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Introduction: Alcohol septal ablation (ASA) is a percutaneous procedure for patients with refractory hypertrophic obstructive cardiomyopathy (HOCM). Asymmetric septal hypertrophy (ASH) and systolic anterior motion of the mitral valve (SAM) results in a dynamic left ventricular outflow tract gradient (LVOTG). LVOTG leads to concentric left ventricular hypertrophy and diastolic dysfunction. Hypothesis: We tested the hypothesis that patients who underwent ASA for treatment of HOCM would experience left ventricular remodeling and long-term improvement in diastolic function. Methods: Using a patient database maintained internally we analyzed the echocardiograms of 96 patients (36:60 M:F)(Age=60.5±13.2 years) who underwent successful ASA and had a follow-up echocardiogram at least 270 days following the procedure. Parameters used to describe diastology included interventricular septal thickness (IVSd), LV mass index (LVd mass index), LV diastolic internal diameter (LVIDd), LV end diastolic volume index (LVEDVi), left atrial end systolic volume index (LAESVi), early and late velocities across the mitral valve (MV E and A, respectively), and the MV E/A ratio. A paired t-test was used to compare baseline and follow-up echocardiogram values within individual subjects. Results: The time between ASA and follow-up echocardiogram was 653.9±350.4 days (mean±SD). At follow-up, the resting and provoked gradients were significantly reduced. Baseline and follow-up echocardiogram values were compared, revealing a significant difference in IVSd, LVPWd, LVd mass index, LVEDVi, LAESVi, MV E velocity, MV A velocity and MV E/A ratio. (Figure 1) Conclusions: Alcohol septal ablation induces significant regression of left ventricular hypertrophy and improvement in diastolic function. These changes likely contribute to long-term symptomatic improvement in patients who undergo alcohol septal ablation for treatment of hypertrophic obstructive cardiomyopathy.

Apical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy characterized by apical hypertrophy, deep T-wave inversions in precordial electrocardiogram (EKG) leads, and a ventriculogram shaped like the "Ace of Spades." Patients are often asymptomatic but sometimes present with atypical chest pain, angina, or atrial fibrillation. The deep T-wave inversions on EKG often mimic acute coronary syndrome. Coronary angiogram in these patients is unrevealing, but the characteristic left ventriculogram establishes this diagnosis. The deep T-wave inversions can appear suddenly or deepen over years, making the diagnosis difficult to establish early in the disease. Transthoracic echocardiogram may miss the hypertrophied apex, but echo contrast imaging or cardiac magnetic resonance imaging can reliably confirm the diagnosis and detect apical aneurysms. We present a case of apical hypertrophic cardiomyopathy which was not evident despite many admissions, EKGs, cardiac catheterizations and echocardiograms until the diagnosis was confirmed with left ventriculogram and cardiac magnetic resonance imaging 20 years after initial presentation.

Sustainable concrete has reduced CO 2 emissions, is durable, and is expected to have less detrimental effect on future generations, due to the fact that it utilizes waste materials. However, the need for external heat limits construction applications. The effects of sodium hydroxide ratio, external heat amount, and partial Portland cement replacement on fly ash-based geopolymer concrete were investigated. The early compressive strength, density, absorption, and permeable voids were measured, and the microstructure of the fly ash-based geopolymer paste was observed and characterized. The activating solution was a combination of silica fume, sodium hydroxide, and water. Experimentation showed that application of external heat plays a major role in compressive strength. Results also show that early and final compressive strength gains, in case of absence of external heat, can be improved by using Portland cement as a partial replacement of fly ash. The Scanning Electron Microscopy (SEM) results showed that the addition of Portland cement utilized the free water from the geopolymerization reaction. It not only led to a reduction in the microcracks formation due to less shrinkage, but also provided extra alkalinity, such as calcium hydroxide, which helped accelerate the fly ash and the activating solution reaction. Additionally, the permeable void ratio is affected by the Portland cement replacement, showing a significant reduction when the Portland cement ratio is increased.

This study investigates the geopolymerization process of fly ash–based geopolymer paste specimens using acoustic emissions; the activating solution is a combination of silica fume and sodiu...

Hypertrophic obstructive cardiomyopathy (HOCM) treated with alcohol septal ablation (ASA) often results in right bundle branch block (RBBB). The effect of RBBB-induced dyssynchrony on cardiac function has not been well described. We sought to determine the effect of ASA-induced RBBB on RV function

Left ventricular end diastolic pressure (LVEDP) is a representation of left ventricular performance. An increased LVEDP correlates to an increased left ventricular workload, which can be seen in pathologic conditions such as an obstructed left ventricular outflow tract (LVOT) in hypertrophic

Alcohol septal ablation (ASA) produces a targeted infarction of the septum, thereby relieving the outflow obstruction in hypertrophic obstructive cardiomyopathy (HOCM). There are several changes in the left ventricle with the relief of outflow obstruction. We sought to determine the medium-term