Additional Expertise

Generally speaking, T&C often address these types of issues: Who is allowed to use the website; the possible payment methods; a declaration that the website owner may change his or her offering in the future; the types of warranties the website owner gives his or her customers; a reference to issues of intellectual property or copyrights, where relevant; the website owner’s right to suspend or cancel a member’s account; and much much more.

To learn more about this, check out our article “Creating a Terms and Conditions Policy”.

What to include in the T&C document

Having said that, Terms and Conditions (“T&C”) are a set of legally binding terms defined by you, as the owner of this website. The T&C set forth the legal boundaries governing the activities of the website visitors, or your customers, while they visit or engage with this website. The T&C are meant to establish the legal relationship between the site visitors and you as the website owner.

T&C should be defined according to the specific needs and nature of each website. For example, a website offering products to customers in e-commerce transactions requires T&C that are different from the T&C of a website only providing information (like a blog, a landing page, and so on).

T&C provide you as the website owner the ability to protect yourself from potential legal exposure, but this may differ from jurisdiction to jurisdiction, so make sure to receive local legal advice if you are trying to protect yourself from legal exposure.

Terms & Conditions - the basics

Diagnosis

Some atrial septal defects are diagnosed before or soon after a child is born. However, smaller atrial septal defects may not be diagnosed until later in life. If an atrial septal defect is present, the health care provider may hear a whooshing sound (heart murmur) when listening to the heart with a stethoscope. Tests that are done to help diagnose an atrial septal defect include:

Echocardiogram. This is the most commonly used test to diagnose an atrial septal defect. Sound waves are used to create pictures of the heart in motion. An echocardiogram can show how well blood is moving through the heart and heart valves.
Chest X-ray. A chest X-ray shows the condition of the heart and lungs.
Electrocardiogram (ECG or EKG). This quick and painless test records the electrical activity of the heart. An ECG can help identify irregular heartbeats (arrhythmias).
Cardiac magnetic resonance imaging (MRI) scan. This imaging test uses magnetic fields and radio waves to create detailed images of the heart. A health care provider might request this type of MRI if echocardiography didn't provide a definitive diagnosis.
Computed tomography (CT) scan. This uses a series of X-rays to create detailed images of your heart. It can be used to diagnose an atrial septal defect and related congenital heart defects if echocardiography hasn't definitely diagnosed an atrial septal defect.

Treatment

Treatment for atrial septal defect depends on the size of the hole in the heart and whether you or your child has other congenital heart defects.

Many atrial septal defects close on their own during childhood. For those that don't close, some small atrial septal defects might not require treatment. A doctor specializing in heart diseases (cardiologist) might recommend monitoring it with regular health checkups to see if it closes on its own.

Your health care provider will discuss with you when you or your child needs treatment. Many persistent atrial septal defects eventually require surgery. However, closure isn't recommended if severe pulmonary hypertension is present.

Medications

Medications won't repair an atrial septal defect, but they can help reduce signs and symptoms. Medications for atrial septal defect might include drugs to control the heartbeat (beta blockers) or to reduce the risk of blood clots (anticoagulants).

Surgery or other procedures

Many cardiologists recommend surgery to repair a medium to large atrial septal defect that's diagnosed during childhood or adulthood to prevent future complications.

For adults and children, atrial septal defect repair surgery involves closing the hole in the heart. This can be done two ways:

Catheter-based repair. A thin, flexible tube (catheter) is inserted into a blood vessel, usually in the groin, and guided to the heart using imaging techniques. A mesh patch or plug is passed through the catheter and used to close the hole. Heart tissue grows around the seal, permanently closing the hole.

The catheter-based repair procedure is used only for the secundum type of atrial septal defects. Some large secundum atrial septal defects, however, might require open-heart surgery.
Open-heart surgery. This type of atrial septal defect repair surgery involves an incision through the chest wall to access the heart directly. The surgeons use patches to close the hole. This open-heart repair surgery is the only way to fix primum, sinus venosus and coronary sinus atrial defects.

Sometimes, atrial septal defect repair can be done using small incisions (minimally invasive surgery) and with a robot (robot-assisted heart surgery).

Anyone who has had surgery for atrial septal defect needs regular echocardiograms and health checkups to watch for possible complications, such as irregular heartbeats (arrhythmias), heart valve problems, high blood pressure in the lung arteries (pulmonary hypertension) and heart failure.

People with large atrial septal defects who do not have surgery to close the hole typically have worse long-term outcomes. They may have more difficulty performing everyday activities (reduced functional capacity) and are at greater risk for arrhythmias and pulmonary hypertension.

Atrial Septal defect Closing

Complex Angioplasty / Stents:

A brief explanation of some of the most common complex lesions follows.

Bifurcation lesions- This type of lesion arises at or adjacent to the separation of a major coronary artery. These lesions subdivide into three anatomic portions. The three portions are the proximal main branch, distal main branch, and side branch. A bifurcation lesion is one with significant stenosis (over 50%) in a coronary artery involving the origin of a side branch or in a coronary artery adjacent to the origin of the side branch. [5] The Medina classification system assesses and defines the location of stenosis in each of these locations. This system is a simple numeric system that encompasses the main branch, distal branch, and side branch.
Calcified lesions- Vascular calcification of the coronary arteries is a common process that is active, regulated, and involves atherosclerotic as well as inflammatory and hormonal disease processes. Coronary artery calcification (CAC) involved intimal and medial calcification.[6] CAC increases vessel stiffness and increases the potential for cardiovascular events.[7]
Chronic total occlusions- This is the complete obstruction of a coronary artery. These occlusions must show TIMI 0 or TIMI 1 flow and have a duration of 3 months.
Left main coronary artery (LMCA) disease- Left main coronary artery disease can be problematic given that it is the origin of the majority of the left ventricular coronary supply. An unprotected left main coronary artery leaves the majority of the myocardium susceptible to death if significant stenosis is present.[8] A protected left main coronary artery is such that there is a bypass graft supplying the left anterior descending artery or the left circumflex artery.
Ostial lesion- An ostial lesion is one that starts within 3 mm of the origin of a major coronary artery. These may be challenging to stent due to their proximity to the aorta.
Stenosis of saphenous vein graft (SVG)- This type of stenosis occurs commonly, with some reports up to 20% of patients within 1 year. PCI of SVG contains a significant risk for myocardial infarction or diminished anterograde flow. Atherosclerotic disease within graft results in a high restenosis rate as well.

Epidemiology

Coronary bifurcation lesions are the most common of the complex coronary lesions. Some estimates have reported that these are found in up to 20% of all PCIs.

Coronary artery calcification is a nonspecific term, and the amount of calcification can vary greatly. The majority of the population has some degree of calcification and atherosclerosis, though it may not be significant enough to cause significant stenosis. One large study noted calcifications to be present in 50% of individuals age 40 to 49. This number rose to 80% of individuals aged 60 to 69.[18] Gender and age are significant risk factors for coronary calcification. Studies have reported the incidence of coronary calcification at 93% for men aged over 70 years and 77% for women aged greater than 70.
Chronic total occlusions (CTO) are extremely common as well. CTOs are present in 20% of individuals undergoing non-urgent angiography. The incidence is even higher in higher-risk individuals. CTOs are found in 47% of individuals who present with an acute coronary syndrome and in 89% of individuals with prior coronary artery bypass grafting.
Estimates for unprotected left main coronary artery (ULMCA) disease vary. One study cited its prevalence in 5% of individuals who underwent coronary angiography. Another study estimated its prevalence at less than 2% of individuals who underwent coronary angiography.
Approximately 300000 individuals undergo coronary artery bypass grafting (CABG) in the United States annually. Among those with saphenous venous graft, 8 to 12% experience early occlusion before discharge. Approximately 15 to 30% of saphenous vein grafts experience occlusion within the first year after CABG. About 50% of individuals have saphenous vein graft failure within 10 years of surgery.

Why Complete Revascularization help to improve the outcome of procedure and patient mortality and morbidity. The most commonly used is the IMPELLA catheter (to improve cardiac output and coronary flow) Associated with Improved Outcomes. To less common Intra Aortic Balloon Pump of ECHMO.

IMPELLA Protect III study suggest the following benefits:

Benefits in high-risk acute coronary syndrome (ACS) patients at 1 year4

71% risk reduction in all-cause death
27% risk reduction in major adverse cardiovascular events (MACE)
41% risk reduction in myocardial infarction (MI)

Benefits in high-risk STEMI patients at 3 years5

26% risk reduction in cardiovascular (CV) Death/MI
47% risk reduction in CV Death/MI/Revascularization

Meta-analysis of benefits in 11 high-risk STEMI studies6

29% risk reduction in CV Death/MI

Advance Heart Failure Treatments Using OPTIMIZER Min System:

Understanding the Symptoms of Heart Failure

Chronic heart failure (CHF) occurs when your heart is unable to pump sufficient blood to meet the needs of your body due to weakened heart pumping strength. Measured by ejection fraction (EF), a normal EF is greater than 55%. In patients with CHF, this value can fall to 25%, or even lower.

Heart failure is often caused by damage to the heart muscle due to a heart attack, untreated coronary artery disease, or persistent high blood pressure. The symptoms of heart failure include, but are not limited to:

Dyspnea or shortness of breath during movement or while resting
Fatigue and general weakness
Edema or swelling in your legs, ankles, and feet
Fast or irregular heartbeat
Swelling of your abdomen
Nausea and lack of appetite
Chest pain

You may also notice that tasks such as grocery shopping or climbing stairs are increasingly difficult for you due to fatigue and shortness of breath.

What to Expect From the Optimizer® Smart Mini System

The Optimizer® Smart Mini System includes an implantable stimulation device (similar in size to a pacemaker) and an external charging station. The device is implanted in a small pocket under the skin of the upper chest, along with commercially available pacemaker leads that are placed in the heart’s right ventricular septum, while the patient is under light sedation. After implantation, the physician custom-programs and activates the device for the patient. The Optimizer® Smart Mini then begins sending electrical pulses to the heart muscle for a total of 5 to 7 hours a day, in one-hour treatments separated by regular intervals. The patient charges the device one hour per week using the external charger. The Optimizer® Smart Mini device is expected to last at least 20 years without replacement.

The implant procedure doesn’t require open-heart surgery and most patients can return home soon after the implant is complete. Plus, most patients are able to return to everyday activities shortly after the procedure.

The Optimizer® Smart Mini: Improving Your Day-to-Day Life

The Optimizer® Smart Mini is designed to increase the strength of your heart’s contractions. The therapy you’ll receive may diminish the symptoms of CHF, allowing you to take your life back. Walking, climbing steps, and playing with your kids or grandkids could become easier due to the reduction in the need to rest after performing simple activities.

This device has already improved the lives of thousands of patients struggling with the symptoms of CHF.

How Do We Treat Chronic Heart Failure?

If you are diagnosed with heart failure, you’ll need lifelong management for the condition. Although treatment of CHF depends on its cause, it’s typically treated with drugs or implanted devices such as implantable cardiac defibrillators or cardiac resynchronization devices.

These treatments don’t always result in an improvement of symptoms for all patients. That’s why we’ve developed Optimizer® Smart Mini; to help you find relief even when traditional approaches prove minimally effective, and other treatments aren’t yet applicable.

How Does the Optimizer® Smart Mini Work?

The Optimizer® Smart Mini is a minimally invasive implantable device that delivers precisely timed electrical pulses to the heart cells during a special period of the beating cycle (called the absolute refractory period, or the period just after the heart contracts). In doing so, it strengthens and helps the heart contract more forcibly, thereby delivering more blood and oxygen to the body. Studies have shown CCM® therapy to improve 6-minute hall walk distance, quality of life and functional status among patients who are candidates for the device.