BACKGROUND:Left ventricular midventricular obstruction (MVO) is thought to be dynamic with hypertrophic cardiomyopathy (HCM). Therefore, the distance between the anterior papillary muscle (APM) and the interventricular septum (IVS) was used to assess MVO on rest echocardiography. METHODS:MVO was defined as a midventricular gradient of ≥30 mm Hg at rest or after being provoked. APM-IVS distance was analyzed in the apical three-chamber view at end-diastole. RESULTS:A total of 2,125 patients with HCM were enrolled in this study. Among these, data from 1,453 patients with measurable APM-IVS distances were analyzed. Of the 1,453 patients, 596 had MVO, while 857 did not exhibit MVO. Multivariate logistic regression analyses showed that APM-IVS distance was an independent indicator of MVO (adjusted odds ratio, 0.487; 95% CI, 0.448-0.529). APM-IVS distance demonstrated the highest diagnostic accuracy in identifying MVO, exhibiting an area under the receiver operating characteristic curve of 0.949 (95% CI, 0.937-0.960). The presence of a smaller APM-IVS distance was correlated with increased incidence of left ventricular apical aneurysm and MVO, elevated levels of N-terminal pro-brain natriuretic peptide, and higher New York Heart Association functional class. Among patients with MVO, 198 underwent surgical myectomy and were followed up after a median time of 12 months. APM-IVS distance increased from 7.6 ± 2.2 to 18.9 ± 4.9 mm, and the peak midventricular gradient decreased from 50 mm Hg (36-57 mm Hg) to 3 mm Hg (3-7 mm Hg) at follow-up. CONCLUSIONS:A small APM-IVS distance was associated with MVO, which was alleviated after myectomy following an increase in APM-IVS distance.

Objective:This study aimed to evaluate the effects of cardiac resynchronization therapy (CRT) on cardiac reverse remodeling and long-term clinical outcomes in individuals with advanced heart failure, stratified by body mass index (BMI), using two-dimensional speckle-tracking echocardiography. Methods:In this retrospective, single-center study, a cohort of 141 patients with heart failure who underwent CRT implantation between 2008 and 2014 was categorized into 4 BMI groups. Clinical and echocardiographic parameters were assessed at baseline and six months post-therapy. Strain analyses of the left atrium and left ventricle were performed using EchoPAC, and long-term clinical outcomes were recorded. Results:Participants classified as overweight (BMI 24-28 kg/m²) or obese (BMI ≥ 28 kg/m²) demonstrated greater improvements in clinical status and echocardiographic strain measures (p < 0.05), along with higher CRT response rates compared to those classified as underweight (BMI < 18.5 kg/m²) or normal weight (BMI 18.5-24 kg/m²). Additionally, patients who were overweight and obese exhibited more favorable long-term outcomes. Left atrial conduit strain (LAScd) emerged as an independent predictor of CRT response and prognosis. Conclusion:CRT was associated with greater clinical and echocardiographic benefits in patients with higher BMI, and LAScd was identified as a key predictor of therapeutic response and long-term prognosis.

The longevity protein p66Shc is essential for the senescence signaling that is involved in heart regeneration and remodeling. However, the exact role of p66Shc in heart regeneration is unknown. In this study, we found that p66Shc deficiency decreased neonatal mouse cardiomyocyte (CM) proliferation and impeded neonatal heart regeneration after apical resection injury. RNA sequencing and functional verification demonstrated that p66Shc regulated CM proliferation by activating β-catenin signaling. These findings reveal the critical role of p66Shc in neonatal heart regeneration and provide new insights into senescence signaling in heart regeneration.

Aims Many factors cause left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM). Previous studies reported that left ventricular basal muscle bundle (BMB) may be associated with LVOTO. We aimed to evaluate the role of BMB in LVOTO by echocardiography. Methods and results Two hundred fifty-six patients diagnosed with HCM were recruited. The morphologic characteristics of left ventricular outflow tract (LVOT) were analysed. BMB was detected in 178 (69.5%) patients by echocardiography. Patients were separated by a resting or provocative LVOT gradient >= 30 mmHg or not. Compared to patients without LVOTO, patients with LVOTO had a significantly thicker basal septum, elongated anterior mitral leaflet (AML), shorter distance between the AML-free margin and the septum or BMB (M-sept/bundle), larger angle between the plane of the mitral valvular orifice and the ascending aorta (MV-AO angle), and higher prevalence of BMB (P < 0.05). According to multivariate analysis, the independent predictors of LVOTO were the presence of BMB, a large basal septum thickness, a short M-sept/bundle, a large MV-AO angle, and a large AML [odds ratio (95% confidence interval): 5.207 (1.381-19.633), 1.386(1.141-1.683), 0.615(0.499-0.756), 1.113(1.054-1.176), and 1.343(1.076-1.677), respectively, P < 0.05]. Of the 256 included patients, 139 underwent surgical myectomy. The transthoracic echocardiography, compared with surgical specimen, showed: sensitivity 98.3%, specificity 82.3%, positive predictive value 97.6%, negative predictive value 87.5%, and accuracy 96.4% to detect BMB. Conclusions BMB is common in HCM. BMB is a risk factor for LVOTO.

Posttranslational modifications of histones are critically involved in gene expression and regulate pathophysiologic processes such as cardiovascular diseases.Metabolic enzymes modulate the intracellular levels of metabolites to support posttranslational modifications. 1 Recently, new histone acylations have been identified to regulate gene expression.For example, histone crotonylation (H3K18cr and H2BK12cr) can trigger gene transcription and regulate metabolism, DNA repair, depression, and reproductive development. 2The roles of histone crotonylation in pathophysiologic processes of cardiovascular diseases-cardiac hypertrophy, for example-remain unknown.Short-chain enoyl-coenzyme A (CoA) hydratase (encoded by ECHS1) is a hydratase that has the highest activity for hydrolyzing crotonyl-CoA, reducing intracellular crotonyl-CoA, the orchestrator of histone crotonylation (Figure [A]). 2,3In human newborns or children, mutations in the ECHS1 gene lead to cardiomyopathies (>60%), such as hypertrophic cardiomyopathy, with unknown mechanisms. 3,4ownregulation of ECHS1 was observed in human hearts with hypertrophic cardiomyopathy (Figure [B]).ECHS1 downregulation was coupled with the upregulation of H3K18cr and H2BK12cr (Figure [C]), suggesting the involvement of ECHS1 and histone crotonylation in cardiac hypertrophy.To understand the roles of ECHS1 in cardiac hypertrophy, we generated 3 lines of germline Echs1 mutant mice with CRISPR-Cas9.However, no homozygote of Echs1 mutation was obtained, which might be attributable to the embryonic death induced by Echs1 knockout.Echs1 expression in heart tissues of Echs1 +/- mice was decreased to ≈50%, and Echs1 +/-mice developed normally (Figure [D] and data not shown).Cardiac hypertrophy in male adult Echs1 deficient (Echs1 +/-) and littermate wild-type (Echs1 +/+ ) mice was induced by a chronic infusion of angiotensin II (Ang II).Ang II treatment significantly increased heart weight, which was further enhanced in Echs1 +/-mice (Figure [E]).Histologic analysis showed that Echs1 deficiency promoted the increase in heart and cardiomyocyte size induced by Ang II (Figure [E]).We also analyzed whether ECHS1 regulated cardiac hypertrophy by directly targeting cardiomyocytes.Echs1 was knocked down with siRNA in neonatal rat cardiomyocytes (NRCMs) and cardiomyocyte hypertrophy was induced by Ang II.Echs1 knockdown alone induced hypertrophic growth and promoted the prohypertrophic effects of Ang II (Figure [F]).To test whether rescuing ECHS1 expression can repress hypertrophic growth of NRCMs, ECHS1 was overexpressed in NRCMs with adenovirus.ECHS1 overexpression repressed Ang II-induced increase in cardiomyocyte size (Figure [F]).To further investigate whether ECHS1 expression in cardiomyocytes can repress cardiac hypertrophy in vivo, we generated 2 lines of mice with cardiomyocyte-specific ECHS1 overexpression.Among them, 1 line moderately expressed ECHS1 and Short-Chain Enoyl-CoA Hydratase Mediates Histone Crotonylation and Contributes to Cardiac Homeostasis

The diagnostic criteria for cirrhotic cardiomyopathy (CCM) were recently revised to reflect the contemporary advancements in echocardiographic technology. This study evaluates the prevalence of CCM, according to the new criteria, and its impact on posttransplant cardiovascular disease (CVD). This is a single-center retrospective matched cohort study of liver transplantation (LT) recipients who underwent LT between January 1, 2008 and November 30, 2017. A total of 3 cohorts with decompensated cirrhosis (nonalcoholic steatohepatitis, alcohol-related liver disease, or other etiologies) were matched based on age, sex, and year of transplant after excluding patients listed without evidence of hepatic decompensation. CCM was defined, according to 2020 criteria, as having diastolic dysfunction, left ventricular ejection fraction ≤50%, and/or a global longitudinal strain (GLS) absolute value <18%. The study echocardiographers were blinded to the clinical data. Posttransplant CVD included new coronary artery disease, congestive heart failure, atrial and ventricular arrhythmia, and stroke. The study included 141 patients of whom 59 were women. The mean age at LT was 57.8 (±7.6) years. A total of 49 patients (34.8%) had CCM. Patients with CCM were at an increased risk for post-LT CVD (hazard ratio, 2.57; 95% confidence interval, 1.2-5.5; P = 0.016). Changes in CCM individual parameters pretransplant, such as GLS, early diastolic transmitral flow to early diastolic mitral annular velocity, and left atrial volume index were associated with an increased risk for posttransplant CVD. CCM, defined by the new diagnostic criteria, affects approximately one-third of decompensated LT candidates. CCM predicts an increased risk for new CVD following LT. Studies into addressing and follow-up to mitigate these risks are needed.

Lysine crotonylation (Kcr) is a recently discovered post-translational modification that potentially regulates multiple biological processes. With an objective to expand the available crotonylation datasets, LC-MS/MS is performed using mouse liver samples under normal physiological conditions to obtain in vivo crotonylome. A label-free strategy is used and 10 034 Class I (localization probabilities > 0.75) crotonylated sites are identified in 2245 proteins. The KcrE, KcrD, and EKcr motifs are significantly enriched in the crotonylated peptides. The identified crotonylated proteins are mostly enzymes and primarily located in the cytoplasm and nucleus. Functional enrichment analysis based on Gene Ontology and Kyoto Encyclopedia of Genes and Genomes shows that the crotonylated proteins are closely related to the purine-containing compound metabolic process, ribose phosphate metabolic process, carbon metabolism pathway, ribosome pathway, and a series of metabolism-associated biological processes. To the best of the authors' knowledge, this research provides the first report on the mouse liver crotonylome. Furthermore, it offers additional evidence that crotonylation exists in non-histone proteins, and is likely involved in various biological processes. The mass spectrometry proteomics data have been deposited in the ProteomeXchange Consortium with the dataset identifiers PXD019145.

Purpose The aim of this study was to compare the efficacy of liver transplantation (LT) and liver resection (LR) for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to investigate risk factors affecting prognosis. Materials and Methods A total of 94 HCC patients with PVTT type I (segmental PVTT) and PVTT type II (lobar PVTT) were involved and divided into LR (n=47) and LT groups (n=47). Recurrence-free survival (RFS) and overall survival (OS) were compared before and after inverse probability of treatment weighting (IPTW). Prognostic factors for RFS and OS were explored. Results Two treatment groups were well-balanced using IPTW. In the entire cohort, LT provided a better prognosis than LR. Among patients with PVTT type I, RFS was better with LT (p=0.039); OS was not different significantly between LT and LR (p=0.093). In subgroup analysis of PVTT type I patients with α-fetoprotein (AFP) levels >200 ng/mL, LT elicited significantly longer median RFS (18.0 months vs. 2.1 months, p=0.022) and relatively longer median OS time (23.6 months vs. 9.8 months, p=0.065). Among patients with PVTT type II, no significant differences in RFS and OS were found between LT and LR (p=0.115 and 0.335, respectively). Multivariate analyses showed treatment allocation (LR), tumor size (>5 cm), AFP and aspartate aminotransferase (AST) levels to be risk factors of RFS and treatment allocation (LR), AFP and AST as risk factors for OS. Conclusion LT appeared to afford a better prognosis for HCC with PVTT type I than LR, especially in patients with AFP levels >200 ng/mL.

We read with interest the leading article by Gerbes et al 1 published in Gut. This roundtable meeting article proposed that hepatocellular carcinoma (HCC) staging linked to first-line treatment indication can help clinicians guide patients through treatment decision-making process, patients and researchers need reliable ways to stage disease and predict prognosis. Controversies always exist during multidisciplinary team (MDT) decision-making for HCC patients within the Milan criteria (MC) due to the lack of evidence-based studies of composite multiparametric evaluations among the three potential curative therapies: liver transplantation (LT), liver resection (LR) and local ablation (LA).2–4 Herein, we retrospectively evaluated the efficacy of LT, LR and LA for HCC patients within the MC and explored an individualised assessment prediction model to assist with MDT decision-making. Institutional ethics committees approved the retrospective analyses of consecutive HCC patients admitted to two medical centres of Nankai University (Tianjin, China) between November 2011 and March 2016. A total of 283 HCC patients within the MC were finally enrolled and classified into LT (n=100), LR (n=89) and LA (n=94) groups based on the first-line treatments. Under the three treatment groups, subgroups were divided according to …

目的:探讨术中经食管超声心动图对心脏瓣膜置换术后即刻人工瓣膜功能异常的诊断价值.方法:回顾性分析2011年4月至2016年9月我院心脏瓣膜置换术后即刻急性人工瓣膜功能异常患者11例资料,总结术中经食管超声心动图结果,并与手术结果进行对照分析.结果:11例患者中,机械瓣置换术8例,生物瓣置换术3例.术中经食管超声心动图显示,瓣膜功能异常包括人工瓣膜梗阻(7例)及瓣膜关闭不全(4例).术中经手术证实,人工瓣膜梗阻原因包括:残留血栓、残留腱索、保留二尖瓣后叶、主动脉瓣下隔膜、机械瓣离体瓣叶开放受限;人工瓣膜关闭不全原因包括:生物瓣瓣叶脱垂、缝线勒住生物瓣瓣脚及瓣膜内源性因素.11例患者再次接受手术,其中6例更换新的人工瓣膜,其余5例去除梗阻原因,所有患者均未再次出现人工瓣膜功能异常,住院期间无患者死亡.结论:经食管超声心动图可及时确认心脏瓣膜置换术后即刻人工瓣膜功能异常,协助判别内源性因素并指导外科补救.

以开源R语言为平台,东方财富网的股评为研究对象,结合中文文本挖掘技术和SVR支持向量回归模型.利用中文挖掘技术,对股评进行去噪声、分词、同义词合并、去停用词、TFIDF、文本向量化将非结构化文本数据转化为结构化的特征向量矩阵,与股票的收益率建立SVR回归模型,通过预测未来的股票收益率来预测股价的涨跌趋势.研究结果表明,预测股价涨跌趋势与实际趋势基本吻合,可以通过分析网络舆情来对股市未来发展趋势进行预测.

HomeCirculationVol. 133, No. 17Three-Dimensional Printing as an Aid in Transcatheter Closure of Secundum Atrial Septal Defect With Rim Deficiency Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBThree-Dimensional Printing as an Aid in Transcatheter Closure of Secundum Atrial Septal Defect With Rim DeficiencyIn Vitro Trial Occlusion Based on a Personalized Heart Model Yan Chaowu, PhD, MD, Li Hua, MD and Sun Xin, PhD, MD Yan ChaowuYan Chaowu From Department of Radiology (Y.C.) and Department of Echocardiography (S.X.), Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; and Department of Cardiology, Beijing TongRen Hospital, China (L.H.). Search for more papers by this author , Li HuaLi Hua From Department of Radiology (Y.C.) and Department of Echocardiography (S.X.), Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; and Department of Cardiology, Beijing TongRen Hospital, China (L.H.). Search for more papers by this author and Sun XinSun Xin From Department of Radiology (Y.C.) and Department of Echocardiography (S.X.), Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; and Department of Cardiology, Beijing TongRen Hospital, China (L.H.). Search for more papers by this author Originally published26 Apr 2016https://doi.org/10.1161/CIRCULATIONAHA.115.020735Circulation. 2016;133:e608–e610A 54-year-old woman was admitted with systolic murmur and exertional dyspnea. ECG demonstrated right ventricular hypertrophy with an rsR’ pattern in the leads on the right side of the chest. Chest x-ray revealed cardiomegaly, increased pulmonary arterial vascularity, and prominent main pulmonary artery segment. The cardiothoracic ratio was 57%. Transthoracic echocardiography showed a large secundum atrial septal defect (ASD) with left-to-right shunt, and the maximal diameter was 30 mm. Doppler-calculated systolic pulmonary arterial pressure (SPAP) was 76 mm Hg. The transesophageal echocardiography was absent because of contraindications, and coronary arterial disease was excluded with multislice computed tomography (MSCT). Furthermore, MSCT demonstrated that the size of ASD was 28×35 mm and that a partial defect occurred in the posterior-inferior rim of ASD with normal pulmonary vein anatomy (Figure 1). Because of the large size and poor septal rim, surgical repair was suggested for the patient. However, she resisted the surgery intensely and insisted on transcatheter closure.Download figureDownload PowerPointFigure 1. Multislice computed tomography showed that the superior (A) and anterior (B) rims were sufficient. However, a partial defect can be detected in the posterior-inferior rim (C, arrow). The distance from the atrial septal defect to the inferior vena was also sufficient (D).On the basis of the MSCT imaging, a personalized heart model was produced with 3-dimensional printing (Figure 2A and Movie I in the online-only Data Supplement). Subsequently, in vitro trial occlusion was performed in the elastic rubber model for preoperative evaluation. The model showed that a 38-mm Amplatzer septal occluder (St. Jude Medical) would cover the ASD successfully (Figure 2B and 2C). Three days later, informed consent was obtained, and the patient underwent right-sided heart catheterization and transcatheter closure successfully, as illustrated by the use of the rapid prototyping. Right-sided heart catheterization demonstrated that the SPAP was 70 mm Hg, ratio of pulmonary to systemic flow (Qp/Qs) was 2.2, and pulmonary vascular resistance was 3.7 Wood units. During inhalation of oxygen, the SPAP decreased to 56 mm Hg, Qp/Qs increased to 2.8, and pulmonary vascular resistance was 2.4 Wood units. After implantation of the device, the immediate postocclusion SPAP was further reduced to 40 mm Hg. Transthoracic echocardiography verified the correct position of the occluder without abrasion of surrounding tissue (Figure 3). Furthermore, no residual shunt was detected. At the 1-year follow-up, the patient’s symptoms were relieved greatly, and no complications occurred. There was a significant decrease in right ventricular size (basal dimension, 5.5–4.2 cm), and the Doppler-calculated SPAP was 36 mm Hg. Repeat MSCT confirmed complete occlusion of the ASD (Figure 4).Download figureDownload PowerPointFigure 2. The personalized 3-dimensional printed heart model was produced on the basis of multislice computed tomography (A), and in vitro trial occlusion was achieved successfully with a 38-mm Amplatzer septal occluder (B and C).Download figureDownload PowerPointFigure 3. The transcatheter closure was performed successfully in the patient, and transthoracic echocardiography in the 4-chamber view (A, diastole; B, systole) demonstrated that the atrial septal defect was closed completely.Download figureDownload PowerPointFigure 4. In the follow-up, repeated multislice computed tomography indicated the good position of the occluder (A–D, corresponding to preoperative images). The defect of the posterior-inferior rim was also closed (arrow in C). Furthermore, the position and morphology of the device were almost identical between the preoperative trial occlusion and postoperative occlusion (reconstructed 3-dimensional images; E, in the view of right atrium; F, in the view of left atrium).In transcatheter closure of an ASD, the surrounding rim dimension is a crucial parameter that determines the placement of the device. Unfortunately, some of the large ASDs are usually associated with deficient rim, which makes device implantation difficult and increases the risk for device embolization. Although successful transcatheter closure has been reported in some ASDs with deficient posterior-inferior rim, it is still difficult to predict successful closure in these patients.1,2 The transcatheter closure has been regarded as the preferred strategy in patients with ASD, but the potential complications should be considered preoperatively. Therefore, it is necessary to develop a feasible method to identify the appropriate candidates, especially for large ASDs with rim deficiency.MSCT can provide the high-quality imaging for anatomic evaluation of an ASD, including maximal defect size and surrounding rim morphology. From the MSCT images, a personalized heart model can be produced with 3-dimensional printing,3 which contributes to the preoperative evaluation of ASD with rim deficiency. The trial occlusion in the model can prevent unnecessary transcatheter closure in patients and thus decrease related complications. To the best of our knowledge, this is the first application of 3-dimensional printing in the transcatheter closure of an ASD with rim deficiency. In this patient, our findings suggested that 3-dimensional printing has the potential to screen the appropriate candidates.Sources of FundingThe research was supported by Beijing Natural Science Foundation (7162160) and National Natural Science Foundation of China (81341045).DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.115.020735/-/DC1.Correspondence to Yan Chaowu, PhD, MD, Department of Radiology, Fuwai Hospital, 167 Beilishi Rd, Beijing 100037 China. E-mail [email protected]References1. Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K; Amplatzer Investigators. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial.J Am Coll Cardiol. 2002; 39:1836–1844.CrossrefMedlineGoogle Scholar2. Mathewson JW, Bichell D, Rothman A, Ing FF. Absent posteroinferior and anterosuperior atrial septal defect rims: factors affecting nonsurgical closure of large secundum defects using the Amplatzer occluder.J Am Soc Echocardiogr. 2004; 17:62–69. doi: 10.1016/j.echo.2003.09.018.CrossrefMedlineGoogle Scholar3. Kim MS, Hansgen AR, Wink O, Quaife RA, Carroll JD. Rapid prototyping: a new tool in understanding and treating structural heart disease.Circulation. 2008; 117:2388–2394. doi: 10.1161/CIRCULATIONAHA.107.740977.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Cohen J, Asrani P, Lee S, Frush D, Han B, Chelliah A and Farooqi K (2022) Cardiovascular computed tomography in pediatric congenital heart disease: A state of the art review, Journal of Cardiovascular Computed Tomography, 10.1016/j.jcct.2022.04.004, Online publication date: 1-May-2022. 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Bertolini M, Rossoni M and Colombo G (2021) Operative Workflow from CT to 3D Printing of the Heart: Opportunities and Challenges, Bioengineering, 10.3390/bioengineering8100130, 8:10, (130) Avesani M, Kang S, Jalal Z, Thambo J and Iriart X (2022) Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging, Frontiers in Pediatrics, 10.3389/fped.2022.894472, 10 April 26, 2016Vol 133, Issue 17 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.115.020735PMID: 27143157 Originally publishedApril 26, 2016 PDF download Advertisement SubjectsCardiovascular SurgeryComputerized Tomography (CT)Treatment

Objective To analyze the 3D structure of mitral annulus in patients with mitral valve (MV) prolapse before and after MV repair with real-time 3D transesophageal echocardiography (RT-3D TEE).Methods RT-3D TEE was performed in 38 patients and 20 controls.Qlab was used for 3D quantification analysis.Results MV prolased patients had larger APD,CW,2D A,3D Min A (P＜0.05),smaller ellipticity(P＜0.05),while H,3D Min/2D A,AHCWR were similar (P＞0.05).After MV repair,ellipticity became larger and similar to the controls.All the other parameters significantly decreased (P＜0.05).Conclusions MV prolapsed patients had enlarged and more circular annulus.After MV repair,the annulus decreased obviously in dimensions and become more flattened while regained annular ellipticity.

Background. Surgical extended septal myectomy is appropriate treatment for obstructive hypertrophic cardiomyopathy (HCM) with refractory symptoms. Using 3-layer speckle tracking imaging, we aimed to evaluate the effects of myectomy on left ventricular (LV) regions and the potential factors associated with LV reverse remodeling.Methods. In 71 patients (mean age, 41.0 +/- 15.0 years) undergoing septal myectomy, 3-layer speckle tracking was performed before myectomy and latest review. We evaluated the myectomy site (target anteroseptum) and LV free wall longitudinal strain (LS) and circumferential strain (CS) in endocardial, midmyocardial, and epicardial layers. The thickness of each free wall segment was calculated and totaled for the free wall thickness score.Results. Compared with before myectomy, LS increased; however, CS decreased at the myectomy site after myectomy. For the free wall, LS and CS improved in all 3 layers after the procedure (all p < 0.05). Factors independently associated with latest-review free wall strain were free wall thickness score (LS, beta = -0.150; p < 0.001; CS, beta = -0.090; p < 0.001), age (LS, beta = 0.118; p < 0.001), and Delta LV outflow tract gradient (CS, beta = 0.039; p = 0.002). Factors independently associated with myectomy site strain were resected thickness (LS, beta = -0.439; p = 0.001; CS, beta = -0.736; p = 0.001), and age (LS, beta = 0.178; p < 0.001).Conclusions. Sufficient relief of obstruction and lower resected thickness in the target anteroseptum lead to more favorable remodeling. Free wall thickness score and age are important factors associated with reverse remodeling. (C) 2016 by The Society of Thoracic Surgeons

Background: Hypertrophic cardiomyopathy with left ventricular apical aneurysm is a unique entity with diverse manifestations and varied prognoses among races. This study evaluated the prevalence, clinical characteristics and outcomes of apical aneurysm in Chinese patients with hypertrophic cardiomyopathy.Methods: Consecutive patients with apical aneurysm were recruited from 1,844 patients with HCM treated at our hospital from 2002-2013. Basic clinical data and follow-up data were collected and analyzed.Results: Apical aneurysm was identified in 24 patients (1.3%) (meanage: 52 +/- 14 years). We identified an hourglass-shaped (71%) or distally hypertrophic (29%) left ventricle and found mural thrombi and nonsustained and sustained ventricular tachycardia in 11 (46%), 4 (17%) and 9 (38%) patients, respectively. During follow-up (5.0 +/- 3.4 years [range: 1-14 years]), following were the clinical adverse events experienced by 14 patients (58%) (annual rate: 11.7%): sudden cardiac death (n = 4), appropriate discharge of an implantable cardioverter-defibrillator (n = 4), progressive heart failure(n = 4) or heart failure-related death (n = 1) and stroke (n = 4). The 4 patients who underwent aneurysm ectomy had no adverse events. Patients with SCD had a lower ejection fraction (P = 0.004) and a larger left ventricular end-diastolic diameter (P < 0.001) than nonoperated survivors.Conclusions: Apical aneurysm is not rare inpatients with HCM and it confers an extremely poor prognosis. Early aggressive therapies should be considered for this entity and prophylactic aneurysmectomy may be an option.

A 54-year-old woman was admitted with systolic murmur and exertional dyspnea. ECG demonstrated right ventricular hypertrophy with an rsR’ pattern in the leads on the right side of the chest. Chest x-ray revealed cardiomegaly, increased pulmonary arterial vascularity, and prominent main pulmonary artery segment. The cardiothoracic ratio was 57%. Transthoracic echocardiography showed a large secundum atrial septal defect (ASD) with left-to-right shunt, and the maximal diameter was 30 mm. Doppler-calculated systolic pulmonary arterial pressure (SPAP) was 76 mm Hg. The transesophageal echocardiography was absent because of contraindications, and coronary arterial disease was excluded with multislice computed tomography (MSCT). Furthermore, MSCT demonstrated that the size of ASD was 28×35 mm and that a partial defect occurred in the posterior-inferior rim of ASD with normal pulmonary vein anatomy (Figure 1). Because of the large size and poor septal rim, surgical repair was suggested for the patient. However, she resisted the surgery intensely and insisted on transcatheter closure.Figure 1. Multislice computed tomography showed that the superior ( A ) and …