The Development of the !trumpet

The !trumpet is software synthesis system controlled from, and playing back through, a trumpet. It is not an electronically extended trumpet: the player produces no acoustic sounds by blowing through the mouthpiece. Instead, breath pressure and valve movement on the brass instrument are read by an embedded Arduino microcontroller and sent to a laptop, where the data is mapped onto various parameters in synthesis software; the resulting electronic sound is returned to the trumpet, where it plays through a loudspeaker inside the bell, and is further processed acoustically by valve position (changes in the length of tubing filter the speaker output), movement of a plunger mute (wah-wah style filtering), and orientation of the instrument in space (panning).

Edge-to-edge mitral valve repair in the surgical treatment of hypertrophic cardiomyopathy

<p>Septal myectomy is the method of choice for treating symptomatic left ventricular outlet obstruction in patients with hypertrophic cardiomyopathy who are resistant to drug therapy. An important role in persistence, residual obstruction, mitral valve abnormalities and anterior systolic mitral valve movement is systolic anterior motion. Several authors have reported the use of edge-to-edge mitral valve repair in addition to septal myectomy in patients with mild septal hypertrophy. We performed a literature review on the surgical treatment of obstructive hypertrophic cardiomyopathy—mitral valve repair using the edge-to-edge technique with septal myectomy. Four retrospective studies and three clinical cases were analysed. The data of patients who underwent mitral valve repair surgery using the edge-to-edge technique with septal myectomy and had satisfactory long-term clinical and hemodynamic results were studied. This treatment technique should be considered in cases of unexpressed hypertrophy when isolated limited myectomy is insufficient to eliminate the left ventricular outlet or when there is a hemodynamically significant mitral insufficiency caused by anterior systolic movement of the mitral valve that increases the need for intervention on interventricular hypertrophy of the associated disease. Septal defect, plastic mitral valve, surgically significant residual mitral regurgitation and high residual left ventricular outflow gradients in long-term follow-up are feasible, safe and effective for anterior systolic mitral valve movement.</p><p>Received 28 September 2020. Revised 23 March 2021. Accepted 25 March 2021.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev<br />Data collection and analysis: S.A. Budagaev, M.A. Ovchinnikova, A.N. Pivkin, I.I. Demin<br />Drafting the article: S.A. Budagaev, A.V. Afanasyev<br />Critical revision of the article: A.V. Bogachev-Prokophiev, D.A. Astapov<br />Final approval of the version to be published: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev, <br />M.A. Ovchinnikova, A.N. Pivkin, D.A. Astapov, I.I. Demin</p>

Unsupervised Mitral Valve Tracking for Disease Detection in Echocardiogram Videos

In this work, a novel algorithmic scheme is developed that processes echocardiogram videos, and tracks the movement of the mitral valve leaflets, and thereby estimates whether the movement is symptomatic of a healthy or diseased heart. This algorithm uses automatic Otsu’s thresholding to find a closed boundary around the left atrium, with the basic presumption that it is situated in the bottom right corner of the apical 4 chamber view. A centroid is calculated, and protruding prongs are taken within a 40-degree cone above the centroid, where the mitral valve is located. Binary images are obtained from the videos where the mitral valve leaflets have different pixel values than the cavity of the left atrium. Thus, the points where the prongs touch the valve will show where the mitral valve leaflets are located. The standard deviation of these points is used to calculate closeness of the leaflets. The estimation of the valve movement across subsequent frames is used to determine if the movement is regular, or affected by heart disease. Tests conducted with numerous videos containing both healthy and diseased hearts attest to our method’s efficacy, with a key novelty in being fully unsupervised and computationally efficient.

Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome

AimsTo define the hitherto unknown aetiology/mechanism distributions of mitral regurgitation (MR) in the community and the linked clinical characteristics/outcomes.Methods and resultsWe identified all isolated, moderate/severe MR diagnosed in our community (Olmsted County, MN, USA) between 2000 and 2010 and classified MR aetiology/mechanisms. Eligible patients (n = 727) were 73 ± 18 years, 51% females, with ejection fraction (EF) 49 ± 17%. MR was functional (FMR) in 65%, organic (OMR) in 32% and 2% mixed. Functional MR was linked to left ventricular remodelling (FMR-v) 38% and isolated atrial dilatation (FMR-a) 27%. At diagnosis FMR-v vs. FMR-a, vs. OMR displayed profound differences (all P < 0.0001) in age (73 ± 14, 80 ± 10, 68 ± 21years), male-sex (59, 33, 51%), atrial-fibrillation (28, 54, 13%), EF (33 ± 14, 57 ± 11, 61 ± 10%), and regurgitant-volume (38 ± 13, 37 ± 11, 51 ± 24 mL/beat). Dominant MR mechanism was Type I (normal valve-movement) 38%, Type II (excessive valve-movement) 25%, Type IIIa (diastolic movement-restriction) 3%, and Type IIIb (systolic movement-restriction) 34%. Outcomes were mediocre with excess-mortality vs. general-population in FMR-v [risk ratio 3.45 (2.98–3.99), P < 0.0001] but also FMR-a [risk ratio 1.88 (1.52–2.25), P < 0.0001] and OMR [risk ratio 1.83 (1.50–2.22), P < 0.0001]. Heart failure was frequent, particularly in FMR-v (5-year 83 ± 3% vs. 59 ± 4% FMR-a, 40 ± 3% OMR, P < 0.0001). Mitral surgery during patients’ lifetime was performed in 4% of FMR-v, 3% of FMR-a, and 37% of OMR.ConclusionModerate/severe isolated MR in the community displays considerable aetiology/mechanism heterogeneity. Functional MR dominates, mostly FMR-v but FMR-a is frequent and degenerative MR dominates OMR. Outcomes are mediocre with excess-mortality particularly with FMR-v but FMR-a, despite normal EF incurs notable excess-mortality and frequent heart failure. Pervasive undertreatment warrants clinical trials of therapies tailored to specific MR cause/mechanisms.