The 2D strain provides accurate assessment of LV regional function. Evaluation of circumferential and longitudinal strains during DSE has real potential for quantitative evaluation of LV deformation in the routine assessment of ischemia.

Background-Thoracic endovascular aortic repair (TEVAR) represents a novel concept for type B aortic dissection.Although life-saving in acute emergencies, outcomes and survival of TEVAR in stable dissection are unknown. Methods and Results-One hundred forty patients in stable clinical condition at least 2 weeks after index dissection were randomly subjected to elective stent-graft placement in addition to optimal medical therapy (nϭ72) or to optimal medical therapy alone (nϭ68) with surveillance (arterial pressure according to World Health Organization guidelines Յ120/ 80 mm Hg). The primary end point was all-cause death at 2 years, whereas aorta-related death, progression (with need for conversion or additional endovascular or open surgery), and aortic remodeling were secondary end points. There was no difference in all-cause deaths, with a 2-year cumulative survival rate of 95.6Ϯ2.5% with optimal medical therapy versus 88.9Ϯ3.7% with TEVAR (Pϭ0.15); the trial, however, turned out to be underpowered. Moreover, the aorta-related death rate was not different (Pϭ0.44), and the risk for the combined end point of aorta-related death (rupture) and progression (including conversion or additional endovascular or open surgery) was similar (Pϭ0.65). Three neurological adverse events occurred in the TEVAR group (1 paraplegia, 1 stroke, and 1 transient paraparesis), versus 1 case of paraparesis with medical treatment. Finally, aortic remodeling (with true-lumen recovery and thoracic false-lumen thrombosis) occurred in 91.3% of patients with TEVAR versus 19.4% of those who received medical treatment (PϽ0.001), which suggests ongoing aortic remodeling. Conclusions-In the first randomized study on elective stent-graft placement in survivors of uncomplicated type B aortic dissection, TEVAR failed to improve 2-year survival and adverse event rates despite favorable aortic remodeling. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00525356.

The use of the double patch technique and glue by avoiding recurrence of the VSD played a role in the reduction of the hospital mortality. This technique has to be recommended in the early repair of post infarction VSD. Concomitant CABG can be done safely to control the added risk of an associated coronary artery lesion.