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Newsletters May 2010 - Jefferson Cardiology Happenings

What's in this Newsletter:

An Alternative To Mitral Surgery

In past issues this newsletter detailed the development of a technique to replace the aortic valve without surgery. At the recently completed Scientific Sessions of the American College of Cardiology, a study examined the nonsurgical repair of the mitral valve.

The results of a study were pre-sented comparing a technique to repair a leaking mitral valve with a clip device applied at catheterization with surgical repair or replacement of the mitral valve. Surprisingly, the clip technique had fewer complications than the surgical procedures. Specifically, there were six times more blood transfusions with the surgical patients. There were no deaths or strokes with the clip procedure. How-ever the surgical patients had a 2.5% in-cidence of death and a 2.5% incidence of stroke.

Meanwhile the surgical patients had either a greater chance of total elimination of valve leakage or minimal residual leakage. Of the surgical patients who had no residual mitral valve leakage almost half had mitral valve replacement rather than repair. Mitral repair often is credited with better outcomes as the mi-tral apparatus is left intact. Among the clip patients, 81.5% had mild or less re-sidual leakage compared to 97% of the surgical patients. At one year 98% of the clip patients were asymptomatic or had only mild limitations. This com-pares with 88% of the surgical patients.

Time will tell if these early results will stand up long term. If the catheterization clip procedure can main-tain this level of safety and improvement over time, then there may be a new less invasive treatment available for patients with leaking mitral valves.

Novel Home Treatment for Heart Failure

In the journal, Circulation, there was a recent description of a new technique to treat heart failure patients at home. Specifically, 40 patients with heart failure had a device implanted to record pressure in the left atrium. This was done as pressure levels in the left atrium may be used to detect elevated pressure that may be associated with congestive heart failure. Once returning home, pressures were measured twice daily.
For the first 3 months, treatment was determined by traditional evaluation of symptoms and physical examinations. There after, treatment decisions were made by determination of left atrial pres-sure. Once treatment was based on pressure readings, the pressures fell and symptoms decreased. Measurements of capability for physical activity improved as did measurements of heart pumping performance.

This was the first experience in this type of therapy. The improvement in heart function symptoms and im-proved outcomes was notable. This technique may have future applications and could reduce the number of hospital admissions for heart failure. This could be a major cost savings as congestive heart failure is the most frequent diagno-sis for Medicare hospital admissions.

Carotid Surgery vs Stenting

In recent years there has been great controversy between the values of carotid surgery compared to stenting in patients with carotid artery blockage. A study was recently presented comparing the effects of surgery vs stents in 2500 patients with symptomatic or asymptomatic carotid disease. The study involved 117 centers in the United States.

In the 30-day period after the procedures, the rate of stroke was 2.3% in the surgical patients and 4.1% in the stent group. The heart attack rate was 2.3% in the surgical group and 1.1% in the stent group. Younger patients, under age of 69, had better outcomes than older patients. Also the benefit of stents decreased as the patient’s age increased. In those over the age of 70, the benefits of surgery clearly were superior to stent-ing. These results differ from a previous study and more information may be forthcoming.

Alcohol Consumption and Cardiovas-cular Mortality

Researchers have analyzed alco-hol consumption in 245,000 persons. These persons were placed into 6 catego-ries depending on the amount of alcohol they consumed. Moderate drinkers were defined as 3-7 drinks per week for women and 3-14 drinks per week for men. Those persons characterized as light drinkers, averaged less than 3 drinks per week. Light and moderate drinkers appeared to have fewer cardio-vascular events than those having neglible or heavy alcohol intake. This information is compatible with previous studies and the reduced risk appears to be due to less death from coronary artery disease.

Grilled Stuffed Portabello Mushrooms

2/3 cup chopped plum tomato 1 garlic clove, crushed
¼ cup shredded part-skim mozzarella cheese 4 (5-inch) Portobello mushroom caps
1 teaspoon olive oil, divided 2 tablespoons fresh lemon juice
½ teaspoon finely chopped fresh rosemary 2 teaspoons low sodium soy sauce
1/8 teaspoon coarsely ground black pepper 2 teaspoons minced fresh parsley
Cooking spray

Prepare grill

Combine the tomato, cheese, ½ teaspoon oil, rosemary, pepper and garlic in small bowl.

Remove brown gills from the undersides of mushroom caps using a spoon , discard gills. Remove stems; discard. Combine ½ teaspoon oil, juice, and soy sauce in small bowl; brush over both sides of mushroom caps. Place the mushroom caps, stem sides down, on grill rack coated with cooking spray; grill 5 minutes on each side or until soft.

Spoon ¼ cup tomato mixture into each mushroom cap. Cover and grill 3 minutes or until cheese is melted. Sprinkle with parsley.

A publication of Jefferson Cardiology Association
Alan D. Bramowitz, M.D. | Michael S. Nathanson, M.D. | Gennady Geskin, M.D.

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