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ObjectiveWe sought to evaluate the potential impact of racial difference (Asians vs Caucasians) on the clinical usefulness of pressure recovery (PR) adjustment for preventing discordant aortic stenosis (AS) grading in patients with severe AS.MethodsData from 1450 patients (mean age, 70.2±10.6 years; 290 (20%) Caucasians; aortic valve area (AVA), 0.77±0.26 cm2) were retrospectively analysed. PR-adjusted AVA was calculated using a validated equation. Discordant grading of severe AS was defined as AVA of <1.0 cm2and mean gradient of <40 mm Hg. The frequency of discordant grading was assessed in the overall cohort and the propensity score-matched cohort.ResultsBefore PR adjustment, 1186 patients showed AVA values of <1.0 cm2; after PR adjustment, 170 (14.3%) were reclassified as having moderate AS. PR adjustment decreased the frequency of discordant grading from 31.4% to 14.1% in Caucasians and from 13.8% to 7.9% in Asians. Patients with reclassification to moderate AS after PR adjustment had a significantly lower risk of a composite of aortic valve replacement or all-cause death than did those with severe AS after PR adjustment (HR 0.38; 95% CI 0.31–0.46; p<0.001). In propensity score-matched cohorts (173 pairs), the frequency of discordant grading before PR adjustment was 42.2% and 43.9% in the Caucasian and Asian patients, respectively, which decreased to 21.4% and 20.2%, respectively, after PR adjustment.ConclusionsClinically relevant PR occurred, regardless of race in patients with moderate to severe AS. Routine PR adjustment may be useful for reconciling discordant AS grading.

Compared with conventional bilateral femoral (BF) approach, radial plus ipsilateral femoral (RF) approach may be feasible in the percutaneous intervention for iliac artery chronic total occlusion (CTO).

ObjectivesAlthough the incidence of patients with isolated tricuspid regurgitation (TR) is increasing, data regarding the clinical outcomes of isolated TR surgery are limited. This study sought to investigate the prognostic implications according to procedural types, and to identify preoperative predictors of clinical outcomes after isolated TR surgery.MethodsAmong consecutive 2610 patients receiving tricuspid valve (TV) procedure, we analysed 238 patients (age, 59.6 years; 143 females) who underwent stand-alone TV surgery (repair, 132; replacement, 106) for severe TR. Primary outcome was the composite of all-cause mortality and heart transplantation. Clinical outcomes between the repair and the replacement groups were compared after adjusting with the inverse probability of treatment weighting (IPTW) method.ResultsDuring follow-up (median, 4.1 years), 53 patients died and 4 received heart transplantation. Multivariable analysis revealed that age (p=0.001), haemoglobin level (p=0.003), total bilirubin (p=0.040), TR jet area (p=0.005) and right atrial (RA) pressure (p=0.022) were independent predictors of the primary outcome. After IPTW adjustment, there were no significant intergroup differences in the risk of primary outcome (HR 1.01; 95% CI 0.55 to 1.87). In the subgroup analysis, tricuspid annular diameter was identified as a significant effect modifier (p=0.012) in the comparison between repair versus replacement, showing a trend favouring replacement in patients with annular diameter >44 mm.ConclusionsThe outcomes of stand-alone severe TR surgery were independently associated with the severity of TR and RA pressure. In selected patients with severe annular dilation >44 mm, replacement may become a feasible option.

Regurgitant volume (RVol) calculated using the proximal flow convergence method (proximal isovelocity surface area [PISA]) has been accepted as a key quantitative parameter for the diagnosis of and clinical decision-making with regard to severe mitral regurgitation (MR). However, a recent prospective study showed a significant overestimation of RVol by the echocardiographic PISA method compared with the MR volume measured using magnetic resonance imaging. We aimed to evaluate the frequency of overestimation of RVol by the PISA method and the clinical conditions that require a different quantitative method to correct the overestimation.

Evaluation of left ventricular global longitudinal strain (LVGLS) has allowed better characterization than left ventricular ejection fraction (LVEF) of subtle differences in left ventricular performance. The aim of this study was to determine whether LVGLS has prognostic value in patients with severe aortic stenosis and preserved LVEF undergoing transcatheter aortic valve implantation (TAVI).

Sex-specific thresholds of computed tomography (CT)–derived aortic valve calcification (AVC) or AVC density (AVCd) to identify severe aortic stenosis (AS) have been established in populations that consisted mainly of Caucasians with a tricuspid aortic valve. The objective of this study was to evaluate the accuracy (i.e., sensitivity and specificity) of previously established thresholds to identify severe AS in patients with bicuspid aortic valve (BAV) and according to ethnicity: Caucasian vs. Asian.

Novel wafer-level fabrication of a glass ball-lens is realized for optoelectronic applications. A Pyrex wafer is bonded to a silicon wafer and cross-cut into a square-tile pattern, followed by wet-etching of the underlying silicon. Cubes of Pyrex on the undercut silicon are then turned into ball shapes by thermal reflow, and separated from the wafer by further etching of the silicon support. Radial variation and surface roughness are measured to be less than ±3 µm and ±1 µm, respectively, for ball diameter of about 500 µm. A surface defect on the ball that is due to the silicon support is shown to be healed by using a silicon-optical-bench. Optical power-relay of the ball lens showed the maximum efficiency of 65% between two single-mode fibers on the silicon-optical-bench.

Adjustment for pressure recovery (PR) may reconcile discrepancies in pressure gradients measured by Doppler echocardiography and direct catheterization in patients with mild to moderately severe aortic stenosis (AS). The aim of this study was to evaluate whether PR adjustment is useful in a large cohort of predominantly patients with severe AS.

A 76-year-old woman was referred to our hospital due to further evaluation of anaemia. During the past 3 years, she had been treated for multiple spinal compression fractures with vertebroplasty. Her blood pressure was 90/50 mm Hg, heart rate 75 beats/min, body temperature 37.7°C and respiratory rate 20/min at admission.On blood sampling, her haemoglobin level was 5.2 g/dL and white cell count and platelet count 3.7 and 22×103/ µL, respectively. She was diagnosed with multiple myeloma after serial diagnostic workups. Because her chest radiography showed cardiomegaly and left-sided pleural effusion with small atelectasis, transthoracic echocardiography and contrast enhanced chest CT were performed (figure 1, see online ). [Figure]QuestionWhich of the following is the most likely diagnosis of the cystic lesion?AscitesPericardial cystPericardial effusionBronchogenic cystPleural effusion

The refractive indices of photoresist are usually measured by an ellipsometer or spectrophotometer, but the values are limited to pre-exposure. It is known that the real and imaginary indices are changed during the exposure. But there is little report on these variations since it is difficult to measure this refractive index change at deep ultraviolet. The Dill ABCparameters show a significant variation with the resist and substrate thickness as well as the experimental conditions. A method is suggested to extract the parameters from the refractive index changes. We can get the refractive index change and extract the Dill ABCexposure parameters from that. The multiple thin film interference calculation is used to fit the measured transmittance data. The results of our experiments and calculations for several resists including 193 nm chemically amplified resists are compared with other methods. The results are agreed well with the full multilayer thin film simulation.