Volume 5 Issue 8, August 2008

Patients with dilated cardiomyopathy and functional mitral regurgitation (MR) have a very poor prognosis. Surgical correction of MR in this setting is controversial because survival benefit has not been proven; however, patients who have undergone mitral repair often show substantial symptomatic improvement and reverse left ventricular remodeling. Here, Michele De Bonis and Ottavio Alfieri argue that these 'end-stage' patients should not be denied surgery, and that mitral repair should be performed before irreversible deterioration occurs.

Transposition of the great arteries is a common but serious congenital heart malformation. It is estimated that approximately 9,000 patients in the US live with an atrial-level repair. Barry Love and colleagues discuss the anatomy, potential late complications, and appropriate therapies in this patient group—everything needed to properly care for these patients.

Ventricular tachycardia (VT) is a cause of early, intermediate and late morbidity and mortality in patients who have undergone palliative repair of congenital heart disease. Christopher Snyder provides a concise overview regarding the etiology of ventricular tachycardia in these patients and in-depth information to aid diagnosis, risk assessment and long-term management of postoperative VT in this unique population.

Here, Stephen Westaby highlights the promise of new blood pumps in severely symptomatic patients with heart failure, a patient population with very limited treatment options.

Congenital heart defects can remain undiagnosed until adulthood. In this Case Study, Alegriaet al. describe a 20-year-old male presenting with systemic hypertension who was found to have coarctation of the aorta, a bicuspid aortic valve, an ascending aortic aneurysm and an atrial septal defect. He was successfully treated in a single surgical procedure.

Endothelial dysfunction is an early manifestation of atherosclerotic disease. Circulating cells that express CD34, including endothelial and hematopoietic progenitor cells, might play a part in the development and progression of atherosclerosis. In this paper the authors evaluate the association between coronary endothelial dysfunction and concentrations of circulating CD34⁺cell subsets.

Many coronary heart disease patients fail to reach recommended LDL levels, either due to intolerance or inadequate response to available lipid-lowering therapy. Microsomal triglyceride transfer protein (MTP) inhibitors may provide a novel alternative pathway for LDL lowering. In this paper the authors tested the safety and LDL lowering efficacy of the MTP inhibitor, AEGR-733, alone and in combination with ezetimibe.

Clinical Context commentary on Samaha et al.