Fidest – Agenzia giornalistica/press agency

Quotidiano di informazione – Anno 31 n° 259

Posts Tagged ‘valve’

Nearly one-quarter of patients say mechanical heart valve disturbs sleep

Posted by fidest press agency su sabato, 20 maggio 2017

jonkoping swedenJonkoping, Sweden Nearly one-quarter of patients with a mechanical heart valve say it disturbs their sleep, according to research presented today at EuroHeartCare 2017. “For some patients the closing sound of their mechanical heart valve reduces their quality of life, disturbs their sleep, causes them to avoid social situations, and leads to depression and anxiety,” said lead author Dr Kjersti Oterhals, a nurse researcher at Haukeland University Hospital in Bergen, Norway.This study investigated how the noise of a mechanical heart valve affected patients’ lives, in particular their sleep, and whether there were any differences between women and men.In April 2013 all 1,045 patients who had undergone aortic valve replacement at Haukeland University Hospital between 2000 and 2011 were invited to participate in a postal survey. Of the 908 patients who responded, 245 had received a mechanical valve and were included in the current analysis.Patients were asked if the valve sound was audible to them or others, if they sometimes felt uneasy about the sound, if the sound disturbed them during daytime or during sleep, and whether they wanted to replace the mechanical valve with a soundless prosthetic valve if possible. Patients ranked the noise on a scale of 0 (does not disturb them at all) to 10 (causes maximum stress). The Minimal Insomnia Symptom Scale, which consists of three questions about sleep, was used to give patients a score of 0 to 12 for insomnia.
Patients were 60 years old on average and 76% were men. Nearly one-quarter (23%) said the valve sound disturbed them during sleep and 9% said it disturbed them during the day. Some 28% wanted to replace their valve with a soundless prosthetic valve if possible. Over half (51%) said the noise was often or sometimes audible to others, but only 16% said they sometimes felt uneasy about others hearing it.The researchers found that 87% of men and 75% of women said that they were able to hear the closing sound of their mechanical valve. Women were more disturbed by the valve sound than men.Some 53% of the respondents had no insomnia, 31% had subclinical insomnia, and 17% had moderate to severe insomnia. Valve noise perception was the strongest predictor of insomnia, followed by age, and female gender. There was a linear association between insomnia and valve noise perception. And the more patients considered the valve noise a disturbance in daily life, the more insomnia they reported.Dr Oterhals said: “Almost one-fourth of patients said that the sound of their mechanical heart valve makes it difficult for them to sleep. Most of us need a quiet environment when we are going to sleep and these patients found it hard to ignore the noise from the valve.” Not all patients are aware before surgery that they may hear their mechanical valve, and while most get used to it, for some it is troublesome for many years. “One female patient said to me, ‘I will never have silence around me again’ when she realised she would hear the noise 24 hours a day for the rest of her life,” said Dr Oterhals.The most common ways patients coped with the noise when trying to sleep were to sleep on their right side which reduced the valve noise, put the duvet around their bodies to isolate the sound, listen to music, and do relaxation exercises. Ear plugs were not effective and made the valve noise louder.Dr Oterhals said: “We are not very proactive about this issue at the moment. It would improve many patients’ quality of life if we asked them about valve noise and provided advice to those who find it distressing.”

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Novel heart valve replacement offers hope for thousands with rheumatic heart disease

Posted by fidest press agency su venerdì, 9 settembre 2016

cape-townCape Town, South Africa. A novel heart valve replacement method is revealed today that offers hope for the thousands of patients with rheumatic heart disease who need the procedure each year. The research is being presented at the SA Heart Congress 2016.
The annual congress of the South African Heart Association is held in Cape Town from 8 to 11 September 2016 and is jointly organised with the annual congress of the World Society of Cardiothoracic Surgeons. Experts from the European Society of Cardiology (ESC) will present a special programme. “Over the past decade heart valve surgery has been revolutionised by transcatheter aortic valve implantation (TAVI),” said lead author Dr Jacques Scherman, a cardiac surgeon in the Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, South Africa. “Heart valves are replaced or repaired via a catheter, obviating the need for open heart surgery or a heart-lung machine.”He continued: “TAVI is only indicated in patients with calcific degenerative aortic valve disease, which is the most prevalent aortic valve pathology in developed countries. In developing countries, rheumatic heart disease still accounts for the majority of patients in need of a heart valve intervention.”Rheumatic heart disease is caused by rheumatic fever, which results from a streptococcal infection. Patients develop fibrosis of the heart valves, leading to valvular heart disease, heart failure and death. In Africa alone there are around 15 million patients living with rheumatic heart disease of whom 100 000 per year might need a heart valve intervention at some stage of their life. The vast majority of these patients have no access to cardiac surgery or sophisticated cardiac imaging.Dr Scherman said: “Inspired by the success of TAVI for calcific aortic valve disease, we developed a simplified TAVI device for transcatheter aortic valve replacement in patients with rheumatic heart disease.”Currently available balloon expandable TAVI devices require the use of sophisticated cardiovascular imaging to correctly position the new valve. They also use a temporary pacemaker which allows the heart to beat so quickly that it stops blood circulating to the rest of the body (called rapid ventricular pacing).Dr Scherman said: “Rapid ventricular pacing can only be tolerated for a short period and therefore limits the time available to do the implantation.”The team in South Africa developed a novel TAVI device which is “non-occlusive”, meaning that there is no need to stop blood circulating to the body with rapid ventricular pacing. The device is also “self-locating” and does not require sophisticated cardiac imaging for positioning.The proof of concept study presented today tested the device in a sheep model. The investigators found that the device was easy to use and positioned the valve correctly, and the procedure could be performed without rapid ventricular pacing.Dr Scherman said: “We showed that this new non-occlusive, self-locating TAVI delivery system made it easy to perform transcatheter aortic valve replacement. Using tactile feedback the device is stabilised in the correct position within the aortic root during the implantation. It also has a temporary backflow valve to prevent blood leaking backwards into the ventricle during the implantation of the new valve. All these factors together allowed for a slow, controlled implantation compared to the currently available balloon expandable devices.”
He added: “This simplified approach to transcatheter aortic valve replacement could be done in hospitals without cardiac surgery at a fraction of the cost of conventional TAVI. It has the potential to save the lives of the large numbers of rheumatic heart disease patients in need of valve replacement.”Professor Karen Sliwa, president of the South African Heart Association, said: “I am truly excited that we have not only an internationally strong group working on epidemiology and prevention of rheumatic heart disease at the University of Cape Town, but also a dedicated and successful surgical group, led by Prof. Peter Zilla at the Chris Barnard Department. Although prevention is the final goal, millions will need surgery as life-saving measure for decades to come. Knowing from my own Pan-African collaborations how inadequate the provision of cardiac surgery is on the African continent this fascinating solution promises surgical help for all these young patients with rheumatic heart disease on a continent that has a fair density of general hospitals but hardly offers any open heart surgery.”Professor Fausto Pinto, ESC president and course director of the ESC programme in South Africa, said: “The development of innovative therapeutic strategies is extremely important to allow a larger number of patients to be treated.”

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