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Two-dimensional echocardiographic measurements of regional left ventricular end-diastolic wall thickness and systolic wall thickening were studied during coronary artery occlusion and early after reperfusion and compared with measurements of regional myocardial infarct size. In 25 closed chest anesthetized dogs with left anterior descending coronary artery occlusion followed by reperfusion, the occlusion period was 3 minutes in group I (n = 4), 20 minutes in group II (n = 4), 60 minutes in group III (n = 5) and 180 minutes in group IV (n = 12). Infarct size in groups III and IV was quantitated using the triphenyltetrazolium chloride technique. After coronary occlusion, wall thickening was replaced by thinning in the center of the ischemic region at the midpapillary echographic short-axis section, and no improvement in function occurred up to 60 minutes after reperfusion, except in group I. Ischemic zone enddiastolic wall thickness did not change significantly from control to the end of the coronary occlusion period, except Group IV. At 60 minutes after reperfusion, enddiastolic wall thickness increased only slightly in groups I and II (by 7.2 and 0.24%, respectively), but a marked increase was observed in groups III and IV (by 41 and 50%, respectively). The percent change in ischemic zone end-diastolic wall thickness from before reperfusion to 60 minutes after reperfusion correlated well with the amount of myocardial necrosis in corresponding segments (r = 0.936, standard error of estimate = 11.4%); an increase in segmental end-diastolic wall thickness of more than 25% was generally associated with 20% or more segmental necrosis. It is concluded that significantly increased regional end-diastolic wall thickness early after reperfusion is associated with irreversibly damaged myocardium, and this might be used as an index of myocardial salvage.

ObjectivesThe purpose of the study was to assess the long-term outcome of patients with small ventricular septal defects (VSDs) considered not to require surgical closure during childhood.BackgroundAlthough patients with small VSDs have generally been considered not to require surgery, more recent data suggest that a significant percentage of these patients develop serious problems during adult life.MethodsA total of 229 consecutive patients (115 females) with a VSD considered too small to require surgery during childhood as defined by normal pulmonary artery pressure, less than 50% shunt, pulmonary vascular resistance ≤200 dynes·s·cm−5, no VSD-related aortic regurgitation (AR), and no symptoms and who had no additional hemodynamically relevant heart defect were followed in an adult congenital heart disease program. Physical examination, electrocardiography, and echocardiography were performed in all patients in one- to three-year intervals; exercise tests and Holter monitoring were performed in 140 and 127 patients, respectively.ResultsFollow-up was completed in 222 patients (97%). Mean age at last visit was 30 ± 10 years. Spontaneous VSD closure was observed in 14 patients (6%). No patients died, four patients (1.8%) had an episode of endocarditis, of whom two required aortic valve replacement, and one additional patient (0.4%) had surgical closure for hemodynamic reasons. For 118 patients who entered the study between 1993 and 1996 and were prospectively followed for 7.4 ± 1.2 years, event-free survival with end points defined as death, endocarditis or heart surgery was 99.1 ± 0.8% at three years, 96.5 ± 1.7% at six years and 95.5 ± 1.9% at eight years. At last visit, 94.6% of all patients studied were symptom free. Left ventricular (LV) size by echocardiography was normal in 198 (89%) patients, borderline in 23 patients and definitely enlarged in only one patient. None had systolic LV dysfunction, and pulmonary artery pressure (PAP) was normal in all patients. Mean exercise capacity was 92 ± 21% of expected, and 87% of patients had no arrhythmias on Holter monitoring, with the remainder showing benign rhythm disorders.ConclusionsOutcome in well-selected patients with a small VSD is good. Surgical closure does not appear to be required during childhood as long as left-to-right shunt is

the initial results of human clinical studies demonstrated the safety and potential benefit of autologous bone marrow cells in improving left ventricular function after acute myocardial infarction (AMI). However, a fundamental problem in developing stem cell (SC)–based therapies has been the

NT-proBNP has been reported as predictor of survival in severe aortic stenosis (AS). Aim of this study was to examine the change in NT-proBNP levels over time and its value as predictor of outcome after treatment with transfemoral aortic valve implantation (TAVI). From May 2007 until June 2013, 142

Cost-effectiveness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) was compared to the costs of coronary artery bypass surgery (CABG) in patients with multivessel coronary artery disease in the first 5 years follow-up (FUP). 199 patients with multivessel DES-PCI (n=114

The intercellular adhesion molecule-1 (ICAM -1) and the vascular cell adhesion molecule-1 (VCAM-1) have been described to be associated with atherosclerotic plaque instability. However, the effect of ICAM-1 and VCAM-1 on mortality in patients with stable atherosclerosis has not been investigated yet