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Heliyon Apr 2024We aimed to evaluate the safety and efficacy of radiation dose reduction with a new-generation biplane angiocardiography system in patients undergoing transcatheter...
OBJECTIVE
We aimed to evaluate the safety and efficacy of radiation dose reduction with a new-generation biplane angiocardiography system in patients undergoing transcatheter isolated patent ductus arteriosus (PDA) closure.
MATERIALS AND METHODS
Fifty pediatric patients who underwent transcatheter PDA closure were randomly divided into two groups as normal radiation dose and low dose. Patients who required additional procedures other than PDA closure were excluded. PDA closure was performed according to the angiographic measurement of the defect. After the procedure, age, weight, sex, PDA measurements, and radiation measurements such as dose-area product (DAP, Gy.cm) and air kerma (AK, mGy) were compared between the groups.
RESULTS
There was no statistically significant difference between the groups in age, sex, weight, PDA diameter, PDA type, device used, and device diameter (p > 0.05). While there was no statistically significant difference between the groups in terms of cine recording, number of recorded images, and fluoroscopy time (p > 0.05), there was a statistically significant difference between the total DAP, cine and fluoroscopy DAP, total AK, frontal and lateral tube AK, and DAP/kg (mGy.m/kg) measurements (p < 0.05).
CONCLUSION
Transcatheter PDA closure with a low radiation dose is as effective as that with a normal radiation dose. The radiation dose received by the patient during the procedure was significantly reduced. With the vision provided by this study, it seems possible to work with a low radiation dose in other groups of patients.
PubMed: 38590841
DOI: 10.1016/j.heliyon.2024.e28138 -
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 -
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 -
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 -
The American Journal of Case Reports Nov 2021BACKGROUND The cardiotoxic effects of chemotherapy in cancer treatment can damage cardiomyocytes. A common link in the pathogenesis is the proliferation of fibroblasts...
BACKGROUND The cardiotoxic effects of chemotherapy in cancer treatment can damage cardiomyocytes. A common link in the pathogenesis is the proliferation of fibroblasts and the increase of collagen synthesis, leading to development of common endomyocardial fibrosis. The walls of ventricles become rigid and their inability to relax prevents them from carrying the required amount of blood. The myocardial contractility gradually decreases and leads to ventricular dysfunction and signs of heart failure. CASE REPORT A 29-year-old woman with reduced exercise tolerance, dyspnea, and heart rhythm disorders was admitted to our hospital. Lymphoblastic leukemia had been diagnosed at the age of 8 years, and she underwent 8 courses of polychemotherapy. She had normal heart anatomy. At the current admission, the diagnostic protocol included echocardiography, computed tomography, cardiac catheterization, and angiocardiography. She was diagnosed with restrictive cardiomyopathy with isolated endomyocardial fibrosis of the right ventricle, and moderate tricuspid valve insufficiency NYHA class III. The patient underwent a right-sided bidirectional cavopulmonary connection with tricuspid valve repair. The early postoperative period was uneventful, and SVCp decreased to 14 mmHg. At discharge, the patient's clinical condition had improved and tricuspid regurgitation was minimal. CONCLUSIONS The one-and-a-half ventricular correction, commonly used in patients with Ebstein's anomaly and RV dysfunction or in patients with congenital heart defects associated with RV hypoplasia, is proposed as the method of choice for cardiomyopathy type RV dysfunction.
Topics: Adult; Cardiomyopathies; Cardiomyopathy, Restrictive; Child; Ebstein Anomaly; Female; Heart Ventricles; Humans; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome
PubMed: 34815376
DOI: 10.12659/AJCR.933677 -
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 -
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 Nuclear Medicine Technology Jun 2020The purpose of this document is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of gated equilibrium...
The purpose of this document is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of gated equilibrium radionuclide angiocardiography (ERNA).
Topics: Angiography; Europe; Humans; Nuclear Medicine; Practice Guidelines as Topic; Radionuclide Imaging; Respiratory-Gated Imaging Techniques; Societies, Scientific
PubMed: 32499322
DOI: 10.2967/jnmt.120.246405 -
Journal of Cardiothoracic Surgery Apr 2020Patent ductus arteriosus (PDA) is a common congenital heart disease. Interventional therapy is an important treatment for PDA. Nevertheless, few studies have...
Short-term results of interventional therapy for infants (7-36 months old) with patent ductus arteriosus and moderate-to-severe pulmonary hypertension: a retrospective study.
BACKGROUND
Patent ductus arteriosus (PDA) is a common congenital heart disease. Interventional therapy is an important treatment for PDA. Nevertheless, few studies have investigated the safety and effectiveness of interventional therapy for infants (age, 0-36 months) with PDA and moderate-to-severe pulmonary hypertension. Therefore, this study aimed to analyze the short-term (6 months) results and interventional therapy experience for infants with PDA and moderate-to-severe pulmonary hypertension.
METHODS
Clinical records, echocardiographic data, and angiocardiography data of 28 infants (age, 7-36 months) who underwent interventional therapy for PDA and moderate-to-severe pulmonary hypertension between December 2011 and January 2017 at our hospital were retrospectively analyzed. All infants were treated using an Amplatzer occluder with local and deep sedation anesthesia under radiographic guidance.
RESULTS
Infants with PDA and moderate-to-severe pulmonary hypertension had poor growth. Trace residual shunts were found in two infants immediately after procedure; both had disappeared by 6 months after procedure. No significant interventional therapy-related complications occurred in the other cases. Pulmonary systolic pressure, left atrial dimension, and left ventricular end-diastolic dimension immediately after interventional therapy and 6 months later were lower than the preoperative levels (P < 0.05). The left atrial and left ventricular end-diastolic dimensions at 6 months after interventional therapy were smaller than those immediately after interventional therapy (P < 0.05). Pulmonary systolic pressure rates immediately after interventional therapy and 6 months later were not significantly different (P = 0.505). Moreover, there were no significant differences in the left ventricular ejection fraction before, immediately after, and at 6 months after interventional therapy (P = 0.628).
CONCLUSIONS
For infants (age, 7-36 months) with PDA and moderate-to-severe pulmonary hypertension, interventional therapy can achieve excellent immediate and short-term (6 months) results with careful preoperative evaluations, strict operative procedures, and careful follow-up.
Topics: Child, Preschool; Ductus Arteriosus, Patent; Echocardiography; Female; Humans; Hypertension, Pulmonary; Infant; Male; Postoperative Complications; Retrospective Studies; Septal Occluder Device; Severity of Illness Index; Treatment Outcome
PubMed: 32321548
DOI: 10.1186/s13019-020-01110-5