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Heart failure with preserved ejection fraction (HFpEF) is common and the therapeutic tools are limited. Treatment of the main comorbidities, e.g.: arterial hypertension, ischemic heart disease and atrial fibrillation and symptomatic therapy with diuretic are the only recommended treatment options in HFpEF patients. Increased left atrial pressure is a key contributor to the symptoms. A novel device intended to lower left atrial pressure by creating an 8mm permanent shunt in the atrial septum (IASD®) has been evaluated in HFpEF patients. The study objective was to assess the one year clinical results of patients treated with IASD.

Background: Constrictive pericarditis (CP) is challenging in diagnosis and treatment. Echocardiographic characteristics of consctrictio has been studied, however little is known about the reversibility of the characteristics during short and long term follow-up after surgical pericardiectomy. Method and Results: A retrospective review found 46 patients (56.5 ± 14.9 yrs) with the diagnosis of CP confirmed by echocardiography and right-sided heart catherization. Echocardiographic exams were available at time of diagnosis and in 22 patients at short and long term follow-up. Most prevalent etiology was rheumatic/inflammatory disease. At time of diagnosis the most significant features were: dilated inferior vena cava (IVC) in 100% (mean 25 ± 4mm), diastolic retrograde liver vein flow (rLVF) in 90%, abnormal presenting pericardium in 98%, septal bounce (SB) in 98%, high for age diastolic septal tissue doppler velocity (septal e') of 13.2 ± 3.9cm/s with a ratio of septal to medial e' of 1.01 ± 0.33. Mitral inflow deceleration time MvDT was general low with a mean of 135 ± 31 msec (range 90-230), but in 29% of patients the MvDT was normal (>140msec) and abnormal respiratory mitral inflow variation (resp. Mvvar) (>25%) was only present in 53%. Early after pericardiectomy (mean 8.8 ± 8 days) the only echocardiographic parameters that was significantly changed was: increased MvDT (22.1 ± 30.7msec, p=0.003), decreased septal e' (3.9 ± 2.8 cm/sec, p=0.006), reduced proportion of patients with abnormal resp. Mvvar (53% vs. 6%,p=0.003). All other of the above mentioned characteristics of CP remained unchanged. At late follow-up (mean 32 ± 27 months) many of the echocardiographic CP characteristics was changed towards normal: decreased IVC diameter (-4.3 ± 4.9mm, p=0.016) but still dilated in 82%, increased MvDT (35.9 ± 47.3 ms, p=0.007), decreased septal e' (-7.0 ± 3.6cm/s, p=0.0004) and decreased lateral e' (-4.5 ± 4.1, p=0.004) with a concomitant normalization of the ratio of septal to lateral e' to 1.44 ± 0.21. The proportion of patients with abnormal resp. Mvvar was reduced to zero and the presence of SB was significantly reduced from 98% to 70% (p=0.009), the rLVF was unchanged present in 44% (NS) as well as the presence of abnormal pericardium in 95%(NS). Conclusions. Specific echocardiographic parameters can be pointed out as characteristic at the time of CP diagnosis like: dilated IVC, SB, rLVF, high septal e' with an abnormal ratio of septal to lateral e'. Many parameters return towards normal at late follow-up but SB and dilated IVC, rLVF as well as an abnormal presenting pericardium remains abnormal in a high proportion of patients.

An 83-year-old morbid woman presented with progredient dyspnoea (New York Heart Association [NYHA] stage IV) and a history of recurrent pulmonary oedema. Owing to type A aortic disection, she underwent aortic surgery 3 years prior (January 2009), which included supracoronary ascending aortic replacement and a proximal aorta-to-prosthesis anastomosis. Transthoracic echocardiography revealed major pulmonary hypertension with an estimated systolic pulmonary pressure of 70-75 mm Hg and severe tricuspid regurgitation. Further investigation, including computed tomography and 3-D transoesophageal echocardiography, revealed rupture of the aortic prothesis with a fistula of the paraprosthetic lumen to the right pulmonary artery. Because of multiple concomitant diseases and severe right-sided heart failure, an interventional approach was initiated. With a complex 3-D-echo-guided intervention, the fistula was successfully closed using a 12-mm Amplatzer ASD Occluder which resulted in a reduction in shunt volume. Postinterventional imaging showed the correct position of the occluder with only a minor residual flow. At 18 months' follow-up, the patient presented with improvement of the preexisting dyspnoea, from NYHA stage IV to NYHA stage II or III. The cardiac ultrasound result indicated a reduction in estimated systolic pulmonary pressure to 45-50 mm Hg. Figure