Background-The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. We assessed the outcome of our institutional policy of urgent surgery for unstable patients and initial medical treatment for stable patients with surgery in cases with complications. .56). The 1-, 2-, and 3-year survival rates of IMH patients were 87.6Ϯ3.6%, 84.9Ϯ3.7%, and 83.1Ϯ4.1%, respectively. There was no statistical difference of overall survival rates between patients with IMH and surgically treated AD patients (Pϭ0.787). Conclusions-The clinical outcome of IMH patients receiving treatment by our policy was comparable to that of surgically treated AD patients. However, adverse clinical events were not uncommon with medical treatment alone, and initial aorta diameter and hematoma thickness may identify patients who might benefit from urgent surgery.

Absence of continuous flow communication can explain a more favorable clinical course of AIH than for AD, and medical treatment with frequent imaging follow-up and timed elective surgery in cases with complications can be a rational option for patients with proximal AIH.

Myocardial dyssynchrony assessed by TDI is a powerful predictor of clinical events in CHF with normal QRS.

Background-Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined. Methods and Results-Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intentionto-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54).

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A 33-year-old woman who reported syncope and dyspnea on exertion was diagnosed with hypertrophic cardiomyopathy and scheduled to undergo surgical septal myectomy to relieve a severe obstruction in the left ventricular (LV) outflow tract. On transthoracic echocardiography, asymmetrical septal hypertrophy and systolic anterior motion of the mitral leaflet were noted, and the peak velocity in the LV outflow tract was 4.4 m/s. Cardiac computed tomography (CT) was performed to evaluate geometric changes in the LV myocardium and coronary artery disease. A CT 3-chamber view ( Figure A) and a color-coded myocardial thickness map ( Figure B) generated by CT data showed asymmetrical thickening of the LV myocardium that predominantly involved the ventricular septum and had a maximal thickness of 26 mm.For better visualization of LV anatomy and to improve surgical planning, 3-dimensional (3D) printing of the heart was performed by using the cardiac CT data. A stereolithography file of a myocardial 3D model ( Figure C) was generated by dedicated software (A-view Cardiac; Asan Medical Center, Seoul, Korea) and transferred to a 3D printer system (Objet 500 Connex3; Stratasys, Minnesota, MN). The LV myocardium, papillary muscle, and intraventricular muscle band, including accessory papillary muscle, were generated with different colors by using rubberlike, transparent, and flexible materials (Tango Series; Stratasys; Figure D through F). The 3D printing enabled visualization of the geometric relationship among the hypertrophied myocardium, papillary muscle, intraventricular muscle band, and mitral annulus. For myectomy planning, the surgeon could handle and disassemble the myocardial 3D model (Movie I in the online-only Data Supplement). Extended septal myectomy was performed via an apical incision into the left ventricle ( Figure G), and the hypertrophied septum and prominent muscle band were excised. Papillary muscle splitting with mitral valvuloplasty was performed to resolve the systolic anterior motion of the mitral valve. In a follow-up echocardiography obtained 4 days after surgery, the peak velocity of the LV outflow tract had decreased to 1.9 m/s. Surgical myectomy is required in hypertrophic cardiomyopathy patients with severe disabling symptoms because of LV outflow obstruction.1 Although surgical myectomy performed in experienced centers shows low mortality in hypertrophic cardiomyopathy patients, a complex LV outflow tract anatomy, combined anomalies of the papillary muscle, and limited visualization of the LV cavity in the surgical field may increase the risk and technical challenge of the surgery. 1Although 3D printing of the heart has been used for surgical planning in patients with complex congenital heart disease, cardiac tumor, and LV aneurysm, 2,3 the use of 3D printing is poorly established in hypertrophic cardiomyopathy patients. In our patient, the 3D printed model generated from cardiac CT provided intuitive information on the LV geometry, including the extent of the hypertrophied septum, location and le...

Crops during their early growth stages are vulnerable to a wide range of environmental stressors; thus, earlier seed invigoration and seedling establishment are essential in crop production. As an alternative to synthetic chemical treatments, plasma technology could be one of the emerging technologies to enhance seed germination and seedling vigor by managing environmental stressors. Recent studies have shown its beneficial effects in various stress conditions, suggesting that plasma treatment can be used for early crop stress management. This paper reviewed the effects of different types of plasma treatments on plant responses in terms of the seed surface environment (seed scarification and pathogen inactivation) and physiological processes (an enhanced antioxidant system and activated defense response) during the early growth stages of plants. As a result, plasma treatment can enhance seed invigoration and seedling establishment by alleviating the adverse effects of environmental stressors such as drought, salinity, and pathogen infection. More information on plasma applications and their mechanisms against a broad range of stressors is required to establish a better plasma technology for early crop stress management.

Purpose:To investigate the prevalence, fate, and effect of focal contrast enhancement lesion within the hematoma on contrast material-enhanced computed tomographic (CT) images in patients with distal aortic intramural hematoma (IMH). Materials and Methods:This retrospective study was approved by the institutional review board; informed consent was waived. Clinical and CT data in 107 patients with distal IMH who received medical treatment were analyzed, including remodeling processes of IMH at follow-up CT. IMH progression was defi ned as development of aortic dissection (AD) and aneurysm or hematoma increase. Results:The frequency of focal contrast enhancement was 39.3%, and hematoma was thicker in patients with focal contrast enhancement than in those without (12.3 mm 6 3.6 [standard deviation] vs 10.1 mm 6 4.1, P = .006). Although development of AD occurred more frequently in patients with focal contrast enhancement (21 % vs 3%, P = .006), hematoma resorption (57% vs 71%) was the most common pattern of remodeling in both groups without any signifi cant difference ( P = .148). The frequency of development of aortic aneurysm (17% vs 14%, P = .690) and increase of hematoma (0% vs 5%, P = .278) was not signifi cantly different between groups. The 1-, 3-, 5-, and 7-year survival rates were 96.3% 6 1.8, 95.2% 6 2.1, 87.9% 6 3.4, and 80.7% 6 4.4, respectively. Patients with IMH progression showed lower survival rates than those without ( P = .028). While no signifi cant difference in the overall survival rates could be demonstrated in patients with and those without focal contrast enhancement ( P = .442), our study had only 17% power to detect a difference of 10%. Initial maximal aortic diameter was the only factor associated with survival rates (hazard ratio = 1.129 ; 95% confi dence interval: 1.063, 1.199). The optimal cutoff for prediction of mortality within 7 years was 41 mm. Conclusion:Urgent intervention for patients with focal contrast enhancement is not necessary during the acute stage, and long-term close monitoring with imaging is a better option considering diverse remodeling processes of distal IMH.q RSNA, 20111 From the Divisions of Cardiology