Intraprocedural electrocardiographic imaging of a hemodynamically unstable ischemic ventricular tachycardia originating from the interventricular septum

The article presents a clinical case of catheter treatment of hemodynamically unstable ischemic ventricular tachycardia originating from interventricular septum using electrocardiographic imaging and high-density endocardial substrate mapping.

Genetic Clues on Implantable Cardioverter-Defibrillator Placement in Young-Age Hypertrophic Cardiomyopathy: A Case Report of Novel MYH7 Mutation and Literature Review

Background: Hypertrophic cardiomyopathy (HCM) is the second most common cardiomyopathy in childhood with a life-threatening risk. Implantable cardioverter-defibrillator (ICD) placement is recommended for early prevention if there are two or more clinical risk factors. Pediatric patients with HCM are at a higher risk of sudden cardiac death (SCD), but there are limited reports on indications for ICD implantation in children. Herein we describe the case of Myh7 mutation-induced HCM and cardiac arrest in a patient and evaluated information originating from genetic background to guide ICD administration.Case Presentation: The patient was a girl aged 7 years and 8 months who had been diagnosed with cardiomyopathy in utero 8 years prior. She had had recurrent cardiac arrests within the last 4 years. Electrocardiography indicated abnormalities in conduction, and ST segment changes. Echocardiography indicated significant left ventricular hypertrophy and hypertrophic systolic interventricular septum. Cardiac magnetic resonance imaging depicted general heart enlargement with hypertrophy, and delayed enhancement in myocardium with perfusion defect was also evident. Whole exon sequencing identified a de novo c.2723T>C (p.L908P) heterozygous mutation in the MYH7 gene. MYH7 p.L908P predicted unstable protein structure and impaired function. The patient was scheduled for ICD implantation. There were no complications after ICD implantation, and she was discharged from hospital on the 10th day. Regular oral beta-blockers, amiodarone, spironolactone, and enalapril were administered, and she was required to attend hospital regularly for follow-up. During follow-up there were no cardiac arrests. Literature review of clinical prognoses associated with genetic mutations of MYH7, MYBPC3, TNNI3, TNNT2, and TPM1 in pediatric HCM patients with and without ICD implantation indicated that they were totally differently. Previous reports also indicated that gene mutations predicted earlier onset of cardiac hypertrophy, and increase likelihood of SCD.Conclusion: Variant burden and variant type contribute to the risk of adverse events in pediatric HCM. Early recognition and intervention are vital in children. Gene mutation could be considered an indication for early ICD placement during standard risk stratification of HCM patients. Whether this extends to the majority of pediatric patients requires further investigation.

The Interventricular Septum Is Biomechanically Distinct from the Ventricular Free Walls

The interventricular septum contributes to the pumping function of both ventricles. However, unlike the ventricular wall, its mechanical behavior remains largely unknown. To fill the knowledge gap, this study aims to characterize the biaxial and transmural variation of the mechanical properties of the septum and compare it to the free walls of the left and right ventricles (LV/RV). Fresh hearts were obtained from healthy, adult sheep. The septal wall was sliced along the mid-line into two septal sides and compared to the epicardial layers of the LV- and RV-free walls. Biaxial tensile mechanical tests and constitutive modeling were performed to obtain the passive mechanical properties of the LV- and RV-side of the septum and ventricular walls. We found that both sides of the septum were significantly softer than the respective ventricular walls, and that the septum presented significantly less collagen than the ventricular walls. At low strains, we observed the symmetric distribution of the fiber orientations and a similar anisotropic behavior between the LV-side and RV-side of the septum, with a stiffer material property in the longitudinal direction, rather than the circumferential direction. At high strains, both sides showed isotropic behavior. Both septal sides had similar intrinsic elasticity, as evidenced by experimental data and constitutive modeling. These new findings offer important knowledge of the biomechanics of the septum wall, which may deepen the understanding of heart physiology.

LEFT VENTRICLE REMODELING IN PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND OBESITY, TAKING INTO ACCOUNT FABP 4 AND CTRP 3 LEVELS

The objective – to study the structural-functional condition of the left ventriclemyocardium (LV) in patients with postinfarction cardiosclerosis and surplus body weighttaking into account the levels of adipokines FABP4 and CTR3.Material and methods. The study involved 189 patients. The first group consisted of60 patients with postinfarction cardiosclerosis, the second group included 68 patientswith postinfarction cardiosclerosis and excess body weight (EBW), the third groupcomprised 61 patients with postinfarction cardiosclerosis and obesity. The content ofFABP 4 and CTRP 3 was determined by enzyme-linked immunosorbent assay. Statisticalprocessing of the survey results was performed using the licensed software package“IBM SPPS Statistics 27.0”. According to the sample size and distribution of indicators,the parametric Student’s test was used. Evaluation of the significance of the differencebetween the means of multiple comparisons for quantitative traits with normaldistribution using Bonferroni correction was performed by one-way analysis of variance(ANOVA).The mean and the error of the mean were determinedThe correlations of theindicators were determined using the Pearson correlation coefficient (r). At a value ofp˂0.05, the difference was considered significant.Results. Patients with post-infarction cardiosclerosis and obesity in comparison withpatients without excess body weight were found to have an increase in end-systolicvolume (ESV), end-diastolic volume, end-diastolic size (EDS), end-systolic size (ESS),stroke volume, thickness of interventricular septum, thickness of the posterior wallof the left ventricle, size of the left atrium, mass of the left ventricular myocardium,LVMMI. A direct relationship between FABP 4 and ESS, ESV, LVMMI1in patients withpostinfarction cardiosclerosis and obesity was determined. There was a significantinverse correlation between CTRP 3 and EDS, ESS, ESV, LVMMI1 in patients withpostinfarction cardiosclerosisand obesity.Conclusions. The study showed that in patients with postinfarction cardiosclerosi 34sand obesity there was an increase in echocardiographic parameters. The influence ofFABP 4 and CTRP 3 content on the structural and functional state of the left ventricularmyocardium was determined.

The mid-term outcome of interventricular septal hematoma after ventricular septal defect closure

We present the case report of a patient who developed interventricular septal hematoma as a complication during perimembranous ventricular septal defect closure. Although cardiopulmonary bypass was re-established and the hematoma was aspirated, postoperative echocardiography revealed that the hematoma reaccumulated in the interventricular septum. She suffered from low-cardiac-output syndrome for 1 week requiring a large amount of inotropic agents. Postoperative echocardiography revealed that the interventricular septal hematoma gradually disappeared. At 1 year follow-up, 99mTc-tetrofosmin myocardial single-photon emission computed tomographic revealed myocardial ischemia in the inferior and septal walls. At 4 years follow-up, her cardiac function has gradually improved. She has no symptoms of heart failure with angiotensin-converting enzyme inhibitor and beta-blocker.

Campylobacter coli Myocarditis: a case report

We report the case of a 14-year-old male presented with raised myocardial injury biomarkers, on the workout, Campylobacter coli was identified on stool culture, treated with antibiotics with total resolution. Cardiac magnetic resonance showed interventricular septum and lateral wall hypokinesia and subepicardial delayed enhancement, with preserved ventricular systolic function. To our knowledge, this is the first report linking Campylobacter coli to myopericarditis in children.

Difference in Thickness Between Right Ventricle and Left Ventricle of Adult Human Heart: A Cadaveric Study

Background: The left ventricle is longer and narrower than the right ventricle, extending from its base in the plane of the atrioventricular groove to the cardiac apex. The wall of the left ventricle is three times thicker (8-12 mm) than those of right ventricle. The wall of the right ventricle is relatively thin (3–5 mm), the ratio of the thickness of the two ventricular walls usually being 1:3. Hypertrophic cardiomyopathy is characterized by myocardial wall thickening, particularly a disproportionate thickening of the interventricular septum in comparison with the posterior wall. An athlete’s heart may physiologically hypertrophy but in a uniform fashion. The objective of the study is to determine the thickness of wall of right and left ventricle of adult human heart and ratio of thickness of right and left ventricle. Materials and Methods: Adult human hearts were procured from the specimens preserved in Anatomy Department of Jawaharlal Nehru Institute of Medical Sciences. A cross-sectional study was conducted on forty- four specimen of adult heart. The measurement of the right and left ventricular wall was done with digital vernier caliper. The measurements were done at three levels in both right and left ventricle: upper, middle and lower part. Result and Conclusion: The ratio of the thickness of the wall of right and left ventricle is well known as 1:3. However, in our study we found the ratio as 1:1.4. We found the thickness of the right ventricle thicker than the normal thickness reported in previous studies. We wish to continue the study with a larger sample size. KEY WORDS: Heart, Right ventricle, left ventricle, Thickness Ratio, Myocardium.

Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report

Background Ventricular septal rupture (VSR) is a rare but severe complication of acute myocardial infarction (AMI). For such cases, surgical repair is recommended by major guidelines, but not always possible for such cases. Case presentation A 72-year-old man presented to the emergency room. ECG showed the ST-segment was elevated by 2–3 mm in lead II, III, and aVF, with Q-waves. Coronary angiography (CAG) showed multi-vessel disease with a total occlusion of the right coronary artery (RCA) and severe stenosis of the left anterior descending artery (LAD). A diagnosis of acute inferior myocardial infarction was made. VSR occurred immediately after percutaneous coronary intervention (a 2.5 × 20 mm drug-eluting stent implanted in RCA), and the patient developed cardiogenic shock. An intra-aortic balloon pump (IABP) was used to stabilize the hemodynamics. Transthoracic echocardiography (TTE) revealed an 11.4-mm left-to-right shunt in the interventricular septum. An attempt was made to reduce the IABP augmentation ratio for weaning on day 12 but failed. Transcatheter closure was conducted using a 24-mm double-umbrella occluder on day 28. The patient was weaned from IABP on day 31 and underwent secondary PCI for LAD lesions on day 35. The patient was discharged on day 41. Upon the last follow-up 6 years later, CAG and TTE revealed no in-stent restenosis, no left-to-right shunt, and 51% left ventricular ejection fraction. Conclusions Prolonged implementation of IABP can be a viable option to allow deferred closure of VSR in AMI patients, and transcatheter closure may be considered as a second choice for the selected senior and vulnerable patients, but the risk is still high.

765 Is acute response to calcium sensitizers drugs predictive of response to cardiac contractility modulation in NYHA IV patients?

A 53-years old man presented to our institution with a diagnosis of decompensated heart failure NYHA Class IV. He had a history of ischaemic heart disease with severe biventricular dysfunction, diabetes, hypertension, dyslipidaemia, advanced chronic kidney disease, previous explanation of dual-chamber implantable electronic device (ICD) due to endocarditis and subsequent implantation of subcutaneous ICD in primary prevention. Home therapy included uptitrated angiotensin-converting enzyme inhibitor, β-blocker, loop-diuretic, spironolactone, acetylsalicylic acid, and oral hypoglycemics. Clinical examination showed signs and symptoms of systemic and pulmonary congestion with pleural effusion and ascites. Echocardiography revealed diffuse left ventricular (LV) hypokinesis with an ejection fraction (EF) of 25%, severe right ventricular dysfunction and increased filling pressures. He was treated with high dose of i.v. diuretics with mild improvement of dyspnoea. However, haemodynamic stability was labile with worsening of symptoms as soon as mild down-titration of iv diuretics was attempted. Levosimendan, a calcium-sensitizer inodilator, indicated for short-term treatment of acutely decompensated severe chronic heart failure (HF), was administered with good clinical response. Thus, we thought that the patient could have benefited from contractility modulation therapy (CCM) which acts on intramyocardial calcium handling. CCM is a novel therapeutic option for patients with classes III–IV HF with EF ≥ 25% to ≤ 45% and narrow QRS complex that acts on intramyocardial calcium-handling. CCM proved effective in alleviating symptoms, improving exercise tolerance and quality of life, and reducing hospitalization rates in HF. It improves myocardial contractility, reverses the foetal myocyte gene program associated with HF and facilitates cardiac reverse remodelling. Therefore, an Optimizer Smart System (Impulse Dynamics) was implanted. Two pacing electrodes were placed on the interventricular septum in apical and mid-septal position, respectively. The leads were connected to a pulse-generator in a right pectoral pocket. In the following days, we observed a progressive improvement in clinical status, with gradual resolution of peripheral oedema, dyspnoea and fatigue and significant weight loss. Six-month echocardiography showed a stable value of EF and significant improvement in stroke volume (35.2 ml from 24.8 ml at baseline). The patient did not undergo further hospitalization for decompensated HF and was in stable ambulatory NYHA Class IV. We believe CCM is an option in patients with advanced HF in which avoiding recurrent hospitalizations, with their overt increase mortality, is often a challenging therapeutic goal. 765 Figure