Pattern and degree of left ventricular remodeling following a tailored surgical approach for hypertrophic obstructive cardiomyopathy.

Background The role of a tailored surgical approach for hypertrophic cardiomyopathy (HCM) on regional ventricular remodelling remains unknown. The aims of this study were to evaluate the pattern, extent and functional impact of regional ventricular remodelling after a tailored surgical approach. Methods From 2005 to 2008, 44 patients with obstructive HCM underwent tailored surgical intervention. Of those, 14 were ineligible for cardiac magnetic resonance (CMR) studies. From the remainder, 14 unselected patients (42±12 years) underwent pre- and post-operative CMR studies at a median 12 months post-operatively (range 4-37 months). Regional changes in left ventricular (LV) thickness as well as global LV function following surgery were assessed using CMR Tools (London, UK). Results Pre-operative mean echocardiographic septal thickness was 21±4 mm and mean LV outflow gradient was 69±32 mmHg. Following surgery, there was a significant degree of regional regression of LV thickness in all segments of the LV, ranging from 16% in the antero-lateral midventricular segment to 41% in the anterior basal segment. Wall thickening was significantly increased in basal segments but showed no significant change in the midventricular or apical segments. Globally, mean indexed LV mass decreased significantly after surgery (120±29g/m2 versus 154±36g/m2; p<0.001). There was a trend for increased indexed LV end-diastolic volume (70±13 mL versus 65±11 mL; p=0.16) with a normalization of LV ejection fraction (68±7% versus 75±9%; p<0.01). Conclusion Following a tailored surgical relief of outflow obstruction for HCM, there is a marked regional reverse LV remodelling. These changes could have a significant impact on overall ventricular dynamics and function

Life-long tailoring of management for patients with hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease, characterised by complex pathophysiology and extensive genetic and clinical heterogeneity. In most patients, HCM is caused by mutations in cardiac sarcomere protein genes and inherited as an autosomal dominant trait. The clinical phenotype ranges from severe presentations at a young age to lack of left ventricular hypertrophy in genotype-positive individuals. No preventative treatment is available as the sequence and causality of the pathomechanisms that initiate and exacerbate HCM are unknown. Sudden cardiac death and end-stage heart failure are devastating expressions of this disease. Contemporary management including surgical myectomy and implantable cardiac defibrillators has shown significant impact on long-term prognosis. However, timely recognition of specific scenarios – including transition to the end-stage phase – may be challenging due to limited awareness of the progression patterns of HCM. This in turn may lead to missed therapeutic opportunities. To illustrate these difficulties, we describe two HCM patients who progressed from the typical hyperdynamic stage of asymmetric septal thickening to end-stage heart failure with severely reduced ejection fraction. We highlight the different stages of this complex inherited cardiomyopathy based on the clinical staging pro-posed by Olivotto and colleagues. In this way, we aim to provide a practical guide for clinicians and hope to increase awareness for this common form of cardiac disease

Què és el que et desitjo, dolça Romania

Aquest treball pretén donar a conèixer un manuscrit inèdit de Josep Matas Perpiñá (1899-1972):ens referim a la traducció catalana de la poesia de Mihai Eminescu (1850-1889) Ce-ţi doresc euţie, dulce Românie ['Què és el que et desitjo, dolça Romania'] (1867). Tot i que hi manquen els dos darrers versos de la quarta, i última, estrofa, cal considerar aquesta versió com un acte pioner de gran valor simbòlic en l'anostrament del màxim poeta romanès a la cultura catalana.L'article, en primer lloc, ofereix una breu semblança biogràfica tant del traductor, Josep Matas(apartat que culmina amb la reproducció de l'esmentat manuscrit inèdit), com del poeta Mihai Eminescu. A continuació, s'apunten alguns detalls sobre la publicació i el contingut de la poesia romanesa original. Clou l'article un apèndix que presenta tant la transcripció de l'original romanès d'Eminescu com de la traducció catalana de Matas, acompanyades de quatre versions complementàriesd'altres traductors al castellà, llatí, anglès i italià.The aim of this article is to present the edition of an unpublished manuscript by Josep Matas Perpiñá (1899-1972) containing a Catalan translation of Mihai Eminescu's poem (1850- 1889) Ce-ţi doresc eu ţie, dulce Românie ['What I wish you, sweet Romanian land'] (1867). Even though two verses are missing (the last two of the fourth stanza), this version must beconsidered a pioneering landmark in the process of introducing the greatest Romanian poet into Catalan culture. Firstly, the article provides a short biographical note on the translator,Josep Matas Perpiñá (section that culminates with the reproduction of the aforementioned manuscript), as well as on Mihai Eminescu. Then, some details are given on the publication and contents of the original Romanian poem. Finally, the reader will find an appendix with the text of Eminescu's original poem and the transcript of Matas' Catalan version, accompanied by four complementary translations into Spanish, Latin, English and Italian by othertranslators