Background. Endocardial fibroelastosis (EFE), characterized by a diffuse endocardial thickening through collagen and elastin fibers, develops in the human fetal heart restricting growth of the left ventricle (LV). Recent advances in fetal imaging indicate that EFE development is directly associated with a distended, poorly contractile LV in evolving hypoplastic left heart syndrome (HLHS). In this study, we developed an animal model of EFE by introducing this human fetal LV morphopathology to an immature rat heart. Methods and Results. A neonatal donor heart, in which aortic regurgitation (AR) was created, was heterotopically transplanted into a recipient adult rat. AR successfully induced the LV morphology of evolving HLHS in the transplanted donor hearts, which resulted in the development of significant EFE covering the entire LV cavity within two weeks postoperatively. In contrast, posttransplants with a competent aortic valve displayed unloaded LVs with a trace of EFE. Conclusions. We could show that distention of the immature LV in combination with stagnant flow triggers EFE development in this animal model. This model would serve as a robust tool to develop therapeutic strategies to treat EFE while providing insight into its pathogenesis.
Objective
Presurgical cognitive and psychiatric status can serve as predictors of surgical outcomes; however, there are no studies that assess the predictive nature of cognitive factors and psychiatric illness on seizure freedom following stereotactic laser ablation, a novel, minimally invasive surgical approach, of the hippocampus (SLAH). Therefore, this study aimed to assess whether neuropsychological factors were associated with long-term postoperative outcome, defined as time maintaining continuous postoperative seizure freedom (Engel Class I outcome persistently after surgery), after mesial temporal laser ablation surgery.
Method
Forty-one patients (Age M = 37.5 ± 12.6; 61% female; 63% left mesial temporal ablation; 37% right mesial temporal ablation) were selected from retrospective data collection of epilepsy surgery outcomes following mesial temporal laser ablation. Patients were assessed with a presurgical neuropsychological battery as part of Phase I work-up.
Results
Wilcoxon rank-sum tests revealed there were no significant differences between groups (seizure free and non-seizure free) across presurgical intellectual functioning, (seizure free M = 37.6; non-seizure free M = 40.6; p = 0.31), verbal memory (p = 0.59), visual memory (p = 0.39), and language composite scores (p = 0.87). There was also no significant difference in presurgical mean depression scores (p = 0.81).
Conclusions
There were no significant differences between groups in presurgical cognitive and psychiatric predictors on seizure outcomes; however, sample size is a limitation. Further investigations are needed given that cognitive and psychiatric predictors may be associated with SLAH outcomes. Additionally, these findings add to the absence of literature on cognitive and psychiatric predictors in SLAH.
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