Combined transcatheter treatment of severe mitral regurgitation and secundum atrial septal defect in an inoperable patient: a case report

Background: Chronic mitral regurgitation (MR) is one of the most common valvular heart diseases and is associated with poor outcomes. Although other structural diseases are regularly seen in such patients, concomitant atrial septal defects (ASDs) remain a rarity in the elderly. Case summary: We report a case of an 82-year-old woman with progressive right-sided heart failure (HF) due to MR and an ASD of secundum type, despite optimal medical therapy. Combined transcatheter mitral valve repair (MVR) by utilizing a separate transseptal puncture and ASD closure was performed resulting in amelioration of symptoms. Discussion: Procedural planning for simultaneous transcatheter therapies of coupled structural heart disease entities remains complex. Our case illustrates feasibility of percutaneous edge-to-edge MVR and consecutive closure of a large secundum ASD. Different options of accessing the left atrium should be discussed on an individual basis, while additional ASD closure may be beneficial in terms of right ventricular function and symptoms of right HF

Transcatheter Caval Valve Implantation for Tricuspid Regurgitation After Single Leaflet Device Attachment

An 86-year-old patient experienced progressive heart failure symptoms. Echocardiographic evaluation revealed severe tricuspid regurgitation, which was treated by transcatheter edge-to-edge repair. During the procedure, single leaflet device attachment occurred. On the basis of a prohibitive surgical risk, caval valve implantation was performed, with no notable complications. (Level of Difficulty: Advanced.

Extended Star Formation and Molecular Gas in the Tidal Arms near NGC3077

We report the detection of ongoing star formation in the prominent tidal arms near NGC 3077 (member of the M 81 triplet). In total, 36 faint compact HII regions were identified, covering an area of ~4x6 kpc^2. Most of the HII regions are found at HI column densities above 1x10^21 cm^-2 (on scales of 200 pc), well within the range of threshold columns measured in normal galaxies. The HII luminosity function resembles the ones derived for other low-mass dwarf galaxies in the same group; we derive a total star formation rate of 2.6x10^-3 M_sun/yr in the tidal feature. We also present new high-resolution imaging of the molecular gas distribution in the tidal arm using CO observations obtained with the OVRO interferometer. We recover about one sixth of the CO flux (or M_H2~2x10^6 M_sun, assuming a Galactic conversion factor) originally detected in the IRAM 30m single dish observations, indicating the presence of a diffuse molecular gas component in the tidal arm. The brightest CO peak in the interferometer map (comprising half of the detected CO flux) is coincident with one of the brightest HII regions in the feature. Assuming a constant star formation rate since the creation of the tidal feature (presumably ~3x10^8 years ago), a total mass of ~7x10^5 M_sun has been transformed from gas into stars. Over this period, the star formation in the tidal arm has resulted in an additional enrichment of Delta(Z)>0.002. The reservoir of atomic and molecular gas in the tidal arm is ~3x10^8 M_sun, allowing star formation to continue at its present rate for a Hubble time. Such wide-spread, low-level star formation would be difficult to image around more distant galaxies but may be detectable through intervening absorption in quasar spectra.Comment: Accepted for publication in the Astronomical Journa

Hubble Space Telescope Wide Field Planetary Camera 2 observations of hyperluminous infrared galaxies

We present Hubble Space Telescope Wide Field Planetary Camera 2 I-band imaging for a sample of nine hyperluminous infrared galaxies (HLIRGs) spanning a redshift range 0.45 < z < 1.34. Three of the sample have morphologies showing evidence for interactions and six are quasi-stellar objects (QSOs). Host galaxies in the QSOs are detected reliably out to z ∼ 0.8. The detected QSO host galaxies have an elliptical morphology with scalelengths spanning 6.5 < re (kpc) < 88 and absolute k-corrected magnitudes spanning −24.5 < MI < −25.2. There is no clear correlation between the infrared (IR) power source and the optical morphology. None of the sources in the sample, including F15307+3252, shows any evidence for gravitational lensing. We infer that the IR luminosities are thus real. Based on these results, and previous studies of HLIRGs, we conclude that this class of object is broadly consistent with being a simple extrapolation of the ULIRG population to higher luminosities; ULIRGs being mainly violently interacting systems powered by starbursts and/or active galactic nuclei. Only a small number of sources, the infrared luminosities of which exceed 1013 L⊙, are intrinsically less luminous objects that have been boosted by gravitational lensing

Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement.

INTRODUCTION Previous analyses have reported the outcomes of transcatheter aortic valve replacement (TAVR) for patients with low-flow, low-gradient (LFLG) aortic stenosis (AS), without stratifying according to the route of access. Differences in mortality rates among access routes have been established for high-gradient (HG) patients and hypothesized to be even more pronounced in LFLG AS patients. This study aims to compare the outcomes of patients with LFLG or HG AS following transfemoral (TF) or transapical (TA) TAVR. METHODS A total of 910 patients, who underwent either TF or TA TAVR with a median follow-up of 2.22 (IQR: 1.22-4.03) years, were included in this multicenter cohort study. In total, 146 patients (16.04%) suffered from LFLG AS. The patients with HG and LFLG AS were stratified according to the route of access and compared statistically. RESULTS The operative mortality rates of patients with HG and LFLG were found to be comparable following TF access. The operative mortality rate was significantly increased for patients who underwent TA access [odds ratio (OR): 2.91 (1.54-5.48), p = 0.001] and patients with LFLG AS [OR: 2.27 (1.13-4.56), p = 0.02], which could be corroborated in a propensity score-matched subanalysis. The observed increase in the risk of operative mortality demonstrated an additive effect [OR for TA LFLG: 5.45 (2.35-12.62), p < 0.001]. LFLG patients who underwent TA access had significantly higher operative mortality rates (17.78%) compared with TF LFLG (3.96%, p = 0.016) and TA HG patients (6.36%, p = 0.024). CONCLUSIONS HG patients experienced a twofold increase in operative mortality rates following TA compared with TF access, while LFLG patients had a fivefold increase in operative mortality rates. TA TAVR appears suboptimal for patients with LFLG AS. Prospective studies should be conducted to evaluate alternative options in cases where TF is not possible

Chandra Observations of Expanding Shells in the Dwarf Starburst Galaxy NGC 3077

Deep Chandra observations (53 ks, ACIS-S3) of NGC 3077, a starburst dwarf galaxy in the M 81 triplet, resolve the X-ray emission from several supershells. The emission is brightest in the cavities defined by expanding shells detected previously in H alpha emission (Martin 1998). Thermal emission models fitted to the data imply temperatures ranging from ~1.3 to 4.9 x 10^(6) K and indicate that the strongest absorption is coincident with the densest clouds traced by CO emission. The fitted emission measures give pressures of P/k~10^(5-6) xi^(-0.5) f_(v)^(-0.5) K cm^(-3) (xi: metallicity of the hot gas in solar units, f_(v): volume filling factor). Despite these high pressures, the radial density profile of the hot gas is not as steep as that expected in a freely expanding wind (e.g., as seen in the neighboring starburst galaxy M 82) implying that the hot gas is still confined by the H alpha shells. The chaotic dynamical state of NGC 3077 undermines reliable estimates of the escape velocity. The more relevant quantity for the ultimate fate of the outflow is probably the gas density in the rich intragroup medium. Based on the HI distribution of NGC 3077 and a connected tidal tail we argue that the wind has the potential to leave the gravitational well of NGC 3077 to the north but not to the south. The total 0.3-6.0 keV X-ray luminosity is ~2-5 x 10^(39) erg s^(-1) (depending on the selected thermal plasma model). Most (~85%) of the X-ray luminosity in NGC 3077 comes from the hot interstellar gas; the remainder comes from six X-ray point sources. In spite of previous claims to the contrary, we do not find X-ray emission originating from the prominent tidal tail near NGC 3077.Comment: Accepted for publication in ApJ. A PDF version with high resolution figures can be obtained from ftp://ftp.atnf.csiro.au/pub/people/jott/down/ott_N3077.pd

The Interacting Dwarf Galaxy NGC 3077: The Interplay of Atomic and Molecular Gas with Violent Star Formation

We present a comprehensive multi-wavelength study of the nearby interacting dwarf galaxy NGC3077 (member of the M81 triplet). High resolution VLA HI observations show that most of the atomic gas (~90%) around NGC3077 is situated in a prominent tidal arm with a complex velocity structure. Little HI (~5 x 10^7 M_sun) is associated with NGC3077 itself. High resolution OVRO observations of the molecular component (CO) reveal the presence of 16 molecular complexes near the center of NGC3077 (total mass: ~1.6 x 10^6 M_sun). A virial mass analysis of the individual complexes yields a lower CO-to-H_2 conversion factor in NGC3077 than the Galactic value - a surprising result for a dwarf galaxy. The total (atomic and molecular) gas content in the centre of NGC3077 is displaced from the stellar component of NGC3077 -- this implies that not only the gas at large galactocentric radii is affected by the interaction within the triplet but also the center. We speculate that the starburst activity of NGC3077 was triggered by this redistribution of gas in the center. Some of these supershells are surrounded by neutral hydrogen. In a few cases, the rims of the ionized supershells are associated with dust absorption. The most prominent star forming region in NGC3077 as probed by Pa-alpha observations is hidden behind a dust cloud which is traced by the molecular complexes. Correcting for extinction we derive a star forming rate of 0.05 M_sun year^-1, i.e. given the reservoir in atomic and molecular gas in NGC3077, star formation may proceed at a similar rate for a few 10^8 years. The efficiency to form stars out of molecular gas in NGC3077 is similar to that in M82.Comment: accepted for publication in the Astronomical Journal. Full paper with figures available at http://www.astro.caltech.edu/~fw/ngc3077.ps.g

Measurement of the W boson helicity in events with a single reconstructed top quark in pp collisions at √s = 8 TeV

A measurement of the W boson helicity is presented, where the W boson originates from the decay of a top quark produced in pp collisions. The event selection, optimized for reconstructing a single top quark in the final state, requires exactly one isolated lepton (muon or electron) and exactly two jets, one of which is likely to originate from the hadronization of a bottom quark. The analysis is performed using data recorded at a center-of-mass energy of 8 TeV with the CMS detector at the CERN LHC in 2012. The data sample corresponds to an integrated luminosity of 19.7 fb[superscript −1]. The measured helicity fractions are F [subscript L] = 0.298 ± 0.028 (stat) ± 0.032(syst), F [subscript 0] = 0.720 ± 0.039 (stat) ± 0.037(syst), and F [subscript R] = −0.018 ± 0.019 (stat) ± 0.011(syst). These results are used to set limits on the real part of the tWb anomalous couplings, g [subscript L] and g [subscript R]

Search for the associated production of the Higgs boson with a top-quark pair

A search for the standard model Higgs boson produced in association with a top-quark pair (tt¯H) is presented, using data samples corresponding to integrated luminosities of up to 5.1 fb−1 and 19.7 fb−1 collected in pp collisions at center-of-mass energies of 7 TeV and 8 TeV respectively. The search is based on the following signatures of the Higgs boson decay: H → hadrons, H → photons, and H → leptons. The results are characterized by an observed tt¯H signal strength relative to the standard model cross section, μ=σ/σ SM,under the assumption that the Higgs boson decays as expected in the standard model. The best fit value is μ = 2.8 ± 1.0 for a Higgs boson mass of 125.6 GeV.National Science Foundation (U.S.