Inﬂuence of LBBB on long-term mortality 20. 21. 22. 23. 24. 25. 26. 27. without an implantable deﬁbrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140–2150. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC, Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001;344:873–880. Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Fedele F, Santini M. Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing. J Am Coll Cardiol 2002; 39:489–499. Kass DA. Ventricular dyssynchrony and mechanisms of resynchronization therapy. Eur Heart J 2002;4(Suppl. D):D23–D30. Kass DA, Chen CH, Curry C, Talbot M, Berger R, Fetics B, Nevo E. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 1999;99:1567–1573. Lane RE, Chow AW, Chin D, Mayet J. Selection and optimisation of biventricular pacing: the role of echocardiography. Heart 2004;90(Suppl. 6): 10–16. Yu CM, Lin H, Zhang Q, Sanderson JE. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003;89:54–60. Achilli A, Sassara M, Ficili S, Pontillo D, Achilli P, Alessi C, De Spirito S, Guerra R, Patruno N, Serra F. Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and ‘narrow’ QRS. J Am Coll Cardiol 2003;42:2117–2124. Turner MS, Bleasdale RA, Vinereanu D, Mumford CE, Paul V, Fraser AG, Frenneaux MP. Electrical and mechanical components of dyssynchrony in heart failure patients with normal QRS duration and left bundle-branch block: impact of left and biventricular pacing. Circulation 2004;109: 2544–2549. Clinical vignette doi:10.1093/eurheartj/ehm178 Online publish-ahead-of-print 26 June 2007 Late pulmonary artery aneurysm combined with subpulmonary left ventricular outﬂow tract obstruction in corrected transposition of the great arteries Jan Dominik1, Karel Medilek1, Pavel Zacek1*, and Josef Stasek2 1 Department of Cardiac Surgery, Faculty of Medicine, Charles University Prague, University Hospital, Sokolska tr. 50, Hradec Kralove 500 05, Czech Republic and 2Department of Internal Medicine, Faculty of Medicine, Charles University Prague, University Hospital, Sokolska tr. 50, Hradec Kralove 500 05, Czech Republic * Corresponding author. Tel: þ42 49 5832143; fax: þ42 49 511953. E-mail address: zacek@fnhk.cz A 57-year-old male was admitted due to exertional dyspnoea and fatigue, which are the ﬁrst symptoms of congenitally corrected transposition of the great arteries. Unusual combination of subpulmonary obstruction caused by membranous ventricular septal aneurysm and a large pulmonary artery aneurysm was diagnosed by cineangiography (Panel A) and echocardiography (Panel B, D). The defects (Panel C) were successfully corrected by reduction pulmonary arterioplasty and interventricular septal aneurysm repair. Post-operative course was uneventful and the patient is free of symptoms at 3 months of follow-up. Panel A. Right ventriculography in left anterior oblique view: aneurysm of the membranous interventricular septum bulging into the subpulmonary left ventricular outﬂow tract. Panel B. Transthoracic echocardiography, four-chamber view in zoom: interventricular septum (IVS), aneurysm of membranous IVS (asterisk) causing outﬂow tract obstruction (arrow), right atrium (RA), and pulmonary valve (PV). Panel C. Median sternotomy: typical transpositional morphology of the great arteries with a large pulmonary artery aneurysm (8 cm in diameter). Pulmonary artery (PA), aorta (Ao), and right atrium (RA). Panel D. Transthoracic echocardiography, modiﬁed short-axis view: pulmonary artery aneurysm. Downloaded from by guest on November 7, 2014 11. Gavazzi A, De Maria R, Porcu M, Beretta L, Casazza F, Castelli G, Luvini M, Parodi O, Recalcati F, Renosto G. Dilated cardiomyopathy: a new natural history? The experience of the Italian Multicenter Cardiomyopathy Study (SPIC). G Ital Cardiol 1995;25:1109–1125. 12. Juilliere Y, Barbier G, Feldmann L, Grentzinger A, Danchin N, Cherrier F. Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy. Eur Heart J 1997;18:276–280. 13. Stenestrand U, Wallentin L. Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001;285:430–436. 14. Criteria committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. Boston, Mass: Little, Brown and Company; 1973. pp238–239. 15. Stenestrand U, Tabrizi F, Lindback J, Englund A, Rosenqvist M, Wallentin L. Comorbidity and myocardial dysfunction are the main explanations for the higher 1-year mortality in acute myocardial infarction with left bundle-branch block. Circulation 2004;110:1896–1902. 16. Hayashi T, Sakai Y, Kobayashi S, Ishii Y, Inoue T, Yamaguchi H, Morooka S. Correlation between interventricular septal motion and left ventricular systolic-diastolic function in patients with left bundle branch block. J Cardiol 2000;35:181–187. 17. Silva JA, Khuri B, Barbee W, Fontenot D, Cheirif J. Systolic excursion of the mitral annulus to assess septal function in paradoxic septal motion. Am Heart J 1996;131:138–145. 18. Lehmann KG, Lee FA, McKenzie WB, Barash PG, Prokop EK, Durkin MA, Ezekowitz MD. Onset of altered interventricular septal motion during cardiac surgery. Assessment by continuous intraoperative transesophageal echocardiography. Circulation 1990;82:1325–1334. 19. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM, Comparison of Medical Therapy, Pacing, and Deﬁbrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or 2455