Experience of a high-risk aortic valve clinic in Ireland.

BACKGROUND: The advent of transcatheter aortic valve implantation (TAVI) has broadened the management options for severe aortic stenosis. The indications for TAVI are narrow. Selecting those that will benefit most from this intervention warrants careful consideration and input from cardiologists, anaesthetists and cardiac surgeons familiar with TAVI and surgical aortic valve replacement (SAVR). AIMS: The aims of this paper were to assess the feasibility of establishing a high-risk aortic clinic in Ireland, and report stratification of the referred group into those suitable for SAVR, TAVI and conservative management. METHODS: Patient data was prospectively collected by a dedicated clinical nurse specialist. ANOVA was used to assess variance in means between groups. Analyses were performed using IBM SPSS v20 (Armonk, NY: IBM Corp.). RESULTS: A total of 105 patients were assessed. Eighty-five patients were deemed suitable for TAVI, 9 (10.5 %) died awaiting the procedure and a further 6 (7 %) declined intervention. Eleven (10.5 %) underwent conventional SAVR, 1 (0.9 %) a balloon valvuloplasty, 4 (3.8 %) entered surveillance and 4 (3.8 %) were declined treatment. CONCLUSIONS: Establishment of a high-risk aortic clinic is feasible in the Irish context. The advent of TAVI has reduced the proportion of patients denied intervention to a minority. Despite being considered high risk, a number of patients were suitable candidates for SAVR. Measuring frailty continues to provide a challenge; a TAVI-specific frailty assessment tool would be advantageous to patient stratification.

Coronary artery fistula; coronary computed topography--the diagnostic modality of choice.

Coronary artery fistulae (CAF) are rare anomalies. They are vascular communications between the coronary arteries and other cardiac structures, either cardiac chambers or great vessels. There can be considerable variation in the course of a coronary artery fistula. We report a case of a coronary artery fistula between the left circumflex coronary artery and the right and left atria. CAF are often diagnosed by coronary angiogram, however with the advent of new technologies such as Coronary Computed Tomography Angiography (Coronary CTA) the course and communications of these fistulae can be delineated non-invasively and with greater accuracy.

Virtual reality technology and surgical training--a survey of general surgeons in Ireland.

BACKGROUND: Virtual Reality Technology (VRT) is a validated method of training in industry but only recently has found a place in the postgraduate surgical curriculum. AIMS: We surveyed 143 Irish consultant surgeons to ascertain their opinions on this topical issue. METHODS: The survey consisted of 22 questions to which the consultants were asked to respond by choosing from a 5-point Likert scale. RESULTS: Sixty-five per cent responded. A majority of 72% had seen VRT but only 47% had 'hands on' experience. Forty-six per cent believed that they were poorly informed regarding available technologies. As consultants became more informed about VRT significant differences were seen with regard to attitudes regarding the role of VR in skills in surgical training (p<0.05) and in the ability to define teaching objectives (p<0.005). CONCLUSIONS: Our survey suggests that the underuse of the current offerings is not due to a perceived lack of interest on the part of the surgical trainers. Suppliers of these programmes have a responsibility to adequately educate and collaborate with all parties involved to improve overall benefit from these simulators.

A computer-based system for patient care and research management in reproductive endocrinology.

We describe a medical information system tailored to the operational needs of the Gynecologic and Infertility Clinic at The Johns Hopkins Hospital. It is used for patient registration and scheduling, medical and surgical record keeping, and research investigation. Data entered include a complete medical history, diagnoses, procedures performed and their outcomes, surgical pathologic study, follow-up notes, phone consultations, and laboratory findings. Data are coded individually and can be retrieved and presented in a standard or user-specific report format. The Reproductive Endocrinology Medical Information System (REMIS) was implemented over 6 months from January to June 1984. To date, 8000 new patient registrations and 3600 outpatient visits have been entered. There are approximately 100 new patient entries and 240 return visit entries per month. Preliminary evaluation of the system based on the effect on quality care, use by each user group, and research applicability demonstrates that the REMIS provides clinicians with more complete, organized, and accessible patient records to serve as an effective adjunct to clinical operations.

Fetal malformations following progesterone therapy during pregnancy: a preliminary report.

This report presents the outcome of pregnancies of 93 women who conceived while taking progesterone (P) suppositories (n = 42) or P in oil intramuscularly (n = 51). The dosage and duration of treatment varied according to the indication. The total dose (in milligrams) increased with the duration of treatment and ranged from 75 to 13,500 mg. Two of 75 term pregnancies (2.6%) were noted to have congenital anomalies. Both women had been treated with P in oil. No patient treated with P suppositories gave birth to a malformed infant. An increased spontaneous abortion rate (28.6%) was noted among women treated with P suppositories. The authors recommend that a national registry be created to document fetal outcome after P therapy.