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Silvestry FE, Kerber RE, Brook MM, Carroll JD, Eberman KM, Goldstein SA, Herrmann HC, Homma S, Mehran R, Packer DL, Parisi AF, Pulerwitz T, Seward JB, Tsang TSM, Wood MA. Echocardiography-guided interventions. J Am Soc Echocardiogr 2009; 22:213-31; quiz 316-7. [PMID: 19258174 DOI: 10.1016/j.echo.2008.12.013] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A major advantage of echocardiography over other advanced imaging modalities (magnetic resonance imaging, computed tomographic angiography) is that echocardiography is mobile and real time. Echocardiograms can be recorded at the bedside, in the cardiac catheterization laboratory, in the cardiovascular intensive care unit, in the emergency room-indeed, any place that can accommodate a wheeled cart. This tremendous advantage allows for the performance of imaging immediately before, during, and after various procedures involving interventions. The purpose of this report is to review the use of echocardiography to guide interventions. We provide information on the selection of patients for interventions, monitoring during the performance of interventions, and assessing the effects of interventions after their completion. In this document, we address the use of echocardiography in commonly performed procedures: transatrial septal catheterization, pericardiocentesis, myocardial biopsy, percutaneous transvenous balloon valvuloplasty, catheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO), alcohol septal ablation for hypertrophic cardiomyopathy, and cardiac electrophysiology. A concluding section addresses interventions that are presently investigational but are likely to enter the realm of practice in the very near future: complex mitral valve repairs, left atrial appendage (LAA) occlusion devices, 3-dimensional (3D) echocardiographic guidance, and percutaneous aortic valve replacement. The use of echocardiography to select and guide cardiac resynchronization therapy has recently been addressed in a separate document published by the American Society of Echocardiography and is not further discussed in this document. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures.
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Affiliation(s)
- Frank E Silvestry
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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252
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Plass AMC, Baars MJ, Cornel MC, Julian-Reynier C, Nippert I, Harris H, Kristoffersson U, Schmidtke J, Anionwu EN, Benjamin C, Challen K, Harris R, ten Kate LP. Testing the Children: Do Non-Genetic Health-Care Providers Differ in Their Decision to Advise Genetic Presymptomatic Testing on Minors? A Cross-Sectional Study in Five Countries in the European Union. Genet Test Mol Biomarkers 2009; 13:367-76. [DOI: 10.1089/gtmb.2008.0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne Marie C. Plass
- Department of Clinical Genetics, Subdivision of Community Genetics, VU University Medical Center, Amsterdam, The Netherlands
- EMGO-Institute, Amsterdam, The Netherlands
| | | | - Martina C. Cornel
- Department of Clinical Genetics, Subdivision of Community Genetics, VU University Medical Center, Amsterdam, The Netherlands
- EMGO-Institute, Amsterdam, The Netherlands
| | - Claire Julian-Reynier
- INSERM, UMR912; Marseilles, France
- Institut Paoli-Calmettes; Marseilles, France
- Université Aix-Marseille, Marseilles, France
| | - Irmgard Nippert
- Frauengesundheitsforschung, Institut für Humangenetik, Universitätsklinikum, Münster, Germany
| | - Hillary Harris
- Department of Medicine, GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | | | - Jörg Schmidtke
- Institut für Humangenetik, Medizinische Hochschule, Hannover, Germany
| | - Elizabeth N. Anionwu
- Faculty of Health and Human Sciences, Thames Valley University, London, United Kingdom
| | - Caroline Benjamin
- Department of Medicine, GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | - Kirsty Challen
- Department of Medicine, GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | - Rodney Harris
- Department of Medicine, GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | - Leo P. ten Kate
- Department of Clinical Genetics, Subdivision of Community Genetics, VU University Medical Center, Amsterdam, The Netherlands
- EMGO-Institute, Amsterdam, The Netherlands
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253
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Hypertrophic cardiomyopathy due to beta-myosin heavy chain mutation with extreme phenotypic variability within a family. Int J Cardiol 2009; 134:e87-93. [PMID: 18374998 DOI: 10.1016/j.ijcard.2007.12.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 12/29/2007] [Indexed: 01/22/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) affects 1 in 500 persons and shows high variability in severity of disease, in genetic heterogeneity and phenotypic patterns. Many affected individuals remain undetected throughout their lives. In this case report a family with proven beta-myosin heavy chain mutation (MYH7) with 3 affected family members with huge phenotypic variability is described. The index patient (male, age 21 years) has severe phenotypic expression with a pathological ECG and maximal septal wall thickness of 29 mm, there is no significant obstruction in the left ventricular outflow tract. The sister (age 16 years), mutation carrier, has no detectable hypertrophy and no ECG changes. The mother (age 44 years), also carrying the mutation, has a normal ECG and shows only mild septal hypertrophy of 12 mm and systolic anterior motion of her mitral valve chordae with no gradient. The maternal grandmother died suddenly at age 65 years of presumed coronary artery disease, and the maternal great-grandmother had a sudden cardiac death at age 50 years of unknown etiology. To conclude, this family shows impressively the wide spectrum of phenotypic presentation and outcome in one family.
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254
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Leonardi S, Raineri C, De Ferrari GM, Ghio S, Scelsi L, Pasotti M, Tagliani M, Valentini A, Dore R, Raisaro A, Arbustini E. Usefulness of cardiac magnetic resonance in assessing the risk of ventricular arrhythmias and sudden death in patients with hypertrophic cardiomyopathy. Eur Heart J 2009; 30:2003-10. [PMID: 19474054 DOI: 10.1093/eurheartj/ehp152] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sergio Leonardi
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia (PV) 27100, Italy
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255
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Hagège AA, Desnos M. New trends in treatment of hypertrophic cardiomyopathy. Arch Cardiovasc Dis 2009; 102:441-7. [PMID: 19520330 DOI: 10.1016/j.acvd.2009.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 03/29/2009] [Accepted: 03/30/2009] [Indexed: 12/31/2022]
Abstract
The management of patients with hypertrophic cardiomyopathy (HCM) has evolved markedly over the past 20 years, particularly with the rising number of indications for implantable cardiac defibrillators (ICDs) and alcohol septal ablation (ASA). However, medical therapies targeted to improve quality of life are underused; when resting and/or exercise obstruction is present, an incremental and additive approach should be used based on a high dosage of beta-blockers, verapamil and/or disopyramide. Radiofrequency catheter ablation of atrial fibrillation or A-V node has been proposed in some instances. Treatment of syncope or presyncope due to an abnormal blood pressure response during exercise remains challenging. Only patients with obstruction who remain severely symptomatic despite maximal medical therapy should be considered for invasive procedures, including dual-chamber (DDD) pacing, ASA or surgery. The reported complication rates of ASA (essentially complete A-V block, incidence above 5-10%, with mortality rates ranging from 0-4%) and the benefits at medium-term follow-up appear comparable to those observed after myectomy, which, according to guidelines, should remain the primary treatment for most severely symptomatic drug-refractory young patients with obstruction. While the overall survival of patients with HCM is similar to that of the general population, detection of patients at high risk of sudden cardiac death remains challenging, particularly in the young, and indications for ICDs in high risk patients without prior cardiac arrest should be patient- and family-orientated.
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Affiliation(s)
- Albert A Hagège
- Département de cardiologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Inserm U 633, faculté de medicine, université Paris-5, 75015 Paris, France.
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256
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O'Mahony C, Elliott P. The quest for perfection: the contribution of the electrocardiogram to the prevention of sudden death in hypertrophic cardiomyopathy. Europace 2009; 11:548-9. [DOI: 10.1093/europace/eup063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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257
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Hypertrophe Kardiomyopathie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2009. [DOI: 10.1007/s00398-009-0702-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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258
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Rodríguez JE, McCudden CR, Willis MS. Familial hypertrophic cardiomyopathy: basic concepts and future molecular diagnostics. Clin Biochem 2009; 42:755-65. [PMID: 19318019 DOI: 10.1016/j.clinbiochem.2009.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 01/24/2009] [Accepted: 01/28/2009] [Indexed: 11/26/2022]
Abstract
Familial hypertrophic cardiomyopathies (FHC) are the most common genetic heart diseases in the United States, affecting nearly 1 in 500 people. Manifesting as increased cardiac wall thickness, this autosomal dominant disease goes mainly unnoticed as most affected individuals are asymptomatic. Up to 1-2% of children and adolescents and 0.5-1% adults with FHC die of sudden cardiac death, making it critical to quickly and accurately diagnose FHC to institute therapy and potentially reduce mortality. However, due to the heterogeneity of the genetic defects in mainly sarcomere proteins, this is a daunting task even with current diagnostic methods. Exciting new methods utilizing high-throughput microarray technology to identify FHC mutations by a method known as array-based resequencing has recently been described. Additionally, next generation sequencing methodologies may aid in improving FHC diagnosis. In this review, we discuss FHC pathophysiology, the rationale for testing, and discuss the limitations and advantages of current and future diagnostics.
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Affiliation(s)
- Jessica E Rodríguez
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599-7525, USA
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259
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Elbardissi AW. Letter by ElBardissi regarding article, "Outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy". Circulation 2009; 119:e187; author reply e188. [PMID: 19188515 DOI: 10.1161/circulationaha.108.806794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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260
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Coto E, Castro MG, Corao AI, Alonso-Montes C, Reguero JR, Morís C, Alvarez V. Mutation analysis of the myocyte enhancer factor 2A gene (MEF2A) in patients with left ventricular hypertrophy/hypertrophic cardiomyopathy. Am J Med Genet A 2009; 149A:286-9. [PMID: 19161138 DOI: 10.1002/ajmg.a.32621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Eliecer Coto
- Genética Molecular and Cardiología-Fundación Asturcor, Hospital Universitario Central Asturias, Oviedo, Spain.
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261
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Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: ultra-low dose of alcohol (1 ml) is still effective. Heart Vessels 2009; 24:27-31. [PMID: 19165565 DOI: 10.1007/s00380-008-1083-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 06/20/2008] [Indexed: 10/21/2022]
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262
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Espectro mutacional de los genes sarcoméricos MYH7, MYBPC3, TNNT2, TNNI3 y TPM1 en pacientes con miocardiopatía hipertrófica. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70020-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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263
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Betiger A, Shankar MN, Cherian K. Pathological findings in apical hypertrophic cardiomyopathy: an indication for orthotopic heart transplantation – Case Report. INDIAN JOURNAL OF TRANSPLANTATION 2009. [DOI: 10.1016/s2212-0017(11)60089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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264
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García-Castro M, Coto E, Reguero JR, Berrazueta JR, Álvarez V, Alonso B, Sainz R, Martín M, Morís C. Mutations in Sarcomeric Genes MYH7, MYBPC3, TNNT2, TNNI3, and TPM1 in Patients With Hypertrophic Cardiomyopathy. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1885-5857(09)71513-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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265
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Van Belle Y, Michels M, Jordaens L. Focal AF-ablation after pulmonary vein isolation in a patient with hypertrophic cardiomyopathy using cryothermal energy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1358-61. [PMID: 18811822 DOI: 10.1111/j.1540-8159.2008.01192.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 42-year-old man, with a history of hypertrophic cardiomyopathy (HCM), an electrocardiogram pattern of ventricular preexcitation typical for mutations in the PRKAG2 gene, and highly symptomatic paroxysmal drug-resistant atrial fibrillation (AF), underwent successful circumferential isolation of his pulmonary veins using a 28-mm double lumen cryoballoon. Because AF was still inducible with programmed stimulation, fractionated signals were targeted in the left atrium with a conventional cryocatheter. Ablation of an endocardial focus with fractionated potentials at the base of the left appendage terminated the episode and rendered AF noninducible. No recurrence of AF was observed during a 10-month follow-up period.
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Affiliation(s)
- Yves Van Belle
- Clinical Electrophysiology Unit, Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
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266
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Modi S, Rao A, Hughes S, Ramsdale D. Cardiac device therapy 2: indications, techniques and complications. Br J Hosp Med (Lond) 2008; 69:692-8. [DOI: 10.12968/hmed.2008.69.12.692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simon Modi
- Specialist Registrar (Cardiac Electrophysiology and Pacing), The Liverpool Heart and Chest Hospital, Liverpool L14 3PE
| | - Archana Rao
- Consultant Cardiologist (Complex Cardiac Pacing and Device Therapy), The Liverpool Heart and Chest Hospital, Liverpool L14 3PE
| | - Susan Hughes
- Chief Device Technician, The Liverpool Heart and Chest Hospital, Liverpool L14 3PE
| | - David Ramsdale
- Consultant Cardiologist (Interventional Cardiology and Cardiac Pacing), The Liverpool Heart and Chest Hospital, Liverpool L14 3PE
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267
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Ehlermann P, Weichenhan D, Zehelein J, Steen H, Pribe R, Zeller R, Lehrke S, Zugck C, Ivandic BT, Katus HA. Adverse events in families with hypertrophic or dilated cardiomyopathy and mutations in the MYBPC3 gene. BMC MEDICAL GENETICS 2008; 9:95. [PMID: 18957093 PMCID: PMC2584029 DOI: 10.1186/1471-2350-9-95] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Accepted: 10/28/2008] [Indexed: 12/02/2022]
Abstract
Background Mutations in MYBPC3 encoding myosin binding protein C belong to the most frequent causes of hypertrophic cardiomyopathy (HCM) and may also lead to dilated cardiomyopathy (DCM). MYBPC3 mutations initially were considered to cause a benign form of HCM. The aim of this study was to examine the clinical outcome of patients and their relatives with 18 different MYBPC3 mutations. Methods 87 patients with HCM and 71 patients with DCM were screened for MYBPC3 mutations by denaturing gradient gel electrophoresis and sequencing. Close relatives of mutation carriers were genotyped for the respective mutation. Relatives with mutation were then evaluated by echocardiography and magnetic resonance imaging. A detailed family history regarding adverse clinical events was recorded. Results In 16 HCM (18.4%) and two DCM (2.8%) index patients a mutation was detected. Seven mutations were novel. Mutation carriers exhibited no additional mutations in genes MYH7, TNNT2, TNNI3, ACTC and TPM1. Including relatives of twelve families, a total number of 42 mutation carriers was identified of which eleven (26.2%) had at least one adverse event. Considering the twelve families and six single patients with mutations, 45 individuals with cardiomyopathy and nine with borderline phenotype were identified. Among the 45 patients, 23 (51.1%) suffered from an adverse event. In eleven patients of seven families an unexplained sudden death was reported at the age between 13 and 67 years. Stroke or a transient ischemic attack occurred in six patients of five families. At least one adverse event occurred in eleven of twelve families. Conclusion MYBPC3 mutations can be associated with cardiac events such as progressive heart failure, stroke and sudden death even at younger age. Therefore, patients with MYBPC3 mutations require thorough clinical risk assessment.
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Affiliation(s)
- Philipp Ehlermann
- Medizinische Klinik, Abt. Innere Medizin III, Universitätsklinikum Heidelberg, Germany.
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268
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Long term exercise capacity in patients with hypertrophic cardiomyopathy treated with percutaneous transluminal septal myocardial ablation. Eur J Heart Fail 2008; 10:1123-6. [DOI: 10.1016/j.ejheart.2008.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 08/04/2008] [Accepted: 09/17/2008] [Indexed: 11/22/2022] Open
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269
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Romero-Puche A, Marín F, González-Carrillo J, García-Honrubia A, Climent V, Feliu E, Ruiz-Espejo F, Payá E, Gimeno-Blanes JR, de la Morena G, Valdés-Chavarri M. Cardiorresonancia magnética con gadolinio y capacidad de esfuerzo en la miocardiopatía hipertrófica. Rev Esp Cardiol 2008. [DOI: 10.1157/13124996] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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270
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Intraoperative TEE Monitoring in a Patient With Hypertrophic Cardiomyopathy During Endoscopic Transsphenoidal Resection of Pituitary Tumor*. J Neurosurg Anesthesiol 2008; 20:210. [DOI: 10.1097/ana.0b013e318177669e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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271
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KOBZA RICHARD, DURU FIRAT, ERNE PAUL. Leisure-Time Activities of Patients with ICDs: Findings of a Survey with Respect to Sports Activity, High Altitude Stays, and Driving Patterns. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:845-9. [DOI: 10.1111/j.1540-8159.2008.01098.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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272
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Sotgia B, Sciagrà R, Olivotto I, Casolo G, Rega L, Betti I, Pupi A, Camici PG, Cecchi F. Spatial relationship between coronary microvascular dysfunction and delayed contrast enhancement in patients with hypertrophic cardiomyopathy. J Nucl Med 2008; 49:1090-6. [PMID: 18552138 DOI: 10.2967/jnumed.107.050138] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED To clarify the spatial relationship between coronary microvascular dysfunction and myocardial fibrosis in hypertrophic cardiomyopathy (HCM), we compared the measurement of hyperemic myocardial blood flow (hMBF) by PET with the extent of delayed contrast enhancement (DCE) detected by MRI. METHODS In 34 patients with HCM, PET was performed using (13)N-labeled ammonia during hyperemia induced by intravenous dipyridamole. DCE and systolic thickening were assessed by MRI. Left ventricular myocardial segments were classified as with DCE, either transmural (DCE-T) or nontransmural (DCE-NT), and without DCE, either contiguous to DCE segments (NoDCE-C) or remote from them (NoDCE-R). RESULTS In the group with DCE, hMBF was significantly lower than in the group without DCE (1.81 +/- 0.94 vs. 2.13 +/- 1.11 mL/min/g; P < 0.001). DCE-T segments had lower hMBF than did DCE-NT segments (1.43 +/- 0.52 vs. 1.91 +/- 1 mL/min/g, P < 0.001). Similarly, NoDCE-C segments had lower hMBF than did NoDCE-R (1.98 +/- 1.10 vs. 2.29 +/- 1.10 mL/min/g, P < 0.01) and had no significant difference from DCE-NT segments. Severe coronary microvascular dysfunction (hMBF in the lowest tertile of all segments) was more prevalent among NoDCE-C than NoDCE-R segments (33% vs. 24%, P < 0.05). Systolic thickening was inversely correlated with percentage transmurality of DCE (Spearman rho = -0.37, P < 0.0001) and directly correlated with hMBF (Spearman rho = 0.20, P < 0.0001). CONCLUSION In myocardial segments exhibiting DCE, hMBF is reduced. DCE extent is inversely correlated and hMBF directly correlated with systolic thickening. In segments without DCE but contiguous to DCE areas, hMBF is significantly lower than in those remote from DCE and is similar to the value obtained in nontransmural DCE segments. These results suggest that increasing degrees of coronary microvascular dysfunction might play a causative role for myocardial fibrosis in HCM.
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Affiliation(s)
- Barbara Sotgia
- Department of Clinical Physiopathology-Nuclear Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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273
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Sen-Chowdhry S, McKenna WJ. Non-invasive risk stratification in hypertrophic cardiomyopathy: don't throw out the baby with the bathwater. Eur Heart J 2008; 29:1600-2. [DOI: 10.1093/eurheartj/ehn238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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274
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Our initial experience with genetic testing of patients with hypertrophic cardiomyopathy: mutations of troponin T and troponin I genes. COR ET VASA 2008. [DOI: 10.33678/cor.2008.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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275
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Dandona S, Roberts R. Identification of myofilament mutations: its role in the diagnosis and management of hypertrophic cardiomyopathy. Mayo Clin Proc 2008; 83:626-7. [PMID: 18533077 DOI: 10.4065/83.6.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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276
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Fokstuen S, Lyle R, Munoz A, Gehrig C, Lerch R, Perrot A, Osterziel KJ, Geier C, Beghetti M, Mach F, Sztajzel J, Sigwart U, Antonarakis SE, Blouin JL. A DNA resequencing array for pathogenic mutation detection in hypertrophic cardiomyopathy. Hum Mutat 2008; 29:879-85. [DOI: 10.1002/humu.20749] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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277
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Miranda R, Cotrim C, Cardim N, Almeida S, Lopes L, Loureiro MJ, Simões O, Cordeiro P, Fazendas P, João I, Carrageta M. Evaluation of left ventricular outflow tract gradient during treadmill exercise and in recovery period in orthostatic position, in patients with hypertrophic cardiomyopathy. Cardiovasc Ultrasound 2008; 6:19. [PMID: 18482456 PMCID: PMC2413212 DOI: 10.1186/1476-7120-6-19] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Accepted: 05/15/2008] [Indexed: 12/26/2022] Open
Abstract
Background- Left ventricular outflow tract obstruction is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). The classical quantification of intraventricular obstruction is performed in resting conditions in supine position, but this assessment does not reflect what happens in HCM patients (pts) in their daily activities, neither during effort nor during orthostatic recovery. Aim- To assess intraventricular gradients with echocardiography during treadmill exercise and in the recovery period in upright position, in HCM pts. Methods- We studied 17 HCM pts (9 males, mean age 53 ± 16 years, 11 with obstructive HCM). Each pt had 2 echocardiographic evaluations at rest (left lateral decubitus (LLD) and orthostatic position). The pts then underwent a treadmill exercise test and intraventricular gradients were measured at peak exercise and during recovery in orthostatic position. Results- 3 pts with non-obstructive HCM at rest developed intraventricular gradients during exercise. 1 pt developed this gradient only during orthostatic recovery. The mean intraventricular gradient in LLD was 49 ± 24 mmHg; in orthostatic position was 62 ± 29 mmHg (p < 0.001 versus in LLD); at peak exercise was 83 ± 35 mmHg (p < 0.001 versus supine rest); during recovery it was 96 ± 35 mmHg (p < 0.001 versus peak exercise) Conclusion- In HCM pts the intraventricular gradient increases in orthostatic position, increases significantly during treadmill exercise and continues increasing in the recovery period in orthostatic position. This type of evaluation can help us to better understand the physiopathology, the symptoms and the efficacy of different therapeutic modalities in this disease and should be routinely used in the assessment of HCM pts.
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Affiliation(s)
- Rita Miranda
- Hospital Garcia de Orta, Cardiology Department, Almada, Portugal.
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278
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[Evolution of the surgical strategy in hypertrophic cardiomyopathy: case studies of eight patients]. Ann Cardiol Angeiol (Paris) 2007; 57:16-21. [PMID: 18054343 DOI: 10.1016/j.ancard.2007.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 08/27/2007] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy is an inherited disease characterized by a left ventricular hypertrophy, a diastolic dysfunction and rhythm troubles with risk of sudden death. There was an evolution in the surgical strategy to treat the patients who present a left ventricular outflow tract gradient. MATERIALS AND METHODS A retrospective study was conducted: We selected eight cases who presented an hypertrophic cardiomyopathy and operated on. Pre and post operative echocardiographic data were analysed. Follow up was obtained by call or mail to the cardiologist. RESULTS The patients were classified in four groups: isolated left ventricular outflow tract obstruction, left ventricular outflow tract obstruction and associated lesions, obstructive hypertrophic cardiomyopathy and endocarditis, post operative complications of the hypertrophic cardiomyopathy surgery. We observed a significant decrease of the left ventricular outflow tract mean gradient in the post operative period and at four years. CONCLUSION Surgical management of obstructive hypertrophic cardiomyopathy remain an important option in young patients, in case of failure of the ethanol septal ablation or in patients who present other surgical lesions. The dual chamber stimulation remain indicated in old patients.
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279
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ElBardissi AW, Dearani JA, Nishimura RA, Ommen SR, Stulak JM, Schaff HV. Septal myectomy after previous septal artery ablation in hypertrophic cardiomyopathy. Mayo Clin Proc 2007; 82:1516-22. [PMID: 18053460 DOI: 10.1016/s0025-6196(11)61096-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review our institution's experience with patients who failed to benefit from septal artery ablation, which necessitated subsequent septal myectomy, and to examine reasons for ablation failure and outcome of myectomy after ablation. PARTICIPANTS AND METHODS Of 550 patients who underwent septal myectomy at Mayo Clinic Rochester between January 1, 1999, and December 31, 2006, 16 (3%) had had a total of 22 previous septal artery ablations. This subset of 16 patients was analyzed and compared with a reference group of 120 patients whose septal artery ablations were performed at our institution during this period. Angiograms obtained during septal ablation were available for 13 (81%) of 16 patients in this series and were reviewed by 2 interventional cardiologists (R.A.N. and S.R.O.). These cardiologists also reviewed preoperative and postoperative echocardiography data, hospital course, and follow-up data to compile a list of characteristics that could have contributed to failed ablation. RESULTS The median age of the patients at operation was 65 years (interquartile range [IQR], 52-72 years), and interval between ablation and myectomy was 409 days (IQR, 162-568 days). Angiograms revealed 2 failed procedures secondary to technical error. One patient had a relatively large first septal perforator with a large resting gradient. In 10 patients no septal perforators supplying the proximal septum were identified. Postoperatively, mitral regurgitation decreased from 3.00 to 1.00 (P less than .001), and left ventricular outflow tract gradient decreased from 75 mm Hg to 0 mm Hg (IQR, 0-29 mm Hg; P less than .001). Two patients died after surgery: 1 patient developed multiple-organ system failure on postoperative day 7, and 1 patient developed arrhythmia on postoperative day 21. Patients with previous septal artery ablation were older (P=.04), were more likely to have preoperative permanent pacemakers or implantable cardioverter-defibrillators (P=.05), were more likely to require postoperative pacemaker placement (P less than .001), and had higher operative mortality (P less than .001) than control patients. Fourteen patients survived the early recovery phase; 9 were followed up at a median of 1.88 years (IQR, 306 days to 3.3 years). All patients' symptoms improved. Median gradient of the left ventricular outflow tract was 13 mm Hg (IQR, 0-15 mm Hg) at follow-up with mild to moderate (1.6) mitral regurgitation. CONCLUSION Septal myectomy performed after failed ablation improves gradient and provides excellent relief of symptoms but is associated with a higher incidence of morbidity and mortality.
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Affiliation(s)
- Andrew W ElBardissi
- Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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280
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Dumont CA, Monserrat L, Soler R, Rodriguez E, Peteiro J, Fernández X, Rodríguez A, Pérez R, Bouzas B, Castro-Beiras A. Left Ventricular Asynchrony in Patients with Hypertrophic Cardiomyopathy: Its Determinants and its Relation to Left Ventricular Function. J Am Soc Echocardiogr 2007; 20:1247-52. [PMID: 17604956 DOI: 10.1016/j.echo.2007.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Indexed: 11/15/2022]
Affiliation(s)
- Carlos A Dumont
- Division of Cardiology, Juan Canalejo Hospital, La Coruña, Spain
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281
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Faber L, Welge D, Fassbender D, Schmidt HK, Horstkotte D, Seggewiss H. One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response. Clin Res Cardiol 2007; 96:864-73. [PMID: 17891518 DOI: 10.1007/s00392-007-0578-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/25/2007] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). METHODS AND RESULTS PTSMA was intended in 337 patients with HOCM (mean age: 54+/-15 years), with 312 procedures completed by injection of 2.8+/-1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9+/-0.4 to 1.5+/-0.7 (p<0.0001) along with a gradient reduction (echo-Doppler) from 59+/-32 to 8+/-15 mmHg at rest, and from 120+/-42 to 28+/-32 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94+/-51 to 119+/-40 watts (p=0.001), and peak oxygen consumption from 18+/-4 to 21+/-6 ml/ kg/min (p=0.01). Younger age and higher outflow gradients at baseline and immediately after intervention were associated with a less favorable hemodynamic outcome. The degree of limitation of exercise capacity at baseline was the only predictor of symptomatic improvement. CONCLUSIONS Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. In contrast to a previous study, in this cohort of 312 patients there was no association between post-interventional enzyme release and hemodynamic success. Younger patients with high baseline gradients, however, tended to have a less favorable hemodynamic outcome with higher residual gradients.
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Affiliation(s)
- L Faber
- Department of Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
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282
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Thadani U, Ripley TL. Side effects of using nitrates to treat heart failure and the acute coronary syndromes, unstable angina and acute myocardial infarction. Expert Opin Drug Saf 2007; 6:385-96. [PMID: 17688382 DOI: 10.1517/14740338.6.4.385] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Nitrates are potent venous dilators and anti-ischemic agents. They are widely used for the relief of chest pain and pulmonary congestion in patients with acute coronary syndromes and heart failure. Nitrates, however, do not reduce mortality in patients with acute coronary syndromes. Combination of nitrates and hydralazine when given in addition to beta-blockers and angiotensin-converting enzyme (ACE) inhibitors reduce mortality and heart failure hospitalizations in patients with heart failure due to left ventricular systolic dysfunction who are of African-American origin. Side effects during nitrate therapy are common but are less well described in the literature compared with the reported side effects in patients with stable angina pectoris. The reported incidence of side effects varies highly among different studies and among various disease states. Headache is the most commonly reported side effect with an incidence of 12% in acute heart failure, 41-73% in chronic heart failure, 3-19% in unstable angina and 2-26% in acute myocardial infarction. The reported incidence of hypotension also differs: 5-10% in acute heart failure, 20% in chronic heart failure, 9% in unstable angina and < 1-48% in acute myocardial infarction, with the incidence being much higher with concomitant nitrate therapy plus angiotensin-converting enzyme inhibitors. Reported incidence of dizziness is as low as 1% in patients with acute myocardial infarction to as high as 29% in patients with heart failure. Severe headaches and/or symptomatic hypotension may necessitate discontinuation of nitrate therapy. Severe life threatening hypotension or even death may occur when nitrates are used in patients with acute inferior myocardial infarction associated with right ventricular dysfunction or infarction, or with concomitant use of phosphodiesterase-5 inhibitors or N-acetylcysteine. Despite the disturbing observational reports in the literature that continuous and prolonged use of nitrates may lead to increased mortality and recurrent myocardial infarction in patients with stable coronary artery disease, no such adverse effects of nitrates have been reported in the large randomized trials in patients with acute myocardial infarction or chronic heart failure.
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Affiliation(s)
- Udho Thadani
- University of Oklahoma Health Sciences Center, Cardiovascular Section, Department of Medicine, Oklahoma City, OK 73104, USA
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283
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Jung W, Andresen D, Block M, Böcker D, Hohnloser SH, Kuck KH, Sperzel J. [Guidelines for the implantation of defibrillators]. Clin Res Cardiol 2007; 95:696-708. [PMID: 17103126 DOI: 10.1007/s00392-006-0475-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- W Jung
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Klinik für Innere Medizin III Kardiologie, Pneumologie, Angiologie, Vöhrenbacherstr. 23, 78050, Villingen-Schwenningen.
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284
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Affiliation(s)
- Michael A Fifer
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114-2696, USA.
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285
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Marín F, Gimeno JR, Martínez JG, Monserrat L. Respuesta. Rev Esp Cardiol (Engl Ed) 2007. [DOI: 10.1157/13108288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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286
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Anwar AM, Soliman OII, Nemes A, Geleijnse ML, ten Cate FJ. An integrated approach to determine left atrial volume, mass and function in hypertrophic cardiomyopathy by two-dimensional echocardiography. Int J Cardiovasc Imaging 2007; 24:45-52. [PMID: 17541727 PMCID: PMC2121119 DOI: 10.1007/s10554-007-9224-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 03/23/2007] [Indexed: 12/21/2022]
Abstract
METHODS The study included 25 hypertrophic cardiomyopathy (HCM) patients (15 non-obstructive and 10 obstructive) and 25 controls for assessment of left atrial (LA) volume, mass and function by two-dimensional echocardiography. Measurement included mean LA diameter (LAD), LA mass = {(mean LAD + anterior LA wall + posterior LA wall)3 - mean LAD3} x 0.8 + 0.6, LA volume = [(8/3 pi L . A1 . A2), where L is LA length, A1 and A2 are LA area in 4-chambers and 2-chambers, respectively] including maximum (V max), minimum (V min), and pre-atrial contraction (V pre-A), total atrial stroke volume (TA-SV), TA emptying fraction (TA-EF), active atrial SV (AA-SV), AA-EF, passive atrial SV (PA-SV), PA-EF, atrial expansion index (AEI), and LA kinetic energy (LA-KE) = (1/2) x AA-SV x P x V2. RESULTS LAD, LA mass, V max, V min, and V pre-A were significantly higher in HCM than controls. TA-SV and TA-EF were comparable in both HCM subgroups and controls. AA-SV and LA-KE were significantly higher in both HCM subgroups than controls. LA-KE was significantly higher in obstructive HCM than non-obstructive (P < 0.001). PA-EF and AEI were significantly lower in obstructive HCM than controls (P < 0.05). CONCLUSION HCM is associated with increased LA size and augmented LA pump function especially obstructive type. LA conduit and reservoir functions are impaired in obstructive HCM.
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Affiliation(s)
- Ashraf M. Anwar
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Room Ba 304, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
| | - Osama I. I. Soliman
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Room Ba 304, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
| | - Attila Nemes
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Room Ba 304, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Second Department of Medicine and Cardiology Center, Szeged University, Szeged, Hungary
| | - Marcel L. Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Room Ba 304, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Folkert J. ten Cate
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Room Ba 304, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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287
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Dumont CA, Monserrat L, Peteiro J, Soler R, Rodriguez E, Bouzas A, Fernández X, Pérez R, Bouzas B, Castro-Beiras A. Relation of left ventricular chamber stiffness at rest to exercise capacity in hypertrophic cardiomyopathy. Am J Cardiol 2007; 99:1454-7. [PMID: 17493479 DOI: 10.1016/j.amjcard.2006.12.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 11/20/2022]
Abstract
The degree of exercise capacity is poorly predicted by conventional markers of disease severity in patients with hypertrophic cardiomyopathy (HC). The principal mechanism of exercise intolerance in patients with HC is the failure of stroke volume augmentation due to left ventricular (LV) diastolic dysfunction. The role of LV chamber stiffness, assessed noninvasively, as a determinant of exercise tolerance is unknown. Sixty-four patients with HC were studied with Doppler echocardiography, exercise testing, and gadolinium cardiac magnetic resonance. The LV chamber stiffness index was determined as the ratio of pulmonary capillary wedge pressure (derived from the E/Ea ratio) to LV end-diastolic volume (assessed by cardiac magnetic resonance). Maximal exercise tolerance was defined as achieved METs. There were inverse correlations between METs achieved and age (r = -0.38, p = 0.003), heart rate deficit (r = -0.39, p = 0.002), LV outflow tract gradient (r = -0.33, p = 0.009), the E/Ea ratio (r = -0.4, p = 0.001), mean LV wall thickness (r = -0.26, p = 0.04), and LV stiffness (r = -0.56, p <0.001) and a positive correlation between METs achieved and LV end-diastolic volume (r = 0.33, p = 0.01). On multivariate analysis, only LV chamber stiffness was associated with exercise capacity. A LV stiffness level of 0.18 mm Hg/ml had 100% sensitivity and 75% specificity (area under the curve 0.84) for predicting < or =7 METs achieved. In conclusion, LV diastolic dysfunction at rest, as manifested by increased LV chamber stiffness, is a major determinant of maximal exercise capacity in patients with HC.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Analysis of Variance
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/physiopathology
- Contrast Media
- Echocardiography, Doppler, Color
- Exercise Test
- Exercise Tolerance
- Female
- Gadolinium DTPA
- Heart Rate
- Humans
- Hypertrophy, Left Ventricular/complications
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Pulmonary Wedge Pressure
- Regression Analysis
- Research Design
- Rest
- Sensitivity and Specificity
- Severity of Illness Index
- Stroke Volume
- Vascular Resistance
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/physiopathology
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288
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Mogensen J. Troponin mutations in cardiomyopathies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2007; 592:201-26. [PMID: 17278367 DOI: 10.1007/978-4-431-38453-3_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jens Mogensen
- Department of Cardiology, Skejby University Hospital Aarhus, Denmark
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289
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290
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Několik mýtů o hypertrofické kardiomyopatii. COR ET VASA 2007. [DOI: 10.33678/cor.2007.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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291
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García-Pavía P, Segovia J, Molano J, Mora R, Kontny F, Erik Berge K, Lerend TP, Alonso-Pulpóna L. Miocardiopatía hipertrófica de alto riesgo asociada con una nueva mutación en la proteína C fijadora de miosina. Rev Esp Cardiol 2007. [DOI: 10.1157/13100284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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292
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Laredo R, Monserrat L, Hermida-Prieto M, Fernández X, Rodríguez I, Cazón L, Alvariño I, Dumont C, Piñón P, Peteiro J, Bouzas B, Castro-Beiras A. [Beta-myosin heavy-chain gene mutations in patients with hypertrophic cardiomyopathy]. Rev Esp Cardiol 2007; 59:1008-18. [PMID: 17125710 DOI: 10.1157/13093977] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine the frequency of mutations in the beta-myosin heavy-chain gene (MYH7) in a cohort of patients with hypertrophic cardiomyopathy (HCM) and their families, and to investigate correlations between genotype and phenotype. METHODS Single-strand conformation polymorphism analysis and sequencing of fragments with abnormal MYH7 gene mobility were carried out in 128 consecutive index patients with HCM. The phenotypes of patients with and without mutations were compared and the phenotypes of identified families were recorded. RESULTS A total of 11 mutations were found in 13 families (10%); 7/11 had been previously described. The I736T mutation was found in three families and the A797T in two. One patient had two mutations (i.e., I736T and R787H). Mutations were more frequent in patients with a family history of sudden death (31%) and in those with severe hypertrophy (39% had a thickness > or = 30 mm). Mutations were found in 29 of 42 members of the 13 families, including six family members (20%) who were healthy carriers and aged < or = 36 years. Sudden death had occurred in eight members of four families: four in two families with the I736T mutation, one in a family with A797T, one in a family with R870H, and two in a family with A901P. CONCLUSIONS MYH7 mutations were present in 10% of our families. Mutations were more frequent in patients with a family history of sudden death and in those with severe hypertrophy. Most mutations had been described previously. Some appeared in several families. For some mutations, the correlation between genotype and phenotype was stable, while for others, there were marked differences between the phenotypes of the index patients and their relatives, suggesting the presence of additional genetic factors that have yet to be identified.
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Affiliation(s)
- Rafael Laredo
- Servicio de Cardiología, Complejo Hospitalario Universitario Juan Canalejo e Instituto Universitario de Ciencias de la Salud de la Universidad de A Coruña, A Coruña, Spain
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293
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de Gregorio C. Left ventricular dynamic obstruction by atypical papillary muscle morphology: is this finding so unusual in clinical practice? J Am Soc Echocardiogr 2007; 20:100-1. [PMID: 17218207 DOI: 10.1016/j.echo.2006.08.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Indexed: 11/29/2022]
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294
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Dumont CA, Monserrat L, Soler R, Rodríguez E, Fernández X, Peteiro J, Bouzas B, Piñón P, Castro-Beiras A. Significado clínico del realce tardío de gadolinio con resonancia magnética en pacientes con miocardiopatía hipertrófica. Rev Esp Cardiol 2007. [DOI: 10.1157/13097921] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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295
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296
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Pearlman AS. Hypertrophic cardiomyopathy: role of echocardiography in diagnosis and management. THE AMERICAN HEART HOSPITAL JOURNAL 2007; 5:184-8. [PMID: 17673865 DOI: 10.1111/j.1541-9215.2007.07300.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Alan S Pearlman
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA 98195, USA.
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297
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Girolami F, Olivotto I, Passerini I, Zachara E, Nistri S, Re F, Fantini S, Baldini K, Torricelli F, Cecchi F. A molecular screening strategy based on beta-myosin heavy chain, cardiac myosin binding protein C and troponin T genes in Italian patients with hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2006; 7:601-7. [PMID: 16858239 DOI: 10.2459/01.jcm.0000237908.26377.d6] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Mutations causing hypertrophic cardiomyopathy (HCM) have been described in nine different genes of the sarcomere. Three genes account for most known mutations: beta-myosin heavy chain (MYH7), cardiac myosin binding protein C (MYBPC3) and cardiac troponin T (TNNT2). Their prevalence in Italian HCM patients is unknown. Thus, we prospectively assessed a molecular screening strategy of these three genes in a consecutive population with HCM from two Italian centres. METHODS Comprehensive screening of MYBPC3, MYH7 and TNNT2 was performed in 88 unrelated HCM patients by denaturing high-performance liquid chromatography and automatic sequencing. RESULTS We identified 32 mutations in 50 patients (57%); 16 were novel. The prevalence rates for MYBPC3, MYH7 and TNNT2 were 32%, 17% and 2%, respectively. MYBPC3 mutations were 18, including two frameshift, five splice-site and two nonsense. All were 'private' except insC1065 and R502Q, present in three and two patients, respectively. Moreover, E258K was found in 14% of patients, suggesting a founder effect. MYH7 mutations were 12, all missense; seven were novel. In TNNT2, only two mutations were found. In addition, five patients had a complex genotype [i.e. carried a double MYBPC3 mutation (n = 2), or were double heterozygous for mutations in MYBPC3 and MYH7 (n = 3)]. CONCLUSIONS The first comprehensive evaluation of MYBPC3, MYH7 and TNNT2 in an Italian HCM population allowed a genetic diagnosis in 57% of the patients. These data support a combined analysis of the three major sarcomeric genes as a rational and cost-effective initial approach to the molecular screening of HCM.
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Affiliation(s)
- Francesca Girolami
- Genetic Diagnostic Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
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298
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Brembilla-Perrot B, Marçon O, Chometon F, Bertrand J, Terrier de la Chaise A, Louis P, Belhakem H, Blangy H, Claudon O, Selton O, Khaldi E, Sadoul N, Beurrier D, Abbas M, Andronache M, Abbas M, Zhang N. Supraventricular tachyarrhythmia as a cause of sudden cardiac arrest. J Interv Card Electrophysiol 2006; 16:97-104. [PMID: 17103314 DOI: 10.1007/s10840-006-9042-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 08/21/2006] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Supraventricular tachyarrhythmias (SVTA) are an accepted cause of cardiac arrest in patients with Wolff-Parkinson-White syndrome (WPW) and hypertrophic cardiomyopathy but their participation in other conditions is less well understood. The purpose of the study was to examine the role of SVTA in sudden cardiac arrest (SCA) by comprehensive evaluation of patients successfully resuscitated from SCA. METHODS A total of 169 survivors of SCA in the absence of acute myocardial infarction underwent systematic evaluation that included echocardiography, Holter monitoring, coronary angiography and electrophysiological study (EPS) with additional testing in selected cases using provocative drug testing with isoproterenol, ajmaline or ergonovine. RESULTS SVTA was found as the only possible cause or as the cause facilitating SCA in 29 patients: (1) 3 had a WPW syndrome related to accessory pathway with short refractory period; (2) for 12 patients, SVTA was the cause of cardiovascular collapse; heart disease (HD) was present in 11 cases, but disappeared in two of four with dilated cardiomyopathy after the restoration of sinus rhythm; (3) in 14 patients, SVTA degenerated either in a VF or ventricular tachycardia (VT); HD was present in 12 cases, but disappeared in one; two had no HD and recurrent similar arrhythmia was documented by cardiac defibrillator in one of them. SVTA induced coronary ischemia was the main cause of SCA. CONCLUSION Rapid SVTA was a cause of SCA, either by cardiovascular collapse or by the degeneration in VT or VF. The complication generally occurred in patients with advanced HD or with rapid SVTA-induced cardiomyopathy and rarely in patients without HD. The incidence of SVTA as the only cause or the facilitating cause of SCAs is probably underestimated, because it is difficult to prove.
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299
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Vujin B, Benc D, Grujić N, Srdić S, Radisić B, Kovac M. [Echocardiographic evaluation of left ventricular morphology and function in active sportsmen]. MEDICINSKI PREGLED 2006; 59:526-30. [PMID: 17633892 DOI: 10.2298/mpns0612526v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Echocardiography is a noninvasive, reliable method for evaluation of left ventricular morphology and function. Judo and wrestling are sports characterized by intensive and high physical and isometric effort, while football is characterized by long-term physical isotonic effort. The key compensatory mechanism with both groups of sportsmen is left ventricular hypertrophy. The aim of this study is evaluate left ventricular morphology and function in a group of judo players, wrestlers and football players during competition season and their interactive comparation. MATERIAL AND METHODS 42 judo players and wrestlers and 43 football players were examined. RESULTS An increase in thickness of the septum and posterior wall was established in both groups of sportsmen, but the thickness was statistically more significant in judo players. On the other hand, in football players, a statistically significant left ventricular end-diastolic volume index enlargement was found, compared to reference values and compared to end-diastolic volume index in judo players and wrestlers. High left ventricular ejection fraction was established in both groups, but it was statistically significantly higher in football players. Left ventricular mass index was statistically increased in both groups, but it was higher in judo players and wrestlers.
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Affiliation(s)
- Bojan Vujin
- Klinika za kardiologiju, Institut za kardiovaskularne bolesti, Sremska Kamenica.
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Cox GF, Sleeper LA, Lowe AM, Towbin JA, Colan SD, Orav EJ, Lurie PR, Messere JE, Wilkinson JD, Lipshultz SE. Factors associated with establishing a causal diagnosis for children with cardiomyopathy. Pediatrics 2006; 118:1519-31. [PMID: 17015543 DOI: 10.1542/peds.2006-0163] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The goal was to identify the clinical variables associated with establishing a cause of cardiomyopathy in children. METHODS The Pediatric Cardiomyopathy Registry contains clinical and causal testing information for 916 children who were diagnosed as having cardiomyopathy in North America between 1990 and 1995. Children with a causal diagnosis were compared with those without with respect to several demographic, clinical, and causal testing variables. RESULTS Cardiomyopathy was 1 of 4 types, hypertrophic (34.2%), dilated (53.8%), restrictive (3.2%), or other or mixed (8.9%). Only one third of cases had a known cause. Children with a known cause for hypertrophic cardiomyopathy were more likely to be female, to be relatively smaller, to present with congestive heart failure, and to have increased left ventricular posterior wall thickness without outflow tract obstruction. For dilated cardiomyopathy, a known cause was associated with older age, lower heart rate, smaller left ventricular dimensions, and greater shortening fraction. Family history of cardiomyopathy predicted a significantly higher rate of causal diagnoses for all cardiomyopathy types, whereas family histories of genetic syndromes and sudden death were also predictive of a cause for hypertrophic and dilated cardiomyopathies. For hypertrophic cardiomyopathy, only blood and urine testing was associated with a causal diagnosis, whereas both viral serologic testing or culture and endomyocardial biopsy were independent predictors of a causal diagnosis in dilated cardiomyopathy. CONCLUSIONS Certain patient characteristics, family history, echocardiographic findings, laboratory testing, and biopsy were associated significantly with establishing a cause of pediatric cardiomyopathy. Early endomyocardial biopsy should be considered strongly for children with dilated cardiomyopathy, for definitive diagnosis of viral myocarditis. Although not widely used, skeletal muscle biopsy may yield a cause for some patients with hypertrophic cardiomyopathy and for patients suspected of having a mitochondrial disorder.
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Affiliation(s)
- Gerald F Cox
- Division of Genetics, Department of Medicine, Children's Hospital, Boston, Massachusetts, USA
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