Revista Portuguesa De Cardiologia最新文献

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Radiation protection practices in diagnostic and interventional cardiology: A position paper from the Portuguese Association of Interventional Cardiology 诊断和介入心脏病学中的辐射防护实践：来自葡萄牙介入心脏病学协会的立场文件。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-12-01 DOI: 10.1016/j.repc.2025.07.006

Diana Ribeiro , Bruno Brochado , Graciano Paulo , Hugo Vinhas , Elisabete Jorge , Ana Felício , Carlos Braga , Pedro Sousa , Rita Calé

Introduction

Interventional cardiovascular procedures are increasingly complex, raising concerns about heightened radiation exposure for both patients and healthcare professionals. This exposure can lead to serious complications, including skin injuries, cataracts, and cancer. A range of protective tools – such as lead aprons, thyroid collars and glasses, ceiling-mounted shields, and table skirts – are available to minimize occupational exposure. Effective radiation protection relies not only on equipment but also on procedural strategies such as improved beam collimation, reduced fluoroscopic pulse rates, fluoroscopy intensity and the number of cine acquisitions, and maintaining distance from the X-ray source. Staff education, ongoing training, and routine audits are essential to ensure adherence to radiation safety protocols. While interventional cardiology teams show general awareness and use of protective measures, significant gaps remain – particularly in the consistent use of eye protection, personal dosimeters, and standardized practices across cath labs. Strengthening these areas is critical to promoting a unified national approach to radiation safety and safeguarding the long-term health of cath lab personnel.

Objectives

This position paper aims to raise operator awareness and propose novel strategies for minimizing ionizing radiation doses, thus mitigating associated risks.

Methods and results

This working group conducted a review of the scientific literature and the most recent international guidelines on radiation protection in cardiac cath labs. Based on this analysis, effective protective measures and best practices were identified and systematized, adapted to the Portuguese context.

Conclusion

Minimizing radiation exposure in the cath lab requires a comprehensive, multidisciplinary approach that combines protective equipment, procedural adjustments, and collaborative safety protocols to safeguard both patients and healthcare providers without compromising clinical outcomes.

导言：介入心血管手术越来越复杂，增加了对患者和医疗保健专业人员辐射暴露的担忧。这种暴露会导致严重的并发症，包括皮肤损伤、白内障和癌症。可以使用一系列防护工具，如铅围裙、甲状腺领和眼镜、安装在天花板上的盾牌和桌裙，以尽量减少职业性接触。有效的辐射防护不仅依赖于设备，还依赖于程序策略，如改进光束准直，降低透视脉冲率，透视强度和电影采集数量，以及保持与x射线源的距离。对工作人员的教育、持续培训和例行审计对于确保遵守辐射安全规程至关重要。虽然介入性心脏病学团队显示出对保护措施的普遍认识和使用，但仍存在重大差距，特别是在整个导管室中一致使用护眼、个人剂量计和标准化操作方面。加强这些领域对于促进国家统一的辐射安全和保障导管室工作人员的长期健康至关重要。目的：本立场文件旨在提高操作人员的意识，并提出最小化电离辐射剂量的新策略，从而减轻相关风险。方法和结果：该工作组对有关心脏导管实验室辐射防护的科学文献和最新国际指南进行了回顾。根据这一分析，确定并系统化了有效的保护措施和最佳做法，并根据葡萄牙的情况进行了调整。结论：最大限度地减少导管管实验室的辐射暴露需要一种综合的、多学科的方法，结合防护设备、程序调整和协作安全协议，以保护患者和医疗保健提供者，同时不影响临床结果。

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引用次数: 0

Successful removal of right atrial thrombus using a large-bore aspiration system 大口径抽吸系统成功清除右心房血栓。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-12-01 DOI: 10.1016/j.repc.2025.06.006

Margarida G. Figueiredo , Mariana Saraiva , Melanie Ferreira , Luís Almeida Morais

引用次数: 0

Response to the Letter to the Editor “Ikigai and cardiovascular health in older adults: A missed opportunity for prevention?” 对《老年人Ikigai和心血管健康：错过了预防的机会？》

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-12-01 DOI: 10.1016/j.repc.2025.10.002

Sofia Cabral , Cristina Gavina , Hélder Pereira

引用次数: 0

The hidden legacy of a surgical triumph: Coronary anomalies after arterial switch operation 外科手术胜利的隐藏遗产：动脉转换手术后的冠状动脉异常

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-12-01 DOI: 10.1016/j.repc.2025.11.002

Sérgio Laranjo

引用次数: 0

Ikigai and cardiovascular health in older adults: A missed opportunity for prevention? 老年人的Ikigai和心血管健康：错过了预防的机会？

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-12-01 DOI: 10.1016/j.repc.2025.07.005

Mariana Alves

引用次数: 0

Cardiogenic shock: A cardiac emergency requires cardiac leadership. 心源性休克：心脏急症需要心脏领导。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-28 DOI: 10.1016/j.repc.2025.11.004

Jorge Ferreira, Ricardo Fontes Carvalho

引用次数: 0

20 years of experience with the Fontan procedure: Risk factors for adverse outcomes 20年的丰坦手术经验：不良后果的危险因素。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 DOI: 10.1016/j.repc.2025.04.006

Tianyu Chen , Linjiang Han , Hailong Qiu , Zewen Chen , Jianzheng Cen , Shusheng Wen , Jimei Chen , Xiaobing Liu , Jian Zhuang

Introduction and objectives

The Fontan procedure and the management of patients with univentricular physiology have undergone significant evolution over the past five decades. However, the long-term outcomes of these patients remain not fully understood. This study aimed to evaluate the early and long-term outcomes of patients undergoing the Fontan procedure and to identify risk factors associated with adverse clinical events.

Methods

Patients who underwent the Fontan procedure between 2004 and 2023 were included in this study. Multivariable logistic regression analysis was employed to assess risk factors for early mortality, while a Cox proportional hazards regression model was used to evaluate predictors of long-term Fontan failure.

Results

A total of 400 patients were included, with a male predominance (67.3%). Median age at the time of the Fontan procedure was 5.8 years (interquartile range: 4.1–11.0 years). The distribution of ventricular morphology was as follows: dominant right ventricle (33%), dominant left ventricle (35.75%), and two well-developed ventricles (28.75%). The early mortality rate was 5.5%. The overall survival rates at 5-, 10-, and 15-years post-Fontan surgery were 97.5%, 92.6%, and 90.0%, respectively. Multivariable analysis identified asplenia (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.8–36.4; p<0.01), single-stage total cavopulmonary connection (OR, 5.3; 95% CI, 1.7–16.8; p<0.01), and prolonged cardiopulmonary bypass time (OR, 1.0; 95% CI, 1.0–1.0; p<0.01) as significant predictors of early mortality. Cox regression analysis demonstrated that heterotaxy (hazard ratio [HR], 3.5; 95% CI, 1.4–8.7; p<0.01) was an independent risk factor for late Fontan failure.

Conclusion

The staged Fontan strategy was associated with reduced early mortality but did not confer significant benefits on long-term outcomes. Patients with heterotaxy were at an increased risk of late Fontan failure, highlighting the need for tailored management strategies in this high-risk population.

前言和目的：在过去的五十年里，Fontan手术和单心室生理患者的管理经历了重大的演变。然而，这些患者的长期预后仍不完全清楚。本研究旨在评估接受Fontan手术的患者的早期和长期预后，并确定与不良临床事件相关的危险因素。方法：2004年至2023年间接受Fontan手术的患者纳入本研究。采用多变量logistic回归分析评估早期死亡的危险因素，采用Cox比例风险回归模型评估长期Fontan失效的预测因素。结果：共纳入400例患者，男性居多（67.3%）。Fontan手术时的中位年龄为5.8岁（四分位数范围：4.1-11.0岁）。心室形态分布：右心室优势（33%），左心室优势（35.75%），两个心室发育良好（28.75%）。早期死亡率为5.5%。fontan手术后5年、10年和15年的总生存率分别为97.5%、92.6%和90.0%。多变量分析发现，脾功能不全（优势比[OR]， 10.2； 95%可信区间[CI]， 2.8-36.4; p < 0.01）、单期全腔肺连接（OR, 5.3; 95% CI, 1.7-16.8; p < 0.01）和延长体外循环时间（OR, 1.0; 95% CI, 1.0-1.0; p < 0.01）是早期死亡的重要预测因素。Cox回归分析显示，异质性（风险比[HR]为3.5；95% CI为1.4 ~ 8.7;p < 0.01）是晚期Fontan衰竭的独立危险因素。结论：分阶段Fontan策略与降低早期死亡率相关，但对长期预后没有显著益处。异位患者晚期Fontan失败的风险增加，突出了在这一高危人群中定制管理策略的必要性。

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引用次数: 0

Etiology of sudden cardiac arrest: Literature review and proposal for an intensive care unit study protocol 心脏骤停的病因学：文献回顾和重症监护病房研究方案的建议。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 DOI: 10.1016/j.repc.2025.04.007

João Cravo , Daniel Inácio Cazeiro , Oana Moldovan , Nuno Cortez-Dias , Doroteia Silva

Sudden cardiac arrest (SCA) affects individuals across all age groups and is defined as the sudden cessation of normal cardiac activity, leading to hemodynamic collapse. Determining the etiology of SCA is challenging due to its wide range of cardiac and noncardiac causes. Structural heart disease, mainly coronary artery disease, is predominant in older adults, while cardiomyopathies and primary electrical diseases are more common in younger individuals. Noncardiac causes, such as intracranial hemorrhage and pulmonary embolism, account for 15–25% of cases. This review examines the epidemiology, etiology, and investigation of SCA and proposes a diagnostic approach for SCA patients admitted to the emergency department and intensive care unit. The study protocol is divided into four main stages: (1) initial evaluation, identification of reversible causes, and exclusion of ischemic heart disease and extracardiac disease; (2) assessment of nonischemic cardiac causes; (3) neuroprognostication; and (4) clinical autopsy and/or genetic testing, if appropriate. We emphasize the importance of a multidisciplinary approach, involving an intensivist, cardiologist, neurologist, geneticist, and pathologist, as well as early genetic testing to identify potential heritable diseases and facilitate early referral of patient relatives. By providing this structured diagnostic algorithm, we aim to improve the management and outcomes of SCA patients.

心脏骤停（SCA）影响所有年龄组的个体，被定义为正常心脏活动突然停止，导致血液动力学崩溃。由于其广泛的心脏和非心脏原因，确定SCA的病因是具有挑战性的。结构性心脏病，主要是冠状动脉疾病，在老年人中占主导地位，而心肌病和原发性电性疾病在年轻人中更常见。非心脏原因，如颅内出血和肺栓塞，占病例的15-25%。本文综述了SCA的流行病学、病因学和调查，并提出了一种用于急诊和重症监护病房的SCA患者的诊断方法。研究方案分为四个主要阶段：(1)初步评估，确定可逆原因，排除缺血性心脏病和心外疾病；(2)评估非缺血性心脏原因；(3) neuroprognostication;(4)临床尸检和/或基因检测，如果合适的话。我们强调多学科方法的重要性，包括重症医师、心脏病专家、遗传学家和病理学家，以及早期基因检测，以识别潜在的遗传性疾病，并促进患者亲属的早期转诊。通过提供这种结构化的诊断算法，我们旨在改善SCA患者的管理和预后。

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引用次数: 0

The long Fontan crusade 漫长的十字军东征。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 DOI: 10.1016/j.repc.2025.09.001

José Fragata

引用次数: 0

Silent expansion: A case report of a young adult with ascending aortic aneurysm 无声扩张：1例年轻成人升主动脉瘤。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 DOI: 10.1016/j.repc.2025.03.009

Carla Costa , Márcio Madeira , Lígia Mendes

引用次数: 0

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