Clinical and Hemodynamic Effects of Percutaneous Edge-to-Edge Mitral Valve Repair in Atrial Versus Ventricular Functional Mitral Regurgitation.

The present study aims to assess the clinical and hemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with atrial functional mitral regurgitation (A-FMR) compared with ventricular functional mitral regurgitation (V-FMR). Mitral regurgitation (MR) grade, functional status (New York Heart Association class), and major adverse cardiac events (MACE; all-cause mortality or hospitalization for heart failure) were evaluated in 52 patients with A-FMR and in 307 patients with V-FMR. In 56 patients, hemodynamic assessment during exercise echocardiography was performed before and 6 months after intervention. MR reduction after MitraClip implantation was noninferior in A-FMR compared with V-FMR (MR grade ≤2 at 6 months in 94% vs 82%, respectively, p <0.001 for noninferiority) and was associated with improvement of functional status (New York Heart Association class ≤2 at 6 months in 90% vs 80%, respectively, p = 0.2). Hemodynamic assessment revealed that cardiac output at 6 months was higher in A-FMR at rest (5.1 ± 1.5 L/min vs 3.8 ± 1.5 L/min, p = 0.002) and during peak exercise (7.9 ± 2.4 L/min vs 6.1 ± 2.1 L/min, p = 0.02). In addition, the reduction in systolic pulmonary artery pressure at rest was more pronounced in A-FMR: Δ SPAP -13.1 ± 15.1 mm Hg versus -2.2 ± 13.3 mm Hg (p = 0.03). MACE rate at follow-up was significantly lower in A-FMR versus V-FMR, with an adjusted odds ratio of 0.46 (95% confidence interval 0.24 to 0.88), which was caused by a reduction in hospitalization for heart failure. In conclusion, percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. However, the hemodynamic improvement and reduction of MACE were significantly better in A-FMR

Suprasternal bronchogenic cyst in an 8-year-old girl

Abstract: In this case report, we present an 8-year-old girl who was referred to the ear-nose-throat department of the Antwerp University Hospital because of an asymptomatic midline neck mass. After resection, histopathological examination was characteristic of a bronchogenic cyst. Bronchogenic cysts are rare, congenital anomalies of the tracheobronchial tree caused by aberrant bud formation of the tracheobronchial tree during embryogenic development. They usually have an intrathoracic location, whereas cervical, cutaneous, and subcutaneous cysts are extremely rare. Initial symptoms are respiratory distress, coughing, and bronchopulmonary infections by compression of the tracheobronchial tree. Imaging studies are recommended to determine the mass's tissue characteristics as well as the engagement of surrounding anatomical structures, which is necessary for adequate preoperative planning. However, a definitive diagnosis may be obtained only after surgery through histopathological analysis

Oculomotor Abnormalities in Large Cerebellopontine Angle Tumors:A Case Series of Bruns' Nystagmus

Patients with large or giant large cerebellopontine angle lesions can present with a wide range of audiovestibular symptoms, including Bruns' nystagmus. This is a rare variant of bidirectional nystagmus, characterized by a combination of slow, large-amplitude nystagmus when looking to the side of the lesion and rapid small-amplitude nystagmus when looking to the contralateral side. This phenomenon arises due to a unique situation in which 2 different neural circuits, specifically the floccular pathways and peripheral vestibular pathways, are simultaneously involved. The presence of Bruns' nystagmus is a good indicator for large CPA lesions of at least 3 cm in diameter with compression and displacement of the cerebellum, comprising the flocculus, and/or the brainstem. A case series of 4 different cases illustrates that investigating the presence of such nystagmus could be incorporated into the common diagnostic work-up of CPA lesions, since it is of particular interest in localizing large CPA tumors requiring urgent imaging