Heart failure (HF) is a major burden in almost all countries. The prevalence of symptomatic HF is still high. Despite our best understanding of its pathophysiologic mechanisms and the recent advances in pharmacologic therapy, it remains a highmortality and morbidity disease. About 30-50% of patients with HF have concurrent electrical delay in the electrocardiogram (ECG), mainly in the form of LBBB.1 This kind of conduction delay commonly occurs in patients with idiopathic dilated cardiomyopathy and ischemic cardiomyopathy as well. The abnormality of left ventricle (LV) conduction will lead to a change in LV contraction pattern resulting dyssynchronized with right ventricle) contraction. Thus, a dyssynchronous LV contractile pattern usually manifested by late activation of the LV lateral wall which in turn impairs LV systolic function, reduces cardiac output, raises filling pressure and worsens mitral regurgitation2. Cardiac resynchronization therapy (CRT) improves cardiac function and exercise capacity leading to an improved survival in patients with advanced heart failure and ventricular conduction delay.3 The underlying mechanisms of these beneficial effects are not fully understood, but they appear to be related to a restored coordination of the left (LV) and right ventricular (RV) contraction and relaxation.4 These effects may directly lead to augmented contractility and reduction of LV filling pressures.5 Echocardiography has been widely used to identify patients who are candidates for CRT and to monitor the response in LV function at follow-up after device implantation. This review addresses the applications of CRT in patients with moderate– severe heart failure and the role of echocardiography in optimizing CRT including patient selection, risk and benefit of CRT and appropriate measures.
Coarctation of the aorta is a congenital anomaly presented by the combination of upper body hypertension and weak or absent femoral pulses. Increased morbidity and shortened life span of infants born with coarctation suggest that the malformation should be treated early in life. Surgical intervention has been recognized as the gold standard of treatment for children born with this defect. Unfortunately, studies in many institutions have shown that the diagnosis of coarctation of the aorta is often missed. As a consequence, many patients with coarctation of the aorta are not detected until adult life. Long-term follow-up of adult patients following surgical intervention for coarctation of the aorta reveals ongoing risks; hence, less invasive endovascular therapy becomes an alternative approach. Literature’s review was performed to compare the results of endovascular therapy (stenting and angioplasty) with surgical techniques to repair adult with coarctation of the aorta. The immediate improvement in hypertension and the morbidity were similar. Although stenting can be expected to show superiority to balloon angioplasty alone, that was not apparent when comparing these two endovascular approaches. The morbidity, mortality, and repeat intervention rates were just as high for stenting as they were for angioplasty or for a combination of both modalities. The majority of surgical complications were minor (i.e., vasculitis, bleeding), whereas the majority of endovascular complications could be considered more severe (i.e., dissection, traumatic aneurysm, stroke). Surgical therapy was associated with a very low risk of restenosis and recurrence, whereas endovascular therapy had a much higher incidence of restenosis and the need for repeat interventions. In conclusion, surgical therapy is superior compared to other modes of interventional therapy for adult with coarctation of the aorta, and it shall remain as current mode of therapy for adult with coarctation of the aorta.