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Jan 18, 2012 · We propose that medical therapy should be used to stabilize the patient and to adequately assess the degree of SAM and MR. If there is only mild SAM and MR, then medical therapy should be used. However, in moderate or worse SAM and MR, we propose that even if medical therapy is able to abolish SAM, a surgical solution should be sought.
- Michael Ibrahim, Christopher Rao, Hutan Ashrafian, Umar Chaudhry, Ara Darzi, Thanos Athanasiou
- 2012
Aug 22, 2023 · Optimal guideline-directed medical therapy is the mainstay therapy and has been shown to reduce the severity of mitral regurgitation in 40–45% of patients. Rapid medication titration protocols reduce heart failure hospitalisation and facilitate earlier referral for device therapy.
Using intraoperative medical therapy (increased mean arterial pressure, slow heart rate, increased preload, and avoidance of inotropes) 35 (85.3%) of 41 patients with intraoperative SAM had resolution or the SAM was downgraded to mild, hence not requiring additional intraoperative intervention.
- Robin Varghese, Anelechi C. Anyanwu, Shinobu Itagaki, Federico Milla, Javier Castillo, David H. Adam...
- 2012
This article focuses on recognizing clinical conditions that may manifest themselves as SAM after mitral valve repair and the clinical manifestations and interventions used to treat the condition and reduce potential associated complications postoperatively.
- Leaflet Motion: A Step-Wise Progression of Sam
- Hemodynamic Force: Lift vs. Drag Force
- Key Factors to Establish Sam
Figure 1 shows serial echocardiograms of the leaflet motions during SAM in patients suffering from SAM after mitral valve repair. At the early systolic phase, the mitral valve closes; coapting the opposing leaflets (Fig. 1.1, .2). Thereafter, the tip of the anterior leaflet moves anteriorly toward the ventricular septum (Fig. 1.3), and the residual...
As seen in the serial echocardiograms in Fig. 2, SAM begins with the displacement of the anterior leaflet tip into LVOT (or prepositioning), indicating that any force should operate on the leaflet. This force was initially considered lift force due to high-flow velocity in LVOT . This phenomenon is known as the “Venturi effect,” wherein the negativ...
Considering the diversity in the clinical setting that predispose SAM, the effort in trying to abstract the key factors for the establishment of SAM can significantly help in its comprehensive recognition. A wide variety of studies have elucidated possible key factors as essential requirements to establish SAM. Among them, three factors could be po...
rection of SAM, irrespective of the response to medical interventions. If mild SAM is present, defined as less than mild MR and a LVOT gradient of less than 50 mm Hg, we usually use no additional surgical intervention and proceed to reversal of heparin and decannulation. An echocardiogram
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SAM therapy reduces pain, improves blood circulation and oxygen in the tissues, thereby accelerating the natural healing process. The device may be used for chronic pain of the knee, elbow pain, wrist pain, low back pain, hip pain, etc. Besides arthritis, SAM may be used for pain from musculoskeletal injuries to the muscles, tendons, and ligaments.
