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Magnetic Resonance Imaging Clinics of... Feb 2003The accurate evaluation of cardiac masses by MR imaging was established in the infancy of cardiac MR imaging. From its advent, MR imaging was believed to be... (Review)
Review
The accurate evaluation of cardiac masses by MR imaging was established in the infancy of cardiac MR imaging. From its advent, MR imaging was believed to be diagnostically superior to echocardiography in the evaluation of suspected cardiac masses. Though excellent in its assessment of the left side of the heart, echocardiography is limited in its evaluation of the right heart, mediastinum, and paracardiac structures. It is also of limited use in patients with emphysema and chest wall deformities. With the advent of ECG gating, MR imaging's ability to assess the presence and anatomy of cardiac and paracardiac masses was well established by a number of studies. This research also demonstrated MR imaging's capacity to exclude a cardiac mass when the echocardiogram was equivocal.
Topics: Contrast Media; Diagnosis, Differential; Heart Neoplasms; Humans; Magnetic Resonance Imaging; Myocardium; Neoplasm Metastasis; Pericardial Effusion; Pericardium
PubMed: 12797518
DOI: 10.1016/s1064-9689(02)00047-8 -
The Annals of Thoracic Surgery Mar 2013Skeletal chest wall reconstruction can be a challenge, depending on the indication, location, and health of the patient; various materials are available. Recently,... (Comparative Study)
Comparative Study
BACKGROUND
Skeletal chest wall reconstruction can be a challenge, depending on the indication, location, and health of the patient; various materials are available. Recently, biomaterials that are remodelable (bovine pericardium patch; Veritas, Synovis Life Technologies Inc, St Paul, MN) or absorbable (polylactic acid [PLA] bar; BioBridge, Acute Innovations, Hillsboro, OR) have been introduced for reconstruction procedures.
METHODS
We performed a retrospective review of all patients who underwent chest wall stabilization or reconstruction between July 1, 2009, and March 31, 2011.
RESULTS
Biomaterials were used in 25 of 112 patients (22%) who underwent chest wall stabilization or reconstruction, and they form the basis of this review. Indication for reconstruction was malignant disease in 17 patients (68%). Overall, 10 (40%) resection sites were infected preoperatively. Reconstruction was performed with a combination of bovine pericardium and PLA bars in 11 patients (44%), bovine pericardium alone in 10, and PLA bars alone in 4; muscle flaps were interposed in 7 patients (28%). There were no operative deaths. Complications occurred in 6 patients (24%). Median follow-up was 12 months (range, 6 to 27 months). Three patients required removal of their biomaterials. Two bovine pericardial patches were removed prophylactically at the time of debridement of a partially necrotic muscle flap, and 1 PLA bar was removed because of an inflammatory reaction. None of the patients with an infected resection site required removal of their biomaterial.
CONCLUSIONS
Chest wall reconstruction with biomaterials is a valuable option in the management of patients with chest wall abnormalities. Early results are promising. Biomaterials may be the preferred method of reconstruction for infected chest wall sites.
Topics: Acrylic Resins; Adult; Aged; Aged, 80 and over; Animals; Biocompatible Materials; Cattle; Female; Humans; Male; Middle Aged; Pericardium; Retrospective Studies; Surgical Flaps; Surgical Mesh; Thoracic Neoplasms; Thoracic Surgical Procedures; Thoracic Wall; Thoracoplasty; Transplantation, Heterologous; Treatment Outcome; Young Adult
PubMed: 23333060
DOI: 10.1016/j.athoracsur.2012.11.024 -
Nutrition, Metabolism, and... Apr 2014Morbid obesity is often accompanied by insulin resistance and increased ectopic fat surrounding the heart. We evaluated the relation of epicardial and pericardial fat...
BACKGROUND AND AIM
Morbid obesity is often accompanied by insulin resistance and increased ectopic fat surrounding the heart. We evaluated the relation of epicardial and pericardial fat with insulin resistance and left ventricular (LV) structure and function.
METHODS AND RESULTS
Epicardial and pericardial fat thicknesses were determined at 2-dimensional echocardiography in 80 morbid obese subjects [age 42 ± 12 years, 31% men, body mass index (BMI) 44.4 ± 7 kg/m(2)]. LV hypertrophy (LV mass ≥51 g/m(2.7)), inappropriately high LV mass for a given cardiac workload (observed vs predicted LV mass >128%), and stress-adjusted LV mid-wall fractional shortening were determined. Pericardial and epicardial fat thicknesses had direct associations with BMI (r = 0.40 and 0.45, both p < 0.01) and waist circumference (r = 0.37 and 0.45, both p < 0.01). Pericardial (partial r = 0.35, p < 0.01), but not epicardial fat thickness (partial r = 0.05, p = n.s.), was correlated with homeostasis model assessment-insulin resistance after adjustment for BMI. Pericardial fat also had a strong negative correlation with mid-wall fractional shortening (p = 0.01) and a positive one with inappropriately high LV mass (p < 0.01), while no such relation was found for epicardial fat (both p = n.s.). Independently of age, male sex, BMI, and anti-hypertensive treatment, pericardial fat thickness had an independent positive association with inappropriately high LV mass (β = 0.29, p = 0.02), and a negative one with stress-adjusted mid-wall fractional shortening (β = -0.26, p = 0.04).
CONCLUSIONS
Pericardial fat thickness is associated with insulin resistance, inappropriately high LV mass, and LV systolic dysfunction in obese individuals. Findings from this study confirm the existence of a connection between insulin resistance, cardiac ectopic fat deposition and cardiac dysfunction in morbid obesity.
Topics: Adipose Tissue; Adiposity; Adult; Biomarkers; Body Mass Index; Cross-Sectional Studies; Female; Humans; Hypertrophy, Left Ventricular; Insulin Resistance; Male; Middle Aged; Obesity, Morbid; Pericardium; Risk Factors; Ultrasonography; Ventricular Dysfunction, Left; Ventricular Function, Left; Waist Circumference
PubMed: 24368081
DOI: 10.1016/j.numecd.2013.09.016 -
International Journal of Cardiology Mar 2019Obesity is a heterogeneous disease with different degrees of cardiovascular (CV) and metabolic manifestations. Certain ectopic fat depots may contribute to... (Review)
Review
Obesity is a heterogeneous disease with different degrees of cardiovascular (CV) and metabolic manifestations. Certain ectopic fat depots may contribute to obesity-related CV risk and may explain part of the risk differential observed in metabolically healthy obese and the so called "obesity paradox". The growing interest towards the potential impact of epicardial adipose tissue (EAT) in cardiovascular (CV) risk has led to deepen its biological function. Genetic, epigenetic and environmental factors may drive the shift towards a dysfunctional EAT characterized by a pro-inflammatory and pro-fibrotic phenotype. Due to the close anatomic proximity to coronary arteries, a thicker and dysfunctional EAT actively contribute to development and progression of coronary atherosclerosis. Beside classical paracrine transmission, EAT may directly release mediators into the vasa vasorum of the coronary arterial wall, a mechanism referred to as "vasocrine". Similarly, the pro-inflammatory and pro-fibrotic secretome characterizing dysfunctional EAT may impair cardiac structure and function, thus being implicated in the pathogenesis of diastolic heart failure and atrial fibrillation. The development of 3D imaging techniques have paved the way for clarifying the causative role of EAT in CV pathophysiology, the use of EAT volume/thickness in CV risk stratification and potential cardio-protective effects of EAT reduction. The aim of this narrative review is to update current knowledge on the pathophysiological functions of EAT, focusing on basic mechanisms and potential clinical implications.
Topics: Adipose Tissue; Animals; Cardiovascular Diseases; Coronary Artery Disease; Humans; Inflammation Mediators; Obesity; Pericardium
PubMed: 30297191
DOI: 10.1016/j.ijcard.2018.09.089 -
Reumatizam 2016Rheumatic disorders can be associated with pericarditis, but severe forms of pericarditis are rare. The aim of this observational study was to evaluate pericardial... (Observational Study)
Observational Study
Rheumatic disorders can be associated with pericarditis, but severe forms of pericarditis are rare. The aim of this observational study was to evaluate pericardial features in patients with different rheumatic diseases. Thirty-five patients hospitalized at the Clinic of Rheumatology, University Clinical Center of Kosovo, from October 1 to October 21, 2014 were included in the study. Demographic data, history, laboratory, ECG, and echocardiography data, with special emphasis on the analysis of the pericardium, were obtained from each patient. Echocardiography was especially focused on the amount of pericardial fluid and pericardial thickness in the posterior wall of the heart. Mean patient age was 51.5 ± 13.8 years. 65.7% of the patients were women. Out of the patients that we analyzed, 88.6% had an inflammatory rheumatologic disease. 11.3% of the patients had mild symptoms, in 68.7% the symptoms were moderate, and in 20% severe. In all patients, pericardial hyperechogenicity was marked, with a mean pericardial thickness of 4.68 ± 1.66 mm. Pericardial effusion in a small amount was present in 57.1% of patients, with a mean pericardial fluid amount of 3.3 ± 1.9 mm. The severity of rheumatic disease had a positive and significant correlation with the presence of pericardial effusion (r= 0.29, p=0.04) and its amount (r= 0.28, p=0.05). The patients had not been aware of the pericardial involvement and did not have any clinical symptoms. In conclusion, in this short-term small observational study pericardial changes were a frequent finding in the rheumatology patients. In general, the pericarditis was subclinical and with small amounts of effusion. The disease activity of rheumatic disorders can be associated with pericarditis. Further studies with larger samples of patients and of longer duration are needed to further explore this issue.
Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pericarditis; Pericardium; Rheumatic Diseases
PubMed: 29624035
DOI: No ID Found -
Clinical Radiology May 2023To report the prevalence of pericardial diverticulum of the right lateral superior aortic recess (RSAR) on computed tomography (CT), to analyse the structural CT...
AIM
To report the prevalence of pericardial diverticulum of the right lateral superior aortic recess (RSAR) on computed tomography (CT), to analyse the structural CT findings of whether or not the structure is large enough to be seen on chest radiographs, and to describe changes in size and shape of RSAR on follow-up CT.
MATERIALS AND METHODS
A well-circumscribed, fluid-attenuation lesion in the anterior mediastinum with the following CT features was defined as a pericardial diverticulum of the RSAR: no enhancing wall, communication with the RSAR, abutment to the heart with an acute angle, and moulding by adjacent structures. Chest CT images of 31 patients with the diverticulum were evaluated, including four selected from 1,130 consecutive patients (0.4%).
RESULTS
The diverticulum projected ventrally from the RSAR and its largest size on axial CT ranged between 12-56 mm. Although the RSAR and the largest diverticular portion were usually seen on the same axial image (n=19), the latter sometimes lay above (n=1) or below (n=11) the former. On sagittal images, the last 11 diverticula resembled teardrops hanging from the RSAR by small stems. All of the 24 patients, each with 1-31 follow-up CT examinations, showed size fluctuations ranging between 1-46 mm (mean, 16 mm) during a follow-up period of 0.5-172 months (mean, 65 months). The diverticulum was not identifiable in five cases and was identifiable but did not show a connection with the RSAR in three cases when the diverticulum was smallest in size.
CONCLUSIONS
In cases of cystic anterior mediastinal mass, a deliberate search for its connection with the RSAR on all available CT images including previous studies is necessary for the diagnosis of pericardial diverticulum of the RSAR.
Topics: Humans; Heart Diseases; Mediastinal Diseases; Pericardium; Tomography, X-Ray Computed; Mediastinum; Diverticulum
PubMed: 36890015
DOI: 10.1016/j.crad.2023.02.005 -
The Journal of Antimicrobial... Feb 1997The concentrations of teicoplanin in serum, pericardium, pericardial fluid and thoracic wall fat were measured in patients undergoing cardio-pulmonary bypass (CPB) after...
The concentrations of teicoplanin in serum, pericardium, pericardial fluid and thoracic wall fat were measured in patients undergoing cardio-pulmonary bypass (CPB) after the administration of a single i.v. 12 mg/kg dose. Five minutes after the start of CPB, teicoplanin serum concentrations decreased by, on average, 35% (95% confidence interval (CI): 28-42%) and remained significantly lower than the expected values over the subsequent 60 min period. After aortic unclamping drug concentrations rebounded but remained significantly lower than the expected values in the next 60 min. Immediately before CPB, penetration of teicoplanin in pericardium and thoracic wall fat was 0.44 (95% CI: 0.23-0.65) and 0.05 (95% CI: 0.03-0.7), respectively, and increased at the end of CPB to 0.90 (95% CI: 0.55-1.25) and 0.17 (95% CI: 0.05-0.29), respectively. MICs for most staphylococcal strains were attained during CPB procedure in pericardium but not in thoracic wall fat. However, since staphylococcal infections involve the interstitial space it is likely that penetration into fat cells is not important for antimicrobial prophylaxis. In this respect, it is worth noting that drug concentration in pericardial fluid, which should reflect the interstitial concentration, was higher than the MIC for most staphylococcal strains. Although no infective complications were observed in our limited series of patients, larger clinical trials are needed to assess whether the dose regimen employed is effective in preventing post-CPB surgery infections.
Topics: Adipose Tissue; Aged; Anti-Bacterial Agents; Cardiopulmonary Bypass; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pericardium; Teicoplanin; Thorax
PubMed: 9069544
DOI: 10.1093/jac/39.2.229 -
Journal of the American Veterinary... Dec 1989Seven puppies with concomitant congenital cranioventral abdominal wall, caudal sternal, diaphragmatic, and pericardial defects were treated surgically when they were...
Seven puppies with concomitant congenital cranioventral abdominal wall, caudal sternal, diaphragmatic, and pericardial defects were treated surgically when they were between 10 and 12 weeks old. Three pups had ventricular septal defects that were not corrected. Diaphragmatic herniorrhaphy without extension of the diaphragmatic defect was performed in 6 pups. In one pup, paracostal extension of the diaphragmatic defect was necessary to decrease tension on the diaphragmatic closure. All pups were healthy at 6-month follow-up examinations, but 2 of 3 pups with ventricular septal defects had moderate generalized cardiomegaly evident on thoracic radiography. Early surgical correction of the congenital defects in these pups was usually simple because there were few or no thoracic adhesions, the dogs were small, the defects were small in 6 of 7 dogs, and the costal arch was pliable in each dog.
Topics: Abdominal Muscles; Abnormalities, Multiple; Animals; Diaphragm; Dog Diseases; Dogs; Female; Male; Pericardium; Sternum; Syndrome
PubMed: 2532191
DOI: No ID Found -
European Heart Journal Jul 2022
Topics: Animals; Esophageal Perforation; Foreign Bodies; Pericardium; Punctures
PubMed: 35574819
DOI: 10.1093/eurheartj/ehac258 -
European Journal of Cardio-thoracic... 1995
Topics: Aged; Fibrin Tissue Adhesive; Heart Rupture; Humans; Pericardium; Suture Techniques; Treatment Outcome
PubMed: 7748576
DOI: 10.1016/s1010-7940(05)80022-3