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Management of unstable angina in a patient with Haemophilia A

World Journal of Hematology 2017年第2期6卷 28-31页

作者： Andreina Carbone Tiziana Formisano Francesco Natale maurizio cappelli bigazzi Donato Tartaglione Enrica Golia Felice Gragnano Mario Crisci Renato Maria Bianchi Raffaele Calabrò Maria Giovanna Russo Paolo Calabrò Chair of Cardiology Second University of NaplesAORN dei ColliMonaldi Hospital

Hemophilia A is an X-linked recessive disorder characterized by a deficiency of coagulation factor Ⅷ(FⅧ) and therefore by a greater risk of bleeding during percutaneous interventional procedures and during the dual antiplatelet therapy(DAPT) in patients with ischemic heart disease. Information regarding safe percutaneous procedures in hemophiliacs is limited. Since the introduction of FVⅧ concentrates, the life expectancy of hemophiliac patients has improved and consequently, the rate of ischemic heart disease in this population is increased. Frequently the replacement therapy can trigger the onset of an acute coronary syndrome. We report a case of a patient with mild Hemophilia A, who presents with unstable angina, treated successfully with coronary angioplasty and drug eluting stent implantation without replacement of FVⅧ, treated with long term DAPT without major bleeding after six months of follow up.

关键词： Hemophilia A Unstable angina Dual antiplatelet therapy Drug eluting stent Coagulation factors replacement therapy

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Patient selection for transcatheter aortic valve replacement:A combined clinical and multimodality imaging approach

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World Journal of Cardiology 2017年第3期9卷 212-229页

作者： Rosangela Cocchia Antonello D’Andrea Marianna Conte Massimo Cavallaro Lucia Riegler Rodolfo Citro Cesare Sirignano Massimo Imbriaco maurizio cappelli Giovanni Gregorio Raffaele Calabrò Eduardo Bossone Department of Cardiology and Cardiac Surgery San Giovanni di Dio Hospital00733 SalernItaly Integrated Diagnostic Cardiology Second University of NaplesAORN“dei Colli”Monaldi Hospital80121 NaplesItaly Institute of Biostructure and Bioimaging National Research Council 80121 NaplesItaly Department of Advanced Biomedical Sciences University Federico II80121 NaplesItaly Department of Cardiology San Luca HospitalVallo della Lucania00733 SalernItaly

Transcatheter aortic valve replacement(TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities should be preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. Ultrasounds represent the first line tool in evaluation of this patients giving detailed anatomic description of aortic valve complex and allowing estimating with enough reliability the hemodynamic entity of valvular stenosis. Angiography should be used to assess coronary involvement and plan a revascularization strategy before the implant. Multislice computed tomography play a central role as it can give anatomical details in order to choice the best fitting prosthesis, evaluate the morphology of the access path and detect other relevant comorbidities. Cardiovascular magnetic resonance and positron emission tomography are emergent modality helpful in aortic stenosis evaluation. The aim of this review is to give an overview onTAVR clinical and technical aspects essential for adequate selection.

关键词：大动脉的狭窄 Doppler echocardiography 心脏的计算断层摄影术二维的紧张三维的 echocardiography 心脏的磁性的回声 Transcatheter 大动脉的阀门代替

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