患者免疫抑制的风险,需要额外的谨慎。
{"title":"Reoperative CABG in a patient with prior concomitant lung transplantation and two-vessel CABG","authors":"Emily Larson, Anson Lee, Jennifer Lawton, Hamza Aziz","doi":"10.21542/gcsp.2023.25","DOIUrl":"https://doi.org/10.21542/gcsp.2023.25","url":null,"abstract":"Background: Lung transplants (LTx) are being offered to increasingly older patients, and as a result, more concomitant coronary artery disease is being encountered in LTx candidates. While concurrent coronary artery bypass grafting (CABG) and LTx have become more common, the long-term considerations of reoperative CABG in patients following CABG with concomitant LTx are not fully understood. Case presentation: A 75-year-old man with a history of bilateral LTx and concomitant CABG X 2 15 years prior presented to the emergency room with tachycardia and chest discomfort radiating to the left upper extremity. Emergent coronary angiography revealed severe three- vessel coronary artery disease with two occluded saphenous vein grafts, severe distal obtuse marginal (OM) and left circumflex disease, a collateralized chronic total occlusion of the mid LAD, and tortuosity of the proximal right innominate artery. The patient underwent a complex redo sternotomy and CABG X 2 due to dense adhesions in the mediastinum and pleura bilaterally. The postoperative course was complicated by left leg SVG harvest site cellulitis treated with IV antibiotics and hypervolemia treated with diuresis. The patient was discharged postoperatively on day 13. Discussion: To our knowledge, this is the first reported successful reoperative CABG in a patient with a history of concomitant LTx and CABG. This case demonstrates feasibility, though additional caution is required due to the technical complexity and risk of immunosuppression in such complex patients.","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136072888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stress cardiomyopathy as a cardiovascular manifestation of COVID-19 应激性心肌病作为COVID-19的心血管表现
Pub Date : 2023-09-10 DOI: 10.21542/gcsp.2023.29
Khaled Abdullah, Mohamad Bakir, Danielle Greenberg, Eyad Almasri
Patients with coronavirus disease 2019 (COVID-19) may present with a broad spectrum of clinical manifestations, affecting several organ systems. Commonly reported cardiac manifestations include myocardial injury, heart failure (HF), cardiogenic shock, and arrhythmias. Stress (takotsubo) cardiomyopathy, which is characterized by apical ballooning of the heart leading to acute left ventricular dysfunction, is rarely seen in patients with COVID-19. We present a case of COVID-19-associated stress cardiomyopathy in a female in her sixties.
2019冠状病毒病(COVID-19)患者可能表现出广泛的临床表现,影响多个器官系统。常见的心脏表现包括心肌损伤、心力衰竭、心源性休克和心律失常。压力性心肌病(takotsubo)在COVID-19患者中很少见,其特征是心脏根尖膨胀导致急性左心室功能障碍。我们提出了一例与covid -19相关的应激性心肌病,发生在一位60多岁的女性身上。
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引用次数: 0
Early detection of reduced left ventricular systolic function by 2D speckle tracking echocardiography in patients with primary mitral regurgitation in a Vietnamese cohort 二维斑点跟踪超声心动图早期检测原发性二尖瓣反流患者左心室收缩功能减退
Pub Date : 2023-09-10 DOI: 10.21542/gcsp.2023.26
Anh Vu Nguyen, Thi Diem Nguyen, Thi To Linh Ong, Viet An Tran, Lam Thai Bao Tran, Minh Chau Tran
Background: Mitral regurgitation (MR) is a common heart valve disease, causing many serious complications in several organ systems, especially the cardiovascular system. The 2D speckle tracking echocardiography (STE) is a new technique for detecting potential cardiac dysfunction when only tissue function abnormalities are present. The study aimed to assess left ventricular (LV) systolic function early by STE in patients with primary MR through global LV deformity along the global longitudinal strain (GLS). Methods: An analytical cross-sectional study was performed on 46 patients with moderate to severe primary MR as recommended by the American Society of Echocardiography (ASE) 2017. Results: The prevalence of patients with GLS reduction with ejection fraction (EF) >60%, New York Heart Association (NYHA) I, and left ventricular internal diameter systolic (LVIDs) <40mm was 38.1%, 35.7%, and 39.5%, respectively. 100% of patients with EF<60% and LVIDs40mm had reduced GLS (<16%). The GLS index strongly correlates with the NYHA classification, degree of MR, EF, and echocardiographic parameters. Conclusion: GLS index gives a significant sign in the early detection of cardiac function abnormalities before symptoms or other echocardiographic parameters in patients with MR.
背景:二尖瓣反流(MR)是一种常见的心脏瓣膜疾病,可导致许多器官系统,特别是心血管系统的严重并发症。二维散斑跟踪超声心动图(STE)是一种新的技术,用于检测潜在的心功能异常时,只有组织功能异常存在。该研究旨在通过左室纵向应变(GLS)的整体畸形,通过STE早期评估原发性MR患者的左室收缩功能。方法:对美国超声心动图学会(ASE) 2017推荐的46例中度至重度原发性MR患者进行分析性横断面研究。结果:GLS降低,射血分数(EF) 60%,纽约心脏协会(NYHA) I级,左室收缩内径(LVIDs) 40mm的患者患病率分别为38.1%,35.7%,39.5%。EF<60%, LVIDs≤40mm的患者GLS降低率为100% (<16%)。GLS指数与NYHA分类、MR程度、EF和超声心动图参数密切相关。结论:GLS指数对MR患者在出现症状或其他超声心动图参数前早期发现心功能异常具有重要意义。
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引用次数: 0
Secondary analysis of REPRISE III trial: The Lotus valve's persistence after withdrawal REPRISE III试验的二次分析:莲花瓣膜停药后的持续性
Pub Date : 2023-09-10 DOI: 10.21542/gcsp.2023.30
Susy Kotit
Introduction: Aortic stenosis (AS) is the leading heart valve disease in developed countries, often caused by calcific degeneration. In low-and-middle-income countries, it's primarily due to RHD. Prevalence of AS increases with age and up to 22.8% of those affected over the age of 75. While surgical aortic valve replacement is standard treatment for AS, many older individuals are not ideal candidates. Transcatheter aortic valve replacement (TAVR) offers an alternative. The REPRISE III trial showed the Lotus valve outperformed the CoreValve/EvolutR TAVR valves in various metrics over 2 years. Despite its success and over 10,000 implantations, the Lotus valve was pulled from the market, highlighting the need to understand its long-term outcomes. Study and results: In the REPRISE III trial, the long-term outcomes of TAVR using the Lotus valve were compared to the CoreValve/EvolutR over 5 years across 55 global centers. Of the participants, 581 (95.7%) used the Lotus valve and 285 (93.4%) used CoreValve/EvolutR. Event rates for all-cause mortality were similar between the groups, but the Lotus valve group had lower rates of disabling stroke and pacemaker implantation. The Lotus valve showed a higher aortic gradient but lower effective orifice area. Additionally, the Lotus valve had reduced mild PVL, valve...
主动脉瓣狭窄(Aortic stenosis, AS)是发达国家主要的心脏瓣膜疾病,常由钙化变性引起。在低收入和中等收入国家,这主要是由于RHD。AS的患病率随着年龄的增长而增加,75岁以上患者的患病率高达22.8%。虽然手术主动脉瓣置换术是AS的标准治疗方法,但许多老年人并不是理想的选择。经导管主动脉瓣置换术(TAVR)提供了另一种选择。REPRISE III试验显示,在2年的时间里,Lotus阀在各种指标上都优于CoreValve/EvolutR TAVR阀。尽管取得了成功,植入了超过1万例,但Lotus瓣膜还是被撤出了市场,这凸显了了解其长期效果的必要性。研究和结果:在REPRISE III试验中,使用Lotus瓣膜的TAVR的长期结果与全球55个中心的CoreValve/EvolutR进行了5年的比较。在参与者中,581人(95.7%)使用Lotus阀,285人(93.4%)使用CoreValve/EvolutR。两组之间的全因死亡率相似,但莲花瓣膜组的致残性中风和起搏器植入率较低。莲花瓣主动脉梯度较高,但有效孔口面积较小。此外,Lotus阀降低了轻度PVL,阀…
{"title":"Secondary analysis of REPRISE III trial: The Lotus valve's persistence after withdrawal","authors":"Susy Kotit","doi":"10.21542/gcsp.2023.30","DOIUrl":"https://doi.org/10.21542/gcsp.2023.30","url":null,"abstract":"Introduction: Aortic stenosis (AS) is the leading heart valve disease in developed countries, often caused by calcific degeneration. In low-and-middle-income countries, it's primarily due to RHD. Prevalence of AS increases with age and up to 22.8% of those affected over the age of 75. While surgical aortic valve replacement is standard treatment for AS, many older individuals are not ideal candidates. Transcatheter aortic valve replacement (TAVR) offers an alternative. The REPRISE III trial showed the Lotus valve outperformed the CoreValve/EvolutR TAVR valves in various metrics over 2 years. Despite its success and over 10,000 implantations, the Lotus valve was pulled from the market, highlighting the need to understand its long-term outcomes. Study and results: In the REPRISE III trial, the long-term outcomes of TAVR using the Lotus valve were compared to the CoreValve/EvolutR over 5 years across 55 global centers. Of the participants, 581 (95.7%) used the Lotus valve and 285 (93.4%) used CoreValve/EvolutR. Event rates for all-cause mortality were similar between the groups, but the Lotus valve group had lower rates of disabling stroke and pacemaker implantation. The Lotus valve showed a higher aortic gradient but lower effective orifice area. Additionally, the Lotus valve had reduced mild PVL, valve...","PeriodicalId":416388,"journal":{"name":"Global Cardiology Science and Practice","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136072883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Global Cardiology Science and Practice
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