Falk, Volkmar

Fiechter, Michael

Fuchs, Tobias A.

Jacobs, Stephan

Kaufmann, Philipp A.

Stehli, Julia

RERO DOC Digital Library

approach to patient care, and a growing practice in transapicalaccess have made possible the high procedural success rate asso-ciated with this therapy. When technically successful, the clinicaloutcomes are reasonable and are without the significant operativemortality rates associated with re-operation. Continued techno-logical and procedural advances and increasing experience willfurther improve the success of transcatheter therapy, reduce itsrisk of complications, and in turn, may improve patient survival.For the high-risk symptomatic PVL patient, percutaneous closureis a viable therapeutic strategy to surgical PVL repair.Conflict of interest: none declared.ReferencesThe list of references is available in the online version of this paper.CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/ehs414Online publish-ahead-of-print 12 December 2012Reversible true myocardial hibernationMichael Fiechter1,2†, Tobias A. Fuchs1†, Julia Stehli1, Stephan Jacobs3, Volkmar Falk3, and Philipp A. Kaufmann1,2*1Department of Radiology, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; 2Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich,Zurich, Switzerland; and 3Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland* Corresponding author. Tel: +41 44 255 41 96, Fax: +41 44 255 44 14, Email: pak@usz.ch† Contributed equally to this work.This paper was guest edited by Brahmajee Nallamothu, University of Michigan, Ann Arbor, MI, USA.Emergency invasive coronary angiography fornon-ST-elevation myocardial infarction revealedan occluded (Panel A) left anterior descendingartery (LAD) and apical akinesia with reducedglobal ejection fraction (EF ¼ 35%) in an83-year-old female patient and a conservativetreatment strategy was amended. Coronarycomputerized tomography angiography revealeda non-occluded LAD with separate ostium andproximal subtotal stenosis (arrowheads, PanelsB–E) causing a substantial left ventricular ante-roapical blood pool defect (dark area in thevolume-rendered CT image; Panel C).18F-fluorodeoxyglucose (FDG) uptake bypositron emission tomography (PET) illustratespreserved viability (Panel D) of the jeopardizedhypokinetic anteroapical myocardium (Panel E).As LAD revascularization was deemed appropri-ate, a catheter-based intervention of the LADwas attempted again but remained unsuccessful.In view of the substantial extent of the dysfunc-tional but viable ischaemic territory, the patientwas referred to minimally invasive direct coron-ary artery bypass (MIDCAB). After successfulMIDCAB procedure (left internal mammaryartery graft on LAD; arrows Panel F), perfusionwas restored (Panel F) resulting in recovered contractility of the akinetic segments (EF ¼ 54%).The presented multimodality images illustrate a ‘flow-metabolism mismatch’ often described as classical pattern of underperfusedbut viable LV myocardium. In this conception, however, the reduced contractility is not considered. The combined illustration ofpreserved FDG uptake (Panel D) and hypokinesia (Panel E) by PET allows the only comprehensive non-invasive assessment of‘true hibernation’ which is reversible and can therefore be recovered by successful revascularization. The non-invasive imaging wasthe key for the decision towards revascularization.Financial contributions from the Swiss National Science Foundation to PAK and to MF are gratefully acknowledged.Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2012. For permissions please email: journals.permissions@oup.comC. Kliger et al.648

Reversible true myocardial hibernation

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