Role of cardiac magnetic resonance (CMR) in planning ventricular septal myomectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).

Septal myectomy is currently the gold standard treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). The procedure needs to be tailored and performed in a personalized fashion, taking into consideration the anatomic and physiologic heterogeneity of this disease. The extent and location of surgical myectomy will depend on the location of the hypertrophy, with the goal of widening the outflow tract and improve the function of the mitral valve. CMR helps to identify hypertrophy not well visualized by TTE, providing more accurate wall thickness measurements and differentiating HOCM from other causes of LV hypertrophy. CMR also helps identify an abnormal attachment of papillary muscle to the MV or to the septal myocardium and mitral valve pathology. A collaborative approach with cardiac surgeons, radiologists and cardiologists will optimize preoperative planning to improve the success for surgical myectomy.

Breast Equalization Augmentation: The Use of Ultrasonic Assisted Liposuction for Correction of Primary Breast Asymmetry with Bilateral Augmentation.

BACKGROUND: The purpose of this study was to determine the effectiveness of using ultrasonic assisted liposuction (UAL) to achieve sufficient breast symmetry allowing for the use of same sized implants in patients presenting for elective breast augmentation surgery. METHODS: A retrospective review was performed of patients presenting for augmentation mammoplasty with breast asymmetry who underwent ultrasonic assisted liposuction in combination with implant augmentation. Pre-operative differences in breast volumes were determined using water displacement, and these measurements were compared to final lipoaspirates required to achieve symmetry. To estimate the volume of lipoaspirate required, we suggested to aim for twice the volume difference obtained by water displacement. The success of the procedure was measured by the ability to use the same size implants bilaterally. RESULTS: A total of 35 patients were included in this review. In 85% of patients, UAL was sufficient to permit the use of equally sized implants bilaterally. However, when different sized implants were required, the size difference between implants was not greater than 25 cc. The UAL was also effective in correcting minor ptosis and nipple position. The main observed disadvantage was prolonged bruising and swelling. CONCLUSION: The use of UAL for correction of primary breast asymmetry with bilateral breast augmentation allows balancing of breast tissue volumes and the use of same size implants and eliminates the need for balancing mastopexy procedures. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Global Longitudinal Strain and Immune Status in Patients Living With Human Immunodeficiency Virus.

Improvement in survival in patients living with human immunodeficiency virus (PLHIV) has led to increased prevalence of cardiovascular disease. Whether HIV-associated immune dysfunction is associated with preclinical left ventricular (LV) dysfunction despite normal LV ejection fraction (LVEF) is unclear. Accordingly, we investigated the relation of immune status and LV function in PLHIV. Global longitudinal strain (GLS) analyses were performed retrospectively on all echocardiograms for PLHIV who had available HIV-1 RNA viral load, nadir, and proximal CD4 cell count data at Duke University Medical Center between 2001 and 2012. The relation between HIV-1 RNA viral load, nadir, and proximal CD4 count and GLS as a continuous dependent variable was assessed with unadjusted and adjusted linear regression. GLS was calculated for 253 PLHIV. Median GLS in our cohort was - 15.1% with interquartile range from (-16.7 to -13.6). All participants had an LVEF ≥50%. In adjusted analyses, proximal CD4 <500 cells/mm3 and nadir CD4 <250 cells/mm3 were significantly inversely correlated with GLS (p = 0.01 and p = 0.004, respectively). In PLHIV, patient with plasma HIV RNA <400 copies/ml at baseline had a trend toward significantly more negative values of GLS compared with those patients without viral suppression at baseline (p = 0.08). In conclusion, this study is the first to demonstrate such a high prevalence of abnormal GLS in PLHIV, and the first to identify that proximal and nadir CD4 cell count are independently associated with GLS despite normal LVEF.

Montreal Children's Hospital formula for nasoalveolar molding cleft therapy.

BACKGROUND: For cleft teams that use nasoalveolar molding for presurgical treatment of cleft lips, the determination of desired cleft-nasal height correction is a subjective assessment. The latter, however, is complicated by a noncleft nasal height that itself is depressed by the shifted nasal pyramid native to the deformity. The authors introduce a simple formula based on the Pythagorean theorem to estimate the corrected height of the nose as an objective guide for the endpoint of nasoalveolar molding therapy. METHODS: Nasal impressions of 20 consecutive patients with unilateral cleft lips who underwent nasoalveolar molding therapy were analyzed. Using identified landmarks on pre-nasoalveolar molding impressions, the Montreal Children's Hospital formula was used to estimate the corrected height of the noncleft nostril (ideal corrected nasal height) as measured on the impressions after nasoalveolar molding therapy had verticalized the nasal pyramid. Statistical analysis was performed using the Pearson correlation test to determine the predictive value of the formula. RESULTS: Twenty patients were included in the study. Analysis demonstrated a statistically significant positive correlation (high degree) between predicted nasal heights (ideal corrected nasal height) and those measured following completion of nasoalveolar molding therapy (r = 0.760, p < 0.01). CONCLUSIONS: The Montreal Children's Hospital formula may serve as a useful tool to predict the corrected nasal height (ideal corrected nasal height) as a benchmark for cleft side nasal correction with nasoalveolar molding. The authors hope it will provide cleft teams, especially those beginning to use nasoalveolar molding, with an objective measure to guide nasoalveolar molding treatment.