Anticoagulant drugs in noncompaction: a mandatory therapy?

BACKGROUND: Noncompaction of left ventricular myocardium is a rare congenital cardiomyopathy resulting from an incomplete myocardial morphogenesis that leads to the persistence of the embryonic myocardium. This condition is characterized by a thin compacted epicardial and an extremely thickened endocardial layer with prominent trabeculations and deep intertrabecular recesses. It is not clear, in noncompaction of myocardium, whether intertrabecular recesses could be responsible for thrombi formation and thromboembolic complications. METHODS: The prevalence of stroke and echocardiographic finding of thrombus was evaluated in a continuous series of 229 patients (men and women) affected by noncompaction of the left ventricular myocardium, who were included in the SIEC registry. We excluded patients affected by atrial fibrillation. RESULTS: The mean age of the patients was 49.5 years. Fifty percent of the patients were affected by a ventricular systolic dysfunction. The mean period of follow-up was 7.3 years. Only four patients had a history of ischemic stroke. A large thrombus into the left ventricular chamber was observed in a 1-year-old child affected by Behcet's disease (high risk of thrombi formation). CONCLUSION: Noncompaction of the left ventricular myocardium, by itself, does not seem to be a risk factor for stroke or embolic results, so there is no indication for oral anticoagulant therapy.

[The risk of noncardiac surgery in patients with heart disease: a new way for an easy approach to a right preoperative assessment]. / Il rischio della chirurgia non cardiaca in pazienti cardiopatici: un'ipotesi di lavoro per una corretta valutazione preoperatoria.

The aim of cardiovascular preoperative evaluation in noncardiac surgery is to assess the current cardiovascular status of patients, to find underlying unknown diseases, to advise about medical management for patients in the preoperative period and, eventually, to postpone noncardiac surgery until cardiac conditions are improved or stabilized. The basic clinical evaluation, obtained by history, physical and ECG examination, provides enough data to estimate the cardiovascular risk. Cardiovascular risk factors and specific surgery risk have a huge importance in this evaluation; the specific surgery risk can be classified into three categories: high, intermediate, and low. However, the evaluation of cardiac risk is not simple and the eventual legal consequences are important. For this reason we propose this hypothesis for an easy approach to a right preoperative assessment based on a succession of eight steps; this way would be a support for specialists and young physicians that are called to give a clinical report on surgery timing and on possible problems of patients with cardiovascular disease undergoing noncardiac surgery.