A Patient with Syncope — NEJM

A Patient with Syncope — NEJM

Sildenafil in post Fontan Patients

Circulation: Cardiovascular Imaging.2014; 7: 265-273

Background—The study exercise hemodynamics and the effect of sildenafil on exercise hemodynamics in Fontan patients.

Methods and Results—Ten Fontan patients (6 men, 20±4 years) underwent cardiac magnetic resonance imaging at rest and during supine bicycle exercise before and after sildenafil. Systemic ventricular volumes were obtained at rest and during low- (34±15 W), moderate- (69±29 W), and high-intensity (97±36 W) exercise using an ungated, free-breathing cardiac magnetic resonance sequence and analyzed correcting for cardiac phase and respiratory translation. Radial and pulmonary artery pressures and cGMP were measured. Before sildenafil, cardiac index increased throughout exercise (4.0±0.9, 5.9±1.1, 7.0±1.6, 7.4±1.7 L/(min·m²); P<0.0001) with 106±49% increase in heart rate. Stroke volume index (P=0.015) and end-diastolic volume index (P=0.001) decreased during exercise. End-systolic volume index remained unchanged (P=0.8). Total pulmonary resistance index (P=0.005) increased, whereas systemic vascular resistance index decreased during exercise (P<0.0001). Sildenafil increased cardiac index (P<0.0001) and stroke volume index (P=0.003), especially at high-intensity exercise (interaction P=0.004 and P=0.003, respectively). Systemic vascular resistance index was reduced (P<0.0001–interaction P=0.1), whereas total pulmonary resistance index was reduced at rest and reduced further during exercise (P=0.008–interaction P=0.029). cGMP remained unchanged before sildenafil (P=0.9), whereas it increased significantly after sildenafil (P=0.019).

Conclusions—In Fontan patients, sildenafil improved cardiac index during exercise with a decrease in total pulmonary resistance index and an increase in stroke volume index. This implies that pulmonary vasculature represents a physiological limitation, which can be attenuated by sildenafil, the clinical significance of which warrants further study.

Early Percutaneous VSD Closure Promising in High-risk, Post MI Patients - Journal News - TCTMD

Early Percutaneous VSD Closure Promising in High-risk, Post MI Patients - Journal News - TCTMD

FETAL CARDIAC DISEASE

FETAL CARDIAC DISEASE

the prevalence of cardiac diseases is increasing. Technological advancement has endowed us with enhanced capability of earlier diagnosis and treatment of cardiovascular diseases. Now every field of cardiology is expanding exponentially. Every day numerous new trials and data are made available to us. Every now and then new practice changing guidelines are coming up. In recent times a plethora of guidelines have come up on a variety of topics like hypertension, lipid disorders, coronary artery disease etc.

This week American heart association has come up with a guideline for diagnosis and management of fetal cardiac diseases. This is a nice piece of publication standardizing the diagnosis and management of fetal cardiac diseases.

Read more @

http://circ.ahajournals.org/content/early/2014/04/23/01.cir.0000437597.44550.5d