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Aims Whereas haemodynamic and echocardiographic studies suggest benefits for left ventricular (LV) function and cardiac output following reduction in LV preload by interventional edge-to-edge repair for mitral regurgitation (MR), there is limited data on volumetric and functional LV and right ventricular (RV) changes using cardiac magnetic resonance (CMR) imaging. Methods and results Patients with moderate to severeMRand high surgical risk underwent MitraClipTM-implantation andCMRimaging before and within 7 days after the procedure. In addition to volumetric and flow studies, myocardial feature tracking (FT) technology for quantification of myocardial strainwas applied.Twenty patients (age: 76+8 years) with functional (n = 15) or degenerative MR (n = 5) with a mean logistic Euroscore I of 33+16 underwent both successful MitraClipTM implantation and CMR imaging. MR fraction (36+10 vs. 19+12%; P , 0.001) and LV end-diastolic volume (115+36 vs. 105+41 mL/m2; P = 0.002) decreased significantly, whereas LV ejection fraction (42+15 vs. 41+16%, P = 0.8) and cardiac index (1.7+0.5 vs. 1.8+0.4 L/min/2, P = 0.4) remained unchanged. MitraClipTM implantation resulted in a significant impairment of circumferential (212.8+4.8 vs. 28.2+3.3; P = 0.002) and radial strain (15.4+7.7 vs. 9.6+5.3; P = 0.02) on basal short-axis view. On RV level, there were no significant changes in end-diastolic volume (83+19 vs. 84+18 mL/2, P = 0.8), ejection fraction (42+9 vs. 43+11%, P = 0.8), or tricuspid regurgitation fraction (24+17 vs. 25+19%, P = 0.7). MitraClipTM implantation led to a significant improvement in New York Heart Association functional class (patients in functional class III-IV pre 100% vs. post 45%; P , 0.001). Conclusion In severely compromised patients, marked reduction in MR by MitraClipTM implantation might not result in immediate improved cardiac output and effective biventricular forward flow. [ABSTRACT FROM AUTHOR]

Aims: Whereas haemodynamic and echocardiographic studies suggest benefits for left ventricular (LV) function and cardiac output following reduction in LV preload by interventional edge-to-edge repair for mitral regurgitation (MR), there is limited data on volumetric and functional LV and right ventricular (RV) changes using cardiac magnetic resonance (CMR) imaging., Methods and Results: Patients with moderate to severe MR and high surgical risk underwent MitraClip-implantation and CMR imaging before and within 7 days after the procedure. In addition to volumetric and flow studies, myocardial feature tracking (FT) technology for quantification of myocardial strain was applied. Twenty patients (age: 76 ± 8 years) with functional (n = 15) or degenerative MR (n = 5) with a mean logistic Euroscore I of 33 ± 16 underwent both successful MitraClip implantation and CMR imaging. MR fraction (36 ± 10 vs. 19 ± 12%; P < 0.001) and LV end-diastolic volume (115 ± 36 vs. 105 ± 41 mL/m2; P = 0.002) decreased significantly, whereas LV ejection fraction (42 ± 15 vs. 41 ± 16%, P = 0.8) and cardiac index (1.7 ± 0.5 vs. 1.8 ± 0.4 L/min/m2, P = 0.4) remained unchanged. MitraClip implantation resulted in a significant impairment of circumferential (-12.8 ± 4.8 vs. -8.2 ± 3.3; P = 0.002) and radial strain (15.4 ± 7.7 vs. 9.6 ± 5.3; P = 0.02) on basal short-axis view. On RV level, there were no significant changes in end-diastolic volume (83 ± 19 vs. 84 ± 18 mL/m2, P = 0.8), ejection fraction (42 ± 9 vs. 43 ± 11%, P = 0.8), or tricuspid regurgitation fraction (24 ± 17 vs. 25 ± 19%, P = 0.7). MitraClip implantation led to a significant improvement in New York Heart Association functional class (patients in functional class III-IV pre 100% vs. post 45%; P < 0.001)., Conclusion: In severely compromised patients, marked reduction in MR by MitraClip implantation might not result in immediate improved cardiac output and effective biventricular forward flow., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Introduction: Rupture of the ventricular septum complicates acute myocardial infarction in 0.2% of cases in the thrombolytic era. Ventricular septal defect (VSD) has a mortality of 90-95% in medically managed and 19-60% in surgically treated patients., Methods: A retrospective analysis was performed of 41 patients, 26 females (63.4%) and 15 males (36.6%), average age 67.5 ± 15 years, with post-infarction VSD who were treated in the VUL SK intensive cardiology unit between 1991 and 2007., Results: Thirty-seven patients had hypertension (90.2%); anterior wall acute myocardial infarction (AMI) was found in 27 patients (68%). VSD was more frequent in women than in men (p=0.043). In 36 patients (87%) treatment was started 24 hours or later after the development of AMI symptoms. In 34 patients (83%) the rupture occurred during the first episode of AMI and in the majority of these (19 patients, 46.3%), preoperative coronary angiography demonstrated disease of only one coronary artery. During the first 10 days after the onset of AMI, 5 patients (12.2%) were treated surgically but did not survive the operation; 33 patients (80.5%) underwent operation 3-4 weeks after the onset of AMI and all survived., Conclusions: Female sex, advanced age, arterial hypertension, anterior wall AMI, absence of previous AMI, and late arrival at hospital are associated with a higher risk of mortality from acute VSD. The most important factor that determines operative mortality and intra-hospital survival is the time from the onset of AMI to operation.