Mitral regurgitation in hypertrophic obstructive cardiomyopathy: relationship to obstruction and relief with myectomy

AbstractOBJECTIVESThis study examined: 1) the impact of myectomy on postoperative mitral regurgitation (MR) and 2) the association between the severity of MR and the left ventricular outflow tract (LVOT) gradient.BACKGROUNDFor patients with hypertrophic obstructive cardiomyopathy (HOCM) and MR, controversy exists as to whether myectomy alone is sufficient in eliminating MR. Furthermore, the relationship between the degree of MR and the LVOT peak gradient has not been well defined.METHODSWe performed pre- and postoperative transthoracic as well as intraoperative transesophageal studies in 104 consecutive patients with HOCM undergoing septal myectomy. Left ventricular outflow tract gradient and the nature of MR were assessed.RESULTSIn the 93 patients without independent mitral valve disease, a relationship was observed between MR severity and the LVOT gradient. Left ventricular outflow tract gradient (mean ± standard deviation) for trivial, mild, moderate and severe MR were: 23.2 ± 19.1, 43.8 ± 25.4, 70.1 ± 21.0 and 104 ± 21.0 mm Hg (p < 0.001). Early postoperative, MR was absent or trivial in 80%, mild in 19% and moderate in 1%. None of these patients required additional mitral valve surgery. For patients with independent mitral valve disease (n = 11), five required mitral valve surgery as well as myectomy. The remainder had significant reductions in the degree of MR with myectomy alone.CONCLUSIONSFor patients with HOCM and MR not due to independent mitral valve disease, myectomy significantly reduced the degree of MR, without requirement for additional mitral valve surgery. In these patients the severity of MR was directly related to the magnitude of the LVOT gradient

Genes as Tags: The Tax Implications of Widely Available Genetic Information

This paper examines how progress in genetics\u27 specifically, the proliferation of knowledge about the human genome\u27 may influence the feasibility and desirability of a tax that is based on individual human endowments or ability. The paper explores various forms that such a genetic endowment tax-and-transfer regime might take and identifies some of the benefits and costs of such a regime. The authors take no position on whether a genetic endowment tax would be desirable or not. However, one contribution of the paper is to observe that current law in the U.S., which restricts the use of genetic information by insurers and employers, is equivalent to a form of genetic endowment tax. The paper also notes that, in the absence of a government-mandated transfer policy with respect to genetic endowments, private insurance markets may arise to fill the gap, allowing individuals to purchase insurance against the possibility of a bad genetic draw

Non-Standard Errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants

Can WealthTaxes Be Justified

A wealth tax is a tax levied periodically on the value of a taxpayer's possessions (excluding opportunities to work or loaf and personal attributes, such as marketable skills, mental capacities, a healthy constitution, or a comely appearance). Could a wealth tax figure in a just, ongoing tax scheme, regardless of whether it might be justified as an extraordinary corrective to an unjust distribution of resources or opportunities? I argue that it almost certainly could not, if one assumes the correctness of one of a wide range of non-utilitarian, liberal egalitarian accounts of justice. It would have no place in a just tax system, not because a wealth tax would be impracticable (though its administration would pose well-known difficulties), but because it would be morally offensive. This paper assesses and finds wanting numerous rationales that have been suggested for taxing wealth, such as protecting democratic politics, maintaining the efficiency of labor and product markets, and spurring productive investment. I also argue at length that a wealth tax probably would have no role in funding government services under various benefit or fair-sacrifice principles for allocating the costs of collective projects. Nor would wealth taxes of the sort common in Western Europe serve as workable proxies for the rents that Left Libertarian theories of justice would charge for the use of natural resources, even if one endorses (though I offer reasons not to do so) some version of Left Libertarianism. A wealth tax might be justified as one component of an unusual tax on gratuitous transfers which I sketch--a tax that takes inspiration from, though it modifies significantly, the Meade Committee's Progressive Annual Wealth and Accessions Tax. Its role, however, would be very limited, and it would look nothing like wealth taxes now in use because it would apply only to a narrow class of assets. Finally, I consider arguments for adding a wealth tax first to a consumption tax, on the assumption that consumption taxation is justified, and then for adding a wealth tax to an income tax, this time on the assumption that an income tax is justified. In both cases, I contend, a wealth tax is inconsistent with the best arguments offered for both consumption and income as tax bases and with liberal egalitarian ideals of fairness

The Estate Tax Compromise

In 2011 the federal estate tax is scheduled to revert to its pre-2001 form, with a $1 million exemption and a 55% rate on large estates. Several compromise bills are now under discussion that would raise the exempt amount and lower rates. Although many arguments bear on this decision, the choice ultimately turns on the relative force of two opposing moral principles: a principle of autonomy with respect to the use of one's justly acquired property and a principle of equality with respect to unmerited advantages. We should worry much less about raising the exempt amount than lowering rates.