[Parachute Implantation in Severe Ischemic Cardiomyopathy]. / Parachute-Implantation bei schwerer ischämischer Herzinsuffizienz.

Congestive heart failure related to myocardial infarction is characterized by left-ventricular remodeling and moreover it is associated with significant morbidity and mortality with currently limited therapeutic options. The catheter-based left ventricular partitioning device (ParachuteTM, CardioKinetix, Inc., Menlo Park, CA) is a novel therapeutic option available for patients with severe systolic dysfunction following antero-apical myocardial infarction with regional wall motion abnormalities. Preliminary clinical data indicate in addition to the safety the improvement in left ventricular hemodynamics, functional capacity and quality of life.

Combined computational and experimental approach to improve the assessment of mitral regurgitation by echocardiography.

Mitral regurgitation (MR) is one of the most frequent valvular heart diseases. To assess MR severity, color Doppler imaging (CDI) is the clinical standard. However, inadequate reliability, poor reproducibility and heavy user-dependence are known limitations. A novel approach combining computational and experimental methods is currently under development aiming to improve the quantification. A flow chamber for a circulatory flow loop was developed. Three different orifices were used to mimic variations of MR. The flow field was recorded simultaneously by a 2D Doppler ultrasound transducer and Particle Image Velocimetry (PIV). Computational Fluid Dynamics (CFD) simulations were conducted using the same geometry and boundary conditions. The resulting computed velocity field was used to simulate synthetic Doppler signals. Comparison between PIV and CFD shows a high level of agreement. The simulated CDI exhibits the same characteristics as the recorded color Doppler images. The feasibility of the proposed combination of experimental and computational methods for the investigation of MR is shown and the numerical methods are successfully validated against the experiments. Furthermore, it is discussed how the approach can be used in the long run as a platform to improve the assessment of MR quantification.

Closure of a paravalvular leak with real-time three-dimensional transesophageal echocardiography for accurate sizing and guiding.

Although closure of paravalvular leaks with Amplatzer occluders has been described in patients with increased perioperative risk, beneficial outcomes have not been consistently reported. Recent reports have described real-time three-dimensional transesophageal echocardiography (3D TEE) for facilitated guidance of the closure procedure. However, they did not focus on the critical issue of defect sizing. We report a case in which 3D TEE with off-line analysis of images to generate en face views of the mitral valve dehiscence allowed a simplified interrogation and definition of defect dimensions. 3D TEE was used for selection of the device size. The improved sizing was an important means to prevent device embolization as well as secure complete defect closure. Surprises with regard to the device size or the ability to anchor the device in a stable position were reduced.