While you can still download older versions of Citrix Receiver, new features and enhancements will be released for Citrix Workspace app.
New Extension Rar Griffin Powermate 3.1 Full Capabilities OfCitrix Workspace app provides the full capabilities of Citrix Receiver, as well as new capabilities based on your organizations Citrix deployment.
New Extension Rar Griffin Powermate 3.1 Download Older VersionsA secondary transthoracic echocardiography evaluation was performed for all the patients between twenty-four hours and six weeks after the procedure in order to evaluate the hemodynamic change and immediate PTMC outcome See additional file 3 and additional file 4. The current study aimed to investigate whether MAC could independently influence the immediate result of PTMC. Methods Of all patients undergoing PTMC in our institution between April 2005 and November 2009, we included 87 patients (28.7male, mean SD age 42.8 12.6 years) with rheumatic mitral stenosis who had additional data on the echocardiographic evaluation of MAC along with MV leaflets morphology. Echocardiographic assessments were repeated up to six weeks after PTMC to evaluate the immediate PTMC outcome. The frequency of the optimal PTMC result (secondary MV area 1.5 cm 2 with 25 increase and without final mitral regurgitation grade 2) was compared between two groups of patients with MAC (n 17) and those without MAC (n 70). Appropriate patient selection, however, is of paramount importance for a successful PTMC. In the selection of patients for PTMC, the echocardiographic assessment of the mitral valve morphology plays a crucial role 7 10 and it is now performed routinely in most centers. The Wilkins score is one of the most widely used echocardiographic scoring systems 7, 9, 11, 12 in that it provides a semi-quantitative assessment of mitral leaflets thickening, mobility, calcification, and the extent of the subvalvular apparatus disease. Nevertheless, there are studies which have questioned the precision of this score as a predictor of the outcome and have suggested the need for more refined and comprehensive echocardiographic assessments 1, 11, 13, 14. Likewise, the Wilkins scoring system does not examine mitral annular calcification (MAC), which is characterized by calcium and lipid deposition within the annular fibrosa of the mitral valve 15, 16 and might independently influence the PTMC result as it appears to be a different feature from leaflets or commissural calcification in terms of the incidence rate, underlying predisposing factors, pathophysiology, and associative cardiovascular disorders or systemic comorbidities 15 21. To our knowledge, there is not enough studies evaluating the impact of MAC on the PTMC immediate result. The current study aimed to investigate if pre-procedure echocardiographic evaluation of MAC could help the clinician to predict the immediate result of PTMC. Methods Study Population From April 2005 to November 2009, PTMC was attempted in 153 consecutive patients with the diagnosis of rheumatic MS at Tehran heart center according to previously established criteria 22. Patients population were those referred from inside cardiology clinics or directly from outside physicians. Pre-procedure conventional echocardiography conducted in all patients to investigate the MV morphology in our echocardiographic units; however, we just included 89 consecutive patients who underwent echocardiographic evaluation in one of our units equipped by Vivid-7 (Vingmed GE) echocardiography apparatus and had additional data on the echocardiographic evaluation of the mitral annulus. After excluding two cases (because of the previous history of open or closed mitral commissurotomy) retrospective analysis conducted on the data of the final 87 patients mean SD age 42.8 12.6 years and 25 (28.7) male. PTMC was contraindicated in the presence of left atrial thrombus, significant coexistent valve lesions, bilateral commissural calcification, and mitral regurgitation (MR) greater than grade 2 and unfavorable MV morphology with Wilkins total score 12 as estimated by echocardiography. The relation between the echocardiographic score of the valve morphology and PTMC immediate result was assessed by defining the optimal result as mitral valve area (MVA) 1.5 cm 2 or more and increase in the MVA of at least 25 without post-procedure MR grade 2. This definition was employed on account of the fact that it is one of the most commonly employed criteria in the existing literature 3, 23. The study protocol was approved by the Ethics Committee Review Board of the hospital. Echocardiographic Evaluation Echocardiographic assessments were conducted in all the patients during the week leading up to the procedure using a combination of transthoracic two-dimensional (2D), pulsed and continuous-wave Doppler with color-flow imaging (Vingmed GE, Horten, Norway, 3.5-MHz transducer), and transesophageal echocardiography (Vivid-7, Vingmed GE, Horten, Norway, 7-MHz transducer). From the echocardiographic study, the MVA was calculated via planimetry See additional file 1 and additional file 2 and MR severity was scored 0 as no or trivial, 1 as mild, 2 as moderate, 3 as moderate to severe, and 4 as severe 24. The morphological features of the mitral valve (MV) were scored individually in terms of (a) leaflet thickening, (b) leaflet mobility, (c) leaflet calcification, and (d) subvalvular thickening according to the Wilkins scoring system 7. Each subcomponent had a possible score of 0 to 4 corresponding to zero to severe abnormality. The presence of calcification of the mitral annulus and commissures determined the use of 2D-echocardiograms in the parasternal short-axis view. MAC was defined as a dense, highly reflected area at the base of the posterior mitral leaflet 15 (Figure 1 ), while anterolateral andor posteromedial commissure calcification was identified by bright and confluent echo which was brighter than the adjacent aortic root 25.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |