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Ahluwalia M, Kpodonu J, Agu E. Risk Stratification in Hypertrophic Cardiomyopathy: Leveraging Artificial Intelligence to Provide Guidance in the Future. JACC. ADVANCES 2023; 2:100562. [PMID: 38939491 PMCID: PMC11198167 DOI: 10.1016/j.jacadv.2023.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Monica Ahluwalia
- Division of Cardiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emmanuel Agu
- Worcester Polytechnic Institute, Worcester, Massachusetts, USA
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Dejea H, Schlepütz CM, Méndez-Carmona N, Arnold M, Garcia-Canadilla P, Longnus SL, Stampanoni M, Bijnens B, Bonnin A. A tomographic microscopy-compatible Langendorff system for the dynamic structural characterization of the cardiac cycle. Front Cardiovasc Med 2022; 9:1023483. [PMID: 36620622 PMCID: PMC9815149 DOI: 10.3389/fcvm.2022.1023483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Cardiac architecture has been extensively investigated ex vivo using a broad spectrum of imaging techniques. Nevertheless, the heart is a dynamic system and the structural mechanisms governing the cardiac cycle can only be unveiled when investigating it as such. Methods This work presents the customization of an isolated, perfused heart system compatible with synchrotron-based X-ray phase contrast imaging (X-PCI). Results Thanks to the capabilities of the developed setup, it was possible to visualize a beating isolated, perfused rat heart for the very first time in 4D at an unprecedented 2.75 μm pixel size (10.6 μm spatial resolution), and 1 ms temporal resolution. Discussion The customized setup allows high-spatial resolution studies of heart architecture along the cardiac cycle and has thus the potential to serve as a tool for the characterization of the structural dynamics of the heart, including the effects of drugs and other substances able to modify the cardiac cycle.
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Affiliation(s)
- Hector Dejea
- Paul Scherrer Institute, Villigen, Switzerland,Institute for Biomedical Engineering, University and ETH Zürich, Zurich, Switzerland,*Correspondence: Hector Dejea ✉
| | | | - Natalia Méndez-Carmona
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, Bern, Switzerland,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Maria Arnold
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, Bern, Switzerland,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Patricia Garcia-Canadilla
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain,Cardiovascular Diseases and Child Development, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Sarah L. Longnus
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, Bern, Switzerland,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Marco Stampanoni
- Paul Scherrer Institute, Villigen, Switzerland,Institute for Biomedical Engineering, University and ETH Zürich, Zurich, Switzerland
| | - Bart Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Anne Bonnin
- Paul Scherrer Institute, Villigen, Switzerland
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Quintana E, Bajona P. The first 200 septal myectomies: Ensuring gold standard outcomes. Asian Cardiovasc Thorac Ann 2021; 30:28-34. [PMID: 34730015 DOI: 10.1177/02184923211055869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Septal myectomy remains the gold standard treatment for symptomatic left ventricular outflow tract obstruction refractory to medical treatment. It is recommended that this operation be performed in dedicated hypertrophic obstructive cardiomyopathy centres by experienced surgeons. The septal myectomy option remains unavailable to many patients based solely on geography, including those who would clearly benefit more substantially from surgery than other therapeutic options. Here, we share our experience in starting new hypertrophic cardiomyopathy programmes. METHODS We retrospectively reviewed initial septal myectomy experiences at two hypertrophic cardiomyopathy programmes starting in 2014. RESULTS Two-hundred septal myectomies were performed. Mean age was 58.8 years and 51% were females. Advanced heart failure symptoms were present in 95.5% of patients and 23.5% had experienced syncope. Mean maximal intraventricular gradient was 89 mmHg and 48.5% underwent concomitant procedures at the time of septal myectomy. There was no perioperative (in-hospital or 30 days) mortality. Ninety-two per cent had provoked left ventricular gradients of ≤ 15 mmHg and 97% had none/mild mitral regurgitation at post-operative assessment. In our contemporary cohort, there were 2 (1%) intraoperative ventricular septal defects and 5% required a permanent pacemaker. CONCLUSIONS Our early septal myectomy experience targeted a complex population, frequently in need of concomitant procedures. Abolition of left ventricular obstruction and resolution of systolic anterior motion mediated mitral regurgitation can be expected. The safety and efficacy of septal myectomy carried at hypertrophic cardiomyopathy centres by properly trained surgeons achieved the desired outcomes established by recent hypertrophic cardiomyopathy guidelines.
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Affiliation(s)
- Eduard Quintana
- Cardiovascular Surgery Department, 16493Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Pietro Bajona
- 92594Allegheny Health Network Cardiovascular Institute-Drexel University College of Medicine, Pittsburgh, PA, USA
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