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BMC Cardiovascular Disorders Jan 2019Advances in the medical and surgical management of Tetralogy of Fallot have led to marked increase of the number and age of survivors. Imaging in patients with Tetralogy... (Review)
Review
Advances in the medical and surgical management of Tetralogy of Fallot have led to marked increase of the number and age of survivors. Imaging in patients with Tetralogy of Fallot plays a crucial role in the diagnosis and follow up, and essentially guides management and intervention in this entity. This study systematically reviews the imaging modalities used in patients with Tetralogy of Fallot in the evaluation of preoperative and postoperative anatomic and hemodynamic lesions, as well as disease progression in this diagnosis. Various invasive and noninvasive imaging modalities, most commonly echocardiography and cardiovascular magnetic resonance, computed tomography and angiocardiography provide the imaging information required for diagnosis, management and follow up in Tetralogy of Fallot. The choice of the appropriate imaging tool or their combination is guided by the clinical question, the patient's clinical condition and contraindications as well as the strengths and weaknesses of each imaging modality. Tetralogy of Fallot is the most common complex congenital heart disease with long term survivors that need close follow up and complicated management, including multiple surgical and transcatheter interventions. Knowledge of the role and protocols of imaging in Tetralogy of Fallot is extremely important for the clinical as well as the imaging physician in order to optimize patients' management and long-term prognosis.
Topics: Cardiac Imaging Techniques; Cardiac Surgical Procedures; Computed Tomography Angiography; Coronary Angiography; Echocardiography; Humans; Magnetic Resonance Imaging; Postoperative Complications; Predictive Value of Tests; Retreatment; Tetralogy of Fallot; Time Factors; Treatment Outcome
PubMed: 30616556
DOI: 10.1186/s12872-018-0996-9 -
Biomedicines Jul 2023The history of arrhythmogenic cardiomyopathy (AC) as a genetically determined desmosomal disease started since the original discovery by Lancisi in a four-generation... (Review)
Review
The history of arrhythmogenic cardiomyopathy (AC) as a genetically determined desmosomal disease started since the original discovery by Lancisi in a four-generation family, published in 1728. Contemporary history at the University of Padua started with Dalla Volta, who haemodynamically investigated patients with "auricularization" of the right ventricle, and with Nava, who confirmed familiarity. The contemporary knowledge advances consisted of (a) AC as a heart muscle disease with peculiar electrical instability of the right ventricle; (b) the finding of pathological substrates, in keeping with a myocardial dystrophy; (c) the inclusion of AC in the cardiomyopathies classification; (d) AC as the main cause of sudden death in athletes; (e) the discovery of the culprit genes coding proteins of the intercalated disc (desmosome); (f) progression in clinical diagnosis with specific ECG abnormalities, angiocardiography, endomyocardial biopsy, 2D echocardiography, electron anatomic mapping and cardiac magnetic resonance; (g) the discovery of left ventricular AC; (h) prevention of SCD with the invention and application of the lifesaving implantable cardioverter defibrillator and external defibrillator scattered in public places and playgrounds as well as the ineligibility for competitive sport activity for AC patients; (i) genetic screening of the proband family to unmask asymptomatic carriers. Nondesmosomal ACs, with a phenotype overlapping desmosomal AC, are also treated, including genetics: Transmembrane protein 43, SCN5A, Desmin, Phospholamban, Lamin A/C, Filamin C, Cadherin 2, Tight junction protein 1.
PubMed: 37509658
DOI: 10.3390/biomedicines11072018 -
Diagnostic and Interventional Radiology... Jan 2023The past five decades have seen significant developments in the knowledge and practice of interventional radiology. Advancements in angiographic equipment have made... (Review)
Review
The past five decades have seen significant developments in the knowledge and practice of interventional radiology. Advancements in angiographic equipment have made interventional radiology a safe, minimally invasive preferred option in the treatment of a variety of diseases. Today, a range of catheters are available in the armamentarium of the interventional radiologist to suit different needs when conducting diagnostic angiograms or performing interventions in various vascular territories. The hardware required for interventions includes needles, wires, catheters, balloons, and stents. Catheters, in particular, are an invaluable tool for interventionists. The purpose of this review is to describe the identification characteristics, properties, and uses of the common angiographic catheters used in interventional radiology, with a special focus on peripheral vascular interventions (excluding neurointerventions).
Topics: Humans; Radiology, Interventional; Angiography; Catheters
PubMed: 36960563
DOI: 10.5152/dir.2022.21233 -
Revista Medica de Chile Feb 2022Ejection fraction (EF) is defined by the ratio of end-systolic volume (ESV) and end-diastolic volume (EDV). The resulting fraction is a dimensionless number whose...
Ejection fraction (EF) is defined by the ratio of end-systolic volume (ESV) and end-diastolic volume (EDV). The resulting fraction is a dimensionless number whose interpretation is ambiguous and most likely misleading. Despite this limitation, EF is widely accepted as a clinical marker of cardiac function. In this article we analyze the role of ESV, a fundamental variable of ventricular mechanics, compared with the popular EF. Common physiology-based mathematics can explain a simple association between EF and ESV. This concept is illustrated by a detailed analysis of the information obtained from angiocardiography, echocardiography and cardiac magnetic resonance studies. EF versus ESV produces a non-linear curve. For a small ESV, the EF approaches 100%, while for a large ESV, the EF gradually decreases toward zero. This elemental relationship is commonly observed in innervated natural hearts. Thus, the popularity of EF mostly derives from a fortuitous connection with the pivotal variable ESV. Alongside this finding, we unfold historical events that facilitated the emergence of EF as a result of serendipity. Our physiology-based approach denounces the circumstantial theories invoked to justify the importance of EF as an index of cardiac function, which are critically discussed. EF appears to be nothing more than a blessing in disguise. For this reason, we propose the ESV as a more logical metric for the analysis of ventricular function.
Topics: Echocardiography; Heart Ventricles; Humans; Magnetic Resonance Imaging; Stroke Volume; Ventricular Function, Left
PubMed: 36156650
DOI: 10.4067/S0034-98872022000200232 -
Frontiers in Surgery 2023Myxoma constitutes the main subtype of all benign cardiac tumors, tending to be more common in women and occurring mostly in the left and right atria. Its classic...
Myxoma constitutes the main subtype of all benign cardiac tumors, tending to be more common in women and occurring mostly in the left and right atria. Its classic clinical presentations are intracardiac obstruction, embolization, and systemic or constitutional symptoms, such as fever, in decreasing order. Several imaging techniques such as echocardiography, computed tomography, and angiocardiography contribute to the diagnosis of myxoma, ruling out significant coronary diseases, and assessment of myocardial invasion and tumor involvement of adjacent structures. Surgical resection is the only effective therapeutic option for patients with cardiac myxoma. Here, we report a unique case of a middle-aged man who presented with a giant myxoma and a 3-day history of chest tightness and shortness of breath after physical activity. Subsequently, transthoracic echocardiography revealed a mass of solid echodensity located within the right ventricle, complicated by abnormal hemodynamics. A cardiac computed tomographic angiography showed a large homogeneous density filling defect consuming most parts of the right ventricle and protruding from beat to beat. A surgical resection and histological study later successfully confirmed the diagnosis, and the patient's postoperative recovery course was found to be uneventful.
PubMed: 36923378
DOI: 10.3389/fsurg.2023.1140016 -
EJNMMI Physics May 2021Left ventricular ejection fraction (LVEF) is usually measured by cine-cardiac magnetic resonance imaging (MRI), planar and single-photon emission-computerized tomography...
Innovative procedure for measuring left ventricular ejection fraction from F-FDG first-pass ultra-sensitive digital PET/CT images: evaluation with an anthropomorphic heart phantom.
BACKGROUND
Left ventricular ejection fraction (LVEF) is usually measured by cine-cardiac magnetic resonance imaging (MRI), planar and single-photon emission-computerized tomography (SPECT) equilibrium radionuclide angiocardiography (ERNA), and echocardiography. It would be clinically useful to measure LVEF from first-pass positron-emission tomography/computed tomography (PET/CT) radionuclide angiography, but this approach has been limited by fast radiotracer diffusion. Ultra-sensitive digital PET systems can produce high-quality images within 3-s acquisition times. This study determined whether digital PET/CT accurately measured LVEF in an anthropomorphic heart phantom under conditions mimicking radiotracer first-pass into the cardiac cavities.
METHODS
Heart phantoms in end-diastole and end-systole were 3D-printed from a patient's MRI dataset. Reference left ventricle end-diastole volume (EDV), end-systole volume (ESV), and LVEF were determined by phantom weights before/after water filling. PET/CT (3-s acquisitions), MRI, and planar and SPECT ERNA were performed. EDV, ESV, and/or LVEF were measured by manual and automated cardiac cavity delineation, using clinical segmentation softwares. LVEF was also measured from PET images converted to 2D "pseudo-planar" images along the short axis and horizontal long axis. LVEF was also calculated for planar ERNA images. All LVEF, ESV and EDV values were compared to the reference values assessed by weighing.
RESULTS
Manually calculated 3D-PET-CT-based EDV, ESV, and LVEF were close to MRI and reference values. Automated calculations on the 3D-PET-CT dataset were unreliable, suggesting that the SPECT-based tool used for this calculation is not well adapted for PET acquisitions. Manual and automated LVEF estimations from "pseudo-planar" PET images were very close/identical to MRI and reference values.
CONCLUSIONS
First-pass "pseudo-planar" PET may be a promising method for estimating LVEF, easy to use in clinical practice. Processing 3D PET images is also a valid method but to date suffers from a lack of well-suited software for automated LV segmentation.
PubMed: 34018067
DOI: 10.1186/s40658-021-00387-2 -
Journal of the American Veterinary... Jul 2016CASE DESCRIPTION An adult sexually intact female Harris hawk (Parabuteo unicinctus) housed at a wildlife hospital was evaluated because of acute collapse during an...
CASE DESCRIPTION An adult sexually intact female Harris hawk (Parabuteo unicinctus) housed at a wildlife hospital was evaluated because of acute collapse during an educational exhibition. CLINICAL FINDINGS Physical examination and hematologic analysis revealed no abnormalities; radiography revealed findings consistent with a previous tibiotarsal fracture. Coelioscopy with histologic examination and fungal culture of lung and air sac samples revealed anthracosis but no fungal infection. The hawk was discharged and temporarily removed from the education program; 1 month later, upon reintroduction into the program, it collapsed again. Physical examination and hematologic findings were similar to those after the first episode. Transcoelomic and transesophageal echocardiography and CT angiocardiography findings were consistent with cardiomyopathy. TREATMENT AND OUTCOME Initial cardiac treatment included furosemide (0.5 mg/kg [0.23 mg/lb], PO, q 24 h) and pimobendan (10 mg/kg [4.5 mg/lb], PO, q 12 h). After 10 days of treatment, peak and trough plasma concentrations of pimobendan were measured at 25, 196 and 715.97 ng/mL, respectively; the dosage was decreased to 0.25 mg/kg (0.11 mg/lb), PO, every 12 hours. No overt signs of toxicosis were detected. A sample was collected to reevaluate plasma pimobendan concentration after 30 days of treatment; results were not obtained prior to the patient's death but revealed a peak concentration of 16.8 ng/mL, with an undetectable trough concentration. The hawk was found dead 6 months after initial evaluation. Necropsy revealed cardiomegaly, but histologic examination did not reveal an inciting cause of cardiac dysfunction. CLINICAL RELEVANCE Cardiac disease in raptors may be underreported. Transcoelomic and transesophageal echocardiography and CT angiography provided useful information for the diagnosis of cardiac disease in the hawk of this report.
Topics: Animals; Bird Diseases; Cardiomyopathies; Cardiotonic Agents; Diuretics; Falconiformes; Female; Furosemide; Pyridazines
PubMed: 27379599
DOI: 10.2460/javma.249.2.221 -
Journal of Clinical Medicine Oct 2021For patients with acute myocardial infarction scheduled to undergo percutaneous coronary stent implantation, in most cases a drug-eluting stent is recommended as the...
For patients with acute myocardial infarction scheduled to undergo percutaneous coronary stent implantation, in most cases a drug-eluting stent is recommended as the first choice for treatment. However, there is a lack of research on the effectiveness of bare-metal stents and drug-eluting stents on patients with different types of myocardial infarction. Our objective was to explore the effects of bare-metal stents and drug-eluting stents on patients with different types of myocardial infarction in terms of major cardiovascular incidents. This retrospective cohort study included 934 patients with myocardial infarction undergoing coronary artery stent implantation for the first time at the cardiac catheter room of the Tri-Service General Hospital in the Neihu District between 2014 and 2018. Patients' information, including demographic data, laboratory data, cardiac echocardiography results, and angiocardiography results, was collected by reviewing medical records. Cox proportional hazards regression was used to adjust the potential confounding factors, and the adjusted data were then used to compare the correlation between different types of stents and major cardiovascular incidents in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. After the confounding factors were adjusted, in patients with ST-elevation myocardial infarction receiving a drug-eluting stent compared with those receiving a bare-metal stent, it was found that the mortality risk was lower in terms of all causes of death (Adj-HR = 0.26, 95% CI = 0.14-0.48, < 0.001) and cardiogenic death (Adj-HR = 0.20, 95% CI = 0.08-0.55, = 0.002), the risk of non-fatal myocardial infarction was lower (Adj-HR = 0.17, 95% CI = 0.04-0.73, = 0.017), and there was no difference in the risk of revascularization at the lesion site (Adj-HR = 0.59, 95% CI = 0.24-1.43, = 0.243). It terms of the findings in patients with non-ST-elevation myocardial infarction, those receiving a drug-eluting stent had a lower risk of revascularization at the lesion site (Adj-HR = 0.48, 95% CI = 0.24-0.97, = 0.04); however, there was no difference in the mortality risk in terms of all causes of death (Adj-HR = 0.71, 95% CI = 0.37-1.35, = 0.296) or cardiogenic death (Adj-HR = 0.59, 95% CI = 0.18-1.90, = 0.379),or in the risk of non-fatal myocardial infarction (Adj-HR = 0.27, 95% CI = 0.06-1.25, = 0.093). Compared with bare-metal stents, drug-eluting stents provide better protection against death to receivers with ST-elevation myocardial infarction; however, this protection is decreased in receivers with non-ST-elevation myocardial infarction. It is recommended that for patients with non-ST-elevation myocardial infarction who are indicated to receive a drug-eluting stent, the clinical effectiveness of the treatment must be considered.
PubMed: 34768613
DOI: 10.3390/jcm10215093 -
Journal of Thoracic Disease Mar 2020To assess the diagnostic value of echocardiography in detecting the various types of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).
BACKGROUND
To assess the diagnostic value of echocardiography in detecting the various types of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).
METHODS
A total of 30 patients with an established diagnosis of ALCAPA were retrospectively analyzed, and classified into infant- (n=20) and adult-type (n=10) groups according to the age of symptom manifestation and the mode of presentation. All patients underwent echocardiography examination.
RESULTS
Twenty-four out of thirty patients were diagnosed with ALCAPA by echocardiography. The remaining six cases were confirmed by dual-source computed tomography (DSCT) and angiocardiography, respectively. In the infant-type group, there was negligible or no collateral flow between the right coronary artery (RCA) and the left coronary artery (LCA). Eighteen of these patients had enhanced echogenicity of left ventricular (LV) papillary muscles, different degrees of mitral regurgitation (MR) and the RCA to aortic annulus ratio (RCA/AO) was >0.12. In the adult-type group, all ten patients had RCA dilation and significant development of collateralization from the RCA to the dilated LCA. They all had mild MR and RCA/AO was >0.20. Preoperatively, left ventricular ejection fraction (LVEF) was significantly lower in infant-type group than in adult-type group (46.24%±5.47% 61.43%±6.38%, P<0.01). Cardiac surgery significantly improved post-operative LVEF (60.12%±6.02%, P<0.01 pre-operation) in infant-type group.
CONCLUSIONS
Echocardiography plays a pivotal role in detecting ALCAPA. Imaging and clinical features differ significantly between infant- and adult-type cases.
PubMed: 32274098
DOI: 10.21037/jtd.2020.01.28 -
Veterinary World Jan 2017The veterinarian should be able to assess congenital and inherited malformations such as heart defects because they may be object of legal disputes. In this study, the...
AIM
The veterinarian should be able to assess congenital and inherited malformations such as heart defects because they may be object of legal disputes. In this study, the authors report some cases of congenital heart defects in pets (dogs and cats) to clarify whether or not they may be considered a redhibitory defect.
MATERIALS AND METHODS
A total of 28 medical records of pets referred with suspected congenital heart disease were examined. All patients aged between 3 and 24 months underwent clinical examination, chest X-ray examination, electrocardiogram, and echocardiography and angiocardiography when necessary.
RESULTS
Congenital heart diseases or associated cardiac malformations were confirmed. Considering the above congenital diseases as redhibitory defect and the rights of the owners from a strictly legal viewpoint, 9 owners demanded an estimatory action and 11 a redhibitory action; 1 owner decided to demand the reimbursement of veterinary expenses because the animal died; 7 owners took no legal action but requested surgical intervention.
CONCLUSIONS
Until more appropriate and detailed legislation on the buying and selling of pet animals is put in place; the authors propose to include in the contract a temporal extension of the guarantee relating to congenital heart disease, which can often become evident later.
PubMed: 28246457
DOI: 10.14202/vetworld.2017.130-135