A number of advances in the treatment of cardiovascular disease.

Many advances in the treatment of cardiovascular diseases in recent years has changed the perspective and prognosis in treatment of cardiovascular disease. Among including the prominent role of Interventional Cardiology industry, has solved many cardiovascular diseases that were previously either surgery or insufficient.

 Advances in the treatment of coronary artery disease.

Perhaps this is a fairly common condition should also have the most progressive.

Understanding and application of anti-platelet new generation has improved the prognosis significantly as mentioned above. The role of clopidogrel in acute coronary syndrome was confirmed by the study CURE and PCI-CURE. As for the drug reduced the relative risk by 30% compared with the group not given. Receptor inhibitors GP IIb / IIIa inhibitors are platelet aggregation in the final stages proved particularly beneficial in patients with acute coronary syndrome, high risk and intervene .

Coronary intervention (percutaneous angioplasty and / or stenting) DMV may not be a new problem because they were made routinely and contribute significantly improved prognosis and development a new branch in the heart. Since Gruntzig (1978) first DMV dilatation catheter through the femoral RESERVED, so far, this method has become one of the leading methods in the treatment of the DMV. However, over time there have been many advances, significant improvements in coronary intervention with increasingly sophisticated equipment, safe and effective.

The traditional hot and put the DMV has certain limitations, such as the rate of coronary artery restenosis remains high (up to 20-30%) after the intervention. In the mechanisms causing restenosis remains the most important phenomena in the mantle proliferation of blood vessels (neointia hyperplasia). To overcome this phenomenon, we have devised methods to cover anti-mitotic Stent to put into the DMV and have significantly reduced restenosis. Sirolimus drug-coated stent present (Cypher Stent) are widely used to prevent restenosis DMV (a significant challenge to intervene DMV).

Figure 3: Image coronary stent placed

A number of other challenges in the intervention DMV as thrombosis, hurt hard, calcified lesions hole in the DMV has advanced solving techniques:

The equipment used to dilute and suck blood clots in the heart of the DMV (X sizer) help please DMV ventilation, especially in cases of acute MI thrombosis because many measures angioplasty or stent placed normally expressed deadlock . For lesions and calcification hard DMV can use drilling equipment rather plaque (rotablator) for generously circuit. This device is rotated at a speed very large (200 000 cycles / min) as plaque piece of equipment into the cell through the bloodstream. Cutting Equipment plaque (DCA) and collected to put out, to be used for the case of narrow holes into the DMV or fibrous plaque is too big to get out.

Particularly in the field of surgery as a bridge DMV also has a lot of progress. The invention of a surgery with beating reduce postoperative period, to avoid complications related to running cardiopulmonary bypass and aortic clamping. Besides, surgery with minimally invasive techniques (mini Invasive) and robotic surgery are promising new direction in surgery DMV.

Figure 4: Drilling Equipment plaque breaking DMV (Rotablator)

 Advances in the treatment of heart valve disease

These advances have been the most prominent of heart valve disease is the percutaneous intervention techniques.

Nong Inoue balloon mitral percutaneous became therapies are the first choice for patients with mitral stenosis. In particular ball slipped from the right femoral vein to the right atrium through the atrial septal to the left atrium and left ventricle to help warm lips wide separation valve stenosis in patients with rheumatic HHL fit. In Vietnam, this technique has been widely applied to nearly 3,000 patients with very good results.

Rather aortic valve and the pulmonary artery catheter through the skin along the road from a large blood vessel in the thigh gave up being quite topical issue today. Group of GS. Cribier has performed on some patients and initial results are very encouraging. From RESERVED or TM thigh, artificial valve (located on the balloon stent types) are taken up through the catheter to the required position (RESERVED pulmonary valve or root), then mounted ball valves are inflated up to valve fixed in place and the ball falling to the van to put in place. This is a very promising therapeutic approach in the future for patients with valvular heart disease without surgery.

Mitral through the catheter is being tested. Through the catheter put the device up to clamp the edges valve in the mitral valve cleft cases more. There is also the author via the catheter put up a device to insert an artificial valve within the coronary sinus shrink around the mitral ring to help open the mitral valve.

Figure 5: Nong Inoue balloon mitral

 Advances in the treatment of congenital heart disease.

Congenital heart disease is very common in social life, the average incidence of congenital heart disease can (according abroad) about 0.4% of children born. We do not have official statistics, but estimates may be greater than the above (due to economic conditions, society, war and toxic pollution ...). Patients usually leave the burden of physical, not mental patients, families and society. However, with the continuous development of science and technology, a lot of congenital heart disease has been detected in time and treated in a very effective, in many cases can completely heal.

Close atrial septal using Amplatzer instruments through the catheter: This is a special type of device using Nitinol shape memory metal mesh, whatever the shape of the two together and connected by a waist. When put into the instrument has been collected in the catheter. From the right femoral venous catheter brought up through the hole into the left atrium to TLN. Thereby pushing up though and opened the front side of the left atrium and then pull back with atrial septal left wing and open to the right atrium to cave in and atrial septal closure. Then check out and disassembled by removing the screws though. This method avoids the open-heart surgery on that still result in similar studies in the world and at the Institute of Cardiology in Vietnam proved.

Figure 6: Tools TLN Amplatzer and play through the catheter

Ductal closure of patent ductus arteriosus in patients with Amplatzer or coil instrument is similar in principle but different instruments shaped to fit the ductus arteriosus. Close the hole with ventricular septal membrane fraction Amplatzer instruments with more complex and are in the testing phase. This method is also promising prospects and bring significant benefits to patients. At the Heart Institute we also have initial success in closing the TLT for some patients.

Some other congenital diseases can be treated through the catheter is quite effective as angioplasty pulmonary valve stenosis through the skin, hot aortic stenosis skin, aortic dilatation narrow waist, close some fistula abnormal coronary arteries or other offerings along the catheter without surgery ...

For patients obstructive hypertrophic cardiomyopathy, previously cut septal surgery with many complications. This can make thin septal by injecting alcohol into the coronary arteries branch septal feed selectively through the catheter. This method is less invasive than surgery and the results are very  

  Some progress in the treatment of arrhythmias.

In the practice of cardiovascular disease, arrhythmias is probably the most complex problems. Today, the relentless progress of science and technology has enabled a thorough treatment of cardiac arrhythmias such as ventricular tachycardia, with extraordinary bridge (WPW); ventricular tachycardia ... and special attention is currently treating atrial fibrillation.

Electrophysiological exploration in the chambers of the heart through the catheter allows to determine the nature of the arrhythmia and can locate the abnormal bridge and the external drive from there to decide whether additional treatment disease.

Treatment with Radio arrhythmias through the catheter (catheter ablation) is a modern method, energy radio frequency waves to dismantle parts pathways causing arrhythmias or in the periphery. This method is now widely used to treat a number of complex arrhythmias exist and persist.

Automatic Implantable Defibrillators in the chambers of the heart (ICD) is effective measures to prevent sudden death in subjects at risk of ventricular fibrillation or ventricular tachycardia malignant.

 Using stem cells in the treatment of cardiovascular disease.

This is really a topical issue today is hot and very much interested. Theoretical basis of this method is used to differentiate stem cells can be generated elements authorities is equivalent to supplement or replace damaged organs without remedy, particularly especially in the field of coronary artery disease.

Figure 7: The image map acts on stem cells DMV system

Although there are many methods of treatment, but the DMV to 10% of patients are incurable. Therefore, if we use stem cells into myocardial DMV or to create new blood vessels can be created to solve the root of the disease mechanism. There have been many studies using stem cells in the treatment of DMV and the initial results are encouraging. This really is an important direction for future of Cardiology.