Minimally invasive left ventricular reconstruction of a postinfarction, anterior left ventricular scar (BioVentrix Revivent TC procedure)

Surgical ventricular reconstruction is a proven option for treating patients who have heart failure due to a postinfarction scar or an aneurysm of the left ventricle. The BioVentrix Revivent TC System offers a reliable alternative to the conventional, more invasive surgical ventricular restoration. The system requires no sternotomy, no heart–lung machine, and no cardioplegic arrest. In this video tutorial, we present our technique for using the Revivent TC System to reconstruct the normal left ventricular shape and volume in a patient with a postinfarction, anteroapical scar.

Abstract 16771: Longitudinal Segmental Shape Analysis of the Remodeling Left Ventricle in Chronic Mitral Regurgitation

Introduction: Severe mitral regurgitation (MR) initiates left ventricular (LV) dilatation, but preserves systolic function. Due to preserved EF, patients are not referred for correction of their MR, and the ventricle continues to enlarge. Identifying patients at risk of heart failure, just from assessing LV size is challenging. In this study, we sought to investigate if ventricular shape and sphericity can represent the pathological remodeling process in this disease. Methods: Sixty adult rats (N=60) were induced with severe MR by puncturing the mitral valve leaflet with a 23G needle on the beating heart, using echo guidance (Fig.A1). Transthoracic echocardiography was performed at 2, 10, 20, and 40 weeks (n=15 rats/group) for analysis of the left ventricular shape. Fifteen healthy rats (N=15) were used as a sham group for comparison. Results: Severe MR was confirmed in all the rats in the MR group with a MR jet area of 40.99±9.40% ( Fig.A2 ), MR volume of 119.50±32.43μl ( Fig.A3 ), and pulmonary flow reversal ( Fig.A4 ). None of these were observed in the control group. LV dilation was observed in MR rats compared to sham ( Fig.B ). Diastolic sphericity index, LV area, and diastolic apical area index was significantly increased at 2, 10, 20, and 40 weeks after MR compared to sham (p<0.05) ( Fig.C1-C3 ). Systolic sphericity index was not significantly increased compared to sham at any time-point ( Fig.D1 ). LV area was unchanged at 2 weeks, and was significantly increased at 10, 20, and 40 weeks ( Fig.D2 ). Systolic apical area index was significantly increased at 2, 20, and 40 weeks compared to sham (p<0.05) ( Fig.D3 ). Conclusions: Analysis of left ventricular shape and its longitudinal changes can help detect remodeling patterns that are not visible using traditional functional indices.

Relationship Between Left Ventricular Geometry and Invasive Hemodynamics in Pediatric Pulmonary Hypertension

Background Ventricular septal flattening, frequently present in pulmonary hypertension (PH), can be quantified using eccentricity index (EI). EI has not been evaluated by concurrent echocardiography and cardiac catheterization and traditionally does not account for postsystolic septal flattening, often seen in PH. We evaluated left ventricular shape, including a novel measure of maximal EI to account for postsystolic septal flattening, to establish the relationship with concurrent invasive hemodynamics. Methods Echocardiography was performed at 2 institutions in 78 pediatric PH patients during cardiac catheterization and in 78 matched controls. From midpapillary parasternal short-axis views, EI and right-to-left ventricular diameter ratio were assessed. Results EI and right-to-left ventricular measures were significantly increased in PH compared with controls. Shape measures correlated with invasive hemodynamics and PH outcome measures (PH-related hospitalization, functional class, medical therapy escalation, and BNP [brain natriuretic peptide]). End-systolic EI of 1.16 best identified the presence of PH, whereas a maximal EI of 1.42 and 1.94 best identified half-systemic and systemic PH, respectively. A maximal EI of 1.27 was associated with an odds ratio of 16.16 (95% CI, 6.62–39.46) for PH-related hospitalization or escalation of therapy. Conclusions Using simultaneous echocardiography and catheterization in the largest study population to date, we demonstrate that EI and right-to-left ventricular ratio correlate with invasive hemodynamics and outcomes measures, and EI can accurately define those with clinically important PH. These measures strengthen the ability of echocardiography to identify and follow pediatric PH patients, especially in the absence of methods to quantify right ventricular systolic pressures.