In the era before reperfusion therapy, ventricular septal rupture complicated 1~3% of acute myocardial infarctions (AMI) usually 3-5 days after onset. Studies have reported a positive correlation between the incidence of septal perforation and total occlusion of the coronary arteries. A 70-year old female patient was referred to the emergency room with the diagnosis of acute anterior myocardial infarction (MI) and recent cerebral infarction. The coronary angiogram showed a 90% stenosis at the mid-portion of the left anterior descending artery (LAD), and the lesion was successfully treated by percutaneous coronary intervention (PCI) with stent implantation. After PCI, the anterior wall motion improved on the follow-up echocardiogram. However, on the 20th hospital day, the patient condition deteriorated suddenly with pulmonary congestion. The echocardiography revealed a 1.3 cm ventricular septal defect at the apical septum with a left-to-right shunt. We report this rare case of delayed septal rupture in a patient with patent LAD after PCI and recovery of wall motion.
Ventricular Septal Rupture/*etiology ; Time Factors ; Stents ; Myocardial Infarction/*complications/surgery ; Humans ; Heart Ventricles/*physiopathology ; Heart Septum/*physiopathology ; Female ; Angioplasty, Transluminal, Percutaneous Coronary ; Aged ; Acute Disease

Lead placement for ventricular pacing variably impacts the physiological benefit of the patient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients (108 males, and 84 females, 63±21 years old) with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum (RVOTs) group had lead placement near the septum (n=97), while the right ventricular apex (RVA) group had a traditional apical placement (n=95). RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projection. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different (4.29±0.61 vs. 2.16±0.22 min; P=0.009). No differences were identified in threshold, impedance or R-wave sensing between the two groups at 1st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.
Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Heart Septum ; physiopathology ; Heart Ventricles ; physiopathology ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial ; Single-Blind Method

BACKGROUNDEffect of percutaneous transluminal septal ablation (PTSA) with ethanol injection on electromechanical remodeling of left ventricule still remains unknown. This study was conducted to assess the potential significance of cardiac electromechanical mapping (CEMM) in analyzing the left ventricular remodeling before and immediately after percutaneous transseptal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM).

METHODSEight patients with drug-refractory HOCM and 6 patients with hypertrophic cardiopathy (HM) without increased left ventricular outtract gradien (LVOTG) were enrolled into the present study. CEMM was undergone in patients with HOCM before and immediately after PTSA procedure, and in patients with HM.

RESULTSPTSA was successful in all patients with HOCM, LVOTG significantly decreased from (62.87 +/- 21.16) mmHg to (12.73 +/- 3.05) mmHg immediately after ablation procedure. Value of UVP in septal-base segment in HM group was higher than that in HOCM group [(22.79 +/- 2.34) mV vs (18.54 +/- 1.76) mV]. In patients with HOCM, lateral-middle and -base segments had lowest value of UVP [(15.93 +/- 1.11) mV and (15.83 +/- 1.07) mV] before PTSA. Value of UVP at posterior-middle segment decreased from (23.58 +/- 2.21) mV pre-PTSA to (18.89 +/- 1.91) mV post-procedure, PTSA led to significant increase of UVP at lateral-middle segment. Septal region in patients with HM and septal-middle, septal-base, posterior-base segments in HOCM had lower value of local linear shortening (LLS) among all patients in both HOCM and HM groups. PTSA resulted in significant reduction of LLS in anterior region and at septal-apex segment. Anterior-base and septal-middle segments in patients with HM had lowest value of local active time (LAT), and significantly differentiated from that in patients with HOCM [(-8.57 +/- 0.68) ms vs (-18.61 +/- 1.02) ms, (-6.75 +/- 0.37)ms vs (-21.90 +/- 0.96) ms, respectively]. LAT at septal-middle and -base segments in patients with HOCM was decreased significantly [(-21.90 +/- 0.96) ms vs (-13.80 +/- 1.04) ms, P < 0.002; and (-15.20 +/- 1.06) ms vs (-6.33 +/- 0.52) ms, respectively] immediately after PTSA.

CONCLUSIONSPosterior-lateral and anterior region probably played important roles in electromechanical remodeling. Significant electromechanical remodeling disassociation (uncoupling) was detected in most left ventricular regions, which would be important in differentiating of HOCM from HM, and in predicting the prognosis in patients with HOCM after PTSA procedure.

Body Surface Potential Mapping ; Cardiomyopathy, Hypertrophic ; physiopathology ; therapy ; Ethanol ; therapeutic use ; Heart Septum ; drug effects ; Humans ; Ventricular Remodeling ; physiology

OBJECTIVETo follow up the electrocardiographic and cardiac autonomic function changes after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM).

METHODSBaseline, 3 days and 3 years post procedure 12-lead electrocardiographic and 24-hour Holter electrocardiographic recordings including PR interval, QRS duration, cardiac conduct block, QT, QTd, QTcd, JT, JTd, JTcd, heart rate variability (HRV) data (SDNN, SDANN, HF, rMSSD, PNN50, LF, HF, LF/HF) were analyzed in 26 patients with HOCM receiving PTSMA.

RESULTThe PTSMA procedure was successful in all 26 patients. One patient developed complete atrioventricular block requiring permanent pacing. The PR interval was significantly prolonged 3 days after ablation and recovered 3 years post procedure. Right bundle branch block was seen in all patients 3 days after post procedure and in 24 patients at 3 years post procedure. The QRS duration was significantly prolonged at 3 days and 3 years post procedure. There was persistent QT interval prolongation up to 3 years and transient QTd, QTcd prolongation (prolonged at 3 days and returned to baseline at 3 years after ablation) while JT, JTd, JTcd were not significantly changed after PTSMA. LF, HF, rMSSD and PNN50 were significantly increased while LF/HF, SDNN, SDANN remained unchanged post procedure.

CONCLUSIONPTSMA is a safe and effective therapy option for HOCM. Right bundle branch block was the main electrocardiographic change post procedure and PTSMA could partly restore the heart sympathovagal balance by improving vagal activity.

Adult ; Autonomic Nervous System ; physiopathology ; Cardiomyopathy, Hypertrophic ; physiopathology ; therapy ; Catheter Ablation ; methods ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Septum ; Humans ; Male ; Middle Aged

OBJECTIVETo observe the incidence of ventricular desynchronization in patients with or without pacemaker syndrome (PMS).

METHODSThe systolic peak velocity, the acceleration and the time to peak velocity of the interventricular septum (IVS), left ventricular (LV) and right ventricular (RV) lateral wall were detected by tissue Doppler imaging (TDI) in 14 atrial fibrillation patients without pacemaker implantation (control), 18 atrial fibrillation patients without PMS and 16 atrial fibrillation patients with PMS. All patients were free of valve disease, myocardial infarction, severe pulmonary hypertension, low left ventricular eject fraction (< or = 50%), significant segmental hypokinesis of ventricular wall or complete bundle branch block.

RESULTSCompared to the control patients, the systolic peak velocity and the accelerations on lateral walls of the LV and RV reduced significantly in patients with implanted pacemakers (P < 0.05). The intervals to peak velocity of the IVS and LV lateral walls were significantly prolonged [PMS group (80.13 +/- 26.92) ms vs. (25.60 +/- 4.30) ms, P < 0.01; without PMS group (76.22 +/- 23.32) ms vs. (25.60 +/- 4.30) ms, P < 0.01] and the intervals to peak velocity of the IVS and RV lateral walls significantly shortened [PMS group (16.33 +/- 6.85) ms vs. (40.70 +/- 7.60) ms, P < 0.01; without PMS group (21.20 +/- 7.34) ms vs. (40.70 +/- 7.60) ms, P < 0.01]. The systolic peak velocities, the accelerations of the IVS and bilateral walls and the intervals to peak velocity of the IVS and LV lateral wall were similar in patients with and without PMS (P > 0.05), however, the intervals to peak velocity of the IVS and RV lateral wall was significant shorter in patients with PMS compared to that of patients without PMS [(16.33 +/- 6.85) ms vs. (21.20 +/- 7.34) ms, P < 0.01].

CONCLUSIONRV desynchronization but not LV desynchronization might play an important role in patients with PMS.

Adult ; Aged ; Aged, 80 and over ; Atrial Fibrillation ; therapy ; Cardiac Pacing, Artificial ; adverse effects ; Echocardiography, Doppler, Pulsed ; Female ; Heart Ventricles ; diagnostic imaging ; physiopathology ; Humans ; Male ; Middle Aged ; Ventricular Septum

BACKGROUND: To study the characteristics of ventricular function in Pulmonary Hypertension (PH) Patients with different shape of Interventricular Septum (IVS) by cardiac magnetic resonance (CMR). METHODS: 36 PH patients diagnosed by right heart catheterization accepted CMR. According to the morphology of IVS, the patients were divided into two groups: the non-deformation group (10 patients) and the deformation group (26 patients). The ventricular function parameters were as follows: RV and LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), cardiac index (CI), ejection fraction (EF), and myocardial mass index (MMI). RESULTS: ANOVA analysis showed that the differences of RVEDVI, RVESVI, RVSVI, RVCI, RVEF, RVMMI, LVEDVI, LVESVI, LVSVI and LVCI were significant among the three groups. Compared with control group, RVSVI (P=0.017), RVEF (P<0.001), LVEDVI (P=0.048) and LVSVI (P=0.015) decreased in IVS non-deformation group. Compared with IVS non-deformation group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.002) and RVMMI (P=0.017) were increased in IVS deformation group; while RVEF (P=0.001), LVEDVI (P=0.003), LVSVI (P<0.001) and LVCI (P=0.029) were decreased. Compared with the control group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.004) and RVMMI (P=0.003) were increased in the IVS deformation group, while RVEF (P<0.001), LVEDVI (P<0.001), LVESVI (P<0.001), LVSVI (P<0.001), LVCI (P<0.001) were decreased. CONCLUSIONS Ventricular function is different in PH Patients with different IVS shape. The IVS shape can represent the changes of ventricular function in PH patients.
Adult ; Aged ; Female ; Heart ; diagnostic imaging ; physiopathology ; Humans ; Hypertension, Pulmonary ; diagnosis ; diagnostic imaging ; physiopathology ; Lung Neoplasms ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Stroke Volume ; Ventricular Function ; Ventricular Septum ; diagnostic imaging ; physiopathology

BACKGROUNDThe connexin43 knockout (Cx43 KO) mouse dies at birth with an enlarged conotruncal region, which leads to the obstruction of the right outflow tract (OFT). Since myocardialization of the proximal OFT septum is one of the key events during heart development, we investigated the process in the Cx43 KO embryo hearts. Rho associated coiled-coil forming protein kinase 1 (ROCK1), is a recently found key molecule to regulate the myocardialization of OFT, but its spatiotemporal expression pattern during myocardialization remains unknown. The objective of this study was to investigate the differentially expressed pattern of ROCK1 between Cx43 KO and wild type embryo hearts, and its relationship with the delayed myocardialization in Cx43 KO embryo hearts.

METHODSUsing immunohistochemistry, the processes of myocardiolization were investigated both in Cx43 KO and wild type embryo hearts. The differentially expressed pattern of ROCK1 between Cx43 KO and wildtype embryo hearts was evaluated both at the mRNA and protein level by real-time RT-PCR and immunohistochemistry.

RESULTSThe expression of α-sarcomeric actin (α-SCA) in the proximal OFT septum of Cx43 KO embryos was delayed. Meanwhile, it was shown that the downregulation of ROCK1 coincided with delayed myocardialization. The expression of ROCK1 protein was mainly limited to the proximal outflow tract septum from embryo day (E) E11.5 to E15.5. Its expression pattern was similar with that of α-SCA. Real-time RT-PCR found that the expression level of Rock-1 mRNA began at a low level on E11.5 and reached peak at E13.5 and E14.5.

CONCLUSIONSROCK1 may have an important role in the process of myocardialization of the proximal OFT septum. Downregulation of ROCK1 is likely to contribute to the aberrant myocardialization in Cx43 KO embryo hearts.

Actins ; metabolism ; Animals ; Connexin 43 ; genetics ; metabolism ; Heart ; embryology ; physiopathology ; Heart Septum ; Immunohistochemistry ; Mice ; Mice, Knockout ; Myocardium ; metabolism ; pathology ; Real-Time Polymerase Chain Reaction ; rho-Associated Kinases ; genetics ; metabolism

No abstract available.
Adolescent ; Adrenergic beta-Antagonists/therapeutic use ; Calcium Channel Blockers/therapeutic use ; Cardiomyopathy, Hypertrophic, Familial/complications/genetics/*pathology/physiopathology/therapy ; Electric Countershock ; Electrocardiography ; Female ; Genetic Predisposition to Disease ; Heart Failure/etiology/therapy ; Heart Septum/drug effects/*pathology/physiopathology/ultrasonography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pedigree ; Phenotype ; Tachycardia, Ventricular/etiology/therapy ; Treatment Outcome ; Ventricular Outflow Obstruction/etiology