ΕΠΙΣΤΗΜΟΝΙΚΑ ΚΙ … ΑΛΛΑ”από τον Ομ. Καθηγητή, Ιωάννη Γουδέβενο, 20.11.2024 – Kawasaki Disease

Εφυγε από τη ζωή ο  Thomas Killip III. Πρωτοπόρος στη δημιουργία των στεφανιαίων μονάδων(CCU) το  1967 και ο πρώτος που επέτρεψε να κάνουν απινίδωση οι νοσηλεύτριες. Γνωστός από τη κατάταξη της ΚΑ μετα OΕΜ. 

Θανάση  παρελθόν δεν υπάρχει; Να μη ξεχνάμε ότι

Από το oloygeia.gr. «Η συμμετοχή της Θεραπευτικής Κλινικής της Ιατρικής Σχολής του ΕΚΠΑ –  στο 35ο Πανελλήνιο Αιματολογικό Συνέδριο ήταν πολύ σημαντική, με τον Διευθυντή της, Καθηγητή Θάνο Δημόπουλο, να έχει αναλάβει τα καθήκοντα του Προέδρου της Επιστημονικής Επιτροπής του Συνεδρίου και την ευθύνη της κατάρτισης του προγράμματος». Συγχαρητήρια και μη ξεχάσετε να μας ενημερώσετε για τα βραβεία!

Ιστορίες που σοκάρουν  .  Η 46 χρονη Μαρία χειρουργήθηκε για ινομυωμα στη μήτρα  και βρέθηκε νεκρή στο θάλαμο μετα πολύωρο χειρουργείο.  Το πιστοποιητικό θανάτου, αναφέρει ως αιτία θανάτου «απροσδιόριστη μετά την ανάνηψη από γυναικολογικό χειρουργείo”

Φοιτήτρια ιατρικής Ιωαννίνων και πρωταθλήτρια στο Taekwon-do. Μπράβο Κατερίνα γιατι στα ΤΕΠ είναι απαραίτητες οι πολεμικές τέχνες

 Η Ελληνική Ιατρική Εταιρεία Κλινικών Εφαρμογών  & Θεραπευτικής Χρονίων Νοσημάτων (Ε.Κ.Ε.Θε.Χ.Νο,/ 7ο Webinar με θέμα: «Συνδυαστική στρατηγική για καρδιαγγειακή πρόληψη σε ασθενείς με ΑΥ.  Συνάδελφοι από το κέντρο αριστείας του ΑΧΕΠΑ λίγο πιο απλά!

   “Historically, men have been treated as the default, with women assumed to experience the same health risks, symptoms, outcomes of disease, and side effects of medications. This false assumption has been harmful for girls and women who, having been left out of clinical trials, now have a shortage of information on how diseases present in them relative to men, and on the safety and effectiveness of drugs and interventions in their bodies. More needs to be done to address and bridge this gap in medical research and care…”   Από την εισαγωγή Lancet Webinar on bridging the women’s health gap: addressing inequalities in medical research and care, now available on-demand. Access is free with registration

  Aνασκόπηση  με ελεύθερη πρόσβαση για το Καρδιογενές Shock.  Lancet 2024; 404: 2006–20  Και για τη στένωση της αορτής  JAMA 2024 online

Ο λόγος πάλι για STRUCTURAL HEART DISEASE.  Tα κάστρα που προσπαθεί να αλώσει η TAVI είναι οι α συμπτωματικοί, οι νέοι και οι δίπτυχες βαλβίδες και ότι άλλο προκύψει

STATE-OF-THE-ART REVIEW. Gupta T, Malaisrie SC, Batchelor W,  Boudoulas ΚD*, et al.,  *Πρόκειται για τον υιό του Χάρη(το μήλο κάτω από τη μηλιά).  Decision-Making Approach to the Treatment of Young and Low-Risk Patients With Aortic Stenosis. JACC Cardiovasc Interv 2024;17:2455-2471.

key points a decision-making approach to the treatment of young and low-risk patients with aortic stenosis (AS):

1. For patients with severe symptomatic AS, current  guidelines support either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) in low-risk patients >65 years of age in the US and >75 years of age in Europe. Use of TAVR has been growing in all age groups, most steeply in patients aged <65 years, for whom life expectancy usually exceeds predicted index valve durability.
2. For patients undergoing SAVR, mechanical valves are more durable than bioprosthetic valves (15-year reintervention rate 6.9% vs. 12.1% for bioprosthetic valves). Moreover, bioprosthetic valve durability is inversely related to patient age (i.e., valve dysfunction tends to occur earlier in younger patients). On the other hand, bioprosthetic valves are associated with a lower risk of major bleeding, given the requirement for warfarin anticoagulation with mechanical valves.
3. Minimally invasive SAVR techniques have gained acceptance and provide improved cosmetic results and similar clinical outcomes as compared with full sternotomy SAVR.
4. The Ross procedure (SAVR with pulmonary autograft, and pulmonic valve replacement with allograft) has favorable outcomes in centers of excellence.
5. Factors favoring SAVR over TAVR include: a) high-risk TAVR anatomy (such as severe PAD or severe left ventricular outflow tract calcification); b) bicuspid aortic stenosis (often with large annulus and asymmetrical cusp calcification); c) concomitant disease that can be best addressed surgically (e.g., severe CAD, aortic root/ascending aortic aneurysm, severe mitral regurgitation, atrial fibrillation); and d) low technical feasibility of redo TAVR. The relative ease of accessing the coronary arteries following SAVR as compared with TAVR is also a potential benefit.
6. Factors favoring TAVR over SAVR include: a) high-risk SAVR anatomy (such as prior coronary artery bypass grafting with exposed patent grafts, porcelain aorta, prior mediastinal radiation); b) feasibility of redo TAVR (predictable based in part on multidetector computed tomography [MDCT] with postprocessing techniques); c) frailty; and d) socioeconomic factors (lack of family support for rehabilitation from surgery, need to return to work quickly after intervention).
7. Patient-prosthesis mismatch (PPM) is associated with adverse clinical outcomes, particularly in younger patients and in patients with LVD. For patients with small aortic roots, self-expanding TAVR or SAVR with aortic root enlargement reduces the risk of PPM. Preprocedural sizing based on MDCT, rather than traditional intraoperative sizing, predicts PPM risk and identifies patients who can benefit from root enlargement.
8. TAVR explantation is more technically challenging and carries higher morbidity and mortality risks than redo SAVR. Therefore, in a younger patient who wishes to avoid a mechanical prosthesis, a bioprosthetic SAVR-first approach is preferable to a TAVR-first approach
9. Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association. Circulation 2024;Nov 13:[Epub ahead of print].

key points:

1. Kawasaki disease (KD), an acute self-limited febrile illness that primarily affects children <5 years old, is the leading cause of acquired heart disease in developed countries, with the potential of leading to coronary artery(CA) dilation and coronary artery aneurysms (CAAs) in 25% of untreated patients.
2. KD remains a clinical diagnosis characterized by fever, unilateral lymphadenopathy, rash, bilateral nonexudative conjunctival injection, swelling and erythema of the hands and feet, and oropharyngeal findings, including strawberry tongue and erythematous lips.
3. Advances in CV imaging have improved the ability to identify CA stenosis in patients with KD, yet knowledge gaps remain regarding optimal frequency of serial imaging and the best imaging modality to identify those at risk for inducible myocardial ischemia.
4. Echo remains the primary noninvasive imaging method for assessing the coronary arteries, and accurate measurement of the coronary arteries is crucial in patients with KD.
5. Intensification of primary therapy with adjunctive anti-inflammatory therapy (dual therapy) may benefit high-risk patients with KD. Patients with large CAAs require antiplatelet and anticoagulation therapy.
6.  DOACs may provide a more convenient and safer alternative than warfarin or LMWH.
7. Medical centers that follow patients with KD with giant CAA need to have a multidisciplinary heart team and a protocol in place to address major adverse cardiac events.
8. Long-term surveillance is necessary in patients with CAA, especially in those with large or giant aneurysms 1 year after KD onset. This may be performed with low-radiation  CTA, MRI  with ferumoxytol, or invasive angiography depending on the patient’s coronary complexity and clinical circumstances, as well as institutional resources.
9. Invasive coronary angiography provides the finest delineation of coronary architecture, and its use must be balanced against risks of an invasive procedure on the basis of patient and institutional factors. Invasive coronary angiography is used for patients with myocardial ischemia and intervention for revascularization.
10. Finally, formal health care transition programs and care teams are needed for adult patients with KD with CAA to ensure uninterrupted transition of care.

ΣΦ  ασθενή που είχε διαγνωσθεί νόσος του Kawasaki  σε ηλικία 11 ετών. Η εικόνα Α είναι σε ηλικία 15 ετών και η Β 3 χρόνια αργότερα. Επαιρνε μόνο ασπιρίνη και δεν συμορφωνότανε με το Sintrom. Τα DOACs δεν είχαν ακομη κυκλοφορήσει και παρουσιάσθηκε με  ΕΜ(κλειστός πρόσθιος κατιόντας). Ο ασθενής υπεβλήθη σε CABG(Στρατή το θυμάσαι;)

Αντιθρομβωτική θεραπεία σε αυξημένου αιμορραγικού κινδύνου μη καρδιακές διακαθετηριακές επεμβάσεις. μέρος ΙΙ

1. Antithrombotic treatment regimens used in patients undergoing percutaneous cardiac interventions, in particular coronary, are frequently extrapolated to patients undergoing noncardiac interventions. However, the differences in risk profile of the population treated and the types of interventions performed may translate into differences in the safety and efficacy associated with antithrombotic therapy.
2. Noncardiac percutaneous interventions are commonly performed in patients at HBR, which may indeed impact outcomes, hence underscoring the importance of risk stratification to guide clinical decision-making processes.
3. This document summarizes the available evidence on antithrombotic therapy in HBR patients undergoing noncardiac percutaneous interventions.
4. Treatment decisions should be based on patient and procedural characteristics, both of which vary widely in this heterogeneous population.
5. The evidence in support of the type and duration of antithrombotic therapy after endovascular revascularization (EVR) in peripheral artery disease patients is modest, particularly for HBR patients. Collectively, available evidence would argue against the use of potent P2Y12 inhibitors (i.e., prasugrel or ticagrelor) or dual pathway inhibition in HBR patients undergoing peripheral EVR, with data more supportive of using short-term (≤1 month) clopidogrel-based dual antiplatelet therapy (DAPT) or single antiplatelet therapy (SAPT), with clopidogrel preferred over aspirin monotherapy, in most cases.
6. In patients requiring concomitant oral anticoagulation (OAC), there is no rationale to add antiplatelet therapy in HBR patients with PAD undergoing EVR. Considering that occlusive stent thrombosis is rare, with a reported incidence of 0.5-0.8%, most guidelines recommend OAC alone.
7. Patients undergoing carotid artery stenting (CAS) are often deemed to be at HBR due to the risk of postoperative intracranial hemorrhage, which is an often-fatal complication. Collectively, a short course of DAPT (e.g., 1-month) or immediate post-procedural SAPT are reasonable in HBR-CAS patients, while among those with concomitant AF, 1-month dual antithrombotic therapy with OAC plus SAPT or OAC alone are possible therapeutic options.
8. Limited data are available on the incidence and predictors of bleeding and consequently risk stratification in patients undergoing percutaneous aortic, renal, subclavian, or mesenteric interventions.
9. In these settings, antithrombotic therapy should be selected taking into account a variety of elements including vessel anatomy (e.g., size, location, tortuosity), source of ischemia (e.g., dissection, local thrombosis, thromboembolism), impact on visceral function (e.g., renal, mesenteric, or peripheral district), risk of local recurrence, and systemic risk of atherosclerotic cardiovascular events.
10. Finally, treatment decisions should be based on patient and procedural characteristics, both of which vary widely in this heterogeneous population. Although limited compared to the coronary setting, randomized and observational evidence also exists in this setting and should be used in conjunction with clinical judgment and operator/center experience to guide decision making in HBR patients.

PBS Ό peripheral bleeding score.  For patients undergoing carotid stenting who do not have an indication for OAC: short DAPT (1 month) or SAPT are reasonable; for those who have an indication for OAC: 1-month DAT or OAC alone are possible options.

• For patients undergoing peripheral interventions who do not have an indication for OAC: short-term (≤1 month) DAPT or SAPT may be used; for those who have an indication for OAC, there is no solid rationale to add antiplatelet therapy and most guidelines suggest OAC alone.

• For patients undergoing other percutaneous noncardiac interventions who do not have an indication for OAC, the most appropriate strategy seems to avoid DAPT, although risks and benefits should be weighed on a case-to-case basis; for those who have an indication for OAC, there is no solid rationale to add antiplatelet therapy and most guidelines suggest OAC alone. Galli M, et al. JACC Cardiovasc Interv. 2024;17(20):2325–2336

Δίλοφο. Ένας παραδοσιακός οικισμός με απίστευτη γοητεία.  Η πατρίδα και η οικία του Γ. Μιχαηλίδη πρώτου καθηγητή καρδιολογίας στο ΕΚΠΑ(πρώτο έφερε στην Ελλάδα ΗΚΓο από το Παρίσι) και προέδρου της ΕΚΕ(από τότε είχε η Ηπειρος το κολάι)

Ευκαιρία για όσους δεν έχετε επισκεφτεί τα Ζαγόρια.  Πληροφορίες Manolis Papantonakos | The Mastermind Group <mp***********@*mg.gr

Πάντως αν ήμουν Αθήνα θα παρακολουθούσα το παρακάτω . Οσοι νομίζουν ότι τα Δερματολογικά υπερέχουν από αισθητικής άποψης πλανώνται πλάνη

οικτρά.

Προσεχώς  νέα από το ΑΗΑ 2024  Σικάγο

Συναδελφικά Γουδέβενος Γιάννης Γιάννινα