An uncommon case of heart failure.

A 55-year-old man evaluated for syncope had mild and gradually progressive left ventricular systolic dysfunction on initial workup. Although not identified initially, repeat cardiac magnetic resonance one year later demonstrated the presence of trabeculations in the left ventricle consistent with the diagnosis of isolated non-compaction of the left ventricular myocardium. This case highlights the need for increased awareness of this entity among primary care physicians, cardiologists, and radiologists in order to enhance its identification. This case also demonstrates the advantages of cardiac magnetic resonance for diagnosis and provides insight into this rare type of cardiomyopathy in adults.

Histological and structural evaluation of growth hormone and PLGA incorporation in macroporous scaffold of α-tricalcium phosphate cement.

An in vivo study was conducted to evaluate the effects of the incorporation of fibers of poly(lactic acid-co-glycolic acid, PLGA) and poly(isoprene) blend and recombinant human growth hormone (rhGH) in a macroporous scaffold of α-tricalcium phosphate cement (α-TCP) samples inserted into calvarial defects (8 mm in diameter) of 48 Wistar rats. The samples of α-TCP + PLGA/poly(isoprene) blend fibers were also submitted to a mechanical test of flexural strength. The animals of the different experimental groups [1] α-TCP (n = 6); [2] α-TCP + PLGA/poly(isoprene) blend fibers (n = 6); [3] α-TCP + rhGH, (n = 6) and [4] α-TCP + PLGA/poly(isoprene) blend fibers + rhGH, (n = 6) (the numbers within square brackets identify the experimental groups), after two weeks (subdivision "a") and four weeks (subdivision "b"), were euthanized and the implants removed for histological analysis. There was no statistical difference (p > 0.05) between the samples with and without fibers in the mechanical test. Light microscopy revealed good integration of the material in the host tissue, represented by tissue penetration into the macropores and adequate angiogenesis. In the two-week period, the groups [3a] and [4a] were significantly superior (p < 0.05) to the other groups with regard to angiogenesis and bone neoformation. In the four-week period, the group [3b] was significantly superior (p < 0.05) to the other groups with regard to bone neoformation. We conclude that the macroporous α-TCP scaffold used in this study has low mechanical resistance, is biocompatible and has significantly improved the osteoconductive capacity when rhGH is incorporated into its structure.

Atrial septal defect closure.

Congenital heart disease accounted for 0.3% of US hospital admissions in 2007, with 48% related to atrial septal defects (ASDs). More than one-fourth of adult congenital heart defects are ASDs, 75% of which are ostium secundum ASDs. The progressive impact of volume overload of the right cardiac chambers can be halted by ASD closure. This review focuses on percutaneous ASD closure.

Variation in quantitative myocardial perfusion due to arterial input selection.

OBJECTIVES: This study compared the clinical implications of quantifying myocardial perfusion among different potential arterial input sites: the high (HAo) and basal (BAo) ascending aorta, descending aorta (DA), left atrium (LA), and left ventricular (LV) cavity. BACKGROUND: Absolute myocardial perfusion and its hyperemic reserve imaged by positron emission tomography (PET) can serve as noninvasive functional measures of physiologic severity. Quantitative myocardial perfusion by PET depends on the time-concentration of vascular activity, called arterial input (AI). However, arterial activity imaged by PET can vary among sites due to partial volume effects from anatomic size, cardiac or respiratory motion out of fixed regions of interest, and spillover from neighboring vascular structures. METHODS: Patients underwent cardiac rubidium-82 PET imaging with flow quantification using various anatomic AI. After excluding sites with overt spillover or misregistration, we selected the customized, highest AI among the BAo, HAo, DA, and LA. Average whole heart flows and percent of LV with substantial definite ischemia were compared among sites. RESULTS: Of 288 cases, LA was selected in roughly half, with HAo in another quarter to one-third. Compared with using the customized AI, rest and stress absolute flow were higher by 5% to 10% for HAo, 14% for BAo, 19% to 23% for DA, and 46% to 49% for LV due to artifactually low AI values. The ratio of coronary flow reserve to its customized value was less affected, although its 95% confidence interval increased among AI locations: 7% for LA, 16% for HAo, 20% for BAo, 28% for DA, and 31% for LV. CONCLUSIONS: The best customized site for AI activity varies for each patient among potential anatomic locations. Selection of the customized arterial site for each individual improved quantification of myocardial perfusion and coronary flow reserve with less variability compared with utilizing a single, pre-selected, fixed anatomic site.