r o m e • i ta ly 2 7 a u g - 3 1 a u g 2 0 1 6 n e w s a n d t e c h n o l o g y u p d a t e s f o r c a r d i a c c a r e cardiology 2016 www.healthcare-in-europe.com www.healthcare-in-europe.com research by a team at john hopkins university (jhu) in baltimore, usa highlights the patients who are most likely to face lethal arrhythmias. when patients suffer arrhythmia, cardiologists often respond by fit- ting a small defibrillator implant to sense the onset of arrhythmia and jolt the heart back to a nor- mal rhythm. however, the ques- tion remains over how they decide which patients need the implant and the invasive surgery needed to fit it. aiming to address this, a team from the department of biomedical engineering and institute for computational medicine at jhu has developed a non-invasive 3-d virtu- al heart assessment tool to help doc- tors determine which patients face the highest risk of a life-threatening arrhythmia and would benefit most from a defibrillator implant. early evidence suggests the new digital approach yielded more accu- rate predictions than the current blood pumping measurement used by most physicians. ‘our virtual heart test significant- ly outperformed several existing clinical metrics in predicting future arrhythmic events,’ professor natalia trayanova, the university’s inaugu- ral murray b. sachs professor of biomedical engineering, said. ‘this non-invasive and personalised virtu- al heart-risk assessment could help prevent sudden cardiac deaths and allow patients who are not at risk to avoid unnecessary defibrillator implantations.’ a pioneer in developing personal- ised imaging-based computer mod- els of the heart, she has worked on the project with cardiologist katherine c wu, associate profes- sor in the johns hopkins school of medicine, whose research has focused on mr resonance imaging approaches to improving cardiovas- cular risk prediction. for the study, trayanova’s team formed its predictions by using the distinctive magnetic resonance imaging (mri) records of patients who had survived a heart attack but were left with damaged cardiac tissue that predisposes the heart to deadly arrhythmias. the study involved data from 41 patients who had survived a heart attack and had an ejection fraction – a measure of how much blood is being pumped out of the heart – of less than thirty- five percent. patients in this range are usu- ally recommended implantable defi- brillators, however, with the jhu team concerned about this measur- ing score system, they invented an alternative to these scores by using pre-implant mri scans of the recipi- ents’ hearts to build patient-specific digital replicas of the organs. using computer-modelling tech- niques developed in trayanova’s lab, the geometrical replica of each patient’s heart was brought to life by incorporating representations of the electrical processes in the cardiac cells and the communication among cells. in some cases, the virtual heart developed an arrhythmia, and in others it did not. the new non-invasive way to gauge the risk of sudden cardiac death due to arrhythmia has been named the varp (virtual-heart arrhythmia risk predictor). subsequent tests showed that patients who tested positive for arrhythmia risk by varp were four times more likely to develop arrhythmia than those who tested negative. varp predicted arrhyth- mia occurrence in patients four- to-five times better than the ejec- tion fraction and other, invasive and non-invasive, existing clinical risk predictors. ‘we demonstrated that varp is better than any other arrhythmia prediction method out there,’ trayanova confirmed. ‘by accurately predicting which patients are at risk of sudden cardiac death, the varp approach will provide the doctors with a tool to iden- tify those patients who truly need the costly implantable device, and those for whom the device would not provide any life-saving benefits.’ wu said that the early results indi- cate the more nuanced varp tech- nique could be a useful alternative to the one-size-fits-all ejection frac- tion score. trayanova is hopeful the new risk prediction methodology could also be applied to patients who had prior heart damage, but whose ejection fraction score did not tar- get them for therapy under current clinical recommendations. the next step is to conduct fur- ther tests involving larger groups of heart patients. the virtual-heart arrhythmia risk predictor natalia trayanova phd is the john hopkins university’s inaugural murray b. sachs professor of biomedical engineering in the department of biomedical engineering and institute for computational medicine. she received her doctorate at the bulgarian academy of sciences in sofia (1986) and post-doctoral training in biomedical engineering at duke university. her research focuses on understanding the normal and pathological electrophysiological and electromechanical behaviour of the heart. the virtual heart arrhythmia risk predictor. patient-specific heart models are constructed from clinical imaging data. a virtual-heart model is then used to predict the patient risk of lethal arrhythmias. identifying patients with cardiac injury at risk for lethal arrhythmias using a combination of cardiac imaging and computational simulations. from the patient’s scan (blue), a virtual heart is constructed and the presence of arrhythmia, indicated by the non- uniform electrical activation (red-yellow), is revealed. researchers have developed a personalised 3-d virtual heart that can help predict the risk of sudden cardiac death. mark nicholls reports r o m e • i ta ly 27 a u g - 31 a u g 2016

syngo.ct cardiac function – enhancement1 and syngo.ct myocardial perfusion1 with a coronary ct angiography, the diagnosis of a coronary stenosis is done easily within clinical routine. but what about the functional relevance of an intermediate lesion? will the patient actually benefit from an intervention? with syngo.ct cardiac function – enhancement you can choose from the full spectrum of myocardial perfusion: from first pass enhancement in both rest and stress assessment to late enhancement for the evaluation of scarred tissue. with its evaluation of dynamic myocardial perfusion, syngo.ct myocardial perfusion takes you to a new level in measuring the myocardial blood flow and allows you to use actual quantitative assessment for the hemodynamic relevance of intermediate stenoses of the coronaries.2 this enables you to choose the right diagnostic approach for every patient. 1 optional application 2 rossi a, pugliese f et al., eur heart j cardiovasc imaging. 2014 jan;15(1):85-94. a9ct-9425-a2-7600 siemens.com/ct-cardio-vascular-engine driving progress with the full spectrum of myocardial perfusion assessment. get further. with the ct cardio-vascular engine. 3934_ct_ad_a9ct-9425-a2-7600_a4_dd.indd 1 09.08.16 09:10 cardiology 3 www.healthcare-in-europe.com the document, which brings a series of tables providing parameters, cri- teria, and new algorithms. ‘although relatively rare, valve dysfunction does occur with prosthetic heart valves in the forms of structural valve deterioration or non-structural problems,’ he explained. ‘though often challenging, establishing the exact cause of phv dysfunction is essential to determine the appro- priate treatment strategy. the new algorithms to help clinicians diag- nose and quantify prosthetic valve dysfunction are easy to use.’ ‘in clinical practice, a compre- hensive approach that integrates several parameters of valve mor- phology and function assessed with echocardiography is key to appro- priately detect and quantitate phv dysfunction. other imaging modali- ties are complementary tools for the diagnosis and management of phv complications.’ ‘nuclear imaging currently has very limited application in the eval- uation of phv, other than in the setting of suspected infective endo- carditis,’ lancellotti explained. the chinese society of echo- cardiography, the inter-american society of echocardiography and the brazilian department of cardiovascular imaging have already endorsed the recommendations in multimodality imaging assessment hms define tic valve dysfunction nce of all imaging modalities – including ate prosthetic heart valves in a new series nigma patrizio lancellotti is head of the intensive care cardiology unit at the university of liège hospital centre and professor of clinical medicine at the university of liège. a pioneer in cardiac imaging techniques, his research has led to significant progress in the care of patients suffering functional mitral insufficiency. a former president of the european association of cardiovascular imaging (eacvi) and the author of 330 peer-reviewed publications, he was also co-chair of the task force that drafted the esc guidelines for endocarditis, promoting the need for an approach based on a multimodal imaging. er the weekend faced a higher risk of dying over the prosthetic heart valve implantation ©beerkoff/www.shutterstock.com 3934_ct_ad_a9ct-9425-a2-7600_a4_dd.indd 109.08.1609:10

intuitive. intelligent. innovative. meet aplio™ i900. engineered to help you get the information you need to make confident decisions quickly, aplio i900 elevates cardiovascular imaging to a new level of imaging precision, diagnostic performance and productivity. intelligent design intuitive workflow support ibeam architecture www.toshiba-medical.eu cardiology 5 www.healthcare-in-europe.com austrian viktor mayer-schönberger, professor of internet governance and regulation at the oxford internet institute, university of oxford, england, founded ikarus software in 1986, which focuses on data security. given his interest in ‘big data’, he researches the role of information in a networked economy. he has authored numerous articles and seven books including ‘delete: the virtue of forgetting in the digital age’. r with 7-t magnetic field-strength cardiomyopathy pared to 3-t,’ the professor added. ‘this translates into being able to acquire the same quality data in five minutes that previously took 30 minutes, or into being able to use a finer spatial resolution, or into being able to measure other metabolites, such as inorganic phosphate which occur at lower concentrations in the body and were not visible in our scans.’ in the healthy heart, the con- centration ratio of phosphocreatine (pcr) – the primary energy buffer of heart muscle cells - to adenosine triphosphate is approximately 2:1. ‘in the failing heart,’ rodgers added, ‘the concentration ratio drops to around 1.5:1. we measured this change in our group at 3-t and 7-t. the more sensitive 7-t experi- ment, in theory allowed us to detect changes in less severe cases of dilated cardiomyopathy than in the cohort we studied.’ whilst still at the basic research stage, rodgers believes the primary impact on patient treatment is that these more sensitive measurements facilitate trials of new treatments such as new drugs, devices, or lifestyle modifications, because the imaging can detect smaller improve- ments or deteriorations in the heart’s metabolic status than were previously visible. ‘it ought to be possible to detect earlier improvement in response to treatment, and to quantify the rela- tive merits of different treatments more accurately,’ he said. ‘we are also planning studies to understand the interplay between heart disease and disease in other organs, e.g. type ii diabetes, or obesity. ‘having treatments that have been based on a more rigorous under- standing of the heart’s biochemis- try will hopefully mean they will be more effective at treating heart disease.’ research centres and teaching hospitals will also benefit, with the new approach helping improve understanding of the heart’s metab- olism in clinical studies. big data: a revolution that will transform how we live, work, and think by viktor mayer-schönberger and kenneth cukier; published by hodder & stoughton, uk 2013; price 7,99 euro. isbn: 9781848547926 © rogers/radiology

sonosite, and the sonosite logo are trademarks and registered trademarks of fujifilm sonosite, inc. in various jurisdictions. fujifilm is a trademark and registered trademark of fujifilm corporation in various jurisdictions. all other trademarks are the property of their respective owners. copyright © 2016 fujifilm sonosite, inc. all rights reserved. subject to change. 2504_ 07/16 the way ultrasound is used at the point of care can help drive and change patient care every day. ahead lies a continuing demand and desire for increased standards of quality for healthcare delivery, for everybody. and so too does the demand for ultrasound: more available, more connected, more at the patient’s side. we share your desire to overcome the obstacles standing in the way of patient care, constantly evolving ultrasound technology to help you get the right answers at the right time. with you we break down the barriers. you make us what we are. see why we continue to put ultrasound machines in your hands. contact your local customer representative or email eraf-sales@sonosite.com for further information. breaking the barriers cardiology 7 www.healthcare-in-europe.com in the fast-evolving field of left atrial appendage closure a new study has delivered data that could ben- efit thousands of patients at risk of stroke. led by professor martin bergmann, head of interventional cardiology at cardiologicum hamburg in germany, the ewolution study was conducted to evaluate the watchman left atrial appendage (laa) closure device from manufacturer boston scientific. ‘the laa field is evolving very quickly for stroke protection, mainly in the elderly.’ professor bergmann explained. ‘anti-coagulants are a great step forward yet have left many patients with bleeding compli- cations, so these drugs are not the solution for all patients.’ the laa is believed to be the source of more than 90% of stroke- causing clots that come from the left atrium in people with non-valvular atrial fibrillation. in recent years laa closure has been seen as an alternative, though progress has been held back because of hesitancy among gps, neurologists and non-interventional cardiologists to refer patients for the procedure because there was no clear data on success rates. however, the recently pub- lished three-month results from the ewolution registry found that laa closure with the boston scientific watchman device has a high success rate in complete laa closure with low peri-procedural risk. ‘we can now say that, irrespec- tive of post procedural drug regi- men, the risk of thrombus on the device is quite low, even in patients that have not received any oral anti- coagulation because of their bleed- ing risk,’ bergmann confirmed. the success of the trial, he added, will see more patients becoming candidates for laa closure. in europe, two laa closure devic- es are currently available - each with a different approach - but bergmann said the watchman device – which is anchored in the distal part of the laa and closes laa right at the entrance leaving the ridge to the pulmonary vein free – is the only one now underpinned by prospec- tive data. watchman is a catheter-delivered heart implant designed to close the left atrial appendage to prevent the migration of blood clots from the laa, and thus, reduce the incidence of stroke and systemic embolism for higher risk patients with non- valvular af. many patients are still being denied anticoagulation, he pointed out, because there are compliance issues, leaving them with a high stroke risk. however, he added: ‘ewolution should pave the way in europe to solidly establish laa closure in routine practice as one of the options that is available.’ dual antiplatelet therapy (dapt) following the implant also appears to be safe. data from the prospective multi- centre registry show that the implant procedure was successful in 98.5% of cases; 99% of implanted devic- es presented no or minimal peri- device leakage at the first follow-up, assessed by peri-procedural trans oesophageal echocardiogram (tee); device or procedure related seri- ous adverse events (sae) rates at 92 days were similar if patients were treated with warfarin or dapt; rates for bleeding sae were also simi- lar if warfarin or dapt was used post-implantation (4.8% vs. 3.6%, respectively). following watchman implan- tation, bergmann added, 6% of patients received no anticoagula- tion, 27% received oral anticoagula- tion (16% warfarin and 11% novel oral anticoagulants - noacs), 60% received dual antiplatelet therapy (dapt) and 7%of patients were on single antiplatelet therapy. stroke (0.4%) and bleeding (4.1%) rates were low overall and did not vary by post-implantation medica- tion. the study, the professor said, is a significant step forward in the treatment of such patients and in the field of stroke preven- tion. ‘we especially see the procedure being adapted in rising numbers in the inter- ventional field because we see a lot of patients who have no indi- cation for pulmonary vein isolation but have a problem with stroke pre- vention based on atrial fibrillation.’ one factor to emerge from the trial was with the 11% of patients treated with noacs, who post-pro- cedurally had the best data. ‘to be able to use noacs for this therapy, which has the advantage of very short half-life,’ bergmann added, ‘means that it may be even better than dual anti-platelet therapy, but this is something we will have to test in randomised trial or larger numbers.’ more at risk patients will become candidates for laa closure device trial could benefit stroke patients transmission success rate of 93.8pc, which is really exceptional. ‘biotronik has invested heav- ily over the years in its home monitoring system and that is borne out in this trial. the most important aspect with the devices is the abil- ity to make a diagnosis, that comes first and foremost, as well as the implantation procedure being not too invasive,’ ooi pointed out. biotronik home monitoring trans- mits patient heart data automatically on a daily basis, rapidly detecting deterioration in a patient’s clinical status. early detection of clinically rel- evant events, in particular paroxys- mal and asymptomatic arrhythmias, such as atrial fibrillation, enables the physician to adapt patient therapy at a very early stage. an interventional cardiologist, professor martin bergmann md heads interventional cardiology at cardiologicum hamburg in germany, a high volume pci centre. his focus is on structural heart work including tavi, mitral clip, laa, pfo and asd procedures. more than 1,000 patients are part of the ewolution registry across 45 centres. sze-yuan ooi md is a coronary inter­ ventionist and cardiac device implanter at the eastern heart clinic and prince of wales hospital in sydney, australia. his research interests include new coronary stents and implantable device technology, coronary inflammation, coronary physio­ logy and pressure wire technology. laa with watchman device device held by physician continued on page 8

headquarters: schiller ag, altgasse 68, ch-6341 baar phone +41 41 766 42 42, fax +41 41 761 08 80 sales@schiller.ch, www.schiller.ch designed for users who value state-of-the-art technology, schiller’s cardiovit ft-1 offers: easy 1-2-3 steps outstanding signal quality for adult and paediatric ecg bidirectional wi-fi communication improved interpretation algorithm with etm sport for athletes maximum performance in a compact electrocardiograph explore the new ecg world: schiller’s cardiovit ft-1 visit us at the esc in rome 27.8.-31.8.2016 e4-0200 eh_2016-08_ft-1_210x297_en.indd 1 11.08.2016 10:41:59 cardiology 9 www.healthcare-in-europe.com from page 6 d versatility increase hospital zurich, who discussed how earlier management of atrial and ventricular arrhythmias is enabled by detection with icms, and dr niraj varma, from the cleveland clinic, who spoke about improving out- come of icd and crt-d patients by continuous remote monitoring. ‘efficient workflow and robust transmissions are critical to leverag- ing the benefits of remote monitor- ing,’ varma said. biotronik home monitoring facilitates this with daily automatic transmissions that pre- serve the highest order of data integrity, and are yet easy to handle. ‘this is a key reason why this system has been associated with improved clinical outcomes in sev- eral trials and why the current remote monitoring guidelines are based largely on home monitoring data,’ varma explained.’ professor josep brugada is medical director of the cardiovascular institute, at hospital clínic, university of barcelona, spain, and a past president of the european heart rhythm society. with his brothers, pedro and ramon, he identified brugada syndrome, a genetic disease characterised by abnormal electrocardiogram (ecg) findings and an increased risk of sudden cardiac death. the group of patients treated with sonr was 75%, compared to 70.4% in the echo group. it also emerged that optimisation with sonr resulted in a significant improvement in clini- cal response for patients with atrial fibrillation and renal dysfunction. professor brugada from the cardiovascular institute, hospital clinic, university of barcelona, said: ‘in order to deliver the very best crt treatment to our heart failure patients, there has been a real need for an optimisation solution that is both automatic and efficient. ‘the results of the respond-crt trial have shown that sonr perfectly meets this need. the high rates of responders together with the ben- eficial improvements in clinical out- comes indicate a significant advance- ment in crt therapy, one that will allow us to better treat a larger num- ber of heart failure patients. ‘automatic optimisation with sonr was as effective as echo-guided opti- misation - 75% v 70.4% – so the primary efficacy end point was met, that a clinical response was in favour of sonr but especially patients with history of af and renal dysfunction, and optimisation, using the sonr contractility sensor, showed signifi- cant reduction of 35% in rates of heart failure hospitalisation during long-term follow up.’ implanted cardiac resynchronisa- tion devices resynchronise the con- tractions of the ventricles of the heart by sending tiny electrical impulses to the heart muscle, helping the heart to pump blood more efficient- ly throughout the body. the sonr sensor uses measurements of car- diac contractility to optimise cardiac resynchronisation therapy. singh, from massachusetts general hospital, boston, explained that although echo-guided optimisation was considered the gold standard in terms of reducing the number of non-responders to crt, it was not widely used because of the com- mitment of time and resources it requires, as well as patients needing to attend the clinic. he added that the sonr can optimise av and vv intervals on a daily basis and on weekly basis for both rest as well as for exercise so patient do not have to come into the clinic or have echo guided optimisation. ‘the device using the sensors can automatically optimise the heart, overcoming the inadequacies of existing optimisation strategies and logistical issues with echo-guided optimisation strategies.’ respond-crt was a prospective, multicentre, randomised, double- blind study designed to evaluate the safety and efficacy of the sonr system. 1,039 patients were enrolled at 125 sites in europe, the usa and australia, who were implanted with a crt-d (cardiac resynchronisation therapy and defibrillation) device, which combines the function of an implantable cardiac defibrillator (icd) with cardiac resynchronisation therapy (crt). patients were randomised 2:1 to receive either av or vv optimisation with sonr or echocardiography, with the study meeting all of its primary safety and efficacy end points. continuous cardiac resynchronisation reduces hospitalisation ng af and renal ion care nce of all imaging modalities – including ate prosthetic heart valves in a new series phone +41417664242, fax +41417610880 eh_2016-08_ft-1_210x297_en.indd 111.08.201610:41:59

cardiology 11 www.healthcare-in-europe.com editor-in-chief: brenda marsh art director: olaf skrober managing editor: sylvia schulz editorial team: sascha keutel, marcel rasch senior writer: john brosky executive director: daniela zimmermann founded by heinz-jürgen witzke correspondents austria: walter depner, michael kraßnitzer, christian pruszinsky. china: nat whitney france: annick chapoy, jane macdougall.germany: anja behringer, annette bus, bettina döbereiner, matthias simon, axel viola, cornelia wels-maug, holger zorn. great britain: brenda marsh, mark nicholls. malta: moira mizzi. poland: pjotr szoblik. russia: olga ostrovskaya, alla astachova. spain: mélisande rouger, eduardo de la sota. switzerland: dr. andré weissen. usa: cynthia e. keen, i.t. communications, nat whitney. subscriptions janka hoppe, european hospital, theodor-althoff-str. 45, 45133 essen, germany subscription rate 6 issues: 42 euro, single copy: 7 euro. send order and cheque to: european hospital subscription 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siemens equipment 55% of heart recipients now survive for 10 years 3-d transducers prove their mettle in cardiology transplants – a much neglected topic the 3-d tee transducer is fast and offers high volume a small report in the press prompt- ed examination of a much neglected topic. the report read ‘heart centre at university hospital no longer carries out transplants’, and referred to the university hospital frankfurt, one of the 22 heart centres that perform these transplantations. so what happened? only four trans- plants were carried out there between 2010 and 2013, and in 2014 and 2015 only two to three were performed per year. why? the same report also men- tioned that around thirty patients per year wait for donor hearts at this hos- pital. donor hearts continue to be in short supply, and organ donation is the problem. there have bee n no improvements in that situation, not only in frankfurt, or all of germany, but also across europe and globally. the ratio between those who received donor hearts and those waiting for donor hearts is increasingly unfavourable. figures from switzerland show an ‘average’ european example: when 33 people received donor hearts in 2005 not even double that number. i.e. 63, were waiting for donor hearts at the time. ten years later, in 2015, the number of transplants‘only’ increased to 40, whilst the number of patients on the waitlist increased to 134. in germany, says professor f w mohr, president of the german society for thoracic and cardiovascular surgery, more than 1,000 patients are currently one of the first facilities to pur- chase a complete set of the 3-d tee transducer, including the equipment, was the department of cardiology and angiology at university hospital magdeburg, as thomas groscheck, specialist physician for internal medicine at the echocardiography lab explains. since july 2015 he has worked with the new siemens transducer – and is enthusiastic. ‘in our department we treat all types of cardio-vascular disease, from cardiac insufficiency to hyperten- sion, valve repair and aortic valve replacement,’ thomas groscheck explains. ‘we perform all neces- sary studies prior to an intervention and do the follow-up for all car- diac patients, particularly those who underwent valve surgery or received a valve replacement.’ this is where the 3-d tee transducer comes in very handy. ‘what’s so special about this 3-d probe is that it is fast and offers high volume’, the specialist explains. this allows live images with a high frame rate, particularly in 3-d, which is very interesting during valve interventions. ‘i found the hardware and the software in the equipment to be very fast. thus you get high temporal and spatial waiting for donor hearts. however, only 320 hearts were actually transplant- ed. ‘the average patient has very little chance of receiving a donor heart. the organs donated are only allocated to particularly urgent cases,’ mohr explains. at the beginning of the 1990s still more than 420 heart transplants a year were carried out. the allocation of donor hearts in eight european countries (germany, belgium, netherlands, luxembourg, austria, slovenia, hungary and croatia) is coordinated by eurotransplant based in leiden, netherlands. the allocation is based on medical criteria, with no consideration given to national or any other criteria. eurotransplant works with a catchment area of 135 million people across europe. there are simi- lar organisations in scandinavia, cover- ing about 25 million people, or for eastern europe, along with the inter- nationally active society for heart and lung transplantation based in addison (texas, usa). a look at international figures and developments helps to better under- stand the situation. as is known, the first ever heart transplantation was carried out by professor christiaan barnard and a 31-strong team in south africa in 1967. the number of operations increased to 100 transplants (worldwide) in 1980 and to 4003 in 1990, with reported figures of 4203 in 1992, 4364 in 1993, 4429 in 1994 and 4396 in 1995. according resolution with regard to valve visu- alisation in 3-d. this translates into much better quality than our previ- ous transducers delivered.’ length of examination in terms of time spent on exami- nations the new tool also offers benefits. ‘the prep examination for a valve intervention takes ten min- utes on average,’ according to mr groscheck. ‘image acquisition and patient handling pre- and post-exam take about twenty minutes. after to the society for heart and lung transplantation, a total of 80,106 heart transplantations were carried out in 300 officially designated centres between 1967 and 2007. from the mid-1990s the numbers decreased continuously to around 3,000 per year. significantly better and more effective prophylaxis and major advanc- es in treatment, along with the lack of donor organs, are considered the rea- sons for this decline. in january 2016 more than 10,000 patients were waiting for donor hearts across the eight european countries coordinated by eurotransplant. if it had not been for advances in treatment the number of those waiting for donor hearts would be much higher still, say the specialist medical societies. however, documenting advantages and disadvantages with statistics does not do justice to the topic of heart trans- plantations. the history of heart transplants is also one of particular success. as is known, the first person to receive a donor heart, transplanted by prof. christiaan barnard in 1967,‘only’ survived the operation for 18 days. in those days the prospects of a ‘longer’ life after the operation were also generally not particularly rosy. however, over the course of the years and decades not only the surgical pro- cedures and the expertise and routines improved but also the direct care and aftercare for patients. that time all images are available, including the valve models.’ data acquisition is fast and the analysis can be speeded up when all tools for automatic valve assessment are used. the raw data that are gener- ated and which, theoretically, can be read by any machine, are turned into dicom images, which in turn can be viewed with any dicom viewer.’ handling transducer handling has been one of the main problems was, and remains, rejection of the donor organ. not least through the discovery and development of the immune suppres- sor cyclosporine has it been possible to achieve major success in this field. this ring-shaped, small protein which con- sists of 11 amino acids was discovered by the swiss biologist hans peter frey in 1969 and was publicised in the 1970s. it then led to the development of other, very effective drugs. it is assumed that the current, five- year survival rate is around seventy-five percent and the ten-year survival rate is still at around fifty-five percent to conclude, there are three things we can hope for: firstly, that the num- ber of those requiring donor hearts will continue to fall due to improved medical knowledge and prophylaxis, along with healthier lifestyles in large parts of the population. secondly, that the number of organ donors increases rather than decreases, and lastly that the survival rate con- tinues to increase closer towards the 100% mark through more experience, knowledge, routine and capabilities of the surgeons, along with advances in technology and aftercare. improved. with its plastic grip it is lighter than metal models. ‘this makes the transducer easy to handle,’ the physician reports. ‘nevertheless it takes some to get used to the new probe. the head is a bit more angular, not quite as round as we were used to. the loca- tion of the function buttons and the two knobs to control transducer head movement could be improved ergonomically. the control elements are no longer centred, which means the probe has to be held in a certain way in order to use it in an optimum way.’ however, these are the only handling issues thomas groscheck encountered with the new trans- ducers. temperature advantages there is one feature groscheck is particularly enthusiastic about: ‘with this transducer, temperature issues are a thing of the past. finally! although the device does have a cooling mode with reduced trans- mission performance, i have never been compelled to us it. despite the fact that in 3-d mode the trans- ducer heats up to about 40 °c, i always could easily complete longer sequences.’ thus interruptions due to overheating – a common prob- lem in longer examinations with high sound intensity, particularly in 3-d – are no longer required. ‘in 3-d mode, the 3-d tee transducer works for minutes without any tem- perature problems. that makes life much easier for patient and physi- cian alike. obviously, patient safety has been considerably improved with this device,’ groscheck points out. hand in glove the overall interaction of all ele- ments and components of the new transducer convinced the expert. ‘with a bit of training using the transducer is no problem. transducer, software, and process- ing programmes for the valve mod- els – they are all well aligned and integrate easily in any daily work- flows. even though the device with all its functions and settings might seem a bit technologically intimi- dating at first, actually using it is a real pleasure particularly because it works without a hitch and the individual components work hand in glove,’ groscheck sums up. thomas groscheck is an internal medicine specialist in the echo­ cardiography lab in the cardiology and angiology department, university hospital magdeburg. following his initial training as a nurse he attended medical school at charité – university hospital berlin. he is currently completing his doctorate. walter depner, writer and consultant specialising in the laboratory field phone: +86-0755-81324036 phone: +496735912993, e-mail: rm@european-hospital.com phone: +33493587743, e-mail: ej@european-hospital.com phone/fax: +31180620020 & pr co., ltd., phone: +972-3-6955367 phone: +8227301234, e-mail: chp@european-hospital.com tel: +13018696610, e-mail: hp@european-hospital.com