901-11 Late Clinical and Echocardiographic Follow-up After Left Ventricular Endoaneurysmorrhaphy

Infarct expansion and aneurysm (LVA) formation has a poor prognosis. Traditional techniques of LVA resection may be associated with suboptimal results, and do not fully restore LV geometry. LV endoaneurysmorrhaphy(LVEA) is a newer operative technique which utilizes an endocardial patch to exclude the aneurysm and normalize LV geometry. Late clinical and echocardiographic features of these patients (pts) is unknown. We prospectively followed 51 consecutive pts who had undergone LVEA. Average duration of follow-up (F/U) was 4.6 years (range 2-10 years). All pts had clinical evaluation and review of medical records.ResultsThere were 2 (4%) peri-operative deaths, 2 (4%) in-hospital deaths, and 13 (24%) late deaths. Clinical improvement was noted in all 34 survivors:NYHAClassPre-opF/UCCSPre-opF/Un(%)n(%)n(%)n(%)I5(15)21(62)I12(35)29(85)II9(26)8(24)II3(9)5(15)III13(38)4(12)III5(15)0IV7(21)1(3)IV14(41)030 surviving pts had F/U 2D echocardiograms (2DE). Near normal LV geometry was restored in all pts, and no patch aneurysms were noted at late F/U. 24/30 2DEs were adequate for quantitative analysis. The average LVEF post-op was 40.2% using the modified biplane analysis.ConclusionsLV endoaneurysmorrhaphy was associated with a 72% overall survival after average 4.6 year F/U. All survivors had improvement in clinical status and normalization of LV geometry

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

Significance of left ventricular apical-basal muscle bundle identified by cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy

Aims Cardiovascular magnetic resonance (CMR) has improved diagnostic and management strategies in hypertrophic cardiomyopathy (HCM) by expanding our appreciation for the diverse phenotypic expression. We sought to characterize the prevalence and clinical significance of a recently identified accessory left ventricular (LV) muscle bundle extending from the apex to the basal septum or anterior wall (i.e. apical-basal). Methods and results CMR was performed in 230 genotyped HCM patients (48 ± 15 years, 69% male), 30 genotype-positive/phenotype-negative (G+/P−) family members (32 ± 15 years, 30% male), and 126 controls. Left ventricular apical-basal muscle bundle was identified in 145 of 230 (63%) HCM patients, 18 of 30 (60%) G+/P− family members, and 12 of 126 (10%) controls (G+/P− vs. controls; P < 0.01). In HCM patients, the prevalence of an apical-basal muscle bundle was similar among those with disease-causing sarcomere mutations compared with patients without mutation (64 vs. 62%; P = 0.88). The presence of an LV apical-basal muscle bundle was not associated with LV outflow tract obstruction (P = 0.61). In follow-up, 33 patients underwent surgical myectomy of whom 22 (67%) were identified to have an accessory LV apical-basal muscle bundle, which was resected in all patients. Conclusion Apical-basal muscle bundles are a unique myocardial structure commonly present in HCM patients as well as in G+/P− family members and may represent an additional morphologic marker for HCM diagnosis in genotype-positive statu

Exploiting Laboratory and Heliophysics Plasma Synergies

Recent advances in space-based heliospheric observations, laboratory experimentation, and plasma simulation codes are creating an exciting new cross-disciplinary opportunity for understanding fast energy release and transport mechanisms in heliophysics and laboratory plasma dynamics, which had not been previously accessible. This article provides an overview of some new observational, experimental, and computational assets, and discusses current and near-term activities towards exploitation of synergies involving those assets. This overview does not claim to be comprehensive, but instead covers mainly activities closely associated with the authors’ interests and reearch. Heliospheric observations reviewed include the Sun Earth Connection Coronal and Heliospheric Investigation (SECCHI) on the National Aeronautics and Space Administration (NASA) Solar Terrestrial Relations Observatory (STEREO) mission, the first instrument to provide remote sensing imagery observations with spatial continuity extending from the Sun to the Earth, and the Extreme-ultraviolet Imaging Spectrometer (EIS) on the Japanese Hinode spacecraft that is measuring spectroscopically physical parameters of the solar atmosphere towards obtaining plasma temperatures, densities, and mass motions. The Solar Dynamics Observatory (SDO) and the upcoming Solar Orbiter with the Heliospheric Imager (SoloHI) on-board will also be discussed. Laboratory plasma experiments surveyed include the line-tied magnetic reconnection experiments at University of Wisconsin (relevant to coronal heating magnetic flux tube observations and simulations), and a dynamo facility under construction there; the Space Plasma Simulation Chamber at the Naval Research Laboratory that currently produces plasmas scalable to ionospheric and magnetospheric conditions and in the future also will be suited to study the physics of the solar corona; the Versatile Toroidal Facility at the Massachusetts Institute of Technology that provides direct experimental observation of reconnection dynamics; and the Swarthmore Spheromak Experiment, which provides well-diagnosed data on three-dimensional (3D) null-point magnetic reconnection that is also applicable to solar active regions embedded in pre-existing coronal fields. New computer capabilities highlighted include: HYPERION, a fully compressible 3D magnetohydrodynamics (MHD) code with radiation transport and thermal conduction; ORBIT-RF, a 4D Monte-Carlo code for the study of wave interactions with fast ions embedded in background MHD plasmas; the 3D implicit multi-fluid MHD spectral element code, HiFi; and, the 3D Hall MHD code VooDoo. Research synergies for these new tools are primarily in the areas of magnetic reconnection, plasma charged particle acceleration, plasma wave propagation and turbulence in a diverging magnetic field, plasma atomic processes, and magnetic dynamo behavior.United States. Office of Naval ResearchNaval Research Laboratory (U.S.

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A Report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography)

"The previous guideline for the use of echocardiography was published in March 1997. Since that time, there have been significant advances in the technology of echocardiography and growth in its clinical use and in the scientific evidence leading to recommendations for its proper use. Each section has been reviewed and updated in evidence tables, and where appropriate, changes have been made in recommendations. A new section on the use of intraoperative transesophageal echocardiography (TEE) is being added to update the guidelines published by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists. There are extensive revisions, especially of the sections on ischemic heart disease; congestive heart failure, cardiomyopathy, and assessment of left ventricular (LV) function; and screening and echocardiography in the critically ill. There are new tables of evidence and extensive revisions in the ischemic heart disease evidence tables. Because of space limitations, only those sections and evidence tables with new recommendations will be printed in this summary article. Where there are minimal changes in a recommendation grouping, such as a change from Class IIa to Class I, only that change will be printed, not the entire set of recommendations. Advances for which the clinical applications are still being investigated, such as the use of myocardial contrast agents and three-dimensional echocardiography, will not be discussed.