Pre-Operative Left Ventricular Torsion, QRS Width/CRT, and Post-Mitral Surgery Outcomes in Patients With Nonischemic, Chronic, Severe Secondary Mitral Regurgitation.

The selection of appropriate candidates for mitral surgery among symptomatic patients with nonischemic, chronic, secondary severe mitral regurgitation (NICSMR) remains a clinical challenge. We studied 50 consecutive symptomatic NICSMR patients for a median follow-up of 2.5 years after mitral surgery and concluded that the pre-operative 2-dimensional speckle tracking echocardiography-derived left ventricular torsional profile and QRS width/cardiac resynchronization therapy are potentially important prognostic indicators for post-surgery survival and reverse remodeling.

Posterior restoration procedures and the long-term results in indicated patients with dilated cardiomyopathy †.

Objectives: Non-transplant surgery for dilated cardiomyopathy (DCM) has been in the process of development. We performed posterior restoration for dilated akinetic or dyskinetic lesions in patients with DCM and obtained favourable outcomes. The early and long-term results of the procedures are discussed.

Temporary epicardial pacing wire migrating to and exiting from the jaw.

A 63-year-old woman underwent cardiac surgery, with atrial and ventricular temporary epicardial pacing wires being placed at the end of the procedure. Four months after the operation, the patient experienced tooth decay and underwent a tooth extraction. Thereafter, the patient developed an infected, swollen neck; computed tomography revealed that one of the temporary pacing wires had migrated into her neck.

Posterior restoration of left ventricle and mitral valve repair in patients with muscular dystrophy.

Background: Congestive heart failure (CHF) is major risk factor for survival among patients with muscular dystrophy (MD). The degenerative postero-lateral wall of the left ventricle (LV), which results in systolic dysfunction and functional mitral regurgitation (MR) at the time of CHF, is not well described in MD.

Methods: We restored the LV and repaired the mitral valves of 6 patients (mean age, 43 ± 9 years) during emergency and elective procedures.

Indication of posterior restoration and surgical results in patients with dilated cardiomyopathy.

Objective: Nontransplant surgery for dilated cardiomyopathy (DCM) has been in the process of development. Anterior restoration for anterior akinesis has shown favourable outcome. Posterior restoration and surgical results are also discussed.

Ventricular untwisting: a temporal link between left ventricular relaxation and suction.

Left ventricular (LV) untwisting starts early during the isovolumic relaxation phase and proceeds throughout the early filling phase, releasing elastic energy stored by the preceding systolic deformation. Data relating untwisting, relaxation, and intraventricular pressure gradients (IVPG), which represent another manifestation of elastic recoil, are sparse. To understand the interaction between LV mechanics and inflow during early diastole, Doppler tissue images (DTI), catheter-derived pressures (apical and basal LV, left atrial, and aortic), and LV volume data were obtained at baseline, during varying pacing modes, and during dobutamine and esmolol infusion in seven closed-chest anesthetized dogs.

Maturational and adaptive modulation of left ventricular torsional biomechanics: Doppler tissue imaging observation from infancy to adulthood.

Background: Left ventricular (LV) torsional deformation, based in part on the helical myocardial fiber architecture, is an important component of LV systolic and diastolic performance. However, there is no comprehensive study describing its normal development during childhood and adult life.

Methods And Results: Forty-five normal subjects (25 children and 20 adults; aged 9 days to 49 years; divided into 5 groups: infants, children, adolescents, and young and middle-age adults) underwent assessment of LV torsion and untwisting rate by Doppler tissue imaging.

Enhanced ventricular untwisting during exercise: a mechanistic manifestation of elastic recoil described by Doppler tissue imaging.

Background: The cascade of events by which early diastolic left ventricular (LV) filling increases with exercise is not fully elucidated. Doppler tissue imaging (DTI) can detect myocardial motion, including torsion, whereas color M-mode Doppler (CMM) can quantify LV intraventricular pressure gradients (IVPGs).

Methods And Results: Twenty healthy volunteers underwent echocardiographic examination with DTI at rest and during submaximal supine bicycle exercise.

Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging.

Objectives: We sought to examine the accuracy/consistency of a novel ultrasound speckle tracking imaging (STI) method for left ventricular torsion (LVtor) measurement in comparison with tagged magnetic resonance imaging (MRI) (a time-domain method similar to STI) and Doppler tissue imaging (DTI) (a velocity-based approach).

Background: Left ventricular torsion from helically oriented myofibers is a key parameter of cardiac performance but is difficult to measure. Ultrasound STI is potentially suitable for measurement of angular motion because of its angle-independence.

Assessment of left ventricular torsional deformation by Doppler tissue imaging: validation study with tagged magnetic resonance imaging.

Background: Left ventricular (LV) torsional deformation is a sensitive index for LV performance but difficult to measure. The present study tested the accuracy of a novel method that uses Doppler tissue imaging (DTI) for quantifying LV torsion in humans with tagged magnetic resonance imaging (MRI) as a reference.

Methods And Results: Twenty patients underwent DTI and tagged MRI studies.