Search

Hypertrophic obstructive cardiomyopathy (HOCM) is characterised by asymmetric myocardial hypertrophy, which is most pronounced in the interventricular septum (IVS) and is responsible for the dynamic obstruction of the left ventricular outflow tract (LVOT). Successful alcohol septal ablation (ASA) of the IVS allows to reduce the thickness of the parabasal part of the IVS myocardium and, in most cases, to permanently reduce the gradient in the LVOT.To assess, using cardiac magnetic resonance imaging (MRI) and transthoracic echocardiography (TTE), the impact of gradient reduction in the LVOT on the type and severity of left ventricular (LV) remodelling.The study included 30 patients (aged 56.9 ± 11.9 years) with HOCM and the mean peak gradient (PG) in the LVOT of 123 ± 33 mm Hg who underwent ASA. MRI measurements were performed before and at 6 months after ASA and TTE measurements were performed before, at 3 months and at 6 months after ASA.PG in the LVOT decreased to an average of 52 ± 37 mm Hg (p 〈 0.0001) at 3 months after ASA and to 37 ± 28 mm Hg (p 〈 0.0001) at 6 months after ASA. TTE revealed a decrease in IVS thickness outside the scar following ASA from 23.6 ± 3.5 mm to 19.3 ± 4.0 mm (p 〈 0.0001) and 19.4 ± 0.4 mm (p 〈 0.0001) at 3 and 6 months, respectively. There was also a decrease in lateral wall (PW) thickness from 15.9 ± 3.2 mm to 14.9 ± 2.9 mm (p = 0.046) and 14.16 ± 2.00 (p = 0.0065) at 3 and 6 months, respectively. MRI revealed a decrease in IVS thickness from 23.7 ± 2.8 mm to 18.04 ± 4.00 mm (p = 0.0001) at 6 months following ASA. We observed a regression of the PW hypertrophy from 13.2 ± 3.35 mm to 12.18 ± 2.4 mm (p = 0.0225). There was a decrease in IVS mass from 108.9 ± 20 g to 91.5 ± 29 g (p = 0.0006). There was a trend towards a decreased LV mass and LV mass excluding IVS mass at 6 months.A significant decrease in PG in the LVOT is associated with a decrease in LV mass and with regression of LV hypertrophy outside the scar after ASA.

The rate of significant conduction disturbances requiring permanent pacemaker implantation (PPI) following surgical aortic valve replacement (AVR) is 2-8%. Transcatheter aortic valve implantation (TAVI) is an alternative management approach in patients with severe aortic stenosis who are not considered candidates for AVR. The TAVI using the CoreValve (CV) bioprosthesis is associated with a nearly 30% rate of conduction disturbances requiring postprocedural PPI.To provide an initial evaluation of the rate of conduction disturbances and the need for PPI, and to analyse factors that increase the risk of this complication in patients undergoing TAVI using CV bioprosthesis. In addition, we evaluated the rate of permanent conduction disturbances in patients who underwent PPI at one year after TAVI.We studies 22 initial patients in a single centre who underwent CV bioprosthesis implantation in 2009-2010. After exclusion of 6 patients with preprocedural PPI, we ultimately evaluated 16 patients. Uni- and multivariate analyses were performed using χ(2), Fisher, and Wilcoxon tests, and logistic regression analysis was performed using the SAS software.Overall, 8 (50%) patients in our study group required PPI after TAVI (TAVI + PPI), and the remaining 8 patients did not require PPI (TAVI). The most common indication for PPI was complete heart block. The decision to implant a pacemaker was made on average at 9 ± 7 days following TAVI (range 3 to 22 days). When we analysed risk factors for PPI that were unrelated to the TAVI procedure, we found that the TAVI + PPI group was characterised (vs the TAVI group) by a significantly larger diameter of the native aortic valve (p = 0.03) and a larger left ventricular outflow tract (LVOT) dimension in the frontal (p = 0.02) and the corresponding frontal dimension in the transverse view (p = 0.01) by computed tomography angiography. Logistic regression analysis showed that the risk of PPI increased more than 2.5 times for each increase in the aortic annulus diameter by 1 mm (OR 2.64; 95% CI 0.90-7.74). None of the risk factors related to TAVI resulted in a significant increase in the rate of PPI. Among the patients who underwent PPI, we only noted a trend for a larger valvulotomy balloon diameter (p = 0.08), shorter procedure duration (p = 0.06), and deeper CV insertion within LVOT (p = 0.09). In addition, the bioprosthesis was inserted deeper in those patients who developed new LBBB after TAVI (p = 0.06). The ECG analysis at one day after the procedure showed a significant prolongation of PR, QRS, QT, and QTc intervals, and increased left axis deviation in the TAVI + + PPI group. In addition, the TAVI + PPI group showed increased QRS duration (p = 0.03) and increased left axis deviation (p = 0.049) compared to the TAVI group. Each increase in QRS duration by 10 ms was associated with 2.5-fold increase in the risk of PPI (OR 1.10; 95% CI 0.97-1.22), and each increase in PR interval duration by 10 ms with a 23% increase in risk (OR 1.02; 95% CI 0.99-1.05). New LBBB following CV implantation was noted significantly more frequently in the TAVI + PPI group vs the TAVI group (p 〈 0.0003). Pacemaker interrogation at one year after TAVI showed that the mean percentage of ventricular pacing in all patients with a pacemaker (DDD and VVI) pacing was 41%, and it was less than 10% in 2 patients.1. Transcatheter implantation of a CV bioprosthesis is associated with an increased risk of persistent conduction disturbances and subsequent PPI. 2. New LBBB after TAVI may predict the need for PPI. 3. Careful ECG monitoring is necessary for one week after CV bioprosthesis implantation due to a risk of atrioventricular conduction disturbances and the need for PPI. 4. Patients at an increased risk of postprocedural PPI may be those with deep bioprosthesis insertion in LVOT, larger LVOT diameter, and larger aortic annulus diameter in the frontal view. These observations require confirmation in a larger group of patients.

The effect of quantum well states on the magnetic anisotropy of Co films grown on vicinal Cu(001) substrates was studied by in situ magneto-optic Kerr effect in a temperature range of 5 K to 365 K. The uniaxial magnetic anisotropy is found to oscillate as a function of Co thickness with a period of 2.3 atomic layers, modulated exactly as theoretically predicted by L. Szunyogh et al. [Phys. Rev. B 56, 14036 (1997)] and independently by M. Cinal [J. Phys. Condens. Matter 15, 29 (2003)] and M. Cinal and A. Umerski [Phys. Rev. B 73, 184423 (2006)]. Sub-monolayer Au coverage was used to fine-tune magnetic anisotropy and to provide convenient experimental access to anisotropy oscillations. The anisotropy oscillations, which are present up to room temperature, are attributed to quantum well states in the minority $d$ band at the Fermi level of Co.

Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of aortic stenosis (AS).To evaluate early results of TAVI using transfemoral/transsubclavian approach (TFA/TSA) or transapical approach (TAA) in patients with severe AS and high risk for surgical aortic valve replacement.Between January 2009 and May 2010, 30 high-risk patients underwent TAVI. The primary treatment option was TFA, and TAA was used if contraindications to TFA were present; one patient underwent the procedure using TSA. Reasons for selecting TAA were as follows: small diameter (7 mm) and/or severe calcification of the iliofemoral arteries, peripheral atherosclerosis, "porcelain" aorta and a horizontal course of the ascending aorta. Edwards-Sapien or CoreValve devices were used in all cases, and procedures were performed without the use of cardiopulmonary bypass in a cardiac catheterisation laboratory.Mean patient age was 82.46 ± 5.79 years, mean NYHA class was 3.23 ± 0.41, and predicted mean surgical mortality using logistic Euroscore was 29.18 ± 16.9% (22.72 ± 12.07% in the TFA/TSA group vs 34.6 ± 15.4% in the TAA group; p = 0.031). Eleven patients were treated using TAA. The valve was implanted successfully in 96% of patients. Inhospital mortality was 3.3%. Mean 30-day mortality was 6.6% in the entire cohort, 0% in the TFA/TSA group and 18% in the TAA group. There were no cases of periprocedural myocardial infarction (MI), cardiogenic shock, stroke/transient ischaemic attack, or need for cardiopulmonary resuscitation. One patient died suddenly three weeks after the procedure; except for this case, there were no major adverse cardiovascular events (MACCE: MI, cerebrovascular accident, re-do procedure) at 30-day follow-up. The TAVI was associated with a significant reduction in the mean maximal aortic gradient in both groups (from 99.6 ± 22.07 mm Hg to 21.83 ± 9.38 mm Hg post-procedure and to 23.25 ± 9.22 mm Hg at 30-day follow up), with no cases of severe aortic valve regurgitation. The NYHA class at 30 days improved from 3.23 ± 0.41 to 1.72 ± 0.52 (p = 0.03).Our results demonstrate lower 30-day complication rate and mortality in the TFA/TSA group. The availability of several techniques of valve implantation in the group of non-surgical patients with severe AS potentially broadens the patient population with indications for this treatment.

Background VIF-CAD randomized, placebo-controlled, double-blind trial was an attempt to induce therapeutic angiogenesis by percutaneous intramyocardial transfer of bicistronic (vascular endothelial growth factor/fibroblast growth factor [VEGF/FGF]) plasmid (pVIF) in patients with refractory heart ischemia. Myocardial perfusion, clinical symptoms, exercise tolerance, left ventricular function, and safety were assessed. Methods Fifty-two patients with refractory coronary artery disease were randomized to receive VEGF/FGF plasmid (n = 33) or placebo plasmid (n = 19) into myocardial region showing stress-induced perfusion defects. Repeat stress and rest technetium Tc 99m sestamibi single-photon emission computed tomography at 5 months was the primary efficacy measure. Secondary assessment included Canadian Cardiovascular Society class and exercise tolerance at 5 and 12 months. Results Rest- and stress-induced perfusion defects did not differ between groups. Canadian Cardiovascular Society functional class improved after 5 ( P = .0210) and 12 months ( P = .0607) in the treatment group. The exercise tolerance of treated patients improved: total exercise time increased marginally ( P = .0541); maximum workload ( P = .0419) and total test distance ( P = .0473) increased significantly, compared to placebo. Conclusion Bicistronic VEGF/FGF plasmid therapy did not improve myocardial perfusion measured by single-photon emission computed tomography. However, treated patients experienced improvement with respect to exercise tolerance and clinical symptoms. Intramyocardial VEGF/FGF bicistronic plasmid transfer seemed safe throughout the follow-up period of 1 year.

Magnetic anisotropy depends strongly on the density of states at the Fermi level. If significant contributions to magnetocrystalline anisotropy energy (MAE) are due to spin-polarized quantum well states (QWS), a significant increase of MAE can occur periodically as a function of film thickness. The oscillation period L is determined by the wavelength of the corresponding electron waves. The uniaxial magnetic anisotropy of fcc-Co is found to oscillate with a period of 2.3 ML. In contrast, in bcc-Fe, the uniaxial magnetic anisotropy oscillates with a period of 5.9 ML. We attribute such oscillations to QWS in a minority-spin d-band at the Fermi level.

Multilayers of (F/NF)N composition, where F means a ferromagnetic layer, NF a nonferromagnetic one, and N the number of repetitions, are studied by simulations and theoretically for different magnetic anisotropy characterized by the quality factor, Q (the ratio of the anisotropy energy to be gained by a magnetization along the easy axis perpendicular to the sample surface and the magnetostatic energy of a uniformly magnetized layer along the surface normal). It is shown that the range of the existence of out-of-plane magnetization states could be extended to Q

A 39-year old man after chest radiotherapy was referred for heart failure. Transesophageal echocardiography revealed stenosed and severely calcified native aortic and mitral valves (mean gradients 46 and 14 mm Hg, respectively). Considering the high surgical risk and based on previous experience [(

The case is reported of a successful transcatheter implantation of an Edwards SAPIEN 3 valve (29 mm) into a failing tricuspid bioprosthesis (Sorin Pericarbon, 31 mm). The procedure was performed in a 69-year-old woman with post-rheumatic mitral and tricuspid valve disease. Multiple previous cardiac surgeries precluded the use of another surgical approach. A large, organized, two-piece thrombus in the enlarged right atrium was not considered an absolute contraindication to the procedure. The SAPIEN 3 valve was implanted under general anesthesia, via a femoral venous access, under three-dimensional transesophageal echocardiography guidance. Postoperatively, the systolic right ventricular pressure was increased from 35 to 52 mmHg, but good function of the implanted valve was confirmed with transthoracic echocardiography. The clinical outcome was favorable and the patient was discharged home 72 h after the intervention. Video 1: Transthoracic echocardiography. Tricuspid color Doppler flow after the procedure. Video 2: Fluoroscopy. Fully expanded Edwards SAPIEN 3 valve in the tricuspid position. Video 3: Fluoroscopy. Expansion of the Edwards SAPIEN 3 valve on the balloon. Video 4: Fluoroscopy. Introduction of the Edwards SAPIEN 3 valve into the right atrium. Video 5: Transthoracic echocardiography. Tricuspid color Doppler flow before the procedure.