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Background— Percutaneous transcatheter patent foramen ovale (PFO) closure is now standard practice and may limit embolic complications for at least 10 years. Implantable PFO closure devices may be complicated by thrombosis, infection, device fracture, or embolization. A novel strategy uses radiofrequency-based thermal energy to seal PFO membranes, with no implanted device. We successfully used this method and examined histopathologic events in swine to characterize safety and efficacy. Methods and Results— Thirteen domestic swine were examined over time after thermal PFO closure. Three animals were euthanized within 1 hour of treatment, 5 after 7 days, and 5 at 28 days. Gross and histopathologic findings were examined. Radiofrequency energy was delivered successfully in all cases, and PFOs were closed in 12 of 13 cases. One case was not suitable for histological examination because of laceration at euthanasia, and the other PFO was clinically closed, with no shunt at 7 days, but was histologically open. All of the other PFOs were confirmed closed histologically. Acute histological results showed edema, hemorrhage, and myocyte necrosis. Minimal thrombus formation occurred on the left atrial endocardial surface. At day 7, transmural thermal effects occurred through the atrial wall that extended to the epicardial surface. At day 28, thermal effects showed excellent scar formation. Collagen, matrix, and neovascularization were present in all cases. No animal experienced adverse events. Conclusions— Thermal PFO closure is feasible, safe, and effective in swine. Thermal healing is nearly complete by 4 weeks and consists of collagen formation and tunnel closure. This technique may allow substantial reduction in PFO closure risk over current device-based therapy.

Introduction: Takotsubo cardiomyopathy (TTC) is characterized by a transient systolic dysfunction of the left ventricle. A few case was reported about left ventricular apical hypertrophy (APH) during recovery from TTC. The purpose of this study was to investigate the incidence of transient APH and the differences in clinical characteristics in TTC patients. Methods: Forty seven TTC patients were enrolled in this study. Patients were divided into two groups as N-APH group which did not show APH like findings in the process of wall motion recovery and T-APH group which showed transient APH findings. Cardiac complications were defined as cardiac death, pump failure, sustained ventricular tachycardia or ventricular fibrillation and advanced atrioventricular block. Results: Twelve of 47 (25.5%) TTC patients demonstrate typical APH findings during recovery from wall motion abnormality. Finally, this APH findings disappeared and left ventricular morphology recovered to normal structure. There is no significant difference between two groups in clinical characteristics (table). Incidence of cardiac complication showed significantly lower in T-APH group than that in N-APH group (P< 0.005). Conclusions: Transient left ventricular APH were observed in 25.5% in TCC patient by serial echocardiographic observation. Incidence of cardiac complications in T-APH group is significantly lower than that in N-APH group. Detection of T-APH is useful as a prognostic indicator in patients with TTC.

Introduction: It is reported that aortic valve reconstruction (AVrC) by using autologous pericardium is useful in patients with various aortic valve diseases. This method may be more effective in preserving the natural motion of the aortic valve annulus. Significant dynamic changes in the aortic annulus have previously been reported in animal models and clinical studies. The purpose of this study is to analize the cyclic changes of the aortic annulus using speckle-tracking trans-esophageal echocardiography in patients who underwent AVrC surgery. Methods: The subjects were 35 patients underwent AVrC surgery for aortic regurgitation or aortic stenosis and 40 controls. Cyclic aortic annulus diameter of the maximum and minimum diameters were determined from a speckle-tracking displacement curve (figure). These data was used to calculate the absolute change in the diameter of the aortic annulus, which was defined as the difference in diameters throughout the cardiac cycle. Results: There was significant difference between maximum and minimum aortic annulus diameter in AVrC group (18.7±3.0 mm vs 16.1±2.9 mm, p Conclusions: Our study suggests that dynamic changes of the aortic annulus occur in the cardiac cycle and can be measured using speckle-tracking trans-esophageal echocardiography. AVrC may preserve the coordination of the left ventricle, aortic annulus, sinus of Valsalva and aorta compared with conventional aortic valve replacement.

We appreciate the questions by Stollberger and colleagues about our article on patent foramen ovale (PFO) coaptation by radiofrequency energy.1 Dr Stollberger comments that indications for PFO closure are not increasing and cites the US Food and Drug Administration finding no randomized data showing efficacy. We disagree. The indications for PFO closure are clearly increasing, although Food and Drug Administration approval has not yet been granted. In Europe, PFO closure is widely used for stroke and migraine. For example, the Migraine Intervention With STARFlex Technology (MIST I) trial examined PFO closure for migraine and found clear benefit for secondary end points of migraine reduction. Other syndromes associated with PFO include …

Backgrounds: The left atrial appendage (LAA) is a structure with unique anatomic and functional features. Unfortunately it is the source of ≥ 90% of all cardiac emboli. Recently, percutaneous LAA obliteration was developed to limit cardioembolic events in patients with atrial fibrillation. The feasibility of this treatment is under study to eliminate anticoagulation and simultaneously eliminate cardioembolic events. We examined the LAA from the standpoint of its structure, function compared with the RAA, as well as analyzing its complexity with Multidetector CT (MDCT). Methods and Results: 64-slice MDCT was used to visualize the LAA and RAA in 25 patients. All patients were scanned and a 3D volume rendered technique. Visual comparison between LAA and RAA was performed and LAA orifice diameter, circumference, total and usable length were measured in 2D and 3D. MDCT images revealed complicated LAA structure including small septation, features often not completely appreciated by 2D images (Figure ). 3D images demonstrated 32% single and 28% multiple septae in LAA. There was an excellent correlation of minimum orifice diameter (95%CI 0.46 – 0.94, p Conclusions: LAA imaging in 3D by MDCT is an excellent method to visualize complex anatomy and morphology. The usable LAA length for device implant bears no relation to 2D and 3D analysis, an important consideration for obliteration technologies.