TAVR using the next-generation THV is clinically safe and effective for treating older patients with severe AS at increased operative risk. (CoreValve Evolut R FORWARD Study [FORWARD]; NCT02592369).

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SUMMARY The concentration of thallium-201 in the myocardium immediately following injection of tracer is the result of both blood flow delivering tracer to the heart and extraction by the myocardium. In these studies, the extraction of thallium-201 by the canine myocardium was determined as a function of heart rate, coronary blood flow, hypoxia, changes in pH, and following administration of propranolol, insulin, and strophanthin. Under basal con-THALLIUM-201 has been advocated for evaluation of regional myocardial perfusion and regional myocardial perfusion reserve in patients with suspected myocardial ischemia.1 However, it is frequently difficult to evaluate the small changes in regional myocardial tracer concentration by visual inspection when images are performed following injection of tracer at rest and following injection at maximum stress, due to changes in the concentration of thallium in the myocardium relative to that in the lungs.2 These problems have led to attempts at quantification of regional thallium concentration3 and complex efforts at determining the lung background to arrive at the net thallium concentration in the myocardium.4 An assumption implicit in all these studies is that the extraction of thallium by the myocardium remains constant. To determine if the extraction of thallium by the myocardium remains unchanged, these experiments were undertaken measuring the extraction fraction of the myocardium for thallium-201 during the initial transit of tracer through the heart using a dual tracer technique.5 Materials and MethodsThe double tracer method employs a mixture of two tracers: one a nonextractable reference or indicator such as I 125 -albumin and the other a test substance such as T1201. A small quantity of this mixture is injected into the left atrium and a blood sample is taken from the venous effluent after the first pass of the bolus through the organ. The concentration of the indicator (I) and the test tracer (Tl) is measured in the arterial bolus (a) and the venous sample (v). The extraction fraction is given by the formula:(1) albumin and 12,uC T120' per ml was agitated by both mechanical and ultrasonic means in a vial to ensure adequate mixing. The initial volume injection was 0.4 ml and subsequently 0.4, 0.8, 1.2 and 2.0 ml were administered.The samples were counted in a 5" diameter Na I scintillation counter as follows: Thallium-201 at a baseline of 130 keV and upper level of 180 keV; Iodine-125 at a baseline of 25 keV and an upper level of 35 keV. Standards of each tracer were counted in each window and appropriate ratio corrections were made for the activity from the higher energy T1201 appearing in the lower energy 1-125 window. Less than 25% of the counts in the iodine window were due to thallium photons. Animal PreparationAdult mongrel dogs weighing 20 to 40 kg were anesthetized with 30-35 mg/kg intravenous sodium pentobarbital, intubated and placed on a Harvard pumprespirator. The heart was exposed through a left lateral thoracotomy in the fourth interspace and the per...

The aim of this study was to describe the clinical, echocardiographic and laboratory characteristics of large pericardial effusions and cardiac tamponade secondary to systemic lupus erythematosus (SLE). An ongoing prospective study was conducted at Tygerberg Academic Hospital, South Africa between 1996 and 2002. All patients older than 13 years presenting with large pericardial effusions (> 10 mm) requiring pericardiocentesis were included. Eight cases (out of 258) were diagnosed with SLE. The mean (SD) age was 29.5 (10.7) years. Common clinical features were Raynaud's phenomenon, arthralgia and lupus nephritis class III/IV. Echocardiography showed Libman-Sacks endocarditis (LSE) in all the mitral valves. Two patients developed transient left ventricular dysfunction; both these patients had pancarditis. Typical serological findings included antinuclear antibodies, anti-double stranded DNA antibodies, low complement C4 levels and low C3 levels. CRP was elevated in six cases. Treatment consisted of oral steroids and complete drainage of the pericardial effusions. No repeat pericardial effusions or constrictive pericarditis developed amongst the survivors (3.1 years follow up). This study concludes that large pericardial effusions due to SLE are rare, and associated with nephritis, LSE and myocardial dysfunction. Treatment with steroids and complete drainage is associated with a good cardiac outcome.

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The South African population harbors genes that are derived from varying degrees of admixture between indigenous groups and immigrants from Europe and the East. This study represents the first direct mutation-based attempt to determine the impact of admixture from other gene pools on the familial hypercholesterolemia (FH) phenotype in the recently founded Coloured population of South Africa, a people of mixed ancestry. A cohort of 236 apparently unrelated patients with clinical features of FH was screened for a common mutation causing familial defective apolipoprotein B-100 (FDB) and seven low-density lipoprotein receptor (LDLR) gene defects known to be relatively common in South Africans with FH. Six founder-type 'South African mutations' were responsible for FH in approximately 20% of the study population, while only 1 patient tested positive for the familial defective apolipoprotein B-100 mutation R3500Q. The detection of multiple founder-type LDLR gene mutations originating from European, Indian and Jewish populations provides direct genetic evidence that Caucasoid admixture contributes significantly to the apparently high prevalence of FH in South African patients of mixed ancestry. This study contributes to our knowledge of the biological history of this unique population and illustrates the potential consequences of recent admixture in populations with different disease risks.

is recommended for the first operator and the individual who will be managing the airway. These are institutional recommendations as there are no official position statements regarding the above.

We describe the first case of implantation of a transcatheter aortic valve implantation (TAVI) in a patient with an anomalous origin of the right coronary artery, coursing in between the aorta and pulmonary truncus to the right. After assessment of the risk of compression of the anomalous origin of the right coronary artery from the left coronary sinus (ARCA), the procedure was performed without complication. A brief discussion of the pathophysiology of ARCA is provided and the implications for TAVI as well as our recommendations are offered.